Sample records for carney complex case

  1. Carney Complex (United States)

    ... Types of Cancer > Carney Complex Request Permissions Carney Complex Approved by the Cancer.Net Editorial Board , 11/2015 What is Carney complex? Carney complex is a hereditary condition associated with: ...

  2. Genetics Home Reference: Carney complex (United States)

    ... Understand Genetics Home Health Conditions Carney complex Carney complex Enable Javascript to view the expand/collapse boxes. Download PDF Open All Close All Description Carney complex is a disorder characterized by an increased risk ...

  3. Carney complex (CNC). (United States)

    Bertherat, Jérôme


    The Carney complex (CNC) is a dominantly inherited syndrome characterized by spotty skin pigmentation, endocrine overactivity and myxomas. Skin pigmentation anomalies include lentigines and blue naevi. The most common endocrine gland manifestations are acromegaly, thyroid and testicular tumors, and adrenocorticotropic hormone (ACTH)-independent Cushing's syndrome due to primary pigmented nodular adrenocortical disease (PPNAD). PPNAD, a rare cause of Cushing's syndrome, is due to primary bilateral adrenal defect that can be also observed in some patients without other CNC manifestations or familial history of the disease. Myxomas can be observed in the heart, skin and breast. Cardiac myxomas can develop in any cardiac chamber and may be multiple. One of the putative CNC genes located on 17q22-24, (PRKAR1A), has been identified to encode the regulatory subunit (R1A) of protein kinase A. Heterozygous inactivating mutations of PRKAR1A were reported initially in 45 to 65% of CNC index cases, and may be present in about 80% of the CNC families presenting mainly with Cushing's syndrome. PRKAR1A is a key component of the cAMP signaling pathway that has been implicated in endocrine tumorigenesis and could, at least partly, function as a tumor suppressor gene. Genetic analysis should be proposed to all CNC index cases. Patients with CNC or with a genetic predisposition to CNC should have regular screening for manifestations of the disease. Clinical work-up for all the manifestations of CNC should be performed at least once a year in all patients and should start in infancy. Cardiac myxomas require surgical removal. Treatment of the other manifestations of CNC should be discussed and may include follow-up, surgery, or medical treatment depending on the location of the tumor, its size, the existence of clinical signs of tumor mass or hormonal excess, and the suspicion of malignancy. Bilateral adrenalectomy is the most common treatment for Cushing's syndrome due to PPNAD.

  4. Carney complex (CNC

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    Bertherat Jérôme


    Full Text Available Abstract The Carney complex (CNC is a dominantly inherited syndrome characterized by spotty skin pigmentation, endocrine overactivity and myxomas. Skin pigmentation anomalies include lentigines and blue naevi. The most common endocrine gland manifestations are acromegaly, thyroid and testicular tumors, and adrenocorticotropic hormone (ACTH-independent Cushing's syndrome due to primary pigmented nodular adrenocortical disease (PPNAD. PPNAD, a rare cause of Cushing's syndrome, is due to primary bilateral adrenal defect that can be also observed in some patients without other CNC manifestations or familial history of the disease. Myxomas can be observed in the heart, skin and breast. Cardiac myxomas can develop in any cardiac chamber and may be multiple. One of the putative CNC genes located on 17q22-24, (PRKAR1A, has been identified to encode the regulatory subunit (R1A of protein kinase A. Heterozygous inactivating mutations of PRKAR1A were reported initially in 45 to 65 % of CNC index cases, and may be present in about 80 % of the CNC families presenting mainly with Cushing's syndrome. PRKAR1A is a key component of the cAMP signaling pathway that has been implicated in endocrine tumorigenesis and could, at least partly, function as a tumor suppressor gene. Genetic analysis should be proposed to all CNC index cases. Patients with CNC or with a genetic predisposition to CNC should have regular screening for manifestations of the disease. Clinical work-up for all the manifestations of CNC should be performed at least once a year in all patients and should start in infancy. Cardiac myxomas require surgical removal. Treatment of the other manifestations of CNC should be discussed and may include follow-up, surgery, or medical treatment depending on the location of the tumor, its size, the existence of clinical signs of tumor mass or hormonal excess, and the suspicion of malignancy. Bilateral adrenalectomy is the most common treatment for Cushing

  5. Primary pigmented nodular adrenocortical disease associated with Carney complex: case report and literature review

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    Fabrícia Torres Gonçalves

    Full Text Available CONTEXT: Carney complex (CNC, a familial multiple neoplasm syndrome with dominant autosomal transmission, is characterized by tumors of the heart, skin, endocrine and peripheral nervous system, and also cutaneous lentiginosis. This is a rare syndrome and its main endocrine manifestation, primary pigmented nodular adrenal disease (PPNAD, is an uncommon cause of adrenocorticotropic hormone-independent Cushing's syndrome. CASE REPORT: We report the case of a 20-year-old patient with a history of weight gain, hirsutism, acne, secondary amenorrhea and facial lentiginosis. Following the diagnosing of CNC and PPNAD, the patient underwent laparoscopic bilateral adrenalectomy, and she evolved with decreasing hypercortisolism. Screening was also performed for other tumors related to this syndrome. The diagnostic criteria, screening and follow-up for patients and affected family members are discussed.

  6. Cryoglobulinemic vasculitis preceding diagnosis of Carney Complex

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    Glerup, Mia; Stausbøl-Grøn, Brian; Heuck, Carsten


    Carney complex (CNC) is a disorder characterized by skin pigmentary abnormalities and benign cardiac, endocrine, skin and neuronal tumors. We present a previously healthy 12-year-old boy with recurrent pain and swelling of the feet. One year later he presented with stiffness of the fingers....... The lentigines and myxoma led to the suggestion of Carney Complex and the diagnosis was confirmed by a PRKAR1A mutation found in the child as well as the mother....

  7. Carney complex with right ventricular myxoma following second excision of left atrial myxoma. (United States)

    Tamura, Yamato; Seki, Toshio


    We report a case of Carney complex with massive right ventricular myxoma after two-time excision of a left atrial myxoma. The patient was a 45-year-old woman with pyrexia. She temporarily lost consciousness during examination, and echocardiography and computed tomography (CT) showed a massive tumor in the right ventricle. Loss of consciousness was determined to be caused by intracardiac obstruction of blood flow due to the tumor, and corrective surgery was performed. Pathological findings indicated myxoma with no malignancy. Myxomas are benign, but there is frequent recurrence of tumors associated with Carney complex. Because her myxomas were accompanied by unusual skin pigmentation, she was diagnosed with Carney complex. Carney complex has a high rate of myxoma recurrence, and often runs in families. In all cases, it is necessary to observe the patient's course closely.

  8. Osteochondromyxoma: Review of a rare carney complex criterion. (United States)

    Golden, Todd; Siordia, Juan A


    Osteochondromyxoma is an extremely rare bone tumor associated with 1% of Carney complex patients and constitutes one of its 11 diagnostic criteria. This narrative review of osteochondromyxoma is based on a search of all references to the topic in PubMed, Web Of Science, SCOPUS, ScienceDirect, and JSTOR databases. Special attention was focused on case reports, leading to a review encompassing the case reports to date, as well as related animal model studies. This review covers the current understanding of osteochondromyxoma, highlighting its variability while providing consensus on the most common clinical presentation, pathological findings, and genetic features of this rare bone tumor.

  9. Growth hormone and risk for cardiac tumors in Carney complex. (United States)

    Bandettini, W Patricia; Karageorgiadis, Alexander S; Sinaii, Ninet; Rosing, Douglas R; Sachdev, Vandana; Schernthaner-Reiter, Marie Helene; Gourgari, Evgenia; Papadakis, Georgios Z; Keil, Meg F; Lyssikatos, Charalampos; Carney, J Aidan; Arai, Andrew E; Lodish, Maya; Stratakis, Constantine A


    Carney complex (CNC) is a multiple neoplasia syndrome that is caused mostly by PRKAR1A mutations. Cardiac myxomas are the leading cause of mortality in CNC patients who, in addition, often develop growth hormone (GH) excess. We studied patients with CNC, who were observed for over a period of 20 years (1995-2015) for the development of both GH excess and cardiac myxomas. GH secretion was evaluated by standard testing; dedicated cardiovascular imaging was used to detect cardiac abnormalities. Four excised cardiac myxomas were tested for the expression of insulin-like growth factor-1 (IGF-1). A total of 99 CNC patients (97 with a PRKAR1A mutation) were included in the study with a mean age of 25.8 ± 16.6 years at presentation. Over an observed mean follow-up of 25.8 years, 60% of patients with GH excess (n = 46) developed a cardiac myxoma compared with only 36% of those without GH excess (n = 54) (P = 0.016). Overall, patients with GH excess were also more likely to have a tumor vs those with normal GH secretion (OR: 2.78, 95% CI: 1.23-6.29; P = 0.014). IGF-1 mRNA and protein were higher in CNC myxomas than in normal heart tissue. We conclude that the development of cardiac myxomas in CNC may be associated with increased GH secretion, in a manner analogous to the association between fibrous dysplasia and GH excess in McCune-Albright syndrome, a condition similar to CNC. We speculate that treatment of GH excess in patients with CNC may reduce the likelihood of cardiac myxoma formation and/or recurrence of this tumor.

  10. Carney complex: the complex of myxomas, spotty pigmentation, endocrine overactivity, and schwannomas. (United States)

    Carney, J A


    The complex of myxomas, spotty pigmentation, endocrine overactivity, and schwannomas (the Carney complex) is a multisystem tumorous disorder that is transmitted as a mendelian autosomal dominant trait. Approximately 150 affected patients are known worldwide. The myxomas, which tend to be multiple in the involved organ, affect the heart, skin and breast. Typical sites for the skin myxomas are the eyelids, external ear canal, and nipples. The lesions commonly recur after excision. The spotty skin pigmentation includes lentigines and blue nevi, but ephelides and junctional and compound nevi also occur. The lentigines are widespread and typically involve the centrofacial area, including the vermilion border of the lips, and the conjunctiva, especially the lacrimal caruncle and the conjunctival semilunar fold. One or more intraoral pigmented spots are seen occasionally. The blue nevi occur on the face, trunk, and limbs, but not the hands and feet. Endocrine overactivity includes Cushing's syndrome (caused by primary pigmented nodular adrenocortical disease), acromegaly (caused by growth hormone-producing pituitary adenoma), and sexual precocity (caused by large-cell calcifying Sertoli cell tumor). The schwannomas are a special histological type, featuring psammoma bodies and melanin. Most commonly, they affect the upper gastrointestinal tract and sympathetic nerve chains, but a few have occurred in the skin. The most serious component of the Carney complex is cardiac myxoma. Patients suspected of having the syndrome (and their primary relatives) should be examined for this neoplasm.

  11. [Primary pigmented nodular adrenocortical disease as cause of Cushing's syndrome associated with Carney complex]. (United States)

    Dumić, Miroslav; Janjanin, Nevena; Uroić, Anita Spehar; Ille, Jasenka; Skegro, Mate; Kusec, Vesna; Marjanac, Igor; Matić, Toni; Jelasić, Drazen


    We report a 11-year-old girl and two 14-year-old boys with Cushing's syndrome due to primary pigmented nodular adrenocortical disease (PPNAD). In these patients, hypercortisolism is a consequence of autonomous cortisol secretion from adrenal glands and is ACTH-independent. Besides PPNAD, the girl had lentigines, spotty pigmentation on her bucal mucosa and lips and she also had schwannoma. One of the reported boys had prolactinoma. Considering this, those two patients fulfill the criteria for Carney complex which is a type of multiple endocrine neoplasia syndromes inherited in an autosomal dominant trait. The other boy had PPNAD but no other obvious signs of Carney complex were noticed. Family study didn't reveal any clinical or laboratory signs of Carney complex in our patients' first relatives. All of our patients underwent bilateral adrenalectomy (in one of the boys laparoscopic surgery was performed). Glucocorticoid and mineralocorticoid substitution has been started. Adrenal glands were macroscopically normal but pathohistological analysis confirmed the diagnosis of PPNAD.

  12. Condroma pulmonar isolado: caso incompleto da tríade de Carney? Isolated pulmonary chondroma: a case of incomplete Carney triad?

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    Raul Lopes Ruiz Júnior


    Full Text Available Um homem, de 45 anos, com infecções pulmonares de repetição havia quatro anos apresentou-se com tosse, secreção amarelada, escarros hemópticos e dor torácica não pleural. A tomografia revelou nódulo calcificado ocluindo brônquio lobar inferior direito. Realizada bilobectomia inferior e média, o exame histopatológico revelou condroma endobrônquico, bem circunscrito. O condroma pulmonar é um tumor raro, em geral associado à tríade de Carney (condroma, leiomiossarcoma gástrico e paraganglioma extra-adrenal, sendo o menos freqüente dos três componentes. No presente caso, os outros dois componentes não foram observados. Podem, entretanto, se manifestar tardiamente, sendo, assim, necessário seguimento clínico em longo prazo do paciente.A 45-year-old man presented with recurrent pulmonary infection for four years, cough, bloody sputum, yellowish excretion and nonpleuritic chest pain. Tomography of the chest revealed a calcified nodule occluding the right lower lobe bronchus. A right lower and middle lobectomy was performed, and the histopathological examination of the bronchi revealed chondroma, a rare pulmonary tumor usually associated with the Carney triad (pulmonary chondroma, gastric leiomyosarcoma and extra-adrenal paraganglioma, being the less common of the three components. In the present case, the other two components of the triad were not observed. Since these components may appear years later, long-term follow-up care is necessary.

