Cooling it gets hot.

PubMed

Weber, D O

1999-01-01

Conflict is an inevitable part of work and relationships. How it is handled determines what can and cannot be accomplished personally, professionally, and organizationally. The pressures and complexities of health care interactions breeds conflicts that require constant, skillful negotiation. Increasingly, health care leaders are recognizing that proficiency at recognizing sources of friction before trouble flares up and at managing and resolving disputes that do break out is an essential part of their executive "toolbox." Resources are now widely available for acquiring fundamental knowledge of dispute prevention and negotiation techniques, and for locating and engaging reliable expertise when third-party intervention appears necessarily to reconcile apparently intractable differences.

Reduced-Dimensionality Semiclassical Transition State Theory: Application to Hydrogen Atom Abstraction and Exchange Reactions of Hydrocarbons.

PubMed

Greene, Samuel M; Shan, Xiao; Clary, David C

2015-12-17

Quantum mechanical methods for calculating rate constants are often intractable for reactions involving many atoms. Semiclassical transition state theory (SCTST) offers computational advantages over these methods but nonetheless scales exponentially with the number of degrees of freedom (DOFs) of the system. Here we present a method with more favorable scaling, reduced-dimensionality SCTST (RD SCTST), that treats only a subset of DOFs of the system explicitly. We apply it to three H abstraction and exchange reactions for which two-dimensional potential energy surfaces (PESs) have previously been constructed and evaluated using RD quantum scattering calculations. We differentiated these PESs to calculate harmonic frequencies and anharmonic constants, which were then used to calculate cumulative reaction probabilities and rate constants by RD SCTST. This method yielded rate constants in good agreement with quantum scattering results. Notably, it performed well for a heavy-light-heavy reaction, even though it does not explicitly account for corner-cutting effects. Recent extensions to SCTST that improve its treatment of deep tunneling were also evaluated within the reduced-dimensionality framework. The success of RD SCTST in this study suggests its potential applicability to larger systems.

A predictive risk model for medical intractability in epilepsy.

PubMed

Huang, Lisu; Li, Shi; He, Dake; Bao, Weiqun; Li, Ling

2014-08-01

This study aimed to investigate early predictors (6 months after diagnosis) of medical intractability in epilepsy. All children <12 years of age having two or more unprovoked seizures 24 h apart at Xinhua Hospital between 1992 and 2006 were included. Medical intractability was defined as failure, due to lack of seizure control, of more than 2 antiepileptic drugs at maximum tolerated doses, with an average of more than 1 seizure per month for 24 months and no more than 3 consecutive months of seizure freedom during this interval. Univariate and multivariate logistic regression models were performed to determine the risk factors for developing medical intractability. Receiver operating characteristic curve was applied to fit the best compounded predictive model. A total of 649 patients were identified, out of which 119 (18%) met the study definition of intractable epilepsy at 2 years after diagnosis, and the rate of intractable epilepsy in patients with idiopathic syndromes was 12%. Multivariate logistic regression analysis revealed that neurodevelopmental delay, symptomatic etiology, partial seizures, and more than 10 seizures before diagnosis were significant and independent risk factors for intractable epilepsy. The best model to predict medical intractability in epilepsy comprised neurological physical abnormality, age at onset of epilepsy under 1 year, more than 10 seizures before diagnosis, and partial epilepsy, and the area under receiver operating characteristic curve was 0.7797. This model also fitted best in patients with idiopathic syndromes. A predictive model of medically intractable epilepsy composed of only four characteristics is established. This model is comparatively accurate and simple to apply clinically. Copyright © 2014 Elsevier Inc. All rights reserved.

Predictors of intractable childhood epilepsy.

PubMed

Seker Yilmaz, Berna; Okuyaz, Cetin; Komur, Mustafa

2013-01-01

Our study sought to identify early predictive factors of medically intractable childhood epilepsy. A cohort of epileptic children from the city of Mersin was retrospectively investigated. All patients received care from the same Department of Pediatric Neurology. The epileptic cohort was divided into a drug-responsive epilepsy group and an intractable epilepsy group. Intractable epilepsy is defined as continued seizures in children despite adequate therapy with two or more antiepileptic drugs for more than 18 months. Strong univariate association was observed between intractability and several factors: age of onset, high initial seizure frequency, symptomatic etiology, mixed seizure types, previous history of status epilepticus, febrile and neonatal seizures, mental and motor developmental delay, multiple seizures in 1 day, electroencephalogram abnormalities, magnetic resonance imaging findings, and specific epileptic syndromes. Logistic regression analysis revealed that a previous history of epilepticus status, abnormal electroencephalogram results, and multiple seizures in 1 day comprise independent predictors of medically intractable childhood epilepsy. We suggest that medical intractability in childhood epilepsy can be predicted by monitoring these factors. Along with early prediction, alternative therapies may be designed to provide patients better seizure control and quality of life. Copyright © 2013 Elsevier Inc. All rights reserved.

Increased self-transcendence in patients with intractable diseases.

PubMed

Iwamoto, Rie; Yamawaki, Niwako; Sato, Takeshi

2011-12-01

Patients with intractable disease require long-term treatment and experience repeated bouts of progressive symptoms and resolutions, which cause them severe suffering. The aim of this study was to elucidate the concepts of self-transcendence and subjective well-being in patients with intractable disease. Forty-four patients with intractable disease (men/women: 22/22) participated. The diseases of the participants were classified into five systems: (i) neural/muscle system; (ii) digestive system; (iii) immunity/blood system; (iv) visual system; and (v) bone/joint system. The controls were 1854 healthy individuals (men/women: 935/869). Participants completed the Self-Transcendence Scale (STS) and the Japanese version of the World Health Organization-Subjective Inventory. The Japanese version of the Mini-International Neuropsychiatric Interview was also used for the intractable disease group. Analysis of covariance found a significant increase in STS score among the intractable disease group (P < 0.001). Multiple regression analysis showed that the positive affect measured by the World Health Organization-Subjective Inventory showed the greatest effect on the STS score for the intractable disease group (β = 0.539, P < 0.001). As a life-changing experience, an intractable disease may influence an increase in self-transcendence. The results also showed that there was a strong correlation between self-transcendence and respondents' subjective well-being. Our results suggest that patients with life-changing intractable disease can have a high level of self-transcendence, which may lead them to regain mental well-being, and increase their psychological health even in situations that cause physical and mental suffering. © 2011 The Authors. Psychiatry and Clinical Neurosciences © 2011 Japanese Society of Psychiatry and Neurology.

Closure of laryngotracheal cavity and tracheostomy for intractable aspiration secondary to radiation encephalopathy or radiation damage of cranial nerve after radiotherapy of nasopharyngeal carcinoma.

PubMed

Qu, Shenhong; Su, Zhengzhong; He, Xiaoguang; Li, Min; Li, Tianying

2006-09-01

Closure of the laryngotracheal cavity and tracheostomy is especially suitable for intractable aspiration secondary to radiation encephalopathy or damage of cranial nerve after radiation for nasopharyngeal carcinoma (NPC). To investigate the clinical value, technique, indications and contraindications of closure of the laryngotracheal cavity and tracheostomy for intractable aspiration secondary to radiation encephalopathy (REP) or radiation damage of cranial nerve after radiotherapy of NPC. Thirty patients, suffering from intractable aspiration secondary to radiotherapy for nasopharyngeal carcinoma, were treated with closure of the laryngotracheal cavity and tracheostomy and were observed for at least 1 year. Intractable aspiration and dyspnea were completely eradicated in all patients. The quality of their life was greatly improved.

Rethinking Intractable Conflict: The Perspective of Dynamical Systems

ERIC Educational Resources Information Center

Vallacher, Robin R.; Coleman, Peter T.; Nowak, Andrzej; Bui-Wrzosinska, Lan

2010-01-01

Intractable conflicts are demoralizing. Beyond destabilizing the families, communities, or international regions in which they occur, they tend to perpetuate the very conditions of misery and hate that contributed to them in the first place. Although the common factors and processes associated with intractable conflicts have been identified…

Recurrent intractable hiccups treated by cervical phrenic nerve block under electromyography: report of a case.

PubMed

Sa, Young Jo; Song, Dae Heon; Kim, Jae Jun; Kim, Young Du; Kim, Chi Kyung; Moon, Seok Whan

2015-11-01

Intractable or persistent hiccups require intensive or invasive treatments. The use of a phrenic nerve block or destructive treatment for intractable hiccups has been reported to be a useful and discrete method that might be valuable to patients with this distressing problem and for whom diverse management efforts have failed. We herein report a successful treatment using a removable and adjustable ligature for the phrenic nerve in a patient with recurrent and intractable hiccups, which was employed under the guidance of electromyography.

Assessment of the Density of Suppression to Identify Risk of Intractable Diplopia in the United Kingdom.

PubMed

Newsham, David; O'Connor, Anna R

2016-06-01

Occlusion used to treat amblyopia towards the end of the developmental component of the critical period gives a risk of inducing intractable diplopia. In the United Kingdom, the density of suppression is assessed via the Sbisa/Bagolini filter bar, but there is very little research evidence to guide clinical practice or interpretation of the tests used. The aims of this study were to determine current practice and estimate the incidence of intractable diplopia following amblyopia treatment. Current practice and incidence of intractable diplopia following amblyopia were determined via a questionnaire distributed to head orthoptists in every eye department in the United Kingdom. The questionnaire explored testing and test conditions, interpretation of the test results, and cases of intractable diplopia over the last 5 years. There was considerable variation in clinical practice of the measurement of the density of suppression and interpretation of the results to guide the treatment of amblyopia. The minimum age of patients taking the test ranged from 2 to 8 years and the minimum filter considered still safe to continue treatment ranged from 4 to 17. It is estimated there were 24 cases of intractable diplopia over the last 5 years. The issue of intractable diplopia and amblyopia treatment is likely to become increasingly important as there appears to be greater plasticity and scope to treat amblyopia in teenagers and adults than was previously thought. Lack of knowledge of how to evaluate the risk may lead to more cases of intractable diplopia or alternatively treatment being withheld unnecessarily.

β-glucuronidase use as a single internal control gene may confound analysis in FMR1 mRNA toxicity studies.

PubMed

Kraan, Claudine M; Cornish, Kim M; Bui, Quang M; Li, Xin; Slater, Howard R; Godler, David E

2018-01-01

Relationships between Fragile X Mental Retardation 1 (FMR1) mRNA levels in blood and intragenic FMR1 CGG triplet expansions support the pathogenic role of RNA gain of function toxicity in premutation (PM: 55-199 CGGs) related disorders. Real-time PCR (RT-PCR) studies reporting these findings normalised FMR1 mRNA level to a single internal control gene called β-glucuronidase (GUS). This study evaluated FMR1 mRNA-CGG correlations in 33 PM and 33 age- and IQ-matched control females using three normalisation strategies in peripheral blood mononuclear cells (PBMCs): (i) GUS as a single internal control; (ii) the mean of GUS, Eukaryotic Translation Initiation Factor 4A2 (EIF4A2) and succinate dehydrogenase complex flavoprotein subunit A (SDHA); and (iii) the mean of EIF4A2 and SDHA (with no contribution from GUS). GUS mRNA levels normalised to the mean of EIF4A2 and SDHA mRNA levels and EIF4A2/SDHA ratio were also evaluated. FMR1mRNA level normalised to the mean of EIF4A2 and SDHA mRNA levels, with no contribution from GUS, showed the most significant correlation with CGG size and the greatest difference between PM and control groups (p = 10-11). Only 15% of FMR1 mRNA PM results exceeded the maximum control value when normalised to GUS, compared with over 42% when normalised to the mean of EIF4A2 and SDHA mRNA levels. Neither GUS mRNA level normalised to the mean RNA levels of EIF4A2 and SDHA, nor to the EIF4A2/SDHA ratio were correlated with CGG size. However, greater variability in GUS mRNA levels were observed for both PM and control females across the full range of CGG repeat as compared to the EIF4A2/SDHA ratio. In conclusion, normalisation with multiple control genes, excluding GUS, can improve assessment of the biological significance of FMR1 mRNA-CGG size relationships.

Political Socialization of Young Children in Intractable Conflicts: Conception and Evidence

ERIC Educational Resources Information Center

Bar-Tal, Daniel; Diamond, Aurel Harrison; Nasie, Meytal

2017-01-01

This article examines the political socialization of young children who live under conditions of intractable conflict. We present four premises: First, we argue that, within the context of intractable conflict, political socialization begins earlier and faster than previously suspected, and is evident among young children. Second, we propose that…

A sterile-female technique proposed for control of Striga hermonthica and other intractable weeds: Advantages, shortcomings, and risk management

USDA-ARS?s Scientific Manuscript database

Weeds have posed intractable challenges to farmers since the dawn of agriculture. This article describes in detail a proposed control strategy based on the introduction of genes conferring female-sterility into the genomes of intractable target weeds. Spread of these genes through target populations...

Predictors and Course of Medically Intractable Epilepsy in Young Children Presenting Before 36 Months of Age: A Retrospective, Population-Based Study

PubMed Central

Wirrell, Elaine; Wong-Kisiel, Lily; Mandrekar, Jay; Nickels, Katherine

2012-01-01

Purpose To determine the prevalence and identify predictors of medical intractability in children presenting with epilepsy prior to 36 months of age, and to assess the impact of medical intractability on long-term mortality and intellectual function. Methods Children with newly-diagnosed epilepsy prior to 36 months between 1980–2009 while resident in Olmsted County, MN were identified. Medical records were reviewed to collect epilepsy specific variables and long-term outcome data. Medically intractable epilepsy was defined as either (1) seizures greater than every 6 months at final follow-up and failure of two or more antiepileptic drugs for lack of efficacy, or (2) having undergone epilepsy surgery after failure of two or more antiepileptic drugs. Key Findings One hundred and twenty seven children with new-onset epilepsy were identified and followed for a median of 78 months. Medically intractable seizures occurred in 35%, and significant predictors on multivariate analysis were age ≤12 months at diagnosis (odds ratio [OR] 6.76, 95% confidence interval [CI] 2.00, 22.84, p=0.002), developmental delay at initial diagnosis of epilepsy (OR 20.03, 95% CI 3.49, 114.83, p=0.0008 ), neuroimaging abnormality (OR 6.48, 95% CI 1.96, 21.40, p=0.002) and focal slowing on initial EEG (OR 5.33, 95% CI 1.14, 24.88, p=0.03). Medical intractability occurred early in the course in most children, being seen in 61% by one year, and 93% by five years after initial diagnosis. Mortality was higher (20% vs 0%, p<0.001) and intellectual outcome poorer (p<0.001) if epilepsy was medically intractable. Significance One third of children presenting with epilepsy before 36 months will be medically intractable and significant predictors are identified. Medically intractable epilepsy is associated with increased mortality risk and significant intellectual disability. PMID:22738069

Growth hormone used to control intractable bleeding caused by radiation-induced gastritis.

PubMed

Zhang, Liang; Xia, Wen-Jie; Zhang, Zheng-Sen; Lu, Xin-Liang

2015-08-21

Intractable bleeding caused by radiation-induced gastritis is rare. We describe a 69-year-old man with intractable hemorrhagic gastritis induced by postoperative radiotherapy for the treatment of esophageal carcinoma. Although anti-secretory therapy with or without octreotide was initiated for hemostasis over three months, melena still occurred off and on, and the patient required blood transfusions to maintain stable hemoglobin. Finally growth hormone was used in the treatment of hemorrhage for two weeks, and hemostasis was successfully achieved. This is the first report that growth hormone has been used to control intractable bleeding caused by radiation-induced gastritis.

The influence of digital filter type, amplitude normalisation method, and co-contraction algorithm on clinically relevant surface electromyography data during clinical movement assessments.

PubMed

Devaprakash, Daniel; Weir, Gillian J; Dunne, James J; Alderson, Jacqueline A; Donnelly, Cyril J

2016-12-01

There is a large and growing body of surface electromyography (sEMG) research using laboratory-specific signal processing procedures (i.e., digital filter type and amplitude normalisation protocols) and data analyses methods (i.e., co-contraction algorithms) to acquire practically meaningful information from these data. As a result, the ability to compare sEMG results between studies is, and continues to be challenging. The aim of this study was to determine if digital filter type, amplitude normalisation method, and co-contraction algorithm could influence the practical or clinical interpretation of processed sEMG data. Sixteen elite female athletes were recruited. During data collection, sEMG data was recorded from nine lower limb muscles while completing a series of calibration and clinical movement assessment trials (running and sidestepping). Three analyses were conducted: (1) signal processing with two different digital filter types (Butterworth or critically damped), (2) three amplitude normalisation methods, and (3) three co-contraction ratio algorithms. Results showed the choice of digital filter did not influence the clinical interpretation of sEMG; however, choice of amplitude normalisation method and co-contraction algorithm did influence the clinical interpretation of the running and sidestepping task. Care is recommended when choosing amplitude normalisation method and co-contraction algorithms if researchers/clinicians are interested in comparing sEMG data between studies. Copyright © 2016 Elsevier Ltd. All rights reserved.

A comparison of working in small-scale and large-scale nursing homes: A systematic review of quantitative and qualitative evidence.

PubMed

Vermeerbergen, Lander; Van Hootegem, Geert; Benders, Jos

2017-02-01

Ongoing shortages of care workers, together with an ageing population, make it of utmost importance to increase the quality of working life in nursing homes. Since the 1970s, normalised and small-scale nursing homes have been increasingly introduced to provide care in a family and homelike environment, potentially providing a richer work life for care workers as well as improved living conditions for residents. 'Normalised' refers to the opportunities given to residents to live in a manner as close as possible to the everyday life of persons not needing care. The study purpose is to provide a synthesis and overview of empirical research comparing the quality of working life - together with related work and health outcomes - of professional care workers in normalised small-scale nursing homes as compared to conventional large-scale ones. A systematic review of qualitative and quantitative studies. A systematic literature search (April 2015) was performed using the electronic databases Pubmed, Embase, PsycInfo, CINAHL and Web of Science. References and citations were tracked to identify additional, relevant studies. We identified 825 studies in the selected databases. After checking the inclusion and exclusion criteria, nine studies were selected for review. Two additional studies were selected after reference and citation tracking. Three studies were excluded after requesting more information on the research setting. The findings from the individual studies suggest that levels of job control and job demands (all but "time pressure") are higher in normalised small-scale homes than in conventional large-scale nursing homes. Additionally, some studies suggested that social support and work motivation are higher, while risks of burnout and mental strain are lower, in normalised small-scale nursing homes. Other studies found no differences or even opposing findings. The studies reviewed showed that these inconclusive findings can be attributed to care workers in some normalised small-scale homes experiencing isolation and too high job demands in their work roles. This systematic review suggests that normalised small-scale homes are a good starting point for creating a higher quality of working life in the nursing home sector. Higher job control enables care workers to manage higher job demands in normalised small-scale homes. However, some jobs would benefit from interventions to address care workers' perceptions of too low social support and of too high job demands. More research is needed to examine strategies to enhance these working life issues in normalised small-scale settings. Copyright © 2016 Elsevier Ltd. All rights reserved.

Peace Education in Societies Involved in Intractable Conflicts: Direct and Indirect Models

ERIC Educational Resources Information Center

Bar-Tal, Daniel; Rosen, Yigal

2009-01-01

The present article deals with the crucial question: Can peace education facilitate change in the sociopsychological infrastructure that feeds continued intractable conflict and then how the change can be carried? Intractable conflicts still rage in various parts of the globe, and they not only cause local misery and suffering but also threaten…

Image processing in digital pathology: an opportunity to solve inter-batch variability of immunohistochemical staining

NASA Astrophysics Data System (ADS)

van Eycke, Yves-Rémi; Allard, Justine; Salmon, Isabelle; Debeir, Olivier; Decaestecker, Christine

2017-02-01

Immunohistochemistry (IHC) is a widely used technique in pathology to evidence protein expression in tissue samples. However, this staining technique is known for presenting inter-batch variations. Whole slide imaging in digital pathology offers a possibility to overcome this problem by means of image normalisation techniques. In the present paper we propose a methodology to objectively evaluate the need of image normalisation and to identify the best way to perform it. This methodology uses tissue microarray (TMA) materials and statistical analyses to evidence the possible variations occurring at colour and intensity levels as well as to evaluate the efficiency of image normalisation methods in correcting them. We applied our methodology to test different methods of image normalisation based on blind colour deconvolution that we adapted for IHC staining. These tests were carried out for different IHC experiments on different tissue types and targeting different proteins with different subcellular localisations. Our methodology enabled us to establish and to validate inter-batch normalization transforms which correct the non-relevant IHC staining variations. The normalised image series were then processed to extract coherent quantitative features characterising the IHC staining patterns.

Image processing in digital pathology: an opportunity to solve inter-batch variability of immunohistochemical staining

PubMed Central

Van Eycke, Yves-Rémi; Allard, Justine; Salmon, Isabelle; Debeir, Olivier; Decaestecker, Christine

2017-01-01

Immunohistochemistry (IHC) is a widely used technique in pathology to evidence protein expression in tissue samples. However, this staining technique is known for presenting inter-batch variations. Whole slide imaging in digital pathology offers a possibility to overcome this problem by means of image normalisation techniques. In the present paper we propose a methodology to objectively evaluate the need of image normalisation and to identify the best way to perform it. This methodology uses tissue microarray (TMA) materials and statistical analyses to evidence the possible variations occurring at colour and intensity levels as well as to evaluate the efficiency of image normalisation methods in correcting them. We applied our methodology to test different methods of image normalisation based on blind colour deconvolution that we adapted for IHC staining. These tests were carried out for different IHC experiments on different tissue types and targeting different proteins with different subcellular localisations. Our methodology enabled us to establish and to validate inter-batch normalization transforms which correct the non-relevant IHC staining variations. The normalised image series were then processed to extract coherent quantitative features characterising the IHC staining patterns. PMID:28220842

There is no silver bullet--a guide to low-level data transforms and normalisation methods for microarray data.

PubMed

Kreil, David P; Russell, Roslin R

2005-03-01

To overcome random experimental variation, even for simple screens, data from multiple microarrays have to be combined. There are, however, systematic differences between arrays, and any bias remaining after experimental measures to ensure consistency needs to be controlled for. It is often difficult to make the right choice of data transformation and normalisation methods to achieve this end. In this tutorial paper we review the problem and a selection of solutions, explaining the basic principles behind normalisation procedures and providing guidance for their application.

On the Parameterized Complexity of Some Optimization Problems Related to Multiple-Interval Graphs

NASA Astrophysics Data System (ADS)

Jiang, Minghui

We show that for any constant t ≥ 2, K -Independent Set and K-Dominating Set in t-track interval graphs are W[1]-hard. This settles an open question recently raised by Fellows, Hermelin, Rosamond, and Vialette. We also give an FPT algorithm for K-Clique in t-interval graphs, parameterized by both k and t, with running time max { t O(k), 2 O(klogk) } ·poly(n), where n is the number of vertices in the graph. This slightly improves the previous FPT algorithm by Fellows, Hermelin, Rosamond, and Vialette. Finally, we use the W[1]-hardness of K-Independent Set in t-track interval graphs to obtain the first parameterized intractability result for a recent bioinformatics problem called Maximal Strip Recovery (MSR). We show that MSR-d is W[1]-hard for any constant d ≥ 4 when the parameter is either the total length of the strips, or the total number of adjacencies in the strips, or the number of strips in the optimal solution.

Characteristics and safety assessment of intractable proteins in genetically modified crops.

PubMed

Bushey, Dean F; Bannon, Gary A; Delaney, Bryan F; Graser, Gerson; Hefford, Mary; Jiang, Xiaoxu; Lee, Thomas C; Madduri, Krishna M; Pariza, Michael; Privalle, Laura S; Ranjan, Rakesh; Saab-Rincon, Gloria; Schafer, Barry W; Thelen, Jay J; Zhang, John X Q; Harper, Marc S

2014-07-01

Genetically modified (GM) crops may contain newly expressed proteins that are described as "intractable". Safety assessment of these proteins may require some adaptations to the current assessment procedures. Intractable proteins are defined here as those proteins with properties that make it extremely difficult or impossible with current methods to express in heterologous systems; isolate, purify, or concentrate; quantify (due to low levels); demonstrate biological activity; or prove equivalency with plant proteins. Five classes of intractable proteins are discussed here: (1) membrane proteins, (2) signaling proteins, (3) transcription factors, (4) N-glycosylated proteins, and (5) resistance proteins (R-proteins, plant pathogen recognition proteins that activate innate immune responses). While the basic tiered weight-of-evidence approach for assessing the safety of GM crops proposed by the International Life Sciences Institute (ILSI) in 2008 is applicable to intractable proteins, new or modified methods may be required. For example, the first two steps in Tier I (hazard identification) analysis, gathering of applicable history of safe use (HOSU) information and bioinformatics analysis, do not require protein isolation. The extremely low level of expression of most intractable proteins should be taken into account while assessing safety of the intractable protein in GM crops. If Tier II (hazard characterization) analyses requiring animal feeding are judged to be necessary, alternatives to feeding high doses of pure protein may be needed. These alternatives are discussed here. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

SNF5 Mutation Leads to Intractable Pain in Schwannomatosis Patients

DTIC Science & Technology

2012-07-01

AD_________________ Award Number: W81XWH-11-1-0143 TITLE: SNF5 mutation leads to intractable pain in schwannomatosis patients...DATES COVERED 15-June-2011 to 14-June-2012 4. TITLE AND SUBTITLE SNF5 mutation leads to intractable pain in schwannomatosis patients 5a. CONTRACT...6 Introduction. Schwannomatosis does not affect longevity but it has profound effects on the patient’s quality of

Physical Feature Encoding and Word Recognition Abilities Are Altered in Children with Intractable Epilepsy: Preliminary Neuromagnetic Evidence

PubMed Central

Pardos, Maria; Korostenskaja, Milena; Xiang, Jing; Fujiwara, Hisako; Lee, Ki H.; Horn, Paul S.; Byars, Anna; Vannest, Jennifer; Wang, Yingying; Hemasilpin, Nat; Rose, Douglas F.

2015-01-01

Objective evaluation of language function is critical for children with intractable epilepsy under consideration for epilepsy surgery. The purpose of this preliminary study was to evaluate word recognition in children with intractable epilepsy by using magnetoencephalography (MEG). Ten children with intractable epilepsy (M/F 6/4, mean ± SD 13.4 ± 2.2 years) were matched on age and sex to healthy controls. Common nouns were presented simultaneously from visual and auditory sensory inputs in “match” and “mismatch” conditions. Neuromagnetic responses M1, M2, M3, M4, and M5 with latencies of ~100 ms, ~150 ms, ~250 ms, ~350 ms, and ~450 ms, respectively, elicited during the “match” condition were identified. Compared to healthy children, epilepsy patients had both significantly delayed latency of the M1 and reduced amplitudes of M3 and M5 responses. These results provide neurophysiologic evidence of altered word recognition in children with intractable epilepsy. PMID:26146459

Nutrient intake of children with intractable epilepsy compared with healthy children.

PubMed

Volpe, Stella L; Schall, Joan I; Gallagher, Paul R; Stallings, Virginia A; Bergqvist, A G Christina

2007-06-01

Growth retardation is common among children with epilepsy, and poor dietary intake may be one of the causes. The goal of this cross-sectional study was to compare the nutrient intake of children 1 to 8 years of age with intractable epilepsy to healthy children of the same age from the National Health and Nutrition Examination Survey 2001 to 2002 (N=1,718) and with the Dietary Reference Intakes. Children with intractable epilepsy were divided into two age groups: 1.0 to 3.9 and 4.0 to 8.9 years, to correspond with the Dietary Reference Intakes. Forty-three children with intractable epilepsy, mean age=4.7+/-2.2 years, had significantly lower intakes (P<0.05) of total energy; protein; carbohydrate; fat; dietary fiber; vitamins A, E, B-6, and B-12; riboflavin; niacin; folate; calcium; phosphorus; magnesium; zinc; copper; and selenium compared with healthy children. Thirty percent or more of the children with intractable epilepsy in both age groups had intakes below the Recommended Dietary Allowance or Adequate Intake for vitamins D, E, and K; folate; calcium; linoleic acid; and alpha-linolenic acid. Health care professionals caring for children with intractable epilepsy should be aware of this pattern of decreased nutrient intake and educate families to provide an adequate diet and/or consider vitamin/mineral supplementation.

Intractable seizures after a lengthy remission in childhood-onset epilepsy.

PubMed

Camfield, Peter R; Camfield, Carol S

2017-12-01

To establish the risk of subsequent intractable epilepsy after ≥2, ≥5, and ≥10 years of remission in childhood-onset epilepsy. From the Nova Scotia childhood-onset epilepsy population-based cohort patients with all types of epilepsy were selected with ≥20 years follow-up from seizure onset (incidence cases). Children with childhood absence epilepsy were excluded. The rate of subsequent intractable epilepsy was then studied for patients with ≥5 years remission on or off AED treatment and compared with the rate for those with ≥2 and ≥10 years of remission. Three hundred eighty-eight eligible patients had ≥20 years follow-up (average 27.7 ± (standard deviation) 4 years) until they were an average of 34 ± 6.5 years of age. Overall, 297 (77%) had a period of ≥5 years of seizure freedom (average 21.2 ± 8 years), with 90% of these remissions continuing to the end of follow-up. Seizures recurred in 31 (10%) and were intractable in 7 (2%). For the 332 with a remission of ≥2 years seizure-free, 6.9% subsequently developed intractable epilepsy (p = 0.001). For the 260 with ≥10 years remission, 0.78% subsequently developed intractable epilepsy (p = 0.25 compared with ≥5 years remission). Even after ≥5 or ≥10 years of seizure freedom, childhood-onset epilepsy may reappear and be intractable. The risk is fortunately small, but for most patients it is not possible to guarantee a permanent remission. Wiley Periodicals, Inc. © 2017 International League Against Epilepsy.

The importance of body mass normalisation for ultrasound measurements of the morphology of oblique abdominis muscles: the effect of age, gender, and sport practice.

PubMed

Linek, P

2018-01-01

Some studies have not considered body mass as a confounder in analysis of oblique abdominis muscles (OAM) (including the oblique externus [OE] and oblique internus [OI]), which may have led to improper interpretation of results. To assess the differences in the effect of age, gender, and physical activity between normalised for body mass and actual values of the OAM as well as to establish the effect of age, gender, and physical activity on normalised for body mass OAM thicknesses in adolescents. A real-time ultrasound was used to obtain images of the OAM. Body mass normalisation for OAM thicknesses was performed with allometric scaling and the following equations: Allometric-scaled OE = OE thickness/body mass0.88; Allometric-scaled OI = OI thickness/body mass0.72. Analysis showed that boys have significantly thicker OAM than girls, and those who practise sports have thicker OAM than non-active individuals. For allometric-scaled OAM, there was only a significant gender effect, where boys have thicker allometric-scaled OAM than girls. There was a significant correlation between participants' age and the actual value of the OAM. The correlations between age and allometric-scaled OAM were insignificant. An analysis of OAM without body mass normalisation can lead to improper interpretation of study results. Thus, future studies should analyse OE and OI thickness measurements after normalisation rather than actual values. In the adolescent population, there is no effect of age and physical activity on allometric-scaled OAM; males have thicker allometric-scaled OAM than females. (Folia Morphol 2018; 77, 1: 123-130).

Random forest meteorological normalisation models for Swiss PM10 trend analysis

NASA Astrophysics Data System (ADS)

Grange, Stuart K.; Carslaw, David C.; Lewis, Alastair C.; Boleti, Eirini; Hueglin, Christoph

2018-05-01

Meteorological normalisation is a technique which accounts for changes in meteorology over time in an air quality time series. Controlling for such changes helps support robust trend analysis because there is more certainty that the observed trends are due to changes in emissions or chemistry, not changes in meteorology. Predictive random forest models (RF; a decision tree machine learning technique) were grown for 31 air quality monitoring sites in Switzerland using surface meteorological, synoptic scale, boundary layer height, and time variables to explain daily PM10 concentrations. The RF models were used to calculate meteorologically normalised trends which were formally tested and evaluated using the Theil-Sen estimator. Between 1997 and 2016, significantly decreasing normalised PM10 trends ranged between -0.09 and -1.16 µg m-3 yr-1 with urban traffic sites experiencing the greatest mean decrease in PM10 concentrations at -0.77 µg m-3 yr-1. Similar magnitudes have been reported for normalised PM10 trends for earlier time periods in Switzerland which indicates PM10 concentrations are continuing to decrease at similar rates as in the past. The ability for RF models to be interpreted was leveraged using partial dependence plots to explain the observed trends and relevant physical and chemical processes influencing PM10 concentrations. Notably, two regimes were suggested by the models which cause elevated PM10 concentrations in Switzerland: one related to poor dispersion conditions and a second resulting from high rates of secondary PM generation in deep, photochemically active boundary layers. The RF meteorological normalisation process was found to be robust, user friendly and simple to implement, and readily interpretable which suggests the technique could be useful in many air quality exploratory data analysis situations.

Clinical outcomes after arthroscopic release for recalcitrant frozen shoulder.

PubMed

Ebrahimzadeh, Mohammad H; Moradi, Ali; Pour, Mostafa Khalili; Moghadam, Mohammad Hallaj; Kachooei, Amir Reza

2014-09-01

To explain the role of arthroscopic release in intractable frozen shoulders. We used different questionnaires and measuring tools to understand whether arthroscopic release is the superior modality to treat patients with intractable frozen shoulders. Between 2007 and 2013, in a prospective study, we enrolled 80 patients (52 females and 28 males) with recalcitrant frozen shoulder, who underwent arthroscopic release at Ghaem Hospital, a tertiary referral center, in Mashhad, Iran. Before operation, all patients filled out the Disability of Arm, Shoulder and Hand (DASH), Constant, University of California Los Angeles (UCLA), ROWE and Visual Analogue Scale (VAS) for pain questionnaires. We measured the difference in range of motion between both the normal and the frozen shoulders in each patient. The average age of the patients was 50.8±7.1 years. In 49 patients, the right shoulder was affected and in the remaining 31 the left side was affected. Before surgery, the patients were suffering from this disease on average for 11.7±10.3 months. The average time to follow-up was 47.2±6.8 months (14 to 60 months). Diabetes mellitus (38%) and history of shoulder trauma (23%) were the most common comorbidities in our patients. We did not find any significant differences between baseline characteristics of diabetics patients with non-diabetics ones. After surgery, the average time to achieve maximum pain improvement and range of motion were 3.6±2.1 and 3.6±2 months, respectively. The VAS score, constant shoulder score, Rowe score, UCLA shoulder score, and DASH score showed significant improvement in shoulder function after surgery, and shoulder range of motion improved in all directions compared to pre-operation range of motion. According to our results, arthroscopic release of recalcitrant frozen shoulder is a valuable modality in treating this disease. This method could decrease pain and improve both subjective and objective mid-term outcomes.

Clinical Outcomes after Arthroscopic Release for Recalcitrant Frozen Shoulder

PubMed Central

Ebrahimzadeh, Mohammad H; Moradi, Ali; Pour, Mostafa Khalili; Moghadam, Mohammad Hallaj; Kachooei, Amir Reza

2014-01-01

Background: To explain the role of arthroscopic release in intractable frozen shoulders. We used different questionnaires and measuring tools to understand whether arthroscopic release is the superior modality to treat patients with intractable frozen shoulders. Methods: Between 2007 and 2013, in a prospective study, we enrolled 80 patients (52 females and 28 males) with recalcitrant frozen shoulder, who underwent arthroscopic release at Ghaem Hospital, a tertiary referral center, in Mashhad, Iran. Before operation, all patients filled out the Disability of Arm, Shoulder and Hand (DASH), Constant, University of California Los Angeles (UCLA), ROWE and Visual Analogue Scale (VAS) for pain questionnaires. We measured the difference in range of motion between both the normal and the frozen shoulders in each patient. Results: The average age of the patients was 50.8±7.1 years. In 49 patients, the right shoulder was affected and in the remaining 31 the left side was affected. Before surgery, the patients were suffering from this disease on average for 11.7±10.3 months. The average time to follow-up was 47.2±6.8 months (14 to 60 months). Diabetes mellitus (38%) and history of shoulder trauma (23%) were the most common comorbidities in our patients. We did not find any significant differences between baseline characteristics of diabetics patients with non-diabetics ones. After surgery, the average time to achieve maximum pain improvement and range of motion were 3.6±2.1 and 3.6±2 months, respectively. The VAS score, constant shoulder score, Rowe score, UCLA shoulder score, and DASH score showed significant improvement in shoulder function after surgery, and shoulder range of motion improved in all directions compared to pre-operation range of motion. Conclusions: According to our results, arthroscopic release of recalcitrant frozen shoulder is a valuable modality in treating this disease. This method could decrease pain and improve both subjective and objective mid-term outcomes. PMID:25386586

J/ψ production as a function of charged-particle pseudorapidity density in p-Pb collisions at √{sNN } = 5.02TeV

NASA Astrophysics Data System (ADS)

Adamová, D.; Aggarwal, M. M.; Aglieri Rinella, G.; Agnello, M.; Agrawal, N.; Ahammed, Z.; Ahmad, N.; Ahn, S. U.; Aiola, S.; Akindinov, A.; Alam, S. N.; Albuquerque, D. S. D.; Aleksandrov, D.; Alessandro, B.; Alexandre, D.; Alfaro Molina, R.; Alici, A.; Alkin, A.; Alme, J.; Alt, T.; Altsybeev, I.; Alves Garcia Prado, C.; An, M.; Andrei, C.; Andrews, H. A.; Andronic, A.; Anguelov, V.; Anson, C.; Antičić, T.; Antinori, F.; Antonioli, P.; Anwar, R.; Aphecetche, L.; Appelshäuser, H.; Arcelli, S.; Arnaldi, R.; Arnold, O. W.; Arsene, I. C.; Arslandok, M.; Audurier, B.; Augustinus, A.; Averbeck, R.; Azmi, M. D.; Badalà, A.; Baek, Y. W.; Bagnasco, S.; Bailhache, R.; Bala, R.; Baldisseri, A.; Ball, M.; Baral, R. C.; Barbano, A. M.; Barbera, R.; Barile, F.; Barioglio, L.; Barnaföldi, G. G.; Barnby, L. S.; Barret, V.; Bartalini, P.; Barth, K.; Bartke, J.; Bartsch, E.; Basile, M.; Bastid, N.; Basu, S.; Bathen, B.; Batigne, G.; Batista Camejo, A.; Batyunya, B.; Batzing, P. C.; Bearden, I. G.; Beck, H.; Bedda, C.; Behera, N. K.; Belikov, I.; Bellini, F.; Bello Martinez, H.; Bellwied, R.; Beltran, L. G. E.; Belyaev, V.; Bencedi, G.; Beole, S.; Bercuci, A.; Berdnikov, Y.; Berenyi, D.; Bertens, R. A.; Berzano, D.; Betev, L.; Bhasin, A.; Bhat, I. R.; Bhati, A. K.; Bhattacharjee, B.; Bhom, J.; Bianchi, L.; Bianchi, N.; Bianchin, C.; Bielčík, J.; Bielčíková, J.; Bilandzic, A.; Biro, G.; Biswas, R.; Biswas, S.; Blair, J. T.; Blau, D.; Blume, C.; Boca, G.; Bock, F.; Bogdanov, A.; Boldizsár, L.; Bombara, M.; Bonomi, G.; Bonora, M.; Book, J.; Borel, H.; Borissov, A.; Borri, M.; Botta, E.; Bourjau, C.; Braun-Munzinger, P.; Bregant, M.; Broker, T. A.; Browning, T. A.; Broz, M.; Brucken, E. J.; Bruna, E.; Bruno, G. E.; Budnikov, D.; Buesching, H.; Bufalino, S.; Buhler, P.; Buitron, S. A. I.; Buncic, P.; Busch, O.; Buthelezi, Z.; Butt, J. B.; Buxton, J. T.; Cabala, J.; Caffarri, D.; Caines, H.; Caliva, A.; Calvo Villar, E.; Camerini, P.; Capon, A. A.; Carena, F.; Carena, W.; Carnesecchi, F.; Castillo Castellanos, J.; Castro, A. J.; Casula, E. A. R.; Ceballos Sanchez, C.; Cerello, P.; Chang, B.; Chapeland, S.; Chartier, M.; Charvet, J. L.; Chattopadhyay, S.; Chattopadhyay, S.; Chauvin, A.; Cherney, M.; Cheshkov, C.; Cheynis, B.; Chibante Barroso, V.; Chinellato, D. D.; Cho, S.; Chochula, P.; Choi, K.; Chojnacki, M.; Choudhury, S.; Christakoglou, P.; Christensen, C. H.; Christiansen, P.; Chujo, T.; Chung, S. U.; Cicalo, C.; Cifarelli, L.; Cindolo, F.; Cleymans, J.; Colamaria, F.; Colella, D.; Collu, A.; Colocci, M.; Conesa Balbastre, G.; Conesa Del Valle, Z.; Connors, M. E.; Contreras, J. G.; Cormier, T. M.; Corrales Morales, Y.; Cortés Maldonado, I.; Cortese, P.; Cosentino, M. R.; Costa, F.; Costanza, S.; Crkovská, J.; Crochet, P.; Cuautle, E.; Cunqueiro, L.; Dahms, T.; Dainese, A.; Danisch, M. C.; Danu, A.; Das, D.; Das, I.; Das, S.; Dash, A.; Dash, S.; de, S.; de Caro, A.; de Cataldo, G.; de Conti, C.; de Cuveland, J.; de Falco, A.; de Gruttola, D.; De Marco, N.; de Pasquale, S.; de Souza, R. D.; Degenhardt, H. F.; Deisting, A.; Deloff, A.; Deplano, C.; Dhankher, P.; di Bari, D.; di Mauro, A.; di Nezza, P.; di Ruzza, B.; Diaz Corchero, M. A.; Dietel, T.; Dillenseger, P.; Divià, R.; Djuvsland, Ø.; Dobrin, A.; Domenicis Gimenez, D.; Dönigus, B.; Dordic, O.; Drozhzhova, T.; Dubey, A. K.; Dubla, A.; Ducroux, L.; Duggal, A. K.; Dupieux, P.; Ehlers, R. J.; Elia, D.; Endress, E.; Engel, H.; Epple, E.; Erazmus, B.; Erhardt, F.; Espagnon, B.; Esumi, S.; Eulisse, G.; Eum, J.; Evans, D.; Evdokimov, S.; Fabbietti, L.; Faivre, J.; Fantoni, A.; Fasel, M.; Feldkamp, L.; Feliciello, A.; Feofilov, G.; Ferencei, J.; Fernández Téllez, A.; Ferreiro, E. G.; Ferretti, A.; Festanti, A.; Feuillard, V. J. G.; Figiel, J.; Figueredo, M. A. S.; Filchagin, S.; Finogeev, D.; Fionda, F. M.; Fiore, E. M.; Floris, M.; Foertsch, S.; Foka, P.; Fokin, S.; Fragiacomo, E.; Francescon, A.; Francisco, A.; Frankenfeld, U.; Fronze, G. G.; Fuchs, U.; Furget, C.; Furs, A.; Fusco Girard, M.; Gaardhøje, J. J.; Gagliardi, M.; Gago, A. M.; Gajdosova, K.; Gallio, M.; Galvan, C. D.; Ganoti, P.; Gao, C.; Garabatos, C.; Garcia-Solis, E.; Garg, K.; Garg, P.; Gargiulo, C.; Gasik, P.; Gauger, E. F.; Gay Ducati, M. B.; Germain, M.; Ghosh, P.; Ghosh, S. K.; Gianotti, P.; Giubellino, P.; Giubilato, P.; Gladysz-Dziadus, E.; Glässel, P.; Goméz Coral, D. M.; Gomez Ramirez, A.; Gonzalez, A. S.; Gonzalez, V.; González-Zamora, P.; Gorbunov, S.; Görlich, L.; Gotovac, S.; Grabski, V.; Graczykowski, L. K.; Graham, K. L.; Greiner, L.; Grelli, A.; Grigoras, C.; Grigoriev, V.; Grigoryan, A.; Grigoryan, S.; Grion, N.; Gronefeld, J. M.; Grosa, F.; Grosse-Oetringhaus, J. F.; Grosso, R.; Gruber, L.; Grull, F. R.; Guber, F.; Guernane, R.; Guerzoni, B.; Gulbrandsen, K.; Gunji, T.; Gupta, A.; Gupta, R.; Guzman, I. B.; Haake, R.; Hadjidakis, C.; Hamagaki, H.; Hamar, G.; Hamon, J. C.; Harris, J. W.; Harton, A.; Hatzifotiadou, D.; Hayashi, S.; Heckel, S. T.; Hellbär, E.; Helstrup, H.; Herghelegiu, A.; Herrera Corral, G.; Herrmann, F.; Hess, B. A.; Hetland, K. F.; Hillemanns, H.; Hippolyte, B.; Hladky, J.; Hohlweger, B.; Horak, D.; Hosokawa, R.; Hristov, P.; Hughes, C.; Humanic, T. J.; Hussain, N.; Hussain, T.; Hutter, D.; Hwang, D. S.; Ilkaev, R.; Inaba, M.; Ippolitov, M.; Irfan, M.; Isakov, V.; Islam, M. S.; Ivanov, M.; Ivanov, V.; Izucheev, V.; Jacak, B.; Jacazio, N.; Jacobs, P. M.; Jadhav, M. B.; Jadlovska, S.; Jadlovsky, J.; Jaelani, S.; Jahnke, C.; Jakubowska, M. J.; Janik, M. A.; Jayarathna, P. H. S. Y.; Jena, C.; Jena, S.; Jercic, M.; Jimenez Bustamante, R. T.; Jones, P. G.; Jusko, A.; Kalinak, P.; Kalweit, A.; Kang, J. H.; Kaplin, V.; Kar, S.; Karasu Uysal, A.; Karavichev, O.; Karavicheva, T.; Karayan, L.; Karpechev, E.; Kebschull, U.; Keidel, R.; Keijdener, D. L. D.; Keil, M.; Ketzer, B.; Mohisin Khan, M.; Khan, P.; Khan, S. A.; Khanzadeev, A.; Kharlov, Y.; Khatun, A.; Khuntia, A.; Kielbowicz, M. M.; Kileng, B.; Kim, D. W.; Kim, D. J.; Kim, D.; Kim, H.; Kim, J. S.; Kim, J.; Kim, M.; Kim, M.; Kim, S.; Kim, T.; Kirsch, S.; Kisel, I.; Kiselev, S.; Kisiel, A.; Kiss, G.; Klay, J. L.; Klein, C.; Klein, J.; Klein-Bösing, C.; Klewin, S.; Kluge, A.; Knichel, M. L.; Knospe, A. G.; Kobdaj, C.; Kofarago, M.; Kollegger, T.; Kolojvari, A.; Kondratiev, V.; Kondratyeva, N.; Kondratyuk, E.; Konevskikh, A.; Kopcik, M.; Kour, M.; Kouzinopoulos, C.; Kovalenko, O.; Kovalenko, V.; Kowalski, M.; Koyithatta Meethaleveedu, G.; Králik, I.; Kravčáková, A.; Krivda, M.; Krizek, F.; Kryshen, E.; Krzewicki, M.; Kubera, A. M.; Kučera, V.; Kuhn, C.; Kuijer, P. G.; Kumar, A.; Kumar, J.; Kumar, L.; Kumar, S.; Kundu, S.; Kurashvili, P.; Kurepin, A.; Kurepin, A. B.; Kuryakin, A.; Kushpil, S.; Kweon, M. J.; Kwon, Y.; La Pointe, S. L.; La Rocca, P.; Lagana Fernandes, C.; Lakomov, I.; Langoy, R.; Lapidus, K.; Lara, C.; Lardeux, A.; Lattuca, A.; Laudi, E.; Lavicka, R.; Lazaridis, L.; Lea, R.; Leardini, L.; Lee, S.; Lehas, F.; Lehner, S.; Lehrbach, J.; Lemmon, R. C.; Lenti, V.; Leogrande, E.; León Monzón, I.; Lévai, P.; Li, S.; Li, X.; Lien, J.; Lietava, R.; Lindal, S.; Lindenstruth, V.; Lippmann, C.; Lisa, M. A.; Litichevskyi, V.; Ljunggren, H. M.; Llope, W. J.; Lodato, D. F.; Loenne, P. I.; Loginov, V.; Loizides, C.; Loncar, P.; Lopez, X.; López Torres, E.; Lowe, A.; Luettig, P.; Lunardon, M.; Luparello, G.; Lupi, M.; Lutz, T. H.; Maevskaya, A.; Mager, M.; Mahajan, S.; Mahmood, S. M.; Maire, A.; Majka, R. D.; Malaev, M.; Maldonado Cervantes, I.; Malinina, L.; Mal'Kevich, D.; Malzacher, P.; Mamonov, A.; Manko, V.; Manso, F.; Manzari, V.; Mao, Y.; Marchisone, M.; Mareš, J.; Margagliotti, G. V.; Margotti, A.; Margutti, J.; Marín, A.; Markert, C.; Marquard, M.; Martin, N. A.; Martin Blanco, J.; Martinengo, P.; Martinez, J. A. L.; Martínez, M. I.; Martínez García, G.; Martinez Pedreira, M.; Mas, A.; Masciocchi, S.; Masera, M.; Masoni, A.; Mastroserio, A.; Mathis, A. M.; Matyja, A.; Mayer, C.; Mazer, J.; Mazzilli, M.; Mazzoni, M. A.; Meddi, F.; Melikyan, Y.; Menchaca-Rocha, A.; Meninno, E.; Mercado Pérez, J.; Meres, M.; Mhlanga, S.; Miake, Y.; Mieskolainen, M. M.; Mihaylov, D. L.; Mikhaylov, K.; Milano, L.; Milosevic, J.; Mischke, A.; Mishra, A. N.; Miśkowiec, D.; Mitra, J.; Mitu, C. M.; Mohammadi, N.; Mohanty, B.; Montes, E.; Moreira de Godoy, D. A.; Moreno, L. A. P.; Moretto, S.; Morreale, A.; Morsch, A.; Muccifora, V.; Mudnic, E.; Mühlheim, D.; Muhuri, S.; Mukherjee, M.; Mulligan, J. D.; Munhoz, M. G.; Münning, K.; Munzer, R. H.; Murakami, H.; Murray, S.; Musa, L.; Musinsky, J.; Myers, C. J.; Naik, B.; Nair, R.; Nandi, B. K.; Nania, R.; Nappi, E.; Naru, M. U.; Natal da Luz, H.; Nattrass, C.; Navarro, S. R.; Nayak, K.; Nayak, R.; Nayak, T. K.; Nazarenko, S.; Nedosekin, A.; Negrao de Oliveira, R. A.; Nellen, L.; Nesbo, S. V.; Ng, F.; Nicassio, M.; Niculescu, M.; Niedziela, J.; Nielsen, B. S.; Nikolaev, S.; Nikulin, S.; Nikulin, V.; Noferini, F.; Nomokonov, P.; Nooren, G.; Noris, J. C. C.; Norman, J.; Nyanin, A.; Nystrand, J.; Oeschler, H.; Oh, S.; Ohlson, A.; Okubo, T.; Olah, L.; Oleniacz, J.; Oliveira da Silva, A. C.; Oliver, M. H.; Onderwaater, J.; Oppedisano, C.; Orava, R.; Oravec, M.; Ortiz Velasquez, A.; Oskarsson, A.; Otwinowski, J.; Oyama, K.; Pachmayer, Y.; Pacik, V.; Pagano, D.; Pagano, P.; Paić, G.; Palni, P.; Pan, J.; Pandey, A. K.; Panebianco, S.; Papikyan, V.; Pappalardo, G. S.; Pareek, P.; Park, J.; Park, W. J.; Parmar, S.; Passfeld, A.; Pathak, S. P.; Paticchio, V.; Patra, R. N.; Paul, B.; Pei, H.; Peitzmann, T.; Peng, X.; Pereira, L. G.; Pereira da Costa, H.; Peresunko, D.; Perez Lezama, E.; Peskov, V.; Pestov, Y.; Petráček, V.; Petrov, V.; Petrovici, M.; Petta, C.; Pezzi, R. P.; Piano, S.; Pikna, M.; Pillot, P.; Pimentel, L. O. D. L.; Pinazza, O.; Pinsky, L.; Piyarathna, D. B.; Płoskoń, M.; Planinic, M.; Pluta, J.; Pochybova, S.; Podesta-Lerma, P. L. M.; Poghosyan, M. G.; Polichtchouk, B.; Poljak, N.; Poonsawat, W.; Pop, A.; Poppenborg, H.; Porteboeuf-Houssais, S.; Porter, J.; Pospisil, J.; Pozdniakov, V.; Prasad, S. K.; Preghenella, R.; Prino, F.; Pruneau, C. A.; Pshenichnov, I.; Puccio, M.; Puddu, G.; Pujahari, P.; Punin, V.; Putschke, J.; Qvigstad, H.; Rachevski, A.; Raha, S.; Rajput, S.; Rak, J.; Rakotozafindrabe, A.; Ramello, L.; Rami, F.; Rana, D. B.; Raniwala, R.; Raniwala, S.; Räsänen, S. S.; Rascanu, B. T.; Rathee, D.; Ratza, V.; Ravasenga, I.; Read, K. F.; Redlich, K.; Rehman, A.; Reichelt, P.; Reidt, F.; Ren, X.; Renfordt, R.; Reolon, A. R.; Reshetin, A.; Reygers, K.; Riabov, V.; Ricci, R. A.; Richert, T.; Richter, M.; Riedler, P.; Riegler, W.; Riggi, F.; Ristea, C.; Rodríguez Cahuantzi, M.; Røed, K.; Rogochaya, E.; Rohr, D.; Röhrich, D.; Rokita, P. S.; Ronchetti, F.; Ronflette, L.; Rosnet, P.; Rossi, A.; Rotondi, A.; Roukoutakis, F.; Roy, A.; Roy, C.; Roy, P.; Rubio Montero, A. J.; Rui, R.; Russo, R.; Rustamov, A.; Ryabinkin, E.; Ryabov, Y.; Rybicki, A.; Saarinen, S.; Sadhu, S.; Sadovsky, S.; Šafařík, K.; Saha, S. K.; Sahlmuller, B.; Sahoo, B.; Sahoo, P.; Sahoo, R.; Sahoo, S.; Sahu, P. K.; Saini, J.; Sakai, S.; Saleh, M. A.; Salzwedel, J.; Sambyal, S.; Samsonov, V.; Sandoval, A.; Sarkar, D.; Sarkar, N.; Sarma, P.; Sas, M. H. P.; Scapparone, E.; Scarlassara, F.; Scharenberg, R. P.; Scheid, H. S.; Schiaua, C.; Schicker, R.; Schmidt, C.; Schmidt, H. R.; Schmidt, M. O.; Schmidt, M.; Schuchmann, S.; Schukraft, J.; Schutz, Y.; Schwarz, K.; Schweda, K.; Scioli, G.; Scomparin, E.; Scott, R.; Šefčík, M.; Seger, J. E.; Sekiguchi, Y.; Sekihata, D.; Selyuzhenkov, I.; Senosi, K.; Senyukov, S.; Serradilla, E.; Sett, P.; Sevcenco, A.; Shabanov, A.; Shabetai, A.; Shadura, O.; Shahoyan, R.; Shangaraev, A.; Sharma, A.; Sharma, A.; Sharma, M.; Sharma, M.; Sharma, N.; Sheikh, A. I.; Shigaki, K.; Shou, Q.; Shtejer, K.; Sibiriak, Y.; Siddhanta, S.; Sielewicz, K. M.; Siemiarczuk, T.; Silvermyr, D.; Silvestre, C.; Simatovic, G.; Simonetti, G.; Singaraju, R.; Singh, R.; Singhal, V.; Sinha, T.; Sitar, B.; Sitta, M.; Skaali, T. B.; Slupecki, M.; Smirnov, N.; Snellings, R. J. M.; Snellman, T. W.; Song, J.; Song, M.; Soramel, F.; Sorensen, S.; Sozzi, F.; Spiriti, E.; Sputowska, I.; Srivastava, B. K.; Stachel, J.; Stan, I.; Stankus, P.; Stenlund, E.; Stiller, J. H.; Stocco, D.; Strmen, P.; Suaide, A. A. P.; Sugitate, T.; Suire, C.; Suleymanov, M.; Suljic, M.; Sultanov, R.; Šumbera, M.; Sumowidagdo, S.; Suzuki, K.; Swain, S.; Szabo, A.; Szarka, I.; Szczepankiewicz, A.; Szymanski, M.; Tabassam, U.; Takahashi, J.; Tambave, G. J.; Tanaka, N.; Tarhini, M.; Tariq, M.; Tarzila, M. G.; Tauro, A.; Tejeda Muñoz, G.; Telesca, A.; Terasaki, K.; Terrevoli, C.; Teyssier, B.; Thakur, D.; Thakur, S.; Thomas, D.; Tieulent, R.; Tikhonov, A.; Timmins, A. R.; Toia, A.; Tripathy, S.; Trogolo, S.; Trombetta, G.; Trubnikov, V.; Trzaska, W. H.; Trzeciak, B. A.; Tsuji, T.; Tumkin, A.; Turrisi, R.; Tveter, T. S.; Ullaland, K.; Umaka, E. N.; Uras, A.; Usai, G. L.; Utrobicic, A.; Vala, M.; van der Maarel, J.; van Hoorne, J. W.; van Leeuwen, M.; Vanat, T.; Vande Vyvre, P.; Varga, D.; Vargas, A.; Vargyas, M.; Varma, R.; Vasileiou, M.; Vasiliev, A.; Vauthier, A.; Vázquez Doce, O.; Vechernin, V.; Veen, A. M.; Velure, A.; Vercellin, E.; Vergara Limón, S.; Vernet, R.; Vértesi, R.; Vickovic, L.; Vigolo, S.; Viinikainen, J.; Vilakazi, Z.; Villalobos Baillie, O.; Villatoro Tello, A.; Vinogradov, A.; Vinogradov, L.; Virgili, T.; Vislavicius, V.; Vodopyanov, A.; Völkl, M. A.; Voloshin, K.; Voloshin, S. A.; Volpe, G.; von Haller, B.; Vorobyev, I.; Voscek, D.; Vranic, D.; Vrláková, J.; Wagner, B.; Wagner, J.; Wang, H.; Wang, M.; Watanabe, D.; Watanabe, Y.; Weber, M.; Weber, S. G.; Weiser, D. F.; Wessels, J. P.; Westerhoff, U.; Whitehead, A. M.; Wiechula, J.; Wikne, J.; Wilk, G.; Wilkinson, J.; Willems, G. A.; Williams, M. C. S.; Windelband, B.; Winn, M.; Witt, W. E.; Yalcin, S.; Yang, P.; Yano, S.; Yin, Z.; Yokoyama, H.; Yoo, I.-K.; Yoon, J. H.; Yurchenko, V.; Zaccolo, V.; Zaman, A.; Zampolli, C.; Zanoli, H. J. C.; Zardoshti, N.; Zarochentsev, A.; Závada, P.; Zaviyalov, N.; Zbroszczyk, H.; Zhalov, M.; Zhang, H.; Zhang, X.; Zhang, Y.; Zhang, C.; Zhang, Z.; Zhao, C.; Zhigareva, N.; Zhou, D.; Zhou, Y.; Zhou, Z.; Zhu, H.; Zhu, J.; Zhu, X.; Zichichi, A.; Zimmermann, A.; Zimmermann, M. B.; Zimmermann, S.; Zinovjev, G.; Zmeskal, J.; Alice Collaboration<

2018-01-01

We report measurements of the inclusive J/ψ yield and average transverse momentum as a function of charged-particle pseudorapidity density dNch / dη in p-Pb collisions at √{sNN } = 5.02TeV with ALICE at the LHC. The observables are normalised to their corresponding averages in non-single diffractive events. An increase of the normalised J/ψ yield with normalised dNch / dη, measured at mid-rapidity, is observed at mid-rapidity and backward rapidity. At forward rapidity, a saturation of the relative yield is observed for high charged-particle multiplicities. The normalised average transverse momentum at forward and backward rapidities increases with multiplicity at low multiplicities and saturates beyond moderate multiplicities. In addition, the forward-to-backward nuclear modification factor ratio is also reported, showing an increasing suppression of J/ψ production at forward rapidity with respect to backward rapidity for increasing charged-particle multiplicity.

J/ψ production as a function of charged-particle pseudorapidity density in p–Pb collisions at s NN = 5.02 TeV

DOE PAGES

Adamová, D.; Aggarwal, M. M.; Aglieri Rinella, G.; ...

2017-11-08

Here, we report measurements of the inclusive J/ψ yield and average transverse momentum as a function of charged-particle pseudorapidity density dN ch/dη in p–Pb collisions atmore » $$\\sqrt{s}$$$_ {NN}$$ = 5.02 TeV with ALICE at the LHC. The observables are normalised to their corresponding averages in non-single diffractive events. An increase of the normalised J/ψ yield with normalised dN ch/dη, measured at mid-rapidity, is observed at mid-rapidity and backward rapidity. At forward rapidity, a saturation of the relative yield is observed for high charged-particle multiplicities. The normalised average transverse momentum at forward and backward rapidities increases with multiplicity at low multiplicities and saturates beyond moderate multiplicities. In addition, the forward-to-backward nuclear modification factor ratio is also reported, showing an increasing suppression of J/ψ production at forward rapidity with respect to backward rapidity for increasing charged-particle multiplicity.« less

J/ψ production as a function of charged-particle pseudorapidity density in p–Pb collisions at s NN = 5.02 TeV

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

Adamová, D.; Aggarwal, M. M.; Aglieri Rinella, G.

Here, we report measurements of the inclusive J/ψ yield and average transverse momentum as a function of charged-particle pseudorapidity density dN ch/dη in p–Pb collisions atmore » $$\\sqrt{s}$$$_ {NN}$$ = 5.02 TeV with ALICE at the LHC. The observables are normalised to their corresponding averages in non-single diffractive events. An increase of the normalised J/ψ yield with normalised dN ch/dη, measured at mid-rapidity, is observed at mid-rapidity and backward rapidity. At forward rapidity, a saturation of the relative yield is observed for high charged-particle multiplicities. The normalised average transverse momentum at forward and backward rapidities increases with multiplicity at low multiplicities and saturates beyond moderate multiplicities. In addition, the forward-to-backward nuclear modification factor ratio is also reported, showing an increasing suppression of J/ψ production at forward rapidity with respect to backward rapidity for increasing charged-particle multiplicity.« less

BABAR: an R package to simplify the normalisation of common reference design microarray-based transcriptomic datasets

PubMed Central

2010-01-01

Background The development of DNA microarrays has facilitated the generation of hundreds of thousands of transcriptomic datasets. The use of a common reference microarray design allows existing transcriptomic data to be readily compared and re-analysed in the light of new data, and the combination of this design with large datasets is ideal for 'systems'-level analyses. One issue is that these datasets are typically collected over many years and may be heterogeneous in nature, containing different microarray file formats and gene array layouts, dye-swaps, and showing varying scales of log2- ratios of expression between microarrays. Excellent software exists for the normalisation and analysis of microarray data but many data have yet to be analysed as existing methods struggle with heterogeneous datasets; options include normalising microarrays on an individual or experimental group basis. Our solution was to develop the Batch Anti-Banana Algorithm in R (BABAR) algorithm and software package which uses cyclic loess to normalise across the complete dataset. We have already used BABAR to analyse the function of Salmonella genes involved in the process of infection of mammalian cells. Results The only input required by BABAR is unprocessed GenePix or BlueFuse microarray data files. BABAR provides a combination of 'within' and 'between' microarray normalisation steps and diagnostic boxplots. When applied to a real heterogeneous dataset, BABAR normalised the dataset to produce a comparable scaling between the microarrays, with the microarray data in excellent agreement with RT-PCR analysis. When applied to a real non-heterogeneous dataset and a simulated dataset, BABAR's performance in identifying differentially expressed genes showed some benefits over standard techniques. Conclusions BABAR is an easy-to-use software tool, simplifying the simultaneous normalisation of heterogeneous two-colour common reference design cDNA microarray-based transcriptomic datasets. We show BABAR transforms real and simulated datasets to allow for the correct interpretation of these data, and is the ideal tool to facilitate the identification of differentially expressed genes or network inference analysis from transcriptomic datasets. PMID:20128918

A novel approach to signal normalisation in atmospheric pressure ionisation mass spectrometry.

PubMed

Vogeser, Michael; Kirchhoff, Fabian; Geyer, Roland

2012-07-01

The aim of our study was to test an alternative principle of signal normalisation in LC-MS/MS. During analyses, post column infusion of the target analyte is done via a T-piece, generating an "area under the analyte peak" (AUP). The ratio of peak area to AUP is assessed as assay response. Acceptable analytical performance of this principle was found for an exemplary analyte. Post-column infusion may allow normalisation of ion suppression not requiring any additional standard compound. This approach can be useful in situations where no appropriate compound is available for classical internal standardisation. Copyright © 2012 Elsevier B.V. All rights reserved.

Attitudes to Normalisation and Inclusive Education

ERIC Educational Resources Information Center

Sanagi, Tomomi

2016-01-01

The purpose of this paper was to clarify the features of teachers' image on normalisation and inclusive education. The participants of the study were both mainstream teachers and special teachers. One hundred and thirty-eight questionnaires were analysed. (1) Teachers completed the questionnaire of SD (semantic differential) images on…

Oxidative stress, metalloproteinase and LDH in children with intractable and non-intractable epilepsy as reflected in salivary analysis.

PubMed

Shahar, Eli; Attias, Uri; Savulescu, Dana; Genizin, Jacob; Gavish, Moshe; Nagler, Rafael

2014-01-01

Oxidative stress and metalloproteinase (MMPs) may have a pivotal role in the pathogenesis of epilepsy. This study examined the underlying mechanism of epilepsy in children and especially in its intractable form, with respect to the roles of MMP's and free radicals in general and in saliva in particular. We also explored the possible diagnostic role of a compositional salivary analysis in these children, as salivary collection is simple, non-invasive (and thus 'children-friendly') and requires almost no expertise. We analyzed saliva parameters of 33 epileptic children: 22 with non-intractable (E's) and 11 with intractable epilepsy (IE's), and compared them with 16 healthy controls. Mean salivary LDH concentration in controls was 213.1±34.0IU/L, dropping by 38% (p=0.014) in E's and by 76% (p=0.0003) in IE's. Mean salivary values of peroxidase activity, SOD activity and carbonyls level were 480±14mU/mL, 1.30±0.15U/mL and 0.34±0.04nmol/mg, respectively, in controls, increasing by 6% (p=0.03), by 37% (p=0.04) and by 59% (p=0.003) in E's, and by 10% (p=0.02), by 29% (p=0.03) and by 56% (p=0.004) in IE's. Mean salivary MMP 9 concentration was 0.062±0.003 (OD) in controls, decreased by 12% (p=0.048) in E's, and by 23%, (p=0.009) in IE's. Our results enhance our understanding of epilepsy's biological underlying mechanism as reflected in the saliva of children with both intractable and non intractable disease. The currently reported salivary analysis and the demonstrated salivary alterations in children suffering from epilepsy represent a novel direction. We found various salivary alterations demonstrated in the general composition as well as the oxidative and metalloproteinase analyses and more so in the intractable epilepsy group than in the non intractable epilepsy group. Hence, salivary oxidative components and MMP levels were found useful in the detection and follow-up of children with epilepsy. As such, we recommend using this non-invasive salivary analysis for diagnosis and monitoring of epileptic activity in children. Copyright © 2013 Elsevier B.V. All rights reserved.

Normalised quantitative polymerase chain reaction for diagnosis of tuberculosis-associated uveitis.

PubMed

Barik, Manas Ranjan; Rath, Soveeta; Modi, Rohit; Rana, Rajkishori; Reddy, Mamatha M; Basu, Soumyava

2018-05-01

Polymerase chain reaction (PCR)-based diagnosis of tuberculosis-associated uveitis (TBU) in TB-endemic countries is challenging due to likelihood of latent mycobacterial infection in both immune and non-immune cells. In this study, we investigated normalised quantitative PCR (nqPCR) in ocular fluids (aqueous/vitreous) for diagnosis of TBU in a TB-endemic population. Mycobacterial copy numbers (mpb64 gene) were normalised to host genome copy numbers (RNAse P RNA component H1 [RPPH1] gene) in TBU (n = 16) and control (n = 13) samples (discovery cohort). The mpb64:RPPH1 ratios (normalised value) from each TBU and control sample were tested against the current reference standard i.e. clinically-diagnosed TBU, to generate Receiver Operating Characteristic (ROC) curves. The optimum cut-off value of mpb64:RPPH1 ratio (0.011) for diagnosing TBU was identified from the highest Youden index. This cut-off value was then tested in a different cohort of TBU and controls (validation cohort, 20 cases and 18 controls), where it yielded specificity, sensitivity and diagnostic accuracy of 94.4%, 85.0%, and 89.4% respectively. The above values for conventional quantitative PCR (≥1 copy of mpb64 per reaction) were 61.1%, 90.0%, and 74.3% respectively. Normalisation markedly improved the specificity and diagnostic accuracy of quantitative PCR for diagnosis of TBU. Copyright © 2018 Elsevier Ltd. All rights reserved.

Ultrasound-Guided Phrenic Nerve Block for Intractable Hiccups following Placement of Esophageal Stent for Esophageal Squamous Cell Carcinoma.

PubMed

Arsanious, David; Khoury, Spiro; Martinez, Edgar; Nawras, Ali; Filatoff, Gregory; Ajabnoor, Hossam; Darr, Umar; Atallah, Joseph

2016-05-01

Hiccups are actions consisting of sudden contractions of the diaphragm and intercostals followed by a sudden inspiration and transient closure of the vocal cords. They are generally short lived and benign; however, in extreme and rare cases, such as esophageal carcinoma, they can become persistent or intractable, up to and involving significant pain, dramatically impacting the patient's quality of life. This case involves a 60-year-old man with a known history of squamous cell carcinoma of the esophagus. He was considered to have high surgical risk, and therefore he received palliative care through the use of fully covered metallic esophageal self-expandable stents due to a spontaneous perforated esophagus, after which he developed intractable hiccups and associated mediastinal pain. Conservative treatment, including baclofen, chlorpromazine, metoclopramide, and omeprazole, provided no relief for his symptoms. The patient was referred to pain management from gastroenterology for consultation on pain control. He ultimately received an ultrasound-guided left phrenic nerve block with bupivacaine and depomedrol, and 3 days later underwent the identical procedure on the right phrenic nerve. This led to complete resolution of his hiccups and associated mediastinal pain. At follow-up, 2 and 4 weeks after the left phrenic nerve block, the patient was found to maintain complete alleviation of the hiccups. Esophageal dilatation and/or phrenic or vagal afferent fiber irritation can be suspected in cases of intractable hiccups secondary to esophageal stenting. Regional anesthesia of the phrenic nerve through ultrasound guidance offers a long-term therapeutic option for intractable hiccups and associated mediastinal pain in selected patients with esophageal carcinoma after stent placement. Esophageal stent, esophageal stenting, intractable hiccups, intractable singultus, phrenic nerve block, phrenic nerve, ultrasound, palliative care, esophageal carcinoma.

Up-regulated ephrinB3/EphB3 expression in intractable temporal lobe epilepsy patients and pilocarpine induced experimental epilepsy rat model.

PubMed

Huang, Hao; Li, Ruohan; Yuan, Jinxian; Zhou, Xin; Liu, Xi; Ou, Shu; Xu, Tao; Chen, Yangmei

2016-05-15

EphB family receptor tyrosine kinases, in cooperation with cell surface-bound ephrinB ligands, play a critical role in maintenance of dendritic spine morphogenesis, axons guidance, synaptogenesis, synaptic reorganization and plasticity in the central nervous system (CNS). However, the expression pattern of ephrinB/EphB in intractable temporal lobe epilepsy (TLE) and the underlying molecular mechanisms during epileptogenesis remain poorly understood. Here we investigated the expression pattern and cellular distribution of ephrinB/EphB in intractable TLE patients and lithium chloride-pilocarpine induced TLE rats using real-time quantitative polymerase chain reaction (RT-qPCR), immunohistochemistry, double-labeled immunofluorescence and Western blot analysis. Compared to control groups, ephrinB3 and EphB3 mRNA expression were significantly up-regulated in intractable TLE patients and TLE rats, while the mRNA expression trend of ephrinB1/2 and EphB1/2/4/6 in intractable TLE patients and TLE rats were inconsistent. Western blot analysis and semi-quantitative immunohistochemistry confirmed that ephrinB3 and EphB3 protein level were up-regulated in intractable TLE patients and TLE rats. At the same time, double-labeled immunofluorescence indicate that ephrinB3 was expressed mainly in the cytoplasm and protrusions of glia and neurons, while EphB3 was expressed mainly in the cytoplasm of neurons. Taken together, up-regulated expression of ephrinB3/EphB3 in intractable TLE patients and experimental TLE rats suggested that ephrinB3/EphB3 might be involved in the pathogenesis of TLE. Copyright © 2016 Elsevier B.V. All rights reserved.

Rethinking intractable conflict: the perspective of dynamical systems.

PubMed

Vallacher, Robin R; Coleman, Peter T; Nowak, Andrzej; Bui-Wrzosinska, Lan

2010-01-01

Intractable conflicts are demoralizing. Beyond destabilizing the families, communities, or international regions in which they occur, they tend to perpetuate the very conditions of misery and hate that contributed to them in the first place. Although the common factors and processes associated with intractable conflicts have been identified through research, they represent an embarrassment of riches for theory construction. Thus, the current task in this area is integrating these diverse factors into an account that provides a coherent perspective yet allows for prediction and a basis for conflict resolution in specific conflict settings. We suggest that the perspective of dynamical systems provides such an account. This article outlines the key concepts and hypotheses associated with this approach. It is organized around a set of basic questions concerning intractable conflict for which the dynamical perspective offers fresh insight and testable propositions. The questions and answers are intended to provide readers with basic concepts and principles of complexity and dynamical systems that are useful for rethinking the nature of intractable conflict and the means by which such conflict can be transformed. Copyright 2010 APA, all rights reserved.

A study of physical properties of ODPA-p-PDA polyimide films

NASA Technical Reports Server (NTRS)

Singh, Jag J.; Eftekhari, Abe; St.clair, Terry L.

1990-01-01

Physical properties were investigated of ODPA-p-PDA polyimide films, including their lower molecular weight versions with phthalimide endcaps. Free volume, determined by low energy positron annihilation in the test films, was the major parameter of interest since all other physical properties are ostensibly related to it. It affects the dielectric constant as well as the saturation moisture pickup of the test films. An empirical relation was developed between the free volume and molecular weight of the test films, comparable to the Mark-Houwink relation between the polymer solution viscosity and the molecular weight. Development of such a relation constitutes a unique achievement since it enables researchers to estimate the molecular weight of an intractable polymer in solid state for the first time.

Prospective study of POLG mutations presenting in children with intractable epilepsy: prevalence and clinical features.

