A rare case of anal carcinosarcoma with human papilloma virus infection in both biphasic tumor elements: An immunohistochemical, molecular and ultrastructural study

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Richard A. Hickman

2016-12-01

Full Text Available Carcinosarcoma of the anus is rare and has yet to be reportedly associated with the keratinocyte-specific Human Papilloma Virus (HPV. We describe a case of anal carcinosarcoma with HPV infection in both the epithelial and mesenchymal components of the tumor by immunohistochemistry, chromogenic in-situ hybridization (CISH and further supported by electron microscopy (EM. Microscopic examination of the tumor showed nests of poorly-differentiated invasive squamous cell carcinoma with basaloid features intermixed with a hypercellular, atypical spindle cell proliferation. Immunohistochemistry demonstrated that the epithelial component was positive for AE1/AE3, p63, CK5/6 and p16, whilst the mesenchymal component was positive for smooth muscle actin, vimentin, and focally positive for desmin and p16, consistent with carcinosarcoma. The tumor was negative for GATA-3, CK7 and CK20. CISH demonstrated that the tumor was positive for high risk HPV (subtype 16/18 in both tumor components. EM further supported the presence of intracellular virus particles (~50 nm that is compatible with HPV infection. Infection of both epithelial and mesenchymal tumor components by HPV has not been previously observed in the gastrointestinal tract. This finding may represent initial epithelial HPV infection with subsequent divergent tumoral differentiation and suggests the presence of viral replication in both biphasic tumor components. Keywords: Carcinosarcoma, Human Papilloma Virus, Gastrointestinal

The impact of adjuvant radiation therapy on survival in women with uterine carcinosarcoma

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Clayton Smith, D.; Kenneth Macdonald, O.; Gaffney, David K.

2008-01-01

Background and purpose: Uterine carcinosarcoma is an aggressive neoplasm and the benefit of adjuvant radiation therapy (RT) is unclear. This retrospective study analyzes the influence of RT on survival using a large population database. Materials and methods: Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) program of the US National Cancer Institute. Women with uterine carcinosarcoma who underwent primary surgery were eligible. Survival rates and multivariate analyses were performed by standard methods. Results: Of the 2461 women in the analysis, 890 received adjuvant RT. Five-year rates of overall survival were 41.5% and 33.2% (P < 0.001) and uterine-specific survival were 56.0% and 50.8% (P = 0.005), for women receiving RT compared to those who did not. Women with stages I-III disease experienced a benefit in overall survival (HR 0.87, P = 0.03) while women with stage IV disease experienced benefits in overall (HR 0.63, P < 0.001) and uterine-specific survival (HR 0.63, P = 0.004) with RT. Conclusions: RT predicted for improved overall and disease specific survival in women with uterine carcinosarcoma within the SEER database. The benefit in disease specific survival was restricted to stage IV disease. These benefits may indicate a role for adjuvant RT in future prospective trials in the treatment of uterine carcinosarcoma

18F-fluorodeoxyglucose positron emission tomography in uterine carcinosarcoma

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Ho, Kung-Chu; Yen, Tzu-Chen; Lai, Chyong-Huey; Wu, Tzu-I; Chang, Ting-Chang; Huang, Huei-Jean; Ng, Koon-Kwan; Lin, Gigin; Wang, Chun-Chieh; Hsueh, Swei

2008-01-01

Uterine carcinosarcomas clinically confined to the uterus usually harbor occult metastases. We conducted a pilot study to evaluate the value of 18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in uterine carcinosarcoma. Patients with histologically confirmed uterine carcinosarcoma were enrolled. Abdominal and pelvic magnetic resonance imaging (MRI)/whole-body computed tomography (CT) scan, and whole-body 18 F-FDG PET or PET/CT were undertaken for primary staging, evaluating response, and restaging/post-therapy surveillance. The clinical impact of 18 F-FDG PET was determined on a scan basis. A total of 19 patients were recruited and 31 18 F-FDG PET scans (including 8 scans performed on a PET/CT scanner) were performed. Positive impacts of scans were found in 36.8% (7/19) for primary staging, 66.7% (2/3) for monitoring response, and 11.1% (1/9) for restaging/post-therapy surveillance. PET excluded falsely inoperable disease defined by MRI in two patients. Aggressive treatment applying to three patients with PET-defined resectable stage IVB disease seemed futile. Two patients died of disease shortly after salvage therapy restaged by PET. With PET monitoring, one stage IVB patient treated by targeted therapy only was alive with good performance. Using PET did not lead to improvement of overall survival of this series compared with the historical control (n = 35) (P 0.779). The preliminary results suggest that 18 F-FDG PET is beneficial in excluding falsely inoperable disease for curative therapy and in making a decision on palliation for better quality of life instead of aggressive treatment under the guidance of PET. PET seems to have limited value in post-therapy surveillance or restaging after failure. (orig.)

Uterine Carcinosarcoma Confined to the Pelvis: A Retrospective Review and Outcome Analysis

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Li, H.; TenNapel, M.J.; Bhatia, S.K.; Ahmed, A.; Lin, L.; Jacobson, G.

2014-01-01

Objective. We compared the treatments of uterine carcinosarcoma at our institution and evaluated their impact on survival. Methods. A retrospective analysis was performed on 60 eligible patients with carcinosarcoma limited to the pelvis. Subjects were divided into four categories: surgery, surgery plus chemotherapy, surgery plus radiation therapy, and a combination of surgery, chemotherapy, and RT. The most commonly used chemotherapy was cisplatin and/or carboplatin and taxol. Radiotherapy included external beam radiation therapy (EBRT) alone or with high dose rate (HDR) brachytherapy or HDR brachytherapy alone. Survival probability data were computed using the Kaplan-Meier method. The differences between groups were compared using the log-rank test. Results. The combination of surgery and radiation therapy with or without chemotherapy is seen to improve overall survival (OS) compared to surgery alone (Ρ =0.044 and Ρ =0.028 resp.). Brachytherapy involving three HDR vaginal cylinder fractions shows an equally effective reduction in local recurrence compared to EBRT. Conclusion. Our study of a relatively large number of carcinosarcoma patients suggests that adjuvant radiation therapy improves OS compared to surgery alone. Brachytherapy with 3 HDR vaginal cylinder fractions is preferred because of its time-saving, better tolerance, low toxicity and equivalent OS, and local control compared to EBRT.

Carcinosarcoma of monoclonal origin arising in a dermoid cyst of ovary: a case report

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Cabibi, Daniela; Martorana, Anna; Cappello, Francesco; Barresi, Elisa; Di Gangi, Claudio; Rodolico, Vito

2006-01-01

Transformation of a cystic benign teratoma of the ovary into a 'carcinosarcoma' has very rarely been reported and its histogenetic origin is still debated. A case of carcinosarcoma arising from a dermoid cyst is reported. The tumor showed cystic areas delimited by normal squamous epithelium, with transitional areas through dysplastic epithelium to 'in situ' and infiltrating squamous cell carcinoma (SCC). The sarcomatous component showed compact tissue composed of round cells concentrically arranged around small vessels, spindle, and pleomorphic cells with a high nuclear-cytoplasmic ratio. Positive staining for vimentin, alpha smooth muscle actin and CD10, as well as P53 and P63, was found in the sarcomatous component and in some atypical basal cells of the squamous epithelium, which also showed the usual epithelial markers. To the best of our knowledge, this is the first case of carcinosarcoma arising from a dermoid cyst in which a histogenetic origin from totipotent stem cells, located in the basal squamous layer, is supported by immunohistochemical findings

A rare case of anal carcinosarcoma with human papilloma virus infection in both biphasic tumor elements: An immunohistochemical, molecular and ultrastructural study.

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Hickman, Richard A; Bradshaw, Azore-Dee; Cassai, Nicholas; Neto, Antonio Galvao; Zhou, David; Fu, Tinghao; Lee, Peng; Pei, Zhiheng; Wieczorek, Rosemary

2016-12-01

Carcinosarcoma of the anus is rare and has yet to be reportedly associated with the keratinocyte-specific Human Papilloma Virus (HPV). We describe a case of anal carcinosarcoma with HPV infection in both the epithelial and mesenchymal components of the tumor by immunohistochemistry, chromogenic in-situ hybridization (CISH) and further supported by electron microscopy (EM). Microscopic examination of the tumor showed nests of poorly-differentiated invasive squamous cell carcinoma with basaloid features intermixed with a hypercellular, atypical spindle cell proliferation. Immunohistochemistry demonstrated that the epithelial component was positive for AE1/AE3, p63, CK5/6 and p16, whilst the mesenchymal component was positive for smooth muscle actin, vimentin, and focally positive for desmin and p16, consistent with carcinosarcoma. The tumor was negative for GATA-3, CK7 and CK20. CISH demonstrated that the tumor was positive for high risk HPV (subtype 16/18) in both tumor components. EM further supported the presence of intracellular virus particles (~50 nm) that is compatible with HPV infection. Infection of both epithelial and mesenchymal tumor components by HPV has not been previously observed in the gastrointestinal tract. This finding may represent initial epithelial HPV infection with subsequent divergent tumoral differentiation and suggests the presence of viral replication in both biphasic tumor components.

Utility of histogram analysis of apparent diffusion coefficient maps obtained using 3.0T MRI for distinguishing uterine carcinosarcoma from endometrial carcinoma.

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Takahashi, Masahiro; Kozawa, Eito; Tanisaka, Megumi; Hasegawa, Kousei; Yasuda, Masanori; Sakai, Fumikazu

2016-06-01

We explored the role of histogram analysis of apparent diffusion coefficient (ADC) maps for discriminating uterine carcinosarcoma and endometrial carcinoma. We retrospectively evaluated findings in 13 patients with uterine carcinosarcoma and 50 patients with endometrial carcinoma who underwent diffusion-weighted imaging (b = 0, 500, 1000 s/mm(2) ) at 3T with acquisition of corresponding ADC maps. We derived histogram data from regions of interest drawn on all slices of the ADC maps in which tumor was visualized, excluding areas of necrosis and hemorrhage in the tumor. We used the Mann-Whitney test to evaluate the capacity of histogram parameters (mean ADC value, 5th to 95th percentiles, skewness, kurtosis) to discriminate uterine carcinosarcoma and endometrial carcinoma and analyzed the receiver operating characteristic (ROC) curve to determine the optimum threshold value for each parameter and its corresponding sensitivity and specificity. Carcinosarcomas demonstrated significantly higher mean vales of ADC, 95th, 90th, 75th, 50th, 25th percentiles and kurtosis than endometrial carcinomas (P Histogram analysis of ADC maps might be helpful for discriminating uterine carcinosarcomas and endometrial carcinomas. J. Magn. Reson. Imaging 2016;43:1301-1307. © 2015 Wiley Periodicals, Inc.

Mature Teratoma Associated with Bilateral Ovarian Carcinosarcoma - Accidental Association or Etiopathogenetic Determinism? - Case Report.

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Birla, Rodica; Catanescu, Elena-Roxana; Caragui, Andrei; Constantinoiu, Silviu

2016-01-01

Carcinosarcoma is a rare form of ovarian cancer with mixed origin, and its association with mature teratoma is extremely rare. We present the case of patient T. M. aged 67, admitted into our clinic on the 15/05/2016, F.O. 4877 for the increase of the abdominal volume. On admission, the patient was afebrile, conscious, cooperative, cardio-respiratory balanced, having the abdomen distended in volume, sharp dullness in the flanks, positive wave sign bioumoral within normal limits except: uric acid = 6.64 mg / dL, serum glucose = 113.7 mg / dl, serum total proteins = 8.65 g / dl, the albumin / globulin subunit, CRP 33.63 mg / l, sideremia 51 ug / dl, CA 125 = 588.4 IU. Abdominal ultrasound: high volume fluid and multiple perihepatic formations and multiple formations with cystic transformation in the abdomen and pelvis. CT exam describes multiple tissular masses localized intraperitoneal in the abdominal-pelvic region, sheath fluid effusion, infiltrative, with mass effect on the digestive lumens, without visible CT obstruction. Surgical treatment consisted in evacuation of the ascites fluid, excision of the tumoral lumps situated in the great omentum, omentectomy, excision of the lumps of the gastrocolic ligament, bilateral ovariectomy and hysterectomy. Postoperative simple evolution. Histopathology confirmed the diagnosis of bilateral ovarian carcinosarcoma associated with tridermic mature teratoma (presence of brain tissue areas associated with cartilage, transitional type epithelium, tubal type epithelium, endometrial stroma type and fatty tissue). IHC confirms the compatibility with the diagnosis of ovarian carcinosarcoma (mixed malignant Mullerian tumor). The patient followed adjuvant polichemotherapy. The association of teratoma with carcinosarcomatoase elements confers a poor prognosis case. Celsius.

{sup 18}F-fluorodeoxyglucose positron emission tomography in uterine carcinosarcoma

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Ho, Kung-Chu; Yen, Tzu-Chen [Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Department of Nuclear Medicine and Molecular Imaging Center, Taoyuan (China); Lai, Chyong-Huey; Wu, Tzu-I; Chang, Ting-Chang; Huang, Huei-Jean [Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Kueishan, Taoyuan (China); Ng, Koon-Kwan; Lin, Gigin [Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Department of Medical Imaging and Intervention, Taoyuan (China); Wang, Chun-Chieh [Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Department of Radiation Oncology, Taoyuan (China); Hsueh, Swei [Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Department of Pathology, Taoyuan (China)

2008-03-15

Uterine carcinosarcomas clinically confined to the uterus usually harbor occult metastases. We conducted a pilot study to evaluate the value of {sup 18}F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in uterine carcinosarcoma. Patients with histologically confirmed uterine carcinosarcoma were enrolled. Abdominal and pelvic magnetic resonance imaging (MRI)/whole-body computed tomography (CT) scan, and whole-body {sup 18}F-FDG PET or PET/CT were undertaken for primary staging, evaluating response, and restaging/post-therapy surveillance. The clinical impact of {sup 18}F-FDG PET was determined on a scan basis. A total of 19 patients were recruited and 31 {sup 18}F-FDG PET scans (including 8 scans performed on a PET/CT scanner) were performed. Positive impacts of scans were found in 36.8% (7/19) for primary staging, 66.7% (2/3) for monitoring response, and 11.1% (1/9) for restaging/post-therapy surveillance. PET excluded falsely inoperable disease defined by MRI in two patients. Aggressive treatment applying to three patients with PET-defined resectable stage IVB disease seemed futile. Two patients died of disease shortly after salvage therapy restaged by PET. With PET monitoring, one stage IVB patient treated by targeted therapy only was alive with good performance. Using PET did not lead to improvement of overall survival of this series compared with the historical control (n = 35) (P = 0.779). The preliminary results suggest that {sup 18}F-FDG PET is beneficial in excluding falsely inoperable disease for curative therapy and in making a decision on palliation for better quality of life instead of aggressive treatment under the guidance of PET. PET seems to have limited value in post-therapy surveillance or restaging after failure. (orig.)

A case of esophageal so-called carcinosarcoma, which proliferated after radiochemotherapy against squamous cell carcinoma

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Sasaki, Shozo; Kurosaka, Yoshiyuki; Funaki, Kohziro; Michiwa, Yoshio; Takegawa, Shigeru; Kiriyama, Masato; Kawashima, Atsuhiro; Kojima, Yasuhiko

2007-01-01

A 89-year-old woman undergoing fibroptic esophagoscopy elsewhere for dysphagia was found to have an esophageal tumor and was referred to our hospital. Upper gastrointestinal endoscopy showed a type 1 esophageal tumor about 3 cm in diameter in the lower thoracic esophagus pathologically diagnosed as moderately differentiated squamous cell carcinoma from the biopsy specimen. CT and MRI showed metastasis in the right lymph node of cardia. Although we advised an esophagectomy, she did not agree to it due to her high age, so we treated her with radiochemotherapy. She underwent radiotherapy (54 Gy) and chemotherapy (cisplatin and 5-fluorouracil (FU)) concurrently. It was effective and the tumor almost disappeared and the biopsy specimen showed few viable cells. After 12 months, the tumor recurred and the pathological diagnosis was so-called carcinosarcoma. She died 14 months after treatment and pathological autopsy showed the tumor of the esophagus to be so-called carcinosarcoma, but metastasized tissue consisted of squamous cell carcinoma and did not have a sarcoma component. We concluded that metaplastic change of squamous carcinoma cells into spindle cells, occurred due to radiochemotherapy and the tumor recurred as so-called carcinosarcoma. (author)

Prognostic value of total lesion glycolysis on preoperative {sup 18}F-FDG PET/CT in patients with uterine carcinosarcoma

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Lee, Jeong-Won [Sungkyunkwan University School of Medicine, Department of Obstetrics and Gynecology, Seoul (Korea, Republic of); Sungkyunkwan University School of Medicine, Samsung Advanced Institute for Health Sciences and Technology, Seoul (Korea, Republic of); Heo, Eun Jin [Sungkyunkwan University School of Medicine, Department of Obstetrics and Gynecology, Seoul (Korea, Republic of); Moon, Seung Hwan [Sungkyunkwan University School of Medicine, Department of Nuclear Medicine, Seoul (Korea, Republic of); Lee, Hyunjong; Cheon, Gi Jeong [Seoul National University College of Medicine, Department of Nuclear Medicine, Seoul (Korea, Republic of); Lee, Maria; Kim, Hee Seung; Chung, Hyun Hoon [Seoul National University College of Medicine, Department of Obstetrics and Gynecology, Cancer Research Institute, Seoul (Korea, Republic of)

2016-11-15

To investigate the relationship between functional tumour parameters measured during preoperative {sup 18}F-FDG PET/CT and clinical outcomes in patients with uterine carcinosarcoma. For patients with pathologically proven uterine carcinosarcoma, we determined the maximal and average standardized uptake values, cumulative total lesion glycolysis (TLG) and sum of all metabolic tumour volumes (MTVs). Their predictive value for recurrence and the effects of pretreatment functional tumour activity on patient survival were compared. Clinicopathological data from 28 eligible patients were reviewed. The median duration of progression-free survival was 18.6 months (range 6.1-84.5 months), and 10 (35.7 %) patients experienced recurrences. Univariate analyses showed significant associations between recurrence and tumour size, lymph node metastasis, high TLG and MTV values, and ovarian invasion. Multivariate analysis identified high TLG value as an independent risk factor for recurrence (p = 0.048, hazard ratio 115.261, 95 % confidence interval 1.041-12,765.483). Kaplan-Meier survival curves showed that progression-free survival significantly differed in groups categorized according to TLG (p = 0.007, log-rank test). Preoperative TLG measured with {sup 18}F-FDG PET/CT was statistically significantly associated with uterine carcinosarcoma recurrence. Metabolic parameters can provide useful quantitative criteria for disease prognostication in patients with uterine carcinosarcoma before treatment. (orig.)

Identical TP53 mutations in pelvic carcinosarcomas and associated serous tubal intraepithelial carcinomas provide evidence of their clonal relationship.

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Ardighieri, Laura; Mori, Luigi; Conzadori, Sara; Bugatti, Mattia; Falchetti, Marcella; Donzelli, Carla Maria; Ravaggi, Antonella; Odicino, Franco E; Facchetti, Fabio

2016-07-01

Pelvic carcinosarcomas (PCSs) are rare aggressive biphasic tumors that localize in the ovary, fallopian tube, or peritoneum and present frequently as bilateral disease. We undertook a morphological, p53 immunohistochemical and TP53 gene mutational analysis study in a single institution cohort of 16 PCSs in order to investigate the nature of bilateral tumors and to shed light on their origin and pathogenesis. Of the 16 patients, 10 presented with bilateral disease, 6 with a carcinosarcoma in both adnexa, and the remaining cases with a carcinosarcoma in one adnexum and a carcinoma in the opposite. The carcinoma component showed high-grade serous features in 13/16 of cases (81 %). In 10 patients (63 %), a serous tubal intraepithelial carcinoma (STIC) was found, in one case bilateral, making a total of 11 STICs. STIC was found only in cases with a carcinoma component with high-grade serous features. All 10 bilateral tumors and all 11 PCS-associated STICs showed a similar p53 immunostaining pattern. At mutation analysis of the TP53 gene, all five bilateral PCS contained an identical mutation in both localizations. Furthermore, a TP53 mutation was found in 8 of 10 STICs, with an identical mutation in the associated PCS. The finding of similar p53 immunostaining in all bilateral cases and identical TP53 mutations in most PCS-associated STIC provides evidence for a clonal relation between these neoplastic lesions, supporting a metastatic nature of bilateral PCS and suggesting that they have an extraovarian origin in a STIC.

METALLOPROTEINS DURING DEVELOPMENT OF WALKER-256 CARCINOSARCOMA RESISTANT PHENOTYPE.

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Chekhun, V F; Lozovska, Yu V; Burlaka, A P; Ganusevich, I I; Shvets, Yu V; Lukianova, N Yu; Todor, I M; Demash, D V; Pavlova, A A; Naleskina, L A

2015-01-01

The study was focused on the detection of changes in serum and tumor metal-containing proteins in animals during development ofdoxorubicin-resistant phenotype in malignant cells after 12 courses of chemotherapy. We found that on every stage of resistance development there was a significant increase in content of ferritin and transferrin proteins (which take part in iron traffick and storage) in Walker-256 carc'inosarcoma tissue. We observed decreased serumferritin levels at the beginning stage of the resistance development and significant elevation of this protein levels in the cases withfully developed resistance phenotype. Transferrin content showed changes opposite to that offerritin. During the development of resistance phenotype the tumor tissue also exhibited increased 'free iron' concentration that putatively correlate with elevation of ROS generation and levels of MMP-2 and MMP-9 active forms. The tumor non-protein thiol content increases gradually as well. The serum of animals with early stages of resistance phenotype development showed high ceruloplasmin activity and its significant reduction after loss of tumor sensitivity to doxorubicin. Therefore, the development of resistance phenotype in Walker-256 carcinosarcoma is accompanied by both the deregulation of metal-containing proteins in serum and tumor tissue and by the changes in activity of antioxidant defense system. Thus, the results of this study allow us to determine the spectrum of metal-containing proteins that are involved in the development of resistant tumor phenotype and that may be targeted for methods for doxorubicin sensitivity correction therapy.

Metalloproteins during development of Walker-256 carcinosarcoma resistant phenotype

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V. F. Chekhun

2015-04-01

Full Text Available The study was focused on the detection of changes in serum and tumor metal-containing proteins in animals during development of doxorubicin-resistant phenotype in malignant cells after 12 courses of chemotherapy. We found that on every stage of resistance development there was a significant increase in content of ferritin and transferrin proteins (which take part in iron traffick and storage in Walker-256 carcinosarcoma tissue. We observed decreased serum ferritin levels at the beginning stage of the resistance development and significant elevation of this protein levels in the cases with fully developed resistance phenotype. Transferrin content showed changes opposite to that of ferritin. During the development of resistance phenotype the tumor tissue also exhibited increased ‘free iron’ concentration that putatively correlate with elevation of ROS generation and levels of MMP-2 and MMP-9 active forms. The tumor non-protein thiol content increases gradually as well. The serum of animals with early stages of resistance phenotype development showed high ceruloplasmin activity and its significant reduction after loss of tumor sensitivity to doxorubicin. Therefore, the development of resistance phenotype in Walker-256 carcinosarcoma is accompanied by both the deregulation of metal-containing proteins in serum and tumor tissue and by the changes in activity of antioxidant defense system. Thus, the results of this study allow us to determine the spectrum of metal-containing proteins that are involved in the development of resistant tumor phenotype and that may be targeted for methods for doxorubicin sensitivity correction therapy.

Metabolic changes during development of Walker-256 carcinosarcoma resistance to doxorubicin.

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Todor, I N; Lukyanova, N Yu; Shvets, Yu V; Lozovska, Yu V; Chekhun, V F

2015-03-01

To study indices of energy metabolism, content of K(+) and Mg(++) both in peripheral blood and in Walker-256 carcinosarcoma during development of resistance to doxorubicin. Resistance of Walker-256 carcinosarcoma to doxorubicin has been developed through 12 subsequent transplantations of tumor after the chemotherapy. Parental strain was inhibited by drug by 65%, while transitional resistant substrains - by 30% and 2%, respectively. Determination of biochemical indices in blood serum and homogenates of tumor tissue, level of potassium, magnesium, lactate, glucose, activities of lactate dehydrogenase and glucose-6-phosphate dehydrogenase was performed with the help of biochemical and immune-enzyme analyzer GBG ChemWell 2990 (USA) using standard kits. Polarography was used to determine indices of mitochondrial oxidative phosphorylation. Study of mitochondrial membrane potential was carried out on flow cytometer Beckman Coulter Epics XL using dye JC-1. It has been determined that development of drug resistance causes the decrease of K(+), Mg(++), glucose content in blood serum and increase of these indices in tumor tissue. At the same time, gradual tumor's loss of sensitivity is characterized by decrease of glycolysis activity in it and activation of mitochondrial oxidative phosphorylation and pentose phosphate pathway of glucose degradation, which causes more intensive formation of NADPH. Development of drug resistance of tumor causes certain metabolic changes in organism and tumor. Further study of such changes will make possible to determine tumor and extratumor markers of resistance.

Homologous Type of Malignant Mixed Mullerian Tumor of the Uterus Presenting as a Cervical Mass

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Umur Kuyumcuoğlu

2009-10-01

Full Text Available Malignant mixed Mullerian tumors are composed of a mixture of sarcoma and carcinoma. The carcinomatous element is usually glandular, whereas the sarcomatous element may resemble normal endometrial stroma (homologous or so-called carcinosarcoma. Here, we present a homologous type of malignant mixed Mullerian tumor of the uterus that presented as a cervical mass. We describe a 55-year-old patient who had a cervical mass arising from the uterus. We performed total abdominal hysterectomy and bilateral salpingo-oophorectomy and surgical staging (including (peritoneal washings, suspicious areas or peritoneal surfaces sampled, infracolic omental sampling, pelvic and paraaortic lymph node sampling, and appendectomy. Carcinosarcomas of the uterine cervix are extremely rare, and when a post-menopausal woman with a cervical mass is admitted to the gynecology clinic, the physician should keep in mind that the mass might be a carcinosarcoma. [J Chin Med Assoc 2009;72(10:533–535

The reasonable timing of the adjuvant radiotherapy in the treatment of uterine carcinosarcoma according to the surgical intent: suggestion based on progression patterns

International Nuclear Information System (INIS)

Yu, Jeong Il; Choi, Doo Ho; Huh, Seung Jae; Park, Won; Oh, Dong Ryul; Bae, Duk Soo

2013-01-01

We designed this study to identify and suggest the reasonable timing of adjuvant radiotherapy in the treatment of uterine carcinosarcoma according to the surgical intent and patterns of progression. We retrospectively analyzed a total of 50 carcinosarcoma patients diagnosed between 1995 and 2010. Among these 50 patients, 32 underwent curative surgery and 13 underwent maximal tumor debulking surgery. The remaining five patients underwent biopsy only. Twenty-six patients received chemotherapy, and 15 patients received adjuvant radiotherapy. The median follow-up period was 17.3 months. Curative resection (p < 0.001) and stage (p < 0.001) were statistically significant factors affecting survival. During follow-up, 30 patients showed progression. Among these, eight patients (16.0%) had loco-regional progression only. The patients who had received adjuvant radiotherapy did not show loco-regional progression, and radiotherapy was a significant negative risk factor for loco-regional progression (p = 0.01). The time to loco-regional progression was much earlier for non-curative than curative resection (range, 0.7 to 7.6 months vs. 7.5 to 39.0 months). Adjuvant radiotherapy in the treatment of carcinosarcoma might be related to a low loco-regional progression rate. Radiotherapy should be considered in non-curatively resected patients as soon as possible.

Enhanced antitumor activity of surface-modified iron oxide nanoparticles and an α-tocopherol derivative in a rat model of mammary gland carcinosarcoma.

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Horák, Daniel; Pustovyy, Vitaliy Igorovych; Babinskyi, Andrii Valeriyovich; Palyvoda, Olga Mikhailovna; Chekhun, Vasyl Fedorovich; Todor, Igor Nikolaevich; Kuzmenko, Oleksandr Ivanovich

2017-01-01

Maghemite (γ-Fe 2 O 3 ) nanoparticles were obtained by coprecipitation of ferrous and ferric salts in an alkaline medium followed by oxidation; the nanoparticles were coated with poly( N,N -dimethylacrylamide) (PDMA) and characterized by transmission electron microscopy, attenuated total reflection (ATR) Fourier transform infrared (FTIR) spectroscopy, dynamic light scattering, thermogravimetric and elemental analyses, and magnetic measurements in terms of particle morphology, size, polydispersity, amount of coating, and magnetization, respectively. The effects of α-tocopherol (Toc) and its phenolic (Toc-6-OH) and acetate (Toc-6-Ac) derivatives on Fe 2+ release from γ-Fe 2 O 3 @PDMA, as well as from γ-Fe 2 O 3 and CuFe 2 O 4 nanoparticles (controls), were examined in vitro using 1,10-phenanthroline. The presence of tocopherols enhanced spontaneous Fe 2+ release from nanoparticles, with Toc-6-OH exhibiting more activity than neat Toc. All of the nanoparticles tested were found to initiate blood lipid oxidation in a concentration-dependent manner, as determined by analysis of 2-thiobarbituric acid reactive species. Wistar rats with Walker-256 carcinosarcoma (a model of mammary gland carcinosarcoma) received Toc-6-Ac, magnetic nanoparticles, or their combination per os, and the antitumor activity of each treatment was determined in vivo. γ-Fe 2 O 3 @PDMA nanoparticles exhibited increased antitumor activity compared to both commercial CuFe 2 O 4 particles and the antitumor drug doxorubicin. Moreover, increased antitumor activity was observed after combined administration of γ-Fe 2 O 3 @PDMA nanoparticles and Toc-6-Ac; however, levels of bilirubin, aspartate aminotransferase, and white bloods normalized and did not differ from those of the intact controls. The antitumor activity of the γ-Fe 2 O 3 nanoparticles strongly correlated with Fe 2+ release from the nanoparticles but not with nanoparticle-initiated lipid peroxidation in vitro.

Irradiation of solid Walker carcino-sarcomas after synchronisation with hydroxyurea

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Wayss, K.; Mattern, J.; Volm, M.

1980-01-01

Sprague-Dawley rats with solid Walker carcino-sarcomas were synchronized with hydroxyurea (HU; 6 x 50 mg and 1 x 300 mg HU/kg body weight) and then irradiated at different time points ( 60 Co). The synchronized tumors showed a significant delay of growth when irradiation was applied in the late G1 phase, at the transition G1/S and in the early S phase. The remaining phases of the cell cycle, especially the S phase showed the same sensitivity as the non-synchronized controls. Improvement of therapy by irradiation after HU application was largely due to the synchronization of tumor cells. Only the increased therapeutic effect of irradiation shortly after application of HU can be explained also by combination of both HU and irradiation. (orig.) 891 MG/orig. 892 MKO [de

Two Cases of Carcinosarcomas of the Ovary Involved in Hereditary Cancer Syndromes.

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Carnevali, Ileana W; Cimetti, Laura; Sahnane, Nora; Libera, Laura; Cavallero, Alessandra; Formenti, Giorgio; Riva, Cristina; Tibiletti, Maria Grazia

2017-01-01

Ovarian carcinosarcomas (OCS), also known as malignant mixed mesodermal/Müllerian tumors, are rare neoplasms (1%-4% of all malignant ovarian tumors) composed of high-grade malignant epithelial and mesenchymal elements. OCS occurs in older women. It is associated with a poor outcome and is usually not involved in inherited cancer syndromes. We present 2 cases of OCS; one arising in a patient with a pathogenetic BRCA1 mutation and the other in a woman affected by Lynch Syndrome (LS) carrying a MSH6 germline mutation. To the best of our knowledge, this is the first time that this second type of case has been reported. In this study, we investigated somatic impairment of the wild-type BRCA1 and MSH6 alleles in the OCS of these 2 patients. We also explored in both OCS, the occurrence of TP53 loss of function, which is a genetic alteration known to occur in BRCA-linked ovarian tumorigenesis but not in LS tumors. Moreover, we also provide further data about the histogenesis of OCS.

Combined therapy of the Walker-256 carcinosarcoma with X-rays and ICRF-159

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Schaphaus, A.

1974-01-01

The radiosensitivity of the Walker-256 carcinosarcoma of the rat under the influence of the tumour-inhibiting bisdioxopiperazine ICRF-159 was studied in collectives of 11-16 animals with tumours. In the combined radio- and chemotherapy, the animals received a daily i.p. injection of 30 mg/kg K.G. of the bisdioxopiperazine ICRF-159 in 1.0 ml NaCl solution containing carboxyl methyl cellulose. The tumour inhibition was determined by multidimensional measurements of the increase in tumour size with the aid of a slide gange. The combined therapy had a better inhibiting effect on tumour growth than radiotherapy alone. (orig./AK) [de

A Case Report of Hodgkin’s Lymphoma in a Patient with Carcinosarcoma of the Bladder

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Anthony Perre

2011-12-01

Full Text Available The screening of patients with a known primary extrathoracic malignancy for pulmonary metastasis may result in the identification of solitary or multiple pulmonary nodules. Radiologic features of these pulmonary nodules may suggest a diagnosis, but these features cannot reliably distinguish between benign and malignant etiologies. We present the case of a patient, diagnosed with carcinosarcoma of the bladder, who was found to have multiple pulmonary nodules by CT evaluation. Physical examination of the patient demonstrated the presence of cervical and axillary lymphadenopathy. An excisional biopsy of an axillary lymph node confirmed the diagnosis of Hodgkin’s lymphoma. This case report demonstrates that radiographic information obtained by CT scan must be carefully correlated with the history and physical examination of the patient. This case report also demonstrates the importance of diagnostic biopsy of pulmonary nodularity discovered in patients with a known primary extrathoracic malignancy. The assumption that these pulmonary nodules represented metastatic malignancies would have had crucial prognostic and therapeutic implications.

The RBE of Fractionated Fast Neutron on Walker 256 Carcinosarcoma with KCCH-Cyclotron

International Nuclear Information System (INIS)

Yoo, Seong Yul; Koh, Kyoung Hwan; Cho, Chul Koo; Park, Charn Il; Kang, Wee Saing

1987-01-01

For evaluation of biological effect of p+(50.5 MeV) Be neutron beam produced by Korea Cancer Center Hospital(KCCH) cyclotron the RBE had been measured in experimental tumor Walker 256 carcinosarcoma as well as normal tissue, mouse intestine and bone marrow, in single and fractionated irradiation. As pilot study, the RBE had been measured for the mouse jejunal crypt cells in single whole body irradiation of which the result was 2.8. The obtained RBE values of TCD 50 of Walker 256 tumor, bone marrow and intestine in single irradiation were 1.9, 1.9 and 1.5 respectively. In fractionated irradiation, the RBE value of tumor Walker 256 was decreased as increasing of fraction number and increased as increasing of fraction size

Carcinosarcoma of the upper urinary tract with an aggressive angiosarcoma component

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Cuadra-Urteaga, José Luis; Font, Albert; Tapia, Gustavo; Areal, Juan; Taron, Miquel

2016-01-01

ABSTRACT Carcinosarcomas (CS) are biphasic tumors with malignant epithelial and mesenchymal elements. The sarcomatoid elements of CS can include chondrosarcoma, malignant fibrous histiocytoma, osteosarcoma, leiomyosarcoma, fibrosarcoma, or liposarcoma. CS of the upper urinary tract are extremely rare but are associated with a poor prognosis. We report a case of a 44-year-old man with a localized right renal pelvis mass treated with a right nephroureterectomy. The pathological examination showed a high-grade urothelial carcinoma of the renal pelvis, stage III (pT3aNxM0). A few days later, he developed lower back pain, hematuria, cough with hemoptoic sputum and progressive dyspnea. Radiological explorations showed multiple bilateral lung nodules and a retroperitoneal mass. A CT-guided biopsy of the retroperitoneal mass revealed a high-grade angiosarcoma. A review of the nephrectomy specimen showed a microscopic focus of angiosarcoma in the urothelial carcinoma. Therefore, the initial diagnosis was changed to CS of the renal pelvis with an angiosarcoma component. The patient developed progressive respiratory failure and died 8 weeks after surgery. An autopsy revealed a large retroperitoneal mass with metastatic nodules to the abdominal wall, diaphragm, small intestine, liver, spleen, and lung. All lesions were angiosarcoma, with no evidence of urothelial carcinoma. This is the first case reported of a patient with CS of the upper urinary tract with an angiosarcoma component with a very aggressive course that caused the immediate appearance of multiple angiosarcoma metastases. We also describe the clinical and molecular characteristics of CS, which will help to contribute to a better understanding of this type of tumor. PMID:26891233

Patterns of care, predictors and outcomes of chemotherapy for uterine carcinosarcoma: a National Cancer Database analysis.

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Rauh-Hain, J Alejandro; Starbuck, Kristen D; Meyer, Larissa A; Clemmer, Joel; Schorge, John O; Lu, Karen H; Del Carmen, Marcela G

2015-10-01

Evaluate rates of chemotherapy and radiotherapy delivery in the treatment of uterine carcinosarcoma, and compare clinical outcomes of treated and untreated patients. The National Cancer Database was queried to identify patients diagnosed with uterine carcinosarcoma between 2003 and 2011. The impact of chemotherapy on survival was analyzed using the Kaplan-Meier method. Factors predictive of outcome were compared using the Cox proportional hazards model. A total of 10,609 patients met study eligibility criteria. Stages I, II, III, and IV disease accounted for 2997 (28.2%), 642 (6.1%), 2037 (19.2%), and 1316 (12.4%) of the study population, respectively. Most patients (91.0%) underwent definitive surgery, and lymphadenectomy was performed in 68.7% of the patients. Chemotherapy was administered in 2378 (22.4%) patients, radiotherapy to 2196 (20.7%), adjuvant chemo-radiation to 1804 (17.0%), and 4231 (39.9%) of women did not received adjuvant therapy. Utilization of chemotherapy became more frequent over time. Over the entire study period, after adjusting for race, period of diagnosis, facility location, facility type, insurance provider, stage, age, treatment modality, lymph node dissection, socioeconomic status, and comorbidity index, there was an association between treatment modality and survival. The lowest hazard ratio observed was in patients that received chemo-radiation. The strongest quantitative predictor of death was stage at the time of diagnosis. In addition, surgical treatment, lymph node dissection, most recent time-periods, lower comorbidity index, and higher socioeconomic status were associated with improved survival. The overall rates of chemotherapy use have increased over time. Adjuvant chemotherapy and chemo-radiation were associated with improved survival. Copyright © 2015 Elsevier Inc. All rights reserved.

The influence of whole-body and local irradiation modified by hyperglycemia on metastatic Walker carcinosarcoma 256 in rats

International Nuclear Information System (INIS)

Kutlimuratov, A.B.; Ivashkin, A.V.; Zakirkhodzhaev, U.D.

1990-01-01

It has been shown that the local radiation therapy, and also radiation therapy modified by the short-term hyperglycemia really increase the life-span of rats with Walker 256 carcinosarcoma. At the same time the metastatic process also increases, especially after the modified radiation therapy. The total irradiation of experimental animals in a dose of 50 sGy before the modified radiation therapy considerably decreases the frequency of metastatic process. A conclusion is drawn that the total irradiation has a prophylactic influence on metastases under conditions of modified radiation therapy

Giant Pendulous Carcinosarcoma – Squamous Cell Carcinoma-Type - of the Leg – A Case Report and Review of the Literature

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Wollina, Uwe; Riedel, Ina; Abushika, Mohammad R.; Lotti, Torello; Tchernev, Georgi

2018-01-01

Cutaneous carcinosarcoma (CCS) is a rare non-melanoma skin cancer with a biphasic growth pattern. A tumour is composed of epithelial and mesenchymal cells that show clonality. In most cases, CCS develops in the head-and-neck region on the chronic sun-exposed skin of males. Here, we describe an 80-year-old female patient who developed a giant, pendulous CCS on the leg.  A tumour was surgically removed. We found no evidence of metastatic spread.

Giant Pendulous Carcinosarcoma – Squamous Cell Carcinoma-Type - of the Leg – A Case Report and Review of the Literature

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Uwe Wollina

2018-01-01

Full Text Available Cutaneous carcinosarcoma (CCS is a rare non-melanoma skin cancer with a biphasic growth pattern. A tumour is composed of epithelial and mesenchymal cells that show clonality. In most cases, CCS develops in the head-and-neck region on the chronic sun-exposed skin of males. Here, we describe an 80-year-old female patient who developed a giant, pendulous CCS on the leg.  A tumour was surgically removed. We found no evidence of metastatic spread.

Target Therapies for Uterine Carcinosarcomas: Current Evidence and Future Perspectives

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Salvatore Giovanni Vitale

2017-05-01

Full Text Available Carcinosarcomas (CS in gynecology are very infrequent and represent only 2–5% of uterine cancers. Despite surgical cytoreduction and subsequent chemotherapy being the primary treatment for uterine CS, the overall five-year survival rate is 30 ± 9% and recurrence is extremely common (50–80%. Due to the poor prognosis of CS, new strategies have been developed in the last few decades, targeting known dysfunctional molecular pathways for immunotherapy. In this paper, we aimed to gather the available evidence on the latest therapies for the treatment of CS. We performed a systematic review using the terms “uterine carcinosarcoma”, “uterine Malignant Mixed Müllerian Tumors”, “target therapies”, “angiogenesis therapy”, “cancer stem cell therapy”, “prognostic biomarker”, and “novel antibody-drug”. Based on our results, the differential expression and accessibility of epithelial cell adhesion molecule-1 on metastatic/chemotherapy-resistant CS cells in comparison to normal tissues and Human Epidermal Growth Factor Receptor 2 (HER2 open up new possibilities in the field of target therapy. Nevertheless, future investigations are needed to clarify the impact of these new therapies on survival rate and medium-/long-term outcomes.

Double Feature: Carcinoma and Sarcoma Present in a Single Breast Tumor

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Catherine M. Stefaniuk

2012-01-01

Full Text Available Introduction. Primary breast sarcomas (PBSs are rare nonepithelial breast tumors compromised of mesenchymal mammary tissue. Although its rare nature has made the best mode of PBS treatment difficult to determine, it seems better to treat it more like a sarcoma creating clear negative margins verses breast carcinoma utilizing lumpectomy, partial mastectomy, and total mastectomy. Case. A 47-year-old obese Caucasian postmenopausal female G2P2 presents with a breast lump demonstrating a histological sample with a biphasic pattern consistent with both ductal carcinoma containing typical malignant epithelial cells and sarcomatous differentiation of carcinosarcoma. Conclusion. Carcinosarcoma is a rare breast malignancy. Sarcomas of the breast tend to be negative for estrogen receptor and lack known risk factors. Current recommended treatment is to treat breast sarcomas like other soft tissue sarcomas by performing wide local excision instead of partial mastectomy. Antiestrogens and other chemotherapeutic agents typically used in breast epithelial malignancies are not recommended since these sarcomas tend to be negative with these receptors.

Adjuvant radiation therapy in uterine carcinosarcoma: A population-based analysis of patient demographic and clinical characteristics, patterns of care and outcomes.

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Manzerova, Julia; Sison, Cristina P; Gupta, Divya; Holcomb, Kevin; Caputo, Thomas A; Parashar, Bhupesh; Nori, Dattatreyudu; Wernicke, A Gabriella

2016-05-01

To examine clinical and demographic characteristics of a population-based cohort of patients with uterine carcinosarcoma (UCS), to assess access to treatment and survival patterns. Surveillance, Epidemiology and End Results database was queried for patients diagnosed in 1999-2010 and treated with surgery with or without adjuvant radiation therapy (aRT). The Kaplan-Meier method was used to estimate survival functions, and Cox proportional hazards regression - to analyze the effect of covariates on survival. 2342 patients were eligible. African Americans presented with more advanced AJCC stages than other races (35.4% vs. 29.1%; pAfrican Americans vs. others, and women diagnosed in 1999-2004 vs. in 2005-2010, received aRT at a similar rate: 36.5% vs. 39.9% (p=NS), and 39.5% vs. 38.9% (p=NS), respectively. There was a trend towards higher aRT utilization among patients younger than 65 vs. older (41.4% vs. 37.5%; paRT group: 42 vs. 22 (paRT group. African Americans were more likely to present with later stage disease and die of UCS than non-African Americans. Age and stage, but not race, influenced receipt of aRT. Patients treated more recently survived longer. Copyright © 2016 Elsevier Inc. All rights reserved.

Serum CA125 predicts extrauterine disease and survival in uterine carcinosarcoma

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Huang, Gloria S.; Chiu, Lydia G.; Gebb, Juliana S.; Gunter, Marc J.; Sukumvanich, Paniti; Goldberg, Gary L.; Einstein, Mark H.

2009-01-01

Objective The purpose of this study was to determine the clinical utility of CA125 measurement in patients with uterine carcinosarcoma (CS). Methods Ninety-five consecutive patients treated for CS at a single institution were identified. All 54 patients who underwent preoperative CA125 measurement were included in the study. Data were abstracted from the medical records. Tests of association between preoperative CA125 and previously identified clinicopathologic prognostic factors were performed using Fisher’s exact test and Pearson chi-square test. To evaluate relationship of CA125 elevation and survival, a Cox proportional hazard model was used for multivariate analysis, incorporating all of prognostic factors identified by univariate analysis. Results Preoperative CA125 was significantly associated with the presence of extrauterine disease (P<0.001), deep myometrial invasion (P<0.001), and serous histology of the epithelial component (P=0.005). Using univariate survival analysis, stage (HR=1.808, P=0.004), postoperative CA125 level (HR=9.855, P<0.001), and estrogen receptor positivity (HR=0.314, P=0.029) were significantly associated with survival. In the multivariate model, only postoperative CA125 level remained significantly associated with poor survival (HR=5.725, P=0.009). Conclusion Preoperative CA125 elevation is a marker of extrauterine disease and deep myometrial invasion in patients with uterine CS. Postoperative CA125 elevation is an independent prognostic factor for poor survival. These findings indicate that CA125 may be a clinically useful serum marker in the management of patients with CS. PMID:17935762

Radiosensitivity of the DS-carcinosarcoma of the rat as influenced by immune reactions

International Nuclear Information System (INIS)

Rotte, K.

1972-01-01

BDII rats obtained humoral antibodies in a xenogenetic or syngenetic immune serum or specific sensitised isogenetic immune cells for passive immunisation. Other animals were actively immunised with a so-called large dose of DS-carcinosarcoma extract or a so-called small dose of the tumour extract. The mode of irradiation was chosen in such a manner that even slight differences in the radiation sensitivity between immunised and non-immunised animals would as far as possible not be hidden by other factors. Thus when irradiating the tumours, one did without the administration of a dose which would have effected a best possible irradiation effect. A greater fractionation of the uniformly administered total dose of 2,000 R in the tests was also avoided. If the growth of a tumour can be inhibited by an immunologic influence of the tumour host relationship, then the radiation sensitivity of these cells is sumultaneously increased. If the specifically prepared immunity against tumours was not transfered to the test animals, no influence on the radiation sensitivity of the tumours was found. If the growth of the tumour accelerates, then a reduced radiation sensitivity of these tumours was simulated by the fast growth partly compensating the irradiation effect. A transfer of animal experimental investigations to the treatment of human cancer is still faced by great difficulties. The experience gathered in the last decades in the field of experimental tumour immunology are, however, important steps to this target. (orig./LH) [de

Gynaecomastia as the initial presentation of thyrotoxicosis

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Triranjan Sanyal

2012-01-01

Full Text Available Gynaecomastia is a well-recognized manifestation of thyrotoxicosis occurring in a widely variable percentage. Some studies have reported the percentage to be high as 40% while others report it being around 10%. The variation can be attributed to the difference in the criteria used to define gynae-comaslia or racial factors. However, thyrotoxicosis presenting with gynaceomastia as an intial manifestation is very rare. Only handful case reports are found in literature. Here we present a case of 35-year-old Indian male, with thyrotoxcosis who presented initially with painful bilateral gynaceomastia.

Pulmonary Embolism as the Initial Presentation of Testicular Carcinoma

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Berber, Ilhami; Erkurt, Mehmet Ali; Ulutas, Ozkan; Ediz, Caner; Nizam, Ilknur; Kırıcı Berber, Nurcan; Unlu, Serkan; Koroglu, Reyhan; Koroglu, Mustafa; Akpolat, Nusret

2013-01-01

Objective. The risk of pulmonary embolism is well recognized as showing an increase in oncological patients. We report a case presenting with pulmonary embolism initially, which was then diagnosed with testicular cancer. Clinical Presentation and Intervention. A 25-year-old man was admitted to the emergency department with a complaint of dyspnoea. Thoracic tomography, lung ventilation/perfusion scintigraphy, and an increased D-dimer level revealed pulmonary embolism. For the aetiology of pulmonary embolism, a left orchiectomy was performed and the patient was diagnosed with a germinal cell tumour of the testicle. Conclusion. In this paper, we present a patient for whom pulmonary embolism was the initial presentation, and a germinal cell tumour was diagnosed later during the search for the aetiology. PMID:24383024

Status Cataplecticus as Initial Presentation of Late Onset Narcolepsy

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Panda, Samhita

2014-01-01

Narcolepsy, one of the important causes of hypersomnia, is an under diagnosed sleep disorder. It has a bimodal age of onset around 15 and 35 years. It is characterized by the tetrad of excessive daytime sleepiness, cataplexy, hypnagogic/ hypnopompic hallucinations, and sleep paralysis. Cataplexy is by far the most predictive feature of narcolepsy. Status cataplecticus is the occurrence of cataplexy repeatedly for hours or days, a rare presentation of narcolepsy. This report describes an elderly gentleman with late onset narcolepsy in the sixth decade of life presenting with initial and chief symptom of status cataplecticus. Citation: Panda S. Status cataplecticus as initial presentation of late onset narcolepsy. J Clin Sleep Med 2014;10(2):207-209. PMID:24533005

Effect of x-irradiation in rats bearing walker-256-carcinosarcoma and normal rats

International Nuclear Information System (INIS)

Ehara, Kazuhiko

1978-01-01

Serum protein fractions and total proteins were studied with bloods obtained from the rats exposed each to the partial-, whole-bodies and the transplanted tumors (Walker-256-carcinosarcoma transplanted in the right hind leg). The electrophoretic variation induced in the sera of tumor-bearing rats (Group II), and the content of total proteins decreased. Early irradiation to the tumor part of rats less induced the variations of the electrophoretic pattern and the decrease of the amount of serum total proteins. When the distant metastasis appeared during irradiation treatment, the electrophoretic patterns and content of total proteins changed proportionally to the variation in sera of Group II. On the other hand, the γ-globulin (G) fraction increased in the long-term survival rat. The separation of the rat serum β-G into two peaks of β 1 - and β 2 -G was shown only in Group IV (late irradiation to the right hind leg). This finding supposed that some factors involve in the sera of rats with transplanted primary tumor grown up to a fixed size and guessed the appearance of the distant metastasis during x-irradiation. The percentages of the albumin and γ-G decreased slightly and those of the α 1 -, α 2 - and β-G increased slightly in the rats with 300 rad partial-body (the right hind leg) x-irradiation daily for 20 days. The remarkable decrease of the albumin and γ-G, the increase of the α 1 - and β-G, the marked increase of the α 2 -G and the decrease of serum total proteins were demonstrated for the sera of rats with 1,000 rad whole-body x-irradiation at a time. These phenomena seem to be related to the destructive and reticuloendothelial injury by the exposure. (auth.)

Secondary Malignancy As A Manifestation Of Late Toxicity Of Curative Treatment For Testicular Cancer

International Nuclear Information System (INIS)

Reckova, M.; Kakalejcik, M.; Beniak, J.; Boljesikova, E.

2008-01-01

The case presents the patient with a diagnosis of bladder carcinosarcoma. He was diagnosed 42 years after adjuvant middle abdominal and pelvic radiotherapy for testicular seminoma. We discuss the problem of late toxicity of oncology treatment in patients with potentially curative germ cell tumors of testes together with diagnosis and treatment of patients with bladder carcinoma and carcinosarcoma. (author)

The Haiti Breast Cancer Initiative: Initial Findings and Analysis of Barriers-to-Care Delaying Patient Presentation

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Ketan Sharma

2013-01-01

Full Text Available Background. In Haiti, breast cancer patients present at such advanced stages that even modern therapies offer modest survival benefit. Identifying the personal, sociocultural, and economic barriers-to-care delaying patient presentation is crucial to controlling disease. Methods. Patients presenting to the Hôpital Bon Sauveur in Cange were prospectively accrued. Delay was defined as 12 weeks or longer from initial sign/symptom discovery to presentation, as durations greater than this cutoff correlate with reduced survival. A matched case-control analysis with multivariate logistic regression was used to identify factors predicting delay. Results. Of N=123 patients accrued, 90 (73% reported symptom-presentation duration and formed the basis of this study: 52 patients presented within 12 weeks of symptoms, while 38 patients waited longer than 12 weeks. On logistic regression, lower education status (OR = 5.6, P=0.03, failure to initially recognize mass as important (OR = 13.0, P<0.01, and fear of treatment cost (OR = 8.3, P=0.03 were shown to independently predict delayed patient presentation. Conclusion. To reduce stage at presentation, future interventions must educate patients on the recognition of initial breast cancer signs and symptoms and address cost concerns by providing care free of charge and/or advertising that existing care is already free.

Acute proptosis: Unusual initial presentation of sinonasal inverted papilloma

Institute of Scientific and Technical Information of China (English)

Norihan Ibrahim; Baharuddin Abdullah; Regunath Kandasamy; Nor Hayati Othman; Mohtar Ibrahim; Adil Hussein

2017-01-01

Inverted papilloma is an uncommon histopathological finding of maxillary sinus tumor. We reported here a rare case of inverted papilloma of maxillary sinus presented initially with ipsilateral proptosis. A middle-aged lady with history of having allergic rhinitis presented with progressive left eye proptosis. Assessment revealed presence of orbital mass arising from paranasal sinus, in which the histopathological examination was initially inconclusive, and later it turned up to be inverted papilloma, partly with malignant transformation. High index of suspicion is necessary especially in those patients with recurrent non-specific sinonasal symptoms, which may need repeated biopsy and histopathological examination. Ocular manifestation signifies a more advance disease.

Survival outcome of women with stage IV uterine carcinosarcoma who received neoadjuvant chemotherapy followed by surgery.

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Matsuo, Koji; Johnson, Marian S; Im, Dwight D; Ross, Malcolm S; Bush, Stephen H; Yunokawa, Mayu; Blake, Erin A; Takano, Tadao; Klobocista, Merieme M; Hasegawa, Kosei; Ueda, Yutaka; Shida, Masako; Baba, Tsukasa; Satoh, Shinya; Yokoyama, Takuhei; Machida, Hiroko; Ikeda, Yuji; Adachi, Sosuke; Miyake, Takahito M; Iwasaki, Keita; Yanai, Shiori; Takeuchi, Satoshi; Nishimura, Masato; Nagano, Tadayoshi; Takekuma, Munetaka; Shahzad, Mian M K; Pejovic, Tanja; Omatsu, Kohei; Kelley, Joseph L; Ueland, Frederick R; Roman, Lynda D

2018-03-01

To examine survival of women with stage IV uterine carcinosarcoma (UCS) who received neoadjuvant chemotherapy followed by hysterectomy. This is a nested case-control study within a retrospective cohort of 1192 UCS cases. Women who received neoadjuvant chemotherapy followed by hysterectomy based-surgery for stage IV UCS (n = 26) were compared to those who had primary hysterectomy-based surgery without neoadjuvant chemotherapy for stage IV UCS (n = 120). Progression-free survival (PFS) and cause-specific survival (CSS) were examined. The most common regimen for neoadjuvant chemotherapy was carboplatin/paclitaxel (53.8%). Median number of neoadjuvant chemotherapy cycles was 4. PFS was similar between the neoadjuvant chemotherapy group and the primary surgery group (unadjusted-hazard ratio [HR] 1.19, 95% confidence interval [CI] 0.75-1.89, P = 0.45). Similarly, CSS was comparable between the two groups (unadjusted-HR 1.13, 95%CI 0.68-1.90, P = 0.64). When the types of neoadjuvant chemotherapy regimens were compared, women who received a carboplatin/paclitaxel regimen had better survival outcomes compared to those who received other regimens: PFS, unadjusted-HR 0.38, 95%CI 0.15-0.93, P = 0.027; and CSS, unadjusted-HR 0.21, 95%CI 0.07-0.61, P = 0.002. Our study found that there is no statistically significant difference in survival between women with stage IV UCS who are tolerated neoadjuvant chemotherapy and those who undergo primary surgery. © 2017 Wiley Periodicals, Inc.

Macrophage Activation Syndrome as Initial Presentation of Systemic Lupus Erythematosus

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Say-Tin Yeap

2008-04-01

Full Text Available Macrophage activation syndrome (MAS is known to be a severe and potentially life-threatening complication of rheumatic disorder, especially systemic juvenile rheumatoid arthritis. It is very rare for MAS to be an initial presentation of systemic lupus erythematosus (SLE. Here, we report a 14-year-old girl in whom MAS developed as an initial presentation of SLE. With early diagnosis and administration of cyclosporine A, she had a fair outcome. Further testing showed positive anti-dsDNA about 8 months later.

Cardiac Tamponade as Initial Presentation of Hodgkin Lymphoma

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Adrija Hajra

2015-01-01

Full Text Available Cardiac involvement in malignant lymphoma is one of the least investigated subjects. Pericardial effusion is rarely symptomatic in patients of Hodgkin lymphoma (HL. Few case reports are available in the literature. There are case reports of diagnosed HL patients presenting with pericardial effusion. HL patients who present with recurrent episodes of pericardial effusion have also been reported. Pericardial effusion has also been reported in cases of non HL. However, pericardial effusion leading to cardiac tamponade as an initial presentation of HL is extremely rare. Very few such cases are there in the literature. Here, we present a case of a 26-year-old male patient who presented with cardiac tamponade and in due course was found to be a case of classical type of HL. This case is interesting because of its presentation.

Amyotrophic Lateral Sclerosis Presenting Respiratory Failure as the Sole Initial Manifestation

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Fuyuki Tateno

2014-08-01

Full Text Available It is rare that amyotrophic lateral sclerosis (ALS presents with respiratory failure as the sole initial manifestation. A 72-year-old man with mild chronic obstructive pulmonary disease developed exertional dyspnea for 13 months. He then progressed to limb weakness that led to the diagnosis of ALS. Although rare, ALS can present with respiratory failure as the sole initial manifestation more than 1 year prior to limb weakness.

Bone metastases as initial presentation of hepatocellular carcinoma.

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Monteserin, Luzdivina; Mesa, Alicia; Fernandez-Garcia, Maria Soledad; Gadanon-Garcia, Arantza; Rodriguez, Manuel; Varela, María

2017-10-18

Extra-hepatic spread is present in 5% to 15% of patients with hepatocellular carcinoma (HCC) at the time of diagnosis. The most frequent sites are lung and regional lymph nodes. Here, we report 3 cases of unsuspected HCC with symptoms due to bone lesions as initial presentation. Morphological characteristics and immunohistochemistry from the examined bone were the key data for diagnosis. None of the patients had an already known chronic liver disease. Differential diagnoses with HCC upon ectopic liver disease or hepatoid adenocarcinoma were shown. Therapy with the orally active multikinase inhibitor sorafenib plus symptomatic treatment was indicated.

Lamellipodia and Membrane Blebs Drive Efficient Electrotactic Migration of Rat Walker Carcinosarcoma Cells WC 256.

