Variations on an Historical Case Study: The Extraordinary Accident of Isidro Mejia

ERIC Educational Resources Information Center

Field, Patrick

2006-01-01

Activities using the same historical case study can be designed for courses of varying degrees of proficiency by altering the format to suit each academic level. The case of Isidro Mejia, a construction worker who had six nails accidentally shot into his head from a nail gun, is the basis for a series of case study exercises. (Contains 4 figures.)

Focal treatment of spasticity using botulinum toxin A in cerebral palsy cases of GMFCS level V: evaluation of adverse effects☆☆☆

PubMed Central

Tedesco, Ana Paula; Martins, Juliana Saccol; Nicolini-Panisson, Renata D’Agostini

2014-01-01

Objective To report on the experience of injections of botulinum toxin A (BTA) in a series of patients with cerebral palsy of Gross Motor Function Classification System (GMFCS) level V. Methods This was a retrospective case series study on 33 patients with cerebral palsy of GMFCS level V who received 89 sessions of BTA application (of which 84 were Botox® and five were other presentations), in which the basic aim was to look for adverse effects. Results The mean number of application sessions per patient was three, and the mean age at the time of each injection was 4 + 6 years (range: 1.6–13 years). The muscles that most frequently received injections were the gastrocnemius, hamstrings, hip adductors, biceps brachii and finger flexors. The mean total dose was 193 U and the mean dose per weight was 12.5 U/kg. Only one patient received anesthesia for the injections and no sedation was used in any case. No local or systemic adverse effects were observed within the minimum follow-up of one month. Conclusion The absence of adverse effects in our series was probably related to the use of low doses and absence of sedation or anesthesia. According to our data, BTA can be safely used for patients with cerebral palsy of GMFCS level V, using low doses and preferably without sedation or anesthesia. PMID:26229827

Clinical Decision Making in the Management of Patients With Cervicogenic Dizziness: A Case Series.

PubMed

Jung, Francis C; Mathew, Sherin; Littmann, Andrew E; MacDonald, Cameron W

2017-11-01

Study Design Case series. Background Although growing recognition of cervicogenic dizziness (CGD) is emerging, there is still no gold standard for the diagnosis of CGD. The purpose of this case series is to describe the clinical decision making utilized in the management of 7 patients presenting with CGD. Case Description Patients presenting with neck pain and accompanying subjective symptoms, including dizziness, unsteadiness, light-headedness, and visual disturbance, were selected. Clinical evidence of a temporal relationship between neck pain and dizziness, with or without sensorimotor disturbances, was assessed. Clinical decision making followed a 4-step process, informed by the current available best evidence. Outcome measures included the numeric rating scale for dizziness and neck pain, the Dizziness Handicap Inventory, Patient-Specific Functional Scale, and global rating of change. Outcomes Seven patients (mean age, 57 years; range, 31-86 years; 7 female) completed physical therapy management at an average of 13 sessions (range, 8-30 sessions) over a mean of 7 weeks. Clinically meaningful improvements were observed in the numeric rating scale for dizziness (mean difference, 5.7; 95% confidence interval [CI]: 4.0, 7.5), neck pain (mean difference, 5.4; 95% CI: 3.8, 7.1), and the Dizziness Handicap Inventory (mean difference, 32.6; 95% CI: 12.9, 52.2) at discontinuation. Patients also demonstrated overall satisfaction via the Patient-Specific Functional Scale (mean difference, 9) and global rating of change (mean, +6). Discussion This case series describes the physical therapist decision making, management, and outcomes in patients with CGD. Further investigation is warranted to develop a valid clinical decision-making guideline to inform management of patients with CGD. Level of Evidence Diagnosis, therapy, level 4. J Orthop Sports Phys Ther 2017;47(11):874-884. Epub 9 Oct 2017. doi:10.2519/jospt.2017.7425.

Head and neck inflammatory pseudotumor: Case series and review of the literature.

PubMed

Kansara, Sagar; Bell, Diana; Johnson, Jason; Zafereo, Mark

2016-12-01

Inflammatory pseudotumor (IP) is an uncommon idiopathic lesion that often imitates malignancy clinically and radiologically. Inflammatory pseudotumors have been found to occur in various sites but rarely in the head and neck. The histopathology, imaging, and treatment of three unique cases of head and neck inflammatory pseudotumors are described in this case series. Patients in Cases 1 and 2 presented with right level II neck mass and left parotid tail mass, respectively. The patient in Case 3 presented with otalgia, jaw pain and trismus, and a left parapharyngeal space mass. The tumors in Cases 1 and 3 significantly decreased in size with tapered courses of oral corticosteroids. The tumor in Case 2 was surgically excised without disease recurrence. Malignancy must be ruled out with incisional or excisional biopsy. Treatment includes surgical excision, oral corticosteroids, or both. The literature shows that radiotherapy and small-molecule inhibitors may be promising alternatives. © The Author(s) 2016.

Head and neck inflammatory pseudotumor: Case series and review of the literature

PubMed Central

Kansara, Sagar; Bell, Diana; Johnson, Jason

2016-01-01

Inflammatory pseudotumor (IP) is an uncommon idiopathic lesion that often imitates malignancy clinically and radiologically. Inflammatory pseudotumors have been found to occur in various sites but rarely in the head and neck. The histopathology, imaging, and treatment of three unique cases of head and neck inflammatory pseudotumors are described in this case series. Patients in Cases 1 and 2 presented with right level II neck mass and left parotid tail mass, respectively. The patient in Case 3 presented with otalgia, jaw pain and trismus, and a left parapharyngeal space mass. The tumors in Cases 1 and 3 significantly decreased in size with tapered courses of oral corticosteroids. The tumor in Case 2 was surgically excised without disease recurrence. Malignancy must be ruled out with incisional or excisional biopsy. Treatment includes surgical excision, oral corticosteroids, or both. The literature shows that radiotherapy and small-molecule inhibitors may be promising alternatives. PMID:27650653

Exploratory wavelet analysis of dengue seasonal patterns in Colombia.

PubMed

Fernández-Niño, Julián Alfredo; Cárdenas-Cárdenas, Luz Mery; Hernández-Ávila, Juan Eugenio; Palacio-Mejía, Lina Sofía; Castañeda-Orjuela, Carlos Andrés

2015-12-04

Dengue has a seasonal behavior associated with climatic changes, vector cycles, circulating serotypes, and population dynamics. The wavelet analysis makes it possible to separate a very long time series into calendar time and periods. This is the first time this technique is used in an exploratory manner to model the behavior of dengue in Colombia.  To explore the annual seasonal dengue patterns in Colombia and in its five most endemic municipalities for the period 2007 to 2012, and for roughly annual cycles between 1978 and 2013 at the national level.  We made an exploratory wavelet analysis using data from all incident cases of dengue per epidemiological week for the period 2007 to 2012, and per year for 1978 to 2013. We used a first-order autoregressive model as the null hypothesis.  The effect of the 2010 epidemic was evident in both the national time series and the series for the five municipalities. Differences in interannual seasonal patterns were observed among municipalities. In addition, we identified roughly annual cycles of 2 to 5 years since 2004 at a national level.  Wavelet analysis is useful to study a long time series containing changing seasonal patterns, as is the case of dengue in Colombia, and to identify differences among regions. These patterns need to be explored at smaller aggregate levels, and their relationships with different predictive variables need to be investigated.

Studies of Excellence in Teacher Education: Preparation at the Graduate Level.

ERIC Educational Resources Information Center

Darling-Hammond, Linda; Macdonald, Maritza B.; Snyder, Jon; Whitford, Betty Lou; Ruscoe, Gordon; Fickel, Letitia

This book presents case studies of three highly successful teacher education programs. It is part of a three-volume series that includes seven case studies. It documents the goals, strategies, content, and processes of teacher education programs that are exemplars for preparing prospective teachers to engage in skillful, learner-centered practice.…

Word Processing in Elementary Schools: Seven Case Studies. Education and Technology Series.

ERIC Educational Resources Information Center

Murray, Jack; And Others

As a result of preliminary observations of word processing in elementary level language the seven case studies presented in this report reveal the effectiveness of current word processing (WP) activities within their respective instructional contexts. Each study is presented separately, detailing the classroom context, tasks and outcomes, program…

Incorporating Ecosystem Services into Community-level Decision-Making: A San Juan, Puerto Rico Case Study

EPA Science Inventory

EPA’s Office of Research and Development’s Sustainable and Healthy Communities Research Program is developing tools and approaches to incorporate ecosystem goods and services concepts into community-level decision-making. The San Juan Community Study is one of a serie...

Estimating Slope and Level Change in N = 1 Designs

ERIC Educational Resources Information Center

Solanas, Antonio; Manolov, Rumen; Onghena, Patrick

2010-01-01

The current study proposes a new procedure for separately estimating slope change and level change between two adjacent phases in single-case designs. The procedure eliminates baseline trend from the whole data series before assessing treatment effectiveness. The steps necessary to obtain the estimates are presented in detail, explained, and…

Evaluation of recent GRACE monthly solution series with an ice sheet perspective

NASA Astrophysics Data System (ADS)

Horwath, Martin; Groh, Andreas

2016-04-01

GRACE monthly global gravity field solutions have undergone a remarkable evolution, leading to the latest (Release 5) series by CSR, GFZ, and JPL, to new series by other processing centers, such as ITSG and AIUB, as well as to efforts to derive combined solutions, particularly by the EGSIEM (European Gravity Service for Improved Emergency Management) project. For applications, such as GRACE inferences on ice sheet mass balance, the obvious question is on what GRACE solution series to base the assessment. Here we evaluate different GRACE solution series (including the ones listed above) in a unified framework. We concentrate on solutions expanded up to degree 90 or higher, since this is most appropriate for polar applications. We empirically assess the error levels in the spectral as well as in the spatial domain based on the month-to-month scatter in the high spherical harmonic degrees. We include empirical assessment of error correlations. We then apply all series to infer Antarctic and Greenland mass change time series and compare the results in terms of apparent signal content and noise level. We find that the ITSG solutions show lowest noise level in the high degrees (above 60). A preliminary combined solution from the EGSIEM project shows lowest noise in the degrees below 60. This virtue maps into the derived ice mass time series, where the EGSIEM-based results show the lowest noise in most cases. Meanwhile, there is no indication that any of the considered series systematically dampens actual geophysical signals.

Bronchiolitis obliterans and consumer exposure to butter-flavored microwave popcorn: a case series.

PubMed

Egilman, David S; Schilling, John Henry

2012-01-01

Respiratory exposure to diacetyl and diacetyl-containing flavorings used in butter-flavored microwave popcorn (BFMP) causes lung disease, including bronchiolitis obliterans (BO), in flavorings and popcorn manufacturing workers. However, there are no published reports of lung disease among BFMP consumers. We present a case series of three BFMP consumers with biopsy-confirmed BO. We review data relating to consumer exposures, estimate case exposures, and compare them to diacetyl-containing flavoring-exposed manufacturing workers with lung disease. These consumer cases' exposure levels are comparable to those that caused disease in workers. We were unable to identify any other exposures or diseases known or suspected to cause BO in these cases. BFMP poses a significant respiratory risk to consumers. Some manufacturers have substituted diacetyl with other alpha-diketones that are likely to pose a similar risk. Simple consumer practices such as cooling the popcorn bag would eliminate the risk of severe lung disease.

Case studies in pathophysiology: The development and evaluation of an interactive online learning environment to develop higher order thinking and argumentation

NASA Astrophysics Data System (ADS)

Titterington, Lynda C.

2007-12-01

This study presents a framework for examining the effects of higher order thinking on the achievement of allied health students enrolled in a pathophysiology course. A series of clinical case studies was developed and published in an enriched online environment that guided students through the process of developing a solution and supporting it through data analysis and interpretation. The series of case study modules scaffolded argumentation through question prompts. The modules began with a simple, direct problem and they became progressively more complex throughout the quarter. A control group was assigned a pencil-and-paper case study based upon recall. The case studies were scored for content accuracy and evidence of higher order thinking skills. Higher order thinking was measured using a rubric based upon the Toulmin argumentation pattern. The results indicated implementing a case study of either online or traditional format was associated with significant gains in achievement. The Web-enhanced case studies were associated with modest gains in knowledge acquisition. The argumentation scores across the series followed two trends: directed case studies were associated with higher levels of argumentation than ill-structured case studies, and there appeared to be an inverse relationship between the students' argumentation and content scores. The protocols developed for this study can serve as a template for a larger, extended investigation into student learning in the online environment.

The spectrum of psychosis in multiple sclerosis: a clinical case series

PubMed Central

Gilberthorpe, Thomas G; O’Connell, Kara E; Carolan, Alison; Silber, Eli; Brex, Peter A; Sibtain, Naomi A; David, Anthony S

2017-01-01

Psychosis in the context of multiple sclerosis (MS) has previously been reported as a rare occurrence. However, recent epidemiological studies have found prevalence rates of psychosis in MS that are two to three times higher than those in the general population. Untreated psychosis in patients with MS can adversely impact on adherence to MS medication, levels of disability, and quality of life. This retrospective case series describes the spectrum of psychotic disorders occurring in association with MS using demographic, clinical, and neuroimaging data. In the discussion, we highlight the particular diagnostic and treatment challenges that such disorders can pose for clinicians and through our case vignettes provide examples of potential interventions for this complex patient population. PMID:28203081

Time Series Analysis of Onchocerciasis Data from Mexico: A Trend towards Elimination

PubMed Central

Pérez-Rodríguez, Miguel A.; Adeleke, Monsuru A.; Orozco-Algarra, María E.; Arrendondo-Jiménez, Juan I.; Guo, Xianwu

2013-01-01

Background In Latin America, there are 13 geographically isolated endemic foci distributed among Mexico, Guatemala, Colombia, Venezuela, Brazil and Ecuador. The communities of the three endemic foci found within Mexico have been receiving ivermectin treatment since 1989. In this study, we predicted the trend of occurrence of cases in Mexico by applying time series analysis to monthly onchocerciasis data reported by the Mexican Secretariat of Health between 1988 and 2011 using the software R. Results A total of 15,584 cases were reported in Mexico from 1988 to 2011. The data of onchocerciasis cases are mainly from the main endemic foci of Chiapas and Oaxaca. The last case in Oaxaca was reported in 1998, but new cases were reported in the Chiapas foci up to 2011. Time series analysis performed for the foci in Mexico showed a decreasing trend of the disease over time. The best-fitted models with the smallest Akaike Information Criterion (AIC) were Auto-Regressive Integrated Moving Average (ARIMA) models, which were used to predict the tendency of onchocerciasis cases for two years ahead. According to the ARIMA models predictions, the cases in very low number (below 1) are expected for the disease between 2012 and 2013 in Chiapas, the last endemic region in Mexico. Conclusion The endemic regions of Mexico evolved from high onchocerciasis-endemic states to the interruption of transmission due to the strategies followed by the MSH, based on treatment with ivermectin. The extremely low level of expected cases as predicted by ARIMA models for the next two years suggest that the onchocerciasis is being eliminated in Mexico. To our knowledge, it is the first study utilizing time series for predicting case dynamics of onchocerciasis, which could be used as a benchmark during monitoring and post-treatment surveillance. PMID:23459370

CD30 Expression by B and T Cells: A Frequent Finding in Angioimmunoblastic T-Cell Lymphoma and Peripheral T-Cell Lymphoma-Not Otherwise Specified.

PubMed

Onaindia, Arantza; Martínez, Nerea; Montes-Moreno, Santiago; Almaraz, Carmen; Rodríguez-Pinilla, Socorro M; Cereceda, Laura; Revert, Jose B; Ortega, César; Tardio, Antoni; González, Lucía; García, Sonia; Camacho, Francisca I; González-Vela, Carmen; Piris, Miguel A

2016-03-01

CD30 expression in peripheral T-cell lymphoma (PTCL) and angioimmunoblastic T-cell lymphoma (AITL) is currently of great interest because therapy targeting CD30 is of clinical benefit, but the clinical and therapeutic relevance of CD30 expression in these neoplasms still remains uncertain. The aim of this study was to better quantify CD30 expression in AITL and PTCL-not otherwise specified (NOS). The secondary objective was to determine whether CD30 cells exhibit a B-cell or a T-cell phenotype. Gene expression profiling was studied in a series of 37 PTCL cases demonstrating a continuous spectrum of TNFRSF8 expression. This prompted us to study CD30 immunohistochemical (IHC) expression and mRNA levels by reverse transcription polymerase chain reaction (RT-PCR) in a different series of 51 cases (43 AITLs and 8 PTCL-NOSs) in routine samples. Double stainings with PAX5/CD30, CD3/CD30, and LEF1/CD30 were performed to study the phenotype of CD30 cells. Most (90%) of the cases showed some level of CD30 expression by IHC (1% to 95%); these levels were high (>50% of tumoral cells) in 14% of cases. CD30 expression was not detected in 10% of the cases. Quantitative RT-PCR results largely confirmed these findings, demonstrating a moderately strong correlation between global CD30 IHC and mRNA levels (r=0.65, P=1.75e-7). Forty-four of the positive cases (98%) contained CD30-positive B cells (PAX5), whereas atypical CD30-positive T cells were detected in 42 cases (93%). In conclusion, our data show that most AITL and PTCL-NOS cases express CD30, exhibiting very variable levels of CD30 expression that may be measured by IHC or RT-PCR techniques.

A COMBINED TREATMENT APPROACH EMPHASIZING IMPAIRMENT-BASED MANUAL THERAPY AND EXERCISE FOR HIP-RELATED COMPENSATORY INJURY IN ELITE ATHLETES: A CASE SERIES

PubMed Central

Short, Gretchen; Strack, Donald; Anloague, Philip; Brewster, Brian

2017-01-01

Background/Purpose: Athletes experiencing hip, groin, and low back pain often exhibit similar clinical characteristics. Individuals with hip, groin and low back pain may have the presence of multiple concurrent pathoanatomical diagnoses. Regardless, similar regional characteristics and dysfunction may contribute to the patient's chief complaint, potentially creating a sub-group of individuals that may be defined by lumbopelvic and hip mobility limitations, motor control impairments, and other shared clinical findings. The purpose of this case series is to describe the conservative management of elite athletes, within the identified aforementioned sub-group, that emphasized regional manual therapy interventions, and therapeutic exercise designed to improve lumbopelvic and hip mobility, stability and motor control. Case Descriptions: Five elite athletes were clinically diagnosed by a physical therapist with primary pathologies including adductor-related groin pain (ARGP), femoral acetabular impingement (FAI) with acetabular labral lesion and acute, mechanical low back pain (LBP). Similar subjective, objective findings and overall clinical profiles were identified among all subjects. Common findings aside from the chief complaint included, but were not limited to, decreased hip range of motion (ROM), impaired lumbopelvic motor control and strength, lumbar hypomobility in at least one segment, and a positive hip flexion-adduction-internal rotation (FADIR) special test. A three-phase impairment-based physical therapy program was implemented to resolve the primary complaints and return the subjects to their desired level of function. Acute phase rehabilitation consisted of manual therapy and fundamental motor control exercises. Progression to the sub-acute and terminal phases was based on improved subjective pain reports and progress with functional impairments. As the subjects progress through the rehabilitation phases, the delivery of physical therapy interventions were defined by decreased manual therapies and an increased emphasis and priority on graded exercise. Outcomes: Significant reductions in reported pain (>2 points Numeric Pain Rating Scale), improved reported function via functional outcome measures (Hip and Groin Outcome Score), and continued participation in sport occurred in all five cases without the need for surgical intervention. Discussion: The athletes described in this case series make up a common clinical sub-group defined by hip and lumbopelvic mobility restrictions, lumbopelvic and lower extremity motor control impairments and potentially other shared clinical findings. Despite differences in pathoanatomic findings, similar objective findings were identified and similar treatment plans were applied, potentially affecting the movement system as a whole. Subjects were conservatively managed allowing continued participation in sport within their competitive seasons. Conclusion: Comprehensive conservative treatment of the athletes with shared impairments, as described in this case series, may be of clinical importance when managing athletes with hip, groin, and low back pain. Level of Evidence: Therapy, Level 4, Case Series PMID:29158960

Does surgical sympathectomy improve clinical outcomes in patients with refractory angina pectoris?

PubMed

Holland, Luke C; Navaratnarajah, Manoraj; Taggart, David P

2016-04-01

A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was: In patients with angina pectoris refractory to medical therapy, does surgical sympathectomy improve clinical outcomes? A total of 528 papers were identified using the search protocol described, of which 6 represented the best evidence to answer the clinical question. There were 5 case series and 1 prospective cohort study. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. All 5 of the case series demonstrated an improvement in symptoms, exercise tolerance or quality of life in patients undergoing surgical sympathectomy. An early case series investigating an open approach had a high morbidity and mortality rate, but the 4 other series used a minimally invasive technique and had low morbidity and zero perioperative mortality rates. The cohort study compared surgical sympathectomy with transmyocardial laser revascularization (TMR) and concluded TMR to be superior. However, this study looked only at unilateral sympathectomy, whereas all 5 case series focused on bilateral surgery. We conclude that the best currently available evidence does suggest that patients report an improvement in their symptoms and quality of life following surgical sympathectomy, but the low level of this evidence does not allow for a statistically proved recommendation. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Children with Disabilities in the Child Protective Services System: An Analog Study of Investigation and Case Management

ERIC Educational Resources Information Center

Manders, Jeanette E.; Stoneman, Zolinda

2009-01-01

Objective: The study used a series of vignettes to investigate how the presence of three disabilities (cerebral palsy, intellectual disabilities, emotional/behavioral disabilities) affects the processes and outcomes of child abuse investigations at two levels of child injury severity (moderate, severe). Method: Seventy-five CPS case workers…

Case Series in Cognitive Neuropsychology: Promise, Perils and Proper Perspective

PubMed Central

Rapp, Brenda

2012-01-01

Schwartz & Dell (2010) advocated for a major role for case series investigations in cognitive neuropsychology. They defined the key features of this approach and presented a number of arguments and examples illustrating the benefits of case series studies and their contribution to computational cognitive neuropsychology. In the Special Issue on “Case Series in Cognitive Neuropsychology” there are six commentaries on Schwartz and Dell (2010) as well as a response to the six commentaries by Dell and Schwartz. In this paper, I provide a brief summary of the key points made in Schwartz and Dell (2010) and I review the promise and perils of case series design as revealed by the six commentaries. I conclude by placing the set of papers within a broader perspective, providing some clarification of the historical record on case series and single case approaches, raising some cautionary notes for case series studies and situating both case series and single case approaches within the larger context of theory development in the cognitive sciences. PMID:22746685

The development of tumours under a ketogenic diet in association with the novel tumour marker TKTL1: A case series in general practice.

PubMed

Jansen, Natalie; Walach, Harald

2016-01-01

Since the initial observations by Warburg in 1924, it has become clear in recent years that tumour cells require a high level of glucose to proliferate. Therefore, a ketogenic diet that provides the body with energy mainly through fat and proteins, but contains a reduced amount of carbohydrates, has become a dietary option for supporting tumour treatment and has exhibited promising results. In the present study, the first case series of such a treatment in general practice is presented, in which 78 patients with tumours were treated within a time window of 10 months. The patients were monitored regarding their levels of transketolase-like-1 (TKTL1), a novel tumour marker associated with aerobic glycolysis of tumour cells, and the patients' degree of adherence to a ketogenic diet. Tumour progression was documented according to oncologists' reports. Tumour status was correlated with TKTL1 expression (Kruskal-Wallis test, P<0.0001), indicating that more progressed and aggressive tumours may require a higher level of aerobic glycolysis. In palliative patients, a clear trend was observed in patients who adhered strictly to a ketogenic diet, with one patient experiencing a stagnation in tumour progression and others an improvement in their condition. The adoption of a ketogenic diet was also observed to affect the levels of TKTL1 in those patients. In conclusion, the results from the present case series in general practice suggest that it may be beneficial to advise tumour patients to adopt a ketogenic diet, and that those who adhere to it may have positive results from this type of diet. Thus, the use of a ketogenic diet as a complementary treatment to tumour therapy must be further studied in rigorously controlled trials.

The development of tumours under a ketogenic diet in association with the novel tumour marker TKTL1: A case series in general practice

PubMed Central

JANSEN, NATALIE; WALACH, HARALD

2016-01-01

Since the initial observations by Warburg in 1924, it has become clear in recent years that tumour cells require a high level of glucose to proliferate. Therefore, a ketogenic diet that provides the body with energy mainly through fat and proteins, but contains a reduced amount of carbohydrates, has become a dietary option for supporting tumour treatment and has exhibited promising results. In the present study, the first case series of such a treatment in general practice is presented, in which 78 patients with tumours were treated within a time window of 10 months. The patients were monitored regarding their levels of transketolase-like-1 (TKTL1), a novel tumour marker associated with aerobic glycolysis of tumour cells, and the patients' degree of adherence to a ketogenic diet. Tumour progression was documented according to oncologists' reports. Tumour status was correlated with TKTL1 expression (Kruskal-Wallis test, P<0.0001), indicating that more progressed and aggressive tumours may require a higher level of aerobic glycolysis. In palliative patients, a clear trend was observed in patients who adhered strictly to a ketogenic diet, with one patient experiencing a stagnation in tumour progression and others an improvement in their condition. The adoption of a ketogenic diet was also observed to affect the levels of TKTL1 in those patients. In conclusion, the results from the present case series in general practice suggest that it may be beneficial to advise tumour patients to adopt a ketogenic diet, and that those who adhere to it may have positive results from this type of diet. Thus, the use of a ketogenic diet as a complementary treatment to tumour therapy must be further studied in rigorously controlled trials. PMID:26870251

Pretreatment serum concentrations of 25-hydroxyvitamin D and breast cancer prognostic characteristics: a case-control and a case-series study.

PubMed

Yao, Song; Sucheston, Lara E; Millen, Amy E; Johnson, Candace S; Trump, Donald L; Nesline, Mary K; Davis, Warren; Hong, Chi-Chen; McCann, Susan E; Hwang, Helena; Kulkarni, Swati; Edge, Stephen B; O'Connor, Tracey L; Ambrosone, Christine B

2011-02-28

Results from epidemiologic studies on the relationship between vitamin D and breast cancer risk are inconclusive. It is possible that vitamin D may be effective in reducing risk only of specific subtypes due to disease heterogeneity. In case-control and case-series analyses, we examined serum concentrations of 25-hydroxyvitamin D (25OHD) in relation to breast cancer prognostic characteristics, including histologic grade, estrogen receptor (ER), and molecular subtypes defined by ER, progesterone receptor (PR) and HER2, among 579 women with incident breast cancer and 574 controls matched on age and time of blood draw enrolled in the Roswell Park Cancer Institute from 2003 to 2008. We found that breast cancer cases had significantly lower 25OHD concentrations than controls (adjusted mean, 22.8 versus 26.2 ng/mL, p<0.001). Among premenopausal women, 25OHD concentrations were lower in those with high- versus low-grade tumors, and ER negative versus ER positive tumors (p≤0.03). Levels were lowest among women with triple-negative cancer (17.5 ng/mL), significantly different from those with luminal A cancer (24.5 ng/mL, p = 0.002). In case-control analyses, premenopausal women with 25OHD concentrations above the median had significantly lower odds of having triple-negative cancer (OR = 0.21, 95% CI = 0.08-0.53) than those with levels below the median; and every 10 ng/mL increase in serum 25OHD concentrations was associated with a 64% lower odds of having triple-negative cancer (OR = 0.36, 95% CI = 0.22-0.56). The differential associations by tumor subtypes among premenopausal women were confirmed in case-series analyses. In our analyses, higher serum levels of 25OHD were associated with reduced risk of breast cancer, with associations strongest for high grade, ER negative or triple negative cancers in premenopausal women. With further confirmation in large prospective studies, these findings could warrant vitamin D supplementation for reducing breast cancer risk, particularly those with poor prognostic characteristics among premenopausal women.

Pretreatment Serum Concentrations of 25-Hydroxyvitamin D and Breast Cancer Prognostic Characteristics: A Case-Control and a Case-Series Study

PubMed Central

Yao, Song; Sucheston, Lara E.; Millen, Amy E.; Johnson, Candace S.; Trump, Donald L.; Nesline, Mary K.; Davis, Warren; Hong, Chi-Chen; McCann, Susan E.; Hwang, Helena; Kulkarni, Swati; Edge, Stephen B.; O'Connor, Tracey L.; Ambrosone, Christine B.

2011-01-01

Background Results from epidemiologic studies on the relationship between vitamin D and breast cancer risk are inconclusive. It is possible that vitamin D may be effective in reducing risk only of specific subtypes due to disease heterogeneity. Methods and Findings In case-control and case-series analyses, we examined serum concentrations of 25-hydroxyvitamin D (25OHD) in relation to breast cancer prognostic characteristics, including histologic grade, estrogen receptor (ER), and molecular subtypes defined by ER, progesterone receptor (PR) and HER2, among 579 women with incident breast cancer and 574 controls matched on age and time of blood draw enrolled in the Roswell Park Cancer Institute from 2003 to 2008. We found that breast cancer cases had significantly lower 25OHD concentrations than controls (adjusted mean, 22.8 versus 26.2 ng/mL, p<0.001). Among premenopausal women, 25OHD concentrations were lower in those with high- versus low-grade tumors, and ER negative versus ER positive tumors (p≤0.03). Levels were lowest among women with triple-negative cancer (17.5 ng/mL), significantly different from those with luminal A cancer (24.5 ng/mL, p = 0.002). In case-control analyses, premenopausal women with 25OHD concentrations above the median had significantly lower odds of having triple-negative cancer (OR = 0.21, 95% CI = 0.08–0.53) than those with levels below the median; and every 10 ng/mL increase in serum 25OHD concentrations was associated with a 64% lower odds of having triple-negative cancer (OR = 0.36, 95% CI = 0.22–0.56). The differential associations by tumor subtypes among premenopausal women were confirmed in case-series analyses. Conclusion In our analyses, higher serum levels of 25OHD were associated with reduced risk of breast cancer, with associations strongest for high grade, ER negative or triple negative cancers in premenopausal women. With further confirmation in large prospective studies, these findings could warrant vitamin D supplementation for reducing breast cancer risk, particularly those with poor prognostic characteristics among premenopausal women. PMID:21386992

Adolescent suicide prevention.

PubMed

Novick, Lloyd F; Cibula, Donald A; Sutphen, Sally M

2003-05-01

This case-prevention of adolescent suicide-is one of a series of teaching cases in the Case-Based Series in Population-Oriented Prevention (C-POP). It has been developed for use in medical school and residency prevention curricula. The complete set of cases is presented in this supplement to the American Journal of Preventive Medicine. This teaching case examines the issue of prevention of adolescent and young adult suicide both at an individual and at a population or community level, using data from the Onondaga County Health Department. In the first section of the case, students are asked to determine whether five deaths related to falling or jumping at a local shopping mall should be considered to be suicidal deaths. Students then develop skills in the reporting as well as in the epidemiology of adolescent suicidal deaths in Onondaga County. As the case progresses, students analyze the results of a local surveillance study of suicidal attempts and ideation. The case concludes with students evaluating a hypothetical screening study intended to reduce the risk of suicidal death and discussing a research design to examine the effectiveness of this prevention strategy.

New modalities for scientific engagement in Africa - the case for computational physics

NASA Astrophysics Data System (ADS)

Chetty, N.

2011-09-01

Computational physics as a mode of studying the mathematical and physical sciences has grown world-wide over the past two decades, but this trend is yet to fully develop in Africa. The essential ingredients are there for this to happen: increasing internet connectivity, cheaper computing resources and the widespread availability of open source and freeware. The missing ingredients centre on intellectual isolation and the low levels of quality international collaborations. Low level of funding for research from local governments remains a critical issue. This paper gives a motivation for the importance of developing computational physics at the university undergraduate level, graduate level and research levels and gives suggestions on how this may be achieved within the African context. It is argued that students develop a more intuitive feel for the mathematical and physical sciences, that they learn useful, transferable skills that make our graduates well-sought after in the industrial and commercial environments, and that such graduates are better prepared to tackle research problems at the masters and doctoral levels. At the research level, the case of the African School Series on Electronic Structure Methods and Applications (ASESMA) is presented as a new multi-national modality for engaging with African scientists. There are many novel aspects to this School series, which are discussed.

Hierarchy of evidence relating to hand surgery in Brazilian orthopedic journals.

PubMed

Moraes, Vinícius Ynoe de; Belloti, João Carlos; Moraes, Fábio Ynoe de; Galbiatti, José Antonio; Palácio, Evandro Pereira; Santos, João Baptista Gomes Dos; Faloppa, Flávio

2011-03-01

There is no systematic assessment of the quality of scientific production in the specialty of hand surgery in our setting. This study aimed to systematically assess the status of evidence generation relating to hand surgery and to evaluate the reproducibility of the classification method based on an evidence pyramid. Secondary study conducted at Universidade Federal de São Paulo (Unifesp) and Faculdade Estadual de Medicina de Marília (Famema). Two researchers independently conducted an electronic database search for hand surgery studies published between 2000 and 2009 in the two main Brazilian orthopedic journals (Acta Ortopédica Brasileira and Revista Brasileira de Ortopedia). The studies identified were subsequently classified according to methodological design (systematic review of the literature, randomized clinical trial, cohort study, case-control study, case series and other studies) and evidence level (I to V). A total of 1,150 articles were evaluated, and 83 (7.2%) were included in the final analysis. Studies with evidence level IV (case series) accounted for 41 (49%) of the published papers. Studies with evidence level V (other studies) accounted for 12 (14.5%) of the papers. Only two studies (2.4%) were ranked as level I or II. The inter-rater reproducibility was excellent (k = 0.94). Hand surgery articles corresponded to less than one tenth of Brazilian orthopedic production. Studies with evidence level IV were the commonest type. The reproducibility of the classification stratified by evidence level was almost perfect.

Socialism. Grade Ten, Unit Two, 10.2. Comprehensive Social Studies Curriculum for the Inner City.

ERIC Educational Resources Information Center

Malone, Helen

The socialism unit of the tenth grade level of the FICSS series (Focus on Inner City Social Studies -- see SO 008 271) explores a selected history of socialist thought and the theoretical model of socialism. Three case studies of socialism are explored: Great Britain, Sweden, and Israel. The case studies are designed to answer questions concerning…

Severe iron deficiency anemia and lice infestation.

PubMed

Guss, David A; Koenig, Mark; Castillo, Edward M

2011-10-01

Lice infestation is a commonly encountered disorder in emergency medicine. The louse survives from a blood meal from its host; hence, iron deficiency anemia is a theoretic possibility. A limited number of reports of severe iron deficiency anemia have appeared in the veterinary literature, but a thorough review of the medical literature did not reveal a single instance in human beings. We report a small case series of patients with heavy louse infestation and profound iron deficiency anemia. The index case along with two other cases discovered from an exhaustive search of 4 years of the institution's Emergency Department records all had heavy infestation with head and body lice. Laboratory evaluation revealed serum hemoglobin levels under 6 gm/dL, low serum ferritin levels, and microcytic red blood cell indices. All patients were admitted to the hospital, received transfusions, and had evaluation of their anemia. No patient had evidence of gastrointestinal blood loss or alternative explanation for their anemia. Although cause and effect cannot be established from this case series, to the best of our knowledge, this is the first published evidence of a provocative association of louse infestation and severe iron deficiency anemia in humans. Copyright © 2011 Elsevier Inc. All rights reserved.

Design considerations for case series models with exposure onset measurement error.

PubMed

Mohammed, Sandra M; Dalrymple, Lorien S; Sentürk, Damla; Nguyen, Danh V

2013-02-28

The case series model allows for estimation of the relative incidence of events, such as cardiovascular events, within a pre-specified time window after an exposure, such as an infection. The method requires only cases (individuals with events) and controls for all fixed/time-invariant confounders. The measurement error case series model extends the original case series model to handle imperfect data, where the timing of an infection (exposure) is not known precisely. In this work, we propose a method for power/sample size determination for the measurement error case series model. Extensive simulation studies are used to assess the accuracy of the proposed sample size formulas. We also examine the magnitude of the relative loss of power due to exposure onset measurement error, compared with the ideal situation where the time of exposure is measured precisely. To facilitate the design of case series studies, we provide publicly available web-based tools for determining power/sample size for both the measurement error case series model as well as the standard case series model. Copyright © 2012 John Wiley & Sons, Ltd.

Secondary Increase of Lactate Levels in Asphyxiated Newborns during Hypothermia Treatment: Reflect of Suboptimal Hemodynamics (A Case Series and Review of the Literature)

PubMed Central

Al Balushi, Asim; Guilbault, Marie-Pier; Wintermark, Pia

2015-01-01

Objective To evaluate whether a secondary increase of serum lactate levels in asphyxiated newborns during hypothermia treatment may reflect suboptimal dynamics. Methods–Retrospective case series and review of the literature. We present the clinical course of four asphyxiated newborns treated with hypothermia who presented with hypotension requiring inotropic support, and who displayed a secondary increase of serum lactate levels during hypothermia treatment. Serial serum lactate levels are correlated with blood pressure and inotropic support within the first 96 hours of life. Results Lactate levels initially decreased in the four patients. However, each of them started to present lower blood pressure, and lactate levels started to increase again. Inotropic support was started to raise blood pressure. The introduction of an epinephrine drip consistently worsened the increase of lactate levels in these newborns, whereas dopamine and dobutamine enabled the clearance of lactate in addition to raising the blood pressure. Rewarming was associated with hemodynamics perturbations (a decrease of blood pressure and/or an increase of lactate levels) in the three newborns who survived. Conclusions Lactate levels during the first 4 days of life should be followed as a potential marker for suboptimal hemodynamic status in term asphyxiated newborns treated with hypothermia, for whom the maintenance of homeostasis during hypothermia treatment is of utmost importance to alleviate brain injury. PMID:26929870

Task 7: Endwall treatment inlet flow distortion analysis

NASA Technical Reports Server (NTRS)

Hall, E. J.; Topp, D. A.; Heidegger, N. J.; McNulty, G. S.; Weber, K. F.; Delaney, R. A.

1996-01-01

The overall objective of this study was to develop a 3-D numerical analysis for compressor casing treatment flowfields, and to perform a series of detailed numerical predictions to assess the effectiveness of various endwall treatments for enhancing the efficiency and stall margin of modern high speed fan rotors. Particular attention was given to examining the effectiveness of endwall treatments to counter the undesirable effects of inflow distortion. Calculations were performed using three different gridding techniques based on the type of casing treatment being tested and the level of complexity desired in the analysis. In each case, the casing treatment itself is modeled as a discrete object in the overall analysis, and the flow through the casing treatment is determined as part of the solution. A series of calculations were performed for both treated and untreated modern fan rotors both with and without inflow distortion. The effectiveness of the various treatments were quantified, and several physical mechanisms by which the effectiveness of endwall treatments is achieved are discussed.

Time series analysis of InSAR data: Methods and trends

NASA Astrophysics Data System (ADS)

Osmanoğlu, Batuhan; Sunar, Filiz; Wdowinski, Shimon; Cabral-Cano, Enrique

2016-05-01

Time series analysis of InSAR data has emerged as an important tool for monitoring and measuring the displacement of the Earth's surface. Changes in the Earth's surface can result from a wide range of phenomena such as earthquakes, volcanoes, landslides, variations in ground water levels, and changes in wetland water levels. Time series analysis is applied to interferometric phase measurements, which wrap around when the observed motion is larger than one-half of the radar wavelength. Thus, the spatio-temporal ;unwrapping; of phase observations is necessary to obtain physically meaningful results. Several different algorithms have been developed for time series analysis of InSAR data to solve for this ambiguity. These algorithms may employ different models for time series analysis, but they all generate a first-order deformation rate, which can be compared to each other. However, there is no single algorithm that can provide optimal results in all cases. Since time series analyses of InSAR data are used in a variety of applications with different characteristics, each algorithm possesses inherently unique strengths and weaknesses. In this review article, following a brief overview of InSAR technology, we discuss several algorithms developed for time series analysis of InSAR data using an example set of results for measuring subsidence rates in Mexico City.

Time Series Analysis of Insar Data: Methods and Trends

NASA Technical Reports Server (NTRS)

Osmanoglu, Batuhan; Sunar, Filiz; Wdowinski, Shimon; Cano-Cabral, Enrique

2015-01-01

Time series analysis of InSAR data has emerged as an important tool for monitoring and measuring the displacement of the Earth's surface. Changes in the Earth's surface can result from a wide range of phenomena such as earthquakes, volcanoes, landslides, variations in ground water levels, and changes in wetland water levels. Time series analysis is applied to interferometric phase measurements, which wrap around when the observed motion is larger than one-half of the radar wavelength. Thus, the spatio-temporal ''unwrapping" of phase observations is necessary to obtain physically meaningful results. Several different algorithms have been developed for time series analysis of InSAR data to solve for this ambiguity. These algorithms may employ different models for time series analysis, but they all generate a first-order deformation rate, which can be compared to each other. However, there is no single algorithm that can provide optimal results in all cases. Since time series analyses of InSAR data are used in a variety of applications with different characteristics, each algorithm possesses inherently unique strengths and weaknesses. In this review article, following a brief overview of InSAR technology, we discuss several algorithms developed for time series analysis of InSAR data using an example set of results for measuring subsidence rates in Mexico City.

So-called massive retinal gliosis: A critical review and reappraisal.

PubMed

Jakobiec, Frederick A; Thanos, Aristomenis; Stagner, Anna M; Grossniklaus, Hans E; Proia, Alan D

2016-01-01

Massive retinal gliosis, a nonneoplastic retinal glial proliferation, was first described in detail over 25 years ago, before the era of immunohistochemistry, in a series of 38 cases-to which can be added 30 case reports or small series (no more than 3 cases) subsequently. We analyze a new series of 3 nontumoral intraretinal glioses and 15 cases of tumoral retinal gliosis, not all of which, strictly speaking, were massive. The data from this series are compared with the findings in previously published cases. Included are 2 cases of massive retinal gliosis diagnosed from evisceration specimens. In reviewing all published and current cases, we were able to establish 3 subgroups of retinal tumoral glioses rather than a single "massive" category: focal nodular gliosis, submassive gliosis, and massive gliosis. Among 43 reported cases, including the present series, but excluding the previous large series of 38 cases in which substantial clinical data were omitted, there were 19 men and 24 women. Their mean and median ages were 36.2 years and 36 years, respectively, with a range of 2 to 79 years. All lesions were composed of mitotically quiet, compact spindled fibrous astrocytes devoid of an Alcian blue-positive myxoid matrix. The most common associated ocular conditions were phthisis bulbi and congenital diseases or malformations. Histopathologically, all 3 tumoral categories were accompanied by progressively more extensive fibrous and osseous metaplasia of the pigment epithelium, the latter forming a clinically and diagnostically useful, almost continuous, outer rim of eggshell calcification in the submassive and massive categories that should be detectable with appropriate imaging studies. In decreasing order of frequency, microcysts and macrocysts, vascular sclerosis, exudates, calcospherites, and Rosenthal fibers were observed among the proliferating fibrous astrocytes. Immunohistochemistry was positive for glial fibrillary acidic protein in all cases and nestin in most (an intermediate cytoplasmic filament typically restricted to embryonic and reparative neural tissue). The nonneoplastic nature of all categories of gliosis was confirmed by absent TP53 (tumor suppressor gene) dysregulation, Ki-67 negativity, and intact p16 expression (the protein product of the p16 tumor suppressor gene) in the overwhelming majority of cases. These findings indicate an intrinsic attempt to regulate and maintain a low level of glial cell proliferation that becomes unsuccessful as the disease evolves. The categories of tumoral proliferation appeared to constitute a spectrum. We conclude that focal nodular tumors encompass lesions previously called retinal vasoproliferative lesions, which display the same histopathologic and immunohistochemical findings as 3 major categories of retinal gliosis characterized herein. Copyright © 2016 Elsevier Inc. All rights reserved.

Myeloradicular damage in traumatic cervical disc herniation.

PubMed

Bucciero, A; Carangelo, B; Cerillo, A; Gammone, V; Panagiotopoulos, K; Vizioli, L

1998-12-01

The literature on pure traumatic disc herniation is now voluminous but diversity of opinion exists regarding frequency, pathogenesis and management of this type of lesion. As a further contribution to the solution of the question it is thus justified to report our series of cervical traumatic disc herniation. During the period from January 1986 to December 1994, 41 patients (25 males and 16 females, between the ages of 24 and 51 years) with traumatic cervical disc herniations were operated on by anterior approach. Twenty-six (63.4%) patients presented with radicular syndrome, 3 (7.3%) with medullary symptoms and signs, and 12 (29.3%) with myeloradiculopathy. Disc herniation was at the C3/4 level in 4 (9.7%) cases, at the C4/5 level in 7 (17.1%) cases, at the C5/6 level in 24 (58.5%) cases, and at the C6/7 level in 8 (19.5%) cases. In 6 (40%) patients suffering from myelopathy (with or without radiculopathy) an area of high MR signal intensity was observed within the cervical cord on T2-weighted images; such area corresponded at the level of cord compression by disc and was not demonstrated on T1-weighted images. All patients underwent discectomy without bone grafting. Among patients with radiculopathy, 27 (71%) experienced complete relief of preoperative symptomatology, and 11 (29%) minor pain and/or neurological deficits without interference with work activities. The myelopathy completely disappeared in 11 (73.3%) cases whereas remained unchanged in 3 (20%); 1 patient with myelopathy experienced amelioration of preoperative specific symptoms and signs. The results of surgery for cervical radiculopathy due to traumatic disc herniation are satisfactory since 92 to 100% of the patients postoperatively regain prior activities, an observation we have confirmed with our own series. The results in cases of myelopathy are less satisfactory: although approximately 73% of our patients with myelopathy reported total relief of preoperative symptomatology, published reports indicate that a significant postoperative improvement is seen in 33 to 56% of patients.

Dental findings and oral health status in patients with mucopolysaccharidosis: a case series.

PubMed

Antunes, Lívia Azeredo Alves; Nogueira, Ana Paula Barreto; Castro, Glória Fernanda; Ribeiro, Márcia Gonçalves; de Souza, Ivete Pomarico Ribeiro

2013-01-01

To present a mucopolysaccharidosis (MPS) case series evaluating oral manifestations (clinical and radiographic), oral health status and discussing its implications. All patients with MPS attending the Genetics clinic/Brazil were evaluated by means of anamnesis, clinical and radiographic examinations. The final sample consisted of 12 subjects (nine males and three females), with ages ranging from 3-31 years old. Concerning oral health, it was observed high levels of caries and periodontal problems. About oral manifestations, this study clinically observed more cases of delayed tooth eruption, thickness of alveolar process and thick lips. Radiographically, it was observed alterations on condyle, mandibular ramus and joint fossa. The dental changes in MPS population are high and consequently it is important to know them for differential diagnoses, early treatment intervention, prevention and education of both patients and parents/caregivers about oral health.

Carboxyhaemoglobin dissociation in the cadaver following attempted resuscitation.

PubMed Central

Rice, H M

1976-01-01

A series of 300 cases of fatal carbon-monoxide poisoning showed wide variations in carboxyhaemoglobin saturation. Levels below 50% in 24 subjects under the age of 70 were probably falsely low following attempted resuscitation on the way to hospital. Artificial respiration, especially with oxygen-rich gas, causes dissociation of carboxyhaemoglobin in the lungs of the cadaver while movement of blood into and out of the lungs, with mixing, lowers the saturation levels in the neighbouring large veins. In four cases subclavian blood showed saturation levels much lower than blood from sites further from the lungs. Blood should be taken from the femoral vein to get true readings. PMID:1249248

Taphonomic problems in reconstructing sea-level history from the late Quaternary marine terraces of Barbados

USGS Publications Warehouse

Muhs, Daniel; Simmons, Kathleen R.

2017-01-01

Although uranium series (U-series) ages of growth-position fossil corals are important to Quaternary sea-level history, coral clast reworking from storms can yield ages on a terrace dating to more than one high-sea stand, confounding interpretations of sea-level history. On northern Barbados, U-series ages corals from a thick storm deposit are not always younger with successively higher stratigraphic positions, but all date to the last interglacial period (~127 ka to ~112 ka), Marine Isotope Substage (MIS) 5.5. The storm deposit ages are consistent with the ages of growth-position corals found at the base of the section and at landward localities on this terrace. Thus, in this case, analysis of only a few corals would not have led to an error in interpreting sea-level history. In contrast, a notch cut into older Pleistocene limestone below the MIS 5.5 terrace contains corals that date to both MIS 5.5 (~125 ka) and MIS 5.3 (~108 ka). We infer that the notch formed during MIS 5.3 and the MIS 5.5 corals are reworked. Similar multiple ages of corals on terraces have been reported elsewhere on Barbados. Thus, care must be taken in interpreting U-series ages of corals that are reported without consideration of taphonomy.

Treatment of osteitis pubis and osteomyelitis of the pubic symphysis in athletes: a systematic review

PubMed Central

Choi, Haemi; McCartney, Michael; Best, Thomas M

2013-01-01

Objectives The authors examined the most current evidence for treatment options in athletes with osteitis pubis and osteomyelitis pubis, attempting to determine which options provide optimal pain relief with rapid return to sport and prevention of symptom reoccurrence. Methods Three databases—MEDLINE, Cochrane Database of Systematic Reviews and CINAHL—were searched using the OVID interface for all years between 1985 and May 2008. References were analysed from included studies, and additional relevant articles were obtained for inclusion. Inclusion criteria included (1) humans only, (2) subjects had no apparent risk factors for development of osteitis pubis or osteomyelitis of the pubic symphysis other than athletic involvement, (3) both physical exam findings and diagnostic imaging were used to confirm either diagnosis, and (4) a definitive treatment strategy was identifiable for management of osteitis pubis or osteomyelitis of the pubic symphysis. In total, 25 articles were included in the review. Results There were no randomised controlled trials identified with this study’s search strategy. A total of 195 athletes were diagnosed as having osteitis pubis (186 males, nine females) and treated with either conservative measures/physical therapy, local injection with corticosteroids and/or local anaesthetic, dextrose prolotherapy, surgery or antibiotic therapy. Six case reports/series described conservative treatment measures (physical therapy, rest, non-steroid anti-inflammatory drugs). Four case series explored the use of corticosteroid injections in treatment. One case series described the use of dextrose prolotherapy as a treatment modality. Six case series described various surgical techniques (pubic symphysis curettage, polypropylene mesh placement and pubic bone stabilisation) in treatment. Ten case reports/ series (10 subjects) outlined antibiotic treatment of osteomyelitis of the pubic symphysis. Conclusions The current medical literature shows only level 4 evidence of the treatment for osteitis pubis in 24 case reports/series in athletes. Without any direct comparison of treatment modalities, it is difficult to determine which individual treatment option is the most efficacious. Further study comparing the different treatment options is necessary to determine which modality provides the fastest return to sport. PMID:18812419

[Clinical features and prognostic factors of meningococcal disease: a case series study in Chile during the 2012-2013 outbreak].

PubMed

Matute, Isabel; Olea, Andrea; López, Darío; Loayza, Sergio; Nájera, Manuel; González, Claudia; Poffald, Lucy; Hirmas, Macarena; Delgado, Iris; Pedroni, Elena; Alfaro, Tania; Gormaz, Ana María; Sanhueza, Gabriel; Vial, Pablo; Dabanch, Jeannette; Gallegos, Doris; Aguilera, Ximena

2015-10-01

Meningococcal disease (MD) is a major global problem because of its case fatality rate and sequels. Since 2012 cases of serogroup W have increased in Chile, with nonspecific clinical presentation, high case fatality rate and serious consequences. To characterize the evolution and outcome of MD cases between January 2012 and March 2013 in Chile. Case series considering 149 MD cases of 7 regions. A questionnaire was applied and clinical records were reviewed, including individual, agent, clinical course and healthcare process variables. The analysis allowed to obtain estimates of the OR as likelihood of dying. 51.5% was meningococcemia, the case fatality rate reached 27%, prevailing serogroup W (46.6%). Factors that increased the probability of dying: > age, belonging to indigenous people, having lived a stressful event, having diarrhea, impaired consciousness, cardiovascular symptoms, low oxygen saturation and low Glasgow coma scale score. The case fatality rate exceeded normal levels and was higher in serogroup W. Increasing in this serogroup, associated to the increased presence of nonspecific symptoms or rapid progression to septicemia, hit a health system accustomed to more classic meningococcal disease presentation, which could partly explain the observed increased fatality rate.

MetaRNA-Seq: An Interactive Tool to Browse and Annotate Metadata from RNA-Seq Studies.

PubMed

Kumar, Pankaj; Halama, Anna; Hayat, Shahina; Billing, Anja M; Gupta, Manish; Yousri, Noha A; Smith, Gregory M; Suhre, Karsten

2015-01-01

The number of RNA-Seq studies has grown in recent years. The design of RNA-Seq studies varies from very simple (e.g., two-condition case-control) to very complicated (e.g., time series involving multiple samples at each time point with separate drug treatments). Most of these publically available RNA-Seq studies are deposited in NCBI databases, but their metadata are scattered throughout four different databases: Sequence Read Archive (SRA), Biosample, Bioprojects, and Gene Expression Omnibus (GEO). Although the NCBI web interface is able to provide all of the metadata information, it often requires significant effort to retrieve study- or project-level information by traversing through multiple hyperlinks and going to another page. Moreover, project- and study-level metadata lack manual or automatic curation by categories, such as disease type, time series, case-control, or replicate type, which are vital to comprehending any RNA-Seq study. Here we describe "MetaRNA-Seq," a new tool for interactively browsing, searching, and annotating RNA-Seq metadata with the capability of semiautomatic curation at the study level.

What Does a College Degree Cost? Comparing Approaches to Measuring "Cost Per Degree". Delta Cost Project White Paper Series

ERIC Educational Resources Information Center

Johnson, Nate

2009-01-01

What does it cost to provide a bachelor's-level education? This question arises with increasing frequency and urgency as pressure mounts on policymakers and education leaders to increase the education attainment level in the United States, to "Double the Numbers" in some cases. At the same time, the two traditional sources of…

Literacy for Citizenship: Gender and Grassroots Dynamics in Brazil. SUNY Series, Literacy, Culture, and Learning.

ERIC Educational Resources Information Center

Stromquist, Nelly P.

This book presents a case study of the MOVA (Movimento de Alfabetizacao de Jovens e Adultos) literacy program in Sao Paulo, Brazil, in 1989-1993. It examines the meaning and uses of literacy at the micro- and macro-levels, the interplay between both levels, and forces influencing educational policy formation and outcome. The foreword provides…

A comparative assessment of statistical methods for extreme weather analysis

NASA Astrophysics Data System (ADS)

Schlögl, Matthias; Laaha, Gregor

2017-04-01

Extreme weather exposure assessment is of major importance for scientists and practitioners alike. We compare different extreme value approaches and fitting methods with respect to their value for assessing extreme precipitation and temperature impacts. Based on an Austrian data set from 25 meteorological stations representing diverse meteorological conditions, we assess the added value of partial duration series over the standardly used annual maxima series in order to give recommendations for performing extreme value statistics of meteorological hazards. Results show the merits of the robust L-moment estimation, which yielded better results than maximum likelihood estimation in 62 % of all cases. At the same time, results question the general assumption of the threshold excess approach (employing partial duration series, PDS) being superior to the block maxima approach (employing annual maxima series, AMS) due to information gain. For low return periods (non-extreme events) the PDS approach tends to overestimate return levels as compared to the AMS approach, whereas an opposite behavior was found for high return levels (extreme events). In extreme cases, an inappropriate threshold was shown to lead to considerable biases that may outperform the possible gain of information from including additional extreme events by far. This effect was neither visible from the square-root criterion, nor from standardly used graphical diagnosis (mean residual life plot), but from a direct comparison of AMS and PDS in synoptic quantile plots. We therefore recommend performing AMS and PDS approaches simultaneously in order to select the best suited approach. This will make the analyses more robust, in cases where threshold selection and dependency introduces biases to the PDS approach, but also in cases where the AMS contains non-extreme events that may introduce similar biases. For assessing the performance of extreme events we recommend conditional performance measures that focus on rare events only in addition to standardly used unconditional indicators. The findings of this study are of relevance for a broad range of environmental variables, including meteorological and hydrological quantities.

Dental movement acceleration: Literature review by an alternative scientific evidence method

PubMed Central

Camacho, Angela Domínguez; Cujar, Sergio Andres Velásquez

2014-01-01

The aim of this study was to analyze the majority of publications using effective methods to speed up orthodontic treatment and determine which publications carry high evidence-based value. The literature published in Pubmed from 1984 to 2013 was reviewed, in addition to well-known reports that were not classified under this database. To facilitate evidence-based decision making, guidelines such as the Consolidation Standards of Reporting Trials, Preferred Reporting items for systematic Reviews and Meta-analyses, and Transparent Reporting of Evaluations with Non-randomized Designs check list were used. The studies were initially divided into three groups: local application of cell mediators, physical stimuli, and techniques that took advantage of the regional acceleration phenomena. The articles were classified according to their level of evidence using an alternative method for orthodontic scientific article classification. 1a: Systematic Reviews (SR) of randomized clinical trials (RCTs), 1b: Individual RCT, 2a: SR of cohort studies, 2b: Individual cohort study, controlled clinical trials and low quality RCT, 3a: SR of case-control studies, 3b: Individual case-control study, low quality cohort study and short time following split mouth designs. 4: Case-series, low quality case-control study and non-systematic review, and 5: Expert opinion. The highest level of evidence for each group was: (1) local application of cell mediators: the highest level of evidence corresponds to a 3B level in Prostaglandins and Vitamin D; (2) physical stimuli: vibratory forces and low level laser irradiation have evidence level 2b, Electrical current is classified as 3b evidence-based level, Pulsed Electromagnetic Field is placed on the 4th level on the evidence scale; and (3) regional acceleration phenomena related techniques: for corticotomy the majority of the reports belong to level 4. Piezocision, dentoalveolar distraction, alveocentesis, monocortical tooth dislocation and ligament distraction technique, only had case series or single report cases (4th level of evidence). Surgery first and periodontal distraction have 1 study at level 2b and corticision one report at level 5. Multiple orthodontic acceleration reports on humans were identified by an alternative evidence level scale, which is a simple and accurate way of determining which techniques are better and have a higher rate of effectiveness. The highest level of evidence for a specific procedure to accelerate orthodontic dental movement up to October 2013 was surgery first followed by low level laser application, corticotomy and periodontal distraction located on level 2, recommendation grade b from this proposed scientific evidence-based scale. PMID:25332914

Refeeding syndrome or refeeding hypophosphatemia: a systematic review of cases.

PubMed

Skipper, Annalynn

2012-02-01

Nutrition support clinicians refer to the abnormalities in laboratory data and changes in clinical signs and symptoms that follow refeeding of starved or malnourished patients as refeeding syndrome. Theoretical descriptions of refeeding syndrome include a complex and extensive list of changes, such as hypophosphatemia, hypomagnesemia, hypokalemia, hyponatremia, hypocalcemia, hyperglycemia, and vitamin deficiency--all of which are accompanied by clinical signs and symptoms. In practice, clinicians see asymptomatic refeeding hypophosphatemia more often than a full-blown syndrome with multiple laboratory and clinical abnormalities. Confusion results because there is no widely accepted or uniformly applied set of defining characteristics for diagnosing refeeding syndrome. To gain insight into the clinical characteristics of refeeding syndrome described in the literature, a systematic review of reported cases and case series was conducted. Since 2000, 20 authors described 27 cases that contained sufficient data for review. Hypophosphatemia occurred in 26 patients (96%). While 19 patients (71%) experienced at least 1 other laboratory abnormality, only 14 (51%) exhibited a consistent pattern of abnormally low phosphorus and magnesium levels. Seven patients had hypocalcemia (26%), and hyponatremia was reported in 3 patients (11%). There were no reports of hyperglycemia. Mean data reported in case series containing data from 63 patients showed that hypophosphatemia was a consistent finding but that other abnormalities were not consistently identified. Findings suggest that refeeding hypophosphatemia is not accompanied by a consistent pattern of biochemical or clinical abnormalities among case reports or case series of patients reported to have refeeding syndrome.

Injectional anthrax at a Scottish district general hospital.

PubMed

Inverarity, D J; Forrester, V M; Cumming, J G R; Paterson, P J; Campbell, R J; Brooks, T J G; Carson, G L; Ruddy, J P

2015-04-01

This retrospective, descriptive case-series reviews the clinical presentations and significant laboratory findings of patients diagnosed with and treated for injectional anthrax (IA) since December 2009 at Monklands Hospital in Central Scotland and represents the largest series of IA cases to be described from a single location. Twenty-one patients who fulfilled National Anthrax Control Team standardized case definitions of confirmed, probable or possible IA are reported. All cases survived and none required limb amputation in contrast to an overall mortality of 28% being experienced for this condition in Scotland. We document the spectrum of presentations of soft tissue infection ranging from mild cases which were managed predominantly with oral antibiotics to severe cases with significant oedema, organ failure and coagulopathy. We describe the surgical management, intensive care management and antibiotic management including the first description of daptomycin being used to treat human anthrax. It is noted that some people who had injected heroin infected with Bacillus anthracis did not develop evidence of IA. Also highlighted are biochemical and haematological parameters which proved useful in identifying deteriorating patients who required greater levels of support and surgical debridement.

Serum Levels of MicroRNA371a-3p: A Highly Sensitive Tool for Diagnosing and Staging Testicular Germ Cell Tumours: A Clinical Case Series.

PubMed

Anheuser, Petra; Radtke, Arlo; Wülfing, Christian; Kranz, Jennifer; Belge, Gazanfer; Dieckmann, Klaus-Peter

2017-01-01

MicroRNA (miR)371a-3p was suggested to be a sensitive and specific new serum biomarker of germ cell tumours (GCTs); however, its clinical usefulness remains unproven. In 312 consecutive cases with various testicular diseases, serum levels of miR371a-3p were measured. Measurement results became available only after completion of treatment. Five patients with testicular seminoma were selected for review because of unanticipated clinical courses. In each two patients, elevated miR levels heralded undetected primary testicular GCT and metastases despite inconclusive radiological findings. In one case, a normal miR371a-3p level correctly pointed to the absence of metastases contrary to clinical assessment. In all cases, knowledge about the miR371a-3p levels would have altered the clinical management. These cases highlight the exceptional usefulness of the new GCT biomarker. In contrast to classical markers, miR371a-3p can identify primary testicular GCT. The marker can aid in clinical decision making in cases with ambiguous clinical findings. © 2017 The Author(s) Published by S. Karger AG, Basel.

Newly occurred L4 spondylolysis in the lumbar spine with pre-existence L5 spondylolysis among sports players: case reports and biomechanical analysis.

PubMed

Sairyo, Koichi; Sakai, Toshinori; Yasui, Natsuo; Kiapour, Ali; Biyani, Ashok; Ebraheim, Nabil; Goel, Vijay K

2009-10-01

Case series and a biomechanical study using a finite element (FE) analysis. To report three cases with multi-level spondylolysis and to understand the mechanism biomechanically. Multi-level spondylolysis is a very rare condition. There have been few reports in the literature on multi-level spondylolysis among sports players. We reviewed three cases of the condition, clinically. These patients were very active young sports players and had newly developed fresh L4 spondylolysis and pre-existing L5 terminal stage spondylolysis. Thus, we assumed that L5 spondylolysis may have increased the pars stress at the cranial adjacent levels, leading to newly developed spondylolysis at these levels. Biomechanically, we investigated pars stress at L4 with or without spondylolysis at L5 using the finite element technique. L4 pars stress decreased in the presence of L5 spondylolysis, which does not support our first hypothesis. It seems that multi-level spondylolysis may occur due to genetic and not biomechanical reasons.

Bridging defects in chronic spinal cord injury using peripheral nerve grafts combined with a chitosan-laminin scaffold and enhancing regeneration through them by co-transplantation with bone-marrow-derived mesenchymal stem cells: Case series of 14 patients

PubMed Central

Amr, Sherif M.; Gouda, Ashraf; Koptan, Wael T.; Galal, Ahmad A.; Abdel-Fattah, Dina Sabry; Rashed, Laila A.; Atta, Hazem M.; Abdel-Aziz, Mohammad T.

2014-01-01

Objective To investigate the effect of bridging defects in chronic spinal cord injury using peripheral nerve grafts combined with a chitosan-laminin scaffold and enhancing regeneration through them by co-transplantation with bone-marrow-derived mesenchymal stem cells. Methods In 14 patients with chronic paraplegia caused by spinal cord injury, cord defects were grafted and stem cells injected into the whole construct and contained using a chitosan-laminin paste. Patients were evaluated using the International Standards for Classification of Spinal Cord Injuries. Results Chitosan disintegration leading to post-operative seroma formation was a complication. Motor level improved four levels in 2 cases and two levels in 12 cases. Sensory-level improved six levels in two cases, five levels in five cases, four levels in three cases, and three levels in four cases. A four-level neurological improvement was recorded in 2 cases and a two-level neurological improvement occurred in 12 cases. The American Spinal Impairment Association (ASIA) impairment scale improved from A to C in 12 cases and from A to B in 2 cases. Although motor power improvement was recorded in the abdominal muscles (2 grades), hip flexors (3 grades), hip adductors (3 grades), knee extensors (2–3 grades), ankle dorsiflexors (1–2 grades), long toe extensors (1–2 grades), and plantar flexors (0–2 grades), this improvement was too low to enable them to stand erect and hold their knees extended while walking unaided. Conclusion Mesenchymal stem cell-derived neural stem cell-like cell transplantation enhances recovery in chronic spinal cord injuries with defects bridged by sural nerve grafts combined with a chitosan-laminin scaffold. PMID:24090088

The effect of tibio-femoral traction mobilization on passive knee flexion motion impairment and pain: a case series

PubMed Central

Maher, Sara; Creighton, Doug; Kondratek, Melodie; Krauss, John; Qu, Xianggui

2010-01-01

The purpose of this case series was to explore the effects of tibio-femoral (TF) manual traction on pain and passive range of motion (PROM) in individuals with unilateral motion impairment and pain in knee flexion. Thirteen participants volunteered for the study. All participants received 6 minutes of TF traction mobilization applied at end-range passive knee flexion. PROM measurements were taken before the intervention and after 2, 4, and 6 minutes of TF joint traction. Pain was measured using a visual analog scale with the TF joint at rest, at end-range passive knee flexion, during the application of joint traction, and immediately post-treatment. There were significant differences in PROM after 2 and 4 minutes of traction, with no significance noted after 4 minutes. A significant change in knee flexion of 25.9°, which exceeded the MDC95, was found when comparing PROM measurements pre- to final intervention. While pain did not change significantly over time, pain levels did change significantly during each treatment session. Pain significantly increased when the participant’s knee was passively flexed to end range; it was reduced, although not significantly, during traction mobilization; and it significantly decreased following traction. This case series supports TF joint traction as a means of stretching shortened articular and periarticular tissues without increasing reported levels of pain during or after treatment. In addition, this is the first study documenting the temporal aspects of treatment effectiveness in motion restoration. PMID:21655421

KRAS mutations in blood circulating cell-free DNA: a pancreatic cancer case-control

PubMed Central

Le Calvez-Kelm, Florence; Foll, Matthieu; Wozniak, Magdalena B.; Delhomme, Tiffany M.; Durand, Geoffroy; Chopard, Priscilia; Pertesi, Maroulio; Fabianova, Eleonora; Adamcakova, Zora; Holcatova, Ivana; Foretova, Lenka; Janout, Vladimir; Vallee, Maxime P.; Rinaldi, Sabina; Brennan, Paul; McKay, James D.; Byrnes, Graham B.; Scelo, Ghislaine

2016-01-01

The utility of KRAS mutations in plasma circulating cell-free DNA (cfDNA) samples as non-invasive biomarkers for the detection of pancreatic cancer has never been evaluated in a large case-control series. We applied a KRAS amplicon-based deep sequencing strategy combined with analytical pipeline specifically designed for the detection of low-abundance mutations to screen plasma samples of 437 pancreatic cancer cases, 141 chronic pancreatitis subjects, and 394 healthy controls. We detected mutations in 21.1% (N=92) of cases, of whom 82 (89.1%) carried at least one mutation at hotspot codons 12, 13 or 61, with mutant allelic fractions from 0.08% to 79%. Advanced stages were associated with an increased proportion of detection, with KRAS cfDNA mutations detected in 10.3%, 17,5% and 33.3% of cases with local, regional and systemic stages, respectively. We also detected KRAS cfDNA mutations in 3.7% (N=14) of healthy controls and in 4.3% (N=6) of subjects with chronic pancreatitis, but at significantly lower allelic fractions than in cases. Combining cfDNA KRAS mutations and CA19-9 plasma levels on a limited set of case-control samples did not improve the overall performance of the biomarkers as compared to CA19-9 alone. Whether the limited sensitivity and specificity observed in our series of KRAS mutations in plasma cfDNA as biomarkers for pancreatic cancer detection are attributable to methodological limitations or to the biology of cfDNA should be further assessed in large case-control series. PMID:27705932

Central Tendon Injuries of Hamstring Muscles: Case Series of Operative Treatment.

PubMed

Lempainen, Lasse; Kosola, Jussi; Pruna, Ricard; Puigdellivol, Jordi; Sarimo, Janne; Niemi, Pekka; Orava, Sakari

2018-02-01

As compared with injuries involving muscle only, those involving the central hamstring tendon have a worse prognosis. Limited information is available regarding the surgical treatment of central tendon injuries of the hamstrings. To describe the operative treatment and outcomes of central tendon injuries of the hamstrings among athletes. Case series; Level of evidence, 4. Eight athletes (6 top level, 2 recreational) with central hamstring tendon injuries underwent magnetic resonance imaging and surgical treatment. The indication for surgery was recurrent (n = 6) or acute (n = 2) central hamstring tendon injury. All patients followed the same postoperative rehabilitation protocol, and return to play was monitored. Magnetic resonance imaging found a central tendon injury in all 3 hamstring muscles (long head of the biceps femoris, semimembranosus, and semitendinosus) with disrupted tendon ends. In acute and recurrent central tendon injuries, full return to play was achieved at 2.5 to 4 months. There were no adverse events during follow-up. Central tendon injuries of the hamstrings can be successfully repaired surgically after acute and recurrent ruptures.

Neck osteotomy for malunion of neglected radial neck fractures in children: a report of 2 cases.

PubMed

Ceroni, Dimitri; Campos, José; Dahl-Farhoumand, Agnes; Holveck, Jérôme; Kaelin, André

2010-01-01

Radial neck fractures are a common injury in children as a result of a fall on an extended and supinated outstretched hand. We present 2 cases of osteotomy of the neck of the radius performed in 2 children with neglected radial neck fractures. Preoperatively, both patients complained of pain and severely reduced mobility of the elbow. Surgery was performed at 6 weeks and 3 months, respectively, after the initial injury and the 2 children were reviewed at 6 and 16 months follow-up. Osteotomies healed within the usual time and no avascular necrosis of the radial head, proximal radioulnar synostosis, or myositis ossificans were observed. The Mayo Elbow Performance Index Score improved significantly after the operation with the 2 patients rated as excellent. In this small series, we present a novel technique of proximal osteotomy of the radius to correct this deformity in children. Case series, level IV evidence.

VET and the Diffusion and Implementation of Innovation in the Mining, Solar Energy and Computer Games Sectors. NCVER Monograph Series 06/2011

ERIC Educational Resources Information Center

Dalitz, Robert; Toner, Phillip; Turpin, Tim

2011-01-01

Innovation is thought to improve productivity at the firm level and economic prosperity at the national level. This would seem to have implications for the skills and skills development of employees. However, little is known about the relationship between skills development and innovation. This report is the culmination of case studies exploring…

A lifestyle intervention program for successfully addressing major cardiometabolic risks in persons with SCI: a three-subject case series

PubMed Central

Bigford, Gregory E; Mendez, Armando J; Betancourt, Luisa; Burns-Drecq, Patricia; Backus, Deborah; Nash, Mark S

2017-01-01

Introduction This study is a prospective case series analyzing the effects of a comprehensive lifestyle intervention program in three patients with chronic paraplegia having major risks for the cardiometabolic syndrome (CMS). Case presentation: Individuals underwent an intense 6-month program of circuit resistance exercise, nutrition using a Mediterranean diet and behavioral support, followed by a 6-month extension (maintenance) phase involving minimal support. The primary goal was a 7% reduction of body mass. Other outcomes analyzed insulin resistance using the HOMA-IR model, and plasma levels of fasting triglycerides and high-density lipoprotein cholesterol. All participants achieved the goal for 7% reduction of body mass and maintained the loss after the MP. Improvements were observed in 2/3 subjects for HOMA-IR and high-density lipoprotein cholesterol. All participants improved their risk for plasma triglycerides. Discussion: We conclude, in a three-person case series of persons with chronic paraplegia, a lifestyle intervention program involving circuit resistance training, a calorie-restrictive Mediterranean-style diet and behavioral support, results in clinically significant loss of body mass and effectively reduced component risks for CMS and diabetes. These results were for the most part maintained after a 6-month MP involving minimal supervision. PMID:28382218

Color Analysis of Periimplant Soft Tissues Focusing on Implant System: A Case Series.

