21 CFR 892.1650 - Image-intensified fluoroscopic x-ray system.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Image-intensified fluoroscopic x-ray system. 892... fluoroscopic x-ray system. (a) Identification. An image-intensified fluoroscopic x-ray system is a device intended to visualize anatomical structures by converting a pattern of x-radiation into a visible image...

Photon-counting intensified random-access charge injection device

NASA Astrophysics Data System (ADS)

Norton, Timothy J.; Morrissey, Patrick F.; Haas, Patrick; Payne, Leslie J.; Carbone, Joseph; Kimble, Randy A.

1999-11-01

At NASA GSFC we are developing a high resolution solar-blind photon counting detector system for UV space based astronomy. The detector comprises a high gain MCP intensifier fiber- optically coupled to a charge injection device (CID). The detector system utilizes an FPGA based centroiding system to locate the center of photon events from the intensifier to high accuracy. The photon event addresses are passed via a PCI interface with a GPS derived time stamp inserted per frame to an integrating memory. Here we present imaging performance data which show resolution of MCP tube pore structure at an MCP pore diameter of 8 micrometer. This data validates the ICID concept for intensified photon counting readout. We also discuss correction techniques used in the removal of fixed pattern noise effects inherent in the centroiding algorithms used and present data which shows the local dynamic range of the device. Progress towards development of a true random access CID (RACID 810) is also discussed and astronomical data taken with the ICID detector system demonstrating the photon event time-tagging mode of the system is also presented.

21 CFR 892.1960 - Radiographic intensifying screen.

Code of Federal Regulations, 2011 CFR

2011-04-01

.... (a) Identification. A radiographic intensifying screen is a device that is a thin radiolucent sheet... for medical purposes to expose radiographic film. (b) Classification. Class I (general controls). The...

Photographic Method For Measurement Of Image Intensifier Tube Contrast

NASA Astrophysics Data System (ADS)

Moore, Robert J.

1981-07-01

An important parameter in an image intensifier-based imaging system is the contrast of the image intensifier tube itself. This paper presents a photographic method for the measurement of the large-scale contrast of an image intensifier tube at the system level which can be performed in the clinical setting with equipment normally found in a modern Radiology Department. A strip of Lead is positioned on-center at the bottom of the grid so that a line image of 100% contrast will be presented to the input phosphor of the image intensifier when the x-ray tube is energized at low kilovoltage. The output phosphor is photographed either with an existing fluorographic camera (photospot or cine) on the imaging tower, or with a 35-mm SLR camera loaded with orthochromatic cine film through the collimating lens of the system from the position normally occupied by the television camera, during fluoroscopy, if no other camera is present on the imaging tower. The resultant on-frame optical density is measured with a densitometer in the central part of the developed frame adjacent to and behind the image of the Lead strip. These optical density readings are converted into a ratio of light intensities from the corresponding regions on the output phosphor using the characteristic curve for the type of film employed, which is obtained by means of light sensitometry. The percent contrast is then calculated from (ratio of intensities - 1)/(ratio of intensities + 1)) X 100. Using data for a variety of CsI image intensifiers used for both gastrointestinal and vascular studies, the method is shown to give measured percent contrasts with a reproducibility of no worse than-2%, independent of type of camera used or type of sensitometer used. Standards of acceptable performance based on the author's experience with this technique over the past five years are presented for systems designed for Barium studies and for systems designed for Iodine studies. The relationship between the percent

Image intensifier-based volume tomographic angiography imaging system: system evaluation

NASA Astrophysics Data System (ADS)

Ning, Ruola; Wang, Xiaohui; Shen, Jianjun; Conover, David L.

1995-05-01

An image intensifier-based rotational volume tomographic angiography imaging system has been constructed. The system consists of an x-ray tube and an image intensifier that are separately mounted on a gantry. This system uses an image intensifier coupled to a TV camera as a two-dimensional detector so that a set of two-dimensional projections can be acquired for a direct three-dimensional reconstruction (3D). This system has been evaluated with two phantoms: a vascular phantom and a monkey head cadaver. One hundred eighty projections of each phantom were acquired with the system. A set of three-dimensional images were directly reconstructed from the projection data. The experimental results indicate that good imaging quality can be obtained with this system.

Improved intensifying screen reduces X-ray exposure

NASA Technical Reports Server (NTRS)

Buchanan, R. A.

1972-01-01

X-ray intensifying screen may make possible radiographic procedures where detection speed and X-ray tube power have been the limiting factors. Device will reduce total population exposure to harmful radiation in the United States.

21 CFR 892.1660 - Non-image-intensified fluoroscopic x-ray system.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Non-image-intensified fluoroscopic x-ray system... fluoroscopic x-ray system. (a) Identification. A non-image-intensified fluoroscopic x-ray system is a device... of x-radiation into a visible image. This generic type of device may include signal analysis and...

21 CFR 892.1660 - Non-image-intensified fluoroscopic x-ray system.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Non-image-intensified fluoroscopic x-ray system... fluoroscopic x-ray system. (a) Identification. A non-image-intensified fluoroscopic x-ray system is a device... of x-radiation into a visible image. This generic type of device may include signal analysis and...

Engineering design criteria for an image intensifier/image converter camera

NASA Technical Reports Server (NTRS)

Sharpsteen, J. T.; Lund, D. L.; Stoap, L. J.; Solheim, C. D.

1976-01-01

The design, display, and evaluation of an image intensifier/image converter camera which can be utilized in various requirements of spaceshuttle experiments are described. An image intensifier tube was utilized in combination with two brassboards as power supply and used for evaluation of night photography in the field. Pictures were obtained showing field details which would have been undistinguishable to the naked eye or to an ordinary camera.

Characterization of domestic and foreign image intensifier tubes

NASA Astrophysics Data System (ADS)

Bender, Edward J.; Wood, Michael V.; Hosek, Daniel J.; Hart, Steve D.

2013-06-01

The market for military-use Generation 2 and Generation 3 image intensifier (I2) tubes has become truly global, with major manufacturers and customers spanning five continents. This worldwide market is becoming increasingly important to U.S. manufacturers, with the majority of U.S. Army intensifier fielding having been completed in 2012. Given this keen global competition, it is not surprising that the advertised tube performance of a given source is often discounted by competitors, and the customers have no objective "honest broker" to determine the relative accuracy of these claims. To help fill this void, the U.S. Army RDECOM CERDEC NVESD recently measured a number of domestic and foreign image intensifier tubes, using consistent test equipment/procedures with which the U.S. industry must correlate for Army tube deliveries. Data and analysis will be presented for the major tube parameters of luminance gain, equivalent background input (EBI), signal-to-noise ratio (SNR), limiting resolution, halo, and modulation transfer function (MTF). The bright-light resolution provided by various auto-gated and non-gated tubes will also be addressed, since this area has been an important factor in the international market. RDECOM CERDEC NVESD measurement data will be compared to the corresponding manufacturer specifications whenever possible.

Photogrammetric calibration of the NASA-Wallops Island image intensifier system

NASA Technical Reports Server (NTRS)

Harp, B. F.

1972-01-01

An image intensifier was designed for use as one of the primary tracking systems for the barium cloud experiment at Wallops Island. Two computer programs, a definitive stellar camara calibration program and a geodetic stellar camara orientation program, were originally developed at Wallops on a GE 625 computer. A mathematical procedure for determining the image intensifier distortions is outlined, and the implementation of the model in the Wallops computer programs is described. The analytical calibration of metric cameras is also discussed.

Evidence of disturbed sleep and mood state in well-trained athletes during short-term intensified training with and without a high carbohydrate nutritional intervention.

PubMed

Killer, S C; Svendsen, I S; Jeukendrup, A E; Gleeson, M

2017-07-01

Few studies have investigated the effects of exercise training on sleep physiology in well-trained athletes. We investigated changes in sleep markers, mood state and exercise performance in well-trained cyclists undergoing short-term intensified training and carbohydrate nutritional intervention. Thirteen highly-trained male cyclists (age: 25 ± 6y, [Formula: see text]O 2max : 72 ± 5 ml/kg/min) participated in two 9-day periods of intensified training while undergoing a high (HCHO) or moderate (CON) carbohydrate nutritional intervention before, during and after training sessions. Sleep was measured each night via wristwatch actigraphy. Mood state questionnaires were completed daily. Performance was assessed with maximal oxygen uptake ([Formula: see text]. Percentage sleep time fell during intensified training (87.9 ± 1.5 to 82.5 ± 2.3%; p < 0.05) despite an increase in time in bed (456 ± 50 to 509 ± 48 min; p = 0.02). Sleep efficiency decreased during intensified training (83.1 ± 5.3 to 77.8 ± 8.6%; p < 0.05). Actual sleep time was significantly higher in CON than HCHO throughout intensified training. Mood disturbance increased during intensified training and was higher in CON than HCHO (p < 0.05). Performance in the [Formula: see text] exercise protocol fell significantly with intensified training. The main findings of this study were that 9-days of intensified training in highly-trained cyclists resulted in significant and progressive declines in sleep quality, mood state and maximal exercise performance.

Evaluation of intensified image enhancement through conspicuity and triangle orientation discrimination measures

NASA Astrophysics Data System (ADS)

Dijk, Judith; van Eekeren, Adam W. M.; Toet, Alexander; den Hollander, Richard J. M.; Schutte, Klamer; van Heijningen, Ad W. P.; Bijl, Piet

2013-04-01

For many military operations, situational awareness is of great importance. During night conditions, this situational awareness can be improved using both analog and digital image-intensified cameras. The quality of image intensifiers is a topic of interest. One of the differences between a digital and analog system is noise behavior. For digital image intensifiers, the noise behavior is not as good as for analog image intensifiers, but it can be improved using noise-reduction techniques. In this paper, the improvement using temporal noise reduction and local adaptive contrast enhancement is shown and quantitatively evaluated by subjective measurement of the conspicuity and triangle orientation discrimination (TOD). The results of the conspicuity and TOD experiments are consistent with each other. The highest improvement is found for a low-clutter environment; for medium- and high-clutter environments, the improvement is less. This can be explained by the fact that image enhancement increases contrast of all image details, irrespective of whether they are targets or clutter. For low-clutter image enhancement, target conspicuity and target detection improvement will be largest, since there are not many distracting elements.

Influence of range-gated intensifiers on underwater imaging system SNR

NASA Astrophysics Data System (ADS)

Wang, Xia; Hu, Ling; Zhi, Qiang; Chen, Zhen-yue; Jin, Wei-qi

2013-08-01

Range-gated technology has been a hot research field in recent years due to its high effective back scattering eliminating. As a result, it can enhance the contrast between a target and its background and extent the working distance of the imaging system. The underwater imaging system is required to have the ability to image in low light level conditions, as well as the ability to eliminate the back scattering effect, which means that the receiver has to be high-speed external trigger function, high resolution, high sensitivity, low noise, higher gain dynamic range. When it comes to an intensifier, the noise characteristics directly restrict the observation effect and range of the imaging system. The background noise may decrease the image contrast and sharpness, even covering the signal making it impossible to recognize the target. So it is quite important to investigate the noise characteristics of intensifiers. SNR is an important parameter reflecting the noise features of a system. Through the use of underwater laser range-gated imaging prediction model, and according to the linear SNR system theory, the gated imaging noise performance of the present market adopted super second generation and generation Ⅲ intensifiers were theoretically analyzed. Based on the active laser underwater range-gated imaging model, the effect to the system by gated intensifiers and the relationship between the system SNR and MTF were studied. Through theoretical and simulation analysis to the image intensifier background noise and SNR, the different influence on system SNR by super second generation and generation Ⅲ ICCD was obtained. Range-gated system SNR formula was put forward, and compared the different effect influence on the system by using two kind of ICCDs was compared. According to the matlab simulation, a detailed analysis was carried out theoretically. All the work in this paper lays a theoretical foundation to further eliminating back scattering effect, improving

Two Cases of Melasma with Unusual Histopathologic Findings

PubMed Central

Kang, Won-Hyoung

2006-01-01

We reported two cases of clinically typical melasma presenting with unusual histopathologic findings. In one case, the epidermal melanocytes were markedly increased in number and protruded into the dermis, and in the other case, increased epidermal pigmentation as well as dermal melanocytosis were found. We suggested that the various treatment modalities of melasma should be applied depend on its histopathologic finding. PMID:16614533

Method of obtaining intensified image from developed photographic films and plates

NASA Technical Reports Server (NTRS)

Askins, B. S. (Inventor)

1978-01-01

A method is explained of obtaining intensified images from silver images on developed photographic films and plates. The steps involve converting silver of the developed film or plate to a radioactive compound by treatment with an aqueous alkaline solution of an organo-S35 compound; placing the treated film or plate in direct contact with a receiver film which is then exposed by radiation from the activated film; and developing and fixing the resulting intensified image on the receiver film.

The association between arthritis and depression is intensified by excessive body weight: Findings from a US national survey, 2005-2012.

PubMed

Politis, Maria D; Johnson, Krystina; Hansen, Andrew R; Sullivan, Kelly L; Zhang, Jian

2016-01-01

Obesity and arthritis are leading chronic conditions, but comorbidity of these conditions and their interaction leading to depression have not been fully investigated. The purpose of this study is to determine the degree to which excess body weight effect-modifies the relationship between arthritis and depressive symptoms. We used the data of 8677 men and 8820 women aged 20 or older, who completed a depression screening and general medical condition interview as a part of the National Health and Nutrition Examination Survey, 2005-2012. Depression was ascertained using the Patient Health Questionnaire-9 (PHQ-9); a PHQ-9 score of 15 or higher was defined as indicative of depression. Arthritis was reported in 26.5% (SE=0.9) of men and 36.9% (SE=1.4) of women. The association between depression and arthritis was not significant among healthy weight women, but significant among overweight and obese women. The prevalence ratios (PRs) of depression among arthritis-free women were 1.00 (reference) for healthy weight, 1.43 (0.85-2.42) for overweight, and 1.99 (1.23-3.23) for obese women. For women with arthritis, the PRs were 1.16 (0.63-2.12) for healthy weight, 3.80 (2.24-6.45) for overweight and 3.73 (2.30-6.05) for obese women. The intensifying effect from excessive body weight on the association between arthritis and depression was less salient among men than women. The association between arthritis and depression is intensified significantly by increased body weight, in particular, among women. Copyright © 2015 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

Collimator application for microchannel plate image intensifier resolution improvement

DOEpatents

Thomas, S.W.

1996-02-27

A collimator is included in a microchannel plate image intensifier (MCPI). Collimators can be useful in improving resolution of MCPIs by eliminating the scattered electron problem and by limiting the transverse energy of electrons reaching the screen. Due to its optical absorption, a collimator will also increase the extinction ratio of an intensifier by approximately an order of magnitude. Additionally, the smooth surface of the collimator will permit a higher focusing field to be employed in the MCP-to-collimator region than is currently permitted in the MCP-to-screen region by the relatively rough and fragile aluminum layer covering the screen. Coating the MCP and collimator surfaces with aluminum oxide appears to permit additional significant increases in the field strength, resulting in better resolution. 2 figs.

Collimator application for microchannel plate image intensifier resolution improvement

DOEpatents

Thomas, Stanley W.

1996-02-27

A collimator is included in a microchannel plate image intensifier (MCPI). Collimators can be useful in improving resolution of MCPIs by eliminating the scattered electron problem and by limiting the transverse energy of electrons reaching the screen. Due to its optical absorption, a collimator will also increase the extinction ratio of an intensifier by approximately an order of magnitude. Additionally, the smooth surface of the collimator will permit a higher focusing field to be employed in the MCP-to-collimator region than is currently permitted in the MCP-to-screen region by the relatively rough and fragile aluminum layer covering the screen. Coating the MCP and collimator surfaces with aluminum oxide appears to permit additional significant increases in the field strength, resulting in better resolution.

Bangladesh intensifies prevention efforts.

PubMed

1993-01-01

Dr. Michael H. Merson, Executive Director of the World Health Organization (WHO) Global Program on AIDS, at an AIDS seminar July 12, called for concerted and coordinated action to prevent a major AIDS epidemic in Bangladesh. Although the WHO office in Bangladesh claims that AIDS prevention efforts have intensified over the past year, initial measures were slow in coming. Bangladesh has only recently viewed AIDS prevention as a priority and is beginning to commit resources and political will; nongovernmental, community, professional, and private organizations are also rising to the occasion. Of particular importance is the interparty censuses on AIDS which has developed and the broad involvement in the national AIDS committee. A Woman's Committee is also studying how to convey AIDS prevention messages to women.

An Enhanced Seasonal Transition that Intensified Summer Drought in the Central U.S.

NASA Technical Reports Server (NTRS)

Wang, S.-Y.Simon; Santanello, Joseph; Wang, Hailan; Barandiaran, Daniel; Pinker, Rachel; Schubert, Siegfried; Gillies, Robert R.; Oglesby, Robert; Hilburn, Kyle; Kilic, Ayse;

Effects of intensified conditioning on Epstein-Barr virus and cytomegalovirus infections in allogeneic hematopoietic stem cell transplantation for hematological malignancies

PubMed Central

2012-01-01

Background Intensified conditioning regimens (increasing the intensity of standard myeloablative conditioning) for hematological malignancies in allogeneic hematopoietic stem cell transplantation (allo-HSCT) could reduce the relapse rate of the underlying disease, but it might simultaneously increase the transplant-related mortality including the mortality of infections. To explore whether intensified conditioning affected Epstein-Barr virus (EBV) and cytomegalovirus (CMV) infections, 185 patients undergoing allo-HSCT were enrolled. Methods A total of 104 cases received standard and 81 intensified conditioning. Cyclosporine A (CsA) withdrawal and/or donor lymphocyte infusion (DLI) were conducted in high-risk patients. The EBV-DNA and CMV-DNA levels of blood were monitored regularly by quantitative real-time polymerase chain reaction (RQ-PCR) and immune reconstitution of recipients were analyzed by flow cytometry. Results The 3-year cumulative incidence of EBV viremia, EBV-associated diseases and mortality of EBV-associated diseases were 25.3% ± 4.6%, 10.5% ± 3.4% and 0.0% ± 0.0% in the standard group, compared with 45.6% ± 6.5%, 26.0% ±5.3% and 7.3% ± 3.1% in the intensified group (P = 0.002, P = 0.002, P = 0.008). The 3-year cumulative incidence of CMV viremia and CMV-associated diseases, mortality of CMV-associated diseases and incidence of bacterial and fungal infections were similar between the two groups (P = 0.855, P = 0.581, P = 0.933, P = 0.142, P = 0.182, respectively). Multivariate analysis showed that intensified conditioning was one of the risk factors for EBV viremia and EBV-associated diseases (P = 0.037, P = 0.037), but it had no effects on CMV infections. The percentage of CD4+ T cells and CD4+/CD8+ ratio at 3 months post-transplantation were lower in the intensified group (P = 0.032, P = 0.022). The 3-year OS and DFS in the standard group were 62.2% ± 5.8% and 60.6%�

Final Report for the Intensified Career Exploration Program.

ERIC Educational Resources Information Center

McCauley, Lynne D.; Rusling, Diane E.

An intensified Career Exploration Program was evaluated through an analysis of the cognitive and affective learning resulting from ninth- and tenth-grade students' participation in the program. Designed to supplement the existing ninth- and tenth-grade components of the Ohio Career Development Program, this three-year program offered additional…

Duodenal fat intensifies the perception of heartburn

PubMed Central

Meyer, J; Lembo, A; Elashoff, J; Fass, R; Mayer, E

2001-01-01

BACKGROUND—Patients with gastro-oesophageal reflux disease (GORD) frequently report that meals high in fat worsen heartburn. Nevertheless, studies to determine whether high fat meals promote gastro-oesophageal reflux have produced conflicting and equivocal conclusions.
PATIENTS AND METHODS—To determine, alternatively, whether fat in the small intestinal lumen intensifies the perception of heartburn, we studied 11 patients with typical heartburn from GORD. After being placed on omeprazole to suppress endogenous acid, these fasting subjects underwent oesophageal perfusions with graded doses of HCl at pH values of 1.0, 1.5, 2.0, and 2.5. Oesophageal perfusions were conducted while the duodenum was perfused with saline (control) and again with fat at 8 g/h.
RESULTS—Time to onset, intensity, and severity of heartburn varied with dose of oesophageal acid (p<0.01). Time to onset was significantly (p<0.01) shorter, and intensity and severity of heartburn significantly (p<0.05) greater, during duodenal perfusion with fat.
CONCLUSION—We conclude that duodenal fat intensifies the perception of heartburn.


Keywords: gastro-oesophageal reflux disease; heartburn; perception; fat PMID:11600463

Plasma glutamine and upper respiratory tract infection during intensified training in swimmers.

PubMed

Mackinnon, L T; Hooper, S L

1996-03-01

The purposes of this study were to determine the effects of 4 wk of intensified training on resting plasma glutamine concentration, and to determine whether changes in plasma glutamine concentration relate to the appearance of upper respiratory tract infection (URTI) in swimmers during intensified training. Resting plasma glutamine concentration was measured by high performance liquid chromatography in 24 elite swimmers (8 male, 16 female, ages 15-26 yr) during 4 wk of intensified training (increased volume). Symptoms of overtraining syndrome (OT) were identified in eight swimmers (2 male, 6 female) based on decrements in swim performance and persistent high fatigue ratings; non-overtrained subjects were considered well-trained (WT). Ten of 24 swimmers (42%, 1 OT and 9 WT) exhibited URTI during the study. Plasma glutamine concentration increased significantly (P = 0.04, ANOVA) over the 4 wk, but the increase was significant only in WT swimmers (P < 0.05, post-hoc analysis). Compared with WT, plasma glutamine was significantly lower in OT at the mid-way timepoint only (P < 0.025, t-test with Bonferroni correction). There was no significant difference in glutamine levels between athletes who developed URTI and those who did not. These data suggest that plasma glutamine levels may not necessarily decrease during periods of intensified training, and that the appearance of URTI is not related to changes in plasma glutamine concentration in overtrained swimmers.

The FIDELIS initiative: innovative strategies for increased case finding.

PubMed

Hinderaker, S G; Rusen, I D; Chiang, C-Y; Yan, L; Heldal, E; Enarson, D A

2011-01-01

Low-income, high tuberculosis (TB) burden countries. To compare case finding of new smear-positive pulmonary TB patients in projects funded to apply innovative approaches. Prospective application of innovative approaches to case finding within routine services to determine the numbers of additional cases detected and the cost per additional case detected, according to the type of approach applied. Between 2003 and 2007, 51 FIDELIS projects were implemented in 18 countries; 273,239 cases were reported, of which 85,267 were additional to the number reported in the previous year. The median cost per additional case was US$103. The interventions employed were: 1) social mobilisation and information, education and communication; 2) engagement of the private sector; 3) innovative approaches for microscopy services; 4) enhanced or semi-active case finding; 5) health systems strengthening; and 6) use of incentives. None of these was significantly more likely to detect additional cases or to have a lower cost per additional case than any of the others. While there was a substantial increase in cases detected, at a moderate cost per additional case, we were unable to show that any single intervention had an advantage over the others.

Growth characteristics of calves fed an intensified milk replacer regimen with additional lactoferrin.

PubMed

Cowles, K E; White, R A; Whitehouse, N L; Erickson, P S

2006-12-01

The objective of this study was to evaluate the effect of lactoferrin addition to milk replacer varying in crude protein (CP) on dry matter intake, growth, and days medicated. Thirty-four Holstein heifer calves were assigned to 4 treatments in a 2 x 2 factorial arrangement of treatments in a randomized complete block design. Treatments were as follows: 562 g daily of a nonmedicated conventional milk replacer (20% CP:20% fat) feeding regimen with or without 1 g of supplemental bovine lactoferrin (n = 9 for both treatments) or a nonmedicated intensified milk replacer feeding regimen (28% CP:20% fat) fed on a metabolizable energy basis (0.2 Mcal/kg BW(0.75)) from d 2 to 9, and at 0.27 Mcal/kg BW(0.75) from d 10 to 42 with or without 1g supplemental bovine lactoferrin (n = 8 for both treatments). Calves were fed pelleted starter (25% CP) in 227.5-g increments beginning on d 2 and had free access to water. Calves remained on the study for 14 d postweaning. Dry matter intake was determined daily. Growth measurements were taken weekly. Blood samples were taken twice weekly for determination of blood urea N. On d 10 of life, calves were subjected to a xylose challenge. Calves on conventional treatments ate more starter preweaning, during weaning, and postweaning. Preweaning, intensively fed calves had higher dry matter intakes. Weights of intensified-fed calves were greater at weaning. Intensified milk replacer-fed calves had greater average daily gain preweaning and overall and higher gain:feed ratios preweaning, but conventionally fed calves had higher gain:feed ratios during weaning. Intensified milk replacer-fed calves had greater hip heights during weaning and postweaning and greater heart girths preweaning, weaning, and postweaning. Days medicated were greater preweaning and overall for intensified-fed calves. There were no differences among treatments for xylose absorption. Calves on conventional treatments had increased blood urea nitrogen concentrations preweaning

Active case finding of tuberculosis: historical perspective and future prospects

PubMed Central

Golub, J. E.; Mohan, C. I.; Comstock, G. W.; Chaisson, R. E.

2015-01-01

SUMMARY Despite a history of remarkable scientific achievements in microbiology and therapeutics, tuberculosis (TB) continues to pose an extraordinary threat to human health. Case finding and treatment of TB disease are the principal means of controlling transmission and reducing incidence. This review presents a historical perspective of active case finding (ACF) of TB, detailing case detection strategies that have been used over the last century. This review is divided into the following sections: mass radiography, house-to-house surveys, out-patient case detection, enhanced case finding, high-risk populations and cost-effectiveness. The report concludes with a discussion and recommendations for future case finding strategies. Understanding the strengths and weaknesses of these methods will help inform and shape ACF as a TB control policy in the twenty-first century. PMID:16333924

Intensified Tuberculosis Case Finding among Malnourished Children in Nutritional Rehabilitation Centres of Karnataka, India: Missed Opportunities

PubMed Central

Bhat, Prashant G.; Kumar, Ajay M. V.; Naik, Balaji; Satyanarayana, Srinath; KG, Deepak; Nair, Sreenivas A.; MD, Suryakanth; Heldal, Einar; Enarson, Donald A.; Reid, Anthony J.

2013-01-01

Background Severe acute malnutrition (SAM) is the most serious form of malnutrition affecting children under-five and is associated with many infectious diseases including Tuberculosis (TB). In India, nutritional rehabilitation centres (NRCs) have been recently established for the management of SAM including TB. The National TB Programme (NTP) in India has introduced a revised algorithm for diagnosing paediatric TB. We aimed to examine whether NRCs adhered to these guidelines in diagnosing TB among SAM children. Methods A cross-sectional study involving review of records of all SAM children identified by health workers during 2012 in six tehsils (sub-districts) with NRCs (population: 1.8 million) of Karnataka, India. Results Of 1927 identified SAM children, 1632 (85%) reached NRCs. Of them, 1173 (72%) were evaluated for TB and 19(2%) were diagnosed as TB. Of 1173, diagnostic algorithm was followed in 460 (37%). Among remaining 763 not evaluated as per algorithm, tuberculin skin test alone was conducted in 307 (41%), chest radiography alone in 99 (13%) and no investigations in 337 (45%). The yield of TB was higher among children evaluated as per algorithm (4%) as compared to those who were not (0.3%) (OR: 15.3 [95%CI: 3.5-66.3]). Several operational challenges including non-availability of a full-time paediatrician, non-functioning X-ray machine due to frequent power cuts, use of tuberculin with suboptimal strength and difficulties in adhering to a complex diagnostic algorithm were observed. Conclusion This study showed that TB screening in NRCs was sub-optimal in Karnataka. Some children did not reach the NRC, while many of those who did were either not or sub-optimally evaluated for TB. This study pointed to a number of operational issues that need to be addressed if this collaborative strategy is to identify more TB cases amongst malnourished children in India. PMID:24358350

The epidemiology of Plasmodium vivax and Plasmodium falciparum malaria in China, 2004-2012: from intensified control to elimination.

PubMed

Zhang, Qian; Lai, Shengjie; Zheng, Canjun; Zhang, Honglong; Zhou, Sheng; Hu, Wenbiao; Clements, Archie C A; Zhou, Xiao-Nong; Yang, Weizhong; Hay, Simon I; Yu, Hongjie; Li, Zhongjie

2014-11-03

In China, the national malaria elimination programme has been operating since 2010. This study aimed to explore the epidemiological changes in patterns of malaria in China from intensified control to elimination stages. Data on nationwide malaria cases from 2004 to 2012 were extracted from the Chinese national malaria surveillance system. The secular trend, gender and age features, seasonality, and spatial distribution by Plasmodium species were analysed. In total, 238,443 malaria cases were reported, and the proportion of Plasmodium falciparum increased drastically from <10% before 2010 to 55.2% in 2012. From 2004 to 2006, malaria showed a significantly increasing trend and with the highest incidence peak in 2006 (4.6/100,000), while from 2007 onwards, malaria decreased sharply to only 0.18/100,000 in 2012. Males and young age groups became the predominantly affected population. The areas affected by Plasmodium vivax malaria shrunk, while areas affected by P. falciparum malaria expanded from 294 counties in 2004 to 600 counties in 2012. This study demonstrated that malaria has decreased dramatically in the last five years, especially since the Chinese government launched a malaria elimination programme in 2010, and areas with reported falciparum malaria cases have expanded over recent years. These findings suggest that elimination efforts should be improved to meet these changes, so as to achieve the nationwide malaria elimination goal in China in 2020.

Dynamics analysis of extraction of manganese intensified by electric field

NASA Astrophysics Data System (ADS)

Ma, Wenrui; Tao, Changyuan; Li, Huizhan; Liu, Zuohua; Liu, Renlong

2018-06-01

In this study, a process reinforcement technology for leaching process of pyrolusite was developed. The electric field was introduced to decrease reaction temperature and improve the leaching rate of pyrolusite. The mechanisms of electric field intensifying leaching process of pyrolusite were investigated through X-ray diffraction (XRD), and Brunauer Emmett Teller (BET) in detail. The results showed that the electric field could decrease obviously the apparent activation energy of leaching process of pyrolusite. The apparent activation energy of the leaching of pyrolusite intensified by electric field was calculated to be 53.76 kJ.mol-1. In addition, the leaching efficiency of manganese was effectively increased by 10% to 20% than that without electric field under the same conditions. This was because that the electron conduit between Fe (II)/Fe (III) and pyrite was dredged effectively by electric field.

Evolution of trees and mycorrhizal fungi intensifies silicate mineral weathering

PubMed Central

Quirk, Joe; Beerling, David J.; Banwart, Steve A.; Kakonyi, Gabriella; Romero-Gonzalez, Maria E.; Leake, Jonathan R.

2012-01-01

Forested ecosystems diversified more than 350 Ma to become major engines of continental silicate weathering, regulating the Earth's atmospheric carbon dioxide concentration by driving calcium export into ocean carbonates. Our field experiments with mature trees demonstrate intensification of this weathering engine as tree lineages diversified in concert with their symbiotic mycorrhizal fungi. Preferential hyphal colonization of the calcium silicate-bearing rock, basalt, progressively increased with advancement from arbuscular mycorrhizal (AM) to later, independently evolved ectomycorrhizal (EM) fungi, and from gymnosperm to angiosperm hosts with both fungal groups. This led to ‘trenching’ of silicate mineral surfaces by AM and EM fungi, with EM gymnosperms and angiosperms releasing calcium from basalt at twice the rate of AM gymnosperms. Our findings indicate mycorrhiza-driven weathering may have originated hundreds of millions of years earlier than previously recognized and subsequently intensified with the evolution of trees and mycorrhizas to affect the Earth's long-term CO2 and climate history. PMID:22859556

Evolution of trees and mycorrhizal fungi intensifies silicate mineral weathering.

PubMed

Quirk, Joe; Beerling, David J; Banwart, Steve A; Kakonyi, Gabriella; Romero-Gonzalez, Maria E; Leake, Jonathan R

2012-12-23

Forested ecosystems diversified more than 350 Ma to become major engines of continental silicate weathering, regulating the Earth's atmospheric carbon dioxide concentration by driving calcium export into ocean carbonates. Our field experiments with mature trees demonstrate intensification of this weathering engine as tree lineages diversified in concert with their symbiotic mycorrhizal fungi. Preferential hyphal colonization of the calcium silicate-bearing rock, basalt, progressively increased with advancement from arbuscular mycorrhizal (AM) to later, independently evolved ectomycorrhizal (EM) fungi, and from gymnosperm to angiosperm hosts with both fungal groups. This led to 'trenching' of silicate mineral surfaces by AM and EM fungi, with EM gymnosperms and angiosperms releasing calcium from basalt at twice the rate of AM gymnosperms. Our findings indicate mycorrhiza-driven weathering may have originated hundreds of millions of years earlier than previously recognized and subsequently intensified with the evolution of trees and mycorrhizas to affect the Earth's long-term CO(2) and climate history.

A case of alkaptonuria - ultrasonographic findings.

PubMed

Damian, Laura Otilia; Felea, Ioana; Boloşiu, Călin; Botar-Jid, Carolina; Fodor, Daniela; Rednic, Simona

2013-12-01

Alkaptonuria is a rare disease with autosomal recessive inheritance and variable expression. The weight-bearing joint involvement and spondylitis-like vertebral changes occur only after the 3rd decade. Musculoskeletal ultrasonographic findings in alkaptonuria were only rarely described, consisting mainly into enthesopathy and non-synovial tendon degeneration. We present the case of a 50 years old man with alkaptonuria and discuss the ultrasonographic findings and the relationship of the disease with chondrocalcinosis. The tendinous and synovial aspect may be peculiar and it could therefore allow recognition and screening for alkaptonuria, along with clinical and radiologic data.

Concept Formation in Environmental Education: 14-Year Olds' Work on the Intensified Greenhouse Effect and the Depletion of the Ozone Layer. Research Report

ERIC Educational Resources Information Center

Osterlind, Karolina

2005-01-01

A case study is presented describing the work of three pupils in the upper level of compulsory school. The pupils were learning about the intensified greenhouse effect and the depletion of the ozone layer. In their work, the need for certain domain-specific knowledge becomes apparent; for example, understanding such concepts as photosynthesis,…

Monte-Carlo simulation of spatial resolution of an image intensifier in a saturation mode

NASA Astrophysics Data System (ADS)

Xie, Yuntao; Wang, Xi; Zhang, Yujun; Sun, Xiaoquan

2018-04-01

In order to investigate the spatial resolution of an image intensifier which is irradiated by high-energy pulsed laser, a three-dimensional electron avalanche model was built and the cascade process of the electrons was numerically simulated. The influence of positive wall charges, due to the failure of replenishing charges extracted from the channel during the avalanche, was considered by calculating its static electric field through particle-in-cell (PIC) method. By tracing the trajectory of electrons throughout the image intensifier, the energy of the electrons at the output of the micro channel plate and the electron distribution at the phosphor screen are numerically calculated. The simulated energy distribution of output electrons are in good agreement with experimental data of previous studies. In addition, the FWHM extensions of the electron spot at phosphor screen as a function of the number of incident electrons are calculated. The results demonstrate that the spot size increases significantly with the increase in the number of incident electrons. Furthermore, we got the MTFs of the image intensifier by Fourier transform of a point spread function at phosphor screen. Comparison between the MTFs in our model and the MTFs by analytic method shows that spatial resolution of the image intensifier decreases significantly as the number of incident electrons increases, and it is particularly obvious when incident electron number greater than 100.

School-Based Asthma Case Finding: The Arkansas Experience

ERIC Educational Resources Information Center

Vargas, Perla A.; Magee, James S.; Bushmiaer, Margo; Simpson, Pippa M.; Jones, Craig A.; Feild, Charles R.; Jones, Stacie M.

2006-01-01

This population-based case-finding study sought to determine asthma prevalence and characterize disease severity and burden among school-aged children in the Little Rock School District. Asthma cases were identified by validated algorithm and parental report of asthma diagnosis. The overall response rate was low. Among schools with greater than…

Development of seals for a geothermal downhole intensifier. Progress report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Captain, K.M.; Harvey, A.C.; Caskey, B.C.

1985-08-01

A system using high-velocity fluid jets in conjunction with a rotary diamond bit is currently considered as the best candidate for reducing the cost of drilling geothermal wells. Technical, safety and cost considerations indicate that the required jet supply pressure can best be established by a downhole pressure intensifier. Key intensifier components are the check valve and plunger seals, which must prevent leakage of the high-pressure, high-temperature abrasive fluid (drilling mud). To achieve the required performance, novel ceramic seals are currently being developed. The check valve seal includes a tapered polymeric plug and ceramic stop acting against a ceramic seat.more » The ceramic plunger seal is a variant of the ''stepped-joint'' piston ring and is designed to minimize contact pressure and abrasive wear. Initial testing of these seals in the laboratory shows encouraging results; design refinement and further testing is in progress. 2 refs., 6 figs., 3 tabs.« less

The Educational System in Japan: Case Study Findings.

ERIC Educational Resources Information Center

Stevenson, Harold; Lee, Shin-Ying; Nerison-Low, Roberta

This document summarizes the findings of a year-long study that used case studies of specific schools in Japan to collect qualitative data on the Japanese educational experience. From 1994-95 the Case Study Project (a component of the Third International Mathematics and Science Study) collected information from interviews with students, parents,…

Agriculture intensifies soil moisture decline in Northern China

DOE PAGES

Liu, Yaling; Pan, Zhihua; Zhuang, Qianlai; ...

2015-07-09

Northern China is one of the most densely populated regions in the world. Agricultural activities have intensified since the 1980s to provide food security to the country. However, this intensification has likely contributed to an increasing scarcity in water resources, which may in turn be endangering food security. Based on in-situ measurements of soil moisture collected in agricultural plots during 1983–2012, we find that topsoil (0–50 cm) volumetric water content during the growing season has declined significantly (p<0.01), with a trend of -0.011 to -0.015 m3 m-3 per decade. Observed discharge declines for the three large river basins are consistentmore » with the effects of agricultural intensification, although other factors (e.g. dam constructions) likely have contributed to these trends. Practices like fertilizer application have favoured biomass growth and increased transpiration rates, thus reducing available soil water. In addition, the rapid proliferation of water-expensive crops (e.g., maize) and the expansion of the area dedicated to food production have also contributed to soil drying. Adoption of alternative agricultural practices that can meet the immediate food demand without compromising future water resources seem critical for the sustainability of the food production system.« less

Agriculture intensifies soil moisture decline in Northern China

DOE Office of Scientific and Technical Information (OSTI.GOV)

Liu, Yaling; Pan, Zhihua; Zhuang, Qianlai

Northern China is one of the most densely populated regions in the world. Agricultural activities have intensified since the 1980s to provide food security to the country. However, this intensification has likely contributed to an increasing scarcity in water resources, which may in turn be endangering food security. Based on in-situ measurements of soil moisture collected in agricultural plots during 1983–2012, we find that topsoil (0–50 cm) volumetric water content during the growing season has declined significantly (p<0.01), with a trend of -0.011 to -0.015 m3 m-3 per decade. Observed discharge declines for the three large river basins are consistentmore » with the effects of agricultural intensification, although other factors (e.g. dam constructions) likely have contributed to these trends. Practices like fertilizer application have favoured biomass growth and increased transpiration rates, thus reducing available soil water. In addition, the rapid proliferation of water-expensive crops (e.g., maize) and the expansion of the area dedicated to food production have also contributed to soil drying. Adoption of alternative agricultural practices that can meet the immediate food demand without compromising future water resources seem critical for the sustainability of the food production system.« less

Agriculture intensifies soil moisture decline in Northern China

PubMed Central

Liu, Yaling; Pan, Zhihua; Zhuang, Qianlai; Miralles, Diego G.; Teuling, Adriaan J.; Zhang, Tonglin; An, Pingli; Dong, Zhiqiang; Zhang, Jingting; He, Di; Wang, Liwei; Pan, Xuebiao; Bai, Wei; Niyogi, Dev

2015-01-01

Northern China is one of the most densely populated regions in the world. Agricultural activities have intensified since the 1980s to provide food security to the country. However, this intensification has likely contributed to an increasing scarcity in water resources, which may in turn be endangering food security. Based on in-situ measurements of soil moisture collected in agricultural plots during 1983–2012, we find that topsoil (0–50 cm) volumetric water content during the growing season has declined significantly (p < 0.01), with a trend of −0.011 to −0.015 m3 m−3 per decade. Observed discharge declines for the three large river basins are consistent with the effects of agricultural intensification, although other factors (e.g. dam constructions) likely have contributed to these trends. Practices like fertilizer application have favoured biomass growth and increased transpiration rates, thus reducing available soil water. In addition, the rapid proliferation of water-expensive crops (e.g., maize) and the expansion of the area dedicated to food production have also contributed to soil drying. Adoption of alternative agricultural practices that can meet the immediate food demand without compromising future water resources seem critical for the sustainability of the food production system. PMID:26158774

21 CFR 892.1650 - Image-intensified fluoroscopic x-ray system.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Image-intensified fluoroscopic x-ray system. 892.1650 Section 892.1650 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... through electronic amplification. This generic type of device may include signal analysis and display...

21 CFR 892.1650 - Image-intensified fluoroscopic x-ray system.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Image-intensified fluoroscopic x-ray system. 892.1650 Section 892.1650 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... through electronic amplification. This generic type of device may include signal analysis and display...

21 CFR 892.1650 - Image-intensified fluoroscopic x-ray system.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Image-intensified fluoroscopic x-ray system. 892.1650 Section 892.1650 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... through electronic amplification. This generic type of device may include signal analysis and display...

Using Brief Experimental Analysis to Intensify Tier 3 Reading Interventions

ERIC Educational Resources Information Center

Coolong-Chaffin, Melissa; Wagner, Dana

2015-01-01

As implementation of multi-tiered systems of support becomes common practice across the nation, practitioners continue to need strategies for intensifying interventions and supports for the subset of students who fail to make adequate progress despite strong programs at Tiers 1 and 2. Experts recommend making several changes to the structure and…

Short- and long-term memory effects in intensified array detectors - Influence on airborne laser fluorosensor measurements

NASA Astrophysics Data System (ADS)

Bristow, Michael P.; Edmonds, Curtis M.; Bundy, Donald H.; Turner, Rudolpha M.

1989-02-01

Phosphorescence and thermoluminescence memory effects in the phosphors of image intensifiers are investigated, with application to the performance improvement of intensified optical multichannel analyzers. Algorithms have been developed which can be used to remove these effects from airborne measurements of laser-induced fluorescence spectra of aquatic and terrestrial targets. The present method can be adapted to situations involving different gating routines, repetition rates, and diode group sizes.

The Effect of Intensified Language Exposure on Accommodating Talker Variability

ERIC Educational Resources Information Center

Antoniou, Mark; Wong, Patrick C. M.; Wang, Suiping

2015-01-01

Purpose: This study systematically examined the role of intensified exposure to a second language on accommodating talker variability. Method: English native listeners (n = 37) were compared with Mandarin listeners who had either lived in the United States for an extended period of time (n = 33) or had lived only in China (n = 44). Listeners…

Therapeutic inertia and intensified treatment in diabetes mellitus prescription patterns: A nationwide population-based study in Taiwan.

PubMed

Huang, Li-Ying; Yeh, Hseng-Long; Yang, Ming-Chin; Shau, Wen-Yi; Su, Syi; Lai, Mei-Shu

2016-12-01

Objective To measure therapeutic inertia by characterizing prescription patterns using secondary data obtained from the nationwide diabetes mellitus pay-for-performance (DM-P4P) programme in Taiwan. Methods Using reimbursement claims from Taiwan's National Health Insurance Research Database, a nationwide retrospective cohort study was undertaken of patients with diabetes mellitus who participated in the DM-P4P programme from 2006-2008. Glycosylated haemoglobin results were used to evaluate modifications in therapy in response to poor diabetes control. Prescription patterns were used to assign patients to either a therapeutic inertia group or an intensified treatment group. Therapeutic inertia was defined as the failure to act on a known problem. Results The research sample comprised of 168 876 patients with diabetes mellitus who had undergone 899 135 tests. Of these, 37.4% (336 615 visits) of prescriptions were for a combination of two types of drug and 27.7% (248 788 visits) were for a combination of three types of drug. The proportion of patients in the intensified therapy group who were prescribed more than two types of drug was considerably higher than that in the therapeutic inertia group. Conclusion In many cases in the therapeutic inertia group only a single type of hypoglycaemic drug was prescribed or the dosage remained unchanged.

Ultrasound Findings in Tension Pneumothorax: A Case Report.

PubMed

Inocencio, Maxine; Childs, Jeannine; Chilstrom, Mikaela L; Berona, Kristin

2017-06-01

Delayed recognition of tension pneumothorax can lead to a mortality of 31% to 91%. However, the classic physical examination findings of tracheal deviation and distended neck veins are poorly sensitive in the diagnosis of tension pneumothorax. Point-of-care ultrasound is accurate in identifying the presence of pneumothorax, but sonographic findings of tension pneumothorax are less well described. We report the case of a 21-year-old man with sudden-onset left-sided chest pain. He was clinically stable without hypoxia or hypotension, and the initial chest x-ray study showed a large pneumothorax without mediastinal shift. While the patient was awaiting tube thoracostomy, a point-of-care ultrasound demonstrated findings of mediastinal shift and a dilated inferior vena cava (IVC) concerning for tension physiology, even though the patient remained hemodynamically stable. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case demonstrates a unique clinical scenario of ultrasound evidence of tension physiology in a clinically stable patient. Although this patient was well appearing without hypotension, respiratory distress, tracheal deviation, or distended neck veins, point-of-care ultrasound revealed mediastinal shift and a plethoric IVC. Given that the classic clinical signs of tension pneumothorax are not uniformly present, this case shows how point-of-care ultrasound may diagnose tension pneumothorax before clinical decompensation. Published by Elsevier Inc.

Impacts of aeration management and polylactic acid addition on dissolved organic matter characteristics in intensified aquaponic systems.

PubMed

Wu, Haiming; Zou, Yina; Lv, Jialong; Hu, Zhen

2018-08-01

Aquaponics as a potential alternative for conventional aquaculture industry has increasingly attracted worldwide attention in recent years. However, the sustainable application of aquaponics is facing a growing challenge. In particular, there is a pressing need to better understand and control the accumulation of dissolved organic matter (DOM) in aquaponics with the aim of optimizing nitrogen utilization efficiency. This study was aiming for assessing the characteristics of DOM in the culture water and the relationship with the nitrogen transformations in different intensified aquaponic systems with hydroponic aeration supplement and polylactic acid (PLA) addition. Two enhancing attempts altered the quantity of DOM in aquaponic systems significantly with a varying DOM content of 21.98-45.65 mg/L. The DOM could be represented by four identified fluorescence components including three humic -like materials (83-86%) and one tryptophan-like substance (14-17%). The fluorescence intensities of humic acid-like components were decreased significantly after the application of intensifying strategies, which indicating that two enhancing attempts possibly affected humic acid-like fluorescence. Variation of optical indices also suggested the reductions of water DOM which could be impacted by the enhancing nitrogen treatment processes. These findings will benefit the potential applications and sustainable operation of these strategies in aquaponics. Copyright © 2018 Elsevier Ltd. All rights reserved.

Image intensifier gain uniformity improvements in sealed tubes by selective scrubbing

DOEpatents

Thomas, S.W.

1995-04-18

The gain uniformity of sealed microchannel plate image intensifiers (MCPIs) is improved by selectively scrubbing the high gain sections with a controlled bright light source. Using the premise that ions returning to the cathode from the microchannel plate (MCP) damage the cathode and reduce its sensitivity, a HeNe laser beam light source is raster scanned across the cathode of a microchannel plate image intensifier (MCPI) tube. Cathode current is monitored and when it exceeds a preset threshold, the sweep rate is decreased 1000 times, giving 1000 times the exposure to cathode areas with sensitivity greater than the threshold. The threshold is set at the cathode current corresponding to the lowest sensitivity in the active cathode area so that sensitivity of the entire cathode is reduced to this level. This process reduces tube gain by between 10% and 30% in the high gain areas while gain reduction in low gain areas is negligible. 4 figs.

Image intensifier gain uniformity improvements in sealed tubes by selective scrubbing

DOEpatents

Thomas, Stanley W.

1995-01-01

The gain uniformity of sealed microchannel plate image intensifiers (MCPIs) is improved by selectively scrubbing the high gain sections with a controlled bright light source. Using the premise that ions returning to the cathode from the microchannel plate (MCP) damage the cathode and reduce its sensitivity, a HeNe laser beam light source is raster scanned across the cathode of a microchannel plate image intensifier (MCPI) tube. Cathode current is monitored and when it exceeds a preset threshold, the sweep rate is decreased 1000 times, giving 1000 times the exposure to cathode areas with sensitivity greater than the threshold. The threshold is set at the cathode current corresponding to the lowest sensitivity in the active cathode area so that sensitivity of the entire cathode is reduced to this level. This process reduces tube gain by between 10% and 30% in the high gain areas while gain reduction in low gain areas is negligible.

Effects of repetitive or intensified instructions in telephone assisted, bystander cardiopulmonary resuscitation: an investigator-blinded, 4-armed, randomized, factorial simulation trial.

PubMed

van Tulder, R; Roth, D; Krammel, M; Laggner, R; Heidinger, B; Kienbacher, C; Novosad, H; Chwojka, C; Havel, C; Sterz, F; Schreiber, W; Herkner, H

2014-01-01

Compression depth is frequently suboptimal in cardiopulmonary resuscitation (CPR). We investigated effects of intensified wording and/or repetitive target depth instructions on compression depth in telephone-assisted, protocol driven, bystander CPR on a simulation manikin. Thirty-two volunteers performed 10 min of compression only-CPR in a prospective, investigator-blinded, 4-armed, factorial setting. Participants were randomized either to standard wording ("push down firmly 5 cm"), intensified wording ("it is very important to push down 5 cm every time") or standard or intensified wording repeated every 20s. Three dispatchers were randomized to give these instructions. Primary outcome was relative compression depth (absolute compression depth minus leaning depth). Secondary outcomes were absolute distance, hands-off times as well as BORG-scale and nine-hole peg test (NHPT), pulse rate and blood pressure to reflect physical exertion. We applied a random effects linear regression model. Relative compression depth was 35 ± 10 mm (standard) versus 31 ± 11 mm (intensified wording) versus 25 ± 8 mm (repeated standard) and 31 ± 14 mm (repeated intensified wording). Adjusted for design, body mass index and female sex, intensified wording and repetition led to decreased compression depth of 13 (95%CI -25 to -1) mm (p=0.04) and 9 (95%CI -21 to 3) mm (p=0.13), respectively. Secondary outcomes regarding intensified wording showed significant differences for absolute distance (43 ± 2 versus 20 (95%CI 3-37) mm; p=0.01) and hands-off times (60 ± 40 versus 157 (95%CI 63-251) s; p=0.04). In protocol driven, telephone-assisted, bystander CPR, intensified wording and/or repetitive target depth instruction will not improve compression depth compared to the standard instruction. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Screening and case-finding instruments for depression: a meta-analysis

PubMed Central

Gilbody, Simon; Sheldon, Trevor; House, Allan

2008-01-01

Background Screening and case-finding has been proposed as a simple, quick and cheap method to improve the quality of care for depression. We sought to establish the effectiveness of screening in improving the recognition of depression, the management of depression and the outcomes of patients with depression. Methods We performed a Cochrane systematic review of randomized controlled trials conducted in nonmental health settings that included case-finding or screening instruments for depression. We conducted a meta-analysis and explored heterogeneity using meta-regression techniques. Results Sixteen studies with 7576 patients met our inclusion criteria. We found that the use of screening or case-finding instruments were associated with a modest increase in the recognition of depression by clinicians (relative risk [RR] 1.27, 95% confidence interval [CI] 1.02 to 1.59). Questionnaires, when administered to all patients and the results given to clinicians irrespective of baseline score, had no impact on recognition (RR 1.03, 95% CI 0.85 to 1.24). Screening or case finding increased the use of any intervention by a relative risk of 1.30 (95% CI 0.97 to 1.76). There was no evidence of influence on the prescription of antidepressant medications (RR 1.20, 95% CI 0.87 to 1.66). Seven studies provided data on outcomes of depression, and no evidence of an effect was found (standardized mean difference –0.02, 95% CI –0.25 to 0.20). Interpretation If used alone, case-finding or screening questionnaires for depression appear to have little or no impact on the detection and management of depression by clinicians. Recommendations to adopt screening strategies using standardized questionnaires without organizational enhancements are not justified. PMID:18390942

Extrapolating intensified forest inventory data to the surrounding landscape using landsat

Treesearch

Evan B. Brooks; John W. Coulston; Valerie A. Thomas; Randolph H. Wynne

2015-01-01

In 2011, a collection of spatially intensified plots was established on three of the Experimental Forests and Ranges (EFRs) sites with the intent of facilitating FIA program objectives for regional extrapolation. Characteristic coefficients from harmonic regression (HR) analysis of associated Landsat stacks are used as inputs into a conditional random forests model to...

21 CFR 892.1660 - Non-image-intensified fluoroscopic x-ray system.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Non-image-intensified fluoroscopic x-ray system. 892.1660 Section 892.1660 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... of x-radiation into a visible image. This generic type of device may include signal analysis and...

21 CFR 892.1660 - Non-image-intensified fluoroscopic x-ray system.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Non-image-intensified fluoroscopic x-ray system. 892.1660 Section 892.1660 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... of x-radiation into a visible image. This generic type of device may include signal analysis and...

21 CFR 892.1660 - Non-image-intensified fluoroscopic x-ray system.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Non-image-intensified fluoroscopic x-ray system. 892.1660 Section 892.1660 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... of x-radiation into a visible image. This generic type of device may include signal analysis and...

Swap intensified WDR CMOS module for I2/LWIR fusion

NASA Astrophysics Data System (ADS)

Ni, Yang; Noguier, Vincent

2015-05-01

The combination of high resolution visible-near-infrared low light sensor and moderate resolution uncooled thermal sensor provides an efficient way for multi-task night vision. Tremendous progress has been made on uncooled thermal sensors (a-Si, VOx, etc.). It's possible to make a miniature uncooled thermal camera module in a tiny 1cm3 cube with <1W power consumption. For silicon based solid-state low light CCD/CMOS sensors have observed also a constant progress in terms of readout noise, dark current, resolution and frame rate. In contrast to thermal sensing which is intrinsic day&night operational, the silicon based solid-state sensors are not yet capable to do the night vision performance required by defense and critical surveillance applications. Readout noise, dark current are 2 major obstacles. The low dynamic range at high sensitivity mode of silicon sensors is also an important limiting factor, which leads to recognition failure due to local or global saturations & blooming. In this context, the image intensifier based solution is still attractive for the following reasons: 1) high gain and ultra-low dark current; 2) wide dynamic range and 3) ultra-low power consumption. With high electron gain and ultra low dark current of image intensifier, the only requirement on the silicon image pickup device are resolution, dynamic range and power consumption. In this paper, we present a SWAP intensified Wide Dynamic Range CMOS module for night vision applications, especially for I2/LWIR fusion. This module is based on a dedicated CMOS image sensor using solar-cell mode photodiode logarithmic pixel design which covers a huge dynamic range (> 140dB) without saturation and blooming. The ultra-wide dynamic range image from this new generation logarithmic sensor can be used directly without any image processing and provide an instant light accommodation. The complete module is slightly bigger than a simple ANVIS format I2 tube with <500mW power consumption.

Design and analysis of a new flux-intensifying permanent magnet brushless motor with multilayer flux barriers

NASA Astrophysics Data System (ADS)

Yang, Shen; Zhu, Xiaoyong; Xiang, Zixuan; Fan, Deyang; Wu, Wenye; Yin, Jianing

2017-05-01

This paper proposes a new flux-intensifying permanent magnet brushless motor for potential application in electric vehicles. The key of the proposed motor is to adopt the concept of flux-intensifying effect, thus the preferable flux-weakening ability and extended speed range can be achieved. The usage of segmented and relatively thinner permanent magnet (PM) in the proposed motor contributes to the increase of d-axis inductance Ld. In addition, the multilayer flux barriers along q-axis flux path will effectively decrease q-axis inductance Lq. As a result, the unique feature of Ld>Lq can be obtained, which is beneficial to extending the speed range of the proposed motor. Furthermore, the flux-intensifying effect can reduce the risk of irreversible demagnetization in PMs. The electromagnetic performances of the proposed motor are analyzed and investigated in details by using the finite element methods, which demonstrate the excellent flux-weakening capability and wide speed range can be achieved in the proposed FI-PMBL motor.

Clinical inertia with regard to intensifying therapy in people with type 2 diabetes treated with basal insulin.

PubMed

Khunti, K; Nikolajsen, A; Thorsted, B L; Andersen, M; Davies, M J; Paul, S K

2016-04-01

To investigate whether clinical inertia, the failure to intensify treatment regimens when required, exists in people with type 2 diabetes treated with basal insulin. This was a retrospective cohort study involving patients with type 2 diabetes in the UK Clinical Practice Research Datalink database between January 2004 and December 2011, with follow-up until December 2013. A total of 11 696 patients were included in the analysis. Among all patients, 36.5% had their treatment intensified during the study period; of these, the treatment of 50.0, 42.5 and 7.4% was intensified with bolus or premix insulin or glucagon-like peptide-1 receptor agonists, respectively. The median time from initiation of basal insulin to treatment intensification was 4.3 years [95% confidence interval (CI) 4.1, 4.6]. Among patients clinically eligible for treatment intensification [glycated haemoglobin (HbA1c) ≥7.5% (58 mmol/mol)], 30.9% had their treatment regimen intensified. The median time to intensification in this group was 3.7 years (95% CI 3.4, 4.0). Increasing age, duration of diabetes, oral antihyperglycaemic agent usage and Charlson comorbidity index score were associated with a significant delay in the time to intensification (p < 0.05). Among patients with HbA1c ≥7.5% (58 mmol/mol), 32.1% stopped basal insulin therapy. Strategies should be developed to increase the number of patients undergoing therapy intensification and to reduce the delay in intensifying therapy for suitable patients on basal insulin. Initiatives to support patients continuing on insulin are also required. © 2016 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.

Therapeutic inertia and intensified treatment in diabetes mellitus prescription patterns: A nationwide population-based study in Taiwan

PubMed Central

Huang, Li-Ying; Yeh, Hseng-Long; Yang, Ming-Chin; Shau, Wen-Yi; Su, Syi

2016-01-01

Objective To measure therapeutic inertia by characterizing prescription patterns using secondary data obtained from the nationwide diabetes mellitus pay-for-performance (DM-P4P) programme in Taiwan. Methods Using reimbursement claims from Taiwan’s National Health Insurance Research Database, a nationwide retrospective cohort study was undertaken of patients with diabetes mellitus who participated in the DM-P4P programme from 2006–2008. Glycosylated haemoglobin results were used to evaluate modifications in therapy in response to poor diabetes control. Prescription patterns were used to assign patients to either a therapeutic inertia group or an intensified treatment group. Therapeutic inertia was defined as the failure to act on a known problem. Results The research sample comprised of 168 876 patients with diabetes mellitus who had undergone 899 135 tests. Of these, 37.4% (336 615 visits) of prescriptions were for a combination of two types of drug and 27.7% (248 788 visits) were for a combination of three types of drug. The proportion of patients in the intensified therapy group who were prescribed more than two types of drug was considerably higher than that in the therapeutic inertia group. Conclusion In many cases in the therapeutic inertia group only a single type of hypoglycaemic drug was prescribed or the dosage remained unchanged. PMID:28322095

15. 3,000TON DAVYUNITED PRESS AND STEAM INTENSIFIER IN THE BLACKSMITH ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

15. 3,000-TON DAVY-UNITED PRESS AND STEAM INTENSIFIER IN THE BLACKSMITH SHOP. (THIS MACHINE WAS NOT EXTANT AT THE TIME OF THE INVENTORY.) Jet Lowe, Photographer, 1989. - U.S. Steel Homestead Works, Auxiliary Buildings & Shops, Along Monongahela River, Homestead, Allegheny County, PA

Electrostatically focused intensified charge coupled devices

NASA Technical Reports Server (NTRS)

Walker, J. W.

1977-01-01

Work performed to develop intensified charge coupled devices (ICCDs) is presented. Four ICCDs, containing 100 x 160 arrays, were fabricated. Electron gains up to 3200 at 15 keV were achieved. Photocathode sensitivities ranged from 190 to 410 micro A/lumen. Dark currents varied from 11 nA/sq cm to 37 nA/sq cm. There was serious concern about the reliability of the bonding scheme for ICCDs due to occassional bond failure. Two solutions to this problem were developed. One involved a modification of the existing bonding technique, and the other was the development of a protected bond pad employing a barrier metal between the aluminum metallization and the gold bond wire. An accumulation process was characterized with respect to its most critical variable. This characterization led to the achievement of reproducible spectral response and the discovery and elimination of dark current increase associated with this process.

High laboratory cost predicted per tuberculosis case diagnosed with increased case finding without a triage strategy.

PubMed

Dunbar, R; Naidoo, P; Beyers, N; Langley, I

2017-09-01

Cape Town, South Africa. To model the effects of increased case finding and triage strategies on laboratory costs per tuberculosis (TB) case diagnosed. We used a validated operational model and published laboratory cost data. We modelled the effect of varying the proportion with TB among presumptive cases and Xpert cartridge price reductions on cost per TB case and per additional TB case diagnosed in the Xpert-based vs. smear/culture-based algorithms. In our current scenario (18.3% with TB among presumptive cases), the proportion of cases diagnosed increased by 8.7% (16.7% vs. 15.0%), and the cost per case diagnosed increased by 142% (US$121 vs. US$50). The cost per additional case diagnosed was US$986. This would increase to US$1619 if the proportion with TB among presumptive cases was 10.6%. At 25.9-30.8% of TB prevalence among presumptive cases and a 50% reduction in Xpert cartridge price, the cost per TB case diagnosed would range from US$50 to US$59 (comparable to the US$48.77 found in routine practice with smear/culture). The operational model illustrates the effect of increased case finding on laboratory costs per TB case diagnosed. Unless triage strategies are identified, the approach will not be sustainable, even if Xpert cartridge prices are reduced.

Biliary Ascariasis: MR Cholangiography Findings in Two Cases

PubMed Central

Hwang, Cheol Mok; Ha, Hyun Kwon; Kim, Pyo Nyun; Lee, Moon-Gyu

2001-01-01

We describe the imaging features of two cases of biliary ascariasis. Ultrasonography and CT showed no specific abnormal findings, but MR cholangiography clearly demonstrated an intraductal linear filling defect that led to the correct diagnosis. MR cholangiography is thus a useful technique for the diagnosis of biliary ascariasis. PMID:11752990

Triangulating case-finding tools for patient safety surveillance: a cross-sectional case study of puncture/laceration.

PubMed

Taylor, Jennifer A; Gerwin, Daniel; Morlock, Laura; Miller, Marlene R

2011-12-01

To evaluate the need for triangulating case-finding tools in patient safety surveillance. This study applied four case-finding tools to error-associated patient safety events to identify and characterise the spectrum of events captured by these tools, using puncture or laceration as an example for in-depth analysis. Retrospective hospital discharge data were collected for calendar year 2005 (n=48,418) from a large, urban medical centre in the USA. The study design was cross-sectional and used data linkage to identify the cases captured by each of four case-finding tools. Three case-finding tools (International Classification of Diseases external (E) and nature (N) of injury codes, Patient Safety Indicators (PSI)) were applied to the administrative discharge data to identify potential patient safety events. The fourth tool was Patient Safety Net, a web-based voluntary patient safety event reporting system. The degree of mutual exclusion among detection methods was substantial. For example, when linking puncture or laceration on unique identifiers, out of 447 potential events, 118 were identical between PSI and E-codes, 152 were identical between N-codes and E-codes and 188 were identical between PSI and N-codes. Only 100 events that were identified by PSI, E-codes and N-codes were identical. Triangulation of multiple tools through data linkage captures potential patient safety events most comprehensively. Existing detection tools target patient safety domains differently, and consequently capture different occurrences, necessitating the integration of data from a combination of tools to fully estimate the total burden.

An Intensified Vibratory Milling Process for Enhancing the Breakage Kinetics during the Preparation of Drug Nanosuspensions.

PubMed

Li, Meng; Zhang, Lu; Davé, Rajesh N; Bilgili, Ecevit

2016-04-01

As a drug-sparing approach in early development, vibratory milling has been used for the preparation of nanosuspensions of poorly water-soluble drugs. The aim of this study was to intensify this process through a systematic increase in vibration intensity and bead loading with the optimal bead size for faster production. Griseofulvin, a poorly water-soluble drug, was wet-milled using yttrium-stabilized zirconia beads with sizes ranging from 50 to 1500 μm at low power density (0.87 W/g). Then, this process was intensified with the optimal bead size by sequentially increasing vibration intensity and bead loading. Additional experiments with several bead sizes were performed at high power density (16 W/g), and the results were compared to those from wet stirred media milling. Laser diffraction, scanning electron microscopy, X-ray diffraction, differential scanning calorimetry, and dissolution tests were used for characterization. Results for the low power density indicated 800 μm as the optimal bead size which led to a median size of 545 nm with more than 10% of the drug particles greater than 1.8 μm albeit the fastest breakage. An increase in either vibration intensity or bead loading resulted in faster breakage. The most intensified process led to 90% of the particles being smaller than 300 nm. At the high power intensity, 400 μm beads were optimal, which enhanced griseofulvin dissolution significantly and signified the importance of bead size in view of the power density. Only the optimally intensified vibratory milling led to a comparable nanosuspension to that prepared by the stirred media milling.

Dynamic imaging with a triggered and intensified CCD camera system in a high-intensity neutron beam

NASA Astrophysics Data System (ADS)

Vontobel, P.; Frei, G.; Brunner, J.; Gildemeister, A. E.; Engelhardt, M.

2005-04-01

When time-dependent processes within metallic structures should be inspected and visualized, neutrons are well suited due to their high penetration through Al, Ag, Ti or even steel. Then it becomes possible to inspect the propagation, distribution and evaporation of organic liquids as lubricants, fuel or water. The principle set-up of a suited real-time system was implemented and tested at the radiography facility NEUTRA of PSI. The highest beam intensity there is 2×107 cm s, which enables to observe sequences in a reasonable time and quality. The heart of the detection system is the MCP intensified CCD camera PI-Max with a Peltier cooled chip (1300×1340 pixels). The intensifier was used for both gating and image enhancement, where as the information was accumulated over many single frames on the chip before readout. Although, a 16-bit dynamic range is advertised by the camera manufacturers, it must be less due to the inherent noise level from the intensifier. The obtained result should be seen as the starting point to go ahead to fit the different requirements of car producers in respect to fuel injection, lubricant distribution, mechanical stability and operation control. Similar inspections will be possible for all devices with repetitive operation principle. Here, we report about two measurements dealing with the lubricant distribution in a running motorcycle motor turning at 1200 rpm. We were monitoring the periodic stationary movements of piston, valves and camshaft with a micro-channel plate intensified CCD camera system (PI-Max 1300RB, Princeton Instruments) triggered at exactly chosen time points.

Medico-Legal Findings, Legal Case Progression, and Outcomes in South African Rape Cases: Retrospective Review

PubMed Central

Jewkes, Rachel; Christofides, Nicola; Vetten, Lisa; Jina, Ruxana; Sigsworth, Romi; Loots, Lizle

2009-01-01

Background Health services for victims of rape are recognised as a particularly neglected area of the health sector internationally. Efforts to strengthen these services need to be guided by clinical research. Expert medical evidence is widely used in rape cases, but its contribution to the progress of legal cases is unclear. Only three studies have found an association between documented bodily injuries and convictions in rape cases. This article aims to describe the processing of rape cases by South African police and courts, and the association between documented injuries and DNA and case progression through the criminal justice system. Methods and Findings We analysed a provincially representative sample of 2,068 attempted and completed rape cases reported to 70 randomly selected Gauteng province police stations in 2003. Data sheets were completed from the police dockets and available medical examination forms were copied. 1,547 cases of rape had medical examinations and available forms and were analysed, which was at least 85% of the proportion of the sample having a medical examination. We present logistic regression models of the association between whether a trial started and whether the accused was found guilty and the medico-legal findings for adult and child rapes. Half the suspects were arrested (n = 771), 14% (209) of cases went to trial, and in 3% (31) of adults and 7% (44) of children there was a conviction. A report on DNA was available in 1.4% (22) of cases, but the presence or absence of injuries were documented in all cases. Documented injuries were not associated with arrest, but they were associated with children's cases (but not adult's) going to trial (adjusted odds ratio [AOR] for having genital and nongenital injuries 5.83, 95% confidence interval [CI] 1.87–18.13, p = 0.003). In adult cases a conviction was more likely if there were documented injuries, whether nongenital injuries alone AOR 6.25 (95% CI 1.14–34.3, p = 0

Metastatic pulmonary calcification: high-resolution computed tomography findings in 23 cases.

PubMed

Belém, Luciana Camara; Souza, Carolina A; Souza, Arthur Soares; Escuissato, Dante Luiz; Hochhegger, Bruno; Nobre, Luiz Felipe; Rodrigues, Rosana Souza; Gomes, Antônio Carlos Portugal; Silva, Claudio S; Guimarães, Marcos Duarte; Zanetti, Gláucia; Marchiori, Edson

2017-01-01

The aim of this study was to evaluate the high-resolution computed tomography (HRCT) findings in patients diagnosed with metastatic pulmonary calcification (MPC). We retrospectively reviewed the HRCT findings from 23 cases of MPC [14 men, 9 women; mean age, 54.3 (range, 26-89) years]. The patients were examined between 2000 and 2014 in nine tertiary hospitals in Brazil, Chile, and Canada. Diagnoses were established by histopathologic study in 18 patients and clinical-radiological correlation in 5 patients. Two chest radiologists analyzed the images and reached decisions by consensus. The predominant HRCT findings were centrilobular ground-glass nodules ( n = 14; 60.9%), consolidation with high attenuation ( n = 10; 43.5%), small dense nodules ( n = 9; 39.1%), peripheral reticular opacities associated with small calcified nodules ( n = 5; 21.7%), and ground-glass opacities without centrilobular ground-glass nodular opacity ( n = 5; 21.7%). Vascular calcification within the chest wall was found in four cases and pleural effusion was observed in five cases. The abnormalities were bilateral in 21 cases. MPC manifested with three main patterns on HRCT, most commonly centrilobular ground-glass nodules, often containing calcifications, followed by dense consolidation and small solid nodules, most of which were calcified. We also described another pattern of peripheral reticular opacities associated with small calcified nodules. These findings should suggest the diagnosis of MPC in the setting of hypercalcemia.

Exposure time, running and skill-related performance in international u20 rugby union players during an intensified tournament

PubMed Central

Carling, Christopher J.; Flanagan, Eamon; O’Doherty, Pearse; Piscione, Julien

2017-01-01

Purpose This study investigated exposure time, running and skill-related performance in two international u20 rugby union teams during an intensified tournament: the 2015 Junior World Rugby Championship. Method Both teams played 5 matches in 19 days. Analyses were conducted using global positioning system (GPS) tracking (Viper 2™, Statsports Technologies Ltd) and event coding (Opta Pro®). Results Of the 62 players monitored, 36 (57.1%) participated in 4 matches and 23 (36.5%) in all 5 matches while player availability for selection was 88%. Analyses of team running output (all players completing >60-min play) showed that the total and peak 5-minute high metabolic load distances covered were likely-to-very likely moderately higher in the final match compared to matches 1 and 2 in back and forward players. In individual players with the highest match-play exposure (participation in >75% of total competition playing time and >75-min in each of the final 3 matches), comparisons of performance in matches 4 and 5 versus match 3 (three most important matches) reported moderate-to-large decreases in total and high metabolic load distance in backs while similar magnitude reductions occurred in high-speed distance in forwards. In contrast, skill-related performance was unchanged, albeit with trivial and unclear changes, while there were no alterations in either total or high-speed running distance covered at the end of matches. Conclusions These findings suggest that despite high availability for selection, players were not over-exposed to match-play during an intensified u20 international tournament. They also imply that the teams coped with the running and skill-related demands. Similarly, individual players with the highest exposure to match-play were also able to maintain skill-related performance and end-match running output (despite an overall reduction in the latter). These results support the need for player rotation and monitoring of performance, recovery and

Exposure time, running and skill-related performance in international u20 rugby union players during an intensified tournament.

PubMed

Carling, Christopher J; Lacome, Mathieu; Flanagan, Eamon; O'Doherty, Pearse; Piscione, Julien

2017-01-01

This study investigated exposure time, running and skill-related performance in two international u20 rugby union teams during an intensified tournament: the 2015 Junior World Rugby Championship. Both teams played 5 matches in 19 days. Analyses were conducted using global positioning system (GPS) tracking (Viper 2™, Statsports Technologies Ltd) and event coding (Opta Pro®). Of the 62 players monitored, 36 (57.1%) participated in 4 matches and 23 (36.5%) in all 5 matches while player availability for selection was 88%. Analyses of team running output (all players completing >60-min play) showed that the total and peak 5-minute high metabolic load distances covered were likely-to-very likely moderately higher in the final match compared to matches 1 and 2 in back and forward players. In individual players with the highest match-play exposure (participation in >75% of total competition playing time and >75-min in each of the final 3 matches), comparisons of performance in matches 4 and 5 versus match 3 (three most important matches) reported moderate-to-large decreases in total and high metabolic load distance in backs while similar magnitude reductions occurred in high-speed distance in forwards. In contrast, skill-related performance was unchanged, albeit with trivial and unclear changes, while there were no alterations in either total or high-speed running distance covered at the end of matches. These findings suggest that despite high availability for selection, players were not over-exposed to match-play during an intensified u20 international tournament. They also imply that the teams coped with the running and skill-related demands. Similarly, individual players with the highest exposure to match-play were also able to maintain skill-related performance and end-match running output (despite an overall reduction in the latter). These results support the need for player rotation and monitoring of performance, recovery and intervention strategies during

Intensified rehabilitation therapy and transitions to skilled nursing facilities in community-living seniors with acute medical illnesses.

PubMed

Yoo, Ji Won; Kim, Sulgi; Choi, Jai Hyun; Ryu, Woo Sang

2013-07-01

To examine whether rehabilitation therapy type would be associated with transitions to skilled nursing facilities (SNF) in community-living seniors with acute medical illnesses. Using administrative and clinical data, multivariate regression analysis examined the relationship between the extent of rehabilitation therapy and transitions to SNF in all participants, as well as participants by physical function at admission. In all participants (n=929), the intensified rehabilitation therapy was associated with a lower probability of transitions to SNF (14% vs 21%; odds ratio [OR] 0.59; 95% confidence intervals [CI] 0.22-0.96; P=0.02). In participants with mild physical limitations (n=270), less frequent transitions to SNF occurred when patients received intensified rehabilitation therapy [16% vs 23%; OR 0.46; 95% CI 0.17-0.94; P=0.01]. In participants with moderate to severe physical limitations (n=265), the decreased frequency of transitions to SNF associated with rehabilitation therapy became more pronounced (18% vs 28%; OR 0.34; 95% CI 0.07-0.89; P=0.004). By contrast, in participants without physical limitation (n=394), the number of transitions to SNF did not change significantly when they received intensified rehabilitation therapy (P=0.53). We found a significant relationship between intensified rehabilitation therapy and the decrease of transitions to SNF in community-living seniors with acute medical illness. The magnitude of this relationship increased in participants with more physical limitations, but not in participants without physical limitations at admission. © 2012 Japan Geriatrics Society.