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Sroka, Jolanta; Krecioch, Izabela; Zimolag, Eliza; Lasota, Slawomir; Rak, Monika; Kedracka-Krok, Sylwia; Borowicz, Pawel; Gajek, Marta; Madeja, Zbigniew

2016-01-01

The endogenous electric field (EF) may provide an important signal for directional cell migration during wound healing, embryonic development and cancer metastasis but the mechanism of cell electrotaxis is poorly understood. Additionally, there is no research addressing the question on the difference in electrotactic motility of cells representing various strategies of cell movement-specifically blebbing vs. lamellipodial migration. In the current study we constructed a unique experimental model which allowed for the investigation of electrotactic movement of cells of the same origin but representing different modes of cell migration: weakly adherent, spontaneously blebbing (BC) and lamellipodia forming (LC) WC256 cells. We report that both BC and LC sublines show robust cathodal migration in a physiological EF (1-3 V/cm). The directionality of cell movement was completely reversible upon reversing the field polarity. However, the full reversal of cell direction after the change of EF polarity was much faster in the case of BC (10 minutes) than LC cells (30 minutes). We also investigated the distinct requirements for Rac, Cdc42 and Rho pathways and intracellular Ca2+ in electrotaxis of WC256 sublines forming different types of cell protrusions. It was found that Rac1 is required for directional movement of LC to a much greater extent than for BC, but Cdc42 and RhoA are more crucial for BC than for LC cells. The inhibition of ROCK did not affect electrotaxis of LC in contrast to BC cells. The results also showed that intracellular Ca2+ is essential only for the electrotactic reaction of BC cells. Moreover, inhibition of MLCK and myosin II did not affect the electrotaxis of LC in contrast to BC cells. In conclusion, our results revealed that both lamellipodia and membrane blebs can efficiently drive electrotactic migration of WC 256 carcinosarcoma cells, however directional migration is mediated by different signalling pathways.

Myositis as the initial presentation of panarteritis nodosa.

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Calvo, Romina; Negri, Melina; Ortiz, Alberto; Roverano, Susana; Paira, Sergio

2017-07-26

A 47-year-old man presented with weight loss, bilateral calf pain, fever, hypertension, orchitis and oligoarthritis. Lab tests: anemia and elevated muscle enzymes. Resonance magnetic imaging: hyperintensity in gastrocnemius muscles (myositis). Histologic exam of the muscles: inflammatory infiltrate with atrophy and perifascicular regeneration. methylprednisone (bolus) and cyclophosphamide. Muscle pain and swelling and difficulty in walking are common in panarteritis nodosa (PAN), whereas histologically demonstrated myositis is not. Even more rare is myositis as the initial presentation of this vasculitis. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

Phrenic Nerve Palsy as Initial Presentation of Large Retrosternal Goitre.

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Hakeem, Arsheed Hussain; Hakeem, Imtiyaz Hussain; Wani, Fozia Jeelani

2016-12-01

Unilateral phrenic nerve palsy as initial presentation of the retrosternal goitre is extremely rare event. This is a case report of a 57-year-old woman with history of cough and breathlessness of 3 months duration, unaware of the thyroid mass. She had large cervico-mediastinal goiter and chest radiograph revealed raised left sided hemidiaphragm. Chest CT scan did not reveal any lung parenchymal or mediastinal pathology. The patient underwent a total thyroidectomy through a cervical approach. The final pathology was in favor of multinodular goitre. Even after 1 year of follow up, phrenic nerve palsy did not improve indicating permanent damage. Phrenic nerve palsy as initial presentation of the retrosternal goitre is unusual event. This case is reported not only because of the rare nature of presentation, but also to make clinicians aware of the entity so that early intervention may prevent attendant morbidity.

Acute anterior uveitis as the initial presentation of alkaptonuria.

Science.gov (United States)

John, S S; Padhan, P; Mathews, J V; David, S

2009-01-01

Alkaptonuria is a rare autosomal recessive metabolic disorder that may present with multi-system involvement such as ochronotic arthropathy, renal, urethral and prostatic calculi, cardiac valvular lesions and pigmentation of the skin, sclera, cartilage and other connective tissues. An association of the disease with uveitis has never been reported. We report the first case of alkaptonuria with ochronotic arthropathy presenting with recurrent acute anterior uveitis as the initial manifestation. The possible common link with the HLA-B27 gene is discussed.

Acute anterior uveitis as the initial presentation of alkaptonuria

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Padhan P

2009-01-01

Full Text Available Alkaptonuria is a rare autosomal recessive metabolic disorder that may present with multi-system involvement such as ochronotic arthropathy, renal, urethral and prostatic calculi, cardiac valvular lesions and pigmentation of the skin, sclera, cartilage and other connective tissues. An association of the disease with uveitis has never been reported. We report the first case of alkaptonuria with ochronotic arthropathy presenting with recurrent acute anterior uveitis as the initial manifestation. The possible common link with the HLA-B27 gene is discussed.

Angioarchitectural characteristics associated with initial hemorrhagic presentation in supratentorial brain arteriovenous malformations

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Pan, Jianwei, E-mail: swordman_pan@yahoo.com.cn [Department of Neurosurgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou 310006 (China); Feng, Lei, E-mail: lei_feng66@yahoo.com [Department of Radiology, Kaiser Permanente Medical Center, Los Angeles, CA 90027 (United States); Vinuela, Fernando, E-mail: fvinuela@mednet.ucla.edu [Interventional Neuroradiology Division, Department of Radiological Sciences, Ronald Reagan UCLA Medical Center, Los Angeles, CA 90095 (United States); He, Hongwei, E-mail: ttyyhhw@126.com [Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, Capital Medical University, 6 Tiantan Xili, Beijing 100050 (China); Wu, Zhongxue, E-mail: 252694812@qq.com [Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, Capital Medical University, 6 Tiantan Xili, Beijing 100050 (China); Zhan, Renya, E-mail: neurovasword@gmail.com [Department of Neurosurgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou 310006 (China)

2013-11-01

Objective: The difference in arterial supply, venous drainage, functional localization in supratentorial and infratentorial compartments may contribute to the conflicting results about risk factors for hemorrhage in published case series of brain arteriovenous malformation (bAVM). Further investigation focused on an individual brain compartment is thus necessary. This retrospective study aims to identify angioarchitectural characteristics associated with the initial hemorrhagic event of supratentorial bAVMs. Materials and methods: The clinical and angiographic features of 152 consecutive patients with supratentorial bAVMs who presented to our hospital from 2005 to 2008 were retrospectively reviewed. All these patients had new diagnosis of bAVM. Univariate (χ{sup 2} test) and multivariate analyses were conducted to assess the angiographic features in patients with and without initial hemorrhagic presentations. A probability value of less than 0.05 was considered statistically significant in each analysis. Results: In 152 patients with supratentorial AVMs, 70.6% of deep and 52.5% of superficial sbAVMs presented with hemorrhage. The deep location was correlated with initial hemorrhagic presentation in univariate analysis (χ{sup 2} = 3.499, p = 0.046) but not in the multivariate model (p = 0.144). There were 44 sbAVMs with perforating feeders, 39 (88.6%) of which bled at a significantly higher rate than those with terminal feeders (χ{sup 2} = 25.904, p = 0.000). 87.5% (21/24) of exclusive deep venous drainage presented with hemorrhage, a significantly higher rate than those of the other type of venous drainage (χ{sup 2} = 11.099, p = 0.004). All 10 patients with both perforating feeders and exclusive deep draining vein presented with initial hemorrhage. Hemorrhagic presentation was correlated with perforating feeders (p = 0.000) and exclusive deep draining vein (p = 0.007) in multivariate analysis as well. Conclusions: Supratentorial bAVMs with perforating feeders

Angioarchitectural characteristics associated with initial hemorrhagic presentation in supratentorial brain arteriovenous malformations

International Nuclear Information System (INIS)

Pan, Jianwei; Feng, Lei; Vinuela, Fernando; He, Hongwei; Wu, Zhongxue; Zhan, Renya

2013-01-01

Objective: The difference in arterial supply, venous drainage, functional localization in supratentorial and infratentorial compartments may contribute to the conflicting results about risk factors for hemorrhage in published case series of brain arteriovenous malformation (bAVM). Further investigation focused on an individual brain compartment is thus necessary. This retrospective study aims to identify angioarchitectural characteristics associated with the initial hemorrhagic event of supratentorial bAVMs. Materials and methods: The clinical and angiographic features of 152 consecutive patients with supratentorial bAVMs who presented to our hospital from 2005 to 2008 were retrospectively reviewed. All these patients had new diagnosis of bAVM. Univariate (χ 2 test) and multivariate analyses were conducted to assess the angiographic features in patients with and without initial hemorrhagic presentations. A probability value of less than 0.05 was considered statistically significant in each analysis. Results: In 152 patients with supratentorial AVMs, 70.6% of deep and 52.5% of superficial sbAVMs presented with hemorrhage. The deep location was correlated with initial hemorrhagic presentation in univariate analysis (χ 2 = 3.499, p = 0.046) but not in the multivariate model (p = 0.144). There were 44 sbAVMs with perforating feeders, 39 (88.6%) of which bled at a significantly higher rate than those with terminal feeders (χ 2 = 25.904, p = 0.000). 87.5% (21/24) of exclusive deep venous drainage presented with hemorrhage, a significantly higher rate than those of the other type of venous drainage (χ 2 = 11.099, p = 0.004). All 10 patients with both perforating feeders and exclusive deep draining vein presented with initial hemorrhage. Hemorrhagic presentation was correlated with perforating feeders (p = 0.000) and exclusive deep draining vein (p = 0.007) in multivariate analysis as well. Conclusions: Supratentorial bAVMs with perforating feeders and deep venous

Clinical Subtypes of Dementia with Lewy Bodies Based on the Initial Clinical Presentation.

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Morenas-Rodríguez, Estrella; Sala, Isabel; Subirana, Andrea; Pascual-Goñi, Elba; Sánchez-Saudinós, MaBelén; Alcolea, Daniel; Illán-Gala, Ignacio; Carmona-Iragui, María; Ribosa-Nogué, Roser; Camacho, Valle; Blesa, Rafael; Fortea, Juan; Lleó, Alberto

2018-06-04

Dementia with Lewy bodies (DLB) is a heterogeneous disease in which clinical presentation, symptoms, and evolution widely varies between patients. To investigate the existence of clinical subtypes in DLB based on the initial clinical presentation. 81 patients with a clinical diagnosis of probable DLB were consecutively included. All patients underwent a neurological evaluation including a structured questionnaire about neuropsychiatric symptoms and sleep, an assessment of motor impairment (Unified Parkinson Disease Rating Scale subscale III), and a formal neuropsychological evaluation. Onset of core symptoms (hallucinations, parkinsonism, and fluctuations) and dementia were systematically reviewed from medical records. We applied a K-means clustering method based on the initial clinical presentation. Cluster analysis yielded three different groups. Patients in cluster I (cognitive-predominant, n = 46) presented more frequently with cognitive symptoms (95.7%, n = 44, p presented more frequently with psychotic symptoms (77.3%, n = 17), and had a shorter duration until the onset of hallucinations (p clinical DLB can be defined when considering the differential initial presentations. The proposed subtypes have distinct clinical profiles and progression patterns.

Lamellipodia and Membrane Blebs Drive Efficient Electrotactic Migration of Rat Walker Carcinosarcoma Cells WC 256

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Sroka, Jolanta; Krecioch, Izabela; Zimolag, Eliza; Lasota, Slawomir; Rak, Monika; Kedracka-Krok, Sylwia; Borowicz, Pawel; Gajek, Marta; Madeja, Zbigniew

2016-01-01

The endogenous electric field (EF) may provide an important signal for directional cell migration during wound healing, embryonic development and cancer metastasis but the mechanism of cell electrotaxis is poorly understood. Additionally, there is no research addressing the question on the difference in electrotactic motility of cells representing various strategies of cell movement—specifically blebbing vs. lamellipodial migration. In the current study we constructed a unique experimental model which allowed for the investigation of electrotactic movement of cells of the same origin but representing different modes of cell migration: weakly adherent, spontaneously blebbing (BC) and lamellipodia forming (LC) WC256 cells. We report that both BC and LC sublines show robust cathodal migration in a physiological EF (1–3 V/cm). The directionality of cell movement was completely reversible upon reversing the field polarity. However, the full reversal of cell direction after the change of EF polarity was much faster in the case of BC (10 minutes) than LC cells (30 minutes). We also investigated the distinct requirements for Rac, Cdc42 and Rho pathways and intracellular Ca2+ in electrotaxis of WC256 sublines forming different types of cell protrusions. It was found that Rac1 is required for directional movement of LC to a much greater extent than for BC, but Cdc42 and RhoA are more crucial for BC than for LC cells. The inhibition of ROCK did not affect electrotaxis of LC in contrast to BC cells. The results also showed that intracellular Ca2+ is essential only for the electrotactic reaction of BC cells. Moreover, inhibition of MLCK and myosin II did not affect the electrotaxis of LC in contrast to BC cells. In conclusion, our results revealed that both lamellipodia and membrane blebs can efficiently drive electrotactic migration of WC 256 carcinosarcoma cells, however directional migration is mediated by different signalling pathways. PMID:26863616

Lamellipodia and Membrane Blebs Drive Efficient Electrotactic Migration of Rat Walker Carcinosarcoma Cells WC 256.

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Jolanta Sroka

Full Text Available The endogenous electric field (EF may provide an important signal for directional cell migration during wound healing, embryonic development and cancer metastasis but the mechanism of cell electrotaxis is poorly understood. Additionally, there is no research addressing the question on the difference in electrotactic motility of cells representing various strategies of cell movement-specifically blebbing vs. lamellipodial migration. In the current study we constructed a unique experimental model which allowed for the investigation of electrotactic movement of cells of the same origin but representing different modes of cell migration: weakly adherent, spontaneously blebbing (BC and lamellipodia forming (LC WC256 cells. We report that both BC and LC sublines show robust cathodal migration in a physiological EF (1-3 V/cm. The directionality of cell movement was completely reversible upon reversing the field polarity. However, the full reversal of cell direction after the change of EF polarity was much faster in the case of BC (10 minutes than LC cells (30 minutes. We also investigated the distinct requirements for Rac, Cdc42 and Rho pathways and intracellular Ca2+ in electrotaxis of WC256 sublines forming different types of cell protrusions. It was found that Rac1 is required for directional movement of LC to a much greater extent than for BC, but Cdc42 and RhoA are more crucial for BC than for LC cells. The inhibition of ROCK did not affect electrotaxis of LC in contrast to BC cells. The results also showed that intracellular Ca2+ is essential only for the electrotactic reaction of BC cells. Moreover, inhibition of MLCK and myosin II did not affect the electrotaxis of LC in contrast to BC cells. In conclusion, our results revealed that both lamellipodia and membrane blebs can efficiently drive electrotactic migration of WC 256 carcinosarcoma cells, however directional migration is mediated by different signalling pathways.

Hematemesis as Initial Presentation in a 10-Week-Old Infant with Eosinophilic Gastroenteritis

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Varun Shetty

2017-01-01

Full Text Available Eosinophilic gastroenteritis is a rare condition characterized by eosinophilic inflammation in the gastrointestinal tract resulting in a variety of gastrointestinal symptoms. There is currently a dearth of information on this topic in the pediatric literature, as very few cases have been reported. In this report, we present a case of eosinophilic gastroenteritis in a 10-week-old patient with initial presenting symptom of hematemesis. To our knowledge, this is the youngest case reported in the literature and is unique in its initial presentation.

Lower extremity necrotizing fasciitis: A unique initial presentation of Crohn's disease

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Anna Weiss

2015-09-01

Full Text Available Crohn's disease is a disease of the bowel, typically presenting with diarrhea, weight loss, and abdominal pain. Complications such as abscesses, fistulas, and strictures may require surgical intervention. We would like to report a patient with Crohn's disease who presented for the first time with left lower extremity necrotizing fasciitis. There are very few reports of necrotizing fasciitis in Crohn's disease as the initial presentation.

Cardiogenic Shock: An Unusual Initial Presentation of Churg-Strauss Syndrome

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M. Apirami

2018-01-01

Full Text Available Churg-Strauss syndrome (CSS is a rare autoimmune condition, characterized by necrotizing extravascular eosinophil rich granulomatous inflammation of the tissues and disseminated small-medium sized vessel vasculitis in a patient with bronchial asthma and tissue eosinophilia. Though pulmonary involvement is the predominant feature of CSS, extra pulmonary involvement, in particular, cardiac involvement, denotes an adverse outcome. Here we report a 50-year-old female who presented with cardiogenic shock due to an acute coronary event as the initial manifestation of CSS. A subsequent coronary angiogram revealed normal epicardial coronaries. She was a patient with bronchial asthma and developed vasculitic rash, bilateral sensory motor polyneuropathy, and migratory peripheral lung field shadows in the background of peripheral eosinophilia during the course of the illness. She was diagnosed as having CSS based on ACR criteria and aggressively treated with immunosuppressants according to her Five-Factor Score and has shown prompt response to therapy. This case report adds to the literature another rare initial presentation of CSS to the existing array of its clinical manifestations.

Male breast cancer is rare: an initial presentation may be as an abscess.

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Ventham, N T; Hussien, M I

2010-08-06

Breast cancer in men is rare. Breast cancer presenting initially as an abscess has been described only a handful of times in the literature. We present the first described case of invasive adenocarcinoma presenting as an abscess in a man. An 80-year-old diabetic man presented with symptoms typical of a breast abscess. The abscess failed to respond to percutaneous therapy and excision of breast abscess was performed. Histology revealed an invasive carcinoma. He went on to have a mastectomy. Histology should be obtained from breast abscesses not resolving within 2 months of initial percutaneous therapy. Histology could be obtained by ultrasound-guided fine-needle aspiration (FNA), core or vacuum assisted biopsy, or by formal incision and drainage.

Acute Appendicitis as the Initial Clinical Presentation of Primary HIV-1 Infection

DEFF Research Database (Denmark)

Schleimann, Mariane H; Leth, Steffen; Krarup, Astrid R

2018-01-01

We report a case of an adolescent who presented at our emergency department with acute abdominal pain. While the initial diagnosis was acute appendicitis, a secondary and coincidental diagnosis of primary HIV-1 infection was made. Concurrent and subsequent clinical and molecular biology findings ...... form the basis of our argument that primary HIV-1 infection was the cause of acute appendicitis in this individual.......We report a case of an adolescent who presented at our emergency department with acute abdominal pain. While the initial diagnosis was acute appendicitis, a secondary and coincidental diagnosis of primary HIV-1 infection was made. Concurrent and subsequent clinical and molecular biology findings...

Pretibial myxedema without ophthalmopathy: an initial presentation of Graves' disease.

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Lohiya, Sheela; Lohiya, Vipin; Stahl, Elizabeth J

2013-07-01

To report a rare case of Graves' disease without ophthalmopathy presenting with pretibial myxedema (PM) as an initial presentation. We present the clinical history, physical findings, laboratory studies and biopsy data of a 62-year-old man with a history of uncontrolled type 2 diabetes (DM2) presenting with arm and leg skin lesions in the absence of other physical findings. Histopathology confirmed PM. Graves' disease and its association with PM without Graves' ophthalmopathy and the pertinent literature are reviewed. A 60-year-old man with a history of uncontrolled DM2 presented for glycemic management. He described symptoms of anxiety, insomnia and fatigue for the last 5 to 6 months. He described diffuse chest pain, occasionally associated with palpitations, and a 50-pound weight loss. He also complained of severe itching and burning of his arms and legs for the past several months. Subsequent thyroid studies revealed hyperthyroidism suggestive of Graves' disease. In the interim, he was hospitalized for atrial flutter and was cardioverted. After being started on methimazole, his symptoms abated. His skin lesions were biopsied, and the leg biopsy was consistent with PM. He however had no lid lag or proptosis characteristic of Graves' disease. He subsequently underwent radioiodine ablation. His hyperglycemia was better control led after treatment of his hyperthyroidism. PM is an autoimmune manifestation of Graves' disease. Almost all cases of thyroid dermopathy are associated with relatively severe ophthalmopathy. Usually ophthalmopathy appears first and dermopathy much later. However, this case represents a rare initial presentation of Graves' disease with PM without ophthalmologic symptoms or findings. Hyperthyroidism is typically associated with worsening glycemic control and increased insulin requirements. In patients with diabetes having hyperthyroidism, deterioration in glycemic control should be anticipated and treatment should be adjusted accordingly

Pancreatic ductal adenocarcinoma presenting with acute and chronic pancreatitis as initial presentation: is prognosis better? A comparison study..

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Thorat, Ashok; Huang, Wen-Hsuan; Yeh, Ta-Sen; Jan, Yi-Yan; Hwang, Tsann-Long

2014-10-01

Pancreatic ductal adenocarcinoma (PDAC) may present with acute and /or chronic pancreatitis due to pancreatic ductal obstruction causing diagnostic dilemma. The aim of this retrospective study was to investigate the outcome and prognosis of the patients of PDAC presenting with pancreatitis. From 1991 to 2009, 298 patients with PDAC that underwent surgical treatment were retrospectively studied and divided in two groups depending upon initial symptomatic presentation. Group A (n=254) comprised patients without pancreatitis while group B (n=44) patients presented with acute and/or chronic pancreatitis initially. All the patients in studied cohort were surgically treated. Mean age of group A was 63.1 years & for group B it was 62.9 years. Location of tumor was in head of the pancreas in 66.14% of group A patients (n=168) and 61.36% of group B patients (n=27). Although statistically insignificant, the patients in group B had overall better 5-year survival than the patients in group A (20% vs 15.9%). This retrospective study highlights the overall better survival of PDAC patients presenting with acute and/or chronic pancreatitis than those without as contrary to previous reports which stated the poor prognosis of PDAC patients if associated with underlying pancreatitis.

A case report of Parry Romberg Syndrome initially presenting as periodontitis

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Taylor, Greig; Culshaw, Shauna; Armas, Jose; Savarrio, Lee; Goodall, Christine

2017-01-01

Parry Romberg Syndrome (PRS) is a rare disorder of progressive hemifacial atrophy, involving soft tissues, fat and occasionally bone. It can co-exist with presentations of Morphea. We describe an unusual case of persistent periodontal and alveolar destruction associated with PRS. A 56-year-old African female initially presented with persistent periodontal destruction, which showed minimal response to conventional periodontal treatment. After non-surgical treatment, surgical debridement follow...

Unusual Initial Presentation of Herpes Simplex Virus as Inguinal Lymphadenopathy

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Sarah A. Fleming

2015-01-01

Full Text Available Genital herpes simplex virus (HSV infections are a common cause of inguinal lymphadenopathy. However, surgical excision of enlarged inguinal nodes is almost never performed to initially diagnose genital herpes simplex virus, due to the distinct external presentation of genital herpetic vesicles that usually occur with the first symptoms of infection. Therefore, the histologic and immunophenotypic features of HSV-associated inguinal lymphadenopathy are unfamiliar to most pathologists. The current report describes the lymph node pathology of two immunocompetent patients, whose initial HSV diagnosis was established through surgical excision of enlarged inguinal lymph nodes. Histologic examination showed features consistent with viral lymphadenopathy, including florid follicular hyperplasia, monocytoid B-cell hyperplasia, and paracortical hyperplasia without extensive necrosis. Immunohistochemical stains for HSV antigens, using polyclonal anti-HSV I and II antibodies, demonstrate strong immunoreactivity for HSV in a small number of cells in the subcapsular sinuses, especially in areas with monocytoid B-cell hyperplasia. Rare scattered HSV-positive cells also are identified in paracortical areas and germinal centers. We conclude that an initial diagnosis of genital HSV infection may be established by inguinal lymph node biopsy.

Unusual initial abdominal presentations of invasive meningococcal disease.

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Guiddir, Tamazoust; Gros, Marion; Hong, Eva; Terrade, Aude; Denizon, Mélanie; Deghmane, Ala-Eddine; Taha, Muhamed-Kheir

2018-03-28

Invasive meningococcal disease (IMD) is recognized as septicemia and/or meningitis. However, early symptoms may vary and are frequently nonspecific. Early abdominal presentations have been increasingly described. We aimed to explore a large cohort of patients with initial abdominal presentations for association with particular meningococcal strains. Confirmed IMD cases in France between 1991-2016 were screened for the presence within the 24 hours before diagnosis of at least one of the following criteria (1) abdominal pain, (2) gastro-enteritis with diarrhea and vomiting, (3) diarrhea only. Whole genome sequencing was performed on all cultured isolates. We identified 105 cases (median age 19 years) of early abdominal presentations with a sharp increase since 2014. Early abdominal pain alone was the most frequent symptom (n=67, 64%), followed by gastro-enteritis (n=26, 25%) and diarrhea alone (n=12, 11%). Twenty patients (20%) had abdominal surgery. A higher case fatality rate (24%) was observed in these cases compared to 10.4% in all IMD in France (p=0.007) with high levels of inflammation markers in the blood. Isolates of group W were significantly more predominant in these cases compared to all IMD. Most of these isolates belonged to clonal complex ST-11 (cc11) of the sublineages of the South American-UK strain. Abdominal presentations are frequently provoked by hyperinvasive isolates of meningococci. Delay in the management of these cases and the virulence of the isolates may explain the high fatality rate. Rapid recognition is a key element to improve their management.

Cryptogenic Organising Pneumonia As The Initial Presenting Manifestation of SLE

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Neena Mampilly

2015-07-01

Full Text Available Cryptogenic Organising Pneumonia (COP, also called idiopathic Bronchiolitis Obliterans Organising Pneumonia( BOOP, is a distinct entity among the idiopathic interstitial pneumonias defined histopathologically by intraalveolar buds of granulation tissue. The etiology includes idiopathic, infectious, drug induced radiation induced and connective tissue diseases. Organising pneumonia occurs particularly in patients with dermatomyositis-polymyositis where it may be the presenting manifestation, and rarely in SLE, rheumatoid arthritis, scleroderma and other connective tissue diseases. We describe a 30 yr old lady who initially presented with respiratory symptoms, not responding to antibiotics. She was subsequently diagnosed as SLE and HRCT thorax showed consolidation involving both lung fields. A percutaneous lung biopsy revealed features of Cryptogenic Organising Pneumonia.

Cauda equina syndrome as the initial presenting clinical feature of medulloblastoma: a case report

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Al-Otaibi Faisal

2012-05-01

Full Text Available Abstract Introduction Medulloblastoma is one of the most common pediatric brain malignancies. The usual presenting clinical features are related to posterior fossa syndrome or/and hydrocephalus. Cauda equina syndrome is a very rare presentation for this disease. Case presentation We describe the case of a three-year-old boy with cauda equina syndrome as the initial presenting clinical feature for medulloblastoma. He was initially diagnosed as having a spinal tumor by magnetic resonance imaging scan. Subsequently, a cranial magnetic resonance imaging scan revealed a posterior fossa tumor with features of dissemination. He had substantial improvement after treatment. This case report is complemented by a literature review related to this unusual presentation. Conclusions Medulloblastoma primarily presenting with cauda equina syndrome is very rare. However, spinal drop metastasis should be considered in the pediatric age group to avoid suboptimal management.

Painless Legs and Moving Toes as an Initial Presentation of Ischemic Stroke

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Se Mi Oh

2009-05-01

Full Text Available Painless legs and moving toes is an unusual syndrome, which has not previously been reported as an initial presentation of ischemic stroke. We encountered a 78-year-old woman who developed dysarthria and involuntary movement of her left toes that was clinically regarded as painless legs and moving toes. These symptoms appeared abruptly and simultaneously as the initial symptoms of stroke, and improved gradually with conservative management by intravenous hydration for a month. We suggest that, in our case, a cortical brain lesion caused by ischemic stroke might be associated with the development of painless legs and moving toes.

Male breast cancer is rare: an initial presentation may be as an abscess

OpenAIRE

Ventham, N T; Hussien, M I

2010-01-01

Breast cancer in men is rare. Breast cancer presenting initially as an abscess has been described only a handful of times in the literature. We present the first described case of invasive adenocarcinoma presenting as an abscess in a man. An 80-year-old diabetic man presented with symptoms typical of a breast abscess. The abscess failed to respond to percutaneous therapy and excision of breast abscess was performed. Histology revealed an invasive carcinoma. He went on to have a mastectomy. Hi...

Communicative dynamism and prosodic prominence in presentation sentences with initial rhematic subjects

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Martin Adam

2017-08-01

Full Text Available Within the framework of the theory of functional sentence perspective (Firbas 1992, the distinction between presentation and quality scale sentences plays a vital role. The present paper proposes to shed light on one of the most common configurations of presentation sentences, viz. structures with initial rhematic subject (e.g. an uninvited dwarf came, examining the way native speakers place the intonation centre in such structures, i.e. to map the correspondence between the degrees of communicative dynamism and prosodic prominence. For the purpose of the investigation selected chapters from Tolkien’s The Hobbit are used.

Maxillary brown tumor as initial presentation of parathyroid adenoma: A case report

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Hon-Ke Sia

2012-07-01

Full Text Available Brown tumor is a rare late-stage skeletal change caused by long-term stimulation of excess parathyroid hormone. It is not neoplastic, but a reparative cellular process. Common sites of brown tumor are the ribs, clavicle, long bones and pelvic girdle. Solitary maxillary brown tumor as initial presentation of primary hyperparathyroidism is rare; it is often accompanied by brown tumors of the other facial bones. Here, we present the first case of solitary maxillary brown tumor in a 29-year-old ethnic Chinese woman with initial presentation of a large tumor filling the left maxillary sinus. Underlying long-standing primary hyperparathyroidism caused by a large parathyroid adenoma was finally diagnosed. Brown tumor tends to be misdiagnosed as malignancy, and delayed diagnosis of the underlying hyperparathyroidism is common. Our case validates the suggestion that young women have a higher probability of brown tumor. Biopsy of the suspicious bone tumor and blood tests for calcium and parathyroid hormone level are crucial and essential to reach the correct diagnosis. Most brown tumors show spontaneous regression after parathyroidectomy. However, direct excision of the brown tumor may be indicated to avoid the risk of facial deformity and orbital compression at a special anatomical site, as in our case.

An analysis of 78 breast sarcoma patients without distant metastases at presentation

International Nuclear Information System (INIS)

McGowan, T.S.; Cummings, B.J.; O'Sullivan, B.; Catton, C.N.; Miller, N.; Panzarella, T.

2000-01-01

Purpose: A retrospective review of a single cancer center experience was undertaken to identify clinical or treatment prognostic factors for these unusual tumors, to allow for a recommendation regarding management. Methods and Materials: The charts of 76 women and 2 men with breast sarcoma and without distant metastases at presentation registered from 1958 to 1990 were reviewed. Pathology was centrally reviewed in 54 cases. Histology, tumor size, grade, nodal status, age, menopausal status, history of benign breast disease, extent of surgery, resection margins, and radiation dose were each examined as potential prognostic factors by univariate analysis. To allow an analysis of radiation dose, total dose was normalized to a daily fraction size of 2 Gy. Results: The median age at diagnosis was 50.5 years (13-82 years). The pathologic diagnosis was found to be malignant cystosarcoma phyllodes in 32 patients, with the remainder being stromal sarcoma (14), angiosarcoma (8), fibrosarcoma (7), carcinosarcoma (5), liposarcoma (4), other (8). Eighteen patients had grade I or II tumors, 43 had grade III or IV, and 18 were not evaluable. The 5- and 10-year actuarial rates for all 78 patients were 57% and 48% for cause-specific survival (CSS), and 47% and 42% for the relapse-free rates (RFR), respectively. The local relapse-free rate (LRFR) was 75% at both 5 and 10 years. The 5-year CSS for grade I or II tumors was 84% versus 55% for grade III or IV tumors (p = 0.01). Conservative surgery versus mastectomy did not lead to statistically significant different outcomes for CSS, RFR, or LRFR. The comparison of positive versus negative margins showed a 5-year LRFR of 33% versus 80% (p = 0.009). Pairwise comparisons of the 5-year CSS of 91% for > 48 Gy versus either 50% for ≤ 48 Gy or 50% for no radiation showed p-values of 0.03 and 0.06, respectively. Conclusion: The authors propose that if negative surgical margins can be achieved, breast sarcoma should be managed by

IAEA Technical Meeting on Status of IAEA Fast Reactor Knowledge Preservation Initiative. Presentations

International Nuclear Information System (INIS)

2013-01-01

The objectives of the technical meeting were to: • exchange information between the Member States/International Organizations on national and international initiatives addressing knowledge preservation and data retrieval/collection in the field of fast neutron systems; • present and discuss the Member States’/International Organizations’ policies and conditions for releasing to the IAEA both publicly available and confidential information on fast neutron systems; • collect data on fast neutron systems provided by participating Member States/International Organizations and encourage participants to contribute in data collection; • provide recommendations for further IAEA initiatives in the field of fast reactor knowledge preservation

Isolated ileal perforation in infancy: a lethal initial presentation of Hirschsprung’s disease

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Fadi Iskandarani

2017-06-01

Full Text Available A rare case of ileal perforation, as a fatal initial presentation of total colonic aganglionosis (TCA in infancy is reported. A 10-week-old boy, was brought to the emergency department with symptoms of complicated intestinal obstruction. He looked ill, was lethargic, markedly dehydrated and had a severely distended abdomen. An abdominal X-ray revealed multiple air fluid levels seen in a distended small intestine. During exploratory laparotomy the ileum was massively dilated with distal segment perforation. Ileal perforation repair was performed. A totally collapsed microcolon was identified. Biopsies were taken from the high rectum, sigmoid and hepatic flexure. Appendectomy and ileostomy were performed. All biopsies, as well as the appendix, showed absence of ganglion cells. Despite this procedure the patient progressively deteriorated and later died due to sepsis. Ileal perforation in infants is a rare, but potentially fatal initial presentation of TCA. Early detection is essential to prevent life-threatening complications.

Subacromial bursitis with giant rice bodies as initial presentation of rheumatoid arthritis.

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Subramaniam, Ramesh; Tan, Justina Wei Lyn; Chau, Cora Yuk Ping; Lee, Keng Thiam

2012-10-01

Rice body formation is a nonspecific response to chronic synovial inflammation associated with tuberculous arthritis, rheumatoid arthritis, juvenile rheumatoid arthritis, seronegative inflammatory arthritis, and even osteoarthritis. Such bodies were termed rice bodies because of their close resemblance to grains of polished white rice. We present a case report of a middle-aged woman with right shoulder subacromial/subdeltoid bursitis with giant rice body formation as her initial presentation of rheumatoid arthritis. Her right shoulder symptoms resolved after subacromial and subdeltoid bursectomy and removal of the rice bodies. She subsequently developed inflammatory arthritis of other joints, met the criteria for rheumatoid arthritis, and has been treated medically.

A phase II evaluation of ixabepilone in the treatment of recurrent/persistent carcinosarcoma of the uterus, an NRG Oncology/Gynecologic Oncology Group study.

Science.gov (United States)

McCourt, Carolyn K; Deng, Wei; Dizon, Don S; Lankes, Heather A; Birrer, Michael J; Lomme, Michele M; Powell, Matthew A; Kendrick, James E; Saltzman, Joel N; Warshal, David; Tenney, Meaghan E; Kushner, David M; Aghajanian, Carol

2017-01-01

The primary objectives were to determine the objective response rate (ORR) and safety profile of ixabepilone in women with recurrent or persistent uterine carcinosarcoma (UCS). Secondary objectives included progression-free survival (PFS) and overall survival (OS). Exploratory translational objectives included characterization of class III beta tubulin expression and its association with response, PFS, and OS. Patients had measurable disease; up to two prior chemotherapeutic regimens were allowed, but must have included a taxane. Women received ixabepilone 40mg/m 2 as a 3hour IV infusion on day 1 of a 21daycycle. Treatment was continued until disease progression or unacceptable toxicity occurred. Forty-two women were enrolled, with 34 eligible and evaluable. Median age was 68years. ECOG performance status was 0 in 56% of women, 38% had received radiation, and 15% had received 2 lines of chemotherapy. Overall ORR was 11.8% (4/34, 90% CI 4.2-25.1%); all were partial responses. Stable disease for at least 8weeks was achieved in 8 patients (23.5%). Median PFS and OS were 1.7mo and 7.7mo, respectively, with a median follow-up of 37mo. Six month PFS was 20.6%. Major grade≥3 toxicities were neutropenia (47%), fatigue (15%), dehydration (15%), hypertension (15%), and hyponatremia (15%); grade 2 peripheral neuropathy was reported in 18%. In this small sample size, class III beta tubulin expression in the primary tumor was not associated with the response to ixabepilone, PFS, or OS. In this cohort of women, single agent ixabepilone showed modest but insufficient clinical activity. Copyright © 2016. Published by Elsevier Inc.

Laboratory findings in neurosyphilis patients with epileptic seizures alone as the initial presenting symptom.

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Tong, Man-Li; Liu, Li-Li; Zeng, Yan-Li; Zhang, Hui-Lin; Liu, Gui-Li; Zheng, Wei-Hong; Dong, Jie; Wu, Jing-Yi; Su, Yuan-Hui; Lin, Li-Rong; Yang, Tian-Ci

2013-04-01

A retrospective chart review was performed to characterize the clinical presentation, the characteristic combination of serologic and cerebrospinal fluid (CSF) abnormalities, and the neuroimaging findings of neurosyphilis (NS) patients who had epileptic seizures alone as an initial presenting symptom. In a 6.75-year period, 169 inpatients with NS were identified at Zhongshan Hospital (from June 2005 to February 2012). We demonstrated that 13 (7.7%) of the 169 NS patients had epileptic seizures alone as an initial presenting feature. Epileptic seizures occurred in NS patients with syphilitic meningitis (2 cases), meningovascular NS (5 cases), and general paresis (6 cases). The types of epileptic seizures included simple partial, complex partial with secondary generalization (including status epilepticus), and generalized seizures (no focal onset reported). Nine of NS patients with only epileptic seizures as primary symptom were misdiagnosed, and the original misdiagnosis was 69.23% (9/13). Ten (10/13, 76.9%) patients had an abnormal magnetic resonance imaging, and 7 (7/13 53.8%) patients had abnormal electroencephalogram recordings. In addition, the sera rapid plasma reagin (RPR) and Treponema pallidum particle agglutination (TPPA) from all 13 patients were positive. The overall positive rates of the CSF-RPR and CSF-TPPA were 61.5% and 69.2%, respectively. Three patients demonstrated CSF pleocytosis, and 9 patients exhibited elevated CSF protein levels. Therefore, NS with only epileptic seizures at the initial presentation exhibits a lack of specificity. It is recommended that every patient with clinically evident symptoms of epileptic seizures should have a blood test performed for syphilis. When the serology results are positive, all of the patients should undergo a CSF examination to diagnose NS. Copyright © 2013 Elsevier Inc. All rights reserved.

Initial heart rate and cardiovascular outcomes in patients presenting with acute coronary syndrome.

Science.gov (United States)

Asaad, Nidal; El-Menyar, Ayman; AlHabib, Khalid F; Shabana, Adel; Alsheikh-Ali, Alawi A; Almahmeed, Wael; Al Faleh, Hussam; Hersi, Ahmad; Al Saif, Shukri; Al-Motarreb, Ahmed; Sulaiman, Kadhim; Al Nemer, Khalid; Amin, Haitham; Al Suwaidi, Jassim

2014-06-01

To assess the impact of on-admission heart rate (HR) in patients presenting with acute coronary syndrome (ACS). Data were collected retrospectively from the second Gulf Registry of Acute Coronary Events. Patients were divided according to their initial HR into: (I: < 60, II: 60-69, III: 70-79, IV: 80-89 and V: ≥ 90 bpm). Patients' characteristics and hospital and one- and 12-month outcomes were analyzed and compared. Among 7939 consecutive ACS patients, groups I to V represented 7%, 13%, 20%, 23.5%, and 37%, respectively. Mean age was higher in groups I and V. Group V were more likely males, diabetic and hypertensive. ST-elevation myocardial infarction was the main presentation in groups I and V. Reperfusion therapies were less likely given to group V. Beta blockers were more frequently prescribed to group III in comparison to groups with higher HR. Groups I and V were associated with worse hospital outcomes. Multivariate analysis showed initial tachycardia as an independent predictor for heart failure (OR 2.2; 95%CI: 1.39-3.32), while bradycardia was independently associated with higher one-month mortality (OR 2.0; 95%CI: 1.04-3.85) CONCLUSION: The majority of ACS patients present with tachycardia. However, low or high HR is a marker of high risk that needs more attention and management.

[Hydrocephalus as initial presentation of a spinal cord tumour in a child

DEFF Research Database (Denmark)

Jorgensen, L.M.; Nysom, K.; Lavard, L.D.

2008-01-01

We report a previously healthy two-year-old girl who initially presented with signs of increased intracranial pressure of vomiting, lethargy and unstable gait. She had communicating hydrocephalus and a ventriculoperitoneal shunt was placed. Two years later the girl developed signs of myelopathy...... and was diagnosed with a spinal cord tumour between Th3 and Th9. We suggest that spinal cord tumour should be considered in patients with increased intracranial pressure or hydrocephalus of unknown origin Udgivelsesdato: 2008/9/15...

Sarcomatoid Carcinoma of the lung: A rare case of three small intestinal intussusceptions and literature review

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Angela Romano

2015-01-01

Conclusion: There are rare reports of small intestinal intussusceptions caused by metastatic lung carcinosarcoma, this presentation shows the third case in literature. Physicians should be more alert to symptoms or signs indicating GI metastais in patients with a history of lung cancer.

Megaloblastic anemia with peripheral neuropathy, a misleading initial presentation in POEMS syndrome: A case report

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Iadarilang Tiewsoh

2014-01-01

Full Text Available POEMS (peripheral neuropathy, organomegaly, endocrinopathy, M protein, skin changes syndrome is a rare multisystem paraneoplastic disorder that occurs in the setting of a plasma cell dyscrasia. A 57-year-old male with initial presentation of peripheral neuropathy of lower limbs and a peripheral blood picture of megaloblastic anemia, presented with progressive lower motor neuron weakness over few months; followed by additional features of skin hyperpigmentation, generalized lymphadenopathy, erectile dysfunction, weight loss, and an attack of cerebrovascular accident (stroke infarct which recovered. On further evaluation with time, there were presence of hepatosplenomegaly, Castleman′s disease of the lymph node on biopsy, serum electrophoresis suggestive of monoclonal gammopathy with light band lambda chain, and endocrinopathy (hypothyroidism and hypogonadism. His bone marrow was suggestive of plasmacytosis. This case report describes a patient who presented with initial picture of peripheral neuropathy with megaloblastic anemia, but when followed-up there were diverse clinical manifestations fulfilling the diagnostic clinical criteria of POEMS Syndrome.

Pneumatosis Intestinalis as the Initial Presentation of Systemic Sclerosis: A Case Report and Review of the Literature

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Farshid Ejtehadi

2012-01-01

Full Text Available Introduction. Pneumatosis intestinalis (PI is an uncommon pathology characterised by the presence of gas within the intestinal wall. It has been associated with various conditions, including connective tissue diseases. This is the first report of PI being the initial presentation of systemic sclerosis. Case Presentation. The patient, a 75-year-old female, presented with an 8-month history of worsening dysphagia and epigastric pain, as well as other nonspecific symptoms. Initial investigations with an oesophagogastroduodenoscopy diagnosed Candida oesophagitis and also identified an extrinsic compression of the gastric antrum. Subsequently a CT scan of the abdomen and pelvis showed moderately dilated small bowel loops and PI. Due to the patient’s stability, non-critical clinical condition, conservative management was instituted. More detailed investigations confirmed the diagnosis of systemic sclerosis with positive anticentromeric and antinuclear antibodies. The patient improved on methotrexate and was discharged with appropriate outpatient follow-up. Discussion. PI is a rare but well-documented pathology associated with connective tissue diseases, such as systemic sclerosis. In most cases, conservative management is preferable to surgical intervention, depending on the patient’s clinical presentation and progress. This is the first report of PI being the initial presentation of a patient with systemic sclerosis responsive to conservative management.

Refractory Hypotension as an Initial Presentation of Bilateral Subclavian Artery Stenosis

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Maxwell Eyram Afari

2016-01-01

Full Text Available Bilateral subclavian stenosis is a rare clinical condition. An interbrachial pressure difference of 15 mm Hg can raise suspicion for unilateral subclavian artery stenosis, but the diagnosis of bilateral subclavian artery stenosis can be challenging. We present a case of a 75-year-old woman who presented with refractory hypotension after surgery. Initial vitals revealed blood pressure in the 60s/50s mm Hg in both arms. Cardiopulmonary examination was remarkable for diminished pulses in all 4 extremities and audible carotid bruits. She continued to be hypotensive despite aggressive fluid resuscitation. Troponin T peaked at 0.24 ng/mL (reference < 0.04, and an echocardiogram revealed a reduction in ejection fraction (37% from 50%. Left and right heart catheterization demonstrated normal filling pressures and cardiac output. During the procedure, however, it was noted that the patient’s central blood pressure was 70–80 mm Hg higher than cuff pressures obtained in either arm. Selective angiography revealed 90% left subclavian ostial stenosis as well as 70% stenosis of the right subclavian artery.

Mucosa-associated lymphoid tissue lymphoma with initial supradiaphragmatic presentation: natural history and patterns of disease progression

International Nuclear Information System (INIS)

Liao Zhongxing; Ha, Chul S.; McLaughlin, Peter; Manning, John T.; Hess, Mark; Cabanillas, Fernando; Cox, James D.

2000-01-01

Purpose: Mucosa-associated lymphoid tissue (MALT) lymphoma commonly presents in the gastrointestinal (GI) tract. Supradiaphragmatic MALT lymphoma is less common and its natural history is not well defined. This study was conducted to understand the natural history, to determine the frequency of synchronous disease in the GI tract, and to understand the patterns of disease progression after treatment for supradiaphragmatic MALT lymphoma. Patients and Methods: We retrospectively reviewed the medical records of 39 patients who presented with supradiaphragmatic MALT lymphoma between 1991 and 1997. Results: The median age of patients was 58 years (range, 25-90 years) with 16 male and 23 female patients. The most common primary site was salivary gland followed by ocular adnexa, lung, oral cavity, and others. Sixteen patients underwent esophagogastroduodenoscopy and biopsy (EGD + Bx) and 4 were found to have gastric involvement. Ann Arbor stages were the following: IEA, 17; IIEA, 5, IIEB, 1; and IVA, 16. The initial treatments were: involved field radiation therapy (n = 10), chemotherapy (n = 14), combination of radiation therapy and chemotherapy (n = 9), observation after biopsy (n = 4), antibiotics only (n = 1), and patient refusal of further intervention (n = 1). Seven patients received antibiotics as a part of the initial treatment. Every patient except for 1 was alive at a median follow-up of 39.5 months (range, 3-83 months). Thirty-six patients achieved complete response (CR) to the initial treatment. The actuarial 5-year progression-free survival rate was 83%. Progression of the disease occurred in 4 patients, with 2 in the stomach. Salvage attempts were made to 4 and were successful in 3. Of the 2 patients who relapsed in the stomach, 1 had negative EGD + Bx at the time of initial diagnosis. An EGD + Bx was not done in the second patient. Conclusion: Supradiaphragmatic MALT lymphoma appears to have a favorable prognosis. However, routine evaluation of the stomach

Massive retroperitoneal ganglioneuroma presenting with small bowel obstruction 18 years following initial diagnosis.

LENUS (Irish Health Repository)

Cronin, E M P

2012-02-03

BACKGROUND: Ganglioneuroma is a rare tumour of neural crest origin, which arises from maturation of a neuroblastoma. While previously considered to be non-functioning, they are now known to be frequently endocrinologically active. AIMS AND METHODS: We report a case of a massive retroperitoneal ganglioneuroma presenting with small bowel obstruction in an adult, 18 years after initial diagnosis. Urinary dopamine levels were elevated, but other catecholamines were within normal limits. This is the first report in the English-language literature of a retroperitoneal ganglioneuroma presenting with or causing intestinal obstruction. We also review the metabolic, radiological, and histological features of these tumours. Relevant publications were identified from a Medline search using the MeSH headings \\'ganglioneuroma\\

Spontaneous acute subdural hematoma as an initial presentation of choriocarcinoma: A case report

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Rocque Brandon G

2008-06-01

Full Text Available Abstract Introduction Diverse sequelae of central nervous system metastasis of choriocarcinoma have been reported, including infarction, intra or extra axial hemorrhages, aneurysm formation and carotid-cavernous fistula. Here we report a case of subdural hematoma as the first presentation of choriocarcinoma. Case presentation The patient is a 34-year-old woman whose initial presentation of widely metastatic choriocarcinoma was an acute subdural hematoma, requiring decompressive craniectomy. Histopathologic examination of the tissue showed no evidence of choriocarcinoma, but the patient was found to have diffuse metastatic disease and cerebrospinal fluid indices highly suggestive of intracranial metastasis. Conclusion Choriocarcinoma frequently metastasizes intracranially. We review the diverse possible manifestations of this process. In addition, the cerebrospinal fluid:serum beta-human chorionic gonadotropin ratio is an important factor in diagnosing these cases. Finally, the role of the neurosurgeon is discussed.

A Rare Presentation of the Syndrome of Inappropriate Antidiuretic Hormone in a 12-Year-Old Girl as the Initial Presentation of an Immature Ovarian Teratoma.

Science.gov (United States)

Iqbal, Anoop Mohamed; Schwenk, W Frederick

2018-02-01

Immature ovarian teratoma is very rare in childhood. We report on a 12-year-old girl with immature ovarian teratoma who presented initially with syndrome of inappropriate antidiuretic hormone. A 12-year-old girl presented with acute abdomen and distention. Initial laboratory tests showed hyponatremia (sodium, 123 mmol/L), that did not respond to fluid management. Computed tomography imaging showed a 15 cm × 9 cm × 20 cm mass in the right ovary with multifocal internal fat, and dystrophic calcifications. She underwent exploratory laparotomy with a right salpingo-oophorectomy, omentectomy, and peritoneal stripping. The pathology revealed metastatic immature teratoma. Hyponatremia resolved soon after the surgery. Although a rare diagnosis, immature ovarian teratoma must be considered in a girl who presents with abdominal mass and hyponatremia. Copyright © 2017 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Cardiac arrhythmia as initial presentation of aneurysmal subarachnoid hemorrhage

NARCIS (Netherlands)

van der Kleij, FGH; Henselmans, JML; van de Loosdrecht, AA

1999-01-01

Cardiac arrhythmia and sudden death are most frequently caused by preexisting heart disease. Rarely, cardiac arrhythmia is a first symptom of an acute neurological event. We describe a patient with asystole and other cardiac arrhythmias, as initial symptoms of acute aneurysmal subarachnoid

Streptococcus pneumoniae sepsis as the initial presentation of systemic lupus erythematosus

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Erdem I

2016-09-01

Full Text Available Ilknur Erdem,1 Senay Elbasan Omar,1 Ridvan Kara Ali,1 Hayati Gunes,2 Aynur Eren Topkaya2 1Department of Infectious Diseases, 2Department of Medical Microbiology, Faculty of Medicine, Namik Kemal University, Tekirdag, Turkey Objective: Infections are among the most important causes of morbidity and mortality in patients with systemic lupus erythematosus (SLE but are rare initial presentation of the disease. Therefore, in this study, we describe a case of Streptococcus pneumoniae sepsis in a young woman with previously undiagnosed SLE. Case report: A 23-year-old female patient was admitted to our outpatient clinic complaining of high fever (40°C, chills, fatigue, generalized myalgia, and cough with brown sputum for 5 days. Blood cultures grew gram-positive coccus defined as S. pneumoniae using standard procedures. Antinuclear antibody was positive at a titer of 1/1,000, and anti-double-stranded DNA was positive at 984 IU/mL. She was diagnosed with SLE. Her respiratory symptoms and pleural effusion were considered to be due to pulmonary manifestation of SLE. Conclusion: The underlying immunosuppression caused by SLE could have predisposed the patient to invasive pneumococcal disease. It may also occur as a primary presenting feature, although a rare condition. Keywords: Streptococcus pneumoniae, sepsis, systemic lupus erythematosus

An uncommon initial presentation of snake bite-subarachnoid hemorrhage: A case report with literature review

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Manoj Kumar Roy

2015-01-01

Full Text Available Snake bites are very common in India, particularly in West Bengal. Snake bite can cause various hematological, neuromyopathical complications. It can be very fatal if not detected and treated early. Timely intervention can save the patient. We are reporting a case of hematotoxic Russell viper snake bite presented with subarachnoid hemorrhage. Patient was successfully treated with antivenom serum (AVS along with other conservative management. Subarachnoid hemorrhage as an initial presentation in viper bite is very rare and we discuss the case with proper literature review.

Conjunctival mass as an initial presentation of mantle cell lymphoma: a case report

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Khanlari Mahsa

2012-12-01

Full Text Available Abstract Background To describe a rare manifestation of mantle cell lymphoma (MCL in conjunctiva, with clinical, hisologic, immunohistologic and genetic findings together with review of the Literature. Case presentation Most ocular adnexal lymphomas are extranodal marginal zone B-cell lymphomas of mucosa-associated lymphoid tissue (MALT. A few cases of ocular adnexal mantle cell lymphomas have been reported in the literature. We present a case of mantle cell lymphoma presenting as right conjunctival mass of at least three months duration in a 64-year-old man. Histopathologic examination showed a proliferation of monomorphous small-to-medium-sized lymphoid cells with cleaved nuclei in the subconjunctiva. By immunohistochemistry, the infiltrate was positive for CD20, CD5, BCL-2, cyclin D1, and the transcription factor SOX11. Fluorescent in situ hybridization demonstrated the presence of IGH-CCND1 fusion indicating t(11;14. Conclusion A rigorous approach to initial diagnosis and staging of small cell lymphomas of the ocular adnexa is needed. The recognition of ocular MCL requires appropriate immunohistochemical staining and/or genetic confirmation to differentiate this rare form of presentation of MCL from other more frequent small cell lymphomas.

Carpal spasm in a girl as initial presentation of celiac disease: a case report.

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Ramosaj-Morina, Atifete; Keka-Sylaj, A; Hasbahta, V; Baloku-Zejnullahu, A; Azemi, M; Zunec, R

2017-09-04

Celiac disease is an immune-mediated disorder elicited by ingestion of gluten in genetically susceptible persons. This disorder is characterized by specific histological changes of the small intestine mucosa resulting in malabsorption. This case was written up as it was an unusual and dramatic presentation of celiac disease. We report the case of a 3-year-old Albanian girl who presented at our clinic with carpal spasms and hand paresthesia. A physical examination at admission revealed a relatively good general condition and body weight of 10.5 kg (10 percentile). Carpal spasms and paresthesias of her extremities were present. Neuromuscular irritability was demonstrated by positive Chvostek and Trousseau signs. Blood tests showed severe hypocalcemia with a total serum calcium of 1.2 mmol/L (normal range 2.12 to 2.55 mmol/L), ionized calcium of 0.87 (normal range 1.11 to 1.30 mmol/L), and 24-hour urine calcium excretion of 9.16 mmol (normal range female celiac disease was performed: antigliadin immunoglobulin A, anti-tissue transglutaminase, and anti-endomysial immunoglobulin A antibodies were positive. A duodenal biopsy revealed lymphocyte infiltration, crypt hyperplasia, and villous atrophy compatible with celiac disease grade IIIb according to the Marsh classification. Following the diagnosis of celiac disease, human leukocyte antigen typing was performed, giving a definite diagnosis of celiac disease. She was started on a gluten-free diet. Due to failure to follow a gluten-free diet, episodes of carpal spasms appeared again. Unfortunately, at the age of 7 years she presents with delayed psychophysical development. Although hypocalcemia is a common finding in celiac disease, hypocalcemic carpal spasm is a rare initial manifestation of the disease. Therefore, the possibility of celiac disease should be considered in patients with repeated carpal spasms that seem unduly difficult to treat. This should be evaluated even in the absence of gastrointestinal

Cerebral Venous Thrombosis and Venous Infarction: Case Report of a Rare Initial Presentation of Smoker’s Polycythemia

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Mihir Raval

2010-11-01

Full Text Available Introduction: Cerebral venous thrombosis is a rare initial presentation of polycythemia. If diagnosed early, treatment can reduce mortality and morbidity significantly. Often it may present with headache as the only complaint, and thus the diagnosis is likely to be missed. Case Presentation: A medically stable 31-year-old male, a chronic smoker with a ∼17 pack-year history of smoking, was admitted to the emergency room with a 2-week history of gradually worsening, severe, throbbing headache in the occipital region sensitive to light. Initial neurological examination was positive only for some involuntary motor tics of the left leg. Initial laboratory workup showed hemoglobin of 20 g/dl and hematocrit of 56.5%. The carboxyhemoglobin level was normal, but the oxygen dissociation curve was shifted to the left. Further evaluation by MRI and MRA of the brain suggested extensive and complete thrombosis of the superior sagittal sinus, right transverse sinus and right sigmoid sinus with a small venous infarct in the right parafrontal region. Given that the patient first presented with a thrombotic event, workup for primary polycythemia and hypercoagulable disorders was carried out, including JAK2 mutation evaluation, which was negative. This left us with smoking as the only risk factor and possible cause for secondary polycythemia. He improved significantly with phlebotomy and anticoagulation treatment. Conclusion: This case illustrates a rare but severe complication of secondary polycythemia stressing the importance of being aware of the risk of developing cerebral thrombosis in patients with chronic smoking exposure.

Bilateral Proliferative Retinopathy as the Initial Presentation of Chronic Myeloid Leukemia

Science.gov (United States)

Macedo, Mafalda S. F.; Figueiredo, Ana R. M.; Ferreira, Natália N.; Barbosa, Irene M. A.; Furtado, Maria João F. B. S.; Correia, Nuno F. C. B. A.; Gomes, Miguel P.; Lume, Miguel R. B.; Menéres, Maria João S.; Santos, Marinho M. N.; Meireles S., M. Angelina C.

2013-01-01

The authors report a rare case of a 48-year-old male with chronic myeloid leukemia (CML) who initially presented with a bilateral proliferative retinopathy. The patient complained of recent visual loss and floaters in both eyes (BE). Ophthalmologic evaluation revealed a best corrected visual acuity (BCVA) of 20/50 in the right eye and 20/200 in the left eye (LE). Fundoscopy showed the presence of bilateral peripheral capillary dropout with multiple retinal sea fan neovascularisations, which were confirmed on fluorescein angiography. Full blood count revealed hyperleukocytosis, thrombocytosis, anemia, and hyperuricemia. Bone marrow aspiration and biopsy showed the reciprocal chromosomal translocation t (9;22), diagnostic of CML. The patient was started on hydroxyurea, allopurinol and imatinib mesylate. He received bilateral panretinal laser photocoagulation and a vitrectomy was performed in the LE. The patient has been in complete hematologic, cytogenetic, and major molecular remission while on imatinib and his BCVA is 20/25 in BE. PMID:24339689

WLB in the UK: Present situation and challenges for national and corporate initiatives, suggestions for Japan (Japanese)

OpenAIRE

YAJIMA Yoko

2011-01-01

In this paper, we develop a sense of the present situation and challenges of work-life balance (WLB) policies, corporate initiatives, and the workplace environment from the perspective of workers in the UK, and we carry out a comparison analysis with initiatives in Japan. Further, the analysis in this paper is a summary based on the results of a questionnaire survey of workers in Japan and the UK, a survey of the literature, and the results of local interview surveys in the UK. The UK resembl...

Refractory Post-Herpetic Neuralgia As An Initial Presentation Of Olfactory Neuroblastoma-Related Ectopic ACTH Syndrome

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Hsiang-Hung Lin

2009-03-01

Full Text Available We report a woman aged 64 years with ectopic adrenocorticotropic hormone (ACTH syndrome caused by olfactory neuroblastoma as an initial presentation of refractory post-herpetic neuralgia. The manifestations such as cushingoid appearance and endocrine abnormalities are compatible with Cushing's syndrome. Brain computed tomography revealed a sellar mass. A biopsy revealed olfactory neuroblastoma. Immunohistochemical staining further defined the tumor as an ACTH-secreting neuroblastoma. Subsequent opportunistic infections by Candida glabrata fungemia and multiple drug-resistant Acinetobacter baumannii pneumonia occurred during hospitalization as a complication of severe hypercortisolism. Before any therapy for Cushing's syndrome and neuroblastoma could be initiated, the patient died from sepsis and multiorgan failure. We propose that Cushing's syndrome is more complex than what clinicians thought, and that meticulous cerebral imaging studies are crucial.