PubMed

Varoni, Elena M; Moltrasio, Giuseppe; Gargano, Marco; Ludwig, Nicola; Lodi, Giovanni; Scaringi, Riccardo

2017-04-01

To assess the impact of implant system on color harmonization of periimplant mucosa. In this case series, color of periimplant mucosa was compared with color of natural tooth gingiva. Seventeen intercanine implants were analyzed (11 bone level [BL], 6 tissue level [TL] implants). Colorimetric data, at 2, 4, and 6 mm from gingival margin, were collected through fiber optics reflectance spectroscopy, and color differences calculated as ΔE. Dentists, dental students, and lay people, in blind, performed an additional visual color analysis on clinical images. Independently from implant system, the color of periimplant mucosa was significantly different from gingiva (ΔE = 8.2 ± 0.7), resulting darker at L* comparison (P ≤ 0.05). TL periimplant mucosa showed higher ΔE than BL (9.0 ± 1.0 vs 6.6 ± 0.8, respectively; P ≤ 0.05). Observers correctly identified where the implant was placed in about half of the cases, with no significant difference between implant systems. Within the limitations of this study, the color of periimplant soft tissues appears different from gingiva, at spectroscopic analysis. Color discrepancy results higher in the presence of TL implants than in BL implants, although the difference may not be clinically significant.

Severe Propanil [N-(3,4-dichlorophenyl) propanamide] Pesticide Self-Poisoning

PubMed Central

Eddleston, Michael; Rajapakshe, Manjula; Roberts, Darren; Reginald, K; Sheriff, M H Rezvi; Dissanayake, Wasantha; Buckley, Nick

2007-01-01

Background propanil pesticide poisoning can produce methaemoglobinaemia, tissue hypoxia, and depression of CNS and respiratory system. It has been recorded only rarely worldwide and most current poison texts consider propanil to be of low toxicity. However, propanil self-poisoning is a significant clinical problem in parts of Sri Lanka and a not uncommon cause of death. Aim of study to report the clinical features and management of severe propanil poisoning. Patients and Methods we report a retrospective case series of patients who were treated in the intensive care unit (ICU) of and/or died in Anuradhapura General Hospital between 1998 and early 2002. Results sixteen patients were identified. Common manifestations of toxicity included confusion, reduced conscious level, cyanosis, and respiratory depression. Marked haemolysis was noted in several patients. Nine deaths occurred due to respiratory depression and cardiorespiratory arrest. Management was difficult given the lack of IV methylene blue, inability to measure methaemoglobin levels, and paucity of ICU beds. Conclusions this series indicates that propanil poisoning can be a severe form of self-poisoning, particularly in resource-poor settings. We have now initiated the establishment of a prospective series of propanil poisoned patients to further describe its clinical features, responsiveness to therapy, and case fatality rate. PMID:12507053

[Post-therapeutic evolution and prognostic factors of intestinal lymphomas, Retrospective analysis of 42 cases].

PubMed

Sánchez-Fayos, M P; Hernández Guío, C; Rivas, M C; Outeiriño, J; González-Campos, C; Lobo, F

1993-12-01

To evaluate in retrospect the response to therapy and long-term evolution of a series of primitive intestinal lymphomas. The series was comprised of 42 patients diagnosed in our hospital during 1960-1962. The mean age was 34.5 years (range, 3-73), the M/F ratio was 21/21, and the histopathology distributes as follows: high grade (HG), 24 cases, low grade (LG), 12 cases, and mixed (LG/HG), 6 cases. B/T immunophenotype: 40/2. Staging: IE1,29 cases, IIE2-IV, 11 cases. The treatment applied in the series was classified in various types: ample surgical resection (aSR), 21 cases; partial surgical resection (pSR), 9 cases; abdominal radiation therapy (RT), 7 cases; monochemotherapy (MCT), 7 cases, and polychemotherapy (PCT), 28 cases. The correlation of clinicobiological variables with immediate response to treatment was evaluated by means of the chi square test, and the acturial post-therapeutic survival curves in accordance to the life tables, differences being calculated by the log rank test. Small intestine was the commonest site of involvement, 31 cases; ileocecal region, 7 cases; colon, 2 cases, and colon plus small intestine, 2 cases. Regardless of therapy type, complete remission (CR) was attained in 20 patients (47.5%), partial remission in 5; 11 cases were unresponsive (26.5%) and early death occurred in 6 instances (14.2%). The acturial post-therapeutic survival offered an 8-year expectancy of 47%. The correlation between immediate complete response and 16 clinico-biologic variables showed favourable significance for tumoral proliferation index (i.e., Pc10-positive cells < 15%) and for therapeutic regimens including PCT+aSR. On the other hand, the necessity of emergency surgery for diagnosis was a poor-risk factor. The correlation between a post-therapeutic survival and 19 other variables showed the following as favorable data: female sex, tumour proliferative index (i.e., Pc10-positive cells < 15%), the use of PCT+aSR, and attaining CR. Poor-risk factors were the need of emergency surgery, multicentric lymphomatous involvement and serum LDH rates 350 UI/L. Although immediate response (CR) and long-term results (survival) were better in the patients with favourable histology (LG+LG/HG) and in those with loco-regional disease (stages IE-IE1), the differences had no statistical significance, possibly due to the low number of cases. 1) Even though these findings should be carefully evaluated, dut to lack of homogeneity of the series and the fact of being a retrospective study, the rate of CR in this series (47.5%) is similar to that of current studies. 2) Female sex, type of therapy, multifocal involvement, the need of emergency surgery and high LDH levels have significant value in univariate analyses.

Porous and nonporous orbital implants for treating the anophthalmic socket: A meta-analysis of case series studies.

PubMed

Schellini, Silvana; Jorge, Eliane; Sousa, Roberta; Burroughs, John; El-Dib, Regina

2016-01-01

To assess the efficacy and safety of porous and nonporous implants for management of the anophthalmic socket. Case series meta-analysis was conducted with no language restriction, including studies from: PUBMED, EMBASE and LILACS. Study eligibility criteria were case series design with more than 20 cases reported, use of porous and/or nonporous orbital implants, anophthalmic socket and, treatment success defined as no implant exposure or extrusion. Complications rates from each included study were quantified. Proportional meta-analysis was performed on both outcomes with a random-effects model and the 95% confidential intervals were calculated. A total of 35 case series studies with a total of 3,805 patients were included in the meta-analysis. There are no studies comparing porous and nonporous implants in the anophthalmic socket treatment. There was no statistically significant difference between porous polyethylene (PP) and hydroxyapatite (HA) on implant exposure: 0.026 (0.012-0.045) vs 0.054 (0.041-0.070), respectively and, neither on implant extrusion: 0.0042 (0.0008-0.010) vs. 0.018 (0.004-0.042), respectively. However, there was a significant difference supporting the use of PP when compared to bioceramic implant: 0.026 (0.012 -0.045) vs. 0.12 (0.06-0.20), respectively, on implant exposure. PP implants showed lower chance of exposure than bioceramic implant for anophthalmic socket reconstruction, although we cannot rule out the possibility of heterogeneity bias due to the nature and level of evidence of the included studies. Clinical trials are necessary to expand the knowledge of porous and nonporous orbital implants in the anophthalmic socket management.

A home-based body weight supported treadmill training program for children with cerebral palsy: A case series.

PubMed

Kenyon, Lisa K; Westman, Marci; Hefferan, Ashley; McCrary, Peter; Baker, Barbara J

2017-07-01

Contemporary approaches to the treatment of cerebral palsy (CP) advocate a task-specific approach that emphasizes repetition and practice of specific tasks. Recent studies suggest that body-weight-supported treadmill training (BWSTT) programs may be beneficial in clinical settings. The purposes of this case series were to explore the outcomes and feasibility of a home-based BWSTT program for three children with CP. Three children with CP at Gross Motor Function Classification System (GMFCS) Levels III or IV participated in this case series. Examination included the Functional Assessment Questionnaire (FAQ), the 10-meter walk test, the Gross Motor Function Measure (GMFM-66), and the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT). A harness system was used to conduct the BWSTT program over an 8-12 week period. All of the families reported enjoying the BWSTT program and found the harness easy to use. Participant 2 increased from a 2 to a 4 on the FAQ, while Participant 3 increased from a 6 to a 7. Two of the participants demonstrated post-intervention improvements in functional mobility. In addition to mobility outcomes, future research should explore the potential health benefits of a home-based BWSTT program.

Power Mobility Training for Young Children with Multiple, Severe Impairments: A Case Series.

PubMed

Kenyon, Lisa K; Farris, John P; Gallagher, Cailee; Hammond, Lyndsay; Webster, Lauren M; Aldrich, Naomi J

2017-02-01

Young children with neurodevelopmental conditions are often limited in their ability to explore and learn from their environment. The purposes of this case series were to (1) describe the outcomes of using an alternative power mobility device with young children who had multiple, severe impairments; (2) develop power mobility training methods for use with these children; and (3) determine the feasibility of using various outcome measures. Three children with cerebral palsy (Gross Motor Function Classification System Levels IV, V, and V) ages 17 months to 3.5 years participated in the case series. Examination included the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT) and the Dimensions of Mastery Questionnaire (DMQ). An individualized, engaging power mobility training environment was created for each participant. Intervention was provided for 60 minutes per week over 12 weeks. All participants exhibited improvements in power mobility skills. Post-intervention PEDI-CAT scores increased in various domains for all participants. Post-intervention DMQ scores improved in Participants 1 and 2. The participants appeared to make improvements in their beginning power mobility skills. Additional research is planned to further explore the impact of power mobility training in this unique population.

A lifestyle intervention program for successfully addressing major cardiometabolic risks in persons with SCI: a three-subject case series.

PubMed

Bigford, Gregory E; Mendez, Armando J; Betancourt, Luisa; Burns-Drecq, Patricia; Backus, Deborah; Nash, Mark S

2017-01-01

This study is a prospective case series analyzing the effects of a comprehensive lifestyle intervention program in three patients with chronic paraplegia having major risks for the cardiometabolic syndrome (CMS). Individuals underwent an intense 6-month program of circuit resistance exercise, nutrition using a Mediterranean diet and behavioral support, followed by a 6-month extension (maintenance) phase involving minimal support. The primary goal was a 7% reduction of body mass. Other outcomes analyzed insulin resistance using the HOMA-IR model, and plasma levels of fasting triglycerides and high-density lipoprotein cholesterol. All participants achieved the goal for 7% reduction of body mass and maintained the loss after the MP. Improvements were observed in 2/3 subjects for HOMA-IR and high-density lipoprotein cholesterol. All participants improved their risk for plasma triglycerides. We conclude, in a three-person case series of persons with chronic paraplegia, a lifestyle intervention program involving circuit resistance training, a calorie-restrictive Mediterranean-style diet and behavioral support, results in clinically significant loss of body mass and effectively reduced component risks for CMS and diabetes. These results were for the most part maintained after a 6-month MP involving minimal supervision.

MORPHOLOGICAL AND HISTOCHEMICAL CHANGES IN THE SPLEEN AND LYMPH NODE OF WHITE MICE IN RESPONSE TO RADIATION AND ANTIGENIC EFFECTS (in Russian)

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

Akopova, V.A.

1961-01-01

Research was carried out on 90 white ntice subjected to x irradiation (Series I), vaccination with a brucellosis vaccine (Series II), and to a combined action of these factors (Series III and IV). The spleen and lymph nodes were studied both morphologically and histochemically. When exposing the mice to a total x-ray dose of 335 r, visible destructive changes and the lowering of desoxyribonucleic and ribonucleic acid level were found to occur in the spleen and lymph nodes. In the case of a single vaccination of the mice with the brucellosis vaccine, a certain vaccinal hyperplasia was observed in themore » spleen and lymph nodes, the level of desoxyribonucleic and ribonucleic acid being normal. In vaccinating the white mice, following total irradiation, destructive changes along with a gradual lowering of desoxyribonucleic and ribonucleic acid level are observed in the spleen and lymph nodes. The total x irradiation following a singie vaccination with the brucellosis vaccine, brings about slight destructive changes along with a simultaneous reticular hyperplasia in the spleen and lymph nodes. The levels of desoxyribonucleic and ribonucleic acids are high at all times. (auth)« less

Preliminary evidence for associations between second-trimester human chorionic gonadotropin and unconjugated oestriol levels with pregnancy outcome in Down syndrome pregnancies.

PubMed

Benn, P A

1998-04-01

Fifty-six cases of Down syndrome were identified in a population of women who had undergone maternal serum triple marker screening [alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), and unconjugated oestriol (uE3) analyses]. These affected pregnancies represented all known cases present in the population of 34,368 women screened. Using a 1:270 mid-trimester Down syndrome risk to define the screen-positive group, 42 affected pregnancies were screen-positive (medians: AFP = 0.79 MOM, hCG = 2.13 MOM, uE3 = 0.62 MOM, age 34.6 years) and 14 pregnancies were screen-negative (medians: AFP = 0.82 MOM, hCG = 1.57 MOM, uE3 = 0.92 MOM, age 24.2 years). Four affected pregnancies were associated with in utero death and each of these cases was associated with relatively extreme values of AFP, hCG, and uE3, including the three highest levels of hCG in the entire series of Down syndrome pregnancies. Twenty-nine (15 screen-positive and 14 screen-negative) affected pregnancies resulted in liveborns. Down syndrome pregnancies had a significantly shorter gestational term than controls, and Down syndrome babies were also lighter than controls, even after adjustment for sex and gestational age. In affected pregnancies, a low uE3 level appeared to be associated with a greater chance of a small-for-gestational age baby. No correlations could be demonstrated between AFP or hCG levels and gestational age-adjusted term weight. Based on this small series, it would appear that uE3 may be particularly useful in detecting those Down syndrome cases associated with small-for-gestational age fetuses. A very high hCG value may indicate a higher probability of fetal death.

High levels of PROM1 (CD133) transcript are a potential predictor of poor prognosis in medulloblastoma

PubMed Central

Raso, Alessandro; Mascelli, Samantha; Biassoni, Roberto; Nozza, Paolo; Kool, Marcel; Pistorio, Angela; Ugolotti, Elisabetta; Milanaccio, Claudia; Pignatelli, Sara; Ferraro, Manuela; Pavanello, Marco; Ravegnani, Marcello; Cama, Armando; Garrè, Maria Luisa; Capra, Valeria

2011-01-01

The surface marker PROM1 is considered one of the most important markers of tumor-initiating cells, and its expression is believed to be an adverse prognostic factor in gliomas and in other malignancies. To date, to our knowledge, no specific studies of its expression in medulloblastoma series have been performed. The aims of our study were to evaluate the expression profile of the PROM1 gene in medulloblastoma and to assess its possible role as a prognostic factor. The PROM1 gene expression was evaluated by quantitative– polymerase chain reaction on 45 medulloblastoma samples by using specific dye-labeled probe systems. A significantly higher expression of PROM1 was found both in patients with poorer prognosis (P= .007) and in those with metastasis (P= .03). Kaplan–Meier analysis showed that both overall survival (OS) and progression-free survival (PFS) were shorter in patients with higher PROM1 mRNA levels than in patients with lower expression, even when the desmoplastic cases were excluded (P= .0004 and P= .002, for OS and PFS for all cases, respectively; P= .002 and P= .008 for OS and PFS for nondesmoplastic cases, respectively). Cox regression model demonstrated that PROM1 expression is an independent prognostic factor (hazard ratio, 4.56; P= .008). The result was validated on an independent cohort of 42 cases by microarray-based analysis (P= .019). This work suggests that high mRNA levels of PROM1 are associated with poor outcome in pediatric medulloblastoma. Furthermore, high PROM1 expression levels seem to increase the likelihood of metastases. Such results need to be confirmed in larger prospective series to possibly incorporate PROM1 gene expression into risk classification systems to be used in the clinical setting. PMID:21486962

A Bayesian nonparametric approach to dynamical noise reduction

NASA Astrophysics Data System (ADS)

Kaloudis, Konstantinos; Hatjispyros, Spyridon J.

2018-06-01

We propose a Bayesian nonparametric approach for the noise reduction of a given chaotic time series contaminated by dynamical noise, based on Markov Chain Monte Carlo methods. The underlying unknown noise process (possibly) exhibits heavy tailed behavior. We introduce the Dynamic Noise Reduction Replicator model with which we reconstruct the unknown dynamic equations and in parallel we replicate the dynamics under reduced noise level dynamical perturbations. The dynamic noise reduction procedure is demonstrated specifically in the case of polynomial maps. Simulations based on synthetic time series are presented.

Linear phase compressive filter

DOEpatents

McEwan, Thomas E.

1995-01-01

A phase linear filter for soliton suppression is in the form of a laddered series of stages of non-commensurate low pass filters with each low pass filter having a series coupled inductance (L) and a reverse biased, voltage dependent varactor diode, to ground which acts as a variable capacitance (C). L and C values are set to levels which correspond to a linear or conventional phase linear filter. Inductance is mapped directly from that of an equivalent nonlinear transmission line and capacitance is mapped from the linear case using a large signal equivalent of a nonlinear transmission line.

Advanced interferometric synthetic aperture radar (InSAR) time series analysis using interferograms of multiple-orbit tracks: A case study on Miyake-jima

NASA Astrophysics Data System (ADS)

Ozawa, Taku; Ueda, Hideki

2011-12-01

InSAR time series analysis is an effective tool for detecting spatially and temporally complicated volcanic deformation. To obtain details of such deformation, we developed an advanced InSAR time series analysis using interferograms of multiple-orbit tracks. Considering only right- (or only left-) looking SAR observations, incidence directions for different orbit tracks are mostly included in a common plane. Therefore, slant-range changes in their interferograms can be expressed by two components in the plane. This approach estimates the time series of their components from interferograms of multiple-orbit tracks by the least squares analysis, and higher accuracy is obtained if many interferograms of different orbit tracks are available. Additionally, this analysis can combine interferograms for different incidence angles. In a case study on Miyake-jima, we obtained a deformation time series corresponding to GPS observations from PALSAR interferograms of six orbit tracks. The obtained accuracy was better than that with the SBAS approach, demonstrating its effectiveness. Furthermore, it is expected that higher accuracy would be obtained if SAR observations were carried out more frequently in all orbit tracks. The deformation obtained in the case study indicates uplift along the west coast and subsidence with contraction around the caldera. The speed of the uplift was almost constant, but the subsidence around the caldera decelerated from 2009. A flat deformation source was estimated near sea level under the caldera, implying that deceleration of subsidence was related to interaction between volcanic thermal activity and the aquifer.

Effect of Yeonryeonggobon-dan (YRGBD), an herbal complex, on glycemic control in patients with Type 2 diabetes mellitus: a case series.

PubMed

Kim, Jiman; Byun, A Ri; Kwon, Seungwon

2014-12-01

Diabetes mellitus has significant effects on the human body. Recently, herbal medicines have received attention as complementary anti-diabetic agents on the basis of the results of several experimental studies. We present a series of 38 cases that demonstrate the positive effect of Yeonryeonggobon-dan (YRGBD), an herbal complex, in lowering blood sugar levels in patients with uncontrolled type 2 diabetes mellitus. We reviewed the medical records of 38 patients treated with YRGBD. The types and doses of other hypoglycemic agents administered to the patients remained unchanged during treatment with YRGBD. After YRGBD therapy, the glycated haemoglobin level decreased from 76.16±19.90mmol/mol (9.11±1.82%) to 51.21±8.82mmol/mol (6.84±0.81%). There was a statistically significant difference between the glycated haemoglobin levels measured before and after treatment (paired t test, p<0.001). In the present study, we show the clinical effects of YRGBD on blood sugar control in patients with type 2 diabetes mellitus. Further clinical studies investigating the effects of YRGBD are needed. Copyright © 2014 Elsevier Ltd. All rights reserved.

Leading under Pressure: Leadership for Social Inclusion

ERIC Educational Resources Information Center

Muijs, Daniel; Ainscow, Mel; Dyson, Alan; Raffo, Carlo; Goldrick, Sue; Kerr, Kirstin; Lennie, Clare; Miles, Susie

2010-01-01

In this study we undertook to look at leadership issues specifically in relation to social inclusion, through a series of six case studies in three districts showing high levels of disadvantage. Findings indicated that schools' views on social inclusion could be typified as leaning towards three main orientations: (1) improving achievement and…

Education and Gender Egalitarianism: The Case of China

ERIC Educational Resources Information Center

Shu, Xiaoling

2004-01-01

This study examined Chinese attitudes toward women's careers, marriage rights, sexual freedom, and the importance of having sons using a 1991 national sample of individuals and community-level data and through a series of nested multilevel models. Education influences gender attitudes in multiple ways at both the micro- and macrolevels.…

The Relationship of Drawing and Mathematical Problem Solving: "Draw for Math" Tasks

ERIC Educational Resources Information Center

Edens, Kellah; Potter, Ellen

2007-01-01

This study examines a series of children's drawings ("Draw for Math" tasks) to determine the relationship of students' spatial understanding and mathematical problem solving. Level of spatial understanding was assessed by applying the framework of central conceptual structures suggested by Case (1996), a cognitive developmental researcher.…

Evaluation of the effects of climate and man intervention on ground waters and their dependent ecosystems using time series analysis

NASA Astrophysics Data System (ADS)

Gemitzi, Alexandra; Stefanopoulos, Kyriakos

2011-06-01

SummaryGroundwaters and their dependent ecosystems are affected both by the meteorological conditions as well as from human interventions, mainly in the form of groundwater abstractions for irrigation needs. This work aims at investigating the quantitative effects of meteorological conditions and man intervention on groundwater resources and their dependent ecosystems. Various seasonal Auto-Regressive Integrated Moving Average (ARIMA) models with external predictor variables were used in order to model the influence of meteorological conditions and man intervention on the groundwater level time series. Initially, a seasonal ARIMA model that simulates the abstraction time series using as external predictor variable temperature ( T) was prepared. Thereafter, seasonal ARIMA models were developed in order to simulate groundwater level time series in 8 monitoring locations, using the appropriate predictor variables determined for each individual case. The spatial component was introduced through the use of Geographical Information Systems (GIS). Application of the proposed methodology took place in the Neon Sidirochorion alluvial aquifer (Northern Greece), for which a 7-year long time series (i.e., 2003-2010) of piezometric and groundwater abstraction data exists. According to the developed ARIMA models, three distinct groups of groundwater level time series exist; the first one proves to be dependent only on the meteorological parameters, the second group demonstrates a mixed dependence both on meteorological conditions and on human intervention, whereas the third group shows a clear influence from man intervention. Moreover, there is evidence that groundwater abstraction has affected an important protected ecosystem.

Regenerative endodontics.

PubMed

Simon, S; Smith, A J

2014-03-01

Significant advances in our understanding of the biological processes involved in tooth development and repair at the cellular and molecular levels have underpinned the newly emerging area of regenerative endodontics. Development of treatment protocols based on exploiting the natural wound healing properties of the dental pulp and applying tissue engineering principles has allowed reporting of case series showing preservation of tissue vitality and apexogenesis. To review current case series reporting regenerative endodontics. Current treatment approaches tend to stimulate more reparative than regenerative responses in respect of the new tissue generated, which often does not closely resemble the physiological structure of dentine-pulp. However, despite these biological limitations, such techniques appear to offer significant promise for improved treatment outcomes. Improved biological outcomes will likely emerge from the many experimental studies being reported and will further contribute to improvements in clinical treatment protocols.

Fuzzy Inference System Approach for Locating Series, Shunt, and Simultaneous Series-Shunt Faults in Double Circuit Transmission Lines

PubMed Central

Swetapadma, Aleena; Yadav, Anamika

2015-01-01

Many schemes are reported for shunt fault location estimation, but fault location estimation of series or open conductor faults has not been dealt with so far. The existing numerical relays only detect the open conductor (series) fault and give the indication of the faulty phase(s), but they are unable to locate the series fault. The repair crew needs to patrol the complete line to find the location of series fault. In this paper fuzzy based fault detection/classification and location schemes in time domain are proposed for both series faults, shunt faults, and simultaneous series and shunt faults. The fault simulation studies and fault location algorithm have been developed using Matlab/Simulink. Synchronized phasors of voltage and current signals of both the ends of the line have been used as input to the proposed fuzzy based fault location scheme. Percentage of error in location of series fault is within 1% and shunt fault is 5% for all the tested fault cases. Validation of percentage of error in location estimation is done using Chi square test with both 1% and 5% level of significance. PMID:26413088

Intrinsic and induced isoproturon catabolic activity in dissimilar soils and soils under dissimilar land use.

PubMed

Reid, Brian J; Papanikolaou, Niki D; Wilcox, Ronah K

2005-02-01

The catabolic activity with respect to the systemic herbicide isoproturon was determined in soil samples by (14)C-radiorespirometry. The first experiment assessed levels of intrinsic catabolic activity in soil samples that represented three dissimilar soil series under arable cultivation. Results showed average extents of isoproturon mineralisation (after 240 h assay time) in the three soil series to be low. A second experiment assessed the impact of addition of isoproturon (0.05 microg kg(-1)) into these soils on the levels of catabolic activity following 28 days of incubation. Increased catabolic activity was observed in all three soils. A third experiment assessed levels of intrinsic catabolic activity in soil samples representing a single soil series managed under either conventional agricultural practice (including the use of isoproturon) or organic farming practice (with no use of isoproturon). Results showed higher (and more consistent) levels of isoproturon mineralisation in the soil samples collected from conventional land use. The final experiment assessed the impact of isoproturon addition on the levels of inducible catabolic activity in these soils. The results showed no significant difference in the case of the conventional farm soil samples while the induction of catabolic activity in the organic farm soil samples was significant.

[Audit of artificial nutrition in an intensive care unit].

PubMed

Blesa Malpica, A L; Salaverría Garzón, I; Prado López, L M; Simón García, M J; Reta Pérez, O; Ramos Polo, J

2001-01-01

To study compliance with an artificial nutrition protocol at an Intensive Care Unit. During a second stage and after introducing the modifications considered appropriate in the protocol, to verify its implementation and compare both series. REFERENCE POPULATION: All patients with artificial nutrition support were included. Artificial nutrition (AN) was deemed to be the dispensation of commercial preparations for enteral nutrition, formulas with amino acids and glucose and the parenteral provision of fat, including propofol in this case, even where it was the only source of energy. The provision of crystalloid solutions was not considered to be AN. The period of observation was two months in both cases. The provision of AN to all such patients was systematically recorded on a daily basis. After analysis of the first series, the members at the unit agreed to increase the nitrogen provision. A second series was recorded, with the data being collected for patients with AN during a similar period. The study of the first series revealed the provisions of energy and nitrogen were below theoretical levels (both in the corrected Harris-Benedict test and at the fixed prescription of 25 kcal/kg). In the second series, there was greater agreement between the theoretical values and the amounts actually received. The deviation in energy and nitrogen was significantly less in the second series. And although the total nitrogen load per patient did not reveal any differences, there were discrepancies in the daily provision per patient. On most days, the diet provided covered over 75% of the energy requirements. With parenteral nutrition on its own or in combination with enteral nutrition, the requirements of energy and nitrogen were exceeded. There were no differences between the two series. The type of provision was enteral on 55% of the days and parenteral on 18%. There was no difference in the type of provision between the two series, although there was a difference in the type of diet administered in that the second series saw a significant increase in the provision of hyperproteic diets, both enterally and through patenteral formulations, rising from 9-13 grammes to 18-20 grammes of nitrogen. Using the enteral route on its own, there was a discreet increase in the energy load in the second series, but this did not occur in the other types of provision. Both series revealed over-nutrition in terms of both calories and nitrogen when enteral and parenteral nutrition were used together, although there was no difference between the series. Early enteral nutrition is possible in critically-ill patients, while artificial nutrition was used most frequently and for longer in our patients. The existence of nutrition protocols allow acceptable levels of nutritional provision. Their controlled use allows the correction of deviations between real and theoretical provisions, customizing the nutrition for each patient. The use of parenteral formulas with high levels of nitrogen requires more accurate adjustment in order to avoid over-nutrition.

Visceral leishmaniasis mimicking systemic lupus erythematosus: Case series and a systematic literature review.

PubMed

Santana, Iuri Usêda; Dias, Blenda; Nunes, Eduardo Araújo Santana; Rocha, Francisco Airton Castro da; Silva, Francisco Saraiva; Santiago, Mittermayer Barreto

2015-06-01

Systemic lupus erythematosus (SLE) is an autoimmune disease that may present manifestations that resemble other diseases. Visceral leishmaniasis (VL) is a parasitic infection whose hallmarks may mimic SLE symptoms. Here, we report a case series and evaluate the published, scientific evidence of the relationship between SLE and VL infection. To assess original studies reporting cases of VL-infected patients presenting manifestations that are capable of leading to inappropriate suspicions of SLE or mimicking an SLE flare, we performed an extensive search in several scientific databases (MEDLINE, LILACS, SciELO, and Scopus). Two authors independently screened all citations and abstracts identified by the search strategy to identify eligible studies. Secondary references were additionally obtained from the selected articles. The literature search identified 53 eligible studies, but only 17 articles met our criteria. Among these, 10 lupus patients with VL mimicking an SLE flare and 18 cases of VL leading to unappropriated suspicions of SLE were described. The most common manifestations in patients infected with VL were intermittent fever, pancytopenia, visceromegaly, and increased serum level of acute phase reactants. The most frequent autoantibodies were antinuclear antibodies, rheumatoid factor, and direct Coombs' test. In endemic areas for VL, the diagnosis of SLE or its exacerbation may be a clinical dilemma. Hepatosplenomegaly or isolated splenomegaly was identified in the majority of the reported cases where VL occurred, leading to unappropriated suspicions of SLE or mimicking an SLE flare. Furthermore, the lack of response to steroids, the normal levels of complement proteins C3 and C4, and the increased level of transaminases suggest a possible infectious origin. Copyright © 2015 Elsevier Inc. All rights reserved.

A 10-session cognitive-behavioral therapy (CBT-T) for eating disorders: Outcomes from a case series of nonunderweight adult patients.

PubMed

Waller, Glenn; Tatham, Madeleine; Turner, Hannah; Mountford, Victoria A; Bennetts, Alison; Bramwell, Kate; Dodd, Julie; Ingram, Lauren

2018-03-01

Existing forms of evidence-based cognitive behavior therapy for eating disorders (CBT-ED) are relatively effective for nonunderweight cases. However, they are also expensive compared to CBT for other disorders. This study reports the first outcomes for a shorter, 10-session form of CBT-ED (CBT-T) for such cases, designed to be less demanding of resources. A case series of 106 nonunderweight eating disordered cases were considered for this effectiveness study. A protocolized 10-session version of CBT-ED was delivered by clinical assistants, under supervision. Measures assessed eating attitudes and behaviors, anxiety, depression, personality pathology, and the working alliance. Intention-to-treat analyses were used. Suitability, acceptability, working alliance ratings, and retention were all positive. Outcomes by the end of therapy and at three-month follow-up were positive for all symptoms, with levels of change, abstinence and remission that were comparable to those from effectiveness studies of longer forms of CBT. Higher levels of pretreatment anxiety predicted retention in treatment, but no factors predicted poorer response. Early change in eating attitudes and the working alliance were the strongest predictors of a positive response. This 10-session form of CBT-ED for nonunderweight eating disorders performed at a level that is comparable to versions of CBT-ED that are twice as long, despite being delivered by nonspecialist therapists. Replication and longer-term follow-ups are needed to ensure retained effects. However, CBT-T has promise as a therapy for use in a range of healthcare settings, to enhance access to treatment for such eating disorders. © 2018 Wiley Periodicals, Inc.

Pediatric colonic volvulus: A single-institution experience and review.

PubMed

Tannouri, Sami; Hendi, Aditi; Gilje, Elizabeth; Grissom, Leslie; Katz, Douglas

2017-06-01

Pediatric colonic volvulus is both rare and underreported. Existing literature consists only of case reports and small series. We present an analysis of cases (n=11) over 15 years at a single institution, focusing on workup and diagnosis. This was an institutional review board approved single-institution retrospective chart review of 11 cases of large bowel volvulus occurring over 15 years (2000-2015). In our series, the most common presenting symptoms were abdominal pain and distention. Afflicted patients often had prior abdominal surgery, a neurodevelopmental disorder or chronic constipation. Of the imaging modalities utilized in the 11 patients studied, colonic volvulus was correctly diagnosed by barium enema in 100% of both cases, CT in 55.6% of cases and by plain radiography of the abdomen in only 22.2%of cases. Colonic volvulus was confirmed by laparotomy in all cases. The cecum (n=5) was the most often affected colonic segment, followed by the sigmoid (n=3). Operative treatment mainly consisted of resection (63.6%) and ostomy creation (36.4%). Colopexy was performed in 18.2% of cases. Plain abdominal radiography may be performed as an initial diagnostic study, however, it should be followed CT or air or contrast enema in children where there is high clinical suspicion and who do not have indications for immediate laparotomy. CT may be the most specific and useful test in diagnosis of colonic volvulus and has the added advantage of detection of complications including bowel ischemia. We demonstrate a range of diagnostic and therapeutic modalities for pediatric colonic volvulus. This underscores the need for further study to draft standard best practices for this life-threatening condition. Prognosis Study: Level IV. Study of a Diagnostic Test: Level III. Copyright © 2017 Elsevier Inc. All rights reserved.

Diabetic Ketoacidosis—A Review of Cases at a University Medical Center

PubMed Central

Kiraly, John F.; Becker, Charles E.; Williams, Hibbard E.

1970-01-01

Twenty-five cases of diabetic ketoacidosis were studied retrospectively with respect to clinical characteristics and results of therapy. In this series (as with all 88 patients admitted in the last five years with a diagnosis of diabetic ketoacidosis) there were no deaths. Infection was found to be the most common precipitating event, documented by physical findings and cultures in one-third of these cases. In about two-thirds of the cases, electrocardiograms which were read as abnormal on admission reverted to normal after therapy. In all patients serum potassium levels decreased from admission values; one patient became symptomatically hypokalemic. Low serum potassium levels on admission and early vigorous bicarbonate therapy are emphasized as major predisposing factors of symptomatic hypokalemia. None of the patients had overt hyperosmolar coma, lactic acidosis or cerebral edema during therapy. PMID:4985288

Posterior approach and dislocation rate: a 213 total hip replacements case-control study comparing the dual mobility cup with a conventional 28-mm metal head/polyethylene prosthesis.

PubMed

Bouchet, R; Mercier, N; Saragaglia, D

2011-02-01

Dislocation is a frequent complication of total hip arthroplasties (THA) especially in older patients, especially when using a posterior approach. In these cases, dual mobility (DM) cups developed by Gilles Bousquet in 1975 can be indicated to reduce this complication risk. Dual mobility cups reduce the rate of dislocation in primary total hip arthroplasty using posterior approach in a single-surgeon series. Test this hypothesis in a controlled study to compare the rate of dislocation in primary total hip arthroplasties done in patients over 50 years old either with a dual mobility cup or a conventional metal-on-polyethylene 28-mm diameter head. Two consecutive series of primary total hip replacements were performed by a single surgeon using a posterolateral approach. The piriformis tendon was left intact. The DM series included 105 patients who underwent arthroplasty between January 2005 and June 2007 with a dual mobility cup (60 women and 45 men, mean age 76.6±5.65 years old [53-93]). The control series (S series) included 108 patients who underwent arthroplasty (56 women and 52 men, mean age 74.2±5.9 years old [53-87]) with a conventional 28-mm polyethylene cup between January 2003 and June 2005. All hip replacements included a 28-mm metal-polyethylene cup and a 12-14-mm Morse taper. Both groups were comparable for gender, diagnosis, body mass index, type of anesthesia and ASA score distribution. All patients included in this series had a minimum follow-up of 1 year. There were no dislocations in the DM series and five early dislocations (before the third month) in the S series for a rate of 4.63%. Although the rate of dislocation was higher in the S series (4.63% vs 0%), the difference was barely significant (P=0.0597). This study comparing the incidence of dislocations after THA with conventional or dual mobility cups, shows that even using a posterior approach and in older patients, dual mobility cups increase stability with no postoperative dislocations. Although results are barely significant, a larger series should confirm the benefit of this implant. In this series, morbidity was not increased with dual mobility cups. Level III: retrospective case-control study. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

Impacts of a mass vaccination campaign against pandemic H1N1 2009 influenza in Taiwan: a time-series regression analysis.

PubMed

Wu, Un-In; Wang, Jann-Tay; Chang, Shan-Chwen; Chuang, Yu-Chung; Lin, Wei-Ru; Lu, Min-Chi; Lu, Po-Liang; Hu, Fu-Chang; Chuang, Jen-Hsiang; Chen, Yee-Chun

2014-06-01

A multicenter, hospital-wide, clinical and epidemiological study was conducted to assess the effectiveness of the mass influenza vaccination program during the 2009 H1N1 influenza pandemic, and the impact of the prioritization strategy among people at different levels of risk. Among the 34 359 medically attended patients who displayed an influenza-like illness and had a rapid influenza diagnostic test (RIDT) at one of the three participating hospitals, 21.0% tested positive for influenza A. The highest daily number of RIDT-positive cases in each hospital ranged from 33 to 56. A well-fitted multiple linear regression time-series model (R(2)=0.89) showed that the establishment of special community flu clinics averted an average of nine cases daily (p=0.005), and an increment of 10% in daily mean level of population immunity against pH1N1 through vaccination prevented five cases daily (p<0.001). Moreover, the regression model predicted five-fold or more RIDT-positive cases if the mass influenza vaccination program had not been implemented, and 39.1% more RIDT-positive cases if older adults had been prioritized for vaccination above school-aged children. Mass influenza vaccination was an effective control measure, and school-aged children should be assigned a higher priority for vaccination than older adults during an influenza pandemic. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Acute unclassified leukemia: A clinicopathologic study with diagnostic implications of electron microscopy.

PubMed

Youness, E; Trujillo, J M; Ahearn, M J; McCredie, K B; Cork, A

1980-01-01

By rigid cytological and cytochemical criteria, the diagnosis of acute and undifferentiated leukemia was established in 22 patients. According to defined criteria, the leukemic cells could not be classified by conventional light microscopic techniques employed in the study of hematopoietic tissue. Cytochemical studies including peroxidase, periodic acid schiff (PAS) and nonspecific esterase (alpha napthyl butyrate-reacting esterase) stains were done on fresh bone marrow samples, and the percentage of positive leukemia cells for each of these stains was determined on 200 cells. In this series of leukemias, cytochemistry at the light microscope level did not contribute to further classification. Subsequent electron microscopic examination of bone marrow samples from these patients confirmed the immaturity and nuclear/cytoplasmic asynchrony of the leukemic cells. Several in vivo neoplastic markers, such as nuclear blebs, increased nuclear bodies, and cytoplasmic fibrillar bundles could be demonstrated in these cells. Fourteen cases from this series exhibited peroxidase-positive developmental granule formation at the ultrastructural level and were reclassified as acute granulocyte leukemia (AGL). One case was reclassified as lymphoma (poor differentiated type), one case was diagnosed as acute monocytic leukemia (AmonoL), and six cases remained in the undifferentiated category (AUL). Clinical and laboratory features, response to treatment, and survival data were evaluated for these patients. This study demonstrated that electron microscopy is useful in the cytological diagnosis of human leukemia.

Validation of a new algorithm for a quick and easy RT-PCR-based ALK test in a large series of lung adenocarcinomas: Comparison with FISH, immunohistochemistry and next generation sequencing assays.

PubMed

Marchetti, Antonio; Pace, Maria Vittoria; Di Lorito, Alessia; Canarecci, Sara; Felicioni, Lara; D'Antuono, Tommaso; Liberatore, Marcella; Filice, Giampaolo; Guetti, Luigi; Mucilli, Felice; Buttitta, Fiamma

2016-09-01

Anaplastic Lymphoma Kinase (ALK) gene rearrangements have been described in 3-5% of lung adenocarcinomas (ADC) and their identification is essential to select patients for treatment with ALK tyrosine kinase inhibitors. For several years, fluorescent in situ hybridization (FISH) has been considered as the only validated diagnostic assay. Currently, alternative methods are commercially available as diagnostic tests. A series of 217 ADC comprising 196 consecutive resected tumors and 21 ALK FISH-positive cases from an independent series of 702 ADC were investigated. All specimens were screened by IHC (ALK-D5F3-CDx-Ventana), FISH (Vysis ALK Break-Apart-Abbott) and RT-PCR (ALK RGQ RT-PCR-Qiagen). Results were compared and discordant cases subjected to Next Generation Sequencing. Thirty-nine of 217 samples were positive by the ALK RGQ RT-PCR assay, using a threshold cycle (Ct) cut-off ≤35.9, as recommended. Of these positive samples, 14 were negative by IHC and 12 by FISH. ALK RGQ RT-PCR/FISH discordant cases were analyzed by the NGS assay with results concordant with FISH data. In order to obtain the maximum level of agreement between FISH and ALK RGQ RT-PCR data, we introduced a new scoring algorithm based on the ΔCt value. A ΔCt cut-off level ≤3.5 was used in a pilot series. Then the algorithm was tested on a completely independent validation series. By using the new scoring algorithm and FISH as reference standard, the sensitivity and the specificity of the ALK RGQ RT-PCR(ΔCt) assay were 100% and 100%, respectively. Our results suggest that the ALK RGQ RT-PCR test could be useful in clinical practice as a complementary assay in multi-test diagnostic algorithms or even, if our data will be confirmed in independent studies, as a standalone or screening test for the selection of patients to be treated with ALK inhibitors. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

A COMBINED TREATMENT APPROACH EMPHASIZING IMPAIRMENT-BASED MANUAL THERAPY AND EXERCISE FOR HIP-RELATED COMPENSATORY INJURY IN ELITE ATHLETES: A CASE SERIES.

PubMed

Short, Steve; Short, Gretchen; Strack, Donald; Anloague, Philip; Brewster, Brian

2017-11-01

Athletes experiencing hip, groin, and low back pain often exhibit similar clinical characteristics. Individuals with hip, groin and low back pain may have the presence of multiple concurrent pathoanatomical diagnoses. Regardless, similar regional characteristics and dysfunction may contribute to the patient's chief complaint, potentially creating a sub-group of individuals that may be defined by lumbopelvic and hip mobility limitations, motor control impairments, and other shared clinical findings. The purpose of this case series is to describe the conservative management of elite athletes, within the identified aforementioned sub-group, that emphasized regional manual therapy interventions, and therapeutic exercise designed to improve lumbopelvic and hip mobility, stability and motor control. Five elite athletes were clinically diagnosed by a physical therapist with primary pathologies including adductor-related groin pain (ARGP), femoral acetabular impingement (FAI) with acetabular labral lesion and acute, mechanical low back pain (LBP). Similar subjective, objective findings and overall clinical profiles were identified among all subjects. Common findings aside from the chief complaint included, but were not limited to, decreased hip range of motion (ROM), impaired lumbopelvic motor control and strength, lumbar hypomobility in at least one segment, and a positive hip flexion-adduction-internal rotation (FADIR) special test. A three-phase impairment-based physical therapy program was implemented to resolve the primary complaints and return the subjects to their desired level of function. Acute phase rehabilitation consisted of manual therapy and fundamental motor control exercises. Progression to the sub-acute and terminal phases was based on improved subjective pain reports and progress with functional impairments. As the subjects progress through the rehabilitation phases, the delivery of physical therapy interventions were defined by decreased manual therapies and an increased emphasis and priority on graded exercise. Significant reductions in reported pain (>2 points Numeric Pain Rating Scale), improved reported function via functional outcome measures (Hip and Groin Outcome Score), and continued participation in sport occurred in all five cases without the need for surgical intervention. The athletes described in this case series make up a common clinical sub-group defined by hip and lumbopelvic mobility restrictions, lumbopelvic and lower extremity motor control impairments and potentially other shared clinical findings. Despite differences in pathoanatomic findings, similar objective findings were identified and similar treatment plans were applied, potentially affecting the movement system as a whole. Subjects were conservatively managed allowing continued participation in sport within their competitive seasons. Comprehensive conservative treatment of the athletes with shared impairments, as described in this case series, may be of clinical importance when managing athletes with hip, groin, and low back pain. Therapy, Level 4, Case Series.

Case reports and case series in prehospital emergency care research.

PubMed

Patterson, P Daniel; Weaver, Matthew; Clark, Sunday; Yealy, Donald M

2010-11-01

Research begins with a clearly stated question, problem or hypothesis. The selection of a study design appropriate to the task is the next key step. This paper provides guidance for the use of case report and case series designs by describing the 'what', 'when' and 'how' of both designs. Also described is the use of case reports and case series study designs in prehospital emergency research and the quality of published literature from 2000 to mid-2008.

Photoionization of N 2X ¹Σ g⁺, v"=0 and 1 near threshold. Preionization of the Worley–Jenkins Rydberg series.

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

Dehmer, Patricia M.; Miller, P. J.; Chupka, W. A.

The high resolution relative photoionization cross section for N 2 is reported in the wavelength region from the ionization threshold to 650 Â, with particular attention given to the region between the N₂⁺ X ²Σ g⁺, v'=0 and 1 ionization limits. Cross sections from both the X ¹Σ g⁺, v''=0 and 1 vibrational levels were determined in this region, and preionized members of the n ρπ u ¹Π u Worley–Jenkins Rydberg series converging to N₂⁺ X ²Σ g⁺, v' = 1 are observed in both spectra. In the spectrum excited from v'' = 1, the Worley–Jenkins series appears prominently asmore » a result of good Franck–Condon overlap between the N₂⁺ X ¹Σ g, v"=1 and the N₂⁺ X ²Σ g⁺, v'=1 levels; the intensities of the series members decrease approximately as 1/n³, in accord with simple theoretical predictions. However, in the spectrum excited from v''=0, the Worley–Jenkins series converging to N₂⁺ X ²Σ g⁺, v'=1 is weak as a result of a poor Franck–Condon overlap with the ground vibrational level; the intensities of the series members show large deviations from the simple theory as a result of channel interactions with Rydberg states converging to N₂ ⁺A ²Π u. These perturbing Rydberg states have low photoabsorptionoscillator strengths for excitation from v"=1 (in contrast to excitation from v"=0) and hence have only a small effect on the cross section from the excited vibrational level. Just as in the case of photoionization of H₂, the results demonstrate that channel interaction can redistribute the oscillator strength of a perturbing Rydberg state of low principal quantum number over a number of members of an interacting Rydberg series and that the spectral range affected by the perturber can be much greater than the width of the perturbing level.« less

A multi-tiered time-series modelling approach to forecasting respiratory syncytial virus incidence at the local level.

PubMed

Spaeder, M C; Fackler, J C

2012-04-01

Respiratory syncytial virus (RSV) is the most common cause of documented viral respiratory infections, and the leading cause of hospitalization, in young children. We performed a retrospective time-series analysis of all patients aged <18 years with laboratory-confirmed RSV within a network of multiple affiliated academic medical institutions. Forecasting models of weekly RSV incidence for the local community, inpatient paediatric hospital and paediatric intensive-care unit (PICU) were created. Ninety-five percent confidence intervals calculated around our models' 2-week forecasts were accurate to ±9·3, ±7·5 and ±1·5 cases/week for the local community, inpatient hospital and PICU, respectively. Our results suggest that time-series models may be useful tools in forecasting the burden of RSV infection at the local and institutional levels, helping communities and institutions to optimize distribution of resources based on the changing burden and severity of illness in their respective communities.

Dynamic Mesh Adaptation for Front Evolution Using Discontinuous Galerkin Based Weighted Condition Number Mesh Relaxation

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

Greene, Patrick T.; Schofield, Samuel P.; Nourgaliev, Robert

2016-06-21

A new mesh smoothing method designed to cluster mesh cells near a dynamically evolving interface is presented. The method is based on weighted condition number mesh relaxation with the weight function being computed from a level set representation of the interface. The weight function is expressed as a Taylor series based discontinuous Galerkin projection, which makes the computation of the derivatives of the weight function needed during the condition number optimization process a trivial matter. For cases when a level set is not available, a fast method for generating a low-order level set from discrete cell-centered elds, such as amore » volume fraction or index function, is provided. Results show that the low-order level set works equally well for the weight function as the actual level set. Meshes generated for a number of interface geometries are presented, including cases with multiple level sets. Dynamic cases for moving interfaces are presented to demonstrate the method's potential usefulness to arbitrary Lagrangian Eulerian (ALE) methods.« less

Employment as a welder and Parkinson disease among heavy equipment manufacturing workers.

PubMed

Marsh, Gary M; Gula, Mary Jean

2006-10-01

We investigated whether employment as a welder with potential exposure to manganese and other substances is associated with Parkinson disease (PD), parkinsonism or related neurological disorders, or accelerates the age of onset of PD. We selected cases and controls from 12,595 persons ever employed at three Caterpillar Inc. (CAT) plants between 1976 and 2004 with potential to make a medical insurance claim between 1998 and 2004. Cases had filed a claim for 1) PD, 2) "secondary parkinsonism", 3) "other degenerative diseases of the basal ganglia" or 4) "essential and other specific forms of tremor". Cases were grouped by claims: Group 1-claims 1 and 2 and Group 2-claims 1 to 4, and as study period incident (SPI) or prevalent. Each case was matched to two series of 10 controls each on date of case's first claim, year of birth, race and sex. Series I was also matched on plant. Odds ratios (OR) and 95% confidence intervals (CI) for the variable, "ever welder in any CAT plant" were: Group 1-SPI Cases: Series I (OR = .76, CI = .26-2.19), Series II (OR = .81, CI = .29-2.25); Group 1- Prevalent Cases: Series I (OR = .82, CI = .36-1.86), Series II (OR = .97, CI = .42-2.23); Group 2- SPI Cases: Series I (OR = 1.03, CI = .57-1.87), Series II (OR = 1.21, CI = .67-2.20) Group 2-Prevalent Cases: Series I (OR = 1.02, CI = .62-1.71), Series II (OR = .86, CI = .51-1.43). Our finding of no statistically significant associations for welding employment was maintained following adjustment for potential confounding and evaluation of possible effect modification. Employment as a welder did not accelerate the age of onset of PD. Our study supported the conclusion that employment as a welder is not associated with Parkinson disease, parkinsonism or a related neurological disorder.

High definition spectral domain optical coherence tomography findings in three patients with solar retinopathy and review of the literature.

PubMed

Chen, Kevin C; Jung, Jesse J; Aizman, Alexander

2012-01-01

To describe ocular findings in 3 cases of solar retinopathy using high definition, spectral domain optical coherence tomography (SD-OCT) and review the literature for optical coherence tomography (OCT) characteristics associated with worse vision. Case series and retrospective review of clinical features and Spectralis SD-OCT (Heidelberg Engineering, Vista, California, United States of America). A literature review of OCT findings in cases of solar retinopathy reported on MEDLINE was also performed and analyzed. Six eyes of 3 patients with solar retinopathy revealed significant foveal pathology. Visual acuity ranged from Snellen 20/30 to 20/50. High definition SD-OCT demonstrated defects at the level of the inner and outer segment junction of the photoreceptors as well as in the inner high reflective layer. There was a significant correlation between chronic disruption of the inner photoreceptor junction with worse vision based on the current case series and literature review. Screening patients with exposure to central foveal damage from solar retinopathy with high definition SD-OCT improves diagnosis and assessment of photoreceptor damage and vision loss.

Inflammatory myoglandular colorectal polyps: a series of seven cases and review of literature.

PubMed

Becheanu, G; Gheorghe, C; Dumbravă, M; Serban-Barbu, V; Diculescu, M

2011-01-01

Inflammatory myoglandular polyp is an unusual but distinct, non-neoplastic type of colorectal polyp, commonly with a distal localization at the recto-sigmoidian level. It was first described in 1992 by Nakamura and his colleagues and it is considered to have few particular histological features. We report a series of seven cases (two male and five female patients) of myoglandular polyps with different localization from 15 to 40 cm from anus. Only four out of seven cases presented with rectal bleeding, the others polyps we incidentally discovered. The polyps varied between 4 and 30 mm in the maximum diameter. Grossly, they had firm consistency and smooth reddish surface. Histological examination of the specimens revealed hyperplastic glands with occasional cystic dilatation, proliferation of smooth muscle with no regular distribution, a variable amount of granulation tissue (usually minimal) and no evidence of epithelial dysplasia. All the lesions were removed endoscopically without any complications. Inflammatory myoglandular polyps are distinct histopathological entities, with insufficiently investigated pathogenesis that can include local trauma, mucosal prolapse or ischemia. Being benign they can be removed endoscopically, surgical treatment being reserved in selected cases.

Low-level Light Therapy for Treatment of Diabetic Foot Ulcer: A Review of Clinical Experiences.

PubMed

Tchanque-Fossuo, Catherine N; Ho, Derek; Dahle, Sara E; Koo, Eugene; Isseroff, R Rivkah; Jagdeo, Jared

2016-07-01

Diabetic foot ulcers (DFU) represent a significant complication of diabetes mellitus (DM). DFU affect one in four patients with DM and treatments of DFU are limited and challenging. The management of DFU remains a significant healthcare and socioeconomic burden ($245 billion). There is a wide range of advanced therapies for DFU, but these are costly and have demonstrated only minimal efficacy in limited published studies. An emerging treatment modality to improve DFU and optimize wound healing is the use of low-level light therapy (LLLT). LLLT involves the use of light in the form of low-level or low-power laser or light emitting diodes to alter biochemical pathways, which may result in changes to cell shape, cell migration, and cell signaling.
To review published clinical experiences (case series and case reports) using LLLT for treatment of DFU, and provide evidence-based recommendations and future directions on the potential of LLLT as a therapeutic modality for DFU.
On January 16, 2016 we searched the published literature using databases: PubMed, EMBASE, CINAHL, and Web of Science with key terms: "diabetic foot" AND ("low level laser therapy" OR "low level light therapy" OR "LLLT" OR "light emitting diode" OR "phototherapy" OR "laser").
After screening of titles, abstracts and/or full-text, 7 original articles were suitable in our review. Our review contains 5 case series and 2 case reports that evaluated LLLT for treatment of DFU, and all reviewed studies have shown positive improvement of DFU using LLLT with no adverse events, albeit with limitations that may be minimized with future RCTs.
LLLT is an emerging and promising treatment modality to current alternatives that are costly and have shown limited success. Based upon the published evidence, we envision additional research may allow for stronger recommendation with LLLT for treatment of DFU.

J Drugs Dermatol. 2016;15(7):843-848.

Ultrasound-guided stellate ganglion blocks combined with pharmacological and occupational therapy in Complex Regional Pain Syndrome (CRPS): a pilot case series ad interim.

PubMed

Wei, Karin; Feldmann, Robert E; Brascher, Anne-Kathrin; Benrath, Justus

2014-12-01

This preliminary and retrospective pilot case series examines a treatment concept consisting of ultrasound-guided stellate ganglion blocks (SGBs) combined with pharmacological and occupational therapy in patients with complex regional pain syndrome (CRPS) of the hand. Efficacy of combined treatment concepts and safety of ultrasound-guided SGB have not been sufficiently investigated yet. A total number of 156 blocks were evaluated in 16 patients with CRPS in a retrospective analysis. All patients received pharmacotherapy and a standard regimen of occupational therapy offered simultaneously to the SGBs. Changes in both spontaneous and evoked pain levels were assessed by numerical pain rating score before and after the last blockade of a series. Side effects were documented. The overall mean pain reduction was 63.2% regarding spontaneous and 45.3% regarding evoked pain. Mild complications, such as hoarseness or dysphagia, occurred in 13.5% of the blocks (21 SGBs). Serious complications, such as plexus paresis or accidental puncture of vessels or other structures, did not occur. Time between symptom onset and start of treatment did not affect the extent of pain reduction. The combination of ultrasound-guided SGB and simultaneous pharmacological and occupational therapy showed encouraging treatment results under conditions of this pilot case series. Assessment of efficacy of this combined treatment concept and safety of ultrasound-guided SGB require further prospective clinical studies with larger number of participants. Wiley Periodicals, Inc.

The Industrial Manufacturing Technician Apprenticeship. Work-Based Learning in Action

ERIC Educational Resources Information Center

Scott, Geri

2016-01-01

This case study, one of a series of publications exploring effective and inclusive models of work-based learning, finds that entry-level occupations in manufacturing have historically been considered unskilled jobs for which little or no training is necessary. As a consequence, employers have experienced high turnover among new-hires, and…

Organizational Mechanisms and Practice of Innovative Talents Cultivation in Local Colleges--A Case Study of Hubei University

ERIC Educational Resources Information Center

Hu, Xin; Wan, Hong; Yang, Dejin; Shen, Xi

2018-01-01

The organizational mechanisms of innovative talents cultivation in Hubei University are as follows. Firstly, make top-level design on organizational administration such as improving the organization structure, setting up a committee of teaching instruction, establishing the mechanism of coordinative cultivation. Secondly, carry out a series of…

Statistical Analysis and Time Series Modeling of Air Traffic Operations Data From Flight Service Stations and Terminal Radar Approach Control Facilities : Two Case Studies

DOT National Transportation Integrated Search

1981-10-01

Two statistical procedures have been developed to estimate hourly or daily aircraft counts. These counts can then be transformed into estimates of instantaneous air counts. The first procedure estimates the stable (deterministic) mean level of hourly...

How Do Students' Behaviors Relate to the Growth of Their Mathematical Ideas?

ERIC Educational Resources Information Center

Warner, Lisa B.

2008-01-01

The purpose of this study is to analyze the relationship between student behaviors and the growth of mathematical ideas (using the Pirie-Kieren model). This analysis was accomplished through a series of case studies, involving middle school students of varying ability levels, who were investigating a combinatorics problem in after-school…

The Validity of the Comparative Interrupted Time Series Design for Evaluating the Effect of School-Level Interventions.

PubMed

Jacob, Robin; Somers, Marie-Andree; Zhu, Pei; Bloom, Howard

2016-06-01

In this article, we examine whether a well-executed comparative interrupted time series (CITS) design can produce valid inferences about the effectiveness of a school-level intervention. This article also explores the trade-off between bias reduction and precision loss across different methods of selecting comparison groups for the CITS design and assesses whether choosing matched comparison schools based only on preintervention test scores is sufficient to produce internally valid impact estimates. We conduct a validation study of the CITS design based on the federal Reading First program as implemented in one state using results from a regression discontinuity design as a causal benchmark. Our results contribute to the growing base of evidence regarding the validity of nonexperimental designs. We demonstrate that the CITS design can, in our example, produce internally valid estimates of program impacts when multiple years of preintervention outcome data (test scores in the present case) are available and when a set of reasonable criteria are used to select comparison organizations (schools in the present case). © The Author(s) 2016.

Central Tendon Injuries of Hamstring Muscles: Case Series of Operative Treatment

PubMed Central

Lempainen, Lasse; Kosola, Jussi; Pruna, Ricard; Puigdellivol, Jordi; Sarimo, Janne; Niemi, Pekka; Orava, Sakari

2018-01-01

Background: As compared with injuries involving muscle only, those involving the central hamstring tendon have a worse prognosis. Limited information is available regarding the surgical treatment of central tendon injuries of the hamstrings. Purpose: To describe the operative treatment and outcomes of central tendon injuries of the hamstrings among athletes. Study Design: Case series; Level of evidence, 4. Methods: Eight athletes (6 top level, 2 recreational) with central hamstring tendon injuries underwent magnetic resonance imaging and surgical treatment. The indication for surgery was recurrent (n = 6) or acute (n = 2) central hamstring tendon injury. All patients followed the same postoperative rehabilitation protocol, and return to play was monitored. Results: Magnetic resonance imaging found a central tendon injury in all 3 hamstring muscles (long head of the biceps femoris, semimembranosus, and semitendinosus) with disrupted tendon ends. In acute and recurrent central tendon injuries, full return to play was achieved at 2.5 to 4 months. There were no adverse events during follow-up. Conclusion: Central tendon injuries of the hamstrings can be successfully repaired surgically after acute and recurrent ruptures. PMID:29479545

Medicinal cannabis (Bedrolite) substitution therapy in inpatients with a psychotic disorder and a comorbid cannabis use disorder: A case series.

PubMed

Schipper, Regi; Dekker, Mathilde; de Haan, Lieuwe; van den Brink, Wim

2018-03-01

Cannabis use disorders are frequently comorbid in patients with a psychotic disorder and are associated with worse outcomes. To date there are no proven effective strategies to achieve cannabis abstinence in this population. An alternative for abstinence might be harm reduction, i.e. replacing the use of street cannabis with high tetrahydrocannabinol and low cannabidiol levels by medicinal cannabis variants with relatively low tetrahydrocannabinol and relatively high cannabidiol levels, thereby reducing the psychosis inducing effects of cannabis and enhancing the antipsychotic effects of cannabis. Here we present the data of a case series with seven inpatients diagnosed with a psychotic disorder and a treatment-resistant cannabis use disorder who received substitution therapy with a low tetrahydrocannabinol medicinal cannabis variant (Bedrolite). The results suggest that the low tetrahydrocannabinol medicinal cannabis variant Bedrolite is not effective in the treatment of inpatients with a psychotic disorder and comorbid cannabis use disorder. Bedrolite is thus not very likely to become an effective harm reduction strategy in these patients.

Case Series Investigations in Cognitive Neuropsychology

PubMed Central

Schwartz, Myrna F.; Dell, Gary S.

2011-01-01

Case series methodology involves the systematic assessment of a sample of related patients, with the goal of understanding how and why they differ from one another. This method has become increasingly important in cognitive neuropsychology, which has long been identified with single-subject research. We review case series studies dealing with impaired semantic memory, reading, and language production, and draw attention to the affinity of this methodology for testing theories that are expressed as computational models and for addressing questions about neuroanatomy. It is concluded that case series methods usefully complement single-subject techniques. PMID:21714756

Acute toxicity in five dogs after ingestion of a commercial snail and slug bait containing iron EDTA.

PubMed

Haldane, S L; Davis, R M

2009-07-01

This case series of five dogs describes the effects of ingesting large amounts of an iron EDTA snail-bait product. In all cases signs of toxicity occurred between 6 and 24 h after ingestion and included abdominal pain and haemorrhagic gastroenteritis. Two of the dogs had pretreatment serum iron levels measured and in both cases the levels were above normal limits. All of the dogs were treated with iron chelation therapy and supportive care including intravenous fluids, analgesics, gastric protectants and antibiotics. Chelation therapy with desferrioxamine mesylate did not cause adverse effects in any of the dogs and all survived to discharge. The effects of iron EDTA snail bait in dogs requires further study and minimum toxic doses need to be established.

Factors Associated with Evidence-Based Clinical Questions Presented in a Vertically Integrated Seminar Series at a U.S. Dental School.

PubMed

Shenoy, Gayathri M; Dragan, Irina F; Pagni, Sarah; Murphy, Jennipher; Karimbux, Nadeem

2018-06-01

The Basic Science/Clinical Science Spiral Seminar Series (BaSiCSsss) was implemented at Tufts University School of Dental Medicine in 2013. In the series, teams of dental students from all four years presented components of a clinical case, supported by evidence-based dentistry concepts. The role of the third-year student on each team was to present questions based on the PICO (Population, Intervention, Comparison, Outcome) method to support the treatment plan for the selected case. The primary aim of this study was to identify the dental discipline from which the PICO question was chosen, and the secondary aim was to review the level of evidence (journal impact factor, study design, and year of publication) of sources used to support the PICO questions. Presentations compiled during the 2014-15 and 2015-16 academic years were reviewed. The PICO questions and additional details from the publications used as reference (choice of journal, year of publication, study design) were reviewed. A total of 224 presentations were reviewed. The results showed that most topics were from the subjects of periodontology and prosthodontics. Systematic reviews and cohort studies were the most often used types of study design. The majority of the articles cited were recently published. The students used supporting references for the clinical questions published recently with a high level of evidence.

Use of daptomycin in the treatment of vancomycin-resistant enterococcal urinary tract infections: a short case series.

PubMed

Ramaswamy, Divya Pradeep; Amodio-Groton, Maria; Scholand, Stephen J

2013-07-16

Vancomycin-resistant enterococci are a leading cause of hospital-acquired urinary tract infection and a growing concern for the clinician. The aim of this study was to evaluate the effectiveness of daptomycin in the treatment of patients with vancomycin-resistant enterococcal urinary tract infection treated in our 200-bed community-based institution. Patients with confirmed symptomatic vancomycin-resistant enterococcal urinary tract infection identified by infectious disease consultation between January 1, 2007, and December 8, 2009, vancomycin-resistant enterococci-positive urine culture, and urinary symptoms and/or pyuria on urinalysis, and treated with daptomycin, were included in this case series. Daptomycin was generally administered at a planned dosage regimen of ≥ 5 mg/kg every 24 hours in patients with normal to moderately impaired kidney function or every 48 hours in patients with severe kidney disease. Microbiologic cure was defined as eradication of vancomycin-resistant enterococci in urine cultures taken after the completion of daptomycin treatment. Clinical cure was defined by symptom resolution, as assessed by the infectious disease clinician caring for the patient. Included in this case series are 10 patients who received daptomycin for confirmed vancomycin-resistant enterococcal urinary tract infection. Patients had a history of extensive hospital stays. Chart review revealed that all levels of kidney function (3, 2, 3, and 2 patients with kidney disease classified as normal, mild, moderate, and severe/kidney failure, respectively) were represented in the sample and that patients with (n = 5) or without (n = 5) previous urinary tract infection and with (n = 3) or without (n = 7) Foley catheters were included. Treatment with daptomycin achieved clinical cure and vancomycin-resistant enterococcal eradication in all cases in this series. Treatment with daptomycin was well tolerated and effective in all patients in this series, regardless of renal function, history of urinary tract infection, or Foley catheter use. This study adds to emerging clinical evidence that daptomycin is a valuable treatment for vancomycin-resistant enterococcal urinary tract infection.

Back-Analyses of Landfill Instability Induced by High Water Level: Case Study of Shenzhen Landfill

PubMed Central

Peng, Ren; Hou, Yujing; Zhan, Liangtong; Yao, Yangping

2016-01-01

In June 2008, the Shenzhen landfill slope failed. This case is used as an example to study the deformation characteristics and failure mode of a slope induced by high water levels. An integrated monitoring system, including water level gauges, electronic total stations, and inclinometers, was used to monitor the slope failure process. The field measurements suggest that the landfill landslide was caused by a deep slip along the weak interface of the composite liner system at the base of the landfill. The high water level is considered to be the main factor that caused this failure. To calculate the relative interface shear displacements in the geosynthetic multilayer liner system, a series of numerical direct shear tests were carried out. Based on the numerical results, the composite lining system simplified and the centrifuge modeling technique was used to quantitatively evaluate the effect of water levels on landfill instability. PMID:26771627

Magneto-optical far-infrared absorption spectroscopy of the hole states of indium phosphide

NASA Astrophysics Data System (ADS)

Lewis, R. A.; Wang, Y.-J.

2005-03-01

Far-infrared absorption spectroscopy in magnetic fields of up to 30 T of the zinc acceptor impurity in indium phosphide has revealed for the first time a series of free-hole transitions (Landau-related series) in addition to the familiar bound-hole transitions (Lyman series) as well as hitherto unobserved phonon replicas of both series. Analysis of these data permits the simultaneous direct experimental determination of (i) the hole effective mass, (ii) the species-specific binding energy of the acceptor impurity, (iii) the absolute energy levels of the acceptor excited states of both odd and even parity, (iv) more reliable, and in some cases the only, g factors for acceptor states, through relaxation of the selection rules for phonon replicas, and (v) the LO phonon energy. The method is applicable to other semiconductors and may lead to the reappraisal of their physical parameters.

Clinical examination & record-keeping: Part 2: History taking.

PubMed

Hadden, A M

2017-12-15

This article is the second part of a BDJ series of Practice papers on the subject of clinical examination and related record keeping. The series is taken from the Faculty of General Dental Practice UK (FGDP[UK]) 2016 Good Practice Guidelines book on this topic, edited by A. M. Hadden. This particular article discusses history taking, where information may be gathered prior to the patient seeing the clinician or, in some cases, this may be carried out chairside by the individual. The information gathered can include a medical history, socio-behavioural history, and patient anxiety levels. It is important to note that throughout this article (and the BDJ series and associated FGDP[UK] book), the specific guidelines will be marked as follows: A: Aspirational, B: Basic, C: Conditional. Further information about this guideline notation system is provided in Part 1 of this series ( 2017; 223: 765-768).

Impact of Noise on a Dynamical System: Prediction and Uncertainties from a Swarm-Optimized Neural Network

PubMed Central

López-Caraballo, C. H.; Lazzús, J. A.; Salfate, I.; Rojas, P.; Rivera, M.; Palma-Chilla, L.

2015-01-01

An artificial neural network (ANN) based on particle swarm optimization (PSO) was developed for the time series prediction. The hybrid ANN+PSO algorithm was applied on Mackey-Glass chaotic time series in the short-term x(t + 6). The performance prediction was evaluated and compared with other studies available in the literature. Also, we presented properties of the dynamical system via the study of chaotic behaviour obtained from the predicted time series. Next, the hybrid ANN+PSO algorithm was complemented with a Gaussian stochastic procedure (called stochastic hybrid ANN+PSO) in order to obtain a new estimator of the predictions, which also allowed us to compute the uncertainties of predictions for noisy Mackey-Glass chaotic time series. Thus, we studied the impact of noise for several cases with a white noise level (σ N) from 0.01 to 0.1. PMID:26351449

Impact of Noise on a Dynamical System: Prediction and Uncertainties from a Swarm-Optimized Neural Network.

PubMed

López-Caraballo, C H; Lazzús, J A; Salfate, I; Rojas, P; Rivera, M; Palma-Chilla, L

2015-01-01

An artificial neural network (ANN) based on particle swarm optimization (PSO) was developed for the time series prediction. The hybrid ANN+PSO algorithm was applied on Mackey-Glass chaotic time series in the short-term x(t + 6). The performance prediction was evaluated and compared with other studies available in the literature. Also, we presented properties of the dynamical system via the study of chaotic behaviour obtained from the predicted time series. Next, the hybrid ANN+PSO algorithm was complemented with a Gaussian stochastic procedure (called stochastic hybrid ANN+PSO) in order to obtain a new estimator of the predictions, which also allowed us to compute the uncertainties of predictions for noisy Mackey-Glass chaotic time series. Thus, we studied the impact of noise for several cases with a white noise level (σ(N)) from 0.01 to 0.1.

Summary of: Regenerative endodontics.

PubMed

Clark, Stephen J

2014-03-01

Significant advances in our understanding of the biological processes involved in tooth development and repair at the cellular and molecular levels have underpinned the newly emerging area of regenerative endodontics. Development of treatment protocols based on exploiting the natural wound healing properties of the dental pulp and applying tissue engineering principles has allowed reporting of case series showing preservation of tissue vitality and apexogenesis. To review current case series reporting regenerative endodontics. Current treatment approaches tend to stimulate more reparative than regenerative responses in respect of the new tissue generated, which often does not closely resemble the physiological structure of dentine-pulp. However, despite these biological limitations, such techniques appear to offer significant promise for improved treatment outcomes. Improved biological outcomes will likely emerge from the many experimental studies being reported and will further contribute to improvements in clinical treatment protocols.

Towards understanding temporal and spatial dynamics of seagrass landscapes using time-series remote sensing

NASA Astrophysics Data System (ADS)

Lyons, Mitchell B.; Roelfsema, Chris M.; Phinn, Stuart R.