  13. Case Report of a Left Atrial Myxoma Associated with Carney%u2019s Syndrome

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    Anil Ozen


    Full Text Available Primary cardiac neoplasms are very rare as compared to metastatic tumors. 70% to 80% of them are benign myxomas. Complications of myxomas include cyst and microabscess formation, embolization, syncope and sudden death. Rarely, cardiac myxomas are associated with primary nodular adrenal cortical disease, mammary fibroadenomas, testicular tumors or pitiutary adenomas with gigantism or acromegaly known as Carney%u2019s syndrome. We present a patient with a left atrial myxoma who underwent reoperation associated with Carney%u2019s syndrome.

  14. Carney complex and McCune Albright syndrome: an overview of clinical manifestations and human molecular genetics. (United States)

    Salpea, Paraskevi; Stratakis, Constantine A


    Endocrine neoplasia syndromes feature a wide spectrum of benign and malignant tumors of endocrine and non-endocrine organs associated with other clinical manifestations. This study outlines the main clinical features, genetic basis, and molecular mechanisms behind two multiple endocrine neoplasia syndromes that share quite a bit of similarities, but one can be inherited whereas the other is always sporadic, Carney complex (CNC) and McCune-Albright (MAS), respectively. Spotty skin pigmentation, cardiac and other myxomas, and different types of endocrine tumors and other characterize Carney complex, which is caused largely by inactivating Protein kinase A, regulatory subunit, type I, Alpha (PRKAR1A) gene mutations. The main features of McCune-Albright are fibrous dysplasia of bone (FD), café-au-lait macules and precocious puberty; the disease is caused by activating mutations in the Guanine Nucleotide-binding protein, Alpha-stimulating activity polypeptide (GNAS) gene which are always somatic. We review the clinical manifestations of the two syndromes and provide an update on their molecular genetics.

  15. Hepato-pancreato-biliary lesions are present in both Carney complex and McCune Albright syndrome: comments on P. Salpea and C. Stratakis. (United States)

    Gaujoux, Sébastien; Chanson, Philippe; Bertherat, Jérôme; Sauvanet, Alain; Ruszniewski, Philippe


    One of the key messages of recent Salpea and Stratakis work is to underline the clinical similarities shared by these syndromes that could be explained by a defect in the same signaling pathway, i.e. activation of the cAMP pathway. That being said, we would like to emphasize that hepatopancreato-biliary lesions are one additional feature shared both by Carney complex and McCune Albright syndrome.

  16. Melanosis of the uterine cervix: a case report and literature review

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    Daniel Chang


    Full Text Available Melanosis of the uterine cervix is an extremely rare melanocytic lesion and should be differentiated from melanoma. It is a melanocytic hyperpigmentation of basal layer cells from the squamous mucosa of the uterine cervix without an increase in the number of melanocytes. We present a typical case of this entity. Furthermore, we discuss the possible origins of melanocytes in this region and their association with Laugier-Hunziker syndrome and Carney complex.

  17. A novel germline SDHB mutation in a gastrointestinal stromal tumor patient without bona fide features of the Carney-Stratakis dyad. (United States)

    Celestino, Ricardo; Lima, Jorge; Faustino, Alexandra; Máximo, Valdemar; Gouveia, António; Vinagre, João; Soares, Paula; Lopes, José Manuel


    Gastrointestinal stromal tumors (GISTs) are the most common mesenchyme neoplasms of the gastrointestinal tract. Gain-of-function somatic mutations of the KIT or PDGFRA genes represent the most prevalent molecular alterations in GISTs. In Carney-Stratakis dyad, patients portray germline mutations of the succinate dehydrogenase subunits B (SDHB), C (SDHC) and D (SDHD) and develop multifocal GISTs and multicentric paragangliomas (PGLs). We herein report a novel germline SDHB mutation (c.T282A--Ile44Asn) occurring in a 26 years-old patient diagnosed with a spindle cell intermediate risk GIST that did not present KIT/PDGFRA/BRAF gene mutations. Further analyses revealed loss of the wild-type SDHB allele and complete loss of SDHB expression in the tumor tissue. After genetic screening of other family members, we detected in the patient's mother a SDHB mutation without any clinical/laboratorial evidence of GIST or PGL. Altogether, our findings (germline SDHB mutation with absence of PGL in the index case and of GIST and/or PGL in his mother) raise the possibility that this familiar setting corresponds to an incomplete phenotype of the Carney-Stratakis dyad.

  18. Large erupting complex odontoma: a case report. (United States)

    Vengal, Manoj; Arora, Honey; Ghosh, Sujoy; Pai, Keerthilatha M


    Odontomas are the most common odontogenic tumours. They are usually asymptomatic and are often discovered during routine radiography. We report a case of a large erupting complex odontoma that caused pain, infection and facial asymmetry. This case is significant as there are few reports of complex odontoma erupting in the oral cavity.

  19. Infected Complex Odontoma: A Case Report


    Damodar, Shanthala; Veena KM; Chatra, Laxmikanth; Shenai, Prashanth; Rao, Prasanna Kumar; Prabhu, Rachana V.; Kushraj, Tashika; Shetty, Prathima; Hameed, Shaul


    Odontoma represent a hamartomatous malformation. They are usually asymptomatic and are diagnosed on routine radiological examination. Infection of an odontome is very uncommon. Few cases of infected odontoma are reported in the literature. We report a special case of infected complex odontoma and perforation of the cheeks with a tooth impacted upon along with computed tomographic (CT) image. Thus, making the present case unusual.

  20. Tuberous sclerosis complex: a case report

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    Harris Poolakundan


    Full Text Available Tuberous Sclerosis Complex is an autosomal dominant phakomatosis. This neurocutaneous disorder usually presents with seizures, facial angiofibroma and mental retardation (Vogt's triad. Here we report a case where a 25 year old gentleman presented with recurrent seizures, and was diagnosed to have tuberous sclerosis complex. [Int J Res Med Sci 2015; 3(10.000: 2844-2846

  1. Infected Complex Odontoma: A Case Report

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    Shanthala Damodar


    Full Text Available Odontoma represent a hamartomatous malformation. They are usually asymptomatic and are diagnosed on routine radiological examination. Infection of an odontome is very uncommon. Few cases of infected odontoma are reported in the literature. We report a special case of infected complex odontoma and perforation of the cheeks with a tooth impacted upon along with computed tomographic (CT image. Thus, making the present case unusual. [Cukurova Med J 2015; 40(2.000: 379-383

  2. Complex Pediatric Elbow Injury: An Uncommon Case


    Taylor GR; Ayer R; Sharma H


    Abstract Background There is paucity of literature describing complex elbow trauma in the pediatric population. We described a case of an uncommon pediatric elbow injury comprised of lateral condyle fracture associated with posterolateral dislocation of elbow. Case presentation A 12-year-old boy sustained a direct elbow trauma and presented with Milch type II lateral condyle fracture associated with posterolateral dislocation of elbow. Elbow dislocation was managed by closed reduction. The el...

  3. Complex Pediatric Elbow Injury: An Uncommon Case

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    Taylor GR


    Full Text Available Abstract Background There is paucity of literature describing complex elbow trauma in the pediatric population. We described a case of an uncommon pediatric elbow injury comprised of lateral condyle fracture associated with posterolateral dislocation of elbow. Case presentation A 12-year-old boy sustained a direct elbow trauma and presented with Milch type II lateral condyle fracture associated with posterolateral dislocation of elbow. Elbow dislocation was managed by closed reduction. The elbow stability was assessed under general anaesthesia, followed by open K-wiring for the lateral condylar fracture fixation. The patient had an uneventful recovery with an excellent outcome at 39 months follow-up. Conclusion Complex pediatric elbow injuries are quite unusual to encounter, the management of such fractures can be technically demanding. Concomitant elbow dislocation should be managed by closed reduction followed by open reduction and internal fixation (K-wires or cannulated screws of the lateral condyle fracture.

  4. Melanotic schwannoma arising in association with nevus of Ota: 2 cases suggesting a shared mechanism. (United States)

    Trufant, Joshua W; Brenn, Thomas; Fletcher, Christopher D M; Virata, Andrew R; Cook, Deborah L; Bosenberg, Marcus W


    Melanotic schwannoma is a rare markedly pigmented peripheral nerve sheath tumor comprising cells with prominent melanization and schwannian features. The psammomatous variety is associated with Carney complex, a multiple neoplasia syndrome with spotty skin pigmentation. We present the first 2 reported cases of melanotic schwannoma arising in patients with a history of nevus of Ota, a rare dermal melanosis believed to represent a failure of melanocyte migration to the epidermis during embryogenesis. Case 1 involves a 40-year-old woman with a 1.8-cm, deeply pigmented, trigeminal nerve mass and pigmentation of the maxillary sinus mucosa and bone. Case 2 involves a 53-year-old woman with a 1.5-cm mass adjacent to the clavicle. Microscopically, both masses consist of partially encapsulated epithelioid and spindle cells with abundant melanin pigment, arising in association with peripheral nerves. Morphological, immunohistochemical, and ultrastructural features support a diagnosis of melanotic schwannoma. No psammoma bodies are noted, and neither patient exhibits any additional features of Carney complex. Melanotic schwannoma is most often benign but has been associated with malignant behavior in some cases. Distinguishing this nerve sheath tumor from malignant melanoma can be difficult but is of great clinical importance due to differences in prognosis and treatment.

  5. [Complex odontoma with dentigerous cyst: a case report]. (United States)

    Qizhang, Xu; Hongliang, Zhang; Xiaoyu, Wang; Zhanji, Wang; Qianqian, Xu; Qiong, Ma


    Complex odontoma is a relatively rare dental dysplasia. In particular, a complex odontoma with dentigerous cyst is seldom observed. A case of complex odontoma with dentigerous cyst is reported in this paper.

  6. Case Complexity and Quality Attestation for Clinical Ethics Consultants. (United States)

    Spielman, Bethany; Craig, Jana; Gorka, Christine; Miller, Keith


    A proposal by the American Society for Bioethics and Humanities (ASBH) to identify individuals who are qualified to perform ethics consultations neglects case complexity in candidates' portfolios. To protect patients and healthcare organizations, and to be fair to candidates, a minimum case complexity level must be clearly and publicly articulated. This proof-of-concept study supports the feasibility of assessing case complexity. Using text analytics, we developed a complexity scoring system, and retrospectively analyzed more than 500 ethics summaries of consults performed at an academic medical center during 2013. We demonstrate its use with seven case summaries that range in complexity from uncomplicated to very complicated. We encourage the ASBH to require a minimum level of case complexity, and recommend that attestation portfolios include several cases of moderate complexity and at least one very complex case.

  7. A subtle case of tuberous sclerosis complex

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    Hitoshi Nakano


    Full Text Available Tuberous sclerosis complex (TSC is known to cause severe intractable epilepsy and mental retardation; however, diagnosis can be delayed in milder cases. We report a 26-year-old right-handed female patient who started having convulsions at age 7 days. She had several focal seizures per year that were intractable to treatment with carbamazepine or phenytoin. Her two sisters had several episodes of suspected epileptic seizures but had no symptoms related to TSC. Seizure semiology of the patient comprised of visual hallucination, loss of consciousness, and convulsive movements predominantly on the right. Physical examination revealed several small scattered angiofibromas over the nose that were histologically determined by skin biopsy. Hypomelanotic macules, shagreen patches, or periungual fibromas were not seen. Neurological examination showed mental retardation (MMSE: 23/30, WAIS-III: VIQ63, PIQ59, FIQ58 and decreased vibration sensation in both legs. Interictal EEG showed slow waves and epileptiform discharges broadly over the anterior quadrants bilaterally. Brain imaging showed multiple cortical tubers and malformation of cortical development but no subependymal nodules. Interictal IMP-SPECT showed hypoperfusion in the left frontal lobe. Cardiac rhabdomyoma was not noticed by cardiac echography. Truncal CT showed sclerosis of the bilateral lumbosacral joints. There was no abnormality in the lung, major arteries, liver, or kidneys. No hamartomas or retinal achromic patches were noticed by ophthalmologic evaluation. Administration of lamotrigine was effective for her seizures. This patient fulfilled two major features of diagnostic criteria for TSC and was diagnosed as definite TSC. Patients with mental retardation and epilepsy should be carefully evaluated for the possible diagnosis of TSC.

  8. Combined PET/CT by 18F-FDOPA, 18F-FDA, 18F-FDG, and MRI correlation on a patient with Carney triad. (United States)

    Papadakis, Georgios Z; Patronas, Nicholas J; Chen, Clara C; Carney, J Aidan; Stratakis, Constantine A


    Carney triad is a rare syndrome involving gastrointestinal stromal tumor, pulmonary chondroma, and extra-adrenal paraganglioma. We present a 21-year-old woman with the complete triad who was evaluated with MRI, F-FDOPA, F-FDA, and F-FDG. F-FDOPA best demonstrated the paraganglioma, whereas hepatic metastases noted by MRI demonstrated increased uptake only by F-FDG.


    Institute of Scientific and Technical Information of China (English)

    SONG Jian


    The author argues that the population system of human societies, the highest form of lives on the planet, may serve as standard paradigm for study of complex systems. it turned out to be a well investigable, nonlinearly controllable dynamic system, where census plays pivotal role. The theory has led China to succeed in checking the upsurge of population growth of 1970-80s and remains reliable basis for family-planning policy-making in all countries world-wide. It suggests that statistics could be a powerful tool in studying holistic properties of complex systems.

