Comparison of Space Radiation Calculations from Deterministic and Monte Carlo Transport Codes

NASA Technical Reports Server (NTRS)

Adams, J. H.; Lin, Z. W.; Nasser, A. F.; Randeniya, S.; Tripathi, r. K.; Watts, J. W.; Yepes, P.

2010-01-01

The presentation outline includes motivation, radiation transport codes being considered, space radiation cases being considered, results for slab geometry, results from spherical geometry, and summary. ///////// main physics in radiation transport codes hzetrn uprop fluka geant4, slab geometry, spe, gcr,

Finite elements and finite differences for transonic flow calculations

NASA Technical Reports Server (NTRS)

Hafez, M. M.; Murman, E. M.; Wellford, L. C.

1978-01-01

The paper reviews the chief finite difference and finite element techniques used for numerical solution of nonlinear mixed elliptic-hyperbolic equations governing transonic flow. The forms of the governing equations for unsteady two-dimensional transonic flow considered are the Euler equation, the full potential equation in both conservative and nonconservative form, the transonic small-disturbance equation in both conservative and nonconservative form, and the hodograph equations for the small-disturbance case and the full-potential case. Finite difference methods considered include time-dependent methods, relaxation methods, semidirect methods, and hybrid methods. Finite element methods include finite element Lax-Wendroff schemes, implicit Galerkin method, mixed variational principles, dual iterative procedures, optimal control methods and least squares.

40 CFR 1037.660 - Automatic engine shutdown systems.

Code of Federal Regulations, 2013 CFR

2013-07-01

... exhaust emission control device is regenerating. The period considered to be regeneration for purposes of... period considered to be regeneration for other purposes. For example, in some cases it may be appropriate to include a cool down period for this purpose but not for infrequent regeneration adjustment factors...

40 CFR 1037.660 - Automatic engine shutdown systems.

Code of Federal Regulations, 2012 CFR

2012-07-01

... exhaust emission control device is regenerating. The period considered to be regeneration for purposes of... period considered to be regeneration for other purposes. For example, in some cases it may be appropriate to include a cool down period for this purpose but not for infrequent regeneration adjustment factors...

Considering the case for vitamin B12 fortification of flour

USDA-ARS?s Scientific Manuscript database

Reasons to fortify flour with vitamin B12 are considered, which include the high prevalence of depletion and deficiency of this vitamin that occurs in persons of all ages in resource-poor countries and in elderly in wealthier countries, as well as the adverse functional consequences of poor vitamin ...

"Because She Was My First Girlfriend, I Didn't Know Any Different": Making the Case for Mainstreaming Same-Sex Sex/Relationship Education

ERIC Educational Resources Information Center

Donovan, Catherine; Hester, Marianne

2008-01-01

In this paper we present the case for those entering/considering same-sex relationships to be included in sex and relationship education in schools. The Government's Guidance on Sex and Relationship Education provides a rationale for including same-sex relationships when it says that schools should meet the needs of all their pupils "whatever…

48 CFR 50.103-5 - Processing cases.

Code of Federal Regulations, 2011 CFR

2011-10-01

... before receiving advice that the funds will be available. The request for this advice shall give the... to decide a given case. Facts and evidence, including signed statements of material facts within the... considering requests for amendment without consideration involving another agency shall obtain advice on the...

Coccidioidomycosis in Biopsies with Presumptive Diagnosis of Malignancy in Dogs: Report of Three Cases and Comparative Discussion of Published Reports.

PubMed

Ramírez-Romero, Rafael; Silva-Pérez, Rolando Antonio; Lara-Arias, Jorge; Ramírez-Hernández, Cecilia; Marino-Martínez, Iván Alberto; Barbosa-Quintana, Álvaro; López-Mayagoitia, Alfonso

2016-02-01

Coccidioidomycosis is a respiratory fungal infection with occasional systemic dissemination. The disseminated coccidioidomycosis is considered a multifaceted disease. In medicine, disseminated coccidioidomycosis is included within a group of infectious diseases that have been referred as the great imitators. In many cases, malignancies are included in the presumptive diagnosis. In veterinary medicine, disseminated coccidioidomycosis is common in dogs. Nonetheless, despite of being a diagnostic dilemma, disseminated coccidioidomycosis is underestimated and frequently not included into differentials, even in endemic zones. Herein, we describe three cases of granulomatous inflammation caused by Coccidioides spp. which were masquerading malignancies in dogs (0.39 %). The presumptive diagnoses in these cases were osteosarcoma, lymphoma and neurofibroma, respectively. A PCR assay employing tissues in paraffin blocks resulted positive for C. posadasii in one of these cases. A comparative discussion on the ambiguous clinic-pathological presentation of disseminated coccidioidomycosis in dogs and humans is included.

"I Don't Consider Myself Handicapped". Profiles of Adults in Special Education.

ERIC Educational Resources Information Center

McNett, Ian E.

The book reports on a study of 65 handicapped adults working in special education programs and includes case studies. Positions occupied by these handicapped adults include aides, teachers, administrators, speech therapists, psychologists, and guidance counselors; their handicaps include blindness, cerebral palsy, deafness, and dwarfism. The…

Choosing the Standard of Care in Private Individual Defamation Cases.

ERIC Educational Resources Information Center

Caudill, Susan

1989-01-01

Examines private individual defamation cases that include discussion of whether the reasonably prudent publisher/editor or the reasonably prudent person should set the standard of care when negligence is at issue. Considers the implication of judicial reasoning in adopting one standard of care rather than the other. (RS)

The Zoom Lens: A Case Study in Geometrical Optics.

ERIC Educational Resources Information Center

Cheville, Alan; Scepanovic, Misa

2002-01-01

Introduces a case study on a motion picture company considering the purchase of a newly developed zoom lens in which students act as the engineers designing the zoom lens based on the criteria of company's specifications. Focuses on geometrical optics. Includes teaching notes and classroom management strategies. (YDS)

45 CFR 150.455 - Sanctions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... of a regulation, for abandonment of a case, or for other actions that interfere with the speedy... severity and nature of the failure or action. (b) A sanction may include any of the following actions: (1... case. (6) Entering a decision by default. (7) Refusing to consider any motion or other document that is...

Outpatient Treatment of Primary Anorexia Nervosa in Adult Males.

ERIC Educational Resources Information Center

Ziesat, Harold A., Jr.; Ferguson, James M.

1984-01-01

Describes three cases of adult-onset primary anorexia nervosa in males. For each case, the history and diagnostic patterns are considered, followed by a discussion of the course of outpatient treatment. The therapy was multimodal and included elements of behavioral contingency management, cognitive therapy, and dynamic psychotherapy. (JAC)

Autochthonous Leprosy without Armadillo Exposure, Eastern United States.

PubMed

Rendini, Tina; Levis, William

2017-11-01

Autochthonous leprosy has been reported in New York City, where there are no wild armadillos. Recent autochthonous cases also have been reported in Georgia and Florida and blamed on armadillos, including cases with no known armadillo exposure. International migration needs to be considered as a cause of autochthonous leprosy.

Science Around the Corner.

ERIC Educational Resources Information Center

Lunetta, Vincent N.; And Others

1984-01-01

Advocates including environmental issues balanced with basic science concepts/processes to provide a sound science foundation. Suggests case studies of regional environmental issues to sensitize/motivate students while reflecting complex nature of science/society issues. Issues considered include: fresh water quality, earthquake predication,…

Ethanol or Biodiesel? A Systems-Analysis Decision

ERIC Educational Resources Information Center

Dinan, Frank; Stabler, Tom

2008-01-01

This case study stresses the need to broadly consider an entire system, including all of the energy inputs and outputs involved, to determine the real efficiency of that system. It also asks its student audience to consider the role that scientific input plays in policy decision-making processes. It emphasizes that, despite the importance of this…

Development Impact Assessment (DIA) Case Study. South Africa

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

Cox, Sadie; Nawaz, Kathleen; Sandor, Debra

2015-05-19

This case study reviews South Africa’s experience in considering the impacts of climate change action on development goals, focusing on the South African energy sector and development impact assessments (DIAs) that have and could be used to influence energy policy or inform the selection of energy activities. It includes a review of assessments—conducted by government ministries, technical partners, and academic institutes and non-governmental organizations (NGOs)—that consider employment, health, and water implications of possible energy sector actions, as well as multi-criteria impact assessments.

Camelid heat stress: 15 cases (2003–2011)

PubMed Central

Norton, Piper L.; Gold, Jenifer R.; Russell, Karen E.; Schulz, Kara L.; Porter, Brian F.

2014-01-01

This case series describes novel findings associated with heat stress in 15 cases in South American camelids that had no pre-existing illnesses and which had clinical signs of illness after exposure to a warm environment. Novel findings include decreased packed cell volume and albumin concentration and mild spinal axonal degeneration. Heat stress should be considered in weak camelids with a history of hyperthermia. PMID:25320390

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.

Sensitivity and Specificity of Histoplasma Antigen Detection by Enzyme Immunoassay.

PubMed

Cunningham, Lauren; Cook, Audrey; Hanzlicek, Andrew; Harkin, Kenneth; Wheat, Joseph; Goad, Carla; Kirsch, Emily

2015-01-01

The objective of this study was to evaluate the sensitivity and specificity of an antigen enzyme immunoassay (EIA) on urine samples for the diagnosis of histoplasmosis in dogs. This retrospective medical records review included canine cases with urine samples submitted for Histoplasma EIA antigen assay between 2007 and 2011 from three veterinary institutions. Cases for which urine samples were submitted for Histoplasma antigen testing were reviewed and compared to the gold standard of finding Histoplasma organisms or an alternative diagnosis on cytology or histopathology. Sensitivity, specificity, negative predictive value, positive predictive value, and the kappa coefficient and associated confidence interval were calculated for the EIA-based Histoplasma antigen assay. Sixty cases met the inclusion criteria. Seventeen cases were considered true positives based on identification of the organism, and 41 cases were considered true negatives with an alternative definitive diagnosis. Two cases were considered false negatives, and there were no false positives. Sensitivity was 89.47% and the negative predictive value was 95.35%. Specificity and the positive predictive value were both 100%. The kappa coefficient was 0.9207 (95% confidence interval, 0.8131-1). The Histoplasma antigen EIA test demonstrated high specificity and sensitivity for the diagnosis of histoplasmosis in dogs.

International or national publication of case reports.

PubMed

Lundh, Andreas; Christensen, Mikkel; Jørgensen, Anders W

2011-02-01

Case reports are often regarded as second-class research, but are an important part of medical science as they often present first evidence of new discoveries. We here describe the type of case reports published in a Danish general medical journal. We included all case reports published in Ugeskrift for Laeger in 2009. For each report, two authors extracted information on study characteristics and classified the relevance and the role of the report. We included 139 case reports written in Danish. Thirty-nine (28%) were of general relevance and 100 (72%) of speciality relevance. The median number of authors was three (range: 1-7). The first author was a non-specialist physician in 119 (86%) of the reports and the last author a specialist in 103 (78%). A total of 124 (89%) reports had an educational role, six (4%) dealt with new diseases, two (1%) with new side effects, three (2%) with new mechanisms and four (3%) were curiosities. A total of 59 (42%) reports were surgical, 64 (46%) non-surgical and 16 (12%) paraclinical. We found that most case reports published in Ugeskrift for Laeger were of speciality relevance and had an educational perspective. The journal may consider focusing on cases of more general educational relevance and should also consider whether the current form and language suit the aim and role of the various types of case reports.

Cuban Voices: A Case Study of English Language Teacher Education

ERIC Educational Resources Information Center

Smith, Steven John

2016-01-01

This case study uses qualitative research methods and a postcolonial paradigm to listen to the voices of Cuban teacher educators describing how they educate and prepare English language teachers in Cuba. English language teacher education in Cuba includes features that are considered innovative, contemporary and good practice in the Western world.…

Socio-Cultural Factors in Second Language Learning: A Case Study of Adventurous Adult Language Learners

ERIC Educational Resources Information Center

Ozfidan, Burhan; Machtmes, Krisanna L.; Demir, Husamettin

2014-01-01

Sociocultural theories consider language learning as a social practice examines students as active participants in the construction of learning processes. This study investigates sociocultural theories' central concepts, which includes peer interaction and feedback, private speech, and self-efficacy. The present study is a case study of twenty…

20 CFR 10.210 - What are the employee's responsibilities in COP cases?

Code of Federal Regulations, 2012 CFR

2012-04-01

... responsibilities in COP cases? An employee who sustains a traumatic injury which he or she considers disabling, or... possible, but no later than 30 days from the date the traumatic injury occurred. (b) Ensure that medical evidence supporting disability resulting from the claimed traumatic injury, including a statement as to...

20 CFR 10.210 - What are the employee's responsibilities in COP cases?

Code of Federal Regulations, 2013 CFR

2013-04-01

... responsibilities in COP cases? An employee who sustains a traumatic injury which he or she considers disabling, or... possible, but no later than 30 days from the date the traumatic injury occurred. (b) Ensure that medical evidence supporting disability resulting from the claimed traumatic injury, including a statement as to...

20 CFR 10.210 - What are the employee's responsibilities in COP cases?

Code of Federal Regulations, 2010 CFR

2010-04-01

... responsibilities in COP cases? An employee who sustains a traumatic injury which he or she considers disabling, or... possible, but no later than 30 days from the date the traumatic injury occurred. (b) Ensure that medical evidence supporting disability resulting from the claimed traumatic injury, including a statement as to...

20 CFR 10.210 - What are the employee's responsibilities in COP cases?

Code of Federal Regulations, 2011 CFR

2011-04-01

... responsibilities in COP cases? An employee who sustains a traumatic injury which he or she considers disabling, or... possible, but no later than 30 days from the date the traumatic injury occurred. (b) Ensure that medical evidence supporting disability resulting from the claimed traumatic injury, including a statement as to...

20 CFR 10.210 - What are the employee's responsibilities in COP cases?

Code of Federal Regulations, 2014 CFR

2014-04-01

... responsibilities in COP cases? An employee who sustains a traumatic injury which he or she considers disabling, or... possible, but no later than 30 days from the date the traumatic injury occurred. (b) Ensure that medical evidence supporting disability resulting from the claimed traumatic injury, including a statement as to...

Molecular Subtyping to Detect Human Listeriosis Clusters

PubMed Central

Sauders, Brian D.; Fortes, Esther D.; Morse, Dale L.; Dumas, Nellie; Kiehlbauch, Julia A.; Schukken, Ynte; Hibbs, Jonathan R.

2003-01-01

We analyzed the diversity (Simpson’s Index, D) and distribution of Listeria monocytogenes in human listeriosis cases in New York State (excluding New York City) from November 1996 to June 2000 by using automated ribotyping and pulsed-field gel electrophoresis (PFGE). We applied a scan statistic (p<0.05) to detect listeriosis clusters caused by a specific Listeria monocytogenes subtype. Of 131 human isolates, 34 (D=0.923) ribotypes and 74 (D=0.975) PFGE types were found. Nine (31% of cases) clusters were identified by ribotype or PFGE; five (18% of cases) clusters were identified by using both methods. Two of the nine clusters (13% of cases) identified corresponded with investigated multistate listeriosis outbreaks. While most human listeriosis cases are considered sporadic, highly discriminatory molecular subtyping approaches thus indicated that 13% to 31% of cases reported in New York State may represent single-source clusters. Listeriosis control and reduction efforts should include broad-based subtyping of human isolates and consider that a large number of cases may represent outbreaks. PMID:12781006

The impact of Magnetic Resonance Imaging (MRI) on ischemic stroke detection and incidence: minimal impact within a population-based study.

PubMed

Kleindorfer, Dawn; Khoury, Jane; Alwell, Kathleen; Moomaw, Charles J; Woo, Daniel; Flaherty, Matthew L; Adeoye, Opeolu; Ferioli, Simona; Khatri, Pooja; Kissela, Brett M

2015-09-25

There are several situations in which magnetic resonance imaging (MRI) might impact whether an cerebrovascular event is considered a new stroke. These include clinically non-focal events with positive imaging for acute cerebral infarction, and worsening of older symptoms without evidence of new infarction on MRI. We sought to investigate the impact of MRI on stroke detection and stroke incidence, by describing agreement between a strictly clinical definition of stroke and a definition based on physician opinion, including MRI imaging findings. All hospitalized strokes that occurred in five Ohio and Northern Kentucky counties (population 1.3 million) in the calendar year of 2005 were identified using ICD-9 discharge codes 430-436. The two definitions used were: "clinical case definition" which included sudden onset focal neurologic symptoms referable to a vascular territory for >24 h, compared to the "best clinical judgment of the physician definition", which considers all relevant information, including neuroimaging findings. The 95% confidence intervals (CI) for the incidence rates were calculated assuming a Poisson distribution. Rates were standardized to the 2000 U.S. population, adjusting for age, race, and sex, and included all age groups. There were 2403 ischemic stroke events in 2269 patients; 1556 (64%) had MRI performed. Of the events, 2049 (83%) were cases by both definitions, 185 (7.7%) met the clinical case definition but were non-cases in the physician's opinion and 169 (7.0%) were non-cases by clinical definition but were cases in the physician's opinion. There was no significant difference in the incidence rates of first-ever or total ischemic strokes generated by the two different definitions, or when only those with MRI imaging were included. We found that MRI findings do not appear to substantially change stroke incidence estimates, as the strictly clinical definition of stroke did not significantly differ from a definition that included imaging findings. Including MRI in the case definition "rules out" almost the same number of strokes as it "rules in".

Mumps Outbreak Among a Highly Vaccinated University Community-New York City, January-April 2014.

PubMed

Patel, Leena N; Arciuolo, Robert J; Fu, Jie; Giancotti, Francesca R; Zucker, Jane R; Rakeman, Jennifer L; Rosen, Jennifer B

2017-02-15

On 14 January 2014, a vaccinated student presented with parotitis. Mumps immunoglobulin M (IgM) testing was negative and reverse-transcription polymerase chain reaction (RT-PCR) testing was not performed, resulting in a missed diagnosis and the start of an outbreak at a New York City (NYC) university. Mumps case investigations included patient interviews, medical records review, and laboratory testing including mumps serology and RT-PCR. Case patients were considered linked to the outbreak if they attended or had epidemiologic linkage to the university. Epidemiologic, clinical, and laboratory data for outbreak cases residing in NYC were analyzed. Fifty-six NYC residents with mumps were identified with onset between 12 January and 30 April 2014. Fifty-three cases (95%) were university students, 1 (2%) was a staff member, and 2 (4%) had epidemiologic links to the university. The median age was 20 years (range 18-37 years). All cases had parotitis. Three cases were hospitalized, including 1 of 2 cases with orchitis. Fifty-four (96%) cases had received ≥1 mumps-containing vaccine, 1 (2%) was unvaccinated due to religious exemption, and 1 (2%) had unknown vaccination status. Two of the 44 (5%) cases tested by serology were mumps IgM positive, and 27 of the 40 (68%) tested by RT-PCR were positive. Mumps outbreaks can occur in highly vaccinated populations. Mumps should be considered in patients with parotitis regardless of vaccination status. RT-PCR is the preferred testing method; providers should not rely on IgM testing alone. High vaccination coverage and control measures likely limited the extent of the outbreak. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

Predictors for delayed encephalopathy following acute carbon monoxide poisoning.

PubMed

Kudo, Kaoru; Otsuka, Kotaro; Yagi, Junko; Sanjo, Katsumi; Koizumi, Noritaka; Koeda, Atsuhiko; Umetsu, Miki Yokota; Yoshioka, Yasuhito; Mizugai, Ayumi; Mita, Toshinari; Shiga, Yu; Koizumi, Fumito; Nakamura, Hikaru; Sakai, Akio

2014-01-31

In Japan, many carbon monoxide (CO) poisoning cases are transported to emergency settings, making treatment and prognostic assessment an urgent task. However, there is currently no reliable means to predict whether "delayed neuropsychiatric sequelae (DNS)" will develop after acute CO poisoning. This study is intended to find out risk factors for the development of DNS and to characterize the clinical course following the development of DNS in acute CO poisoning cases. This is a retrospective cohort study of 79 consecutive patients treated at a single institution for CO poisoning. This study included 79 cases of acute CO poisoning admitted to our emergency department after attempted suicide, who were divided into two groups consisting of 13 cases who developed DNS and 66 cases who did not. The two groups were compared and analyzed in terms of clinical symptoms, laboratory findings, etc. Predictors for the development of DNS following acute CO poisoning included: serious consciousness disturbance at emergency admission; head CT findings indicating hypoxic encephalopathy; hematology findings including high creatine kinase, creatine kinase-MB and lactate dehydrogenase levels; and low Global Assessment Scale scores. The clinical course of the DNS-developing cases was characterized by prolonged hospital stay and a larger number of hyperbaric oxygen (HBO) therapy sessions. In patients with the characteristics identified in this study, administration of HBO therapy should be proactively considered after informing their family, at initial stage, of the risk of developing DNS, and at least 5 weeks' follow-up to watch for the development of DNS is considered necessary.

Patterns of measles transmission among airplane travelers.

PubMed

Edelson, Paul J

2012-09-01

With advanced air handling systems on modern aircraft and the high level of measles immunity in many countries, measles infection in air travelers may be considered a low-risk event. However, introduction of measles into countries where transmission has been controlled or eliminated can have substantial consequences both for the use of public health resources and for those still susceptible. In an effort to balance the relatively low likelihood of disease transmission among largely immune travelers and the risk to the public health of the occurrence of secondary cases resulting from importations, criteria in the United States for contact investigations for measles exposures consider contacts to be those passengers who are seated within 2 rows of the index case. However, recent work has shown that cabin air flow may not be as reliable a barrier to the spread of measles virus as previously believed. Along with these new studies, several reports have described measles developing after travel in passengers seated some distance from the index case. To understand better the potential for measles virus to spread on an airplane, reports of apparent secondary cases occurring in co-travelers of passengers with infectious cases of measles were reviewed. Medline™ was searched for articles in all languages from 1946 to week 1 of March 2012, using the search terms "measles [human] or rubeola" and ("aircraft" or "airplane" or "aeroplane" or "aviation" or "travel" or "traveler" or "traveller"); 45 citations were returned. Embase™ was searched from 1988 to week 11 2012, using the same search strategy; 95 citations were returned. Papers were included in this review if they reported secondary cases of measles occurring in persons traveling on an airplane on which a person or persons with measles also flew, and which included the seating location of both the index case(s) and the secondary case(s) on the plane. Nine reports, including 13 index cases and 23 apparent secondary cases on 10 flights, were identified in which transmission on board the aircraft appeared likely and which included seating information for both the index (primary) and secondary cases. Separation between index and secondary cases ranged from adjacent seats to 17 rows, with a median of 6 rows. Three flights had more than one index case aboard. Based on previously published data, it is not possible to say how unusual cases of measles transmission among air travelers beyond the usual zone of contact investigation (the row the index case sat in and 2 rows ahead of or behind that row) may be. The fact that several flights had more than one infectious case aboard and that all but two index cases were in the prodromal phase may be of importance in understanding the wider spread described in several of the reviewed reports. Although the pattern of cabin air flow typical of modern commercial aircraft has been considered highly effective in limiting the airborne spread of microorganisms, concerns have been raised about relying on the operation of these systems to determine exposure risk, as turbulence in the cabin air stream is generated when passengers and crew are aboard, allowing the transmission of infectious agents over many rows. Additionally, the characteristics of some index cases may reflect a greater likelihood of disease transmission. Investigators should continue to examine carefully both aircraft and index-case factors that may influence disease transmission and could serve as indicators on a case-by-case basis to include a broader group of travelers in a contact investigation. Published by Elsevier Ltd.

Should idiopathic facial aseptic granuloma be considered granulomatous rosacea? Report of three pediatric cases.

PubMed

Neri, Iria; Raone, Beatrice; Dondi, Arianna; Misciali, Cosimo; Patrizi, Annalisa

2013-01-01

Idiopathic facial aseptic granuloma (IFAG), or pyodermite froide du visage, is a skin disease reported only in children and characterized by painless red nodules usually located on the cheeks. Its etiology is still unclear, but some authors considered the possibility that IFAG might be included in the spectrum of granulomatous rosacea (GR). The histopathological features of IFAG and GR are quite similar, showing perifolliculitis, granulomas, folliculitis, and lymphocytes and plasmacells around epithelioid histiocytes. In the present article, we discuss three cases in which an association between a facial nodule, compatible with both IFAG and GR, and recurrent chalazia make us support the hypothesis that IFAG should be considered as GR. © 2012 Wiley Periodicals, Inc.

Variables affecting the financial viability of your practice: a case study.

PubMed

Binderman, J

2001-01-01

Utilizing the discussion of variables affecting practice financial viability, a case study is considered. The case study reveals the relative impact multiple variables have upon the bottom line, including: practice capacity, percentage of capitation, and fee-for-service in the practice, as well as patient visit rates and patient churning. This article presents basic financial information through a case study model, utilizing a series of worksheets that can be adapted to any practice situation to encourage improved financial viability.

Auto-Bäcklund transformations for a matrix partial differential equation

NASA Astrophysics Data System (ADS)

Gordoa, P. R.; Pickering, A.

2018-07-01

We derive auto-Bäcklund transformations, analogous to those of the matrix second Painlevé equation, for a matrix partial differential equation. We also then use these auto-Bäcklund transformations to derive matrix equations involving shifts in a discrete variable, a process analogous to the use of the auto-Bäcklund transformations of the matrix second Painlevé equation to derive a discrete matrix first Painlevé equation. The equations thus derived then include amongst other examples a semidiscrete matrix equation which can be considered to be an extension of this discrete matrix first Painlevé equation. The application of this technique to the auto-Bäcklund transformations of the scalar case of our partial differential equation has not been considered before, and so the results obtained here in this scalar case are also new. Other equations obtained here using this technique include a scalar semidiscrete equation which arises in the case of the second Painlevé equation, and which does not seem to have been thus derived previously.

May one-stage exchange for Candida albicans peri-prosthetic infection be successful?

PubMed

Jenny, J-Y; Goukodadja, O; Boeri, C; Gaudias, J

2016-02-01

Fungal infection of a total joint arthroplasty has a low incidence but is generally considered as more difficult to cure than bacterial infection. As for bacterial infection, two-stage exchange is considered as the gold standard of treatment. We report two cases of one-stage total joint exchange for fungal peri-prosthetic infection with Candida albicans, where the responsible pathogens was only identified on intraoperative samples. This situation can be considered as a one-stage exchange for fungal peri-prosthetic infection without preoperative identification of the responsible organism, which is considered as having a poor prognosis. Both cases were free of infection after two years. One-stage revision has several potential advantages over two-stage revision, including shorter hospital stay and rehabilitation, no interim period with significant functional impairment, shorter antibiotic treatment, better functional outcome and probably lower costs. We suggest that one-stage revision for C. albicans peri-prosthetic infection may be successful even without preoperative fungal identification. Level IV-Historical cases. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Teacher Education for Citizenship in a Globalized World: A Case Study in Spain

ERIC Educational Resources Information Center

Estellés, Marta; Romero, Jesús

2016-01-01

Considering the attention that global citizenship education has recently received, it is not much of a surprise that teacher education programs and courses around the world are including stated goals related to the preparation of teachers to educate their students for global and participatory citizenship. This is also the case of the Faculty of…

A Comparison of Trajectory Optimization Methods for the Impulsive Minimum Fuel Rendezvous Problem

NASA Technical Reports Server (NTRS)

Hughes, Steven P.; Mailhe, Laurie M.; Guzman, Jose J.

2003-01-01

In this paper we present, a comparison of trajectory optimization approaches for the minimum fuel rendezvous problem. Both indirect and direct methods are compared for a variety of test cases. The indirect approach is based on primer vector theory. The direct approaches are implemented numerically and include Sequential Quadratic Programming (SQP). Quasi- Newton and Nelder-Meade Simplex. Several cost function parameterizations are considered for the direct approach. We choose one direct approach that appears to be the most flexible. Both the direct and indirect methods are applied to a variety of test cases which are chosen to demonstrate the performance of each method in different flight regimes. The first test case is a simple circular-to-circular coplanar rendezvous. The second test case is an elliptic-to-elliptic line of apsides rotation. The final test case is an orbit phasing maneuver sequence in a highly elliptic orbit. For each test case we present a comparison of the performance of all methods we consider in this paper.

Characterization of hypersensitivity reactions reported among Andrographis paniculata users in Thailand using Health Product Vigilance Center (HPVC) database.

PubMed

Suwankesawong, Wimon; Saokaew, Surasak; Permsuwan, Unchalee; Chaiyakunapruk, Nathorn

2014-12-24

Andrographis paniculata (andrographis) is one of the herbal products that are widely used for various indications. Hypersensitivity reactions have been reported among subjects receiving Andrographis paniculata in Thailand. Understanding of characteristics of patients, adverse events, and clinical outcomes is essential for ensuring population safety.This study aimed to describe the characteristics of hypersensitivity reactions reported in patients receiving andrographis containing products in Thailand using national pharmacovigilance database. Thai Vigibase data from February 2001 to December 2012 involving andrographis products were used. This database includes the reports submitted through the spontaneous reporting system and intensive monitoring programmes. The database contained patient characteristic, adverse events associated with andrographis products, and details on seriousness, causality, and clinical outcomes. Case reports were included for final analysis if they met the inclusion criteria; 1) reports with andrographis being the only suspected cause, 2) reports with terms consistent with the constellation of hypersensitivity reactions, and 3) reports with terms considered critical terms according to WHO criteria. Descriptive statistics were used. A total of 248 case reports of andrographis-associated adverse events were identified. Only 106 case reports specified andrographis herbal product as the only suspected drug and reported at least one term consistent with constellation of hypersensitivity reactions. Most case reports (89%) came from spontaneous reporting system with no previously documented history of drug allergy (88%). Of these, 18 case reports were classified as serious with 16 cases requiring hospitalization. For final assessment, the case reports with terms consistent with constellation of hypersensitivity reactions and critical terms were included. Thirteen case reports met such criteria including anaphylactic shock (n = 5), anaphylactic reaction (n = 4) and angioedema (n = 4). Time to development of symptoms ranged from 5 minutes to 1 day. The doses of andrographis used varied from 352 mg to 1,750 mg. Causality assessment of 13 case reports were certain (n = 3), probable (n = 8) and possible (n = 2). Our findings suggested that hypersensitivity reactions have been reported among patients receiving Andrographis paniculata. Healthcare professionals should be aware of this potential risk. Further investigation of the causal relationship is needed; meanwhile including hypersensitivity reactions for andrographis product labeling should be considered.

Acute Liver Failure During Deferasirox Chelation: A Toxicity Worth Considering.

PubMed

Menaker, Nathan; Halligan, Katharine; Shur, Natasha; Paige, John; Hickling, Matthew; Nepo, Anne; Weintraub, Lauren

2017-04-01

This case report details a unique case of acute, reversible liver failure in a 12-year-old male with sickle cell anemia on chronic transfusion protocol and deferasirox chelation. There is substantial literature documenting deferasirox-induced renal injury, including Fanconi syndrome, but less documentation of hepatic toxicity and few reports of hepatic failure. The case highlights the importance of close monitoring of ferritin, bilirubin, and transaminases for patients on deferasirox.

Papular sarcoidosis of the knees. A frequent form of presentation of systemic sarcoidosis.

PubMed

Marcoval, Joaquim; Mañá, Juan

2016-03-29

In recent years we have observed with increasing frequency granulomatous papular lesions involving the knees, for which we proposed the term papular sarcoidosis of knees. To evaluate the clinicopathological features of papular sarcoidosis of the knees. Patients with papular lesions of the knees and histopathologically sarcoid granulomas were included in the study. Systemic sarcoidosis was investigated in all cases. Clinical charts were retrospectively retrieved. Biopsy specimens were evaluated under polarized light to detect foreign bodies. Fifty-three patients fulfilled inclusion criteria. In 36 cases systemic sarcoidosis was diagnosed and these cases were considered as papular sarcoidosis of the knees. Foreign particles were observed in 21 of these 36 patients. In only 9/36 patients did the activity of systemic disease persist over two years. In 17 cases sarcoidosis could not be demonstrated during follow-up. Papular sarcoidosis of the knees can be considered a relatively frequent form of cutaneous sarcoidosis usually present at the beginning of the disease that can be useful for the diagnosis of sarcoidosis. It is mainly observed in acute forms of sarcoidosis and can be considered a sign of good prognosis.

Buying and Selling Words: What Every Good Librarian Should Know about the Dictionary Business.

ERIC Educational Resources Information Center

Kister, Ken

1993-01-01

Discusses features to consider when selecting dictionaries. Topics addressed include the publishing industry; the dictionary market; profits from dictionaries; pricing; competitive marketing tactics, including similar titles, claims to numbers of entries and numbers of definitions, and similar physical appearance; a trademark infringement case;…

Gifted Children and Divorce

ERIC Educational Resources Information Center

Dudley, John; Karnes, Frances A.

2011-01-01

Divorce is often a contentious process with multiple issues to decide, especially in cases in which there are children involved. Divorce raises several legal issues when considering the well-being of children, including those who are gifted. In this article, the authors discuss these issues which include school choice, child support, and custody…

An approach for integrating toxicogenomic data in risk assessment: The dibutyl phthalate case study

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

Euling, Susan Y., E-mail: euling.susan@epa.gov; Thompson, Chad M.; Chiu, Weihsueh A.

An approach for evaluating and integrating genomic data in chemical risk assessment was developed based on the lessons learned from performing a case study for the chemical dibutyl phthalate. A case study prototype approach was first developed in accordance with EPA guidance and recommendations of the scientific community. Dibutyl phthalate (DBP) was selected for the case study exercise. The scoping phase of the dibutyl phthalate case study was conducted by considering the available DBP genomic data, taken together with the entire data set, for whether they could inform various risk assessment aspects, such as toxicodynamics, toxicokinetics, and dose–response. A descriptionmore » of weighing the available dibutyl phthalate data set for utility in risk assessment provides an example for considering genomic data for future chemical assessments. As a result of conducting the scoping process, two questions—Do the DBP toxicogenomic data inform 1) the mechanisms or modes of action?, and 2) the interspecies differences in toxicodynamics?—were selected to focus the case study exercise. Principles of the general approach include considering the genomics data in conjunction with all other data to determine their ability to inform the various qualitative and/or quantitative aspects of risk assessment, and evaluating the relationship between the available genomic and toxicity outcome data with respect to study comparability and phenotypic anchoring. Based on experience from the DBP case study, recommendations and a general approach for integrating genomic data in chemical assessment were developed to advance the broader effort to utilize 21st century data in risk assessment. - Highlights: • Performed DBP case study for integrating genomic data in risk assessment • Present approach for considering genomic data in chemical risk assessment • Present recommendations for use of genomic data in chemical risk assessment.« less

How Dangerous Can Localized Corrosion Be? An Experiment that Studies Its Effects.

ERIC Educational Resources Information Center

Celdran, R.; Gonzalo, P.

1988-01-01

Considers three common cases of localized corrosion of metals: pitting, crevice, and stress corrosion. Provides experimental methods for studying all three methods. Includes a discussion of expected results. (ML)

40 CFR 211.203 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... entering the ear. This includes devices of which hearing protection may not be the primary function, but... -carrying case. (u) Primary Panel. The surface that is considered to be the front surface or that surface...

40 CFR 211.203 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... entering the ear. This includes devices of which hearing protection may not be the primary function, but... -carrying case. (u) Primary Panel. The surface that is considered to be the front surface or that surface...

40 CFR 211.203 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... entering the ear. This includes devices of which hearing protection may not be the primary function, but... -carrying case. (u) Primary Panel. The surface that is considered to be the front surface or that surface...

Safety in the Chemical Laboratory: Hazards in a Photography Lab.

ERIC Educational Resources Information Center

Houk, Cliff; Hart, Charles

1987-01-01

Described are case studies illustrating chemical hazards in a photography lab due to compounds containing cyanide. Suggestions for preventing problems including proper procedures, housekeeping, facilities, and ventilation are considered. (RH)

A case of probable trimethoprim-sulfamethoxazole induced circulating antineutrophil cytoplasmic antibody-positive small vessel vasculitis.

PubMed

Woodring, Therese; Abraham, Ronnie; Frisch, Stephanie

2017-08-15

Cutaneous leukocytoclastic vasculitis (LCV) can occur as skin-limited disease or as part a systemic vasculitis. Appropriate workup includes the evaluation of antineutrophil cytoplasmic antibodies (ANCAs), with a positive titer raising concern for the associated primary vasculitides including microscopic polyangiitis (MPA), granulomatosis with polyangiitis (GPA), or eosinophilic granulomatosis with polyangiitis (EGPA). In the absence of systemic findings, however, a drug etiology must also be considered. Tumor necrosis factor (TNF) inhibitors, propylthiouracil, levamisole-adulterated cocaine, hydralazine, and minocycline have been previously documented to induce ANCA-positive vasculitis (APV), which may present with conspicuously high ANCA titers. Herein we report trimethoprim-sulfamethoxazole as another culprit in drug-induced APV. Our case reinforces the need to consider drug etiology for APV and cautions against interpreting positive ANCAs as equivalent to evidence of systemic disease.

Historical Trends of Participation of Women Scientists in Robotic Spacecraft Mission Science Teams: Effect of Participating Scientist Programs

NASA Astrophysics Data System (ADS)

Rathbun, Julie A.; Castillo-Rogez, Julie; Diniega, Serina; Hurley, Dana; New, Michael; Pappalardo, Robert T.; Prockter, Louise; Sayanagi, Kunio M.; Schug, Joanna; Turtle, Elizabeth P.; Vasavada, Ashwin R.

2016-10-01

Many planetary scientists consider involvement in a robotic spacecraft mission the highlight of their career. We have searched for names of science team members and determined the percentage of women on each team. We have limited the lists to members working at US institutions at the time of selection. We also determined the year each team was selected. The gender of each team member was limited to male and female and based on gender expression. In some cases one of the authors knew the team member and what pronouns they use. In other cases, we based our determinations on the team member's name or photo (obtained via a google search, including institution). Our initial analysis considered 22 NASA planetary science missions over a period of 41 years and only considered NASA-selected PI and Co-Is and not participating scientists, postdocs, or graduate students. We found that there has been a dramatic increase in participation of women on spacecraft science teams since 1974, from 0-2% in the 1970s - 1980s to an average of 14% 2000-present. This, however, is still lower than the recent percentage of women in planetary science, which 3 different surveys found to be ~25%. Here we will present our latest results, which include consideration of participating scientists. As in the case of PIs and Co-Is, we consider only participating scientists working at US institutions at the time of their selection.

Predictors for delayed encephalopathy following acute carbon monoxide poisoning

PubMed Central

2014-01-01

Background In Japan, many carbon monoxide (CO) poisoning cases are transported to emergency settings, making treatment and prognostic assessment an urgent task. However, there is currently no reliable means to predict whether “delayed neuropsychiatric sequelae (DNS)” will develop after acute CO poisoning. This study is intended to find out risk factors for the development of DNS and to characterize the clinical course following the development of DNS in acute CO poisoning cases. Methods This is a retrospective cohort study of 79 consecutive patients treated at a single institution for CO poisoning. This study included 79 cases of acute CO poisoning admitted to our emergency department after attempted suicide, who were divided into two groups consisting of 13 cases who developed DNS and 66 cases who did not. The two groups were compared and analyzed in terms of clinical symptoms, laboratory findings, etc. Results Predictors for the development of DNS following acute CO poisoning included: serious consciousness disturbance at emergency admission; head CT findings indicating hypoxic encephalopathy; hematology findings including high creatine kinase, creatine kinase-MB and lactate dehydrogenase levels; and low Global Assessment Scale scores. The clinical course of the DNS-developing cases was characterized by prolonged hospital stay and a larger number of hyperbaric oxygen (HBO) therapy sessions. Conclusion In patients with the characteristics identified in this study, administration of HBO therapy should be proactively considered after informing their family, at initial stage, of the risk of developing DNS, and at least 5 weeks’ follow-up to watch for the development of DNS is considered necessary. PMID:24484081

Guillain-Barré syndrome. Review and presentation of a case with pedal manifestations.

PubMed

Viegas, G V

1997-05-01

Guillan-Barré syndrome is an acute, symmetrical polyneuropathy with distinctive features. The early clinical course involves painful paresthesia that is usually followed by proximal motor weakness. Albuminocytologic dissociation in the cerebrospinal fluid is considered diagnostically important. Therapy ranges from supportive measures including physical therapy to surgical intervention for residual deformities. A case with pedal manifestations is presented.

Campylobacter concisus and Acute Gastroenteritis in Children: Lack of Association.

PubMed

Tilmanne, Anne; Martiny, Delphine; Hallin, Marie; Cornelius, Angela; Wautier, Magali; Quach, Caroline; Lepage, Philippe; Vandenberg, Olivier

2018-03-29

The role of Campylobacter concisus as a cause of acute gastroenteritis (AGE) remains to be demonstrated. This prospective study includes 184 cases and 176 controls. It shows no evidence that C. concisus plays a role in AGE. Considering the very low prevalence in cases and controls, if there is an etiological link, it would be moderate and difficult to demonstrate.

Understanding the Process: An Ethnographic Case Study of School Psychologists' Experiences in the Referral of African Americans to Special Education

ERIC Educational Resources Information Center

Lester, Pamela Denise

2017-01-01

A qualitative method of research was chosen for this study. This ethnographic case study examined school psychologists' and the referral process for special education services. The participants included school psychologists in a specific county in the state of Maryland. School psychologists are considered crucial members of an Individualized…

Yellow Fever outbreaks in unvaccinated populations, Brazil, 2008-2009.

PubMed

Romano, Alessandro Pecego Martins; Costa, Zouraide Guerra Antunes; Ramos, Daniel Garkauskas; Andrade, Maria Auxiliadora; Jayme, Valéria de Sá; Almeida, Marco Antônio Barreto de; Vettorello, Kátia Campomar; Mascheretti, Melissa; Flannery, Brendan

2014-03-01

Due to the risk of severe vaccine-associated adverse events, yellow fever vaccination in Brazil is only recommended in areas considered at risk for disease. From September 2008 through June 2009, two outbreaks of yellow fever in previously unvaccinated populations resulted in 21 confirmed cases with 9 deaths (case-fatality, 43%) in the southern state of Rio Grande do Sul and 28 cases with 11 deaths (39%) in Sao Paulo state. Epizootic deaths of non-human primates were reported before and during the outbreak. Over 5.5 million doses of yellow fever vaccine were administered in the two most affected states. Vaccine-associated adverse events were associated with six deaths due to acute viscerotropic disease (0.8 deaths per million doses administered) and 45 cases of acute neurotropic disease (5.6 per million doses administered). Yellow fever vaccine recommendations were revised to include areas in Brazil previously not considered at risk for yellow fever.

Yellow Fever Outbreaks in Unvaccinated Populations, Brazil, 2008–2009

PubMed Central

Romano, Alessandro Pecego Martins; Costa, Zouraide Guerra Antunes; Ramos, Daniel Garkauskas; Andrade, Maria Auxiliadora; Jayme, Valéria de Sá; de Almeida, Marco Antônio Barreto; Vettorello, Kátia Campomar; Mascheretti, Melissa; Flannery, Brendan

2014-01-01

Due to the risk of severe vaccine-associated adverse events, yellow fever vaccination in Brazil is only recommended in areas considered at risk for disease. From September 2008 through June 2009, two outbreaks of yellow fever in previously unvaccinated populations resulted in 21 confirmed cases with 9 deaths (case-fatality, 43%) in the southern state of Rio Grande do Sul and 28 cases with 11 deaths (39%) in Sao Paulo state. Epizootic deaths of non-human primates were reported before and during the outbreak. Over 5.5 million doses of yellow fever vaccine were administered in the two most affected states. Vaccine-associated adverse events were associated with six deaths due to acute viscerotropic disease (0.8 deaths per million doses administered) and 45 cases of acute neurotropic disease (5.6 per million doses administered). Yellow fever vaccine recommendations were revised to include areas in Brazil previously not considered at risk for yellow fever. PMID:24625634

Identification and selection of cases and controls in the Pneumonia Etiology Research for Child Health project.

PubMed

Deloria-Knoll, Maria; Feikin, Daniel R; Scott, J Anthony G; O'Brien, Katherine L; DeLuca, Andrea N; Driscoll, Amanda J; Levine, Orin S

2012-04-01

Methods for the identification and selection of patients (cases) with severe or very severe pneumonia and controls for the Pneumonia Etiology Research for Child Health (PERCH) project were needed. Issues considered include eligibility criteria and sampling strategies, whether to enroll hospital or community controls, whether to exclude controls with upper respiratory tract infection (URTI) or nonsevere pneumonia, and matching criteria, among others. PERCH ultimately decided to enroll community controls and an additional human immunodeficiency virus (HIV)-infected control group at high HIV-prevalence sites matched on age and enrollment date of cases; controls with symptoms of URTI or nonsevere pneumonia will not be excluded. Systematic sampling of cases (when necessary) and random sampling of controls will be implemented. For each issue, we present the options that were considered, the advantages and disadvantages of each, the rationale for the methods selected for PERCH, and remaining implications and limitations.

Perspectives on polio and immunization in Northern Nigeria.

PubMed

Renne, Elisha

2006-10-01

Through the efforts of the global campaign to eradicate poliomyelitis, polio cases have declined worldwide, from 35,251 cases in 1988, to 1449 cases as of 28 October 2005. However, confirmed cases of wild polio virus continue to be reported from Northern Nigeria. This paper examines the reasons for the difficulties in eradicating polio in Northern Nigeria from the perspective of residents of one town, Zaria, in northern Kaduna State. Research methods included participant observation, open-ended interviews and the collection of polio-related documents. While some people believed that the vaccine was contaminated by anti-fertility substances, others questioned the focus on polio when measles and malaria were considered more harmful. Some also distrusted claims about the safety of Western biomedicine. These concerns relate to questions about the appropriateness of vertical health interventions, where levels of routine immunization are low. While the Polio Eradication Initiative was considered to be cost-effective by Western donors, from the perspective of some people in Zaria it was seen as undermining primary health care, suggesting that a collaborative, community-based framework for primary health care, which includes routine immunization, would be a more acceptable approach.

Ascaris lumbricoides causing infarction of the mesenteric lymph nodes and intestinal gangrene in a child: a case report

PubMed Central

Bhutia, Kincho Lhasong; Dey, Subhajeet; Singh, Varun; Gupta, Amlan

2011-01-01

Ascaris lumbricoides or round worm infestation is quite common in the developing world. It affects all age groups but is more common in children. Most of the cases remain asymptomatic. The usual presentation is an intestinal obstruction. The physicians should be aware of this condition and consider it in the differential diagnosis when faced with such a case. The rare fatal complications include bleeding, perforation and gangrene. PMID:21698086

Preventability of adverse effects of analgesics: analysis of spontaneous reports.

PubMed

Cazacu, Irina; Miremont-Salamé, Ghada; Mogosan, Cristina; Fourrier-Réglat, Annie; Loghin, Felicia; Haramburu, Françoise

2015-05-01

The aims of this study were to determine the patterns of analgesic adverse drug reactions (ADRs) and to assess their preventability and contributing factors. This is a retrospective, descriptive study conducted on ADRs of analgesics and other drugs indicated as analgesics, spontaneously reported to the Bordeaux pharmacovigilance center from January 2011 to June 2012. The 141 cases selected for the analysis included 16 cases of medication errors (11.3%) and 15 addiction cases (10.6%). In total, 214 ADRs were registered, for which 173 analgesic medicines were suspected. The most frequent ADRs reported were nervous system disorders (26.6%), psychiatric disorders (15.0%), and skin and subcutaneous tissue disorders (12.1%). Tramadol alone or in combination (17.3%), followed by morphine (15%), fentanyl (9.8%), and paracetamol (8.7%) were the most frequently involved analgesics. More than half of the cases (54.6%) were serious and led to hospitalization or prolonged hospitalization. Preventability was determined for 134 cases (95%): 51.5% were considered as preventable, 26.1% not preventable, and 22.4% not assessable. The main contributing factors for the preventable cases included negligence of recommendations for analgesic use and failure to consider patients' risk factors when prescribing. A significant number of analgesic ADRs could be prevented, and being aware of their contributing factors promotes efficient analgesia with minimum risks to the patients.

The Use of Constructive Modeling and Virtual Simulation in Large-Scale Team Training: A Military Case Study.

ERIC Educational Resources Information Center

Andrews, Dee H.; Dineen, Toni; Bell, Herbert H.

1999-01-01

Discusses the use of constructive modeling and virtual simulation in team training; describes a military application of constructive modeling, including technology issues and communication protocols; considers possible improvements; and discusses applications in team-learning environments other than military, including industry and education. (LRW)

The Case for Creating a Scholars Portal to the Web: A White Paper.

ERIC Educational Resources Information Center

Campbell, Jerry D.

2001-01-01

Considers the need for reliable, scholarly access to the Web and suggests that the Association for Research Libraries, in partnership with OCLC and the Library of Congress, develop a so-called scholar's portal. Topics include quality content; enhanced library services; and gateway functions, including access to commercial databases and focused…

Electronic characterization of defects in narrow gap semiconductors

NASA Technical Reports Server (NTRS)

Patterson, James D.

1994-01-01

We use a Green's function technique to calculate the position of deep defects in narrow gap semiconductors. We consider substitutional (including antisite), vacancy, and interstitial (self and foreign) deep defects. We also use perturbation theory to look at the effect of nonparabolic bands on shallow defect energies and find nonparabolicity can increase the binding by 10 percent or so. We consider mercury cadmium telluride (MCT), mercury zinc telluride (MZT), and mercury zinc selenide (MZS). For substitutional and interstitial defects we look at the situation with and without relaxation. For substitutional impurities in MCT, MZT, and MZS, we consider x (the concentration of Cd or Zn) in the range 0.1 less than x less than 0.3 and also consider appropriate x so E(sub g) = 0.1 eV for each of the three compounds. We consider several cation site s-like deep levels and anion site p-like levels. For E(sub g) = 0.1 eV, we also consider the effects of relaxation. Similar comments apply to the interstitial deep levels whereas no relaxation is considered for the ideal vacancy model. Relaxation effects can be greater for the interstitial than the substitutional cases. Specific results are given in figures and tables and comparison to experiment is made in a limited number of cases. We find, for example, that I, Se, S, Rn, and N are possible cation site, s-like deep levels in MCT and Zn and Mg are for anion site, p-like levels (both levels for substitutional cases). The corresponding cation and anion site levels for interstitial deep defects are (Au, Ag, Hg, Cd, Cu, Zn) and (N, Ar, O, F). For the substitutional cases we have some examples of relaxation moving the levels into the band gap, whereas for the interstitial case we have examples where relaxation moves it out of the band gap. Future work involves calculating the effects of charge state interaction and seeing the effect of relaxation on vacancy levels.

Advanced Solid Rocket Motor case design status

NASA Technical Reports Server (NTRS)

Palmer, G. L.; Cash, S. F.; Beck, J. P.

1993-01-01

The Advanced Solid Rocket Motor (ASRM) case design aimed at achieving a safer and more reliable solid rocket motor for the Space Shuttle system is considered. The ASRM case has a 150.0 inch diameter, three equal length segment, and 9Ni-4CO-0.3C steel alloy. The major design features include bolted casebolted case joints which close during pressurization, plasma arc welded factory joints, integral stiffener for splash down and recovery, and integral External Tank attachment rings. Each mechanical joint has redundant and verifiable o-ring seals.

Triceps Ruptures After Fluoroquinolone Antibiotics: A Report of 2 Cases.

PubMed

Shybut, Theodore B; Puckett, Ernest R

Rupture of the triceps brachii tendon is exceedingly rare, and surgical repair is generally indicated. Fluoroquinolone antibiotics have been implicated in tendon pathology, including tendon ruptures. Triceps rupture has not been previously reported in the setting of fluoroquinolone antibiotic therapy. We present 2 cases of triceps tendon rupture after treatment with fluoroquinolones. In both cases, triceps repair was performed with good outcomes. These cases highlight a risk of fluoroquinolone-induced tendinopathy to athletes. The sports medicine team should be aware of this risk and consider it when choosing antibiotics to treat athletes.

‘Abnormal’ cervical imaging?: Cervical pneumatocysts – A case report of a cervical spine pneumatocyst

PubMed Central

Renshaw, Hanna; Patel, Amit; Boctor, Daniel Sherif Zakaria Matta; Hakmi, Mohamed Atef

2015-01-01

To our knowledge there are only 15 reported cases of pneumatocysts in the cervical spine, but awareness of their existence should help the clinician when diagnosing abnormalities in radiological images. When faced with intravertebral gas, in addition to considering more sinister causes, one should consider the differentials including pneumatocysts. Despite our relative lack of understanding of these benign lesions the knowledge that they can change over time should prevent unnecessary testing or treating. We present a patient who fell down stairs and was found to have cervical intravertebral gas, on computed tomography imaging, with the typical appearance of a pneumatocyst. PMID:26719615

'Abnormal' cervical imaging?: Cervical pneumatocysts - A case report of a cervical spine pneumatocyst.

PubMed

Renshaw, Hanna; Patel, Amit; Boctor, Daniel Sherif Zakaria Matta; Hakmi, Mohamed Atef

2015-10-01

To our knowledge there are only 15 reported cases of pneumatocysts in the cervical spine, but awareness of their existence should help the clinician when diagnosing abnormalities in radiological images. When faced with intravertebral gas, in addition to considering more sinister causes, one should consider the differentials including pneumatocysts. Despite our relative lack of understanding of these benign lesions the knowledge that they can change over time should prevent unnecessary testing or treating. We present a patient who fell down stairs and was found to have cervical intravertebral gas, on computed tomography imaging, with the typical appearance of a pneumatocyst.

A case series of patients diagnosed with orofacial granulomatosis presenting primarily with dense infiltrates and severe periorbital edema.

PubMed

Sabet-Peyman, Esfandiar J; Woodward, Julie A

2014-01-01

Orofacial granulomatosis is a relapsing nonnecrotizing granulomatous syndrome that classically presents with lip and perioral swelling. Over the years, several patients have been referred to the Duke Eye Center Oculoplastics Department for severe, progressive, recurrent eyelid swelling interfering with both their functional vision and their appearance. In this IRB approved retrospective case series, we describe the clinical course of 5 such patients, including their presenting symptoms, diagnosis, and response to treatment. We hope that oculoplastics specialists will consider this entity in the differential diagnosis of periorbital edema and consider initiating localized anti-inflammatory treatment once the diagnosis has been made.

Severe disease exacerbations in patients with multiple sclerosis after discontinuing fingolimod.

PubMed

Członkowska, Anna; Smoliński, Łukasz; Litwin, Tomasz

Discontinuation of fingolimod in patients with multiple sclerosis (MS) can lead to disease reactivation. In this review, we describe cases of severe exacerbations in patients with MS following discontinuation of fingolimod, including three cases from our center. We consider potential mechanisms of disease reactivation after cessation of fingolimod, and the evidence supporting this rebound effect. We conclude that discontinuation of fingolimod results in the return of disease activity, which then leads to severe exacerbations (i.e., rebounds) in a clinically significant proportion of patients. Lastly, we consider disease-modifying treatment options for patients who discontinue fingolimod. Copyright © 2017. Published by Elsevier Urban & Partner Sp. z o.o.

Two extraordinarily severe cases of Treacher Collins syndrome.

PubMed

Bauer, Mislen; Saldarriaga, Wilmar; Wolfe, S Anthony; Beckwith, J Bruce; Frias, Jaime L; Cohen, M Michael

2013-03-01

Here, we report two extraordinarily severe cases of Teacher Collins syndrome. Initially, amniotic bands and plical fold disruption were considered, but downslanting eyes made us consider severe Treacher Collins syndrome. A TCOF1 mutation in exon 24 was identified in Patient 1 (c.4355_4356ins14, resulting in p.1456Thrfs*18). Patient 2, who expired on day 4, is so similar to Patient 1 that severe Treacher Collins syndrome may be inferred in this instance. Neither the TCOF1 mutation nor the well-known variability in the expression in affected families with Treacher Collins syndrome (∼40% of reported cases) can explain the severity of these cases; otherwise, we would be aware of such cases within families from time to time. We are unaware of any recent sporadic cases (∼60% of reported cases) exactly like ours either with a single exception in the case reported by Writzl et al. [2008] with a TCOF1 mutation. The case described by Otto in 1841 is spectacular. We propose several hypotheses to be considered in explaining this developmental amplification, including some promoter effect on the gene, some position effect on the gene, a polymorphism elsewhere in the gene, a point mutation elsewhere in the gene, a polymorphism in another gene, or a point mutation in another gene, such as POLR1C (which maps to 6p21.1) or POLR1D (which maps to13q12.2). We also review the etiology and pathogenesis of Treacher Collins syndrome, and discuss several other severe cases from the past. Copyright © 2013 Wiley Periodicals, Inc.

Total fibrous obliteration of main portal vein and portal foam cell venopathy in chronic hepatic allograft rejection.

PubMed

Jain, Dhanpat; Robert, Marie E; Navarro, Victor; Friedman, Amy L; Crawford, James M

2004-01-01

Chronic hepatic allograft rejection is characterized by arteriopathy and bile duct loss. Pathology of the portal vein or its branches is not considered to play a major role in chronic rejection. A recent case of chronic rejection with total fibrous obliteration of the portal vein at the hilum and graft loss prompted us to retrospectively analyze cases of failed allografts for portal vein changes. Six cases of failed hepatic allograft recorded in our files from 1994 to 1998 were selected for the study. For comparison, 4 cases of hepatitis C cirrhosis were included. Clinical features, including arteriograms or Doppler studies, were reviewed whenever available. Sections taken from the hilum and random parenchyma stained with routine hematoxylin-eosin, elastic van Gieson, and Masson trichrome were examined by 3 experienced liver pathologists in a randomized, blinded fashion. Significant hepatic artery occlusion with foam cell change and bile duct loss was seen in all cases of chronic rejection (3/3), but not in the other cases. Foam cell change in the portal vein at the hilum (3/3) and occasionally into the distal branches (2/3) with variable occlusion of the lumen was seen only in cases of chronic hepatic allograft rejection. Mild luminal narrowing was observed in all the cases of cirrhosis (4/4) as a result of phlebosclerosis, most likely representing a change secondary to portal hypertension. Total obliteration of the portal vein at the hilum was seen in the index case (case 1) only. Portal venopathy can be a significant finding in chronic hepatic allograft rejection and may contribute to graft dysfunction or failure. Two-vessel disease must be considered in cases of chronic hepatic allograft rejection, and pathologists should thoroughly examine the hilum in explanted hepatic allografts.

Second-Order Moller-Plesset Perturbation Theory for Molecular Dirac-Hartree-Fock Wave Functions

NASA Technical Reports Server (NTRS)

Dyall, Kenneth G.; Arnold, James O. (Technical Monitor)

1994-01-01

Moller-Plesset perturbation theory is developed to second order for a selection of Kramers restricted Dirac-Hartree-Fock closed and open-shell reference wave functions. The open-shell wave functions considered are limited to those with no more than two electrons in open shells, but include the case of a two-configuration SCF reference. Denominator shifts are included in the style of Davidson's OPT2 method. An implementation which uses unordered integrals with labels is presented, and results are given for a few test cases.

Getting the Facts, Analyzing the Data, Building the Case for Institutional Distinctiveness.

ERIC Educational Resources Information Center

Ratcliff, James L.

1989-01-01

Suggests sources of data related to the distinctiveness of a community college, including institutional histories, needs assessments, institutional impact studies, marketing research, and strategic planning studies. Considers ways of organizing the data. (DMM)

Application of non-invasive mechanical ventilation in an asthmatic pregnant woman in respiratory failure: a case report

PubMed Central

Caner, Hanife; Eryuksel, Emel; Kosar, Filiz

2013-01-01

The use of non-invasive mechanical ventilation (NIV) during an asthma attack is controversial. We report a case of a 28-year-old female patient in her 16th week of pregnancy with community-acquired pneumonia who presented during an asthma attack, which led to hypoxic respiratory failure. She was successfully treated using NIV. This case is worth discussing as it includes two clinical conditions in which NIV is often considered contraindicated. PMID:23372957

Wave Riemann description of friction terms in unsteady shallow flows: Application to water and mud/debris floods

NASA Astrophysics Data System (ADS)

Murillo, J.; García-Navarro, P.