2013-03-01

The spatial and temporal dynamics of seagrasses have been well studied at the leaf to patch scales, however, the link to large spatial extent landscape and population dynamics is still unresolved in seagrass ecology. Traditional remote sensing approaches have lacked the temporal resolution and consistency to appropriately address this issue. This study uses two high temporal resolution time-series of thematic seagrass cover maps to examine the spatial and temporal dynamics of seagrass at both an inter- and intra-annual time scales, one of the first globally to do so at this scale. Previous work by the authors developed an object-based approach to map seagrass cover level distribution from a long term archive of Landsat TM and ETM+ images on the Eastern Banks (≈200 km2), Moreton Bay, Australia. In this work a range of trend and time-series analysis methods are demonstrated for a time-series of 23 annual maps from 1988 to 2010 and a time-series of 16 monthly maps during 2008-2010. Significant new insight was presented regarding the inter- and intra-annual dynamics of seagrass persistence over time, seagrass cover level variability, seagrass cover level trajectory, and change in area of seagrass and cover levels over time. Overall we found that there was no significant decline in total seagrass area on the Eastern Banks, but there was a significant decline in seagrass cover level condition. A case study of two smaller communities within the Eastern Banks that experienced a decline in both overall seagrass area and condition are examined in detail, highlighting possible differences in environmental and process drivers. We demonstrate how trend and time-series analysis enabled seagrass distribution to be appropriately assessed in context of its spatial and temporal history and provides the ability to not only quantify change, but also describe the type of change. We also demonstrate the potential use of time-series analysis products to investigate seagrass growth and decline as well as the processes that drive it. This study demonstrates clear benefits over traditional seagrass mapping and monitoring approaches, and provides a proof of concept for the use of trend and time-series analysis of remotely sensed seagrass products to benefit current endeavours in seagrass ecology.

Associations of daily pediatric asthma emergency department visits with air pollution in Newark, NJ: utilizing time-series and case-crossover study designs.

PubMed

Gleason, Jessie A; Fagliano, Jerald A

2015-10-01

Asthma is one of the most common chronic diseases affecting children. This study assesses the associations of ozone and fine particulate matter (PM2.5) with pediatric emergency department visits in the urban environment of Newark, NJ. Two study designs were utilized and evaluated for usability. We obtained daily emergency department visits among children aged 3-17 years with a primary diagnosis of asthma during April to September for 2004-2007. Both a time-stratified case-crossover study design with bi-directional control sampling and a time-series study design were utilized. Lagged effects (1-d through 5-d lag, 3-d average, and 5-d average) of ozone and PM2.5 were explored and a dose-response analysis comparing the bottom 5th percentile of 3-d average lag ozone with each 5 percentile increase was performed. Associations of interquartile range increase in same-day ozone were similar between the time-series and case-crossover study designs (RR = 1.08, 95% CI 1.04-1.12) and (OR = 1.10, 95% CI 1.06-1.14), respectively. Similar associations were seen for 1-day lag and 3-day average lag ozone levels. PM2.5 was not associated with the outcome in either study design. Dose-response assessment indicated a statistically significant and increasing association around 50-55 ppb consistent for both study designs. Ozone was statistically positively associated with pediatric asthma ED visits in Newark, NJ. Our results were generally comparable across the time-series and case-crossover study designs, indicating both are useful to assess local air pollution impacts.

Cervical lymph node metastases in squamous cell carcinoma of tongue and floor of mouth.

PubMed

Ehsan-ul-Haq, Muhammad; Warraich, Riaz Ahmed; Abid, Hina; Sajid, Malik Ali Hassan

2011-01-01

Oral squamous cell carcinoma has high chances of cervical lymph node metastasis. This case series describes the distribution of cervical lymph nodes in 50 cases of squamous cell carcinoma of tongue and floor of mouth. The mean age was 47.28±10.5 years. Thirty positive metastatic lymph nodes were found; 90% occurring at level I-II mostly in T4 size but also in T1 and T2 cases. The distribution of involved lymph nodes in oral cancer affects the neck dissection extent and is, therefore, an important pre-operative feature.

Using interrupted time series design to analyze changes in hand, foot, and mouth disease incidence during the declining incidence periods of 2008-2010 in China.

PubMed

Yu, Shi Cheng; Hao, Yuan Tao; Zhang, Jing; Xiao, Ge Xin; Liu, Zhuang; Zhu, Qi; Ma, Jia Qi; Wang, Yu

2012-12-01

To identify patterns of hand, foot and mouth disease (HFMD) incidence in China during declining incidence periods of 2008, 2009, and 2010. Reported HFMD cases over a period of 25 months were extracted from the National Disease Reporting System (NDRS) and analyzed. An interrupted time series (ITS) technique was used to detect changes in HFMD incidence rates in terms of level and slope between declining incidence periods of the three years. Over 3.58 million HFMD cases younger than 5 years were reported to the NDRS between May 1, 2008, and May 31, 2011. Males comprised 63.4% of the cases. ITS analyses demonstrated a significant increase in incidence rate level (P<0.0001) when comparing the current period with the previous period. There were significant changes in declining slopes when comparing 2010 to 2009, and 2010 to 2008 (all P<0.005), but not 2009 to 2008. Incremental changes in incidence rate level during the declining incidence periods of 2009 and 2010 can potentially be attributed to a few factors. The more steeply declining slope in 2010 compared with previous years could be ascribed to the implementation of more effective interventions and preventive strategies in 2010. Further investigation is required to examine this possibility. Copyright © 2012 The Editorial Board of Biomedical and Environmental Sciences. Published by Elsevier B.V. All rights reserved.

Linear phase compressive filter

DOEpatents

McEwan, T.E.

1995-06-06

A phase linear filter for soliton suppression is in the form of a laddered series of stages of non-commensurate low pass filters with each low pass filter having a series coupled inductance (L) and a reverse biased, voltage dependent varactor diode, to ground which acts as a variable capacitance (C). L and C values are set to levels which correspond to a linear or conventional phase linear filter. Inductance is mapped directly from that of an equivalent nonlinear transmission line and capacitance is mapped from the linear case using a large signal equivalent of a nonlinear transmission line. 2 figs.

A combined treatment approach emphasizing impairment-based manual physical therapy for plantar heel pain: a case series.

PubMed

Young, Brian; Walker, Michael J; Strunce, Joseph; Boyles, Robert

2004-11-01

Case series. To describe an impairment-based physical therapy treatment approach for 4 patients with plantar heel pain. There is limited evidence from clinical trials on which to base treatment decision making for plantar heel pain. Four patients completed a course of physical therapy based on an impairment-based model. All patients received manual physical therapy and stretching. Two patients were also treated with custom orthoses, and 1 patient received an additional strengthening program. Outcome measures included a numeric pain rating scale (NPRS) and self-reported functional status. Symptom duration ranged from 6 to 52 weeks (mean duration+/-SD, 33+/-19 weeks). Treatment duration ranged from 8 to 49 days (mean duration+/-SD, 23+/-18 days), with number of treatment sessions ranging from 2 to 7 (mode, 3). All 4 patients reported a decrease in NPRS scores from an average (+/-SD) of 5.8+/-2.2 to 0 (out of 10) during previously painful activities. Additionally, all patients returned to prior activity levels. In this case series, patients with plantar heel pain treated with an impairment-based physical therapy approach emphasizing manual therapy demonstrated complete pain relief and full return to activities. Further research is necessary to determine the effectiveness of impairment-based physical therapy interventions for patients with plantar heel pain/plantar fasciitis.

Telerehabilitation booster sessions and remote patient monitoring in the management of chronic low back pain: A case series.

PubMed

Peterson, Seth

2018-05-01

Improvements in chronic low back pain (CLBP) seen in physical therapy do not appear to be retained over the long term. Booster sessions have been proposed, but barriers exist to their implementation. Telerehabilitation (TR) and remote patient monitoring (RPM) may be ways to circumvent these barriers. The purpose of this case series was to describe the implementation of TR booster sessions and RPM in three patients with CLBP. Three females with CLBP tracked their daily pain level and home exercise program adherence using a mobile phone application for 12 months following discharge from traditional face-to-face physical therapy. Synchronous audio and video TR booster sessions were conducted at months 1, 3, 6, and 12. All patients met their individual goals. They demonstrated excellent home exercise program adherence and self-efficacy. A temporary increase in pain was seen in all patients, but they managed solely with the TR booster sessions and without other healthcare resources. Satisfaction with the program was very high. This case series describes the use of TR booster sessions and RPM in three patients with CLBP. The positive results suggest this approach may be helpful in improving long-term management of patients with CLBP but demand further investigation.

Seasonal dynamics of bacterial meningitis: a time-series analysis.

PubMed

Paireau, Juliette; Chen, Angelica; Broutin, Helene; Grenfell, Bryan; Basta, Nicole E

2016-06-01

Bacterial meningitis, which is caused mainly by Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae, inflicts a substantial burden of disease worldwide. Yet, the temporal dynamics of this disease are poorly characterised and many questions remain about the ecology of the disease. We aimed to comprehensively assess seasonal trends in bacterial meningitis on a global scale. We developed the first bacterial meningitis global database by compiling monthly incidence data as reported by country-level surveillance systems. Using country-level wavelet analysis, we identified whether a 12 month periodic component (annual seasonality) was detected in time-series that had at least 5 years of data with at least 40 cases reported per year. We estimated the mean timing of disease activity by computing the centre of gravity of the distribution of cases and investigated whether synchrony exists between the three pathogens responsible for most cases of bacterial meningitis. We used country-level data from 66 countries, including from 47 countries outside the meningitis belt in sub-Saharan Africa. A persistent seasonality was detected in 49 (96%) of the 51 time-series from 38 countries eligible for inclusion in the wavelet analyses. The mean timing of disease activity had a latitudinal trend, with bacterial meningitis seasons peaking during the winter months in countries in both the northern and southern hemispheres. The three pathogens shared similar seasonality, but time-shifts differed slightly by country. Our findings provide key insight into the seasonal dynamics of bacterial meningitis and add to knowledge about the global epidemiology of meningitis and the host, environment, and pathogen characteristics driving these patterns. Comprehensive understanding of global seasonal trends in meningitis could be used to design more effective prevention and control strategies. Princeton University Health Grand Challenge, US National Institutes of Health (NIH), NIH Fogarty International Center Research and Policy for Infectious Disease Dynamics programme (RAPIDD), Bill & Melinda Gates Foundation. Copyright © 2016 Paireau et al. Open Access article distributed under the terms of CC BY NC-ND. Published by Elsevier Ltd.. All rights reserved.

Isolated and synergistic effects of PM10 and average temperature on cardiovascular and respiratory mortality.

PubMed

Pinheiro, Samya de Lara Lins de Araujo; Saldiva, Paulo Hilário Nascimento; Schwartz, Joel; Zanobetti, Antonella

2014-12-01

OBJECTIVE To analyze the effect of air pollution and temperature on mortality due to cardiovascular and respiratory diseases. METHODS We evaluated the isolated and synergistic effects of temperature and particulate matter with aerodynamic diameter < 10 µm (PM10) on the mortality of individuals > 40 years old due to cardiovascular disease and that of individuals > 60 years old due to respiratory diseases in Sao Paulo, SP, Southeastern Brazil, between 1998 and 2008. Three methodologies were used to evaluate the isolated association: time-series analysis using Poisson regression model, bidirectional case-crossover analysis matched by period, and case-crossover analysis matched by the confounding factor, i.e., average temperature or pollutant concentration. The graphical representation of the response surface, generated by the interaction term between these factors added to the Poisson regression model, was interpreted to evaluate the synergistic effect of the risk factors. RESULTS No differences were observed between the results of the case-crossover and time-series analyses. The percentage change in the relative risk of cardiovascular and respiratory mortality was 0.85% (0.45;1.25) and 1.60% (0.74;2.46), respectively, due to an increase of 10 μg/m3 in the PM10 concentration. The pattern of correlation of the temperature with cardiovascular mortality was U-shaped and that with respiratory mortality was J-shaped, indicating an increased relative risk at high temperatures. The values for the interaction term indicated a higher relative risk for cardiovascular and respiratory mortalities at low temperatures and high temperatures, respectively, when the pollution levels reached approximately 60 μg/m3. CONCLUSIONS The positive association standardized in the Poisson regression model for pollutant concentration is not confounded by temperature, and the effect of temperature is not confounded by the pollutant levels in the time-series analysis. The simultaneous exposure to different levels of environmental factors can create synergistic effects that are as disturbing as those caused by extreme concentrations.

Seasonal dynamics of bacterial meningitis: a time-series analysis

PubMed Central

Paireau, Juliette; Chen, Angelica; Broutin, Helene; Grenfell, Bryan; Basta, Nicole E

2017-01-01

Summary Background Bacterial meningitis, which is caused mainly by Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae, inflicts a substantial burden of disease worldwide. Yet, the temporal dynamics of this disease are poorly characterised and many questions remain about the ecology of the disease. We aimed to comprehensively assess seasonal trends in bacterial meningitis on a global scale. Methods We developed the first bacterial meningitis global database by compiling monthly incidence data as reported by country-level surveillance systems. Using country-level wavelet analysis, we identified whether a 12 month periodic component (annual seasonality) was detected in time-series that had at least 5 years of data with at least 40 cases reported per year. We estimated the mean timing of disease activity by computing the centre of gravity of the distribution of cases and investigated whether synchrony exists between the three pathogens responsible for most cases of bacterial meningitis. Findings We used country-level data from 66 countries, including from 47 countries outside the meningitis belt in sub-Saharan Africa. A persistent seasonality was detected in 49 (96%) of the 51 time-series from 38 countries eligible for inclusion in the wavelet analyses. The mean timing of disease activity had a latitudinal trend, with bacterial meningitis seasons peaking during the winter months in countries in both the northern and southern hemispheres. The three pathogens shared similar seasonality, but time-shifts differed slightly by country. Interpretation Our findings provide key insight into the seasonal dynamics of bacterial meningitis and add to knowledge about the global epidemiology of meningitis and the host, environment, and pathogen characteristics driving these patterns. Comprehensive understanding of global seasonal trends in meningitis could be used to design more effective prevention and control strategies. Funding Princeton University Health Grand Challenge, US National Institutes of Health (NIH), NIH Fogarty International Center Research and Policy for Infectious Disease Dynamics programme (RAPIDD), Bill & Melinda Gates Foundation. PMID:27198841

GOATS - Orbitology Component

NASA Technical Reports Server (NTRS)

Haber, Benjamin M.; Green, Joseph J.

2010-01-01

The GOATS Orbitology Component software was developed to specifically address the concerns presented by orbit analysis tools that are often written as stand-alone applications. These applications do not easily interface with standard JPL first-principles analysis tools, and have a steep learning curve due to their complicated nature. This toolset is written as a series of MATLAB functions, allowing seamless integration into existing JPL optical systems engineering modeling and analysis modules. The functions are completely open, and allow for advanced users to delve into and modify the underlying physics being modeled. Additionally, this software module fills an analysis gap, allowing for quick, high-level mission analysis trades without the need for detailed and complicated orbit analysis using commercial stand-alone tools. This software consists of a series of MATLAB functions to provide for geometric orbit-related analysis. This includes propagation of orbits to varying levels of generalization. In the simplest case, geosynchronous orbits can be modeled by specifying a subset of three orbit elements. The next case is a circular orbit, which can be specified by a subset of four orbit elements. The most general case is an arbitrary elliptical orbit specified by all six orbit elements. These orbits are all solved geometrically, under the basic problem of an object in circular (or elliptical) orbit around a rotating spheroid. The orbit functions output time series ground tracks, which serve as the basis for more detailed orbit analysis. This software module also includes functions to track the positions of the Sun, Moon, and arbitrary celestial bodies specified by right ascension and declination. Also included are functions to calculate line-of-sight geometries to ground-based targets, angular rotations and decompositions, and other line-of-site calculations. The toolset allows for the rapid execution of orbit trade studies at the level of detail required for the early stage of mission concept development.

Dramatic and long-term lake level changes in the Qinghai-Tibet Plateau from Cryosat-2 altimeter: validation and augmentation by results from repeat altimeter missions and satellite imagery

NASA Astrophysics Data System (ADS)

Hwang, Cheinway; Huang, YongRuei; Cheng, Ys; Shen, WenBin; Pan, Yuanjin

2017-04-01

The mean elevation of the Qinghai-Tibet Plateau (QTP) exceeds 4000 m. Lake levels in the QTP are less affected by human activities than elsewhere, and may better reflect the state of contemporary climate change. Here ground-based lake level measurements are rare. Repeat altimeter missions, particularly those from the TOPEX and ERS series of altimetry, have provided long-term lake level observations in the QTP, but their large cross-track distances allow only few lakes to be monitored. In contrast, the Cryosat-2 altimeter, equipped with the new sensor SIRAL (interferometric/ synthetic aperture radar altimeter), provides a much better ranging accuracy and a finer spatial coverage than these repeated missions, and can detect water level changes over a large number of lakes in the QTP. In this study, Cryosat-2 data are used to determine lake level changes over 75˚E-100˚E and 28˚N-37.5˚N, where Cryosat-2 covers 60 lakes and SARAL/ AltiKa covers 32 lakes from 2013 to 2016. Over a lake, Cryosat-2 in different cycles can pass through different spots of the lake, making the numbers of observations non-uniform and requiring corrections for lake slopes. Four cases are investigated to cope with these situations: (1) neglecting inconsistency in data volume and lake slopes (2) considering data volume, (3) considering lake slopes only, and (4) considering both data volume and lake slopes. The CRYOSAT-2 result is then compared with the result from the SARAL to determine the best case. Because Cryosat-2 is available from 2010 to 2016, Jason-2 data are used to fill gaps between the time series of Cryosat-2 and ICESat (2003-2009) to obtain >10 years of lake level series. The Cryosat-2 result shows dramatic lake level rises in Lakes Kusai, Zhuoaihu and Salt in 2011 caused by floods. Landsat satellite imagery assists the determination and interpretation of such rises.

A novel water quality data analysis framework based on time-series data mining.

PubMed

Deng, Weihui; Wang, Guoyin

2017-07-01

The rapid development of time-series data mining provides an emerging method for water resource management research. In this paper, based on the time-series data mining methodology, we propose a novel and general analysis framework for water quality time-series data. It consists of two parts: implementation components and common tasks of time-series data mining in water quality data. In the first part, we propose to granulate the time series into several two-dimensional normal clouds and calculate the similarities in the granulated level. On the basis of the similarity matrix, the similarity search, anomaly detection, and pattern discovery tasks in the water quality time-series instance dataset can be easily implemented in the second part. We present a case study of this analysis framework on weekly Dissolve Oxygen time-series data collected from five monitoring stations on the upper reaches of Yangtze River, China. It discovered the relationship of water quality in the mainstream and tributary as well as the main changing patterns of DO. The experimental results show that the proposed analysis framework is a feasible and efficient method to mine the hidden and valuable knowledge from water quality historical time-series data. Copyright © 2017 Elsevier Ltd. All rights reserved.

Improvement of downscaled rainfall and temperature across generations over the Western Himalayan region of India

NASA Astrophysics Data System (ADS)

Das, L.; Dutta, M.; Akhter, J.; Meher, J. K.

2016-12-01

It is a challenging task to create station level (local scale) climate change information over the mountainous locations of Western Himalayan Region (WHR) in India because of limited data availability and poor data quality. In the present study, missing values of station data were handled through Multiple Imputation Chained Equation (MICE) technique. Finally 22 numbers of rain gauge and 16 number of temperature station data having continuous record during 1901­2005 and 1969­2009 period respectively were considered as reference stations for developing downscaled rainfall and temperature time series from five commonly available GCMs in the IPCC's different generation assessment reports namely 2nd, 3rd, 4th and 5th hereafter known as SAR, TAR, AR4 and AR5 respectively. Downscaled models were developed using the combined data from the ERA-interim reanalysis and GCMs historical runs (in spite of forcing were not identical in different generation) as predictor and station level rainfall and temperature as predictands. Station level downscaled rainfall and temperature time series were constructed for five GCMs available in each generation. Regional averaged downscaled time series comprising of all stations was prepared for each model and generation and the downscaled results were compared with observed time series. Finally an Overall Model Improvement Index (OMII) was developed using the downscaling results, which was used to investigate the model improvement across generations as well as the improvement of downscaling results obtained from the Empirical Statistical Downscaling (ESD) methods. In case of temperature, models have improved from SAR to AR5 over the study area. In all most all the GCMs TAR is showing worst performance over the WHR by considering the different statistical indices used in this study. In case of precipitation, no model has shown gradual improvement from SAR to AR5 both for interpolated and downscaled values.

Nursing Case Management, Peer Coaching, and Hepatitis A and B Vaccine Completion Among Homeless Men Recently Released on Parole: Randomized Clinical Trial

PubMed Central

Nyamathi, Adeline; Salem, Benissa E.; Zhang, Sheldon; Farabee, David; Hall, Betsy; Khalilifard, Farinaz; Leake, Barbara

2015-01-01

Background Although hepatitis A virus (HAV) and hepatitis B virus (HBV) infections are vaccine-preventable diseases, few homeless parolees coming out of prisons and jails have received the hepatitis A and B vaccination series. Objectives The study focused on completion of the HAV and HBV vaccine series among homeless men on parole. The efficacy of three levels of peer coaching and nurse-delivered interventions was compared at 12-month follow up: (a) intensive peer coaching and nurse case management (PC-NCM); (b) intensive peer coaching (PC) intervention condition, with minimal nurse involvement; and a (c) usual care (UC) intervention condition, which included minimal PC and nurse involvement. Further, we assessed predictors of vaccine completion among this targeted sample. Methods A randomized control trial was conducted with 600 recently paroled men to assess the impact of the three intervention conditions (PC-NCM vs. PC vs. UC) on reducing drug use and recidivism; of these, 345 seronegative, vaccine-eligible subjects were included in this analysis of completion of the Twinrix HAV/HAB vaccine. Logistic regression was added to assess predictors of completion of the HAV/HBV vaccine series and chi-squared analysis to compare completion rates across the three levels of intervention. Results Vaccine completion rate for the intervention conditions were 75.4% (PC-NCM), 71.8% (PC), and 71.9% (UC) (p =. 78). Predictors of vaccine noncompletion included being Asian and Pacific Islander, experiencing high levels of hostility, positive social support, reporting a history of injection drug use, being released early from California prisons, and being admitted for psychiatric illness. Predictors of vaccine series completion included reporting six or more friends, recent cocaine use, and staying in drug treatment for at least 90 days. Discussion Findings allow greater understanding of factors affecting vaccination completion in order to design more effective programs among the high-risk population of men recently released from prison and on parole. PMID:25932697

Nursing case management, peer coaching, and hepatitis a and B vaccine completion among homeless men recently released on parole: randomized clinical trial.

PubMed

Nyamathi, Adeline; Salem, Benissa E; Zhang, Sheldon; Farabee, David; Hall, Betsy; Khalilifard, Farinaz; Leake, Barbara

2015-01-01

Although hepatitis A virus (HAV) and hepatitis B virus (HBV) infections are vaccine-preventable diseases, few homeless parolees coming out of prisons and jails have received the hepatitis A and B vaccination series. The study focused on completion of the HAV and HBV vaccine series among homeless men on parole. The efficacy of three levels of peer coaching (PC) and nurse-delivered interventions was compared at 12-month follow-up: (a) intensive peer coaching and nurse case management (PC-NCM); (b) intensive PC intervention condition, with minimal nurse involvement; and (c) usual care (UC) intervention condition, which included minimal PC and nurse involvement. Furthermore, we assessed predictors of vaccine completion among this targeted sample. A randomized control trial was conducted with 600 recently paroled men to assess the impact of the three intervention conditions (PC-NCM vs. PC vs. UC) on reducing drug use and recidivism; of these, 345 seronegative, vaccine-eligible subjects were included in this analysis of completion of the Twinrix HAV/HBV vaccine. Logistic regression was added to assess predictors of completion of the HAV/HBV vaccine series and chi-square analysis to compare completion rates across the three levels of intervention. Vaccine completion rate for the intervention conditions were 75.4% (PC-NCM), 71.8% (PC), and 71.9% (UC; p = .78). Predictors of vaccine noncompletion included being Asian and Pacific Islander, experiencing high levels of hostility, positive social support, reporting a history of injection drug use, being released early from California prisons, and being admitted for psychiatric illness. Predictors of vaccine series completion included reporting having six or more friends, recent cocaine use, and staying in drug treatment for at least 90 days. Findings allow greater understanding of factors affecting vaccination completion in order to design more effective programs among the high-risk population of men recently released from prison and on parole.

Decompression sickness rates for chamber personnel: case series from one facility.

PubMed

Brandt, Megan S; Morrison, Thomas O; Butler, William P

2009-06-01

During 2004, a case series of decompression sickness (DCS) meeting the definition of epidemic DCS was observed in the Shaw AFB Physiological Training Program. There were 10 cases of chamber-induced altitude DCS observed. Internal and external investigations focused on time, place, person, and environment. No temporal trend was observed. Chamber, masks, regulators, crew positions, and oxygen sources revealed no defects. Among the cases, mean age was 27 yr. Peak altitude in four cases was 35,000 ft and in the other six cases was 25,000 ft. Six had joint pain, one skin symptoms, and three neurological findings. Four were treated with 100% ground-level oxygen and six with hyperbaric oxygen. Four were students and six were inside observers (IO). Four were women and six men. In the IO, where four of the six were women, no gender effect was seen. Examining the IO monthly exposure load (exposures per month) against DCS suggested a dose-response relationship. This relationship held true when 4 yr of Shaw AFB IO data was studied. Indeed, Poisson regression analysis demonstrated a statistically significant 2.1-fold rise in DCS risk with each monthly exposure. Consequently, the number of exposures per month may need to be considered when devising IO schedules.

Saturating time-delay transformer for overcurrent protection. [Patent application

DOEpatents

Praeg, W.F.

1975-12-18

Electrical loads connected to dc supplies are protected from damage by overcurrent in the case of a load fault by connecting in series with the load a saturating transformer that detects a load fault and limits the fault current to a safe level for a period long enough to correct the fault or else disconnect the power supply.

Open Classroom: Distance Learning In and Out of Schools. Open and Distance Learning Series.

ERIC Educational Resources Information Center

Bradley, Jo, Ed.

This collection of essays, which is separated into 4 sections, concerns open and distance learning at school level, or grades K-12. The first section, "The Knowledge Society," includes the following chapters: "Classroom Open Learning: A Case of Old Wine in New Bottles?" (Jenkins); "Living and Learning in the Information…

A Behavior-Based Circuit Model of How Outcome Expectations Organize Learned Behavior in Larval "Drosophila"

ERIC Educational Resources Information Center

Schleyer, Michael; Saumweber, Timo; Nahrendorf, Wiebke; Fischer, Benjamin; von Alpen, Desiree; Pauls, Dennis; Thum, Andreas; Gerber, Bertram

2011-01-01

Drosophila larvae combine a numerically simple brain, a correspondingly moderate behavioral complexity, and the availability of a rich toolbox for transgenic manipulation. This makes them attractive as a study case when trying to achieve a circuit-level understanding of behavior organization. From a series of behavioral experiments, we suggest a…

Adapting, Not Adopting: Barriers Affecting Teaching for Critical Thinking at Two Rwandan Universities

ERIC Educational Resources Information Center

Schendel, Rebecca

2016-01-01

A recent study of student learning at three of Rwanda's most prestigious public universities has suggested that Rwandan students are not improving in their critical thinking ability during their time at university. This article reports on a series of faculty-level case studies, which were conducted at two of the participating institutions in order…

Saturating time-delay transformer for overcurrent protection

DOEpatents

Praeg, Walter F.

1977-01-01

Electrical loads connected to d-c supplies are protected from damage by overcurrent in the case of a load fault by connecting in series with the load a saturating transformer that detects a load fault and limits the fault current to a safe level for a period long enough to correct the fault or else disconnect the power supply.

Engaging Teachers in the School Improvement Process. Turning Points: Recommendations into Action.

ERIC Educational Resources Information Center

Painter, Bryan; Valentine, Jerry

This publication is the second in a series of monographs developed as a resource for middle-level leaders. It presents case studies at three fictional schools to show variations in improvement efforts and to examine faculty members' participation in the process. The teachers at one school were informed about change initiatives but were never…

Restructuring Rural Communities. Part 2: Grazing the Ideas, Approaches, and Resources of Selected Countries. University Extension Press Monograph Series.

ERIC Educational Resources Information Center

Baker, Harold R.

This book examines cases of rural community development initiatives in the United States, Canada, and Europe, identified during a study of multicommunity collaboration projects. Section 1 includes 36 community development ideas operating at provincial, regional, and local levels. Included are ideas such as bank community development corporations,…

ADULT EDUCATION TECHNIQUES IN DEVELOPING COUNTRIES, A GREEK CASE STUDY. PROBLEMS OF DEVELOPMENT SERIES.

ERIC Educational Resources Information Center

FOURRE, PIERRE; AND OTHERS

AIDED BY THE ORGANIZATION FOR ECONOMIC COOPERATION AND DEVELOPMENT AND THE ORGANIZATION FOR EUROPEAN ECONOMIC COOPERATION, GREECE HAS ESTABLISHED A NETWORK OF ADULT EDUCATION CENTERS OUTSIDE TOWNS, TO MEET THE PROBLEMS OF ILLITERACY AND LOW EDUCATION LEVEL. THE CENTER PROVIDES FOR ACADEMIC AND LIBRARY PROGRAMS, SIX TO SEVEN MONTHS, AND RECREATION…

Retrospective testing and case series study of porcine delta coronavirus in U.S. swine herds.

PubMed

McCluskey, Brian J; Haley, Charles; Rovira, Albert; Main, Rodger; Zhang, Yan; Barder, Sunny

2016-01-01

Porcine deltacoronavirus (PDCoV) was first reported in the United States (US) in February 2014. This was the second novel swine enteric coronavirus detected in the US since May 2013. In this study, we conducted retrospective testing of samples submitted to three veterinary diagnostic laboratories where qualifying biological samples were derived from previously submitted diagnostic case submissions from US commercial swine farms with a clinical history of enteric disease or from cases that had been previously tested for transmissible gastroenteritis virus, PEDV, or rotavirus. Overall, 2286 banked samples were tested from 27 States. Samples were collected in 3 separate years and in 17 different months. Test results revealed 4 positive samples, 3 collected in August 2013 and 1 collected in October 2013. In addition, a case series including 42 operations in 10 States was conducted through administration of a survey. Survey data collected included information on characteristics of swine operations that had experienced PDCoV clinical signs. Special emphasis was placed on obtaining descriptive estimates of biosecurity practices and disease status over time of each operation. Clinical signs of PDCoV were reported to be similar to those of PEDV. The average number of animals on each operation exhibiting clinical signs (morbidity) and the average number of case fatalities was greatest for suckling and weaned pigs. Average operation-level weaned pig morbidity was greatest in the first week of the outbreak while average operation-level suckling pig case fatality was greatest in the second week of the outbreak. The survey included questions regarding biosecurity practices for visitors and operation employees; trucks, equipment and drivers; and feed sources. These questions attempted to identify a likely pathway of introduction of PDCoV onto the operations surveyed. Published by Elsevier B.V.

Risk of revision surgery for adult idiopathic scoliosis: a survival analysis of 517 cases over 25 years.

PubMed

Riouallon, Guillaume; Bouyer, Benjamin; Wolff, Stéphane

2016-08-01

Little is known about the long-term status of patients operated for spine deformities. The aim of this study was to determine the survival of primary fusion in adult idiopathic scoliosis and identify the risk factors of revision surgery. Adult patients who underwent primary fusion for idiopathic scoliosis between 1983 and 2011 were included in a continuous monocentric retrospective series. Any additional surgery was registered for survival analysis. Survival and follow-up were estimated by the Kaplan-Meier method and an analysis was performed to identify the risk factors of revision surgery. This series included 447 women (86.5 %) and 70 men (13.5 %) reviewed after a mean follow-up of 7 years (range 0-26.4). Mean age was 44.4 years. Fusion was performed on a median 11 levels (range 3-15); revision rate was 13 % (CI 10-17), 18 % (CI 14-23) and 20 % (CI 16-26) at 5, 10 and 15 years, respectively. Revision surgery was associated with age, anterior release, length of fusion, the inferior limit of fusion, post-operative sagittal balance and junctional kyphosis. The length of fusion (HR 1.13 per vertebrae fused, p = 0.007) and the lower limit of fusion (HR 5.9, p < 0.001) remained independent predictors of revision surgery on multivariate analysis. This series evaluated the risk of revision surgery following spinal fusion for idiopathic scoliosis. Our results show that the risk seemed to increase linearly with a rate of nearly 20 % after 10 years. The length and lower limit of fusion are the main risk factors for revision surgery. Level IV (e.g. case series).

To what extent does variability of historical rainfall series influence extreme event statistics of sewer system surcharge and overflows?

PubMed

Schaarup-Jensen, K; Rasmussen, M R; Thorndahl, S

2009-01-01

In urban drainage modelling long-term extreme statistics has become an important basis for decision-making e.g. in connection with renovation projects. Therefore it is of great importance to minimize the uncertainties with regards to long-term prediction of maximum water levels and combined sewer overflow (CSO) in drainage systems. These uncertainties originate from large uncertainties regarding rainfall inputs, parameters, and assessment of return periods. This paper investigates how the choice of rainfall time series influences the extreme events statistics of max water levels in manholes and CSO volumes. Traditionally, long-term rainfall series, from a local rain gauge, are unavailable. In the present case study, however, long and local rain series are available. 2 rainfall gauges have recorded events for approximately 9 years at 2 locations within the catchment. Beside these 2 gauges another 7 gauges are located at a distance of max 20 kilometers from the catchment. All gauges are included in the Danish national rain gauge system which was launched in 1976. The paper describes to what extent the extreme events statistics based on these 9 series diverge from each other and how this diversity can be handled, e.g. by introducing an "averaging procedure" based on the variability within the set of statistics. All simulations are performed by means of the MOUSE LTS model.

Cognitive neuropsychology and its vicissitudes: The fate of Caramazza's axioms.

PubMed

Shallice, Tim

2015-01-01

Cognitive neuropsychology is characterized as the discipline in which one draws conclusions about the organization of the normal cognitive systems from the behaviour of brain-damaged individuals. In a series of papers, Caramazza, later in collaboration with McCloskey, put forward four assumptions as the bridge principles for making such inferences. Four potential pitfalls, one for each axiom, are discussed with respect to the use of single-case methods. Two of the pitfalls also apply to case series and group study procedures, and the other two are held to be indirectly testable or avoidable. Moreover, four other pitfalls are held to apply to case series or group study methods. It is held that inferences from single-case procedures may profitably be supported or rejected using case series/group study methods, but also that analogous support needs to be given in the other direction for functionally based case series or group studies. It is argued that at least six types of neuropsychological method are valuable for extrapolation to theories of the normal cognitive system but that the single- or multiple-case study remains a critical part of cognitive neuropsychology's methods.

Medicaid payment rates, case-mix reimbursement, and nursing home staffing--1996-2004.

PubMed

Feng, Zhanlian; Grabowski, David C; Intrator, Orna; Zinn, Jacqueline; Mor, Vincent

2008-01-01

We examined the impact of state Medicaid payment rates and case-mix reimbursement on direct care staffing levels in US nursing homes. We used a recent time series of national nursing home data from the Online Survey Certification and Reporting system for 1996-2004, merged with annual state Medicaid payment rates and case-mix reimbursement information. A 5-category response measure of total staffing levels was defined according to expert recommended thresholds, and examined in a multinomial logistic regression model. Facility fixed-effects models were estimated separately for Registered Nurse (RN), Licensed Practical Nurse (LPN), and Certified Nurse Aide (CNA) staffing levels measured as average hours per resident day. Higher Medicaid payment rates were associated with increases in total staffing levels to meet a higher recommended threshold. However, these gains in overall staffing were accompanied by a reduction of RN staffing and an increase in both LPN and CNA staffing levels. Under case-mix reimbursement, the likelihood of nursing homes achieving higher recommended staffing thresholds decreased, as did levels of professional staffing. Independent of the effects of state, market, and facility characteristics, there was a significant downward trend in RN staffing and an upward trend in both LPN and CNA staffing. Although overall staffing may increase in response to more generous Medicaid reimbursement, it may not translate into improvements in the skill mix of staff. Adjusting for reimbursement levels and resident acuity, total staffing has not increased after the implementation of case-mix reimbursement.

An approach to checking case-crossover analyses based on equivalence with time-series methods.

PubMed

Lu, Yun; Symons, James Morel; Geyh, Alison S; Zeger, Scott L

2008-03-01

The case-crossover design has been increasingly applied to epidemiologic investigations of acute adverse health effects associated with ambient air pollution. The correspondence of the design to that of matched case-control studies makes it inferentially appealing for epidemiologic studies. Case-crossover analyses generally use conditional logistic regression modeling. This technique is equivalent to time-series log-linear regression models when there is a common exposure across individuals, as in air pollution studies. Previous methods for obtaining unbiased estimates for case-crossover analyses have assumed that time-varying risk factors are constant within reference windows. In this paper, we rely on the connection between case-crossover and time-series methods to illustrate model-checking procedures from log-linear model diagnostics for time-stratified case-crossover analyses. Additionally, we compare the relative performance of the time-stratified case-crossover approach to time-series methods under 3 simulated scenarios representing different temporal patterns of daily mortality associated with air pollution in Chicago, Illinois, during 1995 and 1996. Whenever a model-be it time-series or case-crossover-fails to account appropriately for fluctuations in time that confound the exposure, the effect estimate will be biased. It is therefore important to perform model-checking in time-stratified case-crossover analyses rather than assume the estimator is unbiased.

MINIMAL ENDOILLUMINATION LEVELS AND DISPLAY LUMINOUS EMITTANCE DURING THREE-DIMENSIONAL HEADS-UP VITREORETINAL SURGERY.

PubMed

Adam, Murtaza K; Thornton, Sarah; Regillo, Carl D; Park, Carl; Ho, Allen C; Hsu, Jason

2017-09-01

To determine minimal endoillumination levels required to perform 3-dimensional heads-up vitreoretinal surgery and to correlate endoillumination levels used for measurements of heads-up display (HUD) luminous emittance. Prospective, observational surgical case series of 10 patients undergoing vitreoretinal surgery. Endoillumination levels were set to 40% of maximum output and were decreased at set intervals until the illumination level was 0%. Corresponding luminous emittance (lux) of the HUD was measured 40 cm from the display using a luxmeter (Dr. Meter, Model #LX1010BS). In 9 of 10 cases, the surgeon felt that they could operate comfortably at an endoillumination level of 10% of maximum output with corresponding HUD emittance of 14.3 ± 9.5 lux. In the remaining case, the surgeon felt comfortable at a 3% endoillumination level with corresponding HUD emittance of 15 lux. Below this threshold, subjective image dimness and digital noise limited visibility. Endoillumination levels were correlated with luminous emittance from the 3-dimensional HUD (P < 0.01). The average coefficient of variation of HUD luminance was 0.546. There were no intraoperative complications. With real-time digital processing and automated brightness control, 3-dimensional HUD platforms may allow for reduced intraoperative endoillumination levels and a theoretically reduced risk of retinal phototoxicity during vitreoretinal surgery.

Uric acid, an important screening tool to detect inborn errors of metabolism: a case series.

PubMed

Jasinge, Eresha; Kularatnam, Grace Angeline Malarnangai; Dilanthi, Hewa Warawitage; Vidanapathirana, Dinesha Maduri; Jayasena, Kandana Liyanage Subhashinie Priyadarshika Kapilani Menike; Chandrasiri, Nambage Dona Priyani Dhammika; Indika, Neluwa Liyanage Ruwan; Ratnayake, Pyara Dilani; Gunasekara, Vindya Nandani; Fairbanks, Lynette Dianne; Stiburkova, Blanka

2017-09-06

Uric acid is the metabolic end product of purine metabolism in humans. Altered serum and urine uric acid level (both above and below the reference ranges) is an indispensable marker in detecting rare inborn errors of metabolism. We describe different case scenarios of 4 Sri Lankan patients related to abnormal uric acid levels in blood and urine. CASE 1: A one-and-half-year-old boy was investigated for haematuria and a calculus in the bladder. Xanthine crystals were seen in microscopic examination of urine sediment. Low uric acid concentrations in serum and low urinary fractional excretion of uric acid associated with high urinary excretion of xanthine and hypoxanthine were compatible with xanthine oxidase deficiency. CASE 2: An 8-month-old boy presented with intractable seizures, feeding difficulties, screaming episodes, microcephaly, facial dysmorphism and severe neuro developmental delay. Low uric acid level in serum, low fractional excretion of uric acid and radiological findings were consistent with possible molybdenum cofactor deficiency. Diagnosis was confirmed by elevated levels of xanthine, hypoxanthine and sulfocysteine levels in urine. CASE 3: A 3-year-10-month-old boy presented with global developmental delay, failure to thrive, dystonia and self-destructive behaviour. High uric acid levels in serum, increased fractional excretion of uric acid and absent hypoxanthine-guanine phosphoribosyltransferase enzyme level confirmed the diagnosis of Lesch-Nyhan syndrome. CASE 4: A 9-year-old boy was investigated for lower abdominal pain, gross haematuria and right renal calculus. Low uric acid level in serum and increased fractional excretion of uric acid pointed towards hereditary renal hypouricaemia which was confirmed by genetic studies. Abnormal uric acid level in blood and urine is a valuable tool in screening for clinical conditions related to derangement of the nucleic acid metabolic pathway.

Enhanced Androgen Signaling with Androgen Receptor Overexpression in the Osteoblast Lineage Controls Skeletal Turnover, Matrix Quality, and Bone Architecture

DTIC Science & Technology

2005-12-01

the BMD of female-to-male transsexuals treated with ‘male’ levels of testosterone increased to normal male levels at cortical sites [35]. Finally, men...Testosterone increases bone mineral density in female-to- male transsexuals : a case series of 15 subjects.Clin Endocrinol (Oxf) 2004, 61:560-566. 35...Ruetsche A, Kneubuehl R, Birkhaeuser M, Lippuner K: Cortical and trabecular bone mineral density in transsexuals after long-term cross-sex hormonal treatment

Cannabis Intoxication Case Series: The Dangers of Edibles Containing Tetrahydrocannabinol.

PubMed

Vo, Kathy T; Horng, Howard; Li, Kai; Ho, Raymond Y; Wu, Alan H B; Lynch, Kara L; Smollin, Craig G

2018-03-01

Cannabis and its principal active constituent, Δ9-tetrahydrocannabinol (THC), are increasingly available as edibles resembling commercially available food products. In this case series, we describe a population of predominantly pediatric patients who were inadvertently exposed to a THC-containing product in San Francisco. Twelve children and 9 adults were identified, with 16 patients having detectable serum THC and THC metabolites. All patients presented to hospitals with a variety of constitutional symptoms and all were discharged home within 12 hours. In general, pediatric patients had more severe symptoms and longer hospital length of stay, and, uniquely, a majority presented with leukocytosis and elevated lactic acid levels. We recommend that efforts be made to increase general public awareness in regard to the potential hazards of THC-containing edibles resembling commercially available food products. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Revised definition of neuropathic pain and its grading system: an open case series illustrating its use in clinical practice.

PubMed

Geber, Christian; Baumgärtner, Ulf; Schwab, Rainer; Müller, Harald; Stoeter, Peter; Dieterich, Marianne; Sommer, Clemens; Birklein, Frank; Treede, Rolf-Detlef

2009-10-01

The definition of neuropathic pain has recently been revised by an expert committee of the Neuropathic Pain Special Interest Group of the International Association for the Study of Pain (NeuPSIG) as "pain arising as direct consequence of a lesion or disease affecting the somatosensory system," and a grading system of "definite," "probable," and "possible" neuropathic pain has been introduced. This open case series of 5 outpatients (3 men, 2 women; mean age 48 +/- 12 years) demonstrates how the grading system can be applied, in combination with appropriate confirmatory testing, to diagnosis neuropathic conditions in clinical practice. The proposed grading system includes a dynamic algorithm that enhances the physician's ability to determine with a greater level of certainty whether a pain condition is neuropathic. Its clinical use should be further validated in prospective studies.

Congenital unilateral absence of the upper extremity may give rise to a specific kind of thoracolumbar curve.

PubMed

Olgun, Z Deniz; Demirkiran, Gokhan; Polly, David; Yazici, Muharrem

2018-03-01

There is an increased incidence of scoliosis in patients with congenital malformations of the upper extremity even in the absence of overt vertebral abnormalities. In this case series, we summarize the curve characteristics of four patients presenting to two spine surgery clinics with unilateral amelia or phocomelia and a progressive scoliotic curve with the apex on the side of deficiency. All patients required orthopedic intervention for their curves. Amelia and phocomelia are severe congenital malformations of the upper limb affecting trunk balance and, conceivably, causing scoliosis with the absence of counterbalancing weight on the affected side. The combination of upper limb absence and same-sided scoliosis in these patients may provide a clue of the mechanical factors causing scoliosis in other disorders. In this article, we attempt to define this exceptional deformity, theorize on its etiology, and draw attention to this particular combination of problems. Case series; Level IV.

Burns from illegal drug manufacture: case series and management.

PubMed

Porter, C J W; Armstrong, J R

2004-01-01

This case series presents our experience with burns sustained while manufacturing illegal drugs. All adult burn admissions in an 18-month period were retrospectively reviewed. All patients suspected of sustaining burns from illegal drug manufacture were contacted. Information regarding the burn mechanism was sought. Nine of the 64 adult burn admissions were caused by explosions during the manufacture of cannabis oil. Young males with hand and face burns were heavily represented. First-aid treatment was often ignored in favor of hiding incriminating evidence. Only two patients gave honest admission histories. Illegal drug manufacture is becoming more common as synthetic drugs become more consumer desirable. Burns sustained may be thermal and/or chemical. Dishonest patient histories negatively influence burn management. A high level of suspicion is required for diagnosing and treating burns from illegal drug manufacture. Public education is unlikely to be effective as the financial rewards outweigh the perceived risks.

Dynamic mesh adaptation for front evolution using discontinuous Galerkin based weighted condition number relaxation

DOE PAGES

Greene, Patrick T.; Schofield, Samuel P.; Nourgaliev, Robert

2017-01-27

A new mesh smoothing method designed to cluster cells near a dynamically evolving interface is presented. The method is based on weighted condition number mesh relaxation with the weight function computed from a level set representation of the interface. The weight function is expressed as a Taylor series based discontinuous Galerkin projection, which makes the computation of the derivatives of the weight function needed during the condition number optimization process a trivial matter. For cases when a level set is not available, a fast method for generating a low-order level set from discrete cell-centered fields, such as a volume fractionmore » or index function, is provided. Results show that the low-order level set works equally well as the actual level set for mesh smoothing. Meshes generated for a number of interface geometries are presented, including cases with multiple level sets. Lastly, dynamic cases with moving interfaces show the new method is capable of maintaining a desired resolution near the interface with an acceptable number of relaxation iterations per time step, which demonstrates the method's potential to be used as a mesh relaxer for arbitrary Lagrangian Eulerian (ALE) methods.« less

Systematic review of the methodological and reporting quality of case series in surgery.

PubMed

Agha, R A; Fowler, A J; Lee, S-Y; Gundogan, B; Whitehurst, K; Sagoo, H K; Jeong, K J L; Altman, D G; Orgill, D P

2016-09-01

Case series are an important and common study type. No guideline exists for reporting case series and there is evidence of key data being missed from such reports. The first step in the process of developing a methodologically sound reporting guideline is a systematic review of literature relevant to the reporting deficiencies of case series. A systematic review of methodological and reporting quality in surgical case series was performed. The electronic search strategy was developed by an information specialist and included MEDLINE, Embase, Cochrane Methods Register, Science Citation Index and Conference Proceedings Citation index, from the start of indexing to 5 November 2014. Independent screening, eligibility assessments and data extraction were performed. Included articles were then analysed for five areas of deficiency: failure to use standardized definitions, missing or selective data (including the omission of whole cases or important variables), transparency or incomplete reporting, whether alternative study designs were considered, and other issues. Database searching identified 2205 records. Through the process of screening and eligibility assessments, 92 articles met inclusion criteria. Frequencies of methodological and reporting issues identified were: failure to use standardized definitions (57 per cent), missing or selective data (66 per cent), transparency or incomplete reporting (70 per cent), whether alternative study designs were considered (11 per cent) and other issues (52 per cent). The methodological and reporting quality of surgical case series needs improvement. The data indicate that evidence-based guidelines for the conduct and reporting of case series may be useful. © 2016 BJS Society Ltd Published by John Wiley & Sons Ltd.

[Poisoning with Jatropha curcas: 24 cases reported to Paris and Marseille Poisons Centers].

PubMed

Langrand, J; Médernach, C; Schmitt, C; Blanc-Brisset, I; Villa, A F; de Haro, L; Garnier, R

2015-03-01

Jatropha curcas L. is an inedible plant belonging to the Euphorbiaceae family that is growing in subtropical zones of all continents. We report a series of 24 cases of poisoning with J. curcas seeds or fruits reported to poison centers in Paris and Marseille between December 2000 and June 2014. Fifteen adults and 9 children ingested J. curcas seeds or fruits. All patients experienced gastrointestinal disorders, within the first hours following ingestion: nausea, vomiting, diarrhea and abdominal pain. Laboratory investigations performed in 10 patients revealed minor abnormalities: CK elevation (8 cases), dehydration (5 cases) with moderate elevation of serum creatinine levels (3 cases), and mildly increased serum bilirubin (8 cases). Complete remission of all clinical signs was observed within 48 hours in the 20 cases for which the outcome was known. Previously published cases of J. curcas poisoning were very similar to ours: As in our series, gastrointestinal disorders were always present. They were sometimes associated with neurological or cardiovascular signs, and hepatic or renal disorders; these were generally interpreted as complications of severe gastroenteritis, although direct toxic effects could not be formally excluded. In most cases, simple supportive measures were sufficient to ensure complete recovery within 24-48 hours. J Curcas poisoning incidence is certainly increasing because the plant is cultivated to produce biodiesel and is now largely present in most subtropical countries. As a consequence, local health professionals should be informed of the toxic properties of this plant.

Plasmapheresis in thrombotic microangiopathy-associated syndromes: review of outcome data derived from clinical trials and open studies.

PubMed

von Baeyer, Hans

2002-08-01

Current reimbursement policy of health insurance for therapeutic plasmapheresis requires proof of efficacy using the concept of evidence-based medicine. The aim of this paper is to review the outcome of plasmapheresis used to treat thrombotic microangiopathy (TMA)-associated syndromes in the last decade to provide scientific evidence to back up reimbursement applications. The strength of evidence of each reviewed study was assessed using the five levels of evidence criteria as defined by the American Society of Hematology in 1996 for assessment of the treatment of immune thrombocytopenia. The level Experimental indication was added for situations where only case reports or small series supported by pathophysiological reasoning are available. The definitions of evidence used in this paper are as follows: Level I, randomized clinical trial with low rates of error (p < 0.01); Level II, randomized clinical trial with high rates of error (p < 0.05); Level III, nonrandomized studies with concurrent control group; Level IV, nonrandomized studies with historical control group; Level V, case series without a control group or expert opinion; and Experimental, case reports and pathophysiological reasoning. The results of this analysis based on the published data is summarized as follows: The indication of plasmapheresis is assigned to Level IV evidence for thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS); cancer/chemotherapy-associated TTP/HUS is assigned to Level V evidence; and TTP/HUS refractory to standard plasma exchange and post-bone marrow transplantation TTP/HUS are assigned to Experimental indication. For both subsets, protein A immunoadsorption is reportedly successful. The other TMA-associated syndromes, hemolysis elevated liver enzymes low platelets and HUS in early childhood, are no indication of plasmapheresis. Two randomized clinical trials were performed in order to demonstrate the superiority of plasma exchange/fresh frozen plasma (PEX/FFP) over plasma transfusion in the management of TTP/HUS. The results prove the greater clinical success of the latter type of plasma administration. Standard PEX/FFP has reduced the mortality of TTP/HUS from 94.5% to 13%.

Glass corrosion in natural environment

NASA Technical Reports Server (NTRS)

Thorpe, Arthur N.

1989-01-01

A series of studies of the effects of solutes which appear in natural aqueous environments, specifically Mg and Al, under controlled conditions, permit characterization of the retardation of silicate glass leaching in water containing such solutes. In the case of Mg the interaction with the glass appears to consist of exchange with alkali ions present in the glass to a depth of several microns. The effect of Al can be observed at much lower levels, indicating that the mechanism in the case of Al involves irreversible formation of aluminosilicate species at the glass surface.

Local search heuristic for the discrete leader-follower problem with multiple follower objectives

NASA Astrophysics Data System (ADS)

Kochetov, Yury; Alekseeva, Ekaterina; Mezmaz, Mohand

2016-10-01

We study a discrete bilevel problem, called as well as leader-follower problem, with multiple objectives at the lower level. It is assumed that constraints at the upper level can include variables of both levels. For such ill-posed problem we define feasible and optimal solutions for pessimistic case. A central point of this work is a two stage method to get a feasible solution under the pessimistic case, given a leader decision. The target of the first stage is a follower solution that violates the leader constraints. The target of the second stage is a pessimistic feasible solution. Each stage calls a heuristic and a solver for a series of particular mixed integer programs. The method is integrated inside a local search based heuristic that is designed to find near-optimal leader solutions.

The Medial Sural Artery Perforator Flap: The First Choice for Soft-Tissue Reconstruction About the Knee.

PubMed

Ling, Barbara M; Wettstein, Reto; Staub, Daniel; Schaefer, Dirk J; Kalbermatten, Daniel F

2018-02-07

The gastrocnemius muscle flap may be considered the first choice in many cases of soft-tissue reconstruction about the knee. Limited arc of rotation and reach of the flap as well as unsightly muscle bulk are major disadvantages and were the impetus to look for a local alternative. The aim of this study is to present a consecutive series of patients with a reconstruction about the knee involving the medial sural artery perforator flap (MSAPF). A consecutive series of 17 cases of defect reconstructions about the knee using the MSAPF is described, with an emphasis on early postoperative complications. No major flap-related complications occurred except 1 case of tip necrosis that healed uneventfully after excision and secondary suture. Two patients with direct donor-site closure had a minor complication that required no revision, and 2 had partial skin-graft loss. In summary, use of this pedicled perforator flap represents a reliable technique for soft-tissue reconstruction about the knee with an acceptable complication rate and optimal contour reconstruction without the need for a skin graft and secondary debulking procedures. The range of motion associated with the MSAPF in comparison to the range associated with the gastrocnemius muscle flap is increased so that more proximal and lateral defects can be covered. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Comparing Visual and Statistical Analysis in Single-Case Studies Using Published Studies

PubMed Central

Harrington, Magadalena; Velicer, Wayne F.

2015-01-01

Little is known about the extent to which interrupted time-series analysis (ITSA) can be applied to short, single-case study designs and whether those applications produce results consistent with visual analysis (VA). This paper examines the extent to which ITSA can be applied to single-case study designs and compares the results based on two methods: ITSA and VA, using papers published in the Journal of Applied Behavior Analysis in 2010. The study was made possible by the development of software called UnGraph® which facilitates the recovery of raw data from the graphs. ITSA was successfully applied to 94% of the examined graphs with the number of observations ranging from 8 to 136. Moderate to high lag 1 autocorrelations (> .50) were found for 46% of the data series. Effect sizes similar to group-level Cohen’s d were identified based on the tertile distribution. Effects ranging from 0.00 to 0.99 were classified as small, those ranging from 1.00 to 2.49 as medium, and large effect sizes were defined as 2.50 or greater. Comparison of the conclusions from VA and ITSA had a low level of agreement (Kappa = .14, accounting for the agreement expected by chance). The results demonstrate that ITSA can be broadly implemented in applied behavior analysis research. These two methods should be viewed as complimentary and used concurrently. PMID:26609876

46,XX males: a case series based on clinical and genetics evaluation.

PubMed

Mohammadpour Lashkari, F; Totonchi, M; Zamanian, M R; Mansouri, Z; Sadighi Gilani, M A; Sabbaghian, M; Mohseni Meybodi, A

2017-09-01

46,XX male sex reversal syndrome is one of the rarest sex chromosomal aberrations. The presence of SRY gene on one of the X chromosomes is the most frequent cause of this syndrome. Based on Y chromosome profile, there are SRY-positive and SRY-negative forms. The purpose of our study was to report first case series of Iranian patients and describe the different clinical appearances based on their genetic component. From the 8,114 azoospermic and severe oligozoospermic patients referred to Royan institute, we diagnosed 57 cases as sex reversal patients. Based on the endocrinological history, we performed karyotyping, SRY and AZF microdeletion screening. Patients had a female karyotype. According to available hormonal reports of 37 patients, 16 cases had low levels of testosterone (43.2%). On the other hand, 15 males were SRY positive (90.2%), while they lacked the spermatogenic factors encoding genes on Yq. Commencing the testicular differentiation in males, the SRY gene is considered to be very important in this process. Due to homogeneous results of karyotyping and AZF deletion, there are both positive and negative SRY cases that show similar sex reversal phenotypes. Evidences show that there could be diverse phenotypic differences that could be raised from various reasons. © 2016 Blackwell Verlag GmbH.

Hydraulic modeling of riverbank filtration systems with curved boundaries using analytic elements and series solutions

NASA Astrophysics Data System (ADS)

Bakker, Mark

2010-08-01

A new analytic solution approach is presented for the modeling of steady flow to pumping wells near rivers in strip aquifers; all boundaries of the river and strip aquifer may be curved. The river penetrates the aquifer only partially and has a leaky stream bed. The water level in the river may vary spatially. Flow in the aquifer below the river is semi-confined while flow in the aquifer adjacent to the river is confined or unconfined and may be subject to areal recharge. Analytic solutions are obtained through superposition of analytic elements and Fourier series. Boundary conditions are specified at collocation points along the boundaries. The number of collocation points is larger than the number of coefficients in the Fourier series and a solution is obtained in the least squares sense. The solution is analytic while boundary conditions are met approximately. Very accurate solutions are obtained when enough terms are used in the series. Several examples are presented for domains with straight and curved boundaries, including a well pumping near a meandering river with a varying water level. The area of the river bottom where water infiltrates into the aquifer is delineated and the fraction of river water in the well water is computed for several cases.

75 FR 9581 - Wooden Bedroom Furniture from the People's Republic of China: Preliminary Results of Antidumping...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-03

..., the Office of Policy issued a memorandum identifying six countries as being at a level of economic... for sale in coordinated groups, or bedrooms, in which all of the individual pieces are of... case piece taller than it is wide featuring a series of drawers and with or without one or more doors...

Teaching with Acoustic Guidance the Operant Conditioning of EEG in Children with Autism: A Feasibility Case Series

ERIC Educational Resources Information Center

LaMarca, Kristen

2013-01-01

Dysfunction in the mirror neuron system has been proposed to underlie sociocognitive deficits of autism--such as imitation, empathy, and Theory of Mind, and has been linked with a deficient level of mu (8-13 Hz) suppression over the sensorimotor cortex during observed but not executed actions. Previous research has found that Neurofeedback…

Implementing Education Reforms in New Zealand, 1987-97: A Case Study. The Education Reform and Management Series, Vol. 1, No. 1.

ERIC Educational Resources Information Center

Perris, Lyall

In 1987 New Zealand faced multiple economic problems and high unemployment. A flexible and responsive education system was needed to produce the skills, attitudes, and learning required for New Zealand's future. The primary objective was decentralizing authority to school level. This book emphasizes the process of successful reform, rather than…

Coupling detrended fluctuation analysis for analyzing coupled nonstationary signals.

PubMed

Hedayatifar, L; Vahabi, M; Jafari, G R

2011-08-01

When many variables are coupled to each other, a single case study could not give us thorough and precise information. When these time series are stationary, different methods of random matrix analysis and complex networks can be used. But, in nonstationary cases, the multifractal-detrended-cross-correlation-analysis (MF-DXA) method was introduced for just two coupled time series. In this article, we have extended the MF-DXA to the method of coupling detrended fluctuation analysis (CDFA) for the case when more than two series are correlated to each other. Here, we have calculated the multifractal properties of the coupled time series, and by comparing CDFA results of the original series with those of the shuffled and surrogate series, we can estimate the source of multifractality and the extent to which our series are coupled to each other. We illustrate the method by selected examples from air pollution and foreign exchange rates.

Coupling detrended fluctuation analysis for analyzing coupled nonstationary signals

NASA Astrophysics Data System (ADS)

Hedayatifar, L.; Vahabi, M.; Jafari, G. R.

2011-08-01

When many variables are coupled to each other, a single case study could not give us thorough and precise information. When these time series are stationary, different methods of random matrix analysis and complex networks can be used. But, in nonstationary cases, the multifractal-detrended-cross-correlation-analysis (MF-DXA) method was introduced for just two coupled time series. In this article, we have extended the MF-DXA to the method of coupling detrended fluctuation analysis (CDFA) for the case when more than two series are correlated to each other. Here, we have calculated the multifractal properties of the coupled time series, and by comparing CDFA results of the original series with those of the shuffled and surrogate series, we can estimate the source of multifractality and the extent to which our series are coupled to each other. We illustrate the method by selected examples from air pollution and foreign exchange rates.

Impact of Complex-Valued Energy Function Singularities on the Behaviour of RAYLEIGH-SCHRöDINGER Perturbation Series. H_2CO Molecule Vibrational Energy Spectrum.

NASA Astrophysics Data System (ADS)

Duchko, Andrey; Bykov, Alexandr

2015-06-01

Nowadays the task of spectra processing is as relevant as ever in molecular spectroscopy. Nevertheless, existing techniques of vibrational energy levels and wave functions computation often come to a dead-lock. Application of standard quantum-mechanical approaches often faces inextricable difficulties. Variational method requires unimaginable computational performance. On the other hand perturbational approaches beat against divergent series. That's why this problem faces an urgent need in application of specific resummation techniques. In this research Rayleigh-Schrödinger perturbation theory is applied to vibrational energy levels calculation of excited vibrational states of H_2CO. It is known that perturbation series diverge in the case of anharmonic resonance coupling between vibrational states [1]. Nevertheless, application of advanced divergent series summation techniques makes it possible to calculate the value of energy with high precision (more than 10 true digits) even for highly excited states of the molecule [2]. For this purposes we have applied several summation techniques based on high-order Pade-Hermite approximations. Our research shows that series behaviour completely depends on the singularities of complex energy function inside unit circle. That's why choosing an approximation function modelling this singularities allows to calculate the sum of divergent series. Our calculations for formaldehyde molecule show that the efficiency of each summation technique depends on the resonant type. REFERENCES 1. J. Cizek, V. Spirko, and O. Bludsky, ON THE USE OF DIVERGENT SERIES IN VIBRATIONAL SPECTROSCOPY. TWO- AND THREE-DIMENSIONAL OSCILLATORS, J. Chem. Phys. 99, 7331 (1993). 2. A. V. Sergeev and D. Z. Goodson, SINGULARITY ANALYSIS OF FOURTH-ORDER MöLLER-PLESSET PERTURBATION THEORY, J. Chem. Phys. 124, 4111 (2006).

Electron series resonance in a magnetized 13.56 MHz symmetric capacitive coupled discharge

NASA Astrophysics Data System (ADS)

Joshi, J. K.; Binwal, S.; Karkari, S. K.; Kumar, Sunil

2018-03-01

A 13.56 MHz capacitive coupled radio-frequency (RF) argon discharge under transverse magnetic field has been investigated. The discharge is operated in a push-pull mode using a 1:1 isolation transformer with its centre tap grounded to a RF generator. The power delivered to the plasma has been calculated from phase-calibrated RF current/voltage waveforms measured on the secondary side of the isolation transformer. An equivalent electrical circuit of the discharge has been described to determine the net plasma impedance. It is found that in the presence of magnetic field, the discharge impedance exhibits a series resonance as the RF power level is increased gradually. However, in the un-magnetized case, the discharge remains entirely capacitive. A qualitative discussion has been given to explain the role of external magnetic field in achieving the series resonance.

Transverse uterine fundal incision for placenta praevia with accreta, involving the entire anterior uterine wall: a case series.

PubMed

Kotsuji, F; Nishijima, K; Kurokawa, T; Yoshida, Y; Sekiya, T; Banzai, M; Minakami, H; Udagawa, Y

2013-08-01

To determine the feasibility and safety of transverse fundal incision with manual placental removal in women with placenta praevia and possible placenta accreta. Case series. Four level-three Japanese obstetric centres. Thirty-four women with prior caesarean section and placenta praevia that widely covers the anterior uterine wall, in whom placenta accreta cannot be ruled out. A transverse fundal incision was performed at the time of caesarean section and manual placental removal was attempted under direct observation. Operative fluid loss. The total volume of fluid lost during our operative procedure compares favourably with the volume lost during our routine transverse lower-segment caesarean sections performed in patients without placenta praevia or accreta. The average fluid loss was 1370 g. No patients required transfer to intensive care, and there were no cases of fetal anaemia. This procedure has the potential to reduce the heavy bleeding that arises from caesarean deliveries in women with placenta praevia and placenta accreta. © 2013 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2013 RCOG.

Oral lichen planus in childhood: a case series.

PubMed

Cascone, Marco; Celentano, Antonio; Adamo, Daniela; Leuci, Stefania; Ruoppo, Elvira; Mignogna, Michele D

2017-06-01

Although the exact incidence of pediatric oral lichen planus (OLP) is unknown, the oral mucosa seems to be less commonly involved, and the clinical presentation is often atypical. The aim of the study is to present a case series of OLP in childhood. From our database, we retrospectively selected and analyzed the clinical data of OLP patients under the age of 18 where the diagnosis had been confirmed by histopathological analysis. The case series from our database shows eight patients, four males and four females. The mean (±SD) age at the time of diagnosis of the disease was 13.5 (±2.73) years, ranging in age from 9 to 17. Clinically, a reticular pattern was present in six patients (75%), and the tongue was the most commonly involved oral site (six cases, 75%). We also report the first case of OLP in a 9-year-old girl affected by autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy. We report the largest case series of pediatric OLP published in literature thus far. Differences in the disease between adults and pediatric patients have been detected, but further investigation and a larger case series are needed to establish any detailed differences in clinical outcomes. © 2017 The International Society of Dermatology.

A literature review of intercostal-to-musculocutaneous-nerve transfers in brachial plexus injury patients: Does body mass index influence results in Eastern versus Western countries?

PubMed

Socolovsky, Mariano; Paez, Miguel Domínguez

2013-11-27

A wide range of results have appeared in the literature for intercostal nerve transfers in brachial plexus patients. Oriental countries generally have a lower body mass index (BMI) than their occidental counterparts. We analyzed published series of intercostal nerve transfers for elbow reinnervation to determine if a difference in outcomes exists between Eastern and Western series that could be inversely related to BMI. A PubMed search was conducted. Inclusion criteria were: (1) time from trauma to surgery <12 months, (2) minimum follow-up one year, (3) intercostal to musculocutaneous nerve transfer the only surgical procedure performed to reestablish elbow flexion, and (4) males comprising more than 75% of cases. Two groups were created: Series from western countries, including America, Europe, and Africa; and series from Asia. Pearson correlation analysis was performed to assess for the degree of correlation between percent responders and mean national BMI. A total of 26 series were included, 14 from western countries and 12 from Eastern countries, encompassing a total of 274 and 432 surgical cases, respectively. The two groups were almost identical in mean age, but quite different in mean national BMI (26.3 vs. 22.5) and in the percentage of patients who achieved at least a Medical Research Council (MRC) level 3 (59.5% vs. 79.3%). Time from trauma to surgery was slightly shorter in Eastern (3.4 months) versus Western countries (5.0 months). The percentage of responders to intercostal to musculocutaneous nerve transfer was inversely correlated with the mean national BMI among male residents of the country where the series was performed.

Rapid chondrolysis of the knee after partial lateral meniscectomy in professional athletes.

PubMed

Sonnery-Cottet, Bertrand; Archbold, Pooler; Thaunat, Mathieu; Carnesecchi, Olivier; Tostes, Marcelo; Chambat, Pierre

2014-03-01

Postoperative knee joint chondrolysis is a rare but serious complication. The aim of our study is to report the clinical presentation, the early, mid and long-term outcomes of rapid chondrolysis after a partial lateral meniscectomy in elite athletes. Clinical records of 10 consecutive cases of rapid chondrolysis after partial lateral meniscectomy in eight professional athletes were retrospectively reviewed. There were seven males and one female with a mean age of 25.2 years (range 20-32 years) at index procedure. An initial conservative approach to its treatment was attempted in all cases. Arthroscopic lavage was advocated in two cases. Patients were clinically reviewed at last follow-up with comparative X-rays, a subjective IKDC, a Lysholm and Tegner scale. All patients resumed their pre-injury level of activity at a mean 8 (±2.45) months after the index procedure. At a mean of 82 (±36) months of follow-up, the mean subjective IKDC, Lyshom and Tegner scale were respectively 82.64 (±8.61), 86.6 (±6.44), 9 (±1.41). All knees demonstrated joint space narrowing scored Kellgren and Lawrence II (n=1) III (n=4) or IV (n=5) on conventional radiographs. By reviewing the common factors in each of these cases we believe that rapid chondrolysis occurs primarily due to the excessive loading of the articular cartilage in the lateral compartment of the knee. In this series, although the results in the medium term were good, the long-term outcome must be guarded due to the high rate of radiographic osteoarthritis of the lateral compartment seen in this population. Retrospective case series, Level IV. Copyright © 2014 Elsevier B.V. All rights reserved.

Adjacent segment infection after surgical treatment of spondylodiscitis.

PubMed

Siam, Ahmed Ezzat; El Saghir, Hesham; Boehm, Heinrich

2016-03-01

This is the first case series to describe adjacent segment infection (ASI) after surgical treatment of spondylodiscitis (SD). Patients with SD, spondylitis who were surgically treated between 1994 and 2012 were included. Out of 1187 cases, 23 (1.94 %) returned to our institution (Zentralklinik Bad Berka) with ASI: 10 males, 13 females, with a mean age of 65.1 years and a mean follow-up of 69 months. ASI most commonly involved L3-4 (seven patients), T12-L1 (five) and L2-3 (four). The mean interval between operations of primary infection and ASI was 36.9 months. All cases needed surgical intervention, debridement, reconstruction and fusion with longer instrumentation, with culture and sensitivity-based postoperative antimicrobial therapy. At last follow-up, six patients (26.1 %) were mobilized in a wheelchair with a varying degree of paraplegia (three had pre-existing paralysis). Three patients died within 2 months after the ASI operation (13 %). Excellent outcomes were achieved in five patients, and good in eight. Adjacent segment infection after surgical treatment of spondylodiscitis is a rare complication (1.94 %). It is associated with multimorbidity and shows a high mortality rate and a high neurological affection rate. Possible explanations are: haematomas of repeated micro-fractures around screw loosening, haematogenous spread, direct inoculation or a combination of these factors. ASI may also lead to proximal junctional kyphosis, as found in this series. We suggest early surgical intervention with anterior debridement, reconstruction and fusion with posterior instrumentation, followed by antimicrobial therapy for 12 weeks. Level IV retrospective uncontrolled case series.