PubMed

Uusimaa, Johanna; Gowda, Vasantha; McShane, Anthony; Smith, Conrad; Evans, Julie; Shrier, Annie; Narasimhan, Manisha; O'Rourke, Anthony; Rajabally, Yusuf; Hedderly, Tammy; Cowan, Frances; Fratter, Carl; Poulton, Joanna

2013-06-01

To assess the frequency and clinical features of childhood-onset intractable epilepsy caused by the most common mutations in the POLG gene, which encodes the catalytic subunit of mitochondrial DNA polymerase gamma. Children presenting with nonsyndromic intractable epilepsy of unknown etiology but without documented liver dysfunction at presentation were eligible for this prospective, population-based study. Blood samples were analyzed for the three most common POLG mutations. If any of the three tested mutations were found, all the exons and the exon-intron boundaries of the POLG gene were sequenced. In addition, we retrospectively reviewed the notes of patients presenting with intractable epilepsy in which we had found POLG mutations. All available clinical data were collected by questionnaire and by reviewing the medical records. We analyzed 213 blood DNA samples from patients fulfilling the inclusion criteria of the prospective study. Among these, five patients (2.3%) were found with one of the three common POLG mutations as homozygous or compound heterozygous states. In addition, three patients were retrospectively identified. Seven of the eight patients had either raised cerebrospinal fluid (CSF) lactate (n = 3) or brain magnetic resonance imaging (MRI) changes (n = 4) at presentation with intractable epilepsy. Three patients later developed liver dysfunction, progressing to fatal liver failure in two without previous treatment with sodium valproate (VPA). Furthermore, it is worth mentioning that one patient presented first with an autism spectrum disorder before seizures emerged. Mutations in POLG are an important cause of early and juvenile onset nonsyndromic intractable epilepsy with highly variable associated manifestations including autistic features. This study emphasizes that genetic testing for POLG mutations in patients with nonsyndromic intractable epilepsies is very important for clinical diagnostics, genetic counseling, and treatment decisions because of the increased risk for VPA-induced liver failure in patients with POLG mutations. We recommend POLG gene testing for patients with intractable seizures and at least one elevated CSF lactate or suggestive brain MRI changes (predominantly abnormal T2 -weighted thalamic signal) with or without status epilepticus, epilepsia partialis continua, or liver manifestations typical for Alpers disease, especially when the disease course is progressive. Wiley Periodicals, Inc. © 2013 International League Against Epilepsy.

Prospective study of POLG mutations presenting in children with intractable epilepsy: Prevalence and clinical features

PubMed Central

Uusimaa, Johanna; Gowda, Vasantha; McShane, Anthony; Smith, Conrad; Evans, Julie; Shrier, Annie; Narasimhan, Manisha; O'Rourke, Anthony; Rajabally, Yusuf; Hedderly, Tammy; Cowan, Frances; Fratter, Carl; Poulton, Joanna

2013-01-01

Purpose To assess the frequency and clinical features of childhood-onset intractable epilepsy caused by the most common mutations in the POLG gene, which encodes the catalytic subunit of mitochondrial DNA polymerase gamma. Methods Children presenting with nonsyndromic intractable epilepsy of unknown etiology but without documented liver dysfunction at presentation were eligible for this prospective, population-based study. Blood samples were analyzed for the three most common POLG mutations. If any of the three tested mutations were found, all the exons and the exon–intron boundaries of the POLG gene were sequenced. In addition, we retrospectively reviewed the notes of patients presenting with intractable epilepsy in which we had found POLG mutations. All available clinical data were collected by questionnaire and by reviewing the medical records. Key Findings We analyzed 213 blood DNA samples from patients fulfilling the inclusion criteria of the prospective study. Among these, five patients (2.3%) were found with one of the three common POLG mutations as homozygous or compound heterozygous states. In addition, three patients were retrospectively identified. Seven of the eight patients had either raised cerebrospinal fluid (CSF) lactate (n = 3) or brain magnetic resonance imaging (MRI) changes (n = 4) at presentation with intractable epilepsy. Three patients later developed liver dysfunction, progressing to fatal liver failure in two without previous treatment with sodium valproate (VPA). Furthermore, it is worth mentioning that one patient presented first with an autism spectrum disorder before seizures emerged. Significance Mutations in POLG are an important cause of early and juvenile onset nonsyndromic intractable epilepsy with highly variable associated manifestations including autistic features. This study emphasizes that genetic testing for POLG mutations in patients with nonsyndromic intractable epilepsies is very important for clinical diagnostics, genetic counseling, and treatment decisions because of the increased risk for VPA-induced liver failure in patients with POLG mutations. We recommend POLG gene testing for patients with intractable seizures and at least one elevated CSF lactate or suggestive brain MRI changes (predominantly abnormal T2-weighted thalamic signal) with or without status epilepticus, epilepsia partialis continua, or liver manifestations typical for Alpers disease, especially when the disease course is progressive. PMID:23448099

The Normalisation of Homeschooling in the USA

ERIC Educational Resources Information Center

Stevens, Mitchell L.

2003-01-01

Home education emerged as a deviant practice in the USA in the late 1970s and became an acceptable alternative to conventional schooling in a remarkably short period of time. This paper argues that the trajectory of normalisation has been shaped by cultural and institutional features peculiar to the US national context. The paper also offers…

"It's Just the Way It Is..." or Not? How Physical Education Teachers Categorise and Normalise Differences

ERIC Educational Resources Information Center

van Amsterdam, Noortje; Knoppers, Annelies; Claringbould, Inge; Jongmans, Marian

2012-01-01

This article explores how Dutch physical education (PE) teachers discursively construct body differences between students related to gender, (dis)ability and health. Our results show how disciplinary technologies of categorisation and normalisation are embedded in two distinct discourses that our participants used: the discourse of naturalness for…

Sequencing intractable DNA to close microbial genomes.

PubMed

Hurt, Richard A; Brown, Steven D; Podar, Mircea; Palumbo, Anthony V; Elias, Dwayne A

2012-01-01

Advancement in high throughput DNA sequencing technologies has supported a rapid proliferation of microbial genome sequencing projects, providing the genetic blueprint for in-depth studies. Oftentimes, difficult to sequence regions in microbial genomes are ruled "intractable" resulting in a growing number of genomes with sequence gaps deposited in databases. A procedure was developed to sequence such problematic regions in the "non-contiguous finished" Desulfovibrio desulfuricans ND132 genome (6 intractable gaps) and the Desulfovibrio africanus genome (1 intractable gap). The polynucleotides surrounding each gap formed GC rich secondary structures making the regions refractory to amplification and sequencing. Strand-displacing DNA polymerases used in concert with a novel ramped PCR extension cycle supported amplification and closure of all gap regions in both genomes. The developed procedures support accurate gene annotation, and provide a step-wise method that reduces the effort required for genome finishing.

Space-time acupuncture for intractable cough after lupus nephropathy: A case report and literature review.

PubMed

Guo, Taipin; Chen, Zukun; Tai, Xiantao; Liu, Zili; Zhu, Miansheng

2017-12-01

Some intractable chronic cough remains a common complaint for seeking medical care. Unexplained cough in lupus nephropathy patient is rare and therapeutic options are limited. A 57 year-old woman with a 7-year history of lupus nephropathy. She has suffered from chronic cough for 3 years accompanied with chronic low back pain and fatigue, as the conventional therapy cannot relieve the symptoms. The woman is diagnosed as intractable cough after lupus nephropathy. 9 times space-time acupuncture (STA) treatment was performed. The cough, as well as other uncomfortable symptoms like chronic low-back pain and fatigue have resolved, and no relapse for one year follow-up. STA may be an effective therapy to treat intractable chronic cough. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

The importance of body mass normalisation for ultrasound measurement of the transversus abdominis muscle: The effect of age, gender and sport practice.

PubMed

Linek, Pawel

2017-04-01

Some studies have not considered body mass as a confounder in TrA analysis, which may have led to improper interpretation of results. To assess the differences in the effect of age, gender and physical activity between normalised for body mass and actual values of the TrA as well as to establish the effect of age, gender and physical activity on normalised for body mass TrA thickness in adolescents. The study was a cross-sectional study conducted at selected primary and secondary schools, and colleges in the Silesian region of Poland. A real-time ultrasound was used to obtain images of the TrA muscle. Body mass normalisation for TrA thickness was performed with allometric scaling and the following equation: Allometric-scaled TrA = TrA thickness/body mass 0.61 . Analysis has shown that boys have significantly thicker muscle by 0.27 mm (95% CI 0.04-0.50) than girls, and those who practise sports have thicker muscle by 0.30 mm (95% CI 0.06-0.52) than non-active individuals. For allometric-scaled TrA, there were no significant effects (p > 0.50). There was a significant correlation between participants age and the actual value of the TrA (r = 0.42, p < 0.05). The correlation between age and allometric-scaled TrA was insignificant and close to zero (r = -0.006, p = 0.93). An analysis of TrA thickness without body mass normalisation can deliver improper interpretation of study results. Thus, it is recommended in future researches to analyse TrA thickness measurement after normalisation rather than actual values. In the adolescent population, there is no effect of gender, age and physical activity on allometric-scaled TrA thickness. Copyright © 2017 Elsevier Ltd. All rights reserved.

Gait characteristics under different walking conditions: Association with the presence of cognitive impairment in community-dwelling older people

PubMed Central

Fransen, Erik; Perkisas, Stany; Verhoeven, Veronique; Beauchet, Olivier; Remmen, Roy

2017-01-01

Background Gait characteristics measured at usual pace may allow profiling in patients with cognitive problems. The influence of age, gender, leg length, modified speed or dual tasking is unclear. Methods Cross-sectional analysis was performed on a data registry containing demographic, physical and spatial-temporal gait parameters recorded in five walking conditions with a GAITRite® electronic carpet in community-dwelling older persons with memory complaints. Four cognitive stages were studied: cognitively healthy individuals, mild cognitive impaired patients, mild dementia patients and advanced dementia patients. Results The association between spatial-temporal gait characteristics and cognitive stages was the most prominent: in the entire study population using gait speed, steps per meter (translation for mean step length), swing time variability, normalised gait speed (corrected for leg length) and normalised steps per meter at all five walking conditions; in the 50-to-70 years old participants applying step width at fast pace and steps per meter at usual pace; in the 70-to-80 years old persons using gait speed and normalised gait speed at usual pace, fast pace, animal walk and counting walk or steps per meter and normalised steps per meter at all five walking conditions; in over-80 years old participants using gait speed, normalised gait speed, steps per meter and normalised steps per meter at fast pace and animal dual-task walking. Multivariable logistic regression analysis adjusted for gender predicted in two compiled models the presence of dementia or cognitive impairment with acceptable accuracy in persons with memory complaints. Conclusion Gait parameters in multiple walking conditions adjusted for age, gender and leg length showed a significant association with cognitive impairment. This study suggested that multifactorial gait analysis could be more informative than using gait analysis with only one test or one variable. Using this type of gait analysis in clinical practice could facilitate screening for cognitive impairment. PMID:28570662

Learning from doing: the case for combining normalisation process theory and participatory learning and action research methodology for primary healthcare implementation research.

PubMed

de Brún, Tomas; O'Reilly-de Brún, Mary; O'Donnell, Catherine A; MacFarlane, Anne

2016-08-03

The implementation of research findings is not a straightforward matter. There are substantive and recognised gaps in the process of translating research findings into practice and policy. In order to overcome some of these translational difficulties, a number of strategies have been proposed for researchers. These include greater use of theoretical approaches in research focused on implementation, and use of a wider range of research methods appropriate to policy questions and the wider social context in which they are placed. However, questions remain about how to combine theory and method in implementation research. In this paper, we respond to these proposals. Focussing on a contemporary social theory, Normalisation Process Theory, and a participatory research methodology, Participatory Learning and Action, we discuss the potential of their combined use for implementation research. We note ways in which Normalisation Process Theory and Participatory Learning and Action are congruent and may therefore be used as heuristic devices to explore, better understand and support implementation. We also provide examples of their use in our own research programme about community involvement in primary healthcare. Normalisation Process Theory alone has, to date, offered useful explanations for the success or otherwise of implementation projects post-implementation. We argue that Normalisation Process Theory can also be used to prospectively support implementation journeys. Furthermore, Normalisation Process Theory and Participatory Learning and Action can be used together so that interventions to support implementation work are devised and enacted with the expertise of key stakeholders. We propose that the specific combination of this theory and methodology possesses the potential, because of their combined heuristic force, to offer a more effective means of supporting implementation projects than either one might do on its own, and of providing deeper understandings of implementation contexts, rather than merely describing change.

Surgical Considerations of Intractable Mesial Temporal Lobe Epilepsy

PubMed Central

Boling, Warren W.

2018-01-01

Surgery of temporal lobe epilepsy is the best opportunity for seizure freedom in medically intractable patients. The surgical approach has evolved to recognize the paramount importance of the mesial temporal structures in the majority of patients with temporal lobe epilepsy who have a seizure origin in the mesial temporal structures. For those individuals with medically intractable mesial temporal lobe epilepsy, a selective amygdalohippocampectomy surgery can be done that provides an excellent opportunity for seizure freedom and limits the resection to temporal lobe structures primarily involved in seizure genesis. PMID:29461485

An automated gas exchange tank for determining gas transfer velocities in natural seawater samples

NASA Astrophysics Data System (ADS)

Schneider-Zapp, K.; Salter, M. E.; Upstill-Goddard, R. C.

2014-07-01

In order to advance understanding of the role of seawater surfactants in the air-sea exchange of climatically active trace gases via suppression of the gas transfer velocity (kw), we constructed a fully automated, closed air-water gas exchange tank and coupled analytical system. The system allows water-side turbulence in the tank to be precisely controlled with an electronically operated baffle. Two coupled gas chromatographs and an integral equilibrator, connected to the tank in a continuous gas-tight system, allow temporal changes in the partial pressures of SF6, CH4 and N2O to be measured simultaneously in the tank water and headspace at multiple turbulence settings, during a typical experimental run of 3.25 h. PC software developed by the authors controls all operations and data acquisition, enabling the optimisation of experimental conditions with high reproducibility. The use of three gases allows three independent estimates of kw for each turbulence setting; these values are subsequently normalised to a constant Schmidt number for direct comparison. The normalised kw estimates show close agreement. Repeated experiments with Milli-Q water demonstrate a typical measurement accuracy of 4% for kw. Experiments with natural seawater show that the system clearly resolves the effects on kw of spatial and temporal trends in natural surfactant activity. The system is an effective tool with which to probe the relationships between kw, surfactant activity and biogeochemical indices of primary productivity, and should assist in providing valuable new insights into the air-sea gas exchange process.

An automated gas exchange tank for determining gas transfer velocities in natural seawater samples

NASA Astrophysics Data System (ADS)

Schneider-Zapp, K.; Salter, M. E.; Upstill-Goddard, R. C.

2014-02-01

In order to advance understanding of the role of seawater surfactants in the air-sea exchange of climatically active trace gases via suppression of the gas transfer velocity (kw), we constructed a fully automated, closed air-water gas exchange tank and coupled analytical system. The system allows water-side turbulence in the tank to be precisely controlled with an electronically operated baffle. Two coupled gas chromatographs and an integral equilibrator, connected to the tank in a continuous gas-tight system, allow temporal changes in the partial pressures of SF6, CH4 and N2O to be measured simultaneously in the tank water and headspace at multiple turbulence settings, during a typical experimental run of 3.25 h. PC software developed by the authors controls all operations and data acquisition, enabling the optimisation of experimental conditions with high reproducibility. The use of three gases allows three independent estimates of kw for each turbulence setting; these values are subsequently normalised to a constant Schmidt number for direct comparison. The normalised kw estimates show close agreement. Repeated experiments with MilliQ water demonstrate a typical measurement accuracy of 4% for kw. Experiments with natural seawater show that the system clearly resolves the effects on kw of spatial and temporal trends in natural surfactant activity. The system is an effective tool with which to probe the relationships between kw, surfactant activity and biogeochemical indices of primary productivity, and should assist in providing valuable new insights into the air-sea gas exchange process.

Treatment of dry age-related macular degeneration with dobesilate

PubMed Central

Cuevas, P; Outeiriño, L A; Angulo, J; Giménez-Gallego, G

2012-01-01

The authors present anatomical and functional evidences of dry age-macular degeneration improvement, after intravitreal treatment with dobesilate. Main outcomes measures were normalisation of retinal structure and function, assessed by optical coherence tomography, fundus-monitored microperimetry, electrophysiology and visual acuity. The effect might be related to the normalisation of the outer retinal architecture. PMID:22729337

Multiphoton correlations in parametric down-conversion and their measurement in the pulsed regime

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

Ivanova, O A; Iskhakov, T Sh; Penin, A N

2006-10-31

We consider normalised intensity correlation functions (CFs) of different orders for light emitted via parametric down-conversion (PDC) and their dependence on the number of photons per mode. The main problem in measuring such correlation functions is their extremely small width, which considerably reduces their contrast. It is shown that if the radiation under study is modulated by a periodic sequence of pulses that are short compared to the CF width, no decrease in the contrast occurs. A procedure is proposed for measuring normalised CFs of various orders in the pulsed regime. For nanosecond-pulsed PDC radiation, normalised second-order CF is measuredmore » experimentally as a function of the mean photon number. (nonlinear optical phenomena)« less

Lorentzian symmetry predicts universality beyond scaling laws

NASA Astrophysics Data System (ADS)

Watson, Stephen J.

2017-06-01

We present a covariant theory for the ageing characteristics of phase-ordering systems that possess dynamical symmetries beyond mere scalings. A chiral spin dynamics which conserves the spin-up (+) and spin-down (-) fractions, μ+ and μ- , serves as the emblematic paradigm of our theory. Beyond a parabolic spatio-temporal scaling, we discover a hidden Lorentzian dynamical symmetry therein, and thereby prove that the characteristic length L of spin domains grows in time t according to L = \\fracβ{\\sqrt{1 - σ^2}}t\\frac{1{2}} , where σ:= μ+ - μ- (the invariant spin-excess) and β is a universal constant. Furthermore, the normalised length distributions of the spin-up and the spin-down domains each provably adopt a coincident universal (σ-independent) time-invariant form, and this supra-universal probability distribution is empirically verified to assume a form reminiscent of the Wigner surmise.

Ketogenic diet for treatment of intractable epilepsy in adults: A meta-analysis of observational studies.

PubMed

Liu, Hongyan; Yang, Yi; Wang, Yunbing; Tang, Hong; Zhang, Fan; Zhang, Yong; Zhao, Yong

2018-03-01

The ketogenic diet (KD) is an effective treatment for children with drug-resistant epilepsy and has been widely used in young children. Adult patients with intractable epilepsy would also benefit from this dietary treatment. However, only a few studies have been published, and the use of the KD in intractable epilepsy in adults has been limited. This meta-analysis summarized the findings of the relevant published studies to identify the efficacy of the KD for the treatment of intractable epilepsy in adults. In this meta-analysis, PubMed, Embase, and Cochrane Library were used for searching studies concerning the effects of the KD and its major subtypes with intractable epilepsy in adults published up to January 10, 2017. The primary outcomes were seizure freedom, seizure reduction by 50% or more, and seizure reduction by <50%. The quality of the methodology of the observational studies was reviewed by using the Newcastle-Ottawa Scale. We identified 402 articles, of which, 16 studies including 338 patients met the inclusion criteria. The results of the meta-analysis showed that the combined efficacy rates of all the symptoms of seizure freedom, seizure reduction by 50% or more, and seizure reduction below 50% in adults with intractable epilepsy were 13%, 53%, and 27%, respectively. The adverse reactions of the KD were mild, whereas low glycemic index diet (LGID) and low-dose fish oil diet (LFOD) may have fewer side effects. Weight loss, high level of low-density lipoprotein, and elevated total cholesterol were most frequent. The meta-analysis indicates that the KD for refractory epilepsy in adults is a well-tolerated treatment and that its side effects are acceptable, which show that the KD is a promising treatment in adult intractable epilepsy. Further research is needed to assess which type of diet or ratio is more effective in the KD treatment.

Clinical presentation of asbestosis with intractable pleural pain in the adult child of a taconite miner and radiographic demonstration of the probable pathology causing the pain.

PubMed

Harbut, Michael R; Endress, Carmen; Graff, John J; Weis, Christopher; Pass, Harvey

2009-01-01

Taconite, although not classified by the United States Government as asbestos or asbestiform material, has been associated with asbestos-related diseases. The mineral is used in the production of steel and as a road-patch material and is mined in Michigan and Minnesota. This report describes the case of a middle-aged Caucasian woman with exposure to taconite mining dust from her miner father's clothing in childhood with a resultant presentation consistent with asbestosis and intractable pleural pain. Intractable pleural pain has been described in asbestos-exposed patients with theorized etiologies. However, no in vivo reported mechanism has demonstrated a plausible, anatomically apparent mechanism for the pain. We utilize an application of the Vitrea software for enhancement of high-resolution computerized tomography which demonstrates at least one likely mechanism for intractable pleural pain.

Use of an Oral Elemental Diet in Infants with Severe Intractable Diarrhea

ERIC Educational Resources Information Center

Sherman, Joseph O.; And Others

1975-01-01

Evaluated was the use of an oral elemental diet consisting of crystalline amino acids, glucose, electrolytes, and vitamins to control severe intractable diarrhea in 27 infants (1-day to 9-months of age). (DB)

A combination of low-dose bevacizumab and imatinib enhances vascular normalisation without inducing extracellular matrix deposition.

PubMed

Schiffmann, L M; Brunold, M; Liwschitz, M; Goede, V; Loges, S; Wroblewski, M; Quaas, A; Alakus, H; Stippel, D; Bruns, C J; Hallek, M; Kashkar, H; Hacker, U T; Coutelle, O

2017-02-28

Vascular endothelial growth factor (VEGF)-targeting drugs normalise the tumour vasculature and improve access for chemotherapy. However, excessive VEGF inhibition fails to improve clinical outcome, and successive treatment cycles lead to incremental extracellular matrix (ECM) deposition, which limits perfusion and drug delivery. We show here, that low-dose VEGF inhibition augmented with PDGF-R inhibition leads to superior vascular normalisation without incremental ECM deposition thus maintaining access for therapy. Collagen IV expression was analysed in response to VEGF inhibition in liver metastasis of colorectal cancer (CRC) patients, in syngeneic (Panc02) and xenograft tumours of human colorectal cancer cells (LS174T). The xenograft tumours were treated with low (0.5 mg kg -1 body weight) or high (5 mg kg -1 body weight) doses of the anti-VEGF antibody bevacizumab with or without the tyrosine kinase inhibitor imatinib. Changes in tumour growth, and vascular parameters, including microvessel density, pericyte coverage, leakiness, hypoxia, perfusion, fraction of vessels with an open lumen, and type IV collagen deposition were compared. ECM deposition was increased after standard VEGF inhibition in patients and tumour models. In contrast, treatment with low-dose bevacizumab and imatinib produced similar growth inhibition without inducing detrimental collagen IV deposition, leading to superior vascular normalisation, reduced leakiness, improved oxygenation, more open vessels that permit perfusion and access for therapy. Low-dose bevacizumab augmented by imatinib selects a mature, highly normalised and well perfused tumour vasculature without inducing incremental ECM deposition that normally limits the effectiveness of VEGF targeting drugs.

The legacy of 'normalisation': the role of classical and contemporary criminological theory in understanding young people's drug use.

PubMed

Measham, Fiona; Shiner, Michael

2009-11-01

Since it began in the mid-1990s, the debate surrounding the normalisation of adolescent recreational drug use has attracted considerable attention and has tended to polarise opinion within the field. In this article two of the main protagonists in the debate come together to discuss its legacy. Focusing on the twin themes of continuity and change the authors begin by considering the relevance of early developments in the sociology of drug use, noting that this earlier work anticipated much that has recently been written on the subject, including the emphasis on hedonism and consumption in leisure lifestyles. From here they go on to critically reflect on the role that structure and agency have played in the normalisation debate, suggesting that the original thesis underplayed the role of structural influences in favour of a rational action model of adolescent drug use. In their more recent work, both authors have come to emphasise how drug use is shaped by an interplay between social structure and human agency. While some areas of disagreement remain, they agree that normalisation is best understood as a contingent process negotiated by distinct social groups operating in bounded situations.

Clinical studies of the Research Committee on Intractable Vasculitides, the Ministry of Health, Labour and Welfare of Japan.

PubMed

Makino, Hirofumi; Sada, Ken-Ei

2013-10-01

In Japan, the Research Committee on Intractable Vasculitides, supported by the Ministry of Health, Labour and Welfare, has been promoting basic and clinical research on vasculitis since 1972. The present Research Committee on Intractable Vasculitides comprises 4 subcommittees under the direction of a Principal Investigator: Basic and Pathological Research Subcommittee, Clinical Research Subcommittee of Small and Medium-sized Vessel Vasculitis, Clinical Research Subcommittee of Large-sized Vessel Vasculitis, and International Cooperation Research Subcommittee. Since 2008, 9 nationwide clinical studies for vasculitis have been conducted and 8 clinical and basic studies are in progress.

Secondary Voice Restoration After Laryngotracheal Separation (LTS) for Dysphagia with Intractable Aspiration.

PubMed

Bonte, Katrien; Huvenne, Wouter; De Loof, Marie; Deron, Philippe; Viaene, Annick; Duprez, Fréderic; Vermeersch, Hubert

2015-12-01

Intractable aspiration is a serious, often life-threatening condition due to its potential impact on pulmonary function. Aspiration requires therapeutic measures, starting with conservative management but often necessitating surgical treatment. The basic surgical principle is to separate the alimentary and respiratory tracts through a variety of procedures which, unfortunately, nearly all result in the loss of phonation, with the exception of total laryngectomy (TL) which includes the placement of an indwelling voice prosthesis. In this study, we present a modified laryngotracheal separation (LTS) technique that, we believe, offers multiple advantages compared to standard TL. After reviewing the medical records of 35 patients with intractable aspiration who have undergone LTS, we describe the surgical technique and present the postoperative result. In a second surgical procedure about two months following LTS, we aimed to achieve voice restoration by placement of an indwelling voice prosthesis. Intractable aspiration was successfully treated in all patients. Placement of an indwelling voice prosthesis during a second operation was successful in 15 patients, representing the largest reported cohort thus far. LTS is a reliable surgical technique to treat intractable aspiration, with restoration of oral intake, thereby improving the general condition and quality of life of these unfortunate patients. Furthermore, voice restoration can be achieved in selected patients, by placement of a voice prosthesis.

Unsupervised color normalisation for H and E stained histopathology image analysis

NASA Astrophysics Data System (ADS)

Celis, Raúl; Romero, Eduardo

2015-12-01

In histology, each dye component attempts to specifically characterise different microscopic structures. In the case of the Hematoxylin-Eosin (H&E) stain, universally used for routine examination, quantitative analysis may often require the inspection of different morphological signatures related mainly to nuclei patterns, but also to stroma distribution. Nevertheless, computer systems for automatic diagnosis are often fraught by color variations ranging from the capturing device to the laboratory specific staining protocol and stains. This paper presents a novel colour normalisation method for H&E stained histopathology images. This method is based upon the opponent process theory and blindly estimates the best color basis for the Hematoxylin and Eosin stains without relying on prior knowledge. Stain Normalisation and Color Separation are transversal to any Framework of Histopathology Image Analysis.

Voluntary activation failure is detectable in some myositis patients with persisting quadriceps femoris weakness: an observational study

PubMed Central

Molloy, Catherine B; Al-Omar, Ahmed O; Edge, Kathryn T; Cooper, Robert G

2006-01-01

This cross-sectional, observational study was undertaken to examine whether voluntary activation failure could contribute to the persisting weakness observed in some patients with treated idiopathic inflammatory myositis. In 20 patients with myositis of more than six months' duration (5 males, 15 females; mean [± 1 SD] age 53 [11] years) and 102 normal subjects (44 males, 58 females; mean age 32 [8] years), isometric maximum voluntary contractions (MVCs) of the dominant quadriceps femoris (QF) were quantified. Absolute MVC results of normal subjects and patients were then normalised with respect to lean body mass (force per units of lean body mass), giving a result in Newtons per kilogram. Based on mass-normalised force data of normal subjects, patients were arbitrarily stratified into "weak" and "not weak" subgroups. During further MVC attempts, the "twitch interpolation" technique was used to assess whether the QF voluntary activation of patients was complete. This technique relies on the fact that, because muscle activation is incomplete during submaximal voluntary contractions, electrical stimulation of the muscle can induce force increments superimposed on the submaximal voluntary force being generated. No between-gender differences were seen in the mass-normalised MVC results of healthy subjects, so the gender-combined results of 6.6 (1.5) N/kg were used for patient stratification. No between-gender difference was found for mass-normalised MVCs in patients: males 5.4 (3.2) and females 3.0 (1.7) N/kg (p > 0.05). Mass-normalised MVCs of male patients were as great as those of normal subjects (p > 0.05), but mass-normalised MVCs of female patients were significantly smaller than those of the normal subjects (p < 0.001). Only one of the six "not weak" patients exhibited interpolated twitches during electrical stimulation, but six of the 14 "weak" patients did, the biggest twitches being seen in the weakest patient. That interpolated twitches can be induced in some myositis patients with ongoing QF weakness during supposed MVCs clearly suggests that voluntary activation failure does contribute to QF weakness in those patients. PMID:16606441

Reference gene identification for reliable normalisation of quantitative RT-PCR data in Setaria viridis.

PubMed

Nguyen, Duc Quan; Eamens, Andrew L; Grof, Christopher P L

2018-01-01

Quantitative real-time polymerase chain reaction (RT-qPCR) is the key platform for the quantitative analysis of gene expression in a wide range of experimental systems and conditions. However, the accuracy and reproducibility of gene expression quantification via RT-qPCR is entirely dependent on the identification of reliable reference genes for data normalisation. Green foxtail ( Setaria viridis ) has recently been proposed as a potential experimental model for the study of C 4 photosynthesis and is closely related to many economically important crop species of the Panicoideae subfamily of grasses, including Zea mays (maize), Sorghum bicolor (sorghum) and Sacchurum officinarum (sugarcane). Setaria viridis (Accession 10) possesses a number of key traits as an experimental model, namely; (i) a small sized, sequenced and well annotated genome; (ii) short stature and generation time; (iii) prolific seed production, and; (iv) is amendable to Agrobacterium tumefaciens -mediated transformation. There is currently however, a lack of reference gene expression information for Setaria viridis ( S. viridis ). We therefore aimed to identify a cohort of suitable S. viridis reference genes for accurate and reliable normalisation of S. viridis RT-qPCR expression data. Eleven putative candidate reference genes were identified and examined across thirteen different S. viridis tissues. Of these, the geNorm and NormFinder analysis software identified SERINE / THERONINE - PROTEIN PHOSPHATASE 2A ( PP2A ), 5 '- ADENYLYLSULFATE REDUCTASE 6 ( ASPR6 ) and DUAL SPECIFICITY PHOSPHATASE ( DUSP ) as the most suitable combination of reference genes for the accurate and reliable normalisation of S. viridis RT-qPCR expression data. To demonstrate the suitability of the three selected reference genes, PP2A , ASPR6 and DUSP , were used to normalise the expression of CINNAMYL ALCOHOL DEHYDROGENASE ( CAD ) genes across the same tissues. This approach readily demonstrated the suitably of the three selected reference genes for the accurate and reliable normalisation of S. viridis RT-qPCR expression data. Further, the work reported here forms a highly useful platform for future gene expression quantification in S. viridis and can also be potentially directly translatable to other closely related and agronomically important C 4 crop species.

Normalisation theory: Does it accurately describe temporal changes in adolescent drunkenness and smoking?

PubMed

Sznitman, Sharon R; Zlotnick, Cheryl; Harel-Fisch, Yossi

2016-07-01

The multiple risk model postulates that accumulating risk factors increase adolescent drunkenness and smoking. The normalisation theory adds to this by arguing that the relation between accumulative risk and drunkenness and smoking is dependent on the distribution of these behaviours in the larger population. More concretely, normalisation theory predicts that: (i) when population level use increases, low risk adolescents will be more likely to use alcohol and cigarettes; and (ii) adolescents facing multiple risk factors will be equally likely to use alcohol and cigarettes, regardless of trends in population level use. The current study empirically tests these assumptions on five waves of nationally representative samples of Israeli Jewish youth. Five cross-sectional waves of data from the Israeli Health Behaviour in School-aged Children survey for Jewish 10th graders were used. Logistic regression models measured the impact of changes in population level use across waves on drunkenness and smoking, and their association with differing levels of risk factors. Between zero and two risk factors, the risk of drunkenness and smoking increases for each additional risk factor. When reaching two risk factors, added risk does not significantly increase the likelihood of smoking and drunkenness. Changes in population level drunkenness and smoking did not systematically relate to changes in the individual level relationship between risk factors and smoking and drunkenness. The pattern of results in this study provides strong evidence for the multiple risk factor model and inconsistent evidence for the normalisation theory. [Sznitman SR, Zlotnick C, Harel-Fisch Y. Normalisation theory: Does it accurately describe temporal changes in adolescent drunkenness and smoking? Drug Alcohol Rev 2016;35:424-432]. © 2015 Australasian Professional Society on Alcohol and other Drugs.

[Therapeutic effect of cervical Jiaji electroacupuncture on postoperative intractable hiccup of liver neoplasms].

PubMed

Zhang, S K; Gao, W B; Liu, Y; He, H

2018-02-23

Objective: To evaluate the therapeutic effect of cervical Jiaji electroacupuncture on postoperative intractable hiccup of liver neoplasms. Methods: A total of 39 patients with postoperative intractable hiccup of liver neoplasms in The First Affiliated Hospital of Heilongjiang University of Chinese Medicine from May 2013 to May 2017 were collected and divided into 2 groups randomly. The electroacupuncture group included 20 cases, the control group included 19 cases. Patients in the electroacupuncture group were treated by cervical Jiaji electroacupuncture (located in C3-5, sympathetic ganglion), while the control group were treated by metoclopramide combined with chlorpromazine for three days. The therapeutic effects of two groups were compared and the onset time were recorded. Results: Total effective rates of electroacupuncture group and control group were 95.0% and 47.4%, respectively. The onset time in electroacupuncture group and control group were (14.8±3.3) h and (30.5±3.1) h, respectively ( P <0.01). Ten cases who resisted the control treatment were then treated by electroacupuncture for 3 days, 6 cases were recovered, 3 cases became better, while 1 case demonstrated no response. No serious adverse reactions were appeared in each group. Conclusion: Cervical Jiaji electroacupuncture is an effective and safe treatment for postoperative intractable hiccup of liver neoplasms, and it can be used as a remedy for intractable hiccup patients who don't respond to drug treatment.

The Power of Positioning: On the Normalisation of Gender, Race/Ethnicity, Nation and Class Positions in a Swedish Social Work Textbook

ERIC Educational Resources Information Center

Fahlgren, Siv; Sawyer, Lena

2011-01-01

This article presents a feminist reading of a Swedish social work academic textbook as a case study. We use a discourse analytic approach and positioning theory, focusing on author positions through different story lines. The aim is to make visible how differences are created and positions of the author/reader normalised in terms of gender,…

[Polycythaemia in a patient with uterus myomatosus].

PubMed

de Boer, J P; Velders, G; Aliredjo, R; Scheenjes, E; Flinsenberg, T W H

2017-01-01

Myomatous erythrocytosis syndrome (MES) is characterised by a combination of polycythaemia, uterus myomatosus and the normalisation of erythrocyte count after hysterectomy. A 58-year-old postmenopausal woman was referred to the gynaecologist with symptoms of vaginal blood loss, increased abdominal circumference and pollakiuria. Physical examination indicated her uterus was enlarged to the size of a 24-week gestation. Endometrial malignancy was excluded and ultrasound showed a myoma. In consultation with the patient a hysterectomy was planned. Pre-operative blood tests showed increased haemoglobin levels (14.2 mmol/l). No indications of polycythaemia vera or secondary polycythaemia were found after which the diagnosis of MES was made. Haemoglobin levels normalised after hysterectomy without any further intervention. MES is common, although relatively unknown. Its pathophysiology is most likely based on ectopic production of erythropoietin by leiomyoma tissue. The combination of polycythaemia and uterus myomatosus should alert clinicians to this syndrome, especially as polycythaemia normalises after hysterectomy.

Temporal Lobe Epilepsy in Children

PubMed Central

Nickels, Katherine C.; Wong-Kisiel, Lily C.; Moseley, Brian D.; Wirrell, Elaine C.

2012-01-01

The temporal lobe is a common focus for epilepsy. Temporal lobe epilepsy in infants and children differs from the relatively homogeneous syndrome seen in adults in several important clinical and pathological ways. Seizure semiology varies by age, and the ictal EEG pattern may be less clear cut than what is seen in adults. Additionally, the occurrence of intractable seizures in the developing brain may impact neurocognitive function remote from the temporal area. While many children will respond favorably to medical therapy, those with focal imaging abnormalities including cortical dysplasia, hippocampal sclerosis, or low-grade tumors are likely to be intractable. Expedient workup and surgical intervention in these medically intractable cases are needed to maximize long-term developmental outcome. PMID:22957247

Dynamical Systems and Jung, with a Note on Language

ERIC Educational Resources Information Center

Barrett, Bruce E.

2011-01-01

Comments on the original article "Rethinking intractable conflict: The perspective of dynamical systems," by R. R. Vallacher, P. T. Coleman, A. Nowak, and L. Bui-Wrzosinska. Vallacher et al presented an intriguing description of dynamical systems theory as applied to the understanding of intractable conflicts ranging from the intrapsychic to the…

Engaging across Intractable Differences: Why, When, and How Should Educators Work With?

ERIC Educational Resources Information Center

Lake, Danielle

2017-01-01

When should instructors encourage students to work across ideological differences and within unjust institutional structures in order to affect change? What are the dangers and challenges inherent in working across seemingly intractable differences in the community? And what is the value of such a pedagogical approach? The scholarship on feminist…

Early Career Teacher Attrition: New Thoughts on an Intractable Problem

ERIC Educational Resources Information Center

Gallant, Andrea; Riley, Philip

2014-01-01

Early career exit from teaching has reached epidemic proportions and appears intractable. Previous attempts to find solutions are yet to make much of an inroad. The aim of the research was to discover what nine beginning teachers required to remain in the classroom, by adopting a phenomenological approach. The authors identified participants'…

Spinal epidural neurostimulation for treatment of acute and chronic intractable pain: initial and long term results.

PubMed

Richardson, R R; Siqueira, E B; Cerullo, L J

1979-09-01

Spinal epidural neurostimulation, which evolved from dorsal column stimulation, has been found to be effective in the treatment of acute and chronic intractable pain. Urban and Hashold have shown that it is a safe, simplified alternative to dorsal column stimulation, especially because laminectomy is not required if the electrodes are inserted percutaneously. Percutaneous epidural neurostimulation is also advantageous because there can be a diagnostic trial period before permanent internalization and implantation. This diagnostic and therapeutic modality has been used in 36 patients during the past 3 years at Northwestern Memorial Hospital. Eleven of these patients had acute intractable pain, which was defined as pain of less than 1 year in duration. Initial postimplantation results from the 36 patients indicate that spinal epidural neurostimulation is most effective in treating the intractable pain of diabetes, arachnoiditis, and post-traumatic and postamputation neuroma. Long term follow-up, varying from 1 year to 3 years postimplantation in the 20 initially responding patients, indicates that the neurostimulation continues to provide significant pain relief (50% or greater) in a majority of the patients who experienced initial significant pain relief.

Perspectives of primary health care staff on the implementation of a sexual health quality improvement program: a qualitative study in remote aboriginal communities in Australia.

PubMed

Hengel, Belinda; Bell, Stephen; Garton, Linda; Ward, James; Rumbold, Alice; Taylor-Thomson, Debbie; Silver, Bronwyn; McGregor, Skye; Dyda, Amalie; Knox, Janet; Guy, Rebecca; Maher, Lisa; Kaldor, John Martin

2018-04-02

Young people living in remote Australian Aboriginal communities experience high rates of sexually transmissible infections (STIs). STRIVE (STIs in Remote communities, ImproVed and Enhanced primary care) was a cluster randomised control trial of a sexual health continuous quality improvement (CQI) program. As part of the trial, qualitative research was conducted to explore staff perceptions of the CQI components, their normalisation and integration into routine practice, and the factors which influenced these processes. In-depth semi-structured interviews were conducted with 41 clinical staff at 22 remote community clinics during 2011-2013. Normalisation process theory was used to frame the analysis of interview data and to provide insights into enablers and barriers to the integration and normalisation of the CQI program and its six specific components. Of the CQI components, participants reported that the clinical data reports had the highest degree of integration and normalisation. Action plan setting, the Systems Assessment Tool, and the STRIVE coordinator role, were perceived as adding value to the program, but were less readily integrated or normalised. The remaining two components (dedicated funding for health promotion and service incentive payments) were seen as least relevant. Our analysis also highlighted factors which enabled greater integration of the CQI components. These included familiarity with CQI tools, increased accountability of health centre staff and the translation of the CQI program into guideline-driven care. The analysis also identified barriers, including high staff turnover, limited time involved in the program and competing clinical demands and programs. Across all of the CQI components, the clinical data reports had the highest degree of integration and normalisation. The action plans, systems assessment tool and the STRIVE coordinator role all complemented the data reports and allowed these components to be translated directly into clinical activity. To ensure their uptake, CQI programs must acknowledge local clinical guidelines, be compatible with translation into clinical activity and have managerial support. Sexual health CQI needs to align with other CQI activities, engage staff and promote accountability through the provision of clinic specific data and regular face-to-face meetings. Australian and New Zealand Clinical Trials Registry ACTRN12610000358044 . Registered 6/05/2010. Prospectively Registered.

[Chronological analysis of individually linked data for patients with intractable disease receiving public financial aid for treatment].

PubMed

Shibazaki, Satomi; Nagai, Masaki; Fuchigami, Hiroshi; Nishina, Motoko; Ohta, Akiko; Kawamura, Takashi; Ohno, Yoshiyuki

2005-12-01

Nationwide surveys of intractable disease patients receiving public financial aid for treatment were performed by Research Committee for Epidemiology of Intractable Disease (Ministry of Health and Welfare, Japan) 4 times in the past, in 1984, 1988, 1992 and 1997. The purpose of the present study was to clarify the features of continuance with intractable disease patients receiving public financial aid for treatment. Individual information collected by each nationwide survey was linked using the disease, the residence, the sex, and the birth date. The proportion of intractable disease patients according to receipt duration, kind of medical insurance, sex and age was calculated with reference to the disease and an estimation of the receipt persistence rate was calculated for every year. Moreover, in consideration of variation in the data, average receipt persistence rates over years were also calculated. According to observation on individual patient's follow up, the proportion for which financial aid was discontinued within four years was 25%, while 70% continued receiving aid for at least four years and some 55% for eight or nine years. The proportion of those who continue receiving support long-term is high about the so-called autoimmune diseases, such as systemic lupus erythematosus, Behçet's disease, and the aortic syndrome. In contrast, with diseases having a poor prognosis, such as fulminant hepatitis, amyloidosis, and amyotrophic lateral sclerosis, periods of continuance are short. The proportion needing long-term continuation is higher in women than in men, especially with diseases which have long been eligible for support. However, with diseases for which receipt was started recently, there is a tendency for persistence to be higher in men than in women. With reform of insurance systems, including the medical system for intractable diseases, it is predicted that receipt continuation will change with alteration of social factors, and it is necessary to monitor receipt continuation carefully from now on.

ReadqPCR and NormqPCR: R packages for the reading, quality checking and normalisation of RT-qPCR quantification cycle (Cq) data.

PubMed

Perkins, James R; Dawes, John M; McMahon, Steve B; Bennett, David L H; Orengo, Christine; Kohl, Matthias

2012-07-02

Measuring gene transcription using real-time reverse transcription polymerase chain reaction (RT-qPCR) technology is a mainstay of molecular biology. Technologies now exist to measure the abundance of many transcripts in parallel. The selection of the optimal reference gene for the normalisation of this data is a recurring problem, and several algorithms have been developed in order to solve it. So far nothing in R exists to unite these methods, together with other functions to read in and normalise the data using the chosen reference gene(s). We have developed two R/Bioconductor packages, ReadqPCR and NormqPCR, intended for a user with some experience with high-throughput data analysis using R, who wishes to use R to analyse RT-qPCR data. We illustrate their potential use in a workflow analysing a generic RT-qPCR experiment, and apply this to a real dataset. Packages are available from http://www.bioconductor.org/packages/release/bioc/html/ReadqPCR.htmland http://www.bioconductor.org/packages/release/bioc/html/NormqPCR.html These packages increase the repetoire of RT-qPCR analysis tools available to the R user and allow them to (amongst other things) read their data into R, hold it in an ExpressionSet compatible R object, choose appropriate reference genes, normalise the data and look for differential expression between samples.

Diagnostic reframing of intractable environmental problems: Case of a contested multiparty public land-use conflict

Treesearch

Stanley T. Asah; David N. Bengston; Keith Wendt; Kristen C. Nelson

2012-01-01

Intractable conflicts are omnipresent in environmental management. These conflicts do not necessarily resist resolution but need to be fundamentally transformed in order to reach agreement. Reframing, a process that allows disputants to create new alternative understandings of the problem, is one way of transforming these conflicts. Cognitive and interactional...

Developing Agency through Peacebuilding in the Midst of Intractable Conflict: The Case of Israel and Palestine

ERIC Educational Resources Information Center

Plonski, Sharri

2005-01-01

This paper discusses the presence of "peacebuilding islands" within civil society as potential agents of transformation in the midst of intractable conflict. Focusing on the particular case of the Israeli-Palestinian conflict, the argument stems from a deconstruction of the legacy of national myopia perpetuated through social and…

Internationalization under Intractable Conflict: The Influence of National Conflict on Israeli Higher Education Institutions' Internationalization Efforts

ERIC Educational Resources Information Center

Yemini, Miri

2017-01-01

Intractable conflicts are usually defined as long-lasting, violent, intergroup ones perceived as having no foreseen solutions. Such conflicts heavily affect the societies involved, which invest massive resources in all issues related to the conflict, including various educational elements. Regardless of the context of national conflict,…

Dual Pathology in Rasmussen's Encephalitis: A Report of Coexistent Focal Cortical Dysplasia and Review of the Literature.

PubMed

Prayson, Richard A

2012-01-01

Rasmussen's encephalitis is a well-established, albeit rare cause of medically intractable epilepsy. In a small number of Rasmussen's cases, a second pathology is identified, which independently can cause medically intractable seizures (dual pathology). This paper documents a case of a 13-year-old male who presented with medically intractable epilepsy. The patient underwent a series of surgical resections, early on resulting in a diagnosis of focal cortical dysplasia and later yielding a diagnosis of coexistent Rasmussen's encephalitis, marked by chronic inflammation, microglial nodules, and focal cortical atrophy, combined with focal cortical dysplasia (Palmini et al. type IIA, ILAE type IIA). The literature on dual pathology in the setting of Rasmussen's encephalitis is reviewed.

Dual Pathology in Rasmussen's Encephalitis: A Report of Coexistent Focal Cortical Dysplasia and Review of the Literature

PubMed Central

Prayson, Richard A.

2012-01-01

Rasmussen's encephalitis is a well-established, albeit rare cause of medically intractable epilepsy. In a small number of Rasmussen's cases, a second pathology is identified, which independently can cause medically intractable seizures (dual pathology). This paper documents a case of a 13-year-old male who presented with medically intractable epilepsy. The patient underwent a series of surgical resections, early on resulting in a diagnosis of focal cortical dysplasia and later yielding a diagnosis of coexistent Rasmussen's encephalitis, marked by chronic inflammation, microglial nodules, and focal cortical atrophy, combined with focal cortical dysplasia (Palmini et al. type IIA, ILAE type IIA). The literature on dual pathology in the setting of Rasmussen's encephalitis is reviewed. PMID:23056977

Effect of biomass concentration on methane oxidation activity using mature compost and graphite granules as substrata.

PubMed

Xie, S; O'Dwyer, T; Freguia, S; Pikaar, I; Clarke, W P

2016-10-01

Reported methane oxidation activity (MOA) varies widely for common landfill cover materials. Variation is expected due to differences in surface area, the composition of the substratum and culturing conditions. MOA per methanotrophic cell has been calculated in the study of natural systems such as lake sediments to examine the inherent conditions for methanotrophic activity. In this study, biomass normalised MOA (i.e., MOA per methanotophic cell) was measured on stabilised compost, a commonly used cover in landfills, and on graphite granules, an inert substratum widely used in microbial electrosynthesis studies. After initially enriching methanotrophs on both substrata, biomass normalised MOA was quantified under excess oxygen and limiting methane conditions in 160ml serum vials on both substrata and blends of the substrata. Biomass concentration was measured using the bicinchoninic acid assay for microbial protein. The biomass normalised MOA was consistent across all compost-to-graphite granules blends, but varied with time, reflecting the growth phase of the microorganisms. The biomass normalised MOA ranged from 0.069±0.006μmol CH4/mg dry biomass/h during active growth, to 0.024±0.001μmol CH4/mg dry biomass/h for established biofilms regardless of the substrata employed, indicating the substrata were equally effective in terms of inherent composition. The correlation of MOA with biomass is consistent with studies on methanotrophic activity in natural systems, but biomass normalised MOA varies by over 5 orders of magnitude between studies. This is partially due to different methods being used to quantify biomass, such as pmoA gene quantification and the culture dependent Most Probable Number method, but also indicates that long term exposure of materials to a supply of methane in an aerobic environment, as can occur in natural systems, leads to the enrichment and adaptation of types suitable for those conditions. Copyright © 2016 Elsevier Ltd. All rights reserved.

Lung Cancer Pathological Image Analysis Using a Hidden Potts Model

PubMed Central

Li, Qianyun; Yi, Faliu; Wang, Tao; Xiao, Guanghua; Liang, Faming

2017-01-01

Nowadays, many biological data are acquired via images. In this article, we study the pathological images scanned from 205 patients with lung cancer with the goal to find out the relationship between the survival time and the spatial distribution of different types of cells, including lymphocyte, stroma, and tumor cells. Toward this goal, we model the spatial distribution of different types of cells using a modified Potts model for which the parameters represent interactions between different types of cells and estimate the parameters of the Potts model using the double Metropolis-Hastings algorithm. The double Metropolis-Hastings algorithm allows us to simulate samples approximately from a distribution with an intractable normalizing constant. Our numerical results indicate that the spatial interaction between the lymphocyte and tumor cells is significantly associated with the patient’s survival time, and it can be used together with the cell count information to predict the survival of the patients. PMID:28615918

Reliable quantum certification of photonic state preparations

PubMed Central

Aolita, Leandro; Gogolin, Christian; Kliesch, Martin; Eisert, Jens

2015-01-01

Quantum technologies promise a variety of exciting applications. Even though impressive progress has been achieved recently, a major bottleneck currently is the lack of practical certification techniques. The challenge consists of ensuring that classically intractable quantum devices perform as expected. Here we present an experimentally friendly and reliable certification tool for photonic quantum technologies: an efficient certification test for experimental preparations of multimode pure Gaussian states, pure non-Gaussian states generated by linear-optical circuits with Fock-basis states of constant boson number as inputs, and pure states generated from the latter class by post-selecting with Fock-basis measurements on ancillary modes. Only classical computing capabilities and homodyne or hetorodyne detection are required. Minimal assumptions are made on the noise or experimental capabilities of the preparation. The method constitutes a step forward in many-body quantum certification, which is ultimately about testing quantum mechanics at large scales. PMID:26577800

Defining intractability: comparisons among published definitions.

PubMed

Berg, Anne T; Kelly, Molly M

2006-02-01

Intractable epilepsy is the focus of much research; however, this concept is defined in no single way. Individual studies use different definitions, creating difficulties for comparisons of results across studies. A head-to-head comparison of definitions could highlight these differences and motivate the development of consensus guidelines. Within a single prospective study of 613 children in Connecticut with newly diagnosed epilepsy (1993-1997), six different published definitions or indicators for intractability were applied and compared. All definitions were assessed at various times within the first 5 years after diagnosis, with the exact timing reflecting how they were used in their initial reports. Observed and chance-adjusted agreement (kappa) were computed. The associations of each definition with remission status 7-10 years after diagnosis were quantified with a relative risk. Depending on the specific definition, the epilepsy of 9-24% of children was considered intractable. Observed agreements among the definitions ranged from a low of 0.83 to a high of 0.96. Kappas ranged from low of 0.45 to 0.79. More similar definitions had higher levels of agreement. All definitions were strongly associated with remission status as of last follow-up. Agreement among the different definitions is strong but imperfect. All definitions were significantly associated with longer-term outcome. No single preferred definition of intractable epilepsy exists. Some discussion within the field of epilepsy and a consensus process should be considered as a future step for enhancing comparability of research efforts and clinical guidelines. Consideration should be given to whether a single definition will suit all purposes or whether different types of definitions are needed for different purposes.

Neural Development in tsc2-Deficient Zebrafish

DTIC Science & Technology

2011-10-01

mTOR signaling pathway, current therapies remain ineffective with many patients suffering from intractable epilepsy as well as autism , developmental...are generally severe, with many patients suffering from intractable epilepsy, autism , behavioral problems and mental retardation (Ess, 2006). These...is an important model system for the study of brain malformations as well as the pathogenesis of epilepsy and autism . Advances in these fields require

Narrative spaces between intractability outside the clinic.

PubMed

Wiederhold, Anna M

2014-01-01

In this essay, the author reflects on her experience conducting field research outside an abortion clinic amid volatile protests and counterprotests. She identifies moments of convergence in the oppositional groups' narrative explanations for participating in the weekly protests, and contemplates the possibilities for dialogue in these sorts of intractable conflicts. She concludes with reflections on communication scholars' roles in engaging with polarizing health narratives.

CDKL5 mutations in boys with severe encephalopathy and early-onset intractable epilepsy.

PubMed

Elia, M; Falco, M; Ferri, R; Spalletta, A; Bottitta, M; Calabrese, G; Carotenuto, M; Musumeci, S A; Lo Giudice, M; Fichera, M

2008-09-23

To search for CDKL5 gene mutations in boys presenting with severe early-onset encephalopathy and intractable epilepsy, a clinical picture very similar to that already described in girls with CDKL5 mutations. Eight boys (age range 3-16 years, mean age 8.5 years, SD 4.38) with severe or profound mental retardation and early-onset intractable seizures were selected for CDKL5 gene mutation screening by denaturing high-performance liquid chromatography analysis. We found three unrelated boys carrying three different missense mutations of the CDKL5 gene: c.872G>A (p.C291Y), c.863C>T (p.T288I), and c.533G>C (p.R178P). They presented early-onset, polymorphous, and drug-resistant seizures, mostly myoclonic and tonic or spasms. EEG showed epileptiform abnormalities which were multifocal during wakefulness, and pseudoperiodic bisynchronous during sleep. This study describes three boys carrying CDKL5 missense mutations and their detailed clinical and EEG data, and indicates that CDKL5 gene mutations may represent a cause of severe or profound mental retardation and early-onset intractable seizures, also in boys. Screening for CDKL5 mutations is strongly recommended in individuals with these clinical features.

A case report of dexmedetomidine used to treat intractable pain and delirium in a tertiary palliative care unit.

PubMed

Hilliard, Neil; Brown, Stuart; Mitchinson, Steve

2015-03-01

This case report describes an end-stage cancer patient with intractable neuropathic pain and delirium who was successfully managed during the last 3 weeks of her life with a continuous subcutaneous infusion of dexmedetomidine. A 55-year-old woman with locally advanced cervical cancer and uncontrolled pelvic pain was admitted to a tertiary palliative care unit for pain management. As her disease progressed, the patient's pelvic pain intensified despite treatment with methadone, gabapentin, ketamine, and hydromorphone administered by continuous subcutaneous infusion plus frequent breakthrough doses of hydromorphone and sufentanil. A continuous subcutaneous infusion of dexmedetomidine was started and titrated to achieve pain relief. The patient's pain and delirium cleared. The treatment was successful in fulfilling the patient's goal of care: not to be deeply and continuously sedated, but to be rousable and of clear mind while still having good pain control. Dexmedetomidine is a potentially useful medication for the targeted treatment of intractable pain and delirium in the tertiary palliative care environment. Future research is required to compare dexmedetomidine infusion to standard treatment with midazolam infusion for treatment of intractable symptoms in the palliative care environment. © The Author(s) 2014.

[Gabapentin in the treatment of chronic intractable pain].

PubMed

Gustorff, B; Nahlik, G; Spacek, A; Kress, H G

2002-02-01

Gabapentin has been shown to reduce pain associated with diabetic neuropathia and postherpetic neuralgia. To date it is not known, whether gabapentin is generally effective in other types of pain. It was therefore the aim to study gabapentin in patients suffering from intractable pain with respect to efficacy, predictive factors and side effects. Retrospective analysis of the data sheet of pretreated patients suffering from intractable pain and treated with gabapentin as a third line drug at a university pain clinic. Pain intensity (visual analogue scale, VAS 0 -10 cm), pain characteristics, diagnosis, pre- and co-treatment, and side effects were assessed. Response to treatment was defined as a 50% reduction in pain or a pain intensity of VAS

The Use of Hemoglobin Vesicles for Delivering Medicinal Gas for the Treatment of Intractable Disorders.

PubMed

Taguchi, Kazuaki; Yamasaki, Keishi; Sakai, Hiromi; Maruyama, Toru; Otagiri, Masaki

2017-09-01

Bioactive gaseous molecules, such as oxygen (O 2 ) and carbon monoxide (CO), are essential elements for most living organisms to maintain their homeostasis and biological activities. An accumulating body of evidence suggests that such molecules can be used in clinics as a medical gas in the treatment of various intractable disorders. Recent developments in hemoglobin-encapsulated liposomes, namely hemoglobin vesicles (HbV), possess great potential for retaining O 2 and CO and could lead to strategies for the development of novel pharmacological agents as medical gas donors. HbV with either O 2 or CO bound to it has been demonstrated to have therapeutic potential for treating certain intractable disorders and has the possibility to serve as diagnostic and augmenting product by virtue of unique physicochemical characteristics of HbV. The present review provides an overview of the present status of the use of O 2 - or CO-binding HbV in experimental animal models of intractable disorders and discusses prospective clinical applications of HbV as a medical gas donor. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Drosophila as a model for intractable epilepsy: gilgamesh suppresses seizures in para(bss1) heterozygote flies.

PubMed

Howlett, Iris C; Rusan, Zeid M; Parker, Louise; Tanouye, Mark A

2013-08-07

Intractable epilepsies, that is, seizure disorders that do not respond to currently available therapies, are difficult, often tragic, neurological disorders. Na(+) channelopathies have been implicated in some intractable epilepsies, including Dravet syndrome (Dravet 1978), but little progress has been forthcoming in therapeutics. Here we examine a Drosophila model for intractable epilepsy, the Na(+) channel gain-of-function mutant para(bss1) that resembles Dravet syndrome in some aspects (parker et al. 2011a). In particular, we identify second-site mutations that interact with para(bss1), seizure enhancers, and seizure suppressors. We describe one seizure-enhancer mutation named charlatan (chn). The chn gene normally encodes an Neuron-Restrictive Silencer Factor/RE1-Silencing Transcription factor transcriptional repressor of neuronal-specific genes. We identify a second-site seizure-suppressor mutation, gilgamesh (gish), that reduces the severity of several seizure-like phenotypes of para(bss1)/+ heterozygotes. The gish gene normally encodes the Drosophila ortholog of casein kinase CK1g3, a member of the CK1 family of serine-threonine kinases. We suggest that CK1g3 is an unexpected but promising new target for seizure therapeutics.

Limpets counteract ocean acidification induced shell corrosion by thickening of aragonitic shell layers

NASA Astrophysics Data System (ADS)

Langer, G.; Nehrke, G.; Baggini, C.; Rodolfo-Metalpa, R.; Hall-Spencer, J.; Bijma, J.

2014-08-01

Specimens of the patellogastropod limpet Patella caerulea were collected within (pHlow-shells) and outside (pHn-shells) a CO2 vent site at Ischia, Italy. Four pHlow-shells and four pHn-shells were sectioned transversally and scanned for polymorph distribution by means of confocal Raman microscopy. The pHlow-shells displayed a twofold increase in aragonite area fraction and size normalised aragonite area. Size normalised calcite area was halved in pHlow-shells. Taken together with the increased apical and the decreased flank size normalised thickness of the pHlow-shells, these data led us to conclude that low pH exposed P. caerulea specimens counteract shell dissolution by enhanced shell production. The latter is different from normal elongation growth and proceeds through addition of aragonitic layers only, while the production of calcitic layers is confined to elongation growth. Therefore aragonite cannot be regarded as a per se disadvantageous polymorph under ocean acidification conditions.

Limpets counteract ocean acidification induced shell corrosion by thickening of aragonitic shell layers

NASA Astrophysics Data System (ADS)

Langer, G.; Nehrke, G.; Baggini, C.; Rodolfo-Metalpa, R.; Hall-Spencer, J. M.; Bijma, J.

2014-12-01

Specimens of the patellogastropod limpet Patella caerulea were collected within (pHlow-shells) and outside (pHn-shells) a CO2 vent site at Ischia, Italy. Four pHlow-shells and four pHn-shells were sectioned transversally and scanned for polymorph distribution by means of confocal Raman microscopy. The pHlow-shells displayed a twofold increase in aragonite area fraction and size-normalised aragonite area. Size-normalised calcite area was halved in pHlow-shells. Taken together with the increased apical and the decreased flank size-normalised thickness of the pHlow-shells, these data led us to conclude that low-pH-exposed P. caerulea specimens counteract shell dissolution by enhanced shell production. This is different from normal elongation growth and proceeds through addition of aragonitic parts only, while the production of calcitic parts is confined to elongation growth. Therefore, aragonite cannot be regarded as a disadvantageous polymorph per se under ocean acidification conditions.

A Case of Intractable Hemophagocytic Syndrome Associated with Systemic Lupus Erythematosus Resistant to Corticosteroids and Intravenous Cyclophosphamide that Was Successfully Treated with Cyclosporine A.

PubMed

Toko, Hirofumi; Tsuboi, Hiroto; Umeda, Naoto; Honda, Fumika; Ohyama, Ayako; Takahashi, Hidenori; Abe, Saori; Yokosawa, Masahiro; Asashima, Hiromitsu; Hagiwara, Shinya; Hirota, Tomoya; Kondo, Yuya; Matsumoto, Isao; Sumida, Takayuki

2018-05-18

Hemophagocytic syndrome (HPS) associated with systemic lupus erythematosus (SLE), dubbed acute lupus hemophagocytic syndrome (ALHS), is an intractable complication of SLE. A 24-year-old man who had been diagnosed with SLE three months previously, presented with fever, rash, hallucination, and pancytopenia accompanied with hyperferritinemia and bone marrow hemophagocytosis. He was diagnosed with ALHS and neuropsychiatric (NP)-SLE. Although 4 courses of methylprednisolone pulse therapy and 1 course of intravenous cyclophosphamide (IVCY) improved his NP-SLE, his ALHS did not respond. However, the addition of cyclosporine A (CsA) led to a rapid remission from ALHS. This suggests the usefulness of CsA in the treatment of intractable, corticosteroid- and IVCY-resistant ALHS.

Noninvasive treatment alternative for intractable startle epilepsy

PubMed Central

Klinkenberg, Sylvia; Ubbink, Sander; Vles, Johannes; de Louw, Anton; van Hall, Mariette Debeij; Scheijen, Dyon; Brokx, Jan

2014-01-01

We describe a treatment alternative for intractable, startle-provoked, epileptic seizures in four children aged between 8 and 14. Three of the four children had symptomatic localization-related epilepsy. They all suffered from intractable epilepsy precipitated by sudden sounds. The fact that seizures tended to occur with high frequency – more than one seizure a day – had a clear impact on daily life. Clinical seizure pattern demonstrated asymmetric tonic posturing in all four children. Three children experienced several seizure types including focal seizure onset. All children had focal neurological signs or learning disabilities or a combination of both. Our noninvasive treatment method using psychoeducational counseling and sound generators was applied in four children, resulting in a seizure frequency reduction of ≥ 50% in two of them. PMID:25667869

Applying social constructionism in the treatment of patients who are intractably aggressive.

PubMed

Caldwell, M F

1994-06-01

Interventions based on the philosophy of social constructionism can be used for the treatment of patients who are intractably aggressive. The interventions are aimed at disrupting common interactive patterns between the patient and treaters in the treatment milieu and replacing them with patterns that do not allow the intractable symptoms to disrupt treatment efforts. Two case examples illustrate the use of this approach with extremely violent inpatients with long histories of unsuccessful interventions. In both cases the treatment included discontinuing certain therapeutic or prosocial interventions; one case involved determining the patient's daily privilege level randomly. The author discusses the advantages and difficulties of such approaches, including the need for staff to reframe their own logical structure and to overcome resistance from different levels of the treatment system.

ReadqPCR and NormqPCR: R packages for the reading, quality checking and normalisation of RT-qPCR quantification cycle (Cq) data

PubMed Central

2012-01-01

Background Measuring gene transcription using real-time reverse transcription polymerase chain reaction (RT-qPCR) technology is a mainstay of molecular biology. Technologies now exist to measure the abundance of many transcripts in parallel. The selection of the optimal reference gene for the normalisation of this data is a recurring problem, and several algorithms have been developed in order to solve it. So far nothing in R exists to unite these methods, together with other functions to read in and normalise the data using the chosen reference gene(s). Results We have developed two R/Bioconductor packages, ReadqPCR and NormqPCR, intended for a user with some experience with high-throughput data analysis using R, who wishes to use R to analyse RT-qPCR data. We illustrate their potential use in a workflow analysing a generic RT-qPCR experiment, and apply this to a real dataset. Packages are available from http://www.bioconductor.org/packages/release/bioc/html/ReadqPCR.htmland http://www.bioconductor.org/packages/release/bioc/html/NormqPCR.html Conclusions These packages increase the repetoire of RT-qPCR analysis tools available to the R user and allow them to (amongst other things) read their data into R, hold it in an ExpressionSet compatible R object, choose appropriate reference genes, normalise the data and look for differential expression between samples. PMID:22748112

OpenPrescribing: normalised data and software tool to research trends in English NHS primary care prescribing 1998-2016.

PubMed

Curtis, Helen J; Goldacre, Ben

2018-02-23

We aimed to compile and normalise England's national prescribing data for 1998-2016 to facilitate research on long-term time trends and create an open-data exploration tool for wider use. We compiled data from each individual year's national statistical publications and normalised them by mapping each drug to its current classification within the national formulary where possible. We created a freely accessible, interactive web tool to allow anyone to interact with the processed data. We downloaded all available annual prescription cost analysis datasets, which include cost and quantity for all prescription items dispensed in the community in England. Medical devices and appliances were excluded. We measured the extent of normalisation of data and aimed to produce a functioning accessible analysis tool. All data were imported successfully. 87.5% of drugs were matched exactly on name to the current formulary and a further 6.5% to similar drug names. All drugs in core clinical chapters were reconciled to their current location in the data schema, with only 1.26% of drugs not assigned a current chemical code. We created an openly accessible interactive tool to facilitate wider use of these data. Publicly available data can be made accessible through interactive online tools to help researchers and policy-makers explore time trends in prescribing. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Significant improvement of intractable headache after transsphenoidal surgery in patients with pituitary adenomas; preoperative neuroradiological evaluation and intraoperative intrasellar pressure measurement.

PubMed

Hayashi, Yasuhiko; Kita, Daisuke; Iwato, Masayuki; Fukui, Issei; Oishi, Masahiro; Tsutsui, Taishi; Tachibana, Osamu; Nakada, Mitsutoshi

2016-04-01

Headache is the most common symptom of both primary and metastatic brain tumor, and is generally considered the primary symptom in patients with large pituitary adenomas. However, patients with small pituitary adenomas rarely complain of intractable headache, and neurosurgeons are unsure whether such small adenomas actually contribute to headache. If conventional medical treatments for headache prove ineffective, surgical removal of the adenoma can be considered as an alternative management strategy. We conducted a retrospective review of 180 patients who underwent transsphenoidal surgery (TSS) for pituitary adenomas at Kanazawa University Hospital between 2006 and 2014. Patients with acute phase intratumoral hemorrhage were excluded. We identified nine patients with intractable headache as the chief complaint associated with small pituitary adenoma (diameters 15.8 ± 2.6 mm, 11-20 mm), non-functioning in eight, and prolactin-secreting in one. The preoperative neuroradiological studies and headache characteristics were assessed retrospectively, and the intrasellar pressure evaluation was performed during TSS in the last seven patients. All nine patients had complete or substantial resolution of their formerly intractable headache after TSS. Headaches consisted of ocular pain ipsilateral to the adenoma localization within the sella in four cases and bifrontal headache in five. Magnetic resonance imaging of these patients revealed small diaphragmatic foramen, which were so narrow that only the pituitary stalk could pass. Computed tomography scans showed ossification beneath the sellar floor in the sphenoid sinus, presellar type in six cases, and choncal type in three. The adenomas included cysts in seven cases. There was no cavernous sinus invasion. Intrasellar pressure measurements averaged 41.5 ± 8.5 mmHg, range 34-59, significantly higher than in control patients without headache (n = 12), namely 22.2 ± 10.6 mmHg (16-30). In this study, the authors demonstrated the validity of TSS in the treatment of intractable headache associated with pituitary adenoma. The presence of ocular pain, especially ipsilateral to the adenoma, integrity of the diaphragm sella, and ossification in the sphenoid sinus, cyst or hemorrhage and the absence of cavernous sinus invasion were the indications for TSS for patients complaining of intractable headache and having pituitary adenomas.

Removal of pharmaceuticals in conventionally treated wastewater by a polishing moving bed biofilm reactor (MBBR) with intermittent feeding.

PubMed

Tang, Kai; Ooi, Gordon T H; Litty, Klaus; Sundmark, Kim; Kaarsholm, Kamilla M S; Sund, Christina; Kragelund, Caroline; Christensson, Magnus; Bester, Kai; Andersen, Henrik R

2017-07-01

Previous studies have demonstrated that aerobic moving bed biofilm reactors (MBBRs) remove pharmaceuticals better than activated sludge. Thus we used a MBBR system to polish the effluent of an activated sludge wastewater treatment plant. To overcome that effluent contains insufficient organic matter to sustain enough biomass, the biofilm was intermittently fed with raw wastewater. The capacity of pharmaceutical degradation was investigated by spiking pharmaceuticals. Actual removal during treatment was assessed by sampling the inlets and outlets of reactors. The removal of the majority of pharmaceuticals was enhanced through the intermittent feeding of the MBBR. First-order rate constants for pharmaceutical removal, normalised to biomass, were significantly higher compared to other studies on activated sludge and suspended biofilms, especially for diclofenac, metoprolol and atenolol. Due to the intermittently feeding, degradation of diclofenac occurred with a half-life of only 2.1h and was thus much faster than any hitherto described wastewater bioreactor treatment. Copyright © 2017 Elsevier Ltd. All rights reserved.

Treatment of intractable chronic cluster headache by occipital nerve stimulation: a cohort of 51 patients.

PubMed

Miller, S; Watkins, L; Matharu, M

2017-02-01

Chronic cluster headache is a rare, highly disabling primary headache condition. When medically intractable, occipital nerve stimulation can offer effective treatment. Open-label series have provided data on small cohorts only. We analyzed 51 subjects to evaluate the long-term outcomes of highly intractable chronic cluster headache with occipital nerve stimulation. Patients with intractable chronic cluster headache were implanted with occipital nerve stimulators during the period 2007-2014. The primary endpoint was improvement in daily attack frequency. Secondary endpoints included attack severity, attack duration, quality-of-life measures, headache disability scores and adverse events. We studied 51 patients [35 males; mean age at implant 47.78 (range 31-70) years; mean follow-up 39.17 (range 2-81) months]. Nineteen patients had other chronic headache types in addition in chronic cluster headache. At final follow-up, there was a 46.1% improvement in attack frequency (P < 0001) across all patients, 49.5% (P < 0.001) in those with cluster headache alone and 40.3% (P = 0.036) in those with multiple phenotypes. There were no significant differences in response in those with or without multiple headache types. The overall response rate (defined as at least a 50% improvement in attack frequency) was 52.9%. Significant reductions were also seen in attack duration and severity. Improvements were noted in headache disability scores and quality-of-life measures. Triptan use of responders dropped by 62.56%, resulting in significant cost savings. Adverse event rates were highly favorable. Occipital nerve stimulation appears to be a safe and efficacious treatment for highly intractable chronic cluster headache even after a mean follow-up of over 3 years. © 2016 EAN.

Long-term outcome and prognostic factors after C2 ganglion decompression in 68 consecutive patients with intractable occipital neuralgia.

PubMed

Choi, Kyu-Sun; Ko, Yong; Kim, Young-Soo; Yi, Hyeong-Joong

2015-01-01

Occipital neuralgia is a rare cause of severe headache characterized by paroxysmal shooting or stabbing pain in the distribution of the greater occipital or lesser occipital nerve. In cases of intractable occipital neuralgia, a definite cause has not been uncovered, so various types of treatment have been applied. The aim of this study is to evaluate the prognostic factors, safety, and long-term clinical efficacy of second cervical (C2) ganglion decompression for intractable occipital neuralgia. Retrospective analysis was performed in 68 patients with medically refractory occipital neuralgia who underwent C2 ganglion decompression. Factors based on patients' demography, pre- and postoperative headache severity/characteristics, medication use, and postoperative complications were investigated. Therapeutic success was defined as pain relief by at least 50 % without ongoing medication. The visual analog scale (VAS) score was significantly reduced between the preoperative and most recent follow-up period. One year later, excellent or good results were achieved in 57 patients (83.9 %), but poor in 11 patients (16.1 %). The long-term outcome after 5 years was only slightly less than the 1-year outcome; 47 of the 68 patients (69.1 %) obtained therapeutic success. Longer duration of headache (over 13 years; p = 0.029) and presence of retro-orbital/frontal radiation (p = 0.040) were significantly associated with poor prognosis. In the current study, C2 ganglion decompression provided durable, adequate pain relief with minimal complications in patients suffering from intractable occipital neuralgia. Due to the minimally invasive and nondestructive nature of this surgical procedure, C2 ganglion decompression is recommended as an initial surgical treatment option for intractable occipital neuralgia before attempting occipital nerve stimulation. However, further study is required to manage the pain recurrence associated with longstanding nerve injury.

Intractable Pruritus After Traumatic Spinal Cord Injury

PubMed Central

Crane, Deborah A; Jaffee, Kenneth M; Kundu, Anjana

2009-01-01

Background: This report describes a young woman with incomplete traumatic cervical spinal cord injury and intractable pruritus involving her dorsal forearm. Method: Case report. Findings: Anatomic distribution of the pruritus corresponded to the dermatomal distribution of her level of spinal cord injury and vertebral fusion. Symptoms were attributed to the spinal cord injury and possible cervical root injury. Pruritus was refractory to all treatments, including topical lidocaine, gabapentin, transcutaneous electrical nerve stimulation, intravenous Bier block, stellate ganglion block, and acupuncture. Conclusions: Further understanding of neuropathic pruritus is needed. Diagnostic workup of intractable pruritus should include advanced imaging to detect ongoing nerve root compression. If diagnostic studies suggest radiculopathy, epidural steroid injection should be considered. Because the autonomic nervous system may be involved in complex chronic pain or pruritic syndromes, sympatholysis via such techniques as stellate ganglion block might be effective. PMID:19777867

Peripheral neurostimulation for control of intractable occipital neuralgia.

PubMed

Weiner, R L; Reed, K L

1999-07-01

Objective. To present a novel approach for treatment of intractable occipital neuralgia using percutaneous peripheral nerve electrostimulation techniques. Methods. Thirteen patients underwent 17 implant procedures for medically refractory occipital neuralgia. A subcutaneous electrode placed transversely at the level of C1 across the base of the occipital nerve trunk produced paresthesias and pain relief covering the regions of occipital nerve pain Results. With follow-up ranging from 1-½ to 6 years, 12 patients continue to report good to excellent response with greater than 50% pain control and requiring little or no additional medications. The 13th patient (first in the series) was subsequently explanted following symptom resolution. Conclusions. In patients with medically intractable occipital neuralgia, peripheral nerve electrostimulation subcutaneously at the level of C1 appears to be a reasonable alternative to more invasive surgical procedures following failure of more conservative therapies.

