Selection of Worst-Case Pesticide Leaching Scenarios for Pesticide Registration

NASA Astrophysics Data System (ADS)

Vereecken, H.; Tiktak, A.; Boesten, J.; Vanderborght, J.

2010-12-01

The use of pesticides, fertilizers and manure in intensive agriculture may have a negative impact on the quality of ground- and surface water resources. Legislative action has been undertaken in many countries to protect surface and groundwater resources from contamination by surface applied agrochemicals. Of particular concern are pesticides. The registration procedure plays an important role in the regulation of pesticide use in the European Union. In order to register a certain pesticide use, the notifier needs to prove that the use does not entail a risk of groundwater contamination. Therefore, leaching concentrations of the pesticide need to be assessed using model simulations for so called worst-case scenarios. In the current procedure, a worst-case scenario represents a parameterized pesticide fate model for a certain soil and a certain time series of weather conditions that tries to represent all relevant processes such as transient water flow, root water uptake, pesticide transport, sorption, decay and volatilisation as accurate as possible. Since this model has been parameterized for only one soil and weather time series, it is uncertain whether it represents a worst-case condition for a certain pesticide use. We discuss an alternative approach that uses a simpler model that requires less detailed information about the soil and weather conditions but still represents the effect of soil and climate on pesticide leaching using information that is available for the entire European Union. A comparison between the two approaches demonstrates that the higher precision that the detailed model provides for the prediction of pesticide leaching at a certain site is counteracted by its smaller accuracy to represent a worst case condition. The simpler model predicts leaching concentrations less precise at a certain site but has a complete coverage of the area so that it selects a worst-case condition more accurately.

Reasoning with case histories of process knowledge for efficient process development

NASA Technical Reports Server (NTRS)

Bharwani, Seraj S.; Walls, Joe T.; Jackson, Michael E.

1988-01-01

The significance of compiling case histories of empirical process knowledge and the role of such histories in improving the efficiency of manufacturing process development is discussed in this paper. Methods of representing important investigations as cases and using the information from such cases to eliminate redundancy of empirical investigations in analogous process development situations are also discussed. A system is proposed that uses such methods to capture the problem-solving framework of the application domain. A conceptual design of the system is presented and discussed.

The Fender Stratocaster Electric Guitar: A Case Study for both Nontransferable and Transferable Skills Learning in a Generalist Electronic Engineering Cohort

ERIC Educational Resources Information Center

Joyce, M. J.

2010-01-01

A case-study approach to teaching electronics system design that has been used since 2004 to demonstrate the importance of both nontransferable and transferable design issues to first-year undergraduate students is described. The student cohort of relevance to this work represents a diverse group comprising both students studying for a four-year…

Economic Cost and Burden of Dengue in the Philippines

PubMed Central

Edillo, Frances E.; Halasa, Yara A.; Largo, Francisco M.; Erasmo, Jonathan Neil V.; Amoin, Naomi B.; Alera, Maria Theresa P.; Yoon, In-Kyu; Alcantara, Arturo C.; Shepard, Donald S.

2015-01-01

Dengue, the world's most important mosquito-borne viral disease, is endemic in the Philippines. During 2008–2012, the country's Department of Health reported an annual average of 117,065 dengue cases, placing the country fourth in dengue burden in southeast Asia. This study estimates the country's annual number of dengue episodes and their economic cost. Our comparison of cases between active and passive surveillance in Punta Princesa, Cebu City yielded an expansion factor of 7.2, close to the predicted value (7.0) based on the country's health system. We estimated an annual average of 842,867 clinically diagnosed dengue cases, with direct medical costs (in 2012 US dollars) of $345 million ($3.26 per capita). This is 54% higher than an earlier estimate without Philippines-specific costs. Ambulatory settings treated 35% of cases (representing 10% of direct costs), whereas inpatient hospitals served 65% of cases (representing 90% of direct costs). The economic burden of dengue in the Philippines is substantial. PMID:25510723

Economic cost and burden of dengue in the Philippines.

PubMed

Edillo, Frances E; Halasa, Yara A; Largo, Francisco M; Erasmo, Jonathan Neil V; Amoin, Naomi B; Alera, Maria Theresa P; Yoon, In-Kyu; Alcantara, Arturo C; Shepard, Donald S

2015-02-01

Dengue, the world's most important mosquito-borne viral disease, is endemic in the Philippines. During 2008-2012, the country's Department of Health reported an annual average of 117,065 dengue cases, placing the country fourth in dengue burden in southeast Asia. This study estimates the country's annual number of dengue episodes and their economic cost. Our comparison of cases between active and passive surveillance in Punta Princesa, Cebu City yielded an expansion factor of 7.2, close to the predicted value (7.0) based on the country's health system. We estimated an annual average of 842,867 clinically diagnosed dengue cases, with direct medical costs (in 2012 US dollars) of $345 million ($3.26 per capita). This is 54% higher than an earlier estimate without Philippines-specific costs. Ambulatory settings treated 35% of cases (representing 10% of direct costs), whereas inpatient hospitals served 65% of cases (representing 90% of direct costs). The economic burden of dengue in the Philippines is substantial. © The American Society of Tropical Medicine and Hygiene.

Diagnostic labels assigned to patients with orthopedic conditions and the influence of the label on selection of interventions: a qualitative study of orthopaedic clinical specialists.

PubMed

Miller-Spoto, Marcia; Gombatto, Sara P

2014-06-01

A variety of diagnostic classification systems are used by physical therapists, but little information about how therapists assign diagnostic labels and how the labels are used to direct intervention is available. The purposes of this study were: (1) to examine the diagnostic labels assigned to patient problems by physical therapists who are board-certified Orthopaedic Clinical Specialists (OCSs) and (2) to determine whether the label influences selection of interventions. A cross-sectional survey was conducted. Two written cases were developed for patients with low back and shoulder pain. A survey was used to evaluate the diagnostic label assigned and the interventions considered important for each case. The cases and survey were sent to therapists who are board-certified OCSs. Respondents assigned a diagnostic label and rated the importance of intervention categories for each case. Each diagnostic label was coded based on the construct it represented. Percentage responses for each diagnostic label code and intervention category were calculated. Relative importance of intervention category based on diagnostic label was examined. For the low back pain and shoulder pain cases, respectively, "Combination" (48.5%, 34.9%) and "Pathology/Pathophysiology" (32.7%, 57.3%) diagnostic labels were most common. Strengthening (85.9%, 98.1%), stretching (86.8%, 84.9%), neuromuscular re-education (87.6%, 93.4%), functional training (91.4%, 88.6%), and mobilization/manipulation (85.1%, 86.8%) were considered the most important interventions. Relative importance of interventions did not differ based on diagnostic label (χ2=0.050-1.263, P=.261-.824). The low response rate may limit the generalizability of the findings. Also, examples provided for labels may have influenced responses, and some of the label codes may have represented overlapping constructs. There is little consistency with which OCS therapists assign diagnostic labels, and the label does not seem to influence selection of interventions. © 2014 American Physical Therapy Association.

[Tuberculosis and drug-resistance tuberculosis in prisoners. Colombia, 2010-2012].

PubMed

Gómez, Ingrid T; Llerena, Claudia R; Zabaleta, Angie P

2015-01-01

To characterize tuberculosis drug-resistance using anti-tuberculosis drug-sensitivity tests in Colombian prisoners. Descriptive-retrospective analyses were performed on cases of tuberculosis in prisoners. Samples were evaluated by the National Reference Laboratory. Conditions like gender, TB/VIH co-infection and drug-resistance were evaluated. Anti-tuberculosis drug-sensitivity tests were carried out on 72 prisoners. Results showed a distribution of 90.7 % of cases in males and 9.3 % of cases in females. 12 % of cases were TB/VIH co-infections, 94 % of the cases had not received any anti-tuberculosis treatment before, six isolates were drug-resistant corresponding to 8.8 % of total cases, and two cases were multi drug-resistant representing 1.3 % of the cases. Of the drug-resistant cases, 83.3 % were TB/VIH co-infected. Previously treated cases corresponded to 5.6 % of the total cases analyzed. One case with TB/VIH co-infection and rifampicin resistance was observed, representing 1.3 % of the total cases. The government must create a clear policy for prisoners in Colombia, because a high rate of disease in prisoners was observed. In addition, the results showed an association between drug-resistance and TB/VIH co-infection. Overcrowding and low quality of life in penitentiaries could become an important public health problem.

Pulmonary Embolization of Fat and Bone Marrow in Cynomolgus Macaques (Macaca fascicularis)

PubMed Central

Fong, Derek L.; Murnane, Robert D.; Hotchkiss, Charlotte E.; Green, Damian J.; Hukkanen, Renee R.

2011-01-01

Fat embolization (FE), the introduction of bone marrow elements into circulation, is a known complication of bone fractures. Although FE has been described in other animal models, this study represents the first reported cases of FE and bone marrow embolism in nonhuman primates. Histopathologic findings from cynomolgus macaques (Macaca fascicularis) indicated that in all 5 cases, fat and bone marrow embolization occurred subsequent to multiple bone marrow biopsies. In the most severe case, extensive embolization was associated pulmonary damage consistent with acute respiratory distress syndrome. Fat embolism syndrome (FES) is an infrequent clinical outcome of FE and is triggered by systemic biochemical and mechanical responses to fat in circulation. Although clinical criteria diagnostic of FES were not investigated at the time of death, this severe case may represent the fulminant form of FES, which occurs within 12 h after trauma. Bone marrow biopsy as an etiology of FES has been reported only once in humans. In addition, the association of embolization with bone marrow biopsies suggests that nonhuman primates may be a useful animal model of FE. FE and FES represent important research confounders and FES should be considered as a differential diagnosis for clinical complications subsequent to skeletal trauma. PMID:21819686

Pulmonary embolization of fat and bone marrow in cynomolgus Macaques (Macaca fascicularis).

PubMed

Fong, Derek L; Murnane, Robert D; Hotchkiss, Charlotte E; Green, Damian J; Hukkanen, Renee R

2011-02-01

Fat embolization (FE), the introduction of bone marrow elements into circulation, is a known complication of bone fractures. Although FE has been described in other animal models, this study represents the first reported cases of FE and bone marrow embolism in nonhuman primates. Histopathologic findings from cynomolgus macaques (Macaca fascicularis) indicated that in all 5 cases, fat and bone marrow embolization occurred subsequent to multiple bone marrow biopsies. In the most severe case, extensive embolization was associated pulmonary damage consistent with acute respiratory distress syndrome. Fat embolism syndrome (FES) is an infrequent clinical outcome of FE and is triggered by systemic biochemical and mechanical responses to fat in circulation. Although clinical criteria diagnostic of FES were not investigated at the time of death, this severe case may represent the fulminant form of FES, which occurs within 12 h after trauma. Bone marrow biopsy as an etiology of FES has been reported only once in humans. In addition, the association of embolization with bone marrow biopsies suggests that nonhuman primates may be a useful animal model of FE. FE and FES represent important research confounders and FES should be considered as a differential diagnosis for clinical complications subsequent to skeletal trauma.

China-U.S. Relations: Current Issues and Implications for U.S. Policy

DTIC Science & Technology

2009-11-20

would ease restrictions on foreign investments in the culture industry, to include film , publishing, entertainment, online games, and multi-media...President Obama did raise human rights issues in his discussions, in particular the case of American geologist Xue Feng who had been detained several...decision represents a departure from the previous administration of President George W. Bush, which denied import relief in six previous cases of petitions

Revisiting the Importance of Knowledge: From Namibia, a Case for Promoting Knowledge by Campaigns to Reduce Stigma

ERIC Educational Resources Information Center

Chung, Adrienne H.; Rimal, Rajiv N.

2015-01-01

Reducing stigma against people living with HIV is key to encouraging HIV testing, which in turn is an important component in the treatment-as-prevention approach. We analyzed nationally representative survey data of participants aged 15 years and older in Namibia (N = 4,300) to determine whether knowledge about HIV and self-efficacy to protect…

Validity threats: overcoming interference with proposed interpretations of assessment data.

PubMed

Downing, Steven M; Haladyna, Thomas M

2004-03-01

Factors that interfere with the ability to interpret assessment scores or ratings in the proposed manner threaten validity. To be interpreted in a meaningful manner, all assessments in medical education require sound, scientific evidence of validity. The purpose of this essay is to discuss 2 major threats to validity: construct under-representation (CU) and construct-irrelevant variance (CIV). Examples of each type of threat for written, performance and clinical performance examinations are provided. The CU threat to validity refers to undersampling the content domain. Using too few items, cases or clinical performance observations to adequately generalise to the domain represents CU. Variables that systematically (rather than randomly) interfere with the ability to meaningfully interpret scores or ratings represent CIV. Issues such as flawed test items written at inappropriate reading levels or statistically biased questions represent CIV in written tests. For performance examinations, such as standardised patient examinations, flawed cases or cases that are too difficult for student ability contribute CIV to the assessment. For clinical performance data, systematic rater error, such as halo or central tendency error, represents CIV. The term face validity is rejected as representative of any type of legitimate validity evidence, although the fact that the appearance of the assessment may be an important characteristic other than validity is acknowledged. There are multiple threats to validity in all types of assessment in medical education. Methods to eliminate or control validity threats are suggested.

Prescribers prefer people: The sources of information used by doctors for prescribing suggest that the medium is more important than the message

PubMed Central

McGettigan, P; Golden, J; Fryer, J; Chan, R; Feely, J

2001-01-01

Aims The sources of prescribing information are legion but there is little knowledge about which are actually used in practice by doctors when prescribing. The aims of this study were to determine the sources of prescribing information considered important by doctors, establish which were used in practice, and investigate if hospital and primary care physicians differed in their use of the sources. Methods Two hundred general practitioners (GPs) and 230 hospital doctors were asked to rate information sources in terms of their importance for prescribing ‘old’ and ‘new’ drugs, and then to name the source from which information about the last new drug prescribed was actually derived. Results Among 108 GPs, the Drugs and Therapeutics Bulletin and medical journal articles were most frequently rated as important for information on both old and new drugs while pharmaceutical representatives and hospital/consultant recommendations were more important for information on new drugs, as opposed to old. In practice, information on the last new drug prescribed was derived from pharmaceutical representatives in 42% of cases and hospital/consultant recommendations in 36%, with other sources used infrequently. Among 118 hospital doctors, the British National Formulary (BNF) and senior colleagues were of greatest theoretical importance. In practice, information on the last new drug prescribed was derived from a broad range of sources: colleagues, 29%; pharmaceutical representatives, 18%; hospital clinical meetings, 15%; journal articles, 13%; lectures, 10%. GPs and hospital doctors differed significantly in their use of pharmaceutical representatives (42% vs 18%) and colleagues (7% vs 29%) as sources of prescribing information (P < 0.0001 for both). Conclusions The sources most frequently rated important in theory were not those most used in practice, especially among GPs. Both groups under-estimated the importance of pharmaceutical representatives. Most importantly, the sources of greatest practical importance were those involving the transfer of information through the medium of personal contact. PMID:11259994

[Methodology of psychiatric case histories].

PubMed

Scherbaum, N; Mirzaian, E

1999-05-01

This paper deals with the methodology of psychiatric case histories. Three types of case histories are differentiated. The didactic case history teaches about the typical aspects of a psychiatric disorder or treatment by using an individual patient as an example. In the heuristic case history the individual case gives rise to challenging established concepts or to generate new hypotheses. Such hypotheses drawn from inductive reasoning have then to be tested using representative samples. The focus of hermeneutic case histories is the significance of pathological behaviour and experience in the context of the biography of an individual patient. So-called psychopathographies of important historical figures can also be differentiated according to these types. Based on these methodological considerations, quality standards for the named types of case histories are stated.

Intracystic breast carcinoma. An important differential diagnosis in postmenopausal patients presenting with a rapidly growing breast cyst. Management and literature review.

PubMed

Salemis, Nikolaos S

2018-03-16

Intracystic breast carcinoma is a rare clinical entity accounting for 0.5-2% of all breast cancers. It represents a distinctive clinical form rather a histological subtype of breast cancer and can either be in situ or invasive tumor. We herein describe a rare case of intracystic breast carcinoma arising from the wall of a cyst in a postmenopausal patient, who presented with a rapidly growing complex breast cyst. Diagnostic evaluation and management of the patient are discussed along with a review of the literature. Complex breast cysts may represent a diagnostic and therapeutic challenge. An underlying malignancy has been reported in 21-31% of the cases. Preoperative diagnosis is challenging. Complex breast cysts with thick wall, thick inner septations, and intracystic solid components should undergo histological evaluation in order to rule out an underlying malignancy. The cytological analysis may be inconclusive. Ultrasound-guided biopsy is the diagnostic modality of choice. The correlation of clinical features, with imaging and histopathological findings is very important for the optimal treatment. In cases of discordance, a complete surgical excision is necessary with careful assessment of the extent of the disease and appropriate treatment.

DNA vaccines in veterinary use

PubMed Central

Redding, Laurel; Werner, David B

2015-01-01

DNA vaccines represent a new frontier in vaccine technology. One important application of this technology is in the veterinary arena. DNA vaccines have already gained a foothold in certain fields of veterinary medicine. However, several important questions must be addressed when developing DNA vaccines for animals, including whether or not the vaccine is efficacious and cost effective compared with currently available options. Another important question to consider is how to apply this developing technology in a wide range of different situations, from the domestic pet to individual fish in fisheries with several thousand animals, to wildlife programs for disease control. In some cases, DNA vaccines represent an interesting option for vaccination, while in others, currently available options are sufficient. This review will examine a number of diseases of veterinary importance and the progress being made in DNA vaccine technology relevant to these diseases, and we compare these with the conventional treatment options available. PMID:19722897

Status of imported malaria on Réunion Island in 2016.

PubMed

Pagès, Frédéric; Houze, Sandrine; Kurtkowiak, Brian; Balleydier, Elsa; Chieze, François; Filleul, Laurent

2018-05-24

Autochthonous malaria has been eliminated from Réunion in 1979. To prevent secondary transmission and re-emergence of autochthonous malaria, permanent epidemiologic and entomological surveillance and vector control measures are conducted around imported malaria cases. Results of local malaria surveillance (clinical data and results of epidemiological and entomological investigations around cases) were collected for 2013-2016 and were analysed according to historical data and to the exchanges with malaria-affected areas (estimated by airport data). Form 2013 to 2016, 95 imported malaria cases have been detected in Reunion Island: 42% of cases occurred in the area of repartition of Anopheles arabiensis, but Anopheles mosquitoes were present only around seven cases including one gametocyte carrier. No autochthonous or introduced case has occurred during this period. The lack of chemoprophylaxis or poor adherence was found in the majority (96%) of malaria cases between 2013 and 2016, regardless of trip type. Affinity tourism in Madagascar and Comoros was the cause of 65% of imported malaria cases. The incidence of imported malaria and the incidence rate per 100,000 travellers has continuously decreased since 2001. Now with the drastic decrease of malaria transmission in the Comoros archipelago, most of imported malaria cases in Reunion Island have been contaminated in Madagascar. Immigrants regularly resident in Reunion Island, which travel to malaria endemic countries (mainly Madagascar) to visit their friends and relatives (VFRs) represent a high-risk group of contracting malaria. VFRs, low adherence to pre-travel recommendations, in particular, the compliance on the use of chemoprophylaxis are the main drivers of imported malaria in Reunion Island. Furthermore as previously described, some general practitioners in Reunion Island are always not sufficiently aware of the official recommendations for prescriptions of prophylactic treatments. Social mobilization targeted on the Malagasy community in Reunion Island could help to decrease the burden of imported malaria in Reunion Island. Because of the low number of gametocyte carriers and the absence of an Anopheles mosquito population when most malaria cases were imported those last 4 years, the risk of the appearance of introduced malaria cases and indigenous malaria cases appears low in Reunion Island.

China-U.S. Relations: Current Issues and Implications for U.S. Policy

DTIC Science & Technology

2009-10-08

restrictions on foreign investments in the culture industry, to include film , publishing, entertainment, online games, and multi-media. September 25, 2009...departure from the previous administration of President George W. Bush, which denied import relief in six previous cases of petitions filed under section...Representative (USTR) filed a case against China in the WTO in December 2008 charging that the PRC’s “Famous Chinese” brand program amounted to unfair

China-U.S. Relations: Current Issues and Implications for U.S. Policy

DTIC Science & Technology

2009-07-10

Trade Representative (USTR) filed a case against China in the WTO in December 2008 charging that the PRC’s “Famous Chinese” brand program amounted to...Association of America, Inc. has charged that China may be blocking the import of American films , creating more opportunities for pirated versions...Relations: Current Issues and Implications for U.S. Policy Congressional Research Service 10 consumers. In 2007, the USTR filed several cases in

Accidental death in autoerotic maneuvers.

PubMed

Focardi, Martina; Gualco, Barbara; Norelli, GianAristide

2008-03-01

The authors from the Florence Forensic Department present a case that demonstrates the paradigms attached to accidental deaths while performing autoerotic maneuvers. The incidents of such practices are underestimated and are only the tip of the iceberg since they do not represent the cases that are never reported due to successful practice. After analyzing the statistic data, the authors describe the case and discuss about the element that prove the accidental nature of the death and the importance of the correct application of forensic methodology at the scene and in the mortuary.

Prescription opioid abuse based on representative postmortem toxicology.

PubMed

Häkkinen, Margareeta; Vuori, Erkki; Ojanperä, Ilkka

2014-12-01

Opioids are important medications for pain and opioid maintenance treatment. Increasing use and abuse of prescription opioids has, however, caused worldwide concern. Our aim was to estimate the ratio between prescription opioid abuse and total use, based on representative postmortem toxicology. Our material included all the medico-legally examined deaths in Finland during 2010-2011 involving positive findings involving buprenorphine, codeine, fentanyl, methadone, oxycodone, or tramadol. We studied drug abuse by age group, with "abuse" meaning licit opioids used illicitly as narcotics. Drug-abuse history, drug injecting, or laboratory findings of illicit drugs defined an abuser case. We then compared abuser cases and other opioid-related cases between the opioids with the number of fatal poisonings, accidents, suicides, alcohol findings, concomitant opioid use, and median postmortem blood opioid concentrations. Opioid findings numbered 2499 in 2088 cases. Drug abuse involved 545 opioid-positive cases, which in Finland represented 0.5% of those deceased. The proportion of abuser cases among all opioid-related cases for buprenorphine was 85.5%, for methadone 82.4%, for tramadol 29.4%, for codeine 16.3%, for fentanyl 14.5%, and for oxycodone 6.9%. Abuse in age-groups >60 was rare. Concomitant other opioid findings were more frequent in abuser- than in other cases for codeine, oxycodone, and tramadol, whereas alcohol findings were more frequent in buprenorphine, codeine, and fentanyl abuse. Buprenorphine and methadone were most often related to drug abuse. Every other opioid studied involved some abuse, and especially tramadol. Abuse and fatal poisonings were concentrated in men aged 20-49. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Dengue, chikungunya, and Zika virus infections imported to Paris between 2009 and 2016: Characteristics and correlation with outbreaks in the French overseas territories of Guadeloupe and Martinique.

PubMed

Vasquez, Victor; Haddad, Elie; Perignon, Alice; Jaureguiberry, Stéphane; Brichler, Ségolène; Leparc-Goffart, Isabelle; Caumes, Eric

2018-07-01

Dengue virus (DENV), chikungunya virus (CHIKV), and Zika virus (ZIKV) infections are rapidly expanding across countries and are being diagnosed in returned travellers who represent epidemiological sentinels. The French Territories of America (FTA) such as Guadeloupe and Martinique see high levels of tourism and have experienced three consecutive outbreaks by these viruses in the last decade. This study was performed to evaluate how ill returned travellers could have represented epidemiological sentinels for these three expanding arboviral diseases over eight consecutive years. The degree of correlation between the cases of ill returned travellers arriving at a French tertiary hospital in Paris and the three outbreaks that occurred in the FTA during the study period was estimated. All consecutive ill returned travellers diagnosed at the hospital in Paris with imported DENV, CHIKV, or ZIKV infections from January 2009 to December 2016 were included. Epidemiological and clinical variables were evaluated. Data concerning the incidence of arboviruses in the FTA, as well as the temporal relationship between the occurrence of imported cases and outbreaks in the FTA, were analyzed. Overall, 320 cases of arboviral infection were reported: 216 DENV, 68 CHIKV, and 36 ZIKV. Most of the patients presented with fever and exanthema. One hundred and fifteen patients were exposed in Guadeloupe or Martinique, which were the at-risk destinations in 25% of patients with DENV, 59% of patients with CHIKV, and 58% of patients with ZIKV. The occurrence of cases diagnosed in returning travellers followed the same time pattern as the outbreaks in these areas. A temporal correlation was found between newly diagnosed imported cases of arboviruses and the three corresponding outbreaks that occurred in Martinique and Guadeloupe during 8 consecutive years. Thus, ill returned travellers act as epidemiological sentinels from the beginning up to the end of outbreaks occurring in touristic locations. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

International Trade in Educational Services: Good or Bad?

ERIC Educational Resources Information Center

Larsen, Kurt; Vincent-Lancrin, Stephan

2002-01-01

Analyzes the challenges and opportunities that international trade in educational services represents for higher education systems in industrialized and developing countries and shows the importance of international quality assurance in education. Makes the case that the lifelong learning sector is most likely to be affected by developments…

Latent tuberculosis infection in foreign-born communities: Import vs. transmission in The Netherlands derived through mathematical modelling.

PubMed

Korthals Altes, Hester; Kloet, Serieke; Cobelens, Frank; Bootsma, Martin

2018-01-01

While tuberculosis (TB) represents a significant disease burden worldwide, low-incidence countries strive to reach the WHO target of pre-elimination by 2035. Screening for TB in immigrants is an important component of the strategy to reduce the TB burden in low-incidence settings. An important option is the screening and preventive treatment of latent TB infection (LTBI). Whether this policy is worthwhile depends on the extent of transmission within the country, and introduction of new cases through import. Mathematical transmission models of TB have been used to identify key parameters in the epidemiology of TB and estimate transmission rates. An important application has also been to investigate the consequences of policy scenarios. Here, we formulate a mathematical model for TB transmission within the Netherlands to estimate the size of the pool of latent infections, and to determine the share of importation-either through immigration or travel- versus transmission within the Netherlands. We take into account importation of infections due to immigration, and travel to the country of origin, focusing on the three ethnicities most represented among foreign-born TB cases (after exclusion of those overrepresented among asylum seekers): Moroccans, Turkish and Indonesians. We fit a system of ordinary differential equations to the data from the Netherlands Tuberculosis Registry on (extra-)pulmonary TB cases from 1995-2013. We estimate that about 27% of Moroccans, 25% of Indonesians, and 16% of Turkish, are latently infected. Furthermore, we find that for all three foreign-born communities, immigration is the most important source of LTBI, but the extent of within-country transmission is much lower (about half) for the Turkish and Indonesian communities than for the Moroccan. This would imply that contact investigation would have a greater yield in the latter community than in the former. Travel remains a minor factor contributing LTBI, suggesting that targeting returning travelers might be less effective at preventing LTBI than immigrants upon entry in the country.

Non-anastomotic strictures after transplanting a liver graft with an accidentally ligated and unflushed common bile duct: A case report.

PubMed

Meurisse, Nicolas; Pirenne, Jacques; Monbaliu, Diethard

2017-01-01

Non-anastomotic biliary strictures (NAS) represent a major cause of morbidity, graft loss, and mortality after liver transplantation (LTx). NAS can result from an ischemic/immune-mediated injury, or from the cytotoxic effect that bile salts have on the biliary mucosa under hypothermic conditions. For this reason it is crucial to flush the bile duct at the time of procurement. We report a case of an imported liver with an accidentally ligated and subsequently completely unflushed common bile duct. The recipient was a 60 year-old man suffering from hepatocellular carcinoma and post-alcoholic cirrhosis. Post-operative course was uneventful and the patient was discharged after 18days. Within 2 months post-transplantation, a rapidly evolving cholestasis was diagnosed. Endoscopic-retrograde-cholangio-pancreaticography revealed diffuse NAS. Due to the rapid clinical and biochemical deterioration there was no other option than re-transplantation. Suboptimally flushed bile ducts are often encountered and represent a risk factor for NAS after LTx. This unique case represented an extreme form where the biliary tree was not flushed at all. The dilemma of this unforeseen situation raised the question to transplant or discard this liver for transplantation? Given the organ shortage, the pressure to use less-than-ideal organs, the otherwise normal aspect of the liver and our incapacity to predict with certainty the development (or not) of NAS, we accepted this liver for transplantation. This case illustrates a contrario the importance of flushing the bile duct and risk of extensive dissection of the hepatic hilum at the time of procurement. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Appendiceal diverticulum associated with chronic appendicitis

PubMed Central

Zubieta-O’Farrill, Gregorio; Guerra-Mora, José Raúl; Gudiño-Chávez, Andrés; Gonzalez-Alvarado, Carlos; Cornejo-López, Gilberto Bernabe; Villanueva-Sáenz, Eduardo

2014-01-01

INTRODUCTION Appendiceal diverticulosis is a rare entity, with a global incidence between 0.004% and 2.1% of all appendectomies. It has been related with an elevated risk of perforation in comparison to acute appendicitis, as well as an increased risk for synchronic appendicular cancer in 48% of the cases, and colonic cancer in 43%. The incidence of chronic appendicitis has been reported in 1.5% of all appendicitis cases. PRESENTATION OF CASE We present a 73-year-old female, with no relevant familial history, who presented due to a four-month-long oppressive, moderate pain in the lower right abdominal quadrant without irradiation or any other accompanying symptoms. DISCUSSION The documented incidence of appendiceal diverticula and chronic appendicitis by themselves is low; therefore the presence of both entities at the same time is extremely rare. CONCLUSION We present a case in which both diagnoses concurred in the same patient. The relevance of this case relies on the importance of the adequate knowledge of these pathologies, so we can approach them correctly. Although it does not represent an absolute surgical emergency, appendectomy represents the first therapeutic option. PMID:25460447

Small-intestine pneumocystis jiroveci pseudotumor as an acquired immunodeficiency syndrome-presenting illness: report of a case and review of the literature.

PubMed

Zhou, Yi; Shetty, Jayarama; Pins, Michael R

2012-09-01

A Pneumocystis jiroveci infection-associated mass clinically mimicking a malignancy (ie, pseudotumor) is rare and usually occurs in the lung in association with Pneumocystis pneumonia. Pneumocystis jiroveci pseudotumors of the small intestine are extremely rare and represent an unusual form of disseminated P jiroveci infection. We present a case of small-intestine P jiroveci pseudotumor as an acquired immunodeficiency syndrome-presenting illness in a patient with coinfection with cytomegalovirus, no pulmonary symptoms, and no known risk factors for human immunodeficiency virus infection. This case reinforces the potential importance of cytomegalovirus coinfection in the disseminated form of Pneumocystis infection and illustrates the importance of an expanded differential diagnosis when confronted with a clinically atypical mass lesion.

Moving Apart and Coming Together: Discourse, Engagement, and Deep Learning

ERIC Educational Resources Information Center

Gomoll, Andrea S.; Hmelo-Silver, Cindy E.; Tolar, Erin; Šabanovic, Selma; Francisco, Matthew

2017-01-01

An important part of "doing" science is engaging in collaborative science practices. To better understand how to support these practices, we need to consider how students collaboratively construct and represent shared understanding in complex, problem-oriented, and authentic learning environments. This research presents a case study…

The Ongoing and Open-Ended Simulation

ERIC Educational Resources Information Center

Cohen, Alexander

2016-01-01

This case study explores a novel form of classroom simulation that differs from published examples in two important respects. First, it is ongoing. While most simulations represent a single learning episode embedded within a course, the ongoing simulation is a continuous set of interrelated events and decisions that accompany learning throughout…

Granulomatous mastitis caused by histoplasma and mimicking inflammatory breast carcinoma.

PubMed

Osborne, B M

1989-01-01

Two cases of a lobular, necrotizing granulomatous process causing a unilateral painful breast mass mimicking carcinoma are presented for comparison. While the morphologic appearance in each case was that of lobular granulomatous mastitis, the etiologic agent in one case appeared to be Histoplasma capsulatum, based on Grocott methenamine silver staining, and represents the second reported case of histoplasmosis involving only breast parenchyma. Awareness of the rare entity, granulomatous mastitis, is important for the pathologist because the definitive diagnosis is made microscopically. Thorough evaluation of the breast tissue is essential for its management and should eventually contribute to the clarification of its etiology.

Latent tuberculosis infection in foreign-born communities: Import vs. transmission in The Netherlands derived through mathematical modelling

PubMed Central

Kloet, Serieke; Cobelens, Frank; Bootsma, Martin

2018-01-01

While tuberculosis (TB) represents a significant disease burden worldwide, low-incidence countries strive to reach the WHO target of pre-elimination by 2035. Screening for TB in immigrants is an important component of the strategy to reduce the TB burden in low-incidence settings. An important option is the screening and preventive treatment of latent TB infection (LTBI). Whether this policy is worthwhile depends on the extent of transmission within the country, and introduction of new cases through import. Mathematical transmission models of TB have been used to identify key parameters in the epidemiology of TB and estimate transmission rates. An important application has also been to investigate the consequences of policy scenarios. Here, we formulate a mathematical model for TB transmission within the Netherlands to estimate the size of the pool of latent infections, and to determine the share of importation–either through immigration or travel- versus transmission within the Netherlands. We take into account importation of infections due to immigration, and travel to the country of origin, focusing on the three ethnicities most represented among foreign-born TB cases (after exclusion of those overrepresented among asylum seekers): Moroccans, Turkish and Indonesians. We fit a system of ordinary differential equations to the data from the Netherlands Tuberculosis Registry on (extra-)pulmonary TB cases from 1995–2013. We estimate that about 27% of Moroccans, 25% of Indonesians, and 16% of Turkish, are latently infected. Furthermore, we find that for all three foreign-born communities, immigration is the most important source of LTBI, but the extent of within-country transmission is much lower (about half) for the Turkish and Indonesian communities than for the Moroccan. This would imply that contact investigation would have a greater yield in the latter community than in the former. Travel remains a minor factor contributing LTBI, suggesting that targeting returning travelers might be less effective at preventing LTBI than immigrants upon entry in the country. PMID:29444122

Imported malaria in a non-endemic area: the experience of the university of Campinas hospital in the Brazilian Southeast

PubMed Central

2014-01-01

Background Although malaria in Brazil almost exclusively occurs within the boundaries of the Amazon Region, some concerns are raised regarding imported malaria to non-endemic areas of the country, notably increased incidence of complications due to delayed diagnoses. However, although imported malaria in Brazil represents a major health problem, only a few studies have addressed this subject. Methods A retrospective case series is presented in which 263 medical charts were analysed to investigate the clinical and epidemiological characterization of malaria cases that were diagnosed and treated at Hospital & Clinics, State University of Campinas between 1998 and 2011. Results Amongst all medical charts analysed, 224 patients had a parasitological confirmed diagnosis of malaria. Plasmodium vivax and Plasmodium falciparum were responsible for 67% and 30% of the infections, respectively. The majority of patients were male (83%) of a productive age (median, 37 years old). Importantly, severe complications did not differ significantly between P. vivax (14 cases, 9%) and P. falciparum (7 cases, 10%) infections. Conclusions Severe malaria cases were frequent among imported cases in Brazil outside of the Amazon area. The findings reinforce the idea that P. vivax infections in Brazil are not benign, regardless the endemicity of the area studied. Moreover, as the hospital is located in a privileged site, it could be used for future studies of malaria relapses and primaquine resistance mechanisms. Finally, based on the volume of cases treated and the secondary complications, referral malaria services are needed in the non-endemic areas of Brazil for a rapid and efficient and treatment. PMID:25047177

Imported malaria in a non-endemic area: the experience of the university of Campinas hospital in the Brazilian Southeast.

PubMed

Dos-Santos, João C K; Angerami, Rodrigo N; Castiñeiras, Catarina M S; Lopes, Stefanie C P; Albrecht, Letusa; Garcia, Márcia T; Levy, Carlos E; Moretti, Maria L; Lacerda, Marcus V G; Costa, Fabio T M

2014-07-22

Although malaria in Brazil almost exclusively occurs within the boundaries of the Amazon Region, some concerns are raised regarding imported malaria to non-endemic areas of the country, notably increased incidence of complications due to delayed diagnoses. However, although imported malaria in Brazil represents a major health problem, only a few studies have addressed this subject. A retrospective case series is presented in which 263 medical charts were analysed to investigate the clinical and epidemiological characterization of malaria cases that were diagnosed and treated at Hospital & Clinics, State University of Campinas between 1998 and 2011. Amongst all medical charts analysed, 224 patients had a parasitological confirmed diagnosis of malaria. Plasmodium vivax and Plasmodium falciparum were responsible for 67% and 30% of the infections, respectively. The majority of patients were male (83%) of a productive age (median, 37 years old). Importantly, severe complications did not differ significantly between P. vivax (14 cases, 9%) and P. falciparum (7 cases, 10%) infections. Severe malaria cases were frequent among imported cases in Brazil outside of the Amazon area. The findings reinforce the idea that P. vivax infections in Brazil are not benign, regardless the endemicity of the area studied. Moreover, as the hospital is located in a privileged site, it could be used for future studies of malaria relapses and primaquine resistance mechanisms. Finally, based on the volume of cases treated and the secondary complications, referral malaria services are needed in the non-endemic areas of Brazil for a rapid and efficient and treatment.

Edema associated with quetiapine

PubMed Central

Koleva, Hristina K.; Erickson, Mark A.; Vanderlip, Erik R.; Tansey, Janeta; Mac, Joseph; Fiedorowicz, Jess G.

2010-01-01

Background Edema associated with quetiapine has been described in only one case report to date and represents a potentially serious adverse reaction. Methods We present a case series of three patients who developed bilateral leg edema following initiation of quetiapine. Results One of these patients had a recurrence of edema with subsequent rechallenge. Another patient developed quetiapine-induced edema following a prior episode of olanzapine-induced edema. All the cases present a compelling temporal relationship between the drug challenge and the adverse event. Conclusions Prompt recognition and intervention with discontinuation of the offending agent is important for this potentially serious, seemingly idiosyncratic, vascular complication. PMID:19439156

Case study of first episode schizophrenia in pregnancy and postpartum.

PubMed

Kast, Kristopher A; Agarkar, Smita

2017-08-01

Patients with first-episode psychosis of peripartum onset commonly prove to have a mood-disorder diathesis; however, a proportion of cases represent first-episode schizophrenia. We present such a case and discuss the clinical relevance of recognizing this small but important population of new mothers. These patients are at considerable risk of misdiagnosis, resulting in ineffective maintenance therapy, poorer recovery of function, and development of treatment resistance. Accurate diagnosis in the peripartum period will impact treatment decisions and long-term therapy. Clinicians need to be vigilant, especially during maintenance therapy, to identify these patients and ensure appropriate antipsychotic therapy is provided.

OPTOELECTRONICS, FIBER OPTICS, AND OTHER ASPECTS OF QUANTUM ELECTRONICS: Influence of the Rayleigh backscattering on the mode composition of radiation in multimode graded-index waveguides with a quadratic refractive-index profile

NASA Astrophysics Data System (ADS)

Esayan, G. L.; Krivoshlykov, S. G.

1989-08-01

A method of coherent states is used to describe the process of Rayleigh scattering in a multimode graded-index waveguide with a quadratic refractive-index profile. Explicit expressions are obtained for the coefficients representing excitation of Gaussian-Hermite backscattering modes in two cases of practical importance: excitation of a waveguide by an extended noncoherent light source and selective excitation of different modes at the entry to a waveguide. An analysis is also made of the coefficients of coupling between forward and backward modes. Explicit expressions for the coefficients representing capture of backscattered radiation by a waveguide are obtained for two special cases of excitation (extended light source and zeroth mode).

Homicide-suicide in Victoria, Australia.

PubMed

Milroy, C M; Dratsas, M; Ranson, D L

1997-12-01

Thirty-nine incidents of homicide-suicide occurring in Victoria, Australia between 1985 and 1989 were examined. In 33 cases the assailants were men. The victims were spouses or women living in a de facto marriage. The majority of the victims were shot, and this was also the most frequent method of suicide. Breakdown in a relationship was the most frequent reason for killing. Mental illness of the assailant accounted for the killing in approximately 20% of cases. Physical ill health and financial stress were identified as important associative factors, particularly in the elderly. The pattern of homicide-suicide in Victoria is similar to that observed in other jurisdictions and represents an important and distinct subgroup of homicide.

Predicting Local Dengue Transmission in Guangzhou, China, through the Influence of Imported Cases, Mosquito Density and Climate Variability

PubMed Central

Sang, Shaowei; Yin, Wenwu; Bi, Peng; Zhang, Honglong; Wang, Chenggang; Liu, Xiaobo; Chen, Bin; Yang, Weizhong; Liu, Qiyong

2014-01-01

Introduction Each year there are approximately 390 million dengue infections worldwide. Weather variables have a significant impact on the transmission of Dengue Fever (DF), a mosquito borne viral disease. DF in mainland China is characterized as an imported disease. Hence it is necessary to explore the roles of imported cases, mosquito density and climate variability in dengue transmission in China. The study was to identify the relationship between dengue occurrence and possible risk factors and to develop a predicting model for dengue’s control and prevention purpose. Methodology and Principal Findings Three traditional suburbs and one district with an international airport in Guangzhou city were selected as the study areas. Autocorrelation and cross-correlation analysis were used to perform univariate analysis to identify possible risk factors, with relevant lagged effects, associated with local dengue cases. Principal component analysis (PCA) was applied to extract principal components and PCA score was used to represent the original variables to reduce multi-collinearity. Combining the univariate analysis and prior knowledge, time-series Poisson regression analysis was conducted to quantify the relationship between weather variables, Breteau Index, imported DF cases and the local dengue transmission in Guangzhou, China. The goodness-of-fit of the constructed model was determined by pseudo-R2, Akaike information criterion (AIC) and residual test. There were a total of 707 notified local DF cases from March 2006 to December 2012, with a seasonal distribution from August to November. There were a total of 65 notified imported DF cases from 20 countries, with forty-six cases (70.8%) imported from Southeast Asia. The model showed that local DF cases were positively associated with mosquito density, imported cases, temperature, precipitation, vapour pressure and minimum relative humidity, whilst being negatively associated with air pressure, with different time lags. Conclusions Imported DF cases and mosquito density play a critical role in local DF transmission, together with weather variables. The establishment of an early warning system, using existing surveillance datasets will help to control and prevent dengue in Guangzhou, China. PMID:25019967

Predicting local dengue transmission in Guangzhou, China, through the influence of imported cases, mosquito density and climate variability.

PubMed

Sang, Shaowei; Yin, Wenwu; Bi, Peng; Zhang, Honglong; Wang, Chenggang; Liu, Xiaobo; Chen, Bin; Yang, Weizhong; Liu, Qiyong

2014-01-01

Each year there are approximately 390 million dengue infections worldwide. Weather variables have a significant impact on the transmission of Dengue Fever (DF), a mosquito borne viral disease. DF in mainland China is characterized as an imported disease. Hence it is necessary to explore the roles of imported cases, mosquito density and climate variability in dengue transmission in China. The study was to identify the relationship between dengue occurrence and possible risk factors and to develop a predicting model for dengue's control and prevention purpose. Three traditional suburbs and one district with an international airport in Guangzhou city were selected as the study areas. Autocorrelation and cross-correlation analysis were used to perform univariate analysis to identify possible risk factors, with relevant lagged effects, associated with local dengue cases. Principal component analysis (PCA) was applied to extract principal components and PCA score was used to represent the original variables to reduce multi-collinearity. Combining the univariate analysis and prior knowledge, time-series Poisson regression analysis was conducted to quantify the relationship between weather variables, Breteau Index, imported DF cases and the local dengue transmission in Guangzhou, China. The goodness-of-fit of the constructed model was determined by pseudo-R2, Akaike information criterion (AIC) and residual test. There were a total of 707 notified local DF cases from March 2006 to December 2012, with a seasonal distribution from August to November. There were a total of 65 notified imported DF cases from 20 countries, with forty-six cases (70.8%) imported from Southeast Asia. The model showed that local DF cases were positively associated with mosquito density, imported cases, temperature, precipitation, vapour pressure and minimum relative humidity, whilst being negatively associated with air pressure, with different time lags. Imported DF cases and mosquito density play a critical role in local DF transmission, together with weather variables. The establishment of an early warning system, using existing surveillance datasets will help to control and prevent dengue in Guangzhou, China.

China-U.S. Relations: Current Issues and Implications for U.S. Policy

DTIC Science & Technology

2009-07-29

Representative (USTR) filed a case against China in the WTO in December 2008 charging that the PRC’s “Famous Chinese” brand program amounted to...compared with 92% in 2003.30 The Motion Pictures Association of America, Inc. has charged that China may be blocking the import of American films , creating...the USTR filed several cases in the WTO: one alleging that the PRC had failed to comply with its commitments under the WTO’s Trade-Related Aspects

Radiological pitfalls of age estimation in adopted children: a case report.

PubMed

Gibelli, D; De Angelis, D; Cattaneo, C

2015-04-01

Age estimation has a relevant importance in assessing adopted children, also in cases where the age of the minor seems unquestioned, since pathological conditions may radically alter bodily growth. This may lead to an incorrect age evaluation, with consequent social and psychological problems linked to an inadequate collocation in public school. This study aims at exposing a case report concerning age estimation for a newly adopted child from Cambodia; previous clinical documentation reported information suggesting possible malnutrition, which was verified by the observation of a general disalignment of bone and dental structures. This example shows the importance of a thorough forensic evaluation of adopted children from other countries in order to verify the possible environmental modification of physiological growth even where it seems not to be needed, and represents a caveat for clinical and social personnel dealing with adoption procedures.

The General Surgery Chief Resident Operative Experience

PubMed Central

Drake, Frederick Thurston; Horvath, Karen D.; Goldin, Adam B.; Gow, Kenneth W.

2014-01-01

IMPORTANCE The chief resident (CR) year is a pivotal experience in surgical training. Changes in case volume and diversity may impact the educational quality of this important year. OBJECTIVE To evaluate changes in operative experience for general surgery CRs. DESIGN, SETTING, AND PARTICIPANTS Review of Accreditation Council for Graduate Medical Education case logs from 1989–1990 through 2011–2012 divided into 5 periods. Graduates in period 3 were the last to train with unrestricted work hours; those in period 4 were part of a transition period and trained under both systems; and those in period 5 trained fully under the 80-hour work week. Diversity of cases was assessed based on Accreditation Council for Graduate Medical Education defined categories. MAIN OUTCOMES AND MEASURES Total cases and defined categories were evaluated for changes over time. RESULTS The average total CR case numbers have fallen (271 in period 1 vs 242 in period 5, P < .001). Total CR cases dropped to their lowest following implementation of the 80-hour work week (236 cases), but rebounded in period 5. The percentage of residents’ 5-year operative experience performed as CRs has decreased (30% in period 1 vs 25.6% in period 5, P < .001). Regarding case mix: thoracic, trauma, and vascular cases declined steadily, while alimentary and intra-abdominal operations increased. Recent graduates averaged 80 alimentary and 78 intra-abdominal procedures during their CR years. Compared with period 1, in which these 2 categories represented 47.1% of CR experience, in period 5, they represented 65.2% (P < .001). Endocrine experience has been relatively unchanged. CONCLUSIONS AND RELEVANCE Total CR cases declined especially acutely following implementation of the 80-hour work week but have since rebounded. Chief resident cases contribute less to overall experience, although this proportion stabilized before the 80-hour work week. Case mix has narrowed, with significant increases in alimentary and intra-abdominal cases. Broad-based general surgery training may be jeopardized by reduced case diversity. Chief resident cases are crucial in surgical training and educators should consider these findings as surgical training evolves. PMID:23864049

Electromagnetic Launch Vehicle Fairing and Acoustic Blanket Model of Received Power Using FEKO

NASA Technical Reports Server (NTRS)

Trout, Dawn H.; Stanley, James E.; Wahid, Parveen F.

2011-01-01

Evaluating the impact of radio frequency transmission in vehicle fairings is important to sensitive spacecraft. This paper employees the Multilevel Fast Multipole Method (MLFMM) feature of a commercial electromagnetic tool to model the fairing electromagnetic environment in the presence of an internal transmitter. This work is an extension of the perfect electric conductor model that was used to represent the bare aluminum internal fairing cavity. This fairing model includes typical acoustic blanketing commonly used in vehicle fairings. Representative material models within FEKO were successfully used to simulate the test case.

Assessment of timeliness, representativeness and quality of data reported to Italy's national integrated surveillance system for acute viral hepatitis (SEIEVA).

PubMed

Tosti, M E; Longhi, S; de Waure, C; Mele, A; Franco, E; Ricciardi, W; Filia, A

2015-05-01

Periodic assessment of surveillance systems is recommended to verify whether they are appropriately monitoring the public health problem under surveillance. The aim of this study was to evaluate timeliness, data quality and representativeness of data reported to the Italian Integrated Epidemiological System for Acute Viral Hepatitis (SEIEVA). Cross-sectional analysis of surveillance data. Quantitative indicators were used to evaluate representativeness of reported cases, data quality, and timeliness between surveillance steps, for reports of acute viral hepatitis cases with date of onset of symptoms from 2009 to 2012 (N = 4516). Representativeness was 75%. Over 95% of records reported information on age, sex, city of residence, risk factors for hepatitis A and vaccination status. Information on risk factors for hepatitis B and C were reported less consistently (83%), as was information on early outcome (60%). Wide delays were found between surveillance steps. The system collects high quality data on acute viral hepatitis cases in Italy. Timeliness was found to be the main limit and needs to be improved by optimizing web-based reporting procedures, increasing communication with participating centres, improving feedback and increasing dissemination of surveillance results. The study highlights the importance of reporting timeliness to detect outbreaks of acute viral hepatitis. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Arthropods of medicoveterinary importance in zoos.

PubMed

Adler, Peter H; Tuten, Holly C; Nelder, Mark P

2011-01-01

Zoos present a unique assemblage of arthropods, captive vertebrates, free-roaming wildlife, humans, and plants, each with its own biota of symbiotic organisms. Arthropods of medicoveterinary importance are well represented in zoos, and an ample literature documents their influence in these animal-rich environments. Mosquitoes are of greatest significance because of the animal and human pathogens they transmit, followed by ectoparasites, many of which are exotic and present health risks to captive and native animals. Biting flies, cockroaches, filth flies, and triatomid bugs represent additional concerns. Integrated management programs for arthropods in zoos are commonplace. Zoos can play a role in biosurveillance, serving as an advanced guard for detecting exotic arthropods and vector-borne diseases. We provide the first review of arthropods of medicoveterinary importance in zoos. A case is made for the value of collaborations between entomologists and zoo personnel as a means of enhancing research and public education while safeguarding the health of captive animals and the public.

Observing and understanding the ultrafast photochemistry in small molecules: applications to sunscreens.

PubMed

Baker, Lewis A; Stavros, Vasilios G

2016-09-01

In this review, we discuss the importance of biological and artificial photoprotection against overexposure to harmful ultraviolet radiation. Transient electronic and transient vibrational absorption spectroscopies are highlighted as important tools in understanding the energy transfer in small molecules, with a focus on the application to commercial sunscreens with representative examples given. Oxybenzone, a common ingredient in commercial sunscreens and sinapoyl malate, a biological sunscreen in plant leaves are presented as case studies.

Astroblaster--A Fascinating Game of Multi-Ball Collisions

ERIC Educational Resources Information Center

Kires, Marian

2009-01-01

Multi-ball collisions inside the Astroblaster toy are explained from the conservation of momentum point of view. The important role of the coefficient of restitution is demonstrated in ideal and real cases. Real experimental results with the simple toy can be compared with a computer model represented by an interactive Java applet. (Contains 1…

Public Attitudes towards Socio-Cultural Aspects of Water Supply and Sanitation Services: Palestine as a Case Study

ERIC Educational Resources Information Center

Haddad, Marwan

2005-01-01

Identifying and considering public attitudes towards various aspects of water supply and sanitation services by planners and decision makers represent an important developmental element relating to the quality, efficiency, and performance of those services. A sample of 1000 Palestinian adults completed a questionnaire assessing attitudes towards…

The effect of improving task representativeness on capturing nurses’ risk assessment judgements: a comparison of written case simulations and physical simulations

PubMed Central

2013-01-01

Background The validity of studies describing clinicians’ judgements based on their responses to paper cases is questionable, because - commonly used - paper case simulations only partly reflect real clinical environments. In this study we test whether paper case simulations evoke similar risk assessment judgements to the more realistic simulated patients used in high fidelity physical simulations. Methods 97 nurses (34 experienced nurses and 63 student nurses) made dichotomous assessments of risk of acute deterioration on the same 25 simulated scenarios in both paper case and physical simulation settings. Scenarios were generated from real patient cases. Measures of judgement ‘ecology’ were derived from the same case records. The relationship between nurses’ judgements, actual patient outcomes (i.e. ecological criteria), and patient characteristics were described using the methodology of judgement analysis. Logistic regression models were constructed to calculate Lens Model Equation parameters. Parameters were then compared between the modeled paper-case and physical-simulation judgements. Results Participants had significantly less achievement (ra) judging physical simulations than when judging paper cases. They used less modelable knowledge (G) with physical simulations than with paper cases, while retaining similar cognitive control and consistency on repeated patients. Respiration rate, the most important cue for predicting patient risk in the ecological model, was weighted most heavily by participants. Conclusions To the extent that accuracy in judgement analysis studies is a function of task representativeness, improving task representativeness via high fidelity physical simulations resulted in lower judgement performance in risk assessments amongst nurses when compared to paper case simulations. Lens Model statistics could prove useful when comparing different options for the design of simulations used in clinical judgement analysis. The approach outlined may be of value to those designing and evaluating clinical simulations as part of education and training strategies aimed at improving clinical judgement and reasoning. PMID:23718556

Incubation period for campylobacteriosis and its importance in the estimation of incidence related to travel.

PubMed

Horn, B J; Lake, R J

2013-10-03

Differentiation between travel-related and domestic cases of infectious disease is important in managing risk. Incubation periods of cases from several outbreaks of campylobacteriosis in Canada, Europe, and the United States with defined exposure time of less than 24 hours were collated to provide information on the incubation period distribution. This distribution was consistent across the varied outbreaks considered, with 84% (702/832) of cases having an incubation period of four days or less and 1% having an incubation period of eight days or more. The incubation period distribution was incorporated into a model for the number of travel-related cases presenting with symptom onset at given dates after return to their country of residence. Using New Zealand notification data between 2006 and 2010 for cases who had undertaken foreign travel within 10 days prior to symptom onset, we found that 29.6% (67/227 cases; 95% confidence interval (CI): 28.3–30.8%) of these cases were likely to have been domestic cases. When cases with symptom onset prior to arrival were included, the probable domestic cases represented 11.8% (67/571; 95% CI: 11.2–12.3%). Consideration of incubation time distributions and consistent collection of travel start/end dates with symptom onset dates would assist attribution of cases to foreign travel.

From K giants to G dwarfs: stellar lifetime effects on metallicity distributions derived from red giants

NASA Astrophysics Data System (ADS)

Manning, Ellen M.; Cole, Andrew A.

2017-11-01

We examine the biases inherent to chemical abundance distributions when targets are selected from the red giant branch (RGB), using simulated giant branches created from isochrones. We find that even when stars are chosen from the entire colour range of RGB stars and over a broad range of magnitudes, the relative numbers of stars of different ages and metallicities, integrated over all stellar types, are not accurately represented in the giant branch sample. The result is that metallicity distribution functions derived from RGB star samples require a correction before they can be fitted by chemical evolution models. We derive simple correction factors for over- and under-represented populations for the limiting cases of single-age populations with a broad range of metallicities and of continuous star formation at constant metallicity; an important general conclusion is that intermediate-age populations (≈1-4 Gyr) are over-represented in RGB samples. We apply our models to the case of the Large Magellanic Cloud bar and show that the observed metallicity distribution underestimates the true number of metal-poor stars by more than 25 per cent; as a result, the inferred importance of gas flows in chemical evolution models could potentially be overestimated. The age- and metallicity-dependences of RGB lifetimes require careful modelling if they are not to lead to spurious conclusions about the chemical enrichment history of galaxies.

[Digital x-ray image processing as an aid in forensic medicine].

PubMed

Buitrago-Tellez, C; Wenz, W; Friedrich, G

1992-02-01

Radiology plays an important role in the identification of unknown corpses. Positive radiographic identification by comparison with antemortem films is an established technique in this setting. Technical defects together with non-well-preserved films make it sometimes difficult or even impossible to establish a confident comparison. Digital image processing after secondary digitalization of ante- and postmortem films represents an important development and aid in forensic medicine. The application of this method is demonstrated on a single case.

Oral histoplasmosis after radiation therapy for laryngeal squamous cell carcinoma.

PubMed

Ezzedine, Khaled; Accoceberry, Isabelle; Malvy, Denis

2007-05-01

Histoplasmosis is a usually asymptomatic deep fungal infection of tropical origin with respiratory entry and possible oral, pharyngeal, or metastatic localization. The condition represents an important imported systemic mycosis with oral involvement. We report the case of a patient who developed an oropharyngeal reactivation of a latent Histoplasma infection after receiving local antitumoral radiation therapy of the neck. H capsulatum was shown to be present in the lesion by both histopathology and staining, and was deduced to be the causative organism of the disease.

An Effective Educational Tool: Construction Kits for Fun and Meaningful Learning

ERIC Educational Resources Information Center

Somyürek, Sibel

2015-01-01

The integration of robotics in education is still relatively new and represents an important advance in education practices. So, this paper aims to share the results from the perspectives of both students and trainers in an experimental case research in which LEGO Mindstorms construction kits were used. Sixty-two students between the ages of 8 and…

System Simulation Modeling: A Case Study Illustration of the Model Development Life Cycle

Treesearch

Janice K. Wiedenbeck; D. Earl Kline

1994-01-01

Systems simulation modeling techniques offer a method of representing the individual elements of a manufacturing system and their interactions. By developing and experimenting with simulation models, one can obtain a better understanding of the overall physical system. Forest products industries are beginning to understand the importance of simulation modeling to help...

Developmental Relationships between Speech and Writing: Is Verb-Phrase Anaphora Production a Special Case?

ERIC Educational Resources Information Center

Donaldson, Morag L.; Cooper, Lynn S. M.

2013-01-01

Background: Young children's speech is typically more linguistically sophisticated than their writing. However, there are grounds for asking whether production of cohesive devices, such as verb-phrase anaphora (VPA), might represent an exception to this developmental pattern, as cohesive devices are generally more important in writing than in…

(Re)constructing and (Re)presenting Heritage: Education and Representation in an American Indian Homeland Preservation Project

ERIC Educational Resources Information Center

Graybeal, Lesley Marie

2011-01-01

Experiences of the Occaneechi Band of the Saponi Nation (Occaneechi) in constructing a heritage revitalization initiative known as the Homeland Preservation Project and organizing related educational programming were analyzed through an ethnographic case study. The purpose of the study was to understand the importance of the heritage museum as a…

Superhero Physiology: The Case for Captain America

ERIC Educational Resources Information Center

Brown, Stanley P.; Smith, JohnEric W.; McAllister, Matthew; Joe, LeeAnn

2017-01-01

Using pop icons in the science classroom represents a creative way to engage often-distracted students in a relevant and, perhaps more importantly, fun way. When the pop icon is as universally known as Captain America, the pedagogical stage is set. However, when the movies can also be employed to link dramatic references to the science concepts at…

Rethinking Gifted Education in South Africa: The Voices of Gifted Grade 11 Students

ERIC Educational Resources Information Center

Oswald, Marietjie; Rabie, Erika

2017-01-01

In this article, we report the findings of a qualitative, collective case study exploring the academic experiences of six grade 11 gifted students in two schools in diverse socio-economic communities in rural Western South Africa. Gifted students represent an important component of a nation's intellectual capital. They possess the qualities needed…

Experiencing conceptual change about teaching: A case study from astronomy

NASA Astrophysics Data System (ADS)

Bailey, Janelle M.; Nagamine, Kentaro

2012-06-01

Understanding faculty motivations for and barriers to change is an important component of facilitating instructional reform efforts to improve student learning. This case study describes the process of adoption of learner-centered instructional strategies by an astronomy faculty member, Ken, as viewed through the lens of conceptual change. Specifically, we applied the Cognitive Reconstruction of Knowledge Model (CRKM) to understand why Ken was willing to change his instructional strategies, what barriers to and supports for change existed, and how he and his students were impacted by this change. Ken's statements and actions represented characteristics consistent with the CRKM. Notably, dissatisfaction, considered the primary motivator in many conceptual change models, was not of high importance in this case. Upon implementing learner-centered strategies, Ken's students performed better on a measure of knowledge about stellar properties, which served to reinforce his motivation to continue with learner-centered methods.

[Hyperthyroidism in surgery at the Teaching Hospital Yalgado Ouedraogo Burkina Faso. About 95 cases].

PubMed

Traoré, S S; Zida, M; Bonkoungou, G P; Tierno, H; Coulidiati, U; Sano, D

2007-01-01

The authors pay in a retrospective study, 95 cases of hyperthyroidism, listed in the teaching hospital Yalgado Ouedraogo of Ouagadougou from January 2000 to June 2005. These hyperthyroidism represent 39% of the thyroid affections, with a female prevalence (97%), 32 years of average age, the urban source of the patients (90% of the cases) and the importance of self medication (73%). They stress the importance of sonography, allowing a classification in diffuse goiter (44%) and multi nodular (56%). They insist on a good preparation of the patient before the intervention and on the interest of the sub total thyroïdectomy. They estimate that a correct binding of the vessels, the dissection of recurring, the visualization and the dissection of parathyroid and their vascular pedicle should make it possible to reduce the post-operative complications: null morbidity and death rate 12.5%.

End-of-Life Care Decisions: Importance of Reviewing Systems and Limitations After 2 Recent North American Cases

PubMed Central

Burkle, Christopher M.; Benson, Jeffre J.

2012-01-01

Two recent and unfortunate North American cases involving end-of-life treatment highlight the difficulties surrounding medical futility conflicts. As countries have explored the greater influence that patients and their representatives may play on end-of-life treatment decisions, the benefits and struggles involved with such a movement must be appreciated. These 2 cases are used to examine the present systems existing in the United States and Canada for resolving end-of-life decisions, including the difficulty in defining medical futility, the role of medical ethics committees, and controversies involving surrogate decision making. PMID:23127734

[Assessment and prevention of zoonoses: "one health approach"].

PubMed

Bonizzi, Luigi; Guarino, Marcella; Roncada, Paola; Colosio, Claudio

2013-01-01

Zoonotic pathologies represent diseases that can be transmittable from animals to humans and vice versa. In most cases zoonotic agents are bacteria or viruses and represent a huge problem for health. Zoonosis could represent easily solvable diseases such as simple infections or even deathly such as prion infections. They could be directly transmittable as tuberculosis or brucellosis or indirectly transmittable through vectors as biological fluids or foods from animal production. The increasing production and the globalization of animal food production have caused the spread of zoonosis worldwide turning this topic into a global problem. It is necessary to enforce the actual scientific collaboration between all countries in order to counteract the spread of these pathologies. About this topic WHO, FAO and OIE took part to the world project "one health" highlighting as most important topics the research on Rabies virus, influenza virus and on antibiotic resistance. In particular antibiotic resistance represents one of the most important topics of the last decade due to the inappropriate use of antibiotics, from animal production to human health. This last topic represents a serious problem for health system worldwide. This paper is mainly based on zoonoses such as avian flu, BSE and brucellosis and will describe the strategies used to limit their expansion.

Representing motion in a static image: constraints and parallels in art, science, and popular culture.

PubMed

Cutting, James E

2002-01-01

Representing motion in a picture is a challenge to artists, scientists, and all other imagemakers. Moreover, it presents a problem that will not go away with electronic and digital media, because often the pedagogical purpose of the representation of motion is more important than the motion itself. All satisfactory solutions evoke motion-for example, dynamic balance (or broken symmetry), stroboscopic sequences, affine shear (or forward lean), and photographic blur-but they also typically sacrifice the accuracy of the motion represented, a solution often unsuitable for science. Vector representations superimposed on static images allow for accuracy, but are not applicable to all situations. Workable solutions are almost certainly case specific and subject to continual evolution through exploration by imagemakers.

Vocal fold hemorrhage associated with coumadin therapy in an opera singer.

PubMed

Neely, J L; Rosen, C

2000-06-01

Vocal fold hemorrhage can represent a disastrous and potentially career ending injury to a singer or professional voice user. The risk factors of vocal fold hemorrhage, including laryngeal trauma, phonotrauma, aspirin and nonsteroidal antiinflammatories, and hormonal imbalances are well known. We present a case of an opera singer who developed recurrent vocal fold hemorrhage associated with coumadin anticoagulation therapy. This case highlights the importance of the risk of vocal fold hemorrhage to professional singers and professional voice users and offers an alternative to long-term coumadin therapy in this select population.

Respiratory infections: pneumonia, lung abscess, and empyema.

PubMed

Puligandla, Pramod S; Laberge, Jean-Martin

2008-02-01

Pneumonia is an important clinical problem that affects children of all ages. Although effectively treated on an outpatient basis in the majority of cases, some children with respiratory infections still require hospitalization. This may be particularly true for patients with immunocompromise, for whom the lung represents the most common site of infection. Furthermore, respiratory infections represent a significant source of morbidity and mortality in this patient population. This article focuses on the clinical presentation, etiology, and treatment of childhood pneumonia, with special consideration given to the immunocompromised child. Two specific complications of pneumonia, lung abscess and empyema, are discussed.

Pandemic influenza A (H1N1) in Saudi Arabia: description of the first one hundred cases.

PubMed

AlMazroa, Mohammad A; Memish, Ziad A; AlWadey, Ali M

2010-01-01

In April 2009, the World Health Organization (WHO) declared pandemic influenza A (H1N1) "public health emergency of international concern". On June 11, 2009, WHO raised the pandemic alert level to phase 6, indicating a global pandemic. By December 2009, more than 208 countries and territories had reported swine flu cases. The descriptive epidemiology of the first reported 100 cases of this virus in Saudi Arabia are summarized in this report. Data were collected from 1 June to 3 July, 2009 using a predesigned questionnaire. Questionnaires were filled by Field Epidemiology Training Program residents. Data for the first 100 complete cases of confirmed pandemic influenza A (H1N1) were compiled and analyzed. The age of reported cases was in the range of 1 to 56 years. The highest percentage of cases was in the age group of 20 to 30 years followed by the age group of 1 to 10 years. Females represented 55% of the cases; imported cases represented 47%, 58% of whom had come via the King Khaled Airport. The most common nationalities most were from Saudi Arabia and the Philippines. The main symptoms were fever (56%), cough (54%), and sore throat and the number of cases was seen to peak from the 27 to 29 June. Pandemic influenza A (H1N1) is still a threat to Saudi Arabia. Thus, comprehensive and effective measures for surveillance and prevention of the disease are needed to control its spread.

Liver pathology in Malawian children with fatal encephalopathy

PubMed Central

Whitten, Richard; Milner, Danny A.; Yeh, Matthew M.; Kamiza, Steve; Molyneux, Malcolm E.; Taylor, Terrie E.

2010-01-01

A common clinical presentation of Plasmodium falciparum is parasitemia complicated by an encephalopathy for which other explanations cannot be found, termed cerebral malaria—an important cause of death in young children in endemic areas. Our objective was to study hepatic histopathology in Malawian children with fatal encephalopathy, with and without P falciparum parasitaemia, in order to assess the contributions of severe malaria. We report autopsy results from a series of 87 Malawian children who died between 1996 and 2008. Among 75 cases with P falciparum parasitaemia, 51 had intracerebral sequestered parasites, while 24 without sequestered parasites had other causes of death revealed by autopsy including 4 patients with clinicopathological findings which may represent Reye’s Syndrome. Hepatic histology in parasitaemic cases revealed very limited sequestration of parasites in hepatic sinusoids, even in cases with extensive sequestration elsewhere, but increased numbers of hemozoin-laden Kupffer cells were invariably present with a strong association with histological evidence of cerebral malaria by quantitative analysis. Of 12 patients who were consistently aparasitaemic during their fatal illness, 5 had clinicopathological findings which may represent Reye’s Syndrome. Hepatic sequestration of parasitized erythrocytes is not a feature of fatal malaria in Malawian children, and there is no structural damage in the liver. Reye’s syndrome may be an important cause of fatal encephalopathy in children in Malawi with and without peripheral parasitemia and warrants close scrutiny of aspirin use in malaria endemic areas. PMID:21396681

Influence of Flow Sequencing Attributed to Climate Change and Climate Variability on the Assessment of Water-dependent Ecosystem Outcomes

NASA Astrophysics Data System (ADS)

Wang, J.; Nathan, R.; Horne, A.

2017-12-01

Traditional approaches to characterize water-dependent ecosystem outcomes in response to flow have been based on time-averaged hydrological indicators, however there is increasing recognition for the need to characterize ecological processes that are highly dependent on the sequencing of flow conditions (i.e. floods and droughts). This study considers the representation of flow regimes when considering assessment of ecological outcomes, and in particular, the need to account for sequencing and variability of flow. We conducted two case studies - one in the largely unregulated Ovens River catchment and one in the highly regulated Murray River catchment (both located in south-eastern Australia) - to explore the importance of flow sequencing to the condition of a typical long-lived ecological asset in Australia, the River Red Gum forests. In the first, the Ovens River case study, the implications of representing climate change using different downscaling methods (annual scaling, monthly scaling, quantile mapping, and weather generator method) on the sequencing of flows and resulting ecological outcomes were considered. In the second, the Murray River catchment, sequencing within a historic drought period was considered by systematically making modest adjustments on an annual basis to the hydrological records. In both cases, the condition of River Red Gum forests was assessed using an ecological model that incorporates transitions between ecological conditions in response to sequences of required flow components. The results of both studies show the importance of considering how hydrological alterations are represented when assessing ecological outcomes. The Ovens case study showed that there is significant variation in the predicted ecological outcomes when different downscaling techniques are applied. Similarly, the analysis in the Murray case study showed that the drought as it historically occurred provided one of the best possible outcomes for River Red Gum forests when compared to other re-arrangements of flow within the same drought. These results have implications for the way we represent climate change impacts and drought risk assessments where ecological outcomes are a key management objective.