2012-02-01

In this work, the source term discretization in hyperbolic conservation laws with source terms is considered using an approximate augmented Riemann solver. The technique is applied to the shallow water equations with bed slope and friction terms with the focus on the friction discretization. The augmented Roe approximate Riemann solver provides a family of weak solutions for the shallow water equations, that are the basis of the upwind treatment of the source term. This has proved successful to explain and to avoid the appearance of instabilities and negative values of the thickness of the water layer in cases of variable bottom topography. Here, this strategy is extended to capture the peculiarities that may arise when defining more ambitious scenarios, that may include relevant stresses in cases of mud/debris flow. The conclusions of this analysis lead to the definition of an accurate and robust first order finite volume scheme, able to handle correctly transient problems considering frictional stresses in both clean water and debris flow, including in this last case a correct modelling of stopping conditions.

A Comprehensive Comparison of Relativistic Particle Integrators

NASA Astrophysics Data System (ADS)

Ripperda, B.; Bacchini, F.; Teunissen, J.; Xia, C.; Porth, O.; Sironi, L.; Lapenta, G.; Keppens, R.

2018-03-01

We compare relativistic particle integrators commonly used in plasma physics, showing several test cases relevant for astrophysics. Three explicit particle pushers are considered, namely, the Boris, Vay, and Higuera–Cary schemes. We also present a new relativistic fully implicit particle integrator that is energy conserving. Furthermore, a method based on the relativistic guiding center approximation is included. The algorithms are described such that they can be readily implemented in magnetohydrodynamics codes or Particle-in-Cell codes. Our comparison focuses on the strengths and key features of the particle integrators. We test the conservation of invariants of motion and the accuracy of particle drift dynamics in highly relativistic, mildly relativistic, and non-relativistic settings. The methods are compared in idealized test cases, i.e., without considering feedback onto the electrodynamic fields, collisions, pair creation, or radiation. The test cases include uniform electric and magnetic fields, {\\boldsymbol{E}}× {\\boldsymbol{B}} fields, force-free fields, and setups relevant for high-energy astrophysics, e.g., a magnetic mirror, a magnetic dipole, and a magnetic null. These tests have direct relevance for particle acceleration in shocks and in magnetic reconnection.

Stationary scalar clouds around a BTZ black hole

NASA Astrophysics Data System (ADS)

Ferreira, Hugo R. C.; Herdeiro, Carlos A. R.

2017-10-01

We establish the existence of stationary clouds of massive test scalar fields around BTZ black holes. These clouds are zero-modes of the superradiant instability and are possible when Robin boundary conditions (RBCs) are considered at the AdS boundary. These boundary conditions are the most general ones that ensure the AdS space is an isolated system, and include, as a particular case, the commonly considered Dirichlet or Neumann-type boundary conditions (DBCs or NBCs). We obtain an explicit, closed form, resonance condition, relating the RBCs that allow the existence of normalizable (and regular on and outside the horizon) clouds to the system's parameters. Such RBCs never include pure DBCs or NBCs. We illustrate the spatial distribution of these clouds, their energy and angular momentum density for some cases. Our results show that BTZ black holes with scalar hair can be constructed, as the non-linear realization of these clouds.

Examining key design decisions involved in developing a serious game for child sexual abuse prevention.

PubMed

Stieler-Hunt, Colleen; Jones, Christian M; Rolfe, Ben; Pozzebon, Kay

2014-01-01

This paper presents a case study of the key decisions made in the design of Orbit, a child sexual abuse prevention computer game targeted at school students between 8 and 10 years of age. Key decisions include providing supported delivery for the target age group, featuring adults in the program, not over-sanitizing game content, having a focus on building healthy self-concept of players, making the game engaging and relatable for all players and evaluating the program. This case study has implications for the design of Serious Games more generally, including that research should underpin game design decisions, game designers should consider ways of bridging the game to real life, the learning that arises from the game should go beyond rote-learning, designers should consider how the player can make the game-world their own and comprehensive evaluations of Serious Games should be undertaken.

Healthcare managers' decision making: findings of a small scale exploratory study.

PubMed

Macdonald, Jackie; Bath, Peter A; Booth, Andrew

2008-12-01

Managers who work in publicly funded healthcare organizations are an understudied group. Some of the influences on their decisions may be unique to healthcare. This study considers how to integrate research knowledge effectively into healthcare managers' decision making, and how to manage and integrate information that will include community data. This first phase in a two-phase mixed methods research study used a qualitative, multiple case studies design. Nineteen semi-structured interviews were undertaken using the critical incident technique. Interview transcripts were analysed using the NatCen Framework. One theme represented ;information and decisions'. Cases were determined to involve complex multi-level, multi-situational decisions with participants in practical rather than ceremonial work roles. Most considered organizational knowledge in the first two decision phases and external knowledge, including research, in the third phase. All participants engaged in satisficing to some degree.

Examining key design decisions involved in developing a serious game for child sexual abuse prevention

PubMed Central

Stieler-Hunt, Colleen; Jones, Christian M.; Rolfe, Ben; Pozzebon, Kay

2014-01-01

This paper presents a case study of the key decisions made in the design of Orbit, a child sexual abuse prevention computer game targeted at school students between 8 and 10 years of age. Key decisions include providing supported delivery for the target age group, featuring adults in the program, not over-sanitizing game content, having a focus on building healthy self-concept of players, making the game engaging and relatable for all players and evaluating the program. This case study has implications for the design of Serious Games more generally, including that research should underpin game design decisions, game designers should consider ways of bridging the game to real life, the learning that arises from the game should go beyond rote-learning, designers should consider how the player can make the game-world their own and comprehensive evaluations of Serious Games should be undertaken. PMID:24550880

The successful treatment of mania due to acquired immunodeficiency syndrome using ziprasidone: a case series.

PubMed

Spiegel, David R; Weller, Amanda L; Pennell, Kirsten; Turner, Krista

2010-01-01

Secondary causes of mania need to be considered when atypical features of mania are manifested. These would include those patients with a later onset and without a prior psychiatric history. This case series investigates the use of ziprasidone for the treatment of mania due to HIV, a complication that could develop in those patients with advanced stages of AIDS.

The Case for Change in College Admissions: A Call for Individual and Collective Leadership. A Report Informed and Inspired by the Los Angeles Conference Jan 26-28, 2011

ERIC Educational Resources Information Center

Wegner, Gregory R.; Thacker, Lloyd; Lucido, Jerome A.; Schulz, Scott Andrew

2011-01-01

In January 2011, the University of Southern California Center for Enrollment Research, Policy, and Practice in conjunction with the Education Conservancy convened a national workshop--a unique experiment meant to consider "The Case for Change in College Admissions." Its 180 participants included university and college admissions officers…

Reversible dementia with psychosis: Hashimoto's encephalopathy.

PubMed

Mocellin, Ramon; Lubman, Dan I; Lloyd, John; Tomlinson, E Bruce; Velakoulis, Dennis

2006-12-01

A case of presumed Hashimoto's encephalopathy (HE) is presented. The presentation included memory loss, delusions, functional decline and culminated in a generalized seizure. Anti-thyroid antibodies were detected and symptoms resolved with prednisolone. Patients with HE may present with prominent neuropsychiatric symptoms, attract psychiatric diagnoses and present to psychiatric services. Primarily a diagnosis of exclusion, HE should be considered in cases of encephalopathy in which standard investigations are negative.

[Seasonal and regional distribution of tularemia cases in Amasya, Turkey].

PubMed

Yanık, Keramettin; Sarıaydın, Muzaffer; Uzun, M Önder; Çoban, Ahmet Yılmaz; Seçilmiş, Halil

2015-01-01

Tularemia have attracted attention due to increased number of cases since 2009 in Amasya region which is located at Central Blacksea Region of Turkey. The aims of this letter were to provide information about the disease, to emphasize the importance of early treatment due to the outbreak peak in our province between 2009-2012 and water chlorination in epidemic areas. A total of 250 tularemia-suspected patients (117 female, 133 male; mean age: 42 yrs) who were admitted to our hospital with the symptoms of sore throat, fever, malaise and/or presence of neck mass, from 20 different locations within last four years were included in the study. Serum samples of 73 (29.2%) patients yielded ≥ 1/160 titers with F.tularensis microagglutination test which were considered as positive. All positive cases presented with the oropharyngeal form of the disease. The year with the highest number of tularemia cases was 2010. When the regional distribution was evaluated, it was detected that positive cases have precipitated especially in the southeastern (highland area) and northeastern (lowland area) parts of Amasya (34/73; 46.6%). Majority of the tularemia cases (53/73; 72.6%) were identified in colder seasons. The number of cases in rural and urban centers have decreased after 2010. In conclusion, it is considered that the emergence of new cases is likely to persist due to the geographical characteristics of Amasya and occupational properties (livestock breeding) of the population. Therefore, the clinicians should consider tularemia in differential diagnosis of the cases originated from risky rural areas.

Standardized classification unsuitable for spontaneous reporting: the example of osteonecrosis of the jaw.

PubMed

de Boissieu, Paul; Trenque, Thierry

2015-07-01

This study assessed the impact of using a standardized definition of bisphosphonate-related osteonecrosis of the jaw (BRONJ) in the analysis of a spontaneous reporting database. All notifications of osteonecrosis of the jaw (ONJ) in the French National Pharmacovigilance Database as of 31 December 2013 were analyzed. First, we considered all reports of ONJ with bisphosphonates as BRONJ. Second, we applied the 2014 definition of BRONJ from the American Association of Oral and Maxillofacial Surgeons (AAOMS), retaining only bisphosphonates as antiresorptive medication. In the absence of any one of these criteria, or missing data, cases were not considered as BRONJ. The first analysis found 158 cases of ONJ, among which 153 were associated with bisphosphonate use. The second analysis identified only 43 cases of BRONJ (28.1%). The definition of BRONJ as laid down by the AAOMS is not suitable for use in spontaneous reporting database. The use of the AAOMS definition alone should be avoided, as it leads to the exclusion of over 70% of cases. When cases of ONJ are identified, all results should be presented including confirmed and excluded cases.

Evaluation of Visual Field Progression in Glaucoma: Quasar Regression Program and Event Analysis.

PubMed

Díaz-Alemán, Valentín T; González-Hernández, Marta; Perera-Sanz, Daniel; Armas-Domínguez, Karintia

2016-01-01

To determine the sensitivity, specificity and agreement between the Quasar program, glaucoma progression analysis (GPA II) event analysis and expert opinion in the detection of glaucomatous progression. The Quasar program is based on linear regression analysis of both mean defect (MD) and pattern standard deviation (PSD). Each series of visual fields was evaluated by three methods; Quasar, GPA II and four experts. The sensitivity, specificity and agreement (kappa) for each method was calculated, using expert opinion as the reference standard. The study included 439 SITA Standard visual fields of 56 eyes of 42 patients, with a mean of 7.8 ± 0.8 visual fields per eye. When suspected cases of progression were considered stable, sensitivity and specificity of Quasar, GPA II and the experts were 86.6% and 70.7%, 26.6% and 95.1%, and 86.6% and 92.6% respectively. When suspected cases of progression were considered as progressing, sensitivity and specificity of Quasar, GPA II and the experts were 79.1% and 81.2%, 45.8% and 90.6%, and 85.4% and 90.6% respectively. The agreement between Quasar and GPA II when suspected cases were considered stable or progressing was 0.03 and 0.28 respectively. The degree of agreement between Quasar and the experts when suspected cases were considered stable or progressing was 0.472 and 0.507. The degree of agreement between GPA II and the experts when suspected cases were considered stable or progressing was 0.262 and 0.342. The combination of MD and PSD regression analysis in the Quasar program showed better agreement with the experts and higher sensitivity than GPA II.

Characterization of Navy Solid Waste and Collection and Disposal Practices.

DTIC Science & Technology

1980-01-01

26 A-7 Calculation of Design Capacity for Sample Cases.......A-30 A-8 Incineration Plant Capacities Considered for Economic Analysis ...CONSIDERED FOR ECONOMIC ANALYSIS Approximate Quantity of Plant Design Quantity of No. of Shifts Refuse Generateda Capacityb Refuse Burned Operated (tons/day...including a site visit to the 50-ton/day plant in Yokohama, Japan. (2) A preliminary technoeconomic evaluation of a fluidized bed combustor (preceded

Development of the major trauma case review tool.

PubMed

Curtis, Kate; Mitchell, Rebecca; McCarthy, Amy; Wilson, Kellie; Van, Connie; Kennedy, Belinda; Tall, Gary; Holland, Andrew; Foster, Kim; Dickinson, Stuart; Stelfox, Henry T

2017-02-28

As many as half of all patients with major traumatic injuries do not receive the recommended care, with variance in preventable mortality reported across the globe. This variance highlights the need for a comprehensive process for monitoring and reviewing patient care, central to which is a consistent peer-review process that includes trauma system safety and human factors. There is no published, evidence-informed standardised tool that considers these factors for use in adult or paediatric trauma case peer-review. The aim of this research was to develop and validate a trauma case review tool to facilitate clinical review of paediatric trauma patient care in extracting information to facilitate monitoring, inform change and enable loop closure. Development of the trauma case review tool was multi-faceted, beginning with a review of the trauma audit tool literature. Data were extracted from the literature to inform iterative tool development using a consensus approach. Inter-rater agreement was assessed for both the pilot and finalised versions of the tool. The final trauma case review tool contained ten sections, including patient factors (such as pre-existing conditions), presenting problem, a timeline of events, factors contributing to the care delivery problem (including equipment, work environment, staff action, organizational factors), positive aspects of care and the outcome of panel discussion. After refinement, the inter-rater reliability of the human factors and outcome components of the tool improved with an average 86% agreement between raters. This research developed an evidence-informed tool for use in paediatric trauma case review that considers both system safety and human factors to facilitate clinical review of trauma patient care. This tool can be used to identify opportunities for improvement in trauma care and guide quality assurance activities. Validation is required in the adult population.

Assessment of Aerothermal Heating Augmentation Attributed to Surface Catalysis in High Enthalpy Shock Tunnel Flows

NASA Astrophysics Data System (ADS)

MacLean, M.; Holden, M.

2009-01-01

The effect of gas/surface interaction in making CFD predictions of convective heating has been considered with application to ground tests performed in high enthalpy shock tunnels where additional heating augmentation attributable to surface recombination has been observed for nitrogen, air and carbon dioxide flows. For test articles constructed of stainless steel and aluminum, measurements have been made with several types of heat transfer instrumentation including thin- film, calorimeter, and coaxial thermocouple sensors. These experiments have been modeled by computations made with the high quality, chemically reacting, Navier- Stokes solver, DPLR and the heating results compared. Some typical cases considered include results on an axisymmetric sphere-cone, axisymmetric spherical capsule, spherical capsule at angle of attack, and two- dimensional cylinder. In nitrogen flows, cases considered show a recombination probability on the order of 10-3, which agrees with published data. In many cases in air and CO2, measurements exceeding the predicted level of convective heating have been observed which are consistent with approximately complete recombination (to O2/N2 or CO2) on the surface of the model (sometimes called a super-catalytic wall). It has been recognized that the conclusion that this behavior is tied to an excessively high degree of catalytic efficiency is dependent on the current understanding of the freestream and shock-layer state of the gas.

The dynamics and optimal control of spinning spacecraft and movable telescoping appendages, part A. [two axis control with single offset boom

NASA Technical Reports Server (NTRS)

Bainum, P. M.; Sellappan, R.

1977-01-01

The problem of optimal control with a minimum time criterion as applied to a single boom system for achieving two axis control is discussed. The special case where the initial conditions are such that the system can be driven to the equilibrium state with only a single switching maneuver in the bang-bang optimal sequence is analyzed. The system responses are presented. Application of the linear regulator problem for the optimal control of the telescoping system is extended to consider the effects of measurement and plant noises. The noise uncertainties are included with an application of the estimator - Kalman filter problem. Different schemes for measuring the components of the angular velocity are considered. Analytical results are obtained for special cases, and numerical results are presented for the general case.

A Course on the Physics of Urban and Environmental Problems

ERIC Educational Resources Information Center

Marston, Edwin H.

1970-01-01

Presents a physics course for social scientists. Physics problems are presented within the context of several urban and environmental case studies. The problems considered include transportation, air pollution, thermal pollution of water, and scarcity of resources. (LS)

Countering resistance to protected-area extension.

PubMed

Lindenmayer, David; Thorn, Simon; Noss, Reed

2018-04-01

The establishment of protected areas is a critical strategy for conserving biodiversity. Key policy directives like the Aichi targets seek to expand protected areas to 17% of Earth's land surface, with calls by some conservation biologists for much more. However, in places such as the United States, Germany, and Australia, attempts to increase protected areas are meeting strong resistance from communities, industry groups, and governments. We examined case studies of such resistance in Victoria, Australia, Bavaria, Germany, and Florida, United States. We considered 4 ways to tackle this problem. First, broaden the case for protected areas beyond nature conservation to include economic, human health, and other benefits, and translate these into a persuasive business case for protected areas. Second, better communicate the conservation values of protected areas. This should include highlighting how many species, communities, and ecosystems have been conserved by protected areas and the counterfactual (i.e., what would have been lost without protected area establishment). Third, consider zoning of activities to ensure the maintenance of effective management. Finally, remind citizens to think about conservation when they vote, including holding politicians accountable for their environmental promises. Without tackling resistance to expanding the protected estate, it will be impossible to reach conservation targets, and this will undermine attempts to stem the global extinction crisis. © 2017 Society for Conservation Biology.

Consummated mother-son incest in latency: a case report of an adult analysis.

PubMed

Rudominer, Howard S

2002-01-01

Reported cases of mother-son incest are very rare in the psychoanalytic literature; the fact of such incest, however, may not be so rare as has generally been believed. A detailed case report of the analysis of an adult with a history of severe physical, sexual, and verbal abuse, including consummated incest with his mother during latency, is considered in the context of other reported studies. The author raises some issues of resistance and countertransference that may influence the reporting, treatment, and perhaps even recognition of cases of mother-son incest.

Nonleaking battery terminals.

NASA Technical Reports Server (NTRS)

Snider, W. E.; Nagle, W. J.

1972-01-01

Three different terminals were designed for usage in a 40 ampere/hour silver zinc battery which has a 45% KOH by weight electrolyte in a plastic battery case. Life tests, including thermal cycling, electrical charge and discharge for up to three years duration, were conducted on these three different terminal designs. Tests for creep rate and tensile strength were conducted on the polyphenylene oxide plastic battery cases. Some cases were unused and others containing KOH electrolyte were placed on life tests. The design and testing of nonleaking battery terminals for use with a KOH electrolyte in a plastic case are considered.

Necrotizing Fasciitis of the Abdominal Wall in a Premature Infant: A Case Study.

PubMed

Narvey, Michael; Byrne, Paul; Fraser, Debbie

2017-01-01

We present a first report of necrotizing fasciitis of the abdominal wall in a 23-day-of-age, former 32-week-gestation premature infant. She was successfully treated with antibiotics without the need for initial debridement. After reviewing the etiology of necrotizing fasciitis, we discuss the unique aspects of this case, including the noninvasive approach to initial treatment, which we consider significantly contributed to her survival.

Human exploration mission studies

NASA Technical Reports Server (NTRS)

Cataldo, Robert L.

1990-01-01

This paper describes several case studies of human space exploration, considered by the NASA's Office of Exploration in 1988. Special attention is given to the mission scenarios, the critical technology required in these expeditions, and the extraterrestrial power requirements of significant system elements. The cases examined include a manned expedition to Phobos, the inner Martian moon; a human expedition to Mars; the Lunar Observatory; and a lunar outpost to early Mars evolution.

Exact and quasi-classical density matrix and Wigner functions for a particle in the box and half space

NASA Technical Reports Server (NTRS)

Akhundova, E. A.; Dodonov, V. V.; Manko, V. I.

1993-01-01

The exact expressions for density matrix and Wigner functions of quantum systems are known only in special cases. Corresponding Hamiltonians are quadratic forms of Euclidean coordinates and momenta. In this paper we consider the problem of one-dimensional free particle movement in the bounded region 0 is less than x is less than a (including the case a = infinity).

Case-Mix Variables and Predictors for Outcomes of Laparoscopic Hysterectomy: A Systematic Review.

PubMed

Driessen, Sara R C; Sandberg, Evelien M; la Chapelle, Claire F; Twijnstra, Andries R H; Rhemrev, Johann P T; Jansen, Frank Willem

2016-01-01

The assessment of surgical quality is complex, and an adequate case-mix correction is missing in currently applied quality indicators. The purpose of this study is to give an overview of all studies mentioning statistically significant associations between patient characteristics and surgical outcomes for laparoscopic hysterectomy (LH). Additionally, we identified a set of potential case-mix characteristics for LH. This systematic review was conducted according to the Meta-Analysis of Observational Studies in Epidemiology guidelines. We searched PubMed and EMBASE from January 1, 2000 to August 1, 2015. All articles describing statistically significant associations between patient characteristics and adverse outcomes of LH for benign indications were included. Primary outcomes were blood loss, operative time, conversion, and complications. The methodologic quality of the included studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. The included articles were summed per predictor and surgical outcome. Three sets of case-mix characteristics were determined, stratified by different levels of evidence. Eighty-five of 1549 identified studies were considered eligible. Uterine weight and body mass index (BMI) were the most mentioned predictors (described, respectively, 83 and 45 times) in high quality studies. For longer operative time and higher blood loss, uterine weight ≥ 250 to 300 g and ≥500 g and BMI ≥ 30 kg/m(2) dominated as predictors. Previous operations, adhesions, and higher age were also considered as predictors for longer operative time. For complications and conversions, the patient characteristics varied widely, and uterine weight, BMI, previous operations, adhesions, and age predominated. Studies of high methodologic quality indicated uterine weight and BMI as relevant case-mix characteristics for all surgical outcomes. For future development of quality indicators of LH and to compare surgical outcomes adequately, a case-mix correction is suggested for at least uterine weight and BMI. A potential case-mix correction for adhesions and previous operations can be considered. For both surgeons and patients it is valuable to be aware of potential factors predicting adverse outcomes and to anticipate this. Finally, to benchmark clinical outcomes at an international level, it is of the utmost importance to introduce uniform outcome definitions. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

Design Your Own Budget: A Case Study Based on the 1988 Budget.

ERIC Educational Resources Information Center

Williams, Paul

1992-01-01

Presents a classroom activity in which students work in groups to develop a national budget. Requires students to consider economic factors such as inflation, unemployment, and taxation. Includes charts and a national budget work sheet. (CFR)

Down's Syndrome in Fiji and Tonga.

ERIC Educational Resources Information Center

Price, John

1979-01-01

The article reports results of a survey of 42 Down's syndrome individuals in Fiji and Tonga. Considered are physical characteristics including complications, chromosome analysis (in most cases), and, in Fiji only, an examination of the social consequences for the family. (Author/SBH)

Functionally graded biomimetic energy absorption concept development for transportation systems.

DOT National Transportation Integrated Search

2014-02-01

Mechanics of a functionally graded cylinder subject to static or dynamic axial loading is considered, including a potential application as energy absorber. The mass density and stiffness are power functions of the radial coordinate as may be the case...

Nurse entrepreneur ... what are you waiting for?

PubMed

Vonfrolio, L G

1993-01-01

With the wealth of knowledge and experience many nurses have, they could become successful nurse entrepreneurs. This article presents several possibilities for nurses to consider: independent practitioners, case managers, writers, seminar leaders, and video producers. Useful tips on marketing yourself are included.

Fetal Abuse.

ERIC Educational Resources Information Center

Kent, Lindsey; And Others

1997-01-01

Five cases of fetal abuse by mothers suffering from depression are discussed. Four of the women had unplanned pregnancies and had considered termination of the pregnancy. Other factors associated with fetal abuse include pregnancy denial, pregnancy ambivalence, previous postpartum depression, and difficulties in relationships. Vigilance for…

Updating the Behavior Engineering Model.

ERIC Educational Resources Information Center

Chevalier, Roger

2003-01-01

Considers Thomas Gilbert's Behavior Engineering Model as a tool for systematically identifying barriers to individual and organizational performance. Includes a detailed case study and a performance aid that incorporates gap analysis, cause analysis, and force field analysis to update the original model. (Author/LRW)

A Business Case for Home Performance Contracting

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

Baechler, Michael C.; Antonopoulos, Chrissi A.; Sevigny, Maureen

This report was prepared by PNNL for the DOE Building America program. The report provides information for businesses considering entering the home performance contracting industry. Metrics discussed include industry trends and drivers, specific points of entry, business models, startup costs, and marketing strategies. The report includes detailed analysis of eight businesses around the country that have successfully entered the home performance contracting industry. Data is provided on their financial structures, program participation, marketing efforts, and staff training. This report will be distributed via the DOE Building America website, www.buildingamerica.gov. Individual case studies will also be cleared separately.

A case of cooperation in the European OR education

NASA Astrophysics Data System (ADS)

Miranda, João; Nagy, Mariana

2011-12-01

European cooperation is a relevant subject that contributes to building a competitive network of high education institutions. A case of teacher mobility on behalf of the Erasmus programme is presented: it considers some Operations Research topics and the development of the Lego on My Decision module. The module considers eight lecture hours in four sessions: (i) the introductory session, to focus on the basics of computational linear algebra, linear programming, integer programming, with computational support (Excel®); (ii) the interim session, to address modelling subjects in a drop by-session; (iii) the advanced session, on the sequence of (i), to consider uncertainty and also how to use multi-criteria decision-making methods; (iv) the final session, to perform the evaluation of learning outcomes. This cooperation at European level is further exploited, including curricula normalisation and adjustments, cultural exchanges and research lines sharing in the idea of promoting the mobility of students and faculty.

Evaluation of Liquid Fuel Spray Models for Hybrid RANS/LES and DLES Prediction of Turbulent Reactive Flows

NASA Astrophysics Data System (ADS)

Afshar, Ali

An evaluation of Lagrangian-based, discrete-phase models for multi-component liquid sprays encountered in the combustors of gas turbine engines is considered. In particular, the spray modeling capabilities of the commercial software, ANSYS Fluent, was evaluated. Spray modeling was performed for various cold flow validation cases. These validation cases include a liquid jet in a cross-flow, an airblast atomizer, and a high shear fuel nozzle. Droplet properties including velocity and diameter were investigated and compared with previous experimental and numerical results. Different primary and secondary breakup models were evaluated in this thesis. The secondary breakup models investigated include the Taylor analogy breakup (TAB) model, the wave model, the Kelvin-Helmholtz Rayleigh-Taylor model (KHRT), and the Stochastic secondary droplet (SSD) approach. The modeling of fuel sprays requires a proper treatment for the turbulence. Reynolds-averaged Navier-Stokes (RANS), large eddy simulation (LES), hybrid RANS/LES, and dynamic LES (DLES) were also considered for the turbulent flows involving sprays. The spray and turbulence models were evaluated using the available benchmark experimental data.

Serologic Evidence of Tick-Borne Encephalitis Virus Infection in a Patient with Suspected Lyme Disease in Japan.

PubMed

Yoshii, Kentaro; Sato, Kozue; Ishizuka, Mariko; Kobayashi, Shintaro; Kariwa, Hiroaki; Kawabata, Hiroki

2018-05-29

Tick-borne encephalitis (TBE) is widely prevalent on the Eurasian continent, including Japan, but four cases of TBE have been reported in Japan. To inspect unconfirmed TBE cases in Japan, we conducted a retrospective seroepidemiological study of a total of 158 samples from 81 meningoencephalitis patients suspected as Lyme disease. Two serum samples from one patient showed neutralizing antibodies against TBE virus. The patient with severe and progressive encephalitis had a history of tick bite in Hokkaido in 2012. These results demonstrated that tick-borne encephalitis virus (TBEV) case was actually unconfirmed in Japan. Further seroepidemiological surveys are required to identify unconfirmed TBEV infections to consider the pros and cons of introducing specific countermeasures including vaccination in Japan.

Turbulent solutions of the equations of fluid motion

NASA Technical Reports Server (NTRS)

Deissler, R. G.

1984-01-01

Some turbulent solutions of the unaveraged Navier-Stokes equations (equations of fluid motion) are reviewed. Those equations are solved numerically in order to study the nonlinear physics of incompressible turbulent flow. Initial three-dimensional cosine velocity fluctuations and periodic boundary conditions are used in most of the work considered. The three components of the mean-square velocity fluctuations are initially equal for the conditions chosen. The resulting solutions show characteristics of turbulence such as the linear and nonlinear excitation of small-scale fluctuations. For the stronger fluctuations, the initially nonrandom flow develops into an apparently random turbulence. Thus randomness or turbulence can arise as a consequence of the structure of the Navier-Stokes equations. The cases considered include turbulence which is statistically homogeneous or inhomogeneous and isotropic or anisotropic. A mean shear is present in some cases. A statistically steady-state turbulence is obtained by using a spatially periodic body force. Various turbulence processes, including the transfer of energy between eddy sizes and between directional components, and the production, dissipation, and spatial diffusion of turbulence, are considered. It is concluded that the physical processes occurring in turbulence can be profitably studied numerically.

[A case of infectious mononucleosis with splenic infarction].

PubMed

Kobe, Daisuke; Nakatani, Toshiya; Fujinaga, Yukihisa; Seki, Kenichiro; Saikawa, Soichiro; Sawada, Yasuhiko; Sato, Yoshiki; Nagamatsu, Shinsaku; Matsuo, Hideki; Kikuchi, Eiryo

2013-08-01

A 22-year-old man complaining of persisting high fever and right hypochondralgia was admitted to our hospital for infectious mononucleosis with splenic infarction detected by computed tomography. The splenic infarction deteriorated with a marked elevation of inflammatory parameters. This necessitated the commencement of methylprednisolone pulse therapy, resulting in prompt amelioration of inflammation and a reduction in cytokine levels. Including our case, only 9 cases of mononucleosis with splenic infarction have been reported to date; however, splenic infarction should be considered because it is a significant complication of infectious mononucleosis.

Clinical significance of the isolation of Staphylococcus epidermidis from bone biopsy in diabetic foot osteomyelitis.

PubMed

Aragón-Sánchez, Javier; Lázaro-Martínez, Jose Luis; Hernández-Herrero, María José; Quintana-Marrero, Yurena; Cabrera-Galván, Juan J

2010-01-01

Coagulase-negative staphylococci are considered as microorganisms with little virulence and usually as contaminants. In order to establish the role of Staphylococcus epidermidis as a pathogen in diabetic foot osteomyelitis, in addition to the isolation of the sole bacterium from the bone it will be necessary to demonstrate the histopathological changes caused by the infection. A consecutive series of 222 diabetic patients with foot osteomyelitis treated surgically in the Diabetic Foot Unit at La Paloma Hospital (Las Palmas de Gran Canaria, Canary Islands, Spain) between 1 October 2002 and 31 October 2008. From the entire series including 213 bone cultures with 241 isolated organisms, we have analyzed only the 139 cases where Staphylococci were found. We analyzed several variables between the two groups: Staphylococcus aureus versus Staphylococcus epidermidis. Of the 134 patients included in this study, Staphlylococcus epidermidis was found as the sole bacterium isolated in 11 cases and accompanied by other bacteria in 12 cases. Staphlylococcus aureus was found as the sole bacterium isolated in 72 cases and accompanied by other bacteria in 39 cases. Histopathological changes were found in the cases of osteomyelitis where Staphylococcus epidermidis was the sole bacterium isolated. Acute osteomyelitis was found to a lesser extent when Staphylococcus epidermidis was the sole bacterium isolated but without significant differences with the cases where Staphylococcus aureus was the sole bacterium isolated. Staphylococcus epidermidis should be considered as a real pathogen, not only a contaminant, in diabetic patients with foot osteomyelitis when the bacterium is isolated from the bone. No differences in the outcomes of surgical treatment have been found with cases which Staphlylococcus aureus was isolated.

Clinical significance of the isolation of Staphylococcus epidermidis from bone biopsy in diabetic foot osteomyelitis

PubMed Central

Aragón-Sánchez, Javier; Lázaro-Martínez, Jose Luis; Hernández-Herrero, María José; Quintana-Marrero, Yurena; Cabrera-Galván, Juan J.

2010-01-01

Introduction Coagulase-negative staphylococci are considered as microorganisms with little virulence and usually as contaminants. In order to establish the role of Staphylococcus epidermidis as a pathogen in diabetic foot osteomyelitis, in addition to the isolation of the sole bacterium from the bone it will be necessary to demonstrate the histopathological changes caused by the infection. Methods A consecutive series of 222 diabetic patients with foot osteomyelitis treated surgically in the Diabetic Foot Unit at La Paloma Hospital (Las Palmas de Gran Canaria, Canary Islands, Spain) between 1 October 2002 and 31 October 2008. From the entire series including 213 bone cultures with 241 isolated organisms, we have analyzed only the 139 cases where Staphylococci were found. We analyzed several variables between the two groups: Staphylococcus aureus versus Staphylococcus epidermidis. Results Of the 134 patients included in this study, Staphlylococcus epidermidis was found as the sole bacterium isolated in 11 cases and accompanied by other bacteria in 12 cases. Staphlylococcus aureus was found as the sole bacterium isolated in 72 cases and accompanied by other bacteria in 39 cases. Histopathological changes were found in the cases of osteomyelitis where Staphylococcus epidermidis was the sole bacterium isolated. Acute osteomyelitis was found to a lesser extent when Staphylococcus epidermidis was the sole bacterium isolated but without significant differences with the cases where Staphylococcus aureus was the sole bacterium isolated. Conclusion Staphylococcus epidermidis should be considered as a real pathogen, not only a contaminant, in diabetic patients with foot osteomyelitis when the bacterium is isolated from the bone. No differences in the outcomes of surgical treatment have been found with cases which Staphlylococcus aureus was isolated. PMID:22396808

Anti-HI can cause a severe delayed hemolytic transfusion reaction with hyperhemolysis in sickle cell disease patients.

PubMed

Ibanez, Clara; Habibi, Anoosha; Mekontso-Dessap, Armand; Chadebech, Philippe; Chami, Btissam; Bierling, Philippe; Galactéros, Frédéric; Rieux, Claire; Nataf, Joëlle; Bartolucci, Pablo; Peyrard, Thierry; Pirenne, France

2016-07-01

Delayed hemolytic transfusion reaction (DHTR) is a life-threatening condition in sickle cell disease (SCD) patients that is frequently complicated by hyperhemolysis. Antibodies resulting from antigen disparity between donors of European ancestry and patients of African ancestry are common, but situations involving antibodies not classically of clinical significance are also encountered. Anti-HI is generally considered to be an innocuous naturally occurring antibody. We describe two cases of hyperhemolysis with anti-HI and provide details of the reported cases. Both SCD patients were polyimmunized and belonged to blood group B. They developed anti-HI that was reactive at 37°C, after the transfusion of group O red blood cell units matched for all known and produced antibodies classically considered to be clinically significant. Both patients developed DHTR with hyperhemolysis. In the first case, a pregnant woman, a second transfusion was unavoidable and the patient died from cardiac arrest. The state of the second patient improved without the need for further transfusion. Three other cases of DHTR with anti-HI have been described in the literature in SCD patients. The two additional cases reported here definitively demonstrate that anti-HI is dangerous in SCD patients. As a result, ABO-identical matching (including A1 status) must be considered in SCD patients with anti-HI. © 2016 AABB.

Analyzing self-controlled case series data when case confirmation rates are estimated from an internal validation sample.

PubMed

Xu, Stanley; Clarke, Christina L; Newcomer, Sophia R; Daley, Matthew F; Glanz, Jason M

2018-05-16

Vaccine safety studies are often electronic health record (EHR)-based observational studies. These studies often face significant methodological challenges, including confounding and misclassification of adverse event. Vaccine safety researchers use self-controlled case series (SCCS) study design to handle confounding effect and employ medical chart review to ascertain cases that are identified using EHR data. However, for common adverse events, limited resources often make it impossible to adjudicate all adverse events observed in electronic data. In this paper, we considered four approaches for analyzing SCCS data with confirmation rates estimated from an internal validation sample: (1) observed cases, (2) confirmed cases only, (3) known confirmation rate, and (4) multiple imputation (MI). We conducted a simulation study to evaluate these four approaches using type I error rates, percent bias, and empirical power. Our simulation results suggest that when misclassification of adverse events is present, approaches such as observed cases, confirmed case only, and known confirmation rate may inflate the type I error, yield biased point estimates, and affect statistical power. The multiple imputation approach considers the uncertainty of estimated confirmation rates from an internal validation sample, yields a proper type I error rate, largely unbiased point estimate, proper variance estimate, and statistical power. © 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

When to Consider Risk-Reducing Mastectomy in BRCA1/BRCA2 Mutation Carriers with Advanced Stage Ovarian Cancer: a Case Study Illustrating the Genetic Counseling Challenges.

PubMed

Speight, Beverley; Tischkowitz, Marc

2017-12-01

Germline mutations in BRCA1/BRCA2 significantly increase the risk of breast and ovarian cancer in women. This case report describes a BRCA1 germline mutation identified in a woman with stage IV epithelial ovarian cancer and the provision of genetic counseling about BRCA1-associated breast cancer risk in the three years following diagnosis. The report centers on the patient's enquiry about risk-reducing breast surgery. We focus on the challenges for health professionals and patients in understanding and balancing the risks and benefits of major prophylactic surgery in the context of a potentially life-limiting cancer diagnosis. Breast cancer risk management in BRCA1/BRCA2 carriers with advanced ovarian cancer is an under-explored area of genetic counseling research. This article includes a case report, a review of the relevant literature and considers some implications for practice.

"Nature" and the "Environment" in Jamaica's Primary School Curriculum Guides

ERIC Educational Resources Information Center

Ferguson, Therese

2008-01-01

In cases where environmental education is institutionalised within schools, the curriculum can affect what and how students learn about "nature" and the "environment". In Jamaica, schools are considered important settings for environmental education; the curriculum therefore includes environmental issues. Using content…

Necrotizing cellulitis with multiple abscesses on the leg caused by Serratia marcescens.

PubMed

Hau, Estelle; Bouaziz, Jean-David; Lafaurie, Matthieu; Saussine, Anne; Masson, Vincent; Rausky, Jonathan; Bagot, Martine; Guibal, Fabien

2016-03-01

Serratia marcescens is an unusual cause of severe skin infection initially described in immunocompromised patients. We report a case of necrotizing cellulitis of the leg caused by S marcescens in a 68-year-old woman with diabetes mellitus and a history of chronic lymphoedema of the leg. We reviewed the literature and found 49 cases of severe skin infections from S marcescens that included 20 cases of necrotizing fasciitis (NF) as well as 29 cases of severe skin infections without NF (non-NF cases). Patients were immunocompromised in 59% to 70% of cases. The mortality rate was high in NF cases (60%) versus non-NF cases (3%). Surgery was required in 95% of NF cases and in 24% of non-NF cases. The other clinical manifestations of S marcescens skin infection reported in the literature included disseminated papular eruptions in patients infected with human immunodeficiency virus with folliculitis on the trunk. Serratia marcescens is naturally resistant to amoxicillin alone and amoxicillin associated with clavulanic acid. Broad-spectrum antibiotics are indicated to treat S marcescens skin infections, and surgery should be promptly considered in cases of severe skin infections if appropriate antibiotic therapy does not lead to rapid improvement.

Application of Density Functional Theory to Systems Containing Metal Atoms

NASA Technical Reports Server (NTRS)

Bauschlicher, Charles W., Jr.

2006-01-01

The accuracy of density functional theory (DFT) for problems involving metal atoms is considered. The DFT results are compared with experiment as well as results obtained using the coupled cluster approach. The comparisons include geometries, frequencies, and bond energies. The systems considered include MO2, M(OH)+n, MNO+, and MCO+2. The DFT works well for frequencies and geometries, even in case with symmetry breaking; however, some examples have been found where the symmetry breaking is quite severe and the DFT methods do not work well. The calculation of bond energies is more difficult and examples of successes as well as failures of DFT will be given.

[Several cases of giant epulis observed in West Africa].

PubMed

Cantaloube, D; Larroque, G; Ndiaye, R; Rives, J M; Seurat, P

1987-01-01

The presenting symptomatology in 9 cases of giant epulis seen in West Africa was constantly difficulties in mastication or even speech, and on some occasions tumefaction of the face. A certain number of factors are involved in the development of these benign tumors, and although inflammation represents the primum movens of this affection, other causes, including some specific to the African continent, must be considered with a view to a pathogenic approach.

Mixed Fungal Lung Infection with Aspergillus Fumigatus and Candida Albicans in a Immunocomprimised Patient: Case Report

PubMed Central

Vipparti, Haritha

2014-01-01

The frequency of invasive, opportunistic mycoses has increased significantly over the past 2 decades. In the immune-compromised host, many fungi, including species of fungi typically considered non-pathogenic, have the potential to cause serious morbidity and mortality. Here we report a rare case of mixed fungal infection of the lung with Candida albicans and Aspergillus fumigatus in a patient on prolonged steroid therapy. PMID:24959447

Fusion of Scores in a Detection Context Based on Alpha Integration.

PubMed

Soriano, Antonio; Vergara, Luis; Ahmed, Bouziane; Salazar, Addisson

2015-09-01

We present a new method for fusing scores corresponding to different detectors (two-hypotheses case). It is based on alpha integration, which we have adapted to the detection context. Three optimization methods are presented: least mean square error, maximization of the area under the ROC curve, and minimization of the probability of error. Gradient algorithms are proposed for the three methods. Different experiments with simulated and real data are included. Simulated data consider the two-detector case to illustrate the factors influencing alpha integration and demonstrate the improvements obtained by score fusion with respect to individual detector performance. Two real data cases have been considered. In the first, multimodal biometric data have been processed. This case is representative of scenarios in which the probability of detection is to be maximized for a given probability of false alarm. The second case is the automatic analysis of electroencephalogram and electrocardiogram records with the aim of reproducing the medical expert detections of arousal during sleeping. This case is representative of scenarios in which probability of error is to be minimized. The general superior performance of alpha integration verifies the interest of optimizing the fusing parameters.

Herbalife hepatotoxicity: Evaluation of cases with positive reexposure tests.

PubMed

Teschke, Rolf; Frenzel, Christian; Schulze, Johannes; Schwarzenboeck, Alexander; Eickhoff, Axel

2013-07-27

To analyze the validity of applied test criteria and causality assessment methods in assumed Herbalife hepatotoxicity with positive reexposure tests. We searched the Medline database for suspected cases of Herbalife hepatotoxicity and retrieved 53 cases including eight cases with a positive unintentional reexposure and a high causality level for Herbalife. First, analysis of these eight cases focused on the data quality of the positive reexposure cases, requiring a baseline value of alanine aminotransferase (ALT) < 5 upper limit of normal (N) before reexposure, with N as the upper limit of normal, and a doubling of the ALT value at reexposure as compared to the ALT value at baseline prior to reexposure. Second, reported methods to assess causality in the eight cases were evaluated, and then the liver specific Council for International Organizations of Medical Sciences (CIOMS) scale validated for hepatotoxicity cases was used for quantitative causality reevaluation. This scale consists of various specific elements with scores provided through the respective case data, and the sum of the scores yields a causality grading for each individual case of initially suspected hepatotoxicity. Details of positive reexposure test conditions and their individual results were scattered in virtually all cases, since reexposures were unintentional and allowed only retrospective rather than prospective assessments. In 1/8 cases, criteria for a positive reexposure were fulfilled, whereas in the remaining cases the reexposure test was classified as negative (n = 1), or the data were considered as uninterpretable due to missing information to comply adequately with the criteria (n = 6). In virtually all assessed cases, liver unspecific causality assessment methods were applied rather than a liver specific method such as the CIOMS scale. Using this scale, causality gradings for Herbalife in these eight cases were probable (n = 1), unlikely (n = 4), and excluded (n = 3). Confounding variables included low data quality, alternative diagnoses, poor exclusion of important other causes, and comedication by drugs and herbs in 6/8 cases. More specifically, problems were evident in some cases regarding temporal association, daily doses, exact start and end dates of product use, actual data of laboratory parameters such as ALT, and exact dechallenge characteristics. Shortcomings included scattered exclusion of hepatitis A-C, cytomegalovirus and Epstein Barr virus infection with only globally presented or lacking parameters. Hepatitis E virus infection was considered in one single patient and found positive, infections by herpes simplex virus and varicella zoster virus were excluded in none. Only one case fulfilled positive reexposure test criteria in initially assumed Herbalife hepatotoxicity, with lower CIOMS based causality gradings for the other cases than hitherto proposed.

Evaluation of integration methods for hybrid simulation of complex structural systems through collapse

NASA Astrophysics Data System (ADS)

Del Carpio R., Maikol; Hashemi, M. Javad; Mosqueda, Gilberto

2017-10-01

This study examines the performance of integration methods for hybrid simulation of large and complex structural systems in the context of structural collapse due to seismic excitations. The target application is not necessarily for real-time testing, but rather for models that involve large-scale physical sub-structures and highly nonlinear numerical models. Four case studies are presented and discussed. In the first case study, the accuracy of integration schemes including two widely used methods, namely, modified version of the implicit Newmark with fixed-number of iteration (iterative) and the operator-splitting (non-iterative) is examined through pure numerical simulations. The second case study presents the results of 10 hybrid simulations repeated with the two aforementioned integration methods considering various time steps and fixed-number of iterations for the iterative integration method. The physical sub-structure in these tests consists of a single-degree-of-freedom (SDOF) cantilever column with replaceable steel coupons that provides repeatable highlynonlinear behavior including fracture-type strength and stiffness degradations. In case study three, the implicit Newmark with fixed-number of iterations is applied for hybrid simulations of a 1:2 scale steel moment frame that includes a relatively complex nonlinear numerical substructure. Lastly, a more complex numerical substructure is considered by constructing a nonlinear computational model of a moment frame coupled to a hybrid model of a 1:2 scale steel gravity frame. The last two case studies are conducted on the same porotype structure and the selection of time steps and fixed number of iterations are closely examined in pre-test simulations. The generated unbalance forces is used as an index to track the equilibrium error and predict the accuracy and stability of the simulations.

Clinical Review of 20 Cases of Addison’s Disease in Korea

PubMed Central

Sung, Sang Kyu; Kwon, Yong Joon; Lee, Bum Woo; Kim, Doo Man; Yoo, Hyung Joon

1988-01-01

Addison’s disease is a rare disorder resulting from a chronic deficiency of adrenol cortical hormone. The clinical manifestations and data of 20 patients with Addison’s disease were reviewed. They include 14 previously reported cases, total cases in korea upto 1987, and 6 new cases at National Medical Center. 13 patients were male and 7 female. The mean age was 39 years and ranged from 16 to 61 years.Common symptoms included mucocutaneous pigmentation (95 %), general weakness (90%), nasuea and/or vomiting (80%), and weight loss (60%).Initial mean blood pressure was 96±21/63±14 mmHg and adrenal crises were found in 5 cases (25%).Laboratory data indicated hyponatremia and hyperkalemia, resulting in a decreased Na/K ratio. Serum basal cortisol and ACTH levels were 2.86±1.93 ug/dl and 482.5/269.3 pg/ml, respectively.Extra-adrenal tuberculosis was present in 14 cases (70%) as a very high incidence.These 14 cases (70%) were presumed to be due to adrenal tuberculosis, although only two cases were confirmed as such by histopathology. The other cases were likely to be non-tuberculous. Thus, tuberculosis may be-considered as a predominant cause of Addision’s disease in Korea. Other features were not unusual. But further detailed and extensive studies are necessary including more pathologically confirmed cases. PMID:3153796

Certifying Domain-Specific Policies

NASA Technical Reports Server (NTRS)

Lowry, Michael; Pressburger, Thomas; Rosu, Grigore; Koga, Dennis (Technical Monitor)

2001-01-01

Proof-checking code for compliance to safety policies potentially enables a product-oriented approach to certain aspects of software certification. To date, previous research has focused on generic, low-level programming-language properties such as memory type safety. In this paper we consider proof-checking higher-level domain -specific properties for compliance to safety policies. The paper first describes a framework related to abstract interpretation in which compliance to a class of certification policies can be efficiently calculated Membership equational logic is shown to provide a rich logic for carrying out such calculations, including partiality, for certification. The architecture for a domain-specific certifier is described, followed by an implemented case study. The case study considers consistency of abstract variable attributes in code that performs geometric calculations in Aerospace systems.

Travel history key to picking up on signs of bubonic plague.

PubMed

2015-11-01

Health officials note an uptick in cases of bubonic plague in the United States this year, with at least 12 reported human cases reported since April 1. The CDC notes that healthcare providers should consider plague in patients who have traveled to plague-endemic areas and exhibit fever, headache, chills, weakness, and one or more swollen or tender and painful lymph nodes, referred to as buboes. Officials note that the disease rarely passes from person to person, but that this is a concern with patients who have developed the pneumonic form of the disease. Health officials note that in recent years there has been an average of seven cases of human plague each year in the United States, and that most of these cases are the bubonic form of the illness. Four patients confirmed to have plague this year have died, including the most recent case, a Utah man in his 70s. Most cases of plague in the United States occur in two regions. The first includes northern New Mexico, northern Arizona, and southern Colorado, and the second includes California, southern Oregon, and far western Nevada. When plague is suspected, treatment with antibiotics should begin immediately.

Proton Pump Inhibitors: Risk for Myopathy?

PubMed

Colmenares, Evan W; Pappas, Ashley L

2017-01-01

The purpose of this article is to describe the relationship between proton pump inhibitors (PPIs) and symptoms of myopathy based on case reports. A literature search was conducted in PubMed (1946 to June 2016) using MeSH terms proton pump inhibitors, omeprazole, esomeprazole, lansoprazole, dexlansoprazole, rabeprazole, pantoprazole, and muscular diseases. Additionally, a search was conducted in ToxNet and EMBASE using similar search criteria. The resulting articles were scanned to assess relevance to the review. Bibliographies of all relevant articles were evaluated for additional sources; 26 articles resulted from the search of PubMed, ToxNet, and EMBASE; articles that involved medications typically considered to have myalgia-like side effects (eg, statins), or included patients who presented with a confounding disease state (eg, Guillain-Barré) were excluded. In total, 11 case reports as well as a review of an adverse event reporting database that included 292 cases were evaluated. Association of PPI use and myopathy symptoms does not have a clear etiology. Overall, the available published data do not show a high risk of myopathy with PPI use but should be considered if a patient presents with myopathy symptoms and concurrent PPI use. A limited body of published data suggests that PPI use has been associated with myopathy-like symptoms without long-term effects following discontinuation. Although myopathy is a rare adverse effect observed with PPIs, it can be a serious side effect to be considered when starting a patient on acid suppression therapy.

Glutathione S-transferase M1 (GSTM1) polymorphisms and lung cancer: a literature-based systematic HuGE review and meta-analysis.

PubMed

Carlsten, C; Sagoo, G S; Frodsham, A J; Burke, W; Higgins, J P T

2008-04-01

Multiple genes have been studied for potential associations with lung cancer. The gene most frequently associated with increased risk has been glutathione S-transferase M1 (GSTM1). The glutathione S-transferase enzyme family is known to catalyze detoxification of electrophilic compounds, including carcinogens, therapeutic drugs, environmental toxins, and products of oxidative stress. In this review, the authors summarize the available evidence associating lung cancer with the GSTM1 gene. They describe results from an updated meta-analysis of 98 published genetic association studies investigating the relation between the GSTM1 null variant and lung cancer risk including 19,638 lung cancer cases and 25,266 controls (counting cases and controls in each study only once). All studies considered, the GSTM1 null variant was associated with an increased risk of lung cancer (odds ratio (OR) = 1.22, 95% confidence interval (CI): 1.14, 1.30), but no increase in risk was seen (OR = 1.01, 95% CI: 0.91, 1.12) when only the five largest studies (>500 cases each) were considered. Furthermore, while GSTM1 null status conferred a significantly increased risk of lung cancer to East Asians (OR = 1.38, 95% CI: 1.24, 1.55), such a genotype did not confer increased risk to Caucasians. More data regarding the predictive value of GSTM1 genetic testing are needed before population-based testing may be reasonably considered.

The management of vertebral artery injury in anterior cervical spine operation: a systematic review of published cases.

PubMed

Park, Hyung-Ki; Jho, Hae-Dong

2012-12-01

Anterior cervical spine operations (ACSO) are generally considered to be safe and effective, but the vertebral artery (VA) is at risk during the procedure. Because the consequences of VA injury can be catastrophic, properly managing a VA injury is very important. However, due to the rarity of these injuries, there is no agreed upon treatment strategy. Studies were identified for inclusion in the review via sensitive searches of electronic databases through 31 December 2011. All cases included in the review were qualitatively analyzed to explore the relationship between type of VA injury management and neurological complications. Seventeen articles describing 39 cases of VA injury during ACSO were included in this study. Seven patients (17.9 %) had neurological complications followed by VA insufficiency. Two patients (5.1 %) had root damage due to ligation. One case (2.6 %) resulted in intraoperative death due to fatal bleeding. Delayed vascular complications were identified in nine (45.0 %) of the 20 patients that underwent only tamponade or hemostatic agent during the operation. Four patients underwent intraoperative endovascular treatment, and three of these patients had a cerebral infarction. All three patients who underwent clipping also had neurological complications. The five patients treated by direct repair did not have any complications. Our review suggests the management of VA injury should be considered in order listed: (1) performing tamponade with a hemostatic agent, (2) direct repair, (3) postoperative endovascular procedures to prevent delayed complications. If tamponade fails to achieve proper hemostasis, additional procedures as endovascular embolization, clipping and ligation should be considered but carry the risk of neurological complications. Because of the limitations of this review, further studies are recommended with larger sample sizes.

IMPLEMENTING NONPROFESSIONAL PROGRAMS IN HUMAN SERVICES. MANPOWER TRAINING SERIES.

ERIC Educational Resources Information Center

SCHMAIS, AARON

SPECIFIC PROCESSES FOR UTILIZING NONPROFESSIONAL EMPLOYEES IN HUMAN SERVICES ARE PRESENTED. THE BACKGROUND, CURRENT STATUS, AND PROBLEMS ARE DISCUSSED. THE ELEMENTS CONSIDERED ARE RECRUITMENT, SCREENING AND SELECTION, TRAINING, PLACEMENT, SUPERVISION, UPGRADING, AND EVALUATION. EXAMPLES OF NONPROFESSIONAL POSITIONS INCLUDE THE CASE AIDE IN SOCIAL…

Functional Multiple-Set Canonical Correlation Analysis

ERIC Educational Resources Information Center

Hwang, Heungsun; Jung, Kwanghee; Takane, Yoshio; Woodward, Todd S.

2012-01-01

We propose functional multiple-set canonical correlation analysis for exploring associations among multiple sets of functions. The proposed method includes functional canonical correlation analysis as a special case when only two sets of functions are considered. As in classical multiple-set canonical correlation analysis, computationally, the…

Two More Tests to Consider.

ERIC Educational Resources Information Center

Roe, Andrew G.

1985-01-01

Presents the case for taking the Engineer in Training examination (EIT), also called the Fundamentals of Engineering Examination, and the Graduate Record Examinations (GRE), indicating that they can affect future employment opportunities, career advancement, and post-graduate studies. Includes subject areas tested, test format, and how to prepare…

Integrating algaculture into small wastewater treatment plants: process flow options and life cycle impacts.

PubMed

Steele, Muriel M; Anctil, Annick; Ladner, David A

2014-05-01

Algaculture has the potential to be a sustainable option for nutrient removal at wastewater treatment plants. The purpose of this study was to compare the environmental impacts of three likely algaculture integration strategies to a conventional nutrient removal strategy. Process modeling was used to determine life cycle inventory data and a comparative life cycle assessment was used to determine environmental impacts. Treatment scenarios included a base case treatment plant without nutrient removal, a plant with conventional nutrient removal, and three other cases with algal unit processes placed at the head of the plant, in a side stream, and at the end of the plant, respectively. Impact categories included eutrophication, global warming, ecotoxicity, and primary energy demand. Integrating algaculture prior to activated sludge proved to be most beneficial of the scenarios considered for all impact categories; however, this scenario would also require primary sedimentation and impacts of that unit process should be considered for implementation of such a system.

Removal of foot-and-mouth disease virus infectivity in salted natural casings by minor adaptation of standardized industrial procedures.

PubMed

Wijnker, J J; Haas, B; Berends, B R

2007-04-10

Intestines are used for the production of natural casings as edible sausage containers. Derived from animals (pigs and sheep) experimentally infected with FMDV (initial dosage 10(7.3) PFU/ml, strain O(1Kaufbeuren)), these natural casings were treated with sodium chloride or a phosphate salts/sodium chloride mixture and the residual FMDV titres measured. After storage at about 20 degrees C, no remaining infectivity was found after either treatment, whereas casings stored at 4 degrees C still contained infectivity. Storage of salted casings at about 20 degrees C for 30 days is already part of the Standard Operating Procedures (included in HACCP) of the international casing industry and can therefore be considered as a protective measure for the international trade in natural casings.

Characteristics of phase-correcting fresnel zone plates and elliptical waveguides

NASA Astrophysics Data System (ADS)

Wiltse, James C.

1994-02-01

The primary area of activity has been concentrated on the investigations relating to Fresnel zone plate antennas. A secondary effort has dealt with the characteristics of propagation in waveguides of elliptical cross section. In both cases, applications at microwave and millimeter-wavelengths have been emphasized. Thorough literature searches were conducted, and the results are given in Appendices A and B. The zone plate work has dealt with both transmission and reflection types, and has included considering the off-axis-fed cases. In the latter case, the plate may consist of elliptical zones, rather than the usual circular configuration. In general, the characteristics studied include far-field patterns, focal region fields, off-axis performance, bandwidth, and aberrations. In the case of propagation in elliptical waveguides, the attenuation and modal properties were studied for enclosed metal waveguides, coaxial transmission lines, and various surface waveguides.

An unusual autopsy case of pyogenic liver abscess caused by periodontal bacteria.

PubMed

Ohyama, Hideki; Nakasho, Keiji; Yamanegi, Koji; Noiri, Yuichiro; Kuhara, Ayako; Kato-Kogoe, Nahoko; Yamada, Naoko; Hata, Masaki; Nishimura, Fusanori; Ebisu, Shigeyuki; Terada, Nobuyuki

2009-09-01

Pyogenic liver abscess (PLA) formation is thought to originate from the transmission of infection via three major routes including the biliary tract, portal vein and hepatic artery. However, about 50% of PLA cases are considered to be cryptogenic. Here we report an unusual autopsy case of PLA associated with periodontopathic bacterial infection. A 59-year-old female suddenly developed cardiopulmonary arrest and died. Despite macroscopic and microscopic examinations, the infectious routes and source of infection were unidentified, and the case appeared to be cryptogenic. Since this patient had suffered severe periodontitis for a long period of time, we investigated the involvement of periodontal infection in PLA formation by performing immunohistochemical analyses. We identified several periodontopathic bacterial species in the PLA of this patient, including Fusobacterium nucleatum, Treponema denticola, Prevotella intermedia and Porphyromonas gingivalis. Thus, we demonstrate here that periodontal infection is a potential source of infection in the formation of PLA.

Pyomyositis of tensor fascia lata: a case report

PubMed Central

Ozkan, Korhan; Unay, Koray; Ugutmen, Ender; Eren, Abdullah; Eceviz, Engin; Saygý, Baransel

2008-01-01

Introduction Pyomyositis is a disease in which an abscess is formed deep within large striated muscles. Case presentation We report the case of a 10-year-old boy who presented with fever and a painful hip and was subsequently diagnosed with pyomyositis of the tensor fascia lata. In children with clinical and laboratory findings of inflammation in the vicinity of the hip joint, the differential diagnosis includes transient synovitis, an early stage of Legg-Calvé-Perthes disease, infectious arthritis of the hip, rheumatologic diseases and extracapsular infection such as osteomyelitis. Conclusion To the best of the authors' knowledge, this is the first report of pyomyositis of the tensor fascia lata. Although pyomyositis is a rare disease and the differential diagnosis includes a variety of other commonly observed diseases, pyomyositis should be considered in cases where children present with fever, leukocytosis and localized pain. PMID:18652647

Ebola Virus Disease Candidate Vaccines Under Evaluation in Clinical Trials

PubMed Central

Martins, Karen A.; Jahrling, Peter B.; Bavari, Sina; Kuhn, Jens H.