Initial clinical presentation of young children with N-methyl-d-aspartate receptor encephalitis.

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Favier, Marion; Joubert, Bastien; Picard, Géraldine; Rogemond, Véronique; Thomas, Laure; Rheims, Sylvain; Bailhache, Marion; Villega, Frédéric; Pédespan, Jean-Michel; Berzero, Giulia; Psimaras, Dimitri; Antoine, Jean-Christophe; Desestret, Virginie; Honnorat, Jérôme

2018-05-01

Autoimmune encephalitis with anti-N-methyl-d-aspartate receptor autoantibodies (NMDA-R-Abs) is a recently described disease affecting adult and pediatric patients. Symptoms of the disease are now perfectly described in the adult population but the clinical presentation is less known in young children. The aim of the present study was to describe the clinical presentation and the specificities of symptoms presented by young children with NMDA-R-Abs encephalitis to improve diagnosis of this disease, and to compare these to a series of previously published female adult patients. Fifty cases of children younger than twelve years of age diagnosed with NMDA-R-Abs encephalitis between January 1, 2007 and December 31, 2016 (27 females and 23 males) were retrospectively studied. The first neurological symptoms observed in young children with NMDA-R-Abs encephalitis were characterized by seizure (72%), especially focal seizure (42%), within a median of 15 days before other encephalitis symptoms; other patients mostly had behavioral disorders (26%). The seizures were frequently difficult to diagnose because of the transient unilateral dystonic or tonic posturing presentation or sudden unilateral pain in the absence of clonic movements. A post-ictal motor deficit was also frequently observed. This clinical presentation is different from that observed in adult females with NMDA-R-Abs encephalitis who initially present mainly psychiatric disorders (67%) or cognitive impairment (19%), and less frequently seizures (14%). The diagnosis of NMDA-R-Abs encephalitis should be systematically considered in young children of both sexes who present neurological symptoms suggesting recent seizures (focal or generalized) without obvious other etiology. Copyright © 2017 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

Genitourinary complications as initial presentation of inherited ...

African Journals Online (AJOL)

Epidermolysis bullosa (EB) is a rare disorder that presents with urological complications. We present a 6-year-old boy admitted with urological symptoms that revealed an inherited EB misdiagnosed. We also review the literature on this disorder and management of the common urological complications.

The Long-Term Benefits of Positive Self-Presentation via Profile Pictures, Number of Friends and the Initiation of Relationships on Facebook for Adolescents' Self-Esteem and the Initiation of Offline Relationships.

Science.gov (United States)

Metzler, Anna; Scheithauer, Herbert

2017-01-01

Social networking sites are a substantial part of adolescents' daily lives. By using a longitudinal approach the current study examined the impact of (a) positive self-presentation, (b) number of friends, and (c) the initiation of online relationships on Facebook on adolescents' self-esteem and their initiation of offline relationships, as well as the mediating role of positive feedback. Questionnaire data were obtained from 217 adolescents (68% girls, mean age 16.7 years) in two waves. Adolescents' positive self-presentation and number of friends were found to be related to a higher frequency of receiving positive feedback, which in turn was negatively associated with self-esteem. However, the number of Facebook friends had a positive impact on self-esteem, and the initiation of online relationships positively influenced the initiation of offline relationships over time, demonstrating that Facebook may be a training ground for increasing adolescents' social skills. Implications and suggestions for future research are provided.

The Long-Term Benefits of Positive Self-Presentation via Profile Pictures, Number of Friends and the Initiation of Relationships on Facebook for Adolescents’ Self-Esteem and the Initiation of Offline Relationships

Science.gov (United States)

Metzler, Anna; Scheithauer, Herbert

2017-01-01

Social networking sites are a substantial part of adolescents’ daily lives. By using a longitudinal approach the current study examined the impact of (a) positive self-presentation, (b) number of friends, and (c) the initiation of online relationships on Facebook on adolescents’ self-esteem and their initiation of offline relationships, as well as the mediating role of positive feedback. Questionnaire data were obtained from 217 adolescents (68% girls, mean age 16.7 years) in two waves. Adolescents’ positive self-presentation and number of friends were found to be related to a higher frequency of receiving positive feedback, which in turn was negatively associated with self-esteem. However, the number of Facebook friends had a positive impact on self-esteem, and the initiation of online relationships positively influenced the initiation of offline relationships over time, demonstrating that Facebook may be a training ground for increasing adolescents’ social skills. Implications and suggestions for future research are provided. PMID:29187827

The Long-Term Benefits of Positive Self-Presentation via Profile Pictures, Number of Friends and the Initiation of Relationships on Facebook for Adolescents’ Self-Esteem and the Initiation of Offline Relationships

Directory of Open Access Journals (Sweden)

Anna Metzler

2017-11-01

Full Text Available Social networking sites are a substantial part of adolescents’ daily lives. By using a longitudinal approach the current study examined the impact of (a positive self-presentation, (b number of friends, and (c the initiation of online relationships on Facebook on adolescents’ self-esteem and their initiation of offline relationships, as well as the mediating role of positive feedback. Questionnaire data were obtained from 217 adolescents (68% girls, mean age 16.7 years in two waves. Adolescents’ positive self-presentation and number of friends were found to be related to a higher frequency of receiving positive feedback, which in turn was negatively associated with self-esteem. However, the number of Facebook friends had a positive impact on self-esteem, and the initiation of online relationships positively influenced the initiation of offline relationships over time, demonstrating that Facebook may be a training ground for increasing adolescents’ social skills. Implications and suggestions for future research are provided.

Uterine cervical cancer with brain metastasis as the initial site of presentation.

Science.gov (United States)

Sato, Yumi; Tanaka, Kei; Kobayashi, Yoichi; Shibuya, Hiromi; Nishigaya, Yoshiko; Momomura, Mai; Matsumoto, Hironori; Iwashita, Mitsutoshi

2015-07-01

Brain metastasis from uterine cervical cancer is rare, with an incidence of 0.5%, and usually occurs late in the course of the disease. We report a case of uterine cervical cancer with brain metastasis as the initial site of presentation. A 50-year-old woman with headache, vertigo, amnesia and loss of appetite was admitted for persistent vomiting. Contrast enhanced computed tomography showed a solitary right frontal cerebral lesion with ring enhancement and uterine cervical tumor. She was diagnosed with uterine cervical squamous cell carcinoma with parametrium invasion and no other distant affected organs were detected. The cerebral lesion was surgically removed and pathologically proved to be metastasis of uterine cervical squamous cell carcinoma. The patient underwent concurrent chemoradiotherapy, followed by cerebral radiation therapy, but multiple metastases to the liver and lung developed and the patient died 7 months after diagnosis of brain metastasis. © 2015 The Authors. Journal of Obstetrics and Gynaecology Research © 2015 Japan Society of Obstetrics and Gynecology.

Granulocytic sarcoma presenting with necrotic cervical lymph nodes as an initial manifestation of childhood leukaemia: imaging features

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An, Sang Bu; Cheon, Jung-Eun; Kim, In-One; Kim, Woo Sun [Seoul National University College of Medicine, Department of Radiology, Seoul (Korea); Seoul National University Medical Research Center, Institute of Radiation Medicine, Seoul (Korea); Ahn, Hyo Seop; Shin, Hee Young; Kang, Hyoung Jin; Yeon, Kyung Mo [Seoul National University College of Medicine, Department of Pediatrics, Cancer Research Institute, Seoul (Korea)

2008-06-15

We present two cases of granulocytic sarcoma of the cervical lymph nodes with central necrosis as an initial manifestation of childhood leukaemia, focusing on the imaging features. Recognition of the CT and MR imaging findings of granulocytic sarcoma involving the cervical lymph nodes assists the differential diagnosis of noninfective lymphadenopathy in children. (orig.)

Northern Eurasia Future Initiative (NEFI): Presentation and Justification of the NEFI Science Plan

Science.gov (United States)

Groisman, P. Y.; Gutman, G.; Gulev, S.; Maksyutov, S. S.; Qi, J.; Shugart, H. H., Jr.

2016-12-01

Since 2004, the Northern Eurasia Earth Science Partnership Initiative (NEESPI) - an interdisciplinary program of internationally-supported Earth systems and science research - has addressed large-scale and long-term manifestations of climate and environmental changes over Northern Eurasia and their impact on the Global Earth system. With more than 1500 peer-reviewed journal publications and 40 books to its credit, NEESPI's activities resulted in significant scientific outreach. This created a new research realm through self-organization of NEESPI scientists in a broad research network, accumulation of knowledge while developing new tools (observations, models, and collaborative networks) and producing new, exciting results that can be applied to directly support decision-making for societal needs. At the Synthesis NEESPI Workshop in Prague, Czechia (April 9-12, 2015) it was decided to shift gradually the foci of regional studies in Northern Eurasia towards applications with the following major Science Question: "What dynamic and interactive change(s) will affect societal well-being, activities, and health, and what might be the mitigation and adaptation strategies that could support sustainable development and decision-making activities in Northern Eurasia?". To answer this question requires a stronger socio-economic component in the ongoing and future regional studies focused on sustainable societal development under changing climatic and environmental conditions. The NEESPI Research Team has reorganized itself into "Northern Eurasia Future Initiative" (NEFI) and began development of the NEFI Programmatic White Paper released at http://neespi.org in June 2016. Presentation will provide justification of the new NEFI research foci and approach examples addressing them. The societal challenges, particularly the socio-economic challenges are the top priority in most of them. Throughout the NEESP Initiative duration, support for it studies has been provided by

Nystagmus-based approach to vertebrobasilar stroke presenting as vertigo without initial neurologic signs.

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Kim, Min-Beom; Boo, Sung Hyun; Ban, Jae Ho

2013-01-01

We aimed to investigate the clinical courses and common nystagmus of isolated vertigo patients with vertebrobasilar stroke. The patients who presented with isolated acute spontaneous vertigo with spontaneous nystagmus (acute vestibular syndrome) at the Emergency Department were retrospectively analyzed. They were referred to the Otolaryngology Department due to the absence of neurologic signs or even of imaging abnormalities after the initial examination at the Emergency Department. Various clinical features, including presenting symptoms, delayed neurologic signs, the site of infarction, and videonystagmographic (VNG) findings were analyzed. Of the 468 cases of acute vestibular syndrome, 23 (4.9%) cases of radiologically proven vertebrobasilar stroke were identified. Of the 23 patients, 17 (74%) showed aggravation of vertigo or delayed neurologic signs during the admission. In the analysis of VNG, 11 (48%) cases of direction-changing gaze-evoked nystagmus, 7 (30%) cases of fixation failure in the caloric test, 6 (27%) cases of periodic alternating nystagmus, and 4 (17%) cases of atypical head-shaking nystagmus were presented. Stroke occurred in the cerebellum (n=18, 78%), medulla (n=4, 17%), and pons (n=1, 4%). In the early stage of vertebrobasilar stroke, an accurate diagnosis was difficult in the Emergency Department even though a radiologic study was performed, but various VNG abnormalities and delayed neurologic signs could help to diagnose whether the origin is central or not. Copyright © 2013 S. Karger AG, Basel.

Dysphagia as initial presentation of primary amyloidosis

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Piyush Ranjan

2013-01-01

Full Text Available Amyloidosis involves all parts of the gastrointestinal tract including the esophagus. The esophageal involvement in amyloidosis has been reported to vary from 13% in a radiology study to 22% in an autopsy series; however, such patients have symptoms of gastroesophageal reflux. Dysphagia is an uncommon presentation of amyloidosis. We report a 64-year-old patient who presented with progressive dysphagia of 4 months duration which was confirmed to be due to primary amyloidosis with multiple myeloma. The esophageal involvement by amyloidosis was confirmed by esophageal mucosal biopsies, and 22-channel high-resolution manometry.

Can cognitive assessment really discriminate early stages of Alzheimer's and behavioural variant frontotemporal dementia at initial clinical presentation?

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Reul, Sophia; Lohmann, Hubertus; Wiendl, Heinz; Duning, Thomas; Johnen, Andreas

2017-08-09

Neuropsychological testing is considered crucial for differential diagnosis of Alzheimer's disease (AD) and behavioural variant frontotemporal dementia (bvFTD). In-depth neuropsychological assessment revealed specific dysfunctions in the two dementia syndromes. However, a significant overlap of cognitive impairments exists in early disease stages. We questioned whether a standard neuropsychological assessment at initial clinical presentation can delineate patients with AD versus bvFTD. In a retrospective approach, we evaluated and compared how cognitive profiles assessed at initial clinical presentation predicted the diagnosis of later verified AD (n = 43) and bvFTD (n = 26). Additionally, the neuropsychological standard domains memory, language, visuospatial skills, executive functions, praxis and social cognition were subjected to stepwise discriminant analysis to compare their differential contribution to diagnosis. Regardless of diagnosis, a percentage of patients presented with major deterioration in a wide range of cognitive domains when compared with age-matched normative data. Only few significant differences were detected on the group level: Patients with AD were relatively more impaired in the verbal recall, verbal recognition, figure copy, and surprisingly in the executive subdomains, set shifting and processing speed whereas bvFTD was characterised by more deficits in imitation of face postures. A combination of tests for verbal recall, imitation of limb and face postures, and figure copy showed the greatest discriminatory power. Our results imply that the contribution of a standard neuropsychological assessment is limited for differential diagnosis of AD and bvFTD at initial presentation. In contrast to current clinical guidelines, executive functions are neither particularly nor exclusively impaired in patients with bvFTD when assessed within a standard clinical neuropsychological test battery. The significant overlap of bvFTD and AD

Clinicopathological correlates in HIV seropositive tuberculosis cases presenting with jaundice after initiating antiretroviral therapy with a structured review of the literature

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Barr David A

2012-10-01

Full Text Available Abstract Background The development of jaundice after initiation of HAART in HIV-TB co-infected patients is a challenging presentation in resource constrained settings, and is often attributed to drug induced liver injury (DILI.Some investigators have described hepatic tuberculosis Immune Reconstitution Inflammatory Syndrome (TB-IRIS as a cause of liver disease in patients initiating HAART, which could also cause jaundice. Case presentations We report the clinical and histopathological features of five HIV-TB co-infected patients presenting with a syndrome of jaundice, tender hepatomegaly, bile canalicular enzyme rise and return of constitutional symptoms within 8 weeks of initiation of highly active antiretroviral therapy (HAART for advanced HIV infection at a rural clinic in KwaZulu Natal, South Africa. All five patients had been diagnosed with tuberculosis infection prior to HAART initiation and were on antituberculous medication at time of developing jaundice. There was evidence of multiple aetiologies of liver injury in all patients. However, based on clinical course and pathological findings, predominant hepatic injury was thought to be drug induced in one case and hepatic tuberculosis associated immune reconstitution inflammatory syndrome (TB-IRIS in the other four. In these later 4 patients, liver biopsy findings included necrotising and non-necrotising granulomatous inflammation in the lobules and portal tracts. The granulomas demonstrated – in addition to epithelioid histiocytes and Langhans giant cells – neutrophils, plasma cells and large numbers of lymphocytes, which are not features of a conventional untreated tuberculous response. Conclusion In this high TB prevalent, low resource setting, TB-IRIS may be an important cause of jaundice post-HAART initiation. Clinicopathological correlation is essential for optimal diagnosis. Further multi-organ based histopathological studies in the context of immune reconstitution would be

Breast abscess as the initial manifestation of primary pure squamous cell carcinoma: a rare presentation and literature review.

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Salemis, Nikolaos S

2011-01-01

Primary squamous cell carcinoma of the breast is a very rare tumor accounting for less than 0.4% of all breast cancers. Fewer than 100 cases have been reported in the literature so far. The diagnosis requires strict pathologic criteria to be fulfilled. Due to the rarity of this tumor the optimal treatment and prognosis are both unclear. Breast abscess as the initial presentation of a primary squamous cell breast carcinoma is an extremely rare clinical entity. In this study, we describe a case of a 61-year-old postmenopausal woman who presented with typical manifestations of a breast abscess and was diagnosed with a pure primary squamous cell breast carcinoma. Diagnostic evaluation and management of the patient are discussed along with a review of the literature. Despite its rarity, the possibility of a primary pure squamous cell breast carcinoma should always be considered in the differential diagnosis in postmenopausal patients presenting with manifestations of a breast abscess, especially in those who respond poorly to the initial treatment. Physicians should be aware of this rare malignancy in order to avoid delays in diagnosis and treatment.

Primary Sjögren syndrome that initially presented with repeated hypergammaglobulinemic purpura after prolonged sitting: A case report.

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Zhou, Zhihua; Jiang, Weiqiang; Wang, Ming; Liu, Yongyuan; Zhang, Wei; Huang, Manping; Liang, Donghui

2017-12-01

Purpura is a common dermatologic manifestation in Sjögren syndrome (SS). When a patient presents with sicca symptoms, the diagnosis of SS is not difficult. Here, we reported a case of a 52-year-old Chinese woman who initially presented with nonpalpable purpura on both lower extremities, and these lesions had developed soon after prolonged sitting. In the past 2 years, she had repeated cutaneous nonpalpable purpura 4 times. She had no sicca symptoms, dry eyes, or dry mouth. Combining the laboratory findings, Schirmer test, and labial gland biopsy, primary SS was confirmed. The patient was placed on a trial of hydroxychloroquine (200 mg once daily). The purpura on both lower extremities had faded at the sixth day after onset and at the third day after hydroxychloroquine treatment. These case was not easy to diagnosis primary SS because she had no sicca symptoms. A patient with primary SS who initially presented with recurrent purpura associated with prolonged sitting. Prolonged sitting had been a possible aggravating factor for the cutaneous purpura of this patient with primary SS. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

Elevated Lipase during Initial Presentation of Ulcerative Colitis in a Pediatric Patient: Do We Check for It

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Piyali Ray

2016-10-01

Full Text Available There are very few reports of elevated lipase in pediatric inflammatory bowel disease (IBD. Symptoms of pancreatitis may be masked by abdominal pain in pediatric IBD. During the initial presentation of IBD in our patient, lipase was elevated to more than 3 times the upper limit of normal. Normalization of values coincided with remission of IBD. This may be due to extraintestinal involvement of the pancreas as part of the inflammatory process or due to leakage of pancreatic enzymes from an inflamed gut or mediated by inflammatory cytokines. Checking pancreatic enzymes during initial presentation of IBD may, therefore, be important to determine if pancreatic involvement has resulted from the inflammation in IBD or as an adverse effect of therapy. If unchecked, recurrent subclinical pancreatitis may be masked by IBD symptoms and missed prior to starting IBD therapy. This may result in chronic pancreatic insufficiency as reported in 50% of adults with IBD. Early detection of elevated pancreatic enzymes in IBD may help direct the management strategy, as treatment of the underlying inflammation in IBD may be the most important management for resolution of pancreatitis instead of cessation of therapy for fear of iatrogenic medication-induced pancreatitis.

Clinicopathological correlates in HIV seropositive tuberculosis cases presenting with jaundice after initiating antiretroviral therapy with a structured review of the literature.

Science.gov (United States)

Barr, David A; Ramdial, Pravistadevi K

2012-10-14

The development of jaundice after initiation of HAART in HIV-TB co-infected patients is a challenging presentation in resource constrained settings, and is often attributed to drug induced liver injury (DILI).Some investigators have described hepatic tuberculosis Immune Reconstitution Inflammatory Syndrome (TB-IRIS) as a cause of liver disease in patients initiating HAART, which could also cause jaundice. We report the clinical and histopathological features of five HIV-TB co-infected patients presenting with a syndrome of jaundice, tender hepatomegaly, bile canalicular enzyme rise and return of constitutional symptoms within 8 weeks of initiation of highly active antiretroviral therapy (HAART) for advanced HIV infection at a rural clinic in KwaZulu Natal, South Africa.All five patients had been diagnosed with tuberculosis infection prior to HAART initiation and were on antituberculous medication at time of developing jaundice. There was evidence of multiple aetiologies of liver injury in all patients. However, based on clinical course and pathological findings, predominant hepatic injury was thought to be drug induced in one case and hepatic tuberculosis associated immune reconstitution inflammatory syndrome (TB-IRIS) in the other four.In these later 4 patients, liver biopsy findings included necrotising and non-necrotising granulomatous inflammation in the lobules and portal tracts. The granulomas demonstrated - in addition to epithelioid histiocytes and Langhans giant cells - neutrophils, plasma cells and large numbers of lymphocytes, which are not features of a conventional untreated tuberculous response. In this high TB prevalent, low resource setting, TB-IRIS may be an important cause of jaundice post-HAART initiation. Clinicopathological correlation is essential for optimal diagnosis. Further multi-organ based histopathological studies in the context of immune reconstitution would be useful to clinicians in low resource settings dealing with this challenging

The Long-Term Benefits of Positive Self-Presentation via Profile Pictures, Number of Friends and the Initiation of Relationships on Facebook for Adolescents’ Self-Esteem and the Initiation of Offline Relationships

OpenAIRE

Metzler, Anna; Scheithauer, Herbert

2017-01-01

Social networking sites are a substantial part of adolescents’ daily lives. By using a longitudinal approach the current study examined the impact of (a) positive self-presentation, (b) number of friends, and (c) the initiation of online relationships on Facebook on adolescents’ self-esteem and their initiation of offline relationships, as well as the mediating role of positive feedback. Questionnaire data were obtained from 217 adolescents (68% girls, mean age 16.7 years) in two waves. Adole...

Delayed Presentation of Ureteropelvic Junction Obstruction and Loss of Renal Function After Initially Mild (SFU Grade 1-2) Hydronephrosis.

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Bowen, Diana K; Yerkes, Elizabeth B; Lindgren, Bruce W; Gong, Edward M; Faasse, Mark A

2015-07-01

We report 4 pediatric cases of ureteropelvic junction obstruction involving delayed progression of initially mild postnatal hydronephrosis. All 4 children became symptomatic; however, 3 already had a substantial decrement of ipsilateral kidney function by the time of diagnosis. Two of these 3 patients had previous renal scintigraphy demonstrating normal differential function. We caution that counseling regarding hydronephrosis should emphasize the importance of prompt re-evaluation for any symptoms potentially referable to delayed presentation of ureteropelvic junction obstruction, irrespective of initial hydronephrosis grade. Future studies are needed to determine the optimal follow-up regimen for conservative management of hydronephrosis. Copyright © 2015 Elsevier Inc. All rights reserved.

Estimation of the Net Present Value of the Investment Project in the Situation of Fuzzy Initial Data

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Kotsyuba Oleksiy S.

2017-03-01

Full Text Available The article investigates the problem of estimating the net present value of the investment project using a methodology based on the theory of fuzzy sets in the situation when the initial data are described by fuzzy estimates. In the general case the fuzzy-multiple estimation of the specified indicator at a discrete-interval representation of the initial parameters is reduced to a set of homogeneous optimization problems. Often, depending on the characteristics of fuzzy estimates of cash flows of the investment project under consideration, the solutions to these problems can be found directly on the basis of relevant analytical expressions, while other problems require using special optimization methods. In the work there made an attempt to develop the analytical component of the fuzzy-multiple modeling of the net present value indicator. First, we examined the general search and optimization approach, which allows providing a predetermined degree of accuracy, as well as the method for approximate determination of the fuzzy estimate of the net present value on the basis of analytical relationships developed by Сhui-Yu Chiu and Chan S. Park. After that, the situation was analyzed, and the corresponding calculation model was proposed, when fuzzy estimates of the cash flows of the investment project can be interpreted from the perspective of the concept of the money-generating operation formulated by O. B. Lozhkin. Among other things, it allowed to develop a general scheme for determining the fuzzy estimate of the net present value, supplementing it with the situation of this concept. As the main direction of the further development of the problems discussed in the publication there determined the formation of a holistic methodology for evaluating the effectiveness of real investments, which would cover different in their nature and structural characteristics types of uncertainty from unified theoretical positions.

Clinical characteristics and outcomes for patients with an initial emergency presentation of malignancy: a 15 month audit of patient level data.

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Savage, Philip; Sharkey, Rachel; Kua, Teresa; Papanastasopoulos, Panagiotis; McDonald-Burrows, Zoe; Hassan, Shazalia; Probst, Fay; Sanders, Ali; Millington, Hugh

2015-02-01

To investigate the demographics, diagnoses and outcomes for new adult cancer patients with an initial presentation via the A&E or acute oncology teams. Patients with initial emergency presentation of malignancy have been documented to have poorer treatment outcomes and shorter survival. Patient level data on this subject is relatively limited with regard to the demographics, diagnoses and the clinical factors that may underlie late presentations. A 15 month audit of the patients presenting with a new diagnosis of malignancy was performed in 2011-2012. Data on demographics, diagnosis and outcome were assembled and analysed. The clinical data on emergency presentations were compared to reference information on the incidence and median age at presentation for each malignancy within the standard population. During the study a total of 178 new cancer patients presented via the A and E service. The most frequent diagnoses were lung cancer with 21% of cases and CNS and colorectal cancer each with 9% of cases. There was a higher incidence of emergency new presentations of lung cancer, CNS tumours, ovarian, pancreatic and testicular cancer than in the standard population, whilst breast cancer, bladder cancer and prostate cancer patients were under-represented. The median age at diagnosis was 74 and for a number of malignancies including CNS tumours, breast cancer, colorectal cancer and head and neck cancer the emergency cases presented at significantly greater ages than in the standard population. Overall 27% of patients were unfit or unsuitable for a diagnostic biopsy, this group had only a 3 month median survival compared to 14 months for those suitable for biopsy and treatment. Despite a wide range of initiatives, the emergency and late diagnosis of patients with metastatic cancer remains a significant challenge with many patients too advanced and unwell at presentation for active treatment. These patients tend to be older and have malignancies that present with either

Pleural effusion as the initial clinical presentation in disseminated cryptococcosis and fungaemia: an unusual manifestation and a literature review.

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Chen, Mayun; Wang, Xiaomi; Yu, Xianjuan; Dai, Caijun; Chen, Dunshun; Yu, Chang; Xu, Xiaomei; Yao, Dan; Yang, Li; Li, Yuping; Wang, Liangxing; Huang, Xiaoying

2015-09-22

Cryptococcus neoformans infection usually presents as chronic meningitis and is increasingly being recognized in immunocompromised patients. Presentation with pleural effusion is rare in cryptococcal disease; in fact, only 4 cases of pleural effusion as the initial clinical presentation in cryptococcosis have been reported in English-language literature to date. We report the first case of pleural effusion as the initial clinical presentation in a renal transplant recipient who was initially misdiagnosed with tuberculous pleuritis but who then developed fungaemia and disseminated cryptococcosis. The examination of this rare manifestation and the accompanying literature review will contribute to increased recognition of the disease and a reduction in misdiagnoses. We describe a 63-year-old male renal transplant recipient on an immunosuppressive regimen who was admitted for left pleural effusion and fever. Cytological examinations and pleural fluid culture were nonspecific and negative. Thoracoscopy only found chronic, nonspecific inflammation with fibrosis in the pleura. After empirical anti-tuberculous therapy, the patient developed an elevated temperature, a severe headache and vomiting and fainted in the ward. Cryptococci were specifically found in the cerebrospinal fluid following lumbar puncture. Blood cultures were twice positive for C. neoformans one week later. He was transferred to the respiratory intensive care unit (RICU) immediately and was placed on non-invasive ventilation for respiratory failure for 2 days. He developed meningoencephalitis and fungaemia with C. neoformans during hospitalization. He was given amphotericin B liposome combined with 5-flucytosine and voriconazole for first 11 days, then amphotericin B liposome combined with 5-flucytosine sustained to 8 weeks, after that changed to fluconazole for maintenance. His condition improved after antifungal treatment, non-invasive ventilation and other support. Further pathological consultation

Hepcidin as a possible marker in determination of malignancy degree and sensitivity of breast cancer cells to cytostatic drugs.

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Yalovenko, T M; Todor, I M; Lukianova, N Y; Chekhun, V F

2016-06-01

To investigate the role of hepcidin (Hepc) in the formation of cells malignant phenotype in vitro and its expression in the dyna-mics of growth of Walker-256 carcinosarcoma with different sensitivity to doxorubicin (Dox). The cell lines used in the analysis included T47D, MCF-7, MDA-MB-231, MDA-MB-468, MCF/CP, and MCF/Dox. Hepc expression was studied by immunocytochemical method. "Free" iron content was determined by EPR spectroscopy. Determination of Hepc expression in homogenates of tumor tissue and in blood serum of rats with Dox-sensitive and -resistant Walker-256 carcinosarcoma was performed. It was found that Hepc levels in breast cancer (BC) cells with high degree of malignancy (MDA-MB-231, MDA-MB-468) and drug-resistant phenotype (MCF/CP, MCF/Dox) were by 1.5-2 times higher (p < 0.05) in comparison with sensitive and less malignant BC cells. The development of drug-resistant phenotype in Walker-256 carcinosarcoma cells was accompanied by increasing of Hepc and "free" iron content (by 2.4 and 1.2 times, respectively). The data of in vitro and in vivo research evidenced on involvement of Hepc in formation of BC cells malignant phenotype and their resistance to Dox.

Predicting Recurrence and Progression of Noninvasive Papillary Bladder Cancer at Initial Presentation Based on Quantitative Gene Expression Profiles

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Birkhahn, M.; Mitra, A.P.; Williams, Johan

2010-01-01

Background: Currently, tumor grade is the best predictor of outcome at first presentation of noninvasive papillary (Ta) bladder cancer. However, reliable predictors of Ta tumor recurrence and progression for individual patients, which could optimize treatment and follow-up schedules based...... on specific tumor biology, are yet to be identified. Objective: To identify genes predictive for recurrence and progression in Ta bladder cancer at first presentation using a quantitative, pathway-specific approach. Design, setting, and participants: Retrospective study of patients with Ta G2/3 bladder tumors...... at initial presentation with three distinct clinical outcomes: absence of recurrence (n = 16), recurrence without progression (n = 16), and progression to carcinoma in situ or invasive disease (n = 16). Measurements: Expressions of 24 genes that feature in relevant pathways that are deregulated in bladder...

Recurrent Venous Thromboembolism as the Initial Clinical Presentation of Gastric Cancer: A Case Report

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Fariba Rezaeetalab

2017-09-01

Full Text Available Pulmonary thromboembolism (PTE is a clinically critical disease, misdiagnosis or delayed diagnosis of which can lead to increased rate of mortality. For prevention of recurrence of PTE, recognition of its risk factors or underlying diseases is of great importance. PTE is common in patients with cancer and has high morbidity and mortality rates. Although cancer is a lethal condition, PTE accelerates death in these patients. In the current study, we reported the case of a 50-year-old male presenting with dyspnea, pleuritic chest pain, and non-massive hemoptysis indicating pulmonary embolism. Anticoagulant therapy was initiated, but after 12 days of treatment, new deep vein thromboses in the left upper and right lower limbs were diagnosed. However, no specific risk factors or laboratory abnormalities were detected. History of weight loss during the recent months encouraged further investigation for ruling out malignancy, which led a diagnosis of gastric adenocarcinoma. He did not have any complaints of gastrointestinal disorders.

Atypical Initial Presentation of Painful Muscle Cramps in a Patient with Amyotrophic Lateral Sclerosis: A Case Report and Brief Review of the Literature.

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Kuzel, Aaron R; Lodhi, Muhammad Uzair; Syed, Intekhab Askari; Rahim, Mustafa

2017-11-10

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder characterized clinically by progressive muscle weakness that can occur proximally or distally in either the upper or lower extremities. It includes both upper motor neuron signs (spasticity, hyperreflexia, clonus, and Babinski sign) and lower motor neuron signs (atrophy, weakness, and muscle fasciculation). Initial presentation of progressively painful muscle cramps should lead the physician to screen for other signs of amyotrophic lateral sclerosis. We report the case of a 51-year-old male, who presented with dull muscle cramps in the right upper shoulder and arm. After a careful history and physical exam, it was found that patient had both upper and lower motor neuron signs; therefore, a diagnosis of amyotrophic lateral sclerosis was made. Amyotrophic lateral sclerosis should strongly be considered in the differential diagnosis of patients presenting with an atypical initial presentation of progressively painful muscle cramps.

Ocular metastasis as initial presentation in breast cancer ...

African Journals Online (AJOL)

Two patients presented to their ophthalmologists with vision disturbances. On ocular examination, retinopathic lesions were observed. On subsequent examination, these lesions were diagnosed as metastases of breast cancer. Neither patient had a history of breast cancer. In patients with breast cancer and multiple ...

Evaluation of the purified fraction of Wilbrandia (c. f. verticillata for antitumour activity

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V. S. N. Rao

1991-01-01

Full Text Available Cucurbatacins are known to produce cytotoxic and anticancer activities. Two novel norcucurbitacin glucosides (Wvl and Wv2 have recently been isolated from a purified fraction obtained from the rhizome of Wilbrandia verticillata. The present study evaluates the cytotoxic and anti-tumour activities of the norcucurbitacins. We have found a regular cytotoxicity in KB cells (Cy50 = 12µg/ml as well as a significant inhibition in the Walker 256 carcinosarcoma growth (approximately 75%.

Predicting Recurrence and Progression of Noninvasive Papillary Bladder Cancer at Initial Presentation Based on Quantitative Gene Expression Profiles

DEFF Research Database (Denmark)

Birkhahn, M.; Mitra, A.P.; Williams, Johan

2010-01-01

% specificity. Since this is a small retrospective study using medium-throughput profiling, larger confirmatory studies are needed. Conclusions: Gene expression profiling across relevant cancer pathways appears to be a promising approach for Ta bladder tumor outcome prediction at initial diagnosis......Background: Currently, tumor grade is the best predictor of outcome at first presentation of noninvasive papillary (Ta) bladder cancer. However, reliable predictors of Ta tumor recurrence and progression for individual patients, which could optimize treatment and follow-up schedules based...... on specific tumor biology, are yet to be identified. Objective: To identify genes predictive for recurrence and progression in Ta bladder cancer at first presentation using a quantitative, pathway-specific approach. Design, setting, and participants: Retrospective study of patients with Ta G2/3 bladder tumors...

morbidity and cd4+ cell counts at initial presentation of a cohort of

African Journals Online (AJOL)

2013-12-01

Dec 1, 2013 ... POSITIVE KENYAN PATIENTS: IMPLICATIONS TO INITIATING HAART. A. E. O. Otedo .... CCCs) because of stigma, poor socio- economic status, inaccessibility to care ..... lymphoma and not other cancers (13, 14). Thus, such.

Cross-Sectional Analysis of Late HAART Initiation in Latin America and the Caribbean: Late Testers and Late Presenters

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Crabtree-Ramírez, Brenda; Caro-Vega, Yanink; Shepherd, Bryan E.; Wehbe, Firas; Cesar, Carina; Cortés, Claudia; Padgett, Denis; Koenig, Serena; Gotuzzo, Eduardo; Cahn, Pedro; McGowan, Catherine; Masys, Daniel; Sierra-Madero, Juan

2011-01-01

Background Starting HAART in a very advanced stage of disease is assumed to be the most prevalent form of initiation in HIV-infected subjects in developing countries. Data from Latin America and the Caribbean is still lacking. Our main objective was to determine the frequency, risk factors and trends in time for being late HAART initiator (LHI) in this region. Methodology Cross-sectional analysis from 9817 HIV-infected treatment-naïve patients initiating HAART at 6 sites (Argentina, Chile, Haiti, Honduras, Peru and Mexico) from October 1999 to July 2010. LHI had CD4+ count ≤200cells/mm3 prior to HAART. Late testers (LT) were those LHI who initiated HAART within 6 months of HIV diagnosis. Late presenters (LP) initiated after 6 months of diagnosis. Prevalence, risk factors and trends over time were analyzed. Principal Findings Among subjects starting HAART (n = 9817) who had baseline CD4+ available (n = 8515), 76% were LHI: Argentina (56%[95%CI:52–59]), Chile (80%[95%CI:77–82]), Haiti (76%[95%CI:74–77]), Honduras (91%[95%CI:87–94]), Mexico (79%[95%CI:75–83]), Peru (86%[95%CI:84–88]). The proportion of LHI statistically changed over time (except in Honduras) (p≤0.02; Honduras p = 0.7), with a tendency towards lower rates in recent years. Males had increased risk of LHI in Chile, Haiti, Peru, and in the combined site analyses (CSA). Older patients were more likely LHI in Argentina and Peru (OR 1.21 per +10-year of age, 95%CI:1.02–1.45; OR 1.20, 95%CI:1.02–1.43; respectively), but not in CSA (OR 1.07, 95%CI:0.94–1.21). Higher education was associated with decreased risk for LHI in Chile (OR 0.92 per +1-year of education, 95%CI:0.87–0.98) (similar trends in Mexico, Peru, and CSA). LHI with date of HIV-diagnosis available, 55% were LT and 45% LP. Conclusion LHI was highly prevalent in CCASAnet sites, mostly due to LT; the main risk factors associated were being male and older age. Earlier HIV-diagnosis and earlier treatment initiation

Involuntary psychiatric attendances at an Australasian emergency department: A comparison of police and health-care worker initiated presentations.

Science.gov (United States)

Llewellin, Peter; Arendts, Glenn; Weeden, Jacqueline; Pethebridge, Andrew

2011-10-01

To identify any significant differences in the population of patients brought in to a hospital ED under involuntary mental health orders, based on whether the orders are initiated by police or health professionals. A retrospective analysis of consecutive presentations to a tertiary hospital ED with a co-located psychiatric emergency care centre over a 12 month period, with univariate and multivariate statistical comparisons. Two hundred and eighty-two patients (making 378 ED presentations) met the case definition and were analysed. Compared with patients on medical orders, patients on police orders had significantly more presentations related to violence, longer stays in ED and lower rates of admission to an inpatient bed, but were no more likely to require restraint or security intervention within the ED. Patients on police and medical orders differ considerably, but the impact of these differences on ED workload is small. © 2011 The Authors. EMA © 2011 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Risk factors for late-stage HIV disease presentation at initial HIV diagnosis in Durban, South Africa.

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Paul K Drain

Full Text Available After observing persistently low CD4 counts at initial HIV diagnosis in South Africa, we sought to determine risk factors for late-stage HIV disease presentation among adults.We surveyed adults prior to HIV testing at four outpatient clinics in Durban from August 2010 to November 2011. All HIV-infected adults were offered CD4 testing, and late-stage HIV disease was defined as a CD4 count <100 cells/mm(3. We used multivariate regression models to determine the effects of sex, emotional health, social support, distance from clinic, employment, perceived barriers to receiving healthcare, and foregoing healthcare to use money for food, clothing, or housing ("competing needs to healthcare" on presentation with late-stage HIV disease.Among 3,669 adults screened, 830 were enrolled, newly-diagnosed with HIV and obtained a CD4 result. Among those, 279 (33.6% presented with late-stage HIV disease. In multivariate analyses, participants who lived ≥5 kilometers from the test site [adjusted odds ratio (AOR 2.8, 95% CI 1.7-4.7], reported competing needs to healthcare (AOR 1.7, 95% CI 1.2-2.4, were male (AOR 1.7, 95% CI 1.2-2.3, worked outside the home (AOR 1.5, 95% CI 1.1-2.1, perceived health service delivery barriers (AOR 1.5, 95% CI 1.1-2.1, and/or had poor emotional health (AOR 1.4, 95% CI 1.0-1.9 had higher odds of late-stage HIV disease presentation.Independent risk factors for late-stage HIV disease presentation were from diverse domains, including geographic, economic, demographic, social, and psychosocial. These findings can inform various interventions, such as mobile testing or financial assistance, to reduce the risk of presentation with late-stage HIV disease.

Presentation of an infant with nutritional deficiency dermatitis as the initial manifestation of cystic fibrosis

Directory of Open Access Journals (Sweden)

Stojković Anđelka

2013-01-01

Full Text Available Introduction. Cystic fibrosis (CF is a multisystemic autosomal recessive disease most frequently recognized by characteristic respiratory and/or digestive manifestations. Exceptionally rare, as is the case with the infant we are presenting, the initial sign of the disease can be nutritional deficiency dermatitis (NDD. Case Outline. A three-month-old male infant of young and healthy non-consanguineous parents, born at term after the first uneventful pregnancy, was hospitalized due to atopic dermatitis (AD-like skin changes, failure to thrive and normochromic anemia (Hb 60 g/L. As exclusively breast-fed, failure to thrive was attributed to hypogalactia and skin changes to nutritional allergy, so that, besides exclusion of cow’s milk protein and other highly allergenic foods in mother’s diet, hypoallergenic milk formula was added to the child’s diet. However, dietetic measures were without effect, and the child was re-hospitalized at age 4.5 months, this time in the condition of severe malnutrition with hypoproteinemic edemas, extensive dermatitis, moderate hepatosplenomegaly and recurrent normochromic anemia (Hb 57 g/L. After plasma-free erythrocyte transfusion, correction of hypoalbuminemia and two-week parenteral and semi-elementary nutrition resulted in gradual recovery of the child, also including the resolution of skin changes. Having in mind the clinical course of the disease, as well as the response to applied therapeutic measures, CF was suspected as the cause of the child’s problems, which was also confirmed by a high level of sweat chlorine (92 mmol/L and DNA analysis (∆F508/∆F508. Conclusion. Our experience indicates that NDD, as the initial manifestation of CF, should be also kept in mind in differential diagnosis of the infant’s AD-like changes.

Short Course Vaginal Cuff Brachytherapy in Treating Patients With Stage I-II Endometrial Cancer

Science.gov (United States)

2018-04-17

Endometrial Clear Cell Adenocarcinoma; Endometrial Endometrioid Adenocarcinoma; Endometrial Serous Adenocarcinoma; Stage I Uterine Corpus Cancer; Stage IA Uterine Corpus Cancer; Stage IB Uterine Corpus Cancer; Stage II Uterine Corpus Cancer; Uterine Corpus Carcinosarcoma; Uterine Corpus Sarcoma

Carcinoma or Sarcoma of the Breast

African Journals Online (AJOL)

case reports of this unusual tumor.[8]. Hereby, we report a case of carcinosarcoma of breast comprising ... ulceration of overlying skin, occupying almost all quadrants of left breast. ... aggressive, treatment refractory tumors with shared clinical ...

Pneumomediastinum as initial presentation of paralytic rabies: A case report

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Hemachudha Thiravat

2005-10-01

Full Text Available Abstract Background Rabies is readily diagnosed when it presents as the classic furious form. Paralytic and atypical forms can pose significant problems in diagnosis. Catastrophic incidents included 7 organ transplant recipients who died of rabies recently in United States and Germany. Although rabies remains top in the lists of differential diagnosis of encephalitis in rabies endemic area, its complication may divert physicians from making a relevant management. We encountered an unusual case of paralytic rabies who presented with spontaneous pneumomediastinum. Case Presentation A young male presented with fever and dysphagia. There was a history of fluctuating consciousness and aerophobia but they were absent or could not be demonstrated at the time of admission. He exhibited subcutaneous chest wall emphysema and was found to have pneumomediastinum which resulted in surgical intervention. He developed paralysis followed by seizures during postoperative period. Diagnosis was confirmed by demonstration of rabies RNA in saliva during the preterminal phase and by the autopsy. Over 200 hospital staff subsequently received rabies postexposure prophylaxis. Conclusion Spontaneous pneumomediastinum can be a rare complication of rabies. It may lead clinicians to perform inappropriate treatment, particularly when phobic spasms are not present and agitation is not prominent. High level of awareness of rabies in any patient with confusion albeit subtle or with any obscure neurological presentations such as difficulty swallowing with no identifiable causes must be borne in mind.

Initial Presentation of Renal Cell Carcinoma as a Metastatic Mass within the Masseter Muscle: A Case Report and Literature Review

Energy Technology Data Exchange (ETDEWEB)

Bae, Kyung Eun; Lee, Han Bee; Cho, Woo Ho; Kim, Jae Hyung; Lee, Ji Hae; Kang, Min Jin [Dept. of Radiology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul (Korea, Republic of); Kim, Hyun Jung [Dept. of Pathology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul (Korea, Republic of)

2012-02-15

Renal cell carcinoma (RCC) is often concomitant with distant metastasis, and these metastases are the first sign of an otherwise occult primary. Whereas metastasis of RCC to the head and neck has been reported, metastasis to the masseter muscle, which is composed of skeletal muscle, is quite rare. We now report the case of a 66-year-old man who had a past history of pulmonary tuberculosis, with RCC metastasis of a well-defined intensely enhancing hypervascular mass in the masseter muscle as the initial presentation. We present the imaging findings of this case and a literature review about radiologic differential diagnosis of intramasseteric masses.

Action of tacrolimus on Wistar rat kidneys implanted with Walker 256 carcinosarcoma Estudo da ação do tacrolimus em rins de ratos Wistar implantados com carcinossarcoma de Walker

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Cristiano Machado Inácio

2010-02-01

Full Text Available PURPOSE: To evaluate the development of Walker 256 tumor in male Wistar rats treated with tacrolimus using an experimental kidney tumor model. METHODS: 40 male Wistar rats were divided into four groups: Tumor group (TU (n=10, Tacrolimus-Tumor group (TT (n=10, Tacrolimus group (TC (n=10 and Control group (C (n=10. Treatment with tacrolimus was performed in groups TT and TC. Under anesthesia, the right kidney of each animal of TU and TT was accessed through a supraumbilical incision and inoculated with a 0.1mL solution containing 2x10(6 tumor cells (Walker 256 carcinosarcoma tumor cells. Group TC was treated with a saline solution. All the animals of groups TC and TT were treated with tacrolimus (5mg/kg/day by gavage for 15 days. TU group animals received saline by gavage for 15 days. On the 15th postoperative day, all animals were submitted to euthanasia and blood sampling for analysis of serum creatinine (Cr and blood urea nitrogen (BUN. Abdominal gross examination was performed, the right kidney removed and prepared for histological analysis by hematoxylin-eosin staining. The resulting data were submitted to statistical analysis by ANOVA. RESULTS: Statistical significance was found when comparing creatinine level between groups TU, TT and TC -TT group culminated with a marked increased in creatinine levels (Cr=1.013 ± 0.3028 mg/mL, TU group (Cr=0.5670 ± 0.03536 mg/dL P=0.00256, TC group (Cr =0.711 ± 0.1653 mg/mL P= 0.02832. Statistical significance was found when comparing BUN levels in TT group (71.32 ± 17.14 mg/mL, compared with TU group (45.83 ± 5.046 mg/dL, P=0.000318. There were no statistically significant differences between groups TT and TC (61.23 ± 9.503 mg/mL P=0.7242. Histological analysis showed a poor evolution in TT group with multiple foci of hemorrhage and cortical invasion by the Walker tumor. CONCLUSION: The Tacrolimus-treated group developed a more aggressive tumor and a drug-related nephrotoxic effect.OBJETIVO: Avaliar

Choroidal Metastases as the Initial Presentation of Lung Cancer: A ...

African Journals Online (AJOL)

We report the case of a 49-year-old female patient who presented with ... nonsmall cell carcinoma of the right lung, which had multiple distant metastases. KEYWORDS: ... metastasis in lung cancer is very low, reported to be ... Kolkata, West Bengal, India. E-mail: .... awareness regarding this rare presentation of lung cancer.

Bilateral parotitis as the initial presentation of childhood sarcoidosis.

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Banks, Gretchen C; Kirse, Daniel J; Anthony, Evelyn; Bergman, Simon; Shetty, Avinash K

2013-01-01

The differential diagnosis of bilateral parotid gland enlargement in children includes infectious, inflammatory, and neoplastic disorders. We present the case of a 13-year-old male who presented with a 5-week history of bilateral parotid swelling. On exam, both parotid glands were nontender, smooth, and diffusely enlarged. He had slightly elevated inflammatory markers, but other lab results were normal. A neck CT revealed symmetric enlargement of the parotid, submandibular, and sublingual glands. A chest CT revealed scattered peripheral pulmonary nodules and bilateral hilar adenopathy. A parotid gland biopsy showed multiple noncaseating granulomas with multinucleated giant cells surrounded by lymphocytes, consistent with the diagnosis of sarcoidosis. Special stains for acid-fast and fungal organisms were negative. Using this illustrative case, we discuss the differential diagnosis of bilateral salivary gland enlargement in children and review the etiology, diagnosis, clinical manifestations, and treatment of pediatric sarcoidosis. Copyright © 2013 Elsevier Inc. All rights reserved.

Primary malignant head and neck tumours in Ghana: a survey of ...

African Journals Online (AJOL)

McRoy

Results: 2,041 of 4,546 reports were malignant. 1342 were ... Conclusion: We observed a rising incidence of head and neck .... head and neck cancer rose from 44 cases in ... Carcinosarcoma. 1. Clear cell tumour. 0. 1. Cutaneous lymphoma. 1.

Conjunctival Mass as an Initial Presentation of Iatrogenic Orbital Encephalocele.

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Rautenbach, Pierre; Thyagaraja, Dhanurjaya Vignesh; Irvine, Fiona

2015-01-01

A 46-year-old woman presented with a symptomatic conjunctival mass of the right eye, appearing 2 months after undergoing right frontal craniotomy to excise a meningioma. MRI of the brain revealed a new iatrogenic encephalocele extending into the right temporal orbit. Our opinion is that the conjunctival mass resulted directly from this encephalocele. To date this has been conservatively managed, and we believe this to be the first report of an iatrogenic encephalocele presenting in this manner.

The importance of reliability to the SunShot Initiative (Presentation Recording)

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Jones-Albertus, Rebecca

2015-09-01

The U.S. Department of Energy's SunShot Initiative was launched in 2011 to make subsidy-free solar electricity cost competitive with conventional energy sources by the end of the decade. Research in reliability can play a major role in realizing the SunShot goal of 0.06/kWh. By improving photovoltaic module lifetime and reducing degradation rates, a system's lifetime energy output is increased. Increasing confidence in photovoltaic performance prediction can lower perceived investment risk and thus the cost of capital. Accordingly, in 2015, SunShot expects to award more than $40 million through its SunShot National Laboratory Multiyear Partnership (SuNLaMP) and Physics of Reliability: Evaluating Design Insights for Component Technologies in Solar (PREDICTS) 2 funding programs, for research into reliability topics such as determining acceleration factors, modeling degradation rates and failure mechanisms, improving predictive performance models, and developing new test methods and instrumentation.

Multiple Cutaneous Metastases as Initial Presentation in Advanced Colon Cancer

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Sudheer Nambiar

2018-01-01

Full Text Available Skin metastases from advanced colorectal cancer are relatively rare and occur most often when the cancer is advanced, following the spread to other organs. Cutaneous metastases occur in about 3% of advanced colorectal cancers. We present an extremely rare case of a 68-year-old woman with advanced ascending colon adenocarcinoma that presented with multiple rapidly progressing painless cutaneous metastatic lesions with no other distant metastases. Of all the tumors, breast cancer most commonly spreads as cutaneous metastasis is followed by lung, colorectal, renal, ovarian, and bladder cancers. Cutaneous metastases can present in a variety of clinical manifestations, such as a rapidly growing painless dermal or subcutaneous nodule with intact overlying epidermis or as ulcers. In cases where the cutaneous deposit is isolated, as in visceral metastasis, there is a role for radical management such as wide local excision and reconstruction. In our patient, since she had multiple cutaneous metastases she began treatment with palliative systemic combination chemotherapy.

Initiation disruptor systems and methods of initiation disruption

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Baum, Dennis W

2014-09-23

A system that may be used as an initiation disruption system (IDS) according to one embodiment includes an explosive charge; a plurality of particles in a layer at least partially surrounding the explosive charge; and a fire suppressant adjacent the plurality of particles. A method for disabling an object according to one embodiment includes placing the system as recited above near an object; and causing the explosive charge to initiate, thereby applying mechanical loading to the object such that the object becomes disabled. Additional systems and methods are also presented. A device according to another embodiment includes a plurality of particles bound by a binder thereby defining a sidewall having an interior for receiving an explosive; and a fire suppressant adjacent the plurality of particles and binder. Additional systems and methods are also presented.

[Integrative management using Ayurvedic medicine in a patient with advanced malignant mixed Muellerian tumor - a case report].

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Kronpaß, Ludwig; Krampol, Stefan; Brattinger, Petra; Stapelfeldt, Elmar; Kessler, Christian

2014-01-01

Carcinosarcoma of the uterus is a rare malignant tumor with an extremely poor prognosis. Because there are just a few cases described, there is little evidence on possible treatment options. An improvement in the overall unsatisfactory therapeutic situation is required. The management of an advanced stage uterine carcinosarcoma, at the time of primary diagnosis in FIGO stage 4, in a 67-year-old woman is described, including multiple surgical interventions, radiotherapy, chemotherapy, and the complementary use of elements of Ayurvedic medicine. To this date, the 3-year follow-up revealed no evidence of distant metastasis. A high quality of life could be ensured continuously. Even with poor prognosis, tumor entities can be controlled by using all the available medical resources, enabling a satisfactory quality of life over a longer period of time. For this reason, the complementary use of the traditional medical system Ayurveda could be helpful.

Rare Cause of Stricture Esophagus—Sarcoma: A Case Report and Review of the literature

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S. Patricia

2011-01-01

Full Text Available Adenocarcinoma and squamous cell carcinoma account for the vast majority of oesophageal malignancies. Other malignancies known to occur in the oesophagus include melanoma, sarcoma, and lymphoma. Among the sarcomas, carcinosarcoma is the commonest with both carcinomatous and sarcomatous elements followed by leiomyosarcoma of mesenchymal origin. Other sarcomas reported in the literature are liposarcoma, synovial sarcoma, myxofibrosarcoma, Ewing's sarcoma, granulocytic sarcoma, histiocytic sarcoma, schwannoma rhabdomyosarcoma, and epithelioid sarcoma. We report a case of malignant spindle cell tumour of oesophagus. Sarcomas of esophagus present as a polypoid exophytic soft tissue mass. Our patient presented with a stricture which is a rare presentation. Locally aggressive treatment with surgery is beneficial, and local palliative treatment including radiotherapy is worthwhile.

Light-initiated detonation systems

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Cooper, Stafford S.; Malone, Philip G.; Bartholomew, Stephen W.; Necker, William J.

1986-09-01

Numerous light sources could be employed in detonation systems, but lasers have the most efficient coupling to optical fibers and can generate energetic light pulses required for detonation. Flash lamp-pumped, solid state lasers are presently the most useful light source for explosive initiation. Laser diodes in current production cannot generate enough energy for practical applications. The most useful optical fiber for blast line application is a step index fiber with a large core-to-cladding ratio. The large core minimizes energy losses due to misalignment core of fibers in connectors. Couplers that involve mechanically crimped connectors and cleaved fibers, rather than the epoxy-cemented connectors with polished fibers, provide superior energy transmission due to the reduced carbonization at the fiber end. Detonators for optical initiation systems are similar in basic construction to those employed in electrical initiation systems. Explosive and pyrotechnic charges can also be similar. Either primary or secondary explosives can be initiated in present laser-based systems. Two laser detonation systems are presently accessible; a multiple-shot laser with a single-shot, single fiber system designed for use with detonators containing primary explosives. Additional research related to development of low-energy, photoreactive detonators, continuity checking techniques and improved connectors and fibers can produce significant improvements in presently fielded systems.

Subacute sclerosing panencephalitis presenting as mania

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Aggarwal Ashish

2011-01-01

Full Text Available Subacute sclerosing panencephalitis (SSPE is a rare, invariably fatal degenerative disease of the central nervous system developing after measles infection. Besides neurological symptoms as initial presenting symptoms, rare reports of its presentation with pure psychiatric symptoms have been reported. We here report a case of 14 year old male who initially presented with manic symptoms and then subsequently diagnosed to be suffering from SSPE. Improtance of ruling our organic conditions is emphasized.

Mixed phenotype (T/B/myeloid) extramedullary blast crisis as an initial presentation of chronic myelogenous leukemia.

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Qing, Xin; Qing, Annie; Ji, Ping; French, Samuel W; Mason, Holli

2018-04-01

Chronic myelogenous leukemia (CML) is a myeloproliferative disorder characterized by the Philadelphia (Ph) chromosome generated by the reciprocal translocation t(9,22)(q34;q11). The natural progression of the disease follows a biphasic or triphasic course. Most cases of CML are diagnosed in the chronic phase. Extramedullary blast crisis rarely occurs during the course of CML, and is extremely rare as the initial presentation of CML. Here, we report the case of a 32-year-old female with enlarged neck lymph nodes and fatigue. She was diagnosed with B-lymphoblastic leukemia/lymphoma with possible mixed phenotype (B/myeloid) by right neck lymph node biopsy at an outside hospital. However, review of her peripheral blood smear and her bone marrow aspirate and biopsy showed features consistent with CML, which was confirmed by PCR and karyotyping. An ultrasound-guided right cervical lymph node core biopsy showed a diffuse infiltrate of blasts, near totally replacing the normal lymph node tissue, admixed with some hematopoietic cells including megakaryocytes, erythroid precursors and maturing myeloid cells. By flow cytometry and immunohistochemistry, the blasts expressed CD2, cytoplasmic CD3, CD5, CD7, CD56, TdT, CD10 (weak, subset), CD19 (subset), CD79a, PAX-5 (subset), CD34, CD38, CD117 (subset), HLA-DR (subset), CD11b, CD13 (subset), CD33 (subset), and weak cytoplasmic myeloperoxidase, without co-expression of surface CD3, CD4, CD8, CD20, CD22, CD14, CD15, CD16 and CD64, consistent with blasts with mixed phenotype (T/B/myeloid). A diagnosis of extramedullary blast crisis of CML was made. Chromosomal analysis performed on the lymph node biopsy tissue revealed multiple numerical and structural abnormalities including the Ph chromosome (46-49,XX,add(1)(p34),add(3)(p25),add(5)(q13),-6,t(9;22)(q34;q11.2),+10,-15,add(17)(p11.2),+19, +der(22)t(9;22),+mar[cp8]). After completion of one cycle of combined chemotherapy plus dasatinib treatment, she was transferred to City of Hope

Citizen participation and citizen initiatives

International Nuclear Information System (INIS)

Matthoefer, H.

1977-01-01

Contents: Social conditions for citizen initiatives - technical change and employment - crisis behaviour - socio-psychological analysis of political planning; legitimation - presentation and criticism - conditions for citizen initiatives coming into being within the field of tension citizen : administration - legal problems of citizen initiatives - environmental protection in the energy discussion; participation; models. (HP) [de

Paraneoplastic pemphigus as the initial presentation of chronic lymphocytic leukemia

NARCIS (Netherlands)

van Mook, WNKA; Fickers, MMF; Theunissen, PHMH; vander Kley, JAMJ; Duijvestijn, JA; Pas, HH; Flikweert, DC

The case history of a 61-year-old male patient is described, who presented with severe stomatitis, conjunctivitis and leukocytosis. The diagnosis chronic lymphocytic leukemia (CLL) stage A (0) was made, for which no treatment was necessary. Progression of stomatitis and conjunctivitis and

Seizure is a rare presentation for acute hemolysis due to G6PD deficiency. We report a previously healthy boy who presented initially with seizure and cyanosis and subsequently acute hemolysis, due to glucose-6-phosphate dehydrogenase deficiency (G6PD) an

OpenAIRE

Afshin FAYYAZI; Ali KHAJEH; Hosein ESFAHANI

2012-01-01

Seizure is a rare presentation for acute hemolysis due to G6PD deficiency. We report a previously healthy boy who presented initially with seizure and cyanosis and subsequently acute hemolysis, due to glucose-6-phosphate dehydrogenase deficiency (G6PD) and probably secondary methemoglobinemia, following the ingestion of fava beans.