"Let's Be Honest Most People in the Sporting Industry Are Still Males": The Importance of Socio-Cultural Context for Female Graduates

ERIC Educational Resources Information Center

Leberman, Sarah; Shaw, Sally

2015-01-01

The business case for diversity is increasingly being recognised. However, worldwide women are still under-represented at the executive level. The notions of employability and career adaptability are examined in the context of female sport management graduates, to better understand why they are not attaining leadership positions in New Zealand…

Professional and Personal Factors Associated with Gerontological Practice: Implications for Training and Education

ERIC Educational Resources Information Center

Black, Kathy

2011-01-01

Professional practice with older adults is performed in a variety of settings and across a broad range of areas. Planning for care throughout the end of life represents an increasingly important aspect of work with older adults as a result of the nation's aging demographic and concomitant health care needs. Community-based geriatric case managers…

The Bologna Process and the Economic Impacts of Research and Development within the Context of Europeanization: The Case of Finland

ERIC Educational Resources Information Center

Habti, Driss

2010-01-01

Higher education and public research play an important role in economic development, mainly in industrial research and development (R & D) and innovation through the manufacturing sector. Finland has taken great strides in this regard as it represents a Europeanization of a knowledge system in the European Union, being relevant at the…

Screening Cereals Quality by Electronic Nose: the Example of Mycotoxins Naturally Contaminated Maize and Durum Wheat

NASA Astrophysics Data System (ADS)

Campagnoli, Anna; Dell'Orto, Vittorio; Savoini, Giovanni; Cheli, Federica

2009-05-01

Mycotoxins represent an heterogeneous group of toxic compounds from fungi metabolism. Due to the frequent occurrence of mycotoxins in cereals commodities the develop of cost/effective screening methods represent an important topic to ensure food and feed safety. In the presented study a commercial electronic nose constituted by ten MOS (Metal Oxide Sensors) was applied to verify the possibility of discriminating between mycotoxins contaminated and non-contaminated cereals. The described analytical approach was able to discriminate contaminated and non-contaminated samples both in the case of aflatoxins infected maize and deoxynivalenol infected durum wheat samples. In the case of maize data two sensors from the array revealed a partial relation with the level of aflatoxins. These results could be promising for a further improvement of electronic nose application in order to develop a semi-quantitative screening approach to mycotoxins contamination.

On knowledge transfer management as a learning process for ad hoc teams

NASA Astrophysics Data System (ADS)

Iliescu, D.

2017-08-01

Knowledge management represents an emerging domain becoming more and more important. Concepts like knowledge codification and personalisation, knowledge life-cycle, social and technological dimensions, knowledge transfer and learning management are integral parts. Focus goes here in the process of knowledge transfer for the case of ad hoc teams. The social dimension of knowledge transfer plays an important role. No single individual actors involved in the process, but a collective one, representing the organisation. It is critically important for knowledge to be managed from the life-cycle point of view. A complex communication network needs to be in place to supports the process of knowledge transfer. Two particular concepts, the bridge tie and transactive memory, would eventually enhance the communication. The paper focuses on an informational communication platform supporting the collaborative work on knowledge transfer. The platform facilitates the creation of a topic language to be used in knowledge modelling, storage and reuse, by the ad hoc teams.

Fatal lightning strikes in Malaysia.

PubMed

Murty, O P; Kian, Chong Kah; Ari Husin, Mohammed Husrul; Nanta Kumar, Ranjeev Kumar; Mohammed Yusuf, Wan Yuhana W

2009-09-01

Lightning strike is a natural phenomenon with potentially devastating effects and represents one of the important causes of deaths from environmental phenomena. Almost every organ system may be affected as lightning current passes through the human body taking the shortest pathways between the contact points. A 10 years retrospective study (1996-2005) was conducted at University Hospital Kuala Lumpur (20 cases) also including cases during last 3 years from Hospital Tengku Ampuan Rahimah, Klang (7 cases) from the autopsy reports at Forensic Pathology Units of these 2 hospitals. Both these hospitals are attached to University of Malaya. There were 27 fatal cases of lightning strike with male preponderance(92.59%) and male to female ratio of 12.5:1. Majority of victims of lightning strike were from the age group between 30 and 39 years old. Most of the victims were foreign workers. Indonesians workers contributed to 59.26% of overall cases. Majority of them were construction workers who attributed i.e.11 of 27 cases (40.74%). Most of the victims were brought in dead (37.04%). In majority of the cases the lightning incidence occurred in the evenings, with the frequency of 15 of 27 cases (62.5%). The month of December represented with the highest number of cases (5 cases of 23 cases); 2004 had the highest incidence of lightning strike which was 5 (19.23%). Lightning strike incidence occurred when victims had taken shelter (25.9%) under trees or shades. Lightning strike in open areas occurred in 10 of 27 cases (37.0%). Head and neck were the most commonly affected sites with the incidence of 77.78% and 74% respectively in all the victims. Only 29.63% of the cases presented with ear bleeding.

Determination Plastic Properties of a Material by Spherical Indentation Base on the Representative Stress Approach

NASA Astrophysics Data System (ADS)

Budiarsa, I. N.; Gde Antara, I. N.; Dharma, Agus; Karnata, I. N.

2018-04-01

Under an indentation, the material undergoes a complex deformation. One of the most effective ways to analyse indentation has been the representative method. The concept coupled with finite element (FE) modelling has been used successfully in analysing sharp indenters. It is of great importance to extend this method to spherical indentation and associated hardness system. One particular case is the Rockwell B test, where the hardness is determined by two points on the P-h curve of a spherical indenter. In this case, an established link between materials parameters and P-h curves can naturally lead to direct hardness estimation from the materials parameters (e.g. yield stress (y) and work hardening coefficients (n)). This could provide a useful tool for both research and industrial applications. Two method to predict p-h curve in spherical indentation has been established. One is use method using C1-C2 polynomial equation approach and another one by depth approach. Both approach has been successfully. An effective method in representing the P-h curves using a normalized representative stress concept was established. The concept and methodology developed is used to predict hardness (HRB) values of materials through direct analysis and validated with experimental data on selected samples of steel.

Status of steam generator tubing integrity at Jaslovske Bohunice NPP

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

Cepcek, S.

1997-02-01

Steam generator represents one of the most important component of nuclear power plants. Especially, loss of tubing integrity of steam generators can lead to the primary coolant leak to secondary circuit and in worse cases to the unit shut down or to the PTS events occurrence. Therefore, to ensure the steam generator tubing integrity and the current knowledge about tube degradation propagation and development is of the highest importance. In this paper the present status of steam generator tubing integrity in operated NPP in Slovak Republic is presented.

Intestinal obstruction caused by omphalomesenteric duct remnant: usefulness of laparoscopy.

PubMed

Bueno Lledó, J; Serralta Serra, A; Planeéis Roig, M; Dobón Giménez, F; Ibáñez Palacín, F; Rodero Rodero, R

2003-10-01

The anomalies related to omphalomesenteric duct remnant constitute an uncommon cause of intestinal obstruction, of which Meckel"s diverticulum and its variants represent the most important clinical presentation. In most cases they are asymptomatic and usually affect young patients. When symptomatic, they usually present episodes of gastrointestinal bleeding or acute abdomen syndromes caused by strangulation of intestinal loops as a result of fibrous intraabdominal remnants or inflammation produced by the diverticulum. In most cases, the unexpected presence of these alterations makes intraoperative diagnosis necessary. Treatment is surgical and consists in exeresis of the diverticulum or the fibrous band causing the clinical picture. We report two cases of persistence of the vitelline duct resolved by laparoscopic approach.

Hemophagocytic lymphohistiocytosis secondary to T-cell/histiocyte-rich large B-cell lymphoma

PubMed Central

Devitt, Katherine; Cerny, Jan; Switzer, Bradley; Ramanathan, Muthalagu; Nath, Rajneesh; Yu, Hongbo; Woda, Bruce A.; Chen, Benjamin J.

2014-01-01

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening clinical syndrome characterized by dysregulation of the immune system. Impaired function of cytotoxic T cells and natural killer cells is often seen, and T-cell malignancies represent most cases of lymphoma-associated HLH. HLH associated with B-cell lymphoma is rare. We describe a case of a 30-year-old man who presented with fever, splenomegaly, and hyperferritinemia. Bone marrow biopsy revealed T-cell/histiocyte-rich large B-cell lymphoma, a rare, aggressive B-cell malignancy. This case highlights the interplay between a pro-inflammatory cytokine microenvironment and tumor-mediated immune suppression, and addresses the importance of accurately diagnosing these entities for appropriate clinical management. PMID:24955327

Hemophagocytic lymphohistiocytosis secondary to T-cell/histiocyte-rich large B-cell lymphoma.

PubMed

Devitt, Katherine; Cerny, Jan; Switzer, Bradley; Ramanathan, Muthalagu; Nath, Rajneesh; Yu, Hongbo; Woda, Bruce A; Chen, Benjamin J

2014-01-01

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening clinical syndrome characterized by dysregulation of the immune system. Impaired function of cytotoxic T cells and natural killer cells is often seen, and T-cell malignancies represent most cases of lymphoma-associated HLH. HLH associated with B-cell lymphoma is rare. We describe a case of a 30-year-old man who presented with fever, splenomegaly, and hyperferritinemia. Bone marrow biopsy revealed T-cell/histiocyte-rich large B-cell lymphoma, a rare, aggressive B-cell malignancy. This case highlights the interplay between a pro-inflammatory cytokine microenvironment and tumor-mediated immune suppression, and addresses the importance of accurately diagnosing these entities for appropriate clinical management.

Cervicothoracic epidural hematoma in a toddler with miosis, ptosis, nonspecific symptoms, and no history of major trauma: case report.

PubMed

Root, Brandon K; Schartz, Derrek A; Calnan, Dan R; Hickey, William F; Bauer, David F

2018-06-01

Spinal epidural hematomas are uncommon in children. The diagnosis can be elusive as most cases present without a history of trauma, while symptoms can be atypical. We encountered a 35-month-old male presenting with nonspecific symptoms and no history of trauma. He later developed unilateral miosis and ptosis; MRI discovered a subacute cervicothoracic epidural which was promptly evacuated. The patient made an excellent recovery. We emphasize the frequent absence of identifiable trauma and the importance of thorough imaging when this entity is suspected. Miosis and ptosis, likely representing a partial Horner syndrome, is an extremely rare presentation, this being one of the only reported cases.

Aseptic meningitis and viral myelitis.

PubMed

Irani, David N

2008-08-01

Meningitis and myelitis represent common and very infrequent viral infections of the central nervous system, respectively. The number of cases of viral meningitis that occurs annually exceeds the total number of meningitis cases caused by all other etiologies combined. Focal central nervous system infections, such as occur in the spinal cord with viral myelitis, are much less common and may be confused with noninfectious disorders that cause acute flaccid paralysis. This article reviews some of the important clinical features, epidemiology, diagnostic approaches, and management strategies for patients with aseptic meningitis and viral myelitis. Particular focus is placed on the diseases caused by enteroviruses, which as a group account for most aseptic meningitis cases and many focal infections of the spinal cord.

Rabies surveillance in the United States during 2010

PubMed Central

Blanton, Jesse D.; Palmer, Dustyn; Dyer, Jessie; Rupprecht, Charles E.

2016-01-01

Summary During 2010, 48 states and Puerto Rico reported 6,154 rabid animals and 2 human rabies cases to the CDC, representing an 8% decrease from the 6,690 rabid animals and 4 human cases reported in 2009. Hawaii and Mississippi did not report any laboratory-confirmed rabid animals during 2010. Approximately 92% of reported rabid animals were wildlife. Relative contributions by the major animal groups were as follows: 2,246 raccoons (36.5%), 1,448 skunks (23.5%), 1,430 bats (23.2%), 429 foxes (6.9%), 303 cats (4.9%), 71 cattle (1.1%), and 69 dogs (1.1%). Compared with 2009, number of reported rabid animals decreased across all animal types with the exception of a 1% increase in the number of reported rabid cats. Two cases of rabies involving humans were reported from Louisiana and Wisconsin in 2010. Louisiana reported an imported human rabies case involving a 19-year-old male migrant farm worker who had a history of a vampire bat (Desmodus rotundus) bite received while in Mexico. This represents the first human rabies case reported in the United States confirmed to have been caused by a vampire bat rabies virus variant. Wisconsin reported a human rabies case involving a 70-year-old male that was confirmed to have been caused by a rabies virus variant associated with tri-colored bats (Perimyotis subflavus). PMID:21916759

Rabies surveillance in the United States during 2010.

PubMed

Blanton, Jesse D; Palmer, Dustyn; Dyer, Jessie; Rupprecht, Charles E

2011-09-15

During 2010, 48 states and Puerto Rico reported 6,154 rabid animals and 2 human rabies cases to the CDC, representing an 8% decrease from the 6,690 rabid animals and 4 human cases reported in 2009. Hawaii and Mississippi did not report any laboratory-confirmed rabid animals during 2010. Approximately 92% of reported rabid animals were wildlife. Relative contributions by the major animal groups were as follows: 2,246 raccoons (36.5%), 1,448 skunks (23.5%), 1,430 bats (23.2%), 429 foxes (6.9%), 303 cats (4.9%), 71 cattle (1.1 %), and 69 dogs (1.1 %). Compared with 2009, number of reported rabid animals decreased across all animal types with the exception of a 1 % increase in the number of reported rabid cats. Two cases of rabies involving humans were reported from Louisiana and Wisconsin in 2010. Louisiana reported an imported human rabies case involving a 19-year-old male migrant farm worker who had a history of a vampire bat (Desmodus rotundus) bite received while in Mexico. This represents the first human rabies case reported in the United States confirmed to have been caused by a vampire bat rabies virus variant. Wisconsin reported a human rabies case involving a 70-year-old male that was confirmed to have been caused by a rabies virus variant associated with tri-colored bats (Perimyotis subflavus).

Diego Rivera's fresco and the case taken from Morgagni's De sedibus.

PubMed

Zampieri, Fabio; Zanatta, Alberto; Scattolin, Giuliano; Stramare, Roberto; Thiene, Gaetano

2013-09-01

The fresco by Diego Rivera (1886 to 1957) on the history of cardiology was displayed at the "Instituto Nacional de Cardiología" of Mexico City at the time of inauguration on April 14, 1944. Some of the most important masters of the Padua Medical School were depicted, namely Vesalius, Harvey, and Morgagni. There is a vivid description of the anatomoclinical method introduced by Giovanni Battista Morgagni (1682 to 1771), when he was professor of Theoretical Medicine first and then of Anatomy at the University of Padua (1711 to 1771). By reading Morgagni's De sedibus, we found the case of aortic syphilitic aneurysm that corresponds perfectly with the one represented in Diego Rivera's mural. In the Museum of Pathological Anatomy of the Padua University, an anatomical specimen that displays the same lesion is preserved, and we have performed a computed tomography scan to analyze the state of the heart and aneurysm, thus finding diffuse calcific deposits of aorta and pericardium. In conclusion, in Diego Rivera's fresco the clinicopathologic method of Morgagni is well represented and the case of syphilitic aneurysm, reported by Morgagni in his De sedibus, depicted.

46 CFR 6.01 - Procedures for effecting individual waivers of navigation and vessel inspection laws and...

Code of Federal Regulations, 2011 CFR

2011-10-01

... the designated representative of the Commandant, as the case may be) reaches the conclusion referred... representative at the port or place where the vessel is located. In the case of a vessel in any foreign port or... representative or the designated representative of the Commandant, as the case may be) shall promptly examine...

Brown-McLean Syndrome in a Pediatric Patient

PubMed Central

Tourkmani, Abdo Karim; Martinez, Jaime D.; Berrones, David; Juárez-Domínguez, Brenda Y.; Beltrán, Francisco; Galor, Anat

2015-01-01

The purpose of this manuscript is to report the case of a 12-year-old patient who presented for routine ophthalmic examination after congenital cataract surgery performed at 2 months of age. The patient was diagnosed with bilateral Brown-McLean syndrome by slit lamp examination. No treatment was required because the patient was asymptomatic and had a clear central cornea. This is the first described case of Brown-McLean syndrome in a pediatric patient, representing the importance of clinical examination in the pediatric age group after cataract surgery because of the risk for patients of developing peripheral edema. PMID:26034485

Misclassification of men with reported HIV infection in Ukraine.

PubMed

Čakalo, Jurja-Ivana; Božičević, Ivana; Vitek, Charles; Mandel, Jeffrey S; Salyuk, Tetyana; Rutherford, George W

2015-10-01

We analyzed data on reported mode of transmission in case reports of HIV-infections among men in Ukraine. The number of men who were reported to have acquired HIV through heterosexual transmission increased substantially in 2006-2011. However, we estimate that up to 40 % of reported cases of heterosexual transmission among men may actually represent misclassified men who have sex with men or persons who inject drugs. These findings indicate a need to improve the quality of data on reported mode of HIV transmission. Accurate information has important public health implications in planning prevention and treatment services.

Brown-McLean Syndrome in a Pediatric Patient.

PubMed

Tourkmani, Abdo Karim; Martinez, Jaime D; Berrones, David; Juárez-Domínguez, Brenda Y; Beltrán, Francisco; Galor, Anat

2015-01-01

The purpose of this manuscript is to report the case of a 12-year-old patient who presented for routine ophthalmic examination after congenital cataract surgery performed at 2 months of age. The patient was diagnosed with bilateral Brown-McLean syndrome by slit lamp examination. No treatment was required because the patient was asymptomatic and had a clear central cornea. This is the first described case of Brown-McLean syndrome in a pediatric patient, representing the importance of clinical examination in the pediatric age group after cataract surgery because of the risk for patients of developing peripheral edema.

[Female incontinence surgery: state of the art].

PubMed

Marson, Francesco; Ammirati, Enrico; Gurioli, Alberto; Destefanis, Paolo; Gontero, Paolo; Frea, Bruno

2015-01-01

Female urinary incontinence represents a medical and social problem with huge impact regarding both patient's quality of life and social costs. The diagnosis is important for therapeutic choice and should consider some factors: the degree of urethral mobility, urodynamics parameters, patient's will and expectations, information about surgical complications and risks. Nowadays suburethral sling evolution and bulking therapy for selected cases consent to perform miniinvasive surgery; the most relevant problem concerns the management of postoperative complications: in this sense autologous slings are used after urethrolisis. In most difficult cases, it is possible to consider artificial sphincter as the best option.

Oral ulcers produced by mycophenolate mofetil in two liver transplant patients.

PubMed

Naranjo, J; Poniachik, J; Cisco, D; Contreras, J; Oksenberg, D; Valera, J M; Díaz, J C; Rojas, J; Cardemil, G; Mena, S; Castillo, J; Rencoret, G; Godoy, J; Escobar, J; Rodríguez, J; Leyton, P; Fica, A; Toledo, C

2007-04-01

Oral ulcers are a frequent problem in transplant medicine. It is important to consider infectious etiologies, exacerbated by the immunosuppressive treatment, but other etiologies are also possible, like adverse drug reactions. Mycophenolate mofetil (MMF) is an immunosuppressive medication that has been used in combination with calcineurin inhibitors and steroids. Reports of renal transplant patients with oral ulcers related to MMF have appeared lately and herein we have described 2 cases in liver transplant patients. Their oral ulcers resolved quickly after suspension of the medication. Our 2 cases in liver transplant patients represented a unique setting for this type of complication.

Afghanistan: Reconstituting a Collapsed State

DTIC Science & Technology

2005-04-01

tool in Afghanistan’s deeply religious culture. Persuading the EU to relax its Common Agricultural Policy to accept Afghan agricultural products...Afghanistan, representing 95 percent of its heroin consumption, it is in the EU’s best interests to relax some provisions of its Common Agricultural ... Policy (CAP), permitting Afghan agricultural products into the EU.45 In this case, the EU could collaborate with Afghanistan 10 to import a high

iHelp: an intelligent online helpdesk system.

PubMed

Wang, Dingding; Li, Tao; Zhu, Shenghuo; Gong, Yihong

2011-02-01

Due to the importance of high-quality customer service, many companies use intelligent helpdesk systems (e.g., case-based systems) to improve customer service quality. However, these systems face two challenges: 1) Case retrieval measures: most case-based systems use traditional keyword-matching-based ranking schemes for case retrieval and have difficulty to capture the semantic meanings of cases and 2) result representation: most case-based systems return a list of past cases ranked by their relevance to a new request, and customers have to go through the list and examine the cases one by one to identify their desired cases. To address these challenges, we develop iHelp, an intelligent online helpdesk system, to automatically find problem-solution patterns from the past customer-representative interactions. When a new customer request arrives, iHelp searches and ranks the past cases based on their semantic relevance to the request, groups the relevant cases into different clusters using a mixture language model and symmetric matrix factorization, and summarizes each case cluster to generate recommended solutions. Case and user studies have been conducted to show the full functionality and the effectiveness of iHelp.

Adaptive Importance Sampling for Control and Inference

NASA Astrophysics Data System (ADS)

Kappen, H. J.; Ruiz, H. C.

2016-03-01

Path integral (PI) control problems are a restricted class of non-linear control problems that can be solved formally as a Feynman-Kac PI and can be estimated using Monte Carlo sampling. In this contribution we review PI control theory in the finite horizon case. We subsequently focus on the problem how to compute and represent control solutions. We review the most commonly used methods in robotics and control. Within the PI theory, the question of how to compute becomes the question of importance sampling. Efficient importance samplers are state feedback controllers and the use of these requires an efficient representation. Learning and representing effective state-feedback controllers for non-linear stochastic control problems is a very challenging, and largely unsolved, problem. We show how to learn and represent such controllers using ideas from the cross entropy method. We derive a gradient descent method that allows to learn feed-back controllers using an arbitrary parametrisation. We refer to this method as the path integral cross entropy method or PICE. We illustrate this method for some simple examples. The PI control methods can be used to estimate the posterior distribution in latent state models. In neuroscience these problems arise when estimating connectivity from neural recording data using EM. We demonstrate the PI control method as an accurate alternative to particle filtering.

The effect of stereochemistry on the biological activity of natural phytotoxins, fungicides, insecticides and herbicides.

PubMed

Evidente, Antonio; Cimmino, Alessio; Andolfi, Anna

2013-02-01

Phytotoxins are secondary microbial metabolites that play an essential role in the development of disease symptoms induced by fungi on host plants. Although phytotoxins can cause extensive-and in some cases devastating-damage to agricultural crops, they can also represent an important tool to develop natural herbicides when produced by fungi and plants to inhibit the growth and spread of weeds. An alternative strategy to biologically control parasitic plants is based on the use of plant and fungal metabolites, which stimulate seed germination in the absence of the host plant. Nontoxigenic fungi also produce bioactive metabolites with potential fungicide and insecticide activity, and could be applied for crop protection. All these metabolites represent important tools to develop eco-friendly pesticides. This review deals with the relationships between the biological activity of some phytotoxins, seed germination stimulants, fungicides and insecticides, and their stereochemistry. Copyright © 2012 Wiley Periodicals, Inc.

Warfarin monitoring in nursing homes assessed by case histories. Do recommendations and electronic alerts affect judgements?

PubMed

Teruel, Reyes Serrano; Thue, Geir; Fylkesnes, Svein Ivar; Sandberg, Sverre; Kristoffersen, Ann Helen

2017-09-01

Older adults treated with warfarin are prone to complications, and high-quality monitoring is essential. The aim of this case history based study was to assess the quality of warfarin monitoring in a routine situation, and in a situation with an antibiotic-warfarin interaction, before and after receiving an electronic alert. In April 2014, a national web-based survey with two case histories was distributed among Norwegian nursing home physicians and general practitioners working part-time in nursing homes. Case A represented a patient on stable warfarin treatment, but with a substantial INR increase within the therapeutic interval. Case B represented a more challenging patient with trimethoprim sulfamethoxazole (TMS) treatment due to pyelonephritis. In both cases, the physicians were asked to state the next warfarin dose and the INR recall interval. In case B, the physicians could change their suggestions after receiving an electronic alert on the TMS-warfarin interaction. Three hundred and ninety eight physicians in 292 nursing homes responded. Suggested INR recall intervals and warfarin doses varied substantially in both cases. In case A, 61% gave acceptable answers according to published recommendations, while only 9% did so for case B. Regarding the TMS-warfarin interaction in case history B, the electronic alert increased the percentage of respondents correctly suggesting a dose reduction from 29% to 53%. Having an INR instrument in the nursing home was associated with shortened INR recall times. Practical advice on handling of warfarin treatment and drug interactions is needed. Electronic alerts as presented in electronic medical records seem insufficient to change practice. Availability of INR instruments may be important regarding recall time.

Reliability of clinical impact grading by healthcare professionals of common prescribing error and optimisation cases in critical care patients.

PubMed

Bourne, Richard S; Shulman, Rob; Tomlin, Mark; Borthwick, Mark; Berry, Will; Mills, Gary H

2017-04-01

To identify between and within profession-rater reliability of clinical impact grading for common critical care prescribing error and optimisation cases. To identify representative clinical impact grades for each individual case. Electronic questionnaire. 5 UK NHS Trusts. 30 Critical care healthcare professionals (doctors, pharmacists and nurses). Participants graded severity of clinical impact (5-point categorical scale) of 50 error and 55 optimisation cases. Case between and within profession-rater reliability and modal clinical impact grading. Between and within profession rater reliability analysis used linear mixed model and intraclass correlation, respectively. The majority of error and optimisation cases (both 76%) had a modal clinical severity grade of moderate or higher. Error cases: doctors graded clinical impact significantly lower than pharmacists (-0.25; P < 0.001) and nurses (-0.53; P < 0.001), with nurses significantly higher than pharmacists (0.28; P < 0.001). Optimisation cases: doctors graded clinical impact significantly lower than nurses and pharmacists (-0.39 and -0.5; P < 0.001, respectively). Within profession reliability grading was excellent for pharmacists (0.88 and 0.89; P < 0.001) and doctors (0.79 and 0.83; P < 0.001) but only fair to good for nurses (0.43 and 0.74; P < 0.001), for optimisation and error cases, respectively. Representative clinical impact grades for over 100 common prescribing error and optimisation cases are reported for potential clinical practice and research application. The between professional variability highlights the importance of multidisciplinary perspectives in assessment of medication error and optimisation cases in clinical practice and research. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Comparison of SNOMED CT versus Medcin Terminology Concept Coverage for Mild Traumatic Brain Injury

PubMed Central

Montella, Diane; Brown, Steven H.; Elkin, Peter L.; Jackson, James C.; Rosenbloom, S. Trent; Wahner-Roedler, Dietlind; Welsh, Gail; Cotton, Bryan; Guillamondegui, Oscar D.; Lew, Henry; Taber, Katherine H.; Tupler, Larry A.; Vanderploeg, Rodney; Speroff, Theodore

2011-01-01

Background: Traumatic Brain Injury (TBI) is a “signature” injury of the current wars in Iraq and Afghanistan. Structured electronic data regarding TBI findings is important for research, population health and other secondary uses but requires appropriate underlying standard terminologies to ensure interoperability and reuse. Currently the U.S. Department of Veterans Affairs (VA) uses the terminology SNOMED CT and the Department of Defense (DOD) uses Medcin. Methods: We developed a comprehensive case definition of mild TBI composed of 68 clinical terms. Using automated and manual techniques, we evaluated how well the mild TBI case definition terms could be represented by SNOMED CT and Medcin, and compared the results. We performed additional analysis stratified by whether the concepts were rated by a TBI expert panel as having High, Medium, or Low importance to the definition of mild TBI. Results: SNOMED CT sensitivity (recall) was 90% overall for coverage of mild TBI concepts, and Medcin sensitivity was 49%, p < 0.001 (using McNemar’s chi square). Positive predictive value (precision) for each was 100%. SNOMED CT outperformed Medcin for concept coverage independent of import rating by our TBI experts. Discussion: SNOMED CT was significantly better able to represent mild TBI concepts than Medcin. This finding may inform data gathering, management and sharing, and data exchange strategies between the VA and DOD for active duty soldiers and veterans with mild TBI. Since mild TBI is an important condition in the civilian population as well, the current study results may be useful also for the general medical setting. PMID:22195156

Control means for a gas turbine engine

NASA Technical Reports Server (NTRS)

Beitler, R. S.; Sellers, F. J.; Bennett, G. W. (Inventor)

1982-01-01

A means is provided for developing a signal representative of the actual compressor casing temperature, a second signal representative of compressor inlet gas temperature, and a third signal representative of compressor speed. Another means is provided for receiving the gas temperature and compressor speed signals and developing a schedule output signal which is a representative of a reference casing temperature at which a predetermined compressor blade stabilized clearance is provided. A means is also provided for comparing the actual compressor casing temperature signal and the reference casing temperature signal and developing a clearance control system representative of the difference. The clearance control signal is coupled to a control valve which controls a flow of air to the compressor casing to control the clearance between the compressor blades and the compressor casing. The clearance control signal can be modified to accommodate transient characteristics. Other embodiments are disclosed.

77 FR 56714 - Agency Information Collection (Statement of Accredited Representative in Appealed Case...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-13

... Representative in Appealed Case, VA Form 646. OMB Control Number: 2900-0042. Type of Review: Extension of a... (Statement of Accredited Representative in Appealed Case) Activities Under OMB Review AGENCY: Board of Veterans' Appeals, Department of Veterans Affairs. ACTION: Notice. SUMMARY: In compliance with the...

Rehabilitation of a patient with amelogenesis imperfecta using porcelain veneers and CAD/CAM polymer restorations: A clinical report.

PubMed

Saeidi Pour, Reza; Edelhoff, Daniel; Prandtner, Otto; Liebermann, Anja

2015-01-01

The complete dental rehabilitation of patients with a vertical dimension loss (VDL) caused by structural enamel deficits associated with amelogenesis imperfecta (AI) represents a difficult challenge for restorative teams. Accurate analysis and treatment planning that includes esthetic and functional evaluations and adequate material selection are important prerequisites for successful results. Long-term provisional restorations play an important role in exploring and elucidating the patients' esthetic demands and functional needs. Restorative treatment options can vary from requiring only oral hygiene instructions to extensive dental restorations that include composite fillings, ceramic veneers, metal-ceramic, or all-ceramic crowns. This case report describes a full-mouth rehabilitation of a patient with amelogenesis imperfecta including the case planning, bite replacement, preparation, and restoration setting steps with an experimental CAD/CAM polymer and porcelain veneers.

Adolescent muscle dysmorphia and family-based treatment: a case report.

PubMed

Murray, Stuart B; Griffiths, Scott

2015-04-01

A growing body of evidence suggests that the prevalence of male body dissatisfaction and muscle dysmorphia is rising. To date, however, there is no published evidence on the efficacy of treatments for muscle dysmorphia. We present the case of a 15-year-old boy who met full diagnostic criteria for muscle dysmorphia, whose symptoms were treated into remission with eating disorder-focused, family-based treatment. The age of this patient fell within the time period in which symptoms of muscle dysmorphia are most likely to develop and this case represents the first published case report of family-based treatment for muscle dysmorphia in this age group. Thus, this case report has important implications for clinicians considering treatment options for presentations of muscle dysmorphia when first presenting in adolescence. Implications for the development of treatment guidelines for muscle dysmorphia and for the diagnostic debate surrounding muscle dysmorphia are also discussed. © The Author(s) 2014.

The use of effective treatments: the case of an adolescent girl with anorexia nervosa in the context of a conversion disorder.

PubMed

Goldstein, Mandy; Madden, Sloane; Peters, Lorna

2013-04-01

The use of empirically supported treatment (EST) has been shown to enhance treatment outcome. The purpose of this case study was to suggest that ESTs further encourage effective reconceptualisation and the ongoing delivery of effective treatment, especially in the case of complex or atypical presentations or response to treatment. This report describes the case of an adolescent girl who underwent Maudsley family-based treatment for anorexia nervosa (AN) for a period of 12 months. Atypical response lead to an understanding of her presentation as representing a primary conversion disorder, within which AN symptoms were conceptualised as another somatic conversion of emotional distress. The report details her clinical presentation and management over the course of her illness. The case offers an important opportunity to explore the central role of the use of ESTs in guiding effective treatment delivery.

Bilateral Breast Metastases from Vulvar Carcinoma: A Case Report and Literature Review

PubMed Central

Kalogerakos, K.; Dimopoulos, Johannes Carl Athanasios; Kalinoglou, N.

2017-01-01

Vulvar carcinoma is a rare disease that accounts for 3–5% of all gynecologic malignancies. Breast represents an unusual site of metastasis and only a few cases are reported. We describe the first case of bilateral metastatic breast carcinoma of vulvar origin, at an 80-year-old female patient. Six months after treatment of her primary disease, she presented with bilateral metastatic squamous cell breast carcinoma. Diagnosis was based on clinical, radiological, and histological facts. Breast although rare is another potential site of metastasis in vulvar cancer and thus mammary gland examination should be considered in the follow-up of these patients. Differential diagnosis between primary and metastatic lesions is of utmost importance for appropriate management. PMID:28487793

Tinea pedis presenting as asymmetric purpuric papules on the sole of the foot: a case report.

PubMed

Chen, Jennifer Yan Fei; Stroz, Marianne J; Adam, David N

2015-01-01

In this report we describe a unique case of tinea pedis. A 29-year-old man presented with a 3-day history of asymptomatic purpuric papules predominantly on his left foot. Potassium hydroxide preparation demonstrated fungal hyphae and culture yielded Trichophyton mentagrophytes. This patient presented unusually with purpuric papules, unlike the three commonly described types of tinea pedis. Given the morphology, positive potassium hydroxide slide preparation, T. mentagrophytes on fungal culture and clinical response to ketoconazole cream, we conclude that this represents a unique variant of tinea pedis. We recognize that even common dermatological diagnoses can have unique presentations, and it is important for clinicians to maintain a broad differential for new dermatologic cases.

Tinea Pedis Presenting as Asymmetric Purpuric Papules on the Sole of the Foot: A Case Report

PubMed Central

Chen, Jennifer Yan Fei; Stroz, Marianne J.; Adam, David N.

2015-01-01

In this report we describe a unique case of tinea pedis. A 29-year-old man presented with a 3-day history of asymptomatic purpuric papules predominantly on his left foot. Potassium hydroxide preparation demonstrated fungal hyphae and culture yielded Trichophyton mentagrophytes. This patient presented unusually with purpuric papules, unlike the three commonly described types of tinea pedis. Given the morphology, positive potassium hydroxide slide preparation, T. mentagrophytes on fungal culture and clinical response to ketoconazole cream, we conclude that this represents a unique variant of tinea pedis. We recognize that even common dermatological diagnoses can have unique presentations, and it is important for clinicians to maintain a broad differential for new dermatologic cases. PMID:25873874

Potential Genetic Risk Factors for Chronic TMD: Genetic Associations from the OPPERA Case Control Study

PubMed Central

Smith, Shad B.; Maixner, Dylan; Greenspan, Joel; Dubner, Ron; Fillingim, Roger; Ohrbach, Richard; Knott, Charles; Slade, Gary; Bair, Eric; Gibson, Dustin G.; Zaykin, Dmitri V.; Weir, Bruce; Maixner, William; Diatchenko, Luda

2011-01-01

Genetic factors play a role in the etiology of persistent pain conditions, putatively by modulating underlying processes such as nociceptive sensitivity, psychological well-being, inflammation, and autonomic response. However, to date, only a few genes have been associated with temporomandibular disorders (TMD). This study evaluated 358 genes involved in pain processes, comparing allelic frequencies between 166 cases with chronic TMD and 1442 controls enrolled in the OPPERA (Orofacial Pain: Prospective Evaluation and Risk Assessment) study cooperative agreement. To enhance statistical power, 182 TMD cases and 170 controls from a similar study were included in the analysis. Genotyping was performed using the Pain Research Panel, an Affymetrix gene chip representing 3295 single nucleotide polymorphisms, including ancestry-informative markers that were used to adjust for population stratification. Adjusted associations between genetic markers and TMD case status were evaluated using logistic regression. The OPPERA findings provided evidence supporting previously-reported associations between TMD and two genes: HTR2A and COMT. Other genes were revealed as potential new genetic risk factors for TMD, including NR3C1, CAMK4, CHRM2, IFRD1, and GRK5. While these findings need to be replicated in independent cohorts, the genes potentially represent important markers of risk for TMD and they identify potential targets for therapeutic intervention. PMID:22074755

Pediatric Old World cutaneous leishmaniasis treated with oral fluconazole: A case series.

PubMed

Michelerio, Andrea; Barruscotti, Stefania; Bossi, Grazia; Brazzelli, Valeria

2018-05-01

Cutaneous leishmaniasis has an incidence of 0.7-1.2 million cases per year and represents a growing concern in the outpatient dermatologic practice in Europe because of imported cases due to increased travel to risk areas and to immigration phenomena. When dealing with children, the treatment can be challenging because of side effects and pain of classic antimonial therapy leading to poor rates of course completion and requirement of sedation for several children. We retrospectively studied three cases of cutaneous leishmaniasis in pediatric patients, between the ages of 3 and 6 years of age, treated with oral fluconazole. We examined the efficacy, the tolerability, the safety profile and the cosmetic result of fluconazole at a dose of 6 mg/kg/daily for 6 weeks. The patients had a complete resolution of their lesions with minimal scarring. No adverse effect was reported. The leishmaniasis species identified were L. major or L. tropica. Considering sides effects and the parents' and the clinician's concern for systemic treatment in the pediatric population, fluconazole represents a valid, safe and easily manageable option for Old World cutaneous leishmaniasis in pediatric outpatients caused by L. major or L. tropica. © 2018 Wiley Periodicals, Inc.

Aspects of renal function in patients with colorectal cancer in a gastroenterology clinic of a county hospital in Western Romania.

PubMed

Velciov, Silvia; Hoinoiu, B; Hoinoiu, Teodora; Popescu, Alina; Gluhovschi, Cristina; Grădinaru, Oana; Popescu, Mădalină; Moţiu, Flavia; Timar, R; Gluhovschi, G H; Sporea, I

2013-01-01

Colorectal cancer represents the third cause of cancer. Since its detection in due time is important resolution, appropriate monitoring is mandatory. The present study deals with the relationship between colorectal cancer and renal function, as well as other associated risk factors. Chronic kidney disease (CKD) represents a risk factor of cancer, both in non-dialysed patients and especially in dialysed patients and in patients with renal transplant. It can get aggravated with cancer in general and particularly with colorectal cancer, partly related to the toxins that cannot be appropriately eliminated because of renal functional disturbances. At the same time, immunosuppressive therapy used for treating glomerular or secondary nephropathies represents an important risk factor of cancer. Some patients with colorectal cancer were found to present also impaired renal function, a fact whose significance is still little known. The object of the present paper is an analysis of the case records of a clinic of gastroenterology on the relationship between colorectal cancer and renal functional impairment. We found in the patients with colorectal cancer under study a glomerular filtration rate (GFR calculated with the EPI formula) of < 60 ml/min/1.73m2 in 31/180 patients, respectively 17.22% of the cases, a value that is similar to that in specialised literature. We also analysed associated risk factors that could be related to renal function impairment in these patients: age, gender, anaemia, diabetes mellitus and hypertension. These could represent, together with the colorectal cancer of the investigated patients, risk factors affecting on the one hand renal function, and on the other hand, potentially increasing the risk of cancer. Correction of these risk factors would have beneficial effects on patients. The relationship between renal functional impairment, respectively CKD, and colorectal cancer is to be regarded from the point of view of complex reciprocity: the impairment of the renal function is a factor of risk of colorectal cancer and colorectal cancer can influence renal function of these patients. This report of reciprocity based on important pathogenic mechanisms also interrelates with factors of risk consecutive to both renal function impairment and colorectal cancer.

HER2-positive male breast cancer: an update

PubMed Central

Ottini, Laura; Capalbo, Carlo; Rizzolo, Piera; Silvestri, Valentina; Bronte, Giuseppe; Rizzo, Sergio; Russo, Antonio

2010-01-01

Although rare, male breast cancer (MBC) remains a substantial cause for morbidity and mortality in men. Based on age frequency distribution, age-specific incidence rate pattern, and prognostic factor profiles, MBC is considered similar to postmenopausal breast cancer (BC). Compared with female BC (FBC), MBC cases are more often hormonal receptor (estrogen receptor/progesterone receptor [ER/PR]) positive and human epidermal growth factor receptor 2 (HER2) negative. Treatment of MBC patients follows the same indications as female postmenopausal with surgery, systemic therapy, and radiotherapy. To date, ER/PR and HER2 status provides baseline predictive information used in selecting optimal adjuvant/neoadjuvant therapy and in the selection of therapy for recurrent or metastatic disease. HER2 represents a very interesting molecular target and a number of compounds (trastuzumab [Herceptin®; F. Hoffmann-La Roche, Basel, Switzerland] and lapatinib [Tykerb®, GlaxoSmithKline, London, UK]) are currently under clinical evaluation. Particularly, trastuzumab, a monoclonal antibody which selectively binds the extracellular domain of HER2, has become an important therapeutic agent for women with HER2-positive (HER2+) BC. Currently, data regarding the use of trastuzumab in MBC patients is limited and only few case reports exist. In all cases, MBC patients received trastuzumab concomitantly with other drugs and no severe toxicity above grade 3 was observed. However, MBC patients that would be candidate for trastuzumab therapy (ie, HER2+/ER+ or HER2+/ER− MBCs) represent only a very small percentage of MBC cases. This is noteworthy, when taking into account that trastuzumab is an important and expensive component of systemic BC therapy. Since there is no data supporting the fact that response to therapy is different for men or women, we concluded that systemic therapy in MBC should be considered on the same basis as for FBC. Particularly in male patients, trastuzumab should be considered exclusively for advanced disease or high-risk HER2+ early BCs. On the other hand, lapatinib (Tykerb), a novel oral dual tyrosine kinase inhibitor that targets both HER2 and epidermal growth factor receptor, may represent an interesting and promising therapeutic agent for trastuzumab-resistant MBC patients. PMID:24367166

Storage and release of organic carbon from glaciers and ice sheets

NASA Astrophysics Data System (ADS)

Hood, Eran; Battin, Tom J.; Fellman, Jason; O'Neel, Shad; Spencer, Robert G. M.

2015-02-01

Polar ice sheets and mountain glaciers, which cover roughly 11% of the Earth's land surface, store organic carbon from local and distant sources and then release it to downstream environments. Climate-driven changes to glacier runoff are expected to be larger than climate impacts on other components of the hydrological cycle, and may represent an important flux of organic carbon. A compilation of published data on dissolved organic carbon from glaciers across five continents reveals that mountain and polar glaciers represent a quantitatively important store of organic carbon. The Antarctic Ice Sheet is the repository of most of the roughly 6 petagrams (Pg) of organic carbon stored in glacier ice, but the annual release of glacier organic carbon is dominated by mountain glaciers in the case of dissolved organic carbon and the Greenland Ice Sheet in the case of particulate organic carbon. Climate change contributes to these fluxes: approximately 13% of the annual flux of glacier dissolved organic carbon is a result of glacier mass loss. These losses are expected to accelerate, leading to a cumulative loss of roughly 15 teragrams (Tg) of glacial dissolved organic carbon by 2050 due to climate change -- equivalent to about half of the annual flux of dissolved organic carbon from the Amazon River. Thus, glaciers constitute a key link between terrestrial and aquatic carbon fluxes, and will be of increasing importance in land-to-ocean fluxes of organic carbon in glacierized regions.

Storage and release of organic carbon from glaciers and ice sheets

USGS Publications Warehouse

Hood, Eran; Battin, Tom J.; Fellman, Jason; O'Neel, Shad; Spencer, Robert G. M.

2015-01-01

Polar ice sheets and mountain glaciers, which cover roughly 11% of the Earth's land surface, store organic carbon from local and distant sources and then release it to downstream environments. Climate-driven changes to glacier runoff are expected to be larger than climate impacts on other components of the hydrological cycle, and may represent an important flux of organic carbon. A compilation of published data on dissolved organic carbon from glaciers across five continents reveals that mountain and polar glaciers represent a quantitatively important store of organic carbon. The Antarctic Ice Sheet is the repository of most of the roughly 6 petagrams (Pg) of organic carbon stored in glacier ice, but the annual release of glacier organic carbon is dominated by mountain glaciers in the case of dissolved organic carbon and the Greenland Ice Sheet in the case of particulate organic carbon. Climate change contributes to these fluxes: approximately 13% of the annual flux of glacier dissolved organic carbon is a result of glacier mass loss. These losses are expected to accelerate, leading to a cumulative loss of roughly 15 teragrams (Tg) of glacial dissolved organic carbon by 2050 due to climate change — equivalent to about half of the annual flux of dissolved organic carbon from the Amazon River. Thus, glaciers constitute a key link between terrestrial and aquatic carbon fluxes, and will be of increasing importance in land-to-ocean fluxes of organic carbon in glacierized regions.

The Human Dimension of Systemic Department-Level Change: A Change Agent's Retrospective on a Case of Reform

ERIC Educational Resources Information Center

Vanasupa, Linda

2011-01-01

This paper represents a narrative of the process of department-level reform through the eyes of the initiating agent of change. Over the course of reform, our program has grown by 40%, primarily through retaining students. We exhibit a 10% net important rate of engineering students in the first two years of the curriculum relative to the college's…

Process Definition and Modeling Guidebook. Version 01.00.02

DTIC Science & Technology

1992-12-01

material (and throughout the guidebook)process defnition is considered to be the act of representing the important characteristics of a process in a...characterized by software standards and guidelines, software inspections and reviews, and more formalized testing (including test plans, test sup- port tools...paper-based approach works well for training, examples, and possibly even small pilot projects and case studies. However, large projects will benefit from

Ethical dilemmas among nurses as they transition to hospital case management: implications for organizational ethics, part I.

PubMed

O'Donnell, Lolita T

2007-01-01

To describe the experiences of ethical concerns by clinical nurses as they transitioned into their new role in hospital case management. Through this study, an attempt was made to explore experiences of ethical concerns and identify the implications for organizational ethics. In this study, nurse case managers practicing in the acute hospital setting, military, not-for-profit community, and teaching hospitals were interviewed. The majority of the nurse case manager participants were engaged in hospital discharge planning and utilization review activities. An interpretive phenomenological approach was used to identify the themes inherent in ethical concerns and articulate them within the context of hospital nurse case management. Fifteen participants were interviewed to obtain a qualitative description of the nurse case managers' lived experiences of ethical dilemmas and how they were resolved. Nurse case managers' perceptions of solutions/options to resolve such ethical dilemmas were explored. As nurses transition into the expanded role of case management in the present healthcare delivery system, they frequently face situations demanding ethical choices and judgments to accommodate diverse patient interests and needs. These ethical decisions required in daily practice in case management represent ethical dilemmas to nurses. The insights derived from the analysis of the interviews have implications for nursing practice, education, policy, ethics, and research; recommendations for organizations employing nurse case managers in terms of recruitment, orientation, training, and continued need for educational support are identified. 1. The clinical decisions required in daily practice of case management represented challenges to the nurses. This highlights the critical role of adequate educational orientation to case management for beginning case managers. 2. Nurse case managers should be cognizant of the "disconnect" that could occur between their obligations to the organizations that employ them and the healthcare needs of the patients that they advocate for. 3. Aside from the importance of linking patient care outcomes with accountability, nurse case managers may need to advocate for policy change and system reform.

Prevalence of resistance to second-line tuberculosis drug among multidrug-resistant tuberculosis patients in Viet Nam, 2011

PubMed Central

Tran, Huong Thi Giang; Bui, Quyen Thi Tu

2016-01-01

Introduction Extensively drug-resistant tuberculosis (XDR-TB) represents an emerging public health problem worldwide. According to the World Health Organization, an estimated 9.7% of multidrug-resistant TB (MDR-TB) cases are defined as XDR-TB globally. The objective of this study was to determine the prevalence of drug resistance to second-line TB drugs among MDR-TB cases detected in the Fourth National Anti-Tuberculosis Drug Resistance Survey in Viet Nam. Methods Eighty clusters of TB cases were selected using a probability-proportion-to-size approach. To identify MDR-TB cases, drug susceptibility testing (DST) was performed for the four major first-line TB drugs. DST of second-line drugs (ofloxacin, amikacin, kanamycin, capreomycin) was performed on isolates from MDR-TB cases to identify pre-XDR and XDR cases. Results A total of 1629 smear-positive TB cases were eligible for culture and DST. Of those, DST results for first-line drugs were available for 1312 cases, and 91 (6.9%) had MDR-TB. Second-line DST results were available for 84 of these cases. Of those, 15 cases (17.9%) had ofloxacin resistance and 6.0% were resistant to kanamycin and capreomycin. Five MDR-TB cases (6.0%) met the criteria of XDR-TB. Conclusion This survey provides the first estimates of the proportion of XDR-TB among MDR-TB cases in Viet Nam and provides important information for local policies regarding second-line DST. Local policies and programmes that are geared towards TB prevention, early diagnosis and treatment with effective regimens are of high importance. PMID:27508089

Prevalence of resistance to second-line tuberculosis drug among multidrug-resistant tuberculosis patients in Viet Nam, 2011.

PubMed

Nguyen, Hoa Binh; Nguyen, Nhung Viet; Tran, Huong Thi Giang; Nguyen, Hai Viet; Bui, Quyen Thi Tu

2016-01-01

Extensively drug-resistant tuberculosis (XDR-TB) represents an emerging public health problem worldwide. According to the World Health Organization, an estimated 9.7% of multidrug-resistant TB (MDR-TB) cases are defined as XDR-TB globally. The objective of this study was to determine the prevalence of drug resistance to second-line TB drugs among MDR-TB cases detected in the Fourth National Anti-Tuberculosis Drug Resistance Survey in Viet Nam. Eighty clusters of TB cases were selected using a probability-proportion-to-size approach. To identify MDR-TB cases, drug susceptibility testing (DST) was performed for the four major first-line TB drugs. DST of second-line drugs (ofloxacin, amikacin, kanamycin, capreomycin) was performed on isolates from MDR-TB cases to identify pre-XDR and XDR cases. A total of 1629 smear-positive TB cases were eligible for culture and DST. Of those, DST results for first-line drugs were available for 1312 cases, and 91 (6.9%) had MDR-TB. Second-line DST results were available for 84 of these cases. Of those, 15 cases (17.9%) had ofloxacin resistance and 6.0% were resistant to kanamycin and capreomycin. Five MDR-TB cases (6.0%) met the criteria of XDR-TB. This survey provides the first estimates of the proportion of XDR-TB among MDR-TB cases in Viet Nam and provides important information for local policies regarding second-line DST. Local policies and programmes that are geared towards TB prevention, early diagnosis and treatment with effective regimens are of high importance.

Importance of electromyography and the electrophysiological severity scale in forensic reports.

PubMed

Bilgin, Nursel Gamsiz; Ozge, Aynur; Mert, Ertan; Yalçinkaya, Deniz E; Kar, Hakan

2007-05-01

Forensic reports on traumatic peripheral nerve injuries include dysfunction degrees of extremities, which are arranged according to the Turkish Penalty Code. The aim of this study is to discuss the role and importance of electromyography while preparing forensic reports in the cases of traumatic peripheral nerve injuries and the usefulness of scoring systems. A modified global scale, recommended by Mondelli et al., was used to assess the electrophysiological impairment of each peripheral nerve. Forensic reports of 106 patients, reported between 2002 and 2004, were evaluated. Thirty-four percent of the cases were reported as "total loss of function," 41.5% were reported as "functional disability," and there were no dysfunctions in the other cases in forensic reports that were prepared based on Council of Social Insurance Regulations of Health Processes and Guide prepared by the Council of Forensic Medicine and profession associations of forensic medicine. When we rearranged these forensic reports based on the electrophysiological severity scale (ESS), it was clearly found that all of the score 2 cases and 86.7% of the score 3 cases corresponded to "functional disability" and 91.4% of the score 4 cases correspond to "total loss of function." We found a significant correlation between the ESS and functional evaluation in peripheral nerve injury cases. Evaluation of functional disabilities in peripheral nerve injuries with the ESS represents a standardized and objective method used for forensic reports.

Outbreaks of paralytic poliomyelitis during 1996-2012: the changing epidemiology of a disease in the final stages of eradication.

PubMed

Mach, Ondrej; Tangermann, Rudolf H; Wassilak, Steve G; Singh, Simarjit; Sutter, Roland W

2014-11-01

Despite substantial progress toward eradication of poliomyelitis, the risk of poliomyelitis outbreaks resulting from virus importations into polio-free areas persists. We reviewed the changing epidemiology of outbreaks in the final stages of the eradication initiative. Available literature on outbreaks of poliomyelitis caused by wild polioviruses between 1996 and 2012 was reviewed. During this period, there were 22 outbreaks involving 39 countries. Outbreaks ranged in size from 1 to 1335 cases. These outbreaks caused 4571 cases, representing 21% of all cases reported during this period. Five outbreaks involved multiple countries. In 76% of outbreaks (16/21) with a known age distribution, cases concentrated among children aged <5 years; in 19% (4/21), most cases were among adolescents and adults. The outbreaks among adolescents and adults were associated with higher case-fatality ratios, ranging from 12% in Albania in 1994 to 41% in the Republic of Congo in 2010. The majority of outbreaks were controlled within 6 months with oral poliovirus vaccine. Importations resulting in epidemic transmission of wild poliovirus caused thousands of cases of paralysis often in countries where poliomyelitis had not occurred for many years. The changing epidemiology, with cases and higher case-fatality ratios among adults, increased the severity of these outbreaks. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Grey literature in systematic reviews: a cross-sectional study of the contribution of non-English reports, unpublished studies and dissertations to the results of meta-analyses in child-relevant reviews.

PubMed

Hartling, Lisa; Featherstone, Robin; Nuspl, Megan; Shave, Kassi; Dryden, Donna M; Vandermeer, Ben

2017-04-19

Systematic reviews (SRs) are an important source of information about healthcare interventions. A key component of a well-conducted SR is a comprehensive literature search. There is limited evidence on the contribution of non-English reports, unpublished studies, and dissertations and their impact on results of meta-analyses. Our sample included SRs from three Cochrane Review Groups: Acute Respiratory Infections (ARI), Infectious Diseases (ID), Developmental Psychosocial and Learning Problems (DPLP) (n = 129). Outcomes included: 1) proportion of reviews that searched for and included each study type; 2) proportion of relevant studies represented by each study type; and 3) impact on results and conclusions of the primary meta-analysis for each study type. Most SRs searched for non-English studies; however, these were included in only 12% of reviews and represented less than 5% of included studies. There was a change in results in only four reviews (total sample = 129); in two cases the change did not have an impact on the statistical or clinical significance of results. Most SRs searched for unpublished studies but the majority did not include these (only 6%) and they represented 2% of included studies. In most cases the impact of including unpublished studies was small; a substantial impact was observed in one case that relied solely on unpublished data. Few reviews in ARI (9%) and ID (3%) searched for dissertations compared to 65% in DPLP. Overall, dissertations were included in only nine SRs and represented less than 2% of included studies. In the majority of cases the change in results was negligible or small; in the case where a large change was noted, the estimate was more conservative without dissertations. The majority of SRs searched for non-English and unpublished studies; however, these represented a small proportion of included studies and rarely impacted the results and conclusions of the review. Inclusion of these study types may have an impact in situations where there are few relevant studies, or where there are questionable vested interests in the published literature. We found substantial variation in whether SRs searched for dissertations; in most reviews that included dissertations, these had little impact on results.

U.S. Commercial Spent Nuclear Fuel Assembly Characteristics - 1968-2013

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

Hu, Jianwei; Peterson, Joshua L.; Gauld, Ian C.

2016-09-01

Activities related to management of spent nuclear fuel (SNF) are increasing in the US and many other countries. Over 240,000 SNF assemblies have been discharged from US commercial reactors since the late 1960s. The enrichment and burnup of SNF have changed significantly over the past 40 years, and fuel assembly designs have also evolved. Understanding the general characteristics of SNF helps regulators and other stakeholders form overall strategies towards the final disposal of US SNF. This report documents a survey of all US commercial SNF assemblies in the GC-859 database and provides reference SNF source terms (e.g., nuclide inventories, decaymore » heat, and neutron/photon emission) at various cooling times up to 200 years after fuel discharge. This study reviews the distribution and evolution of fuel parameters of all SNF assemblies discharged over the past 40 years. Assemblies were categorized into three groups based on discharge year, and the median burnups and enrichments of each group were used to establish representative cases. An extended burnup case was created for boiling water reactor (BWR) fuels, and another was created for the pressurized water reactor (PWR) fuels. Two additional cases were developed to represent the eight mixed oxide (MOX) fuel assemblies in the database. Burnup calculations were performed for each representative case. Realistic parameters for fuel design and operations were used to model the SNF and to provide reference fuel characteristics representative of the current inventory. Burnup calculations were performed using the ORIGEN code, which is part of the SCALE nuclear modeling and simulation code system. Results include total activity, decay heat, photon emission, neutron flux, gamma heat, and plutonium content, as well as concentrations for 115 significant nuclides. These quantities are important in the design, regulation, and operations of SNF storage, transportation, and disposal systems.« less

Fixation orientation in ankle fractures with syndesmosis injury.

PubMed

Nimick, Craig J; Collman, David R; Lagaay, Pieter

2013-01-01

Accurate reduction of the syndesmosis has been shown to be an important prognostic factor for functional outcome in ankle injuries that disrupt the syndesmosis. The purpose of the present case series was to assess the fixation orientation and the position of the fibula within the tibial incisura after open reduction and internal fixation of ankle fractures with syndesmosis injury. Computed tomography was used to assess the accuracy of the reduction. Twelve patients were included in the present case series. A ratio representing the relationship between the tibia and fibula and the orientation of the syndesmotic fixation was measured preoperatively and postoperatively and compared with the uninjured contralateral ankle, representing the patient's normal anatomy. The measurements were accomplished electronically to one tenth of 1 mm using Stentor Intelligent Informatics, I-site, version 3.3.1 (Phillips Electronics; Andover, MA). Posteriorly oriented syndesmotic fixation caused posterior translation of the fibula with respect to the tibia and anteriorly oriented syndesmotic fixation caused anterior translation. Copyright © 2013. Published by Elsevier Inc.

Overview of Seismic Hazard and Vulnerability of Ordinary Buildings in Belgium: Methodological Aspects and Study Cases

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

Barszez, Anne-Marie; Camelbeeck, Thierry; Plumier, Andre

Northwest Europe is a region in which damaging earthquakes exist. Assessing the risks of damages is useful, but this is not an easy work based on exact science.In this paper, we propose a general tool for a first level assessment of seismic risks (rapid diagnosis). General methodological aspects are presented. For a given building, the risk is represented by a volume in a multi-dimensional space. This space is defined by axes representing the main parameters that have an influence on the risk. We notably express the importance of including a parameter to consider the specific value of cultural heritage.Then wemore » apply the proposed tool to analyze and compare methods of seismic risk assessment used in Belgium. They differ by the spatial scale of the studied area. Study cases for the whole Belgian Territory and for part of cities in Liege and Mons (Be) aim also to give some sense of the overall risk in Belgium.« less

Transcriptomic resources for environmental risk assessment: a case study in the Venice lagoon.

PubMed

Milan, M; Pauletto, M; Boffo, L; Carrer, C; Sorrentino, F; Ferrari, G; Pavan, L; Patarnello, T; Bargelloni, L

2015-02-01

The development of new resources to evaluate the environmental status is becoming increasingly important representing a key challenge for ocean and coastal management. Recently, the employment of transcriptomics in aquatic toxicology has led to increasing initiatives proposing to integrate eco-toxicogenomics in the evaluation of marine ecosystem health. However, several technical issues need to be addressed before introducing genomics as a reliable tool in regulatory ecotoxicology. The Venice lagoon constitutes an excellent case, in which the assessment of environmental risks derived from the nearby industrial activities represents a crucial task. In this context, the potential role of genomics to assist environmental monitoring was investigated through the definition of reliable gene expression markers associated to chemical contamination in Manila clams, and their subsequent employment for the classification of Venice lagoon areas. Overall, the present study addresses key issues to evaluate the future outlooks of genomics in the environmental monitoring and risk assessment. Copyright © 2014 Elsevier Ltd. All rights reserved.

Propagation of flexural and membrane waves with fluid loaded NASTRAN plate and shell elements

NASA Technical Reports Server (NTRS)

Kalinowski, A. J.; Wagner, C. A.

1983-01-01

Modeling of flexural and membrane type waves existing in various submerged (or in vacuo) plate and/or shell finite element models that are excited with steady state type harmonic loadings proportioned to e(i omega t) is discussed. Only thin walled plates and shells are treated wherein rotary inertia and shear correction factors are not included. More specifically, the issue of determining the shell or plate mesh size needed to represent the spatial distribution of the plate or shell response is of prime importance towards successfully representing the solution to the problem at hand. To this end, a procedure is presented for establishing guide lines for determining the mesh size based on a simple test model that can be used for a variety of plate and shell configurations such as, cylindrical shells with water loading, cylindrical shells in vacuo, plates with water loading, and plates in vacuo. The procedure for doing these four cases is given, with specific numerical examples present only for the cylindrical shell case.

Weak variations of Lipschitz graphs and stability of phase boundaries

NASA Astrophysics Data System (ADS)

Grabovsky, Yury; Kucher, Vladislav A.; Truskinovsky, Lev

2011-03-01

In the case of Lipschitz extremals of vectorial variational problems, an important class of strong variations originates from smooth deformations of the corresponding non-smooth graphs. These seemingly singular variations, which can be viewed as combinations of weak inner and outer variations, produce directions of differentiability of the functional and lead to singularity-centered necessary conditions on strong local minima: an equality, arising from stationarity, and an inequality, implying configurational stability of the singularity set. To illustrate the underlying coupling between inner and outer variations, we study in detail the case of smooth surfaces of gradient discontinuity representing, for instance, martensitic phase boundaries in non-linear elasticity.

Generalized time-dependent Schrödinger equation in two dimensions under constraints

NASA Astrophysics Data System (ADS)

Sandev, Trifce; Petreska, Irina; Lenzi, Ervin K.

2018-01-01

We investigate a generalized two-dimensional time-dependent Schrödinger equation on a comb with a memory kernel. A Dirac delta term is introduced in the Schrödinger equation so that the quantum motion along the x-direction is constrained at y = 0. The wave function is analyzed by using Green's function approach for several forms of the memory kernel, which are of particular interest. Closed form solutions for the cases of Dirac delta and power-law memory kernels in terms of Fox H-function, as well as for a distributed order memory kernel, are obtained. Further, a nonlocal term is also introduced and investigated analytically. It is shown that the solution for such a case can be represented in terms of infinite series in Fox H-functions. Green's functions for each of the considered cases are analyzed and plotted for the most representative ones. Anomalous diffusion signatures are evident from the presence of the power-law tails. The normalized Green's functions obtained in this work are of broader interest, as they are an important ingredient for further calculations and analyses of some interesting effects in the transport properties in low-dimensional heterogeneous media.

[Hypoacusia as a result of chronic traumatic acoustic lesion in workers with affiliation to the Mexican Social Security Institute, 1992-2002].

PubMed

Loera-González, Maria de los Angeles; Salinas-Tovar, Santiago; Aguilar-Madrid, Guadalupe; Borja-Aburto, Victor Hugo

2006-01-01

Hypoacusia by chronic acoustic trauma (HTAC) is one of the main work diseases. to analyze the distribution and frequency of hearing loss produced by chronic acoustic trauma (HLON) in workers who attend to Mexican Social Security Institute (IMSS). Also analyze the estimated cost of permanent work disabilities. We analyze all hearing loss cases of the workers who attend to IMSS in the period between 1992 to 2001, registered in the Subsystem of registration of work's risk in the IMSS. Measures of central tendency, odds ratio (OR) and direct costs by means were calculated. The HLON represents 41% (1867) of all work's disease, during the period it was observed an increase of number of cases, the average of permanent disabilities, the rate of incidence and the average of rating percentage. The cases solved through a demand showed an increase to 105% in four years. The estimate monthly cost for every worker was 277 pesos. The HLON represents an important problem for the IMSS causing social and economic impact. If they don't take some actions to improve the quality of chronic acoustic trauma diagnosis it will have more serious consequences.

Identifying hospital-onset Escherichia coli bacteraemia cases from English mandatory surveillance: the case for applying a two-day post-admission rule.

PubMed

Davies, J; Johnson, A P; Hope, R

2017-11-01

A national voluntary surveillance programme has shown year-on-year increases in the number of bacteraemias caused by Escherichia coli. Mandatory surveillance of E. coli bacteraemia was introduced in 2011 with the aim of improving the quantity and quality of data collected. In contrast to the other national mandatory surveillance programmes, cases are not currently categorized based upon time of onset in relation to hospital admission. To assess the case for applying time-of-onset categorization to cases of E. coli bacteraemia in England. Data for all cases of E. coli bacteraemia reported to Public Health England between April 2012 and March 2016 were extracted from the national mandatory surveillance database. Cases were categorized as hospital-onset if positive blood cultures were obtained two or more days after admission. Approximately 21% of cases were categorized as hospital-onset. However, the proportion of hospital-onset cases decreased by 1% in each successive 12-month period, from 23% in 2012/13 to 20% in 2015/16 (P<0.001). Approximately one-fifth of E. coli bacteraemia cases reported via mandatory surveillance were identified as hospital-onset. Given that prevention and control strategies will vary by setting, the routine feedback of this information will prove important in informing infection prevention and control efforts. The categorization of this subset of cases represents an important step towards better understanding of the epidemiology of E. coli bacteraemia. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

33 CFR 19.01 - Procedures for effecting individual waivers of navigation and vessel inspection laws and...

Code of Federal Regulations, 2010 CFR

2010-07-01

... the designated representative of the Commandant, as the case may be) reaches the conclusion referred... vessel is located. In the case of a vessel in any port or place of the Canal Zone or in any foreign port... designated representative or the designated representative of the Commandant, as the case may be) shall...

33 CFR 19.01 - Procedures for effecting individual waivers of navigation and vessel inspection laws and...

Code of Federal Regulations, 2011 CFR

2011-07-01

... the designated representative of the Commandant, as the case may be) reaches the conclusion referred... vessel is located. In the case of a vessel in any port or place of the Canal Zone or in any foreign port... designated representative or the designated representative of the Commandant, as the case may be) shall...

Genotype heterogeneity of Mycobacterium tuberculosis within geospatial hotspots suggests foci of imported infection in Sydney, Australia.

PubMed

Gurjav, Ulziijargal; Jelfs, Peter; Hill-Cawthorne, Grant A; Marais, Ben J; Sintchenko, Vitali

2016-06-01

In recent years the State of New South Wales (NSW), Australia, has maintained a low tuberculosis incidence rate with little evidence of local transmission. Nearly 90% of notified tuberculosis cases occurred in people born in tuberculosis-endemic countries. We analyzed geographic, epidemiological and genotypic data of all culture-confirmed tuberculosis cases to identify the bacterial and demographic determinants of tuberculosis hotspot areas in NSW. Standard 24-loci mycobacterium interspersed repetitive unit-variable number tandem repeat (MIRU-24) typing was performed on all isolates recovered between 2009 and 2013. In total 1692/1841 (91.9%) cases with confirmed Mycobacterium tuberculosis infection had complete MIRU-24 and demographic data and were included in the study. Despite some year-to-year variability, spatio-temporal analysis identified four tuberculosis hotspots. The incidence rate and the relative risk of tuberculosis in these hotspots were 2- to 10-fold and 4- to 8-fold higher than the state average, respectively. MIRU-24 profiles of M. tuberculosis isolates associated with these hotspots revealed high levels of heterogeneity. This suggests that these spatio-temporal hotspots, within this low incidence setting, can represent areas of predominantly imported infection rather than clusters of cases due to local transmission. These findings provide important epidemiological insight and demonstrate the value of combining tuberculosis genotyping and spatiotemporal data to guide better-targeted public health interventions. Copyright © 2015 Elsevier B.V. All rights reserved.

MEASUREMENT: ACCOUNTING FOR RELIABILITY IN PERFORMANCE ESTIMATES.

PubMed

Waterman, Brian; Sutter, Robert; Burroughs, Thomas; Dunagan, W Claiborne

2014-01-01

When evaluating physician performance measures, physician leaders are faced with the quandary of determining whether departures from expected physician performance measurements represent a true signal or random error. This uncertainty impedes the physician leader's ability and confidence to take appropriate performance improvement actions based on physician performance measurements. Incorporating reliability adjustment into physician performance measurement is a valuable way of reducing the impact of random error in the measurements, such as those caused by small sample sizes. Consequently, the physician executive has more confidence that the results represent true performance and is positioned to make better physician performance improvement decisions. Applying reliability adjustment to physician-level performance data is relatively new. As others have noted previously, it's important to keep in mind that reliability adjustment adds significant complexity to the production, interpretation and utilization of results. Furthermore, the methods explored in this case study only scratch the surface of the range of available Bayesian methods that can be used for reliability adjustment; further study is needed to test and compare these methods in practice and to examine important extensions for handling specialty-specific concerns (e.g., average case volumes, which have been shown to be important in cardiac surgery outcomes). Moreover, it's important to note that the provider group average as a basis for shrinkage is one of several possible choices that could be employed in practice and deserves further exploration in future research. With these caveats, our results demonstrate that incorporating reliability adjustment into physician performance measurements is feasible and can notably reduce the incidence of "real" signals relative to what one would expect to see using more traditional approaches. A physician leader who is interested in catalyzing performance improvement through focused, effective physician performance improvement is well advised to consider the value of incorporating reliability adjustments into their performance measurement system.

Lifestyles through Expenditures: A Case-Based Approach to Saving

PubMed Central

Keister, Lisa A.; Benton, Richard; Moody, James

2016-01-01

Treating people as cases that are proximate in a behavior space—representing lifestyles—rather than as markers of single variables has a long history in sociology. Yet, because it is difficult to find analytically tractable ways to implement this idea, this approach is rarely used. We take seriously the idea that people are whole packages, and we use household spending to identify groups who occupy similar positions in social space. Using detailed data on household consumption, we identify eight positions that are clearly similar in lifestyle. We then study how the lifestyles we identify are associated with saving, an important measure of household well-being. We find that households cluster into distinct lifestyles based on similarities and differences in consumption. These lifestyles are meaningfully related in social space and save in distinct ways that have important implications for understanding inequality and stratification. PMID:27904877

Understanding and Managing Immune-Related Adverse Events Associated With Immune Checkpoint Inhibitors in Patients With Advanced Melanoma

PubMed Central

Weinstein, Alyona; Gordon, Ruth-Ann; Kasler, Mary Kate; Burke, Matthew; Ranjan, Smita; Hodgetts, Jackie; Reed, Vanessa; Shames, Yelena; Prempeh-Keteku, Nana; Lingard, Karla

2017-01-01

The immune checkpoint inhibitors ipilimumab, nivolumab, and pembrolizumab represent a substantial improvement in treating advanced melanoma but are associated with adverse events (AEs) likely related to general immunologic enhancement. To ensure that patients receive optimal benefit from these agents, prompt assessment and treatment of AEs are essential. We review the efficacy and safety profiles of these immune checkpoint inhibitors and describe guidelines for managing immune-related AEs. We also present case studies describing the management of toxicities in patients receiving immune checkpoint inhibitor therapy. These cases illustrate the importance of collecting a detailed medical history when administering immunotherapy, as this information is necessary to establish baseline, inform monitoring, and determine the etiology of symptoms. Advanced practice nurses and physician assistants are uniquely positioned to educate patients on the early recognition of AEs and have an important role in establishing appropriate monitoring and open dialogue among services. PMID:29900017

The TOM Complex of Amoebozoans: the Cases of the Amoeba Acanthamoeba castellanii and the Slime Mold Dictyostelium discoideum.

PubMed

Wojtkowska, Małgorzata; Buczek, Dorota; Stobienia, Olgierd; Karachitos, Andonis; Antoniewicz, Monika; Slocinska, Małgorzata; Makałowski, Wojciech; Kmita, Hanna

2015-07-01

Protein import into mitochondria requires a wide variety of proteins, forming complexes in both mitochondrial membranes. The TOM complex (translocase of the outer membrane) is responsible for decoding of targeting signals, translocation of imported proteins across or into the outer membrane, and their subsequent sorting. Thus the TOM complex is regarded as the main gate into mitochondria for imported proteins. Available data indicate that mitochondria of representative organisms from across the major phylogenetic lineages of eukaryotes differ in subunit organization of the TOM complex. The subunit organization of the TOM complex in the Amoebozoa is still elusive, so we decided to investigate its organization in the soil amoeba Acanthamoeba castellanii and the slime mold Dictyostelium discoideum. They represent two major subclades of the Amoebozoa: the Lobosa and Conosa, respectively. Our results confirm the presence of Tom70, Tom40 and Tom7 in the A. castellanii and D. discoideum TOM complex, while the presence of Tom22 and Tom20 is less supported. Interestingly, the Tom proteins display the highest similarity to Opisthokonta cognate proteins, with the exception of Tom40. Thus representatives of two major subclades of the Amoebozoa appear to be similar in organization of the TOM complex, despite differences in their lifestyle. Copyright © 2015 The Authors. Published by Elsevier GmbH.. All rights reserved.