Time Series Analysis of Trends in Malaria Cases and Deaths at Hospitals and the Effect of Antimalarial Interventions, 2001–2011, Ethiopia

PubMed Central

Aregawi, Maru; Lynch, Michael; Bekele, Worku; Kebede, Henok; Jima, Daddi; Taffese, Hiwot Solomon; Yenehun, Meseret Aseffa; Lilay, Abraham; Williams, Ryan; Thomson, Madeleine; Nafo-Traore, Fatoumata; Admasu, Kesetebirhan; Gebreyesus, Tedros Adhanom; Coosemans, Marc

2014-01-01

Background The Government of Ethiopia and its partners have deployed artemisinin-based combination therapies (ACT) since 2004 and long-lasting insecticidal nets (LLINs) since 2005. Malaria interventions and trends in malaria cases and deaths were assessed at hospitals in malaria transmission areas during 2001–2011. Methods Regional LLINs distribution records were used to estimate the proportion of the population-at-risk protected by LLINs. Hospital records were reviewed to estimate ACT availability. Time-series analysis was applied to data from 41 hospitals in malaria risk areas to assess trends of malaria cases and deaths during pre-intervention (2001–2005) and post-interventions (2006–2011) periods. Findings The proportion of the population-at-risk potentially protected by LLINs increased to 51% in 2011. The proportion of facilities with ACTs in stock exceeded 87% during 2006–2011. Among all ages, confirmed malaria cases in 2011 declined by 66% (95% confidence interval [CI], 44–79%) and SPR by 37% (CI, 20%–51%) compared to the level predicted by pre-intervention trends. In children under 5 years of age, malaria admissions and deaths fell by 81% (CI, 47%–94%) and 73% (CI, 48%–86%) respectively. Optimal breakpoint of the trendlines occurred between January and June 2006, consistent with the timing of malaria interventions. Over the same period, non-malaria cases and deaths either increased or remained unchanged, the number of malaria diagnostic tests performed reflected the decline in malaria cases, and rainfall remained at levels supportive of malaria transmission. Conclusions Malaria cases and deaths in Ethiopian hospitals decreased substantially during 2006–2011 in conjunction with scale-up of malaria interventions. The decrease could not be accounted for by changes in hospital visits, malaria diagnostic testing or rainfall. However, given the history of variable malaria transmission in Ethiopia, more data would be required to exclude the possibility that the decrease is due to other factors. PMID:25406083

On the multifractal effects generated by monofractal signals

NASA Astrophysics Data System (ADS)

Grech, Dariusz; Pamuła, Grzegorz

2013-12-01

We study quantitatively the level of false multifractal signal one may encounter while analyzing multifractal phenomena in time series within multifractal detrended fluctuation analysis (MF-DFA). The investigated effect appears as a result of finite length of used data series and is additionally amplified by the long-term memory the data eventually may contain. We provide the detailed quantitative description of such apparent multifractal background signal as a threshold in spread of generalized Hurst exponent values Δh or a threshold in the width of multifractal spectrum Δα below which multifractal properties of the system are only apparent, i.e. do not exist, despite Δα≠0 or Δh≠0. We find this effect quite important for shorter or persistent series and we argue it is linear with respect to autocorrelation exponent γ. Its strength decays according to power law with respect to the length of time series. The influence of basic linear and nonlinear transformations applied to initial data in finite time series with various levels of long memory is also investigated. This provides additional set of semi-analytical results. The obtained formulas are significant in any interdisciplinary application of multifractality, including physics, financial data analysis or physiology, because they allow to separate the ‘true’ multifractal phenomena from the apparent (artificial) multifractal effects. They should be a helpful tool of the first choice to decide whether we do in particular case with the signal with real multiscaling properties or not.

Interrupted time series analysis of children’s blood lead levels: A case study of lead hazard control program in Syracuse, New York

PubMed Central

Shao, Liyang; Zhang, Lianjun; Zhen, Zhen

2017-01-01

Children’s blood lead concentrations have been closely monitored over the last two decades in the United States. The bio-monitoring surveillance data collected in local agencies reflected the local temporal trends of children’s blood lead levels (BLLs). However, the analysis and modeling of the long-term time series of BLLs have rarely been reported. We attempted to quantify the long-term trends of children’s BLLs in the city of Syracuse, New York and evaluate the impacts of local lead poisoning prevention programs and Lead Hazard Control Program on reducing the children’s BLLs. We applied interrupted time series analysis on the monthly time series of BLLs surveillance data and used ARMA (autoregressive and moving average) models to measure the average children’s blood lead level shift and detect the seasonal pattern change. Our results showed that there were three intervention stages over the past 20 years to reduce children’s BLLs in the city of Syracuse, NY. The average of children’s BLLs was significantly decreased after the interventions, declining from 8.77μg/dL to 3.94μg/dL during1992 to 2011. The seasonal variation diminished over the past decade, but more short term influences were in the variation. The lead hazard control treatment intervention proved effective in reducing the children’s blood lead levels in Syracuse, NY. Also, the reduction of the seasonal variation of children’s BLLs reflected the impacts of the local lead-based paint mitigation program. The replacement of window and door was the major cost of lead house abatement. However, soil lead was not considered a major source of lead hazard in our analysis. PMID:28182688

Interrupted time series analysis of children's blood lead levels: A case study of lead hazard control program in Syracuse, New York.

PubMed

Shao, Liyang; Zhang, Lianjun; Zhen, Zhen

2017-01-01

Children's blood lead concentrations have been closely monitored over the last two decades in the United States. The bio-monitoring surveillance data collected in local agencies reflected the local temporal trends of children's blood lead levels (BLLs). However, the analysis and modeling of the long-term time series of BLLs have rarely been reported. We attempted to quantify the long-term trends of children's BLLs in the city of Syracuse, New York and evaluate the impacts of local lead poisoning prevention programs and Lead Hazard Control Program on reducing the children's BLLs. We applied interrupted time series analysis on the monthly time series of BLLs surveillance data and used ARMA (autoregressive and moving average) models to measure the average children's blood lead level shift and detect the seasonal pattern change. Our results showed that there were three intervention stages over the past 20 years to reduce children's BLLs in the city of Syracuse, NY. The average of children's BLLs was significantly decreased after the interventions, declining from 8.77μg/dL to 3.94μg/dL during1992 to 2011. The seasonal variation diminished over the past decade, but more short term influences were in the variation. The lead hazard control treatment intervention proved effective in reducing the children's blood lead levels in Syracuse, NY. Also, the reduction of the seasonal variation of children's BLLs reflected the impacts of the local lead-based paint mitigation program. The replacement of window and door was the major cost of lead house abatement. However, soil lead was not considered a major source of lead hazard in our analysis.

Successful use of right unilateral ECT for catatonia: a case series.

PubMed

Cristancho, Pilar; Jewkes, Delaina; Mon, Thetsu; Conway, Charles

2014-03-01

Catatonia is a neuropsychiatric syndrome involving motor signs in association with disorders of mood, behavior, or thought. Bitemporal electrode placement electroconvulsive therapy (ECT) is a proven effective treatment for catatonia, and this mode of ECT delivery is the preferred method of treatment in this condition. Studies in major depressive disorder have demonstrated that suprathreshold, nondominant (right) hemisphere, unilateral electrode placement ECT has fewer adverse effects, especially cognitive adverse effects, than bitemporal ECT. This case series describes the use of right unilateral (RUL) ECT in 5 patients with catatonia. Before ECT, all 5 patients in this series initially failed therapy with benzodiazepines and psychotropic medications. Each catatonic patient received a series of 8 to 12 RUL ECT in an every-other-day series. After ECT, 4 of the 5 patients had a full recovery from catatonia. One patient achieved only partial response to RUL ECT, and no additional benefit was obtained with bitemporal ECT. All patients in this case series tolerated RUL ECT without major adverse effects. This case series illustrates successful use of RUL ECT in patients with catatonia and adds to the early literature demonstrating its effective use in treating this complex condition.

Into hot water head first: distribution of intentional and unintentional immersion burns.

PubMed

Daria, Sonya; Sugar, Naomi F; Feldman, Kenneth W; Boos, Stephen C; Benton, Scott A; Ornstein, Amy

2004-05-01

Experience with several, previously unreported, intentional face-first immersion burns led us to evaluate the distribution of inflicted and unintentional immersion scald burns in a hospital series. (1) Authors' clinical and legal practices; (2) Burn center at regional Level 1 trauma hospital. : (1) Case series of face-first, inflicted immersion burn victims; (2) Consecutive hospitalized scald burn victims younger than 5 years old, 1/3/1996 to 3/25/2000. (1) Individual case reports; (2) Retrospective records review. Simple descriptive statistics, Fisher Exact test and t test. (1) Six cases of inflicted head and neck immersion injury are described. Four were tap water and 2 food/drink scalds. (2) 22/195 hospitalized victims had sustained immersion burns, 13 from tap water and 9 from other fluids. Six (46%) tap water immersions and no (0%) other immersions had inflicted injuries (P = 0.05). Two of the tap water immersions and one other source immersion included burning of the head and neck. Of these, one tap water immersion, but no other immersion, was inflicted. In no patients were head and neck injuries the sole or predominant site of scalding. In all, 9 children sustained inflicted scalds. Bilateral lower extremity tap water immersion scalds occurred in 100% (6/6) of abusive and 29% (2/7) of unintentional injuries (P = 0.02). Buttock and perineal injuries occurred in 67% (4/6) inflicted versus 29% (2/7) unintentional tap water immersion scalds (P = 0.28). Other fluids caused bilateral lower extremity immersion burns in 3/9 (33 %) unintentionally injured patients, but no abused children (NS). Craniofacial immersion injury, although seen by the authors in legal cases, is infrequent. It was present incidentally in one inflicted tap water burn in the consecutive hospital series. This series affirms the predominance of bilateral lower extremity burns in inflicted tap water immersions. Buttock/perineal immersions were more common with abuse than with unintentional injury.

Knee arthrodesis using a vascularized fibular rotatory graft after tumor resection.

PubMed

Nouri, H; Meherzi, M H; Jenzeri, M; Daghfous, M; Hdidane, R; Zehi, K; Tarhouni, L; Karray, S; Baccari, S; Mestiri, M; Zouari, M

2010-02-01

Knee arthrodesis is one of the reconstruction options for limb preservation after malignant tumor resection. Vascularised rotatory fibular transfer allows biological and, thus,definitive reconstruction. The goal of this work was to analyse the results of knee arthrodesis with vascularised fibular graft after tumor resection and to discuss the reliability of this technique. We report a retrospective series of 13 patients with an average age of 29.6 years. The pathological diagnosis was bone sarcoma in 12 cases and synovial chondrosarcoma in one case. Resection/arthrodesis was undertaken as the primary procedure in 11 cases.In two cases, arthrodesis was indicated after failure of an endoprosthesis. Reconstruction was achieved with a vascularised fibular rotatory transfer in all cases. For stabilisation, an external fixator was utilised in eight cases, a femorotibial nail in three cases, and a plate in two cases.Mean follow-up was 6 years. We encountered infection in 53% of cases, mechanical complications in 53% of cases,and nerve palsy in 23% of cases. Four patients died from metastases (only one had arthrodesis complete union). In the nine surviving patients, arthrodesis was fully united in seven cases,after an average period of 36 months. The functional score average (Enneking classification)was 20 points. Knee arthrodesis after tumor resection is a complex technique. Septic complications and mechanical failure are frequent regardless of the technique employed. They are related to the extent of bone sacrifice but also to that of soft tissues. The use of vascularised fibula alone and stabilisation by external fixation were the main shortcomings in this series. TYPE OF STUDY RETROSPECTIVE: Level IV. 2009 Published by Elsevier Masson SAS.

Design for Life. Abortion. A Student's Lesson Plan [and] A Teacher's Lesson Plan [and] A Lawyer's Lesson Plan.

ERIC Educational Resources Information Center

Howard, Estelle; And Others

One of a series of secondary level teaching units presenting case studies with pro and con analyses of particular legal problems, the document consists of a student's lesson plan, a teacher's lesson plan, and a lawyer's lesson plan for a unit on abortion. The lessons are designed to expose students to the Supreme Court's decision concerning…

Acute cellular insulin resistance and hyperglycemia associated with hypophosphatemia after cardiac surgery.

PubMed

Garazi, Esther; Bridge, Suzanne; Caffarelli, Anthony; Ruoss, Stephen; Van der Starre, Pieter

2015-01-15

Successful glycemic control reduces morbidity and mortality in cardiac surgery patients. Protocols that include insulin infusions are commonly followed to achieve target blood glucose levels. Insulin resistance has been reported and linked to low serum phosphate levels in animal models and studies in diabetic outpatients, but not in postoperative patients. The following case series is a retrospective observational review of 8 cardiac surgery patients who developed insulin resistance early after surgery; this resistance was reversed by correcting serum hypophosphatemia. We discuss the multiple underlying mechanisms causing hypophosphatemia.

Levels in N 12 via the N 14 ( p ,   t ) reaction using the JENSA gas-jet target

DOE PAGES

Chipps, K. A.; Pain, S. D.; Greife, U.; ...

2015-09-25

As one of a series of physics cases to demonstrate the unique benefit of the new Jet Experiments in Nuclear Structure and Astrophysics gas-jet target for enabling next-generation transfer reaction studies, the ¹⁴N (p, t)¹²N reaction was studied for the first time, using a pure jet of nitrogen, in an attempt to resolve conflicting information on the structure of ¹²N. A new level at 4.561-MeV excitation energy in ¹²N was found.

A case study of the sensitivity of forecast skill to data and data analysis techniques

NASA Technical Reports Server (NTRS)

Baker, W. E.; Atlas, R.; Halem, M.; Susskind, J.

1983-01-01

A series of experiments have been conducted to examine the sensitivity of forecast skill to various data and data analysis techniques for the 0000 GMT case of January 21, 1979. These include the individual components of the FGGE observing system, the temperatures obtained with different satellite retrieval methods, and the method of vertical interpolation between the mandatory pressure analysis levels and the model sigma levels. It is found that NESS TIROS-N infrared retrievals seriously degrade a rawinsonde-only analysis over land, resulting in a poorer forecast over North America. Less degradation in the 72-hr forecast skill at sea level and some improvement at 500 mb is noted, relative to the control with TIROS-N retrievals produced with a physical inversion method which utilizes a 6-hr forecast first guess. NESS VTPR oceanic retrievals lead to an improved forecast over North America when added to the control.

What's in a Name? The Incorrect Use of Case Series as a Study Design Label in Studies Involving Dogs and Cats.

PubMed

Sargeant, J M; O'Connor, A M; Cullen, J N; Makielski, K M; Jones-Bitton, A

2017-07-01

Study design labels are used to identify relevant literature to address specific clinical and research questions and to aid in evaluating the evidentiary value of research. Evidence from the human healthcare literature indicates that the label "case series" may be used inconsistently and inappropriately. Our primary objective was to determine the proportion of studies in the canine and feline veterinary literature labeled as case series that actually corresponded to descriptive cohort studies, population-based cohort studies, or other study designs. Our secondary objective was to identify the proportion of case series in which potentially inappropriate inferential statements were made. Descriptive evaluation of published literature. One-hundred published studies (from 19 journals) labeled as case series. Studies were identified by a structured literature search, with random selection of 100 studies from the relevant citations. Two reviewers independently characterized each study, with disagreements resolved by consensus. Of the 100 studies, 16 were case series. The remaining studies were descriptive cohort studies (35), population-based cohort studies (36), or other observational or experimental study designs (13). Almost half (48.8%) of the case series or descriptive cohort studies, with no control group and no formal statistical analysis, included inferential statements about the efficacy of treatment or statistical significance of potential risk factors. Authors, peer-reviewers, and editors should carefully consider the design elements of a study to accurately identify and label the study design. Doing so will facilitate an understanding of the evidentiary value of the results. Copyright © 2017 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

High progesterone levels during the luteal phase related to the use of an aromatase inhibitor in breast cancer patients.

PubMed

Alviggi, C; Marci, R; Vallone, R; Conforti, A; Di Rella, F; Strina, I; Picarelli, S; De Rosa, P; De Laurentiis, M; Yding Andersen, C; De Placido, G

2017-07-01

To evaluate the hormonal profile in three breast cancer patients who underwent controlled ovarian stimulation in the presence of the aromatase inhibitor letrozole. In IVF University referral center, a case series of three breast cancer patients who underwent controlled ovarian stimulation (COS) with recombinant FSH and letrozole were investigated. Ovulation was induced with hCG (case No. 1) or with GnRH agonist (case No. 2-3). The primary outcome of our study was the detection of progesterone levels in the luteal phase. Very high progesterone values (mean 186.6 ± 43.6 ng/mL) during the luteal phase were recorded in all three cases. High progesterone levels can be related to the use of letrozole independently of the most commonly used trigger regimen. Although progesterone has long been considered a protective factor against breast cancer, several studies have demonstrated that progesterone could expand a transformation-sensitive stem cell population in the mammary glands. The estrogen negative feedback effect on the hypothalamus-pituitary axis and the disruption of steroid biosynthesis and could represent an intriguing reason behind this phenomenon. Our results highlight the need to evaluate further the increase in progesterone levels in the luteal phase in women with breast cancer undergoing COS with letrozole.

A time series analysis of the rabies control programme in Chile.

PubMed Central

Ernst, S. N.; Fabrega, F.

1989-01-01

The classical time series decomposition method was used to compare the temporal pattern of rabies in Chile before and after the implementation of the control programme. In the years 1950-60, a period without control measures, rabies showed an increasing trend, a seasonal excess of cases in November and December and a cyclic behaviour with outbreaks occurring every 5 years. During 1961-1970 and 1971-86, a 26-year period that includes two different phases of the rabies programme which started in 1961, there was a general decline in the incidence of rabies. The seasonality disappeared when the disease reached a low frequency level and the cyclical component was not evident. PMID:2606167

Panel data analysis of cardiotocograph (CTG) data.

PubMed

Horio, Hiroyuki; Kikuchi, Hitomi; Ikeda, Tomoaki

2013-01-01

Panel data analysis is a statistical method, widely used in econometrics, which deals with two-dimensional panel data collected over time and over individuals. Cardiotocograph (CTG) which monitors fetal heart rate (FHR) using Doppler ultrasound and uterine contraction by strain gage is commonly used in intrapartum treatment of pregnant women. Although the relationship between FHR waveform pattern and the outcome such as umbilical blood gas data at delivery has long been analyzed, there exists no accumulated FHR patterns from large number of cases. As time-series economic fluctuations in econometrics such as consumption trend has been studied using panel data which consists of time-series and cross-sectional data, we tried to apply this method to CTG data. The panel data composed of a symbolized segment of FHR pattern can be easily handled, and a perinatologist can get the whole FHR pattern view from the microscopic level of time-series FHR data.

Statistical models and time series forecasting of sulfur dioxide: a case study Tehran.

PubMed

Hassanzadeh, S; Hosseinibalam, F; Alizadeh, R

2009-08-01

This study performed a time-series analysis, frequency distribution and prediction of SO(2) levels for five stations (Pardisan, Vila, Azadi, Gholhak and Bahman) in Tehran for the period of 2000-2005. Most sites show a quite similar characteristic with highest pollution in autumn-winter time and least pollution in spring-summer. The frequency distributions show higher peaks at two residential sites. The potential for SO(2) problems is high because of high emissions and the close geographical proximity of the major industrial and urban centers. The ACF and PACF are nonzero for several lags, indicating a mixed (ARMA) model, then at Bahman station an ARMA model was used for forecasting SO(2). The partial autocorrelations become close to 0 after about 5 lags while the autocorrelations remain strong through all the lags shown. The results proved that ARMA (2,2) model can provides reliable, satisfactory predictions for time series.

Rate of Change in Lake Level and its Impact on Reservoir-triggered Seismicity

NASA Astrophysics Data System (ADS)

Simpson, D. W.

2017-12-01

With recent interest in increased seismicity related to fluid injection, it is useful to review cases of reservoir-triggered earthquakes to explore common characteristics and seek ways to mitigate the influence of anthropogenic impacts. Three reservoirs - Koyna, India; Nurek, Tajikistan; and Aswan, Egypt - are well-documented cases of triggered earthquakes with recorded time series of seismicity and water levels that extend for more than 30 years. The geological setting, regional tectonics and modes of reservoir utilization, along with the characteristics of the reservoir-seismicity interaction, are distinctly different in each of these three cases. Similarities and differences between these three cases point to regional and local geological and hydrological structures and the rate of changes in reservoir water level as important factors controlling the presence and timing of triggered seismicity. In a manner similar to the way in which the rate of fluid injection influences injection-related seismicity, the rate of change in reservoir water level is a significant factor in determining whether or not reservoir-triggered seismicity occurs. The high rate of annual water level rise may be important in sustaining the exceptionally long sequence of earthquakes at Koyna. In addition to the rate of filling being a determining factor in whether or not earthquakes are triggered, changes in the rate of filling may influence the time of occurrence of individual earthquakes.

76 FR 71341 - BASINS and WEPP Climate Assessment Tools: Case Study Guide to Potential Applications

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-17

... report presents a series of short case studies designed to illustrate the capabilities of these tools for... change impacts on water. This report presents a series of short case studies using the BASINS and WEPP climate assessment tools. The case studies are designed to illustrate the capabilities of these tools for...

Neonatal medical exposures and characteristics of low birth weight hepatoblastoma cases: a report from the Children's Oncology Group.

PubMed

Turcotte, Lucie M; Georgieff, Michael K; Ross, Julie A; Feusner, James H; Tomlinson, Gail E; Malogolowkin, Marcio H; Krailo, Mark D; Miller, Nicole; Fonstad, Rachel; Spector, Logan G

2014-11-01

Hepatoblastoma is a malignancy of young children. Low birth weight is associated with significantly increased risk of hepatoblastoma and neonatal medical exposures are hypothesized as contributors. This study represents the largest case-control study of hepatoblastoma to date and aimed to define the role of neonatal exposures in hepatoblastoma risk among low birth weight children. Incident hepatoblastoma cases who were born <2,500 g (N = 60), diagnosed between 2000 and 2008, were identified through the Children's Oncology Group. Controls were recruited through state birth registries (N = 51). Neonatal medical exposures were abstracted from medical records. Subjects from the Vermont Oxford Network were used for further comparisons, as were existing reports on neonatal medical exposures. Case-control comparisons were hindered by poor matching within birth weight strata. Cases were smaller and received more aggressive neonatal treatment compared to controls, and reflected high correlation levels between birth weight and treatments. Similar difficulty was encountered when comparing cases to Vermont Oxford Network subjects; cases were smaller and required more aggressive neonatal therapy. Furthermore, it appears hepatoblastoma cases were exposed to a greater number of diagnostic X-rays than in case series previously reported in the neonatal literature. This study presents the largest case series of hepatoblastoma in <2,500 g birth weight infants with accompanying neonatal medical exposure data. Findings confirm that birth weight is highly correlated with exposure intensity, and neonatal exposures are themselves highly correlated, which hampers the identification of a causal exposure among hepatoblastoma cases. Experimental models or genetic susceptibility testing may be more revealing of etiology. © 2014 Wiley Periodicals, Inc.

Lead intoxication due to ayurvedic medications as a cause of abdominal pain in adults.

PubMed

Mehta, Varun; Midha, Vandana; Mahajan, Ramit; Narang, Vikram; Wander, Praneet; Sood, Ridhi; Sood, Ajit

2017-02-01

Though a majority of cases of lead intoxication come from occupational exposures, traditional and folk remedies have also been reported to contain toxic amounts of lead. We present a large series of patients with lead poisoning due to intake of Ayurvedic medicines, all of whom presented with unexplained abdominal pain. This was a retrospective, observational case series from a tertiary care center in India. The charts of patients who underwent blood lead level (BLL) testing as a part of workup for unexplained abdominal pain between 2005 and 2013 were reviewed. The patients with lead intoxication (BLLs >25 μg/dl) were identified and demographics, history, possible risk factors, clinical presentation and investigations were reviewed. Treatment details, duration, time to symptomatic recovery, laboratory follow-up and adverse events during therapy were recorded. BLLs were tested in 786 patients with unexplained abdominal pain and high levels were identified in 75 (9.5%) patients, of which a majority (73 patients, 9.3%) had history of Ayurvedic medication intake and only two had occupational exposure. Five randomly chosen Ayurvedic medications were analyzed and lead levels were impermissibly high (14-34,950 ppm) in all of them. Besides pain in abdomen, other presenting complaints were constipation, hypertension, neurological symptoms and acute kidney injury. Anemia and abnormal liver biochemical tests were observed in all the 73 patients. Discontinuing the Ayurvedic medicines and chelation with d-penicillamine led to improvement in symptoms and reduction in BLLs in all patients within 3-4 months. The patients presenting with severe recurrent abdominal pain, anemia and history of use of Ayurvedic medicines should be evaluated for lead toxicity. Early diagnosis in such cases can prevent unnecessary investigations and interventions, and permits early commencement of the treatment.

100 top-cited scientific papers in limb prosthetics.

PubMed

Eshraghi, Arezoo; Osman, Noor Azuan Abu; Gholizadeh, Hossein; Ali, Sadeeq; Shadgan, Babak

2013-11-17

Research has tremendously contributed to the developments in both practical and fundamental aspects of limb prosthetics. These advancements are reflected in scientific articles, particularly in the most cited papers. This article aimed to identify the 100 top-cited articles in the field of limb prosthetics and to investigate their main characteristics. Articles related to the field of limb prosthetics and published in the Web of Knowledge database of the Institute for Scientific Information (ISI) from the period of 1980 to 2012. The 100 most cited articles in limb prosthetics were selected based on the citation index report. All types of articles except for proceedings and letters were included in the study. The study design and level of evidence were determined using Sackett's initial rules of evidence. The level of evidence was categorized either as a systematic review or meta-analysis, randomized controlled trial, cohort study, case-control study, case series, expert opinion, or design and development. The top cited articles in prosthetics were published from 1980 to 2012 with a citation range of 11 to 90 times since publication. The mean citation rate was 24.43 (SD 16.7) times. Eighty-four percent of the articles were original publications and were most commonly prospective (76%) and case series studies (67%) that used human subjects (96%) providing level 4 evidence. Among the various fields, rehabilitation (47%), orthopedics (29%), and sport sciences (28%) were the most common fields of study. The study established that studies conducted in North America and were written in English had the highest citations. Top cited articles primarily dealt with lower limb prosthetics, specifically, on transtibial and transradial prosthetic limbs. Majority of the articles were experimental studies.

A theoretically consistent stochastic cascade for temporal disaggregation of intermittent rainfall

NASA Astrophysics Data System (ADS)

Lombardo, F.; Volpi, E.; Koutsoyiannis, D.; Serinaldi, F.

2017-06-01

Generating fine-scale time series of intermittent rainfall that are fully consistent with any given coarse-scale totals is a key and open issue in many hydrological problems. We propose a stationary disaggregation method that simulates rainfall time series with given dependence structure, wet/dry probability, and marginal distribution at a target finer (lower-level) time scale, preserving full consistency with variables at a parent coarser (higher-level) time scale. We account for the intermittent character of rainfall at fine time scales by merging a discrete stochastic representation of intermittency and a continuous one of rainfall depths. This approach yields a unique and parsimonious mathematical framework providing general analytical formulations of mean, variance, and autocorrelation function (ACF) for a mixed-type stochastic process in terms of mean, variance, and ACFs of both continuous and discrete components, respectively. To achieve the full consistency between variables at finer and coarser time scales in terms of marginal distribution and coarse-scale totals, the generated lower-level series are adjusted according to a procedure that does not affect the stochastic structure implied by the original model. To assess model performance, we study rainfall process as intermittent with both independent and dependent occurrences, where dependence is quantified by the probability that two consecutive time intervals are dry. In either case, we provide analytical formulations of main statistics of our mixed-type disaggregation model and show their clear accordance with Monte Carlo simulations. An application to rainfall time series from real world is shown as a proof of concept.

Memetic Approaches for Optimizing Hidden Markov Models: A Case Study in Time Series Prediction

NASA Astrophysics Data System (ADS)

Bui, Lam Thu; Barlow, Michael

We propose a methodology for employing memetics (local search) within the framework of evolutionary algorithms to optimize parameters of hidden markov models. With this proposal, the rate and frequency of using local search are automatically changed over time either at a population or individual level. At the population level, we allow the rate of using local search to decay over time to zero (at the final generation). At the individual level, each individual is equipped with information of when it will do local search and for how long. This information evolves over time alongside the main elements of the chromosome representing the individual.

Neurovascular safety and clinical outcome of outside-in repair of tears of the posterior horn of the medial meniscus.

PubMed

Sobhy, Mohamed Hassan; AbouElsoud, Maged M Samy; Kamel, Ezzat Mohamed; Desouki, Ahmed Mohamed

2010-12-01

The purpose of this study was to evaluate the safety and clinical outcome of a new posterior approach for the known outside-in technique for repair of tears of the posterior horn of the medial meniscus (PHMM). First, a cadaveric study was performed on 6 cadaveric knees to assess the safety of a point just lateral to the semitendinosus tendon as an entry point for outside-in repair. Dissection was done to measure the clearance of this point to the nearby popliteal bundle and saphenous nerve. A prospective case series study was then performed to assess the clinical outcome of such an approach. We treated 41 consecutive cases with PHMM tears by the outside-in technique using a shuttle relay method through the same point. Clinical assessments, magnetic resonance imaging findings, Lysholm scores, and International Knee Documentation Committee subjective scores were recorded for all patients. After a minimum postoperative period of 2 years, all cases were re-evaluated and re-scored. The cadaveric study showed a mean clearance distance of 2.4 cm for the popliteal bundle and 4.6 cm for the saphenous nerve. The case series study was done on 41 meniscal repairs; 15 of 41 cases (37%) were performed in conjunction with anterior cruciate ligament reconstruction. There were 22 right knees (54%) and 19 left knees (36%). After a mean follow-up period of 27 months, patients showed a clinical success rate of 88% in terms of disappearance of pain, locking, and swelling, together with improved Lysholm scores (from 34 to 88) and International Knee Documentation Committee scores (from 25 to 88). These improvements were statistically significant (P < .05). An outside-in repair technique with a posterior entry central to the semitendinosus tendon was used safely with 88% satisfactory clinical results for treatment of PHMM tears. Level IV, therapeutic case series. Copyright © 2010 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Framework for Small-Scale Experiments in Software Engineering: Guidance and Control Software Project: Software Engineering Case Study

NASA Technical Reports Server (NTRS)

Hayhurst, Kelly J.

1998-01-01

Software is becoming increasingly significant in today's critical avionics systems. To achieve safe, reliable software, government regulatory agencies such as the Federal Aviation Administration (FAA) and the Department of Defense mandate the use of certain software development methods. However, little scientific evidence exists to show a correlation between software development methods and product quality. Given this lack of evidence, a series of experiments has been conducted to understand why and how software fails. The Guidance and Control Software (GCS) project is the latest in this series. The GCS project is a case study of the Requirements and Technical Concepts for Aviation RTCA/DO-178B guidelines, Software Considerations in Airborne Systems and Equipment Certification. All civil transport airframe and equipment vendors are expected to comply with these guidelines in building systems to be certified by the FAA for use in commercial aircraft. For the case study, two implementations of a guidance and control application were developed to comply with the DO-178B guidelines for Level A (critical) software. The development included the requirements, design, coding, verification, configuration management, and quality assurance processes. This paper discusses the details of the GCS project and presents the results of the case study.

Primary or recurring extra-abdominal desmoid fibromatosis: assessment of treatment by observation only.

PubMed

Barbier, O; Anract, P; Pluot, E; Larouserie, F; Sailhan, F; Babinet, A; Tomeno, B

2010-12-01

Extra-abdominal desmoid fibromatosis (EADF) is a benign tumoral condition, classically managed by more or less radical and sometimes mutilating excision. This treatment strategy is associated with a recurrence rate of nearly 50% according to various reports. EADF may show spontaneous stabilization over time. A retrospective series of 26 cases of EADF managed by simple observation was studied to assess spontaneous favorable evolution and identify possible factors impacting evolution. Eleven cases were of primary EADF with no treatment or surgery, and 15 of recurrence after surgery with no adjuvant treatment. MRI was the reference examination during follow-up. Twenty-four cases showed stabilization at a median 14 months; there were no cases of renewed evolution after stabilization. One primary tumor showed spontaneous regression, and one recurrence still showed evolution at end of follow-up (23 months). The sole factor impacting potential for evolution was prior surgery. No radiologic or pathologic criteria of evolution emerged from analysis. The present series, one of the largest dedicated to EADF managed by observation, confirmed recent literature findings: a conservative "wait-and-see" attitude is reasonable and should be considered when large-scale resection would entail significant functional or esthetic impairment. Level IV, retrospective study. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

Spontaneous Swallowing Frequency [Has Potential to] Identify Dysphagia in Acute Stroke

PubMed Central

Carnaby, Giselle D; Sia, Isaac; Khanna, Anna; Waters, Michael

2014-01-01

Background and Purpose Spontaneous swallowing frequency has been described as an index of dysphagia in various health conditions. This study evaluated the potential of spontaneous swallow frequency analysis as a screening protocol for dysphagia in acute stroke. Methods In a cohort of 63 acute stroke cases swallow frequency rates (swallows per minute: SPM) were compared to stroke and swallow severity indices, age, time from stroke to assessment, and consciousness level. Mean differences in SPM were compared between patients with vs. without clinically significant dysphagia. ROC analysis was used to identify the optimal threshold in SPM which was compared to a validated clinical dysphagia examination for identification of dysphagia cases. Time series analysis was employed to identify the minimally adequate time period to complete spontaneous swallow frequency analysis. Results SPM correlated significantly with stroke and swallow severity indices but not with age, time from stroke onset, or consciousness level. Patients with dysphagia demonstrated significantly lower SPM rates. SPM differed by dysphagia severity. ROC analysis yielded a threshold of SPM ≤ 0.40 which identified dysphagia (per the criterion referent) with 0.96 sensitivity, 0.68 specificity, and 0.96 negative predictive value. Time series analysis indicated that a 5 to 10 minute sampling window was sufficient to calculate spontaneous swallow frequency to identify dysphagia cases in acute stroke. Conclusions Spontaneous swallowing frequency presents high potential to screen for dysphagia in acute stroke without the need for trained, available personnel. PMID:24149008

[Work-related stress and mobbing: case series and gender differences].

PubMed

Tonini, Stefano; Lanfranco, Andrea; Costa, Maria Cristina; Lumelli, Diego; Giorgi, Ines; Mazzacane, Fulvio; Scafa, Fabrizio; Candura, Stefano M

2011-01-01

The attention of international agencies and scientific community on mobbing (bullying) and work-related stress is increasing. However, research on gender differences and etiologic agents is still limited. This study describes the gender differences found in victims of mobbing and work-related stress in an Italian case series. Between 2001 and 2009, at the Occupational Medicine Unit of our Institution we examined 345 outpatients (197 women and 148 men) for suspected psychopathological work-related problems. After interdisciplinary diagnostic evaluation, the diagnosis of "mobbing syndrome" was formulated, according to international criteria (ICD-I0 and DSM-IV), in a minority of cases: 35 subjects. In the other workers, we found pre-existing psychiatric conditions (not related to work), or altered relationships dynamics with the colleagues. Significant gender differences emerged among people with "mobbing syndrome": there was a high prevalence of women (65%), with medium to high level of education; the most affected age group was between 34 and 45 years; several occupations were involved, with a clear preponderance of office workers. Women are mostly harassed for personal aspects related to emotional and relational factors; men for the content of their work. The knowledge of the phenomenon is an essential prerogative to contrast mobbing; this can be realized, at a preventive level, only through effective information and training for workers and employers, who have the legal obligation to preserve the integrity of the mental and physical status of their employees during the work.

Spontaneous swallowing frequency has potential to identify dysphagia in acute stroke.

PubMed

Crary, Michael A; Carnaby, Giselle D; Sia, Isaac; Khanna, Anna; Waters, Michael F

2013-12-01

Spontaneous swallowing frequency has been described as an index of dysphagia in various health conditions. This study evaluated the potential of spontaneous swallow frequency analysis as a screening protocol for dysphagia in acute stroke. In a cohort of 63 acute stroke cases, swallow frequency rates (swallows per minute [SPM]) were compared with stroke and swallow severity indices, age, time from stroke to assessment, and consciousness level. Mean differences in SPM were compared between patients with versus without clinically significant dysphagia. Receiver operating characteristic curve analysis was used to identify the optimal threshold in SPM, which was compared with a validated clinical dysphagia examination for identification of dysphagia cases. Time series analysis was used to identify the minimally adequate time period to complete spontaneous swallow frequency analysis. SPM correlated significantly with stroke and swallow severity indices but not with age, time from stroke onset, or consciousness level. Patients with dysphagia demonstrated significantly lower SPM rates. SPM differed by dysphagia severity. Receiver operating characteristic curve analysis yielded a threshold of SPM≤0.40 that identified dysphagia (per the criterion referent) with 0.96 sensitivity, 0.68 specificity, and 0.96 negative predictive value. Time series analysis indicated that a 5- to 10-minute sampling window was sufficient to calculate spontaneous swallow frequency to identify dysphagia cases in acute stroke. Spontaneous swallowing frequency presents high potential to screen for dysphagia in acute stroke without the need for trained, available personnel.

Modelling the effects of booster dose vaccination schedules and recommendations for public health immunization programs: the case of Haemophilus influenzae serotype b.

PubMed

Charania, Nadia A; Moghadas, Seyed M

2017-09-13

Haemophilus influenzae serotype b (Hib) has yet to be eliminated despite the implementation of routine infant immunization programs. There is no consensus regarding the number of primary vaccine doses and an optimal schedule for the booster dose. We sought to evaluate the effect of a booster dose after receiving the primary series on the long-term disease incidence. A stochastic model of Hib transmission dynamics was constructed to compare the long-term impact of a booster vaccination and different booster schedules after receiving the primary series on the incidence of carriage and symptomatic disease. We parameterized the model with available estimates for the efficacy of Hib conjugate vaccine and durations of both vaccine-induced and naturally acquired immunity. We found that administering a booster dose substantially reduced the population burden of Hib disease compared to the scenario of only receiving the primary series. Comparing the schedules, the incidence of carriage for a 2-year delay (on average) in booster vaccination was comparable or lower than that observed for the scenario of booster dose within 1 year after primary series. The temporal reduction of symptomatic disease was similar in the two booster schedules, suggesting no superiority of one schedule over the other in terms of reducing the incidence of symptomatic disease. The findings underscore the importance of a booster vaccination for continued decline of Hib incidence. When the primary series provides a high level of protection temporarily, delaying the booster dose (still within the average duration of protection conferred by the primary series) may be beneficial to maintain longer-term protection levels and decelerate the decline of herd immunity in the population.

[Changes in the diagnosis and therapeutic management of hepatic trauma. A retrospective study comparing 2 series of cases in different (1997-1984 vs. 2001-2008)].

PubMed

Sánchez-Bueno, Francisco; Fernández-Carrión, Jezabel; Torres Salmerón, Gloria; García Pérez, Rocío; Ramírez Romero, Pablo; Fuster Quiñonero, Matilde; Parrilla, Pascual

2011-01-01

We present a series of 146 cases of hepatic trauma (HT) treated in our hospital over a period of 8 yearsm (2001-2008), and comparing it with a previous series of 92 cases (1977-1984). The mean age in the current series was 28.6 years and the majority were male. The closed traumas were mainly penetrating, with the most frequent cause being road traffic accidents. The American Association for the Surgery of Trauma (AAST) classification was used to evaluate the grade of the hepatic injury. Associated abdominal and /or extra-abdominal injuries were seen in 79.5% of the patients, with the most frequent being chest trauma, compared to bone fractures in the previous series. The most common associated intra-abdominal injury was the spleen in both series. The most used diagnostic technique in the current series was abdominal CT. Simple peritoneal puncture and lavage (PLP) were the most used examinations used in the previous series. Non-surgical treatment (NST) was given in 98 cases and the surgery was indicated in the remaining 48. In the previous series, 97.8% of patients were operated on. In the current series, on the 15 patients with severe liver injuries, 5 right hepatectomies, 2 segmentectomies and 6 packing compressions were performed, with the remaining two dying during surgery due to hepatic avulsion. The overall mortality was 3.4%, being 1% in the NST group and 8.3% in the surgical patients. In the previous series, the overall mortality was 29.3%. The key factor for using NST is to control haemodynamic stability, leaving surgical treatment for haemodynamically unstable patients. Copyright © 2011 AEC. Published by Elsevier Espana. All rights reserved.

Intradural disc herniation: radiographic findings and surgical results with a literature review.

PubMed

Kobayashi, Kazuyoshi; Imagama, Shiro; Matsubara, Yuji; Yoshihara, Hisatake; Hirano, Kenichi; Ito, Zenya; Ando, Kei; Ukai, Junichi; Muramoto, Akio; Shinjo, Ryuichi; Matsumoto, Tomohiro; Nakashima, Hiroaki; Ishiguro, Naoki

2014-10-01

To report a series of four cases of intradural disc herniation (IDH) with a review of the literature. IDH is a rare type of disc herniation. Preoperative diagnosis is difficult and IDH is only confirmed during surgery in most cases. Here, we describe four cases of IDH, including three with lumbar hernia and one with thoracic hernia. A retrospective chart review, surgical database query, and review of radiology reports are presented for each case, along with a literature review of IDH. Two of the four patients had a history of surgery at the same spinal level. Ring enhancement in gadolinium-enhanced MRI, an air image in computed tomography, and complete block in myelography were observed in the series. Surgery was performed with a transdural approach in all patients. One patient underwent transforaminal lumbar interbody fusion after postoperative recurrence. Three patients with lumbar involvement had nerve root symptoms preoperatively, but showed symptomatic improvement in the early postoperative period. In contrast, the patient with thoracic involvement had preoperative muscle weakness due to myelopathy symptoms, and had residual symptoms after surgery. IDH is a rare disease and characteristic imaging findings can be useful for diagnosis. Intraoperative findings lead to a definitive diagnosis in many cases and recognition of the pathological characteristics of IDH is important. Copyright © 2014 Elsevier B.V. All rights reserved.

The reverse boomerang sign: a marker for first-trimester transposition of great arteries.

PubMed

Bravo-Valenzuela, Nathalie Jeanne; Peixoto, Alberto Borges; Araujo Júnior, Edward; Da Silva Costa, Fabricio; Meagher, Simon

2017-10-12

To describe a new sonographic marker of transposition of great arteries (TGA) during the first-trimester screening. We reviewed six cases of TGA from 2013 to 2016 in which an antenatal diagnosis of TGA at first-trimester screening (11-13 + 6 weeks of gestation) was confirmed postnatally. We specifically assessed images obtained by scanning the fetal heart in three vessels (3V) and three-vessel with trachea (3VT) views using color Doppler. The "reverse boomerang" sign was defined as a reverse curvature of right ventricle outflow tract (RVOT) at level of the 3VT view. We described six cases of confirmed TGA, five singletons and one twin pregnancy, among which only two vessels and the reverse curvature of RVOT (reverse boomerang sign) was demonstrated in the first-trimester screening at level of 3VT view. Ventricular septal defects were observed in three cases, and double outlet right ventricle in one case. No other cardiac or extracardiac anomalies were identified. Termination of pregnancy was not performed in any case. Our series case suggests that the reverse boomerang sign may improve the early prenatal screening for TGA.

The neurovascular complexity index as a potential indicator of traumatic brain injury severity: A case-series study.

PubMed

Howard, Jeffrey T; Janak, Jud C; Bukhman, Vladislav; Robertson, Claudia; Frolov, Iurii; Nawn, Corinne D; Schiller, Alicia M; Convertino, Victor A

2017-07-01

Multimodal monitoring of brain physiology following a traumatic brain injury (TBI) shows promise as a strategy to improve management and outcomes of TBI patients within civilian and military trauma. Valid and reliable measures of different aspects of brain physiology following a TBI could prove critical to accurately capturing these changes. Using a case-series design with a control subject group comparison, we evaluated a new proprietary algorithm called the Neurovascular Complexity Index (NCI) using transcranial Doppler to noninvasively obtain measures of cerebral blood flow variability. Baseline NCI data from 169 control subjects were compared with 12 patients with moderate to severe TBI. Patients with TBI exhibited significantly greater mean and variability in NCI scores compared with control subjects (F = 195.48; p < 0.001). The mean absolute deviation (MAD) of NCI scores increased significantly and in a monotonic fashion with severity of injury, where control subjects exhibited a small MAD of 0.44, patients with moderate TBI had a higher MAD of 4.20, and patients with severe TBI had an MAD of 6.51 (p < 0.001). Advancement in multimodal monitoring of TBI patients is important in reducing the potential risk of secondary injury. This study reports results indicating that a new noninvasive quantifiable assessment of TBI based on a noninvasive measure of cerebral blood flow variability shows potential for continuous monitoring and early identification of brain-injured patients, deployable in far-forward military environments, to better inform individualized management. Case series, level IV.

Is mindfulness-based therapy an effective intervention for obsessive-intrusive thoughts: a case series.

PubMed

Wilkinson-Tough, Megan; Bocci, Laura; Thorne, Kirsty; Herlihy, Jane

2010-01-01

Despite the efficacy of cognitive-behavioural interventions in improving the experience of obsessions and compulsions, some people do not benefit from this approach. The present research uses a case series design to establish whether mindfulness-based therapy could benefit those experiencing obsessive-intrusive thoughts by targeting thought-action fusion and thought suppression. Three participants received a relaxation control intervention followed by a six-session mindfulness-based intervention which emphasized daily practice. Following therapy all participants demonstrated reductions in Yale-Brown Obsessive-Compulsive Scale scores to below clinical levels, with two participants maintaining this at follow-up. Qualitative analysis of post-therapy feedback suggested that mindfulness skills such as observation, awareness and acceptance were seen as helpful in managing thought-action fusion and suppression. Despite being limited by small participant numbers, these results suggest that mindfulness may be beneficial to some people experiencing intrusive unwanted thoughts and that further research could establish the possible efficacy of this approach in larger samples. Copyright (c) 2009 John Wiley & Sons, Ltd.

Systematic review: transient left ventricular apical ballooning: a syndrome that mimics ST-segment elevation myocardial infarction.

PubMed

Bybee, Kevin A; Kara, Tomas; Prasad, Abhiram; Lerman, Amir; Barsness, Greg W; Wright, R Scott; Rihal, Charanjit S

2004-12-07

The transient left ventricular apical ballooning syndrome, also known as takotsubo cardiomyopathy, is characterized by transient wall-motion abnormalities involving the left ventricular apex and mid-ventricle in the absence of obstructive epicardial coronary disease. In this paper, we review case series that report on patients with the transient left ventricular apical ballooning syndrome to better characterize patients presenting with the syndrome. We identified 7 case series that reported on at least 5 consecutive patients with the transient left ventricular apical ballooning syndrome. The syndrome more often affects postmenopausal women (82% to 100%) (mean age, 62 to 75 years). Patients commonly present with ST-segment elevation in the precordial leads, chest pain, relatively minor elevation of cardiac enzyme and biomarker levels, and transient apical systolic left ventricular dysfunction despite the absence of obstructive epicardial coronary disease. An episode of emotional or physiologic stress frequently precedes presentation with the syndrome. The in-hospital mortality rate seems to be low, as does the risk for recurrence.

Investigation of Severe Craniomaxillofacial Battle Injuries Sustained by U.S. Service Members: A Case Series

PubMed Central

Brown Baer, Pamela R.; Wenke, Joseph C.; Thomas, Steven J.; Hale, Colonel Robert G.

2012-01-01

This case series describes craniomaxillofacial battle injuries, currently available surgical techniques, and the compromised outcomes of four service members who sustained severe craniomaxillofacial battle injuries in Iraq or Afghanistan. Demographic information, diagnostic evaluation, surgical procedures, and outcomes were collected and detailed with a follow-up of over 2 years. Reconstructive efforts with advanced, multidisciplinary, and multiple revision procedures were indicated; the full scope of conventional surgical options and resources were utilized. Patients experienced surgical complications, including postoperative wound dehiscence, infection, flap failure, inadequate mandibular healing, and failure of fixation. These complications required multiple revisions and salvage interventions. In addition, facial burns complicated reconstructive efforts by delaying treatment, decreasing surgical options, and increasing procedural numbers. All patients, despite multiple surgeries, continue to have functional and aesthetic deficits as a result of their injuries. Currently, no conventional treatments are available to satisfactorily reconstruct the face severely ravaged by explosive devices to an acceptable level, much less to natural form and function. PMID:24294409

Results of revision total knee arthroplasty using press-fit cementless stem.

PubMed

Iamaguchi, Maurício Masasi; de Castro, Fernando Bley Vicente; Gobbi, Riccardo Gomes; Tirico, Luis Eduardo Passarelli; Pécora, José Ricardo; Camanho, Gilberto Luis

2013-01-01

To show our experience with press-fit cementless stem and metaphyseal fixation with cement in a selected series of patients who underwent revision total knee arthroplasty. Thirty-four patients (35 knees) underwent revision total knee arthroplasty using the press-fit technique. Minimum follow-up was one year (mean 2.2 years) with a maximum length of three years. Of 34 patients, 20 were women and 14 were men. There was one death due to causes not related to arthroplasty and one patient dropout. There were no cases in which further review was necessary. Patients who underwent revision had clinical and functional improvement demonstrated by the results of the KSS, results of the SF-36 quality of life questionnaire, through gains in range of motion and improved limb alignment. There was postoperative clinical and functional improvement in comparison to the preoperative status in revision total knee arthroplasty with press-fit cementless stem. Level of Evidence IV, Case series.

Does the Well-Being of Individuals with Down Syndrome and Dementia Improve When Using Life Story Books and Rummage Boxes? A Randomized Single Case Series Experiment.

PubMed

Crook, Nicola; Adams, Malcolm; Shorten, Nicola; Langdon, Peter E

2016-01-01

This study investigated whether a personalized life story book and rummage box enhanced well-being and led to changes in behaviour for people with Down syndrome (DS) who have dementia. A randomized single case series design was used with five participants who had DS and a diagnosis of dementia. Participants were invited to take part in three conditions at random (i) life story book, (ii) rummage box and (iii) no-intervention condition. The two reminiscence conditions were significantly associated with enhanced well-being as compared to the no-intervention condition. However, for one participant, the life story book was associated with significantly higher well-being, while for another participant, the rummage box was associated with significantly higher well-being, suggesting some participants may prefer one method over another. Personalized life story books and rummage boxes are associated with higher levels of well-being for people with DS and dementia. © 2015 John Wiley & Sons Ltd.

Low-dose divalproex in agitated patients with Alzheimer's disease.

PubMed

Dolder, Christian; McKinsey, Jonathan

2010-01-01

Adequate treatment of behavioral disturbances in Alzheimer's disease is both important and difficult. This report describes a case series that examined the effectiveness and safety of low-dose divalproex in the treatment of agitated patients with Alzheimer's disease who were admitted to an inpatient geriatric psychiatry unit over a 1-year period. All patients had agitation due to probable Alzheimer's disease or mixed dementia and were prescribed divalproex monotherapy at low and completely flexible doses. Patients and nursing staff were blind to study enrollment. Clinical global impression scale scores, divalproex serum levels, and a variety of medical chart data were collected. Twenty patients met selection criteria and were included in the study. Of those, 13 patients (65%) were considered responders, while 4 patients (20%) required augmentation with other psychotropic medications; divalproex was discontinued in 1 patient. Adverse events occurred in 25% of patients. This case series suggests that low-dose divalproex may offer behavioral improvement and a reduced risk of side effects for some patients with agitation in Alzheimer's disease.

The effects of neck and trunk stabilization exercises on cerebral palsy children’s static and dynamic trunk balance: case series

PubMed Central

Shin, Ji-won; Song, Gui-bin; Ko, Jooyeon

2017-01-01

[Purpose] The purpose of this case series was to examination the effects of trunk and neck stabilization exercise on the static, dynamic trunk balance abilities of children with cerebral palsy. [Subjects and Methods] The study included 11 school aged children diagnosed with paraplegia due to a premature birth. Each child engaged in exercise treatments twice per week for eight weeks; each treatment lasted for 45 minutes. After conducting a preliminary assessment, exercise treatments were designed based on each child’s level of functioning. Another assessment was conducted after the eight weeks of treatment. [Results] The Trunk Control Measurement Scale evaluation showed that the exercise treatments had a significant effect on static sitting balance, selective movement control, dynamic reaching, and total Trunk Control Measurement Scale scores. [Conclusion] The results indicate that neck and trunk stabilization exercises that require children’s active participation are helpful for improving static and dynamic balance ability among children diagnosed with cerebral palsy. PMID:28533628

Characterization of NLRP3 variants in Japanese cryopyrin-associated periodic syndrome patients.

PubMed

Ohnishi, Hidenori; Teramoto, Takahide; Iwata, Hiroaki; Kato, Zenichiro; Kimura, Takeshi; Kubota, Kazuo; Nishikomori, Ryuta; Kaneko, Hideo; Seishima, Mariko; Kondo, Naomi

2012-04-01

The etiology of cryopyrin-associated periodic syndrome (CAPS) is caused by germline gene mutations in NOD-like receptor family, pryin domain containing 3 (NLRP3)/cold-induced autoinflammatory syndrome 1 (CIAS1). CAPS includes diseases with various severities. The aim of this study was to characterize patients according to the disease severity of CAPS. Five Japanese patients with four kinds of gene variations in NLRP3 were found and diagnosed as CAPS or juvenile idiopathic arthritis. Two mutations in NLRP3, Y563N and E688K, found in CAPS patients exhibit significant positive activities in the nuclear factor-κB reporter gene assay. Increased serum interleukin (IL)-18 levels were only observed in severe cases of CAPS. In mild cases of CAPS, the serum IL-18 levels were not increased, although lipopolysaccharide- or hypothermia-enhanced IL-1β and IL-18 production levels by their peripheral blood mononuclear cells were detectable. This series of case reports suggests that a combination of in vitro assays could be a useful tool for the diagnosis and characterization of the disease severity of CAPS.

Hemoadsorption by CytoSorb in septic patients: a case series.

PubMed

Kogelmann, Klaus; Jarczak, Dominik; Scheller, Morten; Drüner, Matthias

2017-03-27

Septic shock, defined as life-threatening organ dysfunction caused by a dysregulated host response to infection, is a highly lethal condition that causes substantial morbidity and mortality among critically ill patients. One of the hallmarks of sepsis is the excessive release of cytokines and other inflammatory mediators causing refractory hypotension, tissue damage, metabolic acidosis and ultimately multiple organ failure. In this context, cytokine reduction by hemoadsorption represents a new concept for blood purification, developed to attenuate the overwhelming systemic levels of pro-inflammatory and anti-inflammatory mediators released in the early phase of sepsis. In the present case series, we evaluated the impact of a new hemoadsorption device (CytoSorb) used as adjunctive therapy, on hemodynamics and clinically relevant outcome parameters in 26 critically ill patients with septic shock and in need of renal replacement therapy. We found that treatment of these patients with septic shock was associated with hemodynamic stabilization and a reduction in blood lactate levels. Actual mortality in the overall patient population was lower than mortality predicted by acute physiology and chronic health evaluation II (APACHE II). These effects seem to be more pronounced in patients in whom therapy started within 24 h of sepsis diagnosis, whereas a delay in the start of therapy was associated with a poor response to therapy in terms of reduction of catecholamine demand and survival. Moreover, from our patient population, medical patients seemed to benefit more than post-surgical patients in terms of survival. Treatment using the CytoSorb device was safe and well-tolerated with no device-related adverse events during or after the treatment sessions. Hemoadsorption using CytoSorb resulted in rapid hemodynamic stabilization and increased survival, particularly in patients in whom therapy was started early. Given the positive clinical experience of this case series, randomized controlled trials are urgently needed to define the potential benefits of this new treatment option.

[Urban air pollution and children respiratory hospital admissions in Pisa (Italy): a time series and a case-crossover approach].

PubMed

Vigotti, Maria Angela; Serinelli, Maria; Marchini, Laura

2010-01-01

we evaluated the association of daily pollutants' concentrations with daily hospital admissions for respiratory causes in children residents in Pisa during 1998-2002. We compared the results obtained with two methods of statistical analyses. A total of 657 children under ten years and admitted to local hospitals for respiratory diseases (ICD 9: 460-469, 480- 519) were included in the study. both time-series and case-crossover analysis were applied, controlling for temperature, holidays, influenza epidemics,rain and relative humidity. Pollutants' effects are expressed as percentage increase (and 95% CI) of hospital admissions for an increase of 10 μg/m³ of pollutants (1 mg/m³ for CO). with both analyses, children's hospital admissions for respiratory conditions were significantly associated to increasing daily levels of PM10 and CO at different time lags, while no association was found for NO₂ and O₃. In the case-crossover analysis, for a daily increase of 10 μg/m³ in PM10, a significant increment of 8.5% (CI 95% 0.02; 17.6) in children respiratory admissions was observed at lag 0-3. Results were stronger for males and during the warm season. A 1 mg/m³ increment in daily CO levels was associated with an increase of respiratory admissions at lag 0 (20.2%, CI 95% 5.3; 37.2) and at all cumulative lags: the maximum value was observed at lag 0-3 (32.6%, CI 95%8.3; 62.2). Time series analyses provides similar results, although the estimates were lower than with the other method, in terms of percentage increment and length of confidence intervals. this study indicates adverse effects of air pollution on respiratory health of children living in urban environment. The results of both analyses were consistent.

Zero-P: a new zero-profile cage-plate device for single and multilevel ACDF. A single institution series with four years maximum follow-up and review of the literature on zero-profile devices.

PubMed

Barbagallo, Giuseppe M V; Romano, Dario; Certo, Francesco; Milone, Pietro; Albanese, Vincenzo

2013-11-01

To analyze the prospectively collected data in a series of patients treated with single- or multilevel ACDF with a stand-alone, zero-profile device, focusing on clinico-radiological outcome, complications and technical hints, and to review the literature on such new devices. Eighty-five patients harboring symptomatic DDD underwent ACDF with the Zero-P cage-plate: 29 at 1-level and 56 at 2-4 levels (total 162 devices). In the multilevel group, 9 patients received a combination of Zero-P and stand-alone cages (hybrid implants). This study focuses on 32 patients with follow-up ranging from 20 to 48 months. NDI, SF-36 and arm pain VAS scores were registered preoperatively and at follow-up visits. Dysphagia was assessed using the Bazaz score. Imaging included X-rays, CT and MRI, also to assess the presence of vertebral body fractures in multilevel cases. Paired Student t test was used for statistical analysis. SF-36 and NDI showed a statistically significant improvement (p < 0.01) and mean arm pain VAS score decreased from 79 to 41. X-rays and CT demonstrated, respectively, a 94.5 % and a 92 % fusion rate. Three patients complained of moderate and two of mild transient dysphagia (15.5 %). No device-related complications occurred and no fractures, secondary to four screws insertion in one vertebral body (i.e., swiss cheese effect), were detected in multilevel cases. In patients with extensive anterior osteophytes only a "focal spondylectomy" was required. The Zero-P device is safe and efficient, even in multilevel cases. Dysphagia is minimal, extensive anterior osteophytectomy is unnecessary and technical hints may ease the surgical workflow. This is the largest series, with the longest follow-up, reported.

Learning from Multiple Cases: A New Paradigm for Investigating the Effects of Clinical Experience on Knowledge Restructuring and Knowledge Acquisition.

ERIC Educational Resources Information Center

Boshuizen, Henny P. A.; Bongaerts, Maureen Machiels; van de Wiel, Margaretha W. J.; Schmidt, Henk G.

The effects of experience with a series of similar cases on the knowledge restructuring and learning from text were studied in a longitudinal design. Two groups of fourth-year medical students were confronted with a series of cases, part of them having the same underlying disease. The cases were interspersed with fillers, and each set of cases had…

[Non-Hodgkin's malignant lymphoma with cervicofacial expression. Modulation of the radiotherapy-chemotherapy combination according to the cytological class].

PubMed

Bolla, M; Sotto, J J; Sotto, M F; Junien Lavillauroy, C; Bryon, J P; Vrousos, C; Holland, D

1984-01-01

An analysis was conducted in March 1983, after a mean follow up of 40 months, of cases of cervicofacial stages I and II non-Hodgkins malignant lymphoma in 3 children and 41 adults (mean age: 51 years, range: 6-90 years) treated between 1969 and March 1981. According to the Working Formulation malignancy was low in 4 cases, intermediate in 24 and high in 13; 3 cases could not ne classified retrospectively. Cytologic classification showed 13 of class 1 of low malignancy, 7 of class 2 of high malignancy with leukemic potential, and 16 of class 3 of high malignancy with a course leading to tumor formation. The cavum was involved in 10 cases, the tonsils in 9, the parotids in 1, the uvula in 1, isolated cervical adenopathies in 14, multiple unilateral adenopathies in 3 and bilateral cervical adenopathies in 5 cases. Therapy varied according to the series: in the first series (1969-1975) the 23 cases were treated by radiotherapy alone (40-55 Gy). In the second series (1976-1981) of 21 cases, chemotherapy was given as a function of the cytologic class: prophylactic chemotherapy for 6 months after radiation for classes 1 and 2, initial chemotherapy for 6 weeks, cerebral radiation and methotrexate intrathecally, and maintenance chemotherapy for 3 months in class 3. The failure rate for radiated zones was identical in the 2 series (less than 10%). Adjusted 5-year survival rate was 60% for series 1 against 70% for series 2 (p = 0.9), and adjusted remission rate was 43% against 64% (p = 0.8).

Arthroscopic Shoulder Surgery in Female Professional Tennis Players: Ability and Timing to Return to Play.

PubMed

Young, Simon W; Dakic, Jodie; Stroia, Kathleen; Nguyen, Michael L; Safran, Marc R

2017-07-01

To assess the outcome and time to return to previous level of competitive play after shoulder surgery in professional tennis players. Retrospective case series. Tertiary academic centre. The records of all female tennis players on the Women's Tennis Association (WTA) professional circuit between January 2008 and June 2010 were reviewed to identify players who underwent shoulder surgery on their dominant (serving) shoulder. Primary outcomes were the ability and time to return to professional play and if they were able to return to their previous level of function as determined by singles ranking. Preoperative and postoperative singles rankings were used to determine rate and completeness of return to preoperative function. During the study period, 8 professional women tennis players from the WTA tour underwent shoulder surgery on their dominant arm. Indications included rotator cuff debridement or repair, labral reconstruction for instability or superior labral anterior posterior lesion, and neurolysis of the suprascapular nerve. Seven players (88%) returned to professional play. The mean time to return to play was 7 months after surgery. However, only 25% (2 of 8) players achieved their preinjury singles rank or better by 18 months postoperatively. In total, 4 players returned to their preinjury singles ranking, with their peak singles ranking being attained at a mean of 2.4 years postoperatively. In professional female tennis players, a high return to play rate after arthroscopic shoulder surgery is associated with a prolonged and often incomplete return to previous level of performance. Thus, counseling the patient to this fact is important to manage expectations. Level IV-Case Series.

Owner Evaluation of a CORA-Based Leveling Osteotomy for Treatment of Cranial Cruciate Ligament Injury in Dogs.

PubMed

Kishi, Erin N; Hulse, Don

2016-05-01

To evaluate a center of rotation of angulation (CORA)-based leveling osteotomy for cranial cruciate ligament injury in dogs. Retrospective case series. Dogs (n=70). Medical records (March 2011 to March 2012) of dogs diagnosed with a cranial cruciate ligament (CCL) injury treated with a CORA-based leveling osteotomy and stabilized using a bone plate and headless compression screw were reviewed. Radiographs were reviewed for tibial plateau angle and radiographic healing at final evaluation graded on a 5-point scale. Follow-up for a minimum of 6 months postoperatively was conducted by owner completion of a questionnaire regarding their dog's function after surgery. Based on owner responses, clinical outcomes were established. CORA-based leveling osteotomy was used for 70 stifles with CCL injury. The mean time to final radiographic recheck was 107 days (range, 32-424 days). Radiographic healing scores were 42 dogs (69%) with grade 4, 17 dogs (28%) with grade 3, and 2 dogs (3%) with grade 2. The mean time to follow-up was 11.9 months (range 6-18 months). Fifty-four of the 70 (77%) dogs had full function, 13 (19%) had acceptable function, and 3 (4%) had unacceptable function. Complications occurred in 11 stifles (16%), including 3 incisional, 6 late-onset meniscal tears, and 2 implant related. The described method of a CORA-based leveling osteotomy can be successfully performed for treatment of CCL injury in dogs. At the time of mid-term and long-term owner follow-up, most dogs in this case series had returned to full function. © Copyright 2016 by The American College of Veterinary Surgeons.

Sawflies and ponderosa pine: hypothetical response surfaces for pine genotype, ontogenic stage, and stress level

Treesearch

Michael R. Wagner

1991-01-01

Patterns that occur in nature are the result of a complex set of current and historical factors that interact with one another and the adaptive plasticity of plants. Scientists are forced to assess such processes on the basis of series of "snapshots" over a relatively short time that represent only part of the grand pattern. In the case of insects interacting...

Policies and Procedures To Develop Effective School-Wide Discipline Practices at the Elementary School Level. CASE/CCBD Mini-Library Series on Safe, Drug-Free, and Effective Schools.

ERIC Educational Resources Information Center

Newcomer, Lori L.; Lewis, Timothy J.; Powers, Lisa J.

Elementary schools can play an important role in early identification of and intervention for children with problem behavior by creating the infrastructure to provide preventive, proactive supports for all students. This monograph provides an overview of key features of effective school-wide systems of positive behavior support (PBS) at the…

With Interest It Comes To...Unconscionable Clauses in Sales Contracts. A Student's Lesson Plan [and] A Teacher's Lesson Plan [and] A Lawyer's Lesson Plan.

ERIC Educational Resources Information Center

Howard, Estelle; And Others

One of a series of secondary level teaching units presenting case studies with pro and con analysis of particular legal problems, the document presents a student's lesson plan, a teacher's lesson plan, and a lawyer's lesson plan on unconscionable clauses in sales contracts. The unit acquaints students with the operation of sales contracts and…

Dirac-Kähler particle in Riemann spherical space: boson interpretation

NASA Astrophysics Data System (ADS)

Ishkhanyan, A. M.; Florea, O.; Ovsiyuk, E. M.; Red'kov, V. M.

2015-11-01

In the context of the composite boson interpretation, we construct the exact general solution of the Dirac--K\\"ahler equation for the case of the spherical Riemann space of constant positive curvature, for which due to the geometry itself one may expect to have a discrete energy spectrum. In the case of the minimal value of the total angular momentum, $j=0$, the radial equations are reduced to second-order ordinary differential equations, which are straightforwardly solved in terms of the hypergeometric functions. For non-zero values of the total angular momentum, however, the radial equations are reduced to a pair of complicated fourth-order differential equations. Employing the factorization approach, we derive the general solution of these equations involving four independent fundamental solutions written in terms of combinations of the hypergeometric functions. The corresponding discrete energy spectrum is then determined via termination of the involved hypergeometric series, resulting in quasi-polynomial wave-functions. The constructed solutions lead to notable observations when compared with those for the ordinary Dirac particle. The energy spectrum for the Dirac-K\\"ahler particle in spherical space is much more complicated. Its structure substantially differs from that for the Dirac particle since it consists of two paralleled energy level series each of which is twofold degenerate. Besides, none of the two separate series coincides with the series for the Dirac particle. Thus, the Dirac--K\\"ahler field cannot be interpreted as a system of four Dirac fermions. Additional arguments supporting this conclusion are discussed.

Drug-induced Fanconi syndrome associated with fumaric acid esters treatment for psoriasis: a case series.

PubMed

Balak, Deepak M W; Bouwes Bavinck, Jan Nico; de Vries, Aiko P J; Hartman, Jenny; Neumann, Hendrik A Martino; Zietse, Robert; Thio, Hok Bing

2016-02-01

Fumaric acid esters (FAEs), an oral immunomodulating treatment for psoriasis and multiple sclerosis, have been anecdotally associated with proximal renal tubular dysfunction due to a drug-induced Fanconi syndrome. Few data are available on clinical outcomes of FAE-induced Fanconi syndrome. Descriptive case series with two cases of Fanconi syndrome associated with FAE treatment diagnosed at two Dutch university nephrology departments, three cases reported at the Dutch and German national pharmacovigilance databases and six previously reported cases. All 11 cases involved female patients with psoriasis. The median age at the time of onset was 38 years [interquartile range (IQR) 37-46]. Patients received long-term FAEs treatment with a median treatment duration of 60 months (IQR 28-111). Laboratory tests were typically significant for low serum levels of phosphate and uric acid, while urinalysis showed glycosuria and proteinuria. Eight (73%) patients had developed a hypophosphataemic osteomalacia and three (27%) had pathological bone fractures. All patients discontinued FAEs, while four (36%) patients were treated with supplementation of phosphate and/or vitamin D. Five (45%) patients had persisting symptoms despite FAEs discontinuation. FAEs treatment can cause drug-induced Fanconi syndrome, but the association has been reported infrequently. Female patients with psoriasis treated long term with FAEs seem to be particularly at risk. Physicians treating patients with FAEs should be vigilant and monitor for the potential occurrence of Fanconi syndrome. Measurement of the urinary albumin:total protein ratio is a suggested screening tool for tubular proteinuria in Fanconi syndrome.

On Sums of Numerical Series and Fourier Series

ERIC Educational Resources Information Center

Pavao, H. Germano; de Oliveira, E. Capelas

2008-01-01

We discuss a class of trigonometric functions whose corresponding Fourier series, on a conveniently chosen interval, can be used to calculate several numerical series. Particular cases are presented and two recent results involving numerical series are recovered. (Contains 1 note.)

Development of the NEDO implantable ventricular assist device with Gyro centrifugal pump.

PubMed

Yoshikawa, M; Nonaka, K; Linneweber, J; Kawahito, S; Ohtsuka, G; Nakata, K; Takano, T; Schulte-Eistrup, S; Glueck, J; Schima, H; Wolner, E; Nosé, Y

2000-06-01

The Gyro centrifugal pump, PI (permanently implantable) series, is being developed as a totally implantable artificial heart. Our final goal is to establish a "functional TAH," a totally implantable biventricular assist system (BiVAS) with centrifugal pumps. A plastic prototype pump, Gyro PI 601, was evaluated through in vitro and in vivo studies as a single ventricular assist device (VAD). Based upon these results, the pump head material was converted to a titanium alloy, and the actuator was modified. These titanium Gyro pumps, PI 700 series, also were subjected to in vitro and in vivo studies. The Gyro PI 601 and PI 700 series have the same inner dimensions and characteristics, such as the eccentric inlet port, double pivot bearing system, secondary vane, and magnet coupling system; however, the material of the PI 700 is different from the PI 601. The Gyro PI series is driven by the Vienna DC brushless motor actuator. The inlet cannula of the right ventricular assist system (RVAS) specially made for this system consists of 2 parts: a hat-shaped silicone tip biolized with gelatin and an angled wire reinforced tube made of polyvinylchloride. The pump-actuator package was implanted into 8 calves in the preperitoneal space, bypassing from the left ventricle apex to the descending aorta for the left ventricular assist system (LVAS) and bypassing the right ventricle to the main pulmonary artery for the RVAS. According to the PI 601 feasibility protocol, 2 LVAS cases were terminated after 2 weeks, and 1 LVAS case and 1 RVAS were terminated after 1 month. The PI 700 series was implanted into 4 cases: 3 LVAS cases survived for a long term, 2 of them over 200 days (72-283 days), and 1 RVAS case survived for 1 month and was terminated according to the protocol for a short-term antithrombogenic screening and system feasibility study. Regarding power consumption, the plastic pump cases demonstrated from 6.2 to 12.1 W as LVAS and 7.3 W as RVAS, the titanium pump cases showed from 10.4 to 14.2 W as LVAS and 15.8 W as RVAS. All cases exhibited low hemolysis. The renal function and the liver function were maintained normally in all cases throughout these experimental periods. In the 2 RVAS cases, pulmonary function was normally maintained. No calves demonstrated thromboembolic signs or symptoms throughout the experiments except Case 1 with the plastic pump. However, in the plastic pump cases, bilateral renal infarction was suspected in 2 cases during necropsy whereas no abnormal findings were revealed in the titanium pump cases. There were also no blood clots inside the PI 700 series. As for the 601, the explanted pumps demonstrated slight thrombus formations at the top and bottom pivots except in 1 case. The Gyro PI series, especially the PI 700 series, demonstrated superior performance, biocompatibility, antithrombogenicity and low hemolysis. Also, the durability of the actuator was demonstrated. Based on these results, this titanium centrifugal pump is suitable as an implantable LVAS and RVAS. It is likely that the Gyro PI series is a feasible component of the BiVAS functional TAH.

Time series analysis for the estimation of tidal fluctuation effect on different aquifers in a small coastal area of Saijo plain, Ehime prefecture, Japan.

PubMed

Kumar, Pankaj; Tsujimura, Maki; Nakano, Takanori; Minoru, Tokumasu

2013-04-01

Considering the current poor understanding of the seawater-freshwater (SW-FW) interaction pattern at dynamic hydro-geological boundary of coastal aquifers, this work strives to study tidal effect on groundwater quality using chemical tracers combined with environmental isotopes. In situ measurement data of electrical conductivity and groundwater level along with laboratory measurement data of hydro-chemical species were compared with tidal level data measured by Hydrographic and Oceanographic Department, Saijo City, Japan for time series analysis. Result shows that diurnal tides have significant effect on groundwater level as well as its chemical characteristics; however, the magnitude of effect is different in case of different aquifers. Various scatter diagrams were plotted in order to infer mechanisms responsible for water quality change with tidal phase, and results show that cations exchange, selective movement and local SW-FW mixing were likely to be the main processes responsible for water quality changes. It was also found that geological structure of the aquifers is the most important factor affecting the intensity of tidal effect on water quality.