Growth Failure in Children with Intractable Epilepsy Is Not Due to Increased Resting Energy Expenditure

ERIC Educational Resources Information Center

Bergqvist, A. G. Christina; Trabulsi, Jillian; Schall, Joan I.; Stallings, Virginia A.

2008-01-01

The aim of this study was to evaluate the resting energy expenditure (REE) of children with intractable epilepsy (IE) compared with healthy children, and to determine factors that contribute to the pattern of REE. REE, growth status, and body composition were assessed in 25 prepubertal children with IE (15 males, 10 females; mean age 5y 5mo [SD 2y…

Modified Atkins diet vs classic ketogenic formula in intractable epilepsy.

PubMed

El-Rashidy, O F; Nassar, M F; Abdel-Hamid, I A; Shatla, R H; Abdel-Hamid, M H; Gabr, S S; Mohamed, S G; El-Sayed, W S; Shaaban, S Y

2013-12-01

The study was designed to evaluate the efficacy, safety, and tolerability of the ketogenic diet (KD) whether classic 4:1 formula or the modified Atkins diet (MAD) in intractable childhood epilepsy. Anthropometric measurements and serum lipid profile were measured upon enrollment and after 3 and 6 months in 40 patients with symptomatic intractable epilepsy. Fifteen were given MAD diet, ten were kept on classic 4:1 ketogenic liquid formula, and the rest were allowed to eat as desired. The liquid ketogenic formula group showed significantly higher body mass index compared with those who did not receive KD after 6 months. The lipid profile of KD patients was within normal limits for age and sex during the study period. The rate of change of frequency and severity of seizures showed best improvement in ketogenic liquid formula patients followed by the MAD group than the patients on anti-epileptic medications alone. The KD whether classic 4:1 or MAD is a tolerable, safe, and effective adjuvant therapy for intractable symptomatic childhood epilepsy with limited adverse effects on the growth parameters and accepted changes in the lipid profile. The liquid ketogenic formula patients showed better growth pattern and significantly more seizure control. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Low cadmium exposure in males and lactating females–estimation of biomarkers

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

Stajnko, Anja

Background: Urine cadmium (Cd) and renal function biomarkers, mostly analysed in urine spot samples, are well established biomarkers of occupational exposure. Their use and associations at low environmental level are common, but have recently been questioned, particularly in terms of physiological variability and normalisation bias in the case of urine spot samples. Aim: To determine the appropriateness of spot urine and/or blood Cd exposure biomarkers and their relationships with renal function biomarkers at low levels of exposure. To this end, we used data from Slovenian human biomonitoring program involving 1081 Slovenians (548 males, mean age 31 years; 533 lactating females,more » mean age 29 years; 2007–2015) who have not been exposed to Cd occupationally. Results: Geometric means (GMs) of Cd in blood and spot urine samples were 0.27 ng/mL (0.28 for males and 0.33 for females) and 0.19 ng/mL (0.21 for males and 0.17 for females), respectively. Differing results were obtained when contrasting normalisation by urine creatinine with specific gravity. GMs of urine albumin (Alb), alpha-1-microglobulin (A1M), N-acetyl-beta-glucosaminidase (NAG), and immunoglobulin G (IgG) were far below their upper reference limits. Statistical analysis of unnormalised or normalised urine data often yielded inconsistent and conflicting results (or trends), so association analyses with unnormalised data were taken as more valid. Relatively weak positive associations were observed between urine Cd (ng/mL) and blood Cd (β=0.11, p=0.002 for males and β=0.33, p<0.001 for females) and for females between urine NAG and blood Cd (β=0.14, p=0.04). No associations were found between other renal function biomarkers and blood Cd. Associations between Cd and renal function biomarkers in urine were stronger (p<0.05, β=0.11–0.63). Mostly, all of the associations stayed significant but weakened after normalisation for diuresis. In the case of A1M, its associations with Cd were influenced by current smoking and blood Pb in males and by pre-pregnancy smoking and blood Se in females (β up to 0.34, p<0.001). Statistical analysis of unnormalised or normalised urine data often yielded inconsistent and conflicting results (or trends), so association analyses data with unnormalised were taken as more valid. Conclusions: The observed uncertainties introduced by urine normalisation, particularly by creatinine, confirm blood Cd as a superior low-Cd exposure biomarker versus urine Cd in cases when 24 h urine is unattainable. Evidence that A1M can be positively related to Cd, smoking (current or pre-pregnancy), Pb, and Se status, points to the versatile biological functions of A1M. - Highlights: • Creatinine normalisation of spot urine data is inappropriate at low Cd exposure. • Blood Cd as low-Cd exposure biomarker is superior over spot urine Cd. • Cd in urine, but not in blood, was significantly associated with A1M. • A1M – Cd relations were influenced by smoking, Se and less so by Pb.« less

The contribution of online content to the promotion and normalisation of female genital cosmetic surgery: a systematic review of the literature.

PubMed

Mowat, Hayley; McDonald, Karalyn; Dobson, Amy Shields; Fisher, Jane; Kirkman, Maggie

2015-11-25

Women considering female genital cosmetic surgery (FGCS) are likely to use the internet as a key source of information during the decision-making process. The aim of this systematic review was to determine what is known about the role of the internet in the promotion and normalisation of female genital cosmetic surgery and to identify areas for future research. Eight social science, medical, and communication databases and Google Scholar were searched for peer-reviewed papers published in English. Results from all papers were analysed to identify recurring and unique themes. Five papers met inclusion criteria. Three of the papers reported investigations of website content of FGCS providers, a fourth compared motivations for labiaplasty publicised on provider websites with those disclosed by women in online communities, and the fifth analysed visual depictions of female genitalia in online pornography. Analysis yielded five significant and interrelated patterns of representation, each functioning to promote and normalise the practice of FGCS: pathologisation of genital diversity; female genital appearance as important to wellbeing; characteristics of women's genitals are important for sex life; female body as degenerative and improvable through surgery; and FGCS as safe, easy, and effective. A significant gap was identified in the literature: the ways in which user-generated content might function to perpetuate, challenge, or subvert the normative discourses prevalent in online pornography and surgical websites. Further research is needed to contribute to knowledge of the role played by the internet in the promotion and normalisation of female genital cosmetic surgery.

Transient hyperthyroidism of hyperemesis gravidarum.

PubMed

Tan, Jackie Y L; Loh, Keh Chuan; Yeo, George S H; Chee, Yam Cheng

2002-06-01

To characterise the clinical, biochemical and thyroid antibody profile in women with transient hyperthyroidism of hyperemesis gravidarum. Prospective observational study. Hospital inpatient gynaecological ward. Women admitted with hyperemesis gravidarum and found to have hyperthyroidism. Fifty-three women were admitted with hyperemesis gravidarum and were found to have hyperthyroidism. Each woman was examined for clinical signs of thyroid disease and underwent investigations including urea, creatinine, electrolytes, liver function test, thyroid antibody profile and serial thyroid function test until normalisation. Gestation at which thyroid function normalised, clinical and thyroid antibody profile and pregnancy outcome (birthweight, gestation at delivery and Apgar score at 5 minutes). Full data were available for 44 women. Free T4 levels normalised by 15 weeks of gestation in the 39 women with transient hyperthyroidism while TSH remained suppressed until 19 weeks of gestation. None of these women were clinically hyperthyroid. Thyroid antibodies were not found in most of them. Median birthweight in the infants of mothers who experienced weight loss of > 5% of their pre-pregnancy weight was lower compared with those of women who did not (P = 0.093). Five women were diagnosed with Graves' disease based on clinical features and thyroid antibody profile. In transient hyperthyroidism of hyperemesis gravidarum, thyroid function normalises by the middle of the second trimester without anti-thyroid treatment. Clinically overt hyperthyroidism and thyroid antibodies are usually absent. Apart from a non-significant trend towards lower birthweights in the infants of mothers who experienced significant weight loss, pregnancy outcome was generally good. Routine assessment of thyroid function is unnecessary for women with hyperemesis gravidarum in the absence of any clinical features of hyperthyroidism.

Development and validation of a computational model of the knee joint for the evaluation of surgical treatments for osteoarthritis

PubMed Central

Mootanah, R.; Imhauser, C.W.; Reisse, F.; Carpanen, D.; Walker, R.W.; Koff, M.F.; Lenhoff, M.W.; Rozbruch, S.R.; Fragomen, A.T.; Dewan, Z.; Kirane, Y.M.; Cheah, Pamela A.; Dowell, J.K.; Hillstrom, H.J.

2014-01-01

A three-dimensional (3D) knee joint computational model was developed and validated to predict knee joint contact forces and pressures for different degrees of malalignment. A 3D computational knee model was created from high-resolution radiological images to emulate passive sagittal rotation (full-extension to 65°-flexion) and weight acceptance. A cadaveric knee mounted on a six-degree-of-freedom robot was subjected to matching boundary and loading conditions. A ligament-tuning process minimised kinematic differences between the robotically loaded cadaver specimen and the finite element (FE) model. The model was validated by measured intra-articular force and pressure measurements. Percent full scale error between EE-predicted and in vitro-measured values in the medial and lateral compartments were 6.67% and 5.94%, respectively, for normalised peak pressure values, and 7.56% and 4.48%, respectively, for normalised force values. The knee model can accurately predict normalised intra-articular pressure and forces for different loading conditions and could be further developed for subject-specific surgical planning. PMID:24786914

Development and validation of a computational model of the knee joint for the evaluation of surgical treatments for osteoarthritis.

PubMed

Mootanah, R; Imhauser, C W; Reisse, F; Carpanen, D; Walker, R W; Koff, M F; Lenhoff, M W; Rozbruch, S R; Fragomen, A T; Dewan, Z; Kirane, Y M; Cheah, K; Dowell, J K; Hillstrom, H J

2014-01-01

A three-dimensional (3D) knee joint computational model was developed and validated to predict knee joint contact forces and pressures for different degrees of malalignment. A 3D computational knee model was created from high-resolution radiological images to emulate passive sagittal rotation (full-extension to 65°-flexion) and weight acceptance. A cadaveric knee mounted on a six-degree-of-freedom robot was subjected to matching boundary and loading conditions. A ligament-tuning process minimised kinematic differences between the robotically loaded cadaver specimen and the finite element (FE) model. The model was validated by measured intra-articular force and pressure measurements. Percent full scale error between FE-predicted and in vitro-measured values in the medial and lateral compartments were 6.67% and 5.94%, respectively, for normalised peak pressure values, and 7.56% and 4.48%, respectively, for normalised force values. The knee model can accurately predict normalised intra-articular pressure and forces for different loading conditions and could be further developed for subject-specific surgical planning.

Matrix-normalised quantification of species by threshold-calibrated competitive real-time PCR: allergenic peanut in food as one example.

PubMed

Holzhauser, Thomas; Kleiner, Kornelia; Janise, Annabella; Röder, Martin

2014-11-15

A novel method to quantify species or DNA on the basis of a competitive quantitative real-time polymerase chain reaction (cqPCR) was developed. Potentially allergenic peanut in food served as one example. Based on an internal competitive DNA sequence for normalisation of DNA extraction and amplification, the cqPCR was threshold-calibrated against 100mg/kg incurred peanut in milk chocolate. No external standards were necessary. The competitive molecule successfully served as calibrator for quantification, matrix normalisation, and inhibition control. Although designed for verification of a virtual threshold of 100mg/kg, the method allowed quantification of 10-1,000 mg/kg peanut incurred in various food matrices and without further matrix adaption: On the basis of four PCR replicates per sample, mean recovery of 10-1,000 mg/kg peanut in chocolate, vanilla ice cream, cookie dough, cookie, and muesli was 87% (range: 39-147%) in comparison to 199% (range: 114-237%) by three commercial ELISA kits. Copyright © 2014 Elsevier Ltd. All rights reserved.

The moral experience of illness and its impact on normalisation: Examples from narratives with Punjabi women living with rheumatoid arthritis in the UK.

PubMed

Sanderson, Tessa; Calnan, Michael; Kumar, Kanta

2015-11-01

The moral component of living with illness has been neglected in analyses of long-term illness experiences. This article attempts to fill this gap by exploring the role of the moral experience of illness in mediating the ability of those living with a long-term condition (LTC) to normalise. This is explored through an empirical study of women of Punjabi origin living with rheumatoid arthritis (RA) in the UK. Sixteen informants were recruited through three hospitals in UK cities and interviews conducted and analysed using a grounded theory approach. The intersection between moral experience and normalisation, within the broader context of ethnic, gender and socioeconomic influences, was evident in the following: disruption of a core lived value (the centrality of family duty), beliefs about illness causation affecting informants' 'moral career', and perceived discrimination in the workplace. The data illustrate the importance of considering an ethnic community's specific values and beliefs when understanding differences in adapting to LTCs and changing identities. © 2015 Foundation for the Sociology of Health & Illness.

Palliative Sedation at Home

PubMed Central

Barathi, B

2012-01-01

Patients with advanced cancer often suffer from multiple intractable physical symptoms. Though majority of the symptoms can be controlled, in some of the patients these symptoms remain refractory and uncontrolled till the end. Palliative sedation (PS) is one of the ways to relieve intractable suffering of the dying cancer patients. The main concern while using PS is its life-shortening effect. This case report describes the feasibility of administering PS in Indian home settings. PMID:22837615

Intractability and Mediation of the Nagorno-Karabakh Conflict

DTIC Science & Technology

2013-12-01

belief that “the origins of the current conflict are shrouded in the mists of the twentieth century,” and assert that conflict resolution requires... origin of a dispute as a seed of conflict is not only a poetic metaphor but also a fitting analogy. Some seeds are carefully cultivated while others...than one level with different factors influencing each plane of development. Understanding the origin of an intractable conflict is important but it

The use of ketogenic diet in special situations: expanding use in intractable epilepsy and other neurologic disorders

PubMed Central

2012-01-01

The ketogenic diet has been widely used and proved to be effective for intractable epilepsy. Although the mechanisms underlying its anti-epileptic effects remain to be proven, there are increasing experimental evidences for its neuroprotective effects along with many researches about expanding use of the diet in other neurologic disorders. The first success was reported in glucose transporter type 1 deficiency syndrome, in which the diet served as an alternative metabolic source. Many neurologic disorders share some of the common pathologic mechanisms such as mitochondrial dysfunction, altered neurotransmitter function and synaptic transmission, or abnormal regulation of reactive oxygen species, and the role of the ketogenic diet has been postulated in these mechanisms. In this article, we introduce an overview about the expanding use and emerging trials of the ketogenic diet in various neurologic disorders excluding intractable epilepsy and provide explanations of the mechanisms in that usage. PMID:23049588

Lymphoid irradiation in intractable rheumatoid arthritis. A double-blind, randomized study comparing 750-rad treatment with 2,000-rad treatment

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

Hanly, J.G.; Hassan, J.; Moriarty, M.

1986-01-01

Twenty patients with intractable rheumatoid arthritis were treated with 750-rad or 2,000-rad lymphoid irradiation in a randomized double-blind comparative study. Over a 12-month followup period, there was a significant improvement in 4 of 7 and 6 of 7 standard parameters of disease activity following treatment with 750 rads and 2,000 rads, respectively. Transient, short-term toxicity was less frequent with the lower dose. In both groups, there was a sustained peripheral blood lymphopenia, a selective depletion of T helper (Leu-3a+) lymphocytes, and reduced in vitro mitogen responses. These changes did not occur, however, in synovial fluid. These results suggest that 750-radmore » lymphoid irradiation is as effective as, but less toxic than, that with 2,000 rads in the management of patients with intractable rheumatoid arthritis.« less

An unusual cause of intractable heel pain.

PubMed

Ghani, Samuel; Fazal, Muhammad Ali

2011-01-01

We report a case of severe heel pain that did not respond to noninvasive measures. Magnetic resonance imaging scans revealed a soft tissue mass that after complete surgical excision was found to be an epidermal cyst. The patient experienced full resolution of the symptoms after excision of the epidermal cyst. To our knowledge, intractable heel pain due to an epidermal cyst is rare. We were unable to identify a previous publication describing the presence of an epidermal cyst localized to the heel without a history of previous trauma. From our experience with the present case, we believe that clinicians should consider the possibility of an epidermal inclusion cyst and should have a low threshold for obtaining magnetic resonance imaging scans, in particular, before the initiation of invasive treatment, in the case of intractable heel pain. Copyright © 2011 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

PET MRI Coregistration in Intractable Epilepsy and Gray Matter Heterotopia.

PubMed

Seniaray, Nikhil; Jain, Anuj

2017-03-01

A 25-year-old woman with intractable seizures underwent FDG PET/MRI for seizure focus localization. MRI demonstrated bilateral carpetlike nodular subependymal gray matter and asymmetrical focal dilatation in the right temporal horn. PET/MRI showed increased FDG within subependymal gray matter with significant hypometabolism in right anterior temporal lobe. EEG and ictal semiology confirmed the right temporal seizure origin. This case highlights the importance of identification of gray matter heterotopia on FDG PET/MRI.

Intractable Electrical Storm After Coronary Artery Bypass Grafting Originating in Abnormal Purkinje Fibers.

PubMed

Tokunaga, Chiho; Tsukada, Toru; Sakamoto, Hiroaki; Naruse, Yoshihisa; Yoshida, Kentaro; Sekiguchi, Yukio; Imai, Akito; Aonuma, Kazutaka; Hiramatsu, Yuji

2016-01-01

Electrical storm is a rare but critical complication following revascularization in patients with ischemic heart disease. We report the case of a 67-year-old man who developed drug refractory intractable electrical storm after emergent coronary artery bypass grafting for ischemic cardiomyopathy. The electrical storm was successfully eliminated by percutaneous endocardial radiofrequency catheter ablation targeting the abnormal Purkinje-related triggering ventricular premature contractions in a low-voltage zone. © 2015 Wiley Periodicals, Inc.

The Predictable Failure of Educational Reform: Can We Change Course before It's Too Late? The Jossey-Bass Education Series and the Jossey-Bass Social and Behavioral Science Series.

ERIC Educational Resources Information Center

Sarason, Seymour B.

Schools have been intractable to change and the attainment of goals set by reformers. A major failure has been the inability of reformers to confront this intractability. As a result, each new wave of reform learns nothing from earlier efforts and comes up with recommendations that have failed in the past. Nine chapters explore why reform efforts…

[Clinical efficacy of one-lung ventilation in treatment of children postoperatively intractable atelectasis].

PubMed

Huo, J M; Bai, K; Fu, Y Q; Liu, C J; Xu, F

2017-11-02

Objective: To investigate the effect of fiberoptic bronchoscope-guided one-lung ventilation (OLV) on treatment of intractable atelectasis in children. Method: This retrospective cohort study was conducted in Pediatric Intensive Care Unit, Children's Hospital of Chongqing Medical University from December 2014 to May 2017. Six patients with intractable atelectasis of left lung were included. Three cases were male and three female with the age from 1.5 to 11.0 years. The endotracheal tube was intubated to the left main bronchus for OLV by the guidance of fiberoptic bronchoscopy. The effect of treatment by monitoring the chest imaging after treatment was evaluated. Result: Six pediatric patients were successfully cured by OLV. The duration of OLV ranged from 1.5 to 30.0 hours, and the intervals of OLV were usually 3 to 5 days. Each patient received 6 to 20 OLV treatments. Chest images showed the left lung reexpanded obviously after OLV treatments. Five patients successfully weaned from invasive ventilation and were discharged. Another patient turned better, discharged from hospital with noninvasive ventilation and weaned from noninvasive ventilation one month later after discharge. During the procedure of OLV, the vital signs of all patients were stable and no complication occurred. Conclusion: OLV with selective bronchial intubation guided by fiber bronchoscope is a safe and effective treatment for intractable atelectasis in children.

Clinical observation of a modified surgical method: posterior vaginal mesh suspension of female rectocele with intractable constipation.

PubMed

Hong, Ling; Li, Huai-Fang; Sun, Jing; Zhu, Jian-Long; Ai, Gui-hai; Li, Li; Zhang, Bo; Chi, Feng-li; Tong, Xiao-Wen

2012-01-01

To explore the feasibility and effectiveness of a modified posterior vaginal mesh suspension method in treating female rectocele with intractable constipation. Descriptive study (Canadian Task Force classification II-3). The study was performed in the Study Center for Female Pelvic Dysfunction Disease, Department of Obstetrics and Gynecology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China. The Study Center includes 15 physicians, most of whom have received advanced training in pelvic floor dysfunctional disease and can skillfully perform many types of operations in patients with such disease. Almost 1500 operations to treat pelvic floor dysfunctional disease are performed every year at the center. Thirty-six women with rectocele with intractable constipation. Posterior vaginal mesh suspension. All patients were followed up for 15 to 36 months. In 29 patients, the condition was cured completely; in 5 patients it had improved; and in 2 patients, the intervention had no effect. Insofar as recovery and improved results, the overall effectiveness rate was 94.4%. Posterior vaginal mesh suspension is an effective, harmless, and convenient method for treatment of female rectocele with intractable constipation. It has positive short-term curative effects, with few complications and sequelae. However, the long-term effects of posterior vaginal mesh suspension should be evaluated. Copyright © 2012 AAGL. Published by Elsevier Inc. All rights reserved.

Role of geospatial technology in identifying natural habitat of malarial vectors in South Andaman, India.

PubMed

Shankar, Shiva; Agrawal, Deepak Kumar

2016-03-01

Malaria is a serious disease which has repeatedly threatened Andaman, an island territory of India. Uncharted dense vegetation and inaccessibility are the salient features of the area and the major areas are covered by remotely sensed data to identify the malaria vector's natural habitat. The present investigation appraises the role of geospatial technologies in identifying the natural habitat of malarial vectors. The base map was prepared from Survey of India's toposheets, the landuse map was prepared from indices techniques like normalised difference vegetation index (NDVI), normalised difference water index (NDWI), modified normalised difference water index (MNDWI), normalised difference pond index (NDPI), and normalized difference turbidity index (NDTI) in conjugation with visual interpretation. The soil moisture content map was reproduced from the soil atlas of Andaman and Nicobar Islands followed by generation of an aspect profile from ASTER-GDEM satellite data. Both the landuse map and aspect profile were validated for accuracy in the field. A weighted overlay analysis of the classes like landuse, soil moisture and aspect profile of the study area resulted in identification of the potential natural habitat map of malaria vector surrounding the areas of Tushnabad, Garacharma, Manglutan, Chouldari, Ferrargunj and Wimberlygunj hamlets. The natural habitat of malaria vector indicated that Tushnabad, Garacharma, Manglutan, Chouldari, Ferrargunj and Wimberlygunj hamlets are within the proximity of 2.5 km from the prime habitat location with more number of malaria positive cases. Also these hamlets are surrounded by dense evergreen forest and the land surface is draped by clay loam and clay soil texture exhibiting high soil moisture content warranting high rates of survival and proliferation of the vector ensuring resurgence of malaria every year. It is thus concluded that application of geospatial technologies plays an important role in identifying the natural habitat of malaria vector.

Dietary soya protein improves intra-myocardial lipid deposition and altered glucose metabolism in a hypertensive, dyslipidaemic, insulin-resistant rat model.

PubMed

Oliva, María E; Creus, Agustina; Ferreira, María R; Chicco, Adriana; Lombardo, Yolanda B

2018-01-01

This study investigates the effects of replacing dietary casein by soya protein on the underlying mechanisms involved in the impaired metabolic fate of glucose and lipid metabolisms in the heart of dyslipidaemic rats chronically fed (8 months) a sucrose-rich (62·5 %) diet (SRD). To test this hypothesis, Wistar rats were fed an SRD for 4 months. From months 4 to 8, half the animals continued with the SRD and the other half were fed an SRD in which casein was substituted by soya. The control group received a diet with maize starch as the carbohydrate source. Compared with the SRD-fed group, the following results were obtained. First, soya protein significantly (P<0·001) reduced the plasma NEFA levels and normalised dyslipidaemia and glucose homoeostasis, improving insulin resistance. The protein levels of fatty acid translocase at basal state and under insulin stimulation and the protein levels and activity of muscle-type carnitine palmitoyltransferase 1 were normalised. Second, a significant (P<0·001) reduction of TAG, long-chain acyl CoA and diacylglycerol levels was observed in the heart muscle. Third, soya protein significantly increased (P<0·01) GLUT4 protein level under insulin stimulation and normalised glucose phosphorylation and oxidation. A reduction of phosphorylated AMP protein kinase protein level was recorded without changes in uncoupling protein 2 and PPARα. Fourth, hydroxyproline concentration decreased in the left ventricle and hypertension was normalised. The new information provided shows the beneficial effects of soya protein upon the altered pathways of glucose and lipid metabolism in the heart muscle of this rat model.

Spatio-temporal footprints of urbanisation in Surat, the Diamond City of India (1990-2009).

PubMed

Sharma, Richa; Ghosh, Aniruddha; Joshi, Pawan Kumar

2013-04-01

Urbanisation is a ubiquitous phenomenon with greater prominence in developing nations. Urban expansion involves land conversions from vegetated moisture-rich to impervious moisture-deficient land surfaces. The urban land transformations alter biophysical parameters in a mode that promotes development of heat islands and degrades environmental health. This study elaborates relationships among various environmental variables using remote sensing dataset to study spatio-temporal footprint of urbanisation in Surat city. Landsat Thematic Mapper satellite data were used in conjugation with geo-spatial techniques to study urbanisation and correlation among various satellite-derived biophysical parameters, [Normalised Difference Vegetation Index, Normalised Difference Built-up Index, Normalised Difference Water Index, Normalised Difference Bareness Index, Modified NDWI and land surface temperature (LST)]. Land use land cover was prepared using hierarchical decision tree classification with an accuracy of 90.4 % (kappa = 0.88) for 1990 and 85 % (kappa = 0.81) for 2009. It was found that the city has expanded over 42.75 km(2) within a decade, and these changes resulted in elevated surface temperatures. For example, transformation from vegetation to built-up has resulted in 5.5 ± 2.6 °C increase in land surface temperature, vegetation to fallow 6.7 ± 3 °C, fallow to built-up is 3.5 ± 2.9 °C and built-up to dense built-up is 5.3 ± 2.8 °C. Directional profiling for LST was done to study spatial patterns of LST in and around Surat city. Emergence of two new LST peaks for 2009 was observed in N-S and NE-SW profiles.

Pulse EPR distance measurements to study multimers and multimerisation

NASA Astrophysics Data System (ADS)

Ackermann, Katrin; Bode, Bela E.

2018-06-01

Pulse dipolar electron paramagnetic resonance (PD-EPR) has become a powerful tool for structural biology determining distances on the nanometre scale. Recent advances in hardware, methodology, and data analysis have widened the scope to complex biological systems. PD-EPR can be applied to systems containing lowly populated conformers or displaying large intrinsic flexibility, making them all but intractable for cryo-electron microscopy and crystallography. Membrane protein applications are of particular interest due to the intrinsic difficulties for obtaining high-resolution structures of all relevant conformations. Many drug targets involved in critical cell functions are multimeric channels or transporters. Here, common approaches for introducing spin labels for PD-EPR cause the presence of more than two electron spins per multimeric complex. This requires careful experimental design to overcome detrimental multi-spin effects and to secure sufficient distance resolution in presence of multiple distances. In addition to obtaining mere distances, PD-EPR can also provide information on multimerisation degrees allowing to study binding equilibria and to determine dissociation constants.

Neonatal severe intractable diarrhoea as the presenting manifestation of an unclassified congenital disorder of glycosylation (CDG-x)

PubMed Central

Mention, K; Michaud, L; Dobbelaere, D; Guimber, D; Gottrand, F; Turck, D

2001-01-01

A case of severe and protracted diarrhoea is reported, which started in the neonatal period and progressively associated with neurological impairment, dysmorphy, hepatosplenomegaly, and hepatic insufficiency, from which the patient died at 2 years of age. Isoelectric focusing of serum transferrin showed a congenital disorder of glycosylation type I pattern but the basic defect could not be identified. This observation shows that congenital disorder of glycosylation is a cause of intractable diarrhoea in neonates.

 PMID:11668168

Integrative Network-based Analysis of Magnetic Resonance Spectroscopy and Genome Wide Expression in Glioblastoma multiforme

PubMed Central

Heiland, Dieter Henrik; Mader, Irina; Schlosser, Pascal; Pfeifer, Dietmar; Carro, Maria Stella; Lange, Thomas; Schwarzwald, Ralf; Vasilikos, Ioannis; Urbach, Horst; Weyerbrock, Astrid

2016-01-01

The goal of this study was to identify correlations between metabolites from proton MR spectroscopy and genetic pathway activity in glioblastoma multiforme (GBM). Twenty patients with primary GBM were analysed by short echo-time chemical shift imaging and genome-wide expression analyses. Weighed Gene Co-Expression Analysis was used for an integrative analysis of imaging and genetic data. N-acetylaspartate, normalised to the contralateral healthy side (nNAA), was significantly correlated to oligodendrocytic and neural development. For normalised creatine (nCr), a group with low nCr was linked to the mesenchymal subtype, while high nCr could be assigned to the proneural subtype. Moreover, clustering of normalised glutamine and glutamate (nGlx) revealed two groups, one with high nGlx being attributed to the neural subtype, and one with low nGlx associated with the classical subtype. Hence, the metabolites nNAA, nCr, and nGlx correlate with a specific gene expression pattern reflecting the previously described subtypes of GBM. Moreover high nNAA was associated with better clinical prognosis, whereas patients with lower nNAA revealed a shorter progression-free survival (PFS). PMID:27350391

Towards a Normalised 3D Geovisualisation: The Viewpoint Management

NASA Astrophysics Data System (ADS)

Neuville, R.; Poux, F.; Hallot, P.; Billen, R.

2016-10-01

This paper deals with the viewpoint management in 3D environments considering an allocentric environment. The recent advances in computer sciences and the growing number of affordable remote sensors lead to impressive improvements in the 3D visualisation. Despite some research relating to the analysis of visual variables used in 3D environments, we notice that it lacks a real standardisation of 3D representation rules. In this paper we study the "viewpoint" as being the first considered parameter for a normalised visualisation of 3D data. Unlike in a 2D environment, the viewing direction is not only fixed in a top down direction in 3D. A non-optimal camera location means a poor 3D representation in terms of relayed information. Based on this statement we propose a model based on the analysis of the computational display pixels that determines a viewpoint maximising the relayed information according to one kind of query. We developed an OpenGL prototype working on screen pixels that allows to determine the optimal camera location based on a screen pixels colour algorithm. The viewpoint management constitutes a first step towards a normalised 3D geovisualisation.

A low-cost method for estimating energy expenditure during soccer refereeing.

PubMed

Ardigò, Luca Paolo; Padulo, Johnny; Zuliani, Andrea; Capelli, Carlo

2015-01-01

This study aimed to apply a validated bioenergetics model of sprint running to recordings obtained from commercial basic high-sensitivity global positioning system receivers to estimate energy expenditure and physical activity variables during soccer refereeing. We studied five Italian fifth division referees during 20 official matches while carrying the receivers. By applying the model to the recorded speed and acceleration data, we calculated energy consumption during activity, mass-normalised total energy consumption, total distance, metabolically equivalent distance and their ratio over the entire match and the two halves. Main results were as follows: (match) energy consumption = 4729 ± 608 kJ, mass normalised total energy consumption = 74 ± 8 kJ · kg(-1), total distance = 13,112 ± 1225 m, metabolically equivalent distance = 13,788 ± 1151 m and metabolically equivalent/total distance = 1.05 ± 0.05. By using a very low-cost device, it is possible to estimate the energy expenditure of soccer refereeing. The provided predicting mass-normalised total energy consumption versus total distance equation can supply information about soccer refereeing energy demand.

[The effects of Cardiodoron on cardio-respiratory coordination--a literature review].

PubMed

Cysarz, D; Heckmann, C; Kümmell, H C

2002-10-01

In healthy subjects self-regulation of the organism establishes the order of rhythmical functions. This self-regulation is altered in patients suffering from idiopathic orthostatic syndrome resulting from disturbances of functional aspects only. Thus the cardio-respiratory coordination, which may serve as the representative of the order of rhythmical functions, is modified. In the case of idiopathic orthostatic syndrome the anthroposophic medicine offers the medicament Cardiodoron(r). Does it stimulate self-regulation in order to normalise the cardio-respiratory coordination? This claim is analysed by a systematic review of the literature. Only those publications were considered where the cardio-respiratory coordination was analysed in studies with patients or healthy subjects. The methods of the studies with patients and healthy subjects vary strongly. Nevertheless, a normalisation of the cardio-respiratory coordination could be found in studies with patients suffering from idiopathic orthostatic syndrome as well as in studies with healthy subjects. The studies show that the use of the medicament results in a normalisation of the cardiorespiratory coordination. By stimulating the self-regulation the medicament leads to an improvement of the order of rhythmical functions in the human organism. Copyright 2002 S. Karger GmbH, Freiburg

Anal heterosex among young people and implications for health promotion: a qualitative study in the UK

PubMed Central

Marston, C; Lewis, R

2014-01-01

Objective To explore expectations, experiences and circumstances of anal sex among young people. Design Qualitative, longitudinal study using individual and group interviews. Participants 130 men and women aged 16–18 from diverse social backgrounds. Setting 3 contrasting sites in England (London, a northern industrial city, rural southwest). Results Anal heterosex often appeared to be painful, risky and coercive, particularly for women. Interviewees frequently cited pornography as the ‘explanation’ for anal sex, yet their accounts revealed a complex context with availability of pornography being only one element. Other key elements included competition between men; the claim that ‘people must like it if they do it’ (made alongside the seemingly contradictory expectation that it will be painful for women); and, crucially, normalisation of coercion and ‘accidental’ penetration. It seemed that men were expected to persuade or coerce reluctant partners. Conclusions Young people's narratives normalised coercive, painful and unsafe anal heterosex. This study suggests an urgent need for harm reduction efforts targeting anal sex to help encourage discussion about mutuality and consent, reduce risky and painful techniques and challenge views that normalise coercion. PMID:25122073

MicroRNA Expression Profiling to Identify and Validate Reference Genes for the Relative Quantification of microRNA in Rectal Cancer.

PubMed

Eriksen, Anne Haahr Mellergaard; Andersen, Rikke Fredslund; Pallisgaard, Niels; Sørensen, Flemming Brandt; Jakobsen, Anders; Hansen, Torben Frøstrup

2016-01-01

MicroRNAs (miRNAs) play important roles in regulating biological processes at the post-transcriptional level. Deregulation of miRNAs has been observed in cancer, and miRNAs are being investigated as potential biomarkers regarding diagnosis, prognosis and prediction in cancer management. Real-time quantitative polymerase chain reaction (RT-qPCR) is commonly used, when measuring miRNA expression. Appropriate normalisation of RT-qPCR data is important to ensure reliable results. The aim of the present study was to identify stably expressed miRNAs applicable as normaliser candidates in future studies of miRNA expression in rectal cancer. We performed high-throughput miRNA profiling (OpenArray®) on ten pairs of laser micro-dissected rectal cancer tissue and adjacent stroma. A global mean expression normalisation strategy was applied to identify the most stably expressed miRNAs for subsequent validation. In the first validation experiment, a panel of miRNAs were analysed on 25 pairs of micro dissected rectal cancer tissue and adjacent stroma. Subsequently, the same miRNAs were analysed in 28 pairs of rectal cancer tissue and normal rectal mucosa. From the miRNA profiling experiment, miR-645, miR-193a-5p, miR-27a and let-7g were identified as stably expressed, both in malignant and stromal tissue. In addition, NormFinder confirmed high expression stability for the four miRNAs. In the RT-qPCR based validation experiments, no significant difference between tumour and stroma/normal rectal mucosa was detected for the mean of the normaliser candidates miR-27a, miR-193a-5p and let-7g (first validation P = 0.801, second validation P = 0.321). MiR-645 was excluded from the data analysis, because it was undetected in 35 of 50 samples (first validation) and in 24 of 56 samples (second validation), respectively. Significant difference in expression level of RNU6B was observed between tumour and adjacent stromal (first validation), and between tumour and normal rectal mucosa (second validation). We recommend the mean expression of miR-27a, miR-193a-5p and let-7g as normalisation factor, when performing miRNA expression analyses by RT-qPCR on rectal cancer tissue.

Therapeutic options for intractable hematuria in advanced bladder cancer.

PubMed

Abt, Dominik; Bywater, Mirjam; Engeler, Daniel Stephan; Schmid, Hans-Peter

2013-07-01

Intractable hematuria is a common and severe complication in patients with inoperable bladder carcinoma. The aim was to provide an overview of therapeutic options for such cases, and analyze their effectiveness and risk profile, so a systematic literature search of peer-reviewed papers published up to September 2012 was carried out. Various options are available to treat hematuria in patients with inoperable bladder cancer; these include orally administered epsilon-aminocaproic acid, intravesical formalin, alum or prostaglandin irrigation, hydrostatic pressure, urinary diversion, radiotherapy, embolization and intraarterial mitoxantrone perfusion. These treatment options are associated with different prospects of success, risks and side-effects. Well-designed and large studies comparing options are completely lacking. Despite various treatment options, management of intractable hematuria in patients with inoperable bladder cancer remains a challenge, and most of the reported methods should be seen as experimental. Interventional radiology and alum instillation seem to be suitable alternative options for patients who, after critical consideration, cannot be treated by irrigation, transurethral resection or palliative cystectomy. © 2013 The Japanese Urological Association.

Young Children in Intractable Conflicts: The Israeli Case.

PubMed

Nasie, Meytal; Diamond, Aurel Harrison; Bar-Tal, Daniel

2015-10-08

The article examines the political socialization of young Jewish-Israeli children who live under the Israeli-Palestinian intractable conflict. It proposes arguments and presents empirical evidence to suggest that the way in which political socialization of young children happens in this context contributes to the development of conflict-supporting narratives of ethos of conflict and collective memory by the youngest generation. As a result, the conflict solidifies adherence to these narratives in adulthood, thereby serving as a major obstacle to the processes of peace-making and peace-building. Specifically, as evidence for showing how the political socialization works in Israel, a series of studies conducted in Israeli kindergartens and elementary schools are presented. These studies recount the contents acquired by young children, as well as contents delivered by teachers, related to the Israeli-Palestinian conflict. This indicates the serious consequences of acquiring conflict-supporting narratives at an early age in societies involved in intractable conflict. © 2015 by the Society for Personality and Social Psychology, Inc.

Bayesian inference of physiologically meaningful parameters from body sway measurements.

PubMed

Tietäväinen, A; Gutmann, M U; Keski-Vakkuri, E; Corander, J; Hæggström, E

2017-06-19

The control of the human body sway by the central nervous system, muscles, and conscious brain is of interest since body sway carries information about the physiological status of a person. Several models have been proposed to describe body sway in an upright standing position, however, due to the statistical intractability of the more realistic models, no formal parameter inference has previously been conducted and the expressive power of such models for real human subjects remains unknown. Using the latest advances in Bayesian statistical inference for intractable models, we fitted a nonlinear control model to posturographic measurements, and we showed that it can accurately predict the sway characteristics of both simulated and real subjects. Our method provides a full statistical characterization of the uncertainty related to all model parameters as quantified by posterior probability density functions, which is useful for comparisons across subjects and test settings. The ability to infer intractable control models from sensor data opens new possibilities for monitoring and predicting body status in health applications.

Neonatal hypoglycemia: A wide range of electroclinical manifestations and seizure outcomes.

PubMed

Arhan, Ebru; Öztürk, Zeynep; Serdaroğlu, Ayşe; Aydın, Kürşad; Hirfanoğlu, Tuğba; Akbaş, Yılmaz

2017-09-01

We examined the various types of epilepsy in children with neonatal hypoglycemia in order to define electroclinical and prognostic features of these patients. We retrospectively reviewed the medical records of patients with a history of symptomatic neonatal hypoglycaemia who have been followed at Gazi University Hospital Pediatric Neurology Department between 2006 and 2015. Patients with perinatal asphyxia were excluded. Details of each patient's perinatal history, neurological outcome, epilepsy details, seizure outcome and EEG and brain MRI findings were reviewed. Fourty five patients (range 6 mo-15 y) with a history of symptomatic neonatal hypoglycaemia were included the study. Epilepsy developed in 36 patients and 23 of them had intractable epilepsy. All patients had occipital brain injury. We observed that most of the patients, either manifesting focal or generalized seizures, further develop intractable epilepsy. This finding establishes neonatal hypoglycemia as a possible cause to be considered in any case of intractable epilepsy. Copyright © 2017 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

Chronic herpes simplex type-1 encephalitis with intractable epilepsy in an immunosuppressed patient.

PubMed

Laohathai, Christopher; Weber, Daniel J; Hayat, Ghazala; Thomas, Florian P

2016-02-01

Chronic herpes simplex virus type-1 encephalitis (HSE-1) is uncommon. Past reports focused on its association with prior documented acute infection. Here, we describe a patient with increasingly intractable epilepsy from chronic HSE-1 reactivation without history of acute central nervous system infection. A 49-year-old liver transplant patient with 4-year history of epilepsy after initiation of cyclosporine developed increasingly frequent seizures over 3 months. Serial brain magnetic resonance imaging showed left temporoparietal cortical edema that gradually improved despite clinical decline. Herpes simplex virus type-1 (HSV-1) DNA was detected in cerebrospinal fluid by polymerase chain reaction. Cerebrospinal fluid HSV-1&2 IgM was negative. Seizures were controlled after acyclovir treatment, and the patient remained seizure free at 1-year follow-up. Chronic HSE is a cause of intractable epilepsy, can occur without a recognized preceding acute phase, and the clinical course of infection may not directly correlate with neuroimaging changes.

Pre-game perceived wellness highly associates with match running performances during an international field hockey tournament.

PubMed

Ihsan, Mohammed; Tan, Frankie; Sahrom, Sofyan; Choo, Hui Cheng; Chia, Michael; Aziz, Abdul Rashid

2017-06-01

This study examined the associations between pre-game wellness and changes in match running performance normalised to either (i) playing time, (ii) post-match RPE or (iii) both playing time and post-match RPE, over the course of a field hockey tournament. Twelve male hockey players were equipped with global positioning system (GPS) units while competing in an international tournament (six matches over 9 days). The following GPS-derived variables, total distance (TD), low-intensity activity (LIA; <15 km/h), high-intensity running (HIR; >15 km/h), high-intensity accelerations (HIACC; >2 m/s 2 ) and decelerations (HIDEC; >-2 m/s 2 ) were acquired and normalised to either (i) playing time, (ii) post-match RPE or (iii) both playing time and post-match RPE. Each morning, players completed ratings on a 0-10 scale for four variables: fatigue, muscle soreness, mood state and sleep quality, with cumulative scores determined as wellness. Associations between match performances and wellness were analysed using Pearson's correlation coefficient. Combined time and RPE normalisation demonstrated the largest associations with Δwellness compared with time or RPE alone for most variables; TD (r = -0.95; -1.00 to -0.82, p = .004), HIR (r = -0.95; -1.00 to -0.83, p = .003), LIA (r = -0.94; -1.00 to -0.81, p = .026), HIACC (r = -0.87; -1.00 to -0.66, p = .004) and HIDEC (r = -0.90; -0.99 to -0.74, p = .008). These findings support the use of wellness measures as a pre-match tool to assist with managing internal load over the course of a field hockey tournament. Highlights Fixtures during international field hockey tournaments are typically congested and impose high physiological demands on an athlete. To minimise decrements in running performance over the course of a tournament, measures to identify players who have sustained high internal loads are logically warranted. The present study examined the association between changes in simple customised psychometric wellness measures, on changes in match running performance normalised to (i) playing time, (ii) post-match RPE and (iii) playing time and post-match RPE, over the course of a field hockey tournament. Changes in match running performance were better associated to changes in wellness (r = -0.87 to -0.95), when running performances were normalised to both time and RPE compared with time or RPE alone. The present findings support the use of wellness measures as a pre-match tool to assist with managing internal load over the course of a field hockey tournament. Improved associations between wellness scores and match running performances were evident, when running variables were normalised to both playing time and post-match RPE.

Efficacy of and patient compliance with a ketogenic diet in adults with intractable epilepsy: a meta-analysis.

PubMed

Ye, Fang; Li, Xiao-Jia; Jiang, Wan-Lin; Sun, Hong-Bin; Liu, Jie

2015-01-01

Despite the successful use of a ketogenic diet in pediatric epilepsy, its application in adults has been limited. The aim of this meta-analysis was to summarize the findings of relevant published studies in order to identify the efficacy of and compliance with a ketogenic diet and its main subtypes (i.e., classic ketogenic diet and modified Atkins diet) in adults with intractable epilepsy, and to provide useful information for clinical practice. Electronic searches of PubMed, EMBASE, Google Scholar, and the ISI Web of Science were conducted to identify studies of the efficacy of and patient compliance with a ketogenic diet in adults with intractable epilepsy; the included studies were reviewed. Meta-analyses were performed using STATA to determine combined efficacy rates and combined rates of compliance with the ketogenic diet and its main subtypes. In total, 12 studies qualified for inclusion, and data from 270 patients were evaluated.The results of the meta-analysis revealed combined efficacy rates of all types of ketogenic diet, a classical ketogenic diet, and a modified Atkins diet were 42%, 52%, and 34%, respectively; the corresponding combined compliance rates were 45%, 38%, and 56%. The results indicate that a ketogenic diet is a promising complementary therapy in adult intractable epilepsy, and that while a classical ketogenic diet may be more effective, adult patients are likely to be less compliant with it than with a modified Atkins diet.

Mutation screening of the CDKL5 gene in cryptogenic infantile intractable epilepsy and review of clinical sensitivity.

PubMed

Intusoma, Utcharee; Hayeeduereh, Fadell; Plong-On, Oradawan; Sripo, Thanya; Vasiknanonte, Punnee; Janjindamai, Supachai; Lusawat, Apasri; Thammongkol, Sasipa; Visudtibhan, Anannit; Limprasert, Pornprot

2011-09-01

To perform CDKL5 mutation screening in Thai children with cryptogenic infantile intractable epilepsy and to determine the clinical sensitivity of CDKL5 screening when different inclusion criteria were applied. Children with cryptogenic infantile intractable epilepsy were screened for CDKL5 mutation using multiplex ligation-dependent probe amplification and DNA sequencing. The clinical sensitivity was reviewed by combining the results of studies using similar inclusion screening criteria. Thirty children (19 girls and 11 boys) with a median seizure onset of 7 months were screened. Almost a half had infantile spasms and one fifth had stereotypic hand movements. A novel c.2854C>T (p.R952X) was identified in an ambulatory girl who had severe mental retardation, multiple types of seizures without Rett-like features. Her mother had a mild intellectual disability, yet her grandmother and half sister were normal despite having the same genetic alteration (random X-inactivation patterns). The pathogenicity of p.R952X identified here was uncertain since healthy relatives and 6 female controls also harbor this alteration. The clinical sensitivity of CDKL5 mutation screening among females with Rett-like features and negative MECP2 screening was 7.8% while the clinical sensitivity among females having cryptogenic intractable seizures with an onset before the ages of 12, 6 and 3 months were 4.7, 11.6 and 14.3%, respectively. Copyright © 2011 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

Xp22.3 genomic deletions involving the CDKL5 gene in girls with early onset epileptic encephalopathy.

PubMed

Mei, Davide; Marini, Carla; Novara, Francesca; Bernardina, Bernardo D; Granata, Tiziana; Fontana, Elena; Parrini, Elena; Ferrari, Anna R; Murgia, Alessandra; Zuffardi, Orsetta; Guerrini, Renzo

2010-04-01

Mutations of the X-linked gene cyclin-dependent kinase-like 5 (CDKL5) cause an X-linked encephalopathy with early onset intractable epilepsy, including infantile spasms and other seizure types, and a Rett syndrome (RTT)-like phenotype. Very limited information is available on the frequency and phenotypic spectrum associated with CDKL5 deletions/duplications. We investigated the role of CDKL5 deletions/duplications in causing early onset intractable epilepsy of unknown etiology in girls. We studied 49 girls with early onset intractable epilepsy, with or without infantile spasms, and developmental impairment, for whom no etiologic factors were obvious after clinical examination, brain magnetic resonance imaging (MRI) and expanded screening for inborn errors of metabolism. We performed CDKL5 gene mutation analysis in all and multiplex ligation dependent probe amplification assay (MLPA) in those who were mutation negative. Custom Array-comparative genomic hybridization (CGH), breakpoint polymerase chain reaction (PCR) analysis, and X-inactivation studies were performed in patients in whom MLPA uncovered a genomic alteration. We found CDKL5 mutations in 8.2% (4 of 49) of patients and genomic deletions in 8.2% (4 of 49). Overall, abnormalities of the CDKL5 gene accounted for 16.3% (8 of 49) of patients. CDKL5 gene deletions are an under-ascertained cause of early onset intractable epilepsy in girls. Genetic testing of CDKL5, including both mutation and deletion/duplication analysis, should be considered in this clinical subgroup.

Early experience with activated recombinant factor VII for intractable hemorrhage after cardiovascular surgery.

PubMed

Halkos, Michael E; Levy, Jerrold H; Chen, Edward; Reddy, V Seenu; Lattouf, Omar M; Guyton, Robert A; Song, Howard K

2005-04-01

Intractable hemorrhage after complex cardiovascular operations is a serious and potentially lethal complication. We report our experience with the use of activated recombinant factor VIIa (rFVIIa) as rescue therapy for patients with refractory postoperative hemorrhage. From April 2002 through December 2003, 9 patients received rFVIIa for intractable hemorrhage after cardiovascular surgery. Patients underwent aortic surgery (2), coronary artery bypass graft surgery (4), double valve operations (2), and mitral valve replacement (1). Four of these procedures were reoperations. Intraoperative aprotinin was used in all patients. All patients underwent standard heparinization (300 IU/kg) before cardiopulmonary bypass and reversal with protamine. Five patients underwent reexploration for mediastinal hemorrhage before treatment; 2 were reexplored twice. The average transfusion requirement before rFVIIa administration was 9 U of blood, 7 U of plasma, 22 U of platelets, and 19 U of cryoprecipitate. rFVIIa was administered as an intravenous bolus at 68 to 120 mug/kg. Mean time of administration from the first operation was 10.9 +/- 7.2 hours. At the time of activated rFVIIa administration, chest tube drainage averaged 640 mL/h. In all patients, chest tube drainage was dramatically reduced to less than 100 mL/h within 5 hours after drug delivery. None of the patients required reexploration after treatment. There were no postoperative neurologic or cardiovascular complications. When used as rescue therapy for intractable hemorrhage after cardiovascular surgery, rFVIIa may be effective in promoting hemostasis, preventing reexploration, and reducing transfusion requirements.

Familial partial trisomy 15q11-13 presenting as intractable epilepsy in the child and schizophrenia in the mother.

PubMed

Michelson, Marina; Eden, Avi; Vinkler, Chana; Leshinsky-Silver, Esther; Kremer, Uri; Lerman-Sagie, Tally; Lev, Dorit

2011-05-01

Various rearrangements involve the proximal long arm of chromosome 15, including deletions, duplications, translocations, inversions and supernumerary marker chromosome of an inverted duplication. The large marker 15, that contains the Prader-Willi syndrome (PWS)/Angelman syndrome (AS) chromosome region, is usually associated with an abnormal phenotype of moderate to severe mental retardation, seizures, poor motor coordination, early-onset central hypotonia, autism and autistic-like behavior, schizophrenia and mild dysmorphic features. We report a ten year-old girl with normal intelligence prior to the onset of seizures, who developed severe intractable epilepsy at the age of seven years. Family history was significant for a mother with recurrent episodes of acute psychosis. The patient's and mother's karyotype revealed 47,XX+m. Array comparative genomic hybridization (A-CGH) identified a gain of 13 BAC clones from 15q11.2 through 15q13.1, which was then confirmed by FISH to be part of the marker chromosome. This duplicated region contains the SNRPN/UBE3A locus. This case demonstrates that a duplication of 15q11-13 can present differently in the same family either as intractable epilepsy or as a psychiatric illness and that intelligence can be preserved. We suggest that CGH microarray should be performed in cases with intractable epilepsy or schizophrenia, with or without mental retardation. Copyright © 2010 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

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

Timonen, Hilkka; Cubison, Mike; Aurela, Minna

The applicability, methods and limitations of constrained peak fitting on mass spectra of low mass resolving power ( m/Δ m 50~500) recorded with a time-of-flight aerosol chemical speciation monitor (ToF-ACSM) are explored. Calibration measurements as well as ambient data are used to exemplify the methods that should be applied to maximise data quality and assess confidence in peak-fitting results. Sensitivity analyses and basic peak fit metrics such as normalised ion separation are employed to demonstrate which peak-fitting analyses commonly performed in high-resolution aerosol mass spectrometry are appropriate to perform on spectra of this resolving power. Information on aerosol sulfate, nitrate,more » sodium chloride, methanesulfonic acid as well as semi-volatile metal species retrieved from these methods is evaluated. The constants in a commonly used formula for the estimation of the mass concentration of hydrocarbon-like organic aerosol may be refined based on peak-fitting results. Lastly, application of a recently published parameterisation for the estimation of carbon oxidation state to ToF-ACSM spectra is validated for a range of organic standards and its use demonstrated for ambient urban data.« less

Price discrimination in essential medicines: evidence from International Drug Price Indicator Guide data.

PubMed

Hanlon, Michael; Zhang, Raymond

2013-03-01

Few data are available on what donors, governments and other implementing organisations pay for the medicines they procure. To partly address this shortcoming, we analyse transactions of pharmaceuticals on the WHO's essential medicines list. Our objective was to identify the determinants of prices paid for these drugs. We used data from the 2008 version of the International Drug Price Indicator Guide. We normalised transactions by representing their value as a 'price per daily dose'. We used a mixed-effects regression model to quantify the impact of observable characteristics on prices paid. We present evidence of first-degree price discrimination in the market for essential medicines. We find that as a country's per capita wealth doubles, prices paid for the same pharmaceutical increase by 33%. These data indicate that purchasing agents from wealthier countries pay more for essential medicines, all factors constant. This behaviour is not a form of development assistance for health but rather is indicative of inefficient markets in which buyers' lack of information enables suppliers to charge higher prices than they could otherwise.

Intractable Seizures and Rehabilitation in Ciguatera Poisoning.

PubMed

Derian, Armen; Khurana, Seema; Rothenberg, Joshua; Plumlee, Charles

2017-05-01

Ciguatera fish poisoning is the most frequently reported seafood toxin illness associated with the ingestion of contaminated tropical fish. Diagnosis relies on a history of recent tropical fish ingestion and subsequent development of gastrointestinal, cardiovascular, and neurological symptoms. Ciguatera poisoning usually has a self-limited time course, and its management involves symptomatic control and supportive care. This case report presents an uncommon case of ciguatera poisoning with prolonged intractable seizures refractory to standard antiseizure medications. The patient also had significant functional decline that responded to rigorous inpatient rehabilitation not previously described in literature.

Intractable diarrhea in hyperthyroidism: management with beta-adrenergic blockade.

PubMed

Bricker, L A; Such, F; Loehrke, M E; Kavanaugh, K

2001-01-01

To describe a patient with intractable diarrhea and thyrotoxic Graves' disease, for whom b-adrenergic blockade ultimately proved to be effective therapy for the diarrhea, and to review the types of hyperthyroidism-associated diarrhea. We present the clinical course of a young man with a prolonged siege of diarrhea that proved elusive to diagnostic inquiries and resistant to all means of management until its endocrine basis was discovered. Control of such cases with b-adrenergic blockade is discussed, as are the pathophysiologic bases of intestinal hypermotility in hyperthyroidism. A 26-year-old man with Down syndrome, and no prior gastrointestinal disorder, had insidious, chronic, constant diarrhea, which was associated with loss of 14 kg during a 5-month period. Numerous laboratory and imaging studies and endoscopic examinations failed to disclose the cause of the diarrhea. Furthermore, a broad range of antibiotics and other empiric remedies failed to control the problem. No other symptoms of hyperthyroidism were reported, but when the endocrinopathy was suspected and identified, the diarrhea was promptly controlled by treatment with propranolol. In patients with hyperthyroidism, two types of diarrheal disorders have been described-secretory diarrhea and steatorrhea; bile acid malabsorption may have a role in either of these settings. In addition to its capacity for blocking the peripheral effects of thyroid hormone on the heart and central nervous system, b-adrenergic blockade is effective in slowing intestinal transit time and ameliorating the uncommon diarrhea associated with hyperthyroidism. Thyroid hormone in excess, among its other possible effects on the gastrointestinal tract, may exert a stimulatory effect by means of intermediary sympathetic activation, as it does with the heart. Thus, sympathetic blockade can mimic the salutary effects on the gastrointestinal tract conventionally brought about by direct antithyroid therapy, and well before the hyperthyroid state per se is eliminated. The current patient illustrates the value of considering hyperthyroidism in the differential diagnosis of diarrhea of unknown cause.

An integrated bioinformatics approach to improve two-color microarray quality-control: impact on biological conclusions.

PubMed

van Haaften, Rachel I M; Luceri, Cristina; van Erk, Arie; Evelo, Chris T A

2009-06-01

Omics technology used for large-scale measurements of gene expression is rapidly evolving. This work pointed out the need of an extensive bioinformatics analyses for array quality assessment before and after gene expression clustering and pathway analysis. A study focused on the effect of red wine polyphenols on rat colon mucosa was used to test the impact of quality control and normalisation steps on the biological conclusions. The integration of data visualization, pathway analysis and clustering revealed an artifact problem that was solved with an adapted normalisation. We propose a possible point to point standard analysis procedure, based on a combination of clustering and data visualization for the analysis of microarray data.

Differences in distal lower extremity tissue masses and mass ratios exist in athletes of sports involving repetitive impacts.

PubMed

Schinkel-Ivy, Alison; Burkhart, Timothy A; Andrews, David M

2014-01-01

This study aimed to examine the effects of sex and sport on the tissue composition of the distal lower extremity of varsity athletes, in sports that involve repetitive-impact loading patterns. Fat mass, lean mass, bone mineral content and wobbling mass were predicted for the leg and leg + foot segments of varsity basketball, cross-country, soccer and volleyball athletes. The absolute masses were normalised to body mass, and also expressed relative to each other as ratios. Females and males differed on most normalised tissue masses and ratios by 11-101%. Characteristic differences were found in the normalised tissue masses across sports, with the lowest and highest values displayed by cross-country and volleyball (female)/basketball (male) athletes, respectively. Conversely, cross-country athletes had the highest wobbling mass:bone mineral content and lean mass:bone mineral content ratios for females by 10% and 16%, respectively. The differences between sports may be explained in part by different impact loading patterns characteristic of each sport. Tissue mass ratio differences between sports may suggest that the ratios of soft to rigid tissues are optimised by the body in response to typical loading patterns, and may therefore be useful in investigations of distal lower extremity injury mechanisms in athletes.

Hungry bone syndrome and normalisation of renal phosphorus threshold after total parathyroidectomy for tertiary hyperparathyroidism in X-linked hypophosphataemia: a case report.

PubMed

Crowley, Rachel K; Kilbane, Mark; King, Thomas Fj; Morrin, Michelle; O'Keane, Myra; McKenna, Malachi J

2014-03-04

This is the first report of which the authors are aware to describe this c.2166delinsGG mutation in X-linked hypophosphataemia and to describe normalisation of renal threshold for phosphate excretion after parathyroidectomy for tertiary hyperparathyroidism in X-linked hypophosphataemia. We present the case of a 34-year-old Caucasian woman with X-linked hypophosphataemia. She developed tertiary hyperparathyroidism with markedly high bone turnover requiring total parathyroidectomy and had prolonged requirement for intravenous calcium infusion after surgery. She had a novel mutation in her phosphate-regulating gene with homologies to endopeptidases on the X-chromosome and had an unusual degree of dependence on phosphate supplementation. Prior to operative intervention she had a trial of cinacalcet that improved bone turnover markers when used in isolation but which led to a paradoxical rise in parathyroid hormone levels when given with phosphate supplementation. After correction of hungry bone syndrome, the renal phosphorus threshold normalised as a manifestation of hypoparathyroid state despite marked elevation in level of fibroblast growth factor 23. This case illustrates the risk of tertiary hyperparathyroidism as a complication of treatment for hypophosphataemia; it highlights the morbidity associated with hungry bone syndrome and provides novel insight into renal handling of phosphorus.

Normalisation in product life cycle assessment: an LCA of the global and European economic systems in the year 2000.

PubMed

Sleeswijk, Anneke Wegener; van Oers, Lauran F C M; Guinée, Jeroen B; Struijs, Jaap; Huijbregts, Mark A J

2008-02-01

In the methodological context of the interpretation of environmental life cycle assessment (LCA) results, a normalisation study was performed. 15 impact categories were accounted for, including climate change, acidification, eutrophication, human toxicity, ecotoxicity, depletion of fossil energy resources, and land use. The year 2000 was chosen as a reference year, and information was gathered on two spatial levels: the global and the European level. From the 860 environmental interventions collected, 48 interventions turned out to account for at least 75% of the impact scores of all impact categories. All non-toxicity related, emission dependent impacts are fully dominated by the bulk emissions of only 10 substances or substance groups: CO(2), CH(4), SO(2), NO(x), NH(3), PM(10), NMVOC, and (H)CFCs emissions to air and emissions of N- and P-compounds to fresh water. For the toxicity-related emissions (pesticides, organics, metal compounds and some specific inorganics), the availability of information was still very limited, leading to large uncertainty in the corresponding normalisation factors. Apart from their usefulness as a reference for LCA studies, the results of this study stress the importance of efficient measures to combat bulk emissions and to promote the registration of potentially toxic emissions on a more comprehensive scale.

Follicle vascularity coordinates corpus luteum blood flow and progesterone production.

PubMed

de Tarso, S G S; Gastal, G D A; Bashir, S T; Gastal, M O; Apgar, G A; Gastal, E L

2017-03-01

Colour Doppler ultrasonography was used to compare the ability of preovulatory follicle (POF) blood flow and its dimensions to predict the size, blood flow and progesterone production capability of the subsequent corpus luteum (CL). Cows (n=30) were submitted to a synchronisation protocol. Follicles ≥7mm were measured and follicular wall blood flow evaluated every 12h for approximately 3.5 days until ovulation. After ovulation, cows were scanned daily for 8 days and similar parameters were evaluated for the CL. Blood samples were collected and plasma progesterone concentrations quantified. All parameters were positively correlated. Correlation values ranged from 0.26 to 0.74 on data normalised to ovulation and from 0.31 to 0.74 on data normalised to maximum values. Correlations between calculated ratios of both POF and CL in data normalised to ovulation and to maximum values ranged from moderate (0.57) to strong (0.87). Significant (P<0.0001) linear regression analyses were seen in all comparisons. In conclusion, higher correlations were observed between the dimensions of POF and/or CL and blood flow of both structures, as well as POF and/or CL blood flow with plasma progesterone concentrations of the resultant CL. These findings indicate that follicle vascularity coordinates CL blood flow and progesterone production in synchronised beef cows.

Selection of reference genes for expression studies with fish myogenic cell cultures.

PubMed

Bower, Neil I; Johnston, Ian A

2009-08-10

Relatively few studies have used cell culture systems to investigate gene expression and the regulation of myogenesis in fish. To produce robust data from quantitative real-time PCR mRNA levels need to be normalised using internal reference genes which have stable expression across all experimental samples. We have investigated the expression of eight candidate genes to identify suitable reference genes for use in primary myogenic cell cultures from Atlantic salmon (Salmo salar L.). The software analysis packages geNorm, Normfinder and Best keeper were used to rank genes according to their stability across 42 samples during the course of myogenic differentiation. Initial results showed several of the candidate genes exhibited stable expression throughout myogenic culture while Sdha was identified as the least stable gene. Further analysis with geNorm, Normfinder and Bestkeeper identified Ef1alpha, Hprt1, Ppia and RNApolII as stably expressed. Comparison of data normalised with the geometric average obtained from combinations of any three of these genes showed no significant differences, indicating that any combination of these genes is valid. The geometric average of any three of Hprt1, Ef1alpha, Ppia and RNApolII is suitable for normalisation of gene expression data in primary myogenic cultures from Atlantic salmon.

Stigma and quality of life at long-term follow-up after surgery for epilepsy in Uganda.

PubMed

Fletcher, Anita; Sims-Williams, Helen; Wabulya, Angela; Boling, Warren

2015-11-01

Epilepsy is a worldwide health problem with a 10-fold greater prevalence in the developing world. Commonly, the seizure focus is in the temporal lobe, and seizures in about 30% of people with epilepsy are intractable to medication. For these individuals, surgery for intractable temporal lobe epilepsy (iTLE) is more effective than medication alone and may be the only option for cure. Intractable temporal lobe epilepsy is associated with elevated morbidity and mortality, reduced quality of life (QOL), and associated stigma particularly occurring in the developing world. Individuals with intractable epilepsy who participated in an earlier Uganda pilot study were selected for the current study based on their undergoing previous surgery for iTLE or having comparable seizure type who did not have surgery. At long-term follow-up, 10 who underwent surgery for iTLE in addition to 9 patients with focal dyscognitive type epilepsy who did not have surgery were evaluated in the current study. Tests were administered to look at various outcome parameters: seizure severity, QOL, stigma, and self-esteem. Stigma and self-esteem were additionally evaluated in the parent/caregiver. Seventy-percent of surgical resection patients were seizure-free at 8 years postsurgery. The QOLIE-31 scores were higher in surgical patients. Child/patient and parent/proxy surveys identified lower stigma in seizure-free patients. The results suggest that surgery for iTLE is an effective treatment for epilepsy in the developing world and provides an opportunity to reduce stigma and improve QOL. Copyright © 2015 Elsevier Inc. All rights reserved.

Therapeutic approach to mite-induced intractable dermatitis using novel immunomodulator FTY720 ointment (fingolimod) in NC/Nga mice.

PubMed

Tsuji, Takumi; Okuno, Satoshi; Kuroda, Ayano; Hamazaki, Junya; Chikami, Takuma; Sakurai, Sakura; Yoshida, Yuya; Banno, Rie; Fujita, Tetsuro; Kohno, Takeyuki

2016-04-01

The increasing incidence and prevalence of atopic dermatitis (AD) demands new therapeutic approaches for treating the disease. We investigated the therapeutic efficacy of immunomodulator FTY720 ointment (fingolimod) for mite-induced intractable AD using an NC/Nga mouse model. Female NC/Nga mice that developed severe AD were divided into four groups: (1) FTY720 (0.001% FTY720 ointment), (2) tacrolimus (tacrolimus hydrate ointment) (3) betamethasone (betamethasone ointment), and (4) ointment base (hydrophilic petrolatum), all of which received treatment six times per week. Therapeutic efficacy after two weeks was evaluated in terms of AD severity, histochemical observations (epidermal hypertrophy, mast cell accumulation, and CD3(+) T cell infiltration), transepidermal water loss (TEWL), and epidermal barrier function (filaggrin expression). Betamethasone treatment showed little effect, confirming that the AD was intractable. In the FTY720 group, AD improved significantly compared with the ointment base group, as did epidermal hypertrophy, mast cell accumulation, and CD3(+) T cell infiltration. In contrast, AD in the tacrolimus and betamethasone groups did not improve significantly, nor did epidermal hypertrophy or mast cell accumulation. Furthermore, in the FTY720 group, TEWL decreased significantly compared with the ointment base group, and filaggrin expression significantly increased compared with the betamethasone and ointment base groups. FTY720 ointment is a promising candidate for treatment of intractable AD. These findings also provide the first evidence that FTY720 ointment ameliorates epidermal barrier function. Copyright © 2015 Japanese Society of Allergology. Production and hosting by Elsevier B.V. All rights reserved.

Postoperative seizure freedom does not normalize altered connectivity in temporal lobe epilepsy.

PubMed

Maccotta, Luigi; Lopez, Mayra A; Adeyemo, Babatunde; Ances, Beau M; Day, Brian K; Eisenman, Lawrence N; Dowling, Joshua L; Leuthardt, Eric C; Schlaggar, Bradley L; Hogan, Robert Edward

2017-11-01

Specific changes in the functional connectivity of brain networks occur in patients with epilepsy. Yet whether such changes reflect a stable disease effect or one that is a function of active seizure burden remains unclear. Here, we longitudinally assessed the connectivity of canonical cognitive functional networks in patients with intractable temporal lobe epilepsy (TLE), both before and after patients underwent epilepsy surgery and achieved seizure freedom. Seventeen patients with intractable TLE who underwent epilepsy surgery with Engel class I outcome and 17 matched healthy controls took part in the study. The functional connectivity of a set of cognitive functional networks derived from typical cognitive tasks was assessed in patients, preoperatively and postoperatively, as well as in controls, using stringent methods of artifact reduction. Preoperatively, functional networks in TLE patients differed significantly from healthy controls, with differences that largely, but not exclusively, involved the default mode and temporal/auditory subnetworks. However, undergoing epilepsy surgery and achieving seizure freedom did not lead to significant changes in network connectivity, with postoperative functional network abnormalities closely mirroring the preoperative state. This result argues for a stable chronic effect of the disease on brain connectivity, with changes that are largely "burned in" by the time a patient with intractable TLE undergoes epilepsy surgery, which typically occurs years after the initial diagnosis. The result has potential implications for the treatment of intractable epilepsy, suggesting that delaying surgical intervention that may achieve seizure freedom may lead to functional network changes that are no longer reversible by the time of epilepsy surgery. Wiley Periodicals, Inc. © 2017 International League Against Epilepsy.

Unique and shared areas of cognitive function in children with intractable frontal or temporal lobe epilepsy.

PubMed

Law, Nicole; Widjaja, Elysa; Smith, Mary Lou

2018-03-01

Previous findings have been mixed in terms of identifying a distinct pattern of neuropsychological deficits in children with frontal lobe epilepsy (FLE) and in those with temporal lobe epilepsy (TLE). The current study investigated the neuropsychological similarities and differences across these two pediatric medically intractable localization-related epilepsies. Thirty-eight children with FLE, 20 children with TLE, and 40 healthy children (HC) participated in this study. A comprehensive battery of standardized tests assessed five neuropsychological domains including intelligence, language, memory, executive function, and motor function. A principal component analysis (PCA) was used to distill our neuropsychological measures into latent components to compare between groups. Principal component analysis extracted 5 latent components: executive function (F1), verbal semantics (F2), motor (F3), nonverbal cognition/impulsivity (F4), and verbal cognition/attention (F5). The group with FLE differed from the HC group on F1, F2, F4, and F5, and had worse performance than the group with TLE on F1; the group with TLE had lower performance relative to the HC group on F2. Our findings suggest that, in comparison with neurotypically developing children, children with medically intractable FLE have more widespread neuropsychological impairments than do children with TLE. The differences between the two patient groups were greatest for the factor score most clearly related to executive function. The results provide mixed support for the concept of specificity in neuropsychological dysfunction among different subtypes of localization-related medically intractable childhood epilepsies. Copyright © 2018 Elsevier Inc. All rights reserved.

Implementation of cardiovascular disease prevention in primary health care: enhancing understanding using normalisation process theory.

PubMed

Volker, Nerida; Williams, Lauren T; Davey, Rachel C; Cochrane, Thomas; Clancy, Tanya

2017-02-24

The reorientation of primary health care towards prevention is fundamental to addressing the rising burden of chronic disease. However, in Australia, cardiovascular disease prevention practice in primary health care is not generally consistent with existing guidelines. The Model for Prevention study was a whole-of-system cardiovascular disease prevention intervention, with one component being enhanced lifestyle modification support and addition of a health coaching service in the general practice setting. To determine the feasibility of translating intervention outcomes into real world practice, implementation work done by stakeholders was examined using Normalisation Process Theory as a framework. Data was collected through interviews with 40 intervention participants and included general practitioners, practice nurses, practice managers, lifestyle advisors and participants. Data analysis was informed by normalisation process theory constructs. Stakeholders were in agreement that, while prevention is a key function of general practice, it was not their usual work. There were varying levels of engagement with the intervention by practice staff due to staff interest, capacity and turnover, but most staff reconfigured their work for required activities. The Lifestyle Advisors believed staff had varied levels of interest in and understanding of, their service, but most staff felt their role was useful. Patients expanded their existing relationships with their general practice, and most achieved their lifestyle modification goals. While the study highlighted the complex nature of the change required, many of the new or enhanced processes implemented as part of the intervention could be scaled up to improve the systems approach to prevention. Overcoming the barriers to change, such as the perception of CVD prevention as a 'hard sell', is going to rely on improving the value proposition for all stakeholders. The study provided a detailed understanding of the work required to implement a complex cardiovascular disease prevention intervention within general practice. The findings highlighted the need for multiple strategies that engage all stakeholders. Normalisation process theory was a useful framework for guiding change implementation.

Factors influencing the robustness of P-value measurements in CT texture prognosis studies

NASA Astrophysics Data System (ADS)

McQuaid, Sarah; Scuffham, James; Alobaidli, Sheaka; Prakash, Vineet; Ezhil, Veni; Nisbet, Andrew; South, Christopher; Evans, Philip

2017-07-01

Several studies have recently reported on the value of CT texture analysis in predicting survival, although the topic remains controversial, with further validation needed in order to consolidate the evidence base. The aim of this study was to investigate the effect of varying the input parameters in the Kaplan-Meier analysis, to determine whether the resulting P-value can be considered to be a robust indicator of the parameter’s prognostic potential. A retrospective analysis of the CT-based normalised entropy of 51 patients with lung cancer was performed and overall survival data for these patients were collected. A normalised entropy cut-off was chosen to split the patient cohort into two groups and log-rank testing was performed to assess the survival difference of the two groups. This was repeated for varying normalised entropy cut-offs and varying follow-up periods. Our findings were also compared with previously published results to assess robustness of this parameter in a multi-centre patient cohort. The P-value was found to be highly sensitive to the choice of cut-off value, with small changes in cut-off producing substantial changes in P. The P-value was also sensitive to follow-up period, with particularly noisy results at short follow-up periods. Using matched conditions to previously published results, a P-value of 0.162 was obtained. Survival analysis results can be highly sensitive to the choice in texture cut-off value in dichotomising patients, which should be taken into account when performing such studies to avoid reporting false positive results. Short follow-up periods also produce unstable results and should therefore be avoided to ensure the results produced are reproducible. Previously published findings that indicated the prognostic value of normalised entropy were not replicated here, but further studies with larger patient numbers would be required to determine the cause of the different outcomes.

The Use of EST Expression Matrixes for the Quality Control of Gene Expression Data

PubMed Central

Milnthorpe, Andrew T.; Soloviev, Mikhail

2012-01-01

EST expression profiling provides an attractive tool for studying differential gene expression, but cDNA libraries' origins and EST data quality are not always known or reported. Libraries may originate from pooled or mixed tissues; EST clustering, EST counts, library annotations and analysis algorithms may contain errors. Traditional data analysis methods, including research into tissue-specific gene expression, assume EST counts to be correct and libraries to be correctly annotated, which is not always the case. Therefore, a method capable of assessing the quality of expression data based on that data alone would be invaluable for assessing the quality of EST data and determining their suitability for mRNA expression analysis. Here we report an approach to the selection of a small generic subset of 244 UniGene clusters suitable for identification of the tissue of origin for EST libraries and quality control of the expression data using EST expression information alone. We created a small expression matrix of UniGene IDs using two rounds of selection followed by two rounds of optimisation. Our selection procedures differ from traditional approaches to finding “tissue-specific” genes and our matrix yields consistency high positive correlation values for libraries with confirmed tissues of origin and can be applied for tissue typing and quality control of libraries as small as just a few hundred total ESTs. Furthermore, we can pick up tissue correlations between related tissues e.g. brain and peripheral nervous tissue, heart and muscle tissues and identify tissue origins for a few libraries of uncharacterised tissue identity. It was possible to confirm tissue identity for some libraries which have been derived from cancer tissues or have been normalised. Tissue matching is affected strongly by cancer progression or library normalisation and our approach may potentially be applied for elucidating the stage of normalisation in normalised libraries or for cancer staging. PMID:22412959

Hepatic parenchymal atrophy induction for intractable segmental bile duct injury after liver resection.