Earliest evidence for arthrogryposis multiplex congenita or Larsen syndrome?

PubMed

Anderson, T

1997-08-08

A sixteenth-century illustrated pamphlet from Great Britain suggests that documentary evidence may permit accurate diagnosis of pathological conditions in earlier societies. The document is of particular importance, since the presented congenital abnormalities, including cleft lip, spina bifida cystica, genu recurvatum, and talipes deformity are reported rarely in archaeological skeletal material. It is suggested that the combination of abnormalities may represent the earliest case of arthrogryposis multiplex congenita or Larsen syndrome.

Forensic evaluation of medical liability cases in general surgery.

PubMed

Moreira, H; Magalhães, T; Dinis-Oliveira, Rj; Taveira-Gomes, A

2014-10-01

Although medical liability (disciplinary, civil and criminal) is increasingly becoming an issue, few studies exist, particularly from the perspective of forensic science, which demonstrate the extent to which medical malpractice occurs, or when it does, the reasons for it. Our aims were to evaluate the current situation concerning medical liability in general surgery (GS) in Portugal, the reasons for claims, and the forensic evaluations and conclusions, as well as the association between these issues and the judicial outcomes. We analysed the Medico-Legal Council (CML) reports of the National Institute of Legal Medicine and Forensic Sciences of Portugal related to GS during 2001-2010. The judicial outcomes of each case were requested from the Public Prosecutor Office (PPO) and the court. Alleged cases of medical liability in GS represented 11.2% of the total cases analysed by the CML. We estimated that in Portugal, 4:100,000 surgeries are subject to litigation. The majority of complaints were due to the patient's death (75.4%), with laparoscopic cholecystectomy surgeries representing 55.2% of cases. In 76.1% of the cases, the CML believed that there was no violation of legesartis and in 55.2% of cases, no causal nexus was found between the medical practice and the alleged harm. The PPO prosecuted physicians in 6.4% of the cases and resulted in one conviction. Finally, the importance of the CML reports as a relevant technical-scientific tool for judicial decision was evident because these reports significantly (p < 0.05) influenced the prosecutor's decision, whether to prosecute or not. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Definition and characterization of data needs to describe the potential effects of increased atmospheric CO2 on marine fisheries from the northeast Pacific Ocean. [Theragra chalcogramma; Clupea harengus pallasi; Pandalus borealis; Limanda aspera

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

Strickland, R.M.; Grosse, D.J.; Stubin, A.I.

1985-12-01

Four northeast Pacific region case study species were studied to determine individual fishery responses to climate change. These fishes (Alaska pollock, Theragra chalcogramma; Pacific herring, Clupea harengus pallasi; pink shrimp, Pandalus borealis; and yellowfin sole, Limanda aspera) represent a spectrum of habitats and life cycles among commercially important species, and the northeast Pacific (including the eastern Bering Sea) is relatively well-studied and representative of subpolar continental shelf areas that also are important in the North Atlantic. In addition to the general effects of climate, these fisheries have specific climate-related environmental sensitivities: (a) pollock sensitivity to ice extent, cannibalism, and birdmore » and mammal predation in the Bering Sea, and to coastal currents in the Gulf of Alaska; (b) sensitivity of herring to waves, dessication, and probably currents in the immediate vicinity of discrete spawning beaches along the British Columbia coast; (c) the relative insensitivity of bottom-dwelling shrimp to temperature changes; and (d) the probable sensitivity of yellowfin sole to ice extent and to associated changes in food supply caused by alterations in plankton species composition. It is difficult to extrapolate from the results of the present case studies to other fisheries. These results are particularly inapplicable to other major categories of fisheries, including open-ocean, upwelling, and tropical and subtropical shelf fisheries. Such fisheries should be the focus of additional case studies. Possible temperature effects on the incidence of disease and parasitism in fish also should be investigated.« less

Multidimensional stock network analysis: An Escoufier's RV coefficient approach

NASA Astrophysics Data System (ADS)

Lee, Gan Siew; Djauhari, Maman A.

2013-09-01

The current practice of stocks network analysis is based on the assumption that the time series of closed stock price could represent the behaviour of the each stock. This assumption leads to consider minimal spanning tree (MST) and sub-dominant ultrametric (SDU) as an indispensible tool to filter the economic information contained in the network. Recently, there is an attempt where researchers represent stock not only as a univariate time series of closed price but as a bivariate time series of closed price and volume. In this case, they developed the so-called multidimensional MST to filter the important economic information. However, in this paper, we show that their approach is only applicable for that bivariate time series only. This leads us to introduce a new methodology to construct MST where each stock is represented by a multivariate time series. An example of Malaysian stock exchange will be presented and discussed to illustrate the advantages of the method.

Analysis and Visualization of Internet QA Bulletin Boards Represented as Heterogeneous Networks

NASA Astrophysics Data System (ADS)

Murata, Tsuyoshi; Ikeya, Tomoyuki

Visualizing and analyzing social interactions of CGM (Consumer Generated Media) are important for understanding overall activities on the internet. Social interactions are often represented as simple networks that are composed of homogeneous nodes and edges between them. However, related entities in real world are often not homogeneous. Such relations are naturally represented as heterogeneous networks composed of more than one kind of nodes and edges connecting them. In the case of CGM, for example, users and their contents constitute nodes of heterogeneous networks. There are related users (user communities) and related contents (contents communities) in the heterogeneous networks. Discovering both communities and finding correspondence among them will clarify the characteristics of the communites. This paper describes an attempt for visualizing and analyzing social interactions of Yahoo! Chiebukuro (Japanese Yahoo! Answers). New criteria for measuring correspondence between user communities and board communites are defined, and characteristics of both communities are analyzed using the criteria.

Skin, ear and testis--unusual sites of tuberculosis.

PubMed

Ene, Cătălina Elena; Toma, Claudia; Belaconi, Ionela; Dumitrache-Rujinski, Stefan; Jipa, Daniela; Tudor, Adrian; Leonte, Diana; Bogdan, Miron Alexandru

2016-01-01

Pulmonary localization is the most common site of tuberculosis (TB)and the most contagious form. Extrapulmonary tuberculosis with the rarest and most unexpected localizations represents a significant proportion of all cases of tuberculosis and remains an important public health problem. We report three unusual TB locations: skin, ear and testis occurred in three immunocompetent patients. In the case of skin and testicular lesions, diagnosis was based on pathological confirmation of granulomas with caseous necrosis. In the third case the diagnosis was made possible by identification of positive Acid-Fast Bacilli smear and positive culture from othic drainage fluid. The outcome at all three patients was good with antituberculous treatment. These unusual localization of tuberculosis also highlight the possibility of extrapulmonary tuberculosis as a differential diagnosis in many common diseases.

My Vocational Situation (MVS): Case Example and Psychometric Review.

PubMed

Nitsch, Kristian P; Pedersen, Jessica; Miliotto, Alexandra; Petersen, Brett; Robbins, Samantha; Garcia, Ana; Hoisington, Molly Ansel; The, Kimberly J; Smiley, Jill; Janikowski, Timothy

This case report provides an overview of the psychometric properties and clinical utility of the My Vocational Situation (MVS) instrument. The accompanying hypothetical case description illustrates how clinicians could use the MVS to evaluate vocational preferences and outcomes and how the MVS can be used to inform treatment planning and rehabilitation decision making. The information contained in this report is intended to familiarize clinicians with the administration and scoring of the MVS, the psychometric information necessary to interpret results obtained from the MVS, and how the results could be used to provide comprehensive, patient-centered care. It is important to note that the information provided represents only a sample of the available research literature on the MVS. Copyright © 2017 by the American Occupational Therapy Association, Inc.

Bilateral Mycobacterium chelonae Keratitis after Phacoemulsification Cataract Surgery.

PubMed

Martinez, Jaime D; Amescua, Guillermo; Lozano-Cárdenas, Jesus; Suh, Leejee H

2017-01-01

The purpose of this manuscript is to report the case of an 81-year-old patient who presented with bilateral keratitis after phacoemulsification surgery. Cultures came back positive for Mycobacterium chelonae . Despite aggressive topical and systemic antimicrobial treatment, the patient developed a corneal perforation in both eyes, treated with corneal glue in the right eye and corneoscleral patch in the left eye. After two years of follow-up, patient was free of infection in the right eye with visual acuity of 20/200 and the left eye progressed to phthisis bulbi. We present an unusual case of bilateral Mycobacterium chelonae keratitis associated with phacoemulsification cataract surgery. This case represents the importance of making clinicians aware of this devastating infection and highlights the need for better management to improve outcomes.

Nonsyndromic Familial Oligodontia with Multiple Dens Invaginatus: A Case Report of an Unusual Case

PubMed Central

Vinuth, D. P.; Agarwal, Poonam; Dube, Gunjan; Abhilash, S.; Dube, Pallavi

2013-01-01

Oligodontia is a rare dental anomaly with a prevalence of 0.3% in permanent teeth and much less frequency in the primary dentition. Familial oligodontia represents an absence of varying numbers of primary and/or secondary teeth as an isolated trait. It is a complex and multifactorial condition. Many explanations—evolutionary, genetic, and environmental—have been proposed as the etiology. Simultaneous with oligodontia are often the different positional changes of the existing teeth, their morphology, size, and growth disturbances of the maxillofacial skeleton. Early recognition is vital to provide adequate treatment and prevent squeal. Multidisciplinary referral or consultation is thus important in treatment planning to improve function and esthetics. The present paper reports a rare case of familial oligodontia associated with multiple dense invaginatus and microdontia. PMID:24319603

Surgical treatment in stenosing rectal cancer.

PubMed

Deaconescu, V; Simion, L; Alecu, M; Ionescu, S; Mastalier, B; Straja, N D

2014-01-01

Rectal cancer represents an important health issue, which involves multidisciplinary treatment, posing a major surgical challenge, both in terms of diagnosis and treatment. Between 2009-2013, we analysed 83 patients with stenosing rectal cancer operated on at the Clinic of General Surgery II of Colentina Clinical Hospital and at the Clinic of General Surgery I of "Prof. Dr. Al. Trestioreanu"€ Oncology Institute, in Bucharest. Gender distribution was: 51 males and 32 females. Average age was 65 years old. The most frequently encountered symptoms were colicky abdominal pain and rectorrhagia. 25 patients presented intestinal occlusion phenomena at admission, the other 58 cases being in subocclusive stage. In occlusive stages: 17 patients presented with resectable tumour, while 8 patients had locally advanced neoplastic forms (€œfrozen pelvis€), left iliac colostomy with tumour biopsy being the chosen approach. In subocclusive stages: 5 cases had unresectable tumours for which left iliac anus with tumour biopsy was performed; 53 cases presented with resectable tumour, for which the Hartmann procedure (12 patients) and left iliac colostomy with tumour biopsy (41 patients) were performed. Depending on the histopathological result, patients were submitted to radio- and chemotherapy.Tumour resection was possible in 70 cases (84.33%), only 34 of these (40.96%) being with radical intent. Treatment for stenosing rectal cancer is multimodal,represented by surgical approach, radio- and chemotherapy. The rationality behind surgery as a first therapeutic gesture in the given study group was represented by the need to treat occlusive type complications, patients benefitting subsequently from radio- and chemotherapy. The opportunity of a second surgical intervention, with the objective to remove the tumour, was established based on the therapeutic response to radio- and chemotherapy. Celsius.

A population-based estimate of the economic burden of influenza in Peru, 2009-2010.

PubMed

Tinoco, Yeny O; Azziz-Baumgartner, Eduardo; Rázuri, Hugo; Kasper, Matthew R; Romero, Candice; Ortiz, Ernesto; Gomez, Jorge; Widdowson, Marc-Alain; Uyeki, Timothy M; Gilman, Robert H; Bausch, Daniel G; Montgomery, Joel M

2016-07-01

Influenza disease burden and economic impact data are needed to assess the potential value of interventions. Such information is limited from resource-limited settings. We therefore studied the cost of influenza in Peru. We used data collected during June 2009-December 2010 from laboratory-confirmed influenza cases identified through a household cohort in Peru. We determined the self-reported direct and indirect costs of self-treatment, outpatient care, emergency ward care, and hospitalizations through standardized questionnaires. We recorded costs accrued 15-day from illness onset. Direct costs represented medication, consultation, diagnostic fees, and health-related expenses such as transportation and phone calls. Indirect costs represented lost productivity during days of illness by both cases and caregivers. We estimated the annual economic cost and the impact of a case of influenza on a household. There were 1321 confirmed influenza cases, of which 47% sought health care. Participants with confirmed influenza illness paid a median of $13 [interquartile range (IQR) 5-26] for self-treatment, $19 (IQR 9-34) for ambulatory non-medical attended illness, $29 (IQR 14-51) for ambulatory medical attended illness, and $171 (IQR 113-258) for hospitalizations. Overall, the projected national cost of an influenza illness was $83-$85 millions. Costs per influenza illness represented 14% of the monthly household income of the lowest income quartile (compared to 3% of the highest quartile). Influenza virus infection causes an important economic burden, particularly among the poorest families and those hospitalized. Prevention strategies such as annual influenza vaccination program targeting SAGE population at risk could reduce the overall economic impact of seasonal influenza. © 2015 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.

[Recommendations for terminating child custody--reasons and grounds in 30 expert decisions].

PubMed

Klosinski, G; Karle, M

1996-11-01

In a retrospective analysis 30 expert opinions on the right of visitation, which recommend the exclusion of this right for the non-custodial parent, are evaluated. These cases represent 23% of the expert opinions concerning the right of visitation that have been given by the department of Child and Adolescent Psychiatry of the University of Tübingen between 1991 and 1994. Focusing on the decisive argument for the expert to exclude the right of visitation, it became apparent that in 40% of the cases the will of the child was the determining factor, followed by sustained tension between the parents in 33% of the cases. Emotional neglect, (continuous) abuse and maltreatment (12%) as well as offences against the clause of good behaviour (Wohlverhaltensklausel) were of significant smaller influence on the decision. And although 61% of the children have been classified as psychological disturbed, only in 5% of the cases this diagnosis was of importance.

Optical Sensor/Actuator Locations for Active Structural Acoustic Control

NASA Technical Reports Server (NTRS)

Padula, Sharon L.; Palumbo, Daniel L.; Kincaid, Rex K.

1998-01-01

Researchers at NASA Langley Research Center have extensive experience using active structural acoustic control (ASAC) for aircraft interior noise reduction. One aspect of ASAC involves the selection of optimum locations for microphone sensors and force actuators. This paper explains the importance of sensor/actuator selection, reviews optimization techniques, and summarizes experimental and numerical results. Three combinatorial optimization problems are described. Two involve the determination of the number and position of piezoelectric actuators, and the other involves the determination of the number and location of the sensors. For each case, a solution method is suggested, and typical results are examined. The first case, a simplified problem with simulated data, is used to illustrate the method. The second and third cases are more representative of the potential of the method and use measured data. The three case studies and laboratory test results establish the usefulness of the numerical methods.

Imported submicroscopic malaria in Madrid.

PubMed

Ramírez-Olivencia, Germán; Rubio, José Miguel; Rivas, Pablo; Subirats, Mercedes; Herrero, María Dolores; Lago, Mar; Puente, Sabino

2012-09-12

Submicroscopic malaria (SMM) can be defined as low-density infections of Plasmodium that are unlikely to be detected by conventional microscopy. Such submicroscopic infections only occasionally cause acute disease, but they are capable of infecting mosquitoes and contributing to transmission. This entity is frequent in endemic countries; however, little is known about imported SMM.The goals of this study were two-fold: a) to know the frequency of imported SMM, and b) to describe epidemiological, laboratorial and clinical features of imported SMM. A retrospective study based on review of medical records was performed. The study population consisted of patients older than 15 years attended at the Tropical Medicine Unit of Hospital Carlos III, between January 1, 2002 and December 31, 2007. Routinely detection techniques for Plasmodium included Field staining and microscopic examination through thick and thin blood smear. A semi-nested multiplex malaria PCR was used to diagnose or to confirm cases with low parasitaemia. SMM was diagnosed in 104 cases, representing 35.5% of all malaria cases. Mean age (IC95%) was 40.38 years (37.41-43.34), and sex distribution was similar. Most cases were in immigrants, but some cases were found in travellers. Equatorial Guinea was the main country where infection was acquired (81.7%). Symptoms were present only in 28.8% of all SMM cases, mainly asthenia (73.3% of symptomatic patients), fever (60%) and arthromialgias (53.3%). The associated laboratory abnormalities were anaemia (27.9%), leukopaenia (15.4%) and thrombopaenia (15.4%). Co-morbidity was described in 75 cases (72.1%). Results from this study suggest that imported SMM should be considered in some patients attended at Tropical Medicine Units. Although it is usually asymptomatic, it may be responsible of fever, or laboratory abnormalities in patients coming from endemic areas. The possibility of transmission in SMM has been previously described in endemic zones, and presence of vector in Europe has also been reported. Implementation of molecular tests in all asymptomatic individuals coming from endemic area is not economically feasible. So re-emergence of malaria (Plasmodium vivax) in Europe may be speculated.

Imported submicroscopic malaria in Madrid

PubMed Central

2012-01-01

Background Submicroscopic malaria (SMM) can be defined as low-density infections of Plasmodium that are unlikely to be detected by conventional microscopy. Such submicroscopic infections only occasionally cause acute disease, but they are capable of infecting mosquitoes and contributing to transmission. This entity is frequent in endemic countries; however, little is known about imported SMM. The goals of this study were two-fold: a) to know the frequency of imported SMM, and b) to describe epidemiological, laboratorial and clinical features of imported SMM. Methods A retrospective study based on review of medical records was performed. The study population consisted of patients older than 15 years attended at the Tropical Medicine Unit of Hospital Carlos III, between January 1, 2002 and December 31, 2007. Routinely detection techniques for Plasmodium included Field staining and microscopic examination through thick and thin blood smear. A semi-nested multiplex malaria PCR was used to diagnose or to confirm cases with low parasitaemia. Results SMM was diagnosed in 104 cases, representing 35.5% of all malaria cases. Mean age (IC95%) was 40.38 years (37.41-43.34), and sex distribution was similar. Most cases were in immigrants, but some cases were found in travellers. Equatorial Guinea was the main country where infection was acquired (81.7%). Symptoms were present only in 28.8% of all SMM cases, mainly asthenia (73.3% of symptomatic patients), fever (60%) and arthromialgias (53.3%). The associated laboratory abnormalities were anaemia (27.9%), leukopaenia (15.4%) and thrombopaenia (15.4%). Co-morbidity was described in 75 cases (72.1%). Conclusions Results from this study suggest that imported SMM should be considered in some patients attended at Tropical Medicine Units. Although it is usually asymptomatic, it may be responsible of fever, or laboratory abnormalities in patients coming from endemic areas. The possibility of transmission in SMM has been previously described in endemic zones, and presence of vector in Europe has also been reported. Implementation of molecular tests in all asymptomatic individuals coming from endemic area is not economically feasible. So re-emergence of malaria (Plasmodium vivax) in Europe may be speculated. PMID:22970903

Sanitary protection zoning based on time-dependent vulnerability assessment model - case examples at two different type of aquifers

NASA Astrophysics Data System (ADS)

Živanović, Vladimir; Jemcov, Igor; Dragišić, Veselin; Atanacković, Nebojša

2017-04-01

Delineation of sanitary protection zones of groundwater source is a comprehensive and multidisciplinary task. Uniform methodology for protection zoning for various type of aquifers is not established. Currently applied methods mostly rely on horizontal groundwater travel time toward the tapping structure. On the other hand, groundwater vulnerability assessment methods evaluate the protective function of unsaturated zone as an important part of groundwater source protection. In some particular cases surface flow might also be important, because of rapid transfer of contaminants toward the zones with intense infiltration. For delineation of sanitary protection zones three major components should be analysed: vertical travel time through unsaturated zone, horizontal travel time through saturated zone and surface water travel time toward intense infiltration zones. Integrating the aforementioned components into one time-dependent model represents a basis of presented method for delineation of groundwater source protection zones in rocks and sediments of different porosity. The proposed model comprises of travel time components of surface water, as well as groundwater (horizontal and vertical component). The results obtained using the model, represent the groundwater vulnerability as the sum of the surface and groundwater travel time and corresponds to the travel time of potential contaminants from the ground surface to the tapping structure. This vulnerability assessment approach do not consider contaminant properties (intrinsic vulnerability) although it can be easily improved for evaluating the specific groundwater vulnerability. This concept of the sanitary protection zones was applied at two different type of aquifers: karstic aquifer of catchment area of Blederija springs and "Beli Timok" source of intergranular shallow aquifer. The first one represents a typical karst hydrogeological system with part of the catchment with allogenic recharge, and the second one, the groundwater source within shallow intergranular alluvial aquifer, dominantly recharged by river bank filtration. For sanitary protection zones delineation, the applied method has shown the importance of introducing all travel time components equally. In the case of the karstic source, the importance of the surface flow toward ponor zones has been emphasized, as a consequence of rapid travel time of water in relation to diffuse infiltration from autogenic part. When it comes to the shallow intergranular aquifer, the character of the unsaturated zone gets more prominent role in the source protection, as important buffer of the vertical movement downward. The applicability of proposed method has been shown regardless of the type of the aquifer, and at the same time intelligible results of the delineated sanitary protection zones are possible to validate with various methods. Key words: groundwater protection zoning, time dependent model, karst aquifer, intergranular aquifer, groundwater source protection

XML technologies for the Omaha System: a data model, a Java tool and several case studies supporting home healthcare.

PubMed

Vittorini, Pierpaolo; Tarquinio, Antonietta; di Orio, Ferdinando

2009-03-01

The eXtensible markup language (XML) is a metalanguage which is useful to represent and exchange data between heterogeneous systems. XML may enable healthcare practitioners to document, monitor, evaluate, and archive medical information and services into distributed computer environments. Therefore, the most recent proposals on electronic health records (EHRs) are usually based on XML documents. Since none of the existing nomenclatures were specifically developed for use in automated clinical information systems, but were adapted to such use, numerous current EHRs are organized as a sequence of events, each represented through codes taken from international classification systems. In nursing, a hierarchically organized problem-solving approach is followed, which hardly couples with the sequential organization of such EHRs. Therefore, the paper presents an XML data model for the Omaha System taxonomy, which is one of the most important international nomenclatures used in the home healthcare nursing context. Such a data model represents the formal definition of EHRs specifically developed for nursing practice. Furthermore, the paper delineates a Java application prototype which is able to manage such documents, shows the possibility to transform such documents into readable web pages, and reports several case studies, one currently managed by the home care service of a Health Center in Central Italy.

Evolutionary model with genetics, aging, and knowledge

NASA Astrophysics Data System (ADS)

Bustillos, Armando Ticona; de Oliveira, Paulo Murilo

2004-02-01

We represent a process of learning by using bit strings, where 1 bits represent the knowledge acquired by individuals. Two ways of learning are considered: individual learning by trial and error, and social learning by copying knowledge from other individuals or from parents in the case of species with parental care. The age-structured bit string allows us to study how knowledge is accumulated during life and its influence over the genetic pool of a population after many generations. We use the Penna model to represent the genetic inheritance of each individual. In order to study how the accumulated knowledge influences the survival process, we include it to help individuals to avoid the various death situations. Modifications in the Verhulst factor do not show any special feature due to its random nature. However, by adding years to life as a function of the accumulated knowledge, we observe an improvement of the survival rates while the genetic fitness of the population becomes worse. In this latter case, knowledge becomes more important in the last years of life where individuals are threatened by diseases. Effects of offspring overprotection and differences between individual and social learning can also be observed. Sexual selection as a function of knowledge shows some effects when fidelity is imposed.

Educational Game Development Approach to a particular case: the donor's evaluation.

PubMed

Borro Escribano, B; del Blanco, A; Torrente, J; Borro Mate, J M; Fernandez Manjon, B

2015-01-01

Serious games are a current trend nowadays. Almost every sector has used serious games in recent years for different educational purposes. The eLearning research team of the Complutense University of Madrid main focus of research is the development of low-cost serious games. During the past 10 years, we have been working with and developing serious games, paying special attention to those related to healthcare. From all these studies, a methodology was defined-the Educational Game Development Approach (EGDA)-to design, develop, and evaluate game-like simulations or serious games in healthcare. We present the application of the EGDA to a particular case, the development of a serious game representing the donor's evaluation in an intensive care unit from the point of view of a hospital coordinator following the EGDA methodology. In this simulation, we changed the strategy of selection of teaching cases by exponentially increasing the number of teaching cases. This kind of educational content provides several benefits to students as they learn while playing; they receive immediate feedback of mistakes and correct moves and an objective assessment. These simulations allow the students to practice in a risk-free environment. Moreover, the addition of game elements increases engagement and promotes the retention of important information. A game-like simulation has been developed through the use of this methodology. This simulation represents a complex medical procedure. Copyright © 2015 Elsevier Inc. All rights reserved.

Molecular Epidemiology of Streptococcus uberis Clinical Mastitis in Dairy Herds: Strain Heterogeneity and Transmission

PubMed Central

Leigh, J. A.; Bradley, A. J.; Archer, S. C.; Emes, R. D.; Green, M. J.

2015-01-01

Multilocus sequence typing was successfully completed on 494 isolates of Streptococcus uberis from clinical mastitis cases in a study of 52 commercial dairy herds over a 12-month period. In total, 195 sequence types (STs) were identified. S. uberis mastitis cases that occurred in different cows within the same herd and were attributed to a common ST were classified as potential transmission events (PTEs). Clinical cases attributed to 35 of the 195 STs identified in this study were classified PTE. PTEs were identified in 63% of the herds. PTE-associated cases, which include the first recorded occurrence of that ST in that herd (index case) and all persistent infections with that PTE ST, represented 40% of all the clinical mastitis cases and occurred in 63% of the herds. PTE-associated cases accounted for >50% of all S. uberis clinical mastitis cases in 33% of the herds. Nine STs (ST-5, -6, -20, -22, -24, -35, -233, -361, and -512), eight of which were grouped within a clonal complex (sharing at least four alleles), were statistically overrepresented (OVR STs). The findings indicate that 38% of all clinical mastitis cases and 63% of the PTEs attributed to S. uberis in dairy herds may be caused by the nine most prevalent strains. The findings suggest that a small subset of STs is disproportionally important in the epidemiology of S. uberis mastitis in the United Kingdom, with cow-to-cow transmission of S. uberis potentially occurring in the majority of herds in the United Kingdom, and may be the most important route of infection in many herds. PMID:26491180

Bimetallic catalysis for C–C and C–X coupling reactions

PubMed Central

Pye, Dominic R.

2017-01-01

Bimetallic catalysis represents an alternative paradigm for coupling chemistry that complements the more traditional single-site catalysis approach. In this perspective, recent advances in bimetallic systems for catalytic C–C and C–X coupling reactions are reviewed. Behavior which complements that of established single-site catalysts is highlighted. Two major reaction classes are covered. First, generation of catalytic amounts of organometallic species of e.g. Cu, Au, or Ni capable of transmetallation to a Pd co-catalyst (or other traditional cross-coupling catalyst) has allowed important new C–C coupling technologies to emerge. Second, catalytic transformations involving binuclear bond-breaking and/or bond-forming steps, in some cases involving metal–metal bonds, represent a frontier area for C–C and C–X coupling processes.

[A survey on fatal work accidents based on Mortality Registry data: results of the Tuscany study on INAIL and RMR cases in the period 1992-2996].

PubMed

Chellini, Elisabetta; Baldasseroni, Alberto; Giovannetti, Lucia; Zoppi, Ombretta

2002-01-01

Work-related deaths are important "sentinel events" of unsuccessful prevention. In Italy the most exhaustive source of such events is the National Fund for Occupational Diseases (INAIL), but the amount of cases from this source seems to be underestimated due to the fact that it refers only to cases occurred to subjects insured by the Fund. A previous survey estimated the real amount of work-related deaths 10-20% higher than that quantified by INAIL. This study evaluated the contribute of the two most important sources (INAIL and the Regional Mortality Registry of Tuscany-RMR) in estimating the number of these cases in Tuscany in the period 1992-96. Cases were identified from each source, and then it was applied a capture-recapture method to size the cases from work-related accident different from road accidents. RMR appeared to be the most exhaustive source with 72.3% completeness versus 56.4% completeness of INAIL source. Nevertheless the last one must be considered the primary source, more specific and accurate, and since few years also timely, than any other one. Work-related deaths from road accident represent 35.9% of INAIL cases but they are difficult to be identified from RMR and were not considered in this study. In conclusion the mortality data should be used for an epidemiologic surveillance system on work-related deaths not due to road accident in order to identify cases occurred to subjects not insured by INAIL (and therefore not defined by the Fund). These deaths are also important in terms of public health. Cases identified only from RMR, occurred in Tuscany in 1992-96, were 155: the vast majority occurred to farmers (mainly pensioners, and due to caterpillar upsetting), to bricklayers, to railway workers, to soldiers and to entrepreneurs.

Social Media, Peer Review, and Responsible Conduct of Research (RCR) in Chemistry: Trends, Pitfalls, and Promises

PubMed Central

Jogalekar, Ashutosh S.

2015-01-01

Over the last two decades, various themes inherent in the responsible conduct of research (RCR) in chemistry have been brought to light through prominent cases of research misconduct. This article will describe a few of these cases especially through the lens of social media such as blogs and Twitter. A case will be made that these wholly novel modalities of online discussion are now complementing, and in some cases even circumventing some of the limitations of traditional peer review in chemistry. We present in detail our evaluation of three recent cases of RCR along with several other social media illustrations. These cases have been selected to be representative and showcase several of the most prominent issues at the intersection of traditional and social-media based peer review. In each case, basic details are presented along with a brief discussion of the underlying issues—readers interested in deeper analysis of each subject are referred to a collection of relevant articles and websites. This perspective focuses on the most important RCR issues that have arisen in the past decade, a time which we believe coincides with the serious participation of the scientific community in general, and the chemistry community in particular, in social media-based, citizen-enabled peer-review. A discussion of important trends in RCR in the age of social media, outstanding developments in this area, and questions of enduring interest for the near future concludes the article. PMID:26155733

Detecting Ebola with limited laboratory access in the Democratic Republic of Congo: evaluation of a clinical passive surveillance reporting system.

PubMed

Ashbaugh, Hayley R; Kuang, Brandon; Gadoth, Adva; Alfonso, Vivian H; Mukadi, Patrick; Doshi, Reena H; Hoff, Nicole A; Sinai, Cyrus; Mossoko, Mathias; Kebela, Benoit Ilunga; Muyembe, Jean-Jacques; Wemakoy, Emile Okitolonda; Rimoin, Anne W

2017-09-01

Ebola virus disease (EVD) can be clinically severe and highly fatal, making surveillance efforts for early disease detection of paramount importance. In areas with limited access to laboratory testing, the Integrated Disease Surveillance and Response (IDSR) strategy in the Democratic Republic of Congo (DRC) may be a vital tool in improving outbreak response. Using DRC IDSR data from the nation's four EVD outbreak periods from 2007-2014, we assessed trends of Viral Hemorrhagic Fever (VHF) and EVD differential diagnoses reportable through IDSR. With official case counts from active surveillance of EVD outbreaks, we assessed accuracy of reporting through the IDSR passive surveillance system. Although the active and passive surveillance represent distinct sets of data, the two were correlated, suggesting that passive surveillance based only on clinical evaluation may be a useful predictor of true cases prior to laboratory confirmation. There were 438 suspect VHF cases reported through the IDSR system and 416 EVD cases officially recorded across the outbreaks examined. Although collected prior to official active surveillance cases, case reporting through the IDSR during the 2007, 2008 and 2012 outbreaks coincided with official EVD epidemic curves. Additionally, all outbreak areas experienced increases in suspected cases for both malaria and typhoid fever during EVD outbreaks, underscoring the importance of training health care workers in recognising EVD differential diagnoses and the potential for co-morbidities. © 2017 John Wiley & Sons Ltd.

Social Media, Peer Review, and Responsible Conduct of Research (RCR) in Chemistry: Trends, Pitfalls, and Promises.

PubMed

Jogalekar, Ashutosh S

2015-01-01

Over the last two decades, various themes inherent in the responsible conduct of research (RCR) in chemistry have been brought to light through prominent cases of research misconduct. This article will describe a few of these cases especially through the lens of social media such as blogs and Twitter. A case will be made that these wholly novel modalities of online discussion are now complementing, and in some cases even circumventing some of the limitations of traditional peer review in chemistry. We present in detail our evaluation of three recent cases of RCR along with several other social media illustrations. These cases have been selected to be representative and showcase several of the most prominent issues at the intersection of traditional and social-media based peer review. In each case, basic details are presented along with a brief discussion of the underlying issues-readers interested in deeper analysis of each subject are referred to a collection of relevant articles and websites. This perspective focuses on the most important RCR issues that have arisen in the past decade, a time which we believe coincides with the serious participation of the scientific community in general, and the chemistry community in particular, in social media-based, citizen-enabled peer-review. A discussion of important trends in RCR in the age of social media, outstanding developments in this area, and questions of enduring interest for the near future concludes the article.

The Challenge of Characterizing Branching in Molecular Species.

DTIC Science & Technology

1986-07-16

representing respectively paths of lengths two and three. Strictly speaking, a septuple rather than a pair should have been used to account for all the paths...same counts, are of fundmental importance in the study of isospectral graphs. These facts were exploited by the latter workers to establish a 1-1...case of the Hosoya index, Z(G), a composition principle was given [38] from which it was apparent that Z(G) depends on certain subgraphs of C for

Survival of viral pathogens in animal feed ingredients under transboundary shipping models

PubMed Central

Bauermann, Fernando V.; Niederwerder, Megan C.; Singrey, Aaron; Clement, Travis; de Lima, Marcelo; Long, Craig; Patterson, Gilbert; Sheahan, Maureen A.; Stoian, Ana M. M.; Petrovan, Vlad; Jones, Cassandra K.; De Jong, Jon; Ji, Ju; Spronk, Gordon D.; Minion, Luke; Christopher-Hennings, Jane; Zimmerman, Jeff J.; Rowland, Raymond R. R.; Nelson, Eric; Sundberg, Paul; Diel, Diego G.

2018-01-01

The goal of this study was to evaluate survival of important viral pathogens of livestock in animal feed ingredients imported daily into the United States under simulated transboundary conditions. Eleven viruses were selected based on global significance and impact to the livestock industry, including Foot and Mouth Disease Virus (FMDV), Classical Swine Fever Virus (CSFV), African Swine Fever Virus (ASFV), Influenza A Virus of Swine (IAV-S), Pseudorabies virus (PRV), Nipah Virus (NiV), Porcine Reproductive and Respiratory Syndrome Virus (PRRSV), Swine Vesicular Disease Virus (SVDV), Vesicular Stomatitis Virus (VSV), Porcine Circovirus Type 2 (PCV2) and Vesicular Exanthema of Swine Virus (VESV). Surrogate viruses with similar genetic and physical properties were used for 6 viruses. Surrogates belonged to the same virus families as target pathogens, and included Senecavirus A (SVA) for FMDV, Bovine Viral Diarrhea Virus (BVDV) for CSFV, Bovine Herpesvirus Type 1 (BHV-1) for PRV, Canine Distemper Virus (CDV) for NiV, Porcine Sapelovirus (PSV) for SVDV and Feline Calicivirus (FCV) for VESV. For the remaining target viruses, actual pathogens were used. Virus survival was evaluated using Trans-Pacific or Trans-Atlantic transboundary models involving representative feed ingredients, transport times and environmental conditions, with samples tested by PCR, VI and/or swine bioassay. SVA (representing FMDV), FCV (representing VESV), BHV-1 (representing PRV), PRRSV, PSV (representing SVDV), ASFV and PCV2 maintained infectivity during transport, while BVDV (representing CSFV), VSV, CDV (representing NiV) and IAV-S did not. Notably, more viruses survived in conventional soybean meal, lysine hydrochloride, choline chloride, vitamin D and pork sausage casings. These results support published data on transboundary risk of PEDV in feed, demonstrate survival of certain viruses in specific feed ingredients (“high-risk combinations”) under conditions simulating transport between continents and provide further evidence that contaminated feed ingredients may represent a risk for transport of pathogens at domestic and global levels. PMID:29558524

Long-term survival in acute leukemia in Japan. A study of 304 cases.

PubMed

Kawashima, K; Suzuki, H; Yamada, K; Kato, Y; Watanabe, E; Morishima, Y; Takeyama, H; Kobayashi, M

1980-04-15

In a national survey of five-year survivors with acute leukemia, 233 of 304 cases were children under 14 years of age and 71 were adults. There were 107 myeloblastic, 10 promyelocytic, 142 lymphocytic, and 37 undifferentiated leukemias, Forty-five cases at age 3 represented the peak. These long-term survivors have shown a yearly increase in number. In 1972, the number of childhood ALL cases reached 38 with no great changes in ANLL cases. With respect to prognosis among long-term survivors, it seemed that neither type of leukemia nor age at diagnosis were factors influencing the future survival. CNS relapse occurring before the third year was an unfavorable complication for a prognosis beyond five years. Only 8 patients died of leukemia among 155 patients who reached five years in their initial complete remission; 49 of 90 patients who had relapse within five years after diagnosis died of leukemia. From these findings, it seems very important to follow patients for five years in their initial complete remission.

A cost-benefit analysis of methods for the determination of biomass concentration in wastewater treatment.

PubMed

Hernandez, J E; Bachmann, R T; Edyvean, R G J

2006-01-01

The measurement of biomass concentration is important in biological wastewater treatment. This paper compares the accuracy and costs of the traditional volatile suspended solids (VSS) and the proposed suspended organic carbon (SOC) methods. VSS and SOC values of a dilution system were very well correlated (R(2)=0.9995). VSS and SOC of 16 samples were determined, the mean SOC/VSS ratio (0.52, n=16, sigma=0.01) was close to the theoretical value (0.53). For costing analysis, two hypothetical cases were analysed. In case A, it is assumed that 108 samples are analysed annually from two continuous reactors. Case B represents a batch experiment to be carried out in 24 incubated serum bottles. The savings, when using the SOC method, were 11,987 pounds for case A and 90 pounds for case B. This study suggests the use of SOC method as a time saving and lower cost biomass concentration measurement.

Positive cell-free fetal DNA testing for trisomy 13 reveals confined placental mosaicism.

PubMed

Hall, April L; Drendel, Holli M; Verbrugge, Jennifer L; Reese, Angela M; Schumacher, Katherine L; Griffith, Christopher B; Weaver, David D; Abernathy, Mary P; Litton, Christian G; Vance, Gail H

2013-09-01

We report on a case in which cell-free fetal DNA was positive for trisomy 13 most likely due to confined placental mosaicism. Cell-free fetal DNA testing analyzes DNA derived from placental trophoblast cells and can lead to incorrect results that are not representative of the fetus. We sought to confirm commercial cell-free fetal DNA testing results by chorionic villus sampling and amniocentesis. These results were followed up by postnatal chromosome analysis of cord blood and placental tissue. First-trimester cell-free fetal DNA test results were positive for trisomy 13. Cytogenetic analysis of chorionic villus sampling yielded a mosaic karyotype of 47,XY,+13[10]/46,XY[12]. G-banded analysis of amniotic fluid was normal, 46,XY. Postnatal cytogenetic analysis of cord blood was normal. Karyotyping of tissues from four quadrants of the placenta demonstrated mosaicism for trisomy 13 in two of the quadrants and a normal karyotype in the other two. Our case illustrates several important aspects of this new testing methodology: that cell-free fetal DNA may not be representative of the fetal karyotype; that follow-up with diagnostic testing of chorionic villus sampling and/or amniotic fluid for abnormal test results should be performed; and that pretest counseling regarding the full benefits, limitations, and possible testing outcomes of cell-free fetal DNA screening is important.

Quantum chemical modeling of enzymatic reactions: the case of histone lysine methyltransferase.

PubMed

Georgieva, Polina; Himo, Fahmi

2010-06-01

Quantum chemical cluster models of enzyme active sites are today an important and powerful tool in the study of various aspects of enzymatic reactivity. This methodology has been applied to a wide spectrum of reactions and many important mechanistic problems have been solved. Herein, we report a systematic study of the reaction mechanism of the histone lysine methyltransferase (HKMT) SET7/9 enzyme, which catalyzes the methylation of the N-terminal histone tail of the chromatin structure. In this study, HKMT SET7/9 serves as a representative case to examine the modeling approach for the important class of methyl transfer enzymes. Active site models of different sizes are used to evaluate the methodology. In particular, the dependence of the calculated energies on the model size, the influence of the dielectric medium, and the particular choice of the dielectric constant are discussed. In addition, we examine the validity of some technical aspects, such as geometry optimization in solvent or with a large basis set, and the use of different density functional methods. Copyright 2010 Wiley Periodicals, Inc.

Atrial fibrillation associated with subclinical hyperthyroidism.

PubMed

Patanè, Salvatore; Marte, Filippo

2009-05-29

Subclinical hyperthyroidism is an increasingly recognized entity that is defined as a normal serum free thyroxine and free triiodothyronine levels with a thyroid-stimulating hormone level suppressed below the normal range and usually undetectable. It has been reported that subclinical hyperthyroidism is not associated with coronary heart disease or mortality from cardiovascular causes but it is sufficient to induce arrhythmias including atrial fibrillation and atrial flutter. It has also been reported that increased factor X activity in patients with subclinical hyperthyroidism represents a potential hypercoagulable state. We present a case of atrial fibrillation associated with subclinical hyperthyroidism, in a 78-year-old Italian woman. Also this case focuses attention on the importance of a correct evaluation of subclinical hyperthyroidism.

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.

Performance of a recoverable tug for planetary missions including use of perigee propulsion and corrections for nodal regression

NASA Technical Reports Server (NTRS)

Borsody, J.

1976-01-01

Mathematical equations are derived by using the Maximum Principle to obtain the maximum payload capability of a reusable tug for planetary missions. The mathematical formulation includes correction for nodal precession of the space shuttle orbit. The tug performs this nodal correction in returning to this precessed orbit. The sample case analyzed represents an inner planet mission as defined by the declination (fixed) and right ascension of the outgoing asymptote and the mission energy. Payload capability is derived for a typical cryogenic tug and the sample case with and without perigee propulsion. Optimal trajectory profiles and some important orbital elements are also discussed.

A gastrointestinal stromal tumour with pulmonary metastases mimicking unilateral gynaecomastia.

PubMed

Cimen, Sanem Guler; MacDonald, Frank; Cimen, Sertac; Molinari, Michele

2013-12-16

Gastrointestinal stromal tumours (GISTs) represent 1% of primary gastrointestinal cancers. These neoplasms most frequently metastasise to the liver and peritoneum and rarely to the lungs and bones. Treatment of unresectable GISTs involves systemic chemotherapy with tyrosine kinase inhibitors, imatinib and sunitinib being first-line and second-line drugs. We report the case of a 52-year-old man with GIST who developed a right-sided subareolar breast swelling and subsequently discovered to be an invasive metastatic pulmonary GIST. Given that gynaecomastia is a known adverse effect of imatinib and sunitinib, this case report illustrates the importance of including metastatic disease in the differential diagnosis of patients with GIST and with the new onset of soft tissue masses.

Unusual placement of intrathecal baclofen pumps: report of two cases.

PubMed

Devine, Oliver; Harborne, Andrew; Lo, William B; Weinberg, Daniel; Ciras, Mahesh; Price, Rupert

2016-01-01

Intrathecal baclofen delivery via implantable pump represents an important modality for symptomatic relief in patients with chronic spasticity. Pumps are routinely implanted subcutaneously in the anterior abdominal wall. We describe two unusual cases where skin-related complications necessitated revision surgery in order to relocate the pump to alternative sites. The first patient was an international power canoeist, whose strenuous exercise programme interfered with his pump's original siting. The second patient was a cachectic university student with a history of cerebral palsy, who maintained low body mass despite attempted weight gain. The relocation of these two intrathecal devices to the medial compartment of the right thigh and right iliac fossa, respectively, is described.

The general surgery chief resident operative experience: 23 years of national ACGME case logs.

PubMed

Drake, Frederick Thurston; Horvath, Karen D; Goldin, Adam B; Gow, Kenneth W

2013-09-01

The chief resident (CR) year is a pivotal experience in surgical training. Changes in case volume and diversity may impact the educational quality of this important year. To evaluate changes in operative experience for general surgery CRs. Review of Accreditation Council for Graduate Medical Education case logs from 1989-1990 through 2011-2012 divided into 5 periods. Graduates in period 3 were the last to train with unrestricted work hours; those in period 4 were part of a transition period and trained under both systems; and those in period 5 trained fully under the 80-hour work week. Diversity of cases was assessed based on Accreditation Council for Graduate Medical Education defined categories. Total cases and defined categories were evaluated for changes over time. The average total CR case numbers have fallen (271 in period 1 vs 242 in period 5, P < .001). Total CR cases dropped to their lowest following implementation of the 80-hour work week (236 cases), but rebounded in period 5. The percentage of residents' 5-year operative experience performed as CRs has decreased (30% in period 1 vs 25.6% in period 5, P < .001). Regarding case mix: thoracic, trauma, and vascular cases declined steadily, while alimentary and intra-abdominal operations increased. Recent graduates averaged 80 alimentary and 78 intra-abdominal procedures during their CR years. Compared with period 1, in which these 2 categories represented 47.1% of CR experience, in period 5, they represented 65.2% (P < .001). Endocrine experience has been relatively unchanged. Total CR cases declined especially acutely following implementation of the 80-hour work week but have since rebounded. Chief resident cases contribute less to overall experience, although this proportion stabilized before the 80-hour work week. Case mix has narrowed, with significant increases in alimentary and intra-abdominal cases. Broad-based general surgery training may be jeopardized by reduced case diversity. Chief resident cases are crucial in surgical training and educators should consider these findings as surgical training evolves.

Aseptic Meningitis and Viral Myelitis

PubMed Central

Irani, David N.

2008-01-01

SYNOPSIS Meningitis and myelitis represent common and very infrequent viral infections of the central nervous system (CNS), respectively. Indeed, the number of cases of viral meningitis that occurs annually exceeds the total number of meningitis cases caused by all other etiologies combined. Focal CNS infections, on the other hand, such as occur in the spinal cord with viral myelitis, are much less common and may be confused with non-infectious disorders that cause acute flaccid paralysis (AFP). This chapter will review some of the important clinical features, epidemiology, diagnostic approaches, and management strategies for patients with aseptic meningitis and viral myelitis. Particular focus will be placed on the diseases caused by enteroviruses (EVs), which as a group account for the vast majority of all aseptic meningitis cases as well as many focal infections of the spinal cord. PMID:18657719

Trade-Off Analysis between Concerns Based on Aspect-Oriented Requirements Engineering

NASA Astrophysics Data System (ADS)

Laurito, Abelyn Methanie R.; Takada, Shingo

The identification of functional and non-functional concerns is an important activity during requirements analysis. However, there may be conflicts between the identified concerns, and they must be discovered and resolved through trade-off analysis. Aspect-Oriented Requirements Engineering (AORE) has trade-off analysis as one of its goals, but most AORE approaches do not actually offer support for trade-off analysis; they focus on describing concerns and generating their composition. This paper proposes an approach for trade-off analysis based on AORE using use cases and the Requirements Conflict Matrix (RCM) to represent compositions. RCM shows the positive or negative effect of non-functional concerns over use cases and other non-functional concerns. Our approach is implemented within a tool called E-UCEd (Extended Use Case Editor). We also show the results of evaluating our tool.

Ethical dilemmas among nurses as they transition to hospital case management: implications for organizational ethics, part II.

PubMed

O'Donnell, Lolita T

2007-01-01

The purpose of this study was to describe the experiences of ethical concerns by clinical nurses as they transitioned into their new role in hospital case management. Through this study, an attempt was made to explore experiences of ethical concerns and identify the implications for organizational ethics. In this study, nurse case managers practicing in the acute care setting, military, not-for-profit community, and teaching hospitals were interviewed. The majority of the nurse case manager participants were engaged in hospital discharge planning and utilization review activities. An interpretive phenomenological approach was used to identify the themes inherent in ethical concerns and articulate them within the context of hospital nurse case management. Fifteen participants were interviewed to obtain a qualitative description of the nurse case managers' lived experiences of ethical dilemmas and how they were resolved. Nurse case managers' perceptions of solutions/options to resolve such ethical dilemmas were explored. As nurses transition into the expanded role of case management in the present healthcare delivery system, they frequently face situations demanding ethical choices and judgments to accommodate diverse patient interests and needs. These ethical decisions required in daily practice of case management represent ethical dilemmas to nurses. The insights derived from the analysis of the interviews have implications for nursing practice, education, policy, ethics, and research; recommendations for organizations employing nurse case managers in terms of recruitment, orientation, training, and continued need for educational support are identified. 1. The clinical decisions required in daily practice of case management represented challenges to the nurses. This highlights the critical role of adequate educational orientation to case management for beginning case managers. 2. Nurse case managers should be cognizant of the "disconnect" that could occur between their obligations to the organizations that employ them and the healthcare needs of the patients that they advocate for. 3. Aside from the importance of linking patient care outcomes with accountability, nurse case managers may need to advocate for policy change and system reform.

Pure endoscopic transsphenoidal surgery for treatment of acromegaly: results of 67 cases treated in a pituitary center.

PubMed

Gondim, Jackson A; Almeida, João Paulo; de Albuquerque, Lucas Alverne F; Gomes, Erika; Schops, Michele; Ferraz, Tania

2010-10-01

Acromegaly is a chronic disease related to the excess of growth hormone (GH) and insulin-like growth factor–I secretion, usually by pituitary adenomas. Traditional treatment of acromegaly consists of surgery, drug therapy, and eventually radiotherapy. The introduction of endoscopy as an additional tool for surgical treatment of pituitary adenomas and, therefore, acromegaly represents an important advance of pituitary surgery in the recent years. The aim of this retrospective study is to evaluate the results of pure transsphenoidal endoscopic surgery in a series of patients with acromegaly who were operated on by a pituitary specialist surgeon. The authors discuss the advantages, outcome, complications, and factors related to the success of the endoscopic approach in cases of GHsecreting adenomas. The authors retrospectively analyzed data from cases involving patients with GH-secreting adenomas who underwent pure transsphenoidal endoscopic surgery at the Department of Neurosurgery of the General Hospital in Fortaleza, Brazil, between 2000 and 2009. Tumors were classified according to size as micro- or macroadenomas, and tumor extension was analyzed based on suprasellar/parasellar extension and sella floor destruction. All patients were followed up for at least 1 year. The criteria of disease control were GH levels < 1 ng/L after oral glucose tolerance test and normal insulin-like growth factor–I levels for age and sex. During the study period, 67 patients underwent pure endoscopic transsphenoidal surgery for treatment of acromegaly. Disease control was obtained in 50 cases (74.6%). The rate of treatment success was higher in patients with microadenomas (disease control achieved in 12 [85.7%] of 14 cases) than in those with larger lesions. Suprasellar/parasellar extension and high levels of sella floor erosion were associated with lower rates of disease control (p = 0.01 and p = 0.02, respectively). Complications related to the endoscopic surgery included epistaxis (6.0%), transitory diabetes insipidus (4.5%), and 1 case of seizure (1.5%). Endoscopic transsphenoidal surgery represents an effective option for treatment of patients with acromegaly. High disease control rates and a small number of complications are some of the most important points related to the technique. Factors related to the success of the endoscopic surgery are lesion size, suprasellar/parasellar extension, and the degree of sella floor erosion. Although presenting important advantages, there is no conclusive evidence that endoscopy is superior to microsurgery in treatment of GH-secreting adenomas.

Addressing trend-related changes within cumulative effects studies in water resources planning

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

Canter, L.W., E-mail: envimptr@aol.com; Chawla, M.K.; Swor, C.T.

2014-01-15

Summarized herein are 28 case studies wherein trend-related causative physical, social, or institutional changes were connected to consequential changes in runoff, water quality, and riparian and aquatic ecological features. The reviewed cases were systematically evaluated relative to their identified environmental effects; usage of analytical frameworks, and appropriate models, methods, and technologies; and the attention given to mitigation and/or management of the resultant causative and consequential changes. These changes also represent important considerations in project design and operation, and in cumulative effects studies associated therewith. The cases were grouped into five categories: institutional changes associated with legislation and policies (seven cases);more » physical changes from land use changes in urbanizing watersheds (eight cases); physical changes from land use changes and development projects in watersheds (four cases); physical, institutional, and social changes from land use and related policy changes in river basins (three cases); and multiple changes within a comprehensive study of land use and policy changes in the Willamette River Basin in Oregon (six cases). A tabulation of 110 models, methods and technologies used in the studies is also presented. General observations from this review were that the features were unique for each case; the consequential changes were logically based on the causative changes; the analytical frameworks provided relevant structures for the studies, and the identified methods and technologies were pertinent for addressing both the causative and consequential changes. One key lesson was that the cases provide useful, “real-world” illustrations of the importance of addressing trend-related changes in cumulative effects studies within water resources planning. Accordingly, they could be used as an “initial tool kit” for addressing trend-related changes.« less

Yellow fever cases in Asia: primed for an epidemic.

PubMed

Wasserman, Sean; Tambyah, Paul Anantharajah; Lim, Poh Lian

2016-07-01

There is currently an emerging outbreak of yellow fever in Angola. Cases in infected travellers have been reported in a number of other African countries, as well as in China, representing the first ever documented cases of yellow fever in Asia. There is a large Chinese workforce in Angola, many of whom may be unvaccinated, increasing the risk of ongoing importation of yellow fever into Asia via busy commercial airline routes. Large parts of the region are hyperendemic for the related Flavivirus dengue and are widely infested by Aedes aegypti, the primary mosquito vector of urban yellow fever transmission. The combination of sustained introduction of viraemic travellers, an ecology conducive to local transmission, and an unimmunized population raises the possibility of a yellow fever epidemic in Asia. This represents a major global health threat, particularly in the context of a depleted emergency vaccine stockpile and untested surveillance systems in the region. In this review, the potential for a yellow fever outbreak in Asia is discussed with reference to the ecological and historical forces that have shaped global yellow fever epidemiology. The limitations of surveillance and vector control in the region are highlighted, and priorities for outbreak preparedness and response are suggested. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Risk Importance Measures in the Designand Operation of Nuclear Power Plants

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

Vrbanic I.; Samanta P.; Basic, I

This monograph presents and discusses risk importance measures as quantified by the probabilistic risk assessment (PRA) models of nuclear power plants (NPPs) developed according to the current standards and practices. Usually, PRA tools calculate risk importance measures related to a single ?basic event? representing particular failure mode. This is, then, reflected in many current PRA applications. The monograph focuses on the concept of ?component-level? importance measures that take into account different failure modes of the component including common-cause failures (CCFs). In opening sections the roleof risk assessment in safety analysis of an NPP is introduced and discussion given of ?traditional?,more » mainly deterministic, design principles which have been established to assign a level of importance to a particular system, structure or component. This is followed by an overview of main risk importance measures for risk increase and risk decrease from current PRAs. Basic relations which exist among the measures are shown. Some of the current practical applications of risk importancemeasures from the field of NPP design, operation and regulation are discussed. The core of the monograph provides a discussion on theoreticalbackground and practical aspects of main risk importance measures at the level of ?component? as modeled in a PRA, starting from the simplest case, single basic event, and going toward more complexcases with multiple basic events and involvements in CCF groups. The intent is to express the component-level importance measures via theimportance measures and probabilities of the underlying single basic events, which are the inputs readily available from a PRA model andits results. Formulas are derived and discussed for some typical cases. The formulas and their results are demonstrated through some practicalexamples, done by means of a simplified PRA model developed in and run by RiskSpectrum? tool, which are presented in the appendices. The monograph concludes with discussion of limitations of the use of risk importance measures and a summary of component-level importance cases evaluated.« less

Automated Terrestrial EMI Emitter Detection, Classification, and Localization

NASA Astrophysics Data System (ADS)

Stottler, R.; Ong, J.; Gioia, C.; Bowman, C.; Bhopale, A.

Clear operating spectrum at ground station antenna locations is critically important for communicating with, commanding, controlling, and maintaining the health of satellites. Electro Magnetic Interference (EMI) can interfere with these communications, so it is extremely important to track down and eliminate sources of EMI. The Terrestrial RFI-locating Automation with CasE based Reasoning (TRACER) system is being implemented to automate terrestrial EMI emitter localization and identification to improve space situational awareness, reduce manpower requirements, dramatically shorten EMI response time, enable the system to evolve without programmer involvement, and support adversarial scenarios such as jamming. The operational version of TRACER is being implemented and applied with real data (power versus frequency over time) for both satellite communication antennas and sweeping Direction Finding (DF) antennas located near them. This paper presents the design and initial implementation of TRACER’s investigation data management, automation, and data visualization capabilities. TRACER monitors DF antenna signals and detects and classifies EMI using neural network technology, trained on past cases of both normal communications and EMI events. When EMI events are detected, an Investigation Object is created automatically. The user interface facilitates the management of multiple investigations simultaneously. Using a variant of the Friis transmission equation, emissions data is used to estimate and plot the emitter’s locations over time for comparison with current flights. The data is also displayed on a set of five linked graphs to aid in the perception of patterns spanning power, time, frequency, and bearing. Based on details of the signal (its classification, direction, and strength, etc.), TRACER retrieves one or more cases of EMI investigation methodologies which are represented as graphical behavior transition networks (BTNs). These BTNs can be edited easily, and they naturally represent the flow-chart-like process often followed by experts in time pressured situations.

Uncertainty Analysis of Coupled Socioeconomic-Cropping Models: Building Confidence in Climate Change Decision-Support Tools for Local Stakeholders

NASA Astrophysics Data System (ADS)

Malard, J. J.; Rojas, M.; Adamowski, J. F.; Gálvez, J.; Tuy, H. A.; Melgar-Quiñonez, H.

2015-12-01

While cropping models represent the biophysical aspects of agricultural systems, system dynamics modelling offers the possibility of representing the socioeconomic (including social and cultural) aspects of these systems. The two types of models can then be coupled in order to include the socioeconomic dimensions of climate change adaptation in the predictions of cropping models.We develop a dynamically coupled socioeconomic-biophysical model of agricultural production and its repercussions on food security in two case studies from Guatemala (a market-based, intensive agricultural system and a low-input, subsistence crop-based system). Through the specification of the climate inputs to the cropping model, the impacts of climate change on the entire system can be analysed, and the participatory nature of the system dynamics model-building process, in which stakeholders from NGOs to local governmental extension workers were included, helps ensure local trust in and use of the model.However, the analysis of climate variability's impacts on agroecosystems includes uncertainty, especially in the case of joint physical-socioeconomic modelling, and the explicit representation of this uncertainty in the participatory development of the models is important to ensure appropriate use of the models by the end users. In addition, standard model calibration, validation, and uncertainty interval estimation techniques used for physically-based models are impractical in the case of socioeconomic modelling. We present a methodology for the calibration and uncertainty analysis of coupled biophysical (cropping) and system dynamics (socioeconomic) agricultural models, using survey data and expert input to calibrate and evaluate the uncertainty of the system dynamics as well as of the overall coupled model. This approach offers an important tool for local decision makers to evaluate the potential impacts of climate change and their feedbacks through the associated socioeconomic system.

Forensic Medicine in South Africa: Associations between Medical Practice and Legal Case Progression and Outcomes in Female Murders

PubMed Central

Abrahams, Naeemah; Jewkes, Rachel; Martin, Lorna J.; Mathews, Shanaaz

2011-01-01

Background Forensic medicine has been largely by-passed by the tide of health systems research and evidence based medicine. Murder victims form a central part of forensic medical examiners' case load, and women murdered by intimate partners are an important subgroup, representing the most severe form and consequence of intimate partner violence. Our aim was to describe the epidemiology of female murder in South Africa (by intimate and non-intimate partners); and to describe and compare autopsy findings, forensic medical management of cases and the contribution of these to legal outcomes. Methods We did a retrospective national study in a proportionate random sample of 25 medico-legal laboratories to identify all homicides in 1999 of women aged 14 years and over. Data were abstracted from the mortuary file and autopsy report, and collected from a police interview. Findings In 21.5% of cases the perpetrator was convicted. Factors associated with a conviction for the female murders included having a history of intimate partner violence 1.18 (95%CI: 0.16–2.20), weapon recovered 1.36 (95% CI:0.58–2.15) and a detective visiting the crime scene 1.57 (95% CI:0.14–3.00). None of the forensic medical activities increased the likelihood of a conviction. Conclusion The findings raise important questions about the role of forensic medicine in these cases. PMID:22194868

Forensic medicine in South Africa: associations between medical practice and legal case progression and outcomes in female murders.

PubMed

Abrahams, Naeemah; Jewkes, Rachel; Martin, Lorna J; Mathews, Shanaaz

2011-01-01

Forensic medicine has been largely by-passed by the tide of health systems research and evidence based medicine. Murder victims form a central part of forensic medical examiners' case load, and women murdered by intimate partners are an important subgroup, representing the most severe form and consequence of intimate partner violence. Our aim was to describe the epidemiology of female murder in South Africa (by intimate and non-intimate partners); and to describe and compare autopsy findings, forensic medical management of cases and the contribution of these to legal outcomes. We did a retrospective national study in a proportionate random sample of 25 medico-legal laboratories to identify all homicides in 1999 of women aged 14 years and over. Data were abstracted from the mortuary file and autopsy report, and collected from a police interview. In 21.5% of cases the perpetrator was convicted. Factors associated with a conviction for the female murders included having a history of intimate partner violence 1.18 (95%CI: 0.16-2.20), weapon recovered 1.36 (95% CI:0.58-2.15) and a detective visiting the crime scene 1.57 (95% CI:0.14-3.00). None of the forensic medical activities increased the likelihood of a conviction. The findings raise important questions about the role of forensic medicine in these cases.

[Therapeutic options for pressure ulcers].

PubMed

Damert, H-G; Meyer, F; Altmann, S

2015-04-01

The aim of this overview is based on remarks on the pathogenesis of and therapy for pressure ulcers and selected but representative cases to demonstrate current options of plastic coverage. As a consequence of the demographic developments, in particular, with regard to the increasing proportion of older patients as well as the advances in modern medicine, the number of multimorbid, geriatric and bedridden patients and of those with prolonged sickbed periods has been steadily growing. Therefore, partly severe manifestations of pressure ulcers at various exposed body regions can be observed in spite of the best preventive intention of care. While in the early stages rather conservative treatment is adequate, surgical intervention might become important and indispensable for a sufficient treatment in advanced stages. To facilitate basic care and to appropriately treat the infectious focus, the methods and procedures of plastic surgery can become relevant. Although there are several options and approaches existing to sanitise and cover defects of pressure ulcers, which are described within the article based on representative cases, preventive measures can still be considered the best approach. Georg Thieme Verlag KG Stuttgart · New York.

[Domestic violence: a current issue to take into account in diagnostic imaging].

PubMed

Santos Corraliza, E; Larrañaga Hernando, G; Neve Lete, I; Sánchez García, A

2014-01-01

Domestic violence is currently an issue of great political and social importance. The real incidence of domestic violence is difficult to determine due to the environment where it takes place and the reluctance of victims to report abuse. On the other hand, all types of violence represent an important public health problem. We report the case of a young woman who presented with thromboembolic phenomena at different sites due to domestic violence. We emphasize that it is necessary for radiologists and other healthcare professionals to consider the possibility of domestic violence when establishing the diagnosis. This can be important for determining the incidence of abuse, diminishing its sequela, and help increase its reporting. Copyright © 2011 SERAM. Published by Elsevier Espana. All rights reserved.

Listeriosis--a review of eighty-four cases.

PubMed

Paul, M L; Dwyer, D E; Chow, C; Robson, J; Chambers, I; Eagles, G; Ackerman, V

1994-04-18

To review the epidemiology, risk factors for acquisition, clinical features and outcomes of Listeria monocytogenes infection in Sydney. A retrospective study over the period 1983-1992 at four university teaching hospitals in Sydney. Cases were identified from microbiology laboratory records of the isolation of L. monocytogenes from sterile sites. Eighty-four cases were reviewed, with 72 patients (86%) having a predisposing underlying condition, including 13 perinatal patients (15%). Septicaemia (56%) and central nervous system disease (41%) were the major clinical presentations. Nineteen patients (23%) had hospital-associated infection. A mortality of 21% (18 patients) was directly attributable to L. monocytogenes infection, with another 10% (nine patients) dying of their underlying disease during admission. The 84 cases represented 80% of all L. monocytogenes cases occurring in Sydney during the study period. Listeriosis is predominantly a disease of the elderly or of immunosuppressed individuals, pregnant women and neonates. The presentation and outcome in these groups are similar to those reported in other Western countries. A significant feature of this study was the number of cases occurring in already hospitalised patients, suggesting that L. monocytogenes may be an important hospital-associated pathogen in immunocompromised patients.

A multi-country outbreak of Salmonella Newport gastroenteritis in Europe associated with watermelon from Brazil, confirmed by whole genome sequencing: October 2011 to January 2012.

PubMed

Byrne, L; Fisher, I; Peters, T; Mather, A; Thomson, N; Rosner, B; Bernard, H; McKeown, P; Cormican, M; Cowden, J; Aiyedun, V; Lane, C

2014-08-07

In November 2011, the presence of Salmonella Newport in a ready-to-eat watermelon slice was confirmed as part of a local food survey in England. In late December 2011, cases of S. Newport were reported in England, Wales, Northern Ireland, Scotland, Ireland and Germany. During the outbreak, 63 confirmed cases of S. Newport were reported across all six countries with isolates indistinguishable by pulsed-field gel electrophoresis from the watermelon isolate.A subset of outbreak isolates were whole-genome sequenced and were identical to, or one single nucleotide polymorphism different from the watermelon isolate.In total, 46 confirmed cases were interviewed of which 27 reported watermelon consumption. Further investigations confirmed the outbreak was linked to the consumption of watermelon imported from Brazil.Although numerous Salmonella outbreaks associated with melons have been reported in the United States and elsewhere, this is the first of its kind in Europe.Expansion of the melon import market from Brazil represents a potential threat for future outbreaks. Whole genome sequencing is rapidly becoming more accessible and can provide a compelling level of evidence of linkage between human cases and sources of infection,to support public health interventions in global food markets.

A multi-country outbreak of Salmonella Newport gastroenteritis in Europe associated with watermelon from Brazil, confirmed by whole genome sequencing: October 2011 to January 2012

PubMed Central

Byrne, L; Fisher, I; Peters, T; Mather, A; Thomson, N; Rosner, B; Bernard, H; McKeown, P; Cormican, M; Cowden, J; Aiyedun, V; Lane, C

2015-01-01

In November 2011, the presence of Salmonella Newport in a ready-to-eat watermelon slice was confirmed as part of a local food survey in England. In late December 2011, cases of S. Newport were reported in England, Wales, Northern Ireland, Scotland, Ireland and Germany. During the outbreak, 63 confirmed cases of S. Newport were reported across all six countries with isolates indistinguishable by pulsed-field gel electrophoresis from the watermelon isolate. A subset of outbreak isolates were whole-genome sequenced and were identical to, or one single nucleotide polymorphism different from the watermelon isolate. In total, 46 confirmed cases were interviewed of which 27 reported watermelon consumption. Further investigations confirmed the outbreak was linked to the consumption of watermelon imported from Brazil. Although numerous Salmonella outbreaks associated with melons have been reported in the United States and elsewhere, this is the first of its kind in Europe. Expansion of the melon import market from Brazil represents a potential threat for future outbreaks. Whole genome sequencing is rapidly becoming more accessible and can provide a compelling level of evidence of linkage between human cases and sources of infection, to support public health interventions in global food markets. PMID:25138971

Patterns of public participation.

PubMed

Slutsky, Jean; Tumilty, Emma; Max, Catherine; Lu, Lanting; Tantivess, Sripen; Hauegen, Renata Curi; Whitty, Jennifer A; Weale, Albert; Pearson, Steven D; Tugendhaft, Aviva; Wang, Hufeng; Staniszewska, Sophie; Weerasuriya, Krisantha; Ahn, Jeonghoon; Cubillos, Leonardo

2016-08-15

Purpose - The paper summarizes data from 12 countries, chosen to exhibit wide variation, on the role and place of public participation in the setting of priorities. The purpose of this paper is to exhibit cross-national patterns in respect of public participation, linking those differences to institutional features of the countries concerned. Design/methodology/approach - The approach is an example of case-orientated qualitative assessment of participation practices. It derives its data from the presentation of country case studies by experts on each system. The country cases are located within the historical development of democracy in each country. Findings - Patterns of participation are widely variable. Participation that is effective through routinized institutional processes appears to be inversely related to contestatory participation that uses political mobilization to challenge the legitimacy of the priority setting process. No system has resolved the conceptual ambiguities that are implicit in the idea of public participation. Originality/value - The paper draws on a unique collection of country case studies in participatory practice in prioritization, supplementing existing published sources. In showing that contestatory participation plays an important role in a sub-set of these countries it makes an important contribution to the field because it broadens the debate about public participation in priority setting beyond the use of minipublics and the observation of public representatives on decision-making bodies.

Raising standards while watching the bottom line: making a business case for infection control.

PubMed

Perencevich, Eli N; Stone, Patricia W; Wright, Sharon B; Carmeli, Yehuda; Fisman, David N; Cosgrove, Sara E

2007-10-01

While society would benefit from a reduced incidence of nosocomial infections, there is currently no direct reimbursement to hospitals for the purpose of infection control, which forces healthcare institutions to make economic decisions about funding infection control activities. Demonstrating value to administrators is an increasingly important function of the hospital epidemiologist because healthcare executives are faced with many demands and shrinking budgets. Aware of the difficulties that face local infection control programs, the Society for Healthcare Epidemiology of America (SHEA) Board of Directors appointed a task force to draft this evidence-based guideline to assist hospital epidemiologists in justifying and expanding their programs. In Part 1, we describe the basic steps needed to complete a business-case analysis for an individual institution. A case study based on a representative infection control intervention is provided. In Part 2, we review important basic economic concepts and describe approaches that can be used to assess the financial impact of infection prevention, surveillance, and control interventions, as well as the attributable costs of specific healthcare-associated infections. Both parts of the guideline aim to provide the hospital epidemiologist, infection control professional, administrator, and researcher with the tools necessary to complete a thorough business-case analysis and to undertake an outcome study of a nosocomial infection or an infection control intervention.

Effects of coding dictionary on signal generation: a consideration of use of MedDRA compared with WHO-ART.