2016-01-01

Summary Filoviruses are the etiological agents of two human illnesses: Ebola virus disease and Marburg virus disease. Until 2013, medical countermeasure development against these afflictions was limited to only a few research institutes worldwide as both infections were considered exotic due to very low case numbers. Together with the high case-fatality rate of both diseases, evaluation of any candidate countermeasure in properly controlled clinical trials seemed impossible. However, in 2013, Ebola virus was identified as the etiological agent of a large disease outbreak in Western Africa including almost 30,000 infections and more than 11,000 deaths, including case exportations to Europe and North America. These large case numbers resulted in medical countermeasure development against Ebola virus disease becoming a global public-health priority. This review summarizes the status quo of candidate vaccines against Ebola virus disease, with a focus on those that are currently under evaluation in clinical trials. PMID:27160784

Anaplasma phagocytophilum infection in a domestic cat in Finland: Case report

PubMed Central

2010-01-01

Background Anaplasmosis is a vectorborne disease caused by the gram-negative bacterium Anaplasma phagocytophilum. This species displays positive tropism to granulocytes and can cause illness in several mammalian species, including cats, dogs, and humans. It is considered as an emerging disease in Europe. The clinical signs are nonspecific and include fever, lethargy, and inappetence. The most typical hematologic abnormality is thrombocytopenia. A tentative diagnosis can be made by detecting intracytoplasmic morulae inside neutrophils. The diagnosis is confirmed by PCR and serology in paired serum samples. A sample for PCR analysis should be taken before treatment. Anaplasmosis is treated with doxycycline. Case presentation A feline case of anaplasmosis is presented. The history, clinical presentation, diagnostics, treatment, and follow-up are discussed. Conclusions This case indicates that Anaplasma phagocytophilum infects cats in Finland. To provide accurate treatment, anaplasmosis should be listed as a differential diagnosis in cats suffering from acute febrile illness with previous tick exposure. PMID:21078141

Alzheimer's Disease Sequencing Project discovery and replication criteria for cases and controls: Data from a community-based prospective cohort study with autopsy follow-up.

PubMed

Crane, Paul K; Foroud, Tatiana; Montine, Thomas J; Larson, Eric B

2017-12-01

The Alzheimer's Disease Sequencing Project (ADSP) used different criteria for assigning case and control status from the discovery and replication phases of the project. We considered data from a community-based prospective cohort study with autopsy follow-up where participants could be categorized as case, control, or neither by both definitions and compared the two sets of criteria. We used data from the Adult Changes in Thought (ACT) study including Diagnostic and Statistical Manual-IV criteria for dementia status, McKhann et al. criteria for clinical Alzheimer's disease, and Braak and Consortium to Establish a Registry for AD findings on neurofibrillary tangles and neuritic plaques to categorize the 621 ACT participants of European ancestry who died and came to autopsy. We applied ADSP discovery and replication definitions to identify controls, cases, and people who were neither controls nor cases. There was some agreement between the discovery and replication definitions. Major areas of discrepancy included the finding that only 40% of the discovery sample controls had sufficiently low levels of neurofibrillary tangles and neuritic plaques to be considered controls by the replication criteria and the finding that 16% of the replication phase cases were diagnosed with non-AD dementia during life and thus were excluded as cases for the discovery phase. These findings should inform interpretation of genetic association findings from the ADSP. Differences in genetic association findings between the two phases of the study may reflect these different phenotype definitions from the discovery and replication phase of the ADSP. Copyright © 2017 the Alzheimer's Association. Published by Elsevier Inc. All rights reserved.

[Clinical characteristics of vestibular migraine: considerations in a series of 41 patients].

PubMed

Martinez, E; Ruiz-Pinero, M; de Lera, M; Baron, J; Pedraza, M I; Guerrero-Peral, A L

2017-01-01

After years of debate about its being approached from headaches and its denomination, vestibular migraine has recently been included in the research appendix of the 3rd edition of the International Headache Classification. To analyse the characteristics of a series of patients with vestibular migraine who visited because of headaches. Our sample consisted of patients who were attended in a headache unit between January 2014 and December 2015. The demographic variables and the characteristics of both migraine and vestibular symptoms were considered, and cases with other otorhinolaryngological conditions were excluded. The sample was finally made up of 41 patients (11 males, 30 females) with a mean age of 31.8 ± 13.3 years at the time they were included in the study. Sixteen patients (39%) met criteria for chronic migraine and two (4.9%) presented visual auras. The vestibular symptoms were considered severe in eight cases (19.5%) and occurred in 74.6% of the migraine attacks. Vertigo was described as internal in 18 cases (43.9%), external in 22 (53.7%) and mixed in one case (2.4%). The most frequent symptom was positional vertigo (n = 25; 61%), followed by that induced by head movements (n = 18; 43.9%) and spontaneous (n = 15; 36.6%). Accompanying symptoms included tinnitus (n = 12; 29.3%) and a feeling of fullness in the ear (n = 8; 19.5%). It is not uncommon to identify symptoms consistent with vestibular migraine in patients who visit a headache unit; they are patients whose day-to-day activities are not usually affected by their vertigo.

Atropa belladonna intoxication: a case report.

PubMed

Berdai, Mohamed Adnane; Labib, Smael; Chetouani, Khadija; Harandou, Mustapha

2012-01-01

Atropa belladonna is a poisonous plant also called deadly nightshade. Its roots, leaves and fruits contain alkaloids: atropine, hyocyamine and scopolamine. The risk of poisoning in children is important because of possible confusion with other berries. Atropa belladonna acute intoxication is a severe condition, it's should be considered in the presence of anti-cholinergic toxidrome, the differential diagnosis include other plants or psychoactive drugs containing atropine. The treatment is mainly symptomatic including gastrointestinal decontamination with activated charcoal. In severe cases, physostigmine can be used as an antidote. We report the case of 11 year old girl with Atropa belladonna poisoning which was administrated in a therapeutic purpose as a remedy to jaundice. The child presented essentially a central anti-cholinergic syndrome. She was admitted in the intensive care unit, the progression was favorable with symptomatic treatment.

An orthodontic bracket embedded in the medial pterygoid surface: a case report.

PubMed

Wilmott, Sheryl E; Ikeagwuani, Okechukwu; McLeod, Niall M H

2016-01-08

There is a potential risk that orthodontic brackets can become dislodged into the aerodigestive tract. This case illustrates the management of an orthodontic bracket, which became embedded in the deep tissues of the oropharynx. We aim to highlight the potential risk misplaced dental instruments and materials pose, including that they may become embedded in the soft tissues of the throat and suggest that that this possibility should be considered when they cannot be localized.

An orthodontic bracket embedded in the medial pterygoid surface: a case report.

PubMed

Wilmott, Sheryl E; Ikeagwuani, Okechukwu; McLeod, Niall M H

2016-03-01

There is a potential risk that orthodontic brackets can become dislodged into the aerodigestive tract. This case illustrates the management of an orthodontic bracket, which became embedded in the deep tissues of the oropharynx. We aim to highlight the potential risk misplaced dental instruments and materials pose, including that they may become embedded in the soft tissues of the throat and suggest that that this possibility should be considered when they cannot be localized.

An estimator for the standard deviation of a natural frequency. I.

NASA Technical Reports Server (NTRS)

Schiff, A. J.; Bogdanoff, J. L.

1971-01-01

A brief review of mean-square approximate systems is given. The case in which the masses are deterministic is considered first in the derivation of an estimator for the upper bound of the standard deviation of a natural frequency. Two examples presented include a two-degree-of-freedom system and a case in which the disorder in the springs is perfectly correlated. For purposes of comparison, a Monte Carlo simulation was done on a digital computer.

Nepheline rock dust pneumoconiosis. A report of 2 cases

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

Olscamp, G.; Herman, S.J.; Weisbrod, G.L.

1982-01-01

Two cases of nepheline rock dust pneumoconiosis are presented. Radiologically, this is seen as a diffuse increase in interstitial lung markings, lymphadenopathy, air-space disease, and atelectasis secondary to extrinsic compression by enlarged hilar lymph nodes. Major differential diagnoses include carcinoma of the lung, sarcoidosis, and interstitial lung disease caused by other inorganic dusts. Nepheline rock dust pneumoconiosis should be considered when the above radiological changes are observed and an occupational exposure to inorganic dust is documented.

Nepheline rock dust pneumoconiosis: a report of 2 cases

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

Olscamp, G.; Herman, S.J.; Weisbrod, G.L.

1982-01-01

Two cases of nepheline rock dust pneumoconiosis are presented. Radiologically, this is seen as a diffuse increase in interstitial lung markings, lymphadenopathy air-space disease, and atelectasis secondary to extrinsic compression by enlarged hilar lymph nodes. Major differential diagnoses include carcinoma of the lung, sarcoidosis, and interstitial lung disease caused by other inorganic dusts. Nepheline rock dust pneumoconiosis should be considered when the above radiological changes are observed and an occupational exposure to inorganic dust is documented.

[Invasive meningococcal disease--management and treatment].

PubMed

Garlicki, Aleksander; Bociqga-Jasik, Monika; Kalinowska-Nowak, Anna

2008-01-01

Invasive meningococcal disease is life threatening disease and in fulminant cases mortality rate may be as high as 70%. Rapid introduction of treatment and monitoring on intensive care unit is crucial for prognosis. The understanding of patomechanism responsible for sepsis development allow to introduce supportive treatment including glicocorticoids and recombinant human activated protein C. Very important is suitable prophylaxis among risk groups with, additional considering vaccination in the case of infection caused by A, C, Y, W-135 serogroups.

General Relativistic Radiative Transfer: Applications to Black-Hole Systems

NASA Technical Reports Server (NTRS)

Wu, Kinwah; Fuerst, Steven V.; Mizuno, Yosuke; Nishikawa, Ken-Ichi; Branduardi-Raymont, Graziella; Lee, Khee-Gan

2007-01-01

We present general relativistic radiation transfer formulations which include opacity effects due to absorption, emission and scattering explicitly. We consider a moment expansions for the transfer in the presence of scattering. The formulation is applied to calculation emissions from accretion and outflows in black-hole systems. Cases with thin accretion disks and accretion tori are considered. Effects, such as emission anisotropy, non-stationary flows and geometrical self-occultation are investigated. Polarisation transfer in curved space-time is discussed qualitatively.

76 FR 34054 - Marine Mammal Stock Assessment Reports

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-10

... draft SAR. They include one Steller sea lion that was found shot on Orcas Island in the San Juan Islands... Hawaii Longline Association), and one individual. Most letters contained multiple comments. Unless... not changed. In some cases, NMFS' responses state that comments would be considered for, or...

Application of CD56, P63 and CK19 immunohistochemistry in the diagnosis of papillary carcinoma of the thyroid

PubMed Central

El Demellawy, Dina; Nasr, Ahmed; Alowami, Salem

2008-01-01

Papillary carcinoma of the thyroid (PTC) is the commonest thyroid cancer. In the recent decades an obvious increase in the incidence of PTC has occurred. The pathological diagnosis of PTC is usually an easy diagnosis in the majority of cases. However since the introduction of follicular variant of PTC and the wide threshold range in interpretation of the clearly set pathological criteria for diagnosis of PTC, between pathologists including experts, the diagnosis in some cases became quite difficult. Unfortunately some cases are unjustifiably over-called as follicular variant of PTC as a result of the wide inter observable variability between pathologists, including thyroid pathologists. Ancillary studies such as immmunohistochemistry may be helpful, but till now there is no 100% consistent marker(s), that distinct between PTC and other follicular thyroid lesions and tumors. We assessed expression of antibodies against CD56, CK19, P63 and E-Cadherin in PTC and other follicular thyroid lesions and neoplasms. A total of 175 cases were studied. The neoplastic cases included 75 carcinomas (72 papillary, 2 follicular, 1 Hurthle cell) and 35 adenomas (32 follicular and 3 Hurthle cell). The non-neoplastic thyroids included 65 cases, (25 nodular hyperplasia, 5 thyrotoxic hyperplasia (Grave's disease), 19 lymphocytic thyroiditis and 6 Hashimoto's thyroiditis). All cases were evaluated by immunohistochemistry for the expression of the above mentioned markers. The markers' patterns and intensities of staining were scored. Positive expression of the markers equal or >10% of the follicular epithelium within the tumor or lesional cells was considered positive. An expression of <10% was considered to be negative. Our results showed CD56 positive in all the lesions and tumors except for PTC in all cases (100%). CD56 was negative in all PTC cases (100%). CK 19 showed positive expression in PTC accounting for 85% of cases and in 26% of non PTC lesions/tumors. P63 showed selective focal positivity in PTC cases, in contrast to other non PTC lesions/tumors. P63 expression was in 70% of cases of PTC and was consistently absent in all the non PTC cases. E-Cadherin showed consistent non discriminatory expression in all cases included in the study. We concluded that a panel consisted of CD56, CK19 and P63 is of value in distinction of PTC from other thyroid follicular lesion. P63 is a specific but less sensitive marker for PTC than CK19. CD56 is more specific and sensitive marker than CK19, however it is a negative rather than a positive marker for PTC. E-Cadherin is of no value in the diagnosis of thyroid follicular lesions/tumors. We recommend application of a panel composed of CK19, P63 and CD56 by a group of expert thyroid pathologists on a large series of follicular malignant thyroid neoplasms of uncertain malignant. PMID:18254952

Cogeneration Technology Alternatives Study (CTAS). Volume 6: Computer data. Part 2: Residual-fired nocogeneration process boiler

NASA Technical Reports Server (NTRS)

Knightly, W. F.

1980-01-01

About fifty industrial processes from the largest energy consuming sectors were used as a basis for matching a similar number of energy conversion systems that are considered as candidate which can be made available by the 1985 to 2000 time period. The sectors considered included food, textiles, lumber, paper, chemicals, petroleum, glass, and primary metals. The energy conversion systems included steam and gas turbines, diesels, thermionics, stirling, closed cycle and steam injected gas turbines, and fuel cells. Fuels considered were coal, both coal and petroleum based residual and distillate liquid fuels, and low Btu gas obtained through the on site gasification of coal. Computer generated reports of the fuel consumption and savings, capital costs, economics and emissions of the cogeneration energy conversion systems (ECS's) heat and power matched to the individual industrial processes are presented. National fuel and emissions savings are also reported for each ECS assuming it alone is implemented. Two nocogeneration base cases are included: coal fired and residual fired process boilers.

Cogeneration Technology Alternatives Study (CTAS). Volume 6: Computer data. Part 1: Coal-fired nocogeneration process boiler, section A

NASA Technical Reports Server (NTRS)

Knightly, W. F.

1980-01-01

About fifty industrial processes from the largest energy consuming sectors were used as a basis for matching a similar number of energy conversion systems that are considered as candidate which can be made available by the 1985 to 2000 time period. The sectors considered included food, textiles, lumber, paper, chemicals, petroleum, glass, and primary metals. The energy conversion systems included steam and gas turbines, diesels, thermionics, stirling, closed cycle and steam injected gas turbines, and fuel cells. Fuels considered were coal, both coal and petroleum based residual and distillate liquid fuels, and low Btu gas obtained through the on site gasification of coal. Computer generated reports of the fuels consumption and savings, capital costs, economics and emissions of the cogeneration energy conversion systems (ECS's) heat and power matched to the individual industrial processes are presented. National fuel and emissions savings are also reported for each ECS assuming it alone is implemented. Two nocogeneration base cases are included: coal fired and residual fired process boilers.

Cogeneration Technology Alternatives Study (CTAS). Volume 6: Computer data. Part 1: Coal-fired nocogeneration process boiler, section B

NASA Technical Reports Server (NTRS)

Knightly, W. F.

1980-01-01

About fifty industrial processes from the largest energy consuming sectors were used as a basis for matching a similar number of energy conversion systems that are considered as candidate which can be made available by the 1985 to 2000 time period. The sectors considered included food, textiles, lumber, paper, chemicals, petroleum, glass, and primary metals. The energy conversion systems included steam and gas turbines, diesels, thermionics, stirling, closed cycle and steam injected gas turbines, and fuel cells. Fuels considered were coal, both coal and petroleum based residual and distillate liquid fuels, and low Btu gas obtained through the on site gasification of coal. Computer generated reports of the fuel consumption and savings, capital costs, economics and emissions of the cogeneration energy conversion systems (ECS's) heat and power matched to the individual industrial processes are presented. National fuel and emissions savings are also reported for each ECS assuming it alone is implemented. Two nocogeneration base cases are included: coal fired and residual fired process boilers.

Leucovorin-induced hypersensitivity reaction.

PubMed

Damaske, Avni; Ma, Nichole; Williams, Reba

2012-03-01

Leucovorin is a reduced form of folic acid, which has multiple uses.(1) In this case report, it is used in combination with fluorouracil in the treatment of colon cancer. We describe a 53-year-old male, who was started on FOLFOX 6 + bevacizumab who experienced a hypersensitivity reaction to leucovorin. There have been very few cases of leucovorin hypersensitivity reactions reported in the literature. In this case, symptoms include flushing, hives, body pain, headaches, elevated blood pressures, and general discomfort. Although leucovorin reactions are considered rare, one should be aware of the types of reactions that can occur with leucovorin.

Addison's disease secondary to connective tissue diseases: a report of six cases.

PubMed

Zhang, Zhuo-li; Wang, Yu; Zhou, Wei; Hao, Yan-jie

2009-04-01

Addison's disease is an autoimmune process. However, Addison's disease associated with connective tissue diseases (CTD) is only occasionally reported. Here, we report six cases of Addison's disease secondary to a variety of CTD, which include systemic lupus erythematosus, Takayasu arteritis, systemic sclerosis, ankylosing spondylitis (AS) and antiphospholipid antibody syndrome. The association of Addison's disease with Takayasu arteritis and AS is reported for the first time. We also found high prevalence of hypothyroidism as concomitant autoimmune disorder. Our case series highlight the autoimmune features of Addison's disease. Therefore, we suggest considering adrenal dysfunction in patients with CTD.

MANAGING UNCERTAINTIES ASSOCIATED WITH RADIOACTIVE WASTE DISPOSAL: TASK GROUP 4 OF THE IAEA PRISM PROJECT

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

Seitz, R.

2011-03-02

It is widely recognized that the results of safety assessment calculations provide an important contribution to the safety arguments for a disposal facility, but cannot in themselves adequately demonstrate the safety of the disposal system. The safety assessment and a broader range of arguments and activities need to be considered holistically to justify radioactive waste disposal at any particular site. Many programs are therefore moving towards the production of what has become known as a Safety Case, which includes all of the different activities that are conducted to demonstrate the safety of a disposal concept. Recognizing the growing interest inmore » the concept of a Safety Case, the International Atomic Energy Agency (IAEA) is undertaking an intercomparison and harmonization project called PRISM (Practical Illustration and use of the Safety Case Concept in the Management of Near-surface Disposal). The PRISM project is organized into four Task Groups that address key aspects of the Safety Case concept: Task Group 1 - Understanding the Safety Case; Task Group 2 - Disposal facility design; Task Group 3 - Managing waste acceptance; and Task Group 4 - Managing uncertainty. This paper addresses the work of Task Group 4, which is investigating approaches for managing the uncertainties associated with near-surface disposal of radioactive waste and their consideration in the context of the Safety Case. Emphasis is placed on identifying a wide variety of approaches that can and have been used to manage different types of uncertainties, especially non-quantitative approaches that have not received as much attention in previous IAEA projects. This paper includes discussions of the current results of work on the task on managing uncertainty, including: the different circumstances being considered, the sources/types of uncertainties being addressed and some initial proposals for approaches that can be used to manage different types of uncertainties.« less

Application of Density Functional Theory to Systems Containing Metal Atoms

NASA Technical Reports Server (NTRS)

Bauschlicher, Charles W., Jr.; Arnold, James O. (Technical Monitor)

1997-01-01

The accuracy of density functional theory (DFT) for problems involving metal atoms is considered. The DFT results are compared with experiment as well as results obtained using the coupled cluster approach. The comparisons include geometries, frequencies, and bond energies. The systems considered include MO2, M(OH)+(sub n), MNO+, and MCO+(sub 2). The DFT works well for frequencies and geometries, even in cases with symmetry breaking; however, some examples have been found where the symmetry breaking is quite severe and the DFT methods do not work well. The calculation of bond energies is more difficult and examples of the successes as well as failures of DFT will be given.

Complications of correction for focal kyphosis after posterior osteotomy and the corresponding management.

PubMed

Zeng, Yan; Chen, Zhongqiang; Guo, Zhaoqing; Qi, Qiang; Li, Weishi; Sun, Chuiguo

2013-10-01

A clinical retrospective study. To analyze the complications and relevant management of the correction procedure for focal kyphosis. The treatment of focal kyphosis is a difficult problem in spine surgery. The potential complications of surgery should be considered cautiously and managed positively. Eighty-one patients with focal kyphosis were treated by posterior osteotomy and correction. The etiology was posttraumatic in 31 cases, healed tuberculosis in 31 cases, congenital in 17 cases, and iatrogenic in 2 cases. The surgical procedures were pedicle subtraction osteotomy in 19 cases, posterior osteotomy with anterior opening-posterior closing correction in 23 cases, and posterior vertebral column resection with dual axial rotation correction in 39 cases. The intraoperative and postoperative complications were summarized, and the corresponding management was described in detail. The average follow-up time was 31 months. Among patients who underwent pedicle subtraction osteotomy, the intraoperative and postoperative complications included 3 cases of dural tear and 1 case of wound infection. For posterior osteotomy with anterior opening-posterior closing correction, the complications included 4 cases of dural tear, 1 case of wound infection, and 1 case of instrumentation loosening and recurrence of kyphosis . For posterior vertebral column resection with dual axial rotation correction, the complications included 3 cases of dural tear, 5 cases of nerve root injury, 1 case of titanium mesh loosening, 1 case of osteotomy segment migration, 2 cases of transient neurological compromise, and 1 case of instrumentation loosening and kyphosis recurrence. All the complications were treated positively and pertinently. During the posterior osteotomy and correction of focal kyphosis, the risk of surgery increases along with the more severe deformity and the more complicated surgical procedure. However, most complications do not significantly affect the outcome if treated appropriately.

Statistical methods for studying disease subtype heterogeneity.

PubMed

Wang, Molin; Spiegelman, Donna; Kuchiba, Aya; Lochhead, Paul; Kim, Sehee; Chan, Andrew T; Poole, Elizabeth M; Tamimi, Rulla; Tworoger, Shelley S; Giovannucci, Edward; Rosner, Bernard; Ogino, Shuji

2016-02-28

A fundamental goal of epidemiologic research is to investigate the relationship between exposures and disease risk. Cases of the disease are often considered a single outcome and assumed to share a common etiology. However, evidence indicates that many human diseases arise and evolve through a range of heterogeneous molecular pathologic processes, influenced by diverse exposures. Pathogenic heterogeneity has been considered in various neoplasms such as colorectal, lung, prostate, and breast cancers, leukemia and lymphoma, and non-neoplastic diseases, including obesity, type II diabetes, glaucoma, stroke, cardiovascular disease, autism, and autoimmune disease. In this article, we discuss analytic options for studying disease subtype heterogeneity, emphasizing methods for evaluating whether the association of a potential risk factor with disease varies by disease subtype. Methods are described for scenarios where disease subtypes are categorical and ordinal and for cohort studies, matched and unmatched case-control studies, and case-case study designs. For illustration, we apply the methods to a molecular pathological epidemiology study of alcohol intake and colon cancer risk by tumor LINE-1 methylation subtypes. User-friendly software to implement the methods is publicly available. Copyright © 2015 John Wiley & Sons, Ltd.

Disseminated Oligodendroglial-like Leptomeningeal Tumor in the Adult: Case Report and Review of the Literature.

PubMed

Fiaschi, Pietro; Badaloni, Filippo; Cagetti, Bernarda; Bruzzone, Luca; Marucci, Gianluca; Dellachà, Anna; Pavanello, Marco; Ganci, Giuseppe; Padolecchia, Riccardo; Valsania, Valtero

2018-06-01

Diffuse leptomeningeal glioneuronal tumor (DLGNT) was recently added to the World Health Organization classification of central nervous system tumors. DLGNT is a rare entity that occurs more commonly in pediatric patients, but occasional cases have been reported in adults. This tumor has been recognized as a distinct pathologic entity; however, its biologic behavior remains unclear. It is considered an indolent neoplasm, although considerable morbidity has been reported. For this reason, further characterization and collection of evidence are crucial. In this article, we reported a case of a 36-year-old woman with a DLGNT characterized by rapid, aggressive behavior. We also performed a review of the literature for reported cases of low-grade and high-grade forms involving adults and children. DLGNTs should no longer be considered only as low-grade tumors affecting pediatric patients. The spectrum of presentations also includes aggressive tumors affecting adults. Further clinical and pathologic data supported by cytogenetic and molecular investigations are mandatory to better characterize DLGNTs. Copyright © 2018 Elsevier Inc. All rights reserved.

Medicolegal Issues in Traumatic Brain Injury.

PubMed

Zasler, Nathan D; Bigler, Erin

2017-05-01

The role of the physiatrist in provision of medicolegal expert testimony in cases involving traumatic brain injury is challenging and complex. This article provides an overview of how such work should be conducted from a practical perspective including discussion of ethical, legal, medical, and business aspects of such activities. Additionally, pointers are provided with regards to how information including preinjury, injury, and postinjury (including neuroimaging and neuropsychological data) should be considered and integrated into medicolegal opinions and testimony. Copyright © 2016 Elsevier Inc. All rights reserved.

Effect of the new standards for case logging on resident operative volume: doing better cases or better numbers?

PubMed

Murthy, Raghav; Shepard, Alex; Swartz, Andrew; Woodward, Ann; Reickert, Craig; Horst, Mathilda; Rubinfeld, Ilan

2012-01-01

The Accreditation Council for Graduate Medical Education (ACGME) modified the designation of major (index) operative cases to include those previously considered "minor." This study assessed the potential effect of these changes on resident operative experience. With Institutional Review Board approval, we analyzed National Surgical Quality Improvement Program participant use files for 2005-2008 for general and vascular surgery cases. Primary CPT case coding was mapped to the ACGME major case category using both the old and new classification schemes. The variables were analyzed using χ(2) analysis in SPSS IBM 19 (IBM, Armonk, New York). A total of 576,019 cases were reviewed. Major cases as defined by the new classification represented an increasing proportion of the cases each year, rising from 88.3% in 2005 to 95% by 2008 (p < 0.001). Major cases as defined by the old scheme decreased from 71% in 2005 to 62% by 2008 (p < 0.001). The cases covered by a resident dropped from 82% in 2005 to 61% in 2008 (p < 0.001). When comparing the new to the old scheme, 364,366 (63.3%) cases were considered major and 30,587 (5.3%) were minor by both standards; 7089 (1.2%) cases previously classified as major were changed to minor, whereas 173,977 (30.2%) (p < 0.001) previously classified as minor were now major. This latter group showed top procedures to include excision of breast lesion (22,175 [12.7%]), laparoscopic gastric bypass (18,825 [10.8%]), ventral hernia repair (14,732 [8.5%]), and appendectomy (10,190 [5.9%]). Of these newly designated major cases, the proportion not covered by residents increased from 22% in 2005 to 44% in 2007 and 2008 (p < 0.001). Although some operative cases newly classified as major are technically advanced procedures (eg, Roux-en-Y gastric bypass), other cases are not (eg, breast lesion excision), which raises the issue as to whether the major case category has been diluted by less demanding case types. The implications of these findings may suggest preservation of case volumes at the expense of case quality. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Special Education and the Law.

ERIC Educational Resources Information Center

Horvath, Michael John; And Others

This paper summarizes results of federal legislation and court litigation addressing special education issues. The first section considers cases in which rights were secured through litigation. These include rights of minority groups, rights of the mentally ill, rights of the mentally retarded, and the right to a fair classification. The second…

Dynamic Assessment or Schema Theory: The Case of Listening Comprehension

ERIC Educational Resources Information Center

Farangi, Mohamad Reza; Kheradmand Saadi, Zahra

2017-01-01

Not only is listening considered as an active skill nowadays, but also different approaches are suggested to incorporate it effectively into language classrooms. Our purpose, here, is to compare two approaches claiming to be effective in enhancing EFL learners' listening capabilities including schema theory and dynamic assessment. Through a…

PHYSIOLOGICALLY-BASED PHARMACOKINETICS/PHARMACODYNAMIC MODELING AND CUMULATIVE RISK ASSESSMENT: CASE STUDY FOR THE N-METHYL CARBMATE PESTICIDES

EPA Science Inventory

The Food Quality Protection Act of 1996 [PL 104-170: 110 STAT. 1513] requires EPA to consider potential cumulative human health risks resulting from aggregate exposure to pesticide chemicals acting through a common mechanism of toxicity. This includes all anticipated dietary e...

1985 Cancer Facts and Figures.

ERIC Educational Resources Information Center

American Cancer Society, Inc., New York, NY.

Information and statistical data about cancer are provided in seven categories. They include: (1) basic cancer data (considering how cancer works, trends in diagnosis and treatment, new cancer cases and deaths for 1985, and other areas); (2) major cancer sites (discussing lung cancer, colorectal cancer, breast cancer, 5-year survival rates/trends…

Trustworthy Insurance: Information Timing and Telling the Truth.

ERIC Educational Resources Information Center

Hirsch, Penny L.; Shwom, Barbara L.; Messick, Judith H.

1998-01-01

Presents a case study for use in business communication classes to help students understand and learn both the context and the strategies for communication with business and management. Deals with dilemmas of moral and ethics within a company that has gone through downsizing and is considering relocating. Includes two assignments. (SR)

40 CFR 1037.660 - Automatic engine shutdown systems.

Code of Federal Regulations, 2014 CFR

2014-07-01

... is regenerating. The period considered to be regeneration for purposes of this allowance must be... regeneration for other purposes. For example, in some cases it may be appropriate to include a cool down period for this purpose but not for infrequent regeneration adjustment factors. (2) If necessary while...

Asperger Syndrome: Advice for School Personnel.

ERIC Educational Resources Information Center

Lamarine, Roland J.

2001-01-01

This guide to Asperger syndrome first reviews clinical features (such as social isolation and a lack of empathy) and diagnosis. It then considers epidemiology and prevalence data and offers a case study. Principles of management and education are discussed, including use of structured, routine regimens, focus on the child's strengths, guided…

Induction Program Design as It Relates to School Setting

ERIC Educational Resources Information Center

Gabel, Jamie Ann

2016-01-01

The purpose of this qualitative case study was to investigate the induction program differences offered to beginning teachers in rural versus suburban school settings and to identify which induction supports beginning teachers considered most important in achieving classroom success. The six participants included an administrator, mentor, and…

Animal Housing: Emotional Support Animals on Campuses

ERIC Educational Resources Information Center

Salminen, Erik; Gregory, Dennis E.

2018-01-01

The results of recent cases indicate that residences and dormitories owned by higher education institutions should be considered "dwellings," and thus subject to the Fair Housing Act. The Fair Housing Act (1968) as amended requires that the providers of dwellings accommodate assistance animals, which includes not only service animals,…

The Language Question: Considering Three Somali American Students with Autism

ERIC Educational Resources Information Center

Baker, Diana

2017-01-01

Little research addresses the experiences of students with autism living in multilingual families. This multiple case study project examines the language-development-related knowledge and beliefs of paired mothers and educators of three Somali American boys with autism. Data include serial interviews, observations, and analysis of educational…

Impaired Verbal Associative Learning after Resection of Left Perirhinal Cortex

ERIC Educational Resources Information Center

Weintrob, David L.; Saling, Michael M.; Berkovic, Samuel F.; Reutens, David C.

2007-01-01

Some patients considered for left temporal lobectomy for epilepsy present with normal verbal learning and no MRI evidence of hippocampal pathology. In order to preserve learning function, the surgical approach in these cases often aims at sparing the hippocampus. Parahippocampal structures, including the left perirhinal region, however, also…

Retroperitoneal abscesses in two western lowland gorillas (Gorilla gorilla gorilla).

PubMed

Hahn, Alicia; D'Agostino, Jennifer; Cole, Gretchen A; Raines, Jan

2014-03-01

This report describes two cases of retroperitoneal abscesses in female western lowland gorillas (Gorilla gorilla gorilla). Clinical symptoms included perivulvar discharge, lameness, hindlimb paresis, and general malaise. Retroperitoneal abscesses should be considered as part of a complete differential list in female gorillas with similar clinical signs.

Velocity diagrams

NASA Technical Reports Server (NTRS)

Whitney, W. J.; Stewart, W. L.

1972-01-01

The selection and design of velocity diagrams for axial flow turbines are considered. Application is treated in two parts which includes: (1) mean-section diagrams, and (2) radial variation of diagrams. In the first part, the velocity diagrams occurring at the mean section are assumed to represent the average conditions encountered by the turbine. The different types of diagrams, their relation to stage efficiency, and their selection when staging is required are discussed. In the second part, it is shown that in certain cases the mean-section diagrams may or may not represent the average flow conditions for the entire blade span. In the case of relatively low hub- to tip-radius ratios, substantial variations in the velocity diagrams are encountered. The radial variations in flow conditions and their effect on the velocity diagrams are considered.

FATAL GASTRIC DILATION IN TWO ADULT BLACK-FOOTED FERRETS (MUSTELA NIGRIPES).

PubMed

Hinton, Jenna D; Aitken-Palmer, Copper; Joyner, Priscilla H; Ware, Lisa; Walsh, Timothy F

2016-03-01

Acute gastric dilation resulting in death was identified in two adult black-footed ferrets (Mustela nigripes) housed at the Smithsonian Conservation Biology Institute in Front Royal, Virginia. Both individuals were adult males (3 and 5 yr) and previously clinically healthy prior to the event. The etiology of gastric dilation in both cases could not be definitively determined, and necropsy revealed severe cardiovascular compromise secondary to bloat. Limited literature is available regarding a syndrome of this type in adult black-footed ferrets. Differential diagnoses considered included gastric dilatation volvulus (GDV), severe gastric distention of unknown origin, and gastric outflow obstruction. Given the severity of this syndrome and the findings in these two cases, acute gastric dilation should be considered in black-footed ferrets presenting with acute abdominal distention, respiratory distress, and cardiovascular compromise.

CFD Validation Experiment of a Mach 2.5 Axisymmetric Shock-Wave/Boundary-Layer Interaction

NASA Technical Reports Server (NTRS)

Davis, David O.

2015-01-01

Experimental investigations of specific flow phenomena, e.g., Shock Wave Boundary-Layer Interactions (SWBLI), provide great insight to the flow behavior but often lack the necessary details to be useful as CFD validation experiments. Reasons include: 1.Undefined boundary conditions Inconsistent results 2.Undocumented 3D effects (CL only measurements) 3.Lack of uncertainty analysis While there are a number of good subsonic experimental investigations that are sufficiently documented to be considered test cases for CFD and turbulence model validation, the number of supersonic and hypersonic cases is much less. This was highlighted by Settles and Dodsons [1] comprehensive review of available supersonic and hypersonic experimental studies. In all, several hundred studies were considered for their database.Of these, over a hundred were subjected to rigorous acceptance criteria. Based on their criteria, only 19 (12 supersonic, 7 hypersonic) were considered of sufficient quality to be used for validation purposes. Aeschliman and Oberkampf [2] recognized the need to develop a specific methodology for experimental studies intended specifically for validation purposes.

[Forensic identification of floating shoulder injury].

PubMed

Li, Sheng-Ya; Huang, Si-Xing; Zhao, Xing-Bin; Zheng, Xiao-Hong; Zhu, Yi

2006-10-15

To discuss forensic identification of floating shoulder injury (FSI). To analyze fifteen cases of FSI which were accepted from Jan. 1993 to Jan. 2006, including 15 shoulder neck fracture, 13 clavide stem fracture and 2 distal end clavide fracture, the function of shoulder joint was evaluated six months after injure considering the following three aspects: result of forensic examination such as X-ray photograph, CT and MRI, the injurers' symptom, objective sign and joint function, shoulder joint territory, degree of pain and local muscle power. Basing on the curative effect standard of Herscovic, all cases were divided into good. Modest, worst, which included 2, 4, 9 cases respectively; referring the standard of GA35-92, GB18667-2002, all cases were divided into six, seven, eight, nine and ten degree, which included 2,9,2,1,1 cases respectively. As a special powerful injure, FSI always companied with concurrent and multiple injure, and characterized by missed, incorrect and delayed diagnosis and infelicitous treatment, which lead to the high frequency and degree of injure. To prevent missed and incorrect forensic identification, we should have a full realization of the particularity of FSI, and evaluate the function of shoulder all-sidely, objectively and synseticaly.

Changing trend of viral hepatitis--"A twenty one year report from Pakistan Medical Research Council Research Centre, Jinnah Postgraduate Medical Centre, Karachi".

PubMed

Ahmed, Waquaruddin; Qureshi, Huma; Arif, Ambreen; Alam, Syed Ejaz

2010-02-01

To determine the frequency and pattern of Hepatitis B and C over the past twenty one years, in a liver research unit of Karachi. Retrospective analysis of the records of PMRC, Research Centre, Jinnah Postgraduate Medical Centre, Karachi, from 1987 to 2007 were reviewed. A special flow sheet was made where information of all patients with viral liver disease was entered. Patients having complete information of viral markers were included in the analysis. Cases with HBsAg, Anti HBc IgM positive and raised ALT were considered as acute Hepatitis B. HBs Ag/Anti HBc IgG positive were considered as chronic Hepatitis B. Delta antibody positive with or without HBsAg were considered as Delta Hepatitis. Anti HCV positive and raised ALT more than ten times for less than 6 months were considered as acute Hepatitis C, whereas Anti HCV and HCV-RNA positive with or without raised ALT for more than six months were considered as chronic Hepatitis C. Anti HEV IgM and Anti HAV IgM positive were considered as acute Hepatitis E and A respectively. A total of 5193 cases fulfilling all criteria of viral hepatitis were seen in the past 21 years. Of the total 3247 (62.5%) were males and 1946 (37.5%) females giving a male to female ratio of 1.7 : 1. Hepatitis C was the most common infection seen in 2896 cases (55.8%), followed by Hepatitis B in 1691 cases (32.6%). Seventy five percent cases of Hepatitis B were males and 25% females while 55% Hepatitis C cases were males and 45% females. Hepatitis B was seen a decade earlier in different age groups than hepatitis C. Overall, out of the total 5193 cases, 2294 (44.2%) were of chronic hepatitis, 1430 (27.5%) cirrhosis, 1083 (20.8%) carriers and 346 (6.7%) had acute hepatitis (hepatitis B; 214 (61.8%), hepatitis C; 21 (6.0%). While hepatitis B and hepatitis C both were present in 3 (1.3%). Hepatitis E was 70 (20.2%), hepatitis A 12 (3.5%) and all markers were negative in 26 (7.5%) cases). Forty cases (0.8%) were of Hepatocellular carcinoma. Year wise analysis of proportion of hepatitis B and C showed gradual decline of Hepatitis B and rise of Hepatitis C with a transition period between 1995 and 1996. Hepatitis C is the most common viral hepatitis, followed by hepatitis B, both are more common in males. Hepatitis B is seen a decade earlier than hepatitis C. Rising trend of hepatitis C and declining evidence of hepatitis B could be due to increased awareness and detection of hepatitis C and effective vaccination for hepatitis B in the country.

Thermal Exposure Effects on Properties of Al-Li Alloy Plate Products

NASA Technical Reports Server (NTRS)

Shah, Sandeep; Wells, Douglas; Wagner, John; Babel, Henry

2003-01-01

The objective of this viewgraph representation is to evaluate the effects of thermal exposure on the mechanical properties of both production mature and developmental Al-Li alloys. The researchers find for these alloys, the data clearly shows that there is no deficit in mechanical properties at lower exposure temperatures in some cases, and a signficant deficit in mechanical properties at higher exposure temperatures in all cases. Topics considered include: Al-Li alloys composition, key characteristics of Al-Li alloys and thermal exposure matrix.

Practical aspects of telehealth: financial considerations.

PubMed

Loh, P K; Sabesan, S; Allen, D; Caldwell, P; Mozer, R; Komesaroff, P A; Talman, P; Williams, M; Shaheen, N; Grabinski, O; Withnall, D

2013-07-01

The second in a series of articles about the practical aspects of telehealth, this paper includes information and a case history on the cost-benefits for patients and practitioners using telehealth. The case history demonstrates that telehealth can save travel time for patients, carers and specialists, and can reduce out-of-pocket expenses. The practical aspects of telehealth article series considers the contextual, clinical, technical and ethical components of online video consultations. © 2013 The Authors; Internal Medicine Journal © 2013 Royal Australasian College of Physicians.

Forensic case formulation: theoretical, ethical and practical issues.

PubMed

Davies, Jason; Black, Susie; Bentley, Natalie; Nagi, Claire

2013-10-01

Forensic case formulation, of increasing interest to practitioners and researchers raises many ethical, theoretical and practical issues for them. Systemic, contextual and individual factors which need to be considered include the multitude of staff often involved with any one individual, the pressure to 'get it right' because of the range of risk implications that are associated with individuals within forensic mental health settings, and individual parameters, for example reluctance to be engaged with services. Copyright © 2013 John Wiley & Sons, Ltd.

Optimal Aerodynamic Design of Conventional and Coaxial Helicopter Rotors in Hover and Forward Flight

DTIC Science & Technology

2015-12-28

graduate career a fun and (at times) productive pursuit. I owe a great deal to my parents , Kevin and Lisa, for their unconditional support. Finally...forward flight. Orchard and Newman [6] investigated fundamental design features of compound helicopters using a wing, a single rotor, and a propul- sor... style compound. For the case considered here, the coaxial rotors are unconstrained in lift offset. If a wing were used in a case that also included a lift

Bounds of the error of Gauss-Turan-type quadratures

NASA Astrophysics Data System (ADS)

Milovanovic, Gradimir V.; Spalevic, Miodrag M.

2005-06-01

We consider the remainder term of the Gauss-Turan quadrature formulaefor analytic functions in some region of the complex plane containing the interval [-1,1] in its interior. The remainder term is presented in the form of a contour integral over confocal ellipses or circles. A strong error analysis is given for the case with a generalized class of weight functions, introduced recently by Gori and Micchelli. Also, we discuss a general case with an even weight function defined on [-1,1]. Numerical results are included.

Clostridium septicum infection and hemolytic uremic syndrome.

PubMed Central

Barnham, M.; Weightman, N.

1998-01-01

Five cases of Clostridium septicum infection secondary to Escherichia coli O157-induced hemolytic uremic syndrome have been reported. We report on three cases (one of which is included in the above five) of dual Cl. septicum and E. coil infection; all three patients were exposed to farm animals. A common zoonotic source for Cl. septicum and E. coli O157 infections should be considered. Patients with hemolytic uremic syndrome should be treated aggressively and monitored closely for Cl. septicum superinfection. PMID:9621207

Three eyelid localized cutaneous anthrax cases.

PubMed

Esmer, Oktay; Karadag, Remzi; Bilgili, Serap Gunes; Gultepe, Bilge; Bayramlar, Huseyin; Karadag, Ayse Serap

2014-12-01

Anthrax is primarily seen in the developing countries, but it can be a worldwide medical concern due to bioterrorism threats. Palpebral anthrax is a rare form of cutaneous anthrax. Untreated cutaneous anthrax can be lethal. Patients with palpebral anthrax can develop complications including cicatrisation and ectropion. Thus, anthrax should be considered in differential diagnosis for patients presenting with preseptal cellulitis in high-risk regions. Herein, we report three anthrax cases (with different age) involving eyelids that were cured without any complications due to early diagnosis and treatment.

Non-psychotropic medication and risk of suicide or attempted suicide: a systematic review

PubMed Central

Gorton, Hayley C; Webb, Roger T; Kapur, Navneet; Ashcroft, Darren M

2016-01-01

Objectives To establish which non-psychotropic medications have been assessed in relation to risk of suicide or attempted suicide in observational studies, document reported associations and consider study strengths and limitations. Design Systematic review. Methods Four databases (Embase, Medline, PsycINFO and International Pharmaceutical Abstracts) were searched from 1990 to June 2014, and reference lists of included articles were hand-searched. Case–control, cohort and case only studies which reported suicide or attempted suicide in association with any non-psychotropic medication were included. Outcome measures The outcomes eligible for inclusion were suicide and attempted suicide, as defined by the authors of the included study. Results Of 11 792 retrieved articles, 19 were eligible for inclusion. Five studies considered cardiovascular medication and antiepileptics; two considered leukotriene receptor antagonists, isotretinoin and corticosteroids; one assessed antibiotics and another assessed varenicline. An additional study compared multiple medications prescribed to suicide cases versus controls. There was marked heterogeneity in study design, outcome and exposure classification, and control for confounding factors; particularly comorbid mental and physical illness. No increased risk was associated with cardiovascular medications, but associations with other medications remained inconclusive and meta-analysis was inappropriate due to study heterogeneity. Conclusions Whether non-psychotropic medications are associated with increased risk of suicide or attempted suicide remains largely unknown. Robust identification of suicide outcomes and control of comorbidities could improve quantification of risk associated with non-psychotropic medication, beyond that conferred by underlying physical and mental illnesses. PMID:26769782

Progress toward poliomyelitis eradication --- Nigeria, January 2010-June 2011.

PubMed

2011-08-12

The Global Polio Eradication Initiative (GPEI) was launched by the World Health Assembly in 1988. By 2006, transmission of indigenous wild poliovirus (WPV) was interrupted in all countries except Nigeria, Afghanistan, Pakistan, and India. Among the 36 states and Federal Capital Territory of Nigeria, WPV transmission has persisted in eight northern states considered at high risk; in addition, four other northern states have been considered at high risk for WPV transmission. In these 12 high-risk states, type 2 circulating vaccine-derived poliovirus (cVDPV2) transmission also was observed during 2005-2011. This report updates GPEI progress in Nigeria during January 2010--June 2011 and describes activities required to interrupt transmission. In Nigeria, confirmed WPV cases decreased 95%, from 388 in 2009 to 21 in 2010; cVDPV2 cases decreased 82%, from 154 in 2009 to 27 in 2010. However, as of July 26, 2011, Nigeria had reported 24 WPV cases (including one WPV/cVDPV2 coinfection) and 11 cVDPV2 cases during January-June 2011, compared with six WPV cases and 10 cVDPV2 cases during January-June 2010. Despite substantial progress, immunization activities and surveillance sensitivity will need to be enhanced further to interrupt WPV transmission in Nigeria by the end of 2011.

Case of a cardiac arrest patient who survived after extracorporeal cardiopulmonary resuscitation and 1.5 hours of resuscitation: A case report.

PubMed

Moon, Seong Ho; Kim, Jong Woo; Byun, Joung Hun; Kim, Sung Hwan; Kim, Ki Nyun; Choi, Jun Young; Jang, In Seok; Lee, Chung Eun; Yang, Jun Ho; Kang, Dong Hun; Park, Hyun Oh

2017-11-01

Per the American Heart Association guidelines, extracorporeal cardiopulmonary resuscitation should be considered for in-hospital patients with easily reversible cardiac arrest. However, there are currently no consensus recommendations regarding resuscitation for prolonged cardiac arrest cases. We encountered a 48-year-old man who survived a cardiac arrest that lasted approximately 1.5 hours. He visited a local hospital's emergency department complaining of chest pain and dyspnea that had started 3 days earlier. Immediately after arriving in the emergency department, a cardiac arrest occurred; he was transferred to our hospital for extracorporeal membrane oxygenation (ECMO). Resuscitation was performed with strict adherence to the American Heart Association/American College of Cardiology advanced cardiac life support guidelines until ECMO could be placed. On hospital day 7, he had a full neurologic recovery. On hospital day 58, additional treatments, including orthotopic heart transplantation, were considered necessary; he was transferred to another hospital. To our knowledge, this is the first case in South Korea of patient survival with good neurologic outcomes after resuscitation that lasted as long as 1.5 hours. Documenting cases of prolonged resuscitation may lead to updated guidelines and improvement of outcomes of similar cases in future. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

Case definition for clinical and subclinical bacterial kidney disease (BKD) in Atlantic Salmon (Salmo salar L.) in New Brunswick, Canada.

PubMed

Boerlage, A S; Stryhn, H; Sanchez, J; Hammell, K L

2017-03-01

Bacterial kidney disease (BKD) is considered an important cause of loss in salmon aquaculture in Atlantic Canada. Causative agent of BKD is the Gram-positive bacteria Renibacterium salmoninarum. Infected salmon are often asymptomatic (subclinical infection), and the disease is considered chronic. One of the challenges in quantifying information from farm production and health records is the application of a standardized case definition. Case definitions for farm-level and cage-level clinical and subclinical BKD were developed using retrospective longitudinal data from aquaculture practices in New Brunswick, Canada, combining (i) industry records of weekly production data including mortalities, (ii) field observations for BKD using reports of veterinarians and/or fish health technicians, (iii) diagnostic submissions and test results and (iv) treatments used to control BKD. Case definitions were evaluated using veterinarians' expert judgements as reference standard. Eighty-nine and 66% of sites and fish groups, respectively, were associated with BKD at least once. For BKD present (subclinical or clinical), sensitivity and specificity of the case definition were 75-100% varying between event, fish group, site cycle and level (site pen). For clinical BKD, sensitivities were 29-64% and specificities 91-100%. Industry data can be used to develop sensitive case definitions. © 2016 John Wiley & Sons Ltd.

Herbalife hepatotoxicity: Evaluation of cases with positive reexposure tests

PubMed Central

Teschke, Rolf; Frenzel, Christian; Schulze, Johannes; Schwarzenboeck, Alexander; Eickhoff, Axel

2013-01-01

AIM: To analyze the validity of applied test criteria and causality assessment methods in assumed Herbalife hepatotoxicity with positive reexposure tests. METHODS: We searched the Medline database for suspected cases of Herbalife hepatotoxicity and retrieved 53 cases including eight cases with a positive unintentional reexposure and a high causality level for Herbalife. First, analysis of these eight cases focused on the data quality of the positive reexposure cases, requiring a baseline value of alanine aminotransferase (ALT) < 5 upper limit of normal (N) before reexposure, with N as the upper limit of normal, and a doubling of the ALT value at reexposure as compared to the ALT value at baseline prior to reexposure. Second, reported methods to assess causality in the eight cases were evaluated, and then the liver specific Council for International Organizations of Medical Sciences (CIOMS) scale validated for hepatotoxicity cases was used for quantitative causality reevaluation. This scale consists of various specific elements with scores provided through the respective case data, and the sum of the scores yields a causality grading for each individual case of initially suspected hepatotoxicity. RESULTS: Details of positive reexposure test conditions and their individual results were scattered in virtually all cases, since reexposures were unintentional and allowed only retrospective rather than prospective assessments. In 1/8 cases, criteria for a positive reexposure were fulfilled, whereas in the remaining cases the reexposure test was classified as negative (n = 1), or the data were considered as uninterpretable due to missing information to comply adequately with the criteria (n = 6). In virtually all assessed cases, liver unspecific causality assessment methods were applied rather than a liver specific method such as the CIOMS scale. Using this scale, causality gradings for Herbalife in these eight cases were probable (n = 1), unlikely (n = 4), and excluded (n = 3). Confounding variables included low data quality, alternative diagnoses, poor exclusion of important other causes, and comedication by drugs and herbs in 6/8 cases. More specifically, problems were evident in some cases regarding temporal association, daily doses, exact start and end dates of product use, actual data of laboratory parameters such as ALT, and exact dechallenge characteristics. Shortcomings included scattered exclusion of hepatitis A-C, cytomegalovirus and Epstein Barr virus infection with only globally presented or lacking parameters. Hepatitis E virus infection was considered in one single patient and found positive, infections by herpes simplex virus and varicella zoster virus were excluded in none. CONCLUSION: Only one case fulfilled positive reexposure test criteria in initially assumed Herbalife hepatotoxicity, with lower CIOMS based causality gradings for the other cases than hitherto proposed. PMID:23898368

Thyrotropin-producing pituitary adenoma simultaneously existing with Graves' disease: a case report.

PubMed

Arai, Nobuhiko; Inaba, Makoto; Ichijyo, Takamasa; Kagami, Hiroshi; Mine, Yutaka

2017-01-06

Thyrotropin-producing pituitary tumor is relatively rare. In particular, concurrent cases associated with Graves' disease are extremely rare and only nine cases have been reported so far. We describe a case of a thyrotropin-producing pituitary adenoma concomitant with Graves' disease, which was successfully treated. A 40-year-old Japanese woman presented with mild signs of hyperthyroidism. She had positive anti-thyroid-stimulating hormone receptor antibody, anti-thyroglobulin antibody, and anti-thyroid peroxidase antibody. Her levels of serum thyroid-stimulating hormone, which ranged from low to normal in the presence of high levels of serum free thyroid hormones, were considered to be close to a state of syndrome of inappropriate secretion of thyroid-stimulating hormone. Magnetic resonance imaging showed a macropituitary tumor. The coexistence of thyrotropin-producing pituitary adenoma and Graves' disease was suspected. Initial therapy included anti-thyroid medication, which was immediately discontinued due to worsening symptoms. Subsequently, surgical therapy for the pituitary tumor was conducted, and her levels of free thyroid hormones, including the thyroid-stimulating hormone, became normal. On postoperative examination, her anti-thyroid-stimulating hormone receptor antibody levels decreased, and the anti-thyroglobulin antibody became negative. The coexistence of thyrotropin-producing pituitary adenoma and Graves' disease is rarely reported. The diagnosis of this condition is complicated, and the appropriate treatment strategy has not been clearly established. This case suggests that physicians should consider the coexistence of thyrotropin-producing pituitary adenoma with Graves' disease in cases in which thyroid-stimulating hormone values range from low to normal in the presence of thyrotoxicosis, and the surgical treatment of thyrotropin-producing pituitary adenoma could be the first-line therapy in patients with both thyrotropin-producing pituitary adenoma and Graves' disease.

Biogenic CO2 fluxes, changes in surface albedo and biodiversity impacts from establishment of a miscanthus plantation.

PubMed

Jørgensen, Susanne V; Cherubini, Francesco; Michelsen, Ottar

2014-12-15

Depletion in oil resources and environmental concern related to the use of fossil fuels has increased the interest in using second generation biomass as alternative feedstock for fuels and materials. However, the land use and land use change for producing second generation (2G) biomass impacts the environment in various ways, of which not all are usually considered in life cycle assessment. This study assesses the biogenic CO2 fluxes, surface albedo changes and biodiversity impacts for 100 years after changing land use from forest or fallow land to miscanthus plantation in Wisconsin, US. Climate change impacts are addressed in terms of effective forcing, a mid-point indicator which can be used to compare impacts from biogenic CO2 fluxes and albedo changes. Biodiversity impacts are assessed through elaboration on two different existing approaches, to express the change in biodiversity impact from one human influenced state to another. Concerning the impacts from biogenic CO2 fluxes, in the case of conversion from a forest to a miscanthus plantation (case A) there is a contribution to global warming, whereas when a fallow land is converted (case B), there is a climate cooling. When the effects from albedo changes are included, both scenarios show a net cooling impact, which is more pronounced in case B. Both cases reduce biodiversity in the area where the miscanthus plantation is established, though most in case A. The results illustrate the relevance of these issues when considering environmental impacts of land use and land use change. The apparent trade-offs in terms of environmental impacts further highlight the importance of including these aspects in LCA of land use and land use changes, in order to enable informed decision making. Copyright © 2014 Elsevier Ltd. All rights reserved.

Tinea genitalis: a new entity of sexually transmitted infection? Case series and review of the literature

PubMed Central

Luchsinger, Isabelle; Bosshard, Philipp Peter; Kasper, Romano Silvio; Reinhardt, Dominic; Lautenschlager, Stephan

2015-01-01

Objective Investigation on recent cases of tinea genitalis after travelling to South East Asia. Methods Patients with tinea in the genital region, which emerged after sex in South East Asia, underwent further assessment including microscopy, cultures and DNA analyses. Results The case series includes seven patients. In six patients, Trichophyton interdigitale (former Trichophyton mentagrophytes) was detected. Three patients suffered from a severe inflammatory reaction of the soft tissue and two of them needed hospitalisation due to severe pain. In four patients, cicatrising healing was noticed. Five patients were declared incapacitated for work. Conclusions Sexual activity should be considered as a potentially important and previously underappreciated means of transmission of T. interdigitale. To avoid irreversible scarring alopecia, prompt initiation of antifungal treatment is essential and adequate isolation and identification of the pathogen is mandatory. PMID:26071391

[Clinical studies on flomoxef in respiratory tract infections].

PubMed

Kanegae, H; Yamada, H; Yamaguchi, T; Kuroki, S; Katoh, O

1987-10-01

Flomoxef (FMOX, 6315-S) is a new oxacephem with a broad spectrum of antimicrobial activity. We used FMOX for treatment of 13 patients with respiratory tract infections including 4 cases of pneumonia, 5 of lung abscess and 4 of exacerbation of the chronic airway diseases. FMOX showed excellent in vitro antimicrobial activities against clinical isolates including 4 strains of Streptococcus pneumoniae, 2 strains of Haemophilus influenzae and each one strain of Escherichia coli and Klebsiella pneumoniae. Clinical responses were excellent in 3 cases, good in 7 and fair or poor in 3. No side effect was observed, but abnormal laboratory findings caused by FMOX administration were found in 2 cases; hypertransaminasemia and eosinophilia. However, neither of them was severe. From the above results, it is considered that FMOX will be useful for treatment of patients with respiratory tract infections.

METACOGNITIVE SCAFFOLDS IMPROVE SELF-JUDGMENTS OF ACCURACY IN A MEDICAL INTELLIGENT TUTORING SYSTEM

PubMed Central

Feyzi-Behnagh, Reza; Azevedo, Roger; Legowski, Elizabeth; Reitmeyer, Kayse; Tseytlin, Eugene; Crowley, Rebecca S.

2013-01-01

In this study, we examined the effect of two metacognitive scaffolds on the accuracy of confidence judgments made while diagnosing dermatopathology slides in SlideTutor. Thirty-one (N = 31) first- to fourth-year pathology and dermatology residents were randomly assigned to one of the two scaffolding conditions. The cases used in this study were selected from the domain of Nodular and Diffuse Dermatitides. Both groups worked with a version of SlideTutor that provided immediate feedback on their actions for two hours before proceeding to solve cases in either the Considering Alternatives or Playback condition. No immediate feedback was provided on actions performed by participants in the scaffolding mode. Measurements included learning gains (pre-test and post-test), as well as metacognitive performance, including Goodman-Kruskal Gamma correlation, bias, and discrimination. Results showed that participants in both conditions improved significantly in terms of their diagnostic scores from pre-test to post-test. More importantly, participants in the Considering Alternatives condition outperformed those in the Playback condition in the accuracy of their confidence judgments and the discrimination of the correctness of their assertions while solving cases. The results suggested that presenting participants with their diagnostic decision paths and highlighting correct and incorrect paths helps them to become more metacognitively accurate in their confidence judgments. PMID:24532850

METACOGNITIVE SCAFFOLDS IMPROVE SELF-JUDGMENTS OF ACCURACY IN A MEDICAL INTELLIGENT TUTORING SYSTEM.

PubMed

Feyzi-Behnagh, Reza; Azevedo, Roger; Legowski, Elizabeth; Reitmeyer, Kayse; Tseytlin, Eugene; Crowley, Rebecca S

2014-03-01

In this study, we examined the effect of two metacognitive scaffolds on the accuracy of confidence judgments made while diagnosing dermatopathology slides in SlideTutor. Thirty-one ( N = 31) first- to fourth-year pathology and dermatology residents were randomly assigned to one of the two scaffolding conditions. The cases used in this study were selected from the domain of Nodular and Diffuse Dermatitides. Both groups worked with a version of SlideTutor that provided immediate feedback on their actions for two hours before proceeding to solve cases in either the Considering Alternatives or Playback condition. No immediate feedback was provided on actions performed by participants in the scaffolding mode. Measurements included learning gains (pre-test and post-test), as well as metacognitive performance, including Goodman-Kruskal Gamma correlation, bias, and discrimination. Results showed that participants in both conditions improved significantly in terms of their diagnostic scores from pre-test to post-test. More importantly, participants in the Considering Alternatives condition outperformed those in the Playback condition in the accuracy of their confidence judgments and the discrimination of the correctness of their assertions while solving cases. The results suggested that presenting participants with their diagnostic decision paths and highlighting correct and incorrect paths helps them to become more metacognitively accurate in their confidence judgments.