  10. Pituitary adenoma in monozigotic twins with Cri du Chat syndome: a rare case report

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    Canaz Gokhan


    Full Text Available Pituitary adenomas are rare tumours of pediatric population. In etiology, genetic factors are more common than they are in adults. Because of the rarity of the cases, there are only a few large case studies in the literature. Pituitary tumours in children are often related with syndromes like MEN type 1, Carney Complex and Mc Cune Albright, but there is no case in the literature associated with Cri Du Chat syndrome. Statisticlly, it has been reported that, pediatric tumours occur more often in twins, in the pediatric population. Main treatment for prolactinomas is medical intervention with dopamine agonists, as in adults. Surgery is prefered when the tumour is resistant to medical treatment or shows mass effects around sellae. In that situation, as in adults, both transcranial and transsphenoidal approach is possible.

  11. On the Average-Case Complexity of Shellsort

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    Vitányi, P.M.B.


    We prove a lower bound expressed in the increment sequence on the average-case complexity (number of inversions which is proportional to the running time) of Shellsort. This lower bound is sharp in every case where it could be checked. We obtain new results e.g. determining the average-case complexi

  12. Average-Case Analysis of Algorithms Using Kolmogorov Complexity

    Institute of Scientific and Technical Information of China (English)

    姜涛; 李明


    Analyzing the average-case complexity of algorithms is a very prac tical but very difficult problem in computer science. In the past few years, we have demonstrated that Kolmogorov complexity is an important tool for analyzing the average-case complexity of algorithms. We have developed the incompressibility method. In this paper, several simple examples are used to further demonstrate the power and simplicity of such method. We prove bounds on the average-case number of stacks (queues) required for sorting sequential or parallel Queuesort or Stacksort.

  13. Unusually large erupted complex odontoma: A rare case report. (United States)

    Bagewadi, Shivanand B; Kukreja, Rahul; Suma, Gundareddy N; Yadav, Bhawna; Sharma, Havi


    Odontomas are nonaggressive, hamartomatous developmental malformations composed of mature tooth substances and may be compound or complex depending on the extent of morphodifferentiation or on their resemblance to normal teeth. Among them, complex odontomas are relatively rare tumors. They are usually asymptomatic in nature. Occasionally, these tumors become large, causing bone expansion followed by facial asymmetry. Odontoma eruptions are uncommon, and thus far, very few cases of erupted complex odontomas have been reported in the literature. Here, we report the case of an unusually large, painless, complex odontoma located in the right posterior mandible.

  14. Unusually large erupted complex odontoma: A rare case report

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    Bagewadi, Shivanand B.; Kukreja, Rahul; Suma, Gundareddy N.; Yadav, Bhawn; Sharma, Havi [Dept. of Oral Medicine and Radiology, ITS Centre for Dental Studies and Research, Murad Nagar (India)


    Odontomas are nonaggressive, hamartomatous developmental malformations composed of mature tooth substances and may be compound or complex depending on the extent of morphodifferentiation or on their resemblance to normal teeth. Among them, complex odontomas are relatively rare tumors. They are usually asymptomatic in nature. Occasionally, these tumors become large, causing bone expansion followed by facial asymmetry. Odontoma eruptions are uncommon, and thus far, very few cases of erupted complex odontomas have been reported in the literature. Here, we report the case of an unusually large, painless, complex odontoma located in the right posterior mandible.

  15. Complex odontoma associated to a primary maxillary canine: case report

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    Estela Maris LOSSO


    Full Text Available Introduction: Odontomas are malformations of the dental tissues and may interfere with the eruption of the associated tooth. The early diagnosis, followed by a proper treatment at the right time, will result in a favorable prognosis and a desirable occlusion development. Complex odontomas associated to primary teeth are rare. Case report and conclusion: This article describes a case of a complex odontoma in a four-year-old girl that prevented eruption of the left primary canine. The treatment choice was enucleation of the odontoma and the maintenance of the left primary canine.In this case, complete removal of the complex odontoma was successfully conducted, since after one year of follow-up the primary maxillary canine restarted its eruption process.

  16. Erupted complex composite odontoma: Report of two atypical cases

    Directory of Open Access Journals (Sweden)

    Preeti Tomar Bhattacharya


    Full Text Available Odontomas are nonaggressive, hamartomatous developmental malformations of odontogenic origin. They are considered one of the most common odontogenic lesions composed by diverse dental tissues. They may interfere with the eruption of an associated tooth and are more prevalent in the posterior mandible. The eruption of a complex odontoma into the oral cavity is rare. Here, we report such two rare cases of gigantic erupted complex composite odontomas.

  17. Entre a História e a Transcendência: Padre Guadalupe Carney e a luta pela Reforma Agrária em Honduras

    Directory of Open Access Journals (Sweden)

    Kevin P Coleman


    Full Text Available Durante a Guerra Fria na América Central, o padre James Hanley Carney escreveu um livro que foi sua história de vida e uma crônica detalhada do movimento camponês em Honduras. Este ensaio analisa e contextualiza o conteúdo da autobiografia de Carney, e ao mesmo tempo reflete sobre a ideologia que é codificada no gênero autobiográfico. Sua autobiografia e as cartas que ele escreveu para sua família, juntamente com os documentos dos movimentos de trabalhadores são as fontes utilizadas. Sua tentativa de entender os camponeses hondurenhos com quem conviveu e trabalhou o levou a questionar as condições históricas e estruturais da pobreza naquele país durante o enfrentamento de Guerra Fria. Este encontro prolongado levou-o a repensar sua fé anticomunista e seus compromissos cristãos.

  18. Simplified Worst-Case Analysis of Complex Systems (United States)

    Pond, C. L.


    Statistical method avoids excessive computer time. Technique involves simplified Monte Carlo simulation of system with randomly chosen parameters and comparison of tolerance extremes of several of worst-case situations found. Resulting combination of tolerance extremes then used in detailed analysis - one that makes use of full complex nonlinear model capable of accurate simulations.

  19. Causal inference for complex longitudinal data: the continuous case

    NARCIS (Netherlands)

    Gill, R.D.; Robins, J.M.


    We extend Robins theory of causal inference for complex longitudinal data to the case of continuously varying as opposed to discrete covariates and treatments In particular we establish versions of the key results of the discrete theory the gcomputation formula and a collection of powerful character

  20. Causal inference in complex longitudinal models: the continuous case

    NARCIS (Netherlands)

    Robins, J.M.


    We extend Robins' theory of causal inference for complex longitudinal data to the case of continuously varying as opposed to discrete covariates and treatments. In particular we establish versions of the key results of the discrete theory: the g-computation formula and a collection of powerful chara

  1. Complex odontoma of the nasal cavity: a case report. (United States)

    Soltan, Michelle; Kacker, Ashutosh


    We describe the case of a 76-year-old man who presented with symptoms of chronic nasal obstruction and recurrent sinusitis of many years' duration. The patient's history and radiographic findings established a diagnosis of a complex odontoma of the nasal cavity. The mass was surgically excised, and the diagnosis was confirmed by histopathology. The occurrence of an odontoma in the nasal cavity is extremely rare.

  2. Apocrine carcinoma arising in a complex fibroadenoma: a case report. (United States)

    Mele, Marco; Vahl, Pernille; Funder, Jonas Amstrup; Sorensen, Anne Schmidt; Jensen, Vibeke


    A carcinoma arising in a fibroadenoma is a rare event, which often entails a diagnostic challenge. The most common type is the lobular carcinoma and secondary a ductal carcinoma. We present an extremely rare case of malignant development of an invasive apocrine carcinoma in a complex fibroadenoma and underline the importance for clinicians to recognize the possibility of benign and malignant co-existence especially in older women.

  3. Molecular alterations and expression of succinate dehydrogenase complex in wild-type KIT/PDGFRA/BRAF gastrointestinal stromal tumors. (United States)

    Celestino, Ricardo; Lima, Jorge; Faustino, Alexandra; Vinagre, João; Máximo, Valdemar; Gouveia, António; Soares, Paula; Lopes, José Manuel


    Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract, disclosing somatic KIT, PDGFRA and BRAF mutations. Loss of function of succinate dehydrogenase (SDH) complex is an alternative molecular mechanism in GISTs, namely in carriers of germline mutations of the SDH complex that develop Carney-Stratakis dyad characterized by multifocal GISTs and multicentric paragangliomas (PGLs). We studied a series of 25 apparently sporadic primary wild-type (WT) KIT/PDGFRA/BRAF GISTs occurring in patients without personal or familial history of PGLs, re-evaluated clinicopathological features and analyzed molecular alterations and immunohistochemistry expression of SDH complex. As control, we used a series of well characterized 49 KIT/PDGFRA/BRAF-mutated GISTs. SDHB expression was absent in 20% and SDHB germline mutations were detected in 12% of WT GISTs. Germline SDHB mutations were significantly associated to younger age at diagnosis. A significant reduction in SDHB expression in WT GISTs was found when compared with KIT/PDGFRA/BRAF-mutated GISTs. No significant differences were found when comparing DOG-1 and c-KIT expression in WT, SDHB-mutated and KIT/PDGFRA/BRAF-mutated GISTs. Our results confirm the occurrence of germline SDH genes mutations in isolated, apparently sporadic WT GISTs. WT KIT/PDGFRA/BRAF GISTs without SDHB or SDHA/SDHB expression may correspond to Carney-Stratakis dyad or Carney triad. Most importantly, the possibility of PGLs (Carney-Stratakis dyad) and/or pulmonary chondroma (Carney triad) should be addressed in these patients and their kindred.

  4. Smile esthetics: a methodology for success in a complex case. (United States)

    Paris, Jean-Christophe; Ortet, Stéphanie; Larmy, Annick; Brouillet, Jean-Louis; Faucher, André-Jean


    The clinical case presented is the demonstration of a multidisciplinary approach to a complex treatment. A precise methodology is important to ensure that the treatment objectives are clear to all the teams. The aim of the treatment is to restore dentofacial harmony to a young, 22-year-old, female patient showing severe attrition of the anterior teeth. The direct effect of this is an ageing of the smile. This type of multidisciplinary treatment, which seems complicated at first, is greatly simplified once time has been spent on the diagnosis and treatment plan: it thereby becomes a succession of clinical stages.

  5. An Unusual Erupted Complex Composite Odontoma: A Rare Case

    Directory of Open Access Journals (Sweden)

    Dawasaz Ali Azhar


    Full Text Available Odontomas are malformations of the dental tissues and may interfere with the eruption of the associated tooth. Complex composite odontoma (CO was described as a distinct entity for the first time by Broca in 1866. This lesion takes place due to the developmental disturbances where the dental components are laid down in a disorganized manner, due to failure of normal morphodifferentiation. Very few cases of erupted complex composite odontomas have been reported in the literature. The case reported here is of an odontoma found in the left mandibular body, associated with an impacted second molar of a 17-year-old Saudi male. Under local anesthesia the odontoma was surgically removed. Histopathological examination confirmed the diagnosis of CO. The impacted second molar which was left in the mandibular body erupted clinically after 6 months. Erupted CO is rarely seen in the mandibular left body. The early diagnosis, followed by a proper treatment at the right time, will result in a favorable prognosis.

  6. Limb body wall complex or body stalk complex or cyllosomas: a case report

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    S. Saritha


    Full Text Available Limb body wall complex (LBWC is also called Body stalk complex and Cyllosomas. We present this rare congenital malformation complex highlighting the importance of early sonographic imaging findings in LBWC along with differentiation from other anterior abdominal wall defects. Limb body wall complex / Body stalk anomaly refers to a rare complicated polymalformative fetal malformation syndrome of uncertain etiology and results in head, heart, lung, diaphragm, kidney or gonadal abnormalities. LBWC was first described by Van Allen et al; in (1987. The two of the three following anomalies must be present to establish the diagnosis: 1. Exencephaly / Encephalocele with facial clefts, 2. Thoraco-Abdominoschisis / ventral body wall defects and 3. Limb defects. LBWC arises as a result of early amnion disruptions or error in embryonic development. If all components of the syndrome are present, the condition is lethal. LBWC is invariably fatal and incompatible with life. No case of postnatal survival is reported so far. Serum alpha-fetoprotein measurement and ultrasonography examination is the key to the prenatal diagnosis and followed by medical termination of pregnancy. It presents two distinct phenotypes described by Russo et al (1993 and later Cusi et al in (1996, according to the foetoplacental relationships: 1. Placento-cranial and 2.Placento-abdominal types. Among the 168 live births at S.V.S. Medical College & hospital Mahabubnagar (INDIA during the period of 2010-2011 we came across an aborted female fetus. It was weighing 1800gms, 30 weeks of gestation diagnosed by antenatal ultrasonography as ventral body wall defect. It was associated with ompholocele, severe scoliosis and limb defects. Its confirmation of the diagnosis of Limb body wall complex with Placento-abdominal type was done by postmortem fetography. [Int J Res Med Sci 2013; 1(2.000: 132-137

  7. Understanding Complex Human Ecosystems: The Case of Ecotourism on Bonaire

    Directory of Open Access Journals (Sweden)

    Thomas Abel


    Full Text Available It is suggested that ecotourism development on the island of Bonaire can be productively understood as a perturbation of a complex human ecosystem. Inputs associated with ecotourism have fueled transformations of the island ecology and sociocultural system. The results of this study indicate that Bonaire's social and economic hierarchy is approaching a new, stable systems state following a 50-yr transition begun by government and industry that stabilized with the appearance of ecotourism development and population growth. Ecotourism can be understood to have "filled in" the middle of the production hierarchy of Bonaire. Interpreted from this perspective, population growth has completed the transformation by expanding into production niches at smaller scales in the production hierarchy. Both a consequence and a cause, ecotourism has transformed the island's social structure and demography. The theory and methods applied in this case study of interdisciplinary research in the field of human ecosystems are also presented.