Low-Timing-Jitter Near-Infrared Single-Photon-Sensitive 16-Channel Intensified-Photodiode Detector

NASA Technical Reports Server (NTRS)

Krainak, Michael A.; Lu, Wei; Yang, Guangning; Sun, Xiaoli; Sykora, Derek; Jurkovic, Mike; Aebi, Verle; Costello, Ken; Burns, Richard

2011-01-01

We developed a 16-channel InGaAsP photocathode intensified-photodiode (IPD) detector with 78 ps (1-sigma) timing-jitter, less than 500 ps FWHM impulse response, greater than 15% quantum efficiency at 1064 nm wavelength with 131 kcps dark counts at 15 C.

Detection of subsurface-intensified eddies from observations of the sea-surface: a case study for Mediterranean Water Eddies in a long-term high-resolution simulation

NASA Astrophysics Data System (ADS)

Ciani, Daniele; Carton, Xavier; Barbosa Aguiar, Ana Claudia; Peliz, Alvaro; Bashmachnikov, Igor; Ienna, Federico; Chapron, Bertrand

2017-04-01

Subsurface-intensified eddies are ubiquitous in the world ocean. They can be generated by exchanges of water masses between semi-enclosed evaporation basins and the open ocean or by deep convection. Past and recent studies have shown that these eddies are carriers of large amounts of heat and salt, that they are coherent over inter-annual timescales and that they can migrate for several thousands of miles from their origination areas towards the open ocean. Hence, subsurface-intensified eddies can influence the three-dimensional distribution of oceanic tracers at global scale. The synoptic knowledge of the eddies positions and mean pathways is then crucial for evaluating temperature and salinity budgets in the world ocean. At present day, satellite sensors constitute the ideal tool for the synoptic and global scale observations of the ocean. Since they only provide informations on the oceanic surface, we characterized the signatures that subsurface eddies generate at the sea-surface, to determine the extent to which they can be isolated from the surrounding surface turbulence and be considered as a trace of an underlying eddy. We studied the surface signature of subsurface-intensified anticyclones (Mediterranean Water Eddies - Meddies) in a realistic, long-term (20 years) and high resolution simulation (dx = 3 km) based on the ROMS model. The novelty and advantage of this approach is given by the simultaneous availability of the full 3D eddies characteristics, the ones of the background ocean and of the sea-surface (in terms of sea-surface height, temperature and salinity). This also allowed us to speculate on a synergy between different satellite observations for the automatic detection of subsurface eddies from space. The along trajectory properties and surface signatures of more than 90 long-lived Meddies were analyzed. We showed that the Meddies constantly generate positive anomalies in sea-surface height and that these anomalies are principally related to the

The ultraviolet detection component based on Te-Cs image intensifier

NASA Astrophysics Data System (ADS)

Qian, Yunsheng; Zhou, Xiaoyu; Wu, Yujing; Wang, Yan; Xu, Hua

2017-05-01

Ultraviolet detection technology has been widely focused and adopted in the fields of ultraviolet warning and corona detection for its significant value and practical meaning. The component structure of ultraviolet ICMOS, imaging driving and the photon counting algorithm are studied in this paper. Firstly, the one-inch and wide dynamic range CMOS chip with the coupling optical fiber panel is coupled to the ultraviolet image intensifier. The photocathode material in ultraviolet image intensifier is Te-Cs, which contributes to the solar blind characteristic, and the dual micro-channel plates (MCP) structure ensures the sufficient gain to achieve the single photon counting. Then, in consideration of the ultraviolet detection demand, the drive circuit of the CMOS chip is designed and the corresponding program based on Verilog language is written. According to the characteristics of ultraviolet imaging, the histogram equalization method is applied to enhance the ultraviolet image and the connected components labeling way is utilized for the ultraviolet single photon counting. Moreover, one visible light video channel is reserved in the ultraviolet ICOMS camera, which can be used for the fusion of ultraviolet and visible images. Based upon the module, the ultraviolet optical lens and the deep cut-off solar blind filter are adopted to construct the ultraviolet detector. At last, the detection experiment of the single photon signal is carried out, and the test results are given and analyzed.

Waiting list randomized controlled trial within a case-finding design: methodological considerations.

PubMed

Ronaldson, Sarah; Adamson, Joy; Dyson, Lisa; Torgerson, David

2014-10-01

Randomized controlled trials (RCTs) are widely used in health care research to provide high-quality evidence of effectiveness of an intervention. However, sometimes a study does not require an RCT in order to answer its primary objective; a case-finding design may be more appropriate. The aim of this paper was to introduce a new study design that nests a waiting list RCT within a case-finding study. An example of the new study design is the DOC Study, which primarily aims to determine the diagnostic accuracy of lung function tests for chronic obstructive pulmonary disease. It also investigates the impact of lung function tests on smoking behaviour through use of a waiting list design. The first step of the study design is to obtain participants' consent. Individuals are then randomized to one of two groups; either the 'intervention now' group or the 'intervention later' group, that is, participants are placed on a waiting list. All participants receive the same intervention; the only difference between the groups is the timing of the intervention. The design addresses patient preference issues and recruitment issues that can arise in other trial designs. Potential limitations include differential attrition between study groups and potential demoralization for the 'intervention later' group. The 'waiting list case-finding trial' design is a valuable method that could be applied to case-finding studies; the design enables the case-finding component of a study to be maintained while simultaneously exploring additional hypotheses through conducting a trial. © 2014 John Wiley & Sons, Ltd.

Relationship between fatigue of generation II image intensifier and input illumination

NASA Astrophysics Data System (ADS)

Chen, Qingyou

1995-09-01

If there is fatigue for an image intesifier, then it has an effect on the imaging property of the night vision system. In this paper, using the principle of Joule Heat, we derive a mathematical formula for the generated heat of semiconductor photocathode. We describe the relationship among the various parameters in the formula. We also discuss reasons for the fatigue of Generation II image intensifier caused by bigger input illumination.

An audit of the toxicology findings in 555 medico-legal autopsies finds manner of death changed in 5 cases.

PubMed

Langlois, Neil E I; Gilbert, John D; Heath, Karen J; Winskog, Calle; Kostakis, Chris

2013-03-01

An audit of toxicological analysis in Coronial autopsies performed at Forensic Science South Australia was conducted on the cases of three pathologists. Toxicological analysis had been performed in 555 (68 %) from a total of 815 autopsies. It was found that the proffered manner of death was changed from the provisional report (provided immediately after the post-mortem examination) in five cases (just under 1 %) as a consequence of the toxicological findings. This is a limited study as it is retrospective, not all cases had toxicological analysis and the findings are constrained by the range of the substances that could be detected. Nonetheless, the audit supports the application of toxicological analysis in medico-legal death investigation and suggests that an inclusive policy should be adopted.

An unusual autopsy case of cytokine storm-derived influenza-associated encephalopathy without typical histopathological findings: autopsy case report.

PubMed

Nara, Akina; Nagai, Hisashi; Yamaguchi, Rutsuko; Yoshida, Ken-ichi; Iwase, Hirotaro; Mizuguchi, Masashi

2015-03-01

Cytokine storm-derived influenza-associated encephalopathy is a severe complication, affecting not only the brain but also multiple systemic organs including the heart and lungs. Hundreds of Japanese children are afflicted by influenza-associated encephalopathy every year. Influenza-associated encephalopathy can be diagnosed by pathological changes, such as advanced brain edema and disruption of astrocytic projections, which is known as clasmatodendrosis. In the present case, despite the absence of significant histopathological findings in the brain, the diagnosis of influenza-associated encephalopathy was made on the basis of autopsy findings such as brain swelling, pathological findings including diffuse alveolar damage, and increase in the concentrations of interleukin-6 in both the serum and cerebrospinal fluid. In this case, the interval from high fever to death was approximately 7 hours and may have been too short for histopathological features to develop. This is an unusual autopsy case of cytokine storm-derived influenza-associated encephalopathy without typical histopathological findings.

An oscilloscope spot intensifier, to improve photographic recordings of action potentials.

PubMed

Evans, M H

1985-06-01

A circuit diagram is shown for a semiconductor device to intensify the brightness of an oscilloscope during the rapidly rising and falling phases of signals such as action potentials. Brightening pulses proportional in amplitude to the rate of change in the Y-axis are available for connection to an oscilloscope with an external intensity ('Z') modulation input. The circuit requires one transistor, one dual operational amplifier and two single fast operational amplifiers.

Human water consumption intensifies hydrological drought worldwide

NASA Astrophysics Data System (ADS)

Wada, Y.; Van Beek, L. P.; Wanders, N.; Bierkens, M. F.

2012-12-01

Over the past decades, human water consumption has more than doubled, and reduced streamflow over various regions of the world. However, it remains unclear to what degree human water consumption intensifies hydrological droughts, i.e. the occurrence of anomalously low streamflow. Here, we quantify over the period 1960-2010 the impact of human water consumption on the intensity and frequency of hydrological droughts worldwide. We simulated streamflow by the global hydrological and water resources model PCR-GLOBWB at a 0.5 degree spatial resolution, and reduced the amount of streamflow with different levels of human water consumption over the period 1960-2010. We applied the commonly used variable threshold level method to identify below-normal water availability as the onset of hydrological droughts. We then standardized the deficit volume dividing relative to the threshold level to express the intensity of drought conditions to normal streamflow conditions. The results show that human water consumption substantially reduced local and downstream streamflow in many regions of the world. This subsequently intensified hydrological droughts regionally by 10-500%. Irrigation is responsible for the intensification of hydrological droughts over western and central U.S., southern Europe, Asia, and southeastern Australia, whereas the impact of industrial and households' consumption on the intensification is considerably larger over eastern U.S., and western and central Europe. The results also show that drought frequency increased by more than 27% compared to pristine or natural condition as a result of human water consumption. The intensification of drought frequency is most severe over Asia, but also substantial over North America and Europe. Importantly, global population under severe hydrological droughts considerably increased from 0.7 billion in 1960 to 2.2 billion in 2010 due to rapid population growth. As a limited validation exercise, we compared simulated deficit

Clinicopathological Findings of Suicide in the Elderly: Three Cases

ERIC Educational Resources Information Center

Peisah, Carmelle; Snowdon, John; Kril, Jillian; Rodriguez, Michael

2007-01-01

The neuropathological correlates of suicide in older persons have received little research attention. Our recent study of elderly suicide victims from an Australian forensic medicine department (n = 143), unlike a previous case-control study, did not find an increased prevalence of Alzheimer's disease (AD) in older persons who committed suicide…

NLP based congestive heart failure case finding: A prospective analysis on statewide electronic medical records.

PubMed

Wang, Yue; Luo, Jin; Hao, Shiying; Xu, Haihua; Shin, Andrew Young; Jin, Bo; Liu, Rui; Deng, Xiaohong; Wang, Lijuan; Zheng, Le; Zhao, Yifan; Zhu, Chunqing; Hu, Zhongkai; Fu, Changlin; Hao, Yanpeng; Zhao, Yingzhen; Jiang, Yunliang; Dai, Dorothy; Culver, Devore S; Alfreds, Shaun T; Todd, Rogow; Stearns, Frank; Sylvester, Karl G; Widen, Eric; Ling, Xuefeng B

2015-12-01

In order to proactively manage congestive heart failure (CHF) patients, an effective CHF case finding algorithm is required to process both structured and unstructured electronic medical records (EMR) to allow complementary and cost-efficient identification of CHF patients. We set to identify CHF cases from both EMR codified and natural language processing (NLP) found cases. Using narrative clinical notes from all Maine Health Information Exchange (HIE) patients, the NLP case finding algorithm was retrospectively (July 1, 2012-June 30, 2013) developed with a random subset of HIE associated facilities, and blind-tested with the remaining facilities. The NLP based method was integrated into a live HIE population exploration system and validated prospectively (July 1, 2013-June 30, 2014). Total of 18,295 codified CHF patients were included in Maine HIE. Among the 253,803 subjects without CHF codings, our case finding algorithm prospectively identified 2411 uncodified CHF cases. The positive predictive value (PPV) is 0.914, and 70.1% of these 2411 cases were found to be with CHF histories in the clinical notes. A CHF case finding algorithm was developed, tested and prospectively validated. The successful integration of the CHF case findings algorithm into the Maine HIE live system is expected to improve the Maine CHF care. Copyright © 2015. Published by Elsevier Ireland Ltd.

Outcome and toxicity associated with a dose-intensified, maintenance-free CHOP-based chemotherapy protocol in canine lymphoma: 130 cases.

PubMed

Sorenmo, Karin; Overley, B; Krick, E; Ferrara, T; LaBlanc, A; Shofer, F

2010-09-01

A dose-intensified/dose-dense chemotherapy protocol for canine lymphoma was designed and implemented at the Veterinary Hospital of the University of Pennsylvania. In this study, we describe the clinical characteristics, prognostic factors, efficacy and toxicity in 130 dogs treated with this protocol. The majority of the dogs had advanced stage disease (63.1% stage V) and sub-stage b (58.5%). The median time to progression (TTP) and lymphoma-specific survival were 219 and 323 days, respectively. These results are similar to previous less dose-intense protocols. Sub-stage was a significant negative prognostic factor for survival. The incidence of toxicity was high; 53.9 and 45% of the dogs needed dose reductions and treatment delays, respectively. Dogs that required dose reductions and treatment delays had significantly longer TTP and lymphoma-specific survival times. These results suggest that dose density is important, but likely relative, and needs to be adjusted according to the individual patient's toxicity for optimal outcome.

The effects of intensified training on resting metabolic rate (RMR), body composition and performance in trained cyclists

PubMed Central

Lundy, Bronwen; Rogers, Margot A.; Welvaert, Marijke; Halson, Shona; McKune, Andrew

2018-01-01

Background Recent research has demonstrated decreases in resting metabolic rate (RMR), body composition and performance following a period of intensified training in elite athletes, however the underlying mechanisms of change remain unclear. Therefore, the aim of the present study was to investigate how an intensified training period, designed to elicit overreaching, affects RMR, body composition, and performance in trained endurance athletes, and to elucidate underlying mechanisms. Method Thirteen (n = 13) trained male cyclists completed a six-week training program consisting of a “Baseline” week (100% of regular training load), a “Build” week (~120% of Baseline load), two “Loading” weeks (~140, 150% of Baseline load, respectively) and two “Recovery” weeks (~80% of Baseline load). Training comprised of a combination of laboratory based interval sessions and on-road cycling. RMR, body composition, energy intake, appetite, heart rate variability (HRV), cycling performance, biochemical markers and mood responses were assessed at multiple time points throughout the six-week period. Data were analysed using a linear mixed modeling approach. Results The intensified training period elicited significant decreases in RMR (F(5,123.36) = 12.0947, p = <0.001), body mass (F(2,19.242) = 4.3362, p = 0.03), fat mass (F(2,20.35) = 56.2494, p = <0.001) and HRV (F(2,22.608) = 6.5212, p = 0.005); all of which improved following a period of recovery. A state of overreaching was induced, as identified by a reduction in anaerobic performance (F(5,121.87) = 8.2622, p = <0.001), aerobic performance (F(5,118.26) = 2.766, p = 0.02) and increase in total mood disturbance (F(5, 110.61) = 8.1159, p = <0.001). Conclusion Intensified training periods elicit greater energy demands in trained cyclists, which, if not sufficiently compensated with increased dietary intake, appears to provoke a cascade of metabolic, hormonal and neural responses in an attempt to restore homeostasis

Radiologist Agreement for Mammographic Recall by Case Difficulty and Finding Type

PubMed Central

Onega, Tracy; Smith, Megan; Miglioretti, Diana L.; Carney, Patricia A.; Geller, Berta; Kerlikowske, Karla; Buist, Diana SM; Rosenberg, Robert D.; Smith, Robert; Sickles, Edward A.; Haneuse, Sebastien; Anderson, Melissa L.; Yankaskas, Bonnie

2012-01-01

INTRODUCTIONS To assess agreement of mammography interpretations by community radiologists with consensus interpretations of an expert radiology panel, to inform approaches that improve mammography performance. METHODS From six mammography registries, 119 community-based radiologists were recruited to assess one of four randomly assigned test sets of 109 screening mammograms with comparison studies for no recall or recall, giving the most significant finding type [mass, calcifications, asymmetric density or architectural distortion] and location. The mean proportion of agreement with an expert radiology panel was calculated by cancer status, finding type, and difficulty level of identifying the finding at the woman, breast, and lesion level. We also examined concordance in finding type between study radiologists and the expert panel. For each finding type, we determined the proportion of unnecessary recalls, defined as study radiologist recalls that were not expert panel recalls. RESULTS Recall agreement was 100% for masses and for exams with obvious findings in both cancer and non-cancer cases. Among cancer cases, recall agreement was lower for lesions that were subtle (50%) or asymmetric (60%). Subtle non-cancer findings and benign calcifications showed 33% agreement for recall. Agreement for finding responsible for recall was low, especially for architectural distortions (43%) and asymmetric densities (40%). Most unnecessary recalls (51%) were asymmetric densities. CONCLUSION Agreement in mammography interpretation was low for asymmetric densities and architectural distortions. Training focused on these interpretations could improve mammography accuracy and reduce unnecessary recalls. PMID:23122345

Inducible defenses in prey intensify predator cannibalism.

PubMed

Kishida, Osamu; Trussell, Geoffrey C; Nishimura, Kinya; Ohgushi, Takayuki

2009-11-01

Trophic cascades are often a potent force in ecological communities, but abiotic and biotic heterogeneity can diffuse their influence. For example, inducible defenses in many species create variation in prey edibility, and size-structured interactions, such as cannibalism, can shift predator diets away from heterospecific prey. Although both factors diffuse cascade strength by adding heterogeneity to trophic interactions, the consequences of their interactioh remain poorly understood. We show that inducible defenses in tadpole prey greatly intensify cannibalism in predatory larval salamanders. The likelihood of cannibalism was also strongly influenced by asymmetries in salamander size that appear to be most important in the presence of defended prey. Hence, variation in prey edibility and the size structure of the predator may synergistically affect predator-prey population dynamics by reducing prey mortality and increasing predator mortality via cannibalism. We also suggest that the indirect effects of prey defenses may shape the evolution of predator traits that determine diet breadth and how trophic dynamics unfold in natural systems.

5 CFR 890.1039 - Cases where additional fact-finding is required.

Code of Federal Regulations, 2010 CFR

2010-01-01

...) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Suspension § 890.1039 Cases where additional fact-finding is...

Radiologist Agreement for Mammographic Recall by Case Difficulty and Finding Type.

PubMed

Onega, Tracy; Smith, Megan; Miglioretti, Diana L; Carney, Patricia A; Geller, Berta A; Kerlikowske, Karla; Buist, Diana S M; Rosenberg, Robert D; Smith, Robert A; Sickles, Edward A; Haneuse, Sebastien; Anderson, Melissa L; Yankaskas, Bonnie

2016-11-01

The aim of this study was to assess agreement of mammographic interpretations by community radiologists with consensus interpretations of an expert radiology panel to inform approaches that improve mammographic performance. From 6 mammographic registries, 119 community-based radiologists were recruited to assess 1 of 4 randomly assigned test sets of 109 screening mammograms with comparison studies for no recall or recall, giving the most significant finding type (mass, calcifications, asymmetric density, or architectural distortion) and location. The mean proportion of agreement with an expert radiology panel was calculated by cancer status, finding type, and difficulty level of identifying the finding at the patient, breast, and lesion level. Concordance in finding type between study radiologists and the expert panel was also examined. For each finding type, the proportion of unnecessary recalls, defined as study radiologist recalls that were not expert panel recalls, was determined. Recall agreement was 100% for masses and for examinations with obvious findings in both cancer and noncancer cases. Among cancer cases, recall agreement was lower for lesions that were subtle (50%) or asymmetric (60%). Subtle noncancer findings and benign calcifications showed 33% agreement for recall. Agreement for finding responsible for recall was low, especially for architectural distortions (43%) and asymmetric densities (40%). Most unnecessary recalls (51%) were asymmetric densities. Agreement in mammographic interpretation was low for asymmetric densities and architectural distortions. Training focused on these interpretations could improve the accuracy of mammography and reduce unnecessary recalls. Copyright © 2012 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Diels–Alder reactions of myrcene using intensified continuous-flow reactors

PubMed Central

Álvarez-Diéguez, Miguel Á; Kohl, Thomas M; Tsanaktsidis, John

2017-01-01

This work describes the Diels–Alder reaction of the naturally occurring substituted butadiene, myrcene, with a range of different naturally occurring and synthetic dienophiles. The synthesis of the Diels–Alder adduct from myrcene and acrylic acid, containing surfactant properties, was scaled-up in a plate-type continuous-flow reactor with a volume of 105 mL to a throughput of 2.79 kg of the final product per day. This continuous-flow approach provides a facile alternative scale-up route to conventional batch processing, and it helps to intensify the synthesis protocol by applying higher reaction temperatures and shorter reaction times. PMID:28228853

Isolated primary craniosynostosis in an adult: Imaging findings of a case

PubMed Central

Thakur, Shruti; Jhobta, Anupam; Kumar, Suresh; Thakur, Charu Smita

2014-01-01

Craniosynostosis means premature closure of calvarial sutures. It may be primary or secondary. The patient presents with unexplained neuropsychological impairment and radiological imaging clinches the diagnosis. We present a case of 31-year-old female having primary isolated craniosynostosis who survived into adulthood without any surgical intervention. The imaging findings of such a case are rarely described in the literature. PMID:24753669

Isolated primary craniosynostosis in an adult: Imaging findings of a case.

PubMed

Thakur, Shruti; Jhobta, Anupam; Kumar, Suresh; Thakur, Charu Smita

2014-01-01

Craniosynostosis means premature closure of calvarial sutures. It may be primary or secondary. The patient presents with unexplained neuropsychological impairment and radiological imaging clinches the diagnosis. We present a case of 31-year-old female having primary isolated craniosynostosis who survived into adulthood without any surgical intervention. The imaging findings of such a case are rarely described in the literature.

Infectious mononucleosis lymphoadenitis showing histologic findings indistinguishable from toxoplasma lymphadenitis. A report of three cases.

PubMed

Kojima, Masaru; Kashimura, Makoto; Itoh, Hideaki; Noro, Masahiro; Matsuda, Hazuki; Tsukamoto, Norihumi; Akikusa, Bunshiro; Masawa, Nobuhide; Morita, Yukio

2010-06-15

Lymph node lesions in infectious mononucleosis (IM) show a marked histologic diversity. We report here three cases of IM lymphadenitis with histologic findings indistinguishable from those of toxoplasmic lymphadenitis. The histologic findings of the three cases presented here showed a histologic triad of toxoplasmic lymphadenitis, including (i) numerous lymphoid follicles with hyperplastic germinal centers; (ii) small clusters or single epithelioid histiocytes; and (iii) multiple foci of monocytoid B-cells. Moreover, all three lesions contained isolated or small clusters of epithelioid histiocytes within the hyperplastic germinal centers and the periphery of lymphoid follicles, which are the most specific histologic findings of toxoplasmic lymphadenitis. However, serologic findings confirmed EBV infection in all three cases. On in situ hybridization, numerous Epstein-Barr virus (EBV)-encoded small RNA (EBER)-positive cells were demonstrated in the germinal center, as well as in interfollicular areas in all three cases. Toxoplasmosis gondii infection was excluded in at least one case, based on serologic findings. Polymerase chain reaction analysis also demonstrated that there was no T. gondii DNA in the remaining two cases. Two of our three cases showed atypical clinical presentations, including an absence of atypical lymphocytosis in peripheral blood in two cases, age more than 30 years, and an absence of systemic symptoms in one case. It appears that previous descriptions emphasize the differential diagnostic problems between IM lymphadenitis and malignant lymphomas. However, from a therapeutic perspective, it is important to discriminate IM lymphadenitis from toxoplasmic lymphadenitis particularly in patients showing atypical clinical features. 2010 Elsevier GmbH. All rights reserved.

Performance in sports--With specific emphasis on the effect of intensified training.

PubMed

Bangsbo, J

2015-12-01

Performance in most sports is determined by the athlete's technical, tactical, physiological and psychological/social characteristics. In the present article, the physical aspect will be evaluated with a focus on what limits performance, and how training can be conducted to improve performance. Specifically how intensified training, i.e., increasing the amount of aerobic high-intensity and speed endurance training, affects physiological adaptations and performance of trained subjects. Periods of speed endurance training do improve performance in events lasting 30 s-4 min, and when combined with aerobic high-intensity sessions, also performance during longer events. Athletes in team sports involving intense exercise actions and endurance aspects, such as soccer and basketball, can also benefit from intensified training. Speed endurance training does reduce energy expenditure and increase expression of muscle Na(+), K(+) pump α subunits, which may preserve muscle cell excitability and delay fatigue development during intense exercise. When various types of training are conducted in the same period (concurrent training), as done in a number of sports, one type of training may blunt the effect of other types of training. It is not, however, clear how various training modalities are affecting each other, and this issue should be addressed in future studies. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Alkyl gallates, intensifiers of beta-lactam susceptibility in methicillin-resistant Staphylococcus aureus.

PubMed

Shibata, Hirofumi; Kondo, Kyoko; Katsuyama, Ryo; Kawazoe, Kazuyoshi; Sato, Yoichi; Murakami, Kotaro; Takaishi, Yoshihisa; Arakaki, Naokatu; Higuti, Tomihiko

2005-02-01

We found that ethyl gallate purified from a dried pod of tara (Caesalpinia spinosa) intensified beta-lactam susceptibility in methicillin-resistant and methicillin-sensitive strains of Staphylococcus aureus (MRSA and MSSA strains, respectively). This compound and several known alkyl gallates were tested with MRSA and MSSA strains to gain new insights into their structural functions in relation to antimicrobial and beta-lactam susceptibility-intensifying activities. The maximum activity of alkyl gallates against MRSA and MSSA strains occurred at 1-nonyl and 1-decyl gallate, with an MIC at which 90% of the isolates tested were inhibited of 15.6 microg/ml. At concentrations lower than the MIC, alkyl gallates synergistically elevated the susceptibility of MRSA and MSSA strains to beta-lactam antibiotics. Such a synergistic activity of the alkyl gallates appears to be specific for beta-lactam antibiotics, because no significant changes were observed in the MICs of other classes of antibiotics examined in this study. The length of the alkyl chain was also associated with the modifying activity of the alkyl gallates, and the optimum length was C5 to C6. The present work clearly demonstrates that the length of the alkyl chain has a key role in the elevation of susceptibility to beta-lactam antibiotics.

How do Rumination and Social Problem Solving Intensify Depression? A Longitudinal Study.

PubMed

Hasegawa, Akira; Kunisato, Yoshihiko; Morimoto, Hiroshi; Nishimura, Haruki; Matsuda, Yuko

2018-01-01

In order to examine how rumination and social problem solving intensify depression, the present study investigated longitudinal associations among each dimension of rumination and social problem solving and evaluated aspects of these constructs that predicted subsequent depression. A three-wave longitudinal study, with an interval of 4 weeks between waves, was conducted. Japanese university students completed the Beck Depression Inventory-Second Edition, Ruminative Responses Scale, Social Problem-Solving Inventory-Revised Short Version, and Interpersonal Stress Event Scale on three occasions 4 weeks apart ( n  = 284 at Time 1, 198 at Time 2, 165 at Time 3). Linear mixed models were analyzed to test whether each variable predicted subsequent depression, rumination, and each dimension of social problem solving. Rumination and negative problem orientation demonstrated a mutually enhancing relationship. Because these two variables were not associated with interpersonal conflict during the subsequent 4 weeks, rumination and negative problem orientation appear to strengthen each other without environmental change. Rumination and impulsivity/carelessness style were associated with subsequent depressive symptoms, after controlling for the effect of initial depression. Because rumination and impulsivity/carelessness style were not concurrently and longitudinally associated with each other, rumination and impulsive/careless problem solving style appear to be independent processes that serve to intensify depression.

Investigating the Effectiveness of Audio Input Enhancement on EFL Learners' Retention of Intensifiers

ERIC Educational Resources Information Center

Negari, Giti Mousapour; Azizi, Aliye; Arani, Davood Khedmatkar

2018-01-01

The present study attempted to investigate the effects of audio input enhancement on EFL learners' retention of intensifiers. To this end, two research questions were formulated. In order to address these research questions, this study attempted to reject two null hypotheses. Pretest-posttest control group quasi-experimental design was employed to…

Evaluation of the irising effect of a slow-gating intensified charge-coupled device on laser-induced incandescence measurements of soot

NASA Astrophysics Data System (ADS)

Shaddix, Christopher R.; Williams, Timothy C.

2009-03-01

Intensified charge-coupled devices (ICCDs) are used extensively in many scientific and engineering environments to image weak or temporally short optical events. To optimize the quantum efficiency of light collection, many of these devices are chosen to have characteristic intensifier gate times that are relatively slow, on the order of tens of nanoseconds. For many measurements associated with nanosecond laser sources, such as scattering-based diagnostics and most laser-induced fluorescence applications, the signals rise and decay sufficiently fast during and after the laser pulse that the intensifier gate may be set to close after the cessation of the signal and still effectively reject interferences associated with longer time scales. However, the relatively long time scale and complex temporal response of laser-induced incandescence (LII) of nanometer-sized particles (such as soot) offer a difficult challenge to the use of slow-gating ICCDs for quantitative measurements. In this paper, ultraviolet Rayleigh scattering imaging is used to quantify the irising effect of a slow-gating scientific ICCD camera, and an analysis is conducted of LII image data collected with this camera as a function of intensifier gate width. The results demonstrate that relatively prompt LII detection, generally desirable to minimize the influences of particle size and local gas pressure and temperature on measurements of the soot volume fraction, is strongly influenced by the irising effect of slow-gating ICCDs.

Workload, Fatigue and Muscle Damage in an u20 Rugby Union Team Over an Intensified International Tournament.

PubMed

Lacome, Mathieu; Carling, Christopher; Hager, Jean-Philippe; Dine, Gerard; Piscione, Julien

2018-02-12

This study examined the effects of an intensified tournament on workload, perceptual and neuromuscular fatigue and muscle damage responses in an international under-20 rugby union team. Players were subdivided into two groups according to match-play exposure time: high (HEG, n=13) and low (LEG, n=11). Measures monitored over the 19-day period included training session (n=10) and match (n=5) workload determined via global positioning systems and session ratings of perceived exertion (sRPE). Wellbeing scores, countermovement jump height performance (CMJ) and blood creatine kinase [CK]b concentrations were collected at various time points. Analysis of workload cumulated across the tournament entirety for training and match-play combined showed that high-speed running distance was similar between groups while a very likely larger sRPE load was reported in HEG vs. LEG. In HEG high-speed activity fluctuated across the 5 successive matches albeit with no clear trend for a progressive decrease. No clear tendency for a progressive decrease in wellbeing scores prior to or following matches was observed in either group. In HEG trivial to possibly small reductions in post-match CMJ performance were observed while unclear to most likely moderate increases in pre-match [CK]b concentrations occurred until prior to match 4. The magnitude of match-to-match changes in external workload, perceptual and neuromuscular fatigue and muscle damage was generally unclear or small. These results suggest that irrespective of exposure time to match-play players generally maintained performance and readiness to play across the intensified tournament. These findings support the need for holistic systematic player monitoring programmes.

An unusual case of KBG syndrome with unique oral findings

PubMed Central

Hafiz, Abdul; Mufeed, Abdulla; Ismael, Mohamad; Alam, Mheboob

2015-01-01

KBG syndrome is a condition characterised by macrodontia, neurological disturbance, short stature, a distinct cranio-facial appearance, and skeletal anomalies. The authors describe what appears to be the first case of KBG syndrome reported from the Indian subcontinent. Meticulous evaluation of the dental findings helps to identify such cases which may otherwise remain undiagnosed. Further research is warranted to determine the classic and variant presentations of this condition, with follow-up data providing valuable insights into its natural history and long-term prognosis. PMID:26187867

Reemergence of Mycobacterium chimaera in Heater-Cooler Units despite Intensified Cleaning and Disinfection Protocol.

PubMed

Schreiber, Peter W; Kuster, Stefan P; Hasse, Barbara; Bayard, Cornelia; Rüegg, Christian; Kohler, Philipp; Keller, Peter M; Bloemberg, Guido V; Maisano, Francesco; Bettex, Dominique; Halbe, Maximilian; Sommerstein, Rami; Sax, Hugo

2016-10-01

Invasive Mycobacterium chimaera infections after open-heart surgery have been reported internationally. These devastating infections result from aerosols generated by contaminated heater-cooler units used with extracorporeal circulation during surgery. Despite intensified cleaning and disinfection, surveillance samples from factory-new units acquired during 2014 grew nontuberculous mycobacteria after a median of 174 days.

Cheap streak camera based on the LD-S-10 intensifier tube

NASA Astrophysics Data System (ADS)

Dashevsky, Boris E.; Krutik, Mikhail I.; Surovegin, Alexander L.

1992-01-01

Basic properties of a new streak camera and its test results are reported. To intensify images on its screen, we employed modular G1 tubes, the LD-A-1.0 and LD-A-0.33, enabling magnification of 1.0 and 0.33, respectively. If necessary, the LD-A-0.33 tube may be substituted by any other image intensifier of the LDA series, the choice to be determined by the size of the CCD matrix with fiber-optical windows. The reported camera employs a 12.5- mm-long CCD strip consisting of 1024 pixels, each 12 X 500 micrometers in size. Registered radiation was imaged on a 5 X 0.04 mm slit diaphragm tightly connected with the LD-S- 10 fiber-optical input window. Electrons escaping the cathode are accelerated in a 5 kV electric field and focused onto a phosphor screen covering a fiber-optical plate as they travel between deflection plates. Sensitivity of the latter was 18 V/mm, which implies that the total deflecting voltage was 720 V per 40 mm of the screen surface, since reversed-polarity scan pulses +360 V and -360 V were applied across the deflection plate. The streak camera provides full scan times over the screen of 15, 30, 50, 100, 250, and 500 ns. Timing of the electrically or optically driven camera was done using a 10 ns step-controlled-delay (0 - 500 ns) circuit.

Reemergence of Mycobacterium chimaera in Heater–Cooler Units despite Intensified Cleaning and Disinfection Protocol

PubMed Central

Schreiber, Peter W.; Kuster, Stefan P.; Hasse, Barbara; Bayard, Cornelia; Rüegg, Christian; Kohler, Philipp; Keller, Peter M.; Bloemberg, Guido V.; Maisano, Francesco; Bettex, Dominique; Halbe, Maximilian; Sommerstein, Rami

2016-01-01

Invasive Mycobacterium chimaera infections after open-heart surgery have been reported internationally. These devastating infections result from aerosols generated by contaminated heater–cooler units used with extracorporeal circulation during surgery. Despite intensified cleaning and disinfection, surveillance samples from factory-new units acquired during 2014 grew nontuberculous mycobacteria after a median of 174 days. PMID:27649345

An effective framework for finding similar cases of dengue from audio and text data using domain thesaurus and case base reasoning

NASA Astrophysics Data System (ADS)

Sandhu, Rajinder; Kaur, Jaspreet; Thapar, Vivek

2018-02-01

Dengue, also known as break-bone fever, is a tropical disease transmitted by mosquitoes. If the similarity between dengue infected users can be identified, it can help government's health agencies to manage the outbreak more effectively. To find similarity between cases affected by Dengue, user's personal and health information are the two fundamental requirements. Identification of similar symptoms, causes, effects, predictions and treatment procedures, is important. In this paper, an effective framework is proposed which finds similar patients suffering from dengue using keyword aware domain thesaurus and case base reasoning method. This paper focuses on the use of ontology dependent domain thesaurus technique to extract relevant keywords and then build cases with the help of case base reasoning method. Similar cases can be shared with users, nearby hospitals and health organizations to manage the problem more adequately. Two million case bases were generated to test the proposed similarity method. Experimental evaluations of proposed framework resulted in high accuracy and low error rate for finding similar cases of dengue as compared to UPCC and IPCC algorithms. The framework developed in this paper is for dengue but can easily be extended to other domains also.

Comparison of prandial AIR inhaled insulin alone to intensified insulin glargine alone and to AIR insulin plus intensified insulin glargine in patients with type 2 diabetes previously treated with once-daily insulin glargine.

PubMed

Rosenstock, Julio; Eliaschewitz, Freddy G; Heilmann, Cory R; Muchmore, Douglas B; Hayes, Risa P; Belin, Ruth M

2009-09-01

Patients with type 2 diabetes often initiate insulin with once-daily basal insulin. Over time, many patients intensify their insulin regimens in an attempt to attain and sustain glycemic targets. This study compares three intensification approaches: changing insulin glargine to preprandial AIR inhaled insulin (developed by Alkermes, Inc. [Cambridge, MA] and Eli Lilly and Company [Indianapolis, IN]; AIR is a registered trademark of Alkermes, Inc.), intensifying glargine via validated titration algorithms (IG), or adding AIR insulin while intensifying glargine (AIR + IG). Five hundred sixty patients with hemoglobin A(1c) (A1C) of 7.5-10.5%, on one or more antihyperglycemic medications, and on once-daily insulin glargine for > or =4 months were randomly allocated to one of the three treatments lasting 52 weeks. The primary objective assessed between-group differences in A1C mean change from baseline to 24 weeks using last-observation-carried-forward (LOCF) in the intent-to-treat population. At 24 weeks, A1C was reduced from a mean baseline of 8.5% to 7.7%, 7.9%, and 7.5% for the AIR, IG, and AIR + IG groups, respectively. AIR produced 0.20% greater A1C decrease than IG (least-squares mean difference = -0.20%; 95% confidence interval [CI], -0.39, -0.02). AIR + IG had a 0.35% greater A1C decrease versus IG (95% CI, -0.57, -0.13). The -0.15% difference between AIR + IG versus AIR was not significant (P < 0.198). More hypoglycemia categorized as severe occurred with AIR alone versus IG alone at LOCF end points. More nocturnal hypoglycemia occurred with IG alone versus AIR alone and AIR + IG. Preprandial inhaled insulin provides an alternative for patients not optimized on insulin glargine alone. Glycemic control, hypoglycemic risk, delivery preference, and regimen complexity must be considered when selecting insulin initiation and optimization regimens.

Effect of process intensifying parameters on the hydrodynamic cavitation based degradation of commercial pesticide (methomyl) in the aqueous solution.

PubMed

Raut-Jadhav, Sunita; Saini, Daulat; Sonawane, Shirish; Pandit, Aniruddha

2016-01-01

Methomyl, a carbamate pesticide, is classified as a pesticide of category-1 toxicity and hence shows harmful effects on both human and aquatic life. In the present work, the degradation of methomyl has been studied by using hydrodynamic cavitation reactor (HC) and its combination with intensifying agents such as H2O2, fenton reagent and ozone (hybrid processes). Initially, the optimization of operating parameters such pH and inlet pressure to the cavitating device (circular venturi) has been carried out for maximizing the efficacy of hydrodynamic cavitation. Further degradation study of methomyl by the application of hybrid processes was carried out at an optimal pH of 2.5 and the optimal inlet pressure of 5 bar. Significant synergetic effect has been observed in case of all the hybrid processes studied. Synergetic coefficient of 5.8, 13.41 and 47.6 has been obtained by combining hydrodynamic cavitation with H2O2, fenton process and ozone respectively. Efficacy of individual and hybrid processes has also been obtained in terms of energy efficiency and extent of mineralization. HC+Ozone process has proved to be the most effective process having highest synergetic coefficient, energy efficiency and the extent of mineralization. The study has also encompassed the identification of intermediate by-products generated during the degradation and has proposed the probable degradation pathway. It has been conclusively established that hydrodynamic cavitation in the presence of intensifying agents can effectively be used for complete degradation of methomyl. Copyright © 2015 Elsevier B.V. All rights reserved.

Intensified Vegetation Water Use due to Soil Calcium Leaching under Acid Deposition

NASA Astrophysics Data System (ADS)

Lanning, M.; Wang, L.; Scanlon, T. M.; Vadeboncoeur, M. A.; Adams, M. B.; Epstein, H. E.; Druckenbrod, D.

2017-12-01

Despite the important role vegetation plays in the global water cycle, the exact controls of vegetation water use, especially the role of soil biogeochemistry, remain elusive. Nitrate and sulfate deposition from fossil fuel burning has caused significant soil acidification, leading to the leaching of soil base cations. From a physiological perspective, plants require various soil cations as signaling and regulatory ions as well as integral parts of structural molecules; a depletion of soil cations can cause reduced productivity and abnormal responses to environmental change. A deficiency in calcium could also potentially prolong stomatal opening, leading to increased transpiration until enough calcium had been acquired to stimulate stomatal closure. Based on the plant physiology and the nature of acidic deposition, we hypothesize that depletion of the soil calcium supply, induced by acid deposition, would intensify vegetation water use at the watershed scale. We tested this hypothesis by analyzing a long-term and unique data set (1989-2012) of soil lysimeter data along with stream flow and evapotranspiration data at the Fernow Experimental Forest. We show that depletion of soil calcium by acid deposition can intensify vegetation water use ( 10% increase in evapotranspiration and depletion in soil water) for the first time. These results are critical to understanding future water availability, biogeochemical cycles, and surficial energy flux and may help reduce uncertainties in terrestrial biosphere models.

Intensified Voice Therapy: A New Model for the Rehabilitation of Patients Suffering from Functional Dysphonias

ERIC Educational Resources Information Center

Fischer, Michael J.; Gutenbrunner, Christoph; Ptok, Martin

2009-01-01

The objective of this study was to evaluate a new intervention for chronic dysphonias, consisting of a 2-week outpatient treatment period using intensified voice therapy combined with elements of physical medicine, including physiotherapy (orthotherapy, detonisation and training of the trunk muscles, respiratory therapy and others), manual therapy…

Intensified Sampling in Response to a Salmonella Heidelberg Outbreak Associated with Multiple Establishments Within a Single Poultry Corporation

PubMed Central

Defibaugh-Chavez, Stephanie; Douris, Aphrodite; Vetter, Danah; Atkinson, Richard; Kissler, Bonnie; Khroustalev, Allison; Robertson, Kis; Sharma, Yudhbir; Becker, Karen; Dessai, Uday; Antoine, Nisha; Allen, Latasha; Holt, Kristin; Gieraltowski, Laura; Wise, Matthew; Schwensohn, Colin

2018-01-01

Abstract On June 28, 2013, the Food Safety and Inspection Service (FSIS) was notified by the Centers for Disease Control and Prevention (CDC) of an investigation of a multistate cluster of illnesses of Salmonella enterica serovar Heidelberg. Since case-patients in the cluster reported consumption of a variety of chicken products, FSIS used a simple likelihood-based approach using traceback information to focus on intensified sampling efforts. This article describes the multiphased product sampling approach taken by FSIS when epidemiologic evidence implicated chicken products from multiple establishments operating under one corporation. The objectives of sampling were to (1) assess process control of chicken slaughter and further processing and (2) determine whether outbreak strains were present in products from these implicated establishments. As part of the sample collection process, data collected by FSIS personnel to characterize product included category (whole chicken and type of chicken parts), brand, organic or conventional product, injection with salt solutions or flavorings, and whether product was skinless or skin-on. From the period September 9, 2013, through October 31, 2014, 3164 samples were taken as part of this effort. Salmonella percent positive declined from 19.7% to 5.3% during this timeframe as a result of regulatory and company efforts. The results of intensified sampling for this outbreak investigation informed an FSIS regulatory response and corrective actions taken by the implicated establishments. The company noted that a multihurdle approach to reduce Salmonella in products was taken, including on-farm efforts such as environmental testing, depopulation of affected flocks, disinfection of affected houses, vaccination, and use of various interventions within the establishments over the course of several months. PMID:29638165

The role of oxidative, inflammatory and neuroendocrinological systems during exercise stress in athletes: implications of antioxidant supplementation on physiological adaptation during intensified physical training.

PubMed

Slattery, Katie; Bentley, David; Coutts, Aaron J

2015-04-01

During periods of intensified physical training, reactive oxygen species (ROS) release may exceed the protective capacity of the antioxidant system and lead to dysregulation within the inflammatory and neuroendocrinological systems. Consequently, the efficacy of exogenous antioxidant supplementation to maintain the oxidative balance in states of exercise stress has been widely investigated. The aim of this review was to (1) collate the findings of prior research on the effect of intensive physical training on oxidant-antioxidant balance; (2) summarise the influence of antioxidant supplementation on the reduction-oxidation signalling pathways involved in physiological adaptation; and (3) provide a synopsis on the interactions between the oxidative, inflammatory and neuroendocrinological response to exercise stimuli. Based on prior research, it is evident that ROS are an underlying aetiology in the adaptive process; however, the impact of antioxidant supplementation on physiological adaptation remains unclear. Equivocal results have been reported on the impact of antioxidant supplementation on exercise-induced gene expression. Further research is required to establish whether the interference of antioxidant supplementation consistently observed in animal-based and in vivo research extends to a practical sports setting. Moreover, the varied results reported within the literature may be due to the hormetic response of oxidative, inflammatory and neuroendocrinological systems to an exercise stimulus. The collective findings suggest that intensified physical training places substantial stress on the body, which can manifest as an adaptive or maladaptive physiological response. Additional research is required to determine the efficacy of antioxidant supplementation to minimise exercise-stress during intensive training and promote an adaptive state.

Risk of adverse effects of intensified treatment in insulin-dependent diabetes mellitus: a meta-analysis.

PubMed

Egger, M; Davey Smith, G; Stettler, C; Diem, P

1997-11-01

While the benefits of intensified insulin treatment in insulin-dependent (Type 1) diabetes mellitus (IDDM) are well recognized, the risks have not been comprehensively characterized. We examined the risk of severe hypoglycaemia, ketoacidosis, and death in a meta-analysis of randomized controlled trials. The MEDLINE database, reference lists, and specialist journals were searched electronically or by hand to identify relevant studies with at least 6 months of follow-up and the monitoring of glycaemia by glycosylated haemoglobin measurements. Logistic regression was used for calculation of combined odds ratios and 95% confidence intervals (95% CI). The influence of covariates was examined by including covariate-by-treatment interaction terms. Methodological study quality was assessed and sensitivity analyses were performed. Fourteen trials were identified. These contributed 16 comparisons with 1028 patients allocated to intensified and 1039 allocated to conventional treatment. A total of 846 patients suffered at least one episode of severe hypoglycaemia, 175 patients experienced ketoacidosis and 26 patients died. The combined odds ratio (95% CI) for hypoglycaemia was 2.99 (2.45-3.64), for ketoacidosis 1.74 (1.27-2.38) and for death from all causes 1.40 (0.65-3.01). The risk of severe hypoglycaemia was determined by the degree of normalization of glycaemia achieved (p=0.005 for interaction term), with the results from the Diabetes Control and Complications Trial (DCCT) in line with the other trials. Ketoacidosis risk depended on the type of intensified treatment used. Odds ratios (95% CI) were 7.20 (2.95-17.58) for exclusive use of pumps, 1.13 (0.15-8.35) for multiple daily injections and 1.28 (0.90-1.83) for trials offering a choice between the two (p = 0.004 for interaction). Mortality was significantly (p = 0.007) increased for causes potentially associated with acute complications (7 vs 0 deaths, 5 deaths attributed to ketoacidosis, and 2 sudden deaths), and non

Intensifying weathering and land use in Iron Age Central Africa.

PubMed

Bayon, Germain; Dennielou, Bernard; Etoubleau, Joël; Ponzevera, Emmanuel; Toucanne, Samuel; Bermell, Sylvain

2012-03-09

About 3000 years ago, a major vegetation change occurred in Central Africa, when rainforest trees were abruptly replaced by savannas. Up to this point, the consensus of the scientific community has been that the forest disturbance was caused by climate change. We show here that chemical weathering in Central Africa, reconstructed from geochemical analyses of a marine sediment core, intensified abruptly at the same period, departing substantially from the long-term weathering fluctuations related to the Late Quaternary climate. Evidence that this weathering event was also contemporaneous with the migration of Bantu-speaking farmers across Central Africa suggests that human land-use intensification at that time had already made a major impact on the rainforest.

5 CFR 890.1037 - Cases where additional fact-finding is not required.

Code of Federal Regulations, 2010 CFR

2010-01-01

... (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Suspension § 890.1037 Cases where additional fact-finding is...

Optical diagnostics of the arc plasma using fast intensified CCD-spectrograph system

NASA Astrophysics Data System (ADS)

Pavelescu, Gabriela; Guillot, Stephane; Braic, Mariana T.; Hong, Dunpin; Pavelescu, D.; Fleurier, Claude; Braic, Viorel; Gherendi, F.; Dumitrescu, G.; Anghelita, P.; Bauchire, J. M.

2004-10-01

Spectroscopic diagnostics, using intensified high speed CCD camera, was applied to study the arc dynamics in low voltage circuit breakers, in vacuum and in air. Time-resolved emission spectroscopy of the vacuum arc plasma, generated during electrode separation, provided information about the interruption process. The investigations were focused on the partial unsuccessful interruption around current zero. Absorption spectroscopy, in a peculiar setup, was used in order to determine the metallic atoms densities in the interelectrode space of a low voltage circuit breaker, working in ambient air.

High Speed Intensified Video Observations of TLEs in Support of PhOCAL

NASA Technical Reports Server (NTRS)

Lyons, Walter A.; Nelson, Thomas E.; Cummer, Steven A.; Lang, Timothy; Miller, Steven; Beavis, Nick; Yue, Jia; Samaras, Tim; Warner, Tom A.

2013-01-01

The third observing season of PhOCAL (Physical Origins of Coupling to the upper Atmosphere by Lightning) was conducted over the U.S. High Plains during the late spring and summer of 2013. The goal was to capture using an intensified high-speed camera, a transient luminous event (TLE), especially a sprite, as well as its parent cloud-to-ground (SP+CG) lightning discharge, preferably within the domain of a 3-D lightning mapping array (LMA). The co-capture of sprite and its SP+CG was achieved within useful range of an interferometer operating near Rapid City. Other high-speed sprite video sequences were captured above the West Texas LMA. On several occasions the large mesoscale convective complexes (MCSs) producing the TLE-class lightning were also generating vertically propagating convectively generated gravity waves (CGGWs) at the mesopause which were easily visible using NIR-sensitive color cameras. These were captured concurrent with sprites. These observations were follow-ons to a case on 15 April 2012 in which CGGWs were also imaged by the new Day/Night Band on the Suomi NPP satellite system. The relationship between the CGGW and sprite initiation are being investigated. The past year was notable for a large number of elve+halo+sprite sequences sequences generated by the same parent CG. And on several occasions there appear to be prominent banded modulations of the elves' luminosity imaged at >3000 ips. These stripes appear coincident with the banded CGGW structure, and presumably its density variations. Several elves and a sprite from negative CGs were also noted. New color imaging systems have been tested and found capable of capturing sprites. Two cases of sprites with an aurora as a backdrop were also recorded. High speed imaging was also provided in support of the UPLIGHTS program near Rapid City, SD and the USAFA SPRITES II airborne campaign over the Great Plains.

Intensified summer monsoon and the urbanization of Indus Civilization in northwest India.

PubMed

Dixit, Yama; Hodell, David A; Giesche, Alena; Tandon, Sampat K; Gázquez, Fernando; Saini, Hari S; Skinner, Luke C; Mujtaba, Syed A I; Pawar, Vikas; Singh, Ravindra N; Petrie, Cameron A

2018-03-09

Today the desert margins of northwest India are dry and unable to support large populations, but were densely occupied by the populations of the Indus Civilization during the middle to late Holocene. The hydroclimatic conditions under which Indus urbanization took place, which was marked by a period of expanded settlement into the Thar Desert margins, remains poorly understood. We measured the isotopic values (δ 18 O and δD) of gypsum hydration water in paleolake Karsandi sediments in northern Rajasthan to infer past changes in lake hydrology, which is sensitive to changing amounts of precipitation and evaporation. Our record reveals that relatively wet conditions prevailed at the northern edge of Rajasthan from ~5.1 ± 0.2 ka BP, during the beginning of the agricultural-based Early Harappan phase of the Indus Civilization. Monsoon rainfall intensified further between 5.0 and 4.4 ka BP, during the period when Indus urban centres developed in the western Thar Desert margin and on the plains of Haryana to its north. Drier conditions set in sometime after 4.4 ka BP, and by ~3.9 ka BP an eastward shift of populations had occurred. Our findings provide evidence that climate change was associated with both the expansion and contraction of Indus urbanism along the desert margin in northwest India.

Dispersal limitation drives successional pathways in Central Siberian forests under current and intensified fire regimes.

PubMed

Tautenhahn, Susanne; Lichstein, Jeremy W; Jung, Martin; Kattge, Jens; Bohlman, Stephanie A; Heilmeier, Hermann; Prokushkin, Anatoly; Kahl, Anja; Wirth, Christian

2016-06-01

Fire is a primary driver of boreal forest dynamics. Intensifying fire regimes due to climate change may cause a shift in boreal forest composition toward reduced dominance of conifers and greater abundance of deciduous hardwoods, with potential biogeochemical and biophysical feedbacks to regional and global climate. This shift has already been observed in some North American boreal forests and has been attributed to changes in site conditions. However, it is unknown if the mechanisms controlling fire-induced changes in deciduous hardwood cover are similar among different boreal forests, which differ in the ecological traits of the dominant tree species. To better understand the consequences of intensifying fire regimes in boreal forests, we studied postfire regeneration in five burns in the Central Siberian dark taiga, a vast but poorly studied boreal region. We combined field measurements, dendrochronological analysis, and seed-source maps derived from high-resolution satellite images to quantify the importance of site conditions (e.g., organic layer depth) vs. seed availability in shaping postfire regeneration. We show that dispersal limitation of evergreen conifers was the main factor determining postfire regeneration composition and density. Site conditions had significant but weaker effects. We used information on postfire regeneration to develop a classification scheme for successional pathways, representing the dominance of deciduous hardwoods vs. evergreen conifers at different successional stages. We estimated the spatial distribution of different successional pathways under alternative fire regime scenarios. Under intensified fire regimes, dispersal limitation of evergreen conifers is predicted to become more severe, primarily due to reduced abundance of surviving seed sources within burned areas. Increased dispersal limitation of evergreen conifers, in turn, is predicted to increase the prevalence of successional pathways dominated by deciduous hardwoods

Perinatal Autopsy Findings in a Case of De Novo Hypohidrotic Ectodermal Dysplasia.

PubMed

Chikkannaiah, Panduranga; Nagaraju, Smitha; Kangle, Rajit; Gosavi, Mansi

2015-01-01

Ectodermal dysplasia are group of inherited disorders involving the developmental defects of ectodermal structures like hair, teeth, nails, sweat glands, and others. X-linked recessive inheritance is most common. Here we describe perinatal autopsy findings in a case of de novo ectodermal dysplasia in a female fetus. To the best of our knowledge, this is the first fetal autopsy description in a case of ectodermal dysplasia.

Megadroughts and Intensified Terrestrial Flooding - Underrated Consequences of Early Eocene Hyperthermals?

NASA Astrophysics Data System (ADS)

Plink-Bjorklund, P.; Birgenheier, L.; Golab, J.

2011-12-01

Here we present results of independent multi-proxy analyses of an Early Eocene sedimentary succession from the interior of the US, combining detailed sedimentologic and stratigraphic analyses with ichno-pedogenic analyses and stable carbon isotope analyses through 1000 m of river and lake deposits, across an area of ca 600 km2 in the Uinta Basin, Utah. This Early Eocene Climatic Optimum (ca 55.5-51.4 Myr ago) dataset is different from previously published terrestrial climate proxy analyses, in that we document the Palaeocene Eocene Thermal Maximum (PETM) as well as 6-8 post-PETM transient global warming events or hyperthermals by δ13Corg excursions, as well as river systems response to these events from the sedimentary record. Moreover, our dataset indicates that palaeosols and isotope values may in some cases only capture the long-term conditions, and are not able to reproduce the seasonality. We show that there are 6-8 Early Eocene hyperthermals that are climatically prominent enough to cause significant changes in the climate processes, as well as generate significant consequences to the river systems behaviour, recorded in the geological record. We show that in the continental interior of North America each of the Early Eocene transient global warming events or hyperthermals includes an onset period that reflects increased temperatures, weathering and sediment production, while the peaks of the hyperthermals indicate a shift to significantly intensified hydrological cycle with extreme conditions of prolonged megadroughts and short catastrophic terrestrial flooding episodes, followed by a recovery period. We demonstrate that only the PETM event exhibits a non-linear response to global warming, in that the system responded by alternations between increasing and decreasing seasonality during onset and offset, and has two distinct episodes of peak conditions. The PETM, and the H1, H2, I1, I2 events are distinct in both sedimentary and isotope record, whereas the

[Results of a multidisciplinary and intensified treatment program for type 1 Diabetes Mellitus in a Chilean Public Hospital].

PubMed

Codner, Ethel; Mericq, Verónica; García, Hernán; López, Claudia; Cáceres, Jeannette; Gaete, Ximena; Avila, Alejandra

2003-08-01

During the last decade, the importance of glycemic control in the prevention of the microvascular complications of type 1 Diabetes Mellitus (DM1) was clearly demonstrated. To evaluate the metabolic and anthropometric results of a multidisciplinary intensified treatment program of DMI in children and adolescents. Report of 54 patients treated during 2001. The intensified treatment consisted of: multiple daily doses of insulin, frequent glycemic control, nutritional, psychological and educational support, and permanent availability of a diabetes nurse for telephonic support. Thirty one patients were female, their mean age was 10.4 +/- 0.5 years old and 52% were experiencing puberty. Fifty three percent of the patients used 3 insulin doses per day, 95% changed rapid insulin dose based on glucose levels and 18% considered carbohydrates in their rapid insulin dosing. Mean glycosilated hemoglobin was 8.18 +/- 0.23% without differences by sex or pubertal status. Sex, pubertal stage and the number of insulin doses did not contribute to glycosilated hemoglobin changes. There were no differences in weight or BMI, but there was a decrease in height Z score from the admission to the program until the last control (0.1 +/- 0.1 vs--0.3 +/- 0.1 DS; p < 0.01). A modified intensified modality of DM1 therapy for pediatric patients in a public hospital in Chile is feasible, achieving similar metabolic control, compared to international large centers.

Kissing nevus of the penis: a case report and dermatoscopic findings*

PubMed Central

Godinho, Nivea; Nai, Gisele Alborghetti; Schaefer, Arnaldo Luiz Flávio; Schaefer, Luiza Vasconcelos

2017-01-01

Divided nevus, also known as kissing nevus, is a rare variant of congenital melanocytic nevi in which there are two adjacent nevi in areas of the body that undergo embryonic cleavage. The original description of this type of lesion was on the eyelid. The location on the penis is even rarer, with only 17 case reports in the literature so far, and only one of them described the dermoscopic findings. We report the case of a patient with divided nevus of the penis and its clinical, dermoscopic and histopathological features. PMID:29267459

Has the DOTS Strategy Improved Case Finding or Treatment Success? An Empirical Assessment

PubMed Central

Obermeyer, Ziad; Abbott-Klafter, Jesse; Murray, Christopher J. L.

2008-01-01

Background Nearly fifteen years after the start of WHO's DOTS strategy, tuberculosis remains a major global health problem. Given the lack of empirical evidence that DOTS reduces tuberculosis burden, considerable debate has arisen about its place in the future of global tuberculosis control efforts. An independent evaluation of DOTS, one of the most widely-implemented and longest-running interventions in global health, is a prerequisite for meaningful improvements to tuberculosis control efforts, including WHO's new Stop TB Strategy. We investigate the impact of the expansion of the DOTS strategy on tuberculosis case finding and treatment success, using only empirical data. Methods and Findings We study the effect of DOTS using time-series cross-sectional methods. We first estimate the impact of DOTS expansion on case detection, using reported case notification data and controlling for other determinants of change in notifications, including HIV prevalence, GDP, and country-specific effects. We then estimate the effect of DOTS expansion on treatment success. DOTS programme variables had no statistically significant impact on case detection in a wide range of models and specifications. DOTS population coverage had a significant effect on overall treatment success rates, such that countries with full DOTS coverage benefit from at least an 18% increase in treatment success (95% CI: 5–31%). Conclusions The DOTS technical package improved overall treatment success. By contrast, DOTS expansion had no effect on case detection. This finding is less optimistic than previous analyses. Better epidemiological and programme data would facilitate future monitoring and evaluation efforts. PMID:18320042

Position and time resolution measurements with a microchannel plate image intensifier: A comparison of monolithic and pixelated CeBr3 scintillators

NASA Astrophysics Data System (ADS)

Ackermann, Ulrich; Eschbaumer, Stephan; Bergmaier, Andreas; Egger, Werner; Sperr, Peter; Greubel, Christoph; Löwe, Benjamin; Schotanus, Paul; Dollinger, Günther

2016-07-01

To perform Four Dimensional Age Momentum Correlation measurements in the near future, where one obtains the positron lifetime in coincidence with the three dimensional momentum of the electron annihilating with the positron, we have investigated the time and position resolution of two CeBr3 scintillators (monolithic and an array of pixels) using a Photek IPD340/Q/BI/RS microchannel plate image intensifier. The microchannel plate image intensifier has an active diameter of 40 mm and a stack of two microchannel plates in chevron configuration. The monolithic CeBr3 scintillator was cylindrically shaped with a diameter of 40 mm and a height of 5 mm. The pixelated scintillator array covered the whole active area of the microchannel plate image intensifier and the shape of each pixel was 2.5·2.5·8 mm3 with a pixel pitch of 3.3 mm. For the monolithic setup the measured mean single time resolution was 330 ps (FWHM) at a gamma energy of 511 keV. No significant dependence on the position was detected. The position resolution at the center of the monolithic scintillator was about 2.5 mm (FWHM) at a gamma energy of 662 keV. The single time resolution of the pixelated crystal setup reached 320 ps (FWHM) in the region of the center of the active area of the microchannel plate image intensifier. The position resolution was limited by the cross-section of the pixels. The gamma energy for the pixel setup measurements was 511 keV.

A Transdisciplinary Approach to Training: Preliminary Research Findings Based on a Case Analysis

ERIC Educational Resources Information Center

Bimpitsos, Christos; Petridou, Eugenia

2012-01-01

Purpose: The purpose of this paper is to discuss the benefits, barriers and challenges of the transdisciplinary approach to training, and to present findings of a case analysis. Design/methodology/approach: The paper is based on the research findings of an experimental training program for Greek local government managers co-funded by the European…

AAPM/RSNA physics tutorial for residents: physics of flat-panel fluoroscopy systems: Survey of modern fluoroscopy imaging: flat-panel detectors versus image intensifiers and more.

PubMed

Nickoloff, Edward Lee

2011-01-01

This article reviews the design and operation of both flat-panel detector (FPD) and image intensifier fluoroscopy systems. The different components of each imaging chain and their functions are explained and compared. FPD systems have multiple advantages such as a smaller size, extended dynamic range, no spatial distortion, and greater stability. However, FPD systems typically have the same spatial resolution for all fields of view (FOVs) and are prone to ghosting. Image intensifier systems have better spatial resolution with the use of smaller FOVs (magnification modes) and tend to be less expensive. However, the spatial resolution of image intensifier systems is limited by the television system to which they are coupled. Moreover, image intensifier systems are degraded by glare, vignetting, spatial distortions, and defocusing effects. FPD systems do not have these problems. Some recent innovations to fluoroscopy systems include automated filtration, pulsed fluoroscopy, automatic positioning, dose-area product meters, and improved automatic dose rate control programs. Operator-selectable features may affect both the patient radiation dose and image quality; these selectable features include dose level setting, the FOV employed, fluoroscopic pulse rates, geometric factors, display software settings, and methods to reduce the imaging time. © RSNA, 2011.

Design and analysis of a flux intensifying permanent magnet embedded salient pole wind generator

NASA Astrophysics Data System (ADS)

Guo, Yujing; Jin, Ping; Lin, Heyun; Yang, Hui; Lyu, Shukang

2018-05-01

This paper presents an improved flux intensifying permanent magnet embedded salient pole wind generator (FI-PMESPWG) with mirror symmetrical magnetizing directions permanent magnet (PM) for improving generator's performances. The air-gap flux densities, the output voltage, the cogging torque and the d- and q-axis inductances of FI-PMESPWG are all calculated and analyzed by using the finite element method (FEM). To highlight the advantages of the proposed FI-PMESPWG, an original permanent magnet embedded salient pole wind generator (PMESPWG) model is adopted for comparison under the same operating conditions. The calculating results show that the air-gap flux densities of FI-PMESPWG are intensified with the same magnet amounts because the PMs are set in a form of V shape in each pole. The difference between d-axis inductance and q-axis inductance of the proposed FI-PMESPWG is reduced. Thus, the output power of the proposed FI-PMESPWG reaches a higher value than that of the original PMESPWG at the same current phase angle. The cogging torque is diminished because the flux path is changed. All the analysis results indicate that the electromagnetic characteristics of the proposed FI-PMESPWG are significantly better than that of the original PMESPWG.

Advances in Gamma-Ray Imaging with Intensified Quantum-Imaging Detectors

NASA Astrophysics Data System (ADS)

Han, Ling

Nuclear medicine, an important branch of modern medical imaging, is an essential tool for both diagnosis and treatment of disease. As the fundamental element of nuclear medicine imaging, the gamma camera is able to detect gamma-ray photons emitted by radiotracers injected into a patient and form an image of the radiotracer distribution, reflecting biological functions of organs or tissues. Recently, an intensified CCD/CMOS-based quantum detector, called iQID, was developed in the Center for Gamma-Ray Imaging. Originally designed as a novel type of gamma camera, iQID demonstrated ultra-high spatial resolution (< 100 micron) and many other advantages over traditional gamma cameras. This work focuses on advancing this conceptually-proven gamma-ray imaging technology to make it ready for both preclinical and clinical applications. To start with, a Monte Carlo simulation of the key light-intensification device, i.e. the image intensifier, was developed, which revealed the dominating factor(s) that limit energy resolution performance of the iQID cameras. For preclinical imaging applications, a previously-developed iQID-based single-photon-emission computed-tomography (SPECT) system, called FastSPECT III, was fully advanced in terms of data acquisition software, system sensitivity and effective FOV by developing and adopting a new photon-counting algorithm, thicker columnar scintillation detectors, and system calibration method. Originally designed for mouse brain imaging, the system is now able to provide full-body mouse imaging with sub-350-micron spatial resolution. To further advance the iQID technology to include clinical imaging applications, a novel large-area iQID gamma camera, called LA-iQID, was developed from concept to prototype. Sub-mm system resolution in an effective FOV of 188 mm x 188 mm has been achieved. The camera architecture, system components, design and integration, data acquisition, camera calibration, and performance evaluation are presented in

Nursing home case mix in Wisconsin. Findings and policy implications.

PubMed

Arling, G; Zimmerman, D; Updike, L

1989-02-01

Along with many other states, Wisconsin is considering a case mix approach to Medicaid nursing home reimbursement. To support this effort, a nursing home case mix model was developed from a representative sample of 410 Medicaid nursing home residents from 56 facilities in Wisconsin. The model classified residents into mutually exclusive groups that were homogeneous in their use of direct care resources, i.e., minutes of direct care time (weighted for nurse skill level) over a 7-day period. Groups were defined initially by intense, Special, or Routine nursing requirements. Within these nursing requirement categories, subgroups were formed by the presence/absence of behavioral problems and dependency in activities of daily living (ADL). Wisconsin's current Skilled/Intermediate Care (SNF/ICF) classification system was analyzed in light of the case mix model and found to be less effective in distinguishing residents by resource use. The case mix model accounted for 48% of the variance in resource use, whereas the SNF/ICF classification system explained 22%. Comparisons were drawn with nursing home case mix models in New York State (RUG-II) and Minnesota. Despite progress in the study of nursing home case mix and its application to reimbursement reform, methodologic and policy issues remain. These include the differing operational definitions for nursing requirements and ADL dependency, the inconsistency in findings concerning psychobehavioral problems, and the problem of promoting positive health and functional outcomes based on models that may be insensitive to change in resident conditions over time.

Low temperature multi-alkali photocathode processing technique for sealed intensified CCD tubes

NASA Technical Reports Server (NTRS)

Doliber, D. L.; Dozier, E. E.; Wenzel, H.; Beaver, E. A.; Hier, R. G.

1989-01-01

A low temperature photocathode process has been used to fabricate an intensified CCD visual photocathode image tube, by incorporating a thinned, backside-illumined CCD as the target anode of a digicon tube of Hubble Space Telescope (HST) design. The CCD digicon tube employs the HST's sodium bialkali photocathode and MgF2 substrate, thereby allowing a direct photocathode quantum efficiency comparison between photocathodes produced by the presently employed low temperature process and those of the conventional high temperature process. Attention is given to the processing chamber used, as well as the details of gas desorption and photocathode processing.

Use of a night vision intensifier for direct visualization by eye of far-red and near-infrared fluorescence through an optical microscope.

PubMed

Siddiqi, M A; Kilduff, G M; Gearhart, J D

2003-11-01

We describe the design, construction and testing of a prototype device that allows the direct visualization by eye of far-red and near-infrared (NIR) fluorescence through an optical microscope. The device incorporates a gallium arsenide (GaAs) image intensifier, typically utilized in low-light or 'night vision' applications. The intensifier converts far-red and NIR light into electrons and then into green light, which is visible to the human eye. The prototype makes possible the direct, real-time viewing by eye of normally invisible far-red and NIR fluorescence from a wide variety of fluorophores, using the full field of view of the microscope to which it is applied. The high sensitivity of the image intensifier facilitates the viewing of a wide variety of photosensitive specimens, including live cells and embryos, at vastly reduced illumination levels in both fluorescence and bright-field microscopy. Modifications to the microscope are not required in order to use the prototype, which is fully compatible with all current fluorescence techniques. Refined versions of the prototype device will have broad research and clinical applications.

Early 20th Century Arctic Warming Intensified by Pacific and Atlantic Multidecadal Variability

NASA Astrophysics Data System (ADS)

Tokinaga, H.; Xie, S. P.; Mukougawa, H.

2017-12-01

We investigate the influence of Pacific and Atlantic multidecadal variability on the Arctic temperature, with a particular focus on the early 20th century Arctic warming. Arctic surface air temperature increased rapidly over the early 20th century, at rates comparable to those of recent decades despite much weaker greenhouse gas forcing than at present. We find that the concurrent phase shift of Pacific and Atlantic multidecadal variability is the major driver for the early 20th century Arctic warming. Atmospheric model simulations reproduce the early Arctic warming when the interdecadal variability of sea surface temperature (SST) is properly prescribed. The early Arctic warming is associated with the cold-to-warm phase shifts of Atlantic and Pacific multidecadal variability modes, a SST pattern reminiscent of the positive phase of the Pacific decadal and Atlantic multidecadal oscillations. The extratropical North Atlantic and North Pacific SST warming strengthens surface westerly winds over northern Eurasia, intensifying the warming there. The equatorial Pacific warming deepens the Aleutian low, advecting warm air to the North American Arctic. Coupled ocean-atmosphere simulations support the constructive intensification of Arctic warming by a concurrent, cold-to-warm phase shift of the Pacific and Atlantic multidecadal variability. Our results aid attributing the historical Arctic warming and thereby constrain the amplified warming projected for this important region.

Review of systems, physical examination, and routine tests for case-finding in ambulatory patients.

PubMed

Boland, B J; Wollan, P C; Silverstein, M D

1995-04-01

The screening value of the comprehensive review of systems and the complete physical examination in detecting unsuspected diseases for which therapeutic interventions are initiated has not been formally studied in ambulatory patients. The medical records of 100 randomly selected adult patients who had an ambulatory general medical evaluation at the Mayo Clinic in 1990-1991 were surveyed to compare review of systems and physical examination with routine laboratory tests, chest radiography, and electrocardiography as case-finding maneuvers. The main outcome measure was the therapeutic yield of each case-finding maneuver, defined as the proportion of maneuvers leading to a new therapy for a new clinically important diagnosis. The utilization rate of routine tests in the 100 patients (mean age: 59 +/- 16 years; 58% women) was high, ranging from 77 to 98%. Overall, the case-finding maneuvers led to 36 unsuspected clinically important diagnoses and resulted in 25 new therapeutic interventions. Higher therapeutic yield was observed for review of systems (7%), physical examination (5%), and lipid screening (9.2%) than for chemistry group (2.2%), complete blood count (1.8%), thyroid tests (1.5%), urinalysis (1.1%), electrocardiography (0%), or chest radiography (0%). The number of therapeutic interventions was not associated with patient's age (P = 0.55), sex (P = 0.88), comorbidity (P = 0.30) or with the time interval since the last general medical evaluation (P = 0.12). Based on therapeutic yield, these data suggest that review of systems and physical examination are valuable case-finding maneuvers in the periodic medical evaluation of ambulatory patients.

Is climate change intensifying the drying-trend in the Caribbean?

NASA Astrophysics Data System (ADS)

Herrera, D. A.; Ault, T.; Fasullo, J.; Carrillo, C. M.

2017-12-01

Since 1950, the Caribbean (11ºN-25ºN; 85ºW-60ºW) has seen a significant drying trend characterized by several recent droughts, some of them contemporaneous with El Niño events. Moreover, the most recent drought from 2013 to 2016 was both the most severe and widespread event since at least 1950, and was associated with high temperatures, likely driven in part by climate change. This work examines the role of increased evaporative demand resulting from warmer temperatures on the drying trend observed in the Caribbean since 1950, using observations and model simulations. Large-scale dynamics associated with drought are also analyzed using sea surface temperature, geopotential height, wind, and precipitation anomalies, as well as radiative fluxes anomalies. Furthermore, land surface model soil moisture and high-resolution self-calibrated Palmer Drought Severity Index (scPDSI) datasets are used to quantify drought severity at local scales. The anthropogenic contribution to drought severity is estimated as the difference between the scPDSI calculated using linearly-detrended temperatures, and the scPDSI computed with the observed trend, with unadjusted precipitation, net radiation, and wind speed. Soil moisture anomalies driven by climate change are derived by comparing a large ensemble of forced simulations against a pre-industrial control. The resulting analysis indicates that anthropogenic forcing has intensified the drying trend in the Caribbean by -0.4 scPDSI-units over 60 years, and has increased the dry-land area by 10%. These findings are consistent with observed potential evapotranspiration (PET) anomalies, which are 30% higher than PET-anomalies estimated using detrended temperatures. These results suggest that climate change is already increasing the risk of drought in the Caribbean by enhancing the atmospheric demand of moisture through temperature, and provide insights into the role of climate change in future drought risk in the region.