Dissociation of heavy quarkonia in an anisotropic hot QCD medium in a quasiparticle model

NASA Astrophysics Data System (ADS)

Jamal, Mohammad Yousuf; Nilima, Indrani; Chandra, Vinod; Agotiya, Vineet Kumar

2018-05-01

The present article is the follow-up work of Phys. Rev. D 94, 094006 (2016), 10.1103/PhysRevD.94.094006, where we have extended the study of quarkonia dissociation in (momentum) anisotropic hot QCD medium. As evident by the experimentally observed collective flow at the RHIC and LHC, the momentum anisotropy is present at almost all the stages after the collision, and therefore, it is important to include its effects in the analysis. Employing the in-medium (corrected) potential while considering the anisotropy (both oblate and prolate cases) in the medium, the thermal widths and the binding energies of the heavy quarkonia states (s -wave charmonia and s -wave bottomonia specifically, for radial quantum numbers n =1 and 2) have been determined. The hot QCD medium effects have been included by employing a quasiparticle description. The presence of anisotropy has modified the potential and then the thermal widths and binding energies of these states in a significant manner. The results show a quite visible shift in the values of dissociation temperatures as compared to the isotropic case. Further, the hot QCD medium interaction effects suppress the dissociation temperature as compared to the case where we consider the medium as a noninteracting ultrarelativistic gas of quarks (antiquarks) and gluons.

Churg-Strauss syndrome: a new endotype of severe asthma? Results of 14 Turkish patients.

PubMed

Yılmaz, İnsu; Çelik, Gülfem; Aydın, Ömür; Özdemir, Seçil Kepil; Soyyiğit, Şadan; Sözener, Zeynep; Özgüçlü, Selcan; Atasoy, Çetin; Düzgün, Nurşen; Mungan, Dilşad; Sin, Betül; Demirel, Yavuz Selim; Mısırlıgil, Zeynep

2015-07-01

Churg-Strauss syndrome (CSS) is a rare multisystem vasculitis. Considering the variation of autoimmune diseases in different races, it is of interest to determine whether any outstanding features exist for Turkish patients with CSS. The aim of this study was to evaluate the clinical and serological features of the disease, the treatment, and long-term follow-up details, and to investigate possible etiological factors of Turkish CSS patients. The study included 14 patients who were diagnosed with CSS, and followed by our department between 2004 and 2012. Possible etiological factors, initial symptoms, clinical presentations, treatment, as well as outcomes were documented. The study was approved by the local ethics. All patients fulfilled the American College of Rheumatology criteria. Initial symptoms were worsening asthma (n = 14; 100%) and skin lesions (n = 6; 43%). All patients had a diagnosis of asthma and nasal polyps, whereas 57.1% had aspirin hypersensitivity at the time of diagnosis. The lungs (100%) and skin (43%) were most commonly involved. Peripheral eosinophilia dominated on initial presentations of all patients. Initial treatments included oral methyl prednisolone in all cases, whereas cyclophosphamide and azathioprine were used in three cases. Relapses were detected in five cases. None of the cases were able to stop the oral corticosteroid treatment. No fatalities were observed. We herein describe a new severe asthma endotype in connection with CSS. We suggest that physicians who deal with uncontrolled severe asthma cases should consider CSS in the presence of nasal polyps, aspirin hypersensitivity, and especially peripheral blood eosinophilia over 10%. © 2014 John Wiley & Sons Ltd.

Planet signatures and Size Segregation in Debris Discs

NASA Astrophysics Data System (ADS)

Thébault, Philippe

2014-01-01

The response of a debris disc to a planetary perturber is the result of the complex interplay between gravitational effects, grain collisions and stellar radiation pressure (Stark & Kuchner (2009). We investigate to what extent this response can depart from the pure gravitational case when including grain collisional production and radiation pressure. We use the DyCoSS code (Thébault (2012), designed to study the coupled effect of collisions and dynamics for systems at steady state with one perturbing body. We focus on two outcomes: the 2D surface density profile of the disc+planet system, and the way the Particle Size Distribution (PSD) is spatially segregated within the disc. We consider two set-ups: 1) a narrow ring with an exterior ``shepherding'' planet, and 2) an extended disc in which a planet is embedded. For each case, the planet mass and orbit are explored as free parameters, and an unperturbed ``no-planet'' case is also considered. Another parameter is the disc's collisional activity, as parameterized by its optical depth τ.

On the estimation of the domain of attraction for discrete-time switched and hybrid nonlinear systems

NASA Astrophysics Data System (ADS)

Kit Luk, Chuen; Chesi, Graziano

2015-11-01

This paper addresses the estimation of the domain of attraction for discrete-time nonlinear systems where the vector field is subject to changes. First, the paper considers the case of switched systems, where the vector field is allowed to arbitrarily switch among the elements of a finite family. Second, the paper considers the case of hybrid systems, where the state space is partitioned into several regions described by polynomial inequalities, and the vector field is defined on each region independently from the other ones. In both cases, the problem consists of computing the largest sublevel set of a Lyapunov function included in the domain of attraction. An approach is proposed for solving this problem based on convex programming, which provides a guaranteed inner estimate of the sought sublevel set. The conservatism of the provided estimate can be decreased by increasing the size of the optimisation problem. Some numerical examples illustrate the proposed approach.

Exact solutions for an oscillator with anti-symmetric quadratic nonlinearity

NASA Astrophysics Data System (ADS)

Beléndez, A.; Martínez, F. J.; Beléndez, T.; Pascual, C.; Alvarez, M. L.; Gimeno, E.; Arribas, E.

2018-04-01

Closed-form exact solutions for an oscillator with anti-symmetric quadratic nonlinearity are derived from the first integral of the nonlinear differential equation governing the behaviour of this oscillator. The mathematical model is an ordinary second order differential equation in which the sign of the quadratic nonlinear term changes. Two parameters characterize this oscillator: the coefficient of the linear term and the coefficient of the quadratic term. Not only the common case in which both coefficients are positive but also all possible combinations of positive and negative signs of these coefficients which provide periodic motions are considered, giving rise to four different cases. Three different periods and solutions are obtained, since the same result is valid in two of these cases. An interesting feature is that oscillatory motions whose equilibrium points are not at x = 0 are also considered. The periods are given in terms of an incomplete or complete elliptic integral of the first kind, and the exact solutions are expressed as functions including Jacobi elliptic cosine or sine functions.

Testing the EKC hypothesis by considering trade openness, urbanization, and financial development: the case of Turkey.

PubMed

Ozatac, Nesrin; Gokmenoglu, Korhan K; Taspinar, Nigar

2017-07-01

This study investigates the environmental Kuznets curve (EKC) hypothesis for the case of Turkey from 1960 to 2013 by considering energy consumption, trade, urbanization, and financial development variables. Although previous literature examines various aspects of the EKC hypothesis for the case of Turkey, our model augments the basic model with several covariates to develop a better understanding of the relationship among the variables and to refrain from omitted variable bias. The results of the bounds test and the error correction model under autoregressive distributed lag mechanism suggest long-run relationships among the variables as well as proof of the EKC and the scale effect in Turkey. A conditional Granger causality test reveals that there are causal relationships among the variables. Our findings can have policy implications including the imposition of a "polluter pays" mechanism, such as the implementation of a carbon tax for pollution trading, to raise the urban population's awareness about the importance of adopting renewable energy and to support clean, environmentally friendly technology.

Diarrhea in the International Traveler.

PubMed

Duchini; Rodgers

1999-06-01

International travelers to developing countries have a 40% risk of developing a diarrheal illness, usually acute and occasionally chronic. Preventive measures, including diet and lifestyle modifications, are highly recommended but may not be sufficient. Prophylaxis with bismuth subsalicylate or an antimicrobial should be considered in travelers with immunodeficiencies, co-morbid conditions, achlorhydria, or those who cannot afford a loss of time. Oral rehydration is the primary goal of therapy. Bismuth-subsalicylate is a first-line agent for treatment of milder cases with less than three watery bowel movements per day and prominent nausea. Use of an antibiotic is indicated for more severe cases or in the presence of fever, dysentery, or severe dehydration. A short course of a quinolone is highly effective, safe and well tolerated. Antimicrobial resistance among enteropathogens is growing and appropriate therapeutic modifications should be considered according to specific geographic areas. Metronidazole may be empirically added in those cases that do not respond to quinolones. Specific guidelines for particular pathogens are highlighted.

Definitive treatment of androgen receptor-positive salivary duct carcinoma with androgen deprivation therapy and external beam radiotherapy.

PubMed

Soper, Margaret S; Iganej, Shawn; Thompson, Lester D R

2014-01-01

Salivary duct carcinoma (SDC) is an aggressive malignancy with high recurrence rates. Standard management includes surgical resection followed by adjuvant radiation. Androgen receptor positivity has been described to be present in 40% to 90% of SDCs, and a recent case series showed a benefit to androgen deprivation therapy (ADT) in recurrent or metastatic disease. We present the case of an 87-year-old woman with a locally advanced androgen receptor-positive parotid SDC treated definitively with ADT and external beam radiotherapy, a regimen modeled after the treatment of prostate cancer. She had a complete response on positron emission tomography (PET)/CT scan and had no evidence of disease 24 months after the completion of treatment. To our knowledge, this case report is the first to describe the use of ADT plus radiation to definitively treat SDC. This regimen could be considered in patients with androgen receptor-positive SDCs who are considered unresectable or who refuse surgery. Copyright © 2013 Wiley Periodicals, Inc.

Histological Changes in Autoimmune Hepatitis with Graves' Disease: A Child Case Report.

PubMed

Yamada, Mamiko; Shibata, Hironori; Masugi, Yohei; Ishi, Tomohiro; Kameyama, Kaori; Ebinuma, Hirotoshi; Hasegawa, Tomonobu

2017-08-15

We herein report a child case of autoimmune hepatitis (AIH) accompanied with Graves' disease. Elevated aminotransferase levels were found in a 12-year-old Japanese girl with Graves' disease. In her first liver biopsy, necrosis and inflammation was limited to the centrilobular area, while the second biopsy showed different findings. Namely, portal injury newly appeared, including interface hepatitis, which represents the histological characteristics of AIH. As the histological findings at the onset of AIH do not always show typical findings, a re-biopsy is considered to be important in individuals suspected to have AIH. AIH should be included in the differential diagnosis of liver dysfunction in Graves' disease, even in children.

Substructure procedure for including tile flexibility in stress analysis of shuttle thermal protection system

NASA Technical Reports Server (NTRS)

Giles, G. L.

1980-01-01

A substructure procedure to include the flexibility of the tile in the stress analysis of the shuttle thermal protection system (TPS) is described. In this procedure, the TPS is divided into substructures of (1) the tile which is modeled by linear finite elements and (2) the SIP which is modeled as a nonlinear continuum. This procedure was applied for loading cases of uniform pressure, uniform moment, and an aerodynamic shock on various tile thicknesses. The ratios of through-the-thickness stresses in the SIP which were calculated using a flexible tile compared to using a rigid tile were found to be less than 1.05 for the cases considered.

New generation tissue sealants and hemostatic agents: innovative urologic applications.

PubMed

Traver, Michael A; Assimos, Dean G

2006-01-01

Control of blood loss during urologic surgery is paramount to the success of patient recovery. Hemostatic agents and tissue sealants are used routinely to prevent excess blood loss and in reconstruction during surgical repair. Some of the available products include thrombin sealant, fibrin glue, bovine serum/albumin/glutaraldehyde, and gelatin matrix. Each of these agents differs in mechanism, cost, and application. Complications can include allergic reactions or thromboembolism and the risk of contracting bovine spongiform encephalitis or hepatitis. Many new hemostatic agents are being developed and approved. The benefits and risks of use of these agents versus conventional treatment need to be considered on a case-by-case basis by the surgeon.

An update on the causes, assessment and management of third division sensory trigeminal neuropathies.

PubMed

Carter, E; Yilmaz, Z; Devine, M; Renton, T

2016-06-24

Introduction Sensory neuropathies of the mandibular division of the trigeminal (V3) nerve can be debilitating, causing difficulty with daily function. It has a variety of causes, including iatrogenic injury, usually caused by third molar removal, local anaesthetic administration, implant placement or endodontic treatment. Non-iatrogenic causes include infection, primary or secondary neoplasia and various medical conditions.Objective To review the aetiology, evaluation and management of V3 neuropathy in a retrospective case-series of patients referred to a specialist nerve injury clinic over an eight-year period, particularly focusing on the non-iatrogenic causes of this presentation.Methods A retrospective analysis of the case notes of 372 patients referred to the specialist nerve injury clinic between 2006 and 2014 was carried out to establish the cause of the neuropathy and subsequent management or referral. The assessment protocol of trigeminal neuropathy used in the clinic is also outlined.Results Most patients (89.5%) presented with neuropathy due to iatrogenic injury. Of the non-iatrogenic causes (10.5%), malignancy accounted for a fifth of presentations, and infection almost two-fifths, demonstrating the importance of prompt identification of a cause and management by the clinician, or referral to the appropriate specialty. Other, more rare causes are also presented, including multiple sclerosis, sickle-cell anaemia and Paget's disease, highlighting the importance to the clinician of considering differential diagnoses.Conclusions This case series demonstrates the less frequent, but nevertheless important, non-iatrogenic causes which clinicians should consider when assessing patients with trigeminal neuropathy.

Single-incision laparoscopic cholecystectomy: a cost comparison.

PubMed

Love, Katie M; Durham, Christopher A; Meara, Michael P; Mays, Ashley C; Bower, Curtis E

2011-05-01

Single-incision laparoscopic cholecystectomy (SILC) should not cost more or less than traditional laparoscopic cholecystectomy (LC). Retrospective cost data were collected from the accounting records of a single institution. A direct comparison of LC and SILC was conducted. Data on the SILC cases converted to LC were included. The total operating room (OR) cost (actual cost to the hospital for equipment, time, and personnel) and the total OR charges (total derived from the OR cost plus a margin to cover overhead costs beyond material costs) were examined. The total hospital charges (OR charges plus hospital charges accrued in the perioperative period) also were included. Descriptive statistics were used to analyze the data, with p values less than 0.05 considered statistically significant. Over a period of 19 months, 116 cases of minimally invasive cholecystectomy were evaluated. Of the 116 patients, 48 underwent LC during the first half of that period, and 68 patients underwent SILC during the second half of that period. Nine of the single-incision procedures were converted to traditional LC, for a 13% conversion rate. The groups were well matched from a demographics standpoint, with no significant differences in age, gender, body mass index (BMI), diagnoses, American Society of Anesthesiology (ASA) class, or payment. Comparison of all attempted SILCs, including those converted, with all LCs showed no significant difference in cost category totals. A significant difference among all cost variables was found when SILCs were compared with SILCs that required conversion to LC. A significant difference among the cost variables also was found when LCs were compared with converted SILCs. The cost for SILC did not differ significantly from that for LC when standard materials were used and the duration of the procedure was considered. Converted cases were significantly more expensive than completed SILC and LC cases.

Admixture mapping of pelvic organ prolapse in African Americans from the Women’s Health Initiative Hormone Therapy trial

PubMed Central

Hartmann, Katherine E.; Aldrich, Melinda C.; Ward, Renee M.; Wu, Jennifer M.; Park, Amy J.; Graff, Mariaelisa; Qi, Lihong; Nassir, Rami; Wallace, Robert B.; O'Sullivan, Mary J.; North, Kari E.; Velez Edwards, Digna R.; Edwards, Todd L.

2017-01-01

Evidence suggests European American (EA) women have two- to five-fold increased odds of having pelvic organ prolapse (POP) when compared with African American (AA) women. However, the role of genetic ancestry in relation to POP risk is not clear. Here we evaluate the association between genetic ancestry and POP in AA women from the Women’s Health Initiative Hormone Therapy trial. Women with grade 1 or higher classification, and grade 2 or higher classification for uterine prolapse, cystocele or rectocele at baseline or during follow-up were considered to have any POP (N = 805) and moderate/severe POP (N = 156), respectively. Women with at least two pelvic exams with no indication for POP served as controls (N = 344). We performed case-only, and case-control admixture-mapping analyses using multiple logistic regression while adjusting for age, BMI, parity and global ancestry. We evaluated the association between global ancestry and POP using multiple logistic regression. European ancestry at the individual level was not associated with POP risk. Case-only and case-control local ancestry analyses identified two ancestry-specific loci that may be associated with POP. One locus (Chromosome 15q26.2) achieved empirically-estimated statistical significance and was associated with decreased POP odds (considering grade ≥2 POP) with each unit increase in European ancestry (OR: 0.35; 95% CI: 0.30, 0.57; p-value = 1.48x10-5). This region includes RGMA, a potent regulator of the BMP family of genes. The second locus (Chromosome 1q42.1-q42.3) was associated with increased POP odds with each unit increase in European ancestry (Odds ratio [OR]: 1.69; 95% confidence interval [CI]: 1.28, 2.22; p-value = 1.93x10-4). Although this region did not reach statistical significance after considering multiple comparisons, it includes potentially relevant genes including TBCE, and ACTA1. Unique non-overlapping European and African ancestry-specific susceptibility loci may be associated with increased POP risk. PMID:28582460

Delayed-onset post-traumatic headache after a motor vehicle collision: a case report

PubMed Central

Stupar, Maja; Kim, Peter SY

2007-01-01

Introduction Headaches are common after a motor vehicle accident (MVA). Post-traumatic headaches share many clinical symptoms including the clinical course of primary headaches. Secondary headaches (including those resulting from a subdural hematoma) are not as common, but should be considered in cases of post-traumatic events particularly if clinical symptoms progress. Clinical Features A case of a patient with a post-traumatic subdural hematoma demonstrates the importance of carefully examining, properly diagnosing and managing patients that experience headaches after MVAs. This patient presented with uncomplicated low back pain, neck pain and headache which progressed at one month to include focal neurological deficits. Since clinical examination alone may not be sufficient to diagnose secondary headaches, immediate referral to the emergency department may be required. Conclusion Primary contact practitioners should be aware of the various causes of headaches that result after a MVA. Headaches, which do not respond or progress, should be followed aggressively to determine their source. PMID:17657301

Development of a framework for the assessment of capacity and throughput technologies within the National Airspace System

NASA Astrophysics Data System (ADS)

Garcia, Elena

The demand for air travel is expanding beyond the capacity of the existing National Airspace System. Excess traffic results in delays and compromised safety. Thus, a number of initiatives to improve airspace capacity have been proposed. To assess the impact of these technologies on air traffic one must move beyond the vehicle to a system-of-systems point of view. This top-level perspective must include consideration of the aircraft, airports, air traffic control and airlines that make up the airspace system. In addition to these components and their interactions economics, safety and government regulations must also be considered. Furthermore, the air transportation system is inherently variable with changes in everything from fuel prices to the weather. The development of a modeling environment that enables a comprehensive probabilistic evaluation of technological impacts was the subject of this thesis. The final modeling environment developed used economics as the thread to tie the airspace components together. Airport capacities and delays were calculated explicitly with due consideration to the impacts of air traffic control. The delay costs were then calculated for an entire fleet, and an airline economic analysis, considering the impact of these costs, was carried out. Airline return on investment was considered the metric of choice since it brings together all costs and revenues, including the cost of delays, landing fees for airport use and aircraft financing costs. Safety was found to require a level of detail unsuitable for a system-of-systems approach and was relegated to future airspace studies. Environmental concerns were considered to be incorporated into airport regulations and procedures and were not explicitly modeled. A deterministic case study was developed to test this modeling environment. The Atlanta airport operations for the year 2000 were used for validation purposes. A 2005 baseline was used as a basis for comparing the four technologies considered: a very large aircraft, Terminal Area Productivity air traffic control technologies, smoothing of an airline schedule, and the addition of a runway. A case including all four technologies simultaneously was also considered. Unfortunately, the complexity of the system prevented full exploration of the probabilistic aspects of the National Airspace System.

[Occupational toxic exposure and the pregnant woman. 2: results of a prospective study of 100 pregnancies].

PubMed

Testud, F; Lambert-Chhum, R; Bellemin, B; Descotes, J

2001-12-01

Many women of childbearing age are occupationally exposed to chemicals and concerned with the ensuing risk when pregnant. To present the results of a prospective follow-up study of 100 pregnant women and to discuss them after a brief overview of the published data on this topic. Since January 1996 the Lyon Poison Center has been conducting a prospective follow-up of all request concerning pregnant women occupationally exposed to chemicals. A thorough evaluation of the hazards of the handled products and of the actual exposure at the workplace is done for each patient. A toxicological advice is given and the outcome of the pregnancy is followed-up. One hundred pregnant women were included between January 1996 and December 2000. Based on the nature of the handled products, two groups have been identified: the first included 73 women exposed to organic solvents and the second 27 women exposed to miscellaneous. When the exposure was considered potentially hazardous for the pregnancy, either withdrawal from the workstation (19 cases), avoidance of certain activities (9 cases) or improvement of individual protective measures (29 cases) was recommended. In 43% of the cases, the occupational exposure was not considered hazardous to the outcome of the pregnancy. No increase of adverse outcome was identified: 4 miscarriages and 96 living births were observed, with 2 major malformations and 1 minor malformation. Occupational exposure to chemicals was not found to affect adversely the outcome of these 100 pregnancies.

Review of hepatitis B surveillance in China: improving information to frame future directions in prevention and control.

PubMed

Cui, Fuqiang; Drobeniuc, Jan; Hadler, Stephen C; Hutin, Yvan J; Ma, Fubao; Wiersma, Steve; Wang, Fuzhen; Wu, Jiang; Zheng, Hui; Zhou, Liwei; Zuo, Shuyan

2013-12-27

As the WHO verified that China reached the target of 1% prevalence of chronic hepatitis B infection among children targeted by universal hepatitis B immunization of newborns, the country considered new options for hepatitis B prevention and control. We reviewed hepatitis B surveillance in the broader context of viral hepatitis surveillance to propose recommendations to improve the system. We described surveillance for viral hepatitis in China with a specific focus on hepatitis B. We assessed critical attributes of the system, including data quality, predictive positive value and usefulness. While remarkable progress in hepatitis B immunization of infants and children has likely almost eliminated transmission in younger age groups, reported rates of hepatitis B increased steadily in China between 1990 and 2008, probably because of a failure to distinguish acute from chronic infections. Elements that prevented a clearer separation between acute and chronic cases included (1) missed opportunity to report cases accurately among clinicians, (2) low availability and use of tests to detect IgM against the hepatitis B core antigen (IgM anti-HBc) and (3) lack of systems to sort, manage and analyze surveillance data. To improve hepatitis B surveillance, China may consider (1) training clinicians to diagnose acute cases and to use IgM anti-HBc to confirm them, (2) improving access and use of validated IgM anti-HBc tests and (3) developing data management and analysis techniques that sort out acute from chronic cases. Copyright © 2013 Elsevier Ltd. All rights reserved.

[Criminal claims about medical professional liability in the Instituto de Medicina Legal of Lima, Peru].

PubMed

Navarro-Sandoval, Cleyber; Arones-Guevara, Shermany; Carrera-Palao, Rosa; Casana-Jara, Kelly; Colque-Jaliri, Tomasa

2013-07-01

To determine the characteristics of the criminal complaints claining medical professional liability, based on the expert reports issued by the Forensic Examination Division of Lima, Peru. A cross-sectional study was carried out, which included all the expert reports issued between 2005 and 2010 at the Forensic Examination Division of Lima, Peru. A descriptive analysis of each of the variables was performed. 60.3% (495/821) of the criminal complaints for medical professional liability were valued as being in accordance with the lex artis while 16.8% (138/821) were not in accordance with the lex artis. In 13% (107/821) of the cases, conclusions could not be drawn;in 9.9% (81/821) of the cases, the conclusions in the expert report did not include an valuations of the medical act.The cases in which the injury was attributed to the process of the disease itself accounted for 80.9% (502/620), and those in which in the injury was considered a result of the health care received were 19.0% (118/620). The distribution of the cause of the injury based on accordance with the lex artis showed significant differences. In our country, the number of claims for claimed medical liability is increasing, predominantly in relation to surgical specialties, where a medical act is more likely to be considered not in accordance with the lex artis. In addition, in a significant percentage of cases, no conclusions are drawn about the medical act.

ON THE DYNAMICAL DERIVATION OF EQUILIBRIUM STATISTICAL MECHANICS

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

Prigogine, I.; Balescu, R.; Henin, F.

1960-12-01

Work on nonequilibrium statistical mechanics, which allows an extension of the kinetic proof to all results of equilibrium statistical mechanics involving a finite number of degrees of freedom, is summarized. As an introduction to the general N-body problem, the scattering theory in classical mechanics is considered. The general N-body problem is considered for the case of classical mechanics, quantum mechanics with Boltzmann statistics, and quantum mechanics including quantum statistics. Six basic diagrams, which describe the elementary processes of the dynamics of correlations, were obtained. (M.C.G.)

Government Ownership Restrictions and Efficiency: The Case of the FCC's Dupoply Rule.

ERIC Educational Resources Information Center

Anderson, Keith B.; Woodbury, John R.

Recently the Federal Communications Commission (FCC) has been considering modifications to its regulations governing local and national media ownership and has indicated more interest in the efficiency consequences of the regulations, including those that might arise from common ownership of multiple radio stations. This paper seeks to determine…

Developing Partnerships to Create Electronic Reserves at the University of Kansas Libraries

ERIC Educational Resources Information Center

Burich, Nancy J.; Rholes, Julia

2003-01-01

Today, it is advantageous for academic libraries to look outside their own organizations to other potential campus and commercial partners when considering new services. This case study describes the planning and implementation of electronic reserves at the University of Kansas Libraries, including the integration of two commercial partners,…

Block Scheduling: Restructuring the School Day. Hot Topics Series.

ERIC Educational Resources Information Center

Flinders, David J., Ed.

The advantages and disadvantages of block scheduling are considered in 24 articles. The editors provide an overview for each section and a conclusion for the anthology. The first section includes articles which examine issues, concepts, and cases: (1) "All around the Block" (Michael D. Rettig and Robert Lynn Canady); (2) "Block Scheduling: A Means…

Filtering the Net in Libraries: The Case (Mostly) in Favor.

ERIC Educational Resources Information Center

Banks, Michael A.

1998-01-01

Examines issues and decision-making involved in restricting Internet access in libraries, for the most part favoring filtering devices. Questions to consider when selecting a filtering program are provided. Some of the better filtering programs are described, and Web addresses are included for each. Security risks associated with Java and…

Perspectives on the Integration of Technology and Assessment

ERIC Educational Resources Information Center

Pellegrino, James W.; Quellmalz, Edys S.

2011-01-01

This paper considers uses of technology in educational assessment from the perspective of innovation and support for teaching and learning. It examines assessment cases drawn from contexts that include large-scale testing programs as well as classroom-based programs, and attempts that have been made to harness the power of technology to provide…

32 CFR 199.8 - Double coverage.

Code of Federal Regulations, 2012 CFR

2012-07-01

..., except in the case of a plan administered under title XIX of the Social Security Act (42 U.S.C. 1396 et... not include: (i) Plans administered under title XIX of the Social Security Act (Medicaid); (ii... under Title XIX of the Social Security Act (Medicaid) are never considered to be available in the...

IAQ Tools for Schools Awards, 2000-2002.

ERIC Educational Resources Information Center

Environmental Protection Agency, Washington, DC.

This document provides descriptions of the 2000, 2001, and 2002 winners of the Environmental Protection Agency's Indoor Air Quality Tools for Schools Excellence Awards. The winners are considered to be national leaders in improving indoor air quality in schools. Also included are case studies for selected 2000 winners and a press release for the…

On the importance of considering disease subtypes: Earliest detection of a parosteal osteosarcoma? Differential diagnosis of an osteosarcoma in an Anglo-Saxon female.

PubMed

Ferrante di Ruffano, Lavinia; Waldron, Tony

2016-12-30

A case of potentially dedifferentiated parosteal osteosarcoma was found in the proximal humerus of an adult female buried in the late Anglo-Saxon cemetery of Cherry Hinton, Cambridgeshire, UK. Key features include a large, dense, lobulated mass attached to the medial metaphysis of the proximal humerus by a broad-based attachment, accompanied by cortical destruction and widespread spiculated periosteal reaction. Radiographic images confirm medullary involvement, lack of continuity between the cortex and external mass, a radiolucent cleavage plane and possible radiolucent zones within the bony masses. Differential diagnoses considered include osteochondroma, myositis ossificans, fracture callus, as well as the primary malignancies of osteosarcoma and chondrosarcoma, and their various subtypes. The macroscopic and radiographic analysis of the tumor is described and discussed within clinical and paleopathological contexts. One of only 19 uncontested examples of osteosarcoma from past human populations, most of which remain unconfirmed, this case represents what we believe to be the earliest, and probably singular, bioarcheological example of parosteal osteosarcoma in human history. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

Combinations of SNP genotypes from the Wellcome Trust Case Control Study of bipolar patients.

PubMed

Mellerup, Erling; Jørgensen, Martin Balslev; Dam, Henrik; Møller, Gert Lykke

2018-04-01

Combinations of genetic variants are the basis for polygenic disorders. We examined combinations of SNP genotypes taken from the 446 729 SNPs in The Wellcome Trust Case Control Study of bipolar patients. Parallel computing by graphics processing units, cloud computing, and data mining tools were used to scan The Wellcome Trust data set for combinations. Two clusters of combinations were significantly associated with bipolar disorder. One cluster contained 68 combinations, each of which included five SNP genotypes. Of the 1998 patients, 305 had combinations from this cluster in their genome, but none of the 1500 controls had any of these combinations in their genome. The other cluster contained six combinations, each of which included five SNP genotypes. Of the 1998 patients, 515 had combinations from the cluster in their genome, but none of the 1500 controls had any of these combinations in their genome. Clusters of combinations of genetic variants can be considered general risk factors for polygenic disorders, whereas accumulation of combinations from the clusters in the genome of a patient can be considered a personal risk factor.

The Melatonin Receptor Agonist Ramelteon Effectively Treats Insomnia and Behavioral Symptoms in Autistic Disorder

PubMed Central

Oka, Yasunori

2014-01-01

Children with autism spectrum disorders (ASD), including autistic disorder, frequently suffer from comorbid sleep problems. An altered melatonin rhythm is considered to underlie the impairment in sleep onset and maintenance in ASD. We report three cases with autistic disorder in whom nocturnal symptoms improved with ramelteon, a selective melatonin receptor agonist. Insomnia and behavior, assessed using the Clinical Global Impression-Improvement Scale, improved in two cases with 2 mg ramelteon and in the third case with 8 mg ramelteon. Our findings demonstrate that ramelteon is effective not only for insomnia, but for behavioral problems as well, in patients with autistic disorder. PMID:24955274

The melatonin receptor agonist ramelteon effectively treats insomnia and behavioral symptoms in autistic disorder.

PubMed

Kawabe, Kentaro; Horiuchi, Fumie; Oka, Yasunori; Ueno, Shu-Ichi

2014-01-01

Children with autism spectrum disorders (ASD), including autistic disorder, frequently suffer from comorbid sleep problems. An altered melatonin rhythm is considered to underlie the impairment in sleep onset and maintenance in ASD. We report three cases with autistic disorder in whom nocturnal symptoms improved with ramelteon, a selective melatonin receptor agonist. Insomnia and behavior, assessed using the Clinical Global Impression-Improvement Scale, improved in two cases with 2 mg ramelteon and in the third case with 8 mg ramelteon. Our findings demonstrate that ramelteon is effective not only for insomnia, but for behavioral problems as well, in patients with autistic disorder.

Technical assistance for law-enforcement communications: Case study report two

NASA Technical Reports Server (NTRS)

Reilly, N. B.; Mustain, J. A.

1979-01-01

Two case histories are presented. In one study the feasibility of consolidating dispatch center operations for small agencies is considered. System load measurements were taken and queueing analysis applied to determine numbers of personnel required for each separate agency and for a consolidated dispatch center. Functional requirements were developed and a cost model was designed to compare relative costs of various alternatives including continuation of the present system, consolidation of a manual system, and consolidated computer-aided dispatching. The second case history deals with the consideration of a multi-regional, intrastate radio frequency for improved interregional communications. Sample standards and specifications for radio equipment are provided.

Elective tracheostomy in intensive care unit: Looking between techniques, a three cases report

PubMed Central

Ferraro, Fausto; Marullo, Lucia; d’Elia, Anna; Izzo, Giuseppe

2014-01-01

There is no optimal tracheostomy (TS) technique, proved to be the best. For this reason, operators’ skills, clinical anatomical and physio-pathological features of the patient should be considered as discriminating factors in the choice of percutaneous dilation tracheostomy (PDT) technique. This article includes reports of three cases of PDT: In the first case distance between jugular notch and the first tracheal ring was too long, the second case involving a patient with mild ectasia of the ascending aorta and aortic regurgitation with De Musset's sign with great risk of perioperative bleeding and a third case, of tracheomalacia with inflammatory stenosis at the 4th tracheal ring. All together, this case series describes how decisions were made by an experienced staff, in which the patient characteristics were assessed and techniques best suited for each case were implemented. PMID:24963186

Hunting for tularaemia - a review of cases in North Carolina.

PubMed

Rimawi, R H; Shah, K B; Chowdhary, R A; Cook, P P

2015-05-01

Human infections with Francisella tularensis can be acquired via numerous routes, including ingestion, inhalation, arthropod bite or direct contact with infected animals. Since 1991, there have been 25 reported cases of tularaemia in North Carolina, most of which were associated with rabbit hunting or cat bites. We present two adults cases of pulmonary and oropharyngeal tularaemia and review the reported cases since 1991-2013. We also present the fifth case of pulmonary empyema. While cavitary pneumonias are primarily treated with drainage, we illustrate a case of cavitary pneumonia associated with tularaemia successfully treated with oral ciprofloxacin after drainage. Tularaemia should be considered in patients with a perplexing radiographic image, animal exposure and lack of response to conventional empiric broad-spectrum antibiotics. Even in serious cases of pneumonic tularaemia, fluoroquinolones may provide a suitable alternative to aminoglycosides. © 2014 Blackwell Verlag GmbH.

Solwnd: A 3D Compressible MHD Code for Solar Wind Studies. Version 1.0: Cartesian Coordinates

NASA Technical Reports Server (NTRS)

Deane, Anil E.

1996-01-01

Solwnd 1.0 is a three-dimensional compressible MHD code written in Fortran for studying the solar wind. Time-dependent boundary conditions are available. The computational algorithm is based on Flux Corrected Transport and the code is based on the existing code of Zalesak and Spicer. The flow considered is that of shear flow with incoming flow that perturbs this base flow. Several test cases corresponding to pressure balanced magnetic structures with velocity shear flow and various inflows including Alfven waves are presented. Version 1.0 of solwnd considers a rectangular Cartesian geometry. Future versions of solwnd will consider a spherical geometry. Some discussions of this issue is presented.

Central nervous system infection by Listeria monocytogenes in patients with systemic lupus erythematosus: analysis of 26 cases, including the report of a new case.

PubMed

Horta-Baas, Gabriel; Guerrero-Soto, Omar; Barile-Fabris, Leonor

2013-01-01

Infections in patients with systemic lupus erythematosus cause significant morbidity. Infection due to Listeria monocytogenes (LM) is considered an opportunistic disease, and has been published on rare occasions in patients with SLE. To review the presentation of listeria infections in the central nervous system (CNS) in SLE patients. We conducted a literature review, selecting cases with central nervous system infection and confirmation of LM infection through culture. Twenty six cases are described. The most common presentation was meningitis, with meningoencephalitis and brain abscesses being less frequent. The predisposing factors are: use of glucocorticoids, immunosuppressants, renal replacement therapy and the activity flares. CNS infection by listeria is rare and sometimes fatal. The atypical presentation may lead to a delay in diagnosis and appropriate treatment. L. monocytogenes should be included in the differential diagnosis of patients with SLE with neurological manifestations. Copyright © 2013 Elsevier España, S.L. All rights reserved.

[Imported tropical fish causes ciguatera fish poisoning in Germany].

PubMed

Zimmermann, Katharina; Eisenblätter, Anneka; Vetter, Irina; Ebbecke, Martin; Friedemann, Miriam; Desel, Herbert

2015-01-01

Ciguatera is a seafood-borne illness caused by consumption of tropical fish contaminated with ciguatoxins, lipophilic polyethers that are produced in benthic dinoflagellates and accumulate through the marine food chain. Ciguatera cases in Europe usually occur in travellers returning from tropical and subtropical regions of the Pacific and Carribean, where ciguatera is endemic. In 2012, several cases of ciguatera occurred in Germany due to sale of contaminated fish products originating from the Indian Ocean. Although the symptomatology in these cases were typical of ciguatera, with patients reporting gastrointestinal discomfort including nausea, vomiting and diarrhea as well as neurological effects including widespread intense pruritus, paresthesias, hypothermia or altered temperature sensation and diffuse pain, correct diagnosis was delayed in all cases due to lack of awareness of the treating medical practitioners. In light of increasing global mobility, trade, and occurrence of ciguatoxic fish in previously non-endemic areas, ciguatera should be considered as a possible diagnosis if gastrointestinal and neurological symptoms occur shortly after consumption of fish. Georg Thieme Verlag Stuttgart.

Suicide by Fatal Pentobarbital Intoxication in Ontario, Canada, from 2012 to 2015.

PubMed

Solbeck, Patricia; Snowdon, Victoria; Rajagopalan, Ashwyn; Jhirad, Reuven

2018-05-24

A fatal concentration of pentobarbital found in a coroner's case where the history had not indicated use of this drug prompted a review of fatalities in Ontario from 2012 to 2015. Coroner's case files, including police and toxicology reports, were reviewed in twenty deaths, in which pentobarbital was identified as the primary cause of death. In all of the deaths (11 females, 9 males), the blood concentration of pentobarbital was greater than 10 mg/L. There were three to eight deaths per year and each was classified as suicide. In 11 cases, there was clear evidence that the drug was purchased over the internet from Mexico or China and imported into Canada. In four cases, it appears that the pentobarbital was labeled as a different, innocuous chemical to facilitate crossing the border without scrutiny. The findings underscore the value of a thorough scene investigation, including details of evidence that may be considered unrelated. © 2018 American Academy of Forensic Sciences.

A dynamic case definition is warranted for adequate notification in an extended epidemic setting: the Dutch Q fever outbreak 2007-2009 as exemplar.

PubMed

Jaramillo-Gutierrez, G; Wegdam-Blans, M C; ter Schegget, R; Korbeeck, J M; van Aken, R; Bijlmer, H A; Tjhie, J H; Koopmans, M P

2013-10-10

Q fever is a notifiable disease in the Netherlands:laboratories are obliged to notify possible cases to the Municipal Health Services. These services then try to reconfirm cases with additional clinical and epidemiological data and provide anonymised reports to the national case register of notifiable diseases. Since the start of the 2007–2009 Dutch Q fever outbreak,notification rules remained unchanged, despite new laboratory insights and altered epidemiology. In this study, we retrospectively analysed how these changes influenced the proportion of laboratory-defined acute Q fever cases (confirmed, probable and possible)that were included in the national case register, during(2009) and after the outbreak (2010 and 2011).The number of laboratory-defined cases notified to the Municipal Health Services was 377 in 2009, 96 in 2010 and 50 in 2011. Of these, 186 (49.3%) in 2009, 12(12.5%) in 2010 and 9 (18.0%) in 2011 were confirmed as acute infection by laboratory interpretation. The proportion of laboratory-defined acute Q fever cases that was reconfirmed by the Municipal Health Services and that were included in the national case register decreased from 90% in 2009, to 22% and 24% in 2010 and 2011, respectively. The decrease was observed in all categories of cases, including those considered to be confirmed by laboratory criteria. Continued use ofa pre-outbreak case definition led to over-reporting of cases to the Municipal Health Services in the post-epidemic years. Therefore we recommend dynamic laboratory notification rules, by reviewing case definitions periodically in an ongoing epidemic, as in the Dutch Q fever outbreak.

Electronic Characterization of Defects in Narrow Gap Semiconductors-Comparison of Electronic Energy Levels and Formation Energies in Mercury Cadmium Telluride, Mercury Zinc Telluride, and Mercury Zinc Selenide

NASA Technical Reports Server (NTRS)

Patterson, James D.

1996-01-01

We have used a Green's function technique to calculate the energy levels and formation energy of deep defects in the narrow gap semiconductors mercury cadmium telluride (MCT), mercury zinc telluride (MZT) and mercury zinc selenide (MZS). The formation energy is calculated from the difference between the total energy with an impurity cluster and the total energy for the perfect crystal. Substitutional (including antisite), interstitial (self and foreign), and vacancy deep defects are considered. Relaxation effects are calculated (with molecular dynamics). By use of a pseudopotential, we generalize the ideal vacancy model so as to be able to consider relaxation for vacancies. Different charge states are considered and the charged state energy shift (as computed by a modified Haldane-Anderson model) can be twice that due to relaxation. Different charged states for vacancies were not calculated to have much effect on the formation energy. For all cases we find deep defects in the energy gap only for cation site s-like orbitals or anion site p-like orbitals, and for the substitutional case only the latter are appreciably effected by relaxation. For most cases for MCT, MZT, MZS, we consider x (the concentration of Cd or Zn) in the range appropriate for a band gap of 0.1 eV. For defect energy levels, the absolute accuracy of our results is limited, but the precision is good, and hence chemical trends are accurately predicted. For the same reason, defect formation energies are more accurately predicted than energy level position. We attempt, in Appendix B, to calculate vacancy formation energies using relatively simple chemical bonding ideas due to Harrison. However, these results are only marginally accurate for estimating vacancy binding energies. Appendix C lists all written reports and publications produced for the grant. We include abstracts and a complete paper that summarizes our work which is not yet available.

Prevalence of hyponatraemia in patients over the age of 65 who have an in-hospital fall.

PubMed

Lobo-Rodríguez, Carmen; García-Pozo, Ana M; Gadea-Cedenilla, Carmen; Moro-Tejedor, M Nieves; Pedraz Marcos, Azucena; Tejedor-Jorge, Alberto

2016-01-01

Hyponatraemia is the most common electrolyte disorder. Some studies have found that it increases morbidity and mortality. There are new lines of research that are investigating the link between hyponatraemia and patient falls. To determine if hyponatraemia is associated with falls in elderly hospitalised patients. Design observational, analytical, case-control study. Patients older than 65 years who had fallen during their hospitalisation at Gregorio Marañón Hospital (Madrid) were considered cases. Patients who did not fall were considered to be controls, paired according to the following variables: hospital ward, age, length of hospital stay, gender and Downton fall risk index. The sample size was 206 subjects. Socio-demographic factors, variables included in the falls record sheet, Downton fall risk index and sodium levels were studied (hyponatraemia was considered Na(+)< 135mmol/l). A descriptive analysis was performed to determine the sample homogeneity. The OR was calculated, and an analytical analysis using Chi-square test and a multivariate logistic regression analysis were also performed. Of 103 cases recruited, 61 were men (50.4%) and 42 were women (49.4%). Hyponatraemia was detected in 29 cases with an association with falls of P: 0.002. The adjusted OR was 3.708 (1.6-8.3), 95% CI. Risk factors for falls were identified as hyponatraemia and limb sensory deficits. Given that hyponatraemia could be considered a risk factor for falls, the inclusion of the determination of sodium level would be important for fall prevention strategies in the elderly. Copyright © 2016 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

[Feasibility of implementing a learning based problem solving and peer evaluation approach among medical students in Mexico].

PubMed

Amato, Dante; de Jesús Novales-Castro, Xavier

2009-01-01

Assess the degree to which medical students accept and consider useful the techniques of problem based learning (PBL) and evaluation among peers. Analyze the association between the number of PBL clinical cases reviewed and the students' perception about their own learning in a basic course. A questionnaire was administered to 334 students enrolled in the third semester of medical school (Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México). Questions included acceptability of PBL, peer evaluation, and their perception about the usefulness of these techniques after having used them during the school year. We used a Likert scale to measure opinions on the degree of usefulness of the PBL, perception of their own learning, and the acceptance of the notion that evaluation activities evaluation among peers promote justice and favor the student's character formation. We measured the association of these variables with the number of clinical cases studied using Spearman's rank correlation coefficient. Most of the students considered that PBL method is useful (82%) and that evaluation activities among peers promote justice and character formation (70%). Students who reviewed more PBL cases considered the PBL activities more useful (rho = 0.489, p < 0.0001), and perceived that they achieved a better learning experience (rho = 0.200, p < 0.0001). Results show a fair acceptance by the students of the PBL method and activities of peer evaluation. The number of clinical cases reviewed during the course correlated with considering the PBL to be a useful method and perceiving a better learning experience. Our results support the inclusion of PBL and peer evaluation in the medical school curricula.

Endoscopic ultrasound-guided evaluation of the pleura and cases of pleural effusion

PubMed Central

Sharma, Malay; Rameshbabu, Chittapuram Srinivasan

2017-01-01

The most efficient and cost-effective approach for the diagnosis of pleural exudates remains uncertain and is a subject of controversy. Essential factors to be considered include the respective diagnostic yields of thoracocentesis, closed pleural biopsy, and thoracoscopy. The role of endoscopic ultrasound (EUS) of the esophagus as a modality for the evaluation of pleural exudates has not yet been evaluated. The applied anatomy of the pleura has been discussed. The techniques involved in the EUS imaging of different aspects of the pleura in normal cases and in cases with pleural effusion are elaborated. The practical application of this knowledge can be useful in EUS-guided sampling of the pleural wall, pleural nodules, and in cases of pleural effusion. PMID:28869229

Endoscopic ultrasound-guided evaluation of the pleura and cases of pleural effusion.

PubMed

Sharma, Malay; Rameshbabu, Chittapuram Srinivasan

2017-01-01

The most efficient and cost-effective approach for the diagnosis of pleural exudates remains uncertain and is a subject of controversy. Essential factors to be considered include the respective diagnostic yields of thoracocentesis, closed pleural biopsy, and thoracoscopy. The role of endoscopic ultrasound (EUS) of the esophagus as a modality for the evaluation of pleural exudates has not yet been evaluated. The applied anatomy of the pleura has been discussed. The techniques involved in the EUS imaging of different aspects of the pleura in normal cases and in cases with pleural effusion are elaborated. The practical application of this knowledge can be useful in EUS-guided sampling of the pleural wall, pleural nodules, and in cases of pleural effusion.

A case of gabapentin-induced rhabdomyolysis requiring renal replacement therapy.

PubMed

Choi, Min Seok; Jeon, Howook; Kim, Hyo Suk; Jang, Bo Hyun; Lee, Yoon Hee; Park, Hoon Suk; Kim, HyungWook; Jin, Dong Chan

2017-01-01

Gabapentin is commonly used for controlling convulsions, restless pain syndrome, and pain in diabetic neuropathy. Common side effects include dizziness, somnolence, ataxia, peripheral edema, and confusion; gabapentin-induced rhabdomyolysis is rarely reported. To date, the reported cases of gabapentin-induced rhabdomyolysis have been associated with patients with multiple underlying diseases and assuming multiple medicines for various reasons. In this report, we describe a case of gabapentin-induced rhabdomyolysis in a 32-year-old woman with no medical history. We also review related literature and discuss the possible mechanism and the association with other factors. This case shows that gabapentin can induce rhabdomyolysis in healthy patients and that clinicians must consider the possible association between gabapentin and rhabdomyolysis. © 2016 International Society for Hemodialysis.

Stakeholder Perceptions of Cyberbullying Cases: Application of the Uniform Definition of Bullying.

PubMed

Moreno, Megan A; Suthamjariya, Nina; Selkie, Ellen

2018-04-01

The Uniform Definition of Bullying was developed to address bullying and cyberbullying, and to promote consistency in measurement and policy. The purpose of this study was to understand community stakeholder perceptions of typical cyberbullying cases, and to evaluate how these case descriptions align with the Uniform Definition. In this qualitative case analysis we recruited stakeholders commonly involved in cyberbullying. We used purposeful sampling to identify and recruit adolescents and young adults, parents, and professionals representing education and health care. Participants were asked to write a typical case of cyberbullying and descriptors in the context of a group discussion. We applied content analysis to case excerpts using inductive and deductive approaches, and chi-squared tests for mixed methods analyses. A total of 68 participants contributed; participants included 73% adults and 27% adolescents and young adults. A total of 650 excerpts were coded from participants' example cases and 362 (55.6%) were consistent with components of the Uniform Definition. The most frequently mentioned component of the Uniform Definition was Aggressive Behavior (n = 218 excerpts), whereas Repeated was mentioned infrequently (n = 19). Most participants included two to three components of the Uniform Definition within an example case; none of the example cases included all components of the Uniform Definition. We found that most participants described cyberbullying cases using few components of the Uniform Definition. Findings can be applied toward considering refinement of the Uniform Definition to ensure stakeholders find it applicable to cyberbullying. Copyright © 2017 The Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Technology for planning and scheduling under complex constraints

NASA Astrophysics Data System (ADS)

Alguire, Karen M.; Pedro Gomes, Carla O.

1997-02-01

Within the context of law enforcement, several problems fall into the category of planning and scheduling under constraints. Examples include resource and personnel scheduling, and court scheduling. In the case of court scheduling, a schedule must be generated considering available resources, e.g., court rooms and personnel. Additionally, there are constraints on individual court cases, e.g., temporal and spatial, and between different cases, e.g., precedence. Finally, there are overall objectives that the schedule should satisfy such as timely processing of cases and optimal use of court facilities. Manually generating a schedule that satisfies all of the constraints is a very time consuming task. As the number of court cases and constraints increases, this becomes increasingly harder to handle without the assistance of automatic scheduling techniques. This paper describes artificial intelligence (AI) technology that has been used to develop several high performance scheduling applications including a military transportation scheduler, a military in-theater airlift scheduler, and a nuclear power plant outage scheduler. We discuss possible law enforcement applications where we feel the same technology could provide long-term benefits to law enforcement agencies and their operations personnel.

Defining Innovation in Neurosurgery: Results from an International Survey.

PubMed

Zaki, Mark M; Cote, David J; Muskens, Ivo S; Smith, Timothy R; Broekman, Marike L

2018-06-01

Innovation is a part of the daily practice of neurosurgery. However, a clear definition of what constitutes innovation is lacking and opinions vary from continent to continent, from hospital to hospital, and from surgeon to surgeon. In this study, we distributed an online survey to neurosurgeons from multiple countries to investigate what neurosurgeons consider innovative, by gathering opinions on several hypothetical cases. The anonymous survey consisted of 52 questions and took approximately 10 minutes to complete. A total of 355 neurosurgeons across all continents excluding Antarctica completed the survey. Neurosurgeons achieved consensus (>75%) in considering specific cases to be innovative, including laser resection of meningioma, focused ultrasonography for tumor, oncolytic virus, deep brain stimulation for addiction, and photodynamic therapy for tumor. Although the new dura substitute case was not considered innovative, there was consensus among neurosurgeons indicating that institutional review board approval was still necessary to maintain ethical standards. Furthermore, although 90% of neurosurgeons considered an oncolytic virus for glioblastoma multiforme to be innovative, only 78% believed that institutional review board approval was necessary before treatment. Our results indicate that innovation is a heterogeneous concept among neurosurgeons that necessitates standardization to ensure appropriate patient safety without stifling progress. We discuss both the ethical drawbacks of not having a clear definition of innovation and the challenges in achieving a unified understanding of innovation in neurosurgery and offer suggestions for uniting the field. Copyright © 2018 Elsevier Inc. All rights reserved.

Optimization of the treatment with immunosuppressants and biologics in inflammatory bowel disease

PubMed Central

Renna, Sara; Cottone, Mario; Orlando, Ambrogio

2014-01-01

Many placebo controlled trials and meta-analyses evaluated the efficacy of different drugs for the treatment of inflammatory bowel disease (IBD), including immunosuppressants and biologics. Their use is indicated in moderate to severe disease in non responders to corticosteroids and in steroid-dependent patients, as induction and maintainance treatment. Infliximab, as well as cyclosporine, is considered a second line therapy in the case of severe ulcerative colitis, or non-responders to intravenous corticosteroids. An adequate dosage and duration of therapy with thiopurines should be reached before evaluating their efficacy. Methotrexate is a valid option in patients with Crohn’s disease but its use is confined to patients who are intolerant or non-responders to thiopurines. Evidence for the use of methotrexate in ulcerative colitis is insufficient. The use of thalidomide and mycophenolate mofetil is not recommended in patients with inflammatory bowel disease, these treatments could be considered in case of failure of all other therapeutic options. In patients with moderately active ulcerative colitis, refractory to thiopurines, the use of tacrolimus is considered an alternative to biologics. An increase of the dose or a decrease in the interval of administration of biological treatment could be useful in the presence of an incomplete clinical response. In the case of primary failure of an anti-tumor necrosis factor alpha a switch to another one should be considered. Data on the efficacy of combination therapy are up to now insufficient to consider this strategy in all IBD patients. The final outcome of the treatment should be considered the clinical remission, with mucosa healing, and not the clinical response. The evaluation of serum concentration of thiopurine methyl transferase activity, thiopurine metabolites, biologic serum levels and antibiologic antibodies could be useful for the management of the treatment but it has not been routinely applied in clinical practice. The evidence of high risk development of lymphoma and cutaneous malignancies should be considered in patients treated with immunosuppressants and biologics for a long period. PMID:25110407

Are Law and Policy Clear and Consistent? Roles and Responsibilities of the Defense Acquisition Executive and the Chief Information Officer

DTIC Science & Technology

2010-01-01

Not Considered Relevant Two current CIO R&R pertain to Year-2000 ( Y2K ) issues. Although it is likely that the software conversion tasks associated...CIOs with tasks related to Y2K software conversion. 44 USC §3506 does not include the term information technology, but does include the term...information resources, which, in this case appears to include IT but explicitly excludes NSS. The CIO R&R in 44 USC §3603 charges the CIO Council with Y2K

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

Luke Chen; Hsu-Cheng Chang

An air pollutant (CO) distribution in a typical street canyon is simulated to evaluate pedestrian exposure. In this study, we consider factors those may affect the pollutant distribution in a typical street canyon. The considered factors include aspect ratio of a street canyon, atmospheric stability, traffic load and turbulent buoyancy effect. A two-dimensional domain that includes suburban roughness and urban street canyon is considered. The factors such as atmospheric stability, traffic load and turbulent buoyancy are imposed through the associated boundary conditions. With numerical simulation, the critical aspect ration of a street canyon the includes two vortices and results inmore » pollutant accumulation are found. The buoyant effect is found to raise the same pollutant concentration up to the position higher than the results come out from the case without buoyancy. The pedestrian exposure to the street air pollutant under various traffic loads and atmospheric stability are evaluated. This study conclude that the local building regulations that specify the building height/street width ratio will not cause significant pedestrian exposure to the street air pollution in most of traffic loads and atmospheric stability conditions.« less

Cogeneration Technology Alternatives Study (CTAS). Volume 5: Cogeneration systems results

NASA Technical Reports Server (NTRS)

Gerlaugh, H. E.; Hall, E. W.; Brown, D. H.; Priestley, R. R.; Knightly, W. F.

1980-01-01

The use of various advanced energy conversion systems is examined and compared with each other and with current technology systems for savings in fuel energy, costs, and emissions in individual plants and on a national level. About fifty industrial processes from the largest energy consuming sectors were used as a basis for matching a similar number of energy conversion systems that are considered as candidate which can be made available by the 1985 to 2000 time period. The sectors considered included food, textiles, lumber, paper, chemicals, petroleum, glass, and primary metals. The energy conversion systems included steam and gas turbines, diesels, thermionics, stirling, closed cycle and steam injected gas turbines, and fuel cells. Fuels considered were coal, both coal and petroleum based residual and distillate liquid fuels, and low Btu gas obtained through the on site gasification of coal. The methodology and results of matching the cogeneration energy conversion systems to approximately 50 industrial processes are described. Results include fuel energy saved, levelized annual energy cost saved, return on investment, and operational factors relative to the noncogeneration base cases.

Effective environmental factors on geographical distribution of traffic accidents on pedestrians, downtown of Tehran City.

PubMed

Moradi, Ali; Rahmani, Khaled; Kavousi, Amir; Eshghabadi, Farshid; Nematollahi, Shahrzad; Zainni, Slahedyn; Soori, Hamid

2018-02-20

The aim of this study was to geographically analyse the traffic casualties in pedestrians in downtown of Tehran City. Study population consisted of pedestrians who had traffic injury accidents from April 2014 to March 2015 in Tehran City. Data were extracted from the offices of traffic police and municipality. For analysis of environmental factors and site of accidents, Ordinary Least Square (OLS) regression models and Geographically Weighted Regression (GWR) were used. All pedestrian accidents including 514 accidents were assessed in this study in which the site of accidents included arterial streets in 370 (71.9%) cases, collector streets in 133 cases (25.2%) and highways in 11 cases (2.1%). Geographical units of traffic accidents in pedestrians had statistically significant relationship with the number of bus stations, number of crossroads and recreational areas. Neighbourhoods close to markets are considered as the most dangerous places for injury in traffic accidents.

Initial neuro-ophthalmological manifestations in Churg–Strauss syndrome

PubMed Central

Vallet, Anne-Evelyne; Didelot, Adrien; Guebre-Egziabher, Fitsum; Bernard, Martine; Mauguière, François

2010-01-01

Churg–Strauss syndrome (CSS) is a systemic vasculitis with frequent respiratory tract involvement. It can also affect the nervous system, notably the optic tract. The present work reports the case of a 65-year-old man diagnosed as having CSS in the context of several acute onset neurological symptoms including muscle weakness and signs of temporal arteritis, including bilateral anterior ischaemic optic neuropathy (ON). Electroretinograms (ERGs) and visual evoked potentials (VEPs) were performed. Flash ERGs were normal whereas VEPs were highly abnormal, showing a dramatic voltage reduction, thus confirming the ON. The vision outcome was poor. Ophthalmological presentations of CSS have rarely been reported, but no previous case of sudden blindness documented by combined ERG and VEP investigations were found in the literature. The present case strongly suggests that the occurrence of visual loss in the context of systemic inflammation with hypereosinophilia should lead to considering the diagnosis of CSS. PMID:22789694

Canonical multi-valued input Reed-Muller trees and forms

NASA Technical Reports Server (NTRS)

Perkowski, M. A.; Johnson, P. D.

1991-01-01

There is recently an increased interest in logic synthesis using EXOR gates. The paper introduces the fundamental concept of Orthogonal Expansion, which generalizes the ring form of the Shannon expansion to the logic with multiple-valued (mv) inputs. Based on this concept we are able to define a family of canonical tree circuits. Such circuits can be considered for binary and multiple-valued input cases. They can be multi-level (trees and DAG's) or flattened to two-level AND-EXOR circuits. Input decoders similar to those used in Sum of Products (SOP) PLA's are used in realizations of multiple-valued input functions. In the case of the binary logic the family of flattened AND-EXOR circuits includes several forms discussed by Davio and Green. For the case of the logic with multiple-valued inputs, the family of the flattened mv AND-EXOR circuits includes three expansions known from literature and two new expansions.

Percutaneous dilatational tracheostomy following total artificial heart implantation.

PubMed

Spiliopoulos, Sotirios; Dimitriou, Alexandros Merkourios; Serrano, Maria Rosario; Guersoy, Dilek; Autschbach, Ruediger; Goetzenich, Andreas; Koerfer, Reiner; Tenderich, Gero

2015-07-01

Coagulation disorders and an immune-altered state are common among total artificial heart patients. In this context, we sought to evaluate the safety of percutaneous dilatational tracheostomy in cases of prolonged need for mechanical ventilatory support. We retrospectively analysed the charts of 11 total artificial heart patients who received percutaneous dilatational tracheostomy. We focused on early and late complications. We observed no major complications and no procedure-related deaths. Early minor complications included venous oozing (45.4%) and one case of local infection. Late complications, including subglottic stenosis, stomal infection or infections of the lower respiratory tract, were not observed. In conclusion, percutaneous dilatational tracheostomy in total artificial heart patients is safe. Considering the well-known benefits of early tracheotomy over prolonged translaryngeal intubation, we advocate early timing of therapy in cases of prolonged mechanical ventilation. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Effective theory of monolayer TMDC double quantum dots

NASA Astrophysics Data System (ADS)

David, Alessandro; Burkard, Guido; Kormányos, Andor

2018-07-01

Monolayer transition metal dichalcogenides (TMDCs) are promising candidates for quantum technologies, such as spin qubits in quantum dots, because they are truly two-dimensional semiconductors with a direct band gap. In this work, we analyse theoretically the behaviour of a double quantum dot (DQD) system created in the conduction band of these materials, with two electrons in the (1,1) charge configuration. Motivated by recent experimental progress, we consider several scenarios, including different spin–orbit splittings in the two dots and including the case when the valley degeneracy is lifted due to an insulating ferromagnetic substrate. Finally, we discuss in which cases it is possible to reduce the low energy subspace to the lowest Kramers pairs. We find that in this case the low energy model is formally identical to the Heisenberg exchange Hamiltonian, indicating that such Kramers pairs may serve as qubit implementations.