  8. [Circulating immuns complexes and infections endocarditis. 64 cases (author's transl)]. (United States)

    Herreman, G; Godeau, P; Cabane, J; Acar, J F; Digeon, M; Bach, J F


    An immunological study, with examination for circulating immune complexes (CIC) by precipitation by polyethylene-glycol (PEG) and by fixation of labelled C1q, was carried out in 64 patients with infectious endocarditis (IE). One or more complementary studies during the course of the illness were possible in 23. CIC were found in 84 p. 100 of cases (66 p. 100 of acute IE and 89 p. 100 of subacute IE), during the active phase of the disease. High levels of PEG precipitate were correlated with typical cutaneous signs (including Osler's nodes), with the presence of cryoglobulins. With effective antibiotic treatment, the level of PEG precipitate (17 patients) returned to normal within one month, in parallel with a fall in rheumatoid factor and in cryoglobulins. By contrast, ineffective treatment was invariably reflected (6 patients) by a rise in levels of PEG precipitate. The estimation of CIC using the PEG technique during IE would already appear to be a value aid in cases of difficult diagnosis, and a research area worthy of further exploration within the context of IE.

  9. Tríada de Carney incompleta e hipertensión arterial en una mujer joven Incomplete Carney’s triad and arterial hypertension in a young woman

    Directory of Open Access Journals (Sweden)

    Alberto Allievi


    Full Text Available Se presenta una el caso de paciente joven, con tríada de Carney incompleta que cursa hipertensión arterial de dos años de evolución y anemia ferropénica grave por pérdida crónica de sangre por tubo digestivo, con tumores gástricos múltiples y paraganglioma pararrenal. No presenta aún desarrollo de condromas pulmonares visibles por tomografía axial computada. En nuestra paciente el paraganglioma no resultó funcionante. Resaltamos que la presencia de tumores gástricos múltiples en un adulto joven debe sugerir la posibilidad de tumores estromales (GIST, cuyo diagnóstico por biopsia endoscópica es difícil debido a su localización profunda, situada en las capas musculares de la pared gástrica. Asimismo queremos remarcar la importancia de las técnicas de marcación descriptas para el diagnóstico preciso. El seguimiento debe ser constante dado el pronóstico incierto de estos tumores. Los condromas pulmonares pueden aparecer años después de la resección del GIST y ser confundidos con metástasis del GIST.The case of young woman with arterial hypertension diagnosed two years before, is here presented; she had a ferropenic anemia caused by digestive loss of blood. Multiple gastric tumors and pararenal non functioning paraganglioma were found. No chondromas were detected. An incomplete Carney’s Triad was diagnosed. We remark that multiple gastric tumors in a young adult suggest the possibility of gastrointestinal stromal tumors (GIST Endoscopic biopsy frequently is not effective because these tumors are deep placed in the muscular gastric layers. The importance of specific techniques for a positive diagnosis are emphasized. Continuous follow up is needed because these tumors have uncertain prognosis. Lung chondromas may appear years later after the GIST was removed and might be confused with GIST metastases.

  10. Complexity of case mix in a regional allergy service

    Directory of Open Access Journals (Sweden)

    Kaminski Edward R


    Full Text Available Abstract Background Currently in the United Kingdom (UK, there is a mismatch between limited financial resources and the large proportion of patients with suspected allergies actually being referred to specialist allergy clinics. To better understand the case mix of patients being referred, we audited referrals to a regional allergy service over an 8 year period. The main source of data was consultant letters to General Practitioners (GP summarising the diagnosis of patients, archived from January 2002 to September 2009. Letters were reviewed, extracting the clinic date, doctor seen, gender, date of birth, postcode, GP, and diagnoses. Diagnoses were classified into seven groups and illustrative cases for each group noted. Findings Data from 2,028 new referrals with suspected allergy were analysed. The largest group of patients (43% were diagnosed with a type I hypersensitivity. The other diagnostic groups were chronic idiopathic (spontaneous urticaria (35%, suspected type I hypersensitivity but no allergen identified (8%, idiopathic (spontaneous angioedema (8%, physical urticaria (2.5%, non-allergic symptoms (1.6%, type IV hypersensitivity (0.8% and ACE inhibitor sensitivity (0.5%. Two thirds of patients seen were female with a higher percentage of female patients in the non type-I hypersensitivity group (71% than the type 1 hypersensitivity (66% (χ2 = 5.1, 1df, p = 0.024. The type 1 hypersensitivity patients were younger than other patients (38 Vs 46 years, t = -10.8, p Conclusions This study highlights the complexity of specialist allergy practice and the large proportion of patients referred with non-type I hypersensitivities, chronic idiopathic (spontaneous urticaria being by far the largest group. Such information is critical to inform commissioning decisions, define referral pathways and in primary care education.

  11. Data science and complex networks real case studies with Python

    CERN Document Server

    Caldarelli, Guido


    This book provides a comprehensive yet short description of the basic concepts of complex network theory and the code to implement this theory. Differently from other books, we present these concepts starting from real cases of study. The application topics span from food webs, to the Internet, the World Wide Web, and social networks, passing through the international trade web and financial time series. The final part is devoted to definition and implementation of the most important network models. We provide information on the structure of the data and on the quality of available datasets. Furthermore, we provide a series of codes to implement instantly what is described theoretically in the book. People knowing the basis of network theory could learn the art of coding in Python by checking our codes and using the online material. In particular, the interactive Python notebook format is used so that the reader can immediately experiment by themselves with the codes present in the manuscript. To this purpose...

  12. Complex organizations: the case of the Brazilian nuclear sector

    Energy Technology Data Exchange (ETDEWEB)

    Xavier, Roberto Salles [Comissao Nacional de Energia Nuclear (CNEN), Rio de Janeiro, RJ (Brazil). Coordenacao-Geral de Planejamento e Avaliacao], e-mail:


    The resumption of the Brazilian Nuclear Program (BNP), in the proposed size and after 20 years of paralysis, requires profound changes in the current organizational modeling of the national nuclear industry. The effectiveness of any process of organizational change is limited to three factors. The theoretical bottleneck happens when you do not know enough about a phenomenon in order to effect the desired changes. The resource bottleneck occurs when knowledge may be available to change people's behavior but the funds necessary for implementation may be lacking. The organizational bottleneck emerges when there are knowledge and resources to solve a problem, but may not able to organize the resources in order to carry out the problem-solving effort. In the case of resumption of BNP seems clear that there is the knowledge of what is needed to make policy and the intention to allocate the necessary resources. But the question is the following: the current organizational model of the Brazilian nuclear sector is consistent with the goals laid down in the scenario of resumption of BNP? That is, is there organizational ability to leverage a program of the size proposed for the nuclear area? Find answers to these questions is crucial, because the organizational model of the Brazilian nuclear sector consists of elements involving a complex interorganizational system. Thus, this article is to examine the appropriateness of the current organizational modeling of the Brazilian nuclear sector to current demands of society. As a result, the article aims to propose recommendations for a remodeling of the nuclear sector, taking into account the current national and international scenarios of nuclear energy. (author)

  13. A Case Report for a Complex Denture Case on a Special Care Patient with Osteogenesis Imperfecta. (United States)

    Sawyer, Colin; Drysdale, David


    This case report presents a patient with Dentogenesis Imperfecta (DI) associated with Osteogenesis Imperfecta (OI) and its subsequent dental manifestations. The patient in this report (see Figure 1) has spent his life living with his disability type III OI (also known as brittle bone disease) and its degenerative affects. The patient is independent and enjoys his social life but felt his existing dentures were having an adverse effect on the quality of his life. The patient attended Dorset County Hospitals Special Care Dentistry and on clinical examination it was noted the patient was partially dentate with a class III malocclusion and brownish discoloration of the remaining teeth caused by enamel hypoplasia. Treatment for this patient would entail making a maxillary complete denture and a mandibular partial chrome denture, normally quite simple tasks but due to the DI and its dental manifestations, the treatment would be complicated. This case demonstrates how a complex case treated by a collaborative dental team using their different skills and knowledge can lead to a successful and rewarding treatment for both patient and team.

  14. Complex phonic tic and disinhibition in Tourette syndrome: case report. (United States)

    Maia, D P; Cardoso, F


    Tourette syndrome (TS) is a neuropsychiatric disorder characterized by a combination of multiple motor tics and at least one phonic tic. TS patients often have associated behavioral abnormalities such as obsessive compulsive disorder, attention deficit and hyperactive disorder. Coprolalia, defined as emission of obscenities or swearing, is one type of complex vocal tic, present in 8% to 26% of patients. The pathophysiology of coprolalia and other complex phonic tics remains ill-defined. We report a patient whose complex phonic tic was characterized by repetitively saying "breast cancer" on seeing the son of aunt who suffered from this condition. The patient was unable to suppress the tic and did not meet criteria for obsessive compulsive disorder. The phenomenology herein described supports the theory that complex phonic tics result from disinhibition of the loop connecting the basal ganglia with the limbic cortex.

  15. Axial mesodermal dysplasia complex: a new case with parental consanguinity. (United States)

    Mota, C R; Azevedo, M; Rocha, G; Manuela, F; Coelho, R; Lima, M R


    A female is described with axial mesodermal dysplasia complex (AMDC) born to a consanguineous couple. This is thought to be the first description of a patient with AMDC born to consanguineous parents.

  16. Erupted complex odontoma: a case report and literature review. (United States)

    Litonjua, Luis A; Suresh, Lakshmanan; Valderrama, Lucia S; Neiders, Mirdza E


    A case involving a 17-year-old girl with a large erupted odontoma associated with a deeply impacted mandibular molar is reported. The molar, which previously had been displaced to the border of the mandible, erupted successfully three years after surgical removal of the odontoma. A review of the literature presents guidelines for treating similar cases.

  17. Complexity, Representation and Practice: Case Study as Method and Methodology (United States)

    Miles, Rebecca


    While case study is considered a common approach to examining specific and particular examples in research disciplines such as law, medicine and psychology, in the social sciences case study is often treated as a lesser, flawed or undemanding methodology which is less valid, reliable or theoretically rigorous than other methodologies. Building on…

  18. A practical approach to language complexity: a Wikipedia case study. (United States)

    Yasseri, Taha; Kornai, András; Kertész, János


    In this paper we present statistical analysis of English texts from Wikipedia. We try to address the issue of language complexity empirically by comparing the simple English Wikipedia (Simple) to comparable samples of the main English Wikipedia (Main). Simple is supposed to use a more simplified language with a limited vocabulary, and editors are explicitly requested to follow this guideline, yet in practice the vocabulary richness of both samples are at the same level. Detailed analysis of longer units (n-grams of words and part of speech tags) shows that the language of Simple is less complex than that of Main primarily due to the use of shorter sentences, as opposed to drastically simplified syntax or vocabulary. Comparing the two language varieties by the Gunning readability index supports this conclusion. We also report on the topical dependence of language complexity, that is, that the language is more advanced in conceptual articles compared to person-based (biographical) and object-based articles. Finally, we investigate the relation between conflict and language complexity by analyzing the content of the talk pages associated to controversial and peacefully developing articles, concluding that controversy has the effect of reducing language complexity.

  19. Nursing in a complex world: a case for grand theory. (United States)

    Florczak, Kristine; Poradzisz, Michele; Hampson, Susan


    The authors of this column put forth a call for more grand theory to be used as the basis of nursing research. To that end, complexity theory and the Neuman systems model are reviewed followed by a discussion of the links that occur between them. Then evidence of the increased use of middle-range theory as the foundation of current nursing research is put forth. Finally, there is a discussion about the authors' conclusion that the complexity of the phenomena of interest for nursing research requires theories to be used as underpinnings that are more abstract and less reductionistic.

  20. Success case studies contribute to evaluation of complex research infrastructure. (United States)

    Hogle, Janice A; Moberg, D Paul


    The success case studies approach examines in depth what works well in a program by describing cases and examining factors leading to successful outcomes. In this article, we describe the use of success case studies as part of an evaluation of the transformation of a health sciences research support infrastructure. Using project-specific descriptions and the researchers' perceptions of the impact of improved research infrastructure, we added depth of understanding to the quantitative data required by funding agencies. Each case study included an interview with the lead researcher, along with review of documents about the research, the investigator, and their collaborators. Our analyses elucidated themes regarding contributions of the Clinical and Translational Science Awards program of the National Institutes of Health to scientific achievements and career advancement of investigators in one academic institution.

  1. Case report of Plasmodium falciparum malaria presenting as wide complex tachycardia

    Institute of Scientific and Technical Information of China (English)

    Sunil Kumar; Diwan SK; Mahajan SN; Shilpa Bawankule; Chetan Mahure


    Malaria caused by Plasmodium falciparum is a multisystem disorder and may have diversity of clinical presentations. We are presenting a case report of patients of falciparum malaria who presented to us with palpitation and fever. On electrocardiogram he had wide complex tachycardia. This case reiterates the need to think of malaria in any case with symptoms of fever with chills, even with various unusual presentations like palpitation due to wide complex tachycardia, especially in endemic country like India.

  2. A Rare Presentation of Conjunctival Myxoma with Pain and Redness: Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Yu-Po Chen


    Full Text Available Background: Conjunctival myxoma is a type of rare, benign tumor of mesenchymal cells, with fewer than 30 reported cases in the English literature. It is mostly an isolated occurrence but can sometimes be associated with systemic diseases such as Carney complex or Zollinger-Ellison syndrome. It is necessary in clinical practice to differentiate it from other similar lesions, such as amelanotic nevus, lymphangioma, myxoid liposarcoma, spindle-cell lipoma, myxoid neurofibroma, and rhabdomyosarcoma. Case Presentation: The usual presentation of conjunctival myxoma is a translucent, well-circumscribed, and painless conjunctival mass, but in this report we discuss an unusual case of conjunctival myxoma in a 47-year-old Taiwanese woman who presented initially with pain and redness. This atypical presentation complicated the diagnosis and the management at first. Surgical excision of the mass was performed. The mass was found to be a conjunctival myxoma. The patient subsequently underwent extensive evaluation but was found not to have any systemic diseases with known association with conjunctival myxoma. Conclusions: In summary, we present a case of conjunctival myxoma in a 47-year-old Taiwanese woman. The initial presentation with pain and redness was atypical for conjunctival myxoma. The lesion was successfully managed with complete excisional biopsy.