5 CFR 890.1025 - Cases where additional fact-finding is not required.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Sanctions Imposed Against Health Care Providers Permissive Debarments § 890.1025 Cases where additional fact..., suspension, restriction, or nonrenewal by a State licensing authority; (2) Debarment, exclusion, suspension... additional fact-finding proceeding is not required when: (a) Prior adjudication. The proposed debarment is...

The Response of the South Asian Summer Monsoon Circulation to Intensified Irrigation in Global Climate Model Simulations

NASA Technical Reports Server (NTRS)

Shukla, Sonali P.; Puma, Michael J.; Cook, Benjamin I.

2013-01-01

Agricultural intensification in South Asia has resulted in the expansion and intensification of surface irrigation over the twentieth century. The resulting changes to the surface energy balance could affect the temperature contrasts between the South Asian land surface and the equatorial Indian Ocean, potentially altering the South Asian Summer Monsoon (SASM) circulation. Prior studies have noted apparent declines in the monsoon intensity over the twentieth century and have focused on how altered surface energy balances impact the SASM rainfall distribution. Here, we use the coupled Goddard Institute for Space Studies ModelE-R general circulation model to investigate the impact of intensifying irrigation on the large-scale SASM circulation over the twentieth century, including how the effect of irrigation compares to the impact of increasing greenhouse gas (GHG) forcing. We force our simulations with time-varying, historical estimates of irrigation, both alone and with twentieth century GHGs and other forcings. In the irrigation only experiment, irrigation rates correlate strongly with lower and upper level temperature contrasts between the Indian sub-continent and the Indian Ocean (Pearson's r = -0.66 and r = -0.46, respectively), important quantities that control the strength of the SASM circulation. When GHG forcing is included, these correlations strengthen: r = -0.72 and r = -0.47 for lower and upper level temperature contrasts, respectively. Under irrigated conditions, the mean SASM intensity in the model decreases only slightly and insignificantly. However, in the simulation with irrigation and GHG forcing, inter-annual variability of the SASM circulation decreases by *40 %, consistent with trends in the reanalysis products. This suggests that the inclusion of irrigation may be necessary to accurately simulate the historical trends and variability of the SASM system over the last 50 years. These findings suggest that intensifying irrigation, in concert with

Findings of florid cemento-osseous dysplasia: a report of three cases.

PubMed

Köse, Taha Emre; Köse, Onur Dincer; Karabas, Hulya Cakir; Erdem, Tamer Lutfi; Ozcan, Ilknur

2013-10-01

Florid cemento-osseous dysplasia (FCOD) is a benign jaw lesion originating from periodontal ligament tissues usually asymptomatic and diagnosed accidentally at routine dental radiographic examination. The purpose of this paper is to report three cases diagnosed as FCOD with their clinical, radiographic and histological findings. Radiologic and clinical symptoms of three cases diagnosed as FCOD are presented. Serum alkaline phosphatase test and biopsy taken from two of the patients are discussed to eliminate the Paget's disease. Three patients diagnosed as FCOD and called for routine follow-up. Because of no sign of infection or osteomyelitis, conservative treatment was applied. Radiographic examination is significant for the diagnosis of florid cemento-osseous dysplasia, especially in the asymptomatic cases. The roles of the dentist are to ensure the follow-up of the diagnosed patients and to take the necessary measures for preventing from the infections.

Bilateral optic neuritis--the only ocular finding in a case of subacute sclerosing panencephalitis.

PubMed

Ozer, Pinar Altiaylik; Ozkan, Mehpare; Sekeroglu, Hande Taylan; Kadayifcilar, Sibel; Yuksel, Deniz; Aksoy, Ayse

2014-02-01

Subacute sclerosing panencephalitis is a rare disease of central nervous system caused by defective measles virus. Chorioretinitis with macular involvement is the mostly observed ocular finding in the disease. Other reported ocular findings in the disease are cortical blindness, hemianopsia, nystagmus, extraocular muscle paresis and optic atrophy. We present a rare case of subacute sclerosing panencephalitis with isolated bilateral optic neuritis as the only ocular finding without macular involvement.

CBCT findings of periapical cemento-osseous dysplasia: A case report.

PubMed

Eskandarloo, Amir; Yousefi, Faezeh

2013-09-01

Periapical cemento-osseous dysplasia (PCOD) is a subtype of cemento-osseous dysplasia that usually occurs in middle-aged black women. This report described a case of a 45-year-old Iranian woman who was diagnosed with PCOD on the basis of cone beam computed tomographic (CBCT) findings. CBCT enabled detailed visualization of the bone changes. This report described the special radiographic characteristics of PCOD, including discontinuity of the lingual cortex on the CBCT sectional and three-dimensional images.

Severe malaria - a case of fatal Plasmodium knowlesi infection with post-mortem findings: a case report

PubMed Central

2010-01-01

Background Zoonotic malaria caused by Plasmodium knowlesi is an important, but newly recognized, human pathogen. For the first time, post-mortem findings from a fatal case of knowlesi malaria are reported here. Case presentation A formerly healthy 40 year-old male became symptomatic 10 days after spending time in the jungle of North Borneo. Four days later, he presented to hospital in a state of collapse and died within two hours. He was hyponatraemic and had elevated blood urea, potassium, lactate dehydrogenase and amino transferase values; he was also thrombocytopenic and eosinophilic. Dengue haemorrhagic shock was suspected and a post-mortem examination performed. Investigations for dengue virus were negative. Blood for malaria parasites indicated hyperparasitaemia and single species P. knowlesi infection was confirmed by nested-PCR. Macroscopic pathology of the brain and endocardium showed multiple petechial haemorrhages, the liver and spleen were enlarged and lungs had features consistent with ARDS. Microscopic pathology showed sequestration of pigmented parasitized red blood cells in the vessels of the cerebrum, cerebellum, heart and kidney without evidence of chronic inflammatory reaction in the brain or any other organ examined. Brain sections were negative for intracellular adhesion molecule-1. The spleen and liver had abundant pigment containing macrophages and parasitized red blood cells. The kidney had evidence of acute tubular necrosis and endothelial cells in heart sections were prominent. Conclusions The overall picture in this case was one of systemic malaria infection that fit the WHO classification for severe malaria. Post-mortem findings in this case were unexpectedly similar to those that define fatal falciparum malaria, including cerebral pathology. There were important differences including the absence of coma despite petechial haemorrhages and parasite sequestration in the brain. These results suggest that further study of knowlesi malaria

A New Class of Transients Marking Intensified Accretion onto Supermassive Black Holes

NASA Astrophysics Data System (ADS)

Trakhtenbrot, Benny; Arcavi, Iair; Ricci, Claudio; Horesh, Assaf; Tacchella, Sandro; Stern, Daniel

2018-01-01

Our understanding of the demographics and evolution of supermassive black holes (SMBHs) beyond the local universe is limited to actively growing SMBHs, where relatively stable accretion of gas persists over several hundreds of millions of years. A growing number of transient and/or variable phenomena in galaxy nuclei have recently begun to shed new light on SMBH demographics and the physics of gas accretion onto these objects, tracing events where this accretion has drastically intensified. We present such an event, identified in the nucleus of an early-type galaxy at z=0.064, in which a previously-active SMBH experienced a dramatic increase in ultraviolet-optical emission. The emerging optical spectrum exhibits a mix of emission features, some of which are typical of luminous, unobscured active galactic nuclei. Other observed emission features of high-ionization species are likely driven by Bowen fluorescence -- seen for the first time in high-velocity lines, with ~2000 km/s, in a galaxy nucleus -- originating in dense, metal-rich gas that is exposed to the recently intensified UV radiation. Our multiwavelength space- and ground-based monitoring campaign shows that the spectral features and elevated UV flux show little to no evolution, over a period of at least six months. This disfavours the tidal disruption of a star as the origin of the UV “flash”, but suggests a rather longer-term re-ignition event. This event joins two other recently reported transients with similar emission properties, forming a new class of transients which has important implications for the identification and understanding of tidal disruption events, as well as other drivers of SMBH re-ignition.

[Clinical forensic examination findings and legal outcome in cases of suspected physical child abuse].

PubMed

Bode-Jänisch, Stefanie; Meyer, Yvonne; Schroeder, Günter; Günther, Detlef; Debertin, Anette Solveig

2011-01-01

Clinical forensic examinations performed at the Institute of Legal Medicine of the Hanover Medical School between 1999 and 2008 in cases of suspected physical abuse of children were analyzed retrospectively with special emphasis on the legal consequences. Altogether, 192 children (85 girls, 107 boys) with a median age of 4.4 years were examined. In 47 cases (24.5 %), the clinical forensic examination findings were interpreted as accidental injuries, birth traumas or unspecific findings. 29 victims (20.0 %) had suffered a shaken baby syndrome. Only part of the presented cases ended with conviction, which was more likely if the victims were aged between 7 and 11 years. Prison terms of 2 years and more were imposed only if the child suffered potentially or acute life-threatening injuries or if additional anogenital lesions were diagnosed indicating sexual child abuse.

Intensified nitrate and phosphorus removal in an electrolysis -integrated horizontal subsurface-flow constructed wetland.

PubMed

Gao, Y; Xie, Y W; Zhang, Q; Wang, A L; Yu, Y X; Yang, L Y

2017-01-01

A novel electrolysis-integrated horizontal subsurface-flow constructed wetland system (E-HFCWs) was developed for intensified removal of nitrogen and phosphorus contaminated water. The dynamics of nitrogen and phosphorus removal and that of main water qualities of inflow and outflow were also evaluated. The hydraulic retention time (HRT) greatly enhanced nitrate removal when the electrolysis current intensity was stabilized at 0.07 mA/cm 2 . When the HRT ranged from 2 h to 12 h, the removal rate of nitrate increased from 20% to 84%. Phosphorus (P) removal was also greatly enhanced-exceeding 90% when the HRT was longer than 4 h in the electrolysis-integrated HFCWs. This improved P removal is due to the in-situ formation of ferric ions by anodizing of sacrificial iron anodes, causing chemical precipitation, physical adsorption and flocculation of phosphorus. Thus, electrolysis plays an important role in nitrate and phosphorus removal. The diversity and communities of bacteria in the biofilm of substrate was established by the analysis of 16S rDNA gene sequences, and the biofilm was abundant with Comamonadaceae and Xanthomonadaceae bacteria in E-HFCWs. Test results illustrated that the electrolysis integrated with horizontal subsurface-flow constructed wetland is a feasible and effective technology for intensified nitrogen and phosphorus removal. Copyright © 2016. Published by Elsevier Ltd.

Cytomorphologic findings of hemangiopericytoma of the meninges: a case report.

PubMed

Gill, S S; Bharadwaj, R

2007-04-01

Hemangiopericytomas (HPCs) are tumors, constituting 2.5%, of soft tissue neoplasms. Meningeal hemangiopericytomas are rare non meningothelial mesenchymal tumors of the dura. They were classified as angioblastic meningiomas because of their similarity to meningiomas. However, these tumors are now regarded as distinct entities, akin to hemangiopericytoma elsewhere in the body. Few reports have addressed the fine needle aspiration (FNA) cytology of HPC. We present the cytological findings of one such rare case ofprimary meningeal hemangiopericytoma which metastasized to the lymph node. A 47 years male presented with cervical lymphadenopathy of 2 months duration. He was operated twice in the last 4 years and diagnosed atypical meningioma both times. The patient now also had spinal metastasis producing nerve root compression. Aspiration cytology of the node revealed cellular aspirate demonstrating round to oval cells with ample cytoplasm, round nuclei and inconspicuous nuclei. They showed a characteristic ferning out of blood vessels. Occasional mitosis was present. A diagnosis of malignant tumor of vascular origin was offered. Lymph node biopsy showed a characteristic histological picture of hemangiopericytoma described in other soft tissues. The cytology of this tumor is characteristic, but the rarity of the lesion, especially in metastatic sites makes diagnosis difficult unless a high index of suspicion is present. The recognition of the distinct cytological findings makes this possible. The case documents the role of FNA cytology in confirming HPC.

Active case finding of undetected tuberculosis among chronic coughers in a slum setting in Kampala, Uganda

PubMed Central

Sekandi, J. N.; Neuhauser, D.; Smyth, K.; Whalen, C. C.

2010-01-01

SUMMARY SETTING Kisenyi slum in peri-urban Kampala, Uganda. OBJECTIVES Using chronic cough (≥2 weeks) inquiry as a screening tool to identify undetected smear-positive tuberculosis (TB) cases and to describe the characteristics of smear-positive TB cases detected by active case finding. DESIGN A house-to-house survey was conducted in five randomly selected villages in Kampala between June and August 2005. A sample of households was visited; adults aged ≥15 years were consecutively interviewed to identify those with chronic cough. Three sputum specimens were collected and examined by smear microscopy. RESULTS Among 930 individuals, we identified 189 (20%) chronic coughers. Of these, we found 33 (18%) undiagnosed smear-positive cases. The newly detected cases had an even sex distribution (P = 0.47), a median age of 30 years, a median cough duration of 1 month and 55% had acid-fast bacilli 1+ sputum smear grade. CONCLUSION These findings suggest that active case finding could supplement DOTS to yield additional smear-positive TB cases, lead to early diagnosis and thus shorten the duration of infectiousness before effective chemotherapy is initiated. In communities such as Kisenyi, this is a feasible strategy that may prove useful for TB control, but its cost-effectiveness needs to be evaluated. Early health care seeking for cough should be emphasized. PMID:19335958

Impacts of Intensified Agriculture Developments on Marsh Wetlands

PubMed Central

Luan, Zhaoqing; Zhou, Demin

2013-01-01

A spatiotemporal analysis on the changes in the marsh landscape in the Honghe National Nature Reserve, a Ramsar reserve, and the surrounding farms in the core area of the Sanjiang Plain during the past 30 years was conducted by integrating field survey work with remote sensing techniques. The results indicated that intensified agricultural development had transformed a unique natural marsh landscape into an agricultural landscape during the past 30 years. Ninety percent of the natural marsh wetlands have been lost, and the areas of the other natural landscapes have decreased very rapidly. Most dry farmland had been replaced by paddy fields during the progressive change of the natural landscape to a farm landscape. Attempts of current Chinese institutions in preserving natural wetlands have achieved limited success. Few marsh wetlands have remained healthy, even after the establishment of the nature reserve. Their ecological qualities have been declining in response to the increasing threats to the remaining wetland habitats. Irrigation projects play a key role in such threats. Therefore, the sustainability of the natural wetland ecosystems is being threatened by increased regional agricultural development which reduced the number of wetland ecotypes and damaged the ecological quality. PMID:24027441

Tide-surge Interaction Intensified by the Taiwan Strait

NASA Astrophysics Data System (ADS)

Zhang, Wen-Zhou; Shi, Fengyan; Hong, Hua-Sheng; Shang, Shao-Ping; Kirby, James T.

2010-06-01

The Taiwan Strait is a long and wide shelf-channel where the hydrodynamics is extremely complex, being characterized by strong tides, and where storm surges frequently occur during the typhoon season. Obvious oscillations due to tide-surge interaction were observed by tide gauges along the northern Fujian coast, the west bank of the Taiwan Strait, during Typhoon Dan (1999). Numerical experiments indicate that nonlinear bottom friction (described by the quadratic formula) is a major factor to predict these oscillations while the nonlinear advective terms and the shallow water effect have little contribution. It is found that the tide-surge interaction in the northern portion of the Taiwan Strait is intensified by the strait. Simulations based on simplified topographies with and without the island of Taiwan show that, in the presence of the island, the channel effect strengthens tidal currents and tends to align the major axes of tidal ellipses along the channel direction. Storm-induced currents are also strengthened by the channel. The pattern of strong tidal currents and storm-induced currents along the channel direction enhances tide-surge interaction via the nonlinear bottom friction, resulting in the obvious oscillations along the northern Fujian coast.

Hilar biliary neurofibroma without neurofibromatosis: case report with contrast-enhanced ultrasound findings.

PubMed

Guo, Huan-Ling; Chen, Li-da; Wang, Zhu; Huang, Yang; Liu, Jin-Ya; Shan, Quan-Yuan; Xie, Xiao-Yan; Lu, Ming-de; Wang, Wei

2016-10-01

Solitary neurofibroma located in the hilum of the liver is extremely rare, particularly without neurofibromatosis. We herein report a case of hilar biliary neurofibroma without signs of von Recklinghausen's disease. A 36-year-old man was admitted to our department with progressive jaundice. The case was diagnosed as hilar cholangiocarcinoma based on preoperative imaging. The patient consequently received a Roux-en-Y hepaticojejunostomy and was confirmed with neurofibroma pathologically. This is the first reported imaging finding of hilar biliary neurofibroma using contrast-enhanced ultrasound, emphasizing the differential diagnosis of biliary tumors.

Evaluation of a treatment and teaching refresher programme for the optimization of intensified insulin therapy in type 1 diabetes.

PubMed

Müller, Nicolle; Kloos, Christof; Sämann, Alexander; Wolf, Gunter; Müller, Ulrich Alfons

2013-10-01

Evaluation of an ambulatory diabetes teaching and treatment refresher programme (DTTP) for the optimization of intensified insulin therapy in patients with type 1 diabetes (refresher course). 85 outpatients took part in this prospective multicentre trial. Metabolic and psychosocial data were analyzed at baseline (V1), 6 weeks (V2) and 12 months after DTTP (V3). In patients with baseline HbA1c>7% (88%), HbA1c decreased by 0.36% (p=0.004). The percentage of patients with HbA1c≤7% increased from 21.3 to 34.9% and with HbA1c above 10% decreased from 6.6 to 1.6% at V3. The incidence of hypoglycaemia decreased significantly: non severe hypoglycaemia from 3.31 to 1.39 episodes/pat/week (p=0.001) and severe hypoglycaemia from 0.16 to 0.03 episodes/pat/year (p=0.02). The treatment satisfaction increased by +10 of maximal ±18 points. The negative influence of diabetes on quality of life decreased from -1.93 to -1.69 points (p=0.031). In a group of patients with moderately controlled diabetes type 1 who were already treated with intensified insulin therapy, metabolic control, treatment satisfaction and quality of life were improved after participation in an ambulatory DTTP without increasing insulin dosage, number of injections or insulin species. This DTTP is effective for the optimization of intensified insulin therapy. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

CBCT findings of periapical cemento-osseous dysplasia: A case report

PubMed Central

Eskandarloo, Amir

2013-01-01

Periapical cemento-osseous dysplasia (PCOD) is a subtype of cemento-osseous dysplasia that usually occurs in middle-aged black women. This report described a case of a 45-year-old Iranian woman who was diagnosed with PCOD on the basis of cone beam computed tomographic (CBCT) findings. CBCT enabled detailed visualization of the bone changes. This report described the special radiographic characteristics of PCOD, including discontinuity of the lingual cortex on the CBCT sectional and three-dimensional images. PMID:24083217

Returning Incidental Findings in Low-Resource Settings: A Case of Rescue?

PubMed

Mackay, Douglas

2018-05-01

In a carefully argued article, Haley K. Sullivan and Benjamin E. Berkman address the important question of whether investigators have a duty to report incidental findings to research participants in low-resource settings. They suggest that the duty to rescue offers the most plausible justification for the duty to return incidental findings, and they explore the implications of this duty for the context of research in low-resource settings. While I think they make valuable headway on an important problem, in this commentary, I identify a significant difference between the paradigmatic rescue case and the return of incidental findings in low-resource settings. This difference, I suggest, implies that their framework may be too narrow in scope. If investigators (and their sponsors) really wish to fulfill their duty to rescue, they must consider factors that are left out of Sullivan and Berkman's framework. © 2018 The Hastings Center.

Clinical inertia in poorly controlled elderly hypertensive patients: a cross-sectional study in Spanish physicians to ascertain reasons for not intensifying treatment.

PubMed

Gil-Guillén, Vicente; Orozco-Beltrán, Domingo; Carratalá-Munuera, Concepción; Márquez-Contreras, Emilio; Durazo-Arvizu, Ramón; Cooper, Richard; Pertusa-Martínez, Salvador; Pita-Fernandez, Salvador; González-Segura, Diego; Martin-de-Pablo, José Luis; Pallarés, Vicente; Fernández, Antonio; Redón, Josep

2013-06-01

Clinical inertia, the failure of physicians to initiate or intensify therapy when indicated, is a major problem in the management of hypertension and may be more prevalent in elderly patients. Overcoming clinical inertia requires understanding its causes and evaluating certain factors, particularly those related to physicians. The objective of our study was to determine the rate of clinical inertia and the physician-reported reasons for it. An observational, cross-sectional, multi-center study was carried out in a primary care setting. We included 512 physicians, with a consecutive sampling of 1,499 hypertensive patients with clinical inertia. Clinical inertia was defined when physicians did not modify treatment despite knowing that the therapeutic target had not been reached. Clinical inertia was considered to be justified (JCI) when physicians provided an explanation for not intensifying treatment and as not justified (nJCI) when no reasons were given. JCI was observed in 30.1 % (95 % CI 27.8-32.4) of patients (n = 451) and nJCI in 69.9 % (95 % CI 67.6-72.2) (n = 1,058). JCI was associated with higher blood pressure (BP) values (both systolic and diastolic) and diabetes (p = 0.012) than nJCI. nJCI was associated with patients having an isolated increase of systolic or diastolic or high borderline BP values or cardiovascular disease. Physicians provided reasons for not intensifying treatment in poorly controlled patients in only 30 % of instances. Main reasons for not intensifying treatment were borderline BP values, co-morbidity, suspected white coat effect, or perceived difficulty achieving target. nJCI was associated with high borderline BP values and cardiovascular disease.

Intensified autophagy compromises the efficacy of radiotherapy against prostate cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Koukourakis, Michael I., E-mail: targ@her.forthnet.gr; Kalamida, Dimitra; Mitrakas, Achilleas

2015-05-29

Introduction: Radiotherapy is an equivalent alternative or complement to radical prostatectomy, with high therapeutic efficacy. High risk patients, however, experience high relapse rates, so that research on radio-sensitization is the most evident route to improve curability of this common disease. Materials and methods: In the current study we investigated the autophagic activity in a series of patients with localized prostate tumors treated with radical radiotherapy, using the LC3A and the LAMP2a proteins as markers of autophagosome and lysosome cellular content, respectively. The role of autophagy on prostate cancer cell line resistance to radiation was also examined. Results: Using confocal microscopymore » on tissue biopsies, we showed that prostate cancer cells have, overall, high levels of LC3A and low levels of LAMP2a compared to normal prostate glands. Tumors with a ‘highLC3A/lowLAMP2a’ phenotype, suggestive of intensified lysosomal consumption, had a significantly poorer biochemical relapse free survival. The PC3 radioresistant cell line sustained remarkably its autophagic flux ability after radiation, while the DU145 radiosensitive one experiences a prolonged blockage of the autophagic process. This was assessed with aggresome accumulation detection and LC3A/LAMP2a double immunofluorescence, as well as with sequestrosome/p62 protein detection. By silencing the LC3A or LAMP2a expression, both cell lines became more sensitive to escalated doses of radiation. Conclusions: High base line autophagy activity and cell ability to sustain functional autophagy define resistance of prostate cancer cells to radiotherapy. This can be reversed by blocking up-regulated components of the autophagy pathway, which may prove of importance in the field of clinical radiotherapy. - Highlights: • High LC3A and low LAMP2a levels is a frequent expression pattern of prostate carcinoma. • This pattern of intensified autophagic flux relates with high relapse rates after

CT findings associated with blastic plasmacytoid dendritic cell neoplasm: a case report

PubMed Central

Choi, Jung W; Jeong, Katherine; Sokol, Lubomir

2016-01-01

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematologic malignancy that is frequently misdiagnosed. We present a case of a 53-year-old man diagnosed with blastic plasmacytoid dendritic cell neoplasm with extensive computed tomography (CT) findings and provide an imaging focused review of this uncommon malignancy. PMID:27504192

Various hysterosalpingography findings of female genital tuberculosis: A case series

PubMed Central

Afzali, Nargess; Ahmadi, Firoozeh; Akhbari, Farnaz

2013-01-01

Background: Genital tuberculosis is a chorionic disease and mostly occurs by haematogenous spread from extra genital source like lungs, peritoneum, lymph nodes and bones. Transmission through a sexual intercourse is also possible. Since the majority of patients are in reproductive ages, involvement of fallopian tubes and endometrium cause infertility in patients. Cases: Reviewing 4 cases of female genital tuberculosis, which referred to an infertility treatment center with various symptoms, we encountered various appearances on hysterosalpingography (HSG). Conclusion: The genitourinary tract is the most common site of extra pulmonary TB. The primary focus of genital tuberculosis is fallopian tubes, which are almost always affected bilaterally but not symmetrically. Because of common involvement of fallopian tubes and endometrial cavity, disease causes infertility. Diagnosis is not easy because genital tuberculosis has a wide range of clinical and radiological manifestations with slow growing symptoms. Detailed hysterosalpingography finding may be helpful in better diagnosis of the disease. This case series aims to depict the various hystrosalpingographic appearances and pathology produced by tuberculosis and related literatures are reviewed in order to establish a better diagnostic evaluation of genital tuberculosis. PMID:24639787

Lipoid proteinosis: A case with distinct histopathological and radiological findings.

PubMed

Brar, Balvinder Kaur; Jain, Sarina; Brar, Sukhmani Kaur

2017-10-01

Lipoid proteinosis is a rare inherited genodermatosis characterized by hyaline deposits in various tissues. Clinically, it manifests with cutaneous as well as extracutaneous features. Periodic acid-Schiff (PAS)-reactive hyaline deposits in the upper dermis, with localization around blood vessels and eccrine sweat glands, in particular, is the histopathological hallmark finding. On brain imaging, bilateral symmetrical temporal lobe calcifications are considered to be pathognomonic of this disorder. We report a case of lipoid proteinosis in which hyaline deposits were present in the papillary and reticular dermis, without being seen at the periphery of eccrine sweat glands, along with dystrophic calcification. Magnetic resonance imaging (MRI) of brain revealed hydrocephalus, subependymal heterotropia and absent splenium of corpus callosum with no evidence of temporal lobe calcification. Thus, our case highlights the inherent diverse nature of lipoid proteinosis. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Feasibility Study of Case-Finding for Breast Cancer by Community Health Workers in Rural Bangladesh.

PubMed

Chowdhury, Touhidul Imran; Love, Richard Reed; Chowdhury, Mohammad Touhidul Imran; Artif, Abu Saeem; Ahsan, Hasib; Mamun, Anwarul; Khanam, Tahmina; Woods, James; Salim, Reza

2015-01-01

Mortality from breast cancer is high in low- and middle-income countries, in part because most patients have advanced stage disease when first diagnosed. Case-finding may be one approach to changing this situation. We conducted a pilot study to explore the feasibility of population-based case finding for breast cancer by community health workers (CHWs) using different data collection methods and approaches to management of women found to have breast abnormalities. After training 8 CHWs in breast problem recognition, manual paper data collection and operation of a cell-phone software platform for reporting demographic, history and physical finding information, these CHWs visited 3150 women >age 18 and over they could find--from 2356 households in 8 villages in rural Bangladesh. By 4 random assignments of villages, data were collected manually (Group 1), or with the cell-phone program alone (Group 2) or with management algorithms (Groups 3 and 4), and women adjudged to have a serious breast problem were shown a motivational video (Group 3), or navigated/accompanied to a breast problem center for evaluation (Group 4). Only three visited women refused evaluation. The manual data acquisition group (1) had missing data in 80% of cases, and took an average of 5 minutes longer to acquire, versus no missing data in the cell phone-reporting groups (2,3 and 4). One woman was identified with stage III breast cancer, and was appropriately treated. Among very poor rural Bangladeshi women, there was very limited reluctance to undergo breast evaluation. The estimated rarity of clinical breast cancer is supported by these population-based findings. The feasibility and efficient use of mobile technology in this setting is supported. Successor studies may most appropriately be trials focusing on improving the suggested benefits of motivation and navigation, on increasing the numbers of cases found, and on stage of disease at diagnosis as the primary endpoint.

Tuberculosis active case finding in Cambodia: a pragmatic, cost-effectiveness comparison of three implementation models.

PubMed

James, Richard; Khim, Keovathanak; Boudarene, Lydia; Yoong, Joanne; Phalla, Chea; Saint, Saly; Koeut, Pichenda; Mao, Tan Eang; Coker, Richard; Khan, Mishal Sameer

2017-08-22

Globally, almost 40% of tuberculosis (TB) patients remain undiagnosed, and those that are diagnosed often experience prolonged delays before initiating correct treatment, leading to ongoing transmission. While there is a push for active case finding (ACF) to improve early detection and treatment of TB, there is extremely limited evidence about the relative cost-effectiveness of different ACF implementation models. Cambodia presents a unique opportunity for addressing this gap in evidence as ACF has been implemented using different models, but no comparisons have been conducted. The objective of our study is to contribute to knowledge and methodology on comparing cost-effectiveness of alternative ACF implementation models from the health service perspective, using programmatic data, in order to inform national policy and practice. We retrospectively compared three distinct ACF implementation models - door to door symptom screening in urban slums, checking contacts of TB patients, and door to door symptom screening focusing on rural populations aged above 55 - in terms of the number of new bacteriologically-positive pulmonary TB cases diagnosed and the cost of implementation assuming activities are conducted by the national TB program of Cambodia. We calculated the cost per additional case detected using the alternative ACF models. Our analysis, which is the first of its kind for TB, revealed that the ACF model based on door to door screening in poor urban areas of Phnom Penh was the most cost-effective (249 USD per case detected, 737 cases diagnosed), followed by the model based on testing contacts of TB patients (308 USD per case detected, 807 cases diagnosed), and symptomatic screening of older rural populations (316 USD per case detected, 397 cases diagnosed). Our study provides new evidence on the relative effectiveness and economics of three implementation models for enhanced TB case finding, in line with calls for data from 'routine conditions' to be included

Professional commitment: Does it buffer or intensify job demands?

PubMed

Nesje, Kjersti

2017-04-01

The purpose of this study is to investigate whether professional commitment can be seen as a moderator in the relationship between job demands and emotional exhaustion among Norwegian nurses. Inspired by the job demands-resources model, this study explores whether having a strong commitment to the nursing profession can be seen as a resource that buffers the effect of job demands on emotional exhaustion or, conversely, intensifies the impact of job demands. A survey that comprised Norwegian nurses who had graduated three years previously (N = 388) was conducted. Multiple regression was performed to test the hypothesis. The results provide support to a buffering effect; thus, individuals with a higher degree of professional commitment conveyed a weaker association between job demands and emotional exhaustion compared with nurses with a lower degree of commitment. Developing a better understanding of the potential buffering effect of professional commitment is of great interest. The present study is the first to utilize professional commitment as a resource within the job demands-resources framework. © 2017 Scandinavian Psychological Associations and John Wiley & Sons Ltd.

[New intensifying screens in clinical radiology. II. Examinations in clinical practice].

PubMed

Freyschmidt, J; Saure, D; Hagemann, G

1976-09-01

A clinically applicable procedure for testing new intensifying rare earth screens, as well as the special Siemens' screen is described. The results are related to universal screens. The film-screen combination alpha 4XD (gadolinium oxysulphide with normal, green sensitive film) results in a reduction of radiation dose to half with detail comparable with universal screens. The Siemens' special screen has similar advantages. Screens with a higher intensification factor and reduction of the mAs to one sixth results in loss of detail. This does not necessarily reduce their clinical use if they are used for appropriate purposes. The results of this clinically orientated technique agreed well with physically objective methods using lead grids. The advantages of the new screens are discussed in terms of their practical application.

[Morphological findings in fatal cases of hantavirus cardiopulmonary syndrome. Report of 7 autopsies].

PubMed

Guzmán G, Pablo; Tapia E, Oscar; Villaseca H, Miguel; Araya O, Juan; Antonio P, Lilia; Lee O, Bolívar; Roa S, Juan

2010-10-01

Hantavirus cardiopulmonary syndrome (HCPS) is an acute infectious disease characterized by sudden cardiorespiratory failure and high mortality, caused by a RNA virus of the genus Hantavirus, family Bunyaviridae, 15% of Chilean cases have been detected in the Araucania Region. To determine in fatal cases of HCPS, clinical and morphological characteristics. Descriptive-retrospective analysis of seven fatal cases with postmortem study of HCPS, attended between 1997 and 2009 at the Hospital of Temuco, Chile. Cases were young patients from rural areas, and presented as an illness of progressive respiratory failure, with leukocytosis, thrombocytopenia and bilateral interstitial pulmonary infiltrates. Main morphological findings were marked intersticial and intraalveolar pulmonary edema, with minimal epithelial injury and mononuclear cell intersticial infiltrate and mild edematous intersticial inflamatory process. Epidemiological, clinical and laboratory background allow to suspect HCPS. In fatal cases, the autopsy makes possible to discard other similar pathologies and provide tissue for confirmation of the disease.

Clonidine intensifies memantine cutaneous analgesia in response to local skin noxious pinprick in the rat.

PubMed

Wu, Bor-Tsang; Chen, Kuan-Ting; Liu, Kuo-Sheng; Chen, Yu-Wen; Hung, Ching-Hsia; Wang, Jhi-Joung

2015-06-01

The purposes of this study were to evaluate the co-administration of clonidine with memantine and to determine whether it has a peripheral action in intensifying cutaneous analgesia. Cutaneous analgesia was examined through inhibition of the cutaneous trunci muscle reflex in response to the local noxious pinprick in rats. Effect of the added subcutaneous clonidine to memantine on infiltrative cutaneous analgesia was assessed and compared with the local anesthetic lidocaine. On the 50% effective dose (ED50) basis, the rank of drug potency was memantine [4.05 (3.95-4.18) μmol]>lidocaine [5.81 (5.70-5.98) μmol] (p<0.01). Clonidine at a dose of 0.12 μmol did not elicit cutaneous analgesia. Mixtures of clonidine (0.12 μmol) with drug (memantine or lidocaine) at ED50 or ED95 prolonged the duration of action and enhanced the potency as infiltrative cutaneous analgesia. Clonidine enhanced the lidocaine cutaneous analgesia in which had a better effect than added to memantine. Our resulting data showed that memantine displayed more potent cutaneous analgesia than lidocaine. Co-administration of memantine or lidocaine with clonidine increased the potency and duration of the cutaneous analgesia. Clonidine intensified the effects of lidocaine promoting cutaneous analgesia than added to memantine. Copyright © 2014 Institute of Pharmacology, Polish Academy of Sciences. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

Congenital Stapes Ankylosis in Children: Surgical Findings and Results in 35 Cases.

PubMed

Vincent, Robert; Wegner, Inge; Kamalski, Digna M A; Bittermann, Arnold J N; Grolman, Wilko

2016-04-01

To evaluate surgical findings and hearing results in children undergoing middle ear surgery for congenital stapes ankylosis with or without other ossicular malformations (Teunissen and Cremers class I and class II malformations). A nonrandomized, nonblinded case series of prospectively collected data. A tertiary referral center. Twenty-eight consecutive pediatric patients who underwent 35 surgical procedures for congenital stapes ankylosis with or without other ossicular malformations and had available postoperative pure-tone audiometry. Primary stapedotomy with vein graft interposition and reconstruction with a Teflon piston, bucket handle prosthesis or total ossicular replacement prosthesis. Pre- and postoperative audiometric evaluation using four-frequency (0.5, 1, 2, and 4 kHz) audiometry. Air-conduction thresholds, bone-conduction thresholds, and air-bone gaps (ABGs) were measured. Postoperative audiometry was performed at 3, 6, 9, 12, 18, and 24 months after surgery and at a yearly interval thereafter. Overall, a postoperative ABG closure of 10 dB or less was achieved in 73% of class I cases and in 50% of class II cases. A postoperative ABG closure of 20 dB or less was achieved in 77% of class I cases and 67% of class II cases. Postoperative sensorineural hearing loss occurred in one class I case (4%) and none of the class II cases. Stapedotomy is a safe and feasible treatment option in children with congenital stapes ankylosis.

Elevated Serum Hepcidin Levels during an Intensified Training Period in Well-Trained Female Long-Distance Runners

PubMed Central

Ishibashi, Aya; Maeda, Naho; Sumi, Daichi; Goto, Kazushige

2017-01-01

Iron is essential for providing oxygen to working muscles during exercise, and iron deficiency leads to decreased exercise capacity during endurance events. However, the mechanism of iron deficiency among endurance athletes remains unclear. In this study, we compared iron status between two periods involving different training regimens. Sixteen female long-distance runners participated. Over a seven-month period, fasting blood samples were collected during their regular training period (LOW; middle of February) and during an intensified training period (INT; late of August) to determine blood hematological, iron, and inflammatory parameters. Three-day food diaries were also assessed. Body weight and lean body mass did not differ significantly between LOW and INT, while body fat and body fat percentage were significantly lower in INT (p < 0.05). Blood hemoglobin, serum ferritin, total protein, and iron levels, total iron-binding capacity, and transferrin saturation did not differ significantly between the two periods. Serum hepcidin levels were significantly higher during INT than LOW (p < 0.05). Carbohydrate and iron intakes from the daily diet were significantly higher during INT than LOW (p < 0.05). In conclusion, an elevated hepcidin level was observed during an intensified training period in long-distance runners, despite an apparently adequate daily intake of iron. PMID:28335426

Elevated Serum Hepcidin Levels during an Intensified Training Period in Well-Trained Female Long-Distance Runners.

PubMed

Ishibashi, Aya; Maeda, Naho; Sumi, Daichi; Goto, Kazushige

2017-03-14

Iron is essential for providing oxygen to working muscles during exercise, and iron deficiency leads to decreased exercise capacity during endurance events. However, the mechanism of iron deficiency among endurance athletes remains unclear. In this study, we compared iron status between two periods involving different training regimens. Sixteen female long-distance runners participated. Over a seven-month period, fasting blood samples were collected during their regular training period (LOW; middle of February) and during an intensified training period (INT; late of August) to determine blood hematological, iron, and inflammatory parameters. Three-day food diaries were also assessed. Body weight and lean body mass did not differ significantly between LOW and INT, while body fat and body fat percentage were significantly lower in INT ( p < 0.05). Blood hemoglobin, serum ferritin, total protein, and iron levels, total iron-binding capacity, and transferrin saturation did not differ significantly between the two periods. Serum hepcidin levels were significantly higher during INT than LOW ( p < 0.05). Carbohydrate and iron intakes from the daily diet were significantly higher during INT than LOW ( p < 0.05). In conclusion, an elevated hepcidin level was observed during an intensified training period in long-distance runners, despite an apparently adequate daily intake of iron.

Intensified plant N and C pool with more available nitrogen under experimental warming in an alpine meadow ecosystem.

PubMed

Peng, Fei; Xue, Xian; You, Quangang; Xu, Manhou; Chen, Xiang; Guo, Jian; Wang, Tao

2016-12-01

Nitrogen (N) availability is projected to increase in a warming climate. But whether the more available N is immobilized by microbes (thus stimulates soil carbon (C) decomposition), or is absorbed by plants (thus intensifies C uptake) remains unknown in the alpine meadow ecosystem. Infrared heaters were used to simulate climate warming with a paired experimental design. Soil ammonification, nitrification, and net mineralization were obtained by in situ incubation in a permafrost region of the Qinghai-Tibet Plateau (QTP). Available N significantly increased due to the stimulation of net nitrification and mineralization in 0-30 cm soil layer. Microbes immobilized N in the end of growing season in both warming and control plots. The magnitude of immobilized N was lower in the warming plots. The root N concentration significantly reduced, but root N pool intensified due to the significant increase in root biomass in the warming treatment. Our results suggest that a warming-induced increase in biomass is the major N sink and will continue to stimulate plant growth until plant N saturation, which could sustain the positive warming effect on ecosystem productivity.

Case Finding Using Syndromic Surveillance Data During an Outbreak of Shiga Toxin-Producing Escherichia coli O26 Infections, Oregon, 2015.

PubMed

Hines, Jonas Z; Bancroft, June; Powell, Melissa; Hedberg, Katrina

Shiga toxin-producing Escherichia coli (STEC) causes an estimated 265 000 infections in the United States annually. Of emerging non-O157:H7 STEC serotypes, O26 is the most commonly recognized. During an outbreak of STEC O26 in Oregon in 2015, we used syndromic surveillance data to supplement case finding by laboratory reporting. From 157 records retrieved by querying syndromic surveillance data, we detected 4 confirmed and 5 suspected cases. However, none of the suspected cases were confirmed by stool culture, and by the time that the data were being analyzed, the confirmed cases were already known to investigators. Syndromic surveillance data can potentially supplement case finding during outbreaks of foodborne disease. To be an effective case-finding strategy, timely completion of all steps, including collecting specimens from suspected cases, should be performed in real time.

Nanoparticles generated by laser in liquids as contrast medium and radiotherapy intensifiers

NASA Astrophysics Data System (ADS)

Restuccia, Nancy; Torrisi, Lorenzo

2018-01-01

The synthesis of Au and Ag nanoparticles (NP) though laser ablation in liquids as a function the laser parameters is presented. Spherical NPs with diameter distribution within 1 and 100 nm were prepared by laser ablation in water. The nanoparticles characterization was performed using optical spectroscopy and electronic microscopy (SEM and TEM) measurements. Studies of the possible use of metallic nanoparticles as intensifier of diagnostics imaging contrast medium and absorbing dose from ionizing radiations in traditional radiotherapy and protontherapy are presented. Examples of in vitro (in tissue equivalent materials) and in vivo (in mice), were conducted thank to simulation programs permitting to evaluate the enhancement of efficiency in imaging and therapy as a function of the NPs concentrations and irradiation conditions.

Imaging findings in a case of Gorlin-Goltz syndrome: a survey using advanced modalities

PubMed Central

Shakibafar, Ali Reza; Houshyar, Maneli; Nafarzade, Shima

2011-01-01

Gorlin-Goltz syndrome is an infrequent multi-systemic disease which is characterized by multiple keratocysts in the jaws, calcification of falx cerebri, and basal cell carcinomas. We report a case of Gorlin-Goltz syndrome in a 23-year-old man with emphasis on image findings of keratocyctic odontogenic tumors (KCOTs) on panoramic radiograph, computed tomography, magnetic resonance (MR) imaging, and Ultrasonography (US). In this case, pericoronal lesions were mostly orthokeratinized odontogenic cyst (OOC) concerning the MR and US study, which tended to recur less. The aim of this report was to clarify the characteristic imaging features of the syndrome-related keratocysts that can be used to differentiate KCOT from OOC. Also, our findings suggested that the recurrence rate of KCOTs might be predicted based on their association to teeth. PMID:22232727

Imaging findings in a case of Gorlin-Goltz syndrome: a survey using advanced modalities.

PubMed

Bronoosh, Pegah; Shakibafar, Ali Reza; Houshyar, Maneli; Nafarzade, Shima

2011-12-01

Gorlin-Goltz syndrome is an infrequent multi-systemic disease which is characterized by multiple keratocysts in the jaws, calcification of falx cerebri, and basal cell carcinomas. We report a case of Gorlin-Goltz syndrome in a 23-year-old man with emphasis on image findings of keratocyctic odontogenic tumors (KCOTs) on panoramic radiograph, computed tomography, magnetic resonance (MR) imaging, and Ultrasonography (US). In this case, pericoronal lesions were mostly orthokeratinized odontogenic cyst (OOC) concerning the MR and US study, which tended to recur less. The aim of this report was to clarify the characteristic imaging features of the syndrome-related keratocysts that can be used to differentiate KCOT from OOC. Also, our findings suggested that the recurrence rate of KCOTs might be predicted based on their association to teeth.

Community pharmacy-based case finding for COPD in urban and rural settings is feasible and effective.

PubMed

Fathima, Mariam; Saini, Bandana; Foster, Juliet M; Armour, Carol L

2017-01-01

Case finding of patients at risk of COPD by community pharmacists could identify a substantial number of people with undiagnosed COPD, but little is known about the feasibility and effectiveness of pharmacy-based COPD case finding using microspirometry. The objective of this study was to assess the feasibility and effectiveness of COPD case-finding service provided by community pharmacists, utilizing a combination of risk assessment questionnaire and microspirometry. A 6-month service was conducted in 21 community pharmacies in Australia. Pharmacists trained in COPD case finding, including lung function test (LFT), invited their patients aged ≥35 years with a history of smoking and/or respiratory symptoms to participate. High-risk patients were identified via a COPD risk assessment questionnaire (Initial Screening Questionnaire [ISQ]) and underwent LFT. Pharmacists referred patients with a forced expiratory volume in 1 second (FEV 1 )/forced expiratory volume in 6 seconds (FEV 6 ) ratio <0.75 to their general practitioner (GP) for further assessment and diagnosis. In all, 91 of 167 (54%) patients had an ISQ score >3 indicating high COPD risk. Of the 157 patients who were able to complete LFT, 61 (39%) had an FEV 1 /FEV 6 ratio of <0.75 and were referred to their GP. Patients with high ISQ symptoms scores (>3) were at a significantly higher risk of an FEV 1 /FEV 6 ratio of <0.75, compared to patients with fewer COPD symptoms. A total of 15 (10%) patients were diagnosed with COPD by their GP. Another eight (5%) patients were diagnosed with other medical conditions and 87% of these were initiated on treatment. Although only half of all screened patients lived in regional areas, 93% of those diagnosed with COPD were from regional areas. A brief community pharmacy-based COPD case-finding service utilizing the ISQ, LFT and GP referral is feasible and may lead to identification and diagnosis of a substantial number of people with COPD. This might be an important

Evaluation of a tuberculosis active case finding project in peri-urban areas, Myanmar: 2014-2016.

PubMed

Aye, Sandar; Majumdar, Suman S; Oo, Myo Minn; Tripathy, Jaya Prasad; Satyanarayana, S; Kyaw, Nang Thu Thu; Kyaw, Khine Wut Yee; Oo, Nay Lynn; Thein, Saw; Thu, Myat Kyaw; Soe, Kyaw Thu; Aung, Si Thu

2018-05-01

We assessed the effect of an active case finding (ACF) project on tuberculosis (TB) case notification and the yields from a household and neigbourhood intervention (screening contacts of historical index TB patients diagnosed >24months ago) and a community intervention (screening attendants of health education sessions/mobile clinics). Cross-sectional analysis of project records, township TB registers and annual TB reports. In the household and neigbourhood intervention, of 56,709 people screened, 1,076 were presumptive TB and 74 patients were treated for active TB with a screening yield of 0.1% and a yield from presumptive cases of 6.9%. In the community intervention, of 162,881 people screened, 4,497 were presumptive TB and 984 were treated for active TB with a screening yield of 0.6% and yield from presumptive cases of 21.9%. Of active TB cases, 94% were new, 89% were pulmonary, 44% were bacteriologically-confirmed and 5% had HIV. Case notification rates per 100,000 in project townships increased from 142 during baseline (2011-2013) to 148 during intervention (2014-2016) periods. The yield from household and neigbourhood intervention was lower than community intervention. This finding highlights reconsidering the strategy of screening of contacts from historical index cases. Strategies to reach high-risk groups should be explored for future ACF interventions to increase yield of TB. Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Brain MRI findings in two cases with eclampsia.

PubMed

Unal, M; Senakayli, O C; Serçe, K

1996-08-01

Neurological complications in patients with eclampsia are varied and include headache, visual disturbances, focal neurological deficits, altered mental status and coma. Occasionally, a focal neurological deficit includes a variety of visual disturbances. The pathophysiology of CNS abnormalities in patients with eclampsia is uncertain. Our cases, combined with a review of the literature, demonstrate that there is no correlation among severity of hypertension, parity, and location of lesions at initial magnetic resonance (MR) imaging findings or between the severity of hypertension and neurological symptoms. Two typical patterns are seen on MR images of patients with eclampsia. Lesions in the region of the posterior cerebral circulation are most common and are frequently associated with visual disturbances. Although there are lesions in the deep white matter or basal ganglia, a focal neurological deficit or alterations in mental status may not develop. This demonstrates the sensitivity of MR imaging in the detection of abnormalities in patients with eclampsia, even those without neurological deficits.

When general practitioners talk about alcohol: exploring facilitating and hampering factors for pragmatic case finding.

PubMed

Lid, Torgeir Gilje; Nesvåg, Sverre; Meland, Eivind

2015-03-01

The aim was to explore individual and system factors facilitating or hampering pragmatic case finding, an identification strategy based on clinical signs and targeted screening. Two focus groups with general practitioners were interviewed twice, in the context of a four-session seminar on alcohol and complex drug problems, and an additional focus group interview with general practitioners not attending the seminar. Interviews focused mainly on conditions for talking about alcohol, views on collaboration with colleagues, how they deal with complex issues, and strategies for learning and quality improvement. The participants presented many deliberate strategies for quality improvement and learning together, but there was a tendency to avoid discussing complex case stories or potentially controversial topics with colleagues. Possible barriers to change were presented. The majority of their stories on talking about alcohol coincided well with the concept of pragmatic case finding. The duality between shame and normality, time constraints and a need for structure were the most important individual barriers to an open and respectful conversation about alcohol with patients. Our study supports pragmatic case finding as a relevant and viable strategy for talking about alcohol in general practice, and as an alternative to screening and brief intervention. Quality improvement in practice is strengthened when it is adapted to the clinical setting, and builds on and stimulates the GPS' and staff's own strategies for learning and quality work. © 2015 the Nordic Societies of Public Health.

Finding the right prescription.

PubMed

Runy, Lee Ann

2005-05-01

Demand for pharmacists continues to outpace supply, and with competition from commercial chains intensifying, hospitals' staffing woes won't ease any time soon. To fill the void, hospital executives are considering a number of aggressive steps, exploring everything from better pay and benefits to outsourcing to technological breakthroughs.

New approaches to determine fatigue in elite athletes during intensified training: Resting metabolic rate and pacing profile

PubMed Central

2017-01-01

Background Elite rowers complete a high volume of training across a number of modalities to prepare for competition, including periods of intensified load, which may lead to fatigue and short-term performance decrements. As yet, the influence of substantial fatigue on resting metabolic rate (RMR) and exercise regulation (pacing), and their subsequent utility as monitoring parameters, has not been explicitly investigated in elite endurance athletes. Method Ten National-level rowers completed a four-week period of intensified training. RMR, body composition and energy intake were assessed PRE and POST the four-week period using indirect calorimetry, Dual-Energy X-Ray Densitometry (DXA), and three-day food diary, respectively. On-water rowing performance and pacing strategy was evaluated from 5 km time trials. Wellness was assessed weekly using the Multicomponent Training Distress Scale (MTDS). Results Significant decreases in absolute (mean ± SD of difference, p-value: -466 ± 488 kJ.day-1, p = 0.01) and relative RMR (-8.0 ± 8.1 kJ.kg.FFM-1, p = 0.01) were observed. Significant reductions in body mass (-1.6 ± 1.3 kg, p = 0.003) and fat mass (-2.2 ± 1.2 kg, p = 0.0001) were detected, while energy intake was unchanged. On-water 5 km rowing performance worsened (p < 0.05) and an altered pacing strategy was evident. Fatigue and total mood disturbance significantly increased across the cycle (p < 0.05), and trends were observed for reduced vigour and increased sleep disturbance (p < 0.1). Conclusion Four weeks of heavy training decreased RMR and body composition variables in elite rowers and induced substantial fatigue, likely related to an imbalance between energy intake and output. This study demonstrates that highly experienced athletes do not necessarily select the correct energy intake during periods of intensified training, and this can be assessed by reductions in RMR and body composition. The shortfall in energy availability likely affected recovery from

Hantavirus pulmonary syndrome clinical findings: evaluating a surveillance case definition.

PubMed

Knust, Barbara; Macneil, Adam; Rollin, Pierre E

2012-05-01

Clinical cases of hantavirus pulmonary syndrome (HPS) can be challenging to differentiate from other acute respiratory diseases, which can lead to delays in diagnosis, treatment, and disease reporting. Rapid onset of severe disease occurs, at times before diagnostic test results are available. This study's objective was to examine the clinical characteristics of patients that would indicate HPS to aid in detection and reporting. Test results of blood samples from U.S. patients suspected of having HPS submitted to the Centers for Disease Control and Prevention from 1998-2010 were reviewed. Patient information collected by case report forms was compared between HPS-confirmed and test-negative patients. Diagnostic sensitivity, specificity, predictive values, and likelihood ratios were calculated for individual clinical findings and combinations of variables. Of 567 patients included, 36% were HPS-confirmed. Thrombocytopenia, chest x-rays with suggestive signs, and receiving supplemental oxygenation were highly sensitive (>95%), while elevated hematocrit was highly specific (83%) in detecting HPS. Combinations that maximized sensitivity required the presence of thrombocytopenia. Using a national sample of suspect patients, we found that thrombocytopenia was a highly sensitive indicator of HPS and should be included in surveillance definitions for suspected HPS. Using a sensitive suspect case definition to identify potential HPS patients that are confirmed by highly specific diagnostic testing will ensure accurate reporting of this disease.

Applying Corpus-Based Findings to Form-Focused Instruction: The Case of Reported Speech

ERIC Educational Resources Information Center

Barbieri, Federica; Eckhardt, Suzanne E. B.

2007-01-01

Arguing that the introduction of corpus linguistics in teaching materials and the language classroom should be informed by theories and principles of SLA, this paper presents a case study illustrating how corpus-based findings on reported speech can be integrated into a form-focused model of instruction. After overviewing previous work which…

Neonatal alloimmune thrombocytopenia with HLA alloimmunization: case report with immunohematologic and placental findings.

PubMed

De Tar, Michael W; Klohe, Ellen; Grosset, Alan; Rau, Thomas

2002-01-01

Severe neonatal thrombocytopenia is associated with a significant risk of neonatal bleeding complications. It may result from increased consumption, increased destruction, deficient production, or abnormal sequestration within the spleen. When immune mediated, most cases of clinically significant neonatal thrombocytopenia are due to maternal alloimmunization to paternally derived platelet antigens present on fetal platelets. We present the clinical, placental, and immunohematologic findings of a case of severe neonatal alloimmune thrombocytopenia (NAITP) complicated by additional HLA group alloimmunization. The placenta showed chronic villitis of unknown etiology (VUE) and diffuse microthrombi within the villous capillaries, indicating that abnormal thrombogenesis can be a complication of severe NAITP.

Targeted case finding for chronic obstructive pulmonary disease versus routine practice in primary care (TargetCOPD): a cluster-randomised controlled trial.

PubMed

Jordan, Rachel E; Adab, Peymané; Sitch, Alice; Enocson, Alexandra; Blissett, Deirdre; Jowett, Sue; Marsh, Jen; Riley, Richard D; Miller, Martin R; Cooper, Brendan G; Turner, Alice M; Jolly, Kate; Ayres, Jon G; Haroon, Shamil; Stockley, Robert; Greenfield, Sheila; Siebert, Stanley; Daley, Amanda J; Cheng, K K; Fitzmaurice, David

2016-09-01

Many individuals with chronic obstructive pulmonary disease (COPD) remain undiagnosed worldwide. Health-care organisations are implementing case-finding programmes without good evidence of which are the most effective and cost-effective approaches. We assessed the effectiveness and cost-effectiveness of two alternative approaches to targeted case finding for COPD compared with routine practice. In this cluster-randomised controlled trial, participating general practices in the West Midlands, UK, were randomly assigned (1:1), via a computer-generated block randomisation sequence, to either a targeted case-finding group or a routine care group. Eligible patients were ever-smokers aged 40-79 years without a previously recorded diagnosis of COPD. Patients in the targeted case-finding group were further randomly assigned (1:1) via their household to receive either a screening questionnaire at the general practitioner (GP) consultation (opportunistic) or a screening questionnaire at the GP consultation plus a mailed questionnaire (active). Respondents reporting relevant respiratory symptoms were invited for post-bronchodilator spirometry. Patients, clinicians, and investigators were not masked to allocation, but group allocation was concealed from the researchers who performed the spirometry assessments. Primary outcomes were the percentage of the eligible population diagnosed with COPD within 1 year (defined as post-bronchodilator forced expiratory volume in 1 s [FEV1] to forced vital capacity [FVC] ratio <0·7 in patients with symptoms or a new diagnosis on their GP record) and cost per new COPD diagnosis. Multiple logistic and Poisson regression were used to estimate effect sizes. Costs were obtained from the trial. This trial is registered with ISRCTN, number ISRCTN14930255. From Aug 10, 2012, to June 22, 2014, 74 818 eligible patients from 54 diverse general practices were randomly assigned and completed the trial. At 1 year, 1278 (4%) cases of COPD were newly

Neuroimaging Findings of Congenital Toxoplasmosis, Cytomegalovirus, and Zika Virus Infections: A Comparison of Three Cases.

PubMed

Werner, Heron; Daltro, Pedro; Fazecas, Tatiana; Zare Mehrjardi, Mohammad; Araujo Júnior, Edward

2017-12-01

Toxoplasmosis, cytomegalovirus (CMV), and Zika virus (ZIKV) are among the common infectious agents that may infect the fetuses vertically. Clinical presentations of these congenital infections overlap significantly, and it is usually impossible to determine the causative agent clinically. The objective was the comparison of neuroimaging findings in three fetuses who underwent intrauterine infection by toxoplasmosis, CMV, and ZIKV. Three confirmed cases of congenital toxoplasmosis, CMV, and ZIKV infections were included in the study over 7 months prospectively. Prenatal ultrasound, fetal brain MRI, and postnatal neuroimaging (CT or MRI) were performed on all of the included cases and interpreted by an expert radiologist. The mean GA at the time of prenatal imaging was 34.5 ± 3.5 weeks. The main neuroimaging findings in congenital toxoplasmosis were randomly distributed brain calcifications and ventricular dilatation on ultrasounds (US), as well as white matter signal change on fetal brain MRI. The main neuroimaging findings of congenital CMV infection included microcephaly, ventriculomegaly, and periventricular calcifications on US, as well as pachygyria revealed by fetal MRI. The case of congenital ZIKV infection showed microcephaly, ventriculomegaly, and periventricular calcifications on ultrasound, as well as brain atrophy and brain surface smoothness on fetal MRI. Although the neuroimaging findings in congenital infections are not pathognomonic, in combination with the patient history may be suggestive of one of the infectious agents, which will guide the management strategy. Copyright © 2017 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.

[Musical-verbal hallucinations and their correlation with electroencephalography and PET findings. Case report].

PubMed

Erkwoh, R; Ebel, H; Kachel, F; Reiche, W; Ringelstein, E B; Zimmermann, J; Büll, U; Sass, H

1992-03-01

A case is reported of an organic auditory hallucinosis and depressive episode in a man aged 52. A new finding is the correlation of the musical hallucinosis to a central nervous disorder as shown by pathological sphenoidal EEG and 18FDG-PET-examination and not to acquired peripheral hearing deficit as often reported before.

Projecting of wave height and water level on reef-lined coasts due to intensified tropical cyclones and sea level rise in Palau to 2100

NASA Astrophysics Data System (ADS)

Hongo, Chuki; Kurihara, Haruko; Golbuu, Yimnang

2018-03-01

Tropical cyclones (TCs) and sea level rise (SLR) cause major problems including beach erosion, saltwater intrusion into groundwater, and damage to infrastructure in coastal areas. The magnitude and extent of damage is predicted to increase as a consequence of future climate change and local factors. Upward reef growth has attracted attention for its role as a natural breakwater, reducing the risks of natural disasters to coastal communities. However, projections of change in the risk to coastal reefs under conditions of intensified TCs and SLR are poorly quantified. In this study we projected the wave height and water level on Melekeok reef in the Palau Islands by 2100, based on wave simulations under intensified TCs (significant wave height at the outer ocean: SWHo = 8.7-11.0 m; significant wave period at the outer ocean: SWPo = 13-15 s) and SLR (0.24-0.98 m). To understand effects of upward reef growth on the reduction of the wave height and water level, the simulation was conducted for two reef condition scenarios: a degraded reef and a healthy reef. Moreover, analyses of reef growth based on a drilled core provided an assessment of the coral community and rate of reef production necessary to reduce the risk from TCs and SLR on the coastal areas. According to our calculations under intensified TCs and SLR by 2100, significant wave heights at the reef flat (SWHr) will increase from 1.05-1.24 m at present to 2.14 m if reefs are degraded. Similarly, by 2100 the water level at the shoreline (WLs) will increase from 0.86-2.10 m at present to 1.19-3.45 m if reefs are degraded. These predicted changes will probably cause beach erosion, saltwater intrusion into groundwater, and damage to infrastructure, because the coastal village is located at ˜ 3 m above the present mean sea level. These findings imply that even if the SWHr is decreased by only 0.1 m by upward reef growth, it will probably reduce the risks of costal damages. Our results showed that a healthy reef

Tuberculosis Case Finding in Benin, 2000–2014 and Beyond: A Retrospective Cohort and Time Series Study

PubMed Central

Ade, Serge; Békou, Wilfried; Adjobimey, Mênonli; Adjibode, Omer; Ade, Gabriel; Harries, Anthony D.; Anagonou, Séverin

2016-01-01

Objective. To determine any changes in tuberculosis epidemiology in the last 15 years in Benin, seasonal variations, and forecasted numbers of tuberculosis cases in the next five years. Materials and Methods. Retrospective cohort and time series study of all tuberculosis cases notified between 2000 and 2014. The “R” software version 3.2.1 (Institute for Statistics and Mathematics Vienna Austria) and the Box-Jenkins 1976 modeling approach were used for time series analysis. Results. Of 246943 presumptive cases, 54303 (22%) were diagnosed with tuberculosis. Annual notified case numbers increased, with the highest reported in 2011. New pulmonary bacteriologically confirmed tuberculosis (NPBCT) represented 78%  ± SD 2%. Retreatment cases decreased from 10% to 6% and new pulmonary clinically diagnosed cases increased from 2% to 8%. NPBCT notification rates decreased in males from 2012, in young people aged 15–34 years and in Borgou-Alibori region. There was a seasonal pattern in tuberculosis cases. Over 90% of NPBCT were HIV-tested with a stable HIV prevalence of 13%. The ARIMA best fit model predicted a decrease in tuberculosis cases finding in the next five years. Conclusion. Tuberculosis case notifications are predicted to decrease in the next five years if current passive case finding is used. Additional strategies are needed in the country. PMID:27293887

Community pharmacy-based case finding for COPD in urban and rural settings is feasible and effective

PubMed Central

Fathima, Mariam; Saini, Bandana; Foster, Juliet M; Armour, Carol L

2017-01-01

Background and objective Case finding of patients at risk of COPD by community pharmacists could identify a substantial number of people with undiagnosed COPD, but little is known about the feasibility and effectiveness of pharmacy-based COPD case finding using microspirometry. The objective of this study was to assess the feasibility and effectiveness of COPD case-finding service provided by community pharmacists, utilizing a combination of risk assessment questionnaire and microspirometry. Methods A 6-month service was conducted in 21 community pharmacies in Australia. Pharmacists trained in COPD case finding, including lung function test (LFT), invited their patients aged ≥35 years with a history of smoking and/or respiratory symptoms to participate. High-risk patients were identified via a COPD risk assessment questionnaire (Initial Screening Questionnaire [ISQ]) and underwent LFT. Pharmacists referred patients with a forced expiratory volume in 1 second (FEV1)/forced expiratory volume in 6 seconds (FEV6) ratio <0.75 to their general practitioner (GP) for further assessment and diagnosis. Results In all, 91 of 167 (54%) patients had an ISQ score >3 indicating high COPD risk. Of the 157 patients who were able to complete LFT, 61 (39%) had an FEV1/FEV6 ratio of <0.75 and were referred to their GP. Patients with high ISQ symptoms scores (>3) were at a significantly higher risk of an FEV1/FEV6 ratio of <0.75, compared to patients with fewer COPD symptoms. A total of 15 (10%) patients were diagnosed with COPD by their GP. Another eight (5%) patients were diagnosed with other medical conditions and 87% of these were initiated on treatment. Although only half of all screened patients lived in regional areas, 93% of those diagnosed with COPD were from regional areas. Conclusion A brief community pharmacy-based COPD case-finding service utilizing the ISQ, LFT and GP referral is feasible and may lead to identification and diagnosis of a substantial number of people

Interaction of “readthrough” acetylcholinesterase with RACK1 and PKCβII correlates with intensified fear-induced conflict behavior

PubMed Central

Birikh, Klara R.; Sklan, Ella H.; Shoham, Shai; Soreq, Hermona

2003-01-01

Behavioral reactions to stress are altered in numerous psychiatric and neurodegenerative syndromes, but the corresponding molecular processes and signal transduction pathways are yet unknown. Here, we report that, in mice, the stress-induced splice variant of acetylcholinesterase, AChE-R, interacts intraneuronally with the scaffold protein RACK1 and through it, with its target, protein kinase CβII (PKCβII), which is known to be involved in fear conditioning. In stress-responsive brain regions of normal FVB/N mice, the mild stress of i.p. injection increased AChE and PKCβII levels in a manner suppressible by antisense prevention of AChE-R accumulation. Injection stress also prolonged conflict between escape and hiding in the emergence into an open field test. Moreover, transgenic FVB/N mice overexpressing AChE-R displayed prolonged delay to emerge into another field (fear-induced behavioral inhibition), associated with chronically intensified neuronal colabeling of RACK1 and PKCβII in stress-responsive brain regions. These findings are consistent with the hypothesis that stress-associated changes in cholinergic gene expression regulate neuronal PKCβII functioning, promoting fear-induced conflict behavior after stress. PMID:12509514

Towards improved biomonitoring tools for an intensified sustainable multi-use environment.

PubMed

van der Meer, Jan Roelof

2016-09-01

The increasing use of our environment for multiple contrasting activities (e.g. fisheries, tourism) will have to be accompanied by improved monitoring of environmental quality, to avoid transboundary conflicts and ensure long-term sustainable intensified usage. Biomonitoring approaches are appropriate for this, since they can integrate biological effects of environmental exposure rather than measure individual compound concentrations. Recent advances in biomonitoring concepts and tools focus on single-cell assays and purified biological components that can be miniaturized and integrated in automated systems. Despite these advances, we are still very far from being able to deploy bioassays routinely in environmental monitoring, mostly because of lack of experience in interpreting responses and insufficient robustness of the biosensors for their environmental application. Further future challenges include broadening the spectrum of detectable compounds by biosensors, accelerate response times and combining sample pretreatment strategies with bioassays. © 2016 The Author. Microbial Biotechnology published by John Wiley & Sons Ltd and Society for Applied Microbiology.

Spectral domain optical coherence tomography findings in tamoxifen retinopathy--a case report.

PubMed

Nair, Sandhya Narayanan; Anantharaman, Giridhar; Gopalakrishnan, Mahesh; Vyas, Jyothiprakash

2013-01-01

To report spectral domain optical coherence tomography findings in a case of typical tamoxifen retinopathy. In this observational case report, a patient with tamoxifen retinopathy was imaged with spectral domain optical coherence tomography and fundus auto fluorescence. Spectral domain optical coherence tomography showed numerous hyperreflective spots within the retina, mainly in the inner retinal layers in both the eyes. The external limiting membrane, the Inner Segment-Outer Segment junction, and the photoreceptors were not discernable at the fovea in the right eye. In the left eye, there was foveal atrophy with total loss of photoreceptors. The autofluorescent images showed macular hypofluorescence with foveal hyperfluorescence. Spectral domain optical coherence tomography demonstrated abnormalities in the outer retinal layers in tamoxifen retinopathy. There were also characteristic alterations in the autofluorescence pattern at the macula in tamoxifen retinopathy.

Social exclusion intensifies anxiety-like behavior in adolescent rats.

PubMed

Lee, Hyunchan; Noh, Jihyun

2015-05-01

Social connection reduces the physiological reactivity to stressors, while social exclusion causes emotional distress. Stressful experiences in rats result in the facilitation of aversive memory and induction of anxiety. To determine the effect of social interaction, such as social connection, social exclusion and equality or inequality, on emotional change in adolescent distressed rats, the emotional alteration induced by restraint stress in individual rats following exposure to various social interaction circumstances was examined. Rats were assigned to one of the following groups: all freely moving rats, all rats restrained, rats restrained in the presence of freely moving rats and freely moving rats with a restrained rat. No significant difference in fear-memory and sucrose consumption between all groups was found. Change in body weight significantly increased in freely moving rats with a restrained rat, suggesting that those rats seems to share the stressful experience of the restrained rat. Interestingly, examination of the anxiety-like behavior revealed only rats restrained in the presence of freely moving rats to have a significant increase, suggesting that emotional distress intensifies in positions of social exclusion. These results demonstrate that unequally excluded social interaction circumstances could cause the amplification of distressed status and anxiety-related emotional alteration. Copyright © 2015 Elsevier B.V. All rights reserved.

Oral findings in a patient with Sebaceous Nevi - A Case Report.

PubMed

Baliga, Vidya; Gopinath, V P K; Baliga, Sudhindra; Chandra, Umesh

2013-10-01

The presentation herewith as scripted is to describe a case with Nevus sebaceous with oral manifestations. Nevus Sebaceous or Jadassohn's nevus is an epidermal nevus with predominant sebaceous glands seen histologically. Reports of oral involvement have been few ranging from papillomatous growths of the tongue, gingiva, palate to dental abnormalities such as anodontia and dysodontia. The present case describes a nevus sebaceous present on the right half of the face and neck, showing intraoral papillomatous growth on the lateral part of the tongue on the right side. The patient was healthy and did not report involvement of any other organ systems. Intraoral involvement may be seen in patients with Nevus Sebaceous, hence proper screening is important. In patients presenting with large nevi on the head and neck such as ours, involvement of other systems such as ocular, neurologic and oral lesions may be seen, therefore screening of such patients is of importance. Patients with nevus sebaceous may be predisposed to the occurrence of tumours. Therefore, careful screening of such patients is necessary. How to cite this article: Baliga V, Gopinath VP, Baliga S, Chandra U. Oral findings in a patient with Sebaceous Nevi - A Case Report. J Int Oral Health 2013; 5(5):139-42.

Lead foil in dental X-ray film: Backscattering rejection or image intensifier?

NASA Astrophysics Data System (ADS)

Hönnicke, M. G.; Delben, G. J.; Godoi, W. C.; Swinka-Filho, V.

2014-11-01

Dental X-ray films are still largely used due to sterilization issues, simplicity and, mainly, economic reasons. These films almost always are double coated (double emulsion) and have a lead foil in contact with the film for X-ray backscattering rejection. Herein we explore the use of the lead foil as an image intensifier. In these studies, spatial resolution was investigated when images were acquired on the dental X-ray films with and without the lead foil. Also, the lead foil was subjected to atomic analysis (fluorescent measurements) and structure analysis (X-ray diffraction). We determined that the use of the lead foil reduces the exposure time, however, does not affect the spatial resolution on the acquired images. This suggests that the fluorescent radiation spread is smaller than the grain sizes of the dental X-ray films.

Retrospective study of sonographic findings in bone involvement associated with rotator cuff calcific tendinopathy: preliminary results of a case series.

PubMed

Nogueira-Barbosa, Marcello H; Gregio-Junior, Everaldo; Lorenzato, Mario Muller

2015-01-01

The present study was aimed at investigating bone involvement secondary to rotator cuff calcific tendonitis at ultrasonography. Retrospective study of a case series. The authors reviewed shoulder ultrasonography reports of 141 patients diagnosed with rotator cuff calcific tendonitis, collected from the computer-based data records of their institution over a four-year period. Imaging findings were retrospectively and consensually analyzed by two experienced musculoskeletal radiologists looking for bone involvement associated with calcific tendonitis. Only the cases confirmed by computed tomography were considered for descriptive analysis. Sonographic findings of calcific tendinopathy with bone involvement were observed in 7/141 (~ 5%) patients (mean age, 50.9 years; age range, 42-58 years; 42% female). Cortical bone erosion adjacent to tendon calcification was the most common finding, observed in 7/7 cases. Signs of intraosseous migration were found in 3/7 cases, and subcortical cysts in 2/7 cases. The findings were confirmed by computed tomography. Calcifications associated with bone abnormalities showed no acoustic shadowing at ultrasonography, favoring the hypothesis of resorption phase of the disease. Preliminary results of the present study suggest that ultrasonography can identify bone abnormalities secondary to rotator cuff calcific tendinopathy, particularly the presence of cortical bone erosion.

Short-term Risk of Serious Fall Injuries in Older Adults Initiating and Intensifying Treatment with Antihypertensive Medication

PubMed Central

Shimbo, Daichi; Bowling, C. Barrett; Levitan, Emily B.; Deng, Luqin; Sim, John J.; Huang, Lei; Reynolds, Kristi; Muntner, Paul

2016-01-01

Background Antihypertensive medication use has been associated with an increased risk of falls in some but not all studies. Few data are available on the short-term risk of falls following antihypertensive medication initiation and intensification. Methods and Results We examined the association between initiating and intensifying antihypertensive medication and serious fall injuries in a case-crossover study of 90,127 Medicare beneficiaries who were ≥65 years old and had a serious fall injury between July 1, 2007 and December 31, 2012, based on emergency department and inpatient claims. Antihypertensive medication initiation was defined by a prescription fill with no fills in the prior year. Intensification was defined by the addition of a new antihypertensive class, and, separately, titration by the addition of a new class or increase in dosage of a current class. Exposures were ascertained for the 15 days before the fall (case period) and six 15-day earlier periods (control periods). Overall, 272, 1508, and 3113 Medicare beneficiaries initiated, added a new class of antihypertensive medication or titrated therapy, respectively, within 15 days of their serious fall injury. The odds for a serious fall injury was increased during the 15 days following antihypertensive medication initiation [odds ratio, OR, 1.36 (95% CI 1.19, 1.55)], adding a new class [OR 1.16 (95% CI 1.10, 1.23)], and titration [OR 1.13 (95% CI 1.08, 1.18)]. These associations were attenuated beyond 15 days. Conclusions Antihypertensive medication initiation and intensification was associated with a short-term, but not long-term, increased risk of serious fall injuries among older adults. PMID:27166208

Short-Term Risk of Serious Fall Injuries in Older Adults Initiating and Intensifying Treatment With Antihypertensive Medication.

PubMed

Shimbo, Daichi; Barrett Bowling, C; Levitan, Emily B; Deng, Luqin; Sim, John J; Huang, Lei; Reynolds, Kristi; Muntner, Paul

2016-05-01

Antihypertensive medication use has been associated with an increased risk of falls in some but not all studies. Few data are available on the short-term risk of falls after antihypertensive medication initiation and intensification. We examined the association between initiating and intensifying antihypertensive medication and serious fall injuries in a case-crossover study of 90 127 Medicare beneficiaries who were ≥65 years old and had a serious fall injury between July 1, 2007, and December 31, 2012, based on emergency department and inpatient claims. Antihypertensive medication initiation was defined by a prescription fill with no fills in the previous year. Intensification was defined by the addition of a new antihypertensive class, and separately, titration by the addition of a new class or increase in dosage of a current class. Exposures were ascertained for the 15 days before the fall (case period) and six 15-day earlier periods (control periods). Overall, 272, 1508, and 3113 Medicare beneficiaries initiated, added a new class of antihypertensive medication or titrated therapy within 15 days of their serious fall injury. The odds for a serious fall injury was increased during the 15 days after antihypertensive medication initiation (odds ratio, 1.36 [95% confidence interval, 1.19-1.55]), adding a new class (odds ratio, 1.16 [95% confidence interval, 1.10-1.23]), and titration [odds ratio, 1.13 [95% confidence interval, 1.08-1.18]). These associations were attenuated beyond 15 days. Antihypertensive medication initiation and intensification was associated with a short-term, but not long-term, increased risk of serious fall injuries among older adults. © 2016 American Heart Association, Inc.