Münchhausen by proxy syndrome in clinical child neuropsychology: a case presenting with neuropsychological symptoms.

PubMed

Heubrock, D

2001-12-01

Münchhausen by proxy syndrome (MBPS) is a rare but dramatic variant of child abuse. In MBPS adults, mostly the mother, invent, manipulate, or produce the child's illness, and as a consequence the child has to undergo numerous diagnostic or treatment procedures. Typically, valid information about the etiology of the child's illness is withheld by the parents, and reversible symptoms vanish, when the child and the responsible adults are separated. Although valid statistical data about the epidemiology of MBPS are not available, MBPS should be considered more often than normally recognized. Neurological and neuropsychological presentations including developmental delays and learning problems appear to be common among MBPS cases so that clinical child neuropsychologists should be aware of this problem and consider MBPS at least in some of the mysterious cases that come to their attention. The present study describes a case of MBPS in which neurological and neuropsychological symptoms predominate. It presents a MBPS variant that is characterized by developmental delays and learning problems induced by unnecessary isolation at home, hospitalization, and treatment procedures. In the present case MBPS was at first suspected following neuropsychological assessment, since some of the main features of non-authenticity of symptom presentation gave cause for suspecting deceptive behavior on the mother's (and possibly also on the maternal grandmother's) side.

Isolated Nonvisualization of the Fetal Gallbladder Should Be Considered for the Prenatal Diagnosis of Cystic Fibrosis.

PubMed

Bergougnoux, Anne; Jouannic, Jean-Marie; Verneau, Fanny; Bienvenu, Thierry; Gaitch, Natacha; Raynal, Caroline; Girodon, Emmanuelle

2018-06-19

Cystic fibrosis (CF) can be revealed during fetal life by diverse ultrasound digestive abnormalities (USDA) such as fetal echogenic bowel or fetal intestinal loop dilatation, nonvisualization of the fetal gallbladder (NVFGB) being rarely observed in isolation. Only 6 cases of CF revealed by isolated NVFGB have been reported so far in the literature. Furthermore, recent studies suggested that this sign is of poor predictive value for CF. We report on the results of a 6-year French tricenter study on 1,124 cases of fetal USDA for whom a comprehensive molecular study was performed for CF. Among the 37 CF fetuses, 5 (13.5%) presented with isolated NVFGB at ultrasound (US) examination at 24-31 weeks of gestation. This sign was more frequently observed in CF fetuses than in non-CF fetuses, with a likelihood ratio of 2.7. The genotypes included three c.1521_1523del (F508del) homozygous cases and two compound heterozygous cases for a frequent and a rare CF-causing variant. These observations highlight the importance to report on the presence and aspect of the fetal gallbladder at the second trimester US scan and to consider prenatal CFTR molecular analysis in cases of isolated NVFGB. © 2018 S. Karger AG, Basel.

Another self-similar blast wave: Early time asymptote with shock heated electrons and high thermal conductivity

NASA Technical Reports Server (NTRS)

Cox, D. P.; Edgar, R. J.

1982-01-01

Accurate approximations are presented for the self-similar structures of nonradiating blast waves with adiabatic ions, isothermal electrons, and equation ion and electron temperatures at the shock. The cases considered evolve in cavities with power law ambient densities (including the uniform density case) and have negligible external pressure. The results provide the early time asymptote for systems with shock heating of electrons and strong thermal conduction. In addition, they provide analytical results against which two fluid numerical hydrodynamic codes can be checked.

[Mitochondrial disease due to the deficit of Q-cytochrome C oxidoreductase coenzyme in the respiratory chain. Report of a new case].

PubMed

Roldán, S; Lluch, M D; Navarro Quesada, F J; Hevia, A

1995-01-01

Reference has been made in the literature of the variability in the clinical presentation of deficiency of complex III of the respiratory chain, identifying up to the moment, four groups, the first of which is characterized by hipotonia and wearness starting at variable ages. We report a new case of mitochondrial myopathy due to deficiency of this complex and included within this first group, and consider the importance of defining the clinical and histochemical characteristics of this polymorphous entity.

A comprehensive screening program for β-thalassemia and other hemoglobinopathies in the Hooghly District of West Bengal, India, dealing with 21 137 cases.

PubMed

Bhattacharyya, Kallol Kumar; Chatterjee, Tridip; Mondal, Ujjalendu Bikash

2016-11-01

We here present a report of population screening programs (January 2012-December 2015) conducted by the Thalassemia Control Unit, Imambara Sadar Hospital, Chinsurah, Hooghly in the Hooghly District of West Bengal, India for prevention of thalassemia. We screened β-thalassemia (β-thal) heterozygotes and homozygotes, and Hb E (HBB: c.79G > A)-β-thal compound heterozygotes. Among 21 137 cases, we found 1968 heterozygotes and 192 homozygotes or compound heterozygotes. Results were evaluated with standard hematological analyses including red cell indices, hemoglobin (Hb) typing and quantification. The participants of the screening program were divided into six groups (children, pre-marriage cases, post-marital cases, family members of affected individuals, family members of carriers and pregnant women). While considering the average frequency of carriers, many reports recorded both related individuals (family members of trait and affected individuals) as well as unrelated individuals such as school children and pregnant women. These would have to be considered separately and only the unrelated individuals taken to estimate carrier frequencies in this article that would give more realistic data on carrier frequency of unrelated individuals.

Evaluation of Approaches to Deal with Low-Frequency Nuisance Covariates in Population Pharmacokinetic Analyses.

PubMed

Lagishetty, Chakradhar V; Duffull, Stephen B

2015-11-01

Clinical studies include occurrences of rare variables, like genotypes, which due to their frequency and strength render their effects difficult to estimate from a dataset. Variables that influence the estimated value of a model-based parameter are termed covariates. It is often difficult to determine if such an effect is significant, since type I error can be inflated when the covariate is rare. Their presence may have either an insubstantial effect on the parameters of interest, hence are ignorable, or conversely they may be influential and therefore non-ignorable. In the case that these covariate effects cannot be estimated due to power and are non-ignorable, then these are considered nuisance, in that they have to be considered but due to type 1 error are of limited interest. This study assesses methods of handling nuisance covariate effects. The specific objectives include (1) calibrating the frequency of a covariate that is associated with type 1 error inflation, (2) calibrating its strength that renders it non-ignorable and (3) evaluating methods for handling these non-ignorable covariates in a nonlinear mixed effects model setting. Type 1 error was determined for the Wald test. Methods considered for handling the nuisance covariate effects were case deletion, Box-Cox transformation and inclusion of a specific fixed effects parameter. Non-ignorable nuisance covariates were found to be effectively handled through addition of a fixed effect parameter.

Diagnosis and management of symptomatic seminal vesicle calculi.

PubMed

Christodoulidou, Michelle; Parnham, Arie; Nigam, Raj

2017-08-01

The aim of this study was to review the management of patients with symptomatic seminal vesicle calculi, from presentation and diagnosis to postoperative outcomes. A systematic review of the English literature in MEDLINE and Embase was performed, based on the following model: patients with a diagnosis of seminal vesicle calculi; all interventions considered with or without control groups with single and comparator interventions; outcomes considered were incidence, presentation, diagnostic methods and treatment. A narrative synthesis of the data was performed according to PRISMA 2009 guidelines. The study protocol was registered on PROSPERO (CRD42016032971). In total, 213 cases of seminal vesicle calculi from 37 studies were identified between 1928 and 2016. Published articles included cohort studies (16), case-control studies (two) and case reports (19). The most likely aetiology was stasis of ejaculate secondary to impaired drainage of secretions from the seminal vesicles. Transrectal ultrasound remains the primary investigation for haematospermia and painful ejaculation; however, magnetic resonance imaging seems to play an increasingly important role, especially when considering surgery. Transurethral seminal vesiculoscopy and lithotripsy is the ideal procedure for small calculi but requires surgical expertise. For larger calculi a transperitoneal laparoscopic approach is safe in the hands of experienced laparoscopic surgeons. Modern imaging techniques and cross-sectional imaging are leading to an increased number of diagnosed cases of seminal vesicle calculi. Optimal treatment depends on the stone size and burden, and centralization of services will assist in the development of specialized centres.

Toxocariasis Diagnosed in International Travelers at the Institute of Tropical Medicine, Antwerp, Belgium, from 2000 to 2013

PubMed Central

Van Den Broucke, Steven; Kanobana, Kirezi; Polman, Katja; Soentjens, Patrick; Vekemans, Marc; Theunissen, Caroline; Vlieghe, Erika; Van Esbroeck, Marjan; Jacobs, Jan; Van Den Ende, Jef; Van Gompel, Alfons; Clerinx, Jan; Bottieau, Emmanuel

2015-01-01

Although infection with Toxocara canis or T. catis (commonly referred as toxocariasis) appears to be highly prevalent in (sub)tropical countries, information on its frequency and presentation in returning travelers and migrants is scarce. In this study, we reviewed all cases of asymptomatic and symptomatic toxocariasis diagnosed during post-travel consultations at the reference travel clinic of the Institute of Tropical Medicine, Antwerp, Belgium. Toxocariasis was considered as highly probable if serum Toxocara-antibodies were detected in combination with symptoms of visceral larva migrans if present, elevated eosinophil count in blood or other relevant fluid and reasonable exclusion of alternative diagnosis, or definitive in case of documented seroconversion. From 2000 to 2013, 190 travelers showed Toxocara-antibodies, of a total of 3436 for whom the test was requested (5.5%). Toxocariasis was diagnosed in 28 cases (23 symptomatic and 5 asymptomatic) including 21 highly probable and 7 definitive. All but one patients were adults. Africa and Asia were the place of acquisition for 10 and 9 cases, respectively. Twelve patients (43%) were short-term travelers (< 1 month). Symptoms, when present, developed during travel or within 8 weeks maximum after return, and included abdominal complaints (11/23 symptomatic patients, 48%), respiratory symptoms and skin abnormalities (10 each, 43%) and fever (9, 39%), often in combination. Two patients were diagnosed with transverse myelitis. At presentation, the median blood eosinophil count was 1720/μL [range: 510–14160] in the 21 symptomatic cases without neurological complication and 2080/μL [range: 1100–2970] in the 5 asymptomatic individuals. All patients recovered either spontaneously or with an anti-helminthic treatment (mostly a 5-day course of albendazole), except both neurological cases who kept sequelae despite repeated treatments and prolonged corticotherapy. Toxocariasis has to be considered in travelers returning from a (sub)tropical stay with varying clinical manifestations or eosinophilia. Prognosis appears favorable with adequate treatment except in case of neurological involvement. PMID:25746418

Toxocariasis diagnosed in international travelers at the Institute of Tropical Medicine, Antwerp, Belgium, from 2000 to 2013.

PubMed

Van Den Broucke, Steven; Kanobana, Kirezi; Polman, Katja; Soentjens, Patrick; Vekemans, Marc; Theunissen, Caroline; Vlieghe, Erika; Van Esbroeck, Marjan; Jacobs, Jan; Van Den Enden, Erwin; Van Den Ende, Jef; Van Gompel, Alfons; Clerinx, Jan; Bottieau, Emmanuel

2015-03-01

Although infection with Toxocara canis or T. catis (commonly referred as toxocariasis) appears to be highly prevalent in (sub)tropical countries, information on its frequency and presentation in returning travelers and migrants is scarce. In this study, we reviewed all cases of asymptomatic and symptomatic toxocariasis diagnosed during post-travel consultations at the reference travel clinic of the Institute of Tropical Medicine, Antwerp, Belgium. Toxocariasis was considered as highly probable if serum Toxocara-antibodies were detected in combination with symptoms of visceral larva migrans if present, elevated eosinophil count in blood or other relevant fluid and reasonable exclusion of alternative diagnosis, or definitive in case of documented seroconversion. From 2000 to 2013, 190 travelers showed Toxocara-antibodies, of a total of 3436 for whom the test was requested (5.5%). Toxocariasis was diagnosed in 28 cases (23 symptomatic and 5 asymptomatic) including 21 highly probable and 7 definitive. All but one patients were adults. Africa and Asia were the place of acquisition for 10 and 9 cases, respectively. Twelve patients (43%) were short-term travelers (< 1 month). Symptoms, when present, developed during travel or within 8 weeks maximum after return, and included abdominal complaints (11/23 symptomatic patients, 48%), respiratory symptoms and skin abnormalities (10 each, 43%) and fever (9, 39%), often in combination. Two patients were diagnosed with transverse myelitis. At presentation, the median blood eosinophil count was 1720/μL [range: 510-14160] in the 21 symptomatic cases without neurological complication and 2080/μL [range: 1100-2970] in the 5 asymptomatic individuals. All patients recovered either spontaneously or with an anti-helminthic treatment (mostly a 5-day course of albendazole), except both neurological cases who kept sequelae despite repeated treatments and prolonged corticotherapy. Toxocariasis has to be considered in travelers returning from a (sub)tropical stay with varying clinical manifestations or eosinophilia. Prognosis appears favorable with adequate treatment except in case of neurological involvement.

Using Object Oriented Bayesian Networks to Model Linkage, Linkage Disequilibrium and Mutations between STR Markers

PubMed Central

Kling, Daniel; Egeland, Thore; Mostad, Petter

2012-01-01

In a number of applications there is a need to determine the most likely pedigree for a group of persons based on genetic markers. Adequate models are needed to reach this goal. The markers used to perform the statistical calculations can be linked and there may also be linkage disequilibrium (LD) in the population. The purpose of this paper is to present a graphical Bayesian Network framework to deal with such data. Potential LD is normally ignored and it is important to verify that the resulting calculations are not biased. Even if linkage does not influence results for regular paternity cases, it may have substantial impact on likelihood ratios involving other, more extended pedigrees. Models for LD influence likelihoods for all pedigrees to some degree and an initial estimate of the impact of ignoring LD and/or linkage is desirable, going beyond mere rules of thumb based on marker distance. Furthermore, we show how one can readily include a mutation model in the Bayesian Network; extending other programs or formulas to include such models may require considerable amounts of work and will in many case not be practical. As an example, we consider the two STR markers vWa and D12S391. We estimate probabilities for population haplotypes to account for LD using a method based on data from trios, while an estimate for the degree of linkage is taken from the literature. The results show that accounting for haplotype frequencies is unnecessary in most cases for this specific pair of markers. When doing calculations on regular paternity cases, the markers can be considered statistically independent. In more complex cases of disputed relatedness, for instance cases involving siblings or so-called deficient cases, or when small differences in the LR matter, independence should not be assumed. (The networks are freely available at http://arken.umb.no/~dakl/BayesianNetworks.) PMID:22984448

Validated surrogate endpoints needed for peri-implantitis.

PubMed

Lee, Dong Won

2011-01-01

Pubmed, Cochrane and Lilac databases, Google, Google Scholar, hand searching of websites of major dental journals. The reference list of five recently published systematic reviews on peri-implantitis treatment were also screened for potential studies. Randomised controlled trials and non-randomised studies in English, German, French, Spanish and Italian on peri-implantitis treatment in humans were included. Case series, case reports and cross sectional or non-therapy studies were excluded from the assessment of endpoints. No minimum follow up time was set for studies that were included. Data were extracted in duplicate by two reviewers and disagreements were resolved by consensus. True endpoints for peri-implantitis treatment were considered only if they provided evidence of tangible benefit to the patient. The outcome variables regarded as true endpoints were implant failure, aesthetic assessment and variables related to quality of life, but these were only considered if they were clearly identified as an objective of the research, not as an outcome of treatment. Surrogate endpoints were considered as those measurements of clinical outcomes such as probing pocket depth and clinical attachment level. Fourteen studies were included in this review with data on implant failure presented solely as consequence of peri-implantitis therapy. No true endpoint was described for any study on peri-implantitis. Mean pocket probing depth, clinical attachment level and bleeding on probing were the three surrogate endpoints cited most often in the literature. All endpoints used in the trials reviewed are surrogates of clinical events, such as implant failure. Clinical surrogate endpoints should be validated to assess the real effect of these measures on true endpoints.

Using National Health Care Databases and Problem-Based Practice Analysis to Inform Integrated Curriculum Development.

PubMed

Baker, Amy J; Raymond, Mark R; Haist, Steven A; Boulet, John R

2017-04-01

One challenge when implementing case-based learning, and other approaches to contextualized learning, is determining which clinical problems to include. This article illustrates how health care utilization data, readily available from the National Center for Health Statistics (NCHS), can be incorporated into an educational needs assessment to identify medical problems physicians are likely to encounter in clinical practice. The NCHS survey data summarize patient demographics, diagnoses, and interventions for tens of thousands of patients seen in various settings, including emergency departments (EDs), clinics, and hospitals.Selected data from the National Hospital Ambulatory Medical Care Survey: Emergency Department illustrate how instructional materials can be derived from the results of such public-use health care data. Using fever as the reason for visit to the ED, the patient management path is depicted in the form of a case drill-down by exploring the most common diagnoses, blood tests, diagnostic studies, procedures, and medications associated with fever.Although these types of data are quite useful, they should not serve as the sole basis for determining which instructional cases to include. Additional sources of information should be considered to ensure the inclusion of cases that represent infrequent but high-impact problems and those that illustrate fundamental principles that generalize to other cases.

A devastating outcome after adenoidectomy and tonsillectomy: ideas for improved prevention and management.

PubMed

Windfuhr, Jochen P; Schloendorff, Georg; Sesterhenn, Andreas M; Prescher, Andreas; Kremer, Bernd

2009-02-01

To develop strategies that may assist the surgeon to prevent and manage severe bleeding complications after adenoidectomy and tonsillectomy. Retrospective. Expert reports for malpractice lawsuits or professional boards were reviewed. The review was restricted to "deaths" and "permanent generalized neurological deficiencies." Forty-three cases matched our search criteria, including 32 deaths. Adenoidectomy cases (2) were associated with immediate bleeding because of direct vascular injury resulting in one death. Tonsillectomy cases were associated with delayed and repeated episodes of bleeding resulting in 31 deaths, including 19 children. Autopsy verified predominantly aspiration and vascular injuries. An apallic syndrome prevailed in surviving patients. Careful inspection of the nasopharynx immediately before adenoidectomy and curettage in a piecemeal fashion under visual control is helpful to prevent direct injury to aberrant arteries. Tonsillectomy cases are associated with delayed and episodic bleeding with spontaneous cessation and young age. Inpatient observation should be strongly considered in cases with repeated bleeding episodes to provide immediate treatment. The follow-up should be focused on disturbed wound healing. Outcome appears to be dependent on adequate airway management. Rigid instruments and tracheotomy in case of intubation failure are highly recommended to facilitate airway protection and ventilation.

Congeneration feasibility: Otis Elevator Company and Polychrome Corporation. Final report

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

Fox, H.

1982-05-01

This report summarizes an investigation of the technical and economic feasibility of cogenerating electric and thermal power at two manufacturing plants (Otis Elevator Company and Polychrome Corporation) located on neighboring properties in Yonkers, NY. Existing electrical- and steam-producing equipment and energy consumption date are summarized. Alternative cases examined include electrical energy generation, electrical energy generation with waste heat recovery and a combined cycle case. Also reported are life cycle cost economic evaluations including simple payback period and return-on-investment indices. While it was concluded that cogeneration of heat and electricity at these industrial plant sites would not be economically viable, thismore » detailed study provides valuable insight into the types of problems encountered when considering cogeneration feasibility.« less

Meningitis and legal liability: an otolaryngology perspective.

PubMed

Svider, Peter F; Blake, Danielle M; Sahni, Kiren P; Folbe, Adam J; Liu, James K; Baredes, Soly; Eloy, Jean Anderson

2014-01-01

Meningitis is a potential complication in otolaryngologic procedures and conditions. Severe sequelae make understanding factors involved in relevant malpractice litigation critical. We analyze pertinent litigation for awards, outcomes, patient demographic factors, and other alleged causes of malpractice. Pertinent jury verdict and settlement reports were examined using the Westlaw legal database (Thomson Reuters, New York, NY). Twenty-three cases (60.5%) involved non-iatrogenic injuries, including inadequate treatment or failure to diagnose sinusitis or otitis media, while 15 (39.5%) involved iatrogenic cases, mostly rhinologic procedures. 36.8% of cases were resolved for the defendant, 28.9% with juries awarding damages, and 34.2% with settlements. Although not statistically significant, mean damages awarded were higher than settlements ($2.1 vs. 1.5M, p=0.056), and cases involving pediatric patients were more likely to be resolved with payment than those with adult litigants (80.0% vs. 52.2%, p=0.08 respectively). Other frequent alleged factors included permanent deficits (63.2%), requiring additional surgery (41.1%), death (34.2%), cognitive deficits (21.2%), deafness (15.8%), and inadequate informed consent (33.0% of iatrogenic cases). Practitioners facing litigation related to meningitis may wish to consider these findings, notably for cases involving death or permanent functional deficits, as cases with out of court settlements tended to be resolved with lower payments. Cases involving misdiagnosis may be more likely to be resolved with payment compared with iatrogenic cases. By understanding the issues detailed in this analysis and including them in the informed consent process for patients undergoing rhinologic and otologic procedures, otolaryngologists may potentially improve patient safety and decrease liability. © 2014.

Benefit-Cost Analysis of Foreign Student Flows from Developing Countries: The Case of Postgraduate Education.

ERIC Educational Resources Information Center

Heaton, Christopher; Throsby, David

1998-01-01

Demonstrates the formulation and computation of major benefit and cost items included in an evaluation of social rates of return to foreign study. Considers incidence of measured effects between sending, host, and third countries, focusing on south/north flow of postgraduate students, specifically Fiji students studying at Australian universities.…

Using Debates as Assessment in a Physiotherapy Capstone Course: A Case Example

ERIC Educational Resources Information Center

Weeks, Benjamin K.; Laakso, Liisa

2016-01-01

While not a new teaching and learning approach, debating may be considered novel when included in a suite of more traditional teaching and learning activities. Despite the potential benefits of debates for the development of generic skills, their use in physiotherapy education remains unreported. Thus, our aim was to evaluate student satisfaction…

[Waardenburg's syndrome].

PubMed

Gimñenez, F; Carbonell, R; Pérez, F; Lozano, I

1994-01-01

Reporting one case of this condition type-2 with heterochromia iridis and cochlear deafness. The AA. review the syndrome's components and it nomenclature as well. They discuss about the convenience of including this deviation in the chapter of "diseases of the embryonic neural crest". The specific place of the gene responsibly in the chromosome-2 and the possibilities of genetic counselling are considered.

Research Says / Mindsets Are Key to Effective Data Use

ERIC Educational Resources Information Center

Goodwin, Bryan

2015-01-01

All around us are examples of people and organizations with good information making bad decisions. Consider the case of Blockbuster. Less than a decade ago, Blockbuster had 8,000 stores in 17 countries and millions of customers. It was awash in data, including customer surveys that said people disliked going to video stores and hated late fees.…

A Model for Institutional Policy Analysis: The Case of Student Financial Aid. AIR Forum 1981 Paper.

ERIC Educational Resources Information Center

Fenske, Robert H.; Parker, John D.

The development of an operational model that would enable a college institutional research unit to improve administrative decision-making by expanding its data base to include new activities not widely recognized throughout the institution is considered. Attention is directed to institutional research as a function within an institution,…

76 FR 40798 - Antidrug and Alcohol Misuse Prevention Programs for Personnel Engaged in Specified Aviation...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-12

... includes contractors and subcontractors. Contracting companies have two testing options: Option one is for... case today and as such, there are no alternatives to the final rule that could have been considered and... stations would be classified as small business under NAICS 488180, the FAA reviewed a recent study...

The Application of Research Generalizations from Staff Development to a Rural School District: A Case Study-Research Report.

ERIC Educational Resources Information Center

Kilgore, Alvah M.; And Others

This paper describes the effects of applying research generalizations about inservice teacher education to the practices of a local school district. Generalizations considered include: (1) short- and long-range planning needs; (2) joint planning and participation by administrators and teachers; (3) relationships among inservice and curriculum…

Ground-water as a nuisance

NASA Astrophysics Data System (ADS)

Straskraba, V.

1984-03-01

In certain circumstances, ground-water causes geotechnical problems and can be considered a nuisance rather than a blessing. The cases where ground-water creates considerable complications include construction, tunnelling, mining, landslides, and land subsidence. The development of hydrogeology as a science has proved over the years to substantially reduce the severe problems and disasterous problems caused by ground-water.

It Comes from the People: Community Development and Local Theology.

ERIC Educational Resources Information Center

Hinsdale, Mary Ann; And Others

The closing of local mines and factories collapsed the economic and social structure of Ivanhoe, Virginia, a small rural town once considered a dying community. This book is a case study that tells how the people of Ivanhoe organized to revitalize their town. It documents the community development process--a process that included hard work, a…

Integration of a Social Skills Training: A Case Study of Children with Low Social Skills

ERIC Educational Resources Information Center

Choi, Dong Hwa; Md-Yunus, Sham'ah

2011-01-01

This study explores changes in children's social skills after a cognitive-social skills model intervention. The intervention was conducted over a period of 12 weeks within a regular preschool setting. Sixteen children including four considered to have low social skills participated in the study. Data analysis revealed that the four children with…

Equity- and Tolerance-Oriented Teachers: Approaches to Teaching Race in the Social Studies Classroom

ERIC Educational Resources Information Center

Martell, Christopher C.; Stevens, Kaylene M.

2017-01-01

In this interpretative case study, the researchers examined the beliefs and practices of 10 self-identifying race-conscious social studies teachers. Using critical race theory as the lens, the researchers found that most of the teachers made race explicit in their classrooms by including race in units not typically considered race-related and…

Follow-up survey of the prevalence, diagnosis, clinical manifestations and treatment of Spirocerca lupi in South Africa.

PubMed

Lobetti, Remo

2014-11-14

Spirocercosis is an important disease in South Africa. The object of this study was to determine if there had been a change in the prevalence, clinical manifestations and treatment of Spirocerca lupi over a 14-year period. A questionnaire was sent to 577 veterinary practices throughout South Africa in 2012. Of responders, 76% indicated that S. lupi occurred in their area, whilst 24% indicated that it did not; 84% considered S. lupi not to be a new phenomenon, whereas 16% considered it to be new. Monthly or seasonal distribution of the disease was not reported, and 76% of responders reported it to occur in no specific breed of dog, whereas 24% reported a breed risk, most considering large breeds to be at greater risk. No specific age or sex was identified as at higher risk. Common owner complaints were vomiting, weight loss, cough, or regurgitation. Reported clinical findings tended to mirror the clinical signs reported by owners. Most common diagnostic methods used were radiology, endoscopy, faecal flotation, and post mortem examination. Forty-four percent did not report seeing asymptomatic cases, 40% reported asymptomatic cases and 16% did not know. Associated complications were reported by 85% of responders, and included oesophageal neoplasia, hypertrophic osteopathy and acute haemothorax. Four different drugs were used as therapy: doramectin, ivermectin, milbemycin and Advocate®, with 9% of the responders using a combination of these four; 85% considered treatment to be effective and 15% ineffective. Treatment was considered more effective if the disease was diagnosed early and there were no complications. Two important conclusions were that more cases are being seen and that efficacy of therapy has increased, with a decrease in the mortality rate.

Measuring the quantum geometric tensor in two-dimensional photonic and exciton-polariton systems

NASA Astrophysics Data System (ADS)

Bleu, O.; Solnyshkov, D. D.; Malpuech, G.

2018-05-01

We propose theoretically a method that allows to measure all the components of the quantum geometric tensor (the metric tensor and the Berry curvature) in a photonic system. The method is based on standard optical measurements. It applies to two-band systems, which can be mapped to a pseudospin, and to four-band systems, which can be described by two entangled pseudospins. We apply this method to several specific cases. We consider a 2D planar cavity with two polarization eigenmodes, where the pseudospin measurement can be performed via polarization-resolved photoluminescence. We also consider the s band of a staggered honeycomb lattice with polarization-degenerate modes (scalar photons), where the sublattice pseudospin can be measured by performing spatially resolved interferometric measurements. We finally consider the s band of a honeycomb lattice with polarized (spinor) photons as an example of a four-band model. We simulate realistic experimental situations in all cases. We find the photon eigenstates by solving the Schrödinger equation including pumping and finite lifetime, and then simulate the measurements to finally extract realistic mappings of the k-dependent tensor components.

Investigation of self-help oil-spill response techniques and equipment

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

Enderlin, W I; Downing, J P; Enderlin, C W

1992-06-01

The US Coast Guard commissioned Pacific Northwest Laboratory (PNL) to conduct this study of 45 self-help oil-spill response techniques and equipment for oceangoing tankers and inland tank barges to assess the potential effectiveness of the proposed countermeasure categories. This study considers the hypothetical outflow of oil in the case of side damage and bottom damage to single-hull designs. The results will be considered by the Coast Guard in drafting regulations pertaining to the requirement for tanker vessels to carry oil pollution response equipment (i.e., in response to the oil Pollution Act of 1990). PNL's approach to this investigation included: assessingmore » time-dependent oil outflow in the cases of collision and grounding of both tankers and barges; identifying environmental constraints on self-help countermeasure operation; identifying human factor issues, such as crew performance, safety, and training requirements for the self-help countermeasures considered; and assessing each self-help countermeasure with respect to its potential for minimizing oil loss to the environment. Results from the time-dependent oil outflow, environmental limitations, and human factors requirements were input into a simulation model.« less

Space shuttle solid rocket booster water entry cavity collapse loads

NASA Technical Reports Server (NTRS)

Keefe, R. T.; Rawls, E. A.; Kross, D. A.

1982-01-01

Solid rocket booster cavity collapse flight measurements included external pressures on the motor case and aft skirt, internal motor case pressures, accelerometers located in the forward skirt, mid-body area, and aft skirt, as well as strain gages located on the skin of the motor case. This flight data yielded applied pressure longitudinal and circumferential distributions which compare well with model test predictions. The internal motor case ullage pressure, which is below atmospheric due to the rapid cooling of the hot internal gas, was more severe (lower) than anticipated due to the ullage gas being hotter than predicted. The structural dynamic response characteristics were as expected. Structural ring and wall damage are detailed and are considered to be attributable to the direct application of cavity collapse pressure combined with the structurally destabilizing, low internal motor case pressure.

A compilation of cold cases using scanning electron microscopy at the University of Rhode Island

NASA Astrophysics Data System (ADS)

Platek, Michael J.; Gregory, Otto J.

2015-10-01

Scanning electron microscopy combined with microchemical analysis has evolved into one of the most widely used instruments in forensic science today. In particular, the environmental scanning electron microscope (SEM) in conjunction with energy dispersive spectroscopy (EDS), has created unique opportunities in forensic science in regard to the examination of trace evidence; i.e. the examination of evidence without altering the evidence with conductive coatings, thereby enabling criminalists to solve cases that were previously considered unsolvable. Two cold cases were solved at URI using a JEOL 5900 LV SEM in conjunction with EDS. A cold case murder and a cold missing person case will be presented from the viewpoint of the microscopist and will include sample preparation, as well as image and chemical analysis of the trace evidence using electron microscopy and optical microscopy.

Management of Inguinal Involvement of Peritoneal Surface Malignancies by Cytoreduction and HIPEC with Inguinal Perfusion.

PubMed

Shachar, Yair; Adileh, Mohamed; Keidar, Assaf; Eid, Luminita; Hubert, Ayalah; Temper, Mark; Azam, Salah; Beny, Alex; Grednader, Tal; Khalaileh, Abed; Yuval, Jonathan B; Stojadinovic, Alexander; Avital, Itzhak; Nissan, Aviram

2015-01-01

Achieving complete cytoreduction of peritoneal surface malignancies (PSM) can be challenging. In most cases, delivery of heated intra-peritoneal chemotherapy (HIPEC) is straightforward. However, using the closed technique in some cases may be technically challenging; for example, in patients requiring abdominal closure using a large synthetic mesh. In cases where groin hernias are present, it is imperative to resect the hernia sac, since it may contain tumor deposits. In cases with major inguinal involvement where disease may spread out of the hernia sac or in cases where a hernia repair was performed while disease is present, inguinal perfusion should be considered. To describe our experience with combined intra-peritoneal and inguinal perfusion of HIPEC following cytoreductive surgery. This is a retrospective review of all patients who underwent cytoreductive surgery (CRS) and HIPEC at our institution. A prospectively maintained database containing data of patients treated by CRS and HIPEC (n=122) was reviewed. All patients with macroscopic inguinal involvement by PSM with complete cytoreduction perfused by HIPEC were included. We identified five cases who underwent CRS and combined intraperitoneal and inguinal perfusion after resection of large inguinal tumor deposits (n=4) or after a recent hernia repair with hernial sac involvement by mucinous adenocarcinoma (n=1). All five patients were successfully perfused using an additional outflow catheter placed in the groin. In cases of inguinal involvement by PSM, complete cytoreduction should be achieved and perfusion of the involved groin considered as it is feasible and safe.

The Advantages of Parental Involvement in Cognitive-Behavioral Treatment of Childhood Obsessive-Compulsive Disorder: A Single-Case Example.

PubMed

Oldham-Cooper, Rose; Glasman, David; Loades, Maria

2016-04-01

Interventions for the treatment of anxiety disorders in children have a growing evidence base. Cognitive-behavioral therapy for the treatment of specific anxiety disorders in children and adolescents, including obsessive-compulsive disorder, is now an established intervention. However, a question remains concerning the benefits of parental involvement in treatment. Some studies report limited or no benefit of including parents in treatment, whereas other studies have indicated additional advantages of parental involvement. The present case report describes the treatment of an 11-year-old girl with obsessive-compulsive disorder using cognitive-behavioral therapy derived largely from the treatment approaches outlined in Carr (2006), March and Mulle (1998), and Derisley, Heyman, Robinson, and Turner (2008). The child's mother attended all sessions and also a one-off parent-only session toward the end of treatment. The report considers the benefits of involving the child's mother in treatment and possible factors that could suggest parental involvement is indicated in future cases. Both child and mother, and the therapist, believed that parental involvement had been an important and useful element of treatment. Possible reasons for benefits of parental involvement were considered to be high parental anxiety at the outset of treatment, age of the client, and involvement of the parent in obsessions and compulsions. © 2016 Wiley Periodicals, Inc.

At most hospitals in the state of Iowa, most surgeons' daily lists of elective cases include only 1 or 2 cases: Individual surgeons' percentage operating room utilization is a consistently unreliable metric.

PubMed

Dexter, Franklin; Jarvie, Craig; Epstein, Richard H

2017-11-01

Percentage utilization of operating room (OR) time is not an appropriate endpoint for planning additional OR time for surgeons with high caseloads, and cannot be measured accurately for surgeons with low caseloads. Nonetheless, many OR directors claim that their hospitals make decisions based on individual surgeons' OR utilizations. This incongruity could be explained by the OR managers considering the earlier mathematical studies, performed using data from a few large teaching hospitals, as irrelevant to their hospitals. The important mathematical parameter for the prior observations is the percentage of surgeon lists of elective cases that include 1 or 2 cases; "list" meaning a combination of surgeon, hospital, and date. We measure the incidence among many hospitals. Observational cohort study. 117 hospitals in Iowa from July 2013 through September 2015. Surgeons with same identifier among hospitals. Surgeon lists of cases including at least one outpatient surgical case, so that Relative Value Units (RVU's) could be measured. Averaging among hospitals in Iowa, more than half of the surgeons' lists included 1 or 2 cases (77%; P<0.00001 vs. 50%). Approximately half had 1 case (54%; P=0.0012 vs. 50%). These percentages exceeded 50% even though nearly all the surgeons operated at just 1 hospital on days with at least 1 case (97.74%; P<0.00001 vs. 50%). The cases were not of long durations; among the 82,928 lists with 1 case, the median was 6 intraoperative RVUs (e.g., adult inguinal herniorrhaphy). Accurate confidence intervals for raw or adjusted utilizations are so wide for individual surgeons that decisions based on utilization are equivalent to decisions based on random error. The implication of the current study is generalizability of that finding from the largest teaching hospital in the state to the other hospitals in the state. Copyright © 2017 Elsevier Inc. All rights reserved.

Lessons from a national audit of acute pancreatitis: A summary of the NCEPOD report 'Treat the Cause'.

PubMed

O'Reilly, D A; McPherson, S J; Sinclair, M T; Smith, N

The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) is an independent organisation whose remit is to review the quality of medical and surgical care provided in the United Kingdom. We undertook a review into the care provided to patients treated for acute pancreatitis during a 6 month study period between 1st January and 30th June 2014. This included assessment of care at an organisational level, clinical level within hospitals and external peer review. From a random sample, 712 patients underwent hospital clinician review and 418 patients had external peer review. Overall, we found that there was room for improvement in care in over 50% of patients with acute pancreatitis. Case reviewers felt that efforts to prevent recurrent episodes due to gallstones and alcohol were inadequate as 21% of patients in the study had one or more previous episodes of acute pancreatitis. Aspects of general care where improvements could be made include better antibiotic stewardship; as 1/5 of patients were considered to have been given antibiotics unnecessarily. Overall management of the patients' nutrition was considered adequate by the case reviewers in only 85% of cases. The use of an early warning score was omitted in 31% of emergency department admissions. Recommendations include standardised early warning scoring systems to be used throughout the hospital and commenced in the emergency department. The development of better networking arrangements and regional pancreatitis units, with shared management guidelines, is also essential to improve the coordination of care. Copyright © 2017 IAP and EPC. Published by Elsevier B.V. All rights reserved.

Spatial variation in attributable risks.

PubMed

Congdon, Peter

2015-01-01

The attributable risk (AR) measures the contribution of a particular risk factor to a disease, and allows estimation of disease rates specific to that risk. While previous studies consider variability in ARs over demographic categories, this paper considers the extent of spatial variability in ARs estimated from multilevel data with confounders both at individual and geographic levels. A case study considers the AR for diabetes in relation to elevated BMI, and area rates for diabetes attributable to excess weight. Contextual adjustment includes known area variables, and unobserved spatially clustered influences, while spatial heterogeneity (effect modification) is considered in terms of varying effects of elevated BMI by neighbourhood deprivation category. The application is to patient register data in London, with clear evidence of spatial variation in ARs, and in small area diabetes rates attributable to excess weight. Copyright © 2015 Elsevier Ltd. All rights reserved.

Purple Glove Syndrome after Phenytoin or Fosphenytoin Administration: Review of Reported Cases and Recommendations for Prevention.

PubMed

Garbovsky, Lyudmila A; Drumheller, Byron C; Perrone, Jeanmarie

2015-12-01

The aim of our study was to identify all previously reported cases of phenytoin- or fosphenytoin-associated purple glove syndrome (PGS) and summarize the most current understanding of the pathophysiology, clinical presentation, diagnosis, and treatment of the disease. We searched the English language references from MEDLINE, EMBASE, CINAHL, TOXNET, and gray literature that featured one or more case descriptions of phenytoin- or fosphenytoin-associated PGS after administration and provided information on the clinical setting of the event and associated outcome(s). Descriptive statistics were employed to summarize relevant facts about the cases. We identified 82 unique cases of parenteral phenytoin-associated PGS and 5 cases of fosphenytoin-associated PGS that were published from 1984 to 2015. Additionally, we found two cases of PGS associated with oral formulation of phenytoin published from 1999 to 2015. The spectrum of tissue injury ranged from mild local cutaneous reactions around the infusion site to frank limb ischemia. Just over a half of cases reported symptoms after one dose of IV phenytoin. Pathologic findings included evidence for microvascular thrombosis and possible microvascular or subclinical extravasation as a contributing mechanism. Dopper ultrasound and conventional angiography were used in some patients to identify arterial or venous thrombosis. Various treatments were documented including the use of supportive care such as limb elevation and heat or cold application, utilization of systemic antibiotics, anticoagulants, or vasodilators, and local infiltration of hyaluronidase, heparin, or other compounds. In a small number of patients, invasive interventions such as regional anesthesia, thrombectomy, fasciotomy, and debridement were described. Time to resolution varied from days to weeks. Resolution of PGS without deficits was documented in the majority of cases. Skin changes followed by sensory and motor deficits were described in 16, 6, and 5 cases, respectively. Four patients underwent skin grafting and eight patients required limb amputation. Death as a result of PGS was documented in two patients. PGS associated with oral and injectable phenytoin or parenteral fosphenytoin has been documented in the literature and sometimes includes significant vascular thrombosis and potentially limb-threatening ischemia. Avoidance of small hand veins, adherence to recommended IV administration guidelines and monitoring of the infusion site for reactions should be considered to decrease the morbidity of IV phenytoin or fosphenytoin use. Patients with PGS and evidence of decreased distal perfusion should undergo prompt vascular imaging and potential intervention to avoid ischemic sequelae. Alternative anticonvulsant drugs should be considered in patients at risk for PGS when possible.

Hermansky-Pudlak Syndrome: A Case Report

PubMed Central

Berber, Ilhami; Erkurt, Mehmet Ali; Kuku, Irfan; Kaya, Emin; Koroglu, Mustafa; Gul, Mehmet; Bentli, Recep

2014-01-01

Objective. The aim of this paper is to report the case of a patient diagnosed with Hermansky-Pudlak syndrome, as a result of bleeding diathesis. Clinical Presentation and Intervention. A 23-year-old male presented with recurrent epistaxis and, upon physical examination, was found to be remarkable for albinism and suborbital ecchymosis. The absence of dense bodies in the platelets was demonstrated using electron microscopy. This patient was (slowly) administered one unit of a platelet suspension, and his bleeding decreased considerably. Conclusion. This case shows that Hermansky-Pudlak syndrome should be considered in the differential diagnosis of a patient presenting with bleeding diathesis, when the clinical presentation also includes oculocutaneous albinism and visual problems. PMID:24707413

Analysis of eco-innovation with triple helix approach: case-study of biofloc catfish farming in Yogyakarta

NASA Astrophysics Data System (ADS)

Purwadi, D.; Nurlaily, I.

2018-03-01

Concerning environmental into focus of innovation process will expand the number of actor involved. Eco-innovation and triple helix are often frameworks applied to analyse how environmental concern are integrated in innovation process and how different stakeholder groups are having inter relation. Case study from biofloc catfish farming in Yogyakarta is presented to demonstrate a possible approach for researching the success of triple helix frameworks. This case is considered on basic of the result of a survey among farmers, academician and government. The paper concludes the creating of full triple helix encounters problem in practice. It also includes suggestion for further research on fisheries development.

Endemic Babesiosis in Another Eastern State: New Jersey

PubMed Central

McGovern, Paul C.; Gerwel, Michal P.; Easton, Rachael M.; MacGregor, Rob Roy

2003-01-01

In the United States, most reported cases of babesiosis have been caused by Babesia microti and acquired in the northeast. Although three cases of babesiosis acquired in New Jersey were recently described by others, babesiosis has not been widely known to be endemic in New Jersey. We describe a case of babesiosis acquired in New Jersey in 1999 in an otherwise healthy 53-year-old woman who developed life-threatening disease. We also provide composite data on 40 cases of babesiosis acquired from 1993 through 2001 in New Jersey. The 40 cases include the one we describe, the three cases previously described, and 36 other cases reported to public health agencies. The 40 cases were acquired in eight (38.1%) of the 21 counties in the state. Babesiosis, a potentially serious zoonosis, is endemic in New Jersey and should be considered in the differential diagnosis of patients with fever and hemolytic anemia, particularly in the spring, summer, and early fall. PMID:12603988

Infection control: beyond the horizon.

PubMed

Gray, J

2015-04-01

This article will consider possible future directions for innovation and research in infection prevention and control, and will make the case for the importance of including clinical and cost-effectiveness evaluation in such research. Opportunities for studies in a number of broad subject areas will be considered, including prevention and control of existing and emerging infection hazards, the challenges posed by changes in the way that medical care is being delivered, technological developments that could be harnessed for infection prevention and control, how new laboratory diagnostic technologies might benefit infection prevention and control, cleaning and decontamination, and the infection control aspects of hospital design. The need for robust economic data to support the wide and timely implementation of evidence-based practice is emphasized. Copyright © 2014 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Coupled rotor-body vibrations with inplane degrees of freedom

NASA Technical Reports Server (NTRS)

Ming-Sheng, H.; Peters, D. A.

1985-01-01

In an effort to understand the vibration mechanisms of helicopters, the following basic studies are considered. A coupled rotor-fuselage vibration analysis including inplane degrees of freedom of both rotor and airframe is performed by matching of rotor and fuselage impedances at the hub. A rigid blade model including hub motion is used to set up the rotor flaplag equations. For the airframe, 9 degrees of freedom and hub offsets are used. The equations are solved by harmonic balance. For a 4-bladed rotor, the coupled responses and hub loads are calculated for various parameters in forward flight. The results show that the addition of inplane degrees of freedom does not significantly affect the vertical vibrations for the cases considered, and that inplane vibrations have similar resonance trends as do flapping vibrations.

Apocalyptic suicide: from a pathological to an eschatological interpretation.

PubMed

Dein, Simon; Littlewood, Roland

2005-09-01

The authors examine the possible interpretations of apocalyptic suicide--a form of suicide amongst a group which believes that the world will end imminently. Through a literature search the authors identify a number of paradigmatic cases exemplifying this phenomenon including Jonestown, Waco, The Order of the Solar Temple and Heaven's Gate. Interpretations of apocalyptic suicide might consider individual factors--the most common approach--but also the social and eschatological themes which are found in the group's ideological work. Religious violence (including suicide) may be precipitated in a dialectical interaction between group members and the perceived outside world. We consider here the ideological aspects that commonly lead to a dualist epistemology for the group. Apocalyptic suicide involves a shift of personal self and agency to the social self of the charismatic group.

[On the text of Ihon Yamai-no-Soshi].

PubMed

Hayashi, Yoshiro

2002-03-01

There are about fifteen variant texts of Yamai-no-Soshi (Ihon Yamai-no-Soshi), which is considered to have been originally compiled in the late Heian period (latter half of the twelfth century). However, few discussions have ever addressed the work's bibliography, formation or text in detail. In this study, the formation and text critique of Ihon Yamai-no-Soshi are considered. It is found that the variant texts can be divided into two categories, short and long, the former describing mainly the ten-kyo cases typical of ancient Japan before the Kamakura period, and the latter including the atypical and vulgar cases of the Edo period which were added later. For part of the texts, the corresponding source texts were found through the bibliographic research. This study highlights the value of Ihon Yamai-no-Soshi as a reference text for the historical study of psychiatry.

Violations of Assumptions in School-Based Single-Case Data: Implications for the Selection and Interpretation of Effect Sizes.

PubMed

Solomon, Benjamin George

2014-07-01

A wide variety of effect sizes (ESs) has been used in the single-case design literature. Several researchers have "stress tested" these ESs by subjecting them to various degrees of problem data (e.g., autocorrelation, slope), resulting in the conditions by which different ESs can be considered valid. However, on the back end, few researchers have considered how prevalent and severe these problems are in extant data and as a result, how concerned applied researchers should be. The current study extracted and aggregated indicators of violations of normality and independence across four domains of educational study. Significant violations were found in total and across fields, including low levels of autocorrelation and moderate levels of absolute trend. These violations affect the selection and interpretation of ESs at the individual study level and for meta-analysis. Implications and recommendations are discussed. © The Author(s) 2013.

Five-year all-cause mortality rates across five categories of substantiated elder abuse occurring in the community.

PubMed

Burnett, Jason; Jackson, Shelly L; Sinha, Arup K; Aschenbrenner, Andrew R; Murphy, Kathleen Pace; Xia, Rui; Diamond, Pamela M

2016-01-01

Elder abuse increases the likelihood of early mortality, but little is known regarding which types of abuse may be resulting in the greatest mortality risk. This study included N = 1,670 cases of substantiated elder abuse and estimated the 5-year all-cause mortality for five types of elder abuse (caregiver neglect, physical abuse, emotional abuse, financial exploitation, and polyvictimization). Statistically significant differences in 5-year mortality risks were found between abuse types and across gender. Caregiver neglect and financial exploitation had the lowest survival rates, underscoring the value of considering the long-term consequences associated with different forms of abuse. Likewise, mortality differences between genders and abuse types indicate the need to consider this interaction in elder abuse case investigations and responses. Further mortality studies are needed in this population to better understand these patterns and implications for public health and clinical management of community-dwelling elder abuse victims.

Pulmonary hemorrhage with capillaritis secondary to mycophenolate mofetil in a heart-transplant patient.

PubMed

Gorgan, Maria; Bockorny, Bruno; Lawlor, Michael; Volpe, John; Fiel-Gan, Mary

2013-11-01

Immunosuppressive drugs are an integral part of therapy in organ transplantation. However, they are not without side effects, and although rare, these agents should be considered in the differential diagnosis of pulmonary complications in patients receiving transplants. We present a case of a patient who developed acute respiratory failure 7 days after orthotopic heart transplantation and who had been on both mycophenolate mofetil (MMF) and tacrolimus agents. Lung biopsy revealed features of pulmonary hemorrhage with capillaritis. Considered as a possible etiology, MMF was withdrawn. There was immediate improvement of the patient's symptoms. The temporal relationship between MMF exposure and onset of pulmonary symptoms in the absence of other possible etiologies strongly suggests a causal relationship. Previously published reports of pulmonary toxicity from MMF included interstitial fibrosis. To the best of our knowledge, this is the first reported case of pulmonary hemorrhage with capillaritis because of administration of MMF.

Early recognition of encephalitis in acute settings.

PubMed

Mower, Kellie-Ann

2017-04-13

Encephalitis is a life-threatening condition in which inflammation of the brain tissue occurs. Although it is relatively rare, misdiagnosis or delays in recognition and treatment can have devastating consequences for patients, and there is a high mortality rate. People who survive are often left with neuropsychological impairment. This article describes the pathophysiology of the condition, as well as clinical presentation and treatment, and explains why it can be easily missed. It includes a case study that describes a situation in which the condition was not considered initially as a differential diagnosis, and considers implications for practice.

Surveillance of nasal and bladder cancer to locate sources of exposure to occupational carcinogens.

PubMed Central

Teschke, K; Morgan, M S; Checkoway, H; Franklin, G; Spinelli, J J; van Belle, G; Weiss, N S

1997-01-01

OBJECTIVE: To locate sources of occupational exposure to nasal and bladder carcinogens for surveillance follow up in British Columbia, Canada. METHODS: Incident cases of nasal cancer (n = 48), bladder cancer (n = 105), and population based controls (n = 159) matched for sex and age, were interviewed about their jobs, exposures, and smoking histories. Odds ratios (ORs) were calculated for 57 occupational groups with stratified exact methods to control for age, sex, and smoking. RESULTS: Occupational groups at increased risk of nasal cancer included: textile workers (six cases, OR 7.6); miners, drillers, and blasters (six cases, OR 3.5); welders (two cases, OR 3.5); pulp and paper workers (three cases, OR 3.1); and plumbers and pipefitters (two cases, OR 3.0). Nasal cancer ORs were not increased in occupations exposed to wood dust, possibly due to low exposures in local wood industries. Strongly increased risks of bladder cancer were found for sheet metal workers (four cases, OR 5.3), miners (19 cases, OR 4.5), gardeners (six cases, OR 3.7), and hairdressers (three cases, OR 3.2). Among occupations originally considered at risk, the following had increased risks of bladder cancer: painters (four cases, OR 2.8); laundry workers (five cases, OR 2.3); chemical and petroleum workers (15 cases, OR 1.8); machinists (eight cases, OR 1.6); and textile workers (three cases, OR 1.5). CONCLUSIONS: Occupational groups with increased risks and three or more cases with similar duties were selected for surveillance follow up. For nasal cancer, these included textile workers (five were garment makers) and pulp and paper workers (three performed maintenance tasks likely to entail stainless steel welding). For bladder cancer, these included miners (12 worked underground), machinists (five worked in traditional machining), hairdressers (three had applied hair dyes), and laundry workers (three were drycleaners). PMID:9245952

Early surgical treatment of retinal hemangioblastomas.

PubMed

van Overdam, Koen A; Missotten, Tom; Kilic, Emine; Spielberg, Leigh H

2017-02-01

To evaluate the clinical course after early surgical treatment with excision of retinal hemangioblastomas (RHs) before development of major complications. Interventional case series of four eyes (four patients) with a peripheral RH that had not yet been treated by laser or cryotherapy prior to surgery. All eyes underwent 23-gauge vitrectomy with lesion excision. One patient underwent ligation of the feeder vessel prior to lesion excision. Best-corrected visual acuity and clinical course were assessed during a follow-up period of at least 4 years. Four patients (mean age 27.3 years; range 19-32) were included, of whom two had von Hippel-Lindau syndrome. Visual acuity improved in three patients (mean 4.8 lines; range 3-10) and remained stable at 0.0 logMAR in one patient. There were no intraoperative complications. Postoperative complications included transient mild vitreous haemorrhage (n = 2), and local epiretinal membrane formation at the excision location (n = 1). At 4 years postoperatively, there were no long-term complications. There was one case of a new lesion, which was effectively treated with laser. Vitrectomy with RH excision seems to be an effective approach for larger RHs and could be considered an early treatment option in selected cases. Postoperative complications were limited in scope of this case series. Important points to consider during vitrectomy are effective closure of feeder and draining vessels as well as complete removal of posterior hyaloid and epiretinal membranes in order to avoid postoperative vitreous haemorrhage and proliferative vitreoretinopathy. © 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Association of paraoxonase gene cluster polymorphisms with ALS in France, Quebec, and Sweden.

PubMed

Valdmanis, P N; Kabashi, E; Dyck, A; Hince, P; Lee, J; Dion, P; D'Amour, M; Souchon, F; Bouchard, J-P; Salachas, F; Meininger, V; Andersen, P M; Camu, W; Dupré, N; Rouleau, G A

2008-08-12

The paraoxonase gene cluster on chromosome 7 comprising the PON1-3 genes is an attractive candidate for association in amyotrophic lateral sclerosis (ALS) given the role of paraoxonase genes during the response to oxidative stress and their contribution to the enzymatic break down of nerve toxins. Oxidative stress is considered one of the mechanisms involved in ALS pathogenesis. Evidence for this includes the fact that mutations of SOD1, which normally reduce the production of toxic superoxide anion, account for 12% to 23% of familial cases in ALS. In addition, PON variants were shown to be associated with susceptibility to ALS in several North American and European populations. We extended this analysis to examine 20 single nucleotide polymorphisms (SNPs) across the PON gene cluster in a set of patients from France (480 cases, 475 controls), Quebec (159 cases, 95 controls), and Sweden (558 cases, 506 controls). Although individual SNPs were not considered associated on their own, a haplotype of SNPs at the C-terminal portion of PON2 that includes the PON2 C311S amino acid change was significant in the French (p value 0.0075) and Quebec (p value 0.026) populations as well as all three populations combined (p value 1.69 x 10(-6)). Stratification of the samples showed that this variation was pertinent to ALS susceptibility as a whole, and not to a particular subset of patients. These findings contribute to the increasing weight of evidence that genetic variants in the paraoxonase gene cluster are associated with amyotrophic lateral sclerosis.

An unusual case of smothering secondary to ingesting raw pet cat.

PubMed

Redpath, Margaret; Sauvageau, Anny

2011-06-01

Smothering is defined as an obstruction of the air passages above the level of the epiglottis, including the nose, mouth, and pharynx. This is in contrast to choking, which is considered to be due to an obstruction of the air passages below the epiglottis. The manner of death in smothering can be homicidal, suicidal, or an accident. Accidental smothering is considered to be a rare event among middle-aged adults, yet many cases still occur. Presented here is the case of a 39-year-old woman with a history of bipolar disease who was found dead on her living room floor by her neighbors. Her hands were covered in scratches and her pet cat was found disemboweled in the kitchen with its tail hacked off. On autopsy her stomach was found to be full of cat intestines, adipose tissue, and strips of fur-covered skin. An intact left kidney and adipose tissue were found lodged in her throat just above her epiglottis. After a complete investigation, the cause of death was determined to be asphyxia by smothering due to animal tissue.

Use of electron microscopy to classify canine perivascular wall tumors.

PubMed

Palmieri, C; Avallone, G; Cimini, M; Roccabianca, P; Stefanello, D; Della Salda, L

2013-03-01

The histologic classification of canine perivascular wall tumors (PWTs) is controversial. Many PWTs are still classified as hemangiopericytomas (HEPs), and the distinction from peripheral nerve sheath tumors (PNSTs) is still under debate. A recent histologic classification of canine soft tissue sarcomas included most histologic types of PWT but omitted those that were termed undifferentiated. Twelve cases of undifferentiated canine PWTs were evaluated by transmission electron microscopy. The ultrastructural findings supported a perivascular wall origin for all cases with 4 categories of differentiation: myopericytic (n = 4), myofibroblastic (n = 1), fibroblastic (n = 2), and undifferentiated (n = 5). A PNST was considered unlikely in each case based on immunohistochemical expression of desmin and/or the lack of typical ultrastructural features, such as basal lamina. Electron microscopy was pivotal for the subclassification of canine PWTs, and the results support the hypothesis that canine PWTs represent a continuum paralleling the phenotypic plasticity of vascular mural cells. The hypothesis that a subgroup of PWTs could arise from a pluripotent mesenchymal perivascular wall cell was also considered and may explain the diverse differentiation of canine PWTs.

Primary pulmonary lymphoma mimicking a refractory lung abscess: A case report.

PubMed

Matsumoto, Takeshi; Otsuka, Kojiro; Funayama, Yuki; Imai, Yukihiro; Tomii, Keisuke

2015-04-01

The current study presents a case of primary pulmonary lymphoma (PPL) mimicking refractory lung abscess that was diagnosed at autopsy. An 80-year-old male with clinically inapparent aspiration presented with a large cavitated mass and pleural effusion. A lung abscess and empyema was diagnosed, therefore, antibiotics were administered and the pleural effusion was drained. Various examinations, including a biopsy, yielded no specific diagnosis. The lesion was considered inoperable due to the poor general condition of the patient. Subsequently, the mass that had been diagnosed as a refractory lung abscess became enlarged and a repeat biopsy resulted in a diagnosis of diffuse large B-cell lymphoma. The patient succumbed to sudden respiratory failure, and the final diagnosis of PPL was confirmed at autopsy. PPL is a rare disease that accounts for 0.45% of all pulmonary malignant tumors and is difficult to diagnose in inoperable cases. Therefore, patients with PPL who do not undergo surgery can be misdiagnosed and consequently treated inappropriately. PPL should therefore be considered in the differential diagnosis of a refractory lung abscess.

Cytologic characteristics of adenoid cystic carcinoma of the cervix uteri--case report.

PubMed

Barisić, Ana; Mahovlić, Vesna; Ovanin-Rakić, Ana; Skopljanac-Macina, Lada; Rajhvajn, Sanda; Juric, Danijela; Babić, Damir

2010-03-01

Adenoid cystic carcinoma is a rare malignancy, usually found in the salivary glands, although this unusual tumor can be found at other sites of the body. In particular, regarding adenoid cystic carcinoma of the cervix (ACCC) most frequently reports are given for postmenopausal women. In this respect, our work is one among very few in the literature that considers a cytologic picture of this uncommon cervix carcinoma. The case of 74 year old patient with postmenopausal bleeding is described. Both Pap smear and air dried smear of the uterine cervix were analyzed. The cytologic findings revealed very few small clusters of abnormal glandular cells, as well as some amorphous eosinophilic globule-like material, with granulomatous and necrotic background. The latter includes a lot of histiocytes, multinucleated giant cells, large aggregates of epitheloid cells and lymphocytes. Histology revealed the diagnosis of ACCC. We emphasize the importance of careful screening of Pap smear that might be crucial in the case of suspicious clinical findings in postmenopausal women, when the possibility of ACCC has to be considered.

Nonlinear guided wave propagation in prestressed plates.

PubMed

Pau, Annamaria; Lanza di Scalea, Francesco

2015-03-01

The measurement of stress in a structure presents considerable interest in many fields of engineering. In this paper, the diagnostic potential of nonlinear elastic guided waves in a prestressed plate is investigated. To do so, an analytical model is formulated accounting for different aspects involved in the phenomenon. The fact that the initial strains can be finite is considered using the Green Lagrange strain tensor, and initial and final configurations are not merged, as it would be assumed in the infinitesimal strain theory. Moreover, an appropriate third-order expression of the strain energy of the hyperelastic body is adopted to account for the material nonlinearities. The model obtained enables to investigate both the linearized case, which gives the variation of phase and group velocity as a function of the initial stress, and the nonlinear case, involving second-harmonic generation as a function of the initial state of stress. The analysis is limited to Rayleigh-Lamb waves propagating in a plate. Three cases of initial prestress are considered, including prestress in the direction of the wave propagation, prestress orthogonal to the direction of wave propagation, and plane isotropic stress.