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.

Scaly scalp associated with crusted scabies: case series.

PubMed

Anbar, T S; El-Domyati, M B; Mansour, H A; Ahmad, H M

2007-07-13

The diagnosis of crusted scabies is becoming more relevant due to the increase in number of immunocompromised patients. To date, more than 200 cases have been reported in the literature. However, crusted scabies seems to be under-diagnosed because of its unusual presentations. In this case series we present history, clinical manifestations, KOH smear, and histopathological findings of a series of four patients with crusted scabies. Scaly scalp was a prominent feature of the disease in all cases. Examination of and treatment of the scalp of patients with suspected crusted scabies should not be neglected. A KOH smear from the scalp offers a simple and reliable technique for diagnosis.

Posterior ankle impingement syndrome in football players: Case series of 26 elite athletes.

PubMed

Kudaş, Savaş; Dönmez, Gürhan; Işık, Çetin; Çelebi, Mesut; Çay, Nurdan; Bozkurt, Murat

2016-12-01

To describe a clinical treatment algorithm for posterior ankle impingement (PAI) syndrome in professional football players. A case series of 26 elite professional football players diagnosed and treated for posterior ankle impingement syndrome were included for the study. All of the athletes received conservative treatment with physical therapy modalities initially. If the first line medical treatment and rehabilitation was ineffective to alleviate the symptoms, ultrasound-guided corticosteroid injection was proposed and thereafter the patients underwent posterior ankle arthroscopy if the complaints are still unresolved. The pain scores (AOFAS, VAS), and time to return to play were the main outcome measures. The complaints of 18 (69.2%) players were subsided with non-surgical treatment whereas three of acute cases and five of the chronic cases did not respond to medical treatment and arthroscopic surgery was performed for eight athletes. Eighteen players returned to training for a mean time of 36.3 days (24-42 days) after conservative treatment. The patients who underwent arthroscopic surgery returned to training for a mean time of 49.8 days (42-56 days) after the surgery. All athletes returned to their previous level of competition after treatment without any complications or recurrence in a mean follow-up 36.5 months (19-77 months). Non-surgical treatment modalities were effective in 2/3 of posterior ankle impingement syndrome in elite football players. On the other hand, posterior ankle arthroscopy is safe and effective treatment option for posterior ankle impingement syndrome if the conservative treatment fails. Level IV, Therapeutic study. Copyright © 2016 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

Multiple Victims of Carbon Monoxide Poisoning in the Aftermath of a Wildfire: A Case Series.

PubMed

Santos, Luís Ramos; Alves-Correia, Magna; Câmara, Margarida; Lélis, Manuela; Caldeira, Carmo; Brazão, Maria Luz; Nóbrega, José Júlio

2018-03-29

Carbon monoxide poisoning may occur in several contexts. Retrospective of 37 carbon monoxide poisoning cases that underwent hyperbaric oxygen during wildfires in Funchal in August 2016. The studied sample included 37 patients, mean age of 38 years, 78% males. Ten were firefighters, four children and two pregnant victims. Neurological symptoms were the most reported. Median carboxyhemoglobin level was 3.7% (IQR 2.7). All received high-flow oxygen from admission to delivery of hyperbaric oxygen. Persistence of symptoms was the main indication for hyperbaric oxygen. Median time to hyperbaric oxygen was 4.8 hours (IQR 9.5), at 2.5 ATA for 90 minutes, without major complications. Discharge in less than 24 hours occurred in 92% of the cases. Thirty days follow-up: five patients presented clinical symptoms of late neurological syndrome; twelve patients were lost to follow-up. Carboxyhemoglobin levels on admission and mean time to hyperbaric oxygen were no different between those who did and did not develop the syndrome at 30 days (p = 0.44 and p = 0.58, respectively). Late neurological syndrome at 30 days occurred in 20% and no new cases were reported at 12 months. Use of hyperbaric oxygen appears to have reduced the incidence of the syndrome. This seems to be the first Portuguese series reporting use of hyperbaric oxygen in carbon monoxide poisoning due to wildfires. The authors intend to alert to the importance of referral of these patients because the indications and benefits of this treatment are well documented. This is especially important given the ever-growing issue of wildfires in Portugal.

Nonoperative Management, Rehabilitation, and Functional and Clinical Progression of Osteitis Pubis/Pubic Bone Stress in Professional Soccer Players: A Case Series.

PubMed

McAleer, Stephen S; Lippie, Ed; Norman, Darcy; Riepenhof, Helge

2017-09-01

Study Design Case series. Background Pubic bone stress (PBS) is a common acute or chronic response of the pelvis in sports where sprinting, kicking, twisting, and cutting are the dominant movements. There are few nonoperative rehabilitation strategies for the condition reported in the literature, and the outcome of conservative treatment has not been documented. Case Description Five professional and academy soccer players complaining of pubic symphysis pain, confirmed as PBS on magnetic resonance imaging and objective assessment, were treated with a nonoperative rehabilitation program that featured functional and clinical objective markers as progression criteria. Interventions in the acute phase included pharmacological and physical therapeutic modalities to reduce pain initially. Rehabilitation management focused on improving range of motion at the hips and thorax, adductor strengthening, trunk and lumbopelvic stability, gym-based strength training, and field-based rehabilitation and conditioning. Clinical follow-up was performed at least 8 months following return to play. Outcomes All players demonstrated reduced or resolved pain, increased adductor squeeze strength, and return to pain-free training and match play. Return-to-training time averaged 40.6 days (range, 30-60 days) and return to play averaged 49.4 days (range, 38-72 days) within the 5 players. At final follow-up (mean, 29.6 months; range, 16-33 months), there had been no recurrences. Discussion This report of 5 cases suggests that a nonoperative protocol, using clinical and functional progression criteria, may be successful in rehabilitating athletes with PBS for return to sport within 11 weeks. Level of Evidence Therapy, level 4. J Orthop Sports Phys Ther 2017;47(9):683-690. Epub 3 Aug 2017. doi:10.2519/jospt.2017.7314.

Comparison of Intraoperative Portable CT Scanners in Skull Base and Endoscopic Sinus Surgery: Single Center Case Series

PubMed Central

Conley, David B.; Tan, Bruce; Bendok, Bernard R.; Batjer, H. Hunt; Chandra, Rakesh; Sidle, Douglas; Rahme, Rudy J.; Adel, Joseph G.; Fishman, Andrew J.

2011-01-01

Precise and safe management of complex skull base lesions can be enhanced by intraoperative computed tomography (CT) scanning. Surgery in these areas requires real-time feedback of anatomic landmarks. Several portable CT scanners are currently available. We present a comparison of our clinical experience with three portable scanners in skull base and craniofacial surgery. We present clinical case series and the participants were from the Northwestern Memorial Hospital. Three scanners are studied: one conventional multidetector CT (MDCT), two digital flat panel cone-beam CT (CBCT) devices. Technical considerations, ease of use, image characteristics, and integration with image guidance are presented for each device. All three scanners provide good quality images. Intraoperative scanning can be used to update the image guidance system in real time. The conventional MDCT is unique in its ability to resolve soft tissue. The flat panel CBCT scanners generally emit lower levels of radiation and have less metal artifact effect. In this series, intraoperative CT scanning was technically feasible and deemed useful in surgical decision-making in 75% of patients. Intraoperative portable CT scanning has significant utility in complex skull base surgery. This technology informs the surgeon of the precise extent of dissection and updates intraoperative stereotactic navigation. PMID:22470270

An Analysis of the Environments of Intense Convective Systems in West Africa in 2003

NASA Technical Reports Server (NTRS)

Nicholls, Stephen D.; Mohr, Karen I.

2010-01-01

We investigated the local- and regional-scale thermodynamical and dynamical environments associated with intense convective systems in West Africa during 2003. We identified convective system cases from TRMM microwave imagery, classifying each case by the system minimum 85-GHz brightness temperature and by the estimated elapsed time of propagation from high terrain. The speed of the mid-level jet, the magnitude of the low-level shear, and the surface equivalent potential temperature (theta(sub e)) were greater for the intense cases compared to the non-intense cases, although the differences between the means tended to be small, less than 3K for surface theta(sub e). Hypothesis testing of a series of commonly used intensity prediction metrics resulted in significant results only for low-level metrics such as convective available potential energy and not for any of the mid- or upper-level metrics such as 700-hPa theta(sub e). None of the environmental variables or intensity metrics by themselves or in combination appeared to be reliable direct predictors of intensity. In the regional scale analysis, the majority of intense convective systems occurred in the surface baroclinic zone where surface theta(sub e) exceeded 344 K and the 700-hPa zonal wind speeds were less than -6/ms. Fewer intense cases compared to non-intense cases were associated with African easterly wave troughs. Fewer than 25% of our cases occurred in environments with detectable Saharan dust loads, and the results for intense and non-intense cases were similar. Our results for the regional analysis were consistent with the seasonal movement of the WAM and the intertropical front, regional differences in topography, and AEW energetics.

Achieving Good Perioperative Outcomes After Pancreaticoduodenectomy in a Low-Volume Setting: A 25-Year Experience

PubMed Central

Chedid, Aljamir D.; Chedid, Marcio F.; Winkelmann, Leonardo V.; Filho, Tomaz J. M. Grezzana; Kruel, Cleber D. P.

2015-01-01

Perioperative mortality following pancreaticoduodenectomy has improved over time and is lower than 5% in selected high-volume centers. Based on several large literature series on pancreaticoduodenectomy from high-volume centers, some defend that high annual volumes are necessary for good outcomes after pancreaticoduodenectomy. We report here the outcomes of a low annual volume pancreaticoduodenectomy series after incorporating technical expertise from a high-volume center. We included all patients who underwent pancreaticoduodenectomy performed by a single surgeon (ADC.) as treatment for periampullary malignancies from 1981 to 2005. Outcomes of this series were compared to those of 3 high-volume literature series. Additionally, outcomes for first 10 cases in the present series were compared to those of all 37 remaining cases in this series. A total of 47 pancreaticoduodenectomies were performed over a 25-year period. Overall in-hospital mortality was 2 cases (4.3%), and morbidity occurred in 23 patients (48.9%). Both mortality and morbidity were similar to those of each of the three high-volume center comparison series. Comparison of the outcomes for the first 10 to the remaining 37 cases in this series revealed that the latter 37 cases had inferior mortality (20% versus 0%; P = 0.042), less tumor-positive margins (50 versus 13.5%; P = 0.024), less use of intraoperative blood transfusions (90% versus 32.4%; P = 0.003), and tendency to a shorter length of in-hospital stay (20 versus 15.8 days; P = 0.053). Accumulation of surgical experience and incorporation of expertise from high-volume centers may enable achieving satisfactory outcomes after pancreaticoduodenectomy in low-volume settings whenever referral to a high-volume center is limited. PMID:25875555

Applications of time-series analysis to mood fluctuations in bipolar disorder to promote treatment innovation: a case series.

PubMed

Holmes, E A; Bonsall, M B; Hales, S A; Mitchell, H; Renner, F; Blackwell, S E; Watson, P; Goodwin, G M; Di Simplicio, M

2016-01-26

Treatment innovation for bipolar disorder has been hampered by a lack of techniques to capture a hallmark symptom: ongoing mood instability. Mood swings persist during remission from acute mood episodes and impair daily functioning. The last significant treatment advance remains Lithium (in the 1970s), which aids only the minority of patients. There is no accepted way to establish proof of concept for a new mood-stabilizing treatment. We suggest that combining insights from mood measurement with applied mathematics may provide a step change: repeated daily mood measurement (depression) over a short time frame (1 month) can create individual bipolar mood instability profiles. A time-series approach allows comparison of mood instability pre- and post-treatment. We test a new imagery-focused cognitive therapy treatment approach (MAPP; Mood Action Psychology Programme) targeting a driver of mood instability, and apply these measurement methods in a non-concurrent multiple baseline design case series of 14 patients with bipolar disorder. Weekly mood monitoring and treatment target data improved for the whole sample combined. Time-series analyses of daily mood data, sampled remotely (mobile phone/Internet) for 28 days pre- and post-treatment, demonstrated improvements in individuals' mood stability for 11 of 14 patients. Thus the findings offer preliminary support for a new imagery-focused treatment approach. They also indicate a step in treatment innovation without the requirement for trials in illness episodes or relapse prevention. Importantly, daily measurement offers a description of mood instability at the individual patient level in a clinically meaningful time frame. This costly, chronic and disabling mental illness demands innovation in both treatment approaches (whether pharmacological or psychological) and measurement tool: this work indicates that daily measurements can be used to detect improvement in individual mood stability for treatment innovation (MAPP).

Obsessive Compulsive Disorder Treatment in Patients with Down Syndrome: A Case Series

ERIC Educational Resources Information Center

Sutor, Bruce; Hansen, Mark R.; Black, John L.

2006-01-01

In this case series we report four cases of patients with Down syndrome with symptoms consistent with obsessive compulsive disorder. Each patient experienced substantial reduction in compulsive behaviors with pharmacotherapy of an SSRI alone or with the addition of risperidone to SSRI therapy. None of the patients experienced significant side…

Intensive (Daily) Behavior Therapy for School Refusal: A Multiple Baseline Case Series

ERIC Educational Resources Information Center

Tolin, David F.; Whiting, Sara; Maltby, Nicholas; Diefenbach, Gretchen J.; Lothstein, Mary Anne; Hardcastle, Surrey; Catalano, Amy; Gray, Krista

2009-01-01

The following multiple baseline case series examines school refusal behavior in 4 male adolescents. School refusal symptom presentation was ascertained utilizing a functional analysis from the School Refusal Assessment Scale (Kearney, 2002). For the majority of cases, treatment was conducted within a 15-session intensive format over a 3-week…

Knocked by the shuttlecock: twelve sight-threatening blunt-eye injuries in Australian badminton players.

PubMed

Jao, Kathy K; Atik, Alp; Jamieson, Michael P; Sheales, Mariana P; Lee, Matthew H; Porter, Ashley; Roufas, Athena; Goldberg, Ivan; Zamir, Ehud; White, Andrew; Skalicky, Simon E

2017-07-01

Non-penetrating ocular injuries from badminton shuttlecocks can result in severe damage and life-long complications. This case series highlights the morbidity of such injuries, particularly in regard to post-traumatic glaucoma. This is a retrospective case series of 12 patients with shuttlecock-related blunt eye injuries sustained during badminton play without eye protection. By approaching colleagues through conference presentations and networking, the authors have attempted to gather all known cases of shuttlecock ocular injury managed in tertiary ocular emergency departments or private ophthalmological clinics in Victoria and New South Wales, Australia in 2015. This is the first multicentre case series to describe badminton-related ocular injuries in Australia. Our case series demonstrates, in particular, long-term glaucoma-related morbidity for patients over a large age range (16 to 77 years), with one patient requiring ongoing management 26 years following their initial injury. The cases reported further add to the literature promoting awareness of badminton-related ocular injury. We encourage player education and advocacy on badminton-related eye injuries and appropriate use of eye protection to reduce associated morbidity. © 2016 Optometry Australia.

Spontaneous regression of posterior epidural migrated lumbar disc fragments: case series.

PubMed

Tarukado, Kiyoshi; Ikuta, Ko; Fukutoku, Yoshiaki; Tono, Osamu; Doi, Toshio

2015-06-01

Posterior epidural migrated lumbar disc fragments is an extremely rare disorder. Surgical treatment was performed in all reported cases. To the best of our knowledge, there are no reported cases of the use of conservative treatment for posterior epidural migrated lumbar disc fragments. To report the possibility of a spontaneous regression of posterior epidural migrated lumbar disc fragments. Case series. Four patients with posterior epidural migrated lumbar disc fragments were treated at Karatsu Red Cross Hospital between April 2008 and August 2010. Spontaneous regression of the posterior epidural migrated lumbar disc fragments with relief of symptoms was observed on magnetic resonance imaging (MRI) in three cases. Another patient underwent surgical treatment. The present and previously reported cases of posterior epidural migrated lumbar disc fragments were analyzed with respect to patient age, imaging features on MRI, the level of the lesion, clinical symptoms, treatment, and outcomes. Conservative treatment was successful, and spontaneous lesion regression was seen on MRI with symptom relief in three cases. Although posterior epidural migrated lumbar disc fragment cases are generally treated surgically, the condition can regress spontaneously over time, as do sequestrated disc fragments. Spontaneous regression of lumbar disc herniations is a widely accepted observation at present. Posterior epidural migrated lumbar disc fragments fall under the sequestrated type of disc herniation. In fact, the course of treatment for posterior epidural migrated lumbar disc fragments should be determined based on the symptoms and examination findings, as in cases of ordinary herniation. However, providing early surgical treatment is important if the patient has acute cauda equina syndrome or the neurologic symptoms worsen over time. Copyright © 2015 Elsevier Inc. All rights reserved.

Neonatal Medical Exposures and Characteristics of Low Birth Weight Hepatoblastoma Cases: A Report From the Children's Oncology Group

PubMed Central

Turcotte, Lucie M.; Georgieff, Michael K.; Ross, Julie A.; Feusner, James H.; Tomlinson, Gail E.; Malogolowkin, Marcio H.; Krailo, Mark D.; Miller, Nicole; Fonstad, Rachel; Spector, Logan G.

2015-01-01

Background Hepatoblastoma is a malignancy of young children. Low birth weight is associated with significantly increased risk of hepatoblastoma and neonatal medical exposures are hypothesized as contributors. This study represents the largest case–control study of hepatoblastoma to date and aimed to define the role of neonatal exposures in hepatoblastoma risk among low birth weight children. Procedure Incident hepatoblastoma cases who were born <2,500 g (N = 60), diagnosed between 2000 and 2008, were identified through the Children's Oncology Group. Controls were recruited through state birth registries (N = 51). Neonatal medical exposures were abstracted from medical records. Subjects from the Vermont Oxford Network were used for further comparisons, as were existing reports on neonatal medical exposures. Results Case–control comparisons were hindered by poor matching within birth weight strata. Cases were smaller and received more aggressive neonatal treatment compared to controls, and reflected high correlation levels between birth weight and treatments. Similar difficulty was encountered when comparing cases to Vermont Oxford Network subjects; cases were smaller and required more aggressive neonatal therapy. Furthermore, it appears hepatoblastoma cases were exposed to a greater number of diagnostic X-rays than in case series previously reported in the neonatal literature. Conclusions This study presents the largest case series of hepatoblastoma in <2,500 g birth weight infants with accompanying neonatal medical exposure data. Findings confirm that birth weight is highly correlated with exposure intensity, and neonatal exposures are themselves highly correlated, which hampers the identification of a causal exposure among hepatoblastoma cases. Experimental models or genetic susceptibility testing may be more revealing of etiology. PMID:25044669

Nonunion After Clavicle Osteosynthesis: High Incidence of Propionibacterium acnes.

PubMed

Gausden, Elizabeth B; Villa, Jordan; Warner, Stephen J; Redko, Mariya; Pearle, Andrew; Miller, Andy; Henry, Michael; Lorich, Dean G; Helfet, David L; Wellman, David S

2017-04-01

The objective of this study was to review the etiology of clavicle nonunions after osteosynthesis and investigate the outcomes of a treatment with a single-stage revision. Retrospective case series. Orthopaedic specialty hospital. Twenty cases of nonunion after osteosynthesis of the clavicle were identified. The average age was 44 years (±13 years). In 9 cases, there was catastrophic implant failure that prompted the revision surgery. In the 18 cases in which cultures were taken, 15 of the 18 (83%) were treated as infections with a course of antibiotics. In 14 cases, the cultures were positive for Propionibacterium acnes. Fifteen patients were treated with a prolonged course of antibiotics. Eighteen patients had follow-up, and the average time to radiographic union was 22 weeks. There were no cases of nonunion after revision surgery. There is a high rate of positive cultures in cases of nonunion after osteosynthesis of the clavicle. This suggests the etiology of midshaft clavicle nonunions may result from a combination of suboptimal mechanical fixation and latent infection. Our treatment protocol of superior and anterior plating, interfragmentary fixation, bone grafting, and appropriate antimicrobial treatment of latent infections has resulted in 100% union rate. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Rapid amelioration of severe manic episodes with right unilateral ultrabrief pulse ECT: a case series of four patients.

PubMed

Sidorov, Alexey; Mayur, Prashanth

2017-02-01

The aim of this small case series is to describe four cases of severe mania, where ultrabrief pulse electroconvulsive therapy (ECT) was used as a primary mode of treatment. A retrospective file review was undertaken of four patients identified as having received ultrabrief pulse ECT for severe mania. The outcome measures for treatment efficacy were the Young Mania Rating Scale (YMRS) and Clinical Global Impression (CGI). All the patients showed significant clinical improvement. A comparison of pre- and post-treatment YMRS and CGI scores showed a dramatic decrease in all four cases. However, one patient was shifted to brief pulse ECT due to inadequate response. Ultrabrief pulse ECT may be an effective treatment in cases of severe mania. Due to the very small number of cases in the current case series, no specific conclusions regarding efficacy may be drawn; however, larger, controlled studies would be indicated.

Lenticular neovascularization subsequent to traumatic cataract formation.

PubMed

Kabat, Alan G

2011-09-01

To report a series of cases involving neovascularization within the human crystalline lens-a normally avascular structure-after ocular trauma. This is a retrospective, consecutive observational case series with review of the prevailing literature. Four individuals with a history of ocular trauma and subsequent cataract development were examined between May 2004 and April 2007. All had hypermature cataracts and intraocular inflammation, presumably secondary to phacolysis; two of the four had concurrent hyphema and ocular hypertension in the involved eye. All subjects in this series were found to display a discrete network of blood vessels within the structure of the crystalline lens, just beneath the anterior lens capsule. Neovascularization of the crystalline lens has received little attention in the ophthalmic literature, having been described only rarely in individual case reports. This manuscript details the first known case series involving lenticular neovascularization, and offers insight into its possible developmental mechanism.

Amniotic fluid embolism mortality rate.

PubMed

Benson, Michael D

2017-11-01

The objective of this study was to determine the mortality rate of amniotic fluid embolism (AFE) using population-based studies and case series. A literature search was conducted using the two key words: 'amniotic fluid embolism (AFE)' AND 'mortality rate'. Thirteen population-based studies were evaluated, as well as 36 case series including at least two patients. The mortality rate from population-based studies varied from 11% to 44%. When nine population-based studies with over 17 000 000 live births were aggregated, the maternal mortality rate was 20.4%. In contrast, the mortality rate of AFE in case series varies from 0% to 100% with numerous rates in between. The AFE mortality rate in population-based studies varied from 11% to 44% with the best available evidence supporting an overall mortality rate of 20.4%. Data from case series should no longer be used as a basis for describing the lethality of AFE. © 2017 Japan Society of Obstetrics and Gynecology.

Vitamin D Toxicity in Adults: A Case Series from an Area with Endemic Hypovitaminosis D

PubMed Central

Koul, Parvaiz A.; Ahmad, Sheikh Hilal; Ahmad, Feroze; Jan, Rafi A.; Shah, S.U.; Khan, Umar H.

2011-01-01

Vitamin D deficiency state is endemic to the Kashmir valley of the Indian subcontinent. Physicians often treat patients with high doses of vitamin D for various ailments and on occasion the prescribed doses far exceed the requirements of the patients. Ten cases of hypercalcemia due to vitamin D intoxication are presented with features of vomiting, polyuria, polydipsia, encephalopathy and renal dysfunction. All the patients had demonstrable hypercalcemia and vitamin D levels were high in nine of the 10 cases. The patients had received high doses of vitamin D and no other cause of hypercalcemia was identified. Treatment of hypercalcemia resulted in clinical recovery in nine cases. We conclude that hypervitaminosis D must be considered in the differential diagnosis of patients with hypercalcemia in endemically vitamin D deficient areas. A careful history and appropriate biochemical investigation will unravel the diagnosis in most of the cases. PMID:22043417

An Improved Rank Correlation Effect Size Statistic for Single-Case Designs: Baseline Corrected Tau.

PubMed

Tarlow, Kevin R

2017-07-01

Measuring treatment effects when an individual's pretreatment performance is improving poses a challenge for single-case experimental designs. It may be difficult to determine whether improvement is due to the treatment or due to the preexisting baseline trend. Tau- U is a popular single-case effect size statistic that purports to control for baseline trend. However, despite its strengths, Tau- U has substantial limitations: Its values are inflated and not bound between -1 and +1, it cannot be visually graphed, and its relatively weak method of trend control leads to unacceptable levels of Type I error wherein ineffective treatments appear effective. An improved effect size statistic based on rank correlation and robust regression, Baseline Corrected Tau, is proposed and field-tested with both published and simulated single-case time series. A web-based calculator for Baseline Corrected Tau is also introduced for use by single-case investigators.

Duodenoduodenal intussusception: Report of three challenging cases with literature review.

PubMed

Pradhan, Dinesh; Kaur, Neeraj; Nagi, Birinder

2015-01-01

Small bowel intussusception is an uncommon condition with cases of duodenoduodenal intussusception (DDI) being exceptionally rare. Adult intussusception occurs infrequently and differs from childhood intussusception in its presentation, etiology, and treatment. DDI is very unusual due to the fixed position of the duodenum within the retroperitoneum. The lead point usually is hamartomatous polyp, adenoma, or adenocarcinoma. Only few cases of DDI in adults have been reported in the literature. We herein report a series of three cases of DDI encountered in a tertiary level research institute. All cases had underlying abnormality acting as lead point with different etiologies. DDI is a challenging condition due to its rarity and nonspecific presentation and should be considered in the differential diagnosis of gastric outlet obstruction, pancreatitis, and obstructive jaundice. We elaborate this condition with a detailed review of the literature to gain a better understanding of its clinical features and enable early diagnosis.

Diode Laser Assisted Excision and Low Level Laser Therapy in the Management of Mucus Extravasation Cysts: A Case Series

PubMed Central

Ahad, Abdul; Tandon, Shruti; Lamba, Arundeep Kaur; Faraz, Farrukh; Anand, Parimal; Aleem, Abdul

2017-01-01

Introduction: Mucus extravasation cyst is a commonly occurring lesion in oral cavity that may result from traumatic severance of a salivary gland duct with subsequent extravasation of mucus into fibrous connective tissue. After a conventional excision or marsupialization, recurrence is not uncommon. Diode laser offers an effective modality for management of such lesions. Case Reports: Four patients were referred with painless fluctuant swellings on labial and buccal mucosa. After recording history and clinical examination, provisional diagnosis of mucocele was made. All the lesions were excised with a diode laser and biopsy was performed. Surgical wounds were treated with low-level laser therapy (LLLT). Results: Uneventful healing was observed in all 4 cases. Significant reduction in postoperative discomfort was recorded after application of LLLT. Histopathological findings were suggestive of mucus extravasation cysts. Conclusion: Diode laser appears to be a good alternative to conventional modalities for the management of mucus extravasation cysts. PMID:29123637

Diode Laser Assisted Excision and Low Level Laser Therapy in the Management of Mucus Extravasation Cysts: A Case Series.

PubMed

Ahad, Abdul; Tandon, Shruti; Lamba, Arundeep Kaur; Faraz, Farrukh; Anand, Parimal; Aleem, Abdul

2017-01-01

Introduction: Mucus extravasation cyst is a commonly occurring lesion in oral cavity that may result from traumatic severance of a salivary gland duct with subsequent extravasation of mucus into fibrous connective tissue. After a conventional excision or marsupialization, recurrence is not uncommon. Diode laser offers an effective modality for management of such lesions. Case Reports: Four patients were referred with painless fluctuant swellings on labial and buccal mucosa. After recording history and clinical examination, provisional diagnosis of mucocele was made. All the lesions were excised with a diode laser and biopsy was performed. Surgical wounds were treated with low-level laser therapy (LLLT). Results: Uneventful healing was observed in all 4 cases. Significant reduction in postoperative discomfort was recorded after application of LLLT. Histopathological findings were suggestive of mucus extravasation cysts. Conclusion: Diode laser appears to be a good alternative to conventional modalities for the management of mucus extravasation cysts.

A Practical Guide for the Formulation of Propositions in the Bayesian Approach to DNA Evidence Interpretation in an Adversarial Environment.

PubMed

Gittelson, Simone; Kalafut, Tim; Myers, Steven; Taylor, Duncan; Hicks, Tacha; Taroni, Franco; Evett, Ian W; Bright, Jo-Anne; Buckleton, John

2016-01-01

The interpretation of complex DNA profiles is facilitated by a Bayesian approach. This approach requires the development of a pair of propositions: one aligned to the prosecution case and one to the defense case. This note explores the issue of proposition setting in an adversarial environment by a series of examples. A set of guidelines generalize how to formulate propositions when there is a single person of interest and when there are multiple individuals of interest. Additional explanations cover how to handle multiple defense propositions, relatives, and the transition from subsource level to activity level propositions. The propositions depend on case information and the allegations of each of the parties. The prosecution proposition is usually known. The authors suggest that a sensible proposition is selected for the defense that is consistent with their stance, if available, and consistent with a realistic defense if their position is not known. © 2015 American Academy of Forensic Sciences.

Dyskerin and TERC expression may condition survival in lung cancer patients

PubMed Central

Penzo, Marianna; Ludovini, Vienna; Treré, Davide; Siggillino, Annamaria; Vannucci, Jacopo; Bellezza, Guido; Crinò, Lucio; Montanaro, Lorenzo

2015-01-01

Dyskerin mediates both the modification of uridine on ribosomal and small nuclear RNAs and the stabilization of the telomerase RNA component (TERC). In human tumors dyskerin expression was found to be associated with both rRNA modification and TERC levels. Moreover, dyskerin overexpression has been linked to unfavorable prognosis in a variety of tumor types, however an explanation for the latter association is not available. To clarify this point, we analyzed the connection between dyskerin expression, TERC levels and clinical outcome in two series of primary lung cancers, differing for the presence of TERC gene amplification, a genetic alteration inducing strong TERC overexpression. TERC levels were significantly higher in tumors bearing TERC gene amplification (P = 0.017). In addition, the well-established association between dyskerin expression and TERC levels was observed only in the series without TERC gene amplification (P = 0.003), while it was not present in TERC amplified tumors (P = 0.929). Similarly, the association between dyskerin expression and survival was found in cases not bearing TERC gene amplification (P = 0.009) and was not observed in TERC amplified tumors (P = 0.584). These results indicate that the influence of dyskerin expression on tumor clinical outcome is linked to its role on the maintenance of high levels of TERC. PMID:26301749

The Running Athlete

PubMed Central

Henning, P. Troy

2014-01-01

Context: Pelvic stress fractures, osteitis pubis, and snapping hip syndrome account for a portion of the overuse injuries that can occur in the running athlete. Evidence Acquisition: PubMed searches were performed for each entity using the following keywords: snapping hip syndrome, coxa sultans, pelvic stress fracture, and osteitis pubis from 2008 to 2013. Topic reviews, case reports, case series, and randomized trials were included for review. Study Design: Clinical review. Level of Evidence: Level 4. Results: Collectively, 188 articles were identified. Of these, 58 were included in this review. Conclusion: Based on the available evidence, the majority of these overuse injuries can be managed non-operatively. Primary treatment should include removal from offending activity, normalizing regional muscle strength/length imbalances and nutritional deficiencies, and mitigating training errors through proper education of the athlete and training staff. Strength of Recommendation Taxonomy: C PMID:24587861

[Reemergence of measles in vaccinated patients: report of 6 cases and proposals for prevention].

PubMed

Agut-Busquet, Eugènia; Gené Tous, Emili; Navarro, Gemma; González, Araceli

2016-06-01

A 2014 measles outbreak in Catalonia affected 131 persons. We describe a series of 6 cases diagnosed in our emergency department. All the patients were under 31 years of age and complained of flu-like symptoms, including high fever and rash. Five had been properly vaccinated and one was a health care worker. A firm diagnosis of measles need not be made in the emergency department, but a high level of suspicion is important for ruling out complications, isolating the patient, and protecting health care staff at high risk for exposure. We found that 6% of the staff of our emergency department had a low level of immunity to measles. Given our findings, we suggest that preventive treatment is necessary when health care staff have been exposed to measles and their vaccination status is unknown.

A Study in Child Care (Case Study from Volume II-B): "We Come with the Dust and We Go with the Wind." Day Care Programs Reprint Series.

ERIC Educational Resources Information Center

Elbow, Linda

Approximately 468 children of migrant agricultural workers in the state of Washington are served in the nine Northwest Rural Opportunities (NRO) day care centers described here. A community organization program was also formed by the NRO system. Ninety percent of the families served are Chicano, and all are below the poverty level. These aspects…

To Prosecute or Not? Enforcement of Federal Criminal Regulatory Statutes. Revised Edition. A Student's Lesson Plan [and] A Teacher's Lesson Plan [and] A Lawyer's Lesson Plan.

ERIC Educational Resources Information Center

Howard, Estelle; And Others

One of a series of secondary level teaching units presenting case studies with pro and con analyses of particular legal problems, the document consists of a student's lesson plan, a teacher's lesson plan, and a lawyer's lesson plan for a unit about the enforcement of federal criminal regulatory statutes. The lesson plan presents an analysis of the…

Valproate Induced Hyperammonemic Delirium.

PubMed

Muraleedharan, Anupama; Palappallil, Dhanya Sasidharan; Gangadhar, Reneega; Das, Soumitra

2015-12-01

Sodium valproate induced hyperammonaemic delirium with normal liver function tests is a relatively uncommon adverse effect. It may be mistaken for psychosis or worsening of mania leading to wrong diagnosis and improper management. Plasma ammonia levels should be monitored in all patients developing altered mental status after receiving valproate therapy. This is a case series of hyperammonaemic delirium due to valproate reported to the Department of Pharmacology from Department of Psychiatry over a period of one year.

Valproate Induced Hyperammonemic Delirium

PubMed Central

Muraleedharan, Anupama; Gangadhar, Reneega; Das, Soumitra

2015-01-01

Sodium valproate induced hyperammonaemic delirium with normal liver function tests is a relatively uncommon adverse effect. It may be mistaken for psychosis or worsening of mania leading to wrong diagnosis and improper management. Plasma ammonia levels should be monitored in all patients developing altered mental status after receiving valproate therapy. This is a case series of hyperammonaemic delirium due to valproate reported to the Department of Pharmacology from Department of Psychiatry over a period of one year. PMID:26816916

"Our Success Is Our Graduates" Case Study of Year Up: A Career Advancement Model for Low-Income Young Adults. Advancement for Low-Wage Workers Report Series

ERIC Educational Resources Information Center

Biswas, Radha Roy

2005-01-01

This report describes the "Year Up" program, an innovative technology training program, that prepares and places low-income, urban young adults in entry-level IT jobs while also preparing them for college. The program targets recent high school graduates and GED recipients between the ages of 18 and 24 who are either unemployed or…

Applying a Systems Approach to School-Wide Discipline in Secondary Schools: What We Are Learning and Need To Learn. CASE/CCBD Mini-Library Series on Safe, Drug-Free, and Effective Schools.

ERIC Educational Resources Information Center

Lewis-Palmer, Teri; Flannery, Brigid; Sugai, George; Eber, Lucille

This monograph describes the unique features of secondary schools and the application of a systems approach to school discipline at the secondary level. The use of effective behavior support (EBS) designed to increase the capacity of schools to educate all students, especially students with behavioral challenges, is highlighted. Critical features…

Documentation of a spreadsheet for time-series analysis and drawdown estimation

USGS Publications Warehouse

Halford, Keith J.

2006-01-01

Drawdowns during aquifer tests can be obscured by barometric pressure changes, earth tides, regional pumping, and recharge events in the water-level record. These stresses can create water-level fluctuations that should be removed from observed water levels prior to estimating drawdowns. Simple models have been developed for estimating unpumped water levels during aquifer tests that are referred to as synthetic water levels. These models sum multiple time series such as barometric pressure, tidal potential, and background water levels to simulate non-pumping water levels. The amplitude and phase of each time series are adjusted so that synthetic water levels match measured water levels during periods unaffected by an aquifer test. Differences between synthetic and measured water levels are minimized with a sum-of-squares objective function. Root-mean-square errors during fitting and prediction periods were compared multiple times at four geographically diverse sites. Prediction error equaled fitting error when fitting periods were greater than or equal to four times prediction periods. The proposed drawdown estimation approach has been implemented in a spreadsheet application. Measured time series are independent so that collection frequencies can differ and sampling times can be asynchronous. Time series can be viewed selectively and magnified easily. Fitting and prediction periods can be defined graphically or entered directly. Synthetic water levels for each observation well are created with earth tides, measured time series, moving averages of time series, and differences between measured and moving averages of time series. Selected series and fitting parameters for synthetic water levels are stored and drawdowns are estimated for prediction periods. Drawdowns can be viewed independently and adjusted visually if an anomaly skews initial drawdowns away from 0. The number of observations in a drawdown time series can be reduced by averaging across user-defined periods. Raw or reduced drawdown estimates can be copied from the spreadsheet application or written to tab-delimited ASCII files.

Streptococcus pneumoniae-associated pneumonia complicated by purulent pericarditis: case series *

PubMed Central

Cillóniz, Catia; Rangel, Ernesto; Barlascini, Cornelius; Piroddi, Ines Maria Grazia; Torres, Antoni; Nicolini, Antonello

2015-01-01

Abstract Objective: In the antibiotic era, purulent pericarditis is a rare entity. However, there are still reports of cases of the disease, which is associated with high mortality, and most such cases are attributed to delayed diagnosis. Approximately 40-50% of all cases of purulent pericarditis are caused by Gram-positive bacteria, Streptococcus pneumoniae in particular. Methods: We report four cases of pneumococcal pneumonia complicated by pericarditis, with different clinical features and levels of severity. Results: In three of the four cases, the main complication was cardiac tamponade. Microbiological screening (urinary antigen testing and pleural fluid culture) confirmed the diagnosis of severe pneumococcal pneumonia complicated by purulent pericarditis. Conclusions: In cases of pneumococcal pneumonia complicated by pericarditis, early diagnosis is of paramount importance to avoid severe hemodynamic compromise. The complications of acute pericarditis appear early in the clinical course of the infection. The most serious complications are cardiac tamponade and its consequences. Antibiotic therapy combined with pericardiocentesis drastically reduces the mortality associated with purulent pericarditis. PMID:26398760

Eruption patterns of the chilean volcanoes Villarrica, Llaima, and Tupungatito

NASA Astrophysics Data System (ADS)

Muñoz, Miguel

1983-09-01

The historical eruption records of three Chilean volcanoes have been subjected to many statistical tests, and none have been found to differ significantly from random, or Poissonian, behaviour. The statistical analysis shows rough conformity with the descriptions determined from the eruption rate functions. It is possible that a constant eruption rate describes the activity of Villarrica; Llaima and Tupungatito present complex eruption rate patterns that appear, however, to have no statistical significance. Questions related to loading and extinction processes and to the existence of shallow secondary magma chambers to which magma is supplied from a deeper system are also addressed. The analysis and the computation of the serial correlation coefficients indicate that the three series may be regarded as stationary renewal processes. None of the test statistics indicates rejection of the Poisson hypothesis at a level less than 5%, but the coefficient of variation for the eruption series at Llaima is significantly different from the value expected for a Poisson process. Also, the estimates of the normalized spectrum of the counting process for the three series suggest a departure from the random model, but the deviations are not found to be significant at the 5% level. Kolmogorov-Smirnov and chi-squared test statistics, applied directly to ascertaining to which probability P the random Poisson model fits the data, indicate that there is significant agreement in the case of Villarrica ( P=0.59) and Tupungatito ( P=0.3). Even though the P-value for Llaima is a marginally significant 0.1 (which is equivalent to rejecting the Poisson model at the 90% confidence level), the series suggests that nonrandom features are possibly present in the eruptive activity of this volcano.

An analysis of the influence of the local effects of climatic and hydrological factors affecting new malaria cases in riverine areas along the Rio Negro and surrounding Puraquequara Lake, Amazonas, Brazil.

PubMed

Coutinho, Paulo Eduardo Guzzo; Candido, Luiz Antonio; Tadei, Wanderli Pedro; da Silva Junior, Urbano Lopes; Correa, Honorly Katia Mestre

2018-04-26

A study was conducted at three sampling regions along the Rio Negro and surrounding Puraquequara Lake, Amazonas, Brazil. The aim was to determine the influence of the local effects of climatic and hydrological variables on new malaria cases. Data was gathered on the river level, precipitation, air temperature, and the number of new cases of autochthonous malaria between January 2003 and December 2013. Monthly averages, time series decompositions, cross-correlations, and multiple regressions revealed different relationships at each location. The sampling region in the upper Rio Negro indicated no statistically significant results. However, monthly averages suggest that precipitation and air temperature correlate positively with the occurrence of new cases of malaria. In the mid Rio Negro and Puraquequara Lake, the river level positively correlated, and temperature negatively correlated with new transmissions, while precipitation correlated negatively in the mid Rio Negro and positively on the lake. Overall, the river level is a key variable affecting the formation of breeding sites, while precipitation may either develop or damage them. A negative temperature correlation is associated with the occurrence of new annual post-peak cases of malaria, when the monthly average exceeds 28.5 °C. This suggests that several factors contribute to the occurrence of new malaria cases as higher temperatures are reached at the same time as precipitation and the river levels are lowest. Differences between signals and correlation lags indicate that local characteristics have an impact on how different variables influence the disease vector's life cycle, pathogens, and consequently, new cases of malaria.

Red-bellied black snake (Pseudechis porphyriacus) envenomation in the dog: Diagnosis and treatment of nine cases.

PubMed

Padula, Andrew M; Winkel, Kenneth D

2016-07-01

The clinical signs, biochemical changes and serum and urine venom concentrations for a series of nine cases of Red bellied black snake [RBBS] (Pseudechis porphyriacus) envenomation in eight dogs seen in a regional Australian veterinary hospital are described. Although the resulting envenomation syndrome was, in most cases, relatively mild and responded rapidly to intravenous administration of a novel bivalent caprylic acid purified whole IgG equine antivenom for tiger (Notechis scutatus) and brown snake (Pseudonaja textilis), one fatality prior to antivenom treatment was recorded. The latter case occurred within 1 h of envenomation prior to receiving antivenom treatment. Intravascular haemolysis, pigmenturia, bite site swelling, lethargy, and generally mild coagulopathy were present in most cases. Detectable RBBS venom specific components were found in serum, bite site swab or urine using a standard sandwich ELISA approach. Serum levels fell within the range previously reported for human RBBS envenomation cases (6-79 ng/ml) whilst bite site and urine samples varied more markedly (8.2 to >5000 ng/ml and 2.2-1300 ng/ml respectively). No venom was detected from serum after antivenom treatment. The envenomation syndrome in dogs is similar to what is described for humans, with the exception of the presence of potentially severe venom induced consumption coagulopathy in one case (aPTT > 300 s and fibrinogen < 0.43 g/L) and potential for fatal outcomes. This series represents the largest and most detailed examination of RBBS envenomation in animals yet reported. It reinforces the emerging view that the potential severity of this envenomation has been underappreciated by veterinary practitioners and highlights the possibility of severe venom induced consumption coagulopathy in canine cases. Copyright © 2016 Elsevier Ltd. All rights reserved.

Painful legs and moving toes syndrome: a 76-patient case series.

PubMed

Hassan, Anhar; Mateen, Farrah J; Coon, Elizabeth A; Ahlskog, J Eric

2012-08-01

To better characterize the clinical features, electrophysiologic features, and treatment outcomes of painful legs and moving toes (PLMT) syndrome. Large case series. Neurology outpatient clinic at a tertiary referral center, 1983-2011. All cases of PLMT seen at our institution during an 18-year period were identified using our medical record linkage system. Key demographic, clinical, imaging, and electrophysiologic features of PLMT. Treatment outcomes and long-term follow-up are also reported. Of 76 cases identified (including 50 women [66%]), the mean age at onset was 58 years (range, 24-86 years) and at neurologic evaluation was 63 years (range, 26-88 years). Pure lower limb involvement was most common (69 patients [91%]), and 44 cases (58%) were bilateral. The most frequently diagnosed causes were peripheral neuropathy (21 cases [28%]), previous trauma (8 [11%]), and radiculopathy (7 [9%]); 32 cases (42%) were cryptogenic. Electromyography consistently showed irregular 50-millisecond to 1-second bursts of normal motor unit potential firing at 2 to 200 Hz accompanying the movements. Pain occurred first in nearly all cases and was more distressing to patients than the movements. Both components were difficult to treat, with no consistent benefit from a variety of drugs and therapeutic modalities. The syndrome persisted in most patients (83%) during the mean follow-up of 4.6 years, suggesting low likelihood of spontaneous resolution. Painful legs and moving toes syndrome is a debilitating clinical syndrome, not because of the movements but rather because of the pain, which often is refractory to treatment. Segmental lower limb involvement is most common, and neurophysiologic findings support a pathophysiologic process localizing to a central generator at the spinal cord or brainstem level.

Yellow corneal ring associated with vitamin supplementation for age-related macular degeneration

PubMed Central

Eller, Andrew W; Gorovoy, Ian R; Mayercik, Vera A

2012-01-01

Purpose To report the first described cases of peripheral yellow corneal rings secondary to vitamin supplementation for age-related macular degeneration (ARMD). Design Retrospective single-center case series. Participants The eyes of four patients taking vitamin supplementation for ARMD were examined at University of Pittsburgh Medical Center (UPMC) Department of Ophthalmology between January 2010 and April 2011. Methods We reviewed the medical records of four patients with peripheral corneal rings receiving vitamin supplementation for ARMD. Main Outcome Measures the presence of peripheral yellow corneal rings, skin findings, and serum carotene levels. Results Each patient had circumferential yellow peripheral corneal rings and exhibited subtle yellowing of the skin most notable on the palms. Serum carotene levels were normal in two of the three cases and markedly elevated in the last case in which it was measured. Conclusion It is unclear at this time how to counsel patients with this ocular finding. We suspect that these rings are more common than generally appreciated as they can have a subtle appearance or may be misdiagnosed as arcus senilis. We suggest that a formal study be performed on a cohort of patients taking macular degeneration vitamin supplementation that specifically screens for yellow rings and measures serum carotene levels when they are identified. PMID:22330962

Interchangeability of counts of cases and hours of cases for quantifying a hospital's change in workload among four-week periods of 1 year.

PubMed

Dexter, Franklin; Epstein, Richard H; Ledolter, Johannes; Wanderer, Jonathan P

2018-05-16

Recent studies have made longitudinal assessments of case counts using State (e.g., United States) and Provincial (e.g., Canada) databases. Such databases rarely include either operating room (OR) or anesthesia times and, even when duration data are available, there are major statistical limitations to their use. We evaluated how to forecast short-term changes in OR caseload and workload (hours) and how to decide whether changes are outliers (e.g., significant, abrupt decline in anesthetics). Observational cohort study. Large teaching hospital. 35 years of annual anesthesia caseload data. Annual data were used without regard to where or when in the year each case was performed, thereby matching public use files. Changes in caseload or hours among four-week periods were examined within individual year-long periods using 159 consecutive four-week periods from the same hospital. Series of 12 four-week periods of the hours of cases performed on workdays lacked trend or correlation among periods for 49 of 50 series and followed normal distributions for 50 of 50 series. These criteria also were satisfied for 50 of 50 series based on counts of cases. The Pearson r = 0.999 between hours of anesthetics and cases. For purposes of time series analysis of total workload at a hospital within 1-year, hours of cases and counts of cases are interchangeable. Simple control chart methods of detecting sudden changes in workload or caseload, based simply on the sample mean and standard deviation from the preceding year, are appropriate. Copyright © 2018 Elsevier Inc. All rights reserved.

Transvestism as a Symptom: A Case Series.

PubMed

Anupama, M; Gangadhar, K H; Shetty, Vandana B; Dip, P Bhadja

2016-01-01

Transvestism, commonly termed as cross-dressing, means to dress in the clothing of opposite sex. We describe a series of three cases with transvestism as one of their primary complaints. The discussion sheds light on the various ways in which transvestism as a symptom can present in Psychiatry. In the first two cases, there was lower intelligence. In first and third case, there were other paraphilia along with transvestism. Second case had co-morbid obsessive-compulsive disorder (OCD) and had good response to selective serotonin reuptake inhibitor (SSRI).

Case Series: Chikungunya and Dengue at a Forward Operating Location

DTIC Science & Technology

2015-05-01

Journal Article 3. DATES COVERED (From – To) November 2014 – January 2015 4. TITLE AND SUBTITLE Case Series: Chikungunya and Dengue at a Forward...series and discusses the significance of this disease in the Americas and diagnostic challenges when other arboviruses such as dengue are present. 15...SUBJECT TERMS Chikungunya, dengue , mosquitoes 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT SAR 18. NUMBER OF PAGES 3

The Libyan civil conflict: selected case series of orthopaedic trauma managed in Malta in 2014.

PubMed

Ng, Colin; Mifsud, Max; Borg, Joseph N; Mizzi, Colin

2015-11-20

The purpose of this series of cases was to analyse our management of orthopaedic trauma casualties in the Libyan civil war crisis in the European summer of 2014. We looked at both damage control orthopaedics and for case variety of war trauma at a civilian hospital. Due to our geographical proximity to Libya, Malta was the closest European tertiary referral centre. Having only one Level 1 trauma care hospital in our country, our Trauma and Orthopaedics department played a pivotal role in the management of Libyan battlefield injuries. Our aims were to assess acute outcomes and short term mortality of surgery within the perspective of a damage control orthopaedic strategy whereby aggressive wound management, early fixation using relative stability principles, antibiotic cover with adequate soft tissue cover are paramount. We also aim to describe the variety of war injuries we came across, with a goal for future improvement in regards to service providing. Prospective collection of six interesting cases with severe limb and spinal injuries sustained in Libya during the Libyan civil war between June and November 2014. We applied current trends in the treatment of war injuries, specifically in damage control orthopaedic strategy and converting to definitive treatment where permissible. The majority of our cases were classified as most severe (Type IIIB/C) according to the Gustilo-Anderson classification of open fractures. The injuries treated reflected the type of standard and improved weaponry available in modern warfare affecting both militants and civilians alike with increasing severity and extent of damage. Due to this fact, multidisciplinary team approach to patient centred care was utilised with an ultimate aim of swift recovery and early mobilisation. It also highlighted the difficulties and complex issues required on a hospital management level as a neighbouring country to war zone countries in transforming care of civil trauma to military trauma.

InSAR detection of aquifer recovery: Case studies of Koehn Lake (central California) and Lone Tree Gold Mine (Basin and Range)

NASA Astrophysics Data System (ADS)

Wdowinski, S.; Greene, F.; Amelung, F.

2013-12-01

Anthropogenic intervention in groundwater flow and aquifer storage often results in vertical movements of Earth's surface, which are well detected by InSAR observations. Most anthropogenic intervention occurs due to groundwater extraction for both agriculture and human consumption and results in land subsidence. However in some cases, ending anthropogenic intervention can lead to aquifer recovery and, consequently, surface uplift. In this study we present two such cases of aquifer recovery. The first case is the aquifer beneath Koehn Lake in Central California, which was overused to meet agricultural demands until the 1990's. The second case is the Lone Tree Gold Mine in Nevada that during active mining in the 1991-2006 groundwater pumping disrupted the aquifer and cause subsidence. But after mining ceased, groundwater flow was recovered and resulted in uplift. In both cases we studied the surface uplift using InSAR time series observations. We conduct an ERS and Envisat InSAR survey over Koehn Lake in California and Lone Tree Gold Mine in Nevada between 1992 and 2010. We followed the SBAS algorithm to generate a time-series of ground displacements and average velocities of pixels, which remain coherent through time in the SAR dataset. A total of 100 and 80 combined ERS and Envisat SAR dates are inverted for Koehn Lake and Lone Tree Gold Mine respectively. Results for the Koehn Lake area indicate a rapid uplift of about 3.5 mm/yr between 1992-2000 and a slower uplift rate of 1.6 mm/yr between 2000-2004, suggesting a decrease in the recovery process. The observed uplift correlates well with groundwater level increase in the Koehn Lake area. Results for the Lone Tree Gold Mine show a constant subsidence (~ 1 cm/yr) due to groundwater extraction between 1992-2006, but uplift of ~1 cm/yr since the beginning of 2007. In both case studies, InSAR observations reveal that the aquifer recovery is accompanied by surface uplift. We plan to use the InSAR observations and the groundwater level records to model and better understand aquifer recovery processes.

Proposed algorithm for the management of athletes with athletic pubalgia (sports hernia): a case series.

PubMed

Kachingwe, Aimie F; Grech, Steven

2008-12-01

A case series of 6 athletes with a suspected sports hernia. Groin pain in athletes is common, and 1 source of groin pain is athletic pubalgia, or a sports hernia. Description of this condition and its management is scarce in the physical therapy literature. The purpose of this case series is to describe a conservative approach to treating athletes with a likely sports hernia and to provide physical therapists with an algorithm for managing athletes with this dysfunction. Six collegiate athletes (age range, 19-22 years; 4 males, 2 females) with a physician diagnosis of groin pain secondary to possible/probable sports hernia were referred to physical therapy. A method of evaluation was constructed and a cluster of 5 key findings indicative of a sports hernia is presented. The athletes were managed according to a proposed algorithm and received physical therapy consisting of soft tissue and joint mobilization/manipulation, neuromuscular re-education, manual stretching, and therapeutic exercise. Three of the athletes received conservative intervention and were able to fully return to sport after a mean of 7.7 sessions of physical therapy. The other 3 athletes reached this outcome after surgical repair and a mean of 6.7 sessions of physical therapy. Conservative management including manual therapy appears to be a viable option in the management of athletes with a sports hernia. Follow-up randomized clinical trials should be performed to further investigate the effectiveness of conservative rehabilitation compared to a homogeneous group of patients undergoing surgical repair for this condition. Therapy, level 4.

Enhanced physical health screening for people with severe mental illness in Hong Kong: results from a one-year prospective case series study.

PubMed

Bressington, Daniel; Mui, Jolene; Hulbert, Sabina; Cheung, Eric; Bradford, Stephen; Gray, Richard

2014-02-27

People with severe mental illness have significantly poorer physical health compared to the general population; previous health screening studies conducted outside Asian countries have demonstrated the potential in addressing this issue. This case series aimed to explore the effects and utility of integrating an enhanced physical health screening programme for community dwelling patients with severe mental illness into routine clinical practice in Hong Kong. This study utilises a consecutive prospective case series design. The serious mental illness Health Improvement Profile (HIP) was used as a screening tool at baseline and repeated at 12 months follow-up. A total of 148 community-based patients with severe mental illness completed the study. At one year follow-up analysis showed a significant improvement in self-reported levels of exercise and a reduction in the numbers of patients prescribed medications for diabetes However, mean waist circumference increased at follow-up. In addition to the statistically significant results some general trends were observed, including: a lack of deterioration in most areas of cardiovascular risk; a reduction in medicines prescribed for physical health problems; and general improvements in health behaviours over the 12 month period. The findings demonstrate that using the HIP is feasible and acceptable in Hong Kong. The results of the enhanced physical health-screening programme are promising, but require further testing using a randomised controlled trial design in order to more confidently attribute the improvements in well-being and health behaviours to the HIP. ISRCTN12582470.

Combination of paclitaxel and bevacizumab in heavily pre-treated non-small-cell lung cancer (NSCLC) patients: a case series study on 15 patients.

PubMed

Le Moulec, Sylvestre; Hadoux, Julien; Gontier, Eric; Chargari, Cyrus; Helissey, Carole; Lamand, Virginie; Tanz, Rachid; Farace, Françoise; Vedrine, Lionel; Bonardel, Gérald; Soria, Jean-Charles; Besse, Benjamin

2013-12-01

The combination of paclitaxel and bevacizumab was EMA-approved as first-line therapy in metastatic breast cancer. Moreover, in vitro studies showed a potential antiangiogenic synergistic effect of paclitaxel and bevacizumab. Between November 2008 and March 2010, this case series study included 15 patients with metastatic non squamous-cell lung carcinoma (NSCLC). Those were bevacizumab eligible and received the same regimen used in metastatic breast cancer with weekly paclitaxel (80 mg/m(2), days 1, 8 and 15) and bevacizumab (10 mg/kg at days 1 and 15) after at least one prior line of chemotherapy. Efficacy was evaluated by CT-scan and PET-FDG every two months. Circulating endothelial progenitor cells (CEP) and circulating endothelial cells (CEC) levels were explored in a subset of patients. Median age 56 (36-75), female: 47%, never smokers: 27%, adenocarcinoma: 100%, PS 0-1: 87% and PS 3: 13%. All patients were treated with a first-line platinum-based doublet with or without bevacizumab and 70% of them with erlotinib in the second-line. No major toxicity was observed. Partial response (PR) rate was 44% (31-63%) using RECIST criteria on CT-scan, and 65% (29-88%) with PET FDG. PS improved in 33% of the cases. Median progression free survival was 4.6 months. An increase of CEC and CEP was observed in patients with NSCLC treated with paclitaxel and bevacizumab. In this retrospective series, our results suggest efficacy signal in pre-treated metastatic NSCLC and warrant further assessment in a randomized clinical trial.

Disulfide oil hazard assessment using categorical analysis and a mode of action determination.

PubMed

Morgott, David; Lewis, Christopher; Bootman, James; Banton, Marcy

2014-01-01

Diethyl and diphenyl disulfides, naphtha sweetening (Chemical Abstracts Service [CAS] # 68955-96-4), are primarily composed of low-molecular-weight dialkyl disulfides extracted from C4 to C5 light hydrocarbon streams during the refining of crude oil. The substance, commonly known as disulfide oil (DSO), can be composed of up to 17 different disulfides and trisulfides with monoalkyl chain lengths no greater than C4. The disulfides in DSO constitute a homologous series of chemical constituents that are perfectly suited for a hazard evaluation using a read-across/worst-case approach. The DSO constituents exhibit a common mode of action that is operable at all trophic levels. The observed oxidative stress response is mediated by reactive oxygen species and free radical intermediates generated after disulfide bond cleavage and subsequent redox cycling of the resulting mercaptan. Evidence indicates that the lowest series member, dimethyl disulfide (DMDS), can operate as a worst-case surrogate for other members of the series, since it displays the highest toxicity. Increasing the alkyl chain length or degree of substitution has been shown to serially reduce disulfide toxicity through resonance stabilization of the radical intermediate or steric inhibition of the initial enzymatic step. The following case study examines the mode of action for dialkyl disulfide toxicity and documents the use of read-across information from DMDS to assess the hazards of DSO. The results indicate that DSO possesses high aquatic toxicity, moderate environmental persistence, low to moderate acute toxicity, high repeated dose toxicity, and a low potential for genotoxicity, carcinogenicity, and reproductive/developmental effects.

Multi-stage 3D-2D registration for correction of anatomical deformation in image-guided spine surgery

NASA Astrophysics Data System (ADS)

Ketcha, M. D.; De Silva, T.; Uneri, A.; Jacobson, M. W.; Goerres, J.; Kleinszig, G.; Vogt, S.; Wolinsky, J.-P.; Siewerdsen, J. H.

2017-06-01

A multi-stage image-based 3D-2D registration method is presented that maps annotations in a 3D image (e.g. point labels annotating individual vertebrae in preoperative CT) to an intraoperative radiograph in which the patient has undergone non-rigid anatomical deformation due to changes in patient positioning or due to the intervention itself. The proposed method (termed msLevelCheck) extends a previous rigid registration solution (LevelCheck) to provide an accurate mapping of vertebral labels in the presence of spinal deformation. The method employs a multi-stage series of rigid 3D-2D registrations performed on sets of automatically determined and increasingly localized sub-images, with the final stage achieving a rigid mapping for each label to yield a locally rigid yet globally deformable solution. The method was evaluated first in a phantom study in which a CT image of the spine was acquired followed by a series of 7 mobile radiographs with increasing degree of deformation applied. Second, the method was validated using a clinical data set of patients exhibiting strong spinal deformation during thoracolumbar spine surgery. Registration accuracy was assessed using projection distance error (PDE) and failure rate (PDE  >  20 mm—i.e. label registered outside vertebra). The msLevelCheck method was able to register all vertebrae accurately for all cases of deformation in the phantom study, improving the maximum PDE of the rigid method from 22.4 mm to 3.9 mm. The clinical study demonstrated the feasibility of the approach in real patient data by accurately registering all vertebral labels in each case, eliminating all instances of failure encountered in the conventional rigid method. The multi-stage approach demonstrated accurate mapping of vertebral labels in the presence of strong spinal deformation. The msLevelCheck method maintains other advantageous aspects of the original LevelCheck method (e.g. compatibility with standard clinical workflow, large capture range, and robustness against mismatch in image content) and extends capability to cases exhibiting strong changes in spinal curvature.

Toxicological results in a fatal and two non-fatal cases of scopolamine-facilitated robberies.

PubMed

Lusthof, K J; Bosman, I J; Kubat, B; Vincenten-van Maanen, M J

2017-05-01

The use of scopolamine as an incapacitating drug, in sexual crimes and robberies, has been known for many decades. However, blood concentrations and doses of scopolamine in those cases are largely unknown. Here we present the toxicological results of one fatal and two non-fatal cases in a series of scopolamine-facilitated robberies. In the fatal case, the concentration of scopolamine in heart blood was 0.30mg/L, about 3000 times higher than the average therapeutic level of 0.0001mg/L (for one dermal patch). In femoral blood, the concentration of scopolamine was much lower (0.0048mg/L), but still 50 times higher than therapeutic levels. The scopolamine concentration in the stomach was very high (20mg/kg) as compared to the heart blood and femoral blood, which explains the very high concentration in heart blood by postmortem leakage from the stomach. In the non-fatal case, the scopolamine concentration in serum, obtained 23h after the incident, was 0.00035mg/L. The estimated concentration of scopolamine at the time of the incident is 0.0035mg/L. In the other non-fatal case, scopolamine was detected in urine and in hair. Copyright © 2017 Elsevier B.V. All rights reserved.

Use of the levonorgestrel 52-mg intrauterine system in adolescent and young adult solid organ transplant recipients: a case series.

PubMed

Huguelet, P S; Sheehan, C; Spitzer, R F; Scott, S

2017-04-01

This case series reports on the safety and efficacy of the levonorgestrel 52-mg intrauterine system in adolescent and young adult solid organ transplant recipients. All patients used the device for contraception, with no documented cases of disseminated pelvic infection or unplanned pregnancy. Copyright © 2016 Elsevier Inc. All rights reserved.

27 CFR 19.490 - Numbering of packages and cases filled in processing.

Code of Federal Regulations, 2011 CFR

2011-04-01

... cases filled in processing. 19.490 Section 19.490 Alcohol, Tobacco Products and Firearms ALCOHOL AND... Marks Marking Requirements for Spirits § 19.490 Numbering of packages and cases filled in processing. (a... any series reaches “1,000,000”, the proprietor may begin a new series with “1” but must add an...

Etiologies of Autism in a Case-Series from Tanzania

ERIC Educational Resources Information Center

Mankoski, Raymond E.; Collins, Martha; Ndosi, Noah K.; Mgalla, Ella H.; Sarwatt, Veronica V.; Folstein, Susan E.

2006-01-01

Most autism has a genetic cause although post-encephalitis cases are reported. In a case-series (N = 20) from Tanzania, 14 met research criteria for autism. Three (M:F = 1:2) had normal development to age 22, 35, and 42 months, with onset of autism upon recovery from severe malaria, attended by prolonged high fever, convulsions, and in one case…

T-cell receptor excision circle levels and safety of paediatric immunization: A population-based self-controlled case series analysis.

PubMed

Wilson, Kumanan; Duque, Daniel Rodriguez; Murphy, Malia Sq; Hawken, Steven; Pham-Huy, Anne; Kwong, Jeffrey; Deeks, Shelley L; Potter, Beth K; Crowcroft, Natasha S; Bulman, Dennis E; Chakraborty, Pranesh; Little, Julian

2018-02-08

T-cell receptor excision circle levels are a surrogate marker of T-cell production and immune system function. We sought to determine whether non-pathological levels of infant T-cell receptor excision circles were associated with adverse events following immunization. A self-controlled case series design was applied on a sample of 231,693 children who completed newborn screening for severe combined immunodeficiency in Ontario, Canada between August 2013 and December 2015. Exposures included routinely administered pediatric vaccines up to 15 months of age. Main outcomes were combined health services utilization for recognized adverse events following immunization. 1,406,981 vaccination events were included in the final dataset. 103,007 children received the Pneu-C-13 or Men-C-C vaccine and 97,998 received the MMR vaccine at 12 months of age. 67,725 children received the varicella immunization at 15 months. Our analysis identified no association between newborn T-cell receptor excision circle levels and subsequent health services utilization events following DTa-IPV-Hib, Pneu-C-13, and Men-C-C vaccinations at 2-month (RI 0.94[95%CI 0.87-1.02]), 4-month (RI 0.82[95%CI 0.75-0.9]), 6-month (RI 0.63[95%CI 0.57-0.7]) and 12-month (RI 0.49[95%CI 0.44-0.55]). We also found no trends in health services utilization following MMR (RI 1.43[95%1.34-1.52]) or varicella (RI 1.14[95%CI 1.05-1.23]) vaccination. Our findings provide further support for the safety of pediatric vaccinations.

Design and Development of a Series Switch for High Voltage in RF Heating

NASA Astrophysics Data System (ADS)

Patel, Himanshu K.; Shah, Deep; Thacker, Mauli; Shah, Atman

2013-02-01

Plasma is the fourth state of matter. To sustain plasma in its ionic form very high temperature is essential. RF heating systems are used to provide the required temperature. Arching phenomenon in these systems can cause enormous damage to the RF tube. Heavy current flows across the anode-cathode junction, which need to be suppressed in minimal time for its protection. Fast-switching circuit breakers are used to cut-off the load from the supply in cases of arching. The crowbar interrupts the connection between the high voltage power supply (HVPS) and the RF tube for a temporary period between which the series switch has to open. The crowbar shunts the current across the load but in the process leads to short circuiting the HVPS. Thus, to protect the load as well as the HVPS a series switch is necessary. This paper presents the design and development of high voltage Series Switch for the high power switching applications. Fiber optic based Optimum triggering scheme is designed and tested to restrict the time delay well within the stipulated limits. The design is well supported with the experimental results for the whole set-up along with the series switch at various voltage level before its approval for operation at 5.2 kV.

Drug-induced Fanconi syndrome associated with fumaric acid esters treatment for psoriasis: a case series

PubMed Central

Balak, Deepak M.W.; Bouwes Bavinck, Jan Nico; de Vries, Aiko P.J.; Hartman, Jenny; Neumann, Hendrik A. Martino; Zietse, Robert; Thio, Hok Bing

2016-01-01

Background Fumaric acid esters (FAEs), an oral immunomodulating treatment for psoriasis and multiple sclerosis, have been anecdotally associated with proximal renal tubular dysfunction due to a drug-induced Fanconi syndrome. Few data are available on clinical outcomes of FAE-induced Fanconi syndrome. Methods Descriptive case series with two cases of Fanconi syndrome associated with FAE treatment diagnosed at two Dutch university nephrology departments, three cases reported at the Dutch and German national pharmacovigilance databases and six previously reported cases. Results All 11 cases involved female patients with psoriasis. The median age at the time of onset was 38 years [interquartile range (IQR) 37–46]. Patients received long-term FAEs treatment with a median treatment duration of 60 months (IQR 28–111). Laboratory tests were typically significant for low serum levels of phosphate and uric acid, while urinalysis showed glycosuria and proteinuria. Eight (73%) patients had developed a hypophosphataemic osteomalacia and three (27%) had pathological bone fractures. All patients discontinued FAEs, while four (36%) patients were treated with supplementation of phosphate and/or vitamin D. Five (45%) patients had persisting symptoms despite FAEs discontinuation. Conclusions FAEs treatment can cause drug-induced Fanconi syndrome, but the association has been reported infrequently. Female patients with psoriasis treated long term with FAEs seem to be particularly at risk. Physicians treating patients with FAEs should be vigilant and monitor for the potential occurrence of Fanconi syndrome. Measurement of the urinary albumin:total protein ratio is a suggested screening tool for tubular proteinuria in Fanconi syndrome. PMID:26798466

Fragrance contact allergy: a 4-year retrospective study.

PubMed

Cuesta, Laura; Silvestre, Juan Francisco; Toledo, Fernando; Lucas, Ana; Pérez-Crespo, María; Ballester, Irene

2010-08-01

Fragrance chemicals are the second most frequent cause of contact allergy. The mandatory labelling of 26 fragrance chemicals when present in cosmetics has facilitated management of patients allergic to fragrances. The study was aimed to define the characteristics of the population allergic to perfumes detected in our hospital district, to determine the usefulness of markers of fragrance allergy in the baseline GEIDAC series, and to describe the contribution made by the fragrance series to the data obtained with the baseline series. We performed a 4-year retrospective study of patients tested with the Spanish baseline series and/or fragrance series. There are four fragrance markers in the baseline series: fragrance mix I (FM I), Myroxylon pereirae, fragrance mix II (FM II), and hydroxyisohexyl 3-cyclohexene carboxaldehyde. A total of 1253 patients were patch tested, 117 (9.3%) of whom were positive to a fragrance marker. FM I and M. pereirae detected 92.5% of the cases of fragrance contact allergy. FM II and hydroxyisohexyl 3-cyclohexene carboxaldehyde detected 6 additional cases and provided further information in 8, enabling improved management. A fragrance series was tested in a selected group of 86 patients and positive results were obtained in 45.3%. Geraniol was the allergen most frequently found in the group of patients tested with the fragrance series. Classic markers detect the majority of cases of fragrance contact allergy. We recommend incorporating FM II in the Spanish baseline series, as in the European baseline series, and using a specific fragrance series to study patients allergic to a fragrance marker.

Noise-assisted data processing with empirical mode decomposition in biomedical signals.

PubMed

Karagiannis, Alexandros; Constantinou, Philip

2011-01-01

In this paper, a methodology is described in order to investigate the performance of empirical mode decomposition (EMD) in biomedical signals, and especially in the case of electrocardiogram (ECG). Synthetic ECG signals corrupted with white Gaussian noise are employed and time series of various lengths are processed with EMD in order to extract the intrinsic mode functions (IMFs). A statistical significance test is implemented for the identification of IMFs with high-level noise components and their exclusion from denoising procedures. Simulation campaign results reveal that a decrease of processing time is accomplished with the introduction of preprocessing stage, prior to the application of EMD in biomedical time series. Furthermore, the variation in the number of IMFs according to the type of the preprocessing stage is studied as a function of SNR and time-series length. The application of the methodology in MIT-BIH ECG records is also presented in order to verify the findings in real ECG signals.

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

Ferraioli, Luigi; Hueller, Mauro; Vitale, Stefano

The scientific objectives of the LISA Technology Package experiment on board of the LISA Pathfinder mission demand accurate calibration and validation of the data analysis tools in advance of the mission launch. The level of confidence required in the mission outcomes can be reached only by intensively testing the tools on synthetically generated data. A flexible procedure allowing the generation of a cross-correlated stationary noise time series was set up. A multichannel time series with the desired cross-correlation behavior can be generated once a model for a multichannel cross-spectral matrix is provided. The core of the procedure comprises a noisemore » coloring, multichannel filter designed via a frequency-by-frequency eigendecomposition of the model cross-spectral matrix and a subsequent fit in the Z domain. The common problem of initial transients in a filtered time series is solved with a proper initialization of the filter recursion equations. The noise generator performance was tested in a two-dimensional case study of the closed-loop LISA Technology Package dynamics along the two principal degrees of freedom.« less

Monitoring mangrove forests after aquaculture abandonment using time series of very high spatial resolution satellite images: A case study from the Perancak estuary, Bali, Indonesia.