PubMed

Hwang, Shin; Park, Gil-Chun; Ha, Tae-Yong; Ko, Gi-Young; Gwon, Dong-Il; Choi, Young-Il; Song, Gi-Won; Lee, Sung-Gyu

2012-05-01

Liver resection can result in various types of bile duct injuries but their treatment is usually difficult and often leads to intractable clinical course. We present an unusual case of hepatic segment III duct (B3) injury, which occurred after left medial sectionectomy for large hepatocellular carcinoma and was incidentally detected 1 week later due to bile leak. Since the pattern of this B3 injury was not adequate for operative biliary reconstruction, atrophy induction of the involved hepatic parenchyma was attempted. This treatment consisted of embolization of the segment III portal branch to inhibit bile production, induction of heavy adhesion at the bile leak site and clamping of the percutaneous transhepatic biliary drainage (PTBD) tube to accelerate segment III atrophy. This entire procedure, from liver resection to PTBD tube removal took 4 months. This patient has shown no other complication or tumor recurrence for 4 years to date. These findings suggest that percutaneous segmental portal vein embolization, followed by intentional clamping of external biliary drainage, can effectively control intractable bile leak from segmental bile duct injury.

[Factors for the onset of and the exacerbation of tuberculosis. 4. Clinical factors related to the onset and exacerbation of tuberculosis. b. Middle-aged and elderly patients].

PubMed

Nakagawa, M

1999-10-01

Exacerbating factors of tuberculosis were evaluated from the viewpoint of intractability of the disease including the effectiveness of chemotherapy by comparing patients with intractable tuberculosis and those with nonintractable tuberculosis. Of the patients aged 30 years or above admitted to our hospital for the initial episode of tuberculosis, 42 patients with intractable tuberculosis and 247 controls were compared. No difference was observed between the two groups in life-style factors such as smoking, drinking, and living alone or complications such as diabetes mellitus and cerebrospinal diseases. In the refractory group, a poor general condition with fever and body weight losses on admission, massive discharge of tubercle bacillus, and delayed diagnosis and treatment were frequently observed. Also, patients with a lymphocyte count of 500/mm3 or less such as those with anemia, hypoproteinemia/hypoalbuminemia, high LDH and CRP levels, and a low cholinesterase level were significantly more frequent, and resistant bacteria were detected more frequently in this group.

Successful control of intractable nausea and vomiting requiring combined ondansetron and haloperidol in a patient with advanced cancer.

PubMed

Cole, R M; Robinson, F; Harvey, L; Trethowan, K; Murdoch, V

1994-01-01

Chemically induced nausea and vomiting is a common symptom of advanced cancer effected through stimulation of dopamine (D2) or serotonin (5-HT3) receptors located in the chemoreceptor trigger zone (CTZ). These may be blocked by therapeutic doses of haloperidol and ondansetron, respectively. This case, reporting on a single patient acting as her own control, establishes that combined blockade of these receptors is sometimes required to relieve intractable nausea and vomiting. It also demonstrates the value of clinical review, audit of care, and quality assurance in the palliative care setting.

SNF5 Mutation Leads to Intractable Pain in Schwannomatosis Patients

DTIC Science & Technology

2013-07-01

in schwannomatosis patients PRINCIPAL INVESTIGATOR: Steven G. Matsumoto...AND SUBTITLE 5a. CONTRACT NUMBER SNF5 mutation leads to intractable pain in schwannomatosis patients 5b. GRANT NUMBER W81XWH-11-1-0143 5c...Conclusion…………………………………………………………………………… 6 References……………………………………………………………………………. 7 Introduction. Schwannomatosis is a

Emotions in conflicts: understanding emotional processes sheds light on the nature and potential resolution of intractable conflicts.

PubMed

Halperin, Eran; Tagar, Michal Reifen

2017-10-01

In recent years, researchers have been making substantial advances in understanding the central role of emotions in intractable conflict. We now know that discrete emotions uniquely shape policy preferences in conflict through their unique emotional goals and action tendencies in all stages of conflict including conflict management, conflict resolution and reconciliation. Drawing on this understanding, recent research also points to emotion regulation as a path to reduce conflict and advance peace, exploring both direct and indirect strategies of emotion regulation. Copyright © 2017 Elsevier Ltd. All rights reserved.

ANTICOOL: Simulating positron cooling and annihilation in atomic gases

NASA Astrophysics Data System (ADS)

Green, D. G.

2018-03-01

The Fortran program ANTICOOL, developed to simulate positron cooling and annihilation in atomic gases for positron energies below the positronium-formation threshold, is presented. Given positron-atom elastic scattering phase shifts, normalised annihilation rates Zeff, and γ spectra as a function of momentum k, ANTICOOL enables the calculation of the positron momentum distribution f(k , t) as a function of time t, the time-varying normalised annihilation rate Z¯eff(t) , the lifetime spectrum and time-varying annihilation γ spectra. The capability and functionality of the program is demonstrated via a tutorial-style example for positron cooling and annihilation in room temperature helium gas, using accurate scattering and annihilation cross sections and γ spectra calculated using many-body theory as input.

Text analysis of MEDLINE for discovering functional relationships among genes: evaluation of keyword extraction weighting schemes.

PubMed

Liu, Ying; Navathe, Shamkant B; Pivoshenko, Alex; Dasigi, Venu G; Dingledine, Ray; Ciliax, Brian J

2006-01-01

One of the key challenges of microarray studies is to derive biological insights from the gene-expression patterns. Clustering genes by functional keyword association can provide direct information about the functional links among genes. However, the quality of the keyword lists significantly affects the clustering results. We compared two keyword weighting schemes: normalised z-score and term frequency-inverse document frequency (TFIDF). Two gene sets were tested to evaluate the effectiveness of the weighting schemes for keyword extraction for gene clustering. Using established measures of cluster quality, the results produced from TFIDF-weighted keywords outperformed those produced from normalised z-score weighted keywords. The optimised algorithms should be useful for partitioning genes from microarray lists into functionally discrete clusters.

Talking about depression: a qualitative study of barriers to managing depression in people with long term conditions in primary care

PubMed Central

2011-01-01

Background The risk of depression is increased in people with long term conditions (LTCs) and is associated with poorer patient outcomes for both the depressive illness and the LTC, but often remains undetected and poorly managed. The aim of this study was to identify and explore barriers to detecting and managing depression in primary care in people with two exemplar LTCs: diabetes and coronary heart disease (CHD). Methods Qualitative in-depth interviews were conducted with 19 healthcare professionals drawn predominately from primary care, along with 7 service users and 3 carers (n = 29). One focus group was then held with a set of 6 healthcare professionals and a set of 7 service users and 1 carer (n = 14). Interviews and the focus group were digitally recorded, transcribed verbatim, and analysed independently. The two data sets were then inspected for commonalities using a constant comparative method, leading to a final thematic framework used in this paper. Results Barriers to detecting and managing depression in people with LTCs in primary care exist: i) when practitioners in partnership with patients conceptualise depression as a common and understandable response to the losses associated with LTCs - depression in the presence of LTCs is normalised, militating against its recognition and treatment; ii) where highly performanced managed consultations under the terms of the Quality and Outcomes Framework encourage reductionist approaches to case-finding in people with CHD and diabetes, and iii) where there is uncertainty among practitioners about how to negotiate labels for depression in people with LTCs in ways that might facilitate shared understanding and future management. Conclusion Depression was often normalised in the presence of LTCs, obviating rather than facilitating further assessment and management. Furthermore, structural constraints imposed by the QOF encouraged reductionist approaches to case-finding for depression in consultations for CHD and diabetes. Future work might focus on how interventions that draw on the principles of the chronic care model, such as collaborative care, could support primary care practitioners to better recognise and manage depression in patients with LTCs. PMID:21426542

Assessment of reference gene stability influenced by extremely divergent disease symptoms in Solanum lycopersicum L.

PubMed

Wieczorek, Przemysław; Wrzesińska, Barbara; Obrępalska-Stęplowska, Aleksandra

2013-12-01

Tomato (Solanum lycopersicum L.) is one of the most important vegetables of great worldwide economic value. The scientific importance of the vegetable results from the fact that the genome of S. lycopersicum has been sequenced. This allows researchers to study fundamental mechanisms playing an essential role during tomato development and response to environmental factors contributing significantly to cell metabolism alterations. Parallel with the development of contemporary genetics and the constant increase in sequencing data, progress has to be aligned with improvement of experimental methods used for studying genes functions and gene expression levels, of which the quantitative polymerase chain reaction (qPCR) is still the most reliable. As well as with other nucleic acid-based methods used for comparison of the abundance of specific RNAs, the RT-qPCR data have to be normalised to the levels of RNAs represented stably in a cell. To achieve the goal, the so-called housekeeping genes (i.e., RNAs encoding, for instance, proteins playing an important role in the cell metabolism or structure maintenance), are used for normalisation of the target gene expression data. However, a number of studies have indicated the transcriptional instability of commonly used reference genes analysed in different situations or conditions; for instance, the origin of cells, tissue types, or environmental or other experimental conditions. The expression of ten common housekeeping genes of S. lycopersicum, namely EF1α, TUB, CAC, EXP, RPL8, GAPDH, TBP, ACT, SAND and 18S rRNA were examined during viral infections of tomato. Changes in the expression levels of the genes were estimated by comparison of the non-inoculated tomato plants with those infected with commonly known tomato viral pathogens, Tomato torrado virus, Cucumber mosaic virus, Tobacco mosaic virus and Pepino mosaic virus, inducing a diverse range of disease symptoms on the common host, ranging from mild leaves chlorosis to very severe stem necrosis. It is emphasised that despite the wide range of diverse disease symptoms it is concluded that ACT, CAC and EF1α could be used as the most suitable reference genes in studies of host-virus interactions in tomato. Copyright © 2013 Elsevier B.V. All rights reserved.

Integrating collaborative place-based health promotion coalitions into existing health system structures: the experience from one Australian health coalition.

PubMed

Ehrlich, Carolyn; Kendall, Elizabeth

2015-01-01

Increasingly, place-based collaborative partnerships are being implemented to develop the capacity of communities to build supportive environments and improve population health outcomes. These place-based initiatives require cooperative and coordinated responses that can exist within social systems and integrate multiple responses. However, the dynamic interplay between co-existing systems and new ways of working makes implementation outcomes unpredictable. We interviewed eight programme leaders, three programme teams and two advisory groups to explore the capacity of one social system to implement and normalise a collaborative integrated place-based health promotion initiative in the Logan and Beaudesert area in South East Queensland, Australia. The construct of capacity as defined in the General Theory of Implementation was used to develop a coding framework. Data were then placed into conceptually coherent groupings according to this framework until all data could be accounted for. Four themes defined capacity for implementation of a collaborative and integrated response; namely, the ability to (1) traverse a nested and contradictory social landscape, (2) be a responsive and 'good' community partner, (3) establish the scaffolding required to work 'in place'; and (4) build a shared meaning and engender trust. Overall, we found that the capacity of the system to embed a place-based health promotion initiative was severely limited by the absence of these features. Conflict, disruption and constant change within the context into which the place-based collaborative partnership was being implemented meant that existing relationships were constantly undermined and the capacity of the partners to develop trust-based coherent partnerships was constantly diminished. To enhance the likelihood that collaborative and integrated place-based health promotion initiatives will become established ways of working, an agreed, meaningful and clearly articulated vision and identity are required; goals must be prioritised and negotiated; and sustainable resourcing must be assured.

K+-selective nanospheres: maximising response range and minimising response time.

PubMed

Ruedas-Rama, Maria Jose; Hall, Elizabeth A H

2006-12-01

Cross-linked K(+) ion-selective copolymer nanospheres have been prepared by free-radical photo-initiated polymerization of n-butyl acrylate (nBA) with hexanedioldiacrylate (HDDA). Nanospheres (<200 nm) containing H(+)-chromoionophore (ETH 5294) and lipophilic salt (KTClPB) for H(+)-sensors, or ETH 5294, a K(+)-selective ionophore (valinomycin) and anionic sites for K(+)-sensors were compared, and the effect of varying the normalised concentrations for beta (R(T)(-)/L(T)) and gamma (C(m)(T)/L(T)) was studied. Experimental data were fitted to theoretical curves for the dynamic response range, based on the effect of changes in the concentration of these lipophilic sensing components incorporated into the spheres, and conditions identified for maximising the response range. A complex valinomycin-K(+) formation constant, log K(IL) = 13.13 +/- 2.22, was obtained in the nBA matrix, and from the calibration curves the apparent acid-dissociation equilibrium constant (pK(a) = 12.92 +/- 0.03) was extracted for the H(+)-sensing system, and the equilibrium exchange constant (pK(exch) = 6.16 +/- 0.03, at pH 7) calculated for the K(+)-sensing nanospheres. A basis for establishing optimum performance was identified, whereby response range and response time were balanced with maximum fluorescence yield. Parameters for achieving nanospheres with a response time <5 minutes, covering 2-3 orders of magnitude change in activity were identified, demanding nanospheres with radius <300 nm and beta(crit) approximately 0.6. An RSD(%) approximately 3% was obtained in a study of the reproducibility of the response of the proposed nanospheres, and selectivity was also evaluated for a K(+)-selective nanosensor using several cations as interfering agents. In most cases, the fluorescent emission spectra showed no response to the cations tested, confirming the selectivity of nanospheres to potassium ion. The nanosensors were satisfactorily applied to the determination of K(+) in samples mimicking physiological conditions.

Does ketogenic diet have any negative effect on cardiac systolic and diastolic functions in children with intractable epilepsy?: One-year follow-up results.

PubMed

Ozdemir, Rahmi; Kucuk, Mehmet; Guzel, Orkide; Karadeniz, Cem; Yilmaz, Unsal; Mese, Timur

2016-10-01

The ketogenic diet (KD) has been referred to as an "effective therapy with side effects" for children with intractable epilepsy. Among the most recognized adverse effects, there are cardiac conduction abnormalities, vascular and myocardial dysfunction. However, very limited and controversial data are available regarding the effects of the KD on cardiac functions. We sought to analyze the mid-term effect of ketogenic diet on cardiac functions in patients with intractable epilepsy who received a ketogenic diet for at least 12months using conventional and relatively new imaging techniques. This prospective study included 61 patients with intractable epilepsy who received ketogenic diet for at least 12months. Clinical examinations, serum carnitine and selenium levels as well as electrocardiographic and echocardiographic examinations were scheduled prior to the procedure and at 1, 3, 6 and 12months. We utilized two-dimensional, M-mode, colored Doppler, spectral Doppler and pulsed wave tissue Doppler imaging techniques to investigate ventricular systolic and diastolic functions of this subgroup of patients. In our study, there was no significant difference after 1year of KD therapy compared to baseline values-except a significantly decreased A wave velocity-in terms of pulse wave Doppler echocardiographic measurements of the diastolic function. The tissue Doppler measurements obtained from the lateral wall of tricuspide and mitral annuli were not different at baseline and at month 12 of the treatment, as well. The ketogenic diet appears to have no disturbing effect on ventricular functions in epileptic children in the midterm. Copyright © 2016 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

Lexicon before and after epilepsy surgery in adolescents.

PubMed

Meekes, Joost; Chanturidze, Mari; Braams, Olga B; Braun, Kees P J; van Rijen, Peter C; Hendriks, Marc P H; Jennekens-Schinkel, Aag; van Nieuwenhuizen, Onno

2016-05-01

Poor performance on confrontation naming tasks by children and adolescents with pharmacologically intractable epilepsy has been interpreted as indicating impairments of lexicon, that is, the store of words in long-term memory. However, confrontation naming performance crucially depends not only on word knowledge but also on other functions such as fluency. We applied an alternative method to assess lexicon with the aim of tracing deficits in lexicon before and after surgery in adolescents with pharmacologically intractable epilepsy. Sixteen patients and 32 age- and sex-matched controls completed the Dutch version of the controlled oral word production task. Responses were used to calculate indices of lexical fluency (retrieval efficiency), lexical breadth (vocabulary size), and lexical depth (knowledge of word properties), as well as use of search strategies. Adolescents with pharmacologically intractable epilepsy had lower lexical fluency scores than healthy peers, but did not differ from them on the dimensions of lexical breadth and lexical depth. Patients demonstrated reduced use of search strategies. In fact, the difference in lexical fluency between patients and controls disappeared after controlling for Full Scale IQ (obtained using the Dutch version of the 3rd edition of the Wechsler Intelligence Scale for Children (WISC-IIINL; Kort et al., 2005; Wechsler, 2002) or-for older children-the Dutch version of the first edition of the Kaufman Adult and Adolescent Intelligence Test (KAIT; Kaufman & Kaufman, 1993; Mulder, Dekker, & Dekker, 2004) and use of search strategies. In patients, changes in the use of the antiepileptic drug carbamazepine were associated with lexical fluency. Adolescents with pharmacologically intractable epilepsy differ from their healthy peers mainly in lexical fluency, rather than word knowledge per se. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

A good preoperative response to transcutaneous electrical nerve stimulation predicts a better therapeutic effect of implanted occipital nerve stimulation in pharmacologically intractable headaches.

PubMed

Nguyen, Jean-Paul; Nizard, Julien; Kuhn, Emmanuelle; Carduner, Florence; Penverne, Frédérique; Verleysen-Robin, Marie-Christine; Terreaux, Luc; de Gaalon, Solène; Raoul, Sylvie; Lefaucheur, Jean-Pascal

2016-02-01

Occipital nerve stimulation (ONS) is a surgical approach to treat patients with medically intractable chronic headache disorders. However, no preoperative test has been yet validated to allow candidates to be selected for implantation. In this study, the analgesic efficacy of transcutaneous electrical nerve stimulation (TENS) was tested for 1 to 3 months in 41 patients with pharmacologically intractable headache disorders of various origins, using a new technique of electrode placement over the occipital nerve. ONS electrodes were subsequently implanted in 33 patients (occipital neuralgia [n=15], cervicogenic headache [n=7], cluster headache [n=6], chronic migraine [n=5]) who had responded at least moderately to TENS. Assessment was performed up to five years after implantation (three years on average), based on the mean and maximum daily pain intensity scored on a 0-10 visual analogue scale and the number of headache days per month. Both TENS and chronic ONS therapy were found to be efficacious (57-76% improvement compared to baseline on the various clinical variables). The efficacy of ONS was better in cases of good or very good preoperative response to TENS than in cases of moderate response to TENS. Implanted ONS may be a valuable therapeutic option in the long term for patients with pharmacologically intractable chronic headache. Although we cannot conclude in patients with poor or no response to TENS, a good or very good response to TENS can support the indication of ONS therapy. This preoperative test could particularly be useful in patients with chronic migraine, in whom it may be difficult to indicate an invasive technique of cranial neurostimulation. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Resting-State Functional MR Imaging for Determining Language Laterality in Intractable Epilepsy.

PubMed

DeSalvo, Matthew N; Tanaka, Naoaki; Douw, Linda; Leveroni, Catherine L; Buchbinder, Bradley R; Greve, Douglas N; Stufflebeam, Steven M

2016-10-01

Purpose To measure the accuracy of resting-state functional magnetic resonance (MR) imaging in determining hemispheric language dominance in patients with medically intractable focal epilepsies against the results of an intracarotid amobarbital procedure (IAP). Materials and Methods This study was approved by the institutional review board, and all subjects gave signed informed consent. Data in 23 patients with medically intractable focal epilepsy were retrospectively analyzed. All 23 patients were candidates for epilepsy surgery and underwent both IAP and resting-state functional MR imaging as part of presurgical evaluation. Language dominance was determined from functional MR imaging data by calculating a laterality index (LI) after using independent component analysis. The accuracy of this method was assessed against that of IAP by using a variety of thresholds. Sensitivity and specificity were calculated by using leave-one-out cross validation. Spatial maps of language components were qualitatively compared among each hemispheric language dominance group. Results Measurement of hemispheric language dominance with resting-state functional MR imaging was highly concordant with IAP results, with up to 96% (22 of 23) accuracy, 96% (22 of 23) sensitivity, and 96% (22 of 23) specificity. Composite language component maps in patients with typical language laterality consistently included classic language areas such as the inferior frontal gyrus, the posterior superior temporal gyrus, and the inferior parietal lobule, while those of patients with atypical language laterality also included non-classical language areas such as the superior and middle frontal gyri, the insula, and the occipital cortex. Conclusion Resting-state functional MR imaging can be used to measure language laterality in patients with medically intractable focal epilepsy. (©) RSNA, 2016 Online supplemental material is available for this article.

Resting-State Functional MR Imaging for Determining Language Laterality in Intractable Epilepsy

PubMed Central

Tanaka, Naoaki; Douw, Linda; Leveroni, Catherine L.; Buchbinder, Bradley R.; Greve, Douglas N.; Stufflebeam, Steven M.

2016-01-01

Purpose To measure the accuracy of resting-state functional magnetic resonance (MR) imaging in determining hemispheric language dominance in patients with medically intractable focal epilepsies against the results of an intracarotid amobarbital procedure (IAP). Materials and Methods This study was approved by the institutional review board, and all subjects gave signed informed consent. Data in 23 patients with medically intractable focal epilepsy were retrospectively analyzed. All 23 patients were candidates for epilepsy surgery and underwent both IAP and resting-state functional MR imaging as part of presurgical evaluation. Language dominance was determined from functional MR imaging data by calculating a laterality index (LI) after using independent component analysis. The accuracy of this method was assessed against that of IAP by using a variety of thresholds. Sensitivity and specificity were calculated by using leave-one-out cross validation. Spatial maps of language components were qualitatively compared among each hemispheric language dominance group. Results Measurement of hemispheric language dominance with resting-state functional MR imaging was highly concordant with IAP results, with up to 96% (22 of 23) accuracy, 96% (22 of 23) sensitivity, and 96% (22 of 23) specificity. Composite language component maps in patients with typical language laterality consistently included classic language areas such as the inferior frontal gyrus, the posterior superior temporal gyrus, and the inferior parietal lobule, while those of patients with atypical language laterality also included non-classical language areas such as the superior and middle frontal gyri, the insula, and the occipital cortex. Conclusion Resting-state functional MR imaging can be used to measure language laterality in patients with medically intractable focal epilepsy. © RSNA, 2016 Online supplemental material is available for this article. PMID:27467465

Preliminary experience with epsilon aminocaproic acid for treatment of intractable upper tract hematuria in children with hematological disorders.

PubMed

Kaye, Jonathan D; Smith, Edwin A; Kirsch, Andrew J; Cerwinka, Wolfgang H; Elmore, James M

2010-09-01

Gross, intractable hematuria is rare in children. Although the role of epsilon aminocaproic acid in the management of refractory hematuria is well established in the adult population, few data exist about its use in children for this indication. We present our initial experience with epsilon aminocaproic acid for the treatment of intractable hematuria after more conservative measures failed, and propose an algorithm for administration of epsilon aminocaproic acid in children. We reviewed the charts of all patients treated with epsilon aminocaproic acid for intractable gross hematuria at our institution during a period of 36 months. All patients underwent hematological evaluation and any underlying bleeding dyscrasias were addressed. All patients also underwent renal and bladder ultrasound, retrograde pyelogram and ureteroscopy. Demographic information, medical and surgical histories, and epsilon aminocaproic acid dosing and outcomes were recorded. Three boys and 1 girl 11 to 17 years old were treated with epsilon aminocaproic acid. Three patients had sickle trait (1 with nutcracker phenomenon) and 1 had hemophilia A. Three patients required packed red blood cell transfusions to maintain hematocrit. Three renal angiograms were performed, all of which were nondiagnostic. Duration of hematuria ranged from 1 to 52 weeks before administration of epsilon aminocaproic acid. Endoscopic evaluation demonstrated hematuria localized to 1 ureteral orifice in all 4 patients. All patients received 100 mg/kg epsilon aminocaproic acid orally every 6 hours, which uniformly led to cessation of hematuria. Epsilon aminocaproic acid is useful for the management of gross refractory hematuria when more conservative measures fail. Because of its potential side effects, it should be used cautiously. 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

CBD-enriched medical cannabis for intractable pediatric epilepsy: The current Israeli experience.

PubMed

Tzadok, Michal; Uliel-Siboni, Shimrit; Linder, Ilan; Kramer, Uri; Epstein, Orna; Menascu, Shay; Nissenkorn, Andrea; Yosef, Omer Bar; Hyman, Eli; Granot, Dorit; Dor, Michael; Lerman-Sagie, Tali; Ben-Zeev, Bruria

2016-02-01

To describe the experience of five Israeli pediatric epilepsy clinics treating children and adolescents diagnosed as having intractable epilepsy with a regimen of medical cannabis oil. A retrospective study describing the effect of cannabidiol (CBD)-enriched medical cannabis on children with epilepsy. The cohort included 74 patients (age range 1-18 years) with intractable epilepsy resistant to >7 antiepileptic drugs. Forty-nine (66%) also failed a ketogenic diet, vagal nerve stimulator implantation, or both. They all started medical cannabis oil treatment between 2-11/2014 and were treated for at least 3 months (average 6 months). The selected formula contained CBD and tetrahydrocannabinol at a ratio of 20:1 dissolved in olive oil. The CBD dose ranged from 1 to 20mg/kg/d. Seizure frequency was assessed by parental report during clinical visits. CBD treatment yielded a significant positive effect on seizure load. Most of the children (66/74, 89%) reported reduction in seizure frequency: 13 (18%) reported 75-100% reduction, 25 (34%) reported 50-75% reduction, 9 (12%) reported 25-50% reduction, and 19 (26%) reported <25% reduction. Five (7%) patients reported aggravation of seizures which led to CBD withdrawal. In addition, we observed improvement in behavior and alertness, language, communication, motor skills and sleep. Adverse reactions included somnolence, fatigue, gastrointestinal disturbances and irritability leading to withdrawal of cannabis use in 5 patients. The results of this multicenter study on CBD treatment for intractable epilepsy in a population of children and adolescents are highly promising. Further prospective, well-designed clinical trials using enriched CBD medical cannabis are warranted. Copyright © 2016 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Intractable bone marrow edema syndrome of the hip.

PubMed

Gao, Fuqiang; Sun, Wei; Li, Zirong; Guo, Wanshou; Kush, Nepali; Ozaki, Koji

2015-04-01

There is a need for an effective and noninvasive treatment for intractable bone marrow edema syndrome of the hip. Forty-six patients with intractable bone marrow edema syndrome of the hip were retrospectively studied to compare the short-term clinical effects of treatment with high-energy extracorporeal shock wave therapy vs femoral head core decompression. The postoperative visual analog scale score decreased significantly more in the extracorporeal shock wave therapy group compared with the femoral head core decompression group (P<.05). For unilateral lesions, postoperative Harris Hip Scores for all hips in the extracorporeal shock wave therapy group were more significantly improved than Harris Hip Scores for all hips in the femoral head core decompression group (P<.05). Patients who underwent extracorporeal shock wave therapy also resumed daily activities significantly earlier. Average overall operative time was similar in both groups. Symptoms disappeared significantly sooner in the extracorporeal shock wave therapy group in patients with both unilateral (P<.01) and bilateral lesions (P<.05). Hospital costs were significantly lower with extracorporeal shock wave therapy compared with femoral head core decompression. The intraoperative fluoroscopy radiation dose was lower in extracorporeal shock wave therapy than in femoral head core decompression for both unilateral (P<.05) and bilateral lesions (P<.01). On magnetic resonance imaging (MRI), bone marrow edema improved in all patients during the follow-up period. After extracorporeal shock wave therapy, all patients remained pain-free and had normal findings on posttreatment radiographs and MRI scans. Extracorporeal shock wave therapy appears to be a valid, reliable, and noninvasive tool for rapidly resolving intractable bone marrow edema syndrome of the hip, and it has a low complication rate and relatively low cost compared with other conservative and surgical treatment approaches. Copyright 2015, SLACK Incorporated.

Health insurance system and payments provided to patients for the management of severe acute pancreatitis in Japan.

PubMed

Yoshida, Masahiro; Takada, Tadahiro; Kawarada, Yoshifumi; Hirata, Koichi; Mayumi, Toshihiko; Sekimoto, Miho; Hirota, Masahiko; Kimura, Yasutoshi; Takeda, Kazunori; Isaji, Shuji; Koizumi, Masaru; Otsuki, Makoto; Matsuno, Seiki

2006-01-01

The health insurance system in Japan is based upon the Universal Medical Care Insurance System, which gives all citizens the right to join an insurance scheme of their own choice, as guaranteed by the provisions of Article 25 of the Constitution of Japan, which states: "All people shall have the right to maintain the minimum standards of wholesome and cultured living." The health care system in Japan includes national medical insurance, nursing care for the elderly, and government payments for the treatment of intractable diseases. Medical insurance provisions are handled by Employee's Health Insurance (Social Insurance), which mainly covers employees of private companies and their families, and by National Health Insurance, which provides for the needs of self-employed people. Both schemes have their own medical care service programs for retired persons and their families. The health care system for the elderly covers people 75 years of age and over and bedridden people 65 years of age and over. There is also a system under which the government pays all or part of medical expenses, and/or pays medical expenses not covered by insurance. This is referred to collectively as the "medical expenses payment system" and includes the provision of medical assistance for specified intractable diseases. Because severe acute pancreatitis has a high mortality rate, it is specified as an intractable disease. In order to lower the mortality rate of various diseases, including severe acute pancreatitis, the specification system has been adopted by the government. The cost of treatment for severe acute pancreatitis is paid in full by the government from the date the application is made for a certificate verifying that the patient has an intractable disease.

[Effect of neurolysis on intractable greater occipital nerve neuralgia].

PubMed

Tian, Yunhu; Liu, Ya; Liu, Huancai

2007-09-01

To investigate the effect of neurolysis on intractable greater occipital nerve neuralgia. From March 1998 to August 2005, twenty-six patients suffering from intractable greater occipital nerve neuralgia were treated. There were 12 males and 14 females with an average age of 52 years (ranged 38-63 years). The disease course was 3-7 years. Sixteen cases had a long duration of work with bowing head, 5 cases symptoms appeared after trauma, and others had no identified causes. The visual analogue scales (VAS) scoring was 6.0 to 9.5, averaged 8. 6. Seven cases were treated by apocope of obliquus capitis inferior under general anaesthesia and 19 cases were treated by neurolysis of greater occipital nerve under local anaesthesia. The compression mass were examined. Symptoms ameliorated or disappeared in 26 cases immediately after operation. The wounds healed by first intention. The pathological results of the removal mass included lymph node (3 cases), neurilemmoma (2 cases) and scar (5 cases). The VAS scoring of 26 cases was 0 to 5 (average, 2) 3 days after operation. Twenty-three cases were followed up for 1 to 3 years. The VAS scoring of 23 cases was 0 to 4.5 ( average, 1.9) 1 months after operation. Only two cases recurred and the symptoms were ameliorated. Pain aggavated after tiredness and reliveed after oral anti-inflammatory analgesics in 6 cases. No relapse occurred in the others. The complete neurolysis of greater occipital nerve (including apocope of obliquus capitis inferior, release between the cucullaris and semispinalis) which make the greater occipital nerve goes without any compression is the key point to treat intractable greater occipital nerve neuralgia.

Influencing Busy People in a Social Network

PubMed Central

Sarkar, Kaushik; Sundaram, Hari

2016-01-01

We identify influential early adopters in a social network, where individuals are resource constrained, to maximize the spread of multiple, costly behaviors. A solution to this problem is especially important for viral marketing. The problem of maximizing influence in a social network is challenging since it is computationally intractable. We make three contributions. First, we propose a new model of collective behavior that incorporates individual intent, knowledge of neighbors actions and resource constraints. Second, we show that the multiple behavior influence maximization is NP-hard. Furthermore, we show that the problem is submodular, implying the existence of a greedy solution that approximates the optimal solution to within a constant. However, since the greedy algorithm is expensive for large networks, we propose efficient heuristics to identify the influential individuals, including heuristics to assign behaviors to the different early adopters. We test our approach on synthetic and real-world topologies with excellent results. We evaluate the effectiveness under three metrics: unique number of participants, total number of active behaviors and network resource utilization. Our heuristics produce 15-51% increase in expected resource utilization over the naïve approach. PMID:27711127

A master equation and moment approach for biochemical systems with creation-time-dependent bimolecular rate functions

PubMed Central

Chevalier, Michael W.; El-Samad, Hana

2014-01-01

Noise and stochasticity are fundamental to biology and derive from the very nature of biochemical reactions where thermal motion of molecules translates into randomness in the sequence and timing of reactions. This randomness leads to cell-to-cell variability even in clonal populations. Stochastic biochemical networks have been traditionally modeled as continuous-time discrete-state Markov processes whose probability density functions evolve according to a chemical master equation (CME). In diffusion reaction systems on membranes, the Markov formalism, which assumes constant reaction propensities is not directly appropriate. This is because the instantaneous propensity for a diffusion reaction to occur depends on the creation times of the molecules involved. In this work, we develop a chemical master equation for systems of this type. While this new CME is computationally intractable, we make rational dimensional reductions to form an approximate equation, whose moments are also derived and are shown to yield efficient, accurate results. This new framework forms a more general approach than the Markov CME and expands upon the realm of possible stochastic biochemical systems that can be efficiently modeled. PMID:25481130

A master equation and moment approach for biochemical systems with creation-time-dependent bimolecular rate functions

NASA Astrophysics Data System (ADS)

Chevalier, Michael W.; El-Samad, Hana

2014-12-01

Noise and stochasticity are fundamental to biology and derive from the very nature of biochemical reactions where thermal motion of molecules translates into randomness in the sequence and timing of reactions. This randomness leads to cell-to-cell variability even in clonal populations. Stochastic biochemical networks have been traditionally modeled as continuous-time discrete-state Markov processes whose probability density functions evolve according to a chemical master equation (CME). In diffusion reaction systems on membranes, the Markov formalism, which assumes constant reaction propensities is not directly appropriate. This is because the instantaneous propensity for a diffusion reaction to occur depends on the creation times of the molecules involved. In this work, we develop a chemical master equation for systems of this type. While this new CME is computationally intractable, we make rational dimensional reductions to form an approximate equation, whose moments are also derived and are shown to yield efficient, accurate results. This new framework forms a more general approach than the Markov CME and expands upon the realm of possible stochastic biochemical systems that can be efficiently modeled.

Influencing Busy People in a Social Network.

PubMed

Sarkar, Kaushik; Sundaram, Hari

2016-01-01

We identify influential early adopters in a social network, where individuals are resource constrained, to maximize the spread of multiple, costly behaviors. A solution to this problem is especially important for viral marketing. The problem of maximizing influence in a social network is challenging since it is computationally intractable. We make three contributions. First, we propose a new model of collective behavior that incorporates individual intent, knowledge of neighbors actions and resource constraints. Second, we show that the multiple behavior influence maximization is NP-hard. Furthermore, we show that the problem is submodular, implying the existence of a greedy solution that approximates the optimal solution to within a constant. However, since the greedy algorithm is expensive for large networks, we propose efficient heuristics to identify the influential individuals, including heuristics to assign behaviors to the different early adopters. We test our approach on synthetic and real-world topologies with excellent results. We evaluate the effectiveness under three metrics: unique number of participants, total number of active behaviors and network resource utilization. Our heuristics produce 15-51% increase in expected resource utilization over the naïve approach.

A novel approach to detect respiratory phases from pulmonary acoustic signals using normalised power spectral density and fuzzy inference system.

PubMed

Palaniappan, Rajkumar; Sundaraj, Kenneth; Sundaraj, Sebastian; Huliraj, N; Revadi, S S

2016-07-01

Monitoring respiration is important in several medical applications. One such application is respiratory rate monitoring in patients with sleep apnoea. The respiratory rate in patients with sleep apnoea disorder is irregular compared with the controls. Respiratory phase detection is required for a proper monitoring of respiration in patients with sleep apnoea. To develop a model to detect the respiratory phases present in the pulmonary acoustic signals and to evaluate the performance of the model in detecting the respiratory phases. Normalised averaged power spectral density for each frame and change in normalised averaged power spectral density between the adjacent frames were fuzzified and fuzzy rules were formulated. The fuzzy inference system (FIS) was developed with both Mamdani and Sugeno methods. To evaluate the performance of both Mamdani and Sugeno methods, correlation coefficient and root mean square error (RMSE) were calculated. In the correlation coefficient analysis in evaluating the fuzzy model using Mamdani and Sugeno method, the strength of the correlation was found to be r = 0.9892 and r = 0.9964, respectively. The RMSE for Mamdani and Sugeno methods are RMSE = 0.0853 and RMSE = 0.0817, respectively. The correlation coefficient and the RMSE of the proposed fuzzy models in detecting the respiratory phases reveals that Sugeno method performs better compared with the Mamdani method. © 2014 John Wiley & Sons Ltd.

Projectile penetration into ballistic gelatin.

PubMed

Swain, M V; Kieser, D C; Shah, S; Kieser, J A

2014-01-01

Ballistic gelatin is frequently used as a model for soft biological tissues that experience projectile impact. In this paper we investigate the response of a number of gelatin materials to the penetration of spherical steel projectiles (7 to 11mm diameter) with a range of lower impacting velocities (<120m/s). The results of sphere penetration depth versus projectile velocity are found to be linear for all systems above a certain threshold velocity required for initiating penetration. The data for a specific material impacted with different diameter spheres were able to be condensed to a single curve when the penetration depth was normalised by the projectile diameter. When the results are compared with a number of predictive relationships available in the literature, it is found that over the range of projectiles and compositions used, the results fit a simple relationship that takes into account the projectile diameter, the threshold velocity for penetration into the gelatin and a value of the shear modulus of the gelatin estimated from the threshold velocity for penetration. The normalised depth is found to fit the elastic Froude number when this is modified to allow for a threshold impact velocity. The normalised penetration data are found to best fit this modified elastic Froude number with a slope of 1/2 instead of 1/3 as suggested by Akers and Belmonte (2006). Possible explanations for this difference are discussed. © 2013 Published by Elsevier Ltd.

With Reference to Reference Genes: A Systematic Review of Endogenous Controls in Gene Expression Studies.

PubMed

Chapman, Joanne R; Waldenström, Jonas

2015-01-01

The choice of reference genes that are stably expressed amongst treatment groups is a crucial step in real-time quantitative PCR gene expression studies. Recent guidelines have specified that a minimum of two validated reference genes should be used for normalisation. However, a quantitative review of the literature showed that the average number of reference genes used across all studies was 1.2. Thus, the vast majority of studies continue to use a single gene, with β-actin (ACTB) and/or glyceraldehyde 3-phosphate dehydrogenase (GAPDH) being commonly selected in studies of vertebrate gene expression. Few studies (15%) tested a panel of potential reference genes for stability of expression before using them to normalise data. Amongst studies specifically testing reference gene stability, few found ACTB or GAPDH to be optimal, whereby these genes were significantly less likely to be chosen when larger panels of potential reference genes were screened. Fewer reference genes were tested for stability in non-model organisms, presumably owing to a dearth of available primers in less well characterised species. Furthermore, the experimental conditions under which real-time quantitative PCR analyses were conducted had a large influence on the choice of reference genes, whereby different studies of rat brain tissue showed different reference genes to be the most stable. These results highlight the importance of validating the choice of normalising reference genes before conducting gene expression studies.

Identification of stable reference genes for quantitative PCR in cells derived from chicken lymphoid organs.

PubMed

Borowska, D; Rothwell, L; Bailey, R A; Watson, K; Kaiser, P

2016-02-01

Quantitative polymerase chain reaction (qPCR) is a powerful technique for quantification of gene expression, especially genes involved in immune responses. Although qPCR is a very efficient and sensitive tool, variations in the enzymatic efficiency, quality of RNA and the presence of inhibitors can lead to errors. Therefore, qPCR needs to be normalised to obtain reliable results and allow comparison. The most common approach is to use reference genes as internal controls in qPCR analyses. In this study, expression of seven genes, including β-actin (ACTB), β-2-microglobulin (B2M), glyceraldehyde-3-phosphate dehydrogenase (GAPDH), β-glucuronidase (GUSB), TATA box binding protein (TBP), α-tubulin (TUBAT) and 28S ribosomal RNA (r28S), was determined in cells isolated from chicken lymphoid tissues and stimulated with three different mitogens. The stability of the genes was measured using geNorm, NormFinder and BestKeeper software. The results from both geNorm and NormFinder were that the three most stably expressed genes in this panel were TBP, GAPDH and r28S. BestKeeper did not generate clear answers because of the highly heterogeneous sample set. Based on these data we will include TBP in future qPCR normalisation. The study shows the importance of appropriate reference gene normalisation in other tissues before qPCR analysis. Copyright © 2016 Elsevier B.V. All rights reserved.

Partial monosomy Xq(Xq23 --> qter) and trisomy 4p(4p15.33 --> pter) in a woman with intractable focal epilepsy, borderline intellectual functioning, and dysmorphic features.

PubMed

Bartocci, Arnaldo; Striano, Pasquale; Mancardi, Maria Margherita; Fichera, Marco; Castiglia, Lucia; Galesi, Ornella; Michelucci, Roberto; Elia, Maurizio

2008-06-01

Studies of epilepsy associated with chromosomal abnormalities may provide information about clinical and EEG phenotypes and possibly to identify new epilepsy genes. We describe a female patient with intractable focal epilepsy, borderline intellectual functioning, and facial dysmorphisms, in whom genetic study (i.e., karyotype and array-CGH analysis) revealed a distal trisomy 4p and distal monosomy Xq. Although any genetic hypothesis remains speculative, several genes are located in the 4p chromosome segment involved in the rearrangement, some of which may be related to epilepsy.

Acute intractable vomiting and severe ketoacidosis secondary to the Dukan Diet©.

PubMed

Freeman, Thomas F; Willis, Blake; Krywko, Diann M

2014-10-01

The benefits of low-carbohydrate, high-protein diets, such as the Dukan Diet©, are well documented, whereas reported adverse effects are rare in literature. Such diets mimic starvation states in that they promote the breakdown of fat and the production of ketones secondary to fatty acid metabolism. In fact, one measure of the effectiveness of such diets is the presence of ketosis. To our knowledge, there have been no reported cases of ketoacidosis resulting from the Dukan Diet. The purpose of this case report is to illustrate the importance of a detailed dietary history in patients with severe ketoacidosis secondary to the Dukan Diet and suggest treatment that may allow outpatient management. A 42-year-old Iranian woman with no prior medical problems presented with 10 h of intractable nausea and vomiting secondary to ketoacidosis 2 days after starting the Dukan Diet. Although rare, ketoacidosis secondary to a low-carbohydrate, high-protein diet can have serious complications if untreated. Clinical suspicion should arise in any patient presenting with intractable nausea and vomiting after starting a diet such as the Dukan Diet. Early recognition and intervention is essential to quicken patient recovery and outpatient management. Published by Elsevier Inc.

Microorganism Nutrition Processes as a General Route for the Preparation of Bionic Nanocomposites Based on Intractable Polymers.

PubMed

Valentini, L; Bon, S Bittolo; Pugno, N M

2016-08-31

In this paper the fermentation process activated by living microorganisms of the baker's yeast is proposed as a facile assembly method of hybrid nanoparticles at liquid interface. Water dispersion of commercial baker's yeast extract used for bread production, graphene nanoplatelets (GNPs), and carbon nanotubes (CNTs) were added to oil/water interface; when the yeast is activated by adding sugar, the byproduct carbon dioxide bubbles migrate from the water phase to the oil/water interface generating a floating nanostructured film at liquid interface where it is trapped. Starting from this simple method, we propose a general approach for the stabilization of intractable poly(etheretherketone) polymeric particles with GNPs and CNTs at immiscible liquid interface. This process allowed the formation of sintered porous composites with improved mechanical properties. The porous structure of the composites gave rise to a low thermal conductivity making them good candidates for thermal insulating applications. Liquid absorption by these porous composites has been also reported. We believe that this new approach may have applications in the large scale fabrication of nanomaterials and is particularly suited for the preparation of nanocomposites starting from polymers that are intractable by solvent casting.

ST-Segment Elevation Myocardial Infarction with Acute Stent Thrombosis Presenting as Intractable Hiccups: An Unusual Case.

PubMed

Zhang, Fan; Tongo, Nosakhare Douglas; Hastings, Victoria; Kanzali, Parisa; Zhu, Ziqiang; Chadow, Hal; Rafii, Shahrokh E

2017-04-29

BACKGROUND Acute coronary syndrome (ACS) can present with atypical chest pain or symptoms not attributed to heart disease, such as indigestion. Hiccups, a benign and self-limited condition, can become persistent or intractable with overlooked underlying etiology. There are various causes of protracted hiccups, including metabolic abnormalities, psychogenic disorders, malignancy, central nervous system pathology, medications, pulmonary disorders, or gastrointestinal etiologies. It is rarely attributed to cardiac disease. CASE REPORT We report a case of intractable hiccups in a 51-year-old male with cocaine related myocardial infarction (MI) before and after stent placement. Coronary angiogram showed in-stent thrombosis of the initial intervention. Following thrombectomy, balloon angioplasty, and stent, the patient recovered well without additional episodes of hiccups. Although hiccups are not known to present with a predilection for a particular cause of myocardial ischemia, this case may additionally be explained by the sympathomimetic effects of cocaine, which lead to vasoconstriction of coronary arteries. CONCLUSIONS Hiccups associated with cardiac enzyme elevation and EKG ST-segment elevation before and after percutaneous coronary intervention (PCI) maybe a manifestation of acute MI with or without stent. The fact that this patient was a cocaine user may have contributed to the unique presentation.

[Successful treatment with chloramphenicol in four pediatric cases of intractable bacterial meningitis].

PubMed

Morita, Kayo; Abe, Yu-ichi; Itano, Atsushi; Musha, Ikuma; Koga, Takeshi; Yamazaki, Taro; Yamanouchi, Hideo

2016-01-01

Chloramphenicol (CP) is recently one of the rarely-used antibiotics. In this study, we present four patients with intractable bacterial meningitis, who were successfully treated with CP and discuss the therapeutic indications of CP in these pediatric cases. The patients were diagnosed as bacterial meningitis at the ages ranging from 2 months to 1 year and 4 months. The causative organisms found in three of the patients were H. influenzae and in the fourth patient, S. pneumoniae. According to the microbial sensitivity tests, these organisms were highly sensitive to antibiotics including ceftriaxone, meropenem and/or panipenem/betamipron. Treatment with these antibiotics was initially effective; however, recurrences of meningitis appeared in all patients. Administration of CP (100 mg/kg/day) started between the 11th and the 58th days, and was continued for 9 days up to 19 days. Their fever had disappeared within four days after the administration of CP, and it was confirmed that all patients completely recovered from meningitis. Two of the patients developed a mild degree of anemia, but soon recovered after the discontinuation of CP. None of them had neurological sequela. We recommend CP as one of the choices for the treatment of intractable bacterial meningitis.

Magnetic resonance imaging-guided laser interstitial thermal therapy as treatment for intractable insular epilepsy in children.

PubMed

Perry, M Scott; Donahue, David J; Malik, Saleem I; Keator, Cynthia G; Hernandez, Angel; Reddy, Rohit K; Perkins, Freedom F; Lee, Mark R; Clarke, Dave F

2017-12-01

OBJECTIVE Seizure onset within the insula is increasingly recognized as a cause of intractable epilepsy. Surgery within the insula is difficult, with considerable risks, given the rich vascular supply and location near critical cortex. MRI-guided laser interstitial thermal therapy (LiTT) provides an attractive treatment option for insular epilepsy, allowing direct ablation of abnormal tissue while sparing nearby normal cortex. Herein, the authors describe their experience using this technique in a large cohort of children undergoing treatment of intractable localization-related epilepsy of insular onset. METHODS The combined epilepsy surgery database of Cook Children's Medical Center and Dell Children's Hospital was queried for all cases of insular onset epilepsy treated with LiTT. Patients without at least 6 months of follow-up data and cases preoperatively designated as palliative were excluded. Patient demographics, presurgical evaluation, surgical plan, and outcome were collected from patient charts and described. RESULTS Twenty patients (mean age 12.8 years, range 6.1-18.6 years) underwent a total of 24 LiTT procedures; 70% of these patients had normal findings on MRI. Patients underwent a mean follow-up of 20.4 months after their last surgery (range 7-39 months), with 10 (50%) in Engel Class I, 1 (5%) in Engel Class II, 5 (25%) in Engel Class III, and 4 (20%) in Engel Class IV at last follow-up. Patients were discharged within 24 hours of the procedure in 15 (63%) cases, in 48 hours in 6 (24%) cases, and in more than 48 hours in the remaining cases. Adverse functional effects were experienced following 7 (29%) of the procedures: mild hemiparesis after 6 procedures (all patients experienced complete resolution or had minimal residual dysfunction by 6 months), and expressive language dysfunction after 1 procedure (resolved by 3 months). CONCLUSIONS To their knowledge, the authors present the largest cohort of pediatric patients undergoing insular surgery for treatment of intractable epilepsy. The patient outcomes suggest that LiTT can successfully treat intractable seizures originating within the insula and offers an attractive alternative to open resection. This is the first description of LiTT applied to insular epilepsy and represents one of only a few series describing the use of LiTT in children. The results indicate that seizure reduction after LiTT compares favorably to that after conventional open surgical techniques.

Effective symptomatic treatment for severe and intractable pruritus associated with severe burn-induced hypertrophic scars: A prospective, multicenter, controlled trial.

PubMed

Wu, Jun; Xu, Rui; Zhan, Rixing; Luo, Gaoxing; Niu, Xihua; Liu, Yi; Lee, Benjamin Tak-Kwong; Flury, Meinrad; Wong, Chun-Ho; Fok, Manson; Lau, Johnson Yiu-Nam

2016-08-01

Burn-induced hypertrophic scars are disfiguring and can be associated with severe and intractable pruritus. No effective treatment modalities are currently available for symptomatic control of pruritus for most patients. We assessed the effect of the Antipruritic Hydrogel (CQ-01) in the symptomatic treatment of severe and intractable pruritus associated with burn-induced hypertrophic scars in a prospective, multicenter, controlled trial. A pilot study was conducted in healthy adult volunteers to identify the most appropriate hydrogel formulation. A selected preparation called Chongqing No. 1 (CQ-01; a guar gum-based hydrogel impregnated with peppermint oil, menthol, and methyl salicylate by a nanoemulsion), showed an excellent symptomatic relief in an exploratory study in 2 patients with intractable pruritus. A statistically powered, prospective, multicenter, controlled study was then conducted in 74 patients to evaluate the efficacy and safety of a 24-h application of CQ-01 compared to a gel control and a negative control on three separate areas in each patient. Symptom assessment was based on our visual analog JW scale (ranging from 0 to 100) at baseline and various time points up to 7 days after application. Follow-up studies were conducted to determine the reproducibility of CQ-01 in repeated applications. Of the 74 enrolled subjects, the only observed adverse event was skin irritation reported in 6 patients (8%) and resolved shortly after gel removal. Compared to the baseline, the gauze negative control had a mean JW score reduction of 7; while the gel control and CQ-01 had a drop of 18 (p<0.001) and 36 (p<0.001), respectively. The CQ-01 clinical effect was significant for up to 3 days and waned slowly from 3 to 7 days. There was no statistical correlation between the treatment response and any of the demographic, patient or burn-related factors. Further studies showed a trend that repeated applications might be more effective, suggesting the absence of tachyphylaxis. This prospective, multicenter, controlled study showed that this novel hydrogel CQ-01 is safe and provides significant symptomatic relief for severe and intractable pruritus associated with hypertrophic scars, an unmet medical need for these patients. This effect is independent of the etiology of the burn trauma, extent of the scarring, and duration of the scar formation. Copyright © 2016. Published by Elsevier Ltd.

Normalised subband adaptive filtering with extended adaptiveness on degree of subband filters

NASA Astrophysics Data System (ADS)

Samuyelu, Bommu; Rajesh Kumar, Pullakura

2017-12-01

This paper proposes an adaptive normalised subband adaptive filtering (NSAF) to accomplish the betterment of NSAF performance. In the proposed NSAF, an extended adaptiveness is introduced from its variants in two ways. In the first way, the step-size is set adaptive, and in the second way, the selection of subbands is set adaptive. Hence, the proposed NSAF is termed here as variable step-size-based NSAF with selected subbands (VS-SNSAF). Experimental investigations are carried out to demonstrate the performance (in terms of convergence) of the VS-SNSAF against the conventional NSAF and its state-of-the-art adaptive variants. The results report the superior performance of VS-SNSAF over the traditional NSAF and its variants. It is also proved for its stability, robustness against noise and substantial computing complexity.

Measurement of the timing behaviour of off-the-shelf cameras

NASA Astrophysics Data System (ADS)

Schatz, Volker

2017-04-01

This paper presents a measurement method suitable for investigating the timing properties of cameras. A single light source illuminates the camera detector starting with a varying defined delay after the camera trigger. Pixels from the recorded camera frames are summed up and normalised, and the resulting function is indicative of the overlap between illumination and exposure. This allows one to infer the trigger delay and the exposure time with sub-microsecond accuracy. The method is therefore of interest when off-the-shelf cameras are used in reactive systems or synchronised with other cameras. It can supplement radiometric and geometric calibration methods for cameras in scientific use. A closer look at the measurement results reveals deviations from the ideal camera behaviour of constant sensitivity limited to the exposure interval. One of the industrial cameras investigated retains a small sensitivity long after the end of the nominal exposure interval. All three investigated cameras show non-linear variations of sensitivity at O≤ft({{10}-3}\\right) to O≤ft({{10}-2}\\right) during exposure. Due to its sign, the latter effect cannot be described by a sensitivity function depending on the time after triggering, but represents non-linear pixel characteristics.

Modelling foot height and foot shape-related dimensions.

PubMed

Xiong, Shuping; Goonetilleke, Ravindra S; Witana, Channa P; Lee Au, Emily Yim

2008-08-01

The application of foot anthropometry to design good-fitting footwear has been difficult due to the lack of generalised models. This study seeks to model foot dimensions so that the characteristic shapes of feet, especially in the midfoot region, can be understood. Fifty Hong Kong Chinese adults (26 males and 24 females) participated in this study. Their foot lengths, foot widths, ball girths and foot heights were measured and then evaluated using mathematical models. The results showed that there were no significant allometry (p > 0.05) effects of foot length on ball girth and foot width. Foot height showed no direct relationship with foot length. However, a normalisation with respect to foot length and foot height resulted in a significant relationship for both males and females with R(2) greater than 0.97. Due to the lack of a direct relationship between foot height and foot length, the current practice of grading shoes with a constant increase in height or proportionate scaling in response to foot length is less than ideal. The results when validated with other populations can be a significant way forward in the design of footwear that has an improved fit in the height dimension.

Applications and limitations of constrained high-resolution peak fitting on low resolving power mass spectra from the ToF-ACSM

DOE PAGES

Timonen, Hilkka; Cubison, Mike; Aurela, Minna; ...

2016-07-25

The applicability, methods and limitations of constrained peak fitting on mass spectra of low mass resolving power ( m/Δ m 50~500) recorded with a time-of-flight aerosol chemical speciation monitor (ToF-ACSM) are explored. Calibration measurements as well as ambient data are used to exemplify the methods that should be applied to maximise data quality and assess confidence in peak-fitting results. Sensitivity analyses and basic peak fit metrics such as normalised ion separation are employed to demonstrate which peak-fitting analyses commonly performed in high-resolution aerosol mass spectrometry are appropriate to perform on spectra of this resolving power. Information on aerosol sulfate, nitrate,more » sodium chloride, methanesulfonic acid as well as semi-volatile metal species retrieved from these methods is evaluated. The constants in a commonly used formula for the estimation of the mass concentration of hydrocarbon-like organic aerosol may be refined based on peak-fitting results. Lastly, application of a recently published parameterisation for the estimation of carbon oxidation state to ToF-ACSM spectra is validated for a range of organic standards and its use demonstrated for ambient urban data.« less

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

Chakraborty, Bipasha; Davies, C. T. H.; Donald, G. C.

Here, we compare correlators for pseudoscalar and vector mesons made from valence strange quarks using the clover quark and highly improved staggered quark (HISQ) formalisms in full lattice QCD. We use fully nonperturbative methods to normalise vector and axial vector current operators made from HISQ quarks, clover quarks and from combining HISQ and clover fields. This allows us to test expectations for the renormalisation factors based on perturbative QCD, with implications for the error budget of lattice QCD calculations of the matrix elements of clover-staggeredmore » $b$-light weak currents, as well as further HISQ calculations of the hadronic vacuum polarisation. We also compare the approach to the (same) continuum limit in clover and HISQ formalisms for the mass and decay constant of the $$\\phi$$ meson. Our final results for these parameters, using single-meson correlators and neglecting quark-line disconnected diagrams are: $$m_{\\phi} =$$ 1.023(5) GeV and $$f_{\\phi} = $$ 0.238(3) GeV in good agreement with experiment. These results come from calculations in the HISQ formalism using gluon fields that include the effect of $u$, $d$, $s$ and $c$ quarks in the sea with three lattice spacing values and $$m_{u/d}$$ values going down to the physical point.« less

Time-resolved and temperature tuneable measurements of fluorescent intensity using a smartphone fluorimeter.

PubMed

Hossain, Md Arafat; Canning, John; Yu, Zhikang; Ast, Sandra; Rutledge, Peter J; Wong, Joseph K-H; Jamalipour, Abbas; Crossley, Maxwell J

2017-05-30

A smartphone fluorimeter capable of time-based fluorescence intensity measurements at various temperatures is reported. Excitation is provided by an integrated UV LED (λ ex = 370 nm) and detection obtained using the in-built CMOS camera. A Peltier is integrated to allow measurements of the intensity over T = 10 to 40 °C. All components are controlled using a smartphone battery powered Arduino microcontroller and a customised Android application that allows sequential fluorescence imaging and quantification every δt = 4 seconds. The temperature dependence of fluorescence intensity for four emitters (rhodamine B, rhodamine 6G, 5,10,15,20-tetraphenylporphyrin and 6-(1,4,8,11-tetraazacyclotetradecane)2-ethyl-naphthalimide) are characterised. The normalised fluorescence intensity over time of the latter chemosensor dye complex in the presence of Zn 2+ is observed to accelerate with an increasing rate constant, k = 1.94 min -1 at T = 15 °C and k = 3.64 min -1 at T = 30 °C, approaching a factor of ∼2 with only a change in temperature of ΔT = 15 °C. Thermally tuning these twist and bend associated rates to optimise sensor approaches and device applications is proposed.

NDVI, scale invariance and the modifiable areal unit problem: An assessment of vegetation in the Adelaide Parklands

USGS Publications Warehouse

Nouri, Hamideh; Anderson, Sharolyn; Sutton, Paul; Beecham, Simon; Nagler, Pamela L.; Jarchow, Christopher J.; Roberts, Dar A.

2017-01-01

This research addresses the question as to whether or not the Normalised Difference Vegetation Index (NDVI) is scale invariant (i.e. constant over spatial aggregation) for pure pixels of urban vegetation. It has been long recognized that there are issues related to the modifiable areal unit problem (MAUP) pertaining to indices such as NDVI and images at varying spatial resolutions. These issues are relevant to using NDVI values in spatial analyses. We compare two different methods of calculation of a mean NDVI: 1) using pixel values of NDVI within feature/object boundaries and 2) first calculating the mean red and mean near-infrared across all feature pixels and then calculating NDVI. We explore the nature and magnitude of these differences for images taken from two sensors, a 1.24 m resolution WorldView-3 and a 0.1 m resolution digital aerial image. We apply these methods over an urban park located in the Adelaide Parklands of South Australia. We demonstrate that the MAUP is not an issue for calculation of NDVI within a sensor for pure urban vegetation pixels. This may prove useful for future rule-based monitoring of the ecosystem functioning of green infrastructure.

Assessment of dynamic closure for premixed combustion large eddy simulation

NASA Astrophysics Data System (ADS)

Langella, Ivan; Swaminathan, Nedunchezhian; Gao, Yuan; Chakraborty, Nilanjan

2015-09-01

Turbulent piloted Bunsen flames of stoichiometric methane-air mixtures are computed using the large eddy simulation (LES) paradigm involving an algebraic closure for the filtered reaction rate. This closure involves the filtered scalar dissipation rate of a reaction progress variable. The model for this dissipation rate involves a parameter βc representing the flame front curvature effects induced by turbulence, chemical reactions, molecular dissipation, and their interactions at the sub-grid level, suggesting that this parameter may vary with filter width or be a scale-dependent. Thus, it would be ideal to evaluate this parameter dynamically by LES. A procedure for this evaluation is discussed and assessed using direct numerical simulation (DNS) data and LES calculations. The probability density functions of βc obtained from the DNS and LES calculations are very similar when the turbulent Reynolds number is sufficiently large and when the filter width normalised by the laminar flame thermal thickness is larger than unity. Results obtained using a constant (static) value for this parameter are also used for comparative evaluation. Detailed discussion presented in this paper suggests that the dynamic procedure works well and physical insights and reasonings are provided to explain the observed behaviour.

BASiCS: Bayesian Analysis of Single-Cell Sequencing Data

PubMed Central

Vallejos, Catalina A.; Marioni, John C.; Richardson, Sylvia

2015-01-01

Single-cell mRNA sequencing can uncover novel cell-to-cell heterogeneity in gene expression levels in seemingly homogeneous populations of cells. However, these experiments are prone to high levels of unexplained technical noise, creating new challenges for identifying genes that show genuine heterogeneous expression within the population of cells under study. BASiCS (Bayesian Analysis of Single-Cell Sequencing data) is an integrated Bayesian hierarchical model where: (i) cell-specific normalisation constants are estimated as part of the model parameters, (ii) technical variability is quantified based on spike-in genes that are artificially introduced to each analysed cell’s lysate and (iii) the total variability of the expression counts is decomposed into technical and biological components. BASiCS also provides an intuitive detection criterion for highly (or lowly) variable genes within the population of cells under study. This is formalised by means of tail posterior probabilities associated to high (or low) biological cell-to-cell variance contributions, quantities that can be easily interpreted by users. We demonstrate our method using gene expression measurements from mouse Embryonic Stem Cells. Cross-validation and meaningful enrichment of gene ontology categories within genes classified as highly (or lowly) variable supports the efficacy of our approach. PMID:26107944

BASiCS: Bayesian Analysis of Single-Cell Sequencing Data.

PubMed

Vallejos, Catalina A; Marioni, John C; Richardson, Sylvia

2015-06-01

Single-cell mRNA sequencing can uncover novel cell-to-cell heterogeneity in gene expression levels in seemingly homogeneous populations of cells. However, these experiments are prone to high levels of unexplained technical noise, creating new challenges for identifying genes that show genuine heterogeneous expression within the population of cells under study. BASiCS (Bayesian Analysis of Single-Cell Sequencing data) is an integrated Bayesian hierarchical model where: (i) cell-specific normalisation constants are estimated as part of the model parameters, (ii) technical variability is quantified based on spike-in genes that are artificially introduced to each analysed cell's lysate and (iii) the total variability of the expression counts is decomposed into technical and biological components. BASiCS also provides an intuitive detection criterion for highly (or lowly) variable genes within the population of cells under study. This is formalised by means of tail posterior probabilities associated to high (or low) biological cell-to-cell variance contributions, quantities that can be easily interpreted by users. We demonstrate our method using gene expression measurements from mouse Embryonic Stem Cells. Cross-validation and meaningful enrichment of gene ontology categories within genes classified as highly (or lowly) variable supports the efficacy of our approach.

Embedding chiropractic in Indigenous Health Care Organisations: applying the normalisation process model.

PubMed

Polus, Barbara I; Paterson, Charlotte; van Rotterdam, Joan; Vindigni, Dein

2012-11-26

Improving the health of Indigenous Australians remains a major challenge. A chiropractic service was established to evaluate this treatment option for musculoskeletal illness in rural Indigenous communities, based on the philosophy of keeping the community involved in all the phases of development, implementation, and evaluation. The development and integration of this service has experienced many difficulties with referrals, funding and building sustainability. Evaluation of the program was a key aspect of its implementation, requiring an appropriate process to identify specific problems and formulate solutions to improve the service. We used the normalisation process model (May 2006) to order the data collected in consultation meetings and to inform our strategy and actions. The normalisation process model provided us with a structure for organising consultation meeting data and helped prioritise tasks. Our data was analysed as it applied to each dimension of the model, noting aspects that the model did not encompass. During this process we reworded the dimensions into more everyday terminology. The final analysis focused on to what extent the model helped us to prioritise and systematise our tasks and plans. We used the model to consider ways to promote the chiropractic service, to enhance relationships and interactions between clinicians and procedures within the health service, and to avoid disruption of the existing service. We identified ways in which chiropractors can become trusted team members who have acceptable and recognised knowledge and skills. We also developed strategies that should result in chiropractic practitioners finding a place within a complex occupational web, by being seen as similar to well-known occupations such as physiotherapy. Interestingly, one dimension identified by our data, which we have labelled 'emancipatory', was absent from the model. The normalisation process model has resulted in a number of new insights and questions. We have now established thriving weekly chiropractic clinics staffed by a team of volunteer chiropractors. We identified an 'emancipatory' dimension that requires further study. We provide a worked example of using this model to establish, integrate and evaluate a chiropractic service in an Indigenous Australian community.

Microencephaloceles: another dual pathology of intractable temporal lobe epilepsy in childhood.

PubMed

Aquilina, Kristian; Clarke, Dave F; Wheless, James W; Boop, Frederick A

2010-04-01

Temporal lobe encephaloceles can be associated with temporal lobe epilepsy. The authors report on the case of an adolescent with multiple microencephaloceles, in the anterolateral middle fossa floor, identified at surgery (temporal lobectomy) for intractable partial-onset seizures of temporal origin. Magnetic resonance imaging revealed only hippocampal atrophy. Subdural electrodes demonstrated ictal activity arising primarily from the anterior and lateral temporal lobe, close to the microencephaloceles, spreading to the anterior and posterior mesial structures. Pathological examination revealed diffuse temporal gliosis involving the hippocampus, together with microdysgenesis of the amygdala. The literature on epilepsy secondary to encephaloceles is reviewed and the contribution of the microencephaloceles to the seizure disorder in this patient is discussed.

The patient had a normal magnetic resonance imaging and temporal lobe epilepsy secondary to a porencephalic cyst but showed structural lesions (hippocampal sclerosis)☆

PubMed Central

Matsubara, Teppei; Ayuzawa, Satoshi; Aoki, Tsukasa; Fujiomto, Ayataka; Osuka, Satoru; Matsumura, Akira

2013-01-01

Patients with a porencephalic cyst frequently develop intractable temporal lobe epilepsy (TLE). We report a surgically-treated male patient with intractable mesial TLE (mTLE) secondary to a porencephalic cyst. Although magnetic resonance imaging showed no hippocampal abnormalities, long-term video-electrocorticography revealed seizure onset discharges in the hippocampus. Temporal lobectomy brought an end to the patient's seizures. Hippocampal sclerosis was histopathologically confirmed (dual pathology). Careful evaluation of hippocampal epileptogenicity is required, and temporal lobectomy, which is less invasive than hemispherectomy, can be a treatment of choice for patients with mTLE secondary to a porencephalic cyst. PMID:25667851

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

Brown, Nicholas, E-mail: nibrown@cantab.net; Olayos, Elizabeth; Elmer, Sandra

Management of intractable haematuria and obstructive urosepsis from upper tract urothelial carcinoma can be problematic in patients not suitable for surgery, chemotherapy or radiotherapy. Interventional radiology techniques provide alternative approaches in this setting, such as complete kidney embolization to cease urine output, percutaneous nephrostomy, antegrade injection of sclerotherapy agents and sterilisation of the upper collecting system. Related approaches have been successfully employed to sclerose renal cysts, lymphoceles, chyluria and intractable lower tract haemorrhage. No reports of percutaneous, antegrade sclerotherapy in the upper urinary tract have previously been published. We present a case of recurrent haematuria and obstructive urosepsis caused bymore » invasive upper tract urothelial carcinoma in a non-operative patient, which was treated with renal embolisation and percutaneous upper tract urothelial sclerotherapy.« less

Intradural approach to selective stimulation in the spinal cord for treatment of intractable pain: design principles and wireless protocol

NASA Astrophysics Data System (ADS)

Howard, M. A.; Utz, M.; Brennan, T. J.; Dalm, B. D.; Viljoen, S.; Jeffery, N. D.; Gillies, G. T.

2011-08-01

We introduce an intradural approach to spinal cord stimulation for the relief of intractable pain, and describe the biophysical rationale that underlies its design and performance requirements. The proposed device relies on wireless, inductive coupling between a pial surface implant and its epidural controller, and we present the results of benchtop experiments that demonstrate the ability to transmit and receive a frequency-modulated 1.6 MHz carrier signal between micro-coil antennae scaled to the ≈ 1 cm dimensions of the implant, at power levels of about 5 mW. Plans for materials selection, microfabrication, and other aspects of future development are presented and discussed.

Using normalisation process theory to understand barriers and facilitators to implementing mindfulness-based stress reduction for people with multiple sclerosis.

PubMed

Simpson, Robert; Simpson, Sharon; Wood, Karen; Mercer, Stewart W; Mair, Frances S

2018-01-01

Objectives To study barriers and facilitators to implementation of mindfulness-based stress reduction for people with multiple sclerosis. Methods Qualitative interviews were used to explore barriers and facilitators to implementation of mindfulness-based stress reduction, including 33 people with multiple sclerosis, 6 multiple sclerosis clinicians and 2 course instructors. Normalisation process theory provided the underpinning conceptual framework. Data were analysed deductively using normalisation process theory constructs (coherence, cognitive participation, collective action and reflexive monitoring). Results Key barriers included mismatched stakeholder expectations, lack of knowledge about mindfulness-based stress reduction, high levels of comorbidity and disability and skepticism about embedding mindfulness-based stress reduction in routine multiple sclerosis care. Facilitators to implementation included introducing a pre-course orientation session; adaptations to mindfulness-based stress reduction to accommodate comorbidity and disability and participants suggested smaller, shorter classes, shortened practices, exclusion of mindful-walking and more time with peers. Post-mindfulness-based stress reduction booster sessions may be required, and objective and subjective reports of benefit would increase clinician confidence in mindfulness-based stress reduction. Discussion Multiple sclerosis patients and clinicians know little about mindfulness-based stress reduction. Mismatched expectations are a barrier to participation, as is rigid application of mindfulness-based stress reduction in the context of disability. Course adaptations in response to patient needs would facilitate uptake and utilisation. Rendering access to mindfulness-based stress reduction rapid and flexible could facilitate implementation. Embedded outcome assessment is desirable.

Drying method has no substantial effect on δ(15)N or δ(13)C values of muscle tissue from teleost fishes.

PubMed

Bessey, Cindy; Vanderklift, Mathew A

2014-02-15

Stable isotope analysis (SIA) is a powerful tool in many fields of research that enables quantitative comparisons among studies, if similar methods have been used. The goal of this study was to determine if three different drying methods commonly used to prepare samples for SIA yielded different δ(15)N and δ(13)C values. Muscle subsamples from 10 individuals each of three teleost species were dried using three methods: (i) oven, (ii) food dehydrator, and (iii) freeze-dryer. All subsamples were analysed for δ(15)N and δ(13)C values, and nitrogen and carbon content, using a continuous flow system consisting of a Delta V Plus mass spectrometer and a Flush 1112 elemental analyser via a Conflo IV universal interface. The δ(13)C values were normalized to constant lipid content using the equations proposed by McConnaughey and McRoy. Although statistically significant, the differences in δ(15)N values between the drying methods were small (mean differences ≤0.21‰). The differences in δ(13)C values between the drying methods were not statistically significant, and normalising the δ(13)C values to constant lipid content reduced the mean differences for all treatments to ≤0.65‰. A statistically significant difference of ~2% in C content existed between tissues dried in a food dehydrator and those dried in a freeze-dryer for two fish species. There was no significant effect of fish size on the differences between methods. No substantial effect of drying method was found on the δ(15)N or δ(13)C values of teleost muscle tissue. Copyright © 2013 John Wiley & Sons, Ltd.

[Investigations on the effect of "ecstasy" on cerebral glucose metabolism: an 18-FDG PET study].

PubMed

Schreckenberger, M; Gouzoulis-Mayfrank, E; Sabri, O; Arning, C; Tuttass, T; Schulz, G; Kaiser, H J; Wagenknecht, G; Sass, H; Büll, U

1998-01-01

The aim of the present study was to determine the acute effects of the "Ecstasy" analogue MDE (3, 4-methylendioxyethamphetamine) on the cerebral glucose metabolism (rMRGlu) of healthy volunteers. In a randomised double-blind trial, 16 healthy volunteers without a history of drug abuse were examined with 18-FDG PET 110-120 minutes after oral administration of 2 mg/kg MDE (n = 8) or placebo (n = 8). Beginning two minutes prior to radiotracer injection, a constant cognitive stimulation was maintained for 32 minutes using a word repetition paradigm in order to ensure constant and comparable mental conditions during cerebral 18-FDG uptake. Individual brain anatomy was represented using T1-weighted 3D flash MRI, followed by manual regionalisation into 108 regions-of-interest and PFT/MRI overlay. Absolute quantification of rMRGlu and comparison of glucose metabolism under MDE versus placebo were performed using Mann-Whitney U-test. Absolute global MRGlu was not significantly changed under MDE versus placebo (MDE: 41.8 +/- 11.1 mumol/min/100 g, placebo: 50.1 +/- 18.1 mumol/min/100 g, p = 0.298). The normalised regional metabolic data showed a significantly decreased rMRGlu in the bilateral frontal cortex: left frontal posterior (-7.1%, p < 0.05) and right prefrontal superior (-4.6%, p < 0.05). On the other hand, rMRGlu was significantly increased in the bilateral cerebellum (right: +10.1%, p < 0.05; left +7.6%, p < 0.05) and in the right putamen (+6.2%, p < 0.05). The present study revealed acute neurometabolic changes under the "Ecstasy" analogon MDE indicating a fronto-striato-cerebellar dysbalance with parallels to other psychotropic substances and various endogenous psychoses respectively.

Flicker sensitivity as a function of target area with and without temporal noise.