PubMed

Brown, Elliot G

2002-01-01

To support signal generation a terminology should facilitate recognition of medical conditions by using terms which represent unique concepts, providing appropriate, homogeneous grouping of related terms. It should allow intuitive or mathematical identification of adverse events reaching a threshold frequency or with disproportionate incidence, permit identification of important events which are commonly drug-related, and support recognition of new syndromes. It is probable that the Medical Dictionary for Regulatory Activities (MedDRA) preferred terms (PTs) or high level terms (HLTs) will be used to represent adverse events for the purposes of signal generation. A comparison with 315 WHO Adverse Reaction Terminology (WHO-ART) PTs showed that for about 72% of WHO-ART PTs, there were one or two corresponding MedDRA PTs. However, there were instances where there were many MedDRA PTs corresponding to single WHO-ART PTs. In many cases, MedDRA HLTs grouped large numbers of PTs and sometimes there could be problems when a single HLT comprises PTs which represent very different medical concepts, or conditions which differ greatly in their clinical importance. Further studies are needed to compare the way in which identical data sets coded with MedDRA and with other terminologies actually function in generating and exploring signals using the same methods of detection and evaluation.

Rabies surveillance in the United States during 2008.

PubMed

Blanton, Jesse D; Robertson, Kis; Palmer, Dustyn; Rupprecht, Charles E

2009-09-15

During 2008, 49 states and Puerto Rico reported 6,841 cases of rabies in animals and 2 cases in humans to the CDC, representing a 3.1% decrease from the 7,060 cases in animals and 1 case in a human reported in 2007. Approximately 93% of the cases were in wildlife, and 7% were in domestic animals. Relative contributions by the major animal groups were as follows: 2,389 (34.9%) raccoons, 1,806 (26.4%) bats, 1,589 (23.2%) skunks, 454 (6.6%) foxes, 294 (4.3%) cats, 75 (1.1%) dogs, and 59 (0.9%) cattle. Compared with numbers of cases reported in 2007, numbers of cases reported in 2008 increased among cats, cattle, and skunks and decreased among dogs, raccoons, bats, and foxes. Numbers of rabid raccoons reported during 2008 decreased in 11 of the 20 eastern states where raccoon rabies was enzootic; overall number of rabid raccoons reported decreased by 8.6% during 2008, compared with 2007. On a national level, the number of rabies cases involving skunks increased by 7.7% during 2008, compared with the number reported in 2007; this was the first increase in the number of reported rabid skunks since 2006. The total number of cases of rabies reported nationally in foxes decreased 1.7% in 2008, compared with 2007. The 1,806 cases of rabies reported in bats represented a 6.7% decrease, compared with the number reported in 2007. One case of rabies in a dog imported from Iraq was reported at a quarantine station in New Jersey during 2008. Follow-up of potentially exposed animals in the same shipment did not reveal any secondary transmission. The United States remained free from dog-to-dog transmission of canine rabies virus variants. Total number of rabid dogs reported decreased 19.4% in 2008, compared with 2007. Two human rabies cases were reported from California and Missouri during 2008. The California case involved a recent immigrant from Mexico and was attributed to a newly identified rabies virus variant most likely associated with Mexican free-tailed bats. The case in Missouri was attributed to a rabies virus variant associated with eastern pipistrelle and silver-haired bats.

Geometric Transforms for Fast Geometric Algorithms.

DTIC Science & Technology

1979-12-01

representation is not an important issue in a real RAM.) For more complicated geometrical objects such as polygons, polyhedrons , and Voronoi diagrams the issue...of N disks canl be represented as a convex polyhedron in O(N log N) time. Proof: We illustrate thle construction in Figurc 3-1 1. We first embed the N...or intersection of N arbitrary planar disks by a convex polyhedron in O(N log N) time. 0. Figure 3-11: General case for intersection or union of N

Fault-tolerant clock synchronization in distributed systems

NASA Technical Reports Server (NTRS)

Ramanathan, Parameswaran; Shin, Kang G.; Butler, Ricky W.

1990-01-01

Existing fault-tolerant clock synchronization algorithms are compared and contrasted. These include the following: software synchronization algorithms, such as convergence-averaging, convergence-nonaveraging, and consistency algorithms, as well as probabilistic synchronization; hardware synchronization algorithms; and hybrid synchronization. The worst-case clock skews guaranteed by representative algorithms are compared, along with other important aspects such as time, message, and cost overhead imposed by the algorithms. More recent developments such as hardware-assisted software synchronization and algorithms for synchronizing large, partially connected distributed systems are especially emphasized.

Evaluating and optimizing the NERSC workload on Knights Landing

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

Barnes, T; Cook, B; Deslippe, J

2017-01-30

NERSC has partnered with 20 representative application teams to evaluate performance on the Xeon-Phi Knights Landing architecture and develop an application-optimization strategy for the greater NERSC workload on the recently installed Cori system. In this article, we present early case studies and summarized results from a subset of the 20 applications highlighting the impact of important architecture differences between the Xeon-Phi and traditional Xeon processors. We summarize the status of the applications and describe the greater optimization strategy that has formed.

Evaluating and Optimizing the NERSC Workload on Knights Landing

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

Barnes, Taylor; Cook, Brandon; Doerfler, Douglas

2016-01-01

NERSC has partnered with 20 representative application teams to evaluate performance on the Xeon-Phi Knights Landing architecture and develop an application-optimization strategy for the greater NERSC workload on the recently installed Cori system. In this article, we present early case studies and summarized results from a subset of the 20 applications highlighting the impact of important architecture differences between the Xeon-Phi and traditional Xeon processors. We summarize the status of the applications and describe the greater optimization strategy that has formed.

A comparison of stress in cracked fibrous tissue specimens with varied crack location, loading, and orientation using finite element analysis.

PubMed

Peloquin, John M; Elliott, Dawn M

2016-04-01

Cracks in fibrous soft tissue, such as intervertebral disc annulus fibrosus and knee meniscus, cause pain and compromise joint mechanics. A crack concentrates stress at its tip, making further failure and crack extension (fracture) more likely. Ex vivo mechanical testing is an important tool for studying the loading conditions required for crack extension, but prior work has shown that it is difficult to reproduce crack extension. Most prior work used edge crack specimens in uniaxial tension, with the crack 90° to the edge of the specimen. This configuration does not necessarily represent the loading conditions that cause in vivo crack extension. To find a potentially better choice for experiments aiming to reproduce crack extension, we used finite element analysis to compare, in factorial combination, (1) center crack vs. edge crack location, (2) biaxial vs. uniaxial loading, and (3) crack-fiber angles ranging from 0° to 90°. The simulated material was annulus fibrosus fibrocartilage with a single fiber family. We hypothesized that one of the simulated test cases would produce a stronger stress concentration than the commonly used uniaxially loaded 90° crack-fiber angle edge crack case. Stress concentrations were compared between cases in terms of fiber-parallel stress (representing risk of fiber rupture), fiber-perpendicular stress (representing risk of matrix rupture), and fiber shear stress (representing risk of fiber sliding). Fiber-perpendicular stress and fiber shear stress concentrations were greatest in edge crack specimens (of any crack-fiber angle) and center crack specimens with a 90° crack-fiber angle. However, unless the crack is parallel to the fiber direction, these stress components alone are insufficient to cause crack opening and extension. Fiber-parallel stress concentrations were greatest in center crack specimens with a 45° crack-fiber angle, either biaxially or uniaxially loaded. We therefore recommend that the 45° center crack case be tried in future experiments intended to study crack extension by fiber rupture. Copyright © 2015 Elsevier Ltd. All rights reserved.

Epidemiology and Clinical Relevance of Toxic Shock Syndrome in US Children.

PubMed

Gaensbauer, James T; Birkholz, Meghan; Smit, Michael A; Garcia, Roger; Todd, James K

2018-03-27

It is important for clinicians to recognize the contribution of toxic shock syndrome (TSS) to the overall burden of pediatric septic shock because the clinical features, optimal therapy and prognosis differ from non-TSS septic shock. We analyzed cases of pediatric septic shock reported to the Pediatric Health Information Systems (PHIS) database between 2009 and 2013 to define the clinical and demographic characteristics of pediatric TSS in the US. Using a validated ICD-9 coding strategy we identified patients with infectious shock among inpatients age 1 to 18 years, and classified cases of staphylococcal and streptococcal TSS for comparison with non-TSS cases. Of 8,226 cases of pediatric septic shock, 909 (11.1%) were classified as TSS and 562 (6.8%) were possible TSS cases. Staphylococcal TSS represented the majority (83%) of TSS cases, and occurred more commonly in females and at an older age. Compared with non-TSS septic shock, TSS had significantly lower fatality rates, disease severity, and length of hospital stay, and was present more often at the time of admission (p<0.001 for each). Streptococcal TSS was associated with poorer outcomes than staphylococcal TSS. Treatment for TSS differed from non-TSS septic shock in use of more clindamycin, vancomycin and IVIG, and less need for vasopressors. Results demonstrate a significant contribution of TSS to the burden of pediatric septic shock in the US. The findings emphasize the importance of inclusion of TSS diagnostic and therapeutic considerations in sepsis treatment protocols for children.

Setbacks in the process of assimilation of problematic experiences in two cases of emotion-focused therapy for depression.

PubMed

Mendes, Inês; Rosa, Catarina; Stiles, William B; Caro Gabalda, Isabel; Gomes, Pedro; Basto, Isabel; Salgado, João

2016-11-01

Research on the assimilation model has suggested that psychological change takes place in a sequence of stages punctuated by setbacks, that is, by transient reversals in the developmental course. This study analyzed such setbacks in one good outcome case and one poor outcome case of Emotion-focused therapy (EFT) for depression. Intensive analyses of five transcribed sessions from each case identified 26 setbacks in the good outcome case and 27 in the poor outcome case. The reason for each setback was classified into one of four categories: balance strategy, exceeding the therapeutic zone of proximal development either induced by the therapist (ZPD-T) or induced by the client (ZPD-C), or spontaneous switches. In the good outcome case the most frequent reasons for setbacks were balance strategy and spontaneous switches, whereas in the poor outcome case the most frequent reason for setbacks was ZPD-T. As in previously studied therapies, setbacks in EFT, usually represent productive work on relatively less advanced strands of the client's major problems. Results point to the importance of the therapist attending to the limits of the client's therapeutic ZPD.

Integrating chronological uncertainties for annually laminated lake sediments using layer counting, independent chronologies and Bayesian age modelling (Lake Ohau, South Island, New Zealand)

NASA Astrophysics Data System (ADS)

Vandergoes, Marcus J.; Howarth, Jamie D.; Dunbar, Gavin B.; Turnbull, Jocelyn C.; Roop, Heidi A.; Levy, Richard H.; Li, Xun; Prior, Christine; Norris, Margaret; Keller, Liz D.; Baisden, W. Troy; Ditchburn, Robert; Fitzsimons, Sean J.; Bronk Ramsey, Christopher

2018-05-01

Annually resolved (varved) lake sequences are important palaeoenvironmental archives as they offer a direct incremental dating technique for high-frequency reconstruction of environmental and climate change. Despite the importance of these records, establishing a robust chronology and quantifying its precision and accuracy (estimations of error) remains an essential but challenging component of their development. We outline an approach for building reliable independent chronologies, testing the accuracy of layer counts and integrating all chronological uncertainties to provide quantitative age and error estimates for varved lake sequences. The approach incorporates (1) layer counts and estimates of counting precision; (2) radiometric and biostratigrapic dating techniques to derive independent chronology; and (3) the application of Bayesian age modelling to produce an integrated age model. This approach is applied to a case study of an annually resolved sediment record from Lake Ohau, New Zealand. The most robust age model provides an average error of 72 years across the whole depth range. This represents a fractional uncertainty of ∼5%, higher than the <3% quoted for most published varve records. However, the age model and reported uncertainty represent the best fit between layer counts and independent chronology and the uncertainties account for both layer counting precision and the chronological accuracy of the layer counts. This integrated approach provides a more representative estimate of age uncertainty and therefore represents a statistically more robust chronology.

RACORO continental boundary layer cloud investigations. Part I: Case study development and ensemble large-scale forcings

DOE PAGES

Vogelmann, Andrew M.; Fridlind, Ann M.; Toto, Tami; ...

2015-06-19

Observation-based modeling case studies of continental boundary layer clouds have been developed to study cloudy boundary layers, aerosol influences upon them, and their representation in cloud- and global-scale models. Three 60-hour case study periods span the temporal evolution of cumulus, stratiform, and drizzling boundary layer cloud systems, representing mixed and transitional states rather than idealized or canonical cases. Based on in-situ measurements from the RACORO field campaign and remote-sensing observations, the cases are designed with a modular configuration to simplify use in large-eddy simulations (LES) and single-column models. Aircraft measurements of aerosol number size distribution are fit to lognormal functionsmore » for concise representation in models. Values of the aerosol hygroscopicity parameter, κ, are derived from observations to be ~0.10, which are lower than the 0.3 typical over continents and suggestive of a large aerosol organic fraction. Ensemble large-scale forcing datasets are derived from the ARM variational analysis, ECMWF forecasts, and a multi-scale data assimilation system. The forcings are assessed through comparison of measured bulk atmospheric and cloud properties to those computed in 'trial' large-eddy simulations, where more efficient run times are enabled through modest reductions in grid resolution and domain size compared to the full-sized LES grid. Simulations capture many of the general features observed, but the state-of-the-art forcings were limited at representing details of cloud onset, and tight gradients and high-resolution transients of importance. Methods for improving the initial conditions and forcings are discussed. The cases developed are available to the general modeling community for studying continental boundary clouds.« less

RACORO Continental Boundary Layer Cloud Investigations: 1. Case Study Development and Ensemble Large-Scale Forcings

NASA Technical Reports Server (NTRS)

Vogelmann, Andrew M.; Fridlind, Ann M.; Toto, Tami; Endo, Satoshi; Lin, Wuyin; Wang, Jian; Feng, Sha; Zhang, Yunyan; Turner, David D.; Liu, Yangang;

RACORO continental boundary layer cloud investigations: 1. Case study development and ensemble large-scale forcings

NASA Astrophysics Data System (ADS)

Vogelmann, Andrew M.; Fridlind, Ann M.; Toto, Tami; Endo, Satoshi; Lin, Wuyin; Wang, Jian; Feng, Sha; Zhang, Yunyan; Turner, David D.; Liu, Yangang; Li, Zhijin; Xie, Shaocheng; Ackerman, Andrew S.; Zhang, Minghua; Khairoutdinov, Marat

2015-06-01

Observation-based modeling case studies of continental boundary layer clouds have been developed to study cloudy boundary layers, aerosol influences upon them, and their representation in cloud- and global-scale models. Three 60 h case study periods span the temporal evolution of cumulus, stratiform, and drizzling boundary layer cloud systems, representing mixed and transitional states rather than idealized or canonical cases. Based on in situ measurements from the Routine AAF (Atmospheric Radiation Measurement (ARM) Aerial Facility) CLOWD (Clouds with Low Optical Water Depth) Optical Radiative Observations (RACORO) field campaign and remote sensing observations, the cases are designed with a modular configuration to simplify use in large-eddy simulations (LES) and single-column models. Aircraft measurements of aerosol number size distribution are fit to lognormal functions for concise representation in models. Values of the aerosol hygroscopicity parameter, κ, are derived from observations to be 0.10, which are lower than the 0.3 typical over continents and suggestive of a large aerosol organic fraction. Ensemble large-scale forcing data sets are derived from the ARM variational analysis, European Centre for Medium-Range Weather Forecasts, and a multiscale data assimilation system. The forcings are assessed through comparison of measured bulk atmospheric and cloud properties to those computed in "trial" large-eddy simulations, where more efficient run times are enabled through modest reductions in grid resolution and domain size compared to the full-sized LES grid. Simulations capture many of the general features observed, but the state-of-the-art forcings were limited at representing details of cloud onset, and tight gradients and high-resolution transients of importance. Methods for improving the initial conditions and forcings are discussed. The cases developed are available to the general modeling community for studying continental boundary clouds.

Visualising Pareto-optimal trade-offs helps move beyond monetary-only criteria for water management decisions

NASA Astrophysics Data System (ADS)

Hurford, Anthony; Harou, Julien

2014-05-01

Water related eco-system services are important to the livelihoods of the poorest sectors of society in developing countries. Degradation or loss of these services can increase the vulnerability of people decreasing their capacity to support themselves. New approaches to help guide water resources management decisions are needed which account for the non-market value of ecosystem goods and services. In case studies from Brazil and Kenya we demonstrate the capability of many objective Pareto-optimal trade-off analysis to help decision makers balance economic and non-market benefits from the management of existing multi-reservoir systems. A multi-criteria search algorithm is coupled to a water resources management simulator of each basin to generate a set of Pareto-approximate trade-offs representing the best case management decisions. In both cases, volume dependent reservoir release rules are the management decisions being optimised. In the Kenyan case we further assess the impacts of proposed irrigation investments, and how the possibility of new investments impacts the system's trade-offs. During the multi-criteria search (optimisation), performance of different sets of management decisions (policies) is assessed against case-specific objective functions representing provision of water supply and irrigation, hydropower generation and maintenance of ecosystem services. Results are visualised as trade-off surfaces to help decision makers understand the impacts of different policies on a broad range of stakeholders and to assist in decision-making. These case studies show how the approach can reveal unexpected opportunities for win-win solutions, and quantify the trade-offs between investing to increase agricultural revenue and negative impacts on protected ecosystems which support rural livelihoods.

Molecular Epidemiology of Streptococcus uberis Clinical Mastitis in Dairy Herds: Strain Heterogeneity and Transmission.

PubMed

Davies, P L; Leigh, J A; Bradley, A J; Archer, S C; Emes, R D; Green, M J

2016-01-01

Multilocus sequence typing was successfully completed on 494 isolates of Streptococcus uberis from clinical mastitis cases in a study of 52 commercial dairy herds over a 12-month period. In total, 195 sequence types (STs) were identified. S. uberis mastitis cases that occurred in different cows within the same herd and were attributed to a common ST were classified as potential transmission events (PTEs). Clinical cases attributed to 35 of the 195 STs identified in this study were classified PTE. PTEs were identified in 63% of the herds. PTE-associated cases, which include the first recorded occurrence of that ST in that herd (index case) and all persistent infections with that PTE ST, represented 40% of all the clinical mastitis cases and occurred in 63% of the herds. PTE-associated cases accounted for >50% of all S. uberis clinical mastitis cases in 33% of the herds. Nine STs (ST-5, -6, -20, -22, -24, -35, -233, -361, and -512), eight of which were grouped within a clonal complex (sharing at least four alleles), were statistically overrepresented (OVR STs). The findings indicate that 38% of all clinical mastitis cases and 63% of the PTEs attributed to S. uberis in dairy herds may be caused by the nine most prevalent strains. The findings suggest that a small subset of STs is disproportionally important in the epidemiology of S. uberis mastitis in the United Kingdom, with cow-to-cow transmission of S. uberis potentially occurring in the majority of herds in the United Kingdom, and may be the most important route of infection in many herds. Copyright © 2015 Davies et al.

The Theme of Celestial Bodies in Armenian Lullabies

NASA Astrophysics Data System (ADS)

Hakobyan, Ani

2016-12-01

Folk art is representing the type and the mentality of the nation. People's perceptions and understanding of life, the universe and the world around them are reflected in it. In folk songs coming from the times before Christianity and preserved until now there are many cosmic bodies commemorations and many attempts to consider man as heliocentric and important phenomenon. In this case, we focus on the presence of the sun, the moon and stars in one of the most interesting genres of Armenian folk music - lullabies. This article is meant to represent the ancient Pythagorean theory of cosmic origins of music and coming back to the mentioned genre of the folk art it is also showing the imaging of cosmic bodies on recorded samples of Armenian lullabies of various areas and provinces.

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.

Multidisciplinary care in severe pediatric electrical oral burn.

PubMed

Pontini, A; Reho, F; Giatsidis, G; Bacci, C; Azzena, B; Tiengo, C

2015-05-01

Oral burns in pediatric patient are commonly due to electrical injuries, representing an important reconstructive issue even for functional than esthetic reason. Different classification, surgical management and even oral device were described to allow the best long-term result. In most case a multidisciplinary approach is necessary to achieve a satisfactory outcome. A severe case of pediatric oral burn with germinative teeth damage is presented, describing a multispecialist team approach that guarantee a satisfactory outcome by reconstructive surgery, careful progressive evaluation of dental and soft tissue healing and speech recovery. The use of acellular dermal substitute template within traditional reconstructive surgery had provided a good functional and esthetic result joint to valid preservation of germinative dental element as shown at long-term X-ray evaluation. Intensive rehabilitation speech program has also avoided phonetic impairment in an important speech develop period. It was so evident that the necessity of a multispecialist care in such difficult injury to achieve the best long-term result. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Application of a 980-nanometer diode laser in neuroendoscopy: a case series.

PubMed

Reis, Rodolfo Casimiro; Teixeira, Manoel Jacobsen; Mancini, Marilia Wellichan; Almeida-Lopes, Luciana; de Oliveira, Matheus Fernandes; Pinto, Fernando Campos Gomes

2016-02-01

Ventricular neuroendoscopy represents an important advance in the treatment of hydrocephalus. High-power (surgical) Nd:YAG laser and low-level laser therapy (using 685-nm-wavelength diode laser) have been used in conjunction with neuroendoscopy with favorable results. This study evaluated the use of surgical 980-nm-wavelength diode laser for the neuroendoscopic treatment of ventricular diseases. Nine patients underwent a neuroendoscopic procedure with 980-nm diode laser. Complications and follow-up were recorded. Three in-hospital postoperative complications were recorded (1 intraventricular hemorrhage and 2 meningitis cases). The remaining 6 patients had symptom improvement after endoscopic surgery and were discharged from the hospital within 24-48 hours after surgery. Patients were followed for an average of 14 months: 1 patient developed meningitis and another died suddenly at home. The other patients did well and were asymptomatic until the last follow-up consultation. The 980-nm diode laser is considered an important therapeutic tool for endoscopic neurological surgeries. This study showed its application in different ventricular diseases.

Grassmann phase space methods for fermions. II. Field theory

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

Dalton, B.J., E-mail: bdalton@swin.edu.au; Jeffers, J.; Barnett, S.M.

In both quantum optics and cold atom physics, the behaviour of bosonic photons and atoms is often treated using phase space methods, where mode annihilation and creation operators are represented by c-number phase space variables, with the density operator equivalent to a distribution function of these variables. The anti-commutation rules for fermion annihilation, creation operators suggests the possibility of using anti-commuting Grassmann variables to represent these operators. However, in spite of the seminal work by Cahill and Glauber and a few applications, the use of Grassmann phase space methods in quantum-atom optics to treat fermionic systems is rather rare, thoughmore » fermion coherent states using Grassmann variables are widely used in particle physics. This paper presents a phase space theory for fermion systems based on distribution functionals, which replace the density operator and involve Grassmann fields representing anti-commuting fermion field annihilation, creation operators. It is an extension of a previous phase space theory paper for fermions (Paper I) based on separate modes, in which the density operator is replaced by a distribution function depending on Grassmann phase space variables which represent the mode annihilation and creation operators. This further development of the theory is important for the situation when large numbers of fermions are involved, resulting in too many modes to treat separately. Here Grassmann fields, distribution functionals, functional Fokker–Planck equations and Ito stochastic field equations are involved. Typical applications to a trapped Fermi gas of interacting spin 1/2 fermionic atoms and to multi-component Fermi gases with non-zero range interactions are presented, showing that the Ito stochastic field equations are local in these cases. For the spin 1/2 case we also show how simple solutions can be obtained both for the untrapped case and for an optical lattice trapping potential.« less

Algorithms and theory for the design and programming of industrial control systems materialized with PLC's

NASA Astrophysics Data System (ADS)

Montoya Villena, Rafael

According to its title, the general objective of the Thesis consists in developing a clear, simple and systematic methodology for programming type PLC devices. With this aim in mind, we will use the following elements: Codification of all variables types. This section is very important since it allows us working with little information. The necessary rules are given to codify all type of phrases produced in industrial processes. An algorithm that describes process evolution and that has been called process D.F. This is one of the most important contributions, since it will allow us, together with information codification, representing the process evolution in a graphic way and with any design theory used. Theory selection. Evidently, the use of some kind of design method is necessary to obtain logic equations. For this particular case, we will use binodal theory, an ideal theory for wired technologies, since it can obtain highly reduced schemas for relatively simple automatisms, which means a minimum number of components used. User program outline algorithm (D.F.P.). This is another necessary contribution and perhaps the most important one, since logic equations resulting from binodal theory are compatible with process evolution if wired technology is used, whether it is electric, electronic, pneumatic, etc. On the other hand, PLC devices performance characteristics force the program instructions order to validate or not the automatism, as we have proven in different articles and lectures at congresses both national and international. Therefore, we will codify any information concerning the automating process, graphically represent its temporal evolution and, applying binodal theory and D.F.P (previously adapted), succeed in making logic equations compatible with the process to be automated and the device in which they will be implemented (PLC in our case)

A methodology to estimate representativeness of LAI station observation for validation: a case study with Chinese Ecosystem Research Network (CERN) in situ data

NASA Astrophysics Data System (ADS)

Xu, Baodong; Li, Jing; Liu, Qinhuo; Zeng, Yelu; Yin, Gaofei

2014-11-01

Leaf Area Index (LAI) is known as a key vegetation biophysical variable. To effectively use remote sensing LAI products in various disciplines, it is critical to understand the accuracy of them. The common method for the validation of LAI products is firstly establish the empirical relationship between the field data and high-resolution imagery, to derive LAI maps, then aggregate high-resolution LAI maps to match moderate-resolution LAI products. This method is just suited for the small region, and its frequencies of measurement are limited. Therefore, the continuous observing LAI datasets from ground station network are important for the validation of multi-temporal LAI products. However, due to the scale mismatch between the point observation in the ground station and the pixel observation, the direct comparison will bring the scale error. Thus it is needed to evaluate the representativeness of ground station measurement within pixel scale of products for the reasonable validation. In this paper, a case study with Chinese Ecosystem Research Network (CERN) in situ data was taken to introduce a methodology to estimate representativeness of LAI station observation for validating LAI products. We first analyzed the indicators to evaluate the observation representativeness, and then graded the station measurement data. Finally, the LAI measurement data which can represent the pixel scale was used to validate the MODIS, GLASS and GEOV1 LAI products. The result shows that the best agreement is reached between the GLASS and GEOV1, while the lowest uncertainty is achieved by GEOV1 followed by GLASS and MODIS. We conclude that the ground station measurement data can validate multi-temporal LAI products objectively based on the evaluation indicators of station observation representativeness, which can also improve the reliability for the validation of remote sensing products.

Linear models of activation cascades: analytical solutions and coarse-graining of delayed signal transduction

PubMed Central

Desikan, Radhika

2016-01-01

Cellular signal transduction usually involves activation cascades, the sequential activation of a series of proteins following the reception of an input signal. Here, we study the classic model of weakly activated cascades and obtain analytical solutions for a variety of inputs. We show that in the special but important case of optimal gain cascades (i.e. when the deactivation rates are identical) the downstream output of the cascade can be represented exactly as a lumped nonlinear module containing an incomplete gamma function with real parameters that depend on the rates and length of the cascade, as well as parameters of the input signal. The expressions obtained can be applied to the non-identical case when the deactivation rates are random to capture the variability in the cascade outputs. We also show that cascades can be rearranged so that blocks with similar rates can be lumped and represented through our nonlinear modules. Our results can be used both to represent cascades in computational models of differential equations and to fit data efficiently, by reducing the number of equations and parameters involved. In particular, the length of the cascade appears as a real-valued parameter and can thus be fitted in the same manner as Hill coefficients. Finally, we show how the obtained nonlinear modules can be used instead of delay differential equations to model delays in signal transduction. PMID:27581482

Epidemiological Scenario of Dengue in Brazil

PubMed Central

2015-01-01

Dengue is the most important reemerging mosquito-borne viral disease worldwide. It is caused by any of four Dengue virus types or serotypes (DENV-1 to DENV-4) and is transmitted by mosquitoes from the genus Aedes. Ecological changes have favored the geographic expansion of the vector and, since the dengue pandemic in the Asian and Pacific regions, the infection became widely distributed worldwide, reaching Brazil in 1845. The incidence of dengue in Brazil has been frequently high, and the number of cases in the country has at some point in time represented up to 60% of the dengue reported cases worldwide. This review addresses vector distribution, dengue outbreaks, circulating serotypes and genotypes, and prevention approaches being utilized in Brazil. PMID:26413514

A 71-Year-Old Female with Myocardial Infarction and Long-Standing Ulcers on the Thigh

PubMed Central

De Flammineis, Eduardo; Mulvaney, Patrick M.; Kraft, Stefan; Mihm Jr., Martin C.; Das, Shinjita; Kroshinsky, Daniela

2017-01-01

Calciphylaxis is most commonly encountered in patients with end-stage renal disease; however, it is increasingly observed in nonuremic patients as well. It is important to consider and diagnose nonuremic calciphylaxis early, as prompt treatment and mitigation of associated risk factors is essential to improve long-term outcomes for these patients. Here, we present the case of a 71-year-old woman with atrial fibrillation on warfarin, but without renal disease, who presented with two long-standing ulcers on her thigh and was diagnosed with the aid of biopsy with calciphylaxis. We review the existing literature on the subject and offer this case as a representative report of a clinicopathologic correlation for this disorder. PMID:29456997

Bilateral maxillary brown tumors in a patient with primary hyperparathyroidism: Report of a rare entity and review of literature

PubMed Central

Soundarya, N; Sharada, P; Prakash, Nilima; Pradeep, GL

2011-01-01

Brown tumors are erosive bony lesions caused by rapid osteoclastic activity and peritrabecular fibrosis due to hyperparathyroidism, resulting in a local destructive phenomenon. The classical “brown tumor” is commonly seen in ends of long bones, the pelvis and ribs. Facial involvement is rare and, when present, usually involves the mandible. We report a case of 60-year-old male with a rare initial presentation of primary hyperparathyroidism with bilateral maxillary brown tumors. The present case represents the third report of the bilateral maxillary brown tumors in a patient with primary hyperparathyroidism. Differential diagnosis is important for the right treatment choice. It should exclude other giant cell lesions that affect the maxillae. PMID:21731279

A gastrointestinal stromal tumour with pulmonary metastases mimicking unilateral gynaecomastia

PubMed Central

Guler Cimen, Sanem; MacDonald, Frank; Cimen, Sertac; Molinari, Michele

2013-01-01

Gastrointestinal stromal tumours (GISTs) represent 1% of primary gastrointestinal cancers. These neoplasms most frequently metastasise to the liver and peritoneum and rarely to the lungs and bones. Treatment of unresectable GISTs involves systemic chemotherapy with tyrosine kinase inhibitors, imatinib and sunitinib being first-line and second-line drugs. We report the case of a 52-year-old man with GIST who developed a right-sided subareolar breast swelling and subsequently discovered to be an invasive metastatic pulmonary GIST. Given that gynaecomastia is a known adverse effect of imatinib and sunitinib, this case report illustrates the importance of including metastatic disease in the differential diagnosis of patients with GIST and with the new onset of soft tissue masses. PMID:24343802

Severe psychosocial compromise in idiopathic trigeminal neuralgia: case report.

PubMed

Siqueira, Silvia R D T; Teixeira, Manoel J; de Siqueira, José T T

2010-03-01

This article describes a 60-year-old man with 17 years of idiopathic trigeminal neuralgia (ITN) which affected tooth brushing for 6 years, causing severe dental complications and psychosocial problems. Case report. Following ITN diagnosis, this patient underwent neurosurgery (microcompression of the trigeminal ganglion with a balloon) with immediate relief, but after three months, pain recurred and was accompanied by dysesthesia and periodontal disease. After dental treatment, he had complete alleviation of pain and no further need of medication over the following 3 years. The intense suffering of this patient represents the importance of a multidisciplinary evaluation for pain-caused secondary complications. ITN is a simple diagnosis but may have complex course. Appropriately trained health professionals are necessary to evaluate and treat these patients.

Ciguatera fish poisoning in East Asia and southeast Asia.

PubMed

Chan, Thomas Y K

2015-06-02

In the coastal countries of East Asia and Southeast Asia, ciguatera should be common because of the extensive tropical and subtropical coral reefs along the coasts and in the neighboring seas with ciguatoxic fishes. An extensive search of journal databases, the Internet and the government websites was performed to identify all reports of ciguatera from the regions. Based on the official data and large published case series, the incidence of ciguatera was higher in the coastal cities (Hong Kong, Foshan, Zhongshan) of southern China than in Japan (Okinawa Prefecture). In Singapore, ciguatera appeared to be almost unknown. In other countries, only isolated cases or small case series were reported, but under-reporting was assumed to be common. Ciguatera may cause severe acute illness and prolonged neurological symptoms. Ciguatera represents an important public health issue for endemic regions, with significant socio-economic impact. Coordinated strategies to improve risk assessment, risk management and risk communication are required. The systematic collection of accurate data on the incidence and epidemiology of ciguatera should enable better assessment and management of its risk. Much more work needs to be done to define the size threshold for important coral reef fish species from different regions, above which the risk of ciguatera significantly increases.

Retesting of liquefaction and nonliquefaction case histories from the 1976 Tangshan earthquake

USGS Publications Warehouse

Moss, R.E.S.; Kayen, R.E.; Tong, L.-Y.; Liu, S.-Y.; Cai, G.-J.; Wu, J.

2011-01-01

A field investigation was performed to retest liquefaction and nonliquefaction sites from the 1976 Tangshan earthquake in China. These sites were carefully investigated in 1978 and 1979 by using standard penetration test (SPT) and cone penetration test (CPT) equipment; however, the CPT measurements are obsolete because of the now nonstandard cone that was used at the time. In 2007, a modern cone was mobilized to retest 18 selected sites that are particularly important because of the intense ground shaking they sustained despite their high fines content and/or because the site did not liquefy. Of the sites reinvestigated and carefully reprocessed, 13 were considered accurate representative case histories. Two of the sites that were originally investigated for liquefaction have been reinvestigated for cyclic failure of fine-grained soil and removed from consideration for liquefaction triggering. The most important outcome of these field investigations was the collection of more accurate data for three nonliquefaction sites that experienced intense ground shaking. Data for these three case histories is now included in an area of the liquefaction triggering database that was poorly populated and will help constrain the upper bound of future liquefaction triggering curves. ?? 2011 American Society of Civil Engineers.

77 FR 39346 - Proposed Information Collection (Statement of Accredited Representative in Appealed Case, VA Form...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-02

... in Appealed Case, VA Form 646. OMB Control Number: 2900-0042. Type of Review: Extension of a... (Statement of Accredited Representative in Appealed Case, VA Form 646) Activity: Comment Request AGENCY: The Board of Veterans' Appeals (BVA), Department of Veterans Affairs. ACTION: Notice. SUMMARY: The Board of...

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

PubMed

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

2008-03-01

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

Case studies, cross-site comparisons, and the challenge of generalization: comparing agent-based models of land-use change in frontier regions

PubMed Central

Parker, Dawn C.; Entwisle, Barbara; Rindfuss, Ronald R.; Vanwey, Leah K.; Manson, Steven M.; Moran, Emilio; An, Li; Deadman, Peter; Evans, Tom P.; Linderman, Marc; Rizi, S. Mohammad Mussavi; Malanson, George

2009-01-01

Cross-site comparisons of case studies have been identified as an important priority by the land-use science community. From an empirical perspective, such comparisons potentially allow generalizations that may contribute to production of global-scale land-use and land-cover change projections. From a theoretical perspective, such comparisons can inform development of a theory of land-use science by identifying potential hypotheses and supporting or refuting evidence. This paper undertakes a structured comparison of four case studies of land-use change in frontier regions that follow an agent-based modeling approach. Our hypothesis is that each case study represents a particular manifestation of a common process. Given differences in initial conditions among sites and the time at which the process is observed, actual mechanisms and outcomes are anticipated to differ substantially between sites. Our goal is to reveal both commonalities and differences among research sites, model implementations, and ultimately, conclusions derived from the modeling process. PMID:19960107

Case studies, cross-site comparisons, and the challenge of generalization: comparing agent-based models of land-use change in frontier regions.

PubMed

Parker, Dawn C; Entwisle, Barbara; Rindfuss, Ronald R; Vanwey, Leah K; Manson, Steven M; Moran, Emilio; An, Li; Deadman, Peter; Evans, Tom P; Linderman, Marc; Rizi, S Mohammad Mussavi; Malanson, George

2008-01-01

Cross-site comparisons of case studies have been identified as an important priority by the land-use science community. From an empirical perspective, such comparisons potentially allow generalizations that may contribute to production of global-scale land-use and land-cover change projections. From a theoretical perspective, such comparisons can inform development of a theory of land-use science by identifying potential hypotheses and supporting or refuting evidence. This paper undertakes a structured comparison of four case studies of land-use change in frontier regions that follow an agent-based modeling approach. Our hypothesis is that each case study represents a particular manifestation of a common process. Given differences in initial conditions among sites and the time at which the process is observed, actual mechanisms and outcomes are anticipated to differ substantially between sites. Our goal is to reveal both commonalities and differences among research sites, model implementations, and ultimately, conclusions derived from the modeling process.

Barriers to treatment access for Chagas disease in Mexico.

PubMed

Manne, Jennifer M; Snively, Callae S; Ramsey, Janine M; Salgado, Marco Ocampo; Bärnighausen, Till; Reich, Michael R

2013-01-01

According to World Health Organization (WHO) prevalence estimates, 1.1 million people in Mexico are infected with Trypanosoma cruzi, the etiologic agent of Chagas disease (CD). However, limited information is available about access to antitrypanosomal treatment. This study assesses the extent of access in Mexico, analyzes the barriers to access, and suggests strategies to overcome them. Semi-structured in-depth interviews were conducted with 18 key informants and policymakers at the national level in Mexico. Data on CD cases, relevant policy documents and interview data were analyzed using the Flagship Framework for Pharmaceutical Policy Reform policy interventions: regulation, financing, payment, organization, and persuasion. Data showed that 3,013 cases were registered nationally from 2007-2011, representing 0.41% of total expected cases based on Mexico's national prevalence estimate. In four of five years, new registered cases were below national targets by 11-36%. Of 1,329 cases registered nationally in 2010-2011, 834 received treatment, 120 were pending treatment as of January 2012, and the treatment status of 375 was unknown. The analysis revealed that the national program mainly coordinated donation of nifurtimox and that important obstacles to access include the exclusion of antitrypanosomal medicines from the national formulary (regulation), historical exclusion of CD from the social insurance package (organization), absence of national clinical guidelines (organization), and limited provider awareness (persuasion). Efforts to treat CD in Mexico indicate an increased commitment to addressing this disease. Access to treatment could be advanced by improving the importation process for antitrypanosomal medicines and adding them to the national formulary, increasing education for healthcare providers, and strengthening clinical guidelines. These recommendations have important implications for other countries in the region with similar problems in access to treatment for CD.

Epidemiology of infectious meningitis in the State of Amazonas, Brazil.

PubMed

Saraiva, Maria das Graças Gomes; Santos, Eyde Cristianne Saraiva; Saraceni, Valéria; Rocha, Lívia Laura dos Santos; Monte, Rossicléia Lins; Albuquerque, Bernardino Cláudio de; Bastos, Michele de Souza; Santos, Marcelo Cordeiro dos; Monteiro, Wuelton Marcelo; Mourão, Maria Paula Gomes; Guerra, Marcus Vinitius de Farias; Lacerda, Marcus Vinícius Guimarães de

2015-01-01

In the State of Amazonas, particularly in the capital Manaus, meningitis has affected populations of different cultures and social strata over the years. Bacterial meningitis is caused by several different species and represents a major issue of public health importance. The present study reports the meningitis case numbers with different etiologies in Amazonas from January 1976 to December 2012. Since the 1970s, the (currently named) Tropical Medicine Foundation of Doutor Heitor Vieira Dourado [Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD)] has remained a reference center in Amazonas for the treatment of meningitis through the diagnosis and notification of cases and the confirmation of such cases using specific laboratory tests. The foundation has achieved coverage of over 90% of the state medical records for many years. Between 1990 and 2012, meningitis cases caused by Haemophilus influenzae decreased with the introduction of the H. influenzae vaccine. Meningococcal disease previously had a higher frequency of serogroup B disease, but starting in 2008, the detection of serogroup C increased gradually and has outpaced the detection of serogroup B. Recently, surveillance has improved the etiological definition of viral meningitis at FMT-HVD, with enteroviruses, Epstein-Barr virus (EBV) and varicella zoster virus (VZV) prevailing in this group of pathogens. With the advent of acquired immunodeficiency syndrome (AIDS), cryptococcal meningitis has become an important disease in Amazonas. Additionally, infectious meningitis is an important burden in the State of Amazonas. Changes in the epidemiological profile for the different etiology-defined cases are the result of continuous epidemiological surveillance and laboratory capacity improvements and control measures, such as Haemophilus influenzae vaccination.

Barriers to Treatment Access for Chagas Disease in Mexico

PubMed Central

Manne, Jennifer M.; Snively, Callae S.; Ramsey, Janine M.; Salgado, Marco Ocampo; Bärnighausen, Till; Reich, Michael R.

2013-01-01

Background According to World Health Organization (WHO) prevalence estimates, 1.1 million people in Mexico are infected with Trypanosoma cruzi, the etiologic agent of Chagas disease (CD). However, limited information is available about access to antitrypanosomal treatment. This study assesses the extent of access in Mexico, analyzes the barriers to access, and suggests strategies to overcome them. Methods and Findings Semi-structured in-depth interviews were conducted with 18 key informants and policymakers at the national level in Mexico. Data on CD cases, relevant policy documents and interview data were analyzed using the Flagship Framework for Pharmaceutical Policy Reform policy interventions: regulation, financing, payment, organization, and persuasion. Data showed that 3,013 cases were registered nationally from 2007–2011, representing 0.41% of total expected cases based on Mexico's national prevalence estimate. In four of five years, new registered cases were below national targets by 11–36%. Of 1,329 cases registered nationally in 2010–2011, 834 received treatment, 120 were pending treatment as of January 2012, and the treatment status of 375 was unknown. The analysis revealed that the national program mainly coordinated donation of nifurtimox and that important obstacles to access include the exclusion of antitrypanosomal medicines from the national formulary (regulation), historical exclusion of CD from the social insurance package (organization), absence of national clinical guidelines (organization), and limited provider awareness (persuasion). Conclusions Efforts to treat CD in Mexico indicate an increased commitment to addressing this disease. Access to treatment could be advanced by improving the importation process for antitrypanosomal medicines and adding them to the national formulary, increasing education for healthcare providers, and strengthening clinical guidelines. These recommendations have important implications for other countries in the region with similar problems in access to treatment for CD. PMID:24147169

Liver graft vascular variant with 3 extra-hepatic arteries.

PubMed

Martins, Paulo N

2010-06-01

Vascular anatomy of the liver is varied, and the "standard" anatomy is seen in 55%-80% of cases. It is very important that extrahepatic arteries are identified precisely at the time of graft procurement to avoid injuries that might compromise the liver function. In the present case the liver donor had the vascular anatomy of Michels type VII, e.g. a hepatic artery originating from the celiac trunk and going to the left lobe, an accessory left hepatic artery coming from the left gastric artery, and a replaced right hepatic artery coming from the superior mesenteric artery. This pattern of vascular supply is uncommon, representing less than 5% of cases. The replaced hepatic artery was reconstructed in the back-table with polypropylene suture 7.0 by connecting it to the stump of the splenic artery, and the celiac trunk of the graft was anastomosed to the recipient common hepatic artery.

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

Mills, Evan; Jones, Richard B.

Large yet infrequent disruptions of electrical power can impact tens of millions of people in a single event, triggering significant economic damages, portions of which are insured. Small and frequent events are also significant in the aggregate. This article explores the role that insurance claims data can play in better defining the broader economic impacts of grid disruptions in the U.S. context. We developed four case studies, using previously unpublished data for specific actual grid disruptions. The cases include the 1977 New York City blackout, the 2003 Northeast blackout, multi-year national annual lightning-related electrical damage and multi-year national line-disturbance events.more » Insured losses represent between 3 and 64 per cent of total loss costs across the case studies. Here, the household sector emerges as a larger locus of costs than indicated in previous studies, and short-lived events emerge as important sources of loss costs.« less

Successful treatment of toxoplasmic encephalitis diagnosed early by polymerase chain reaction after allogeneic hematopoietic stem cell transplantation: two case reports and review of the literature.

PubMed

Miyagi, T; Itonaga, H; Aosai, F; Taguchi, J; Norose, K; Mochizuki, K; Fujii, H; Furumoto, A; Ohama, M; Karimata, K; Yamanoha, A; Taniguchi, H; Sato, S; Taira, N; Moriuchi, Y; Fukushima, T; Masuzaki, H; Miyazaki, Y

2015-08-01

Toxoplasmic encephalitis represents a rare, but often fatal infection after allogeneic hematopoietic stem cell transplantation. Polymerase chain reaction (PCR)-based preemptive therapy is considered promising for this disease, but is not routinely applied, especially in low seroprevalence countries including Japan. We encountered 2 cases of toxoplasmic encephalitis after transplantation that were successfully treated. The diagnosis of toxoplasmic encephalitis in these cases was confirmed by PCR testing when neurological symptoms were observed. Both patients received pyrimethamine and sulfadiazine treatments within 2 weeks of the development of neurological symptoms, and remained free of recurrence for 32 and 12 months. These results emphasized the importance of the PCR test and immediate treatment after diagnosis for the management of toxoplasmic encephalitis. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Oral infections and orofacial pain in Alzheimer’s disease: Case report and review

PubMed Central

de Siqueira, Silvia Regina Dowgan T.; Rolim, Thaís de Souza; Teixeira, Manoel Jacobsen; Nitrini, Ricardo; Anghinah, Renato; de Siqueira, José Tadeu T.

2010-01-01

Dental infections, frequent in the general population, are a common cause of inflammation with systemic impact, and are the most common cause of orofacial pain. Temporomandibular disorders are also frequent in the elderly and represent an important cause of secondary headache. Both inflammation and pain can also contribute to cognitive, functional and behavioral impairment of the elderly and aggravate symptoms of patients with Alzheimer’s disease (AD). We report a case of a 74-year-old woman with AD and chronic facial pain who had a significant improvement in functional activities as well as in cognition and depressive symptoms after successful treatment of her facial pain. Patients with AD have higher compromise of oral health with infections and teeth loss. The investigation of orofacial pain should be performed in patients with AD, because of the associations reviewed and given the potential for improvement as highlighted by this case. PMID:29213678

Serological level of ICAM and ELAM adhesion molecules in allergic vascularitis.

PubMed

Alecu, M; Coman, G; Gălăţescu, E

1997-01-01

A 24-patient lot with hypersensitivity vasculitis was investigated for serological determinations of ICAM and ELAM adhesion molecules. Determinations were made in attack and in remission. Over two thirds of the cases presented elevated serological levels of ICAM and ELAM in attack, with twofold higher values than normal. In remission, in the absence of clinical signs, ICAM and ELAM values were normal in 19 cases (ICAM) and 22 cases (ELAM). Serological level of ICAM and ELAM was concordant with serological level of IL-2, IL-6, circulating immune complexes and clinical status. The increased values of ICAM and ELAM are due to the expression of these molecules both on the surface of endothelial cells and on immune cells. The adherence of leukocytes on the endothelial cells, by adhesion molecules involvement, followed by their extravasation represents an important event in the vascular lesion pathogeny of the hypersensitivity vasculitis.

[Acquired perforating dermatosis in the patient with chronic kidney disease – case report and literature review].

PubMed

Steć, Anna; Paluch-Oleś, Jolanta; Korolczuk, Agnieszka; Magdalena Grzebalska, Agnieszka; Kozioł-Montewka, Maria; Książek, Andrzej

Acquired perforating dermatosis (APD) represents a heterogenous group of skin disorders characterized histopathologically by transepithelial elimination (TEE) of dermal structures. APD is manifested clinically as multi-localized, papulo-nodular skin lesions accompanied by a refractory pruritus. APD typically coexists with long-term disorders, most often diabetic kidney disease (DKD). The paper presents a case of a 56-year-old male patient with chronic kidney disease (CKD) and concomitant acquired reactive perforating collagenosis (ARPC), which is a subtype of APD. Etiological theories of ARPC as well as current diagnostic and treatment principles in dermatosis were described. On the basis of the presented case report and the literature review attention was paid to diagnostic difficulties associated with APD. The assumption was made that APD can be an underdiagnosed disease and thus it is not treated correctly. According to the authors’ opinion, this is an important circumstance to popularize the knowledge about APD.

An insurance perspective on U.S. electric grid disruption costs

DOE PAGES

Mills, Evan; Jones, Richard B.

2016-10-12

Large yet infrequent disruptions of electrical power can impact tens of millions of people in a single event, triggering significant economic damages, portions of which are insured. Small and frequent events are also significant in the aggregate. This article explores the role that insurance claims data can play in better defining the broader economic impacts of grid disruptions in the U.S. context. We developed four case studies, using previously unpublished data for specific actual grid disruptions. The cases include the 1977 New York City blackout, the 2003 Northeast blackout, multi-year national annual lightning-related electrical damage and multi-year national line-disturbance events.more » Insured losses represent between 3 and 64 per cent of total loss costs across the case studies. Here, the household sector emerges as a larger locus of costs than indicated in previous studies, and short-lived events emerge as important sources of loss costs.« less

Correlation between clinical and histopathological diagnoses in periapical inflammatory lesions.

PubMed

Diegues, Liliane Lopes; Colombo Robazza, Carlos Roberto; Costa Hanemann, João Adolfo; Costa Pereira, Alessandro Antônio; Silva, Cléverson O

2011-08-01

  The purpose of the present study was to evaluate the correlation between clinical and histopathological diagnoses of periapical inflammatory lesions, focusing mainly on cystic conditions.   Files dating from 1998 to 2006 at the Oral Pathology Laboratory, School of Dentistry, Alfenas Federal University, Brazil, were reviewed to identify cases with histopathological diagnoses of periapical inflammatory lesions. A total of 1788 files were analyzed, and 255 cases were identified with clinical diagnoses of periapical inflammatory lesions.   The most prevalent clinical diagnosis was apical periodontal cyst (59%), followed by periapical granuloma (20%), and dentoalveolar abscess (2%). After histopathological analysis, 53% of the cases represented apical periodontal cyst, 42% periapical granuloma, and 5% dentoalveolar abscess.   The outcomes of the present study show a high prevalence of periapical cysts among periapical inflammatory lesions. Moreover, this study highlights the importance of histopathological evaluation for the correct diagnosis of periapical inflammatory lesions. © 2011 Blackwell Publishing Asia Pty Ltd.

Numerical exploration of dissimilar supersonic coaxial jets mixing

NASA Astrophysics Data System (ADS)

Dharavath, Malsur; Manna, P.; Chakraborty, Debasis

2015-06-01

Mixing of two coaxial supersonic dissimilar gases in free jet environment is numerically explored. Three dimensional RANS equations with a k-ε turbulence model are solved using commercial CFD software. Two important experimental cases (RELIEF experiments) representing compressible mixing flow phenomenon under scramjet operating conditions for which detail profiles of thermochemical variables are available are taken as validation cases. Two different convective Mach numbers 0.16 and 0.70 are considered for simulations. The computed growth rate, pitot pressure and mass fraction profiles for both these cases match extremely well with experimental values and results of other high fidelity numerical results both in far field and near field regions. For higher convective Mach number predicted growth rate matches nicely with empirical Dimotakis curve; whereas for lower convective Mach number, predicted growth rate is higher. It is shown that well resolved RANS calculation can capture the mixing of two supersonic dissimilar gases better than high fidelity LES calculations.

Exploring the perspectives and preferences for HTA across German healthcare stakeholders using a multi-criteria assessment of a pulmonary heart sensor as a case study.

PubMed

Wahlster, Philip; Goetghebeur, Mireille; Schaller, Sandra; Kriza, Christine; Kolominsky-Rabas, Peter

2015-04-28

Health technology assessment and healthcare decision-making are based on multiple criteria and evidence, and heterogeneous opinions of participating stakeholders. Multi-criteria decision analysis (MCDA) offers a potential framework to systematize this process and take different perspectives into account. The objectives of this study were to explore perspectives and preferences across German stakeholders when appraising healthcare interventions, using multi-criteria assessment of a heart pulmonary sensor as a case study. An online survey of 100 German healthcare stakeholders was conducted using a comprehensive MCDA framework (EVIDEM V2.2). Participants were asked to provide i) relative weights for each criterion of the framework; ii) performance scores for a health pulmonary sensor, based on available data synthesized for each criterion; and iii) qualitative feedback on the consideration of contextual criteria. Normalized weights and scores were combined using a linear model to calculate a value estimate across different stakeholders. Differences across types of stakeholders were explored. The survey was completed by 54 participants. The most important criteria were efficacy, patient reported outcomes, disease severity, safety, and quality of evidence (relative weight >0.075 each). Compared to all participants, policymakers gave more weight to budget impact and quality of evidence. The quantitative appraisal of a pulmonary heart sensor revealed differences in scoring performance of this intervention at the criteria level between stakeholder groups. The highest value estimate of the sensor reached 0.68 (on a scale of 0 to 1, 1 representing maximum value) for industry representatives and the lowest value of 0.40 was reported for policymakers, compared to 0.48 for all participants. Participants indicated that most qualitative criteria should be considered and their impact on the quantitative appraisal was captured transparently. The study identified important variations in perspectives across German stakeholders when appraising a healthcare intervention and revealed that MCDA can demonstrate the value of a specified technology for all participating stakeholders. Better understanding of these differences at the criteria level, in particular between policymakers and industry representatives, is important to focus innovation aligned with patient health and healthcare system values and constraints.

Phylogenetic Relationships of the Triassic Archaeosemionotus Deecke (Halecomorphi, Ionoscopiformes) from the ‘Perledo Fauna’

PubMed Central

López-Arbarello, Adriana; Stockar, Rudolf; Bürgin, Toni

2014-01-01

The lagerstätten in the Monte San Giorgio have provided excellent fossils representing one of the most important windows to the marine life during the Triassic. Among these fossils, fishes are abundant and extraordinarily well preserved. Most of these fishes represent extinct lineages and were difficult to understand and classify during the early years after discovery. These difficulties usually led to a mixture of species under the same taxonomic name. This is the case of fishes referred to the genus Archaeosemionotus. The name bearing type of A. connectens, the type species of this genus, represents a basal halecomorph, but most other fishes referred to this genus represent basal ginglymodians. Therefore, we conducted this study to clarify the taxonomic status and phylogenetic relationships of A. connectens, which is a member of the family Furidae (Halecomorphi, Ionoscopiformes) representing the second cladistically supported evidence of ionoscopiforms in the Triassic and it is thus one of the two oldest reliable records of this group. Ionoscopiforms have a long stratigraphic range, though their fossil record is rather patchy. In our analysis, the sister taxon of Archaeosemionotus is Robustichthys from the Anisian of China, and they together form a clade with Furo, which is known from several localities ranging from the Early to the Late Jurassic. Other ionoscopiforms are so far known from the Kimmeridgian to the Albian and it is thus evident that recent efforts have concentrated on the later history of the group (Late Jurassic to Cretaceous). The phylogenetic relationships obtained for the Ionoscopiformes do not show a clear palaeobiogeographic pattern, but give important new insights into the origin, divergence date and early history of this clade. PMID:25296174

Phylogenetic relationships of the triassic archaeosemionotus deecke (halecomorphi, ionoscopiformes) from the 'perledo fauna'.

PubMed

López-Arbarello, Adriana; Stockar, Rudolf; Bürgin, Toni

2014-01-01

The lagerstätten in the Monte San Giorgio have provided excellent fossils representing one of the most important windows to the marine life during the Triassic. Among these fossils, fishes are abundant and extraordinarily well preserved. Most of these fishes represent extinct lineages and were difficult to understand and classify during the early years after discovery. These difficulties usually led to a mixture of species under the same taxonomic name. This is the case of fishes referred to the genus Archaeosemionotus. The name bearing type of A. connectens, the type species of this genus, represents a basal halecomorph, but most other fishes referred to this genus represent basal ginglymodians. Therefore, we conducted this study to clarify the taxonomic status and phylogenetic relationships of A. connectens, which is a member of the family Furidae (Halecomorphi, Ionoscopiformes) representing the second cladistically supported evidence of ionoscopiforms in the Triassic and it is thus one of the two oldest reliable records of this group. Ionoscopiforms have a long stratigraphic range, though their fossil record is rather patchy. In our analysis, the sister taxon of Archaeosemionotus is Robustichthys from the Anisian of China, and they together form a clade with Furo, which is known from several localities ranging from the Early to the Late Jurassic. Other ionoscopiforms are so far known from the Kimmeridgian to the Albian and it is thus evident that recent efforts have concentrated on the later history of the group (Late Jurassic to Cretaceous). The phylogenetic relationships obtained for the Ionoscopiformes do not show a clear palaeobiogeographic pattern, but give important new insights into the origin, divergence date and early history of this clade.

21 CFR 312.68 - Inspection of investigator's records and reports.

Code of Federal Regulations, 2010 CFR

2010-04-01

... particular individuals require a more detailed study of the cases, or unless there is reason to believe that the records do not represent actual case studies, or do not represent actual results obtained. ...

Travel-acquired infections in Canada: CanTravNet 2011—2012

PubMed Central

Boggild, AK; Geduld, J; Libman, M; Ward, BJ; McCarthy, A; Hajek, J; Ghesquiere, W; Vincelette, J; Kuhn, S; Freedman, DO; Kain, KC

2014-01-01

Background Important gaps remain in our knowledge of the infectious diseases people acquire while travelling and the impact of pathogens imported by Canadian travellers. Objective To provide a surveillance update of illness in a cohort of returned Canadian travellers and new immigrants. Methods Data on returning Canadian travellers and new immigrants presenting to a CanTravNet site between September 2011 and September 2012 were extracted and analyzed by destination, presenting symptoms, common and emerging infectious diseases and disease severity. Results During the study period, 2283 travellers and immigrants presented to a CanTravNet site, 88% (N=2004) of whom were assigned a travel-related diagnosis. Top three destinations for non-immigrant travellers were India (N=132), Mexico (N=103) and Cuba (N=89). Fifty-one cases of malaria were imported by ill returned travellers during the study period, 60% (N=30) of which were Plasmodium falciparum infections. Individuals travelling to visit friends and relatives accounted for 83% of enteric fever cases (15/18) and 41% of malaria cases (21/51). The requirement for inpatient management was over-represented among those with malaria compared to those without malaria (25% versus 2.8%; p<0.0001) and those travelling to visit friends and relatives versus those travelling for other reasons (12.1% versus 2.4%; p<0.0001). Nine new cases of HIV were diagnosed among the cohort, as well as one case of acute hepatitis B. Emerging infections among travellers included hepatitis E virus (N=6), chikungunya fever (N=4) and cutaneous leishmaniasis (N=16). Common chief complaints included gastrointestinal (N=804), dermatologic (N=440) and fever (N=287). Common specific causes of chief complaint of fever in the cohort were malaria (N=47/51 total cases), dengue fever (14/18 total cases), enteric fever (14/17 total cases) and influenza and influenza-like illness (15/21 total cases). Animal bites were the tenth most common diagnosis among tourist travellers. Interpretation Our analysis of surveillance data on ill returned Canadian travellers provides a recent update to the spectrum of imported illness among travelling Canadians. Preventable travel-acquired illnesses and injuries in the cohort include malaria, enteric fever, HIV, hepatitis B, hepatitis A, influenza and animal bites. Strategies to improve uptake of preventive interventions such as malaria chemoprophylaxis, immunizations and arthropod/animal avoidance may be warranted. PMID:29769859

AIDS in Brazilian children: history, surveillance, antiretroviral therapy, and epidemiologic transition, 1984-2008.

PubMed

Ramos, Alberto Novaes; Matida, Luiza Harunari; Hearst, Norman; Heukelbach, Jorg

2011-04-01

We present a systematic review of historical, political, and epidemiologic aspects of AIDS in Brazilian children. Over 25 years, Brazil has developed different strategies to control AIDS in children. Three revisions of criteria for defining AIDS cases in children and nine national guidelines on antiretroviral therapy administration for management of HIV infection were published. These guidelines represent important progress, including aspects of HIV/AIDS surveillance, antiretroviral treatment, opportunistic conditions, prophylaxis, and laboratory testing. Brazil has significantly expanded access to free therapy with different classes of antiretroviral drugs. Initially focusing on treatment for HIV and opportunistic conditions, the scope of treatment guidelines gradually expanded to comprehensive health care for children and adolescents. From 1996 to 2008, the number of AIDS cases and deaths in children has been reduced by 67% and 65%, respectively, as a result of different strategies to prevent mother-to-child transmission of HIV and highly active antiretroviral therapy administration to infected children. Improved morbidity, mortality, and survival of Brazilian children with AIDS demonstrate clear benefits of adopting a policy of free and universal access to antiretroviral drugs associated with comprehensive care. However, important issues remain to be resolved, mainly concerning social, operational, and regional inequalities in coverage and quality of care, and epidemiological surveillance in different regions of the country. This broad review shows that the overall situation of pediatric AIDS in Brazil represents an incomplete process of epidemiologic and demographic transition, with the coexistence of old and new clinical and epidemiologic challenges.

Parametric study of guided waves dispersion curves for composite plates

NASA Astrophysics Data System (ADS)

Predoi, Mihai Valentin; Petre, Cristian Cǎtǎlin; Kettani, Mounsif Ech Cherif El; Leduc, Damien

2018-02-01

Nondestructive testing of composite panels benefit from the relatively long range propagation of guided waves in sandwich structures. The guided waves are sensitive to delamination, air bubbles inclusions and cracks and can thus bring information about hidden defects in the composite panel. The preliminary data in all such inspections is represented by the dispersion curves, representing the dependency of the phase/group velocity on the frequency for the propagating modes. In fact, all modes are more or less attenuated, so it is even more important to compute the dispersion curves, which provide also the modal attenuation as function of frequency. Another important aspect is the sensitivity of the dispersion curves on each of the elastic constant of the composite, which are orthotropic in most cases. All these aspects are investigated in the present work, based on our specially developed finite element numerical model implemented in Comsol, which has several advantages over existing methods. The dispersion curves and modal displacements are computed for an example of composite plate. Comparison with literature data validates the accuracy of our results.

Challenges and strategies to facilitate formulation development of pediatric drug products: Safety qualification of excipients.

PubMed

Buckley, Lorrene A; Salunke, Smita; Thompson, Karen; Baer, Gerri; Fegley, Darren; Turner, Mark A

2018-02-05

A public workshop entitled "Challenges and strategies to facilitate formulation development of pediatric drug products" focused on current status and gaps as well as recommendations for risk-based strategies to support the development of pediatric age-appropriate drug products. Representatives from industry, academia, and regulatory agencies discussed the issues within plenary, panel, and case-study breakout sessions. By enabling practical and meaningful discussion between scientists representing the diversity of involved disciplines (formulators, nonclinical scientists, clinicians, and regulators) and geographies (eg, US, EU), the Excipients Safety workshop session was successful in providing specific and key recommendations for defining paths forward. Leveraging orthogonal sources of data (eg. food industry, agro science), collaborative data sharing, and increased awareness of the existing sources such as the Safety and Toxicity of Excipients for Paediatrics (STEP) database will be important to address the gap in excipients knowledge needed for risk assessment. The importance of defining risk-based approaches to safety assessments for excipients vital to pediatric formulations was emphasized, as was the need for meaningful stakeholder (eg, patient, caregiver) engagement. Copyright © 2017 Elsevier B.V. All rights reserved.

Representing life as opposed to being: the bio-objectification process of the HeLa cells and its relation to personalized medicine

PubMed Central

Svalastog, Anna Lydia; Martinelli, Lucia

2013-01-01

The immortal HeLa cells case is an intriguing example of bio-objectification processes with great scientific, social, and symbolic impacts. These cells generate questions about representation, significance, and value of the exceptional, variety, individuality, and property. Of frightening (a lethal cancer) and emarginated (a black, poor woman) origins, with their ability to “contaminate” cultures and to “spread” into spaces for becoming of extraordinary value for human knowledge, well-being, and economy advancements, HeLa cells have represented humanity, and emphasized the importance of individual as a core concept of the personalized medicine. Starting from the process leading from HeLa “cells” to HeLa “bio-objects,” we focus on their importance as high quality bio-specimen. We discuss the tension between phenomenological characteristic of fundamental biological research and the variety of material and methodologies in epidemiology and personalized medicine. The emerging methodologies and societal changes reflect present EU policies and lead toward a new paradigm of science. PMID:23986283

[Suicide in adolescence].

PubMed

Bouvard, M P; Doyen, C

1996-12-01

With 1500 death each year, suicide does represent the second cause of death in young people (between 15 and 25 years). There is a clear increase of suicide rate during adolescence, with an higher rate of suicide attempts in females, but an higher mortality in boys. Suicidal behaviors in adolescents are clinically characterized by impulsivity, rhythmicity (during schooling) and seasonality. Risks factors are numerous. However, psychiatric disorders represent the main one, especially depressive states, conduct disorders and their association. In adolescents familial and environment events may have an important role in suicidal behaviors, especially the role of imitation behavior. These different factors interact and constitute dynamic models. The role of each factor can be involved differently considering the sex. Dangerosity of suicide in adolescents should not be under-estimated, as it has been the case in the past. It is particularly true if we consider the high rate of recidive (approximatively 50%) in this population. These data emphasized the importance of a careful evaluation of all suicidal adolescents more precisely of depressive symptoms and aggressive and/or delinquent behavior and of prevention.

Utility of GenBank and the Barcode of Life Data Systems (BOLD) for the identification of forensically important Diptera from Belgium and France

PubMed Central

Sonet, Gontran; Jordaens, Kurt; Braet, Yves; Bourguignon, Luc; Dupont, Eréna; Backeljau, Thierry; De Meyer, Marc; Desmyter, Stijn

2013-01-01

Abstract Fly larvae living on dead corpses can be used to estimate post-mortem intervals. The identification of these flies is decisive in forensic casework and can be facilitated by using DNA barcodes provided that a representative and comprehensive reference library of DNA barcodes is available. We constructed a local (Belgium and France) reference library of 85 sequences of the COI DNA barcode fragment (mitochondrial cytochrome c oxidase subunit I gene), from 16 fly species of forensic interest (Calliphoridae, Muscidae, Fanniidae). This library was then used to evaluate the ability of two public libraries (GenBank and the Barcode of Life Data Systems – BOLD) to identify specimens from Belgian and French forensic cases. The public libraries indeed allow a correct identification of most specimens. Yet, some of the identifications remain ambiguous and some forensically important fly species are not, or insufficiently, represented in the reference libraries. Several search options offered by GenBank and BOLD can be used to further improve the identifications obtained from both libraries using DNA barcodes. PMID:24453564

Representativeness of Tuberculosis Genotyping Surveillance in the United States, 2009-2010.

PubMed

Shak, Emma B; France, Anne Marie; Cowan, Lauren; Starks, Angela M; Grant, Juliana

2015-01-01

Genotyping of Mycobacterium tuberculosis isolates contributes to tuberculosis (TB) control through detection of possible outbreaks. However, 20% of U.S. cases do not have an isolate for testing, and 10% of cases with isolates do not have a genotype reported. TB outbreaks in populations with incomplete genotyping data might be missed by genotyping-based outbreak detection. Therefore, we assessed the representativeness of TB genotyping data by comparing characteristics of cases reported during January 1, 2009-December 31, 2010, that had a genotype result with those cases that did not. Of 22,476 cases, 14,922 (66%) had a genotype result. Cases without genotype results were more likely to be patients <19 years of age, with unknown HIV status, of female sex, U.S.-born, and with no recent history of homelessness or substance abuse. Although cases with a genotype result are largely representative of all reported U.S. TB cases, outbreak detection methods that rely solely on genotyping data may underestimate TB transmission among certain groups.

Representativeness of Tuberculosis Genotyping Surveillance in the United States, 2009–2010

PubMed Central

Shak, Emma B.; Cowan, Lauren; Starks, Angela M.; Grant, Juliana

2015-01-01

Genotyping of Mycobacterium tuberculosis isolates contributes to tuberculosis (TB) control through detection of possible outbreaks. However, 20% of U.S. cases do not have an isolate for testing, and 10% of cases with isolates do not have a genotype reported. TB outbreaks in populations with incomplete genotyping data might be missed by genotyping-based outbreak detection. Therefore, we assessed the representativeness of TB genotyping data by comparing characteristics of cases reported during January 1, 2009–December 31, 2010, that had a genotype result with those cases that did not. Of 22,476 cases, 14,922 (66%) had a genotype result. Cases without genotype results were more likely to be patients <19 years of age, with unknown HIV status, of female sex, U.S.-born, and with no recent history of homelessness or substance abuse. Although cases with a genotype result are largely representative of all reported U.S. TB cases, outbreak detection methods that rely solely on genotyping data may underestimate TB transmission among certain groups. PMID:26556930

Inaccuracy of age assessment from images of postpubescent subjects in cases of alleged child pornography.

PubMed

Rosenbloom, Arlan L

2013-03-01

Despite frequent medical expert testimony authoritatively stating that images of individuals who are postpubescent indicate age less than 18 and therefore, child pornography, developmental experts have noted that a scientific basis for such estimation is lacking. In fact, recent studies have demonstrated a high degree of inaccuracy in such estimates, and that the stage of breast development often used as indicative of age under 18 years is present in a substantial percentage of adult women. Ten images of adult women from legitimate pornographic sites promoting youthful images were shown to 16 pediatric endocrinologists expert in evaluating maturation, who determined whether or not the individuals represented were under 18 years of age. They also provided information about what features were most important in their evaluations. Sixty-nine percent of the 160 estimates were that the images represented females under 18 years of age. There was wide variability in the designation of importance of the various features of maturation in reaching conclusions, with breast development and facial appearance considered most important. This study confirms that medical testimony, even by experts in adolescent development, can deem images of adult women selected for their youthful appearance to be under age 18 two thirds of the time. Thus, important as prosecuting users of child pornographic material may be, justice requires the avoidance of testimony that is not scientifically based.

Measuring underreporting and under-ascertainment in infectious disease datasets: a comparison of methods

PubMed Central

2014-01-01

Background Efficient and reliable surveillance and notification systems are vital for monitoring public health and disease outbreaks. However, most surveillance and notification systems are affected by a degree of underestimation (UE) and therefore uncertainty surrounds the 'true’ incidence of disease affecting morbidity and mortality rates. Surveillance systems fail to capture cases at two distinct levels of the surveillance pyramid: from the community since not all cases seek healthcare (under-ascertainment), and at the healthcare-level, representing a failure to adequately report symptomatic cases that have sought medical advice (underreporting). There are several methods to estimate the extent of under-ascertainment and underreporting. Methods Within the context of the ECDC-funded Burden of Communicable Diseases in Europe (BCoDE)-project, an extensive literature review was conducted to identify studies that estimate ascertainment or reporting rates for salmonellosis and campylobacteriosis in European Union Member States (MS) plus European Free Trade Area (EFTA) countries Iceland, Norway and Switzerland and four other OECD countries (USA, Canada, Australia and Japan). Multiplication factors (MFs), a measure of the magnitude of underestimation, were taken directly from the literature or derived (where the proportion of underestimated, under-ascertained, or underreported cases was known) and compared for the two pathogens. Results MFs varied between and within diseases and countries, representing a need to carefully select the most appropriate MFs and methods for calculating them. The most appropriate MFs are often disease-, country-, age-, and sex-specific. Conclusions When routine data are used to make decisions on resource allocation or to estimate epidemiological parameters in populations, it becomes important to understand when, where and to what extent these data represent the true picture of disease, and in some instances (such as priority setting) it is necessary to adjust for underestimation. MFs can be used to adjust notification and surveillance data to provide more realistic estimates of incidence. PMID:24517715

The Differential Diagnosis Between Natural Death and Homicide, an Everlasting Challenge for the Forensic Pathologist: An Exemplar Case Report.