PubMed

Proisy, Christophe; Viennois, Gaëlle; Sidik, Frida; Andayani, Ariani; Enright, James Anthony; Guitet, Stéphane; Gusmawati, Niken; Lemonnier, Hugues; Muthusankar, Gowrappan; Olagoke, Adewole; Prosperi, Juliana; Rahmania, Rinny; Ricout, Anaïs; Soulard, Benoit; Suhardjono

2018-06-01

Revegetation of abandoned aquaculture regions should be a priority for any integrated coastal zone management (ICZM). This paper examines the potential of a matchless time series of 20 very high spatial resolution (VHSR) optical satellite images acquired for mapping trends in the evolution of mangrove forests from 2001 to 2015 in an estuary fragmented into aquaculture ponds. Evolution of mangrove extent was quantified through robust multitemporal analysis based on supervised image classification. Results indicated that mangroves are expanding inside and outside ponds and over pond dykes. However, the yearly expansion rate of vegetation cover greatly varied between replanted ponds. Ground truthing showed that only Rhizophora species had been planted, whereas natural mangroves consist of Avicennia and Sonneratia species. In addition, the dense Rhizophora plantations present very low regeneration capabilities compared with natural mangroves. Time series of VHSR images provide comprehensive and intuitive level of information for the support of ICZM. Copyright © 2017 Elsevier Ltd. All rights reserved.

Long-range prediction of the low-frequency mode in the low-level Indian monsoon circulation with a simple statistical method

NASA Astrophysics Data System (ADS)

Chen, Tsing-Chang; Yen, Ming-Cheng; Wu, Kuang-Der; Ng, Thomas

1992-08-01

The time evolution of the Indian monsoon is closely related to locations of the northward migrating monsoon troughs and ridges which can be well depicted with the 30 60day filtered 850-mb streamfunction. Thus, long-range forecasts of the large-scale low-level monsoon can be obtained from those of the filtered 850-mb streamfunction. These long-range forecasts were made in this study in terms of the Auto Regressive (AR) Moving-Average process. The historical series of the AR model were constructed with the 30 60day filtered 850-mb streamfunction [˜ψ (850mb)] time series of 4months. However, the phase of the last low-frequency cycle in the ˜ψ (850mb) time series can be skewed by the bandpass filtering. To reduce this phase skewness, a simple scheme is introduced. With this phase modification of the filtered 850-mb streamfunction, we performed the pilot forecast experiments of three summers with the AR forecast process. The forecast errors in the positions of the northward propagating monsoon troughs and ridges at Day 20 are generally within the range of 12days behind the observed, except in some extreme cases.

Hypoplasia or Absence of Posterior Leaflet: A Rare Congenital Anomaly of The Mitral Valve in Adulthood - Case Series.

PubMed

Parato, Vito Maurizio; Masia, Stefano Lucio

2018-01-01

We present a case series of two adult patients with almost complete absence of the posterior mitral valve leaflet and who are asymptomatic or mildly symptomatic, with two different degrees of mitral regurgitation.

Use of cantilever mechanics for impacted teeth: case series.

PubMed

Paduano, Sergio; Spagnuolo, Gianrico; Franzese, Gerardo; Pellegrino, Gioacchino; Valletta, Rosa; Cioffi, Iacopo

2013-01-01

This paper describes the orthodontic treatment, and the biomechanics of cantilevers for the impaction of permanent teeth in youngs, adolescents, and adults. In these case series, multibracket straightwire fixed appliances, together with cantilever mechanics, were used to treat the impaired occlusion.

Benchmarking algorithms for the solution of Collisional Radiative Model (CRM) equations.

NASA Astrophysics Data System (ADS)

Klapisch, Marcel; Busquet, Michel

2007-11-01

Elements used in ICF target designs can have many charge states in the same plasma conditions, each charge state having numerous energy levels. When LTE conditions are not met, one has to solve CRM equations for the populations of energy levels, which are necessary for opacities/emissivities, Z* etc. In case of sparse spectra, or when configuration interaction is important (open d or f shells), statistical methods[1] are insufficient. For these cases one must resort to a detailed level CRM rate generator[2]. The equations to be solved may involve tens of thousands of levels. The system is by nature ill conditioned. We show that some classical methods do not converge. Improvements of the latter will be compared with new algorithms[3] with respect to performance, robustness, and accuracy. [1] A Bar-Shalom, J Oreg, and M Klapisch, J. Q. S. R. T.,65, 43 (2000). [2] M Klapisch, M Busquet and A. Bar-Shalom, Proceedings of APIP'07, AIP series (to be published). [3] M Klapisch and M Busquet, High Ener. Density Phys. 3,143 (2007)

Vitamin D toxicity of dietary origin in cats fed a natural complementary kitten food

PubMed Central

Crossley, Victoria J; Bovens, Catherine PV; Pineda, Carmen; Hibbert, Angie; Finch, Natalie C

2017-01-01

Case series summary This case series describes two young sibling cats and an additional unrelated cat, from two separate households, that developed hypercalcaemia associated with hypervitaminosis D. Excessive vitamin D concentrations were identified in a natural complementary tinned kitten food that was fed to all three cats as part of their diet. In one of the cases, there was clinical evidence of soft tissue mineralisation. The hypercalcaemia and soft tissue mineralisation resolved following withdrawal of the affected food and medical management of the hypercalcaemia. Relevance and novel information This case series demonstrates the importance of obtaining a thorough dietary history in patients presenting with hypercalcaemia and the measurement of vitamin D metabolites when investigating such cases. Complementary foods may have the potential to induce nutritional toxicity even when fed with complete, nutritionally balanced diets. PMID:29270305

Assessment of Macro-Level Socioeconomic Factors That Impact Waterborne Diseases: The Case of Jordan.

PubMed

Polimeni, John M; Almalki, Ahmad; Iorgulescu, Raluca I; Albu, Lucian-Liviu; Parker, Wendy M; Chandrasekara, Ray

2016-11-25

The Hashemite Kingdom of Jordan is an example of a country that suffers from high water scarcity. Additionally, due to the economic drivers in the country, such as phosphate and potash extraction and pharmaceutical production, the little fresh water that remains is generally polluted. The infrastructure, often antiquated in urban areas and non-existent in rural areas, also contributes to poor water conditions and to the spread of waterborne diseases. This paper examines the socioeconomic factors that contribute to diarrhea and hepatitis A on a macro level in Jordan and discusses the public-policies that government officials could use to abate those problems. Ordinary least squares time series models are used to understand the macro-level variables that impact the incidence of these diseases in Jordan. Public health expenditure has a significant impact on reducing their incidence. Furthermore, investment in sanitation facilities in rural regions is likely to reduce the number of cases of hepatitis A. Perhaps the most surprising outcome is that importation of goods and services likely results in a decrease in cases of hepatitis A. However, income has little impact on the incidence of diarrhea and hepatitis A.

Assessment of Macro-Level Socioeconomic Factors That Impact Waterborne Diseases: The Case of Jordan

PubMed Central

Polimeni, John M.; Almalki, Ahmad; Iorgulescu, Raluca I.; Albu, Lucian-Liviu; Parker, Wendy M.; Chandrasekara, Ray

2016-01-01

The Hashemite Kingdom of Jordan is an example of a country that suffers from high water scarcity. Additionally, due to the economic drivers in the country, such as phosphate and potash extraction and pharmaceutical production, the little fresh water that remains is generally polluted. The infrastructure, often antiquated in urban areas and non-existent in rural areas, also contributes to poor water conditions and to the spread of waterborne diseases. This paper examines the socioeconomic factors that contribute to diarrhea and hepatitis A on a macro level in Jordan and discusses the public-policies that government officials could use to abate those problems. Ordinary least squares time series models are used to understand the macro-level variables that impact the incidence of these diseases in Jordan. Public health expenditure has a significant impact on reducing their incidence. Furthermore, investment in sanitation facilities in rural regions is likely to reduce the number of cases of hepatitis A. Perhaps the most surprising outcome is that importation of goods and services likely results in a decrease in cases of hepatitis A. However, income has little impact on the incidence of diarrhea and hepatitis A. PMID:27898017

State-level gonorrhea rates and expedited partner therapy laws: insights from time series analyses.

PubMed

Owusu-Edusei, K; Cramer, R; Chesson, H W; Gift, T L; Leichliter, J S

2017-06-01

In this study, we examined state-level monthly gonorrhea morbidity and assessed the potential impact of existing expedited partner therapy (EPT) laws in relation to the time that the laws were enacted. Longitudinal study. We obtained state-level monthly gonorrhea morbidity (number of cases/100,000 for males, females and total) from the national surveillance data. We used visual examination (of morbidity trends) and an autoregressive time series model in a panel format with intervention (interrupted time series) analysis to assess the impact of state EPT laws based on the months in which the laws were enacted. For over 84% of the states with EPT laws, the monthly morbidity trends did not show any noticeable decreases on or after the laws were enacted. Although we found statistically significant decreases in gonorrhea morbidity within four of the states with EPT laws (Alaska, Illinois, Minnesota, and Vermont), there were no significant decreases when the decreases in the four states were compared contemporaneously with the decreases in states that do not have the laws. We found no impact (decrease in gonorrhea morbidity) attributable exclusively to the EPT law(s). However, these results do not imply that the EPT laws themselves were not effective (or failed to reduce gonorrhea morbidity), because the effectiveness of the EPT law is dependent on necessary intermediate events/outcomes, including sexually transmitted infection service providers' awareness and practice, as well as acceptance by patients and their partners. Published by Elsevier Ltd.

The many faces of intestinal tract gastric heterotopia; a series of four cases highlighting clinical and pathological heterogeneity.

PubMed

Nasir, Aqsa; Amateau, Stuart K; Khan, Sabina; Simpson, Ross W; Snover, Dale C; Amin, Khalid

2018-04-01

Gastric heterotopia of the intestinal tract can have a diverse clinicopathologic presentation, resulting in a diagnostic dilemma. We present a series of four cases, two male and two female patients with age range of 31-82 years, found in the duodenum, jejunum, and transverse colon. The most common and rather unusual clinical presentation was iron deficiency anemia, seen in three cases, while one patient presented with abdominal pain. Endoscopically, two cases were visualized as pedunculated polyps and two as sessile/plaque-like lesions. Polypectomy was performed in three patients, and one patient underwent biopsy followed by resection. Two cases showed oxyntic-type epithelium, and two cases exhibited pyloric-type gastric epithelium. Three patients were relieved of their presenting symptoms after therapeutic procedures with no evidence of recurrence noted on follow-up. Follow-up was not available on one patient. This case series highlights a diverse clinicopathologic spectrum of gastric heterotopia. Accurate diagnosis is essential for proper management. Copyright © 2018. Published by Elsevier Inc.

On a General Class of Trigonometric Functions and Fourier Series

ERIC Educational Resources Information Center

Pavao, H. Germano; Capelas de Oliveira, E.

2008-01-01

We discuss a general class of trigonometric functions whose corresponding Fourier series can be used to calculate several interesting numerical series. Particular cases are presented. (Contains 4 notes.)

BestPractices Corporate Energy Management Case Study: Alcoa Teams with DOE to Reduce Energy Consumption

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

Not Available

2004-05-01

This is the first in a series of DOE Industrial Technologies Program case studies on corporate energy management. The case study highlights Alcoa Aluminum's successful results and activities through its corporate energy management approach and collaboration with DOE. Case studies in this series will be used to encourage other energy-intensive industrial plants to adopt a corporate strategy, and to promote the concept of replicating results with a company or industry.

Accounting for Non-Gaussian Sources of Spatial Correlation in Parametric Functional Magnetic Resonance Imaging Paradigms II: A Method to Obtain First-Level Analysis Residuals with Uniform and Gaussian Spatial Autocorrelation Function and Independent and Identically Distributed Time-Series.

PubMed

Gopinath, Kaundinya; Krishnamurthy, Venkatagiri; Lacey, Simon; Sathian, K

2018-02-01

In a recent study Eklund et al. have shown that cluster-wise family-wise error (FWE) rate-corrected inferences made in parametric statistical method-based functional magnetic resonance imaging (fMRI) studies over the past couple of decades may have been invalid, particularly for cluster defining thresholds less stringent than p < 0.001; principally because the spatial autocorrelation functions (sACFs) of fMRI data had been modeled incorrectly to follow a Gaussian form, whereas empirical data suggest otherwise. Hence, the residuals from general linear model (GLM)-based fMRI activation estimates in these studies may not have possessed a homogenously Gaussian sACF. Here we propose a method based on the assumption that heterogeneity and non-Gaussianity of the sACF of the first-level GLM analysis residuals, as well as temporal autocorrelations in the first-level voxel residual time-series, are caused by unmodeled MRI signal from neuronal and physiological processes as well as motion and other artifacts, which can be approximated by appropriate decompositions of the first-level residuals with principal component analysis (PCA), and removed. We show that application of this method yields GLM residuals with significantly reduced spatial correlation, nearly Gaussian sACF and uniform spatial smoothness across the brain, thereby allowing valid cluster-based FWE-corrected inferences based on assumption of Gaussian spatial noise. We further show that application of this method renders the voxel time-series of first-level GLM residuals independent, and identically distributed across time (which is a necessary condition for appropriate voxel-level GLM inference), without having to fit ad hoc stochastic colored noise models. Furthermore, the detection power of individual subject brain activation analysis is enhanced. This method will be especially useful for case studies, which rely on first-level GLM analysis inferences.

U.S.-Japan Relations: The View from Both Sides of the Pacific. Part I, Episodes in the History of U.S.-Japan Relations: Case Studies of Conflict, Conflict Management & Resolution.

ERIC Educational Resources Information Center

Mukai, Gary

This curriculum unit is the first part of a three-part series; it focuses on the theme of conflict. It introduces students to conflict on personal, group, international, and global levels and to basic conflict resolution/management alternatives. Students learn about six categories of conflict through the analysis of episodes in the history of…

Arthroscopic rotator cuff debridement without decompression for the treatment of tendinosis.

PubMed

Budoff, Jeffrey E; Rodin, Dennis; Ochiai, Derek; Nirschl, Robert P

2005-09-01

The treatment of rotator cuff injury in the absence of a full-thickness tear has traditionally consisted of acromioplasty. However, this disorder may also be treated by arthroscopic rotator cuff debridement without acromioplasty. Our previous study of 79 shoulders so treated reported 87% good or excellent results at an average 53-month follow-up. The purpose of this article is to report the long-term, average 9.5-year follow-up of this cohort. Long-term follow-up of case series. We retrospectively reviewed the records of 62 shoulders in 60 patients who had undergone arthroscopic rotator cuff debridement for partial-thickness rotator cuff tears. Demographic criteria, residual pain, and the ability to return to recreational athletics were noted. The UCLA Shoulder Score and the Simple Shoulder Test scores were determined and statistical analysis performed. Using the UCLA Shoulder Score, there were 79% excellent or good results at an average 114 months of follow-up. Patients with Workers' Compensation claims had significantly worse results, with only 40% rated good or excellent. Of the 60 patients, 77% had no or only minimal pain, 57% were still able to perform recreational athletics without difficulty, and 20% could participate at a lower level of intensity. Arthroscopic debridement of rotator cuff injury in the absence of a full-thickness tear has good long-term results and minimizes additional surgical trauma. Level IV, case series.

The application of mechanical diagnosis and therapy in lateral epicondylalgia

PubMed Central

Maccio, Joseph R.; Fink, Sarah; Yarznbowicz, Richard; May, Stephen

2016-01-01

Background lateral epicondylalgia (LE) is a musculoskeletal diagnosis that causes pain and dysfunction in the lateral aspect of the elbow. Mechanical diagnosis and therapy (MDT) is an orthopaedic classification and treatment system based on mechanical and symptomatic response to repeated and sustained end-range movement. There has been no investigation of the association between MDT and patients diagnosed with LE. Case description this report presents three patients matching the currently accepted diagnostic criteria for LE, two with a diagnosis of lateral epicondylitis (tennis elbow) from a medical doctor. These patients were classified and treated by a diplomat of MDT and two third-year doctoral students of physical therapy using MDT. Outcomes short- and long-term (one year) outcomes were excellent, demonstrating rapid abolishment of symptoms and return to prior levels of function in 3–6 visits between 11–59 days. Patients demonstrated the ability to prevent and manage reoccurrence of symptoms independently without seeking further health care. Discussion this case series raises questions about whether or not the pathologies traditionally associated with the aetiology of LE are actually at fault. Moreover, it raises questions about the utility of special tests typically utilized to identify those structures. The series provides preliminary evidence that MDT may be capable of providing effective short- and long-term outcomes in the management of LE. Level of Evidence: 4 PMID:27559286

A view on coupled cluster perturbation theory using a bivariational Lagrangian formulation.

PubMed

Kristensen, Kasper; Eriksen, Janus J; Matthews, Devin A; Olsen, Jeppe; Jørgensen, Poul

2016-02-14

We consider two distinct coupled cluster (CC) perturbation series that both expand the difference between the energies of the CCSD (CC with single and double excitations) and CCSDT (CC with single, double, and triple excitations) models in orders of the Møller-Plesset fluctuation potential. We initially introduce the E-CCSD(T-n) series, in which the CCSD amplitude equations are satisfied at the expansion point, and compare it to the recently developed CCSD(T-n) series [J. J. Eriksen et al., J. Chem. Phys. 140, 064108 (2014)], in which not only the CCSD amplitude, but also the CCSD multiplier equations are satisfied at the expansion point. The computational scaling is similar for the two series, and both are term-wise size extensive with a formal convergence towards the CCSDT target energy. However, the two series are different, and the CCSD(T-n) series is found to exhibit a more rapid convergence up through the series, which we trace back to the fact that more information at the expansion point is utilized than for the E-CCSD(T-n) series. The present analysis can be generalized to any perturbation expansion representing the difference between a parent CC model and a higher-level target CC model. In general, we demonstrate that, whenever the parent parameters depend upon the perturbation operator, a perturbation expansion of the CC energy (where only parent amplitudes are used) differs from a perturbation expansion of the CC Lagrangian (where both parent amplitudes and parent multipliers are used). For the latter case, the bivariational Lagrangian formulation becomes more than a convenient mathematical tool, since it facilitates a different and faster convergent perturbation series than the simpler energy-based expansion.

Use of Cantilever Mechanics for Impacted Teeth: Case Series

PubMed Central

Paduano, Sergio; Spagnuolo, Gianrico; Franzese, Gerardo; Pellegrino, Gioacchino; Valletta, Rosa; Cioffi, Iacopo

2013-01-01

This paper describes the orthodontic treatment, and the biomechanics of cantilevers for the impaction of permanent teeth in youngs, adolescents, and adults. In these case series, multibracket straightwire fixed appliances, together with cantilever mechanics, were used to treat the impaired occlusion. PMID:24511332

Killing two birds with one stone: successful opioid monotherapy in intractable migraine-triggered epilepsy, a case series

PubMed Central

Derakhshan, Iraj

2017-01-01

The novel concept explored in this case series is the primacy of headaches in generating seizures in those patients who suffer from migraine-triggered epilepsy. In this series, once the migraine headaches were fully suppressed, via daily scheduled opioid therapy, the seizures also stopped. Seizures returned, however, after the patients stopped the opiate regimen for any reason. The above pharmacological scenario is reminiscent of a similar but naturalistic course of events reported on the salutary effects of ketogenic diet, or changes in life style, in similar cases of migraine-triggered epilepsy. The primacy of migraine in treating what has been named ‘seizure headaches’ is seen in two other scenarios (i.e. the salutary effect of ketogenic diet and lifestyle changes resulting in restoration of one’s sleeping pattern) thus stopping the migraine as well as the seizures associated with the same. This case series recounts the same phenomenon via utilizing around-the-clock maintenance opioid therapy. PMID:28203347

Killing two birds with one stone: successful opioid monotherapy in intractable migraine-triggered epilepsy, a case series.

PubMed

Derakhshan, Iraj

2017-01-01

The novel concept explored in this case series is the primacy of headaches in generating seizures in those patients who suffer from migraine-triggered epilepsy. In this series, once the migraine headaches were fully suppressed, via daily scheduled opioid therapy, the seizures also stopped. Seizures returned, however, after the patients stopped the opiate regimen for any reason. The above pharmacological scenario is reminiscent of a similar but naturalistic course of events reported on the salutary effects of ketogenic diet, or changes in life style, in similar cases of migraine-triggered epilepsy. The primacy of migraine in treating what has been named 'seizure headaches' is seen in two other scenarios (i.e. the salutary effect of ketogenic diet and lifestyle changes resulting in restoration of one's sleeping pattern) thus stopping the migraine as well as the seizures associated with the same. This case series recounts the same phenomenon via utilizing around-the-clock maintenance opioid therapy.

Pediatric and adolescent gynecology learned via a Web-based computerized case series.

PubMed

De Silva, Nirupama K; Dietrich, Jennifer E; Young, Amy E

2010-04-01

To increase resident knowledge in pediatric and adolescent gynecology via a Web-based self-tutorial. Prospective cohort involving 11 third- and fourth-year residents in a large university program. Residents were asked to complete a Web-based teaching series of cases involving common topics of pediatric and adolescent gynecology (PAG). A pretest and a posttest were completed to assess knowledge gained. Residents were asked to give feedback regarding improvements to the Web-based series for future case development. University-affiliated residency program in a major metropolitan area. Resident physicians in the Department of Obstetrics and Gynecology. Introduction of a Web-based teaching series to enhance resident education. Improvement of resident knowledge in PAG. All residents improved their knowledge in PAG after reviewing the series of cases. The pretest group mean score was 50%. The posttest group score was 69% (P < .05). All (100%) of participants said that this tool was an effective way to improve resident knowledge in PAG. A computer-based self-tutorial in pediatric and adolescent gynecology is a feasible and satisfactory teaching adjunct to PAG. Copyright 2010 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Laser arytenoidectomy in children with bilateral vocal fold immobility.

PubMed

Worley, G; Bajaj, Y; Cavalli, L; Hartley, B

2007-01-01

Bilateral vocal fold immobility in children is a challenging problem because a balance between good airway and voice quality has to be achieved. Surgery to improve the airway is often postponed or avoided because of fear of losing the voice. In this study our results of laser arytenoidectomy in children are described. This was a retrospective case notes review at a tertiary level paediatric ENT department. The six patients in this case series ranged from nine to 16 years old at the time of laser arytenoidectomy. Post-operative airway and voice quality were assessed. All children in the series had an adequate post-operative airway. Four of these patients had tracheostomies pre-operatively and achieved decannulation. All six patients rated their post-operative voice as better than pre-operatively. This is principally due to increased loudness associated with increased airflow through the larynx, particularly after tracheostomy decannulation. It is recommended that special care should be taken not to disturb the anterior two thirds of the vocal fold during the surgery in order to achieve a good post-operative voice outcome.

Orlistat and the risk of acute liver injury: self controlled case series study in UK Clinical Practice Research Datalink

PubMed Central

Langham, Julia; Bhaskaran, Krishnan; Brauer, Ruth; Smeeth, Liam

2013-01-01

Objective To measure the association between orlistat and acute liver injury. Design Self controlled case series study. Setting Population based primary care setting, United Kingdom. Participants 94 695 patients receiving orlistat and registered in the UK Clinical Practice Research Datalink and linked with Hospital Episode Statistics data between 1999 and 2011. Main outcome measure Relative incidence of acute liver injury comparing periods when patients were receiving orlistat with periods of non-usage. Results Among 94 695 patients who received orlistat, 988 cases of acute liver injury were identified, with 335 confirmed as definite cases and 653 as probable cases. For all cases an increased incidence of liver injury was detected during the 90 day period before orlistat was first started, with an incidence rate ratio of 1.50 (95% confidence interval 1.10 to 2.06). The incidence remained raised during the first 30 days of treatment (2.21, 1.43 to 3.42), before returning to baseline levels with prolonged treatment. When the risk during the first 90 days of treatment was compared with the 90 days preceding first treatment, the incidence of liver injury was not increased (1.02, 0.67 to 1.56). An analysis restricted to definite cases showed no evidence of an increased risk of liver injury during treatment. Conclusion The incidence of acute liver injury was higher in the periods both immediately before and immediately after the start of orlistat treatment. This suggests that the observed increased risks of liver injury linked to the start of treatment may reflect changes in health status associated with the decision to begin treatment rather than any causal effect of the drug. PMID:23585064

Severe acute pulmonary haemorrhage and haemoptysis in ten dogs following eastern brown snake (Pseudonaja textilis) envenomation: Clinical signs, treatment and outcomes.

PubMed

Leong, Oriana S; Padula, Andrew M; Leister, Ellie

2018-05-29

This report describes a series of ten cases of fulminant pulmonary haemorrhage in dogs following envenomation by the eastern brown snake (Pseudonaja textilis) in south eastern Queensland, Australia. All cases were presented for veterinary treatment during 2011-2018 at a specialist veterinary emergency centre. Each case received prompt antivenom treatment and supportive care. Pulmonary haemorrhage was diagnosed based on clinical examination; overt haemoptysis; thoracic radiographic demonstration of a diffuse alveolar pattern; and, the presence of venom induced consumptive coagulopathy. The median elapsed time from hospital admission to onset of haemoptysis was 2 h (range 0-18 h). In 80% (8/10) of cases endotracheal intubation was required, whilst 20% (2/10) were successfully treated with mask oxygen supplementation alone, and 40% (4/10) received mechanical ventilation; but only 25% (1/4) of these survived to hospital discharge. Fresh frozen canine plasma was administered to 70% (7/10) of cases and 43% (3/7) of these survived. Of the total number of cases presented for treatment, 30% (3/10) survived to hospital discharge, 60% (6/10) were euthanised due to poor prognosis and 10% (1/10) died from cardiac arrest. Initial serum brown snake venom antigen levels were retrospectively measured from frozen serum samples by venom specific sandwich ELISA in two dogs at 154 ng/mL (survived) and 3607 ng/mL (euthanised); no free venom was detected post-antivenom. Dogs that survived were discharged from hospital without apparent complications. Pulmonary haemorrhage is an uncommon event following envenomation by P. textilis in dogs and has not been described in similarly envenomed humans. This case series highlights the potential for fulminant and fatal pulmonary haemorrhage in dogs following eastern brown snake envenomation. Copyright © 2018 Elsevier Ltd. All rights reserved.

Transvestism as a Symptom: A Case Series

PubMed Central

Anupama, M.; Gangadhar, K. H.; Shetty, Vandana B.; Dip, P. Bhadja

2016-01-01

Transvestism, commonly termed as cross-dressing, means to dress in the clothing of opposite sex. We describe a series of three cases with transvestism as one of their primary complaints. The discussion sheds light on the various ways in which transvestism as a symptom can present in Psychiatry. In the first two cases, there was lower intelligence. In first and third case, there were other paraphilia along with transvestism. Second case had co-morbid obsessive-compulsive disorder (OCD) and had good response to selective serotonin reuptake inhibitor (SSRI). PMID:27011411

Primary Repair of Moderate Severity Rhegmatogenous Retinal Detachment: A Critical Decision-Making Algorithm.

PubMed

Velez-Montoya, Raul; Jacobo-Oceguera, Paola; Flores-Preciado, Javier; Dalma-Weiszhausz, Jose; Guerrero-Naranjo, Jose; Salcedo-Villanueva, Guillermo; Garcia-Aguirre, Gerardo; Fromow-Guerra, Jans; Morales-Canton, Virgilio

2016-01-01

We reviewed all the available data regarding the current management of non-complex rhegmatogenous retinal detachment and aimed to propose a new decision-making algorithm aimed to improve the single surgery success rate for mid-severity rhegmatogenous retinal detachment. An online review of the Pubmed database was performed. We searched for all available manuscripts about the anatomical and functional outcomes after the surgical management, by either scleral buckle or primary pars plana vitrectomy, of retinal detachment. The search was limited to articles published from January 1995 to December 2015. All articles obtained from the search were carefully screened and their references were manually reviewed for additional relevant data. Our search specifically focused on preoperative clinical data that were associated with the surgical outcomes. After categorizing the available data according to their level of evidence, with randomized-controlled clinical trials as the highest possible level of evidence, followed by retrospective studies, and retrospective case series as the lowest level of evidence, we proceeded to design a logical decision-making algorithm, enhanced by our experiences as retinal surgeons. A total of 7 randomized-controlled clinical trials, 19 retrospective studies, and 9 case series were considered. Additional articles were also included in order to support the observations further. Rhegmatogenous retinal detachment is a potentially blinding disorder. Its surgical management seems to depend more on a surgeon´s preference than solid scientific data or is based on a good clinical history and examination. The algorithms proposed herein strive to offer a more rational approach to improve both anatomical and functional outcomes after the first surgery.

Primary Repair of Moderate Severity Rhegmatogenous Retinal Detachment: A Critical Decision-Making Algorithm

PubMed Central

VELEZ-MONTOYA, Raul; JACOBO-OCEGUERA, Paola; FLORES-PRECIADO, Javier; DALMA-WEISZHAUSZ, Jose; GUERRERO-NARANJO, Jose; SALCEDO-VILLANUEVA, Guillermo; GARCIA-AGUIRRE, Gerardo; FROMOW-GUERRA, Jans; MORALES-CANTON, Virgilio

2016-01-01

We reviewed all the available data regarding the current management of non-complex rhegmatogenous retinal detachment and aimed to propose a new decision-making algorithm aimed to improve the single surgery success rate for mid-severity rhegmatogenous retinal detachment. An online review of the Pubmed database was performed. We searched for all available manuscripts about the anatomical and functional outcomes after the surgical management, by either scleral buckle or primary pars plana vitrectomy, of retinal detachment. The search was limited to articles published from January 1995 to December 2015. All articles obtained from the search were carefully screened and their references were manually reviewed for additional relevant data. Our search specifically focused on preoperative clinical data that were associated with the surgical outcomes. After categorizing the available data according to their level of evidence, with randomized-controlled clinical trials as the highest possible level of evidence, followed by retrospective studies, and retrospective case series as the lowest level of evidence, we proceeded to design a logical decision-making algorithm, enhanced by our experiences as retinal surgeons. A total of 7 randomized-controlled clinical trials, 19 retrospective studies, and 9 case series were considered. Additional articles were also included in order to support the observations further. Rhegmatogenous retinal detachment is a potentially blinding disorder. Its surgical management seems to depend more on a surgeon´s preference than solid scientific data or is based on a good clinical history and examination. The algorithms proposed herein strive to offer a more rational approach to improve both anatomical and functional outcomes after the first surgery. PMID:28289689

Etanercept therapy for toxic epidermal necrolysis.

PubMed

Paradisi, Andrea; Abeni, Damiano; Bergamo, Fabio; Ricci, Francesco; Didona, Dario; Didona, Biagio

2014-08-01

Toxic epidermal necrolysis (TEN) is a severe and potentially lethal drug reaction for which no standard treatment is available. To describe a case series of patients with TEN treated with a single dose of etanercept. We observed 10 consecutive patients with TEN. For each patient, we recorded the presence of comorbidities and all the drugs recently started (ie, in the last month). In all cases, 50 mg of etanercept was administered in a single subcutaneous injection. The clinical severity of disease was computed using the SCORe of Toxic Epidermal Necrosis (SCORTEN) scale. Using the probabilities of death linked to each level of SCORTEN score, we calculated the expected probability of death in our patients. Healing was defined as complete reepithelialization, and a time to healing curve was then obtained using the Kaplan-Meier method. All patients promptly responded to treatment, reaching complete reepithelialization without complications or side effects. The median time to healing was 8.5 days. This is a small, uncontrolled case series. These preliminary results suggest the possibility that tumor necrosis factor-alfa may be an effective target for control of TEN, a dangerous skin condition for which no effective cure has yet been found. Copyright © 2014 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

Exact semiclassical expansions for one-dimensional quantum oscillators

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

Delabaere, E.; Dillinger, H.; Pham, F.

1997-12-01

A set of rules is given for dealing with WKB expansions in the one-dimensional analytic case, whereby such expansions are not considered as approximations but as exact encodings of wave functions, thus allowing for analytic continuation with respect to whichever parameters the potential function depends on, with an exact control of small exponential effects. These rules, which include also the case when there are double turning points, are illustrated on various examples, and applied to the study of bound state or resonance spectra. In the case of simple oscillators, it is thus shown that the Rayleigh{endash}Schr{umlt o}dinger series is Borelmore » resummable, yielding the exact energy levels. In the case of the symmetrical anharmonic oscillator, one gets a simple and rigorous justification of the Zinn-Justin quantization condition, and of its solution in terms of {open_quotes}multi-instanton expansions.{close_quotes} {copyright} {ital 1997 American Institute of Physics.}« less

Modular, multi-level groundwater sampler

DOEpatents

Nichols, Ralph L.; Widdowson, Mark A.; Mullinex, Harry; Orne, William H.; Looney, Brian B.

1994-01-01

Apparatus for taking a multiple of samples of groundwater or pressure measurements from a well simultaneously. The apparatus comprises a series of chambers arranged in an axial array, each of which is dimensioned to fit into a perforated well casing and leave a small gap between the well casing and the exterior of the chamber. Seals at each end of the container define the limits to the axial portion of the well to be sampled. A submersible pump in each chamber pumps the groundwater that passes through the well casing perforations into the gap from the gap to the surface for analysis. The power lines and hoses for the chambers farther down the array pass through each chamber above them in the array. The seals are solid, water-proof, non-reactive, resilient disks supported to engage the inside surface of the well casing. Because of the modular design, the apparatus provides flexibility for use in a variety of well configurations.

Fourier and Wavelet Analysis of Coronal Time Series

NASA Astrophysics Data System (ADS)

Auchère, F.; Froment, C.; Bocchialini, K.; Buchlin, E.; Solomon, J.

2016-10-01

Using Fourier and wavelet analysis, we critically re-assess the significance of our detection of periodic pulsations in coronal loops. We show that the proper identification of the frequency dependence and statistical properties of the different components of the power spectra provies a strong argument against the common practice of data detrending, which tends to produce spurious detections around the cut-off frequency of the filter. In addition, the white and red noise models built into the widely used wavelet code of Torrence & Compo cannot, in most cases, adequately represent the power spectra of coronal time series, thus also possibly causing false positives. Both effects suggest that several reports of periodic phenomena should be re-examined. The Torrence & Compo code nonetheless effectively computes rigorous confidence levels if provided with pertinent models of mean power spectra, and we describe the appropriate manner in which to call its core routines. We recall the meaning of the default confidence levels output from the code, and we propose new Monte-Carlo-derived levels that take into account the total number of degrees of freedom in the wavelet spectra. These improvements allow us to confirm that the power peaks that we detected have a very low probability of being caused by noise.

Constructing Weyl group multiple Dirichlet series

NASA Astrophysics Data System (ADS)

Chinta, Gautam; Gunnells, Paul E.

2010-01-01

Let Phi be a reduced root system of rank r . A Weyl group multiple Dirichlet series for Phi is a Dirichlet series in r complex variables s_1,dots,s_r , initially converging for {Re}(s_i) sufficiently large, that has meromorphic continuation to {{C}}^r and satisfies functional equations under the transformations of {{C}}^r corresponding to the Weyl group of Phi . A heuristic definition of such a series was given by Brubaker, Bump, Chinta, Friedberg, and Hoffstein, and they have been investigated in certain special cases by others. In this paper we generalize results by Chinta and Gunnells to construct Weyl group multiple Dirichlet series by a uniform method and show in all cases that they have the expected properties.

Hypoplasia or Absence of Posterior Leaflet: A Rare Congenital Anomaly of The Mitral Valve in Adulthood – Case Series

PubMed Central

Parato, Vito Maurizio; Masia, Stefano Lucio

2018-01-01

We present a case series of two adult patients with almost complete absence of the posterior mitral valve leaflet and who are asymptomatic or mildly symptomatic, with two different degrees of mitral regurgitation. PMID:29629259

Characterizing chaotic dynamics from integrate-and-fire interspike intervals at the presence of noise

NASA Astrophysics Data System (ADS)

Mohammad, Yasir K.; Pavlova, Olga N.; Pavlov, Alexey N.

2016-04-01

We discuss the problem of quantifying chaotic dynamics at the input of the "integrate-and-fire" (IF) model from the output sequences of interspike intervals (ISIs) for the case when the fluctuating threshold level leads to the appearance of noise in ISI series. We propose a way to detect an ability of computing dynamical characteristics of the input dynamics and the level of noise in the output point processes. The proposed approach is based on the dependence of the largest Lyapunov exponent from the maximal orientation error used at the estimation of the averaged rate of divergence of nearby phase trajectories.

[AIDS and level of education in Brazil: temporal evolution from 1986 to 1996].

PubMed

Fonseca, M G; Bastos, F I; Derrico, M; Andrade, C L; Travassos, C; Szwarcwald, C L

2000-01-01

This article analyzes the temporal distribution of reported AIDS cases by level of education used as a proxy variable for individual socioeconomic status. All AIDS cases aged 20-69 years and reported through May 29, 1999, with date of diagnosis between 1986-1996, were included in the study. Incidence rates were calculated for men and women according to level of education ("level 1" up to 8 years of schooling and "level 2" with over 8 years of schooling), by five geographic regions, and by year of diagnosis. Incidence rates for men with less schooling were close to or higher than those for men with more schooling (particularly in the Southeast region). For women, a time series showed that incidence rates increased at a higher rate among women with less schooling in all regions of the country; in the Southeast, the incidence rate for women with less schooling was already greater than for women with more schooling by 1989. According to the present analysis, the AIDS epidemic in Brazil began among people from the more highly educated social strata and progressed steadily through to the less educated social strata, especially among women.

Chondral Rib Fractures in Professional American Football: Two Cases and Current Practice Patterns Among NFL Team Physicians.

PubMed

McAdams, Timothy R; Deimel, Jay F; Ferguson, Jeff; Beamer, Brandon S; Beaulieu, Christopher F

2016-02-01

Although a recognized and discussed injury, chondral rib fractures in professional American football have not been previously reported in the literature. There currently exists no consensus on how to identify and treat these injuries or the expected return to play for the athlete. To present 2 cases of chondral rib injuries in the National Football League (NFL) and discuss the current practice patterns for management of these injuries among the NFL team physicians. Case series; Level of evidence, 4. Two cases of NFL players with chondral rib injuries are presented. A survey regarding work-up and treatment of these injuries was completed by team physicians at the 2014 NFL Combine. Our experience in identifying and treating these injuries is presented in conjunction with a survey of NFL team physicians' experiences. Two cases of rib chondral injuries were diagnosed by computed tomography (CT) and treated with rest and protective splinting. Return to play was 2 to 4 weeks. NFL Combine survey results show that NFL team physicians see a mean of 4 costal cartilage injuries per 5-year period, or approximately 1 case per year per team. Seventy percent of team physicians use CT scanning and 43% use magnetic resonance imaging for diagnosis of these injuries. An anesthetic block is used acutely in 57% and only electively in subsequent games by 39%. A high index of suspicion is necessary to diagnose chondral rib injuries in American football. CT scan is most commonly used to confirm diagnosis. Return to play can take up to 2 to 4 weeks with a protective device, although anesthetic blocks can be used to potentially expedite return. Chondral rib injuries are common among NFL football players, while there is no literature to support proper diagnosis and treatment of these injuries or expected duration of recovery. These injuries are likely common in other contact sports and levels of competition as well. Our series combined with NFL team physician survey results can aid team physicians in identifying these injuries, obtaining useful imaging, and counseling players and coaches and the expected time of recovery.

Plasmapheresis in immune hematology: review of clinical outcome data with respect to evidence-based medicine and clinical experience.

PubMed

von Baeyer, Hans

2003-02-01

The objective of this paper is to assess the role of plasmapheresis in immune hematology by reviewing published clinical outcome data and narrative review articles. This information will be used to define evidence levels for appraisal of the efficacy and rank of plasmapheresis among other management options. This evidence-based strategy conforms to the concepts of the American Society of Hematology (ASH). as put forward in 1996 in the context of immune thrombocytopenia (ITP) treatment. The term 'experimental' is used to describe indications where the only scientific evidence of the efficacy of plasmapheresis consists of pathophysiological reasoning and empiric clinical findings. We reviewed the available literature on the use of plasmapheresis in autoimmune hemolytic anemia (AIHA), hemolytic disease of the newborn (HDN), autoimmune thrombocytopenic purpura (AITP), heparin-induced thrombocytopenia type II (HIT II), post-transfusion purpura (PTP), refractoriness to platelet transfusion (RPT), coagulation factor inhibitor (CFI) and catastrophic antiphospholipid syndrome (CAS). Plasmapheresis completes the spectrum of management options as it eliminates physically circulating free antibodies involved in the pathogenesis of these immune hematological syndromes. Because of the paucity of data, evidence levels had to be defined based on the findings of uncontrolled case series and the opinions of independent experts. In many cases, randomized clinical trials were not feasible because the syndromes are so rare. When defined as an 'experimental indication', plasmapheresis has a firm scientific basis, but larger scale clinical experience with the method is still lacking. In these cases, the detection and monitoring of symptomatic disease-related circulating free antibodies or immune complexes is a mandatory prerequisite for the use of plasmapheresis. The therapeutic benefit of plasmapheresis is substantiated by the level V of evidence of its efficacy in treatment of HDN, HIV-associated AITP, induction of tolerance in CFI and in CAS. The goal of future studies should be to establish a firmer base of scientific evidence for indications classified as experimental by setting up case series large enough for proper assessment of plasmapheresis alone or combination with other treatment measures. This goal can only be achieved through multiinstitutional cooperation.

The potential impact of scatterometry on oceanography - A wave forecasting case

NASA Technical Reports Server (NTRS)

Cane, M. A.; Cardone, V. J.

1981-01-01

A series of observing system simulation experiments have been performed in order to assess the potential impact of marine surface wind data on numerical weather prediction. In addition to conventional data, the experiments simulated the time-continuous assimilation of remotely sensed marine surface wind or temperature sounding data. The wind data were fabricated directly for model grid points intercepted by a Seasat-1 scatterometer swath and were assimilated into the lowest active level (945 mb) of the model using a localized successive correction method. It is shown that Seasat wind data can greatly improve numerical weather forecasts due to better definition of specific features. The case of the QE II storm is examined.

Heparin and insulin in the management of hypertriglyceridemia-associated pancreatitis: case series and literature review.

PubMed

Kuchay, Mohammad Shafi; Farooqui, Khalid J; Bano, Tarannum; Khandelwal, Manoj; Gill, Harmandeep; Mithal, Ambrish

2017-01-01

Severe hypertriglyceridemia accounts for up to 7% of all cases of acute pancreatitis. Heparin and insulin activate lipoprotein lipase (LPL), thereby reducing plasma triglyceride levels. However, the safety and efficacy of heparin and insulin in the treatment of hypertriglyceridemia-associated acute pancreatitis have not been well established yet. We successfully used heparin and insulin as first-line therapy in four consecutive patients with acute pancreatitis secondary to hypertriglyceridemia. In a literature search, we revised almost all reports published to date of patients managed successfully with this combination. Heparin and insulin appear to be a safe, effective, and inexpensive first-line therapy for hypertriglyceridemia-associated acute pancreatitis.

The Knowledge-Based Software Assistant: Beyond CASE

NASA Technical Reports Server (NTRS)

Carozzoni, Joseph A.

1993-01-01

This paper will outline the similarities and differences between two paradigms of software development. Both support the whole software life cycle and provide automation for most of the software development process, but have different approaches. The CASE approach is based on a set of tools linked by a central data repository. This tool-based approach is data driven and views software development as a series of sequential steps, each resulting in a product. The Knowledge-Based Software Assistant (KBSA) approach, a radical departure from existing software development practices, is knowledge driven and centers around a formalized software development process. KBSA views software development as an incremental, iterative, and evolutionary process with development occurring at the specification level.

Perioperative use of angiotensin-converting-enzyme inhibitors and angiotensin receptor antagonists.

PubMed

Vaquero Roncero, Luis Mario; Sánchez Poveda, David; Valdunciel García, Joaquín José; Sánchez Barrado, María Elisa; Calvo Vecino, José María

2017-08-01

Clinical repercussions of perioperative treatment with ACEIs/ARBs. Systematic review according to PRISMA statement. Perioperative period. 29 studies 11 cases/cases series, 12 observational studies and 6 randomized studies. Arterial blood pressure differences, refractory hypotension, other comorbidities. The studies show different results regarding the topics measured. They are divided in the results regarding blood pressure, long term morbidities and effects in neuraxial anesthesia. Withholding AECI/ARBs on the morning prior to surgery could be recommended as a potentially effective measure, with a low level of evidence, in order to reduce the appearance of hypotension in the perioperative period of non-cardiac surgery. Copyright © 2017 Elsevier Inc. All rights reserved.

A Fourier Method for Sidelobe Reduction in Equally Spaced Linear Arrays

NASA Astrophysics Data System (ADS)

Safaai-Jazi, Ahmad; Stutzman, Warren L.

2018-04-01

Uniformly excited, equally spaced linear arrays have a sidelobe level larger than -13.3 dB, which is too high for many applications. This limitation can be remedied by nonuniform excitation of array elements. We present an efficient method for sidelobe reduction in equally spaced linear arrays with low penalty on the directivity. The method involves the following steps: construction of a periodic function containing only the sidelobes of the uniformly excited array, calculation of the Fourier series of this periodic function, subtracting the series from the array factor of the original uniformly excited array after it is truncated, and finally mitigating the truncation effects which yields significant increase in sidelobe level reduction. A sidelobe reduction factor is incorporated into element currents that makes much larger sidelobe reductions possible and also allows varying the sidelobe level incrementally. It is shown that such newly formed arrays can provide sidelobe levels that are at least 22.7 dB below those of the uniformly excited arrays with the same size and number of elements. Analytical expressions for element currents are presented. Radiation characteristics of the sidelobe-reduced arrays introduced here are examined, and numerical results for directivity, sidelobe level, and half-power beam width are presented for example cases. Performance improvements over popular conventional array synthesis methods, such as Chebyshev and linear current tapered arrays, are obtained with the new method.

Alive with the sound of music: a case series on patients presenting with musical hallucinations in a general hospital.

PubMed

Kinson, Rochelle Melina; Lim, Wen Phei; Rahman, Habeebul

2015-01-01

Musical hallucinations are a rare phenomenon that renders appropriate identification and treatment a challenge. This case series describes three women who presented with hearing complex, familiar melodies in the absence of external stimuli on a background of hearing impairment.

Night of the sirens: analysis of carbon monoxide-detector experience in suburban Chicago.

PubMed

Bizovi, K E; Leikin, J B; Hryhorczuk, D O; Frateschi, L J

1998-06-01

To determine the pattern and environmental causes of carbon monoxide (CO)-detector alarms. Data including time, location, detector manufacturer, CO measurements in the home, reported illness, cause, and actions taken were collected between July 15, 1994, and January 26, 1995, on all calls to 17 suburban Chicago fire departments for CO-detector alarms. We used univariate time-series analysis involving joint estimation of model parameters and outlier effects to analyze data and compared data on ambient CO levels from the Illinois Environmental Protection Agency to the number of calls per day. During the study period, 777 calls for sounding CO detectors were made to the fire departments in question. The median number of calls per day was three. Our univariate time series identified 3 days with a significant excess of calls (December 12, 29 calls; December 21, 69; December 22, 128; P < .001). The average ambient CO readings on these days were 0.99, 3.25, and 3.89 ppm, respectively, compared with an overall mean of 8.8 ppm. In-home CO levels among all 828 measurements taken from the 777 domestic calls ranged from 0 to 425 ppm, 0 in 249 (30%), 1 to 10 in 340 (41%), 11 to 50 in 149 (18%), 51 to 100 in 22 (9%), and more than 100 in 11 (1.3%). No measurement was taken in six cases. Cause of alarm was listed as furnace in 25 cases, auto exhaust in 24, stove/oven in 22, poor location of detector in 14, water heater in 11, outside sources in 7, and multiple sources in 7. Other sources accounted for fewer than 1% each. The participating fire departments considered 242 cases (31%) to be false alarms. Cause was not determined in 400 calls (51%). In 37 calls (4.8%), people reported illness. Above-average ambient CO levels coincided with a significant increase in the number of calls and may have contributed to the triggering of CO alarms.

Arthroscopic repair of lateral ankle ligament complex by suture anchor.

PubMed

Wang, Jingwei; Hua, Yinghui; Chen, Shiyi; Li, Hongyun; Zhang, Jian; Li, Yunxia

2014-06-01

Arthroscopic repair of the lateral ligament complex with suture anchors is increasingly used to treat chronic ankle instability (CAI). Our aims are (1) to analyze and evaluate the literature on arthroscopic suture anchor repair of the anterior talofibular ligament and (2) to conduct a systematic review of the clinical evidence on the reported outcomes and complications of treating CAI with this technique. We performed a systematic review of the literature using PubMed, Ovid, Elsevier ScienceDirect, Web of Science-Conference Proceedings Citation Index, and the Cochrane Database of Systematic Reviews from 1987 to September 2013. Clinical studies using the arthroscopic suture anchor technique to treat CAI were included. Outcome measures consisted of clinical assessment of postoperative ligament stability and complications. In addition, the methodologic quality of the included studies was assessed by use of the modified Coleman Methodology Score. After reviewing 371 studies, we identified 6 studies (5 retrospective case series and 1 prospective case series, all Level IV) that met the inclusion criteria, with a mean Coleman Methodology Score of 71.8 ± 7.52 (range, 63 to 82). In these studies 178 patients (179 ankles) underwent arthroscopic suture anchor repair of the anterior talofibular ligament with a mean follow-up period of 38.9 months (range, 6 to 117.6 months). All patients were reported to have subjective improvement of their ankle instability, with complications in 31 cases. Studies of arthroscopic suture anchor technique to treat CAI are sparse, with moderate mean methodologic quality. The included studies suggest that the arthroscopic technique is a feasible procedure to restore ankle stability; however, on the basis of our review, this technique seems to be associated with a relatively high complication rate. Extensive cadaveric studies, clinical trials, and comparative studies comparing arthroscopic and open repair should be performed in the future. Level IV, systematic review of Level IV studies. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Alcoa Teams with DOE to Reduce Energy Consumption

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

None

2004-05-01

This is the first in a series of DOE Industrial Technologies Program case studies on corporate energy management. The case study highlights Alcoa Aluminum's successful results and activities through its corporate energy management approach and collaboration with DOE. Case studies in this series will be used to encourage other energy-intensive industrial plants to adopt a corporate strategy, and to promote the concept of replicating results with a company or industry.

BASINS and WEPP Climate Assessment Tools (CAT): Case ...

EPA Pesticide Factsheets

This draft report supports application of two recently developed water modeling tools, the BASINS and WEPP climate assessment tools. The report presents a series of short case studies designed to illustrate the capabilities of these tools for conducting scenario based assessments of the potential future effects of climate change on water resources. This report presents a series of short, illustrative case studies using the BASINS and WEPP climate assessment tools.

Ischemic Gastritis: A Multicenter Case Series of a Rare Clinical Entity and a Review of the Literature.

PubMed

Elwir, Saleh; Shaukat, Aasma; Mesa, Hector; Colbach, Christine; Dambowy, Paul; Shaw, Michael

2016-10-01

To report a case series of ischemic gastritis and discuss its etiology, management, and associated mortality according to our results and the published English literature. Ischemic gastritis is rare, given the rich blood supply of the stomach. It has been reported in isolated case reports and small case series. Most cases are vascular in origin and associated with a high mortality. Pathology databases from 3 hospitals affiliated with the University of Minnesota Medical School were searched for cases of ischemic gastritis in the last 10 years. Patients' demographics, clinical course, and 1-month and 1-year mortalities were collected from electronic medical records. A total of 12 patients were identified (age range, 32.1 to 83.2), the largest series reported to date. The presenting symptom was gastrointestinal bleeding (8), abdominal pain (2), nausea (1), and symptomatic anemia (1). The etiology included postinterventional radiology embolization (2), hemodynamic changes in the setting of celiac axis stenosis (2), vasculitis (1), systemic hypotension (1), and unknown (6). Treatment included steroid therapy, revascularization by interventional radiology, surgery, or supportive treatment. Thirty-day and 1-year mortalities were 33% and 41%, respectively. Ischemic gastritis is rare, but associated with a high mortality. Evaluation for treatable etiologies should be sought and corrected if present.

Homeopathic Treatment of Vitiligo: A Report of Fourteen Cases

PubMed Central

Mahesh, Seema; Mallappa, Mahesh; Tsintzas, Dionysios; Vithoulkas, George

2017-01-01

Case series Patient: — Final Diagnosis: — Symptoms: Skin lesions Medication: — Clinical Procedure: — Specialty: Dermatology Objective: Unusual or unexpected effect of treatment Background: Vitiligo, also known as leukoderma, is an autoimmune skin condition that results in the loss of melanin pigment. Vitiligo is not a rare condition but is difficult to treat and is associated with psychological distress. Case Reports: A series of 14 cases of vitiligo are presented that were treated with individualized homeopathic remedies that were based on plant, animal, or mineral compounds. There were 13 women and one man in the case series, with a mean age 29.8 years, and a mean follow-up from treatment of 58 months. The mean time between the onset of the appearance of vitiligo and the first consultation at our clinic was 96 months. Homeopathic treatment for patients is holistic and was performed on an individualized basis as described in this case series. Photographic images of the skin are presented before and after treatment. Conclusions: In 14 patients with vitiligo treated with individualized homeopathy, the best results were achieved in the patients who were treated in the early stages of the disease. We believe that homeopathy may be effective in the early stages of vitiligo, but large controlled clinical studies are needed in this area. PMID:29196612

Assimilation of satellite altimetry data in hydrological models for improved inland surface water information: Case studies from the "Sentinel-3 Hydrologic Altimetry Processor prototypE" project (SHAPE)

NASA Astrophysics Data System (ADS)

Gustafsson, David; Pimentel, Rafael; Fabry, Pierre; Bercher, Nicolas; Roca, Mónica; Garcia-Mondejar, Albert; Fernandes, Joana; Lázaro, Clara; Ambrózio, Américo; Restano, Marco; Benveniste, Jérôme

2017-04-01

This communication is about the Sentinel-3 Hydrologic Altimetry Processor prototypE (SHAPE) project, with a focus on the components dealing with assimilation of satellite altimetry data into hydrological models. The SHAPE research and development project started in September 2015, within the Scientific Exploitation of Operational Missions (SEOM) programme of the European Space Agency. The objectives of the project are to further develop and assess recent improvement in altimetry data, processing algorithms and methods for assimilation in hydrological models, with the overarching goal to support improved scientific use of altimetry data and improved inland water information. The objective is also to take scientific steps towards a future Inland Water dedicated processor on the Sentinel-3 ground segment. The study focuses on three main variables of interest in hydrology: river stage, river discharge and lake level. The improved altimetry data from the project is used to estimate river stage, river discharge and lake level information in a data assimilation framework using the hydrological dynamic and semi-distributed model HYPE (Hydrological Predictions for the Environment). This model has been developed by SMHI and includes data assimilation module based on the Ensemble Kalman filter method. The method will be developed and assessed for a number of case studies with available in situ reference data and satellite altimetry data based on mainly the CryoSat-2 mission on which the new processor will be run; Results will be presented from case studies on the Amazon and Danube rivers and Lake Vänern (Sweden). The production of alti-hydro products (water level time series) are improved thanks to the use of water masks. This eases the geo-selection of the CryoSat-2 altimetric measurements since there are acquired from a geodetic orbit and are thus spread along the river course in space and and time. The specific processing of data from this geodetic orbit space-time pattern will be discussed as well as the subsequent possible strategies for data assimilation into models (and eventually highlight a generalized approach toward multi-mission data processing). Notably, in case of data assimilation along the course of rivers, the river slope might be estimated and compensated for, in order to produce local water level "pseudo time series" at arbitrary locations, and specifically at model's inlets.

Advantages of analyzing postmortem brain samples in routine forensic drug screening-Case series of three non-natural deaths tested positive for lysergic acid diethylamide (LSD).

PubMed

Mardal, Marie; Johansen, Sys Stybe; Thomsen, Ragnar; Linnet, Kristian

2017-09-01

Three case reports are presented, including autopsy findings and toxicological screening results, which were tested positive for the potent hallucinogenic drug lysergic acid diethylamide (LSD). LSD and its main metabolites were quantified in brain tissue and femoral blood, and furthermore hematoma and urine when available. LSD, its main metabolite 2-oxo-3-hydroxy-LSD (oxo-HO-LSD), and iso-LSD were quantified in biological samples according to a previously published procedure involving liquid-liquid extraction and ultra-high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS). LSD was measured in the brain tissue of all presented cases at a concentration level from 0.34-10.8μg/kg. The concentration level in the target organ was higher than in peripheral blood. Additional psychoactive compounds were quantified in blood and brain tissue, though all below toxic concentration levels. The cause of death in case 1 was collision-induced brain injury, while it was drowning in case 2 and 3 and thus not drug intoxication. However, the toxicological findings could help explain the decedent's inability to cope with brain injury or drowning incidents. The presented findings could help establish reference concentrations in brain samples and assist in interpretation of results from forensic drug screening in brain tissue. This is to the author's knowledge the first report of LSD, iso-LSD, and oxo-HO-LSD measured in brain tissue samples. Copyright © 2017 Elsevier B.V. All rights reserved.

Solitary Fibrous Tumors of the Orbit and Central Nervous System: A Case Series Analysis

PubMed Central

Brum, Marisa; Nzwalo, Hipólito; Oliveira, Edson; Pelejão, Maria Rita; Pereira, Pedro; Farias, João Paulo; Pimentel, José

2018-01-01

Introduction: Solitary fibrous tumor (SFT) is rarely diagnosed in clinical practice. Since its initial descriptions in the central nervous system (CNS) and the orbits, very few case reports and small case series have expanded their clinical and pathological characterization. We sought to describe a cases series of SFT from a single laboratory of neuropathology belonging to a tertiary university hospital. Methods: Retrospective clinical and histopathological description of eight cases of CNS and orbital SFT diagnosed over a 21-year period of time. Results: Median age was 47.3 years and four were males. Clinical presentation was related to local mass effect in all. Tumors occurred in the orbits (5/62.5%), intracranial dura attached (2), and the spinal medulla (1). The neuropathology showed the presence of hemangiopericytoma type (2), classic type (3), and mixed type (3). Histological anaplasia was present in two cases. Widespread/total immunoreactivity for vimentin, CD34, and Bcl-2 was present in all. Gross total removal was conducted in the majority (6/75%) and subtotal removal in 2 (25%). Three patients were submitted to adjuvant treatment (radiosurgery and radiotherapy). Recurrence occurred in four patients, 13–120 months after surgical intervention. Anaplasia was present in one case of recurrence. Conclusion: Our case series confirms the clinical and neuropathological diversity of CNS and orbital SFTs. Studies with longer follow-up periods are necessary to better understand the clinical behavior and prognosis of the SFT in the CNS and orbits. PMID:29682031

Keep Out - Danger! Use of Devices Which Can Cause Death or Serious Bodily Injury in Defense of Real and/or Personal Property. A Student's Lesson Plan [and] A Teacher's Lesson Plan [and] A Lawyer's Lesson Plan.

ERIC Educational Resources Information Center

Howard, Estelle; And Others

One of a series of secondary level teaching units presenting case studies with pro and con analysis of particular legal problems, the document presents a student's lesson plan, a teacher's lesson plan, and a lawyer's lesson plan for introducing torts (any wrong, other than a breach of contract, resulting in a personal injury or property damage…

Fatty Acid Synthesis Gene Variants and Breast Cancer Risk: A Study within the European Prospective Investigation into Cancer and Nutrition

DTIC Science & Technology

2005-02-01

refined carbohydrates, is associated with high incidence of breast cancer in women. Excess energy intake causes elevated blood levels of glucose and...confer increased breast cancer susceptibility. In a series of 46 breast cancer cases, we are systematically searching the coding and regulatory regions of...of excess energy in the form of triglycerides , produced either from the diet fatty acids or from those synthesized de novo. Excess energy intake and

Life cycle assessment in market, research, and policy: Harmonization beyond standardization.

PubMed

Zamagni, Alessandra; Cutaia, Laura

2015-07-01

This article introduces the special series "LCA in Market Research and Policy: Harmonization beyond standardization," which was generated from the 19th SETAC Life Cycle Assessment (LCA) Case Study Symposium held November 2013, in Rome, Italy. This collection of invited articles reflects the purpose of symposium and focuses on how LCA can support the decision-making process at all levels (i.e., in industry and policy contexts) and how LCA results can be efficiently communicated and used to support market strategies. © 2015 SETAC.

Manual Physical Therapy Following Immobilization for Stable Ankle Fracture: A Case Series.

PubMed

Painter, Elizabeth E; Deyle, Gail D; Allen, Christopher; Petersen, Evan J; Croy, Theodore; Rivera, Kenneth P

2015-09-01

Case series. Ankle fractures commonly result in persistent pain, stiffness, and functional impairments. There is insufficient evidence to favor any particular rehabilitation approach after ankle fracture. The purpose of this case series was to describe an impairment-based manual physical therapy approach to treating patients with conservatively managed ankle fractures. Patients with stable ankle fractures postimmobilization were treated with manual physical therapy and exercise targeted at associated impairments in the lower limb. The primary outcome measure was the Lower Extremity Functional Scale. Secondary outcome measures included the ankle lunge test, numeric pain-rating scale, and global rating of change. Outcome measures were collected at baseline (performed within 7 days of immobilization removal) and at 4 and 12 weeks postbaseline. Eleven patients (mean age, 39.6 years; range, 18-64 years; 2 male), after ankle fracture-related immobilization (mean duration, 48 days; range, 21-75 days), were treated for an average of 6.6 sessions (range, 3-10 sessions) over a mean of 46.1 days (range, 13-81 days). Compared to baseline, statistically significant and clinically meaningful improvements were observed in Lower Extremity Functional Scale score (P = .001; mean change, 21.9 points; 95% confidence interval: 10.4, 33.4) and in the ankle lunge test (P = .001; mean change, 7.8 cm; 95% confidence interval: 3.9, 11.7) at 4 weeks. These changes persisted at 12 weeks. Statistically significant and clinically meaningful improvements in self-reported function and ankle range of motion were observed at 4 and 12 weeks following treatment with impairment-based manual physical therapy. All patients tolerated treatment well. Results suggest that this approach may have efficacy in this population. Therapy, level 4.

Case Series of a Knowledge Translation Intervention to Increase Upper Limb Exercise in Stroke Rehabilitation.

PubMed

Connell, Louise A; McMahon, Naoimh E; Tyson, Sarah F; Watkins, Caroline L; Eng, Janice J

2016-12-01

Current approaches to upper limb rehabilitation are not sufficient to drive neural reorganization and maximize recovery after stroke. To address this evidence-practice gap, a knowledge translation intervention using the Behaviour Change Wheel was developed. The intervention involves collaboratively working with stroke therapy teams to change their practice and increase therapy intensity by therapists prescribing supplementary self-directed arm exercise. The purposes of this case series are: (1) to provide an illustrative example of how a research-informed process changed clinical practice and (2) to report on staff members' and patients' perceptions of the utility of the developed intervention. A participatory action research approach was used in 3 stroke rehabilitation units in the United Kingdom. The intervention aimed to change 4 therapist-level behaviors: (1) screening patients for suitability for supplementary self-directed arm exercise, (2) provision of exercises, (3) involving family and caregivers in assisting with exercises, and (4) monitoring and progressing exercises. Data on changes in practice were collected by therapy teams using a bespoke audit tool. Utility of the intervention was explored in qualitative interviews with patients and staff. Components of the intervention were successfully embedded in 2 of the 3 stroke units. At these sites, almost all admitted patients were screened for suitability for supplementary self-directed exercise. Exercises were provided to 77%, 70%, and 88% of suitable patients across the 3 sites. Involving family and caregivers and monitoring and progressing exercises were not performed consistently. This case series is an example of how a rigorous research-informed knowledge translation process resulted in practice change. Research is needed to demonstrate that these changes can translate into increased intensity of upper limb exercise and affect patient outcomes. © 2016 American Physical Therapy Association.

Management of twin anemia-polycythemia sequence using intrauterine blood transfusion for the donor and partial exchange transfusion for the recipient.

PubMed

Genova, L; Slaghekke, F; Klumper, F J; Middeldorp, J M; Steggerda, S J; Oepkes, D; Lopriore, E

2013-01-01

Twin anemia-polycythemia sequence (TAPS) is a rare condition which may occur either spontaneously in uncomplicated monochorionic twin pregnancies or may develop after laser treatment in twin-twin transfusion syndrome. TAPS is characterized by a large intertwin discordance in hemoglobin levels without discordance in amniotic fluid levels, and may lead to severe complications including fetal hydrops, hematological morbidity and perinatal mortality. Several treatments have been proposed including intrauterine transfusion, laser surgery, elective delivery and expectant management. The optimal treatment remains unclear. In this case series we report 3 TAPS cases managed recently at our center with a combination of intrauterine blood transfusion for the anemic twin and intrauterine partial exchange transfusion for the polycythemic twin. In 1 case, the donor was found to have severe cerebral injury on neuroimaging examination. We propose etiologic mechanisms for cerebral injury in TAPS, discuss the rationale behind this treatment alternative, and evaluate the pros and cons of the various management options. Copyright © 2013 S. Karger AG, Basel.

Transforaminal Lumbar Interbody Fusion with Rigid Interspinous Process Fixation: A Learning Curve Analysis of a Surgeon Team's First 74 Cases.

PubMed

Doherty, Patrick; Welch, Arthur; Tharpe, Jason; Moore, Camille; Ferry, Chris

2017-05-30

Studies have shown that a significant learning curve may be associated with adopting minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) with bilateral pedicle screw fixation (BPSF). Accordingly, several hybrid TLIF techniques have been proposed as surrogates to the accepted BPSF technique, asserting that less/fewer fixation(s) or less disruptive fixation may decrease the learning curve while still maintaining the minimally disruptive benefits. TLIF with interspinous process fixation (ISPF) is one such surrogate procedure. However, despite perceived ease of adaptability given the favorable proximity of the spinous processes, no evidence exists demonstrating whether or not the technique may possess its own inherent learning curve. The purpose of this study was to determine whether an intraoperative learning curve for one- and two-level TLIF + ISPF may exist for a single lead surgeon. Seventy-four consecutive patients who received one- or two-Level TLIF with rigid ISPF by a single lead surgeon were retrospectively reviewed. It was the first TLIF + ISPF case series for the lead surgeon. Intraoperative blood loss (EBL), hospitalization length-of-stay (LOS), fluoroscopy time, and postoperative complications were collected. EBL, LOS, and fluoroscopy time were modeled as a function of case number using multiple linear regression methods. A change point was included in each model to allow the trajectory of the outcomes to change during the duration of the case series. These change points were determined using profile likelihood methods. Models were fit using the maximum likelihood estimates for the change points. Age, sex, body mass index (BMI), and the number of treated levels were included as covariates. EBL, LOS, and fluoroscopy time did not significantly differ by age, sex, or BMI (p ≥ 0.12). Only EBL differed significantly by the number of levels (p = 0.026). The case number was not a significant predictor of EBL, LOS, or fluoroscopy time (p ≥ 0.21). At the time of data collection (mean time from surgery: 13.3 months), six patients had undergone revision due to interbody migration. No ISPF device complications were observed. Study outcomes support the ideal that TLIF + ISPF can be a readily adopted procedure without a significant intraoperative learning curve. However, the authors emphasize that further assessment of long-term healing outcomes is essential in fully characterizing both the efficacy and the indication learning curve for the TLIF + ISPF technique.

Results of Surgery for Low-Grade Brain Arteriovenous Malformation Resection by Early Career Neurosurgeons: An Observational Study.

PubMed

Patel, Nirav J; Bervini, David; Eftekhar, Behzad; Davidson, Andrew Stewart; Walsh, Daniel C; Assaad, Nazih N; Morgan, Michael Kerin

2018-03-28

For sustainability of arteriovenous malformation (AVM) surgery, results from early career cerebrovascular neurosurgeons (ECCNs) must be acceptably safe. To determine whether ECCNs performance of Spetzler-Ponce Class A AVM (SPC A) resection can be acceptably safe. ECCNs completing a cerebrovascular fellowship (2004-2015) with the last author were included. Inclusion of the ECCN cases occurred if they: had a prospective database of all AVM cases since commencing independent practice; were the primary surgeon on SPC A; and had made the significant management decisions. All SPC A surgical cases from the beginning of the ECCN's independent surgical practice to a maximum of 8 yr were included. An adverse outcome was considered a complication of surgery leading to a new permanent neurological deficit with a last modified Rankin Scale score >1. A cumulative summation (Cusum) plot examined the performance of each surgery. The highest acceptable level of adverse outcomes for the Cusum was 3.3%, derived from the upper 95% confidence interval of the last author's reported series. Six ECCNs contributed 110 cases for analysis. The median number of SPC A cases operated by each ECCN was 16.5 (range 4-40). Preoperative embolization was performed in 5 (4.5%). The incidence of adverse outcomes was 1.8% (95% confidence interval: <0.01%-6.8%). At no point during the accumulated series did the combined cohort become unacceptable by the Cusum plot. ECCNs with appropriate training appointed to large-volume cerebrovascular centers can achieve results for surgery for SPC A that are not appreciably worse than those published from high-volume neurosurgeons.

Case Mis-Conceptualization in Psychological Treatment: An Enduring Clinical Problem.

PubMed

Ridley, Charles R; Jeffrey, Christina E; Roberson, Richard B

2017-04-01

Case conceptualization, an integral component of mental health treatment, aims to facilitate therapeutic gains by formulating a clear picture of a client's psychological presentation. However, despite numerous attempts to improve this clinical activity, it remains unclear how well existing methods achieve their purported purpose. Case formulation is inconsistently defined in the literature and implemented in practice, with many methods varying in complexity, theoretical grounding, and empirical support. In addition, many of the methods demand a precise clinical acumen that is easily influenced by judgmental and inferential errors. These errors occur regardless of clinicians' level of training or amount of clinical experience. Overall, the lack of a consensus definition, a diversity of methods, and susceptibility of clinicians to errors are manifestations of the state of crisis in case conceptualization. This article, the 2nd in a series of 5 on thematic mapping, argues the need for more reliable and valid models of case conceptualization. © 2017 Wiley Periodicals, Inc.

[The protective efficacy of BCG against leprosy in São Paulo, Brazil].

PubMed

Lombardi, C; Pedrazzani, E S; Pedrazzani, J C; Ferreira Filho, P; Zicker, F

1995-11-01

The protection against leprosy conferred by BCG vaccination was evaluated in a case-control study. Selected for the study were 97 patients under 16 years of age who had been diagnosed with leprosy (cases) and 385 healthy persons (controls), who were matched according to sex, age, place of residence, and type of contact (intra- or extradomicilliary). The cases were selected from a register of active cases as well as a series of new leprosy patients treated in 50 centers in the city of São Paulo, Brasil. To estimate the protective effect of BCG, the prevalences of BCG scars among cases and controls were compared. The presence of one or more scars was associated with a protective efficacy of 90% (95% confidence interval: 78%-96%). Stratified analysis by age group, sex, socioeconomic level, and clinical form of leprosy did not reveal any important differences in the protection conferred by the vaccine. The significance of these findings and the appropriateness of using BCG in leprosy control programs is discussed.

Plasmapheresis for Preventing Complication of Hypertriglyceridemia: A Case Report and Review of Literature.

PubMed

Costantini, Nicoletta; Mameli, Antonella; Marongiu, Francesco

2016-01-01

Severe hypertriglyceridemia is a common indication for the need of plasma exchange in treatment of hypertriglyceridemic-induced pancreatitis when normal therapies fail to garner a response. Application of plasmapheresis to prevent complication of hypertriglyceridemia is limited because of its cost and availability. We present a case of a 44-year-old man with metabolic syndrome and a medical history of secondary polycythemia in obesity hypoventilation syndrome, whose laboratory tests revealed a triglycerides value of 3965 mg/dL. To prevent the complication of pancreatitis due to hypertriglyceridemia, we performed plasma exchange 3 times when conventional treatments did not sufficiently reduce the high level of triglycerides. A review of the current available literature was therefore conducted to provide an overview of the present data on apheretic treatment for patients with severe hypertriglyceridemia. Several case reports and case series have used plasmapheresis in acute treatment of hypertriglyceridemia pancreatitis related. In our case, the choice of plasmapheresis was applied in prevention of possible complications of hypertriglyceridemia.

Angiofibroma of the nasal cavity in 13 dogs.

PubMed

Burgess, K E; Green, E M; Wood, R D; Dubielzig, R R

2011-12-01

This case series describes a rare entity, nasal angiofibroma, in 13 dogs that were presented to the University of Wisconsin, School of Veterinary Medicine from 1988 to 2000. All dogs in this case series presented with clinical signs and radiographic changes that were strongly suggestive of a locally invasive neoplasm. However, histopathology completed on transnostral core biopsy samples revealed benign appearing vascular proliferation with secondary lymphosuppurative inflammation was established despite cytologic criteria of malignancy present in five dogs. On the basis of the outcomes in this case series, nasal angiofibroma should be considered a differential for dogs presenting with clinical signs consistent with a malignant nasal tumour. © 2011 Blackwell Publishing Ltd.