PubMed

Rovamo, J; Donner, K; Näsänen, R; Raninen, A

2000-01-01

Flicker sensitivities (1-30 Hz) in foveal, photopic vision were measured as functions of stimulus area with and without strong external white temporal noise. Stimuli were circular, sinusoidally flickering sharp-edged spots of variable diameters (0.25-4 degrees ) but constant duration (2 s), surrounded by a uniform equiluminant field. The data was described with a model comprising (i) low-pass filtering in the retina (R), with a modulation transfer function (MTF) of a form derived from responses of cones; (ii) normalisation of the temporal luminance distribution by the average luminance; (iii) high-pass filtering by postreceptoral neural pathways (P), with an MTF proportional to temporal frequency; (iv) addition of internal white neural noise (N(i)); (v) integration over a spatial window; and (vi) detection by a suboptimal temporal matched filter of efficiency eta. In strong external noise, flicker sensitivity was independent of spot area. Without external noise, sensitivity increased with the square root of stimulus area (Piper's law) up to a critical area (A(c)), where it reaches a maximum level (S(max)). Both A(c) and eta were monotonic functions of temporal frequency (f), such that log A(c) increased and log eta decreased linearly with log f. Remarkably, the increase in spatial integration area and the decrease in efficiency were just balanced, so A(c)(f)eta(f) was invariant against f. Thus the bandpass characteristics of S(max)(f) directly reflected the composite effect of the distal filters R(f) and P(f). The temporal equivalent (N(it)) of internal neural noise (N(i)) decreased in inverse proportion to spot area up to A(c) and then stayed constant indicating that spatially homogeneous signals and noise are integrated over the same area.

Etanercept overcomes P-glycoprotein-induced drug resistance in lymphocytes of patients with intractable rheumatoid arthritis.

PubMed

Tsujimura, Shizuyo; Saito, Kazuyoshi; Nakayamada, Shingo; Tanaka, Yoshiya

2010-04-01

P-glycoprotein (P-gp) on activated lymphocytes is an adenosine triphosphate (ATP)-binding cassette transporter that causes drug resistance by exclusion of intracellular drugs in patients with active rheumatoid arthritis (RA). However, infliximab with methotrexate (MTX) can overcome P-gp-mediated drug resistance. We encounter patients who cannot continue infliximab or MTX. Here we tested how etanercept affected P-gp-mediated drug resistance in such intractable RA patients. Peripheral lymphocytes of 11 RA patients (3 switched from infliximab and 8 who could not be treated with MTX) were analyzed for P-gp expression by flow cytometry and for drug exclusion using radioisotope-labeled dexamethasone. Activated lymphocytes of RA patients overexpressed P-gp and coexpressed CD69. Incubation of these lymphocytes with dexamethasone in vitro reduced intracellular dexamethasone levels. Two-week etanercept therapy significantly reduced P-gp expression and eliminated such P-gp- and CD69-high-expressing subgroup. The reduction in P-gp resulted in recovery of intracellular dexamethasone levels in lymphocytes and improvement of disease activity, thus allowing tapering of corticosteroids. None of the patients experienced any severe adverse effects. Etanercept is useful for overcoming P-gp-mediated treatment resistance in intractable RA patients who have to discontinue infliximab or are intolerant to MTX.

Ahmed glaucoma valve in eyes with preexisting episcleral encircling element.

PubMed

Choudhari, Nikhil Shreeram; George, Ronnie; Shantha, Balekudaru; Neog, Aditya; Tripathi, Shweta; Srinivasan, Bhaskar; Vijaya, Lingam

2014-05-01

To describe the use of Ahmed glaucoma valve (AGV) in the management of intractable glaucoma in eyes with a preexisting episcleral encircling element. This is a retrospective, consecutive, noncomparative study. The study included 12 eyes of 12 patients with a preexisting episcleral encircling element that underwent implantation of silicone AGV to treat intractable glaucoma during January 2009 to September 2010. The mean patient age was 25.6 (standard deviation 17.1) years. Five (41.6%) patients were monocular. The indications for AGV were varied. The mean duration between placement of episcleral encircling element and implantation of AGV was 30.5 (33.8) months. The mean follow-up was 37.4 (22.9) weeks. Preoperatively, the mean intraocular pressure (IOP) was 31.4 (7.9) mmHg and the mean antiglaucoma medications were 2.8. At the final postoperative follow-up, the mean IOP was 12.5 (3.5) mmHg and the mean number of antiglaucoma medications was 0.8 (P < 0.001). The complications observed over the follow-up period did include corneal graft failure in three eyes, tube erosion in two eyes and rhegmatogenous retinal detachment in one eye. AGV is an effective option in the management of intractable glaucoma in eyes with a preexisting episcleral encircling element keeping in mind the possibility of significant postoperative complications.

The role of executive functioning in quality of life in pediatric intractable epilepsy.

PubMed

Love, Christina Eguizabal; Webbe, Frank; Kim, Gunha; Lee, Ki Hyeong; Westerveld, Michael; Salinas, Christine M

2016-11-01

Children with epilepsy are vulnerable to executive dysfunction, but the relationship between executive functioning (EF) and quality of life (QOL) in children with epilepsy is not fully delineated. This exploratory study elucidated the relationship between ecological EF and QOL in pediatric intractable epilepsy. Fifty-four consecutively referred pediatric epilepsy surgery candidates and their parents were administered IQ measures, the Behavior Rating Inventory of Executive Function (BRIEF), and the Quality of Life in Childhood Epilepsy (QOLCE) as part of a comprehensive neuropsychological evaluation. A significant difference was found in QOL between those with and without clinical impairments on the BRIEF [t(52)=3.93; p<.001]. That is, children with executive dysfunction had lower overall QOL. All seizure variables and BRIEF scales were associated with overall QOL [F(12, 40)=6.508; p=.001; R 2 =.661]. Working memory from the BRIEF was the most frequently elevated scale in our sample (57%). Those with executive dysfunction had 9.7 times the risk of having poor QOL. Poor EF control according to behavior ratings is significantly related to QOL in intractable pediatric epilepsy. Identification of executive dysfunction in home environments is an essential component of presurgical evaluations and target for intervention, which may improve QOL. Copyright © 2016 Elsevier Inc. All rights reserved.

Combined ultrasound and fluoroscopic guidance for radiofrequency ablation of the obturator nerve for intractable cancer-associated hip pain.

PubMed

Stone, Jonathan; Matchett, Gerald

2014-01-01

Management of pain from skeletal metastases is notoriously difficult. Case reports and case series have described radiofrequency ablation of the obturator nerve branches to the femoral head for treatment of intractable hip pain. Ablation of the obturator branches to the femoral head is technically difficult because of bony and vascular anatomy, including close proximity of the femoral vessels. Here we present the case of a 79-year-old woman with intractable right hip pain and inability to ambulate secondary to metastatic non-small cell lung cancer in the femoral head and acetabulum, treated with thermal radiofrequency ablation of the obturator and femoral nerve branches to the femoral head. Ablation of the obturator nerve was done via anterior placement of the radiofrequency needle under combined ultrasound and fluoroscopic guidance, passing the radiofrequency needle between the femoral artery and femoral vein. Real-time ultrasound guidance was used to avoid vascular puncture. Thermal radiofrequency ablation resulted in sustained pain relief, and resumption in the ability of the patient to ambulate. From this case we suggest that an anterior approach to the obturator nerve branches to the femoral head may be technically feasible using combined ultrasound and fluoroscopic guidance to avoid vascular puncture.

Unfreezing cognitions during an intractable conflict: Does an external incentive for negotiating peace and (low levels of) collective angst increase information seeking?

PubMed

Wohl, Michael J A; Porat, Roni; Halperin, Eran

2016-03-01

A core feature of intractable conflicts is the tendency to cognitively freeze on existing, pro-ingroup beliefs. In three experiments, conducted in the context of the Palestinian-Israeli conflict, we tested the idea that an external incentive for negotiating peace helps unfreeze cognitions. In Experiment 1, making salient that peace with the Palestinians would reduce the Iranian nuclear threat (an external incentive) led to a process of unfreezing. In Experiment 2, we examined whether collective angst as an emotional sentiment (i.e., concern for the ingroup's future vitality as a temporally stable emotional disposition) moderated the aforementioned external incentive-cognitive unfreezing link. As predicted, external incentive salience promoted cognitive unfreezing, but only among people low in collective angst (i.e., people who are not concerned for the ingroup's future). In Experiment 3, we sought to replicate the results of Experiment 2. However, socio-political forces (i.e., a significant upswing in tensions between Palestinians and Israelis) likely served to freeze cognitions to such an extent that thawing was not possible by the means demonstrated in Experiments 1 and 2. The importance of confidence in a peace process is discussed in the context of efforts to unfreeze cognitions during an intractable conflict. © 2015 The British Psychological Society.

Relieving existential suffering through palliative sedation: discussion of an uneasy practice.

PubMed

Bruce, Anne; Boston, Patricia

2011-12-01

This article presents a discussion of the use of palliative sedation in response to intractable (not responsive to treatment) existential suffering. Patients suffering from a terminal illness are often faced with severe symptoms at the end of life. Although palliative sedation is sometimes used when no other options are effective in relieving unbearable pain or suffering, its use in response to intractable existential suffering in terminal illness remains controversial. A literature search was conducted for published articles addressing the use of palliative sedation between 1996 and 2009 using established databases. Palliative sedation remains an uneasy practice. The debates have centred on ethical issues surrounding decisions to use sedation and on separating the intent of palliative sedation (relief of intolerable symptoms) from the intent of euthanasia (hastening death). There is lack of consensus in defining existential suffering. Consequently, there is limited understanding of how decisions are being made when using palliative sedation to treat intractable existential suffering. Given the confusion and uncertainty about ethical and clinical justifications for palliative sedation in treating existential suffering, we argue that a better understanding of the controversies and decision-making process is needed. Greater understanding is required to prevent palliative sedation from becoming a substitute for intensive treatment of this kind of suffering. © 2011 Blackwell Publishing Ltd.

Evidence-Based Modification of Intratympanic Gentamicin Injections in Patients With Intractable Vertigo

PubMed Central

Zhai, Feng; Liu, Jian-Ping; Dai, Chun-Fu; Wang, Qi; Steyger, Peter S.

2013-01-01

Objectives To compare the cochlear distribution of low-dose fluorescent gentamicin after intra-tympanic administration in guinea pig (GPs) with clinical data of low dose intra-tympanic gentamicin in patients with intractable vertigo. Materials and Methods Purified gentamicin-Texas Red (GTTR) was injected intratympanically into GPs and the cochlear distribution and time course of GTTR fluorescence in outer hair cells (OHCs) was determined using confocal microscopy. Results GTTR was rapidly taken up by OHCs, particularly in the subcuticular zone. GTTR was distributed in the cochlea in a decreasing baso-apical gradient, and was retained within OHCs without significant decrease in fluorescence until 4 weeks after injection. Conclusion OHCs rapidly take up GTTR after intra-tympanic administration with slow clearance. Clinical Application A modified low-dose titration intratympanic approach was applied to patients with intractable Ménière’s Disease (MD) based on our animal data and the clinical outcome was followed. After the modified intratympanic injections for MD patients, vertigo control was achieved in 89% patients, with hearing deterioration identified in 16% patients. The 3-week interval titration injection technique thereby had a relatively high vertigo control rate with a low risk of hearing loss, and is a viable alternative to other intratympanic injection protocols. PMID:20393376

[Manegement and countermeasures against tuberculous patients with chronic positive sputum].

PubMed

Sato, K

1996-01-01

We studied measures for the prevention and treatment of chronic positive-sputum tuberculosis. Most physicians treating chronic intractable pulmonary tuberculosis are concerned about treatment and control measures. However, both the medical and social aspects of the disease must be dealt with. The study of the medical aspects of tuberculosis used data on patients at the Tokyo National Chest Hospital and other sanitoria in Japan. The socioeconomic study employed data from a health center in Tokyo. Recently, new cases of tuberculosis are concentrated in socioeconomically high risk groups, such as the homeless and illegal aliens, in a few large cities. Patients in these groups often have multidrug-resistant tuberculosis (MDRTB), including many patients with relapsing tuberculosis. However, it is dificult to keep such patients under treatment because of poor compliance and patient dropout. The results of our study are summarized as follows: 1. Prevention and treatment of chronic intractable tuberculosis should involve both the medical and socioeconomic aspects of the disease. 2. Surgical treatment offers benefits for patients with chronically positive sputum. Therefore, surgery should be recommended to patients with chronic intractable MDRTB. 3. If resistance to both isoniazid and rifampin is demonstrated, it is better to replace all ineffective drugs with a new effective regimen than to add a single drug to a failing regimen.

Successful treatment of a primary gastric plasmacytoma mimicking intractable gastric ulcer by using high-dose dexamethasone therapy: a case report.

PubMed

Kang, Da-yeong; Kim, Gee-Bum; Choi, Byung-Seok; Seo, Jun-won; Lim, Hyun-Jong; Hong, Ran; Park, Sang-Gon

2016-03-31

Extramedullary plasmacytoma is a plasma cell neoplasm that presents as a solitary lesion in soft tissue. Most extramedullary plasmacytomas involve the nasopharynx or upper respiratory tract. Primary plasmacytoma of the stomach is extremely rare. A 78-year-old Korean woman presented with epigastric pain for 3 months. She had a history of an intractable gastric ulcer despite repeated endoscopic biopsies and appropriate medical therapy for the ulcer. She underwent another endoscopy and a biopsy was performed for multiple large and deep specimens. Ultimately, primary gastric plasmacytoma was confirmed. However, she and her attendant refused standard local radiotherapy or surgical resection. She came to our emergency room 3 months later with hematemesis due to a large gastric ulcer, despite management with medication for over 3 months at a local clinic. We again recommended local radiation or surgical resection. However, as she was willing to undergo only medical therapy, she was prescribed high-dose dexamethasone. Surprisingly, her ulcer completely regressed and remission was maintained for over 1 year. We report successful treatment of a rare primary gastric plasmacytoma mimicking intractable ulcer by using high-dose dexamethasone. To the best of our knowledge, this is the first reported case successfully treated with only high-dose dexamethasone.

Primary non-Hodgkin’s lymphoma of the prostate with intractable hematuria: A case report and review of the literature

PubMed Central

HU, SHANBIAO; WANG, YINHUAI; YANG, LUOYAN; YI, LU; NIAN, YEQI

2015-01-01

Cases of primary non-Hodgkin’s lymphoma of the prostate are globally rare. The present study reports a case of prostatic diffuse large B-cell lymphoma (DLBCL) with intractable hematuria in a 75-year-old male. The patient presented with difficulties in urination and gross hematuria. A prostate biopsy was performed immediately, followed by conservative treatment for bleeding. A bilateral iliac arteriography and chemoembolization were then performed as emergency procedures under local anesthesia due to significant bleeding and a sharply decreased blood pressure, indicating the failure of the conservative treatment. Consequently, the bleeding was effectively controlled. Pathological examination of the prostate biopsy confirmed the presence of a DLBCL of non-germinal center B-cell origin. Immunohistochemical examination demonstrated cluster of differentiation (CD)20(++), CD3(+), leukocyte common antigen(+++), B-cell lymphoma-2(+) and prostate-specific antigen(−) results. Due to the poor general condition and low hemoglobin levels of the patient, a low-dose Rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) chemotherapy regimen was administered. Subsequent to three courses of chemotherapy, the patient achieved complete remission. In conclusion, combining R-CHOP and bilateral selective iliac arterial chemoembolization could be a safe and effective way to treat patients with non-Hodgkin’s lymphoma of the prostate and intractable hematuria. PMID:25663879

Preclinical and Clinical Studies of Unrelieved Aural Fullness following Intratympanic Gentamicin Injection in Patients with Intractable Ménière’s Disease

PubMed Central

Zhai, Feng; Zhang, Ru; Zhang, Ting; Steyger, Peter S.; Dai, Chun-Fu

2014-01-01

Objective To clarify whether gentamicin affects vestibular dark cells in guinea pigs and relieves patients of aural fullness with intractable Ménière’s disease following intratympanic administration. Materials and Methods Purified gentamicin-Texas Red (GTTR) was injected intratympanically in guinea pigs that were sacrificed at 1, 3, 7, 14 and 28 days. GTTR uptake was examined in hair cells, and transitional cells and dark cells in vestibular end-organs were examined. Specific attention was paid to its distribution in dark cells under confocal microscopy, and the ultrastructure of dark cells using electron microscopy, following intratympanic injection. Results Dark cells in the semicircular canals showed weak GTTR uptake at 1, 3, 7, 14 and 28 days after intratympanic injection, with no significant differences at various time points after injection. However, the adjacent transitional cells demonstrated intense GTTR uptake that was retained for at least 28 days. Ultrastructural studies demonstrated negligible characteristics associated with apoptosis or necrosis in these dark cells. The tight junctions between dark cells showed no signs of disruption at 7 or 28 days after injection. Conclusion Intratympanic gentamicin has little direct impact on vestibular dark cells. Clinical Application A modified low-dose titration intratympanic approach was used in 29 patients with intractable vertigo and the clinical outcomes were followed. Aural fullness following intratympanic gentamicin injection was not relieved based on our subjective scales, demonstrated by no statistically significant difference between preinjection (4.16 ± 3.08) and postinjection (3.58 ± 2.93; p > 0.05) aural fullness scores. Vertigo control was achieved in 88% of patients, with hearing deterioration identified in 16% of patients. Intratympanic gentamicin administration might not lead to relief of aural fullness in patients with intractable vertigo, although it can achieve a high vertigo control rate with some cochleotoxicity. PMID:24008307

Quality of life after surgery for intractable partial epilepsy in children: a cohort study with controls.

PubMed

Mikati, Mohamad A; Ataya, Nour; Ferzli, Jessica; Kurdi, Rana; El-Banna, Diana; Rahi, Amal; Shamseddine, Alhan; Sinno, Durriyah; Comair, Youssef

2010-08-01

Investigate if quality of life (QOL) normalizes on long-term follow-up after surgery for partial epilepsy in children. This is a cohort study with controls in which a consecutive cohort of nineteen 2-14-year-old children who underwent focal resections for intractable partial seizures between 1996 and 2006, were matched with 19 non-surgery intractable partial epilepsy patients, and with 19 healthy subjects. The two epilepsy groups were matched for age, sex, socio-economic status (SES), cognitive level, seizure type, and seizure frequency. The healthy group was matched with the two epilepsy groups for age, sex, SES, and cognitive level. QOL was assessed using the QOLCE (Quality of Life in Childhood Epilepsy Questionnaire). In the surgery group (follow-up 3.84+/-2.26 years), 78.9% had Engel class-I versus 21.1% in non-surgery (p=0.01) (follow-up 3.44+/-2.95 years). Surgery patients were similar to healthy subjects in the social, emotional, cognitive, behavioral, and overall QOL (p>0.05) but had lower scores in the total QOL, physical, and health domains (p<0.05). Surgery patients scored better than non-surgery in the behavioral domain and the HASES (Hague Side Effects Scale) score (p<0.05). Non-surgery patients scored worse than healthy in total QOL, physical, behavioral, health, and overall QOL (p<0.05). IQ, HASS (Hague Seizure Severity Scale), and HASES scores were positively associated with total QOL score (p<0.05). Subgroup analysis on seizure-free surgery patients showed that they did not differ from healthy subjects in any of QOL domains (p>0.05, power>0.8). Our data indicate that epilepsy surgery for partial seizures in children is associated with better QOL as compared to children with intractable epilepsy who are not operated on, and suggest that in those who achieve seizure freedom normal QOL may at least potentially be possible.

Acoustic response variability in automotive vehicles

NASA Astrophysics Data System (ADS)

Hills, E.; Mace, B. R.; Ferguson, N. S.

2009-03-01

A statistical analysis of a series of measurements of the audio-frequency response of a large set of automotive vehicles is presented: a small hatchback model with both a three-door (411 vehicles) and five-door (403 vehicles) derivative and a mid-sized family five-door car (316 vehicles). The sets included vehicles of various specifications, engines, gearboxes, interior trim, wheels and tyres. The tests were performed in a hemianechoic chamber with the temperature and humidity recorded. Two tests were performed on each vehicle and the interior cabin noise measured. In the first, the excitation was acoustically induced by sets of external loudspeakers. In the second test, predominantly structure-borne noise was induced by running the vehicle at a steady speed on a rough roller. For both types of excitation, it is seen that the effects of temperature are small, indicating that manufacturing variability is larger than that due to temperature for the tests conducted. It is also observed that there are no significant outlying vehicles, i.e. there are at most only a few vehicles that consistently have the lowest or highest noise levels over the whole spectrum. For the acoustically excited tests, measured 1/3-octave noise reduction levels typically have a spread of 5 dB or so and the normalised standard deviation of the linear data is typically 0.1 or higher. Regarding the statistical distribution of the linear data, a lognormal distribution is a somewhat better fit than a Gaussian distribution for lower 1/3-octave bands, while the reverse is true at higher frequencies. For the distribution of the overall linear levels, a Gaussian distribution is generally the most representative. As a simple description of the response variability, it is sufficient for this series of measurements to assume that the acoustically induced airborne cabin noise is best described by a Gaussian distribution with a normalised standard deviation between 0.09 and 0.145. There is generally considerable variability in the roller-induced noise, with individual 1/3-octave levels varying by typically 15 dB or so and with the normalised standard deviation being in the range 0.2-0.35 or more. These levels are strongly affected by wheel rim and tyre constructions. For vehicles with nominally identical wheel rims and tyres, the normalised standard deviation for 1/3-octave levels in the frequency range 40-600 Hz is 0.2 or so. The distribution of the linear roller-induced noise level in each 1/3-octave frequency band is well described by a lognormal distribution as is the overall level. As a simple description of the response variability, it is sufficient for this series of measurements to assume that the roller-induced road noise is best described by a lognormal distribution with a normalised standard deviation of 0.2 or so, but that this can be significantly affected by the tyre and rim type, especially at lower frequencies.

Alliinase and cysteine synthase transcription in developing garlic (Allium sativum L.) over time.

PubMed

Mitrová, Katarina; Svoboda, Pavel; Milella, Luigi; Ovesná, Jaroslava

2018-06-15

Garlic is a valuable source of healthy compounds, including secondary metabolites rich in sulphur such as cysteine sulphoxides (CSOs). Here, we present new qRT-PCR assays analysing the transcription of two genes encoding key enzymes in CSO biosynthetic pathways (cysteine synthase and alliinase) in developing garlic. We also identified a set of genes (ACT I, GAPDH, and TUB) to use as transcription normalisation controls. We showed that the (normalised) transcription of both enzymes was highest during sprouting and decreased significantly in fully developed leaves, which are the major CSO-producing organs. Transcriptional activity further declined at the end of the growing season. Different cultivars show similar sulphur metabolism gene expression when European garlics were compared to Chinese and American genotypes. The qRT-PCR assays presented are also suitable for investigating the effects of agricultural practices on CSO formation in garlic to satisfy consumer demands. Copyright © 2017. Published by Elsevier Ltd.

Attention training normalises combat-related post-traumatic stress disorder effects on emotional Stroop performance using lexically matched word lists.

PubMed

Khanna, Maya M; Badura-Brack, Amy S; McDermott, Timothy J; Shepherd, Alex; Heinrichs-Graham, Elizabeth; Pine, Daniel S; Bar-Haim, Yair; Wilson, Tony W

2015-08-26

We examined two groups of combat veterans, one with post-traumatic stress disorder (PTSD) (n = 27) and another without PTSD (n = 16), using an emotional Stroop task (EST) with word lists matched across a series of lexical variables (e.g. length, frequency, neighbourhood size, etc.). Participants with PTSD exhibited a strong EST effect (longer colour-naming latencies for combat-relevant words as compared to neutral words). Veterans without PTSD produced no such effect, t < .918, p > .37. Participants with PTSD then completed eight sessions of attention training (Attention Control Training or Attention Bias Modification Training) with a dot-probe task utilising threatening and neutral faces. After training, participants-especially those undergoing Attention Control Training-no longer produced longer colour-naming latencies for combat-related words as compared to other words, indicating normalised attention allocation processes after treatment.

Spatial generalised linear mixed models based on distances.

PubMed

Melo, Oscar O; Mateu, Jorge; Melo, Carlos E

2016-10-01

Risk models derived from environmental data have been widely shown to be effective in delineating geographical areas of risk because they are intuitively easy to understand. We present a new method based on distances, which allows the modelling of continuous and non-continuous random variables through distance-based spatial generalised linear mixed models. The parameters are estimated using Markov chain Monte Carlo maximum likelihood, which is a feasible and a useful technique. The proposed method depends on a detrending step built from continuous or categorical explanatory variables, or a mixture among them, by using an appropriate Euclidean distance. The method is illustrated through the analysis of the variation in the prevalence of Loa loa among a sample of village residents in Cameroon, where the explanatory variables included elevation, together with maximum normalised-difference vegetation index and the standard deviation of normalised-difference vegetation index calculated from repeated satellite scans over time. © The Author(s) 2013.

High-dose intravenous levetiracetam for acute seizure exacerbation in children with intractable epilepsy.

PubMed

Depositario-Cabacar, Dewi T; Peters, Jurriaan M; Pong, Amanda W; Roth, Julie; Rotenberg, Alexander; Riviello, James J; Takeoka, Masanori

2010-07-01

We review our experience with high-dose intravenous levetiracetam (IV-LEV) for acute seizure exacerbations in nine children with medically intractable epilepsy. All children had acute repetitive seizures-while on chronic antiepileptic drugs-that either led to hospitalization (eight) or occurred during hospitalization (one), and received doses of IV-LEV of 150 mg/kg/day or greater, with a mean dose of 228 +/- 48 mg/kg/day. Eight of nine children had resolution of the acute repetitive seizures. Seizure frequency was reduced to less than baseline in seven children (seizure-free in two, >/=80% reduction in four, and 50% reduction in one). Except for one child with increased seizures, IV-LEV was well tolerated in all children without complications.

Pediatric epilepsy -- an Indian perspective.

PubMed

Udani, Vrajesh

2005-04-01

Prevalence studies from India suggest that epilepsy prevalence is similar to developed nations. Neurocysticercosis (NCC) predominates as an etiology. A large treatment gap is still a public health problem. Benign epilepsies and West syndrome appear to be underrepresented in studies on classification of seizures/syndromes. Febrile seizures prevalence in India is similar to other countries and appear to be as benign. Risk factors of intractable epilepsy (IE) in Indian studies include early age of onset, neurodevelopmental abnormalities and certain seizure types. Perinatal injuries underlie many IE. Many IE are not truly intractable and respond to simple therapeutic measures. The ketogenic diet and surgery are other methods now being used in Indian centers. Neurocysticercosis and neonatal hypoglycemic brain injury, two widely prevalent etiologies are reviewed in detail.

Pediatric epilepsy - an Indian perspective.

PubMed

Udani, Vrajesh

2005-04-01

Prevalence studies from India suggest that epilepsy prevalence is similar to developed nations. Neurocysticercosis (NCC) predominates as an etiology. A large treatment gap is still a public health problem. Benign epilepsies and West syndrome appear to be underrepresented in studies on classification of seizures/syndromes. Febrile seizures prevalence in India is similar to other countries and appear to be as benign. Risk factors of intractable epilepsy (IE) in Indian studies include early age of onset, neurodevelopmental abnormalities and certain seizure types. Perinatal injuries underlie many IE. Many IE are not truly intractable and respond to simple therapeutic measures. The ketogenic diet and surgery are other methods now being used in Indian centers. Neurocysticercosis and neonatal hypoglycemic brain injury, two widely prevalent etiologies are reviewed in detail.

Hematopoietic Stem Cell Transplantation for Systemic Lupus Erythematosus

PubMed Central

Marmont du Haut Champ, Alberto M.

2012-01-01

Two streams of research are at the origin of the utilization of hematopoietic stem cell transplantation (HSCT) for severe autoimmune diseases (SADs). The allogeneic approach came from experimental studies on lupus mice, besides clinical results in coincidental diseases. The autologous procedure was encouraged by researches on experimental neurological and rheumatic disorders. At present the number of allogeneic HSCT performed for human SADs can be estimated to not over 100 patients, and the results are not greatly encouraging, considering the significant transplant-related mortality (TRM) and the occasional development of a new autoimmune disorder and/or relapses notwithstanding full donor chimerism. Autologous HSCT for refractory SLE has become a major target. Severe cases have been salvaged, TRM is low and diminishing, and prolonged clinical remissions are obtainable. Two types of immune resetting have been established, “re-education” and regulatory T cell (Tregs) normalization. Allogeneic HSCT for SLE seems best indicated for patients with disease complicated by an oncohematologic malignancy. Autologous HSCT is a powerful salvage therapy for otherwise intractable SLE. The duration of remission in uncertain, but a favorable response to previously inactive treatments is a generally constant feature. The comparison with new biological agents, or the combination of both, are to be ascertained. PMID:22969816

The rational parameterization theorem for multisite post-translational modification systems.

PubMed

Thomson, Matthew; Gunawardena, Jeremy

2009-12-21

Post-translational modification of proteins plays a central role in cellular regulation but its study has been hampered by the exponential increase in substrate modification forms ("modforms") with increasing numbers of sites. We consider here biochemical networks arising from post-translational modification under mass-action kinetics, allowing for multiple substrates, having different types of modification (phosphorylation, methylation, acetylation, etc.) on multiple sites, acted upon by multiple forward and reverse enzymes (in total number L), using general enzymatic mechanisms. These assumptions are substantially more general than in previous studies. We show that the steady-state modform concentrations constitute an algebraic variety that can be parameterized by rational functions of the L free enzyme concentrations, with coefficients which are rational functions of the rate constants. The parameterization allows steady states to be calculated by solving L algebraic equations, a dramatic reduction compared to simulating an exponentially large number of differential equations. This complexity collapse enables analysis in contexts that were previously intractable and leads to biological predictions that we review. Our results lay a foundation for the systems biology of post-translational modification and suggest deeper connections between biochemical networks and algebraic geometry.

Simultaneous Mean and Covariance Correction Filter for Orbit Estimation.

PubMed

Wang, Xiaoxu; Pan, Quan; Ding, Zhengtao; Ma, Zhengya

2018-05-05

This paper proposes a novel filtering design, from a viewpoint of identification instead of the conventional nonlinear estimation schemes (NESs), to improve the performance of orbit state estimation for a space target. First, a nonlinear perturbation is viewed or modeled as an unknown input (UI) coupled with the orbit state, to avoid the intractable nonlinear perturbation integral (INPI) required by NESs. Then, a simultaneous mean and covariance correction filter (SMCCF), based on a two-stage expectation maximization (EM) framework, is proposed to simply and analytically fit or identify the first two moments (FTM) of the perturbation (viewed as UI), instead of directly computing such the INPI in NESs. Orbit estimation performance is greatly improved by utilizing the fit UI-FTM to simultaneously correct the state estimation and its covariance. Third, depending on whether enough information is mined, SMCCF should outperform existing NESs or the standard identification algorithms (which view the UI as a constant independent of the state and only utilize the identified UI-mean to correct the state estimation, regardless of its covariance), since it further incorporates the useful covariance information in addition to the mean of the UI. Finally, our simulations demonstrate the superior performance of SMCCF via an orbit estimation example.

A master equation and moment approach for biochemical systems with creation-time-dependent bimolecular rate functions

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

Chevalier, Michael W., E-mail: Michael.Chevalier@ucsf.edu; El-Samad, Hana, E-mail: Hana.El-Samad@ucsf.edu

Noise and stochasticity are fundamental to biology and derive from the very nature of biochemical reactions where thermal motion of molecules translates into randomness in the sequence and timing of reactions. This randomness leads to cell-to-cell variability even in clonal populations. Stochastic biochemical networks have been traditionally modeled as continuous-time discrete-state Markov processes whose probability density functions evolve according to a chemical master equation (CME). In diffusion reaction systems on membranes, the Markov formalism, which assumes constant reaction propensities is not directly appropriate. This is because the instantaneous propensity for a diffusion reaction to occur depends on the creation timesmore » of the molecules involved. In this work, we develop a chemical master equation for systems of this type. While this new CME is computationally intractable, we make rational dimensional reductions to form an approximate equation, whose moments are also derived and are shown to yield efficient, accurate results. This new framework forms a more general approach than the Markov CME and expands upon the realm of possible stochastic biochemical systems that can be efficiently modeled.« less

Long-term intake of soyabean phytosterols lowers serum TAG and NEFA concentrations, increases bile acid synthesis and protects against fatty liver development in dyslipidaemic hamsters.

PubMed

Laos, Sirle; Caimari, Antoni; Crescenti, Anna; Lakkis, Jamileh; Puiggròs, Francesc; Arola, Lluís; del Bas, Josep Maria

2014-09-14

Various human trials and pre-clinical studies have suggested that dietary plant sterols possess hypotriacylglycerolaemic properties apart from their cholesterol-lowering properties. We hypothesised that phytosterols (PS) might attenuate triacylglycerolaemia by interfering with the deleterious effects of cholesterol overload in the liver. In the present study, twenty hamsters (Mesocricetus auratus) with diet-induced combined hyperlipidaemia were fed a high-fat diet (HFD, n 10) or a HFD supplemented with soyabean PS (n 10) for 40 d. In parallel, a healthy group was fed a standard diet (n 10). PS normalised fasting plasma cholesterol concentrations completely after 20 d and were also able to normalise serum TAG and NEFA concentrations after 40 d. HFD feeding caused microvesicular steatosis and impaired the expression of key genes related to fatty acid oxidation such as PPARA, carnitine palmitoyltransferase-Iα (CPT1A) and phosphoenolpyruvate carboxykinase 1 (PCK1) in the liver. PS treatment completely protected against HFD-induced steatosis and resulted in a normalised hepatic gene expression profile. The protection of the hepatic function by PS was paralleled by increased faecal cholesterol excretion along with a 2-fold increase in the biliary bile acid (BA):cholesterol ratio. The present study supports the conclusion that long-term consumption of PS can reduce serum TAG and NEFA concentrations and can protect against the development of fatty liver via different mechanisms, including the enhancement of BA synthesis. The results of the present study place these compounds as promising hepatoprotective agents against fatty liver and its derived pathologies.

Critical role for GLP-1 in symptomatic post-bariatric hypoglycaemia.

PubMed

Craig, Colleen M; Liu, Li-Fen; Deacon, Carolyn F; Holst, Jens J; McLaughlin, Tracey L

2017-03-01

Post-bariatric hypoglycaemia (PBH) is a rare, but severe, metabolic disorder arising months to years after bariatric surgery. It is characterised by symptomatic postprandial hypoglycaemia, with inappropriately elevated insulin concentrations. The relative contribution of exaggerated incretin hormone signalling to dysregulated insulin secretion and symptomatic hypoglycaemia is a subject of ongoing inquiry. This study was designed to test the hypothesis that PBH and associated symptoms are primarily mediated by glucagon-like peptide-1 (GLP-1). We conducted a double-blinded crossover study wherein eight participants with confirmed PBH were assigned in random order to intravenous infusion of the GLP-1 receptor (GLP-1r) antagonist. Exendin (9-39) (Ex-9), or placebo during an OGTT on two separate days at the Stanford University Clinical and Translational Research Unit. Metabolic, symptomatic and pharmacokinetic variables were evaluated. Results were compared with a cohort of BMI- and glucose-matched non-surgical controls (NSCs). Infusion of Ex-9 decreased the time to peak glucose and rate of glucose decline during OGTT, and raised the postprandial nadir by over 70%, normalising it relative to NSCs and preventing hypoglycaemia in all PBH participants. Insulin AUC and secretion rate decreased by 57% and 71% respectively, and peak postprandial insulin was normalised relative to NSCs. Autonomic and neuroglycopenic symptoms were significantly reduced during Ex-9 infusion. GLP-1r blockade prevented hypoglycaemia in 100% of individuals, normalised beta cell function and reversed neuroglycopenic symptoms, supporting the conclusion that GLP-1 plays a primary role in mediating hyperinsulinaemic hypoglycaemia in PBH. Competitive antagonism at the GLP-1r merits consideration as a therapeutic strategy. ClinicalTrials.gov NCT02550145.

Classification of the European Union member states according to the relative level of sustainable development.

PubMed

Anna, Bluszcz

Nowadays methods of measurement and assessment of the level of sustained development at the international, national and regional level are a current research problem, which requires multi-dimensional analysis. The relative assessment of the sustainability level of the European Union member states and the comparative analysis of the position of Poland relative to other countries was the aim of the conducted studies in the article. EU member states were treated as objects in the multi-dimensional space. Dimensions of space were specified by ten diagnostic variables describing the sustainability level of UE countries in three dimensions, i.e., social, economic and environmental. Because the compiled statistical data were expressed in different units of measure, taxonomic methods were used for building an aggregated measure to assess the level of sustainable development of EU member states, which through normalisation of variables enabled the comparative analysis between countries. Methodology of studies consisted of eight stages, which included, among others: defining data matrices, calculating the variability coefficient for all variables, which variability coefficient was under 10 %, division of variables into stimulants and destimulants, selection of the method of variable normalisation, developing matrices of normalised data, selection of the formula and calculating the aggregated indicator of the relative level of sustainable development of the EU countries, calculating partial development indicators for three studies dimensions: social, economic and environmental and the classification of the EU countries according to the relative level of sustainable development. Statistical date were collected based on the Polish Central Statistical Office publication.

London 2012 Paralympic swimming: passive drag and the classification system.

PubMed

Oh, Yim-Taek; Burkett, Brendan; Osborough, Conor; Formosa, Danielle; Payton, Carl

2013-09-01

The key difference between the Olympic and Paralympic Games is the use of classification systems within Paralympic sports to provide a fair competition for athletes with a range of physical disabilities. In 2009, the International Paralympic Committee mandated the development of new, evidence-based classification systems. This study aims to assess objectively the swimming classification system by determining the relationship between passive drag and level of swimming-specific impairment, as defined by the current swimming class. Data were collected on participants at the London 2012 Paralympic Games. The passive drag force of 113 swimmers (classes 3-14) was measured using an electro-mechanical towing device and load cell. Swimmers were towed on the surface of a swimming pool at 1.5 m/s while holding their most streamlined position. Passive drag ranged from 24.9 to 82.8 N; the normalised drag (drag/mass) ranged from 0.45 to 1.86 N/kg. Significant negative associations were found between drag and the swimming class (τ = -0.41, p < 0.01) and normalised drag and the swimming class (τ = -0.60, p < 0.01). The mean difference in drag between adjacent classes was inconsistent, ranging from 0 N (6 vs 7) to 11.9 N (5 vs 6). Reciprocal Ponderal Index (a measure of slenderness) correlated moderately with normalised drag (r(P) = -0.40, p < 0.01). Although swimmers with the lowest swimming class experienced the highest passive drag and vice versa, the inconsistent difference in mean passive drag between adjacent classes indicates that the current classification system does not always differentiate clearly between swimming groups.

Wall conditioning by ECRH discharges and He-GDC in the limiter phase of Wendelstein 7-X

NASA Astrophysics Data System (ADS)

Wauters, T.; Brakel, R.; Brezinsek, S.; Dinklage, A.; Goriaev, A.; Laqua, H. P.; Marsen, S.; Moseev, D.; Stange, T.; Schlisio, G.; Pedersen, T. Sunn; Volzke, O.; Wenzel, U.; the W7-X Team

2018-06-01

Wendelstein 7-X (W7-X) relies on wall conditioning to control the density and the impurity content of the plasma. Wall conditioning in the first operation campaign of W7-X consisted of baking at 150 °C during 1 week prior to operation, glow discharge conditioning (GDC) in helium (He) and electron cyclotron resonance heating (ECRH) discharges. Additionally, the usage of He-GDC was limited to avoid sputtering and migration of metallic plasma facing components. This presented a unique opportunity for studying the applicability of ECRH discharges for initial wall conditioning on a stellarator, albeit in the carbon limiter configuration. A single envelope curve is observed in the normalised outgassing data that takes into account all ECRH discharges. This illustrates that the majority of discharges operates at the limits of a radiative collapse. Hydrogen recycling dominated the fuelling of ECRH discharges throughout while CO outgassing was found strongest at the start of the campaign. A reduction of recycling was observed throughout the campaign. Temporarily depleting the walls from H and impurities was possible by He-GDC. It was shown that the recycling coefficient in -ECRH plasmas could be reduced and the pulse duration significantly extended by He-’recovery’ ECRH plasmas. Good wall conditions were defined by normalised outgassing values below mbar kJ‑1. In absence of -GDC, more than 311 cumulated discharge seconds of ECRH discharges are needed for obtaining lasting low outgassing levels. A release model with two trapping reservoirs could reproduce the normalised outgassing trend, including ECRH and GDC plasma wall interactions.

Use of the melting curve assay as a means for high-throughput quantification of Illumina sequencing libraries.

PubMed

Shinozuka, Hiroshi; Forster, John W

2016-01-01

Background. Multiplexed sequencing is commonly performed on massively parallel short-read sequencing platforms such as Illumina, and the efficiency of library normalisation can affect the quality of the output dataset. Although several library normalisation approaches have been established, none are ideal for highly multiplexed sequencing due to issues of cost and/or processing time. Methods. An inexpensive and high-throughput library quantification method has been developed, based on an adaptation of the melting curve assay. Sequencing libraries were subjected to the assay using the Bio-Rad Laboratories CFX Connect(TM) Real-Time PCR Detection System. The library quantity was calculated through summation of reduction of relative fluorescence units between 86 and 95 °C. Results.PCR-enriched sequencing libraries are suitable for this quantification without pre-purification of DNA. Short DNA molecules, which ideally should be eliminated from the library for subsequent processing, were differentiated from the target DNA in a mixture on the basis of differences in melting temperature. Quantification results for long sequences targeted using the melting curve assay were correlated with those from existing methods (R (2) > 0.77), and that observed from MiSeq sequencing (R (2) = 0.82). Discussion.The results of multiplexed sequencing suggested that the normalisation performance of the described method is equivalent to that of another recently reported high-throughput bead-based method, BeNUS. However, costs for the melting curve assay are considerably lower and processing times shorter than those of other existing methods, suggesting greater suitability for highly multiplexed sequencing applications.

Artificial Neural Network Based Fault Diagnostics of Rolling Element Bearings Using Time-Domain Features

NASA Astrophysics Data System (ADS)

Samanta, B.; Al-Balushi, K. R.

2003-03-01

A procedure is presented for fault diagnosis of rolling element bearings through artificial neural network (ANN). The characteristic features of time-domain vibration signals of the rotating machinery with normal and defective bearings have been used as inputs to the ANN consisting of input, hidden and output layers. The features are obtained from direct processing of the signal segments using very simple preprocessing. The input layer consists of five nodes, one each for root mean square, variance, skewness, kurtosis and normalised sixth central moment of the time-domain vibration signals. The inputs are normalised in the range of 0.0 and 1.0 except for the skewness which is normalised between -1.0 and 1.0. The output layer consists of two binary nodes indicating the status of the machine—normal or defective bearings. Two hidden layers with different number of neurons have been used. The ANN is trained using backpropagation algorithm with a subset of the experimental data for known machine conditions. The ANN is tested using the remaining set of data. The effects of some preprocessing techniques like high-pass, band-pass filtration, envelope detection (demodulation) and wavelet transform of the vibration signals, prior to feature extraction, are also studied. The results show the effectiveness of the ANN in diagnosis of the machine condition. The proposed procedure requires only a few features extracted from the measured vibration data either directly or with simple preprocessing. The reduced number of inputs leads to faster training requiring far less iterations making the procedure suitable for on-line condition monitoring and diagnostics of machines.

Regional magnetic resonance imaging measures for multivariate analysis in Alzheimer's disease and mild cognitive impairment.

PubMed

Westman, Eric; Aguilar, Carlos; Muehlboeck, J-Sebastian; Simmons, Andrew

2013-01-01

Automated structural magnetic resonance imaging (MRI) processing pipelines are gaining popularity for Alzheimer's disease (AD) research. They generate regional volumes, cortical thickness measures and other measures, which can be used as input for multivariate analysis. It is not clear which combination of measures and normalization approach are most useful for AD classification and to predict mild cognitive impairment (MCI) conversion. The current study includes MRI scans from 699 subjects [AD, MCI and controls (CTL)] from the Alzheimer's disease Neuroimaging Initiative (ADNI). The Freesurfer pipeline was used to generate regional volume, cortical thickness, gray matter volume, surface area, mean curvature, gaussian curvature, folding index and curvature index measures. 259 variables were used for orthogonal partial least square to latent structures (OPLS) multivariate analysis. Normalisation approaches were explored and the optimal combination of measures determined. Results indicate that cortical thickness measures should not be normalized, while volumes should probably be normalized by intracranial volume (ICV). Combining regional cortical thickness measures (not normalized) with cortical and subcortical volumes (normalized with ICV) using OPLS gave a prediction accuracy of 91.5 % when distinguishing AD versus CTL. This model prospectively predicted future decline from MCI to AD with 75.9 % of converters correctly classified. Normalization strategy did not have a significant effect on the accuracies of multivariate models containing multiple MRI measures for this large dataset. The appropriate choice of input for multivariate analysis in AD and MCI is of great importance. The results support the use of un-normalised cortical thickness measures and volumes normalised by ICV.

Use of the Physiotherapy Evidence Database (PEDro) in Japan

PubMed Central

TAKASAKI, Hiroshi; ELKINS, Mark R.; MOSELEY, Anne M.

2016-01-01

Background: The Physiotherapy Evidence Database (PEDro) may help users to overcome some obstacles to evidence-based physiotherapy. Understanding the extent to which Japanese physiotherapists access research evidence via the PEDro website may suggest strategies to enhance evidence-based physiotherapy in Japan. Objectives: To quantify usage of PEDro in Japan, to compare this to usage in other countries, and to examine variations in PEDro usage within Japan. Design: An observational study of PEDro usage with geographic analysis. Methods: Data about visits to the home-page and searches of the database were recorded for 4 years. These data were analysed by each region of the World Confederation for Physical Therapy, each country in the Asia Western Pacific region, and each prefecture in Japan. Results: From 2010 to 2013, users of PEDro made 2.27 million visits to the home-page and ran 6.28 million searches. Usage (ie, number of searches normalised by population) was highest in Europe, followed by North America Carribean, South America, Asia Western Pacific, and Africa. Within the Asia Western Pacific region, population-normalised usage was highest in Australia, then New Zealand and Singapore. Japan ranked 10 among the 26 countries in the region. Within Japan, the highest population-normalised usage was in the Nagano, Kumamoto and Aomori prefectures, which was ten-fold higher usage than in some other prefectures. Conclusions: Although Japan has higher PEDro usage than many other countries in the Asia Western Pacific region, some prefectures had very low usage, suggesting that evidence-based practice may not be being adopted uniformly across Japan. PMID:28289582

Validation of reference genes for quantitative RT-PCR studies of gene expression in perennial ryegrass (Lolium perenne L.)

PubMed Central

2010-01-01

Background Perennial ryegrass (Lolium perenne L.) is an important pasture and turf crop. Biotechniques such as gene expression studies are being employed to improve traits in this temperate grass. Quantitative reverse transcription-polymerase chain reaction (qRT-PCR) is among the best methods available for determining changes in gene expression. Before analysis of target gene expression, it is essential to select an appropriate normalisation strategy to control for non-specific variation between samples. Reference genes that have stable expression at different biological and physiological states can be effectively used for normalisation; however, their expression stability must be validated before use. Results Existing Serial Analysis of Gene Expression data were queried to identify six moderately expressed genes that had relatively stable gene expression throughout the year. These six candidate reference genes (eukaryotic elongation factor 1 alpha, eEF1A; TAT-binding protein homolog 1, TBP-1; eukaryotic translation initiation factor 4 alpha, eIF4A; YT521-B-like protein family protein, YT521-B; histone 3, H3; ubiquitin-conjugating enzyme, E2) were validated for qRT-PCR normalisation in 442 diverse perennial ryegrass (Lolium perenne L.) samples sourced from field- and laboratory-grown plants under a wide range of experimental conditions. Eukaryotic EF1A is encoded by members of a multigene family exhibiting differential expression and necessitated the expression analysis of different eEF1A encoding genes; a highly expressed eEF1A (h), a moderately, but stably expressed eEF1A (s), and combined expression of multigene eEF1A (m). NormFinder identified eEF1A (s) and YT521-B as the best combination of two genes for normalisation of gene expression data in perennial ryegrass following different defoliation management in the field. Conclusions This study is unique in the magnitude of samples tested with the inclusion of numerous field-grown samples, helping pave the way to conduct gene expression studies in perennial biomass crops under field-conditions. From our study several stably expressed reference genes have been validated. This provides useful candidates for reference gene selection in perennial ryegrass under conditions other than those tested here. PMID:20089196

Typhoid fever as a triggering factor in acute and intractable bronchial asthma attack.

PubMed

Wardhana; Surachmanto, Eko E; Datau, E A

2013-10-01

Typhoid fever is an enteric infection caused by Salmonella typhi. In Indonesia, typhoid fever is endemic with high incidence of the disease. In daily practice we frequently have patients with bronchial asthma, and it is becoming worse when these patients get typhoid fever. After oral ingestion, Salmonella typhi invades the the intestine mucosa after conducted by microbial binding to epithelial cells, destroying the microfold cells (M cell) then passed through the lamina propria and detected by dendritic cells (DC) which express a variety of pathogen recognition receptors on the surfaces, including Toll-Like Receptor (TLR). expressed on macrophages and on intestinal epithelial cells inducing degradation of IB, and translocation of NF-B (Nuclear Factor-Kappa Beta). This process initiates the induction of pro-inflammatory gene expression profile adhesion molecules, chemokines, adhesion molecules, and other proteins that induce and perpetuate the inflammation in host cells then will induce acute ant intractable attack of bronchial asthma. The role of typhoid fever in bronchial asthma, especially in persons with acute attack of bronchial asthma, is not well understood. In this article, we will discuss the role of typhoid fever in the bronchial asthma patients which may cause bronchial asthma significantly become more severe even triggering the acute and intractable attack of bronchial asthma. This fact makes an important point, to treat completely the typhoid fever in patients with bronchial asthma.

Ahmed glaucoma valve in eyes with preexisting episcleral encircling element

PubMed Central

Choudhari, Nikhil Shreeram; George, Ronnie; Shantha, Balekudaru; Neog, Aditya; Tripathi, Shweta; Srinivasan, Bhaskar; Vijaya, Lingam

2014-01-01

Background: To describe the use of Ahmed glaucoma valve (AGV) in the management of intractable glaucoma in eyes with a preexisting episcleral encircling element. Materials and Methods: This is a retrospective, consecutive, noncomparative study. The study included 12 eyes of 12 patients with a preexisting episcleral encircling element that underwent implantation of silicone AGV to treat intractable glaucoma during January 2009 to September 2010. Results: The mean patient age was 25.6 (standard deviation 17.1) years. Five (41.6%) patients were monocular. The indications for AGV were varied. The mean duration between placement of episcleral encircling element and implantation of AGV was 30.5 (33.8) months. The mean follow-up was 37.4 (22.9) weeks. Preoperatively, the mean intraocular pressure (IOP) was 31.4 (7.9) mmHg and the mean antiglaucoma medications were 2.8. At the final postoperative follow-up, the mean IOP was 12.5 (3.5) mmHg and the mean number of antiglaucoma medications was 0.8 (P < 0.001). The complications observed over the follow-up period did include corneal graft failure in three eyes, tube erosion in two eyes and rhegmatogenous retinal detachment in one eye. Conclusion: AGV is an effective option in the management of intractable glaucoma in eyes with a preexisting episcleral encircling element keeping in mind the possibility of significant postoperative complications. PMID:24881603

ST-Segment Elevation Myocardial Infarction with Acute Stent Thrombosis Presenting as Intractable Hiccups: An Unusual Case

PubMed Central

Zhang, Fan; Tongo, Nosakhare Douglas; Hastings, Victoria; Kanzali, Parisa; Zhu, Ziqiang; Chadow, Hal; Rafii, Shahrokh E.

2017-01-01

Patient: Male, 51 Final Diagnosis: ST-segment elevation myocardial infarction with acute stent thrombosis Symptoms: Chest pain • hiccups Medication: — Clinical Procedure: — Specialty: Cardiology Objective: Unusual clinical course Background: Acute coronary syndrome (ACS) can present with atypical chest pain or symptoms not attributed to heart disease, such as indigestion. Hiccups, a benign and self-limited condition, can become persistent or intractable with overlooked underlying etiology. There are various causes of protracted hiccups, including metabolic abnormalities, psychogenic disorders, malignancy, central nervous system pathology, medications, pulmonary disorders, or gastrointestinal etiologies. It is rarely attributed to cardiac disease. Case Report: We report a case of intractable hiccups in a 51-year-old male with cocaine related myocardial infarction (MI) before and after stent placement. Coronary angiogram showed in-stent thrombosis of the initial intervention. Following thrombectomy, balloon angioplasty, and stent, the patient recovered well without additional episodes of hiccups. Although hiccups are not known to present with a predilection for a particular cause of myocardial ischemia, this case may additionally be explained by the sympathomimetic effects of cocaine, which lead to vasoconstriction of coronary arteries. Conclusions: Hiccups associated with cardiac enzyme elevation and EKG ST-segment elevation before and after percutaneous coronary intervention (PCI) maybe a manifestation of acute MI with or without stent. The fact that this patient was a cocaine user may have contributed to the unique presentation. PMID:28455489

Atypical language laterality is associated with large-scale disruption of network integration in children with intractable focal epilepsy.

PubMed

Ibrahim, George M; Morgan, Benjamin R; Doesburg, Sam M; Taylor, Margot J; Pang, Elizabeth W; Donner, Elizabeth; Go, Cristina Y; Rutka, James T; Snead, O Carter

2015-04-01

Epilepsy is associated with disruption of integration in distributed networks, together with altered localization for functions such as expressive language. The relation between atypical network connectivity and altered localization is unknown. In the current study we tested whether atypical expressive language laterality was associated with the alteration of large-scale network integration in children with medically-intractable localization-related epilepsy (LRE). Twenty-three right-handed children (age range 8-17) with medically-intractable LRE performed a verb generation task in fMRI. Language network activation was identified and the Laterality index (LI) was calculated within the pars triangularis and pars opercularis. Resting-state data from the same cohort were subjected to independent component analysis. Dual regression was used to identify associations between resting-state integration and LI values. Higher positive values of the LI, indicating typical language localization were associated with stronger functional integration of various networks including the default mode network (DMN). The normally symmetric resting-state networks showed a pattern of lateralized connectivity mirroring that of language function. The association between atypical language localization and network integration implies a widespread disruption of neural network development. These findings may inform the interpretation of localization studies by providing novel insights into reorganization of neural networks in epilepsy. Copyright © 2015 Elsevier Ltd. All rights reserved.

Noninvasive testing, early surgery, and seizure freedom in tuberous sclerosis complex.

PubMed

Wu, J Y; Salamon, N; Kirsch, H E; Mantle, M M; Nagarajan, S S; Kurelowech, L; Aung, M H; Sankar, R; Shields, W D; Mathern, G W

2010-02-02

The unambiguous identification of the epileptogenic tubers in individuals with tuberous sclerosis complex (TSC) can be challenging. We assessed whether magnetic source imaging (MSI) and coregistration of (18)fluorodeoxyglucose PET (FDG-PET) with MRI could improve the identification of the epileptogenic regions noninvasively in children with TSC. In addition to standard presurgical evaluation, 28 children with intractable epilepsy from TSC referred from 2000 to 2007 had MSI and FDG-PET/MRI coregistration without extraoperative intracranial EEG. Based on the concordance of test results, 18 patients with TSC (64%) underwent surgical resection, with the final resection zone confirmed by intraoperative electrocorticography. Twelve patients are seizure free postoperatively (67%), with an average follow-up of 4.1 years. Younger age at surgery and shorter seizure duration were associated with postoperative seizure freedom. Conversely, older age and longer seizure duration were linked with continued seizures postoperatively or prevented surgery because of nonlateralizing or bilateral independent epileptogenic zones. Complete removal of presurgery MSI dipole clusters correlated with postoperative seizure freedom. Magnetic source imaging and (18)fluorodeoxyglucose PET/MRI coregistration noninvasively localized the epileptogenic zones in many children with intractable epilepsy from tuberous sclerosis complex (TSC), with 67% seizure free postoperatively. Seizure freedom after surgery correlated with younger age and shorter seizure duration. These findings support the concept that early epilepsy surgery is associated with seizure freedom in children with TSC and intractable epilepsy.

Motive attribution asymmetry for love vs. hate drives intractable conflict.

PubMed

Waytz, Adam; Young, Liane L; Ginges, Jeremy

2014-11-04

Five studies across cultures involving 661 American Democrats and Republicans, 995 Israelis, and 1,266 Palestinians provide previously unidentified evidence of a fundamental bias, what we term the "motive attribution asymmetry," driving seemingly intractable human conflict. These studies show that in political and ethnoreligious intergroup conflict, adversaries tend to attribute their own group's aggression to ingroup love more than outgroup hate and to attribute their outgroup's aggression to outgroup hate more than ingroup love. Study 1 demonstrates that American Democrats and Republicans attribute their own party's involvement in conflict to ingroup love more than outgroup hate but attribute the opposing party's involvement to outgroup hate more than ingroup love. Studies 2 and 3 demonstrate this biased attributional pattern for Israelis and Palestinians evaluating their own group and the opposing group's involvement in the current regional conflict. Study 4 demonstrates in an Israeli population that this bias increases beliefs and intentions associated with conflict intractability toward Palestinians. Finally, study 5 demonstrates, in the context of American political conflict, that offering Democrats and Republicans financial incentives for accuracy in evaluating the opposing party can mitigate this bias and its consequences. Although people find it difficult to explain their adversaries' actions in terms of love and affiliation, we suggest that recognizing this attributional bias and how to reduce it can contribute to reducing human conflict on a global scale.

Motive attribution asymmetry for love vs. hate drives intractable conflict

PubMed Central

Waytz, Adam; Young, Liane L.; Ginges, Jeremy

2014-01-01

Five studies across cultures involving 661 American Democrats and Republicans, 995 Israelis, and 1,266 Palestinians provide previously unidentified evidence of a fundamental bias, what we term the “motive attribution asymmetry,” driving seemingly intractable human conflict. These studies show that in political and ethnoreligious intergroup conflict, adversaries tend to attribute their own group’s aggression to ingroup love more than outgroup hate and to attribute their outgroup’s aggression to outgroup hate more than ingroup love. Study 1 demonstrates that American Democrats and Republicans attribute their own party’s involvement in conflict to ingroup love more than outgroup hate but attribute the opposing party’s involvement to outgroup hate more than ingroup love. Studies 2 and 3 demonstrate this biased attributional pattern for Israelis and Palestinians evaluating their own group and the opposing group’s involvement in the current regional conflict. Study 4 demonstrates in an Israeli population that this bias increases beliefs and intentions associated with conflict intractability toward Palestinians. Finally, study 5 demonstrates, in the context of American political conflict, that offering Democrats and Republicans financial incentives for accuracy in evaluating the opposing party can mitigate this bias and its consequences. Although people find it difficult to explain their adversaries’ actions in terms of love and affiliation, we suggest that recognizing this attributional bias and how to reduce it can contribute to reducing human conflict on a global scale. PMID:25331879

Les minéraux accessoires des granitoïdes de la suite taourirt, Hoggar (Algérie): conséquences pétrogénétiques

NASA Astrophysics Data System (ADS)

Azzouni-Sekkal, Abla; Bonin, Bernard

1998-01-01

The post-Pan-African 'taourirt' suite of Hoggar (Algeria) is made up by themagmatic suite: G I monzogranite, G IIa monzogranite+syenogranite, G IIb subsolvus alkali feldspar granite (alaskite), GIII hypersolvus alkali feldspar syenite + granite. Silicates (zircon, thorite, allanite, chevkinite, titanite), oxides (magnetite, ilmenite, fergusonite) and phosphates (apatite, monazite), often abundant, constitute various accessory mineral associations. Crystal morphology, place in the sequence of crystallisation and mineral chemistry change as a function of parageneses. The constant titanite + magnetite + ilmenite assemblage in G I and G II rocks illustrates more oxidising conditions than in G III group, where hedenbergite + magnetite + ilmenite coexist. Two groups of accessory minerals are distinguished: (1) LREE rich (3×10 4 to 3×10 5 × chondrites) and Y rich (50 to 10 4 × chondrites), such as allanite, chevkinite and monazite, (2) LREE poor (100 to 10 4 × chondrites) and Y rich (1000 to 10 5 × chondrites), such as zircon, thorite, titanite and fergusonite. Shapes of chondrite-normalised patterns and evolutionary trends of REE, as well as of other HFSE, such as Nb, Zr, U and Th, in bulk rocks are dependent on relative abundances of the different accessory minerals.

Nonperturbative comparison of clover and highly improved staggered quarks in lattice QCD and the properties of the Φ meson

DOE PAGES

Chakraborty, Bipasha; Davies, C. T. H.; Donald, G. C.; ...

2017-10-02

Here, we compare correlators for pseudoscalar and vector mesons made from valence strange quarks using the clover quark and highly improved staggered quark (HISQ) formalisms in full lattice QCD. We use fully nonperturbative methods to normalise vector and axial vector current operators made from HISQ quarks, clover quarks and from combining HISQ and clover fields. This allows us to test expectations for the renormalisation factors based on perturbative QCD, with implications for the error budget of lattice QCD calculations of the matrix elements of clover-staggeredmore » $b$-light weak currents, as well as further HISQ calculations of the hadronic vacuum polarisation. We also compare the approach to the (same) continuum limit in clover and HISQ formalisms for the mass and decay constant of the $$\\phi$$ meson. Our final results for these parameters, using single-meson correlators and neglecting quark-line disconnected diagrams are: $$m_{\\phi} =$$ 1.023(5) GeV and $$f_{\\phi} = $$ 0.238(3) GeV in good agreement with experiment. These results come from calculations in the HISQ formalism using gluon fields that include the effect of $u$, $d$, $s$ and $c$ quarks in the sea with three lattice spacing values and $$m_{u/d}$$ values going down to the physical point.« less

Visual adaptation alters the apparent speed of real-world actions.

PubMed

Mather, George; Sharman, Rebecca J; Parsons, Todd

2017-07-27

The apparent physical speed of an object in the field of view remains constant despite variations in retinal velocity due to viewing conditions (velocity constancy). For example, people and cars appear to move across the field of view at the same objective speed regardless of distance. In this study a series of experiments investigated the visual processes underpinning judgements of objective speed using an adaptation paradigm and video recordings of natural human locomotion. Viewing a video played in slow-motion for 30 seconds caused participants to perceive subsequently viewed clips played at standard speed as too fast, so playback had to be slowed down in order for it to appear natural; conversely after viewing fast-forward videos for 30 seconds, playback had to be speeded up in order to appear natural. The perceived speed of locomotion shifted towards the speed depicted in the adapting video ('re-normalisation'). Results were qualitatively different from those obtained in previously reported studies of retinal velocity adaptation. Adapting videos that were scrambled to remove recognizable human figures or coherent motion caused significant, though smaller shifts in apparent locomotion speed, indicating that both low-level and high-level visual properties of the adapting stimulus contributed to the changes in apparent speed.

NDVI, scale invariance and the modifiable areal unit problem: An assessment of vegetation in the Adelaide Parklands.

PubMed

Nouri, Hamideh; Anderson, Sharolyn; Sutton, Paul; Beecham, Simon; Nagler, Pamela; Jarchow, Christopher J; Roberts, Dar A

2017-04-15

This research addresses the question as to whether or not the Normalised Difference Vegetation Index (NDVI) is scale invariant (i.e. constant over spatial aggregation) for pure pixels of urban vegetation. It has been long recognized that there are issues related to the modifiable areal unit problem (MAUP) pertaining to indices such as NDVI and images at varying spatial resolutions. These issues are relevant to using NDVI values in spatial analyses. We compare two different methods of calculation of a mean NDVI: 1) using pixel values of NDVI within feature/object boundaries and 2) first calculating the mean red and mean near-infrared across all feature pixels and then calculating NDVI. We explore the nature and magnitude of these differences for images taken from two sensors, a 1.24m resolution WorldView-3 and a 0.1m resolution digital aerial image. We apply these methods over an urban park located in the Adelaide Parklands of South Australia. We demonstrate that the MAUP is not an issue for calculation of NDVI within a sensor for pure urban vegetation pixels. This may prove useful for future rule-based monitoring of the ecosystem functioning of green infrastructure. Copyright © 2017 Elsevier B.V. All rights reserved.

Discrete geometric analysis of message passing algorithm on graphs

NASA Astrophysics Data System (ADS)

Watanabe, Yusuke

2010-04-01

We often encounter probability distributions given as unnormalized products of non-negative functions. The factorization structures are represented by hypergraphs called factor graphs. Such distributions appear in various fields, including statistics, artificial intelligence, statistical physics, error correcting codes, etc. Given such a distribution, computations of marginal distributions and the normalization constant are often required. However, they are computationally intractable because of their computational costs. One successful approximation method is Loopy Belief Propagation (LBP) algorithm. The focus of this thesis is an analysis of the LBP algorithm. If the factor graph is a tree, i.e. having no cycle, the algorithm gives the exact quantities. If the factor graph has cycles, however, the LBP algorithm does not give exact results and possibly exhibits oscillatory and non-convergent behaviors. The thematic question of this thesis is "How the behaviors of the LBP algorithm are affected by the discrete geometry of the factor graph?" The primary contribution of this thesis is the discovery of a formula that establishes the relation between the LBP, the Bethe free energy and the graph zeta function. This formula provides new techniques for analysis of the LBP algorithm, connecting properties of the graph and of the LBP and the Bethe free energy. We demonstrate applications of the techniques to several problems including (non) convexity of the Bethe free energy, the uniqueness and stability of the LBP fixed point. We also discuss the loop series initiated by Chertkov and Chernyak. The loop series is a subgraph expansion of the normalization constant, or partition function, and reflects the graph geometry. We investigate theoretical natures of the series. Moreover, we show a partial connection between the loop series and the graph zeta function.

Lumbar paravertebral blockade as intractable pain management method in palliative care

PubMed Central

Zaporowska-Stachowiak, Iwona; Kotlinska-Lemieszek, Aleksandra; Kowalski, Grzegorz; Kosicka, Katarzyna; Hoffmann, Karolina; Główka, Franciszek; Łuczak, Jacek

2013-01-01

Optimal symptoms control in advanced cancer disease, with refractory to conventional pain treatment, needs an interventional procedure. This paper presents coadministration of local anesthetic (LA) via paravertebral blockade (PVB) as the alternative to an unsuccessful subcutaneous fentanyl pain control in a 71-year old cancer patient with pathological fracture of femoral neck, bone metastases, and contraindications to morphine. Bupivacaine in continuous infusion (0.25%, 5 mL · hour−1) or in boluses (10 mL of 0.125%–0.5% solution), used for lumbar PVB, resulted in pain relief, decreased demand for opioids, and led to better social interactions. The factors contributing to an increased risk of systemic toxicity from LA in the patient were: renal impairment; heart failure; hypoalbuminemia; hypocalcemia; and a complex therapy with possible drug-drug interactions. These factors were taken into consideration during treatment. Bupivacaine’s side effects were absent. Coadministered drugs could mask LA’s toxicity. Elevated plasma α1-acid glycoprotein levels were a protective factor. To evaluate the benefit-risk ratio of the PVB treatment in boluses and in constant infusion, bupivacaine serum levels were determined and the drug plasma half-lives were calculated. Bupivacaine’s elimination was slower when administered in constant infusion than in boluses (t½ = 7.80 hours versus 2.64 hours). Total drug serum concentrations remained within the safe ranges during the whole treatment course (22.9–927.4 ng mL−1). In the case presented, lumbar PVB with bupivacaine in boluses (≤ 137.5 mg · 24 hours−1) was an easy to perform, safe, effective method for pain control. Bupivacaine in continuous infusion (≤150 mg · 12 hours−1) had an acceptable risk-benefits ratio, but was ineffective. PMID:24043944

Lumbar paravertebral blockade as intractable pain management method in palliative care.

PubMed

Zaporowska-Stachowiak, Iwona; Kotlinska-Lemieszek, Aleksandra; Kowalski, Grzegorz; Kosicka, Katarzyna; Hoffmann, Karolina; Główka, Franciszek; Luczak, Jacek

2013-01-01

Optimal symptoms control in advanced cancer disease, with refractory to conventional pain treatment, needs an interventional procedure. This paper presents coadministration of local anesthetic (LA) via paravertebral blockade (PVB) as the alternative to an unsuccessful subcutaneous fentanyl pain control in a 71-year old cancer patient with pathological fracture of femoral neck, bone metastases, and contraindications to morphine. Bupivacaine in continuous infusion (0.25%, 5 mL · hour(-1)) or in boluses (10 mL of 0.125%-0.5% solution), used for lumbar PVB, resulted in pain relief, decreased demand for opioids, and led to better social interactions. The factors contributing to an increased risk of systemic toxicity from LA in the patient were: renal impairment; heart failure; hypoalbuminemia; hypocalcemia; and a complex therapy with possible drug-drug interactions. These factors were taken into consideration during treatment. Bupivacaine's side effects were absent. Coadministered drugs could mask LA's toxicity. Elevated plasma α1-acid glycoprotein levels were a protective factor. To evaluate the benefit-risk ratio of the PVB treatment in boluses and in constant infusion, bupivacaine serum levels were determined and the drug plasma half-lives were calculated. Bupivacaine's elimination was slower when administered in constant infusion than in boluses (t½ = 7.80 hours versus 2.64 hours). Total drug serum concentrations remained within the safe ranges during the whole treatment course (22.9-927.4 ng mL(-1)). In the case presented, lumbar PVB with bupivacaine in boluses (≤ 137.5 mg · 24 hours(-1)) was an easy to perform, safe, effective method for pain control. Bupivacaine in continuous infusion (≤150 mg · 12 hours(-1)) had an acceptable risk-benefits ratio, but was ineffective.

Nonlinear closures for scale separation in supersonic magnetohydrodynamic turbulence

NASA Astrophysics Data System (ADS)

Grete, Philipp; Vlaykov, Dimitar G.; Schmidt, Wolfram; Schleicher, Dominik R. G.; Federrath, Christoph

2015-02-01

Turbulence in compressible plasma plays a key role in many areas of astrophysics and engineering. The extreme plasma parameters in these environments, e.g. high Reynolds numbers, supersonic and super-Alfvenic flows, however, make direct numerical simulations computationally intractable even for the simplest treatment—magnetohydrodynamics (MHD). To overcome this problem one can use subgrid-scale (SGS) closures—models for the influence of unresolved, subgrid-scales on the resolved ones. In this work we propose and validate a set of constant coefficient closures for the resolved, compressible, ideal MHD equations. The SGS energies are modeled by Smagorinsky-like equilibrium closures. The turbulent stresses and the electromotive force (EMF) are described by expressions that are nonlinear in terms of large scale velocity and magnetic field gradients. To verify the closures we conduct a priori tests over 137 simulation snapshots from two different codes with varying ratios of thermal to magnetic pressure ({{β }p}=0.25,1,2.5,5,25) and sonic Mach numbers ({{M}s}=2,2.5,4). Furthermore, we make a comparison to traditional, phenomenological eddy-viscosity and α -β -γ closures. We find only mediocre performance of the kinetic eddy-viscosity and α -β -γ closures, and that the magnetic eddy-viscosity closure is poorly correlated with the simulation data. Moreover, three of five coefficients of the traditional closures exhibit a significant spread in values. In contrast, our new closures demonstrate consistently high correlations and constant coefficient values over time and over the wide range of parameters tested. Important aspects in compressible MHD turbulence such as the bi-directional energy cascade, turbulent magnetic pressure and proper alignment of the EMF are well described by our new closures.

Antinociceptive effect of intrathecal microencapsulated human pheochromocytoma cell in a rat model of bone cancer pain.

PubMed

Li, Xiao; Li, Guoqi; Wu, Shaoling; Zhang, Baiyu; Wan, Qing; Yu, Ding; Zhou, Ruijun; Ma, Chao

2014-07-08

Human pheochromocytoma cells, which are demonstrated to contain and release met-enkephalin and norepinephrine, may be a promising resource for cell therapy in cancer-induced intractable pain. Intrathecal injection of alginate-poly (l) lysine-alginate (APA) microencapsulated human pheochromocytoma cells leads to antinociceptive effect in a rat model of bone cancer pain, and this effect was blocked by opioid antagonist naloxone and alpha 2-adrenergic antagonist rauwolscine. Neurochemical changes of cerebrospinal fluid are in accordance with the analgesic responses. Taken together, these data support that human pheochromocytoma cell implant-induced antinociception was mediated by met-enkephalin and norepinephrine secreted from the cell implants and acting at spinal receptors. Spinal implantation of microencapsulated human pheochromocytoma cells may provide an alternative approach for the therapy of chronic intractable pain.

Palliative Sedation and What Constitutes Active Dying: A Case of Severe Progressive Dystonia and Intractable Pain.

PubMed

Strand, Jacob J; Feely, Molly A; Kramer, Neha M; Moeschler, Susan M; Swetz, Keith M

2016-05-01

We present the case of a 34-year-old woman with Klippel-Feil syndrome who developed progressive generalized dystonia of unclear etiology, resulting in intractable pain despite aggressive medical and surgical interventions. Ultimately, palliative sedation was required to relieve suffering. Herein, we describe ethical considerations including defining sedation, determining prognosis in the setting of an undefined neurodegenerative condition, and use of treatments that concurrently might prolong or alter end-of-life trajectory. We highlight pertinent literature and how it may be applied in challenging and unique clinical situations. Finally, we discuss the need for expert multidisciplinary involvement when implementing palliative sedation and illustrate that procedures and rules need to be interpreted to deliver optimal patient-centered plan of care. © The Author(s) 2014.

Use of a Palmaz stent for tracheomalacia: case report of an infant with esophageal atresia.

PubMed

Tazuke, Y; Kawahara, H; Yagi, M; Yoneda, A; Soh, H; Maeda, K; Yamamoto, T; Imura, K

1999-08-01

A male infant with congenital cardiac anomalies and esophageal atresia with tracheoesophageal fistula (EA-TEF) showed intractable respiratory symptoms after delayed primary repair of EA-TEF. Computed tomography demonstrated that the trachea was compressed by the enlarged aorta. Artificial ventilation was necessary even after aortopexy performed at 2 months of age. At 140 days of age, an expandable metallic stent (Palmaz stent) was inserted through a rigid bronchoscope into the trachea underfluoroscopic control. His respiratory status improved dramatically, and he was extubated in 18 hours. Although the follow-up period has been 9 months, the short-term result is satisfactory. The expandable metallic stent placement should be considered in patients with EA-TEF who show intractable respiratory symptoms caused by tracheomalacia.

Intractable nausea, vomiting and diarrhea in a Mexican woman with No recent travel history.

PubMed

Dimaunahan, C; Nader, S; Watson, R; Lewin, M R

2000-01-01

A 45-year-old Mexican woman with a history of noninsulin dependent diabetes mellitus (NIDDM), hypertension, and coronary artery disease presented to the hospital after 2 months of intractable nausea, vomiting and diarrhea-all made worse by eating and drinking. She reported fever, chills, anorexia and a documented 50-pound weight loss during this period. She denied the signs and symptoms of melena, hematochezia, steatorrhea or constipation. She also reported left leg pain and decreased sensation and strength of her left leg compared to the right leg. She had been hospitalized 2 weeks prior to admission with the same symptoms and a diagnosis of viral gastroenteritis. She was also treated for H. pylori, but subsequent biopsy results were negative by Steiner stain.

[Rational combinations of antiepileptic drugs for refractory epilepsy].

PubMed

Yoshino, Aihide

2011-04-01

Although epilepsy surgery is most effective for patients with intractable epilepsy, a majority of them is not eligible for the surgery. Most of patients with refractory epilepsy are eventually treated with polypharmacy in hope of seizure control. Therefore, rational combinations of antiepileptic drugs are needed to control intractable seizures. Drug combinations should be rationally chosen based on the evidence of synergic efficacy and on avoidance of neurotoxicity. Several clinical studies suggest that the combination of valproate with lamotrigine has synergic antiepileptic effect. It has also been reported that the combination of carbamazepine with lamotrigine paradoxically decreases efficacy and increases toxicity. Animal studies using isobolography suggest that the combinations of topiramate with lamotrigine or levetiracetam are also promising on both seizure control and neurotoxicity. Clinical research is needed to examine these combinations.