PubMed

di Luca, Alessandro; de Matteis, Valentino; Marcelli, Antonio; Polacco, Matteo; Pascali, Vincenzo L; Oliva, Antonio

2017-03-01

Most of the work performed by the forensic expert is to find proof for different plausible hypotheses that may be used in a trial to serve justice purposes when the "identity" of a case is already unveiled. Yet the previous phase of the investigation is also of great importance, and sometimes (like in the presented case), it represents the core element of the entire investigation. The appropriate determination of the differential diagnosis between a natural death and a death of forensic interest (ie, homicide) is the first and crucial step in the classification of a case. This article analyzes the case of the body of a man found lying on the border of a country road with his wrists tied up with rope and the resulting investigation performed by the medicolegal forensic expert. In the end, as more specific examinations where performed aimed to find the truth, the final conclusions excluded a violent death and confirmed that the cause of the death was an acute myocardial infarction.

Multilevel Complex Networks and Systems

NASA Astrophysics Data System (ADS)

Caldarelli, Guido

2014-03-01

Network theory has been a powerful tool to model isolated complex systems. However, the classical approach does not take into account the interactions often present among different systems. Hence, the scientific community is nowadays concentrating the efforts on the foundations of new mathematical tools for understanding what happens when multiple networks interact. The case of economic and financial networks represents a paramount example of multilevel networks. In the case of trade, trade among countries the different levels can be described by the different granularity of the trading relations. Indeed, we have now data from the scale of consumers to that of the country level. In the case of financial institutions, we have a variety of levels at the same scale. For example one bank can appear in the interbank networks, ownership network and cds networks in which the same institution can take place. In both cases the systemically important vertices need to be determined by different procedures of centrality definition and community detection. In this talk I will present some specific cases of study related to these topics and present the regularities found. Acknowledged support from EU FET Project ``Multiplex'' 317532.

[Sexually transmitted diseases: epidemiological and social aspects].

PubMed

Marin, V; Bertoncello, C

2002-01-01

STDs represent a major public health problem for two reasons: their serious sequelae and the facts that they facilitate transmission of HIV. This article presents WHO estimates new cases of some of curable STDs, and italian data from national reporting system (published from ISTAT and ISS). The number of new reported cases decreases in Italy, but reported cases are not all cases. People with STDs tend not to seek treatment or to self-medicate, this behaviour is common in youths. In many cases STDs are asymptomatic in both sexes, particularly in women. Women are also much more vulnerable biologically, culturally, socioeconomically. There is also a lack of notification by physicians. Important social determinants of STDs diffusion are migration and travels. Prevention and control of STDs need collaboration between medical disciplines: gynaecology, urology, dermo-venerology, microbiology, epidemiology, public health. Contributions of nurses, laboratory technician and social workers are also required. The role of public health specialists in the prevention is strictly related to health education. Health education will promote responsible sexual behaviour and early recourse to health services by people with STDs and their sexual partners.

Prioritising in situ conservation of crop resources: A case study of African cowpea (Vigna unguiculata)

PubMed Central

Moray, C.; Game, E. T.; Maxted, N.

2014-01-01

Conserving crop wild relatives (CWR) is critical for maintaining food security. However, CWR-focused conservation plans are lacking, and are often based on the entire genus, even though only a few taxa are useful for crop improvement. We used taxonomic and geographic prioritisation to identify the best locations for in situ conservation of the most important (priority) CWR, using African cowpea (Vigna unguiculata (L.) Walp.) as a case study. Cowpea is an important crop for subsistence farmers in sub-Saharan Africa, yet its CWR are under-collected, under-conserved and under-utilised in breeding. We identified the most efficient sites to focus in situ cowpea CWR conservation and assessed whether priority CWR would be adequately represented in a genus-based conservation plan. We also investigated whether priority cowpea CWR are likely to be found in existing conservation areas and in areas important for mammal conservation. The genus-based method captured most priority CWR, and the distributions of many priority CWR overlapped with established conservation reserves and targets. These results suggest that priority cowpea CWR can be conserved by building on conservation initiatives established for other species. PMID:24936740

[Clinical microbiology laboratory and imported parasitic diseases].

PubMed

Martín-Rabadán, Pablo; Martínez-Ruiz, Rocío; Cuadros, Juan; Cañavate, Carmen

2010-12-01

Imported parasitosis represents an increasingly frequent diagnostic challenge for microbiology laboratories. A surge in immigration and international travel has led to a rise in the number of imported cases of parasitosis, and this trend is expected to continue in the future. The present article addresses this challenge by reviewing recommended diagnostic approaches and tests. Currently, microscopy is always recommended when analysing blood samples for parasites. If malaria is suspected, rapid antigen testing (including at least HRP2 antigen) should also be performed. The work-up for suspected leishmaniasis should include serology, culture, and in selected cases detection of antigen in urine. In suspected Chagas disease, two different serological tests should be performed. PCR for blood protozoa is highly sensitive, although it cannot be used to rule out Chagas disease, since this condition may be present without parasitemia. Accurate diagnosis of intestinal amebiasis usually requires PCR or antigen detection tests. In helminthiasis, traditional microscopy may need to be complemented with other tests, such as agar plate culture for strongyloidiasis, Og4C3 antigen detection for bancroftian filariasis, and antibody detection test for filariasis and schistosomiasis. Copyright © 2010 Elsevier España, S.L. All rights reserved.

The importance of perinatal autopsy. Review of the literature and series of cases.

PubMed

Şorop-Florea, Maria; Ciurea, Raluca Niculina; Ioana, Mihai; Stepan, Alex Emilian; Stoica, George Alin; Tănase, Florentina; Comănescu, Maria Cristina; Novac, Marius Bogdan; Drăgan, Ioana; Pătru, Ciprian LaurenŢiu; Drăguşin, Roxana Cristina; Zorilă, George Lucian; Cărbunaru, Ovidiu Marian; Oprescu, NuŢi Daniela; Ceauşu, Iuliana; Vlădăreanu, Simona; Tudorache, Ştefania; Iliescu, Dominic Gabriel

2017-01-01

Perinatal autopsy remains the gold-standard procedure used to establish the fetal, neonatal or infant abnormalities. Progressively, perinatal pathology has become a specialized field with important roles of audit for fetal prenatal diagnostic tools, in parents counseling regarding future pregnancies, in scientific research, for epidemiology of congenital abnormalities and teaching. The differences between prenatal ultrasound and autopsy reports represent a strong argument for the autopsy examination following termination of pregnancy. The reasons for such discrepancies are related to the ultrasonographic or pathological examination conditions, the type of the anomalies, the expertise and availability of the operators. Several facts led to an undesirable increase of refusals from parents to consent to a conventional invasive autopsy: the centralization of pathology services, the poor counseling provided by non-experts in fetal medicine and the clinicians' over-appreciation of the importance of the ultrasound diagnostic investigation. Although non-invasive alternatives have been tested with promising results, conventional autopsy remains the gold standard technique for the prenatal diagnosis audit. We report and analyze several cases of prenatally diagnosed malformed fetuses with different particularities that underline the necessity of perinatal autopsy. We discuss the antenatal findings and management and post-mortem autopsies in the respective pregnancies.

Prioritising in situ conservation of crop resources: a case study of African cowpea (Vigna unguiculata).

PubMed

Moray, C; Game, E T; Maxted, N

2014-06-17

Conserving crop wild relatives (CWR) is critical for maintaining food security. However, CWR-focused conservation plans are lacking, and are often based on the entire genus, even though only a few taxa are useful for crop improvement. We used taxonomic and geographic prioritisation to identify the best locations for in situ conservation of the most important (priority) CWR, using African cowpea (Vigna unguiculata (L.) Walp.) as a case study. Cowpea is an important crop for subsistence farmers in sub-Saharan Africa, yet its CWR are under-collected, under-conserved and under-utilised in breeding. We identified the most efficient sites to focus in situ cowpea CWR conservation and assessed whether priority CWR would be adequately represented in a genus-based conservation plan. We also investigated whether priority cowpea CWR are likely to be found in existing conservation areas and in areas important for mammal conservation. The genus-based method captured most priority CWR, and the distributions of many priority CWR overlapped with established conservation reserves and targets. These results suggest that priority cowpea CWR can be conserved by building on conservation initiatives established for other species.

Major decrease in malaria transmission on Mayotte Island.

PubMed

Maillard, Olivier; Lernout, Tinne; Olivier, Sophie; Achirafi, Aboubacar; Aubert, Lydéric; Lepère, Jean François; Thiria, Julien; Pagès, Frédéric; Filleul, Laurent

2015-08-19

Plasmodium falciparum is responsible for most malaria cases on Mayotte Island, in the Comorian Archipelago. Malaria is endemic and a major public health problem in the archipelago with an intense, stable and permanent transmission. This study reports results of 8 years of malaria surveillance from 2007 to 2014 after the strengthening of malaria control activities in Mayotte and the neighbouring islands. Surveillance was based on physicians' reports of malaria cases between January 2007 and December 2014. Malaria cases were confirmed by at least a positive rapid diagnostic test and/or demonstration of Plasmodium sp. in a blood smear. The date, and the patients' age, sex, address, presentation of symptoms, biology, treatment and recent history of travel were collected by verbal questioning during consultation and/or hospitalization. Monthly rainfall data were also compiled during the study period. From 2007 to 2014, 2073 cases were reported on Mayotte Island: 977 imported cases, 807 autochthonous cases and 289 cases of unknown origin. The total malaria annual parasite incidence lowered from 3.0 in 2007 to 0.07 per 1,000 inhabitants in 2014 as the autochthonous malaria incidence decreased from 1.6 to 0.004 per 1,000 inhabitants in the same period and in all age groups. Most of the imported cases came from Comoros (94 %). Severe forms represented approximately 11 % of cases, and only two deaths have been recorded among the imported cases. Approximately 19 % of cases were hospitalized (3 % in an intensive care unit). There is clearly a decrease in malaria transmission in Mayotte since 2007 and the goal of elimination seems more achievable than ever. In 2011, Mayotte entered the elimination phase when P. falciparum API passed under 1 case per 1,000 people at risk. The combination of vector control measures, active surveillance and case management, including effective treatment with artemisinin-based combination therapy, has been essential to achieve a present status of low and decreasing malaria transmission on the island. Mayotte has entered the elimination phase, but some goals remain to be accomplished before a programme re-orientation toward malaria elimination is contemplated. Moreover, a regional management policy is crucial because this would allow control measures to be targeted and based on a regional surveillance-response system rather than isolated.

The importance of early detection of lip cancer risk groups

NASA Astrophysics Data System (ADS)

Fratila, M.; Rosu, S.

2014-03-01

Oral maxillo-facial region cancer carries major importance in the tumour pathology of the organism being characterized by a high frequency as well as by the variety of the clinical anatomical and topographic forms through which it is presented. Over 60% of labial carcinoma begins as an asymptomatic ulceration, therefore patients do not pay due attention, considering it a "rebellious thrush" and they make a specialized medical appointment in an advanced stage of the tumor. In this study we pursued the frequency of the lip cancer pathology compared to the total CMF; the distribution the lip cancer by sex and age in patients who submitted to the specialized service; the originating environment of the patient with lip cancer; the anatomical location of the lip cancer; the frequency of relapses after treatment; the presence of adenopathy in the first consultation. The study was performed at the Clinic of Cranio-Maxillofacial Surgery, University of Medicine and Pharmacy "Victor Babes" Timişoara and pursued statistical aspects of the lip cancer incidence over a period of five years (2007-2012). Pre- and postoperative patients were monitored constantly, registering in individual sheets the evolution of the disease, monitoring the relapses after treatment and the presence of adenopathy in the first consultation. As shown in the statistics made in the last five years (2007-2012), from a total of 8135 cases with CMF pathology hospitalized in the Timisoara surgery clinic, 163 cases, or 2%, were cancer of the lip. Analyzing the gender distribution shows that males represent 81% of cases while the remaining 19% were found in women. From the study of age distribution, we found that the number of cases increases with age: 153 cases over 60 years old and 58 cases between 20 - 60 years. Personal statistics from the 212 cases of cancer of the lip reveal that 143 (67%) patients were from the rural areas and 69 (33%) from urban areas. Neoplastic pathology is constantly increasing both in frequency as well as in the therapeutic problems raised. In the face and oral cavity cancer catagory, lip represents 2% of all cases and 19-25% of the total facial cancer area. Lip cancer is one of the localizations that, when detected early, can benefit from an effective therapy with high chances of healing. In order to achieve a complex treatment, interdisciplinary collaboration is required, only thus being able to determine both the therapeutic methods as well as their association.

Clinical knowledge-based inverse treatment planning

NASA Astrophysics Data System (ADS)

Yang, Yong; Xing, Lei

2004-11-01

Clinical IMRT treatment plans are currently made using dose-based optimization algorithms, which do not consider the nonlinear dose-volume effects for tumours and normal structures. The choice of structure specific importance factors represents an additional degree of freedom of the system and makes rigorous optimization intractable. The purpose of this work is to circumvent the two problems by developing a biologically more sensible yet clinically practical inverse planning framework. To implement this, the dose-volume status of a structure was characterized by using the effective volume in the voxel domain. A new objective function was constructed with the incorporation of the volumetric information of the system so that the figure of merit of a given IMRT plan depends not only on the dose deviation from the desired distribution but also the dose-volume status of the involved organs. The conventional importance factor of an organ was written into a product of two components: (i) a generic importance that parametrizes the relative importance of the organs in the ideal situation when the goals for all the organs are met; (ii) a dose-dependent factor that quantifies our level of clinical/dosimetric satisfaction for a given plan. The generic importance can be determined a priori, and in most circumstances, does not need adjustment, whereas the second one, which is responsible for the intractable behaviour of the trade-off seen in conventional inverse planning, was determined automatically. An inverse planning module based on the proposed formalism was implemented and applied to a prostate case and a head-neck case. A comparison with the conventional inverse planning technique indicated that, for the same target dose coverage, the critical structure sparing was substantially improved for both cases. The incorporation of clinical knowledge allows us to obtain better IMRT plans and makes it possible to auto-select the importance factors, greatly facilitating the inverse planning process. The new formalism proposed also reveals the relationship between different inverse planning schemes and gives important insight into the problem of therapeutic plan optimization. In particular, we show that the EUD-based optimization is a special case of the general inverse planning formalism described in this paper.

Effect of Fish Collagen Hydrolysates on Type I Collagen mRNA Levels of Human Dermal Fibroblast Culture

PubMed Central

Sanchez, Ana; Blanco, Maria; Correa, Begoña

2018-01-01

Fish discards and subproducts may represent an important source of raw material, not only for the food industry, but for other different kind of industries, such as the nutraceutical and cosmetic industries. Collagen, which is mainly obtained from animal skins, is an important structural protein in the animal kingdom having many different applications. It is well known that fish skins constitute a significant subproduct in the fishery industry, especially in the case of some species, where fish skins may represent up to 20% of the total body weight of fish. Peptides from collagen hydrolysates have been described to be useful for preventing skin aging and osteoarthritis, however, the mechanism for these biological activities is not well known. Fibroblasts are the main cell types involved in the collagen synthesis, and in the present work, human dermal fibroblasts have been exposed to the treatment of collagen peptides of two different molecular weight ranges. Results show that higher molecular weight collagen peptides produce higher synthesis of collagen type I mRNA and, therefore, it may suggest that prior molecular weight selection may be an important step to maximize the effect of collagen hydrolysates on collagen type I synthesis by dermal fibroblasts. PMID:29701725

Pathophysiology and biology of peritoneal carcinomatosis.

PubMed

Kusamura, Shigeki; Baratti, Dario; Zaffaroni, Nadia; Villa, Raffaella; Laterza, Barbara; Balestra, Maria Rosaria; Deraco, Marcello

2010-01-15

Peritoneal carcinomatosis represents a devastating form of cancer progression with a very poor prognosis. Its complex pathogenesis is represented by a dynamic process comprising several steps. To the best of our knowledge pathogenesis can be partly explained by 3 major molecular pathways: (1) dissemination from the primary tumor; (2) primary tumor of peritoneum; and (3) independent origins of the primary tumor and peritoneal implants. These are not mutually exclusive and combinations of different mechanisms could occur inside a single case. There are still several aspects which need explanation by future studies. A comprehensive understanding of molecular events involved in peritoneal carcinomatosis is of paramount importance and should be systematically pursued not only to identify novel strategies for the prevention of the condition, but also to obtain therapeutic advances, through the identification of surrogate markers of prognosis and development of future molecular targeted therapies.

Pathophysiology and biology of peritoneal carcinomatosis

PubMed Central

Kusamura, Shigeki; Baratti, Dario; Zaffaroni, Nadia; Villa, Raffaella; Laterza, Barbara; Balestra, Maria Rosaria; Deraco, Marcello

2010-01-01

Peritoneal carcinomatosis represents a devastating form of cancer progression with a very poor prognosis. Its complex pathogenesis is represented by a dynamic process comprising several steps. To the best of our knowledge pathogenesis can be partly explained by 3 major molecular pathways: (1) dissemination from the primary tumor; (2) primary tumor of peritoneum; and (3) independent origins of the primary tumor and peritoneal implants. These are not mutually exclusive and combinations of different mechanisms could occur inside a single case. There are still several aspects which need explanation by future studies. A comprehensive understanding of molecular events involved in peritoneal carcinomatosis is of paramount importance and should be systematically pursued not only to identify novel strategies for the prevention of the condition, but also to obtain therapeutic advances, through the identification of surrogate markers of prognosis and development of future molecular targeted therapies. PMID:21160812

Science in pictures: Visual representation of climate change in Spain's television news.

PubMed

León, Bienvenido; Erviti, M Carmen

2015-02-01

The images used by the media to represent science can help people's understanding of complex processes and create meaningful links with audiences. This is particularly relevant in the case of climate change (CC), an important phenomenon that, nevertheless, is often perceived as a remote issue, with no relevance to daily life. This article presents the main results of a research on the images used in television news to represent CC. From a sample of 1476.4 hours of Spanish television news programmes, a content analysis of 78 stories on climate change was carried out. This was complemented with six semi-structured interviews at five TV newsrooms. Results indicate that the low rate of coverage of CC can be related to the scarcity of attractive images available to the channels. © The Author(s) 2013.

Probing Chemical Space with Alkaloid-Inspired Libraries

PubMed Central

McLeod, Michael C.; Singh, Gurpreet; Plampin, James N.; Rane, Digamber; Wang, Jenna L.; Day, Victor W.; Aubé, Jeffrey

2014-01-01

Screening of small molecule libraries is an important aspect of probe and drug discovery science. Numerous authors have suggested that bioactive natural products are attractive starting points for such libraries, due to their structural complexity and sp3-rich character. Here, we describe the construction of a screening library based on representative members of four families of biologically active alkaloids (Stemonaceae, the structurally related cyclindricine and lepadiformine families, lupin, and Amaryllidaceae). In each case, scaffolds were based on structures of the naturally occurring compounds or a close derivative. Scaffold preparation was pursued following the development of appropriate enabling chemical methods. Diversification provided 686 new compounds suitable for screening. The libraries thus prepared had structural characteristics, including sp3 content, comparable to a basis set of representative natural products and were highly rule-of-five compliant. PMID:24451589

Integrated Medical Curriculum: Advantages and Disadvantages

PubMed Central

Quintero, Gustavo A.; Vergel, John; Arredondo, Martha; Ariza, María-Cristina; Gómez, Paula; Pinzon-Barrios, Ana-Maria

2016-01-01

Most curricula for medical education have been integrated horizontally and vertically–-vertically between basic and clinical sciences. The Flexnerian curriculum has disappeared to permit integration between basic sciences and clinical sciences, which are taught throughout the curriculum. We have proposed a different form of integration where the horizontal axis represents the defined learning outcomes and the vertical axis represents the teaching of the sciences throughout the courses. We believe that a mere integration of basic and clinical sciences is not enough because it is necessary to emphasize the importance of humanism as well as health population sciences in medicine. It is necessary to integrate basic and clinical sciences, humanism, and health population in the vertical axis, not only in the early years but also throughout the curriculum, presupposing the use of active teaching methods based on problems or cases in small groups. PMID:29349303

Black Hole Binaries in Quiescence

NASA Astrophysics Data System (ADS)

Bailyn, Charles D.

I discuss some of what is known and unknown about the behavior of black hole binary systems in the quiescent accretion state. Quiescence is important for several reasons: 1) the dominance of the companion star in optical and IR wavelengths allows the binary parameters to be robustly determined - as an example, we argue that the longer proposed distance to the X-ray source GRO J1655-40 is correct; 2) quiescence represents the limiting case of an extremely low accretion rate, in which both accretion and jets can be observed; 3) understanding the evolution and duration of the quiescent state is a key factor in determining the overall demographics of X-ray binaries, which has taken on a new importance in the era of gravitational wave astronomy.

[Acute hepatitis in infectious diseases].

PubMed

Podymova, S D

2013-01-01

Hepatitis A, B, C, D, E, G are the most common causes of acute hepatitis, however, there are many infectious diseases affecting liver and with fever, early diagnostics of which is very important for the clinic of internal diseases. This review presents infections, causing fever and hepatitis, but not necessarily accompanied by jaundice. Leptospirosis, yellow fever have been considered, in which liver damage determines the clinic and the prognosis of the disease. In other cases, such as infectious mononucleosis, cytomegalovirus and herpetic hepatitis, typho-para-typhoid infections, typhoid, pneumonia, some viral diseases, malaria, Legionnaire's disease, hepatitis do not have their independent status and represent one of the important syndromes of a common disease. Modern methods of diagnostics and treatment of these diseases have been described.

[Indications for surgery in thyroiditis].

PubMed

Diaconescu, M R; Glod, M; Costea, I; Grigorovici, M; Diaconescu, S

2012-01-01

Inflammatory processes of the thyroid represents a main proportion of the gland's pathology but the majority of them are treated by medical methods, surgery being indicated. In 14 cases (3%) from 464 operations for different thyroid conditions we have encountered authentic inflammatory lesions in 9 cases of Hashimoto's thyroiditis (two associated with papillary thyroid carcinoma and one with malignant lymphoma), two cases of Riedel's thyroiditis and respectively de Quervain thyoiditis, tuberculous thyroiditis and actynomicosis one case each. The common lymphoplasmacytic infiltration in Basedow's disease was not considered likewise as the inflammatory nespecific lesions encountered in benign and malignant pathology of the gland. The clinical and imagistic data, biological evaluation and titer of anticorps but particularly the paraffine examination together with intraoperative estimations are decisive for the diagnosis. Firm diagnosis of thyroiditis was rarely affirmed before operation, surgical indication being formulated on clinical criterions dominated by cancer suspicion. Among these are diffuse or (multi)nodular thyromegaly with a dominant nodule with recent appearance and rapid growing in temporal and geographic proximity of Chemobyl disaster, with hard consistence, celsian or compressive features and adenopathy. More added the imagistic signs but especially suspect aspects of the FNAB (follicular or with Hürthle cells smears) and also of the frozen sections. Certainty diagnosis was established by paraffine examination not always without hesitations or reexamination (Hashimoto's thyroiditis diagnosed in one case was finally a malignant lymphoma). Large removal decided after intraoperative findings induced for the most of patients a definitive hypothyroidism. All the diagnosis resources must be exhausted for the diagnosis of the inflammatory lesions of the thyroid to avoid unnecessary surgery. On the other side the chronic overstimulation by the TSH of the glandular tissue affected by the immune process, represent an important factor of producing neoplasia.

Expressing the sense of the House of Representatives that the United States should ban and prevent the import of shark fins from sharks caught through the practice of finning, and for other purposes.

THOMAS, 113th Congress

Rep. Buchanan, Vern [R-FL-16

2013-06-28

House - 06/28/2013 Referred to the Committee on Natural Resources, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee... (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

Clinical efficacy analysis of the mouth rinsing with pomegranate and chamomile plant extracts in the gingival bleeding reduction.

PubMed

Batista, Ana Luzia Araújo; Lins, Ruthineia Diógenes Alves Uchôa; de Souza Coelho, Renata; do Nascimento Barbosa, Danielle; Moura Belém, Nayara; Alves Celestino, Frayni Josley

2014-02-01

Medicinal plants represent important therapeutic resources to health restoration, including the use of herbal products in the mouth conditions treatment. A randomized controlled clinical trial was performed in order to evaluate the effectiveness of mouth rinse with pomegranate and chamomile plant extracts, against chlorhexidine 0.12% in the gingiva bleeding condition. The mouth rinses with the herbal products were effective for this case, showing thus, antimicrobial and anti-inflammatory properties similar to that of chlorhexidine 0.12%. Copyright © 2013 Elsevier Ltd. All rights reserved.

Surveying unsteady flows by means of movie sequences - A case study

NASA Astrophysics Data System (ADS)

Freymuth, P.; Bank, W.; Finaish, F.

Photographic surveying techniques and their results are presented for vortical pattern development in unsteady two-dimensional flows, which depends on a multitude of parameters that have heretofore hampered broad investigation, in order to delineate the more important parametric dependencies. Samples are given from 100 films representing over 2000 sequences consisting of 400,000 photographic frames. Attention is given to the problems posed by resolution of time and lateral dimensions, spanwise vortical structure, and the dependence of angle of attack on Reynolds number and flow geometry.

The Role of the Orthopaedic Surgeon in Workers' Compensation Cases.

PubMed

Daniels, Alan H; Kuris, Eren O; Palumbo, Mark A

2017-03-01

Workers' compensation is an employer-funded insurance program that provides financial and medical benefits for employees injured at work. Because many occupational injuries are musculoskeletal in nature, the orthopaedic surgeon plays an important role in the workers' compensation system. Along with establishing the correct diagnosis and implementing an appropriate treatment plan, the clinician must understand the fundamental components of the workers' compensation system to manage an injured employee. Ultimately, effective claim management requires collaboration among the employer, the employee, the legal representatives, the insurance company, and the orthopaedic surgeon.

Tailoring the Statistical Experimental Design Process for LVC Experiments

DTIC Science & Technology

2011-03-01

incredibly large test space, it is important to point out that Gray is presenting a simple case to demonstrate the application of an experimental...weapon’s effectiveness. Gray defines k1 = 4 factors in the whole plot and k2 = 3 factors in the sub plot with f1 and f2 as the number of factors...aliased with interaction terms in the whole plot and sub plot respectively. Gray uses the notation 2k1−f1 × 2k2−f2 [?] to represent the fractional

Ureteritis Cystica: A Radiologic Pathologic Correlation

PubMed Central

Rothschild, Jennifer G; Wu, Guan

2011-01-01

Ureteritis cystica (UC) is a benign condition that commonly affects the ureter and can mimic other conditions such as transitional cell carcinoma, blood clots, air bubbles, radiolucent stones, fibroepithelial polyps, and sloughed renal papillae. Radiographically, UC is characterized by multiple small, round, lucent defects, which cause scalloping of the ureteral margins when seen in profile. The scalloping is produced by the projection of the submucosal cysts into the lumen and represents an important differential feature of this disease. We present a case of UC with a radiological pathological correlation. PMID:21966620

Personalizing and Contextualizing Multimedia Case Methods in University-based Teacher Education: An Important Modification for Promoting Technological Design in School Science

NASA Astrophysics Data System (ADS)

Bencze, Larry; Hewitt, Jim; Pedretti, Erminia

2009-01-01

Results of various studies suggest that multimedia ‘case methods’ (activities associated with case documentaries) have many benefits in university-based teacher education contexts. They can, for example, help to ‘bridge the gap’ between perspectives and practices held by academic teacher educators and those held by student-teachers - who may adhere to perspectives and practices commonly supported in schools. On the other hand, some studies, along with theoretical arguments, suggest that there are limits to the effectiveness of multimedia case methods - because, for example, they can never fully represent realities of teaching and learning in schools. Furthermore, often missing from multimedia case methods is the student-teacher in the role of teacher. To address these concerns, we modified an existing multimedia case method by associating it with a special practice teaching situation in a school context. Qualitative data analyzed using constant comparative methods suggest that student-teachers engaged in this modified multimedia case method developed relatively deep commitments to encouraging students to conduct technology design projects - a non-traditional practice in school science. Factors that appeared to influence development of this motivation included student-teachers’ pre-instructional perspectives about science and the personalization and contextualization inherent to the modified multimedia case method.

The Starlight Initiative in relation to the A&WHI

NASA Astrophysics Data System (ADS)

Marin, Cipriano

2015-08-01

Launched in 2007 on the occasion of the Starlight Conference (La Palma), the Starlight Initiative is designed as an international action in defence of the values associated with the night sky and the general right to observe the stars.The contribution of the Starlight initiative to UNESCO's Astronomy and World Heritage Thematic Initiative is focused on some actions that provide new perspectives on the heritage of astronomy in the framework of the Global Strategy for the balanced, representative and credible World Heritage List.1. Recognition of Windows to the Universe, the Astronomical Observatories of High Mountain. Only a few places on the planet where we find a unique combination of environmental and natural circumstances: well conserved spaces with very little alteration to natural starlight. These exceptional sites, including their natural components, can be considered as “landscapes of science and knowledge”. As we would have expected, the world’s largest contemporary observatories, true scientific monuments, are located in these places and are, to a greater or lesser extent, historical sources of modern astronomical culture. The case of Mauna Kea (Hawaii), the Canarian observatories (Spain), Pic-du-Midi (France) and northern Chile observatories are for an ensemble of discrete sites that have outstanding universal significance as a group.2. Highlight the importance of heritage of astronomy in ancient island cultures. One aspect scarcely represented in the case studies on this subject. In this context, Risco Caído and the sacred mountains of Gran Canaria can be taken as reference on the evolution of astronomical cultures in complete isolation.3. Emphasize the importance of preserving the dark skies and natural lighting in the conservation of biodiversity and landscapes in prime locations with outstanding natural values, including cultural landscapes. This represents a new dimension that affects the improvement of properties included in the List, and also a new field to develop in other sites that address a new vision of the integrity of certain exceptional values, providing new interpretations to the application criteria.

Qualitatively Coherent Representation Makes Decision-Making Easier with Binary-Colored Multi-Attribute Tables: An Eye-Tracking Study

PubMed Central

Morii, Masahiro; Ideno, Takashi; Takemura, Kazuhisa; Okada, Mitsuhiro

2017-01-01

We aimed to identify the ways in which coloring cells affected decision-making in the context of binary-colored multi-attribute tables, using eye movement data. In our black-white attribute tables, the value of attributes was limited to two (with a certain threshold for each attribute) and each cell of the table was colored either black or white on the white background. We compared the two natural ways of systematic color assignment: “quantitatively coherent” ways and “qualitatively coherent” ways (namely, the ways in which the black-white distinction represented the quantitative amount distinction, and the ways in which the black-white distinction represented the quality distinction). The former consists of the following two types: (Type 1) “larger is black,” where the larger value-level was represented by black, and “smaller is white,” and (Type 2) “smaller is black.” The latter consisted of the following two types: (Type 3) “better is black,” and (Type 4) “worse is black.” We obtained the following two findings. [Result 1] The qualitatively coherent black-white tables (Types 3 and 4) made decision-making easier than the quantitatively coherent ones (Types 1 and 2). [Result 2] Among the two qualitatively coherent types, the “black is better” tables (Type 3) made decision making easier; in fact, the participants focused on the more important (black) cells in the case of “black is better” tables (Type 3) while they did not focus enough on the more important (white) ones in the case of the “white is better” tables (Type 4). We also examined some measures of eye movement patterns and showed that these measures supported our hypotheses. The data showed differences in the eye movement patterns between the first and second halves of each trial, which indicated the phased or combined decision strategies taken by the participants. PMID:28861020

Economic cost analysis of malaria case management at the household level during the malaria elimination phase in The People's Republic of China.

PubMed

Xia, Shang; Ma, Jin-Xiang; Wang, Duo-Quan; Li, Shi-Zhu; Rollinson, David; Zhou, Shui-Sen; Zhou, Xiao-Nong

2016-06-03

In China, malaria has been posing a significant economic burden on households. To evaluate malaria economic burden in terms of both direct and indirect costs has its meaning in improving the effectiveness of malaria elimination program in China. A number of study sites (eight counties in five provinces) were selected from the malaria endemic area in China, representing the different levels of malaria incidence, risk classification, economic development. A number of households with malaria cases (n = 923) were surveyed during the May to December in 2012 to collect information on malaria economic burden. Descriptive statistics were used to characterize the basic profiles of selected malaria cases in terms of their gender, age group, occupation and malaria type. The malaria economic costs were evaluated by direct and indirect costs. Comparisons were carried out by using the chi-square test (or Z-test) and the Mann-Whitney U test among malaria cases with reference to local/imported malaria patients, hospitalized/out patients, and treatment hospitals. The average cost of malaria per case was 1 691.23 CNY (direct cost was 735.41 CNY and indirect cost was 955.82 CNY), which accounted for 11.1 % of a household's total income. The average costs per case for local and imported malaria were 1 087.58 CNY and 4271.93 CNY, respectively. The average cost of a malaria patient being diagnosed and treated in a hospital at the county level or above (3 975.43 CNY) was 4.23 times higher than that of malaria patient being diagnosed and treated at a village or township hospital (938.80 CNY). This study found that malaria has been posing a significant economic burden on households in terms of direct and indirect costs. There is a need to improve the effectiveness of interventions in order to reduce the impact costs of malaria, especially of imported infections, in order to eliminate the disease in China.

Tunable bandgaps in a deployable metamaterial

NASA Astrophysics Data System (ADS)

Nanda, Aditya; Karami, M. Amin

2018-03-01

In this manuscript, we envision deployable structures (such as solar arrays) and origami-inspired foldable structures as metamaterials capable of tunable wave manipulation. Specifically, we present a metamaterial whose bandgaps can be modulated by changing the fold angle of adjacent panels. The repeating unit cell of the structure consists of a beam (representing a panel) and a torsional spring (representing the folding mechanism). Two important cases are considered. Firstly, the fold angle (angle between adjacent beams), Ψ, is zero and only flexural waves propagate. In the second case, the fold angle is greater than zero (Ψ > 0). This causes longitudinal and transverse vibration to be coupled. FEM models are used to validate both these analyses. Increasing the fold angle was found to inflict profound changes to the wave transmission characteristics of the structure. In general, increasing the fold angles caused the bandwidth of bandgaps to increase significantly. For the lowest four bandgaps we found bandwidth increases of 252 %, 177 %, 230 % and 163 % respectively at Ψ = 90 deg (relative to the bandwidths at Ψ = 0). In addition, significant increase in bandwidth of the odd-numbered bandgaps occurs even at small fold angles- the bandwidth for the first and third bandgaps effectively double in size (increase by 100%) at Ψ = 20 deg relative to those at Ψ = 0. This has important ramifications in the context of tunable wave manipulation and adaptive filtering. In addition, by expanding out the characteristic equation of transfer matrix for the straight structure, we prove that the upper band edge of the nth bandgap will always equal the nth simply supported natural frequency of the constituent beam. Further, we found that the ratio (EI/kt) is an important parameter affecting the bandwidth of bandgaps. For low values of the ratio, effectively, no bandgap exists. For higher values of the ratio (EI/kt), we obtain a relatively large bandgap over which no waves propagate. This can have important ramifications for the design of foldable structures. As an alternative to impedance-based structural health monitoring, these insights can aid in health monitoring of deployable structures by tracking the bandwidth of bandgaps which can provide important clues about the mechanical parameters of the structure.

Influence of upstream disturbance on the draft-tube flow of Francis turbine under part-load conditions

NASA Astrophysics Data System (ADS)

Chen, Ting; Zheng, Xianghao; Zhang, Yu-ning; Li, Shengcai

2018-02-01

Owing to the part-load operations for the enhancement of grid flexibility, the Francis turbine often suffers from severe low-frequency and large-amplitude hydraulic instability, which is mostly pertinent to the highly unsteady swirling vortex rope in the draft tube. The influence of disturbances in the upstream (e.g., large-scale vortex structures in the spiral casing) on the draft-tube vortex flow is not well understood yet. In the present paper, the influence of the upstream disturbances on the vortical flow in the draft tube is studied based on the vortex identification method and the analysis of several important parameters (e.g., the swirl number and the velocity profile). For a small guide vane opening (representing the part-load condition), the vortices triggered in the spiral casing propagate downstream and significantly affect the swirling vortex-rope precession in the draft tube, leading to the changes of the intensity and the processional frequency of the swirling vortex rope. When the guide vane opening approaches the optimum one (representing the full-load condition), the upstream disturbance becomes weaker and thus its influences on the downstream flow are very limited.

A case of multicentric low-grade neuroendocrine breast tumor with an unusual histological pattern.

PubMed

D'Antonio, Antonio; Addesso, Maria; Memoli, Domenico; Cascone, Annamaria; Cremone, Luigi

2016-01-01

Neuroendocrine features are detectable in carcinomas of the breast either as scattered cells, that are recognized by their expression of neuroendocrine cell markers. Instead, pure breast carcinomas with neuroendocrine features (NEBC) are very rare and represent <1% of all breast cancer. Usually NEBC may be well or poorly differentiated and more frequent in older woman. These tumors showed variable histological pattern but a common feature is represented by expression of neuroendocrine markers. Here we report a case of a primary multicentric low-grade neuroendocrine carcinoma of the breast presented because of its rarity and for the unusual tubular and cribriform pattern resembling a well-differentiated conventional breast carcinoma. The tumor was treated with left quadrantectomy with concomitant wide excisional biopsy of other two nodules and lymph node sentinel biopsy. No recurrence was observed during 1-year follow-up. Because of its rarity and variability of morphologic features, there exist diagnostic challenges for pathologists to differentiate primary NEBC to some conventional breast carcinomas and to the breast metastasis from neuroendocrine tumor of the lung or gastrointestinal tract. It is important to be able recognize this tumor in order to avoid potential misdiagnosis and improper management of afflicted patients.

Bathroom scald burns in Queensland Children.

PubMed

Gole, Hobia; Kimble, Roy; Stockton, Kellie

2017-05-01

To evaluate the current characteristics of bathroom scald injuries in Queensland Children. Data was collected from patients who presented with a bathroom scald injury to the Stuart Pegg Paediatric Burns Centre at the Royal Children's Hospital and Lady Cilento Children's Hospital, Brisbane from January 2013 to December 2014. Bathroom scald burns represented 2.6% of total burns cases with an inpatient rate of 39%. The family home is the location of injury in 84% of cases and in 79% the patient was aged 2 years of age or younger. Total body surface area ranged from 0.5% to 20% with a median of 1.75% (IQR 0.63, 3.38%). In our study 8% of patients underwent grafting and 24% received follow up for scar management. Injuries occurred in rental properties in 47% of tempering valve survey respondents. The rate of installation of tempering valves was 23%. Bathroom scald burns continue to be over-represented in inpatient data. Tempering valves were not consistently installed after injury, this intervention would require further legislation to be an effective prevention strategy. This study provides important insights into paediatric bathroom scald injuries and will assist with the development of prevention strategies. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Gastric epithelioid haemangioendothelioma.

PubMed

Tavares, A B; Almeida, A G; Viveiros, F A; Cidade, C N; Barbosa, J M

2011-05-10

Epithelioid haemangioendothelioma (EHE) is a rare tumour of vascular origin, characterised by celular proliferation, endotelial, epitelioid or hystiocitoid. It may develop in any organ, but it is more common in lung and liver. Surgery is the recommended treatment; however, in case of a potentially benign situation, an expectant attitude should be adopted. The case reports a 71-year-old female who underwent a laparotomy for a colonic adenocarcinoma. During surgery, a polypoid lesion in the dependency of the gastric wall was found incidentally, which was removed. Histopathology and immunohistochemical analysis confirmed the diagnosis of EHE. Gastric vascular neoplasms represent about 0.9-3.3% of all gastric tumours. Usually have a good prognosis, but due to the borderline biological behaviour of these tumours, it is important to have a detailed clinical evaluation at follow-up of these patients.

A comparative study of machine learning models for ethnicity classification

NASA Astrophysics Data System (ADS)

Trivedi, Advait; Bessie Amali, D. Geraldine

2017-11-01

This paper endeavours to adopt a machine learning approach to solve the problem of ethnicity recognition. Ethnicity identification is an important vision problem with its use cases being extended to various domains. Despite the multitude of complexity involved, ethnicity identification comes naturally to humans. This meta information can be leveraged to make several decisions, be it in target marketing or security. With the recent development of intelligent systems a sub module to efficiently capture ethnicity would be useful in several use cases. Several attempts to identify an ideal learning model to represent a multi-ethnic dataset have been recorded. A comparative study of classifiers such as support vector machines, logistic regression has been documented. Experimental results indicate that the logical classifier provides a much accurate classification than the support vector machine.

Sustainability or Collapse: Interplay Between Decadal Climate Variability and Human Activities Matters

NASA Astrophysics Data System (ADS)

Lu, Y.; Hu, H.; Tian, F.

2016-12-01

The Aral Sea Crisis and the deterioration of Tarim River Basin are representative cases of emergent water deficit problems in arid areas. Comparing cases of water deficit problems in different regions and considering the in the perspective of socio-hydrology is helpful to obtain guidance on integrated management of arid area basins. Analyzing the interplay between decadal climate variability and human activities in both basins, the important role of human activities is observed. Decadal climate variability tempts people to adapt fast to increasing water resources and slowly to decreasing water resources, while using unsustainable technical measures to offset water shortage. Due to this asymmetry the situation deteriorates with technically enhanced capabilities of societies to exploit water resources, and more integrated long-term management capacity is in high demand.

Helicopter emergency medical services response to equestrian accidents.

PubMed

Lyon, Richard M; Macauley, Ben; Richardson, Sarah; de Coverly, Richard; Russell, Malcolm

2015-04-01

Horse riding is a common leisure activity associated with a significant rate of injury. Helicopter emergency medical services (HEMS) may be called to equestrian accidents. Accurate HEMS tasking is important to ensure appropriate use of this valuable medical resource. We sought to review HEMS response to equestrian accidents and identify factors associated with the need for HEMS intervention or transport of the patient to a major trauma centre. Retrospective case review of all missions flown by Kent, Surrey & Sussex Air Ambulance Trust over a 1-year period (1 July 2011 to 1 July 2012). All missions were screened for accidents involving a horse. Call details, patient demographics, suspected injuries, clinical interventions and patient disposition were all analysed. In the 12-month data collection period there were 47 equestrian accidents, representing ∼3% of the total annual missions. Of the 42 cases HEMS attended, one patient was pronounced life extinct at the scene. In 15 (36%) cases the patient was airlifted to hospital. In four (10%) cases, the patient underwent prehospital anaesthesia. There were no specific predictors of HEMS intervention. Admission to a major trauma centre was associated with the rider not wearing a helmet, a fall onto their head or the horse falling onto the rider. Equestrian accidents represent a significant proportion of HEMS missions. The majority of patients injured in equestrian accidents do not require HEMS intervention, however, a small proportion have life-threatening injuries, requiring immediate critical intervention. Further research is warranted, particularly regarding HEMS dispatch, to further improve accuracy of tasking to equestrian accidents.

Recovery of Repressed Memories in Fibromyalgia Patients Treated With Hyperbaric Oxygen – Case Series Presentation and Suggested Bio-Psycho-Social Mechanism

PubMed Central

Efrati, Shai; Hadanny, Amir; Daphna-Tekoah, Shir; Bechor, Yair; Tiberg, Kobi; Pik, Nimrod; Suzin, Gil; Lev-Wiesel, Rachel

2018-01-01

Fibromyalgia Syndrome (FMS) is a condition considered to represent a prototype of central sensitization syndrome, characterized by chronic widespread pain and along with symptoms of fatigue, non-restorative sleep and cognitive difficulties. FMS can be induced by trauma, infection or emotional stress with cumulative evidence that dissociation is relatively frequent in FMS patients. Two randomized controlled trials have shown that hyperbaric oxygen therapy (HBOT) can induce neuroplasticity and be effective in patients suffering from FMS. In this paper we present, for the first time, case series of female fibromyalgia patients who, in the course of HBOT, suddenly recalled repressed traumatic memories of childhood sexual abuse (CSA). The surfacing of the repressed (dissociative) memories decades after the sexual abuse events was sudden and utterly surprising. No psychological intervention was involved. As the memories surfaced, the physical pain related to FMS subsided. In one patient who had brain single photon emission CT (SPECT) before and after HBOT, the prefrontal cortex appeared suppressed before and reactivated after. The 3 cases reported in this article are representative of a total of nine fibromyalgia patients who experienced a retrieval of repressed memory during HBOT. These cases provide insights on dissociative amnesia and suggested mechanism hypothesis that is further discussed in the article. Obviously, prospective studies cannot be planned since patients are not aware of their repressed memories. However, it is very important to keep in mind the possibility of surfacing memories when treating fibromyalgia patients with HBOT or other interventions capable of awakening dormant brain regions. PMID:29896150

Potential Clinical and Economic Impact of Switching Branded Medications to Generics.

PubMed

Straka, Robert J; Keohane, Denis J; Liu, Larry Z

2017-05-01

Switching branded to generic medications has become a common cost-containment measure. Although this is an important objective for health care systems worldwide, the impact of this practice on patient outcomes needs to be carefully considered. We reviewed the literature summarizing the potential clinical and economic consequences of switching from branded to generic medications on patient outcomes. A literature search of peer-reviewed articles published 2003-2013 using key words of "generic switching" or "substitution" was conducted using PubMed, OvidSP, and ScienceDirect. Of 30 articles identified and reviewed, most were related to the diseases of the central nervous system, especially epilepsy. Based on our review, potential impacts of switching fell into 3 broad categories: patient attitudes and adherence, clinical and safety outcomes, and cost and resource utilization. Although in many cases generics may represent an appropriate alternative to branded products, this may not always be the case. Specifically, several studies suggested that switching may negatively impact medication adherence, whereas other studies found that generic switching was associated with poorer clinical outcomes and more adverse events. In some instances, switching accomplished cost savings but did so at increased total cost of care because of increased physician visits or hospitalizations. Although in many cases generics may represent an appropriate alternative, mandatory generic switching may lead to unintended consequences, especially in certain therapeutic areas. Although further study is warranted, based on our review, it may be medically justifiable for physicians and patients to retain the right to request the branded product in certain cases.

Potential Clinical and Economic Impact of Switching Branded Medications to Generics

PubMed Central

Straka, Robert J.; Keohane, Denis J.; Liu, Larry Z.

2017-01-01

Switching branded to generic medications has become a common cost-containment measure. Although this is an important objective for health care systems worldwide, the impact of this practice on patient outcomes needs to be carefully considered. We reviewed the literature summarizing the potential clinical and economic consequences of switching from branded to generic medications on patient outcomes. A literature search of peer-reviewed articles published 2003–2013 using key words of “generic switching” or “substitution” was conducted using PubMed, OvidSP, and ScienceDirect. Of 30 articles identified and reviewed, most were related to the diseases of the central nervous system, especially epilepsy. Based on our review, potential impacts of switching fell into 3 broad categories: patient attitudes and adherence, clinical and safety outcomes, and cost and resource utilization. Although in many cases generics may represent an appropriate alternative to branded products, this may not always be the case. Specifically, several studies suggested that switching may negatively impact medication adherence, whereas other studies found that generic switching was associated with poorer clinical outcomes and more adverse events. In some instances, switching accomplished cost savings but did so at increased total cost of care because of increased physician visits or hospitalizations. Although in many cases generics may represent an appropriate alternative, mandatory generic switching may lead to unintended consequences, especially in certain therapeutic areas. Although further study is warranted, based on our review, it may be medically justifiable for physicians and patients to retain the right to request the branded product in certain cases. PMID:26099048

Hypercellular round cell liposarcoma: A comprehensive cytomorphologic study and review of 8 cases.

PubMed

Chufal, Sanjay S; Chufal, Kundan S; Pant, Prabhat; Rizvi, Ghazala; Pandey, Hari S; Shahi, Kedar S

2017-01-01

Myxoid and round cell liposarcomas (RCL) are low and high-grade counterparts of a common subtype of liposarcomas (LPS), representing a histologic continuum. The aim was to study the cytomorphology of hypercellular RCL and to look for features that differentiate RCL from other sarcomas displaying round cells with myxoid change. Eight cases of hypercellular RCL were identified retrospectively in which round cell component constituted greater than 75% of the area. Cytomorphological features were studied in detail. Four cases were predominantly composed of round cells, out of which 2 were entirely composed of round cells. Myxoid metachromatic stroma was absent in 2 cases, while it was present in ample amounts in the remaining 6 cases. Spindle cells were completely absent in 5 cases and lipoblasts were observed in a single case of RCL. Plexiform vascular capillaries were seen in 4 cases. Adherence of neoplastic round cells around thin capillaries (ANAC) was observed in 7 cases. Plexiform capillary plexus and ANAC should be separately evaluated. The latter feature is the most consistent one, and is an important clue to the adipocytic nature of the neoplasm when hypercellular round cell areas are aspirated. Confident diagnosis of hypercellular RCL can be made on the basis of this feature. Lipoblasts, although specific, are seen in few cases. The rest of the features are nonspecific and useful only in combination.

Unusual Association Between Spontaneous Lateral Sphenoid Encephalocele and Chiari Malformation Type I: Endoscopic Repair Through a Transpterygoid Approach.

PubMed

Starnoni, Daniele; Daniel, Roy Thomas; George, Mercy; Messerer, Mahmoud

2017-01-01

Spontaneous meningoencephaloceles of the lateral sphenoid sinus are rare entities, and their peculiar location represents a surgical challenge due to the importance of a wide exposure and skull base reconstruction. They are thought to arise from the congenital base defect of the lateral sphenoid or in some cases have been postulated to represent a rare manifestation of altered cerebrospinal fluid (CSF) dynamics. We report the first case in the literature of a Chiari malformation type I (CMI) and a lateral sphenoid encephalocele, revising the theoretic etiology and surgical technique of endoscopic repair. A 50-year-old woman with a surgical history of symptomatic CMI presented with episodes of spontaneous CSF rhinorrhea. Radiologic investigations revealed a left mesial temporal encephalocele herniating into the lateral recess of the sphenoid sinus and radiologic features of altered CSF dynamics, which may have played an etiologic role. An endoscopic transpterygoid excision of the encephalocele and multilayer skull base repair were performed. The association of spontaneous lateral sphenoid encephaloceles with CMI is distinctly unusual. Predisposing factors and disruption of CSF dynamics may play a major role in the development of these rare complications in patients with CMI. Because of their distinct location, transethmoid or transpterygoid endoscopic approaches represent an excellent surgical technique to treat these lesions thanks to their wide and direct visualization of the entire skull base defect following the encephalocele excision, allowing an adequate multilayer repair and lateral sphenoid recess occlusion. Copyright © 2016 Elsevier Inc. All rights reserved.

The determination of the botanical origin in honeys with over-represented pollen: combination of melissopalynological, sensory and physicochemical analysis.

PubMed

Rodopoulou, Maria-Anna; Tananaki, Chrysoula; Dimou, Maria; Liolios, Vasilios; Kanelis, Dimitrios; Goras, Georgios; Thrasyvoulou, Andreas

2018-05-01

Pollen analysis of honey is the basic method for the determination of its botanical origin. However, the presence of over-represented pollen in honeys may lead the analysis to false results. This can be more severe if this pollen is present in unifloral under-represented honeys of commercial importance (e.g. thyme honey). In the present study, we investigated the abundance of over-represented pollen grains on several quality characteristics in honey samples. In particular, we mixed honeys characterised as over-represented, specifically chestnut and eucalyptus, with thyme honeys in different analogies, and we also analysed the melissopalynological, organoleptic, physicochemical (water content, electrical conductivity, colour) and volatile characteristics of the blends. The most sensitive parameters were the microscopic characteristics, followed by the organoleptic ones. Blends of thyme honey with an originally low percentage of thyme pollen were the most influenced and could not be characterised as unifloral regarding their melissopalynological characteristics, even when they were mixed with small quantities of honeys with over-represented pollen (i.e. 5%). The present study confirms that, in the case of presence of over-represented pollen in honeys, pollen analysis alone cannot give trustworthy results for the determination of the botanical origin, even though their exclusion during pollen analysis, when they are present in percentages of up to 30%, could provide more accurate results. Consequently, pollen analysis should also be combined with the other analyses, especially in honeys with under-represented and over-represented pollens, to give safer results for the botanical characterisation of honeys. © 2017 Society of Chemical Industry. © 2017 Society of Chemical Industry.

Method for siting detectors within a facility

DOEpatents

Gleason, Nathaniel Jeremy Meyer

2007-12-11

A method, system and article of manufacture of siting one or more detectors in a facility represented with zones are provided. Signals S.sub.i,j representing an effect in zone j in response to a release of contaminant in zone i for one or more flow conditions are provided. A candidate architecture has one or more candidate zones. A limiting case signal is determined for each flow condition for multiple candidate architectures. The limiting case signal is a smallest system signal of multiple system signals associated with a release in a zone. Each system signal is a maximum one of the signals representing the effect in the candidate zones from the release in one zone for the flow condition. For each candidate architecture, a robust limiting case signal is determined based on a minimum of the limiting case signals. One candidate architecture is selected based on the robust limiting case signals.

Mycetoma (Madura Foot) in Israel: Recent Cases and a Systematic Review of the Literature.

PubMed

Bitan, Ohad; Wiener-Well, Yonit; Segal, Rina; Schwartz, Eli

2017-06-01

AbstractMycetoma is a chronic soft tissue infection caused by fungal or bacterial pathogens, and is endemic in tropical and subtropical regions. Cases in developed countries outside the mycetoma belt are rare and usually imported by immigrants. Sporadic cases have been reported in Israel. Unpublished cases in the participating medical centers are reported. In addition, a systematic review of the literature was performed. All published mycetoma cases diagnosed in Israel were included with relevant variables collected. Twenty-one cases of mycetoma were diagnosed in Israel between 1942 and 2015, including four unpublished cases and 17 published cases. The mean age at diagnosis was 42 years (range 23-73), and 16 of the patients were male. The foot was the primary involved organ. Fifteen patients were immigrants from Yemen, Ethiopia, and Sudan. Five cases were autochthonous. One case was travel related. Among patients who developed symptoms after immigration, the mean time from exposure to symptom onset was 5.6 years (range 1-10 years). The mean time from symptom onset to diagnosis was 6.6 years (range 0.2-35 years). The autochthonous cases demonstrate that Israel is endemic of mycetoma. The immigrant population represents two distinct waves of immigration to Israel in the past century. Two unpublished cases of Ethiopian immigrants are the first reported cases of mycetoma acquired in Ethiopia. The diagnostic and therapeutic challenges along with the epidemiological data emphasize the need of raising the awareness of physicians to this devastating condition even in developed countries.

Importation and circulation of poliovirus in Bulgaria in 2001.

PubMed Central

Kojouharova, Mira; Zuber, Patrick L. F.; Gyurova, Snejana; Fiore, Lucia; Buttinelli, Gabriele; Kunchev, Angel; Vladimirova, Nadejda; Korsun, Neli; Filipova, Radosveta; Boneva, Roumiana; Gavrilin, Eugene; Deshpande, Jagadish M.; Oblapenko, George; Wassilak, Steven G.

2003-01-01

OBJECTIVE: To characterize the circumstances in which poliomyelitis occurred among three children in Bulgaria during 2001 and to describe the public health response. METHODS: Bulgarian authorities investigated the three cases of polio and their contacts, conducted faecal and serological screening of children from high-risk groups, implemented enhanced surveillance for acute flaccid paralysis, and conducted supplemental immunization activities. FINDINGS: The three cases of polio studied had not been vaccinated and lived in socioeconomically deprived areas of two cities. Four Roma children from the Bourgas district had antibody titres to serotype 1 poliovirus only, and wild type 1 virus was isolated from the faeces of two asymptomatic Roma children in the Bourgas and Sofia districts. Poliovirus isolates were related genetically and represented a single evolutionary lineage; genomic sequences were less than 90% identical to poliovirus strains isolated previously in Europe, but 98.3% similar to a strain isolated in India in 2000. No cases or wild virus isolates were found after supplemental immunization activities were launched in May 2001. CONCLUSIONS: In Bulgaria, an imported poliovirus was able to circulate for two to five months among minority populations. Surveillance data strongly suggest that wild poliovirus circulation ceased shortly after supplemental immunization activities with oral poliovirus vaccine were conducted. PMID:12973639

Underreporting of fatal occupational injuries in Catalonia (Spain).

PubMed

Benavides, Fernando G; Pérez, Gloria; Martínez, Jordi; Martínez, José Miguel; Gispert, Rosa; Benach, Joan

2004-03-01

Thoroughness in a given health information system is one of its most important quality indicators. In Spain, in approximately 30% of serious occupational injuries, there is no information on the final outcome. To assess underreporting of fatal occupational injuries in Catalonia. All serious occupational injuries (excluding commuting injuries) reported in Catalonia (Spain) between 1994 and 1998 (n = 7330) were linked with data from the Catalonian Mortality Register, 117 deaths being identified during the year following the injury date. In order to assess whether death could or could not have been related to the prior occupational injury, two experts examined these cases independently. The experts concluded (kappa = 0.98) that 69 (59%) of these deaths were probably related to occupational injuries; the vast majority (n = 65) occurred within 3 months of the injury. This represents an accumulated risk of dying of approximately 1% for the total of serious injuries, not varying with economic activity or job category. However, this risk varied depending on the form of accident, and the site and nature of the injury. Occupational injury cases, especially serious ones, should be followed up over at least 3 months. These results suggest the importance of carrying out active case-finding and of incorporating the death certificate as one of the documents to be systematically reviewed in order to complete the statistics.

Ciguatera Fish Poisoning in East Asia and Southeast Asia

PubMed Central

Chan, Thomas Y. K.

2015-01-01

In the coastal countries of East Asia and Southeast Asia, ciguatera should be common because of the extensive tropical and subtropical coral reefs along the coasts and in the neighboring seas with ciguatoxic fishes. An extensive search of journal databases, the Internet and the government websites was performed to identify all reports of ciguatera from the regions. Based on the official data and large published case series, the incidence of ciguatera was higher in the coastal cities (Hong Kong, Foshan, Zhongshan) of southern China than in Japan (Okinawa Prefecture). In Singapore, ciguatera appeared to be almost unknown. In other countries, only isolated cases or small case series were reported, but under-reporting was assumed to be common. Ciguatera may cause severe acute illness and prolonged neurological symptoms. Ciguatera represents an important public health issue for endemic regions, with significant socio-economic impact. Coordinated strategies to improve risk assessment, risk management and risk communication are required. The systematic collection of accurate data on the incidence and epidemiology of ciguatera should enable better assessment and management of its risk. Much more work needs to be done to define the size threshold for important coral reef fish species from different regions, above which the risk of ciguatera significantly increases. PMID:26042615

New congenital coronary artery anomaly - double supply of single left anterior descending coronary artery from the left and right coronary sinuses: a case report.

PubMed

Daralammouri, Yunis; Ghannam, Malik; Lauer, Bernward

2016-08-02

A normal anatomy of coronary arteries is important to have adequate cardiac muscle blood supply especially during extraneous physical activities. This case report describes a rare coronary anomaly in which the accessory coronary artery arose from the right coronary artery, reentered the left anterior descending coronary artery, and then ran as a single vessel. We present a case of a coronary anomaly in a 47-year-old white man who presented with atypical angina. Computed tomographic angiography and coronary angiography showed a variant of dual left anterior descending coronary artery not previously described. Our patient's accessory coronary artery arose from his right coronary artery. It took an intramuscular course beneath the right ventricular outflow tract in the interventricular septal area to the anterior interventricular sulcus, giving off septal perforators that reentered his medial left anterior descending coronary artery. Both vessels ran after the anastomosis in the anterior interventricular sulcus as a single vessel. We propose that this anomaly represents a new variant of coronary artery anomaly. This coronary artery anomaly does not cause ischemia. Recognition of this coronary anomaly is important in patients undergoing percutaneous coronary intervention or coronary artery bypass graft operations.

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

Singer, B.S.; Fanini, O.; Strack, K.M.

Through casing resistivity measurements confirmed the original concept proposed by Alpin and recently revived and improved by Kaufman and Vail. A commercial tool can be used for monitoring producing wells, waterflooding control, and searching for bypassed hydrocarbons in abandoned and active wells. The information on the resistivity of the formation is represented by the second spacial derivative of the casing voltage that is generally small. This makes the evaluation of possible distortions arising from different kinds of casing imperfections important. These imperfections include casing collars, corrosion, perforations, etc. The fact that only low frequencies can be used for the measurementmore » allows us to propose fast and accurate modeling algorithms. Numerical evaluation shows that the distorting effect of casing imperfections is quite moderate. Typically, it does not exceed 10 - 20% of the measured apparent resistivity. The vertical resolution of the measurements is limited by the spacing between the voltage sensing electrodes. It can be deteriorate due to the cement sheath that always exists around the casing. A significant distortion of the measurement occurs near the bottom of the casing. This distortion can reach 50% of the signal. To improve the readings, a simplified inversion algorithm has been developed. The most direct application of the algorithm is the monitoring of the pay zone resistivity.« less

Coupling between shear and bending in the analysis of beam problems: Planar case

NASA Astrophysics Data System (ADS)

Shabana, Ahmed A.; Patel, Mohil

2018-04-01

The interpretation of invariants, such as curvatures which uniquely define the bending and twist of space curves and surfaces, is fundamental in the formulation of the beam and plate elastic forces. Accurate representations of curve and surface invariants, which enter into the definition of the strain energy equations, is particularly important in the case of large displacement analysis. This paper discusses this important subject in view of the fact that shear and bending are independent modes of deformation and do not have kinematic coupling; this is despite the fact that kinetic coupling may exist. The paper shows, using simple examples, that shear without bending and bending without shear at an arbitrary point and along a certain direction are scenarios that higher-order finite elements (FE) can represent with a degree of accuracy that depends on the order of interpolation and/or mesh size. The FE representation of these two kinematically uncoupled modes of deformation is evaluated in order to examine the effect of the order of the polynomial interpolation on the accuracy of representing these two independent modes. It is also shown in this paper that not all the curvature vectors contribute to bending deformation. In view of the conclusions drawn from the analysis of simple beam problems, the material curvature used in several previous investigations is evaluated both analytically and numerically. The problems associated with the material curvature matrix, obtained using the rotation of the beam cross-section, and the fundamental differences between this material curvature matrix and the Serret-Frenet curvature matrix are discussed.

Numerical results on noise-induced dynamics in the subthreshold regime for thermoacoustic systems

NASA Astrophysics Data System (ADS)

Gupta, Vikrant; Saurabh, Aditya; Paschereit, Christian Oliver; Kabiraj, Lipika

2017-03-01

Thermoacoustic instability is a serious issue in practical combustion systems. Such systems are inherently noisy, and hence the influence of noise on the dynamics of thermoacoustic instability is an aspect of practical importance. The present work is motivated by a recent report on the experimental observation of coherence resonance, or noise-induced coherence with a resonance-like dependence on the noise intensity as the system approaches the stability margin, for a prototypical premixed laminar flame combustor (Kabiraj et al., Phys. Rev. E, 4 (2015)). We numerically investigate representative thermoacoustic models for such noise-induced dynamics. Similar to the experiments, we study variation in system dynamics in response to variations in the noise intensity and in a critical control parameter as the systems approach their stability margins. The qualitative match identified between experimental results and observations in the representative models investigated here confirms that coherence resonance is a feature of thermoacoustic systems. We also extend the experimental results, which were limited to the case of subcritical Hopf bifurcation, to the case of supercritical Hopf bifurcation. We identify that the phenomenon has qualitative differences for the systems undergoing transition via subcritical and supercritical Hopf bifurcations. Two important practical implications are associated with the findings. Firstly, the increase in noise-induced coherence as the system approaches the onset of thermoacoustic instability can be considered as a precursor to the instability. Secondly, the dependence of noise-induced dynamics on the bifurcation type can be utilised to distinguish between subcritical and supercritical bifurcation prior to the onset of the instability.

Opinion Dynamics with Disagreement and Modulated Information

NASA Astrophysics Data System (ADS)

Sîrbu, Alina; Loreto, Vittorio; Servedio, Vito D. P.; Tria, Francesca

2013-04-01

Opinion dynamics concerns social processes through which populations or groups of individuals agree or disagree on specific issues. As such, modelling opinion dynamics represents an important research area that has been progressively acquiring relevance in many different domains. Existing approaches have mostly represented opinions through discrete binary or continuous variables by exploring a whole panoply of cases: e.g. independence, noise, external effects, multiple issues. In most of these cases the crucial ingredient is an attractive dynamics through which similar or similar enough agents get closer. Only rarely the possibility of explicit disagreement has been taken into account (i.e., the possibility for a repulsive interaction among individuals' opinions), and mostly for discrete or 1-dimensional opinions, through the introduction of additional model parameters. Here we introduce a new model of opinion formation, which focuses on the interplay between the possibility of explicit disagreement, modulated in a self-consistent way by the existing opinions' overlaps between the interacting individuals, and the effect of external information on the system. Opinions are modelled as a vector of continuous variables related to multiple possible choices for an issue. Information can be modulated to account for promoting multiple possible choices. Numerical results show that extreme information results in segregation and has a limited effect on the population, while milder messages have better success and a cohesion effect. Additionally, the initial condition plays an important role, with the population forming one or multiple clusters based on the initial average similarity between individuals, with a transition point depending on the number of opinion choices.

Science foundation Chapter 5 Appendix 5.1: Case study marsh macroinvertebrates

USGS Publications Warehouse

Brusati, Elizabeth; Woo, Isa

2015-01-01

This case study includes representative macroinvertebrates that live in the marsh plain, its associated channels and pannes (ponds), and the marsh-upland transition zone. While less visible than animals such as birds, invertebrates play important roles in physical and biological processes (e.g., burrowing activity and channel bank erosion, and detritivores breaking down organic matter) and are important food resources for higher trophic animals. Common invertebrates in these habitats include plant-hopper (Prokelisia marginata), beach hopper (Traskorchestia traskiana), pygmy blue butterfly (Brephidium exilis), inchworm moth (Perizoma custodiata), western tanarthus beetle (Tanarthus occidentalis), salt marsh mosquitoes (Aedes spp.; Maffei 2000a, Maffei 2000b, Maffei 2000c), crabs (native Hemigrapsus oregonensis and introduced Carcinus maenas), copepods, snails (e.g. native California horn snail Cerithidea californica and introduced Ilyanassa obsoleta, Myosotella myosotis), polychaetes (e.g. Capitella spp., Eteone californica, Neanthes brandti), small clams (Macoma petalum/M. balthica), and corophiid amphipods (Cohen 2011, Race 1982, Robinson et al. 2011). Some common species were described in detail in the San Francisco Bay Goals Project Species and Community Profiles (Goals Project 2000).

The association of 22 Y chromosome short tandem repeat loci with initiative-aggressive behavior.

PubMed

Yang, Chun; Ba, Huajie; Zhang, Wei; Zhang, Shuyou; Zhao, Hanqing; Yu, Haiying; Gao, Zhiqin; Wang, Binbin

2018-05-15

Aggressive behavior represents an important public concern and a clinical challenge to behaviorists and psychiatrists. Aggression in humans is known to have an important genetic basis, so to investigate the association of Y chromosome short tandem repeat (Y-STR) loci with initiative-aggressive behavior, we compared allelic and haplotypic distributions of 22 Y-STRs in a group of Chinese males convicted of premeditated extremely violent crimes (n = 271) with a normal control group (n = 492). Allelic distributions of DYS533 and DYS437 loci differed significantly between the two groups (P < 0.05). The case group had higher frequencies of DYS533 allele 14, DYS437 allele 14, and haplotypes 11-14 of DYS533-DYS437 compared with the control group. Additionally, the DYS437 allele 15 frequency was significantly lower in cases than controls. No frequency differences were observed in the other 20 Y-STR loci between these two groups. Our results indicate a genetic role for Y-STR loci in the development of initiative aggression in non-psychiatric subjects. Copyright © 2018 Elsevier B.V. All rights reserved.

Risk factors for age-related maculopathy.

PubMed

Connell, Paul P; Keane, Pearse A; O'Neill, Evelyn C; Altaie, Rasha W; Loane, Edward; Neelam, Kumari; Nolan, John M; Beatty, Stephen

2009-01-01

Age-related maculopathy (ARM) is the leading cause of blindness in the elderly. Although beneficial therapeutic strategies have recently begun to emerge, much remains unclear regarding the etiopathogenesis of this disorder. Epidemiologic studies have enhanced our understanding of ARM, but the data, often conflicting, has led to difficulties with drawing firm conclusions with respect to risk for this condition. As a consequence, we saw a need to assimilate the published findings with respect to risk factors for ARM, through a review of the literature appraising results from published cross-sectional studies, prospective cohort studies, case series, and case control studies investigating risk for this condition. Our review shows that, to date, and across a spectrum of epidemiologic study designs, only age, cigarette smoking, and family history of ARM have been consistently demonstrated to represent risk for this condition. In addition, genetic studies have recently implicated many genes in the pathogenesis of age-related maculopathy, including Complement Factor H, PLEKHA 1, and LOC387715/HTRA1, demonstrating that environmental and genetic factors are important for the development of ARM suggesting that gene-environment interaction plays an important role in the pathogenesis of this condition.

Virtuous acts as practical medical ethics: an empirical study.

PubMed

Little, Miles; Gordon, Jill; Markham, Pippa; Rychetnik, Lucie; Kerridge, Ian

2011-10-01

To examine the nature, scope and significance of virtues in the biographies of medical practitioners and to determine what kind of virtues are at play in their ethical behaviour and reflection. A case study involving 19 medical practitioners associated with the Sydney Medical School, using semi-structured narrative interviews. Narrative data were analysed using dialectical empiricism, constant comparison and iterative reformulation of research questions. Participants represented virtuous acts as centrally important in their moral assessments of both themselves and others. Acts appeared to be contextually virtuous, rather than expressions of stable character traits, and virtue was linked to acts that served to protect or enhance fundamental values attached to ontological security and human flourishing. Virtue ethics, in this sense, was the single most important ethical system for each of the participants. Virtue ethics, construed as the appraisal of acts in contexts of risk, danger or threat to foundational values, emerged as the 'natural' ethical approach for medical practitioners in this case study. Teaching medical ethics to students and graduates alike needs to accommodate the priority attached to virtuous acts. © 2011 Blackwell Publishing Ltd.

Effectively managing partnership evolution: a case study from Chicago.

PubMed

Tishuk, Brian S

Given the continued proliferation of public/ private partnerships as vehicles for sharing best practices, lessons learned and actionable information, the keys to their success become more important to identify. Effective partnerships enhance the resilience of their respective members, which, in turn, improves community resilience. Thus, identifying the attributes of a successful partnership should be a high priority for those looking to foster collaboration between the public and private sectors. This paper will illustrate with two case studies how successful partnerships creatively leverage opportunities and manage the evolution of public/private relationships, while always seeking to institutionalise these collaborative efforts. The first will discuss briefly the development of the most important national partnership within the financial sector. The other focuses on a public/private task force in Chicago, composed of public safety agencies and representatives of critical infrastructure, which owes its existence to an unexpected research project and that needed to be restructured in light of experience. The manner in which the task force formed and evolved yields many lessons for partnerships interested in remaining relevant and effective.