A Systematic Review of Diuretics in the Medical Management of Ménière's Disease.

PubMed

Crowson, Matthew G; Patki, Aniruddha; Tucci, Debara L

2016-05-01

(1) Review evidence for the use of oral diuretic medications in the management of Ménière's disease. (2) Analyze therapy-related hearing and vertigo outcomes. Literature was obtained through directed searches of MEDLINE, EMBASE, Web of Science, EBSCO Host, Cochrane Reviews, and linked citations through seminal papers. We searched independent electronic databases for articles that reported the use of diuretics in patients with Ménière's disease. All articles of level 4 evidence or higher, per the Oxford Centre for Evidence-Based Medicine, were included with no limit for number of patients, duration of therapy, or follow-up period. Two independent investigators reviewed the articles for inclusion eligibility. Outcomes were tabulated, including subjective or quantitative measures of hearing, tinnitus, vertigo episode frequency, and medication adverse effects. Nineteen articles were included from 1962 to 2012 from 11 countries. Twelve retrospective case series, 4 randomized controlled trials, 2 case-control trials, and 1 prospective case series were identified. Six studies investigated isosorbide; 5, hydrochlorothiazide; 2, acetazolamide; 2, chlorthalidone; and 1 each of betahistine, hydrochlorothiazide, chlorthalidone, acetazolamide, hydrochlorothiazide-triamterene, and nimodipine. Eight (42.1%) studies reported hearing outcomes improvement. Fifteen (79.0%) studies reported vertigo outcomes improvement. Ten (52.6%) studies reported no side effects, and 4 studies (21.1%) reported abdominal discomfort. No significant morbidity or mortality was reported in any study. Multiple low evidence-level studies report that oral diuretic therapy may be beneficial in the medical management of Ménière's disease. Improvement in vertigo episode frequency was consistently reported, with less convincing evidence for improvement in hearing outcomes. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

Transfer and persistence of non-self DNA on hands over time: Using empirical data to evaluate DNA evidence given activity level propositions.

PubMed

Szkuta, Bianca; Ballantyne, Kaye N; Kokshoorn, Bas; van Oorschot, Roland A H

2018-03-01

Questions relating to how DNA from an individual got to where it was recovered from and the activities associated with its pickup, retention and deposition are increasingly relevant to criminal investigations and judicial considerations. To address activity level propositions, investigators are typically required to assess the likelihood that DNA was transferred indirectly and not deposited through direct contact with an item or surface. By constructing a series of Bayesian networks, we demonstrate their use in assessing activity level propositions derived from a recent legal case involving the alleged secondary transfer of DNA to a surface following a handshaking event. In the absence of data required to perform the assessment, a set of handshaking simulations were performed to obtain probabilities on the persistence of non-self DNA on the hands following a 40min, 5h or 8h delay between the handshake and contact with the final surface (an axe handle). Variables such as time elapsed, and the activities performed and objects contacted between the handshake and contact with the axe handle, were also considered when assessing the DNA results. DNA from a known contributor was transferred to the right hand of an opposing hand-shaker (as a depositor), and could be subsequently transferred to, and detected on, a surface contacted by the depositor 40min to 5h post-handshake. No non-self DNA from the known contributor was detected in deposits made 8h post-handshake. DNA from the depositor was generally detected as the major or only contributor in the profiles generated. Contributions from the known contributor were minor, decreasing in presence and in the strength of support for inclusion as the time between the handshake and transfer event increased. The construction of a series of Bayesian networks based on the case circumstances provided empirical estimations of the likelihood of direct or indirect deposition. The analyses and conclusions presented demonstrate both the complexity of activity level assessments concerning DNA evidence, and the power of Bayesian networks to visualise and explore the issues of interest for a given case. Copyright © 2017 Elsevier B.V. All rights reserved.

Sphenopalatine ganglion: block, radiofrequency ablation and neurostimulation - a systematic review.

PubMed

Ho, Kwo Wei David; Przkora, Rene; Kumar, Sanjeev

2017-12-28

Sphenopalatine ganglion is the largest collection of neurons in the calvarium outside of the brain. Over the past century, it has been a target for interventional treatment of head and facial pain due to its ease of access. Block, radiofrequency ablation, and neurostimulation have all been applied to treat a myriad of painful syndromes. Despite the routine use of these interventions, the literature supporting their use has not been systematically summarized. This systematic review aims to collect and summarize the level of evidence supporting the use of sphenopalatine ganglion block, radiofrequency ablation and neurostimulation. Medline, Google Scholar, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases were reviewed for studies on sphenopalatine ganglion block, radiofrequency ablation and neurostimulation. Studies included in this review were compiled and analyzed for their treated medical conditions, study design, outcomes and procedural details. Studies were graded using Oxford Center for Evidence-Based Medicine for level of evidence. Based on the level of evidence, grades of recommendations are provided for each intervention and its associated medical conditions. Eighty-three publications were included in this review, of which 60 were studies on sphenopalatine ganglion block, 15 were on radiofrequency ablation, and 8 were on neurostimulation. Of all the studies, 23 have evidence level above case series. Of the 23 studies, 19 were on sphenopalatine ganglion block, 1 study on radiofrequency ablation, and 3 studies on neurostimulation. The rest of the available literature was case reports and case series. The strongest evidence lies in using sphenopalatine ganglion block, radiofrequency ablation and neurostimulation for cluster headache. Sphenopalatine ganglion block also has evidence in treating trigeminal neuralgia, migraines, reducing the needs of analgesics after endoscopic sinus surgery and reducing pain associated with nasal packing removal after nasal operations. Overall, sphenopalatine ganglion is a promising target for treating cluster headache using blocks, radiofrequency ablation and neurostimulation. Sphenopalatine ganglion block also has some evidence supporting its use in a few other conditions. However, most of the controlled studies were small and without replications. Further controlled studies are warranted to replicate and expand on these previous findings.

Conservative chiropractic management of urinary incontinence using applied kinesiology: a retrospective case-series report.

PubMed

Cuthbert, Scott C; Rosner, Anthony L

2012-03-01

The purpose of this case series is to describe the chiropractic management of 21 patients with daily stress and occasional total urinary incontinence (UI). Twenty-one case files of patients 13 to 90 years of age with UI from a chiropractic clinic were reviewed. The patients had a 4-month to 49-year history of UI and associated muscle dysfunction and low back and/or pelvic pain. Eighteen wore an incontinence pad throughout the day and night at the time of their appointments because of unpredictable UI. Patients were evaluated for muscle impairments in the lumbar spine, pelvis, and pelvic floor and low back and/or hip pain. Positive manual muscle test results of the pelvis, lumbar spine muscles, and pelvic floor muscles were the most common findings. Lumbosacral dysfunction was found in 13 of the cases with pain provocation tests (applied kinesiology sensorimotor challenge); in 8 cases, this sensorimotor challenge was absent. Chiropractic manipulative therapy and soft tissue treatment addressed the soft tissue and articular dysfunctions. Chiropractic manipulative therapy involved high-velocity, low-amplitude manipulation; Cox flexion distraction manipulation; and/or use of a percussion instrument for the treatment of myofascial trigger points. Urinary incontinence symptoms resolved in 10 patients, considerably improved in 7 cases, and slightly improved in 4 cases. Periodic follow-up examinations for the past 6 years, and no less than 2 years, indicate that for each participant in this case-series report, the improvements of UI remained stable. The patients reported in this retrospective case series showed improvement in UI symptoms that persisted over time.

Acute Esophageal Necrosis: A Case Series

PubMed Central

Mavilia, Marianna G; Gurvits, Grigoriy E

2018-01-01

Acute esophageal necrosis (AEN) is a particularly rare syndrome with an incidence of only 0.1-0.28%, whose appearance is notable for proximal extensions of black, necrotic appearing mucosa extending proximally in the esophagus and abruptly interrupted at the gastroesophageal junction. In this case series, we explore the cases of two males: one middle-aged and one elderly, who after presenting with emesis, were found to have acute esophageal necrosis on esophagogastroduodenoscopy. PMID:29850386

Clustering Financial Time Series by Network Community Analysis

NASA Astrophysics Data System (ADS)

Piccardi, Carlo; Calatroni, Lisa; Bertoni, Fabio

In this paper, we describe a method for clustering financial time series which is based on community analysis, a recently developed approach for partitioning the nodes of a network (graph). A network with N nodes is associated to the set of N time series. The weight of the link (i, j), which quantifies the similarity between the two corresponding time series, is defined according to a metric based on symbolic time series analysis, which has recently proved effective in the context of financial time series. Then, searching for network communities allows one to identify groups of nodes (and then time series) with strong similarity. A quantitative assessment of the significance of the obtained partition is also provided. The method is applied to two distinct case-studies concerning the US and Italy Stock Exchange, respectively. In the US case, the stability of the partitions over time is also thoroughly investigated. The results favorably compare with those obtained with the standard tools typically used for clustering financial time series, such as the minimal spanning tree and the hierarchical tree.

Inheritance rules for Hierarchical Metadata Based on ISO 19115

NASA Astrophysics Data System (ADS)

Zabala, A.; Masó, J.; Pons, X.

2012-04-01

Mainly, ISO19115 has been used to describe metadata for datasets and services. Furthermore, ISO19115 standard (as well as the new draft ISO19115-1) includes a conceptual model that allows to describe metadata at different levels of granularity structured in hierarchical levels, both in aggregated resources such as particularly series, datasets, and also in more disaggregated resources such as types of entities (feature type), types of attributes (attribute type), entities (feature instances) and attributes (attribute instances). In theory, to apply a complete metadata structure to all hierarchical levels of metadata, from the whole series to an individual feature attributes, is possible, but to store all metadata at all levels is completely impractical. An inheritance mechanism is needed to store each metadata and quality information at the optimum hierarchical level and to allow an ease and efficient documentation of metadata in both an Earth observation scenario such as a multi-satellite mission multiband imagery, as well as in a complex vector topographical map that includes several feature types separated in layers (e.g. administrative limits, contour lines, edification polygons, road lines, etc). Moreover, and due to the traditional split of maps in tiles due to map handling at detailed scales or due to the satellite characteristics, each of the previous thematic layers (e.g. 1:5000 roads for a country) or band (Landsat-5 TM cover of the Earth) are tiled on several parts (sheets or scenes respectively). According to hierarchy in ISO 19115, the definition of general metadata can be supplemented by spatially specific metadata that, when required, either inherits or overrides the general case (G.1.3). Annex H of this standard states that only metadata exceptions are defined at lower levels, so it is not necessary to generate the full registry of metadata for each level but to link particular values to the general value that they inherit. Conceptually the metadata registry is complete for each metadata hierarchical level, but at the implementation level most of the metadata elements are not stored at both levels but only at more generic one. This communication defines a metadata system that covers 4 levels, describes which metadata has to support series-layer inheritance and in which way, and how hierarchical levels are defined and stored. Metadata elements are classified according to the type of inheritance between products, series, tiles and the datasets. It explains the metadata elements classification and exemplifies it using core metadata elements. The communication also presents a metadata viewer and edition tool that uses the described model to propagate metadata elements and to show to the user a complete set of metadata for each level in a transparent way. This tool is integrated in the MiraMon GIS software.

Applications of time-series analysis to mood fluctuations in bipolar disorder to promote treatment innovation: a case series

PubMed Central

Holmes, E A; Bonsall, M B; Hales, S A; Mitchell, H; Renner, F; Blackwell, S E; Watson, P; Goodwin, G M; Di Simplicio, M

2016-01-01

Treatment innovation for bipolar disorder has been hampered by a lack of techniques to capture a hallmark symptom: ongoing mood instability. Mood swings persist during remission from acute mood episodes and impair daily functioning. The last significant treatment advance remains Lithium (in the 1970s), which aids only the minority of patients. There is no accepted way to establish proof of concept for a new mood-stabilizing treatment. We suggest that combining insights from mood measurement with applied mathematics may provide a step change: repeated daily mood measurement (depression) over a short time frame (1 month) can create individual bipolar mood instability profiles. A time-series approach allows comparison of mood instability pre- and post-treatment. We test a new imagery-focused cognitive therapy treatment approach (MAPP; Mood Action Psychology Programme) targeting a driver of mood instability, and apply these measurement methods in a non-concurrent multiple baseline design case series of 14 patients with bipolar disorder. Weekly mood monitoring and treatment target data improved for the whole sample combined. Time-series analyses of daily mood data, sampled remotely (mobile phone/Internet) for 28 days pre- and post-treatment, demonstrated improvements in individuals' mood stability for 11 of 14 patients. Thus the findings offer preliminary support for a new imagery-focused treatment approach. They also indicate a step in treatment innovation without the requirement for trials in illness episodes or relapse prevention. Importantly, daily measurement offers a description of mood instability at the individual patient level in a clinically meaningful time frame. This costly, chronic and disabling mental illness demands innovation in both treatment approaches (whether pharmacological or psychological) and measurement tool: this work indicates that daily measurements can be used to detect improvement in individual mood stability for treatment innovation (MAPP). PMID:26812041

Head and neck squamous cell carcinoma in chronic areca nut chewing Indian women: Case series and review of literature.

PubMed

Muttagi, Sidramesh Shivanand; Chaturvedi, Pankaj; Gaikwad, Rohith; Singh, Bikramjit; Pawar, Prashant

2012-01-01

Head and neck squamous cell carcinoma (HNSCC) is an important public health problem in India. Several risk factors such as tobacco, human papilloma virus, alcohol, areca nut usage have been extensively studied as causative agents. Though Areca nut chewing is known cause of oral cancer, its association with hypopharynx cancer has not been previously reported. Since areca nut is mostly consumed along with tobacco, it is uncommon to find patients who consume the areca nut alone. This is a prospective case series of ten women who presented to us with HNSCC with history of chewing of areca nut alone for several years. We have excluded all those cases where areca nut was consumed along with tobacco in any form. The data were prospectively collected with regard to clinical parameters, duration and frequency of areca nut usage, the socio-economic status and education level. All ten females had varying degree of submucous fibrosis and coexisting squamous cell carcinoma either in the oral cavity or hypopharynx. Submucous fibrosis was characterized by burning mouth, unhealthy oral mucosa, buried third molars, trismus, poor oral hygiene, etc. The disease presented in an advanced stage in majority of the cases. All patients were unaware of areca nut's deleterious effects. Areca nut chewing is an important risk factor for HNSCC in females. Despite plethora of information, little importance is given to areca nut control in cancer prevention campaigns in India.

Spatio-Temporal Trends and Risk Factors for Shigella from 2001 to 2011 in Jiangsu Province, People's Republic of China

PubMed Central

Bao, Changjun; Hu, Jianli; Liu, Wendong; Liang, Qi; Wu, Ying; Norris, Jessie; Peng, Zhihang; Yu, Rongbin; Shen, Hongbing; Chen, Feng

2014-01-01

Objective This study aimed to describe the spatial and temporal trends of Shigella incidence rates in Jiangsu Province, People's Republic of China. It also intended to explore complex risk modes facilitating Shigella transmission. Methods County-level incidence rates were obtained for analysis using geographic information system (GIS) tools. Trend surface and incidence maps were established to describe geographic distributions. Spatio-temporal cluster analysis and autocorrelation analysis were used for detecting clusters. Based on the number of monthly Shigella cases, an autoregressive integrated moving average (ARIMA) model successfully established a time series model. A spatial correlation analysis and a case-control study were conducted to identify risk factors contributing to Shigella transmissions. Results The far southwestern and northwestern areas of Jiangsu were the most infected. A cluster was detected in southwestern Jiangsu (LLR = 11674.74, P<0.001). The time series model was established as ARIMA (1, 12, 0), which predicted well for cases from August to December, 2011. Highways and water sources potentially caused spatial variation in Shigella development in Jiangsu. The case-control study confirmed not washing hands before dinner (OR = 3.64) and not having access to a safe water source (OR = 2.04) as the main causes of Shigella in Jiangsu Province. Conclusion Improvement of sanitation and hygiene should be strengthened in economically developed counties, while access to a safe water supply in impoverished areas should be increased at the same time. PMID:24416167

Predictors and Rates of Delayed Symptomatic Hyponatremia after Transsphenoidal Surgery: A Systematic Review [corrected].

PubMed

Cote, David J; Alzarea, Abdulaziz; Acosta, Michael A; Hulou, Mohamed Maher; Huang, Kevin T; Almutairi, Hamoud; Alharbi, Ahmad; Zaidi, Hasan A; Algrani, Majed; Alatawi, Ahmad; Mekary, Rania A; Smith, Timothy R

2016-04-01

Delayed symptomatic hyponatremia (DSH) is a known complication of transsphenoidal surgery that can lead to prolonged hospital stay, readmission, and in rare cases, death. Many potential predictors for development of DSH have been investigated. A better understanding of DSH risk can lead to better patient outcomes. We performed a systematic review to determine the rates and predictors of DSH after both endoscopic transsphenoidal surgery and microscopic transsphenoidal surgery. A systematic search of the literature was conducted using MEDLINE/PUBMED, EMBASE, and Cochrane databases. Inclusion criteria were 1) case series with at least 10 cases reported, 2) adult patients who underwent eTSS or mTSS for pituitary tumors, and 3) reported occurrence of DSH (defined as serum sodium level <135 mEq/L with associated symptoms) after postoperative day 3. Data were analyzed using CMA V.3 Statistical Software (2014). Ten case series satisfied the inclusion criteria for a total of 2947 patients. Various factors including age, gender, cerebrospinal fluid leak, and tumor size were investigated as potential predictors of DSH. DSH event rates for both mTSS and eTSS fell between around 4 and 12 percent and included a variety of proposed predictors. Age, gender, tumor size, rate of decline of blood sodium, and Cushing disease are potential predictors of DSH. By identifying patients at high risk for DSH, preventative efforts can be implemented in the perioperative setting to reduce the incidence of potentially catastrophic hyponatremia following transsphenoidal surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

Single-Case Time Series with Bayesian Analysis: A Practitioner's Guide.

ERIC Educational Resources Information Center

Jones, W. Paul

2003-01-01

This article illustrates a simplified time series analysis for use by the counseling researcher practitioner in single-case baseline plus intervention studies with a Bayesian probability analysis to integrate findings from replications. The C statistic is recommended as a primary analysis tool with particular relevance in the context of actual…

Sclerosing encapsulating peritonitis: a case series.

PubMed

Nandedkar, Shirish; Malukani, Kamal; Nayak, Renu; Patidar, Ekta

2014-03-01

Sclerosing encapsulating peritonitis (SEP) is a relatively rare cause of intestinal obstruction characterized by total or partial encapsulation of the small intestine by a thick fibrous membrane and is a difficult preoperative diagnosis. A series of seven cases of SEP is reported. Modalities of preoperative diagnosis along with clinical presentation, operative findings, and histopathology are discussed.

The Right to Live and Die. Canadian Critical Issues Series.

ERIC Educational Resources Information Center

Eisenberg, John; Bourne, Paula

One of a series adapted from the Canadian Public Issues Project, this book is designed to stimulate discussion and reflection about controversial issues through case studies. The book is based on high school units originally drawn from cases in newspapers, journals, books, legal documents, and government reports. Conflicts from issues arising over…

[New method for determining endemic levels].

PubMed

Orellano, Pablo Wenceslao; Reynoso, Julieta Itatí

2011-05-01

Design an instrument for determining endemic levels or ranges using simple calculations; identify and estimate the parameters related to the dynamic transmission of communicable diseases. The parameters for establishing a theoretical curve of expected incidence based on the logistic growth model were identified. The parameters were estimated by nonlinear regression based on the cumulative incidence data from the previous five years. The weekly cumulative incidence of cases of influenza-like illness in Argentina in 2009 was used as an example. It was compared to the 2004-2008 case series in order to determine the cumulative and non-cumulative endemic levels. According to the cumulative endemic levels identified, the country entered the outbreak area in week 2. The data from previous years showed that the maximum expected number of cases or carrying capacity (K) was 1 090 660. When the non-cumulative levels were considered, the outbreak was present in 34 out of 51 weeks. A range of 1.05 to 1.13 was estimated for the basic reproductive rate (R0) in the non-epidemic period from 2004-2008. The new method facilitated the determination of endemic levels using a simple procedure with the identification of parameters that are important for transmission. Although it has limitations such as the fact that the equation used is more appropriate for evaluating diseases with a pronounced annual cycle and less accurate for cycles of less than 1 year, it can be considered a valuable alternative method for determining endemic ranges and a new contribution to the study of epidemic outbreaks at local health surveillance levels.

Energy conserving site design case study: Shenandoah, Georgia. Final report

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

Not Available

The case study examines the means by which energy conservation can be achieved at an aggregate community level by using proper planning and analytical techniques for a new town, Shenandoah, Georgia, located twenty-five miles southwest of Atlanta's Hartsfield International Airport. A potentially implementable energy conservation community plan is achieved by a study team examining the land use options, siting characteristics of each building type, alternate infrastructure plans, possible decentralized energy options, and central utility schemes to determine how community energy conservation can be achieved by use of pre-construction planning. The concept for the development of mixed land uses as amore » passively sited, energy conserving community is based on a plan (Level 1 Plan) that uses the natural site characteristics, maximizes on passive energy siting requirement, and allows flexibility for the changing needs of the developers. The Level 2 Plan is identical with Level 1 plan plus a series of decentraized systems that have been added to the residential units: the single-family detached, the apartments, and the townhouses. Level 3 Plan is similar to the Level 1 Plan except that higher density dwellings have been moved to areas adjacent to central site. The total energy savings for each plan relative to the conventional plan are indicated. (MCW)« less

A time series analysis performed on a 25-year period of kidney transplantation activity in a single center.

PubMed

Santori, G; Fontana, I; Bertocchi, M; Gasloli, G; Valente, U

2010-05-01

Following the example of many Western countries, where a "minimum volume rule" policy has been adopted as a quality parameter for complex surgical procedures, the Italian National Transplant Centre set the minimum number of kidney transplantation procedures/y at 30/center. The number of procedures performed in a single center over a large period may be treated as a time series to evaluate trends, seasonal cycles, and nonsystematic fluctuations. Between January 1, 1983, and December 31, 2007, we performed 1376 procedures in adult or pediatric recipients from living or cadaveric donors. The greatest numbers of cases/y were performed in 1998 (n = 86) followed by 2004 (n = 82), 1996 (n = 75), and 2003 (n = 73). A time series analysis performed using R Statistical Software (Foundation for Statistical Computing, Vienna, Austria), a free software environment for statistical computing and graphics, showed a whole incremental trend after exponential smoothing as well as after seasonal decomposition. However, starting from 2005, we observed a decreased trend in the series. The number of kidney transplants expected to be performed for 2008 by using the Holt-Winters exponential smoothing applied to the period 1983 to 2007 suggested 58 procedures, while in that year there were 52. The time series approach may be helpful to establish a minimum volume/y at a single-center level. Copyright (c) 2010 Elsevier Inc. All rights reserved.

M-52 spray booth qualification test

NASA Technical Reports Server (NTRS)

1990-01-01

The procedures, performance, and results obtained from the M-52 spray booth qualification test are documented. The test was conducted at Thiokol Corporation, Space Operations, M-52 Inert Parts Preparation facility. The purpose of this testing sequence was to ensure the spray booth would produce flight qualified hardware. The testing sequence was conducted in two series. The first series was conducted under CTP-0142, Revision 1. The second series was conducted in accordance with CTP-0142, Revision 2. The test sequence started with CTP-0142, Revision 1. The series consisted of the contamination removal test and the performance test. The contamination removal test was used to assess the Teflon level in the spray booth. The performance test consisted of painting and Chemloking a forward dome inside the spray booth per flight procedures. During the performance test, two sets of witness panels (case/insulation and steel/epoxy/steel) were prepared and pull tested. The CTP-0142, Revision 2, series of testing consisted of re-testing the steel/epoxy/steel witness panels. The pull tests analysis indicates the results of the tensile tests were comparable to the systems tunnel witness panel database. The exposed panel set and the control panel set average tensile values were above the 1-basis lower limits established on the systems tunnel witness panel database. It is recommended that the M-52 spray booth be qualified for producing flight hardware.

Operative Treatment of Traumatic Hallux Valgus in Elite Athletes.

PubMed

Covell, D Jeff; Lareau, Craig R; Anderson, Robert B

2017-06-01

Traumatic hallux valgus is an increasingly common injury in the athletic population and represents a unique variant of turf toe. Failure to appropriately recognize and treat these injuries can lead to continued pain, decreased performance, progressive deformities, and ultimately degeneration of the hallux metatarsophalangeal joint. Limited literature currently exists to assist in the diagnosis, management, and operative treatment. Nineteen patients were reviewed in this series, including 12 National Football League, 6 college, and 1 high school player who was a college prospect. The average age for all patients at the time of surgery was 24.4 years (range, 19-33 years). Return to play and complications were evaluated. Overall, good operative results were obtained, with 74% of patients returning to their preinjury level of play at an average recovery time of 3.4 months. Traumatic hallux valgus is an increasingly common injury in the athletic population and represents a unique variant of turf toe. The impact of this injury cannot be overstated, as one-quarter of players were unable to return to play. Level IV, case series.

FINITE ELEMENT MODEL FOR TIDES AND CURRENTS WITH FIELD APPLICATIONS.

USGS Publications Warehouse

Walters, Roy A.

1988-01-01

A finite element model, based upon the shallow water equations, is used to calculate tidal amplitudes and currents for two field-scale test problems. Because tides are characterized by line spectra, the governing equations are subjected to harmonic decomposition. Thus the solution variables are the real and imaginary parts of the amplitude of sea level and velocity rather than a time series of these variables. The time series is recovered through synthesis. This scheme, coupled with a modified form of the governing equations, leads to high computational efficiency and freedom from excessive numerical noise. Two test-cases are presented. The first is a solution for eleven tidal constituents in the English Channel and southern North Sea, and three constituents are discussed. The second is an analysis of the frequency response and tidal harmonics for south San Francisco Bay.

Influence of Temperature and Relative Humidity on the Insecticidal Efficacy of Metarhizium anisopliae against Larvae of Ephestia kuehniella (Lepidoptera: Pyralidae) on Wheat.

PubMed

Athanassiou, Christos G; Kavallieratos, Nickolas G; Rumbos, Christos I; Kontodimas, Demetrius C

2017-01-01

A series of laboratory bioassays were conducted for the evaluation of the insecticidal efficacy of an isolate of Metarhizium anisopliae (Metschnikoff) Sorokin (Ascomycota: Hypocreales) against larvae of the Mediterranean flour moth, Ephestia kuehniella Zeller (Lepidoptera: Pyralidae), under various temperature-relative humidity (r.h.) conditions. The fungus was applied at four doses (0, 8 × 106, 8 × 108, and 8 × 1010 conidia ml-1) on wheat and insect mortality was assessed after exposure of 1, 2, 7, and 14 d. Bioassays were conducted at three temperatures (20, 25, and 30 °C) and two r.h. levels (55 and 75%). Although complete control was not achieved in any case, the fungus provided a considerable level of insect control. Mortality of E. kuehniella larvae on wheat treated with M. anisopliae ranged between 41.1 and 93.3% after 14 d of exposure, whereas the respective mortality levels in control dishes never exceeded 28.3%. The increase of temperature resulted in most cases to higher efficacy, indicating that temperature is an important factor for the performance of the fungus. In contrast, in most cases r.h. did not significantly affect the efficacy of the fungus, at least for the humidity levels tested. © The Author 2017. Published by Oxford University Press on behalf of the Entomological Society of America.

The Indian Reading Series: Stories and Legends of the Northwest. Level I. Books 1-20.

ERIC Educational Resources Information Center

Northwest Regional Educational Lab., Portland, OR.

Designed as supplementary reading materials appropriate for Indian and non-Indian children in the primary grades, this series of 20 booklets presents legends and stories of Northwest tribes. Stories in this first level of a six-level series were developed by the Blackfeet, Northern Cheyenne, Skokomish, Shoshone-Bannock, Crow, and Muckleshoot…

The Indian Reading Series: Stories and Legends of the Northwest. Level III. Books 1-20.

ERIC Educational Resources Information Center

Northwest Regional Educational Lab., Portland, OR.

Designed as supplementary reading materials for Indian and non-Indian children in the primary grades, this series of 20 booklets presents legends and stories of Northwest tribes. Stories in this third level of the six-level series were developed cooperatively by people of the Blackfeet, Kootenai, Jamestown-Clallam, Assiniboine, Sioux,…

Use of Landsat series data to analyse the spatial and temporal variations of land degradation in a dispersive soil environment: A case of King Sabata Dalindyebo local municipality in the Eastern Cape Province, South Africa

NASA Astrophysics Data System (ADS)

Dube, Timothy; Mutanga, Onisimo; Sibanda, Mbulisi; Seutloali, Khoboso; Shoko, Cletah

2017-08-01

Land degradation as a result of inappropriate land use practices, such as overgrazing and cultivation on steep slopes, etc. is one of the major global environmental challenges. Specifically, land degradation threatens the productivity and sustainability of the natural environment, agriculture, and most importantly rural economies in most developing countries, particularly the sub-Saharan region. The main aim of this study was therefore, to assess the potential and strength of using the free or readily available Landsat series data in mapping degraded land areas at the King Sabata Dalindyebo local municipality in the Eastern Cape, South Africa (1984-2010). Data analysis was done using a robust non-parametric classification ensemble; Discriminant Analysis (DA). The results show that degraded areas vary over the years. For example, the results show that the year 1994 and 2004 incurred high degradation levels, when compared to the year 1984 and 2010. Moreover, the observed degradation significantly (α = 0.05) varies with soil type. The chromic acrisols have the highest levels of erosion (approx. 80% in 1984), when compared to humic-umbric acrisols (less than 10% for the entire period under study). It can also be observed that considerable part of degradation occurred in the northern part of the municipal district. Overall, the findings of this research underlines the importance and efficacy of multispectral Landsat series data-set in mapping and monitoring levels of land degradation in data-scarce catchments.

Impact of Rainfall, Land-Cover and Population Growth on Groundwater - A Case Study From Karnataka State, India

NASA Astrophysics Data System (ADS)

Srivastav, R. K.; Chinnapa Reddy, A. R.

2015-12-01

Recent trends in climate, land-use pattern and population has affected almost every portable water resources in the world. Due to depleting surface water and untimely distribution of precipitation, the demand to use groundwater has increased considerably. Further recent studies have shown that the groundwater stress is more in developing countries like India. This study focuses on understanding the impacts of three major factors (i.e., rainfall, land-cover and population growth) effecting the groundwater levels. For this purpose, the correlation between the trends in groundwater time series is compared with trends in rainfall, land-cover and population growth. To detect the trends in time series, two statistical methods namely, least square method and Mann-Kendall method, are adopted. The results were analyzed based on the measurements from 1800 observation wells in the Karnataka state, India. The data is obtained for a total of 9 year time period ranging from 2005 to 2013. A gridded precipitation data of 0.5o× 0.5o over the entire region is used. The change in land-cover and population data was approximately obtained from the local governing bodies. The early results show significant correlation between rainfall and groundwater time series trends. The outcomes will assess the vulnerability of groundwater levels under changing physical and hydroclimatic conditions, especially under climate change.

The use of γ-rays analysis by HPGe detector to assess the gross alpha and beta activities in waters.

PubMed

Casagrande, M F S; Bonotto, D M

2018-07-01

This paper describes an alternative method for evaluating gross alpha and beta radioactivity in waters by using γ-rays analysis performed with hyper-pure germanium detector (HPGe). Several gamma emissions related to α and β - decays were used to provide the activity concentration data due to natural radionuclides commonly present in waters like 40 K and those belonging to the 238 U and 232 Th decay series. The most suitable gamma emissions related to β - decays were 214 Bi (1120.29 keV, 238 U series) and 208 Tl (583.19 keV, 232 Th series) as the equation in activity concentration yielded values compatible to those generated by the formula taking into account the detection efficiency. The absence of isolated and intense γ-rays peaks associated to α decays limited the choice to 226 Ra (186.21 keV, 238 U series) and 224 Ra (240.99 keV, 232 Th series). In these cases, it was adopted appropriate correction factors involving the absolute intensities and specific activities for avoiding the interferences of other γ-rays energies. The critical level of detection across the 186-1461 keV energy region corresponded to 0.010, 0.023, 0.038, 0.086, and 0.042 Bq/L, respectively, for 226 Ra, 224 Ra, 208 Tl, 214 Bi and 40 K. It is much lower than the WHO guideline reference value for gross alpha (0.5 Bq/L) and beta (1.0 Bq/L) in waters. The method applicability was checked by the analysis of groundwater samples from different aquifer systems occurring in the Brazilian states of São Paulo, Minas Gerais and Mato Grosso do Sul. The waters exhibit very different chemical composition and the samples with the highest radioactivity levels were those associated with lithotypes possessing enhanced uranium and thorium levels. The technique allowed directly discard the 40 K contribution to the gross beta activity as potassium is an essential element for humans. Copyright © 2018 Elsevier Ltd. All rights reserved.

Comparison of time series models for predicting campylobacteriosis risk in New Zealand.

PubMed

Al-Sakkaf, A; Jones, G

2014-05-01

Predicting campylobacteriosis cases is a matter of considerable concern in New Zealand, after the number of the notified cases was the highest among the developed countries in 2006. Thus, there is a need to develop a model or a tool to predict accurately the number of campylobacteriosis cases as the Microbial Risk Assessment Model used to predict the number of campylobacteriosis cases failed to predict accurately the number of actual cases. We explore the appropriateness of classical time series modelling approaches for predicting campylobacteriosis. Finding the most appropriate time series model for New Zealand data has additional practical considerations given a possible structural change, that is, a specific and sudden change in response to the implemented interventions. A univariate methodological approach was used to predict monthly disease cases using New Zealand surveillance data of campylobacteriosis incidence from 1998 to 2009. The data from the years 1998 to 2008 were used to model the time series with the year 2009 held out of the data set for model validation. The best two models were then fitted to the full 1998-2009 data and used to predict for each month of 2010. The Holt-Winters (multiplicative) and ARIMA (additive) intervention models were considered the best models for predicting campylobacteriosis in New Zealand. It was noticed that the prediction by an additive ARIMA with intervention was slightly better than the prediction by a Holt-Winter multiplicative method for the annual total in year 2010, the former predicting only 23 cases less than the actual reported cases. It is confirmed that classical time series techniques such as ARIMA with intervention and Holt-Winters can provide a good prediction performance for campylobacteriosis risk in New Zealand. The results reported by this study are useful to the New Zealand Health and Safety Authority's efforts in addressing the problem of the campylobacteriosis epidemic. © 2013 Blackwell Verlag GmbH.

Crotaline Fab antivenom appears to be effective in cases of severe North American pit viper envenomation: An integrative review

PubMed Central

Lavonas, Eric J; Schaeffer, Tammi H; Kokko, Jamie; Mlynarchek, Sara L; Bogdan, Gregory M

2009-01-01

Background In 2000, the United States Food and Drug Administration approved Crotalidae Polyvalent Immune Fab (Ovine) (hereafter, FabAV), "for the management of patients with minimal to moderate North American Crotalid envenomation." Because whole-IgG pit viper antivenom is no longer available in the United States, FabAV is currently the only specific treatment option available to United States clinicians treating snakebite victims of any severity. No clinical trial data are available concerning the effectiveness of FabAV for treatment of severe snakebite, but several published articles describe its use in this setting. Methods We performed a comprehensive review of the English-language medical literature to identify all publications (1996 to July, 2008) containing data about the administration of FabAV. Two trained reviewers separately extracted case-level data concerning the administration of FabAV to patients with severe envenomation by North American crotaline snakes to a standardized form. Descriptive statistics were used. In addition, we hand-searched the US National Poison Data System reports for the years 2000–2006 to identify and describe any reports of death that occurred after FabAV administration. Results The literature review found 147 unique publications regarding FabAV. Twenty-four evaluable cases of severe human envenomation treated with FabAV were identified in 19 publications. Seven cases were described in five cohort studies, and 17 cases were described in 14 single patient case reports or non-cohort case series. Sixty-five specific severe venom effects were reported in these 24 patients, of which 50 effects (77%) improved or resolved after FabAV therapy. Initial control of all severe venom effects was achieved in 12 patients (50%). The rate at which initial control was achieved was significantly higher among patients reported in the cohort series than in the case series and non-cohort reports (100% vs. 29%, P = 0.005). The median dose of FabAV used to obtain initial control was 6 vials (range: 4 – 18 vials). Nine patients had severe venom effects that persisted despite FabAV therapy. Recurrent and/or delayed-onset severe defibrination syndrome occurred in 12 patients, most of whom did not receive recommended maintenance FabAV dosing. No patient developed systemic bleeding. Conclusion In this structured literature review, FabAV appears to be effective in the management of severe crotaline snake envenomation. Incomplete response to therapy, recurrence of venom effects, and delayed-onset venom effects were reported in case reports, but not reported in cohort studies. PMID:19545426

Unilateral hypertrophy of the labia minora: A case series.

PubMed

Boulos, Scarlett; Rubin, Adam I; Yan, Albert C; McMahon, Patrick J; Perman, Marissa J

2018-05-01

Asymmetric hypertrophy of the labia minora is a variant of normal anatomy that has not been described in the pediatric dermatology literature. Although often asymptomatic, in some cases, it can cause functional, emotional, and psychological problems. We report the clinical characteristics and outcomes of four children who presented with unilateral labium minus hypertrophy. This case series aims to establish awareness of this condition among pediatric dermatologists and provide recommendations regarding management. © 2018 Wiley Periodicals, Inc.

DEFENDER: Detecting and Forecasting Epidemics Using Novel Data-Analytics for Enhanced Response.

PubMed

Thapen, Nicholas; Simmie, Donal; Hankin, Chris; Gillard, Joseph

2016-01-01

In recent years social and news media have increasingly been used to explain patterns in disease activity and progression. Social media data, principally from the Twitter network, has been shown to correlate well with official disease case counts. This fact has been exploited to provide advance warning of outbreak detection, forecasting of disease levels and the ability to predict the likelihood of individuals developing symptoms. In this paper we introduce DEFENDER, a software system that integrates data from social and news media and incorporates algorithms for outbreak detection, situational awareness and forecasting. As part of this system we have developed a technique for creating a location network for any country or region based purely on Twitter data. We also present a disease nowcasting (forecasting the current but still unknown level) approach which leverages counts from multiple symptoms, which was found to improve the nowcasting accuracy by 37 percent over a model that used only previous case data. Finally we attempt to forecast future levels of symptom activity based on observed user movement on Twitter, finding a moderate gain of 5 percent over a time series forecasting model.

27 CFR 19.594 - Numbering of packages and cases in processing.

Code of Federal Regulations, 2010 CFR

2010-04-01

... trade name, all series in use at that time shall be continued. However, for a change in proprietorship... spirits and denatured spirits shall, when filled, be consecutively numbered in a separate series by the proprietor commencing with “1” in each series of serial numbers, except that any series of such numbers in...

Increased expression of nucleophosmin/B23 in hepatocellular carcinoma and correlation with clinicopathological parameters

PubMed Central

Yun, J-P; Miao, J; Chen, G G; Tian, Q-H; Zhang, C-Q; Xiang, J; Fu, J; Lai, P B S

2007-01-01

Nucleophosmin (NPM, B23, numatrin, NO38) is an abundant nucleolar phosphoprotein involved in multiple cellular functions. Previous evidence indicates that high-level expression of NPM causes uncontrolled cell growth and suggests that NPM may have oncogenic potential. In this study, we examined NPM expression in 103 paired cases of hepatocellular carcinoma (HCC), 12 cases of hepatic focal nodular hyperplasia, 17 cases of liver tissue adjacent to a hepatic haemangioma, and series of array tissues from normal human organs and malignancies using a monoclonal antibody against NPM and reverse transcription–PCR techniques, Western blot analysis, immunohistochemistry, and immunocytofluorescence. Our data indicated that NPM expression was significantly higher in HCC than in the non-malignant hepatocytes (P<0.001). Nucleophosmin was weakly expressed in hepatocytes from a 5-month-old embryo and in stationary hepatocytes of healthy adults. Moreover, enhanced expression of NPM in HCC correlated with the level of PCNA (R2=0.5639) and with the clinical prognostic parameters such as serum alpha fetal protein level, tumour pathological grading, and liver cirrhosis (P<0.05). Our results suggest that NPM may play an important role in the progression of tumorigenesis and that NPM may serve as a potential marker for HCC. PMID:17245342

Propensity score matching for selection of local areas as controls for evaluation of effects of alcohol policies in case series and quasi case-control designs.

PubMed

de Vocht, F; Campbell, R; Brennan, A; Mooney, J; Angus, C; Hickman, M

2016-03-01

Area-level public health interventions can be difficult to evaluate using natural experiments. We describe the use of propensity score matching (PSM) to select control local authority areas (LAU) to evaluate the public health impact of alcohol policies for (1) prospective evaluation of alcohol policies using area-level data, and (2) a novel two-stage quasi case-control design. Ecological. Alcohol-related indicator data (Local Alcohol Profiles for England, PHE Health Profiles and ONS data) were linked at LAU level. Six LAUs (Blackpool, Bradford, Bristol, Ipswich, Islington, and Newcastle-upon-Tyne) as sample intervention or case areas were matched to two control LAUs each using PSM. For the quasi case-control study a second stage was added aimed at obtaining maximum contrast in outcomes based on propensity scores. Matching was evaluated based on average standardized absolute mean differences (ASAM) and variable-specific P-values after matching. The six LAUs were matched to suitable control areas (with ASAM < 0.20, P-values >0.05 indicating good matching) for a prospective evaluation study that sought areas that were similar at baseline in order to assess whether a change in intervention exposure led to a change in the outcome (alcohol related harm). PSM also generated appropriate matches for a quasi case-control study--whereby the contrast in health outcomes between cases and control areas needed to be optimized in order to assess retrospectively whether differences in intervention exposure were associated with the outcome. The use of PSM for area-level alcohol policy evaluation, but also for other public health interventions, will improve the value of these evaluations by objective and quantitative selection of the most appropriate control areas. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Use of the challenge point framework to guide motor learning of stepping reactions for improved balance control in people with stroke: a case series.

PubMed

Pollock, Courtney L; Boyd, Lara A; Hunt, Michael A; Garland, S Jayne

2014-04-01

Stepping reactions are important for walking balance and community-level mobility. Stepping reactions of people with stroke are characterized by slow reaction times, poor coordination of motor responses, and low amplitude of movements, which may contribute to their decreased ability to recover their balance when challenged. An important aspect of rehabilitation of mobility after stroke is optimizing the motor learning associated with retraining effective stepping reactions. The Challenge Point Framework (CPF) is a model that can be used to promote motor learning through manipulation of conditions of practice to modify task difficulty, that is, the interaction of the skill of the learner and the difficulty of the task to be learned. This case series illustrates how the retraining of multidirectional stepping reactions may be informed by the CPF to improve balance function in people with stroke. Four people (53-68 years of age) with chronic stroke (>1 year) and mild to moderate motor recovery received 4 weeks of multidirectional stepping reaction retraining. Important tenets of motor learning were optimized for each person during retraining in accordance with the CPF. Participants demonstrated improved community-level walking balance, as determined with the Community Balance and Mobility Scale. These improvements were evident 1 year later. Aspects of balance-related self-efficacy and movement kinematics also showed improvements during the course of the intervention. The application of CPF motor learning principles in the retraining of stepping reactions to improve community-level walking balance in people with chronic stroke appears to be promising. The CPF provides a plausible theoretical framework for the progression of functional task training in neurorehabilitation.

Atmospheric gradients from very long baseline interferometry observations

NASA Technical Reports Server (NTRS)

Macmillan, D. S.

1995-01-01

Azimuthal asymmetries in the atmospheric refractive index can lead to errors in estimated vertical and horizontal station coordinates. Daily average gradient effects can be as large as 50 mm of delay at a 7 deg elevation. To model gradients, the constrained estimation of gradient paramters was added to the standard VLBI solution procedure. Here the analysis of two sets of data is summarized: the set of all geodetic VLBI experiments from 1990-1993 and a series of 12 state-of-the-art R&D experiments run on consecutive days in January 1994. In both cases, when the gradient parameters are estimated, the overall fit of the geodetic solution is improved at greater than the 99% confidence level. Repeatabilities of baseline lengths ranging up to 11,000 km are improved by 1 to 8 mm in a root-sum-square sense. This varies from about 20% to 40% of the total baseline length scatter without gradient modeling for the 1990-1993 series and 40% to 50% for the January series. Gradients estimated independently for each day as a piecewise linear function are mostly continuous from day to day within their formal uncertainties.

Economics and politics of climate change

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

Hahn, R.W.

1998-12-31

A fundamental issue is what steps, if any, nations should take to control greenhouse gas emissions. Robert Hahn argues that over the next decade the best strategy for policy makers is to build institutions that can address climate change in the future by developing a capacity at the nation-state level to measure greenhouse gas emissions and to implement and enforce cost-effective ways of limiting emissions. Policy makers must also improve the capacity of an international body to assess greenhouse gas inventories and review national policies. Hahn recommends that the developed nations craft an agreement for the next decade that providesmore » a slight emission limitation and allows for a series of case studies, in which developing nations would participate, to preserve diversity and build useful institutional knowledge. The Economics and Politics of Climate Change is one in a series of new AEI studies related to the globalization of environmental policy. These studies will focus on specific issues and on the new institutional arrangements required to deal with them. A list of publications in this series appears inside.« less

An Interrupted Time-Series Analysis of Durkheim's Social Deregulation Thesis: The Case of the Russian Federation.

PubMed

Pridemore, William Alex; Chamlin, Mitchell B; Cochran, John K

2007-06-01

The dissolution of the Soviet Union resulted in sudden, widespread, and fundamental changes to Russian society. The former social welfare system-with its broad guarantees of employment, healthcare, education, and other forms of social support-was dismantled in the shift toward democracy, rule of law, and a free-market economy. This unique natural experiment provides a rare opportunity to examine the potentially disintegrative effects of rapid social change on deviance, and thus to evaluate one of Durkheim's core tenets. We took advantage of this opportunity by performing interrupted time-series analyses of annual age-adjusted homicide, suicide, and alcohol-related mortality rates for the Russian Federation using data from 1956 to 2002, with 1992-2002 as the postintervention time-frame. The ARIMA models indicate that, controlling for the long-term processes that generated these three time series, the breakup of the Soviet Union was associated with an appreciable increase in each of the cause-of-death rates. We interpret these findings as being consistent with the Durkheimian hypothesis that rapid social change disrupts social order, thereby increasing the level of crime and deviance.

Stellate ganglion block used to treat symptoms associated with combat-related post-traumatic stress disorder: a case series of 166 patients.

PubMed

Mulvaney, Sean W; Lynch, James H; Hickey, Matthew J; Rahman-Rawlins, Tabassum; Schroeder, Matthew; Kane, Shawn; Lipov, Eugene

2014-10-01

Report the successful use of stellate ganglion blocks (SGBs) in 166 active duty service members with multiple combat deployments experiencing anxiety symptoms associated with post-traumatic stress disorder (PTSD). Successful treatment of PTSD symptoms with SGB has been reported previously. This is the largest published case series evaluating SGB with a minimum of 3 months follow-up. Following clinical interview including administration of the PTSD Checklist (PCL), 166 service members with symptoms of PTSD elected to receive a SGB. All patients received a SGB on the right side at the level of the sixth cervical vertebrae (C6). The PCL was administered the day before treatment to establish a baseline, repeated 1 week later, and then monthly out to 3 months. A positive response was considered to be an improvement in the PCL score by 10 or greater points. Follow-up PCL scores from 3 to 6 months were obtained and analyzed for 166 patients. In a military population with multiple combat deployments, over 70% of the patients treated had a clinically significant improvement in their PCL score which persisted beyond 3 to 6 months postprocedure. Selective blockade of the right cervical sympathetic chain at the C6 level is a safe and minimally invasive procedure that may provide durable relief from anxiety symptoms associated with PTSD. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

Pain and Anxiety Levels of Patients Undergoing Tissue Expansion After Mastectomies: A Case Series Study.

PubMed

Le, Nicole K; García-Molina, Carla; Kumar, Ambuj; Griffin, Lisa; Dayicioglu, Deniz

2017-01-01

The tissue expansion process is done after mastectomies to increase the submuscular space in preparation for the placement of permanent breast implant. The process is often believed to be painful by patients who are often intimidated by the prospect of mechanically stretching out their skin and muscle. This study aims to quantify the pain experienced by patients and determine the different pain management techniques used. We used a case series approach, in which patients who were undergoing serial tissue expansion process were asked to rate their pain and anxiety on a scale from 1 to 10, using a questionnaire and the visual analog scale. Pain was rated during and after the expansion procedure, and patients were also surveyed to find the most commonly used and most effective pain management technique. Patients typically reported very little pain during and after the procedure, with an average of 0.4 to 2.5 pain experienced out of 10. The pain did not last, on average, longer than 1 day. Furthermore, the most widely used and most helpful pain medication was ibuprofen. During the tissue expansion procedure, the mean anxiety level was 0.64 (1.3). The findings show that tissue expansion process is a relatively low pain procedure and is not a contraindication for undergoing breast reconstruction. Ibuprofen, a mild treatment with few side effects, was efficacious in pain relief though most patients required no pain relief.

Inter-comparison of time series models of lake levels predicted by several modeling strategies

NASA Astrophysics Data System (ADS)

Khatibi, R.; Ghorbani, M. A.; Naghipour, L.; Jothiprakash, V.; Fathima, T. A.; Fazelifard, M. H.

2014-04-01

Five modeling strategies are employed to analyze water level time series of six lakes with different physical characteristics such as shape, size, altitude and range of variations. The models comprise chaos theory, Auto-Regressive Integrated Moving Average (ARIMA) - treated for seasonality and hence SARIMA, Artificial Neural Networks (ANN), Gene Expression Programming (GEP) and Multiple Linear Regression (MLR). Each is formulated on a different premise with different underlying assumptions. Chaos theory is elaborated in a greater detail as it is customary to identify the existence of chaotic signals by a number of techniques (e.g. average mutual information and false nearest neighbors) and future values are predicted using the Nonlinear Local Prediction (NLP) technique. This paper takes a critical view of past inter-comparison studies seeking a superior performance, against which it is reported that (i) the performances of all five modeling strategies vary from good to poor, hampering the recommendation of a clear-cut predictive model; (ii) the performances of the datasets of two cases are consistently better with all five modeling strategies; (iii) in other cases, their performances are poor but the results can still be fit-for-purpose; (iv) the simultaneous good performances of NLP and SARIMA pull their underlying assumptions to different ends, which cannot be reconciled. A number of arguments are presented including the culture of pluralism, according to which the various modeling strategies facilitate an insight into the data from different vantages.

Evolution of the Instructional Design in a Series of Online Workshops

ERIC Educational Resources Information Center

Patry, Anne; Brown, Elizabeth Campbell; Rousseau, Rémi; Caron, Jeanette

2015-01-01

This case recounts the story of the design and production of a series of online workshops for French-speaking healthcare professionals in Canada. The project spans a couple of years and, despite encountering some challenges, succeeds in large part because of its strong foundation: the instructional design. This case study features an instructional…

Advantages of the Multiple Case Series Approach to the Study of Cognitive Deficits in Autism Spectrum Disorder

ERIC Educational Resources Information Center

Towgood, Karren J.; Meuwese, Julia D. I.; Gilbert, Sam J.; Turner, Martha S.; Burgess, Paul W.

2009-01-01

In the neuropsychological case series approach, tasks are administered that tap different cognitive domains, and differences within rather than across individuals are the basis for theorising; each individual is effectively their own control. This approach is a mainstay of cognitive neuropsychology, and is particularly suited to the study of…

The Understanding Words Reading Intervention: Evidence from a Case Series Design

ERIC Educational Resources Information Center

Wright, Craig; Conlon, Elizabeth G.; Wright, Michalle

2012-01-01

Using a case-series design with double baseline and 10-week maintenance phase, 5 struggling readers from middle- to high-income families (age range 6.4-7.9 years) completed a 5-times-weekly intervention (96 sessions) administered by a parent. All participants completed the intervention with phonological decoding, text-reading accuracy and reading…

Case Studies: Persecution/Genocide. The Human Rights Series. Volume III.

ERIC Educational Resources Information Center

Litynsky, Walter; And Others

A continuation of the study of those factors that lead to persecutions and acts of genocide is presented. As students read the materials included in the case studies, they should be referred to the organizing concepts discussed in "Teaching about the Holocaust and Genocide: Introduction. The Human Rights Series, Volume I." Unit 1 in that…

Brief Report: Retrospective Case Series of Oxcarbazepine for Irritability/Agitation Symptoms in Autism Spectrum Disorder

ERIC Educational Resources Information Center

Douglas, Jessica F.; Sanders, Kevin B.; Benneyworth, M. Hannah; Smith, Jessica L.; DeJean, Virginia M.; McGrew, Susan G.; Veenstra-VanderWeele, Jeremy

2013-01-01

We examined response to oxcarbazepine prescribed for irritability/agitation symptoms in a retrospective case series of 30 patients with Autism Spectrum Disorder (ASD). The average patient was 12.0 years old (range 5-21) and taking two other psychotropic medications (range 0-4). Fourteen patients (47 %) had a clinical global impression of…

Intake Interview Skills for Rehabilitation Counselors: A Typescript Manual. Advanced Facilitative Case Management Series, Training Package I.

ERIC Educational Resources Information Center

Rubin, Stanford E.; Farley, Roy C.

This guide is the case study manual for the first in a series of instructor-assisted training modules for rehabilitation counselors, supervisors, and graduate students. This typescript manual for the first module focuses on basic intake interviewing skills consisting of: (1) systematic interview programming including attracting, planning and…

Assessing Outcome in Cognitive Behavior Therapy for Child Depression: An Illustrative Case Series

ERIC Educational Resources Information Center

Eckshtain, Dikla; Gaynor, Scott T.

2009-01-01

Recent meta-analytic data suggest a need for ongoing evaluation of treatments for youth depression. The present article calls attention to a number of issues relevant to the empirical evaluation of if and how cognitive behavior therapy for child depression works. A case series of 6 children and a primary caregiver received treatment--individual…

Manualized Family-Based Treatment for Anorexia Nervosa: A Case Series.

ERIC Educational Resources Information Center

Le Grange, Daniel; Binford, Roslyn; Loeb, Katharine L.

2005-01-01

Objective: The purpose of this study was to describe a case series of children and adolescents (mean age = 14.5 years, SD = 2.3; range 9-18) with anorexia nervosa who received manualized family-based treatment for their eating disorder. Method: Forty-five patients with anorexia nervosa were compared pre- and post-treatment on weight and menstrual…

Clinical Practice as Natural Laboratory for Psychotherapy Research: A Guide to Case-Based Time-Series Analysis

ERIC Educational Resources Information Center

Borckardt, Jeffrey J.; Nash, Michael R.; Murphy, Martin D.; Moore, Mark; Shaw, Darlene; O'Neil, Patrick

2008-01-01

Both researchers and practitioners need to know more about how laboratory treatment protocols translate to real-world practice settings and how clinical innovations can be systematically tested and communicated to a skeptical scientific community. The single-case time-series study is well suited to opening a productive discourse between practice…

Single-specialty management and reconstruction of necrotizing fasciitis of the upper extremities: clinical and economic benefits from a case series.

PubMed

Mattison, Gennaya; Leis, Amber R; Gupta, Subhas C

2014-05-01

Patients with necrotizing fasciitis are managed with multiple prompt, radical surgical debridements and critical care support. Debridement and reconstruction are often provided by different surgical teams. Anecdotally, single-specialty management seemed to be a more efficient management strategy. This study aimed to investigate and compare the outcomes of management by plastic surgery versus multiple disciplines through a retrospective economic and clinical analysis of patients with necrotizing fasciitis treated over 8 years. We also present 3 index cases for which our service functioned as the primary management team. Necrotizing fasciitis cases evaluated and treated by our department, covering both Level I and Level II Trauma Centers, were reviewed for total charges, length of hospital stay, length of intensive care unit (ICU) stay, and number of procedures. The admission Acute Physiology and Chronic Health Evaluation II score was calculated for each patient. Three comparative index cases of upper extremity necrotizing fasciitis managed primarily by the plastic surgery team are presented in greater detail. Patients managed primarily by the plastic surgery service had equivalent Acute Physiology and Chronic Health Evaluation II scores to patients managed by multiple services for their necrotizing fasciitis, with the average score higher for patients managed by plastic surgery alone. In a case-matched series of upper extremity necrotizing fasciitis, the patients admitted directly to plastic surgery had shorter average lengths of hospital and ICU stays as well as decreased total number of procedures, resulting in decreased average total hospital charges. There were no amputations among the cases treated primarily by the plastic surgery. The patients also required smaller areas of reconstruction with skin grafting despite large initial areas of debridement compared to those whose reconstructive teams differed from the team performing the debridement. Improved economic and clinical outcomes-as indicated by the reduced lengths of overall and ICU stay, the reduced number of procedures, none of the cases requiring amputation, and the reduced need for skin grafting-may be attainable when the surgeon eventually performing the reconstruction is involved early in management. We propose that, in the interest of improving patient care, a closer collaboration should be established between the reconstructive and primary managing teams.

Testing the effectiveness of family therapeutic assessment: a case study using a time-series design.

PubMed

Smith, Justin D; Wolf, Nicole J; Handler, Leonard; Nash, Michael R

2009-11-01

We describe a family Therapeutic Assessment (TA) case study employing 2 assessors, 2 assessment rooms, and a video link. In the study, we employed a daily measures time-series design with a pretreatment baseline and follow-up period to examine the family TA treatment model. In addition to being an illustrative addition to a number of clinical reports suggesting the efficacy of family TA, this study is the first to apply a case-based time-series design to test whether family TA leads to clinical improvement and also illustrates when that improvement occurs. Results support the trajectory of change proposed by Finn (2007), the TA model's creator, who posits that benefits continue beyond the formal treatment itself.

Effective assessment of egfr mutation status in bronchoalveolar lavage and pleural fluids by next-generation sequencing.

PubMed

Buttitta, Fiamma; Felicioni, Lara; Del Grammastro, Maela; Filice, Giampaolo; Di Lorito, Alessia; Malatesta, Sara; Viola, Patrizia; Centi, Irene; D'Antuono, Tommaso; Zappacosta, Roberta; Rosini, Sandra; Cuccurullo, Franco; Marchetti, Antonio

2013-02-01

The therapeutic choice for patients with lung adenocarcinoma depends on the presence of EGF receptor (EGFR) mutations. In many cases, only cytologic samples are available for molecular diagnosis. Bronchoalveolar lavage (BAL) and pleural fluid, which represent a considerable proportion of cytologic specimens, cannot always be used for molecular testing because of low rate of tumor cells. We tested the feasibility of EGFR mutation analysis on BAL and pleural fluid samples by next-generation sequencing (NGS), an innovative and extremely sensitive platform. The study was devised to extend the EGFR test to those patients who could not get it due to the paucity of biologic material. A series of 830 lung cytology specimens was used to select 48 samples (BAL and pleural fluid) from patients with EGFR mutations in resected tumors. These samples included 36 cases with 0.3% to 9% of neoplastic cells (series A) and 12 cases without evidence of tumor (series B). All samples were analyzed by Sanger sequencing and NGS on 454 Roche platform. A mean of 21,130 ± 2,370 sequences per sample were obtained by NGS. In series A, EGFR mutations were detected in 16% of cases by Sanger sequencing and in 81% of cases by NGS. Seventy-seven percent of cases found to be negative by Sanger sequencing showed mutations by NGS. In series B, all samples were negative for EGFR mutation by Sanger sequencing whereas 42% of them were positive by NGS. The very sensitive EGFR-NGS assay may open up to the possibility of specific treatments for patients otherwise doomed to re-biopsies or nontargeted therapies.

Account Deletion Prediction on RuNet: A Case Study of Suspicious Twitter Accounts Active During the Russian-Ukrainian Crisis

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

Volkova, Svitlana; Bell, Eric B.

Social networks are dynamically changing over time e.g., some accounts are being created and some are being deleted or become private. This ephemerality at both an account level and content level results from a combination of privacy concerns, spam, and deceptive behaviors. In this study we analyze a large dataset of 180,340 accounts active during the Russian-Ukrainian crisis to discover a series of predictive features for the removal or shutdown of a suspicious account. We find that unlike previously reported profile and net- work features, lexical features form the basis for highly accurate prediction of the deletion of an account.

Osteochondral lesions of the ankle joint in professional soccer players: treatment with autologous matrix-induced chondrogenesis.

PubMed

Valderrabano, Victor; Barg, Alexej; Alattar, Abdulhameed; Wiewiorski, Martin

2014-12-01

Acute and recurrent ankle sprains and other trauma to the ankle joint are common injuries in soccer and can be accompanied by or result in osteochondral lesions of the ankle joint, majorly of the talus. Conservative treatment frequently fails. Several operative treatment techniques exist; however, the choice of the right procedure is difficult due to lack of literature with a high level of evidence. We present our treatment method for acute and chronic ankle osteochondral lesions with cystic formation approached by a new surgical technique combining bone plasty and a collagen matrix (autologous matrix-induced chondrogenesis). Therapeutic, Level IV: Case series. © 2014 The Author(s).

Time lag between immigration and tuberculosis rates in immigrants in the Netherlands: a time-series analysis.

PubMed

van Aart, C; Boshuizen, H; Dekkers, A; Korthals Altes, H

2017-05-01

In low-incidence countries, most tuberculosis (TB) cases are foreign-born. We explored the temporal relationship between immigration and TB in first-generation immigrants between 1995 and 2012 to assess whether immigration can be a predictor for TB in immigrants from high-incidence countries. We obtained monthly data on immigrant TB cases and immigration for the three countries of origin most frequently represented among TB cases in the Netherlands: Morocco, Somalia and Turkey. The best-fit seasonal autoregressive integrated moving average (SARIMA) model to the immigration time-series was used to prewhiten the TB time series. The cross-correlation function (CCF) was then computed on the residual time series to detect time lags between immigration and TB rates. We identified a 17-month lag between Somali immigration and Somali immigrant TB cases, but no time lag for immigrants from Morocco and Turkey. The absence of a lag in the Moroccan and Turkish population may be attributed to the relatively low TB prevalence in the countries of origin and an increased likelihood of reactivation TB in an ageing immigrant population. Understanding the time lag between Somali immigration and TB disease would benefit from a closer epidemiological analysis of cohorts of Somali cases diagnosed within the first years after entry.

Central neuraxial anaesthesia presenting with spinal myoclonus in the perioperative period: a case series

PubMed Central

2009-01-01

Introduction Perioperative spinal myoclonus is extremely rare. Many anaesthetists and perioperative practitioners may not diagnose or manage this complication appropriately when it occurs. This case report of unusual acute spinal myoclonus following regional anaesthesia highlights certain aspects of this rare complication that have not previously been published. Case presentations A series of four consecutive patients who developed acute lower-limb myoclonus following spinal or epidural anaesthesia are described. The case series occurred at three different hospitals and involved four anaesthetists over a 3-year period. Two Caucasian men, aged 90-years-old and 67-years-old, manifested unilateral myoclonus. Two Caucasian women, aged 64-years-old and 53-years-old, developed bilateral myoclonus. Myoclonus was self-limiting in one patient, treated with further regional anaesthesia in one patient and treated with intravenous midazolam in two patients. The overall outcome was good in all patients, with no recurrence or sequelae in any of the patients. Conclusion This case series emphasizes that spinal myoclonus following regional anaesthesia is rare, has diverse pathophysiology and can have diverse presentations. The treatment of perioperative spinal myoclonus should be directed at the aetiology. Anaesthetists and perioperative practitioners who are unfamiliar with this rare complication should be reassured that it may be treated successfully with midazolam. PMID:19830168

Efficacy and Safety of Gabapentin in the Treatment of Chronic Cough: A Systematic Review.

PubMed

Shi, Guanglin; Shen, Qin; Zhang, Caixin; Ma, Jun; Mohammed, Anaz; Zhao, Huan

2018-06-19

Despite recent clinical guidelines, the optimal therapeutic strategy for the management of refractory chronic cough is still a challenge. The present systematic review was designed to assess the evidence for efficacy and safety of gabapentin in the treatment of chronic cough. A systematic search of PubMed, Embase, Cochrane Library databases, and publications cited in bibliographies was performed. Articles were searched by two reviewers with a priori criteria for study selection. Seven relevant articles were identified, including two randomized controlled trials, one prospective case-series designed with consecutive patients, one retrospective case series of consecutive patients, one retrospective case series with unknown consecutive status, and two case reports comprising six and two patients, respectively. Improvements were detected in cough-specific quality of life (Leicester Cough Questionnaire score) and cough severity (visual analogue scale score) following gabapentin treatment in randomized controlled trials. The results of prospective case-series showed that the rate of overall improvement of cough and sensory neuropathy with gabapentin was 68%. Gabapentin treatment of patients with chronic cough showed superior efficacy and a good safety record compared with placebo or standard medications. Additional randomized and controlled trials are needed. Copyright©2018. The Korean Academy of Tuberculosis and Respiratory Diseases.

Estimating the basic reproduction rate of HFMD using the time series SIR model in Guangdong, China

PubMed Central

Du, Zhicheng; Zhang, Wangjian; Zhang, Dingmei; Yu, Shicheng

2017-01-01

Hand, foot, and mouth disease (HFMD) has caused a substantial burden of disease in China, especially in Guangdong Province. Based on notifiable cases, we use the time series Susceptible-Infected-Recovered model to estimate the basic reproduction rate (R0) and the herd immunity threshold, understanding the transmission and persistence of HFMD more completely for efficient intervention in this province. The standardized difference between the reported and fitted time series of HFMD was 0.009 (<0.2). The median basic reproduction rate of total, enterovirus 71, and coxsackievirus 16 cases in Guangdong were 4.621 (IQR: 3.907–5.823), 3.023 (IQR: 2.289–4.292) and 7.767 (IQR: 6.903–10.353), respectively. The heatmap of R0 showed semiannual peaks of activity, including a major peak in spring and early summer (about the 12th week) followed by a smaller peak in autumn (about the 36th week). The county-level model showed that Longchuan (R0 = 33), Gaozhou (R0 = 24), Huazhou (R0 = 23) and Qingxin (R0 = 19) counties have higher basic reproduction rate than other counties in the province. The epidemic of HFMD in Guangdong Province is still grim, and strategies like the World Health Organization’s expanded program on immunization need to be implemented. An elimination of HFMD in Guangdong might need a Herd Immunity Threshold of 78%. PMID:28692654

The Indian Reading Series: Stories and Legends of the Northwest. Level IV. Books 1-21.

ERIC Educational Resources Information Center

Northwest Regional Educational Lab., Portland, OR.

Designed as supplementary reading material for Indian and non-Indian children in the elementary grades, this series of 21 booklets presents 36 stories and legends of Northwest tribes. Stories in this fourth level of the six-level series were developed cooperatively by Indian people of reservations in the Pacific Northwest. Booklets range from 7 to…

Intradiscal injection of triamcinolone hexacetonide for acute, subacute, and chronic sciatica. Results at 3 months an open-prospectus study of 30 cases and review of the literature.

PubMed

Bertin, P; Rochet, N; Arnaud, M; Treves, R; Desproges Gotteron, R; Charissoux, J L

1990-09-01

The authors report an open study of 30 cases of intradiscal injection of triamcinolone hexacetonide in the treatment of sciatica. The patients were monitored at months 1 and 3. The results were judged to be good in 36.6% of the cases, moderate in 36.6% and poor in 26.7% of the cases. Two adverse effects were reported: 1 case of reversible urinary retention and 1 case of deficiency of the dorsiflexor muscles of the foot. The good results reported in previous series were only found in this study when the indications were restricted to certain favourable prognostic factors: duration of sciatica less than 6 months and CAT-scan appearance of discal hernia. This technique has the advantage of being simple, economical and nonallergic. On the basis of the encouraging results of the initial series, this technique should be considered as an interesting therapeutic alternative in sciatica. Larger series and double-blind studies, however, are necessary to confirm the initial results.

A comparative study of shallow groundwater level simulation with three time series models in a coastal aquifer of South China

NASA Astrophysics Data System (ADS)

Yang, Q.; Wang, Y.; Zhang, J.; Delgado, J.

2017-05-01

Accurate and reliable groundwater level forecasting models can help ensure the sustainable use of a watershed's aquifers for urban and rural water supply. In this paper, three time series analysis methods, Holt-Winters (HW), integrated time series (ITS), and seasonal autoregressive integrated moving average (SARIMA), are explored to simulate the groundwater level in a coastal aquifer, China. The monthly groundwater table depth data collected in a long time series from 2000 to 2011 are simulated and compared with those three time series models. The error criteria are estimated using coefficient of determination ( R 2), Nash-Sutcliffe model efficiency coefficient ( E), and root-mean-squared error. The results indicate that three models are all accurate in reproducing the historical time series of groundwater levels. The comparisons of three models show that HW model is more accurate in predicting the groundwater levels than SARIMA and ITS models. It is recommended that additional studies explore this proposed method, which can be used in turn to facilitate the development and implementation of more effective and sustainable groundwater management strategies.

Conservative chiropractic management of urinary incontinence using applied kinesiology: a retrospective case-series report

PubMed Central

Cuthbert, Scott C.; Rosner, Anthony L.

2012-01-01

Objective The purpose of this case series is to describe the chiropractic management of 21 patients with daily stress and occasional total urinary incontinence (UI). Clinical Features Twenty-one case files of patients 13 to 90 years of age with UI from a chiropractic clinic were reviewed. The patients had a 4-month to 49-year history of UI and associated muscle dysfunction and low back and/or pelvic pain. Eighteen wore an incontinence pad throughout the day and night at the time of their appointments because of unpredictable UI. Intervention and Outcome Patients were evaluated for muscle impairments in the lumbar spine, pelvis, and pelvic floor and low back and/or hip pain. Positive manual muscle test results of the pelvis, lumbar spine muscles, and pelvic floor muscles were the most common findings. Lumbosacral dysfunction was found in 13 of the cases with pain provocation tests (applied kinesiology sensorimotor challenge); in 8 cases, this sensorimotor challenge was absent. Chiropractic manipulative therapy and soft tissue treatment addressed the soft tissue and articular dysfunctions. Chiropractic manipulative therapy involved high-velocity, low-amplitude manipulation; Cox flexion distraction manipulation; and/or use of a percussion instrument for the treatment of myofascial trigger points. Urinary incontinence symptoms resolved in 10 patients, considerably improved in 7 cases, and slightly improved in 4 cases. Periodic follow-up examinations for the past 6 years, and no less than 2 years, indicate that for each participant in this case-series report, the improvements of UI remained stable. Conclusion The patients reported in this retrospective case series showed improvement in UI symptoms that persisted over time. PMID:22942842

Variation in the levels of pregnancy-specific beta-1-glycoprotein in maternal serum from chromosomally abnormal pregnancies.

PubMed

Graham, G W; Crossley, J A; Aitken, D A; Connor, J M

1992-06-01

Human pregnancy-specific beta-1-glycoprotein (SP1) was assayed retrospectively in stored maternal serum (MS) samples from 82 chromosomally abnormal pregnancies and 377 matched controls. The median MSSP1 concentration in 48 Down's syndrome pregnancies was significantly elevated at 1.17 multiples of the control median (MOM), and significantly reduced (0.5 MOM) in a group of eight cases of unbalanced translocations. There was no significant difference in median SP1 concentrations in cases of trisomy 18, trisomy 13, balanced translocations, or sex chromosome abnormalities. A comparison with human chorionic gonadotrophin results in the same series of samples indicates that SP1 is a less sensitive predictor of Down's syndrome pregnancies.

Trichuris dysentery syndrome: Do we learn enough from case studies?