  3. A practical approach to language complexity: a Wikipedia case study

    CERN Document Server

    Yasseri, Taha; Kertész, János


    In this paper we present statistical analysis of English texts from Wikipedia (WP). We try to address the issue of language complexity empirically by comparing samples of the main English WP (Main) and the simple English WP (Simple). Simple is supposed to use a more simplified language with a limited vocabulary, and editors are explicitly requested to follow this guideline, yet in practice the vocabulary richness of both samples are at the same level. However, detailed analysis of longer units (n-grams rather than words alone) shows that the language of Simple is indeed less complex than that of Main. Comparing the two language varieties by the Gunning readability index supports this conclusion. We also report on the topical dependence of language complexity, e.g. that the language is more advanced in conceptual articles compared to person-based (biographical) and object-based articles. Finally, we investigate the relation between conflict and language complexity by analysing the content of the talk pages ass...

  4. Change Management and Complexity: The Case for Narrative Action Research (United States)

    Boxelaar, Lucia; Paine, Mark; Beilin, Ruth


    Post-modern theorists have challenged the totalizing and unifying ambitions of change management practices. This paper explores how a narrative action research approach may be used to combine our modernist commitment to facilitate change and collaboration in the land management context with a post-modern sensitivity to complexity and difference.…

  5. Data Mining and Complex Problems: Case Study in Composite Materials (United States)

    Rabelo, Luis; Marin, Mario


    Data mining is defined as the discovery of useful, possibly unexpected, patterns and relationships in data using statistical and non-statistical techniques in order to develop schemes for decision and policy making. Data mining can be used to discover the sources and causes of problems in complex systems. In addition, data mining can support simulation strategies by finding the different constants and parameters to be used in the development of simulation models. This paper introduces a framework for data mining and its application to complex problems. To further explain some of the concepts outlined in this paper, the potential application to the NASA Shuttle Reinforced Carbon-Carbon structures and genetic programming is used as an illustration.

  6. Similar levels of immune complexes in cases of multiple sclerosis and their unaffected relatives. (United States)

    Haile, R W; Karavodin, L M; Visscher, B R; Detels, R; Valdiviezo, N L


    To investigate the possible effect of the hypothetical multiple sclerosis susceptibility (MSS) gene on circulating immune complexes, we employed a sensitive assay to test for the presence of immune complexes in sera of MS patients and unaffected relatives classified by the presence/absence of HLA-defined markers for the MSS gene. We found no significant differences between cases and relatives. The results suggest that elevated immune complex levels in MS patients' sera reported by others may not be unique to MS cases, but may represent instead a familial phenomenon. We also report a possible association between the A3 + B7 haplotype and increased immune complexes.

  7. Management of a complex dentoalveolar trauma: a case report. (United States)

    De Rossi, Moara; De Rossi, Andiara; Queiroz, Alexandra Mussolino de; Nelson Filho, Paulo


    This paper describes the case of a 12-year-old male patient who presented a severe lateral luxation of the maxillary central incisors due to a bicycle fall. Treatment involved suture of the soft tissues lacerations, and repositioning and splinting of the injured teeth, followed by endodontic treatment and periodontal surgery. After a 2-year follow-up, clinical and radiographic evaluation revealed that the incisors presented satisfactory esthetic and functional demands.

  8. Complex nasal reconstruction after paracoccidioidomycosis infection--Case report. (United States)

    Ribeiro, Emilie Barreto; Pochat, Victor Diniz de; Magaldi, Eduarda Nilo de; Figueiredo, Bruno Suffredini; Alonso, Nivaldo; Meneses, José Valber de Lima


    Paracoccidioidomycosis is an infectious disease whose etiological agent belongs to the Paracoccidioides genus. Although it affects primarily the lungs, it can spread to other tissues, including the skin and mucous membranes. Despite the clinical treatment for this disease, scarring can produce sequelae, manifesting as anatomical and functional deformities of the face. We present a case of extensive, nasal unaesthetic and functional sequelae resulting from paracoccidioidomycosis, reconstructed using the paramedian forehead flap in three stages, through the regional unit principles.

  9. Assessing health care needs and clinical outcome with Urological case complexity : A study using INTERMED

    NARCIS (Netherlands)

    Herms, AMRD; Pinggera, GM; De Jonge, P; Strasser, H; Sollner, W


    Urinary tract symptoms and, particularly, urinary incontinence are often chronic and complex conditions that cause diagnosis, treatment, and management problems. In many cases, psychosocial factors contribute to the development of a chronic condition. The authors investigated whether INTERMED, an in

  10. Assurance Cases for Design Analysis of Complex System of Systems Software (United States)


    2009 Carnegie Mellon University Assurance Cases for Design Analysis of Complex System of Systems Software Presented at AIAA Infotech@Aerospace...Conference Software Assurance Session 8 April 2009 Stephen Blanchette, Jr. Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting...TITLE AND SUBTITLE Assurance Cases for Design Analysis of Complex System of Systems Software 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM

  11. Complex Syntax Acquisition: A Longitudinal Case Study of a Child with Specific Language Impairment (United States)

    Schuele, Melanie C.; Dykes, Julianna C.


    Although there is extensive documentation of the morphological limitations of children with specific language impairment (SLI), few studies have reported on complex syntax acquisition in children with SLI. This case study examined the development of complex syntax in a child with SLI between 3 and 7 years. Twelve conversational samples were…

  12. Large complex odontoma of mandible in a young boy: a rare and unusual case report. (United States)

    Reddy, G Siva Prasad; Reddy, G V; Sidhartha, B; Sriharsha, K; Koshy, John; Sultana, Rehana


    Odontomas are the most common odontogenic tumors. They are broadly classified in to Compound Odontoma and Complex Odontoma. Among them complex odontoma is a rare tumor. Occasionally this tumor becomes large, causing expansion of bone followed by facial asymmetry. Otherwise these tumors are asymptomatic and are generally diagnosed on radiographic examination. We report a rare case of complex odontoma of mandible in a young boy. The tumor was treated by surgical excision under general anesthesia.

  13. Large Complex Odontoma of Mandible in a Young Boy: A Rare and Unusual Case Report

    Directory of Open Access Journals (Sweden)

    G. Siva Prasad Reddy


    Full Text Available Odontomas are the most common odontogenic tumors. They are broadly classified in to Compound Odontoma and Complex Odontoma. Among them complex odontoma is a rare tumor. Occasionally this tumor becomes large, causing expansion of bone followed by facial asymmetry. Otherwise these tumors are asymptomatic and are generally diagnosed on radiographic examination. We report a rare case of complex odontoma of mandible in a young boy. The tumor was treated by surgical excision under general anesthesia.

  14. A Real-Life Case Study of Audit Interactions--Resolving Messy, Complex Problems (United States)

    Beattie, Vivien; Fearnley, Stella; Hines, Tony


    Real-life accounting and auditing problems are often complex and messy, requiring the synthesis of technical knowledge in addition to the application of generic skills. To help students acquire the necessary skills to deal with these problems effectively, educators have called for the use of case-based methods. Cases based on real situations (such…


    Institute of Scientific and Technical Information of China (English)

    Fang Gensun; Ye Peixin


    The order of computational complexity of all bounded linear functional approximation problem is determined for the generalized Sobolev class Wp∧(Id), Nikolskii class Hk∞(Id) in the worst (deterministic), stochastic and average case setting, from which it is concluded that the bounded linear functional approximation problem for the classes stochastic and average case setting.

  16. Presence of voltage-gated potassium channel complex antibody in a case of genetic prion disease. (United States)

    Jammoul, Adham; Lederman, Richard J; Tavee, Jinny; Li, Yuebing


    Voltage-gated potassium channel (VGKC) complex antibody-mediated encephalitis is a recently recognised entity which has been reported to mimic the clinical presentation of Creutzfeldt-Jakob disease (CJD). Testing for the presence of this neuronal surface autoantibody in patients presenting with subacute encephalopathy is therefore crucial as it may both revoke the bleak diagnosis of prion disease and allow institution of potentially life-saving immunotherapy. Tempering this optimistic view is the rare instance when a positive VGKC complex antibody titre occurs in a definite case of prion disease. We present a pathologically and genetically confirmed case of CJD with elevated serum VGKC complex antibody titres. This case highlights the importance of interpreting the result of a positive VGKC complex antibody with caution and in the context of the overall clinical manifestation.

  17. Analysis and Perspective from the Complex Aerospace Systems Exchange (CASE) 2013 (United States)

    Jones, Kennie H.; Parker, Peter A.; Detweiler, Kurt N.; McGowan, Anna-Maria R.; Dress, David A.; Kimmel, William M.


    NASA Langley Research Center embedded four rapporteurs at the Complex Aerospace Systems Exchange (CASE) held in August 2013 with the objective to capture the essence of the conference presentations and discussions. CASE was established to provide a discussion forum among chief engineers, program managers, and systems engineers on challenges in the engineering of complex aerospace systems. The meeting consists of invited presentations and panels from industry, academia, and government followed by discussions among attendees. This report presents the major and reoccurring themes captured throughout the meeting and provides analysis and insights to further the CASE mission.

  18. Peripheral ameloblastic fibro-odontoma or peripheral developing complex odontoma: report of a case

    DEFF Research Database (Denmark)

    Reibel, Jesper; Grønbæk, Anni Birgitte; Poulsen, Sven


    BACKGROUND. Peripheral (extraosseous) odontogenic tumors are rare. CASE REPORT. This report describes a case which illustrates the clinical and histopathological features of a lesion in an 8-year-old, healthy Caucasian girl that on purely morphological grounds would seem to be an ameloblastic fibro-odontoma......, but may represent a case of a peripheral developing complex odontoma. CONCLUSION. Conservative surgical enucleation of the lesion was followed by unbcomplicated healing and no recurrence was seen....

  19. Peripheral ameloblastic fibro-odontoma or peripheral developing complex odontoma: report of a case. (United States)

    Reibel, Jesper; Grønbaek, Anni B; Poulsen, Sven


    BACKGROUND. Peripheral (extraosseous) odontogenic tumors are rare. CASE REPORT. This report describes a case which illustrates the clinical and histopathological features of a lesion in an 8-year-old, healthy Caucasian girl that on purely morphological grounds would seem to be an ameloblastic fibro-odontoma, but may represent a case of a peripheral developing complex odontoma. CONCLUSION. Conservative surgical enucleation of the lesion was followed by unbcomplicated healing and no recurrence was seen.

  20. Succinate dehydrogenase (SDHx) mutations in pituitary tumors: could this be a new role for mitochondrial complex II and/or Krebs cycle defects? (United States)

    Xekouki, Paraskevi; Stratakis, Constantine A


    Succinate dehydrogenase (SDH) or mitochondrial complex II is a multimeric enzyme that is bound to the inner membrane of mitochondria and has a dual role as it serves both as a critical step of the tricarboxylic acid or Krebs cycle and as a member of the respiratory chain that transfers electrons directly to the ubiquinone pool. Mutations in SDH subunits have been implicated in the formation of familial paragangliomas (PGLs) and/or pheochromocytomas (PHEOs) and in Carney-Stratakis syndrome. More recently, SDH defects were associated with predisposition to a Cowden disease phenotype, renal, and thyroid cancer. We recently described a kindred with the coexistence of familial PGLs and an aggressive GH-secreting pituitary adenoma, harboring an SDHD mutation. The pituitary tumor showed loss of heterozygosity at the SDHD locus, indicating the possibility that SDHD's loss was causatively linked to the development of the neoplasm. In total, 29 cases of pituitary adenomas presenting in association with PHEOs and/or extra-adrenal PGLs have been reported in the literature since 1952. Although a number of other genetic defects are possible in these cases, we speculate that the association of PHEOs and/or PGLs with pituitary tumors is a new syndromic association and a novel phenotype for SDH defects.

  1. Review of 61 cases of odontoma. Presentation of an erupted complex odontoma. (United States)

    Amado Cuesta, Susana; Gargallo Albiol, Jordi; Berini Aytés, Leonardo; Gay Escoda, Cosme


    Odontomas are benign tumors of odontogenic origin characterized by their slow growth. They consist of enamel, dentine, cementum and pulpal tissue and constitute 22% of all odontogenic tumors. Two types of odontoma are recognized: compound and complex. The first is approximately twice as common as complex odontomas. The purpose of this study is to value the prevalence of this kind of tumors in the ambulatory-surgical gambit and their clinical symptoms. We want to emphasize the exceptional spontaneous eruption of this tumors and we report a case of erupted complex odontoma. We made the revision of the cases of diagnosed odontomas between 1983 and 2001 in the Clínica Ntra. Sra. del Remei, in the Centro Médico Teknon and the Master de Cirugía e Implantología Bucal of the Odontologic Clínic (Barcelona University). We analyzed their prevalence, distribution in gender, age of the patients, anatomic location, adjacent structures affectation, symptoms, histologic classification and treatment. 52.4% of the cases were diagnosed in females. 37.7% of the tumors were complex odontomas and 62.3% were diagnosed as compound odontomas. 55.7% of all cases were in the maxilla and 44.3% in the mandible. The anterior portion of maxilla was the most common location (54% of cases). Only a case (1.6%) was erupted, in the molars area of the maxilla.