Numerical operator calculus in higher dimensions.

PubMed

Beylkin, Gregory; Mohlenkamp, Martin J

2002-08-06

When an algorithm in dimension one is extended to dimension d, in nearly every case its computational cost is taken to the power d. This fundamental difficulty is the single greatest impediment to solving many important problems and has been dubbed the curse of dimensionality. For numerical analysis in dimension d, we propose to use a representation for vectors and matrices that generalizes separation of variables while allowing controlled accuracy. Basic linear algebra operations can be performed in this representation using one-dimensional operations, thus bypassing the exponential scaling with respect to the dimension. Although not all operators and algorithms may be compatible with this representation, we believe that many of the most important ones are. We prove that the multiparticle Schrödinger operator, as well as the inverse Laplacian, can be represented very efficiently in this form. We give numerical evidence to support the conjecture that eigenfunctions inherit this property by computing the ground-state eigenfunction for a simplified Schrödinger operator with 30 particles. We conjecture and provide numerical evidence that functions of operators inherit this property, in which case numerical operator calculus in higher dimensions becomes feasible.

An ontology for major histocompatibility restriction.

PubMed

Vita, Randi; Overton, James A; Seymour, Emily; Sidney, John; Kaufman, Jim; Tallmadge, Rebecca L; Ellis, Shirley; Hammond, John; Butcher, Geoff W; Sette, Alessandro; Peters, Bjoern

2016-01-01

MHC molecules are a highly diverse family of proteins that play a key role in cellular immune recognition. Over time, different techniques and terminologies have been developed to identify the specific type(s) of MHC molecule involved in a specific immune recognition context. No consistent nomenclature exists across different vertebrate species. To correctly represent MHC related data in The Immune Epitope Database (IEDB), we built upon a previously established MHC ontology and created an ontology to represent MHC molecules as they relate to immunological experiments. This ontology models MHC protein chains from 16 species, deals with different approaches used to identify MHC, such as direct sequencing verses serotyping, relates engineered MHC molecules to naturally occurring ones, connects genetic loci, alleles, protein chains and multi-chain proteins, and establishes evidence codes for MHC restriction. Where available, this work is based on existing ontologies from the OBO foundry. Overall, representing MHC molecules provides a challenging and practically important test case for ontology building, and could serve as an example of how to integrate other ontology building efforts into web resources.

The Diffuse Gamma-Ray Background from Type Ia Supernovae

NASA Technical Reports Server (NTRS)

Lien, Amy; Fields, Brian D.

2012-01-01

The origin of the diffuse extragalactic gamma-ray background (EGB) has been intensively studied but remains unsettled. Current popular source candidates include unresolved star-forming galaxies, starburst galaxies, and blazars. In this paper we calculate the EGB contribution from the interactions of cosmic rays accelerated by Type Ia supernovae, extending earlier work which only included core-collapse supernovae. We consider Type Ia events in star-forming galaxies, but also in quiescent galaxies that lack star formation. In the case of star-forming galaxies, consistently including Type Ia events makes little change to the star-forming EGB prediction, so long as both supernova types have the same cosmic-ray acceleration efficiencies in star-forming galaxies. Thus our updated EGB estimate continues to show that star-forming galaxies can represent a substantial portion of the signal measured by Fermi. In the case of quiescent galaxies, conversely, we find a wide range of possibilities for the EGB contribution. The dominant uncertainty we investigated comes from the mass in hot gas in these objects, which provides targets for cosmic rays: total gas masses are as yet poorly known, particularly at larger radii. Additionally, the EGB estimation is very sensitive to the cosmic-ray acceleration efficiency and confinement, especially in quiescent galaxies. In the most optimistic allowed scenarios, quiescent galaxies can be an important source of the EGB. In this case, star-forming galaxies and quiescent galaxies together will dominate the EGB and leave little room for other contributions. If other sources, such as blazars, are found to have important contributions to the EGB, then either the gas mass or cosmic-ray content of quiescent galaxies must be significantly lower than in their star-forming counterparts. In any case, improved Fermi EGB measurements will provide important constraints on hot gas and cosmic rays in quiescent galaxies.

[Involvement of the peripheral nervous system in systemic connective tissue diseases: report on clinical cases].

PubMed

Kujawska-Danecka, Hanna; Masiak, Anna; Smoleńska, Zaneta; Zdrojewski, Zbigniew

2011-01-01

The peripheral nervous system is usually involved in the majority of systemic connective tissue diseases, particularly in systemic lupus erythematosus, Sjögren's syndrome, vasculitis and systemic sclerosis. The pathogenesis of lesions in the peripheral nervous system associated with the autoimmune process is complex and it appears that two mechanisms, immunological and ischemic, are of greatest importance. Structures of the nervous system may be damaged by several autoantibodies (e.g. antineuronal, anti-nerve growth factor, anti-neurotrophins), by cytotoxic effects ofproinflammatory cytokines and by activated cells of the immune system. Local ischemia and hypoxia of neurons caused by inflammation of vasa nervosum represents the second significant mechanism leading to damage of nerve fibres in the peripheral nervous system. We present 3 cases with involvement of the peripheral nervous system as a dominant feature in the clinical picture of systemic connective tissue diseases. Clinical conditions in which the peripheral nervous system is involved include peripheral sensory and sensorimotor polyneuropathy, mononeuropathies, cranial neuropathies, acute inflammatory demyelinating polyneuropathy (Guillian-Barré syndrome), chronic inflammatory demyelinating polyneuropathy, plexopathy, myasthenia gravis, and dysfunctions of the autonomic nervous system. The diagnosis is based on clinical symptoms reported by the patient and disclosed during neurologic examination. The importance of electrophysiologic tests is advocated. Selection of treatment depends on the patient's clinical condition, as well as on the clinical form and type of disease. Treatment relies principally on glucocorticosteroids, intravenous immunoglobulins, cyclophosphamide, and other immunosuppressive drugs. Plasmapheresis and rituximab are administered in severe cases. Rehabilitation of the patient appears to be an important element of therapy. Cases with neurologic symptoms as the first and often the sole manifestation of systemic connective tissue disease are particularly problematic requiring a multidimensional approach; their process of diagnosis and treatment is usually long.

[Hemorrhagic rectocolitis or ulcerative colitis in the black Senegalese. Apropos of 14 cases].

PubMed

Aubry, P; Klotz, F; Oddes, B; Seurat, P L

1984-01-01

Ulcerative colitis is exceptional in Africa South of the Sahara. The first case was described in 1964: up to 1982, 46 cases were reported. We report on 14 cases (6 females and 8 males) observed in black Senegalese for three years and a half. The medium age of patients was 30 years. All of them had a high social standard of living. Four patients showed intestinal amebiasis in their previous medical history. Clinical and evolutive patterns of ulcerative colitis in Africa present few differences in comparison with the classical ones. The diagnosis is established by endoscopy (rectosigmoidoscopy and/or colonoscopy) and histopathology. Cryptic abscesses were found in only 2 out of 14 cases. Rectal dysplasia was noted in 2 cases. The course of the disease developed on a fulminating acute mode in one case, on a continuous chronic mode in another case and on a chronic mode with relapses in 11 cases. Irrespective to the clinical form observed, intestinal amebiasis represents the most pressing differential diagnosis. Treatment appears to be difficult in severe acute forms out of an intensive care department, as well as in advanced extensive chronic forms. For the later in black Africa endoscopic and histopathological surveillance appears to be preferable to a total colectomy, made necessary by the important rectal lesions, because the functional sequelae of an ileostomy.

Automated Terrestrial EMI Emitter Detection, Classification, and Localization

NASA Astrophysics Data System (ADS)

Stottler, R.; Bowman, C.; Bhopale, A.

2016-09-01

Clear operating spectrum at ground station antenna locations is critically important for communicating with, commanding, controlling, and maintaining the health of satellites. Electro Magnetic Interference (EMI) can interfere with these communications so tracking down the source of EMI is extremely important to prevent it from occurring in the future. The Terrestrial RFI-locating Automation with CasE based Reasoning (TRACER) system is designed to automate terrestrial EMI emitter localization and identification, providing improved space situational awareness, realizing significant manpower savings, dramatically shortening EMI response time, providing capabilities for the system to evolve without programmer involvement, and offering increased support for adversarial scenarios (e.g. jamming). TRACER has been prototyped and tested with real data (amplitudes versus frequency over time) for both satellite communication antennas and sweeping Direction Finding (DF) antennas located near them. TRACER monitors the satellite communication and DF antenna signals to detect and classify EMI using neural network technology trained on past cases of both normal communications and EMI events. Based on details of the signal (its classification, its direction and strength, etc.) one or more cases of EMI investigation methodologies are retrieved, represented as graphical behavior transition networks (BTNs), which very naturally represent the flowchart-like process often followed by experts in time pressured situations, are intuitive to SMEs, and easily edited by them. The appropriate actions, as determined by the BTN are executed and the resulting data processed by Bayesian Networks to update the probabilities of the various possible platforms and source types of the EMI. Bearing sweep of the EMI is used to determine if the EMI's platform is aerial, a ground vehicle or ship, or stationary. If moving, the Friis transmission equation is used to plot the emitter's location and compare it to current flights or moving vehicles. This paper describes the TRACER technologies and results of prototype testing.

Two variants of fat embolism syndrome evolving in a young patient with multiple fractures

PubMed Central

Bajuri, Mohd Yazid; Johan, Rudy Reza; Shukur, Hassan

2013-01-01

Fat embolism syndrome (FES) is a continuum of fat emboli. Variants of FES: acute fulminant form and classic FES are postulated to represent two different pathomechanisms. Acute fulminant FES occurs during the first 24 h. It is attributed to massive mechanical blockage pulmonary vasculature by the fat emboli. The classic FES typically has a latency period of 24–36 h manifestation of respiratory failure and other signs of fat embolism. Progression of asymptomatic fat embolism with FES frequently represents inadequate treatment of hypovolaemic shock. We present a rare case of two variants of FES evolving in a patient with multiple fractures to emphasis the importance of adequate and appropriate treatment of shock in preventing the development of FES. Since supportive therapy which is a ventilatory support remains as the treatment of FES, it is appropriate to treat FES in the intensive care unit setting. PMID:23576653

Two variants of fat embolism syndrome evolving in a young patient with multiple fractures.

PubMed

Bajuri, Mohd Yazid; Johan, Rudy Reza; Shukur, Hassan

2013-04-09

Fat embolism syndrome (FES) is a continuum of fat emboli. Variants of FES: acute fulminant form and classic FES are postulated to represent two different pathomechanisms. Acute fulminant FES occurs during the first 24 h. It is attributed to massive mechanical blockage pulmonary vasculature by the fat emboli. The classic FES typically has a latency period of 24-36 h manifestation of respiratory failure and other signs of fat embolism. Progression of asymptomatic fat embolism with FES frequently represents inadequate treatment of hypovolaemic shock. We present a rare case of two variants of FES evolving in a patient with multiple fractures to emphasis the importance of adequate and appropriate treatment of shock in preventing the development of FES. Since supportive therapy which is a ventilatory support remains as the treatment of FES, it is appropriate to treat FES in the intensive care unit setting.

Discovery of Multitarget Agents Active as Broad-Spectrum Antivirals and Correctors of Cystic Fibrosis Transmembrane Conductance Regulator for Associated Pulmonary Diseases.

PubMed

Tassini, Sabrina; Sun, Liang; Lanko, Kristina; Crespan, Emmanuele; Langron, Emily; Falchi, Federico; Kissova, Miroslava; Armijos-Rivera, Jorge I; Delang, Leen; Mirabelli, Carmen; Neyts, Johan; Pieroni, Marco; Cavalli, Andrea; Costantino, Gabriele; Maga, Giovanni; Vergani, Paola; Leyssen, Pieter; Radi, Marco

2017-02-23

Enteroviruses (EVs) are among the most frequent infectious agents in humans worldwide and represent the leading cause of upper respiratory tract infections. No drugs for the treatment of EV infections are currently available. Recent studies have also linked EV infection with pulmonary exacerbations, especially in cystic fibrosis (CF) patients, and the importance of this link is probably underestimated. The aim of this work was to develop a new class of multitarget agents active both as broad-spectrum antivirals and as correctors of the F508del-cystic fibrosis transmembrane conductance regulator (CFTR) folding defect responsible for >90% of CF cases. We report herein the discovery of the first small molecules able to simultaneously act as correctors of the F508del-CFTR folding defect and as broad-spectrum antivirals against a panel of EVs representative of all major species.

Designing vaccines based on biology of human dendritic cell subsets

PubMed Central

Palucka, Karolina; Banchereau, Jacques; Mellman, Ira

2010-01-01

The effective vaccines developed against a variety of infectious agents, including polio, measles and Hepatitis B, represent major achievements in medicine. These vaccines, usually composed of microbial antigens, are often associated with an adjuvant that activates dendritic cells (DCs). Many infectious diseases are still in need of an effective vaccine including HIV, malaria, hepatitis C and tuberculosis. In some cases, the induction of cellular rather than humoral responses may be more important as the goal is to control and eliminate the existing infection rather than to prevent it. Our increased understanding of the mechanisms of antigen presentation, particularly with the description of DC subsets with distinct functions, as well as their plasticity in responding to extrinsic signals, represent opportunities to develop novel vaccines. In addition, we foresee that this increased knowledge will permit us to design vaccines that will reprogram the immune system to intervene therapeutically in cancer, allergy and autoimmunity. PMID:21029958

2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias.

PubMed

Birindelli, Arianna; Sartelli, Massimo; Di Saverio, Salomone; Coccolini, Federico; Ansaloni, Luca; van Ramshorst, Gabrielle H; Campanelli, Giampiero; Khokha, Vladimir; Moore, Ernest E; Peitzman, Andrew; Velmahos, George; Moore, Frederick Alan; Leppaniemi, Ari; Burlew, Clay Cothren; Biffl, Walter L; Koike, Kaoru; Kluger, Yoram; Fraga, Gustavo P; Ordonez, Carlos A; Novello, Matteo; Agresta, Ferdinando; Sakakushev, Boris; Gerych, Igor; Wani, Imtiaz; Kelly, Michael D; Gomes, Carlos Augusto; Faro, Mario Paulo; Tarasconi, Antonio; Demetrashvili, Zaza; Lee, Jae Gil; Vettoretto, Nereo; Guercioni, Gianluca; Persiani, Roberto; Tranà, Cristian; Cui, Yunfeng; Kok, Kenneth Y Y; Ghnnam, Wagih M; Abbas, Ashraf El-Sayed; Sato, Norio; Marwah, Sanjay; Rangarajan, Muthukumaran; Ben-Ishay, Offir; Adesunkanmi, Abdul Rashid K; Lohse, Helmut Alfredo Segovia; Kenig, Jakub; Mandalà, Stefano; Coimbra, Raul; Bhangu, Aneel; Suggett, Nigel; Biondi, Antonio; Portolani, Nazario; Baiocchi, Gianluca; Kirkpatrick, Andrew W; Scibé, Rodolfo; Sugrue, Michael; Chiara, Osvaldo; Catena, Fausto

2017-01-01

Emergency repair of complicated abdominal wall hernias may be associated with worsen outcome and a significant rate of postoperative complications. There is no consensus on management of complicated abdominal hernias. The main matter of debate is about the use of mesh in case of intestinal resection and the type of mesh to be used. Wound infection is the most common complication encountered and represents an immense burden especially in the presence of a mesh. The recurrence rate is an important topic that influences the final outcome. A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bergamo in July 2013 with the aim to define recommendations for emergency repair of abdominal wall hernias in adults. This document represents the executive summary of the consensus conference approved by a WSES expert panel. In 2016, the guidelines have been revised and updated according to the most recent available literature.

"The Effect of Alternative Representations of Lake ...

EPA Pesticide Factsheets

Lakes can play a significant role in regional climate, modulating inland extremes in temperature and enhancing precipitation. Representing these effects becomes more important as regional climate modeling (RCM) efforts focus on simulating smaller scales. When using the Weather Research and Forecasting (WRF) model to downscale future global climate model (GCM) projections into RCM simulations, model users typically must rely on the GCM to represent temperatures at all water points. However, GCMs have insufficient resolution to adequately represent even large inland lakes, such as the Great Lakes. Some interpolation methods, such as setting lake surface temperatures (LSTs) equal to the nearest water point, can result in inland lake temperatures being set from sea surface temperatures (SSTs) that are hundreds of km away. In other cases, a single point is tasked with representing multiple large, heterogeneous lakes. Similar consequences can result from interpolating ice from GCMs to inland lake points, resulting in lakes as large as Lake Superior freezing completely in the space of a single timestep. The use of a computationally-efficient inland lake model can improve RCM simulations where the input data is too coarse to adequately represent inland lake temperatures and ice (Gula and Peltier 2012). This study examines three scenarios under which ice and LSTs can be set within the WRF model when applied as an RCM to produce 2-year simulations at 12 km gri

Understanding Customers: The Jobs to Be Done Theory Applied in the Context of a Rural Food Pantry.

PubMed

Vaterlaus, J Mitchell; Cottle, Natalie Martineau; Patten, Emily Vaterlaus; Gibbons, Robyn

2018-04-28

Food insecurity, and particularly rural food insecurity, has unique challenges associated with it. Understanding the customer or patron needs is increasingly important in resolving this national concern. The Jobs to Be Done Theory posits that when considering customers, it is beneficial to move past demographic profiling and focus on what the customer wants to accomplish by using a particular product or service. This qualitative study aimed to determine customers' jobs to be done at a rural food pantry. In addition, it seeks to demonstrate the application of contemporary management theory to dietetics practice. A case study approach was used in this study. Case study data collection procedures included six male and six female food pantry patrons in Montana completing in-depth, audio-recorded interviews and surveys. Each person's interview and survey were constructed into individual case descriptions; the case descriptions were analyzed using uniform categories determined by researchers. To identify themes in the holistic case, word tables were created for each uniform category and assessed for key themes representing patrons' experiences. The key themes that emerged were the customer in context, customers' food relief needs, connecting with customers, and barriers to utilization. The application of Jobs to Be Done Theory to rural food pantry customers demonstrates that demographic segmentation does not capture the social, emotional, and functional dimensions for this sample. Investigation of customer experiences, circumstances, and obstacles is important for improving dietetics services. Copyright © 2018 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Case-control study of an outbreak of acute toxoplasmosis in an industrial plant in the state of São Paulo, Brazil.

PubMed

Ekman, Claudio Cesar Jaguaribe; Chiossi, Maria Fernanda do Valle; Meireles, Luciana Regina; Andrade Júnior, Heitor Franco de; Figueiredo, Walter Manso; Marciano, Maria Aparecida Moraes; Luna, Expedito José de Albuquerque

2012-01-01

Foodborne diseases represent operational risks in industrial restaurants. We described an outbreak of nine clustered cases of acute illness resembling acute toxoplasmosis in an industrial plant with 2300 employees. These patients and another 36 similar asymptomatic employees were diagnosed with anti-T. gondii IgG titer and avidity by ELISA. We excluded 14 patients based on high IgG avidity and chronic toxoplasmosis: 13 from controls and one from acute disease other than T. gondii infection. We also identified another three asymptomatic employees with T.gondii acute infection and also anti-T. gondii IgM positive as remaining acute cases. Case control study was conducted by interview in 11 acute infections and 20 negative controls. The ingestion of green vegetables, but not meat or water, was observed to be associated with the incidence of acute disease. These data reinforce the importance of sanitation control in industrial restaurants and also demonstrate the need for improvement in quality control regarding vegetables at risk for T. gondii oocyst contamination. We emphasized the accurate diagnosis of indexed cases and the detection of asymptomatic infections to determine the extent of the toxoplasmosis outbreak.

Reading the lesson: eliciting requirements for a mammography training application

NASA Astrophysics Data System (ADS)

Hartswood, M.; Blot, L.; Taylor, P.; Anderson, S.; Procter, R.; Wilkinson, L.; Smart, L.

2009-02-01

Demonstrations of a prototype training tool were used to elicit requirements for an intelligent training system for screening mammography. The prototype allowed senior radiologists (mentors) to select cases from a distributed database of images to meet the specific training requirements of junior colleagues (trainees) and then provided automated feedback in response to trainees' attempts at interpretation. The tool was demonstrated to radiologists and radiographers working in the breast screening service at four evaluation sessions. Participants highlighted ease of selecting cases that can deliver specific learning objectives as important for delivering effective training. To usefully structure a large data set of training images we undertook a classification exercise of mentor authored free text 'learning points' attached to training case obtained from two screening centres (n=333, n=129 respectively). We were able to adduce a hierarchy of abstract categories representing classes of lesson that groups of cases were intended to convey (e.g. Temporal change, Misleading juxtapositions, Position of lesion, Typical/Atypical presentation, and so on). In this paper we present the method used to devise this classification, the classification scheme itself, initial user-feedback, and our plans to incorporated it into a software tool to aid case selection.

Tacrolimus interaction with nafcillin resulting in significant decreases in tacrolimus concentrations: A case report.

PubMed

Wungwattana, Minkey; Savic, Marizela

2017-04-01

Tacrolimus (TAC) is subject to many drug interactions as a result of its metabolism primarily via CYP450 isoenzyme 3A4. Numerous case reports of TAC and CYP3A4 inducers and inhibitors have been described including antimicrobials, calcium channel antagonists, and antiepileptic drugs. We present the case of a 13-year-old patient with cystic fibrosis and a history of liver transplantation, where subtherapeutic TAC concentrations were suspected to be a result of concomitant TAC and nafcillin (NAF) therapy. The observed drug interaction occurred on two separate hospital admissions, during both of which the patient exhibited therapeutic TAC concentrations prior to exposure to NAF, a CYP3A4 inducer. Upon discontinuation of NAF, TAC concentrations recovered in both instances. This case represents a drug-drug interaction between TAC and NAF that has not previously been reported to our knowledge. Despite the lack of existing reports of interaction between these two agents, this case highlights the importance of therapeutic drug monitoring and assessing for any potential drug-drug or drug-food interactions in patients receiving TAC therapy. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Imported malaria including HIV and pregnant woman risk groups: overview of the case of a Spanish city 2004-2014.

PubMed

Fernández López, María; Ruiz Giardín, Jose Manuel; San Martín López, Juan Víctor; Jaquetti, Jerónimo; García Arata, Isabel; Jiménez Navarro, Carolina; Cabello Clotet, Noemi

2015-09-17

Arrival of inmigrants from malaria endemic areas has led to a emergence of cases of this parasitic disease in Spain. The objective of this study was to analyse the high incidence rate of imported malaria in Fuenlabrada, a city in the south of Madrid, together with the frequent the lack of chemoprophylaxis, for the period between 2004 and 2014. Both pregnant women and HIV risk groups have been considered. Retrospective descriptive study of laboratory-confirmed malaria at the Fuenlabrada University Hospital, in Madrid, during a 10-year period (2004-2014). These data were obtained reviewing medical histories of the cases. Relevant epidemiological, clinical and laboratory results were analysed, with focus on the following risk groups: pregnant women and individuals with HIV. A total of 185 cases were diagnosed (90.3 % Plasmodium falciparum). The annual incidence rate was 11.9/100,000 inhabitants/year. The average age was 30.8 years (SD: 14.3). Infections originating in sub-Saharan Africa comprised the 97.6 % of the cases. A total of 85.9 % were Visiting Friends and Relatives. Only a 4.3 % completed adequate prophylaxis. A total of 14.28 % of the fertile women were pregnant, and 8 cases (4.3 %) had HIV. None of them in these special groups completed prophylaxis. The incidence rate in Fuenlabrada is higher than in the rest of Spain, due to the large number of immigrants from endemic areas living in the municipality. However, the results are not representative of all the country. It seems to be reasonable to implement prevention and pre-travel assessment programs to increase chemoprophylaxis. Pregnancy tests and HIV serology should be completed for all patients to improve prophylactic methods.

Energy crops on landfills: functional, environmental, and costs analysis of different landfill configurations.

PubMed

Pivato, Alberto; Garbo, Francesco; Moretto, Marco; Lavagnolo, Maria Cristina

2018-02-09

The cultivation of energy crops on landfills represents an important challenge for the near future, as the possibility to use devalued sites for energy production is very attractive. In this study, four scenarios have been assessed and compared with respect to a reference case defined for northern Italy. The scenarios were defined taking into consideration current energy crops issues. In particular, the first three scenarios were based on energy maximisation, phytotreatment ability, and environmental impact, respectively. The fourth scenario was a combination of these characteristics emphasised by the previous scenarios. A multi-criteria analysis, based on economic, energetic, and environmental aspects, was performed. From the analysis, the best scenario resulted to be the fourth, with its ability to pursue several objectives simultaneously and obtain the best score relatively to both environmental and energetic criteria. On the contrary, the economic criterion emerges as weak, as all the considered scenarios showed some limits from this point of view. Important indications for future designs can be derived. The decrease of leachate production due to the presence of energy crops on the top cover, which enhances evapotranspiration, represents a favourable but critical aspect in the definition of the results.

Applying Petri nets to modeling the chemical stage of radiobiological mechanism

NASA Astrophysics Data System (ADS)

Barilla, J.; Lokajíček, M.; Pisaková, H.; Simr, P.

2015-03-01

The chemical stage represents important part of radiological mechanism as double strand breaks of DNA molecules represent main damages leading to final biological effect. These breaks are formed mainly by water radicals arising in clusters formed by densely ionizing ends of primary or secondary charged particles in neighborhood of a DNA molecule. The given effect may be significantly influenced by other species present in water, which may depend on the size and diffusion of corresponding clusters. We have already proposed a model describing the corresponding process (i.e., the combined effect of cluster diffusion and chemical reactions) running in individual radical clusters and influencing the formation probability of main damages (i.e., DSBs). Now a full number of corresponding species will be considered. With the help of Continuous Petri nets it will then be possible to follow the time evolution of corresponding species in individual clusters, which might be important especially in the case of studying the biological effect of very low-LET radiation. The results in deoxygenated water will be presented; the ratio of final and initial contents of corresponding species being in good agreement with values established experimentally.

The Ontology of Biological and Clinical Statistics (OBCS) for standardized and reproducible statistical analysis.

PubMed

Zheng, Jie; Harris, Marcelline R; Masci, Anna Maria; Lin, Yu; Hero, Alfred; Smith, Barry; He, Yongqun

2016-09-14

Statistics play a critical role in biological and clinical research. However, most reports of scientific results in the published literature make it difficult for the reader to reproduce the statistical analyses performed in achieving those results because they provide inadequate documentation of the statistical tests and algorithms applied. The Ontology of Biological and Clinical Statistics (OBCS) is put forward here as a step towards solving this problem. The terms in OBCS including 'data collection', 'data transformation in statistics', 'data visualization', 'statistical data analysis', and 'drawing a conclusion based on data', cover the major types of statistical processes used in basic biological research and clinical outcome studies. OBCS is aligned with the Basic Formal Ontology (BFO) and extends the Ontology of Biomedical Investigations (OBI), an OBO (Open Biological and Biomedical Ontologies) Foundry ontology supported by over 20 research communities. Currently, OBCS comprehends 878 terms, representing 20 BFO classes, 403 OBI classes, 229 OBCS specific classes, and 122 classes imported from ten other OBO ontologies. We discuss two examples illustrating how the ontology is being applied. In the first (biological) use case, we describe how OBCS was applied to represent the high throughput microarray data analysis of immunological transcriptional profiles in human subjects vaccinated with an influenza vaccine. In the second (clinical outcomes) use case, we applied OBCS to represent the processing of electronic health care data to determine the associations between hospital staffing levels and patient mortality. Our case studies were designed to show how OBCS can be used for the consistent representation of statistical analysis pipelines under two different research paradigms. Other ongoing projects using OBCS for statistical data processing are also discussed. The OBCS source code and documentation are available at: https://github.com/obcs/obcs . The Ontology of Biological and Clinical Statistics (OBCS) is a community-based open source ontology in the domain of biological and clinical statistics. OBCS is a timely ontology that represents statistics-related terms and their relations in a rigorous fashion, facilitates standard data analysis and integration, and supports reproducible biological and clinical research.

The Genetic Challenges and Opportunities in Advanced Heart Failure

PubMed Central

Hannah-Shmouni, Fady; Seidelmann, Sara B.; Sirrs, Sandra; Mani, Arya; Jacoby, Daniel

2017-01-01

The causes of heart failure are diverse. Inherited causes represent an important clinical entity and can be divided into 2 major categories: familial and metabolic cardiomyopathies. The distinct features that might be present in early disease states can become broadly overlapping with other diseases, such as in the case of inherited cardiomyopathies (ie, familial hypertrophic cardiomyopathy or mitochondrial diseases). In this review article, we focus on genetic issues related to advanced heart failure. Because of the emerging importance of this topic and its breadth, we sought to focus our discussion on the known genetic forms of heart failure syndromes, genetic testing, and newer data on pharmacogenetics and therapeutics in the treatment of heart failure, to primarily encourage clinicians to place a priority on the diagnosis and treatment of these potentially treatable conditions. PMID:26518444

Consumer involvement in seafood as family meals in Norway: an application of the expectancy-value approach.

PubMed

Olsen, S O

2001-04-01

A theoretical model of involvement in consumption of food products was tested in a representative survey of Norwegian households for the particular case of consuming seafood as a common family meal. The empirical study is based on using structural equation approach to test construct validity of measures and the empirical fit of the theoretical model. Attitudes, negative feelings, social norms and moral obligation were proved to be important, reliable and different constructs and explained 63% of the variation in seafood involvement. Negative feelings and moral obligation was the most important antecedents of involvement. Both our proposed model and modified model with seafood involvement as a mediator fit well with the data and proved our expectations in a promising way. Copyright 2001 Academic Press.

Developing a cross-docking network design model under uncertain environment

NASA Astrophysics Data System (ADS)

Seyedhoseini, S. M.; Rashid, Reza; Teimoury, E.

2015-06-01

Cross-docking is a logistic concept, which plays an important role in supply chain management by decreasing inventory holding, order packing, transportation costs and delivery time. Paying attention to these concerns, and importance of the congestion in cross docks, we present a mixed-integer model to optimize the location and design of cross docks at the same time to minimize the total transportation and operating costs. The model combines queuing theory for design aspects, for that matter, we consider a network of cross docks and customers where two M/M/c queues have been represented to describe operations of indoor trucks and outdoor trucks in each cross dock. To prepare a perfect illustration for performance of the model, a real case also has been examined that indicated effectiveness of the proposed model.

Complexity and conflicts of interest statements: a case-study of emails exchanged between Coca-Cola and the principal investigators of the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE).

PubMed

Stuckler, David; Ruskin, Gary; McKee, Martin

2018-02-01

Statements on conflicts of interest provide important information for readers of scientific papers. There is now compelling evidence from several fields that papers reporting funding from organizations that have an interest in the results often generate different findings from those that do not report such funding. We describe the findings of an analysis of correspondence between representatives of a major soft drinks company and scientists researching childhood obesity. Although the studies report no influence by the funder, the correspondence describes detailed exchanges on the study design, presentation of results and acknowledgement of funding. This raises important questions about the meaning of standard statements on conflicts of interest.

Epstein-Barr Virus in Gastric Carcinoma

PubMed Central

Nishikawa, Jun; Yoshiyama, Hironori; Iizasa, Hisashi; Kanehiro, Yuichi; Nakamura, Munetaka; Nishimura, Junichi; Saito, Mari; Okamoto, Takeshi; Sakai, Kouhei; Suehiro, Yutaka; Yamasaki, Takahiro; Oga, Atsunori; Yanai, Hideo; Sakaida, Isao

2014-01-01

The Epstein-Barr virus (EBV) is detected in about 10% of gastric carcinoma cases throughout the world. In EBV-associated gastric carcinoma, all tumor cells harbor the clonal EBV genome. Gastric carcinoma associated with EBV has distinct clinicopathological features, occurs predominately in men and in younger-aged individuals, and presents a generally diffuse histological type. Most cases of EBV-associated gastric carcinoma exhibit a histology rich in lymphocyte infiltration. The immunological reactiveness in the host may represent a relatively preferable prognosis in EBV-positive cases. This fact highlights the important role of EBV in the development of EBV-associated gastric carcinoma. We have clearly proved direct infection of human gastric epithelialcells by EBV. The infection was achieved by using a recombinant EBV. Promotion of growth by EBV infection was observed in the cells. Considerable data suggest that EBV may directly contribute to the development of EBV-associated GC. This tumor-promoting effect seems to involve multiple mechanisms, because EBV affects several host proteins and pathways that normally promote apoptosis and regulate cell proliferation. PMID:25386788

Identical twins with mature cystic teratomas treated with laparoscopic surgery: Two case reports.

PubMed

Mabuchi, Yasushi; Ota, Nami; Kobayashi, Aya; Tanizaki, Yuko; Minami, Sawako; Ino, Kazuhiko

2017-02-01

Mature cystic teratomas are the most common among all ovarian neoplasms, representing 30-40% of the cases. However, to the best of our knowledge, there have been only two reports of mature cystic teratomas occurring in identical twins to date. We herein report a case of identical twins with mature cystic teratomas who were treated with laparoscopic surgery. A 32-year-old woman was referred to our hospital due to a tumor in the right ovary. The patient underwent laparoscopic resection of the ovarian tumor and the pathological diagnosis was benign mature cystic teratoma. Two years later, the identical twin of the abovementioned patient was referred to our hospital also due to a right ovarian tumor. The patient underwent laparoscopic resection of the ovarian tumor and the pathological diagnosis was benign mature cystic teratoma. Therefore, for early diagnosis, it may be important to consider the possibility of mature cystic teratoma in the identical twin of a patient, even in the absence of symptoms.

A salmonella data bank for routine surveillance and research.

PubMed

Talaska, T

1994-01-01

A salmonella data bank has been established in the State of Brandenburg, Germany, with due steps being taken to ensure the protection of personal data. The system of data collection and rapid return of information to the local health and veterinary services have become essential elements in intersectoral cooperation in case investigation, disease prevention, and epidemiological research. A number of issues, particularly those concerning the pathways of infection, characteristics of clusters of cases, and the infection of different population strata can now be examined and monitored. An important feature of the data bank is its accessibility by local as well as central state services using a PC-based program and the wide interdisciplinary circulation of regular reports. Preliminary results on the data volume, age distribution of cases, and salmonella isolation rates in different population strata are presented. The data bank supports studies on marketing and purchasing patterns of agricultural products representing potential vehicles of infection, and it should encourage investigations to trace the reservoirs of infection and contamination points along the food chain.

Identifying barriers from home to the appropriate hospital through near-miss audits in developing countries.

PubMed

Filippi, Véronique; Richard, Fabienne; Lange, Isabelle; Ouattara, Fatoumata

2009-06-01

Near-miss cases often arrive in critical condition in referral hospitals in developing countries. Understanding the reasons why women arrive at these hospitals in a moribund state is crucial to the reduction of the incidence and case fatality of severe obstetric complications. This paper discusses how near-miss audits can empower the hospital teams to document and help reduce barriers to obstetric care in the most useful way and makes practical suggestions on interviews, analytical framework, ethical issues and staff motivation. Review of the evidence shows that case reviews and confidential enquiries appear particularly suitable to the understanding of delays. Criterion-based audits can also achieve this by establishing criteria for referral. However, hospital staff have limited intervention tools at their disposal to address barriers to emergency care at the community level. It is therefore important to involve the district management team and representatives of the community in auditing the health care seeking and treatment of women with near-miss complications.

An Economic Analysis of Strategies to Control Clostridium Difficile Transmission and Infection Using an Agent-Based Simulation Model.

PubMed

Nelson, Richard E; Jones, Makoto; Leecaster, Molly; Samore, Matthew H; Ray, William; Huttner, Angela; Huttner, Benedikt; Khader, Karim; Stevens, Vanessa W; Gerding, Dale; Schweizer, Marin L; Rubin, Michael A

2016-01-01

A number of strategies exist to reduce Clostridium difficile (C. difficile) transmission. We conducted an economic evaluation of "bundling" these strategies together. We constructed an agent-based computer simulation of nosocomial C. difficile transmission and infection in a hospital setting. This model included the following components: interactions between patients and health care workers; room contamination via C. difficile shedding; C. difficile hand carriage and removal via hand hygiene; patient acquisition of C. difficile via contact with contaminated rooms or health care workers; and patient antimicrobial use. Six interventions were introduced alone and "bundled" together: (a) aggressive C. difficile testing; (b) empiric isolation and treatment of symptomatic patients; (c) improved adherence to hand hygiene and (d) contact precautions; (e) improved use of soap and water for hand hygiene; and (f) improved environmental cleaning. Our analysis compared these interventions using values representing 3 different scenarios: (1) base-case (BASE) values that reflect typical hospital practice, (2) intervention (INT) values that represent implementation of hospital-wide efforts to reduce C. diff transmission, and (3) optimal (OPT) values representing the highest expected results from strong adherence to the interventions. Cost parameters for each intervention were obtained from published literature. We performed our analyses assuming low, normal, and high C. difficile importation prevalence and transmissibility of C. difficile. INT levels of the "bundled" intervention were cost-effective at a willingness-to-pay threshold of $100,000/quality-adjusted life-year in all importation prevalence and transmissibility scenarios. OPT levels of intervention were cost-effective for normal and high importation prevalence and transmissibility scenarios. When analyzed separately, hand hygiene compliance, environmental decontamination, and empiric isolation and treatment were the interventions that had the greatest impact on both cost and effectiveness. A combination of available interventions to prevent CDI is likely to be cost-effective but the cost-effectiveness varies for different levels of intensity of the interventions depending on epidemiological conditions such as C. difficile importation prevalence and transmissibility.

Emergence of a global science-business initiative for ocean stewardship.

PubMed

Österblom, Henrik; Jouffray, Jean-Baptiste; Folke, Carl; Rockström, Johan

2017-08-22

The ocean represents a fundamental source of micronutrients and protein for a growing world population. Seafood is a highly traded and sought after commodity on international markets, and is critically dependent on healthy marine ecosystems. A global trend of wild stocks being overfished and in decline, as well as multiple sustainability challenges associated with a rapid growth of aquaculture, represent key concerns in relation to the United Nations Sustainable Development Goals. Existing efforts aimed to improve the sustainability of seafood production have generated important progress, primarily at the local and national levels, but have yet to effectively address the global challenges associated with the ocean. This study highlights the importance of transnational corporations in enabling transformative change, and thereby contributes to advancing the limited understanding of large-scale private actors within the sustainability science literature. We describe how we engaged with large seafood producers to coproduce a global science-business initiative for ocean stewardship. We suggest that this initiative is improving the prospects for transformative change by providing novel links between science and business, between wild-capture fisheries and aquaculture, and across geographical space. We argue that scientists can play an important role in facilitating change by connecting knowledge to action among global actors, while recognizing risks associated with such engagement. The methods developed through this case study contribute to identifying key competences in sustainability science and hold promises for other sectors as well.

Emergence of a global science–business initiative for ocean stewardship

PubMed Central

Jouffray, Jean-Baptiste; Folke, Carl; Rockström, Johan

2017-01-01

The ocean represents a fundamental source of micronutrients and protein for a growing world population. Seafood is a highly traded and sought after commodity on international markets, and is critically dependent on healthy marine ecosystems. A global trend of wild stocks being overfished and in decline, as well as multiple sustainability challenges associated with a rapid growth of aquaculture, represent key concerns in relation to the United Nations Sustainable Development Goals. Existing efforts aimed to improve the sustainability of seafood production have generated important progress, primarily at the local and national levels, but have yet to effectively address the global challenges associated with the ocean. This study highlights the importance of transnational corporations in enabling transformative change, and thereby contributes to advancing the limited understanding of large-scale private actors within the sustainability science literature. We describe how we engaged with large seafood producers to coproduce a global science–business initiative for ocean stewardship. We suggest that this initiative is improving the prospects for transformative change by providing novel links between science and business, between wild-capture fisheries and aquaculture, and across geographical space. We argue that scientists can play an important role in facilitating change by connecting knowledge to action among global actors, while recognizing risks associated with such engagement. The methods developed through this case study contribute to identifying key competences in sustainability science and hold promises for other sectors as well. PMID:28784792

[Insights about uncertainty in genetic counseling].

PubMed

Huicochea-Montiel, Juan Carlos; Cárdenas-Conejo, Alan; Cervantes-Díaz, María Teresa; Araujo-Solís, María Antonieta de Jesús

2015-01-01

Genetic counseling is an information process to help people in the understanding and adaptation to the medical, psychological and family implications of the genetic contribution in diseases. This counseling encompasses all sorts of patients. This represents a challenge in the daily work of the medical geneticist, because giving information in a meaningful way to the patient and his family implies an emotional and psychological burden. Generally we can see two outcomes in the medical practice of genetics, which converge after a diagnosis process: 1) we can face the inability to reach a diagnostic conclusion or 2) we can establish or confirm a diagnosis with certainty, which is the main piece in the genetic counseling. However, in all the situations the uncertainty is a fact, since in the case of those individuals who come in for genetic counseling before symptoms appear or those in prenatal cases, the absence of clinical manifestations and the impossibility to change the course of events lead to the appearance of helplessness and despair. In those cases without diagnostic conclusion, this situation represents a reason for uncertainty, and even in those patients with a diagnosis, certain factors can modify the circumstances in which genetic counseling occurs, such as unpredictability or lack of control. Therefore, it is important to consider the management of uncertainty as an inherent part throughout the process of care in medical genetics. The teaching of medical genetics should also consider the inclusion of topics related to this circumstance.

Advanced Stent Graft Treatment of Venous Stenosis Affecting Hemodialysis Vascular Access: Case Illustrations

PubMed Central

Patel, Darshan; Ray, Charles E.; Lokken, R. Peter; Bui, James T.; Lipnik, Andrew J.; Gaba, Ron C.

2016-01-01

Surgically placed dialysis access is an important component of dialysis replacement therapy. The vast majority of patients undergoing dialysis will have surgically placed accesses at some point in the course of their disease, and for many patients these accesses may represent their definitive renal replacement option. Most, if not all, arteriovenous fistulae and grafts will require interventions at some point in time. Percutaneous angioplasty is the typical first treatment performed for venous stenoses, with stents and stent grafts being reserved for patients in whom angioplasty and surgical options are exhausted. In some salvage situations, stent graft placement may be the only or best option for patients. This article describes, using case illustrations, placement of stent grafts in such patients; a focus will also be made on the techniques utilized in such salvage situations. PMID:27011426

A new patent-based approach for technology mapping in the pharmaceutical domain.

PubMed

Russo, Davide; Montecchi, Tiziano; Carrara, Paolo

2013-09-01

The key factor in decision-making is the quality of information collected and processed in the problem analysis. In most cases, patents represent a very important source of information. The main problem is how to extract such information from the huge corpus of documents with a high recall and precision, and in a short time. This article demonstrates a patent search and classification method, called Knowledge Organizing Module, which consists of creating, almost automatically, a pool of patents based on polysemy expansion and homonymy disambiguation. Since the pool is done, an automatic patent technology landscaping is provided for fixing the state of the art of our product, and exploring competing alternative treatments and/or possible technological opportunities. An exemplary case study is provided, it deals with a patent analysis in the field of verruca treatments.

Rayleigh–Taylor and Richtmyer–Meshkov instability induced flow, turbulence, and mixing. I

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

Zhou, Ye

Rayleigh–Taylor (RT) and Richtmyer–Meshkov (RM) instabilities play an important role in a wide range of engineering, geophysical, and astrophysical flows. They represent a triggering event that, in many cases, leads to large-scale turbulent mixing. Much effort has been expended over the past 140 years, beginning with the seminal work of Lord Rayleigh, to predict the evolution of the instabilities and of the instability-induced mixing layers. Furthermore, the objective of Part I of this review is to provide the basic properties of the flow, turbulence, and mixing induced by RT, RM, and Kelvin–Helmholtz (KH) instabilities. Historical efforts to study these instabilitiesmore » are briefly reviewed, and the significance of these instabilities is discussed for a variety of flows, particularly for astrophysical flows and for the case of inertial confinement fusion.« less

Stereotypes of autism

PubMed Central

Draaisma, Douwe

2009-01-01

In their landmark papers, both Kanner and Asperger employed a series of case histories to shape clinical insight into autistic disorders. This way of introducing, assessing and representing disorders has disappeared from today's psychiatric practice, yet it offers a convincing model of the way stereotypes may build up as a result of representations of autism. Considering that much of what society at large learns on disorders on the autism spectrum is produced by representations of autism in novels, TV-series, movies or autobiographies, it will be of vital importance to scrutinize these representations and to check whether or not they are, in fact, misrepresenting autism. In quite a few cases, media representations of talent and special abilities can be said to have contributed to a harmful divergence between the general image of autism and the clinical reality of the autistic condition. PMID:19528033

Hemichorea-hemiballismus as an initial manifestation in a Moroccan patient with acquired immunodeficiency syndrome and toxoplasma infection: a case report and review of the literature.

PubMed

Rabhi, Samira; Amrani, Kawthar; Maaroufi, Mustapha; Khammar, Zineb; Khibri, Hajar; Ouazzani, Maha; Berrady, Rhizlane; Tizniti, Siham; Messouak, Ouafae; Belahsen, Faouzy; Bono, Wafaa

2011-01-01

Neurologic signs and symptoms may represent the initial presentation of AIDS in 10-30% of patients. Movement disorders may be the result of direct central nervous system infection by human immunodeficiency virus (HIV) or the result of opportunistic infections. We report the case of a 59 years old woman who had hemichorea-hemiballismus subsequently found to be secondary to a cerebral toxoplasmosis infection revealing HIV infection. Movement disorders, headache and nausea were resolved after two weeks of antitoxoplasmic treatment. Brain MRI control showed a marked resolution of cerebral lesion. Occurrence of hemichorea-ballismus in patient without familial history of movement disorders suggests a diagnosis of AIDS and in particular the diagnosis of secondary cerebral toxoplasmosis. Early recognition is important since it is a treatable entity.

Rayleigh–Taylor and Richtmyer–Meshkov instability induced flow, turbulence, and mixing. I

DOE PAGES

Zhou, Ye

2017-09-06

Rayleigh–Taylor (RT) and Richtmyer–Meshkov (RM) instabilities play an important role in a wide range of engineering, geophysical, and astrophysical flows. They represent a triggering event that, in many cases, leads to large-scale turbulent mixing. Much effort has been expended over the past 140 years, beginning with the seminal work of Lord Rayleigh, to predict the evolution of the instabilities and of the instability-induced mixing layers. Furthermore, the objective of Part I of this review is to provide the basic properties of the flow, turbulence, and mixing induced by RT, RM, and Kelvin–Helmholtz (KH) instabilities. Historical efforts to study these instabilitiesmore » are briefly reviewed, and the significance of these instabilities is discussed for a variety of flows, particularly for astrophysical flows and for the case of inertial confinement fusion.« less

Stereotypes of autism.

PubMed

Draaisma, Douwe

2009-05-27

In their landmark papers, both Kanner and Asperger employed a series of case histories to shape clinical insight into autistic disorders. This way of introducing, assessing and representing disorders has disappeared from today's psychiatric practice, yet it offers a convincing model of the way stereotypes may build up as a result of representations of autism. Considering that much of what society at large learns on disorders on the autism spectrum is produced by representations of autism in novels, TV-series, movies or autobiographies, it will be of vital importance to scrutinize these representations and to check whether or not they are, in fact, misrepresenting autism. In quite a few cases, media representations of talent and special abilities can be said to have contributed to a harmful divergence between the general image of autism and the clinical reality of the autistic condition.

Binocular Vision

PubMed Central

Blake, Randolph; Wilson, Hugh

2010-01-01

This essay reviews major developments –empirical and theoretical –in the field of binocular vision during the last 25 years. We limit our survey primarily to work on human stereopsis, binocular rivalry and binocular contrast summation, with discussion where relevant of single-unit neurophysiology and human brain imaging. We identify several key controversies that have stimulated important work on these problems. In the case of stereopsis those controversies include position versus phase encoding of disparity, dependence of disparity limits on spatial scale, role of occlusion in binocular depth and surface perception, and motion in 3D. In the case of binocular rivalry, controversies include eye versus stimulus rivalry, role of “top-down” influences on rivalry dynamics, and the interaction of binocular rivalry and stereopsis. Concerning binocular contrast summation, the essay focuses on two representative models that highlight the evolving complexity in this field of study. PMID:20951722

Recent Advances in Dengue: Relevance to Puerto Rico

PubMed Central

Noyd, David H.; Sharp, Tyler M.

2015-01-01

Dengue represents an increasingly important public health challenge in Puerto Rico, with recent epidemics in 2007, 2010, and 2012–2013. Although recent advances in dengue vaccine development offer hope for primary prevention, the role of health professionals in the diagnosis and management of dengue patients is paramount. Case definitions for dengue, dengue with warning signs, and severe dengue provide a framework to guide clinical decision-making. Furthermore, the differentiation between dengue and other acute febrile illnesses, such as leptospirosis and chikungunya, is necessary for the appropriate diagnosis and management of cases. An understanding of dengue epidemiology and surveillance in Puerto Rico provides context for clinicians in epidemic and non-epidemic periods. This review aims to improve health professionals’ ability to diagnose dengue, and as highlight the relevance of recent advances in dengue prevention and management in Puerto Rico. PMID:26061055

Evaluating social media's capacity to develop engaged audiences in health promotion settings: use of Twitter metrics as a case study.

PubMed

Neiger, Brad L; Thackeray, Rosemary; Burton, Scott H; Giraud-Carrier, Christophe G; Fagen, Michael C

2013-03-01

Use of social media in health promotion and public health continues to grow in popularity, though most of what is reported in literature represents one-way messaging devoid of attributes associated with engagement, a core attribute, if not the central purpose, of social media. This article defines engagement, describes its value in maximizing the potential of social media in health promotion, proposes an evaluation hierarchy for social media engagement, and uses Twitter as a case study to illustrate how the hierarchy might function in practice. Partnership and participation are proposed as culminating outcomes for social media use in health promotion. As use of social media in health promotion moves toward this end, evaluation metrics that verify progress and inform subsequent strategies will become increasingly important.

Geometrical considerations in analyzing isotropic or anisotropic surface reflections.

PubMed

Simonot, Lionel; Obein, Gael

2007-05-10

The bidirectional reflectance distribution function (BRDF) represents the evolution of the reflectance with the directions of incidence and observation. Today BRDF measurements are increasingly applied and have become important to the study of the appearance of surfaces. The representation and the analysis of BRDF data are discussed, and the distortions caused by the traditional representation of the BRDF in a Fourier plane are pointed out and illustrated for two theoretical cases: an isotropic surface and a brushed surface. These considerations will help characterize either the specular peak width of an isotropic rough surface or the main directions of the light scattered by an anisotropic rough surface without misinterpretations. Finally, what is believed to be a new space is suggested for the representation of the BRDF, which avoids the geometrical deformations and in numerous cases is more convenient for BRDF analysis.

Eight Years of Severe Allergic Reactions in Finland: A Register-Based Report

PubMed Central

2008-01-01

Background No data have been available on severe allergic reactions in Finland. Materials and Methods We summarize the data accumulated from 2000 to 2007 in the national register established at the Skin and Allergy Hospital of the Helsinki University Central Hospital, where physicians voluntarily report on patients with severe allergic reactions. Results During the period, the 530 reported cases of severe allergic reactions represented an annual frequency of 0.001%. Of the patients, 66% were adults and 56% were female, with a median age of 27 years. Food was the causative agent in 53% of the cases, drugs in 26%, allergen preparations in 12%, and insects in 8%. Dermatologic symptoms were reported in 85%, respiratory in 76%, cardiovascular in 50%, gastrointestinal in 33%, and eye/nose symptoms in 18%. The reaction was a life-threatening anaphylactic shock in 26% of the cases, with no deaths reported. Patients were treated with intramuscular adrenaline in 75% of the cases. Not only nuts and seeds, but also fruit and vegetables were the most important allergens for the adults. Nuts were also important allergens for children, along with milk, egg, and wheat. In addition, many "exotic" allergens were identified: patent blue, carmine dye, yeast, buckwheat, and macrogol. Conclusions Severe allergic reactions are underreported, but a register reflects the real-life situation and helps to identify new causative agents. It also contributes to improvements in first aid treatment practice. PMID:23282762

Method for assessing the need for case-specific hemodynamics: application to the distribution of vascular permeability.

PubMed

Hazel, A L; Friedman, M H

2000-01-01

A common approach to understanding the role of hemodynamics in atherogenesis is to seek relationships between parameters of the hemodynamic environment, and the distribution of tissue variables thought to be indicative of early disease. An important question arising in such investigations is whether the distributions of tissue variables are sufficiently similar among cases to permit them to be described by an ensemble average distribution. If they are, the hemodynamic environment needs be determined only once, for a nominal representative geometry; if not, the hemodynamic environment must be obtained for each case. A method for classifying distributions from multiple cases to answer this question is proposed and applied to the distributions of the uptake of Evans blue dye labeled albumin by the external iliac arteries of swine in response to a step increase in flow. It is found that the uptake patterns in the proximal segment of the arteries, between the aortic trifurcation and the ostium of the circumflex iliac artery, show considerable case-to-case variability. In the distal segment, extending to the deep femoral ostium, many cases show very little spatial variation, and the patterns in those that do are similar among the cases. Thus the response of the distal segment may be understood with fewer simulations, but the proximal segment has more information to offer.

Malaria in the state of Rio de Janeiro, Brazil, an Atlantic Forest area: an assessment using the health surveillance service

PubMed Central

Miguel, Renata Bortolasse; Peiter, Paulo Cesar; de Albuquerque, Hermano; Coura, José Rodrigues; Moza, Patrícia Ganzenmüller; Costa, Anielle de Pina; Brasil, Patricia; Suárez-Mutis, Martha Cecília

2014-01-01

The lethality of malaria in the extra-Amazonian region is more than 70 times higher than in Amazonia itself. Recently, several studies have shown that autochthonous malaria is not a rare event in the Brazilian southeastern states in the Atlantic Forest biome. Information about autochthonous malaria in the state of Rio de Janeiro (RJ) is scarce. This study aims to assess malaria cases reported to the Health Surveillance System of the State of Rio de Janeiro between 2000-2010. An average of 90 cases per year had parasitological malaria confirmation by thick smear. The number of malaria notifications due to Plasmodium falciparum increased over time. Imported cases reported during the period studied were spread among 51% of the municipalities (counties) of the state. Only 35 cases (4.3%) were autochthonous, which represents an average of 3.8 new cases per year. Eleven municipalities reported autochthonous cases; within these, six could be characterised as areas of residual or new foci of malaria from the Atlantic Forest system. The other 28 municipalities could become receptive for transmission reintroduction. Cases occurred during all periods of the year, but 62.9% of cases were in the first semester of each year. Assessing vulnerability and receptivity conditions and vector ecology is imperative to establish the real risk of malaria reintroduction in RJ. PMID:25185004

Distance between RBS and AUG plays an important role in overexpression of recombinant proteins.

PubMed

Berwal, Sunil K; Sreejith, R K; Pal, Jayanta K

2010-10-15

The spacing between ribosome binding site (RBS) and AUG is crucial for efficient overexpression of genes when cloned in prokaryotic expression vectors. We undertook a brief study on the overexpression of genes cloned in Escherichia coli expression vectors, wherein the spacing between the RBS and the start codon was varied. SDS-PAGE and Western blot analysis indicated a high level of protein expression only in constructs where the spacing between RBS and AUG was approximately 40 nucleotides or more, despite the synthesis of the transcripts in the representative cases investigated. Copyright 2010 Elsevier Inc. All rights reserved.

[Incidence of irritant dermatosis among employees of the shipbuilding industry].

PubMed

Heise, H; Kühne, G; Kröger, D

1983-10-01

Irritant dermatosis is a non-specific reactive change on the skin. In most cases it represents the summated effects induced by various agents. Not only the shortened recovery phases of the skin but also a dispositional factor are important. Such changes, which are relatively common in some vocations but are usually only slight, cannot, as a rule, be regarded as signs of illness. Nevertheless, attention should be drawn to the necessity of intensive skin care and observation of the recovery phases because the frequency of irritant dermatosis can increase with increasing length of employment.

Chemical kinetics of homogeneous atmospheric oxidation of sulfur dioxide

NASA Technical Reports Server (NTRS)

Sander, S. P.; Seinfeld, J. H.

1976-01-01

A systematic evaluation of known homogeneous SO2 reactions which might be important in air pollution chemistry is carried out. A mechanism is developed to represent the chemistry of NOx/hydrocarbon/SO2 systems, and the mechanism is used to analyze available experimental data appropriate for quantitative analysis of SO2 oxidation kinetics. Detailed comparisons of observed and predicted concentration behavior are presented. In all cases, observed SO2 oxidation rates cannot be explained solely on the basis of those SO2 reactions for which rate constants have been measured. The role of ozone-olefin reactions in SO2 oxidation is elucidated.

Advanced Mechanistic 3D Spatial Modeling and Analysis Methods to Accurately Represent Nuclear Facility External Event Scenarios

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

Sezen, Halil; Aldemir, Tunc; Denning, R.

Probabilistic risk assessment of nuclear power plants initially focused on events initiated by internal faults at the plant, rather than external hazards including earthquakes and flooding. Although the importance of external hazards risk analysis is now well recognized, the methods for analyzing low probability external hazards rely heavily on subjective judgment of specialists, often resulting in substantial conservatism. This research developed a framework to integrate the risk of seismic and flooding events using realistic structural models and simulation of response of nuclear structures. The results of four application case studies are presented.

[Differential Diagnosis of Mediastinal and Hilar Lymphadenopathy with Focus on Occupational Diseases].

PubMed

Lux, H; Cavalcante, L Barreira; Baur, X

2018-06-01

Hilar and mediastinal lymphadenopathy may represent a diagnostic challenge in clinical practice. This article is intended to facilitate differential diagnosis by a systematic description of relevant pathologies, notably with occupational etiology. Clinical findings of relevant diseases, i. e. of tuberculosis, chronic beryllium disease, sarcoidosis, lung cancer, malignant lymphoma, Epstein-Barr virus infection, and histoplasmosis are compared.Case history, imaging and laboratory tests have important diagnostic impact. But also invasive methods can be necessary in order to exclude and prove malignancy, infection or autoimmune disease. © Georg Thieme Verlag KG Stuttgart · New York.

Stakeholder engagement in dredged material management decisions.

PubMed

Collier, Zachary A; Bates, Matthew E; Wood, Matthew D; Linkov, Igor

2014-10-15

Dredging and disposal issues often become controversial with local stakeholders because of their competing interests. These interests tend to manifest themselves in stakeholders holding onto entrenched positions, and deadlock can result without a methodology to move the stakeholder group past the status quo. However, these situations can be represented as multi-stakeholder, multi-criteria decision problems. In this paper, we describe a case study in which multi-criteria decision analysis was implemented in a multi-stakeholder setting in order to generate recommendations on dredged material placement for Long Island Sound's Dredged Material Management Plan. A working-group of representatives from various stakeholder organizations was formed and consulted to help prioritize sediment placement sites for each dredging center in the region by collaboratively building a multi-criteria decision model. The resulting model framed the problem as several alternatives, criteria, sub-criteria, and metrics relevant to stakeholder interests in the Long Island Sound region. An elicitation of values, represented as criteria weights, was then conducted. Results show that in general, stakeholders tended to agree that all criteria were at least somewhat important, and on average there was strong agreement on the order of preferences among the diverse groups of stakeholders. By developing the decision model iteratively with stakeholders as a group and soliciting their preferences, the process sought to increase stakeholder involvement at the front-end of the prioritization process and lead to increased knowledge and consensus regarding the importance of site-specific criteria. Published by Elsevier B.V.

Importance of mycological confirmation of clinically suspected cases of tinea corporis, tinea pedis and tinea cruris.

PubMed

Omar, Abeer Aly

2004-01-01

Tinea corporis, tinea cruris, and tinea pedis are of the most prevalent dermatophytoses. Several conditions that mimic dermatophytoses and atypical and steroid modified forms of the disease usually present difficulties in diagnosis. Hence, the present investigation aimed at studying these conditions on mycological basis. The study included 163 cases clinically diagnosed as having tinea corporis, tinea pedis or tinea cruris. Specimens were taken by skin scraping. Samples were cultured on Sabouraud's dextrose agar and examined microscopically. The results revealed that, only 90.8% of cases were mycologically proven (positive by one or both methods). Most of tinea corporis, tinea pedis and tinea cruris cases (68.9%, 79.1%& 83.9% respectively) were diagnosed by both methods (P>0.05). For cases of tinea corporis and tinea cruris, males were more than females (51.4%, 48.6% and 58.1%, 41.9% respectively) while females exceeded males (72.1%, 27.9% respectively) in cases with tinea pedis (P<0.05). Trichophyton rubrum (T. rubrum) was the most common isolate in all the studied conditions, represented 64.9% in tinea corporis, 53.4 %, for tinea pedis and 64.6% for tinea cruris. T. mentagrophytes var. interdigitale was mostly isolated from cases of tinea pedis (23.3%). The majority of T. violaceum was isolated from cases of tinea corporis (12.2%). The main isolation of E. floccosum was from cases of tinea cruris (16.1%) Microsporum canis (M. canis) was only isolated from one case (1.4%) of tinea corporis while Candida albicans (C. albicans) alone (9.3%) or with T. rubrum (7.0%) was isolated only from cases of interdigital tinea pedis. (P<0.05). The majority of cases of tinea corporis, tinea pedis and tinea cruris had chronic lesions (78.4%, 76.7% and 54.8% respectively) (P<0.05) and received prior therapy for the condition (79.7%, 76.7% and 58.1% respectively, (P>0.05). In conclusion, early accurate diagnosis (on mycological basis) is an important tool to control and reduce the incidence of dermatophytosis. Periodic epidemiological analysis of these conditions is required to ensure their efficacious control.

75 FR 26160 - Drug and Drug-Related Supply Promotion by Pharmaceutical Company Sales Representatives at VA...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-11

... consistent standard of permissible business practice at VA facilities. It would also facilitate mutually... include suspension of a sales representative's access privileges, or, in extreme cases, denying access to... corrective action by the individual or company will suffice. In most cases, we expect that the infraction...

Comprehensive Genomic Profiling Aids in Distinguishing Metastatic Recurrence from Second Primary Cancers

PubMed Central

Weinberg, Benjamin A.; Gowen, Kyle; Lee, Thomas K.; Ou, Sai‐Hong Ignatius; Bristow, Robert; Krill, Lauren; Almira‐Suarez, M. Isabel; Ali, Siraj M.; Miller, Vincent A.; Liu, Stephen V.

2017-01-01

Abstract Background. Metastatic recurrence after treatment for locoregional cancer is a major cause of morbidity and cancer‐specific mortality. Distinguishing metastatic recurrence from the development of a second primary cancer has important prognostic and therapeutic value and represents a difficult clinical scenario. Advances beyond histopathological comparison are needed. We sought to interrogate the ability of comprehensive genomic profiling (CGP) to aid in distinguishing between these clinical scenarios. Materials and Methods. We identified three prospective cases of recurrent tumors in patients previously treated for localized cancers in which histologic analyses suggested subsequent development of a distinct second primary. Paired samples from the original primary and recurrent tumor were subjected to hybrid capture next‐generation sequencing‐based CGP to identify base pair substitutions, insertions, deletions, copy number alterations (CNA), and chromosomal rearrangements. Genomic profiles between paired samples were compared using previously established statistical clonality assessment software to gauge relatedness beyond global CGP similarities. Results. A high degree of similarity was observed among genomic profiles from morphologically distinct primary and recurrent tumors. Genomic information suggested reclassification as recurrent metastatic disease, and patients received therapy for metastatic disease based on the molecular determination. Conclusions. Our cases demonstrate an important adjunct role for CGP technologies in separating metastatic recurrence from development of a second primary cancer. Larger series are needed to confirm our observations, but comparative CGP may be considered in patients for whom distinguishing metastatic recurrence from a second primary would alter the therapeutic approach. Implications for Practice. Distinguishing a metastatic recurrence from a second primary cancer can represent a difficult clinicopathologic problem but has important prognostic and therapeutic implications. Approaches to aid histologic analysis may improve clinician and pathologist confidence in this increasingly common clinical scenario. Our series provides early support for incorporating paired comprehensive genomic profiling in clinical situations in which determination of metastatic recurrence versus a distinct second primary cancer would influence patient management. PMID:28193735

Bilateral wilms tumor with TP53-related anaplasia.

PubMed

Popov, Sergey D; Vujanic, Gordan M; Sebire, Neil J; Chagtai, Tasnim; Williams, Richard; Vaidya, Sucheta; Pritchard-Jones, Kathy

2013-01-01

Wilms tumor (WT) with diffuse anaplasia has an unfavorable prognosis and is often (>70%) associated with mutations in the TP53 gene. Although most WTs are unilateral, 5-10% are bilateral, and they are almost always present with nephrogenic rests. The latter are considered a precursor of WT. Two cases of bilateral WTs with nephroblastomatosis, in which anaplastic changes were detected over a period of time, were analyzed using clinical, radiological, histopathological, and molecular-genetic data. TP53 was analyzed by direct sequencing of its full coding sequence and intron-exon boundaries in 11 fragments. DNA was extracted from paraffin-embedded or frozen specimens. High-resolution genomic copy number profiling was carried out by UCL Genomics on the Affymetrix Human Mapping 250K Nsp or Genome-Wide Human SNP Array 6.0 platform. Both cases demonstrated a strong association between the appearance of anaplastic clones and TP53 mutations. Synchronous ganglioneuroma was diagnosed in one case. Our cases are unique as they represent a long disease history and demonstrate the difficulties in managing rare cases of bilateral WT with anaplasia. These cases also emphasize the practical importance of modern molecular-genetic techniques and their clinical application. Moreover, they highlight the issue of the adequate sampling needed in order to gather comprehensive, efficient, and sufficient information about genetic events in a single tumor.

Acute acalculous cholecystitis: A new safety risk for patients with MS treated with alemtuzumab.

PubMed

Croteau, David; Flowers, Charlene; Kulick, Corrinne G; Brinker, Allen; Kortepeter, Cindy M

2018-05-01

To evaluate acute acalculous cholecystitis (AAC) as a potential safety risk for patients treated with alemtuzumab. The Food and Drug Administration Adverse Event Reporting System and the medical literature were searched for cases of AAC in conjunction with alemtuzumab for all clinical indications. Eight spontaneously reported cases meeting the case definition of AAC in close temporal association with alemtuzumab use were identified. Based on established criteria within the Food and Drug Administration Division of Pharmacovigilance for causality assessment, 4 cases were assessed as probable while 4 were possible. All cases occurred in patients with relapsing-remitting multiple sclerosis. Seven of the 8 cases presented with AAC during or shortly after alemtuzumab treatment, thereby suggesting an acute cytokine release syndrome as a putative pathogenic mechanism. The cases identified in this review differ from the typical AAC cases described in the medical literature based on female preponderance, lack of concurrent critical illnesses, inconsistent presence of other risk factors, and resolution with conservative treatment in the majority of cases. AAC represents a new and potentially life-threatening adverse event associated with alemtuzumab use in relapsing-remitting multiple sclerosis. In cases seen to date, early and conservative treatment resulted in good clinical outcome, although the natural history of AAC in this population without critical illness is not well defined. Awareness of this safety risk by general and specialty neurologists is important for prompt recognition and optimal management. © 2018 American Academy of Neurology.

The Children's Oncology Group Childhood Cancer Research Network (CCRN): case catchment in the United States.

PubMed

Musselman, Jessica R B; Spector, Logan G; Krailo, Mark D; Reaman, Gregory H; Linabery, Amy M; Poynter, Jenny N; Stork, Susan K; Adamson, Peter C; Ross, Julie A

2014-10-01

The Childhood Cancer Research Network (CCRN) was established within the Children's Oncology Group (COG) in July 2008 to provide a centralized pediatric cancer research registry for investigators conducting approved etiologic and survivorship studies. The authors conducted an ecological analysis to characterize CCRN catchment at >200 COG institutions by demographic characteristics, diagnosis, and geographic location to determine whether the CCRN can serve as a population-based registry for childhood cancer. During 2009 to 2011, 18,580 US children newly diagnosed with cancer were registered in the CCRN. These observed cases were compared with age-specific, sex-specific, and race/ethnicity-specific expected numbers calculated from Surveillance, Epidemiology, and End Results (SEER) Program cancer incidence rates and 2010 US Census data. Overall, 42% of children (18,580 observed/44,267 expected) who were diagnosed with cancer at age <20 years were registered in the CCRN, including 45%, 57%, 51%, 44%, and 24% of those diagnosed at birth, ages 1 to 4 years, ages 5 to 9 years, ages 10 to 14 years, and ages 15 to 19 years, respectively. Some malignancies were better represented in the CCRN (leukemia, 59%; renal tumors, 67%) than others (retinoblastoma, 34%). There was little evidence of differences by sex or race/ethnicity, although rates in nonwhites were somewhat lower than rates in whites. Given the low observed-to-expected ratio, it will be important to identify challenges and barriers to registration to improve case ascertainment, especially for rarer diagnoses and older age groups; however, it is encouraging that some diagnoses in younger children are fairly representative of the population. Overall, the CCRN is providing centralized, real-time access to cases for research and could be used as a model for other national cooperative groups. © 2014 American Cancer Society.

The Role of Environmental Toxins on ALS: A Case-Control Study of Occupational Risk Factors

PubMed Central

Su, Feng-Chiao.; Goutman, Stephen A.; Chernyak, Sergey; Mukherjee, Bhramar; Callaghan, Brian C.; Batterman, Stuart; Feldman, Eva L.

2016-01-01

Importance Persistent environmental pollutants may represent a modifiable risk factor involved in the gene-time-environment hypothesis in amyotrophic lateral sclerosis (ALS). Objective To evaluate the association of occupational exposures and environmental toxins on the odds of developing ALS in Michigan, a state with historically high levels of environmental pollution. Design Case-control study conducted between 2011 and 2014. Setting Tertiary referral center/ALS referral center Participants ALS cases (n=156) with a diagnosis of definitive, probable, probable with laboratory support, or possible ALS by revised El Escorial criteria. Controls (n=128) were excluded if they had a diagnosis of ALS, another neurodegenerative condition, or a family history of ALS in a first- or second-degree blood relative. Additional exclusions included age less than 18 or inability to communicate in English. Main Outcome and Measure(s) Cases and controls completed a survey assessing occupational and residential exposures. Blood concentrations of 122 persistent environmental pollutants, including organochlorine pesticides (OCP), polychlorinated biphenyls (PCBs), and brominated flame retardants (BFRs), were measured using gas chromatography/mass spectrometry. Multivariable models with self-reported occupational exposures in various exposure time windows and environmental toxin blood concentrations were separately fit by logistic regression models. Concordance between the survey data and pollutant measurements was assessed using the nonparametric Kendall’s Tau correlation coefficient. Results Survey data revealed that reported pesticide exposure in the cumulative exposure windows was significantly associated with ALS (OR = 5.09, 95% CI = 1.85–14.0). Military service was also associated with ALS in two time windows. A multivariable model of measured persistent environmental pollutants in the blood, representing cumulative occupational and residential exposure, showed increased odds of ALS for 2 OCPs, 2 PCBs, and 1 BFR. There was modest concordance between survey data and the measurements of persistent environmental pollutants in blood. Conclusions and Relevance Persistent environmental pollutants measured in blood are significantly associated with ALS. These environmental pollutants may represent a modifiable ALS disease risk factor and should be further studied. PMID:27159543

Mycetoma (Madura Foot) in Israel: Recent Cases and a Systematic Review of the Literature

PubMed Central

Bitan, Ohad; Wiener-Well, Yonit; Segal, Rina; Schwartz, Eli

2017-01-01

Mycetoma is a chronic soft tissue infection caused by fungal or bacterial pathogens, and is endemic in tropical and subtropical regions. Cases in developed countries outside the mycetoma belt are rare and usually imported by immigrants. Sporadic cases have been reported in Israel. Unpublished cases in the participating medical centers are reported. In addition, a systematic review of the literature was performed. All published mycetoma cases diagnosed in Israel were included with relevant variables collected. Twenty-one cases of mycetoma were diagnosed in Israel between 1942 and 2015, including four unpublished cases and 17 published cases. The mean age at diagnosis was 42 years (range 23–73), and 16 of the patients were male. The foot was the primary involved organ. Fifteen patients were immigrants from Yemen, Ethiopia, and Sudan. Five cases were autochthonous. One case was travel related. Among patients who developed symptoms after immigration, the mean time from exposure to symptom onset was 5.6 years (range 1–10 years). The mean time from symptom onset to diagnosis was 6.6 years (range 0.2–35 years). The autochthonous cases demonstrate that Israel is endemic of mycetoma. The immigrant population represents two distinct waves of immigration to Israel in the past century. Two unpublished cases of Ethiopian immigrants are the first reported cases of mycetoma acquired in Ethiopia. The diagnostic and therapeutic challenges along with the epidemiological data emphasize the need of raising the awareness of physicians to this devastating condition even in developed countries. PMID:28719270

[HIV epidemic: a study among physicians in Vaud].