First-episode psychosis as the initial presentation of multiple sclerosis: a case report

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Enderami A

2018-04-01

Full Text Available Athena Enderami,1 Rose Fouladi,2 Seyed Hamzeh Hosseini3 1Department of Psychiatry, School of Medicine, Mazandaran University of Medical Sciences, Mazandaran, Sari, Iran; 2Sport Injuries and Corrective Exercise, University of Mazandaran, Mazandaran, Babolsar, Iran; 3Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran Background: Multiple sclerosis (MS is an inflammatory disease that affects the central nervous system (CNS. MS with episode of psychosis is a rare entity, and to the best of our knowledge, no case has been reported from Iran till date. Case presentation: We report a case of MS with first-episode psychosis in a 27-year-old single man with no history of psychiatric disorder or drug abuse. The patient developed neurological symptoms after 3 months and was finally diagnosed as a case of MS. His symptoms started with behavioral dysfunctions and progressively resulted in depression. Subsequently, treatment was performed with citalopram 20 mg daily, risperidone 2 mg three times a day, and biperiden 2 mg three times a day; however, no improvements in the symptoms were observed. T2-weighted magnetic resonance imaging has demonstrated periventricular and white matter multiple sclerotic plugs with lesions. Eventually, MS was diagnosed after the appearance of paresthesia, upper and lower limb muscle weakness, ataxia, and urinary incontinency as typical signs. Then, the medications were changed to methylprednisolone and interferon therapy, which resulted in improvements in the clinical conditions of the patient. Conclusion: Based on the fact that organic disorders such as MS may sometimes appear with initial pure psychiatric symptoms without any neurological signs and symptoms, examinations for symptoms linked to CNS dysfunction, cognitive changes, atypical symptoms, detailed neurological examination, and limited response to conventional antipsychotic drugs are highly

Atypical Initial Presentation of Painful Muscle Cramps in a Patient with Amyotrophic Lateral Sclerosis: A Case Report and Brief Review of the Literature

OpenAIRE

Kuzel, Aaron R; Lodhi, Muhammad Uzair; Syed, Intekhab Askari; Rahim, Mustafa

2017-01-01

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder characterized clinically by progressive muscle weakness that can occur proximally or distally in either the upper or lower extremities. It includes both upper motor neuron signs (spasticity, hyperreflexia, clonus, and Babinski sign) and lower motor neuron signs (atrophy, weakness, and muscle fasciculation). Initial presentation of progressively painful muscle cramps should lead the physician to screen for other signs of amyot...

Some Visual Literacy Initiatives in Academic Institutions: A Literature Review from 1999 to the Present

Science.gov (United States)

Blummer, Barbara

2015-01-01

The ubiquitousness of images in the digital era highlights the importance of individuals' visual communication skills in the 21st Century. We conducted a literature review of visual literacy initiatives in academic institutions to illustrate best practices for imparting these skills in students. The literature review identified five categories of…

Rheumatoid Arthritis and Incidence of Twelve Initial Presentations of Cardiovascular Disease: A Population Record-Linkage Cohort Study in England.

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Mar Pujades-Rodriguez

Full Text Available While rheumatoid arthritis is an established risk factor for cardiovascular disease (CVD, our knowledge of how the pattern of risk varies for different cardiovascular phenotypes is incomplete. The association between rheumatoid arthritis and the initial presentation of 12 types of CVDs were examined in a contemporary population of men and women of a wide age range.CALIBER data, which links primary care, hospital and mortality data in England, was analysed. A cohort of people aged ≥18 years and without history of CVD was assembled and included all patients with prospectively recorded rheumatoid arthritis from January 1997, until March 2010, matched with up to ten people without rheumatoid arthritis by age, sex and general practice. The associations between rheumatoid arthritis and the initial presentation of 12 types of CVDs were estimated using multivariable random effects Poisson regression models.The analysis included 12,120 individuals with rheumatoid arthritis and 121,191 comparators. Of these, 2,525 patients with and 18,146 without rheumatoid arthritis developed CVDs during a median of 4.2 years of follow-up. Patients with rheumatoid arthritis had higher rates of myocardial infarction (adjusted incidence ratio [IRR] = 1.43, 95%CI 1.21-1.70, unheralded coronary death (IRR = 1.60, 95%CI 1.18-2.18, heart failure (IRR = 1.61, 95%CI 1.43-1.83, cardiac arrest (HR = 2.26, 95%CI 1.69-3.02 and peripheral arterial disease (HR = 1.36, 95%CI 1.14-1.62; and lower rates of stable angina (HR = 0.83, 95%CI 0.73-0.95. There was no evidence of association with cerebrovascular diseases, abdominal aortic aneurysm or unstable angina, or of interactions with sex or age.The observed associations with some but not all types of CVDs inform both clinical practice and the selection of cardiovascular endpoints for trials and for the development of prognostic models for patients with rheumatoid arthritis.

Systemic non-Hodgkin's lymphoma initially presenting as a bladder mass

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Naveen Kumar Gupta

2017-01-01

Full Text Available Urinary bladder lymphomas are rare lesions which may be primary bladder lymphomas or part of systemic lymphoma with bladder involvement. We report a case of non-Hodgkin's lymphoma (NHL in a 73-year-old female who presented with bladder tumor which on evaluation revealed NHL with extensive systemic involvement. The management of such an advanced case is discussed here with literature review.

Initial experience with a group presentation of study results to research participants

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Bent Stephen

2008-03-01

Full Text Available Abstract Background Despite ethical imperatives, informing research participants about the results of the studies in which they take part is not often performed. This is due, in part, to the costs and burdens of communicating with each participant after publication of the results. Methods Following the closeout and publication of a randomized clinical trial of saw palmetto for treatment of symptoms of benign prostatic hyperplasia, patients were invited back to the research center to participate in a group presentation of the study results. Results Approximately 10% of participants attended one of two presentation sessions. Reaction to the experience of the group presentation was very positive among the attendees. Conclusion A group presentation to research participants is an efficient method of communicating study results to those who desire to be informed and was highly valued by those who attended. Prospectively planning for such presentations and greater scheduling flexibility may result in higher attendance rates. Trial Registration Number Clinicaltrials.gov #NCT00037154

Sporadic Creutzfeldt-Jakob disease with unusual initial presentation as posterior reversible encephalopathy syndrome: a case report.

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Dirzius, Edgaras; Balnyte, Renata; Steibliene, Vesta; Gleizniene, Rymante; Gudinaviciene, Inga; Radziunas, Andrius; Petrikonis, Kestutis

2016-11-22

Creutzfeldt - Jakob disease (CJD) is a rapidly progressive and fatal neurodegenerative prion disease. MRI findings are included in diagnostic criteria for probable CJD, giving a sensitivity and specificity more than 90%, but the atypical radiological presentations in the early stage of the disease could cause the diagnostic difficulties. CJD can be definitively diagnosed by histopathological confirmation, brain biopsy or at autopsy. We present a case of 53-year-old woman with a history of a rapidly progressive dementia with symptoms of visual impairment, increased extrapyramidal type muscle tonus, stereotypical movements and ataxic gait resulting in the patient's death after13 months. The clinical symptoms deteriorated progressively to myoclonus and akinetic mutism already on the 14th week. The series of diagnostic examinations were done to exclude the possible causes of dementia. Initial MRI evaluation as posterior reversible encephalopathy syndrome (PRES) on the 9th week after the onset of symptoms created us a diagnostic conundrum. Subsequent MRI findings of symmetrical lesions in the basal ganglia (nucleus caudatus, putamen) on the 13th week and EEG with periodic sharp wave complexes (PSWC) in frontal regions on the 18th week allowed us to diagnose the probable sCJD. The histopathological findings after brain biopsy on the 14th week demonstrated the presence of the abnormal prion protein deposits in the grey matter by immunohistochemistry with ICSM35, KG9 and 12 F10 antibodies and confirmed the diagnosis of sCJD. In this article we focus our attention on a rare association between radiological PRES syndrome and early clinical stage of sCJD. Although concurrent manifestation of these conditions can be accidental, but the immunogenic or neuropeptide mechanisms could explain such radiological MRI findings. A thorough knowledge of differential diagnostic of PRES may be especially useful in earlier diagnosis of sCJD.

Behavioral Initiatives in Broad Perspective.

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California Univ., Los Angeles. Center for Mental Health in Schools.

This booklet is a technical assistance sampler addressing the issues of student misbehavior, discipline problems, and behavioral initiatives. The term behavioral initiative is defined, disciplining children with disabilities is discussed, and a cautionary note concerning ignoring students' reasons for misbehavior is presented. A brief entitled…

Initial Study

DEFF Research Database (Denmark)

Torp, Kristian

2009-01-01

increased. In the initial study presented here, the time it takes to pass an intersection is studied in details. Two major signal-controlled four-way intersections in the center of the city Aalborg are studied in details to estimate the congestion levels in these intersections, based on the time it takes...

Delays before Diagnosis and Initiation of Treatment in Patients Presenting to Mental Health Services with Bipolar Disorder.

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Rashmi Patel

Full Text Available Bipolar disorder is a significant cause of morbidity and mortality. Although existing treatments are effective, there is often a substantial delay before diagnosis and treatment initiation. We sought to investigate factors associated with the delay before diagnosis of bipolar disorder and the onset of treatment in secondary mental healthcare.Retrospective cohort study using anonymised electronic mental health record data from the South London and Maudsley NHS Foundation Trust (SLaM Biomedical Research Centre (BRC Case Register on 1364 adults diagnosed with bipolar disorder between 2007 and 2012. The following predictor variables were analysed in a multivariable Cox regression analysis: age, gender, ethnicity, compulsory admission to hospital under the UK Mental Health Act, marital status and other diagnoses prior to bipolar disorder. The outcomes were time to recorded diagnosis from first presentation to specialist mental health services (the diagnostic delay, and time to the start of appropriate therapy (treatment delay.The median diagnostic delay was 62 days (interquartile range: 17-243 and median treatment delay was 31 days (4-122. Compulsory hospital admission was associated with a significant reduction in both diagnostic delay (hazard ratio 2.58, 95% CI 2.18-3.06 and treatment delay (4.40, 3.63-5.62. Prior diagnoses of other psychiatric disorders were associated with increased diagnostic delay, particularly alcohol (0.48, 0.33-0.41 and substance misuse disorders (0.44, 0.31-0.61. Prior diagnosis of schizophrenia and psychotic depression were associated with reduced treatment delay.Some individuals experience a significant delay in diagnosis and treatment of bipolar disorder after initiation of specialist mental healthcare, particularly those who have prior diagnoses of alcohol and substance misuse disorders. These findings highlight a need for further study on strategies to better identify underlying symptoms and offer appropriate treatment

Delays before Diagnosis and Initiation of Treatment in Patients Presenting to Mental Health Services with Bipolar Disorder.

Science.gov (United States)

Patel, Rashmi; Shetty, Hitesh; Jackson, Richard; Broadbent, Matthew; Stewart, Robert; Boydell, Jane; McGuire, Philip; Taylor, Matthew

2015-01-01

Bipolar disorder is a significant cause of morbidity and mortality. Although existing treatments are effective, there is often a substantial delay before diagnosis and treatment initiation. We sought to investigate factors associated with the delay before diagnosis of bipolar disorder and the onset of treatment in secondary mental healthcare. Retrospective cohort study using anonymised electronic mental health record data from the South London and Maudsley NHS Foundation Trust (SLaM) Biomedical Research Centre (BRC) Case Register on 1364 adults diagnosed with bipolar disorder between 2007 and 2012. The following predictor variables were analysed in a multivariable Cox regression analysis: age, gender, ethnicity, compulsory admission to hospital under the UK Mental Health Act, marital status and other diagnoses prior to bipolar disorder. The outcomes were time to recorded diagnosis from first presentation to specialist mental health services (the diagnostic delay), and time to the start of appropriate therapy (treatment delay). The median diagnostic delay was 62 days (interquartile range: 17-243) and median treatment delay was 31 days (4-122). Compulsory hospital admission was associated with a significant reduction in both diagnostic delay (hazard ratio 2.58, 95% CI 2.18-3.06) and treatment delay (4.40, 3.63-5.62). Prior diagnoses of other psychiatric disorders were associated with increased diagnostic delay, particularly alcohol (0.48, 0.33-0.41) and substance misuse disorders (0.44, 0.31-0.61). Prior diagnosis of schizophrenia and psychotic depression were associated with reduced treatment delay. Some individuals experience a significant delay in diagnosis and treatment of bipolar disorder after initiation of specialist mental healthcare, particularly those who have prior diagnoses of alcohol and substance misuse disorders. These findings highlight a need for further study on strategies to better identify underlying symptoms and offer appropriate treatment sooner

Isolated Mass-Forming IgG4-Related Cholangitis as an Initial Clinical Presentation of Systemic IgG4-Related Disease

Directory of Open Access Journals (Sweden)

Seokhwi Kim

2016-07-01

Full Text Available IgG4-related disease (IgG4-RD may involve multiple organs. Although it usually presents as diffuse organ involvement, localized mass-forming lesions have been occasionally encountered in pancreas. However, the same pattern has been seldom reported in biliary tract. A 61-year-old male showed a hilar bile duct mass with multiple enlarged lymph nodes in imaging studies and he underwent trisectionectomy under impression of cholangiocarcinoma. Gross examination revealed a mass-like lesion around hilar bile duct. Histopathologically, dense lymphoplasmacytic infiltration and storiform fibrosis were identified without evidence of malignancy. Immunohistochemical stain demonstrated rich IgG4-positive plasma cell infiltration. Follow-up imaging studies disclosed multiple enlarged lymph nodes with involvement of pancreas and perisplenic soft tissue. The lesions have been significantly reduced after steroid treatment, which suggests multi-organ involvement of systemic IgG4-RD. Here, we report an unusual localized mass-forming IgG4-related cholangitis as an initial presentation of IgG4-RD, which was biliary manifestation of systemic IgG4-related autoimmune disease.

1996 environmental initiatives report

International Nuclear Information System (INIS)

1996-01-01

Progress by Consumers Gas in addressing environmental challenges were reviewed. Proposed environmental initiatives for the next fiscal year and beyond were introduced. Proposed initiatives were placed into three priority categories, high, medium or low, which together with the environmental management framework form the the utility's overall environmental agenda. High on the list of environmental priorities for the company are atmospheric air emissions, planning and construction practices, energy conservation and efficiency, environmental compliance, and methane emissions. The present state of the initiatives by the various company divisions and regions, compiled from the respective business plans, were reported. 21 figs

Initial value gravitational quadrupole radiation theorem

International Nuclear Information System (INIS)

Winicour, J.

1987-01-01

A rigorous version of the quadrupole radiation formula is derived using the characteristic initial value formulation of a general relativistic fluid space-time. Starting from initial data for a Newtonian fluid, an algorithm is presented that determines characteristic initial data for a one-parameter family of general relativistic fluid space-times. At the initial time, a one-parameter family of space-times with this initial data osculates the evolution of the Newtonian fluid and has leading order news function equal to the third time derivative of the transverse Newtonian quadrupole moment

Initiation devices, initiation systems including initiation devices and related methods

Energy Technology Data Exchange (ETDEWEB)

Daniels, Michael A.; Condit, Reston A.; Rasmussen, Nikki; Wallace, Ronald S.

2018-04-10

Initiation devices may include at least one substrate, an initiation element positioned on a first side of the at least one substrate, and a spark gap electrically coupled to the initiation element and positioned on a second side of the at least one substrate. Initiation devices may include a plurality of substrates where at least one substrate of the plurality of substrates is electrically connected to at least one adjacent substrate of the plurality of substrates with at least one via extending through the at least one substrate. Initiation systems may include such initiation devices. Methods of igniting energetic materials include passing a current through a spark gap formed on at least one substrate of the initiation device, passing the current through at least one via formed through the at least one substrate, and passing the current through an explosive bridge wire of the initiation device.

Initial Misdiagnosis of Proximal Pancreatic Adenocarcinoma Is Associated with Delay in Diagnosis and Advanced Stage at Presentation.

Science.gov (United States)

Swords, Douglas S; Mone, Mary C; Zhang, Chong; Presson, Angela P; Mulvihill, Sean J; Scaife, Courtney L

2015-10-01

Delay in diagnosis of pancreatic ductal adenocarcinoma (PDAC) is associated with decreased survival. The effect of an initial misdiagnosis on delay in diagnosis and stage of PDAC is unknown. This study is a retrospective review (2000-2010) from a University-based cancer center of new diagnoses of proximal PDAC. Of 313 patients, 98 (31.3 %) had an initial misdiagnosis. Misdiagnosed patients were younger, 62.8 ± 12.6 vs. 68.0 ± 10.1 (p < 0.001). The most common initial misdiagnoses were: gallbladder disease, gastroesophageal reflux disease, and peptic ulcer disease. After excluding patients with prior cholecystectomy, 14.2 % were misdiagnosed with gallbladder disease and underwent cholecystectomy before PDAC diagnosis. Misdiagnosed patients had higher rates of abdominal pain (p < 0.001), weight loss (p = 0.04), and acute pancreatitis (p < 0.001) and lower rate of jaundice (p < 0.001). Median time between symptoms to PDAC diagnosis was longer in misdiagnosed: 4.2 months vs. 1.4 (p < 0.001). Median time from contact with medical provider to axial imaging was longer in misdiagnosed (p < 0.001). Rate of stages III-IV disease at diagnosis was higher in misdiagnosed: 61.2 vs. 43.7 % (p = 0.004), with a 1.4 (95 % confidence interval (CI), 1.12-1.74) higher risk of stages III-IV disease at diagnosis; however, there was no difference in median overall survival in misdiagnosed patients (9.6 months in misdiagnosed vs. 10.3 months in correctly diagnosed, p = 0.69). Initial misdiagnosis of patients with proximal PDAC is associated with delay in diagnosis and higher risk of locally advanced or advanced disease at time of PDAC diagnosis.

Characterization of Heterogeneous Prostate Tumors in Targeted Pten Knockout Mice.

Directory of Open Access Journals (Sweden)

Hanneke Korsten

Full Text Available Previously, we generated a preclinical mouse prostate tumor model based on PSA-Cre driven inactivation of Pten. In this model homogeneous hyperplastic prostates (4-5m developed at older age (>10m into tumors. Here, we describe the molecular and histological characterization of the tumors in order to better understand the processes that are associated with prostate tumorigenesis in this targeted mouse Pten knockout model. The morphologies of the tumors that developed were very heterogeneous. Different histopathological growth patterns could be identified, including intraductal carcinoma (IDC, adenocarcinoma and undifferentiated carcinoma, all strongly positive for the epithelial cell marker Cytokeratin (CK, and carcinosarcomas, which were negative for CK. IDC pattern was already detected in prostates of 7-8 month old mice, indicating that it could be a precursor stage. At more than 10 months IDC and carcinosarcoma were most frequently observed. Gene expression profiling discriminated essentially two molecular subtypes, denoted tumor class 1 (TC1 and tumor class 2 (TC2. TC1 tumors were characterized by high expression of epithelial markers like Cytokeratin 8 and E-Cadherin whereas TC2 tumors showed high expression of mesenchyme/stroma markers such as Snail and Fibronectin. These molecular subtypes corresponded with histological growth patterns: where TC1 tumors mainly represented adenocarcinoma/intraductal carcinoma, in TC2 tumors carcinosarcoma was the dominant growth pattern. Further molecular characterization of the prostate tumors revealed an increased expression of genes associated with the inflammatory response. Moreover, functional markers for senescence, proliferation, angiogenesis and apoptosis were higher expressed in tumors compared to hyperplasia. The highest expression of proliferation and angiogenesis markers was detected in TC2 tumors. Our data clearly showed that in the genetically well-defined PSA-Cre;Pten-loxP/loxP prostate tumor

Non-canonical transcription initiation: the expanding universe of transcription initiating substrates.

Science.gov (United States)

Barvík, Ivan; Rejman, Dominik; Panova, Natalya; Šanderová, Hana; Krásný, Libor

2017-03-01

RNA polymerase (RNAP) is the central enzyme of transcription of the genetic information from DNA into RNA. RNAP recognizes four main substrates: ATP, CTP, GTP and UTP. Experimental evidence from the past several years suggests that, besides these four NTPs, other molecules can be used to initiate transcription: (i) ribooligonucleotides (nanoRNAs) and (ii) coenzymes such as NAD+, NADH, dephospho-CoA and FAD. The presence of these molecules at the 5΄ ends of RNAs affects the properties of the RNA. Here, we discuss the expanding portfolio of molecules that can initiate transcription, their mechanism of incorporation, effects on RNA and cellular processes, and we present an outlook toward other possible initiation substrates. © FEMS 2016. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Metastatic neuroendocrine tumor with initial presentation of orbital apex syndrome

Directory of Open Access Journals (Sweden)

Yen-Yu Huang

2017-03-01

Full Text Available The possible etiologies of orbital apex syndrome range from inflammatory, infectious, neoplastic, iatrogenic/traumatic, to vascular processes. In patients without obvious infection or systemic cancer history, judicious use of corticosteroids is a reasonable strategy. We describe a 64-year-old man who presented with orbital apex syndrome and had progressed to total visual loss in three days after admission. Radiological imaging and pathological studies were consistent with a neuroendocrine tumor with multiple metastases. We recommend that a biopsy-proven specimen is warranted in patient with orbital apex syndrome even without a cancer history.

Supply Chain Initiatives Database

Energy Technology Data Exchange (ETDEWEB)

None

2012-11-01

The Supply Chain Initiatives Database (SCID) presents innovative approaches to engaging industrial suppliers in efforts to save energy, increase productivity and improve environmental performance. This comprehensive and freely-accessible database was developed by the Institute for Industrial Productivity (IIP). IIP acknowledges Ecofys for their valuable contributions. The database contains case studies searchable according to the types of activities buyers are undertaking to motivate suppliers, target sector, organization leading the initiative, and program or partnership linkages.

Initial time singularities and admissible initial states for a system of coupled scalar fields

Energy Technology Data Exchange (ETDEWEB)

Baacke, Juergen [Technische Univ. Dortmund (Germany). Fakultaet Physik; Kevlishvili, Nina [Deutsches Elektronen-Synchrotron (DESY), Hamburg (Germany); GAS, Tbilisi (Georgia). Andronikashvili Inst. of Physics

2009-10-15

We discuss the problem of initial states for a system of coupled scalar fields out of equilibrium in the one-loop approximation. The fields consist of classical background fields, taken constant in space, and quantum fluctuations. If the initial state is the adiabatic vacuum, i.e., the ground state of a Fock space of particle excitations that diagonalize the mass matrix, the energy-momentum tensor is infinite at t=0, its most singular part behaves as 1/t. When the system is coupled to gravity this presents a problem that we solve by a Bogoliubov transformation of the naive initial state. As a side result we also discuss the canonical formalism and the adiabatic particle number for such a system. Most of the formalism is presented for Minkowksi space. Embedding the system and its dynamics into a flat FRW universe is straightforward and we briefly address the essential modifications. (orig.)

Initial time singularities and admissible initial states for a system of coupled scalar fields

International Nuclear Information System (INIS)

Baacke, Juergen; Kevlishvili, Nina; GAS, Tbilisi

2009-10-01

We discuss the problem of initial states for a system of coupled scalar fields out of equilibrium in the one-loop approximation. The fields consist of classical background fields, taken constant in space, and quantum fluctuations. If the initial state is the adiabatic vacuum, i.e., the ground state of a Fock space of particle excitations that diagonalize the mass matrix, the energy-momentum tensor is infinite at t=0, its most singular part behaves as 1/t. When the system is coupled to gravity this presents a problem that we solve by a Bogoliubov transformation of the naive initial state. As a side result we also discuss the canonical formalism and the adiabatic particle number for such a system. Most of the formalism is presented for Minkowksi space. Embedding the system and its dynamics into a flat FRW universe is straightforward and we briefly address the essential modifications. (orig.)

Initiation of protein synthesis in bacteria

DEFF Research Database (Denmark)

Laursen, Brian Søgaard; Sørensen, Hans Peter; Mortensen, Kim Kusk

2005-01-01

Valuable information on translation initiation is available from biochemical data and recently solved structures. We present a detailed description of current knowledge about the structure, function, and interactions of the individual components involved in bacterial translation initiation. The f...

The Yekaterinburg headache initiative

DEFF Research Database (Denmark)

Lebedeva, Elena R; Olesen, Jes; Osipova, Vera V

2013-01-01

for a demonstrational interventional project in Russia, undertaken within the Global Campaign against Headache. The initiative proposes three actions: 1) raise awareness of need for improvement; 2) design and implement a three-tier model (from primary care to a single highly specialized centre with academic affiliation......) for efficient and equitable delivery of headache-related health care; 3) develop a range of educational initiatives aimed at primary-care physicians, non-specialist neurologists, pharmacists and the general public to support the second action. RESULTS AND CONCLUSION: We set these proposals in a context...... of a health-care needs assessment, and as a model for all Russia. We present and discuss early progress of the initiative, justify the investment of resources required for implementation and call for the political support that full implementation requires. The more that the Yekaterinburg headache initiative...

Embedding initial data for black hole collisions

OpenAIRE

Romano, Joseph D.; Price, Richard H.

1994-01-01

We discuss isometric embedding diagrams for the visualization of initial data for the problem of the head-on collision of two black holes. The problem of constructing the embedding diagrams is explicitly presented for the best studied initial data, the Misner geometry. We present a partial solution of the embedding diagrams and discuss issues related to completing the solution.

Motivation and Training Initiation: Evidence from Poland

Science.gov (United States)

Mielniczuk, Emilia; Laguna, Mariola

2017-01-01

Purpose: Based on the self-determination theory and the model of action phases, the present study aims to provide insight into motivational factors that are important for training initiation. It investigates the relations between three types of motivation (intrinsic, extrinsic and amotivation) and training initiation: intention to initiate new…

Olecranon bursitis as initial presentation of gout in asymptomatic normouricemic patients

NARCIS (Netherlands)

Emad, Yasser; Ragab, Yasser; El Shaarawy, Nashwa; Rasker, Johannes J.

2014-01-01

Background Acute bursitis is a less frequent presentation of gout, especially in normouricemic subjects compared to the typical pattern of acute gouty arthritis. Aim of the work The aim of the current case reports is to describe the clinical and the magnetic resonance imaging features of acute gouty

Congenital pulmonary airway malformation (CPAM) with initial presentation in an adult: a rare presentation of a rare disease.

Science.gov (United States)

Abu Omar, Mohannad; Tylski, Emily; Abu Ghanimeh, Mouhanna; Gohar, Ashraf

2016-09-26

Congenital pulmonary airway malformation (CPAM) is a rare congenital abnormality with unknown exact aetiology or clear genetic association. It is characterised by a failure of bronchial development and localised glandular overgrowth. Typically, it is diagnosed on prenatal ultrasound, only infrequently in children, and even less commonly in adults. We present a case of a 25-year-old man, with no previous lung diseases who presented with right-sided chest pain, fever and cough suggestive of pulmonary infection. Chest imaging, including CT scan, showed a large focal cystic mass within the right lower lobe along with ground glass opacities suggestive of CPAM. He was started on intravenous antibiotics. Bronchoscopy showed a large amount of pus in the right lung and bronchoalveolar lavage confirmed the microbiological diagnosis of methicillin-resistant Staphylococcus aureus. He improved with antibiotic treatment. He was discharged with 6-week course of antibiotics and follow-up afterward. 2016 BMJ Publishing Group Ltd.

Endometrial cancers occurring 10 or more years after pelvic irradiation for carcinoma

International Nuclear Information System (INIS)

Rodriguez, J.; Hart, W.R.

1982-01-01

Fifteen patients who developed cancer of the endometrium 10 or more years after pelvic irradiation for carcinoma were selected for study from a group of 64 cases of postirradiation malignant pelvic tumors diagnosed during a 48-year span. The average interval between radiotherapy and diagnosis of the subsequent endometrial cancer was 17.2 years. Irradiation initially had been done for squamous cell carcinoma of the cervix in 13 cases (87%) and for ovarian tumors in two instances. Almost all patients had received megavoltage external radiation combined with radium implants. Two-thirds of the tumors were adenocarcinomas and one-third were carcinosarcomas (either homologous or heterologous). Although the risk of second primary malignant tumors following therapeutic irradiation for pelvic tumors probably is very low, the emergence of new genital tract cancers in long-term survivors must be anticipated, regardless of whether the postirradiation cancers are spontaneous or radiation-induced

Syphilitic posterior placoid chorioretinitis as initial presentation of early neurosyphilis.

Science.gov (United States)

Molina-Sócola, F E; López-Herrero, F; Medina-Tapia, A; Rueda-Rueda, T; Contreras-Díaz, M; Sánchez-Vicente, J L

2017-10-01

A 36 year-old male with a recent HIV diagnosis, presented with loss of vision of his left eye. Ophthalmoscopy revealed a unilateral yellowish placoid lesion in the macula. After fluorescein angiography, optical coherence tomography, optical coherence tomography angiography, syphilis serology, and cerebrospinal fluid results, he was diagnosed with neurosyphilis and syphilitic posterior placoid chorioretinitis. Acute syphilitic posterior placoid chorioretinitis is a rare ocular manifestation of syphilis. All patients with characteristic clinical and angiographic findings of acute syphilitic posterior placoid chorioretinitis should be tested for a neurosyphilis and human immunodeficiency virus co-infection. Early treatment with intravenous penicillin is usually effective with good visual results. Copyright © 2016 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.

Desmoplastic malignant melanoma presenting as large lung mass.

LENUS (Irish Health Repository)

Al-Alao, Bassel Suffian

2010-08-01

We describe a case of successful minimally invasive thoracoscopic surgical resection of metastatic desmoplastic malignant melanoma replacing the entire right lower lobe of the lung, presenting 4 years after the initial complete resection of the primary scalp lesion. An 89-year-old man presented with a 6-month history of right-sided chest pain. A computed tomographic scan showed a large paravertebral mass with possibility of chest wall invasion. Core biopsy initially raised the suspicion of a schwannoma. We also discussed the atypical delayed presentation and misleading radiologic and histologic findings.

The first report of CADASIL in Peru: Olfactory dysfunction on initial presentation

Directory of Open Access Journals (Sweden)

Anastasia Vishnevetsky

2016-12-01

Full Text Available Cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL is a rare, heritable, small vessel vascular disease caused by mutations in the Notch3 gene that is characterized by migraines, subcortical vascular events, cognitive decline, and mood disturbances. However, many CADASIL cases present with unusual symptoms such as status epilepticus, a movement disorder, or sensory dysfunction. This study describes the clinical, genetic, and radiologic characteristics of a Peruvian family with CADASIL in which multiple family members presented with severe olfactory deficits. Seven members of the family have symptoms suggestive of CADASIL, with genetic testing revealing R133C mutations in the two patients who underwent genetic testing. Cognitive testing and olfactory identification testing (Smell Identification Test were performed in three CADASIL patients revealing total anosmia in two tested patients and severe hyposmia in the other. Olfactory dysfunction has been associated with various neurologic and psychiatric conditions, though few studies have linked it with neurovascular disorders such as CADASIL. This first reported case of CADASIL in Peru emphasizes that symptomatic olfactory dysfunction may be an unusual presentation of CADASIL and that olfactory dysfunction is important to evaluate in CADASIL patients.

Jejunojejunal Intussusception as the Initial Presentation of Non-Hodgkin’s B-Cell Lymphoma in an Adult Patient: A Case Report and Review of the Literature

Directory of Open Access Journals (Sweden)

V. Stohlner

2013-01-01

Full Text Available Introduction. Intussusception is a rare cause of bowel obstruction in adults and is usually associated with an underlying pathology, benign, or malignant. This is a report of a case of jejunojejunal intussusception secondary to non-Hodgkin’s B-cell lymphoma in an adult patient. Case Presentation. A 74-year-old male with no previous significant medical history presented with symptoms of acute intestinal obstruction. A CT scan of the abdomen and pelvis revealed 2 areas of jejunojejunal intussusception, which were surgically managed successfully. Histopathological examination of the specimen revealed the presence of high grade diffuse large B-cell-type non-Hodgkin’s lymphoma, and the patient was referred to the oncology team for further management. Discussion. B-cell lymphoma is a rare but well-documented cause of intussusception in adults, with most cases being at the ileocolic region. We present a rare case of jejunojejunal intussusception as the initial presentation of non-Hodgkin’s B-cell lymphoma in an adult patient.

Prediction of Response to Therapy and Clinical Outcome through a Pilot Study of Complete Genetic Assessment of Ovarian Cancer

Science.gov (United States)

2015-12-01

B, PIK3CA, BRCA2, ATM, SETD2, ATRX, MTOR, PIK3R1 Mucinous KRAS, TP53, CDKN2A, SMAD4 , TERT Carcinosarcoma TP53, RB1, APC Granulasa cell ATM...alterations in the PTEN- PI3K- AKT -mTOR pathway in a cohort of 379 ovarian cancer patients. Submitted to American Society of Clinical Oncology Annual meeting

Modulation of the toxicity and antitumour activity of alkylating drugs by steroids.

OpenAIRE

Shepherd, R.; Harrap, K. R.

1982-01-01

The steroids prednisolone and progesterone significantly altered the therapeutic indices of the alkylating agents, nitrogen mustard, melphalan, cyclophosphamide, phenyl acetic mustard and chlorambucil. For nitrogen mustard, chlorambucil and phenyl acetic mustard, prednisolone reduced host toxicity in the rat and enhanced the antitumour effectiveness against alkylating-agent-resistant strains of the Yoshida sarcoma and Walker carcinosarcoma. Progesterone also increased the therapeutic index of...

Artery of Percheron: an unusual stroke presentation.

Science.gov (United States)

Pitts-Tucker, Toby; Small, Jeremy

2018-03-28

An 86-year-old woman was admitted with multiple episodes of transient loss of consciousness. She was initially treated for seizures, and stroke was not considered likely. MRI on the same day of admission showed acute bilateral medial thalamic infarcts in keeping with the Artery of Percheron (AOP) territory infarcts. Investigation for polycythaemia and thrombocytosis showed JAK2 positive myeloproliferative neoplasm.A diagnosis of AOP infarction is often missed or delayed because it is rare and presents with variable neurological symptoms. Initial imaging in the form of CT is often negative, and some report that initial MRI findings may also be normal.An awareness of a wide range of differential diagnoses alongside a multi-modality imaging approach is required to reach a diagnosis.Although there are several other case reports of AOP infarction in the literature, this is the first to present with transient symptoms initially mistaken for seizure activity. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Single and multiple transverse fracture initiation from horizontal wells

Energy Technology Data Exchange (ETDEWEB)

Crosby, D.G.; Rahman, M.M.; Rahman, M.K.; Rahman, S.S. [School of Petroleum Engineering, The University of New South Wales, 2052 Sydney (Australia)

2002-08-01

The results of an analytical and experimental study of the initiation of transverse fractures from horizontal wells are presented. Analytical criteria for the initiation of single hydraulic fracture are reviewed, and criterion for initiation of multiple hydraulic fractures was developed by modification of the existing Drucker and Prager criterion for single hydraulic fracture initiation. The developed criterion for multiple fracture initiation was validated by comparisons with actual hydraulic fracture initiation pressures, which were obtained from scaled laboratory experiments and numerical results from boundary element analysis. Other criteria are assessed against the experimental results. Experimentally obtained transverse fracture initiation pressures were found close to longitudinal fracture initiation pressures estimated from maximum tensile stress criterion and Hoek and Brown criterion. One possible explanation of this finding is presented. Results from Drucker and Prager criteria for single and multiple fracture initiation were, however, found closer to experimental values. Therefore, these criteria could be useful to engineers involved with hydraulic fracturing for predicting transverse fracture initiation pressures from horizontal wells drilled parallel to the minimum horizontal in-situ stress.

Flourishing in the now : Initial validation of a present-eudaimonic time perspective scale

NARCIS (Netherlands)

Vowinckel, Jonte C.; Westerhof, Gerben J.; Bohlmeijer, Ernst T.; Webster, Jeffrey D.

2017-01-01

Introduction: A positive focus on the present, the only time zone which we experience directly and permanently, is at least as relevant as perspectives on the past and future in a balanced time perspective and its relation to wellbeing. Yet, few instruments examining a positive present time

Higher-dimensional puncture initial data

International Nuclear Information System (INIS)

Zilhao, Miguel; Ansorg, Marcus; Cardoso, Vitor; Gualtieri, Leonardo; Herdeiro, Carlos; Sperhake, Ulrich; Witek, Helvi

2011-01-01

We calculate puncture initial data, corresponding to single and binary black holes with linear momenta, which solve the constraint equations of D-dimensional vacuum gravity. The data are generated by a modification of the pseudospectral code presented in [M. Ansorg, B. Bruegmann, and W. Tichy, Phys. Rev. D 70, 064011 (2004).] and made available as the TwoPunctures thorn inside the Cactus computational toolkit. As examples, we exhibit convergence plots, the violation of the Hamiltonian constraint as well as the initial data for D=4,5,6,7. These initial data are the starting point to perform high-energy collisions of black holes in D dimensions.

Investigating the Present Day Cosmic Dust Flux at the Earth's Surface: Initial Results from the Kwajalein Micrometeorite Collection

Science.gov (United States)

Wozniakiewicz, P. J.; Bradley, J. P.; Price, M. C.; Zolensky, M. E.; Ishii, H. A.; Brownlee, D. E.; Russell, S. S.

2014-01-01

Examination of impact craters on the Long Duration Exposure Facility satellite indicate a present day micrometeoroid flux of approx. 30,000 tonnes [1 after 2]. But what portion of this material arrives at the Earth's surface as micrometeorites? Studies of available micrometeorite collections from deep sea sediments [e.g. 3], Greenland blue ice [e.g. 4] and the South Pole water well [e.g. 1] may be complicated by terrestrial weathering and, in some cases, collection bias (magnetic separation for deep sea sediments) and poorly constrained ages. We have recently set up a micrometeorite collection station on Kwajalein Island in the Republic of the Marshall Islands in the Pacific Ocean, using high volume air samplers to collect particles directly from the atmosphere. By collecting in this way, the terrestrial age of the particles is known, the weathering they experience is minimal, and we are able to constrain particle arrival times. Collecting at this location also exploits the considerably reduced anthropogenic background [5]. Method: High volume air samplers were installed on top of the two-story airport building on Kwajalein. These were fitted with polycarbonate membrane filters with 5µm diameter perforations. The flow rates were set to 0.5m3/min, and filters were changed once a week. After collection, filters were washed to remove salt and concentrate particles [see 5] in preparation for analysis by SEM. Results and Discussion: A selection of filters have been prepared and surveyed. Due to their ease of identification our initial investigations have focused on particles resembling cosmic spherules. The spheres can be divided into three main groups: 1. Silicate spherules rich in Al, Ca, K and Na (to varying degrees), 2. Silicate spherules rich in Mg and Fe and 3. Fe-rich spherules. Group 1 spherules are often vesiculated and can occur as aggregates. They are similar in appearance and composition to volcanic microspheres [e.g. 6] and are thus likely terrestrial in

Caesarean section delivery and breastfeeding initiation at the ...

African Journals Online (AJOL)

Background: Caesarean section (CS) presents a challenge for early breastfeeding of the newborn infant. It is expected that with the Baby Friendly Hospital Initiative (BFHI), mothers who deliver by CS can be helped to initiate breastfeeding early. Objectives: This study aims to determine the time of initiation of breastfeeding in ...

Do patient expectations about arthroplasty at initial presentation for hip or knee pain differ by sex and ethnicity?

Science.gov (United States)

Lavernia, Carlos J; Contreras, Juan S; Parvizi, Javad; Sharkey, Peter F; Barrack, Robert; Rossi, Mark D

2012-10-01

Many studies show gender and ethnic differences in healthcare utilization and outcomes. Patients' presurgical cognitions regarding surgical outcomes also may vary by gender and ethnicity and play a role in explaining utilization and outcome differences. However, it is unclear whether and to what extent gender and ethnicity play a role in patients' presurgical cognitions. Do gender and ethnicity influence outcome expectations? Is arthroplasty-related knowledge affected by gender and ethnicity? Do gender and ethnicity influence willingness to pay for surgery? In a prospective, multicenter study we gave 765 patients an anonymous questionnaire on expectations, arthroplasty knowledge, and preferences before their consultation for hip and/or knee pain, from March 2005 to July 2007. Six hundred seventy-two of the 765 patients (88%) completed questionnaires. Non-Hispanics and men were more likely to indicate they would be able to engage in more activities. Non-Hispanics and men had greater arthroplasty knowledge. Hispanics and women were more likely to report they would not pay for a total joint arthroplasty (TJA) relative to non-Hispanics and men. Sex and ethnic differences in patients presenting for their initial visit to the orthopaedists for hip or knee pain influence expectations, knowledge, and preferences concerning TJAs. Longitudinal study of relationships between patients' perceptions and utilization or outcomes regarding TJA is warranted.

Mature cystic Theratome. Presentation of a case

International Nuclear Information System (INIS)

Rivera B, Aura Lucia; Carrillo B, Jorge Alberto; Ojeda L, Paulina

2004-01-01

The case of a patient of five months of age is presented, to which was diagnosed cystic theratome, initially was assisted in another institution to present consistent square of four days in dry cough and sialorrea. It was managed initially with pneumonia diagnosis and spill paraneumonic. The x-ray of initial thorax demonstrated an opacity committing the two inferior thirds of the left hemithorax, with obliteration of the costofrenic angle and contralateral deviation of the cardio mediastinum, later on another thorax x-ray to the entrance with diagnostic impression of sepsis of lung origin and pneumonia suspicion with spill associate pleural, was practiced closed thoracotomy, obtaining 60 cc of sallow liquid. For the persistence of the opacity basal left in the control x-ray, he was practiced thorax tomography. For the presence of multiple densities and the localization of the lesion it outlines the possibility of cystic theratome

WWNPQFT-2010 - Slides of the presentations

International Nuclear Information System (INIS)

Fried, H.M.; Huber, M.Q.; Grandou, T.; Bianchi, E.; Gracey, J.; Reys, V.; Jevicki, A.; Ferrante, D.; Bouakaz, K.; Spielmann, D.; Cucchieri, A.; Culetu, H.; Gelis, F.; Zwanziger, D.; Candelpergher, B.; Bender, C.

2013-01-01

This document is made up of the slides of the presentations. The object of this workshop is to consolidate and publicize new efforts in non-perturbative field theories. The main topics are quantum chromodynamics, Yang-Mills theory, effective locality, the Gribov-Zwanziger Lagrangian, and renormalization. A presentation is dedicated to the initial stages of high energy nucleus-nucleus collisions

Stellar Presentations (Abstract)

Science.gov (United States)

Young, D.

2015-12-01

(Abstract only) The AAVSO is in the process of expanding its education, outreach and speakers bureau program. powerpoint presentations prepared for specific target audiences such as AAVSO members, educators, students, the general public, and Science Olympiad teams, coaches, event supervisors, and state directors will be available online for members to use. The presentations range from specific and general content relating to stellar evolution and variable stars to specific activities for a workshop environment. A presentation—even with a general topic—that works for high school students will not work for educators, Science Olympiad teams, or the general public. Each audience is unique and requires a different approach. The current environment necessitates presentations that are captivating for a younger generation that is embedded in a highly visual and sound-bite world of social media, twitter and U-Tube, and mobile devices. For educators, presentations and workshops for themselves and their students must support the Next Generation Science Standards (NGSS), the Common Core Content Standards, and the Science Technology, Engineering and Mathematics (STEM) initiative. Current best practices for developing relevant and engaging powerpoint presentations to deliver information to a variety of targeted audiences will be presented along with several examples.

Nuclear data for radiotherapy: Presentation of a new ICRU report and IAEA initiatives

International Nuclear Information System (INIS)

Chadwick, M.B.; Jones, D.T.L.; Barschall, H.H.

1998-01-01

An ICRU report entitled ''Nuclear Data for neutron and Proton Radiotherapy and for Radiation Protection'' is in preparation. The present paper presents an overview of this report, along with examples of some of the results obtained for evaluated nuclear cross sections and kerma coefficients. These cross sections are evaluated using a combination of measured data and the GNASH nuclear model code for elements of importance for biological, dosimetric, beam modification and shielding purposes. In the case of hydrogen both R-matrix and phase-shift scattering theories are used. In the report neutron cross sections and kerma coefficients will be presented up to 100 MeV and proton cross sections up to 250 MeV. An IAEA Consultants' Meeting was also convened to examine the ''Status of Nuclear Data needed for Radiation Therapy and Existing Data Development Activities in Member States''. Recommendations were made regarding future endeavors

Mandibular metastasis presenting as the initial maifestation of malignant pheochromocytoma

Energy Technology Data Exchange (ETDEWEB)

Yanagi, Yoshinobu; Asaumi, Jun-ichi E-mail: asaumi@md.okayama-u.ac.jp; Hisatomi, Miki; Konouchi, Hironobu; Wakasa, Toru; Kishi, Kanji

2002-10-01

A case of 59-year-old male patient presenting with metastasis to the mandible from malignant pheochromocytoma is described. The conventional radiographs and CT images suggested that the lesion was malignant osteogenic tumors or metastatic tumors due to the existence of calcification and widesoread periosteal sunburst spiculation. On MRI, an expansive mass was clearly depicted and the signal intensities of the lesion were low to intermediate on T1 weighted image with intermediate to high signal intensity on T2 weighted image. A strong enhancement of the lesion was also observed on contrast enhanced T1 weighted image. On maximum intensity projection image in the arterial phase, the mass showed exceedingly early enhancement and excessively dislocated adjacent vessels. The diagnosis of a pheochromcytoma was difficult on the basis of these imagings. The final diagnosis was based on a biopsy of the mandible and I-131 Meta-iodobenzylguanidine scintigraphy (MIBG) scintigraphy. A primary lesion of the right adrenal showed low uptake due to wide centric necrosis and metastatic lesions of liver, lumber vertebrae, ribs and sacroiliac joint showed high uptake on the I-131 MIBG scintigraphy. The final diagnosis was nonfunctioning malignant pheochromocytoma due to the absence of elevation of catecholamine or its metabolite.

Teachers’ perceptions of their own initiative: Collective initiative vs. personal initiative

Directory of Open Access Journals (Sweden)

Džinović Vladimir

2013-01-01

Full Text Available Current trends in education demand from teachers to exhibit proactive behaviour and assume responsibility for the implementation of changes in school practice. In that sense, it is important to study how teachers perceive their own initiative and to gain insight into the activities where such initiative is demonstrated. This study has been conceived as a mixed-methods research. The qualitative study implied forming four focus groups with subject teachers and class teachers (N=38, while the quantitative study entailed surveying 1441 teachers in forty primary schools in Serbia using the questionnaire constructed based on qualitative data. Data from focus groups were processed by qualitative thematic analysis, while the questionnaire data were processed by principal component analysis and univariate analysis of variance. The findings of the study have shown that teachers mostly demonstrate initiative through co­operative activities that include planning of joint teaching as well as conducting joint projects within school and with the local community actors. Teachers are least ready to demonstrate personal initiative and the initiative aimed at accomplishing considerable changes in school work. The concluding part includes the recommendations for encouraging teachers’ personal initiative and building organizational culture that would support such initiative. [Projekat Ministarstva nauke Republike Srbije, br. br. 47008: Unapređivanje kvaliteta i dostupnosti obrazovanja u procesima modernizacije Srbije i br. 179034: Od podsticanja inicijative, saradnje i stvaralaštva u obrazovanju do novih uloga i identiteta u društvu

Initial performance of the PIGMI prototype

International Nuclear Information System (INIS)

Stovall, J.E.

1979-01-01

The PIGMI (Pion Generator for Medical Irradiations) program at LASL is an accelerator development program aimed at completing the design of an accelerator suitable for use as a pion generator in a hospital-based radiotherapy program. The major thrust of the program has been the design of a 7 MeV prototype accelerator which emphasizes compactness, economy of construction, and operation and reliability. To achieve these goals the design of the prototype has exploited a number of innovations in proton linac technology. An overview of the program discussing the major innovative features of the prototype is presented. The initial operating experience is discussed and initial performance measurements are presented

Bilateral Acromioclavicular Septic Arthritis as an Initial Presentation of Streptococcus pneumoniae Endocarditis

Directory of Open Access Journals (Sweden)

Neda Hashemi-Sadraei

2014-01-01

Full Text Available Infective endocarditis (IE is infrequently associated with septic arthritis. Moreover, septic arthritis of the acromioclavicular (AC joint is rarely reported in the literature. We report a case of Streptococcus pneumoniae IE in a patient who presented with bilateral AC joint septic arthritis and we review the literature on the topic.

Cosmological constant and general isocurvature initial conditions

International Nuclear Information System (INIS)

Trotta, R.; Riazuelo, A.; Durrer, R.

2003-01-01

We investigate in detail the question of whether a nonvanishing cosmological constant is required by the present-day cosmic microwave background and large scale structure data when general isocurvature initial conditions are taken into account. We also discuss the differences between the usual Bayesian and the frequentist approaches in data analysis. We show that the Cosmic Background Explorer (COBE)-normalized matter power spectrum is dominated by the adiabatic mode and therefore breaks the degeneracy between initial conditions which is present in the cosmic microwave background anisotropies. We find that in a flat universe the Bayesian analysis requires Ω Λ =e0 to more than 3σ, while in the frequentist approach Ω Λ =0 is still within 3σ for a value of h≤0.48. Both conclusions hold regardless of the initial conditions

Systematic Review about Personal Growth Initiative

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Clarissa Pinto Pizarro de Freitas

Full Text Available The present study aimed to realize a systematic review of publications about personal growth initiative. A literature review was realized in Bireme, Index Psi, LILACS, PePSIC, Pubmed - Publisher's Medlme, Wiley Online Library, PsycINFO, OneFile, SciVerse ScienceDirect, ERIC, Emerald Journals, PsycARTICLES - American Psychological Association, Directory of Open Access Journals - DOAJ, SAGE Journals, SpringerLink, PLoS, IngentaConnect, IEEE Journals & Magazines and SciELO databases. The literature review was performed from December of 2014 to January of 2015, without stipulating date limits for the publication of the articles. It was found 53 studies, excluded seven, and analyzed 46 researches. The studies aimed to investigate the psychometric properties of personal growth initiative scale and personal growth initiative scale II. The relations of personal initiative growth and others constructs were also evaluated. Furthermore the studies investigated the impact of interventions to promote personal growth initiative. Results of these studies showed that personal growth initiative was positively related to levels of well-being, selfesteem and others positive dimensions, and negatively to anxiety, depression and others negative factors.

Net present value approaches for drug discovery.

Science.gov (United States)

Svennebring, Andreas M; Wikberg, Jarl Es

2013-12-01

Three dedicated approaches to the calculation of the risk-adjusted net present value (rNPV) in drug discovery projects under different assumptions are suggested. The probability of finding a candidate drug suitable for clinical development and the time to the initiation of the clinical development is assumed to be flexible in contrast to the previously used models. The rNPV of the post-discovery cash flows is calculated as the probability weighted average of the rNPV at each potential time of initiation of clinical development. Practical considerations how to set probability rates, in particular during the initiation and termination of a project is discussed.

Compensatory Self-Presentation in Upward Comparison Situations

Science.gov (United States)

Tyler, James M.

2009-01-01

This article focuses on the communication of compensatory self-presentations (CSP) (i.e., self-presentations that people engage in after publicly receiving unfavorable feedback), with prior work showing that people prudently constrain CSP to areas unrelated (vs. related) to the initial feedback. With the current project we examine the influence…

Initial conditions and entanglement sudden death

International Nuclear Information System (INIS)

Qian, Xiao-Feng; Eberly, J.H.

2012-01-01

We report results bearing on the behavior of non-local decoherence and its potential for being managed or even controlled. The decoherence process known as entanglement sudden death (ESD) can drive prepared entanglement to zero at the same time that local coherences and fidelity remain non-zero. For a generic ESD-susceptible Bell superposition state, we provide rules restricting the occurrence and timing of ESD, amounting to management tools over a continuous variation of initial conditions. These depend on only three parameters: initial purity, entanglement and excitation. Knowledge or control of initial phases is not needed. -- Highlights: ► We study the possibility of managing disentanglement through initial conditions. ► The initial parameters are the amount of entanglement, excitation, and purity. ► Entanglement sudden death (ESD) free and ESD susceptible phases are identified. ► ESD onset time is also presented in the ESD susceptible phase. ► Our results may guide experiments to prepare ESD free or delayed ESD states.

Exo-electrons and initiation of electric discharges

International Nuclear Information System (INIS)

Laube, Sylvain

1992-01-01

As some observations seemed to indicate that glass submitted to an electric field could be a source of electrons, and that any dielectric could play the role, this research thesis aimed at verifying this hypothesis, at least for two industrially used dielectrics (Teflon and Kapton). The author also shows the advantage which could be taken from such an emission, as well in the field of electric discharges as in the field of their applications. Electrons emitted in such conditions are herein called exo-electrons. In a first part, the author analysed the characteristic magnitudes which govern the conditions of discharge initiation, i.e. the initiation voltage and the statistic delay between the application of an electric field and the initiative occurrence. The second part presents the different measurements devices which have been designed, and the third part presents and discusses experimental results, and shows that the theoretical model is in compliance with initiation voltage measurements. As far as electron emission is concerned, a possible explication of this phenomenon is proposed [fr

[Metachromatic Leukodystrophy. Case Presentation].

Science.gov (United States)

Espejo, Lina María; de la Espriella, Ricardo; Hernández, José Fernando

Metachromatic leukodystrophy (MLD) is a rare demyelinating disease (prevalence 1:40 000), also called arylsulfatase A deficiency (ARS-A), which may present with neurological and psychiatric symptoms. Clinical assessment may be difficult, due to unspecific signs and symptoms. A case is presented of a 16 year-old female patient seen in psychiatry due to behavioural changes, psychosis, and with impaired overall performance. She was initially diagnosed with schizophrenia, but the Nuclear Magnetic Resonance (NMR) scan and laboratory tests lead to the diagnosis of MLD. Copyright © 2016 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

Inhomogeneous inflation: The initial-value problem

International Nuclear Information System (INIS)

Laguna, P.; Kurki-Suonio, H.; Matzner, R.A.

1991-01-01

We present a spatially three-dimensional study for solving the initial-value problem in general relativity for inhomogeneous cosmologies. We use York's conformal approach to solve the constraint equations of Einstein's field equations for scalar field sources and find the initial data which will be used in the evolution. This work constitutes the first stage in the development of a code to analyze the effects of matter and spacetime inhomogeneities on inflation

Neurologic Manifestation as Initial Presentation in a Case of Hereditary Haemorrhagic Telangiectasia

Directory of Open Access Journals (Sweden)

Yeow Kwan Teo

2010-01-01

Full Text Available Hereditary Haemorrhagic Telangiectasia (HHT, or Osler-Weber-Rendu syndrome is an uncommon autosomal dominant multi-organ condition of vascular dysplasias. We describe a 19 year old Indian female who presented with cerebral abscess secondary to paradoxical emboli from pulmonary arteriovenous malformations (PAVMs associated with HHT. Cerebral, pulmonary, hepatic and gastrointestinal involvement can be life-threatening and it is important to have lifelong follow-ups on these patients.

Initial state with shear in peripheral heavy ion collisions

Science.gov (United States)

Magas, V. K.; Gordillo, J.; Strottman, D.; Xie, Y. L.; Csernai, L. P.

2018-06-01

In the present work we propose a new way of constructing the initial state for further hydrodynamic simulation of relativistic heavy ion collisions based on Bjorken-like solution applied streak by streak in the transverse plane. Previous fluid dynamical calculations in Cartesian coordinates with an initial state based on a streak by streak Yang-Mills field led for peripheral higher energy collisions to large angular momentum, initial shear flow and significant local vorticity. Recent experiments verified the existence of this vorticity via the resulting polarization of emitted Λ and Λ ¯ particles. At the same time parton cascade models indicated the existence of more compact initial state configurations, which we are going to simulate in our approach. The proposed model satisfies all the conservation laws, including conservation of a strong initial angular momentum, which is present in noncentral collisions. As a consequence of this large initial angular momentum we observe the rotation of the whole system as well as the fluid shear in the initial state, which leads to large flow vorticity. Another advantage of the proposed model is that the initial state can be given in both [t,x,y,z] and [τ ,x ,y ,η ] coordinates and thus can be tested by all 3+1D hydrodynamical codes which exist in the field.

A Knowledge Management Approach to Support Software Process Improvement Implementation Initiatives

Science.gov (United States)

Montoni, Mariano Angel; Cerdeiral, Cristina; Zanetti, David; Cavalcanti da Rocha, Ana Regina

The success of software process improvement (SPI) implementation initiatives depends fundamentally of the strategies adopted to support the execution of such initiatives. Therefore, it is essential to define adequate SPI implementation strategies aiming to facilitate the achievement of organizational business goals and to increase the benefits of process improvements. The objective of this work is to present an approach to support the execution of SPI implementation initiatives. We also describe a methodology applied to capture knowledge related to critical success factors that influence SPI initiatives. This knowledge was used to define effective SPI strategies aiming to increase the success of SPI initiatives coordinated by a specific SPI consultancy organization. This work also presents the functionalities of a set of tools integrated in a process-centered knowledge management environment, named CORE-KM, customized to support the presented approach.

New Internet Business Initiatives in the Context of Change Management

Directory of Open Access Journals (Sweden)

Adam Sofronijević

2015-05-01

Full Text Available The paper presents the changing role of the Internet as a framework of several new business initiatives. In the last five years the Internet has evolved from being just a useful tool to a force shaping business strategies and influencing long-term managerial decision making. The paper presents an analysis of several cutting edge business initiatives and relates the success opportunities they have with evolving features of the Internet. The growth of importance of the Internet stresses the need to evaluate the state of local ICT development and precise data in this area for successful new business initiatives and meaningful change management. The paper presents the importance of such an evaluation for engaging change management that may be the crucial factor for the future of business initiatives in the era of ubiquitous, smart Internet.