Ocular findings in MELAS syndrome – a case report.

PubMed

Modrzejewska, Monika; Chrzanowska, Martyna; Modrzejewska, Anna; Romanowska, Hanna; Ostrowska, Iwona; Giżewska, Maria

We present a case of a child with MELAS syndrome (mitochondrial encephalo-myopathy with lactic acidosis and stroke-like episodes), discussing clinical manifestation, ocular findings and diagnostic challenges. Predominant ocular symptom was a transient complete visual loss, while the predominant ocular sign was a visual field defect. The diagnosia was based on clinical manifestation, laboratory tests, brain scans and genetic testing which confirmed the pathognomonic mutation in the MTTL1 gene encoding the mitochondrial tRNA for leucine 3243> G. Ocular examination demonstrated decreased visual acuity (with bilateral best corrected visual acuity of .1). Periodical, transient visual loss and visual field defects were clinically predominant. Specialist investigations were carried out, which demonstrated homonymous hemianopia (kinetic perimetry), bilateral partial optic nerve atrophy (RetCam). Funduscopy and electrophysiology mfERG study did not confirm features of retinitis pigmentosa. The brain scans revealed numerous small cortical ischemic lesions within the frontal, parietal and temporal lobes, post-stroke focal areas within the occipital lobes and diffuse calcifications of the basal ganglia. During several years of follow-up, visual field defects showed progressive concentric narrowing. The patient received a long-term treatment with arginine, coenzyme Q and vitamin D, both oral and intravenous, but no beneficial effect for the improvement of ophthalmic condition was observed. As it is the case in severe MELAS syndrome, the course of disease was fatal and the patientdied at the age of 14.

TargetCOPD: a pragmatic randomised controlled trial of targeted case finding for COPD versus routine practice in primary care: protocol.

PubMed

Jordan, Rachel E; Adab, Peymané; Jowett, Sue; Marsh, Jen L; Riley, Richard D; Enocson, Alexandra; Miller, Martin R; Cooper, Brendan G; Turner, Alice M; Ayres, Jon G; Cheng, Kar Keung; Jolly, Kate; Stockley, Robert A; Greenfield, Sheila; Siebert, Stanley; Daley, Amanda; Fitzmaurice, David A

2014-10-04

Many people with clinically significant chronic obstructive pulmonary disease (COPD) remain undiagnosed worldwide. There are a number of small studies which have examined possible methods of case finding through primary care, but no large RCTs that have adequately assessed the most cost-effective approach. In this study, using a cluster randomised controlled trial (RCT) in 56 general practices in the West Midlands, we plan to investigate the effectiveness and cost-effectiveness of a Targeted approach to case finding for COPD compared with routine practice. Using an individual patient RCT nested in the Targeted arm, we plan also to compare the effectiveness and cost-effectiveness of Active case finding using a postal questionnaire (with supplementary opportunistic questionnaires), and Opportunistic-only case finding during routine surgery consultations.All ever-smoking patients aged 40-79 years, without a current diagnosis of COPD and registered with participating practices will be eligible. Patients in the Targeted arm who report positive respiratory symptoms (chronic cough or phlegm, wheeze or dyspnoea) using a brief questionnaire will be invited for further spirometric assessment to ascertain whether they have COPD or not. Post-bronchodilator spirometry will be conducted to ATS standards using an Easy One spirometer by trained research assistants.The primary outcomes will be new cases of COPD and cost per new case identified, comparing targeted case finding with routine care, and two types of targeted case finding (active versus opportunistic). A multilevel logistic regression model will be used to model the probability of detecting a new case of COPD for each treatment arm, with clustering of patients (by practice and household) accounted for using a multi-level structure.A trial-based analysis will be undertaken using costs and outcomes collected during the trial. Secondary outcomes include the feasibility, efficiency, long-term cost-effectiveness, patient and

Target prioritization and strategy selection for active case-finding of pulmonary tuberculosis: a tool to support country-level project planning.

PubMed

Nishikiori, Nobuyuki; Van Weezenbeek, Catharina

2013-02-02

Despite the progress made in the past decade, tuberculosis (TB) control still faces significant challenges. In many countries with declining TB incidence, the disease tends to concentrate in vulnerable populations that often have limited access to health care. In light of the limitations of the current case-finding approach and the global urgency to improve case detection, active case-finding (ACF) has been suggested as an important complementary strategy to accelerate tuberculosis control especially among high-risk populations. The present exercise aims to develop a model that can be used for county-level project planning. A simple deterministic model was developed to calculate the number of estimated TB cases diagnosed and the associated costs of diagnosis. The model was designed to compare cost-effectiveness parameters, such as the cost per case detected, for different diagnostic algorithms when they are applied to different risk populations. The model was transformed into a web-based tool that can support national TB programmes and civil society partners in designing ACF activities. According to the model output, tuberculosis active case-finding can be a costly endeavor, depending on the target population and the diagnostic strategy. The analysis suggests the following: (1) Active case-finding activities are cost-effective only if the tuberculosis prevalence among the target population is high. (2) Extensive diagnostic methods (e.g. X-ray screening for the entire group, use of sputum culture or molecular diagnostics) can be applied only to very high-risk groups such as TB contacts, prisoners or people living with human immunodeficiency virus (HIV) infection. (3) Basic diagnostic approaches such as TB symptom screening are always applicable although the diagnostic yield is very limited. The cost-effectiveness parameter was sensitive to local diagnostic costs and the tuberculosis prevalence of target populations. The prioritization of appropriate target

The contribution of a non-governmental organisation's Community Based Tuberculosis Care Programme to case finding in Myanmar: trend over time.

PubMed

Maung, Htet Myet Win; Saw, Saw; Isaakidis, Petros; Khogali, Mohammed; Reid, Anthony; Hoa, Nguyen Binh; Zaw, Ko Ko; Thein, Saw; Aung, Si Thu

2017-04-03

It is estimated that the standard, passive case finding (PCF) strategy for detecting cases of tuberculosis (TB) in Myanmar has not been successful: 26% of cases are missing. Therefore, alternative strategies, such as active case finding (ACF) by community volunteers, have been initiated since 2011. This study aimed to assess the contribution of a Community Based TB Care Programme (CBTC) by local non-government organizations (NGOs) to TB case finding in Myanmar over 4 years. This was a descriptive study using routine, monitoring data. Original data from the NGOs were sent to a central registry within the National TB Programme and data for this study were extracted from that database. Data from all 84 project townships in five regions and three states in Myanmar were used. The project was launched in 2011. Over time, the number of presumptive TB cases that were referred decreased, except in the Yangon Region, although in some areas, the numbers fluctuated. At the same time, there was a trend for the proportion of cases treated, compared to those referred, that decreased over time (P = 0.051). Overall, among 84 townships, the contribution of CBTC to total case detection deceased from 6% to 4% over time (P < 0.001). Contrary to expectations and evidence from previous studies in other countries, a concerning reduction in TB case finding by local NGO volunteer networks in several areas in Myanmar was recorded over 4 years. This suggests that measures to support the volunteer network and improve its performance are needed. They may include discussion with local NGOs human resources personnel, incentives for the volunteers, closer supervision of volunteers and improved monitoring and evaluation tools.

Effects of Intensified 21st Century Drought on the Boreal Forest of Alaska

NASA Astrophysics Data System (ADS)

Juday, G. P.; Alix, C. M.; Jess, R.; Grant, T. A., III

2014-12-01

A long term perspective on several quasi-decadal cycles of intensifying drought stress across boreal Alaska has been synthesized from monitoring of forest reference stands at Bonanza Creek LTER, Interior Alaska Research Natural Areas, and tree ring sampling across Alaska. The Alaska boreal forest is largely made up of tree populations with two growth responses to temperature increases. Negative responders are more common, and found across the warm, dry Interior. Positive responders are largely in western Alaska, a maritime climate region near the Bering Sea, and at high elevation of the Brooks and Alaska Ranges. Following the North Pacific climate regime shift in 1976-77, negative responder Interior white and black spruce, aspen, and birch all experienced major growth reductions, particularly in warm drought years. Elevated summer temperatures and low annual precipitation of recent decades at low elevations of the Tanana and central Yukon Valleys were outside the values which previously defined the species distributions limits, Long term survival prospects are questionable. Simultaneously, recent elevated temperatures were associated with growth increases of positive responders. On fertile floodplain sites of the lower Yukon and Kuskokwim Rivers, the growth rate of positive responding white spruce is now greater than negative responders for the first time in centuries. NDVI trends in recent decades confirm these opposite growth trends in their respective regions. During peak warm/dry anomalies, forest disturbance, an important process for tree regeneration over the long term, intensified in boreal Alaska. Several insect outbreaks of wood-boring and defoliating species associated with warm temperature/drought stress anomalies appeared, many of them severe, and some not previously known to outbreak. Significant tree injury (e.g. top dieback) and mortality resulted. Wildfire extent and severity increased and reached record levels. The overall pattern has been

The Effect of Intensified Language Exposure on Accommodating Talker Variability.

PubMed

Antoniou, Mark; Wong, Patrick C M; Wang, Suiping

2015-06-01

This study systematically examined the role of intensified exposure to a second language on accommodating talker variability. English native listeners (n = 37) were compared with Mandarin listeners who had either lived in the United States for an extended period of time (n = 33) or had lived only in China (n = 44). Listeners responded to target words in an English word-monitoring task in which sequences of words were randomized. Half of the sequences were spoken by a single talker and the other half by multiple talkers. Mandarin listeners living in China were slower and less accurate than both English listeners and Mandarin listeners living in the United States. Mandarin listeners living in the United States were less accurate than English natives only in the more cognitively demanding mixed-talker condition. Mixed-talker speech affects processing in native and nonnative listeners alike, although the decrement is larger in nonnatives and further exaggerated in less proficient listeners. Language immersion improves listeners' ability to resolve talker variability, and this suggests that immersion may automatize nonnative processing, freeing cognitive resources that may play a crucial role in speech perception. These results lend support to the active control model of speech perception.

FDG PET/CT findings in a case of myositis ossificans circumscripta of the forearm.

PubMed

Clarençon, Frédéric; Larousserie, Frédérique; Babinet, Antoine; Zylbersztein, Christophe; Talbot, Jean-Noël; Kerrou, Khaldoun

2011-01-01

Myositis ossificans circumscripta (MOC) is a rare benign neoplasm located in soft tissues that, most of the time, appears after a local trauma. The positive diagnosis of MOC may be challenging on CT or MRI findings. We report on an atypical case of a spontaneous nontraumatic MOC in a 54-year-old man, located in the longus supinatus muscle diagnosed with MRI and F-18 FDG PET/CT findings. Rarely described F-18 FDG PET/CT features in MOC are presented. Pattern of avid FDG focus on PET/CT, that may wrongly suggest osteosarcoma, is presented.

Swallowing endoscopy findings in Huntington's disease: a case report.

PubMed

Alves, Thaís Coelho; Cola, Paula Cristina; Santos, Rarissa Rúbia Dallaqua Dos; Motonaga, Suely Mayumi; Silva, Roberta Gonçalves da

2016-01-01

Huntington's disease (HD) is a degenerative genetic disorder with autosomal-dominant transmission. The triad of symptoms of this disease consists of psychiatric disorders, jerky movements, and dementia. Oropharyngeal dysphagia, which is more evident with disease progression, is also present. Few studies have addressed the swallowing characteristics using objective analysis in this population. The purpose of this research was to describe the swallowing endoscopic findings of the pharyngeal phase in HD. This is a cross-sectional study addressing a clinical case which included two individuals of the same family, male, 32 and 63 years old, designated as individual A and individual B, with progression of the disease for five and 13 years, respectively. Consistent liquid, nectar, and puree were offered during the evaluation. There was presence of posterior oral spillage in liquid and nectar, small amount of pharyngeal residues, and no laryngeal penetration or aspiration in the individuals with HD in this study.

Exfoliative cytologic findings of primary pulmonary adenoid cystic carcinom: a report of 2 cases with a review of the cytologic features.

PubMed

Daneshbod, Yahya; Modjtahedi, Ebrahim; Atefi, Sohrab; Bedayat, Gholam Reza; Daneshbod, Khosrow

2007-01-01

Adenoid cystic carcinoma is a very rare primary pulmonary neoplasm. Cytologic findings of pulmonary washing and brushing in 2 cases of primary bronchial adenoid cystic carcinoma with special histologic features are described, with an emphasis on some points that have not been reported previously, together with the diagnostic pitfalls. Two cases of primary adenoid cystic carcinoma of the lung were diagnosed on exfoliative cytology. The patients' ages were 55 and 65 years old. Cytologic findings included large and small clusters of small cells in both 2 and 3 dimensions with occasional cystlike spaces containing mucoid material. The cells were arranged in spherical, cylindrical, basaloid and rosettelike arrangements. There were also abundant small and large mucoid globules, cylinders of homogeneous, acellular, mucous material and "cannon balls." Cytoplasmic and intranuclear round inclusions were noted in case 1. Rare findings of nuclear molding were noted. In case 2, chondromyxoid material and a bimorphic population of tumor cells caused diagnostic confusion with other salivary gland-type tumors of the lung. These cases showed characteristic cytologic findings of adenoid cystic carcinoma together with rare findings of intracellular and extracellular inclusionlike bodies, myxochondroid material, bimorphic populations and nuclear molding, which can cause diagnostic confusion with other lung tumors.

Retrospective study of sonographic findings in bone involvement associated with rotator cuff calcific tendinopathy: preliminary results of a case series*

PubMed Central

Nogueira-Barbosa, Marcello H.; Gregio-Junior, Everaldo; Lorenzato, Mario Muller

2015-01-01

Objective The present study was aimed at investigating bone involvement secondary to rotator cuff calcific tendonitis at ultrasonography. Materials and Methods Retrospective study of a case series. The authors reviewed shoulder ultrasonography reports of 141 patients diagnosed with rotator cuff calcific tendonitis, collected from the computer-based data records of their institution over a four-year period. Imaging findings were retrospectively and consensually analyzed by two experienced musculoskeletal radiologists looking for bone involvement associated with calcific tendonitis. Only the cases confirmed by computed tomography were considered for descriptive analysis. Results Sonographic findings of calcific tendinopathy with bone involvement were observed in 7/141 (~ 5%) patients (mean age, 50.9 years; age range, 42-58 years; 42% female). Cortical bone erosion adjacent to tendon calcification was the most common finding, observed in 7/7 cases. Signs of intraosseous migration were found in 3/7 cases, and subcortical cysts in 2/7 cases. The findings were confirmed by computed tomography. Calcifications associated with bone abnormalities showed no acoustic shadowing at ultrasonography, favoring the hypothesis of resorption phase of the disease. Conclusion Preliminary results of the present study suggest that ultrasonography can identify bone abnormalities secondary to rotator cuff calcific tendinopathy, particularly the presence of cortical bone erosion. PMID:26811551

Effect of Using High Signal-to-Noise Image Intensifier Tubes on Night Vision Goggle (NVG) Aided Visual Acuity

DTIC Science & Technology

2006-05-01

tubes utilizing thin- filmed technology allowing for a higher SNR, and the F4949G goggles were tested. Twelve participants tested each goggle under six...LogMAR Visual Acuity as a Function of Illumination, Contrast, and NVG ........ 37 Repeated Measures Within-Subjects Analysis of Variance...auto-gated power supply and thin- filmed technology. The Pinnacle’sTM thin- filmed technology gave the image intensifier tube an increase in the signal-to

BUTIMBA: Intensifying the Hunt for Child TB in Swaziland through Household Contact Tracing

PubMed Central

Alonso Ustero, Pilar; Golin, Rachel; Anabwani, Florence; Mzileni, Bulisile; Sikhondze, Welile; Stevens, Robert

2017-01-01

Background Limited data exists to inform contact tracing guidelines in children and HIV-affected populations. We evaluated the yield and additionality of household contact and source case investigations in Swaziland, a TB/HIV high-burden setting, while prioritizing identification of childhood TB. Methods In partnership with 7 local TB clinics, we implemented standardized contact tracing of index cases (IC) receiving TB treatment. Prioritizing child contacts and HIV-affected households, screening officers screened contacts for TB symptoms and to identify risk factors associated with TB. We ascertained factors moderating the yield of contact tracing and measured the impact of our program by additional notifications. Results From March 2013 to November 2015, 3,258 ICs (54% bacteriologically confirmed; 70% HIV-infected; 85% adults) were enrolled leading to evaluation of 12,175 contacts (median age 18 years, IQR 24–42; 45% children; 9% HIV-infected). Among contacts, 196 TB cases (56% bacteriologically confirmed) were diagnosed resulting in a program yield of 1.6% for all forms of TB. The number needed to screen (NNS) to identify a bacteriologically confirmed TB case or all forms TB case traced from a child IC <5 years was respectively 62% and 40% greater than the NNS for tracing from an adult IC. In year one, we demonstrated a 32% increase in detection of bacteriologically confirmed child TB. Contacts were more likely to have TB if <5 years (OR = 2.0), HIV-infected (OR = 4.9), reporting ≥1 TB symptoms (OR = 7.7), and sharing a bed (OR = 1.7) or home (OR = 1.4) with the IC. There was a 1.4 fold increased chance of detecting a TB case in households known to be HIV-affected. Conclusion Contact tracing prioritizing children is not only feasible in a TB/HIV high-burden setting but contributes to overall case detection. Our findings support WHO guidelines prioritizing contact tracing among children and HIV-infected populations while highlighting potential to integrate TB

Two micron pore size MCP-based image intensifiers

NASA Astrophysics Data System (ADS)

Glesener, John; Estrera, Joseph

2010-02-01

Image intensifiers (I2) have many advantages as detectors. They offer single photon sensitivity in an imaging format, they're light in weight and analog I2 systems can operate for hours on a single AA battery. Their light output is such as to exploit the peak in color sensitivity of the human eye. Until recent developments in CMOS sensors, they also were one of the highest resolution sensors available. The closest all solid state solution, the Texas Instruments Impactron chip, comes in a 1 megapixel format. Depending on the level of integration, an Impactron based system can consume 20 to 40 watts in a system configuration. In further investing in I2 technology, L-3 EOS determined that increasing I2 resolution merited a high priority. Increased I2 resolution offers the system user two desirable options: 1) increased detection and identification ranges while maintaining field-of-view (FOV) or 2) increasing FOV while maintaining the original system resolution. One of the areas where an investment in resolution is being made is in the microchannel plate (MCP). Incorporation of a 2 micron MCP into an image tube has the potential of increasing the system resolution of currently fielded systems. Both inverting and non-inverting configurations are being evaluated. Inverting tubes are being characterized in night vision goggle (NVG) and sights. The non-inverting 2 micron tube is being characterized for high resolution I2CMOS camera applications. Preliminary measurements show an increase in the MTF over a standard 5 micron pore size, 6 micron pitch plate. Current results will be presented.

The theoretical simulation on electrostatic distribution of 1st proximity region in proximity focusing low-light-level image intensifier

NASA Astrophysics Data System (ADS)

Zhang, Liandong; Bai, Xiaofeng; Song, De; Fu, Shencheng; Li, Ye; Duanmu, Qingduo

2015-03-01

Low-light-level night vision technology is magnifying low light level signal large enough to be seen by naked eye, which uses the photons - photoelectron as information carrier. Until the micro-channel plate was invented, it has been possibility for the realization of high performance and miniaturization of low-light-level night vision device. The device is double-proximity focusing low-light-level image intensifier which places a micro-channel plate close to photocathode and phosphor screen. The advantages of proximity focusing low-light-level night vision are small size, light weight, small power consumption, no distortion, fast response speed, wide dynamic range and so on. It is placed parallel to each other for Micro-channel plate (both sides of it with metal electrode), the photocathode and the phosphor screen are placed parallel to each other. The voltage is applied between photocathode and the input of micro-channel plate when image intensifier works. The emission electron excited by photo on the photocathode move towards to micro-channel plate under the electric field in 1st proximity focusing region, and then it is multiplied through the micro-channel. The movement locus of emission electrons can be calculated and simulated when the distributions of electrostatic field equipotential lines are determined in the 1st proximity focusing region. Furthermore the resolution of image tube can be determined. However the distributions of electrostatic fields and equipotential lines are complex due to a lot of micro-channel existing in the micro channel plate. This paper simulates electrostatic distribution of 1st proximity region in double-proximity focusing low-light-level image intensifier with the finite element simulation analysis software Ansoft maxwell 3D. The electrostatic field distributions of 1st proximity region are compared when the micro-channel plates' pore size, spacing and inclination angle ranged. We believe that the electron beam movement

A qualitative study of primary care professionals’ views of case finding for depression in patients with diabetes or coronary heart disease in the UK

PubMed Central

2013-01-01

Background Routinely conducting case finding (also commonly referred to as screening) in patients with chronic illness for depression in primary care appears to have little impact. We explored the views and experiences of primary care nurses, doctors and managers to understand how the implementation of case finding/screening might impact on its effectiveness. Methods Two complementary qualitative focus group studies of primary care professionals including nurses, doctors and managers, in five primary care practices and five Community Health Partnerships, were conducted in Scotland. Results We identified several features of the way case finding/screening was implemented that may lead to systematic under-detection of depression. These included obstacles to incorporating case finding/screening into a clinical review consultation; a perception of replacing individualised care with mechanistic assessment, and a disconnection for nurses between management of physical and mental health. Far from being a standardised process that encouraged detection of depression, participants described case finding/screening as being conducted in a way which biased it towards negative responses, and for nurses, it was an uncomfortable task for which they lacked the necessary skills to provide immediate support to patients at the time of diagnosis. Conclusion The introduction of case finding/screening for depression into routine chronic illness management is not straightforward. Routinized case finding/screening for depression can be implemented in ways that may be counterproductive to engagement (particularly by nurses), with the mental health needs of patients living with long term conditions. If case finding/screening or engagement with mental health problems is to be promoted, primary care nurses require more training to increase their confidence in raising and dealing with mental health issues and GPs and nurses need to work collectively to develop the relational work required to

A qualitative study of primary care professionals' views of case finding for depression in patients with diabetes or coronary heart disease in the UK.

PubMed

Maxwell, Margaret; Harris, Fiona; Hibberd, Carina; Donaghy, Eddie; Pratt, Rebekah; Williams, Chris; Morrison, Jill; Gibb, Jennifer; Watson, Philip; Burton, Chris

2013-04-04

Routinely conducting case finding (also commonly referred to as screening) in patients with chronic illness for depression in primary care appears to have little impact. We explored the views and experiences of primary care nurses, doctors and managers to understand how the implementation of case finding/screening might impact on its effectiveness. Two complementary qualitative focus group studies of primary care professionals including nurses, doctors and managers, in five primary care practices and five Community Health Partnerships, were conducted in Scotland. We identified several features of the way case finding/screening was implemented that may lead to systematic under-detection of depression. These included obstacles to incorporating case finding/screening into a clinical review consultation; a perception of replacing individualised care with mechanistic assessment, and a disconnection for nurses between management of physical and mental health. Far from being a standardised process that encouraged detection of depression, participants described case finding/screening as being conducted in a way which biased it towards negative responses, and for nurses, it was an uncomfortable task for which they lacked the necessary skills to provide immediate support to patients at the time of diagnosis. The introduction of case finding/screening for depression into routine chronic illness management is not straightforward. Routinized case finding/screening for depression can be implemented in ways that may be counterproductive to engagement (particularly by nurses), with the mental health needs of patients living with long term conditions. If case finding/screening or engagement with mental health problems is to be promoted, primary care nurses require more training to increase their confidence in raising and dealing with mental health issues and GPs and nurses need to work collectively to develop the relational work required to promote cognitive participation in case

Radiologic Findings of Primary Mucinous Cystadenocarcinoma of the Breast: A Report of Two Cases and a Literature Review.

PubMed

Seong, Minjung; Ko, Eun Young; Han, Boo-Kyung; Cho, Soo Youn; Cho, Eun Yoon; Lee, Se Kyung; Lee, Jeong Eon

2016-09-01

Primary mucinous cystadenocarcinoma (MCA) of the breast is a rare but pathologically distinct breast tumor. There have been some case reports on primary MCA of the breast; however, they have all focused on pathologic findings. Here, we report the radiologic findings of two cases of MCA along with a review of the literature. Breast MCA shows a circumscribed mass with some calcifications on mammography, an intracystic solid mass without increased vascularity or a vascular stalk on ultrasound, and a heterogeneously enhancing mass within a rim-enhancing cyst with intermediate signal intensity on T2-weighted magnetic resonance imaging. These radiologic findings and the presence of mucin in the percutaneous biopsy specimen should suggest the possibility of MCA in the differential diagnosis of a breast tumor.

Radiologic Findings of Primary Mucinous Cystadenocarcinoma of the Breast: A Report of Two Cases and a Literature Review

PubMed Central

Seong, Minjung; Han, Boo-Kyung; Cho, Soo Youn; Cho, Eun Yoon; Lee, Se Kyung; Lee, Jeong Eon

2016-01-01

Primary mucinous cystadenocarcinoma (MCA) of the breast is a rare but pathologically distinct breast tumor. There have been some case reports on primary MCA of the breast; however, they have all focused on pathologic findings. Here, we report the radiologic findings of two cases of MCA along with a review of the literature. Breast MCA shows a circumscribed mass with some calcifications on mammography, an intracystic solid mass without increased vascularity or a vascular stalk on ultrasound, and a heterogeneously enhancing mass within a rim-enhancing cyst with intermediate signal intensity on T2-weighted magnetic resonance imaging. These radiologic findings and the presence of mucin in the percutaneous biopsy specimen should suggest the possibility of MCA in the differential diagnosis of a breast tumor. PMID:27721884

Star tracking method based on multiexposure imaging for intensified star trackers.

PubMed

Yu, Wenbo; Jiang, Jie; Zhang, Guangjun

2017-07-20

The requirements for the dynamic performance of star trackers are rapidly increasing with the development of space exploration technologies. However, insufficient knowledge of the angular acceleration has largely decreased the performance of the existing star tracking methods, and star trackers may even fail to track under highly dynamic conditions. This study proposes a star tracking method based on multiexposure imaging for intensified star trackers. The accurate estimation model of the complete motion parameters, including the angular velocity and angular acceleration, is established according to the working characteristic of multiexposure imaging. The estimation of the complete motion parameters is utilized to generate the predictive star image accurately. Therefore, the correct matching and tracking between stars in the real and predictive star images can be reliably accomplished under highly dynamic conditions. Simulations with specific dynamic conditions are conducted to verify the feasibility and effectiveness of the proposed method. Experiments with real starry night sky observation are also conducted for further verification. Simulations and experiments demonstrate that the proposed method is effective and shows excellent performance under highly dynamic conditions.

Climate change and ocean deoxygenation within intensified surface-driven upwelling circulations.

PubMed

Bakun, Andrew

2017-09-13

Ocean deoxygenation often takes place in proximity to zones of intense upwelling. Associated concerns about amplified ocean deoxygenation arise from an arguable likelihood that coastal upwelling systems in the world's oceans may further intensify as anthropogenic climate change proceeds. Comparative examples discussed include the uniquely intense seasonal Somali Current upwelling, the massive upwelling that occurs quasi-continuously off Namibia and the recently appearing and now annually recurring 'dead zone' off the US State of Oregon. The evident 'transience' in causal dynamics off Oregon is somewhat mirrored in an interannual-scale intermittence in eruptions of anaerobically formed noxious gases off Namibia. A mechanistic scheme draws the three examples towards a common context in which, in addition to the obvious but politically problematic remedy of actually reducing 'greenhouse' gas emissions, the potentially manageable abundance of strongly swimming, finely gill raker-meshed small pelagic fish emerges as a plausible regulating factor.This article is part of the themed issue 'Ocean ventilation and deoxygenation in a warming world'. © 2017 The Author(s).

Submucosal hematoma is a highly suggestive finding for amyloid light-chain amyloidosis: Two case reports

PubMed Central

Yoshii, Shinji; Mabe, Katsuhiro; Nosho, Katsuhiko; Yamamoto, Hiroyuki; Yasui, Hiroshi; Okuda, Hiroyuki; Suzuki, Akira; Fujita, Masahiro; Sato, Toshihiro

2012-01-01

The clinical and endoscopic features of amyloid light-chain (AL) amyloidosis are diverse and mimic various other diseases. Endoscopically, few reports on submucosal hematomas of the gastrointestinal (GI) tract are available in the literature. Here, we report two cases of AL amyloidosis presenting as submucosal hematomas in the absence of clinical disease elsewhere in the body. The 2 cases were referred to our hospital because of hematochezia. The endoscopic findings in both cases were similar in submucosal hematoma formation. However, the clinical courses differed. In the first case, there was no evidence of systemic amyloidosis and the disease was conservatively managed. In the second case, the disease progressed to systemic amyloidosis and the patient died within a short time. We conclude that the endoscopic detection of a submucosal hematoma in the setting of GI bleeding should raise suspicion of AL amyloidosis. Referral to a hematologist should be done immediately for treatment while the involvement is limited to the GI tract. PMID:23125904

Active Surveillance of Hansen's Disease (Leprosy): Importance for Case Finding among Extra-domiciliary Contacts

PubMed Central

Moura, Maria L. N.; Dupnik, Kathryn M.; Sampaio, Gabriel A. A.; Nóbrega, Priscilla F. C.; Jeronimo, Ana K.; do Nascimento-Filho, Jose M.; Miranda Dantas, Roberta L.; Queiroz, Jose W.; Barbosa, James D.; Dias, Gutemberg; Jeronimo, Selma M. B.; Souza, Marcia C. F.; Nobre, Maurício L.

2013-01-01

Hansen's disease (leprosy) remains an important health problem in Brazil, where 34,894 new cases were diagnosed in 2010, corresponding to 15.3% of the world's new cases detected in that year. The purpose of this study was to use home visits as a tool for surveillance of Hansen's disease in a hyperendemic area in Brazil. A total of 258 residences were visited with 719 individuals examined. Of these, 82 individuals had had a previous history of Hansen's disease, 209 were their household contacts and 428 lived in neighboring residences. Fifteen new Hansen's disease cases were confirmed, yielding a detection rate of 2.0% of people examined. There was no difference in the detection rate between household and neighbor contacts (p = 0.615). The two groups had the same background in relation to education (p = 0.510), household income (p = 0.582), and the number of people living in the residence (p = 0.188). Spatial analysis showed clustering of newly diagnosed cases and association with residential coordinates of previously diagnosed multibacillary cases. Active case finding is an important tool for Hansen's disease control in hyperendemic areas, enabling earlier diagnosis, treatment, decrease in disability from Hansen's disease and potentially less spread of Mycobacterium leprae. PMID:23516645

Enhanced tuberculosis case finding through advocacy and sensitisation meetings in prisons of Central India

PubMed Central

Mallick, G.; Agrawal, T. K.; Kumar, A. M. V.; Chadha, S. S.

2017-01-01

Tuberculosis (TB) in prisons is a major problem. The prisons in Chhattisgarh, India, are overcrowded, and there are no formal efforts to engage them in TB control. In 2014, the International Union Against Tuberculosis and Lung Disease and the state TB programme advocated with state prison authorities to implement an enhanced case-finding strategy in the prisons. Sensitisation meetings (one/quarter/prison) to improve awareness among prisoners about TB symptoms and services were coupled with improved access to diagnosis. Patients with presumptive TB who were examined by sputum microscopy increased by 39% per 100 000 prisoners, and TB case notification rates increased by 38%, in 2014 relative to 2013. PMID:28775946

Reduced risk of heart failure with intensified multifactorial intervention in individuals with type 2 diabetes and microalbuminuria: 21 years of follow-up in the randomised Steno-2 study.

PubMed

Oellgaard, Jens; Gæde, Peter; Rossing, Peter; Rørth, Rasmus; Køber, Lars; Parving, Hans-Henrik; Pedersen, Oluf

2018-05-30

In type 2 diabetes mellitus, heart failure is a frequent, potentially fatal and often forgotten complication. Glucose-lowering agents and adjuvant therapies modify the risk of heart failure. We recently reported that 7.8 years of intensified compared with conventional multifactorial intervention in individuals with type 2 diabetes and microalbuminuria in the Steno-2 study reduced the risk of cardiovascular disease and prolonged life over 21.2 years of follow-up. In this post hoc analysis, we examine the impact of intensified multifactorial intervention on the risk of hospitalisation for heart failure. One hundred and sixty individuals were randomised to conventional or intensified multifactorial intervention, using sealed envelopes. The trial was conducted using the Prospective, Randomised, Open, Blinded Endpoints (PROBE) design. After 7.8 years, all individuals were offered intensified therapy and the study continued as an observational follow-up study for an additional 13.4 years. Heart-failure hospitalisations were adjudicated from patient records by an external expert committee blinded for treatment allocation. Event rates were compared using a Cox regression model adjusted for age and sex. Eighty patients were assigned to each treatment group. Ten patients undergoing intensive therapy vs 24 undergoing conventional therapy were hospitalised for heart failure during follow-up. The HR (95% CI) was 0.30 (0.14, 0.64), p = 0.002 in the intensive-therapy group compared with the conventional-therapy group. Including death in the endpoint did not lead to an alternate overall outcome; HR 0.51 (0.34, 0.76), p = 0.001. In a pooled cohort analysis, an increase in plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) during the first two years of the trial was associated with incident heart failure. Intensified, multifactorial intervention for 7.8 years in type 2 diabetic individuals with microalbuminuria reduced the risk of hospitalisation for heart

A qualitative study of GP, nurse and practice manager views on using targeted case-finding to identify patients with COPD in primary care.

PubMed

Summers, Rachael H; Sharmeen, Taniya; Lippiett, Kate; Gillett, Kate; Astles, Carla; Vu, Linh; Stafford-Watson, Mark; Bruton, Anne; Thomas, Mike; Wilkinson, Tom

2017-08-29

'Finding the missing millions' with chronic obstructive pulmonary disease became part of the Department of Health strategy for England in 2010. Targeted case-finding within primary care is one potential pro-active strategy, but currently little is known about the views of healthcare professionals on this approach. In this study, 36 healthcare professionals (12 GPs, 14 nurses, and 10 practice managers) from 34 UK practices participated in semi-structured telephone interviews about targeted case-finding. Interviews followed an interview guide, were audio-recorded, transcribed verbatim, coded and analysed using 'Framework Approach'. Most of those interviewed practiced opportunistic case-finding. The main perceived barriers to wider case-finding programmes were the resource implications associated with running such programmes and identifying more chronic obstructive pulmonary disease patients. Financial incentives, support from specialist clinicians, and comprehensive guidance were viewed as facilitators. While targeted case-finding is conceptually accepted by primary care staff, scepticism surrounding (1) the value of identifying those with mild disease and (2) the availability of effective targeted case-finding methods, may lead some to favour an opportunistic approach. Key concerns were a lack of unequivocal evidence for the relative benefits vs. disadvantages of diagnosing patients earlier, and resource constraints in an already over-burdened system. Barriers to practical implementation of case-finding studies may be addressed with financial, human and educational resources, such as additional staff to undertake searches and perform spirometry tests, and practical and educational support from specialist teams. SUPPORT NEEDED TO IDENTIFY THOSE UNDIAGNOSED: Additional staff and resources would facilitate targeted searches for patients showing symptoms of early-stage chronic lung disease. Chronic obstructive pulmonary disease (COPD) costs the UK economy billions of

Factors associated with trace evidence analyses and DNA findings among police reported cases of rape.

PubMed

Forr, Camilla; Schei, Berit; Stene, Lise Eilin; Ormstad, Kari; Hagemann, Cecilie Therese

2018-02-01

The aim of this study was to examine the association between victim, suspect and assault characteristics and (1) forensic analysis of trace evidence, (2) detection of spermatozoa and (3) DNA match in police-reported cases of rape/attempted rape. In addition, we explored whether DNA findings were associated with legal outcome. We conducted a retrospective, descriptive study based on police-reported rapes and attempted rapes of women  ≥16 years of age in Sør-Trøndelag Police District throughout 1997-2010. Police data were merged with information from the Sexual Assault Centre (SAC) at St. Olavs University Hospital, Trondheim, Norway. We used binary and multivariable logistic regression for the comparisons. We identified 324 victims (mean age 24 years). The police requested analysis in 135 (45%) of the 299 collected victim samples. The police decision to analyze was after adjustment associated with the victim being employed or under education, and a public venue, but not with interval from assault to sampling. Spermatozoa were detected in 79 (61%) of the analyzed cases, of which 71 were collected from victims within 24h. Interval from assault being <24h and reporting a penetrative assault remained associated with the findings of spermatozoa after adjustments. Forensic analyses of trace evidence collected from victim, suspect and/or venue disclosed matching DNA profiles in 57 (40%) of a total of 143 analyzed cases. Matching DNA profiles were associated with suspect being known to the victim and with the venue being private. A higher proportion of cases with a DNA match were prosecuted in court: 20 of the 29 cases prosecuted. However, despite a DNA match 35 cases were anyway dismissed because of insufficient evidence. Although many of the associations in our study were expected, it is still important to report the actual numbers to gain insight into the importance of a DNA match in legal proceedings. A substantial proportion of cases with DNA match was dismissed

Chronic obstructive pulmonary disease case finding by community pharmacists: a potential cost-effective public health intervention.

PubMed

Wright, David; Twigg, Michael; Thornley, Tracey

2015-02-01

This study aims to pilot a community pharmacy chronic obstructive pulmonary disease (COPD) case finding service in England, estimating costs and effects. Patients potentially at risk of COPD were screened with validated tools. Smoking cessation was offered to all smokers identified as potentially having undiagnosed COPD. Cost and effects of the service were estimated. Twenty-one community pharmacies screened 238 patients over 9 months. One hundred thirty-five patients were identified with potentially undiagnosed COPD; 88 were smokers. Smoking cessation initiation provided a project gain of 38.62 life years, 19.92 quality-adjusted life years and a cost saving of £392.67 per patient screened. COPD case finding by community pharmacists potentially provides cost-savings and improves quality of life. © 2014 The Authors. International Journal of Pharmacy Practice published by John Wiley & Sons Ltd on behalf of Royal Pharmaceutical Society.

Ocular findings in a case of trisomy 18 with variant of Dandy-Walker syndrome.

PubMed

Lim, Fong-Fong; Ng, Yan-Yan; Hu, Jui-Ming; Chen, Suh-Jen; Su, Pen-Hua; Chen, Jia-Yuh

2010-10-01

Trisomy 18 is the second most common chromosomal syndrome and has multiple dysmorphic features. However, ocular findings in trisomy 18 are rarely reported. Retinal folds are the most common ocular finding described to date, although retinal hypopigmentation, dysplasia, and areas of hemorrhage and gliosis are also found in trisomy 18. Dandy-Walker syndrome is a brain malformation that has been reported in association with numerous chromosomal abnormalities, although it has rarely been reported in association with trisomy 18. Here, we present a case of trisomy 18 with ocular pathology and variant of Dandy-Walker syndrome, a combination that has not previously been reported. Copyright © 2010 Taiwan Pediatric Association. Published by Elsevier B.V. All rights reserved.

Literacy and Numeracy Needs and Priorities: A Case Study of Regional TAFE Courses in Western Australia.

ERIC Educational Resources Information Center

Chapman, Anne; Pyvis, David

Rural Technical and Further Education (TAFE) students making the transition from rural and remote areas of Australia to urban university environments are likely to face educational challenges. Different understandings of literacy and numeracy held by the TAFE and tertiary sectors intensify these challenges. Case studies of four Western Australia…

Late onset epilepsy associated with marijuana abuse: a case report with MRI findings.

PubMed

Fogang, Yannick Fogoum; Camara, Massaman; Mbonda, Paul Chimi; Toffa, Dènahin; Touré, Kamadore

2014-01-01

Marijuana is the most widely used illicit substance in the world. The relation between marijuana use and epileptic seizures is still controversial. We report a case of late onset epilepsy associated with marijuana abuse, with brain magnetic resonance imaging (MRI) findings. A 44-year-old patient was admitted for 03 isolated episodes of secondary generalized tonic-clonic seizures. He had a history of 26 years regular marijuana smoking. On admission, we found a tachycardia, psychomotor slowing, asymmetric hyperreflexia, bilateral Babinski sign without weakness. Laboratory work-up showed a high level of urine of Δ-9-tétrahydroxycannabinol. Electroencephalogram was normal. Brain MRI revealed abnormal signal intensities in the right frontal lobe and basal ganglia. Seizures cessation was obtained with anti-epileptic treatment. We suggest that marijuana abuse through vascular and toxic mechanisms could explain seizures in this case.

Animation of Tropical Storm Joaquin right before it intensified into a hurricane on September 29, 2015

NASA Image and Video Library

2017-12-08

system moving over warm waters, the National Hurricane Center is forecasting Joaquin to intensify further, possibly into a major hurricane within the next few days. Credit: NASA's Scientific Visualization Studio Data provided by the joint NASA/JAXA GPM mission NASA image use policy. NASA Goddard Space Flight Center enables NASA’s mission through four scientific endeavors: Earth Science, Heliophysics, Solar System Exploration, and Astrophysics. Goddard plays a leading role in NASA’s accomplishments by contributing compelling scientific knowledge to advance the Agency’s mission. Follow us on Twitter Like us on Facebook Find us on Instagram

Stepping back to advance: Why IGD needs an intensified debate instead of a consensus.

PubMed

Quandt, Thorsten

2017-06-01

Based on their analysis of Internet gaming disorder (IGD) criteria, Kuss, Griffiths, and Pontes (2017) come to the conclusion that the current situation can be described as "chaos and confusion." Their assessment is not an exaggeration. It can be argued that there are even more issues, on logical/definitional and political/social levels: (a) the IGD diagnosis is lacking a well-defined object, (b) the cause and effect cannot be differentiated outside lab conditions, (c) the social and political effects of declaring a social behavior as a disease are worrying, and (d) a rushed diagnosis may construct an addiction with potentially harmful effects on (formerly) healthy populations. Instead of closing the debate by declaring a consensus and codifying IGD in the DSM, an undogmatic, intensified, and broader discussion is needed.

'Finding the person the disease has'--the case for multisensory environments.

PubMed

Hope, K W; Easby, R; Waterman, H

2004-10-01

Education about, and exposure to, the utilization of a multisensory environment (MSE) was provided to clinical staff as a response to findings from the problem identification stage of an action research study. Feedback was obtained about their experience and perceptions of its use. Through the auspices of focus groups and one-to-one interviews, respondents commented on the impact that using the MSE had on their perception of their clients and on subsequent care. The case is made that MSEs afford an opportunity to impact on care through their mediating influence on formal carers' perceptions of their clients and, as such represent a significant but as yet unrealized potential for improving the quality of care of older people with dementia.

Epidermolysis bullosa acquisita: clinical manifestations, microscopic findings, and surgical periodontal therapy. A case report.

PubMed

Hakki, S S; Celenligil-Nazliel, H; Karaduman, A; Usubütün, A; Ertoy, D; Ayhan, A; Ruacan, S

2001-04-01

Epidermolysis bullosa acquisita (EBA) is an uncommon, acquired, chronic subepidermal bullous disease. This report describes a case of EBA with gingival involvement. A 43-year-old woman with EBA was referred to our clinic for periodontal therapy because of gingival tenderness and bleeding. She has been on cyclosporin A therapy for the last 2 years. Clinical findings were analyzed. Anterior gingivectomy operations were performed in 2 stages. The samples obtained during the surgery were examined using histopathologic, immunohistologic, and electronmicroscopic methods. Long-term effects of the surgical periodontal treatment on gingiva were evaluated both clinically and microscopically. The dentition displayed minimal enamel hypoplasia. Decayed, missing, and filled surfaces score was found to be elevated. Periodontal examination showed generalized diffuse gingival inflammation and gingival enlargement localized mainly to the anterior region. Nikolsky's sign was positive. However, wound healing was uneventful after the operations. Microscopic findings were similar to those obtained from the skin. Twenty-one months after the operations, Nikolsky's sign was negative and no remarkable gingival inflammation was noted. Microscopic examination revealed that the blisters were fewer in number and smaller in size. These results indicate that gingival tissues may also be involved in EBA. Uneventful wound healing after periodontal surgery in this case suggests that periodontal surgery can be performed in patients with EBA. Moreover, both our clinical and histopathologic findings imply that gingivectomy proves useful in maintaining gingival integrity in these patients. Our data may also suggest that the patients with EBA are highly likely to develop dental caries.

Ultrasonographic findings of placenta lacunae and a lack of a clear zone in cases with placenta previa and normal placenta.

PubMed

Hamada, Shoko; Hasegawa, Junichi; Nakamura, Masamitsu; Matsuoka, Ryu; Ichizuka, Kiyotake; Sekizawa, Akihiko; Okai, Takashi

2011-11-01

To evaluate whether the frequencies of placenta lacunae and lack of a clear zone are higher in cases of placenta previa compared with those without it. Ultrasonographic findings just before delivery, including placenta lacunae and lack of a clear zone were prospectively evaluated in consecutive subjects. After collection, a case-control study with 1:5 matched pairs was conducted. The frequencies of ultrasonographic findings were analyzed in cases with placenta previa and normal placenta. Seventy cases with placenta previa and 350 cases with normal placentas were observed. Five and zero cases with abnormal placental adherence were observed in cases with placenta previa and normal placenta, respectively. Lack of a clear zone was observed in 60 and 1.5% of cases with and without the placental adherence (p = 0.001). Placenta lacunae and lack of a clear zone were observed in 31.4 and 9.7% of cases with and without placenta previa [odds ratio (OR) 4.2]. Lack of a clear zone was observed in 5.7 and 0.9% of cases with and without placenta previa (OR 7.0). Placenta lacunae and lack of a clear zone are frequently observed in placenta previa even when there is no adherence of the placenta. Copyright © 2011 John Wiley & Sons, Ltd.

New on the Shelf: Teens in the Library. Findings from the Evaluation of Public Libraries as Partners in Youth Development, An Initiative of the Wallace Foundation. Final Report

ERIC Educational Resources Information Center

Spielberger, Julie; Horton, Carol; Michels, Lisa; Halpern, Robert

2004-01-01

Several trends have come together to intensify interest in how public libraries might best support the interests and needs of youth in their communities. This study reports on findings from the Public Libraries as Partners in Youth Development (PLPYD) Initiative, a four-year, nine-site initiative funded by the Wallace Foundation to develop…

Randomized comparison of renal denervation versus intensified pharmacotherapy including spironolactone in true-resistant hypertension: six-month results from the Prague-15 study.

PubMed

Rosa, Ján; Widimský, Petr; Toušek, Petr; Petrák, Ondřej; Čurila, Karol; Waldauf, Petr; Bednář, František; Zelinka, Tomáš; Holaj, Robert; Štrauch, Branislav; Šomlóová, Zuzana; Táborský, Miloš; Václavík, Jan; Kociánová, Eva; Branny, Marian; Nykl, Igor; Jiravský, Otakar; Widimský, Jiří

2015-02-01

This prospective, randomized, open-label multicenter trial evaluated the efficacy of catheter-based renal denervation (Symplicity, Medtronic) versus intensified pharmacological treatment including spironolactone (if tolerated) in patients with true-resistant hypertension. This was confirmed by 24-hour ambulatory blood pressure monitoring after excluding secondary hypertension and confirmation of adherence to therapy by measurement of plasma antihypertensive drug levels before enrollment. One-hundred six patients were randomized to renal denervation (n=52), or intensified pharmacological treatment (n=54) with baseline systolic blood pressure of 159±17 and 155±17 mm Hg and average number of drugs 5.1 and 5.4, respectively. A significant reduction in 24-hour average systolic blood pressure after 6 months (-8.6 [95% cofidence interval: -11.8, -5.3] mm Hg; P<0.001 in renal denervation versus -8.1 [95% cofidence interval: -12.7, -3.4] mm Hg; P=0.001 in pharmacological group) was observed, which was comparable in both groups. Similarly, a significant reduction in systolic office blood pressure (-12.4 [95% cofidence interval: -17.0, -7.8] mm Hg; P<0.001 in renal denervation versus -14.3 [95% cofidence interval: -19.7, -8.9] mm Hg; P<0.001 in pharmacological group) was present. Between-group differences in change were not significant. The average number of antihypertensive drugs used after 6 months was significantly higher in the pharmacological group (+0.3 drugs; P<0.001). A significant increase in serum creatinine and a parallel decrease of creatinine clearance were observed in the pharmacological group; between-group difference were borderline significant. The 6-month results of this study confirmed the safety of renal denervation. In conclusion, renal denervation achieved reduction of blood pressure comparable with intensified pharmacotherapy. © 2014 American Heart Association, Inc.

COPD case finding by spirometry in high-risk customers of urban community pharmacies: a pilot study.

PubMed

Castillo, D; Guayta, R; Giner, J; Burgos, F; Capdevila, C; Soriano, J B; Barau, M; Casan, P

2009-06-01

COPD case finding is currently recommended at primary and tertiary care levels only. To evaluate the feasibility of a community pharmacy program for COPD case finding in high-risk customers by means of spirometry. Pilot cross-sectional descriptive study in 13 urban community pharmacies in Barcelona, Spain, from April to May 2007. Customers >40 years old with respiratory symptoms and/or a history of smoking were invited to participate in the study during pharmacists' routine work shifts. High-risk customers were identified by means of a 5-item COPD screening questionnaire based on criteria of the Global Initiative for Chronic Obstructive Lung Disease, and were invited to perform spirometry accordingly. Those with an FEV(1)/FVC ratio less than 0.70 were referred to the hospital for a repeat spirometry. Of the 161 pharmacy customers studied, 100 (62%) scored 3 or more items in the COPD screening questionnaire, and after spirometry, 21 (24%) had an FEV(1)/FVC ratio<0.7. When these subjects with airflow limitation were offered referral to a hospital respiratory function laboratory for further assessments, 11 (52%) attended the appointment. Over 70% of spirometries were rated as being of acceptable quality. No significant differences were observed in lung function parameters between the pharmacy and hospital measurements. COPD case finding by spirometry in high-risk customers of urban community pharmacies is feasible. Similarly to primary care practitioners, pharmacists have access to high-risk, middle-aged subjects who have never been tested for COPD. Pharmacists can help with early detection of COPD if they are correctly trained.

Cognitive Therapy and Task Concentration Training Applied as Intensified Group Therapies for Social Anxiety Disorder with Fear of Blushing-A Randomized Controlled Trial.

PubMed

Härtling, Samia; Klotsche, Jens; Heinrich, Anke; Hoyer, Jürgen

2016-11-01

The current study examines the efficacy of intensified group therapy for social anxiety disorder with fear of blushing. Task concentration training (TCT) and cognitive therapy (CT) were applied during one weekend and compared with a waiting list condition in a randomized controlled trial including 82 patients. On a second weekend, another intervention was added (resulting in TCT-CT and CT-TCT sequences) to examine order effects. Task concentration training and CT were both superior to the waiting list and equally effective after the first therapy weekend. Also, no differences were found between the sequences TCT-CT and CT-TCT at post-assessment. At 6- and 12-month follow-up, effects remained stable or further improved. At the 6-month follow-up, remission rates in completers, established by diagnostic status, were between 69% and 73%. Intensified group therapy is highly effective in treating social anxiety disorder with fear of blushing. Group formats for patients sharing a common primary concern may contribute to the dissemination of cognitive-behavioural therapy. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message: This study focuses on blushing from fearful individuals within the SAD spectrum to improve evidence for treatment efficacy in those whose social fears are centred around observable bodily sensations. This study integrates task concentration training into the SAD model of Clark and Wells to combine two evidence-based treatments for SAD under one treatment model. This study uses an innovative format of brief, intensified group therapy, conducted on two full-day weekend group sessions delivered over two weekends, with strong observed effect sizes. Copyright © 2015 John Wiley & Sons, Ltd.

Clinical features and imaging findings in a case of Capgras syndrome.

PubMed

Luca, Maria; Bordone, Andrea; Luca, Antonina; Patti, Andrea; Sortino, Giuseppe; Calandra, Carmela

2013-01-01

Capgras syndrome consists of the delusional belief that a person or persons have been replaced by doubles or impostors. It can occur in the context of both psychiatric and organic illness, and seems to be related to lesions of the bifrontal and right limbic and temporal regions. Indeed, magnetic resonance imaging has revealed brain lesions in patients suffering from Capgras syndrome. This case study reports the findings of a thorough diagnostic evaluation in a woman suffering from Capgras syndrome and presenting with the following clinical peculiarities: obsessive modality of presentation of the delusional ideation, intrusiveness of such ideation (that even disturbed her sleep), as well as a sense of alienation and utter disgust towards the double. These characteristics bring to mind the typical aspects of obsessive-compulsive disorder. Neuroanatomic investigation, through magnetic resonance imaging, performed on this patient showed alteration of the bilateral semioval centers, which are brain regions associated with the emotion of disgust and often show alterations in subjects suffering from obsessive-compulsive disorder. Hence, neuroimaging allows researchers to put forward the hypothesis of a common neuroanatomic basis for Capgras syndrome and obsessive-compulsive disorder, at least for cases in which the delusional ideation is associated with deep feelings of disgust and presents with a certain pervasiveness.

Clinical features and imaging findings in a case of Capgras syndrome

PubMed Central

Luca, Maria; Bordone, Andrea; Luca, Antonina; Patti, Andrea; Sortino, Giuseppe; Calandra, Carmela

2013-01-01

Capgras syndrome consists of the delusional belief that a person or persons have been replaced by doubles or impostors. It can occur in the context of both psychiatric and organic illness, and seems to be related to lesions of the bifrontal and right limbic and temporal regions. Indeed, magnetic resonance imaging has revealed brain lesions in patients suffering from Capgras syndrome. This case study reports the findings of a thorough diagnostic evaluation in a woman suffering from Capgras syndrome and presenting with the following clinical peculiarities: obsessive modality of presentation of the delusional ideation, intrusiveness of such ideation (that even disturbed her sleep), as well as a sense of alienation and utter disgust towards the double. These characteristics bring to mind the typical aspects of obsessive-compulsive disorder. Neuroanatomic investigation, through magnetic resonance imaging, performed on this patient showed alteration of the bilateral semioval centers, which are brain regions associated with the emotion of disgust and often show alterations in subjects suffering from obsessive-compulsive disorder. Hence, neuroimaging allows researchers to put forward the hypothesis of a common neuroanatomic basis for Capgras syndrome and obsessive-compulsive disorder, at least for cases in which the delusional ideation is associated with deep feelings of disgust and presents with a certain pervasiveness. PMID:23950650

Foetus in foetu: CT findings in two cases.

PubMed

Chadha, M; Aggarwal, B K

2002-01-01

Foetus in foetu is a rare abdominal mass presenting in early childhood, which shows classic radiologic appearances that make a preoperative diagnosis certain. We present two such cases in which the diagnosis was initially established on computed tomography, which showed mature skeletal structures including vertebrae and long bones in addition to fat. The diagnosis was corroborated by plain radiography and magnetic resonance imaging in one case and confirmed operatively and histopathologically in both cases.

Seismo-Ionospheric Coupling as Intensified EIA Observed by Satellite Electron Density and GPS-TEC Data

NASA Astrophysics Data System (ADS)

Ryu, K.; Jangsoo, C.; Kim, S. G.; Jeong, K. S.; Parrot, M.; Pulinets, S. A.; Oyama, K. I.

2014-12-01

Examples of intensified EIA features temporally and spatially related to large earthquakes observed by satellites and GPS-TEC are introduced. The precursory, concurrent, and ex-post enhancements of EIA represented by the equatorial electron density, which are thought to be related to the M8.7 Northern Sumatra earthquake of March 2005, the M8.0 Pisco earthquake of August 2007, and the M7.9 Wenchuan Earthquake of 12 May 2008, are shown with space weather condition. Based on the case studies, statistical analysis on the ionospheric electron density data measured by the Detection of Electro-Magnetic Emissions Transmitted from Earthquake Regions satellite (DEMETER) over a period of 2005-2010 was executed in order to investigate the correlation between seismic activity and equatorial plasma density variations. To simplify the analysis, three equatorial regions with frequent earthquakes were selected and then one-dimensional time series analysis between the daily seismic activity indices and the EIA intensity indices were performed for each region with excluding the possible effects from the geomagnetic and solar activity. The statistically significant values of the lagged cross-correlation function, particularly in the region with minimal effects of longitudinal asymmetry, indicate that some of the very large earthquakes with M > 7.0 in the low latitude region can accompany observable seismo-ionospheric coupling phenomena in the form of EIA enhancements, even though the seismic activity is not the most significant driver of the equatorial ionospheric evolution. The physical mechanisms of the seismo-ionospheric coupling to explain the observation and the possibility of earthquake prediction using the EIA intensity variation are discussed.

Development of natural cellulase inhibitor mediated intensified biological pretreatment technology using Pleurotus florida for maximum recovery of cellulose from paddy straw under solid state condition.

PubMed

Naresh Kumar, Manickam; Ravikumar, Rajarathinam; Thenmozhi, Senniyappan; Kirupa Sankar, Muthuvelu

2017-11-01

Inhibitor mediated intensified bio-pretreatment (IMBP) technology using natural cellulase inhibitor (NCI) for maximum cellulose recovery from paddy straw was studied. Pretreatment was carried out under solid state condition. Supplementation of 8% NCI in pretreatment medium improves cellulose recovery and delignification by 1.2 and 1.5-fold respectively, compared to conventional bio-pretreatment due to inhibition of 61% of cellulase activity in IMBP. Further increase in NCI concentration showed negative effect on Pleurotus florida growth and suppress the laccase productivity by 1.1-fold. Laccase activity in IMBP was found to be 2.0U/mL on 19 th day, which is higher than (1.5U/mL) conventional bio-pretreatment. Physico-chemical modifications in paddy straw before and after pretreatment were analysed by SEM, ATR-FTIR, XRD and TGA. According to these findings, the IMBP technology can be a viable eco-friendly technology for sustainable production of bioethanol with maximum cellulose recovery. Copyright © 2017 Elsevier Ltd. All rights reserved.

Qualitative numerical study of simultaneous high-G-intensified gas–solids contact, separation and segregation in a bi-disperse rotating fluidized bed in a vortex chamber

DOE PAGES

De Wilde, Juray; Richards, George; Benyahia, Sofiane

2016-05-13

Coupled discrete particle method – computational fluid dynamics simulations are carried out to demonstrate the potential of combined high-G-intensified gas-solids contact, gas-solids separation and segregation in a rotating fluidized bed in a static vortex chamber. A case study with two distinct types of particles is focused on. When feeding solids using a standard solids inlet design, a dense and uniform rotating fluidized bed is formed, guaranteeing intense gas-solids contact. The presence of both types of particles near the chimney region reduces, however, the strength of the central vortex and is detrimental for separation and segregation. Optimization of the solids inletmore » design is required, as illustrated by stopping the solids feeding. High-G separation and segregation of the batch of particles is demonstrated, as the strength of the central vortex is restored. The flexibility with respect to the gas flow rate of the bed density and uniformity and of the gas-solids separation and segregation is demonstrated, a unique feature of vortex chamber generated rotating fluidized beds. With the particles considered in this case study, turbulent dispersion by large eddies in the gas phase is shown to have only a minor impact on the height of the inner bed of small/light particles.« less

Abdominal Wall Endometriosis Eleven Years After Cesarean Section: Case Report

PubMed

Djaković, Ivka; Vuković, Ante; Bolanča, Ivan; Soljačić Vraneš, Hrvojka; Kuna, Krunoslav

2017-03-01

Endometriosis is a common chronic disease characterized by growth of the endometrial gland and stroma outside the uterus. Symptoms affect physical, mental and social well-being. Extrapelvic location of endometriosis is very rare. Abdominal wall endometriosis occurs in 0.03%-2% of women with a previous cesarean section or other abdominopelvic operation. The leading symptoms are abdominal nodular mass, pain and cyclic symptomatology. The number of cesarean sections is increasing and so is the incidence of abdominal wall endometriosis as a potential complication of the procedure. There are cases of malignant transformation of abdominal wall endometriosis. Therefore, it is important to recognize this condition and treat it surgically. We report a case of a 37-year-old woman with abdominal wall endometriosis 11 years after cesarean section. She had low abdominal pain related to menstrual cycle, which intensified at the end of menstrual bleeding. A nodule painful to palpation was found in the medial part of previous Pfannenstiel incision. Ultrasound guided biopsy was performed and the diagnosis of endometriosis confirmed. Surgery is the treatment of choice for abdominal wall endometriosis. Excision with histologically proven free surgical margins of 1 cm is mandatory to prevent recurrence. A wide spectrum of mimicking conditions is the main reason for late diagnosis and treatment of abdominal wall endometriosis. In our case, the symptoms lasted for eight years and had intensified in the last six months prior to surgery.

Barriers to glaucoma case finding as perceived by optometrists in Ireland.

PubMed

Barrett, Catriona; O'Brien, Colm; Butler, John S; Loughman, James

2018-01-01

This research was designed to provide an in-depth exploration of the perceptions of optometrists relating to the challenges of glaucoma case finding in the Irish health-care system. A survey was developed, piloted and distributed for anonymous completion by optometrists registered to practise in Ireland. The survey included 10 five-level Likert items exploring potential barriers to glaucoma detection and a free-text box for participants to comment more broadly. One hundred and ninety-nine optometrists (27 per cent of registrants) responded to the survey. Among the barriers identified, there was notable agreement (71 per cent) with the need for extra training on glaucoma detection. Logistic regression showed that optometrists without postgraduate qualifications were more likely to agree with the need for extra training (OR 3.2, 95 per cent CI 1.3-8.1). Respondents largely agreed (61 per cent) that patient unwillingness to pay additional fees for supplementary glaucoma-specific tests was also a barrier. Appointment times of less than 30 minutes were significantly associated with six of the 10 proposed barriers to glaucoma detection. A logistic regression analysis (n = 179) confirmed that the time allotted per appointment was a significant predictor of the agreement time of optometrists as a barrier (χ 2 [1] = 13.52, p < 0.001). Multiple linear regression showed that optometrists with less experience, charging lower fees, and working in large multiples or franchised practices have the shortest appointment times. The strong link found between postgraduate education and the confidence of optometrists in detecting glaucoma indicates that optometrists wishing to increase their scope of practice in the new legislative environment in Ireland may more actively seek training in areas of interest. The responses also indicate a lack of funding for the level of diagnostic testing required for accurate glaucoma diagnosis. Recent increases in the state's eye examination fees look

Finding a Balance: Fifteen Institutional Case Studies on the Relationship between Part-Time Work and Advanced Level Study. Report.

ERIC Educational Resources Information Center

Hodgson, Ann, Ed.; Spours, Ken, Ed.

This document presents and discusses case studies that examined the relationship between part-time employment and advanced level study at 15 schools in Essex, England. "Foreword" (David Jones) provides a brief overview of the project. "Finding a Balance--Fifteen Institutional Case Studies on the Relationship between Part-time Work…

An evaluation of clinical, radiological and three-dimensional dental tomography findings in ectodermal dysplasia cases.

PubMed

Doğan, Mehmet-Sinan; Callea, Michele; Yavuz, Ìzzet; Aksoy, Orhan; Clarich, Gabriella; Günay, Ayse; Günay, Ahmet; Güven, Sedat; Maglione, Michele; Akkuş, Zeki

2015-05-01

This study aimed to review the results related to head and jaw disorders in cases of ectodermal dysplasia. The evaluation of ectodermal dysplasia cases was made by clinical examination and examination of the jaw and facial areas radiologically and on cone-beam 3-dimensional dental tomography (CBCT) images. In the 36 cases evaluated in the study, typical clinical findings of pure hypohidrotic ectodermal displasia (HED) were seen, such as missing teeth, dry skin, hair and nail disorders. CBCT images were obtained from 12 of the 36 cases, aged 1.5- 45 years, and orthodontic analyses were made on these images. The clinical and radiological evaluations determined, hypodontia or oligodontia, breathing problems, sweating problems, a history of fever, sparse hair, saddle nose, skin peeling, hypopigmentation, hyperpigmentation, finger and nail deformities, conical teeth anomalies, abnormal tooth root formation, tooth resorption in the root, gingivitis, history of epilepsy, absent lachrymal canals and vision problems in the cases which included to the study. Ectodermal dysplasia cases have a particular place in dentistry and require a professional, multi-disciplinary approach in respect of the chewing function, orthognathic problems, growth, oral and dental health. It has been understood that with data obtained from modern technologies such as three-dimensional dental tomography and the treatments applied, the quality of life of these cases can be improved.

Real-Time Detection of Sporadic Meteors in the Intensified TV Imaging Systems.

PubMed

Vítek, Stanislav; Nasyrova, Maria

2017-12-29

The automatic observation of the night sky through wide-angle video systems with the aim of detecting meteor and fireballs is currently among routine astronomical observations. The observation is usually done in multi-station or network mode, so it is possible to estimate the direction and the speed of the body flight. The high velocity of the meteorite flying through the atmosphere determines the important features of the camera systems, namely the high frame rate. Thanks to high frame rates, such imaging systems produce a large amount of data, of which only a small fragment has scientific potential. This paper focuses on methods for the real-time detection of fast moving objects in the video sequences recorded by intensified TV systems with frame rates of about 60 frames per second. The goal of our effort is to remove all unnecessary data during the daytime and make free hard-drive capacity for the next observation. The processing of data from the MAIA (Meteor Automatic Imager and Analyzer) system is demonstrated in the paper.

Real-Time Detection of Sporadic Meteors in the Intensified TV Imaging Systems

PubMed Central

2017-01-01

The automatic observation of the night sky through wide-angle video systems with the aim of detecting meteor and fireballs is currently among routine astronomical observations. The observation is usually done in multi-station or network mode, so it is possible to estimate the direction and the speed of the body flight. The high velocity of the meteorite flying through the atmosphere determines the important features of the camera systems, namely the high frame rate. Thanks to high frame rates, such imaging systems produce a large amount of data, of which only a small fragment has scientific potential. This paper focuses on methods for the real-time detection of fast moving objects in the video sequences recorded by intensified TV systems with frame rates of about 60 frames per second. The goal of our effort is to remove all unnecessary data during the daytime and make free hard-drive capacity for the next observation. The processing of data from the MAIA (Meteor Automatic Imager and Analyzer) system is demonstrated in the paper. PMID:29286294

Inducing Stable α + β Microstructures during Selective Laser Melting of Ti-6Al-4V Using Intensified Intrinsic Heat Treatments

PubMed Central

Barriobero-Vila, Pere; Gussone, Joachim; Haubrich, Jan; Sandlöbes, Stefanie; Da Silva, Julio Cesar; Cloetens, Peter; Schell, Norbert; Requena, Guillermo

2017-01-01

Selective laser melting is a promising powder-bed-based additive manufacturing technique for titanium alloys: near net-shaped metallic components can be produced with high resource-efficiency and cost savings. For the most commercialized titanium alloy, namely Ti-6Al-4V, the complicated thermal profile of selective laser melting manufacturing (sharp cycles of steep heating and cooling rates) usually hinders manufacturing of components in a one-step process owing to the formation of brittle martensitic microstructures unsuitable for structural applications. In this work, an intensified intrinsic heat treatment is applied during selective laser melting of Ti-6Al-4V powder using a scanning strategy that combines porosity-optimized processing with a very tight hatch distance. Extensive martensite decomposition providing a uniform, fine lamellar α + β microstructure is obtained along the building direction. Moreover, structural evidence of the formation of the intermetallic α2-Ti3Al phase is provided. Variations in the lattice parameter of β serve as an indicator of the microstructural degree of stabilization. Interconnected 3D networks of β are generated in regions highly affected by the intensified intrinsic heat treatment applied. The results obtained reflect a contribution towards simultaneous selective laser melting-manufacturing and heat treatment for fabrication of Ti-6Al-4V parts. PMID:28772630

Effects of a natural community intervention intensifying alcohol law enforcement combined with a restrictive alcohol policy on adolescent alcohol use.

PubMed

Schelleman-Offermans, Karen; Knibbe, Ronald A; Kuntsche, Emmanuel; Casswell, Sally

2012-12-01

Determining whether intensified inspections on alcohol retailers, combined with a policy withdrawing liquor licenses if retailers are fined twice per annum, is effective in reducing adolescents' odds to initiate weekly drinking and drunkenness. Causal pathways by which the intervention was assumed to work were tested. A longitudinal (2008, 2009, and 2010) quasi-experimental comparison group design including two Dutch communities, one intervention and one comparison, was used. Outcomes were assessed by following a cohort of 1,327 adolescents (aged 13-15 years at baseline). The intervention resulted in increased retail inspections but only seven sanctions and no repeated sanctions in 1 year. The intervention did not reduce adolescents' odds to initiate weekly drinking. Weekly drinking adolescents in the intervention community were at reduced risk to initiate drunkenness. This effect was not mediated by smaller increases in the frequency of adolescents' alcohol purchases or their perceived ease of purchasing alcohol. Intensified enforcement was effective in preventing adolescent drunkenness. No mediating causal pathways were detected. Effectiveness of enforcement could be increased by adopting enforcement methods with a high likelihood of apprehension, increasing social support for restrictive measures, and mobilizing the community to be more outspoken against adolescent (heavy) drinking. Copyright © 2012 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

New type of x-ray-wafer image intensifier with CsI-CsI/MCP photocathodes: its design and assessment

NASA Astrophysics Data System (ADS)

Xiang, Shiming; Zhao, Hong

1993-04-01

The article introduces a new type of x-ray wafer image intensifier with a double proximity focusing system, (Phi) 50 CsI-CsI/MCP photocathode, and a series of welding constructions of glass window or ceramic components with metal rings. This kind of x-ray image intensifier has been widely used in the field of medical diagnosis and industrial non-destructive detection by means of sophisticated portable x-ray diagnoscopes, featuring a number of satisfactory performances such as low x-ray dosage, miniature x-ray tube and power supply, high output brightness and good resolution, light weight, small volume, low cost, and easy operation without any condition constrained by working environment and illumination. In the paper, the authors have given a series of formulae to determine characteristic parameters of the device, i.e., the quantum detection efficiencies of both reflection mode (CsI/MCP) and transmission mode (glass window CsI/MCP) photocathode, the brightness conversion factor, and resolution. The relations of the mentioned parameters with the performances of constituent components, which include CsI photocathodes layer thickness, MCP bias angle and gain, phosphor screen conversion efficiency, and double proximity focusing distances, are also briefly analyzed. The analysis thought and methods mentioned in the paper have been successfully used for the optimal design and assessment work of our devices and shows that they have a good coincidence with experimental results.

(18)F-FDG PET/CT findings in a case with HIV (-) Kaposi sarcoma.

PubMed

Ozdemir, E; Poyraz, N Y; Keskin, M; Kandemir, Z; Turkolmez, S

2014-01-01

Although mucocutaneous sites are the most frequently encountered sites of involvement, Kaposi Sarcoma (KS) may also occasionally involve the breast and the skeletal, endocrine, urinary and nervous systems.. Various imaging modalities may be used to delineate the extent of the disease by detecting unexpected sites of involvement. Herein, we report a case of classical type KS, in whom staging with (18)F-FDG PET/CT imaging disclosed widespread disease and unexpected findings of bone and salivary gland involvement. Copyright © 2013 Elsevier España, S.L. and SEMNIM. All rights reserved.

Culturally and Linguistically Responsive Teaching in Practice: A Case Study of a Fourth-Grade Mainstream Classroom Teacher

ERIC Educational Resources Information Center

Zhang-Wu, Qianqian

2017-01-01

As a result of increases in immigration, more students from culturally and linguistically diverse backgrounds are entering K-12 classrooms in the United States. Thus, the need to study the education of diverse learners is intensified. Drawing upon semi-structured interviews, observations, and informal conversations, this case study examined how a…

Forecast simulation of rapidly-intensified typhoon in the Eddy-Rich Northwest Pacific region

NASA Astrophysics Data System (ADS)

Kim, Kyeong Ok; Yuk, Jin-Hee; Jung, Kyung Tae; Kuh Kang, Suk

2017-04-01

The real-time typhoon predictions in the Northwest Pacific (NWP) are being distributed by various agencies (for example, KMA, JMA, JTWC, NMC, CWB, HKO and PAGASA). Currently the movement of the typhoon can be predicted with an error of less than 100 km in 48 hours, however it is difficult to the predict of the intensity of the typhoon especially the Rapidly Intensified (RI) Typhoons. The mean occurrence of RI typhoon amounts to 5.4 times a year during 39 years (1977-2015), occupying 21% of typhoons in NWP. Especially the RI typhoon in the Eddy-Rich Northwest Pacific (ER-NWP) occurred 1.8 times a year, covering 29% of typhoons in ER-NWP. A RI typhoon, NEPARTAK (T201601), occurred in July 2016. It was formed in Caroline Islands and moved northwest, straightly heading for Taiwan. However, at the beginning stage many forecasting agencies predicts as move to the Yellow Sea. The accuracy of prediction data of the Typhoon NEPARTAK (T201601) from KMA, JMA and JTWC was compared with the adjusted best-track data from Digital-Typhoon (JMA-RSMC). The sequential prediction data are summarized with 6-hour interval from 3th to 10th July 2016.The JMA prediction of the typhoon track and the JTWC predictions of the maximum wind speed were found to be best. The numerical simulations using WRF model forced with NCEP GFS prediction data and microwave SST is compared. The simulations using one domain (D1), two domains (D2) using a moving nest scheme, and with or without the spectral nudging (-SN) are compared. Comparison of the errors on the track shows the differences of 100 km in 48-hour prediction and200 km in 72-hour prediction on average. The best results on the track prediction are shown in the D2 case of WRF model. However, underestimation of the maximum wind speed of WRF prediction still exists, obviously requiring better understanding of RI-related processes to improve the model prediction.

Impact of medico-legal findings on charge filing in cases of rape in adult women.

PubMed

Hagemann, Cecilie T; Stene, Lise E; Myhre, Arne K; Ormstad, Kari; Schei, Berit

2011-11-01

To assess the impact of the medical documentation and biological trace evidence in rape cases on the legal process. Retrospective descriptive study. Police-reported cases of rape of women ≥16 years old in the Norwegian county of Sør-Trøndelag from January 1997 to June 2003. Police data were merged with data from the Sexual Assault Center at St Olav's Hospital. Charged and non-charged cases were compared. Medico-legal findings and legal outcome. A total of 185 police-reported cases were identified. Of the 101 cases examined at Sexual Assault Center, charges were filed in 18 cases. Extragenital injuries were documented in 49 women; five were life threatening. Anogenital injuries were documented in 14 women; eight had multiple anogenital injuries. Documentation of injuries was not associated with charge filing. In only 33% of the cases were swabs collected from women's genitals used as trace evidence by the police. When used, this increased the likelihood for charge filing. A DNA profile matching the suspect was identified in four of the 18 charged cases and in only one among the 54 non-charged cases. Half of the women had one or more documented injury. Only one-third of the trace evidence kits collected from the women's anogenital area were analyzed. The analysis of swabs was associated with charge filing, regardless of test results. Increased use of such medical evidence, especially in cases of stranger rape, may ensure women's rights and increase available information to the legal system. © 2011 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2011 Nordic Federation of Societies of Obstetrics and Gynecology.