PubMed

Meystre-Agustoni, G; Van Melle, G; Chave, J P; Martin, J; Billo, N; Glauser, M P; Francioli, P

1990-09-22

A two-phase survey was conducted in the Canton of Vaud among the 1006 registered private practitioners (response rate 98%). The first phase aimed at determining the proportion of these physicians involved in the care of HIV+ persons. The results showed that 43% of the practitioners had been consulted by HIV+ patients. In the second phase, all institutions (hospitals, prisons and IV-drug user rehabilitation and testing centers) and a representative sample of the physicians with HIV+ patients were asked about the transmission category of their HIV+ patients. A mathematical method was used to estimate the true number of known HIV+ individuals by December 1988. Approximately 60% of the HIV+ persons had been seen exclusively by the private practitioners. IV-drug users represented 57% of all HIV+ persons compared to only 27% of the AIDS cases registered in 1988, suggesting that an important change in the transmission categories of AIDS cases is to be expected in the near future. These observations underscore the evolving nature of the HIV epidemic on the one hand, and the crucial role of the private practitioners in the prevention of the HIV infection on the other. This also points to the need for methods specifically designed to monitor HIV and AIDS epidemics respectively.

Characterizing Adversity of Lysosomal Accumulation in Nonclinical Toxicity Studies: Results from the 5th ESTP International Expert Workshop.

PubMed

Lenz, B; Braendli-Baiocco, A; Engelhardt, J; Fant, P; Fischer, H; Francke, S; Fukuda, R; Gröters, S; Harada, T; Harleman, H; Kaufmann, W; Kustermann, S; Nolte, T; Palazzi, X; Pohlmeyer-Esch, G; Popp, A; Romeike, A; Schulte, A; Lima, B Silva; Tomlinson, L; Willard, J; Wood, C E; Yoshida, M

2018-02-01

Lysosomes have a central role in cellular catabolism, trafficking, and processing of foreign particles. Accumulation of endogenous and exogenous materials in lysosomes represents a common finding in nonclinical toxicity studies. Histologically, these accumulations often lack distinctive features indicative of lysosomal or cellular dysfunction, making it difficult to consistently interpret and assign adverse dose levels. To help address this issue, the European Society of Toxicologic Pathology organized a workshop where representative types of lysosomal accumulation induced by pharmaceuticals and environmental chemicals were presented and discussed. The expert working group agreed that the diversity of lysosomal accumulations requires a case-by-case weight-of-evidence approach and outlined several factors to consider in the adversity assessment, including location and type of cell affected, lysosomal contents, severity of the accumulation, and related pathological effects as evidence of cellular or organ dysfunction. Lysosomal accumulations associated with cytotoxicity, inflammation, or fibrosis were generally considered to be adverse, while those found in isolation (without morphologic or functional consequences) were not. Workshop examples highlighted the importance of thoroughly characterizing the biological context of lysosomal effects, including mechanistic data and functional in vitro readouts if available. The information provided here should facilitate greater consistency and transparency in the interpretation of lysosomal effects.

Thermal activation of dislocations in large scale obstacle bypass

NASA Astrophysics Data System (ADS)

Sobie, Cameron; Capolungo, Laurent; McDowell, David L.; Martinez, Enrique

2017-08-01

Dislocation dynamics simulations have been used extensively to predict hardening caused by dislocation-obstacle interactions, including irradiation defect hardening in the athermal case. Incorporating the role of thermal energy on these interactions is possible with a framework provided by harmonic transition state theory (HTST) enabling direct access to thermally activated reaction rates using the Arrhenius equation, including rates of dislocation-obstacle bypass processes. Moving beyond unit dislocation-defect reactions to a representative environment containing a large number of defects requires coarse-graining the activation energy barriers of a population of obstacles into an effective energy barrier that accurately represents the large scale collective process. The work presented here investigates the relationship between unit dislocation-defect bypass processes and the distribution of activation energy barriers calculated for ensemble bypass processes. A significant difference between these cases is observed, which is attributed to the inherent cooperative nature of dislocation bypass processes. In addition to the dislocation-defect interaction, the morphology of the dislocation segments pinned to the defects play an important role on the activation energies for bypass. A phenomenological model for activation energy stress dependence is shown to describe well the effect of a distribution of activation energies, and a probabilistic activation energy model incorporating the stress distribution in a material is presented.

Probabilistic liver atlas construction.

PubMed

Dura, Esther; Domingo, Juan; Ayala, Guillermo; Marti-Bonmati, Luis; Goceri, E

2017-01-13

Anatomical atlases are 3D volumes or shapes representing an organ or structure of the human body. They contain either the prototypical shape of the object of interest together with other shapes representing its statistical variations (statistical atlas) or a probability map of belonging to the object (probabilistic atlas). Probabilistic atlases are mostly built with simple estimations only involving the data at each spatial location. A new method for probabilistic atlas construction that uses a generalized linear model is proposed. This method aims to improve the estimation of the probability to be covered by the liver. Furthermore, all methods to build an atlas involve previous coregistration of the sample of shapes available. The influence of the geometrical transformation adopted for registration in the quality of the final atlas has not been sufficiently investigated. The ability of an atlas to adapt to a new case is one of the most important quality criteria that should be taken into account. The presented experiments show that some methods for atlas construction are severely affected by the previous coregistration step. We show the good performance of the new approach. Furthermore, results suggest that extremely flexible registration methods are not always beneficial, since they can reduce the variability of the atlas and hence its ability to give sensible values of probability when used as an aid in segmentation of new cases.

[General Agreement on Trade in Services and its implications for public health].

PubMed

Umaña-Peña, Román; Alvarez-Dardet, Carlos

2005-01-01

Due to the economic importance of the service sector and its trade potential, in 1995 the World Trade Organization (WTO) launched the General Agreement on Trade in Services with the objective of liberalizing trade in services worldwide and of establishing rules and disciplines to regulate it. Until now, the Agreement has produced few case laws on its rules and some of them are in the process of being developed, which makes the Agreement ambiguous and hampers accurate forecasting of its implications. Nevertheless, some analysts consider that certain characteristics and rules represent a threat to the funding mechanisms of public services and to the sovereignty of governments to generate their own rules. Moreover, the Agreement would lead to irreversible formalization of commitments, without the possibility of returning to previous conditions in the case of failure of the market and/or private participation. In addition, the Agreement acts against exclusive monopolies and providers and to a certain extent this will affect subsidies to local providers. The ability of the European Communities Court of Justice to enforce the implementation of competitive measures in public services has produced uncertainty because of the implications for health services. The Spanish Agreement with the WTO contains many questions that remain open, representing an opportunity for the participation of the health sector in the next negotiation rounds.

[Dysfunctional workplace organization and mobbing. 4 representative cases].

PubMed

Albini, Elisa; Benedetti, Laura; Giordano, S; Punzi, Silvia; Cassitto, Maria Grazia

2003-01-01

Stress and psychological harassment at work are increasing worldwide, according to International Agencies (European Community, NIOSH) and to most authors. To describe typical working situations responsible for distress and mobbing, with the aim of early diagnosis and effectiveness of therapy and rehabilitation. Four cases are reported as representative of dysfunctional organization producing distress and pathology or inducing mobbing behavior or mobbing without clear organization responsibilities. In all cases dysfunctional organization appeared to have played a significant role even though not always a direct one. Also, common characteristics were highlighted in the three cases where mobbing was recognized.

Making a case for anterior inferior iliac spine/subspine hip impingement: three representative case reports and proposed concept.

PubMed

Larson, Christopher M; Kelly, Bryan T; Stone, Rebecca M

2011-12-01

Femoroacetabular impingement is typically described as occurring due to a conflict between the femoral head-neck junction and acetabular rim. A prior case report described an open decompression of the anterior inferior iliac spine (AIIS) due to impingement against the proximal femur. AIIS impingement may be developmental or the result of a prior AIIS avulsion or pelvic osteotomy. We describe 3 representative cases with minimum 1-year follow-up treated with an arthroscopic AIIS decompression. Copyright © 2011 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Pesticide intoxications in the Centre of Portugal: three years analysis.

PubMed

Teixeira, Helena; Proença, Paula; Alvarenga, Margarida; Oliveira, Margarida; Marques, Estela P; Vieira, Duarte Nuno

2004-07-16

Pesticides are used in most countries around the world to protect agricultural and horticultural crops against damage. Poisoning by these toxicant agents occurs as a result of misuse or accidental exposure, and also by oral ingestion (voluntary or not). In Portugal, pesticide intoxications are still a cause of death, found in a considerable number of cases. The authors retrospectively examined the cases of pesticide poisoning in the Centre of Portugal, from autopsies performed in the Forensic Pathology Service of Coimbra's Delegation of the National Institute of Legal Medicine (NILM) and from other autopsies carried out in the Centre of Portugal, as well as some samples taken in hospitals in cases of suspected intoxication. In this study, the positive cases have been especially studied, in order to identify the pesticide used, as well as the etiology. The frequency of intoxications and its distribution by sex and age were also analyzed. Between January 2000 and December 2002, the Forensic Toxicology Laboratory received 639 pesticide analysis requests. In 2000, in a total of 149 analysis requests, 30 cases were positive, 63.3% from male individuals and 36.7% from female. In 2001, the analysis requests increased to 240 as well as the positive cases (43), 74.4% from male individuals and 25.6% from female and in 2002, the total cases analyzed also increased to 250, with 38 positive (73.6% from male individuals and 26.4% from female). Among the pesticides, organophosphorus insecticides still constitute the most important class detected in forensic intoxications, representing 63% of the total positive cases, followed by herbicides, with 33% of the positive results. Quinalphos is the most important organophosphorus insecticide, present in 32 of the 111 positive cases, followed by the herbicide paraquat, detected in 31 cases. The study emphasizes the increasing number of pesticide analyses, particularly relevant for the organophosphorus compounds and herbicides. Intoxication suspicion, accidental or voluntary, seems to be the most common cause of the incidents, for which analyses are requested, but it is also evident that the putative cause is unknown in a large number of cases. Therefore, more stringent legislation and enforcement regarding the sale and distribution of these toxic substances are needed.

Initial characterization of novel beaked whale morbillivirus in Hawaiian cetaceans.

PubMed

Jacob, Jessica M; West, Kristi L; Levine, Gregg; Sanchez, Susan; Jensen, Brenda A

2016-01-13

Cetacean morbillivirus (CeMV) is a causative factor in epizootics that have resulted in thousands of deaths throughout the Atlantic and Mediterranean since 1987, but less is known of its presence and significance in the Pacific. The first case of CeMV reported in Hawai'i was in a Longman's beaked whale that stranded in 2010. The initial CeMV sequence from this individual indicated the possibility of a novel strain. To address this, archived samples from cetaceans that stranded in Hawai'i between 1997 and 2014 were screened for CeMV. The beaked whale morbillivirus (BWMV) was detected in 15 individuals representing 12 different species (24% of Code 1 and 2 stranded cetaceans). The earliest detected case was a humpback whale that stranded in 1998. Sequence comparisons of a 2.2 kb sequence spanning the phosphoprotein (P) and nucleocapsid (N) genes strongly suggest that the BWMV represents a novel strain of CeMV present in Hawai'i and the Central Pacific. In contrast to recently reported isolates from Brazil and Australia that may represent a distinct clade, BWMV appears to be more closely related to known strains of CeMV (dolphin morbillivirus; porpoise morbillivirus; and pilot whale morbillivirus). Detection rates with repeat sampling of positive lymph nodes were between 2 and 61%, illustrating the extreme heterogeneity that can occur in affected tissues. Taken together, these results suggest that BWMV may be common and established in Hawaiian cetacean populations. BWMV will be important for understanding CeMV and health threats in the relatively understudied cetaceans of the Pacific.

75 FR 24510 - Drug and Drug-Related Supply Promotion by Pharmaceutical Company Sales Representatives at VA...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-05

... VA facilities and the business relationships between VA staff and sales representatives promoting..., and provide sales representatives with a consistent standard of permissible business practice at VA... include suspension of a sales representative's access privileges, or, in extreme cases, denying access to...

Influence of intensive fishing on the partitioning of mercury and methylmercury in three lakes of Northern Québec.

PubMed

Surette, Céline; Lucotte, Marc; Tremblay, A

2006-09-01

It has been demonstrated that intensive fishing, i.e., removing more than 25% of the fish biomass, can reduce mercury levels in predator fish in a lake. We test here the hypothesis that, by removing an important part of the fish biomass from a lake, a significant amount of methylmercury can be eliminated, therefore reducing the mercury available to the remaining biota, at least in the short term. A mass burden approach is used to evaluate the partitioning of total mercury and methylmercury in natural lake ecosystems. Three small natural lakes from the James Bay territory, in northern Québec, Canada, were selected for intensive fishing. Mercury (Hg) and methylmercury (MeHg) concentrations were evaluated for sediments, water column (dissolved fraction and suspended particulate matter), plankton, aquatic invertebrates, and fish. Biomasses were determined for fish, plankton, and aquatic invertebrates. Two case scenarios are presented using different mercury contributions from the sediment component (1 cm depth, and no sediment). Our results for the scenario including the sediment contribution show that lake sediments represent over 98% of the total mercury while the biotic components represent less than 0.1% of the same burden. For methylmercury, fish account for up to 5% of the burden, while sediments make up 84.6% to 93.1%. If we put aside the sediment contribution, the methylmercury in fish partitioning can represent up to 48%. As for invertebrates, they can account for up to 48% of the total MeHg burden. We do not observe any change in the partitionings or the quantities of Hg and MeHg before and after fishing in either of the two case scenarios even when we do not take into account dynamics of the ecosystems. This will be all the more the case when the dynamics of the system are included in the analyses. Therefore, biological parameters such as growth rates or fish diet must be considered.

False-positive liver scan in a patient with hepatic amyloidosis: case report

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

Suzuki, K.; Okuda, K.; Yoshida, T.

1976-01-01

A case of secondary hepatic amyloidosis exhibiting a large liver and multiple defects on the $sup 198$Au-radiocolloid scintigraph is presented. Biopsy and angiographic studies indicated that the areas of reduced colloid uptake represented heavy amyloid deposition, and the area of the left lobe with contrasting high activity most probably represented compensatory hypertrophy. (auth)

"Wish You Were Here": Examining Characteristics, Outcomes, and Statistical Solutions for Missing Cases in Web-Based Psychotherapeutic Trials.

PubMed

Karin, Eyal; Dear, Blake F; Heller, Gillian Z; Crane, Monique F; Titov, Nickolai

2018-04-19

Missing cases following treatment are common in Web-based psychotherapy trials. Without the ability to directly measure and evaluate the outcomes for missing cases, the ability to measure and evaluate the effects of treatment is challenging. Although common, little is known about the characteristics of Web-based psychotherapy participants who present as missing cases, their likely clinical outcomes, or the suitability of different statistical assumptions that can characterize missing cases. Using a large sample of individuals who underwent Web-based psychotherapy for depressive symptoms (n=820), the aim of this study was to explore the characteristics of cases who present as missing cases at posttreatment (n=138), their likely treatment outcomes, and compare between statistical methods for replacing their missing data. First, common participant and treatment features were tested through binary logistic regression models, evaluating the ability to predict missing cases. Second, the same variables were screened for their ability to increase or impede the rate symptom change that was observed following treatment. Third, using recontacted cases at 3-month follow-up to proximally represent missing cases outcomes following treatment, various simulated replacement scores were compared and evaluated against observed clinical follow-up scores. Missing cases were dominantly predicted by lower treatment adherence and increased symptoms at pretreatment. Statistical methods that ignored these characteristics can overlook an important clinical phenomenon and consequently produce inaccurate replacement outcomes, with symptoms estimates that can swing from -32% to 70% from the observed outcomes of recontacted cases. In contrast, longitudinal statistical methods that adjusted their estimates for missing cases outcomes by treatment adherence rates and baseline symptoms scores resulted in minimal measurement bias (<8%). Certain variables can characterize and predict missing cases likelihood and jointly predict lesser clinical improvement. Under such circumstances, individuals with potentially worst off treatment outcomes can become concealed, and failure to adjust for this can lead to substantial clinical measurement bias. Together, this preliminary research suggests that missing cases in Web-based psychotherapeutic interventions may not occur as random events and can be systematically predicted. Critically, at the same time, missing cases may experience outcomes that are distinct and important for a complete understanding of the treatment effect. ©Eyal Karin, Blake F Dear, Gillian Z Heller, Monique F Crane, Nickolai Titov. Originally published in JMIR Mental Health (http://mental.jmir.org), 19.04.2018.

“Wish You Were Here”: Examining Characteristics, Outcomes, and Statistical Solutions for Missing Cases in Web-Based Psychotherapeutic Trials

PubMed Central

Dear, Blake F; Heller, Gillian Z; Crane, Monique F; Titov, Nickolai

2018-01-01

Background Missing cases following treatment are common in Web-based psychotherapy trials. Without the ability to directly measure and evaluate the outcomes for missing cases, the ability to measure and evaluate the effects of treatment is challenging. Although common, little is known about the characteristics of Web-based psychotherapy participants who present as missing cases, their likely clinical outcomes, or the suitability of different statistical assumptions that can characterize missing cases. Objective Using a large sample of individuals who underwent Web-based psychotherapy for depressive symptoms (n=820), the aim of this study was to explore the characteristics of cases who present as missing cases at posttreatment (n=138), their likely treatment outcomes, and compare between statistical methods for replacing their missing data. Methods First, common participant and treatment features were tested through binary logistic regression models, evaluating the ability to predict missing cases. Second, the same variables were screened for their ability to increase or impede the rate symptom change that was observed following treatment. Third, using recontacted cases at 3-month follow-up to proximally represent missing cases outcomes following treatment, various simulated replacement scores were compared and evaluated against observed clinical follow-up scores. Results Missing cases were dominantly predicted by lower treatment adherence and increased symptoms at pretreatment. Statistical methods that ignored these characteristics can overlook an important clinical phenomenon and consequently produce inaccurate replacement outcomes, with symptoms estimates that can swing from −32% to 70% from the observed outcomes of recontacted cases. In contrast, longitudinal statistical methods that adjusted their estimates for missing cases outcomes by treatment adherence rates and baseline symptoms scores resulted in minimal measurement bias (<8%). Conclusions Certain variables can characterize and predict missing cases likelihood and jointly predict lesser clinical improvement. Under such circumstances, individuals with potentially worst off treatment outcomes can become concealed, and failure to adjust for this can lead to substantial clinical measurement bias. Together, this preliminary research suggests that missing cases in Web-based psychotherapeutic interventions may not occur as random events and can be systematically predicted. Critically, at the same time, missing cases may experience outcomes that are distinct and important for a complete understanding of the treatment effect. PMID:29674311

Phylogeny of imported and reestablished wild polioviruses in theDemocratic Republic of the Congo from 2006 to 2011.

PubMed

Gumede, Nicksy; Jorba, Jaume; Deshpande, Jagadish; Pallansch, Mark; Yogolelo, Riziki; Muyembe-Tamfum, Jean Jacques; Kew, Olen; Venter, Marietjie; Burns, Cara C

2014-11-01

The last case of polio associated with wild poliovirus (WPV) indigenous to the Democratic Republic of the Congo (DRC) was reported in 2001, marking a major milestone toward polio eradication in Africa. However, during 2006-2011, outbreaks associated with WPV type 1 (WPV1) were widespread in the DRC, with >250 reported cases. WPV1 isolates obtained from patients with acute flaccid paralysis (AFP) were compared by nucleotide sequencing of the VP1 capsid region (906 nucleotides). VP1 sequence relationships among isolates from the DRC and other countries were visualized in phylogenetic trees, and isolates representing distinct lineage groups were mapped. Phylogenetic analysis indicated that WPV1 was imported twice in 2004-2005 and once in approximately 2006 from Uttar Pradesh, India (a major reservoir of endemicity for WPV1 and WPV3 until 2010-2011), into Angola. WPV1 from the first importation spread to the DRC in 2006, sparking a series of outbreaks that continued into 2011. WPV1 from the second importation was widely disseminated in the DRC and spread to the Congo in 2010-2011. VP1 sequence relationships revealed frequent transmission of WPV1 across the borders of Angola, the DRC, and the Congo. Long branches on the phylogenetic tree signaled prolonged gaps in AFP surveillance and a likely underreporting of polio cases. The reestablishment of widespread and protracted WPV1 transmission in the DRC and Angola following long-range importations highlights the continuing risks of WPV spread until global eradication is achieved, and it further underscores the need for all countries to maintain high levels of poliovirus vaccine coverage and sensitive surveillance to protect their polio-free status. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

How well do meteorological indicators represent agricultural and forest drought across Europe?

NASA Astrophysics Data System (ADS)

Bachmair, S.; Tanguy, M.; Hannaford, J.; Stahl, K.

2018-03-01

Drought monitoring and early warning (M&EW) systems are an important component of agriculture/silviculture drought risk assessment. Many operational information systems rely mostly on meteorological indicators, and a few incorporate vegetation state information. However, the relationships between meteorological drought indicators and agricultural/silvicultural drought impacts vary across Europe. The details of this variability have not been elucidated sufficiently on a continental scale in Europe to inform drought risk management at administrative scales. The objective of this study is to fill this gap and evaluate how useful the variety of meteorological indicators are to assess agricultural/silvicultural drought across Europe. The first part of the analysis systematically linked meteorological drought indicators to remote sensing based vegetation indices (VIs) for Europe at NUTs3 administrative regions scale using correlation analysis for crops and forests. In a second step, a stepwise multiple linear regression model was deployed to identify variables explaining the spatial differences observed. Finally, corn crop yield in Germany was chosen as a case study to verify VIs’ representativeness of agricultural drought impacts. Results show that short accumulation periods of SPI and SPEI are best linked to crop vegetation stress in most cases, which further validates the use of SPI3 in existing operational drought monitors. However, large regional differences in correlations are also revealed. Climate (temperature and precipitation) explained the largest proportion of variance, suggesting that meteorological indices are less informative of agricultural/silvicultural drought in colder/wetter parts of Europe. These findings provide important context for interpreting meteorological indices on widely used national to continental M&EW systems, leading to a better understanding of where/when such M&EW tools can be indicative of likely agricultural stress and impacts.

Use of in-vitro experimental results to model in-situ experiments: bio-denitrification under geological disposal conditions.

PubMed

Masuda, Kaoru; Murakami, Hiroshi; Kurimoto, Yoshitaka; Kato, Osamu; Kato, Ko; Honda, Akira

2013-01-01

Some of the low level radioactive wastes from reprocessing of spent nuclear fuels contain nitrates. Nitrates can be present in the form of soluble salts and can be reduced by various reactions. Among them, reduction by metal compounds and microorganisms seems to be important in the underground repository. Reduction by microorganism is more important in near field area than inside the repository because high pH and extremely high salt concentration would prevent microorganism activities. In the near field, pH is more moderate (pH is around 8) and salt concentration is lower. However, the electron donor may be limited there and it might be the control factor for microorganism's denitrification activities. In this study, in-vitro experiments of the nitrate reduction reaction were conducted using model organic materials purported to exist in underground conditions relevant to geological disposal. Two kinds of organic materials were selected. A super plasticizer was selected as being representative of the geological disposal system and humic acid was selected as being representative of pre-existing organic materials in the bedrock. Nitrates were reduced almost to N2 gas in the existence of super plasticizer. In the case of humic acids, although nitrates were reduced, the rate was much lower and, in this case, dead organism was used as an electron donor instead of humic acids. A reaction model was developed based on the in-vitro experiments and verified by running simulations against data obtained from in-situ experiments using actual groundwaters and microorganisms. The simulation showed a good correlation with the experimental data and contributes to the understanding of microbially mediated denitrification in geological disposal systems.

Towards a Science of Community Stakeholder Engagement in Biomedical HIV Prevention Trials: An Embedded Four-Country Case Study.

PubMed

Newman, Peter A; Rubincam, Clara; Slack, Catherine; Essack, Zaynab; Chakrapani, Venkatesan; Chuang, Deng-Min; Tepjan, Suchon; Shunmugam, Murali; Roungprakhon, Surachet; Logie, Carmen; Koen, Jennifer; Lindegger, Graham

2015-01-01

Broad international guidelines and studies in the context of individual clinical trials highlight the centrality of community stakeholder engagement in conducting ethically rigorous HIV prevention trials. We explored and identified challenges and facilitators for community stakeholder engagement in biomedical HIV prevention trials in diverse global settings. Our aim was to assess and deepen the empirical foundation for priorities included in the GPP guidelines and to highlight challenges in implementation that may merit further attention in subsequent GPP iterations. From 2008-2012 we conducted an embedded, multiple case study centered in Thailand, India, South Africa and Canada. We conducted in-depth interviews and focus groups with respondents from different trial-related subsystems: civil society organization representatives, community advocates, service providers, clinical trialists/researchers, former trial participants, and key HIV risk populations. Interviews/focus groups were recorded, and coded using thematic content analysis. After intra-case analyses, we conducted cross-case analysis to contrast and synthesize themes and sub-themes across cases. Lastly, we applied the case study findings to explore and assess UNAIDS/AVAC GPP guidelines and the GPP Blueprint for Stakeholder Engagement. Across settings, we identified three cross-cutting themes as essential to community stakeholder engagement: trial literacy, including lexicon challenges and misconceptions that imperil sound communication; mistrust due to historical exploitation; and participatory processes: engaging early; considering the breadth of "community"; and, developing appropriate stakeholder roles. Site-specific challenges arose in resource-limited settings and settings where trials were halted. This multiple case study revealed common themes underlying community stakeholder engagement across four country settings that largely mirror GPP goals and the GPP Blueprint, as well as highlighting challenges in the implementation of important guidelines. GPP guidance documents could be strengthened through greater focus on: identifying and addressing the community-specific roots of mistrust and its impact on trial literacy activities; achieving and evaluating representativeness in community stakeholder groups; and addressing the impact of power and funding streams on meaningful engagement and independent decision-making.

Towards a Science of Community Stakeholder Engagement in Biomedical HIV Prevention Trials: An Embedded Four-Country Case Study

PubMed Central

Newman, Peter A.; Rubincam, Clara; Slack, Catherine; Essack, Zaynab; Chakrapani, Venkatesan; Chuang, Deng-Min; Tepjan, Suchon; Shunmugam, Murali; Roungprakhon, Surachet; Logie, Carmen; Koen, Jennifer; Lindegger, Graham

2015-01-01

Objectives Broad international guidelines and studies in the context of individual clinical trials highlight the centrality of community stakeholder engagement in conducting ethically rigorous HIV prevention trials. We explored and identified challenges and facilitators for community stakeholder engagement in biomedical HIV prevention trials in diverse global settings. Our aim was to assess and deepen the empirical foundation for priorities included in the GPP guidelines and to highlight challenges in implementation that may merit further attention in subsequent GPP iterations. Methods From 2008–2012 we conducted an embedded, multiple case study centered in Thailand, India, South Africa and Canada. We conducted in-depth interviews and focus groups with respondents from different trial-related subsystems: civil society organization representatives, community advocates, service providers, clinical trialists/researchers, former trial participants, and key HIV risk populations. Interviews/focus groups were recorded, and coded using thematic content analysis. After intra-case analyses, we conducted cross-case analysis to contrast and synthesize themes and sub-themes across cases. Lastly, we applied the case study findings to explore and assess UNAIDS/AVAC GPP guidelines and the GPP Blueprint for Stakeholder Engagement. Results Across settings, we identified three cross-cutting themes as essential to community stakeholder engagement: trial literacy, including lexicon challenges and misconceptions that imperil sound communication; mistrust due to historical exploitation; and participatory processes: engaging early; considering the breadth of “community”; and, developing appropriate stakeholder roles. Site-specific challenges arose in resource-limited settings and settings where trials were halted. Conclusions This multiple case study revealed common themes underlying community stakeholder engagement across four country settings that largely mirror GPP goals and the GPP Blueprint, as well as highlighting challenges in the implementation of important guidelines. GPP guidance documents could be strengthened through greater focus on: identifying and addressing the community-specific roots of mistrust and its impact on trial literacy activities; achieving and evaluating representativeness in community stakeholder groups; and addressing the impact of power and funding streams on meaningful engagement and independent decision-making. PMID:26295159

Pan-Cancer Molecular Classes Transcending Tumor Lineage Across 32 Cancer Types, Multiple Data Platforms, and over 10,000 Cases.

PubMed

Chen, Fengju; Zhang, Yiqun; Gibbons, Don L; Deneen, Benjamin; Kwiatkowski, David J; Ittmann, Michael; Creighton, Chad J

2018-05-01

Purpose: The Cancer Genome Atlas data resources represent an opportunity to explore commonalities across cancer types involving multiple molecular levels, but tumor lineage and histology can represent a barrier in moving beyond differences related to cancer type. Experimental Design: On the basis of gene expression data, we classified 10,224 cancers, representing 32 major types, into 10 molecular-based "classes." Molecular patterns representing tissue or histologic dominant effects were first removed computationally, with the resulting classes representing emergent themes across tumor lineages. Results: Key differences involving mRNAs, miRNAs, proteins, and DNA methylation underscored the pan-cancer classes. One class expressing neuroendocrine and cancer-testis antigen markers represented ∼4% of cancers surveyed. Basal-like breast cancers segregated into an exclusive class, distinct from all other cancers. Immune checkpoint pathway markers and molecular signatures of immune infiltrates were most strongly manifested within a class representing ∼13% of cancers. Pathway-level differences involving hypoxia, NRF2-ARE, Wnt, and Notch were manifested in two additional classes enriched for mesenchymal markers and miR200 silencing. Conclusions: All pan-cancer molecular classes uncovered here, with the important exception of the basal-like breast cancer class, involve a wide range of cancer types and would facilitate understanding the molecular underpinnings of cancers beyond tissue-oriented domains. Numerous biological processes associated with cancer in the laboratory setting were found here to be coordinately manifested across large subsets of human cancers. The number of cancers manifesting features of neuroendocrine tumors may be much higher than previously thought, which disease is known to occur in many different tissues. Clin Cancer Res; 24(9); 2182-93. ©2018 AACR . ©2018 American Association for Cancer Research.

Idiom of distress or delusional state? Cultural clash as the cause of misdiagnosis: a case report.

PubMed

Ulman, Anne-Marie; Bar, Faina

2011-01-01

The Beta Israel (House of Israel) represent a total number of more than 100,000 individuals. Ethiopian Jewish culture is based on a tribal cultural model. With their arrival in Israel, many difficulties surfaced. Ethiopian Jews had to deal with cultural choices that challenged their traditions. It has been suggested that the trauma of their journey coupled to the difficulties of the adaptation process to Israeli society, ( the culture shock), was directly responsible for psychopathology found among this population. It also appeared that culture plays a central role in the construction of the clinical picture, blurring at times the boundary between expressions of distress and pathology. It became increasingly difficult to draw the line between culturally normative behavior and psychopathology. The following case report underlines the importance of socio cultural considerations in both staff and patients, and illustrates the dangers of misdiagnosis due to patient therapeutic team cultural clash. A 41 year old woman of Ethiopian origin was hospitalized for suspected schizophrenia. Because of the striking contrast between the patients behavior, responses and so called psychotic content, possible misunderstanding based on cultural differences was considered by the clinical management team. This case underlines the dangers of the psychiatric diagnostic process, emphasizes the important role of sociocultural backgrounds of both staff and patients in patient management and encourages the consideration of cultural factors in all patient evaluations.

[Prevention and control of infectious diseases from a disciplinary-law perspective].

PubMed

van Dijk, E Ivar; Dute, Jos C J; ten Ham, Peter B G

2015-01-01

To gain insight into the importance for medical disciplinary courts of the collective health interest in the prevention and control of infectious diseases. Descriptive retrospective study. The electronic databases of the Dutch government gazette (Staatscourant) and the Netherlands' medical disciplinary courts were searched for disciplinary court rulings on actions and negligence in the prevention and control of infectious diseases. We found 67 verdicts relevant to our subject in the period 1995-2013. Of these 67 disciplinary hearings, 12 were filed by the Netherlands' health inspectorate, 29 by the patient and 26 by a representative or next of kin. The defendants included 31 medical specialists, 12 dentists and 11 general practitioners. The disciplinary tribunal imposed measures in 23 cases, including 5 suspensions. In the case of serious infectious diseases the disciplinary courts decide that the caregiver also has to take into account the interests of other parties than caregiver and the patient. Medical microbiologists in hospitals should even go so far as to surrender their responsibility for general patient safety, if they are unable to comply with the applicable medical guideline. It is also striking that in questions of vaccination the disciplinary court judge is inclined to put a child's health interests before parental authority. One final striking point is that the health inspectorate plays an important role as complainant in disciplinary cases concerning prevention of infection.

Assessing the validity of using serious game technology to analyze physician decision making.

PubMed

Mohan, Deepika; Angus, Derek C; Ricketts, Daniel; Farris, Coreen; Fischhoff, Baruch; Rosengart, Matthew R; Yealy, Donald M; Barnato, Amber E

2014-01-01

Physician non-compliance with clinical practice guidelines remains a critical barrier to high quality care. Serious games (using gaming technology for serious purposes) have emerged as a method of studying physician decision making. However, little is known about their validity. We created a serious game and evaluated its construct validity. We used the decision context of trauma triage in the Emergency Department of non-trauma centers, given widely accepted guidelines that recommend the transfer of severely injured patients to trauma centers. We designed cases with the premise that the representativeness heuristic influences triage (i.e. physicians make transfer decisions based on archetypes of severely injured patients rather than guidelines). We randomized a convenience sample of emergency medicine physicians to a control or cognitive load arm, and compared performance (disposition decisions, number of orders entered, time spent per case). We hypothesized that cognitive load would increase the use of heuristics, increasing the transfer of representative cases and decreasing the transfer of non-representative cases. We recruited 209 physicians, of whom 168 (79%) began and 142 (68%) completed the task. Physicians transferred 31% of severely injured patients during the game, consistent with rates of transfer for severely injured patients in practice. They entered the same average number of orders in both arms (control (C): 10.9 [SD 4.8] vs. cognitive load (CL):10.7 [SD 5.6], p = 0.74), despite spending less time per case in the control arm (C: 9.7 [SD 7.1] vs. CL: 11.7 [SD 6.7] minutes, p<0.01). Physicians were equally likely to transfer representative cases in the two arms (C: 45% vs. CL: 34%, p = 0.20), but were more likely to transfer non-representative cases in the control arm (C: 38% vs. CL: 26%, p = 0.03). We found that physicians made decisions consistent with actual practice, that we could manipulate cognitive load, and that load increased the use of heuristics, as predicted by cognitive theory.

Extrusomes in ciliates: diversification, distribution, and phylogenetic implications.

PubMed

Rosati, Giovanna; Modeo, Letizia

2003-01-01

Exocytosis is, in all likelihood, an important communication method among microbes. Ciliates are highly differentiated and specialized micro-organisms for which versatile and/or sophisticated exocytotic organelles may represent important adaptive tools. Thus, in ciliates, we find a broad range of different extrusomes, i.e ejectable membrane-bound organelles. Structurally simple extrusomes, like mucocysts and cortical granules, are widespread in different taxa within the phylum. They play the roles in each case required for the ecological needs of the organisms. Then, we find a number of more elaborate extrusomes, whose distribution within the phylum is more limited, and in some way related to phylogenetic affinities. Herein we provide a survey of literature and our data on selected extrusomes in ciliates. Their morphology, distribution, and possible function are discussed. The possible phylogenetic implications of their diversity are considered.

Perceived Safety and Value of Inpatient "Very Important Person" Services.

PubMed

Allen-Dicker, Joshua; Auerbach, Andrew; Herzig, Shoshana J

2017-03-01

Providing care to "very important person" (VIP) patients can pose unique moral and value-based challenges for providers. No studies have examined VIP services in the inpatient setting. Through a multi-institutional survey of hospitalists, we assessed physician viewpoints and behavior surrounding the care of VIP patients. A significant proportion of respondents reported feeling pressured by patients, family members, and hospital representatives to provide unnecessary care to VIP patients. Based on self-reported perceptions, as well as case-based questions, we also found that the VIP status of a patient may impact physician clinical decision-making related to unnecessary medical care. Additional studies to quantify the use of VIP services and its effect on cost, resource availability, and patient-specific outcomes are needed. Journal of Hospital Medicine 2017;12:177-179. © 2017 Society of Hospital Medicine.

In Vitro Evaluation of Molecular Tumor Targets in Nuclear Medicine: Immunohistochemistry Is One Option, but Under Which Conditions?

PubMed

Reubi, Jean Claude

2017-12-01

The identification of new molecular targets for diagnostic and therapeutic applications using in vitro methods is an important challenge in nuclear medicine. One such method is immunohistochemistry, increasingly popular because it is easy to perform. This review presents the case for conducting receptor immunohistochemistry to evaluate potential molecular targets in human tumor tissue sections. The focus is on the immunohistochemistry of G-protein-coupled receptors, one of the largest families of cell surface proteins, representing a major class of drug targets and thus playing an important role in nuclear medicine. This review identifies common pitfalls and challenges and provides guidelines on performing such immunohistochemical studies. An appropriate validation of the target is a prerequisite for developing robust and informative new molecular probes. © 2017 by the Society of Nuclear Medicine and Molecular Imaging.

Roles of scholars in the practice of combating-desertification: a case study in northwest China.

PubMed

Yang, Lihua; Lan, Zhiyong; Wu, Jianguo

2010-08-01

This study investigated the perceived importance of scholars' participation in combating-desertification programs in northwest China and analyzed the underlying factors and mechanisms. Our results show that, while various experts, professors, and researchers have participated in combating-desertification programs, their actions were often not effective. Only those scholars who understood the local situations adequately had important and positive impacts. These scholars served as information brokers between the governments and other stakeholders, entrepreneurial activity organizers for farmers, governmental representatives, or advocators for local affairs themselves. They played indispensible roles in facilitating efforts in combating desertification. The study also identified key factors that led to the success of scholars' participation in combating-desertification activities. Our findings have practical implications for improving the effectiveness of scholars' participation in land restoration and environmental management.

Stochasticity and determinism in models of hematopoiesis.

PubMed

Kimmel, Marek

2014-01-01

This chapter represents a novel view of modeling in hematopoiesis, synthesizing both deterministic and stochastic approaches. Whereas the stochastic models work in situations where chance dominates, for example when the number of cells is small, or under random mutations, the deterministic models are more important for large-scale, normal hematopoiesis. New types of models are on the horizon. These models attempt to account for distributed environments such as hematopoietic niches and their impact on dynamics. Mixed effects of such structures and chance events are largely unknown and constitute both a challenge and promise for modeling. Our discussion is presented under the separate headings of deterministic and stochastic modeling; however, the connections between both are frequently mentioned. Four case studies are included to elucidate important examples. We also include a primer of deterministic and stochastic dynamics for the reader's use.

Potential pitfalls and methods of improving in utero diagnosis of transposition of the great arteries, including the baby bird's beak image.

PubMed

McGahan, John P; Moon-Grady, Anita J; Pahwa, Anokh; Towner, Dena; Rhee-Morris, Laila; Gerscovich, Eugenio O; Fogata, Maria

2007-11-01

The goal of this study was to analyze our recent experience with fetuses with transposition of the great arteries (TGA) to identify potential pitfalls and possible methods to better detect conotruncal anomalies such as TGA. We analyzed all nonreferral obstetric ultrasound examinations in which we performed basic, targeted, or formal fetal echocardiography with a newborn diagnosis of TGA. Nine neonates had TGA. Five of these cases were diagnosed prenatally, and 4 of these had complex congenital heart abnormalities. In these 4 cases, there were abnormalities in the cardiac axis (n = 3), abnormal valves or ventricular size (n = 2), and ventricular septal defects (n = 3) that were detected on the 4-chamber view of the heart. In all cases that were not detected prenatally, both prospective and retrospective reviews of the 4-chamber heart appeared normal. The prospective analyses of the outflow tracts were all interpreted as normal, whereas the retrospective review showed subtle abnormalities such as the "baby bird's beak" image. In review of these cases, there was failure to show the "crisscross" relationship of the outflow tracts. In 1 case, 5 short axis views of the heart, retrospectively showed the artery originating from the left ventricle and bifurcated, representing the pulmonary artery. Transposition of the great arteries may be associated with complex cardiac disease that could be detected on the 4-chamber view of the heart. When the 4-chamber view is normal, it is important to identify the crisscross relationship of the outflow tracts. If this is not done, it is important to document that the pulmonary artery bifurcates and originates from the right ventricle. Five short axis views of the heart may be helpful to detect conotruncal abnormalities.

Hospital-treated mental and behavioral disorders and risk of Alzheimer's disease: A nationwide nested case-control study.

PubMed

Tapiainen, V; Hartikainen, S; Taipale, H; Tiihonen, J; Tolppanen, A-M

2017-06-01

Studies investigating psychiatric disorders as Alzheimer's disease (AD) risk factors have yielded heterogeneous findings. Differences in time windows between the exposure and outcome could be one explanation. We examined whether (1) mental and behavioral disorders in general or (2) specific mental and behavioral disorder categories increase the risk of AD and (3) how the width of the time window between the exposure and outcome affects the results. A nationwide nested case-control study of all Finnish clinically verified AD cases, alive in 2005 and their age, sex and region of residence matched controls (n of case-control pairs 27,948). History of hospital-treated mental and behavioral disorders was available since 1972. Altogether 6.9% (n=1932) of the AD cases and 6.4% (n=1784) of controls had a history of any mental and behavioral disorder. Having any mental and behavioral disorder (adjusted OR=1.07, 95% CI=1.00-1.16) or depression/other mood disorder (adjusted OR=1.17, 95% CI=1.05-1.30) were associated with higher risk of AD with 5-year time window but not with 10-year time window (adjusted OR, 95% CI 0.99, 0.91-1.08 for any disorder and 1.08, 0.96-1.23 for depression). The associations between mental and behavioral disorders and AD were modest and dependent on the time window. Therefore, some of the disorders may represent misdiagnosed prodromal symptoms of AD, which underlines the importance of proper differential diagnostics among older persons. These findings also highlight the importance of appropriate time window in psychiatric and neuroepidemiology research. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Neglected Tropical Diseases in Sub-Saharan Africa: Review of Their Prevalence, Distribution, and Disease Burden

PubMed Central

Hotez, Peter J.; Kamath, Aruna

2009-01-01

The neglected tropical diseases (NTDs) are the most common conditions affecting the poorest 500 million people living in sub-Saharan Africa (SSA), and together produce a burden of disease that may be equivalent to up to one-half of SSA's malaria disease burden and more than double that caused by tuberculosis. Approximately 85% of the NTD disease burden results from helminth infections. Hookworm infection occurs in almost half of SSA's poorest people, including 40–50 million school-aged children and 7 million pregnant women in whom it is a leading cause of anemia. Schistosomiasis is the second most prevalent NTD after hookworm (192 million cases), accounting for 93% of the world's number of cases and possibly associated with increased horizontal transmission of HIV/AIDS. Lymphatic filariasis (46–51 million cases) and onchocerciasis (37 million cases) are also widespread in SSA, each disease representing a significant cause of disability and reduction in the region's agricultural productivity. There is a dearth of information on Africa's non-helminth NTDs. The protozoan infections, human African trypanosomiasis and visceral leishmaniasis, affect almost 100,000 people, primarily in areas of conflict in SSA where they cause high mortality, and where trachoma is the most prevalent bacterial NTD (30 million cases). However, there are little or no data on some very important protozoan infections, e.g., amebiasis and toxoplasmosis; bacterial infections, e.g., typhoid fever and non-typhoidal salmonellosis, the tick-borne bacterial zoonoses, and non-tuberculosis mycobaterial infections; and arboviral infections. Thus, the overall burden of Africa's NTDs may be severely underestimated. A full assessment is an important step for disease control priorities, particularly in Nigeria and the Democratic Republic of Congo, where the greatest number of NTDs may occur. PMID:19707588

Genetic and Clinical Features of Progranulin-Associated Frontotemporal Lobar Degeneration

PubMed Central

Chen-Plotkin, Alice S.; Martinez-Lage, Maria; Sleiman, Patrick M. A.; Hu, William; Greene, Robert; Wood, Elisabeth McCarty; Bing, Shaoxu; Grossman, Murray; Schellenberg, Gerard D.; Hatanpaa, Kimmo J.; Weiner, Myron F.; White, Charles L.; Brooks, William S.; Halliday, Glenda M.; Kril, Jillian J.; Gearing, Marla; Beach, Thomas G.; Graff-Radford, Neill R.; Dickson, Dennis W.; Rademakers, Rosa; Boeve, Bradley F.; Pickering-Brown, Stuart M.; Snowden, Julie; van Swieten, John C.; Heutink, Peter; Seelaar, Harro; Murrell, Jill R.; Ghetti, Bernardino; Spina, Salvatore; Grafman, Jordan; Kaye, Jeffrey A.; Woltjer, Randall L.; Mesulam, Marsel; Bigio, Eileen; Lladó, Albert; Miller, Bruce L.; Alzualde, Ainhoa; Moreno, Fermin; Rohrer, Jonathan D.; Mackenzie, Ian R. A.; Feldman, Howard H.; Hamilton, Ronald L.; Cruts, Marc; Engelborghs, Sebastiaan; De Deyn, Peter P.; Van Broeckhoven, Christine; Bird, Thomas D.; Cairns, Nigel J.; Goate, Allison; Frosch, Matthew P.; Riederer, Peter F.; Bogdanovic, Nenad; Lee, Virginia M. Y.; Trojanowski, John Q.; Van Deerlin, Vivianna M.

2011-01-01

Objective To assess the relative frequency of unique mutations and their associated characteristics in 97 individuals with mutations in progranulin (GRN), an important cause of frontotemporal lobar degeneration (FTLD). Participants and Design A 46-site International Frontotemporal Lobar Degeneration Collaboration was formed to collect cases of FTLD with TAR DNA-binding protein of 43-kDa (TDP-43)–positive inclusions (FTLD-TDP). We identified 97 individuals with FTLD-TDP with pathogenic GRN mutations (GRN+ FTLD-TDP), assessed their genetic and clinical characteristics, and compared them with 453 patients with FTLD-TDP in which GRN mutations were excluded (GRN− FTLD-TDP). No patients were known to be related. Neuropathologic characteristics were confirmed as FTLD-TDP in 79 of the 97 GRN+ FTLDTDP cases and all of the GRN− FTLD-TDP cases. Results Age at onset of FTLD was younger in patients with GRN+ FTLD-TDP vs GRN− FTLD-TDP (median, 58.0 vs 61.0 years; P<.001), as was age at death (median, 65.5 vs 69.0 years; P<.001). Concomitant motor neuron disease was much less common in GRN+ FTLDTDP vs GRN− FTLD-TDP (5.4% vs 26.3%; P<.001). Fifty different GRN mutations were observed, including 2 novel mutations: c.139delG (p.D47TfsX7) and c.378C>A (p.C126X). The 2 most common GRN mutations were c.1477C>T (p.R493X, found in 18 patients, representing 18.6% of GRN cases) and c.26C>A (p.A9D, found in 6 patients, representing 6.2% of cases). Patients with the c.1477C>T mutation shared a haplotype on chromosome 17; clinically, they resembled patients with other GRN mutations. Patients with the c.26C>A mutation appeared to have a younger age at onset of FTLD and at death and more parkinsonian features than those with other GRN mutations. Conclusion GRN+ FTLD-TDP differs in key features from GRN− FTLD-TDP. PMID:21482928

Structure-Specific Movement Patterns in Patients With Chronic Low Back Dysfunction Using Lumbar Combined Movement Examination.

PubMed

Monie, Aubrey P; Price, Roger I; Lind, Christopher R P; Singer, Kevin P

2017-06-01

A test-retest cohort study was conducted to assess the use of a novel computer-aided, combined movement examination (CME) to measure change in low back movement after pain management intervention in 17 cases of lumbar spondylosis. Additionally we desired to use a CME normal reference range (NRR) to compare and contrast movement patterns identified from 3 specific structural pathologic conditions: intervertebral disc, facet joint, and nerve root compression. Computer-aided CME was used before and after intervention, in a cohort study design, to record lumbar range of movement along with pain, disability, and health self-report questionnaires in 17 participants who received image-guided facet, epidural, and/or rhizotomy intervention. In the majority of cases, CME was reassessed after injection together with 2 serial self-reports after an average of 2 and 14 weeks. A minimal clinically important difference of 30% was used to interpret meaningful change in self-reports. A CME NRR (n = 159) was used for comparison with the 17 cases. Post hoc observation included subgrouping cases into 3 discrete pathologic conditions, intervertebral disc, facet dysfunction, and nerve root compression, in order to report intergroup differences in CME movement. Seven of the 17 participants stated that a "combined" movement was their most painful CME direction. Self-report outcome data indicated that 4 participants experienced significant improvement in health survey, 5 improved by ≥30% on low back function, and 8 reported that low back pain was more bothersome than stiffness, 6 of whom achieved the minimal clinically important difference for self-reported pain. Subgrouping of cases into structure-specific groups provided insight to different CME movement patterns. The use of CME assists in identifying atypical lumbar movement relative to an age and sex NRR. Data from this study, exemplified by representative case studies, provide preliminary evidence for distinct intervertebral disc, facet joint, and nerve root compression CME movement patterns in cases of chronic lumbar spondylosis. Copyright © 2017. Published by Elsevier Inc.

The long case and its modifications: a literature review.

PubMed

Ponnamperuma, Gominda G; Karunathilake, Indika M; McAleer, Sean; Davis, Margery H

2009-10-01

This review provides a summary of the published literature on the suitability of the long case and its modifications for high-stakes assessment. Databases related to medicine were searched for articles published from 2000 to 2008, using the keywords 'long case', 'clinical examinations' and 'clinical assessment'. Reference lists of review articles were hand-searched. Articles related to the objective structured clinical examination were eliminated. Research-based articles with hard data were given more emphasis in this review than those based on opinion. Eighteen articles were identified. The main disadvantage of the long case is its inability to sample the curriculum widely, resulting in low reliability. The main advantage of the long case is its ability to assess the candidate's overall (holistic) approach to the patient. Modifications to the long case attempt to: structure the format and the marking scheme; increase the number of examiners; observe the candidate's behaviour, and increase the number of cases. The long case is a traditional clinical examination format for the assessment of clinical competence and assessment at this level is important. The starting point for the majority of recent research on the long case has been an acceptance of its low reliability and modifications to the format have been proposed. Further evidence of the efficacy of these modifications is required, however, before they can be recommended for summative assessment. If further research is to be undertaken on the long case, it should focus on finding practicable ways of sampling the curriculum widely to increase reliability while maintaining the holistic approach towards the patient, which represents the attraction of the long case.

Foresight Study on the Risk Governance of New Technologies: The Case of Nanotechnology.

PubMed

Read, Sheona A K; Kass, Gary S; Sutcliffe, Hilary R; Hankin, Steven M

2016-05-01

Technology-led innovation represents an important driver of European economic and industrial competitiveness and offers solutions to societal challenges. In order to facilitate responsible innovation and public acceptance, a need exists to identify and implement oversight approaches focused on the effective risk governance of emerging technologies. This article describes a foresight study on the governance of new technologies, using nanotechnology as a case example. Following a mapping of the governance landscape, four plausible foresight scenarios were developed, capturing critical uncertainties for nanotechnology governance. Key governance elements were then stress tested within these scenarios to see how well they might perform in a range of possible futures and to inform identification of the strengths, weaknesses, opportunities, and threats for nanotechnology governance in Europe. Based on the study outcomes, recommendations are proposed regarding the development of governance associated with the responsible development of new technologies. © 2015 Society for Risk Analysis.

Changing axis deviation and paroxysmal atrial flutter associated with subclinical hyperthyroidism.

PubMed

Patanè, Salvatore; Marte, Filippo

2010-10-08

Subclinical hyperthyroidism is an increasingly recognized entity that is defined as a normal serum free thyroxine and free triiodothyronine levels with a thyroid-stimulating hormone level suppressed below the normal range and usually undetectable. It has been reported that subclinical hyperthyroidism is not associated with coronary heart disease or mortality from cardiovascular causes but it is sufficient to induce arrhythmias including atrial fibrillation and atrial flutter. It has also been reported that increased factor X activity in patients with subclinical hyperthyroidism represents a potential hypercoagulable state. Rarely, it has also been reported intermittent changing axis deviation during atrial fibrillation and during atrial flutter. We present a case of paroxysmal atrial flutter and changing axis deviation associated with subclinical hyperthyroidism, in a 76-year-old Italian man. Also this case focuses attention on the importance of a correct evaluation of subclinical hyperthyroidism. Copyright © 2008 Elsevier Ireland Ltd. All rights reserved.

Single oral paracoccidioidomycosis mimicking other lesions: report of eight cases.

PubMed

de Oliveira Gondak, Rogério; Mariano, Fernanda Viviane; dos Santos Silva, Alan Roger; Vargas, Pablo Agustin; Lopes, Márcio Ajudarte

2012-01-01

Paracoccidioidomycosis is a fungal infection caused by Paracoccidioides brasiliensis. It is an endemic disease, representing a serious health problem in Latin American countries. This infection primarily affects the lungs and is acquired by inhalation of the fungus. It can spread to other organs and tissues, mainly the oral cavity affecting more adult men from 30 to 50 years of age. On clinical presentation, several signs associated with impaired general and nutritional conditions can be noted. Oral manifestation is more common in the soft palate, gingiva, lower lip, buccal mucosa, and tongue. The classical clinical presentation is a superficial ulcer with granular appearance and hemorrhagic points. Usually, the oral lesion is extensive and generalized. Although uncommon, when the oral manifestation is single, others lesions, particularly squamous cell carcinoma, must be included in the differential diagnosis. In this article, the authors discuss the unusual presentation of eight cases of single oral paracoccidioidomycosis and its diagnostic importance.

Acute compartment syndrome caused by uncontrolled hypothyroidism.

PubMed

Modi, Anar; Amin, Hari; Salzman, Matthew; Morgan, Farah

2017-06-01

Acute compartment syndrome is increased tissue pressure exceeding perfusion pressure in a closed compartment resulting in nerve and muscle ischemia. Common precipitating causes are crush injuries, burns, substance abuse, osseous or vascular limb trauma. This is a case of 42year old female with history of hypothyroidism who presented to emergency room with acute onset of severe pain and swelling in right lower extremity. Physical examination was concerning for acute compartment syndrome of right leg which was confirmed by demonstration of elevated compartmental pressures. No precipitating causes were readily identified. Further laboratory testing revealed uncontrolled hypothyroidism. Management included emergent fasciotomy and initiating thyroid hormone replacement. This case represents a rare association between acute compartment syndrome and uncontrolled hypothyroidism. We also discuss the pathogenesis of compartment syndrome in hypothyroid patients and emphasize the importance of evaluating for less common causes, particularly in setting of non-traumatic compartment syndrome. Copyright © 2016 Elsevier Inc. All rights reserved.

An Adult Case of Bartter Syndrome Type III Presenting with Proteinuria

PubMed Central

Cha, Eun Jung; Hwang, Won Min; Yun, Sung-Ro; Park, Moon Hyang

2016-01-01

Bartter syndrome (BS) I–IV is a rare autosomal recessive disorder affecting salt reabsorption in the thick ascending limb of the loop of Henle. This report highlights clinicopathological findings and genetic studies of classic BS in a 22-year-old female patient who presented with persistent mild proteinuria for 2 years. A renal biopsy demonstrated a mild to moderate increase in the mesangial cells and matrix of most glomeruli, along with marked juxtaglomerular cell hyperplasia. These findings suggested BS associated with mild IgA nephropathy. Focal tubular atrophy, interstitial fibrosis, and lymphocytic infiltration were also observed. A genetic study of the patient and her parents revealed a mutation of the CLCNKB genes. The patient was diagnosed with BS, type III. This case represents an atypical presentation of classic BS in an adult patient. Pathologic findings of renal biopsy combined with genetic analysis and clinicolaboratory findings are important in making an accurate diagnosis. PMID:26755355

An Adult Case of Bartter Syndrome Type III Presenting with Proteinuria.

PubMed

Cha, Eun Jung; Hwang, Won Min; Yun, Sung-Ro; Park, Moon Hyang

2016-03-01

Bartter syndrome (BS) I-IV is a rare autosomal recessive disorder affecting salt reabsorption in the thick ascending limb of the loop of Henle. This report highlights clinicopathological findings and genetic studies of classic BS in a 22-year-old female patient who presented with persistent mild proteinuria for 2 years. A renal biopsy demonstrated a mild to moderate increase in the mesangial cells and matrix of most glomeruli, along with marked juxtaglomerular cell hyperplasia. These findings suggested BS associated with mild IgA nephropathy. Focal tubular atrophy, interstitial fibrosis, and lymphocytic infiltration were also observed. A genetic study of the patient and her parents revealed a mutation of the CLCNKB genes. The patient was diagnosed with BS, type III. This case represents an atypical presentation of classic BS in an adult patient. Pathologic findings of renal biopsy combined with genetic analysis and clinicolaboratory findings are important in making an accurate diagnosis.

Recurrent short rib polydactyly syndrome.

PubMed

Eleftheriades, M; Iavazzo, C; Manolakos, E; Hassiakos, D; Botsis, D; Petersen, M; Konstantinidou, A

2013-01-01

We present three consecutive cases of skeletal dysplasias of a non-consanguineous couple with five pregnancies. The diagnosis of short-rib polydactyly syndrome (SRPS) was feasible by ultrasound during the 1st trimester of pregnancy. SRPS represents a heterogeneous group of lethal skeletal dysplasias. It is characterised by short limb dwarfism complicated by thoracic hypoplasia, polydactyly and different anomalies of major organs such as congenital heart defects and renal dysplasia. Four major types of the SRPS have been described: type I (Saldino-Noonan); type II (Majewski); type III (Verma-Naumoff) and type IV (Beemar-Langer). However, there is phenotypic overlapping between four types and with those of non-lethal skeletal dysplasias (i.e. Ellis-van Creveld syndrome and Jeune syndrome). Our cases show the importance of the nuchal translucency (NT) scan that offers the opportunity to examine fetal anatomy in the 1st trimester and diagnose rare skeletal abnormalities early in pregnancy.

Vaginal metastasis presenting as postmenopausal bleeding.

PubMed

Ng, Qiu Ju; Namuduri, Rama Padma; Yam, Kwai Lam; Lim-Tan, Soo Kim

2015-08-01

Vaginal cancer is rare worldwide and represents 2% of all gynaecological cancers in Singapore. Primary vaginal malignancies are rare and vaginal metastases constitute the majority of vaginal malignancies. Most of these metastases arise from the cervix, endometrium or ovary, although they can also metastasise from distant sites such as the colon, breast and pancreas. We report a rare case of vaginal metastasis in a patient with previous gastric and rectal adenocarcinomas. An 89-year-old woman with a history of gastric and rectal malignancy presented with postmenopausal bleeding. A 2-cm vaginal tumour at the introitus was discovered upon examination. This case demonstrates the importance of performing a gynaecological examination during follow-up for patients with a history of malignancy. The prognosis for vaginal metastasis is poor, as it is often associated with disseminated disease. Depending on the extent of the lesions, radiotherapy or surgery can be considered.

Hemichorea-hemiballismus as an initial manifestation in a Moroccan patient with acquired immunodeficiency syndrome and toxoplasma infection: a case report and review of the literature

PubMed Central

Rabhi, Samira; Amrani, Kawthar; Maaroufi, Mustapha; Khammar, Zineb; Khibri, Hajar; Ouazzani, Maha; Berrady, Rhizlane; Tizniti, Siham; Messouak, Ouafae; Belahsen, Faouzy; Bono, Wafaa

2011-01-01

Neurologic signs and symptoms may represent the initial presentation of AIDS in 10-30% of patients. Movement disorders may be the result of direct central nervous system infection by human immunodeficiency virus (HIV) or the result of opportunistic infections. We report the case of a 59 years old woman who had hemichorea-hemiballismus subsequently found to be secondary to a cerebral toxoplasmosis infection revealing HIV infection. Movement disorders, headache and nausea were resolved after two weeks of antitoxoplasmic treatment. Brain MRI control showed a marked resolution of cerebral lesion. Occurrence of hemichorea-ballismus in patient without familial history of movement disorders suggests a diagnosis of AIDS and in particular the diagnosis of secondary cerebral toxoplasmosis. Early recognition is important since it is a treatable entity. PMID:22187591

Constructing networks with correlation maximization methods.

PubMed

Mellor, Joseph C; Wu, Jie; Delisi, Charles

2004-01-01

Problems of inference in systems biology are ideally reduced to formulations which can efficiently represent the features of interest. In the case of predicting gene regulation and pathway networks, an important feature which describes connected genes and proteins is the relationship between active and inactive forms, i.e. between the "on" and "off" states of the components. While not optimal at the limits of resolution, these logical relationships between discrete states can often yield good approximations of the behavior in larger complex systems, where exact representation of measurement relationships may be intractable. We explore techniques for extracting binary state variables from measurement of gene expression, and go on to describe robust measures for statistical significance and information that can be applied to many such types of data. We show how statistical strength and information are equivalent criteria in limiting cases, and demonstrate the application of these measures to simple systems of gene regulation.

Comparing Visual and Statistical Analysis of Multiple Baseline Design Graphs.

PubMed

Wolfe, Katie; Dickenson, Tammiee S; Miller, Bridget; McGrath, Kathleen V

2018-04-01

A growing number of statistical analyses are being developed for single-case research. One important factor in evaluating these methods is the extent to which each corresponds to visual analysis. Few studies have compared statistical and visual analysis, and information about more recently developed statistics is scarce. Therefore, our purpose was to evaluate the agreement between visual analysis and four statistical analyses: improvement rate difference (IRD); Tau-U; Hedges, Pustejovsky, Shadish (HPS) effect size; and between-case standardized mean difference (BC-SMD). Results indicate that IRD and BC-SMD had the strongest overall agreement with visual analysis. Although Tau-U had strong agreement with visual analysis on raw values, it had poorer agreement when those values were dichotomized to represent the presence or absence of a functional relation. Overall, visual analysis appeared to be more conservative than statistical analysis, but further research is needed to evaluate the nature of these disagreements.

High on Cannabis and Calcineurin Inhibitors: A Word of Warning in an Era of Legalized Marijuana.

PubMed

Hauser, Naomi; Sahai, Tanmay; Richards, Rocco; Roberts, Todd

2016-01-01

Tacrolimus, a potent immunosuppressant medication, acts by inhibiting calcineurin, which eventually leads to inhibition of T-cell activation. The drug is commonly used to prevent graft rejection in solid organ transplant and graft-versus-host disease in hematopoietic stem cell transplant patients. Tacrolimus has a narrow therapeutic index with variable oral bioavailability and metabolism via cytochrome P-450 3A enzyme. Toxicity can occur from overdosing or from drug-drug interactions with the simultaneous administration of cytochrome P-450 3A inhibitors and possibly P-glycoprotein inhibitors. Tacrolimus toxicity can be severe and may include multiorgan damage. We present a case of suspected tacrolimus toxicity in a postallogeneic hematopoietic stem cell transplant patient who was concurrently using oral marijuana. This case represents an important and growing clinical scenario with the increasing legalization and use of marijuana throughout the United States.

Endoport-Assisted Microsurgical Treatment of a Ruptured Periventricular Aneurysm

PubMed Central

Chen, Ching-Jen; Caruso, James; Buell, Thomas; Crowley, R. Webster; Liu, Kenneth C.

2016-01-01

Background and Importance. Ruptured periventricular aneurysms in patients with moyamoya disease represent challenging pathologies. The most common methods of treatment include endovascular embolization and microsurgical clipping. However, rare cases arise in which the location and anatomy of the aneurysm make these treatment modalities particularly challenging. Clinical Presentation. We report a case of a 34-year-old female with moyamoya disease who presented with intraventricular hemorrhage. CT angiography and digital subtraction angiography revealed an aneurysm located in the wall of the atrium of the right lateral ventricle. Distal endovascular access was not possible, and embolization risked the sacrifice of arteries supplying critical brain parenchyma. Using the BrainPath endoport system, the aneurysm was able to be accessed. Since the fusiform architecture of the aneurysm prevented clip placement, the aneurysm was ligated with electrocautery. Conclusion. We demonstrate the feasibility of endoport-assisted approach for minimally invasive access and treatment of uncommon, distally located aneurysms. PMID:27195160

Mapping Indigenous land management for threatened species conservation: An Australian case-study.

PubMed

Renwick, Anna R; Robinson, Catherine J; Garnett, Stephen T; Leiper, Ian; Possingham, Hugh P; Carwardine, Josie

2017-01-01

Much biodiversity lives on lands to which Indigenous people retain strong legal and management rights. However this is rarely quantified. Here we provide the first quantitative overview of the importance of Indigenous land for a critical and vulnerable part of biodiversity, threatened species, using the continent of Australia as a case study. We find that three quarters of Australia's 272 terrestrial or freshwater vertebrate species listed as threatened under national legislation have projected ranges that overlap Indigenous lands. On average this overlap represents 45% of the range of each threatened species while Indigenous land is 52% of the country. Hotspots where multiple threatened species ranges overlap occur predominantly in coastal Northern Australia. Our analysis quantifies the vast potential of Indigenous land in Australia for contributing to national level conservation goals, and identifies the main land management arrangements available to Indigenous people which may enable them to deliver those goals should they choose to do so.

Posterior reversible encephalopathy syndrome: a case of unusual diffusion-weighted MR images.

PubMed

Benziada-Boudour, A; Schmitt, E; Kremer, S; Foscolo, S; Rivière, A-S; Tisserand, M; Boudour, A; Bracard, S

2009-05-01

Posterior reversible encephalopathy (PRES) represents an uncommon entity related to multiple pathologies, the most common of which is hypertensive crisis. PRES is classically characterized as symmetrical parieto-occipital edema, but may affect other areas of the brain. Diffusion-weighted magnetic resonance imaging (DWI) is important for differentiating between vasogenic and cytotoxic edema. We present here the case of a 43-year-old woman, known to suffer from arterial hypertension and severe renal failure, who developed PRES with restricted apparent diffusion coefficients (ADC) in various cerebral areas, suggesting irreversible tissue damage. Nevertheless, follow-up cranial MRI revealed complete remission, indicating that restricted diffusion does not always lead to cell death in this pathology. The underlying pathophysiological mechanism is not well understood. Such reversibility of diffusion anomalies has already been reported with transient ischemia, vasospasm after subarachnoid hemorrhage and epilepsy but, to our knowledge, never before in PRES.

Intragenomic spread of plastid-targeting presequences in the coccolithophore Emiliania huxleyi.

PubMed

Burki, Fabien; Hirakawa, Yoshihisa; Keeling, Patrick J

2012-09-01

Nucleus-encoded plastid-targeted proteins of photosynthetic organisms are generally equipped with an N-terminal presequence required for crossing the plastid membranes. The acquisition of these presequences played a fundamental role in the establishment of plastids. Here, we report a unique case of two non-homologous proteins possessing completely identical presequences consisting of a bipartite plastid-targeting signal in the coccolithophore Emiliania huxleyi. We further show that this presequence is highly conserved in five additional proteins that did not originally function in plastids, representing de novo plastid acquisitions. These are among the most recent cases of presequence spreading from gene to gene and shed light on important evolutionary processes that have been usually erased by the ancient history of plastid evolution. We propose a mechanism of acquisition involving genomic duplications and gene replacement through non-homologous recombination that may have played a more general role for equipping proteins with targeting information.

The Contribution of Mathematical Modeling to Understanding Dynamic Aspects of Rumen Metabolism

PubMed Central

Bannink, André; van Lingen, Henk J.; Ellis, Jennifer L.; France, James; Dijkstra, Jan

2016-01-01

All mechanistic rumen models cover the main drivers of variation in rumen function, which are feed intake, the differences between feedstuffs and feeds in their intrinsic rumen degradation characteristics, and fractional outflow rate of fluid and particulate matter. Dynamic modeling approaches are best suited to the prediction of more nuanced responses in rumen metabolism, and represent the dynamics of the interactions between substrates and micro-organisms and inter-microbial interactions. The concepts of dynamics are discussed for the case of rumen starch digestion as influenced by starch intake rate and frequency of feed intake, and for the case of fermentation of fiber in the large intestine. Adding representations of new functional classes of micro-organisms (i.e., with new characteristics from the perspective of whole rumen function) in rumen models only delivers new insights if complemented by the dynamics of their interactions with other functional classes. Rumen fermentation conditions have to be represented due to their profound impact on the dynamics of substrate degradation and microbial metabolism. Although the importance of rumen pH is generally acknowledged, more emphasis is needed on predicting its variation as well as variation in the processes that underlie rumen fluid dynamics. The rumen wall has an important role in adapting to rapid changes in the rumen environment, clearing of volatile fatty acids (VFA), and maintaining rumen pH within limits. Dynamics of rumen wall epithelia and their role in VFA absorption needs to be better represented in models that aim to predict rumen responses across nutritional or physiological states. For a detailed prediction of rumen N balance there is merit in a dynamic modeling approach compared to the static approaches adopted in current protein evaluation systems. Improvement is needed on previous attempts to predict rumen VFA profiles, and this should be pursued by introducing factors that relate more to microbial metabolism. For rumen model construction, data on rumen microbiomes are preferably coupled with knowledge consolidated in rumen models instead of relying on correlations with rather general aspects of treatment or animal. This helps to prevent the disregard of basic principles and underlying mechanisms of whole rumen function. PMID:27933039

A new spiral dental implant: a tool for oral rehabilitation of difficult cases

PubMed Central

BALAN, I.; CALCATERRA, R.; LAURITANO, D.; GRECCHI, E.; CARINCI, F.