PubMed

Zeehaida, M; Zueter, A; Zairi, N Z; Zunulhisham, S

2015-09-01

Trichuris Dysentery Syndrome (TDS) is a severe persistent trichuriasis associated with heavy worm build-up in the colon that continues to be neglected and underestimated in endemic countries. Trichuriasis is most prevalent in children in tropical countries, and that increases the risk of TDS. We reported a series of four preschool children of both genders chronically having TDS over a period ranging from several months to years presenting with anaemia. The hemoglobin levels ranged from 4.6 to 9.1 g/dl on first admissions. Despite treatment, the cases were reported to have failure to thrive with persistent anaemia. It was concluded that TDS should be considered in endemic areas among children presenting with chronic bloody diarrhea and anaemia.

Early Tibiotalocalcaneal Arthrodesis Intramedullary Nail for Treatment of a Complex Tibial Pilon Fracture (AO/OTA 43-C).

PubMed

Hsu, Andrew R; Szatkowski, Jan P

2015-06-01

Management of severely comminuted, complete articular tibial pilon fractures (AO/OTA 43-C) remains a challenge, with few treatment options providing good clinical outcomes. Open reduction and internal fixation of the tibial plafond, tibiotalar arthrodesis, and salvage hindfoot reconstruction procedures are all associated with surgical complications and functional limitations. In this report, we present a case of a complex pilon fracture in a patient with multiple medical comorbidities and socioeconomic disadvantages that was successfully and acutely treated with a retrograde tibiotalocalcaneal hindfoot arthrodesis nail. At final follow-up examination, the patient had decreased pain, a stable plantigrade foot, and could ambulate with normal shoes without any assistive devices. Therapeutic, Level IV: Case series. © 2014 The Author(s).

Cardiac conduction disturbance after loperamide abuse.

PubMed

Marraffa, J M; Holland, M G; Sullivan, R W; Morgan, B W; Oakes, J A; Wiegand, T J; Hodgman, M J

2014-11-01

Prescription opioid abuse is a major public health concern and an ongoing epidemic in the United States. Loperamide is a widely available and inexpensive over-the-counter antidiarrheal with peripheral mu-opioid receptor activity. Online resources discuss the use of loperamide for the amelioration of withdrawal symptoms or recreational abuse. We describe the clinical course of 5 patients abusing loperamide, 3 of whom had life-threatening cardiac arrhythmias. In this observational case series, patients with cardiac arrhythmias or history of loperamide abuse with cardiac arrhythmias were identified; 5 patients were identified and 4 of the 5 patients were seen directly at the bedside. Clinical profile and outcome of patients is reported. We report 5 patients with history of loperamide abuse; 3 of the 5 patients had life-threatening cardiac arrhythmias. One of the patients experienced a second life-threatening arrhythmia after he resumed loperamide abuse. Loperamide levels were obtained in 4 of the 5 patients and were at least one order of magnitude greater than therapeutic concentrations. Discontinuation of loperamide resulted in complete resolution of cardiac conduction disturbances. This case series describes several patients with cardiac conduction abnormalities and life-threatening ventricular arrhythmias temporally related to loperamide abuse. With the recent efforts to restrict the diversion of prescription opioids, increasing abuse of loperamide as an opioid substitute may be seen. Toxicologists should be aware of these risks and we urge all clinicians to report such cases to FDA Medwatch(®).

Nationwide prospective audit of pancreatic surgery: design, accuracy, and outcomes of the Dutch Pancreatic Cancer Audit.

PubMed

van Rijssen, L Bengt; Koerkamp, Bas G; Zwart, Maurice J; Bonsing, Bert A; Bosscha, Koop; van Dam, Ronald M; van Eijck, Casper H; Gerhards, Michael F; van der Harst, Erwin; de Hingh, Ignace H; de Jong, Koert P; Kazemier, Geert; Klaase, Joost; van Laarhoven, Cornelis J; Molenaar, I Quintus; Patijn, Gijs A; Rupert, Coen G; van Santvoort, Hjalmar C; Scheepers, Joris J; van der Schelling, George P; Busch, Olivier R; Besselink, Marc G

2017-10-01

Auditing is an important tool to identify practice variation and 'best practices'. The Dutch Pancreatic Cancer Audit is mandatory in all 18 Dutch centers for pancreatic surgery. Performance indicators and case-mix factors were identified by a PubMed search for randomized controlled trials (RCT's) and large series in pancreatic surgery. In addition, data dictionaries of two national audits, three institutional databases, and the Dutch national cancer registry were evaluated. Morbidity, mortality, and length of stay were analyzed of all pancreatic resections registered during the first two audit years. Case ascertainment was cross-checked with the Dutch healthcare inspectorate and key-variables validated in all centers. Sixteen RCT's and three large series were found. Sixteen indicators and 20 case-mix factors were included in the audit. During 2014-2015, 1785 pancreatic resections were registered including 1345 pancreatoduodenectomies. Overall in-hospital mortality was 3.6%. Following pancreatoduodenectomy, mortality was 4.1%, Clavien-Dindo grade ≥ III morbidity was 29.9%, median (IQR) length of stay 12 (9-18) days, and readmission rate 16.0%. In total 97.2% of >40,000 variables validated were consistent with the medical charts. The Dutch Pancreatic Cancer Audit, with high quality data, reports good outcomes of pancreatic surgery on a national level. Copyright © 2017 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

Methicillin-resistant Staphylococcus aureus (MRSA) is increasing in Norway: a time series analysis of reported MRSA and methicillin-sensitive S. aureus cases, 1997-2010.

PubMed

Moxnes, John F; de Blasio, Birgitte Freiesleben; Leegaard, Truls Michael; Moen, Aina E Fossum

2013-01-01

Accurate estimates of the incidence and prevalence of methicillin-resistant Staphylococcus aureus (MRSA) infections are needed to inform public health policies. In Norway, where both MRSA infection and carriage are notifiable conditions, the reported incidence of MRSA is slowly increasing. However, the proportion of MRSA in relation to all S. aureus isolates is unknown, making it difficult to determine if the rising incidence is real or an artifact of an increasing number of tests performed. To characterize recent trends in MRSA infections and obtain a more complete understanding of the MRSA level in Norway. All reported cases of MRSA and methicillin-sensitive S. aureus (MSSA) from Oslo County (1997-2010) and Health Region East (2008-2008), representing approximately 11% and 36% of the Norwegian population, respectively, were analyzed using a stochastic time series analysis to characterize trends. In Oslo County, the proportion of methicillin-resistant cases increased from 0.73% to 3.78% during the study period and was well modeled by an exponential growth with a doubling constant of 5.7 years (95% CI 4.5-7.4 years). In Health Region East, the proportion of MRSA cases increased from 0.4% to 2.1% from 2002 to 2008, with a best-fitting linear increase of 0.26% (95% CI 0.21-0.30%) per year. In both cases, the choice of a linear or exponential model for the time trend produced only marginally different model fits. We found no significant changes due to revised national MRSA guidelines published in June 2009. Significant variations in the increasing time trend were observed in the five hospitals within the region. The yearly reported incidence of MSSA was relatively stable in both study areas although we found seasonal patterns with peaks in August. The level of MRSA is increasing in Norway, and the proportion of methicillin resistance in all S. aureus isolates are higher than the reported proportion of MRSA in invasive infections.

A NOVEL APPROACH TO TREATMENT FOR CHRONIC AVULSION FRACTURE OF THE ISCHIAL TUBEROSITY IN THREE ADOLESCENT ATHLETES: A CASE SERIES

PubMed Central

Nilsson, Kurt J.

2014-01-01

Background and Incidence: Ischial tuberosity fracture and its associated complications are an under recognized diagnosis in the adolescent athlete. Apophyseal injuries of the pelvis in the skeletally immature athlete can occur in multiple locations but are most common at the ischial tuberosity, affecting males more commonly than females. Description of Injury and Current Management: The most common cause of ischial tuberosity avulsion fracture is a quick eccentric load to the proximal hamstrings, occurring with kicking as in soccer, football, or dance. Signs and symptoms are similar to a proximal hamstring injury but avulsion injuries often go undiagnosed, as radiographs are not frequently obtained. In acute cases, rest and relative immobilization are the recommended course of care. In chronic cases, including those with delayed diagnosis, or those that remain symptomatic after initial care due to non‐union or associated sciatic nerve adhesions, surgery is often performed in order to restore normal anatomy, alleviate symptoms, and help return the athlete to full activity. Purpose: The authors' share a novel treatment approach consisting of ultrasound guided percutaneous needle fenestration for the treatment of three adolescent athletes with symptomatic delayed diagnoses of ischial tuberosity fractures. Needle fenestration was followed by a physical therapy progression which was developed based on tissue healing rates, symptom presentation, and the available literature related to proximal hamstring injuries. Outcomes: Two athletes reported elimination of pain, full functional recovery and return to sport without limitations as measured by use of the Numeric Pain Rating Scale, the Global Rating of Change Scale, and the Lower Extremity Functional Scale. One athlete reported elimination of pain and full functional recovery and chose to return to a new sport. Symptoms of possible concurrent hamstring syndrome are discussed as well the management of this condition. Discussion/Conclusions: This case series introduced a novel approach for treatment of symptomatic delayed union ischial tuberosity fractures in three adolescents prior to consideration of surgical intervention. Percutanous needle fenestration and the described subsequent rehabilitation provided positive treatment outcomes in the presented cases, including full return to athletic and recreational endeavors. Level of Evidence: Level 5 PMID:25540712

Methicillin-Resistant Staphylococcus aureus (MRSA) Is Increasing in Norway: A Time Series Analysis of Reported MRSA and Methicillin-Sensitive S. aureus Cases, 1997–2010

PubMed Central

Moxnes, John F.; de Blasio, Birgitte Freiesleben; Leegaard, Truls Michael; Moen, Aina E. Fossum

2013-01-01

Background Accurate estimates of the incidence and prevalence of methicillin-resistant Staphylococcus aureus (MRSA) infections are needed to inform public health policies. In Norway, where both MRSA infection and carriage are notifiable conditions, the reported incidence of MRSA is slowly increasing. However, the proportion of MRSA in relation to all S. aureus isolates is unknown, making it difficult to determine if the rising incidence is real or an artifact of an increasing number of tests performed. Aim To characterize recent trends in MRSA infections and obtain a more complete understanding of the MRSA level in Norway. Methods All reported cases of MRSA and methicillin-sensitive S. aureus (MSSA) from Oslo County (1997–2010) and Health Region East (2008–2008), representing approximately 11% and 36% of the Norwegian population, respectively, were analyzed using a stochastic time series analysis to characterize trends. Results In Oslo County, the proportion of methicillin-resistant cases increased from 0.73% to 3.78% during the study period and was well modeled by an exponential growth with a doubling constant of 5.7 years (95% CI 4.5–7.4 years). In Health Region East, the proportion of MRSA cases increased from 0.4% to 2.1% from 2002 to 2008, with a best-fitting linear increase of 0.26% (95% CI 0.21–0.30%) per year. In both cases, the choice of a linear or exponential model for the time trend produced only marginally different model fits. We found no significant changes due to revised national MRSA guidelines published in June 2009. Significant variations in the increasing time trend were observed in the five hospitals within the region. The yearly reported incidence of MSSA was relatively stable in both study areas although we found seasonal patterns with peaks in August. Conclusion The level of MRSA is increasing in Norway, and the proportion of methicillin resistance in all S. aureus isolates are higher than the reported proportion of MRSA in invasive infections. PMID:23936442

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

Two levels ARIMAX and regression models for forecasting time series data with calendar variation effects

NASA Astrophysics Data System (ADS)

Suhartono, Lee, Muhammad Hisyam; Prastyo, Dedy Dwi

2015-12-01

The aim of this research is to develop a calendar variation model for forecasting retail sales data with the Eid ul-Fitr effect. The proposed model is based on two methods, namely two levels ARIMAX and regression methods. Two levels ARIMAX and regression models are built by using ARIMAX for the first level and regression for the second level. Monthly men's jeans and women's trousers sales in a retail company for the period January 2002 to September 2009 are used as case study. In general, two levels of calendar variation model yields two models, namely the first model to reconstruct the sales pattern that already occurred, and the second model to forecast the effect of increasing sales due to Eid ul-Fitr that affected sales at the same and the previous months. The results show that the proposed two level calendar variation model based on ARIMAX and regression methods yields better forecast compared to the seasonal ARIMA model and Neural Networks.

Advanced methods for modeling water-levels and estimating drawdowns with SeriesSEE, an Excel add-in

USGS Publications Warehouse

Halford, Keith; Garcia, C. Amanda; Fenelon, Joe; Mirus, Benjamin B.

2012-12-21

Water-level modeling is used for multiple-well aquifer tests to reliably differentiate pumping responses from natural water-level changes in wells, or “environmental fluctuations.” Synthetic water levels are created during water-level modeling and represent the summation of multiple component fluctuations, including those caused by environmental forcing and pumping. Pumping signals are modeled by transforming step-wise pumping records into water-level changes by using superimposed Theis functions. Water-levels can be modeled robustly with this Theis-transform approach because environmental fluctuations and pumping signals are simulated simultaneously. Water-level modeling with Theis transforms has been implemented in the program SeriesSEE, which is a Microsoft® Excel add-in. Moving average, Theis, pneumatic-lag, and gamma functions transform time series of measured values into water-level model components in SeriesSEE. Earth tides and step transforms are additional computed water-level model components. Water-level models are calibrated by minimizing a sum-of-squares objective function where singular value decomposition and Tikhonov regularization stabilize results. Drawdown estimates from a water-level model are the summation of all Theis transforms minus residual differences between synthetic and measured water levels. The accuracy of drawdown estimates is limited primarily by noise in the data sets, not the Theis-transform approach. Drawdowns much smaller than environmental fluctuations have been detected across major fault structures, at distances of more than 1 mile from the pumping well, and with limited pre-pumping and recovery data at sites across the United States. In addition to water-level modeling, utilities exist in SeriesSEE for viewing, cleaning, manipulating, and analyzing time-series data.

Series: Pragmatic trials and real world evidence: Paper 8. Data collection and management.

PubMed

Meinecke, Anna-Katharina; Welsing, Paco; Kafatos, George; Burke, Des; Trelle, Sven; Kubin, Maria; Nachbaur, Gaelle; Egger, Matthias; Zuidgeest, Mira

2017-11-01

Pragmatic trials can improve our understanding of how treatments will perform in routine practice. In a series of eight papers, the GetReal Consortium has evaluated the challenges in designing and conducting pragmatic trials and their specific methodological, operational, regulatory, and ethical implications. The present final paper of the series discusses the operational and methodological challenges of data collection in pragmatic trials. A more pragmatic data collection needs to balance the delivery of highly accurate and complete data with minimizing the level of interference that data entry and verification induce with clinical practice. Furthermore, it should allow for the involvement of a representative sample of practices, physicians, and patients who prescribe/receive treatment in routine care. This paper discusses challenges that are related to the different methods of data collection and presents potential solutions where possible. No one-size-fits-all recommendation can be given for the collection of data in pragmatic trials, although in general the application of existing routinely used data-collection systems and processes seems to best suit the pragmatic approach. However, data access and privacy, the time points of data collection, the level of detail in the data, and the lack of a clear understanding of the data-collection process were identified as main challenges for the usage of routinely collected data in pragmatic trials. A first step should be to determine to what extent existing health care databases provide the necessary study data and can accommodate data collection and management. When more elaborate or detailed data collection or more structured follow-up is required, data collection in a pragmatic trial will have to be tailor-made, often using a hybrid approach using a dedicated electronic case report form (eCRF). In this case, the eCRF should be kept as simple as possible to reduce the burden for practitioners and minimize influence on routine clinical practice. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

(Meth)Acrylate Occupational Contact Dermatitis in Nail Salon Workers: A Case Series.

PubMed

DeKoven, Samuel; DeKoven, Joel; Holness, D Linn

Recently, many cases of acrylate-associated allergic contact dermatitis have appeared among nail salon workers. Common acrylate-containing products in nail salons include traditional nail polish, ultraviolet-cured shellac nail polish, ultraviolet-cured gel nails, and press-on acrylic nails. Nail salon technicians seen in the occupational medicine clinic in 2015 and 2016 were identified, and their patch test results and clinical features were summarized. Patch testing was done with the Chemotechnique (Meth)Acrylate nail series, and either the North American Standard series or the North American Contact Dermatitis Group screening series. Six patients were identified, all women, ages 38 to 58. Common presentations included erythematous dermatitis of the dorsa of the hands, palms, and forearms and fissures on the fingertips. Less common sites of eruptions included the periorbital region, cheeks, posterior ears, neck, sacral area, lateral thighs, and dorsa of the feet. All patients reacted to hydroxyethyl methacrylate, and 5 patients reacted to ethyl acrylate. Each patient also reacted to (meth)acrylates that are not found on either standard series, including ethyleneglycol dimethacrylate, 2-hydroxypropyl methacrylate, and 2-hydroxyethyl acrylate. The authors report 6 cases of allergic contact dermatitis to acrylates in nail technicians seen over the past year, representing a new trend in their clinic. These cases are reflective of a growing trend of nail technicians with allergic contact dermatitis associated with occupational (meth)acrylate exposure. Efforts to improve prevention are needed.

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

Soubies, B.; Henry, J.Y.; Le Meur, M.

1300 MWe pressurised water reactors (PWRs), like the 1400 MWe reactors, operate with microprocessor-based safety systems. This is particularly the case for the Digital Integrated Protection System (SPIN), which trips the reactor in an emergency and sets in action the safeguard functions. The softwares used in these systems must therefore be highly dependable in the execution of their functions. In the case of SPIN, three players are working at different levels to achieve this goal: the protection system manufacturer, Merlin Gerin; the designer of the nuclear steam supply system, Framatome; the operator of the nuclear power plants, Electricite de Francemore » (EDF), which is also responsible for the safety of its installations. Regulatory licenses are issued by the French safety authority, the Nuclear Installations Safety Directorate (French abbreviation DSIN), subsequent to a successful examination of the technical provisions adopted by the operator. This examination is carried out by the IPSN and the standing group on nuclear reactors. This communication sets out: the methods used by the manufacturer to develop SPIN software for the 1400 MWe PWRs (N4 series); the approach adopted by the IPSN to evaluate the safety software of the protection system for the N4 series of reactors.« less

Rare case-series of electrocautery burn following off-pump coronary artery bypass grafting

PubMed Central

Sabzi, Feridoun; Niazi, Mojtaba; Ahmadi, Alireza

2014-01-01

Abstract: With an increasing number of off-pump coronary artery surgery procedures in high-risk patients with coagulopathy, including renal failure, hepatic failure and anticoagulant drug-using patients, the frequency of related complications such as repeated exploration for bleeding is also increasing. The associated co-morbidity and repeated use of electrocautery in postoperative bleeding leaves patients susceptible to electrocautery ulcers. In this case series, rare cases of cautery burn with unique causative mechanisms are described. PMID:23669602

Impact of climate change on potential evapotranspiration (case study: west and NW of Iran)

NASA Astrophysics Data System (ADS)

Dinpashoh, Y.; Jahanbakhsh-Asl, S.; Rasouli, A. A.; Foroughi, M.; Singh, V. P.

2018-04-01

Potential evapotranspiration (ET0) is one of the main elements when computing agricultural irrigation requirements and scheduling. All climatic parameters as well as ET0 are influenced by climate change. The aim of this study is trend analysis of monthly and annual ET0 time series in the west and NW of Iran. Values of ET0 are estimated at 36 selected stations, using the FAO-56 Penman-Monteith (FAO-56 PM) method. Then, the non-parametric Mann-Kendall (MK) method was used to detect trends. The slopes of trend lines are estimated using Sen's estimator approach. Results showed that about 86%of the monthly ET0 time series had upward trends of which 35.6 and 43% were significant at 0.01 and 0.05 levels, respectively, 47.4% exhibited a significant upward trend at the 10% level. In contrast, less than 0.7% of the whole monthly ET0 time series showed a significant downward trend (α < 0.01). Only 1.1% of the monthly ET0 time series had significant downward trends (α < 0.10). The strongest positive upward trend (significant at the 0.01 level) was detected in August at the Kermanshah station. However, the strongest negative downward trend belonged to the Khodabandeh station. The steepest upward and downward monthly ET0 slopes were observed at Maragheh and Khodabandeh stations. The magnitude of trends for these two stations are estimated as 2.33 and - 2.01 mm/year, respectively. On an annual timescale, above 94% of the stations had upward trend slopes. About 67% of the total stations exhibited significant trends at the 10% level. Very few sites (2.7%) showed downward annual ET0 trends (α < 0.10). At the annual scale, the first three strongest upward trends belonged to the Kermanshah, Urmia, and Tabriz stations, respectively (α < 0.01). It can be concluded that ET0 in the west and NW of Iran have an increasing trend for most of the stations. Therefore, it is important to use water in a prudent manner in this area.

Vitamin D levels and risk for periodontal disease: A systematic review.

PubMed

Pinto, J P N S; Goergen, J; Muniz, F W M G; Haas, A N

2018-06-01

To evaluate the existing evidence supporting or refuting the following questions: (i) Do patients with lower vitamin D levels have higher risk for periodontal disease? (ii) Are periodontal treatment outcomes improved by the adjuvant supplementation of vitamin D or by elevated serum vitamin D levels? MEDLINE, SCOPUS, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched up to September 2017. Studies were included if they had measured serum vitamin D levels or vitamin D intake and any periodontal parameter. Overall, 27 studies were included (13 cross-sectional studies, 6 case-control studies, 5 cohort studies, 2 randomized clinical trials and 1 case series study). Sixty-five percent of the cross-sectional studies reported significant associations between low vitamin D levels and poor periodontal parameters. None of the observational longitudinal studies found that periodontal disease progression could be attributed to lower vitamin D levels. No interventional studies that evaluated the use of vitamin D supplementation as a solely adjuvant to periodontal treatment was found. No meta-analysis was performed due to high variability across studies. The data to support or refute the association between vitamin D levels and periodontal disease are inconclusive at the moment. More rigorously designed longitudinal studies with standardized definitions of periodontal disease and vitamin D are necessary. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Convergence and divergence in spherical harmonic series of the gravitational field generated by high-resolution planetary topography—A case study for the Moon

NASA Astrophysics Data System (ADS)

Hirt, Christian; Kuhn, Michael

2017-08-01

Theoretically, spherical harmonic (SH) series expansions of the external gravitational potential are guaranteed to converge outside the Brillouin sphere enclosing all field-generating masses. Inside that sphere, the series may be convergent or may be divergent. The series convergence behavior is a highly unstable quantity that is little studied for high-resolution mass distributions. Here we shed light on the behavior of SH series expansions of the gravitational potential of the Moon. We present a set of systematic numerical experiments where the gravity field generated by the topographic masses is forward-modeled in spherical harmonics and with numerical integration techniques at various heights and different levels of resolution, increasing from harmonic degree 90 to 2160 ( 61 to 2.5 km scales). The numerical integration is free from any divergence issues and therefore suitable to reliably assess convergence versus divergence of the SH series. Our experiments provide unprecedented detailed insights into the divergence issue. We show that the SH gravity field of degree-180 topography is convergent anywhere in free space. When the resolution of the topographic mass model is increased to degree 360, divergence starts to affect very high degree gravity signals over regions deep inside the Brillouin sphere. For degree 2160 topography/gravity models, severe divergence (with several 1000 mGal amplitudes) prohibits accurate gravity modeling over most of the topography. As a key result, we formulate a new hypothesis to predict divergence: if the potential degree variances show a minimum, then the SH series expansions diverge somewhere inside the Brillouin sphere and modeling of the internal potential becomes relevant.

ON THE FOURIER AND WAVELET ANALYSIS OF CORONAL TIME SERIES

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

Auchère, F.; Froment, C.; Bocchialini, K.

Using Fourier and wavelet analysis, we critically re-assess the significance of our detection of periodic pulsations in coronal loops. We show that the proper identification of the frequency dependence and statistical properties of the different components of the power spectra provides a strong argument against the common practice of data detrending, which tends to produce spurious detections around the cut-off frequency of the filter. In addition, the white and red noise models built into the widely used wavelet code of Torrence and Compo cannot, in most cases, adequately represent the power spectra of coronal time series, thus also possibly causingmore » false positives. Both effects suggest that several reports of periodic phenomena should be re-examined. The Torrence and Compo code nonetheless effectively computes rigorous confidence levels if provided with pertinent models of mean power spectra, and we describe the appropriate manner in which to call its core routines. We recall the meaning of the default confidence levels output from the code, and we propose new Monte-Carlo-derived levels that take into account the total number of degrees of freedom in the wavelet spectra. These improvements allow us to confirm that the power peaks that we detected have a very low probability of being caused by noise.« less

On the Fourier and Wavelet Analysis of Coronal Time Series

NASA Astrophysics Data System (ADS)

Auchère, F.; Froment, C.; Bocchialini, K.; Buchlin, E.; Solomon, J.

2016-07-01

Using Fourier and wavelet analysis, we critically re-assess the significance of our detection of periodic pulsations in coronal loops. We show that the proper identification of the frequency dependence and statistical properties of the different components of the power spectra provides a strong argument against the common practice of data detrending, which tends to produce spurious detections around the cut-off frequency of the filter. In addition, the white and red noise models built into the widely used wavelet code of Torrence & Compo cannot, in most cases, adequately represent the power spectra of coronal time series, thus also possibly causing false positives. Both effects suggest that several reports of periodic phenomena should be re-examined. The Torrence & Compo code nonetheless effectively computes rigorous confidence levels if provided with pertinent models of mean power spectra, and we describe the appropriate manner in which to call its core routines. We recall the meaning of the default confidence levels output from the code, and we propose new Monte-Carlo-derived levels that take into account the total number of degrees of freedom in the wavelet spectra. These improvements allow us to confirm that the power peaks that we detected have a very low probability of being caused by noise.

HMGCR-associated myositis: a New Zealand case series and estimate of incidence.

PubMed

Kennedy, N; Keating, P; O'Donnell, J

2016-05-01

Statins are one of the most commonly prescribed drugs in New Zealand, with 525 772 or 16.5% of the adult New Zealand population prescribed a statin between June 2013 and July 2014. While generally well-tolerated, statins are known to cause a range of muscle-related side effects, ranging from myalgia to life-threatening rhabdomyolysis. Recently, it has been recognised that in rare instances, statins can induce an immune-mediated necrotising myositis with antibodies against 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR), the enzymatic target of statins. In 2014, anti-HMGCR antibody testing was introduced to Canterbury Health Laboratories (CHL), with this being the only laboratory in New Zealand performing this test during the period of this case series. This article describes an index case and characterises the clinical features of a subsequent 12-month series. From this series, we estimated the yearly incidence of HMGCR-associated myositis at 1.7/million/year or ~1/90 000 New Zealand statin users. © 2016 Royal Australasian College of Physicians.

Atmospheric Pressure and Abdominal Aortic Aneurysm Rupture: Results From a Time Series Analysis and Case-Crossover Study.

PubMed

Penning de Vries, Bas B L; Kolkert, Joé L P; Meerwaldt, Robbert; Groenwold, Rolf H H

2017-10-01

Associations between atmospheric pressure and abdominal aortic aneurysm (AAA) rupture risk have been reported, but empirical evidence is inconclusive and largely derived from studies that did not account for possible nonlinearity, seasonality, and confounding by temperature. Associations between atmospheric pressure and AAA rupture risk were investigated using local meteorological data and a case series of 358 patients admitted to hospital for ruptured AAA during the study period, January 2002 to December 2012. Two analyses were performed-a time series analysis and a case-crossover study. Results from the 2 analyses were similar; neither the time series analysis nor the case-crossover study showed a significant association between atmospheric pressure ( P = .627 and P = .625, respectively, for mean daily atmospheric pressure) or atmospheric pressure variation ( P = .464 and P = .816, respectively, for 24-hour change in mean daily atmospheric pressure) and AAA rupture risk. This study failed to support claims that atmospheric pressure causally affects AAA rupture risk. In interpreting our results, one should be aware that the range of atmospheric pressure observed in this study is not representative of the atmospheric pressure to which patients with AAA may be exposed, for example, during air travel or travel to high altitudes in the mountains. Making firm claims regarding these conditions in relation to AAA rupture risk is difficult at best. Furthermore, despite the fact that we used one of the largest case series to date to investigate the effect of atmospheric pressure on AAA rupture risk, it is possible that this study is simply too small to demonstrate a causal link.

Drug induced liver injury with analysis of alternative causes as confounding variables.

PubMed

Teschke, Rolf; Danan, Gaby

2018-04-01

Drug-induced liver injury (DILI) is rare compared to the worldwide frequent acute or chronic liver diseases. Therefore, patients included in series of suspected DILI are at high risk of not having DILI, whereby alternative causes may confound the DILI diagnosis. The aim of this review is to evaluate published case series of DILI for alternative causes. Relevant studies were identified using a computerized search of the Medline database for publications from 1993 through 30 October 2017. We used the following terms: drug hepatotoxicity, drug induced liver injury, hepatotoxic drugs combined with diagnosis, causality assessment and alternative causes. Alternative causes as variables confounding the DILI diagnosis emerged in 22 published DILI case series, ranging from 4 to 47%. Among 13 335 cases of suspected DILI, alternative causes were found to be more likely in 4555 patients (34.2%), suggesting that the suspected DILI was probably not DILI. Biliary diseases such as biliary obstruction, cholangitis, choledocholithiasis, primary biliary cholangitis and primary sclerosing cholangitis were among the most missed diagnoses. Alternative causes included hepatitis B, C and E, cytomegalovirus, Epstein-Barr virus, ischemic hepatitis, cardiac hepatopathy, autoimmune hepatitis, nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, and alcoholic liver disease. In more than one-third of published global DILI case series, alternative causes as published in these reports confounded the DILI diagnosis. In the future, published DILI case series should include only patients with secured DILI diagnosis, preferentially established by prospective use of scored items provided by robust diagnostic algorithms such as the updated Roussel Uclaf causality assessment method. © 2018 The British Pharmacological Society.

Outcome of single-trajectory rigid endoscopic third ventriculostomy and biopsy in the management algorithm of pineal region tumors: a case series and review of the literature.

PubMed

Abbassy, Mahmoud; Aref, Khaled; Farhoud, Ahmed; Hekal, Anwar

2018-05-28

Tumors within the pineal region represent 1.5 to 8.5% of the pediatric brain tumors and 1.2% of all brain tumors. A management algorithm has been proposed in several publications. The algorithm includes endoscopic third ventriculostomy (ETV) and biopsy in cases presenting with hydrocephalus. In this series, we are presenting the efficacy of a single-trajectory approach for both ETV and biopsy. Eleven cases were admitted to Alexandria main university hospital from 2013 to 2016 presenting with pineal region tumors and hydrocephalus. Mean age at diagnosis was 11 years (1-27 years). All cases had ETV and biopsy using rigid ventriculoscope through a single trajectory from a burr hole planned on preoperative imaging. Follow-up period was 7-48 months. All 11 cases presented with hydrocephalus and increased intracranial pressure manifestations. Histopathological diagnosis was successful in 9 out of 11 cases (81.8%). Three cases were germ-cell tumors, two cases were pineoblastomas, two cases were pilocytic astrocytomas, and two cases were grade 2 tectal gliomas. Five of the ETV cases (45.5%) failed and required VPS later on. Other complications of ETV included one case of intraventricular hemorrhage and a case with tumor disseminated to the basal cisterns. In our series, we were able to achieve ETV and biopsy through a single trajectory and a rigid endoscope with results comparable to other studies in the literature.

Therapeutic Assessment for Preadolescent Boys with Oppositional Defiant Disorder: A Replicated Single-Case Time-Series Design

ERIC Educational Resources Information Center

Smith, Justin D.; Handler, Leonard; Nash, Michael R.

2010-01-01

The Therapeutic Assessment (TA) model is a relatively new treatment approach that fuses assessment and psychotherapy. The study examines the efficacy of this model with preadolescent boys with oppositional defiant disorder and their families. A replicated single-case time-series design with daily measures is used to assess the effects of TA and to…

"Excess gooD can be Dangerous". A case series of iatrogenic symptomatic hypercalcemia due to hypervitaminosis D.

PubMed

Pandita, Kamal Kishore; Razdan, Sushil; Kudyar, Rattan Parkash; Beigh, Aadil; Kuchay, Shafi; Banday, Tanveer

2012-05-01

Vitamin D is increasingly recognized to have several beneficial effects. Its toxicity, causing hypercalcemia, is considered as extremely rare. We report case series of 15 patients (most of them being elderly subjects) with iatrogenic symptomatic hypercalcemia in whom toxicity occurred due to empirical excessive administration of vitamin D by oral and parenteral route.

Intervention for Infants at Risk of Developing Autism: A Case Series

ERIC Educational Resources Information Center

Green, Jonathan; Wan, Ming Wai; Guiraud, Jeanne; Holsgrove, Samina; McNally, Janet; Slonims, Vicky; Elsabbagh, Mayada; Charman, Tony; Pickles, Andrew; Johnson, Mark

2013-01-01

Theory and evidence suggest the potential value of prodromal intervention for infants at risk of developing autism. We report an initial case series (n = 8) of a parent-mediated, video-aided and interaction-focused intervention with infant siblings of autistic probands, beginning at 8-10 months of age. We outline the theory and evidence base…

Is Family Therapy Useful for Treating Children with Anorexia Nervosa? Results of a Case Series

ERIC Educational Resources Information Center

Lock, James; le Grange, Daniel; Forsberg, Sarah; Hewell, Kristen

2006-01-01

Objective: Research suggests that family-based treatment (FBT) is an effective treatment for adolescents with anorexia nervosa (AN). This retrospective case series was designed to examine its usefulness with younger children. Method: Data were abstracted from medical records of 32 children with a mean age of 11.9 years (range 9.0-12.9) meeting…

A Case Series of Marijuana Exposures in Pediatric Patients Less than 5 Years of Age

ERIC Educational Resources Information Center

Wang, George Sam; Narang, Sandeep K.; Wells, Kathryn; Chuang, Ryan

2011-01-01

Objective: In Colorado, there has been a large increase in medical marijuana dispensaries and licenses for the use of medical marijuana over the past year. This is a retrospective case series of marijuana exposures that have presented to the emergency department (ED) in children less than 5 years of age. Methods: We performed a retrospective chart…

Repetitive deliberate fires: Development and validation of a methodology to detect series.

PubMed

Bruenisholz, Eva; Delémont, Olivier; Ribaux, Olivier; Wilson-Wilde, Linzi

2017-08-01

The detection of repetitive deliberate fire events is challenging and still often ineffective due to a case-by-case approach. A previous study provided a critical review of the situation and analysis of the main challenges. This study suggested that the intelligence process, integrating forensic data, could be a valid framework to provide a follow-up and systematic analysis provided it is adapted to the specificities of repetitive deliberate fires. In this current manuscript, a specific methodology to detect deliberate fires series, i.e. set by the same perpetrators, is presented and validated. It is based on case profiles relying on specific elements previously identified. The method was validated using a dataset of approximately 8000 deliberate fire events collected over 12 years in a Swiss state. Twenty possible series were detected, including 6 of 9 known series. These results are very promising and lead the way to a systematic implementation of this methodology in an intelligence framework, whilst demonstrating the need and benefit of increasing the collection of forensic specific information to strengthen the value of links between cases. Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.

Clearance of yellow tattoo ink with a novel 532-nm picosecond laser.

PubMed

Alabdulrazzaq, Hamad; Brauer, Jeremy A; Bae, Yoon-Soo; Geronemus, Roy G

2015-04-01

Although technology and tattoo removal methods continue to evolve, yellow pigment clearance continues to be challenging and usually unsuccessful. We describe a case series of six tattoos containing yellow ink, successfully treated with a frequency-doubled Nd:YAG 532-nm picosecond laser. Case series with six subjects participating for the treatment of multicolored tattoos that contain yellow pigment. Treatments performed with a frequency-doubled Nd:YAG 532-nm picosecond laser at 6-8 week intervals. One subject achieved complete clearance of the treated site after one session, and five subjects required 2-4 treatments to achieve over 75% clearance. Minimal downtime was experienced, and no scarring or textural skin changes were observed in any of the treated sites. This is the first case series that demonstrates effective and consistent reduction of yellow tattoo ink using a frequency doubled Nd:YAG 532-nm laser with a picosecond pulse duration. Treatments were well tolerated and subjects had positive outcomes. This is a small observational case series from an ongoing clinical trial, and studies with a larger sample size and comparative group are needed in the future. © 2015 Wiley Periodicals, Inc.

Ketogenic diet therapy for epilepsy during pregnancy: A case series.

PubMed

van der Louw, Elles J T M; Williams, Tanya J; Henry-Barron, Bobbie J; Olieman, Joanne F; Duvekot, Johannes J; Vermeulen, Marijn J; Bannink, Natalja; Williams, Monique; Neuteboom, Rinze F; Kossoff, Eric H; Catsman-Berrevoets, Coriene E; Cervenka, Mackenzie C

2017-02-01

Evaluation of ketogenic diet (KD) therapies for seizure control during pregnancy when safety and appropriate management become considerations. Until now, no information has been available on seizure reduction and human pregnancy related outcomes in women treated with KD therapies. We describe two cases of pregnant women with epilepsy treated with KD therapy either as monotherapy (Case 1) or as adjunctive therapy (Case 2). Case 1: A 27 year old woman, gravida1, started the classic KD with medium chain triglyceride (MCT) emulsion and 75g carbohydrate-restriction, later reduced to 47g. Glucose levels were 4-6mmol/L and blood ketone levels ranged from 0.2 to 1.4mmol/L. Seizure frequency decreased and seizure-free days increased. Mild side effects included intolerance to MCT, reduced serum carnitine and vitamin levels, and mild hyperlipidemia. Fetal and neonatal growth was normal as was growth and development at 12 months. Case 2: A 36 year-old nulliparous woman was treated with a 20 gram carbohydrate-restricted Modified Atkins Diet (MAD) and lamotrigine, resulting in reduction of seizure frequency to once per month prior to pregnancy. Once pregnant, carbohydrates were increased to 30g. When seizures increased, lamotrigine dose was doubled. Urine ketones trended down during second trimester. A male was born with bilateral ear deformities of unknown significance. The child had a normal neurodevelopment at eight months. Non-pharmacological epilepsy therapies like KD and MAD may be effective during human pregnancy. However, safety still has to be established. Further monitoring to identify potential long term side effects is warranted. Copyright © 2017 British Epilepsy Association. All rights reserved.

Cases series of malignant lymphohematopoietic disorder in korean semiconductor industry.

PubMed

Kim, Eun-A; Lee, Hye-Eun; Ryu, Hyung-Woo; Park, Seung-Hyun; Kang, Seong-Kyu

2011-06-01

Seven cases of malignant lymphohematopoietic (LHP) disorder were claimed to have developed from occupational exposure at two plants of a semiconductor company from 2007 to 2010. This study evaluated the possibility of exposure to carcinogenic agents for the cases. Clinical courses were reviewed with assessing possible exposure to carcinogenic agents related to LHP cancers. Chemicals used at six major semiconductor companies in Korea were reviewed. Airborne monitoring for chemicals, including benzene, was conducted and the ionizing radiation dose was measured from 2008 to 2010. The latency of seven cases (five leukemiae, a Non-Hodgkin's lymphoma, and an aplastic anemia) ranged from 16 months to 15 years and 5 months. Most chemical measurements were at levels of less than 10% of the Korean Occupational Exposure Limit value. No carcinogens related to LHP cancers were used or detected. Complete-shielded radiation-generating devices were used, but the ionizing radiation doses were 0.20-0.22 uSv/hr (background level: 0.21 µSv/hr). Airborne benzene was detected at 0.31 ppb when the detection limit was lowered as low as possible. Ethylene oxide and formaldehyde were not found in the cases' processes, while these two were determined to be among the 263 chemicals in the list that was used at the six semiconductor companies at levels lower than 0.1%. Exposures occurring before 2002 could not be assessed because of the lack of information. Considering the possibility of exposure to carcinogenic agents, we could not find any convincing evidence for occupational exposure in all investigated cases. However, further study is needed because the semiconductor industry is a newly developing one.

Cases Series of Malignant Lymphohematopoietic Disorder in Korean Semiconductor Industry

PubMed Central

Lee, Hye-Eun; Ryu, Hyung-Woo; Park, Seung-Hyun; Kang, Seong-Kyu

2011-01-01

Objectives Seven cases of malignant lymphohematopoietic (LHP) disorder were claimed to have developed from occupational exposure at two plants of a semiconductor company from 2007 to 2010. This study evaluated the possibility of exposure to carcinogenic agents for the cases. Methods Clinical courses were reviewed with assessing possible exposure to carcinogenic agents related to LHP cancers. Chemicals used at six major semiconductor companies in Korea were reviewed. Airborne monitoring for chemicals, including benzene, was conducted and the ionizing radiation dose was measured from 2008 to 2010. Results The latency of seven cases (five leukemiae, a Non-Hodgkin's lymphoma, and an aplastic anemia) ranged from 16 months to 15 years and 5 months. Most chemical measurements were at levels of less than 10% of the Korean Occupational Exposure Limit value. No carcinogens related to LHP cancers were used or detected. Complete-shielded radiation-generating devices were used, but the ionizing radiation doses were 0.20-0.22 uSv/hr (background level: 0.21 µSv/hr). Airborne benzene was detected at 0.31 ppb when the detection limit was lowered as low as possible. Ethylene oxide and formaldehyde were not found in the cases' processes, while these two were determined to be among the 263 chemicals in the list that was used at the six semiconductor companies at levels lower than 0.1%. Exposures occurring before 2002 could not be assessed because of the lack of information. Conclusion Considering the possibility of exposure to carcinogenic agents, we could not find any convincing evidence for occupational exposure in all investigated cases. However, further study is needed because the semiconductor industry is a newly developing one. PMID:22953195

39 CFR 262.6 - Retention and disposal.

Code of Federal Regulations, 2013 CFR

2013-07-01

... of time between the creation of a series and its authorized disposal date; however, in some cases it... series that are maintained by components of the Postal Service; it provides maintenance, retention, transfer, and disposal instructions for each series listed, and serves as the authority for Postal...

39 CFR 262.6 - Retention and disposal.

Code of Federal Regulations, 2012 CFR

2012-07-01

... of time between the creation of a series and its authorized disposal date; however, in some cases it... series that are maintained by components of the Postal Service; it provides maintenance, retention, transfer, and disposal instructions for each series listed, and serves as the authority for Postal...

39 CFR 262.6 - Retention and disposal.

Code of Federal Regulations, 2014 CFR

2014-07-01

... of time between the creation of a series and its authorized disposal date; however, in some cases it... series that are maintained by components of the Postal Service; it provides maintenance, retention, transfer, and disposal instructions for each series listed, and serves as the authority for Postal...

39 CFR 262.6 - Retention and disposal.

Code of Federal Regulations, 2010 CFR

2010-07-01

... of time between the creation of a series and its authorized disposal date; however, in some cases it... series that are maintained by components of the Postal Service; it provides maintenance, retention, transfer, and disposal instructions for each series listed, and serves as the authority for Postal...

39 CFR 262.6 - Retention and disposal.

Code of Federal Regulations, 2011 CFR

2011-07-01

... of time between the creation of a series and its authorized disposal date; however, in some cases it... series that are maintained by components of the Postal Service; it provides maintenance, retention, transfer, and disposal instructions for each series listed, and serves as the authority for Postal...

Intralipid therapy does not improve level of consciousness in overdoses with sedating drugs: a case series.

PubMed

Downes, Michael A; Calver, Leonie A; Isbister, Geoffrey K

2014-06-01

To assess the effect of intralipid emulsion therapy (ILE) in sedating drugs presenting to an urban emergency department. Following the introduction of a clinical protocol for the use of ILE a retrospective chart review was undertaken, which describes the use of ILE in treating sedating drug overdose in a facility with a tertiary referral level clinical toxicology unit. Demographic data as well as details of drug ingested, physiological parameters and disposition were extracted from the medical record. Over a 7 month period nine cases were treated with intralipid, of which two were male and the median age was 33 years (17-52 years). Endotracheal intubation was required in seven cases and of the other two, one required a nasopharyngeal airway for several hours while being observed in a critical care area. One patient was managed in the intensive care unit without intubation. The median duration of ventilation in the seven patients was 31 h (22-82 h), and median length of stay for all nine cases was 63 h (24-133 h). This study does not support any clinically significant effect of intralipid in sedating drug overdose. © 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

The association between meteorological factors and road traffic injuries: a case analysis from Shantou city, China

PubMed Central

Gao, Jinghong; Chen, Xiaojun; Woodward, Alistair; Liu, Xiaobo; Wu, Haixia; Lu, Yaogui; Li, Liping; Liu, Qiyong

2016-01-01

Few studies examined the associations of meteorological factors with road traffic injuries (RTIs). The purpose of the present study was to quantify the contributions of meteorological factors to RTI cases treated at a tertiary level hospital in Shantou city, China. A time-series diagram was employed to illustrate the time trends and seasonal variation of RTIs, and correlation analysis and multiple linear regression analysis were conducted to investigate the relationships between meteorological parameters and RTIs. RTIs followed a seasonal pattern as more cases occurred during summer and winter months. RTIs are positively correlated with temperature and sunshine duration, while negatively associated with wind speed. Temperature, sunshine hour and wind speed were included in the final linear model with regression coefficients of 0.65 (t = 2.36, P = 0.019), 2.23 (t = 2.72, P = 0.007) and −27.66 (t = −5.67, P < 0.001), respectively, accounting for 19.93% of the total variation of RTI cases. The findings can help us better understand the associations between meteorological factors and RTIs, and with potential contributions to the development and implementation of regional level evidence-based weather-responsive traffic management system in the future. PMID:27853316

The economic benefits of malaria elimination: do they include increases in tourism?

PubMed

Modrek, Sepideh; Liu, Jenny; Gosling, Roland; Feachem, Richard G A

2012-07-28

Policy makers have speculated that one of the economic benefits of malaria elimination includes increases in foreign direct investment, particularly tourism. This study examines the empirical relationship between the demand for travel and malaria cases in two countries with large tourism industries around the time in which they carried out malaria-elimination campaigns. In Mauritius, this analysis examines historical, yearly tourist arrivals and malaria cases from 1978-1999, accounting for the background secular trend of increasing international travel. In Dominican Republic, a country embarking upon malaria elimination, it employs a time-series analysis of the monthly, international tourist arrivals from 1998-2010 to determine whether the timing of significant deviations in tourist arrivals coincides with malaria outbreaks. While naïve relationships exist in both cases, the results show that the relationships between tourist arrivals and malaria cases are relatively weak and statistically insignificant once secular confounders are accounted for. This suggests that any economic benefits from tourism that may be derived from actively pursuing elimination in countries that have high tourism potential are likely to be small when measured at a national level. Rather, tourism benefits are likely to be experienced with greater impact in more concentrated tourist areas within countries, and future studies should seek to assess these relationships at a regional or local level.

Arthroscopic Treatment of Discoid Lateral Meniscus Tears in Children With Achondroplasia.

PubMed

Atanda, Alfred; Wallace, Maegen; Bober, Michael B; Mackenzie, William

2016-01-01

Achondroplasia is the most common form of skeletal dysplasia that presents to the pediatric orthopaedist. More than half of achondroplasia patients are affected with knee pain. It is thought that the majority of this pain may be due to spinal stenosis, hip pathology, or knee malalignment. Discoid menisci can be a source of lateral knee joint pain in skeletally immature patients in general. We present the first case series of patients with achondroplasia who had symptomatic discoid lateral menisci treated with arthroscopic knee surgery. The charts of 6 patients (8 knees) with achondroplasia who underwent arthroscopic knee surgery for symptomatic discoid lateral menisci were collected. History and physical examination data, magnetic resonance imaging findings, and operative reports were reviewed. Meniscal tear configuration and treatment type (meniscectomy vs. repair) were noted. Each patient was found to have a tear of the discoid meniscus. All menisci were treated with saucerization. In addition, meniscal repair was performed in 2 cases, partial meniscectomy in 3 cases, and subtotal meniscectomy in 3 cases. Two patients had bilateral discoid meniscal tears which were treated. Average follow-up was 2.4 years (range, 1 to 4.5 y) and the average pediatric International Knee Documentation Committee (pedi-IKDC) score was 85.3% (range, 75% to 95.4%). At final follow-up, all patients were pain free and able to return to full activities. Discoid meniscus tears may be a source of lateral joint line pain in patients with achondroplasia. These injuries can be successfully treated with arthroscopic surgery in this patient population. Future studies need to be done to determine the exact incidence of discoid menisci in achondroplasia patients and also to determine whether there is a genetic relationship between the 2 conditions. Level IV-case series.

Modular, multi-level groundwater sampler

DOEpatents

Nichols, R.L.; Widdowson, M.A.; Mullinex, H.; Orne, W.H.; Looney, B.B.

1994-03-15

An apparatus is described for taking a multiple of samples of groundwater or pressure measurements from a well simultaneously. The apparatus comprises a series of chambers arranged in an axial array, each of which is dimensioned to fit into a perforated well casing and leave a small gap between the well casing and the exterior of the chamber. Seals at each end of the container define the limits to the axial portion of the well to be sampled. A submersible pump in each chamber pumps the groundwater that passes through the well casing perforations into the gap from the gap to the surface for analysis. The power lines and hoses for the chambers farther down the array pass through each chamber above them in the array. The seals are solid, water-proof, non-reactive, resilient disks supported to engage the inside surface of the well casing. Because of the modular design, the apparatus provides flexibility for use in a variety of well configurations. 3 figures.

Analysis of cyclical behavior in time series of stock market returns

NASA Astrophysics Data System (ADS)

Stratimirović, Djordje; Sarvan, Darko; Miljković, Vladimir; Blesić, Suzana

2018-01-01

In this paper we have analyzed scaling properties and cyclical behavior of the three types of stock market indexes (SMI) time series: data belonging to stock markets of developed economies, emerging economies, and of the underdeveloped or transitional economies. We have used two techniques of data analysis to obtain and verify our findings: the wavelet transform (WT) spectral analysis to identify cycles in the SMI returns data, and the time-dependent detrended moving average (tdDMA) analysis to investigate local behavior around market cycles and trends. We found cyclical behavior in all SMI data sets that we have analyzed. Moreover, the positions and the boundaries of cyclical intervals that we found seam to be common for all markets in our dataset. We list and illustrate the presence of nine such periods in our SMI data. We report on the possibilities to differentiate between the level of growth of the analyzed markets by way of statistical analysis of the properties of wavelet spectra that characterize particular peak behaviors. Our results show that measures like the relative WT energy content and the relative WT amplitude of the peaks in the small scales region could be used to partially differentiate between market economies. Finally, we propose a way to quantify the level of development of a stock market based on estimation of local complexity of market's SMI series. From the local scaling exponents calculated for our nine peak regions we have defined what we named the Development Index, which proved, at least in the case of our dataset, to be suitable to rank the SMI series that we have analyzed in three distinct groups.

Wine consumption is not associated with a decreased risk of alcoholic cirrhosis in heavy drinkers.

PubMed

Pelletier, Stéphanie; Vaucher, Emmanuel; Aider, Rachid; Martin, Sandrine; Perney, Pascal; Balmès, Jean Louis; Nalpas, Bertrand

2002-01-01

While it was thought that all alcoholic beverages share a similar liver toxicity when drunk at a high level, recent epidemiological surveys have suggested that wine drinking might decrease the risk of alcoholic cirrhosis in heavy drinkers. Therefore, we performed a study aiming to analyse the type and the intake levels of alcoholic beverages in heavy drinkers according to the severity of the liver disease. This is a case-control study enrolling 42 cirrhotic and 60 non-cirrhotic patients. Liver status was assessed using clinical, biological, histological and ultrasonographic procedures. Alcohol consumption was recorded using the Lifetime Drinking History method. We did not find any significant differences in total alcohol consumption between cases and controls and, moreover, in our series, the relative percentage of pure alcohol drunk in wine was significantly higher in cirrhotic, than in non-cirrhotic, patients. Our results confirm that the absence of a link between the type of alcoholic beverage and the occurrence of cirrhosis is still valid.

An Investigation of the Impact of Aerodynamic Model Fidelity on Close-In Combat Effectiveness Prediction in Piloted Simulation

NASA Technical Reports Server (NTRS)

Persing, T. Ray; Bellish, Christine A.; Brandon, Jay; Kenney, P. Sean; Carzoo, Susan; Buttrill, Catherine; Guenther, Arlene

2005-01-01

Several aircraft airframe modeling approaches are currently being used in the DoD community for acquisition, threat evaluation, training, and other purposes. To date there has been no clear empirical study of the impact of airframe simulation fidelity on piloted real-time aircraft simulation study results, or when use of a particular level of fidelity is indicated. This paper documents a series of piloted simulation studies using three different levels of airframe model fidelity. This study was conducted using the NASA Langley Differential Maneuvering Simulator. Evaluations were conducted with three pilots for scenarios requiring extensive maneuvering of the airplanes during air combat. In many cases, a low-fidelity modified point-mass model may be sufficient to evaluate the combat effectiveness of the aircraft. However, in cases where high angle-of-attack flying qualities and aerodynamic performance are a factor or when precision tracking ability of the aircraft must be represented, use of high-fidelity models is indicated.

Study of MET protein levels and MET gene copy number in 72 sinonasal intestinal-type adenocarcinomas.

PubMed

Projetti, Fabrice; Mesturoux, Laura; Coulibaly, Béma; Durand, Karine; Chaunavel, Alain; Léobon, Sophie; Gadeaud, Emilie; Caire, François; Bessède, Jean-Pierre; Labrousse, François

2015-11-01

Sinonasal intestinal-type adenocarcinomas (ITACs) have a poor prognosis, and are defined on the basis of their morphological similarities to colorectal adenocarcinomas. MET signaling pathway is involved in oncogenesis in various cancers. Nothing is currently known about the role of MET in ITACs. In a series of 72 ITACs, we investigated MET protein levels by immunohistochemistry (IHC) and gene copy number by in situ hybridization. These findings were analyzed as a function of clinical data, histological typing, and patient outcome. MET protein was overproduced in 64% of cases and chromosome 7 polysomy was observed in 52% of cases. No tumor displayed MET amplification. The presence of mucinous or solid histological components, T3/T4 tumors, and incomplete resection were associated with a poor outcome. MET is overproduced in about two third of ITACs, suggesting a role for the MET signaling pathway in the oncogenesis of these tumors. © 2014 Wiley Periodicals, Inc.

Does counterterrorist legislation hurt human rights practices? A longitudinal cross-national analysis.

PubMed

Shor, Eran; Filkobski, Ina; Ben-Nun Bloom, Pazit; Alkilabi, Hayder; Su, William

2016-07-01

In the aftermath of the 9/11 terrorist attacks, many countries have passed new counterterrorist legislation. One of the common assumptions about such legislation is that it comes with a price: a compromise to practices of human rights. Previous research, looking at a wide range of case studies, suggested that this is indeed the case and that counterterrorist legislation often leads to subsequent repression. However, no large-scale cross-national study has yet assessed this relationship. Relying on a newly assembled database on nation-level counterterrorist legislation for the years 1981-2009, we conduct a cross-national time series analysis of legislation and repression. Our analyses find little evidence for a significant relationships between national counterterrorist legislation and various measures of core human rights in most countries. However, while legislation does not affect repression of physical integrity rights in countries with low and high levels of repression, it is associated with greater state repression in countries with intermediate scores of repression. Copyright © 2016 Elsevier Inc. All rights reserved.

Anatomical and neuropsychological effects of cluster munitions.

PubMed

Fares, Youssef; Fares, Jawad

2013-12-01

The aim of this article is to investigate the effects of cluster munitions on the different environmental, anatomical and neuropsychological levels. We conducted a study to explore the effects of sub-munitions on Lebanese victims. The study included a total of 407 cases that have been subjected to the detonation of unexploded sub-munitions in Lebanon, between 2006 and 2011. In our series, 356 casualties were injured and 51 were dead. 382 were males and 25 were females. We recorded 83 cases of amputations, and injuries involving cranio-facial regions, thorax, abdomen, and upper and lower extremities. These injuries lead to loss of function, body disfiguration, and chronic pain caused by the injuries or the amputations, as well as post-traumatic stress disorder. The peripheral nervous system was mostly affected and patients suffered from significant psychosocial tribulations. Cluster munitions harm human beings and decrease biodiversity. Survivors suffer from physical and psychological impairments. Laws should be passed and enforced to ban the use of these detrimental weapons that have negative effects on ecosystem and societal levels.

Case report: absent C6 cervical pedicle in a collegiate football player.

PubMed

Fowler, John R; Moyer, Ray A

2010-06-01

Congenital absence of a cervical pedicle is a rare clinical finding with only 70 reported cases in the literature from 1946 until present. The congenitally absent pedicle has clinical importance owing to the frequency of misdiagnosis and inappropriate invasive treatments. We present the case of a 21-year-old college football player who experienced neck and shoulder pain after violent twisting of his neck by the face mask. The player walked off the field under his own power. He was sent to the locker room, where he underwent right shoulder and cervical spine radiographs. Initial review of the radiographs raised concern for a jumped right C6 facet. The patient then underwent CT and MRI of the cervical spine, confirming the diagnosis of an absent cervical pedicle. He was treated nonoperatively for a short time and completed the season. He had no symptoms at last followup at 8 months. The most frequent location of the absent cervical pedicle is at the C6 level, and the next most common is at the C5 level. Neural compression or instability is uncommon and nonsurgical treatment is the mainstay of treatment. Misdiagnosis can lead to inappropriate treatment such as halo or tong application with traction, which occurred in seven of 57 cases in one series, and exploratory surgery, which occurred in four of 57 cases.

IgG4-Related Kidney Disease: Report of a Case Presenting as a Renal Mass.

PubMed

Bianchi, Daniele; Topazio, Luca; Gaziev, Gabriele; Iacovelli, Valerio; Bove, Pierluigi; Mauriello, Alessandro; Finazzi Agrò, Enrico

2017-01-01

IgG4-related disease (IgG4-RD) is a nosological entity defined as a chronic immune-mediated fibro-inflammatory condition characterized by a tendency to form tumefactive, tissue-destructive lesions or by organ failure. Urologic involvement in IgG4-RD has been described in some short series of patients and in isolated case reports, most often involving the kidneys in so-called IgG4-related kidney disease (IgG4-RKD). The disease can occasionally mimic malignancies and is at risk of being misdiagnosed due to its rarity. We report the case of a 56-year-old man presenting with a right renal mass suspected of being malignant. Laboratory tests showed normal creatinine levels, a high erythrocyte sedimentation rate, and high levels of C-reactive protein and microalbuminuria. The patient underwent radical right nephroureterectomy and histopathologic examination revealed features proving IgG4-RKD. He was therefore referred to immunologists. Typical clinical presentation of IgG4-RKD includes altered renal function with inconstant or no radiologic findings. Conversely, in the case we presented, a single nodule was detected upon imaging evaluation, thus mimicking malignancy. This raises the issue of a proper differential diagnosis. A multidisciplinary approach can be useful, although in clinical practice the selection of patients suspected of having IgG4-RKD is critical in the cases presenting with a renal mass that mimics malignancy.

The risk of acute liver injury among users of antibiotic medications: a comparison of case-only studies.

PubMed

Brauer, Ruth; Ruigómez, Ana; Klungel, Olaf; Reynolds, Robert; Feudjo Tepie, Maurille; Smeeth, Liam; Douglas, Ian

2016-03-01

The aims of this study were two-fold: (i) to investigate the effect of exposure to antibiotic agents on the risk of acute liver injury using a self-controlled case series and case-crossover study and (ii) to compare the results between the case-only studies. For the self-controlled case series study relative incidence ratios (IRR) were calculated by dividing the rate of acute liver injury experienced during patients' periods of exposure to antibiotics to patients' rate of events during non-exposed time using conditional Poisson regression. For the case-crossover analysis we calculated Odds Ratios (OR) using conditional logistic regression by comparing exposure during 14- and 30-day risk windows with exposure during control moments. Using the self-controlled case series approach, the IRR was highest during the first 7 days after receipt of a prescription (10.01, 95% CI 6.59-15.18). Omitting post-exposure washout periods lowered the IRR to 7.2. The highest estimate in the case-crossover analysis was found when two 30-day control periods 1 year prior to the 30-day ALI risk period were retained in the analysis: OR = 6.5 (95% CI, 3.95-10.71). The lowest estimate was found when exposure in the 14-day risk period was compared to exposure in four consecutive 14-day control periods immediately prior to the risk period (OR = 3.05, 95% CI, 2.06-4.53). An increased relative risk of acute liver injury was consistently observed using both self-controlled case series and case-crossover designs. Case-only designs can be used as a viable alternative study design to study the risk of acute liver injury, albeit with some limitations. © 2015 The Authors Pharmacoepidemiology and Drug Safety Published by John Wiley & Sons Ltd.

The Soil Series in Soil Classifications of the United States

NASA Astrophysics Data System (ADS)

Indorante, Samuel; Beaudette, Dylan; Brevik, Eric C.

2014-05-01

Organized national soil survey began in the United States in 1899, with soil types as the units being mapped. The soil series concept was introduced into the U.S. soil survey in 1903 as a way to relate soils being mapped in one area to the soils of other areas. The original concept of a soil series was all soil types formed in the same parent materials that were of the same geologic age. However, within about 15 years soil series became the primary units being mapped in U.S. soil survey. Soil types became subdivisions of soil series, with the subdivisions based on changes in texture. As the soil series became the primary mapping unit the concept of what a soil series was also changed. Instead of being based on parent materials and geologic age, the soil series of the 1920s was based on the morphology and composition of the soil profile. Another major change in the concept of soil series occurred when U.S. Soil Taxonomy was released in 1975. Under Soil Taxonomy, the soil series subdivisions were based on the uses the soils might be put to, particularly their agricultural uses (Simonson, 1997). While the concept of the soil series has changed over the years, the term soil series has been the longest-lived term in U.S. soil classification. It has appeared in every official classification system used by the U.S. soil survey (Brevik and Hartemink, 2013). The first classification system was put together by Milton Whitney in 1909 and had soil series at its second lowest level, with soil type at the lowest level. The second classification system used by the U.S. soil survey was developed by C.F. Marbut, H.H. Bennett, J.E. Lapham, and M.H. Lapham in 1913. It had soil series at the second highest level, with soil classes and soil types at more detailed levels. This was followed by another system in 1938 developed by M. Baldwin, C.E. Kellogg, and J. Thorp. In this system soil series were again at the second lowest level with soil types at the lowest level. The soil type concept was dropped and replaced by the soil phase in the 1950s in a modification of the 1938 Baldwin et al. classification (Simonson, 1997). When Soil Taxonomy was released in 1975, soil series became the most detailed (lowest) level of the classification system, and the only term maintained throughout all U.S. classifications to date. While the number of recognized soil series have increased steadily throughout the history of U.S. soil survey, there was a rapid increase in the recognition of new soil series following the introduction of Soil Taxonomy (Brevik and Hartemink, 2013). References Brevik, E.C., and A.E. Hartemink. 2013. Soil maps of the United States of America. Soil Science Society of America Journal 77:1117-1132. doi:10.2136/sssaj2012.0390. Simonson, R.W. 1997. Evolution of soil series and type concepts in the United States. Advances in Geoecology 29:79-108.

Theoretical and Experimental Aspects of Acoustic Modelling of Engine Exhaust Systems with Applications to a Vacuum Pump

NASA Astrophysics Data System (ADS)

Sridhara, Basavapatna Sitaramaiah

In an internal combustion engine, the engine is the noise source and the exhaust pipe is the main transmitter of noise. Mufflers are often used to reduce engine noise level in the exhaust pipe. To optimize a muffler design, a series of experiments could be conducted using various mufflers installed in the exhaust pipe. For each configuration, the radiated sound pressure could be measured. However, this is not a very efficient method. A second approach would be to develop a scheme involving only a few measurements which can predict the radiated sound pressure at a specified distance from the open end of the exhaust pipe. In this work, the engine exhaust system was modelled as a lumped source-muffler-termination system. An expression for the predicted sound pressure level was derived in terms of the source and termination impedances, and the muffler geometry. The pressure source and monopole radiation models were used for the source and the open end of the exhaust pipe. The four pole parameters were used to relate the acoustic properties at two different cross sections of the muffler and the pipe. The developed formulation was verified through a series of experiments. Two loudspeakers and a reciprocating type vacuum pump were used as sound sources during the tests. The source impedance was measured using the direct, two-load and four-load methods. A simple expansion chamber and a side-branch resonator were used as mufflers. Sound pressure level measurements for the prediction scheme were made for several source-muffler and source-straight pipe combinations. The predicted and measured sound pressure levels were compared for all cases considered. In all cases, correlation of the experimental results and those predicted by the developed expressions was good. Predicted and measured values of the insertion loss of the mufflers were compared. The agreement between the two was good. Also, an error analysis of the four-load method was done.

Soil nutrients and liming on dry weight yields and forage quality of Signal grass (Brachiaria decumbens Stapf.), grown on Korat soil series (oxic paleustults) in northeast Thailand.

PubMed

Pholsen, Suradej

2010-07-01

This experiment was carried out at Khon Kaen University Experimental Farm, Khon Kaen University, Thailand during the 2004-2005 aiming to investigate effect of phosphorus (P) and dolomite levels on dry weight yields (DWYs) and forage quality of Signal grass. A 4x3 factorial arranged in a Randomized Complete Block Design (RCBD) was used. Four P levels were: 0, 100, 200 and 400 kg P2O5 ha-1 and three dolomite levels were: 0, 625 and 2,500 kg ha-1. The Signal grass plants were grown on Korat soil series, (Oxic Paleustults). A quadrat with a dimension of 50x50 cm was used for grass yield harvests. Crude Protein (CP), Acid Detergent Fibre (ADF), Neutral Detergent Fibre (NDF) and Dry Matter Degradability (DMD) contents were determined. Tissues phosphorus and calcium contents were also analysed. The results showed that an increase in dolomite levels increased soil pH from 4.4 to 5.1 for levels 1 and 3, respectively. An increase in P levels increased available soil P from 4.56 to 28.38 ppm for levels 1 and 4, respectively. For the first year experiment, dolomite levels had no significant effect on DWYs, whilst P levels significantly increased but only up to level 2. The 2-year average DWYs reached 11,368 kg ha-1 for level 4 of P. With the first year rainy season harvests, P levels had its significant effect on ADF and DMD up to level 2 but not with CP and NDF. For the dry season harvests, P and dolomite levels had no significant effects on forage quality. Dolomite levels had no significant effect on P and Ca contents of the Signal grass tissues but an increase in P levels increased P contents. P and Ca contents, in most cases, were higher for the dry season than the rainy season.

Effects of virtual reality training on mobility and physical function in stroke.

PubMed

Malik, Arshad Nawaz; Masood, Tahir

2017-10-01

Stroke is a common disabling condition which declines the functional and mobility level. The purpose of the case series was to determine the effect of virtual reality training on sensorimotor function and mobility level in stroke patients. Ten male (40-60 year) patients of stroke (08 Infarction, 02 Haemorrhagic) were selected from Physiotherapy department of Pakistan Railway Hospital, Rawalpindi. The additional virtual reality training (15-20 minutes) was provided 03 days per week for 06weeks along with task oriented training. All patients were assessed through Fugl-Meyer Assessment-Lower Extremity (FMA-LE) and Timed Get Up and Go Test (TUG) at baseline and after 06 weeks of training. The results showed that there was significant improvement in mobility level of stroke patients. It is concluded that combination of task oriented and virtual reality training considerably improves the physical performance and mobility level in stroke patients.

The Feldenkrais Method(®) can enhance cognitive function in independent living older adults: A case-series.

PubMed

Ullmann, Gerhild; Williams, Harriet G

2016-07-01

Poor cognitive health a major concern of aging individuals, can compromise independent living. More than 16 million people in the United States are affected by cognitive impairment. We have studied the effects of the Feldenkrais Method(®) on cognitive function. In this case series with three participants cognitive function was assessed with the Trail Making Test A and B at baseline and after the Feldenkrais intervention. All participants improved performance on Trail Making Test A and B after completing the Feldenkrais intervention indicating that Feldenkrais lessons may offset age-related decline in cognitive function. The results of this case series warrant larger scale studies on cognitive outcomes of Feldenkrais interventions in clinical and non-clinical populations. Copyright © 2015 Elsevier Ltd. All rights reserved.

Run-up parameterization and beach vulnerability assessment on a barrier island: a downscaling approach

NASA Astrophysics Data System (ADS)

Medellín, G.; Brinkkemper, J. A.; Torres-Freyermuth, A.; Appendini, C. M.; Mendoza, E. T.; Salles, P.

2016-01-01

We present a downscaling approach for the study of wave-induced extreme water levels at a location on a barrier island in Yucatán (Mexico). Wave information from a 30-year wave hindcast is validated with in situ measurements at 8 m water depth. The maximum dissimilarity algorithm is employed for the selection of 600 representative cases, encompassing different combinations of wave characteristics and tidal level. The selected cases are propagated from 8 m water depth to the shore using the coupling of a third-generation wave model and a phase-resolving non-hydrostatic nonlinear shallow-water equation model. Extreme wave run-up, R2%, is estimated for the simulated cases and can be further employed to reconstruct the 30-year time series using an interpolation algorithm. Downscaling results show run-up saturation during more energetic wave conditions and modulation owing to tides. The latter suggests that the R2% can be parameterized using a hyperbolic-like formulation with dependency on both wave height and tidal level. The new parametric formulation is in agreement with the downscaling results (r2 = 0.78), allowing a fast calculation of wave-induced extreme water levels at this location. Finally, an assessment of beach vulnerability to wave-induced extreme water levels is conducted at the study area by employing the two approaches (reconstruction/parameterization) and a storm impact scale. The 30-year extreme water level hindcast allows the calculation of beach vulnerability as a function of return periods. It is shown that the downscaling-derived parameterization provides reasonable results as compared with the numerical approach. This methodology can be extended to other locations and can be further improved by incorporating the storm surge contributions to the extreme water level.

‘Rutherford’s experiment’ on alpha particles scattering: the experiment that never was

NASA Astrophysics Data System (ADS)

Leone, M.; Robotti, N.; Verna, G.

2018-05-01

The so-called Rutherford’s experiment, as it is outlined in many physics textbooks, is a case in point of the flaws around the history at the educational level of one of the decisive event of modern physics: the discovery that the atom has a nucleus. This paper shows that this alleged experiment is a very approximate and very partial synthesis of a series of different particle scattering experiments, starting with that carried out by Rutherford in 1906 and ending with Geiger and Marsden’s 1913 experiments.

Staff Ride Handbook for the Overland Campaign, Virginia, 4 May to 15 June 1864: A Study in Operational-Level Command. Second Edition

DTIC Science & Technology

2009-02-01

both sides depended more on the caliber of the people manag - ing resources than on the constraints of available materiel. In Lee’s case, the Army of...Northern Virginia managed to scrape by in 864, although the need for forage and food sometimes forced Lee to disperse units to gather supplies. The...addition, exceptional manage - ment within the Confederate Ordnance Bureau led to the creation of a series of arsenals throughout the South that produced

Impact of Serum Vancomycin Trough Levels in the Treatment of Central Nervous System Shunt Infections Caused by Coagulase-Negative Staphylococci.

PubMed

Gibson, Ashley; Kaplan, Sheldon L; Vallejo, Jesus G

2018-04-26

Coagulase-negative staphylococci (CoNS) are a common cause of pediatric ventricular shunt infections. The Infectious Diseases Society of America recommends vancomycin serum troughs of 15-20 µg/mL when treating CoNS shunt infections in adult patients. We report a series of pediatric cases of CoNS shunt infections in which clinical cure was obtained with troughs < 15 µg/mL. These findings question the relevance of this recommendation in pediatric patients. © 2018 S. Karger AG, Basel.

Vaginal gamete intrafallopian transfer. Experience with 14 cases.

PubMed

Lucena, E; Paulson, J D; Ruiz, J; Asmar, P; Mendoza, J C; Ortiz, J A; Gomez, M; Arango, A; Lucena, C; Lucena, A

1990-06-01

A procedure utilizing transvaginal aspiration of stimulated gametes followed by transcervical, ultrasound-guided catheterization of the tubal ostia was performed as a modification of the standardized gamete intrafallopian transfer (GIFT) technique. Among 14 patients with 16 cycles there were four normal, intrauterine pregnancies and one ectopic pregnancy. In two patients the beta-human gonadotropin level rose significantly and then started to fall; the patients aborted spontaneously. The procedure can be performed with a higher degree of patient acceptance than can traditional GIFT, and the success rate in this small series was promising.