Rheumatic polymyalgia like presentation of multiple myeloma and amyloidosis

International Nuclear Information System (INIS)

Medina, Yimy F; Martinez, Jose Bernardo; Restrepo, Jose Felix; Rondon, Federico; Iglesias Gamarra, Antonio

2005-01-01

Polymyalgia rheumatica is a disorder with defined clinical characteristics and may be the initial expression or to be associated to other diseases. Although it is not associated to neoplastic diseases, may be their initial manifestation. We report a patient who presented the initial complaining of polymyalgia rheumatica as a manifestation of another illness, amyloidosis associated to multiple myeloma. We also discuss the clinical characteristics of these entities and revised the available literature with regard to this association

Clinical and radiological features of pandemic H1N1 2009 influenza virus infection manifesting as acute febrile respiratory illness at their initial presentations: comparison with contemporaneous non-H1N1 patients

International Nuclear Information System (INIS)

Yun, Tae Jin; Park, Chang Min; Choi, Seung Hong; Lee, Hyun Ju; Goo, Jin Mo; Kwon, Gu Jin; Woo, Sung Koo; Park, Seung Hoon

2011-01-01

Background Since the first outbreak caused by the pandemic H1N1 2009 influenza in Mexico, the virus has spread widely across the world with meaningful morbidity and mortality. However, there are few data on the comparative investigations to assess the clinical and radiological features between the H1N1 patient and non-H1N1 patients. Purpose To assess the clinical and radiological features of patients infected by the pandemic H1N1 2009 flu virus at their initial presentation and to compare them with contemporaneous non-H1N1 patients with acute febrile respiratory illness. Material and Methods This retrospective study was approved by the ethics committee of the Armed Forces Medical Command, South Korea. From August to September 2009, 337 consecutive patients presented with an acute febrile respiratory illness in a tertiary military hospital. Reverse-transcriptase polymerase-chain-reaction tests were performed in 62 of these patients under the impression of H1N1 infection. Clinical and radiological features at their initial presentation were described for the H1N1 group (n = 35) and non-H1N1 group (n = 27) and compared between the two groups. Results Increased C-reactive protein level (97%) without leukocytosis (9%) or increased erythrocyte sedimentation rate (0%) was common in the H1N1 group at their initial presentation. On chest radiographs, 12 of 35 (34%) H1N1 patients had abnormal findings; nodules in 10 patients (83%) and consolidations in two (17%). Of the 28 H1N1 patients who underwent thin-section CT 16 patients (57%) showed abnormal findings; ground-glass opacities (GGOs) in 15 (94%), and nodules in 13 (81%). However, there were no significant differences between the H1N1 group and non-H1N1 group in terms of symptoms, laboratory results, or radiological findings (P > 0.05). Conclusion Patients with H1N1 infection show consistent clinical and radiological features at their initial presentation, however, clinical and radiological features of the H1N1 group are

Clinical and radiological features of pandemic H1N1 2009 influenza virus infection manifesting as acute febrile respiratory illness at their initial presentations: comparison with contemporaneous non-H1N1 patients

Energy Technology Data Exchange (ETDEWEB)

Yun, Tae Jin (Dept. of Radiology, Armed Force Byukjae Hospital, Gyeonggi-do (Korea, Republic of); Dept. of Radiology, Seoul National Univ. Hospital, Seoul (Korea, Republic of)); Park, Chang Min; Choi, Seung Hong; Lee, Hyun Ju; Goo, Jin Mo (Dept. of Radiology, Seoul National Univ. Hospital, Seoul (Korea, Republic of)), email: cmpark@radiol.snu.ac.kr; Kwon, Gu Jin (Dept. of Family Medicine, Armed Force Byukjae Hospital, Gyeonggi-do (Korea, Republic of); Dept. of Family Medicine, Gangneung Asan Hospital, Gangneung (Korea, Republic of)); Woo, Sung Koo (Dept. of Radiology, Armed Force Byukjae Hospital, Gyeonggi-do (Korea, Republic of)); Park, Seung Hoon (Dept. of Internal Medicine, Armed Force Byukjae Hospital, Gyeonggi-do (Korea, Republic of))

2011-05-15

Background Since the first outbreak caused by the pandemic H1N1 2009 influenza in Mexico, the virus has spread widely across the world with meaningful morbidity and mortality. However, there are few data on the comparative investigations to assess the clinical and radiological features between the H1N1 patient and non-H1N1 patients. Purpose To assess the clinical and radiological features of patients infected by the pandemic H1N1 2009 flu virus at their initial presentation and to compare them with contemporaneous non-H1N1 patients with acute febrile respiratory illness. Material and Methods This retrospective study was approved by the ethics committee of the Armed Forces Medical Command, South Korea. From August to September 2009, 337 consecutive patients presented with an acute febrile respiratory illness in a tertiary military hospital. Reverse-transcriptase polymerase-chain-reaction tests were performed in 62 of these patients under the impression of H1N1 infection. Clinical and radiological features at their initial presentation were described for the H1N1 group (n = 35) and non-H1N1 group (n = 27) and compared between the two groups. Results Increased C-reactive protein level (97%) without leukocytosis (9%) or increased erythrocyte sedimentation rate (0%) was common in the H1N1 group at their initial presentation. On chest radiographs, 12 of 35 (34%) H1N1 patients had abnormal findings; nodules in 10 patients (83%) and consolidations in two (17%). Of the 28 H1N1 patients who underwent thin-section CT 16 patients (57%) showed abnormal findings; ground-glass opacities (GGOs) in 15 (94%), and nodules in 13 (81%). However, there were no significant differences between the H1N1 group and non-H1N1 group in terms of symptoms, laboratory results, or radiological findings (P > 0.05). Conclusion Patients with H1N1 infection show consistent clinical and radiological features at their initial presentation, however, clinical and radiological features of the H1N1 group are

Hydrocephalus: a rare initial manifestation of sporadic intramedullary hemangioblastoma : Intramedullary hemangioblastoma presenting as hydrocephalus.

Science.gov (United States)

Morais, Barbara Albuquerque; Cardeal, Daniel Dante; Ribeiro E Ribeiro, Renan; Frassetto, Fernando Pereira; Andrade, Fernanda Goncalves; Matushita, Hamilton; Teixeira, Manoel Jacobsen

2017-08-01

Intramedullary hemangioblastomas are rare benign vascular tumors, infrequent in pediatric patients. Clinical symptoms vary according to the age of presentation, tumor size, location, and concomitant syringomyelia. This is the second reported case of hemangioblastoma presenting with acute hydrocephalus. A 3-month-old infant with acute hydrocephalus was asymptomatic after a ventriculoperitoneal shunt was placed. She returned 3 months later with irritability, acute paraplegia, and respiratory distress. Magnetic resonance imaging (MRI) showed an intramedullary T8-T9 tumor with syringomyelia. She underwent surgical resection with good results during the 6-month follow-up. Intramedullary tumors may present as hydrocephalus and other nonspecific symptoms, with invariably delayed diagnosis in children, but must be considered in suspicious cases.

PREGO (presentation of Graves' orbitopathy) study

DEFF Research Database (Denmark)

Perros, Petros; Žarković, Miloš; Azzolini, Claudio

2015-01-01

BACKGROUND/AIMS: The epidemiology of Graves' orbitopathy (GO) may be changing. The aim of the study was to identify trends in presentation of GO to tertiary centres and initial management over time. METHODS: Prospective observational study of European Group On Graves' Orbitopathy (EUGOGO) centres...

Initiation of Swarming Motility by Proteus mirabilis Occurs in Response to Specific Cues Present in Urine and Requires Excess l-Glutamine

Science.gov (United States)

Armbruster, Chelsie E.; Hodges, Steven A.

2013-01-01

Proteus mirabilis, a leading cause of catheter-associated urinary tract infection (CaUTI), differentiates into swarm cells that migrate across catheter surfaces and medium solidified with 1.5% agar. While many genes and nutrient requirements involved in the swarming process have been identified, few studies have addressed the signals that promote initiation of swarming following initial contact with a surface. In this study, we show that P. mirabilis CaUTI isolates initiate swarming in response to specific nutrients and environmental cues. Thirty-three compounds, including amino acids, polyamines, fatty acids, and tricarboxylic acid (TCA) cycle intermediates, were tested for the ability to promote swarming when added to normally nonpermissive media. l-Arginine, l-glutamine, dl-histidine, malate, and dl-ornithine promoted swarming on several types of media without enhancing swimming motility or growth rate. Testing of isogenic mutants revealed that swarming in response to the cues required putrescine biosynthesis and pathways involved in amino acid metabolism. Furthermore, excess glutamine was found to be a strict requirement for swarming on normal swarm agar in addition to being a swarming cue under normally nonpermissive conditions. We thus conclude that initiation of swarming occurs in response to specific cues and that manipulating concentrations of key nutrient cues can signal whether or not a particular environment is permissive for swarming. PMID:23316040

INITIAL TRAINING OF RESEARCHERS

Directory of Open Access Journals (Sweden)

Karina Alejandra Cruz-Pallares

2015-07-01

Full Text Available The document presents results of a research that used as strategy a complementary training project with thirty-three students of a Bachelors Degree in Primary School 1997(DPS,1997 of an Education Faculty for the initial training of investigators, applied by four teachers members of the academic research group in Mexico; that develops through process of action research methodology. Highlighted in results is the strengthening of the competition of reading, understanding and writing scientific texts, which is analogous to the first feature of the graduate profile called intellectual skills. Among the conclusions it is emphasized that the initial training of teachers in a task that is quite interesting, challenging and complex, as is the educational complex phenomenon.

Workshop presentations

International Nuclear Information System (INIS)

Sanden, Per-Olof; Edland, Anne; Reiersen, Craig; Mullins, Peter; Ingemarsson, Karl-Fredrik; Bouchard, Andre; Watts, Germaine; Johnstone, John; Hollnagel, Erik; Ramberg, Patric; Reiman, Teemu

2009-01-01

An important part of the workshop was a series of invited presentations. The presentations were intended to both provide the participants with an understanding of various organisational approaches and activities as well as to stimulate the exchange of ideas during the small group discussion sessions. The presentation subjects ranged from current organisational regulations and licensee activities to new organisational research and the benefits of viewing organisations from a different perspective. There were more than a dozen invited presentations. The initial set of presentations gave the participants an overview of the background, structure, and aims of the workshop. This included a short presentation on the results from the regulatory responses to the pre-workshop survey. Representatives from four countries (Sweden, Canada, Finland, and the United Kingdom) expanded upon their survey responses with detailed presentations on both regulatory and licensee safety-related organisational activities in their countries. There were also presentations on new research concerning how to evaluate safety critical organisations and on a resilience engineering perspective to safety critical organisations. Below is the list of the presentations, the slides of which being available in Appendix 2: 1 - Workshop Welcome (Per-Olof Sanden); 2 - CSNI Working Group on Human and Organisational Factors (Craig Reiersen); 3 - Regulatory expectations on justification of suitability of licensee organisational structures, resources and competencies (Anne Edland); 4 - Justifying the suitability of licensee organisational structures, resources and competencies (Karl-Fredrik Ingemarsson); 5 - Nuclear Organisational Suitability in Canada (Andre Bouchard); 6 - Designing and Resourcing for Safety and Effectiveness (Germaine Watts); 7 - Organisational Suitability - What do you need and how do you know that you've got it? (Craig Reiersen); 8 - Suitability of Organisations - UK Regulator's View (Peter

First-episode psychosis as the initial presentation of multiple sclerosis: a case report.

Science.gov (United States)

Enderami, Athena; Fouladi, Rose; Hosseini, Seyed Hamzeh

2018-01-01

Multiple sclerosis (MS) is an inflammatory disease that affects the central nervous system (CNS). MS with episode of psychosis is a rare entity, and to the best of our knowledge, no case has been reported from Iran till date. We report a case of MS with first-episode psychosis in a 27-year-old single man with no history of psychiatric disorder or drug abuse. The patient developed neurological symptoms after 3 months and was finally diagnosed as a case of MS. His symptoms started with behavioral dysfunctions and progressively resulted in depression. Subsequently, treatment was performed with citalopram 20 mg daily, risperidone 2 mg three times a day, and biperiden 2 mg three times a day; however, no improvements in the symptoms were observed. T2-weighted magnetic resonance imaging has demonstrated periventricular and white matter multiple sclerotic plugs with lesions. Eventually, MS was diagnosed after the appearance of paresthesia, upper and lower limb muscle weakness, ataxia, and urinary incontinency as typical signs. Then, the medications were changed to methylprednisolone and interferon therapy, which resulted in improvements in the clinical conditions of the patient. Based on the fact that organic disorders such as MS may sometimes appear with initial pure psychiatric symptoms without any neurological signs and symptoms, examinations for symptoms linked to CNS dysfunction, cognitive changes, atypical symptoms, detailed neurological examination, and limited response to conventional antipsychotic drugs are highly recommended to be carried out for patients with first-episode psychosis and even in the followup period.

Initiation of Meiotic Recombination in Mammals

Directory of Open Access Journals (Sweden)

Rajeev Kumar

2010-12-01

Full Text Available Meiotic recombination is initiated by the induction of programmed DNA double strand breaks (DSBs. DSB repair promotes homologous interactions and pairing and leads to the formation of crossovers (COs, which are required for the proper reductional segregation at the first meiotic division. In mammals, several hundred DSBs are generated at the beginning of meiotic prophase by the catalytic activity of SPO11. Currently it is not well understood how the frequency and timing of DSB formation and their localization are regulated. Several approaches in humans and mice have provided an extensive description of the localization of initiation events based on CO mapping, leading to the identification and characterization of preferred sites (hotspots of initiation. This review presents the current knowledge about the proteins known to be involved in this process, the sites where initiation takes place, and the factors that control hotspot localization.

Influence of initial stress, irregularity and heterogeneity on Love-type ...

Indian Academy of Sciences (India)

The present paper deals with the propagation of Love-type wave in an initially stressed irregular vertically heterogeneous layer lying over an initially stressed isotropic layer and an initially stressed isotropic half- space. Two different types of irregularities, viz., rectangular and parabolic, are considered at the interface.

Teachers’ assessments of demonstration of student initiative

Directory of Open Access Journals (Sweden)

Komlenović Đurđica

2012-01-01

Full Text Available This paper explores student initiative or student engagement in activities in school environment, as an aspect of students’ functioning that is assumed to be a prerequisite for their contribution to the quality of instruction and better use of possibilities for education and development in school environment. We approach this topic from teachers’ perspective since it is our aim to observe how teachers assess the initiative of their students (how important it is, how it is manifested, how present it is in different segments of school activities. In the first part of the paper we analyze the construct “student initiative” and a similar construct “student engagement”. In the second part of the paper we present the results of a research in which primary school teachers (N=182 from the territory of Serbia expressed their views on student initiative. Teachers’ answers to open- and close-ended questions from the questionnaire (19 items in total were processed by quantitative and qualitative methodology. Research results indicate that the majority of teachers believed that student initiative was a very important general feature of behavior in school environment, independent of age, which was most present in the domain of peer socializing and relationship with teachers, and least present in the very domains of student functioning that teachers deemed the most desirable (mastering the curriculum, regulation of disciplinary issues. [Projekat Ministarstva nauke Republike Srbije, br. 179034: Od podsticanja inicijative, saradnje, stvaralaštva u obrazovanju do novih uloga i identiteta u društvu i br. 47008: Unapređivanje kvaliteta i dostupnosti obrazovanja u procesima modernizacije Srbije

Initial response of a rock penetrator

International Nuclear Information System (INIS)

Longcope, D.B.; Grady, D.E.

1977-12-01

An analysis based on elastic rod theory is given for the early-time axisymmetric response of pointed penetrators. Results of measurements by laser interferometry of the back surface particle velocity of laboratory scale penetrators impacted by sandstone targets are presented. Values of the initial pressure on the penetrator tip are determined which give good agreement between the analytical and experimental results. These initial tip pressures are found to be approximated by the stress-particle velocity Hugoniot for the target material

Funding Initiatives | Women in Science | Initiatives | Indian Academy ...

Indian Academy of Sciences (India)

Home; Initiatives; Women in Science; Funding Initiatives ... The Fellowship Scheme for Women Scientists for societal programmes is initiative of the ... at a young age of 52, after a valiant battle with cancer, today on 29th March 2016 in Delhi.

[Nineteen cases of school-aged children with degenerative or metabolic neurological disorders initially presenting with learning difficulty and/or behavior disturbance].

Science.gov (United States)

Honzawa, Shiho; Sugai, Kenji; Akaike, Hiroto; Nakayama, Tojo; Fujikawa, Yoshinao; Komaki, Hirofumi; Nakagawa, Eiji; Sasaki, Masayuki

2012-07-01

We reported 19 cases of school-aged children. They were initially judged to have learning difficulty or school maladaptation because of attention deficits, hyperactive behaviors or poor school performance, followed by the diagnosis such as degenerative or metabolic neurological diseases. The patients consisted of 4 cases of adrenoleukodystrophy, 5 cases of dentatorubral-pallidoluysian atrophy, 3 cases of Sanfilippo syndrome, 3 cases of subacute sclerosing panencephalitis, and each one case of juvenile Gaucher disease, juvenile Huntington disease, juvenile metachromatic leukodystrophy and Leigh disease. They had markedly poor school performance, and/or abnormal behaviors, followed by seizures, character disorders or psychomotor regression. The diagnostic clues included brain CT scan and/or MRI, peculiar facial appearance and notable family histories. When the children were indicated to have learning difficulty or maladjustment to school life, we should make deliberate differential diagnoses before concluding that they have a learning disorder and/or attention-deficit/hyperactivity disorder. Instead they should be recommended to visit child neurologists, when they present with any problems as aforesaid.

Bone metastases from initially unknown origin as unusual presentation of thyroid cancer

International Nuclear Information System (INIS)

Sabate, M.I.; Guerra, J.; Parizzia, W.; Venditti, J.; Negueruela, M.C.; Etchegoyen, F.; Quiros, M.C.; Zarlenga, C.; Martinez, J.

2006-01-01

The insular carcinoma of thyroid gland is a poorly frequent neoplasm, slightly differentiated and of clinical aggressive course. The bone metastasis unique as a form of presentation in absence of regional ganglions compromise or another metastasis localization is very unusual. The local invasion, regional ganglions and metastases at a distance (lung and bone) are the usual conduct. It is of interesting to highlight the importance of the immunoreactivity for Tg (thyroglobulin) to tackle the diagnosis, like also the considerable absorption with Tc 99m -MDP, I 131 and Tc 99m -MIBI by the tissue of the metastasis [es

Dark-bellied Brent Geese Branta bernicla bernicla forego breeding when Arctic Foxes Alopex lagopus are present during nest initiation

NARCIS (Netherlands)

Spaans, B.; Blijleven, H.J.; Popov, I.U.; Rykhlikova, M.E.; Ebbinge, B.S.

1998-01-01

In an area north of the Pyasina delta in Taimyr (Russia), nest distribution, nest initiation and breeding success of Brent Geese Branta bernicla bernicla were studied in six successive summer seasons from 1990-1995 in relation to lemming and Arctic Fox Alopex lagopus abundance. Lemming abundance

Chronic Prurigo: An Unusual Presentation of Hodgkin Lymphoma

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Shireen Dumont

2018-05-01

Full Text Available Background: Prurigo nodularis is a condition of unknown origin defined by papulonodular eruption and intense pruritus. Hodgkin lymphoma often presents nonspecific initial symptoms. An association between systemic malignancy and cutaneous manifestations has long been documented. We report a case of prurigo nodularis as a first presentation of Hodgkin lymphoma. Case: A 35-year-old woman presented with a 2-year history of pruritus. Previously diagnosed with bedbugs, the pruritus persisted even after insect eradication, with the appearance of papulonodular lesions consistent with chronic prurigo. The pruritus and the pain were refractory to all treatments. She had no past medical history or clinical, radiological, or laboratory findings. A lymphadenopathy was revealed 2 years after onset of the symptoms. Lymph node biopsy showed a nodular sclerosis Hodgkin lymphoma. The patient was initiated on chemotherapy and the skin lesions decreased. Conclusion: This case report of chronic prurigo as the first manifestation of a systemic malignancy reminds us of the importance of a systematic diagnostic approach to this kind of patients initially and throughout time, especially if the symptoms do not respond to treatment. Our case may question the role of imaging examinations in the management and follow-up of a persistent prurigo nodularis.

E-Business Initiatives in Indonesian Manufacturing SMEs

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Singgih Saptadi

2014-01-01

Full Text Available The role of information technology (IT in improving companies’ competitiveness, including small and medium enterprises (SMEs, has been widely accepted. But, the IT investment will be in vain, if SMEs do not align their business and IT. There is a need to develop a framework of business-IT alignment. The framework development requires an understanding of the patterns of IT implementation in supporting SMEs’ business (e-business initiatives. This paper presents an empirical study on e-business initiatives in Indonesian manufacturing SMEs. The study uses 41 business processes that are grouped into three business focuses: supplier side, internal side and customer side. Based on the complexity of IT support to business processes, supplier side score, internal side score, customer side score and global score can be calculated. These scores are used to develop e-business initiative groups by using cluster analysis. After validated using discriminant analysis, the cluster analysis gives five e-business initiatives. First initiative is e-business implementation in three sides of business focuses, although in the early stage. Second initiative is IT implementation with internal side focus. Third initiative is e-business with customer side focus. The fourth is initiative that focuses on internal and customer side. The last is e-business initiative that balances and extends IT implementation on the three sides of business focuses. Then, this paper explains the differences between e-business initiatives.

An Endotoxin Tolerance Signature Predicts Sepsis and Organ Dysfunction at Initial Clinical Presentation

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Olga M. Pena

2014-11-01

Interpretation: Our data support an updated model of sepsis pathogenesis in which endotoxin tolerance-mediated immune dysfunction (cellular reprogramming is present throughout the clinical course of disease and related to disease severity. Thus endotoxin tolerance might offer new insights guiding the development of new therapies and diagnostics for early sepsis.

Contrast-enhanced [18F] fluorodeoxyglucose-positron emission tomography-computed tomography as an initial imaging modality in patients presenting with metastatic malignancy of undefined primary origin

International Nuclear Information System (INIS)

Jain, Avani; Srivastava, Madhur Kumar; Pawaskar, Alok Suresh; Shelley, Simon; Elangovan, Indirani; Jain, Hasmukh; Pandey, Somnath; Kalal, Shilpa; Amalachandran, Jaykanth

2005-01-01

To evaluate the advantages of contrast enhanced F-18-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-contrast enhanced CT [CECT]) when used as an initial imaging modality in patients presenting with metastatic malignancy of undefined primary origin (MUO). A total of 243 patients with fine needle aspiration cytology/biopsy proven MUO were included in this prospective study. Patients who were thoroughly evaluated for primary or primary tumor was detected by any other investigation were excluded from the analysis. Totally, 163 patients with pathological diagnosis of malignancy but no apparent sites of the primary tumor were finally selected for analysis. The site of probable primary malignancy suggested by PET-CECT was confirmed by biopsy/follow-up. PET-CECT suggested probable site of primary in 128/163 (78.52%) patients. In 30/35 remaining patients, primary tumor was not detected even after extensive work-up. In 5 patients, where PET-CECT was negative, primary was found on further extensive investigations or follow-up. The sensitivity, specificity, positive predictive value and negative predictive value of the study were 95.76%, 66.67%, 88.28% and 85.71% respectively. F-18 FDG PET-CECT aptly serves the purpose of initial imaging modality owing to high sensitivity, negative and positive predictive value. PET-CECT not only surveys the whole body for the primary malignancy but also stages the disease accurately. Use of contrast improves the diagnostic utility of modality as well as help in staging of the primary tumor. Although benefits of using PET-CECT as initial diagnostic modality are obvious from this study, there is a need for a larger study comparing conventional methods for diagnosing primary in patients with MUO versus PET-CECT

Contrast-enhanced [18F] fluorodeoxyglucose-positron emission tomography-computed tomography as an initial imaging modality in patients presenting with metastatic malignancy of undefined primary origin.

Science.gov (United States)

Jain, Avani; Srivastava, Madhur Kumar; Pawaskar, Alok Suresh; Shelley, Simon; Elangovan, Indirani; Jain, Hasmukh; Pandey, Somnath; Kalal, Shilpa; Amalachandran, Jaykanth

2015-01-01

To evaluate the advantages of contrast enhanced F-18-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-contrast enhanced CT [CECT]) when used as an initial imaging modality in patients presenting with metastatic malignancy of undefined primary origin (MUO). A total of 243 patients with fine needle aspiration cytology/biopsy proven MUO were included in this prospective study. Patients who were thoroughly evaluated for primary or primary tumor was detected by any other investigation were excluded from the analysis. Totally, 163 patients with pathological diagnosis of malignancy but no apparent sites of the primary tumor were finally selected for analysis. The site of probable primary malignancy suggested by PET-CECT was confirmed by biopsy/follow-up. PET-CECT suggested probable site of primary in 128/163 (78.52%) patients. In 30/35 remaining patients, primary tumor was not detected even after extensive work-up. In 5 patients, where PET-CECT was negative, primary was found on further extensive investigations or follow-up. The sensitivity, specificity, positive predictive value and negative predictive value of the study were 95.76%, 66.67%, 88.28% and 85.71% respectively. F-18 FDG PET-CECT aptly serves the purpose of initial imaging modality owing to high sensitivity, negative and positive predictive value. PET-CECT not only surveys the whole body for the primary malignancy but also stages the disease accurately. Use of contrast improves the diagnostic utility of modality as well as help in staging of the primary tumor. Although benefits of using PET-CECT as initial diagnostic modality are obvious from this study, there is a need for a larger study comparing conventional methods for diagnosing primary in patients with MUO versus PET-CECT.

Design, production and initial state of the canister

International Nuclear Information System (INIS)

Cederqvist, Lars; Johansson, Magnus; Leskinen, Nina; Ronneteg, Ulf

2010-12-01

The report is included in a set of Production reports, presenting how the KBS-3 repository is designed, produced and inspected. The set of reports is included in the safety report for the KBS-3 repository and repository facility.The report provides input on the initial state of the canisters to the assessment of the long-term safety, SR-Site. The initial state refers to the properties of the engineered barriers once they have been finally placed in the KBS-3 repository and will not be further handled within the repository facility. In addition, the report provides input to the operational safety report, SR-Operation, on how the canisters shall be handled and disposed. The report presents the design premises and reference design of the canister and verifies the conformity of the reference design to the design premises. The production methods and the ability to produce canisters according to the reference design are described. Finally, the initial state of the canisters and their conformity to the reference design and design premises are presented

Design, production and initial state of the canister

Energy Technology Data Exchange (ETDEWEB)

Cederqvist, Lars; Johansson, Magnus; Leskinen, Nina; Ronneteg, Ulf

2010-12-15

The report is included in a set of Production reports, presenting how the KBS-3 repository is designed, produced and inspected. The set of reports is included in the safety report for the KBS-3 repository and repository facility.The report provides input on the initial state of the canisters to the assessment of the long-term safety, SR-Site. The initial state refers to the properties of the engineered barriers once they have been finally placed in the KBS-3 repository and will not be further handled within the repository facility. In addition, the report provides input to the operational safety report, SR-Operation, on how the canisters shall be handled and disposed. The report presents the design premises and reference design of the canister and verifies the conformity of the reference design to the design premises. The production methods and the ability to produce canisters according to the reference design are described. Finally, the initial state of the canisters and their conformity to the reference design and design premises are presented

Design, production and initial state of the closure

International Nuclear Information System (INIS)

2010-12-01

The report is included in a set of Production reports, presenting how the KBS-3 repository is designed, produced and inspected. The production reports are included in the safety report for the KBS-3 repository and repository facility. The report provides input on the initial state of the closure and plugs in underground openings other than deposition tunnels for the assessment of the long-term safety, SR-Site. The initial state refers to the properties of the engineered barriers once they have been finally placed in the KBS-3 repository and will not be further handled within the repository facility. In addition, the report provides some input to the operational safety report, SR-Operation, on how the closure and plugs shall be handled and installed. The report presents the design premises and reference designs of the closure and plugs and verifies their conformity to the design premises. It also briefly deals with the production of the closure and plugs. Finally, the initial state of the closure and plugs and their conformity to the reference designs and design premises are presented

Design, production and initial state of the closure

Energy Technology Data Exchange (ETDEWEB)

2010-12-15

The report is included in a set of Production reports, presenting how the KBS-3 repository is designed, produced and inspected. The production reports are included in the safety report for the KBS-3 repository and repository facility. The report provides input on the initial state of the closure and plugs in underground openings other than deposition tunnels for the assessment of the long-term safety, SR-Site. The initial state refers to the properties of the engineered barriers once they have been finally placed in the KBS-3 repository and will not be further handled within the repository facility. In addition, the report provides some input to the operational safety report, SR-Operation, on how the closure and plugs shall be handled and installed. The report presents the design premises and reference designs of the closure and plugs and verifies their conformity to the design premises. It also briefly deals with the production of the closure and plugs. Finally, the initial state of the closure and plugs and their conformity to the reference designs and design premises are presented

Design, production and initial state of the buffer

Energy Technology Data Exchange (ETDEWEB)

Boerjesson, Lennart; Gunnarsson, David; Johannesson, Lars-Erik; Jonsson, Esther

2010-12-15

The report is included in a set of Production reports, presenting how the KBS-3 repository is designed, produced and inspected. The set of reports is included in the safety report for the KBS-3 repository and repository facility. The report provides input on the initial state of the buffer for the assessment of the long-term safety, SR-Site. The initial state refers to the properties of the engineered barriers once they have been finally placed in the KBS-3 repository and will not be further handled within the repository facility. In addition, the report provides input to the operational safety report, SR-Operation, on how the buffer shall be handled and installed. The report presents the design premises and reference design of the buffer and verifies the conformity of the reference design to the design premises. It also describes the production of the buffer, from excavation and delivery of buffer material to installation in the deposition hole. Finally, the initial state of the buffer and its conformity to the reference design and design premises is presented

The Myth of Peer Influence in Adolescent Smoking Initiation

Science.gov (United States)

Arnett, Jeffrey Jensen

2007-01-01

The widespread belief that peer influence is the primary cause of adolescent smoking initiation is examined and called into question. Correlational and longitudinal studies purporting to demonstrate peer influence are analyzed, and their limitations described. Qualitative interview studies of adolescent smoking initiation are presented as…

A Case of Sporadic Creutzfeldt-Jakob Disease Presenting as Conversion Disorder.

Science.gov (United States)

Yegya-Raman, Nikhil; Aziz, Rehan; Schneider, Daniel; Tobia, Anthony; Leitch, Megan; Nwobi, Onyi

2017-01-01

Background . Creutzfeldt-Jakob disease is a rare disorder of the central nervous system. Its initial diagnosis may be obscured by its variable presentation. This case report illustrates the complexity of diagnosing this disease early in the clinical course, especially when the initial symptoms may be psychiatric. It offers a brief review of the literature and reinforces a role for consultation psychiatry services. Methods . PUBMED/MEDLINE was searched using the terms "Creutzfeldt-Jakob disease", "psychiatric symptoms", "conversion disorder", "somatic symptom disorder", "functional movement disorder", and "functional neurologic disorder". Case . The patient was a 64-year-old woman with no prior psychiatric history who was initially diagnosed with conversion disorder and unspecified anxiety disorder but soon thereafter was discovered to have Creutzfeldt-Jakob disease. Discussion . This case highlights the central role of psychiatric symptoms in early presentations of Creutzfeldt-Jakob disease. Still, few other cases in the literature report functional neurological symptoms as an initial sign. The consultation psychiatrist must remain alert to changing clinical symptoms, especially with uncharacteristic disease presentations.

Initialization methods and ensembles generation for the IPSL GCM

Science.gov (United States)

Labetoulle, Sonia; Mignot, Juliette; Guilyardi, Eric; Denvil, Sébastien; Masson, Sébastien

2010-05-01

The protocol used and developments made for decadal and seasonal predictability studies at IPSL (Paris, France) are presented. The strategy chosen is to initialize the IPSL-CM5 (NEMO ocean and LMDZ atmosphere) model only at the ocean-atmosphere interface, following the guidance and expertise gained from ocean-only NEMO experiments. Two novel approaches are presented for initializing the coupled system. First, a nudging of sea surface temperature and wind stress towards available reanalysis is made with the surface salinity climatologically restored. Second, the heat, salt and momentum fluxes received by the ocean model are computed as a linear combination of the fluxes computed by the atmospheric model and by a CORE-style bulk formulation using up-to-date reanalysis. The steps that led to these choices are presented, as well as a description of the code adaptation and a comparison of the computational cost of both methods. The strategy for the generation of ensembles at the end of the initialization phase is also presented. We show how the technical environment of IPSL-CM5 (LibIGCM) was modified to achieve these goals.

Design, construction and initial state of the underground openings

International Nuclear Information System (INIS)

2010-12-01

The report is included in a set of Production reports, presenting how the KBS-3 repository is designed, produced and inspected. The set of reports is included in the safety report for the KBS-3 repository and repository facility. The report provides input on the initial state of the underground openings for the assessment of the long-term safety, SR-Site. The initial state refers to the properties of the underground openings at final disposal, backfilling or closure. In addition, the report provides input to the operational safety report, SR-Operation, on how the underground openings shall be constructed and inspected. The report presents the design premises and the methodology applied to design the underground openings and adapt them the to the site conditions so that they conform to the design premises. It presents the reference design at Forsmark and its conformity to the design premises. It also describes the reference methods to be applied to construct and inspect the different kinds of underground openings. Finally, the initial state of the underground openings and its conformity to the design premises is presented

Design, construction and initial state of the underground openings

Energy Technology Data Exchange (ETDEWEB)

2010-12-15

The report is included in a set of Production reports, presenting how the KBS-3 repository is designed, produced and inspected. The set of reports is included in the safety report for the KBS-3 repository and repository facility. The report provides input on the initial state of the underground openings for the assessment of the long-term safety, SR-Site. The initial state refers to the properties of the underground openings at final disposal, backfilling or closure. In addition, the report provides input to the operational safety report, SR-Operation, on how the underground openings shall be constructed and inspected. The report presents the design premises and the methodology applied to design the underground openings and adapt them the to the site conditions so that they conform to the design premises. It presents the reference design at Forsmark and its conformity to the design premises. It also describes the reference methods to be applied to construct and inspect the different kinds of underground openings. Finally, the initial state of the underground openings and its conformity to the design premises is presented

Stroke due to non-bacterial thrombotic endocarditis as initial presentation of breast invasive ductal carcinoma.

Science.gov (United States)

Detremerie, Celine; Timmermans, Frank; De Pauw, Michel; Gheeraert, Peter; Hemelsoet, Dimitri; Toeback, Jonas; Bové, Thierry; Vandecasteele, Els

2017-08-01

We present a case of a 71-year-old woman with recurrent stroke episodes due to non-bacterial thrombotic endocarditis (NBTE) leading to the diagnosis of an early-stage breast carcinoma. NBTE is associated with a variety of inflammatory states, including malignancy. NBTE presents itself with systemic embolization, mostly stroke. Treatment consists of treating the underlying condition and start of systemic anticoagulation therapy. Cardiac surgery is restricted to highly selected cases, since prognosis usually is limited by the neoplasm, which usually is in an advanced stage at time of diagnosis of NBTE. The malignancy usually is diagnosed prior to NBTE. Cases presenting with NBTE leading to the diagnosis of malignancy, however, are rarely reported. To our knowledge, we present the first case leading to the diagnosis of an early-stage breast carcinoma.

Unilateral proptosis as the initial manifestation of malignancy

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K. Rakul Nambiar

2017-09-01

Full Text Available Proptosis, a common sign with a broad differential diagnosis, is defined as anterior displacement and protrusion of one or both orbital globes. Patients can present with varying degrees of chronicity, visual loss and associated symptoms. The etiology of acquired unilateral proptosis is diverse, ranging from benign to life-threatening. The causes of unilateral proptosis include traumatic, vascular, endocrine, inflammatory, infective and malignant. Breast carcinoma is the most common metastatic cause of proptosis; however, proptosis has never been reported as the initial manifestation of breast carcinoma. Our patient presented with unilateral proptosis secondary to an intraorbital lesion and histopathology of orbital lesion was suggestive of metastatic breast adenocarcinoma. She was later diagnosed to have primary breast carcinoma. We present this unusual case of a 56-year-old woman who presented with proptosis as the initial manifestation of a metastatic breast malignancy.

Initial data for N black holes

International Nuclear Information System (INIS)

York, J.W. Jr.

1984-01-01

In the present work I focus attention on the construction of suitably general initial data, with particular attention to some new results that enable consideration of black holes that can possess spin (and electric charge) as well as orbital motion. (orig.)

Gynecomastia as the initial manifestation of hyperthyroidism.

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Gordon, D L; Brown, J L; Emanuele, N V; Hall, L

1997-01-01

To present two new cases of gynecomastia as the initial manifestation of hyperthyroidism. We describe detailed case reports of two men with breast enlargement who were found to have hyperthyroidism, and we review the related literature. Two men sought medical assistance because of unilateral tender gynecomastia. In one of these patients, thyroid, gonadal, and prostate examinations showed normal findings at the time of initial assessment, and symptoms of hyperthyroidism developed later. In our other patient with gynecomastia, other symptoms of hyperthyroidism--for example, nervousness, irritability, palpitations, and fatigue--had been present for a prolonged period but had been considered "normal" by the patient. In both patients, the hyperthyroidism was treated with radioiodine. Breast pain disappeared in both patients, and breast enlargement disappeared in one patient and was decreased in the other patient after euthyroidism was achieved. Review of the literature disclosed only two similar cases. Because of the rarity of gynecomastia as the initial symptom of hyperthyroidism, we believe that thyroid function tests are not indicated in the workup of patients whose major complaint is gynecomastia.

Intraperitoneally placed Foley catheter via verumontanum initially presenting as a bladder rupture.

Science.gov (United States)

Raheem, Omer A; Jeong, Young Beom

2011-09-01

Since urethral Foley catheterization is usually easy and safe, serious complications related to this procedure have been rarely reported. Herein, we describe a case of intraperitoneally placed urethral catheter via verumontanum presenting as intraperitoneal bladder perforation in a chronically debilitated elderly patient. A 82-yr-old male patient was admitted with symptoms of hematuria, lower abdominal pain after traumatic Foley catheterization. The retrograde cystography showed findings of intraperitoneal bladder perforation, but emergency laparotomy with intraoperative urethrocystoscopy revealed a tunnel-like false passage extending from the verumontanum into the rectovesical pouch between the posterior wall of the bladder and the anterior wall of the rectum with no bladder injury. The patient was treated with simple closure of the perforated rectovesical pouch and a placement of suprapubic cystostomy tube.

Atypical initial presentation of Takayasu arteritis as isolated supra-valvular aortic stenosis.

Science.gov (United States)

Kim, Do Yeon; Kim, Hwan Wook

2016-01-19

Among the vascular involvements of Takayasu arteritis, a supra-valvular aortic stenosis has been reported very rarely. We report a case of surgically corrected, supra-valvular aortic stenosis caused by Takayasu arteritis. A 32-year-old female was diagnosed with supra-valvular aortic stenosis by transthoracic echocardiography for the evaluation of cardiac murmur with constitutional symptoms. Under the impression of non-familial sporadic type of supra-valvular aortic stenosis, surgical correction was performed. However, after 1 year from the operation, we could know the cause of her disease through the findings of computed tomographic aortography that Takayasu arteritis was suspected. Takayasu arteritis should be considered in adult female patients presenting supra-valvular aortic stenosis with constitutional symptoms, even if no typical features of vascular involvement.

Next generation initiation techniques

Science.gov (United States)

Warner, Tom; Derber, John; Zupanski, Milija; Cohn, Steve; Verlinde, Hans

1993-01-01

Four-dimensional data assimilation strategies can generally be classified as either current or next generation, depending upon whether they are used operationally or not. Current-generation data-assimilation techniques are those that are presently used routinely in operational-forecasting or research applications. They can be classified into the following categories: intermittent assimilation, Newtonian relaxation, and physical initialization. It should be noted that these techniques are the subject of continued research, and their improvement will parallel the development of next generation techniques described by the other speakers. Next generation assimilation techniques are those that are under development but are not yet used operationally. Most of these procedures are derived from control theory or variational methods and primarily represent continuous assimilation approaches, in which the data and model dynamics are 'fitted' to each other in an optimal way. Another 'next generation' category is the initialization of convective-scale models. Intermittent assimilation systems use an objective analysis to combine all observations within a time window that is centered on the analysis time. Continuous first-generation assimilation systems are usually based on the Newtonian-relaxation or 'nudging' techniques. Physical initialization procedures generally involve the use of standard or nonstandard data to force some physical process in the model during an assimilation period. Under the topic of next-generation assimilation techniques, variational approaches are currently being actively developed. Variational approaches seek to minimize a cost or penalty function which measures a model's fit to observations, background fields and other imposed constraints. Alternatively, the Kalman filter technique, which is also under investigation as a data assimilation procedure for numerical weather prediction, can yield acceptable initial conditions for mesoscale models. The

Clinical presentation and endoscopic features of primary gastric Burkitt lymphoma in childhood, presenting as a protein-losing enteropathy: a case report

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Chieng Jenny Hui Chia

2009-06-01

Full Text Available Abstract Introduction Burkitt lymphoma and B cell lymphomas in childhood may arise in many atypical locations, which on rare occasions can include gastric mucosa. A case of primary gastric Burkitt lymphoma is described in a child presenting as a protein-losing enteropathy, including the direct monitoring of the disease response by sequential endoscopic biopsy and molecular analysis. Case presentation We report a 9-year-old boy who presented with gross oedema, ascites and respiratory distress caused by a protein-losing enteropathy. Initial imaging investigations were non-diagnostic but gastroduodenal endoscopy revealed massive involvement of the gastric mucosa with a primary Burkitt lymphoma. His subsequent clinical progress and disease response were monitored directly by endoscopy and he remains in clinical remission 4 years after initial diagnosis. Conclusions This is the first case report of primary Burkitt lymphoma presenting as a protein-losing enteropathy. The clinical course and progress of the patient were monitored by sequential endoscopic biopsy, histology and molecular analysis by fluorescence in situ hybridisation.

Initial singularity and pure geometric field theories

Science.gov (United States)

Wanas, M. I.; Kamal, Mona M.; Dabash, Tahia F.

2018-01-01

In the present article we use a modified version of the geodesic equation, together with a modified version of the Raychaudhuri equation, to study initial singularities. These modified equations are used to account for the effect of the spin-torsion interaction on the existence of initial singularities in cosmological models. Such models are the results of solutions of the field equations of a class of field theories termed pure geometric. The geometric structure used in this study is an absolute parallelism structure satisfying the cosmological principle. It is shown that the existence of initial singularities is subject to some mathematical (geometric) conditions. The scheme suggested for this study can be easily generalized.

The initiation of environmentally-assisted cracking in semi-elliptical surface cracks

International Nuclear Information System (INIS)

James, L.A.

1997-01-01

A criterion to predict under what conditions EAC would Initiate In cracks In a high-sulfur steel in contact with low-oxygen water was recently proposed by Wire and U. This EAC Initiation Criterion was developed using transient analyses for the diffusion of sulfides plus experimental test results. The experiments were conducted mainly on compact tension-type specimens with initial crack depths of about 2.54 mm. The present paper expands upon the work of Wire and U by presenting results for significantly deeper initial semi-elliptical surface cracks. In addition, in one specimen, the surface crack penetrated weld-deposited cladding into the high-sulfur steel. The results for the semi-elliptical surface cracks agreed quite well with the EAC Initiation Criterion, and provide confirmation of the applicability of the criterion to crack configurations with more restricted access to water

Predicting Schedule Duration for Defense Acquisition Programs: Program Initiation to Initial Operational Capability

Science.gov (United States)

2016-03-24

statistically significant. Variance inflation is a consequence of multicollinearity and the VIF scores are a common way for detecting 43 such a...produced an initial model and we have ascertained there are no issues (and tested that) with respect to multicollinearity (VIF scores), influential...The analysis of this tells us that there is no consequence of multicollinearity present in the preliminary model. By this, there is no linear

Amebiasis Presenting as Pleuropulmonary Disease

OpenAIRE

Kubitschek, Kenneth R.; Peters, Jay; Nickeson, David; Musher, Daniel M.

1985-01-01

Seven patients with amebic liver abscess presenting as pleuropulmonary disease were admitted to hospital initially because of pulmonary symptoms and were found to have amebic liver disease. Three categories of pleuropulmonary involvement included reactive inflammation of the pleura or lung, rupture of a hepatic abscess into the pleural space and rupture of a hepatic abscess into the bronchial airways. The preferred medical treatment is with metronidazole, but rupture of hepatic amebic abscess...

The Trilateral Initiative: The Legal Framework

International Nuclear Information System (INIS)

Rockwood, L.

2015-01-01

The Trilateral Initiative was a six-year effort undertaken by the IAEA, the United States and the Russian Federation between 1996 to 2002 to identify verification arrangements and technologies for IAEA verification of classified forms of Pu and HEU from nuclear warheads or components. As part of that Initiative, between 1999 and 2001, the parties succeeded in negotiating a model agreement for such verification (the Model Agreement). Although the Trilateral Initiative ended in 2002, the Model Agreement produced as a result of those negotiations could still serve as the basis for bilateral agreements between the IAEA and nuclear-weapon States wishing to demonstrate, in a verifiable manner, the release of weapon origin and other fissile material from defence programmes. This presentation will describe the legal framework for the Model Agreement and the major issues addressed during its negotiation

Churg-Strauss syndrome presenting with eosinophilic myocarditis: a diagnostic challenge.

Science.gov (United States)

Correia, Ana Sofia; Gonçalves, Alexandra; Araújo, Vítor; Almeida e Silva, João; Pereira, José Manuel; Rodrigues Pereira, Pedro; Pizarro, Manuel; Silva, João Carlos; Maciel, Maria Júlia

2013-09-01

Churg-Strauss syndrome (CSS) is an unusual disease that presents as systemic vasculitis and peripheral eosinophilia in patients with an atopic constitution. Cardiac involvement is unusual and often not prominent on initial presentation, but is an important cause of morbidity and mortality in patients with CSS. We report the case of a young woman with severe acute myocarditis. Coronary arteriography demonstrated extensive focal vasculopathy, consistent with coronary vasculitis, and myocardial biopsy showed eosinophilic myocarditis. This presentation led to an initial diagnosis of CSS in this patient and appropriate therapy resulted in a spectacular remission of disease activity. Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

Quantum technology past, present, future: quantum energetics (Conference Presentation)

Science.gov (United States)

Choi, Sang H.

2017-04-01

Since the development of quantum physics in the early part of the 1900s, this field of study has made remarkable contributions to our civilization. Some of these advances include lasers, light-emitting diodes (LED), sensors, spectroscopy, quantum dots, quantum gravity and quantum entanglements. In 1998, the NASA Langley Research Center established a quantum technology committee to monitor the progress in this area and initiated research to determine the potential of quantum technology for future NASA missions. The areas of interest in quantum technology at NASA included fundamental quantum-optics materials associated with quantum dots and quantum wells, device-oriented photonic crystals, smart optics, quantum conductors, quantum information and computing, teleportation theorem, and quantum energetics. A brief review of the work performed, the progress made in advancing these technologies, and the potential NASA applications of quantum technology will be presented.

Semiclassical initial value approximation for Green's function.

Science.gov (United States)

Kay, Kenneth G

2010-06-28

A semiclassical initial value approximation is obtained for the energy-dependent Green's function. For a system with f degrees of freedom the Green's function expression has the form of a (2f-1)-dimensional integral over points on the energy surface and an integral over time along classical trajectories initiated from these points. This approximation is derived by requiring an integral ansatz for Green's function to reduce to Gutzwiller's semiclassical formula when the integrations are performed by the stationary phase method. A simpler approximation is also derived involving only an (f-1)-dimensional integral over momentum variables on a Poincare surface and an integral over time. The relationship between the present expressions and an earlier initial value approximation for energy eigenfunctions is explored. Numerical tests for two-dimensional systems indicate that good accuracy can be obtained from the initial value Green's function for calculations of autocorrelation spectra and time-independent wave functions. The relative advantages of initial value approximations for the energy-dependent Green's function and the time-dependent propagator are discussed.

Comparative study of magnetic properties and the anticancer effect of superparamagnetic and ferromagnetic iron oxide nanoparticles in the nanocomplex with doxorubicin

International Nuclear Information System (INIS)

Orel, V.E.; Shevchenko, A.D.; Rikhal's'kij, O.Yu.; Romanov, A.V.; Orel, Yi.V.; Lukyin, S.M.; Burlaka, A.P.; Venger, Je.F.

2015-01-01

Mechano-magneto-chemically synthesized magnetic nanocomplex (MNC) of superparamagnetic iron oxide Fe 3 O 4 nanoparticles (NP) and anticancer drug doxorubicin (DR) had significantly lower saturation magnetic moment and magnetic hysteresis loop area as compared to the MNC of ferro- magnetic NP. However, the last was characterized by lower coercivity. MNC of superparamagnetic NP and DR had g-factors of 2.00, 2.30, and 4.00. MNC of ferromagnetic NP and DR had the g-factor of 2.50, and the integrated intensity of electron spin resonance signals was by 61% greater. Superparamagnetic iron oxide Fe 3 O 4 NP in MNC with DR initiated a greater antitumor effect during magnetic nanotherapy of animals with carcinosarcoma Walker-256 as compared to the MNC composed of ferromagnetic NP and DR. In the future, superparamagnetic iron oxide Fe 3 O 4 NP as a part of the nanocomplex with DR can be used in theranostics - a methodology that combines magnetic resonance diagnostics and magnetic nanotherapy using MNC both as therapeutic and diagnostic agents

From the Northern Eurasia Earth Science Partnership Initiative to the Northern Eurasia Future Initiative

Science.gov (United States)

Streletskiy, D. A.; Groisman, P. Y.; Shugart, H. H., Jr.; Gulev, S.; Maksyutov, S. S.; Qi, J.

2017-12-01

Since 2004, the Northern Eurasia Earth Science Partnership Initiative (NEESPI) - an interdisciplinary program of internationally-supported Earth systems and science research - has addressed large-scale and long-term manifestations of climate and environmental changes over Northern Eurasia and their impact on the Global Earth system. With 40 books and more than 1500 peer-reviewed journal publications to its credit, NEESPI's output can now be used to directly support decision-making for societal needs. Specifically, it was decided to shift gradually the foci of regional studies in Northern Eurasia towards applications with the following major Science Question: "What dynamic and interactive change(s) will affect societal well-being, activities, and health, and what might be the mitigation and adaptation strategies that could support sustainable development and decision-making activities in Northern Eurasia?" To answer this question requires a stronger socio-economic component in the ongoing and future regional studies focused on sustainable societal development under changing climatic and environmental conditions. The NEESPI Research Team has reorganized itself into "Northern Eurasia Future Initiative" (NEFI) and developed a new Science Plan released in June 2016. The Plan underwent a 6-month-long public review and was finalized at the end of 2016. Its description was thereafter split between two review papers: Groisman et al. (2017) and Monier et al. (2017). The first paper describes the Plan rationale and a new set of topical questions. The second paper describes a major modeling approach that will be employed in addressing the "what to do" questions of the NEFI Research (cf., presentation by Monier et al. at this Session). In the current presentation, we outline the new NEFI research foci and present latest NEFI findings including international projects in the Eurasian Arctic, boreal zone, and the Dry Land Belt of Northern Eurasia (cf., also presentations at sister

Peroneal Arteriovenous Fistula and Pseudoaneurysm: An Unusual Presentation

Directory of Open Access Journals (Sweden)

Kevin C. Ching

2014-01-01

Full Text Available Peroneal artery arteriovenous fistulas and pseudoaneurysms are extremely rare with the majority of reported cases due to penetrating, orthopedic, or iatrogenic trauma. Failure to diagnose this unusual vascular pathology may lead to massive hemorrhage or limb threatening ischemia. We report an interesting case of a 14-year-old male who presented with acute musculoskeletal pain of his lower extremity. Initial radiographs were negative. Further imaging workup revealed a peroneal arteriovenous fistula with a large pseudoaneurysm. After initial endovascular intervention was unsuccessful, the vessels were surgically ligated in the operating room. Pathology revealed papillary endothelial hyperplasia consistent with an aneurysm and later genetic testing was consistent with Ehlers-Danlos syndrome Type IV. This case illustrates an unusual cause of acute atraumatic musculoskeletal pain and uncommon presentation of Ehlers-Danlos syndrome.

Brane decay and an initial spacelike singularity.

Science.gov (United States)

Kawai, Shinsuke; Keski-Vakkuri, Esko; Leigh, Robert G; Nowling, Sean

2006-01-27

We present a novel string theory scenario where matter in a spacetime originates from a decaying brane at the origin of time. The decay could be considered as a big-bang-like event at X0=0. The closed string interpretation is a time-dependent spacetime with a semi-infinite time direction, with the initial energy of the brane converted into energy flux from the origin. The open string interpretation can be viewed as a string theoretic nonsingular initial condition.

Policies and Initiatives for Carbon Neutrality in Nordic

DEFF Research Database (Denmark)

Wu, Qiuwei; Møller, Jakob Glarbo; Østergaard, Jacob

2013-01-01

Policies and initiatives promoting carbon neutrality in the Nordic heating and transport systems are presented. The focus within heating systems is the promotion of HPs (heat pumps) while the focus within transport systems is initiatives regarding EVs (electric vehicles). It is found...... for the future heating and transport systems with the ambition of realizing carbon neutrality...... that the conversion to HPs in the Nordic region relies on both private economic and national economic incentives. Initiatives toward carbon neutrality in the transport system are mostly concentrated on research, development and demonstration for deployment of a large number of EVs. All Nordic countries have plans...

Heterogeneous associations between smoking and a wide range of initial presentations of cardiovascular disease in 1937360 people in England: lifetime risks and implications for risk prediction.

Science.gov (United States)

Pujades-Rodriguez, Mar; George, Julie; Shah, Anoop Dinesh; Rapsomaniki, Eleni; Denaxas, Spiros; West, Robert; Smeeth, Liam; Timmis, Adam; Hemingway, Harry

2015-02-01

It is not known how smoking affects the initial presentation of a wide range of chronic and acute cardiovascular diseases (CVDs), nor the extent to which associations are heterogeneous. We estimated the lifetime cumulative incidence of 12 CVD presentations, and examined associations with smoking and smoking cessation. Cohort study of 1.93 million people aged ≥30years, with no history of CVD, in 1997-2010. Individuals were drawn from linked electronic health records in England, covering primary care, hospitalizations, myocardial infarction (MI) registry and cause-specific mortality (the CALIBER programme). During 11.6 million person-years of follow-up, 114859 people had an initial non-fatal or fatal CVD presentation. By age 90 years, current vs never smokers' lifetime risks varied from 0.4% vs 0.2% for subarachnoid haemorrhage (SAH), to 8.9% vs 2.6% for peripheral arterial disease (PAD). Current smoking showed no association with cardiac arrest or sudden cardiac death [hazard ratio (HR)=1.04, 95% confidence interval (CI) 0.91-1.19).The strength of association differed markedly according to disease type: stable angina (HR=1.08, 95% CI 1.01-1.15),transient ischaemic attack (HR=1.41, 95% CI 1.28-1.55), unstable angina (HR=1.54, 95% CI 1.38-1.72), intracerebral haemorrhage (HR=1.61, 95% CI 1.37-1.89), heart failure (HR=1.62, 95% CI 1.47-1.79), ischaemic stroke (HR=1.90, 95% CI 1.72-2.10), MI (HR=2.32, 95% CI 2.20-2.45), SAH (HR= 2.70, 95% CI 2.27-3.21), PAD (HR=5.16, 95% CI 4.80-5.54) and abdominal aortic aneurysm (AAA) (HR=5.18, 95% CI 4.61-5.82). Population-attributable fractions were lower for women than men for unheralded coronary death, ischaemic stroke, PAD and AAA. Ten years after quitting smoking, the risks of PAD, AAA (in men) and unheralded coronary death remained increased (HR=1.36, 1.47 and 2.74, respectively). The heterogeneous associations of smoking with different CVD presentations suggests different underlying mechanisms and have important

Rectal prolapse as initial clinical manifestation of colon cancer.

Science.gov (United States)

Chen, C-W; Hsiao, C-W; Wu, C-C; Jao, S-W

2008-04-01

Rectal prolapse as the initial clinical manifestation of colorectal cancer is uncommon. We describe the case of a 75-year-old woman who was diagnosed as having adenocarcinoma of the sigmoid colon after presenting with complete rectal prolapse. The tumor caused rectosigmoid intussusception and then it prolapsed out through the anus. She underwent rectosigmoidectomy and rectopexy. The postoperative course was uneventful. The relationship between colorectal cancer and rectal prolapse has not been clearly established. This case report describes an unusual presentation of colorectal cancer. It suggests that rectal prolapse can present as the initial symptom of colorectal cancer and may also be a presenting feature of the occult intra-abdominal pathology. The importance of adequate investigation such as colonoscopy should be emphasized in patients who develop a new onset of rectal prolapse.

Openness initiative

Energy Technology Data Exchange (ETDEWEB)

Duncan, S.S. [Los Alamos National Lab., NM (United States)

1995-12-31

Although antinuclear campaigns seem to be effective, public communication and education efforts on low-level radioactive waste have mixed results. Attempts at public information programs on low-level radioactive waste still focus on influencing public opinion. A question then is: {open_quotes}Is it preferable to have a program focus on public education that will empower individuals to make informed decisions rather than trying to influence them in their decisions?{close_quotes} To address this question, a case study with both quantitative and qualitative data will be used. The Ohio Low-Level Radioactive Waste Education Program has a goal to provide people with information they want/need to make their own decisions. The program initiated its efforts by conducting a statewide survey to determine information needed by people and where they turned for that information. This presentation reports data from the survey and then explores the program development process in which programs were designed and presented using the information. Pre and post data from the programs reveal attitude and knowledge shifts.

Openness initiative

International Nuclear Information System (INIS)

Duncan, S.S.

1995-01-01

Although antinuclear campaigns seem to be effective, public communication and education efforts on low-level radioactive waste have mixed results. Attempts at public information programs on low-level radioactive waste still focus on influencing public opinion. A question then is: open-quotes Is it preferable to have a program focus on public education that will empower individuals to make informed decisions rather than trying to influence them in their decisions?close quotes To address this question, a case study with both quantitative and qualitative data will be used. The Ohio Low-Level Radioactive Waste Education Program has a goal to provide people with information they want/need to make their own decisions. The program initiated its efforts by conducting a statewide survey to determine information needed by people and where they turned for that information. This presentation reports data from the survey and then explores the program development process in which programs were designed and presented using the information. Pre and post data from the programs reveal attitude and knowledge shifts

Delayed presentation and diagnosis of metastatic hepatocellular ...

African Journals Online (AJOL)

Hepatocellular carcinoma (HCC) is rarely diagnosed in women of reproductive age. ... an adverse effect on HCC, and that high levels of oestrogen associated with pregnancy may ... A 30-year-old pregnant woman presented at 23 weeks' gestation and was diagnosed as HIV-infected, with anaemia. She was initiated on.

Unilateral proptosis as the initial manifestation of malignancy.

Science.gov (United States)

Rakul Nambiar, K; Ajith, P S; Arjunan, Asha

2017-09-01

Proptosis, a common sign with a broad differential diagnosis, is defined as anterior displacement and protrusion of one or both orbital globes. Patients can present with varying degrees of chronicity, visual loss and associated symptoms. The etiology of acquired unilateral proptosis is diverse, ranging from benign to life-threatening. The causes of unilateral proptosis include traumatic, vascular, endocrine, inflammatory, infective and malignant. Breast carcinoma is the most common metastatic cause of proptosis; however, proptosis has never been reported as the initial manifestation of breast carcinoma. Our patient presented with unilateral proptosis secondary to an intraorbital lesion and histopathology of orbital lesion was suggestive of metastatic breast adenocarcinoma. She was later diagnosed to have primary breast carcinoma. We present this unusual case of a 56-year-old woman who presented with proptosis as the initial manifestation of a metastatic breast malignancy. Copyright © 2017 National Cancer Institute, Cairo University. Production and hosting by Elsevier B.V. All rights reserved.

Celiac crisis presenting with status epilepticus and encephalopathy.

Science.gov (United States)

Hijaz, Nadia M; Bracken, Julia M; Chandratre, Sonal R

2014-12-01

Celiac crisis is a life-threatening presentation of celiac disease which is described in the context of classic gastrointestinal (GI) symptoms of diarrhea, leading to dehydration and electrolyte imbalance. Neurologic manifestations are atypical symptoms of celiac crisis. To the best of our knowledge, there is no published report on seizure or encephalopathy as the presenting manifestation of celiac crisis. We describe a 2-year-old boy presenting with acute status epilepticus and lethargy. Prior to presentation, he had mild abdominal distention and intermittent diarrhea. Laboratory analysis revealed hyponatremia, anemia, hypocalcemia, transaminitis, and hyperglycemia. Electroencephalography revealed severe diffuse encephalopathy, and complete infectious work-up was negative. Initial brain magnetic resonance imaging was normal; however, repeat imaging showed osmotic demyelination syndrome. Given the history of GI symptoms and hyperglycemia, celiac serology was obtained revealing elevated tissue transglutaminase, and a diagnosis was confirmed by Marsh 3c lesions in the duodenum. He significantly improved with steroid therapy in addition to adequate nutrition, fluids, and initiation of a gluten-free diet. We report herein on the first case of celiac crisis presenting with status epilepticus and encephalopathy in the absence of profound GI symptoms. Our case suggests that celiac crisis should be considered in the differential of seizures and encephalopathy in children.

Energy in the Environment - Initiatives 2004-08

Energy Technology Data Exchange (ETDEWEB)

Paul Jehn

2009-09-11

Under the Energy and Environment Initiative, the GWPC/GWPRF will expand the oil and gas electronic commerce initiatives used to enhance the Risk Based Data Management System (RBDMS) and the Cost Effective Regulatory Approach (CERA). The GWPC/GWPRF has identified the following priorities for work efforts during the time period that will act as the base from which selections for each work period will be proposed. Work tasks will be presented for each reporting period by the GWPC from areas selected from the general list of priorities.

CubeSat Launch Initiative

Science.gov (United States)

Higginbotham, Scott

2016-01-01

The National Aeronautics and Space Administration (NASA) recognizes the tremendous potential that CubeSats (very small satellites) have to inexpensively demonstrate advanced technologies, collect scientific data, and enhance student engagement in Science, Technology, Engineering, and Mathematics (STEM). The CubeSat Launch Initiative (CSLI) was created to provide launch opportunities for CubeSats developed by academic institutions, non-profit entities, and NASA centers. This presentation will provide an overview of the CSLI, its benefits, and its results.