  2. A Complex Facial Trauma Case with Multiple Mandibular Fractures and Dentoalveolar Injuries



    The principles of management of mandibular fractures differ in children when compared to adults and depend on the specific age-related status of the growing mandible and the developing dentition. This paper presents a case report with a complex facial trauma affecting the mandibular body and condyle region and dentoalveolar complex. Clinical examination revealed soft tissue injuries, limited mouth opening, lateral deviation of the mandible, an avulsed incisor, a subluxated incisor, and a frac...


    Directory of Open Access Journals (Sweden)

    Braja Mohan


    Full Text Available Cystosarcoma phyllodes is a rare, predominantly benign tumor of the female breast, comprising less than 1% of all breast neoplasms. The incidence of malignancy in phyllodes tumor is even less, only 25% which usually does not ulcerate the skin or involve the nipple areola complex. 1, 2 Herein we report a case of 16years old girl with a right sided big malignant phyllodes tumor with nipple areola complex involvement and skin ulceration

  4. [Integral approach by the case manager and the community nurse to a complex case of diabetes mellitus in the home]. (United States)

    Prats-Guardiola, Marta; López-Pisa, Rosa María


    We present the case of a patient with long-term and clinically complex Diabetes Mellitus. She was taking part in the home care program in Primary Care. The complications of her DM affected her quality of life: blindness, kidney failure, treated with hemodialysis, and a cerebrovascular attack. We describe the evaluation following Virginia's Henderson model. This evaluation was made in the patient's home after she was discharged from the socio-health centre where she was admitted as her right leg was amputated at a supracondylar level. It was designed a care plan between the community nurse and the case manager using NANDA, NOC and NIC taxonomy. The care plan was carried out as a joint effort between the community nurse and the case manager who coordinated the planning with the rest of professionals. Results were evaluated 6 months after the initial assessment. This case, which had a high dependence and a high clinical complexity, required a multidisciplinary approach and the integration of different professionals, services and institutions to implement the patient's treatment. Because of all the above, it is important to mention the case management function to guarantee continuity, and overall and integrated care.

  5. Large Complex Odontome of Maxilla: Report of a case and Literature Review

    Directory of Open Access Journals (Sweden)

    Geeta Singh


    Full Text Available The pathologic al c onditions in which odontogenic differentiation is fully expressed are the odontomas. Odontomas are consi­ dered as hamartomas/developmental anomaly rather than a true neo plasm. These tumors are composed of enamel, dentin, cemen­tum and pulp tissue. They are basically classified into two types, compound and complex. Most compound odontoma are found in the anterior maxilla whereas complex odontomas are commonly found in posterior mandible. We present a rare case of complex odontome in anterior maxilla treated in our center.

  6. A case of hybrid closure of a muscular ventricular septal defect: anatomical complexity and surgical management. (United States)

    Karimi, Mohsen; Hulsebus, Elise; Murdison, Kenneth; Wiles, Henry


    Complex muscular ventricular septal defect poses difficult surgical management and is associated with high morbidity and mortality despite advancements in surgical therapy. Device closure of muscular ventricular septal defect has been encouraging and has been used in hybrid approach at a few centres. However, device closure has some limitations in patients with complex muscular ventricular septal defect. We report a case of perventricular device closure of a complex muscular ventricular septal defect in a beating heart with entrapped right ventricular disc and its surgical management.

  7. Sequestrating giant complex odontoma: a case report and review of the literature. (United States)

    Perumal, C J; Mohamed, A; Singh, A; Noffke, C E E


    Odontomas are the most common benign tumours of odontogenic origin. Due to their hamartomatous nature, they are usually asymptomatic but can cause impaction of one or more teeth. They consist microscopically of all the tissue types found in a developed tooth. We present a case of a large sequestrating complex odontoma resulting in facial asymmetry, cellulitis, pain and partial loss of function. This case has significance, as odontomas of this large size have rarely been reported.

  8. Primary pigmented nodular adrenocortical disease presenting with a unilateral adrenocortical nodule treated with bilateral laparoscopic adrenalectomy: a case report

    Directory of Open Access Journals (Sweden)

    Kaltsas Gregory


    Full Text Available Abstract Introduction Primary pigmented nodular adrenocortical disease is a rare cause of adrenocorticotropic hormone-independent Cushing's syndrome. We report an uncommon primary pigmented nodular adrenocortical disease case presenting with a unilateral adrenocortical nodule and provide a brief overview of the existing literature. Case presentation A 27-year-old Caucasian woman was admitted to our Department with adrenocorticotropic hormone-independent Cushing's syndrome. Its cause was initially considered a left adrenocortical adenoma based on computer tomography imaging. The patient underwent left laparoscopic adrenalectomy and histological examination revealed pigmented micronodular adrenal hyperplasia. Evaluation for the presence of Carney complex was negative. Six months later recurrence of hypercortisolism was documented and a right laparoscopic adrenalectomy was performed further establishing the diagnosis of primary pigmented nodular adrenocortical disease. After a nine-year follow-up there is no evidence of residual disease. Conclusions Even though primary pigmented nodular adrenocortical disease is a rare cause of Cushing's syndrome, it should be included in the differential diagnosis of adrenocorticotropic hormone-independent Cushing's syndrome, especially because adrenal imaging can be misleading mimicking other adrenocortical diseases. Bilateral laparoscopic adrenalectomy is the preferred treatment in these subjects.

  9. How Can We Explain Poverty? Case Study of Dee Reveals the Complexities (United States)

    Seccombe, Karen


    Many theories have been offered to explain why people are impoverished. This article by Karen Seccombe uses the case study of "Dee," a newly single mother, to explore four of the most common: individualism, social structuralism, the culture of poverty, and fatalism. She concludes that poverty is a highly complex phenomenon, and it is likely that…

  10. A Complex Facial Trauma Case with Multiple Mandibular Fractures and Dentoalveolar Injuries

    Directory of Open Access Journals (Sweden)

    Yeliz Guven


    Full Text Available The principles of management of mandibular fractures differ in children when compared to adults and depend on the specific age-related status of the growing mandible and the developing dentition. This paper presents a case report with a complex facial trauma affecting the mandibular body and condyle region and dentoalveolar complex. Clinical examination revealed soft tissue injuries, limited mouth opening, lateral deviation of the mandible, an avulsed incisor, a subluxated incisor, and a fractured crown. CBCT examination revealed a nondisplaced fracture and an oblique greenstick fracture of the mandibular body and unilateral fracture of the condyle. Closed reduction technique was chosen to manage fractures of the mandible. Favorable healing outcomes on multiple fractures of the mandible throughout the 6-year follow-up period proved the success of the conservative treatment. This case report is important since it presents a variety of pathological sequelae to trauma within one case.

  11. A Complex Facial Trauma Case with Multiple Mandibular Fractures and Dentoalveolar Injuries. (United States)

    Guven, Yeliz; Zorlu, Sevgi; Cankaya, Abdulkadir Burak; Aktoren, Oya; Gencay, Koray


    The principles of management of mandibular fractures differ in children when compared to adults and depend on the specific age-related status of the growing mandible and the developing dentition. This paper presents a case report with a complex facial trauma affecting the mandibular body and condyle region and dentoalveolar complex. Clinical examination revealed soft tissue injuries, limited mouth opening, lateral deviation of the mandible, an avulsed incisor, a subluxated incisor, and a fractured crown. CBCT examination revealed a nondisplaced fracture and an oblique greenstick fracture of the mandibular body and unilateral fracture of the condyle. Closed reduction technique was chosen to manage fractures of the mandible. Favorable healing outcomes on multiple fractures of the mandible throughout the 6-year follow-up period proved the success of the conservative treatment. This case report is important since it presents a variety of pathological sequelae to trauma within one case.

  12. Case-Based Reasoning Topological Complexity Calculation of Design for Components

    Institute of Scientific and Technical Information of China (English)


    Directly calculating the topological and geometric complexity from the STEP (standard for the exchange of product model data, ISO 10303) file is a huge task. So, a case-based reasoning approach is presented, which is based on the similarity between the new component and the old one, to calculate the topological and geometric complexity of new components. In order to index, retrieve in historical component database, a new way of component representation is brought forth. And then an algorithm is given to extract topological graph from its STEP files. A mathematical model, which describes how to compare the similarity, is discussed. Finally, an example is given to show the result.

  13. Complexity

    CERN Document Server

    Gershenson, Carlos


    The term complexity derives etymologically from the Latin plexus, which means interwoven. Intuitively, this implies that something complex is composed by elements that are difficult to separate. This difficulty arises from the relevant interactions that take place between components. This lack of separability is at odds with the classical scientific method - which has been used since the times of Galileo, Newton, Descartes, and Laplace - and has also influenced philosophy and engineering. In recent decades, the scientific study of complexity and complex systems has proposed a paradigm shift in science and philosophy, proposing novel methods that take into account relevant interactions.

  14. Circle of Willis variation in a complex stroke presentation: a case report

    Directory of Open Access Journals (Sweden)

    Young Carolyn A


    Full Text Available Abstract Background The impact of circle of Willis anatomical variation upon the presentation of stroke is probably underrecognised. Case presentation A 63-year-old right-handed woman developed a left hemiparesis and right leg weakness sequentially following a road traffic accident (RTA. Despite initial concern about the possibility of cervical spinal cord injury, the final diagnosis was bilateral artery-to-artery embolic cerebral infarction with dominant right internal carotid artery. Conclusion The case illustrates the complex presentation of stroke as a pseudo-cervical cord lesion and the impact of circle of Willis anatomical variation upon the expression of large vessel cerebrovascular disease.

  15. Xanthogranulomatous Pyelonephritis Can Simulate a Complex Cyst: Case Description and Review of Literature

    Directory of Open Access Journals (Sweden)

    Salvatore Butticè


    Full Text Available Xanthogranulomatous pyelonephritis is a rare and peculiar form of chronic pyelonephritis and is generally associated with renal lithiasis. Its incidence is higher in females. The peculiarity of this disease is that it requires a differential diagnosis, because it can often simulate dramatic pathologic conditions. In fact, in the literature are also described cases in association with squamous cell carcinoma of the kidney The radiologic clinical findings simulate renal masses, sometimes in association with caval thrombus. We describe a case of xanthogranulomatous pyelonephritis with radiologic aspects of a complex cyst of Bosniak class III in a man 40-year old.

  16. Average-Case Complexity Versus Approximate Simulation of Commuting Quantum Computations (United States)

    Bremner, Michael J.; Montanaro, Ashley; Shepherd, Dan J.


    We use the class of commuting quantum computations known as IQP (instantaneous quantum polynomial time) to strengthen the conjecture that quantum computers are hard to simulate classically. We show that, if either of two plausible average-case hardness conjectures holds, then IQP computations are hard to simulate classically up to constant additive error. One conjecture relates to the hardness of estimating the complex-temperature partition function for random instances of the Ising model; the other concerns approximating the number of zeroes of random low-degree polynomials. We observe that both conjectures can be shown to be valid in the setting of worst-case complexity. We arrive at these conjectures by deriving spin-based generalizations of the boson sampling problem that avoid the so-called permanent anticoncentration conjecture.

  17. [Case management and complex chronic diseases: concepts, models, evidence and uncertainties]. (United States)

    Morales-Asencio, José Miguel


    Chronic diseases are the greatest challenge for Health Care, but the conventional health care models have failed noticeably. Nurses are one of the main providers of the services developed to tackle this challenge, with special emphasis on case management, as one of the most common forms. But, one of the key problems is that case management is poorly conceptualized, and with the diversity of experience available, make its development and comparative evaluation difficult. An in-depth review on case management definition and concepts is presented in this article, with a description of the models, ingredients and the effectiveness reported in various studies. The remaining uncertainties in case management, such as the heterogeneity of designs and target populations, the weak description of the components, and the scarce use of research models for complex interventions, are also discussed. Finally, some key factors for a successful implementation of case management are detailed, such as a clear definition of accountability and roles, the existence of support to guarantee the competence of case managers, the use of valid mechanisms for case finding, adjusted caseload, accessible and team-shared record systems, or the integration of health and social services.

  18. Management of a complex dentoalveolar trauma with multiple avulsions: a case report. (United States)

    Sheroan, Marianne Mills; Roberts, Michael W


    Treatment of permanent tooth avulsions in an adolescent poses significant difficulties for the dental clinician. This case report gives details about the treatment of a complex dentoalveolar trauma involving multiple avulsions of primary molars, permanent incisors, permanent molars, and premolar toothbuds. Immediate treatment of the injury and short-term esthetic replacement of the dentition is described. A brief review of current research relative to the treatment of permanent tooth avulsions is provided.

  19. A case of recurrent complex regional pain syndrome accompanying Raynaud's disease: a prospective coincidence? (United States)

    Kesikburun, Serdar; Günendi, Zafer; Aydemir, Koray; Özgül, Ahmet; Tan, Arif Kenan


    Complex regional pain syndrome (CPRS) and Raynaud's disease are disorders characterized by vasomotor disturbances associating with abnormal autonomic nervous system. We present a case of CRPS involving a history of recurrence and no initiating event. Raynaud's disease accompanying CRPS was diagnosed clinically in the patient. We propose that a sympathetic dysfunction underlies the pathophysiologies of both disorders and may be responsible for the coexistence of these two distinct entities. Recurrence and unknown etiology of CRPS might account for temporary alterations in sympathetic function.

  20. Surgical treatment of extensive complex odontoma in the mandible by corticotomy. A case report. (United States)

    Nogueira, A S; Gonçales, E S; Gonçales, A G B; Thiegui-Neto, V; Nogueira, C B P; Nogueira, A; Medeiros, R


    Odontomas represent the most prevalent odontogenic tumors in the jaw. The treatment of choice is surgical removal, usually performed by conventional techniques involving ostectomies to expose the tumor. In this paper, the authors describe, through the report of a case of complex odontoma located in the mandibular angle, a more conservative surgical technique called corticotomy, in which the bone removed for access to the tumor (buccal cortical) is repositioned and fixed by titanium plates of 1.5 mm.