[Poles of American tegumentary leishmaniasis production in northern Paraná State, Brazil].

PubMed

Monteiro, Wuelton Marcelo; Neitzke, Herintha Coeto; Silveira, Thaís Gomes Verzignassi; Lonardoni, Maria Valdrinez Campana; Teodoro, Ueslei; Ferreira, Maria Eugênia Moreira Costa

2009-05-01

American tegumentary leishmaniasis is endemic in the State of Paraná, with 99.3% of the cases reported in the South of Brazil. Spatial distribution of the disease in northern Paraná was verified, identifying the most relevant geographic areas in epidemiological terms. The study used data recorded on epidemiological forms from the Teaching and Research Clinical Test Laboratory of the State University in Maringá, from 1987 to 2004. The study only included individuals that were infected in the municipalities (counties) in northern Paraná. Identification of the epidemiological units (poles and circuits) was based on spatial density of cases, according to the model proposed by the National Health Foundation, considering the most likely infection sites. Considering 1,933 reported cases, 1,611 were infected in northern Paraná. American tegumentary leishmaniasis distribution in Paraná State suggests two circuits for production of the disease: Paraná-Paranapanema, highlighting the Cinzas-Laranjinha, Tibagi, Ivaí-Pirapó, Piquiri, and Baixo Iguaçu poles, and Ribeira, highlighting the Alto Ribeira pole.

Associated anomalies in cases with esophageal atresia.

PubMed

Stoll, Claude; Alembik, Yves; Dott, Beatrice; Roth, Marie-Paule

2017-08-01

Esophageal atresia (EA) is a common type of congenital anomaly. The etiology of esophageal atresia is unclear and its pathogenesis is controversial. Infants with esophageal atresia often have other non-EA associated congenital anomalies. The purpose of this investigation was to assess the prevalence and the types of these associated anomalies in a defined population. The associated anomalies in cases with EA were collected in all livebirths, stillbirths, and terminations of pregnancy during 29 years in 387,067 consecutive births in the area covered by our population-based registry of congenital malformations. Of the 116 cases with esophageal atresia, representing a prevalence of 2.99 per 10,000, 54 (46.6%) had associated anomalies. There were 9 (7.8%) cases with chromosomal abnormalities including 6 trisomies 18, and 20 (17.2%) nonchromosomal recognized dysmorphic conditions including 12 cases with VACTERL association and 2 cases with CHARGE syndrome. Twenty five (21.6%) of the cases had multiple congenital anomalies (MCA). Anomalies in the cardiovascular, the digestive, the urogenital, the musculoskeletal, and the central nervous systems were the most common other anomalies. The anomalies associated with esophageal atresia could be classified into a recognizable malformation syndrome or pattern in 29 out of 54 cases (53.7%). This study included special strengths: each affected child was examined by a geneticist, all elective terminations were ascertained, and the surveillance for anomalies was continued until 2 years of age. In conclusion the overall prevalence of associated anomalies, which was close to one in two cases, emphasizes the need for a thorough investigation of cases with EA. A routine screening for other anomalies may be considered in infants and in fetuses with EA. © 2017 Wiley Periodicals, Inc.

Use case driven approach to develop simulation model for PCS of APR1400 simulator

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

Dong Wook, Kim; Hong Soo, Kim; Hyeon Tae, Kang

2006-07-01

The full-scope simulator is being developed to evaluate specific design feature and to support the iterative design and validation in the Man-Machine Interface System (MMIS) design of Advanced Power Reactor (APR) 1400. The simulator consists of process model, control logic model, and MMI for the APR1400 as well as the Power Control System (PCS). In this paper, a use case driven approach is proposed to develop a simulation model for PCS. In this approach, a system is considered from the point of view of its users. User's view of the system is based on interactions with the system and themore » resultant responses. In use case driven approach, we initially consider the system as a black box and look at its interactions with the users. From these interactions, use cases of the system are identified. Then the system is modeled using these use cases as functions. Lower levels expand the functionalities of each of these use cases. Hence, starting from the topmost level view of the system, we proceeded down to the lowest level (the internal view of the system). The model of the system thus developed is use case driven. This paper will introduce the functionality of the PCS simulation model, including a requirement analysis based on use case and the validation result of development of PCS model. The PCS simulation model using use case will be first used during the full-scope simulator development for nuclear power plant and will be supplied to Shin-Kori 3 and 4 plant. The use case based simulation model development can be useful for the design and implementation of simulation models. (authors)« less

Tuberculosis in Auckland autopsies, revisited.

PubMed

Lum, Dennis; Koelmeyer, Timothy

2005-03-11

To review the cases of tuberculosis found at autopsy in the Auckland Coronial Autopsy Service in the previous 10 years, and compare the results with that of a similar study for the period 1975 to 1992. Cases which were not diagnosed prior to autopsy are scrutinised as to why the diagnosis may have been missed. A computerised search of the Forensic Pathology Department database at Auckland Hospital for cases of tuberculosis or atypical mycobacterial infection found at autopsy was done. Basic demographic data, past medical history, and police reports were analysed. The cases were placed into five groups for analysis. A total of 30 cases of tuberculosis (including 3 cases of atypical mycobacterial infection) were found. A large proportion (70%) was undiagnosed before death, and each case was potentially infective. Two cases had respiratory symptoms suggestive of tuberculosis, and a further 5 cases had generalised symptoms which were unexplained yet tuberculosis was not considered. In those cases that were missed, the autopsy played a vital role by identifying the previously undiagnosed cases of tuberculosis and ensuring contact screening. Awareness of tuberculosis and its increasing prevalence in New Zealand is essential for minimising missed diagnoses.

Judgement of suffering in the case of a euthanasia request in The Netherlands.

PubMed

Rietjens, J A C; van Tol, D G; Schermer, M; van der Heide, A

2009-08-01

In The Netherlands, physicians have to be convinced that the patient suffers unbearably and hopelessly before granting a request for euthanasia. The extent to which general practitioners (GPs), consulted physicians and members of the euthanasia review committees judge this criterion similarly was evaluated. 300 GPs, 150 consultants and 27 members of review committees were sent a questionnaire with patient descriptions. Besides a "standard case" of a patient with physical suffering and limited life expectancy, the descriptions included cases in which the request was mainly rooted in psychosocial or existential suffering, such as fear of future suffering or dependency. For each case, respondents were asked whether they recognised the case from their own practice and whether they considered the suffering to be unbearable. The cases were recognisable for almost all respondents. For the "standard case" nearly all respondents were convinced that the patient suffered unbearably. For the other cases, GPs thought the suffering was unbearable less often (2-49%) than consultants (25-79%) and members of the euthanasia review committees (24-88%). In each group, the suffering of patients with early dementia and patients who were "tired of living" was least often considered to be unbearable. When non-physical aspects of suffering are central in a euthanasia request, there is variance between and within GPs, consultants and members of the euthanasia committees in their judgement of the patient's suffering. Possible explanations could be differences in their roles in the decision-making process, differences in experience with evaluating a euthanasia request, or differences in views regarding the permissibility of euthanasia.

Imaging in conjunction with physical therapy in management of a patient with history of thoracic tumour

PubMed Central

Rendeiro, Daniel G.; Deyle, Gail D.; Boissonnault, William G.

2015-01-01

Background: Physical therapy care for musculoskeletal conditions includes an ongoing process that systematically considers and prioritises diagnostic hypotheses. These diagnostic hypotheses include those that are typical for common musculoskeletal conditions, and must also include more rare conditions that would require care outside the scope of practice of the physical therapist. When additional screening is required, physical therapists collaborate with other providers or directly order the appropriate tests to rule out suspected pathology. Case Description: This article illustrates the use of musculoskeletal imaging ordered by a physical therapist to guide ongoing management of a patient with back pain and a history of cancer. Outcomes: The patient successfully returned to moderate-intensity sport activities after a course of physical therapy. Discussion: This case provides an example of how clinical diagnostic reasoning combined with clinical privileges to order musculoskeletal imaging can facilitate diagnostic accuracy in a timely and cost-efficient manner. PMID:26309382

Adverse reactions to sulfites

PubMed Central

Yang, William H.; Purchase, Emerson C.R.

1985-01-01

Sulfites are widely used as preservatives in the food and pharmaceutical industries. In the United States more than 250 cases of sulfite-related adverse reactions, including anaphylactic shock, asthmatic attacks, urticaria and angioedema, nausea, abdominal pain and diarrhea, seizures and death, have been reported, including 6 deaths allegedly associated with restaurant food containing sulfites. In Canada 10 sulfite-related adverse reactions have been documented, and 1 death suspected to be sulfite-related has occurred. The exact mechanism of sulfite-induced reactions is unknown. Practising physicians should be aware of the clinical manifestations of sulfite-related adverse reactions as well as which foods and pharmaceuticals contain sulfites. Cases should be reported to health officials and proper advice given to the victims to prevent further exposure to sulfites. The food industry, including beer and wine manufacturers, and the pharmaceutical industry should consider using alternative preservatives. In the interim, they should list any sulfites in their products. PMID:4052897

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

Arias-Zugasti, Manuel; High Temperature Chemical Reaction Engineering Laboratory and Yale Center for Combustion Studies, Department of Chemical Engineering, Yale University, New Haven, CT 06520-8286; Rosner, Daniel E.

Since, according to ideal gas kinetic theory, Ludwig-Soret species transport (temperature-gradient-driven mass transport) must be simultaneously included along with nonunity Lewis numbers [D.E. Rosner, R.S. Israel, B. La Mantia, Combust. Flame 123 (2000) 547-560], we formally consider here the influence of both effects on laminar, counterflow gaseous diffusion flames in the thin flame limit. Our deliberately idealized theoretical analysis includes cases of steady/unsteady, strained/unstrained flames and formally permits the prediction of trends for the combustion of either light or heavy fuel vapors in O{sub 2}-containing streams. Our results suggest that, in cases of low- or high-molecular-weight gaseous fuels, Ludwig-Soret transportmore » can itself introduce significant shifts in flame position and flame temperature, compared to results of the same mathematical model neglecting Soret fuel-vapor transport but including only nonunity fuel Lewis numbers. These systematic shifts (which in specific cases may have to be supplemented by additional corrections due to variable thermophysical properties) are expected to have important consequences for NO{sub x} production and/or infrared radiation emission. (author)« less

Uniparental disomy and prenatal phenotype: Two case reports and review.

PubMed

Li, Xiaofei; Liu, Yan; Yue, Song; Wang, Li; Zhang, Tiejuan; Guo, Cuixia; Hu, Wenjie; Kagan, Karl-Oliver; Wu, Qingqing

2017-11-01

Uniparental disomy (UPD) gives a description of the inheritance of both homologues of a chromosome pair from the same parent. The consequences of UPD depend on the specific chromosome/segment involved and its parental origin. We report prenatal phenotypes of 2 rare cases of UPD. The prenatal phenotype of case 1 included sonographic markers such as enlarged nuchal translucency (NT), absent nasal bone, short femur and humerus length, and several structural malformations involving Dandy-Walker malformation and congenital heart defects. The prenatal phenotype of Case 2 are sonographic markers, including enlarged NT, thickened nuchal fold, ascites, and polyhydramnios without apparent structural malformations. Conventional G-band karyotype appears normal in case 1, while it shows normal chromosomes with a small supernumerary marker chromosome (sSMC) in case 2. Genetic etiology was left unknown until single-nucleotide polymorphism-based array (SNP-array) was performed, and segmental paternal UPD 22 was identified in case 1 and segmental paternal UPD 14 was found in case 2. The parents of case 1 chose termination of pregnancy. The neonate of case 2 was born prematurely with a bellshaped small thorax and died within a day. UPD cases are rare and the phenotypes are different, which depend on the origin and affected chromosomal part. If a fetus shows multiple anomalies that cannot be attributed to a common aneuploidy or a genetic syndrome, or manifests some features possibly related to an UPD syndrome, such as detection of sSMC, SNP-array should be considered.

49 CFR 1109.4 - Mandatory mediation in rate cases to be considered under the stand-alone cost methodology.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 8 2010-10-01 2010-10-01 false Mandatory mediation in rate cases to be considered... § 1109.4 Mandatory mediation in rate cases to be considered under the stand-alone cost methodology. (a) A... methodology must engage in non-binding mediation of its dispute with the railroad upon filing a formal...

Analyzing risks to protected areas using the human modification framework: a Colorado case study

Treesearch

David M. Theobald; Alisa Wade; Grant Wilcox; Nate Peterson

2010-01-01

A framework that organizes natural and protected areas is often used to help understand the potential risks to natural areas and aspects of their ecological and human dimensions. The spatial (or landscape) context of these dynamics is also a critical, but, rarely considered, factor. Common classification systems include the U.S. Geological (USGS) Gap Analysis Program...

Impact of Childhood Sexual Abuse on College Student Development: A Seven-Vectors Perspective

ERIC Educational Resources Information Center

Goldberg, Daniel B.

2016-01-01

The application of theory in this article expanded on Chickering and Reisser's ([Chickering, A. W., 1993]) 7-vectors framework by considering the effects of childhood sexual abuse (CSA) on the normal experience of student development in higher education. The article includes an overview of the prevalence and effects of CSA and a case study of a…

"Supporting" Beginning Secondary Science Teachers through Induction: A Multi-Case Study of Their Meaning Making and Identities

ERIC Educational Resources Information Center

Webb, Angela W.

2012-01-01

The purpose of this study was to explore the induction experiences of beginning secondary science teachers, including their afforded and enacted identities-in-practice and their meaning making. I applied a model of identities and meaning making that considered the iterative nature of the (a) normative science teacher identities afforded by…

A New Lifetime Distribution with Bathtube and Unimodal Hazard Function

NASA Astrophysics Data System (ADS)

Barriga, Gladys D. C.; Louzada-Neto, Francisco; Cancho, Vicente G.

2008-11-01

In this paper we propose a new lifetime distribution which accommodate bathtub-shaped, unimodal, increasing and decreasing hazard function. Some special particular cases are derived, including the standard Weibull distribution. Maximum likelihood estimation is considered for estimate the tree parameters present in the model. The methodology is illustrated in a real data set on industrial devices on a lite test.

Interoperable Architecture for Command and Control

DTIC Science & Technology

2014-06-01

defined objective. Elements can include other systems, people, processes, technology and other support elements (Adapted from [9]). Enterprise System...An enterprise is an intentionally created entity of human endeavour with a certain purpose. An enterprise could be considered a type of system [7]. In...this case the enterprise is a Defence Enterprise System required by government as a tool to maintain national sovereignty. Capability

On Teaching the Scientific Complexity of Germination: A Study with Prospective Elementary Teachers

ERIC Educational Resources Information Center

Vidal, Manuel; Membiela, Pedro

2014-01-01

This study reveals and discusses the problems of future elementary teachers after they have completed a practical on germination, including the fact that such practice is conceptually more complex than is usually considered, at least when the aim is to experiment with the determinant factors for germination. In this case there seemed to be some…

Recent Advances in Human Protozoan Parasites of Gastrointestinal Tract

DTIC Science & Technology

1987-02-01

biology of the parasites, the epidemiology , diagnosis, pathogenesis and treatment. Furthermore, protozoan parasites formerly considered of no human...gastrointestinal tract and the epidemiology and pathogenesis of the diseases they cause; in most cases only papers published since 1980 were included. FLAGELLATES...are diarrhea, abdominal pain and occasionally anal pruritis. There have also been several reports of eosinophilia associated with D. fragilis

CSS Need Analysis: Theory and Computation Procedures for 1976-77 PCS and SFS Including Sample Cases and Tables.

ERIC Educational Resources Information Center

College Entrance Examination Board, New York, NY. Coll. Scholarship Service.

This guide is to help professional personnel who are involved in the distribution of financial aid understand how the parent's and the student's expected contributions are derived. It prepares the financial aid administrator to consider individual adjustments that may be appropriated in the amounts expected from the student and his family in…

Private College Mergers and State Policy: A Case Study of New York. State Policy and Private College Distress.

ERIC Educational Resources Information Center

Chambers, Gail S.

The regulation of the college merger process in New York, including its effects on a recent merger between private institutions, is examined. New York's higher education policy formation process and the laws and policies that make college mergers possible are considered. The merger of Eisenhower College and Rochester Institute of Technology…

Atrial Arrhythmias and Their Implications for Space Flight - Introduction

NASA Technical Reports Server (NTRS)

Polk, J. D.; Barr, Y. R.; Bauer, P.; Hamilton, D. R.; Kerstman, E.; Tarver, B.

2010-01-01

This panel will discuss the implications of atrial arrhythmias in astronauts from a variety of perspectives; including historical data, current practices, and future challenges for exploration class missions. The panelists will present case histories, outline the evolution of current NASA medical standards for atrial arrhythmias, discuss the use of predictive tools, and consider potential challenges for current and future missions.

A Critical Analysis of Retributive Punishment as a Discipline Measure in Nigeria's Public Secondary Schools

ERIC Educational Resources Information Center

Aboluwodi, Akinjide

2015-01-01

In recent time, students in Nigerian secondary schools engage in certain acts considered to be inimical to the health of their schools. There were cases of students who caused their mates and teachers bodily harm, and tore mates' books and school uniform. Most school authorities in Nigeria adopt different forms of punishment including retributive…

Anthropological Diplomacy: Case Studies in the Applications of Anthropology to International Relations. Studies in Third World Societies, Publication Number Twenty-One.

ERIC Educational Resources Information Center

Magnarella, Paul J., Ed.

Six articles in this volume focus on anthropological diplomacy--the study of the theory and practice of peace and conflict resolution among societies, based on knowledge of a society's fundamental cultural premises. The first article, by Ronald Cohen, considers questions pertinent to anthropological diplomacy, including the impact of diverse…

You Turn up the First Day and They Expect You to Come Back! Gifted Students' Perspectives on School and Being Smart

ERIC Educational Resources Information Center

Gallagher, Selena; Smith, Susen; Merrotsy, Peter

2013-01-01

This qualitative multi-site case study sought to examine the current educational provisions in place for intellectually gifted primary school students in Queensland, and to consider the attitudes and perceptions of a range of different stakeholders, including teachers, parents and students. The perspectives of students towards their school and…

Acceptable Interventions to Reduce Syphilis Transmission Among High-Risk Men Who Have Sex With Men in Los Angeles

PubMed Central

Plant, Aaron; Javanbakht, Marjan; Cross, John; Montoya, Jorge A.; Bolan, Robert; Kerndt, Peter R.

2015-01-01

Objectives. We examined perceptions of and attitudes toward existing and potential syphilis interventions, including case management and Web-based programs, to increase syphilis testing among high-risk men who have sex with men (MSM). Methods. Between October 2010 and June 2011, we conducted in-depth interviews with 19 MSM in Los Angeles, California, with repeat early syphilis infections (primary, secondary, and early latent syphilis) within the previous 5 years. We analyzed the interviews inductively to determine the most acceptable potential interventions. Results. Experiences with health department and community-based standard of care case management were generally positive. The most popular interventions among respondents included a Web site providing information on syphilis and syphilis testing, automated Web reminders to test, being paid to test, free online home testing kits, and preexposure prophylactic medication. Respondents’ beliefs that they would continue to practice high-risk sexual behaviors reinforced their reasons for wanting increased accessibility and convenient testing strategies. Conclusions. Public health officials should consider participant responses to potential interventions for syphilis, which suggest that high-risk MSM would consider testing more often or using other interventions. PMID:25602881

Time-domain full-waveform inversion of Rayleigh and Love waves in presence of free-surface topography

NASA Astrophysics Data System (ADS)

Pan, Yudi; Gao, Lingli; Bohlen, Thomas

2018-05-01

Correct estimation of near-surface seismic-wave velocity when encountering lateral heterogeneity and free surface topography is one of the challenges to current shallow seismic. We propose to use time-domain full-waveform inversion (FWI) of surface waves, including both Rayleigh and Love waves, to solve this problem. We adopt a 2D time-domain finite-difference method with an improved vacuum formulation (IVF) to simulate shallow-seismic Rayleigh wave in presence of free-surface topography. We modify the IVF for SH-wave equation for the simulation of Love wave in presence of topographic free surface and prove its accuracy by benchmark tests. Checkboard model tests are performed in both cases when free-surface topography is included or neglected in FWI. Synthetic model containing a dipping planar free surface and lateral heterogeneity was then tested, in both cases of considering and neglecting free-surface topography. Both checkerboard and synthetic models show that Rayleigh- and Love-wave FWI have similar ability of reconstructing near-surface structures when free-surface topography is considered, while Love-wave FWI could reconstruct near-surface structures better than Rayleigh-wave when free-surface topography is neglected.

Consequences of corporal punishment among African Americans: the importance of context and outcome.

PubMed

Simons, Leslie Gordon; Simons, Ronald L; Su, Xiaoli

2013-08-01

Corporal punishment is a controversial practice used by the majority of American parents and is especially prevalent among African Americans. Research regarding its consequences has produced mixed results although it is clear that there is a need for considering the context within which corporal punishment is administered. To assess the impact of spanking, we employed an expanded parenting typology that includes corporal punishment. Longitudinal self-report data from a sample of 683 African American youth (54% female) were utilized to evaluate the relative impact of the resulting eight parenting styles on three outcomes: conduct problems, depressive symptoms, and school engagement. Results from Negative Binomial Regression Models indicate that the effect of corporal punishment depends upon the constellation of parenting behaviors within which it is embedded and upon the type of outcome being considered. While it is never the case that there is any added benefit of adding corporal punishment, it is also the case that using corporal punishment is not always associated with poor outcomes. Overall, however, our findings show that parenting styles that include corporal punishment do not produce outcomes as positive as those associated with authoritative parenting.

Treatment of malignant gastric outlet obstruction with endoscopically placed self-expandable metal stents

PubMed Central

Gaidos, Jill KJ; Draganov, Peter V

2009-01-01

Malignant gastroduodenal obstruction can occur in up to 20% of patients with primary pancreatic, gastric or duodenal carcinomas. Presenting symptoms include nausea, vomiting, abdominal distention, pain and decreased oral intake which can lead to dehydration, malnutrition, and poor quality of life. Endoscopic stent placement has become the primary therapeutic modality because it is safe, minimally invasive, and a cost-effective option for palliation. Stents can be successfully deployed in the majority of patients. Stent placement appears to lead to a shorter time to symptomatic improvement, shorter time to resumption of an oral diet, and shorter hospital stays as compared with surgical options. Recurrence of the obstructive symptoms resulting from stent occlusion, due to tumor ingrowth or overgrowth, can be successfully treated with repeat endoscopic stent placement in the majority of the cases. Both endoscopic stenting and surgical bypass are considered palliative treatments and, to date, no improvement in survival with either modality has been demonstrated. A tailored therapeutic approach, taking into consideration patient preferences and involving a multidisciplinary team including the therapeutic endoscopist, surgeon, medical oncologist, radiation therapist, and interventional radiologist, should be considered in all cases. PMID:19764086

Estimation of the incidence of severe fever with thrombocytopenia syndrome in high endemic areas in China: an inpatient-based retrospective study.

PubMed

Huang, Xiaoxia; Wang, Shiwen; Wang, Xianjun; Lyu, Yong; Jiang, Mei; Chen, Deying; Li, Kaichun; Liu, Jingyu; Xie, Shaoyu; Lyu, Tao; Sun, Jie; Xu, Pengpeng; Cao, Minghua; Liang, Mifang; Li, Dexin

2018-02-05

Severe fever with thrombocytopenia syndrome (SFTS) is a severe viral disease caused by SFTSV. It is important to estimate the rate of missed SFTS diagnosis and to further understand the actual incidence in high endemic areas in China. This study was conducted in two high SFTS endemic provinces in 2015. Patients hospitalized in 2014 or within 1 year before investigation were selected after considering their clinical manifestations, specifically, fever, platelet, and white blood cell. During retrospective investigation, sera were collected to detect SFTSV antibodies to assess SFTSV infection. To further understand SFTSV infection, acute phase sera were detected; SFTSV infection rate among a healthy population was also investigated to determine the basic infection level. In total, 246 hospitalized cases were included, including 83 cases (33.7%) with fever, thrombocytopenia and leukopenia, 38 cases (15.4%) with fever and thrombocytopenia but without leukopenia, and 125 cases (50.8%) without fever but with thrombocytopenia and leukopenia. In total, 13 patients (5.3%) were SFTSV IgM antibody-positive, 48 (19.5%) were IgG-positive. Of the 13 IgM-positive cases, 11 (84.6%) were IgG-positive (9 with titres ≥1:400). Seropositive rates of antibodies were high (8.4% for IgM and 30.1% for IgG) in patients with fever, thrombocytopenia and leukopenia. Furthermore, among IgG-positive cases in this group, 76% (19/25) of patients' IgG antibody titres were ≥1:400. Additionally, 28 of 246 cases were initially diagnosed with suspected SFTS and were then excluded, and 218 patients were never diagnosed with SFTS; the seropositive rates of IgM and IgG in these two groups were 25% and 67.9% and 2.8% and 13.3%, respectively. These rates were 64.3% and 21.4% in 14 sera collected during acute phase of the 28 cases mentioned above. Seropositive rate of SFTSV IgG was only 1.3% in the patient-matched healthy group, and no IgM antibody was detected. A preliminary estimate of 8.3% of SFTS cases were missed in SFTS high endemic provinces. The actual SFTS incidence was underestimated. Effective measures such as adding a new SFTS case category - "SFTS clinical diagnosis cases" or using serological detection methods during acute phase should be considered to avoid missed diagnoses.

Retrospective Study of Histomoniasis (Blackhead) in California Turkey Flocks, 2000-2014.

PubMed

Hauck, R; Stoute, S; Chin, R P; Sentíes-Cué, C G; Shivaprasad, H L

2018-03-01

The flagellate parasite Histomonas meleagridis causes a severe disease in turkeys. Since nitarsone, the last antiflagellate feed additive, was withdrawn from the market, H. meleagridis has gained increasing clinical and economic importance, and frequently entire turkey flocks are lost to the disease. Even before the antiflagellate market withdrawal, H. meleagridis has been recognized as a noteworthy disease in commercial turkeys. The aim of this study was to compile and analyze data on histomoniasis outbreaks diagnosed by the California Animal Health and Food Safety System in the years 2000 through 2014 while nitarsone was still available. Sixty-two cases were included in the study. In all cases, the parasite was detected by histopathology. Five cases were from breeder flocks, 44 from commercial meat turkey flocks, and 13 from other flocks such as backyard flocks or pet turkeys. There were between one and eight cases each year with no clear trend over time. Most cases occurred in the warmer months between April and October with a clear peak in August. Turkeys in the flocks with the disease were aged between 2 wk and 15 mo, with a median age of 9 wk. In cases for which mortality was reported, daily mortality ranged between 0.04% and 2% with an average of 0.34% and a median of 0.15%. Five-week mortality in infected houses on three infected ranches was between 1.3% and 68%. In 12 cases, the parasite was observed in organs other than ceca and liver. These included spleen, kidney, bursa of Fabricius, proventriculus, lung, pancreas, and crop. In 58 cases, histomoniasis was considered the most significant and primary diagnosis; in four cases histomoniasis was regarded as an incidental finding. In 14 other outbreaks, detailed information was available. In 11 cases, more than one house on the ranch was affected; in five cases the disease spread to all houses. Total mortality in turkeys from affected flocks ranged between 12% and 65%. In eight flocks, the birds were marketed with a weight that was considered too light. In conclusion, the present study shows that even with nitarsone available as antiflagellate feed, additive histomoniasis was a serious disease of turkeys in the United States with an epidemiology similar to that observed in Europe.

Plasmodium vivax Hospitalizations in a Monoendemic Malaria Region: Severe Vivax Malaria?

PubMed Central

Quispe, Antonio M.; Pozo, Edwar; Guerrero, Edith; Durand, Salomón; Baldeviano, G. Christian; Edgel, Kimberly A.; Graf, Paul C. F.; Lescano, Andres G.

2014-01-01

Severe malaria caused by Plasmodium vivax is no longer considered rare. To describe its clinical features, we performed a retrospective case control study in the subregion of Luciano Castillo Colonna, Piura, Peru, an area with nearly exclusive vivax malaria transmission. Severe cases and the subset of critically ill cases were compared with a random set of uncomplicated malaria cases (1:4). Between 2008 and 2009, 6,502 malaria cases were reported, including 106 hospitalized cases, 81 of which fit the World Health Organization definition for severe malaria. Of these 81 individuals, 28 individuals were critically ill (0.4%, 95% confidence interval = 0.2–0.6%) with severe anemia (57%), shock (25%), lung injury (21%), acute renal failure (14%), or cerebral malaria (11%). Two potentially malaria-related deaths occurred. Compared with uncomplicated cases, individuals critically ill were older (38 versus 26 years old, P < 0.001), but similar in other regards. Severe vivax malaria monoinfection with critical illness is more common than previously thought. PMID:24752683

Plasmodium vivax hospitalizations in a monoendemic malaria region: severe vivax malaria?

PubMed

Quispe, Antonio M; Pozo, Edwar; Guerrero, Edith; Durand, Salomón; Baldeviano, G Christian; Edgel, Kimberly A; Graf, Paul C F; Lescano, Andres G

2014-07-01

Severe malaria caused by Plasmodium vivax is no longer considered rare. To describe its clinical features, we performed a retrospective case control study in the subregion of Luciano Castillo Colonna, Piura, Peru, an area with nearly exclusive vivax malaria transmission. Severe cases and the subset of critically ill cases were compared with a random set of uncomplicated malaria cases (1:4). Between 2008 and 2009, 6,502 malaria cases were reported, including 106 hospitalized cases, 81 of which fit the World Health Organization definition for severe malaria. Of these 81 individuals, 28 individuals were critically ill (0.4%, 95% confidence interval = 0.2-0.6%) with severe anemia (57%), shock (25%), lung injury (21%), acute renal failure (14%), or cerebral malaria (11%). Two potentially malaria-related deaths occurred. Compared with uncomplicated cases, individuals critically ill were older (38 versus 26 years old, P < 0.001), but similar in other regards. Severe vivax malaria monoinfection with critical illness is more common than previously thought. © The American Society of Tropical Medicine and Hygiene.

Necrotizing crescentic glomerulonephritis related to sarcoidosis: a case report.

PubMed

Maroz, Natallia; Field, Halle

2015-12-14

Renal injury due to sarcoidosis develops in less than a quarter of patients with this systemic disease. In most cases, granulomatous tissue alters the production of vitamin D, which leads to hypercalciuria, nephrocalcinosis, and nephrolithiasis. Granulomatous interstitial nephritis is another well-recognized pathological process associated with sarcoidosis. However, a glomerular pathology is very rarely noted, and only a few cases are reported to have cellular crescentic glomerulonephritis. We describe the case of a 26-year-old African American woman with systemic sarcoidosis, with a unique constellation of renal lesions, including noncaseating epithelioid granulomatous necrotizing interstitial nephritis, cellular crescent formation, and necrotizing vasculitis. Immunosuppressive therapy was helpful for alleviating her nephrotic syndrome and maintaining the stability of her renal function over a 30-month period. Glomerular involvement of sarcoidosis needs to be considered in the differential diagnosis in cases of rapidly progressive glomerular nephritis.

Effect of Surveillance Method on Reported Characteristics of Lyme Disease, Connecticut, 1996–2007

PubMed Central

Nelson, Randall S.; Cartter, Matthew L.

2012-01-01

To determine the effect of changing public health surveillance methods on the reported epidemiology of Lyme disease, we analyzed Connecticut data for 1996–2007. Data were stratified by 4 surveillance methods and compared. A total of 87,174 reports were received that included 79,896 potential cases. Variations based on surveillance methods were seen. Cases reported through physician-based surveillance were significantly more likely to be classified as confirmed; such case-patients were significantly more likely to have symptoms of erythema migrans only and to have illness onset during summer months. Case-patients reported through laboratory-based surveillance were significantly more likely to have late manifestations only and to be older. Use of multiple surveillance methods provided a more complete clinical and demographic description of cases but lacked efficiency. When interpreting data, changes in surveillance method must be considered. PMID:22304873

Expanding Ethics Review Processes to Include Community-Level Protections: A Case Study from Flint, Michigan.

PubMed

Key, Kent D

2017-10-01

As the Flint community endeavors to recover and move forward in the aftermath of the Flint water crisis, distrust of scientific and governmental authorities must be overcome. Future community engagement in research will require community-level protections ensuring that no further harm is done to the community. A community ethics review explores risks and benefits and complements institutional review board (IRB) review. Using the case of Flint, I describe how community-level ethical protections can reestablish a community's trust. All IRBs reviewing protocols that include risk to communities and not merely individual participants should consider how community members are engaged in the proposed research and identify and respond to questions and domains of concern from community members. © 2017 American Medical Association. All Rights Reserved.

A case of jaundice of obscure origin.

PubMed

Khan, Fahad M; Alcorn, Joseph; Hanson, Joshua

2014-05-01

Idiopathic painless jaundice with significant elevations in serum transaminases, occurring in a previously healthy patient, invokes a circumscribed set of possibilities including viral hepatitis, auto-immune hepatitis (AIH) and drug-induced liver injury (DILI). In this described case, common causes of cholestatic jaundice were considered including drug-induced liver injury, viral causes of hepatitis, and auto-immune antibodies. Biliary obstruction was excluded by appropriate imaging studies. Liver biopsy was obtained, though not definitive. After detailed investigation failed to reveal a cause of the jaundice, an empiric trial of steroids was initiated on the possibility that our patient had antibody-negative AIH and not DILI, with an associated grave prognosis. Empiric treatment with prednisone led to rapid resolution of jaundice and to the conclusion that the correct diagnosis was antibody-negative AIH.

Integrating Hypnosis with Other Therapies for Treating Specific Phobias: A Case Series.

PubMed

Hirsch, Joseph A

2018-04-01

There is a high prevalence of anxiety disorders including specific phobias and panic disorder in the United States and Europe. A variety of therapeutic modalities including pharmacotherapy, cognitive behavioral therapy, systematic desensitization, hypnosis, in vivo exposure, and virtual reality exposure therapy have been applied. No one modality has been entirely successful. There has been only a limited attempt to combine psychological therapies in the treatment of specific phobias and panic disorder and what has been done has been primarily with systematic desensitization or cognitive behavioral therapy along with hypnotherapy. I present two cases of multiple specific phobias that were successfully treated with hypnotherapy combined with virtual reality exposure therapy or in vivo exposure therapy. The rationale for this integrative therapy and the neurobiological constructs are considered.

Light on curved backgrounds

NASA Astrophysics Data System (ADS)

Batic, D.; Nelson, S.; Nowakowski, M.

2015-05-01

We consider the motion of light on different spacetime manifolds by calculating the deflection angle, lensing properties and by probing into the possibility of bound states. The metrics in which we examine the light motion include, among other items, a general relativistic dark matter metric, a dirty black hole, and a worm hole metric, the last two inspired by noncommutative geometry. The lensing in a holographic screen metric is discussed in detail. We study also the bending of light around naked singularities like, e.g., the Janis-Newman-Winicour metric and include other cases. A generic property of light behavior in these exotic metrics is pointed out. For the standard metric like the Schwarzschild and Schwarzschild-de Sitter cases, we improve the accuracy of the lensing results for the weak and strong regimes.

Abdominal Aortic Dissection and Cold-Intolerance After Whole-Body Cryotherapy: A Case Report.

PubMed

Cámara-Lemarroy, Carlos R; Azpiri-López, José R; Vázquez-Díaz, Luis A; Galarza-Delgado, Dionicio A

2017-09-01

Whole-body cryotherapy (WBC) involves short exposures to air temperatures below -100°C and is purported to enhance recovery after exercise and accelerate rehabilitation after injury. It is generally considered a procedure with few side effects, but there are no large studies that have established its safety profile. We present the case of a 56-year-old patient who developed an abdominal aortic dissection after receiving 15 sessions of WBC. The patient had no other strong risk factors for aortic dissection. Exposure to cold temperatures, including WBC, has multiple hemodynamic effects, including increases in blood pressure, heart rate, and an adrenergic response. We suggest that these changes could act as a trigger for the onset of aortic dissections. This could be the first reported cardiovascular complication associated with WBC.

Early Warning Signals of Social Transformation: A Case Study from the US Southwest.

PubMed

Spielmann, Katherine A; Peeples, Matthew A; Glowacki, Donna M; Dugmore, Andrew

2016-01-01

Recent research in ecology suggests that generic indicators, referred to as early warning signals (EWS), may occur before significant transformations, both critical and non-critical, in complex systems. Up to this point, research on EWS has largely focused on simple models and controlled experiments in ecology and climate science. When humans are considered in these arenas they are invariably seen as external sources of disturbance or management. In this article we explore ways to include societal components of socio-ecological systems directly in EWS analysis. Given the growing archaeological literature on 'collapses,' or transformations, in social systems, we investigate whether any early warning signals are apparent in the archaeological records of the build-up to two contemporaneous cases of social transformation in the prehistoric US Southwest, Mesa Verde and Zuni. The social transformations in these two cases differ in scope and severity, thus allowing us to explore the contexts under which warning signals may (or may not) emerge. In both cases our results show increasing variance in settlement size before the transformation, but increasing variance in social institutions only before the critical transformation in Mesa Verde. In the Zuni case, social institutions appear to have managed the process of significant social change. We conclude that variance is of broad relevance in anticipating social change, and the capacity of social institutions to mitigate transformation is critical to consider in EWS research on socio-ecological systems.

The importance of preoperative tissue sampling for mobile spine chordomas: literature review and report of two cases.

PubMed

Zuccato, Jeffrey A; Witiw, Christopher D; Keith, Julia; Dyer, Erin; Saghal, Arjun; da Costa, Leodante

2018-01-01

Pre-operative biopsy and diagnosis of chordomas of the mobile spine is indicated as en bloc resections improve outcomes. This review of the management of mobile spine chordomas includes two cases of unexpected mobile spine chordomas where a preoperative tissue diagnosis was decided against and may have altered surgical decision-making. Two lumbar spine chordomas thought to be metastatic and primary bony lesions preoperatively were not biopsied before surgery and eventual pathology revealed chordoma. Preoperative diagnoses were questioned during surgery after an intraoperative tissue diagnosis of chordoma in one case and unclear pathology with non-characteristic tumor morphology in the other. The surgical plan was altered in these cases to maximize resection as en bloc resection reduces the risk of local recurrence in chordoma. Mobile spine chordomas are rare and en bloc resection is recommended, contrary to the usual approach to more common spine tumors. Since en bloc resection of spine chordomas improves disease free survival, it has been recommended that tissue diagnosis be obtained preoperatively when chordoma is considered in the differential diagnosis, in order to guide surgical planning. We present two cases where a preoperative biopsy was considered but not obtained after neuroradiology consultation and imaging review, which may have been managed differently if the diagnosis of spine chordomas were known pre-operatively.

Prescribed curvature tensor in locally conformally flat manifolds

NASA Astrophysics Data System (ADS)

Pina, Romildo; Pieterzack, Mauricio

2018-01-01

A global existence theorem for the prescribed curvature tensor problem in locally conformally flat manifolds is proved for a special class of tensors R. Necessary and sufficient conditions for the existence of a metric g ¯ , conformal to Euclidean g, are determined such that R ¯ = R, where R ¯ is the Riemannian curvature tensor of the metric g ¯ . The solution to this problem is given explicitly for special cases of the tensor R, including the case where the metric g ¯ is complete on Rn. Similar problems are considered for locally conformally flat manifolds.

Modeling of enhanced spontaneous parametric down-conversion in plasmonic and dielectric structures with realistic waves

NASA Astrophysics Data System (ADS)

Loot, A.; Hizhnyakov, V.

2018-05-01

A numerical study of the enhancement of the spontaneous parametric down-conversion in plasmonic and dielectric structures is considered. The modeling is done using a nonlinear transfer-matrix method which is extended to include vacuum fluctuations and realistic waves (e.g. Gaussian beam). The results indicate that in the case of short-range surface plasmon polaritons, the main limiting factor of the enhancement is the short length of the coherent buildup. In the case of long-range surface plasmon polaritons or dielectric guided waves, the very narrow resonances are the main limiting factor instead.

Atypical Facial and Head Pain in Childhood and Adolescence.

PubMed

Grazzi, Licia; Sansone, Emanuela; Rizzoli, Paul

2018-05-03

This review will consider forms of atypical facial and head pain in children and adolescents. A brief and general overview of typical head and facial pains and treatments will be offered. Moreover, atypical head and face pain will be discussed with treatment options. The most recent literature including case reports will be evaluated; possible pathophysiological mechanisms, resulting disabilities, and family and social impact will be discussed. General indications for pharmacological treatment will be reviewed, when needed in more disabling cases. Also, non-pharmacological treatments that are especially suitable for this category of patients will be illustrated and discussed.

Oropharyngeal dysphagia and language delay in partial trisomy 9p: case report.

PubMed

Rossi, N F; Gatto, A R; Cola, P C; Souza, D H; Moretti-Ferreira, D; Giacheti, C M

2009-09-22

The phenotype of partial trisomy 9p includes global developmental delay, microcephaly, bulbous nose, downturned oral commissures, malformed ears, hypotonia, and severe cognitive and language disorders. We present a case report and a comparative review of clinical findings on this condition, focusing on speech-language development, cognitive abilities and swallowing evaluation. We suggest that oropharyngeal dysphagia should be further investigated, considering that pulmonary and nutritional disorders affect the survival and quality of life of the patient. As far as we know, this is the first study of a patient with partial trisomy 9p described with oropharyngeal dysphagia.

Uniparental disomy and prenatal phenotype

PubMed Central

Li, Xiaofei; Liu, Yan; Yue, Song; Wang, Li; Zhang, Tiejuan; Guo, Cuixia; Hu, Wenjie; Kagan, Karl-Oliver; Wu, Qingqing

2017-01-01

Abstract Rationale: Uniparental disomy (UPD) gives a description of the inheritance of both homologues of a chromosome pair from the same parent. The consequences of UPD depend on the specific chromosome/segment involved and its parental origin. Patient concerns: We report prenatal phenotypes of 2 rare cases of UPD. Diagnoses: The prenatal phenotype of case 1 included sonographic markers such as enlarged nuchal translucency (NT), absent nasal bone, short femur and humerus length, and several structural malformations involving Dandy–Walker malformation and congenital heart defects. The prenatal phenotype of Case 2 are sonographic markers, including enlarged NT, thickened nuchal fold, ascites, and polyhydramnios without apparent structural malformations. Interventions: Conventional G-band karyotype appears normal in case 1, while it shows normal chromosomes with a small supernumerary marker chromosome (sSMC) in case 2. Genetic etiology was left unknown until single-nucleotide polymorphism-based array (SNP-array) was performed, and segmental paternal UPD 22 was identified in case 1 and segmental paternal UPD 14 was found in case 2. Outcomes: The parents of case 1 chose termination of pregnancy. The neonate of case 2 was born prematurely with a bellshaped small thorax and died within a day. Lessons: UPD cases are rare and the phenotypes are different, which depend on the origin and affected chromosomal part. If a fetus shows multiple anomalies that cannot be attributed to a common aneuploidy or a genetic syndrome, or manifests some features possibly related to an UPD syndrome, such as detection of sSMC, SNP-array should be considered. PMID:29137034

Metallic Thermal Protection System Technology Development: Concepts, Requirements and Assessment Overview

NASA Technical Reports Server (NTRS)

Dorsey, John T.; Poteet, Carl C.; Chen, Roger R.; Wurster, Kathryn E.

2002-01-01

A technology development program was conducted to evolve an earlier metallic thermal protection system (TPS) panel design, with the goals of: improving operations features, increasing adaptability (ease of attaching to a variety of tank shapes and structural concepts), and reducing weight. The resulting Adaptable Robust Metallic Operable Reusable (ARMOR) TPS system incorporates a high degree of design flexibility (allowing weight and operability to be traded and balanced) and can also be easily integrated with a large variety of tank shapes, airframe structural arrangements and airframe structure/material concepts. An initial attempt has been made to establish a set of performance based TPS design requirements. A set of general (FARtype) requirements have been proposed, focusing on defining categories that must be included for a comprehensive design. Load cases required for TPS design must reflect the full flight envelope, including a comprehensive set of limit loads, However, including additional loads. such as ascent abort trajectories, as ultimate load cases, and on-orbit debris/micro-meteoroid hypervelocity impact, as one of the discrete -source -damage load cases, will have a significant impact on system design and resulting performance, reliability and operability. Although these load cases have not been established, they are of paramount importance for reusable vehicles, and until properly included, all sizing results and assessments of reliability and operability must be considered optimistic at a minimum.

Categorizing mistaken false positives in regulation of human and environmental health.

PubMed

Hansen, Steffen Foss; Krayer von Krauss, Martin P; Tickner, Joel A

2007-02-01

One of the concerns often voiced by critics of the precautionary principle is that a widespread regulatory application of the principle will lead to a large number of false positives (i.e., over-regulation of minor risks and regulation of nonexisting risks). The present article proposes a general definition of a regulatory false positive, and seeks to identify case studies that can be considered authentic regulatory false positives. Through a comprehensive review of the science policy literature for proclaimed false positives and interviews with authorities on regulation and the precautionary principle we identified 88 cases. Following a detailed analysis of these cases, we found that few of the cases mentioned in the literature can be considered to be authentic false positives. As a result, we have developed a number of different categories for these cases of "mistaken false positives," including: real risks, "The jury is still out," nonregulated proclaimed risks, "Too narrow a definition of risk," and risk-risk tradeoffs. These categories are defined and examples are presented in order to illustrate their key characteristics. On the basis of our analysis, we were able to identify only four cases that could be defined as regulatory false positives in the light of today's knowledge and recognized uncertainty: the Southern Corn Leaf Blight, the Swine Flu, Saccharin, and Food Irradiation in relation to consumer health. We conclude that concerns about false positives do not represent a reasonable argument against future application of the precautionary principle.

Generalized Fisher matrices

NASA Astrophysics Data System (ADS)

Heavens, A. F.; Seikel, M.; Nord, B. D.; Aich, M.; Bouffanais, Y.; Bassett, B. A.; Hobson, M. P.

2014-12-01

The Fisher Information Matrix formalism (Fisher 1935) is extended to cases where the data are divided into two parts (X, Y), where the expectation value of Y depends on X according to some theoretical model, and X and Y both have errors with arbitrary covariance. In the simplest case, (X, Y) represent data pairs of abscissa and ordinate, in which case the analysis deals with the case of data pairs with errors in both coordinates, but X can be any measured quantities on which Y depends. The analysis applies for arbitrary covariance, provided all errors are Gaussian, and provided the errors in X are small, both in comparison with the scale over which the expected signal Y changes, and with the width of the prior distribution. This generalizes the Fisher Matrix approach, which normally only considers errors in the `ordinate' Y. In this work, we include errors in X by marginalizing over latent variables, effectively employing a Bayesian hierarchical model, and deriving the Fisher Matrix for this more general case. The methods here also extend to likelihood surfaces which are not Gaussian in the parameter space, and so techniques such as DALI (Derivative Approximation for Likelihoods) can be generalized straightforwardly to include arbitrary Gaussian data error covariances. For simple mock data and theoretical models, we compare to Markov Chain Monte Carlo experiments, illustrating the method with cosmological supernova data. We also include the new method in the FISHER4CAST software.

Nonlinear predictive control for durability enhancement and efficiency improvement in a fuel cell power system

NASA Astrophysics Data System (ADS)

Luna, Julio; Jemei, Samir; Yousfi-Steiner, Nadia; Husar, Attila; Serra, Maria; Hissel, Daniel

2016-10-01

In this work, a nonlinear model predictive control (NMPC) strategy is proposed to improve the efficiency and enhance the durability of a proton exchange membrane fuel cell (PEMFC) power system. The PEMFC controller is based on a distributed parameters model that describes the nonlinear dynamics of the system, considering spatial variations along the gas channels. Parasitic power from different system auxiliaries is considered, including the main parasitic losses which are those of the compressor. A nonlinear observer is implemented, based on the discretised model of the PEMFC, to estimate the internal states. This information is included in the cost function of the controller to enhance the durability of the system by means of avoiding local starvation and inappropriate water vapour concentrations. Simulation results are presented to show the performance of the proposed controller over a given case study in an automotive application (New European Driving Cycle). With the aim of representing the most relevant phenomena that affects the PEMFC voltage, the simulation model includes a two-phase water model and the effects of liquid water on the catalyst active area. The control model is a simplified version that does not consider two-phase water dynamics.

Current status of pregnancy-related maternal mortality in Japan: a report from the Maternal Death Exploratory Committee in Japan.

PubMed

Hasegawa, Junichi; Sekizawa, Akihiko; Tanaka, Hiroaki; Katsuragi, Shinji; Osato, Kazuhiro; Murakoshi, Takeshi; Nakata, Masahiko; Nakamura, Masamitsu; Yoshimatsu, Jun; Sadahiro, Tomohito; Kanayama, Naohiro; Ishiwata, Isamu; Kinoshita, Katsuyuki; Ikeda, Tomoaki

2016-03-21

To clarify the problems related to maternal deaths in Japan, including the diseases themselves, causes, treatments and the hospital or regional systems. Descriptive study. Maternal death registration system established by the Japan Association of Obstetricians and Gynecologists (JAOG). Women who died during pregnancy or within a year after delivery, from 2010 to 2014, throughout Japan (N=213). The preventability and problems in each maternal death. Maternal deaths were frequently caused by obstetric haemorrhage (23%), brain disease (16%), amniotic fluid embolism (12%), cardiovascular disease (8%) and pulmonary disease (8%). The Committee considered that it was impossible to prevent death in 51% of the cases, whereas they considered prevention in 26%, 15% and 7% of the cases to be slightly, moderately and highly possible, respectively. It was difficult to prevent maternal deaths due to amniotic fluid embolism and brain disease. In contrast, half of the deaths due to obstetric haemorrhage were considered preventable, because the peak duration between the initial symptoms and initial cardiopulmonary arrest was 1-3 h. A range of measures, including individual education and the construction of good relationships among regional hospitals, should be established in the near future, to improve primary care for patients with maternal haemorrhage and to save the lives of mothers in Japan. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Judicial intervention in alcohol regulation: an empirical legal analysis.

PubMed

Muhunthan, Janani; Angell, Blake; Wilson, Andrew; Reeve, Belinda; Jan, Stephen

2017-08-01

While governments draft law and policy to promote public health, it is through cases put before the judiciary that the implementation of law can be challenged and where its practical implications are typically determined. In this paper, we examine the role of court judgements on efforts in Australia to regulate the harmful use of alcohol. Australian case law (2010 to June 2015) involving the judicial review of administrative decisions relating to development applications or liquor licences for retail liquor outlets (bottle shops), hotels, pubs and clubs was identified using a case law database (WestLaw AU). Data were extracted and analysed using standard systematic review techniques. A total of 44 cases were included in the analysis. Of these, 90% involved appeals brought by industry actors against local or state government stakeholders seeking to reject applications for development applications and liquor licences. The proportion of judicial decisions resulting in outcomes in favour of industry was 77%. Public health research evidence appeared to have little or no influence, as there is no requirement for legislation to consider public health benefit. Implications for public health: A requirement that the impact on public health is considered in legislation will help to offset its strong pro-competition emphasis, which in turn has strongly influenced judicial decision making in this area. © 2017 The Authors.

Definition and management of varicella zoster virus-associated meningoradiculitis: a case report.

PubMed

Luisier, Vincent; Weber, Lalensia; Fishman, Daniel; Praz, Gérard; Ghika, Joseph-André; Genoud, Didier; Chabwine, Joelle Nsimire

2016-09-26

The varicella zoster virus affects the central or peripheral nervous systems upon reactivation, especially when cell-mediated immunity is impaired. Among varicella zoster virus-related neurological syndromes, meningoradiculitis is an ill-defined condition for which clear management guidelines are still lacking. Zoster paresis is usually considered to be a varicella zoster virus-peripheral nervous system complication and treated with oral antiviral therapy. Yet in the literature, the few reported cases of herpes zoster with mild cerebral spinal fluid inflammation were all considered meningoradiculitis and treated using intravenous antiviral drugs, despite absence of systemic signs of meningitis. Nevertheless, these two clinical pictures are very similar. We report the case of an alcohol-dependent elderly Caucasian man presenting with left lower limb zoster paresis and mild cerebral spinal fluid inflammation, with favorable outcome upon IV antiviral treatment. We discuss interpretation of liquor inflammation in the absence of clinical meningitis and implications for the antiviral treatment route. From this case report we suggest that varicella zoster virus-associated meningoradiculitis should necessarily include meningitis symptoms with the peripheral neurological deficits and cerebral spinal fluid inflammation, requiring intravenous antiviral treatment. In the absence of (cell-mediated) immunosuppression, isolated zoster paresis does not necessitate spinal tap or intravenous antiviral therapy.

ADHD (ATTENTION DEFFICIT HYPERACTIVITY DISORDER)--A TROUBLING ENTITY, SOMETIMES PERPETUATING DURING ADULT LIFE.

PubMed

Amihăesei, Ioana Cristina; Zamfir, Carmen Lăcrămioara

2016-01-01

Attention deficit hyperactivity disorder (ADHD) is considered a neurologic development disorder resulting in impairment of attention and inhibitory control, manifested as attention deficit, hyperactivity, impulsiveness; symptoms should develop between age six and twelve and have to persist for more than six months. Approximately 30-50% of the diagnosed cases are manifesting the disorder during adulthood and 2.5-5% of the adults are suffering of ADHD. Genetics are important factors in ADHD, being involved in 75% of the cases, as well in the persistence of ADHD during adult life. Three subtypes of ADHD are described--one in which is predominating the attention deficit, one with predominant hyperactivity and impulsiveness and a third combined subtype. Diagnosis criteria in ADHD are established by the American Psychiatric Association (DSM criteria) and by World Health Organization. Differential diagnosis is mainly considering bipolar disorder and borderline personality disorder. Management of ADHD is including behavioral therapies and medication, alone or combined. Stimulant medications such as amphetamine represent the therapy of choice, being effective in 80% of the cases. New data are underlying the need for following up of the cases during adulthood, since the risk for development of psychiatric conditions such as depression, anxiety, as well as the suicidal behavior is higher than in the general population.

Effectiveness and experience of arts-based pedagogy among undergraduate nursing students: a mixed methods systematic review.

PubMed

Rieger, Kendra L; Chernomas, Wanda M; McMillan, Diana E; Morin, Francine L; Demczuk, Lisa

2016-11-01

To develop well rounded professional nurses, educators need diverse pedagogical approaches. There is growing interest in arts-based pedagogy (ABP) as the arts can facilitate reflection, create meaning and engage healthcare students. However, the emerging body of research about ABP needs to be systematically examined. To synthesize the best available evidence on the effectiveness of ABP in enhancing competencies and learning behaviors in undergraduate nursing education and to explore nursing students' experiences with art-based pedagogy. The review considered studies that included participants who are undergraduate nursing students. The qualitative (QL) component considered studies investigating nursing students' experiences of ABP, and the quantitative (QN) component considered studies evaluating the effectiveness of ABP in undergraduate nursing education. The QL component considered QL studies including designs such as phenomenology, grounded theory, ethnography, action research and feminist research. The QN component considered studies that examined the effectiveness of ABP including designs such as randomized controlled trials, non-randomized controlled trials, quasi-experimental, before and after studies, prospective and retrospective cohort studies, case-control studies, analytical cross-sectional studies, case series, individual case reports and descriptive cross-sectional studies. The following QN outcomes of ABP were assessed: knowledge acquisition, level of empathy, attitudes toward others, emotional states, reflective practice, self-transcendence, cognitive/ethical maturity, learning behaviors and students' perspectives of ABP. An extensive three-step search strategy was conducted for primary research studies published between January 1, 1994 and April 7, 2015. The strategy included searching CINAHL, MEDLINE, ERIC, PsycINFO, Academic Search Complete, Arts and Humanities Citation Index, Art Full Text, Scopus, ProQuest Dissertations and Theses, A&I, and gray literature. Only studies published in English were included. Two reviewers assessed all studies for methodological quality using appropriate critical appraisal checklists from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) or the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). Data were extracted from included articles using the standardized data extraction tool from JBI-QARI or JBI-MAStARI. Qualitative studies were pooled through a meta-synthesis. Data from the QN studies were combined using a narrative synthesis as a meta-analysis was not possible. The researchers used a segregated mixed methods approach to integrate the QL and QN components. Twenty-one QL studies of high methodological quality were included. The two synthesized findings revealed that art forms could create meaning and inspire learning in undergraduate nursing education and that ABP can develop important learner outcomes/competencies for professional nursing. These synthesized findings received a moderate ConQual rating. Fifteen experimental/quasi-experimental studies of moderate methodological quality were included. The narrative synthesis suggested that ABP improved nursing students' knowledge acquisition, level of empathy, attitude toward others, emotional states, level of reflective practice, learning behaviors and aspects of cognitive/ethical maturity. In five cross-sectional studies, the majority of students had a positive perspective of ABP. When the QL and QN findings were interpreted as a whole, ABP appeared to facilitate learning in the cognitive and affective domains and may be especially useful in addressing the affective domain. Nurse educators should consider using ABP as students found that this approach offered a meaningful way of learning and resulted in the development of important competencies for professional nursing. The QN studies provide a very low level of evidence that ABP improved students' knowledge acquisition, level of empathy, attitude toward others, emotional states, level of reflective practice, learning behaviors and aspects of cognitive/ethical maturity. Although the QN findings can inform future research, the evidence is not robust enough to demonstrate improved outcomes.

Public Health Responses to a Dengue Outbreak in a Fragile State: A Case Study of Nepal

PubMed Central

Griffiths, Karolina; Banjara, Megha Raj; O'Dempsey, T.; Munslow, B.; Kroeger, Axel

2013-01-01

Objectives. The number of countries reporting dengue cases is increasing worldwide. Nepal saw its first dengue outbreak in 2010, with 96% of cases reported in three districts. There are numerous policy challenges to providing an effective public health response system in a fragile state. This paper evaluates the dengue case notification, surveillance, laboratory facilities, intersectoral collaboration, and how government and community services responded to the outbreak. Methods. Qualitative data were collected through 20 in-depth interviews, with key stakeholders, and two focus-group discussions, with seven participants. Results. Limitations of case recognition included weak diagnostic facilities and private hospitals not incorporated into the case reporting system. Research on vectors was weak, with no virological surveillance. Limitations of outbreak response included poor coordination and an inadequate budget. There was good community mobilization and emergency response but no routine vector control. Conclusions. A weak state has limited response capabilities. Disease surveillance and response plans need to be country-specific and consider state response capacity and the level of endemicity. Two feasible solutions for Nepal are (1) go upwards to regional collaboration for disease and vector surveillance, laboratory assistance, and staff training; (2) go downwards to expand upon community mobilisation, ensuring that vector control is anticipatory to outbreaks. PMID:23690789

The San Diego definition of SIDS: practical application and comparison with the GeSID classification.

PubMed

Bajanowski, T; Brinkmann, B; Vennemann, M

2006-11-01

The new definition of the term sudden infant death syndrome (SIDS) and the criteria introduced in San Diego for the subclassification of cases have been used to re-classify the first 100 consecutive cases of sudden and unexpected infant deaths that were registered with the German SIDS study (GeSID). Although there are 30 different variables that have to be considered in the general and stratified sections of the San Diego definition, it is practical, in particular, as an international standard to perform scientific studies. The comparison of the San Diego definition and the classification used for GeSID shows similarities in the methods but differences in the criteria used. Nevertheless, the numbers of cases classified as SIDS and borderline SIDS are similar (San Diego n=69, GeSID n=74). The SIDS IA criteria of the San Diego definition were not fulfilled by any case because metabolic screening and vitreous chemistry were not included in the GeSID investigation scheme. An important advantage of the San Diego definition is the introduction of the category of unclassified sudden infant death, which includes cases for which no autopsy was performed. This demonstrates that such cases cannot be classified as SIDS. In conclusion, we recommend the universal acceptance and use of the San Diego SIDS definition.

[NMDA-GluR Subunit Antibody-Positive Encephalitis: A Clinical Analysis of Five Cases].