Various upper endoscopic findings of acute esophageal thermal injury induced by diverse food: a case series.

PubMed

Lee, Yu Mi; Kim, Sun Moon; Kim, Ji Young; Song, Hyun Jung; Koo, Hoon Sup; Song, Kyung Ho; Kim, Yong Seok; Huh, Kyu Chan

2014-09-01

Esophageal thermal injury caused by food has been reported to occur mostly after drinking hot liquid food, and is known to produce alternating white and red linear mucosal bands. In addition, thermal injury caused by ingestion of hot solid foods is documented to be a cause of esophageal ulcers or pseudomembranes. From January 2006 to August 2012, five patients with suspected esophageal thermal injury underwent esophagogastroduodenoscopy with biopsy. A "candy-cane" appearance was observed in one case, pseudomembrane was observed in two cases, an esophageal ulcer was observed in one case, and a friable and edematous mucosa was noted in one case. We believe that the endoscopic findings of esophageal thermal injury depend on the following factors: causative materials, amount of food consumed, exposure period, and time to endoscopy after the incident. Therefore, physicians who encounter patients with suspected esophageal thermal injury should carefully take the patient's history considering these factors.

An intervention of active TB case finding among smokers attending routine primary care facilities in China: an exploratory study.

PubMed

Wei, Xiaolin; Zou, Guangyan; Chong, Marc Kc; Xu, Lin

2015-09-01

Smoking is an important risk factor of TB. However, no studies have been conducted to identify TB cases from smokers. We assessed the process and initial impact of active case finding among smokers at primary care facilities in a setting with high smoking rates and TB burden. A prospective quasi-experimental study was conducted in para-urban communities in Yunnan China between September 2013 and June 2014. Smokers attending primary care facilities in the intervention group were prescribed chest X-rays if they had diabetes or TB symptoms, or were elders or close contacts of TB patients. Those with X-rays suggestive of TB were referred to TB dispensaries for diagnosis. Passive case finding was practiced in the control group. In the intervention group, we screened 471 smokers with high risks of TB, of whom 73% took chest X-ray examinations. Eight TB cases were diagnosed, reflecting a 1.7% yield rate of all screened smokers. Smokers with diabetes (OR 6.003, 95% CI 1.057-34.075) were more likely to have TB compared with those without. In total, the intervention group reported significantly higher TB notification rate compared with the control group (38.6 vs 22.9 per 100 000, p=0.016). Active case finding among smokers with high risks of TB was feasible and contributed to improved notification rates. © The Author 2015. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Angioinvasive pulmonary aspergillosis after allogeneic bone marrow transplantation: clinical and high-resolution computed tomography findings in 12 cases.

PubMed

Gasparetto, Emerson L; Souza, Carolina A; Tazoniero, Priscilla; Davaus, Taisa; Escuissato, Dante L; Marchiori, Edson

2007-02-01

The aim of this study was to present the clinical and high-resolution CT scan findings of angioinvasive pulmonary aspergillosis (APA) in 12 patients who underwent allogeneic bone marrow transplantation (BMT). The CT scans were reviewed by three chest radiologists who assessed the pattern and distribution of findings by consent. There were 7 (58%) female and 5 (42%) male patients, with aging between 5 and 50 years (average of 26 years). All patients were submitted to BMT for the treatment of hematological conditions. The diagnosis of APA was defined between 5 and 373 days after BMT, with average of 111 days. Three cases (25%) were diagnosed in the neutropenic phase after the BMT, five (42%) in the early phase and four patients in the late phase post-BMT. Regarding high-resolution CT (HRCT) scan findings, nodules were found in 75% of the cases (9/12), most of the cases with more than 10 lesions (7/9) and of centrilobular localization (6/9). Consolidations were identified in seven patients (58%), being single in six, and commonly presenting ill defined borders (n=3) and subsegmental localization (n=5). Ground glass attenuation was found in six patients (50%). The halo sign was observed in nine cases (75%). Cavitations were seen in two air-space consolidations and one large nodule (2.5 cm). Patients submitted to BMT presenting respiratory symptoms and nodules or consolidations with halo sign at HRCT scan need to have the diagnosis of angioinvasive pulmonary aspergillosis included in all the post BMT phases.

Case Finding of Mild Cognitive Impairment and Dementia and Subsequent Care; Results of a Cluster RCT in Primary Care.

PubMed

van den Dungen, Pim; Moll van Charante, Eric P; van de Ven, Peter M; van Marwijk, Harm W J; van der Horst, Henriëtte E; van Hout, Hein P J

2016-01-01

Despite a call for earlier diagnosis of dementia, the diagnostic yield of case finding and its impact on the mental health of patients and relatives are unclear. This study assessed the effect of a two-component intervention of case finding and subsequent care on these outcomes. In a cluster RCT we assessed whether education of family physicians (FPs; trial stage 1) resulted in more mild cognitive impairment (MCI) and dementia diagnoses among older persons in whom FPs suspected cognitive decline and whether case finding by a practice nurse and the FP (trial stage 2) added to this number of diagnoses. In addition, we assessed mental health effects of case finding and subsequent care (trial stage 2). FPs of 15 primary care practices (PCPs = clusters) judged the cognitive status of all persons ≥ 65 years. The primary outcome, new MCI and dementia diagnoses by FPs after 12 months as indicated on a list, was assessed among all persons in whom FPs suspected cognitive impairment but without a formal diagnosis of dementia. The secondary outcome, mental health of patients and their relatives, was assessed among persons consenting to participate in trial stage 2. Trial stage 1 consisted of either intervention component 1: training FPs to diagnose MCI and dementia, or control: no training. Trial stage 2 consisted of either intervention component 2: case finding of MCI and dementia and care by a trained nurse and the FP, or control: care as usual. Seven PCPs were randomized to the intervention; eight to the control condition. MCI or dementia was diagnosed in 42.3% (138/326) of persons in the intervention, and in 30.5% (98/321) in the control group (estimated difference GEE: 10.8%, OR: 1.51, 95%-CI 0.60-3.76). Among patients and relatives who consented to stage 2 of the trial (n = 145; 25%), there were no differences in mental health between the intervention and control group. We found a non-significant increase in the number of new MCI diagnoses. As we cannot exclude a

Controllable synthesis of (NH4)Fe2(PO4)2(OH)·2H2O using two-step route: Ultrasonic-intensified impinging stream pre-treatment followed by hydrothermal treatment.

PubMed

Dong, Bin; Li, Guang; Yang, Xiaogang; Chen, Luming; Chen, George Z

2018-04-01

(NH 4 )Fe 2 (PO 4 ) 2 (OH)·2H 2 O samples with different morphology are successfully synthesized via two-step synthesis route - ultrasonic-intensified impinging stream pre-treatment followed by hydrothermal treatment (UIHT) method. The effects of the adoption of ultrasonic-intensified impinging stream pre-treatment, reagent concentration (C), pH value of solution and hydrothermal reaction time (T) on the physical and chemical properties of the synthesised (NH 4 )Fe 2 (PO 4 ) 2 (OH)·2H 2 O composites and FePO 4 particles were systematically investigated. Nano-seeds were firstly synthesized using the ultrasonic-intensified T-mixer and these nano-seeds were then transferred into a hydrothermal reactor, heated at 170 °C for 4 h. The obtained samples were characterized by utilising XRD, BET, TG-DTA, SEM, TEM, Mastersizer 3000 and FTIR, respectively. The experimental results have indicated that the particle size and morphology of the obtained samples are remarkably affected by the use of ultrasonic-intensified impinging stream pre-treatment, hydrothermal reaction time, reagent concentration, and pH value of solution. When such (NH 4 )Fe 2 (PO 4 ) 2 (OH)·2H 2 O precursor samples were transformed to FePO 4 products after sintering at 650 °C for 10 h, the SEM images have clearly shown that both the precursor and the final product still retain their monodispersed spherical microstructures with similar particle size of about 3 μm when the samples are synthesised at the optimised condition. Copyright © 2017 Elsevier B.V. All rights reserved.

Incidental finding of carcinoid tumor on Meckel’s diverticulum: case report and literature review, should prophylactic resection be recommended?

PubMed Central

2014-01-01

Meckel’s diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract and is caused by incomplete obliteration of the vitelline duct during intrauterine life. MD affects less than 2% of the population. In most cases, MD is asymptomatic and the estimated average complication risk of MD carriers, which is inversely proportional to age, ranges between 2% and 4%. The most common MD-related complications are gastrointestinal bleeding, intestinal obstruction and acute phlogosis. Excision is mandatory in the case of symptomatic diverticula regardless of age, while surgical treatment for asymptomatic diverticula remains controversial. According to the majority of studies, the incidental finding of MD in children is an indication for surgical resection, while the management of adults is not yet unanimous. In this case report, we describe the prophylactic resection of an incidentally detected MD, which led to the removal of an occult mucosal carcinoid tumor. In literature, the association of MD and carcinoid tumor is reported as a rare finding. Even though the strategy for adult patients of an incidental finding of MD during surgery performed for other reasons divides the experts, we recommend prophylactic excision in order to avoid any further risk. PMID:24884768

Histopathologic Findings in Autopsies with Emphasis on Interesting and Incidental Findings-A Pathologist's Perspective.

PubMed

Patel, Sapna; Rajalakshmi, B R; Manjunath, G V

2016-11-01

Autopsy aids to the knowledge of pathology by unveiling the rare lesions which are a source of learning from a pathologist's perspective Some of them are only diagnosed at autopsy as they do not cause any functional derangement. This study emphasizes the various incidental lesions which otherwise would have been unnoticed during a person's life. The aim of this study was to determine the spectrum of histopathological findings including neoplastic lesions related or unrelated to the cause of death. It was also aimed to highlight various incidental and interesting lesions in autopsies. A retrospective study of medicolegal autopsies for six years was undertaken in a tertiary care centre to determine the spectrum of histopathological findings including neoplastic lesions related or unrelated to the cause of death and to highlight various incidental and interesting lesions in autopsies. Statistical Analysis: Individual lesions were described in numbers and incidence in percentage. The study consisted of a series of 269 autopsy cases and histopathological findings were studied only in 202 cases. The commonest cause of death was pulmonary oedema. The most common incidental histopathological finding noted was atherosclerosis in 55 (27.2%) cases followed by fatty liver in 40 (19.8%) cases. Neoplastic lesions accounted for 2.47% of cases. This study has contributed a handful of findings to the pool of rare lesions in pathology. Some of these lesions encountered which served as feast to a pathologist are tumour to tumour metastasis, a case with coexistent triple lesions, Dubin Johnson syndrome, von Meyenburg complex, Multilocular Cystic Renal Cell Carcinoma (MCRCC), Autosomal Dominant Polycystic Kidney Disease (ADPKD), liver carcinod and an undiagnosed vaso-occlusive sickle cell crisis. Autopsy studies help in the detection of unexpected findings significant enough to have changed patient management had they been recognized before death.

An evaluation of clinical, radiological and three-dimensional dental tomography findings in ectodermal dysplasia cases

PubMed Central

Doğan, Mehmet-Sinan; Callea, Michele; Aksoy, Orhan; Clarich, Gabriella; Günay, Ayşe; Günay, Ahmet; Güven, Sedat; Maglione, Michele; Akkuş, Zeki

2015-01-01

Background This study aimed to review the results related to head and jaw disorders in cases of ectodermal dysplasia. The evaluation of ectodermal dysplasia cases was made by clincal examination and examination of the jaw and facial areas radiologically and on cone-beam 3-dimensional dental tomography (CBCT) images. Material and Methods In the 36 cases evaluated in the study, typical clinical findings of pure hypohidrotic ectodermal displasia (HED) were seen, such as missing teeth, dry skin, hair and nail disorders. CBCT images were obtained from 12 of the 36 cases, aged 1.5- 45 years, and orthodontic analyses were made on these images. Results The clinical and radiological evaluations determined, hypodontia or oligodontia, breathing problems, sweating problems, a history of fever, sparse hair, saddle nose, skin peeling, hypopigmentation, hyperpigmentation, finger and nail deformities, conical teeth anomalies, abnormal tooth root formation, tooth resorption in the root, gingivitis, history of epilepsy, absent lachrymal canals and vision problems in the cases which included to the study. Conclusions Ectodermal dysplasia cases have a particular place in dentistry and require a professional, multi-disciplinary approach in respect of the chewing function, orthognathic problems, growth, oral and dental health. It has been understood that with data obtained from modern technologies such as three-dimensional dental tomography and the treatments applied, the quality of life of these cases can be improved. Key words: Ectodermal dysplasia, three-dimensional dental tomography. PMID:25662550

Image Intensifier Modules For Use With Commercially Available Solid State Cameras

NASA Astrophysics Data System (ADS)

Murphy, Howard; Tyler, Al; Lake, Donald W.

1989-04-01

A modular approach to design has contributed greatly to the success of the family of machine vision video equipment produced by EG&G Reticon during the past several years. Internal modularity allows high-performance area (matrix) and line scan cameras to be assembled with two or three electronic subassemblies with very low labor costs, and permits camera control and interface circuitry to be realized by assemblages of various modules suiting the needs of specific applications. Product modularity benefits equipment users in several ways. Modular matrix and line scan cameras are available in identical enclosures (Fig. 1), which allows enclosure components to be purchased in volume for economies of scale and allows field replacement or exchange of cameras within a customer-designed system to be easily accomplished. The cameras are optically aligned (boresighted) at final test; modularity permits optical adjustments to be made with the same precise test equipment for all camera varieties. The modular cameras contain two, or sometimes three, hybrid microelectronic packages (Fig. 2). These rugged and reliable "submodules" perform all of the electronic operations internal to the camera except for the job of image acquisition performed by the monolithic image sensor. Heat produced by electrical power dissipation in the electronic modules is conducted through low resistance paths to the camera case by the metal plates, which results in a thermally efficient and environmentally tolerant camera with low manufacturing costs. A modular approach has also been followed in design of the camera control, video processor, and computer interface accessory called the Formatter (Fig. 3). This unit can be attached directly onto either a line scan or matrix modular camera to form a self-contained units, or connected via a cable to retain the advantages inherent to a small, light weight, and rugged image sensing component. Available modules permit the bus-structured Formatter to be

Effect of stocking rate on growing juvenile sunshine bass in an outdoor biofloc production system: study shows potential to intensify production of sunshine bass fingerlings

USDA-ARS?s Scientific Manuscript database

A dose–response study was conducted in an outdoor biofloc system to begin quantifying the stocking rate production function for sunshine bass advanced fingerlings. Results showed the potential of the outdoor biofloc system to intensify production of advanced sunshine bass fingerlings, but feed cons...

The effects of financial incentives for case finding for depression in patients with diabetes and coronary heart disease: interrupted time series analysis.

PubMed

McLintock, Kate; Russell, Amy M; Alderson, Sarah L; West, Robert; House, Allan; Westerman, Karen; Foy, Robbie

2014-08-20

To evaluate the effects of Quality and Outcomes Framework (QOF) incentivised case finding for depression on diagnosis and treatment in targeted and non-targeted long-term conditions. Interrupted time series analysis. General practices in Leeds, UK. 65 (58%) of 112 general practices shared data on 37,229 patients with diabetes and coronary heart disease targeted by case finding incentives, and 101,008 patients with four other long-term conditions not targeted (hypertension, epilepsy, chronic obstructive pulmonary disease and asthma). Incentivised case finding for depression using two standard screening questions. Clinical codes indicating new depression-related diagnoses and new prescriptions of antidepressants. We extracted routinely recorded data from February 2002 through April 2012. The number of new diagnoses and prescriptions for those on registers was modelled with a binomial regression, which provided the strength of associations between time periods and their rates. New diagnoses of depression increased from 21 to 94/100,000 per month in targeted patients between the periods 2002-2004 and 2007-2011 (OR 2.09; 1.92 to 2.27). The rate increased from 27 to 77/100,000 per month in non-targeted patients (OR 1.53; 1.46 to 1.62). The slopes in prescribing for both groups flattened to zero immediately after QOF was introduced but before incentivised case finding (p<0.01 for both). Antidepressant prescribing in targeted patients returned to the pre-QOF secular upward trend (Wald test for equivalence of slope, z=0.73, p=0.47); the slope was less steep for non-targeted patients (z=-4.14, p<0.01). Incentivised case finding increased new depression-related diagnoses. The establishment of QOF disrupted rising trends in new prescriptions of antidepressants, which resumed following the introduction of incentivised case finding. Prescribing trends are of concern given that they may include people with mild-to-moderate depression unlikely to respond to such treatment

Conductive diamond electrochemical oxidation of caffeine-intensified biologically treated urban wastewater.

PubMed

Martín de Vidales, María J; Millán, María; Sáez, Cristina; Pérez, José F; Rodrigo, Manuel A; Cañizares, Pablo

2015-10-01

In this work, the usefulness of Conductive Diamond Electrochemical Oxidation (CDEO) to degrade caffeine in real urban wastewater matrixes was assessed. The oxidation of actual wastewater intensified with caffeine (from 1 to 100 mg L(-1)) was studied, paying particular attention to the influence of the initial load of caffeine and the differences observed during the treatment of caffeine in synthetic wastewater. The results showed that CDEO is a technology that is capable of efficiently degrading this compound even at very low concentrations and that it can even be completely depleted. Profiles of the ionic species of S (SO4(2-)), N (NH4(+), NO3(-)) and Cl (ClO(-), ClO3(-) and ClO4(-)) were monitored and explained for plausible oxidation mechanisms. It was observed that the efficiency achieved is higher in the treatment of real wastewater than in the oxidation of synthetic wastewater because of the contribution of electrogenerated oxidant species such as hypochlorite. The formation of chlorate and perchlorate during electrochemical processes was observed, and a combined strategy to prevent this important drawback was successfully tested based on the application of low current densities with the simultaneous dosing of hydrogen peroxide. Copyright © 2015 Elsevier Ltd. All rights reserved.

Highly intensified upconversion luminescence of Ca(2+) -doped Yb/Er:NaGdF(4) nanocrystals prepared by a solvothermal route.

PubMed

Lei, Lei; Chen, Daqin; Xu, Ju; Zhang, Rui; Wang, Yuansheng

2014-03-01

Upon introducing Ca(2+) dopants into the grain lattices by substituting Gd(3+) ions, irregular Yb/Er:NaGdF4 nanocrystals prepared through a simple solvothermal route convert into highly uniform nanorods. Meanwhile, their upconversion luminescence intensifies by about 200 times, probably due to a modification of the crystal structure of NaGdF4 and an improvement in the crystallinity of the nanophase. Copyright © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Malaria burden and costs of intensified control in Bhutan, 2006-14: an observational study and situation analysis.

PubMed

Wangdi, Kinley; Banwell, Cathy; Gatton, Michelle L; Kelly, Gerard C; Namgay, Rinzin; Clements, Archie C A

2016-05-01

The number of malaria cases has fallen in Bhutan in the past two decades, and the country has a goal of complete elimination of malaria by 2016. The aims of this study are to ascertain the trends and burden of malaria, the costs of intensified control activities, the main donors of funding for the control activities, and the costs of different preventive measures in the pre-elimination phase (2006-14) in Bhutan. We undertook a descriptive analysis of malaria surveillance data from 2006 to 2014, using data from the Vector-borne Disease Control Programme (VDCP) run by the Department of Public Health of Bhutan's Ministry of Health. Malaria morbidity and mortality in local Bhutanese people and foreign nationals were analysed. The cost of different control and preventive measures were calculated, and the average numbers of long-lasting insecticidal nests per person were estimated. A total of 5491 confirmed malaria cases occurred in Bhutan between 2006 and 2014. By 2013, there was an average of one long-lasting insecticidal net for every 1·51 individuals. The cost of procuring long-lasting insecticidal nets accounted for more than 90% of the total cost of prevention measures. The Global Fund to Fight AIDS, Tuberculosis and Malaria was the main international donor, accounting for more than 80% of the total funds. The malaria burden in Bhutan decreased significantly during the study period with high coverage of long-lasting insecticidal nets. The foreseeable challenges that require national attention to maintain a malaria-free status after elimination are importation of malaria, especially from India; continued protection of the population in endemic districts through complete coverage with long-lasting insecticidal nets and indoor residual spraying; and exploration of local funding modalities post-elimination in the event of a reduction in international funding. None. Copyright © 2016 Wangdi et al. Open Access article distributed under the terms of CC BY. Published by

Pandemic (H1N1) 2009: clinical and laboratory findings of the first fifty cases in Singapore.

PubMed

Chan, Monica; Chen, Mark I; Chow, Angela; Lee, Caroline P S; Tan, Adriana S H; Lye, David Chien; Leo, Yee Sin

2010-04-01

Since the fi rst imported case on 26 May 2009, pandemic (H1N1) 2009 has spread from travellers and has resulted in sustained community transmission. Singapore began with a strict containment policy where all suspected and confirmed cases of pandemic (H1N1) 2009 were admitted for testing. We describe here the clinical and laboratory characteristics of the fi rst 50 adult cases with confirmed pandemic (H1N1) 2009. A review was conducted of medical notes of adult patients with confirmed pandemic (H1N1) 2009 by polymerase chain reaction assay from combined nasal and throat swabs admitted to the Communicable Disease Centre, Tan Tock Seng Hospital. From 26 May to 18 June 2009, 50 patients with a median age of 27 years old were admitted at a median of 3 days from illness onset. Half were male and all were travellers arriving in Singapore. Non-Singaporean citizens (38%) and other ethnic groups (40%) were over-represented. History of fever was reported in 90% and respiratory symptoms in 92%. Gastrointestinal symptoms were uncommon, present in 4% only. Temperatures on presentation of >or=38.0 degrees C, >or=37.8 degrees C and >or=37.5 degrees C were present in 48%, 56% and 76%, respectively. Only 46% of patients met the United States Centers for Disease Control and Prevention (US CDC) case definition of influenza-like illness (ILI). Clinical and laboratory findings were unremarkable for the majority. All cases were treated with oseltamivir and had uncomplicated recovery. Pandemic (H1N1) 2009 had mild clinical and laboratory findings in immunocompetent patients. Use of the US CDC ILI criteria alone would have detected less than half of confirmed cases.

Case finding of lifestyle and mental health disorders in primary care: validation of the ‘CHAT’ tool

PubMed Central

Goodyear-Smith, Felicity; Coupe, Nicole M; Arroll, Bruce; Elley, C Raina; Sullivan, Sean; McGill, Anne-Thea

2008-01-01

Background Primary care is accessible and ideally placed for case finding of patients with lifestyle and mental health risk factors and subsequent intervention. The short self-administered Case-finding and Help Assessment Tool (CHAT) was developed for lifestyle and mental health assessment of adult patients in primary health care. This tool checks for tobacco use, alcohol and other drug misuse, problem gambling, depression, anxiety and stress, abuse, anger problems, inactivity, and eating disorders. It is well accepted by patients, GPs and nurses. Aim To assess criterion-based validity of CHAT against a composite gold standard. Design of study Conducted according to the Standards for Reporting of Diagnostic Accuracy statement for diagnostic tests. Setting Primary care practices in Auckland, New Zealand. Method One thousand consecutive adult patients completed CHAT and a composite gold standard. Sensitivities, specificities, positive and negative predictive values, and likelihood ratios were calculated. Results Response rates for each item ranged from 79.6 to 99.8%. CHAT was sensitive and specific for almost all issues screened, except exercise and eating disorders. Sensitivity ranged from 96% (95% confidence interval [CI] = 87 to 99%) for major depression to 26% (95% CI = 22 to 30%) for exercise. Specificity ranged from 97% (95% CI = 96 to 98%) for problem gambling and problem drug use to 40% (95% CI = 36 to 45%) for exercise. All had high likelihood ratios (3–30), except exercise and eating disorders. Conclusion CHAT is a valid and acceptable case-finding tool for most common lifestyle and mental health conditions. PMID:18186993

Feline chronic renal failure: clinical findings in 80 cases diagnosed between 1992 and 1995.

PubMed

Elliott, J; Barber, P J

1998-02-01

Clinical and laboratory findings at the time of first diagnosis in 80 cats with chronic renal failure (CRF) were examined in a prospective study to determine the survival time of these animals and identify possible factors contributing to the progression of feline CRF. On the basis of clinical presentation, animals were assigned to one of three groups; compensated (n = 15), uraemic (n = 39) and end-stage (n = 26) CRF. Loss of renal concentrating ability was a common finding, even before clinical signs of renal disease were evident. The plasma creatinine concentration at initial presentation was a poor predictor of survival time and the presence of significant anaemia was indicative of a poor prognosis. The study demonstrated the highly variable degree of renal impairment present at the time of diagnosis and the potentially long survival time of many compensated and uraemic cases.

A Rare Case of Malignant Melanoma of the Mandible: 
CT and MRI Findings.

PubMed

Ogura, Ichiro; Sasaki, Yoshihiko; Kameta, Ayako; Sue, Mikiko; Oda, Takaaki

Malignant melanoma of the mandibular gingiva is extremely rare. It is a malignant tumour of melanocytes or their precursor cells, and often misinterpreted as a benign pigmented process. A few reports have described computed tomography (CT) and magnetic resonance imaging (MRI) findings of malignant melanoma in the oral cavity. We report a rare case of malignant melanoma of the mandible and the related CT and MRI findings. Soft tissue algorithm contrast-enhanced CT showed an expansile mass and irregular destruction of alveolar bone in the right side of the mandibular molar area. MR images showed an enhancing mass and the tumour had a low to intermediate signal intensity and a high-signal intensity. Soft tissue algorithm contrast-enhanced CT and MR images showed lymphadenopathy involving the submandibular lymph nodes. Histopathological examination confirmed the diagnosis of malignant melanoma.

Phosphaturic mesenchymal tumour mixed connective tissue variant: report of three cases with unusual histological findings.

PubMed

Shustik, David A; Ng, David Ce; Sittampalam, Kesavan

2015-01-01

Phosphaturic mesenchymal tumour mixed connective tissue variant (PMTMCT) is a rare tumour occurring in bone and soft tissue that usually behaves in a benign manner. Elaboration of biologically active substances by this tumour gives rise to a paraneoplastic syndrome known as oncogenic osteomalacia, manifesting clinically as bone pain, generalized weakness and pathological fractures. Recognition of PMTMCT and its associated syndrome is important, as resection of the tumour in most instances results in prompt resolution of symptoms. Previously reported cases of this tumour have emphasized the consistent presence of certain histological features that are considered prerequisite for making the diagnosis of PMTMCT. We describe three cases of PMTMCT, of which two first presented with progressive symptoms of osteomalacia and one remained clinically silent aside from the symptom of a palpable lump. Our cases highlight the wide-ranging histological patterns displayed by these tumours, and draw attention to certain microscopic findings that until now have been given little if any mention. Tentacular growth pattern and satellite nodules appear to be common findings in PMTMCTs, and can make complete surgical excision of these tumours challenging. The ability of this otherwise histologically benign tumour to permeate vascular spaces has to our knowledge never been described previously. One tumour lacked the characteristic calcifying matrix of PMTMCT, suggesting that in some tumours this defining feature may be focal if not entirely absent. PMTMCT shares features with and can resemble a variety of bone and soft tissue neoplasms, requiring the surgical pathologist to be familiar with this entity.

Phosphaturic mesenchymal tumour mixed connective tissue variant: report of three cases with unusual histological findings

PubMed Central

Shustik, David A; Ng, David CE; Sittampalam, Kesavan

2015-01-01

Phosphaturic mesenchymal tumour mixed connective tissue variant (PMTMCT) is a rare tumour occurring in bone and soft tissue that usually behaves in a benign manner. Elaboration of biologically active substances by this tumour gives rise to a paraneoplastic syndrome known as oncogenic osteomalacia, manifesting clinically as bone pain, generalized weakness and pathological fractures. Recognition of PMTMCT and its associated syndrome is important, as resection of the tumour in most instances results in prompt resolution of symptoms. Previously reported cases of this tumour have emphasized the consistent presence of certain histological features that are considered prerequisite for making the diagnosis of PMTMCT. We describe three cases of PMTMCT, of which two first presented with progressive symptoms of osteomalacia and one remained clinically silent aside from the symptom of a palpable lump. Our cases highlight the wide-ranging histological patterns displayed by these tumours, and draw attention to certain microscopic findings that until now have been given little if any mention. Tentacular growth pattern and satellite nodules appear to be common findings in PMTMCTs, and can make complete surgical excision of these tumours challenging. The ability of this otherwise histologically benign tumour to permeate vascular spaces has to our knowledge never been described previously. One tumour lacked the characteristic calcifying matrix of PMTMCT, suggesting that in some tumours this defining feature may be focal if not entirely absent. PMTMCT shares features with and can resemble a variety of bone and soft tissue neoplasms, requiring the surgical pathologist to be familiar with this entity. PMID:26261662

Clinical presentation and laboratory findings for the first autochthonous cases of dengue fever in Madeira island, Portugal, October 2012.

PubMed

Alves, M J; Fernandes, P L; Amaro, F; Osório, H; Luz, T; Parreira, P; Andrade, G; Zé-Zé, L; Zeller, H

2013-02-07

An outbreak of dengue fever in Madeira island was reported in 2012. Clinical and laboratory findings of the first two laboratory-confirmed autochthonous cases are reported. Both cases had fever (≥38 °C) and petechial rash. Symptoms also included myalgia, asthenia, nausea, vomiting, anorexia, diffuse abdominal pain, and diarrhoea. The two cases were confirmed by serology and one tested positive for a dengue viral sequence. Dengue virus serotype DEN-1 was identified with probable Central or South American origin.

Pulmonary vascular anomalies: a review of clinical and radiological findings of cases presenting with different complaints in childhood.

PubMed

Nacaroğlu, Hikmet Tekin; Ünsal-Karkıner, Canan Şule; Bahçeci-Erdem, Semiha; Özdemir, Rahmi; Karkıner, Aytaç; Alper, Hüdaver; Can, Demet

2016-01-01

Congenital pulmonary vascular abnormalities arise from several etiologies. These anomalies are difficult to categorize and sorted into distinct classifications. Major pulmonary vascular abnormalities can be ranked as interruption of the main pulmonary artery or its absence, emergence of the left pulmonary artery in the right pulmonary artery, pulmonary venous drainage abnormalities, and pulmonary arteriovenous malformations (PAVMs). Some of the cases are asymptomatic and diagnosed by coincidence, whereas a few of them are diagnosed by typical findings in the newborn and infancy period, symptoms, and radiological appearances. Early diagnosis is important, since death may occur as a result of pulmonary and cardiac pathologies developed in patients with pulmonary vascular anomalies. In this case presentation, the clinical and radiological findings of patients that presented with different complaints and were diagnosed with pulmonary vascular anomalies were introduced.

Sensitometric effects of varying the intensifying screens used with Agfa Dentus ST8G and RP6 panoramic radiographic films.

PubMed

Wakoh, M; Farman, A G; Scarfe, W C; Kitagawa, H; Kuroyanagi, K

1997-07-01

To compare the sensitometric effects and information yield of varying the intensifying screens used with both Dentus ST8G and RP6 Agfa Gevaert, Dormagen, Germany panoramic radiographic films. Four screen-film combinations were employed for each of the two film types. The screens used were blue fluorescing PX-III (Kasei Optonix, Tokyo, Japan) and Special (Siemens AG, Bensheim, Germany), as well as green fluorescing Lanex Regular (Eastman Kodak, Rochester, NY, USA) and Trimax T16 (3M, Mineapolis, Minnesota, USA). The density response for each screen-film combination was evaluated using the characteristic curves generated. Information yield, as determined by the radiographic detection of defects in an aluminium test object, was evaluated by nine observers. The characteristic curves for ST8G were different when green and blue fluorescing screens were used; however, those for RP6 varied little irrespective of the choice of intensifying screens. Observers were able to perceive defects at significantly lower radiation exposures for ST8G combined with green fluorescing screens compared with blue emitting screens. RP6 with all screen combinations provided similar image detail perceptibility at comparable exposures with ST8G with green-fluorescing screens. RP6 is suitable for use with either the spectrally matched blue emitting screens or green-emitting screens. ST8G radiographic film should always be matched to rare earth screens.

40° image intensifier tubes in an integrated helmet system

NASA Astrophysics Data System (ADS)

Schreyer, Herbert; Boehm, Hans-Dieter V.; Svedevall, B.

1993-12-01

EUROCOPTER has been under contract to the French and German ministries of defence for five years to develop the TIGER, a second generation anti-tank helicopter. A piloting thermal imager has been installed on a steerable platform in the helicopter nose in order to achieve the possibility of flying round the clock. In addition to this sensor, which is sensitive at a wavelength of 10 micrometers , the German side has proposed using an Integrated Helmet System in the PAH 2. This helmet, manufactured by GEC-Marconi Avionics, incorporates two cathode ray tubes (CRT) and two image intensifier tubes which allow the pilot to use an additional sensor in the visible and near infrared spectrum. The electronic part will be built by Teldix. EUROCOPTER DEUTSCHLAND has received the first demonstrator of this helmet for testing in the EUROCOPTER Visionics Laboratory. Later, the C-prototype will be integrated into a BK 117 helicopter (AVT Avionik Versuchstrager). This new helmet has a field of view of 40 degree(s), and exit pupil of 15 mm and improved possibilities of adjusting the optical part. Laboratory tests have been carried out to test important parameters like optical resolution under low light level conditions, field of view, eye relief or exit pupil. The CRT channels have been tested for resolution, distortion, vignetting and homogeneity. The requirements and the properties of the helmet, test procedures and the results of these tests are presented in the paper.

Elite synchronized swimmers display decreased energy availability during intensified training.

PubMed

Schaal, K; Tiollier, E; Le Meur, Y; Casazza, G; Hausswirth, C

2017-09-01

Elite synchronized swimmers follow high-volume training regimen that result in elevated rates of exercise energy expenditure (ExEE). While adequate energy intake (EI) is important to optimize recovery, a number of sport-specific constraints may lead to chronically low energy availability (EA = EI-ExEE). This study aimed to quantify changes in EA, endocrine markers of energy conservation, and perceived fatigue in synchronized swimmers, during a week of baseline training followed by 4 weeks of intensified training (IT). EI, ExEE, and body composition were measured in nine swimmers at Baseline, midpoint (IT WK 2 ), and end of IT (IT WK 4 ). Waking saliva samples were obtained to measure [leptin] s , [ghrelin] s , and [cortisol] s . Fatigue ratings were provided daily. ExEE increased by 27% during IT. Swimmers increased EI from Baseline to IT WK 2 , but decreased it significantly from IT WK 2 to IT WK 4 . EA, fat mass, and [leptin] s decreased from Baseline to IT WK 4 , while [ghrelin] s increased significantly. Fatigue at IT WK 4 was inversely correlated with Baseline EI and EA. The significant decrease in EA was accompanied by endocrine signs of energy conservation in elite swimmers. As perceived fatigue was associated with low EA, particular attention should be paid to these athletes' energy intake during phases of heavy training. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Manometric findings in adult eosinophilic oesophagitis: a study of 12 cases.

PubMed

Lucendo, Alfredo J; Castillo, Pilar; Martín-Chávarri, Sonia; Carrión, Gemma; Pajares, Ramón; Pascual, Juan M; Manceñido, Noemí; Erdozain, José C

2007-05-01

To describe the manometric findings detected in adult patients with dysphagia that were diagnosed of eosinophilic oesophagitis, and to compare with the cases of eosinophilic infiltration of the oesophagus reported in the literature. We present 12 adult patients diagnosed as suffering from this disorder in our department in a 1.5-year period, according to histological criteria and discarding any other cause of eosinophilic infiltration of the oesophagus. Stationary oesophageal manometry using a hydropneumocapillary perfusion system was performed in every case. The recommendations of the Spanish Group of Digestive Motility were followed for the interpretation of the results. In seven patients who presented motor disorder in manometric evaluation, treatment with steroid oesophageal lavage using fluticasone propionate was carried out and these patients were subsequently re-evaluated. All patients were young predominantly men, and the first endoscopic examination showed regular concentric stenosis or a 'ring oesophagus'. Six patients had a severe nonspecific oesophageal motor disorder characterized by up to 80% of nontransmitted or very low-amplitude waves in the lower two-thirds of the organ. Three patients presented a manometric disturbance characterized by hyperkinetic peristaltic waves in distal oesophageal third. One patient had an alteration of the oesophageal motor dynamics characterized by 80% of deglutory complexes formed by a primary simultaneous wave in the two lower oesophageal thirds followed by a secondary peristaltic wave in 50% of cases that had a normal duration and amplitude. The remaining two patients had normal oesophageal motility. The upper oesophageal sphincter showed no alterations, and the manometric evaluation of the lower oesophageal sphincter tone proved normal in 10 patients, with slight hypotension in two cases. In seven of the nine patients who presented an oesophageal motor disorder, treatment with steroid oesophageal lavage using

Intensified coastal development in beach-nourishment zones

NASA Astrophysics Data System (ADS)

Lazarus, E.; Armstrong, S.; Limber, P. W.; Goldstein, E. B.; Ballinger, R.

2016-12-01

Population density, housing development, and property values in coastal counties along the U.S. Atlantic and Gulf Coasts continue to rise despite increasing hazard from storm impacts. Beach nourishment, a method for mitigating coastal storm damage or chronic erosion by deliberately replacing sand on an eroded beach, has been the leading form of coastal protection in the U.S. since the 1970s. However, investment in hazard protection can have the unintended consequence of encouraging development in places especially vulnerable to damage. To quantitatively compare development in nourishing and non-nourishing zones, we examine the parcel-scale housing stock of all shorefront single-family homes in the state of Florida. We find that houses in nourishing zones are significantly larger and more numerous than in non-nourishing zones. Florida represents both an advanced case of coastal risk and an exemplar of ubiquitous, fundamental challenges in coastal management. The predominance of larger homes in nourishing zones indicates a positive feedback between nourishment and development that is compounding coastal risk in zones already characterized by high vulnerability. We offer that this phenomenon represents a variant of Jevons' paradox, a theoretical argument from environmental economics in which more efficient use of a resource spurs an increase in its consumption. Here, we suggest reductions in coastal risk through hazard protection are ultimately offset or reversed by increased coastal development.

Serial magnetic resonance imaging findings in subarachnoid hemorrhage due to an initially angiographically occult type II spinal aneurysm: Case report.

PubMed

Kogan, Michael; Morr, Simon; Siddiqui, Adnan H

2017-04-28

Spinal aneurysms are rare causes of spontaneous subarachnoid hemorrhage. We present an unusual, initially occult, case of an upper thoracic intradural extramedullary isolated aneurysm arising from the T2 intercostal-radicular circulation that was initially angiographically occult but was discovered due to unique, albeit nonspecific, magnetic resonance imaging findings of spinal cord T2 hyperintensity and contrast enhancement that were noted to progress with a clinical picture of ictal rehemorrhage. Repeat spinal angiography revealed a spinal aneurysm that was treated surgically. In cases of sufficient clinical suspicion and nonspecific imaging findings, continued vigilance is advised in seeking an underlying pathoanatomic etiology.

Clinical findings and electrodiagnostic testing in 108 consecutive cases of lumbosacral radiculopathy due to herniated disc.

PubMed

Mondelli, M; Aretini, A; Arrigucci, U; Ginanneschi, F; Greco, G; Sicurelli, F

2013-10-01

This prospective study aim to examine whether clinical findings and electrodiagnostic testing (EDX) in patients with lumbosacral monoradiculopathy due to herniated disc (HD) differ as a function of root involvement level (L5 vs. S1) and HD zone (paramedian vs. intraforaminal). All patients with L4, L5 or S1 monoradiculopathy were prospectively enrolled at four electromyography (EMG) labs over a 2-year period. The diagnosis was based on a congruence between patient history and MRI evidence of HD. We compared the sensitivities of clinical findings and EDX with respect to both root involvement level and HD zone. Multivariate logistic regression was performed in order to verify the association between abnormal EMG, clinical, and neuroradiological findings. One hundred and eight patients (mean age 47.7 years, 55% men) were consecutively enrolled. Sensory loss in the painful dermatome was the most frequent finding at physical examination (56% of cases). EMG was abnormal in at least one muscle supplied by femoral and sciatic nerves in 45 cases (42%). Inclusion of paraspinal muscles increased sensitivity to only 49% and that of proximal muscles was useless. Motor and sensory neurography was seldom abnormal. The most frequent motor neurographic abnormalities were a delay of F-wave minimum latency and decrease in the compound muscle action potential amplitude from extensor digitorum brevis and abductor hallucis in L5 and S1 radiculopathies, respectively. Sensory neurography was usually normal, the amplitude of sensory nerve action potential was seldom reduced when HD injured dorsal root ganglion or postganglionic root fibres. Multivariate logistic regression analysis showed that EMG abnormalities could be predicted by myotomal muscular weakness, abnormal deep reflexes, and paraesthesiae. The only clinical and electrophysiological differences with respect to root involvement level concerned deep reflexes and motor neurography of deep peroneal and tibial nerves. Only some EDX

Histopathologic Findings in Autopsies with Emphasis on Interesting and Incidental Findings-A Pathologist’s Perspective

PubMed Central

Rajalakshmi, B.R.; Manjunath, G.V.

2016-01-01

Introduction Autopsy aids to the knowledge of pathology by unveiling the rare lesions which are a source of learning from a pathologist’s perspective Some of them are only diagnosed at autopsy as they do not cause any functional derangement. This study emphasizes the various incidental lesions which otherwise would have been unnoticed during a person’s life. Aim The aim of this study was to determine the spectrum of histopathological findings including neoplastic lesions related or unrelated to the cause of death. It was also aimed to highlight various incidental and interesting lesions in autopsies. Materials and Methods A retrospective study of medicolegal autopsies for six years was undertaken in a tertiary care centre to determine the spectrum of histopathological findings including neoplastic lesions related or unrelated to the cause of death and to highlight various incidental and interesting lesions in autopsies. Statistical Analysis: Individual lesions were described in numbers and incidence in percentage. Results The study consisted of a series of 269 autopsy cases and histopathological findings were studied only in 202 cases. The commonest cause of death was pulmonary oedema. The most common incidental histopathological finding noted was atherosclerosis in 55 (27.2%) cases followed by fatty liver in 40 (19.8%) cases. Neoplastic lesions accounted for 2.47% of cases. Conclusion This study has contributed a handful of findings to the pool of rare lesions in pathology. Some of these lesions encountered which served as feast to a pathologist are tumour to tumour metastasis, a case with coexistent triple lesions, Dubin Johnson syndrome, von Meyenburg complex, Multilocular Cystic Renal Cell Carcinoma (MCRCC), Autosomal Dominant Polycystic Kidney Disease (ADPKD), liver carcinod and an undiagnosed vaso-occlusive sickle cell crisis. Autopsy studies help in the detection of unexpected findings significant enough to have changed patient management had they been

Unusual MRI findings in an immunocompetent patient with EBV encephalitis: a case report

PubMed Central

2011-01-01

Blackground It is well-known that Epstein-Barr virus (EBV) can affect the central nervous system (CNS). Case presentation Herein the authors report unusual timely Magnetic Resonance Imaging (MRI) brain scan findings in an immunocompetent patient with EBV encephalitis. Diffusion weighted MRI sequence performed during the acute phase of the disease was normal, whereas the Fast Relaxation Fast Spin Echo T2 image showed diffuse signal intensity changes in white matter. The enhancement pattern suggested an inflammatory response restricted to the brain microcirculation. Acyclovir and corticosteroid therapy was administered. After three weeks, all signal intensities returned to normal and the patient showed clinical recovery. Conclusion This report demonstrates that EBV in an immunocompetent adult can present with diffuse, reversible brain white matter involvement in the acute phase of mononucleosis. Moreover, our case suggests that a negative DWI sequence is associated with a favorable improvement in severe EBV CNS infection. More extensive studies are needed to assess what other instrumental data can help to distinguish viral lesions from other causes in the acute phase of disease. PMID:21435249

The impact of declining vaccination coverage on measles control: a case study of Abia state Nigeria.

PubMed

Umeh, Chukwuemeka Anthony; Ahaneku, Hycienth Peterson

2013-01-01

Efforts at immunizing children against measles was intensified in Nigeria with nation-wide measles vaccination campaigns in 2005-2006, 2008 and 2011 targeting children between 9 and 59 months. However, there were measles outbreaks in 2010 and 2011 in Abia state Nigeria. This study seeks to find out if there is any association between measles immunization coverage and measles outbreak. This is a descriptive analysis of the 2007 to 2011 Abia state measles case-based surveillance data supplied to Abia state World Health Organization office and Abia State Ministry of Health by the disease surveillance and notification officers. As the proportion of cases with febrile rash who were immunized decreased from 81% in 2007 to 42% in 2011, the laboratory confirmed cases of measles increased from two in 2007 to 53 in 2011.Of the laboratory confirmed cases of measles, five (7%) occurred in children < 9 months, 48 (64%) occurred in children 9-59 months and 22 (29%) occurred in children < 59 months old. Seventy five percent of all laboratory confirmed cases of measles occurred in rural areas. Efforts should be made to increase measles immunization in children between 9 and 59 months as most cases of measles occurred in this age group as immunization coverage dropped. In addition, further studies should be carried out to determine the cause of the disproportional incidence of measles in rural areas in Abia state bearing in mind that measles immunization coverage in urban and rural areas was not markedly different.

Active case-finding for tuberculosis by mobile teams in Myanmar: yield and treatment outcomes.

PubMed

Myint, Ohnmar; Saw, Saw; Isaakidis, Petros; Khogali, Mohammed; Reid, Anthony; Hoa, Nguyen Binh; Kyaw, Thi Thi; Zaw, Ko Ko; Khaing, Tin Mi Mi; Aung, Si Thu

2017-06-02

Since 2005, the Myanmar National Tuberculosis Programme (NTP) has been implementing active case finding (ACF) activities involving mobile teams in hard-to-reach areas. This study revealed the contribution of mobile team activities to total tuberculosis (TB) case detection, characteristics of TB patients detected by mobile teams and their treatment outcomes. This was a descriptive study using routine programme data between October 2014 and December 2014. Mobile team activities were a one-stop service and included portable digital chest radiography (CXR) and microscopy of two sputum samples. The algorithm of the case detection included screening patients by symptoms, then by CXR followed by sputum microscopy for confirmation. Diagnosed patients were started on treatment and followed until a final outcome was ascertained. A total of 9 349 people with symptoms suggestive of TB were screened by CXR, with an uptake of 96.6%. Of those who were meant to undergo sputum smear microscopy, 51.4% had sputum examinations. Finally, 504 TB patients were identified by the mobile teams and the overall contribution to total TB case detection in the respective townships was 25.3%. Among total cases examined by microscopy, 6.4% were sputum smear positive TB. Treatment success rate was high as 91.8% in study townships compared to national rate 85% (2014 cohort). This study confirmed the feasibility and acceptability of ACF by mobile teams in hard-to-reach contexts, especially when equipped with portable, digital CXR machines that provided immediate results. However, the follow-up process of sputum examination created a significant barrier to confirmation of the diagnosis. In order to optimize the ACF through mobile team activity, future ACF activities were needed to be strengthened one stop service including molecular diagnostics or provision of sputum cups to all presumptive TB cases prior to CXR and testing if CXR suggestive of TB.

Case report: clinical and postmortem findings in four cows with rib fracture.

PubMed

Braun, Ueli; Warislohner, Sonja; Hetzel, Udo; Nuss, Karl

2017-02-06

Published reports of rib fractures in adult cattle are limited to the occurrence of chronic rib swellings caused by calluses, which are unremarkable from a clinical standpoint, whereas studies identifying clinical signs of rib fractures were not found in a literature search. This report describes the clinical and postmortem findings in four cows with rib fractures. The 13th rib was fractured in three cows and the 11th rib in the remaining cow; three fractures were on the right and one on the left side. Clinical and postmortem findings varied considerably, and percussion of the rib cage elicited a pain response in only one cow. One cow had generalised peritonitis because of perforation of the rumen by the fractured rib. One cow was recumbent because of pain and became a downer cow, and two other cows had bronchopneumonia, which was a sequel to osteomyelitis of the fracture site in one. In the absence of a history of trauma, the diagnosis of rib fracture based on clinical signs alone is difficult. Although rib fractures undoubtedly are very painful, the four cases described in this report suggest that they are difficult to diagnose in cattle because associated clinical signs are nonspecific.

Stratified mucin-producing intraepithelial lesion with invasive carcinoma: 12 cases with immunohistochemical and ultrastructural findings.

PubMed

Onishi, Junji; Sato, Yuichiro; Sawaguchi, Akira; Yamashita, Atsushi; Maekawa, Kazunari; Sameshima, Hiroshi; Asada, Yujiro

2016-09-01

Stratified mucin-producing intraepithelial lesion (SMILE) is considered to be a variant of adenocarcinoma in situ (defined as intraepithelial malignant glandular epithelium without invasion) or adenosquamous carcinoma in situ of the uterine cervix. However, recent study suggested that SMILE is more similar to high-grade squamous epithelial lesion by their immunohistochemical findings. An invasive form of SMILE "invasive stratified mucin-producing carcinoma (ISMC)" has been also proposed, but immunohistochemical features are not well documented. Therefore, this study aimed to clarify the immunohistochemical characteristics of SMILE and ISMC. Twelve cases of SMILE were found among 445 patients (2.7%) with high-grade intraepithelial lesions or invasive carcinomas, 3 of whom had solely intraepithelial disease with SMILE component (mean age, 37 years; range, 30-48 years) and 9 with invasive carcinomas (mean age, 47 years; range, 37-66 years; including ISMC). Immunohistochemically, SMILE and ISMC were diffusely positive for p16 and CAM5.2, focally for IMP3, and almost negative or only focally positive for p63. Nuclear signals in SMILE and invasive carcinomas were detected by human papillomavirus (HPV) in situ hybridization; 5 cases showed HPV16 and/or HPV18 polymerase chain reaction products. The ultrastructural study of 1 case showed surface microvilli and small vacuolar structure in SMILE; ISMC had mucous-like vacuoles, many mitochondria and intracytoplasmic lumen but lacked tonofilament. These findings were more similar to adenocarcinoma in situ or adenocarcinoma than squamous intraepithelial lesion or squamous cell carcinoma. We suggest that SMILE is an intraepithelial neoplasm and ISMC is an invasive form of SMILE. Copyright © 2016 Elsevier Inc. All rights reserved.

Improving lactate metabolism in an intensified CHO culture process: productivity and product quality considerations.

PubMed

Xu, Sen; Hoshan, Linda; Chen, Hao

2016-11-01

In this study, we discussed the development and optimization of an intensified CHO culture process, highlighting medium and control strategies to improve lactate metabolism. A few strategies, including supplementing glucose with other sugars (fructose, maltose, and galactose), controlling glucose level at <0.2 mM, and supplementing medium with copper sulfate, were found to be effective in reducing lactate accumulation. Among them, copper sulfate supplementation was found to be critical for process optimization when glucose was in excess. When copper sulfate was supplemented in the new process, two-fold increase in cell density (66.5 ± 8.4 × 10(6) cells/mL) and titer (11.9 ± 0.6 g/L) was achieved. Productivity and product quality attributes differences between batch, fed-batch, and concentrated fed-batch cultures were discussed. The importance of process and cell metabolism understanding when adapting the existing process to a new operational mode was demonstrated in the study.

Using a Non-Fit Message Helps to De-Intensify Negative Reactions to Tough Advice

PubMed Central

Fridman, Ilona; Scherr, Karen; Glare, Paul; Higgins, E. Tory

2017-01-01

Sometimes physicians need to provide patients with potentially upsetting advice. For example, physicians may recommend hospice for a terminally ill patient because it best meets their needs, but the patient and their family dislike this advised option. We explore whether regulatory non-fit could be used to improve these types of situations. Across five studies in which participants imagined receiving upsetting advice from a physician, we demonstrate that regulatory non-fit between the form of the physician’s advice (emphasizing gains vs. avoiding losses) and the participants’ motivational orientation (promotion vs. prevention) improves participants’ evaluation of an initially disliked option. Regulatory non-fit de-intensifies participants’ initial attitudes by making them less confident in their initial judgments and motivating them to think more thoroughly about the arguments presented. Furthermore, consistent with previous research on regulatory fit, we showed that the mechanism of regulatory non-fit differs as a function of participants’ cognitive involvement in the evaluation of the option. PMID:27341845

Report of a new case with pentasomy X and novel clinical findings

PubMed Central

Demirhan, O; Tanriverdi, N; Yilmaz, MB; Kocaturk-Sel, S; Inandiklioglu, N; Luleyap, U; Akbal, E; Comertpay, G; Tufan, T; Dur, O

2015-01-01

Pentasomy X is an extremely rare sex chromosome abnormality, a condition that only affects females, in which three more X chromosomes are added to the normally present two chromosomes in females. We investigated the novel clinical findings in a 1-year-old female baby with pentasomy X, and determined the parental origins of the X chromosomes. Our case had thenar atrophy, postnatal growth deficiency, developmental delay, mongoloid slant, microcephaly, ear anomalies, micrognathia and congenital heart disease. A conventional cytogenetic technique was applied for the diagnosis of the polysomy X, and quantitative fluorescent polymerase chain reaction (QF-PCR) using 11 inherited short tandem repeat (STR) alleles specific to the chromosome X for the determination of parental origin of X chromosomes. A cytogenetic evaluation revealed that the karyotype of the infant was 49,XXXXX. Comparison of the infant’s features with previously reported cases indicated a clinically recognizable specific pattern of malformations referred to as the pentasomy X syndrome. However, to the best of our know-ledge, this is the first report of thenar atrophy in a patient with 49,XXXXX. The molecular analysis suggested that four X chromosomes of the infant originated from the mother as a result of the non disjunction events in meiosis I and meiosis II. We here state that the clinical manifestations seen in our case were consistent with those described previously in patients with pentasomy X. The degree of early hypotonia constitutes an important early prognostic feature in this syndrome. The pathogenesis of pentasomy X is not clear at present, but it is thought to be caused by successive maternal non disjunctions. PMID:26929910

En face optical coherence tomography findings in a case of Alport syndrome.

PubMed

Cho, In Hwan; Kim, Hoon Dong; Jung, Sang Joon; Park, Tae Kwann

2017-09-01

Alport syndrome is a rare hereditary disease that is associated with retinal abnormalities such as dot-and-fleck retinopathy and temporal macular thinning. The main pathophysiological process of Alport syndrome is loss of the collagen network in the basement membrane. However, the alterations in each retinal layer have not been fully evaluated. In the case presented here, we evaluated the retina of a patient with Alport syndrome using en face optical coherence tomography (OCT). The findings suggested that the primary alterations occur in the internal limiting membrane and the retinal pigment epithelium basement membrane which is a part of the Bruch's membrane. The adjacent retinal layers are damaged subsequently. In conclusion, en face OCT could be useful in evaluating retinal abnormalities and understanding their underlying pathophysiology in Alport syndrome.

A survey of major east coast snowstorms, 1960-1983. Part 2: Case studies of eighteen storms

NASA Technical Reports Server (NTRS)

Kocin, P. J.; Uccellini, L. W.

1985-01-01

Snowfall, surface and upper air charts, and available satellite images are presented for eighteen major East Coast snowstorms that occurred between 1960 and 1983. The charts and descriptions of key fields are provided so that students, weather forecasters, and researchers alike can visualize how a large sample of major winter cyclones form and intensify. Although there are noted similarities in certain aspects of the surface and upper tropospheric development of the storms, significant case-to-case variability precludes the ability to effectively composite these weather systems.

Clinical and oral findings in an Afro-Brazilian family with Gorlin-Goltz syndrome: case series and literature review.

PubMed

da Silva Pierro, Viviane Santos; Marins, Marcello Roter; Borges de Oliveira, Renata Cabral; Cortezzi, Wladimir; Janini, Maria Elisa; Maia, Lucianne Cople

2015-01-01

Gorlin-Goltz syndrome (GGS) seems to be unusual in black persons. The authors present an Afro-Brazilian family case report of GGS. The main complaint of the index case was a painless swelling of the left mandible, which was diagnosed as an odontogenic keratocyst. Further classical features of the Syndrome were present in this patient. Other two family members were diagnosed as cases of GGS and one of them presented 11 clinical findings characteristic of the syndrome. From the three cases reported, two of them presented five major diagnostic criteria for the GGS, and the diagnosis was only made because of an oral complaint. This case series emphasizes the importance of carefully examining the patient and close relatives for signs of GGS, even if they belong to an ethnic group in which this diagnosis is unusual. © 2014 Special Care Dentistry Association and Wiley Periodicals, Inc.

[The value of transbronchial lung biopsy findings in the diagnosis of a case of TS-1-induced pulmonary toxicity].

PubMed

Ito, Shunsuke; Yamaguchi, Tomoyoshi; Morisue, Ryo; Ogaw, Yukari; Munakata, Kazuo; Fukuda, Yuh

2011-12-01

We report the case of a 67-year-old man with a diagnosis of stage IV stomach cancer in May 2010 who was treated with outpatient chemotherapy using TS-1, paclitaxel and lentinan. Dyspnea and coughing developed after drug administration in November and the patient was hospitalized on day 5 after the appearance of symptoms due to hypoxemia and the presence of ground-glass opacities in the right middle and lower lung fields. On the same day, bronchoscopy was performed for differentiation from infection and lymphangitic carcinomatosis. A transbronchial lung biopsy suggested drug-induced pulmonary toxicity, and a drug lymphocyte stimulation test was highly positive for TS-1. Discontinuation of TS-1 alone improved his respiratory status and imaging findings. TS-1 is available only in Japan, and because it is administered orally and its toxicity is minimal, its use has been expanded to treat a variety of malignancies. Drug-induced pulmonary toxicity due to TS-1 occurs in only 0.03% of all cases, and there are few reports regarding the histopathological findings of TS-1-related pulmonary toxicity. Although it can be difficult to diagnose drug-induced pulmonary toxicity because it demonstrates a variety of imaging findings, the present case suggests that it is important to proactively perform transbronchial lung biopsy at the early stage of diagnosis and promptly determine a course of treatment.

Pleasant mood intensifies brain processing of cognitive control: ERP correlates.

PubMed

Yuan, Jiajin; Xu, Shuang; Yang, Jiemin; Liu, Qiang; Chen, Antao; Zhu, Liping; Chen, Jie; Li, Hong

2011-04-01

The present study investigated the impact of auditory-induced mood on brain processing of cognitive control using a Stroop color-word interference task. A total of 135 positive, negative, and neutral sounds (45 of each) were presented in separate blocks for a mood induction procedure, which was then followed by a Stroop color-word task in each trial. Event-related potentials (ERPs) were recorded for color-word congruent, incongruent and neutral (color-word irrelevant) words and subjects named the printed colors of the words by pressing the appropriate key (irrespective of word meaning). Response latency was delayed during incongruent vs. neutral trials, and this cost did not interact significantly with mood states. ERP data showed prolonged peak latencies in the P200 component and more negative deflections in the Late Positive Component (LPC, 450-550 ms) during incongruent vs. neutral conditions, regardless of mood states. Moreover, the negative deflections (N450) in the 450-550 ms interval of the incongruent- neutral difference waves, which index cognitive control effect in brain potentials, was more pronounced in the pleasant, but not in the unpleasant, mood state when compared with the neutral mood state. These data suggest that, pleasant mood intensifies brain processing of cognitive control, in a situation requiring effective inhibition of task-irrelevant distracting information. In addition, N450 component serves as an affective marker, embodying not only cognitive control effect in the brain but also its interaction with mood states. Copyright © 2011 Elsevier B.V. All rights reserved.

Mortality at Music Festivals: Academic and Grey Literature for Case Finding.

PubMed

Turris, Sheila A; Lund, Adam

2017-02-01

Deaths at music festivals are not infrequently reported in the media; however, the true mortality burden is difficult to determine as the deaths are not yet systematically documented in the academic literature. This was a literature search for case examples using academic and gray literature sources, employing both retrospective and prospective searches of media sources from 1999-2014. The gray literature documents a total of 722 deaths, including traumatic (594/722; 82%) and non-traumatic (128/722; 18%) causes. Fatalities were caused by trampling (n=479), motor-vehicle-related (n=39), structural collapses (n=28), acts of terror (n=26), drowning (n=8), assaults (n=6), falls (n=5), hanging (n=2), and thermal injury (n=2). Non-traumatic deaths included overdoses (n=96/722; 13%), environmental causes (n=8/722; 1%), natural causes (n=10/722; 1%), and unknown/not reported (n=14/722; 2%). The majority of non-trauma-related deaths were related to overdose (75%). The academic literature documents trauma-related deaths (n=368) and overdose-related deaths (n=12). One hundred percent of the trauma-related deaths reported in the academic literature also were reported in the gray literature (n=368). Mortality rates cannot be reported as the total attendance at events is not known. The methodology presented in this manuscript confirms that deaths occur not uncommonly at music festivals, and it represents a starting point in the documentation and surveillance of mortality. Turris SA , Lund A . Mortality at music festivals: academic and grey literature for case finding. Prehosp Disaster Med. 2017;32(1):58-63.

Fugitive from Labor Cases: Henry Garnett (1850) and Moses Honner (1860). The Constitution Community: Civil War and Reconstruction (1850-1870).

ERIC Educational Resources Information Center

Lawlor, John M., Jr.

The cases of Henry Garnett and Moses Honner bookend the 1850s, a decade of intensifying political crisis that was deeply connected to the institution of slavery. In both court actions, which were tried in the Third Circuit Court, Eastern District, Philadelphia, Pennsylvania, the defendants were charged with being "fugitives from labor."…

Higher serum cholesterol is associated with intensified age-related neural network decoupling and cognitive decline in early- to mid-life.

PubMed

Spielberg, Jeffrey M; Sadeh, Naomi; Leritz, Elizabeth C; McGlinchey, Regina E; Milberg, William P; Hayes, Jasmeet P; Salat, David H

2017-06-01

Mounting evidence indicates that serum cholesterol and other risk factors for cardiovascular disease intensify normative trajectories of age-related cognitive decline. However, the neural mechanisms by which this occurs remain largely unknown. To understand the impact of cholesterol on brain networks, we applied graph theory to resting-state fMRI in a large sample of early- to mid-life Veterans (N = 206, Mean age  = 32). A network emerged (centered on the banks of the superior temporal sulcus) that evidenced age-related decoupling (i.e., decreased network connectivity with age), but only in participants with clinically-elevated total cholesterol (≥180 mg/dL). Crucially, decoupling in this network corresponded to greater day-to-day disability and mediated age-related declines in psychomotor speed. Finally, examination of network organization revealed a pattern of age-related dedifferentiation for the banks of the superior temporal sulcus, again present only with higher cholesterol. More specifically, age was related to decreasing within-module communication (indexed by Within-Module Degree Z-Score) and increasing between-module communication (indexed by Participation Coefficient), but only in participants with clinically-elevated cholesterol. Follow-up analyses indicated that all findings were driven by low-density lipoprotein (LDL) levels, rather than high-density lipoprotein (HDL) or triglycerides, which is interesting as LDL levels have been linked to increased risk for cardiovascular disease, whereas HDL levels appear inversely related to such disease. These findings provide novel insight into the deleterious effects of cholesterol on brain health and suggest that cholesterol accelerates the impact of age on neural trajectories by disrupting connectivity in circuits implicated in integrative processes and behavioral control. Hum Brain Mapp 38:3249-3261, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Intensified impact of tropical Atlantic SST on the western North Pacific summer climate under a weakened Atlantic thermohaline circulation

NASA Astrophysics Data System (ADS)

Chen, Wei; Lee, June-Yi; Lu, Riyu; Dong, Buwen; Ha, Kyung-Ja

2015-10-01

The tropical North Atlantic (TNA) sea surface temperature (SST) has been identified as one of regulators on the boreal summer climate over the western North Pacific (WNP), in addition to SSTs in the tropical Pacific and Indian Oceans. The major physical process proposed is that the TNA warming induces a pair of cyclonic circulation anomaly over the eastern Pacific and negative precipitation anomalies over the eastern to central tropical Pacific, which in turn lead to an anticyclonic circulation anomaly over the western to central North Pacific. This study further demonstrates that the modulation of the TNA warming to the WNP summer climate anomaly tends to be intensified under background of the weakened Atlantic thermohaline circulation (THC) by using a water-hosing experiment. The results suggest that the weakened THC induces a decrease in thermocline depth over the TNA region, resulting in the enhanced sensitivity of SST variability to wind anomalies and thus intensification of the interannual variation of TNA SST. Under the weakened THC, the atmospheric responses to the TNA warming are westward shifted, enhancing the anticyclonic circulation and negative precipitation anomaly over the WNP. This study supports the recent finding that the negative phase of the Atlantic multidecadal oscillation after the late 1960s has been favourable for the strengthening of the connection between TNA SST variability and WNP summer climate and has important implications for seasonal prediction and future projection of the WNP summer climate.

Dental, dermatological and radiographic findings in a case of Gorlin-Goltz Syndrome: report and review.

PubMed

Nilesh, Kumar; Tewary, Shivsagar; Zope, Sameer; Patel, Jinesh; Vande, Aaditee

2017-01-01

Gorlin-Goltz syndrome (GGS) is a rare autosomal dominant disorder. The disease shows multiple organ involvement with variable clinical presentation. Thus a multidisciplinary approach is required for its prompt clinical diagnosis and management of this condition. This paper highlights a case of GGS presenting in a young male patient with cranial, facial, dermatological, dental and skeletal involvement. The diagnosis of the syndrome was based on its clinical presentation, radiological features and histopathological findings. A review of the diagnostic criteria is also presented.

Can we Observe and Assess Whether the Global Hydrological Cycle is "Intensifying"?

NASA Astrophysics Data System (ADS)

Wood, E. F.; Sheffield, J.

2012-12-01

There is controversy over whether the hydrological cycle is "intensifying" (or "accelerating"), and if so how and where? Resolving this critical question is a central goal of both national (e.g. NASA's Energy and Water cycle Study: NEWS) and international (WCRP Global Energy and Water cycle Experiment: GEWEX) programs. Its resolution has significant implications for understanding changes in hydroclimatic states and variability, and in future water security at regional to global scales. Over the last decade a number of papers have addressed trends and change in specific water cycle variables with results that can best be described as inconclusive, regardless of the conclusions of specific papers. In this presentation a number of recent studies will be reviewed for their consistency in assessing whether collectively one can make conclusions regarding how the hydrologic cycle is changing. The presentation will also demonstrate a pathway for analyzing where to observe for the detection of change based on a NASA-supported, global, 1983-2009, terrestrial water cycle Earth System Data Record project being led by the author. Initial results will be presented and a discussion presented on the extent that the proposed strategy can be used to detect change in the terrestrial hydrological cycle.

Influence of Ebola on tuberculosis case finding and treatment outcomes in Liberia

PubMed Central

Cambell, C. L.; Ade, S.; Bhat, P.; Harries, A. D; Wilkinson, E.; Cooper, C. T.

2017-01-01

Setting: National Leprosy and Tuberculosis (TB) Control Programme, Liberia. Objectives: To assess TB case finding, including human immunodeficiency virus (HIV) associated interventions and treatment outcomes, before (January 2013–March 2014), during (April 2014–June 2015) and after (July–December 2015) the Ebola virus disease outbreak. Design: A cross-sectional study and retrospective cohort analysis of outcomes. Results: The mean quarterly numbers of individuals with presumptive TB and the proportion diagnosed as smear-positive were: pre-Ebola (n = 7032, 12%), Ebola (n = 6147, 10%) and post-Ebola (n = 6795, 8%). For all forms of TB, stratified by category and age group, there was a non-significant decrease in the number of cases from the pre-Ebola to the Ebola and post-Ebola periods. There were significant decreases in numbers of cases with smear-positive pulmonary TB (PTB) from the pre-Ebola period (n = 855), to the Ebola (n = 640, P < 0.001) and post-Ebola (n = 568, P < 0.001) periods. The proportions of patients tested for HIV, found to be HIV-positive and started on antiretroviral therapy decreased as follows: pre-Ebola (respectively 72%, 15% and 34%), Ebola (69%, 14% and 30%) and post-Ebola (68%, 12% and 26%). Treatment success rates among TB patients were: 80% pre-Ebola, 69% Ebola (P < 0.001) and 73% post-Ebola (P < 0.001). Loss to follow-up was the main contributing adverse outcome. Conclusion: The principal negative effects of Ebola were the significant decreases in diagnoses of smear-positive PTB, the declines in HIV testing and antiretroviral therapy uptake and poor treatment success. Ways to prevent these adverse effects from recurring in the event of another Ebola outbreak need to be found. PMID:28744441

Influence of Ebola on tuberculosis case finding and treatment outcomes in Liberia.

PubMed

Konwloh, P K; Cambell, C L; Ade, S; Bhat, P; Harries, A D; Wilkinson, E; Cooper, C T

2017-06-21

Setting: National Leprosy and Tuberculosis (TB) Control Programme, Liberia. Objectives: To assess TB case finding, including human immunodeficiency virus (HIV) associated interventions and treatment outcomes, before (January 2013-March 2014), during (April 2014-June 2015) and after (July-December 2015) the Ebola virus disease outbreak. Design: A cross-sectional study and retrospective cohort analysis of outcomes. Results: The mean quarterly numbers of individuals with presumptive TB and the proportion diagnosed as smear-positive were: pre-Ebola ( n = 7032, 12%), Ebola ( n = 6147, 10%) and post-Ebola ( n = 6795, 8%). For all forms of TB, stratified by category and age group, there was a non-significant decrease in the number of cases from the pre-Ebola to the Ebola and post-Ebola periods. There were significant decreases in numbers of cases with smear-positive pulmonary TB (PTB) from the pre-Ebola period ( n = 855), to the Ebola ( n = 640, P < 0.001) and post-Ebola ( n = 568, P < 0.001) periods. The proportions of patients tested for HIV, found to be HIV-positive and started on antiretroviral therapy decreased as follows: pre-Ebola (respectively 72%, 15% and 34%), Ebola (69%, 14% and 30%) and post-Ebola (68%, 12% and 26%). Treatment success rates among TB patients were: 80% pre-Ebola, 69% Ebola ( P < 0.001) and 73% post-Ebola ( P < 0.001). Loss to follow-up was the main contributing adverse outcome. Conclusion: The principal negative effects of Ebola were the significant decreases in diagnoses of smear-positive PTB, the declines in HIV testing and antiretroviral therapy uptake and poor treatment success. Ways to prevent these adverse effects from recurring in the event of another Ebola outbreak need to be found.

Diagnostic performance of major depression disorder case-finding instruments used among mothers of young children in the United States: A systematic review.

PubMed

Owora, Arthur H; Carabin, Hélène; Reese, Jessica; Garwe, Tabitha

2016-09-01

Growing recognition of the interrelated negative outcomes associated with major depression disorder (MDD) among mothers and their children has led to renewed public health interest in the early identification and treatment of maternal MDD. Healthcare providers, however, remain unsure of the validity of existing case-finding instruments. We conducted a systematic review to identify the most valid maternal MDD case-finding instrument used in the United States. We identified articles reporting the sensitivity and specificity of MDD case-finding instruments based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) by systematically searching through three electronic bibliographic databases, PubMed, PsycINFO, and EMBASE, from 1994 to 2014. Study eligibility and quality were evaluated using the Standards for the Reporting of Diagnostic Accuracy studies and Quality Assessment of Diagnostic Accuracy Studies guidelines respectively. Overall, we retrieved 996 unduplicated articles and selected 74 for full-text review. Of these, 14 articles examining 21 different instruments were included in the systematic review. The 10 item Edinburgh Postnatal Depression Scale and Postpartum Depression Screening Scale had the most stable (lowest variation) and highest diagnostic performance during the antepartum and postpartum periods (sensitivity range: 0.63-0.94 and 0.67-0.95; specificity range: 0.83-0.98 and 0.68-0.97 respectively). Greater variation in diagnostic performance was observed among studies with higher MDD prevalence. Factors that explain greater variation in instrument diagnostic performance in study populations with higher MDD prevalence were not examined. Findings suggest that the diagnostic performance of maternal MDD case-finding instruments is peripartum period-specific. Published by Elsevier B.V.

The registry case finding engine: an automated tool to identify cancer cases from unstructured, free-text pathology reports and clinical notes.

PubMed

Hanauer, David A; Miela, Gretchen; Chinnaiyan, Arul M; Chang, Alfred E; Blayney, Douglas W

2007-11-01

The American College of Surgeons mandates the maintenance of a cancer registry for hospitals seeking accreditation. At the University of Michigan Health System, more than 90% of all registry patients are identified by manual review, a method common to many institutions. We hypothesized that an automated computer system could accurately perform this time- and labor-intensive task. We created a tool to automatically scan free-text medical documents for terms relevant to cancer. We developed custom-made lists containing approximately 2,500 terms and phrases and 800 SNOMED codes. Text is processed by the Case Finding Engine (CaFE), and relevant terms are highlighted for review by a registrar and used to populate the registry database. We tested our system by comparing results from the CaFE to those by trained registrars who read through 2,200 pathology reports and marked relevant cases for the registry. The clinical documentation (eg, electronic chart notes) of an additional 476 patients was also reviewed by registrars and compared with the automated process by the CaFE. For pathology reports, the sensitivity for automated case identification was 100%, but specificity was 85.0%. For clinical documentation, sensitivity was 100% and specificity was 73.7%. Types of errors made by the CaFE were categorized to direct additional improvements. Use of the CaFE has resulted in a considerable increase in the number of cases added to the registry each month. The system has been well accepted by our registrars. CaFE can improve the accuracy and efficiency of tumor registry personnel and helps ensure that cancer cases are not overlooked.

Dental, dermatological and radiographic findings in a case of Gorlin-Goltz Syndrome: report and review

PubMed Central

Nilesh, Kumar; Tewary, Shivsagar; Zope, Sameer; Patel, Jinesh; Vande, Aaditee

2017-01-01

Gorlin-Goltz syndrome (GGS) is a rare autosomal dominant disorder. The disease shows multiple organ involvement with variable clinical presentation. Thus a multidisciplinary approach is required for its prompt clinical diagnosis and management of this condition. This paper highlights a case of GGS presenting in a young male patient with cranial, facial, dermatological, dental and skeletal involvement. The diagnosis of the syndrome was based on its clinical presentation, radiological features and histopathological findings. A review of the diagnostic criteria is also presented. PMID:28819517

[Case finding in early prevention networks - a heuristic for ambulatory care settings].