  1. Disaster preparedness in a complex urban system: the case of Kathmandu Valley, Nepal. (United States)

    Carpenter, Samuel; Grünewald, François


    The city is a growing centre of humanitarian concern. Yet, aid agencies, governments and donors are only beginning to comprehend the scale and, importantly, the complexity of the humanitarian challenge in urban areas. Using the case study of the Kathmandu Valley, Nepal, this paper examines the analytical utility of recent research on complex urban systems in strengthening scholarly understanding of urban disaster risk management, and outlines its operational relevance to disaster preparedness. Drawing on a literature review and 26 interviews with actors from across the Government of Nepal, the International Red Cross and Red Crescent Movement, non-governmental organisations, United Nations agencies, and at-risk communities, the study argues that complexity can be seen as a defining feature of urban systems and the risks that confront them. To manage risk in these systems effectively, preparedness efforts must be based on adaptive and agile approaches, incorporating the use of network analysis, partnerships, and new technologies.

  2. A Case of Complex Facial Clefts Treated with Staged-tissue Expansion

    Directory of Open Access Journals (Sweden)

    Koichi Ueda, MD, PhD


    Full Text Available Summary: Craniofacial clefts involve all soft tissue and skeletal elements throughout the cleft. Usefulness of tissue expansion in craniofacial clefts is reported. Surgery for a complex type of facial clefts is more difficult and more extensive than for a simple one. We experienced a primary case of complex facial clefts (Tessier No. 2 and 12 on the right and 3, 11, and 5 on the left. Soft-tissue closure of all clefts could be completed by using 4 tissue expanders and 7 operations. Because multiple tissue deficiencies and abnormalities exist in craniofacial clefts, especially complex type, a planned, staged, sequential approach by tissue expansion is necessary to produce ideal results.

  3. Complex Regional Pain Syndrome (CRPS Type II After Carpal Tunnel Release Surgery: Case Report

    Directory of Open Access Journals (Sweden)

    Hakan Tunç


    Full Text Available Summary Complex regional pain syndrome is a chronic syndrome characterised with dystrophic changes and neurovascular disordes of bone and skin of extremities. The most common etiological factors are trauma, ischemic heart disease, cerebral lesions, servical region disorders, infections, and surgical treatments. Carpal tunnel syndrome is the most common compressive neuropaty of the upper extremity. There are various surgical and conservative alternatives in the treatment of carpal tunnel syndrome. Complex regional pain syndrome has been reported as a complication of surgical carpal tunnel release in 2-5% of patients. In this case report clinical characteristics and rehabilitation outcomes of a patient with complex regional pain syndrome after carpal tunnel release surgery is presented. (Osteoporoz Dünyasından 2010;16:41-3

  4. Measuring the evolution of ontology complexity: the gene ontology case study. (United States)

    Dameron, Olivier; Bettembourg, Charles; Le Meur, Nolwenn


    Ontologies support automatic sharing, combination and analysis of life sciences data. They undergo regular curation and enrichment. We studied the impact of an ontology evolution on its structural complexity. As a case study we used the sixty monthly releases between January 2008 and December 2012 of the Gene Ontology and its three independent branches, i.e. biological processes (BP), cellular components (CC) and molecular functions (MF). For each case, we measured complexity by computing metrics related to the size, the nodes connectivity and the hierarchical structure. The number of classes and relations increased monotonously for each branch, with different growth rates. BP and CC had similar connectivity, superior to that of MF. Connectivity increased monotonously for BP, decreased for CC and remained stable for MF, with a marked increase for the three branches in November and December 2012. Hierarchy-related measures showed that CC and MF had similar proportions of leaves, average depths and average heights. BP had a lower proportion of leaves, and a higher average depth and average height. For BP and MF, the late 2012 increase of connectivity resulted in an increase of the average depth and average height and a decrease of the proportion of leaves, indicating that a major enrichment effort of the intermediate-level hierarchy occurred. The variation of the number of classes and relations in an ontology does not provide enough information about the evolution of its complexity. However, connectivity and hierarchy-related metrics revealed different patterns of values as well as of evolution for the three branches of the Gene Ontology. CC was similar to BP in terms of connectivity, and similar to MF in terms of hierarchy. Overall, BP complexity increased, CC was refined with the addition of leaves providing a finer level of annotations but decreasing slightly its complexity, and MF complexity remained stable.

  5. MPO-ANCA associated crescentic glomerulonephritis with numerous immune complexes: case report

    Directory of Open Access Journals (Sweden)

    Morizane Ryuji


    Full Text Available Abstract Background Antineutrophil cytoplasmic antibody (ANCA-associated crescentic glomerulonephritis (CGN is a major cause of rapidly progressive glomerulonephritis (RPGN. ANCA-associated CGN is generally classified into pauci-immune RPGN, in which there are few or no immune complexes. Case Presentation A 78-year-old man presented with RPGN after a 7-year course of chronic proteinuria and hematuria with stable renal function. A blood examination showed a high titer of myeloperoxidase (MPO-ANCA. A renal biopsy showed crescentic glomerulonephritis with abundant subepithelial, intramenbranous and subendothelial deposits by electron microscopy, leading to the diagnosis of ANCA-associated CGN superimposed on type 3 membranoproliferative glomerulonephritis (MPGN. Conclusions This case is unique in that type 3 MPGN and MPO-ANCA-associated CGN coexisted, and no similar case has been reported to date. Because ANCA-associated CGN has a predilection for elderly individuals and primary type 3 MPGN is rarely seen in this age group, coincidental existence appears less likely. This case may confer valuable information regarding the link between immune complex and ANCA-associated CGN.

  6. Complex odontoma: report of a five-year follow-up case. (United States)

    Barros, Luciana D'azevedo; Pedron, Irineu Gregnanin; Utumi, Estevam Rubens; Zambon, Camila Eduarda; Rocha, Andre Caroli


    Odontomas are odontogenic tumors that usually present as benign lesions. They are easily diagnosed and affect individuals in their first and second decades of life. In most cases, odontomas are asymptomatic and the presence could be suspected due to the delay in tooth eruption or via routine radiographic examinations. Treatment of choice has been surgical removal of the lesion, and prognosis is usually favorable because of its benign characteristics and rare recurrence. The purpose of this study is to report the case of a complex odontoma in a child impacting a permanent molar and preventing its eruption. The lesion was surgically removed, and the eruption of the permanent mandibular left second molar tooth occurred after 5 months. Clinical, radiographic, and histopathological characteristics were studied in this case.

  7. A case for Sandia investment in complex adaptive systems science and technology.

    Energy Technology Data Exchange (ETDEWEB)

    Colbaugh, Richard; Tsao, Jeffrey Yeenien; Johnson, Curtis Martin; Backus, George A.; Brown, Theresa Jean; Jones, Katherine A.


    This white paper makes a case for Sandia National Laboratories investments in complex adaptive systems science and technology (S&T) -- investments that could enable higher-value-added and more-robustly-engineered solutions to challenges of importance to Sandia's national security mission and to the nation. Complex adaptive systems are ubiquitous in Sandia's national security mission areas. We often ignore the adaptive complexity of these systems by narrowing our 'aperture of concern' to systems or subsystems with a limited range of function exposed to a limited range of environments over limited periods of time. But by widening our aperture of concern we could increase our impact considerably. To do so, the science and technology of complex adaptive systems must mature considerably. Despite an explosion of interest outside of Sandia, however, that science and technology is still in its youth. What has been missing is contact with real (rather than model) systems and real domain-area detail. With its center-of-gravity as an engineering laboratory, Sandia's has made considerable progress applying existing science and technology to real complex adaptive systems. It has focused much less, however, on advancing the science and technology itself. But its close contact with real systems and real domain-area detail represents a powerful strength with which to help complex adaptive systems science and technology mature. Sandia is thus both a prime beneficiary of, as well as potentially a prime contributor to, complex adaptive systems science and technology. Building a productive program in complex adaptive systems science and technology at Sandia will not be trivial, but a credible path can be envisioned: in the short run, continue to apply existing science and technology to real domain-area complex adaptive systems; in the medium run, jump-start the creation of new science and technology capability through Sandia's Laboratory Directed Research

  8. Dorsal dumb-bell melanotic schwannoma operated on by posterior and anterior approach: case report and a review of the literature. (United States)

    De Cerchio, Leonardo; Contratti, Filiberto; Fraioli, Mario F


    The schwannomas are benign tumors originating from Schwann cells which constitute the nerve sheath. The dorsal pigmented type of schwannomas is relatively rare (Goldstein in Am J Med Genet 86:62-65, 2004; Kurtkaya-Yapicier in Histol Histopathol 18(3):925-934, 2003). There are two distinct types of melanotic schwannoma: the sporadic melanotic schwannomas and the psammomatous melanotic schwannomas of Carney complex. We report a case of a patient harboring a right dorsal dumb-bell melanotic schwannoma and left adrenal mass. The patient underwent a surgical procedure for en bloc total removal of the mass by a posterior and anterior approach. Histopathological examination revealed the diagnosis of melanotic schwannoma. At present, we have no reliable marker of histopathological malignancy of melanotic schwannoma so the follow-up period ought to continue for a period of more than 5 years. As the total removal of the melanotic neurinomas is mandatory to prevent possible malignant transformation of the tumor recurrence or regrowth, we believe that the posterior and trans-thoracic approach are the most suitable one for the dorsal dumb-bell schwannoma.

  9. Comparative Study of Elastic Network Model and Protein Contact Network for Protein Complexes: The Hemoglobin Case

    Directory of Open Access Journals (Sweden)

    Guang Hu


    Full Text Available The overall topology and interfacial interactions play key roles in understanding structural and functional principles of protein complexes. Elastic Network Model (ENM and Protein Contact Network (PCN are two widely used methods for high throughput investigation of structures and interactions within protein complexes. In this work, the comparative analysis of ENM and PCN relative to hemoglobin (Hb was taken as case study. We examine four types of structural and dynamical paradigms, namely, conformational change between different states of Hbs, modular analysis, allosteric mechanisms studies, and interface characterization of an Hb. The comparative study shows that ENM has an advantage in studying dynamical properties and protein-protein interfaces, while PCN is better for describing protein structures quantitatively both from local and from global levels. We suggest that the integration of ENM and PCN would give a potential but powerful tool in structural systems biology.

  10. Viability and resilience of complex systems concepts, methods and case studies from ecology and society

    CERN Document Server

    Deffuant, Guillaume


    One common characteristic of a complex system is its ability to withstand major disturbances and the capacity to rebuild itself. Understanding how such systems demonstrate resilience by absorbing or recovering from major external perturbations requires both quantitative foundations and a multidisciplinary view of the topic. This book demonstrates how new methods can be used to identify the actions favouring the recovery from perturbations on a variety of examples including the dynamics of bacterial biofilms, grassland savannahs, language competition and Internet social networking sites. The reader is taken through an introduction to the idea of resilience and viability and shown the mathematical basis of the techniques used to analyse systems. The idea of individual or agent-based modelling of complex systems is introduced and related to analytically tractable approximations of such models. A set of case studies illustrates the use of the techniques in real applications, and the final section describes how on...

  11. Giant complex odontoma of the anterior mandible: report of case with long follow up. (United States)

    Spini, Pedro Henrique Rezende; Spini, Túlio Humberto; Servato, João Paulo Silva; Faria, Paulo Rogério de; Cardoso, Sérgio Vitorino; Loyola, Adriano Mota


    This paper describes an exceptional case of an enormous complex odontoma affecting the mandibular symphysis of a 9-year-old boy. Because of its dimensions, the lesion produced cortical bone expansion, dental displacement and impactation, which are clinical signs very seldom described for odontomas. The lesion was surgically excised in a conservative way using an intraoral approach with local anesthesia. After 7 years of follow up, all teeth had erupted and the mandibular bone healed totally. Because of its radiographic mixed radiolucent and radiopaque appearance and its expansive growth, it is imperative to make the differential diagnosis of giant complex odontoma for other more aggressive mixed odontogenic tumors, such as ameloblastic fibro-odontoma, odotoameloblastoma and cystic calcified odontogenic tumor. Conservative approach appears to be indicated in the treatment of such lesions.

  12. Case study: Gluteal compartment syndrome as a cause of lumbosacral radiculoplexopathy and complex regional pain syndrome. (United States)

    Lederman, Andrew; Turk, David; Howard, Antonio; Reddy, Srinivas; Stern, Michelle


    We present the case of a 24 yr old male who was diagnosed with gluteal compartment syndrome and was subsequently found to have developed lumbosacral radiculoplexopathy and complex regional pain syndrome. The patient's gluteal compartment syndrome was diagnosed within 24 h of presentation to the emergency room, and he underwent emergent compartment release. While recovering postoperatively, persistent weakness was noted in the right lower limb. Results of electrodiagnostic testing were consistent with a lumbosacral radiculoplexopathy. After admission to inpatient rehabilitation, the patient complained of pain, burning sensation, and numbness in the distal right lower limb. Based on clinical findings, he was diagnosed with complex regional pain syndrome type II, or causalgia, and was referred for a lumbar sympathetic block under fluoroscopic guidance. Sympathetic block resulted in relief of the patient's symptoms. He was discharged home with good pain control on oral medications.