PubMed

Kaneko, Chikako; Shakespear, Norshalena; Tuchiya, Mario; Kubo, Jin; Yamamoto, Teiji; Katayama, Soichi; Takahashi, Yukitoshi

2016-09-01

Five consecutive cases of anti-NMDA-receptor encephalitis that we encountered were marked by a rapidly fluctuating level of consciousness associated with psychotic and delirious mental states. Opisthotonus, catatonia, and rhythmic and non-rhythmic involuntary movements of the mouth and jaw were also characteristic features of these particular cases. Serious and potentially fatal problems included epilepsia partialis continua, partial and generalized seizures, and respiratory depression, resembling the symptoms of encephalitis lethargica. An epidemic of encephalitis lethargica, also known of Economo encephalitis, occurred around 1917. Magnetic resonance imaging revealed edema of the neocortex in two cases and electroencephalography showed polymorphic and monomorphic delta slowing in the acute stage, although electroencephalographic seizure activity were not apparent. Routine cerebrospinal fluid analyses revealed lymphocyte-dominant pleocytosis in three cases, but antibodies against the NMDA-GluR subunit, GluN2B N-terminal, were at a high level in the fluid. All patients recovered without apparent sequelae. Two patients found to have ovarian teratoma underwent surgery for tumor removal. Treatments included pulse intravenous methylprednisolone, high-dose immunoglobulin, and plasma exchange together with seizure control and respiratory support. However, rituximab and or cyclophosphamide pulse therapy should also be considered for intractable cases, as indicated by recent reports. (Received February 16, 2016; Accepted May 2, 2016; Published September 1, 2016).

Alternative approaches to analytical designs in occupational injury epidemiology.

PubMed

Mittleman, M A; Maldonado, G; Gerberich, S G; Smith, G S; Sorock, G S

1997-08-01

In this paper, we discuss the theoretical framework upon which observational studies of occupational injuries are based. Following a general description of how causal effects are estimated, the challenges faced by researchers working in this area are outlined, with an emphasis on case-control studies. These challenges include defining the at-risk period for workers whose tasks change over time and whose hazard period may be very brief, evaluating the underreporting of both exposures and injuries, and considering the effects of multiple injuries per individual on study design and data analysis. We review both the theoretical and practical considerations in the design and conduct of traditional case-control studies, based on the collection of individual level data, as well as other approaches, such as using information culled from administrative and descriptive databases, and case-control studies in which the plant or work site is the unit of analysis. The case-crossover design is also reviewed and its utility for reducing confounding due to differences between individuals by self-matching is highlighted. While this design has not yet been applied to the work setting, its potential for increasing our understanding of the causes of acute-onset occupational injuries seems promising. Finally, a variety of hybrid designs are discussed, including combinations of case-control, case-crossover, and cohort designs.

Immunohistochemical expression of glucose transporter 1 in keratin-producing odontogenic cysts.

PubMed

Vera-Sirera, Beatriz; Forner-Navarro, Leopoldo; Vera-Sempere, Francisco

2016-03-10

Keratin-producing odontogenic cysts (KPOCs) are a group of cystic lesions that are often aggressive, with high rates of recurrence and multifocality. KPOCs included orthokeratinised odontogenic cyst (OOC) and parakeratotic odontogenic cysts, which are now considered true tumours denominated keratocystic odontogenic tumours (KCOTs). GLUT1 is a protein transporter that is involved in the active uptake of glucose across cell membranes and that is overexpressed in tumours in close correlation with the proliferation rate and positron emission tomography (PET) imaging results. A series of 58 keratin-producing odontogenic cysts was evaluated histologically and immunohistochemically in terms of GLUT1 expression. Different data were correlated using the beta regression model in relation to histological type and immunohistochemical expression of GLUT1, which was quantified using two different morphological methods. KPOC cases comprised 12 OOCs and 46 KCOTs, the latter corresponding to 6 syndromic and 40 sporadic KCOTs. GLUT1 expression was very low in OOC cases compared with KCOT cases, with statistical significant differences when quantification was considered. Different GLUT1 localisation patterns were revealed by immunostaining, with the parabasal cells showing higher reactivity in KCOTs. However, among KCOTs cases, GLUT1 expression was unable to establish differences between syndromic and sporadic cases. GLUT1 expression differentiated between OOC and KCOT cases, with significantly higher expression in KCOTs, but did not differentiate between syndromic and sporadic KCOT cases. However, given the structural characteristics of KCOTs, we hypothesised that PET imaging methodology is probably not a useful diagnostic tool for KCOTs. Further studies of GLUT1 expression and PET examination in KCOT series are needed to confirm this last hypothesis.

Concordance of clinical diagnosis of T classification among physicians for locally advanced unresectable thoracic esophageal cancer.

PubMed

Yokota, Tomoya; Yasuda, Takushi; Kato, Hiroyuki; Nozaki, Isao; Sato, Hiroshi; Miyata, Yoshinori; Kuroki, Yoshifumi; Kato, Ken; Hamamoto, Yasuo; Tsubosa, Yasuhiro; Ogawa, Hirofumi; Ito, Yoshinori; Kitagawa, Yuko

2018-02-01

We conducted a multicenter phase II trial assessing chemoselection with docetaxel plus 5-fluorouracil and cisplatin induction chemotherapy and subsequent conversion surgery for locally advanced, unresectable esophageal cancer. The aim of this study was to validate the concordance of clinical T diagnosis among physicians in the cases of this trial. Computed tomography scans and esophagoscopic images of 48 patients taken at baseline were centrally reviewed by 6 senior physicians with experience in esophageal oncology. Individual reviewers voted for definitive T4, relative T4, relative T3, or definitive T3. Discordant diagnoses between reviewers were resolved by the majority opinion. The reviewers were blinded to patient clinical outcome data and to the vote of the other reviewers. Ninety percent of cases were diagnosed as clinical T4 by investigators, while 33.3-75.0% (median 70.8%) of cases were judged to be T4 by 6 reviewers. Discordant diagnosis between investigators and reviewers occurred in 33% (16/48) of all cases (Cohen's kappa coefficient 0.0519), including 12 cases where curative resection was considered possible (48%, n = 25) and 4 cases where curative resection was considered impossible (17%, n = 23). Critical discordance (one reviewer voted for definitive T3 but the other voted for definitive T4, and vice versa) between reviewers occurred in 0-12.5% of cases (median 2.1%). There were inter-observer variations in clinical diagnosis of the T category of locally advanced, unresectable esophageal cancer. Accurate clinical diagnosis of T classification is required for determining the optimum treatment for each patient.

Management of Inguinal Involvement of Peritoneal Surface Malignancies by Cytoreduction and HIPEC with Inguinal Perfusion

PubMed Central

Shachar, Yair; Adileh, Mohamed; Keidar, Assaf; Eid, Luminita; Hubert, Ayalah; Temper, Mark; Azam, Salah; Beny, Alex; Grednader, Tal; Khalaileh, Abed; Yuval, Jonathan B.; Stojadinovic, Alexander; Avital, Itzhak; Nissan, Aviram

2015-01-01

Background: Achieving complete cytoreduction of peritoneal surface malignancies (PSM) can be challenging. In most cases, delivery of heated intra-peritoneal chemotherapy (HIPEC) is straightforward. However, using the closed technique in some cases may be technically challenging; for example, in patients requiring abdominal closure using a large synthetic mesh. In cases where groin hernias are present, it is imperative to resect the hernia sac, since it may contain tumor deposits. In cases with major inguinal involvement where disease may spread out of the hernia sac or in cases where a hernia repair was performed while disease is present, inguinal perfusion should be considered. Aim: To describe our experience with combined intra-peritoneal and inguinal perfusion of HIPEC following cytoreductive surgery. Patients and Methods: This is a retrospective review of all patients who underwent cytoreductive surgery (CRS) and HIPEC at our institution. A prospectively maintained database containing data of patients treated by CRS and HIPEC (n=122) was reviewed. All patients with macroscopic inguinal involvement by PSM with complete cytoreduction perfused by HIPEC were included. Results: We identified five cases who underwent CRS and combined intraperitoneal and inguinal perfusion after resection of large inguinal tumor deposits (n=4) or after a recent hernia repair with hernial sac involvement by mucinous adenocarcinoma (n=1). All five patients were successfully perfused using an additional outflow catheter placed in the groin. Discussion: In cases of inguinal involvement by PSM, complete cytoreduction should be achieved and perfusion of the involved groin considered as it is feasible and safe. PMID:25663941

Diagnosis of imported Ugandan typhoid fever based on local outbreak information: A case report.

PubMed

Ota, Shinichiro; Maki, Yohei; Mori, Kazuma; Hamamoto, Takaaki; Kurokawa, Atsushi; Ishihara, Masashi; Yamamoto, Takayuki; Imai, Kazuo; Misawa, Kazuhisa; Yuki, Atsushi; Fujikura, Yuji; Maeda, Takuya; Kawana, Akihiko

2016-11-01

Re-emerging multidrug-resistant typhoid fever is becoming a worldwide threat, especially in East Africa. At the beginning of 2015, an outbreak of typhoid fever started in the capital city of Uganda, and 1940 suspected cases were reported by 5 March 2015. In this report, we describe a case of typhoid fever caused by a MDR strain with HIV infection and hemoglobin S-syndrome thalassemia in an Ugandan from Kampala City. It is essential to consider MDR strains of Salmonella enterica serovar Typhi infections, including fluoroquinolone-resistant strains, in patients from Africa and Southeast Asia. Copyright © 2016 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Inflammatory nasal polyps: an unusual late complication of Silastic sheet repair of orbital floor fracture.

PubMed

Andrews, A E; Hicklin, L

2006-02-01

Silastic implants are very widely used in surgical practice and are considered to be relatively inert. They do however present with complications, including infection, local foreign body inflammatory response,calcification, migration and failure of repair of the defect, which sometimes may necessitate explantation. Head and neck implants do present a special case, as complications can cause obstruction and disruption of function in small cavities. A pertinent history, clinical review and computed tomography scan are usually invaluable in obtaining a diagnosis. We present a rare case of migrated Silastic orbital sheet, presenting as a nasal polyp and causing maxillary antral pain and infection. A detailed search of the medical literature revealed no other such case.

Effect of surface wave propagation in a four-layered oceanic crust model

NASA Astrophysics Data System (ADS)

Paul, Pasupati; Kundu, Santimoy; Mandal, Dinbandhu

2017-12-01

Dispersion of Rayleigh type surface wave propagation has been discussed in four-layered oceanic crust. It includes a sandy layer over a crystalline elastic half-space and over it there are two more layers—on the top inhomogeneous liquid layer and under it a liquid-saturated porous layer. Frequency equation is obtained in the form of determinant. The effects of the width of different layers as well as the inhomogeneity of liquid layer, sandiness of sandy layer on surface waves are depicted and shown graphically by considering all possible case of the particular model. Some special cases have been deduced, few special cases give the dispersion equation of Scholte wave and Stoneley wave, some of which have already been discussed elsewhere.

Pigmentary glaucoma accompanied by Usher syndrome.

PubMed

Koucheki, Behrooz; Jalali, Kamran Hodjat

2012-08-01

To report a case of pigmentary glaucoma (PG) accompanied by Usher syndrome. Case report. The results were presented after standard ocular examination, visual field test, anterior segment and fundus photography, electroretinography, and otolaryngology consultation were conducted. Typical retinitis pigmentosa, flat electroretinography, congenital sensorineural hearing loss, high intraocular pressure, Krukenberg spindle, iris concavity, radial iris transillumination defect, severe pigment deposition on the trabecular meshwork, and glaucomatous optic nerve damage were indicative of PG accompanied by Usher syndrome. In some rare cases, PG may coexist with Usher syndrome. Common findings of Usher syndrome, including night blindness, impaired vision, visual field defects, and retinal changes may distract the clinician from considering the diagnosis of glaucoma. Such association should be borne in mind to make a timely diagnosis and treatment possible.

Wegener's granulomatosis presenting as multiple bilateral renal masses: case report and literature review.

PubMed

Frigui, Makram; Ben Hmida, Mohamed; Kechaou, Manel; Jlidi, Rachid; Bahloul, Zouhir

2009-04-01

Wegener's granulomatosis (WG) is a disease of unknown etiology characterized by necrotizing granulomatous vascularitis. The upper and lower respiratory tract and kidney involvements are very common; however, its presentation as bilateral renal masses is unusual. We report a case of a 59-year-old female patient who presented with multiple bilateral renal masses. The patient presented with sinusal and ocular symptoms suggestive of WG, and positive antineutrophil cytoplasmic antibodies (c-ANCA) with an anti-PR3 pattern. Histopathologic examination of the renal biopsy specimen revealed granulomatous inflammation with vasculitis and fibrinoid necrosis. The patient management, including prednisone and cyclophosphamid, induced a marked improvement of the renal masses. This case illustrates that WG should be considered in the differential diagnosis of renal masses.

Beyond pretrial publicity: legal and ethical issues associated with change of venue surveys.

PubMed

Posey, Amy J; Dahl, Lisa M

2002-02-01

To combat the effects of pretrial publicity, a court may consider a change of venue, moving the trial to a jurisdiction that has been exposed to little publicity about the case. Social scientists can be of valuable assistance in measuring community attitudes regarding defendant level of guilt and case familiarity. This paper discusses obstacles faced by the authors when conducting change of venue surveys and presenting their findings to the court, including challenges to their ability to act and be viewed as scientists, and pressures to do that which contradicts empirical research in order to please the court. Future research should examine factors predicting judges' decisions on change of venue motions and issues associated with small venues and civil cases.

Sacrococcygeal Teratoma Presenting with Vaginal Discharge and Polyp in an Infant.

PubMed

Ladenhauf, Hannah N; Brandtner, M Georgina; Schimke, Christa; Ardelean, Mircia A; Metzger, Roman

2018-06-01

Sacrococcygeal teratoma accounts for the most common solid tumor in neonates. Because of improved technology, 50%-70% of cases can be diagnosed antenatally during routine ultrasound screenings. If not diagnosed antenatally, clinical findings at birth are distinct in most cases including a palpable or visible mass. We report an unusual case of a 1-year-old girl who presented with persistent vaginal discharge leading to diagnosis of a mucosal polypoid lesion of the vagina, ultimately revealing a hidden sacrococcygeal teratoma. We suggest thorough investigation of all infants who present with purulent discharge and recurrent vaginal mass; sacrococcygeal teratoma should routinely be considered as a differential diagnosis. Copyright © 2017 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

[Renal risks of dietary complements: a forgotten cause].

PubMed

Dori, Olympia; Humbert, Antoine; Burnier, Michel; Teta, Daniel

2014-02-26

The use of dietary complements like vitamins, minerals, trace elements, proteins, aminoacids and plant-derived agents is prevalent in the general population, in order to promote health and treat diseases. Dietary complements are considered as safe natural products and are easily available without prescription. However, these can lead to severe renal toxicity, especially in cases of unknown pre-existing chronic kidney disease (CKD). In particular, Chinese herbs including aristolochic acid, high doses of vitamine C, creatine and protein complements may lead to acute and chronic renal failure, sometimes irreversible. Dietary complement toxicity should be suspected in any case of unexplained renal impairement. In the case of pre-existing CKD, the use of potentially nephrotoxic dietary complements should be screened for.

Development of a set of equations for incorporating disk flexibility effects in rotordynamical analyses

NASA Technical Reports Server (NTRS)

Flowers, George T.; Ryan, Stephen G.

1991-01-01

Rotordynamical equations that account for disk flexibility are developed. These equations employ free-free rotor modes to model the rotor system. Only transverse vibrations of the disks are considered, with the shaft/disk system considered to be torsionally rigid. Second order elastic foreshortening effects that couple with the rotor speed to produce first order terms in the equations of motion are included. The approach developed in this study is readily adaptable for usage in many of the codes that are current used in rotordynamical simulations. The equations are similar to those used in standard rigid disk analyses but with additional terms that include the effects of disk flexibility. An example case is presented to demonstrate the use of the equations and to show the influence of disk flexibility on the rotordynamical behavior of a sample system.

Bartonella, a Common Cause of Endocarditis: a Report on 106 Cases and Review

PubMed Central

Edouard, Sophie; Nabet, Cecile; Lepidi, Hubert; Fournier, Pierre-Edouard

2014-01-01

Bartonella spp. are fastidious bacteria that cause blood culture-negative endocarditis and have been increasingly reported. In this study, we included all patients retrospectively and prospectively diagnosed with Bartonella endocarditis in our French reference center between 2005 and 2013. Our diagnosis was based on the modified Duke criteria and microbiological findings, including serological and PCR results. To review the published literature, we searched all human Bartonella endocarditis cases published in the PubMed database between January 2005 and October 2013. We report here a large series of 106 cases, which include 59 cases that had not previously been reported or mentioned. Indirect immunofluorescence assays, Western blotting, and real-time PCR from total blood, serum, and valve tissue exhibited sensitivities of 58%, 100%, 33%, 36%, and 91%, respectively. The number of cases reported in the literature between 2005 and 2013 increased to reach a cumulative number of 196 cases. The number of cases reported in the literature by other centers is increasing more rapidly than that reported by our French reference center (P < 10−2). Currently, there is a lack of criteria for the diagnosis of Bartonella endocarditis. We suggest that a positive PCR result from a cardiac valve or blood specimen, an IgG titer of ≥800 using an immunofluorescence assay, or a positive Western blot assay be considered major Duke criteria for Bartonella endocarditis. There is no real increase in the incidence of these infections but rather a better understanding and interest in the disease resulting from the improvement of diagnostic tools. PMID:25540398

Case-mix adjustment and the comparison of community health center performance on patient experience measures.

PubMed

Johnson, M Laura; Rodriguez, Hector P; Solorio, M Rosa

2010-06-01

To assess the effect of case-mix adjustment on community health center (CHC) performance on patient experience measures. A Medicaid-managed care plan in Washington State collected patient survey data from 33 CHCs over three fiscal quarters during 2007-2008. The survey included three composite patient experience measures (6-month reports) and two overall ratings of care. The analytic sample includes 2,247 adult patients and 2,859 adults reporting for child patients. We compared the relative importance of patient case-mix adjusters by calculating each adjuster's predictive power and variability across CHCs. We then evaluated the impact of case-mix adjustment on the relative ranking of CHCs. Important case-mix adjusters included adult self-reported health status or parent-reported child health status, adult age, and educational attainment. The effects of case-mix adjustment on patient reports and ratings were different in the adult and child samples. Adjusting for race/ethnicity and language had a greater impact on parent reports than adult reports, but it impacted ratings similarly across the samples. The impact of adjustment on composites and ratings was modest, but it affected the relative ranking of CHCs. To ensure equitable comparison of CHC performance on patient experience measures, reports and ratings should be adjusted for adult self-reported health status or parent-reported child health status, adult age, education, race/ethnicity, and survey language. Because of the differential impact of case-mix adjusters for child and adult surveys, initiatives should consider measuring and reporting adult and child scores separately.

Incidental Finding of Cryptococcus on Prostate Biopsy for Prostate Adenocarcinoma Following Cardiac Transplant: Case Report and Review of the Literature.

PubMed

Shah, Sujal I; Bui, Hai; Velasco, Nelson; Rungta, Shilpa

2017-11-06

BACKGROUND Cryptococcus is the third most common invasive fungal organism in immunocompromised patients, including transplant patients, and usually involves the central nervous system and lungs, with a median time to infection of 25 months. We report a case of Cryptococcus of the prostate gland, found as an incidental finding on prostate biopsy for prostate adenocarcinoma, four months following cardiac transplantation. CASE REPORT A 62-year-old male African-American who had a cardiac transplant four months previously, underwent a six-core prostate biopsy for a two-year history of increasing prostate-specific antigen (PSA) levels, and a recent history of non-specific urinary tract symptoms. A prostatic adenocarcinoma, Gleason grade 4+4=8, was diagnosed on histopathology, and 'foamy' cells were seen in the biopsies. Histochemical stains, including Grocott methenamine silver (GMS), and periodic acid-Schiff (PAS) showed abundant round and oval 5-7 µm diameter fungal elements; mucicarmine highlighted the fungal polysaccharide capsule, diagnostic for Cryptococcus. Cryptococcal antigen detection was made by the latex agglutination test and cultures. We reviewed the literature and found 70 published cases (from 1946-2008) of Cryptococcus of the prostate gland, with only one previous case presenting five years following cardiac transplantation. CONCLUSIONS Fungal infections of the prostate are rare, and occur mainly in immunocompromised patients. We present a unique case of prostatic Cryptococcus found incidentally at four months following cardiac transplantation. This case report highlights the need to consider atypical fungal infection as a differential diagnosis for prostatitis in immunosuppressed patients, including transplant patients.

Identification of CD56 and CD57 by flow cytometry in Ewing's sarcoma or primitive neuroectodermal tumor.

PubMed

Gardner, L J; Polski, J M; Fallon, R; Dunphy, C H

1998-07-01

CD56 and CD57 are commonly considered as natural killer and neuroectodermal markers, but their expression has been identified in a wide spectrum of neoplasms including some cases of Ewing's sarcoma (ES) and primitive neuroectodermal tumor (PNET). We report two cases of small, round blue cell tumor (SRBCT), in which flow cytometry immunophenotyping (FCI) detected strong expression of CD56 and CD57 (one case). Immunohistochemical staining with Leu-19 and Leu-7 confirmed the FI results. Although CD56 and CD57 expression is consistent with ES/PNET, it can be potentially misleading if results of FCI are interpreted in the absence of other findings. These cases suggest the utility of FCI in undifferentiated SRBCT. The literature on CD56 and CD57 expression in ES/PNET is reviewed and discussed.

Acute abdominal pain and constipation due to lead poisoning.

PubMed

Mongolu, S; Sharp, P

2013-01-01

Although uncommon, lead poisoning should be considered as a differential diagnosis in cases of unexplained acute abdominal pain in both adults and children. We present the case of a 35-year-old Asian male who presented with abdominal pain and constipation secondary to lead poisoning. Initially, the source of lead exposure was not apparent; this was later found to be due to ingestion of an Ayurvedic herbal medicine for the treatment of infertility. Lead poisoning due to the ingestion of Ayurvedic remedies is well described. We discuss the diagnosis, pathophysiology and treatment of lead poisoning. This case illustrates one of the rarer medical causes of acute abdominal pain and emphasizes the need to take a thorough history (including specific questioning regarding the use of over-the-counter and traditional/ herbal remedies) in cases of suspected poisoning or drug toxicity.

Beer, Cider, and Wine Allergy

PubMed Central

Tadros, Susan

2017-01-01

Background. Allergy to beer is often due to specific proteins in barley and sometimes to lipid transfer protein. Allergy to wine is frequently due to a sensitivity to grape proteins. We present a rare case of allergy to beer, wine, and cider resulting from IgE reactivity to yeasts and moulds which also explained the patient's additional sensitivity to yeast extracts and blue cheese. Case Presentation. The patient's symptoms included throat and facial itching accompanied by mild wheeze and severe urticaria. Diagnosis of allergy to yeast was confirmed by specific IgE testing as well as that to relevant foods and beverages. The patient's ongoing management included advice to avoid beer, wine, and other food groups containing specific yeasts, in addition to carrying a short acting nonsedating antihistamine as well as an adrenaline autoinjector. Conclusions. Cases of yeast allergy are extremely rare in medical literature but may be underrecognised and should be considered in patients presenting with reactions to alcoholic beverages and other yeast-containing products. PMID:28396809

[A case of focal epilepsy manifesting multiple psychiatric auras].

PubMed

Ezura, Michinori; Kakisaka, Yosuke; Jin, Kazutaka; Kato, Kazuhiro; Iwasaki, Masaki; Fujikawa, Mayu; Aoki, Masashi; Nakasato, Nobukazu

2015-01-01

We present a case of epilepsy with multiple types of focal seizures that were misdiagnosed as psychiatric disorders. A 20-year-old female patient presented with a variety of episodes, including loss of consciousness, deja vu, fear, delusion of possession, violent movements, and generalized convulsions. Each of these symptoms appeared in a stereotypic manner. She was initially diagnosed with a psychiatric disorder and treated with psychoactive medications, which had no effect. Long-term video electroencephalography revealed that her episodes of violent movement with impaired consciousness and secondarily generalized seizure were epileptic events originating in the right hemisphere. High-field brain magnetic resonance imaging for detecting subtle lesions revealed bilateral lesions from periventricular nodular heterotopia. Her final diagnosis was right hemispheric focal epilepsy. Carbamazepine administration was started, which successfully controlled all seizures. The present case demonstrates the pitfall of diagnosing focal epilepsy when it presents with multiple types of psychiatric aura. Epilepsy should thus be included in differential diagnoses, considering the stereotypic nature of symptoms, to avoid misdiagnosis.

Tinea genitalis: a new entity of sexually transmitted infection? Case series and review of the literature.

PubMed

Luchsinger, Isabelle; Bosshard, Philipp Peter; Kasper, Romano Silvio; Reinhardt, Dominic; Lautenschlager, Stephan

2015-11-01

Investigation on recent cases of tinea genitalis after travelling to South East Asia. Patients with tinea in the genital region, which emerged after sex in South East Asia, underwent further assessment including microscopy, cultures and DNA analyses. The case series includes seven patients. In six patients, Trichophyton interdigitale (former Trichophyton mentagrophytes) was detected. Three patients suffered from a severe inflammatory reaction of the soft tissue and two of them needed hospitalisation due to severe pain. In four patients, cicatrising healing was noticed. Five patients were declared incapacitated for work. Sexual activity should be considered as a potentially important and previously underappreciated means of transmission of T. interdigitale. To avoid irreversible scarring alopecia, prompt initiation of antifungal treatment is essential and adequate isolation and identification of the pathogen is mandatory. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Myasthenia triggered by immune checkpoint inhibitors: New case and literature review.

PubMed

Gonzalez, Natalia L; Puwanant, Araya; Lu, Angela; Marks, Stanley M; Živković, Saša A

2017-03-01

Immune checkpoint molecules are potent regulators of immunologic homeostasis that prevent the development of autoimmunity while maintaining self-tolerance. Inhibitors of immune checkpoint molecules are used as immunotherapy in the treatment of melanoma and different types of refractory cancer, and can trigger various autoimmune complications including myositis and myasthenia gravis. We describe a case of generalized myasthenia gravis induced by pembrolizumab and review 11 other cases. Five patients also had elevated serum CK levels ranging from 1200 to 8729 IU/L, and biopsy showed myositis in one. Severity was highly variable as symptoms normalized spontaneously in one patient, but three others developed myasthenic crisis (including two with fatal outcomes). Steroids have been recommended as a preferred treatment of autoimmune complications of immune-checkpoint inhibitors. Myasthenia gravis should be considered when weakness, diplopia or bulbar symptoms are seen after treatment with immune checkpoint inhibitors, and additional studies are needed to characterize association with hyperCKemia. Copyright © 2017 Elsevier B.V. All rights reserved.

Beer, Cider, and Wine Allergy.

PubMed

Bansal, Rhea A; Tadros, Susan; Bansal, Amolak S

2017-01-01

Background . Allergy to beer is often due to specific proteins in barley and sometimes to lipid transfer protein. Allergy to wine is frequently due to a sensitivity to grape proteins. We present a rare case of allergy to beer, wine, and cider resulting from IgE reactivity to yeasts and moulds which also explained the patient's additional sensitivity to yeast extracts and blue cheese. Case Presentation . The patient's symptoms included throat and facial itching accompanied by mild wheeze and severe urticaria. Diagnosis of allergy to yeast was confirmed by specific IgE testing as well as that to relevant foods and beverages. The patient's ongoing management included advice to avoid beer, wine, and other food groups containing specific yeasts, in addition to carrying a short acting nonsedating antihistamine as well as an adrenaline autoinjector. Conclusions . Cases of yeast allergy are extremely rare in medical literature but may be underrecognised and should be considered in patients presenting with reactions to alcoholic beverages and other yeast-containing products.

Statistical Analysis on the Performance of Molecular Mechanics Poisson–Boltzmann Surface Area versus Absolute Binding Free Energy Calculations: Bromodomains as a Case Study

PubMed Central

2017-01-01

Binding free energy calculations that make use of alchemical pathways are becoming increasingly feasible thanks to advances in hardware and algorithms. Although relative binding free energy (RBFE) calculations are starting to find widespread use, absolute binding free energy (ABFE) calculations are still being explored mainly in academic settings due to the high computational requirements and still uncertain predictive value. However, in some drug design scenarios, RBFE calculations are not applicable and ABFE calculations could provide an alternative. Computationally cheaper end-point calculations in implicit solvent, such as molecular mechanics Poisson–Boltzmann surface area (MMPBSA) calculations, could too be used if one is primarily interested in a relative ranking of affinities. Here, we compare MMPBSA calculations to previously performed absolute alchemical free energy calculations in their ability to correlate with experimental binding free energies for three sets of bromodomain–inhibitor pairs. Different MMPBSA approaches have been considered, including a standard single-trajectory protocol, a protocol that includes a binding entropy estimate, and protocols that take into account the ligand hydration shell. Despite the improvements observed with the latter two MMPBSA approaches, ABFE calculations were found to be overall superior in obtaining correlation with experimental affinities for the test cases considered. A difference in weighted average Pearson () and Spearman () correlations of 0.25 and 0.31 was observed when using a standard single-trajectory MMPBSA setup ( = 0.64 and = 0.66 for ABFE; = 0.39 and = 0.35 for MMPBSA). The best performing MMPBSA protocols returned weighted average Pearson and Spearman correlations that were about 0.1 inferior to ABFE calculations: = 0.55 and = 0.56 when including an entropy estimate, and = 0.53 and = 0.55 when including explicit water molecules. Overall, the study suggests that ABFE calculations are indeed the more accurate approach, yet there is also value in MMPBSA calculations considering the lower compute requirements, and if agreement to experimental affinities in absolute terms is not of interest. Moreover, for the specific protein–ligand systems considered in this study, we find that including an explicit ligand hydration shell or a binding entropy estimate in the MMPBSA calculations resulted in significant performance improvements at a negligible computational cost. PMID:28786670

Analysis of the adverse reactions induced by natural product-derived drugs

PubMed Central

Zeng, Zhi-Ping; Jiang, Jian-Guo

2010-01-01

Compared with the therapeutic effects of established medicinal drugs, it is often considered that natural product-derived drugs are of a more benign nature in side-effects, which has made natural medicines become a popular form of therapy. Traditional Chinese medicine (TCM) is generally considered as being natural and harmless. TCM has been paid much more attention than before and widely used for the treatment nowadays. However, with the increasing cases of adverse drug reactions (ADRs), the ADRs induced by TCM are becoming more widely recognized. Some ADRs are sometimes even life-threatening. This article reviews literatures on ADRs induced by TCM which was published in the past 10 years. A total of 3122 cases including complete data are selected for the present analysis. From the data of the 3122 cases, statistics is carried out to the distribution of administration routes and time of the occurrence of ADRs, the prognosis of ADRs, sex and age factors, types and clinical symptoms of ADRs, and drugs involved in ADRs. In addition, occurrence and influencing factors of TCM-induced diseases are also analysed, which includes spices confusion, processing drugs improperly, toxic components, long-term medication, improper concerted application, interaction of TCM and Western medicine. It is concluded that the efficacy and toxicity of TCM, often using the compound prescription involving various plants and animals, resulted from a variety of chemical constituents, which lead to a comprehensive response in the human body. The ‘toxicity’ of TCM should be correctly recognized and reasonably utilized. PMID:20233209

The role of immunohistochemistry in medullomyoblastoma--a case series highlighting divergent differentiation.

PubMed

Sachdeva, Man Updesh S; Vankalakunti, Mahesha; Rangan, Aruna; Radotra, Bishan D; Chhabra, Rajesh; Vasishta, Rakesh K

2008-04-25

To analyse the histo-morphology of cases of medullomyoblastoma and identifying its divergent differentiation. A retrospective review of all cases reported as medulloblastoma between the period of Jan 2000 to Dec 2006 was carried out on Hematoxylin and eosin (H & E) stained slides. The cases were screened on light microscopy for primitive neuroectodermal component of a medulloblastoma accompanied by areas of "myoid" differentiation, identified on the basis of presence of strap cells (indicating a clear skeletal muscle differentiation) and/or large anaplastic cells with vescicular nuclei and moderate to abundant amount of eosinophilic cytoplasm. All these cases were subjected to a panel of immunohistochemical stains, including Desmin, GFAP, NFP, HMB45, SMA, S100, CK and EMA. Ultrastructural analysis was done on tissue obtained from paraffin blocks in 2 cases. Male predominance (M:F = 5:1) was noted with an incidence of five percent of all cases of medulloblastoma (6 out of 120 cases) over a period of 6 years. Primitive neuroectodermal areas were accompanied with areas of "myoid" differentiation, 5 cases showing strap cells. Two cases with epithelial and cartilaginous differentiation were seen. Three cases showed focal melanocytic differentiation, identified only on HMB45 immunostaining. Four cases showed glial differentiation. Neuronal differentiation again was very focally seen in two cases, of which one was identified only by NFP immunostain. Seventh case is included in the study, however it is not considered to calculate incidence as it occurred beyond the period of 6 years of records search. Medullomyoblastoma is a rare childhood tumor of cerebellum. Majority of cases reveal divergent differentiation, which are identified with the help of panel of immunostains indicating multi-potential nature of primitive neuroectodermal cells.

A discontinuous Galerkin method for poroelastic wave propagation: The two-dimensional case

NASA Astrophysics Data System (ADS)

Dudley Ward, N. F.; Lähivaara, T.; Eveson, S.

2017-12-01

In this paper, we consider a high-order discontinuous Galerkin (DG) method for modelling wave propagation in coupled poroelastic-elastic media. The upwind numerical flux is derived as an exact solution for the Riemann problem including the poroelastic-elastic interface. Attenuation mechanisms in both Biot's low- and high-frequency regimes are considered. The current implementation supports non-uniform basis orders which can be used to control the numerical accuracy element by element. In the numerical examples, we study the convergence properties of the proposed DG scheme and provide experiments where the numerical accuracy of the scheme under consideration is compared to analytic and other numerical solutions.

Voltera's Solution of the Wave Equation as Applied to Three-Dimensional Supersonic Airfoil Problems

NASA Technical Reports Server (NTRS)

Heslet, Max A; Lomax, Harvard; Jones, Arthur L

1947-01-01

A surface integral is developed which yields solutions of the linearized partial differential equation for supersonic flow. These solutions satisfy boundary conditions arising in wing theory. Particular applications of this general method are made, using acceleration potentials, to flat surfaces and to uniformly loaded lifting surfaces. Rectangular and trapezoidal plan forms are considered along with triangular forms adaptable to swept-forward and swept-back wings. The case of the triangular plan form in sideslip is also included. Emphasis is placed on the systematic application of the method to the lifting surfaces considered and on the possibility of further application.

Reflections on "Creative" Action Learning in Business Education: Some Issues in Its Theory and Practice

ERIC Educational Resources Information Center

Brook, Cheryl; Milner, Christopher

2014-01-01

The purpose of this paper is to consider some issues in the uses of what we have termed "creative" action learning in a business education context, and to review some aspects of its practice. A review of the literature, including its use in higher education, is followed by a case illustration of its use in a UK business school with…

Azithromycin induced hepatocellular toxicity and hepatic encephalopathy in asymptomatic dilated cardiomyopathy

PubMed Central

Das, Bidyut Kumar

2011-01-01

Azithromycin is a widely used macrolide derivative and has generally been considered to be a very safe medication. Though gastrointestinal symptoms and reversible hearing loss are common, potentially serious side effects including angioedema and cholestatic jaundice occurred in less than one percent of patients. We report a case of asymptomatic dilated cardiomyopathy with Azithromycin induced severe hepatocellular toxicity and hepatic encephalopathy. PMID:22144789

Alternatives for jet engine control

NASA Technical Reports Server (NTRS)

Sain, M. K.

1980-01-01

Nonlinear modeling researches involving the use of tensor analysis are presented. Progress was achieved by extending the studies to a controlled equation and by considering more complex situations. Included in the report are calculations illustrating the modeling methodology for cases in which variables take values in real spaces of dimension up to three, and in which the degree of tensor term retention is as high as three.

Conflict and Trade-Offs between Efficiency and Access: A Case of Day and Boarding Secondary Schools in Kenya

ERIC Educational Resources Information Center

Zachariah, Kosgei K.; Joshua, Keter K.

2016-01-01

While education is considered to be a human right and need, the delivery of secondary education in Kenya has been slow due to a number of bottlenecks that includes: (one), differential trends in access and participation in secondary school education with low participation of the poor and (two), low efficiency and quality of education as indicated…

The Ordination of Women in the Catholic Church: Arguments for Teachers and Students in Catholic Schools to Consider--Part 2 the Case For

ERIC Educational Resources Information Center

Bourgeois, Roy

2015-01-01

Vatican authority is being challenged as Roman Catholic women act upon their vocations to the priesthood, receive ordination, and openly serve their faith communities. Since 2002--when seven women were ordained by male Roman Catholic bishops--190 women have been ordained to the priesthood, including a dozen women bishops. Vatican officials dismiss…

Painful cutaneous metastases from esophageal carcinoma.

PubMed

Stein, Ronnit Hamuy; Spencer, James M

2002-10-01

Cutaneous metastases, which are not included among the painful dermal tumors, are primarily asymptomatic and of variable clinical appearance. Although, to our knowledge, this case report of painful cutaneous metastases is only the fifth in the literature, physicians who discover a painful tumor perhaps now should consider cutaneous metastasis. In this report, we describe painful nodular scalp lesions related to esophageal adenocarcinoma, which rarely metastasizes to the skin.

How Children Talk Together to Make Meaning from Texts: A Dialogic Perspective on Reading Comprehension Strategies

ERIC Educational Resources Information Center

Maine, Fiona

2013-01-01

This study considers reading comprehension as a dialogic transaction of making meaning from text. The concept of text and reading is taken to include the visual and multimodal as well as written forms. Case studies of children discussing texts are analysed to explore how children engage in inter-mental and intra-mental processes of reading,…

Unilateral phrenic nerve lesion in Lyme neuroborreliosis

PubMed Central

2013-01-01

Background Among a variety of more common differential diagnoses, the aetiology of acute respiratory failure includes Lyme neuroborreliosis. Case presentation We report an 87-years old huntsman with unilateral phrenic nerve palsy as a consequence of Lyme neuroborreliosis. Conclusion Although Lyme neuroborreliosis is a rare cause of diaphragmatic weakness, it should be considered in the differential workup because of its potentially treatable nature. PMID:23327473

MURI: Impact of Oceanographic Variability on Acoustic Communications

DTIC Science & Technology

2012-09-30

ACSSC.2010.5757934 (2010). [published] [50] K. Tu, T.M. Duman, J.G. Proakis, and M. Stojanovic, “Cooperative MIMO - OFDM communications: Receiver...considered across bands of frequencies in the range 1-50 kHz. Multiple source and receiver cases ( MIMO ) will be of particular interest. Validating...Parabolic Equation (PE) acoustic models. Communication receiver design has included processors for orthogonal frequency division multiplexing ( OFDM

20 CFR 1002.57 - Is all service as a member of the National Guard considered “service in the uniformed services?”

Code of Federal Regulations, 2010 CFR

2010-04-01

..., it is a State military force subject to call-up by the State Governor for duty not subject to Federal control, such as emergency duty in cases of floods or riots. National Guard members may perform service... authority includes active duty performed under Title 10 of the United States Code. Service under Federal...

20 CFR 1002.57 - Is all service as a member of the National Guard considered “service in the uniformed services?”

Code of Federal Regulations, 2011 CFR

2011-04-01

..., it is a State military force subject to call-up by the State Governor for duty not subject to Federal control, such as emergency duty in cases of floods or riots. National Guard members may perform service... authority includes active duty performed under Title 10 of the United States Code. Service under Federal...

Solid propellant processing factor in rocket motor design

NASA Technical Reports Server (NTRS)

1971-01-01

The ways are described by which propellant processing is affected by choices made in designing rocket engines. Tradeoff studies, design proof or scaleup studies, and special design features are presented that are required to obtain high product quality, and optimum processing costs. Processing is considered to include the operational steps involved with the lining and preparation of the motor case for the grain; the procurement of propellant raw materials; and propellant mixing, casting or extrusion, curing, machining, and finishing. The design criteria, recommended practices, and propellant formulations are included.

Extranodal Marginal Zone Lymphoma of the Central Nervous System.

PubMed

Ayanambakkam, Adanma; Ibrahimi, Sami; Bilal, Khalid; Cherry, Mohamad A

2018-01-01

Extranodal marginal zone lymphoma of the central nervous system (CNS EMZBL) is a rare disease. We present a review of the literature and describe its presentation, differential diagnosis, treatment options, and outcomes. Systematic search of PubMed, Medline, and Embase databases via the Ovid engine for primary articles and case reports yielded 37 unduplicated peer-reviewed articles of CNS EMZBL. We identified 69 cases in these articles and 1 unreported case at our institution, which were included for this review's analysis. Median age at diagnosis was 55 years (range, 18-78 years), with a female preponderance of 77% (n = 54). Most common presenting symptoms were headache in 43% (n = 30), seizures in 31% (n = 22), and visual defects in 27% (n = 19). The most common treatment modalities were localized therapies, which were provided to 67% (n = 47) of cases. These included radiotherapy in 27% (n = 19), radiotherapy with surgery in 24% (n = 17), and surgery alone in 16% (n = 11). Ninety percent (n = 63) of patients had a median follow-up of 23 months. Complete remission was experienced by 77% (n = 49) patients, and 22% (n = 14) were alive with disease. Three patients had evidence of relapse, and one patient died. CNS EMZBL is an indolent, low-grade, radiosensitive lymphoma with good treatment outcomes and prognosis. It is an important differential to consider in extra-axial dural-based masses. Individualized management plans, with preference given to localized treatment options, should be considered after factoring in the site and extent of disease, its resectability, and the expected adverse effects of systemic therapy. Copyright © 2017 Elsevier Inc. All rights reserved.

Primary non-function is frequently associated with fatty liver allografts and high mortality after re-transplantation.

PubMed

Kulik, Ulf; Lehner, Frank; Klempnauer, Jürgen; Borlak, Jürgen

2017-08-01

The shortage of liver donations demands the use of suboptimal grafts with steatosis being a frequent finding. Although ≤30% macrovesicular steatosis is considered to be safe the risk for primary non-function (PNF) and outcome after re-transplantation (re-OLT) is unknown. Among 1205 orthotopic liver transplantations performed at our institution the frequency, survival and reason of re-OLT were evaluated. PNF (group A) cases and those with initial transplant function but subsequent need for re-OLT (group B) were analysed. Histopathology and clinical judgement determined the cause of PNF and included an assessment of hepatic steatosis. Additionally, survival of fatty liver allografts (group C) not requiring re-OLT was considered in Kaplan-Meier and multivariate regression analysis. A total of 77 high urgency re-OLTs were identified and included 39 PNF cases. Nearly 70% of PNF cases were due to primary fatty liver allografts. The 3-month in-hospital mortality for PNF cases after re-OLT was 46% and the mean survival after re-OLT was 0.5 years as compared to 5.2 and 5.1 years for group B, C, respectively, (P<.008). In multivariate Cox regression analysis only hepatic steatosis was associated with an inferior survival (HR 4.272, P=.002). The MELD score, donor BMI, age, cold ischaemic time, ICU stay, serum sodium and transaminases did not influence overall survival. Our study highlights fatty liver allografts to be a major cause for PNF with excessive mortality after re-transplantation. The findings demand the development of new methods to predict risk for PNF of fatty liver allografts. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Ethical issues in human genome epidemiology: a case study based on the Japanese American Family Study in Seattle, Washington.

PubMed

Austin, Melissa A

2002-04-01

Recent completion of the draft sequence of the human genome has been greeted with both excitement and skepticism, and the potential of this accomplishment for advancing public health has been tempered by ethical concerns about the protection of human subjects. This commentary explores ethical issues arising in human genome epidemiology by using a case study approach based on the ongoing Japanese American Family Study at the University of Washington in Seattle (1994-2003). Ethical issues encountered in designing the study, collecting the data, and reporting the study results are considered. When developing studies, investigators must consider whether to restrict the study to specific racial or ethnic groups and whether community involvement is appropriate. Once the study design is in place, further ethical issues emerge, including obtaining informed consent for DNA banking and protecting the privacy and confidentiality of family members. Finally, investigators must carefully consider whether to report genotype results to study participants and whether pedigrees illustrating the results of the study will be published. Overall, the promise of genomics for improving public health must be pursued based on the fundamental ethical principles of respect for persons, beneficence, and justice.

Ulcerative colitis with acute pleurisy

PubMed Central

Lu, Shuming; Wang, Lihua; Zhang, Weisheng; Zhang, Zhuqing; Liu, Lina; Wang, Yingde; Meng, Hua

2017-01-01

Abstract Rationale: Inflammatory bowel diseases (IBD), including ulcerative colitis (UC) and Crohn's disease, are associated with a large number of extraintestinal manifestations. Pulmonary manifestations are infrequently seen in patients with IBD. Moreover, serositis including pleural and pericardial manifestations in UC is rare. Patient concerns: We report a case of UC with acute pleurisy in a 43-year-old man; review literature; and discuss the diagnosis, differential diagnosis, and treatment. Diagnoses: Active duodenal ulcer was found using gastroscopy. Multiple ulcers in segmented pattern were noticed in the left hemi-colon using colonoscopy. An UC in active stage was confirmed subsequently by histology. Intervention: The patient was treated with bifidobacterium tetravaccine tablets, oral mesalazine and mesalazine enemas. The omeprazole and mucosal protective agents were given to treat the duodenal ulcer. Outcomes: As follow-up, the therapy including oral mesalazine and infliximab regularly was continued and the patient condition was stabilized. Main lesson: Pulmonary involvement should be considered in patients who develop pleurisy in UC. Infliximab is considered the better available treatment for patients presenting with pleurisy in UC. PMID:28746225

Electromagnetic cyclotron-loss-cone instability associated with weakly relativistic electrons

NASA Technical Reports Server (NTRS)

Wong, H. K.; Wu, C. S.; Ke, F. J.; Schneider, R. S.; Ziebell, L. F.

1982-01-01

The amplification of fast extraordinary mode waves at frequencies very close to the electron cyclotron frequency, due to the presence of a population of energetic electrons with a loss-cone type distribution, is studied. Low-energy background electrons are included in the analysis. Two types of loss-cone distribution functions are considered, and it is found that the maximum growth rates for both distribution functions are of the same order of magnitude. When the thermal effects of the energetic electrons are included in the dispersion equation, the real frequencies of the waves are lower than those obtained by using the cold plasma approximation. This effect tends to enhance the growth rate. An idealized case including a parallel electric field such that the distribution function of the trapped energetic electrons is modified is also considered. It is assumed that the parallel electric field can remove the low-energy background electrons away from the source region of radiation. Both these effects increase the growth rate.

Diagnosing and discriminating between primary and secondary aneurysmal bone cysts

PubMed Central

Sasaki, Hiromi; Nagano, Satoshi; Shimada, Hirofumi; Yokouchi, Masahiro; Setoguchi, Takao; Ishidou, Yasuhiro; Kunigou, Osamu; Maehara, Kosuke; Komiya, Setsuro

2017-01-01

Aneurysmal bone cysts (ABCs) are benign bony lesions frequently accompanied by multiple cystic lesions and aggressive bone destruction. They are relatively rare lesions, representing only 1% of bone tumors. The pathogenesis of ABCs has yet to be elucidated. In the present study, a series of 22 cases of primary and secondary ABC from patients treated in Department of Orthopedic Surgery, Kagoshima University Hospital (Kagoshima, Japan) from 2001–2015 were retrospectively analyzed. The average age at the time of diagnosis of primary ABC was 17.9 years. Intralesional curettage and artificial bone grafting were performed in the majority of the patients with primary ABC. The local recurrence rate following curettage for primary ABC was 18%, and the cause of local recurrence was considered to be insufficient curettage. Although no adjuvant therapy was administered during the surgeries, it may assist the prevention of local recurrence in certain cases. The cases of secondary ABC were preceded by benign bone tumors, including fibrous dysplasia, giant cell tumors, chondroblastoma and non-ossifying fibroma. The features of the secondary ABC typically reflected those of the preceding bone tumor. In the majority of cases, distinguishing the primary ABC from the secondary ABC was possible based on characteristic features, including age of the patient at diagnosis and the tumor location. In cases that exhibit ambiguous features, including a soft tissue mass or a thick septal enhancement on the preoperative magnetic resonance images, a biopsy must be obtained in order to exclude other types of aggressive bone tumors, including giant cell tumor, osteosarcoma and telangiectatic osteosarcoma. PMID:28454393

Vital Signs: Health Care–Associated Legionnaires’ Disease Surveillance Data from 20 States and a Large Metropolitan Area — United States, 2015

PubMed Central

Barskey, Albert E.; Shah, Priti P.; Schrag, Stephanie; Whitney, Cynthia G.; Arduino, Matthew J.; Reddy, Sujan C.; Kunz, Jasen M.; Hunter, Candis M.; Raphael, Brian H.; Cooley, Laura A.

2017-01-01

Background Legionnaires’ disease, a severe pneumonia, is typically acquired through inhalation of aerosolized water containing Legionella bacteria. Legionella can grow in the complex water systems of buildings, including health care facilities. Effective water management programs could prevent the growth of Legionella in building water systems. Methods Using national surveillance data, Legionnaires’ disease cases were characterized from the 21 jurisdictions (20 U.S. states and one large metropolitan area) that reported exposure information for ≥90% of 2015 Legionella infections. An assessment of whether cases were health care–associated was completed; definite health care association was defined as hospitalization or long-term care facility residence for the entire 10 days preceding symptom onset, and possible association was defined as any exposure to a health care facility for a portion of the 10 days preceding symptom onset. All other Legionnaires’ disease cases were considered unrelated to health care. Results A total of 2,809 confirmed Legionnaires’ disease cases were reported from the 21 jurisdictions, including 85 (3%) definite and 468 (17%) possible health care–associated cases. Among the 21 jurisdictions, 16 (76%) reported 1–21 definite health care–associated cases per jurisdiction. Among definite health care–associated cases, the majority (75, 88%) occurred in persons aged ≥60 years, and exposures occurred at 72 facilities (15 hospitals and 57 long-term care facilities). The case fatality rate was 25% for definite and 10% for possible health care–associated Legionnaires’ disease. Conclusions and Implications for Public Health Practice Exposure to Legionella from health care facility water systems can result in Legionnaires’ disease. The high case fatality rate of health care–associated Legionnaires’ disease highlights the importance of case prevention and response activities, including implementation of effective water management programs and timely case identification. PMID:28594788

Treatment of Patellar Tendinopathy Refractory to Surgical Management Using Percutaneous Ultrasonic Tenotomy and Platelet-Rich Plasma Injection: A Case Presentation.

PubMed

Nanos, Katherine N; Malanga, Gerard A

2015-12-01

Chronic proximal patellar tendinopathy is a common condition in sports medicine that may be refractory to nonoperative treatments, including activity modification, medications, and comprehensive rehabilitation. Percutaneous ultrasonic tenotomy is a recently developed technique designed to cut and debride tendinopathic tissue, thus promoting pain relief and functional recovery. We present a case of a collegiate athlete with chronic proximal patellar tendinopathy who was effectively treated with percutaneous ultrasonic tenotomy after not responding to extensive nonoperative treatment, surgical debridement, and platelet-rich plasma injections. Percutaneous ultrasonic tenotomy can be considered as a treatment option in patients presenting with refractory proximal patellar tendinopathy, including those who do not respond to previous operative intervention. Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Pure Progressive Ataxia and Palatal Tremor (PAPT) Associated with a New Polymerase Gamma (POLG) Mutation.

PubMed

Nicastro, Nicolas; Ranza, Emmanuelle; Antonarakis, Stylianos E; Horvath, Judit

2016-12-01

Progressive ataxia with palatal tremor (PAPT) is a syndrome caused by cerebellar and brainstem lesions involving the dentato-rubro-olivary tract and associated with hypertrophic olivary degeneration. Etiologies include acquired posterior fossa lesions (e.g. tumors, superficial siderosis, and inflammatory diseases) and genetic disorders, such as glial fibrillary acidic protein (GFAP) and polymerase gamma (POLG) mutations. We describe the case of a 52-year-old man who developed pure progressive ataxia and palatal tremor. Genetic analysis has shown that he is compound heterozygote for a known pathogenic (W748S) and a novel POLG variant (I1185N). Patients with POLG recessive mutations usually manifest a more complex clinical picture, including polyneuropathy and epilepsy; our case emphasizes the need to consider a genetic origin in a seemingly sporadic and pure PAPT.

Evaluation of tuberculosis diagnostics in children: 1. Proposed clinical case definitions for classification of intrathoracic tuberculosis disease. Consensus from an expert panel.

PubMed

Graham, Stephen M; Ahmed, Tahmeed; Amanullah, Farhana; Browning, Renee; Cardenas, Vicky; Casenghi, Martina; Cuevas, Luis E; Gale, Marianne; Gie, Robert P; Grzemska, Malgosia; Handelsman, Ed; Hatherill, Mark; Hesseling, Anneke C; Jean-Philippe, Patrick; Kampmann, Beate; Kabra, Sushil Kumar; Lienhardt, Christian; Lighter-Fisher, Jennifer; Madhi, Shabir; Makhene, Mamodikoe; Marais, Ben J; McNeeley, David F; Menzies, Heather; Mitchell, Charles; Modi, Surbhi; Mofenson, Lynne; Musoke, Philippa; Nachman, Sharon; Powell, Clydette; Rigaud, Mona; Rouzier, Vanessa; Starke, Jeffrey R; Swaminathan, Soumya; Wingfield, Claire

2012-05-15

There is a critical need for improved diagnosis of tuberculosis in children, particularly in young children with intrathoracic disease as this represents the most common type of tuberculosis in children and the greatest diagnostic challenge. There is also a need for standardized clinical case definitions for the evaluation of diagnostics in prospective clinical research studies that include children in whom tuberculosis is suspected but not confirmed by culture of Mycobacterium tuberculosis. A panel representing a wide range of expertise and child tuberculosis research experience aimed to develop standardized clinical research case definitions for intrathoracic tuberculosis in children to enable harmonized evaluation of new tuberculosis diagnostic technologies in pediatric populations. Draft definitions and statements were proposed and circulated widely for feedback. An expert panel then considered each of the proposed definitions and statements relating to clinical definitions. Formal group consensus rules were established and consensus was reached for each statement. The definitions presented in this article are intended for use in clinical research to evaluate diagnostic assays and not for individual patient diagnosis or treatment decisions. A complementary article addresses methodological issues to consider for research of diagnostics in children with suspected tuberculosis.

Crusted scabies-associated immune reconstitution inflammatory syndrome

PubMed Central

2012-01-01

Background Despite the widely accepted association between crusted scabies and human immunodeficiency virus (HIV)-infection, crusted scabies has not been included in the spectrum of infections associated with immune reconstitution inflammatory syndrome in HIV-infected patients initiating antiretroviral therapy. Case presentation We report a case of a 28-year-old Mexican individual with late HIV-infection, who had no apparent skin lesions but soon after initiation of antiretroviral therapy, he developed an aggressive form of crusted scabies with rapid progression of lesions. Severe infestation by Sarcoptes scabiei was confirmed by microscopic examination of the scale and skin biopsy. Due to the atypical presentation of scabies in a patient responding to antiretroviral therapy, preceded by no apparent skin lesions at initiation of antiretroviral therapy, the episode was interpreted for the first time as “unmasking crusted scabies-associated immune reconstitution inflammatory syndrome”. Conclusion This case illustrates that when crusted scabies is observed in HIV-infected patients responding to antiretroviral therapy, it might as well be considered as a possible manifestation of immune reconstitution inflammatory syndrome. Patient context should be considered for adequate diagnosis and treatment of conditions exacerbated by antiretroviral therapy-induced immune reconstitution. PMID:23181485

Portal Annular Pancreas

PubMed Central

Harnoss, Jonathan M.; Harnoss, Julian C.; Diener, Markus K.; Contin, Pietro; Ulrich, Alexis B.; Büchler, Markus W.; Schmitz-Winnenthal, Friedrich H.

2014-01-01

Abstract Portal annular pancreas (PAP) is an asymptomatic congenital pancreas anomaly, in which portal and/or mesenteric veins are encased by pancreas tissue. The aim of the study was to determine the role of PAP in pancreatic surgery as well as its management and potential complication, specifically, postoperative pancreatic fistula (POPF). On the basis of a case report, the MEDLINE and ISI Web of Science databases were systematically reviewed up to September 2012. All articles describing a case of PAP were considered. In summary, 21 studies with 59 cases were included. The overall prevalence of PAP was 2.4% and the patients' mean (SD) age was 55.9 (16.2) years. The POPF rate in patients with PAP (12 pancreaticoduodenectomies and 3 distal pancreatectomies) was 46.7% (in accordance with the definition of the International Study Group of Pancreatic Surgery). Portal annular pancreas is a quite unattended pancreatic variant with high prevalence and therefore still remains a clinical challenge to avoid postoperative complications. To decrease the risk for POPF, attentive preoperative diagnostics should also focus on PAP. In pancreaticoduodenectomy, a shift of the resection plane to the pancreas tail should be considered; in extensive pancreatectomy, coverage of the pancreatic remnant by the falciform ligament could be a treatment option. PMID:25207658

Quasilinear parabolic variational inequalities with multi-valued lower-order terms

NASA Astrophysics Data System (ADS)

Carl, Siegfried; Le, Vy K.

2014-10-01

In this paper, we provide an analytical frame work for the following multi-valued parabolic variational inequality in a cylindrical domain : Find and an such that where is some closed and convex subset, A is a time-dependent quasilinear elliptic operator, and the multi-valued function is assumed to be upper semicontinuous only, so that Clarke's generalized gradient is included as a special case. Thus, parabolic variational-hemivariational inequalities are special cases of the problem considered here. The extension of parabolic variational-hemivariational inequalities to the general class of multi-valued problems considered in this paper is not only of disciplinary interest, but is motivated by the need in applications. The main goals are as follows. First, we provide an existence theory for the above-stated problem under coercivity assumptions. Second, in the noncoercive case, we establish an appropriate sub-supersolution method that allows us to get existence, comparison, and enclosure results. Third, the order structure of the solution set enclosed by sub-supersolutions is revealed. In particular, it is shown that the solution set within the sector of sub-supersolutions is a directed set. As an application, a multi-valued parabolic obstacle problem is treated.

Length requirements for numerical-relativity waveforms

NASA Astrophysics Data System (ADS)

Hannam, Mark; Husa, Sascha; Ohme, Frank; Ajith, P.

2010-12-01

One way to produce complete inspiral-merger-ringdown gravitational waveforms from black-hole-binary systems is to connect post-Newtonian (PN) and numerical-relativity (NR) results to create “hybrid” waveforms. Hybrid waveforms are central to the construction of some phenomenological models for gravitational-wave (GW) search templates, and for tests of GW search pipelines. The dominant error source in hybrid waveforms arises from the PN contribution, and can be reduced by increasing the number of NR GW cycles that are included in the hybrid. Hybrid waveforms are considered sufficiently accurate for GW detection if their mismatch error is below 3% (i.e., a fitting factor above 0.97). We address the question of the length requirements of NR waveforms such that the final hybrid waveforms meet this requirement, considering nonspinning binaries with q=M2/M1∈[1,4] and equal-mass binaries with χ=Si/Mi2∈[-0.5,0.5]. We conclude that, for the cases we study, simulations must contain between three (in the equal-mass nonspinning case) and ten (the χ=0.5 case) orbits before merger, but there is also evidence that these are the regions of parameter space for which the least number of cycles will be needed.

A nonlinear self-similar solution to barotropic flow over rapidly varying topography

NASA Astrophysics Data System (ADS)

Ibanez, Ruy; Kuehl, Joseph

2016-11-01

Beginning from the Shallow Water Equations (SWE), a nonlinear self-similar analytic solution is derived for barotropic flow over rapidly varying topography. We study conditions relevant to the ocean slope where the flow is dominated by Earth's rotation and topography. Attention is paid to the northern Gulf of Mexico slope with application to pollutant dispersion and the Norwegian Coastal Current which sheds eddies into the Lofoten Basin that are believe to influence deep water formation. The solution is found to extend the topographic β-plume solution (Kuehl 2014, GRL) in two ways: 1) The solution is valid for intensifying jets. 2) The influence of nonlinear advection is included. The SWE are scaled to the case of a topographically controlled jet, then solved by introducing a similarity variable η = Cxy . The nonlinear solution, valid for topographies h =h0 - αxy3 , takes the form of the Lambert W Function for velocity. The linear solution, valid for topographies h =h0 - αxyγ , takes the form of the Error Function for transport. Kuehl's results considered the case - 1 <= γ < 1 which admits expanding jets, while the new result consider the case γ < - 1 which admits intensifying jets.