Bayesian experimental design for models with intractable likelihoods.

PubMed

Drovandi, Christopher C; Pettitt, Anthony N

2013-12-01

In this paper we present a methodology for designing experiments for efficiently estimating the parameters of models with computationally intractable likelihoods. The approach combines a commonly used methodology for robust experimental design, based on Markov chain Monte Carlo sampling, with approximate Bayesian computation (ABC) to ensure that no likelihood evaluations are required. The utility function considered for precise parameter estimation is based upon the precision of the ABC posterior distribution, which we form efficiently via the ABC rejection algorithm based on pre-computed model simulations. Our focus is on stochastic models and, in particular, we investigate the methodology for Markov process models of epidemics and macroparasite population evolution. The macroparasite example involves a multivariate process and we assess the loss of information from not observing all variables. © 2013, The International Biometric Society.

Rectal diazepam solution is as good as rectal administration of intravenous diazepam in the first-aid cessation of seizures in children with intractable epilepsy.

PubMed

Chiang, Lin-Mei; Wang, Huei-Shyong; Shen, Hsin-Hsien; Deng, Shin-Tang; Tseng, Chi-Hao; Chen, Yu-In; Chou, Ming-Liang; Hung, Po-Cheng; Lin, Kuang-Lin

2011-02-01

Acute seizures are readily recognizable episodes requiring urgent treatment. This study was conducted to compare the efficacy and safety of suppository use of rectal diazepam solution [Stesolid rectal tube (SRT), Alpharma, Inc., Lierskogen, Norway] with those of intravenous diazepam (IVD), Li Ta Pharma Co, Ltd., Taichung, Taiwan for control of acute seizures in children with intractable epilepsy. Subjects were patients, aged 1-18 years, with intractable epilepsy under at least three kinds of antiepileptic treatments. Caregivers were trained to rectally administer SRT or IVD (dosage varying from 0.2 to 0.5mg per kilogram of body weight) and to monitor respiration condition, seizure severity, and adverse drug effects. Among the 24 subjects, 9 males and 15 females, treated for a period of 3 months, the ages ranged from 2 to 18 years, with a mean of 9.1 years. Seizure types were generalized tonic and/or clonic. Seizure frequency varied from once per week to 20 times per day. Twenty-one (87.5%) of them had mental retardation and/or developmental delay, and 103 of the 127 (81.1%) IVD administrations and 90 of the 103 (87.3%) SRT administrations resulted in rapid cessation of seizures within 10 minutes. Each first dose failed to control seizures in 24 and 13 episodes, respectively. A second dose of IVD achieved cessation of seizure in 21 of the 24 episodes and a second dose of SRT in 12 of the 13 episodes within another 10 minutes. Four episodes (3 with rectal IVD and 1 with SRT) of prolonged seizure beyond 20 minutes needed IVD injection at our emergency room. Sedation occurred in 17% of patients, which was attributed to IVD in 8% and SRT in 9% of patients. No respiratory depression was attributable to IVD or SRT. There was no significant statistical difference in efficacy and safety between these two forms of diazepam. Rectal diazepam solution, administered by capable caregivers, is as effective and safe as rectal administration of IVD for children with intractable epilepsy. Copyright © 2011. Published by Elsevier B.V.

Affiliate stigma and caregiver burden in intractable epilepsy.

PubMed

Hansen, Barbara; Szaflarski, Magdalena; Bebin, E Martina; Szaflarski, Jerzy P

2018-06-07

Intractable epilepsy can be challenging for patients and for their families. Disability rates in patients are high, causing tremendous physical and emotional burden on family caregivers. Additionally, caregivers may experience affiliate stigma, where they perceive and internalize the negative societal views of a condition and exhibit a psychological response. Affiliate stigma has been rarely studied in caregivers of those with intractable epilepsy. This study examined the relationship between affiliate stigma and the levels of burden experienced by caregivers, as well as how these levels may vary between those caring for children and adults. This cross-sectional approach used a self-administered survey offered to caregivers of family members with confirmed diagnoses of intractable epilepsy. We measured burden with the 30-item Carer's Assessment of Difficulties Index (CADI) and affiliate stigma with a six-item scale examining caregivers' perceptions of stigma directed toward themselves and their family members with epilepsy. Four nested ordinary-least-squares regression models were estimated using stigma scale scores to predict levels of perceived burden adjusting for demographic variables. Age of the patient with epilepsy was dichotomized (pediatric/adult) to assess a possible moderating effect of patient's age on the relationship between stigma and caregiver burden. Respondents (N = 136) were predominantly White (83%), female (75%), and married (69%), with an average age of 43 years. Patients with epilepsy were 52% male with ages ranging from 2 to 82 years. Each of the regression models yielded positive associations (p < 0.001) between perceived levels of caregiver burden and affiliate stigma. Additionally, the age of the family member with epilepsy moderated (p < 0.05) the effect, with the relationship stronger for caregivers of adults. In a highly select group of patients with refractory epilepsy recruited mostly from a cannabidiol (CBD) clinic, this study demonstrated that caregivers experience affiliate stigma, which is significantly associated with higher burden levels. Additionally, this study identified specific needs, which when met, may improve caregivers' physical and mental health. Copyright © 2018 Elsevier Inc. All rights reserved.

Case report: a case of intractable Meniere's disease treated with autogenic training.

PubMed

Goto, Fumiyuki; Nakai, Kimiko; Kunihiro, Takanobu; Ogawa, Kaoru

2008-01-25

Psychological stress plays an important role in the onset and course of Meniere's disease. Surgical therapy and intratympanic gentamicin treatment are options for cases that are intractable to conventional medical therapy. Psychotherapy, however, including autogenic training (AT), which can be used for general relaxation, is not widely accepted. This paper describes the successful administration of AT in a subject suffering from intractable Meniere's disease. A 51-year-old male patient has suffered from fluctuating right sensorineural hearing loss with vertigo since 1994. In May 2002, he was first admitted to our hospital due to a severe vertigo attack accompanied by right sensorineural hearing loss. Spontaneous nystagmus toward the right side was observed. Since April 2004, he has experienced vertigo spells with right-sided tinnitus a few times per month that are intractable to conventional medical therapy. After four months, tympanic tube insertion was preformed in the right tympanic membrane. Intratympanic injection of dexamethasone was ineffective. He refused Meniett therapy and intratympanic gentamicin injection. In addition to his vertigo spells, he suffered from insomnia, tinnitus, and anxiety. Tranquilizers such as benzodiazepines and antidepressants such as serotonin selective re-uptake inhibitors (SSRIs) failed to stop the vertigo and only slightly improved his insomnia. In December 2006, the patient began psychological counseling with a psychotherapist. After brief psychological counseling along with cognitive behavior therapy (CBT), he began AT. He diligently and regularly continued his AT training in his home according to a written timetable. His insomnia, tinnitus, and vertigo spells disappeared within a few weeks after only four psychotherapy sessions. In order to master the six standard formulas of AT, he underwent two more sessions. Thereafter, he underwent follow-up for 9 months with no additional treatment. He is now free from drugs, including tranquilizers, and has continued AT. No additional treatment was performed. When we examined him six and nine months later for follow-up, he was free of vertigo and insomnia. AT together with CBT can be a viable and palatable treatment option for Meniere's disease patients who are not responsive to other therapies.

Case report: a case of intractable Meniere's disease treated with autogenic training

PubMed Central

Goto, Fumiyuki; Nakai, Kimiko; Kunihiro, Takanobu; Ogawa, Kaoru

2008-01-01

Background Psychological stress plays an important role in the onset and course of Meniere's disease. Surgical therapy and intratympanic gentamicin treatment are options for cases that are intractable to conventional medical therapy. Psychotherapy, however, including autogenic training (AT), which can be used for general relaxation, is not widely accepted. This paper describes the successful administration of AT in a subject suffering from intractable Meniere's disease. Case presentation A 51-year-old male patient has suffered from fluctuating right sensorineural hearing loss with vertigo since 1994. In May 2002, he was first admitted to our hospital due to a severe vertigo attack accompanied by right sensorineural hearing loss. Spontaneous nystagmus toward the right side was observed. Since April 2004, he has experienced vertigo spells with right-sided tinnitus a few times per month that are intractable to conventional medical therapy. After four months, tympanic tube insertion was preformed in the right tympanic membrane. Intratympanic injection of dexamethasone was ineffective. He refused Meniett therapy and intratympanic gentamicin injection. In addition to his vertigo spells, he suffered from insomnia, tinnitus, and anxiety. Tranquilizers such as benzodiazepines and antidepressants such as serotonin selective re-uptake inhibitors (SSRIs) failed to stop the vertigo and only slightly improved his insomnia. In December 2006, the patient began psychological counseling with a psychotherapist. After brief psychological counseling along with cognitive behavior therapy (CBT), he began AT. He diligently and regularly continued his AT training in his home according to a written timetable. His insomnia, tinnitus, and vertigo spells disappeared within a few weeks after only four psychotherapy sessions. In order to master the six standard formulas of AT, he underwent two more sessions. Thereafter, he underwent follow-up for 9 months with no additional treatment. He is now free from drugs, including tranquilizers, and has continued AT. No additional treatment was performed. When we examined him six and nine months later for follow-up, he was free of vertigo and insomnia. Conclusion AT together with CBT can be a viable and palatable treatment option for Meniere's disease patients who are not responsive to other therapies. PMID:18221543

Tropical cyclone-related socio-economic losses in the western North Pacific region

NASA Astrophysics Data System (ADS)

Welker, C.; Faust, E.

2013-01-01

The western North Pacific (WNP) is the area of the world most frequently affected by tropical cyclones (TCs). However, little is known about the socio-economic impacts of TCs in this region, probably because of the limited relevant loss data. Here, loss data from Munich RE's NatCatSERVICE database is used, a high-quality and widely consulted database of natural disasters. In the country-level loss normalisation technique we apply, the original loss data are normalised to present-day exposure levels by using the respective country's nominal gross domestic product at purchasing power parity as a proxy for wealth. The main focus of our study is on the question of whether the decadal-scale TC variability observed in the Northwest Pacific region in recent decades can be shown to manifest itself economically in an associated variability in losses. It is shown that since 1980 the frequency of TC-related loss events in the WNP exhibited, apart from seasonal and interannual variations, interdecadal variability with a period of about 22 yr - driven primarily by corresponding variations of Northwest Pacific TCs. Compared to the long-term mean, the number of loss events was found to be higher (lower) by 14% (9%) in the positive (negative) phase of the decadal-scale WNP TC frequency variability. This was identified for the period 1980-2008 by applying a wavelet analysis technique. It was also possible to demonstrate the same low-frequency variability in normalised direct economic losses from TCs in the WNP region. The identification of possible physical mechanisms responsible for the observed decadal-scale Northwest Pacific TC variability will be the subject of future research, even if suggestions have already been made in earlier studies.

The economic costs of natural disasters globally from 1900-2015: historical and normalised floods, storms, earthquakes, volcanoes, bushfires, drought and other disasters

NASA Astrophysics Data System (ADS)

Daniell, James; Wenzel, Friedemann; Schaefer, Andreas

2016-04-01

For the first time, a breakdown of natural disaster losses from 1900-2015 based on over 30,000 event economic losses globally is given based on increased analysis within the CATDAT Damaging Natural Disaster databases. Using country-CPI and GDP deflator adjustments, over 7 trillion (2015-adjusted) in losses have occurred; over 40% due to flood/rainfall, 26% due to earthquake, 19% due to storm effects, 12% due to drought, 2% due to wildfire and under 1% due to volcano. Using construction cost indices, higher percentages of flood losses are seen. Depending on how the adjustment of dollars are made to 2015 terms (CPI vs. construction cost indices), between 6.5 and 14.0 trillion USD (2015-adjusted) of natural disaster losses have been seen from 1900-2015 globally. Significant reductions in economic losses have been seen in China and Japan from 1950 onwards. An AAL of around 200 billion in the last 16 years has been seen equating to around 0.25% of Global GDP or around 0.1% of Net Capital Stock per year. Normalised losses have also been calculated to examine the trends in vulnerability through time for economic losses. The normalisation methodology globally using the exposure databases within CATDAT that were undertaken previously in papers for the earthquake and volcano databases, are used for this study. The original event year losses are adjusted directly by capital stock change, very high losses are observed with respect to floods over time (however with improved flood control structures). This shows clear trends in the improvement of building stock towards natural disasters and a decreasing trend in most perils for most countries.

Regional snow-avalanche detection using object-based image analysis of near-infrared aerial imagery

NASA Astrophysics Data System (ADS)

Korzeniowska, Karolina; Bühler, Yves; Marty, Mauro; Korup, Oliver

2017-10-01

Snow avalanches are destructive mass movements in mountain regions that continue to claim lives and cause infrastructural damage and traffic detours. Given that avalanches often occur in remote and poorly accessible steep terrain, their detection and mapping is extensive and time consuming. Nonetheless, systematic avalanche detection over large areas could help to generate more complete and up-to-date inventories (cadastres) necessary for validating avalanche forecasting and hazard mapping. In this study, we focused on automatically detecting avalanches and classifying them into release zones, tracks, and run-out zones based on 0.25 m near-infrared (NIR) ADS80-SH92 aerial imagery using an object-based image analysis (OBIA) approach. Our algorithm takes into account the brightness, the normalised difference vegetation index (NDVI), the normalised difference water index (NDWI), and its standard deviation (SDNDWI) to distinguish avalanches from other land-surface elements. Using normalised parameters allows applying this method across large areas. We trained the method by analysing the properties of snow avalanches at three 4 km-2 areas near Davos, Switzerland. We compared the results with manually mapped avalanche polygons and obtained a user's accuracy of > 0.9 and a Cohen's kappa of 0.79-0.85. Testing the method for a larger area of 226.3 km-2, we estimated producer's and user's accuracies of 0.61 and 0.78, respectively, with a Cohen's kappa of 0.67. Detected avalanches that overlapped with reference data by > 80 % occurred randomly throughout the testing area, showing that our method avoids overfitting. Our method has potential for large-scale avalanche mapping, although further investigations into other regions are desirable to verify the robustness of our selected thresholds and the transferability of the method.

Size exclusion deep bed filtration: Experimental and modelling uncertainties

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

Badalyan, Alexander, E-mail: alexander.badalyan@adelaide.edu.au; You, Zhenjiang; Aji, Kaiser

A detailed uncertainty analysis associated with carboxyl-modified latex particle capture in glass bead-formed porous media enabled verification of the two theoretical stochastic models for prediction of particle retention due to size exclusion. At the beginning of this analysis it is established that size exclusion is a dominant particle capture mechanism in the present study: calculated significant repulsive Derjaguin-Landau-Verwey-Overbeek potential between latex particles and glass beads is an indication of their mutual repulsion, thus, fulfilling the necessary condition for size exclusion. Applying linear uncertainty propagation method in the form of truncated Taylor's series expansion, combined standard uncertainties (CSUs) in normalised suspendedmore » particle concentrations are calculated using CSUs in experimentally determined parameters such as: an inlet volumetric flowrate of suspension, particle number in suspensions, particle concentrations in inlet and outlet streams, particle and pore throat size distributions. Weathering of glass beads in high alkaline solutions does not appreciably change particle size distribution, and, therefore, is not considered as an additional contributor to the weighted mean particle radius and corresponded weighted mean standard deviation. Weighted mean particle radius and LogNormal mean pore throat radius are characterised by the highest CSUs among all experimental parameters translating to high CSU in the jamming ratio factor (dimensionless particle size). Normalised suspended particle concentrations calculated via two theoretical models are characterised by higher CSUs than those for experimental data. The model accounting the fraction of inaccessible flow as a function of latex particle radius excellently predicts normalised suspended particle concentrations for the whole range of jamming ratios. The presented uncertainty analysis can be also used for comparison of intra- and inter-laboratory particle size exclusion data.« less

Investigating nurse practitioners in the private sector: a theoretically informed research protocol.

PubMed

Adams, Margaret; Gardner, Glenn; Yates, Patsy

2017-06-01

To report a study protocol and the theoretical framework normalisation process theory that informs this protocol for a case study investigation of private sector nurse practitioners. Most research evaluating nurse practitioner service is focused on public, mainly acute care environments where nurse practitioner service is well established with strong structures for governance and sustainability. Conversely, there is lack of clarity in governance for emerging models in the private sector. In a climate of healthcare reform, nurse practitioner service is extending beyond the familiar public health sector. Further research is required to inform knowledge of the practice, operational framework and governance of new nurse practitioner models. The proposed research will use a multiple exploratory case study design to examine private sector nurse practitioner service. Data collection includes interviews, surveys and audits. A sequential mixed method approach to analysis of each case will be conducted. Findings from within-case analysis will lead to a meta-synthesis across all four cases to gain a holistic understanding of the cases under study, private sector nurse practitioner service. Normalisation process theory will be used to guide the research process, specifically coding and analysis of data using theory constructs and the relevant components associated with those constructs. This article provides a blueprint for the research and describes a theoretical framework, normalisation process theory in terms of its flexibility as an analytical framework. Consistent with the goals of best research practice, this study protocol will inform the research community in the field of primary health care about emerging research in this field. Publishing a study protocol ensures researcher fidelity to the analysis plan and supports research collaboration across teams. © 2016 John Wiley & Sons Ltd.

Clinical significance of liver histology on outcomes in biliary atresia.

PubMed

Webb, Nicholas L; Jiwane, Ashish; Ooi, Chee Y; Nightinghale, Scott; Adams, Susan E; Krishnan, Usha

2017-03-01

Biliary atresia (BA) literature has focussed on the relationship between age at Kasai procedure (KP) and post-KP outcomes. This study primarily examines post-KP outcomes including, 6-month normalisation of bilirubin, 5-year native liver survival (NLS), development of portal hypertension (PHT) and incidence of ascending cholangitis at a single tertiary paediatric centre in Australia. The study also evaluated prognostic factors which may influence these aforementioned outcomes. Retrospective chart review of all BA cases between 1999 and 2014. Age at KP, liver biopsy results, use of ursodeoxycholic acid or prophylactic antibiotics and occurrence of PHT and ascending cholangitis post-KP were recorded and related to the primary post-KP outcome measures. BA was diagnosed in 29 patients. Twenty-four of 29 patients underwent KP. Median age at KP was 68 days (29-104). Fourteen of 24 (58.3%) had bridging fibrosis and 5 of 24 (20.8%) had cirrhosis at time of KP. Median follow-up was 8.4 years (2.08-15.58 years). Bilirubin normalisation within 6 months occurred in 7 of 24 (29.2%) patients and 5-year NLS was 45.8% (11/24). Fourteen of 24 (58.3%) had PHT and 18 of 24 (75%) patients had ascending cholangitis post-KP. Absence of bridging fibrosis in liver histology at KP was the only factor to be significantly associated with improved 5-year NLS. None of the other variables examined had a significant association with either 5-year NLS or bilirubin normalisation by 6 months. Five-year NLS in this series was 45.8%. Absence of bridging fibrosis at time of KP was the only factor significantly associated with improved 5-year NLS. © 2016 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

The importance of normalisation in the construction of deprivation indices.

PubMed

Gilthorpe, M S

1995-12-01

Measuring socio-economic deprivation is a major challenge usually addressed through the use of composite indices. This paper aims to clarify the technical details regarding composite index construction. The distribution of some variables, for example unemployment, varies over time, and these variations must be considered when composite indices are periodically re-evaluated. The process of normalisation is examined in detail and particular attention is paid to the importance of symmetry and skewness of the composite variable distributions. Four different solutions of the Townsend index of socioeconomic deprivation are compared to reveal the effects that differing transformation processes have on the meaning or interpretation of the final index values. Differences in the rank order and the relative separation between values are investigated. Constituent variables which have been transformed to yield a more symmetric distribution provide indices that behave similarly, irrespective of the actual transformation methods adopted. Normalisation is seen to be of less importance than the removal of variable skewness. Furthermore, the degree of success of the transformation in removing skewness has a major effect in determining the variation between the individual electoral ward scores. Constituent variables undergoing no transformation produce an index that is distorted by the inherent variable skewness, and this index is not consistent between re-evaluations, either temporally or spatially. Effective transformation of constituent variables should always be undertaken when generating a composite index. The most important aspect is the removal of variable skewness. There is no need for the transformed variables to be normally distributed, only symmetrically distributed, before standardisation. Even where additional parameter weights are to be applied, which significantly alter the final index, appropriate transformation procedures should be adopted for the purpose of consistency over time and between different geographical areas.

The structure of the stably stratified internal boundary layer in offshore flow over the sea

NASA Astrophysics Data System (ADS)

Garratt, J. R.; Ryan, B. F.

1989-04-01

Observations obtained mainly from a research aircraft are presented of the mean and turbulent structure of the stably stratified internal boundary layer (IBL) over the sea formed by warm air advection from land to sea. The potential temperature and humidity fields reveal the vertical extent of the IBL, for fetches out to several hundred of kilometres, geostrophic winds of 20 25 m s-1, and potential temperature differences between undisturbed continental air and the sea surface of 7 to 17 K. The dependence of IBL depth on these external parameters is discussed in the context of the numerical results of Garratt (1987), and some discrepancies are noted. Wind observations show the development of a low-level wind maximum (wind component normal to the coast) and rotation of the wind to smaller cross-isobar flow angles. Potential temperature (θ) profiles within the IBL reveal quite a different structure to that found in the nocturnal boundary layer (NBL) over land. Over the sea, θ profiles have large positive curvature with vertical gradients increasing monotonically with height; this reflects the dominance of turbulent cooling within the layer. The behaviour is consistent with known behaviour in the NBL over land where curvature becomes negative (vertical gradients of θ decreasing with height) as radiative cooling becomes dominant. Turbulent properties are discussed in terms of non-dimensional quantities, normalised by the surface friction velocity, as functions of normalised height using the IBL depth. Vertical profiles of these and the normalised wavelength of the spectral maximum agree well with known results for the stable boundary layer over land (Caughey et al., 1979).

Eating and rumination behaviour in cows with traumatic reticuloperitonitis.

PubMed

Braun, U; Tschoner, T; Hässig, M; Nuss, K

2017-02-01

Eating and rumination behaviour in 22 cows with traumatic reticuloperitonitis was recorded after the start of treatment. Based on the results of clinical, ultrasonographic and radiographic examinations, the cows were divided into two groups: Group A consisted of 12 cows without an intramural or perforating foreign body and group B had 10 cows with an intramural or perforating foreign body. Cows of group A received amoxicillin, flunixin meglumine and a NaCl-glucose infusion, and cows of group B received the same treatment accompanied by foreign body removal via ruminotomy. All cows were fitted with a horse halter equipped with a pressure sensor integrated into the noseband, and eating and rumination activities were recorded continuously for 7 days. Additional 24-hour- recording periods occurred on days 14 and 30. Results obtained previously from 300 healthy cows were used for comparison. Median daily eating time in group A was 168 minutes (reference interval 211 to 319 min) on day 1 and increased to within the reference interval by day 3. Eating time on day 14 was 290 minutes and significantly longer than on day 1. Eating time was 294 minutes on day 30. Eating time in group B was comparable, and the patterns of normalisation for the number of chewing cycles related to eating, rumination time, the number of regurgitated cuds per day and the number of chewing cycles per cud were similar to that of group A: all variables were significantly reduced on day 1 and normalised within 3 to 5 days. The findings showed that eating and rumination are reduced in cows with traumatic reticuloperitonitis and that successful treatment results in rapid normalisation. Monitoring eating and rumination behaviour using a pressure sensor integrated into a halter allows objective clinical assessment of cows recovering from traumatic reticuloperitonitis.

From theory to 'measurement' in complex interventions: methodological lessons from the development of an e-health normalisation instrument.

PubMed

Finch, Tracy L; Mair, Frances S; O'Donnell, Catherine; Murray, Elizabeth; May, Carl R

2012-05-17

Although empirical and theoretical understanding of processes of implementation in health care is advancing, translation of theory into structured measures that capture the complex interplay between interventions, individuals and context remain limited. This paper aimed to (1) describe the process and outcome of a project to develop a theory-based instrument for measuring implementation processes relating to e-health interventions; and (2) identify key issues and methodological challenges for advancing work in this field. A 30-item instrument (Technology Adoption Readiness Scale (TARS)) for measuring normalisation processes in the context of e-health service interventions was developed on the basis on Normalization Process Theory (NPT). NPT focuses on how new practices become routinely embedded within social contexts. The instrument was pre-tested in two health care settings in which e-health (electronic facilitation of healthcare decision-making and practice) was used by health care professionals. The developed instrument was pre-tested in two professional samples (N=46; N=231). Ratings of items representing normalisation 'processes' were significantly related to staff members' perceptions of whether or not e-health had become 'routine'. Key methodological challenges are discussed in relation to: translating multi-component theoretical constructs into simple questions; developing and choosing appropriate outcome measures; conducting multiple-stakeholder assessments; instrument and question framing; and more general issues for instrument development in practice contexts. To develop theory-derived measures of implementation process for progressing research in this field, four key recommendations are made relating to (1) greater attention to underlying theoretical assumptions and extent of translation work required; (2) the need for appropriate but flexible approaches to outcomes measurement; (3) representation of multiple perspectives and collaborative nature of work; and (4) emphasis on generic measurement approaches that can be flexibly tailored to particular contexts of study.

Sex differences in force attenuation: a clinical assessment of single-leg hop performance on a portable force plate

PubMed Central

Harrison, A D; Ford, K R; Myer, G D; Hewett, T E

2014-01-01

Objective Impaired biomechanics and neuromuscular control have been suggested as probable links to female sex bias in the onset of patellofemoral pain syndrome. There are limited objective, clinical measures for assessment of impaired biomechanics and neuromuscular control. The primary objective of this investigation was to examine sex differences in vertical ground reaction force (vGRF) and force loading rate in young athletes performing maximum, repeated vertical single-leg hops (RVSHs). The authors hypothesised that females would demonstrate greater vGRF and force loading rate than males and show interlimb differences in force attenuation. Design Cross-sectional study. Setting Paediatric sports medicine clinic. Participants 109 Healthy high school, soccer and basketball athletes. Assessment of risk factors Participants performed RVSHs for 15 seconds on a portable force plate with a sampling rate of 400 Hz (Accupower; AMTI, Watertown, Massachusetts, USA). Main outcome measurements Raw vGRF was filtered with a generalised cross-validation spline using a 50-Hz cutoff frequency and then normalised to potential energy. Force loading rate was calculated by dividing normalised vGRF by time-to-peak force. Group means were compared using analysis of variance. Results The females demonstrated significantly greater normalised vGRF (p<0.001) and force loading rate (p<0.001) during landing than their male counterparts. Neither sex demonstrated significant interlimb differences in force attenuation (p>0.05). Conclusions The female athletes may have altered force attenuation capability during RVSHs as identified by increased vGRF and force loading rate compared with the male athletes. Portable force plates may be potential tools to identify altered force attenuation in clinical settings. PMID:19858114

The dynamics of the oesophageal squamous epithelium 'normalisation' process in patients with gastro-oesophageal reflux disease treated with long-term acid suppression or anti-reflux surgery.

PubMed

Mastracci, L; Fiocca, R; Engström, C; Attwood, S; Ell, C; Galmiche, J P; Hatlebakk, J G; Långström, G; Eklund, S; Lind, T; Lundell, L

2017-05-01

Proton pump inhibitors and laparoscopic anti-reflux surgery (LARS) offer long-term symptom control to patients with gastro-oesophageal reflux disease (GERD). To evaluate the process of 'normalisation' of the squamous epithelium morphology of the distal oesophagus on these therapies. In the LOTUS trial, 554 patients with chronic GERD were randomised to receive either esomeprazole (20-40 mg daily) or LARS. After 5 years, 372 patients remained in the study (esomeprazole, 192; LARS, 180). Biopsies were taken at the Z-line and 2 cm above, at baseline, 1, 3 and 5 years. A severity score was calculated based on: papillae elongation, basal cell hyperplasia, intercellular space dilatations and eosinophilic infiltration. The epithelial proliferative activity was assessed by Ki-67 immunohistochemistry. A gradual improvement in all variables over 5 years was noted in both groups, at both the Z-line and 2 cm above. The severity score decreased from baseline at each subsequent time point in both groups (P < 0.001, all comparisons), attaining a normal level by 5 years. Corresponding decreases in Ki-67 expression were observed (P < 0.001, all comparisons). No significant differences were found between esomeprazole treatment and LARS. Neither baseline severity score nor Ki-67 expression predicted the risk of treatment failure. Five years of treatment is generally required before squamous epithelial cell morphology and proliferation are 'normalised' in patients with chronic GERD, despite endoscopic and symptomatic disease control. Control of the acid component of the refluxate seems to play the predominant role in restoring tissue morphology. © 2017 John Wiley & Sons Ltd.

Pituitary gigantism.

PubMed Central

Lu, P W; Silink, M; Johnston, I; Cowell, C T; Jimenez, M

1992-01-01

A case of pituitary gigantism resulting from a pituitary adenoma which secreted growth hormone is described. The patient was successfully treated by surgery, which led to the normalisation of endogenous growth hormone secretion. An acceptable final height was achieved with high dose intramuscular testosterone treatment. Images Figure 1 PMID:1520009

No upward trend in normalised windstorm losses in Europe: 1970-2008

NASA Astrophysics Data System (ADS)

Barredo, J. I.

2010-01-01

On 18 January 2007, windstorm Kyrill battered Europe with hurricane-force winds killing 47 people and causing 10 billion US in damage. Kyrill poses several questions: is Kyrill an isolated or exceptional case? Have there been events costing as much in the past? This paper attempts to put Kyrill into an historical context by examining large historical windstorm event losses in Europe for the period 1970-2008 across 29 European countries. It asks the question what economic losses would these historical events cause if they were to recur under 2008 societal conditions? Loss data were sourced from reinsurance firms and augmented with historical reports, peer-reviewed articles and other ancillary sources. Following the same conceptual approach outlined in previous studies, the data were then adjusted for changes in population, wealth, and inflation at the country level and for inter-country price differences using purchasing power parity. The analyses reveal no trend in the normalised windstorm losses and confirm increasing disaster losses are driven by societal factors and increasing exposure.

Online quantitative analysis of multispectral images of human body tissues

NASA Astrophysics Data System (ADS)

Lisenko, S. A.

2013-08-01

A method is developed for online monitoring of structural and morphological parameters of biological tissues (haemoglobin concentration, degree of blood oxygenation, average diameter of capillaries and the parameter characterising the average size of tissue scatterers), which involves multispectral tissue imaging, image normalisation to one of its spectral layers and determination of unknown parameters based on their stable regression relation with the spectral characteristics of the normalised image. Regression is obtained by simulating numerically the diffuse reflectance spectrum of the tissue by the Monte Carlo method at a wide variation of model parameters. The correctness of the model calculations is confirmed by the good agreement with the experimental data. The error of the method is estimated under conditions of general variability of structural and morphological parameters of the tissue. The method developed is compared with the traditional methods of interpretation of multispectral images of biological tissues, based on the solution of the inverse problem for each pixel of the image in the approximation of different analytical models.

Use of Gene Expression Programming in regionalization of flow duration curve

NASA Astrophysics Data System (ADS)

Hashmi, Muhammad Z.; Shamseldin, Asaad Y.

2014-06-01

In this paper, a recently introduced artificial intelligence technique known as Gene Expression Programming (GEP) has been employed to perform symbolic regression for developing a parametric scheme of flow duration curve (FDC) regionalization, to relate selected FDC characteristics to catchment characteristics. Stream flow records of selected catchments located in the Auckland Region of New Zealand were used. FDCs of the selected catchments were normalised by dividing the ordinates by their median value. Input for the symbolic regression analysis using GEP was (a) selected characteristics of normalised FDCs; and (b) 26 catchment characteristics related to climate, morphology, soil properties and land cover properties obtained using the observed data and GIS analysis. Our study showed that application of this artificial intelligence technique expedites the selection of a set of the most relevant independent variables out of a large set, because these are automatically selected through the GEP process. Values of the FDC characteristics obtained from the developed relationships have high correlations with the observed values.

Degradability of creatinine under sewer conditions affects its potential to be used as biomarker in sewage epidemiology.

PubMed

Thai, Phong K; O'Brien, Jake; Jiang, Guangming; Gernjak, Wolfgang; Yuan, Zhiguo; Eaglesham, Geoff; Mueller, Jochen F

2014-05-15

Creatinine was proposed to be used as a population normalising factor in sewage epidemiology but its stability in the sewer system has not been assessed. This study thus aimed to evaluate the fate of creatinine under different sewer conditions using laboratory sewer reactors. The results showed that while creatinine was stable in wastewater only, it degraded quickly in reactors with the presence of sewer biofilms. The degradation followed first order kinetics with significantly higher rate in rising main condition than in gravity sewer condition. Additionally, daily loads of creatinine were determined in wastewater samples collected on Census day from 10 wastewater treatment plants around Australia. The measured loads of creatinine from those samples were much lower than expected and did not correlate with the populations across the sampled treatment plants. The results suggested that creatinine may not be a suitable biomarker for population normalisation purpose in sewage epidemiology, especially in sewer catchment with high percentage of rising mains. Copyright © 2014 Elsevier Ltd. All rights reserved.

Standardized mean differences cause funnel plot distortion in publication bias assessments.

PubMed

Zwetsloot, Peter-Paul; Van Der Naald, Mira; Sena, Emily S; Howells, David W; IntHout, Joanna; De Groot, Joris Ah; Chamuleau, Steven Aj; MacLeod, Malcolm R; Wever, Kimberley E

2017-09-08

Meta-analyses are increasingly used for synthesis of evidence from biomedical research, and often include an assessment of publication bias based on visual or analytical detection of asymmetry in funnel plots. We studied the influence of different normalisation approaches, sample size and intervention effects on funnel plot asymmetry, using empirical datasets and illustrative simulations. We found that funnel plots of the Standardized Mean Difference (SMD) plotted against the standard error (SE) are susceptible to distortion, leading to overestimation of the existence and extent of publication bias. Distortion was more severe when the primary studies had a small sample size and when an intervention effect was present. We show that using the Normalised Mean Difference measure as effect size (when possible), or plotting the SMD against a sample size-based precision estimate, are more reliable alternatives. We conclude that funnel plots using the SMD in combination with the SE are unsuitable for publication bias assessments and can lead to false-positive results.

Standardized mean differences cause funnel plot distortion in publication bias assessments

PubMed Central

Van Der Naald, Mira; Sena, Emily S; Howells, David W; IntHout, Joanna; De Groot, Joris AH; Chamuleau, Steven AJ; MacLeod, Malcolm R

2017-01-01

Meta-analyses are increasingly used for synthesis of evidence from biomedical research, and often include an assessment of publication bias based on visual or analytical detection of asymmetry in funnel plots. We studied the influence of different normalisation approaches, sample size and intervention effects on funnel plot asymmetry, using empirical datasets and illustrative simulations. We found that funnel plots of the Standardized Mean Difference (SMD) plotted against the standard error (SE) are susceptible to distortion, leading to overestimation of the existence and extent of publication bias. Distortion was more severe when the primary studies had a small sample size and when an intervention effect was present. We show that using the Normalised Mean Difference measure as effect size (when possible), or plotting the SMD against a sample size-based precision estimate, are more reliable alternatives. We conclude that funnel plots using the SMD in combination with the SE are unsuitable for publication bias assessments and can lead to false-positive results. PMID:28884685

The normalisation of terror: the response of Israel's stock market to long periods of terrorism.

PubMed

Peleg, Kobi; Regens, James L; Gunter, James T; Jaffe, Dena H

2011-01-01

Man-made disasters such as acts of terrorism may affect a society's resiliency and sensitivity to prolonged physical and psychological stress. The Israeli Tel Aviv stock market TA-100 Index was used as an indicator of reactivity to suicide terror bombings. After accounting for factors such as world market changes and attack severity and intensity, the analysis reveals that although Israel's financial base remained sensitive to each act of terror across the entire period of the Second Intifada (2000-06), sustained psychological resilience was indicated with no apparent overall market shift. In other words, we saw a 'normalisation of terror' following an extended period of continued suicide bombings. The results suggest that investors responded to less transitory global market forces, indicating sustained resilience and long-term market confidence. Future studies directly measuring investor expectations and reactions to man-made disasters, such as terrorism, are warranted. © 2011 The Author(s). Disasters © Overseas Development Institute, 2011.

Worldwide trends in fishing interest indicated by Internet search volume

USGS Publications Warehouse

Wilde, G.R.; Pope, K.L.

2013-01-01

There is a growing body of literature that shows internet search volume on a topic, such as fishing, is a viable measure of salience. Herein, internet search volume for 'fishing' and 'angling' is used as a measure of public interest in fishing, in particular, recreational fishing. An online tool, Google Insights for Search, which allows one to study internet search terms and their volume since 2004, is used to examine trends in interest in fishing for 50 countries. Trends in normalised fishing search volume, during 2004 through 2011, varied from a 72.6% decrease (Russian Federation) to a 133.7% increase (Hungary). Normalised fishing search volume declined in 40 (80%) of the countries studied. The decline has been relatively large in English-speaking countries, but also has been large in Central and South American, and European countries. Analyses of search queries provide a low-cost means of gaining insight into angler interests and, possibly, behaviour in countries around the world.

Computation and evaluation of features of surface electromyogram to identify the force of muscle contraction and muscle fatigue.

PubMed

Arjunan, Sridhar P; Kumar, Dinesh K; Naik, Ganesh

2014-01-01

The relationship between force of muscle contraction and muscle fatigue with six different features of surface electromyogram (sEMG) was determined by conducting experiments on thirty-five volunteers. The participants performed isometric contractions at 50%, 75%, and 100% of their maximum voluntary contraction (MVC). Six features were considered in this study: normalised spectral index (NSM5), median frequency, root mean square, waveform length, normalised root mean square (NRMS), and increase in synchronization (IIS) index. Analysis of variance (ANOVA) and linear regression analysis were performed to determine the significance of the feature with respect to the three factors: muscle force, muscle fatigue, and subject. The results show that IIS index of sEMG had the highest correlation with muscle fatigue and the relationship was statistically significant (P < 0.01), while NSM5 associated best with level of muscle contraction (%MVC) (P < 0.01). Both of these features were not affected by the intersubject variations (P > 0.05).

Computation and Evaluation of Features of Surface Electromyogram to Identify the Force of Muscle Contraction and Muscle Fatigue

PubMed Central

Arjunan, Sridhar P.; Kumar, Dinesh K.; Naik, Ganesh

2014-01-01

The relationship between force of muscle contraction and muscle fatigue with six different features of surface electromyogram (sEMG) was determined by conducting experiments on thirty-five volunteers. The participants performed isometric contractions at 50%, 75%, and 100% of their maximum voluntary contraction (MVC). Six features were considered in this study: normalised spectral index (NSM5), median frequency, root mean square, waveform length, normalised root mean square (NRMS), and increase in synchronization (IIS) index. Analysis of variance (ANOVA) and linear regression analysis were performed to determine the significance of the feature with respect to the three factors: muscle force, muscle fatigue, and subject. The results show that IIS index of sEMG had the highest correlation with muscle fatigue and the relationship was statistically significant (P < 0.01), while NSM5 associated best with level of muscle contraction (%MVC) (P < 0.01). Both of these features were not affected by the intersubject variations (P > 0.05). PMID:24995275

A nonlinear eigenvalue problem for self-similar spherical force-free magnetic fields

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

Lerche, I.; Low, B. C.

2014-10-15

An axisymmetric force-free magnetic field B(r, θ) in spherical coordinates is defined by a function r sin θB{sub φ}=Q(A) relating its azimuthal component to its poloidal flux-function A. The power law r sin θB{sub φ}=aA|A|{sup 1/n}, n a positive constant, admits separable fields with A=(A{sub n}(θ))/(r{sup n}) , posing a nonlinear boundary-value problem for the constant parameter a as an eigenvalue and A{sub n}(θ) as its eigenfunction [B. C. Low and Y. Q Lou, Astrophys. J. 352, 343 (1990)]. A complete analysis is presented of the eigenvalue spectrum for a given n, providing a unified understanding of the eigenfunctions and the physical relationship betweenmore » the field's degree of multi-polarity and rate of radial decay via the parameter n. These force-free fields, self-similar on spheres of constant r, have basic astrophysical applications. As explicit solutions they have, over the years, served as standard benchmarks for testing 3D numerical codes developed to compute general force-free fields in the solar corona. The study presented includes a set of illustrative multipolar field solutions to address the magnetohydrodynamics (MHD) issues underlying the observation that the solar corona has a statistical preference for negative and positive magnetic helicities in its northern and southern hemispheres, respectively; a hemispherical effect, unchanging as the Sun's global field reverses polarity in successive eleven-year cycles. Generalizing these force-free fields to the separable form B=(H(θ,φ))/(r{sup n+2}) promises field solutions of even richer topological varieties but allowing for φ-dependence greatly complicates the governing equations that have remained intractable. The axisymmetric results obtained are discussed in relation to this generalization and the Parker Magnetostatic Theorem. The axisymmetric solutions are mathematically related to a family of 3D time-dependent ideal MHD solutions for a polytropic fluid of index γ = 4/3 as discussed in the Appendix.« less

"Endovascular embolic hemispherectomy": a strategy for the initial management of catastrophic holohemispheric epilepsy in the neonate.

PubMed

Oluigbo, Chima; Pearl, Monica S; Tsuchida, Tammy N; Chang, Taeun; Ho, Cheng-Ying; Gaillard, William D

2017-03-01

Conflicting challenges abound in the management of the newborn with intractable epilepsy related to hemimegalencephaly. Early hemispherectomy to stop seizures and prevent deleterious consequences to future neurocognitive development must be weighed against the technical and anesthetic challenges of performing major hemispheric surgery in the neonate. We hereby present our experience with two neonates with hemimegalencephaly and intractable seizures who were managed using a strategy of initial minimally invasive embolization of the cerebral blood supply to the involved hemisphere. Immediate significant seizure control was achieved after embolization of the cerebral blood supply to the involved hemisphere followed by delayed ipsilateral hemispheric resection at a later optimal age. The considerations and challenges encountered in the course of the management of these patients are discussed, and a literature review is presented.

CORTISONE IN TREATMENT OF BRONCHIAL ASTHMA

PubMed Central

Harris, Marvin S.

1951-01-01

Twenty patients with intractable asthma were treated with cortisone on various dosage schedules. Results indicated that a rapid improvement in the asthmatic state may be expected in four to five days with high level dosage of the hormone—usually a total dose exceeding 200 mg. per day at the beginning. If treatment is discontinued after a week, relapse usually will occur within a period of eight days. If small doses are given two or three times weekly, following initial response, relapse may not occur for 20 or 30 days. The interspersed administration of ACTH during an attempt to discontinue cortisone apparently was of no value. It therefore appears that cortisone control of intractable asthma is dependent on large dosage until clinical improvement is obtained, then approximately 100 mg. two or three times a week for maintenance of a reasonable state of health. PMID:14848726

New daily persistent headache.

PubMed

Tyagi, Alok

2012-08-01

New daily persistent headache (NDPH) is a chronic headache developing in a person who does not have a past history of headaches. The headache begins acutely and reaches its peak within 3 days. It is important to exclude secondary causes, particularly headaches due to alterations in cerebrospinal fluid (CSF) pressure and volume. A significant proportion of NDPH sufferers may have intractable headaches that are refractory to treatment. The condition is best viewed as a syndrome rather than a diagnosis. The headache can mimic chronic migraine and chronic tension-type headache, and it is also important to exclude secondary causes, particularly headaches due to alterations in CSF pressure and volume. A large proportion of NDPH sufferers have migrainous features to their headache and should be managed with treatments used for treating migraine. A small group of NDPH sufferers may have intractable headaches that are refractory to treatment.

Temporal lobe epilepsy surgery in children versus adults: from etiologies to outcomes

PubMed Central

Lee, Yun-Jin

2013-01-01

Temporal lobe epilepsy (TLE) is the most common type of medically intractable epilepsy in adults and children, and mesial temporal sclerosis is the most common underlying cause of TLE. Unlike in the case of adults, TLE in infants and young children often has etiologies other than mesial temporal sclerosis, such as tumors, cortical dysplasia, trauma, and vascular malformations. Differences in seizure semiology have also been reported. Motor manifestations are prominent in infants and young children, but they become less obvious with increasing age. Further, automatisms tend to become increasingly complex with age. However, in childhood and especially in adolescence, the clinical manifestations are similar to those of the adult population. Selective amygdalohippocampectomy can lead to excellent postoperative seizure outcome in adults, but favorable results have been seen in children as well. Anterior temporal lobectomy may prove to be a more successful surgery than amygdalohippocampectomy in children with intractable TLE. The presence of a focal brain lesion on magnetic resonance imaging is one of the most reliable independent predictors of a good postoperative seizure outcome. Seizure-free status is the most important predictor of improved psychosocial outcome with advanced quality of life and a lower proportion of disability among adults and children. Since the brain is more plastic during infancy and early childhood, recovery is promoted. In contrast, long epilepsy duration is an important risk factor for surgically refractory seizures. Therefore, patients with medically intractable TLE should undergo surgery as early as possible. PMID:23908666

Perceptions regarding a range of work-related issues and corresponding support needs of individuals with an intractable disease.

PubMed

Imahashi, Kumiko; Fukatsu, Reiko; Nakajima, Yasoichi; Nakamura, Megumi; Ito, Tateo; Horigome, Mariko; Haruna, Yuichiro; Noda, Tatsuya; Itoyama, Yasuto

2016-08-01

A number of persons with an intractable disease (ID) experience work-related problems that could lead to job loss. The aim of this study was to ascertain perceptions regarding a range of work-related issues and corresponding support needs of individuals with an ID. Potential participants were people ages 15 to 64 with one of the 130 intractable chronic diseases designated in the Act to Comprehensively Support the Daily and Social Activities of Persons with Disabilities (Comprehensive Support for the Disabled Act). Participants completed a self-administered questionnaire. With the assistance of patients' organizations, 3,000 questionnaires were mailed to potential participants. Questions included demographic characteristics, family concerns, employment/supported employment, work accommodations, and other aspects of life. Responses were received from 889 (29.6%) participants, and respondents had 57 IDs. Forty-six-point-seven percent of respondents reported being unemployed due to fatigue and/or long-term treatment. Nearly half of the unemployed respondents reported that they had been unable to work despite their willingness to do so. Common requests for accommodation included flexible work hours, working at home, and job/workplace modifications. Only 30% of respondents knew about job training programs and supported work available for persons with disabilities. The results of the study are relevant for employees, employers, and occupational health/human resource professionals. The issue of reasonable accommodations for persons with an ID needs to be addressed in future research in order to promote continued work by those persons.

Xeroderma pigmentosum clinical practice guidelines.

PubMed

Moriwaki, Shinichi; Kanda, Fumio; Hayashi, Masaharu; Yamashita, Daisuke; Sakai, Yoshitada; Nishigori, Chikako

2017-10-01

Xeroderma pigmentosum (XP) is a genetic photosensitive disorder in which patients are highly susceptibe to skin cancers on the sun-exposed body sites. In Japan, more than half of patients (30% worldwide) with XP show complications of idiopathic progressive, intractable neurological symptoms with poor prognoses. Therefore, this disease does not merely present with dermatological symptoms, such as photosensitivity, pigmentary change and skin cancers, but is "an intractable neurological and dermatological disease". For this reason, in March 2007, the Japanese Ministry of Health, Labor and Welfare added XP to the neurocutaneous syndromes that are subject to government research initiatives for overcoming intractable diseases. XP is one of the extremely serious photosensitive disorders in which patients easily develop multiple skin cancers if they are not completely protected from ultraviolet radiation. XP patients thus need to be strictly shielded from sunlight throughout their lives, and they often experience idiopathic neurodegenerative complications that markedly reduce the quality of life for both the patients and their families. Hospitals in Japan often see cases of XP as severely photosensitive in children, and as advanced pigmentary disorders of the sun-exposed area with multiple skin cancers in adults (aged in their 20-40s), making XP an important disease to differentiate in everyday clinical practice. It was thus decided that there was a strong need for clinical practice guidelines dedicated to XP. This process led to the creation of new clinical practice guidelines for XP. © 2017 Japanese Dermatological Association.

Cost-effectiveness of pediatric epilepsy surgery compared to medical treatment in children with intractable epilepsy.

PubMed

Widjaja, Elysa; Li, Bing; Schinkel, Corrine Davies; Puchalski Ritchie, Lisa; Weaver, James; Snead, O Carter; Rutka, James T; Coyte, Peter C

2011-03-01

Due to differences in epilepsy types and surgery, economic evaluations of epilepsy treatment in adults cannot be extrapolated to children. We evaluated the cost-effectiveness of epilepsy surgery compared to medical treatment in children with intractable epilepsy. Decision tree analysis was used to evaluate the cost-effectiveness of surgery relative to medical management. Fifteen patients had surgery and 15 had medical treatment. Cost data included inpatient and outpatient costs for the period April 2007 to September 2009, physician fee, and medication costs. Outcome measure was percentage seizure reduction at one-year follow-up. Incremental cost-effectiveness ratio (ICER) was assessed. Sensitivity analysis was performed for different probabilities of surgical and medical treatment outcomes and costs, and surgical mortality or morbidity. More patients managed surgically experienced Engel class I and II outcomes compared to medical treatment at one-year follow-up. Base-case analysis yielded an ICER of $369 per patient for each percentage reduction in seizures for the surgery group relative to medical group. Sensitivity analysis showed robustness for the different probabilities tested. Surgical treatment resulted in greater reduction in seizure frequency compared to medical therapy and was a cost-effective treatment option in children with intractable epilepsy who were evaluated for epilepsy surgery and subsequently underwent surgery compared to continuing medical therapy. However, larger sample size and long-term follow-up are needed to validate these findings. Copyright © 2011 Elsevier B.V. All rights reserved.

Deconstructing Normalisation: Clearing the Way for Inclusion.

ERIC Educational Resources Information Center

Culham, Andrew; Nind, Melanie

2003-01-01

This paper considers two major movements affecting the lives of people with intellectual disabilities: normalization and inclusion. It reviews the aims, processes, and outcomes of the normalization and social role valorization movement and explores its compatibility with inclusion. Lessons from normalization are applied to the inclusion movement.…

Un-Believing the Matrix: Queering Consensual Heteronormativity

ERIC Educational Resources Information Center

Atkinson, Elizabeth; DePalma, Renee

2009-01-01

Two key concepts arising from Butler's work are the heterosexual matrix--the conflation of sex-gender-sexuality which leads to the normalisation of heterosexuality--and performative reinscription--the discursive process by which the marginalised Other brings new meanings to normative identity constructions. While we have found both concepts…

"Queerying" Gender: Heteronormativity in Early Childhood Education

ERIC Educational Resources Information Center

Robinson, Kerry H.

2005-01-01

This paper explores heteronormativity and argues for the "queerying" of gender in early childhood education. The author argues, utilising Butler's theory of performativity and heterosexual matrix, that the construction of gender in young children's lives requires an analysis of the normalising practices in which gendered identities are…

Hooked on a Feeling: Education, Guidance and Rehabilitation of Youth at Risk

ERIC Educational Resources Information Center

Brunila, Kristiina

2013-01-01

Education in Finland is facing new challenges in the form of two related trends: "therapisation" and "projectisation". The concept of therapisation describes the ways in which ideas, discourses and practices from counselling, therapy, psychiatry, educational and clinical psychology become internalised and normalised in…

21 CFR 882.5840 - Implanted intracerebral/subcortical stimulator for pain relief.

Code of Federal Regulations, 2013 CFR

2013-04-01

... to subsurface areas of a patient's brain to treat severe intractable pain. The stimulator consists of an implanted receiver with electrodes that are placed within a patient's brain and an external...

21 CFR 882.5840 - Implanted intracerebral/subcortical stimulator for pain relief.

Code of Federal Regulations, 2012 CFR

2012-04-01

... to subsurface areas of a patient's brain to treat severe intractable pain. The stimulator consists of an implanted receiver with electrodes that are placed within a patient's brain and an external...

21 CFR 882.5840 - Implanted intracerebral/subcortical stimulator for pain relief.

Code of Federal Regulations, 2010 CFR

2010-04-01

... to subsurface areas of a patient's brain to treat severe intractable pain. The stimulator consists of an implanted receiver with electrodes that are placed within a patient's brain and an external...

21 CFR 882.5840 - Implanted intracerebral/subcortical stimulator for pain relief.

Code of Federal Regulations, 2014 CFR

2014-04-01

... to subsurface areas of a patient's brain to treat severe intractable pain. The stimulator consists of an implanted receiver with electrodes that are placed within a patient's brain and an external...

21 CFR 882.5840 - Implanted intracerebral/subcortical stimulator for pain relief.

Code of Federal Regulations, 2011 CFR

2011-04-01

... to subsurface areas of a patient's brain to treat severe intractable pain. The stimulator consists of an implanted receiver with electrodes that are placed within a patient's brain and an external...

Secure medical information sharing in cloud computing.

PubMed

Shao, Zhiyi; Yang, Bo; Zhang, Wenzheng; Zhao, Yi; Wu, Zhenqiang; Miao, Meixia

2015-01-01

Medical information sharing is one of the most attractive applications of cloud computing, where searchable encryption is a fascinating solution for securely and conveniently sharing medical data among different medical organizers. However, almost all previous works are designed in symmetric key encryption environment. The only works in public key encryption do not support keyword trapdoor security, have long ciphertext related to the number of receivers, do not support receiver revocation without re-encrypting, and do not preserve the membership of receivers. In this paper, we propose a searchable encryption supporting multiple receivers for medical information sharing based on bilinear maps in public key encryption environment. In the proposed protocol, data owner stores only one copy of his encrypted file and its corresponding encrypted keywords on cloud for multiple designated receivers. The keyword ciphertext is significantly shorter and its length is constant without relation to the number of designated receivers, i.e., for n receivers the ciphertext length is only twice the element length in the group. Only the owner knows that with whom his data is shared, and the access to his data is still under control after having been put on the cloud. We formally prove the security of keyword ciphertext based on the intractability of Bilinear Diffie-Hellman problem and the keyword trapdoor based on Decisional Diffie-Hellman problem.

Central poststroke pain: an abstruse outcome.

PubMed

Henry, James L; Lalloo, Chitra; Yashpal, Kiran

2008-01-01

Central poststroke pain (CPSP), formerly known as thalamic pain syndrome of Déjerine and Roussy, is a central neuropathic pain occurring in patients affected by stroke. It is one manifestation of central pain, which is broadly defined as central neuropathic pain caused by lesions or dysfunction in the central nervous system. Thalamic pain was first described 100 years ago by Déjerine and Roussy and has been described as "among the most spectacular, distressing, and intractable of pain syndromes". CPSP is characterized by constant or intermittent pain and is associated with sensory abnormalities, particularly of thermal sensation. While the pain is frequently described as burning, scalding, or burning and freezing, other symptoms are usually vague and hard to characterize, making an early diagnosis particularly difficult. In fact, those who develop CPSP may no longer be under the care of health care professionals when their symptoms begin to manifest, resulting in misdiagnosis or a significant delay before treatment begins. Diagnosis is further complicated by cognitive and speech limitations that may occur following stroke, as well as by depression, anxiety and sleep disturbances. Patients may also exhibit spontaneous dysesthesia and the stimulus-evoked sensory disturbances of dysesthesia, allodynia and hyperalgesia. The present study offers a historical reference point for future clinical and basic research into this elusive type of debilitating pain.

Central poststroke pain: An abstruse outcome

PubMed Central

Henry, James L; Lalloo, Chitra; Yashpal, Kiran

2008-01-01

Central poststroke pain (CPSP), formerly known as thalamic pain syndrome of Déjerine and Roussy, is a central neuropathic pain occurring in patients affected by stroke. It is one manifestation of central pain, which is broadly defined as central neuropathic pain caused by lesions or dysfunction in the central nervous system. Thalamic pain was first described 100 years ago by Déjerine and Roussy and has been described as “among the most spectacular, distressing, and intractable of pain syndromes”. CPSP is characterized by constant or intermittent pain and is associated with sensory abnormalities, particularly of thermal sensation. While the pain is frequently described as burning, scalding, or burning and freezing, other symptoms are usually vague and hard to characterize, making an early diagnosis particularly difficult. In fact, those who develop CPSP may no longer be under the care of health care professionals when their symptoms begin to manifest, resulting in misdiagnosis or a significant delay before treatment begins. Diagnosis is further complicated by cognitive and speech limitations that may occur following stroke, as well as by depression, anxiety and sleep disturbances. Patients may also exhibit spontaneous dysesthesia and the stimulus-evoked sensory disturbances of dysesthesia, allodynia and hyperalgesia. The present study offers a historical reference point for future clinical and basic research into this elusive type of debilitating pain. PMID:18301815

Direct numerical simulation of turbulent channel flow over a liquid-infused micro-grooved surface

NASA Astrophysics Data System (ADS)

Chang, Jaehee; Jung, Taeyong; Choi, Haecheon; Kim, John

2016-11-01

Recently a superhydrophobic surface has drawn much attention as a passive device to achieve high drag reduction. Despite the high performance promised at ideal conditions, maintaining the interface in real flow conditions is an intractable problem. A non-wetting surface, known as the slippery liquid-infused porous surface (SLIPS) or the lubricant-impregnated surface (LIS), has shown a potential for drag reduction, as the working fluid slips at the interface but cannot penetrate into the lubricant layer. In the present study, we perform direct numerical simulation of turbulent channel flow over a liquid-infused micro-grooved surface to investigate the effects of this surface on the interfacial slip and drag reduction. The flow rate of water is maintained constant corresponding to Reτ 180 in a fully developed turbulent channel flow, and the lubricant layer is shear-driven by the turbulent water flow. The lubricant layer is also simulated with the assumption that the interface is flat (i.e. the surface tension effect is neglected). The solid substrate in which the lubricant is infused is modelled as straight ridges using an immersed boundary method. DNS results show that drag reduction by the liquid-infused surface is highly dependent on the viscosity of the lubricant.

Mesial temporal lobe morphology in intractable pediatric epilepsy: so-called hippocampal malrotation, associated findings, and relevance to presurgical assessment.

PubMed

Leach, James L; Awwad, Reem; Greiner, Hansel M; Vannest, Jennifer J; Miles, Lili; Mangano, Francesco T

2016-06-01

OBJECTIVE Diagnostic criteria for hippocampal malrotation (HIMAL) on brain MRI typically include a rounded hippocampus, vertical collateral sulcus, and architectural blurring. Relationship to epileptogenesis remains speculative, and usefulness for surgical guidance is unknown. The study was performed to determine the prevalence of hippocampal rotational anomalies in a cohort of pediatric patients with intractable epilepsy undergoing evaluation for surgery and to determine the significance of this finding in the context of surgical planning. METHODS Forty-eight surgically treated children with intractable epilepsy were compared with matched healthy subjects; reviewers were blinded to surgical side. Each temporal lobe was evaluated for rounded hippocampus, blurring, vertical collateral sulcus, wide choroidal fissure, enlarged temporal horn, low fornix, hippocampal signal, and findings of hippocampal sclerosis. A mesial temporal lobe (MTL) score was calculated by summing the number of features, and the collateral sulcus angle (CSA) was measured in each temporal lobe. Surgical side, pathological diagnosis, and imaging findings elsewhere in the brain were tabulated. Presence of HIMAL, associated imaging features, and MTL score were compared between sides, between epilepsy and control groups, in relationship to side of surgery, and in relationship to postoperative outcome. RESULTS Only 3 epilepsy patients (6.2%) and no controls exhibited all 3 features of HIMAL (p = 0.12). Eight of 48 (16.7%) epilepsy versus 2 of 48 (4.6%) control subjects had both a rounded hippocampus and vertical collateral sulcus (suggesting HIMAL) (p = 0.045). In control and epilepsy subjects, most findings were more prevalent on the left, and the left CSA was more vertical (p < 0.0001). Epilepsy subjects had higher MTL scores (z = -2.95, p = 0.002) and more acute CSAs (p = 0.04) than controls. Only lateralizing raw MTL score had a significant association with surgical side (p = 0.03, OR 7.33); however, this was not significant when hippocampal sclerosis cases were excluded. HIMAL findings were more prevalent and MTL scores were higher in patients with resections involving the temporal lobes. On group analysis, HIMAL findings did not predict eventual surgical side and did not predict outcome, although the numbers are small. In 4 patients the abnormally rotated hippocampus was resected and showed hippocampal sclerosis and/or dysplastic changes on histopathology. All of these patients had a good outcome after surgery. CONCLUSIONS While increased in prevalence in children with intractable epilepsy, imaging findings of HIMAL did not have preoperative lateralizing utility in this group. Findings of HIMAL (including round hippocampus, architectural blurring, and vertical collateral sulcus) did not predict outcome after surgery, although the small number of patients with these findings limits evaluation. In the small number of patients in which the malrotated hippocampus was removed, outcome was good. Further research is needed to continue to define this association in children with intractable epilepsy, focusing on a temporal lobe cohort.

At Sea: What Direction for Critical Early Childhood Research?

ERIC Educational Resources Information Center

Urban, Mathias

2016-01-01

In this paper I reflect on the dilemma critical early childhood research finds itself in today. In order to distinguish and distance ourselves from the certainties and seemingly unquestionable truths of post-political, mainstream, "normalised" research and its entanglement with neoliberal agendas and corporate interests, have we rendered…

Challenging Normative Assumptions Regarding Disengaged Youth: A Phenomenological Perspective

ERIC Educational Resources Information Center

Lewthwaite, Brian; Wilson, Kimberley; Wallace, Valda; McGinty, Sue; Swain, Luke

2017-01-01

This paper explores the experiences of 12 young people, all teenagers, who have chosen to attend alternative schools known as flexible learning options within the Australian context. Using a phenomenological approach, the study seeks to understand their experiences outside the normalised public discourse that they had "disengaged" from…

Managing social norms for persuasive impact

Treesearch

R.B. Cialdini; L.J. Demaine; B.J. Sagarin; D.W. Barrett; K. Rhoads; P.L. Winter

2006-01-01

In order to mobilise action against a social problem, public service communicators often include normative information in their persuasive appeals. Such messages can be either effective or ineffective because they can normalise either desirable or undesirable conduct. To examine the implications in an environmental context, visitors to Arizona's Petrified Forest...

The Labour Party's Blunkett Review: A Comprehensive Disappointment

ERIC Educational Resources Information Center

Lichman, Keith

2014-01-01

David Blunkett's "Review of Education Structures" for the Labour Party recognises that there is a chaotic and unsatisfactory situation in the English education system but its response is ambiguous and self-contradictory. Its proposals seek to normalise and regulate rather than remedy a system in which lack of democratic accountability,…

Postgraduate Students as OER Capacitators

ERIC Educational Resources Information Center

King, Thomas William

2017-01-01

A comprehensive theoretical, legal and practical basis for OER has been developed over the past fifteen years, supported by the expansion of open source curation platforms and the work of advocacy groups and international bodies. OER's potential has been sufficiently documented; the question remains how best to support, integrate and normalise OER…

Changing Green Subjectivities in Outdoor and Environmental Education: A Qualitative Study

ERIC Educational Resources Information Center

Preston, Lou

2012-01-01

This article draws on a longitudinal qualitative study of Australian tertiary students studying Outdoor and Environmental Education. It draws on the work of Foucault and Darier to consider how "environmental governmentality" shapes the conduct, desires and attitudes of these students over time. Attention is drawn to normalising and…

The Limits of Pedagogy: "Diaculturalist Pedagogy" as Paradigm Shift in the Education of Adult Immigrants

ERIC Educational Resources Information Center

Entigar, Katherine E.

2017-01-01

Pedagogy develops through the interventions of scholars who believe injustice should not be normalised. Such interventions nonetheless subsume monoculturalist assumptions constructed within the US social and academic narrative. The top-down paradigm of "designing pedagogy" is inappropriate for educating adult immigrants, whose…

Prescriptions: Hyperrealism and the Chemical Regulation of Mood

ERIC Educational Resources Information Center

Bleakley, Alan; Jolly, Margaretta

2012-01-01

Using contemporary literary sources, we explore the powerful ideological framework that normalises prescription dependency as part of everyday life, focusing upon the treatment of mood disorders. Through a literary critical methodology, we read novels by American hyperrealists such as Bret Easton Ellis, David Foster Wallace and Rick Moody as…

From Being Non-Judgemental to Deconstructing Normalising Judgement

ERIC Educational Resources Information Center

Winslade, John M.

2013-01-01

Beginning with Carl Rogers' exhortation for counsellors to be non-judgemental of their clients, this article explores the rationale for withholding judgement in therapy, including diagnostic judgement. It traces Rogers' incipient sociopolitical analysis as a foundation for this ethic and argues that Michel Foucault provides a stronger…

A case of acute infectious mononucleosis presenting with very high ferritin

PubMed Central

Thoufeeq, Muhammed Hameed; Ali Khan, Shahul Leyakath; Jain, Sanjiv Kumar; Al-Shakerchi, Hasanain; Hussain, Munem

2007-01-01

Hepatitis is an important but uncommon manifestation of acute Epstein Barr infection. Infectious mononucleosis is usually a disease of young adults. We report a case of infectious mononucleosis in a 72-year old jaundiced gentleman with ferritin level of 2438 that normalised on clinical improvement. PMID:17278235

Human metabolism and ecological transfer of radioactive caesium: Comparative studies of Chernobyl debris and nuclear weapons fallout, in Southern Sweden and in Bryansk, Russia

NASA Astrophysics Data System (ADS)

Raaf, Christopher Leopold

The whole-body content of radiocaesium was measured in a South-Swedish urban group of people residing in the city of Lund (55.7°N, 13.2°E) between 1960 and 1994. The results from the survey have been analysed in order to estimate the ecological half-time, Teff,eco, of fallout radiocaesium and the aggregate transfer from ground deposition to man in the region. After 1987, the biological half-times, Ts, of 137Cs and 40K in man were also determined in the reference group through whole-body content measurements in combination with 24-hour urine sampling. Relationships between 24-hour urinary excretion and body burden of 137Cs in the group together with data from the literature were then applied to urine samples collected in 1994 and 1995 from adult subjects living in the highly contaminated region of Bryansk, Russia, in order to estimate their average body burden of 137Cs. The equivalent biological half-time for 137Cs in females of the Lund reference group was, on average (+/-1 WSE), 66 +/- 3 d, which agrees with other findings, whereas the value for the males, 81 +/- 4 d, was, on average, significantly lower than what is found in the literature. This is partly explained by the elevated mean age and relatively low mean body muscle mass of the males investigated in the group during the post-Chernobyl study period. The effective ecological half-time for 137Cs from Chernobyl was found to be 1.8 +/- 0.2 y. The aggregate transfer of 137Cs from deposition to mean activity concentration in man was estimated to be 1.7 Bq kg-1/kBq m-2. These vales may be compared with an effective ecological half-time of 1.3 years found in the reference group in the 1960s, and an aggregate transfer factor of 9.8 Bq kg-1/kBq m-2. The average committed effective dose from ingested 137Cs Chernobyl fallout in the study group was estimated to be 0.02 mSv and from the nuclear weapons fallout to 0.20 mSv. The estimates of whole-body content of 137Cs in the Russian subjects obtained through creatinine normalisation of the 137Cs content in urine were, on average, a factor of 2 higher than estimates obtained through a potassium normalisation procedure; 55 +/- 8 (1 SE) kBq for creatinine and 29 +/- 4 (1 SE) kBq for potassium normalisation in the year 1994. This was due to a significant difference in the relationship between the urinary potassium and creatinine concentration between the Swedish and Russian group. The elevated potassium concentration found in the rural Russian subjects indicated a higher dietary intake of potassium, which greatly influences the accuracy and applicability of the potassium normalisation method when estimating body burden of 137Cs through urine assay. It is therefore recommended not to use the potassium normalisation procedure in cases where the daily intake of potassium is unknown. The estimated body burden of 137Cs in the Bryansk group in 1994 corresponds to a contribution to the estimated annual effective dose of 1.8 mSv y-1, which is approximately 200 times greater than the average annual dose received from ingested 137Cs by the subjects of the Lund reference group during the period 1987-1994.

[Summary of professor YANG Jun's experience for intractable facial paralysis].

PubMed

Wang, Tao; Li, Zaiyuan; Ge, Tingqiu; Zhang, Man; Yuan, Aihong; Yang, Jun

2017-06-12

Professor YANG Jun 's experience of diagnosis and treatment for intractable facial paralysis is introduced. Professor YANG focuses on the thinking model that combines TCM, western medicine and acupuncture, and adopts the differentiation system that combines disease differentiation, syndrome differentiation and meridian differentiation; he adopts the treatment integrates etiological treatment, overall regulation, symptomatic treatment as well as acupuncture, moxibustion, medication and flash cupping. The acupoints of yangming meridians are mostly selected, and acupoints of governor vessel such as Dazhui (GV 14) and Jinsuo (GV 8) are highly valued. The multiple-needles shallow-penetration-insertion twirling lifting and thrusting technique are mostly adopted to achieve slow and mild acupuncture sensation; in addition, the facial muscles are pulled up with mechanics action. The intensive stimulation with electroacupuncture is recommended at Qianzheng (Extra), Yifeng (TE 17) and Yangbai (GB 14), which is given two or three treatments per week.

Is Parenteral Levothyroxine Therapy Safe in Intractable Hypothyroidism?

PubMed

Peynirci, Hande; Taskiran, Bengur; Erturk, Erdinc; Sisman, Pınar; Ersoy, Canan

2018-06-01

A 32-year old woman was admitted to the hospital due to intractable hypothyroidism refractory to high dose of oral l-thyroxine therapy. She underwent total thyroidectomy and radioactive iodine therapy due to papillary thyroid cancer. After excluding poor adherence to therapy and malabsorption, levothyroxine absorption test was performed. No response was detected. Transient neurologic symptoms developed during the test. She developed 3 attacks consisting of neurologic symptoms during high dose administration. The patient was considered a case of isolated l-thyroxine malabsorption. She became euthyroid after intramuscular twice weekly l-thyroxine therapy. There are a few case reports regarding isolated l-thyroxine. We report successful long term results of twice weekly administered intramuscular l-thyroxine therapy. We also draw attention to neurologic side effects of high dose l-thyroxine therapy. Copyright © 2017 National Medical Association. Published by Elsevier Inc. All rights reserved.

Botulinum toxin type-A injection to treat patients with intractable anismus unresponsive to simple biofeedback training

PubMed Central

Zhang, Yong; Wang, Zhen-Ning; He, Lei; Gao, Ge; Zhai, Qing; Yin, Zhi-Tao; Zeng, Xian-Dong

2014-01-01

AIM: To evaluate the efficacy of botulinum toxin type A injection to the puborectalis and external sphincter muscle in the treatment of patients with anismus unresponsive to simple biofeedback training. METHODS: This retrospective study included 31 patients suffering from anismus who were unresponsive to simple biofeedback training. Diagnosis was made by anorectal manometry, balloon expulsion test, surface electromyography of the pelvic floor muscle, and defecography. Patients were given botulinum toxin type A (BTX-A) injection and pelvic floor biofeedback training. Follow-up was conducted before the paper was written. Improvement was evaluated using the chronic constipation scoring system. RESULTS: BTX-A injection combined with pelvic floor biofeedback training achieved success in 24 patients, with 23 maintaining persistent satisfaction during a mean period of 8.4 mo. CONCLUSION: BTX-A injection combined with pelvic floor biofeedback training seems to be successful for intractable anismus. PMID:25253964

A variational eigenvalue solver on a photonic quantum processor

PubMed Central

Peruzzo, Alberto; McClean, Jarrod; Shadbolt, Peter; Yung, Man-Hong; Zhou, Xiao-Qi; Love, Peter J.; Aspuru-Guzik, Alán; O’Brien, Jeremy L.

2014-01-01

Quantum computers promise to efficiently solve important problems that are intractable on a conventional computer. For quantum systems, where the physical dimension grows exponentially, finding the eigenvalues of certain operators is one such intractable problem and remains a fundamental challenge. The quantum phase estimation algorithm efficiently finds the eigenvalue of a given eigenvector but requires fully coherent evolution. Here we present an alternative approach that greatly reduces the requirements for coherent evolution and combine this method with a new approach to state preparation based on ansätze and classical optimization. We implement the algorithm by combining a highly reconfigurable photonic quantum processor with a conventional computer. We experimentally demonstrate the feasibility of this approach with an example from quantum chemistry—calculating the ground-state molecular energy for He–H+. The proposed approach drastically reduces the coherence time requirements, enhancing the potential of quantum resources available today and in the near future. PMID:25055053

[The Terminal Phase of an Intractable Neurological Disease from the Viewpoint of Nursing Care: The Importance of the Promotion of a Barrier-Free Mind for ALS Care].

PubMed

Muraoka, Koko

2015-08-01

Amyotrophic lateral sclerosis (ALS) is a particularly serious intractable neurological disease. Patients with ALS have high mortality rates if they are not put on an artificial respirator. Even with an artificial respirator, individuals with ALS are forced to witness their own physical deterioration. Because 24 hour care is usually required, an intense relationship ofter develops between patients with ALS and family caregivers. This relationship forms an invisible barrier and can impede a smooth introduction of external services. As a result, there can be a degradation in the quality of care. The purpose of this paper is to describe the voluntary efforts of patients and family caregivers in order to break down this barrier and to discuss what types of care support are available to promote barrier-free minds.

Perceptions of a Changing World Induce Hope and Promote Peace in Intractable Conflicts

PubMed Central

Cohen-Chen, Smadar; Crisp, Richard J.; Halperin, Eran

2015-01-01

The importance of hope in promoting conciliatory attitudes has been asserted in the field of conflict resolution. However, little is known about conditions inducing hope, especially in intractable conflicts, where reference to the outgroup may backfire. In the current research, five studies yielded convergent support for the hypothesis that hope for peace stems from a general perception of the world as changing. In Study 1, coders observed associations between belief in a changing world, hope regarding peace, and support for concessions. Study 2 revealed the hypothesized relations using self-reported measures. Studies 3 and 4 established causality by instilling a perception of the world as changing (vs. unchanging) using narrative and drawing manipulations. Study 5 compared the changing world message with a control condition during conflict escalation. Across studies, although the specific context was not referred to, the belief in a changing world increased support for concessions through hope for peace. PMID:25713171

Melanosomal sequestration of cytotoxic drugs contributes to the intractability of malignant melanomas

PubMed Central

Chen, Kevin G.; Valencia, Julio C.; Lai, Barry; Zhang, Guofeng; Paterson, Jill K.; Rouzaud, François; Berens, Werner; Wincovitch, Stephen M.; Garfield, Susan H.; Leapman, Richard D.; Hearing, Vincent J.; Gottesman, Michael M.

2006-01-01

Multidrug resistance mechanisms underlying the intractability of malignant melanomas remain largely unknown. In this study, we demonstrate that the development of multidrug resistance in melanomas involves subcellular sequestration of intracellular cytotoxic drugs such as cis-diaminedichloroplatinum II (cisplatin; CDDP). CDDP is initially sequestered in subcellular organelles such as melanosomes, which significantly reduces its nuclear localization when compared with nonmelanoma/KB-3-1 epidermoid carcinoma cells. The melanosomal accumulation of CDDP remarkably modulates melanogenesis through a pronounced increase in tyrosinase activity. The altered melanogenesis manifested an ≈8-fold increase in both intracellular pigmentation and extracellular transport of melanosomes containing CDDP. Thus, our experiments provide evidence that melanosomes contribute to the refractory properties of melanoma cells by sequestering cytotoxic drugs and increasing melanosome-mediated drug export. Preventing melanosomal sequestration of cytotoxic drugs by inhibiting the functions of melanosomes may have great potential as an approach to improving the chemosensitivity of melanoma cells. PMID:16777967

Response to Electroconvulsive Therapy in Patients With Autism Spectrum Disorder and Intractable Challenging Behaviors Associated With Symptoms of Catatonia.