PubMed

Barth, Michael; Belzer, Florian

2016-06-01

One goal of early prevention is the support of families with small children up to three years who are exposed to psychosocial risks. The identification of these cases is often complex and not well-directed, especially in the ambulatory care setting. Development of a model of a feasible and empirical based strategy for case finding in ambulatory care. Based on the risk factors of postpartal depression, lack of maternal responsiveness, parental stress with regulation disorders and poverty a lexicographic and non-compensatory heuristic model with simple decision rules, will be constructed and empirically tested. Therefore the original data set from an evaluation of the pediatric documentary form on psychosocial issues of families with small children in well-child visits will be used and reanalyzed. The first diagnostic step in the non-compensatory and hierarchical classification process is the assessment of postpartal depression followed by maternal responsiveness, parental stress and poverty. The classification model identifies 89.0 % cases from the original study. Compared to the original study the decision process becomes clearer and more concise. The evidence-based and data-driven model exemplifies a strategy for the assessment of psychosocial risk factors in ambulatory care settings. It is based on four evidence-based risk factors and offers a quick and reliable classification. A further advantage of this model is that after a risk factor is identified the diagnostic procedure will be stopped and the counselling process can commence. For further validation of the model studies, in well suited early prevention networks are needed.

Retrospective case series of the imaging findings of facial nerve hemangioma.

PubMed

Yue, Yunlong; Jin, Yanfang; Yang, Bentao; Yuan, Hui; Li, Jiandong; Wang, Zhenchang

2015-09-01

The aim was to compare high-resolution computed tomography (HRCT) and thin-section magnetic resonance imaging (MRI) findings of facial nerve hemangioma. The HRCT and MRI characteristics of 17 facial nerve hemangiomas diagnosed between 2006 and 2013 were retrospectively analyzed. All patients included in the study suffered from a space-occupying lesion of soft tissues at the geniculate ganglion fossa. Affected nerve was compared for size and shape with the contralateral unaffected nerve. HRCT showed irregular expansion and broadening of the facial nerve canal, damage of the bone wall and destruction of adjacent bone, with "point"-like or "needle"-like calcifications in 14 cases. The average CT value was 320.9 ± 141.8 Hu. Fourteen patients had a widened labyrinthine segment; 6/17 had a tympanic segment widening; 2/17 had a greater superficial petrosal nerve canal involvement, and 2/17 had an affected internal auditory canal (IAC) segment. On MRI, all lesions were significantly enhanced due to high blood supply. Using 2D FSE T2WI, the lesion detection rate was 82.4 % (14/17). 3D fast imaging employing steady-state acquisition (3D FIESTA) revealed the lesions in all patients. HRCT showed that the average number of involved segments in the facial nerve canal was 2.41, while MRI revealed an average of 2.70 segments (P < 0.05). HRCT and MR findings of facial nerve hemangioma were typical, revealing irregular masses growing along the facial nerve canal, with calcifications and rich blood supply. Thin-section enhanced MRI was more accurate in lesion detection and assessment compared with HRCT.

Repeated intensified infliximab induction - results from an 11-year prospective study of ulcerative colitis using a novel treatment algorithm.

PubMed

Johnsen, Kay-Martin; Goll, Rasmus; Hansen, Vegard; Olsen, Trine; Rismo, Renathe; Heitmann, Richard; Gundersen, Mona D; Kvamme, Jan M; Paulssen, Eyvind J; Kileng, Hege; Johnsen, Knut; Florholmen, Jon

2017-01-01

Anti-tumour necrosis factor (TNF) agents play a pivotal role in the treatment of moderate to severe ulcerative colitis (UC), and yet, no international consensus on when to discontinue therapy exists. The aim of this study is to study the long-term performance of a treatment algorithm of repeated intensified induction therapy with infliximab (IFX) to remission, followed by discontinuation in patients with UC. Patients with moderate to severe UC were enroled in an open prospective study design. The following algorithm was implemented: (a) intensified induction treatment to remission (Ulcerative Colitis Disease Activity Index score 0-2); (b) discontinuation of IFX; and (c) reinduction treatment if relapse. Mucosal gene expression for TNF was measured with qPCR. A total of 116 patients were included. The median observation time was 47 and 51 months in intention to treat and per protocol. Remission rates of the first three inductions were 95, 93 and 91% per protocol and 83, 56 and 59% by intention to treat. The median time in remission was 40 months per protocol and 34 months by intention to treat. Long-term remission without further anti-TNF treatment during the observation period was obtained for 41%, with a median observation time of 48 months (range: 18-129 months). The median time to relapse was 33 and 11 months with/without normalization of mucosal TNF, respectively. The 5-year success rate for maintaining the effect of IFX in the algorithm was 66%. The treatment algorithm is highly effective for achieving long-term clinical remission in UC. Normalization of mucosal TNF gene expression predicts long-term remission upon discontinuation of IFX.

Dynamic changes in near-infrared spectroscopy (NIRS) findings in first-episode schizophrenia: a case report.

PubMed

Hatakeyama, Tsuyoshi; Kunii, Yasuto; Miura, Itaru; Itagaki, Shuntaro; Kono, Soichi; Shiga, Tetsuya; Oshima, Sachie; Nozaki, Keiko; Suzuki, Rieko; Yabe, Hirooki

2017-04-28

The clinical course of schizophrenia is characterized by recurrence and chronicity and has a large burden on society.　Nevertheless, diagnosis of schizophrenia is based only on distinctive symptoms and the disease course.　Near-infrared spectroscopy (NIRS) is a useful method for measuring changes in the hemoglobin concentration in the cortical surface area and reflects brain function.　We measured NIRS four times during the clinical course in a patient with first-episode schizophrenia.A 17-year-old woman admitted to our hospital because of hallucinations, delusions and appetite loss. After treatment with low-dose antipsychotics, NIRS findings showed a prompt increase in the cerebral blood volume in the frontal region.　On the basis of the clinical course of this patient, we introduce a new point of view, namely, that NIRS findings may be useful as a state marker that indicates the severity of schizophrenia in some cases.

Dynamic changes in near-infrared spectroscopy (NIRS) findings in first-episode schizophrenia: a case report

PubMed Central

Hatakeyama, Tsuyoshi; Kunii, Yasuto; Miura, Itaru; Itagaki, Shuntaro; Kono, Soichi; Shiga, Tetsuya; Oshima, Sachie; Nozaki, Keiko; Suzuki, Rieko; Yabe, Hirooki

2017-01-01

Abstract The clinical course of schizophrenia is characterized by recurrence and chronicity and has a large burden on society. Nevertheless, diagnosis of schizophrenia is based only on distinctive symptoms and the disease course. Near-infrared spectroscopy (NIRS) is a useful method for measuring changes in the hemoglobin concentration in the cortical surface area and reflects brain function. We measured NIRS four times during the clinical course in a patient with first-episode schizophrenia. A 17-year-old woman admitted to our hospital because of hallucinations, delusions and appetite loss. After treatment with low-dose antipsychotics, NIRS findings showed a prompt increase in the cerebral blood volume in the frontal region. On the basis of the clinical course of this patient, we introduce a new point of view, namely, that NIRS findings may be useful as a state marker that indicates the severity of schizophrenia in some cases. PMID:28420824

Computed tomographic findings in dogs and cats with temporomandibular joint disorders: 58 cases (2006-2011).

PubMed

Arzi, Boaz; Cissell, Derek D; Verstraete, Frank J M; Kass, Philip H; DuRaine, Grayson D; Athanasiou, Kyriacos A

2013-01-01

To describe CT findings in dogs and cats with temporomandibular joint (TMJ) disorders. Retrospective case series. 41 dogs and 17 cats. Medical records and CT images of the skull were reviewed for dogs and cats that were examined at a dentistry and oral surgery specialty practice between 2006 and 2011. Of 142 dogs and 42 cats evaluated, 41 dogs and 17 cats had CT findings consistent with a TMJ disorder. In dogs, the most common TMJ disorder was osteoarthritis; however, in most cases, there were other TMJ disorders present in addition to osteoarthritis. Osteoarthritis was more frequently identified at the medial aspect rather than the lateral aspect of the TMJ, whereas the frequency of osteoarthritic involvement of the dorsal and ventral compartments did not differ significantly. In cats, fractures were the most common TMJ disorder, followed by osteoarthritis. Clinical signs were observed in all dogs and cats with TMJ fractures, dysplasia, ankylosis, luxation, and tumors; however, only 4 of 15 dogs and 2 of 4 cats with osteoarthritis alone had clinical signs. Results indicated that TMJ disorders were frequently present in combination. Osteoarthritis was the most common TMJ disorder in dogs and the second most common TMJ disorder in cats. Computed tomography should be considered as a tool for the diagnosis of TMJ disorders in dogs and cats with suspected orofacial disorders and signs of pain. (J Am Vet Med Assoc 2013;242:69-75).

Using a Non-Fit Message Helps to De-Intensify Negative Reactions to Tough Advice.

PubMed

Fridman, Ilona; Scherr, Karen A; Glare, Paul A; Higgins, E Tory

2016-08-01

Sometimes physicians need to provide patients with potentially upsetting advice. For example, physicians may recommend hospice for a terminally ill patient because it best meets their needs, but the patient and their family dislike this advised option. We explore whether regulatory non-fit could be used to improve these types of situations. Across five studies in which participants imagined receiving upsetting advice from a physician, we demonstrate that regulatory non-fit between the form of the physician's advice (emphasizing gains vs. avoiding losses) and the participants' motivational orientation (promotion vs. prevention) improves participants' evaluation of an initially disliked option. Regulatory non-fit de-intensifies participants' initial attitudes by making them less confident in their initial judgments and motivating them to think more thoroughly about the arguments presented. Furthermore, consistent with previous research on regulatory fit, we showed that the mechanism of regulatory non-fit differs as a function of participants' cognitive involvement in the evaluation of the option. © 2016 by the Society for Personality and Social Psychology, Inc.

The impact of declining vaccination coverage on measles control: a case study of Abia state Nigeria

PubMed Central

Umeh, Chukwuemeka Anthony; Ahaneku, Hycienth Peterson

2013-01-01

Introduction Efforts at immunizing children against measles was intensified in Nigeria with nation-wide measles vaccination campaigns in 2005 - 2006, 2008 and 2011 targeting children between 9 and 59 months. However, there were measles outbreaks in 2010 and 2011in Abia state Nigeria. This study seeks to find out if there is any association between measles immunization coverage and measles outbreak. Methods This is a descriptive analysis of the 2007 to 2011 Abia state measles case-based surveillance data supplied to Abia state World Health Organization office and Abia State Ministry of Health by the disease surveillance and notification officers. Results As the proportion of cases with febrile rash who were immunized decreased from 81% in 2007 to 42% in 2011, the laboratory confirmed cases of measles increased from two in 2007 to 53 in 2011.Of the laboratory confirmed cases of measles, five (7%) occurred in children < 9 months, 48 (64%) occurred in children 9 - 59 months and 22 (29%) occurred in children < 59 months old. Seventy five percent of all laboratory confirmed cases of measles occurred in rural areas. Conclusion Efforts should be made to increase measles immunization in children between 9 and 59 months as most cases of measles occurred in this age group as immunization coverage dropped. In addition, further studies should be carried out to determine the cause of the disproportional incidence of measles in rural areas in Abia state bearing in mind that measles immunization coverage in urban and rural areas was not markedly different PMID:24244791

Effect of conventional and intensified milk replacer feeding programs on performance, vaccination response, and neutrophil mRNA levels of Holstein calves.

PubMed

Hengst, B A; Nemec, L M; Rastani, R R; Gressley, T F

2012-09-01

This study compared conventional and intensified milk replacer feeding regimens on growth, intake, respiratory and fecal scores, vaccination response, and neutrophil mRNA levels. Holstein calves were randomly assigned to a 10-wk study on d 2 of life. Treatments were conventional (CON; n=8) and intensified (INT; n=7) milk replacer feeding programs. Conventional calves were fed a 20.8% crude protein and 21.0% fat milk replacer at 1.25% of birth body weight (BW) from wk 1 to 6 of life and 0.625% of birth BW during wk 7. A 29.3% crude protein and 16.2% fat milk replacer was fed to INT calves at 1.5% of birth BW during wk 1, 2% of current BW from wk 2 to 6, and 1% of current BW during wk 7. All calves were given milk replacer twice daily during wk 1 to 6, once daily during wk 7, and were weaned completely during wk 8. Calf starter intake was measured daily through wk 8. Body weight and withers height were measured weekly. Fecal and respiratory scores were recorded twice daily at feeding. Calves were vaccinated against ovalbumin at the end of wk 1, 3, and 5. Blood samples were collected at the end of wk 1, 3, 5, and 8 for analysis of serum anti-ovalbumin IgG concentration and for isolation of neutrophils. Quantitative PCR was used to measure neutrophil mRNA levels of 7 functionality genes. Treatment did not affect total DMI or anti-ovalbumin IgG response. Intensified milk replacer feeding increased average daily gain, protein intake, fat intake, and feed efficiency compared with the CON feeding program. Compared with CON calves, INT calves had greater fecal scores, indicating looser feces and greater respiratory scores, indicating more respiratory problems. Calves assigned to the INT treatment had increased neutrophil mRNA levels of L-selectin, and at wk 8, neutrophil cytosolic factor 1 was increased and toll-like receptor 4 tended to be increased compared with CON calves. This suggests greater activation of neutrophils in INT calves postweaning, but differences were

Pre-Liver Transplant Transthoracic Echocardiogram Findings and 6-Month Post-Transplant Outcomes: A Case-Control Analysis.

PubMed

Konerman, Monica A; Price, Jennifer C; Campbell, Catherine Y; Eluri, Swathi; Gurakar, Ahmet; Hamilton, James; Li, Zhiping

2016-07-05

BACKGROUND Cardiopulmonary (CP) outcomes remain a leading cause of morbidity and mortality following liver transplantation (LT). The optimal CP risk stratification of LT candidates remains unclear. The aim of this study was to evaluate the association of pre-LT transthoracic echocardiogram (TTE) findings and 6-month post-LT outcomes. MATERIAL AND METHODS This retrospective review analyzed adults who underwent LT, comparing those who died within 6 months of LT (cases; n=38) with age- and sex-matched patients who survived >6 months (controls; n=38). Cases were categorized by cause of death (COD) defined as either a primary CP process (n=20) or a non-CP process (n=18). Data were analyzed using logistic regression and survival analysis was performed using Kaplan-Meier curves. RESULTS There was a higher odds of death within 6 months of LT with ≥ mild mitral regurgitation (OR 3.44, p=0.03) or an incomplete assessment of right ventricular systolic function (RVSF) (OR 24, p=0.004). On subgroup analysis, these findings only persisted in patients with a CP COD. Patients with CP COD were older (61 vs. 54.5, p=0.04), had longer intervals between TTE and LT (122 vs. 29 days, p=0.05), less complete assessments of RVSF (p=0.009), and lower RV fractional area change (p=0.04) compared to patients with non-CP COD. CONCLUSIONS Multiple TTE parameters were associated with patients who died within 6 months of LT, and in particular patients with a CP COD. Our findings suggest that pre-LT TTEs can convey useful CP risk stratification information and emphasizes the importance of adequately assessing these parameters prior to LT.

Neuroimaging and clinical findings in a case of linear scleroderma en coup de sabre.

PubMed

Duman, Ikram E; Ekinci, Gazanfer

2018-06-01

Linear scleroderma "en coup de sabre" is a subset of localized scleroderma with band-like sclerotic lesions typically involving the frontoparietal regions of the scalp. En coup de sabre and Parry-Romberg syndrome are variants of linear morphea on the head and neck that can be associated with neurologic manifestations. On imaging, patients may have lesions in the cerebrum ipsilateral to the scalp abnormality. We present a case of an 8-year-old girl with a left frontoparietal "en coup de sabre" scalp lesion and describe the neuroimaging findings of frontoparietal white matter lesion discovered incidentally on routine magnetic resonance imaging. The patient had no neurologic symptoms given the lesion identified.

Intensified food production and correlated risks to human health in the Greater Mekong Subregion: a systematic review.

PubMed

Richter, Carsten H; Custer, Benjamin; Steele, Jennifer A; Wilcox, Bruce A; Xu, Jianchu

2015-05-26

Intensified food production, i.e. agricultural intensification and industrialized livestock operations may have adverse effects on human health and promote disease emergence via numerous mechanisms resulting in either direct impacts on humans or indirect impacts related to animal and environmental health. For example, while biodiversity is intentionally decreased in intensive food production systems, the consequential decrease in resilience in these systems may in turn bear increased health risks. However, quantifying these risks remains challenging, even if individual intensification measures are examined separately. Yet, this is an urgent task, especially in rapidly developing areas of the world with few regulations on intensification measures, such as in the Greater Mekong Subregion (GMS). We systematically searched the databases PubMed and Scopus for recent studies conducted on the association between agricultural (irrigation, fertilization, pesticide application) and livestock (feed additives, animal crowding) intensification measures and human health risks in the GMS. The search terms used were iteratively modified to maximize the number of retrieved studies with relevant quantitative data. We found that alarmingly little research has been done in this regard, considering the level of environmental contamination with pesticides, livestock infection with antibiotic resistant pathogens and disease vector proliferation in irrigated agroecosystems reported in the retrieved studies. In addition, each of the studies identified focused on specific aspects of intensified food production and there have been no efforts to consolidate the health risks from the simultaneous exposures to the range of hazardous chemicals utilized. While some of the studies identified already reported environmental contamination bearing considerable health risks for local people, at the current state of research the actual consolidated risk from regional intensification measures cannot be

Clinical characteristics and brain PET findings in 3 cases of dissociative amnesia: disproportionate retrograde deficit and posterior middle temporal gyrus hypometabolism.

PubMed

Thomas-Antérion, C; Dubas, F; Decousus, M; Jeanguillaume, C; Guedj, E

2014-10-01

Precipitated by psychological stress, dissociative amnesia occurs in the absence of identifiable brain damage. Its clinical characteristics and functional neural basis are still a matter of controversy. In the present paper, we report 3 cases of retrograde autobiographical amnesia, characterized by an acute onset concomitant with emotional/neurological precipitants. We present 2 cases of dissociative amnesia with fugue (cases 1 and 2), and one case of focal dissociative amnesia after a minor head trauma (case 3). The individual case histories and neuropsychological characteristics are reported, as well as the whole-brain voxel-based 18FDG-PET metabolic findings obtained at group-level in comparison to 15 healthy subjects. All patients suffered from autobiographical memory loss, in the absence of structural lesion. They had no significant impairment of anterograde memory or of executive function. Impairment of autobiographical memory was complete for two of the three patients, with loss of personal identity (cases 1 and 2). A clinical recovery was found for the two patients in whom follow-up was available (cases 2 and 3). Voxel-based group analysis highlighted a metabolic impairment of the right posterior middle temporal gyrus. 18FDG-PET was repeated in case 3, and showed a complete functional brain recovery. The situation of dissociative amnesia with disproportionate retrograde amnesia is clinically heterogeneous between individuals. Our findings may suggest that impairment of high-level integration of visual and/or emotional information processing involving dysfunction of the right posterior middle temporal gyrus could reduce triggering of multi-modal visual memory traces, thus impeding reactivation of aversive memories. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

[Radiological findings in congenital anosmia: a case report].

PubMed

Sánchez-Pérez, María; Recio-Rodríguez, Manuel; Jiménez-De la Peña, Mar; Carrascoso-Arranz, Javier; Martínez-De Vega, Vicente

2011-07-16

Hypoplasia of the olfactory tracts and bulbs is a rare cause of anosmia in the paediatric population. In most cases it is usually due to an acquired cause and in only a few is it associated to chromosomal disorders (Kallman's syndrome, among others). A 10-year-old boy with no chromosomal disorders and a family history of anosmia, who visited because of isolated anosmia; a magnetic resonance scan revealed bilateral hypoplasia of the olfactory tracts and bulbs. Magnetic resonance imaging allows the anatomy of the olfactory tract to be studied in detail and this makes it a valuable tool in the diagnosis of structural abnormalities in cases of olfactory disorders and also in the planning of treatment.

How to optimize tuberculosis case finding: explorations for Indonesia with a health system model

PubMed Central

2009-01-01

Background A mathematical model was designed to explore the impact of three strategies for better tuberculosis case finding. Strategies included: (1) reducing the number of tuberculosis patients who do not seek care; (2) reducing diagnostic delay; and (3) engaging non-DOTS providers in the referral of tuberculosis suspects to DOTS services in the Indonesian health system context. The impact of these strategies on tuberculosis mortality and treatment outcome was estimated using a mathematical model of the Indonesian health system. Methods The model consists of multiple compartments representing logical movement of a respiratory symptomatic (tuberculosis suspect) through the health system, including patient- and health system delays. Main outputs of the model are tuberculosis death rate and treatment outcome (i.e. full or partial cure). We quantified the model parameters for the Jogjakarta province context, using a two round Delphi survey with five Indonesian tuberculosis experts. Results The model validation shows that four critical model outputs (average duration of symptom onset to treatment, detection rate, cure rate, and death rate) were reasonably close to existing available data, erring towards more optimistic outcomes than are actually reported. The model predicted that an intervention to reduce the proportion of tuberculosis patients who never seek care would have the biggest impact on tuberculosis death prevention, while an intervention resulting in more referrals of tuberculosis suspects to DOTS facilities would yield higher cure rates. This finding is similar for situations where the alternative sector is a more important health resource, such as in most other parts of Indonesia. Conclusion We used mathematical modeling to explore the impact of Indonesian health system interventions on tuberculosis treatment outcome and deaths. Because detailed data were not available regarding the current Indonesian population, we relied on expert opinion to quantify the

MRI and MR spectroscopy findings of a case of subacute sclerosing panencephalitis affecting the corpus callosum

PubMed Central

Öztürk, Mehmet; Sığırcı, Ahmet; Yakıncı, Cengiz

2015-01-01

Subacute sclerosing panencephalitis (SSPE) is a rare, slowly progressive, fatal, inflammatory and neurodegenerative disease that is seen mostly in children and young adolescents, and primarily affects the parieto-occipital lobes. The corpus callosum, cerebellum and basal ganglia are less frequently involved. MR spectroscopy (MRS) may illustrate the pathophysiological features of SSPE. To the best of our knowledge, this is the second report of MRS findings of corpus callosum involvement in a stage 3 SSPE case. PMID:26163552

Music evoked autobiographical memory after severe acquired brain injury: preliminary findings from a case series.

PubMed

Baird, A; Samson, S

2014-01-01

Music evoked autobiographical memories (MEAMs) have been characterised in the healthy population, but not, to date, in patients with acquired brain injury (ABI). Our aim was to investigate music compared with verbal evoked autobiographical memories. Five patients with severe ABI and matched controls completed the experimental music (MEAM) task (a written questionnaire) while listening to 50 "Number 1 Songs of the Year" (from 1960 to 2010). Patients also completed the Autobiographical Memory Interview (AMI) and a standard neuropsychological assessment. With the exception of Case 5, who reported no MEAMs and no autobiographical incidents on the AMI and who also had impaired pitch perception, the range of frequency and type of MEAMs in patients was broadly in keeping with their matched controls. The relative preservation of MEAMs in four cases was particularly noteworthy given their impaired verbal and/or visual anterograde memory, and in three cases, autobiographical memory impairment. The majority of MEAMs in both cases and matched controls were of a person/people or a period of life. In three patients music was more efficient at evoking autobiographical memories than the AMI verbal prompts. This is the first study of MEAMs after ABI. The findings suggest that music is an effective stimulus for eliciting autobiographical memories, and may be beneficial in the rehabilitation of autobiographical amnesia, but only in patients without a fundamental deficit in autobiographical recall memory and intact pitch perception.

The Cluster-Randomized BRIGHT Trial: Proactive Case Finding for Community-Dwelling Older Adults

PubMed Central

Kerse, Ngaire; McLean, Chris; Moyes, Simon A.; Peri, Kathy; Ng, Terence; Wilkinson-Meyers, Laura; Brown, Paul; Latham, Nancy; Connolly, Martin

2014-01-01

PURPOSE People are now living longer, but disability may affect the quality of those additional years of life. We undertook a trial to assess whether case finding reduces disability among older primary care patients. METHODS We conducted a cluster-randomized trial of the Brief Risk Identification Geriatric Health Tool (BRIGHT) among 60 primary care practices in New Zealand, assigning them to an intervention or control group. Intervention practices sent a BRIGHT screening tool to older adults every birthday; those with a score of 3 or higher were referred to regional geriatric services for assessment and, if needed, service provision. Control practices provided usual care. Main outcomes, assessed in blinded fashion, were residential care placement and hospitalization, and secondary outcomes were disability, assessed with Nottingham Extended Activities of Daily Living Scale (NEADL), and quality of life, assessed with the World Health Organization Quality of Life scale, abbreviated version (WHOQOL-BREF). RESULTS All 8,308 community-dwelling patients aged 75 years and older were approached; 3,893 (47%) participated, of whom 3,010 (77%) completed the trial. Their mean age was 80.3 (SD 4.5) years, and 55% were women. Overall, 88% of the intervention group returned a BRIGHT tool; 549 patients were referred. After 36 months, patients in the intervention group were more likely than those in the control group to have been placed in residential care: 8.4% vs 6.2% (hazard ratio = 1.32; 95% CI, 1.04–1.68; P = .02). Intervention patients had smaller declines in mean scores for physical health-related quality of life (1.6 vs 2.9 points, P = .007) and psychological health-related quality of life (1.1 vs 2.4 points, P = .005). Hospitalization, disability, and use of services did not differ between groups, however. CONCLUSIONS Our case-finding strategy was effective in increasing identification of older adults with disability, but there was little evidence of improved outcomes

Predator cannibalism can intensify negative impacts on heterospecific prey.

PubMed

Takatsu, Kunio; Kishida, Osamu

2015-07-01

Although natural populations consist of individuals with different traits, and the degree of phenotypic variation varies among populations, the impact of phenotypic variation on ecological interactions has received little attention, because traditional approaches to community ecology assume homogeneity of individuals within a population. Stage structure, which is a common way of generating size and developmental variation within predator populations, can drive cannibalistic interactions, which can affect the strength of predatory effects on the predator's heterospecific prey. Studies have shown that predator cannibalism weakens predatory effects on heterospecific prey by reducing the size of the predator population and by inducing less feeding activity of noncannibal predators. We predict, however, that predator cannibalism, by promoting rapid growth of the cannibals, can also intensify predation pressure on heterospecific prey, because large predators have large resource requirements and may utilize a wider variety of prey species. To test this hypothesis, we conducted an experiment in which we created carnivorous salamander (Hynobius retardatus) populations with different stage structures by manipulating the salamander's hatch timing (i.e., populations with large or small variation in the timing of hatching), and explored the resultant impacts on the abundance, behavior, morphology, and life history of the salamander's large heterospecific prey, Rana pirica frog tadpoles. Cannibalism was rare in salamander populations having small hatch-timing variation, but was frequent in those having large hatch-timing variation. Thus, giant salamander cannibals occurred only in the latter. We clearly showed that salamander giants exerted strong predation pressure on frog tadpoles, which induced large behavioral and morphological defenses in the tadpoles and caused them to metamorphose late at large size. Hence, predator cannibalism arising from large variation in the timing

MRI findings in 6 cases of children by inadvertent ingestion of diphenoxylate-atropine.

PubMed

Xiao, Lianxiang; Lin, Xiangtao; Cao, Jinfeng; Wang, Xueyu; Wu, Lebin

2011-09-01

Compound diphenoxylate (diphenoxylate-atropine) poisoning can cause toxic encephalopathy in children, and magnetic resonance imaging (MRI) of the brain in this condition has not been reported. This study is to analyze brain MRI findings and to investigate the relations between MRI features and possible pathophysiological changes in children. Six children accidentally swallowed compound diphenoxylate, 4 males, 2 females, aged 20-46 months, average 33 months. Quantity of ingested diphenoxylate-atropine was from 6 to 30 tablets, each tablet contains diphenoxylate 2.5mg and atropine 0.025 mg. These patients were referred to our hospital within 24h after diphenoxylate-atropine ingestion, and underwent brain MRI scan within 24-72 h after emergency treatment. The characteristics of conventional MRI were analyzed. These pediatric patients had various symptoms of opioid intoxication and atropine toxicity. Brain MRI showed abnormal low signal intensity on T1-weighted images (T1WI) and abnormal high signal intensity on T2-weighted images (T2WI) and fluid-attenuated inversion recovery (FLAIR) imaging in bilateral in all cases; abnormal high signal intensity on T1WI, T2WI and FLAIR in 4 cases. Encephalomalacia was observed in 3 cases during follow-up. In the early stage of compound diphenoxylate poisoning in children, multiple extensive edema-necrosis and hemorrhagic-necrosis focus were observed in basic nucleus, pallium and cerebellum, these resulted in the corresponding brain dysfunction with encephalomalacia. MRI scan in the early stage in this condition may provide evidences of brain impairment, and is beneficial for the early diagnosis, treatment and prognosis assessment. Crown Copyright © 2010. Published by Elsevier Ireland Ltd. All rights reserved.

The effectiveness of a social marketing model on case-finding for COPD in a deprived inner city population.

PubMed

José, Ricardo J P; Roberts, June; Bakerly, Nawar Diar

2010-06-01

To evaluate the effectiveness of a social marketing model on case-finding for COPD in a population with high smoking rates and COPD prevalence. A two-week marketing campaign was conducted using high visibility posters, leaflets distributed with the local newspaper, and the creation of a free automated COPD information line. The primary outcome measure was the number of newly-diagnosed cases of COPD as a result of the campaign. Secondary outcomes measures were: the number of phone calls to the information line up to four weeks after the end of the campaign; the number of individuals who presented to their general practitioner (GP) for spirometry as a result of the campaign; and responses to a questionnaire sent to members of the public to analyse and assess the visibility and impact of the campaign. Ten people came forward to have spirometry performed and all had non-obstructive results. Nine calls were made to the dedicated COPD phone line. 135 out of 400 members of the public (34%) responded to the questionnaire; of these, only 34 (25%) recalled seeing a campaign poster. Posters and leaflets from this campaign were visible but only led to 10 individuals coming forward for spirometry, none of whom had COPD. This form of healthcare marketing was costly and not effective for COPD case-finding in our area.

Communicating Experimental Findings in Single Case Design Research: How to Use Celeration Values and Celeration Multipliers to Measure Direction, Magnitude, and Change of Slope

ERIC Educational Resources Information Center

Datchuk, Shawn M.; Kubina, Richard M., Jr.

2011-01-01

The accumulation of scientific knowledge greatly depends upon the critical review of experimental findings by ones peers. In single case design research, experimenters present findings with graphical displays of data and narrative description of a visual analysis. To aid in efficient and accurate description of experimental findings, the research…

F-18 FDG PET/CT findings of a case of sacral nerve root neurolymphomatosis that occurred during chemotherapy.

PubMed

Suga, Kazuyoshi; Yasuhiko, Kawakami; Matsunaga, Naofumi; Yujiri, Toshiaki; Nakazora, Tatsuki; Ariyoshi, Kouichi

2011-01-01

Neurolymphomatosis (NL) is a rare, unique subtype of lymphomatous infiltration of peripheral nerves. Clinical/radiologic diagnosis of NL is challenging. We report F-18 FDG PET/CT findings of a case of breast diffuse large B-cell lymphoma, in which NL developed regardless of regression of systemic lesions during induction chemotherapy. FDG PET/CT showed characteristic findings of well-demarcated, linear abnormal FDG uptake along a sacral vertebral foramen, leading to diagnosis of NL, with the finding of thickened nerve roots on magnetic resonance imaging. Altered chemotherapeutic regimen resulted in disappearance of these abnormal FDG uptake, with recovery of neurologic symptoms. Peripheral nerve NL may occur during chemotherapy, and FDG PET/CT can be a useful imaging modality in diagnosis and monitoring of therapeutic response of this disease.

MRI and MR spectroscopy findings of a case of subacute sclerosing panencephalitis affecting the corpus callosum.

PubMed

Öztürk, Mehmet; Sığırcı, Ahmet; Yakıncı, Cengiz

2015-07-10

Subacute sclerosing panencephalitis (SSPE) is a rare, slowly progressive, fatal, inflammatory and neurodegenerative disease that is seen mostly in children and young adolescents, and primarily affects the parieto-occipital lobes. The corpus callosum, cerebellum and basal ganglia are less frequently involved. MR spectroscopy (MRS) may illustrate the pathophysiological features of SSPE. To the best of our knowledge, this is the second report of MRS findings of corpus callosum involvement in a stage 3 SSPE case. 2015 BMJ Publishing Group Ltd.

Perinatal findings of Seckel syndrome: a case report of a fetus showing primordial dwarfism and severe microcephaly.

PubMed

Takikawa, Keiko Miyachi; Kikuchi, Akihiko; Yokoyama, Akiko; Ono, Kyoko; Iwasawa, Yuki; Sunagawa, Sorahiro; Takagi, Kimiyo; Kawame, Hiroshi; Nakamura, Tomohiko

2008-01-01

Seckel syndrome is a rare form of primordial dwarfism and most of the previous reports have been limited to postnatal findings. We report on a fetus showing severe microcephaly, intrauterine growth restriction and a few gyri with shallow sulci on the fetal brain suggesting cortical dysplasia, followed by ultrasound and magnetic resonance imaging in the prenatal period. Cardiotocograph revealed a reassuring fetal status throughout the whole pregnancy period. A male infant weighing 1,556 g was delivered at 39 weeks' gestation, and a diagnosis of Seckel syndrome was made based on postnatal typical findings. Although previous reports on prenatal findings of Seckel syndrome are quite limited, we think that our case presents typical features of a fetus affected by this syndrome. When prenatal ultrasound shows severe microcephaly and intrauterine growth restriction, this rare syndrome should be included in the differential diagnosis. Moreover, magnetic resonance imaging of the affected fetal brain provides further diagnostic clues. Copyright 2008 S. Karger AG, Basel.

An unusual case of disseminated toxoplasmosis in a previously healthy pregnant patient: radiographic, CT, and MRI findings.

PubMed

Paruthikunnan, Samir; Shankar, Balasubramanyam; Kadavigere, Rajagopal; Prabhu, Mukhyaprana; Narayanan, Ramakrishna; Jain, Harshwardhan

2014-11-01

Toxoplasmosis is a ubiquitous protozoal infection that during pregnancy commonly affects the fetus severely, with maternal infection usually being mild self-limiting. Disseminated toxoplasmosis in a healthy pregnant woman has, to the best of our knowledge, not been reported before. We present a case of disseminated toxoplasmosis involving pulmonary, central nervous system, and lymph nodes in a pregnant woman and imaging findings on radiography, computed tomography, and magnetic resonance imaging.

Antimicrobial Resistance and Molecular Typing of Neisseria gonorrhoeae Isolates in Kyoto and Osaka, Japan, 2010 to 2012: Intensified Surveillance after Identification of the First Strain (H041) with High-Level Ceftriaxone Resistance

PubMed Central

Shimuta, Ken; Unemo, Magnus; Nakayama, Shu-ichi; Morita-Ishihara, Tomoko; Dorin, Misato; Kawahata, Takuya

2013-01-01

In 2009, the first high-level ceftriaxone-resistant Neisseria gonorrhoeae strain (H041) was isolated in Kyoto, Japan. The present study describes an intensified surveillance (antimicrobial resistance and molecular typing) of Neisseria gonorrhoeae isolates in Kyoto and its neighboring prefecture Osaka, Japan, in 2010 to 2012, which was initiated after the identification of H041. From April 2010 to March 2012, 193 N. gonorrhoeae isolates were collected and the MICs (μg/ml) to six antimicrobials, including ceftriaxone, were determined. All isolates showed susceptibility to ceftriaxone and cefixime (MIC values, <0.5 μg/ml), and spectinomycin. The rates of resistance (intermediate susceptibility) to azithromycin, penicillin G, and ciprofloxacin were 3.6% (19.7%), 24.4% (71.0%), and 78.2% (0.5%), respectively. Multilocus sequence typing (MLST) showed that 40.9%, 19.2%, and 17.1% of isolates belonged to ST1901, ST7359, and ST7363, respectively. Furthermore, N. gonorrhoeae multiantigen sequence typing (NG-MAST) revealed that 12 (63%) of the 19 isolates with decreased susceptibility to ceftriaxone (MIC > 0.064 μg/ml) were of ST1407. NG-MAST ST1407 was also the most prevalent ST (16.1%; 31 of 193 isolates). In those NG-MAST ST1407 strains, several mosaic type penA alleles were found, including SF-A type (penicillin binding protein 2 allele XXXIV) and its derivatives. These were confirmed using transformation of the penA mosaic alleles as critical determinants for enhanced cefixime and ceftriaxone MICs. The intensified surveillance in Kyoto and Osaka, Japan, did not identify any dissemination of the high-level ceftriaxone-resistant N. gonorrhoeae strain H041, suggesting that H041 might have caused only a sporadic case and has not spread further. PMID:23939890

Atypical Findings in Massive Bupropion Overdose: A Case Report and Discussion of Psychopharmacologic Issues.

PubMed

Zhu, Yuanjia; Kolawole, Tiwalola; Jimenez, Xavier F

2016-09-01

Bupropion is an atypical antidepressant that is structurally similar to amphetamines. Its primary toxic effects include seizure, sinus tachycardia, hypertension, and agitation; however, at higher amounts of ingestion, paradoxical cardiac effects are seen. We report the case of a 21-year-old woman who ingested 13.5 g of bupropion, a dose higher than any other previously reported. The patient presented with seizure, sinus tachycardia with prolonged QTc and QRS intervals, dilated pupils, and agitation. Four days after overdose, the patient's sinus tachycardia and prolonged QTc and QRS intervals resolved with symptomatic management, but she soon developed sinus bradycardia, hypotension, and mild transaminitis. With continued conservative management and close monitoring, her sinus bradycardia resolved 8 days after the overdose. The transaminitis resolved 12 days after the overdose. Our findings are consistent with previously reported toxic effects associated with common overdose amounts of bupropion. In addition, we have observed transient cardiotoxicity manifesting as sinus bradycardia associated with massive bupropion overdose. These findings are less frequently reported and must be considered when managing patients with massive bupropion overdose. We review the psychopharmacologic implications of this and comment on previous literature.

Super-dry reforming of methane intensifies CO2 utilization via Le Chatelier's principle.

PubMed

Buelens, Lukas C; Galvita, Vladimir V; Poelman, Hilde; Detavernier, Christophe; Marin, Guy B

2016-10-28

Efficient CO 2 transformation from a waste product to a carbon source for chemicals and fuels will require reaction conditions that effect its reduction. We developed a "super-dry" CH 4 reforming reaction for enhanced CO production from CH 4 and CO 2 We used Ni/MgAl 2 O 4 as a CH 4 -reforming catalyst, Fe 2 O 3 /MgAl 2 O 4 as a solid oxygen carrier, and CaO/Al 2 O 3 as a CO 2 sorbent. The isothermal coupling of these three different processes resulted in higher CO production as compared with that of conventional dry reforming, by avoiding back reactions with water. The reduction of iron oxide was intensified through CH 4 conversion to syngas over Ni and CO 2 extraction and storage as CaCO 3 CO 2 is then used for iron reoxidation and CO production, exploiting equilibrium shifts effected with inert gas sweeping (Le Chatelier's principle). Super-dry reforming uses up to three CO 2 molecules per CH 4 and offers a high CO space-time yield of 7.5 millimole CO per second per kilogram of iron at 1023 kelvin. Copyright © 2016, American Association for the Advancement of Science.

An Enigmatic Case of Acute Mercury Poisoning: Clinical, Immunological Findings and Platelet Function.

PubMed

Kleffner, Ilka; Eichler, Susann; Ruck, Tobias; Schüngel, Lisa; Pfeuffer, Steffen; Polzer, Philipp; Dittrich, Ralf; Dziewas, Rainer; Gross, Catharina C; Göbel, Kerstin; Wiendl, Heinz; Kehrel, Beate E; Meuth, Sven G

2017-01-01

Severe mercury intoxication is very rare in developed countries, but still occurs as the result of volatile substance abuse, suicide attempts, occupational hazards, or endemic food ingestion as reported in the cases of public health disasters in Iraq and in Minamata Bay, Japan. Here, we describe the dramatic physical and cognitive decline of a 23-year-old patient caused by a severe methyl mercury (MeHg) intoxication of unknown origin. We show serial magnetic resonance imaging (MRI) of the patient's brain, as well as ex vivo analyses of blood and cerebrospinal fluid including multicolor flow cytometric measurements, functional assays of hemostaseologic efficacy, and evaluation of regulatory effector molecules. Together with the clinical history, our findings show the progressive neuronal degeneration accompanying the deterioration of the patient. Moreover, the ex vivo analyses display alterations of thrombocyte function and coagulation, as well as an immunological milieu facilitating autoimmunity. Despite the successful reduction of the MeHg concentration in the patient's blood with erythrocyte apheresis and chelator therapy, his condition did not improve and led to a persistent vegetative state. This case illustrates the neurotoxicity of MeHg following severe intoxication for the first time by serial MRI. Data on immune-cell and thrombocyte function as well as on coagulation in mercury poisoning reveal potential implications for anticoagulation and immunomodulatory treatment.

An Enigmatic Case of Acute Mercury Poisoning: Clinical, Immunological Findings and Platelet Function

PubMed Central

Kleffner, Ilka; Eichler, Susann; Ruck, Tobias; Schüngel, Lisa; Pfeuffer, Steffen; Polzer, Philipp; Dittrich, Ralf; Dziewas, Rainer; Gross, Catharina C.; Göbel, Kerstin; Wiendl, Heinz; Kehrel, Beate E.; Meuth, Sven G.

2017-01-01

Severe mercury intoxication is very rare in developed countries, but still occurs as the result of volatile substance abuse, suicide attempts, occupational hazards, or endemic food ingestion as reported in the cases of public health disasters in Iraq and in Minamata Bay, Japan. Here, we describe the dramatic physical and cognitive decline of a 23-year-old patient caused by a severe methyl mercury (MeHg) intoxication of unknown origin. We show serial magnetic resonance imaging (MRI) of the patient’s brain, as well as ex vivo analyses of blood and cerebrospinal fluid including multicolor flow cytometric measurements, functional assays of hemostaseologic efficacy, and evaluation of regulatory effector molecules. Together with the clinical history, our findings show the progressive neuronal degeneration accompanying the deterioration of the patient. Moreover, the ex vivo analyses display alterations of thrombocyte function and coagulation, as well as an immunological milieu facilitating autoimmunity. Despite the successful reduction of the MeHg concentration in the patient’s blood with erythrocyte apheresis and chelator therapy, his condition did not improve and led to a persistent vegetative state. This case illustrates the neurotoxicity of MeHg following severe intoxication for the first time by serial MRI. Data on immune-cell and thrombocyte function as well as on coagulation in mercury poisoning reveal potential implications for anticoagulation and immunomodulatory treatment. PMID:29033890

Reduction of radiation dose and imaging costs in scoliosis radiography. Application of large-screen image intensifier photofluorography

DOE Office of Scientific and Technical Information (OSTI.GOV)

Manninen, H.; Kiekara, O.; Soimakallio, S.

1988-04-01

Photofluorography using a large-field image intensifier (Siemens Optilux 57) was applied to scoliosis radiography and compared with a full-size rare-earth screen/film technique. When scoliosis radiography (PA-projection) was performed on 25 adolescent patients, the photofluorographs were found to be of comparable diagnostic quality with full-size films. A close correspondence between the imaging techniques was found in the Cobb angle measurements as well as in the grading of rotation with the pedicle method. The use of photofluorography results in a radiation dose reduction of about one-half and considerable savings in direct imaging costs and archive space. In our opinion the method ismore » particularly well-suited for follow-up and screening evaluation of scoliosis, but in tall patients the image field size of 40 x 40 cm restricts its usefulness as initial examination.« less

A case of probable mixed-infection with Clonorchis sinensis and Fasciola sp.: CT and parasitological findings.

PubMed

Kim, Tae Yun; Lee, Yun-Sik; Yun, Ji Hye; Kim, Jeong Ju; Choi, Won Hyung; Oh, In Hwan; Song, Hyun Ouk; Chu, Jong Phil

2010-06-01

We report here a human case probably mixed-infected with Clonorchis sinensis and Fasciola sp. who was diagnosed by computed tomography (CT) scan, serological findings, and/or fecal examination. The patient was a 43-year-old Korean female and was admitted to Kyung Hee University Hospital with the complaints of fever and abdominal pain. On admission, marked eosinophilia was noted in her peripheral blood. CT scan showed specific lesions for clonorchiasis and fascioliasis in the liver, along with lesions suggestive of amebic abscess. Micro-ELISA revealed positive results for the 2 helminthic infections. Eggs of C. sinensis and trophozoites of Entamoeba histolytica were observed in the stool. Treatment with praziquantel followed by metronidazole and tinidazole reduced abnormalities in the liver and eosinophilia. This is the first case report of a possible co-infection with 2 kinds of liver flukes in the Republic of Korea.

Cost-effectiveness of WHO-Recommended Algorithms for TB Case Finding at Ethiopian HIV Clinics.

PubMed

Adelman, Max W; McFarland, Deborah A; Tsegaye, Mulugeta; Aseffa, Abraham; Kempker, Russell R; Blumberg, Henry M

2018-01-01

The World Health Organization (WHO) recommends active tuberculosis (TB) case finding and a rapid molecular diagnostic test (Xpert MTB/RIF) to detect TB among people living with HIV (PLHIV) in high-burden settings. Information on the cost-effectiveness of these recommended strategies is crucial for their implementation. We conducted a model-based cost-effectiveness analysis comparing 2 algorithms for TB screening and diagnosis at Ethiopian HIV clinics: (1) WHO-recommended symptom screen combined with Xpert for PLHIV with a positive symptom screen and (2) current recommended practice algorithm (CRPA; based on symptom screening, smear microscopy, and clinical TB diagnosis). Our primary outcome was US$ per disability-adjusted life-year (DALY) averted. Secondary outcomes were additional true-positive diagnoses, and false-negative and false-positive diagnoses averted. Compared with CRPA, combining a WHO-recommended symptom screen with Xpert was highly cost-effective (incremental cost of $5 per DALY averted). Among a cohort of 15 000 PLHIV with a TB prevalence of 6% (900 TB cases), this algorithm detected 8 more true-positive cases than CRPA, and averted 2045 false-positive and 8 false-negative diagnoses compared with CRPA. The WHO-recommended algorithm was marginally costlier ($240 000) than CRPA ($239 000). In sensitivity analysis, the symptom screen/Xpert algorithm was dominated at low Xpert sensitivity (66%). In this model-based analysis, combining a WHO-recommended symptom screen with Xpert for TB diagnosis among PLHIV was highly cost-effective ($5 per DALY averted) and more sensitive than CRPA in a high-burden, resource-limited setting.

Neurosensory findings among electricians with self-reported remaining symptoms after an electrical injury: A case series.

PubMed

Rådman, Lisa; Gunnarsson, Lars-Gunnar; Nilsagård, Ylva; Nilsson, Tohr

2016-12-01

Symptoms described in previous studies indicate that electrical injury can cause longstanding injuries to the neurosensory nerves. The aim of the present case series was to objectively assess the profile of neurosensory dysfunction in electricians in relation to high voltage or low voltage electrical injury and the "no-let-go phenomenon". Twenty-three Swedish male electricians exposed to electrical injury were studied by using a battery of clinical instruments, including quantitative sensory testing (QST). The clinical test followed a predetermined order of assessments: thermal perceptions thresholds, vibration perception thresholds, tactile gnosis (the Shape and Texture Identification test), manual dexterity (Purdue Pegboard Test), and grip strength. In addition, pain was studied by means of a questionnaire, and a colour chart was used for estimation of white fingers. The main findings in the present case series were reduced thermal perceptions thresholds, where half of the group showed abnormal values for warm thermal perception and/or cold thermal perception. Also, the tactile gnosis and manual dexterity were reduced. High voltage injury was associated with more reduced sensibility compared to those with low voltage. Neurosensory injury can be objectively assessed after an electrical injury by using QST with thermal perception thresholds. The findings are consistent with injuries to small nerve fibres. In the clinical setting thermal perception threshold is therefore recommended, in addition to tests of tactile gnosis and manual dexterity (Purdue Pegboard). Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Computed tomographic findings in dogs and cats with temporomandibular joint disorders: 58 cases (2006–2011)

PubMed Central

Arzi, Boaz; Cissell, Derek D.; Verstraete, Frank J. M.; Kass, Philip H.; DuRaine, Grayson D.; Athanasiou, Kyriacos A.

2013-01-01

Objective To describe CT findings in dogs and cats with temporomandibular joint (TMJ) disorders. Design Retrospective case-series. Animals 41 dogs and 17 cats. Procedures Medical records and CT images of the skull were reviewed for dogs and cats that were examined at a dentistry and oral surgery specialty practice between 2006 and 2011. Results Of 142 dogs and 42 cats evaluated, 41 dogs and 17 cats had CT findings consistent with a TMJ disorder. In dogs, the most common TMJ disorder was osteoarthritis; however, in most cases, there were other TMJ disorders present in addition to osteoarthritis. Osteoarthritis was more frequently identified at the medial aspect rather than the lateral aspect of the TMJ, whereas the frequency of osteoarthritic involvement of the dorsal and ventral compartments did not differ significantly. In cats, fractures were the most common TMJ disorder, followed by osteoarthritis. Clinical signs were observed in all dogs and cats with TMJ fractures, dysplasia, ankylosis, luxation, and tumors; however, only 4 of 15 dogs and 2 of 4 cats with osteoarthritis alone had clinical signs. Conclusions and Clinical Relevance Results indicated that TMJ disorders are frequently present in combination. Osteoarthritis was the most common TMJ disorder in dogs and the second most common TMJ disorder in cats. Computed tomography should be considered as a tool for the diagnosis of TMJ disorders in dogs and cats with suspected orofacial disorders and pain. PMID:23234284

Antenatal depression case-finding by community health workers in South Africa: feasibility of a mobile phone application

PubMed Central

Tsai, Alexander C.; Tomlinson, Mark; Dewing, Sarah; le Roux, Ingrid M.; Harwood, Jessica M.; Chopra, Mickey; Rotheram-Borus, Mary Jane

2014-01-01

Purpose Randomised controlled trials conducted in resource-limited settings have shown that once women with depressed mood are evaluated by specialists and referred for treatment, lay health workers can be trained to effectively administer psychological treatments. We sought to determine the extent to which community health workers could also be trained to conduct case finding using short and ultra-short screening instruments programmed into mobile phones. Methods Pregnant, Xhosa-speaking women were recruited independently in two cross-sectional studies (N=1,144 and N=361) conducted in Khayelitsha, South Africa and assessed for antenatal depression. In the smaller study, community health workers with no training in human subjects research were trained to administer the Edinburgh Postnatal Depression Scale (EPDS) during the routine course of their community-based outreach. We compared the operating characteristics of 4 short and ultra-short versions of the EPDS with the criterion standard of probable depression, defined as an EPDS-10 ≥13. Results The prevalence of probable depression (475/1144 [42%] and 165/361 [46%]) was consistent across both samples. The 2-item subscale demonstrated poor internal consistency (Cronbach’s α ranged from 0.55-0.58). All 4 subscales demonstrated excellent discrimination, with area under the receiver operating characteristic curve (AUC) values ranging from 0.91-0.99. Maximal discrimination was observed for the 7-item depressive symptoms subscale: at the conventional screening threshold of ≥10, it had 0.97 sensitivity and 0.76 specificity for detecting probable antenatal depression. Conclusions The comparability of the findings across the two studies suggests that it is feasible to use community health workers to conduct case finding for antenatal depression. PMID:24682529

Antenatal depression case finding by community health workers in South Africa: feasibility of a mobile phone application.

PubMed

Tsai, Alexander C; Tomlinson, Mark; Dewing, Sarah; le Roux, Ingrid M; Harwood, Jessica M; Chopra, Mickey; Rotheram-Borus, Mary Jane

2014-10-01

Randomized controlled trials conducted in resource-limited settings have shown that once women with depressed mood are evaluated by specialists and referred for treatment, lay health workers can be trained to effectively administer psychological treatments. We sought to determine the extent to which community health workers could also be trained to conduct case finding using short and ultrashort screening instruments programmed into mobile phones. Pregnant, Xhosa-speaking women were recruited independently in two cross-sectional studies (N = 1,144 and N = 361) conducted in Khayelitsha, South Africa and assessed for antenatal depression. In the smaller study, community health workers with no training in human subject research were trained to administer the Edinburgh Postnatal Depression Scale (EPDS) during the routine course of their community-based outreach. We compared the operating characteristics of four short and ultrashort versions of the EPDS with the criterion standard of probable depression, defined as an EPDS-10 ≥ 13. The prevalence of probable depression (475/1144 [42 %] and 165/361 [46 %]) was consistent across both samples. The 2-item subscale demonstrated poor internal consistency (Cronbach's α ranged from 0.55 to 0.58). All four subscales demonstrated excellent discrimination, with area under the receiver operating characteristic curve (AUC) values ranging from 0.91 to 0.99. Maximal discrimination was observed for the 7-item depressive symptoms subscale: at the conventional screening threshold of ≥10, it had 0.97 sensitivity and 0.76 specificity for detecting probable antenatal depression. The comparability of the findings across the two studies suggests that it is feasible to use community health workers to conduct case finding for antenatal depression.

Find and treat or find and lose? Tuberculosis treatment outcomes among screened newly arrived asylum seekers in Germany 2002 to 2014.

PubMed

Kuehne, Anna; Hauer, Barbara; Brodhun, Bonita; Haas, Walter; Fiebig, Lena

2018-03-01

BackgroundGermany has a low tuberculosis (TB) incidence. A relevant and increasing proportion of TB cases is diagnosed among asylum seekers upon screening. Aim: We aimed to assess whether cases identified by screening asylum seekers had equally successful and completely reported treatment outcomes as cases diagnosed by passive case finding and contact tracing in the general population. Methods: We analysed characteristics and treatment outcomes of pulmonary TB cases notified in Germany between 2002 and 2014, stratified by mode of case finding. We performed three multivariable analyses with different dependent variables: Model A: successful vs all other outcomes, Model B: successful vs documented non-successful clinical outcome and Model C: known outcome vs lost to follow-up. Results: TB treatment success was highest among cases identified by contact tracing (87%; 3,139/3,591), followed by passive case finding (74%; 28,804/39,019) and by screening asylum seekers (60%; 884/1,474). Cases identified by screening asylum seekers had 2.4 times higher odds of not having a successful treatment outcome as opposed to all other outcomes (A), 1.4 times higher odds of not having a successful treatment outcome as opposed to known non-successful outcomes (B) and 2.3 times higher odds of loss to follow-up (C) than cases identified by passive case finding. Conclusion: Screened asylum seekers had poorer treatment outcomes and were more often lost to follow-up. Linking patients to treatment facilities and investigating potential barriers to treatment completion are needed to secure screening benefits for asylum seekers and communities.

Facilitating access to surgical care through a decentralised case-finding strategy: experience in Madagascar

PubMed Central

Hamer, Mirjam; Biddell, Jasmin; Claus, Nathan; Randall, Kirsten; Alcorn, Dennis; Parker, Gary; Shrime, Mark G

2017-01-01

Over two-thirds of the world’s population lack access to surgical care. Non-governmental organisation’s providing free surgeries may overcome financial barriers, but other barriers to care still exist. This analysis paper discusses two different case-finding strategies in Madagascar that aimed to increase the proportion of poor patients, women and those for whom multiple barriers to care exist. From October 2014 to June 2015, we used a centralised selection strategy, aiming to find 70% of patients from the port city, Toamasina, and 30% from the national capital and two remote cities. From August 2015 to June 2016, a decentralised strategy was used, aiming to find 30% of patients from Toamasina and 70% from 11 remote locations, including the capital. Demographic information and self-reported barriers to care were collected. Wealth quintile was calculated for each patient using a combination of participant responses to asset-related and demographic questions, and publicly available data. A total of 2971 patients were assessed. The change from centralised to decentralised selection resulted in significantly poorer patients undergoing surgery. All reported barriers to prior care, except for lack of transportation, were significantly more likely to be identified in the decentralised group. Patients who identified multiple barriers to prior surgical care were less likely to be from the richest quintile (p=0.037) and more likely to be in the decentralised group (p=0.046). Our country-specific analysis shows that decentralised patient selection strategies may be used to overcome barriers to care and allow patients in greatest need to access surgical care. PMID:29071129

Immunohistochemical Identification and Pathologic Findings in Natural Cases of Equine Abortion Caused by Leptospiral Infection

PubMed Central

Szeredi, L.; Haake, D. A.

2009-01-01

The aim of this study was to examine the utility of immunohistochemistry (IHC) in the diagnosis of leptospiral equine abortion and to compare IHC to silver staining and serology of the aborted mares. Ninety-six fetuses from 57 farms were examined using all 3 diagnostic techniques, revealing evidence of leptospiral infection in 3 fetuses (3.1%) from 3 (5.3%) different farms. A new finding in 1 of these confirmed cases of leptospiral abortion was the presence of macroscopic pinpoint grayish-white nodules that had a histologic correlate of hepatic necrosis; other histologic findings were consistent with those previously reported. IHC performed using 2 different leptospiral antisera (multivalent whole-cell rabbit antiserum and rabbit antiserum against the major outer membrane protein LipL32) yielded similar results. IHC was more sensitive (19/21 [90.5%] tissue samples) than silver staining (8/21 [38.1%] tissue samples), and more specific than serology performed using the microscopic agglutination test. The primary advantage of IHC over silver staining was the ability of IHC to identify leptospiral antigen not only as morphologically intact spiral forms. PMID:16966455

Paediatric interventional cardiology: flat detector versus image intensifier using a test object

NASA Astrophysics Data System (ADS)

Vano, E.; Ubeda, C.; Martinez, L. C.; Leyton, F.; Miranda, P.

2010-12-01

Entrance surface air kerma (ESAK) values and image quality parameters were measured and compared for two biplane angiography x-ray systems dedicated to paediatric interventional cardiology, one equipped with image intensifiers (II) and the other one with dynamic flat detectors (FDs). Polymethyl methacrylate phantoms of different thicknesses, ranging from 8 to 16 cm, and a Leeds TOR 18-FG test object were used. The parameters of the image quality evaluated were noise, signal-difference-to-noise ratio (SdNR), high contrast spatial resolution (HCSR) and three figures of merit combining entrance doses and signal-to-noise ratios or HCSR. The comparisons showed a better behaviour of the II-based system in the low contrast region over the whole interval of thicknesses. The FD-based system showed a better performance in HCSR. The FD system evaluated would need around two times more dose than the II system evaluated to reach a given value of SdNR; moreover, a better spatial resolution was measured (and perceived in conventional monitors) for the system equipped with flat detectors. According to the results of this paper, the use of dynamic FD systems does not lead to an automatic reduction in ESAK or to an automatic improvement in image quality by comparison with II systems. Any improvement also depends on the setting of the x-ray systems and it should still be possible to refine these settings for some of the dynamic FDs used in paediatric cardiology.

Case of possible multiple system atrophy with a characteristic imaging finding of open bladder neck during storage phase as an initial sign.

PubMed

Zhang, Lu; Haga, Nobuhiro; Ogawa, Soichiro; Matsuoka, Kanako; Koguchi, Tomoyuki; Akaihata, Hidenori; Hata, Junya; Kataoka, Masao; Ishibashi, Kei; Kojima, Yoshiyuki

2017-11-01

Multiple system atrophy is a neurodegenerative disease that affects autonomic and motor systems. Patients with multiple system atrophy usually experience lower urinary tract symptoms, which sometimes appear as an initial symptom before the emergence of the generalized symptoms. An open bladder neck during the filling phase on video urodynamic study is one characteristic imaging finding after the diagnosis of multiple system atrophy, but has not previously been reported at an early phase of the disease. We report a case in which an open bladder neck was observed on several imaging modalities before generalized symptoms emerged. Because occult neurogenic bladder might exist in patients whose lower urinary tract symptoms are resistant to pharmacotherapy, we report this case to raise awareness of the importance of sufficient imaging evaluations. An open bladder neck might be an important imaging finding for diagnosing multiple system atrophy, irrespective of the presence of generalized symptoms. This finding could help avoid false diagnosis and unnecessary treatment. © 2017 The Japanese Urological Association.

Adrenoleukodystrophy. Electron microscopic findings.

PubMed

Powell, H; Tindall, R; Schultz, P; Paa, D; O'Brien, J; Lampert, P

1975-04-01

Ultrastructural and neurochemical studies were done on three male patients with adrenoleukodystrophy. In each case, the affected white matter contained enlarged glial cells filled with pathognomic intracytoplasmic inclusions consisting of electron-lucent spicules bounded by 25-Angstrom wide membranes. Similar inclusions were present in adrenocortical cells. These findings and a review of 47 reported cases indicate that adrenoleukodystrophy is a storage disorder caused by a sex-linked recessive error of metabolism.

Association of clinical signs with endoscopic findings in horses with nasopharyngeal cicatrix syndrome: 118 cases (2003-2008).

PubMed

Norman, Tracy E; Chaffin, M Keith; Bisset, Wesley T; Thompson, James A

2012-03-15

To characterize the associations between clinical signs of nasopharyngeal cicatrix syndrome (NCS) and endoscopic findings in horses. Retrospective, case-control study. 239 horses (118 case horses and 121 control horses). Medical records of horses that had an endoscopic evaluation of the upper airway performed between January 2003 and December 2008 were reviewed. Clinical signs and the appearance and anatomic locations of lesions identified during endoscopic evaluation were reviewed and recorded for each horse. The associations between clinical signs and endoscopic findings were evaluated by the use of a prospective logistic model that used a Bayesian method for inference and was implemented by a Markov chain Monte Carlo method. Nasal discharge was associated with acute inflammation of the pharynx and larynx. Exercise intolerance was associated with circumferential pharyngeal lesions. Respiratory noise was associated with chronic scarring of the pharynx, a combination of pharyngeal and laryngeal scarring, and circumferential scarring of the pharynx. Respiratory distress was associated with acute inflammation of all portions of the airway, especially when there was preexisting scarring and narrowing of the airway by ≥ 50%. Cough did not have any significant association with NCS, compared with results in control horses. Associations between the endoscopic appearance of NCS lesions and relevant clinical signs will help practitioners identify horses with NCS and allow them to select appropriate treatment.

Feasibility, Yield, and Cost of Active Tuberculosis Case Finding Linked to a Mobile HIV Service in Cape Town, South Africa: A Cross-sectional Study

PubMed Central

Kranzer, Katharina; Lawn, Stephen D.; Meyer-Rath, Gesine; Vassall, Anna; Raditlhalo, Eudoxia; Govindasamy, Darshini; van Schaik, Nienke; Wood, Robin; Bekker, Linda-Gail

2012-01-01

Background The World Health Organization is currently developing guidelines on screening for tuberculosis disease to inform national screening strategies. This process is complicated by significant gaps in knowledge regarding mass screening. This study aimed to assess feasibility, uptake, yield, treatment outcomes, and costs of adding an active tuberculosis case-finding program to an existing mobile HIV testing service. Methods and Findings The study was conducted at a mobile HIV testing service operating in deprived communities in Cape Town, South Africa. All HIV-negative individuals with symptoms suggestive of tuberculosis, and all HIV-positive individuals regardless of symptoms were eligible for participation and referred for sputum induction. Samples were examined by microscopy and culture. Active tuberculosis case finding was conducted on 181 days at 58 different sites. Of the 6,309 adults who accessed the mobile clinic, 1,385 were eligible and 1,130 (81.6%) were enrolled. The prevalence of smear-positive tuberculosis was 2.2% (95% CI 1.1–4.0), 3.3% (95% CI 1.4–6.4), and 0.4% (95% CI 1.4 015–6.4) in HIV-negative individuals, individuals newly diagnosed with HIV, and known HIV, respectively. The corresponding prevalence of culture-positive tuberculosis was 5.3% (95% CI 3.5–7.7), 7.4% (95% CI 4.5–11.5), 4.3% (95% CI 2.3–7.4), respectively. Of the 56 new tuberculosis cases detected, 42 started tuberculosis treatment and 34 (81.0%) completed treatment. The cost of the intervention was US$1,117 per tuberculosis case detected and US$2,458 per tuberculosis case cured. The generalisability of the study is limited to similar settings with comparable levels of deprivation and TB and HIV prevalence. Conclusions Mobile active tuberculosis case finding in deprived populations with a high burden of HIV and tuberculosis is feasible, has a high uptake, yield, and treatment success. Further work is now required to examine cost-effectiveness and affordability and

An Ontology to Improve Transparency in Case Definition and Increase Case Finding of Infectious Intestinal Disease: Database Study in English General Practice

PubMed Central

2017-01-01

Background Infectious intestinal disease (IID) has considerable health impact; there are 2 billion cases worldwide resulting in 1 million deaths and 78.7 million disability-adjusted life years lost. Reported IID incidence rates vary and this is partly because terms such as “diarrheal disease” and “acute infectious gastroenteritis” are used interchangeably. Ontologies provide a method of transparently comparing case definitions and disease incidence rates. Objective This study sought to show how differences in case definition in part account for variation in incidence estimates for IID and how an ontological approach provides greater transparency to IID case finding. Methods We compared three IID case definitions: (1) Royal College of General Practitioners Research and Surveillance Centre (RCGP RSC) definition based on mapping to the Ninth International Classification of Disease (ICD-9), (2) newer ICD-10 definition, and (3) ontological case definition. We calculated incidence rates and examined the contribution of four supporting concepts related to IID: symptoms, investigations, process of care (eg, notification to public health authorities), and therapies. We created a formal ontology using ontology Web language. Results The ontological approach identified 5712 more cases of IID than the ICD-10 definition and 4482 more than the RCGP RSC definition from an initial cohort of 1,120,490. Weekly incidence using the ontological definition was 17.93/100,000 (95% CI 15.63-20.41), whereas for the ICD-10 definition the rate was 8.13/100,000 (95% CI 6.70-9.87), and for the RSC definition the rate was 10.24/100,000 (95% CI 8.55-12.12). Codes from the four supporting concepts were generally consistent across our three IID case definitions: 37.38% (3905/10,448) (95% CI 36.16-38.5) for the ontological definition, 38.33% (2287/5966) (95% CI 36.79-39.93) for the RSC definition, and 40.82% (1933/4736) (95% CI 39.03-42.66) for the ICD-10 definition. The proportion of

The Influence of Intensifying Irrigation on Glacier Mass Balances in High Mountain Asia

NASA Astrophysics Data System (ADS)

de Kok, R.; Tuinenburg, O.; Bonekamp, P. N. J.; Immerzeel, W. W.

2017-12-01

Melt water from snow and glaciers in High Mountain Asia provide a major source of water for millions of inhabitants in the downstream low lying plains. This densely populated region also hosts some of the largest areas of irrigated land in the world. Not only is the water from High Mountain Asia important as a source of irrigation water, the irrigation itself might also change the regional, and even global, climate by increasing atmospheric moisture and by cooling the surface through evapotranspiration. We explore the effect of irrigation in the region on the synoptic climate patterns in High Mountain Asia using the WRF regional climate model. By studying the changes in the energy balance, temperatures and precipitation, we assess how the changes in irrigation patterns may have contributed to the observed trends in mountain climates and associated glacier mass balances. Initial results show that the intensifying irrigation during the last decades causes an increase in summer snowfall in the mountains in Central Karakoram and Kunlun Shan, which are the regions where slight positive mass balances have been observed in recent years. A moisture tracking model confirms that the irrigated areas are a significant moisture source for summer precipitation in High Mountain Asia. These results thus suggest that irrigation may significantly influence glaciers in High Mountain Asia, especially in the regions of observed anomalous mass balance.

Thirteen-week dose-intensifying simultaneous combination chemotherapy protocol for malignant lymphoma in dogs.

PubMed

Zenker, I; Meichner, K; Steinle, K; Kessler, M; Hirschberger, J

2010-11-06

This prospective study aimed to record the toxicity profile of a dose-intensifying simultaneous chemotherapy (DISC) protocol for lymphoma in dogs. Remission rates and the duration of the protocol were also evaluated. Twenty-one dogs were studied. Diagnosis was based on cytological or histological assessments. The DISC protocol is a 13-week maintenance-free protocol. L-Asparaginase (400 iu/kg) was administered subcutaneously on day 1, followed by weekly simultaneous intravenous administration of vincristine (0.7 mg/m(2) = 100 per cent), cyclophosphamide (200 mg/m(2) = 100 per cent) and doxorubicin (30 mg/m(2) = 100 per cent) at a starting dose level of 33 per cent. Dose levels were given twice and then increased by 5 to 7 per cent if grade 0 or I toxicities were seen, to a maximum dose level of 60 per cent. Two dogs experienced a grade IV toxicity (asymptomatic neutropenia in one dog and sepsis in the other). Two episodes of asymptomatic grade III thrombocytopenia and one episode of neutropenia were recorded. Other toxic events were infrequent and mild. Only one dog required hospitalisation for less than 72 hours. Seventeen dogs (80.9 per cent) achieved complete remission, one (4.8 per cent) achieved partial remission, two (9.5 per cent) had stable disease and in one (4.8 per cent) disease progressed.

Enterobius vermicularis in tubo-ovarian abscess: A rare and interesting incidental finding - A case Report.

PubMed

Saleem, Faryal; Malik, Faizan; Fatima, Saira

2017-04-01

Enterobius vermicularis is a common intestinal nematode; however, rare extraintestinal Enterobius infections have been reported from different parts of the world. Here, we present a case of tubo-ovarian abscess in an otherwise healthy young sexually active female with no known comorbids with history of on and off lower abdominal pain for one year and high grade fever for one month. On the basis of further workup and radiological evaluation, a preoperative diagnosis of right sided tubo-ovarian abscess was made and salpingo-oophorectomy was performed laproscopically in July 2015. Histopathology of the resected tissue revealed necrosis and in one area Enterobius vermicularis was identified surrounded by neutrophils and eosinophil rich abscess. A final diagnosis of severe acute and chronic salpingo-oophoritis with abscess formation, secondary to Enterobius vermicularis was made. Signs and symptoms of parasitic involvement in tubo-ovarian abscesses are not much different than usual presentations of pelvic inflammatory diseases and identification of a parasite in a tubo-ovarian tissue sample is a rare clinical finding. A high index of suspicion on the part of histopathologist as well as clinician is important for timely diagnosis and effective management of such cases.

Medical Findings and Toxicological Analysis in Infant Death by Balloon Gas Asphyxia: A Case Report.

PubMed

Cuypers, Eva; Rosier, Elien; Loix, Sara; Develter, Wim; Van Den Bogaert, Wouter; Wuestenbergs, Joke; Van de Voorde, Wim; Tytgat, Jan

2017-05-01

In recent years, the increasing number of asphyxiation cases due to helium inhalation is remarkable. All described cases in the literature where diagnosed as suicide. In this article, however, we describe a triple infant homicide in which helium, as balloon gas, was administered to three young children after sedation causing asphyxiation and death through the medical findings and toxicological analysis. During autopsy, in addition to standard toxicological samples, gas samples from lungs as well as lung tissue itself were directly collected into headspace vials. Besides routine toxicological analysis, which revealed toxic levels of doxylamine, qualitative analysis on gas and lung samples was performed using headspace gas chromatography-mass spectrometry. As carrier gas, the commonly used helium was replaced by nitrogen. In gas samples from lungs of all three children, no helium was found. Nevertheless, lung tissue samples were found positive on helium. Therefore, sedation followed by asphyxia due to helium inhalation can strongly be assumed as the cause of death of all three children. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

78 FR 47699 - Findings of Research Misconduct

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-06

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of the Secretary Findings of Research Misconduct... Research Integrity (ORI) has taken final action in the following case: Pratima Karnik, Ph.D., Case Western... Professor, Department of Dermatology, Case Western Reserve University (CWRU), engaged in research misconduct...

Active case finding for carbapenemase-producing Enterobacteriaceae in a teaching hospital: prevalence and risk factors for colonization.

PubMed

Poole, K; George, R; Decraene, V; Shankar, K; Cawthorne, J; Savage, N; Welfare, W; Dodgson, A

2016-10-01

Over the past decade, the prevalence of carbapenemase-producing Enterobacteriaceae (CPE) has increased. Whilst basic infection prevention and control practices reduce the risk of transmission, cases of unrecognized carriage pose a potential risk of transmission. To estimate the prevalence of CPE and explore risk factors associated with colonization within a large teaching hospital with an established CPE outbreak. All inpatients that had not previously tested positive for CPE were offered testing. Demographic and hospital episode data were also collected, together with antibiotic and proton pump inhibitor (PPI) use in the preceding 24h. This study identified 70 CPE-positive cases (26 newly identified and 44 previously known) and 592 CPE-negative cases, giving a combined prevalence of 11% [95% confidence interval (CI) 8-13]. Medication (antibiotic and PPI use), previous admission, ethnicity and length of stay were assessed as risk factors for colonization, and none were found to be independently associated with CPE colonization. Using logistic regression, age [odds ratio (OR) 1.03, 95% CI 1.01-1.07] and antibiotic use (OR 2.55, 95% CI 1.08-6.03) were the only risk factors significantly associated with CPE colonization. This study has added to the evidence base by estimating the prevalence of CPE among inpatients in an acute hospital with an established CPE outbreak. A case-finding exercise was feasible and identified a number of new cases. Despite a small sample size, increasing age and prescription of an antibiotic on the day of testing were significantly associated with CPE colonization. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

Rationale and design of the GUIDE-IT study: Guiding Evidence Based Therapy Using Biomarker Intensified Treatment in Heart Failure.

PubMed

Felker, G Michael; Ahmad, Tariq; Anstrom, Kevin J; Adams, Kirkwood F; Cooper, Lawton S; Ezekowitz, Justin A; Fiuzat, Mona; Houston-Miller, Nancy; Januzzi, James L; Leifer, Eric S; Mark, Daniel B; Desvigne-Nickens, Patrice; Paynter, Gayle; Piña, Ileana L; Whellan, David J; O'Connor, Christopher M

2014-10-01

The GUIDE-IT (Guiding Evidence Based Therapy Using Biomarker Intensified Treatment in Heart Failure) study is designed to determine the safety, efficacy, and cost-effectiveness of a strategy of adjusting therapy with the goal of achieving and maintaining a target N-terminal pro-B-type natriuretic peptide (NT-proBNP) level of <1,000 pg/ml compared with usual care in high-risk patients with systolic heart failure (HF). Elevations in natriuretic peptide (NP) levels provide key prognostic information in patients with HF. Therapies proven to improve outcomes in patients with HF are generally associated with decreasing levels of NPs, and observational data show that decreases in NP levels over time are associated with favorable outcomes. Results from smaller prospective, randomized studies of this strategy thus far have been mixed, and current guidelines do not recommend serial measurement of NP levels to guide therapy in patients with HF. GUIDE-IT is a prospective, randomized, controlled, unblinded, multicenter clinical trial designed to randomize approximately 1,100 high-risk subjects with systolic HF (left ventricular ejection fraction ≤40%) to either usual care (optimized guideline-recommended therapy) or a strategy of adjusting therapy with the goal of achieving and maintaining a target NT-proBNP level of <1,000 pg/ml. Patients in either arm of the study are followed up at regular intervals and after treatment adjustments for a minimum of 12 months. The primary endpoint of the study is time to cardiovascular death or first hospitalization for HF. Secondary endpoints include time to cardiovascular death and all-cause mortality, cumulative mortality, health-related quality of life, resource use, cost-effectiveness, and safety. The GUIDE-IT study is designed to definitively assess the effects of an NP-guided strategy in high-risk patients with systolic HF on clinically relevant endpoints of mortality, hospitalization, quality of life, and medical resource

Hypohidrotic ectodermal dysplasia: dental, clinical, genetic and dermatoglyphic findings of three cases.