Effect of input signal and filter parameters on patterning effect in a semiconductor optical amplifier

NASA Astrophysics Data System (ADS)

Hussain, Kamal; Pratap Singh, Satya; Kumar Datta, Prasanta

2013-11-01

A numerical investigation is presented to show the dependence of patterning effect (PE) of an amplified signal in a bulk semiconductor optical amplifier (SOA) and an optical bandpass filter based amplifier on various input signal and filter parameters considering both the cases of including and excluding intraband effects in the SOA model. The simulation shows that the variation of PE with input energy has a characteristic nature which is similar for both the cases. However the variation of PE with pulse width is quite different for the two cases, PE being independent of the pulse width when intraband effects are neglected in the model. We find a simple relationship between the PE and the signal pulse width. Using a simple treatment we study the effect of the amplified spontaneous emission (ASE) on PE and find that the ASE has almost no effect on the PE in the range of energy considered here. The optimum filter parameters are determined to obtain an acceptable extinction ratio greater than 10 dB and a PE less than 1 dB for the amplified signal over a wide range of input signal energy and bit-rate.

Negative inductance circuits for metamaterial bandwidth enhancement

NASA Astrophysics Data System (ADS)

Avignon-Meseldzija, Emilie; Lepetit, Thomas; Ferreira, Pietro Maris; Boust, Fabrice

2017-12-01

Passive metamaterials have yet to be translated into applications on a large scale due in large part to their limited bandwidth. To overcome this limitation many authors have suggested coupling metamaterials to non-Foster circuits. However, up to now, the number of convincing demonstrations based on non-Foster metamaterials has been very limited. This paper intends to clarify why progress has been so slow, i.e., the fundamental difficulty in making a truly broadband and efficient non-Foster metamaterial. To this end, we consider two families of metamaterials, namely Artificial Magnetic Media and Artificial Magnetic Conductors. In both cases, it turns out that bandwidth enhancement requires negative inductance with almost zero resistance. To estimate bandwidth enhancement with actual non-Foster circuits, we consider two classes of such circuits, namely Linvill and gyrator. The issue of stability being critical, both metamaterial families are studied with equivalent circuits that include advanced models of these non-Foster circuits. Conclusions are different for Artificial Magnetic Media coupled to Linvill circuits and Artificial Magnetic Conductors coupled to gyrator circuits. In the first case, requirements for bandwidth enhancement and stability are very hard to meet simultaneously whereas, in the second case, an adjustment of the transistor gain does significantly increase bandwidth.

Making up koro: multiplicity, psychiatry, culture, and penis-shrinking anxieties.

PubMed

Crozier, Ivan

2012-01-01

Koro is a syndrome in which the penis (or sometimes the nipples or vulva) is retracting, with deleterious effects for the sufferer. In modern psychiatry, it is considered a culture-bound syndrome (CBS). This paper considers the formation and development of psychiatric conceptions of koro and related genital retraction syndromes from the 1890s to the present. It does so by examining the different explanations of koro based on shifting conceptions of mental illness, and considers the increased recognition of the role culture has to play in psychiatric concepts. Conceptions of culture (deriving from colonial psychiatry as well as from anthropology) actively shaped the ways in which psychiatrists conceptualized koro. Cases under consideration, additional to the first Dutch descriptions of koro, include the ways in which koro was identified in white western cases, and the 1967 Singaporean koro epidemic. Following a number of psychiatrists and psychologists who have addressed the same material, attention is also paid to the recent genital-theft panics in sub-Saharan Africa, considering the implications of the differences between koro and other genital-theft panics. Finally, the paper addresses the role played by koro in the development of the concept of CBSs, which was first presented in the DSM IV in 1994. This is explored against the backdrop of emerging ideas about culture and psychiatry from the late colonial period, especially in Africa, which are central to modern ideas about transcultural psychiatry.

Rethinking knowledge and pedagogy in dental education.

PubMed

Whipp, J L; Ferguson, D J; Wells, L M; Iacopino, A M

2000-12-01

Dentistry as a profession has often been considered both art and science. Traditional dental education has attempted to address both; however, in many places only the science of dentistry is emphasized. The move toward competency-based curricula in dental education requires an expansion of what constitutes meaningful knowledge in the curriculum and what pedagogies best support that curriculum. The scientific and technical knowledge considered foundational to clinical practice is not sufficient to teach competencies associated with the art of dentistry. Habermas, a social scientist, offers a way of looking beyond technical knowledge to consider two other forms of knowledge: practical and emancipatory. Pedagogy that supports development of practical and emancipatory knowledge includes problem-based learning and case methods, heuristics, reflective practica, journals, storytelling, and performance-based assessment methods. These important teaching strategies are being integrated into various dental curricula including a new competency-based dental curriculum at Marquette University's School of Dentistry. It will be critical for dental educators to continue developing these methods to provide efficient and effective education for future practitioners in both the art and science of dentistry.

Management of type 2 diabetes mellitus in children and adolescents.

PubMed

Springer, Shelley C; Silverstein, Janet; Copeland, Kenneth; Moore, Kelly R; Prazar, Greg E; Raymer, Terry; Shiffman, Richard N; Thaker, Vidhu V; Anderson, Meaghan; Spann, Stephen J; Flinn, Susan K

2013-02-01

Over the last 3 decades, the prevalence of childhood obesity has increased dramatically in North America, ushering in a variety of health problems, including type 2 diabetes mellitus (T2DM), which previously was not typically seen until much later in life. This technical report describes, in detail, the procedures undertaken to develop the recommendations given in the accompanying clinical practice guideline, "Management of Type 2 Diabetes Mellitus in Children and Adolescents," and provides in-depth information about the rationale for the recommendations and the studies used to make the clinical practice guideline's recommendations. A primary literature search was conducted relating to the treatment of T2DM in children and adolescents, and a secondary literature search was conducted relating to the screening and treatment of T2DM's comorbidities in children and adolescents. Inclusion criteria were prospectively and unanimously agreed on by members of the committee. An article was eligible for inclusion if it addressed treatment (primary search) or 1 of 4 comorbidities (secondary search) of T2DM, was published in 1990 or later, was written in English, and included an abstract. Only primary research inquiries were considered; review articles were considered if they included primary data or opinion. The research population had to constitute children and/or adolescents with an existing diagnosis of T2DM; studies of adult patients were considered if at least 10% of the study population was younger than 35 years. All retrieved titles, abstracts, and articles were reviewed by the consulting epidemiologist. Thousands of articles were retrieved and considered in both searches on the basis of the aforementioned criteria. From those, in the primary search, 199 abstracts were identified for possible inclusion, 58 of which were retained for systematic review. Five of these studies were classified as grade A studies, 1 as grade B, 20 as grade C, and 32 as grade D. Articles regarding treatment of T2DM selected for inclusion were divided into 4 major subcategories on the basis of type of treatment being discussed: (1) medical treatments (32 studies); (2) nonmedical treatments (9 studies); (3) provider behaviors (8 studies); and (4) social issues (9 studies). From the secondary search, an additional 336 abstracts relating to comorbidities were identified for possible inclusion, of which 26 were retained for systematic review. These articles included the following: 1 systematic review of literature regarding comorbidities of T2DM in adolescents; 5 expert opinions presenting global recommendations not based on evidence; 5 cohort studies reporting natural history of disease and comorbidities; 3 with specific attention to comorbidity patterns in specific ethnic groups (case-control, cohort, and clinical report using adult literature); 3 reporting an association between microalbuminuria and retinopathy (2 case-control, 1 cohort); 3 reporting the prevalence of nephropathy (cohort); 1 reporting peripheral vascular disease (case series); 2 discussing retinopathy (1 case-control, 1 position statement); and 3 addressing hyperlipidemia (American Heart Association position statement on cardiovascular risks; American Diabetes Association consensus statement; case series). A breakdown of grade of recommendation shows no grade A studies, 10 grade B studies, 6 grade C studies, and 10 grade D studies. With regard to screening and treatment recommendations for comorbidities, data in children are scarce, and the available literature is conflicting. Therapeutic recommendations for hypertension, dyslipidemia, retinopathy, microalbuminuria, and depression were summarized from expert guideline documents and are presented in detail in the guideline. The references are provided, but the committee did not independently assess the supporting evidence. Screening tools are provided in the Supplemental Information.

A methodological review of qualitative case study methodology in midwifery research.

PubMed

Atchan, Marjorie; Davis, Deborah; Foureur, Maralyn

2016-10-01

To explore the use and application of case study research in midwifery. Case study research provides rich data for the analysis of complex issues and interventions in the healthcare disciplines; however, a gap in the midwifery research literature was identified. A methodological review of midwifery case study research using recognized templates, frameworks and reporting guidelines facilitated comprehensive analysis. An electronic database search using the date range January 2005-December 2014: Maternal and Infant Care, CINAHL Plus, Academic Search Complete, Web of Knowledge, SCOPUS, Medline, Health Collection (Informit), Cochrane Library Health Source: Nursing/Academic Edition, Wiley online and ProQuest Central. Narrative evaluation was undertaken. Clearly worded questions reflected the problem and purpose. The application, strengths and limitations of case study methods were identified through a quality appraisal process. The review identified both case study research's applicability to midwifery and its low uptake, especially in clinical studies. Many papers included the necessary criteria to achieve rigour. The included measures of authenticity and methodology were varied. A high standard of authenticity was observed, suggesting authors considered these elements to be routine inclusions. Technical aspects were lacking in many papers, namely a lack of reflexivity and incomplete transparency of processes. This review raises the profile of case study research in midwifery. Midwives will be encouraged to explore if case study research is suitable for their investigation. The raised profile will demonstrate further applicability; encourage support and wider adoption in the midwifery setting. © 2016 John Wiley & Sons Ltd.

Lyme Disease Surveillance in New York State: an Assessment of Case Underreporting.

PubMed

White, J; Noonan-Toly, C; Lukacik, G; Thomas, N; Hinckley, A; Hook, S; Backenson, P B

2018-03-01

Despite the mandatory nature of Lyme disease (LD) reporting in New York State (NYS), it is believed that only a fraction of the LD cases diagnosed annually are reported to public health authorities. Lack of complete LD case reporting generally stems from (i) lack of report of provider-diagnosed cases where supportive laboratory testing is not ordered or results are negative (i.e. provider underreporting) and (ii) incomplete case information (clinical laboratory reporting only with no accompanying clinical information) such that cases are considered 'suspect' and not included in national and statewide case counts (i.e. case misclassification). In an attempt to better understand LD underreporting in NYS, a two-part study was conducted in 2011 using surveillance data from three counties. Case misclassification was assessed by obtaining medical records on suspect cases and reclassifying according to the surveillance case definition. To assess provider underreporting, lists of patients for whom ICD-9-CM code 088.81 (LD) had been used were reported to NYS Department of Health (NYSDOH). These lists were matched to the NYSDOH case reporting system, and medical records were requested on patients not previously reported; cases were then classified according to the case definition. When including both provider underreporting and case misclassification, approximately 20% (range 18.4-24.6%) more LD cases were identified in the three-county study area than were originally reported through standard surveillance. The additional cases represent a minimum percentage of unreported cases; the true percentage of unreported cases is likely higher. Unreported cases were more likely to have a history of erythema migrans (EM) rash and were more likely to be young paediatric cases. Results of the study support the assertion that LD cases are underreported in NYS. Initiatives to increase reporting should highlight the importance of reporting clinically diagnosed EM and be targeted to those providers most likely to diagnose LD, specifically providers treating paediatric patients. © 2016 Blackwell Verlag GmbH.

Incidence and prognostic significance of new onset atrial fibrillation/flutter in acute pericarditis.

PubMed

Imazio, Massimo; Lazaros, George; Picardi, Elisa; Vasileiou, Panagiotis; Orlando, Fabrizio; Carraro, Mara; Tsiachris, Dimitris; Vlachopoulos, Charalambos; Georgiopoulos, George; Tousoulis, Dimitrios; Belli, Riccardo; Gaita, Fiorenzo

2015-09-01

Data on the incidence of new onset atrial fibrillation and flutter (AF/f) in patients with acute pericarditis are limited. We sought to determine the incidence and prognostic significance of AF/f in this setting. Between January 2006 and June 2014, consecutive new cases of acute pericarditis were included in two urban referral centres for pericardial diseases. All new cases of AF/f defined as episodes lasting ≥30 s were recorded. Events considered during follow-up consisted of AF/f and pericarditis recurrence, cardiac tamponade, pericardial constriction and death. 822 consecutive new cases of acute pericarditis (mean age 53±15 years, 444 men) were analysed. AF/f was detected in 35 patients (4.3%, mean age 66.5±11.3 years, 18 men). Patients with AF/f were significantly older (p=0.017) and presented more frequently with pericardial effusion (p<0.001). Arrhythmias developed within 24 h of pericarditis onset in 91.4% of cases, lasted >24 h in 25.7% and spontaneously converted in 74.3% of patients. Underlying structural heart disease was present in 17% of AF/f cases. In a 30-month follow-up, patients with history of AF/f at the initial episode had a higher rate of arrhythmia occurrence (34.3% vs 0.9%, p<0.001), mostly (75%) within 3 months. No other differences were detected in additional clinical events including haemorrhagic complications in patients receiving oral anticoagulation. The occurrence of AF/f in acute pericarditis identifies a predisposed population to AF/f with a high recurrence risk (about 35%): in these patients, pericarditis may act as an arrhythmic trigger and oral anticoagulation should be seriously considered according to guidelines. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Reliability of intraoperative neurophysiological monitoring using motor evoked potentials during resection of metastases in motor-eloquent brain regions: clinical article.

PubMed

Krieg, Sandro M; Schäffner, Michael; Shiban, Ehab; Droese, Doris; Obermüller, Thomas; Gempt, Jens; Meyer, Bernhard; Ringel, Florian

2013-06-01

Resection of gliomas in or adjacent to the motor system is widely performed using intraoperative neuromonitoring (IOM). For resection of cerebral metastases in motor-eloquent regions, however, data are sparse and IOM in such cases is not yet widely described. Since recent studies have shown that cerebral metastases infiltrate surrounding brain tissue, this study was undertaken to assess the value and influence of IOM during resection of supratentorial metastases in motor-eloquent regions. Between 2006 and 2011, the authors resected 206 consecutive supratentorial metastases, including 56 in eloquent motor areas with monitoring of monopolar direct cortically stimulated motor evoked potentials (MEPs). The authors evaluated the relationship between the monitoring data and the course of surgery, clinical data, and postoperative imaging. Motor evoked potential monitoring was successful in 53 cases (93%). Reduction of MEP amplitude correlated better with postoperative outcomes when the threshold for significant amplitude reduction was set at 80% (only > 80% reduction was considered significant decline) than when it was set at 50% (> 50% amplitude reduction was considered significant decline). Evidence of residual tumor was seen on MR images in 28% of the cases with significant MEP reduction. No residual tumor was seen in any case of stable MEP monitoring. Moreover, preoperative motor deficit, recursive partitioning analysis Class 3, and preoperative radiotherapy were independent risk factors for a new surgery-related motor weakness (occurring in 64% of patients with and 11% of patients without radiotherapy, p > 0.01). Continuous MEP monitoring provides reliable monitoring of the motor system and also influences the course of operation in resection of cerebral metastases. However, in establishing warning criteria, only an amplitude decline > 80% of the baseline should be considered significant.

Probiotics and infective endocarditis in patients with hereditary hemorrhagic telangiectasia: a clinical case and a review of the literature.

PubMed

Boumis, Evangelo; Capone, Alessandro; Galati, Vincenzo; Venditti, Carolina; Petrosillo, Nicola

2018-02-01

In the last decades, probiotics have been widely used as food supplements because of their putative beneficial health effects. They are generally considered safe but rare reports of serious infections caused by bacteria included in the definition of probiotics raise concerns on their potential pathogenic role in patients with particular predisposing factors. Patients with hereditary hemorrhagic telangiectasia (HHT) are exposed to infections because of telangiectasias and arteriovenous malformations (AVMs). We describe what is, to our knowledge, the first case of infective endocarditis (IE) caused by Lactobacillus rhamnosus in a patient with HHT. A systematic review of the relevant medical literature is presented. A patient with HHT and an aortic bioprosthesis was admitted because of prolonged fever not responding to antibiotics. The patient had a history of repeated serious infections with hospitalizations and prolonged use of antibiotics, and used to assume large amounts of different commercial products containing probiotics. Weeks before the onset of symptoms the patient had been treated with nasal packings and with surgical closure of a nasal bleeding site because of recurrent epistaxis. A diagnosis of IE of the aortic bioprosthesis was made. All blood coltures were positive for L. rhamnosus. The patients responded to a cycle of 6 weeks of amoxicillin/clavulanate plus gentamicin. A systematic review of IE linked to consumption of probiotics, and of infective endocarditis in patients with HHT was conducted. 10 cases of IE linked to probiotics consumption and 6 cases of IE in patients with HHT were found. Consumption of probiotics can pose a risk of serious infections in patients with particular predisposing factors. Patients with HHT can be considered at risk because of their predisposition to infections. Prophylaxis with antibiotics before nasal packings in patients with HHT can be considered.

Totally Asymmetric Limit for Models of Heat Conduction

NASA Astrophysics Data System (ADS)

De Carlo, Leonardo; Gabrielli, Davide

2017-08-01

We consider one dimensional weakly asymmetric boundary driven models of heat conduction. In the cases of a constant diffusion coefficient and of a quadratic mobility we compute the quasi-potential that is a non local functional obtained by the solution of a variational problem. This is done using the dynamic variational approach of the macroscopic fluctuation theory (Bertini et al. in Rev Mod Phys 87:593, 2015). The case of a concave mobility corresponds essentially to the exclusion model that has been discussed in Bertini et al. (J Stat Mech L11001, 2010; Pure Appl Math 64(5):649-696, 2011; Commun Math Phys 289(1):311-334, 2009) and Enaud and Derrida (J Stat Phys 114:537-562, 2004). We consider here the convex case that includes for example the Kipnis-Marchioro-Presutti (KMP) model and its dual (KMPd) (Kipnis et al. in J Stat Phys 27:6574, 1982). This extends to the weakly asymmetric regime the computations in Bertini et al. (J Stat Phys 121(5/6):843-885, 2005). We consider then, both microscopically and macroscopically, the limit of large externalfields. Microscopically we discuss some possible totally asymmetric limits of the KMP model. In one case the totally asymmetric dynamics has a product invariant measure. Another possible limit dynamics has instead a non trivial invariant measure for which we give a duality representation. Macroscopically we show that the quasi-potentials of KMP and KMPd, which are non local for any value of the external field, become local in the limit. Moreover the dependence on one of the external reservoirs disappears. For models having strictly positive quadratic mobilities we obtain instead in the limit a non local functional having a structure similar to the one of the boundary driven asymmetric exclusion process.

Factors Associated with Tuberculosis Treatment Default in an Endemic Area of the Brazilian Amazon: A Case Control-Study

PubMed Central

Garrido, Marlucia da Silva; Penna, Maria Lucia; Perez-Porcuna, Tomàs M.; de Souza, Alexandra Brito; Marreiro, Leni da Silva; Albuquerque, Bernardino Claudio; Martínez-Espinosa, Flor Ernestina; Bührer-Sékula, Samira

2012-01-01

Setting Treatment default is a serious problem in tuberculosis control because it implies persistence of infection source, increased mortality, increased relapse rates and facilitates the development of resistant strains. Objective This study analyzed tuberculosis treatment default determinants in the Amazonas State to contribute in planning appropriate control interventions. Design Observational study with a retrospective cohort using Brazilian Disease Notification System data from 2005 to 2010. A nested case control study design was used. Patients defaulting from treatment were considered as ‘cases’ and those completing treatment as ‘controls’. In the analysis, 11,312 tuberculosis patients were included, 1,584 cases and 9,728 controls. Results Treatment default was observed to be associated to previous default (aOR 3.20; p<0.001), HIV positivity (aOR 1.62; p<0.001), alcoholism (aOR 1.51; p<0.001), low education level (aOR 1.35; p<0.001) and other co-morbidities (aOR 1.31; p = 0.05). Older patients (aOR 0.98; p = 0.001) and DOT (aOR 0,72; p<0.01) were considered as protective factor for default. Conclusions Associated factors should be considered in addressing care and policy actions to tuberculosis control. Information on disease and treatment should be intensified and appropriate to the level of education of the population, in order to promote adherence to treatment and counter the spread of multidrug resistance to anti-TB drugs. PMID:22720052

Research data collection methods: from paper to tablet computers.

PubMed

Wilcox, Adam B; Gallagher, Kathleen D; Boden-Albala, Bernadette; Bakken, Suzanne R

2012-07-01

Primary data collection is a critical activity in clinical research. Even with significant advances in technical capabilities, clear benefits of use, and even user preferences for using electronic systems for collecting primary data, paper-based data collection is still common in clinical research settings. However, with recent developments in both clinical research and tablet computer technology, the comparative advantages and disadvantages of data collection methods should be determined. To describe case studies using multiple methods of data collection, including next-generation tablets, and consider their various advantages and disadvantages. We reviewed 5 modern case studies using primary data collection, using methods ranging from paper to next-generation tablet computers. We performed semistructured telephone interviews with each project, which considered factors relevant to data collection. We address specific issues with workflow, implementation and security for these different methods, and identify differences in implementation that led to different technology considerations for each case study. There remain multiple methods for primary data collection, each with its own strengths and weaknesses. Two recent methods are electronic health record templates and next-generation tablet computers. Electronic health record templates can link data directly to medical records, but are notably difficult to use. Current tablet computers are substantially different from previous technologies with regard to user familiarity and software cost. The use of cloud-based storage for tablet computers, however, creates a specific challenge for clinical research that must be considered but can be overcome.

Does health promote economic growth? Portuguese case study: from dictatorship to full democracy.

PubMed

Morgado, Sónia Maria Aniceto

2014-07-01

This paper revisits the debate on health and economic growth (Deaton in J Econ Lit 51:113-158, 2003) focusing on the Portuguese case by testing the relationship between growth and health. We test Portuguese insights, using time series data from 1960 to 2005, taking into account different variables (life expectancy, labour, capital, infant mortality) and considering the years that included major events on the political scene, such as the dictatorship and a closed economy (1960-1974), a revolution (1974) and full democracy and an open economy (1975-2005), factors that influence major economic, cultural, social and politic indicators. Therefore the analysis is carried out adopting Lucas' (J Monet Econ 22(1):3-42, 1988) endogenous growth model that considers human capital as one factor of production, it adopts a VAR (vector autoregressive) model to test the causality between growth and health. Estimates based on the VAR seem to confirm that economic growth influences the health process, but health does not promote growth, during the period under study.

Cosmic-ray antiprotons, positrons, and gamma rays from halo dark matter annihilation

NASA Technical Reports Server (NTRS)

Rudaz, S.; Stecker, F. W.

1988-01-01

The subject of cosmic ray antiproton production is reexamined by considering other choices for the nature of the Majorana fermion chi other than the photino considered in a previous article. The calculations are extended to include cosmic-ray positrons and cosmic gamma rays as annihilation products. Taking chi to be a generic higgsino or simply a heavy Majorana neutrino with standard couplings to the Z-zero boson allows the previous interpretation of the cosmic antiproton data to be maintained. In this case also, the annihilation cross section can be calculated independently of unknown particle physics parameters. Whereas the relic density of photinos with the choice of parameters in the previous paper turned out to be only a few percent of the closure density, the corresponding value for Omega in the generic higgsino or Majorana case is about 0.2, in excellent agreement with the value associated with galaxies and one which is sufficient to give the halo mass.

Committee Opinion No. 655 Summary: Hepatitis B, Hepatitis C, and Human Immunodeficiency Virus Infections in Obstetrician-Gynecologists.

PubMed

2016-02-01

To prevent transmission of bloodborne pathogens, it is important that health care providers adhere to standard precautions, follow fundamental infection-control principles, and use appropriate procedural techniques. All obstetrician-gynecologists who provide clinical care should receive the hepatitis B virus vaccine series. The Society for Healthcare Epidemiology of America has established guidelines for the management of health care providers who are infected with hepatitis B virus, hepatitis C virus, or human immunodeficiency virus (HIV). The guidelines categorize representative obstetric and gynecologic procedures according to level of risk of bloodborne pathogen transmission and include recommendations for health care provider clinical activities, based on these categories and viral burden. It is important to note that when no restrictions are recommended, careful supervision should be carried out as highlighted. These recommendations provide a framework within which to consider such cases; however, each case should be independently considered in context by the expert review panel.

A study of two statistical methods as applied to shuttle solid rocket booster expenditures

NASA Technical Reports Server (NTRS)

Perlmutter, M.; Huang, Y.; Graves, M.

1974-01-01

The state probability technique and the Monte Carlo technique are applied to finding shuttle solid rocket booster expenditure statistics. For a given attrition rate per launch, the probable number of boosters needed for a given mission of 440 launches is calculated. Several cases are considered, including the elimination of the booster after a maximum of 20 consecutive launches. Also considered is the case where the booster is composed of replaceable components with independent attrition rates. A simple cost analysis is carried out to indicate the number of boosters to build initially, depending on booster costs. Two statistical methods were applied in the analysis: (1) state probability method which consists of defining an appropriate state space for the outcome of the random trials, and (2) model simulation method or the Monte Carlo technique. It was found that the model simulation method was easier to formulate while the state probability method required less computing time and was more accurate.

Metabolic Complementation in Bacterial Communities: Necessary Conditions and Optimality

PubMed Central

Mori, Matteo; Ponce-de-León, Miguel; Peretó, Juli; Montero, Francisco

2016-01-01

Bacterial communities may display metabolic complementation, in which different members of the association partially contribute to the same biosynthetic pathway. In this way, the end product of the pathway is synthesized by the community as a whole. However, the emergence and the benefits of such complementation are poorly understood. Herein, we present a simple model to analyze the metabolic interactions among bacteria, including the host in the case of endosymbiotic bacteria. The model considers two cell populations, with both cell types encoding for the same linear biosynthetic pathway. We have found that, for metabolic complementation to emerge as an optimal strategy, both product inhibition and large permeabilities are needed. In the light of these results, we then consider the patterns found in the case of tryptophan biosynthesis in the endosymbiont consortium hosted by the aphid Cinara cedri. Using in-silico computed physicochemical properties of metabolites of this and other biosynthetic pathways, we verified that the splitting point of the pathway corresponds to the most permeable intermediate. PMID:27774085

Effects of Tip Clearance and Casing Recess on Heat Transfer and Stage Efficiency in Axial Turbines

NASA Technical Reports Server (NTRS)

Ameri, A. A.; Steinthorsson, E.; Rigby, David L.

1998-01-01

Calculations were performed to assess the effect of the tip leakage flow on the rate of heat transfer to blade, blade tip and casing. The effect on exit angle and efficiency was also examined. Passage geometries with and without casing recess were considered. The geometry and the flow conditions of the GE-E 3 first stage turbine, which represents a modem gas turbine blade were used for the analysis. Clearance heights of 0%, 1%, 1.5% and 3% of the passage height were considered. For the two largest clearance heights considered, different recess depths were studied. There was an increase in the thermal load on all the heat transfer surfaces considered due to enlargement of the clearance gap. Introduction of recessed casing resulted in a drop in the rate of heat transfer on the pressure side but the picture on the suction side was found to be more complex for the smaller tip clearance height considered. For the larger tip clearance height the effect of casing recess was an orderly reduction in the suction side heat transfer as the casing recess height was increased. There was a marked reduction of heat load and peak values on the blade tip upon introduction of casing recess, however only a small reduction was observed on the casing itself. It was reconfirmed that there is a linear relationship between the efficiency and the tip gap height. It was also observed that the recess casing has a small effect on the efficiency but can have a moderating effect on the flow underturning at smaller tip clearances.

Problem- and case-based learning in science: an introduction to distinctions, values, and outcomes.

PubMed

Allchin, Douglas

2013-01-01

Case-based learning and problem-based learning have demonstrated great promise in reforming science education. Yet an instructor, in newly considering this suite of interrelated pedagogical strategies, faces a number of important instructional choices. Different features and their related values and learning outcomes are profiled here, including: the level of student autonomy; instructional focus on content, skills development, or nature-of-science understanding; the role of history, or known outcomes; scope, clarity, and authenticity of problems provided to students; extent of collaboration; complexity, in terms of number of interpretive perspectives; and, perhaps most importantly, the role of applying versus generating knowledge.

Hypocalcaemia following thyroidectomy unresponsive to oral therapy.

PubMed

Etheridge, Zac C; Schofield, Christopher; Prinsloo, Peter J J; Sturrock, Nigel D C

2014-01-01

Hypocalcaemia due to hypoparathyroidism following thyroidectomy is a relatively common occurrence. Standard treatment is with oral calcium and vitamin D replacement therapy; lack of response to oral therapy is rare. Herein we describe a case of hypoparathyroidism following thyroidectomy unresponsive to oral therapy in a patient with a complex medical history. We consider the potential causes in the context of calcium metabolism including: poor adherence, hungry bone syndrome, malabsorption, vitamin D resistance, bisphosphonate use and functional hypoparathyroidism secondary to magnesium deficiency. Malabsorption due to intestinal hurry was likely to be a contributory factor in this case and very large doses of oral therapy were required to avoid symptomatic hypocalcaemia.

Management of a new isolated metastasis during sunitinib treatment in renal cell carcinoma patients: a lesson from two cases.

PubMed

Shablak, Alaaeldin; O'Dwyer, Jackie; Hawkins, Robert; Board, Ruth

2011-01-01

Metastatic renal cell carcinoma (mRCC) is a difficult to treat malignancy and currently Sunitinib is a standard of care first-line therapy. A new metastasis during the treatment is considered a sign of drug failure and alternative therapeutic methods should be tried. Here, we report 2 cases of newly diagnosed isolated metastasis during Sunitinib treatment of mRCC patients. Our management plan included local palliative therapy to the lesion followed by recommencing of Sunitinib. This resulted in a good symptomatic relief locally as well as good overall control of the disease. Copyright © 2010 S. Karger AG, Basel.

Problem- and Case-Based Learning in Science: An Introduction to Distinctions, Values, and Outcomes

PubMed Central

Allchin, Douglas

2013-01-01

Case-based learning and problem-based learning have demonstrated great promise in reforming science education. Yet an instructor, in newly considering this suite of interrelated pedagogical strategies, faces a number of important instructional choices. Different features and their related values and learning outcomes are profiled here, including: the level of student autonomy; instructional focus on content, skills development, or nature-of-science understanding; the role of history, or known outcomes; scope, clarity, and authenticity of problems provided to students; extent of collaboration; complexity, in terms of number of interpretive perspectives; and, perhaps most importantly, the role of applying versus generating knowledge. PMID:24006385

Two-unit cantilevered resin-bonded fixed partial denture as a substitute for a prosthodontic-orthodontic treatment plan: a 5-year case report.

PubMed

Emami, Elham; St-Georges, Annie; de Grandmont, Pierre

2012-01-01

In this case report, we describe the successful long-term treatment of a patient with dental agenesis. The initial treatment plan included an orthodontic phase to provide adequate space for replacing missing lateral incisors with implants. However, because of some complications encountered after 2 years of orthodontic treatment, a revised treatment plan was considered to achieve functional and esthetic goals. The patient was completely satisfied 5 years after being treated with two 2-unit cantilevered resin-bonded fixed partial dentures supported by the cuspids. This conservative treatment plan was cost-effective without having any significant biological cost.

Caustic ulcers caused by cement aqua: report of a case.

PubMed

Machovcova, Alena

2010-01-01

Chromium is widely used in various industries including construction sector. Skin contact with cement has been associated with allergic or irritant contact dermatitis. Contact dermatitis is one of the most frequently reported health problems among construction workers. Irritant contact dermatitis from cement ranges from cement burns to cumulative irritant contact dermatitis. Cement burns are rarely reported and are considered a severe form of acute irritant contact dermatitis. They are associated with amateur user working in a short ready-mix time-frame with poor protective measures. They usually result in significant morbidity and initially are associated with minimal discomfort. We report a typical case.

Non puerperal uterine inversion in a young female- a case report.

PubMed

Rathod, Setu; Samal, Sunil Kumar; Pallavee, P; Ghose, Seetesh

2014-09-01

We report a case of 28-year-old, primipara who presented with complaints of mass descending per vaginum along with excessive bleeding and foul smelling vaginal discharge for the past six months. Clinical examination revealed an inverted uterus, cervix and vagina with a large submucosal fundal fibroid. A diagnosis of non-puerperal uterine inversion was made. Surgical management included vaginal myomectomy with repositioning of the uterus using an abdomino-vaginal approach and a successful outcome. Histopathology confirmed the diagnosis of leiomyoma. Hence, we conclude that uterus-sparing surgery should be considered in young females desirous for future pregnancy until the final pathology is known.

Alcohol consumption and lung cancer risk in never smokers: a pooled analysis of case-control studies.

PubMed

García Lavandeira, José A; Ruano-Ravina, Alberto; Kelsey, Karl T; Torres-Durán, María; Parente-Lamelas, Isaura; Leiro-Fernández, Virginia; Zapata, Maruxa; Abal-Arca, José; Vidal-García, Iria; Montero-Martínez, Carmen; Amenedo, Margarita; Castro-Añón, Olalla; Golpe-Gómez, Antonio; Guzmán-Taveras, Rosirys; Martínez, Cristina; Provencio, Mariano; Mejuto-Martí, María J; García-García, Silvia; Fernández-Villar, Alberto; Piñeiro, María; Barros-Dios, Juan M

2018-06-01

Lung cancer is the deadliest cancer in developed countries but the etiology of lung cancer risk in never smokers (LCRINS) is largely unknown. We aim to assess the effects of alcohol consumption, in its different forms, on LCRINS. We pooled six multi-center case-control studies developed in the northwest of Spain. Cases and controls groups were composed of never smokers. We selected incident cases with anatomopathologically confirmed lung cancer diagnoses. All participants were personally interviewed. We performed two groups of statistical models, applying unconditional logistic regression with generalized additive models. One considered the effect of alcohol type consumption and the other considered the quantity of each alcoholic beverage consumed. A total of 438 cases and 863 controls were included. Median age was 71 and 66, years, respectively. Adenocarcinoma was the predominant histological type, comprising 66% of all cases. We found that any type of wine consumption posed an OR of 2.20 OR 95%CI 1.12-4.35), and spirits consumption had an OR of 1.90 (95%CI 1.13-3.23). Beer consumption had an OR of 1.33 (95%CI 0.82-2.14). These results were similar when women were analyzed separately, but for men there was no apparent risk for any alcoholic beverage. The dose-response analysis for each alcoholic beverage revealed no clear pattern. Wine and spirits consumption might increase the risk of LCRINSs, particularly in females. These results have to be taken with caution given the limitations of the present study.

Early Warning Signals of Social Transformation: A Case Study from the US Southwest

PubMed Central

2016-01-01

Recent research in ecology suggests that generic indicators, referred to as early warning signals (EWS), may occur before significant transformations, both critical and non-critical, in complex systems. Up to this point, research on EWS has largely focused on simple models and controlled experiments in ecology and climate science. When humans are considered in these arenas they are invariably seen as external sources of disturbance or management. In this article we explore ways to include societal components of socio-ecological systems directly in EWS analysis. Given the growing archaeological literature on ‘collapses,’ or transformations, in social systems, we investigate whether any early warning signals are apparent in the archaeological records of the build-up to two contemporaneous cases of social transformation in the prehistoric US Southwest, Mesa Verde and Zuni. The social transformations in these two cases differ in scope and severity, thus allowing us to explore the contexts under which warning signals may (or may not) emerge. In both cases our results show increasing variance in settlement size before the transformation, but increasing variance in social institutions only before the critical transformation in Mesa Verde. In the Zuni case, social institutions appear to have managed the process of significant social change. We conclude that variance is of broad relevance in anticipating social change, and the capacity of social institutions to mitigate transformation is critical to consider in EWS research on socio-ecological systems. PMID:27706200

Sensitivity of worst-case strom surge considering influence of climate change

NASA Astrophysics Data System (ADS)

Takayabu, Izuru; Hibino, Kenshi; Sasaki, Hidetaka; Shiogama, Hideo; Mori, Nobuhito; Shibutani, Yoko; Takemi, Tetsuya

2016-04-01

There are two standpoints when assessing risk caused by climate change. One is how to prevent disaster. For this purpose, we get probabilistic information of meteorological elements, from enough number of ensemble simulations. Another one is to consider disaster mitigation. For this purpose, we have to use very high resolution sophisticated model to represent a worst case event in detail. If we could use enough computer resources to drive many ensemble runs with very high resolution model, we can handle these all themes in one time. However resources are unfortunately limited in most cases, and we have to select the resolution or the number of simulations if we design the experiment. Applying PGWD (Pseudo Global Warming Downscaling) method is one solution to analyze a worst case event in detail. Here we introduce an example to find climate change influence on the worst case storm-surge, by applying PGWD to a super typhoon Haiyan (Takayabu et al, 2015). 1 km grid WRF model could represent both the intensity and structure of a super typhoon. By adopting PGWD method, we can only estimate the influence of climate change on the development process of the Typhoon. Instead, the changes in genesis could not be estimated. Finally, we drove SU-WAT model (which includes shallow water equation model) to get the signal of storm surge height. The result indicates that the height of the storm surge increased up to 20% owing to these 150 years climate change.

The role of Epstein-Barr virus infection in the development of autoimmune thyroid diseases.

PubMed

Janegova, Andrea; Janega, Pavol; Rychly, Boris; Kuracinova, Kristina; Babal, Pavel

2015-01-01

Autoimmune thyroid diseases, including Graves' and Hashimoto's thyroiditis, are the most frequent autoimmune disorders. Viral infection, including Epstein-Barr virus (EBV), is one of the most frequently considered environmental factors involved in autoimmunity. Its role in the development of AITD has not been confirmed so far. Surgical specimens of Graves' and Hashimoto's diseases and nodular goitres were included in the study. The expression of EBV latent membrane protein 1 (LMP1) was analysed by immunohistochemistry, with the parallel detection of virus-encoded small nuclear non-polyadenylated RNAs (EBER) by in situ hybridisation. In none of the Graves' disease specimens but in 34.5% of Hashimoto's thyroiditis cases the cytoplasmic expression of LMP1 was detected in follicular epithelial cells and in infiltrating lymphocytes. EBER nuclear expression was detected in 80.7% of Hashimoto's thyroiditis cases and 62.5% of Graves' disease cases, with positive correlation between LMP1 and EBER positivity in all Hashimoto's thyroiditis LMP1-positive cases. We assume that high prevalence of EBV infection in cases of Hashimoto's and Graves' diseases imply a potential aetiological role of EBV in autoimmune thyroiditis. The initiation of autoimmune thyroiditis could start with EBV latency type III infection of follicular epithelium characterised by LMP1 expression involving the production of inflammatory mediators leading to recruitment of lymphocytes. The EBV positivity of the infiltrating lymphocytes could be only the presentation of a carrier state, but in cases with EBER+/ LMP1+ lymphocytes (transforming latent infection) it could represent a negative prognostic marker pointing to a higher risk of primary thyroid lymphoma development.

Efficacy of intralesional injection of mumps-measles-rubella vaccine in patients with wart.

PubMed

Zamanian, Abbas; Mobasher, Pezhman; Jazi, Ghazaleh Ahmadi

2014-01-01

In the previous studies, it has been shown that mumps-measles-rubella (MMR) vaccine resulted in regression of warts via immunomodulatory effect and induction of immune system. Due to the high prevalence of warts in various populations, we evaluated the efficacy of MMR vaccine injection in the treatment of cutaneous warts. This double-blind randomized controlled clinical trial was conducted in Hazrat-e-Rasoul Hospital in Tehran in 2011-2012 on 24 patients with warts who were allocated to two groups including MMR group and normal saline group. MMR vaccine was injected intralesionally in the MMR group, whereas normal saline was injected into the lesions in the second group. These injections were repeated every 2 weeks intervals for maximum 3 injections. All patients were followed up every 15-day interval up to 45 days and then up to 6 months regarding relapses and finally, side effects, probable relapse, and therapeutic outcomes were evaluated and compared. At the end of follow-up period, therapeutic outcomes in the MMR group included no cure in 2 cases, relative cure in 4 cases, and complete cure in 18 cases. In normal saline group, these rates included no cure in seven cases, relative cure in nine cases, and complete cure in six cases (P < 0.001). No significant complication occurred in the two groups. MMR vaccine may result in desirable therapeutic response. The hypothesis that is considered here is that MMR vaccine, via induction of cellular and humoral immune system, accelerates the destruction of virus and infected host cells.

Determinants of marriage dissolution

NASA Astrophysics Data System (ADS)

Rahim, Mohd Amirul Rafiq Abu; Shafie, Siti Aishah Mohd; Hadi, Az'lina Abdul; Razali, Nornadiah Mohd; Azid @ Maarof, Nur Niswah Naslina

2015-10-01

Nowadays, the number of divorce cases among Muslim couples is very worrisome whereby the total cases reported in 2013 increased by half of the total cases reported in the previous year. The questions on the true key factors of dissolution of marriage continue to arise. Thus, the objective of this study is to reveal the factors that contribute to the dissolution of marriage. A total of 181 cases and ten potential determinants were included in this study. The potential determinants considered were age at marriage of husband and wife, educational level of husband and wife, employment status of husband and wife, income of husband and wife, the number of children and the presence at a counseling session. Logistic regression analysis was used to analyze the data. The findings revealed that four determinants, namely the income of husband and wife, number of children and the presence at a counselling session were significant in predicting the likelihood of divorce among Muslim couples.

[Biliary calculi resistant to dissolution with bile acids: their heterogeneous composition and diversity of treatment response].

PubMed

Ruíz de Aguiar, A; Medina, J A; Garrido, G; Villacorta, J; Berenguer, J

1992-05-01

We have studied thirteen biliary stones resistant to biliary acids, using technical methods of stereomicroscopy, scanning electronic microscopy and EDX analyses. We have investigated changes on surface. Three biliary stones did not change and were considered resistant. Seven biliary stones appear partially dissolved and we observed many irregularities on surface and/or concentric dips in relation with cholesterol dissolution. In six cases, biliary pigment alternates with cholesterol. In three cases we observed a calcium carbonate coat on surface. One case included organic fibers. One biliary stone showed cholesterol with spherical bodies of calcium carbonate and pigment. It was a relapsed case of combined treatment. Three stones are composed of small black portions of polymerized calcium bilirubinate, rich in copper and iron. Our results demonstrate that biliary stones previously selected for treatment are a heterogeneous group. Because of this fact we get variable and unpredictable results.

Bifurcation study of phase oscillator systems with attractive and repulsive interaction.

PubMed

Burylko, Oleksandr; Kazanovich, Yakov; Borisyuk, Roman

2014-08-01

We study a model of globally coupled phase oscillators that contains two groups of oscillators with positive (synchronizing) and negative (desynchronizing) incoming connections for the first and second groups, respectively. This model was previously studied by Hong and Strogatz (the Hong-Strogatz model) in the case of a large number of oscillators. We consider a generalized Hong-Strogatz model with a constant phase shift in coupling. Our approach is based on the study of invariant manifolds and bifurcation analysis of the system. In the case of zero phase shift, various invariant manifolds are analytically described and a new dynamical mode is found. In the case of a nonzero phase shift we obtained a set of bifurcation diagrams for various systems with three or four oscillators. It is shown that in these cases system dynamics can be complex enough and include multistability and chaotic oscillations.

Bifurcation study of phase oscillator systems with attractive and repulsive interaction

NASA Astrophysics Data System (ADS)

Burylko, Oleksandr; Kazanovich, Yakov; Borisyuk, Roman

2014-08-01

We study a model of globally coupled phase oscillators that contains two groups of oscillators with positive (synchronizing) and negative (desynchronizing) incoming connections for the first and second groups, respectively. This model was previously studied by Hong and Strogatz (the Hong-Strogatz model) in the case of a large number of oscillators. We consider a generalized Hong-Strogatz model with a constant phase shift in coupling. Our approach is based on the study of invariant manifolds and bifurcation analysis of the system. In the case of zero phase shift, various invariant manifolds are analytically described and a new dynamical mode is found. In the case of a nonzero phase shift we obtained a set of bifurcation diagrams for various systems with three or four oscillators. It is shown that in these cases system dynamics can be complex enough and include multistability and chaotic oscillations.

The value of routine chest radiographs in acute asthma admissions.

PubMed

Ismail, Y; Loo, C S; Zahary, M K

1994-04-01

We reviewed 116 chest radiographs done in 70 adult asthmatic patients who were admitted to the Hospital Universiti Sains Malaysia from January to December 1989. The chest radiographs were abnormal in 23% of cases. Twelve percent showed hyperinflation and 7% had pneumonia. Eight patients diagnosed clinically to have pneumonia had normal chest radiographs. Seven patients had radiographic findings of conditions which were unsuspected clinically. These included two cases of pneumonia, one case each of fibrosing alveolitis, pneumothorax, pneumomediastinum, mitral stenosis with left ventricular failure and right pleural effusion. In conclusion, we found that significant chest radiograph abnormalities in adult patients admitted for asthma were uncommon although chest radiographs were helpful in detecting complications or coincidental conditions. Chest radiograph is therefore an important investigation in adult asthmatic patients who are admitted. However, considering the cost and the risk of radiation, it should be done only in selective cases rather than as a routine procedure.

Atlanto-occipital dislocation: Case report and discussion.

PubMed

Asfaw, Tehetena; Chow, Bernard; Frederiksen, Ryan A

2011-01-01

Traumatic atlanto-occipital dislocation is an uncommon injury that frequently results in either a fatal outcome or severe neurologic deficit. This diagnosis must be considered for any patients who may have had cervical spine damage after high trauma, even in the absence of neurologic signs, as there have been reports of cases without neurologic impairment. In addition to radiographic examination, including lateral cervical radiographs, supplemental imaging with CT or MRI may be required to confirm diagnosis in equivocal cases, and to help in evaluation of bone and nervous structures. Moreover, these modalities allow measurement of the magnitude of dislocation and aid in classification of type of dislocation, which helps guide management. A systematic approach to evaluating the cranio-cervical relationship is critical to identifying atlanto-occipital dislocation. This case report presents and discusses imaging findings that will assist in the diagnosis of atlanto-occipital dislocation.

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

Shoulder arthrodesis with a reconstruction plate

PubMed Central

Byeon, Hwa Kyo

2008-01-01

From 1995 to 2005, arthrodesis with a reconstruction plate was performed for eight shoulders. The average follow-up period was 44 months. The indications for shoulder arthrodesis were joint destruction as a sequel of tuberculous arthritis, malignant bone tumour, pyogenic arthritis, failed arthrodesis and paralysis of the brachial plexus. The evaluation criteria included bony union and pain. Two cases of malignant tumour required an homologous bone graft due to severe bone deficit—a fracture that occurred in the distal part of the arthrodesed shoulder after removing the plate. With the exception of these two cases, severe pain or other complications did not occur in any other case. Shoulder arthrodesis with a reconstruction plate was judged to be a useful method for glenohumeral salvage in cases without severe bone deficit. Further, additional treatment methods should be considered to prevent fracture that may occur as a result of severe bone deficit. PMID:18716728

[In utero thrombosis of neonates: inherited thrombophilia?].

PubMed

Nagy, Andrea; Mogyorósy, Gábor; Kiss, Csongor; Pataki, István; Amir Houshang, Shemirani; Oláh, Eva

2009-04-19

Thromboembolic events are relatively uncommon in childhood. It involves mainly children under one year of age and adolescents, with an incidence is 5.1/10000 live births. Authors present a course of disease of seven cases with neonatal thromboembolic events (2.5/admissions), diagnosed and treated at the Neonatal Division of Department of Pediatrics. In three of seven cases thrombosis proved to be of intrauterine origin. In each of the latter cases, inherited thrombophilia of the mothers was detected. Additional risk factors including infection could be revealed only in one case. Using in vivo and post mortem DNA analysis, mother-like-thrombophilia could not be confirmed in any of the newborns. Based on their experiences, authors suppose that undetected predisposing factors added to maternal thrombophilia can be considered as etiological factor. Authors suggest the intensive follow-up of pregnant women with thrombophilia and also their fetuses.

Schwannomatosis in a patient with a pelvic mass: case report.

PubMed

Harbaugh, Kimberly; Smith, Patricia; Towfighi, Javad

2007-06-15

Schwannomatosis is the most recently recognized form of neurofibromatosis in which patients harbor multiple non-vestibular nerve schwannomas. The diagnosis is contingent on excluding neurofibromatosis Type 2 (NF2), to which it is related. The authors present a case of schwannomatosis diagnosed fortuitously when a preoperative magnetic resonance (MR) image of a pelvic schwannoma was suggestive of a lesion in the lower lumbar canal. Definitive studies confirmed the presence of multiple spinal tumors including a thoracic schwannoma, which was removed during a subsequent procedure. This case emphasizes the need to consider the possibility of multiple tumors in every patient presenting with a schwannoma because the follow-up and genetic counseling are vastly different in those with NF2 and schwannomatosis compared with those harboring sporadic tumors. Details of this case and current considerations in the diagnosis and management of schwannomatosis are discussed.

Turbulent solutions of equations of fluid motion

NASA Technical Reports Server (NTRS)

Deissler, R. G.

1985-01-01

Some turbulent solutions of the unaveraged Navier-Stokes equations (equations of fluid motion) are reviewed. Those equations are solved numerically in order to study the nonlinear physics of incompressible turbulent flow. The three components of the mean-square velocity fluctuations are initially equal for the conditions chosen. The resulting solutions show characteristics of turbulence, such as the linear and nonlinear excitation of small-scale fluctuations. For the stronger fluctuations the initially nonrandom flow develops into an apparently random turbulence. The cases considered include turbulence that is statistically homogeneous or inhomogeneous and isotropic or anisotropic. A statistically steady-state turbulence is obtained by using a spatially periodic body force. Various turbulence processes, including the transfer of energy between eddy sizes and between directional components and the production, dissipation, and spatial diffusion of turbulence, are considered. It is concluded that the physical processes occurring in turbulence can be profitably studied numerically.

Gateway to understanding: Indigenous ecological activism and education in urban, rural, and remote contexts

NASA Astrophysics Data System (ADS)

Lowan-Trudeau, Gregory

2017-03-01

This article is a response to Kassam, Avery, and Ruelle's insights as presented in this forum on rural science education. Topics considered include troubling the urban/rural divide in the context of Indigenous knowledge and expanding to include the common Canadian notion of the "remote", a designation rooted in our national colonial narrative for the mythic, typically northern, wilderness sparsely inhabited by primarily Indigenous peoples. These concepts are further considered through exploration of Indigenous and allied ecological activism in Canada and the United States related to the proposed Northern Gateway and Keystone XL pipelines. This discussion concludes with an argument for the inherent pedagogical opportunity presented by such cases for contemporary educators to engage students in consideration of wicked problems, geographically rooted cognitive diversity, and the legal, economic, ecological, and cultural underpinnings and ramifications of the current events prominent in their home communities and abroad.

Observational studies are complementary to randomized controlled trials.

PubMed

Grootendorst, Diana C; Jager, Kitty J; Zoccali, Carmine; Dekker, Friedo W

2010-01-01

Randomized controlled trials (RCTs) are considered the gold standard study design to investigate the effect of health interventions, including treatment. However, in some situations, it may be unnecessary, inappropriate, impossible, or inadequate to perform an RCT. In these special situations, well-designed observational studies, including cohort and case-control studies, may provide an alternative to doing nothing in order to obtain estimates of treatment effect. It should be noted that such studies should be performed with caution and correctly. The aims of this review are (1) to explain why RCTs are considered the optimal study design to evaluate treatment effects, (2) to describe the situations in which an RCT is not possible and observational studies are an adequate alternative, and (3) to explain when randomization is not needed and can be approximated in observational studies. Examples from the nephrology literature are used for illustration. Copyright 2009 S. Karger AG, Basel.

Effect of load transients on SOFC operation—current reversal on loss of load

NASA Astrophysics Data System (ADS)

Gemmen, Randall S.; Johnson, Christopher D.

The dynamics of solid oxide fuel cell (SOFC) operation have been considered previously, but mainly through the use of one-dimensional codes applied to co-flow fuel cell systems. In this paper several geometries are considered, including cross-flow, co-flow, and counter-flow. The details of the model are provided, and the model is compared with some initial experimental data. For parameters typical of SOFC operation, a variety of transient cases are investigated, including representative load increase and decrease and system shutdown. Of particular note for large load decrease conditions (e.g., shutdown) is the occurrence of reverse current over significant portions of the cell, starting from the moment of load loss up to the point where equilibrated conditions again provide positive current. Consideration is given as to when such reverse current conditions might most significantly impact the reliability of the cell.

Qualitative analysis of round-table discussions on the business case and procurement challenges for hospital electronic prescribing systems.

PubMed

Cresswell, Kathrin M; Slee, Ann; Coleman, Jamie; Williams, Robin; Bates, David W; Sheikh, Aziz

2013-01-01

There is a pressing need to understand the challenges surrounding procurement of and business case development for hospital electronic prescribing systems, and to identify possible strategies to enhance the efficiency of these processes in order to assist strategic decision making. We organized eight multi-disciplinary round-table discussions in the United Kingdom. Participants included policy makers, representatives from hospitals, system developers, academics, and patients. Each discussion was digitally audio-recorded, transcribed verbatim and, together with accompanying field notes, analyzed thematically with NVivo9. We drew on data from 17 participants (approximately eight per roundtable), six hours of discussion, and 15 pages of field notes. Key challenges included silo planning with systems not being considered as part of an integrated organizational information technology strategy, lack of opportunity for interactions between customers and potential suppliers, lack of support for hospitals in choosing appropriate systems, difficulty of balancing structured planning with flexibility, and the on-going challenge of distinguishing "wants" and aspirations from organizational "needs". Development of business cases for major investments in information technology does not take place in an organizational vacuum. Building on previously identified potentially transferable dimensions to the development and execution of business cases surrounding measurements of costs/benefits and risk management, we have identified additional components relevant to ePrescribing systems. These include: considerations surrounding strategic context, case for change and objectives, future service requirements and options appraisal, capital and revenue implications, timescale and deliverability, and risk analysis and management.

Bacteremia caused by a rare pathogen - Chromobacterium violaceum: a case report from Nepal.

PubMed

Parajuli, Narayan Prasad; Bhetwal, Anjeela; Ghimire, Sumitra; Maharjan, Anjila; Shakya, Shreena; Satyal, Deepa; Pandit, Roshan; Khanal, Puspa Raj

2016-01-01

Chromobacterium violaceum is a gram negative saprophytic bacterium, prevalent in tropical and subtropical climates. Infections caused by C. violaceum are very uncommon, yet it can cause severe systemic infections with higher mortality when entered into the bloodstream through open wound. A case of symptomatic bacteremia in a woman caused by C. violaceum was identified recently at a tertiary care teaching hospital in Nepal. Timely diagnosis by microbiological methods and rapid administration of antimicrobials led to a successful treatment of this life-threatening infection in this case. From this experience, we suggest to include this bacterium in the differential diagnosis of sepsis, especially when abraded skin is exposed to soil or stagnant water in tropical areas. The precise antimicrobial selection and timely administration should be considered when this infection is suspected.

Can Masturbatory Guilt Lead to Severe Psychopathology: A Case Series

PubMed Central

Aneja, Jitender; Grover, Sandeep; Avasthi, Ajit; Mahajan, Sudhir; Pokhrel, Prabhakar; Triveni, Davuluri

2015-01-01

Masturbation is common in all societies. Despite being common, it is admonished culturally and almost all religions prohibit masturbation and consider it an act of immorality. The prohibition for masturbation leads to a lot of cultural beliefs, including certain myths, which influence sexual behavior of the person. The impact of these common cultural myths associated with masturbation, are clinically understood as Dhat syndrome and masturbatory guilt. Although there is a reasonable literature on Dhat syndrome, there is limited literature with regard to masturbatory guilt especially linking the same with axis-I psychopathology. In this case series, three cases of masturbatory guilt are presented in whom masturbatory guilt was associated with manifestation of severe psychopathology. This report suggests that masturbatory guilt must be enquired for in patients presenting with severe mental disorder. PMID:25722518

Ginkgo biloba induced mood dysregulation: a case report.

PubMed

Rho, Seung Sun; Woo, Young Sup; Bahk, Won-Myong

2018-01-15

Impairment of cognitive function as well as negative symptom is the major factor causing the decline of a patient's functioning in chronic stages of schizophrenia. However, until now, there were no definite treatment options that could effectively reduce the impairment. We report a case of mood dysregulation associated with use of Ginkgo biloba in a patient with schizophrenia. After Ginkgo biloba was given, the patient experienced cluster symptoms of mood dysregulation including irritability, difficulty in controlling anger, agitation and restlessness. We estimated the possibility as "probable" according to Naranjo scale considering circumstantial evidence. This case suggests that Ginkgo biloba may have caused mood dysregulation in this patient. Although it is generally accepted as safe, more attention should be given to the adverse effect when treating with Ginkgo biloba.

Simultaneous continuous measurement of non-commuting observables and correlation in qubit trajectories

NASA Astrophysics Data System (ADS)

Chantasri, Areeya; Jordan, Andrew

We consider the continuous quantum measurement of two or more non-commuting observables of a single qubit. Examples are presented for the measurement of two observables which can be mapped to two measurement axes on the Bloch sphere; a special case being the measurement along the X and Z bases. The qubit dynamics is described by the stochastic master equations which include the effect of decoherence and measurement inefficiencies. We investigate the qubit trajectories, their most likely paths, and their correlation functions using the stochastic path integral formalism. The correlation functions in qubit trajectories can be derived exactly for a special case and perturbatively for general cases. The theoretical predictions are compared with numerical simulations, as well as with trajectory data from the transmon superconducting qubit experiments.

Deep brain stimulation in the bed nucleus of the stria terminalis and medial forebrain bundle in a patient with major depressive disorder and anorexia nervosa.

PubMed

Blomstedt, Patric; Naesström, Matilda; Bodlund, Owe

2017-05-01

Deep brain stimulation (DBS) may be considered in severe cases of therapy-refractory major depressive disorder (MDD). However, DBS for MDD is still an experimental therapy. Therefore, it should only be administered in clinical studies driven by multidisciplinary teams, including surgeons with substantial experience of DBS in the treatment of other conditions.

Investigation of Analog Photonic Link Technology for Timing and Metrological Applications

DTIC Science & Technology

2015-05-18

same model bias tee in each case. Fig. 1.8: Measured residual single-sideband (SSB) phase noise for two amplifiers with various RF pads at...deflection at the AO output. The deflected signal is reflected onto a tilted diffraction grating and passed backed through the device to the output...Other TTD modulation mechanisms have been considered including fiber stretches (mechanical and piezoelectric ), electro-optic modulators (i.e

Purtscher-like retinopathy: A rare complication of peribulbar anesthesia.

PubMed

Narendran, Siddharth; Saravanan, V R; Pereira, Merlyn

2016-06-01

Purtscher and Purtscher-like retinopathy is a distinctive retinal syndrome characterized by ischemic retinal whitening in a peripapillary pattern. We report a case of Purtscher-like retinopathy in a healthy 64-year-old man after a routine peribulbar anesthetic injection for cataract surgery. Although peribulbar anesthesia is considered to be a safer alternative to retrobulbar anesthesia, it has been associated with unusual but grave complications including central retinal artery occlusion.

LETTERS AND COMMENTS: Energy in one-dimensional linear waves in a string

NASA Astrophysics Data System (ADS)

Burko, Lior M.

2010-09-01

We consider the energy density and energy transfer in small amplitude, one-dimensional waves on a string and find that the common expressions used in textbooks for the introductory physics with calculus course give wrong results for some cases, including standing waves. We discuss the origin of the problem, and how it can be corrected in a way appropriate for the introductory calculus-based physics course.

Modelling of deformation of underground tunnel lining, interacting with water-saturated soil

NASA Astrophysics Data System (ADS)

Berezhnoi, D. V.; Balafendieva, I. S.; Sachenkov, A. A.; Sekaeva, L. R.

2016-11-01

Built finite element method of calculating the deformation of underground tunnel lining, interacting with dry and water-saturated soils. To simulate the interaction between the lining and soils environments, including physical and non-linear, a special "contact" finite element, which allows to consider all cases of interaction between the contacting surfaces. It solved a number of problems of deformation with the ground subway tunnel lining rings.