PubMed

Sajith, Sreedharan Geetha; Liew, Siew Fai; Tor, Phern Chern

2017-03-01

There are several reports of electroconvulsive therapy (ECT) used in autism spectrum disorder (ASD) in the context of catatonic symptoms. We describe response to ECT in two adults with ASD and intellectual disability with intractable aggression and self-injurious behaviors associated with catatonic symptoms who had not responded to standard interventions. Unilateral ECT at a frequency of 3 times a week was given followed by weekly maintenance ECT. Patients' catatonic symptoms included episodes of agitation and echophenomena. Electroconvulsive therapy resulted in significant improvement in their behavior problems but 1 patient relapsed when the ECT was discontinued or frequency of treatment reduced. The second patient required 2 courses of ECT before improvement which was maintained on weekly ECT. Electroconvulsive therapy could be a potentially beneficial intervention in patients with ASD and severe challenging behaviors associated with catatonic symptoms including agitated or excited forms of catatonia.

Botulinum toxin type-A injection to treat patients with intractable anismus unresponsive to simple biofeedback training.

PubMed

Zhang, Yong; Wang, Zhen-Ning; He, Lei; Gao, Ge; Zhai, Qing; Yin, Zhi-Tao; Zeng, Xian-Dong

2014-09-21

To evaluate the efficacy of botulinum toxin type A injection to the puborectalis and external sphincter muscle in the treatment of patients with anismus unresponsive to simple biofeedback training. This retrospective study included 31 patients suffering from anismus who were unresponsive to simple biofeedback training. Diagnosis was made by anorectal manometry, balloon expulsion test, surface electromyography of the pelvic floor muscle, and defecography. Patients were given botulinum toxin type A (BTX-A) injection and pelvic floor biofeedback training. Follow-up was conducted before the paper was written. Improvement was evaluated using the chronic constipation scoring system. BTX-A injection combined with pelvic floor biofeedback training achieved success in 24 patients, with 23 maintaining persistent satisfaction during a mean period of 8.4 mo. BTX-A injection combined with pelvic floor biofeedback training seems to be successful for intractable anismus.

Investigation of automated task learning, decomposition and scheduling

NASA Technical Reports Server (NTRS)

Livingston, David L.; Serpen, Gursel; Masti, Chandrashekar L.

1990-01-01

The details and results of research conducted in the application of neural networks to task planning and decomposition are presented. Task planning and decomposition are operations that humans perform in a reasonably efficient manner. Without the use of good heuristics and usually much human interaction, automatic planners and decomposers generally do not perform well due to the intractable nature of the problems under consideration. The human-like performance of neural networks has shown promise for generating acceptable solutions to intractable problems such as planning and decomposition. This was the primary reasoning behind attempting the study. The basis for the work is the use of state machines to model tasks. State machine models provide a useful means for examining the structure of tasks since many formal techniques have been developed for their analysis and synthesis. It is the approach to integrate the strong algebraic foundations of state machines with the heretofore trial-and-error approach to neural network synthesis.

Atypical language representation in children with intractable temporal lobe epilepsy.

PubMed

Maulisova, Alice; Korman, Brandon; Rey, Gustavo; Bernal, Byron; Duchowny, Michael; Niederlova, Marketa; Krsek, Pavel; Novak, Vilem

2016-05-01

This study evaluated language organization in children with intractable epilepsy caused by temporal lobe focal cortical dysplasia (FCD) alone or dual pathology (temporal lobe FCD and hippocampal sclerosis, HS). We analyzed clinical, neurological, fMRI, neuropsychological, and histopathologic data in 46 pediatric patients with temporal lobe lesions who underwent excisional epilepsy surgery. The frequency of atypical language representation was similar in both groups, but children with dual pathology were more likely to be left-handed. Atypical receptive language cortex correlated with lower intellectual capacity, verbal abstract conceptualization, receptive language abilities, verbal working memory, and a history of status epilepticus but did not correlate with higher seizure frequency or early seizure onset. Histopathologic substrate had only a minor influence on neuropsychological status. Greater verbal comprehension deficits were noted in children with atypical receptive language representation, a risk factor for cognitive morbidity. Copyright © 2016 Elsevier Inc. All rights reserved.

The habitual brain: an "adapted habit" theory of substance use disorders.

PubMed

Newlin, David B; Strubler, Kevin A

2007-01-01

Behavioral habits are essential to human and animal life. We consider the many ways that habits - which are normally adaptive - can be expressed as drug use behavior and addiction. Although habit theories of substance use disorders have been proposed (e.g., Tiffany, 1990), the behavioral science and underlying neurobiology of habit development, maintenance, and change is only now being studied. We first define "adapted habit." We then propose that the etiology of an adapted habit represents the combination of: (a) initial "capture" of a habit, (b) development of behavioral action schemata, and (c) an overlay of cognitive expectancies concerning aspects of the habit. This combination conspires to make an intractable adapted habit such as substance abuse and addiction. Many intractable habits change, including substance use disorders such as cigarette smoking. As part of a science of habits, we need a real understanding of how to change habits to avoid or minimize harm.

Intractable epilepsy: management and therapeutic alternatives.

PubMed

Schuele, Stephan U; Lüders, Hans O

2008-06-01

More than half of patients with newly diagnosed epilepsy achieve complete seizure control without major side-effects. Patients who continue to have seizures after initial medical therapy should have an early and detailed assessment to confirm the diagnosis, to determine the underlying cause and epilepsy syndrome, and to choose an adequate treatment strategy. The risks and potential benefits of surgical procedures or experimental therapy have to be weighed against the chance of improvement and the potential side-effects of additional medical therapy. Surgery for temporal lobe epilepsy, the most common cause of focal epilepsy, can control seizures and improve quality of life in appropriately selected patients. However, around 20-30% of patients do not respond to medical or surgical treatment. The management of chronic intractable epilepsy requires comprehensive care to address the adverse events of medical treatment, quality of life issues, and comorbid disorders. Much research focuses on the experimental treatment options that offer hope of seizure reduction or cure.

Usefulness of Chinese Herbal Medicines as Host-Directed Therapeutics against Mycobacterial Infections: A Review.

PubMed

Tomioka, Haruaki

2017-01-01

The high incidence of tuberculosis (TB) in developing countries, the resurgence of TB in industrialized countries, and the worldwide increase in the prevalence of Mycobacterium avium complex infections have prompted the quest for new antimycobacterial drugs. However, the development of such chemotherapeutics is currently making very slow progress. It therefore appears that devising improved administration protocols for clinical treatment against intractable mycobacteriosis using existing chemotherapeutics is more practical than awaiting the development of novel antimycobacterial drugs. The modulation of host immune responses using immunoadjunctive agents may increase the efficacy of antimicrobial treatment against mycobacteriosis. Particularly, the mild and long-term up-regulation of host immune reactions against mycobacterial pathogens using Chinese herbal medicines (CHMs) may be beneficial for immunoadjunctive therapy. This review focuses on the current status and future prospects regarding the development of CHMs that can be useful for the clinical control of intractable mycobacterial infections.

Advances in EPG for treatment and research: an illustrative case study.

PubMed

Scobbie, James M; Wood, Sara E; Wrench, Alan A

2004-01-01

Electropalatography (EPG), a technique which reveals tongue-palate contact patterns over time, is a highly effective tool for speech research. We report here on recent developments by Articulate Instruments Ltd. These include hardware for Windows-based computers, backwardly compatible (with Reading EPG3) software systems for clinical intervention and laboratory-based analysis for EPG and acoustic data, and an enhanced clinical interface with client and file management tools. We focus here on a single case study of a child aged 10+/-years who had been diagnosed with an intractable speech disorder possibly resulting ultimately from a complete cleft of hard and soft palate. We illustrate how assessment, diagnosis and treatment of the intractable speech disorder are undertaken using this new generation of instrumental phonetic support. We also look forward to future developments in articulatory phonetics that will link EPG with ultrasound for research and clinical communities.

New daily persistent headache

PubMed Central

Tyagi, Alok

2012-01-01

New daily persistent headache (NDPH) is a chronic headache developing in a person who does not have a past history of headaches. The headache begins acutely and reaches its peak within 3 days. It is important to exclude secondary causes, particularly headaches due to alterations in cerebrospinal fluid (CSF) pressure and volume. A significant proportion of NDPH sufferers may have intractable headaches that are refractory to treatment. The condition is best viewed as a syndrome rather than a diagnosis. The headache can mimic chronic migraine and chronic tension-type headache, and it is also important to exclude secondary causes, particularly headaches due to alterations in CSF pressure and volume. A large proportion of NDPH sufferers have migrainous features to their headache and should be managed with treatments used for treating migraine. A small group of NDPH sufferers may have intractable headaches that are refractory to treatment. PMID:23024565

Partial pleural covering for intractable pneumothorax in patients with Birt-Hogg-Dubé Syndrome.

PubMed

Okada, Akira; Hirono, Tatsuhiko; Watanabe, Takehiro; Hasegawa, Go; Tanaka, Reiko; Furuya, Mitsuko

2017-03-01

Birt-Hogg-Dubé syndrome (BHD) is an inherited disorder associated with a germline mutation of the folliculin (FLCN) gene. Most patients with BHD have multiple pulmonary cysts, and are at high risk of repeated pneumothorax. Although an increasing number of patients are diagnosed with BHD by genetic testing, therapeutic approaches for intractable pneumothorax have not yet been described. We treated three patients who had repeated episodes of pneumothorax. All had multiple pulmonary cysts in the lower lobes, and two had a family history of pneumothorax. Video-assisted thoracic surgery was used to perform wedge resections and partial pleural covering of the cystic lesions. The partial pleural covering technique used sheets of polyglycolic acid felt or regenerative oxidized cellulose mesh. The resected tissues underwent histopathological evaluation, and peripheral blood leukocytes were tested for FLCN mutations. The operative times were less than 2 h, and there were no complications. The resected cysts had histopathological features characteristic of BHD lung. All patients were found to have FLCN germline mutations; thus their repeated pneumothoraces were a manifestation of BHD. None of the patients developed respiratory problems after undergoing the partial pleural covering procedure, and they have all been well without pneumothorax for 30 months or more. Partial pleural covering combined with resection of protruding cysts should be a safe and effective therapeutic approach for BHD patients with intractable pneumothorax. Further investigation is needed to establish a detailed protocol for treatment of pneumothorax that results in minimal functional impairment. © 2015 John Wiley & Sons Ltd.

Intrathecal infusions for intractable cancer pain: A qualitative study of the impact on a case series of patients and caregivers

PubMed Central

Hawley, Philippa; Beddard-Huber, Elizabeth; Grose, Cameron; McDonald, William; Lobb, Daphne; Malysh, Louise

2009-01-01

BACKGROUND: The need for intrathecal infusion in a palliative care setting is infrequent. Despite established efficacy, safety and cost effectiveness, this is considered an ‘extraordinary measure’ in Canada. Patients requiring this approach are not typical palliative care patients, having shorter and more uncertain life expectancies. OBJECTIVES: The present study is a qualitative exploration of the impact of intrathecal pump implantation on cancer patients, and also the impact of the intervention on the staff caring for those patients. METHODS: Palliative care unit patients who received an implanted intrathecal pump or dome catheter for intractable cancer pain participated in multiple semistructured interviews. Doctors and nurses caring for each patient were also interviewed. Interviews were recorded and analyzed for themes. The study terminated when saturation was reached. RESULTS: Six patients participated, with up to three interviews each. Twenty-four staff interviews took place. Patients’ hopes and expectations were not always fully met, but the infusions had a profound positive effect on quality of life. Patients expressed anxiety about dependence on the device, and also on a few highly skilled individuals. Staff interviews revealed a significant impact on the ‘culture’ of the palliative care unit. Clear communication of the rationale for infusion was very important, as was regular education about infusion management. CONCLUSIONS: Implanted intrathecal infusion devices are a necessary part of a tertiary level cancer pain management service for the unfortunate minority with intractable pain. Practical recommendations for care are made for palliative care programs contemplating offering intrathecal infusions. PMID:19862372

Use of Spinal Cord Diffusion Tensor Imaging to Quantify Neural Ablation and Evaluate Outcome after Percutaneous Cordotomy for Intractable Cancer Pain

PubMed Central

Vedantam, Aditya; Hou, Ping; Chi, T. Linda; Dougherty, Patrick M.; Hess, Kenneth R.; Viswanathan, Ashwin

2017-01-01

Background Up to 20% of patients experience only partial pain relief after percutaneous cordotomy for cancer pain. Objective To determine whether diffusion tensor imaging (DTI) can quantify neural ablation and help evaluate early postoperative outcomes after cordotomy. Methods Patients undergoing percutaneous CT-guided cordotomy for intractable cancer pain were prospectively studied. Pre- and postoperative assessment was made using the visual analog scale (VAS) on pain and the pain severity scores of the Brief Pain Inventory Short Form. On postoperative day 1, DTI images of the high cervical spinal cord were obtained. DTI metrics were correlated with the number of ablations as well as early postoperative pain outcomes. Results Seven patients (4 male, mean age 53.8 ± 4.6 years) were studied. Fractional anisotropy of the hemicord was significantly lower on the side of the lesion as compared to the contralateral side (0.54 ± 0.03 vs. 0.63 ± 0.03, p < 0.001). Mean diffusivity correlated with the improvement in the VAS score at 1 week (r = 0.88, 95% CI = 0.34–1.00, p = 0.008), as well as the change in pain severity scores at 1 week (r = 0.99, 95% CI = 0.82–1.00, p < 0.001). Conclusion DTI metrics are sensitive to the number of ablations as well as early improvement in pain scores after cordotomy. DTI of the cervical spinal cord is a potential biomarker of neural ablation after percutaneous cordotomy for intractable cancer pain. PMID:28088799

Selective embolization of the internal iliac arteries for the treatment of intractable hemorrhage in children with malignancies.

PubMed

Bae, Sul Hee; Han, Dong Kyun; Baek, Hee Jo; Park, Sun Ju; Chang, Nam Kyu; Kook, Hoon; Hwang, Tai Ju

2011-04-01

Acute internal hemorrhage is an occasionally life-threatening complication in pediatric cancer patients. Many therapeutic approaches have been used to control bleeding with various degrees of success. In this study, we evaluated the efficacy of selective internal iliac artery embolization for controlling acute intractable bleeding in children with malignancies. We retrospectively evaluated the cases of 6 children with various malignancies (acute lymphoblastic leukemia, acute myelogenous leukemia, chronic myelogenous leukemia, T-cell prolymphocytic leukemia, Langerhans cell histiocytosis, and rhabdomyosarcoma), who had undergone selective arterial embolization (SAE) of the internal iliac artery at the Chonnam National University Hwasun Hospital between January 2004 and December 2009. SAE was performed by an interventional radiologist using Gelfoam® and/or Tornado® coils. The patients were 5 boys and 1 girl with median age of 6.9 years (range, 0.7-14.8 years) at the time of SAE. SAE was performed once in 4 patients and twice in 2, and the procedure was unilateral in 2 and bilateral in 4. The causes of hemorrhage were as follows: hemorrhagic cystitis (HC) in 3 patients, procedure-related internal iliac artery injuries in 2 patients, and tumor rupture in 1 patient. Initial attempt at conservative management was unsuccessful. Of the 6 patients, 5 (83.3%) showed improvement after SAE without complications. SAE may be a safe and effective procedure for controlling acute intractable hemorrhage in pediatric malignancy patients. This procedure may obviate the need for surgery, which carries an attendant risk of morbidity and mortality in cancer patients with critical conditions.

[Combined inflating lung and insufflating calf pulmonary surfactant under general anesthesia in the treatment of postoperative intractable atelectasis].

PubMed

Lu, Ya-ping; Hu, Yi; Shi, Gu-ping; Yao, Ming; Huang, Bing; Zhou, Xu-yan; Sun, Jian-liang; DU, Jian-long; Xie, Guo-hao; Fang, Xiang-ming

2013-06-18

To explore the efficacy and safety of combined inflating lung and insufflating calf pulmonary surfactant under general anesthesia for treating postoperative intractable atelectasis. From August 2006 to January 2013, 15 patients with obstinate postoperative atelectasis receiving pressure control lung expansion were enrolled. The bronchial cannula was intubated into the affected side to assist the expanding of the lung, and the calf pulmonary surfactant was insufflated selectively. The chest auscultation and computed tomography (CT) scan was performed at 1 d and 5 d after the procedure respectively, to evaluation the effect. The airway pressure, mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR) and oxygen saturation (SpO2) were recorded before the treatment, during the treatment and after the treatment.Monitoring arterial blood gas before and after treatment. After the expansion of the lung and insufflation of calf pulmonary surfactants, the iconographic scan showed that collapsed alveolar was reinflated in 12 (80.0%) patients at 1 d after the treatment and in 14 patients(93.3%) at 5 d after the procedure.There were not notable vital sign change and complications during the treatment.At after the treatment, 1, 3, 5 and 7 d after the treatment, PaO2 was higher (P < 0.05), and there were not significantly difference in the PaCO2 and pH (P > 0.05) . Combined pressure control lung expansion with selectively insufflating calf pulmonary surfactant under general anesthesia may be an effective therapy for postoperative intractable atelectasis.

Evaluation of Posterior Hippocampal Epileptogenicity During Epilepsy Surgery For Temporal Lobe Cavernoma by the Occipital Approach.

PubMed

Akiyama, Yukinori; Suzuki, Kengo; Ochi, Satoko; Miyamoto, Susumu; Mikuni, Nobuhiro

2015-11-01

Cavernomas frequently are associated with intractable epilepsy. When cavernomas located in the temporal lobe are associated with intractable epilepsy, the hippocampus also may have an epileptic focus. The objective in the present study was to clarify the importance of evaluation of the posterior hippocampal epileptogenicity during epilepsy surgery for posteromedial temporal lobe cavernoma. In this study, we describe 2 rare cases of medically intractable epilepsy in patients with posteromedial temporal lobe cavernomas who underwent surgery via the occipital approach. Using longitudinal insertion of depth electrodes into the hippocampus, we evaluated epileptogenicity in both patients from the cavernoma cavity and its surrounding hemosiderin, as well as from the posterior hippocampus near the cavernoma. We show that the transoccipital approach to the posteromedial temporal lobe is compatible with depth electrode insertion and subdural electrode placement on the temporal lobe, enabling an accurate evaluation of potential epileptogenic zones in the posterior part of the hippocampus. Both patients did not experience any seizures and had no postoperative neurologic deficits, and their cognitive functions were intact. The transoccipital approach enables the optimization of the extent of posterior hippocampectomy while avoiding unnecessary resection for seizure control. We suggest resecting the posterior part of the hippocampus in addition to the cavernoma and surrounding areas in patients with medically refractory epilepsy due to a posteromedial temporal cavernoma. Tailored systematic resection guided by intraoperative electrocorticography and electroencephalography with a depth electrode was important and necessary in the present cases. Copyright © 2015 Elsevier Inc. All rights reserved.

Revision with Totally Hand-Sewn Gastrojejunostomy and Vagotomy for Refractory Marginal Ulcer after Laparoscopic Roux-en-Y Gastric Bypass.

PubMed

Chang, Po-Chih; Huang, Chih-Kun; Rajan, Mahendra; Hsin, Ming-Che

2016-05-01

Marginal ulcer is not infrequent after laparoscopic Roux-en-Y gastric bypass and could result in undesirable complications, such as intractability, bleeding, or perforation. Those patients who failed medical therapy, regarded as refractory marginal ulcers, may be considered as candidates for revisional surgery. Herein, we make a video presentation of a laparoscopic revisional procedure for refractory marginal ulcer. A 29-year-old morbidly obese woman (initial body mass index 37.1 kg/m(2)), a non-smoker, presented with persistent epigastric pain 3 months after initial laparoscopic Roux-en-Y gastric bypass at another institution. After an exhaustive work-up there, only the gastroendoscopy revealed a marginal ulcer and she underwent medical treatment (proton pump inhibitor and sucralfate) for 3 months, but the patient's symptom aggravated and the serial gastroendoscopies still confirmed the marginal ulcer without obvious resolution after a total of 4 months proton pump inhibitor therapy, suggesting failure of medical treatment and intractability. Laparoscopic revisional procedure with totally hand-sewn gastrojejunostomy and vagotomy was performed to relieve her intractable condition. The procedure took 130 min, without any intra-operative complications. Blood loss was 80 mL. The patient had an uneventful postoperative course, and the postoperative hospital stay was 3 days. She was relieved of her symptoms after this revisional surgery, and a subsequent gastroendoscopy 15 months later showed no marginal ulcers. Though long-term follow-up is needed to draw a definite conclusion, totally hand-sewn gastrojejunostomy and vagotomy remains a practicable revisional procedure to relieve refractory marginal ulcers.

Intractable nausea caused by zolpidem withdrawal: a case report.

PubMed

Baruch, Edward; Vernon, Leonard F; Hasbun, Rafael J

2007-03-01

First launched in France in 1988, zolpidem (Ambien®) is a short-acting hypnotic agent. Early studies reported that that the development of physical dependence and tolerance to sedative-hypnotic drugs, such as the depressant and anticonvulsant effects evidenced with benzodiazepines, is not found with zolpidem. Direct to consumer advertising by the manufacturer continues to state that the risk for dependency is low; however, recent publications seem to contradict this. Additionally, adverse drug reactions affecting the central nervous system, gastrointestinal tract, and respiratory system have been reported. Other studies have examined the interactions of selective serotonin reuptake inhibitors and zolpidem as a possible cause of hallucinations. With continued physician marketing efforts touting the safety and efficacy of zolpidem, there is a high likelihood to overlook the risk of dependency and the symptoms related to zolpidem withdrawal. We report a case of a 41-year-old female who developed a dependency to zolpidem, who on her own decided to decrease her dosage, resulting in intractable nausea requiring hospitalization. Reported cases of zolpidem withdrawal have occurred with doses in excess of 160 mg per day, none of these have reported with intractable nausea as the sole symptom. In our reported case, although exceeding recommended dosage withdrawal phenomenon seemed to be severe after withdrawal from a comparatively low dose of zolpidem. Before zolpidem is prescribed, patient education should include warnings about the potential problems associated with dependency and abrupt discontinuation. Education about this common and likely underrecognized clinical phenomenon will help prevent future episodes and minimize the risk of misdiagnosis.

Tryptophan and Non-Tryptophan Fluorescence of the Eye Lens Proteins Provides Diagnostics of Cataract at the Molecular Level

PubMed Central

Gakamsky, Anna; Duncan, Rory R.; Howarth, Nicola M.; Dhillon, Baljean; Buttenschön, Kim K.; Daly, Daniel J.; Gakamsky, Dmitry

2017-01-01

The chemical nature of the non-tryptophan (non-Trp) fluorescence of porcine and human eye lens proteins was identified by Mass Spectrometry (MS) and Fluorescence Steady-State and Lifetime spectroscopy as post-translational modifications (PTM) of Trp and Arg amino acid residues. Fluorescence intensity profiles measured along the optical axis of human eye lenses with age-related nuclear cataract showed increasing concentration of fluorescent PTM towards the lens centre in accord with the increased optical density in the lens nucleolus. Significant differences between fluorescence lifetimes of “free” Trp derivatives hydroxytryptophan (OH-Trp), N-formylkynurenine (NFK), kynurenine (Kyn), hydroxykynurenine (OH-Kyn) and their residues were observed. Notably, the lifetime constants of these residues in a model peptide were considerably greater than those of their “free” counterparts. Fluorescence of Trp, its derivatives and argpyrimidine (ArgP) can be excited at the red edge of the Trp absorption band which allows normalisation of the emission spectra of these PTMs to the fluorescence intensity of Trp, to determine semi-quantitatively their concentration. We show that the cumulative fraction of OH-Trp, NFK and ArgP emission dominates the total fluorescence spectrum in both emulsified post-surgical human cataract protein samples, as well as in whole lenses and that this correlates strongly with cataract grade and age. PMID:28071717

On the Need for Artificial Intelligence and Advanced Test and Evaluation Methods for Space Exploration

NASA Astrophysics Data System (ADS)

Scheidt, D. H.; Hibbitts, C. A.; Chen, M. H.; Paxton, L. J.; Bekker, D. L.

2017-02-01

Implementing mature artificial intelligence would create the ability to significantly increase the science return from a mission, while potentially saving costs in mission and instrument operations, and solving currently intractable problems.

Intractable Headache - The Pain in Your Head that Just Won't Quit

MedlinePlus

... into those things you can control (medications, life-style, triggers) and systematically work through the process of ... for Acute Migraine Headache ABC’s of Headache Trigger Management Abdominal Migraine Migraine Triggers Hypnic Headache Retinal Migraine ...

[Preoperative evaluation of surgery for intractable aspiration based on the prognostic nutritional index].

PubMed

Uchida, Masaya; Hashimoto, Keiko; Mukudai, Shigeyuki; Ushijima, Chihisa; Dejima, Kenji

2014-12-01

Because there is no absolute indicator of the nutritional status and prognosis in patients with severe aspiration problems, it is quite difficult to arrive at a true long-time prognosis. By performing surgery for intractable aspiration on such patients, both the prognosis and QOL of the patients could be expected to improve. In our department, we have experienced patients dying within 6 months after surgery. In these cases, the patient's preoperative nutritional status was not good. Therefore, we consider that, when we adopt this procedure, there should be some indicators we should use which could have an effect on the prognosis of such nutritionally-challenged patients. In patients who underwent surgery for intractable aspiration; we examined the relationship between their survival and the prognostic nutritional index (PNI) which is an indicator of the risk of complications such as post-operative events in the surgical field. We investigated the relationship between the prognosis and the postoperative indicators of each of the following: WBC, CRP, serum albumin level, and PNI. Out of a total of 31 cases, the average O-PNI of eight cases in which death occurred was 29.45, and the average of six cases in which death occurred within 6 months after surgery was 28.26. The average O-PNI of the survivors was 36.01. A significant association was noted between the early postoperative deaths and some of the four indicators namely that serum albumin level and O-PNI. Based on the ROC curve, the O-PNI offered higher precision than the albumin level. The cut-off value of the O-PNI value for early postoperative mortality rate was 32. The early postoperative mortality rate was 44.4% in patients with less than 32 O-PNI in the preoperative examination, but if it were O-PNI 32 or more, the early postoperative mortality rate was 9.1%, significantly lower. Therefore, O-PNI could be useful as one of the prognostic evaluation factors in the case of preoperative surgery for intractable aspiration. Based on the O-PNI score, it was possible to evaluate the survival benefit associated with this operative procedure. We showed a treatment algorithm based on the preoperative O-PNI value. We believe there is a necessity to develop preoperative effective nutritional therapy as a future issue.

Bupivacaine administered intrathecally versus rectally in the management of intractable rectal cancer pain in palliative care

PubMed Central

Zaporowska-Stachowiak, Iwona; Kowalski, Grzegorz; Łuczak, Jacek; Kosicka, Katarzyna; Kotlinska-Lemieszek, Aleksandra; Sopata, Maciej; Główka, Franciszek

2014-01-01

Background Unacceptable adverse effects, contraindications to and/or ineffectiveness of World Health Organization step III “pain ladder” drugs causes needless suffering among a population of cancer patients. Successful management of severe cancer pain may require invasive treatment. However, a patient’s refusal of an invasive procedure necessitates that clinicians consider alternative options. Objective Intrathecal bupivacaine delivery as a viable treatment of intractable pain is well documented. There are no data on rectal bupivacaine use in cancer patients or in the treatment of cancer tenesmoid pain. This study aims to demonstrate that bupivacaine administered rectally could be a step in between the current treatment options for intractable cancer pain (conventional/conservative analgesia or invasive procedures), and to evaluate the effect of the mode of administration (intrathecal versus rectal) on the bupivacaine plasma concentration. Cases We present two Caucasian, elderly inpatients admitted to hospice due to intractable rectal/tenesmoid pain. The first case is a female with vulvar cancer, and malignant infiltration of the rectum/vagina. Bupivacaine was used intrathecally (0.25–0.5%, 1–2 mL every 6 hours). The second case is a female with ovarian cancer and malignant rectal infiltration. Bupivacaine was adminstered rectally (0.05–0.1%, 100 mL every 4.5–11 hours). Methods Total bupivacaine plasma concentrations were determined using the high-performance liquid chromatography-ultraviolet method. Results Effective pain control was achieved with intrathecal bupivacaine (0.077–0.154 mg·kg−1) and bupivacaine in enema (1.820 mg·kg−1). Intrathecal bupivacaine (0.5%, 2 mL) caused a drop in blood pressure; other side effects were absent in both cases. Total plasma bupivacaine concentrations following intrathecal and rectal bupivacaine application did not exceed 317.2 ng·mL−1 and 235.7 ng·mL−1, respectively. Bupivacaine elimination was slower after rectal than after intrathecal administration (t½= 5.50 versus 2.02 hours, respectively). Limitations This study reports two cases only, and there could be inter-patient variation. Conclusion Bupivacaine in boluses administered intrathecally (0.25%, 2 mL) provided effective, safe analgesia in advanced cancer patients. Bupivacaine enema (100 mg·100 mL−1) was shown to be a valuable option for control of end-of-life tenesmoid cancer pain. PMID:25336967

[Prospective multicenter study on long-term ketogenic diet therapy for intractable childhood epilepsy].

PubMed

2013-04-01

To evaluate the efficacy and safety of long-term ketogenic diet (KD) on the children with intractable epilepsy. This was a prospective, open-label study of intractable epilepsy patients treated with the classic KD with a lipid-to-nonlipid ratio 4:1 between October 2004 and July 2011 at five Chinese epilepsy centers. A total of 299 patients were enrolled. The patients were divided into different groups according to age (including the below-1-year-old group, 1-to-3-year-old group, 3-to-6-year-old group, 6-to-10-year-old group, and over-10-year-old group), etiology (cryptogenic epilepsy, symptomatic epilepsy, and idiopathic epilepsy), and the seizure types (included infantile spasm, Lennox-Gastaut syndrome, Ohtahara syndrome, tuberous sclerosis, Dravet syndrome, generalized epilepsy, and partial epilepsy). Parents were assigned to write seizure diaries which recorded the seizure presentations, tolerability, and complications associated with the KD. Patients' weight and height were measured every week. Blood β-hydroxybutyric acid, blood sugar, and urinary ketone bodies were monitored closely. Patients were followed up through telephone calls by the nutritionists every month and regular outpatient visits or hospitalizations were recommended at all time-points which included the third, sixth and twelfth month after initiation. Efficacy was measured through seizure frequency. The variables related to the efficacy were also analyzed. SPSS 17.0 was used for all statistical analysis. At 3, 6, and 12 months after initiation, 65.9%, 44.8%, and 26.4% patients remained on the diet, and 37.4%, 26.1%, and 20.4% had a > 50% reduction in their seizure frequency, including 21.7%, 10.7%, and 11.0% who became seizure free, respectively. At 24 months after initiation, 29 patients remained on the diet, and 28 patients had a > 90% seizure reduction, including five became seizure free. At 36 months after initiation, 7 patients remained on the diet, and all of them had a > 90% seizure reduction, including five became seizure free. No significant variables were related to the efficacy. Most complications were mild and reversible by conservative treatment. Gastrointestinal disturbances were the main complications, which included vomiting, diarrhea, constipation, and abdominal cramp. Severe complications occurred in four cases, including severe metabolic disturbances and severe pneumonia. The KD is a safe and effective alternative therapy for intractable childhood epilepsy.

Short-term effect of ECT in middle-aged and elderly patients with intractable catatonic schizophrenia.

PubMed

Suzuki, Kazumasa; Awata, Shuichi; Matsuoka, Hiroo

2003-06-01

The management of middle-aged and elderly patients with catatonic schizophrenia has long been a major problem in clinical geriatric psychiatry. Most cases are intractable because of medication resistance, medication intolerance, or severe medical conditions. Electroconvulsive therapy (ECT) is recognized as one of the most efficacious therapies for catatonic schizophrenia. Thus, we conducted a prospective study of the short-term effect of acute ECT on middle-aged and elderly patients with intractable catatonic schizophrenia. Subjects were nine consecutive patients older than 45 years who had fulfilled the DSM-IV criteria for catatonic-type schizophrenia and had been referred for first-time acute ECT after other treatments had failed. The patients were treated at Tohoku University Hospital between January 1998 and March 2002. We evaluated the clinical response of these patients to acute ECT by means of the brief psychiatric rating scale (BPRS). We also evaluated adverse effects of acute ECT. The response rate was 100%. The total BPRS score was improved in all nine subjects at the end of the ECT course and 1 week after the final session in comparison with the total pre-ECT BPRS score (11.9 +/- 7.5 and 9.3 +/- 9.2 versus 57.1 +/- 13.1, respectively, p = 0.008, p = 0.008). The total Global Assessment of Functioning score was also improved significantly (from 10.8 +/- 9.4 just before ECT to 61.6 +/- 18.9 1 week after ECT, p = 0.008). Guy's five factors (thought disturbance, activation, anxiety-depression, hostility-suspiciousness, and anergia) improved significantly (p = 0.008, p = 0.008, p = 0.018, p = 0.012, p = 0.008, respectively). One patient showed supraventricular premature contractions (SVPCs) during an ECT seizure. After some ECT sessions, three patients exhibited mild to moderate delirium that disappeared within 3 days. However, no patient experienced a severe cognitive or physical adverse effect during the course of ECT. Acute ECT has a good short-term effect on middle-aged and elderly patients with intractable catatonic schizophrenia and appears to be safe. Our results indicate that systematic studies on a large scale are warranted for further investigation of the efficacy and safety of acute ECT for treating middle-aged and elderly patients with catatonic schizophrenia.

Subacute and chronic electrical stimulation of the hippocampus on intractable temporal lobe seizures: preliminary report.

PubMed

Velasco, A L; Velasco, M; Velasco, F; Menes, D; Gordon, F; Rocha, L; Briones, M; Márquez, I

2000-01-01

Recent animal experiments show that the application of an electrical stimulus to the amygdala or hippocampus following the kindling stimulus produced a significant and long-lasting suppressive effect on this experimental model of epilepsy. This is a preliminary report on the development of a surgical neuromodulatory procedure by chronic electrical stimulation of the hippocampus (CHCS) for control of intractable temporal lobe seizures in patients in whom anterior temporal lobectomy is not advisable, i.e., patients with bilateral temporal foci or a unilateral focus spreading to surrounding cerebral regions of the dominant hemisphere. This work was divided in two main consecutive stages. In the first stage, we demonstrated that subacute hippocampal stimulation (SAHCS) blocks intractable temporal lobe epileptogenesis with no additional damage to the stimulated tissue, and in a second stage, we attempt to demonstrate that CHCS may produce a sustained, long-lasting antiepileptic condition without additional undesirable effects on language and memory. In addition, taking advantage of this unique and ethically permissible situation, we attempt to determine whether or not the antiepileptic effects of SAHCS and CHCS are due to inhibition of the stimulation of hippocampal tissue by means of a number of electrophysiological, single photon computed tomography (SPECT) perfusion, and autoradiographic techniques.SAHCS during 3-4 weeks prior to anterior temporal lobectomy applied to a critical area located either at the anterior Pes hippocampus close to the amygdala or at the parahippocampal gyrus close to the entorhinal cortex abolished clinical seizures and significantly decreased the number of interictal spikes at focus after 5-6 days. Microscopy analysis of the stimulated tissue showed no evident histopathological differences between stimulated vs. non-stimulated hippocampal tissues. Additionally, CHCS persistently blocked temporal lobe epileptogenesis for 3-4 months with no apparent additional undesirable effects on short memory. Also, inhibition of the stimulated hippocampus seems to be one of the possible mechanisms underlying the beneficial antiepileptic effects of SAHCS and CHCS. This was revealed by increased threshold and decreased duration of the afterdischarges induced by hippocampal stimulation, flattening of the hippocampal-evoked response recovery cycles, SPECT hypoperfusion of the hippocampal region, and increased hippocampal benzodiazepine receptor binding. Future studies increasing the number and time of follow-up of patients under hippocampal stimulation are necessary before considering CHCS a reliable procedure for controlling intractable temporal lobe seizures.

(Re)Conceptualising the Academy: Institutional Development of and beyond the Third Mission

ERIC Educational Resources Information Center

Vorley, Tim; Nelles, Jen

2008-01-01

Framed in terms of the Third Mission, the "enterprise" or "entrepreneurial" university has increasingly become normalised in public policy; however there remains much contention about the implication of third stream activities. There is little rigorous evidence as to whether the Third Mission adversely affects teaching and/or (basic) research.…

Protect and Survive: "Whiteness" and the Middle-Class Family in Civil Defence Pedagogies

ERIC Educational Resources Information Center

Preston, John

2008-01-01

"Civil defence pedagogies" normalise continuous emergency through educational channels such as school, community and adult education. Using critical whiteness studies, and critiques of white supremacy from critical race theory, as a conceptual base, the protection of whiteness, and particularly the white middle-class family, is considered to be…

The "End" of Kant-in-Himself: Nietzschean Difference

ERIC Educational Resources Information Center

Fitzsimons, Peter

2007-01-01

Kant's over-reliance on universal reason and his subjection of free will to the moral law can be seen as normalising a particular and restrictive view of autonomous human existence--a view implicit in liberal accounts of education. Drawing on Nietzsche's critique of Kantian thought, this paper argues that the transcendental and unattainable realm…

Contesting Borders: A Challenge to Some Paradigmatic Assumptions of Intercultural and Comparative Education

ERIC Educational Resources Information Center

Bash, Leslie; Gundara, Jagdish

2012-01-01

Both intercultural education and comparative education have conventionally assumed the primacy of territoriality and sovereignty. This paper engages critically with these assumptions and, in turn, highlights the historical fluidity of nation states while seeking to normalise the process of geographical movement of populations. As such, a number of…

The Policy Discourse of Networking and Its Effect on School Autonomy: A Foucauldian Interpretation

ERIC Educational Resources Information Center

Mifsud, Denise

2016-01-01

Policy discourse officially operates to distinctly influence public perception in an irrevocable and normalising manner. In a Maltese educational scenario of gradual decentralisation and increased accountability, I explore the "effects" of both the global and the local policy discourse of networks and networking on the practising…

Disability and Popular Common Sense in India: Noun versus Adjective

ERIC Educational Resources Information Center

Shahid, Mohd; Raza, Md. Shahid; Alam, Md. Aftab

2016-01-01

Reflecting through the Indian experiences, a brief attempt is made to explore how disability as a noun takes shape in popular common sense "call names" (adjectives) and how does the popular common sense legitimise and normalise the oppressive language and the oppressed reality of the persons with disabilities? In the Indian context, the…

The Use of Educational Objects

ERIC Educational Resources Information Center

Stearns, Clio

2016-01-01

This conceptual paper looks at the Winnicottian notion of object use as it relates to education. Object use is understood as the process of attaching to but then attempting to destroy the educator in an effort to create new knowledge and relationships. The paper argues for educational object use as a way of understanding and normalising resistance…

An ERP Investigation of Regional and Foreign Accent Processing

ERIC Educational Resources Information Center

Goslin, Jeremy; Duffy, Hester; Floccia, Caroline

2012-01-01

This study used event-related potentials (ERPs) to examine whether we employ the same normalisation mechanisms when processing words spoken with a regional accent or foreign accent. Our results showed that the Phonological Mapping Negativity (PMN) following the onset of the final word of sentences spoken with an unfamiliar regional accent was…

Normative "Sexual" Knowledge and Critique as a Mode of Resistance--A Response to Damien Riggs

ERIC Educational Resources Information Center

Burns, Kellie

2013-01-01

In this response to Damien Riggs' analysis of sex education websites, the author draws on Foucault's understanding of knowledge, power and governmentality to understand how some forms of knowledge about sex and sexuality become normalised "official knowledge" that frame institutional policies and practices and shape everyday discourses. Foucault…

Choosing to Lose our Gender Expertise: Queering Sex/Gender in School Settings

ERIC Educational Resources Information Center

DePalma, Renee

2013-01-01

Most people, school teachers and children included, are altogether too sure about what gender is: there are two "opposite" sexes, man and woman, and gender is the inevitable categorical expression of natural sex. Like all commonsense views, however, the gender binary has been socially constructed through normalising discourses that frame…

Politics and Play: Meditations on Rhetorical Bodily Performance

ERIC Educational Resources Information Center

Pauliny, Tara

2013-01-01

Focusing on the drag king performances of Christie Whisman, who lived and worked in Columbus, Ohio, USA, from 1999 to 2001, this essay argues that rhetorical bodily performances have the capacity not only to subvert normalised notions of identity categories, but that such performances can also create alternate pedagogical sites that persuasively…

Regimes of Performance: Practices of the Normalised Self in the Neoliberal University

ERIC Educational Resources Information Center

Morrissey, John

2015-01-01

Universities today inescapably find themselves part of nationally and globally competitive networks that appear firmly inflected by neoliberal concerns of rankings, benchmarking and productivity. This, of course, has in turn led to progressively anticipated and regulated forms of academic subjectivity that many fear are overly econo-centric in…

Interrupting the Symphony: Unpacking the Importance Placed on Classical Concert Experiences

ERIC Educational Resources Information Center

Hess, Juliet

2018-01-01

The Toronto Symphony Orchestra presents a series of youth concerts each year to introduce and attract younger audiences to the symphony. Music teachers often attend these concerts with students, and the importance of such experiences is frequently emphasised and normalised. This article explores the historical roots of the following relations,…

Inference of financial networks using the normalised mutual information rate.

PubMed

Goh, Yong Kheng; Hasim, Haslifah M; Antonopoulos, Chris G

2018-01-01

In this paper, we study data from financial markets, using the normalised Mutual Information Rate. We show how to use it to infer the underlying network structure of interrelations in the foreign currency exchange rates and stock indices of 15 currency areas. We first present the mathematical method and discuss its computational aspects, and apply it to artificial data from chaotic dynamics and to correlated normal-variates data. We then apply the method to infer the structure of the financial system from the time-series of currency exchange rates and stock indices. In particular, we study and reveal the interrelations among the various foreign currency exchange rates and stock indices in two separate networks, of which we also study their structural properties. Our results show that both inferred networks are small-world networks, sharing similar properties and having differences in terms of assortativity. Importantly, our work shows that global economies tend to connect with other economies world-wide, rather than creating small groups of local economies. Finally, the consistent interrelations depicted among the 15 currency areas are further supported by a discussion from the viewpoint of economics.

Cloud-based adaptive exon prediction for DNA analysis.

PubMed

Putluri, Srinivasareddy; Zia Ur Rahman, Md; Fathima, Shaik Yasmeen

2018-02-01

Cloud computing offers significant research and economic benefits to healthcare organisations. Cloud services provide a safe place for storing and managing large amounts of such sensitive data. Under conventional flow of gene information, gene sequence laboratories send out raw and inferred information via Internet to several sequence libraries. DNA sequencing storage costs will be minimised by use of cloud service. In this study, the authors put forward a novel genomic informatics system using Amazon Cloud Services, where genomic sequence information is stored and accessed for processing. True identification of exon regions in a DNA sequence is a key task in bioinformatics, which helps in disease identification and design drugs. Three base periodicity property of exons forms the basis of all exon identification techniques. Adaptive signal processing techniques found to be promising in comparison with several other methods. Several adaptive exon predictors (AEPs) are developed using variable normalised least mean square and its maximum normalised variants to reduce computational complexity. Finally, performance evaluation of various AEPs is done based on measures such as sensitivity, specificity and precision using various standard genomic datasets taken from National Center for Biotechnology Information genomic sequence database.

Poisson mixture model for measurements using counting.

PubMed

Miller, Guthrie; Justus, Alan; Vostrotin, Vadim; Dry, Donald; Bertelli, Luiz

2010-03-01

Starting with the basic Poisson statistical model of a counting measurement process, 'extraPoisson' variance or 'overdispersion' are included by assuming that the Poisson parameter representing the mean number of counts itself comes from another distribution. The Poisson parameter is assumed to be given by the quantity of interest in the inference process multiplied by a lognormally distributed normalising coefficient plus an additional lognormal background that might be correlated with the normalising coefficient (shared uncertainty). The example of lognormal environmental background in uranium urine data is discussed. An additional uncorrelated background is also included. The uncorrelated background is estimated from a background count measurement using Bayesian arguments. The rather complex formulas are validated using Monte Carlo. An analytical expression is obtained for the probability distribution of gross counts coming from the uncorrelated background, which allows straightforward calculation of a classical decision level in the form of a gross-count alarm point with a desired false-positive rate. The main purpose of this paper is to derive formulas for exact likelihood calculations in the case of various kinds of backgrounds.

Lifting the weight of a diagnosis-related groups family change: a comparison between refined and non-refined DRG systems for top-down cost accounting and efficiency indicators.

PubMed

Zlotnik, Alexander; Cuchi, Miguel Alfaro; Pérez Pérez, Maria Carmen

Public healthcare providers in all Spanish Regions - Autonomous Communities (ACs) use All Patients Diagnosis-Related Groups (AP-DRGs) for billing non-insured patients, cost accounting and inpatient efficiency indicators. A national migration to All Patients Refined Diagnosis-Related Groups (APR-DRGs) has been scheduled for 2016. The analysis was performed on 202,912 inpatient care episodes ranging from 2005 to 2010. All episodes were grouped using AP-DRG v25.0 and APR-DRG v24.0. Normalised DRG weight variations for an AP-DRG to APR-DRG migration scenario were calculated and compared. Major differences exist between normalised weights for inpatient episodes depending on the DRGs family used. The usage of the APR-DRG system in Spain without any adjustments, as it was developed in the United States, should be approached with care. In order to avoid reverse incentives and provider financial risks, coding practices should be reviewed and structural differences between DRG families taken into account.

Lesion identification using unified segmentation-normalisation models and fuzzy clustering

PubMed Central

Seghier, Mohamed L.; Ramlackhansingh, Anil; Crinion, Jenny; Leff, Alexander P.; Price, Cathy J.

2008-01-01

In this paper, we propose a new automated procedure for lesion identification from single images based on the detection of outlier voxels. We demonstrate the utility of this procedure using artificial and real lesions. The scheme rests on two innovations: First, we augment the generative model used for combined segmentation and normalization of images, with an empirical prior for an atypical tissue class, which can be optimised iteratively. Second, we adopt a fuzzy clustering procedure to identify outlier voxels in normalised gray and white matter segments. These two advances suppress misclassification of voxels and restrict lesion identification to gray/white matter lesions respectively. Our analyses show a high sensitivity for detecting and delineating brain lesions with different sizes, locations, and textures. Our approach has important implications for the generation of lesion overlap maps of a given population and the assessment of lesion-deficit mappings. From a clinical perspective, our method should help to compute the total volume of lesion or to trace precisely lesion boundaries that might be pertinent for surgical or diagnostic purposes. PMID:18482850

Inference of financial networks using the normalised mutual information rate

PubMed Central

2018-01-01

In this paper, we study data from financial markets, using the normalised Mutual Information Rate. We show how to use it to infer the underlying network structure of interrelations in the foreign currency exchange rates and stock indices of 15 currency areas. We first present the mathematical method and discuss its computational aspects, and apply it to artificial data from chaotic dynamics and to correlated normal-variates data. We then apply the method to infer the structure of the financial system from the time-series of currency exchange rates and stock indices. In particular, we study and reveal the interrelations among the various foreign currency exchange rates and stock indices in two separate networks, of which we also study their structural properties. Our results show that both inferred networks are small-world networks, sharing similar properties and having differences in terms of assortativity. Importantly, our work shows that global economies tend to connect with other economies world-wide, rather than creating small groups of local economies. Finally, the consistent interrelations depicted among the 15 currency areas are further supported by a discussion from the viewpoint of economics. PMID:29420644

Reluctant Rural Regionalists

ERIC Educational Resources Information Center

Hall, Peter V.; Stern, Pamela

2009-01-01

Recently, scholars have begun to explore questions of regionalism and regionalization in rural contexts. Regionalism is often understood and presented as a pragmatic solution to intractable problems of fragmentation, inefficiency, accountability, spillover and neglect in the face of economic restructuring and other external threats. These…

About the Frederick National Laboratory for Cancer Research | FNLCR Staging

Cancer.gov

The Frederick National Lab is a Federally Funded Research and Development Center (FFRDC) sponsored by the National Cancer Institute (NCI) and operated by Leidos Biomedical Research, Inc. The lab addresses some of the most urgent and intractable probl

A normalisation framework for (hyper-)spectral imagery

NASA Astrophysics Data System (ADS)

Grumpe, Arne; Zirin, Vladimir; Wöhler, Christian

2015-06-01

It is well known that the topography has an influence on the observed reflectance spectra. This influence is not compensated by spectral ratios, i.e. the effect is wavelength dependent. In this work, we present a complete normalisation framework. The surface temperature is estimated based on the measured surface reflectance. To normalise the spectral reflectance with respect to a standard illumination geometry, spatially varying reflectance parameters are estimated based on a non-linear reflectance model. The reflectance parameter estimation has one free parameter, i.e. a low-pass function, which sets the scale of the spatial-variance, i.e. the lateral resolution of the reflectance parameter maps. Since the local surface topography has a major influence on the measured reflectance, often neglected shading information is extracted from the spectral imagery and an existing topography model is refined to image resolution. All methods are demonstrated on the Moon Mineralogy Mapper dataset. Additionally, two empirical methods are introduced that deal with observed systematic reflectance changes in co-registered images acquired at different phase angles. These effects, however, may also be caused by the sensor temperature, due to its correlation with the phase angle. Surface temperatures above 300 K are detected and are very similar to a reference method. The proposed method, however, seems more robust in case of absorptions visible in the reflectance spectrum near 2000 nm. By introducing a low-pass into the computation of the reflectance parameters, the reflectance behaviour of the surfaces may be derived at different scales. This allows for an iterative refinement of the local surface topography using shape from shading and the computation reflectance parameters. The inferred parameters are derived from all available co-registered images and do not show significant influence of the local surface topography. The results of the empirical correction show that both proposed methods greatly reduce the influence of different phase angles or sensor temperatures.

Selection of novel reference genes for use in the human central nervous system: a BrainNet Europe Study.

PubMed

Durrenberger, Pascal F; Fernando, Francisca S; Magliozzi, Roberta; Kashefi, Samira N; Bonnert, Timothy P; Ferrer, Isidro; Seilhean, Danielle; Nait-Oumesmar, Brahim; Schmitt, Andrea; Gebicke-Haerter, Peter J; Falkai, Peter; Grünblatt, Edna; Palkovits, Miklos; Parchi, Piero; Capellari, Sabina; Arzberger, Thomas; Kretzschmar, Hans; Roncaroli, Federico; Dexter, David T; Reynolds, Richard

2012-12-01

The use of an appropriate reference gene to ensure accurate normalisation is crucial for the correct quantification of gene expression using qPCR assays and RNA arrays. The main criterion for a gene to qualify as a reference gene is a stable expression across various cell types and experimental settings. Several reference genes are commonly in use but more and more evidence reveals variations in their expression due to the presence of on-going neuropathological disease processes, raising doubts concerning their use. We conducted an analysis of genome-wide changes of gene expression in the human central nervous system (CNS) covering several neurological disorders and regions, including the spinal cord, and were able to identify a number of novel stable reference genes. We tested the stability of expression of eight novel (ATP5E, AARS, GAPVD1, CSNK2B, XPNPEP1, OSBP, NAT5 and DCTN2) and four more commonly used (BECN1, GAPDH, QARS and TUBB) reference genes in a smaller cohort using RT-qPCR. The most stable genes out of the 12 reference genes were tested as normaliser to validate increased levels of a target gene in CNS disease. We found that in human post-mortem tissue the novel reference genes, XPNPEP1 and AARS, were efficient in replicating microarray target gene expression levels and that XPNPEP1 was more efficient as a normaliser than BECN1, which has been shown to change in expression as a consequence of neuronal cell loss. We provide herein one more suitable novel reference gene, XPNPEP1, with no current neuroinflammatory or neurodegenerative associations that can be used for gene quantitative gene expression studies with human CNS post-mortem tissue and also suggest a list of potential other candidates. These data also emphasise the importance of organ/tissue-specific stably expressed genes as reference genes for RNA studies.

Amalgamation of Marginal Gains (AMG) as a potential system to deliver high-quality fundamental nursing care: A qualitative analysis of interviews from high-performance AMG sports and healthcare practitioners.

PubMed

Pentecost, Claire; Richards, David A; Frost, Julia

2017-11-28

To investigate the components of the Amalgamation of Marginal Gains (AMG) performance system to identify a set of principles that can be built into an innovative fundamental nursing care protocol. Nursing is urged to refocus on its fundamental care activities, but little evidence exists to guide practising nurses. Fundamental care is a combination of many small behaviours aimed at meeting a person's care needs. AMG is a successful system of performance management that focusses on small (or marginal) gains, and might provide a new delivery framework for fundamental nursing care. Qualitative interview study. We undertook in-depth interviews with healthcare and sports professionals experienced in AMG. We analysed data using open coding in a framework analysis, and then interrogated the data using Normalisation Process Theory (NPT). We triangulated findings with AMG literature to develop an intervention logic model. We interviewed 20 AMG practitioners. AMG processes were as follows: focusing on many details to optimise performance, identification of marginal gains using different sources, understanding current versus optimum performance, monitoring at micro and macro level and strong leadership. Elements of normalisation were as follows: whole team belief in AMG to improve performance, a collective desire for excellence using evidence-based actions, whole team engagement to identify choose and implement changes, and individual and group responsibility for monitoring performance. We have elicited the processes described by AMG innovators in health care and sport and have mapped the normalisation potential and work required to embed such a system into nursing practice. The development of our logic model based on AMG and NPT may provide a practical framework for improving fundamental nursing care and is ripe for further development and testing in clinical trials. © 2017 The Authors Journal of Clinical Nursing Published by John Wiley & Sons Ltd.

Identifying Stable Reference Genes for qRT-PCR Normalisation in Gene Expression Studies of Narrow-Leafed Lupin (Lupinus angustifolius L.).

PubMed

Taylor, Candy M; Jost, Ricarda; Erskine, William; Nelson, Matthew N

2016-01-01

Quantitative Reverse Transcription PCR (qRT-PCR) is currently one of the most popular, high-throughput and sensitive technologies available for quantifying gene expression. Its accurate application depends heavily upon normalisation of gene-of-interest data with reference genes that are uniformly expressed under experimental conditions. The aim of this study was to provide the first validation of reference genes for Lupinus angustifolius (narrow-leafed lupin, a significant grain legume crop) using a selection of seven genes previously trialed as reference genes for the model legume, Medicago truncatula. In a preliminary evaluation, the seven candidate reference genes were assessed on the basis of primer specificity for their respective targeted region, PCR amplification efficiency, and ability to discriminate between cDNA and gDNA. Following this assessment, expression of the three most promising candidates [Ubiquitin C (UBC), Helicase (HEL), and Polypyrimidine tract-binding protein (PTB)] was evaluated using the NormFinder and RefFinder statistical algorithms in two narrow-leafed lupin lines, both with and without vernalisation treatment, and across seven organ types (cotyledons, stem, leaves, shoot apical meristem, flowers, pods and roots) encompassing three developmental stages. UBC was consistently identified as the most stable candidate and has sufficiently uniform expression that it may be used as a sole reference gene under the experimental conditions tested here. However, as organ type and developmental stage were associated with greater variability in relative expression, it is recommended using UBC and HEL as a pair to achieve optimal normalisation. These results highlight the importance of rigorously assessing candidate reference genes for each species across a diverse range of organs and developmental stages. With emerging technologies, such as RNAseq, and the completion of valuable transcriptome data sets, it is possible that other potentially more suitable reference genes will be identified for this species in future.

Identifying Stable Reference Genes for qRT-PCR Normalisation in Gene Expression Studies of Narrow-Leafed Lupin (Lupinus angustifolius L.)

PubMed Central

Erskine, William; Nelson, Matthew N.

2016-01-01

Quantitative Reverse Transcription PCR (qRT-PCR) is currently one of the most popular, high-throughput and sensitive technologies available for quantifying gene expression. Its accurate application depends heavily upon normalisation of gene-of-interest data with reference genes that are uniformly expressed under experimental conditions. The aim of this study was to provide the first validation of reference genes for Lupinus angustifolius (narrow-leafed lupin, a significant grain legume crop) using a selection of seven genes previously trialed as reference genes for the model legume, Medicago truncatula. In a preliminary evaluation, the seven candidate reference genes were assessed on the basis of primer specificity for their respective targeted region, PCR amplification efficiency, and ability to discriminate between cDNA and gDNA. Following this assessment, expression of the three most promising candidates [Ubiquitin C (UBC), Helicase (HEL), and Polypyrimidine tract-binding protein (PTB)] was evaluated using the NormFinder and RefFinder statistical algorithms in two narrow-leafed lupin lines, both with and without vernalisation treatment, and across seven organ types (cotyledons, stem, leaves, shoot apical meristem, flowers, pods and roots) encompassing three developmental stages. UBC was consistently identified as the most stable candidate and has sufficiently uniform expression that it may be used as a sole reference gene under the experimental conditions tested here. However, as organ type and developmental stage were associated with greater variability in relative expression, it is recommended using UBC and HEL as a pair to achieve optimal normalisation. These results highlight the importance of rigorously assessing candidate reference genes for each species across a diverse range of organs and developmental stages. With emerging technologies, such as RNAseq, and the completion of valuable transcriptome data sets, it is possible that other potentially more suitable reference genes will be identified for this species in future. PMID:26872362

The stories we tell: qualitative research interviews, talking technologies and the 'normalisation' of life with HIV.

PubMed

Mazanderani, Fadhila; Paparini, Sara

2015-04-01

Since the earliest days of the HIV/AIDS epidemic, talking about the virus has been a key way affected communities have challenged the fear and discrimination directed against them and pressed for urgent medical and political attention. Today, HIV/AIDS is one of the most prolifically and intimately documented of all health conditions, with entrenched infrastructures, practices and technologies--what Vinh-Kim Nguyen has dubbed 'confessional technologies'--aimed at encouraging those affected to share their experiences. Among these technologies, we argue, is the semi-structured interview: the principal methodology used in qualitative social science research focused on patient experiences. Taking the performative nature of the research interview as a talking technology seriously has epistemological implications not merely for how we interpret interview data, but also for how we understand the role of research interviews in the enactment of 'life with HIV'. This paper focuses on one crucial aspect of this enactment: the contemporary 'normalisation' of HIV as 'just another' chronic condition--a process taking place at the level of individual subjectivities, social identities, clinical practices and global health policy, and of which social science research is a vital part. Through an analysis of 76 interviews conducted in London (2009-10), we examine tensions in the experiential narratives of individuals living with HIV in which life with the virus is framed as 'normal', yet where this 'normality' is beset with contradictions and ambiguities. Rather than viewing these as a reflection of resistances to or failures of the enactment of HIV as 'normal', we argue that, insofar as these contradictions are generated by the research interview as a distinct 'talking technology', they emerge as crucial to the normative (re)production of what counts as 'living with HIV' (in the UK) and are an inherent part of the broader performative 'normalisation' of the virus. Copyright © 2015 Elsevier Ltd. All rights reserved.

The applicability of normalisation process theory to speech and language therapy: a review of qualitative research on a speech and language intervention.

PubMed

James, Deborah M

2011-08-12

The Bercow review found a high level of public dissatisfaction with speech and language services for children. Children with speech, language, and communication needs (SLCN) often have chronic complex conditions that require provision from health, education, and community services. Speech and language therapists are a small group of Allied Health Professionals with a specialist skill-set that equips them to work with children with SLCN. They work within and across the diverse range of public service providers. The aim of this review was to explore the applicability of Normalisation Process Theory (NPT) to the case of speech and language therapy. A review of qualitative research on a successfully embedded speech and language therapy intervention was undertaken to test the applicability of NPT. The review focused on two of the collective action elements of NPT (relational integration and interaction workability) using all previously published qualitative data from both parents and practitioners' perspectives on the intervention. The synthesis of the data based on the Normalisation Process Model (NPM) uncovered strengths in the interpersonal processes between the practitioners and parents, and weaknesses in how the accountability of the intervention is distributed in the health system. The analysis based on the NPM uncovered interpersonal processes between the practitioners and parents that were likely to have given rise to successful implementation of the intervention. In previous qualitative research on this intervention where the Medical Research Council's guidance on developing a design for a complex intervention had been used as a framework, the interpersonal work within the intervention had emerged as a barrier to implementation of the intervention. It is suggested that the design of services for children and families needs to extend beyond the consideration of benefits and barriers to embrace the social processes that appear to afford success in embedding innovation in healthcare.

An application of Extended Normalisation Process Theory in a randomised controlled trial of a complex social intervention: Process evaluation of the Strengthening Families Programme (10-14) in Wales, UK.

PubMed

Segrott, Jeremy; Murphy, Simon; Rothwell, Heather; Scourfield, Jonathan; Foxcroft, David; Gillespie, David; Holliday, Jo; Hood, Kerenza; Hurlow, Claire; Morgan-Trimmer, Sarah; Phillips, Ceri; Reed, Hayley; Roberts, Zoe; Moore, Laurence

2017-12-01

Process evaluations generate important data on the extent to which interventions are delivered as intended. However, the tendency to focus only on assessment of pre-specified structural aspects of fidelity has been criticised for paying insufficient attention to implementation processes and how intervention-context interactions influence programme delivery. This paper reports findings from a process evaluation nested within a randomised controlled trial of the Strengthening Families Programme 10-14 (SFP 10-14) in Wales, UK. It uses Extended Normalisation Process Theory to theorise how interaction between SFP 10-14 and local delivery systems - particularly practitioner commitment/capability and organisational capacity - influenced delivery of intended programme activities: fidelity (adherence to SFP 10-14 content and implementation requirements); dose delivered; dose received (participant engagement); participant recruitment and reach (intervention attendance). A mixed methods design was utilised. Fidelity assessment sheets (completed by practitioners), structured observation by researchers, and routine data were used to assess: adherence to programme content; staffing numbers and consistency; recruitment/retention; and group size and composition. Interviews with practitioners explored implementation processes and context. Adherence to programme content was high - with some variation, linked to practitioner commitment to, and understanding of, the intervention's content and mechanisms. Variation in adherence rates was associated with the extent to which multi-agency delivery team planning meetings were held. Recruitment challenges meant that targets for group size/composition were not always met, but did not affect adherence levels or family engagement. Targets for staffing numbers and consistency were achieved, though capacity within multi-agency networks reduced over time. Extended Normalisation Process Theory provided a useful framework for assessing implementation and explaining variation by examining intervention-context interactions. Findings highlight the need for process evaluations to consider both the structural and process components of implementation to explain whether programme activities are delivered as intended and why.

GROUNDWATER IMPACTED BY ACID MINE DRAINAGE

EPA Science Inventory

The generation and release of acidic, metal-rich water from mine wastes continues to be an intractable environmental problem. Although the effects of acid mine drainage (AMD) are most evident in surface waters, there is an obvious need for developing cost-effective approaches fo...

Capturing haplotypes in germplasm core collections

USDA-ARS?s Scientific Manuscript database

Genomewide data sets of single nucleotide polymorphisms (SNPs) offer great potential to improve ex situ conservation. Two factors impede their use for producing core collections. First, due to the large number of SNPs, the assembly of collections that maximize diversity may be intractable using ex...

As Bad As It Gets.

ERIC Educational Resources Information Center

Allen, Charlotte

1998-01-01

Many academic departments are damaged by deep resentments and intractable debates. Those that can't survive undergo administrative intervention. The experiences of three such departments are examined: anthropology at Columbia University (New York); literature at the University of California, Santa Cruz; and philosophy at Yale University…

90 Years of Rural Development Programs.

ERIC Educational Resources Information Center

Rasmussen, Wayne D.

1985-01-01

Discusses history of United States government programs to ameliorate rural living and economic conditions. Contrasts early successful efforts to improve physical characteristics--road, electricity--with recent lack of success in dealing with intractable problems--unemployment, persistent poverty. Chart of rural development actions outlines rural…

Long-term impact of the ketogenic diet on growth and resting energy expenditure in children with intractable epilepsy.

PubMed

Groleau, Veronique; Schall, Joan I; Stallings, Virginia A; Bergqvist, Christina A

2014-09-01

The long-term effects of the ketogenic diet, a high fat diet for treating intractable epilepsy, on resting energy expenditure (REE) are unknown. The aim of this study was to evaluate the impact of 15 months of ketogenic diet treatment on growth and REE in children with intractable epilepsy. Growth, body composition, and REE were assessed at baseline, 3 months and 15 months in 24 children (14 males, 10 females; mean age 5 y 6 mo [SD 26 mo], range 7 mo-6 y 5 mo), 10 with cerebral palsy [CP]). Fifteen were identified as ketogenic diet responders at 3 months and continued on the ketogenic diet until 15 months. These were compared to 75 healthy children (43 males, 32 females; mean age 6 y 3 mo [SD 21 mo] age range 2-9 y). REE was expressed as percentage predicted, growth as height (HAz) and weight (WAz) z-scores, and body composition as fat and fat free mass (FFM). HAz declined -0.2 and -0.6 from baseline to 3 months and 15 months respectively (p = 0.001), while WAz was unchanged. In ketogenic diet responders, FFM, age and CP diagnosis predicted REE (overall R(2) = 0.76, p<0.001) and REE did not change. REE adjusted for FFM was lower (p<0.01) in children with CP at baseline (mean [standard error], -143[51] kcals/d) and 15 months (-198[53] kcals/d) compared to the healthy children. After 15 months of the ketogenic diet, linear growth status declined while weight status and REE were unchanged. REE remained reduced in children with CP. © 2014 Mac Keith Press.

Long-term impact of the ketogenic diet on growth and resting energy expenditure in children with intractable epilepsy

PubMed Central

GROLEAU, VERONIQUE; SCHALL, JOAN I; STALLINGS, VIRGINIA A; BERGQVIST, CHRISTINA A

2014-01-01

AIM The long-term effects of the ketogenic diet, a high fat diet for treating intractable epilepsy, on resting energy expenditure (REE) are unknown. The aim of this study was to evaluate the impact of 15 months of ketogenic diet treatment on growth and REE in children with intractable epilepsy. METHOD Growth, body composition and REE were assessed at baseline, 3 and 15 months in 24 children (14 males, 10 females; mean age 5y 6mo (SD 26mo), range 7mo–6y 5mo), 10 with cerebral palsy [CP]). Fifteen were identified as ketogenic diet responders at 3 months and continued on the ketogenic diet until 15 months. These were compared to 75 healthy children (43 males, 32 females; mean age 6y 3mo [SD 21mo] age range 2–9y). REE was expressed as percentage predicted, growth as height (HAz) and weight (WAz) z-scores, and body composition as fat and fat free mass (FFM). RESULTS HAz declined −0.2 and −0.6 from baseline to 3 and 15 months, respectively (p=0.001), while WAz was unchanged. In ketogenic diet responders, FFM, age and CP diagnosis predicted REE (overall R2=0.76, p<0.001) and REE did not change. REE adjusted for FFM was lower (p<0.01) in children with CP at baseline (mean [standard error], −143[51] kcals/d) and 15 months (−198[53] kcals/d) compared to the healthy children. INTERPRETATION After 15 months of the ketogenic diet, linear growth status declined while weight status and REE were unchanged. REE remained reduced in children with CP. PMID:24749520

The Effect of the Ketogenic Diet on the Vascular Structure and Functions in Children With Intractable Epilepsy.

PubMed

Özdemir, Rahmi; Güzel, Orkide; Küçük, Mehmet; Karadeniz, Cem; Katipoglu, Nagehan; Yılmaz, Ünsal; Yılmazer, Murat Muhtar; Meşe, Timur

2016-03-01

We aimed to determine the midterm effect of a ketogenic diet on serum lipid levels, carotid intima-media thickness, and the elastic properties of the carotid artery and the aorta in patients with intractable epilepsy. A total of 52 children aged between 12 months and 18 years with intractable epilepsy who started the ketogenic diet from September 2014 to September 2015 were included into this prospective study. Carotid intima-media thickness and the elastic properties of the carotid artery and the aorta were assessed by echocardiography in all cases before beginning of the ketogenic diet and after at least 12 months on the ketogenic diet. Twenty-one patients at the third month and 25 patients at the first year of the ketogenic diet were seizure free. A reduction of greater than 90% in the seizure frequency was achieved in three patients at the sixth month and in five patients at the first year of the treatment. The serum levels of total cholesterol, low-density lipoprotein, and triglyceride were increased significantly at a median of 12.6 months (range: 12 to 13.5 months) of the ketogenic diet treatment, whereas serum levels of high-density lipoprotein did not change. Carotid intima-media thickness, aortic and carotid strain, the stiffness index, distensibility, and elastic modulus did not change after 12 months of the ketogenic diet therapy. Olive oil-based ketogenic diet appears to have no disturbing effect on the carotid intima-media thickness and the elastic properties of the aorta and the carotid artery in epileptic children, although it may be associated with increased concentrations of serum lipids. Copyright © 2016 Elsevier Inc. All rights reserved.

Development of a job stressor scale for nurses caring for patients with intractable neurological diseases.

PubMed

Ando, Yukako; Kataoka, Tsuyoshi; Okamura, Hitoshi; Tanaka, Katsutoshi; Kobayashi, Toshio

2013-12-01

The purpose of this research is to verify the reliability and validity of a job stressor scale for nurses caring for patients with intractable neurological diseases. A mail survey was conducted using a self-report questionnaire. The subjects were 263 nurses and assistant nurses working in wards specializing in intractable neurological diseases. The response rate was 71.9% (valid response rate, 66.2%). With regard to reliability, internal consistency and stability were assessed. Internal consistency was examined via Cronbach's alpha. For stability, the test-retest method was performed and stability was examined via intraclass correlation coefficients. With regard to validity, factor validity, criterion-related validity, and content validity were assessed. Exploratory factor analysis was used for factor validity. For criterion-related validity, an existing scale was used as an external criterion; concurrent validity was examined via Spearman's rank correlation coefficients. As a result of analysis, there were 26 items in the scale created with an eight factor structure. Cronbach's a for the 26 items was 0.90; with the exception of two factors, alpha for all of the individual sub-factors was high at 0.7 or higher. The intraclass correlation coefficient for the 26 items was 0.89 (p < 0.001). With regard to criterion-related validity, concurrent validity was confirmed and the correlation coefficient with an external criterion was 0.73 (p < 0.001). For content validity, subjects who responded that "The questionnaire represents a stressor well or to a degree" accounted for 81% of the total responses. Reliability and validity were confirmed, so the scale created in the current research is a usable scale.

Intractable duodenal ulcer caused by transmural migration of gossypiboma into the duodenum--a case report and literature review.

PubMed

Lv, Yun-Xiao; Yu, Cheng-Chan; Tung, Chun-Fang; Wu, Cheng-Chung

2014-06-10

Gossypiboma is a term used to describe a mass that forms around a cotton sponge or abdominal compress accidentally left in a patient during surgery. Transmural migration of an intra-abdominal gossypiboma has been reported to occur in the digestive tract, bladder, vagina and diaphragm. Open surgery is the most common approach in the treatment of gossypiboma. However, gossypibomas can be extracted by endoscopy while migrating into the digestive tract. We report a case of intractable duodenal ulcer caused by transmural migration of gossypiboma successfully treated by duodenorrhaphy. A systemic literature review is provided and a scheme of the therapeutic approach is proposed. A 61-year-old Han Chinese man presented with intermittent epigastric pain for the last 10 months. He had undergone laparoscopic cholecystectomy conversion to open cholecystectomy for acute gangrenous cholecystitis 10 months ago at another hospital. Transmural migration of gossypiboma into the duodenum was found. Endoscopic intervention failed to remove the entire gauze, and duodenal ulcer caused by the gauze persisted. Surgical intervention was performed and the gauze was removed successfully. The penetrated ulcer was repaired with duodenorrhaphy. The postoperative period was uneventful.We systematically reviewed the literature on transmural migration of gossypiboma into duodenum and present an overview of published cases. Our PubMed search yielded seven reports of transmural migration of retained surgical sponge into the duodenum. Surgical interventions were necessary in two patients. Transmural migration of gossypiboma into the duodenum is a rare surgical complication. The treatment strategies include endoscopic extraction and surgical intervention. Prompt surgical intervention should be considered for emergent conditions such as active bleeding, gastrointestinal obstruction, or intra-abdominal sepsis. For non-emergent conditions, surgical intervention could be considered for intractable cases in which endoscopic extraction failed.

Seizure frequency reduction after posteromedial hypothalamus deep brain stimulation in drug-resistant epilepsy associated with intractable aggressive behavior.

PubMed

Benedetti-Isaac, Juan C; Torres-Zambrano, Martin; Vargas-Toscano, Andres; Perea-Castro, Esther; Alcalá-Cerra, Gabriel; Furlanetti, Luciano L; Reithmeier, Thomas; Tierney, Travis S; Anastasopoulos, Constantin; Fonoff, Erich T; Contreras Lopez, William Omar

2015-07-01

The aim of this study was to analyze the impact of deep brain stimulation (DBS) of the posteromedial hypothalamus (pHyp) on seizure frequency in patients with drug-resistant epilepsy (DRE) associated with intractable aggressive behavior (IAB). Data were collected retrospectively from nine patients, who received bilateral stereotactic pHyp-DBS for the treatment of medically intractable aggressive behavior, focusing on five patients who also had DRE. All patients were treated at the Colombian Center and Foundation of Epilepsy and Neurological Diseases-FIRE (Chapter of the International Bureau for Epilepsy), in Cartagena de Indias, Colombia from 2010 to 2014. Each case was evaluated previously by the institutional ethical committee, assessing the impact of aggressive behavior on the patient's family and social life, the humanitarian aspects of preserving the safety and physical integrity of caregivers, and the need to prevent self-harm. Epilepsy improvement was measured by a monthly seizure reduction percentage, comparing preoperative state and outcome. Additional response to epilepsy was defined by reduction of the antiepileptic drugs (AEDs). Aggressive behavior response was measured using the Overt Aggression Scale (OAS). All the patients with DRE associated with IAB presented a significant decrease of the rate of epileptic seizures after up to 4 years follow-up, achieving a general 89.6% average seizure reduction from the state before the surgery. Aggressiveness was significantly controlled, with evident improvement in the OAS, enhancing the quality of life of patients and families. In well-selected patients, DBS of the pHyp seems to be a safe and effective procedure for treatment of DRE associated with refractory aggressive behavior. Larger and prospective series are needed to define the pHyp as a target for DRE in different contexts. Wiley Periodicals, Inc. © 2015 International League Against Epilepsy.

The Government's role in regulating, coordinating, and standardizing the response to Alzheimer's disease: Anticipated international cooperation in the area of intractable and rare diseases.