A practical guide to designing a poster for presentation.

Science.gov (United States)

Briggs, D J

Poster presentations are frequently used to disseminate research findings and clinical initiatives at conferences, and present module material for educational courses. However, many nurses lack confidence when it comes to designing posters. This article considers the skills required to design a poster. Aspects of good poster design are also discussed.

Analysis of clinical features of ocular presentation in cranial venous sinus thrombosis

Directory of Open Access Journals (Sweden)

Wang D

2011-07-01

Full Text Available Abstract Background To recognize ocular presentations in cranial venous sinus thrombosis (CVST which were easy to be misdiagnosis. Design Retrospective study. Methods Review clinical informations including general informations, general performances, and ocular presentations of 118 inpatients with CVST in the general hospital of chinese people's liberation army during 2005-2009. Main Outcome Measures The ocular symptoms as the initial onset presentations or simultaneous phenomenon among different onset type patients were analyzed. Results Of all the CVST patients, 21.2% (25/118 presented with ocular symptom as the initial presentation, 30.5% (36/118 presented with ocular symptom as well as the other symptoms, and 48.3% (57/118 presented with non-ocular symptoms as the initial onset. The CVST patients were divided into 3 groups according to the onset type. There was no marked statistical significance among groups. The most common major complaints were blurring and degeneration of acute vision, accounting for 85.9% (61/71 of all abnormal ocular chief complaints. The most common objective sign in eyes was papilloedema, accounting for 48.3% (57/118 in this group of CVST patients. About 22.4% (13/58 showed acute vision deterioration at 1-year follow-up, due to optic atrophy. Conclusions As ophthalmologists, we should master the onset characteristics and clinical manifestations of CVST. Early diagnosis and treatment is very important for the prevention of vision deterioration, especially for patients with ocular syndrome as the initial onset syndrome. For isolated agnogenic intracranial hypertension, we should consider the possibility of CVST.

CASE REPORT : GRAVE'S DISEASE PRESENTING AS PARANOID SCHIZOPHRENIA

OpenAIRE

Singh, S.K.; Hatwal, A.; Agarwal, J.K.; Bajpai, H.S.; Sharma, I.

1989-01-01

SUMMARY The case of a 37 year old male is described who initially presented as paranoid schizophrenia unresponsive to anti-psychotic drug treatment and subsequently developed features of Grave's disease. Treatment with carbimazole alone improved his psychiatric symptoms.

Incidence of tonic spasms as the initial presentation of pediatric multiple sclerosis in Slovenia.

Science.gov (United States)

Bizjak, Neli; Osredkar, Damjan; Meglič, Nuška Pečarič; Benedik, Mirjana Perković

2017-07-01

Tonic spasms (TS) are involuntary movement patterns that can present in patients with multiple sclerosis (MS). They have been first described decades ago, but are frequently missed and misdiagnosed, particularly in the pediatric MS patients and if appearing ahead of hallmark neurological signs and symptoms of MS. Slovenia is a country with the population of about 2 million people. In the years from 1992 to 2016, we have treated 57 sequential pediatric patients with MS at our hospital, which is the only tertiary medical institution for treating children with MS in the country. We present the only two MS patients, a 17-year-old girl and a 14-year-old boy, whose first manifestation of MS were TS. This allowed us to estimate the incidence of TS in pediatric MS patients in Slovenia. Copyright © 2017 Elsevier B.V. All rights reserved.

Initiating Events Modeling for On-Line Risk Monitoring Application

International Nuclear Information System (INIS)

Simic, Z.; Mikulicic, V.

1998-01-01

In order to make on-line risk monitoring application of Probabilistic Risk Assessment more complete and realistic, a special attention need to be dedicated to initiating events modeling. Two different issues are of special importance: one is how to model initiating events frequency according to current plant configuration (equipment alignment and out of service status) and operating condition (weather and various activities), and the second is how to preserve dependencies between initiating events model and rest of PRA model. First, the paper will discuss how initiating events can be treated in on-line risk monitoring application. Second, practical example of initiating events modeling in EPRI's Equipment Out of Service on-line monitoring tool will be presented. Gains from application and possible improvements will be discussed in conclusion. (author)

Kennesaw State University Classroom Technology Initiative.

Science.gov (United States)

McHaney, Jane; Wallace, Deborah; Taylor, Beverley

The purpose of the Kennesaw State University (KSU) Coca Cola/Board of Regents Classroom Technology Initiative was to develop preservice and inservice teachers' expertise in educational technology such as computers, presentation software, and multimedia and to teach educators to apply those skills to content instruction. Project goals were to…

Initial presentation of acute myelogenous leukemia in the infiltrate underlying an actinic keratosis

Directory of Open Access Journals (Sweden)

Collin Blattner

2014-01-01

Full Text Available We report an 85-year-old female patient who presented with an erythematous keratotic lesion on her temple suspicious of squamous cell carcinoma. Histological evaluation revealed actinic keratosis, but the underlying atypical infiltrate contained atypical myeloid forms consistent with acute myelogenous leukemia (AML. Upon further questioning, it was determined that the patient had a history of myelodysplastic syndrome. Her skin biopsy provided the first evidence of progression to AML. This case serves as an important reminder of the role the dermatopathologist plays in identifying serious systemic disease.

Acute Kidney Injury and Rhabdomyolysis as an Initial Presentation of Hashimoto’s Thyroiditis

Directory of Open Access Journals (Sweden)

Deephak Swaminath

2013-03-01

Full Text Available The myopathy associated with hypothyroidism is usually mild and causes myalgia,stiffness, fatigability, and muscle weakness. Severe forms of myopathy, such as rhabdomyolysiswith acute kidney injury (AKI, have rarely been reported in hypothyroidpatients. We describe a young patient who presented with generalized body aches,cramps, and abdominal pain with vomiting after physical exercise. His laboratory studiesdemonstrated that he had rhabdomyolysis and AKI secondary to hypothyroidism;both resolved with thyroid hormone replacement. Hypothyroidism should be consideredin the differential diagnosis of rhabdomyolysis when common causes are excluded.

Evolution of passive continental margins and initiation of subduction zones

NARCIS (Netherlands)

Cloetingh, Sierd

1982-01-01

The initiation of subduction is a key element in plate tectonic schemes for the evolution of the Earth's lithosphere. Nevertheless, up to present, the underlying mechanism has not been very well understood (e.g. Dickinson and Seely, 1979; Hager, 1980; Kanamori, 1980). The insight into the initiation

Initial value problem for plasma oscillations

International Nuclear Information System (INIS)

Li, J.; Spies, G.O.

1991-01-01

The solution of the initial value problem for the linearized one-dimensional electron Vlasov--Poisson equations in a field-free homogeneous equilibrium is examined for small and for large ratios κ of Debye length and wavelength, assuming initial perturbing distribution functions varying on the same velocity scale as the equilibrium. Previously known approximations of the initial evolution (which, unlike the time-asymptotic one, does not depend on analyticity assumptions) are extended to longer times, and to arbitrary stable or unstable equilibria: In the quasifluid regime (small κ), the electric field, within an additive error O(κ 2 ), and independently of the initial data, performs an oscillation near the plasma frequency that corresponds to an eigenmode if it is unstable or marginal, but to an approximate eigenmode arising from the continuous spectrum otherwise. If other unstable or marginal modes are present, these influence only the time-asymptotic behavior because their amplitudes are O(κ 2 ) initially. In the ballistic regime (large κ), there are no instabilities and the perturbing density, now within an error O(κ -2 ), is the Fourier transform of the initial perturbing distribution function, thus following an arbitrary decay law that is independent of the equilibrium. The errors are shown to be time-independent, implying that either approximation is relevant at least until the perturbing density has essentially damped out. Hence the dominating damping mechanism (in the stable case) is Landau damping if κ much-lt 1, but ballistic particle mixing if κ much-gt 1

Reaction-diffusion fronts with inhomogeneous initial conditions

Energy Technology Data Exchange (ETDEWEB)

Bena, I [Departement de Physique Theorique, Universite de Geneve, CH-1211 Geneva 4 (Switzerland); Droz, M [Departement de Physique Theorique, Universite de Geneve, CH-1211 Geneva 4 (Switzerland); Martens, K [Departement de Physique Theorique, Universite de Geneve, CH-1211 Geneva 4 (Switzerland); Racz, Z [Institute for Theoretical Physics, Eoetvoes University, 1117 Budapest (Hungary)

2007-02-14

Properties of reaction zones resulting from A+B {yields} C type reaction-diffusion processes are investigated by analytical and numerical methods. The reagents A and B are separated initially and, in addition, there is an initial macroscopic inhomogeneity in the distribution of the B species. For simple two-dimensional geometries, exact analytical results are presented for the time evolution of the geometric shape of the front. We also show using cellular automata simulations that the fluctuations can be neglected both in the shape and in the width of the front.

Evaluation and Evaluating the Community Initiative "URBAN"

DEFF Research Database (Denmark)

Alves, Sonia

2013-01-01

focus on a more open and democratic process of evaluation. This paper presents and compares different conceptual and methodological frameworks created for the assessment of the European initiative Urban II, including the one that was used by the author in the context of an academic evaluation...... in the city of Porto. The comparative analysis of the results leads us to the recommendation for more democratic processes of evaluation and intervention, in order to improve their quality and accountability and promote the important goal of learning with this type of experimental initiatives....

A mechanical energy analysis of gait initiation

Science.gov (United States)

Miller, C. A.; Verstraete, M. C.

1999-01-01

The analysis of gait initiation (the transient state between standing and walking) is an important diagnostic tool to study pathologic gait and to evaluate prosthetic devices. While past studies have quantified mechanical energy of the body during steady-state gait, to date no one has computed the mechanical energy of the body during gait initiation. In this study, gait initiation in seven normal male subjects was studied using a mechanical energy analysis to compute total body energy. The data showed three separate states: quiet standing, gait initiation, and steady-state gait. During gait initiation, the trends in the energy data for the individual segments were similar to those seen during steady-state gait (and in Winter DA, Quanbury AO, Reimer GD. Analysis of instantaneous energy of normal gait. J Biochem 1976;9:253-257), but diminished in amplitude. However, these amplitudes increased to those seen in steady-state during the gait initiation event (GIE), with the greatest increase occurring in the second step due to the push-off of the foundation leg. The baseline level of mechanical energy was due to the potential energy of the individual segments, while the cyclic nature of the data was indicative of the kinetic energy of the particular leg in swing phase during that step. The data presented showed differences in energy trends during gait initiation from those of steady state, thereby demonstrating the importance of this event in the study of locomotion.

CASE REPORT : GRAVE'S DISEASE PRESENTING AS PARANOID SCHIZOPHRENIA

Science.gov (United States)

Singh, S.K.; Hatwal, A.; Agarwal, J.K.; Bajpai, H.S.; Sharma, I.

1989-01-01

SUMMARY The case of a 37 year old male is described who initially presented as paranoid schizophrenia unresponsive to anti-psychotic drug treatment and subsequently developed features of Grave's disease. Treatment with carbimazole alone improved his psychiatric symptoms. PMID:21927380

Wetting front instability in an initially wet unsaturated fracture

International Nuclear Information System (INIS)

Nicholl, M.J.; Glass, R.J.; Nguyen, H.A.

1992-01-01

Experimental results exploring gravity-driven wetting front instability in a pre-wetted, rough-walled analog fracture are presented. Initial conditions considered include a uniform moisture field wetted to field capacity of the analog fracture and the structured moisture field created by unstable infiltration into an initially dry fracture. As in previous studies performed under dry initial conditions, instability was found to result both at the cessation of stable infiltration and at flux lower than the fracture capacity under gravitational driving force. Individual fingers were faster, narrower, longer, and more numerous than observed under dry initial conditions. Wetting fronts were found to follow existing wetted structure, providing a mechanism for rapid recharge and transport

Wetting front instability in an initially wet unsaturated fracture

International Nuclear Information System (INIS)

Nicholl, M.J.; Glass, R.J.; Nguyen, H.A.

1993-01-01

Experimental results exploring gravity-driven wetting from instability in a pre-wetted, rough-walled analog fractures such as those at Yucca Mountain are presented. Initial conditions considered include a uniform moisture field wetted to field capacity of the analog fracture and the structured moisture field created by unstable infiltration into an initially dry fracture. As in previous studies performed under dry initial conditions, instability was found to result both at the cessation of stable infiltration and at flux lower than the fracture capacity under gravitational driving force. Individual fingers were faster, narrower, longer, and more numerous than observed under dry initial conditions. Wetting fronts were found to follow existing wetted structure, providing a mechanism for rapid recharge and transport

Primary hemochromatosis presented by porphyria cutanea tarda: a case report.

NARCIS (Netherlands)

Bovenschen, H.J.; Vissers, W.H.P.M.

2009-01-01

We present a 27-year-old female Caucasian patient, who initially presented with extensive fragility and blistering of mainly the dorsal side of both hands. Histology and urine porphyrin analysis confirmed the diagnosis of porphyria cutanea tarda. Internal screening for underlying disease revealed

Endometrioid adenocarcinoma associated with endometrial stromal sarcoma: A rare, often unrecognized collision tumor

Directory of Open Access Journals (Sweden)

Grace Kim

2015-08-01

Full Text Available We are reporting 3 cases of the uterine corpus with collision of endometrioid adenocarcinoma (EAC with endometrial stromal sarcoma (ESS. The patients' ages ranged from 36 to 59 years old. The major clinical presentation was abnormal uterine bleeding. Microscopically, all 3 cases presented with 2 separate components, EAC Grade 1 and ESS (one low grade and two high grades. The EAC component ranged from 10% to 70%, and the ESS component ranged from 30% to 70% of total tumor volume. The EAC component was stage 1A in two cases and stage II in one case. The ESS component was stages IA, IIB, and IIIB. Adjuvant hormonal therapy was administrated to one patient while a second patient was treated with chemo/radiation therapy. Two patients were still alive with no evidence of disease at 4 years post-therapy. One patient was lost for follow-up. Collision tumor should be distinguished from carcinosarcoma due to its different treatment modality, outcome and, prognosis.

Late presentation of HIV infection: a consensus definition

DEFF Research Database (Denmark)

Antinori, A; Coenen, T; Costagiola, D

2010-01-01

clinical definition of late presentation. The objective of this article is to present a consensus definition of late presentation of HIV infection. Methods Over the past year, two initiatives have moved towards a harmonized definition. In spring 2009, they joined efforts to identify a common definition...... of what is meant by a 'late-presenting' patient. Results Two definitions were agreed upon, as follows. Late presentation: persons presenting for care with a CD4 count below 350 cells/muL or presenting with an AIDS-defining event, regardless of the CD4 cell count. Presentation with advanced HIV disease...... able to implement this definition (either on its own or alongside their own preferred definition) when reporting surveillance or research data relating to late presentation of HIV infection....

Initialized Fractional Calculus

Science.gov (United States)

Lorenzo, Carl F.; Hartley, Tom T.

2000-01-01

This paper demonstrates the need for a nonconstant initialization for the fractional calculus and establishes a basic definition set for the initialized fractional differintegral. This definition set allows the formalization of an initialized fractional calculus. Two basis calculi are considered; the Riemann-Liouville and the Grunwald fractional calculi. Two forms of initialization, terminal and side are developed.

Lymphogranuloma Venereum-Serovar L2b Presenting With Painful Genital Ulceration: An Emerging Clinical Presentation?

Science.gov (United States)

Haber, Roger; Maatouk, Ismaël; de Barbeyrac, Bertille; Bagot, Martine; Janier, Michel; Fouéré, Sébastien

2017-05-01

These 5 cases of atypical inflammatory lymphogranula venereum (LGV) serovar L2b presenting initially with edema and persistent painful ulceration illustrate that clinical manifestations of LGV in the current outbreak in men who have sex with men reflect the influence of both the serovars virulence and the host immune system and are not confined to proctitis. L2b serovar could have a particular high virulence profile, and the need for awareness of LGV as a cause of genital ulceration is crucial.

A review of initiatives to reduce energy-related CO2 emissions from the city of Oxford: past, present and future

International Nuclear Information System (INIS)

Gupta, Rajat

2007-01-01

This paper reviews three key initiatives undertaken in the historical city of Oxford to bring about reductions in energy-related CO 2 emissions on a city-wide scale. The author has been part of all the three initiatives. In 2002, a collaborative partnership between academia, industry and city council started the Oxford Solar Initiative (OSI) which uses a community-based approach to help households and organisations in Oxford, financially and technically, to install solar energy systems and energy efficiency measures in buildings. So far OSI has facilitated the installation of 80 active solar systems, over 450 energy efficiency measures and 3,000 low energy bulbs. The scientific basis of OSI is a GIS-based DECoRuM model which estimates and maps baseline energy use and CO 2 emissions on a house-by house level, identifies 'pollution' hotspots, predicts the potential for reductions in CO 2 emissions and monitors reductions achieved as a result of deploying energy efficiency measures and renewable energy systems. The application of DECoRuM model to a case study in Oxford shows that CO 2 emission reductions above 60 % are possible, at a cost of between GBP 6 to GBP 77 per tonne of CO 2 emissions saved, depending upon the package of measures used, and the scenario of capital costs (low or high) employed. The OSI and DECoRuM projects have led to the development of an action-oriented Oxford Climate Change Action Plan (OCCAP) which constructs an accurate CO 2 emissions inventory for Oxford city for a baseline year, establishes CO 2 reduction targets and proposes action for each of the energy-related sectors to meet those targets. The OCCAP will be implemented by Oxford City Council and provides a useful example for other cities in their endeavour for emission reductions

Bilateral olecranon bursitis – A rare clinical presentation of gout

Directory of Open Access Journals (Sweden)

Betul Sargın

2018-04-01

Full Text Available Background: Gout is the most common form of crystal arthropathy. Monoarthritis affecting the first metatarsophalangeal joint is the common initial presentation. Bilateral olecranon bursitis is a rare presentation of gout. Aim of the work: To describe the clinical features of bilateral olecranon bursitis as an initial presentation of gout. Case report: A 62-year old male patient presented to the rheumatology clinic , Adnan Menderes University with sudden bilateral elbow pain and swelling for three months . Swellings gradually increased to the size of a golf ball with minimal restriction in the elbow extension (170°. He didn’t have arthritis in the elbows. The patient had medical history of heart failure and chronic obstructive pulmonary disease and medications received included acetylsalicylic acid and diuretics. Blood tests revealed elevated serum uric acid (12.6 mg/dL, with normal renal function tests, erythrocyte sedimentation rate (ESR 43 mm/h and C-reactive protein (CRP 8.8 mg/L. Rheumatoid factor and hepatitis markers were negative. Diagnostic bursal aspiration excluded septic bursitis and under polarized microscopy monosodium urate (MSU crystals were identified with typical negative birefringence. A diagnosis of gout was established. ESR and CRP were normalized after diclofenac potassium (100 mg and colchicine (1.5 mg. Allopurinol 300 mg was added when his joint pain was relieved. Conclusion: This is the first gout case initially presenting with bilateral olecranon bursitis. Bursal fluid analysis is important in such atypical presentation to look for MSU crystals and establish a diagnosis. Keywords: Olecranon bursitis, Gout, Crystal arthropathy, Monosodium urate

Acute presentation of craniopharyngioma in children and adults in a Danish national cohort

DEFF Research Database (Denmark)

Nielsen, E H; Jørgensen, J O; Bjerre, Peter Bjørn

2013-01-01

We aimed to study the occurrence of acute-onset symptoms at initial presentation in a national Danish cohort of patients with childhood- or adult-onset craniopharyngioma, and to investigate potential risk factors for acute presentation. Medical records of 189 consecutive patients (39 children, 150...... adults) presenting with craniopharyngioma during the period 1985-2004 were reviewed, and data regarding initial symptoms, neuroimaging results, vision and pituitary function were systematically collected. Acute symptoms preceding hospital admission were noted. Subgroup analyses were based on age, gender...

A Coordinated Initialization Process for the Distributed Space Exploration Simulation

Science.gov (United States)

Crues, Edwin Z.; Phillips, Robert G.; Dexter, Dan; Hasan, David

2007-01-01

A viewgraph presentation on the federate initialization process for the Distributed Space Exploration Simulation (DSES) is described. The topics include: 1) Background: DSES; 2) Simulation requirements; 3) Nine Step Initialization; 4) Step 1: Create the Federation; 5) Step 2: Publish and Subscribe; 6) Step 3: Create Object Instances; 7) Step 4: Confirm All Federates Have Joined; 8) Step 5: Achieve initialize Synchronization Point; 9) Step 6: Update Object Instances With Initial Data; 10) Step 7: Wait for Object Reflections; 11) Step 8: Set Up Time Management; 12) Step 9: Achieve startup Synchronization Point; and 13) Conclusions

Testing the initial-final mass relationship of white dwarfs

International Nuclear Information System (INIS)

Catalan, S; Isern, J; Garcia-Berro, E; Ribas, I

2009-01-01

In this contribution we revisit the initial-final mass relationship of white dwarfs, which links the mass of a white dwarf with that of its progenitor in the main-sequence. Although this function is of paramount importance to several fields in modern astrophysics, it is still not well constrained either from the theoretical or the observational points of view. We present here a revision of the present semi-empirical initial-final mass relationship using all the available data and including our recent results obtained from studying white dwarfs in common proper motion pairs. We have also analyzed the results obtained so far to provide some clues on the dependence of this relationship on metallicity. Finally, we have also performed an indirect test of the initial-final mass relationship by studying its effect on the luminosity function and on the mass distribution of white dwarfs.

Initialization, conceptualization, and application in the generalized (fractional) calculus.

Science.gov (United States)

Lorenzo, Carl F; Hartley, Tom T

2007-01-01

This paper provides a formalized basis for initialization in the fractional calculus. The intent is to make the fractional calculus readily accessible to engineering and the sciences. A modified set of definitions for the fractional calculus is provided which formally include the effects of initialization. Conceptualizations of fractional derivatives and integrals are shown. Physical examples of the basic elements from electronics are presented along with examples from dynamics, material science, viscoelasticity, filtering, instrumentation, and electrochemistry to indicate the broad application of the theory and to demonstrate the use of the mathematics. The fundamental criteria for a generalized calculus established by Ross (1974) are shown to hold for the generalized fractional calculus under appropriate conditions. A new generalized form for the Laplace transform of the generalized differintegral is derived. The concept of a variable structure (order) differintegral is presented along with initial efforts toward meaningful definitions.

Web Content Analysis On Sustainable Campus Operation (SCO Initiatives

Directory of Open Access Journals (Sweden)

Razman Ruzaimah

2017-01-01

Full Text Available The purpose of this paper is to identify and analyse the current practices implemented in global universities for achieving sustainability throughout campus operations. This study adopted a web content analysis method where 30 international green universities’ websites have been thoroughly examined to identify common initiatives implemented to achieve sustainability through campus operations. The findings are ranked based on the implementation of these initiatives by participating universities. From the websites reviewed, as much as 31 initiatives have been identified as common initiatives frequently implemented by green universities to achieve sustainability in campus operations. It was found that the common initiatives frequently implemented by most of the universities include ‘Provide bin with clearly marked signs to increase the number of recycling items’, and ‘Generate electricity on campus by establishing power generation plants’ with 87% and 83% respectively. This paper fills the gap by presenting the investigation of sustainability initiatives from some of the major green universities internationally. It is suggested that higher education institutions, particularly Malaysian universities, initiate or manage their implementation of sustainable campus operation (SCO initiatives based on the findings of this research.

Persistent Breech Presentation in a Bicornuate Uterus: A Case Report

African Journals Online (AJOL)

We report a case of persistent breech presentation in a primigravida with bicornuate uterus that was initially diagnosed by early ultrasound scan. Persistent breech presentation later in the pregnancy necessitated an elective caesarean section at term. The diagnosis was confirmed intraoperatively by exteriorizing the uterus.

Initial Educational Experiences of Tertiary Students. LSAY Briefing Number 14

Science.gov (United States)

Hillman, Kylie

2008-01-01

This "Briefing" presents information about the initial tertiary education experiences, such as satisfaction with aspects of student life and changes to initial enrolments, of two groups of young people, based on two recent Longitudinal Surveys of Australian Youth (LSAY) research reports. One study focused on the first year experiences of…

Dynamical initial-state model for relativistic heavy-ion collisions

Science.gov (United States)

Shen, Chun; Schenke, Björn

2018-02-01

We present a fully three-dimensional model providing initial conditions for energy and net-baryon density distributions in heavy-ion collisions at arbitrary collision energy. The model includes the dynamical deceleration of participating nucleons or valence quarks, depending on the implementation. The duration of the deceleration continues until the string spanned between colliding participants is assumed to thermalize, which is either after a fixed proper time, or a fluctuating time depending on sampled final rapidities. Energy is deposited in space time along the string, which in general will span a range of space-time rapidities and proper times. We study various observables obtained directly from the initial-state model, including net-baryon rapidity distributions, two-particle rapidity correlations, as well as the rapidity decorrelation of the transverse geometry. Their dependence on the model implementation and parameter values is investigated. We also present the implementation of the model with 3+1-dimensional hydrodynamics, which involves the addition of source terms that deposit energy and net-baryon densities produced by the initial-state model at proper times greater than the initial time for the hydrodynamic simulation.

Lymphocutaneous sporotrichosis in an adolescent girl presenting as mycetoma.

Science.gov (United States)

Tilak, Ragini; Kumari, Varsha; Bansal, Manish; Sharma, Taniya; Pandey, Shyam Sunder

2012-09-01

A 13-year-old girl presented with multiple painless purulent ulcers with raised borders on the medial aspect of the sole of her right foot associated with inguinal lymphadenopathy for the past 4 years. There was history of local trauma at the site prior to the formation of ulcers. There were no other significant associated signs or symptoms. The patient was initially treated with multiple antibiotics with minimal improvement. Fungal cultures of biopsy specimens demonstrated the presence of colonies of Sporothrix schenckii thus confirming the diagnosis of sporotrichosis. Oral itraconazole at the dose of 100 mg twice daily was initiated with marked response at 4 weeks. This case demonstrated a rare morphological presentation of the lymphocutaneous sporotrichosis as mycetoma. The possible diagnosis of sporotrichosis should be kept in mind in such a clinical presentation not responding to antibiotics. Cutaneous sporotrichosis should be diagnosed and treated as early as possible because untreated cases may disseminate to cause visceral involvement with fatal outcome in immunocompromised patients.

Acute lymphoblastic leukemia mimicking Wilms tumor at presentation.

Science.gov (United States)

Singh, Amitabh; Mandal, Anirban; Guru, Vijay; Seth, Rachna

2016-09-01

Acute lymphoblastic leukemia (ALL), the commonest malignancy of childhood, is known to manifest with a myriad of atypical presentations. Nephromegaly is a rare presentation of childhood ALL with hepatic mass being even rarer. We present a 3 year-old child with unilateral renal mass and hepatic mass lesion with normal blood counts, initially suspected to have metastatic Wilms tumor based on clinical, radiological and WT1 positivity on immunocytochemistry of renal mass. He was later diagnosed as ALL with peripheral blood flowcytometry and bone marrow examination. Renomegaly at presentation of acute leukemia is not necessarily due to leukemic infiltration and rarely leads to renal impairment. The radiological differential of such a renal mass includes both benign and malignant entities including metastasis. Over-expression of WT1 mRNA has been found in a number of solid tumors and hematological malignancies and is far from being diagnostic of Wilms tumor. Again, a small number of children with acute leukemia may have a deceptively normal complete blood count at presentation. Though, initial all (clinical, radiological, hematological, and immunocytological) parameters pointed towards a diagnosis of Wilms tumor in our case, the subsequent development of thrombocytopenia and lymphocytic leukocytosis prompted further investigation and final diagnosis of ALL. WT1 positivity is a known phenomenon in childhood ALL and undifferentiated lymphoblasts may be positive for WT1 and negative for Leucocyte common antigen. Acute leukemia with renal and hepatic mass with normal blood counts at presentation is a diagnostic challenge.

The Global Interaction Research Initiative at the IT University of Copenhagen, Denmark

DEFF Research Database (Denmark)

Bardram, Jakob Eyvind; Bjørn, Pernille; Glenstrup, Arne John

2011-01-01

This showcase paper describes the Global Interaction Research Initiative – GIRI – recently inaugurated at the IT University of Copenhagen. It presents the motivation for this initiative, namely that the use of information technology is the core enabling factor for global collaboration and business...... initiative, and we invite other researchers to join....

Late Presentation of a Type III Axis Fracture with Spondyloptosis

Science.gov (United States)

Jayakumar, Prakash; Choi, David; Casey, Adrian

2008-01-01

A 58-year-old man presented with an undiagnosed Effendi type III classification fracture and spondyloptosis of the axis with remarkably normal neurology. We discuss his surgery 4 years since the initial injury, and the presentation, features and management of fractures of the axis. PMID:18430325

Congenic tuberculosis. Presentation of clinical case

International Nuclear Information System (INIS)

David Calabria, Milena; Ojeda Leon, Paulina

2004-01-01

We are presenting the case of less than to 2 month old and premature infant, she had hyaline membrane disease and required mechanical ventilation during 6 days, at the first month. She presented a viral rhinopharyngitis symptomatology, perioral cyanosis with apnoea, and respiratory distress, the chest x-ray showed multiple bilateral hyperlucid images, mainly at the right side afterwards the patient presented intermittent fever of long evolution and initially received treatment for cavitary bronchopneumonia and sequel of mechanical ventilation, receiving multiple antimicrobial antibiotics, the mother had intermittent fevers since the sixth month of pregnancy and was hospitalized for suspected endometritis after delivery, she presented clinical impairment which evolved to sepsis and died in the ICU, the endometrial histopathology showed granulomas suggesting tuberculosis, due to long history of fevers in the baby and the genital tuberculosis in the mother a tuberculosis study was performed in the girl which resulted positive

Crack initiation under generalized plane strain conditions

International Nuclear Information System (INIS)

Shum, D.K.M.; Merkle, J.G.

1991-01-01

A method for estimating the decrease in crack-initiation toughness, from a reference plane strain value, due to positive straining along the crack front of a circumferential flaw in a reactor pressure vessel is presented in this study. This method relates crack initiation under generalized plane strain conditions with material failure at points within a distance of a few crack-tip-opening displacements ahead of a crack front, and involves the formulation of a micromechanical crack-initiation model. While this study is intended to address concerns regarding the effects of positive out-of- plane straining on ductile crack initiation, the approach adopted in this work can be extended in a straightforward fashion to examine conditions of macroscopic cleavage crack initiation. Provided single- parameter dominance of near-tip fields exists in the flawed structure, results from this study could be used to examine the appropriateness of applying plane strain fracture toughness to the evaluation of circumferential flaws, in particular to those in ring-forged vessels which have no longitudinal welds. In addition, results from this study could also be applied toward the analysis of the effects of thermal streaming on the fracture resistance of circumferentially oriented flaws in a pressure vessel. 37 refs., 8 figs., 1 tab

The UNESCO Thematic Initiative ``Astronomy and World Heritage''

Science.gov (United States)

Sidorenko, Anna

2016-10-01

My presentation is divided into two parts: the first part retraces chronologically all the main achievements accomplished within the framework of this Thematic Initiative; the second provides key information regarding the nomination process.

Designers initiating open innovation with multi-stakeholder through co-reflection sessions

NARCIS (Netherlands)

Tomico Plasencia, O.; Lu, Y.; Baha, S.E.; Lehto, P.; Hivikoski, T.; Roozenburg, N.F.M.; Chen, L.; Stappers, P.J.

2011-01-01

This paper explores a designerly approach to open innovation initiation as start of the PhD research of the third author. More specifically, it presents the application of co-reflection sessions by designers in a healthcare open innovation project to initiate multi-stakeholder participation.

Creutzfeldt-Jakob Disease Presenting as Expressive Aphasia and Nonconvulsive Status Epilepticus

Directory of Open Access Journals (Sweden)

Hafiz B. Mahboob

2018-01-01

Full Text Available Creutzfeldt-Jakob disease (CJD, the most common form of human prion diseases, is a fatal condition with a mortality rate reaching 85% within one year of clinical presentation. CJD is characterized by rapidly progressive neurological deterioration in combination with typical electroencephalography (EEG and magnetic resonance imaging (MRI findings and positive cerebrospinal spinal fluid (CSF analysis for 14-3-3 proteins. Unfortunately, CJD can have atypical clinical and radiological presentation in approximately 10% of cases, thus making the diagnosis often challenging. We report a rare clinical presentation of sporadic CJD (sCJD with combination of both expressive aphasia and nonconvulsive status epilepticus. This patient presented with slurred speech, confusion, myoclonus, headaches, and vertigo and succumbed to his disease within ten weeks of initial onset of his symptoms. He had a normal initial diagnostic workup, but subsequent workup initiated due to persistent clinical deterioration revealed CJD with typical MRI, EEG, and CSF findings. Other causes of rapidly progressive dementia and encephalopathy were ruled out. Though a rare condition, we recommend consideration of CJD on patients with expressive aphasia, progressive unexplained neurocognitive decline, and refractory epileptiform activity seen on EEG. Frequent reimaging (MRI, video EEGs and CSF examination might help diagnose this fatal condition earlier.

Southern Cone Initiative for the elimination of domestic populations of Triatoma infestans and the interruption of transfusion Chagas disease: historical aspects, present situation, and perspectives

Directory of Open Access Journals (Sweden)

João Carlos Pinto Dias

2007-10-01

Full Text Available Created in 1991 by the governments of Argentina, Bolivia, Brazil, Chile, Paraguay, and Uruguay, the Southern Cone Initiative (SCI has been extremely important for Chagas disease control in this region. Its basic objective was to reach the interruption of this disease, chiefly by means of the elimination of the principal vector Triatoma infestans and by the selection of safe donors in the regional blood banks. After a summarized historic of SCI, the text shows the advance of technical and operative activities, emphasizing some factors for the initiative success, as well as some difficulties and constraints. The future of SCI will depend of the continuity of the actions and of political priority. Scientific community has been highly responsible for this initiative and its maintenance. At the side of this, national and international efforts must be involved and reinforced to assure the accomplishment of the final targets of SCI. Very specially, the Pan American Health Organization has cooperated with the Initiative in all its moments and activities,being the most important catalytic and technical factor for SCI success.

Color vision abnormality as an initial presentation of the complete type of congenital stationary night blindness.

Science.gov (United States)

Tan, Xue; Aoki, Aya; Yanagi, Yasuo

2013-01-01

Patients with the complete form of congenital stationary night blindness (CSNB) often have reduced visual acuity, myopia, impaired night vision, and sometimes nystagmus and strabismus, however, they seldom complain of color vision abnormality. A 17-year-old male who was at technical school showed abnormalities in the color perception test for employment, and was referred to our hospital for a detailed examination. He had no family history of color vision deficiency and no other symptoms. During the initial examination, his best-corrected visual acuity was 1.2 in both eyes. His fundus showed no abnormalities except for somewhat yellowish reflex in the fovea of both eyes. Electroretinogram (ERG) showed a good response in cone ERG and 30 Hz flicker ERG, however, the bright flash, mixed rod and cone ERG showed a negative type with a reduced b-wave (positive deflection). There was no response in the rod ERG, either. From the findings of the typical ERG, the patient was diagnosed with complete congenital stationary night blindness. This case underscores the importance of ERG in order to diagnose the cause of a color vision anomaly.

Co-Optimization of Fuels & Engines (Co-Optima) Initiative

Energy Technology Data Exchange (ETDEWEB)

Farrell, John T [National Renewable Energy Laboratory (NREL), Golden, CO (United States)

2017-10-04

This is the keynote presentation on the Co-Optimization of Fuels and Engines (Co-Optima) Initiative delivered at SAE International's ICE 2017 - 13th International Conference on Engines & Vehicles held in Capri, Italy.

Russian Initiatives in Internet Governance

Directory of Open Access Journals (Sweden)

Sergey Sergeevich Shirin

2014-01-01

Full Text Available The article is devoted to the research of Russian initiatives concerning its participation in international system of Internet governance. In the research, conceptual and theoretic basis for participation of state governments in Internet governance is given, academic discourse of this issue is assessed, the review of main Russian initiatives made from 2005 (since the second stage of the World Summit on Information Society till the present day is carried out. The conclusion is made that the most successful Internet governance initiative of Russia is the implementation of cyrillic top level domains. Much less successful are Russian attempts to reconstruct existing organizational structure of Internet governance. Russian policy is assessed as a policy of preferring loud statements and PR rather than real influence on development of Internet technologies. Russia consideres Internet as political resource and tries to increase its influence on decision making process on a political, not operational level of Internet governance. The author states that federal government of the United States of America has fully lost the control on the domain name systems. These functions are going to be given to the private sector, while ICANN, which was established according to the Memorandum of Understanding/Joint Project Agreement with U.S. Department of Commerce, is becoming a truly independent international organization. Considering this, the author comes to the conclusion that political transformations for the sake of Russia are already made. He also forecast that next initiatives of Russia will be directed to the segmentation of the Internet.

Doomed to fail from the outset? UNHCR's Convention Plus Initiative revisited

NARCIS (Netherlands)

Zieck, M.

2009-01-01

In September 2002, the High Commissioner for Refugees outlined the contours of a new initiative: the Convention Plus initiative, which set out to develop a normative framework for global burden-sharing. It proceeded from the assumption that the present refugee law regime - in this context, the 1951

Development and Psychometric Evaluation of the Personal Growth Initiative Scale-II

Science.gov (United States)

Robitschek, Christine; Ashton, Matthew W.; Spering, Cynthia C.; Geiger, Nathaniel; Byers, Danielle; Schotts, G. Christian; Thoen, Megan A.

2012-01-01

The original Personal Growth Initiative Scale (PGIS; Robitschek, 1998) was unidimensional, despite theory identifying multiple components (e.g., cognition and behavior) of personal growth initiative (PGI). The present research developed a multidimensional measure of the complex process of PGI, while retaining the brief and psychometrically sound…

Functional neuroimaging and presenting psychiatric features in frontotemporal dementia

Science.gov (United States)

Mendez, M F; McMurtray, A; Chen, A K; Shapira, J S; Mishkin, F; Miller, B L

2006-01-01

Background Frontotemporal dementia (FTD) is a behavioural syndrome caused by degeneration of the frontal and anterior temporal lobes. Behavioural disturbances include psychiatric features. Whether patients with FTD present with psychiatric features varies with the initial neuroanatomical variability of FTD. Objective To identify presenting psychiatric changes not part of diagnostic criteria of FTD and contrast them with the degree of hemispheric asymmetry and frontal and temporal hypoperfusion on single photon emission computed tomography (SPECT) imaging. Methods 74 patients who met consensus criteria for FTD were evaluated at a two year follow up. All had brain SPECT on initial presentation. Results of an FTD psychiatric checklist were contrasted with ratings of regional hypoperfusion. Results The regions of predominant hypoperfusion did not correlate with differences on FTD demographic variables but were associated with presenting psychiatric features. Dysthymia and anxiety were associated with right temporal hypoperfusion. “Moria” or frivolous behaviour also occurred with temporal lobe changes, especially on the right. The only significant frontal lobe feature was the presence of a peculiar physical bearing in association with right frontal hypoperfusion. Conclusions Patients with FTD may present with psychiatric changes distinct from the behavioural diagnostic criteria for this disorder. Early temporal involvement is associated with frivolous behaviour and right temporal involvement is associated with emotional disturbances. In contrast, those with right frontal disease may present with alterations in non‐verbal behaviour. PMID:16043457

Unilateral initiatives

International Nuclear Information System (INIS)

Anon.

1988-01-01

This paper reports on arms control which is generally thought of in terms of formal negotiations with an opponent, with the resulting agreements embodied in a treaty. This is not surprising, since arms control discussions between opponents are both important and politically visible. There are, however, strong reasons for countries to consider and frequently take unilateral initiatives. To do so is entirely consistent with the established major precepts of arms control which state that arms control is designed to reduce the risk of war, the costs of preparing for war, and the death and destruction if war should come. Unilateral initiatives on what weapons are purchased, which ones are eliminated and how forces are deployed can all relate to these objectives. There are two main categories of motives for unilateral initiatives in arms control. In one category, internal national objectives are the dominant, often sole, driving force; the initiative is undertaken for our own good

Mobile Health Initiatives in Vietnam: Scoping Study.

Science.gov (United States)

Lam, Jeffrey A; Dang, Linh Thuy; Phan, Ngoc Tran; Trinh, Hue Thi; Vu, Nguyen Cong; Nguyen, Cuong Kieu

2018-04-24

Mobile health (mHealth) offers a promising solution to the multitude of challenges the Vietnamese health system faces, but there is a scarcity of published information on mHealth in Vietnam. The objectives of this scoping study were (1) to summarize the extent, range, and nature of mHealth initiatives in Vietnam and (2) to examine the opportunities and threats of mHealth utilization in the Vietnamese context. This scoping study systematically identified and extracted relevant information from 20 past and current mHealth initiatives in Vietnam. The study includes multimodal information sources, including published literature, gray literature (ie, government reports and unpublished literature), conference presentations, Web-based documents, and key informant interviews. We extracted information from 27 records from the electronic search and conducted 14 key informant interviews, allowing us to identify 20 mHealth initiatives in Vietnam. Most of the initiatives were primarily funded by external donors (n=15), while other initiatives were government funded (n=1) or self-funded (n=4). A majority of the initiatives targeted vulnerable and hard-to-reach populations (n=11), aimed to prevent the occurrence of disease (n=12), and used text messaging (short message service, SMS) as part of their intervention (n=14). The study revealed that Vietnamese mHealth implementation has been challenged by factors including features unique to the Vietnamese language (n=4) and sociocultural factors (n=3). The largest threats to the popularity of mHealth initiatives are the absence of government policy, lack of government interest, heavy dependence on foreign funding, and lack of technological infrastructure. Finally, while current mHealth initiatives have already demonstrated promising opportunities for alternative models of funding, such as social entrepreneurship or private business models, sustainable mHealth initiatives outside of those funded by external donors have not yet been

Tall Buildings Initiative

Science.gov (United States)

Initiative 2017 TBI Guidelines Version 2.03 Now Available Screen Shot 2017-10-10 at 3.05.10 PM PEER has just initiative to develop design criteria that will ensure safe and usable tall buildings following future earthquakes. Download the primary product of this initiative: Guidelines for Performance-Based Seismic Design

Gallbladder Volvulus Presenting as Acute Appendicitis

Directory of Open Access Journals (Sweden)

Zachary Bauman

2015-01-01

Full Text Available We encountered a case of gallbladder volvulus in an 88-year-old thin female in which the initial presentation was more consistent with that of acute appendicitis. After complete work-up, including physical exam, lab work, and computed tomography, the definite diagnosis of gallbladder volvulus was not made until intraoperative visualization was obtained. Gallbladder volvulus is a rare but serious condition, which requires a high clinical suspicion so prompt surgical intervention can be undertaken.

Budesonide-induced periorificial dermatitis presenting as chalazion and blepharitis

DEFF Research Database (Denmark)

Henningsen, Emil; Bygum, Anette

2011-01-01

We report a case of periorificial dermatitis caused by suboptimal inhalation of budesonide for asthma. The initial skin lesions presented in the eye surroundings, leading to diagnostic difficulties and treatment of presumed chalazion and staphylococcal folliculitis. After several months...

Stirling to Flight Initiative

Science.gov (United States)

Hibbard, Kenneth E.; Mason, Lee S.; Ndu, Obi; Smith, Clayton; Withrow, James P.

2016-01-01

NASA has a consistent need for radioisotope power systems (RPS) to enable robotic scientific missions for planetary exploration that has been present for over four decades and will continue into the foreseeable future, as documented in the most recent Planetary Science Decadal Study Report. As RPS have evolved throughout the years, there has also grown a desire for more efficient power systems, allowing NASA to serve as good stewards of the limited plutonium-238 (238Pu), while also supporting the ever-present need to minimize mass and potential impacts to the desired science measurements. In fact, the recent Nuclear Power Assessment Study (NPAS) released in April 2015 resulted in several key conclusion regarding RPS, including affirmation that RPS will be necessary well into the 2030s (at least) and that 238Pu is indeed a precious resource requiring efficient utilization and preservation. Stirling Radioisotope Generators (SRGs) combine a Stirling cycle engine powered by a radioisotope heater unit into a single generator system. Stirling engine technology has been under development at NASA Glenn Research Center (GRC) in partnership with the Department of Energy (DOE) since the 1970's. The most recent design, the 238Pu-fueled Advanced Stirling Radioisotope Generator (ASRG), was offered as part of the NASA Discovery 2010 Announcement of Opportunity (AO). The Step-2 selections for this AO included two ASRG-enabled concepts, the Titan Mare Explorer (TiME) and the Comet Hopper (CHopper), although the only non-nuclear concept, InSight, was ultimately chosen. The DOE's ASRG contract was terminated in 2013. Given that SRGs utilize significantly less 238Pu than traditional Radioisotope Thermoelectric Generators (RTGs) - approximately one quarter of the nuclear fuel, to produce similar electrical power output - they provide a technology worthy of consideration for meeting the aforementioned NASA objectives. NASA's RPS Program Office has recently investigated a new Stirling to

NMR imaging of the brain: initial impressions

International Nuclear Information System (INIS)

Spencer, D.H.; Bydder, G.M.

1983-01-01

An NMR imaging system designed and built by Thorn-EMI Ltd was installed at Hammersmith Hospital in March 1981. In the first year of operation 180 patients and 40 volunteers have had cranial examinations and initial impressions bases on this experience are presented. Patients with a wide variety of neurological diseases have been studied to provide a basis for diagnostic interpretation, to define distinctive features, and to evaluate different types of scanning sequences. NMR imaging appears to be of considerable value in neurological diagnosis and has a number of advantages over CT. The detailed evaluation of NMR imaging will require much more work but the initial results are very promising

Student-Initiated Use of Facebook for Learning Online Journalism

Science.gov (United States)

Song, Yang

2017-01-01

This article presents a case study of student-initiated use of Facebook Groups in doing a team project for an online journalism course. Drawing upon the concept of affinity space and a theoretical taxonomy of asynchronous online discussion, the present study triangulates classroom observation, semi-structured student interviews, and microanalysis…

Heavy and Light chain amyloidosois presenting as complete heart block: A rare presentation of a rare disease.

Science.gov (United States)

Priyamvada, P S; Morkhandikar, S; Srinivas, B H; Parameswaran, S

2015-01-01

Amyloidosis is an uncommon disease characterized by deposition of proteinaceous material in the extracellular matrix, which results from abnormal protein folding. Even though more than 25 precursor proteins are identified, majority of systemic amyloidosis results from deposition of abnormal immunoglobulin (Ig) light chains. In heavy chain amyloidosis (AH), deposits are derived from both heavy chain alone, whereas in heavy and light chain amyloidosis (AHL), the deposits are derived from Ig heavy chains and light chains. Both AH and AHL are extremely rare diseases. Here, we report an unusual presentation of IgG (lambda) AHL amyloidosis in the background of multiple myeloma, where the initial clinical presentation was complete heart block, which preceded the definitive diagnosis by 18 months.

Feasibility study for improved steady-state initialization algorithms for the RELAP5 computer code

International Nuclear Information System (INIS)

Paulsen, M.P.; Peterson, C.E.; Katsma, K.R.

1993-04-01

A design for a new steady-state initialization method is presented that represents an improvement over the current method used in RELAP5. Current initialization methods for RELAP5 solve the transient fluidflow balance equations simulating a transient to achieve steady-state conditions. Because the transient solution is used, the initial conditions may change from the desired values requiring the use of controllers and long transient running times to obtain steady-state conditions for system problems. The new initialization method allows the user to fix thermal-hydraulic values in volumes and junctions where the conditions are best known and have the code compute the initial conditions in other areas of the system. The steady-state balance equations and solution methods are presented. The constitutive, component, and specialpurpose models are reviewed with respect to modifications required for the new steady-state initialization method. The requirements for user input are defined and the feasibility of the method is demonstrated with a testbed code by initializing some simple channel problems. The initialization of the sample problems using, the old and the new methods are compared

Primary Carcinosarcoma of Ovary an Unusual Tumor Case Report ...

African Journals Online (AJOL)

radiotherapy and chemotherapy or chemotherapy alone.[2]. These tumors are .... stage of disease.[6]. The adverse prognostic factors as enumerated by various ... The effect of epithelial and stromal tumor components on. FIGO stages III and IV ...

Test set for initial value problem solvers

NARCIS (Netherlands)

W.M. Lioen (Walter); J.J.B. de Swart (Jacques)

1998-01-01

textabstractThe CWI test set for IVP solvers presents a collection of Initial Value Problems to test solvers for implicit differential equations. This test set can both decrease the effort for the code developer to test his software in a reliable way, and cross the bridge between the application

Esophageal Gastrointestinal Stromal Tumors Presenting as Mediastinal Mass

Directory of Open Access Journals (Sweden)

M. Kafeel

2013-11-01

Full Text Available Gastrointestinal stromal tumors (GISTs are the most common mesenchymal tumors of the gastrointestinal tract and are predominant in the stomach and intestine but rare in the esophagus. Here, we report a case of esophageal GIST which presented as a mediastinal mass on chest X-ray and dyspnea. The case was initially diagnosed as leiomyosarcoma, which could create a diagnostic dilemma. Therefore, recognizing this uncommon presentation as a mediastinal mass with esophageal GIST is important in the differential diagnosis.

A review of initiatives to reduce energy-related CO{sub 2} emissions from the city of Oxford: past, present and future

Energy Technology Data Exchange (ETDEWEB)

Gupta, Rajat [Dept. of Architecture, School of the Built Environment, Oxford Brookes Univ. (United Kingdom)

2007-07-01

This paper reviews three key initiatives undertaken in the historical city of Oxford to bring about reductions in energy-related CO{sub 2} emissions on a city-wide scale. The author has been part of all the three initiatives. In 2002, a collaborative partnership between academia, industry and city council started the Oxford Solar Initiative (OSI) which uses a community-based approach to help households and organisations in Oxford, financially and technically, to install solar energy systems and energy efficiency measures in buildings. So far OSI has facilitated the installation of 80 active solar systems, over 450 energy efficiency measures and 3,000 low energy bulbs. The scientific basis of OSI is a GIS-based DECoRuM model which estimates and maps baseline energy use and CO{sub 2} emissions on a house-by house level, identifies 'pollution' hotspots, predicts the potential for reductions in CO{sub 2} emissions and monitors reductions achieved as a result of deploying energy efficiency measures and renewable energy systems. The application of DECoRuM model to a case study in Oxford shows that CO{sub 2} emission reductions above 60 % are possible, at a cost of between GBP 6 to GBP 77 per tonne of CO{sub 2} emissions saved, depending upon the package of measures used, and the scenario of capital costs (low or high) employed. The OSI and DECoRuM projects have led to the development of an action-oriented Oxford Climate Change Action Plan (OCCAP) which constructs an accurate CO{sub 2} emissions inventory for Oxford city for a baseline year, establishes CO{sub 2} reduction targets and proposes action for each of the energy-related sectors to meet those targets. The OCCAP will be implemented by Oxford City Council and provides a useful example for other cities in their endeavour for emission reductions.

Reduction of initial shock in decadal predictions using a new initialization strategy

Science.gov (United States)

He, Yujun; Wang, Bin; Liu, Mimi; Liu, Li; Yu, Yongqiang; Liu, Juanjuan; Li, Ruizhe; Zhang, Cheng; Xu, Shiming; Huang, Wenyu; Liu, Qun; Wang, Yong; Li, Feifei

2017-08-01

A novel full-field initialization strategy based on the dimension-reduced projection four-dimensional variational data assimilation (DRP-4DVar) is proposed to alleviate the well-known initial shock occurring in the early years of decadal predictions. It generates consistent initial conditions, which best fit the monthly mean oceanic analysis data along the coupled model trajectory in 1 month windows. Three indices to measure the initial shock intensity are also proposed. Results indicate that this method does reduce the initial shock in decadal predictions by Flexible Global Ocean-Atmosphere-Land System model, Grid-point version 2 (FGOALS-g2) compared with the three-dimensional variational data assimilation-based nudging full-field initialization for the same model and is comparable to or even better than the different initialization strategies for other fifth phase of the Coupled Model Intercomparison Project (CMIP5) models. Better hindcasts of global mean surface air temperature anomalies can be obtained than in other FGOALS-g2 experiments. Due to the good model response to external forcing and the reduction of initial shock, higher decadal prediction skill is achieved than in other CMIP5 models.

Parotid gland as an initial site of metastasis

International Nuclear Information System (INIS)

Borg, Martin F.

2004-01-01

The parotid gland is an uncommon site of metastasis from carcinomas arising outside the head and neck region. Involvement of the parotid gland as an initial site of metastasis or presentation is rare. The present case report is the first, to our knowledge, to describe the management and outcome of an elderly man whose first presentation of an asymptomatic squamous cell carcinoma of the lung was that of a rapidly growing fungating left parotid mass Copyright (2004) Blackwell Publishing Asia Pty Ltd

Initiating Knowledge Management Project in a Regulatory Body in Thailand

International Nuclear Information System (INIS)

Pakdee, K.; Apichaibukol, A.

2016-01-01

Full text: Thailand is one of countries that have adopted the use of nuclear technology in various applications such as medical, agricultural, industrial and research applications. Recognizing this enormous potential in many applications, the Office of Atoms for Peace (OAP) as a regulatory body under the Ministry of Science and Technology, carries out a variety of activities to disseminate and promote youth, entrepreneurs and public on the awareness of the atomic energy in Thailand. In recent years, “knowledge management” is one of the key factors that contribute to safe, secure and efficient operation of nuclear activities and facilities but also for the regulatory processes as well. In this regards, the OAP is aware and recognize of the importance of studying and initiating nuclear knowledge and human resource development programme in the regulatory body. Even though, the OAP has been initiating the project on nuclear knowledge and human resources for several years but the present status of the projects still remain in primarily stage of the initiating. This paper describes the initiating of nuclear knowledge in the past and present status for knowledge management project in regulatory body in Thailand. (author

Delayed splenic rupture presenting 70 days following blunt abdominal trauma.

Science.gov (United States)

Resteghini, Nancy; Nielsen, Jonpaul; Hoimes, Matthew L; Karam, Adib R

2014-01-01

Delayed splenic rupture following conservative management of splenic injury is an extremely rare complication. We report a case of an adult patient who presented with delayed splenic rupture necessitating splenectomy, 2 months following blunt abdominal trauma. Imaging at the initial presentation demonstrated only minimal splenic contusion and the patient was discharge following 24 hours of observation. © 2014.

Environmental management initiatives and stakeholder influences

DEFF Research Database (Denmark)

Madsen, Henning; Ulhøi, John Parm

1999-01-01

in Danish industrial companies. These findings are discussed in the light of similar reported results and case studies of companies which are reportedly pioneers in the introduction of environmental initiatives from a number of EU countries. Implications for theory, practice and training are addressed...... of change, from the point of view of stakeholder theory, from a merely reactive attitude in industry, where companies only tend to respond to stakeholder pressure which cannot be ignored (e.g. ex post responses to one or two stakeholders, such as regulators and customers), towards an increasingly proactive...... attitude characterised by ex ante responses to several strategic groups of stakeholders (including NGOs, employees, neighbours, etc.). The present situation is illustrated by the findings in two recent surveys concerning perceived stakeholder influence in relation to environmental management initiatives...

The Saudi Initiative for asthma

Directory of Open Access Journals (Sweden)

Al-Moamary Mohamed

2009-01-01

Full Text Available The Saudi Initiative for Asthma (SINA provides up-to-date guidelines for healthcare workers managing patients with asthma. SINA was developed by a panel of Saudi experts with respectable academic backgrounds and long-standing experience in the field. SINA is founded on the latest available evidence, local literature, and knowledge of the current setting in Saudi Arabia. Emphasis is placed on understanding the epidemiology, pathophysiology, medications, and clinical presentation. SINA elaborates on the development of patient-doctor partnership, self-management, and control of precipitating factors. Approaches to asthma treatment in SINA are based on disease control by the utilization of Asthma Control Test for the initiation and adjustment of asthma treatment. This guideline is established for the treatment of asthma in both children and adults, with special attention to children 5 years and younger. It is expected that the implementation of these guidelines for treating asthma will lead to better asthma control and decrease patient utilization of the health care system.

Construction of initial data for 3+1 numerical relativity

Energy Technology Data Exchange (ETDEWEB)

Gourgoulhon, Eric [Laboratoire Univers et Theories, UMR 8102 du C.N.R.S., Observatoire de Paris, Universite Paris 7 - Denis Diderot, F-92195 Meudon Cedex (France)

2007-11-15

This lecture is devoted to the problem of computing initial data for the Cauchy problem of 3+1 general relativity. The main task is to solve the constraint equations. The conformal technique, introduced by Lichnerowicz and enhanced by York, is presented. Two standard methods, the conformal transverse-traceless one and the conformal thin sandwich, are discussed and illustrated by some simple examples. Finally a short review regarding initial data for binary systems (black holes and neutron stars) is given.

Clinical presentation of familial exudative vitreoretinopathy.

Science.gov (United States)

Ranchod, Tushar M; Ho, Lawrence Y; Drenser, Kimberly A; Capone, Antonio; Trese, Michael T

2011-10-01

To describe the clinical characteristics, staging and presentation of patients with familial exudative vitreoretinopathy (FEVR) in our clinical practice over the last 25 years. Case series, retrospective review. We included 273 eyes of 145 patients. Data collected from charts included gender, gestational age at birth, birthweight, age at presentation, referring diagnosis, family history, prior ocular surgery, and clinical presentation in each eye. Eyes with invasive posterior segment procedures before initial presentation were excluded. Demographics on presentation and clinical staging. Patients were slightly male predominant (57%) with a mean birthweight of 2.80 kg (range, 740 g-4.76 kg), mean gestational age of 37.8 weeks (range, 25-42), and mean age at presentation of almost 6 years (range, presentation, gestational age, and birthweight. Although a positive family history on presentation may support the diagnosis of FEVR, a negative family history is of little help. The majority of retinal folds extended radially in the temporal quadrants, but radial folds were seen in almost all quadrants. Fellow eyes demonstrated a wide variation in symmetry. The presentation of FEVR may mimic the presentation of other pediatric and adult vitreoretinal disorders, and careful examination is often crucial in making the diagnosis of FEVR. The authors have no proprietary or commercial interest in any of the materials discussed in this article. Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

A Plan for the Evaluation of California's Class Size Reduction Initiative.

Science.gov (United States)

Kirst, Michael; Bomstedt, George; Stecher, Brian

In July 1996, California began its Class Size Reduction (CSR) Initiative. To gauge the effectiveness of this initiative, an analysis of its objectives and an overview of proposed strategies for evaluating CSR are presented here. An outline of the major challenges that stand between CSR and its mission are provided. These include logistical…

Posterior Reversible Encephalopathy Syndrome Presenting as Stroke Mimic

Directory of Open Access Journals (Sweden)

Daniel Frick

2017-05-01

Full Text Available We present the case of a 33-year-old male with end stage renal disease presenting to the emergency department (ED with headache, dizziness, and unilateral weakness. Initial concern was for ischemic or hemorrhagic stroke. Magnetic resonance imaging confirmed posterior reversible encephalopathy syndrome (PRES. The patient was treated appropriately and made a full neurologic recovery. PRES is an under-recognized diagnosis in the ED. As a stroke mimic, PRES can lead the clinician on an incorrect diagnostic pathway with potential for iatrogenic harm.