2017-01-01

SUMMARY Spiral dental implant (SDI) is an implant with a conical internal helix that confers the characteristic of self-drilling, self-tapping, and self-bone condensing. These proprieties offer better control during insertion of SDI giving a high primary stabilization, even in poor quality bone. A shorter diameter of SDI results in reduced drilling during insertion and consequently less trauma and minimal bone loss. To address the research purpose, the investigators designed a retrospective cohort study. The study population was composed of 25 patients, 11 males and 14 females that have been treated by Dr. Balan with 187 SDI positioned in mandible and into maxilla bone. The implants were placed during the years 2013 to 2014 in Dr. Balan clinic. All patients underwent the same surgical protocol. Several variables are investigated: demographic (age and gender), anatomic (upper/lower jaws and tooth site), implant (length and diameter and type) variables, edentulism (partial or total), and comorbid status of health (i.e.: hypothyroidism, parodontitis, hypertension, diabetes, presence of cancer, heart disease, hepatitis and rheumatologic disease). Pearson Chi-Square test was used to investigate variables and p < 0.05 was considered statistically significant. Statistically it has been shown that females have a higher possibility of unsuccessful respect of male, with a “p value” of 0.014. Another important impact factor for success of implant insertion has been represented by concomitants pathologies: cancer represents the most negative high factor risk with a percentage of unsuccessful of 50%, followed by heart disease (15%), and diabetes (3.7%). SDIs are reliable tools for difficult cases of oral rehabilitation. They have a higher success and survival rate, which means stable results over time. No differences were detected among SDI lengths, implant/crown ratio. In addition, the insertion of SDIs in banked bone can be performed without adverse effects. Finally, flapless and computer tomography-planned surgery does not significantly increase the clinical outcome of SDIs in complex rehabilitation. Cancer represents the most important variable to consider when a patient wants to do oral rehabilitation because of its high risk of unsuccessful. PMID:29285328

A new spiral dental implant: a tool for oral rehabilitation of difficult cases.

PubMed

Balan, I; Calcaterra, R; Lauritano, D; Grecchi, E; Carinci, F

2017-01-01

Spiral dental implant (SDI) is an implant with a conical internal helix that confers the characteristic of self-drilling, self-tapping, and self-bone condensing. These proprieties offer better control during insertion of SDI giving a high primary stabilization, even in poor quality bone. A shorter diameter of SDI results in reduced drilling during insertion and consequently less trauma and minimal bone loss. To address the research purpose, the investigators designed a retrospective cohort study. The study population was composed of 25 patients, 11 males and 14 females that have been treated by Dr. Balan with 187 SDI positioned in mandible and into maxilla bone. The implants were placed during the years 2013 to 2014 in Dr. Balan clinic. All patients underwent the same surgical protocol. Several variables are investigated: demographic (age and gender), anatomic (upper/lower jaws and tooth site), implant (length and diameter and type) variables, edentulism (partial or total), and comorbid status of health (i.e.: hypothyroidism, parodontitis, hypertension, diabetes, presence of cancer, heart disease, hepatitis and rheumatologic disease). Pearson Chi-Square test was used to investigate variables and p < 0.05 was considered statistically significant. Statistically it has been shown that females have a higher possibility of unsuccessful respect of male, with a "p value" of 0.014. Another important impact factor for success of implant insertion has been represented by concomitants pathologies: cancer represents the most negative high factor risk with a percentage of unsuccessful of 50%, followed by heart disease (15%), and diabetes (3.7%). SDIs are reliable tools for difficult cases of oral rehabilitation. They have a higher success and survival rate, which means stable results over time. No differences were detected among SDI lengths, implant/crown ratio. In addition, the insertion of SDIs in banked bone can be performed without adverse effects. Finally, flapless and computer tomography-planned surgery does not significantly increase the clinical outcome of SDIs in complex rehabilitation. Cancer represents the most important variable to consider when a patient wants to do oral rehabilitation because of its high risk of unsuccessful.

MATRIX-VBS Condensing Organic Aerosols in an Aerosol Microphysics Model

NASA Technical Reports Server (NTRS)

Gao, Chloe Y.; Tsigaridis, Konstas; Bauer, Susanne E.

2015-01-01

The condensation of organic aerosols is represented in a newly developed box-model scheme, where its effect on the growth and composition of particles are examined. We implemented the volatility-basis set (VBS) framework into the aerosol mixing state resolving microphysical scheme Multiconfiguration Aerosol TRacker of mIXing state (MATRIX). This new scheme is unique and advances the representation of organic aerosols in models in that, contrary to the traditional treatment of organic aerosols as non-volatile in most climate models and in the original version of MATRIX, this new scheme treats them as semi-volatile. Such treatment is important because low-volatility organics contribute significantly to the growth of particles. The new scheme includes several classes of semi-volatile organic compounds from the VBS framework that can partition among aerosol populations in MATRIX, thus representing the growth of particles via condensation of low volatility organic vapors. Results from test cases representing Mexico City and a Finish forrest condistions show good representation of the time evolutions of concentration for VBS species in the gas phase and in the condensed particulate phase. Emitted semi-volatile primary organic aerosols evaporate almost completely in the high volatile range, and they condense more efficiently in the low volatility range.

Workforce ethnic diversity and culturally competent health care: the case of Arab physicians in Israel.

PubMed

Popper-Giveon, Ariela; Liberman, Ido; Keshet, Yael

2014-01-01

In recent years, a growing body of literature has been calling for ethnic diversity in health systems, especially in multicultural contexts. Ethnic diversity within the health care workforce is considered to play an important role in reducing health disparities among different ethnic groups. The present study explores the topic using quantitative data on participation of Arab employees in the Israeli health system and qualitative data collected through semi-structured interviews with Arab physicians working in the predominantly Jewish Israeli health system. We show that despite the underrepresentation of Arabs in the Israeli health system, Arab physicians who hold positions in Israeli hospitals do not perceive themselves as representatives of the Arab sector; moreover, they consider themselves as having broken through the 'glass ceiling' and reject stereotyping as Arab 'niche doctors.' We conclude that minority physicians may prefer to promote culturally competent health care through integration and advocacy of interaction with the different cultures represented in the population, rather than serving as representatives of their own ethnic minority population. These findings may concern various medical contexts in which issues of ethnic underrepresentation in the health system are relevant, as well as sociological contexts, especially those regarding minority populations and professions.

Clinical perspective: creating an effective practice peer review process-a primer.

PubMed

Gandhi, Manisha; Louis, Frances S; Wilson, Shae H; Clark, Steven L

2017-03-01

Peer review serves as an important adjunct to other hospital quality and safety programs. Despite its importance, the available literature contains virtually no guidance regarding the structure and function of effective peer review committees. This Clinical Perspective provides a summary of the purposes, structure, and functioning of effective peer review committees. We also discuss important legal considerations that are a necessary component of such processes. This discussion includes useful templates for case selection and review. Proper committee structure, membership, work flow, and leadership as well as close cooperation with the hospital medical executive committee and legal representatives are essential to any effective peer review process. A thoughtful, fair, systematic, and organized approach to creating a peer review process will lead to confidence in the committee by providers, hospital leadership, and patients. If properly constructed, such committees may also assist in monitoring and enforcing compliance with departmental protocols, thus reducing harm and promoting high-quality practice. Copyright © 2016 Elsevier Inc. All rights reserved.

A credit policy approach in a two-warehouse inventory model for deteriorating items with price- and stock-dependent demand under partial backlogging

NASA Astrophysics Data System (ADS)

Panda, Gobinda Chandra; Khan, Md. Al-Amin; Shaikh, Ali Akbar

2018-04-01

Advertisement of the product is an important factor in inventory analysis. Also, price and stock have an important role to attract more customers in the competitive business situations. Trade credit policy is another important role in inventory analysis. We have combined these three factors together in a two-warehouse inventory model and represented it mathematically. In addition, we have added deteriorating factor of our proposed problem with price- and stock-dependent demand under partial backlogged shortage and solved. The frequency of advertisement is considered constant for a year in this paper. The proposed model is highly nonlinear in nature. Due to highly nonlinearity, we could not find the closed form solution. In this paper, trade credit facility is taken in the perspective of retailer, and all the possible cases and subcases of the model are discussed and solved using lingo 10.0 software. The results of sensitivity analysis prove the effectiveness of the proposed model.

SAPHO Syndrome – A Pictorial Assay

PubMed Central

Khanna, Lokesh; El-khoury, Georges Y.

2012-01-01

SAPHO (synovitis, acne, pustulosis, hyperostosis and osteitis) syndrome is a distinct clinical entity representing involvement of the musculoskeletal and dermatologic systems. It is well known to rheumatologists because of characteristic skin manifestations and polyarthropathy. However, few reports exist in the orthopaedic literature. It is important to be aware of sAPHO syndrome as it can mimic some of the more common disease entities such as infection, tumor, and other inflammatory arthropathies. Anterior chest wall pain centered at sternoclavicular and sternocostal joints is an important and characteristic clinical finding which can point to its diagnosis. A patient may undergo different diagnostic tests and invasive procedures such as biopsies before a diagnosis is made. Imaging can be helpful by offering a detailed evaluation of the abnormalities. More importantly it helps in revealing subclinical foci of involvement due to the polyostotic nature of the disease. The treatment is mostly nonsurgical. NSAIDS are the first line agents. However multiple new agents are being used for refractory cases. Surgery is reserved to treat complications. PMID:23576940

The Force Exerted by the Membrane Potential During Protein Import into the Mitochondrial Matrix

NASA Technical Reports Server (NTRS)

Shariff, Karim; Ghosal, Sandip; Matouschek, Andreas

2002-01-01

The electrostatic force exerted on a targeting sequence by the electrical potential across the inner mitochondrial membrane is calculated and found to vary from 1.4 pN to 2.2 pN (per unit elementary charge) as the radius of the inner membrane pore (assumed aqueous) is varied from 12 to 6.5 Angstroms, its measured range. Since the pore is not very much wider than the distance between water molecules, the full shielding effect of water may not be present; the extreme case of a nonaqueous pore gives a force of 3.1 pN per unit charge, which represents an upper limit. When applied to mitochondrial import experiments on the protein harness, these results imply that a force of 11 plus or minus 4 pN is sufficient to catalyze the unfolding of harness during import. Comparison of these results with unfolding forces measured using atomic force microscopy suggests that the two are not inconsistent.

[Special aspects of food allergy in children].

PubMed

Niggemann, B

2012-04-01

IgE-mediated allergic reactions to foods represent the earliest and most important manifestation of allergic diseases in childhood. Sensitization to foods may happen very early in life. Basic options for alimentary allergy prevention are breast-feeding of at least 4 months and in case nursing is impossible, use of an alternative hypoallergenic formula. The most common food allergens in childhood are cow's milk, hen's egg, peanuts, tree nuts and wheat. The prevalence of food allergies in childhood is 2 to 6%. In up to 50% of infants and children with atopic eczema, food allergies play a role; vice versa 95% of children with an IgE-mediated food allergy have atopic eczema as an underlying disease. Diagnostic reliability in suspected allergic reactions to food is only achieved in most cases by performing controlled oral food challenges. The long-term prognosis is good for cow's milk and hen's egg allergy, while peanut and tree nut allergies often last life-long. The most important therapeutic option is a specific elimination diet; especially in infancy, a nutritionally adequate substitution diet has to be considered. Children who might inadvertently get into contact with their potentially life threatening food allergen, should be provided with an epinephrine autoinjector.

Implant bone integration importance in forensic identification.

PubMed

De Angelis, Danilo; Cattaneo, Cristina

2015-03-01

Odontological identification consists of the comparison of antemortem dental information regarding a missing person with postmortem data from an unidentified corpse or human remains. Usually, the comparison concerns morphologic features that the operator chooses among all the visible characteristics because of inter-individual uniqueness; for this reason, implants can be of enormous assistance. A case concerning the recovery of a burnt oral implant, connected to a bone fragment, among 2780 charred bone fragments, suspected to have belonged to a victim of homicide, is presented to demonstrate that dental implants and their site of bone integration represent a very precious element for personal forensic identification. Because of their morphological invariability in time and because of their morphologic uniqueness, they were used as evidence to associate unidentified human charred remains to a missing person where DNA analysis failed to do so. The case illustrates the fundamental contribution, not yet described in literature, given by the clinical aspects of tooth replacement with dental implants to a forensic discipline. Clinical practitioners should therefore be aware of the great importance of their work and of dental records in a forensic identification scenario. © 2014 American Academy of Forensic Sciences.

Space Technology: A study of the significance of recognition for innovators of spinoff technologies. A case study on the impact of the space technology hall of fame award

NASA Technical Reports Server (NTRS)

1993-01-01

This report represents the preliminary effort in studying the significance of recognition for innovators of spinoff technologies. The purpose of this initial year's effort in this area was to gather preliminary data and define the direction for the remainder of the research. This report focuses on the most recent recipients of the Hall of Fame Award, the developers of liquid-cooled garments. Liquid-cooled garments technology and its spinoffs were used as a case study to define and explore the factors involved in technology transfer and to consider the possible incentives in developing commercial applications including the Hall of Fame Award. Through interviews, views of award recipients were obtained on factors encouraging spinoffs as well as impediments to spinoffs. The researchers observed complex inter-relationships among the significant entities (government, individuals, large and small business), the importance of people, the importance of resource availability, and the significance of intrinsic motivation; drew preliminary conclusions pertaining to the direct and indirect influence of recognition like the Hall of Fame Award; and planned the direction for next year's follow-on research.

Social and economic impacts of carbon sequestration and land use change on peasant households in rural China: a case study of Liping, Guizhou Province.

PubMed

Xu, W; Yin, Y; Zhou, S

2007-11-01

Numerous innovative approaches to mitigate effects of excessive emission of greenhouse gases (GHGs) on global climate change are being proposed and formulated. Sequestering carbon to terrestrial ecosystems represents one of the important clean development mechanisms. Reforestation through converting various non-forest lands to forests is undoubtedly an important dimension of carbon sequestration. Using Liping County in Guizhou Province as a case region, this study examines the perceived change in social and economic livelihoods of peasants and the factors responsible for the variations in the changes. The results of the study reveal that socio-economic changes associated with the government-financed project are multifaceted and profound. Because of the financial subsidies provided by the central government, this environmental action in many aspects can be regarded as a poverty reduction measure in the underdeveloped area where rural poverty is widespread. A majority of peasant households have benefited from project participation. The land conversion project with continued financial support also contributes to the social transformations of traditional rural society in remote areas to a more mobile, less subsistence agriculture-based, and open society.

[Seasonal flu vaccination for older people: Evaluation of the adjuvanted vaccine. Positioning report].

PubMed

López Mongil, Rosa; López Trigo, José Antonio; Mariano Lázaro, Alberto; Mato Chaín, Gloria; Ramos Cordero, Primitivo; Salleras Sanmartí, Luis

2017-11-01

Flu is a major public health problem, particularly for older people, and creates an important clinical and economic burden. A high mortality rate was reported in Spain during the period 2015 to 2016; 3,101 serious cases were hospitalised with a confirmed diagnosis of flu, of which 11% died (352 cases). Furthermore, financial and health costs are greatly increased by the complications of flu; people aged over 65 years represent approximately 64% of the total costs. Seasonal flu vaccination is the fundamental strategy, as demonstrated by cost-benefit and cost-effectiveness studies. A priority objective is to improve the vaccine's immune response and the search for and inclusion of adjuvants and immunostimulants in vaccines is a major line of research. This positioning report evaluates vaccination for older people and the importance of the adjuvanted vaccine in the elderly in strengthening immunogenicity, by means of a critical review of the literature based on the best evidence available on its immunogenicity and effectiveness, and an economic assessment. Copyright © 2017 Sociedad Española de Geriatría y Gerontología. Publicado por Elsevier España, S.L.U. All rights reserved.

Intratumoral heterogeneity identified at the epigenetic, genetic and transcriptional level in glioblastoma.

PubMed

Parker, Nicole R; Hudson, Amanda L; Khong, Peter; Parkinson, Jonathon F; Dwight, Trisha; Ikin, Rowan J; Zhu, Ying; Cheng, Zhangkai Jason; Vafaee, Fatemeh; Chen, Jason; Wheeler, Helen R; Howell, Viive M

2016-03-04

Heterogeneity is a hallmark of glioblastoma with intratumoral heterogeneity contributing to variability in responses and resistance to standard treatments. Promoter methylation status of the DNA repair enzyme O(6)-methylguanine DNA methyltransferase (MGMT) is the most important clinical biomarker in glioblastoma, predicting for therapeutic response. However, it does not always correlate with response. This may be due to intratumoral heterogeneity, with a single biopsy unlikely to represent the entire lesion. Aberrations in other DNA repair mechanisms may also contribute. This study investigated intratumoral heterogeneity in multiple glioblastoma tumors with a particular focus on the DNA repair pathways. Transcriptional intratumoral heterogeneity was identified in 40% of cases with variability in MGMT methylation status found in 14% of cases. As well as identifying intratumoral heterogeneity at the transcriptional and epigenetic levels, targeted next generation sequencing identified between 1 and 37 unique sequence variants per specimen. In-silico tools were then able to identify deleterious variants in both the base excision repair and the mismatch repair pathways that may contribute to therapeutic response. As these pathways have roles in temozolomide response, these findings may confound patient management and highlight the importance of assessing multiple tumor biopsies.

Numerical operator calculus in higher dimensions

PubMed Central

Beylkin, Gregory; Mohlenkamp, Martin J.

2002-01-01

When an algorithm in dimension one is extended to dimension d, in nearly every case its computational cost is taken to the power d. This fundamental difficulty is the single greatest impediment to solving many important problems and has been dubbed the curse of dimensionality. For numerical analysis in dimension d, we propose to use a representation for vectors and matrices that generalizes separation of variables while allowing controlled accuracy. Basic linear algebra operations can be performed in this representation using one-dimensional operations, thus bypassing the exponential scaling with respect to the dimension. Although not all operators and algorithms may be compatible with this representation, we believe that many of the most important ones are. We prove that the multiparticle Schrödinger operator, as well as the inverse Laplacian, can be represented very efficiently in this form. We give numerical evidence to support the conjecture that eigenfunctions inherit this property by computing the ground-state eigenfunction for a simplified Schrödinger operator with 30 particles. We conjecture and provide numerical evidence that functions of operators inherit this property, in which case numerical operator calculus in higher dimensions becomes feasible. PMID:12140360

Immunitary bioeconomy: the economisation of life in the international cord blood market.

PubMed

Brown, Nik; Machin, Laura; McLeod, Danae

2011-04-01

This paper examines an emerging bioeconomy centred on the international banking and trade in cord blood. Since the late 1980s cord blood has been used in an expanding range of treatments and as an alternative to the use of bone marrow stem cells. This is particularly the case in treating ethnic minority populations who have historically been under-represented in bone marrow registries. The paper explores the mobilisation and commercialisation of an increasingly important bioeconomic resource with cord blood units trading internationally at high prices. This is a market mediated through a sophisticated global network of immunologically typed and matched bodily matter in which immunity has become a form of 'corporeal currency'. Based on recent international figures we reflect upon the balance of trade between imports and exports across the world's cord blood bioeconomy. Theoretically, this case is, we suggest, an extension of what Roberto Esposito (2008) has termed an 'immunitary paradigm' in which immunity has become the basis for new forms of bioeconomic flow, circulation and exchange. Esposito (2008). Bios: Biopolitics and Philosophy. Minnesota, MN: University of Minnesota Press. Copyright © 2011 Elsevier Ltd. All rights reserved.

Uncertainty quantification of resonant ultrasound spectroscopy for material property and single crystal orientation estimation on a complex part

NASA Astrophysics Data System (ADS)

Aldrin, John C.; Mayes, Alexander; Jauriqui, Leanne; Biedermann, Eric; Heffernan, Julieanne; Livings, Richard; Goodlet, Brent; Mazdiyasni, Siamack

2018-04-01

A case study is presented evaluating uncertainty in Resonance Ultrasound Spectroscopy (RUS) inversion for a single crystal (SX) Ni-based superalloy Mar-M247 cylindrical dog-bone specimens. A number of surrogate models were developed with FEM model solutions, using different sampling schemes (regular grid, Monte Carlo sampling, Latin Hyper-cube sampling) and model approaches, N-dimensional cubic spline interpolation and Kriging. Repeated studies were used to quantify the well-posedness of the inversion problem, and the uncertainty was assessed in material property and crystallographic orientation estimates given typical geometric dimension variability in aerospace components. Surrogate model quality was found to be an important factor in inversion results when the model more closely represents the test data. One important discovery was when the model matches well with test data, a Kriging surrogate model using un-sorted Latin Hypercube sampled data performed as well as the best results from an N-dimensional interpolation model using sorted data. However, both surrogate model quality and mode sorting were found to be less critical when inverting properties from either experimental data or simulated test cases with uncontrolled geometric variation.

Correlation of Spatially Filtered Dynamic Speckles in Distance Measurement Application

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

Semenov, Dmitry V.; Nippolainen, Ervin; Kamshilin, Alexei A.

2008-04-15

In this paper statistical properties of spatially filtered dynamic speckles are considered. This phenomenon was not sufficiently studied yet while spatial filtering is an important instrument for speckles velocity measurements. In case of spatial filtering speckle velocity information is derived from the modulation frequency of filtered light power which is measured by photodetector. Typical photodetector output is represented by a narrow-band random noise signal which includes non-informative intervals. Therefore more or less precious frequency measurement requires averaging. In its turn averaging implies uncorrelated samples. However, conducting research we found that correlation is typical property not only of dynamic speckle patternsmore » but also of spatially filtered speckles. Using spatial filtering the correlation is observed as a response of measurements provided to the same part of the object surface or in case of simultaneously using several adjacent photodetectors. Found correlations can not be explained using just properties of unfiltered dynamic speckles. As we demonstrate the subject of this paper is important not only from pure theoretical point but also from the point of applied speckle metrology. E.g. using single spatial filter and an array of photodetector can greatly improve accuracy of speckle velocity measurements.« less

[Etiologic classification of cerebral infarct. Experience from a prospective data register].

PubMed

Brainin, M

1990-12-01

Most classifications of stroke include clinically heterogeneous subgroups and therefore are of limited value for comparative studies or clinical protocols. The view is held that a classification according to stroke etiology is clinically more reasonable and more consistent for therapeutic strategies. In order to determine the frequency of various etiological subgroups in a series of stroke cases, the results of the Klosterneuburger Schlaganfall-Datenbank (KSDB) are reported. This stroke registry has prospectively recorded over 300 items on all stroke cases referred to one center since March 1988. Investigation rates include CT in almost 100% and the investigation of cerebral vessels in over 90% of all cases. By applying defined etiological categories (undetermined etiology, atherosclerosis of the large craniocervical vessels, cardiogenic embolism, lacunar, primary hemorrhage, and multiple and other causes) to the first 420 patients registered within the first two years it can be shown that even with CT and neurosonology in routine use, in 29% of all cases the cause of the stroke cannot be determined. To investigate this largest subgroup by means of additional new methods as well as by investigating the long-term natural course represents an important challenge for clinical stroke research.

Partitioning the primary ice formation modes in large eddy simulations of mixed-phase clouds

NASA Astrophysics Data System (ADS)

Hande, Luke B.; Hoose, Corinna

2017-11-01

State-of-the-art aerosol-dependent parameterisations describing each heterogeneous ice nucleation mode (contact, immersion, and deposition ice nucleation), as well as homogeneous nucleation, were incorporated into a large eddy simulation model. Several cases representing commonly occurring cloud types were simulated in an effort to understand which ice nucleation modes contribute the most to total concentrations of ice crystals. The cases include a completely idealised warm bubble, semi-idealised deep convection, an orographic cloud, and a stratiform case. Despite clear differences in thermodynamic conditions between the cases, the results are remarkably consistent between the different cloud types. In all the investigated cloud types and under normal aerosol conditions, immersion freezing dominates and contact freezing also contributes significantly. At colder temperatures, deposition nucleation plays only a small role, and homogeneous freezing is important. To some extent, the temporal evolution of the cloud determines the dominant freezing mechanism and hence the subsequent microphysical processes. Precipitation is not correlated with any one ice nucleation mode, instead occurring simultaneously when several nucleation modes are active. Furthermore, large variations in the aerosol concentration do affect the dominant ice nucleation mode; however, they have only a minor influence on the precipitation amount.

Evaluating the Surveillance System for Spotted Fever in Brazil Using Machine-Learning Techniques.

PubMed

Lopez, Diego Montenegro; de Mello, Flávio Luis; Giordano Dias, Cristina Maria; Almeida, Paula; Araújo, Milton; Magalhães, Monica Avelar; Gazeta, Gilberto Salles; Brasil, Reginaldo Peçanha

2017-01-01

This work analyses the performance of the Brazilian spotted fever (SF) surveillance system in diagnosing and confirming suspected cases in the state of Rio de Janeiro (RJ), from 2007 to 2016 (July) using machine-learning techniques. Of the 890 cases reported to the Disease Notification Information System (SINAN), 11.7% were confirmed as SF, 2.9% as dengue, 1.6% as leptospirosis, and 0.7% as tick bite allergy, with the remainder being diagnosed as other categories (10.5%) or unspecified (72.7%). This study confirms the existence of obstacles in the diagnostic classification of suspected cases of SF by clinical signs and symptoms. Unlike man-capybara contact (1.7% of cases), man-tick contact (71.2%) represents an important risk indicator for SF. The analysis of decision trees highlights some clinical symptoms related to SF patient death or cure, such as: respiratory distress, convulsion, shock, petechiae, coma, icterus, and diarrhea. Moreover, cartographic techniques document patient transit between RJ and bordering states and within RJ itself. This work recommends some changes to SINAN that would provide a greater understanding of the dynamics of SF and serve as a model for other endemic areas in Brazil.

Evaluating the Surveillance System for Spotted Fever in Brazil Using Machine-Learning Techniques

PubMed Central

Lopez, Diego Montenegro; de Mello, Flávio Luis; Giordano Dias, Cristina Maria; Almeida, Paula; Araújo, Milton; Magalhães, Monica Avelar; Gazeta, Gilberto Salles; Brasil, Reginaldo Peçanha

2017-01-01

This work analyses the performance of the Brazilian spotted fever (SF) surveillance system in diagnosing and confirming suspected cases in the state of Rio de Janeiro (RJ), from 2007 to 2016 (July) using machine-learning techniques. Of the 890 cases reported to the Disease Notification Information System (SINAN), 11.7% were confirmed as SF, 2.9% as dengue, 1.6% as leptospirosis, and 0.7% as tick bite allergy, with the remainder being diagnosed as other categories (10.5%) or unspecified (72.7%). This study confirms the existence of obstacles in the diagnostic classification of suspected cases of SF by clinical signs and symptoms. Unlike man–capybara contact (1.7% of cases), man–tick contact (71.2%) represents an important risk indicator for SF. The analysis of decision trees highlights some clinical symptoms related to SF patient death or cure, such as: respiratory distress, convulsion, shock, petechiae, coma, icterus, and diarrhea. Moreover, cartographic techniques document patient transit between RJ and bordering states and within RJ itself. This work recommends some changes to SINAN that would provide a greater understanding of the dynamics of SF and serve as a model for other endemic areas in Brazil. PMID:29250519

Iris juvenile xanthogranuloma in an infant - spontaneous hyphema and secondary glaucoma.

PubMed

Pantalon, Anca; Ștefănache, Tudor; Danciu, Mihai; Zurac, Sabina; Chiseliță, Dorin

2017-01-01

Juvenile xanthogranuloma (JXG) is a benign histiocytic skin disorder mainly encountered during infancy and childhood. Although with multiple potential localizations, less than 1% of the cases exhibit ocular manifestations. Some of these might lead to serious complications, specifically, secondary glaucoma that can result in severe and blinding eye disease. The aim of the present case report was to demonstrate typical clinical features, emphasize the difficulties attributed when managing these patients and literature review. We present the case of 4 months old female baby with spontaneous hyphema and secondary unilateral glaucoma due to ocular JXG. The natural history and treatment of the condition were extremely difficult to handle due to multiple opinions in histopathology related to other severe conditions that resembled with the lesions detected in this case: myelomonocytic leukemia and Langerhans cell histiocytosis. Although a minority of patients with JXG have ocular involvement, recognition of this condition is important because a treatment delay can lead to serious complications, such as glaucoma and spontaneous hyphema, as in our case. A thorough differential diagnosis represents the key to a proper management plan in these patients, both on short and long term. "Triple disease" defined as JXG plus neurofibromatosis type 1 (NF-1) and juvenile chronic myelogenous leukemia (JCML) has been reported, but it was not confirmed in our patient.

Whole genome sequencing of Salmonella Typhimurium illuminates distinct outbreaks caused by an endemic multi-locus variable number tandem repeat analysis type in Australia, 2014.

PubMed

Phillips, Anastasia; Sotomayor, Cristina; Wang, Qinning; Holmes, Nadine; Furlong, Catriona; Ward, Kate; Howard, Peter; Octavia, Sophie; Lan, Ruiting; Sintchenko, Vitali

2016-09-15

Salmonella Typhimurium (STM) is an important cause of foodborne outbreaks worldwide. Subtyping of STM remains critical to outbreak investigation, yet current techniques (e.g. multilocus variable number tandem repeat analysis, MLVA) may provide insufficient discrimination. Whole genome sequencing (WGS) offers potentially greater discriminatory power to support infectious disease surveillance. We performed WGS on 62 STM isolates of a single, endemic MLVA type associated with two epidemiologically independent, food-borne outbreaks along with sporadic cases in New South Wales, Australia, during 2014. Genomes of case and environmental isolates were sequenced using HiSeq (Illumina) and the genetic distance between them was assessed by single nucleotide polymorphism (SNP) analysis. SNP analysis was compared to the epidemiological context. The WGS analysis supported epidemiological evidence and genomes of within-outbreak isolates were nearly identical. Sporadic cases differed from outbreak cases by a small number of SNPs, although their close relationship to outbreak cases may represent an unidentified common food source that may warrant further public health follow up. Previously unrecognised mini-clusters were detected. WGS of STM can discriminate foodborne community outbreaks within a single endemic MLVA clone. Our findings support the translation of WGS into public health laboratory surveillance of salmonellosis.

Nonlinear and dissipative constitutive equations for coupled first-order acoustic field equations that are consistent with the generalized Westervelt equation

NASA Astrophysics Data System (ADS)

Verweij, Martin D.; Huijssen, Jacob

2006-05-01

In diagnostic medical ultrasound, it has become increasingly important to evaluate the nonlinear field of an acoustic beam that propagates in a weakly nonlinear, dissipative medium and that is steered off-axis up to very wide angles. In this case, computations cannot be based on the widely used KZK equation since it applies only to small angles. To benefit from successful computational schemes from elastodynamics and electromagnetics, we propose to use two first-order acoustic field equations, accompanied by two constitutive equations, as an alternative basis. This formulation quite naturally results in the contrast source formalism, makes a clear distinction between fundamental conservation laws and medium behavior, and allows for a straightforward inclusion of any medium inhomogenities. This paper is concerned with the derivation of relevant constitutive equations. We take a pragmatic approach and aim to find those constitutive equations that represent the same medium as implicitly described by the recognized, full wave, nonlinear equations such as the generalized Westervelt equation. We will show how this is achieved by considering the nonlinear case without attenuation, the linear case with attenuation, and the nonlinear case with attenuation. As a result we will obtain surprisingly simple constitutive equations for the full wave case.

Extraluminal venous interruption for free-floating thrombus in the deep veins of lower limbs.

PubMed

Casian, D; Gutsu, E; Culiuc, V

2010-01-01

The free-floating thrombus (FFT) represents a particular form of deep vein thrombosis with extremely high potential of fatal pulmonary embolism. The purpose of the study was to evaluate the early results of aggressive surgical approach to FFT. During the period 2005-2008 years FFT was diagnosed in 13 patients. Demographic characteristics of patients: medium age--54.7 years, male--76.9%, significant comorbidity--5 (38.5%) cases. Localization of FFT: superficial femoral vein (SFV)--5 (38.5%), common femoral vein (CFV)--4 (30.7%), external iliac vein (EIV)--2 (15.4%), inferior cava vein (ICV)--2 (15.4%). Manifestations of previous pulmonary embolism were documented preoperatively in 3 (23.1%) cases. The following emergency surgical procedures were performed: ligation--3 (23.1%) or plication--2 (15.4%) of SFV; plication of CFV--5 (38.5%) patients, combined in 4 cases with partial thrombectomy (free-floating part of thrombus); plication of common iliac vein--1 (7.6%); plication of ICV--2 (15.4%) cases. Primary or recurrent cases of clinically significant pulmonary embolism were not detected in the postoperative period. The accumulated experience of surgical management of patients with FFT reveals the important role of deep vein ligation/plication in prevention of fatal pulmonary embolism.

[Sensitivity of four representative angular cephalometric measures].

PubMed

Xü, T; Ahn, J; Baumrind, S

2000-05-01

Examined the sensitivity of four representative cephalometric angles to the detection of different vectors of craniofacial growth. Landmark coordinate data from a stratified random sample of 48 adolescent subjects were used to calculate conventional values for changes between the pretreatment and end-of-treatment lateral cephalograms. By modifying the end-of-treatment coordinate values appropriately, the angular changes could be recalculated reflecting three hypothetical situations: Case 1. What if there were no downward landmark displacement between timepoints? Case 2. What if there were no forward landmark displacement between timepoints? Case 3. What if there were no Nasion change? These questions were asked for four representative cephalometric angles: SNA, ANB, NAPg and UI-SN. For Case 1, the associations (r) between the baseline and the modified measure for the three angles were very highly significant (P < 0.001) with r2 values no lower than 0.94! For Case 2, however, the associations were much weaker and no r value reached significance. These angular measurements are less sensitive for measuring downward landmark displacement than they are for measuring forward landmark displacement.

Evaluation of a case-based urology learning program.

PubMed

Mishra, Kirtishri; Snow-Lisy, Devon C; Ross, Jonathan; Goldfarb, David A; Goldman, Howard; Campbell, Steven C

2013-12-01

To address the challenges that today's trainees encounter, such as information overload and reduced immersion in the field, and recognizing their preference for novel educational resources, an electronic case-based urology learning program was developed. Each case was designed to illustrate the basic principles of the disease process and the fundamentals of evaluation and management using the Socratic method, recapitulating a prototypical patient encounter. A 21-question survey was developed after review of published reports of classroom and clinical learning environment surveys. The target group was 2 pilot urology training programs (the Cleveland Clinic and University Hospitals-Case Medical Center). The responses were entirely anonymous. A total of 32 trainees participated (8 fellows and 24 residents), representing a 53% response rate. Most trainees (79%) were able to process cases within an average of ≤ 10 minutes. Of the trainees, 91% reported referring back to particular cases for patient care, to review for examinations, or for studying. Most trainees believed a case-based urology learning program would be a potentially important resource for clinical practice (69%) and for preparing for the in-service (63%) or board (69%) examinations. Most trainees believed the program met its goals of illustrating the basics principles of the disease process (88%), outlining the fundamentals of evaluation and management (94%), and improving the trainees' knowledge base (91%). An electronic case-based urology learning program is feasible and useful and stimulates learning at all trainee levels. Copyright © 2013 Elsevier Inc. All rights reserved.

The Importance of Audience and Agency for Representation: A Case Study of an Urban Youth Media Community.

PubMed

Charmaraman, Linda

2010-01-01

PURPOSE: Urban youths' agency to represent their realities through media has been largely unexplored in the youth development literature. In this qualitative case study of an after-school youth media program in the Bay Area, expressions of youth agency and the role of audiences are explored during the process of producing videos for public consumption. METHODOLOGY: As participant observer of 14 ethnically diverse youth participants aged between 15 and 18 years over 18 months, I documented (a) the kind of agencies participants engaged in and (b) the impact of live and imagined future audiences on youths' creative processes. Analyses of field notes, semi-structured interviews, and media projects were conducted using thematic analysis to inductively generate emerging categories. FINDINGS: Themes included an agentive sense of self-efficacy, commitment, and responsibility, as well as perceived contributions to local audiences and an emerging collective identity. The youth demonstrated their increased sense of a social or civic duty to realistically represent youth of color to familiar and unfamiliar audiences. IMPLICATIONS: This case study demonstrated how one youth media organization fostered agency through youth authorship, production, distribution, and local community dialogue. By documenting the impact of audiences from conception to public reception, this study provides valuable insight into the agentive process of publicly "performing" a commitment to complete a social change video project. CONTRIBUTION: This chapter underscores the value of performance within youth development programs and the critical component of audiences as one form of authentic assessment in order to foster individual and collective agency.

The Importance of Audience and Agency for Representation: A Case Study of an Urban Youth Media Community

PubMed Central

Charmaraman, Linda

2010-01-01

Purpose Urban youths' agency to represent their realities through media has been largely unexplored in the youth development literature. In this qualitative case study of an after-school youth media program in the Bay Area, expressions of youth agency and the role of audiences are explored during the process of producing videos for public consumption. Methodology As participant observer of 14 ethnically diverse youth participants aged between 15 and 18 years over 18 months, I documented (a) the kind of agencies participants engaged in and (b) the impact of live and imagined future audiences on youths' creative processes. Analyses of field notes, semi-structured interviews, and media projects were conducted using thematic analysis to inductively generate emerging categories. Findings Themes included an agentive sense of self-efficacy, commitment, and responsibility, as well as perceived contributions to local audiences and an emerging collective identity. The youth demonstrated their increased sense of a social or civic duty to realistically represent youth of color to familiar and unfamiliar audiences. Implications This case study demonstrated how one youth media organization fostered agency through youth authorship, production, distribution, and local community dialogue. By documenting the impact of audiences from conception to public reception, this study provides valuable insight into the agentive process of publicly “performing” a commitment to complete a social change video project. Contribution This chapter underscores the value of performance within youth development programs and the critical component of audiences as one form of authentic assessment in order to foster individual and collective agency. PMID:20671812

Case descriptions of fibropapillomatosis in rehabilitating loggerhead sea turtles Caretta caretta in the southeastern USA.

PubMed

Page-Karjian, Annie; Norton, Terry M; Harms, Craig; Mader, Doug; Herbst, Larry H; Stedman, Nancy; Gottdenker, Nicole L

2015-08-20

Fibropapillomatosis (FP) is a debilitating neoplastic disease that affects all species of hard-shelled sea turtles, including loggerhead turtles Caretta caretta. FP can represent an important clinical concern in rehabilitating turtles, since managing these infectious lesions often requires special husbandry provisions including quarantine, and FP may affect clinical progression, extend rehabilitation duration, and complicate prognoses. Here we describe cases of rehabilitating loggerhead turtles with FP (designated FP+). Medical records of FP+ loggerhead cases from 3 sea turtle rehabilitation facilities in the southeastern USA were reviewed. Between 2001 and 2014, FP was observed in 8 of 818 rehabilitating loggerhead turtles (0.98% overall prevalence in admitted patients). FP+ loggerhead size classes represented were large juvenile (straight carapace length, SCL: 58.1-80 cm; n=7) and adult (SCL>87 cm; n=1). Three turtles presented with FP, and 5 developed tumors during rehabilitation within a range of 45 to 319 d. Sites of new tumor growth included the eyes, sites of trauma, neck, and glottis. FP+ turtles were scored as mildly (3/8), moderately (4/8), or heavily (1/8) afflicted. The mean total time in rehabilitation was 476±355 d (SD) (range: 52-1159 d). Six turtles were released without visible evidence of FP, 1 turtle was released with mild FP, and 1 turtle with internal FP was euthanized. Clinical decision-making for FP+ loggerhead patients can be aided by such information as time to tumor development, anatomic locations to monitor for new tumor growth, husbandry considerations, diagnostic and treatment options, and comparisons to FP in rehabilitating green turtles Chelonia mydas.

Businesses assisting K--12 science instruction: Four case studies of long-term school partnerships

NASA Astrophysics Data System (ADS)

van Trieste, Lynne M.

Businesses lack enough qualified applicants to fill the increasing need for scientists and engineers while educators lack many resources for science programs in K-12 schools. This series of case studies searched for successful collaborations between the two in four geographic locations: Boise, Idaho; Dallas, Texas; Los Angeles County, California, and Orange County, California. These science education partnerships were investigated to gain an understanding of long-term partnership structure, functioning and evaluation methods. Forty-nine individual interviews with representatives from the groups of stakeholders these programs impact were also conducted. Stakeholder groups included students, teachers, parents, school administrators, business liaisons, and non-profit representatives. Several recurring themes in these partnerships reinforced the existing literature research findings. Collaboration and communication between partners, teacher professional development, the need for more minority and female representation in physical science careers, and self-efficacy in relation to how people come to view their scientific abilities, are among these themes. Topics such as program replication, the importance of role models, programs using "hands-on" activities, reward systems for program participants, and program outcome measurement also emerged from the cases investigated. Third-party assistance by a non-profit entity is occurring within all of these partnerships. This assistance ranges from a service providing material resources such as equipment, lesson plans and meeting space, to managing the partnership fundraising, program development and evaluations. Discussions based upon the findings that support or threaten sustainment of these four partnerships, what a "perfect" partnership might look like, and areas in need of further investigation conclude this study.

Beyond the crisis: building back better mental health care in 10 emergency-affected areas using a longer-term perspective.

PubMed

Epping-Jordan, JoAnne E; van Ommeren, Mark; Ashour, Hazem Nayef; Maramis, Albert; Marini, Anita; Mohanraj, Andrew; Noori, Aqila; Rizwan, Humayun; Saeed, Khalid; Silove, Derrick; Suveendran, T; Urbina, Liliana; Ventevogel, Peter; Saxena, Shekhar

2015-01-01

Major gaps remain - especially in low- and middle-income countries - in the realization of comprehensive, community-based mental health care. One potentially important yet overlooked opportunity for accelerating mental health reform lies within emergency situations, such as armed conflicts or natural disasters. Despite their adverse impacts on affected populations' mental health and well being, emergencies also draw attention and resources to these issues and provide openings for mental health service development. Cases were considered if they represented a low- or middle-income country or territory affected by an emergency, were initiated between 2000 and 2010, succeeded in making changes to the mental health system, and were able to be documented by an expert involved directly with the case. Based on these criteria, 10 case examples from diverse emergency-affected settings were included: Afghanistan, Burundi, Indonesia (Aceh Province), Iraq, Jordan, Kosovo, occupied Palestinian territory, Somalia, Sri Lanka, and Timor-Leste. These cases demonstrate generally that emergency contexts can be tapped to make substantial and sustainable improvements in mental health systems. From these experiences, 10 common lessons learnt were identified on how to make this happen. These lessons include the importance of adopting a longer-term perspective for mental health reform from the outset, and focusing on system-wide reform that addresses both new-onset and pre-existing mental disorders. Global progress in mental health care would happen more quickly if, in every crisis, strategic efforts were made to convert short-term interest in mental health problems into momentum for mental health reform.

Swimming Pool Electrical Injuries: Steps Toward Prevention.

PubMed

Tashiro, Jun; Burnweit, Cathy A

2017-01-09

Electrical injuries in swimming pools are an important pediatric public health concern. We sought to (1) improve our understanding of the clinical presentation and outcomes following and (2) describe the epidemiology of swimming pool electrical injuries in the United States. We reviewed 4 cases of pediatric (<18 y old) electrical injury from a single, urban level 1 pediatric trauma center. We also queried the National Electronic Injury Surveillance System (NEISS) for emergency department visits due to electrical injury associated with swimming pools, occurring between 1991 and 2013. Overall, 566 cases were reported, with a mean (SD) age of 9.2 (4.1) years. Patients were mostly treated and released from the emergency department (91.8%), whereas 8.2% were hospitalized. When stated, injuries occurred most frequently at home (57.0%), followed by public (23.9%) and sports facilities (19.1%). Electrical outlets or receptacles (39.8%) were most commonly implicated, followed by electrical system doors (18.2%), electric wiring systems (17.0%), thermostats (16.3%), hair dryers (4.6%), and radios (4.1%). Pediatric cases represented 48.4% of swimming pool-related electrical injuries reported to NEISS. Electrical injuries occurring in and around swimming pools remain an important source of morbidity and mortality. Although NEISS monitors sentinel events, current efforts at preventing such cases are less than adequate. All electrical outlets near swimming pools should be properly wired with ground fault circuit interrupter devices. Possible approaches to increasing safe electrical device installation are through strengthening public awareness and education of the potential for injury, as well as changes to current inspection regulations.

Fire and Thermal Effects of HD 1.3 Accidents: History, Research, and Analysis

DTIC Science & Technology

2010-07-01

consisted of a 1.3 cm thick steel plate (representing the external case), two layers of NBR rubber (representing case lining and ablative...1.3 cm steel plate, 2 layers of NBR rubber , 2.5 cm PMMA • Nitrogen co-flow to prevent ignition of NBR layers • 1D HEATING for prediction 0 200 400...and 100 kW/m 2 . The NBR layers will pyrolyze at elevated temperatures. In a real motor, those gases would be contained by the pressure tight case

Malignant tumors as cause of disability at the Instituto Mexicano del Seguro Social

PubMed

Zitle-García, Edgar Jesús; Sauceda-Valenzuela, Alma Lucila; Ascencio-Montiel, Iván de Jesús; García-Paredes, Jesús

2018-01-01

Cancer represents an important issue in health, with the economic impact that it takes. The aim of this paper is to analyze the epidemiological characteristics of a population with social security who was diagnosed with some type of cancer and required a disability pension. Observational study, retrolective cohort type, carried out at the Instituto Mexicano del Seguro Social (IMSS) with IMSS beneficiaries ruled with a state of disability due to malignancy during the period 2006 to 2012. 13 633 cases were studied, observing an increasing behavior among the years mentioned. The age average of the rightful claimants ruled was 47.75 years; the main causes of disability due to malignant tumors were breast, colon and brain cancer. The definitive opinions represented the 49.66%, which are likely to generate a constituent amount for the IMSS. It is important to have data of the survival in relation to the most frequent malignant tumors, which can provide information about the severity and prognosis of these diseases. The results obtained lead to discuss the effectiveness of programs established on the prevention and early detection of non-communicable diseases, mainly in breast cancer, since the impact that has this type of suffering may involve a major financial problem for the IMSS because of the payment of constituent amounts.

Global health funding and economic development.

PubMed

Martin, Greg; Grant, Alexandra; D'Agostino, Mark

2012-04-10

The impact of increased national wealth, as measured by Gross Domestic Product (GDP), on public health is widely understood, however an equally important but less well-acclaimed relationship exists between improvements in health and the growth of an economy. Communicable diseases such as HIV, TB, Malaria and the Neglected Tropical Diseases (NTDs) are impacting many of the world's poorest and most vulnerable populations, and depressing economic development. Sickness and disease has decreased the size and capabilities of the workforce through impeding access to education and suppressing foreign direct investment (FDI). There is clear evidence that by investing in health improvements a significant increase in GDP per capita can be attained in four ways: Firstly, healthier populations are more economically productive; secondly, proactive healthcare leads to decrease in many of the additive healthcare costs associated with lack of care (treating opportunistic infections in the case of HIV for example); thirdly, improved health represents a real economic and developmental outcome in-and-of itself and finally, healthcare spending capitalises on the Keynesian 'economic multiplier' effect. Continued under-investment in health and health systems represent an important threat to our future global prosperity. This editorial calls for a recognition of health as a major engine of economic growth and for commensurate investment in public health, particularly in poor countries.

Global health funding and economic development

PubMed Central

2012-01-01

The impact of increased national wealth, as measured by Gross Domestic Product (GDP), on public health is widely understood, however an equally important but less well-acclaimed relationship exists between improvements in health and the growth of an economy. Communicable diseases such as HIV, TB, Malaria and the Neglected Tropical Diseases (NTDs) are impacting many of the world's poorest and most vulnerable populations, and depressing economic development. Sickness and disease has decreased the size and capabilities of the workforce through impeding access to education and suppressing foreign direct investment (FDI). There is clear evidence that by investing in health improvements a significant increase in GDP per capita can be attained in four ways: Firstly, healthier populations are more economically productive; secondly, proactive healthcare leads to decrease in many of the additive healthcare costs associated with lack of care (treating opportunistic infections in the case of HIV for example); thirdly, improved health represents a real economic and developmental outcome in-and-of itself and finally, healthcare spending capitalises on the Keynesian 'economic multiplier' effect. Continued under-investment in health and health systems represent an important threat to our future global prosperity. This editorial calls for a recognition of health as a major engine of economic growth and for commensurate investment in public health, particularly in poor countries. PMID:22490207

Monoclonal antibody proteomics: use of antibody mimotope displaying phages and the relevant synthetic peptides for mAb scouting.

PubMed

Hajdú, István; Flachner, Beáta; Bognár, Melinda; Végh, Barbara M; Dobi, Krisztina; Lőrincz, Zsolt; Lázár, József; Cseh, Sándor; Takács, László; Kurucz, István

2014-08-01

Monoclonal antibody proteomics uses nascent libraries or cloned (Plasmascan™, QuantiPlasma™) libraries of mAbs that react with individual epitopes of proteins in the human plasma. At the initial phase of library creation, cognate protein antigen and the epitope interacting with the antibodies are not known. Scouting for monoclonal antibodies (mAbs) with the best binding characteristics is of high importance for mAb based biomarker assay development. However, in the absence of the identity of the cognate antigen the task represents a challenge. We combined phage display, and surface plasmon resonance (Biacore) experiments to test whether specific phages and the respective mimotope peptides obtained from large scale studies are applicable to determine key features of antibodies for scouting. We show here that mAb captured phage-mimotope heterogeneity that is the diversity of the selected peptide sequences, is inversely correlated with an important binding descriptor; the off-rate of the antibodies and that represents clues for driving the selection of useful mAbs for biomarker assay development. Carefully chosen synthetic mimotope peptides are suitable for specificity testing in competitive assays using the target proteome, in our case the human plasma. Copyright © 2014 Elsevier B.V. All rights reserved.

Assessment of Musculoskeletal Injuries from Domestic Violence in the Emergency Department

PubMed Central

Giannakopoulos, Georgios F.; Reijnders, Udo J. L.

2015-01-01

Domestic violence is one of the most common causes of nonfatal injury in women, with musculoskeletal injuries representing the second most prevalent manifestation of this form of violence. It is therefore of great importance that healthcare providers such as emergency department (ED) physicians and surgeons are able to recognize and assess these kinds of injuries. In this case report, a woman is described visiting an ED with injuries caused by a fall. Thanks to the knowledge and attention of the ED physician, the real cause of the injury was discovered. What appeared to be an unsuspicious accident was actually the result of intimate partner violence. PMID:26064703

Counseling the pregnant adolescent.

PubMed

Dibiasi, V; Sturgis, S H

1980-07-01

Approaches employed in counseling pregnant adolescents at the Crittenton Clinic in Boston are described. Concentrating on concrete issues of management of the pregnancy -- supplying information and exploring the pros and cons of various alternatives are advocated; probing into the psychological and emotional background of the pregnant adolescent is discouraged. Counseling about contraceptives and taking into account each individual situation are considered essential. Case studies are reviewed and figures representing the attitudes and contraceptive use of patients 1 year after abortion are presented. It is considered important to establish a trusting relationship with the adolescent, which will increase the likelihood that she will return for follow-up and additional help if she needs it.

Application of a Silicone Sheet in Negative-Pressure Wound Therapy to Treat an Abdominal Wall Defect after Necrotizing Fasciitis.

PubMed

Shin, Jin Su; Choi, Hwan Jun

2017-01-01

Necrotizing fasciitis (NF) is an aggressive soft-tissue infection involving the deep fascia and is characterized by extensive deterioration of the surrounding tissue. Immediate diagnosis and intensive treatment, including debridement and systemic antibiotics, represent the most important factors influencing the survival of NF patients. In this report, we present a case of NF in the abdomen due to an infection caused by a perforated small bowel after abdominal liposuction. It was successfully treated using negative-pressure wound therapy, in which a silicone sheet functioned as a barrier between the sponge and internal organs to protect the small bowel.

Artifacts on electroencephalograms may influence the amplitude-integrated EEG classification: a qualitative analysis in neonatal encephalopathy.

PubMed

Hagmann, Cornelia Franziska; Robertson, Nicola Jayne; Azzopardi, Denis

2006-12-01

This is a case report and a descriptive study demonstrating that artifacts are common during long-term recording of amplitude-integrated electroencephalograms and may lead to erroneous classification of the amplitude-integrated electroencephalogram trace. Artifacts occurred in 12% of 200 hours of recording time sampled from a representative sample of 20 infants with neonatal encephalopathy. Artifacts derived from electrical or movement interference occurred with similar frequency; both types of artifacts influenced the voltage and width of the amplitude-integrated electroencephalogram band. This is important knowledge especially if amplitude-integrated electroencephalogram is used as a selection tool for neuroprotection intervention studies.

Recommended de minimis radiation dose rates for Canada. Report No. INFO-0355

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

Not Available

1990-01-01

A de minimis dose or dose rate as used in this report represents a level of risk which is generally accepted as being of no significance to an individual, or in the case of a population, of no significance to society. The report describes the risk of biological effects from radiation; radiation from natural and man-made sources; normal incidences of cancer and genetic defects; initiatives by other agencies in the U.S., the U.K. and internationally; the importance of collective dose and dose rate; assigning values to the de minimis dose rates; and application of the de minimis dose rates.

Adolescent girls' views on cosmetic surgery: A focus group study.

PubMed

Ashikali, Eleni-Marina; Dittmar, Helga; Ayers, Susan

2016-01-01

This study examined adolescent girls' views of cosmetic surgery. Seven focus groups were run with girls aged 15-18 years (N = 27). Participants read case studies of women having cosmetic surgery, followed by discussion and exploration of their views. Thematic analysis identified four themes: (1) dissatisfaction with appearance, (2) acceptability of cosmetic surgery, (3) feelings about undergoing cosmetic surgery and (4) cosmetic surgery in the media. Results suggest the acceptability of cosmetic surgery varies according to the reasons for having it and that the media play an important role by normalising surgery and under-representing the risks associated with it. © The Author(s) 2014.

Immunohistochemical Pitfalls: Common Mistakes in the Evaluation of Lynch Syndrome.

PubMed

Markow, Michael; Chen, Wei; Frankel, Wendy L

2017-12-01

At least 15% of colorectal cancers diagnosed in the United States are deficient in mismatch repair mechanisms. Most of these are sporadic, but approximately 3% of colorectal cancers result from germline alterations in mismatch repair genes and represent Lynch syndrome. It is critical to identify patients with Lynch syndrome to institute appropriate screening and surveillance for patients and their families. Exclusion of Lynch syndrome in sporadic cases is equally important because it reduces anxiety for patients and prevents excessive spending on unnecessary surveillance. Immunohistochemistry is one of the most widely used screening tools for identifying patients with Lynch syndrome. Copyright © 2017 Elsevier Inc. All rights reserved.

[Surprising discovery: dismembered body found in a commercial laundry--medicolegal differentiation between infanticide, corpse dismemberment and stillbirth].

PubMed

Sautter, Julia; Schröder, Ann Sophie; Lockemann, Ute; Püschel, Klaus

2009-01-01

The discovery of a dismembered corpse, especially that of a newborn, represents a significant challenge for forensic investigators. The cause of the dismemberment, be it natural, accidental, or criminal, must be determined. Another important question to distinguish between neonaticide and stillbirth is whether the infant was alive after birth. The present case - a dismembered infant corpse discovered in the washing at a commercial laundry - describes a forensic investigation which could avoid premature or wrong conclusions by identifying the corpse as a stillbirth that was accidentally disposed of in the laundry after an autopsy had been performed.

Intuitionistic fuzzy analytical hierarchical processes for selecting the paradigms of mangroves in municipal wastewater treatment.

PubMed

Ouyang, Xiaoguang; Guo, Fen

2018-04-01

Municipal wastewater discharge is widespread and one of the sources of coastal eutrophication, and is especially uncontrolled in developing and undeveloped coastal regions. Mangrove forests are natural filters of pollutants in wastewater. There are three paradigms of mangroves for municipal wastewater treatment and the selection of the optimal one is a multi-criteria decision-making problem. Combining intuitionistic fuzzy theory, the Fuzzy Delphi Method and the fuzzy analytical hierarchical process (AHP), this study develops an intuitionistic fuzzy AHP (IFAHP) method. For the Fuzzy Delphi Method, the judgments of experts and representatives on criterion weights are made by linguistic variables and quantified by intuitionistic fuzzy theory, which is also used to weight the importance of experts and representatives. This process generates the entropy weights of criteria, which are combined with indices values and weights to rank the alternatives by the fuzzy AHP method. The IFAHP method was used to select the optimal paradigm of mangroves for treating municipal wastewater. The entropy weights were entrained by the valid evaluation of 64 experts and representatives via online survey. Natural mangroves were found to be the optimal paradigm for municipal wastewater treatment. By assigning different weights to the criteria, sensitivity analysis shows that natural mangroves remain to be the optimal paradigm under most scenarios. This study stresses the importance of mangroves for wastewater treatment. Decision-makers need to contemplate mangrove reforestation projects, especially where mangroves are highly deforested but wastewater discharge is uncontrolled. The IFAHP method is expected to be applied in other multi-criteria decision-making cases. Copyright © 2017 Elsevier Ltd. All rights reserved.

The State's Case

ERIC Educational Resources Information Center

Calhoun, John W.

1972-01-01

Author is Assistant Attorney General in Wisconsin and represented the state in the Wisconsin vs. Yoder case. Cites other cases and decisions handed down by the United States Supreme Court in relation to compulsory education. (RB)

Nanomaterial Case Study: A Comparison of Multiwalled ...

EPA Pesticide Factsheets

The draft document is intended to be used as part of a process to identify what is known and, more importantly, what is not yet known that could be of value in assessing the broad implications of specific nanomaterials. Like previous case studies (see History/ Chronology below), this draft case study on multiwalled carbon nanotubes (MWCNTs) is based on the comprehensive environmental assessment (CEA) approach, which consists of both a framework and a process. Unlike previous case studies this case study incorporates information about a traditional (i.e., “non-nano-enabled”) product, against which the MWCNT flame-retardant coating applied to upholstery textiles (i.e., the “nano-enabled” product) can be compared. The comparative element serves dual-purposes: 1) to provide a more robust database that facilitates identification of data gaps related to the nano-enabled product and 2) to provide a context for identifying key factors and data gaps for future efforts to evaluate risk-related trade-offs between a nano-enabled and non-nano-enabled product. This draft case study does not represent a completed or even a preliminary assessment of MWCNTs; rather, it uses the CEA framework to structure information from available literature and other resources (e.g., government reports) on the product life cycle, fate and transport processes in various environmental media, exposure-dose characterization, and impacts in human, ecological, and environmental receptors.

Descriptive studies: what they can and cannot do.

PubMed

Grimes, David A; Schulz, Kenneth F

2002-01-12

Descriptive studies often represent the first scientific toe in the water in new areas of inquiry. A fundamental element of descriptive reporting is a clear, specific, and measurable definition of the disease or condition in question. Like newspapers, good descriptive reporting answers the five basic W questions: who, what, why, when, where. and a sixth: so what? Case reports, case-series reports, cross-sectional studies, and surveillance studies deal with individuals, whereas ecological correlational studies examine populations. The case report is the least-publishable unit in medical literature. Case-series reports aggregate individual cases in one publication. Clustering of unusual cases in a short period often heralds a new epidemic, as happened with AIDS. Cross-sectional (prevalence) studies describe the health of populations. Surveillance can be thought of as watchfulness over a community; feedback to those who need to know is an integral component of surveillance. Ecological correlational studies look for associations between exposures and outcomes in populations-eg, per capita cigarette sales and rates of coronary artery disease-rather than in individuals. Three important uses of descriptive studies include trend analysis, health-care planning, and hypothesis generation. A frequent error in reports of descriptive studies is overstepping the data: studies without a comparison group allow no inferences to be drawn about associations, causal or otherwise. Hypotheses about causation from descriptive studies are often tested in rigorous analytical studies.

Breast as an unusual site of metastasis- series of 3 cases and review of literature.

PubMed

Hebbar, Ashwin K; Shashidhar, K; S, Krishna Murthy; Kumar, Veerendra; Arjunan, Ravi

2014-09-01

Background and objectives Metastasis to the breast from extra mammary sites is uncommon with an incidence ranging from 1.2 to 2 % in clinical reports. Approximately 300 cases of breast metastasis from extra mammary sites have been reported, mostly in small series or as a single case report. Gastrointestinal adenocarcinoma metastasising to the breast is also very rare and only 30 cases have been reported in the literature. Metastatic deposits within the breast may be difficult to distinguish from primary breast carcinoma. Radiological features and immunohistochemistry especially for steroid hormone receptors (ER/PR) and expression of gross cystic disease fluid protein (GCDFP) and presence of other immunohistochemistry protein factors in breast metastasis which are specific to primary site may be helpful in differentiating these two conditions. Materials and methods In this series of 3 cases of breast as an unusual site of metastasis, we present different cases of adenocarcinoma of stomach, sigmoid colon and kidney with metastasis to the breast and discuss the differential diagnosis and management plans. Conclusion In conclusion, secondary tumors to the breast are rare and thus differentiating primary tumors from metastatic breast carcinoma is important for rational and optimum therapy and avoidance of unnecessary radical surgery. Palpable breast lump without typical radiological signs of primary breast carcinoma in patients with known primary should be suspected of representing metastasis.

Morphologic mimickers of Cryptococcus occurring within inflammatory infiltrates in the setting of neutrophilic dermatitis: a series of three cases highlighting clinical dilemmas associated with a novel histopathologic pitfall.

PubMed

Ko, Jennifer S; Fernandez, Anthony P; Anderson, Kyle A; Burdick, Laura M; Billings, Steven D; Procop, Gary W; McMahon, James T; Bergfeld, Wilma F; Piliang, Melissa P

2013-01-01

A neutrophil-predominant inflammatory infiltrate in a cutaneous biopsy can be associated with a broad spectrum of diseases. Here we describe three cases showing a neutrophil-predominant dermal infiltrate admixed with abundant acellular bodies surrounded by capsule-like vacuolated spaces, which strikingly mimicked Cryptococcus. Two cases occurred within the settings of underlying hematologic malignancies; the third case was associated with immune dysregulation. Two patients were acutely ill in the medical intensive care unit. Fungal work-up, including cultures and multiple stains were negative. Because of clinical deterioration in these patients, transmission electron microscopy was pursued to definitively rule out fungal infection. In both cases, characteristics most compatible with autolysing human cells, not Cryptococcus, were identified. Chemotherapy and high-dose steroids were given, but both patients eventually succumbed to their diseases. To the best of our knowledge, these represent the first reported cases of autolysing human cells mimicking Cryptococcus organisms within neutrophilic infiltrates. They highlight the therapeutic dilemmas arising with histopathologic mimics, as well as the importance of thorough investigation to distinguish mimickers from true infectious organisms. We believe recognition of this microscopic pitfall will be useful to dermatopathologists faced with similar findings in the future, and may prevent unnecessary delay of appropriate therapy in acutely ill patients. Copyright © 2012 John Wiley & Sons A/S.

The importance of improving the quality of emergency surgery for a regional quality collaborative.

PubMed

Smith, Margaret; Hussain, Adnan; Xiao, Jane; Scheidler, William; Reddy, Haritha; Olugbade, Kola; Cummings, Dustin; Terjimanian, Michael; Krapohl, Greta; Waits, Seth A; Campbell, Darrell; Englesbe, Michael J

2013-04-01

Within a large, statewide collaborative, significant improvement in surgical quality has been appreciated (9.0% reduction in morbidity for elective general and vascular surgery). Our group has not noted such quality improvement in the care of patients who had emergency operations. With this work, we aim to describe the scope of emergency surgical care within the Michigan Surgical Quality Collaborative, variations in outcomes among hospitals, and variations in adherence to evidence-based process measures. Overall, these data will form a basis for a broad-based quality improvement initiative within Michigan. We report morbidity, mortality, and costs of emergency and elective general and vascular surgery cases (N = 190,826) within 34 hospitals participating in the Michigan Surgical Quality Collaborative from 2005 to 2010. Adjusted hospital-specific outcomes were calculated using a stepwise multivariable logistic regression model. Adjustment covariates included patient specific comorbidities and case complexity. Hospitals were also compared on the basis of their adherence to evidence-based process measures [measures at the patient level for each case-Surgical Care Improvement Project (SCIP)-1 and SCIP-2 compliance]. Emergency procedures account for approximately 11% of total cases, yet they represented 47% of mortalities and 28% of surgical complications. The complication-specific cost to payers was $126 million for emergency cases and $329 million for elective cases. Adjusted patient outcomes varied widely within Michigan Surgical Quality Collaborative hospitals; morbidity and mortality rates ranged from 16.3% to 33.9% and 4.0% to 12.4%, respectively. The variation among hospitals was not correlated with volume of emergency cases and case complexity. Hospital performance in emergency surgery was found to not depend on its share of emergent cases but rather was found to directly correlate with its performance in elective surgery. For emergency colectomies, there was a wide variation in compliance with SCIP-1 and SCIP-2 measures and overall compliance (42.0%) was markedly lower than that for elective colon surgery (81.7%). Emergency surgical procedures are an important target for future quality improvement efforts within Michigan. Future work will identify best practices within high-performing hospitals and disseminate these practices within the collaborative.

[Availability of condoms in Mexico City].

PubMed

Hernández-Girón, C; Cruz-Valdez, A; Quiterio-Trenado, M; Avila-Burgos, L; Peruga, A; Hernández-Avila, M

2001-12-01

At the beginning of 1999, Mexico occupied third place, after USA and Brazil, in the number of accumulated cases of AIDS (38,390 notified cases) in America. More than 80% of the cases corresponded to men between 20 and 44 years old. The transmission by sexual route has increased in both sexes, the proportion of men infected by sexual contact increased from 85% in 1991 to 90% in 1998 and in women this proportion increased from 41% in 1991 to 57% in 1998. The ratio male/female of cases of AIDS has varied from 17:1 in 1983 to 6:1 in 1998. Condom use is considered an effective method for the prevention of the transmission of STI's/HIV and therefore the availability is of paramount importance to promote use with the finality of combating these diseases. A simple randomized sampling was done in 612 establishments that included: drugstore, bars and nightclubs, hotels and motels, self-service shops and health centers in Mexico City, where am cross sectional study was performed during June and July of 1995, to evaluate the availability of condoms considering three important items: a) percent per capita required to buy an annual endowment of 100 condoms in comparison with this same indicator reported in other countries; b) physical availability, on behalf of the Secretaría de Salud, Mexico City, that considers the volume of existing condoms to be utilized for a year by the public sector in this city; c) physical availability of condoms in different evaluated locations. In order to purchase an annual supply of condoms an individual needs the assign $500 (Pesos) which represents 2.3 to 2.6% of the annual GNP per capita for 1998 and 1997 respectively. The physical availability of condoms, on behalf of the Secretaría de Salud, Mexico City, was 94.9% in health centers. In drugstores, hotels and motels, self-service shops, bars and nightclubs the availability of condoms was 100%, 82.9%, 75% and 1.2%, respectively. It has been documented that the adequate use of condom is an effective strategy for the prevention of STI's/HIV, therefore the availability of this method of prevention is important to decrease the incidence of these diseases The results of this study indicate that the price for this method of prevention represents an important expense for the homes, which is a limiting factor for condom use, especially for those populations that include adolescents and young adults. It then becomes necessary for Government Institutions to implement programs that will subsidize this method of prevention. Availability is less in self-service shops and practically non-existent in bars and nightclubs. It is suggested that the availability of condom should be mandatory in public places, like bars and nightclubs, where the risk to start casual sexual contact is eminent.

What Causes Care Coordination Problems? A Case for Microanalysis

PubMed Central

Zachary, Wayne; Maulitz, Russell Charles; Zachary, Drew A.

2016-01-01

Introduction: Care coordination (CC) is an important fulcrum for pursuing a range of health care goals. Current research and policy analyses have focused on aggregated data rather than on understanding what happens within individual cases. At the case level, CC emerges as a complex network of communications among providers over time, crossing and recrossing many organizational boundaries. Micro-level analysis is needed to understand where and how CC fails, as well as to identify best practices and root causes of problems. Coordination Process Diagramming: Coordination Process Diagramming (CPD) is a new framework for representing and analyzing CC arcs at the micro level, separating an arc into its participants and roles, communication structure, organizational structures, and transitions of care, all on a common time line. Conclusion: Comparative CPD analysis across a sample of CC arcs identifies common CC problems and potential root causes, showing the potential value of the framework. The analyses also suggest intervention strategies that could be applied to attack the root causes of CC problems, including organizational changes, education and training, and additional health information technology development. PMID:27563685

Rethinking the relationship between medicine and media: two examples from Croatia.

PubMed

Jergović, Blanka

2004-08-01

The communication between medicine and media is an important component within the complex process of changes in post-communist transition countries. It reflects not only organizational and legislative state of the society but its cultural adaptability and character. In that respect, media communication could be a tool for shifting the existing attitudes to innovative evaluation of physician's responsibility. Adapting to the democratic society necessitates more effective communication and improvement of all components of communication process: medicine, media, and the public sphere. Existing communication strategies in Croatia were recognized as inefficient and proved damaging for the health care system and society in general. As a demonstration, two representative examples were analyzed in this paper: the case of deaths related to Baxter dialyzers, and the case of pediatric cardiac surgery at the Zagreb University Hospital Center. The cases illustrate the lack of communication within the medical profession and physicians with the executive government, and the public. There is a great need for more effective communication and skillful professionals in transition countries. The future concept of the communication should be characterized by contextual and "cross-talk' approach.

Leveraging the Zachman framework implementation using action - research methodology - a case study: aligning the enterprise architecture and the business goals

NASA Astrophysics Data System (ADS)

Nogueira, Juan Manuel; Romero, David; Espadas, Javier; Molina, Arturo

2013-02-01

With the emergence of new enterprise models, such as technology-based enterprises, and the large quantity of information generated through technological advances, the Zachman framework continues to represent a modelling tool of great utility and value to construct an enterprise architecture (EA) that can integrate and align the IT infrastructure and business goals. Nevertheless, implementing an EA requires an important effort within an enterprise. Small technology-based enterprises and start-ups can take advantage of EAs and frameworks but, because these enterprises have limited resources to allocate for this task, an enterprise framework implementation is not feasible in most cases. This article proposes a new methodology based on action-research for the implementation of the business, system and technology models of the Zachman framework to assist and facilitate its implementation. Following the explanation of cycles of the proposed methodology, a case study is presented to illustrate the results of implementing the Zachman framework in a technology-based enterprise: PyME CREATIVA, using action-research approach.

[Practical Use of Doppler Ultrasonography of the Cardiovascular System and Clinical Laboratory Tests for the Management of Pulmonary Embolism].

PubMed

Mizukami, Naoko

2015-08-01

Acute or chronic pulmonary embolism (PE) is a serious disease, and the risk of mortality is increased if untreated. In 90% of cases the embolus source is deep vein thrombosis (DVT) of the lower limbs or pelvic cavity. Therefore, it is necessary to recognize these as venous thromboembolism (VTE) which includes both DVT and PE. I suggest that Doppler ultrasonography of cardiovascular and clinical laboratory tests provide very valuable medical support for the management of VTE. Specifically, in the early diagnosis of VTE and the prevention of fatal PE, Doppler ultrasonography (cardiac and vascular) can provide very useful information. On the other hand, blood coagulation and thrombophilia tests are important to determine the risk of VTE and evaluate the effect of anticoagulant therapy on VTE. In this paper, I explain the main points of each examination of VTE by describing representative cases. I also show the results on investigating cases in our hospital involving diseases related to VTE and the onset site of DVT. In addition, I introduce how we convey the results of analysis to the clinical side.