PubMed

Tang, Qi; Song, Peipei; Xu, Lingzhong

2016-11-01

The World Health Organization (WHO) has emphasized that aging of the population is inextricably linked to many other global public health issues, such as universal health coverage, non-communicable diseases, and disability. However, Alzheimer's Disease International (ADI) estimates that 46.8 million elderly people worldwide were living with dementia in 2015. Alzheimer's disease (AD), the most common form of dementia, is one of the most common neurodegenerative diseases and is the main cause of cognitive impairment. AD will affect 5-7 out of every 100 older adults who are age 60 years or over. In response to the serious challenge posed by AD, governments are expected to play an important role in the prevention, diagnosis, and treatment of AD. As specific examples, i ) the Japanese Government has instituted and supported regulations to encourage the development of AD drugs in order to accelerate research and development of innovative drugs; ii ) the United States Government has cooperated with multiple partners such as non-governmental organizations in the response to AD; iii ) Chinese governmental measures have standardized clinical diagnosis and treatment as part of the response to AD, including eligible patients, diagnostic criteria, therapeutic schedules, drug selection, and required inspections; iv ) with political support from member governments, the European Union has issued guidelines and conducted clinical studies on medicines for the treatment of AD in order to ascertain the various stages of the disease and the relevance of biomarkers. AD is an intractable disease, so different countries need to share clinic trial information and cooperate in the conduct of those trials. International cooperation will play a key role in the response to other intractable and rare diseases.

Are HLA-DR or TAP genes genetic markers of severity in ulcerative colitis?

PubMed

Heresbach, D; Alizadeh, M; Reumaux, D; Colombel, J F; Delamaire, M; Danze, P M; Gosselin, M; Genetet, B; Bretagne, J F; Semana, G

1996-12-01

The pathogeny of ulcerative colitis (UC) is not yet elucidated, but some arguments suggest the implication of genetic factors. Among the candidate genes, those encoding for HLA class II genotypes have been extensively studied in UC; however, discordant data may be imputable to heterogeneity, characterized by immunological markers such as atypical ANCA (p-ANCA), or to inclusion of more or less intractable UC. The aim of our study is to evaluate the interest of HLA class II and TAP genetic markers to identify different clinical forms of UC, according to p-ANCA status. Unrelated patients with a history of UC (n = 91) and healthy control subjects with no personal or family history of inflammatory bowel diseases (IBD) (n = 200) were included. HLA-DRB1*03 was less frequent in UC patients than in healthy controls (8% vs 28%, PC < 0.03). No association was found with any TAP genotypes. Moreover, there was no association with the HLA-DR2 specificity, either in the entire group of UC patients (38% vs 28%) or in the p-ANCA-positive subgroup of patients (30%). The most consistent finding in the present study is that some genetic markers may characterize intractability in UC patients. HLA-DR2 was associated with poor prognosis, regardless of p-ANCA status. In HLA-DR2 and non-HLA-DR2 groups, colectomy was done in 55% and 27% of patients, respectively, (PC < 0.05). Furthermore, in non-HLA-DR2 patients, p-ANCA could be of interest to characterize those with more severe prognosis. Our results confirm the interest of genetic studies to define UC genetic susceptibility, taking into account intractability of the disease. They do not support the hypothesis that p-ANCA is a subclinical marker of genetic susceptibility to UC.

Postoperative MRI Evaluation of a Radiofrequency Cordotomy Lesion for Intractable Cancer Pain

PubMed Central

Vedantam, A.; Hou, P.; Chi, T.L.; Hess, K.R; Dougherty, P.M.; Bruera, E.; Viswanathan, A.

2017-01-01

BACKGROUND AND PURPOSE There are limited data on the use of postoperative imaging to evaluate the cordotomy lesion. We aimed to describe the cordotomy lesion by using postoperative MR imaging in patients after percutaneous cordotomy for intractable cancer pain. MATERIALS AND METHODS Postoperative MR imaging and clinical outcomes were prospectively obtained for 10 patients after percutaneous cordotomy for intractable cancer pain. Area, signal intensity, and location of the lesion were recorded. Clinical outcomes were measured by using the Visual Analog Scale and the Brief Pain Inventory–Short Form, and correlations with MR imaging metrics were evaluated. RESULTS Ten patients (5 men, 5 women; mean age, 58.5 ± 9.6 years) were included in this study. The cordotomy lesion was hyperintense with central hypointense foci on T2-weighted MR imaging, and it was centered in the anterolateral quadrant at the C1–C2 level. The mean percentage of total cord area lesioned was 24.9% ± 7.9%, and most lesions were centered in the dorsolateral region of the anterolateral quadrant (66% of the anterolateral quadrant). The number of pial penetrations correlated with the percentage of total cord area that was lesioned (r = 0.78; 95% CI, 0.44–0.89; P = .008) and the length of T2-weighted hyperintensity (r = 0.85; 95% CI, 0.54–0.89; P = .002). No significant correlations were found between early clinical outcomes and quantitative MR imaging metrics. CONCLUSIONS We describe qualitative and quantitative characteristics of a cordotomy lesion on early postoperative MR imaging. The size and length of the lesion on MR imaging correlate with the number of pial penetrations. Larger studies are needed to further investigate the clinical correlates of MR imaging metrics after percutaneous cordotomy. PMID:28209581

De novo mutations of KIAA2022 in females cause intellectual disability and intractable epilepsy.

PubMed

de Lange, Iris M; Helbig, Katherine L; Weckhuysen, Sarah; Møller, Rikke S; Velinov, Milen; Dolzhanskaya, Natalia; Marsh, Eric; Helbig, Ingo; Devinsky, Orrin; Tang, Sha; Mefford, Heather C; Myers, Candace T; van Paesschen, Wim; Striano, Pasquale; van Gassen, Koen; van Kempen, Marjan; de Kovel, Carolien G F; Piard, Juliette; Minassian, Berge A; Nezarati, Marjan M; Pessoa, André; Jacquette, Aurelia; Maher, Bridget; Balestrini, Simona; Sisodiya, Sanjay; Warde, Marie Therese Abi; De St Martin, Anne; Chelly, Jamel; van 't Slot, Ruben; Van Maldergem, Lionel; Brilstra, Eva H; Koeleman, Bobby P C

2016-12-01

Mutations in the KIAA2022 gene have been reported in male patients with X-linked intellectual disability, and related female carriers were unaffected. Here, we report 14 female patients who carry a heterozygous de novo KIAA2022 mutation and share a phenotype characterised by intellectual disability and epilepsy. Reported females were selected for genetic testing because of substantial developmental problems and/or epilepsy. X-inactivation and expression studies were performed when possible. All mutations were predicted to result in a frameshift or premature stop. 12 out of 14 patients had intractable epilepsy with myoclonic and/or absence seizures, and generalised in 11. Thirteen patients had mild to severe intellectual disability. This female phenotype partially overlaps with the reported male phenotype which consists of more severe intellectual disability, microcephaly, growth retardation, facial dysmorphisms and, less frequently, epilepsy. One female patient showed completely skewed X-inactivation, complete absence of RNA expression in blood and a phenotype similar to male patients. In the six other tested patients, X-inactivation was random, confirmed by a non-significant twofold to threefold decrease of RNA expression in blood, consistent with the expected mosaicism between cells expressing mutant or normal KIAA2022 alleles. Heterozygous loss of KIAA2022 expression is a cause of intellectual disability in females. Compared with its hemizygous male counterpart, the heterozygous female disease has less severe intellectual disability, but is more often associated with a severe and intractable myoclonic epilepsy. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

The Putative Role of Viruses, Bacteria, and Chronic Fungal Biotoxin Exposure in the Genesis of Intractable Fatigue Accompanied by Cognitive and Physical Disability.

PubMed

Morris, Gerwyn; Berk, Michael; Walder, Ken; Maes, Michael

2016-05-01

Patients who present with severe intractable apparently idiopathic fatigue accompanied by profound physical and or cognitive disability present a significant therapeutic challenge. The effect of psychological counseling is limited, with significant but very slight improvements in psychometric measures of fatigue and disability but no improvement on scientific measures of physical impairment compared to controls. Similarly, exercise regimes either produce significant, but practically unimportant, benefit or provoke symptom exacerbation. Many such patients are afforded the exclusionary, non-specific diagnosis of chronic fatigue syndrome if rudimentary testing fails to discover the cause of their symptoms. More sophisticated investigations often reveal the presence of a range of pathogens capable of establishing life-long infections with sophisticated immune evasion strategies, including Parvoviruses, HHV6, variants of Epstein-Barr, Cytomegalovirus, Mycoplasma, and Borrelia burgdorferi. Other patients have a history of chronic fungal or other biotoxin exposure. Herein, we explain the epigenetic factors that may render such individuals susceptible to the chronic pathology induced by such agents, how such agents induce pathology, and, indeed, how such pathology can persist and even amplify even when infections have cleared or when biotoxin exposure has ceased. The presence of active, reactivated, or even latent Herpes virus could be a potential source of intractable fatigue accompanied by profound physical and or cognitive disability in some patients, and the same may be true of persistent Parvovirus B12 and mycoplasma infection. A history of chronic mold exposure is a feasible explanation for such symptoms, as is the presence of B. burgdorferi. The complex tropism, life cycles, genetic variability, and low titer of many of these pathogens makes their detection in blood a challenge. Examination of lymphoid tissue or CSF in such circumstances may be warranted.

A comprehensive study of the distressing experiences and support needs of parents of children with intractable cancer.

PubMed

Yoshida, Saran; Amano, Koji; Ohta, Hideaki; Kusuki, Shigenori; Morita, Tatsuya; Ogata, Akiko; Hirai, Kei

2014-12-01

The primary endpoints of this study were: (1) to explore the distressing experiences of parents of patients with intractable pediatric cancer in Japan from disclosure of poor prognosis to the present and (2) to explore support they regarded as necessary. A multi-center questionnaire survey was conducted that included 135 bereaved parents of patients with pediatric cancer in Japan. The top five distressing experiences shared by over half of the bereaved parents were: 'Realize that the child's disease was getting worse' (96.7%), 'Witness the child's suffering' (96.7%), 'Make many decisions on the basis that the child will die in the not-so-distant future' (83.6%), 'Feel anxious and nervous about the child's acute deterioration' (82.0%) and 'Realize that there was nothing that I could do for the child' (78.7%). The top five support regarded as necessary were: 'Visit the room and speak to the sick child every day' (90.2%), 'Provide up-to-date information' (80.3%), 'Sufficiently explain the disadvantages of each treatment option' (80.3%), 'Show a never-give-up attitude until the end' (78.7%) and 'Make arrangements to allow the sick child to spend time with his/her siblings' (73.8%). This study identified the common distressing experiences of parents and the support regarded as necessary by them. To provide efficient support with limited manpower in pediatric setting, healthcare professionals should recognize these tasks as high priorities when engage parents of intractable pediatric cancer patients. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Lateral hypothalamic area deep brain stimulation for refractory obesity: a pilot study with preliminary data on safety, body weight, and energy metabolism

PubMed Central

Whiting, Donald M.; Tomycz, Nestor D.; Bailes, Julian; De Jonge, Lilian; Lecoultre, Virgile; Wilent, Bryan; Alcindor, Dunbar; Prostko, E. Richard; Cheng, Boyle C.; Angle, Cynthia; Cantella, Diane; Whiting, Benjamin B.; Mizes, J. Scott; Finnis, Kirk W.; Ravussin, Eric; Oh, Michael Y.

2017-01-01

Object Deep brain stimulation (DBS) of the lateral hypothalamic area (LHA) has been suggested as a potential treatment for intractable obesity. The authors present the 2-year safety results as well as early efficacy and metabolic effects in 3 patients undergoing bilateral LHA DBS in the first study of this approach in humans. Methods Three patients meeting strict criteria for intractable obesity, including failed bariatric surgery, under-went bilateral implantation of LHA DBS electrodes as part of an institutional review board– and FDA-approved pilot study. The primary focus of the study was safety; however, the authors also received approval to collect data on early efficacy including weight change and energy metabolism. Results No serious adverse effects, including detrimental psychological consequences, were observed with continuous LHA DBS after a mean follow-up of 35 months (range 30–39 months). Three-dimensional nonlinear transformation of postoperative imaging superimposed onto brain atlas anatomy was used to confirm and study DBS contact proximity to the LHA. No significant weight loss trends were seen when DBS was programmed using standard settings derived from movement disorder DBS surgery. However, promising weight loss trends have been observed when monopolar DBS stimulation has been applied via specific contacts found to increase the resting metabolic rate measured in a respiratory chamber. Conclusions Deep brain stimulation of the LHA may be applied safely to humans with intractable obesity. Early evidence for some weight loss under metabolically optimized settings provides the first “proof of principle” for this novel antiobesity strategy. A larger follow-up study focused on efficacy along with a more rigorous metabolic analysis is planned to further explore the benefits and therapeutic mechanism behind this investigational therapy. PMID:23560573

Functional Magnetic Resonance Imaging Networks Induced by Intracranial Stimulation May Help Defining the Epileptogenic Zone

PubMed Central

Zhang, Myron; Avitsian, Rafi; Bhattacharyya, Pallab; Bulacio, Juan; Cendes, Fernando; Enatsu, Rei; Lowe, Mark; Najm, Imad; Nair, Dileep; Phillips, Michael; Gonzalez-Martinez, Jorge

2014-01-01

Abstract Patients with medically intractable epilepsy often undergo invasive evaluation and surgery, with a 50% success rate. The low success rate is likely due to poor identification of the epileptogenic zone (EZ), the brain area causing seizures. This work introduces a new method using functional magnetic resonance imaging (fMRI) with simultaneous direct electrical stimulation of the brain that could help localize the EZ, performed in five patients with medically intractable epilepsy undergoing invasive evaluation with intracranial depth electrodes. Stimulation occurred in a location near the hypothesized EZ and a location away. Electrical recordings in response to stimulation were recorded and compared to fMRI. Multiple stimulation parameters were varied, like current and frequency. The brain areas showing fMRI response were compared with the areas resected and the success of surgery. Robust fMRI maps of activation networks were easily produced, which also showed a significant but weak positive correlation between quantitative measures of blood-oxygen-level-dependent (BOLD) activity and measures of electrical activity in response to direct electrical stimulation (mean correlation coefficient of 0.38 for all acquisitions that produced a strong BOLD response). For four patients with outcome data at 6 months, successful surgical outcome is consistent with the resection of brain areas containing high local fMRI activity. In conclusion, this method demonstrates the feasibility of simultaneous direct electrical stimulation and fMRI in humans, which allows the study of brain connectivity with high resolution and full spatial coverage. This innovative technique could be used to better define the localization and extension of the EZ in intractable epilepsies, as well as for other functional neurosurgical procedures. PMID:24735069

Argon Plasma Coagulation Therapy Versus Topical Formalin for Intractable Rectal Bleeding and Anorectal Dysfunction After Radiation Therapy for Prostate Carcinoma

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

Yeoh, Eric, E-mail: eric.yeoh@health.sa.gov.au; School of Medicine, University of Adelaide, Adelaide; Tam, William

Purpose: To evaluate and compare the effect of argon plasma coagulation (APC) and topical formalin for intractable rectal bleeding and anorectal dysfunction associated with chronic radiation proctitis. Methods and Materials: Thirty men (median age, 72 years; range, 49-87 years) with intractable rectal bleeding (defined as ≥1× per week and/or requiring blood transfusions) after radiation therapy for prostate carcinoma were randomized to treatment with APC (n=17) or topical formalin (n=13). Each patient underwent evaluations of (1) anorectal symptoms (validated questionnaires, including modified Late Effects in Normal Tissues–Subjective, Objective, Management, and Analytic and visual analogue scales for rectal bleeding); (2) anorectal motormore » and sensory function (manometry and graded rectal balloon distension); and (3) anal sphincteric morphology (endoanal ultrasound) before and after the treatment endpoint (defined as reduction in rectal bleeding to 1× per month or better, reduction in visual analogue scales to ≤25 mm, and no longer needing blood transfusions). Results: The treatment endpoint was achieved in 94% of the APC group and 100% of the topical formalin group after a median (range) of 2 (1-5) sessions of either treatment. After a follow-up duration of 111 (29-170) months, only 1 patient in each group needed further treatment. Reductions in rectal compliance and volumes of sensory perception occurred after APC, but no effect on anorectal symptoms other than rectal bleeding was observed. There were no differences between APC and topical formalin for anorectal symptoms and function, nor for anal sphincteric morphology. Conclusions: Argon plasma coagulation and topical formalin had comparable efficacy in the durable control of rectal bleeding associated with chronic radiation proctitis but had no beneficial effect on anorectal dysfunction.« less

Therapeutic effect of trans-drain administration of antibiotics in patients showing intractable pancreatic leak-associated pus drainage after pancreaticoduodenectomy

PubMed Central

Yoon, Young-In; Cho, Yu-Jeong; Ha, Tae-Yong; Song, Gi-Won; Jung, Dong-Hwan

2015-01-01

Backgrounds/Aims To cope with intractable pus drainage from persistent pancreatic leak after pancreaticoduodenectomy (PD), we have empirically performed local administration of high-concentration antibiotics cocktail solution into abdominal drains. The purpose of this study was to assess its therapeutic effect in patients showing intractable pus drainage after PD. Methods The study group was 10 patients who underwent trans-drain administration of high-concentration antibiotics cocktail solution. Another 10 patients were selected through propensity score matching for the control group. Their medical records were retrospectively reviewed with focus on comparison of pancreatic fistula (PF)-associated clinical sequences. Results Postoperative PF of grade B and C occurred in 7 and 3 patients in the study group and 9 and 1 patient in the control group, respectively (p=0.58). In the study group, a mean of 1.8 sessions of antibiotics cocktail solution (imipenem 500 mg and vancomycin 500 mg dissolved in 20 ml of normal saline) was administered. Two patients showed procedure-associated febrile episodes that were spontaneously controlled within 48 hours. At 2-4 days after the first-session of antibiotics administration, pus-like drain discharge turned to be serous with significantly decreased amount. The study group showed shortened postoperative hospital stay comparing to the control group (25.2±4.6 vs. 31.8±5.6 days, p=0.011). In both groups, no patient received radiological or surgical intervention due to PF-associated complications. Conclusions The results of our study demonstrated that trans-drain administration of antibiotics could be an effective therapeutic option for pancreaticojejunostomy leak-associated infection. Further validation of our result is necessary in large patient populations from multiple centers. PMID:26155272

Parallel pocket incision: Less invasive surgical intervention for the treatment of intractable pressure ulcer with wound edge undermining.

PubMed

Yamamoto, Takumi; Yoshimatsu, Hidehiko; Hayashi, Akitatsu; Koshima, Isao

2015-10-01

The treatment of deep pressure ulcer with a wide wound edge undermining (pocket) is challenging, especially when conservative treatments are ineffective. As most patients with a pressure ulcer suffer from systemic comorbidities, invasive surgery cannot be performed on all patients, and less invasive treatment is required. Less invasive surgical intervention to a deep pressure ulcer, parallel pocket incision (PPI), was performed on 10 patients with intractable pressure ulcers with a pocket formation. In PPI procedures, two parallel skin incisions were made to open up the deepest fold of the pocket and to preserve the skin overlying the pocket lesion; through the created incisions, the necrotic tissues around the deepest fold of the undermining could be easily removed, which facilitated spontaneous wound healing. Postoperative results and complications were evaluated. All PPI procedures were safely performed under local infiltration anesthesia without major postoperative complication; minor bleeding was seen intraoperatively in three patients, which could be easily controlled with electric cautery coagulation. Nine of 10 ulcers were cured after PPI, and one could not be followed up due to the patient's death non-related to the pressure ulcer. For the nine cured patients, the average time for cure was 14.9 weeks, and no recurrence was observed at postoperative 6 months. PPI is a simple, technically easy, and less invasive surgical intervention to an intractable pressure ulcer with a pocket, which can be safely performed under local infiltration anesthesia even on a patient with severe systemic comorbidities. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Repeat surgery for focal cortical dysplasias in children: indications and outcomes.

PubMed

Sacino, Matthew F; Ho, Cheng-Ying; Whitehead, Matthew T; Kao, Amy; Depositario-Cabacar, Dewi; Myseros, John S; Magge, Suresh N; Keating, Robert F; Gaillard, William D; Oluigbo, Chima O

2017-02-01

OBJECTIVE Focal cortical dysplasia (FCD) is a common cause of medically intractable epilepsy that often may be treated by surgery. Following resection, many patients continue to experience seizures, necessitating a decision for further surgery to achieve the desired seizure outcomes. Few studies exist on the efficacy of reoperation for intractable epilepsy due to FCD in pediatric cohorts, including the definition of prognostic factors correlated with clinical benefit from further resection. METHODS The authors retrospectively analyzed the medical records and MR images of 22 consecutive pediatric patients who underwent repeat FCD resection after unsuccessful first surgery at the Children's National Health System between March 2005 and April 2015. RESULTS Accounting for all reoperations, 13 (59%) of the 22 patients achieved complete seizure freedom and another 5 patients (23%) achieved significant improvement in seizure control. Univariate analysis demonstrated that concordance in electrocorticography (ECoG) and MRI localization (p = 0.005), and completeness of resection (p = 0.0001), were associated with seizure freedom after the first reoperation. Patients with discordant ECoG and MRI findings ultimately benefited from aggressive multilobe lobectomy or hemispherectomy. Repeat lesionectomies utilizing intraoperative MRI (iMRI; n = 9) achieved complete resection and seizure freedom in all cases. CONCLUSIONS Reoperation may be clinically beneficial in patients with intractable epilepsy due to FCD. Patients with concordant intraoperative ECoG and MRI localization may benefit from extended resection of residual dysplasia at the margins of the previous lesional cavity, and iMRI may offer benefits as a quality control mechanism to ensure that a complete resection has been accomplished. Patients with discordant findings may benefit from more aggressive resections at earlier stages to achieve better seizure control and ensure functional plasticity.

Intractable epilepsy and structural lesions of the brain: mapping, resection strategies, and seizure outcome.

PubMed

Awad, I A; Rosenfeld, J; Ahl, J; Hahn, J F; Lüders, H

1991-01-01

Forty-seven patients with structural brain lesions on neuroimaging studies and partial epilepsy intractable to medical therapy were studied. Prolonged noninvasive interictal and ictal EEG recording was performed, followed by more focused mapping using chronically implanted subdural electrode plates. Surgical procedures included lesion biopsy, maximal lesion excision, and/or resection of zones of epileptogenesis depending on accessibility and involvement of speech or other functional areas. The epileptogenic zone involved exclusively the region adjacent to the structural lesion in 11 patients. It extended beyond the lesion in 18 patients. Eighteen other patients had remote noncontiguous zones of epileptogenesis. Postoperative control of epilepsy was accomplished in 17 of 18 patients (94%) with complete lesion excision regardless of extent of seizure focus excision. Postoperative control of epilepsy was accomplished in 5 of 6 patients (83%) with incomplete lesion excision but complete seizure focus excision and in 12 of 23 patients (52%) with incomplete lesion excision and incomplete focus excision. The extent of lesion resection was strongly associated with surgical outcome either in itself (p less than 0.003), or in combination with focus excision. Focus resection was marginally associated with surgical outcome as a dichotomous variable (p = 0.048) and showed a trend toward significance (p = 0.07) only as a three-level outcome variable. We conclude that structural lesions are associated with zones of epileptogenesis in neighboring and remote areas of the brain. Maximum resection of the lesion offers the best chance at controlling intractable epilepsy; however, seizure control is achieved in many patients by carefully planned subtotal resection of lesions or foci.(ABSTRACT TRUNCATED AT 250 WORDS)

Responsive cortical stimulation for the treatment of medically intractable partial epilepsy.

PubMed

Morrell, Martha J

2011-09-27

This multicenter, double-blind, randomized controlled trial assessed the safety and effectiveness of responsive cortical stimulation as an adjunctive therapy for partial onset seizures in adults with medically refractory epilepsy. A total of 191 adults with medically intractable partial epilepsy were implanted with a responsive neurostimulator connected to depth or subdural leads placed at 1 or 2 predetermined seizure foci. The neurostimulator was programmed to detect abnormal electrocorticographic activity. One month after implantation, subjects were randomized 1:1 to receive stimulation in response to detections (treatment) or to receive no stimulation (sham). Efficacy and safety were assessed over a 12-week blinded period and a subsequent 84-week open-label period during which all subjects received responsive stimulation. Seizures were significantly reduced in the treatment (-37.9%, n = 97) compared to the sham group (-17.3%, n = 94; p = 0.012) during the blinded period and there was no difference between the treatment and sham groups in adverse events. During the open-label period, the seizure reduction was sustained in the treatment group and seizures were significantly reduced in the sham group when stimulation began. There were significant improvements in overall quality of life (p < 0.02) and no deterioration in mood or neuropsychological function. Responsive cortical stimulation reduces the frequency of disabling partial seizures, is associated with improvements in quality of life, and is well-tolerated with no mood or cognitive effects. Responsive stimulation may provide another adjunctive treatment option for adults with medically intractable partial seizures. This study provides Class I evidence that responsive cortical stimulation is effective in significantly reducing seizure frequency for 12 weeks in adults who have failed 2 or more antiepileptic medication trials, 3 or more seizures per month, and 1 or 2 seizure foci.

Microcatheter Embolization of Intractable Idiopathic Epistaxis

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

Leppaenen, Martti; Seppaenen, Seppo; Laranne, Jussi

1999-11-15

Purpose: To assess the efficacy and safety of microcatheter embolization in the treatment of intractable idiopathic epistaxis. Methods: Thirty-seven patients underwent microcatheter embolization in 1991-1998. We evaluated retrospectively the technical and clinical outcome, the number of complications, the duration of embolization in each case, and the number of blood transfusions needed. All embolizations were done with biplane digital subtraction angiography (DSA) equipment. The procedure was carried out under local anesthesia using transfemoral catheterization, except in one case where the translumbar route was used. Tracker 18 or 10 microcatheters were advanced as far as possible to the distal branches of themore » sphenopalatine artery. Polyvinyl alcohol (PVA) particles were used for embolization in most cases, while platinum coils or a combination of these two materials were occasionally used. The primary outcome was always assessed immediately by angiography. Follow-up data were obtained from patient records, by interviewing patients on the telephone or by postal questionnaires when necessary. The mean follow-up time was 21 months. Results: The embolization was technically successful in all 37 cases. A curative outcome was achieved in 33 cases (89%). The mean duration of the procedure was 110 min. Four patients (8%) had mild transient complications, but no severe or persistent complications were encountered. Twenty-three patients needed a blood transfusion. Slight rebleeding occurred in three patients during the follow-up; all responded to conservative treatment. One patient suffered two episodes of rebleeding within 2 months after primary embolization. Re-embolizations successfully stopped the bleeding. Conclusion: Embolization is the primary invasive modality for treating intractable idiopathic epistaxis. It proved both safe and effective over a relatively long follow-up.« less

Readmission Following Surgical Resection for Intractable Epilepsy: Nationwide Rates, Causes, Predictors, and Outcomes.

PubMed

Rumalla, Kavelin; Smith, Kyle A; Arnold, Paul M; Schwartz, Theodore H

2018-06-04

Hospital readmissions can be detrimental to patients and may interfere with the potential benefits of the therapeutic procedure. Government agencies have begun to focus on reducing readmissions; however, the etiology of readmissions is lacking. To report the national rates, risk factors, and outcomes associated with 30- and 90-d readmissions following surgery for intractable epilepsy. We queried the Nationwide Readmissions Database from January to September 2013 using International Classification of Diseases, Ninth Edition, Clinical Modification codes to identify all patients with intractable epilepsy, who underwent hemispherectomy (01.52), brain lobectomy (01.53), amydalohippocampectomy, or partial lobectomy (01.59). Predictor variables included epilepsy type, presurgical diagnostic testing, surgery type, medical complications, surgical complications, and discharge disposition. In 1587 patients, the 30- and 90-d readmission rates were 11.5% and 16.8%, respectively. The most common reasons for readmission were persistent epilepsy, video electroencephalography monitoring, postoperative infection, and postoperative central nervous system complication. In multivariable analysis, risk factors associated with both 30- and 90-d readmission were Medicare payer status, lowest quartile of median income, depression, hemispherectomy, and postoperative complications (P < .05). The only unique predictor of 30-d readmission was small bedsize hospital (P = .001). Readmissions within 30 d were associated with longer length of stay (6.8 vs 5.8 d), greater costs ($18 660 vs $15 515), and increased adverse discharges (26.4% vs 21.8%). Following epilepsy surgery, most readmissions that occurred within 30 d can be attributed to management of persistent epilepsy and predicted by Medicare payer status, depression, and complications. These data can assist the clinician in preventing readmissions and assist policy makers determine which admissions are potentially avoidable.

Epilepsy in children with subacute sclerosing panencephalitis.

PubMed

Jović, Nebojša J

2013-01-01

Subacute sclerosing panencephalitis (SSPE) is a rare, progressive, fatal neurodegenerative disease of childhood and early adolescence caused by defective measles virus. The initial symptoms of SSPE usually involve regression in cognitive functioning and behavior or recurrent myoclonic jerks. Seizures revealing SSPE and epilepsy during the clinical course can occur. The aim of the study was to analyze clinical and EEG characteristics of both initially occurred seizures and epilepsy which developed in the course of the disease. Retrospective study was carried out on 19 children (14 boys, 5 girls) with SSPE diagnosed and treated at our Clinic from 1995 to 2010. Seizures revealed SSPE in our patients aged from 6.5 to 11.5 years (mean 8.6 years). SSPE onset ranged from 4.5 to 16.5 years (mean 10.05). Complete vaccination was performed in nine patients. Cognitive and behavioral decline was preceeded by 6-18 months in two children with intractable focal motor seizures with secondary generalization, one child with complex partial seizures and one with atypical absences. During the clinical course of the disease epilepsy developed in 10 (52.6%) cases, including four patients with seizures as the initial SSPE sign. It occurred mainly in the first year, while in three cases seizures appeared between 1 and 5 years of the disease evolution. Myoclonus was present independently from seizures. No significant inter-group differences were found relating to the type of SSPE progression and history of epilepsy. The only child with fulminant SSPE presented with initial seizures. Favorable seizure control was achieved in 60.0% patients. Intractable epilepsy developed in four patients. Atypical SSPE presentation can include mainly focal intractable seizures. Epilepsy developed during clinical course in 52.6% cases. No significant influence was found of the history of epilepsy on the type of SSPE progression.

The Cultural Politics of Language in Sudan: Against the Racialising Logic of Language Rights

ERIC Educational Resources Information Center

Abdelhay, Ashraf; Eljak, Nada; Mugaddam, AbdelRahim; Makoni, Sinfree

2017-01-01

The sociolinguistic repertoires of individuals in Sudan are products of institutionalised orders of normalisation. The visibility of language in popular and official discourses in Sudan is always linked with wider cultural and political projects. This paper intends to engage with and explicate this observation by, first, examining how the dominant…

Writing in a Foreign Language as a Science of Writing or "Grammatology"

ERIC Educational Resources Information Center

Escandón, Arturo

2014-01-01

The present paper explores the issue of writing in a foreign language as a pedagogic process that may produce a radical subjective transformation. Drawing on Bernstein's notions of the "pedagogic device" and "discursive gap," the paper explores the epistemic make-up of language and the way it has been normalised by academic and…

Selection of low-variance expressed Malus x domestica (apple) genes for use as quantitative PCR reference genes (housekeepers)

USDA-ARS?s Scientific Manuscript database

To accurately measure gene expression using PCR-based approaches, there is the need for reference genes that have low variance in expression (housekeeping genes) to normalise the data for RNA quantity and quality. For non-model species such as Malus x domestica (apples), previously, the selection of...

An Outdoor and Environmental Education Community of Practice: Self Stylisation or Normalisation?

ERIC Educational Resources Information Center

Preston, Lou

2012-01-01

In this article, I draw on a qualitative longitudinal study to explore the influence of a tertiary Outdoor and Environmental Education (OEE) course on the formation of environmental ethics among students. In this task, I bring together Lave & Wenger (1991) and Wenger's (1998) concept of "communities of practice" and Michel Foucault's later work on…

Questioning Masculinities: Interrogating Boys' Capacities for Self-Problematization in Schools

ERIC Educational Resources Information Center

Kehler, Michael; Martino, Wayne

2007-01-01

In drawing on selected interviews with adolescent boys from both Australia and North America, we present an analysis of boys' own capacities for interrogating gender normalisation in their school lives. We set this analysis against a critique of the public media debates about boys' education, which continue to be fuelled by a moral panic about the…

The Positive Influence of Active Learning in a Lecture Hall: An Analysis of Normalised Gain Scores in Introductory Environmental Engineering

ERIC Educational Resources Information Center

Kinoshita, Timothy J.; Knight, David B.; Gibbes, Badin

2017-01-01

Burgeoning college enrolments and insufficient funding to higher education have expanded the use of large lecture courses. As this trend continues, it is important to ensure that students can still learn in those challenging learning environments. Within education broadly and undergraduate engineering specifically, active learning pedagogies have…

Identity Strategies in Light of a Low-Prestige Occupation: The Case of Retail Apprentices

ERIC Educational Resources Information Center

Duemmler, Kerstin; Caprani, Isabelle

2017-01-01

Occupations differ in their prestige, but little research has examined how workers manage working in a low-prestige occupation. This case study with retail-clerk apprentices in Switzerland uncovers the identity strategies the apprentices employ to help them normalise the situation they find themselves in: they are learning an occupation that is…

Normalisation in Flux: Teachers' and Learners' Digital Literacy in the Japanese University Context

ERIC Educational Resources Information Center

Bieri, Thomas E.; Elliott, Darren

2017-01-01

Although subsequent research suggests a more nuanced reality, Prensky's (2001) concept of the digital native remains a compelling and influential metaphor, continuing to shape thinking in education and beyond. This paper addresses self-reported digital literacy of 54 teachers and 477 learners in Japanese tertiary education. An online survey was…

CCTV Surveillance in Primary Schools: Normalisation, Resistance, and Children's Privacy Consciousness

ERIC Educational Resources Information Center

Birnhack, Michael; Perry-Hazan, Lotem; German Ben-Hayun, Shiran

2018-01-01

This study explored how primary school children perceive school surveillance by Closed Circuit TV systems (CCTVs) and how their perceptions relate to their privacy consciousness. It drew on interviews with 57 children, aged 9-12, who were enrolled in three Israeli public schools that had installed CCTVs, and on information gathered from members of…

Anabolic androgenic steroid-induced Takotsubo cardiomyopathy

PubMed Central

Sella, Gianluigi; Bellanti, Giancarlo; Margheri, Massimo

2015-01-01

Anabolic steroid abuse, aimed at increasing muscle mass, has been growing in recent years. We describe a case of a 25-year-old bodybuilder who, after taking nandrolone and stanozolol, presented with Takotsubo syndrome. The angiography showed a normal coronary anatomy with the absence of stenosis. The left ventricular function was completely normalised after 1 week. PMID:25804946

Compulsory Participation in Online Discussions: Is This Constructivism or Normalisation of Learning?

ERIC Educational Resources Information Center

Gulati, Shalni

2008-01-01

A constructivist approach in teaching and learning requires one to change various habitual ways for thinking (von Glasersfeld 1995). There is a need for different ways of thinking and doing things, if conventional education is to realise a constructivist worldview. Educators and trainers in both academic and work sectors are promoting the use of…

Dark Matter: The "Gravitational Pull" of Maternalist Discourses on Politicians' Decision Making for Early Childhood Policy in Australia

ERIC Educational Resources Information Center

Bown, Kathryn; Sumsion, Jennifer; Press, Frances

2011-01-01

The article reports on a study investigating influences on Australian politicians' decision making for early childhood education and care (ECEC) policy. The astronomical concept of dark matter is utilised as a metaphor for considering normalising, and therefore frequently difficult to detect and disrupt, influences implicated in politicians'…

Am I a Woman? The Normalisation of Woman in US History

ERIC Educational Resources Information Center

Schmidt, Sandra J.

2012-01-01

The curriculum of US History has improved substantially in its presentation of women over the 40 years since Trecker's 1971 study of US History textbooks. While studies show increased inclusions, they also suggest that women have not yet claimed their own place in the school curriculum. This paper seeks to better understand the woman who is…

"To Correct, Punish and Praise" LRC Leaders Experiences and Expressions of Non-Heterosexuality in Namibian Schools

ERIC Educational Resources Information Center

Francis, Dennis; Brown, Anthony

2017-01-01

Learner representative councils (LRCs) have been constituted to foster democratic participation and citizenry in Namibian schools. Drawing on a larger UNESCO project that focused on gender violence and schooling, we report on focus group interviews with LRC members in schools in Windhoek. Working with how heterosexuality is normalised and…

90-Day Cycle Handbook

ERIC Educational Resources Information Center

Park, Sandra; Takahashi, Sola

2013-01-01

90-Day Cycles are a disciplined and structured form of inquiry designed to produce and test knowledge syntheses, prototyped processes, or products in support of improvement work. With any type of activity, organizations inevitably encounter roadblocks to improving performance and outcomes. These barriers might include intractable problems at…

Closing the Gaps. Research Brief

ERIC Educational Resources Information Center

Johnston, Howard

2011-01-01

Achievement gaps between groups of students (minority and white, rich and poor, English speakers and English language learners) are complex and intractable. Increasingly, they are being seen as a result of disparities between opportunities for learning available to different groups. By changing the opportunity structures of schools and…

Inaugural Technology Showcase Aims to Increase Industry Partnerships and Commercialization of Cancer-Related Inventions | FNLCR Staging

Cancer.gov

Biotechnology stakeholders from across the region will have the opportunity to learn about cutting-edge technologies addressing urgent and intractable problems in cancer research at the 2017 Technology Showcase, to be held at the Frederick National

Success of posterior semicircular canal occlusion and application of the dizziness handicap inventory.

PubMed

Shaia, Wayne T; Zappia, John J; Bojrab, Dennis I; LaRouere, Michael L; Sargent, Eric W; Diaz, Rodney C

2006-03-01

To determine the long-term efficacy and patient satisfaction of posterior semicircular canal occlusion (PSCO) as a treatment for intractable benign paroxysmal positional vertigo (BPPV). Retrospective analysis of patients with BPPV who underwent PSCO was conducted in a tertiary referral center. Demographic data, clinical records, and audiometric data were reviewed. Dix-Hallpike maneuver, dizziness handicap inventory (DHI), and a specific PSCO questionnaire (PCOQ) were used to measure outcome. Twenty-eight patients underwent PSCO. The mean follow-up time was 40 months. All patients had normalization of the Hallpike test. DHI scores of 20 patients were recorded. The mean preoperative score was 70 compared with postoperative mean of 13 (P < 0.001). Mild hearing loss was found in 1 patient. PSCO is highly successful. The DHI scores postoperatively show significant improvement. The PCOQ revealed an overall 85% patient satisfaction rate. PSCO is a safe and effective intervention for intractable BPPV with a high patient satisfaction rate. C-4.

Intermittent intussusception caused by colonic lipoma.

PubMed

Chan, K C; Lin, N H; Lien, H C; Chan, S L; Yu, S C

1998-01-01

Colonic lipomas are rare, usually small, and occur most often in the right colon, particularly in the cecum. They are most common in elderly women. Intermittent episodes of intussusception are not uncommon in patients with colonic lipoma, but they are usually caused by larger pedunculated lipomas. We report a 43-year-old woman with a large colonic submucosal lipoma that induced intermittent colocolic intussusception. The patient presented with symptoms of peptic ulcer, including intractable upper abdominal pain, which did not resolve with treatment. Abdominal sonography showed typical findings of intussusception caused by a lipoma, but the manifestations on barium enema and computed tomography mimicked a malignant colonic tumor. The patient's abdominal pain disappeared after right hemicolectomy and the tumor was demonstrated to be a lipoma. The postoperative course was uneventful; there was no evidence of recurrence at follow-up 6 months later. Physicians should be aware that surrounding organs should also be evaluated in cases of chronic peptic ulcer with intractable upper abdominal pain.

Continuous Ilioinguinal-iliohypogastric Nerve Block for Groin Pain in a Breast-feeding Patient after Cesarean Delivery.

PubMed

Kim, Eun Soo; Kim, Hae Kyu; Baik, Ji Seok; Ji, Young Tae

2016-07-01

Ilioinguinal and iliohypogastric (II/IH) nerve injury is one of the most common nerve injuries following pelvic surgery, especially with the Pfannenstiel incision. We present a case of intractable groin pain, successfully treated with a continuous II/IH nerve block. A 33-year-old woman, following emergency cesarean section due to cephalopelvic disproportion, presented numbness in left inguinal area and severe pain on the labia on the second postoperative day. The pain was burning, lancinating, and exacerbated by standing or movement. However, she didn't want to take additional medicine because of breast-feeding. A diagnostic II/IH nerve block produced a substantial decrease in pain. She underwent a continuous II/IH nerve block with a complete resolution of pain within 3 days. A continuous II/IH nerve block might be a goodoption for II/IH neuropathy with intractable groin pain in breast-feeding mothers without adverse drug reactions in their infants.

Does thalidomide have an analgesic effect? Current status and future directions.

PubMed

Goli, Veeraindar

2007-04-01

Dramatic relief of pain and life-altering changes in quality of life in some patients treated with immunomodulators such as thalidomide compel us to look more closely at unconventional mechanisms that may be involved in propagation of persistent pain. Tumor necrosis factor (TNF)-alpha, interleukin (IL)-1beta, IL-6, and IL-10 are the cytokines with the most evidence in pain modulation. TNF-alpha and IL-1beta seem to initiate neuropathic pain, IL-6 maintains such pain, and IL-10 inhibits this persistent pain. Thalidomide was found to be effective in animal models by inhibiting TNF-alpha production. Several case reports and case series in humans have demonstrated mixed results, with some patients having dramatic responses, especially in chronic intractable conditions such as complex regional pain syndrome. Thalidomide may be an alternative for some patients with intractable pain. However, use of thalidomide is limited by its neurotoxic and teratogenic effects. Newer analogues may significantly improve the risk/benefit of using such immunomodulators.

In the Ethos of the Safety Net: An Expanded Role for Clinical Ethics Mediation.

PubMed

McGreevy, Jolion

2015-01-01

Clinical ethics mediation is invaluable for resolving intractable disputes in the hospital. But it is also a critical day-to-day skill for clinicians, especially those who serve a disproportionate number of vulnerable patients. While mediation is typically reserved for intractable cases, there are two important opportunities to expand its use. First is preventative mediation, in which clinicians incorporate clinical ethics mediation into their daily routine in order to address value-laden conflicts before they reach the point at which outside consultation becomes necessary. Second is guided mediation, in which clinical teams resolve conflicts with patients or surrogates with guidance from an ethics consultant, who operates at some distance from the conflict and, rather than recommending a single action, counsels clinicians on the process they can use to resolve the conflict on their own. These approaches build the capacity of all clinicians to use clinical ethics mediation to improve the care of vulnerable patients. Copyright 2015 The Journal of Clinical Ethics. All rights reserved.

Transbronchial Catheter Drainage via Fiberoptic Bronchoscope in Intractable Lung Abscess

PubMed Central

Jeong, Man Pyo; Kim, Woo Sung; Han, Sung Koo; Shim, Young Soo; Kim, Keun Youl; Han, Yong Chol

1989-01-01

The use of the fiberoptic bronchoscope as a drainage procedure for lung abscess has become more and more widespread. We have recently adopted the technique of inserting a simple polyethylene catheter through the flexible fiberoptic bronchoscope into the abscess cavity of 11 patients with lung absess. All cases had not responded to aggressive postural drainage and adequate antibiotic therapy for at least a week. The results were as follows: Among 11 patients, the therapeutic response was dramatic in 6 patients.In the successful group, the abscess sizes were greater than 8cm in diameter and the air-fluid levels were higher than two-thirds of the cavity.Additional diagnoses, other than bacterial lung abscess, could be made in 2 cases when otherwise the diagnosis would have remained in doubt. The authors suggest that catheter drainage via fiberoptic bronchoscpope is an effective treatment modality in the large lung abscess with a high air-fluid level which is intractable to other medical approaches, and it is also a safe procedure. PMID:2487405

Promoting innovation in small markets: Evidence from the market for rare and intractable diseases.

PubMed

Iizuka, Toshiaki; Uchida, Gyo

2017-07-01

In many medical care markets with limited profit potential, firms often have little incentive to innovate. These include the market for rare diseases, "neglected" tropical diseases, and personalized medicine. Governments and not-for-profit organizations promote innovation in such markets but empirical evidence on the policy effect is limited. We study this issue by analyzing the impact of a demand-side policy in Japan, which reduces the cost sharing of patients with some rare and intractable diseases and attempts to establish and promote the treatment of those diseases. Using clinical trials data taken from public registries, we identify the effect of the policy using a difference-in-difference approach. We find that the demand-side policy increased firms' incentive to innovate: firm-sponsored clinical trials increased 181% (0.16 per disease per year) when covered by the policy. This result indicates that the demand-side policy can be an important part of innovation policies in markets with limited profit potential. Copyright © 2017 Elsevier B.V. All rights reserved.

Use of Vagus Nerve Stimulator on Children With Primary Generalized Epilepsy.

PubMed

Welch, William P; Sitwat, Bilal; Sogawa, Yoshimi

2018-06-01

To describe the response to vagus nerve stimulator (VNS) in otherwise neurotypical children with medically intractable primary generalized epilepsy. Retrospective chart review of patients who underwent vagus nerve stimulator surgery between January 2011 and December 2015. Eleven patients were identified. Median follow-up duration was 2.5 years (1.2-8.4 years). Prior to vagus nerve stimulator surgery, all patients had at least 1 seizure per week, and 7/11 (64%) had daily seizures. At 1-year follow-up after vagus nerve stimulator, 7/11 (64%) reported improved seizure frequency and 6/11 (55%) reported fewer than 1 seizure per month. Three patients (27%) reported complications related to vagus nerve stimulator surgery, and no patients required device removal. In children with medically intractable primary generalized epilepsy, vagus nerve stimulator is well tolerated and appears to lead to improvement in seizure frequency. Improvement was not attributable to epilepsy classification, age at vagus nerve stimulator implantation, output current, duty cycle, or follow-up duration.

Computing quantum discord is NP-complete

NASA Astrophysics Data System (ADS)

Huang, Yichen

2014-03-01

We study the computational complexity of quantum discord (a measure of quantum correlation beyond entanglement), and prove that computing quantum discord is NP-complete. Therefore, quantum discord is computationally intractable: the running time of any algorithm for computing quantum discord is believed to grow exponentially with the dimension of the Hilbert space so that computing quantum discord in a quantum system of moderate size is not possible in practice. As by-products, some entanglement measures (namely entanglement cost, entanglement of formation, relative entropy of entanglement, squashed entanglement, classical squashed entanglement, conditional entanglement of mutual information, and broadcast regularization of mutual information) and constrained Holevo capacity are NP-hard/NP-complete to compute. These complexity-theoretic results are directly applicable in common randomness distillation, quantum state merging, entanglement distillation, superdense coding, and quantum teleportation; they may offer significant insights into quantum information processing. Moreover, we prove the NP-completeness of two typical problems: linear optimization over classical states and detecting classical states in a convex set, providing evidence that working with classical states is generically computationally intractable.

Perceptions of a changing world induce hope and promote peace in intractable conflicts.

PubMed

Cohen-Chen, Smadar; Crisp, Richard J; Halperin, Eran

2015-04-01

The importance of hope in promoting conciliatory attitudes has been asserted in the field of conflict resolution. However, little is known about conditions inducing hope, especially in intractable conflicts, where reference to the outgroup may backfire. In the current research, five studies yielded convergent support for the hypothesis that hope for peace stems from a general perception of the world as changing. In Study 1, coders observed associations between belief in a changing world, hope regarding peace, and support for concessions. Study 2 revealed the hypothesized relations using self-reported measures. Studies 3 and 4 established causality by instilling a perception of the world as changing (vs. unchanging) using narrative and drawing manipulations. Study 5 compared the changing world message with a control condition during conflict escalation. Across studies, although the specific context was not referred to, the belief in a changing world increased support for concessions through hope for peace. © 2015 by the Society for Personality and Social Psychology, Inc.

Fluoroscopy and Sonographic Guided Injection of Obliquus Capitis Inferior Muscle in an Intractable Occipital Neuralgia

PubMed Central

Kim, Ok Sun; Jeong, Seung Min; Ro, Ji Young; Kim, Duck Kyoung; Koh, Young Cho; Ko, Young Sin; Lim, So Dug; Kim, Hae Kyoung

2010-01-01

Occipital neuralgia is a form of headache that involves the posterior occiput in the greater or lesser occipital nerve distribution. Pain can be severe and persistent with conservative treatment. We present a case of intractable occipital neuralgia that conventional therapeutic modalities failed to ameliorate. We speculate that, in this case, the cause of headache could be the greater occipital nerve entrapment by the obliquus capitis inferior muscle. After steroid and local anesthetic injection into obliquus capitis inferior muscles under fluoroscopic and sonographic guidance, the visual analogue scale was decreased from 9-10/10 to 1-2/10 for 2-3 weeks. The patient eventually got both greater occipital neurectomy and partial resection of obliquus capitis inferior muscles due to the short term effect of the injection. The successful steroid and local anesthetic injection for this occipital neuralgia shows that the refractory headache was caused by entrapment of greater occipital nerves by obliquus capitis inferior muscles. PMID:20552081

Judgments of laypersons and general practitioners on justifiability and legality of providing assistance to die to a terminally ill patient: a view from New Zealand.

PubMed

Mitchell, Kay; Glynn Owens, R

2004-07-01

As part of a larger study, four decisions related to a vignette scenario of the elective death of a terminally ill patient suffering intractable pain are examined (doctor supplying information and drugs, assisting patient to take the drugs, or administering a lethal injection). Judgments on justifiability and legality of actions were obtained from laypersons and general practitioners (GPs) in Auckland, New Zealand. The results show that over 72% of laypersons and over 30% of GPs judged all four actions justified. Despite illegality a significant number of laypersons and some doctors were unsure of the legal status of actions. The current law in New Zealand prohibiting physician-assisted death may not reflect judgments by the majority of laypersons or 30% of general practitioners on the justifiability of elective death options for a terminally ill patient with intractable pain. Judgments on justifiability may be related to confusion over the legality of actions.

Risk Factors for Developing Scoliosis in Cerebral Palsy: A Cross-Sectional Descriptive Study.

PubMed

Bertoncelli, Carlo M; Solla, Federico; Loughenbury, Peter R; Tsirikos, Athanasios I; Bertoncelli, Domenico; Rampal, Virginie

2017-06-01

This study aims to identify the risk factors leading to the development of severe scoliosis among children with cerebral palsy. A cross-sectional descriptive study of 70 children (aged 12-18 years) with severe spastic and/or dystonic cerebral palsy treated in a single specialist unit is described. Statistical analysis included Fisher exact test and logistic regression analysis to identify risk factors. Severe scoliosis is more likely to occur in patients with intractable epilepsy ( P = .008), poor gross motor functional assessment scores ( P = .018), limb spasticity ( P = .045), a history of previous hip surgery ( P = .048), and nonambulatory patients ( P = .013). Logistic regression model confirms the major risk factors are previous hip surgery ( P = .001), moderate to severe epilepsy ( P = .007), and female gender ( P = .03). History of previous hip surgery, intractable epilepsy, and female gender are predictors of developing severe scoliosis in children with cerebral palsy. This knowledge should aid in the early diagnosis of scoliosis and timely referral to specialist services.

A case of nasal septal deviation-induced rhinogenic contact point otalgia.

PubMed

Kim, Se-Hyung

2015-01-01

Recently, the author experienced a case of intractable right-sided otalgia in a 17-year-old male patient. The pain was intermittent and frequently radiated to the right forehead and periorbital region. He had received unsuccessful medical treatments for migraine headache. The otoendoscopic examination revealed a normal tympanic membrane. Nasal endoscopy showed only an intranasal mucosal contact point between the septal crest and the right inferior turbinate, without other signs of sinus inflammation. Topical application of an anesthetic and vasoconstrictive solution-soaked cotton pledget at the intranasal contact area made the patient experience a significant improvement of symptoms. After surgical removal of the mucosal contact point by conventional septoplasty and turbinoplasty, he experienced significant relief of symptoms and complete recovery. Here, the author report a case of intractable otalgia induced by nasal septal deviation with review of literatures, and suggestion for new disease entity of rhinogenic contact point otalgia induced by nasal septal deviation is carefully made. Copyright © 2015 Elsevier Inc. All rights reserved.

Melanosomal sequestration of cytotoxic drugs contributes to the intractability of malignant melanomas

NASA Astrophysics Data System (ADS)

Chen, Kevin G.; Valencia, Julio C.; Lai, Barry; Zhang, Guofeng; Paterson, Jill K.; Rouzaud, François; Berens, Werner; Wincovitch, Stephen M.; Garfield, Susan H.; Leapman, Richard D.; Hearing, Vincent J.; Gottesman, Michael M.

2006-06-01

Multidrug resistance mechanisms underlying the intractability of malignant melanomas remain largely unknown. In this study, we demonstrate that the development of multidrug resistance in melanomas involves subcellular sequestration of intracellular cytotoxic drugs such as cis-diaminedichloroplatinum II (cisplatin; CDDP). CDDP is initially sequestered in subcellular organelles such as melanosomes, which significantly reduces its nuclear localization when compared with nonmelanoma/KB-3-1 epidermoid carcinoma cells. The melanosomal accumulation of CDDP remarkably modulates melanogenesis through a pronounced increase in tyrosinase activity. The altered melanogenesis manifested an 8-fold increase in both intracellular pigmentation and extracellular transport of melanosomes containing CDDP. Thus, our experiments provide evidence that melanosomes contribute to the refractory properties of melanoma cells by sequestering cytotoxic drugs and increasing melanosome-mediated drug export. Preventing melanosomal sequestration of cytotoxic drugs by inhibiting the functions of melanosomes may have great potential as an approach to improving the chemosensitivity of melanoma cells. cancer | melanosomes | skin | tumor therapy | multidrug resistance

Harnessing Gene Conversion in Chicken B Cells to Create a Human Antibody Sequence Repertoire

PubMed Central

Schusser, Benjamin; Yi, Henry; Collarini, Ellen J.; Izquierdo, Shelley Mettler; Harriman, William D.; Etches, Robert J.; Leighton, Philip A.

2013-01-01

Transgenic chickens expressing human sequence antibodies would be a powerful tool to access human targets and epitopes that have been intractable in mammalian hosts because of tolerance to conserved proteins. To foster the development of the chicken platform, it is beneficial to validate transgene constructs using a rapid, cell culture-based method prior to generating fully transgenic birds. We describe a method for the expression of human immunoglobulin variable regions in the chicken DT40 B cell line and the further diversification of these genes by gene conversion. Chicken VL and VH loci were knocked out in DT40 cells and replaced with human VK and VH genes. To achieve gene conversion of human genes in chicken B cells, synthetic human pseudogene arrays were inserted upstream of the functional human VK and VH regions. Proper expression of chimeric IgM comprised of human variable regions and chicken constant regions is shown. Most importantly, sequencing of DT40 genetic variants confirmed that the human pseudogene arrays contributed to the generation of diversity through gene conversion at both the Igl and Igh loci. These data show that engineered pseudogene arrays produce a diverse pool of human antibody sequences in chicken B cells, and suggest that these constructs will express a functional repertoire of chimeric antibodies in transgenic chickens. PMID:24278246

AUTOMATION AND UNEMPLOYMENT.

ERIC Educational Resources Information Center

SCHMIDT, EMERSON P.; STEWART, CHARLES T.

HIGH UNEMPLOYMENT RESULTS IN ECONOMIC LOSSES TO THE ECONOMY AND IMPOSES SUFFERING ON MILLIONS OF INDIVIDUALS AND FAMILIES. OF THE MANY TYPES, LONG-TERM STRUCTURAL UNEMPLOYMENT AFFECTS MORE THAN ONE MILLION WORKERS AND IS MOST INTRACTABLE TO TREATMENT AND DISTURBING IN TERMS OF HUMAN HARDSHIP. MOST OF THE WORKERS CLASSIFIED AS STRUCTURALLY…

When Problems Seem Overwhelming: Emphases in Teaching, Supervision, and Consultation.

ERIC Educational Resources Information Center

Kurland, Roselle; Salmon, Robert

1992-01-01

Notes that intractability of many of today's problems creates unusual stress for social workers. Focuses on preparation of social workers for effective work in today's complex social environment and suggests five major areas that need to be emphasized in teaching, supervising, and training. (Author/NB)

EVALUATING HABITAT AS A SURROGATE FOR POPULATION VIABILITY USING A SPATIALLY EXPLICIT POPULATION MODEL

EPA Science Inventory

Because data for conservation planning are always limited, surrogates are often substituted for intractable measurements such as species richness or population viability. We examined the ability of habitat quality to act as a surrogate for population performance for both Red-sho...

A Modern Man's Modest Proposal

ERIC Educational Resources Information Center

Pegg, M. C.

1976-01-01

This satire presents a community college president's view of affirmative action through a blatantly chauvinistic literary "persona." Aspects of the Carnegie report are discussed, and four models of executive behavior are recommended for managing "intractable" females: the "Big Daddy/Little Woman Syndrome," the "Mother/Son Number," the "Boy's…

Retrospective review of eighteen patients who underwent transtibial amputation for intractable pain.

PubMed

Honkamp, N; Amendola, A; Hurwitz, S; Saltzman, C L

2001-10-01

Amputations are rarely performed solely for pain relief because of concerns regarding the persistence of pain and disability after the procedure. The purpose of this study was to assess the outcome of below-the-knee amputations performed to relieve intractable foot and ankle pain. A chart review was conducted to identify all below-the-knee amputations that had been performed for the treatment of chronic foot and ankle pain by three orthopaedic foot and ankle specialists at three institutions. The inclusion criteria included (1) intractable foot or ankle pain as the surgical indication, (2) failure of maximal medical therapy, (3) failure of prior surgical reconstruction, and (4) a minimum follow-up period of twenty-four months after below-the-knee amputation. Patients with diabetes mellitus, peripheral vascular occlusive disease, or peripheral neuropathy were excluded. Each participant completed a two-part questionnaire with regard to the levels of disability, function, pain, and recreational activity both before and after the amputation. Twenty patients met the inclusion criteria, and eighteen completed the study. The study group included four women and fourteen men who had an average age of forty-two years (range, twenty-six to sixty-one years) and were followed for an average of forty-one months (range, twenty-five to eighty-five months) after the amputation. When asked whether they would have the below-the-knee amputation done again under similar circumstances, sixteen patients said yes, one was unsure, and one said no. The same distribution was observed when the patients were asked whether they were satisfied with the outcome: sixteen said yes, one was unsure, and one said no. Disability, pain, and recreational status were assessed with a 10-cm visual analog scale. After the amputation, the patients reported a decrease in both pain frequency (with the average score improving from 9.8 to 1.7; p < 0.0001) and pain intensity (with the average score improving from 8.4 to 2.6; p < 0.0001). Ten patients discontinued the use of narcotics, and seven decreased the level and/or dosage. Three patients worked before the amputation, and eight worked after the amputation. The average walking distance increased from 0.3 to 0.8 mile (p = 0.0034). In selected patients, a below-the-knee amputation may be a good salvage procedure for intractable foot and ankle pain that is unresponsive to all medical and local surgical reconstructive techniques.

Performance over Professional Learning and the Complexity Puzzle: Lesson Observation in England's Further Education Sector

ERIC Educational Resources Information Center

O'Leary, Matt; Wood, Phil

2017-01-01

Attempts to measure the quality of teaching and learning have resulted in an overreliance on quantitative performance data and the normalisation of a set of reductionist practices in England's further education sector in recent years. Focusing on lesson observation as an illustrative example and drawing on data from a national study, this article…

Voluntary Self-Control: Education Reform as a Governmental Strategy

ERIC Educational Resources Information Center

Pongratz, Ludwig A.

2006-01-01

This paper takes the vigorous political debate unleashed in Germany by the results of the PISA study as a stimulus to take a closer look at the strategic aims and effects of the current education reforms, of which the PISA study is only one example. It shows that the reform measures underpin a powerful process of normalisation. In this context,…

D-Lactic acidosis in a boy with short bowel syndrome.

PubMed Central

Schoorel, E P; Giesberts, M A; Blom, W; van Gelderen, H H

1980-01-01

Metabolic acidosis in a 3-year-old child with short bowel syndrome led to the discovery of massive D-lactic aciduria. After normalisation of the intestinal bacterial flora, D-lactate disappeared together with the acidosis. Dysbacteriosis with excessive production of D-lactate by intestinal bacteria (unidentified) and subsequent absorption explains this unusual cause of metabolic acidosis. PMID:7436446

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

Aad, G.

The measurements of the ZZ and WW final states in the mass range above the \\(2m_Z\\) and \\(2m_W\\) thresholds provide a unique opportunity to measure the off-shell coupling strength of the Higgs boson. This paper presents constraints on the off-shell Higgs boson event yields normalised to the Standard Model prediction (signal strength) in the \\(ZZ \\rightarrow 4\\ell \\), \\(ZZ\\rightarrow 2\\ell 2\

"You Don't Have to Be Black Skinned to Be Black": Indigenous Young People's Bodily Practices

ERIC Educational Resources Information Center

Nelson, Alison

2012-01-01

In contemporary Western societies, disciplinary and normalising technologies function to create a sense of moral obligation within each individual to monitor and regulate the body in terms of health, including diet and exercise. The settler/Aboriginal experience in Australia provides an example of the ways in which biopolitics has operated at a…

Between Play and the Quotidian: Inscriptions of Monstrous Characters on the Racialised Bodies of Children

ERIC Educational Resources Information Center

Rosen, Rachel

2017-01-01

Despite critiques pointing out that racism has become normalised in early childhood settings, relatively little attention has been paid in such contexts to the everyday practices in which racial inequities are made. In seeking to interrogate the ways in which racism roosts in the routine, this article interrogates quotidian responses to children's…

Normalising Childhood: Policies and Interventions Concerning Special Children in the United States and Europe (1900-1960)

ERIC Educational Resources Information Center

van Drenth, Annemieke; Myers, Kevin

2011-01-01

In this article, the authors examine policies and interventions concerning special children in the United States and Europe from 1900 to 1960. They focus on concerns about, and interventions on, children defined as having "special needs". They explore interventions, both in the form of words and practices, and examine their effects on…

Invited Review: Challenges of Residential and Community Care--"The Times They Are a-Changin"

ERIC Educational Resources Information Center

Jackson, R.

2011-01-01

This paper seeks to examine a number of issues which relate to the provision of appropriate and high-quality residential and community care for people with an intellectual disability. A number of key themes emerging from this Special Issue of the "Journal of Intellectual Disability Research" are identified and explored: (1) normalisation; (2)…

A Pilot Memory Café for People with Learning Disabilities and Memory Difficulties

ERIC Educational Resources Information Center

Kiddle, Hannah; Drew, Neil; Crabbe, Paul; Wigmore, Jonathan

2016-01-01

Memory cafés have been found to normalise experiences of dementia and provide access to an accepting social network. People with learning disabilities are at increased risk of developing dementia, but the possible benefits of attending a memory café are not known. This study evaluates a 12-week pilot memory café for people with learning…

Technology, normalisation and male sex work.

PubMed

MacPhail, Catherine; Scott, John; Minichiello, Victor

2015-01-01

Technological change, particularly the growth of the Internet and smart phones, has increased the visibility of male escorts, expanded their client base and diversified the range of venues in which male sex work can take place. Specifically, the Internet has relocated some forms of male sex work away from the street and thereby increased market reach, visibility and access and the scope of sex work advertising. Using the online profiles of 257 male sex workers drawn from six of the largest websites advertising male sexual services in Australia, the role of the Internet in facilitating the normalisation of male sex work is discussed. Specifically we examine how engagement with the sex industry has been reconstituted in term of better informed consumer-seller decisions for both clients and sex workers. Rather than being seen as a 'deviant' activity, understood in terms of pathology or criminal activity, male sex work is increasingly presented as an everyday commodity in the market place. In this context, the management of risks associated with sex work has shifted from formalised social control to more informal practices conducted among online communities of clients and sex workers. We discuss the implications for health, legal and welfare responses within an empowerment paradigm.

Approaches of aroma extraction dilution analysis (AEDA) for headspace solid phase microextraction and gas chromatography-olfactometry (HS-SPME-GC-O): Altering sample amount, diluting the sample or adjusting split ratio?

PubMed

Feng, Yunzi; Cai, Yu; Sun-Waterhouse, Dongxiao; Cui, Chun; Su, Guowan; Lin, Lianzhu; Zhao, Mouming

2015-11-15

Aroma extract dilution analysis (AEDA) is widely used for the screening of aroma-active compounds in gas chromatography-olfactometry (GC-O). In this study, three aroma dilution methods, (I) using different test sample volumes, (II) diluting samples, and (III) adjusting the GC injector split ratio, were compared for the analysis of volatiles by using HS-SPME-AEDA. Results showed that adjusting the GC injector split ratio (III) was the most desirable approach, based on the linearity relationships between Ln (normalised peak area) and Ln (normalised flavour dilution factors). Thereafter this dilution method was applied in the analysis of aroma-active compounds in Japanese soy sauce and 36 key odorants were found in this study. The most intense aroma-active components in Japanese soy sauce were: ethyl 2-methylpropanoate, ethyl 2-methylbutanoate, ethyl 3-methylbutanoate, ethyl 4-methylpentanoate, 3-(methylthio)propanal, 1-octen-3-ol, 2-methoxyphenol, 4-ethyl-2-methoxyphenol, 2-methoxy-4-vinylphenol, 2-phenylethanol, and 4-hydroxy-5-ethyl-2-methyl-3(2H)-furanone. Copyright © 2015. Published by Elsevier Ltd.

A robust algorithm for optimisation and customisation of fractal dimensions of time series modified by nonlinearly scaling their time derivatives: mathematical theory and practical applications.

PubMed

Fuss, Franz Konstantin

2013-01-01

Standard methods for computing the fractal dimensions of time series are usually tested with continuous nowhere differentiable functions, but not benchmarked with actual signals. Therefore they can produce opposite results in extreme signals. These methods also use different scaling methods, that is, different amplitude multipliers, which makes it difficult to compare fractal dimensions obtained from different methods. The purpose of this research was to develop an optimisation method that computes the fractal dimension of a normalised (dimensionless) and modified time series signal with a robust algorithm and a running average method, and that maximises the difference between two fractal dimensions, for example, a minimum and a maximum one. The signal is modified by transforming its amplitude by a multiplier, which has a non-linear effect on the signal's time derivative. The optimisation method identifies the optimal multiplier of the normalised amplitude for targeted decision making based on fractal dimensions. The optimisation method provides an additional filter effect and makes the fractal dimensions less noisy. The method is exemplified by, and explained with, different signals, such as human movement, EEG, and acoustic signals.

Cloud-based adaptive exon prediction for DNA analysis

PubMed Central

Putluri, Srinivasareddy; Fathima, Shaik Yasmeen

2018-01-01

Cloud computing offers significant research and economic benefits to healthcare organisations. Cloud services provide a safe place for storing and managing large amounts of such sensitive data. Under conventional flow of gene information, gene sequence laboratories send out raw and inferred information via Internet to several sequence libraries. DNA sequencing storage costs will be minimised by use of cloud service. In this study, the authors put forward a novel genomic informatics system using Amazon Cloud Services, where genomic sequence information is stored and accessed for processing. True identification of exon regions in a DNA sequence is a key task in bioinformatics, which helps in disease identification and design drugs. Three base periodicity property of exons forms the basis of all exon identification techniques. Adaptive signal processing techniques found to be promising in comparison with several other methods. Several adaptive exon predictors (AEPs) are developed using variable normalised least mean square and its maximum normalised variants to reduce computational complexity. Finally, performance evaluation of various AEPs is done based on measures such as sensitivity, specificity and precision using various standard genomic datasets taken from National Center for Biotechnology Information genomic sequence database. PMID:29515813

An automatic iterative decision-making method for intuitionistic fuzzy linguistic preference relations

NASA Astrophysics Data System (ADS)

Pei, Lidan; Jin, Feifei; Ni, Zhiwei; Chen, Huayou; Tao, Zhifu

2017-10-01

As a new preference structure, the intuitionistic fuzzy linguistic preference relation (IFLPR) was recently introduced to efficiently deal with situations in which the membership and non-membership are represented as linguistic terms. In this paper, we study the issues of additive consistency and the derivation of the intuitionistic fuzzy weight vector of an IFLPR. First, the new concepts of order consistency, additive consistency and weak transitivity for IFLPRs are introduced, and followed by a discussion of the characterisation about additive consistent IFLPRs. Then, a parameterised transformation approach is investigated to convert the normalised intuitionistic fuzzy weight vector into additive consistent IFLPRs. After that, a linear optimisation model is established to derive the normalised intuitionistic fuzzy weights for IFLPRs, and a consistency index is defined to measure the deviation degree between an IFLPR and its additive consistent IFLPR. Furthermore, we develop an automatic iterative decision-making method to improve the IFLPRs with unacceptable additive consistency until the adjusted IFLPRs are acceptable additive consistent, and it helps the decision-maker to obtain the reasonable and reliable decision-making results. Finally, an illustrative example is provided to demonstrate the validity and applicability of the proposed method.

A Robust Algorithm for Optimisation and Customisation of Fractal Dimensions of Time Series Modified by Nonlinearly Scaling Their Time Derivatives: Mathematical Theory and Practical Applications

PubMed Central

2013-01-01

Standard methods for computing the fractal dimensions of time series are usually tested with continuous nowhere differentiable functions, but not benchmarked with actual signals. Therefore they can produce opposite results in extreme signals. These methods also use different scaling methods, that is, different amplitude multipliers, which makes it difficult to compare fractal dimensions obtained from different methods. The purpose of this research was to develop an optimisation method that computes the fractal dimension of a normalised (dimensionless) and modified time series signal with a robust algorithm and a running average method, and that maximises the difference between two fractal dimensions, for example, a minimum and a maximum one. The signal is modified by transforming its amplitude by a multiplier, which has a non-linear effect on the signal's time derivative. The optimisation method identifies the optimal multiplier of the normalised amplitude for targeted decision making based on fractal dimensions. The optimisation method provides an additional filter effect and makes the fractal dimensions less noisy. The method is exemplified by, and explained with, different signals, such as human movement, EEG, and acoustic signals. PMID:24151522

Effect of food matrix and thermal processing on the performance of a normalised quantitative real-time PCR approach for lupine (Lupinus albus) detection as a potential allergenic food.

PubMed

Villa, Caterina; Costa, Joana; Gondar, Cristina; Oliveira, M Beatriz P P; Mafra, Isabel

2018-10-01

Lupine is widely used as an ingredient in diverse food products, but it is also a source of allergens. This work aimed at proposing a method to detect/quantify lupine as an allergen in processed foods based on a normalised real-time PCR assay targeting the Lup a 4 allergen-encoding gene of Lupinus albus. Sensitivities down to 0.0005%, 0.01% and 0.05% (w/w) of lupine in rice flour, wheat flour and bread, respectively, and 1 pg of L. albus DNA were obtained, with adequate real-time PCR performance parameters using the ΔCt method. Both food matrix and processing affected negatively the quantitative performance of the assay. The method was successfully validated with blind samples and applied to processed foods. Lupine was estimated between 4.12 and 22.9% in foods, with some results suggesting the common practice of precautionary labelling. In this work, useful and effective tools were proposed for the detection/quantification of lupine in food products. Copyright © 2018 Elsevier Ltd. All rights reserved.

Microbubble and ultrasound radioenhancement of bladder cancer

PubMed Central

Tran, W T; Iradji, S; Sofroni, E; Giles, A; Eddy, D; Czarnota, G J

2012-01-01

Background: Tumour vasculature is an important component of tumour growth and survival. Recent evidence indicates tumour vasculature also has an important role in tumour radiation response. In this study, we investigated ultrasound and microbubbles to enhance the effects of radiation. Methods: Human bladder cancer HT-1376 xenografts in severe combined immuno-deficient mice were used. Treatments consisted of no, low and high concentrations of microbubbles and radiation doses of 0, 2 and 8 Gy in short-term and longitudinal studies. Acute response was assessed 24 h after treatment and longitudinal studies monitored tumour response weekly up to 28 days using power Doppler ultrasound imaging for a total of 9 conditions (n=90 animals). Results: Quantitative analysis of ultrasound data revealed reduced blood flow with ultrasound-microbubble treatments alone and further when combined with radiation. Tumours treated with microbubbles and radiation revealed enhanced cell death, vascular normalisation and areas of fibrosis. Longitudinal data demonstrated a reduced normalised vascular index and increased tumour cell death in both low and high microbubble concentrations with radiation. Conclusion: Our study demonstrated that ultrasound-mediated microbubble exposure can enhance radiation effects in tumours, and can lead to enhanced tumour cell death. PMID:22790798

Physicochemical variations in atmospheric aerosols recorded at sea onboard the Atlantic-Mediterranean 2008 Scholar Ship cruise (Part II): Natural versus anthropogenic influences revealed by PM 10 trace element geochemistry

NASA Astrophysics Data System (ADS)

Moreno, Teresa; Pérez, Noemi; Querol, Xavier; Amato, Fulvio; Alastuey, Andrés; Bhatia, Ravinder; Spiro, Baruch; Hanvey, Melanie; Gibbons, Wes

2010-07-01

The geochemistry of PM 10 filter samples collected at sea during the Scholar Ship Atlantic-Mediterranean 2008 research cruise reveals a constantly changing compositional mix of pollutants into the marine atmosphere. Source apportionment modelling using Positive Matrix Factorization identifies North African desert dust, sea spray, secondary inorganic aerosols, metalliferous carbon, and V-Ni-bearing combustion particles as the main PM 10 factors/sources. The least contaminated samples show an upper continental crust composition (UCC)-normalised geochemistry influenced by seawater chemistry, with marked depletions in Rb, Th and the lighter lanthanoid elements, whereas the arrival of desert dust intrusions imposes a more upper crustal signature enriched in "geological" elements such as Si, Al, Ti, Rb, Li and Sc. Superimposed on these natural background aerosol loadings are anthropogenic metal aerosols (e.g. Cu, Zn, Pb, V, and Mn) which allow identification of pollution sources such as fossil fuel combustion, biomass burning, metalliferous industries, and urban-industrial ports. A particularly sensitive tracer is La/Ce, which rises in response to contamination from coastal FCC oil refineries. The Scholar Ship database allows us to recognise seaborne pollution sourced from NW Africa, the Cape Verde and Canary islands, and European cities and industrial complexes, plumes which in extreme cases can produce a downwind deterioration in marine air quality comparable to that seen in many cities, and can persist hundreds of kilometres from land.

Theory of equilibria of elastic 2-braids with interstrand interaction

NASA Astrophysics Data System (ADS)

Starostin, E. L.; van der Heijden, G. H. M.

2014-03-01

Motivated by continuum models for DNA supercoiling we formulate a theory for equilibria of 2-braids, i.e., structures formed by two elastic rods winding around each other in continuous contact and subject to a local interstrand interaction. No assumption is made on the shape of the contact curve. The theory is developed in terms of a moving frame of directors attached to one of the strands. The other strand is tracked by including in this frame the normalised closest-approach chord connecting the two strands. The kinematic constant-distance constraint is formulated at strain level through the introduction of what we call braid strains. As a result the total potential energy involves arclength derivatives of these strains, thus giving rise to a second-order variational problem. The Euler-Lagrange equations for this problem give balance equations for the overall braid force and moment referred to the moving frame as well as differential equations that can be interpreted as effective constitutive relations encoding the effect that the second strand has on the first as the braid deforms under the action of end loads. Hard contact models are used to obtain the normal contact pressure between strands that has to be non-negative for a physically realisable solution without the need for external devices such as clamps or glue to keep the strands together. The theory is first illustrated by a number of problems that can be solved analytically and then applied to several new problems that have not hitherto been treated.