PubMed

Kargül, B; Alcan, T; Kabalay, U; Atasu, M

2001-01-01

Patients with hypohidrotic ectodermal dysplasia (HED) are characterized by the clinical manifestations of hypodontia, hypohidrosis, hypotrichosis and a highly characteristic facial physiognomy. This disorder is inherited as an X-linked trait. This report presents three cases with HED in which the clinical evaluation (intraoral and radiological), genetic findings and SEM examination of hair. Boys 6 to 14 year old and a 11 year old girl were referred to the Marmara University, Faculty of Dentistry, complaining of oligodontia in the maxillary and mandibular arches and delay in eruption of other teeth. Peg-shaped teeth have been observed. The dermatoglyphs of the patients were striking. SEM examination of hair demonstrated a distinctly abnormal longitudinal grooving along the entire length of each hair and a desquamation of the surface cuticles. The treatment was planned in a multidisciplinary odontological group involving pediatric dentistry, orthodontics, prosthodontics and oral surgery and maxillofacial radiology of future dental habilitation. A specially designed overdenture, a removable prosthesis and osseointegrated implants were constructed. Periodic recall visits were advised, to monitor the dentures and implants during periods of growth and development, and eruption of the permanent teeth.

A case of severe sepsis presenting marked decrease of neutrophils and interesting findings on dynamic CT.

PubMed

Makino, Isamu; Tajima, Hidehiro; Kitagawa, Hirohisa; Nakagawara, Hisatoshi; Miyashita, Tomoharu; Nakanuma, Shinichi; Hayashi, Hironori; Takamura, Hiroyuki; Fushida, Sachio; Ohta, Tetsuo

2015-05-28

In a patient with severe sepsis, we sometimes observe immediate decrease of the counts of white blood cells (WBCs) and neutrophils, which is known as an indicator for poor prognosis. We observed marked decrease of white blood cells and neutrophils on blood examination and interesting findings on dynamic CT. Here, we present the case of a patient with severe postoperative sepsis occurring after major abdominal surgery and we discuss the mechanism of such clinical presentations. A 60-year-old man received pancreatoduodenectomy with colectomy for pancreatic cancer. He developed a high fever on postoperative day 3. We observed marked decrease of WBCs and neutrophils on blood examination. We also observed slight swelling of the liver, inhomogeneous enhancement of liver parenchyma in arterial phase, and periportal low density in the Glisson capsule in portal phase, without any findings indicating infectious complications on dynamic CT. WBCs and neutrophils increased above normal range in just 6 hours. Blood culture examination performed while the patient had a high fever was positive for Aeromonas hydrophila. After receiving intensive care, he promptly recovered from severe sepsis. The CT findings disappeared on second dynamic CT examination performed 3 days after the first examination. We treated a patient with severe sepsis after major abdominal surgery who presented very rapid change of the counts of WBCs and neutrophils and interesting CT findings in the liver. We rescued him from a critical situation by prompt and intensive treatment. Research is needed to accumulate and analyze data from more patients who present a similar clinical course to better understand their pathophysiological conditions.

Anatomic findings and complications after surgical treatment of chronic, partial distal biceps tendon tears: a case cohort comparison study.

PubMed

Ruch, David S; Watters, Tyler Steven; Wartinbee, Daniel A; Richard, Marc J; Leversedge, Fraser J; Mithani, Suhail K

2014-08-01

To describe pertinent anatomic findings during repair of chronic, partial distal biceps tendon tears and to compare the complications of surgery with a similar cohort of acute, complete tears. Group 1 included 14 patients (15 elbows) with partial tears managed operatively an average of 10 months from onset of injury or symptoms. Group 2 included a matched cohort of 16 patients (17 elbows) treated for complete, acute tears an average of 19 days from injury. A retrospective review of all 30 patients focused on demographic data, intraoperative findings, and postoperative complications. A single, anterior incision was used in all cases with multiple suture anchors or a bicortical toggling button for fixation of the repair. We evaluated 27 men and 3 women with an average age of 55 years (group 1) and 48 years (group 2). Intratendinous ganglion formation at the site of rupture of the degenerative tendon was observed in 5 cases of partial tears and none of the complete tears. Partial tears involved the lateral aspect or short head of the biceps tendon insertion in all cases. Postoperative complications included lateral antebrachial cutaneous nerve neuritis in 8 group 1 patients and 6 group 2 patients and transient posterior interosseus nerve palsy in 3 group 1 patients. Partial distal biceps tendon ruptures showed a consistent pattern of pathology involving disruption of the lateral side of the tendon insertion involving the small head of the biceps. Degenerative intratendinous ganglion formation was present in one third of cases. Repair of chronic, partial distal biceps tendon injuries may have a higher incidence of posterior interosseous and lateral antebrachial cutaneous nerve palsies. Therapeutic III. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Intensified nitrogen and phosphorus removal in a novel electrolysis-integrated tidal flow constructed wetland system.

PubMed

Ju, Xinxin; Wu, Shubiao; Zhang, Yansheng; Dong, Renjie

2014-08-01

A novel electrolysis-integrated tidal flow constructed wetland (CW) system was developed in this study. The dynamics of intensified nitrogen and phosphorus removal and that of hydrogen sulphide control were evaluated. Ammonium removal of up to 80% was achieved with an inflow concentration of 60 mg/L in wetland systems with and without electrolysis integration. Effluent nitrate concentration decreased from 2 mg/L to less than 0.5 mg/L with the decrease in current intensity from 1.5 mA/cm(2) to 0.57 mA/cm(2) in the electrolysis-integrated wetland system, thus indicating that the current intensity of electrolysis plays an important role in nitrogen transformations. Phosphorus removal was significantly enhanced, exceeding 95% in the electrolysis-integrated CW system because of the in-situ formation of a ferric iron coagulant through the electro-dissolution of a sacrificial iron anode. Moreover, the electrolyzed wetland system effectively inhibits sulphide accumulation as a result of a sulphide precipitation coupled with ferrous-iron electro-dissolution and/or an inhibition of bacterial sulphate reduction under increased aerobic conditions. Copyright © 2014 Elsevier Ltd. All rights reserved.

An Ontology to Improve Transparency in Case Definition and Increase Case Finding of Infectious Intestinal Disease: Database Study in English General Practice.

PubMed

de Lusignan, Simon; Shinneman, Stacy; Yonova, Ivelina; van Vlymen, Jeremy; Elliot, Alex J; Bolton, Frederick; Smith, Gillian E; O'Brien, Sarah

2017-09-28

Infectious intestinal disease (IID) has considerable health impact; there are 2 billion cases worldwide resulting in 1 million deaths and 78.7 million disability-adjusted life years lost. Reported IID incidence rates vary and this is partly because terms such as "diarrheal disease" and "acute infectious gastroenteritis" are used interchangeably. Ontologies provide a method of transparently comparing case definitions and disease incidence rates. This study sought to show how differences in case definition in part account for variation in incidence estimates for IID and how an ontological approach provides greater transparency to IID case finding. We compared three IID case definitions: (1) Royal College of General Practitioners Research and Surveillance Centre (RCGP RSC) definition based on mapping to the Ninth International Classification of Disease (ICD-9), (2) newer ICD-10 definition, and (3) ontological case definition. We calculated incidence rates and examined the contribution of four supporting concepts related to IID: symptoms, investigations, process of care (eg, notification to public health authorities), and therapies. We created a formal ontology using ontology Web language. The ontological approach identified 5712 more cases of IID than the ICD-10 definition and 4482 more than the RCGP RSC definition from an initial cohort of 1,120,490. Weekly incidence using the ontological definition was 17.93/100,000 (95% CI 15.63-20.41), whereas for the ICD-10 definition the rate was 8.13/100,000 (95% CI 6.70-9.87), and for the RSC definition the rate was 10.24/100,000 (95% CI 8.55-12.12). Codes from the four supporting concepts were generally consistent across our three IID case definitions: 37.38% (3905/10,448) (95% CI 36.16-38.5) for the ontological definition, 38.33% (2287/5966) (95% CI 36.79-39.93) for the RSC definition, and 40.82% (1933/4736) (95% CI 39.03-42.66) for the ICD-10 definition. The proportion of laboratory results associated with a positive test

Posterior mediastinal ganglioneuroma with peripheral replacement by white and brown adipocytes resulting in diagnostic fallacy from a false-positive 18F-2-fluoro-2-deoxyglucose-positron emission tomography finding: a case report

PubMed Central

2014-01-01

Introduction Ganglioneuroma is a rare tumor in the posterior mediastinum; fat-containing ganglioneuromas are rarely reported. The present case report documents a brown fat-containing, posterior mediastinal ganglioneuroma, which has not been reported previously. Radiological examination, in particular 18F-2-fluoro-2-deoxyglucose-positron emission tomography, suggested that the tumor had low-grade malignant potential. This led to uncertainty at preoperative diagnosis. Case presentation An asymptomatic 66-year-old Japanese woman with no significant past medical history was referred for the evaluation of a posterior mediastinal mass. Although its size had not changed in the past 5 years, a malignant lipomatous tumor could not be excluded due to the presence of intratumoral fat and increased 18F-2-fluoro-2-deoxyglucose uptake observed by positron emission tomography imaging. A computed tomography-guided core-needle biopsy revealed a mixture of mature adipocytes, spindle-shaped cells, and fibrotic stroma. Definite diagnosis was not possible, and surgical resection was performed. Three years after the surgery, she remains disease-free. Conclusions Histological diagnosis of the surgically resected mass confirmed ganglioneuroma with substantial amounts of white and brown adipose tissues in peripheral areas. The existence of both ganglion cells and brown fat tissue intensified the accumulation of 18F-2-fluoro-2-deoxyglucose, resulting in a false-positive result by positron emission tomography. Considering this, ganglioneuroma should not be excluded either clinically or pathologically in fat-containing, posterior mediastinal tumors. PMID:25319096

Cocaine-induced pulmonary changes: HRCT findings *

PubMed Central

de Almeida, Renata Rocha; Zanetti, Gláucia; Souza, Arthur Soares; de Souza, Luciana Soares; Silva, Jorge Luiz Pereira e; Escuissato, Dante Luiz; Irion, Klaus Loureiro; Mançano, Alexandre Dias; Nobre, Luiz Felipe; Hochhegger, Bruno; Marchiori, Edson

2015-01-01

Abstract Objective: To evaluate HRCT scans of the chest in 22 patients with cocaine-induced pulmonary disease. Methods: We included patients between 19 and 52 years of age. The HRCT scans were evaluated by two radiologists independently, discordant results being resolved by consensus. The inclusion criterion was an HRCT scan showing abnormalities that were temporally related to cocaine use, with no other apparent causal factors. Results: In 8 patients (36.4%), the clinical and tomographic findings were consistent with "crack lung", those cases being studied separately. The major HRCT findings in that subgroup of patients included ground-glass opacities, in 100% of the cases; consolidations, in 50%; and the halo sign, in 25%. In 12.5% of the cases, smooth septal thickening, paraseptal emphysema, centrilobular nodules, and the tree-in-bud pattern were identified. Among the remaining 14 patients (63.6%), barotrauma was identified in 3 cases, presenting as pneumomediastinum, pneumothorax, and hemopneumothorax, respectively. Talcosis, characterized as perihilar conglomerate masses, architectural distortion, and emphysema, was diagnosed in 3 patients. Other patterns were found less frequently: organizing pneumonia and bullous emphysema, in 2 patients each; and pulmonary infarction, septic embolism, eosinophilic pneumonia, and cardiogenic pulmonary edema, in 1 patient each. Conclusions: Pulmonary changes induced by cocaine use are varied and nonspecific. The diagnostic suspicion of cocaine-induced pulmonary disease depends, in most of the cases, on a careful drawing of correlations between clinical and radiological findings. PMID:26398752

Endoscopic findings and treatment outcome in cases presenting with dysphagia.

PubMed

Hafeez, Muhammad; Salamat, Amjad; Saeed, Farrukh; Zafar, Hafiz; Hassan, Fayyaz; Farooq, Asif

2011-01-01

Dysphagia results from impeded transport of liquids, solids, or both from the pharynx to the stomach. Among the malignant lesions, carcinoma of oesophagus is the commonest cause. Our objective was to find out the frequency of different endoscopic lesions and outcome of the endoscopic therapeutic interventions in patients presenting with dysphagia. This descriptive study was conducted at Department of Gastroenterology, Military Hospital Rawalpindi from June 2008 to May 2009. Patients of dysphagia after their consent were interviewed about the symptoms. Relevant biochemical investigations were done. Barium swallow and upper Gastrointestinal (GI) Endoscopy were carried out. Benign strictures were dilated with Savary Gilliard Dilators. Malignant strictures were further evaluated to decide treatment plan. In patients considered to have oesophageal dysmotility, pressure manometery was done before specific therapy. Seventy nine patients were enrolled. Twenty-five had malignant strictures, out of those commonest was adenocarcinoma 14 (56%). Twenty-nine had benign strictures the commonest being Gastro-oesophageal Reflux Disease (GERD) related peptic stricture 9 (31%). Fifteen had oesophageal dysmotility, and achalasia was present in 10 out of them. After evaluation 12 out of 25 patients with malignant strictures were considered fit for surgery. Self-expanding metal stents (SEMS) were passed in 5. All benign strictures were dilated with Savary-Gillard dilators. Pneumatic balloon dilation was done in patients of achalasia. The commonest malignant lesion resulting in dysphagia was adenocarcinoma while in benign it was GERD related peptic stricture. Achalasia was most frequent in oesophageal motility disorders. Standard of treatment for early oesophageal malignancy is surgical resection. SEMS is a reliable way to allay dysphagia in inoperable cases. Savary Gillard dilatation in benign, and pneumatic balloon achalasia dilatations are effective ways of treatment.

Clear-Cell Meningioma: CT and MR Imaging Findings in Two Cases Involving the Spinal Canal and Cerebellopontine Angle

PubMed Central

Yu, Ki Bong; Kim, Hyung Jin; Suh, Chang Hae; Park, Hyung Chun; Kim, Eun Young; Han, Hye Seung

2002-01-01

Clear-cell meningioma is a rare subtype of meningioma which occurs at a younger age and has a higher recurrence rate than other subtypes. We report two cases of clear-cell meningioma, one in the thoracolumbar spinal canal and the other in the cerebellopontine angle. Though the CT and MR imaging findings were not different from those of ordinary meningioma, after surgical removal the condition recurred repeatedly in the patient with spinal canal involvement. PMID:12087202

Anetoderma due to secondary syphilis: Report of two cases and discussion of the histopathological findings.

PubMed

Veasey, John V; Lellis, Rute F; Porto, Renê L; Mattei, Gladys Ma

2017-12-01

Anetoderma is a rare benign condition of diverse etiology whose characteristic is the diminution or absence of the dermal elastic fibers. Classified as primary and secondary, the latter associated with tumors, inflammatory, and infectious diseases. Although the etiology of the lesions is well described in literature, the pathogenesis is still poorly determined. Anetoderma in syphilis is rare, and occurs even in the most uncommon cutaneous manifestations of the disease, such as the nodular form. In order to better understand the changes that lead to elastolysis, we propose a better correlation with the histopathological findings of the lesions that precede it. We present two cases of anetoderma secondary to syphilis, whose clinical aspects resembled the pattern of their initial secondary syphilis rash.

Non-Infectious Ischiogluteal Bursitis: MRI Findings

PubMed Central

Lee, Sung Moon; Lee, Young Hwan; Suh, Kyung Jin; Kim, Sung Moon; Shin, Myung Jin; Jang, Han Won

2004-01-01

Objective We wished to report on the MRI findings of non-infectious ischiogluteal bursitis. Materials and Methods The MRI findings of 17 confirmed cases of non-infectious ischiogluteal bursitis were analyzed: four out of the 17 cases were confirmed with surgery, and the remaining 13 cases were confirmed with MRI plus the clinical data. Results The enlarged bursae were located deep to the gluteus muscles and postero-inferior to the ischial tuberosity. The superior ends of the bursal sacs abutted to the infero-medial aspect of the ischial tuberosity. The signal intensity within the enlarged bursa on T1-weighted image (WI) was hypo-intense in three cases (3/17, 17.6%), iso-intense in 10 cases (10/17, 58.9%), and hyper-intense in four cases (4/17, 23.5%) in comparison to that of surrounding muscles. The bursal sac appeared homogeneous in 13 patients (13/17, 76.5%) and heterogeneous in the remaining four patients (4/17, 23.5%) on T1-WI. On T2-WI, the bursa was hyper-intense in all cases (17/17, 100%); it was heterogeneous in 10 cases and homogeneous in seven cases. The heterogeneity was variable depending on the degree of the blood-fluid levels and the septae within the bursae. With contrast enhancement, the inner wall of the bursae was smooth (5/17 cases), and irregular (12/17 cases) because of the synovial proliferation and septation. Conclusion Ischiogluteal bursitis can be diagnosed with MRI by its characteristic location and cystic appearance. PMID:15637479

Clinical and cytogenetic findings in seven cases of inverted duplication of 8p with evidence of a telomeric deletion using fluorescence in situ hybridization

DOE Office of Scientific and Technical Information (OSTI.GOV)

Guo, Wen-Jun; Callif-Daley, F.; Zapata, M.C.

1995-09-11

We report on the clinical and cytogenetic findings in 7 cases of inverted duplication of region 8p11.2-p23. The phenotype of inv dup (8p) compiled from this series and the literature (N = 29) consists of severe mental retardation (100%), minor facial alterations (97%), agenesis of the corpus callosum (80%), hypotonia (66%), orthopedic abnormalities (58%), scoliosis/kyphosis (40%), and congenital heart defect (26%). A telomeric deletion of region 8p23.3-pter was confirmed in 3 of our cases studied using fluorescent in situ hybridization with a telomeric probe for 8p. Thus, these karyotypes are inv dup del(8) (qter{r_arrow} p23.1::p23.1{r_arrow}p11.2:). Our findings suggest that mostmore » cases of inv dup(8p) probably have a telomeric deletion. 20 refs., 4 figs., 2 tabs.« less

Early 20th-century Arctic warming intensified by Pacific and Atlantic multidecadal variability

PubMed Central

Tokinaga, Hiroki; Xie, Shang-Ping; Mukougawa, Hitoshi

2017-01-01

With amplified warming and record sea ice loss, the Arctic is the canary of global warming. The historical Arctic warming is poorly understood, limiting our confidence in model projections. Specifically, Arctic surface air temperature increased rapidly over the early 20th century, at rates comparable to those of recent decades despite much weaker greenhouse gas forcing. Here, we show that the concurrent phase shift of Pacific and Atlantic interdecadal variability modes is the major driver for the rapid early 20th-century Arctic warming. Atmospheric model simulations successfully reproduce the early Arctic warming when the interdecadal variability of sea surface temperature (SST) is properly prescribed. The early 20th-century Arctic warming is associated with positive SST anomalies over the tropical and North Atlantic and a Pacific SST pattern reminiscent of the positive phase of the Pacific decadal oscillation. Atmospheric circulation changes are important for the early 20th-century Arctic warming. The equatorial Pacific warming deepens the Aleutian low, advecting warm air into the North American Arctic. The extratropical North Atlantic and North Pacific SST warming strengthens surface westerly winds over northern Eurasia, intensifying the warming there. Coupled ocean–atmosphere simulations support the constructive intensification of Arctic warming by a concurrent, negative-to-positive phase shift of the Pacific and Atlantic interdecadal modes. Our results aid attributing the historical Arctic warming and thereby constrain the amplified warming projected for this important region. PMID:28559341

Early 20th-century Arctic warming intensified by Pacific and Atlantic multidecadal variability

NASA Astrophysics Data System (ADS)

Tokinaga, Hiroki; Xie, Shang-Ping; Mukougawa, Hitoshi

2017-06-01

With amplified warming and record sea ice loss, the Arctic is the canary of global warming. The historical Arctic warming is poorly understood, limiting our confidence in model projections. Specifically, Arctic surface air temperature increased rapidly over the early 20th century, at rates comparable to those of recent decades despite much weaker greenhouse gas forcing. Here, we show that the concurrent phase shift of Pacific and Atlantic interdecadal variability modes is the major driver for the rapid early 20th-century Arctic warming. Atmospheric model simulations successfully reproduce the early Arctic warming when the interdecadal variability of sea surface temperature (SST) is properly prescribed. The early 20th-century Arctic warming is associated with positive SST anomalies over the tropical and North Atlantic and a Pacific SST pattern reminiscent of the positive phase of the Pacific decadal oscillation. Atmospheric circulation changes are important for the early 20th-century Arctic warming. The equatorial Pacific warming deepens the Aleutian low, advecting warm air into the North American Arctic. The extratropical North Atlantic and North Pacific SST warming strengthens surface westerly winds over northern Eurasia, intensifying the warming there. Coupled ocean-atmosphere simulations support the constructive intensification of Arctic warming by a concurrent, negative-to-positive phase shift of the Pacific and Atlantic interdecadal modes. Our results aid attributing the historical Arctic warming and thereby constrain the amplified warming projected for this important region.

Chest Radiograph Findings in Childhood Pneumonia Cases From the Multisite PERCH Study

PubMed Central

Deloria Knoll, Maria; Baggett, Henry C.; Brooks, W. Abdullah; Feikin, Daniel R.; Hammitt, Laura L.; Howie, Stephen R. C.; Kotloff, Karen L.; Levine, Orin S.; Madhi, Shabir A.; Murdoch, David R.; Scott, J. Anthony G.; Thea, Donald M.; Awori, Juliet O.; Barger-Kamate, Breanna; Chipeta, James; DeLuca, Andrea N.; Diallo, Mahamadou; Driscoll, Amanda J.; Ebruke, Bernard E.; Higdon, Melissa M.; Jahan, Yasmin; Karron, Ruth A.; Mahomed, Nasreen; Moore, David P.; Nahar, Kamrun; Naorat, Sathapana; Ominde, Micah Silaba; Park, Daniel E.; Prosperi, Christine; wa Somwe, Somwe; Thamthitiwat, Somsak; Zaman, Syed M. A.; Zeger, Scott L.; O’Brien, Katherine L.; O’Brien, Katherine L.; Levine, Orin S.; Knoll, Maria Deloria; Feikin, Daniel R.; DeLuca, Andrea N.; Driscoll, Amanda J.; Fancourt, Nicholas; Fu, Wei; Hammitt, Laura L.; Higdon, Melissa M.; Kagucia, E. Wangeci; Karron, Ruth A.; Li, Mengying; Park, Daniel E.; Prosperi, Christine; Wu, Zhenke; Zeger, Scott L.; Watson, Nora L.; Crawley, Jane; Murdoch, David R.; Brooks, W. Abdullah; Endtz, Hubert P.; Zaman, Khalequ; Goswami, Doli; Hossain, Lokman; Jahan, Yasmin; Ashraf, Hasan; Howie, Stephen R. C.; Ebruke, Bernard E.; Antonio, Martin; McLellan, Jessica; Machuka, Eunice; Shamsul, Arifin; Zaman, Syed M.A.; Mackenzie, Grant; Scott, J. Anthony G.; Awori, Juliet O.; Morpeth, Susan C.; Kamau, Alice; Kazungu, Sidi; Ominde, Micah Silaba; Kotloff, Karen L.; Tapia, Milagritos D.; Sow, Samba O.; Sylla, Mamadou; Tamboura, Boubou; Onwuchekwa, Uma; Kourouma, Nana; Toure, Aliou; Madhi, Shabir A.; Moore, David P.; Adrian, Peter V.; Baillie, Vicky L.; Kuwanda, Locadiah; Mudau, Azwifarwi; Groome, Michelle J.; Mahomed, Nasreen; Baggett, Henry C.; Thamthitiwat, Somsak; Maloney, Susan A.; Bunthi, Charatdao; Rhodes, Julia; Sawatwong, Pongpun; Akarasewi, Pasakorn; Thea, Donald M.; Mwananyanda, Lawrence; Chipeta, James; Seidenberg, Phil; Mwansa, James; wa Somwe, Somwe; Kwenda, Geoffrey

2017-01-01

Abstract Background. Chest radiographs (CXRs) are frequently used to assess pneumonia cases. Variations in CXR appearances between epidemiological settings and their correlation with clinical signs are not well documented. Methods. The Pneumonia Etiology Research for Child Health project enrolled 4232 cases of hospitalized World Health Organization (WHO)–defined severe and very severe pneumonia from 9 sites in 7 countries (Bangladesh, the Gambia, Kenya, Mali, South Africa, Thailand, and Zambia). At admission, each case underwent a standardized assessment of clinical signs and pneumonia risk factors by trained health personnel, and a CXR was taken that was interpreted using the standardized WHO methodology. CXRs were categorized as abnormal (consolidation and/or other infiltrate), normal, or uninterpretable. Results. CXRs were interpretable in 3587 (85%) cases, of which 1935 (54%) were abnormal (site range, 35%–64%). Cases with abnormal CXRs were more likely than those with normal CXRs to have hypoxemia (45% vs 26%), crackles (69% vs 62%), tachypnea (85% vs 80%), or fever (20% vs 16%) and less likely to have wheeze (30% vs 38%; all P < .05). CXR consolidation was associated with a higher case fatality ratio at 30-day follow-up (13.5%) compared to other infiltrate (4.7%) or normal (4.9%) CXRs. Conclusions. Clinically diagnosed pneumonia cases with abnormal CXRs were more likely to have signs typically associated with pneumonia. However, CXR-normal cases were common, and clinical signs considered indicative of pneumonia were present in substantial proportions of these cases. CXR-consolidation cases represent a group with an increased likelihood of death at 30 days post-discharge. PMID:28575361

Development and Validation of Case-Finding Algorithms for the Identification of Patients with ANCA-Associated Vasculitis in Large Healthcare Administrative Databases

PubMed Central

Sreih, Antoine G.; Annapureddy, Narender; Springer, Jason; Casey, George; Byram, Kevin; Cruz, Andy; Estephan, Maya; Frangiosa, Vince; George, Michael D.; Liu, Mei; Parker, Adam; Sangani, Sapna; Sharim, Rebecca; Merkel, Peter A.

2016-01-01

Purpose To develop and validate case-finding algorithms for granulomatosis with polyangiitis (Wegener’s, GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (Churg-Strauss, EGPA). Methods 250 patients per disease were randomly selected from 2 large healthcare systems using the International Classification of Diseases version 9 (ICD9) codes for GPA/EGPA (446.4) and MPA (446.0). 16 case-finding algorithms were constructed using a combination of ICD9 code, encounter type (inpatient or outpatient), physician specialty, use of immunosuppressive medications, and the anti-neutrophil cytoplasmic antibody (ANCA) type. Algorithms with the highest average positive predictive value (PPV) were validated in a third healthcare system. Results An algorithm excluding patients with eosinophilia or asthma and including the encounter type and physician specialty had the highest PPV for GPA (92.4%). An algorithm including patients with eosinophilia and asthma and the physician specialty had the highest PPV for EGPA (100%). An algorithm including patients with one of the following diagnoses: alveolar hemorrhage, interstitial lung disease, glomerulonephritis, acute or chronic kidney disease, the encounter type, physician specialty, and immunosuppressive medications had the highest PPV for MPA (76.2%). When validated in a third healthcare system, these algorithms had high PPV (85.9% for GPA, 85.7% for EGPA, and 61.5% for MPA). Adding the ANCA type increased the PPV to 94.4%, 100%, and 81.2% for GPA, EGPA, and MPA respectively. Conclusion Case-finding algorithms accurately identify patients with GPA, EGPA, and MPA in administrative databases. These algorithms can be used to assemble population-based cohorts and facilitate future research in epidemiology, drug safety, and comparative effectiveness. PMID:27804171

Ultrasound findings in children with toxocariasis: report on 18 cases.

PubMed

Baldisserotto, M; Conchin, C F; Soares, M da G; Araujo, M A; Kramer, B

1999-05-01

To evaluate abdominal ultrasound (US) findings in children infected with Toxocara canis. Eighteen children, 18 months to 7 years of age, with serological diagnosis of T.canis infection underwent abdominal US. Eosinophil counts, hemoglobin levels and immunoglobulin E titers were measured for all patients. Abdominal ultrasound revealed multiple hypoechoic areas in the livers of 15 patients (83.3%). Hepatohilar lymph-node enlargement was present in 14 patients (77.7%), 2 of whom also showed peripancreatic lymph-node enlargement. Hepatomegaly was present in 13 patients (72.7%) and splenomegaly in 9 (50%). The most prevalent findings of abdominal ultrasound examination of children with T.canis infection are hepatic granulomas and abdominal lymph-node enlargement. This infection should be considered in the differential diagnosis of any children who exhibit these findings on abdominal US examination, especially for those with eosinophilia.

Sonographic findings in a case of tetrasomy 9p associated with increased nuchal translucency and Dandy-Walker malformation.

PubMed

Nakamura-Pereira, Marcos; Cima, Luciana Carneiro do; Llerena, Juan Clinton; Guerra, Fernando Antonio Ramos; Peixoto-Filho, Fernando Maia

2009-10-01

We report a case of a 23-year-old pregnant woman, who underwent amniocentesis after ultrasound (US) examination in the first trimester which revealed a nuchal translucency thickness of 2.9 mm. Cytogenetic analysis revealed complete tetrasomy of the short arm of chromosome 9. Further US evaluation in the second trimester revealed Dandy-Walker malformation, ventriculomegaly, bilateral clubfoot, lip and palate clefts, arthrogryposis and hyperechoic kidneys with bilateral pelvic dilatation. At 30 weeks of gestation, a placental abruption was noted and a Cesarean section was performed. The infant died shortly after birth. A review of previous cases of tetrasomy 9p shows that the remarkable sonographic findings are ventriculomegaly, intrauterine growth restriction, genitourinary anomaly, Dandy-Walker malformation, cleft lip/palate and limb malformation, but the association of tetrasomy 9p and increased nuchal translucency had not been reported.

Canine dilated cardiomyopathy: a retrospective study of signalment, presentation and clinical findings in 369 cases.

PubMed

Martin, M W S; Stafford Johnson, M J; Celona, B

2009-01-01

To review the clinical and diagnostic findings and survival of dilated cardiomyopathy from a large population of dogs in England. A retrospective study of the case records of dogs with dilated cardiomyopathy collected between January 1993 and May 2006. There were 369 dogs with dilated cardiomyopathy of which all were pure-bred dogs except for four. The most commonly affected breeds were dobermanns and boxers. Over 95 per cent of dogs weighed more than 15 kg and 73 per cent were male. The median duration of signs before referral was three weeks with 65 per cent presenting in stage 3 heart failure. The most common signs were breathlessness (67 per cent) and coughing (64 per cent). The majority of dogs (89 per cent) had an arrhythmia at presentation and 74 per cent of dogs had radiographic signs of pulmonary oedema or pleural effusion. The median survival time was 19 weeks. Dilated cardiomyopathy occurs primarily in medium to large breed pure-bred dogs, and males are more frequently affected than females. The duration of clinical signs before referral is often short and the survival times are poor. Greater awareness of affected breeds, clinical signs and diagnostic findings may help in early recognition of this disease which often has a short clinical phase.

Airflow obstruction case finding in community-pharmacies: a novel strategy to reduce COPD underdiagnosis.

PubMed

Castillo, D; Burgos, F; Guayta, R; Giner, J; Lozano, P; Estrada, M; Soriano, J B; Flor, X; Barau, M; Casan, P

2015-04-01

Community pharmacies (CP) have access to subjects at high-risk of suffering Chronic Obstructive Pulmonary Disease (COPD). We investigated if a COPD case finding program in CP could be a new strategy to reduce COPD underdiagnosis. Prospective, cross-sectional, descriptive, uncontrolled, remotely supported study in 100 CP in Barcelona, Spain. Pharmacists were trained in a four-day workshop on spirometry and COPD, and each was provided with a spirometer for 12 weeks. The program included questionnaires and forced spirometry measurements, whose quality was controlled and monitored by web-assistance. Overall 2295 (73.5%), of 3121 CP customers invited to participate in the program accepted, and 1.456 (63.4%) were identified as "high risk" for COPD using the GOLD questionnaire. Only 33 could not conduct spirometry, and a pre-bronchodilator airflow limitation (FEV1/FVC ratio <0.7) was confirmed in 282 (19.8%); 244 of these were referred to their primary care (PC) physician for further diagnostic and therapeutic work-up, but only 39 of them (16%) fed-back this information to the pharmacist. Clinically acceptable quality spirometries (grade A or B) were obtained in 69.4% of the cases. This study shows that adequately trained and supported community pharmacists can effectively identify individuals at high risk of having COPD and can thus contribute to ameliorate underdiagnosis in this disease. Links between PC and CP should be improved to achieve a useful program. Copyright © 2015 Elsevier Ltd. All rights reserved.

Chest Radiograph Findings in Childhood Pneumonia Cases From the Multisite PERCH Study.

PubMed

Fancourt, Nicholas; Deloria Knoll, Maria; Baggett, Henry C; Brooks, W Abdullah; Feikin, Daniel R; Hammitt, Laura L; Howie, Stephen R C; Kotloff, Karen L; Levine, Orin S; Madhi, Shabir A; Murdoch, David R; Scott, J Anthony G; Thea, Donald M; Awori, Juliet O; Barger-Kamate, Breanna; Chipeta, James; DeLuca, Andrea N; Diallo, Mahamadou; Driscoll, Amanda J; Ebruke, Bernard E; Higdon, Melissa M; Jahan, Yasmin; Karron, Ruth A; Mahomed, Nasreen; Moore, David P; Nahar, Kamrun; Naorat, Sathapana; Ominde, Micah Silaba; Park, Daniel E; Prosperi, Christine; Wa Somwe, Somwe; Thamthitiwat, Somsak; Zaman, Syed M A; Zeger, Scott L; O'Brien, Katherine L

2017-06-15

Chest radiographs (CXRs) are frequently used to assess pneumonia cases. Variations in CXR appearances between epidemiological settings and their correlation with clinical signs are not well documented. The Pneumonia Etiology Research for Child Health project enrolled 4232 cases of hospitalized World Health Organization (WHO)-defined severe and very severe pneumonia from 9 sites in 7 countries (Bangladesh, the Gambia, Kenya, Mali, South Africa, Thailand, and Zambia). At admission, each case underwent a standardized assessment of clinical signs and pneumonia risk factors by trained health personnel, and a CXR was taken that was interpreted using the standardized WHO methodology. CXRs were categorized as abnormal (consolidation and/or other infiltrate), normal, or uninterpretable. CXRs were interpretable in 3587 (85%) cases, of which 1935 (54%) were abnormal (site range, 35%-64%). Cases with abnormal CXRs were more likely than those with normal CXRs to have hypoxemia (45% vs 26%), crackles (69% vs 62%), tachypnea (85% vs 80%), or fever (20% vs 16%) and less likely to have wheeze (30% vs 38%; all P < .05). CXR consolidation was associated with a higher case fatality ratio at 30-day follow-up (13.5%) compared to other infiltrate (4.7%) or normal (4.9%) CXRs. Clinically diagnosed pneumonia cases with abnormal CXRs were more likely to have signs typically associated with pneumonia. However, CXR-normal cases were common, and clinical signs considered indicative of pneumonia were present in substantial proportions of these cases. CXR-consolidation cases represent a group with an increased likelihood of death at 30 days post-discharge. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

Dynamic flat panel detector versus image intensifier in cardiac imaging: dose and image quality

NASA Astrophysics Data System (ADS)

Vano, E.; Geiger, B.; Schreiner, A.; Back, C.; Beissel, J.

2005-12-01

The practical aspects of the dosimetric and imaging performance of a digital x-ray system for cardiology procedures were evaluated. The system was configured with an image intensifier (II) and later upgraded to a dynamic flat panel detector (FD). Entrance surface air kerma (ESAK) to phantoms of 16, 20, 24 and 28 cm of polymethyl methacrylate (PMMA) and the image quality of a test object were measured. Images were evaluated directly on the monitor and with numerical methods (noise and signal-to-noise ratio). Information contained in the DICOM header for dosimetry audit purposes was also tested. ESAK values per frame (or kerma rate) for the most commonly used cine and fluoroscopy modes for different PMMA thicknesses and for field sizes of 17 and 23 cm for II, and 20 and 25 cm for FD, produced similar results in the evaluated system with both technologies, ranging between 19 and 589 µGy/frame (cine) and 5 and 95 mGy min-1 (fluoroscopy). Image quality for these dose settings was better for the FD version. The 'study dosimetric report' is comprehensive, and its numerical content is sufficiently accurate. There is potential in the future to set those systems with dynamic FD to lower doses than are possible in the current II versions, especially for digital cine runs, or to benefit from improved image quality.

A presumptive case of Kindler syndrome with a new clinical finding.

PubMed

Satter, Elizabeth K

2008-01-01

Herein we present a 9-year-old boy with a constellation of clinical findings most consistent with Kindler syndrome, and report a new finding, severe corneal ectasia, which resulted in exposure keratitis requiring enucleation.

Transient myeloproliferative disease of the newborn: case report with placental, cytogenetic, and flow cytometric findings.

PubMed

de Tar, M W; Dittman, W; Gilbert, J

2000-03-01

Transient myeloproliferative disease (TMD) of the newborn is a rare hematologic abnormality associated with trisomy 21. It is frequently difficult to distinguish the disorder from true congenital leukemia (TCL). Unlike leukemia, which has a clinically aggressive course, TMD generally resolves within weeks to months. We present a case of TMD of the newborn diagnosed on the basis of peripheral blood studies and describe the pertinent pathological findings within the placenta. Flow cytometric analysis of the blasts in the peripheral blood showed phenotypic heterogeneity with features consistent with megakaryocytic differentiation. Cytogenetic studies showed trisomy 21 within the blastic cells. The placenta showed villous dysmaturity with associated chorangiosis and prominent intravascular aggregates of primitive-appearing cells with focal, early vascular wall invasion. The neonate recovered fully and shows no evidence of disease at 2 years of age.

Pathological findings in 2 cases of fatal 25I-NBOMe toxicity.

PubMed

Walterscheid, Jeffrey P; Phillips, Garrett T; Lopez, Ana E; Gonsoulin, Morna L; Chen, Hsin-Hung; Sanchez, Luis A

2014-03-01

The research compound 25I-NBOMe, also known as CIMBI-5 or INBMeO, was created in academic laboratories as a potent serotonin 2A receptor agonist. Because of its high affinity and ambiguous legal status, recreational drug enthusiasts have used this compound as a powerful alternative to other hallucinogenic drugs such as lysergic acid diethylamide. We report 2 deaths after 25I-NBOMe ingestion by decedents who attended separate "rave" parties. The first case involved a 21-year-old male who admitted taking "acid" to his friend. A sudden violent rage caused him to flail about, and he subsequently became unresponsive. The postmortem examination revealed numerous external injuries that were consistent with physical aggression. The second case involved a 15-year-old female who was socializing outside a rave party, became ill, and rapidly deteriorated as her friend transported her to the hospital. The postmortem assessment was similar to the first case in that external contusions featured prominently. Comprehensive toxicology screens in both cases revealed only evidence of marijuana use. A deeper analysis using time-of-flight mass spectrometry revealed the presence of 25I-NBOMe, which was further confirmed by tandem-mass spectrometry. The behavior and injuries in these cases reveal a consistent pattern preceding fatal 25I-NBOMe toxicity.

An incidental finding on a diagnostic CBCT: a case report.

PubMed

Lyros, Ioannis; Fora, Eleni; Damaskos, Spyridon; Stanko, Peter; Tsolakis, Apostolos

2014-05-01

It is known that Cone Beam Computed Tomography (CBCT) provides reliable spatial data and has many clinical applications for dental and particularly orthodontic patients. The present article provides a short review of the literature and reports an unusual CBCT finding in an orthodontic patient referred for the assessment of impacted upper canines. A unilateral lesion in the left maxillary sinus, was an incidental finding. Following a histological examination, which revealed unilateral nasal polyps, surgical removal was performed as the treatment of choice.

Fine needle aspiration biopsy of three cases of squamous cell carcinoma presenting as a thyroid mass: cytological findings and differential diagnosis.

PubMed

Rosa, M; Toronczyk, K

2012-02-01

Primary squamous cell carcinomas of the thyroid gland are extremely rare, comprising about 1% of thyroid malignancies. Although squamous cell carcinomas are readily identified as such on aspiration cytology in the majority of cases, the differentiation of primary versus metastatic tumour might not always be easy. Herein, we report three cases of squamous cell carcinomas involving the thyroid gland. Fine needle aspiration cytology (FNAC) was performed in three patients with a thyroid mass using standard guidelines. Smears were stained with Diff-Quik and Papanicolaou stains. Two patients were male and one was female, aged 59, 45 and 35 years, respectively. In all three patients a thyroid mass was present. FNAC smears in all cases showed cytological features of squamous cell carcinoma including keratinization and necrosis. After clinical and cytological correlation, one case appeared to be primary, one case metastatic, and in the third case no additional clinical information or biopsy follow-up was available for further characterization. Because primary squamous cell carcinoma of the thyroid is a rare finding, metastatic squamous cell carcinoma should always be excluded first. Metastatic disease usually presents in the setting of widespread malignancy, therefore a dedicated clinical and radiological investigation is necessary in these cases. In both clinical scenarios the patient's prognosis is poor. © 2010 Blackwell Publishing Ltd.

Effect of Active Case Finding on Prevalence and Transmission of Pulmonary Tuberculosis in Dhaka Central Jail, Bangladesh

PubMed Central

Banu, Sayera; Rahman, Md. Toufiq; Uddin, Mohammad Khaja Mafij; Khatun, Razia; Khan, Md. Siddiqur Rahman; Rahman, Md. Mojibur; Uddin, Syed Iftekhar; Ahmed, Tahmeed; Heffelfinger, James D.

2015-01-01

Background Understanding tuberculosis (TB) transmission dynamics is essential for establishing effective TB control strategies in settings where the burden and risk of transmission are high. The objectives of this study were to evaluate the effect of active screening on controlling TB transmission and also to characterize Mycobacterium tuberculosis strains for investigating transmission dynamics in a correctional setting. Methods The study was carried out in Dhaka Central Jail (DCJ), from October 2005 to February 2010. An active case finding strategy for pulmonary TB was established both at the entry point to the prison and inside the prison. Three sputum specimens were collected from all pulmonary TB suspects and subjected to smear microscopy, culture, and drug susceptibility testing as well as genotyping which included deletion analysis, spoligotyping and analysis of mycobacterial interspersed repetitive units (MIRU). Results A total of 60,585 inmates were screened during the study period. We found 466 inmates with pulmonary TB of whom 357 (77%) had positive smear microscopy results and 109 (23%) had negative smear microscopy results but had positive results on culture. The number of pulmonary TB cases declined significantly, from 49 cases during the first quarter to 8 cases in the final quarter of the study period (p=0.001). Deletion analysis identified all isolates as M. tuberculosis and further identified 229 (70%) strains as ‘modern’ and 100 (30%) strains as ‘ancestral’. Analysis of MIRU showed that 347 strains (85%) exhibited unique patterns, whereas 61 strains (15%) clustered into 22 groups. The largest cluster comprised eight strains of the Beijing M. tuberculosis type. The rate of recent transmission was estimated to be 9.6%. Conclusions Implementation of active screening for TB was associated with a decline in TB cases in DCJ. Implementation of active screening in prison settings might substantially reduce the national burden of TB in Bangladesh

Effect of active case finding on prevalence and transmission of pulmonary tuberculosis in Dhaka Central Jail, Bangladesh.

PubMed

Banu, Sayera; Rahman, Md Toufiq; Uddin, Mohammad Khaja Mafij; Khatun, Razia; Khan, Md Siddiqur Rahman; Rahman, Md Mojibur; Uddin, Syed Iftekhar; Ahmed, Tahmeed; Heffelfinger, James D

2015-01-01

Understanding tuberculosis (TB) transmission dynamics is essential for establishing effective TB control strategies in settings where the burden and risk of transmission are high. The objectives of this study were to evaluate the effect of active screening on controlling TB transmission and also to characterize Mycobacterium tuberculosis strains for investigating transmission dynamics in a correctional setting. The study was carried out in Dhaka Central Jail (DCJ), from October 2005 to February 2010. An active case finding strategy for pulmonary TB was established both at the entry point to the prison and inside the prison. Three sputum specimens were collected from all pulmonary TB suspects and subjected to smear microscopy, culture, and drug susceptibility testing as well as genotyping which included deletion analysis, spoligotyping and analysis of mycobacterial interspersed repetitive units (MIRU). A total of 60,585 inmates were screened during the study period. We found 466 inmates with pulmonary TB of whom 357 (77%) had positive smear microscopy results and 109 (23%) had negative smear microscopy results but had positive results on culture. The number of pulmonary TB cases declined significantly, from 49 cases during the first quarter to 8 cases in the final quarter of the study period (p=0.001). Deletion analysis identified all isolates as M. tuberculosis and further identified 229 (70%) strains as 'modern' and 100 (30%) strains as 'ancestral'. Analysis of MIRU showed that 347 strains (85%) exhibited unique patterns, whereas 61 strains (15%) clustered into 22 groups. The largest cluster comprised eight strains of the Beijing M. tuberculosis type. The rate of recent transmission was estimated to be 9.6%. Implementation of active screening for TB was associated with a decline in TB cases in DCJ. Implementation of active screening in prison settings might substantially reduce the national burden of TB in Bangladesh.

Some facts and issues related to livestock theft in Punjab province of Pakistan --findings of series of cases.

PubMed

Abbas, Tariq; Muhammad, Younus; Raza, Sanan; Nasir, Amar; Höreth-Böntgen, Detlef W

2014-01-01

Stock theft is an endemic crime particularly affecting deep rural areas of Pakistan. Analysis of a series of cases was conducted to describe features of herds and farmers who have been the victims of cattle and/buffalo theft in various villages of Punjab in Pakistan during the year 2012. A structured interview was administered to a sample of fifty three affected farmers. The following were the important findings: i) incidents of theft were more amongst small scale farmers, ii) the rate of repeat victimization was high, iii) stealing was the most common modus operandi, iv) the majority of animals were adult, having high sale values, v) more cases occurred during nights with crescent moon, vi) only a proportion of victims stated to have the incident reported to the police, vii) many farmers had a history of making compensation agreements with thieves, viii) foot tracking failed in the majority of the cases, ix) all the respondents were willing to invest in radio frequency identification devices and advocated revision of existing laws. The study has implications for policy makers and proposes a relationship between crime science and veterinary medicine.

A method of sealing perforated sinus membrane and histologic finding of bone substitutes: a case report.

PubMed

Shin, Hong-In; Sohn, Dong-Seok

2005-12-01

To augment the atrophic posterior maxilla, a sinus bone graft has been widely used for sinus floor augmentation. Various bone substitutes have been developed and grafted in the maxillary sinus with and without membranes perforation, although autogenous bone is recommended as a gold standard of grafting materials. Membrane perforation is the most common complication associated with sinus bone graft. To repair a perforation, various methods have been developed. This case report is focused on histologic findings of 1 bovine hydroxyapatite (Bio-Oss; Geistlich Pharma AG, Wolhusen, Switzerland) and 2 kinds of human mineral allograft- Tutoplast cancellous microchips (TutoGen Medical GmbH, Neunkirchen am. Brand Germany), and irradiated allogeniccancellous bone and marrow (ICB; Rocky Mountain Tissue Bank, Aurora, CO) used for sinus graft in the same patient with membrane perforation after various healing periods. Mineral allograft showed favorable new bone regeneration with the repair of membrane perforation. This case report also describes a technique regarding how to repair completely perforated sinus membrane after the removal of a mucocele using human collagen membrane (Tutoplast pericardium; TutoGen Medical GmbH) and fibrin adhesive (Greenplast; Green Cross Co., Youngin, Korea) to stabilize collagen membrane.

Florid cemento-osseous dysplasia: Report of a case documented with clinical, radiographic, biochemical and histological findings

PubMed Central

Çankal, Dilek A.; Bozkaya, Süleyman; Ergün, Gülfem; Bar??, Emre

2013-01-01

Florid cemento-osseous dysplasia (FCOD) has been described as a condition that characteristically affects the jaws of middle-aged black women. This condition has also been classified as gigantiform cementoma, chronic sclerosing osteomyelitis, sclerosing osteitis, multiple estenosis and sclerotic cemental masses. It usually exhibits as multiple radiopaque cementum-like masses distributed throughout the jaws. Radiographically, FCOD appears as dense, lobulated masses, often symmetrically located in various regions of the jaws. Computed tomography, because of its ability to give axial, sagittal, and frontal views, is useful in the evaluation of these lesions. This article reports the case of a 45-year-old white man who was diagnosed with FCOD on the basis of clinical, radiographic, biochemical and histological findings. It is of major importance to realize that all dentists have a unique opportunity as well as ethical obligation to assist in the struggle against wrong dental treatments that might save patients dental health. This case report illustrates the point that periapical radiolucencies may represent benign fibro-osseous lesions that may be overlooked or result in unnecessary endodontic treatment. Key words:Florid cemento-osseous dysplasia, florid osseous dysplasia, fibro-osseous lesions. PMID:24455053

Florid cemento-osseous dysplasia: Report of a case documented with clinical, radiographic, biochemical and histological findings.

PubMed

Kutluay Köklü, Harika; Cankal, Dilek A; Bozkaya, Süleyman; Ergün, Gülfem; Bar, Emre

2013-02-01

Florid cemento-osseous dysplasia (FCOD) has been described as a condition that characteristically affects the jaws of middle-aged black women. This condition has also been classified as gigantiform cementoma, chronic sclerosing osteomyelitis, sclerosing osteitis, multiple estenosis and sclerotic cemental masses. It usually exhibits as multiple radiopaque cementum-like masses distributed throughout the jaws. Radiographically, FCOD appears as dense, lobulated masses, often symmetrically located in various regions of the jaws. Computed tomography, because of its ability to give axial, sagittal, and frontal views, is useful in the evaluation of these lesions. This article reports the case of a 45-year-old white man who was diagnosed with FCOD on the basis of clinical, radiographic, biochemical and histological findings. It is of major importance to realize that all dentists have a unique opportunity as well as ethical obligation to assist in the struggle against wrong dental treatments that might save patients dental health. This case report illustrates the point that periapical radiolucencies may represent benign fibro-osseous lesions that may be overlooked or result in unnecessary endodontic treatment. Key words:Florid cemento-osseous dysplasia, florid osseous dysplasia, fibro-osseous lesions.

Index case finding facilitates identification and linkage to care of children and young persons living with HIV/AIDS in Malawi.

PubMed

Ahmed, Saeed; Sabelli, Rachael A; Simon, Katie; Rosenberg, Nora E; Kavuta, Elijah; Harawa, Mwelura; Dick, Spencer; Linzie, Frank; Kazembe, Peter N; Kim, Maria H

2017-08-01

Evaluation of a novel index case finding and linkage-to-care programme to identify and link HIV-infected children (1-15 years) and young persons (>15-24 years) to care. HIV-infected patients enrolled in HIV services were screened and those who reported untested household members (index cases) were offered home- or facility-based HIV testing and counselling (HTC) of their household by a community health worker (CHW). HIV-infected household members identified were enrolled in a follow-up programme offering home and facility-based follow-up by CHWs. Of the 1567 patients enrolled in HIV services, 1030 (65.7%) were screened and 461 (44.8%) identified as index cases; 93.5% consented to HIV testing of their households and of those, 279 (64.7%) reported an untested child or young person. CHWs tested 711 children and young persons, newly diagnosed 28 HIV-infected persons (yield 4.0%; 95% CI: 2.7-5.6), and identified an additional two HIV-infected persons not enrolled in care. Of the 30 HIV-infected persons identified, 23 (76.6%) were linked to HIV services; 18 of the 20 eligible for ART (90.0%) were initiated. Median time (IQR) from identification to enrolment into HIV services was 4 days (1-8) and from identification to ART start was 6 days (1-8). Almost half of HIV-infected patients enrolled in treatment services had untested household members, many of whom were children and young persons. Index case finding, coupled with home-based testing and tracked follow-up, is acceptable, feasible and facilitates the identification and timely linkage to care of HIV-infected children and young persons. © 2017 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

Case management of individuals with long-term conditions by community matrons: report of qualitative findings of a mixed method evaluation.

PubMed

Randall, Sue; Daly, Guy; Thunhurst, Colin; Mills, Natalie; Guest, David A; Barker, Annette

2014-01-01

To consider findings from a study that evaluated case management of individuals with long-term conditions (LTCs) by a community matron (CM) service. The paper highlights issues related to the implementation of a new role and the impact this had on the experience of care across hospital and community settings for patients and their carers. The introduction of the role of CM was intended to increase effective management of patients with complex comorbid LTCs through the introduction of case management, thereby reducing unplanned hospital admissions. The overall methodological approach was one of mixed methods. This paper reports the qualitative findings from CMs (n = 15); patients (n = 13); family carers (n = 8); and secondary care staff who interface with the CM service (n = 7). Data were collected between October 2009 and May 2010. A thematic analysis resulted in the identification of four themes: (1) visibility; (2) interpersonal relationships; (3) leadership; and (4) systems/professional boundaries. Patients enjoyed being seen as a whole and family carers appreciated the coordination aspect of the role. Difficulties arose from the limited understanding of the CM role and from a lack of a shared vision across healthcare professionals concerning the role and its goals.

Genital Findings in Cases of Child Sexual Abuse: Genital vs Vaginal Penetration.

PubMed

Gallion, H R; Milam, L J; Littrell, L L

2016-12-01

To (1) examine the prevalence of abnormal genital findings in a large cohort of female children presenting with concerns of sexual abuse; and (2) explore how children use language when describing genital contact and genital anatomy. In this prospective study we documented medical histories and genital findings in all children who met inclusion criteria. Findings were categorized as normal, indeterminate, and diagnostic of trauma. Logistic regression analysis was used to determine the effects of key covariates on predicting diagnostic findings. Children older than 4 years of age were asked questions related to genital anatomy to assess their use of language. A regional, university-affiliated sexual abuse clinic. Female children (N = 1500) aged from birth to 17 years (inclusive) who received an anogenital examination with digital images. Physical exam findings, medical history, and the child's use of language were recorded. Physical findings were determined in 99% (n = 1491) of patients. Diagnostic findings were present in 7% (99 of 1491). After adjusting for age, acuity, and type of sexual contact reported by the adult, the estimated odds of diagnostic findings were 12.5 times higher for children reporting genital penetration compared with those who reported only contact (95% confidence interval, 3.46-45.34). Finally, children used the word "inside" to describe contact other than penetration of the vaginal canal (ie, labial penetration). A history of penetration by the child was the primary predictor of diagnostic findings. Interpretation of children's use of "inside" might explain the low prevalence of diagnostic findings and warrants further study. Copyright © 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Neuroimaging findings associated with congenital Zika virus syndrome: case series at the time of first epidemic outbreak in Pernambuco State, Brazil.

PubMed

Pires, Pedro; Jungmann, Patricia; Galvão, Jully Moura; Hazin, Adriano; Menezes, Luiza; Ximenes, Ricardo; Tonni, Gabriele; Araujo Júnior, Edward

2018-05-01

This study aimed to describe the prenatal and postnatal neuroimaging and clinical findings in a clinical series following congenital Zika virus syndrome during the first epidemic Zika virus (ZIKV) outbreak in the State of Pernambuco, Brazil. We (the authors) conducted a retrospective study of a prospectively collected case series of fetuses and neonates with microcephaly born to mothers with presumed/confirmed congenital ZIKV syndrome. Prenatal ultrasound findings were reviewed to identify potential central nervous system (CNS) abnormalities. Neonates underwent postnatal neuroimaging follow up by computed tomography (CT)-scan or magnetic resonance (MR) imaging. The prenatal and postnatal outcomes of eight fetuses/neonates born to mothers with presumed/confirmed congenital ZIKV syndrome were examined. The mean gestational age at ultrasound was 31.3 weeks. Severe microcephaly was identified in seven fetuses (87.5%), while ventriculomegaly and brain calcifications were detected in all fetuses. The mean gestational age at delivery and head circumference were 38 weeks and 30.2 cm, respectively. All cases of microcephaly but one was confirmed postnatally. Brain CT scans or MRIs were performed in seven newborns, and all had periventricular and/or parenchymal calcifications, symmetrical or asymmetrical ventriculomegaly, pachygyria, and reduced sulcation and gyration. MR imaging aided the detection of one undetected case of corpus callosum dysgenesis and was essential in documenting reduced mantel of the cerebral cortex and reduced gyration and sulcation, especially involving the parietal lobe. In addition, MR imaging was also able to display irregular interfaces with the subcortical white matter, a finding consistent with polymicrogyria, more frequently seen at the level of the frontal lobe and atrophic and thinned pons. Severe microcephaly and CNS abnormalities may be associated with congenital ZIKV syndrome.

Cost-effectiveness of active case-finding of household contacts of pulmonary tuberculosis patients in a low HIV, tuberculosis-endemic urban area of Lima, Peru.

PubMed

Shah, L; Rojas, M; Mori, O; Zamudio, C; Kaufman, J S; Otero, L; Gotuzzo, E; Seas, C; Brewer, T F

2017-04-01

We compared the cost-effectiveness (CE) of an active case-finding (ACF) programme for household contacts of tuberculosis (TB) cases enrolled in first-line treatment to routine passive case-finding (PCF) within an established national TB programme in Peru. Decision analysis was used to model detection of TB in household contacts through: (1) self-report of symptomatic cases for evaluation (PCF), (2) a provider-initiated ACF programme, (3) addition of an Xpert MTB/RIF diagnostic test for a single sputum sample from household contacts, and (4) all strategies combined. CE was calculated as the incremental cost-effectiveness ratio (ICER) in terms of US dollars per disability-adjusted life years (DALYs) averted. Compared to PCF alone, ACF for household contacts resulted in an ICER of $2155 per DALY averted. The addition of the Xpert MTB/RIF diagnostic test resulted in an ICER of $3275 per DALY averted within a PCF programme and $3399 per DALY averted when an ACF programme was included. Provider-initiated ACF of household contacts in an urban setting of Lima, Peru can be highly cost-effective, even including costs to seek out contacts and perform an Xpert/MTB RIF test. ACF including Xpert MTB/RIF was not cost-effective if TB cases detected had high rates of default from treatment or poor outcomes.

IS INCREASED HCV CASE-FINDING COMBINED WITH CURRENT OR 8–12 WEEK DAA THERAPY COST-EFFECTIVE IN UK PRISONS? A PREVENTION BENEFIT ANALYSIS

PubMed Central

Martin, Natasha K; Vickerman, Peter; Brew, Iain F; Williamson, Joan; Miners, Alec; Irving, William L; Saksena, Sushma; Hutchinson, Sharon J; Mandal, Sema; O’Moore, Eamonn; Hickman, Matthew

2016-01-01

Background Prisoners have a high prevalence of Hepatitis C virus (HCV), but case-finding may not have been cost-effective because treatment often exceeded average prison stay combined with a lack of continuity-of-care. We assess the cost-effectiveness of increased HCV case-finding and treatment in UK prisons using short-course therapies. Methods A dynamic HCV transmission model assesses the cost-effectiveness of doubling HCV case-finding (achieved through introducing opt-out HCV testing in UK pilot prisons) and increasing treatment in UK prisons, compared to status-quo voluntary risk-based testing (6% prison entrants/year), using currently recommended therapies (8–24 weeks) or IFN-free DAAs (8–12 weeks, 95% SVR, £3300/wk). Costs (GBP£) and health utilities (quality-adjusted life-years, QALYs) were used to calculate mean incremental cost-effectiveness ratios (ICERs). We assume 56% referral and 2.5%/25% of referred people who inject drugs (PWID)/exPWID treated within 2 months of diagnosis in prison. PWID and ex/nonPWID are in prison an average 4/8 months, respectively. Results Doubling prison testing rates with existing treatments produces a mean ICER of £19,850/QALY gained compared to current testing/treatment, and is 45% likely to be cost-effective under a £20,000 willingness-to-pay (WTP) threshold. Switching to 8–12 week IFN-free DAAs in prisons could increase cost-effectiveness (ICER £15,090/QALY gained). Excluding prevention benefit decreases cost-effectiveness. If >10% referred PWID are treated in prison (2.5% base-case), either treatment could be highly cost-effective (ICER<£13,000). HCV case-finding and IFN-free DAAs could be highly cost-effective if DAA cost is 10% lower or 8 weeks duration. Conclusions Increased HCV testing in UK prisons (such as through opt-out testing) is borderline cost-effective compared to status-quo voluntary risk-based testing under a £20,000 WTP with current treatments, but likely to be cost-effective if short

How the novel integration of electrolysis in tidal flow constructed wetlands intensifies nutrient removal and odor control.

PubMed

Ju, Xinxin; Wu, Shubiao; Huang, Xu; Zhang, Yansheng; Dong, Renjie

2014-10-01

Intensified nutrient removal and odor control in a novel electrolysis-integrated tidal flow constructed wetland were evaluated. The average removal efficiencies of COD and NH4(+)-N were above 85% and 80% in the two experimental wetlands at influent COD concentration of 300 mg/L and ammonium nitrogen concentration of 60 mg/L regardless of electrolysis integration. Effluent nitrate concentration decreased from 2.5mg/L to 0.5mg/L with the reduction in current intensity from 1.5 mA/cm(2) to 0.57 mA/cm(2). This result reveals the important role of current intensity in nitrogen transformation. Owing to the ferrous and ferric iron coagulant formed through the electro-dissolution of the iron anode, electrolysis integration not only exerted a positive effect on phosphorus removal but also effectively inhibited sulfide accumulation for odor control. Although electrolysis operation enhanced nutrient removal and promoted the emission of CH4, no significant difference was observed in the microbial communities and abundance of the two experimental wetlands. Copyright © 2014 Elsevier Ltd. All rights reserved.

Continuous, but not intermittent, antipsychotic drug delivery intensifies the pursuit of reward cues.

PubMed

Bédard, Anne-Marie; Maheux, Jérôme; Lévesque, Daniel; Samaha, Anne-Noël

2011-05-01

Chronic exposure to antipsychotic medications can persistently change brain dopamine systems. Most studies on the functional significance of these neural changes have focused on motor behavior and few have addressed how long-term antipsychotic treatment might influence dopamine-mediated reward function. We asked, therefore, whether a clinically relevant antipsychotic treatment regimen would alter the incentive motivational properties of a reward cue. We assessed the ability of a Pavlovian-conditioned stimulus to function as a conditioned reward, as well as to elicit approach behavior in rats treated with haloperidol, either continuously (achieved via subcutaneous osmotic minipump) or intermittently (achieved via daily subcutaneous injections). Continuous, but not intermittent, treatment enhanced the ability of amphetamine to potentiate the conditioned reinforcing effects of a cue associated with water. This effect was not related to differences in the ability to attribute predictive value to a conditioned stimulus (as measured by conditioned approach behavior), but was potentially linked to the development of behavioral supersensitivity to amphetamine and to augmented amphetamine-induced immediate early-gene expression (c-fos and Nur77) in dorsal striatopallidal and striatonigral cells. By enhancing the ability of reward cues to control behavior and by intensifying dopamine-mediated striatopallidal and striatonigral cell activity, standard (ie, continuous) antipsychotic treatment regimens might exacerbate drug-seeking and drug-taking behavior in schizophrenia. Achieving regular but transiently high antipsychotic levels in the brain (as modeled in the intermittent condition) might be a viable option to prevent these changes. This possibility should be explored in the clinic.

Early detection of COPD: a case finding study in general practice.

PubMed

Vandevoorde, Jan; Verbanck, Sylvia; Gijssels, Lieve; Schuermans, Daniel; Devroey, Dirk; De Backer, Joan; Kartounian, Jan; Vincken, Walter

2007-03-01

To estimate the prevalence of undiagnosed chronic obstructive pulmonary disease (COPD) in a population of general practice patients at risk for developing COPD. A further aim was to evaluate the presence of respiratory symptoms as a predictor for the diagnosis of COPD. This study was conducted by eight general practitioners (GP) in six semi-rural general practices. During two consecutive months all patients attending their GP were included if they met the following criteria: current smokers between 40 and 70 yr of age, and a smoking history of at least 15 pack-years. A questionnaire regarding smoking history, respiratory symptoms, exposure to dust or chemical fumes, and history of respiratory diseases was completed for all patients. Subjects without known COPD were invited for spirometric testing. Off the 146 general practice patients included, 17.1% already had an established COPD diagnosis. Screening by spirometry revealed a 46.6% prevalence of COPD. Underdiagnosis of COPD was more frequent in the younger age categories (40-49 Yr; 50-59 Yr). Objective wheezing was the only sign that was significantly more frequent in COPD patients than in non-COPD patients (P<0.001). Patients with previously known COPD were significantly older, and complained more of chronic cough and fatigue than newly detected patients. Almost half of a general practice population of current smokers between 40 and 70 years of age, with a smoking history of at least 15 pack-years, was diagnosed with COPD, and roughly two thirds of these were newly detected as a result of the case finding programme.

Use of bortezomib in heavy-chain deposition disease: a report of 3 cases.

PubMed

Patel, Kinjal; Dillon, John J; Leung, Nelson; Bomback, Andrew S; Appel, Gerald B; D'Agati, Vivette; Canetta, Pietro A

2014-07-01

Heavy-chain deposition disease (HCDD) is a rare complication of plasma cell dyscrasia in which monoclonal heavy chains deposit in glomerular and tubular basement membranes of the kidney. Clinical and pathologic features of HCDD have been well described in case reports and series, but evidence supporting specific therapies is sparse. Historically, the disease has had a poor prognosis, intensifying the need to clarify optimal treatments. We describe 3 cases of HCDD with biopsy-proven glomerular involvement, severe nephrotic syndrome, and decline in kidney function that were treated successfully with bortezomib, a proteasome inhibitor. None of these patients had multiple myeloma. In all cases, bortezomib-based therapy resulted in sustained resolution of nephrotic syndrome and improvement in kidney function. All 3 patients developed peripheral neuropathy; otherwise, treatment was well tolerated. To our knowledge, this is the first description of the clinical effectiveness of bortezomib against HCDD. Copyright © 2014 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Clinical signs and histologic findings in dogs with odontogenic cysts: 41 cases (1995-2010).

PubMed

Verstraete, Frank J M; Zin, Bliss P; Kass, Philip H; Cox, Darren P; Jordan, Richard C

2011-12-01

To characterize clinical signs and histologic findings in dogs with odontogenic cysts and determine whether histologic findings were associated with clinical features. Retrospective case series. 41 dogs. Medical records were reviewed to obtain clinical data, including breed, age, sex, and lesion location. Microscopic sections and results of diagnostic imaging were reviewed. Odontogenic cysts were identified in 41 dogs between 1995 and 2010. There were 29 dogs with dentigerous cysts, 1 with a radicular cyst, 1 with a lateral periodontal cyst, and 1 with a gingival inclusion cyst. In addition, 9 dogs with odontogenic cysts that had clinical and histologic features suggestive of, but not diagnostic for, odontogenic keratocysts seen in people were identified. In all 9 dogs, these cysts were located in the maxilla and surrounded the roots of normally erupted teeth. Of the 29 dogs with dentigerous cysts, 23 had a single cyst, 5 had 2 cysts, and 1 had 3 cysts. Six cysts were associated with an unerupted canine tooth, and 30 were associated with an unerupted first premolar tooth (1 cyst was associated both with an unerupted canine tooth and with an unerupted first premolar tooth). Dentigerous cysts were identified in a variety of breeds, but several brachycephalic breeds were overrepresented, compared with the hospital population during the study period. Results suggested that a variety of odontogenic cysts can occur in dogs. In addition, cysts that resembled odontogenic keratocysts reported in people were identified. We propose the term canine odontogenic parakeratinized cyst for this condition.

Imaging findings of anaplastic astrocytoma in a child with maple syrup urine disease: a case report.

PubMed

Aw-Zoretic, Jessie; Wadhwani, Nitin R; Lulla, Rishi R; Rishi, Lulla R; Ryan, Maura E

2015-09-01

Maple syrup urine disease (MSUD) is an inborn error of branched-chain amino acid metabolism, which usually presents in childhood with encephalopathy due to cerebral edema and dysmyelination. Even with treatment, metabolic stressors may precipitate later episodes of acute decompensation. Changes related to cerebral and white matter edema have been described by magnetic resonance imaging (MRI), and imaging can aid in both initial diagnosis and evaluation of decompensation. To date, there are no published known reports of cancer in patients with MSUD. Here, we present the first case report of an anaplastic astrocytoma in a teenager with MSUD, with a discussion of imaging findings and the use of magnetic resonance spectroscopy (MRS) to help distinguish between tumor and metabolic changes.

78 FR 8148 - Findings of Research Misconduct

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-05

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of the Secretary Findings of Research Misconduct... Research Integrity (ORI) has taken final action in the following case: Bryan William Doreian, Ph.D., Case...), engaged in research misconduct in research supported by National Heart, Lung, and Blood Institute (NHLBI...

Neuroimaging findings in pediatric sports-related concussion.

PubMed

Ellis, Michael J; Leiter, Jeff; Hall, Thomas; McDonald, Patrick J; Sawyer, Scott; Silver, Norm; Bunge, Martin; Essig, Marco

2015-09-01

The goal in this review was to summarize the results of clinical neuroimaging studies performed in patients with sports-related concussion (SRC) who were referred to a multidisciplinar ypediatric concussion program. The authors conducted a retrospective review of medical records and neuroimaging findings for all patients referred to a multidisciplinary pediatric concussion program between September 2013 and July 2014. Inclusion criteria were as follows: 1) age ≤ 19 years; and 2) physician-diagnosed SRC. All patients underwent evaluation and follow-up by the same neurosurgeon. The 2 outcomes examined in this review were the frequency of neuroimaging studies performed in this population (including CT and MRI) and the findings of those studies. Clinical indications for neuroimaging and the impact of neuroimaging findings on clinical decision making were summarized where available. This investigation was approved by the local institutional ethics review board. A total of 151 patients (mean age 14 years, 59% female) were included this study. Overall, 36 patients (24%) underwent neuroimaging studies, the results of which were normal in 78% of cases. Sixteen percent of patients underwent CT imaging; results were normal in 79% of cases. Abnormal CT findings included the following: arachnoid cyst (1 patient), skull fracture (2 patients), suspected intracranial hemorrhage (1 patient), and suspected hemorrhage into an arachnoid cyst (1 patient). Eleven percent of patients underwent MRI; results were normal in 75% of cases. Abnormal MRI findings included the following: intraparenchymal hemorrhage and sylvian fissure arachnoid cyst (1 patient); nonhemorrhagic contusion (1 patient); demyelinating disease (1 patient); and posterior fossa arachnoid cyst, cerebellar volume loss, and nonspecific white matter changes (1 patient). Results of clinical neuroimaging studies are normal in the majority of pediatric patients with SRC. However, in selected cases neuroimaging can provide

Imaging Findings of Ulceroglandular Tularemia.

PubMed

Anand, Neil; Deochand, Osmani; Murphy, Robyn

2017-01-01

Francisella tularensis, the causative organism in Tularemia, is a relatively rare disease. There are a few radiological clues to elucidate its presence when suspicion arises. There should be strong consideration for Tularemia in the differential of any patient with its classic symptoms, diffuse cervical lymphadenopathy with evidence of necrosis, and enlarged adenoids. Ultrasound may demonstrate suppurative lymphadenopathy suggestive of infection, as in the case presented. CT often will demonstrate the extent of lymphadenopathy. On chest radiography, tularemia pneumonia is often the presenting finding, which may demonstrate bilateral or lobar infiltrates. Additionally, hilar lymphadenopathy and pleural effusions are often associated findings. Cavitary lesions may be present, which are better delineated on CT scan. We present a case of a 7-year-old male who presented with a painful right-sided palpable neck mass for 9 days, who was diagnosed with Tularemia after numerous admissions.

Belief revision and way-finding.

PubMed

Bucher, Leandra; Röser, Florian; Nejasmic, Jelica; Hamburger, Kai

2014-02-01

Belief revision is required when veridical information surfaces that contradicts what was previously thought to be the case. In way-finding, belief revision frequently occurs, for example, when the travelled route has led one astray, instead of to one's chosen destination. In past cognitive research, the topics of belief revision and way-finding have been treated in isolation. Here, we introduce an approach for linking the two fields and assess belief revision as it occurs in the process of way-finding. We report the results of two experiments that put participants in (virtual) situations where elements of a previously learned route description do not match the actual environment (thereby requiring the revision of a previously held belief). Experiment 1 puts participants in a highly artificial virtual environment where the landmarks to be used in navigation have a low degree of semantic salience (houses of various color). Experiment 2 puts subjects in a photorealistic environment where the objects to be used in navigation are well-known landmarks (such as the Eiffel Tower) and thus have a high degree of semantic salience. In both experiments, participants are confronted with T-junctions, where a landmark that was expected to indicate the correct route is discovered to be in an unexpected location. The results of the experiments show that a participant's choice of route, in such cases, is affected by differences in the structure of the relevant initial instruction. More precisely, the route chosen by participants is affected by whether the relevant landmark was described as being on the same side of the path as they were instructed to turn (congruent case) or as located on the opposite side of the path as they were instructed to turn (incongruent case).

Ischiogluteal bursitis: a report of three cases with MR findings.

PubMed

Hitora, Toshiaki; Kawaguchi, Yoji; Mori, Masaki; Imaizumi, Yasuhiko; Akisue, Toshihiro; Sasaki, Kanji; Yamada, Eiji; Yamamoto, Tetsuji

2009-02-01

Ischiogluteal bursitis is an uncommon disorder which can be confused with neoplastic conditions in the buttock. Three cases of ischiogluteal bursitis in a 57-year-old man, a 73-year-old woman and a 73-year-old man are presented. All patients presented with a gradually increasing, painful buttock mass. Magnetic resonance imaging (MRI) revealed a soft tissue mass around the ischial tuberosity and showed various features in the three cases. Two patients underwent excision of the lesion, which was histologically diagnosed as ischiogluteal bursitis. One patient was conservatively treated and the symptoms gradually decreased. MRI was very useful in diagnosing and detecting the lesion. Ischiogluteal bursitis should be considered in the differential diagnosis of a buttock mass.

How much is tuberculosis screening worth? Estimating the value of active case finding for tuberculosis in South Africa, China, and India.