Energy efficiency initiatives: Indian experience

Energy Technology Data Exchange (ETDEWEB)

Dey, Dipankar [ICFAI Business School, Kolkata, (IBS-K) (India)

2007-07-01

India, with a population of over 1.10 billion is one of the fastest growing economies of the world. As domestic sources of different conventional commercial energy are drying up, dependence on foreign energy sources is increasing. There exists a huge potential for saving energy in India. After the first 'oil shock' (1973), the government of India realized the need for conservation of energy and a 'Petroleum Conservation Action Group' was formed in 1976. Since then many initiatives aiming at energy conservation and improving energy efficiency, have been undertaken (the establishment of Petroleum Conservation Research Association in 1978; the notification of Eco labelling scheme in 1991; the formation of Bureau of Energy Efficiency in 2002). But no such initiative was successful. In this paper an attempt has been made to analyze the changing importance of energy conservation/efficiency measures which have been initiated in India between 1970 and 2005.The present study tries to analyze the limitations and the reasons of failure of those initiatives. The probable reasons are: fuel pricing mechanism (including subsidies), political factors, corruption and unethical practices, influence of oil and related industry lobbies - both internal and external, the economic situation and the prolonged protection of domestic industries. Further, as India is opening its economy, the study explores the opportunities that the globally competitive market would offer to improve the overall energy efficiency of the economy. The study suggests that the Bureau of Energy Efficiency (BEE) - the newly formed nodal agency for improving energy efficiency of the economy may be made an autonomous institution where intervention from the politicians would be very low. For proper implementation of different initiatives to improve energy efficiency, BEE should involve more the civil societies (NGO) from the inception to the implementation stage of the programs. The paper also

Implication of the dominant design in electronic initiation systems in the South African mining industry

CSIR Research Space (South Africa)

Smit, FC

1998-11-01

Full Text Available This article analyzes an emerging technological innovation, namely, electronic initiation systems for mining explosives in South Africa. The concept of electronic initiation is presenting itself as a challenge to traditional initiation systems...

QUALITY OF INITIAL TEACHER EDUCATION: REFLECTIONS ON WHAT IS BEING RESEARCHED

Directory of Open Access Journals (Sweden)

Josimar de Aparecido Vieira

2009-12-01

Full Text Available This work is discussed, in general, the state of knowledge on research dealing with the quality of the initial training of teachers. Presents an analytical and critical reading of the situation of the quality of the initial training of teachers from the analysis of the theoretical bases produced in the last decade. For this, initially, are presented some considerations on the development of this process, followed by an analysis on the issue of training. Following are considered some of the dilemmas or problems that have been addressed in the study area, suggesting mechanisms or alternative solutions. The main source of data used is the Bank of the CAPES Theses which is available on the home page http://servicos.capes.gov.br/capesdw/, for the period from 2004 until 2006. Was used to search by typing the words "initial teacher training" in the "subject", which in 2004 were examined 33 abstracts were selected and these 15, in 2005 were examined 42 abstracts, of which 07 were deployed in 2006 and were seen 44 abstracts of which 21 have been considered because they relate to the quality of initial teacher education. Involved in this analysis, this study points out some principles and data that can help with the process of initial teacher training, pointing to possible review some indicators of pedagogical projects of degree courses. Emphasizes that the specificity and multidimensionality of the performance of the teacher raises the formulation of a set of information relevant to the qualification of objectives and practices of the initial key step in the process of learning to teach. Key words: Quality of education, initial training, university education, state of knowledge; indicators.

Clinical presentation and treatment of septic arthritis in children.

Science.gov (United States)

Moro-Lago, I; Talavera, G; Moraleda, L; González-Morán, G

The aim of this study is to determine the epidemiological features, clinical presentation, and treatment of children with septic arthritis. A retrospective review was conducted on a total of 141 children with septic arthritis treated in Hospital Universitario La Paz (Madrid) between the years 2000 to 2013. The patient data collected included, the joint affected, the clinical presentation, the laboratory results, the appearance, Gram stain result, and the joint fluid culture, as well as the imaging tests and the treatment. Most (94%) of the patients were less than 2 years-old. The most common location was the knee (52%), followed by the hip (21%). The septic arthritis was confirmed in 53%. No type of fever was initially observed in 49% of them, and 18% had an ESR (mm/h) or CRP (mg/l) less than 30 in the initial laboratory analysis. The joint fluid was purulent in 45% and turbid in 12%. The Gram stain showed bacteria in 4%. The fluid culture was positive in 17%. Staphylococcus aureus was the most common pathogen found, followed by Streptococcus agalactiae, Streptococcus pneumoniae, and Kingella kingae. Antibiotic treatment was intravenous administration for 7 days, followed by 21 days orally. Surgery was performed in 18% of cases. The diagnosis was only confirmed in 53% of the patients. Some of the confirmed septic arthritis did not present with the classical clinical/analytical signs, demonstrating that the traumatologist or paediatrician requires a high initial level of clinical suspicion of the disease. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

Young Adult Capacity Initiative Cross-Site Analysis

Science.gov (United States)

Academy for Educational Development, 2012

2012-01-01

This cross-site analysis presents findings about the implementation, impact, and outcomes of the Young Adult Capacity Initiative (YACI), at 13 community-based organizations in New York City. These agencies received technical assistance and small incentive grants from the Fund for the City of New York Youth Development Institute (YDI) to build…

Adult-onset nemaline myopathy presenting as respiratory failure.

LENUS (Irish Health Repository)

Kelly, Emer

2008-11-01

Nemaline myopathy is a rare congenital myopathy that generally presents in childhood. We report a case of a 44-year-old man who presented with severe hypoxic hypercapnic respiratory failure as the initial manifestation of nemaline myopathy. After starting noninvasive ventilation, his pulmonary function test results improved substantially, and over the 4 years since diagnosis his respiratory function remained stable. There are few reported cases of respiratory failure in patients with adult-onset nemaline myopathy, and the insidious onset in this case is even more unusual. This case highlights the varied presenting features of adult-onset nemaline myopathy and that noninvasive ventilation improves respiratory function.

Teratocarcinosarcoma rinosinusal: Reporte de un caso

OpenAIRE

González G,Claudia; Iñiguez,Rodrigo; Aranís Jiménez,Carolina; Castiblanco Galvis,Adriana

2008-01-01

Teratocarcinosarcoma rinosinusal es una neoplasia maligna infrecuente y rara, que combina elementos de teratoma y carcinosarcoma. Se compone de epitelio benigno o maligno (fibroblastos), mesénquima (cartílago, hueso o músculo liso) y elementos neurales. Hasta el año 2008 se han reportado un total de 63 casos de ubicación rinosinusal. Presentamos el caso de un teratocarcinosarcoma de fosa nasal, en un hombre de 67 años de edad, que consultó por obstrucción nasal rápidamente progresiva. La lesi...

Software Development Initiatives to Identify and Mitigate Security Threats - Two Systematic Mapping Studies

Directory of Open Access Journals (Sweden)

Paulina Silva

2016-12-01

Full Text Available Software Security and development experts have addressed the problem of building secure software systems. There are several processes and initiatives to achieve secure software systems. However, most of these lack empirical evidence of its application and impact in building secure software systems. Two systematic mapping studies (SM have been conducted to cover the existent initiatives for identification and mitigation of security threats. The SMs created were executed in two steps, first in 2015 July, and complemented through a backward snowballing in 2016 July. Integrated results of these two SM studies show a total of 30 relevant sources were identified; 17 different initiatives covering threats identification and 14 covering the mitigation of threats were found. All the initiatives were associated to at least one activity of the Software Development Lifecycle (SDLC; while 6 showed signs of being applied in industrial settings, only 3 initiatives presented experimental evidence of its results through controlled experiments, some of the other selected studies presented case studies or proposals.

Pediatric Burkitt lymphoma presenting as acute pancreatitis: MRI characteristics

Energy Technology Data Exchange (ETDEWEB)

Amodio, John; Brodsky, Jennie E. [SUNY Downstate Medical Center, Department of Radiology, Brooklyn, NY (United States)

2010-05-15

Acute pancreatitis is a rare initial presentation of non-Hodgkin lymphoma with few reported cases described in older adults and even fewer in children. MRI features of Burkitt lymphoma of the pancreas are sparse in the radiologic literature. We present a 6-year-old boy who presented with pancreatitis and obstructive jaundice, which was the result of Burkitt lymphoma of the pancreas. The imaging findings of pancreatic involvement of Burkitt lymphoma on MRI are discussed and the contributory role of the radiologist in guiding the appropriate clinical work-up of this disease is highlighted. (orig.)

[Support Team for Investigator-Initiated Clinical Research].

Science.gov (United States)

Fujii, Hisako

2017-07-01

Investigator-initiated clinical research is that in which investigators plan and carry out their own clinical research in academia. For large-scale clinical research, a team should be organized and implemented. This team should include investigators and supporting staff, who will promote smooth research performance by fulfilling their respective roles. The supporting staff should include project managers, administrative personnel, billing personnel, data managers, and clinical research coordinators. In this article, I will present the current status of clinical research support and introduce the research organization of the Dominantly Inherited Alzheimer Network (DIAN) study, an investigator-initiated international clinical research study, with particular emphasis on the role of the project management staff and clinical research coordinators.

The phenotypic spectrum of organic acidurias and urea cycle disorders Part 1: the initial presentation

NARCIS (Netherlands)

Kölker, Stefan; Garcia-Cazorla, Angeles; Cazorla, Angeles Garcia; Valayannopoulos, Vassili; Lund, Allan M.; Burlina, Alberto B.; Sykut-Cegielska, Jolanta; Wijburg, Frits A.; Teles, Elisa Leão; Zeman, Jiri; Dionisi-Vici, Carlo; Barić, Ivo; Karall, Daniela; Augoustides-Savvopoulou, Persephone; Aksglaede, Lise; Arnoux, Jean-Baptiste; Avram, Paula; Baumgartner, Matthias R.; Blasco-Alonso, Javier; Chabrol, Brigitte; Chakrapani, Anupam; Chapman, Kimberly; I Saladelafont, Elisenda Cortès; Couce, Maria L.; de Meirleir, Linda; Dobbelaere, Dries; Dvorakova, Veronika; Furlan, Francesca; Gleich, Florian; Gradowska, Wanda; Grünewald, Stephanie; Jalan, Anil; Häberle, Johannes; Haege, Gisela; Lachmann, Robin; Laemmle, Alexander; Langereis, Eveline; de Lonlay, Pascale; Martinelli, Diego; Matsumoto, Shirou; Mühlhausen, Chris; de Baulny, Hélène Ogier; Ortez, Carlos; Peña-Quintana, Luis; Ramadža, Danijela Petković; Rodrigues, Esmeralda; Scholl-Bürgi, Sabine; Sokal, Etienne; Staufner, Christian; Summar, Marshall L.; Thompson, Nicholas; Vara, Roshni; Pinera, Inmaculada Vives; Walter, John H.; Williams, Monique; Burgard, Peter

2015-01-01

Background The clinical presentation of patients with organic acidurias (OAD) and urea cycle disorders (UCD) is variable; symptoms are often non-specific. Aims/methods To improve the knowledge about OAD and UCD the E-IMD consortium established a web-based patient registry. Results We registered 795

Heavy and Light chain amyloidosois presenting as complete heart block: A rare presentation of a rare disease

Directory of Open Access Journals (Sweden)

P S Priyamvada

2015-01-01

Full Text Available Amyloidosis is an uncommon disease characterized by deposition of proteinaceous material in the extracellular matrix, which results from abnormal protein folding. Even though more than 25 precursor proteins are identified, majority of systemic amyloidosis results from deposition of abnormal immunoglobulin (Ig light chains. In heavy chain amyloidosis (AH, deposits are derived from both heavy chain alone, whereas in heavy and light chain amyloidosis (AHL, the deposits are derived from Ig heavy chains and light chains. Both AH and AHL are extremely rare diseases. Here, we report an unusual presentation of IgG (lambda AHL amyloidosis in the background of multiple myeloma, where the initial clinical presentation was complete heart block, which preceded the definitive diagnosis by 18 months.

Stochastic Models for Chloride-Initiated Corrosion in Reinforced Concrete

DEFF Research Database (Denmark)

Engelund, Svend; Sørensen, John Dalsgaard

Corrosion of the reinforcement in concrete structures can lead to a substantial decrease of the load-bearing capacity. One mode of corrosion initiation is when the chloride content around the reinforcement exceeds a threshold value. In the present paper a statistical model is developed by which...... the chloride content in a 1reinforced concrete structure can be predicted. The model parameters are estimated on the basis of measurements. The distribution of the time to initiation of corrosion is estimated by FORMISORM-analysis....

Stochastic Models for Chloride-Initiated Corrosion in Reinforced Concrete

DEFF Research Database (Denmark)

Engelund, S.; Sørensen, John Dalsgaard

1996-01-01

Corrosion of the reinforcement in concrete structures can lead to a substantial decrease of the load-bearing capacity. One mode of corrosion initiation is when the chloride content around the reinforcement exceeds a threshold value. In the present paper a statistical model is developed by which...... the chloride content in a reinforced concrete structure can be predicted. The model parameters are estimated on the basis of measurements. The distribution of the time to initiation of corrosion is estimated by FORM/SORM-analysis....

Physics and initial data for multiple black hole spacetimes

International Nuclear Information System (INIS)

Bonning, Erin; Marronetti, Pedro; Neilsen, David; Matzner, Richard

2003-01-01

An orbiting black hole binary will generate strong gravitational radiation signatures, making these binaries important candidates for detection in gravitational wave observatories. The gravitational radiation is characterized by the orbital parameters, including the frequency and separation at the innermost stable circular orbit (ISCO). One approach to estimating these parameters relies on a sequence of initial data slices that attempt to capture the physics of the inspiral. Using calculations of the binding energy, several authors have estimated the ISCO parameters using initial data constructed with various algorithms. In this paper we examine this problem using conformally Kerr-Schild initial data. We present convergence results for our initial data solutions, and give data from numerical solutions of the constraint equations representing a range of physical configurations. In a first attempt to understand the physical content of the initial data, we find that the Newtonian binding energy is contained in the superposed Kerr-Schild background before the constraints are solved. We examine some deficiencies with the initial data approach to orbiting binaries, especially touching on the effects of prior motion and spin-orbital coupling of the angular momenta. Making rough estimates of these effects, we find that they are not insignificant compared to the binding energy, leaving some doubt of the utility of using initial data to predict ISCO parameters. In computations of specific initial-data configurations we find spin-specific effects that are consistent with analytical estimates

The initial representation in reasoning towards an interpretation of conditional sentences.

Science.gov (United States)

Schroyens, Walter; Braem, Senne

2011-02-01

All accounts of human reasoning (whether presented at the symbolic or subsymbolic level) have to reckon with the temporal organization of the human processing systems and the ephemeral nature of the representations it uses. We present three new empirical tests for the hypothesis that people commence the interpretational process by constructing a minimal initial representation. In the case of if A then C the initial representation captures the occurrence of the consequent, C, within the context of the antecedent, A. Conditional inference problems are created by a categorical premise that affirms or denies A or C. The initial representation allows an inference when the explicitly represented information matches (e.g., the categorical premise A affirms the antecedent "A") but not when it mismatches (e.g., "not-A" denies A). Experiments 1 and 2 confirmed that people tend to accept the conclusion that "nothing follows" for the denial problems, as indeed they do not have a determinate initial-model conclusion. Experiment 3 demonstrated the other way round that the effect of problem type (affirmation versus denial) is reduced when we impede the possibility of inferring a determinate conclusion on the basis of the initial representation of both the affirmation and the denial problems.

The Windscale piles - past, present and future

International Nuclear Information System (INIS)

Jones, J.M.; Adams, A.L.

1987-01-01

The paper concerns the Windscale reactor piles, in which a fire occurred in the core of pile 1 thirty years ago. A description is given of the two Windscale piles, along with the events leading up to the accident, and the state of the piles following shutdown. The surveillance and maintenance to ensure that the pile and associated buildings were in a safe condition is outlined. The present state of the core, water ducts and pile chimneys is described. The present and future programme of work to ensure long term safety is discussed. This includes the initial steps in decommissioning of the piles. (U.K.)

Sitosterolemia Presenting as Pseudohomozygous Familial Hypercholesterolemia.

Science.gov (United States)

Renner, Christian; Connor, William E; Steiner, Robert D

2016-06-01

A young girl, age 8.5 years, presented with profound hypercholesterolemia and early xanthomatosis, suggesting homozygous familial (or type II) hypercholesterolemia. The patient's low density lipoprotein (LDL) receptor function and parental lipoprotein profiles were determined to be normal, prompting revision of the initial diagnosis to pseudohomozygous familial hypercholesterolemia. When she subsequently presented with giant platelets, the case was presented to colleagues on an electronic mailing list. It was recommended that plasma and sterol analysis be performed, which led to a diagnosis of sitosterolemia. The presentation of profound hypercholesterolomia in childhood that ultimately is not attributed as due to homozygous or compound heterozygous defects in the LDL receptor gene has been termed pseudohomozygous familial (or type II) hypercholesterolemia (PHT2HC). Patients diagnosed with PHT2HC subsequently confirmed to have sitosterolemia have been previously reported only rarely. The challenge of achieving accurate specific diagnosis and appropriate workup for these conditions in children is discussed in the context of this rare case and review of the historical literature concerning these conditions. © 2016 Marshfield Clinic.

Initialization-free generalized Deutsche-Jazz's algorithm

Energy Technology Data Exchange (ETDEWEB)

Chi, Dong Pyo [School of Mathematical Sciences, Seoul National University, Seoul (Korea, Republic of)]. E-mail: dpchi@math.snu.ac.kr; Kim, Jinsoo [School of Electrical Engineering and Computer Science, Seoul National University, Seoul (Korea)]. E-mail: jkim@ee.snu.ac.kr; Lee, Soojoon [School of Mathematical Sciences, Seoul National University, Seoul (Korea)]. E-mail: level@math.snu.ac.kr

2001-06-29

We generalize the Deutsch-Jozsa algorithm by exploiting summations of the roots of unity. The generalized algorithm distinguishes a wider class of functions promised to be either constant or many to one and onto an evenly spaced range. As previously, the generalized quantum algorithm solves this problem using a single functional evaluation. We also consider the problem of distinguishing constant and evenly balanced functions and present a quantum algorithm for this problem that does not require any initialization of an auxiliary register involved in the process of functional evaluation and after solving the problem recovers the initial state of an auxiliary register. (author)

Scale Transformations and Information Presentation in Supervisory Control

DEFF Research Database (Denmark)

Petersen, Johannes; May, Michael

2006-01-01

It is commonly accepted that designers of supervisory control systems cannot comprehensively anticipate operators' information needs. In order to compensate the lack between the information presented by the Supervisory control system and the information needed, operators tailor the information...... presentation. Currently, there is a lack of theoretical understanding of tailoring activities and hence fundamental principles for the design of Supervisory control systems that support tailoring activities in a systematic manner. Any data being presented to the operator is oil one of the four different scale...... the paper proposes systematic principles for operator-initiated adaptation of the interpretation of system properties as presented by the supervisory control system. The value of the approach is illustrated by means of examples. (c) 2005 Elsevier Ltd. All rights reserved....

Plasticity of DNA replication initiation in Epstein-Barr virus episomes.

Directory of Open Access Journals (Sweden)

Paolo Norio

2004-06-01

Full Text Available In mammalian cells, the activity of the sites of initiation of DNA replication appears to be influenced epigenetically, but this regulation is not fully understood. Most studies of DNA replication have focused on the activity of individual initiation sites, making it difficult to evaluate the impact of changes in initiation activity on the replication of entire genomic loci. Here, we used single molecule analysis of replicated DNA (SMARD to study the latent duplication of Epstein-Barr virus (EBV episomes in human cell lines. We found that initiation sites are present throughout the EBV genome and that their utilization is not conserved in different EBV strains. In addition, SMARD shows that modifications in the utilization of multiple initiation sites occur across large genomic regions (tens of kilobases in size. These observations indicate that individual initiation sites play a limited role in determining the replication dynamics of the EBV genome. Long-range mechanisms and the genomic context appear to play much more important roles, affecting the frequency of utilization and the order of activation of multiple initiation sites. Finally, these results confirm that initiation sites are extremely redundant elements of the EBV genome. We propose that these conclusions also apply to mammalian chromosomes.

Inhomogeneous initial data and small-field inflation

Science.gov (United States)

Marsh, M. C. David; Barrow, John D.; Ganguly, Chandrima

2018-05-01

We consider the robustness of small-field inflation in the presence of scalar field inhomogeneities. Previous numerical work has shown that if the scalar potential is flat only over a narrow interval, such as in commonly considered inflection-point models, even small-amplitude inhomogeneities present at the would-be onset of inflation at τ = τi can disrupt the accelerated expansion. In this paper, we parametrise and evolve the inhomogeneities from an earlier time τIC at which the initial data were imprinted, and show that for a broad range of inflationary and pre-inflationary models, inflection-point inflation withstands initial inhomogeneities. We consider three classes of perturbative pre-inflationary solutions (corresponding to energetic domination by the scalar field kinetic term, a relativistic fluid, and isotropic negative curvature), and two classes of exact solutions to Einstein's equations with large inhomogeneities (corresponding to a stiff fluid with cylindrical symmetry, and anisotropic negative curvature). We derive a stability condition that depends on the Hubble scales H(τi) and H(τIC), and a few properties of the pre-inflationary cosmology. For initial data imprinted at the Planck scale, the absence of an inhomogeneous initial data problem for inflection-point inflation leads to a novel, lower limit on the tensor-to-scalar ratio.

Initiating events in the safety probabilistic analysis of nuclear power plants

International Nuclear Information System (INIS)

Stasiulevicius, R.

1989-01-01

The importance of the initiating event in the probabilistic safety analysis of nuclear power plants are discussed and the basic procedures necessary for preparing reports, quantification and grouping of the events are described. The examples of initiating events with its occurence medium frequency, included those calculated for OCONEE reactor and Angra-1 reactor are presented. (E.G.)

Considerations about mediative in initial petition

Directory of Open Access Journals (Sweden)

Maria das Vitórias Nunes Silva Lourenço

2013-12-01

Full Text Available This paper presents considerations about Initial Petition, textual/discursive genre, which is a genre circumscribed in the judicial domain with relation to the Commitment. For this purpose, this article exposes the text plan of the Initial Petition from the postulations of Adam (2011. In the same way, it studies the mediative frameworks based on Guentchéva (1994, 1996, which develop the notion of mediative grammatical categories, that permits the linguistic marking of distance and engagement of the enunciator with regard to the information expressed. It evidences the relevance of the use of mediated constructions in the judicial text, as they function as attenuated strategies to the responsibility of the producer of the text with what is said, and at the same time points to a discourse of authority through the entrance of the sources of law.

Color vision abnormality as an initial presentation of the complete type of congenital stationary night blindness

Directory of Open Access Journals (Sweden)

Tan X

2013-08-01

Full Text Available Xue Tan, Aya Aoki, Yasuo YanagiDepartment of Ophthalmology, University of Tokyo School of Medicine, Hongo, Bunkyo-ku, Tokyo, JapanAbstract: Patients with the complete form of congenital stationary night blindness (CSNB often have reduced visual acuity, myopia, impaired night vision, and sometimes nystagmus and strabismus, however, they seldom complain of color vision abnormality. A 17-year-old male who was at technical school showed abnormalities in the color perception test for employment, and was referred to our hospital for a detailed examination. He had no family history of color vision deficiency and no other symptoms. During the initial examination, his best-corrected visual acuity was 1.2 in both eyes. His fundus showed no abnormalities except for somewhat yellowish reflex in the fovea of both eyes. Electroretinogram (ERG showed a good response in cone ERG and 30 Hz flicker ERG, however, the bright flash, mixed rod and cone ERG showed a negative type with a reduced b-wave (positive deflection. There was no response in the rod ERG, either. From the findings of the typical ERG, the patient was diagnosed with complete congenital stationary night blindness. This case underscores the importance of ERG in order to diagnose the cause of a color vision anomaly.Keywords: congenital stationary night blindness, CSNB, electroretinogram, ERG, color vision defect

Initiation of CPAP therapy for OSA: does prophylactic humidification during CPAP pressure titration improve initial patient acceptance and comfort?

Science.gov (United States)

Wiest, G H; Harsch, I A; Fuchs, F S; Kitzbichler, S; Bogner, K; Brueckl, W M; Hahn, E G; Ficker, J H

2002-01-01

Heated humidifiers (HH) enable effective treatment of upper airway dryness during nasal continuous positive airway pressure (nCPAP) therapy for obstructive sleep apnoea (OSA), but the role of prophylactic use of HH during the initiation of nCPAP treatment has not been studied so far. The aim of the present study was to investigate whether prophylactic HH during the initiation of CPAP would result in improved initial patient comfort and acceptance. In 44 consecutive, previously untreated OSA patients with no history of upper airway dryness, CPAP titration with and without HH was performed on two consecutive nights in a randomised order. The patients were interviewed after each treatment night in order to establish the comfort of the treatment, and, after the second treatment, they were asked which of the two nights they considered more pleasant, and which treatment they would prefer for long-term use. Following CPAP titration with HH, 32 patients (73%) claimed to have had a better night's sleep than usual (i.e. without CPAP treatment) compared with 33 patients (75%) saying the same following CPAP treatment without HH. For 21 patients (47.7%) treatment with HH was more pleasant, 23 (52.3%) saw no difference or said that treatment without HH was more pleasant. Nineteen patients (43.2%) gave preference to treatment with HH for long-term use, while 25 patients (56.8%) had no preference or said they would prefer treatment without HH. The use of HH during the initiation phase of CPAP treatment was associated neither with an initial improvement in comfort nor with greater initial treatment acceptance. Copyright 2002 S. Karger AG, Basel

Addison's disease presenting with perimyocarditis.

Science.gov (United States)

Baranski Lamback, Elisa; Morandi, Grazia; Rapti, Eleni; Christov, Georgi; Brogan, Paul A; Hindmarsh, Peter

2018-01-26

Polyglandular autoimmune syndrome (PGA) and eosinophilic granulomatosis with polyangiitis (EGPA) do not seem to represent a coincidental association. A case of a 15-year-old boy is reported who presented with severe systemic inflammation, perimyocarditis and cardiogenic shock, in whom EGPA was initially suspected and later diagnosed with autoimmune adrenalitis with PGA. The severity of the systemic inflammation and perimyocarditis suggests a more widespread autoimmune-mediated process. Autoimmune adrenal insufficiency should be considered in all cases of pericarditis and perimyocarditis, especially when the severity of clinical manifestations exceeds the expected for the severity of the cardiac findings, as timely identification and prompt treatment may be life-saving.

Bipolar II disorder as the initial presentation of CADASIL: an underdiagnosed manifestation

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Wang J

2017-08-01

Full Text Available Jianjun Wang,1 Jinfang Li,2 Fanxin Kong,2 Hanqing Lv,3 Zhouke Guo2 1Department of Neurology and Psychology, the Fourth Clinical College, Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, People’s Republic of China; 2Department of Neurology and Psychology, Shenzhen Hospital of Chinese Medicine, Shenzhen, Guangdong, People’s Republic of China; 3Medical Imaging Department, Shenzhen Hospital of Chinese Medicine, Shenzhen, Guangdong, People’s Republic of China Abstract: Mood disturbances have been documented in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL. The highly varied morbidity indicates that the affective symptoms in CADASIL have not been cataloged systematically, leading to ineffective treatment, affecting the patients’ quality of life, and possibly resulting in suicide. We present a case of CADASIL with bipolar II disorder as the first manifestation. A middle-aged female reported recurrent depressive episodes and appeared treatment resistant to adequate dosages and durations of antidepressants. Following a structured psychiatric interview and neuropsychological assessment, a past episode of hypomania was identified. Added treatment with sodium valproate alleviated most symptoms. Considering late-onset bipolar disorder with unexplained decline in cognition, a medical history of migraine, and a suspected family history of stroke, further cranial magnetic resonance imaging scan was performed and revealed severe leukoencephalopathy, prompting further investigation. The diagnosis was revised to CADASIL after Arg587Cys NOTCH3 mutation was confirmed. This case highlights the evolving process of affective disorder diagnosis and underlying organic etiologies. Based on the overlap of white matter hyperintensities, NOTCH3 mutation, and valproate therapy in bipolar disorder and CADASIL, bipolar II depression may be a poorly recognized manifestation of CADASIL. Well

Sensitivity of a Simulated Derecho Event to Model Initial Conditions

Science.gov (United States)

Wang, Wei

2014-05-01

Since 2003, the MMM division at NCAR has been experimenting cloud-permitting scale weather forecasting using Weather Research and Forecasting (WRF) model. Over the years, we've tested different model physics, and tried different initial and boundary conditions. Not surprisingly, we found that the model's forecasts are more sensitive to the initial conditions than model physics. In 2012 real-time experiment, WRF-DART (Data Assimilation Research Testbed) at 15 km was employed to produce initial conditions for twice-a-day forecast at 3 km. On June 29, this forecast system captured one of the most destructive derecho event on record. In this presentation, we will examine forecast sensitivity to different model initial conditions, and try to understand the important features that may contribute to the success of the forecast.

Shakespeare's "Julius Caesar": The Initial Classroom Presentation. An Introduction to Theatre, Volume 2. Revised Edition.

Science.gov (United States)

Hoetker, James; Englesman, Alan

A set of lessons to introduce "Julius Caesar" to secondary school students unfamiliar with Shakespeare is provided in this teaching guide. Only a critical fraction of the play is covered in the lessons. First, a synopsis of a modern high school situation whose conflicts parallel those in "Julius Caesar" is presented; then,…

LOFT reflood as a function of accumulator initial gas volume

International Nuclear Information System (INIS)

Rhodes, H.F.

1978-01-01

The effect of the initial gas volume in the LOFT accumulators on the time to start of core reflood, after a LOCA, has been studied. The bases of the calculations are the data used and results presented in the Safety Analysis Report, Rev.1, August 1977, and the data in the RELAP and TOODEE2 program input and output listings. The results of this study show that an initial nitrogen volume of 12 cu ft, or more (at 600 psig initial pressure), would cause start of core reflood in time to prevent the cladding temperature from reaching 2200 0 F. The 12 cu ft initial volume will expand from 600 psig, initial pressure, to about 10 psig (containment pressure shortly after start of LOCA is approximately 8 psig) when all ECC liquid has been expelled from the accumulator. This pressure margin is considered too small; the ECC flowrate will be zero before the accumulator is empty

Painful vertical diplopia as a presentation of a pituitary mass

Directory of Open Access Journals (Sweden)

Mandal Kaveri

2007-03-01

Full Text Available Abstract Background Pituitary tumours may present with a variety of neurological and endocrinological signs and symptoms. It is very rare however for them to present with sudden onset painful diplopia. The current literature and possible mechanisms for this are discussed. Case presentation We describe a case of a pituitary mass which presented with sudden onset painful diplopia with an associated restricted pattern on Lees Chart testing. This led to an initial working diagnosis of orbital myositis. Conclusion Awareness of different modes of presentation of pituitary lesions is important so that appropriate imaging may be requested and delay in diagnosis prevented.

Strategic Defense Initiative: Splendid Defense or Pipe Dream? Headline Series No. 275.

Science.gov (United States)

Armstrong, Scott; Grier, Peter

This pamphlet presents a discussion of the various components of President Reagan's Strategic Defense Initiative (SDI) including the problem of pulling together various new technologies into an effective defensive system and the politics of the so-called "star wars" system. An important part of the defense initiative is the…

Quality-of-care initiative in patients treated surgically for perforated peptic ulcer

DEFF Research Database (Denmark)

Møller, M H; Larsson, Heidi Jeanet; Rosenstock, S

2013-01-01

Mortality and morbidity are considerable after treatment for perforated peptic ulcer (PPU). Since 2003, a Danish nationwide quality-of-care (QOC) improvement initiative has focused on reducing preoperative delay, and improving perioperative monitoring and care for patients with PPU. The present...... study reports the results of this initiative....

Initiating statistical maintenance optimization

International Nuclear Information System (INIS)

Doyle, E. Kevin; Tuomi, Vesa; Rowley, Ian

2007-01-01

Since the 1980 s maintenance optimization has been centered around various formulations of Reliability Centered Maintenance (RCM). Several such optimization techniques have been implemented at the Bruce Nuclear Station. Further cost refinement of the Station preventive maintenance strategy includes evaluation of statistical optimization techniques. A review of successful pilot efforts in this direction is provided as well as initial work with graphical analysis. The present situation reguarding data sourcing, the principle impediment to use of stochastic methods in previous years, is discussed. The use of Crowe/AMSAA (Army Materials Systems Analysis Activity) plots is demonstrated from the point of view of justifying expenditures in optimization efforts. (author)

Economic gains stimulate negative evaluations of corporate sustainability initiatives

Science.gov (United States)

Makov, Tamar; Newman, George E.

2016-09-01

In recent years, many organizations have sought to align their financial goals with environmental ones by identifying strategies that maximize profits while minimizing environmental impacts. Examples of this `win-win' approach can be found across a wide range of industries, from encouraging the reuse of hotel towels, to the construction of energy efficient buildings, to the large-scale initiatives of multi-national corporations. Although win-win strategies are generally thought to reflect positively on the organizations that employ them, here we find that people tend to respond negatively to the notion of profiting from environmental initiatives. In fact, observers may evaluate environmental win-wins less favourably than profit-seeking strategies that have no environmental benefits. The present studies suggest that how those initiatives are communicated to the general public may be of central importance. Therefore, organizations would benefit from carefully crafting the discourse around their win-win initiatives to ensure that they avoid this type of backlash.

Employability and personal initiative as antecedents of job satisfaction.

Science.gov (United States)

Gamboa, Juan Pablo; Gracia, Francisco; Ripoll, Pilar; Peiró, José María

2009-11-01

In a changing and flexible labour market it is important to clarify the role of environmental and personal variables that contribute to obtaining adequate levels of job satisfaction. The aim of the present study is to analyze the direct effects of employability and personal initiative on intrinsic, extrinsic and social job satisfaction, clarifying their cumulative and interactive effects. The study has been carried out in a sample of 1319 young Spanish workers. Hypotheses were tested by means of the moderated hierarchical regression analysis. Results show that employability and personal initiative predict in a cumulative way the intrinsic, extrinsic and social job satisfaction. Moreover, the interaction between employability and personal initiative increases the prediction of these two variables on intrinsic and extrinsic job satisfaction. Results also indicate that higher values of employability when initiative is also high are associated to higher levels of intrinsic and extrinsic satisfaction. These results have implications for theory and practice in a context of new employment relations.

Research on Initiation Sensitivity of Solid Explosive and Planer Initiation System

OpenAIRE

N Matsuo; M Otuka; H Hamasima; K Hokamoto; S Itoh

2016-01-01

Firstly, recently, there are a lot of techniques being demanded for complex process, various explosive initiation method and highly accurate control of detonation are needed. In this research, the metal foil explosion using high current is focused attention on the method to obtain linear or planate initiation easily, and the main evaluation of metal foil explosion to initiate explosive was conducted. The explosion power was evaluated by observing optically the underwater shock wave generated ...

Does Initial Learning about the Meaning of Fractions Present Similar Challenges for Students with and without Adequate Whole-Number Skill?

Science.gov (United States)

Namkung, Jessica M; Fuchs, Lynn S; Koziol, Natalie

2018-01-01

The purposes of this study were to (a) explore whether early fractions understanding at 4 th grade is differentially challenging for students with versus without adequate whole-number competence and (b) identify specific whole-number skill associated with difficulty in fractions understanding. Based on initial whole-number competence, 1,108 4 th graders were classified as having (a) adequate whole-number competence ( n = 775), (b) less severe whole-number difficulty ( n = 201), and (c) severe whole-number difficulty ( n = 132). At the end of 4 th grade, they were assessed on fractions understanding and further classified as with versus without difficulty in fractions understanding. Multi-level logistic regression indicated that compared to students with adequate whole-number competence, those with less severe whole-number difficulty were almost 5 times as likely to experience difficulty with fractions understanding whereas those with severe whole-number difficulty were about 32 times as likely to experience difficulty with fractions understanding. Students with severe whole-number difficulty were about 7 times as likely to experience difficulty with fractions understanding compared to those with less severe whole-number difficulty. Among students with adequate whole-number competence, the pretest whole-number skill distinguishing those with versus without difficulty in fractions understanding was basic division facts (i.e., 2-digit dividend ÷ 1-digit divisor) and simple multiplication (i.e., 3-digit × 1-digit without regrouping). The role of whole-number competence in developing initial fractions understanding and implications for instruction are discussed.

Initial presentation with dilated cardiomyopathy in a patient of tuberous sclerosis: A rare case report

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Dharmendra Jain

2013-01-01

Full Text Available A 35-year-old man presented with dilated cardiomyopathy, an unusual association with tuberous sclerosis. Clinical history and examination were consistent with tuberous sclerosis including major features of tuberous sclerosis complex (TSC like facial angiofibroma, shagreen patch, subependymal nodules, and angiomyolipoma of kidney. The clinical manifestations, pathogenesis and evaluation of tuberous sclerosis are discussed.

Clinical presentations and MRI findings of angiographically occult vascular malformations

International Nuclear Information System (INIS)

Kida, Yoshihisa; Kobayashi, Tatsuya; Tanaka, Takayuki; Oyama, Hirofumi; Iwakoshi, Takayasu

1994-01-01

Various clinical features as well as MRI findings of AOVM (angiographically occult vascular malformation) were studied. Amongst out patients, since January 1988, there have been 30 cases of symptomatic AOVM (20 males, 10 females) including 4 cases with multiple lesions. The age ranged from 3 to 60 years of age, with a mean of 33.4 years. The locations of symptomatic lesions were in the cerebral hemisphere (15), the thalamus (4), the brain stem (8) and in the cerebellum (3). The initial presentations of these 30 cases were either by hemorrhage (18), convulsive seizure (9) or by progressive neurological deficits (3). The initial presentation was not related to the patient's age and the size of the lesion, but apparently related to the location of AOVM. Most of the lesions in the cerebral hemisphere presented seizures, but all of the lesions in the thalamus, the brain stem and the cerebellum disclosed hemorrhage as an initial presentation. In fact it was noticed that brain stem lesions tend to cause repetitive hemorrhage in a relatively short period. AOVM lesions were clearly visualized with T2-weighted MRI images, consisting of high intensity cores with surrounding low intensity rims. Most of the symptomatic lesions were partially enhanced by Gd-DTPA with varied intensity. Dynamic changes in size and enhancement pattern on MRI were occasionally seen, usually accompanied with episodes such as hemorrhage or neurological deterioration. Although AOVMs were angiographically negative some strands indicating draining veins were observed on MRI in several cases. In contrast, none of the nonsymptomatic lesions (22 lesions) demonstrated enhancement effects with Gd-DTPA. (author)

Socio- cultural effects on children's initiation of joint attention

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Yana eGavrilov

2012-10-01

Full Text Available Exchanging gazes with a social partner in response to an event in the environment is considered an effective means to direct attention, share affective experiences and highlight a target in the environment. This behavior appears during infancy and plays an important role in children's learning and in shaping their socio-emotional development. It has been suggested that cultural values of the community affect socio-emotional development through attentional dynamics of social reference (Rogoff et al., 1993. Maturational processes of brain-circuits have been found to mediate socio-cultural learning and the behavioral manifestation of cultural norms starting at preschool age (Nelson and Guyer, 2011. The aim of the current study was to investigate the relations between cultural ecology levels and children's joint attention (JA. Initiation of JA bids was studied empirically as a function of the level of social load of the target toy (3 levels, the community level of adherence to traditional values (3 levels parental education (2 levels and gender. Sixty-two kindergarten aged children were enrolled in a structured toy-exploration task, during which they were presented with toys of various social loads, with social agents (i.e., mother and experimenter present nearby, and non-social distracters presented intermittently. Analysis of variance indicated that the child's initiation of JA towards the social partner was affected by all levels of cultural ecology (i.e., toy's social load, adherence to tradition values, parental education, gender, thus supporting the study's hypotheses. The effects were such that overall, children, particularly girls' JA initiation was augmented in social toys and moderated by the socio-cultural variables. Cultural ecology seems to be related to children's JA, thereby scaffolding initiation of social sharing cues between children and adults. JA plays a role in adjusting children's internal representations of their ecological

Autoimmune pancreatitis presenting as obstructive jaundice

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Nurul Amin Miah

2016-08-01

Full Text Available A 71 years cachexic male presented with sign symptoms of biliary tract obstruction. There was a large mass in the head of pancreases with raised CA 19.9. But elevated serum lipase raised the suspicion of paocreatitis. Elevated immunoglobu­lin IgG4 confmned this case as a auto immune aetiology. Initially there was much difficulty to differentiate auto immune pancreatitis from pancreatic carcinoma but after successful stenting and a course of corticosteroids, patient improved dramatically along with nonnalisation of all the radiological, bio-chemical and immunological parameters.

Iron Deficiency Anemia in Adolescents Who Present with Heavy Menstrual Bleeding.

Science.gov (United States)

Cooke, Amanda G; McCavit, Timothy L; Buchanan, George R; Powers, Jacquelyn M

2017-04-01

To assess the clinical severity and initial treatment of iron deficiency anemia (IDA) in female adolescents with heavy menstrual bleeding (HMB) in our center. Retrospective cohort study of electronic medical records via search of administrative records using International Classification of Diseases Ninth Revision codes for IDA or unspecified anemia and disorders of menstruation. Children's Medical Center in Dallas, Texas. One hundred seven patients with HMB and concomitant IDA (median age, 14.4 years) who presented to the outpatient, emergency department, and/or inpatient settings. The median initial hemoglobin concentration for all patients (n = 107) was 7.4 g/dL, and most (74%, n = 79) presented to the emergency department or via inpatient transfer. Symptomatic IDA was treated with blood transfusion in 46 (43%, n = 46). Ferrous sulfate was the most commonly prescribed oral iron therapy. Seven patients received intravenous iron therapy either initially or after oral iron treatment failure. Combined oral contraceptives were commonly prescribed for abnormal uterine bleeding, yet 10% of patients (n = 11) received no hormonal therapy during their initial management. Evaluation for underlying bleeding disorders was inconsistent. Severe anemia because of IDA and HMB resulting in urgent medical care, including hospitalization and blood transfusion, is a common but underemphasized problem in adolescent girls. In addition to prevention and early diagnosis, meaningful efforts to improve initial management of adolescents with severe HMB and IDA are necessary. Copyright © 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Band Gap Properties of Magnetoelectroelastic Grid Structures with Initial Stress

International Nuclear Information System (INIS)

Wang Yi-Ze; Li Feng-Ming

2012-01-01

The propagation of elastic waves in magnetoelectroelastic grid structures is studied. Band gap properties are presented and the effects of the magnetoelectroelastic coupling and initial stress are considered. Numerical calculations are performed using the plane-wave expansion method. The results show that the band gap width can be tuned by the initial stress. It is hoped that our results will be helpful for designing acoustic filters with magnetoelectroelastic materials and grid structures

DEPARTMENT OF ENERGY SOIL AND GROUNDWATER SCIENCE AND TECHNOLOGY NEEDS, PLANS AND INITIATIVES

Energy Technology Data Exchange (ETDEWEB)

Aylward, B; V. ADAMS, V; G. M. CHAMBERLAIN, G; T. L. STEWART, T

2007-12-12

This paper presents the process used by the Department of Energy (DOE) Environmental Management (EM) Program to collect and prioritize DOE soil and groundwater site science and technology needs, develop and document strategic plans within the EM Engineering and Technology Roadmap, and establish specific program and project initiatives for inclusion in the EM Multi-Year Program Plan. The paper also presents brief summaries of the goals and objectives for the established soil and groundwater initiatives.

Oak Ridge National Laboratory: Sustainable Landscapes Initiative 2020

Energy Technology Data Exchange (ETDEWEB)

Gardner, Leah [Environmental Landscape Design Associates; Rogers, Sam [Environmental Landscape Design Associates; Sipes, James L. [Sand County Studios

2012-09-01

The goal of the ORNL Sustainable Landscapes Initiative 2020 is to provide a framework that guides future environmental resources and sustainable landscape practices on the ORNL campus. This document builds on the 2003 ORNL Conceptual Landscape Plan and is presented in the context of embracing new opportunities.

A Rare Manifestation of Tuberculosis Presenting in the United States

Directory of Open Access Journals (Sweden)

Osman Bhatty

2016-01-01

Full Text Available A 64-year-old Bangladeshi female presented to her primary care physician with a tender right breast lump that had been present for 4-5 days along with subjective fevers and malaise. Initial biopsy revealed granulomas, but Ziehl-Neelsen and Gram stain were negative for TB so antibiotics were prescribed for abscess until culture came positive for tuberculosis. She was started on triple therapy for extrapulmonary tuberculosis, an exceedingly rare presentation that requires high clinical suspicion in the Western world.

An iterative reconstruction of cosmological initial density fields

Science.gov (United States)

Hada, Ryuichiro; Eisenstein, Daniel J.

2018-05-01

We present an iterative method to reconstruct the linear-theory initial conditions from the late-time cosmological matter density field, with the intent of improving the recovery of the cosmic distance scale from the baryon acoustic oscillations (BAOs). We present tests using the dark matter density field in both real and redshift space generated from an N-body simulation. In redshift space at z = 0.5, we find that the reconstructed displacement field using our iterative method are more than 80% correlated with the true displacement field of the dark matter particles on scales k < 0.10h Mpc-1. Furthermore, we show that the two-point correlation function of our reconstructed density field matches that of the initial density field substantially better, especially on small scales (<40h-1 Mpc). Our redshift-space results are improved if we use an anisotropic smoothing so as to account for the reduced small-scale information along the line of sight in redshift space.

Factors to Consider in Selecting an Organisational Improvement Initiative: Survey Results

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Mohammad Musli

2017-01-01

Full Text Available Organisations should select the appropriate improvement initiative that will fit with the context of organisation and provide value to the organisation. This paper presents 18 factors to be considered when selecting an organisational improvement initiative. Organisational improvement initiatives are approaches, management systems, tools and/or techniques that can be used for managing and improving organisations, such as Lean, ISO9001, Six Sigma and Improvement Team. A survey was conducted to identify the level of importance of these 18 factors as criteria for selecting an improvement initiative. Purposive sampling was used for this survey involving practitioners, managers, engineers, executives, consultants and/or academicians, who have been involved in the selection and/or implementation of organisational improvement initiatives in Malaysia. Two factors were rated as ‘very high importance’, which involve: (1 The ability to gain top management commitment and support to introduce and implement the initiative successfully, and (2 The initiative is aligned to the vision, mission and/or purpose of the organisation. All these factors can be adopted by the organisations as decision criteria to assist in the selection of the most appropriate improvement initiative based on rational decision making.

Dioxin Exposure Initiative

Science.gov (United States)

The Dioxin Exposure Initiative (DEI) is no longer active. This page contains a summary of the dioxin exposure initiative with illustrations, contact and background information.Originally supported by scientist Matthew Lorber, who retired in Mar 2017.

Pericarditis as presenting manifestation of acute nonlymphocytic leukemia in a young child.

Science.gov (United States)

Chu, J Y; Demello, D; O'Connor, D M; Chen, S C; Gale, G B

1983-07-15

A case of acute nonlymphocytic leukemia presenting as pericarditis is reported in a five-year-old boy. Initially, a clinical diagnosis of viral pericarditis was made, because the child did not demonstrate hematologic or clinical manifestations of leukemia. Acute undifferentiated or lymphocytic leukemia. Acute undifferentiated or lymphocytic leukemia was diagnosed one week after admission when his peripheral blood count became abnormal. The patient did not respond to vincristine and prednisone. When cytochemical evaluation indicated acute myelomonocytic leukemia, employment of cytosine arabinoside and 6-thioguanine was instituted and the child began to improve. Currently, he is still in good remission and has no evidence of recurrence of pericarditis, 1 1/2 years after his initial presentation. In reviewing the literature, we found 17 patients who had leukemic pericardial effusion with cardiac tamponade. There are three reported cases of young children with pericardial effusion as the initial manifestation of acute lymphocytic leukemia, but no reported cases due to nonlymphocytic leukemia, as in this child.

Social initiative management: building social leaders

Directory of Open Access Journals (Sweden)

Carlos Eduardo Varejão Marinho

2010-05-01

Full Text Available Some programs of Social Initiative Management are designed to prepare managers to take over a new administrative challenge – the social manager. Such programs help companies to change their administrative policies in which managers are more concerned with ethics and social issues. The objective of this article is to present the basic principles for a new model of manager integrated into social programs, environment preservation and decision-making processes in the organization.

Modelling the initiation of basal sliding

Science.gov (United States)

Mantelli, E.; Schoof, C.

2017-12-01

The initiation of basal sliding is a thermally-controlled process that affects ice speed, englacial heat transport, and melt water production at the bed, and ultimately influences the large-scale dynamics of ice sheets. From a modelling perspective, describing the onset of sliding in thin-film models suitable for ice sheet scale simulations is problematic. In particular, previous work concluded that, under shallow-ice mechanics, the scenario of a hard switch from frozen to molten bed leads to an infinite vertical velocity at the onset, and higher-order mechanical formulations are needed to describe sliding initiation. An alternative view considers the occurrence of subtemperate sliding, which allows for a smooth sliding velocity across the onset. However, the sliding velocity decreases rapidly as temperature drops below the melting point, thus raising the issue of whether a mechanical model that does not resolve the ice sheet thickness scale is ever appropriate to model the onset of sliding. In this study we first present a boundary layer model for the hard switch scenario. Our analysis, which considers a thermo-mechanically coupled Stokes flow near the onset, shows that the abrupt onset of sliding is never possible. In fact, the acceleration of ice flow deflects the flowlines towards the bed, which freezes again immediately downstream to the onset. This leads to the conclusion that the sliding velocity must change smoothly across the onset, thus the temperature dependence of sliding needs to be taken into account. In this context, we examine a limiting case of standard temperature-dependent sliding laws, where sliding onset takes the form of an extended transition region interposed between fully frozen and temperate bed. In the transition region basal temperature is at the melting point, and the sliding velocity varies smoothly as dictated by the energy budget of the bed. As the extent of this region is not small compared to the ice sheet length scale, we couple

HST Replacement Battery Initial Performance

Science.gov (United States)

Krol, Stan; Waldo, Greg; Hollandsworth, Roger

2009-01-01

The Hubble Space Telescope (HST) original Nickel-Hydrogen (NiH2) batteries were replaced during the Servicing Mission 4 (SM4) after 19 years and one month on orbit.The purpose of this presentation is to highlight the findings from the assessment of the initial sm4 replacement battery performance. The batteries are described, the 0 C capacity is reviewed, descriptions, charts and tables reviewing the State Of Charge (SOC) Performance, the Battery Voltage Performance, the battery impedance, the minimum voltage performance, the thermal performance, the battery current, and the battery system recharge ratio,

Graphic presentation of quarterly 90Sr fallout data, 1954-1982

International Nuclear Information System (INIS)

Larsen, R.J.

1984-01-01

This report graphically presents all of the precipitation and 90 Sr deposition data for all stations operated as part of the Environmental Measurements Laboratory's (EML) global fallout program since the initiation of the program in 1954. 3 references, 179 figures

Filtering observations without the initial guess

Science.gov (United States)

Chin, T. M.; Abbondanza, C.; Gross, R. S.; Heflin, M. B.; Parker, J. W.; Soja, B.; Wu, X.

2017-12-01

Noisy geophysical observations sampled irregularly over space and time are often numerically "analyzed" or "filtered" before scientific usage. The standard analysis and filtering techniques based on the Bayesian principle requires "a priori" joint distribution of all the geophysical parameters of interest. However, such prior distributions are seldom known fully in practice, and best-guess mean values (e.g., "climatology" or "background" data if available) accompanied by some arbitrarily set covariance values are often used in lieu. It is therefore desirable to be able to exploit efficient (time sequential) Bayesian algorithms like the Kalman filter while not forced to provide a prior distribution (i.e., initial mean and covariance). An example of this is the estimation of the terrestrial reference frame (TRF) where requirement for numerical precision is such that any use of a priori constraints on the observation data needs to be minimized. We will present the Information Filter algorithm, a variant of the Kalman filter that does not require an initial distribution, and apply the algorithm (and an accompanying smoothing algorithm) to the TRF estimation problem. We show that the information filter allows temporal propagation of partial information on the distribution (marginal distribution of a transformed version of the state vector), instead of the full distribution (mean and covariance) required by the standard Kalman filter. The information filter appears to be a natural choice for the task of filtering observational data in general cases where prior assumption on the initial estimate is not available and/or desirable. For application to data assimilation problems, reduced-order approximations of both the information filter and square-root information filter (SRIF) have been published, and the former has previously been applied to a regional configuration of the HYCOM ocean general circulation model. Such approximation approaches are also briefed in the

Assessing the impact of area-based initiatives in deprived neighborhoods

DEFF Research Database (Denmark)

Alves, Sonia

2017-01-01

assumptions, and social and spatial effects of these initiatives. Among other inter-related issues, the paper discusses the impact of conflicting ideologies upon processes of radical strategy shift and of social and territorial marginalization, and appeals to the need for more pluralistic approaches......Whilst there have been many area-based initiatives to regenerate rundown areas in numerous cities around the world, many of them involving the demolition of stigmatized housing estates, far fewer attempts have been made to assess the effects of these initiatives upon the fortunes of displaced...... households and those who remain in these areas. By presenting the results of an empirical in-depth case study on the effects of an area based initiative targeted at one of the most deprived neighborhoods in Porto, this paper raises several epistemological concerns related to the goals, ideological...

Initial Stages of Recrystallization in Aluminum of Commercial Purity

DEFF Research Database (Denmark)

Hansen, Niels; Bay, Bent

1979-01-01

In commercial aluminum with a purity of 99.4 pct, the formation and growth of recrystallization nuclei were studied by techniques such asin-situ annealing in a high voltage electron microscope, transmission electron microscopy and light microscopy. Sample parameters were the initial grain size (370...... by the FeAl3 particles present in the commercial aluminum as impurities. The nucleation temperatures determined by high voltage electron microscopy and transmission electron microscopy decrease markedly when the initial grain size is decreased both after 50 and 90 pct cold rolling; a less pronounced...

Disseminated neurocysticercosis presenting as acute stress reaction

Directory of Open Access Journals (Sweden)

Shruti Srivastava

2016-01-01

Full Text Available Neurocysticercosis is the most common and preventable parasitic infection of the central nervous system, but disseminated cysticercosis is said to be rare. We report a case of a 31-year-old male, who presented with anxiety manifestations temporally associated with stress related to job. After initial clinical improvement, he presented with an incapacitating headache which was diagnosed as disseminated neurocysticercosis after thorough evaluation and investigations. Magnetic resonance imaging of the brain with contrast showed multiple small hyperintense lesions involving bilateral, temporoparietal, occipital, gangliothalamic with ring enhancement. His cysticercosis antibody IgG serum (EIA was 2.05. The clinical management consisted of antihelminthic and antiepileptic drugs along with stress management.

The Initial Conditions of Fractional Calculus

International Nuclear Information System (INIS)

Trigeassou, J. C.; Maamri, N.

2011-01-01

During the past fifty years , Fractional Calculus has become an original and renowned mathematical tool for the modelling of diffusion Partial Differential Equations and the design of robust control algorithms. However, in spite of these celebrated results, some theoretical problems have not yet received a satisfying solution. The mastery of initial conditions, either for Fractional Differential Equations (FDEs) or for the Caputo and Riemann-Liouville fractional derivatives, remains an open research domain. The solution of this fundamental problem, also related to the long range memory property, is certainly the necessary prerequisite for a satisfying approach to modelling and control applications. The fractional integrator and its continuously frequency distributed differential model is a valuable tool for the simulation of fractional systems and the solution of initial condition problems. Indeed, the infinite dimensional state vector of fractional integrators allows the direct generalization to fractional calculus of the theoretical results of integer order systems. After a reminder of definitions and properties related to fractional derivatives and systems, this presentation is intended to show, based on the results of two recent publications [1,2], how the fractional integrator provides the solution of the initial condition problem of FDEs and of Caputo and Riemann-Liouville fractional derivatives. Numerical simulation examples illustrate and validate these new theoretical concepts.

New method for initial density reconstruction

Science.gov (United States)

Shi, Yanlong; Cautun, Marius; Li, Baojiu

2018-01-01

A theoretically interesting and practically important question in cosmology is the reconstruction of the initial density distribution provided a late-time density field. This is a long-standing question with a revived interest recently, especially in the context of optimally extracting the baryonic acoustic oscillation (BAO) signals from observed galaxy distributions. We present a new efficient method to carry out this reconstruction, which is based on numerical solutions to the nonlinear partial differential equation that governs the mapping between the initial Lagrangian and final Eulerian coordinates of particles in evolved density fields. This is motivated by numerical simulations of the quartic Galileon gravity model, which has similar equations that can be solved effectively by multigrid Gauss-Seidel relaxation. The method is based on mass conservation, and does not assume any specific cosmological model. Our test shows that it has a performance comparable to that of state-of-the-art algorithms that were very recently put forward in the literature, with the reconstructed density field over ˜80 % (50%) correlated with the initial condition at k ≲0.6 h /Mpc (1.0 h /Mpc ). With an example, we demonstrate that this method can significantly improve the accuracy of BAO reconstruction.

Data-to-Decisions S&T Priority Initiative

Science.gov (United States)

2011-11-08

Decisions S&T Priority Initiative Dr. Carey Schwartz PSC Lead Office of Naval Research NDIA Disruptive Technologies Conference November 8-9, 2011...DISTRIBUTION/AVAILABILITY STATEMENT Approved for public release; distribution unlimited 13. SUPPLEMENTARY NOTES Presented at the NDIA Disruptive ... Technologies Conference, November 8,-9, 2011,Washington, DC 14. ABSTRACT 15. SUBJECT TERMS 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT

Catalogue to select the initial guess spectrum during unfolding

CERN Document Server

Vega-Carrillo, H R

2002-01-01

A new method to select the initial guess spectrum is presented. Neutron spectra unfolded from Bonner sphere data are dependent on the initial guess spectrum used in the unfolding code. The method is based on a catalogue of detector count rates calculated from a set of reported neutron spectra. The spectra of three isotopic neutron sources sup 2 sup 5 sup 2 Cf, sup 2 sup 3 sup 9 PuBe and sup 2 sup 5 sup 2 Cf/D sub 2 O, were measured to test the method. The unfolding was carried out using the three initial guess options included in the BUNKIUT code. Neutron spectra were also calculated using MCNP code. Unfolded spectra were compared with those calculated; in all the cases our method gives the best results.

Short term memory bowing effect is consistent with presentation rate dependent decay.

Science.gov (United States)

Tarnow, Eugen

2010-12-01

I reanalyze the free recall data of Murdock, J Exp Psychol 64(5):482-488 (1962) and Murdock and Okada, J Verbal Learn and Verbal Behav 86:263-267 (1970) which show the famous bowing effect in which initial and recent items are recalled better than intermediate items (primacy and recency effects). Recent item recall probabilities follow a logarithmic decay with time of recall consistent with the tagging/retagging theory. The slope of the decay increases with increasing presentation rate. The initial items, with an effectively low presentation rate, decay with the slowest logarithmic slope, explaining the primacy effect. The finding that presentation rate limits the duration of short term memory suggests a basis for memory loss in busy adults, for the importance of slow music practice, for long term memory deficiencies for people with attention deficits who may be artificially increasing the presentation rates of their surroundings. A well-defined, quantitative measure of the primacy effect is introduced.

Cauda equina syndrome presenting as abdominal pain: a case report.

LENUS (Irish Health Repository)

Ellanti, Prasad

2012-09-01

Cauda equina syndrome (CES) is an uncommon entity. Symptoms include bowel and bladder dysfunction, saddle anesthesia, and varying degrees of lower limb motor and sensory disturbances. The consequences of delayed diagnosis can be devastating, resulting in bowel and bladder incontinence and lower limb paralysis. There is little in literature regarding abdominal pain as a significant feature of the initial presentation of CES. We present the case of a 32-year-old woman with CES who presented to the emergency department with gradually worsening lower abdominal pain.