PubMed

Azman, Andrew S; Golub, Jonathan E; Dowdy, David W

2014-10-30

Current approaches are unlikely to achieve the aggressive global tuberculosis (TB) control targets set for 2035 and beyond. Active case finding (ACF) may be an important tool for augmenting existing strategies, but the cost-effectiveness of ACF remains uncertain. Program evaluators can often measure the cost of ACF per TB case detected, but how this accessible measure translates into traditional metrics of cost-effectiveness, such as the cost per disability-adjusted life year (DALY), remains unclear. We constructed dynamic models of TB in India, China, and South Africa to explore the medium-term impact and cost-effectiveness of generic ACF activities, conceptualized separately as discrete (2-year) campaigns and as continuous activities integrated into ongoing TB control programs. Our primary outcome was the cost per DALY, measured in relationship to the cost per TB case actively detected and started on treatment. Discrete campaigns costing up to $1,200 (95% uncertainty range [UR] 850-2,043) per case actively detected and started on treatment in India, $3,800 (95% UR 2,706-6,392) in China, and $9,400 (95% UR 6,957-13,221) in South Africa were all highly cost-effective (cost per DALY averted less than per capita gross domestic product). Prolonged integration was even more effective and cost-effective. Short-term assessments of ACF dramatically underestimated potential longer term gains; for example, an assessment of an ACF program at 2 years might find a non-significant 11% reduction in prevalence, but a 10-year evaluation of that same intervention would show a 33% reduction. ACF can be a powerful and highly cost-effective tool in the fight against TB. Given that short-term assessments may dramatically underestimate medium-term effectiveness, current willingness to pay may be too low. ACF should receive strong consideration as a basic tool for TB control in most high-burden settings, even when it may cost over $1,000 to detect and initiate treatment for each extra

Active Case Finding for Communicable Diseases in Prison Settings: Increasing Testing Coverage and Uptake Among the Prison Population in the European Union/European Economic Area

PubMed Central

Vroling, Hilde; Babudieri, Sergio; Monarca, Roberto; Vonk Noordegraaf-Schouten, Marije; Beer, Netta; Gomes Dias, Joana; O’Moore, Éamonn; Hedrich, Dagmar; Oordt-Speets, Anouk

2018-01-01

Abstract Prison populations are disproportionally affected by communicable diseases when compared with the general community because of a complex mix of socioeconomic determinants and environmental factors. Tailored and adequate health care provision in prisons has the potential to reach vulnerable and underserved groups and address their complex needs. We investigated the available evidence on modalities and effectiveness of active case-finding interventions in prisons by searching PubMed, Embase, and the Cochrane Library for records on prison and active case finding with no language limit. Conference abstracts and unpublished research reports also were retrieved. We analyzed the findings by testing modality, outcomes, and study quality. The included 90 records—63 peer-reviewed, 26 from gray literature, and 1 systematic review—reported variously on viral hepatitis, human immunodeficiency virus, sexually transmitted infections, and tuberculosis. No records were retrieved for other communicable diseases. Provider-initiated opt-in testing was the most frequently investigated modality. Testing at entry and provider-initiated testing were reported to result in comparatively higher uptake ranges. However, no comparative studies were identified that reported statistically significant differences between testing modalities. Positivity rates among tested inmates ranged broadly but were generally high for all diseases. The evidence on active case finding in correctional facilities is limited, heterogeneous, and of low quality, making it challenging to draw conclusions on the effect of different testing modalities. Scale-up of provider-initiated testing in European correctional facilities could substantially reduce the undiagnosed fraction and, hence, prevent additional disease transmission in both prison settings and the community at large. PMID:29648594

[Case of interval form of carbon monoxide poisoning without increased carboxyhemoglobin level diagnosed by characteristic MR spectroscopy findings].

PubMed

Kamisawa, Tomoko; Ikawa, Masamichi; Hamano, Tadanori; Nagata, Miwako; Kimura, Hirohiko; Yoneda, Makoto

2014-01-01

A 67-year-old man living alone was admitted for acute disturbance of consciousness during winter. He presented with semicoma, a decorticate posture, and exaggerated tendon reflexes of the limbs, but brainstem reflexes were intact. The carboxyhemoglobin (COHb) level was normal in arterial blood gas on admission, and protein in cerebrospinal fluid was increased without pleocytosis. Brain MRI showed diffuse T2 high intensities in the deep white matter bilaterally without a contrast effect and abnormal T1 intensity in the pallidum. (1)H-MR spectroscopy (MRS) of the white matter lesion demonstrated findings suggesting demyelination as an increased choline peak, enhanced anaerobic metabolism as increased lactate and lipids peaks, and reduced neurons as a decreased N-acetylaspartate peak, which corresponded to delayed encephalopathy due to the interval form of carbon monoxide (CO) poisoning. The possibility of CO exposure due to coal briquette use 2 weeks before the symptomatic onset was indicated by his family, so he was diagnosed with CO poisoning. His consciousness slightly improved with corticosteroid therapy and repetitive hyperbaric oxygen therapy, but brain MRI and MRS findings did not improve. Characteristic MRS findings of leukoencephalopathy are helpful for diagnosing the interval form of CO poisoning in the case of a normal COHb level.

Sonographic findings in horses with mediastinal lymphosarcoma: 13 cases (1985-1992).

PubMed

Garber, J L; Reef, V B; Reimer, J M

1994-11-15

Sonographic findings correlated with necropsy findings in 8 of 9 horses in which the cranial portion of the mediastinum was evaluated by use of both methods. Cranial mediastinal masses were imaged as multilobular and homogeneously hypoechoic; a complex echogenic pattern was observed with necrosis within the mass. Pleural effusion was a common finding in horses with mediastinal lymphosarcoma. Cytologic evaluation of pleural fluid samples was useful in diagnosis of lymphosarcoma in 10 of 12 horses that had thoracentesis. Sonographic examination of the thorax and cranial portion of the mediastinum can aid in the diagnosis of mediastinal lymphosarcoma in horses. Such examination should be performed in horses with clinical signs of cranial vena cava obstruction in which pleural effusion is detected, or when thoracic lymphosarcoma is suspected.

Depression Case Finding Strategies in a Care Management Program for Chronically Ill Medicare Recipients

PubMed Central

Jennifer, Taylor; Michael, Schoenbaum; Katon Wayne, J; Pincus Harold, A; Diane, Hogan; Jürgen, Unützer

2013-01-01

Objective To examine case-finding strategies for depression in the context of a disease management program for chronically ill Medicare recipients. Study Design Observational analysis of telephone/mail surveys and claims data collected for the Medicare Health Support (MHS) program. Methods This study examines data from 14,902 participants with diabetes and/or congestive heart failure in the MHS program administered by Green Ribbon Health.. Depression screening was performed by administering a 2-item screener (PHQ-2) by telephone or mail. Additional information about depression was drawn from ICD-9 depression diagnoses from claims and self-reported use of antidepressant medications. We compared screener positive rates for depression on the PHQ-2 administered by telephone or mail, examined variations in screener positives by care manager, and compared rates of positive screens to antidepressant use and claims diagnoses of depression. Results Nearly 14 % of participants received an ICD-9 diagnosis of depression in the year prior to program enrollment; 7% reported taking antidepressants, and 5 % screened positive on the PHQ-2. Substantial variation in positive depression screens by care manager was found that could not be explained by case mix, prior depression diagnoses or current depression treatment. After adjusting for demographic and clinical differences, the PHQ2 positive rate was 6.5% by phone and 14.1% by mail screen (p<0.001). Conclusion A combined depression screening approach with mail screening (using the PHQ-2) augmented by information about antidepressant use and claims diagnoses of depression may be the most cost-effective method to identify depression in a large sample of medically ill Medicare recipients. PMID:18690765

The politics of large infrastructure investment decision-making : the case of the second avenue subway case study.

DOT National Transportation Integrated Search

2013-11-01

Over the past few decades, urbanization and economic growth have intensified the need for more efficient urban and : regional transportation, including the expansion and reorganization of existing transportation networks. Given such : huge investment...

Imaging Findings of Ulceroglandular Tularemia

PubMed Central

Anand, Neil; Deochand, Osmani; Murphy, Robyn

2017-01-01

Francisella tularensis, the causative organism in Tularemia, is a relatively rare disease. There are a few radiological clues to elucidate its presence when suspicion arises. There should be strong consideration for Tularemia in the differential of any patient with its classic symptoms, diffuse cervical lymphadenopathy with evidence of necrosis, and enlarged adenoids. Ultrasound may demonstrate suppurative lymphadenopathy suggestive of infection, as in the case presented. CT often will demonstrate the extent of lymphadenopathy. On chest radiography, tularemia pneumonia is often the presenting finding, which may demonstrate bilateral or lobar infiltrates. Additionally, hilar lymphadenopathy and pleural effusions are often associated findings. Cavitary lesions may be present, which are better delineated on CT scan. We present a case of a 7-year-old male who presented with a painful right-sided palpable neck mass for 9 days, who was diagnosed with Tularemia after numerous admissions. PMID:28580063

Germline and reproductive tract effects intensify in male mice with successive generations of estrogenic exposure

PubMed Central

Horan, Tegan S.; Marre, Alyssa; Hassold, Terry; Lawson, Crystal; Hunt, Patricia A.

2017-01-01

The hypothesis that developmental estrogenic exposure induces a constellation of male reproductive tract abnormalities is supported by experimental and human evidence. Experimental data also suggest that some induced effects persist in descendants of exposed males. These multi- and transgenerational effects are assumed to result from epigenetic changes to the germline, but few studies have directly analyzed germ cells. Typically, studies of transgenerational effects have involved exposing one generation and monitoring effects in subsequent unexposed generations. This approach, however, has limited human relevance, since both the number and volume of estrogenic contaminants has increased steadily over time, intensifying rather than reducing or eliminating exposure. Using an outbred CD-1 mouse model, and a sensitive and quantitative marker of germline development, meiotic recombination, we tested the effect of successive generations of exposure on the testis. We targeted the germline during a narrow, perinatal window using oral exposure to the synthetic estrogen, ethinyl estradiol. A complex three generation exposure protocol allowed us to compare the effects of individual, paternal, and grandpaternal (ancestral) exposure. Our data indicate that multiple generations of exposure not only exacerbate germ cell exposure effects, but also increase the incidence and severity of reproductive tract abnormalities. Taken together, our data suggest that male sensitivity to environmental estrogens is increased by successive generations of exposure. PMID:28727826

Overall comparative analysis of management and outcomes of cardiac cases reported on board merchant ships.

PubMed

Apostolatos, Charalampos; Andria, Vivian; Licari, Julie

Telemedical assistance has always been the cornerstone of medical care on board. Significant technological progress has provided improved scientific tools and equipment for high-quality communication and prompt management of either minor incidents or major emergencies on board. Med Solutions International is a medical management company, offering services exclusively to the maritime industry. Registered vessels contact the medical team and healthcare professionals provide immediate guidelines for onboard management as well as necessary action thereafter, i.e. examination ashore or urgent medical evacuation. Since cardiac conditions or diseases are potentially the most dangerous when traveling at sea, it is of major importance to analyse and evaluate the overall management and outcomes of cases reporting symptoms of possible heart disease so as to improve telemedical assistance services in future. The study included cases reporting cardiac symptoms from 5 major shipping companies during the year 2016. Data was collected from telecommunication, emails and seafarers' final medical reports. A descriptive analysis of overall management and outcomes was performed. The study showed that the number of confirmed cardiovascular cases on board was very low. Among 551 total cases and 44 cases with reported cardiac symptoms there was only one heart attack, one pulmonary oedema and one suspected myocarditis. In the majority of cases, chest pain was musculoskeletal or due to respiratory infection. Symptoms resulting from issues such as stress or anxiety often present as potential cardiac conditions. Stress may also amplify the severity of symptoms. Language barriers between the seafarer, the master and the doctor often make communication very difficult. According to our findings there are grounds to intensify the prevention process through more efficient pre-employment medical examinations and improve management on board through more intensive training. Communication problems

Enzymatically modified isoquercitrin supplementation intensifies plantaris muscle fiber hypertrophy in functionally overloaded mice.

PubMed

Kohara, Akiko; Machida, Masanao; Setoguchi, Yuko; Ito, Ryouichi; Sugitani, Masanori; Maruki-Uchida, Hiroko; Inagaki, Hiroyuki; Ito, Tatsuhiko; Omi, Naomi; Takemasa, Tohru

2017-01-01

Enzymatically modified isoquercitrin (EMIQ) is produced from rutin using enzymatic hydrolysis followed by treatment with glycosyltransferase in the presence of dextrin to add glucose residues. EMIQ is absorbed in the same way as quercetin, a powerful antioxidant reported to prevent disused muscle atrophy by targeting mitochondria and to have ergogenic effects. The present study investigated the effect of EMIQ on skeletal muscle hypertrophy induced by functional overload. In Study 1, 6-week-old ICR male mice were divided into 4 groups: sham-operated control, sham-operated EMIQ, overload-operated control, and overload-operated EMIQ groups. In Study 2, mice were divided into 3 groups: overload-operated whey control, overload-operated whey/EMIQ (low dose), and overload-operated whey/EMIQ (high dose) groups. The functional overload of the plantaris muscle was induced by ablation of the synergist (gastrocnemius and soleus) muscles. EMIQ and whey protein were administered with food. Three weeks after the operation, the cross-sectional area and minimal fiber diameter of the plantaris muscle fibers were measured. In Study 1, functional overload increased the cross-sectional area and minimal fiber diameter of the plantaris muscle. EMIQ supplementation significantly increased the cross-sectional area and minimal fiber diameter of the plantaris muscle in both the sham-operated and overload-operated groups. In Study 2, EMIQ supplementation combined with whey protein administration significantly increased the cross-sectional area and minimal fiber diameter of the plantaris muscle. EMIQ, even when administered as an addition to whey protein supplementation, significantly intensified the fiber hypertrophy of the plantaris muscle in functionally overloaded mice. EMIQ supplementation also induced fiber hypertrophy of the plantaris in sham-operated mice.

Active Tuberculosis Case Finding Interventions Among Immigrants, Refugees and Asylum Seekers in Italy

PubMed Central

Schepisi, Monica Sañé; Gualano, Gina; Piselli, Pierluca; Mazza, Marta; D’Angelo, Donatella; Fasciani, Francesca; Barbieri, Alberto; Rocca, Giorgia; Gnolfo, Filippo; Olivani, Piefranco; Ferrarese, Maurizio; Codecasa, Luigi Ruffo; Palmieri, Fabrizio; Girardi, Enrico

2016-01-01

In Italy tuberculosis (TB) is largely concentrated in vulnerable groups such as migrants and in urban settings. We analyzed three TB case finding interventions conducted at primary centers and mobile clinics for regular/irregular immigrants and refugees/asylum seekers performed over a four-year period (November 2009-March 2014) at five different sites in Rome and one site in Milan, Italy. TB history and presence of symptoms suggestive of active TB were investigated by verbal screening through a structured questionnaire in migrants presenting for any medical condition to out-patient and mobile clinics. Individuals reporting TB history or symptoms were referred to a TB clinic for diagnostic workup. Among 6347 migrants enrolled, 891 (14.0%) reported TB history or symptoms suggestive of active TB and 546 (61.3%) were referred to the TB clinic. Of them, 254 (46.5%) did not present for diagnostic evaluation. TB was diagnosed in 11 individuals representing 0.17% of those screened and 3.76% of those evaluated. The overall yield of this intervention was in the range reported for other TB screening programs for migrants, although we recorded an unsatisfactory adherence to diagnostic workup. Possible advantages of this intervention include low cost and reduced burden of medical procedures for the screened population. PMID:27403270

Clinicopathologic findings and outcome in dogs with infective endocarditis: 71 cases (1992-2005).

PubMed

Sykes, Jane E; Kittleson, Mark D; Chomel, Bruno B; Macdonald, Kristin A; Pesavento, Patricia A

2006-06-01

To evaluate clinical, laboratory, and necropsy findings in dogs with infective endocarditis (IE). Retrospective case series. 71 dogs with possible or definite IE. Medical records were reviewed for signalment, clinical features, and results of clinicopathologic testing and diagnostic imaging. Yearly incidence and the effect of variables on survival were determined by use of survival curve analysis. The overall incidence of IE was 0.05%. Most affected dogs were of large breeds, and > 75% were older than 5 years. The aortic valve was affected in 36 of the 71 (51%) dogs, and the mitral valve was affected in 59%. Lameness caused by immune-mediated polyarthritis, septic arthritis, or peripheral arterial thromboembolism was observed in 53% of the dogs. Neurologic complications were diagnosed in 17 of 71 (24%) dogs. Thromboembolic disease was suspected in 31 of 71 (44%) of dogs. The mortality rate associated with IE was 56%, and median survival time was 54 days. Factors negatively associated with survival included thrombocytopenia, high serum creatinine concentration, renal complications, and thromboembolic complications. A diagnosis of IE should be suspected in dogs with fever, systolic or diastolic murmur, and locomotor problems. Dogs with thrombocytopenia, high serum creatinine concentration, thromboembolism, or renal complications may have a shorter survival time.

Intensifying radiation induced grafting of 4-vinylpyridine/glycidyl methacrylate mixtures onto poly(ethylene-co-tetrafluoroethylene) films using ultrasound

NASA Astrophysics Data System (ADS)

Nasef, Mohamed Mahmoud; Sithambaranathan, Paveswari; Ahmad, Arshad; Abouzari-lotf, Ebrahim

2017-05-01

A new ultrasound-aided method was used to enhance grafting of 4-vinylpyridine (4-VP) and glycidyl methacrylate (GMA) monomers mixtures onto electron beam (EB) irradiated poly(ethylene-co-tetrafluoroethylene) (ETFE) film for the first time. The effects of reaction parameters such as absorbed dose, monomer concentration, reaction time on both of degree of grafting (DG) and grafting efficiency (GE) were investigated under sonication and conventional grafting at similar temperatures. Fourier transform infrared (FTIR) and atomic force microscopy (AFM) were used to monitor the impact of the applied ultrasound on composition and surfaces of the grafted films whereas 1H-NMR was used to investigate composition of the grafting residues. The ultrasound-aided grafting of 4-VP/GMA was found to enhance both of DG% and GE remarkably. Moreover, it produced grafted ETFE films having smoother surfaces without homopolymer contamination compared to grafted films obtained from conventional grafting. The results of this study suggest that the use of ultrasound is a promising way for intensifying grafting process and improving its economy.

The practical application of signal detection theory to image quality assessment in x-ray image intensifier-TV fluoroscopy.

PubMed

Marshall, N W

2001-06-01

This paper applies a published version of signal detection theory to x-ray image intensifier fluoroscopy data and compares the results with more conventional subjective image quality measures. An eight-bit digital framestore was used to acquire temporally contiguous frames of fluoroscopy data from which the modulation transfer function (MTF(u)) and noise power spectrum were established. These parameters were then combined to give detective quantum efficiency (DQE(u)) and used in conjunction with signal detection theory to calculate contrast-detail performance. DQE(u) was found to lie between 0.1 and 0.5 for a range of fluoroscopy systems. Two separate image quality experiments were then performed in order to assess the correspondence between the objective and subjective methods. First, image quality for a given fluoroscopy system was studied as a function of doserate using objective parameters and a standard subjective contrast-detail method. Following this, the two approaches were used to assess three different fluoroscopy units. Agreement between objective and subjective methods was good; doserate changes were modelled correctly while both methods ranked the three systems consistently.

Reperfusion injury intensifies the adaptive human T cell alloresponse in a human-mouse chimeric artery model.

PubMed

Yi, Tai; Fogal, Birgit; Hao, Zhengrong; Tobiasova, Zuzana; Wang, Chen; Rao, Deepak A; Al-Lamki, Rafia S; Kirkiles-Smith, Nancy C; Kulkarni, Sanjay; Bradley, John R; Bothwell, Alfred L M; Sessa, William C; Tellides, George; Pober, Jordan S

2012-02-01

Perioperative nonimmune injuries to an allograft can decrease graft survival. We have developed a model for studying this process using human materials. Human artery segments were transplanted as infrarenal aortic interposition grafts into an immunodeficient mouse host, allowed to "heal in" for 30 days, and then retransplanted into a second mouse host. To induce a reperfusion injury, the healed-in artery segments were incubated for 3 hours under hypoxic conditions ex vivo before retransplantation. To induce immunologic rejection, the animals receiving the retransplanted artery segment were adoptively transferred with human peripheral blood mononuclear cells or purified T cells from a donor allogeneic to the artery 1 week before surgery. To compare rejection of injured versus healthy tissues, these manipulations were combined. Results were analyzed ex vivo by histology, morphometry, immunohistochemistry, and mRNA quantitation or in vivo by ultrasound. Our results showed that reperfusion injury, which otherwise heals with minimal sequelae, intensifies the degree of allogeneic T cell-mediated injury to human artery segments. We developed a new human-mouse chimeric model demonstrating interactions of reperfusion injury and alloimmunity using human cells and tissues that may be adapted to study other forms of nonimmune injury and other types of adaptive immune responses.

Intensified fractionation of brewery yeast waste for the recovery of invertase using aqueous two-phase systems.

PubMed

De León-González, Grecia; González-Valdez, José; Mayolo-Deloisa, Karla; Rito-Palomares, Marco

2016-11-01

The potential recovery of high-value products from brewery yeast waste confers value to this industrial residue. Aqueous two-phase systems (ATPS) have demonstrated to be an attractive alternative for the primary recovery of biological products and are therefore suitable for the recovery of invertase from this residue. Sixteen different polyethylene glycol (PEG)-potassium phosphate ATPS were tested to evaluate the effects of PEG molecular weight (MW) and tie-line length (TLL) upon the partition behavior of invertase. Concentrations of crude extract from brewery yeast waste were then varied in the systems that presented the best behaviors to intensify the potential recovery of the enzyme. Results show that the use of a PEG MW 400 g mol -1 system with a TLL of 45.0% (w/w) resulted in an invertase bottom phase recovery with a purification factor of 29.5 and a recovery yield of up to 66.2% after scaling the system to a total weight of 15.0 g. This represents 15.1 mg of invertase per mL of processed bottom phase. With these results, a single-stage ATPS process for the recovery of invertase is proposed. © 2015 International Union of Biochemistry and Molecular Biology, Inc.

BrainCheck - a very brief tool to detect incipient cognitive decline: optimized case-finding combining patient- and informant-based data.

PubMed

Ehrensperger, Michael M; Taylor, Kirsten I; Berres, Manfred; Foldi, Nancy S; Dellenbach, Myriam; Bopp, Irene; Gold, Gabriel; von Gunten, Armin; Inglin, Daniel; Müri, René; Rüegger, Brigitte; Kressig, Reto W; Monsch, Andreas U

2014-01-01

Optimal identification of subtle cognitive impairment in the primary care setting requires a very brief tool combining (a) patients' subjective impairments, (b) cognitive testing, and (c) information from informants. The present study developed a new, very quick and easily administered case-finding tool combining these assessments ('BrainCheck') and tested the feasibility and validity of this instrument in two independent studies. We developed a case-finding tool comprised of patient-directed (a) questions about memory and depression and (b) clock drawing, and (c) the informant-directed 7-item version of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Feasibility study: 52 general practitioners rated the feasibility and acceptance of the patient-directed tool. Validation study: An independent group of 288 Memory Clinic patients (mean ± SD age = 76.6 ± 7.9, education = 12.0 ± 2.6; 53.8% female) with diagnoses of mild cognitive impairment (n = 80), probable Alzheimer's disease (n = 185), or major depression (n = 23) and 126 demographically matched, cognitively healthy volunteer participants (age = 75.2 ± 8.8, education = 12.5 ± 2.7; 40% female) partook. All patient and healthy control participants were administered the patient-directed tool, and informants of 113 patient and 70 healthy control participants completed the very short IQCODE. Feasibility study: General practitioners rated the patient-directed tool as highly feasible and acceptable. Validation study: A Classification and Regression Tree analysis generated an algorithm to categorize patient-directed data which resulted in a correct classification rate (CCR) of 81.2% (sensitivity = 83.0%, specificity = 79.4%). Critically, the CCR of the combined patient- and informant-directed instruments (BrainCheck) reached nearly 90% (that is 89.4%; sensitivity = 97.4%, specificity = 81.6%). A new and very brief instrument for

Training for Night Operations - Research Challenges and Opportunities

DTIC Science & Technology

2012-08-08

Training and Simulation Conference Exhibits and Visuals by Type ……………..……... 1 Figure 2: Radiant Sensitivity of Intensifiers Currently Used in Night Vision...wavelengths across Figure 2. Radiant Sensitivity of Intensifiers the entire radiant sensitivity band. In either case, in order to be Currently...the projector/display technology and NVGs used. NVGs are very sensitive to any light within their band of radiant sensitivity . The intensifier

Incidental Finding of Cryptococcus on Prostate Biopsy for Prostate Adenocarcinoma Following Cardiac Transplant: Case Report and Review of the Literature.

PubMed

Shah, Sujal I; Bui, Hai; Velasco, Nelson; Rungta, Shilpa

2017-11-06

BACKGROUND Cryptococcus is the third most common invasive fungal organism in immunocompromised patients, including transplant patients, and usually involves the central nervous system and lungs, with a median time to infection of 25 months. We report a case of Cryptococcus of the prostate gland, found as an incidental finding on prostate biopsy for prostate adenocarcinoma, four months following cardiac transplantation. CASE REPORT A 62-year-old male African-American who had a cardiac transplant four months previously, underwent a six-core prostate biopsy for a two-year history of increasing prostate-specific antigen (PSA) levels, and a recent history of non-specific urinary tract symptoms. A prostatic adenocarcinoma, Gleason grade 4+4=8, was diagnosed on histopathology, and 'foamy' cells were seen in the biopsies. Histochemical stains, including Grocott methenamine silver (GMS), and periodic acid-Schiff (PAS) showed abundant round and oval 5-7 µm diameter fungal elements; mucicarmine highlighted the fungal polysaccharide capsule, diagnostic for Cryptococcus. Cryptococcal antigen detection was made by the latex agglutination test and cultures. We reviewed the literature and found 70 published cases (from 1946-2008) of Cryptococcus of the prostate gland, with only one previous case presenting five years following cardiac transplantation. CONCLUSIONS Fungal infections of the prostate are rare, and occur mainly in immunocompromised patients. We present a unique case of prostatic Cryptococcus found incidentally at four months following cardiac transplantation. This case report highlights the need to consider atypical fungal infection as a differential diagnosis for prostatitis in immunosuppressed patients, including transplant patients.

Trends of Pesticide Exposure and Related Cases in the Philippines

PubMed Central

Lu, Jinky Leilanie; Cosca, Katherine Z.; Del mundo, Jocelyn

2010-01-01

The study aims to provide a comprehensive trend of pesticide poisoning cases in the Philippines as well as pesticide exposures, and risk factors related to the adverse effects of pesticide. Records were gathered from the National Poison Control and Management Center (NPCMC), the Philippine General Hospital, De La Salle Medical Center, and other hospitals, and reviewed research studies conducted in the Philippines. Based on hospital surveys, the number of pesticide cases as well as mortality trends have been increasing. Studies from 2006 to 2010 showed that human health especially those of the farmers is at risk due to pesticide exposure. Illnesses and symptoms such as headache, skin abnormalities, fatigue, fever, and weaknesses were the common health complaints experienced by the farmers as reported in the research studies. Moreover, the studies showed risk factors to pesticide exposure, work practices, and pesticide residues in environmental media that could be contributory to pesticide poisoning cases. Government agencies should intensify their surveillance and regulation on both household and agricultural pesticides. The state of pesticide-related illnesses mirrors the poor safety practices among farmers as well as lack of necessary supervision from the government agencies. PMID:25649374

Trends of pesticide exposure and related cases in the Philippines.

PubMed

Lu, Jinky Leilanie; Cosca, Katherine Z; Del Mundo, Jocelyn

2010-01-01

The study aims to provide a comprehensive trend of pesticide poisoning cases in the Philippines as well as pesticide exposures, and risk factors related to the adverse effects of pesticide. Records were gathered from the National Poison Control and Management Center (NPCMC), the Philippine General Hospital, De La Salle Medical Center, and other hospitals, and reviewed research studies conducted in the Philippines. Based on hospital surveys, the number of pesticide cases as well as mortality trends have been increasing. Studies from 2006 to 2010 showed that human health especially those of the farmers is at risk due to pesticide exposure. Illnesses and symptoms such as headache, skin abnormalities, fatigue, fever, and weaknesses were the common health complaints experienced by the farmers as reported in the research studies. Moreover, the studies showed risk factors to pesticide exposure, work practices, and pesticide residues in environmental media that could be contributory to pesticide poisoning cases. Government agencies should intensify their surveillance and regulation on both household and agricultural pesticides. The state of pesticide-related illnesses mirrors the poor safety practices among farmers as well as lack of necessary supervision from the government agencies.

Dermal Structure in Lymphedema Patients with History of Acute Dermatolymphangioadenitis Evaluated by Histogram Analysis of Ultrasonography Findings: A Case-Control Study.

PubMed

Dai, Misako; Sato, Aya; Maeba, Hiroko; Iuchi, Terumi; Matsumoto, Masaru; Okuwa, Mayumi; Nakatani, Toshio; Sanada, Hiromi; Sugama, Junko

2016-03-01

Acute dermatolymphangioadenitis (ADLA) is a risk factor for increasing of edema and worsening severity. Reducing ADLA frequency is an important objective of lymphedema management because ADLA episodes are strongly associated with poor quality of life. Lymphedema changes dermal and subcutaneous structure, favoring ADLA; ADLA recurrence may be caused by structural change of the dermis. However, the structure of the skin following ADLA episodes has not been studied in depth. The aim of this study was to examine changes in the skin after episodes of ADLA in breast cancer-related lymphedema (BCRL) using histogram analysis of ultrasonography findings. This was a case-control study with matching for the duration of lymphedema. We compared 10 limbs (5 BCRL patients, Cases) with a history of ADLA and 14 limbs (7 BCRL patients, Controls) without. Ultrasonography was performed using a 20-MHz probe, and measurements were made at a site 10 cm proximal to the ulnar styloid process. We compared "skewness" of the images in the dermis from the histogram analysis. This study was approved by the Ethics Committee of Kanazawa University. Skewness was significantly different between the affected and unaffected limbs (p = 0.02). Cases showed a positive value (median 0.74, range -0.18 to 1.26), whereas Controls showed a negative value (median -0.21, range -0.45 to 0.31). Episodes of ADLA changed the distribution of echogenicity on imaging, which indicates a change in the collagen fibers in the dermis. These findings might contribute to improving the management of lymphedema and prevention of recurrent ADLA.

A pediatric renal lymphoma case presenting with central nervous system findings.

PubMed

Baran, Ahmet; Küpeli, Serhan; Doğru, Omer

2013-06-01

In pediatric patients renal lymphoma frequently presents in the form of multiple, bilateral mass lesions, infrequently as a single or retroperitoneal mass, and rarely as diffuse infiltrative lesions. In patients with apparent central nervous system involvement close attention to other physical and laboratory findings are essential for preventing a delay in the final diagnosis. Herein we present a pediatric patient with renal lymphoma that presented with central nervous system findings that caused a delay in diagnosis. None declared.

Incidental Finding of Metastatic Cutaneous Malignant Melanoma at Uterine Leiomyoma, A Thai University Hospital Experience: A Case Report.

PubMed

Chanthasenanont, Athita; Nantakomon, Tongta; Kintarak, Jutatip; Vithisuvanakul, Nophadol; Pongrojpaw, Densak; Suwannarurk, Komsun

2015-04-01

Metastatic malignant melanomas to the uterus are extremely rare; to our knowledge, no more than 13 cases have been reported to date. A 44-years-old multigravida woman presented with a black and irregular surface mass at medial aspect of left thigh. There was also an enlarged left groin node. Wide excision with lymph node dissection revealed malignant melanoma. Further examination found a huge pelvic mass with left deep vein thrombosis consequent by pressure effect. Chest and complete abdominal computed tomography revealed an enlarged, fibroid uterus with pressure effect at left common iliac vein. A total abdominal hysterectomy and bilateral adnexectomy were performed. Intra-operative finding was scattered hyperpigment spots at surface of the uterus and its tumor Histopathological report showed metastatic malignant melanoma involving myometrium and uterine serosa. Diagnosis of stage IV malignant melanoma (uterine metastasis) was achieved. The patient was counseled about her diagnosis, stage, prognosis and further treatment. Uterine metastatic malignant melanoma was a rare condition. This report represents the first case of a cutaneous malignant melanoma involving a uterine leiomyoma in Thailand.

Cheilitis glandularis: Case report with respect to immunohistochemical findings

PubMed Central

Friedrich, Reinhard E.; Löning, Thomas

2016-01-01

Cheilitis glandularis (CG) is a rare benign affection of the lip mucosa. The etiology and pathogenesis of CG are unknown. Surgical measures are the leading therapeutic options to treat CG. This case report on a 55-year-old female illustrates the recurrent affection of the lips over several years and local therapy. Furthermore, the study of the resected glands intends to differentiate the lesions with respect to the recently introduced concept of immunoglobulin G4-related diseases. PMID:26816670

Drivers of routine immunization coverage improvement in Africa: findings from district-level case studies

PubMed Central

LaFond, Anne; Kanagat, Natasha; Steinglass, Robert; Fields, Rebecca; Sequeira, Jenny; Mookherji, Sangeeta

2015-01-01

There is limited understanding of why routine immunization (RI) coverage improves in some settings in Africa and not in others. Using a grounded theory approach, we conducted in-depth case studies to understand pathways to coverage improvement by comparing immunization programme experience in 12 districts in three countries (Ethiopia, Cameroon and Ghana). Drawing on positive deviance or assets model techniques we compared the experience of districts where diphtheria–tetanus–pertussis (DTP3)/pentavalent3 (Penta3) coverage improved with districts where DTP3/Penta3 coverage remained unchanged (or steady) over the same period, focusing on basic readiness to deliver immunization services and drivers of coverage improvement. The results informed a model for immunization coverage improvement that emphasizes the dynamics of immunization systems at district level. In all districts, whether improving or steady, we found that a set of basic RI system resources were in place from 2006 to 2010 and did not observe major differences in infrastructure. We found that the differences in coverage trends were due to factors other than basic RI system capacity or service readiness. We identified six common drivers of RI coverage performance improvement—four direct drivers and two enabling drivers—that were present in well-performing districts and weaker or absent in steady coverage districts, and map the pathways from driver to improved supply, demand and coverage. Findings emphasize the critical role of implementation strategies and the need for locally skilled managers that are capable of tailoring strategies to specific settings and community needs. The case studies are unique in their focus on the positive drivers of change and the identification of pathways to coverage improvement, an approach that should be considered in future studies and routine assessments of district-level immunization system performance. PMID:24615431

Precise color images a high-speed color video camera system with three intensified sensors

NASA Astrophysics Data System (ADS)

Oki, Sachio; Yamakawa, Masafumi; Gohda, Susumu; Etoh, Takeharu G.

1999-06-01

High speed imaging systems have been used in a large field of science and engineering. Although the high speed camera systems have been improved to high performance, most of their applications are only to get high speed motion pictures. However, in some fields of science and technology, it is useful to get some other information, such as temperature of combustion flame, thermal plasma and molten materials. Recent digital high speed video imaging technology should be able to get such information from those objects. For this purpose, we have already developed a high speed video camera system with three-intensified-sensors and cubic prism image splitter. The maximum frame rate is 40,500 pps (picture per second) at 64 X 64 pixels and 4,500 pps at 256 X 256 pixels with 256 (8 bit) intensity resolution for each pixel. The camera system can store more than 1,000 pictures continuously in solid state memory. In order to get the precise color images from this camera system, we need to develop a digital technique, which consists of a computer program and ancillary instruments, to adjust displacement of images taken from two or three image sensors and to calibrate relationship between incident light intensity and corresponding digital output signals. In this paper, the digital technique for pixel-based displacement adjustment are proposed. Although the displacement of the corresponding circle was more than 8 pixels in original image, the displacement was adjusted within 0.2 pixels at most by this method.

Dermoscopic findings in bowenoid papulosis: report of two cases.

PubMed

Marcucci, Carolina; Sabban, Emilia Cohen; Friedman, Paula; Peralta, Rosario; Calb, Ignacio; Cabo, Horacio

2014-10-01

Bowenoid papulosis (BP) corresponds to an in situ squamous cell carcinoma (SCC) located in the anogenital region. It is related to HPV, and presents with gray-brown elevated papules or plaques. A biopsy is needed to confirm the diagnosis; however, dermoscopy may be useful to differentiate this disease from other conditions, such as genital warts, seborrheic keratosis and lichen planus. In this paper we describe the dermoscopic findings in two patients with this disease.

Determinants of Demand for Private Supplementary Tutoring in China: Findings from a National Survey

ERIC Educational Resources Information Center

Liu, Junyan; Bray, Mark

2017-01-01

Private tutoring has expanded and intensified in China. However, no government statistical data or other empirical studies fully capture its extent and characteristics. This paper analyses private tutoring received by students in Grades 1-12 as indicated by a nationwide representative survey entitled China Family Panel Studies. The paper employs a…

Atypically presenting kaposiform hemangioendothelioma of the knee: ultrasound findings.

PubMed

Erdem Toslak, Iclal; Stegman, Matthew; Reiter, Michael P; Barkan, Güliz A; Borys, Dariusz; Lim-Dunham, Jennifer E

2018-04-10

Kaposiform hemangioendothelioma (KHE) is a rare vascular tumor of early childhood and infancy. Kasabach-Merritt phenomenon, a common complication of KHE, is characterized by life-threatening thrombocytopenia, hemolytic anemia, and consumption coagulopathy. There may be atypical cases that do not present with Kasabach-Merritt phenomenon and do have atypical imaging findings. Knowledge of atypical imaging features may assist radiologists in identifying KHE. In this report, we present a 4-year-old case of KHE with atypical ultrasound findings.

Brain MRI findings in patients with idiopathic hypersomnia.

PubMed

Trotti, Lynn Marie; Bliwise, Donald L

2017-06-01

Proper diagnosis of idiopathic hypersomnia necessitates the exclusion of neurologic or medical causes of sleepiness that better explain the clinical syndrome. However, there are no formal guidelines regarding the use of neuroimaging to identify such secondary causes of symptoms. We sought to characterize brain MRI findings in a series of patients with idiopathic hypersomnia. We reviewed medical records on a consecutive series of 61 patients diagnosed with idiopathic hypersomnia to determine the frequency and results of brain magnetic resonance imaging (MRI). One-third of patients had undergone brain MRI, with focal neurologic signs or symptoms being the most common indication for neuroimaging. Although seven patients had an identifiable finding on neuroimaging (e.g., chronic microvascular ischemic changes), clinical management was changed as a result of imaging in only three cases. In all three, the imaging finding was predated by clear clinical abnormalities. Neuroimaging may be a complementary part of an idiopathic hypersomnia evaluation, but the decision to pursue imaging should be made on a case-by-case basis. Copyright © 2017 Elsevier B.V. All rights reserved.

Super-global distortion correction for a rotational C-arm x-ray image intensifier.

PubMed

Liu, R R; Rudin, S; Bednarek, D R

1999-09-01

Image intensifier (II) distortion changes as a function of C-arm rotation angle because of changes in the orientation of the II with the earth's or other stray magnetic fields. For cone-beam computed tomography (CT), distortion correction for all angles is essential. The new super-global distortion correction consists of a model to continuously correct II distortion not only at each location in the image but for every rotational angle of the C arm. Calibration bead images were acquired with a standard C arm in 9 in. II mode. The super-global (SG) model is obtained from the single-plane global correction of the selected calibration images with given sampling angle interval. The fifth-order single-plane global corrections yielded a residual rms error of 0.20 pixels, while the SG model yielded a rms error of 0.21 pixels, a negligibly small difference. We evaluated the accuracy dependence of the SG model on various factors, such as the single-plane global fitting order, SG order, and angular sampling interval. We found that a good SG model can be obtained using a sixth-order SG polynomial fit based on the fifth-order single-plane global correction, and that a 10 degrees sampling interval was sufficient. Thus, the SG model saves processing resources and storage space. The residual errors from the mechanical errors of the x-ray system were also investigated, and found comparable with the SG residual error. Additionally, a single-plane global correction was done in the cylindrical coordinate system, and physical information about pincushion distortion and S distortion were observed and analyzed; however, this method is not recommended due to a lack of calculational efficiency. In conclusion, the SG model provides an accurate, fast, and simple correction for rotational C-arm images, which may be used for cone-beam CT.

Intuitive Choices Lead to Intensified Positive Emotions: An Overlooked Reason for "Intuition Bias"?

PubMed

Kirkebøen, Geir; Nordbye, Gro H H

2017-01-01

People have, for many well-documented reasons, a tendency to overemphasize their intuitions and to follow them, even when they should not. This "intuition bias" leads to several kinds of specific intuitive biases in judgments and decision making. Previous studies have shown that characteristics of the decision process have a tendency to "leak" into the experience of the choice outcome. We explore whether intuitive choices influence the experience of the choice outcomes differently from "non-intuitive," analytic choices. Since intuition is feeling based, we examine in particular if intuitive choices have stronger affective consequences than non-intuitive ones. Participants in two scenario studies ( N = 90; N = 126) rated the feelings of decision makers who experienced a conflict between two options, one intuitively appealing and another that appeared preferable on analytic grounds. Choosing the intuitive alternative was anticipated to lead to somewhat more regret after negative outcomes and, in particular, much more satisfaction with positive outcomes. In two autobiographical studies, one with psychology students ( N = 88) and the other with experienced engineers ( N = 99), participants were asked to provide examples of choice conflicts between an intuitive and a non-intuitive option from their own private or professional lives. Both groups showed a tendency to report stronger emotions, in particular positive, after intuitive choices. One well-established explanation for intuition bias focuses on the nature of people's anticipated negative counterfactual thoughts if their decisions were to turn out badly. The present data indicate that intuitive choices intensify positive emotions, anticipated and real, after successful outcomes much more than negative emotions after failures. Positive outcomes are also more commonly expected than negative ones, when we make choices. We argue that markedly amplified emotions, mediated by stronger personal involvement, in the

[Virtual bronchoscopy: the correlation between endoscopic simulation and bronchoscopic findings].

PubMed

Salvolini, L; Gasparini, S; Baldelli, S; Bichi Secchi, E; Amici, F

1997-11-01

We carried out a preliminary clinical validation of 3D spiral CT virtual endoscopic reconstructions of the tracheobronchial tree, by comparing virtual bronchoscopic images with actual endoscopic findings. Twenty-two patients with tracheobronchial disease suspected at preliminary clinical, cytopathological and plain chest film findings were submitted to spiral CT of the chest and bronchoscopy. CT was repeated after endobronchial therapy in 2 cases. Virtual endoscopic shaded-surface-display views of the tracheobronchial tree were reconstructed from reformatted CT data with an Advantage Navigator software. Virtual bronchoscopic images were preliminarily evaluated with a semi-quantitative quality score (excellent/good/fair/poor). The depiction of consecutive airway branches was then considered. Virtual bronchoscopies were finally submitted to double-blind comparison with actual endoscopies. Virtual image quality was considered excellent in 8 cases, good in 14 and fair in 2. Virtual exploration was stopped at the lobar bronchi in one case only; the origin of segmental bronchi was depicted in 23 cases and that of some subsegmental branches in 2 cases. Agreement between actual and virtual bronchoscopic findings was good in all cases but 3 where it was nevertheless considered satisfactory. The yield of clinically useful information differed in 8/24 cases: virtual reconstructions provided more information than bronchoscopy in 5 cases and vice versa in 3. Virtual reconstructions are limited in that the procedure is long and difficult and needing a strictly standardized threshold value not to alter virtual findings. Moreover, the reconstructed surface lacks transparency, there is the partial volume effect and the branches < or = 4 pixels phi and/or meandering ones are difficult to explore. Our preliminary data are encouraging. Segmental bronchi were depicted in nearly all cases, except for the branches involved by disease. Obstructing lesions could be bypassed in some cases

Benchmarking Alumni Relations in Community Colleges: Findings from a 2015 CASE Survey. CASE White Paper

ERIC Educational Resources Information Center

Paradise, Andrew

2016-01-01

Building on the inaugural survey conducted three years prior, the 2015 CASE Community College Alumni Relations survey collected additional insightful data on staffing, structure, communications, engagement, and fundraising. This white paper features key data on alumni relations programs at community colleges across the United States. The paper…

AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY POSITION STATEMENT ON THYROID DYSFUNCTION CASE FINDING.

PubMed

Hennessey, James V; Garber, Jeffrey R; Woeber, Kenneth A; Cobin, Rhoda; Klein, Irwin

2016-02-01

Hypothyroidism and hyperthyroidism can be readily diagnosed and can be treated in a safe, cost-effective manner. Professional organizations have given guidance on how and when to employ thyroid-stimulating hormone testing for the detection of thyroid dysfunction. Most recently, the United States Preventive Services Task Force did not endorse screening for thyroid dysfunction based on a lack of proven benefit and potential harm of treating those with thyroid dysfunction, which is mostly subclinical disease. The American Association of Clinical Endocrinologists (AACE) is concerned that this may discourage physicians from testing for thyroid dysfunction when clinically appropriate. Given the lack of specificity of thyroid-associated symptoms, the appropriate diagnosis of thyroid disease requires biochemical confirmation. The Thyroid Scientific Committee of the AACE has produced this White Paper to highlight the important difference between screening and case-based testing in the practice of clinical medicine. We recommend that thyroid dysfunction should be frequently considered as a potential etiology for many of the nonspecific complaints that physicians face daily. The application and success of safe and effective interventions are dependent on an accurate diagnosis. We, therefore, advocate for an aggressive case-finding approach, based on identifying those persons most likely to have thyroid disease that will benefit from its treatment.

Exchange of E. coli from the foreshore reservoir to surface waters during intensified wave conditions

NASA Astrophysics Data System (ADS)

Malott, S. S.; Vogel, L. J.; Edge, T.; O'Carroll, D. M.; Robinson, C. E.

2014-12-01

In recent years a number of studies have suggested that foreshore sand and porewater can act as a non-point source of microbial contamination to adjacent surface waters. Fecal indicator bacteria (FIB) can be released from the sand into the surface water through sand erosion or wave-induced porewater flows leading to FIB detachment. Although regression models often show that there is a strong correlation between wave events and high E. coli in surface waters, there is limited understanding of the mechanisms by which E. coli is transported from the subsurface foreshore reservoir (sand and porewater) to surface waters during wave events. An improved understanding of the transport mechanisms will facilitate the development of better water quality exceedences predictions. Detailed groundwater flow, sand level and E. coli measurements were conducted at Ipperwash Beach, Lake Huron (Ontario) for three wave events during the 2014 bathing season to evaluate the relative contribution of sand erosion and wave-induced pore water flow in transporting E. coli from the subsurface reservoir to the shallow waters. As expected, results indicate increased E. coli concentrations in ankle and waist deep surface water during periods of increased wave activity (wave height > 0.5m). Considerable sand erosion from the foreshore may have contributed to these increased surface water concentrations. The E. coli concentrations in the foreshore reservoir generally decreased as the wave height intensified, while E. coli concentrations in upshore sand and porewater locations increased.

Eastern Pacific tropical cyclones intensified by El Niño delivery of subsurface ocean heat.

PubMed

Jin, F-F; Boucharel, J; Lin, I-I

2014-12-04

The El Niño Southern Oscillation (ENSO) creates strong variations in sea surface temperature in the eastern equatorial Pacific, leading to major climatic and societal impacts. In particular, ENSO influences the yearly variations of tropical cyclone (TC) activities in both the Pacific and Atlantic basins through atmospheric dynamical factors such as vertical wind shear and stability. Until recently, however, the direct ocean thermal control of ENSO on TCs has not been taken into consideration because of an apparent mismatch in both timing and location: ENSO peaks in winter and its surface warming occurs mostly along the Equator, a region without TC activity. Here we show that El Niño--the warm phase of an ENSO cycle--effectively discharges heat into the eastern North Pacific basin two to three seasons after its wintertime peak, leading to intensified TCs. This basin is characterized by abundant TC activity and is the second most active TC region in the world. As a result of the time involved in ocean transport, El Niño's equatorial subsurface 'heat reservoir', built up in boreal winter, appears in the eastern North Pacific several months later during peak TC season (boreal summer and autumn). By means of this delayed ocean transport mechanism, ENSO provides an additional heat supply favourable for the formation of strong hurricanes. This thermal control on intense TC variability has significant implications for seasonal predictions and long-term projections of TC activity over the eastern North Pacific.

Benchmarking Alumni Relations in Community Colleges: Findings from a 2012 CASE Survey. CASE White Paper

ERIC Educational Resources Information Center

Paradise, Andrew; Heaton, Paul

2013-01-01

In 2011, CASE founded the Center for Community College Advancement to provide training and resources to help community colleges build and sustain effective fundraising, alumni relations and communications and marketing programs. This white paper summarizes the results of a groundbreaking survey on alumni relations programs at community colleges…

Epstein-Barr virus-related lymph node lesion resembling autoimmune disease-like clinicopathological findings in elderly patients. Report of three cases.

PubMed

Kojima, Masaru; Yamane, Yuko; Itoh, Hideaki; Tanaka, Hiroshi; Sugihara, Shiro; Masawa, Nobuhide; Nakamura, Shigeo

2003-12-01

Three cases of Epstein-Barr virus (EBV)-related lymphoproliferative disorders in elderly patients showing autoimmune disease-associated lymphadenopathy-like clinicopathological findings have been reported. Clinically, they were characterized by systemic lymphadenopathy, "B" symptoms, polyclonal hypergammaglobulinemia, elevated serum LDH and transient presence of various autoantibodies, and absence of atypical lymphocytosis in peripheral blood. One case was associated with idiopathic thrombocytopenic purpura. The clinical course was self-limiting. Histologically, they exhibited numerous lymphoid follicles with hyperplastic germinal centers and atypical interfollicular widening with prominent vascular proliferation. In the paracortical area, there was a mixed infiltrate comprising small to medium-sized lymphocytes and plasma cells, and variable numbers of eosinophils and T- and B-immunoblasts. In situ hybridization demonstrated a varying number of EBV-infected lymphocytes in the germinal center as well as in the interfollicular area. Polymerase chain reaction demonstrated that neither clonal rearrangement of T-cell receptor gamma-gene nor immunoglobulin heavy-chain rearrangement was detected in two of the cases examined. Although acute EBV infection rarely occurs in older adults, EBV related to reactive lymphoproliferative disorder should be added to the differential diagnosis of autoimmune disease-associated lymphadenopathy and node-based peripheral T-cell lymphoma in elderly patients.

Laryngeal juvenile xanthogranuloma: Imaging finding.

PubMed

Wang, L M; Chen, Q H; Zhang, Y X; Fang, Y Q

2010-08-01

Laryngeal juvenile xanthogranuloma is rare and there were only four cases have been reported previously in English literature. We report a case of isolated JXG of larynx in the superglottic region. The mass was well-defined and homogeneous hypoechoic in ultrasonography while presented indistinct boundary and soft tissue density in Computed Tomography images. Radiological findings are nonspecific but could help to understand the extent of the lesion. We suggest that JXG should be considered as differential diagnosis for laryngeal stridor. Laryngeal ultrasound is safe and reliable, which could be considered a useful diagnostic tool for supplementing laryngoscopy.

Case Studies on the Symbolism of Difference-Finding Problems in First Grade.

ERIC Educational Resources Information Center

Hasegawa, Junichi

2002-01-01

Discusses a class on subtraction or difference-finding, problems such as "There are eight white flowers and five red flowers, how many more white flowers are there than red flowers?" used in the teaching of Japanese first grade children. Describes three instances of introductory teaching of "difference-finding" problems in the…

Magnetic resonance imaging findings of paracoccidioidomycosis in the musculoskeletal system.

PubMed

Savarese, Leonor G; Monsignore, Lucas M; de Andrade Hernandes, Mateus; Martinez, Roberto; Nogueira-Barbosa, Marcello H

2015-10-01

To describe magnetic resonance imaging (MRI) findings in musculoskeletal paracoccidioidomycosis (PCM). Retrospective case series study after IRB approval. Two musculoskeletal radiologists reviewed in consensus the MRI findings of 11 patients with microbiologically and/or pathologically proven osteoarticular PCM. The MRI evaluation included discrimination of abnormalities in joints, bones and soft tissues. Mean age of patients was 29 years (10-55 years), eight men and three women. Musculoskeletal involvement was the only or the primary presentation of the disease in seven patients (63%). Osteomyelitis was the most common presentation, with seven cases (63%). Primary arthritis was found in one patient (9%). Isolated extra-articular soft tissue PCM was found in three patients: myositis (2) and subcutaneous infection (1). All cases showed regions with signal intensity higher than or similar to the signal of muscle on T1-weighted images. Penumbra sign was present in five cases (45%). T2-weighted images showed reactive soft tissue oedema in eight cases (72%). Post-gadolinium images showed peripheral (8/9) or heterogeneous (1/9) enhancement. Synovial enhancement was present in all cases of joint involvement (6/6). Lipomatosis arborescens was documented in one case of chronic knee involvement. To our knowledge, this is the first case series describing MRI findings of musculoskeletal PCM. Musculoskeletal involvement was the primary presentation of the disease in most cases, and therefore, neoplasms were initially in the differential diagnosis. Osteomyelitis was the most common presentation, often with secondary involvement of joint and or soft tissue. © 2015 John Wiley & Sons Ltd.

Vitamin D deficiency intensifies deterioration of risk factors, such as male sex and absence of vision, leading to increased postural body sway.

PubMed

Krause, Matthias; Anschütz, Wilma; Vettorazzi, Eik; Breer, Stefan; Amling, Michael; Barvencik, Florian

2014-01-01

Due to inconsistent findings, the influence of vitamin D on postural body sway (PBS) is currently under debate. This study evaluated the impact of vitamin D on PBS with regards to different foot positions and eye opening states in community-dwelling older individuals. In a cross-sectional study, we assessed PBS in 342 older individuals (264 females [average age (± SD): 68.3 ± 9.0 years], 78 males [65.7 ± 9.6 years]). A detailed medical history and vitamin D level were obtained for each individual. Fall risk was evaluated using the New York-Presbyterian Fall Risk Assessment Tool (NY PFRA). PBS parameters (area, distance, velocity, frequency) were evaluated on a pressure plate with feet in closed stance (CS) or hip-width stance (HWS), open eyes and closed eyes. Statistical analysis included logarithmic mixed models for repeated measures with the MIXED model procedure to test the influence of vitamin D (categorized in <10 μg/l, 10-20 μg/l, 21-30 μg/l, >30 μg/l), foot position, eye opening state, age, sex and frequency of physical activity on PBS. Vitamin D was not an independent risk factor for falls experienced in the last 12 months. Nonetheless, PBS was higher in patients with vitamin D deficiency (<10 μg/l) in HWS (A/P p=0.028 and area p=0.037). Additionally, vitamin D deficiency intensified the deleterious effects of male sex (distance p=0.002) and absence of vision (area p<0.001) on PBS. Independent risk factors for increased PBS like male sex and absence of vision are additionally compromised by vitamin D deficiency. Copyright © 2013 Elsevier B.V. All rights reserved.

High-resolution computed tomography findings in eight patients with hantavirus pulmonary syndrome.

PubMed

Barbosa, Diego de Lacerda; Hochhegger, Bruno; Souza, Arthur Soares; Zanetti, Gláucia; Escuissato, Dante Luiz; Meirelles, Gustavo de Souza Portes; Funari, Marcelo Buarque de Gusmão; Marchiori, Edson

2017-01-01

The purpose of this study was to describe the high-resolution computed tomography (HRCT) findings in patients with hantavirus pulmonary syndrome (HPS). We retrospectively reviewed HRCT findings from eight cases of HPS. All patients were men, aged 19-70 (mean, 41.7) years. Diagnoses were established by serological test (enzyme-linked immunosorbent assay) in all patients. Two chest radiologists analyzed the images and reached decisions by consensus. The predominant HRCT findings were ground-glass opacities (GGOs) and smooth inter- and intralobular septal thickening, found in all eight cases; however, the crazy-paving pattern was found in only three cases. Pleural effusion and peribronchovascular thickening were observed in five patients. The abnormalities were bilateral in all patients. The predominant HRCT findings in patients with HPS were GGOs and smooth inter- and intralobular septal thickening, which probably correlate with the histopathologic findings of pulmonary edema.

Magnetic Resonance Imaging Findings of Intrahepatic Bile Duct Adenoma: A Report of 4 Cases.

PubMed

Liang, Wenjie; Xu, Shunliang

2015-01-01

Intrahepatic bile duct adenoma (BDA) is a rare type of benign hepatic lesions. In this study, 4 cases of BDA diagnosed from surgical resection pathology were examined. Their clinical and magnetic resonance imaging (MRI) data were retrospectively analyzed. The 4 cases (1 men and 3 women) were aged 21 to 55 years without obvious clinical symptoms. Three were identified through routine examination. Three had a history of chronic hepatitis B virus infection. Two cases were accompanied by hepatocellular carcinoma, and one had a higher level of α-fetoprotein. The MRI images of BDA all manifested as peripheral hepatic nodules with abnormal signals. The diameters of the lesions in the 4 cases were 7.7 to 17.0 mm. The MRI images showed slight hypointensity on T1WI and slight hyperintensity on T2WI in all cases, and they showed slight hyperintensity in 2 cases and hyperintensity in 2 cases on diffusion-weighted imaging. Dynamic contrast-enhanced MRI scans show hyperintensity in the arterial phase and slight hyperintensity in the late stage in 3 cases. The other case shows hyperintensity in the arterial and portal phases and isointensity at the delayed phase. During follow-up, 3 cases were recurrence-free. The other case was complicated by the reoccurrence of HCC. In general, BDA shows specific MRI characteristics, and peripheral hepatic nodules show slight hypointensity on T1WI and slight hyperintensity on T2WI. Dynamic contrast-enhanced MRI scans showed obvious enhancement in the arterial phase and continuous enhancement at the late stage.

Highly Sensitive FRET-Based Fluorescence Immunoassay for Detecting of Aflatoxin B1 Using Magnetic/Silica Core-Shell as a Signal Intensifier.

PubMed

Kalarestaghi, Alireza; Bayat, Mansour; Hashemi, Seyed Jamal; Razavilar, Vadood

2015-09-01

Recently, some new nanobiosensors using different nanoparticles or microarray systems for detection of mycotoxins have been designed . However, rapid, sensitive and early detection of aflatoxicosis would be very helpful to distinguish high-risk persons. We report a highly sensitive competitive immunoassay using magnetic/silica core shell as a signal intensifier for the determination of aflatoxin B1 using fluorescence resonance energy transfer (FRET) from Cd/Te quantum dots (antiaflatoxin B1 antibody immobilized on the surface of Cd/Te quantum dots) to Rhodamine 123 (Rho 123-labeled aflatoxin B1 bound to albumin). The specific immune-reaction between the anti-aflatoxin B1 antibody on the QDs and the labeledaflatoxin B1 brings the Rho 123 fluorophore (acting as the acceptor) and the QDs (acting as the donor) in close spatial proximity and causes FRET to occur upon photo-excitation of the QDs. Using magnetic/silica core shell to intensify the obtained signal is the novelty of this study. Cd/Te QDs were synthesized by the simultaneous reduction of cadmium chloride and tellurium in the presence of sodium borohydride under nitrogen atmosphere. Magnetic nanoparticles were synthesized using FeSO 4 and FeCl 3 (1:2 molar ratio) and ammonia as an oxidizing agent under nitrogen atmosphere. The prepared magnetic nanoparticles shelled by silica using tetraethoxysilane in the presence of ammonia. Nanoparticles synthesis and monodispersity confirmed by TEM. Immobilization of Cd/Te QDs to antibodies and labeling of aflatoxin B1-albumin by Rho 123 were performed by EDC/NHS reaction in reaction mixture buffer, pH 6, at room temperature. By using the magnetic/silica core shell sensitivity of the system changed from 2×10 -11 in our previous study to 2×10 -12 in this work. The feasibility of the method established by the detection of aflatoxin B1 in spiked human serum. There is a linear relationship between the decreased fluorescence intensity of Rho 123 with increasing concentration

Corneal confocal microscopy and dry eye findings in contact lens discomfort patients.

PubMed

Dogan, Aysun Sanal; Gurdal, Canan; Arslan, Nese

2018-02-01

To evaluate the corneal confocal microscopy and dry eye findings in patients with contact lens discomfort. The study included 3 groups of participants: Contact lens wearers using silicone hydrogel soft contact lenses who are symptomatic (CLD, n=15) or asymptomatic (ACL, n=11) and non-wearers as controls (n=14). Duration of contact lens wear, Ocular Surface Disease Index (OSDI) questionnaire responses, fluorescein tear break-uptime (FBUT), and corneal confocal microscopy findings were recorded. Mean age was 25.7±8.2 years and male/female ratio was 7/33. Demographic findings were similar regarding the groups. CLD patients had a longer lens use history than ACL (median 5 vs 2 years, p<0.001). OSDI scores were higher in CLD group than ACL or controls (p<0.001, p=0.002). FBUT was significantly lowest in CLD group, compared to controls and ACL (p<0.001, p=0.039). FBUT was also lower in ACL patients compared to controls (p=0.036). There was no difference between basal epithelium cell counts between all 3 groups. Anterior stromal activated keratocyte numbers were similar between contact lens using groups but was lower in controls (p=0.005). However, dendritiform cells in the sub-basal nerve layer were higher in CLD group compared to controls but similar to ACL (p<0.001, p=0.058). Graded sub-basal nerve tortuosity was more prominent in CLD group than the ACL (p=0.014). Patients with CLD had been wearing contact lenses for longer than those without symptoms. OSDI and FBUT scores were worse in CLD patients. In contact lens discomfort patients, there were increased dendritiform cells, indicating intensified inflammatory status of the cornea. Copyright © 2017 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

Discovery and Use of Online Learning Resources: Case Study Findings

ERIC Educational Resources Information Center

Recker, Mimi M.; Dorward, James; Nelson, Laurie Miller

2004-01-01

Much recent research and funding have focused on building Internet-based repositories that contain collections of high-quality learning resources, often called "learning objects." Yet little is known about how non-specialist users, in particular teachers, find, access, and use digital learning resources. To address this gap, this article…

Intensified recovery of valuable products from whey by use of ultrasound in processing steps - A review.

PubMed

Gajendragadkar, Chinmay N; Gogate, Parag R

2016-09-01

The current review focuses on the analysis of different aspects related to intensified recovery of possible valuable products from cheese whey using ultrasound. Ultrasound can be used for process intensification in processing steps such as pre-treatment, ultrafiltration, spray drying and crystallization. The combination of low-frequency, high intensity ultrasound with the pre-heat treatment minimizes the thickening or gelling of protein containing whey solutions. These characteristics of whey after the ultrasound assisted pretreatment helps in improving the efficacy of ultrafiltration used for separation and also helps in preventing the blockage of orifice of spray dryer atomizing device. Further, the heat stability of whey proteins is increased. In the subsequent processing step, use of ultrasound assisted atomization helps to reduce the treatment times as well as yield better quality whey protein concentrate (WPC) powder. After the removal of proteins from the whey, lactose is a major constituent remaining in the solution which can be efficiently recovered by sonocrystallization based on the use of anti-solvent as ethanol. The scale-up parameters to be considered during designing the process for large scale applications are also discussed along with analysis of various reactor designs. Overall, it appears that use of ultrasound can give significant process intensification benefits that can be harnessed even at commercial scale applications. Copyright © 2016 Elsevier B.V. All rights reserved.

Evidence for increased Chlamydia case finding after the introduction of rectal screening among women attending 2 Canadian sexually transmitted infection clinics.

PubMed

Gratrix, Jennifer; Singh, Ameeta E; Bergman, Joshua; Egan, Caroline; Plitt, Sabrina S; McGinnis, Justin; Bell, Christopher A; Drews, Steven J; Read, Ron

2015-02-01

Chlamydia trachomatis is the most common notifiable disease in Canada, and extragenital sites are believed to serve as hidden reservoirs for ongoing transmission of infection. There are no specific Canadian screening guidelines for asymptomatic individuals from extragenital sites. We sought to determine the prevalence and factors associated with rectal C. trachomatis among female sexually transmitted infection (STI) clinic attendees in Alberta, Canada. Between 20 July and 31 December 2012, all female attendees at 2 Provincial STI clinics receiving a pelvic examination, regardless of a history of anal intercourse, were screened for rectal C. trachomatis using the Gen-Probe Aptima COMBO 2 Assay. Demographic and behavior variables were compared between rectal-only chlamydia cases and genitourinary cases using χ(2) or Fisher exact test, Mann-Whitney test, and logistic regression. A total of 3055 women were screened for rectal chlamydia. The prevalence of rectal chlamydia ranged from 11.7% to 13.5%. There were 133 rectal-only cases, increasing case detection by 44.3% from 300 genitourinary cases to 433 total cases, ranging from 21.7% to 88.2% by clinic. Women who were a contact to an STI were less likely to have rectal-only chlamydia for both clinics (P ≤ .001). Our findings add to the growing body of evidence supporting universal rectal screening in high-risk women such as those undergoing pelvic exams at STI clinics. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

[Ultrasonographic findings in ocular toxocariasis].

PubMed

Morais, Fábio Barreto; Maciel, Ana Lúcia; Arantes, Tiago Eugênio Farias e; Muccioli, Cristina; Allemann, Norma

2012-01-01

To evaluate ophthalmic ultrasound findings in the three presentation forms of ocular toxocariasis (peripheral or posterior pole granulomas and chronic endophthalmitis), in patients with confirmed diagnosis of ocular toxocariasis. 11 patients (11 eyes) with clinical and confirmed diagnosis of active ocular toxocariasis, presented positive ELISA test, were analyzed, prospectively, in the study. The patients were submitted to an ocular ultrasound examination (10-MHz transducer, contact technique). In the series of 11 patients, mean age was 7.9 years-old (range from 2 to 17 y), 73% male, referring previous contact with dogs (91%), and with the soil (50%), no referral of appetite perversion. In the analyses of compromised eyes (11 eyes), the ophthalmoscopic examination revealed the following distribution of the 3 forms of ocular toxocariasis: 7 cases (63.6%), posterior pole granuloma; 1 (9.1%), chronic endophthalmitis; 2 (18.2%), peripheral granuloma; and 1 (9.1%), posterior pole granuloma associated with chronic endophthalmitis. Visual acuity impairment: no light perception (3 eyes, 27.3%); hand motion (4 eyes, 36.4%); counting fingers at 10 cm (1 eye, 9.1%); 20/200 (1 eye, 9.1%); 20/70 (1 eye, 9.1%); undefined (1 eye, 9.1%). Serology was positive to Toxocara canis (ELISA test) in 100% of the cases. Ophthalmoscopy was difficult or impossible in 64% of the cases due to the media opacity. Ultrasound findings noted were vitreous membranes with retinal attachment (100%); parietal lesions (granulomas) with high (80%) or medium (20%) reflectivity. The most consistent ultrasound finding in the eye with toxocariasis was a high-reflectivity retinal mass, located in posterior pole or periphery, which may be calcified, and which has as main characteristic the adherence of vitreous membranes. In addition to clinical history, systemic evaluation and serology, the ultrasound can help in the diagnosis of ocular toxocariasis, especially in media opacities.

Socioeconomic benefit to individuals of achieving 2020 targets for four neglected tropical diseases controlled/eliminated by innovative and intensified disease management: Human African trypanosomiasis, leprosy, visceral leishmaniasis, Chagas disease.

PubMed

Lenk, Edeltraud J; Redekop, William K; Luyendijk, Marianne; Fitzpatrick, Christopher; Niessen, Louis; Stolk, Wilma A; Tediosi, Fabrizio; Rijnsburger, Adriana J; Bakker, Roel; Hontelez, Jan A C; Richardus, Jan H; Jacobson, Julie; Le Rutte, Epke A; de Vlas, Sake J; Severens, Johan L

2018-03-01

The control or elimination of neglected tropical diseases (NTDs) has targets defined by the WHO for 2020, reinforced by the 2012 London Declaration. We estimated the economic impact to individuals of meeting these targets for human African trypanosomiasis, leprosy, visceral leishmaniasis and Chagas disease, NTDs controlled or eliminated by innovative and intensified disease management (IDM). A systematic literature review identified information on productivity loss and out-of-pocket payments (OPPs) related to these NTDs, which were combined with projections of the number of people suffering from each NTD, country and year for 2011-2020 and 2021-2030. The ideal scenario in which the WHO's 2020 targets are met was compared with a counterfactual scenario that assumed the situation of 1990 stayed unaltered. Economic benefit equaled the difference between the two scenarios. Values are reported in 2005 US$, purchasing power parity-adjusted, discounted at 3% per annum from 2010. Probabilistic sensitivity analyses were used to quantify the degree of uncertainty around the base-case impact estimate. The total global productivity gained for the four IDM-NTDs was I$ 23.1 (I$ 15.9 -I$ 34.0) billion in 2011-2020 and I$ 35.9 (I$ 25.0 -I$ 51.9) billion in 2021-2030 (2.5th and 97.5th percentiles in brackets), corresponding to US$ 10.7 billion (US$ 7.4 -US$ 15.7) and US$ 16.6 billion (US$ 11.6 -US$ 24.0). Reduction in OPPs was I$ 14 billion (US$ 6.7 billion) and I$ 18 billion (US$ 10.4 billion) for the same periods. We faced important limitations to our work, such as finding no OPPs for leprosy. We had to combine limited data from various sources, heterogeneous background, and of variable quality. Nevertheless, based on conservative assumptions and subsequent uncertainty analyses, we estimate that the benefits of achieving the targets are considerable. Under plausible scenarios, the economic benefits far exceed the necessary investments by endemic country governments and their

[Pulmonary paracoccidioidomycosis: a case report with high-resolution computed tomography findings].

PubMed

Armas, M; Ruivo, C; Alves, R; Gonçalves, M; Teixeira, L

2012-01-01

Paracoccidioidomycosis is a systemic mycosis which is endemic in rural areas of Latin America, an important European source of immigrants and a growing European touristic destination as well, with most cases occurring in Brazil, Argentina, Venezuela and Colombia. The authors report a case of a 43 year old man who previously worked in Venezuela and is living in Portugal for 8 years, presenting with a single cutaneous lesion. Despite the absence of valuable respiratory complaints, severe lung damage was found with high-resolution computed tomography (HRCT). Biopsy of the cutaneous lesion and mycologic sputum examination were performed revealing Paracoccidioides brasiliensis infection. Copyright © 2011 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

PEPFAR support for the scaling up of collaborative TB/HIV activities.

PubMed

Howard, Andrea A; Gasana, Michel; Getahun, Haileyesus; Harries, Anthony; Lawn, Stephen D; Miller, Bess; Nelson, Lisa; Sitienei, Joseph; Coggin, William L

2012-08-15

The US President's Emergency Plan for AIDS Relief (PEPFAR) has supported a comprehensive package of care in which interventions to address HIV-related tuberculosis (TB) have received increased funding and support in recent years. PEPFAR's TB/HIV programming is based on the World Health Organization's 12-point policy for collaborative TB/HIV activities, which are integrated into PEPFAR annual guidance. PEPFAR implementing partners have provided crucial support to TB/HIV collaboration, and as a result, PEPFAR-supported countries in sub-Saharan Africa have made significant gains in HIV testing and counseling of TB patients and linkages to HIV care and treatment, intensified TB case finding, and TB infection control. PEPFAR's support of TB/HIV integration has also included significant investment in health systems, including improved laboratory services and educating and enlarging the workforce. The scale-up of antiretroviral therapy along with support of programs to increase HIV counseling and testing and improve linkage and retention in HIV care may have considerable impact on TB morbidity and mortality, if used synergistically with isoniazid preventive therapy, intensified case finding, and infection control. Issues to be addressed by future programming include accelerating implementation of isoniazid preventive therapy, increasing access and ensuring appropriate use of new TB diagnostics, supporting early initiation of antiretroviral therapy for HIV-infected TB patients, and strengthening systems to monitor and evaluate program implementation.

PEPFAR Support for the Scaling Up of Collaborative TB/HIV Activities

PubMed Central

Howard, Andrea A.; Gasana, Michel; Getahun, Haileyesus; Harries, Anthony; Lawn, Stephen D.; Miller, Bess; Nelson, Lisa; Sitienei, Joseph; Coggin, William L.

2014-01-01

The US President’s Emergency Plan for AIDS Relief (PEPFAR) has supported a comprehensive package of care in which interventions to address HIV-related tuberculosis (TB) have received increased funding and support in recent years. PEPFAR’s TB/HIV programming is based on the World Health Organization 12-point policy for collaborative TB/HIV activities, which are integrated into PEPFAR annual guidance. PEPFAR implementing partners have provided crucial support to TB/HIV collaboration, and as a result PEPFAR-supported countries in sub-Saharan Africa have made significant gains in HIV testing and counseling of TB patients and linkages to HIV care and treatment, intensified TB case finding, and TB infection control. PEPFAR’s support of TB/HIV integration has also included significant investment in health systems, including improved laboratory services and educating and enlarging the workforce. The scale-up of antiretroviral therapy along with support of programs to increase HIV counseling and testing and improve linkage and retention in HIV care may have considerable impact on TB morbidity and mortality, if used synergistically with isoniazid preventive therapy (IPT), intensified case finding and infection control. Issues to be addressed by future programming include accelerating implementation of IPT, increasing access and ensuring appropriate use of new TB diagnostics, supporting early initiation of antiretroviral therapy for HIV-infected TB patients, and strengthening systems to monitor and evaluate program implementation. PMID:22797735

The intensified constructed wetlands are promising for treatment of ammonia stripped effluent: Nitrogen transformations and removal pathways.

PubMed

Lyu, Tao; He, Keli; Dong, Renjie; Wu, Shubiao

2018-05-01

This study investigated the treatment performance and nitrogen removal mechanism of highly alkaline ammonia-stripped digestate effluent in horizontal subsurface flow constructed wetlands (CWs). A promising nitrogen removal performance (up to 91%) was observed in CWs coupled with intensified configurations, i.e., aeration and effluent recirculation. The results clearly supported that the higher aeration ratio and presence of effluent recirculation are important to improve the alkalinity and pollutant removal in CWs. The influent pH (>10) was significantly decreased to 8.2-8.8 under the volumetric hydraulic loading rates of 0.105 and 0.21 d -1 in the CWs. Simultaneously, up to 91% of NH 4 + -N removal was achieved under the operation of a higher aeration ratio and effluent recirculation. Biological nitrogen transformations accounted for 94% of the consumption of alkalinity in the CWs. The significant enrichment of δ 15 N-NH 4 + in the effluent (47-58‰) strongly supports the occurrence of microbial transformations for NH 4 + -N removal. However, relatively lower enrichment factors of δ 15 N-NH 4 + (-1.8‰ to -11.6‰) compared to the values reported in previous studies reflected the inhibition effect of the high pH alkaline environment on nitrifiers in these CWs. Copyright © 2018 Elsevier Ltd. All rights reserved.