Study on synthesis, application and mechanism of benzophenone/amine initiator

International Nuclear Information System (INIS)

Xiong Wei; Liu Jinshui; Wen Yinjun; Wan Qizhong; Zhou Xianyan; Xiao Hanling; Yang Jianwen

1999-01-01

Through Michael addition reaction of trimethylolpropane triacrylate (TMPTA) with diethylamine (DEA), a new kind of tertiary amine derivative was synthesized and its structure was identified by 'H-NMR. When used in combination with benzophenone, this amine presented excellent curing speed and could be a substitute for initiator Darocur R 1173, which is effective but expensive. If so, the cost of UV-curable coatings can descend apparently. The functioning mechanism of benzophenone/amine bimolecular initiator was studied

Initial results from a charge exchange q-diagnostic on TEXT-U

International Nuclear Information System (INIS)

Valanju, P.M.; Duraiappah, L.; Bengtson, R.D.; Karzhavin, Y.; Nikitin, A.

1994-01-01

The authors present initial results from a new q-diagnostic for TEXT-Upgrade. This method is based on using a toroidal array of detectors to determine the plane in which beam-injected neutrals are emitted after two charge-exchange collisions. The potential advantages are low cost, full plasma accessibility, and good time resolution. Their initial series of experiments on TEXT-U established the feasibility of this technique

Influence of the crystalline orientations on microcrack initiation in low-cycle fatigue

Energy Technology Data Exchange (ETDEWEB)

Mu, P. [Univ Lille Nord de France, F-59000 Lille (France); ECLille, LML, F-59650 Villeneuve d’Ascq (France); CNRS, UMR 8107, UMR 8579 (France); Aubin, V., E-mail: veronique.aubin@ecp.fr [ECP, MSSMat, F-92295 Châtenay-Malabry (France); CNRS, UMR 8107, UMR 8579 (France); Alvarez-Armas, I.; Armas, A. [IFIR, CONICET, Universidad Nacional de Rosario (Argentina)

2013-06-20

Present study aims at analyzing the crack initiation in an austenitic stainless steel in low-cycle fatigue. A fatigue test was carried out using a polished specimen. The surface of the specimen was observed in situ during the fatigue test, in order to establish the time of slip activity or crack initiation. After a number of cycles sufficient to initiate small cracks, the test was stopped and the surface observed by scanning electron microscopy. The electron backscattered diffraction technique (EBSD) was used to identify the orientations of surface grains in the central zone of the fatigue specimen. Crack-initiation sites and slip systems associated to the initiated microcracks were identified. The criterion of the maximum Schmid factor explains two-thirds of the cracks initiated in slip systems; however if the favorably oriented slip band with respect to this criterion makes an angle of around 45° to the loading direction, a crack may initiate in another slip system.

Influence of changes in initial conditions for the simulation of dynamic systems

Energy Technology Data Exchange (ETDEWEB)

Kotyrba, Martin [Department of Informatics and Computers, University of Ostrava, 30 dubna 22, Ostrava (Czech Republic)

2015-03-10

Chaos theory is a field of study in mathematics, with applications in several disciplines including meteorology, sociology, physics, engineering, economics, biology, and philosophy. Chaos theory studies the behavior of dynamical systems that are highly sensitive to initial conditions—a paradigm popularly referred to as the butterfly effect. Small differences in initial conditions field widely diverging outcomes for such dynamical systems, rendering long-term prediction impossible in general. This happens even though these systems are deterministic, meaning that their future behavior is fully determined by their initial conditions, with no random elements involved. In this paperinfluence of changes in initial conditions will be presented for the simulation of Lorenz system.

Research on Initiation Sensitivity of Solid Explosive and Planer Initiation System

Directory of Open Access Journals (Sweden)

N Matsuo

2016-09-01

Full Text Available Firstly, recently, there are a lot of techniques being demanded for complex process, various explosive initiation method and highly accurate control of detonation are needed. In this research, the metal foil explosion using high current is focused attention on the method to obtain linear or planate initiation easily, and the main evaluation of metal foil explosion to initiate explosive was conducted. The explosion power was evaluated by observing optically the underwater shock wave generated from the metal foil explosion. Secondly, in high energy explosive processing, there are several applications, such as shock compaction, explosive welding, food processing and explosive forming. In these explosive applications, a high sensitive explosive has been mainly used. The high sensitive explosive is so dangerous, since it can lead to explosion suddenly. So, for developing explosives, the safety is the most important thing as well as low manufacturing cost and explosive characteristics. In this work, we have focused on the initiation sensitivity of a solid explosive and performed numerical analysis of sympathetic detonation. The numerical analysis is calculated by LS-DYNA 3D (commercial code. To understand the initiation reaction of an explosive, Lee-Tarver equation was used and impact detonation process was analyzed by ALE code. Configuration of simulation model is a quarter of circular cylinder. The donor type of explosive (SEP was used as initiation explosive. When the donor explosive is exploded, a shock wave is generated and it propagates into PMMA, air and metallic layers in order. During passing through the layers, the shock wave is attenuated and finally, it has influence on the acceptor explosive, Comp. B. Here, we evaluate the initiation of acceptor explosive and discuss about detonation pressure, reactive rate of acceptor explosive and attenuation of impact pressure.

The Initial Response To Corticosteroid Therapy in Childhood ...

African Journals Online (AJOL)

Background: Nephrotic syndrome (NS) in African children is associated with poor response to corticosteroids. There is disparity in treatment response on the African continent. The aim of this present study was to describe the initial response to corticosteroid therapy of childhood NS in Côte d'ivoire. Materials and methods: ...

Characteristics of patients initiating raloxifene compared to those initiating bisphosphonates

Directory of Open Access Journals (Sweden)

Wang Sara

2008-12-01

Full Text Available Abstract Background Both raloxifene and bisphosphonates are indicated for the prevention and treatment of postmenopausal osteoporosis, however these medications have different efficacy and safety profiles. It is plausible that physicians would prescribe these agents to optimize the benefit/risk profile for individual patients. The objective of this study was to compare demographic and clinical characteristics of patients initiating raloxifene with those of patients initiating bisphosphonates for the prevention and treatment of osteoporosis. Methods This study was conducted using a retrospective cohort design. Female beneficiaries (45 years and older with at least one claim for raloxifene or a bisphosphonate in 2003 through 2005 and continuous enrollment in the previous 12 months and subsequent 6 months were identified using a collection of large national commercial, Medicare supplemental, and Medicaid administrative claims databases (MarketScan®. Patients were divided into two cohorts, a combined commercial/Medicare cohort and a Medicaid cohort. Within each cohort, characteristics (demographic, clinical, and resource utilization of patients initiating raloxifene were compared to those of patients initiating bisphosphonate therapy. Group comparisons were made using chi-square tests for proportions of categorical measures and Wilcoxon rank-sum tests for continuous variables. Logistic regression was used to simultaneously examine factors independently associated with initiation of raloxifene versus a bisphosphonate. Results Within both the commercial/Medicare and Medicaid cohorts, raloxifene patients were younger, had fewer comorbid conditions, and fewer pre-existing fractures than bisphosphonate patients. Raloxifene patients in both cohorts were less likely to have had a bone mineral density (BMD screening in the previous year than were bisphosphonate patients, and were also more likely to have used estrogen or estrogen/progestin therapy in the

Risk estimation for LCF crack initiation

OpenAIRE

Schmitz, Sebastian; Rollmann, Georg; Gottschalk, Hanno; Krause, Rolf

2013-01-01

An accurate risk assessment for fatigue damage is of vital importance for the design and service of today's turbomachinery components. We present an approach for quantifying the probability of crack initiation due to surface driven low-cycle fatigue (LCF). This approach is based on the theory of failure-time processes and takes inhomogeneous stress fields and size effects into account. The method has been implemented as a finite-element postprocessor which uses quadrature formulae of higher o...

Two patients with osteoporosis : initial presentation of systemic mastocytosis

NARCIS (Netherlands)

Donker, Marjolein L.; Bakker, Nicolaas A.; Jaspers, Wim J. M.; Verhage, Albert H.

In two patients with osteoporosis, systemic mastocytosis ultimately turned out to be the underlying disease. Both patients had a history of anaphylactic reactions caused by wasp stings but did not have any skin or other symptoms. This observation reflects the need for careful history taking and

Heart Rate and Initial Presentation of Cardiovascular Diseases (Caliber)

Science.gov (United States)

2013-09-17

Abdominal Aortic Aneurysm; Coronary Heart Disease NOS; Unheralded Coronary Death; Intracerebral Haemorrhage; Heart Failure; Ischemic Stroke; Myocardial Infarction; Stroke; Peripheral Arterial Disease; Stable Angina Pectoris; Subarachnoid Haemorrhage; Transient Ischemic Attack; Unstable Angina; Cardiac Arrest, Sudden Cardiac Death

Age patterns of smoking initiation among Kuwait university male students.

Science.gov (United States)

Sugathan, T N; Moody, P M; Bustan, M A; Elgerges, N S

1998-12-01

The present study is a detailed evaluation of age at smoking initiation among university male students in Kuwait based on a random sample of 664 students selected from all students during 1993. The Acturial Life Table analysis revealed that almost one tenth of the students initiated cigarette smoking between ages 16 and 17 with the rate of initiation increasing rapidly thereafter and reaching 30% by age 20 and almost 50% by the time they celebrate their 24th birthday. The most important environmental risk factor positively associated for smoking initiation was observed to be the history of smoking among siblings with a relative risk of 1.4. Compared to students of medicine and engineering, the students of other faculties revealed a higher risk in smoking initiation with an RR = 1.77 for sciences and commerce and 1.61 for other faculties (arts, law, education and Islamic studies). The analysis revealed a rising generation trend in cigarette smoking. There is a need for reduction of this trend among young adults in Kuwait and throughout other countries in the region.

A Type-II First Branchial Cleft Anomaly Presenting as a Post-Auricular Salivary Fistula: A Rare Presentation.

Science.gov (United States)

Jain, S; Deshmukh, Pt; Gupta, M; Shukla, S

2014-01-01

First branchial cleft anomalies are rare with the average age of presentation as 19 years. There is an average delay of 3.5 years between initial presentation and adequate treatment due to diagnostic dilemma. A very rare variant of first branchial cleft anomaly presenting as a post-auricular salivary fistula is reported. A 12-year-old girl presented with a history of intermittent watery discharge, more so at the time of meals from a right post-auricular opening for last 3 years. Computed tomography sialography revealed a fistulous tract connecting the sub segmental duct of the parotid gland extending along the pre-tragus region in subcutaneous plane up to mastoid tip after passing inferior to external auditory canal. Superficial parotidectomy with identification of facial nerve branches was carried out for excision of the tract. Histopathology revealed sinus tract comprising of ectodermal components and acini of the parotid gland. We classified our case into work's type-2 based on anatomical location at an angle of mandible, its relationship to parotid gland and facial nerve and previous history of ear discharge. To the best of our knowledge, this is the first case of its type to be reported.

A Type-II First Branchial Cleft Anomaly Presenting as a Post-Auricular Salivary Fistula: A Rare Presentation

Science.gov (United States)

Jain, S; Deshmukh, PT; Gupta, M; Shukla, S

2014-01-01

First branchial cleft anomalies are rare with the average age of presentation as 19 years. There is an average delay of 3.5 years between initial presentation and adequate treatment due to diagnostic dilemma. A very rare variant of first branchial cleft anomaly presenting as a post-auricular salivary fistula is reported. A 12-year-old girl presented with a history of intermittent watery discharge, more so at the time of meals from a right post-auricular opening for last 3 years. Computed tomography sialography revealed a fistulous tract connecting the sub segmental duct of the parotid gland extending along the pre-tragus region in subcutaneous plane up to mastoid tip after passing inferior to external auditory canal. Superficial parotidectomy with identification of facial nerve branches was carried out for excision of the tract. Histopathology revealed sinus tract comprising of ectodermal components and acini of the parotid gland. We classified our case into work's type-2 based on anatomical location at an angle of mandible, its relationship to parotid gland and facial nerve and previous history of ear discharge. To the best of our knowledge, this is the first case of its type to be reported. PMID:24669347

Strengthening the Idea of “By Citizens, for Citizens” in the Context of the European Citizens' Initiative - Brief Analysis of Initiatives

Directory of Open Access Journals (Sweden)

Oana - Măriuca Petrescu

2014-06-01

Full Text Available Regulation (EU No. 211 of 16 February 2011 on the European Citizens' Initiative (ECI, as one of the major innovations of the Treaty of Lisbon, represents the first supranational instrument of direct democracy that took effect on April 1, 2012, creating the direct legal link between the European Union citizens and the European institutions. Within the present paper we will give a general overview of the European Citizens’ Initiative instrument, trying also to analyse briefly certain citizens’ initiatives that have been already registered on the European Commission’s website where the online collection of a million signatures is still running, bearing in mind the important role of the citizens as “co-authors” of the law within the European decision-making process. From our point of view this participation will increase the responsibility of the citizens to be more active and to use their new right in the best conditions and without any obstacles.

Evaluation of initial plasma lactate values as a predictor of gastric necrosis and initial and subsequent plasma lactate values as a predictor of survival in dogs with gastric dilatation-volvulus: 84 dogs (2003-2007).

Science.gov (United States)

Green, Tiffany I; Tonozzi, Caroline C; Kirby, Rebecca; Rudloff, Elke

2011-02-01

To test whether an initial plasma lactate ≥ 6.0 mmol/L is associated with the presence of macroscopic gastric wall necrosis and overall survival in dogs presenting with gastric dilatation-volvulus (GDV). Additionally, if no association was identified we sought to identify a different predictive initial plasma lactate concentration and to examine whether serial plasma lactate concentrations provide better prediction of survival. Retrospective study over a 5-year period (2003-2007). Urban private referral small animal teaching hospital. Eighty-four client-owned dogs with a diagnosis of GDV and plasma lactate measurements. None. There was no statistically significant relationship found between survival and the presence of macroscopic gastric wall necrosis with the initial plasma lactate ≥ 6 mmol/L. There was a significant relationship between the initial plasma lactate >2.9 mmol/L for predicting necrosis and dogs that had an increased initial plasma lactate (>2.5 mmol/L) also had a subsequent plasma lactate measured within 12 hours of presentation, with 37/40 dogs surviving and 70% of these surviving dogs having the subsequent lactate decrease by ≥ 50% within 12 hours. The 3/40 that died failed to decrease their plasma lactate by ≥ 50% from the initial blood lactate. The results of this study indicate that an initial presenting plasma lactate concentration ≥ 6.0 mmol/L is not predictive of macroscopic gastric wall necrosis or survival in dogs presenting with GDV. A decrease in plasma lactate concentrations ≥ 50% within 12 hours may be a good indicator for survival. Limitations to the study include its retrospective nature, the small number of patients, and the number of dogs that were euthanized rather than allowed to progress to a natural outcome. © Veterinary Emergency and Critical Care Society 2011.

Sustainable Agricultural Marketing Initiatives

Directory of Open Access Journals (Sweden)

Hakan Adanacıoğlu

2015-07-01

Full Text Available Sustainable marketing is a holistic approach that puts equal emphasis on environmental, social equity, and economic concerns in the development of marketing strategies. The purpose of the study is to examine and discuss the sustainable agricultural marketing initiatives practiced throughout the World and Turkey, and to put forth suggestions to further improve the performance of agricultural marketing initiatives in Turkey. Some of the sustainable agricultural marketing initiatives practiced around the world are carried out through civil organizations. Furthermore; some of these initiatives have also launched by farmers, consumers, food processors and retailers. The long-term strategies to increase these initiatives should be determined due to the fact that examples of successful sustainable agricultural marketing initiatives are inadequate and cannot be spread in Turkey. In this context, first of all, the supports provided by the government to improve agricultural marketing systems, such as EU funds for rural development should be compatible with the goals of sustainable marketing. For this purpose, it should be examined whether all proposed projects related to agricultural marketing meet the social, economic, and environmental principles of sustainable marketing. It is important that supporting organizations, especially civil society organisations, should take an active role for faster dissemination and adoption of sustainable agricultural marketing practices in Turkey. These organizations may provide technical assistance in preparing successful project proposals and training to farm groups. In addition, the other organizations, such as local administrations, producers' associations, cooperatives, can contribute to the success of sustainable agricultural marketing initiatives. The use of direct marketing strategies and vertical integration attempts in sustainable agricultural marketing initiatives that will likely be implemented in Turkey is

Independence of Movement Preparation and Movement Initiation.

Science.gov (United States)

Haith, Adrian M; Pakpoor, Jina; Krakauer, John W

2016-03-09

Initiating a movement in response to a visual stimulus takes significantly longer than might be expected on the basis of neural transmission delays, but it is unclear why. In a visually guided reaching task, we forced human participants to move at lower-than-normal reaction times to test whether normal reaction times are strictly necessary for accurate movement. We found that participants were, in fact, capable of moving accurately ∼80 ms earlier than their reaction times would suggest. Reaction times thus include a seemingly unnecessary delay that accounts for approximately one-third of their duration. Close examination of participants' behavior in conventional reaction-time conditions revealed that they generated occasional, spontaneous errors in trials in which their reaction time was unusually short. The pattern of these errors could be well accounted for by a simple model in which the timing of movement initiation is independent of the timing of movement preparation. This independence provides an explanation for why reaction times are usually so sluggish: delaying the mean time of movement initiation relative to preparation reduces the risk that a movement will be initiated before it has been appropriately prepared. Our results suggest that preparation and initiation of movement are mechanistically independent and may have a distinct neural basis. The results also demonstrate that, even in strongly stimulus-driven tasks, presentation of a stimulus does not directly trigger a movement. Rather, the stimulus appears to trigger an internal decision whether to make a movement, reflecting a volitional rather than reactive mode of control. Copyright © 2016 the authors 0270-6474/16/363007-10$15.00/0.

Initial presentation of a giant gastrointestinal stromal tumour of the stomach with recurrent spontaneous intra-peritoneal haemorrhage

Directory of Open Access Journals (Sweden)

Margarida Vinagreiro

2015-01-01

Discussion and conclusion: GISTs are uncommon and rarely present with spontaneous intra-peritoneal haemorrhage, which may be life threatening. In our understanding, this is the first reported case of the reviewed literature presenting with a chronic hemoperitoneum, due to recurrent brisk episodes of tumour haemorrhage. Tumour rupture and large tumour size are two poor independent prognostic tumour factors for recurrence. Despite this, the patient remains free of disease after surgery and instituted adjuvant imatinib mesylate.

Community Rates of Breastfeeding Initiation.

Science.gov (United States)

Grubesic, Tony H; Durbin, Kelly M

2016-11-01

Breastfeeding initiation rates vary considerably across racial and ethnic groups, maternal age, and education level, yet there are limited data concerning the influence of geography on community rates of breastfeeding initiation. This study aimed to describe how community rates of breastfeeding initiation vary in geographic space, highlighting "hot spots" and "cool spots" of initiation and exploring the potential connections between race, socioeconomic status, and urbanization levels on these patterns. Birth certificate data from the Kentucky Department of Health for 2004-2010 were combined with county-level geographic base files, Census 2010 demographic and socioeconomic data, and Rural-Urban Continuum Codes to conduct a spatial statistical analysis of community rates of breastfeeding initiation. Between 2004 and 2010, the average rate of breastfeeding initiation for Kentucky increased from 43.84% to 49.22%. Simultaneously, the number of counties identified as breastfeeding initiation hot spots also increased, displaying a systematic geographic pattern in doing so. Cool spots of breastfeeding initiation persisted in rural, Appalachian Kentucky. Spatial regression results suggested that unemployment, income, race, education, location, and the availability of International Board Certified Lactation Consultants are connected to breastfeeding initiation. Not only do spatial analytics facilitate the identification of breastfeeding initiation hot spots and cool spots, but they can be used to better understand the landscape of breastfeeding initiation and help target breastfeeding education and/or support efforts.

Full-field initialized decadal predictions with the MPI earth system model: an initial shock in the North Atlantic

Science.gov (United States)

Kröger, Jürgen; Pohlmann, Holger; Sienz, Frank; Marotzke, Jochem; Baehr, Johanna; Köhl, Armin; Modali, Kameswarrao; Polkova, Iuliia; Stammer, Detlef; Vamborg, Freja S. E.; Müller, Wolfgang A.

2017-12-01

Our decadal climate prediction system, which is based on the Max-Planck-Institute Earth System Model, is initialized from a coupled assimilation run that utilizes nudging to selected state parameters from reanalyses. We apply full-field nudging in the atmosphere and either full-field or anomaly nudging in the ocean. Full fields from two different ocean reanalyses are considered. This comparison of initialization strategies focuses on the North Atlantic Subpolar Gyre (SPG) region, where the transition from anomaly to full-field nudging reveals large differences in prediction skill for sea surface temperature and ocean heat content (OHC). We show that nudging of temperature and salinity in the ocean modifies OHC and also induces changes in mass and heat transports associated with the ocean flow. In the SPG region, the assimilated OHC signal resembles well OHC from observations, regardless of using full fields or anomalies. The resulting ocean transport, on the other hand, reveals considerable differences between full-field and anomaly nudging. In all assimilation runs, ocean heat transport together with net heat exchange at the surface does not correspond to OHC tendencies, the SPG heat budget is not closed. Discrepancies in the budget in the cases of full-field nudging exceed those in the case of anomaly nudging by a factor of 2-3. The nudging-induced changes in ocean transport continue to be present in the free running hindcasts for up to 5 years, a clear expression of memory in our coupled system. In hindcast mode, on annual to inter-annual scales, ocean heat transport is the dominant driver of SPG OHC. Thus, we ascribe a significant reduction in OHC prediction skill when using full-field instead of anomaly initialization to an initialization shock resulting from the poor initialization of the ocean flow.

Initiating antiretroviral therapy for HIV at a patient's first clinic visit: a cost-effectiveness analysis of the rapid initiation of treatment randomized controlled trial.

Science.gov (United States)

Long, Lawrence C; Maskew, Mhairi; Brennan, Alana T; Mongwenyana, Constance; Nyoni, Cynthia; Malete, Given; Sanne, Ian; Fox, Matthew P; Rosen, Sydney

2017-07-17

Determine the cost and cost-effectiveness of single-visit (same-day) antiretroviral treatment (ART) initiation compared to standard of care initiation. Cost-effectiveness analysis of individually randomized (1 : 1) pragmatic trial of single-visit initiation, which increased viral suppression at 10 months by 26% [relative risk (95% confidence interval) 1.26 (1.05-1.50)]. Primary health clinic in Johannesburg, South Africa. HIV positive, adult, nonpregnant patients not yet on ART or known to be eligible who presented at the clinic 8 May 2013 to 29 August 2014. Same-day ART initiation using point-of-care laboratory instruments and accelerated clinic procedures to allow treatment-eligible patients to receive antiretroviral medications at the same visit as testing HIV positive or having an eligible CD4 cell count. Comparison was to standard of care ART initiation, which typically required three to five additional clinic visits. Average cost per patient enrolled and per patient achieving the primary outcome of initiated 90 days or less and suppressed 10 months or less, and production cost per patient achieving primary outcome (all costs per primary outcome patients). The average cost per patient enrolled, per patient achieving the primary outcome, and production cost were $319, $487, and $738 in the standard arm and $451, $505, and $707 in the rapid arm. Same-day treatment initiation was more effective than standard initiation, more expensive per patient enrolled, and less expensive to produce a patient achieving the primary outcome. Omitting point-of-care laboratory tests at initiation and focusing on high-volume clinics have the potential to reduce costs substantially and should be evaluated in routine settings.

Deficits in retention for verbally presented medical information.

Science.gov (United States)

Sandberg, Elisabeth H; Sharma, Ritu; Sandberg, Warren S

2012-10-01

Anesthesiologists deliver large quantities of verbal information to patients during preoperative teaching. Basic principles of cognitive psychology dictate that much of this information is likely to be forgotten. Exactly how much and what type of information can be retained and recalled remains an open question. With Institutional Review Board approval, 98 healthy, educated volunteers viewed a brief video containing a preoperative explanation of anesthetic options and instructions. Subjects were then asked to engage in free and cued recall of information from the video, and to complete a recognition task. We developed a coding scheme to objectively score the free and cued recall tasks for the quantity of information recalled relative to the quantity presented in the video. Data are presented as descriptive statistics. Subjects spontaneously recalled less than 25% of the information presented. Providing retrieval cues greatly enhanced recall: Subjects recalled 67%, on average, of the material queried in the cued recall task. Performance was even stronger on the multiple-choice test (83% of items correctly answered), indicating that the information was initially encoded. The category of information that was consistently least-remembered was presurgical medication instructions. Under realistic conditions for recall, most medical instruction given to patients will not be recalled, even if it is initially encoded. Given the limits of short-term memory, clinicians should carefully consider their patterns of information giving. Improvement of memory performance with cues for retrieval indicates that providing printed instructions for later review may be beneficial.

Apakah Personal Initiative Mahasiswa dapat Dikembangkan dengan Mata Kuliah Character Building?

OpenAIRE

Antonina Pantja Juni Wulandari

2010-01-01

Personal initiative is an active behavior to achieve work's target, influenced by self-starting aspects, proactive, and toughness in overcoming some constraints. Article presented on how to achieve effectiveness in Character Building subject on personal initiative development based on a research using different group test method. Compared groups were students having finished Character Building subject and not yet followed with the amount of 103 students. Questionnaires consisting of 43 items ...

Building capacity for low-carbon communities: The role of grassroots initiatives

International Nuclear Information System (INIS)

Middlemiss, Lucie; Parrish, Bradley D.

2010-01-01

Grassroots initiatives for change rely on people with limited power, limited resources and limited ability to influence others. From this position, people acting from the bottom up can change their own actions, seek to influence others around them and seek to change the social structures that they inhabit. These acts are invariably conceived, initiated and enacted within communities, and there is an emerging interest from practitioner, policy and academic circles in the importance of community as a space for realising pro-environmental change. In this paper, we ask what role grassroots initiatives can have in creating low-carbon communities. Using a theoretical framework from work on community-based practice change initiatives, we discuss the interplay between grassroots action and community capacity. We then present two cases of grassroots low-carbon community initiatives in light of this theoretical work. We conclude by discussing key themes emerging from the cases, including the potential for grassroots initiatives to build community capacity for low-carbon practices, and the importance of locally crafted solutions according to the structures specific to place.

Presentation of lipid antigens to T cells.

Science.gov (United States)

Mori, Lucia; De Libero, Gennaro

2008-04-15

T cells specific for lipid antigens participate in regulation of the immune response during infections, tumor immunosurveillance, allergy and autoimmune diseases. T cells recognize lipid antigens as complexes formed with CD1 antigen-presenting molecules, thus resembling recognition of MHC-peptide complexes. The biophysical properties of lipids impose unique mechanisms for their delivery, internalization into antigen-presenting cells, membrane trafficking, processing, and loading of CD1 molecules. Each of these steps is controlled at molecular and celular levels and determines lipid immunogenicity. Lipid antigens may derive from microbes and from the cellular metabolism, thus allowing the immune system to survey a large repertoire of immunogenic molecules. Recognition of lipid antigens facilitates the detection of infectious agents and the initiation of responses involved in immunoregulation and autoimmunity. This review focuses on the presentation mechanisms and specific recognition of self and bacterial lipid antigens and discusses the important open issues.

Breakfast in human nutrition: The international breakfast research initiative

DEFF Research Database (Denmark)

Gibney, Michael J.; Barr, Susan I.; Bellisle, France

2018-01-01

to relate breakfast nutrient intakes to overall diet quality. The present review describes a novel and harmonised approach to the study of the nutritional impact of breakfast through The International Breakfast research Initiative involving national dietary survey data from Canada, Denmark, France, Spain...

Editorial : initiating cultural heritage research to increase Europe's competitiveness

NARCIS (Netherlands)

Pereira Roders, A.R.; Oers, van R.

2011-01-01

Purpose – The purpose of this paper is to present and discuss the contribution of European Commission (EC) initiatives to stimulate cultural heritage research over the last 20 years and the contribution of the research results to cultural heritage management and sustainable development.

Synchronous Bone Metastasis From Multiple Myeloma and Prostate Adenocarcinoma as Initial Presentation of Coexistent Malignancies

Directory of Open Access Journals (Sweden)

Diego Andres Adrianzen Herrera

2018-04-01

Full Text Available The radiographic appearance of bone metastases is usually determined by tumor histology and can be osteolytic, osteoblastic, or mixed. We present a patient with coexistent bone metastasis from multiple myeloma and prostate adenocarcinoma who exhibited synchronous bone involvement of both histologies within the same bone lesion, a rare phenomenon that has not been previously reported and led to atypical radiographic findings. The radiograph of a 71-year-old man with thigh swelling and pain demonstrated a lytic femoral lesion. Magnetic resonance imaging (MRI confirmed a destructive process, but showed coexistent metaphyseal sclerosis. Multiple myeloma was suspected by demonstration of monoclonal gammopathy and confirmed by computed tomography (CT-guided biopsy. Incidentally, CT demonstrated areas of sclerosis corresponding to T2 hypointensity on MRI. Further studies revealed osteoblastic spinal metastasis, prostate enhancement on CT and prostate-specific antigen (PSA level of 90 ng/mL, concerning for concomitant prostate neoplasm. After endoprosthetic reconstruction, pathology of the femur identified both plasma cell neoplasm and metastatic prostate adenocarcinoma. An association between prostate cancer and multiple myeloma is hypothesized due to tumor microenvironment similarities and possible common genetic variations, however, coexisting bone metastases have never been reported. This unusual finding explains the discrepant imaging features in our patient and is evidenced that certain clinical situations merit contemplation of atypical presentations of common malignancies even if this leads to additional testing.

Barriers to initiation of antiretrovirals during antituberculosis therapy in Africa.

Directory of Open Access Journals (Sweden)

Dominique J Pepper

2011-05-01

Full Text Available In the developing world, the principal cause of death among HIV-infected patients is tuberculosis (TB. The initiation of antiretroviral therapy (ART during TB therapy significantly improves survival, however it is not known which barriers prevent eligible TB patients from initiating life-saving ART.Setting. A South African township clinic with integrated tuberculosis and HIV services. Design. Logistic regression analyses of a prospective cohort of HIV-1 infected adults (≥18 years who commenced TB therapy, were eligible for ART, and were followed for 6 months.Of 100 HIV-1 infected adults eligible for ART during TB therapy, 90 TB patients presented to an ART clinic for assessment, 66 TB patients initiated ART, and 15 TB patients died. 34% of eligible TB patients (95%CI: 25-43% did not initiate ART. Male gender and younger age (<36 years were associated with failure to initiate ART (adjusted odds ratios of 3.7 [95%CI: 1.25-10.95] and 3.3 [95%CI: 1.12-9.69], respectively. Death during TB therapy was associated with a CD4+ count <100 cells/µL.In a clinic with integrated services for tuberculosis and HIV, one-third of eligible TB patients--particularly young men--did not initiate ART. Strategies are needed to promote ART initiation during TB therapy, especially among young men.

Supply guarantee initiatives for nuclear fuel materials and services and their compatibility with the market. Present discussions and future prospects

International Nuclear Information System (INIS)

Nagano, Koji

2008-01-01

Under the weakening NPT (Non-Proliferation Treaty) regime, a number of proposals and initiatives for nuclear fuel supply assurance and guarantee mechanisms have been brought on the agenda of international discussions and negotiations. This report first discusses where and why those ideas came out, and then turn to the current situations of markets of nuclear fuel materials and services in terms of degree of market concentration to specific suppliers. Based on those observations, the author attempts to draw a comparison among the proposed schemes in order to examine possible steps for forward that pose least possible influences adverse to the individual markets and thereby could better attract possible recipient states' interests. The report suggests that those initiatives are classified in three types; a) physical assurance, i.e. specific nation(s) and/or entit(-y/-ies) prepare dedicated reserve of materials and/or service capacities for the purpose of supply assurance; b) collective assurance, i.e. a group of nations and/or entities collectively submit their excess materials and service capacities when assurance is activated; and c) financial measures. In view of their feasibility, a two-step approach might be found practical to implement and promote; i.e. 1) in a short-run, a 'soft' scheme which never interferes NPT signatories' right of peaceful development and use of nuclear power could be set and implemented, and 2) in a long-run, R and D efforts should be undertaken to create such a sufficient economic margin that potential recipient states may lose justification of self-development of nuclear fuel cycle technologies and businesses when compared with those services provided by foreign sources attached with a sufficient degree of supply assurances. (author)

Utility of the broccoli sign in the distinction of prolapsed uterine tumor from cervical tumor

Energy Technology Data Exchange (ETDEWEB)

Jha, Priyanka; Chang, Stephanie T. [Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0628 (United States); Rabban, Joseph T. [Department of Anatomic Pathology, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0628 (United States); Chen, Lee-may [Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0628 (United States); Yeh, Benjamin M. [Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0628 (United States); Coakley, Fergus V., E-mail: Fergus.Coakley@radiology.ucsf.edu [Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0628 (United States)

2012-08-15

Objective: To describe the utility, histopathological basis, and clinical correlates of the broccoli sign. Methods: The committee on human research approved this HIPAA compliant study and waived written informed consent. Based on the records of the senior author and our multidisciplinary Gynecologic Oncology Tumor Board, we retrospectively identified thirteen women (mean age of 48.8 years; range, 34-74) with a cervical mass seen at MR imaging (n = 13) or CT (n = 5) that demonstrated the previously reported broccoli sign (i.e., a soft tissue stalk connecting the cervical mass to the uterine cavity) on one or other modality. All available clinical, imaging, and histopathological records were reviewed, with particular emphasis on initially suspected diagnosis, final proven diagnosis, and outcome. Results: Cervical cancer was the initial clinically suspected diagnosis in 6 of 13 patients. Surgical resection demonstrated prolapsed uterine tumor in all patients, consisting of endometrioid adenocarcinoma (n = 7), carcinosarcoma (n = 2), adenosarcoma (n = 1), and leiomyoma (n = 3). Excluding the three patients with leiomyomas, currently, 7 patients with malignant tumors are disease free after a mean interval of 15 months (range, 3-45) and 3 patients have been lost to follow-up. Conclusion: A stalk connecting an apparent cervical mass seen at CT or MR imaging to the endometrial cavity ('broccoli sign') favors the diagnosis of a prolapsed uterine tumor; these prolapsed uterine tumors can often be malignant but appear to have a good prognosis.

Utility of the broccoli sign in the distinction of prolapsed uterine tumor from cervical tumor

International Nuclear Information System (INIS)

Jha, Priyanka; Chang, Stephanie T.; Rabban, Joseph T.; Chen, Lee-may; Yeh, Benjamin M.; Coakley, Fergus V.

2012-01-01

Objective: To describe the utility, histopathological basis, and clinical correlates of the broccoli sign. Methods: The committee on human research approved this HIPAA compliant study and waived written informed consent. Based on the records of the senior author and our multidisciplinary Gynecologic Oncology Tumor Board, we retrospectively identified thirteen women (mean age of 48.8 years; range, 34–74) with a cervical mass seen at MR imaging (n = 13) or CT (n = 5) that demonstrated the previously reported broccoli sign (i.e., a soft tissue stalk connecting the cervical mass to the uterine cavity) on one or other modality. All available clinical, imaging, and histopathological records were reviewed, with particular emphasis on initially suspected diagnosis, final proven diagnosis, and outcome. Results: Cervical cancer was the initial clinically suspected diagnosis in 6 of 13 patients. Surgical resection demonstrated prolapsed uterine tumor in all patients, consisting of endometrioid adenocarcinoma (n = 7), carcinosarcoma (n = 2), adenosarcoma (n = 1), and leiomyoma (n = 3). Excluding the three patients with leiomyomas, currently, 7 patients with malignant tumors are disease free after a mean interval of 15 months (range, 3–45) and 3 patients have been lost to follow-up. Conclusion: A stalk connecting an apparent cervical mass seen at CT or MR imaging to the endometrial cavity (“broccoli sign”) favors the diagnosis of a prolapsed uterine tumor; these prolapsed uterine tumors can often be malignant but appear to have a good prognosis.

Exploring the role of social capital in urban citizens' initiatives in the Netherlands.

Science.gov (United States)

Wentink, Carlijn; Vaandrager, Lenneke; van Dam, Rosalie; Hassink, Jan; Salverda, Irini

2017-07-24

This research explores the role of social capital in urban citizens' initiatives in the Netherlands, by using in-depth interviews. Social capital was operationalized as shared norms and values, connectedness, trust and reciprocity. The findings show that initiatives form around a shared idea or ambition (shared norms and values). An existing network of relationships (connectedness) is needed for an idea to emerge and take form. Connectedness can also increase as a result of an initiative. Some level of trust between people needs to be present from the start of the initiative. For the initiative to persist, strong in-group connections seem important, as well as a good balance between investments and returns. This reciprocity is mainly about intangible assets, such as energy and friendship. This study concludes that social capital within citizens' initiatives is both a prerequisite for the formation of initiatives and a result of the existence of initiatives. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Workshop on initiation of stress corrosion cracking under LWR conditions: Proceedings

International Nuclear Information System (INIS)

Nelson, J.L.; Cubicciotti, D.; Licina, G.J.

1988-05-01

A workshop titled ''Initiation of Stress Corrosion Cracking under LWR Conditions'' was held in Palo Alto, California on November 13, 1986, hosted by the Electric Power Research Institute. Participants were experts on the topic from nuclear steam supply and component manufacturers, public and private research laboratories, and university environments. Presentations included discussions on the definition of crack initiation, the effects of environmental and electrochemical variables on cracking susceptibility, and detection methods for the determination of crack initiation events and measurement of critical environmental and stress parameters. Examination of the questions related to crack initiation and its relative importance to the overall question of cracking of LWR materials from these perspectives provided inputs to EPRI project managers on the future direction of research efforts designed to prevent and control cracking. Thirteen reports have been cataloged separately

Antigen Cross-Presentation of Immune Complexes

Science.gov (United States)

Platzer, Barbara; Stout, Madeleine; Fiebiger, Edda

2014-01-01

The ability of dendritic cells (DCs) to cross-present tumor antigens has long been a focus of interest to physicians, as well as basic scientists, that aim to establish efficient cell-based cancer immune therapy. A prerequisite for exploiting this pathway for therapeutic purposes is a better understanding of the mechanisms that underlie the induction of tumor-specific cytotoxic T-lymphocyte (CTL) responses when initiated by DCs via cross-presentation. The ability of humans DC to perform cross-presentation is of utmost interest, as this cell type is a main target for cell-based immunotherapy in humans. The outcome of a cross-presentation event is guided by the nature of the antigen, the form of antigen uptake, and the subpopulation of DCs that performs presentation. Generally, CD8α+ DCs are considered to be the most potent cross-presenting DCs. This paradigm, however, only applies to soluble antigens. During adaptive immune responses, immune complexes form when antibodies interact with their specific epitopes on soluble antigens. Immunoglobulin G (IgG) immune complexes target Fc-gamma receptors on DCs to shuttle exogenous antigens efficiently into the cross-presentation pathway. This receptor-mediated cross-presentation pathway is a well-described route for the induction of strong CD8+ T cell responses. IgG-mediated cross-presentation is intriguing because it permits the CD8− DCs, which are commonly considered to be weak cross-presenters, to efficiently cross-present. Engaging multiple DC subtypes for cross-presentation might be a superior strategy to boost CTL responses in vivo. We here summarize our current understanding of how DCs use IgG-complexed antigens for the efficient induction of CTL responses. Because of its importance for human cell therapy, we also review the recent advances in the characterization of cross-presentation properties of human DC subsets. PMID:24744762

Relativistic initial conditions for N-body simulations

Energy Technology Data Exchange (ETDEWEB)

Fidler, Christian [Catholic University of Louvain—Center for Cosmology, Particle Physics and Phenomenology (CP3) 2, Chemin du Cyclotron, B-1348 Louvain-la-Neuve (Belgium); Tram, Thomas; Crittenden, Robert; Koyama, Kazuya; Wands, David [Institute of Cosmology and Gravitation, University of Portsmouth, Portsmouth PO1 3FX (United Kingdom); Rampf, Cornelius, E-mail: christian.fidler@uclouvain.be, E-mail: thomas.tram@port.ac.uk, E-mail: rampf@thphys.uni-heidelberg.de, E-mail: robert.crittenden@port.ac.uk, E-mail: kazuya.koyama@port.ac.uk, E-mail: david.wands@port.ac.uk [Institut für Theoretische Physik, Universität Heidelberg, Philosophenweg 16, D–69120 Heidelberg (Germany)

2017-06-01

Initial conditions for (Newtonian) cosmological N-body simulations are usually set by re-scaling the present-day power spectrum obtained from linear (relativistic) Boltzmann codes to the desired initial redshift of the simulation. This back-scaling method can account for the effect of inhomogeneous residual thermal radiation at early times, which is absent in the Newtonian simulations. We analyse this procedure from a fully relativistic perspective, employing the recently-proposed Newtonian motion gauge framework. We find that N-body simulations for ΛCDM cosmology starting from back-scaled initial conditions can be self-consistently embedded in a relativistic space-time with first-order metric potentials calculated using a linear Boltzmann code. This space-time coincides with a simple ''N-body gauge'' for z < 50 for all observable modes. Care must be taken, however, when simulating non-standard cosmologies. As an example, we analyse the back-scaling method in a cosmology with decaying dark matter, and show that metric perturbations become large at early times in the back-scaling approach, indicating a breakdown of the perturbative description. We suggest a suitable ''forwards approach' for such cases.

Solitary brain metastasis as an initial manifestation of gall bladder carcinoma

Directory of Open Access Journals (Sweden)

Kamlesh Kumar Harsh

2015-01-01

Full Text Available Gallbladder cancer is a common malignancy in Northern India, and it accounts for 2-4% of all malignant gastrointestinal tumors. It is an aggressive tumor with early dissemination to liver and lymph nodes and associated with poor prognosis. Systemic metastases from gall bladder carcinoma (Ca frequently occur; however, metastatic involvement of the central nervous system is rare and late manifestation and remains an ominous sign. Initial presentation of gall bladder Ca with brain metastasis is rare. We report a case of 65-year-old women who initially presented with a solitary brain metastasis from an adenocarcinoma of the gallbladder, which was diagnosed incidentally when the patient presented with headache, vomiting, and right temporal region swelling. Palliative chemotherapy and cranial radiotherapy were prescribed. She is symptom-free from 3 months after the completion of the treatment.

Developing agricultural opportunities on mine tailings : the Green Mines green energy initiative

Energy Technology Data Exchange (ETDEWEB)

Tisch, B.; Spiers, G.; Beckett, P.; Lock, A. [Natural Resources Canada, Ottawa, ON (Canada). CANMET Mining and Mineral Sciences Laboratories

2009-02-15

The goal of the Green Mines green energy initiative is to advance mine reclamation through the beneficial use of organic residuals for the sustainable establishment of bioenergy crops and other productive land uses. Target organic residuals include: source separated organic compost; papermill biosolids; leaf and yard waste compost; and municipal wastewater biosolids. This presentation discussed the Green Mines green energy initiative with particular reference to potential uses; current participants; scope of the initiative; and progress to date. The presentation also discussed a column study that involved adding filter, filter fabric, silica sand and polyethylene beads to the base of columns. Unoxidized tailings were slurried and pumped into columns and then the oxidized tailings were dried and homogenized. The results of acidic copper/nickel tailings with lime and no lime were also discussed. A summary of findings from the column study was offered. It was found that nutrient management must be considered and organic covers appear to increase metal and arsenic leaching from unlimed tailings. The presentation also made reference to demonstration field plots; biosolids delivery; tilling; monitoring; biomass sampling; and harvesting. The presentation concluded with a discussion of next steps which involve completing construction of the current suite of field plots and implementing full monitoring. figs.

Analyzing Digital Library Initiatives: 5S Theory Perspective

Science.gov (United States)

Isah, Abdulmumin; Mutshewa, Athulang; Serema, Batlang; Kenosi, Lekoko

2015-01-01

This article traces the historical development of Digital Libraries (DLs), examines some DL initiatives in developed and developing countries and uses 5S Theory as a lens for analyzing the focused DLs. The analysis shows that present-day systems, in both developed and developing nations, are essentially content and user centric, with low level…

Thinking, Language and Learning in Initial Teacher Education

Science.gov (United States)

Taylor, Nick

2016-01-01

Initial teacher education (ITE) serves as a bridge between prospective teachers exiting the school system to enrol in teacher education faculties, on the one hand and newly qualified teachers (NQTs) who are embarking on a career in schooling on the other. The present paper describes the language and thinking skills student teachers bring to their…

Kinematics of self-initiated and reactive karate punches.

Science.gov (United States)

Martinez de Quel, Oscar; Bennett, Simon J

2014-03-01

This study investigated whether within-task expertise affects the reported asymmetry in execution time exhibited in reactive and self-initiated movements. Karate practitioners and no-karate practitioners were compared performing a reverse punch in reaction to an external stimulus or following the intention to produce a response (self-initiated). The task was completed following the presentation of a specific (i.e., life-size image of opponent) or general stimulus and in the presence of click trains or white noise. Kinematic analyses indicated reactive movement had shorter time to peak velocity and movement time, as well as greater accuracy than self-initiated movement. These differences were independent of participant skill level although peak velocity was higher in the karate practice group than in the no-karate practice group. Reaction time (RT) of skilled participants was facilitated by a specific stimulus. There was no effect on RT or kinematic variables of the different type of auditory cues. The results of this study indicate that asymmetry in execution time of reactive and self-initiated movement holds irrespective of within-task expertise and stimulus specificity. This could have implications for training of sports and/or relearning of tasks that require rapid and accurate movements to intercept/contact a target.

Piezoelectrically Initiated Pyrotechnic Igniter

Science.gov (United States)

Quince, Asia; Dutton, Maureen; Hicks, Robert; Burnham, Karen

2013-01-01

This innovation consists of a pyrotechnic initiator and piezoelectric initiation system. The device will be capable of being initiated mechanically; resisting initiation by EMF, RF, and EMI (electromagnetic field, radio frequency, and electromagnetic interference, respectively); and initiating in water environments and space environments. Current devices of this nature are initiated by the mechanical action of a firing pin against a primer. Primers historically are prone to failure. These failures are commonly known as misfires or hang-fires. In many cases, the primer shows the dent where the firing pin struck the primer, but the primer failed to fire. In devices such as "T" handles, which are commonly used to initiate the blowout of canopies, loss of function of the device may result in loss of crew. In devices such as flares or smoke generators, failure can result in failure to spot a downed pilot. The piezoelectrically initiated ignition system consists of a pyrotechnic device that plugs into a mechanical system (activator), which on activation, generates a high-voltage spark. The activator, when released, will strike a stack of electrically linked piezo crystals, generating a high-voltage, low-amperage current that is then conducted to the pyro-initiator. Within the initiator, an electrode releases a spark that passes through a pyrotechnic first-fire mixture, causing it to combust. The combustion of the first-fire initiates a primary pyrotechnic or explosive powder. If used in a "T" handle, the primary would ramp the speed of burn up to the speed of sound, generating a shock wave that would cause a high explosive to go "high order." In a flare or smoke generator, the secondary would produce the heat necessary to ignite the pyrotechnic mixture. The piezo activator subsystem is redundant in that a second stack of crystals would be struck at the same time with the same activation force, doubling the probability of a first strike spark generation. If the first

Identification of Initiating Events for PGSFR

International Nuclear Information System (INIS)

Kim, Jintae; Jae, Moosung

2016-01-01

The Sodium-cooled Fast Reactor (SFR) is by far the most advanced reactor of the six Generation IV reactors. The SFR uses liquid sodium as the reactor coolant, which has superior heat transport characteristics. It also allows high power density with low coolant volume fraction and operation at low pressure. In Korea, KAERI has been developing Prototype Generation-IV Sodium-cooled Fast Reactor (PGSFR) that employs passive safety systems and inherent reactivity feedback effects. In order to prepare for the licensing, it is necessary to assess the safety of the reactor. Thus, the objective of this study is to conduct accident sequence analysis that can contribute to risk assessment. The analysis embraces identification of initiating events and accident sequences development. PGSFR is to test and demonstrate the performance of transuranic (TRU)-containing metal fuel required for a commercial SFR, and to demonstrate the TRU transmutation capability of a burner reactor as a part of an advanced fuel cycle system. Initiating events that can happen in PGSFR were identified through the MLD method. This method presents a model of a plant in terms of individual events and their combinations in a systematic and logical way. The 11 identified initiating events in this study include the events considered in the past analysis that was conducted for PRISM-150

Identification of Initiating Events for PGSFR

Energy Technology Data Exchange (ETDEWEB)

Kim, Jintae; Jae, Moosung [Hanyang University, Seoul (Korea, Republic of)

2016-10-15

The Sodium-cooled Fast Reactor (SFR) is by far the most advanced reactor of the six Generation IV reactors. The SFR uses liquid sodium as the reactor coolant, which has superior heat transport characteristics. It also allows high power density with low coolant volume fraction and operation at low pressure. In Korea, KAERI has been developing Prototype Generation-IV Sodium-cooled Fast Reactor (PGSFR) that employs passive safety systems and inherent reactivity feedback effects. In order to prepare for the licensing, it is necessary to assess the safety of the reactor. Thus, the objective of this study is to conduct accident sequence analysis that can contribute to risk assessment. The analysis embraces identification of initiating events and accident sequences development. PGSFR is to test and demonstrate the performance of transuranic (TRU)-containing metal fuel required for a commercial SFR, and to demonstrate the TRU transmutation capability of a burner reactor as a part of an advanced fuel cycle system. Initiating events that can happen in PGSFR were identified through the MLD method. This method presents a model of a plant in terms of individual events and their combinations in a systematic and logical way. The 11 identified initiating events in this study include the events considered in the past analysis that was conducted for PRISM-150.

Student initiative: A conceptual analysis

Directory of Open Access Journals (Sweden)

Polovina Nada

2014-01-01

Full Text Available In the description and scientific consideration of the attitude of children and youth towards their education and development, the concept of student initiative has been gaining ground lately, and it is hence the subject of analysis in this paper. The analysis is important because of the discrepancy between the increased efforts of the key educational policy holders to promote the idea about the importance of the development of student initiative and rare acceptance of this idea among theoreticians, researchers and practitioners dealing with the education and development of children and youth. By concretising the features of initiative student behaviour, our aim was, on the one hand, to observe the structural determinants and scientific status of the very concept of an initiative student, and, on the other, to contribute to the understanding of the initiative behaviour in practice. In the first part of the paper we deal with different notions and concretisations of the features of initiative behaviour of children and youth, which includes the consideration of: basic student initiative, academic student initiative, individual student initiative, the capacity for initiative and personal development initiative. In the second part of the paper, we discuss the relations of the concept of student initiative with the similar general concepts (activity/passivity, proactivity, agency and the concepts immediately related to school environment (student involvement, student participation. The results of our analysis indicate that the concept of student initiative has: particular features that differentiate it from similar concepts; the potential to reach the status of a scientific concept, bearing in mind the initial empirical specifications and general empirical verifiability of the yet unverified determinants of the concept. In the concluding part of the paper, we discuss the implications of the conceptual analysis for further research, as well as for

Recurrent Hyponatremia as Presenting Manifestation of Pituitary Macroadenoma

Directory of Open Access Journals (Sweden)

Rajput R.

2017-05-01

Full Text Available Hyponatremia is commonly seen electrolyte disturbance clinically. It is potentially life-threatening and requires prompt diagnosis and treatment. Non-functioning pituitary macroadenoma generally presents with a headache, visual disturbances, and the diagnosis is often delayed because of nonspecific nature of symptoms. Hyponatremia being initial manifestation before other common symptoms of pituitary macroadenoma is rare. We present a case of 55-year-old male with recurrent episodes of hyponatremia who was found to non-functioning pituitary macroadenoma along with panhypopituitarism. He was managed with hormone replacements. Our case highlights the importance of correct diagnosis of hyponatremia, measurement of the thyroid, adrenal and pituitary function in cases of hyponatremia.

Automated detection of cavities present in the high explosive filler of artillery shells

International Nuclear Information System (INIS)

Kruger, R.P.; Janney, D.H.; Breedlove, J.R. Jr.

1976-01-01

Initial research has been conducted into the use of digital image analysis techniques for automated detection and characterization of piping cavities present in the high explosive (HE) filler region of 105-mm artillery shells. Experimental work utilizing scene segmentation techniques followed by a sequential similarity detection algorithm for cavitation detection have yielded promising initial results. This work is described with examples of computer-detected defects

LaPlace's law revisited: Cecal perforation as an unusual presentation of pancreatic carcinoma

Directory of Open Access Journals (Sweden)

Cason Frederick D

2007-02-01

Full Text Available Abstract Background Pancreatic cancer is often locally and distally aggressive, but initial presentation as cecal perforation is uncommon. Case presentation We describe a patient presenting with pneumoperitoneum, found at initial exploration to have a cecal perforation believed to be secondary to a large cecal adenoma, after palpation of the remainder of the colon revealed hard stool but no distal obstruction. Postoperatively, however, the patient progressed to large bowel obstruction and upon reexploration, a mass could now be delineated, encompassing the splenic flexure, splenic hilum, and distal pancreas. Histological evaluation determined this was locally invasive pancreatic adenocarcinoma, and therefore the true etiology of the original cecal perforation. Conclusion Any perforation localized to the cecum must be highly suspicious for a distal obstruction, as dictated by the law of LaPlace.

Occult lung malignancy presenting with finger pain: a case report

Directory of Open Access Journals (Sweden)

Embley Matthew A

2008-12-01

Full Text Available Abstract Introduction Lung cancer is currently one of the most common malignancies in the world. Early detection is an important prognostic factor. Unfortunately, initial symptoms may be vague and a substantial proportion of cases present with the effects of metastases. Case presentation We discuss a case of occult lung malignancy in a 61-year-old man. The only symptom at presentation was pain in the right ring finger due to metastasis from the lung primary. Conclusion This case highlights the need for vigilance when a patient presents with unusual or unexplained symptoms, especially if they have known risk factors for cancer.

Three Years of the New Mexico Laptop Learning Initiative (NMLLI): Stumbling toward Innovation

Science.gov (United States)

Rutledge, David; Duran, James; Carroll-Miranda, Joseph

2007-01-01

This article presents qualitative results of the first three years of the New Mexico Laptop Learning Initiative (NMLLI). Results suggest that teachers, students, and their communities support this initiative to improve student learning. Descriptive statistics were used during year two to further understand how the laptops were being used by…

Orofacial granulomatosis in children can be the initial manifestation of systemic disease: a presentation of two cases

DEFF Research Database (Denmark)

Simonsen, Anne Birgitte; Deleuran, Mette

2014-01-01

Orofacial granulomatosis is a chronic granulomatous condition characterized by relapsing and remitting lip swelling and oral involvement that may include deep ulcers, tags and cobblestone formation. It occurs as an independent entity but also in conjunction with systemic diseases...... such as tuberculosis, sarcoidosis and Crohn's disease. The clinical presentation is not indicative of concomitant systemic disease. To highlight the importance of thorough examination to rule out systemic disease, we present two childhood cases of orofacial granulomatosis, one of which was associated to Crohn......'s disease....

Self-initiated object-location memory in young and older adults.

Science.gov (United States)

Berger-Mandelbaum, Anat; Magen, Hagit

2017-11-20

The present study explored self-initiated object-location memory in ecological contexts, as aspect of memory that is largely absent from the research literature. Young and older adults memorized objects-location associations they selected themselves or object-location associations provided to them, and elaborated on the strategy they used when selecting the locations themselves. Retrieval took place 30 min and 1 month after encoding. The results showed an age-related decline in self-initiated and provided object-location memory. Older adults benefited from self-initiation more than young adults when tested after 30 min, while the benefit was equal when tested after 1 month. Furthermore, elaboration enhanced memory only in older adults, and only after 30 min. Both age groups used deep encoding strategies on the majority of the trials, but their percentage was lower in older adults. Overall, the study demonstrated the processes involved in self-initiated object-location memory, which is an essential part of everyday functioning.

Chemical, Biological, Radiological and Nuclear Regional Centres of Excellence Initiative

International Nuclear Information System (INIS)

Bril, L.V.

2013-01-01

This series of slides presents the initiative launched in May 2010 by the European Union to develop at national and regional levels the necessary institutional capacity to fight against the CBRN (Chemical, Biological, Radiological and Nuclear) risk. The origin of the risk can be: -) criminal (proliferation, theft, sabotage and illicit traffics), -) accidental (industrial catastrophes, transport accidents...) and -) natural (mainly pandemics). The initiative consists in the creation of Centres of Excellence for providing assistance and cooperation in the field of CBRN risk and the creation of experts networks for sharing best practices, reviewing laws and regulation, developing technical capacities in order to mitigate the CBRN risk. The initiative is complementary to the instrument for nuclear safety cooperation. Regional Centres of Excellence are being set up in 6 regions: South East Europe, South East Asia, North Africa, West Africa, Middle East, and Central Asia covering nearly 40 countries. A global budget of 100 million Euros will be dedicated to this initiative for the 2009-2013 period. (A.C.)

Lamotrigine-related pseudolymphoma presenting as cervical lymphadenopathy

Directory of Open Access Journals (Sweden)

Eoin Mulroy

2017-01-01

Full Text Available Immune-mediated drug reactions are a potentially life-threatening complication of antiseizure medications. Drug hypersensitivity syndrome (DHS is the best recognised of these, presenting with fever, eosinophilia, rash and internal organ involvement. Isolated lymphadenopathy is a less recognized immune-mediated reaction to antiseizure drugs such as lamotrigine. We describe the case of a 24-year-old woman who developed lamotrigine-related bilateral cervical lymphadenopathy (pseudolymphoma fifteen months following therapy initiation. This is the second such case reported in the medical literature.

Breast conserving therapy in breast cancer patients presenting with nipple discharge

International Nuclear Information System (INIS)

Obedian, Edward; Haffty, Bruce G.

2000-01-01

Purpose: To retrospectively review the outcome of conservatively treated breast cancer patients who present with nipple discharge at initial diagnosis. Methods and Materials: The charts of 1097 patients undergoing conservative surgery and radiation therapy between January 1970 and December 1990 were reviewed. All patient data, including clinical, pathologic, treatment, and outcome variables were entered onto a computerized database. For the current study, specific attention was directed to the initial presenting symptoms and patients were divided into two groups: those presenting at initial diagnosis with nipple discharge (D/C-YES, n = 17), and those presenting without nipple discharge (D/C-NO, n = 1080). Results: As of August 1998, with a median follow-up of 12 years, the 10-year actuarial survival, distant metastasis-free survival, and breast relapse-free survival rates for the overall population were 73%, 78%, and 83%, respectively. Although the D/C-YES and D/C-NO groups were well balanced with respect to the majority of clinical factors, the D/C-YES patients had a higher percentage of DCIS histology (7.3% vs 1.2%, p < 0.01), were less likely to undergo reexcision (12% vs 35%), and were more frequently under age 40 (35% vs 12%) than the D/C-NO patients. Over the time span of this study, status of the final surgical margin was indeterminate in the majority of cases. Local relapses occurred in 6 of the 17 patients in the D/C-YES group, resulting in a 10-year actuarial breast relapse-free survival rate of 50%, which was significantly lower than the 10-year breast relapse-free survival rate of 86% in the D/C-NO population. Among the patients presenting with nipple discharge, those with sacrifice of the nipple areolar complex had a lower local relapse rate than those patients who had conservation of the nipple areolar complex (20% vs 42%), although this difference did not reach statistical significance. Conclusions: Although patients presenting with nipple discharge

A methodology for analyzing precursors to earthquake-initiated and fire-initiated accident sequences

International Nuclear Information System (INIS)

Budnitz, R.J.; Lambert, H.E.; Apostolakis, G.

1998-04-01

This report covers work to develop a methodology for analyzing precursors to both earthquake-initiated and fire-initiated accidents at commercial nuclear power plants. Currently, the U.S. Nuclear Regulatory Commission sponsors a large ongoing project, the Accident Sequence Precursor project, to analyze the safety significance of other types of accident precursors, such as those arising from internally-initiated transients and pipe breaks, but earthquakes and fires are not within the current scope. The results of this project are that: (1) an overall step-by-step methodology has been developed for precursors to both fire-initiated and seismic-initiated potential accidents; (2) some stylized case-study examples are provided to demonstrate how the fully-developed methodology works in practice, and (3) a generic seismic-fragility date base for equipment is provided for use in seismic-precursors analyses. 44 refs., 23 figs., 16 tabs