  13. Shone's complex with dextrocardia and situs inversus totalis: a case report. (United States)

    Ekici, Berkay; Erkan, Aycan Fahri; Sökmen, Yeliz; Tüfekçioğlu, Omaç


    Parachute mitral valve complex is an unusual congenital anomaly that has been described by Shone et al. It is characterized by a parachute deformity of the mitral valve associated with additional forms of left heart anomalies, such as aortic valvular stenosis and coarctation of the aorta. A 21-year-old female who was referred to our department because of progressive dyspnea on effort and at rest and minimal cyanosis is presented in this case report. On cardiac auscultation, the patient had a grade III/VI pansystolic murmur best heard at the lower left sternal border. The chest X-ray demonstrated dextrocardia and mild cardiomegaly. Echocardiographic evaluation revealed Shone's complex, including parachute mitral valve anomaly.

  14. Bacterial flagella and Type III secretion: case studies in the evolution of complexity. (United States)

    Pallen, M J; Gophna, U


    Bacterial flagella at first sight appear uniquely sophisticated in structure, so much so that they have even been considered 'irreducibly complex' by the intelligent design movement. However, a more detailed analysis reveals that these remarkable pieces of molecular machinery are the product of processes that are fully compatible with Darwinian evolution. In this chapter we present evidence for such processes, based on a review of experimental studies, molecular phylogeny and microbial genomics. Several processes have played important roles in flagellar evolution: self-assembly of simple repeating subunits, gene duplication with subsequent divergence, recruitment of elements from other systems ('molecular bricolage'), and recombination. We also discuss additional tentative new assignments of homology (FliG with MgtE, FliO with YscJ). In conclusion, rather than providing evidence of intelligent design, flagellar and non-flagellar Type III secretion systems instead provide excellent case studies in the evolution of complex systems from simpler components.

  15. Epilepsy surgery for tuberous sclerosis complex: a case report and literature review

    Institute of Scientific and Technical Information of China (English)

    ZHAO Guo-guang; SHAN Yong-zhi; DU Jian-xin; LING Feng


    @@ Tuberous sclerosis complex (TSC) is a multisystem genetic disorder with variable phenotypic expression.Epilepsy is the most common neurological complication and up to 80%-90% of the individuals with TSC suffer from epilepsy at some point in their lifetime.Developmental delay, intellectual impairment, autism,behavioral problems, and neuropsychiatric disorders occur commonly in individuals with TSC and may be associated with poorly controlled epilepsy.1 In this paper we reported a case report of TSC, focusing on the patient's clinical symptom, surgical aspects and neuropathology through a comprehensive analysis.

  16. Complex Variant t(9;22 Chromosome Translocations in Five Cases of Chronic Myeloid Leukemia

    Directory of Open Access Journals (Sweden)

    Ana Valencia


    Full Text Available The Philadelphia (Ph1 chromosome arising from the reciprocal t(9;22 translocation is found in more than 90% of chronic myeloid leukemia (CML patients and results in the formation of the chimeric fusion gene BCR-ABL. However, a small proportion of patients with CML have simple or complex variants of this translocation, involving various breakpoints in addition to 9q34 and 22q11. We report five CML cases carrying variant Ph translocations involving both chromosomes 9 and 22 as well as chromosomes 3, 5, 7, 8, or 10. G-banding showed a reciprocal three-way translocation involving 3q21, 5q31, 7q32, 8q24, and 10q22 bands. BCR-ABL fusion signal on der(22 was found in all of the cases by FISH.

  17. Complex regional pain syndrome with associated chest wall dystonia: a case report

    Directory of Open Access Journals (Sweden)

    Schwartzman Robert J


    Full Text Available Abstract Patients with complex regional pain syndrome (CRPS often suffer from an array of associated movement disorders, including dystonia of an affected limb. We present a case of a patient with long standing CRPS after a brachial plexus injury, who after displaying several features of the movement disorder previously, developed painful dystonia of chest wall musculature. Detailed neurologic examination found palpable sustained contractions of the pectoral and intercostal muscles in addition to surface allodynia. Needle electromyography of the intercostal and paraspinal muscles supported the diagnosis of dystonia. In addition, pulmonary function testing showed both restrictive and obstructive features in the absence of a clear cardiopulmonary etiology. Treatment was initiated with intrathecal baclofen and the patient had symptomatic relief and improvement of dystonia. This case illustrates a novel form of the movement disorder associated with CRPS with response to intrathecal baclofen treatment.


    Directory of Open Access Journals (Sweden)



    Full Text Available Superficial angiomyxomas are rare benign soft tissue tumour usually solitary and predominantly involving the dermis and subcutis. We report a case of 21 year s old male who presented with a history of swelling on the left upper anterolateral aspect of neck, measuring 3x2cm with irregular surface, non - tender, mobile and firm in consistency, fixed to the skin but not to the underlying structured. No lymph node was palpable. There was no evidence of any of the components of Carney’s complex at the time of presentation. Provisional diagnosis was made as Pleomorphic adenoma by FNAC. Wide local surgical excision was done. Histopathology examination revealed to be super ficial angiomyxoma. Here, we present a case of superficial angiomyxoma with a review to its rarity and difficulty in diagnosing and distinguishing from other soft tissue tumour of the skin.

  19. Complex regional pain syndrome after surgery of complex metacarpophalangeal dislocation of the little finger:case report and literature review

    Institute of Scientific and Technical Information of China (English)

    QIN De-an; SONG Jie-fu; WEI Jie; SU Yun-xing


    @@ Post-traumatic complex regional pain syndrome type 1 (CRPS1) is uncommon and can cause the disability of patients. Complex dislocation of the metacarpophalangeal joint on the little finger due to interposition of the sesamoid bone is rare and was firstly reported by Pribyl.

  20. Complex II deficiency--a case report and review of the literature. (United States)

    Jain-Ghai, Shailly; Cameron, Jessie M; Al Maawali, Almundher; Blaser, Susan; MacKay, Nevena; Robinson, Brian; Raiman, Julian


    Complex II deficiency is a rare cause of mitochondrial respiratory chain defects with a prevalence of 2-23%. It is exclusively nuclear encoded and functions in the citric acid cycle by oxidizing succinate to fumarate and in the mitochondrial electron transport chain (ETC) by transferring electrons to ubiquinone. Of the four subunits, SDHA and SDHB are catalytic and SDHC and SDHD are anchoring. Mutations in SDHA and SDHAF1 (assembly factor) have been found in patients with CII deficiency and a mitochondrial phenotype. We present a patient with CII deficiency with a previously undescribed phenotype of dilated cardiomyopathy, left ventricular noncompaction, failure to thrive, hypotonia, and developmental delay. Also, a comprehensive review of 36 cases published in the literature was undertaken. The results show that CII deficiency has a variable phenotype with no correlation with residual complex activity in muscle although the phenotype and enzyme activities are comparable within a family. For some, the condition was fatal in infancy, others had multisystem involvement and some had onset in adulthood with mild symptoms and normal cognition. Neurological involvement is most commonly observed and brain imaging commonly shows leukoencephalopathy, Leigh syndrome, or cerebellar atrophy. Mutations in SDHAF1 are associated with leukoencephalopathy. Other organ systems like heart, muscle, and eyes are only involved in about 50% of the cases but cardiomyopathy is associated with high mortality and morbidity. In some patients, riboflavin has provided clinical improvement.

  1. Piezoelectric surgery and navigation: a safe approach for complex cases of Eagle syndrome. (United States)

    Spalthoff, S; Zimmerer, R; Dittmann, O; Tavassol, F; Dittmann, J; Gellrich, N-C; Jehn, P


    Eagle syndrome was first described by Eagle in 1937. It is associated with an elongated styloid process and/or calcification of the stylohyoid ligament, mainly resulting in pain in the orofacial region. The treatment of Eagle syndrome includes conservative treatment with physical therapy supported by medication, or surgical removal of the styloid process. Two different surgical approaches are described in the literature: the transoral and transcervical approaches. Both have their limitations and specific intraoperative risks. A modification of the transcervical approach that adds an extra security measure to the treatment of complex cases of Eagle syndrome is presented herein. The styloid process was removed by combining piezoelectric surgery, preoperative digital planning, and surgical navigation. No complication was noted, and the patient recovered quickly after surgery. A follow-up visit 2 months later showed no remaining symptoms of Eagle syndrome on the treated side. Therefore, digital planning and surgical navigation could add valuable safety measures to the treatment of complex cases of Eagle syndrome.


    Directory of Open Access Journals (Sweden)

    Kamen Kotsilkov


    Full Text Available INTRODUCTION: Periodontitis is characterized by progressive destruction of periodontium, caused by relatively small group of microorganisms. The treatment aims to create proper environment which hampers the colonization of pathogens. The mechanical cleaning of the root surfaces combined with meticulous oral hygiene is the consensus treatment. In advanced cases the progression of the disease could lead to different problems - gingival recessions, insufficiency of attached gingiva, mobility and tooth loss which require complex treatment. OBJECTIVE: This presentation demonstrates the multidisciplinary treatment approach in a patient with a severe chronic periodontitis. METHODS: S.S. (42 with severe chronic periodontitis, insufficient mandibular vestibule depth, lack of keratinized gingiva, class III recessions and central incisors with grade III mobility. The #12 is missing and a crossbite is present on #32. The anti-infective therapy led to stable periodontal status. The corrective phase included the creation of vestibule depth with an autogenous gingival graft, dental implant placement with immediate provisional loading for #12, extraction of #31 and #41 due to attachment loss to the apex and immediate placement of provisionals with crossbite correction. RESULT: The reevaluation demonstrated good control of the gingival inflammation and stable periodontal status. The subsequent implant and prosthetic treatment led to the restoration of a functional dentition. CONCLUSION: The long term success of the treatment of the complex cases with severe chronic periodontitis depends significantly upon the proper control of the periodontal infection and the achievement of a stable periodontal status. These are the major prerequisites for successful further implant and prosthetic rehabilitation.

  3. Idealized tropical cyclone simulations of intermediate complexity: A test case for AGCMs

    Directory of Open Access Journals (Sweden)

    Kevin Reed


    Full Text Available The paper introduces a moist, deterministic test case of intermediate complexity for Atmospheric General Circulation Models (AGCMs. We suggest pairing an AGCM dynamical core with simple physical parameterizations to test the evolution of a single, idealized, initially weak vortex into a tropical cyclone. The initial conditions are based on an initial vortex seed that is in gradient-wind and hydrostatic balance. The suggested ``simple-physics'' package consists of parameterizations of bulk aerodynamic surface fluxes for moisture, sensible heat and momentum, boundary layer diffusion, and large-scale condensation. Such a configuration includes the important driving mechanisms for tropical cyclones, and leads to a rapid intensification of the initial vortex over a forecast period of ten days. The simple-physics test paradigm is not limited to tropical cyclones, and can be universally applied to other flow fields. The physical parameterizations are described in detail to foster model intercomparisons.The characteristics of the intermediate-complexity test case are demonstrated with the help of four hydrostatic dynamical cores that are part of the Community Atmosphere Model version 5 (CAM 5 developed at the National Center for Atmospheric Research (NCAR. In particular, these are the Finite-Volume, Spectral Element, and spectral transform Eulerian and semi-Lagrangian dynamical cores that are coupled to the simple-physics suite. The simulations show that despite the simplicity of the physics forcings the models develop the tropical cyclone at horizontal grid spacings of about 55 km and finer. The simple-physics simulations reveal essential differences in the storm's structure and strength due to the choice of the dynamical core. Similar differences are also seen in complex full-physics aqua-planet experiments with CAM 5 which serve as a motivator for this work. The results suggest that differences in complex full-physics simulations can be, at least


    NARCIS (Netherlands)



    We report two cases of apparently balanced complex de novo chromosomal rearrangements (BCCR) detected prenatally at 17 weeks and 10 weeks of gestation, respectively. Chromosomes were studied using GTG-banding and fluorescent in situ hybridization (FISH). In one case four chromosomes and in the other

  5. An Orchestrating Evaluation of Complex Educational Technologies: a Case Study of a CSCL System

    Directory of Open Access Journals (Sweden)

    Luis P. Prieto


    Full Text Available As digital technologies permeate every aspect of our lives, the complexity of the educational settings, and of the technological support we use within them, unceasingly rises. This increased complexity, along with the need for educational practitioners to apply such technologies within multi-constraint authentic settings, has given rise to the notion of technology-enhanced learning practice as “orchestration of learning”. However, at the same time, the complexity involved in evaluating the benefits of such educational technologies has also increased, prompting questions about the way evaluators can cope with the different places, technologies, informants and issues involved in their evaluation activity. By proposing the notion of “orchestrating evaluation”, this paper tries to reconcile the often disparate “front office accounts” of research publications and the “shop floor practice” of evaluation of educational technology, through the case study of evaluating a system to help teachers in coordinating computer-supported collaborative learning (CSCL scenarios. We reuse an internationally-evaluated conceptual framework of “orchestration aspects” (design, management, adaptation, pragmatism, etc. to structure the case‟s narrative, showing how the original evaluation questions and methods were modulated in the face of the multiple (authentic evaluation setting constraints.

  6. Mirror therapy in patients with causalgia (complex regional pain syndrome type II) following peripheral nerve injury: Two cases

    NARCIS (Netherlands)

    R.W. Selles (Ruud); A.R. Schreuders (Ton); H.J. Stam (Henk)


    textabstractObjective: To describe the use of mirror therapy in 2 patients with complex regional pain syndrome type II following traumatic nerve injury. Design: Two case reports. Subjects: Two patients with complex regional pain syndrome type II. Methods: Two patients received mirror therapy with th

  7. Creating a Safe Space: A Case Study of Complex Trauma and a Call for Proactive Comprehensive Psychoeducational Assessments and Reviews (United States)

    Mainwaring, Debra J.


    This article advocates for proactive, dynamic and comprehensive psycho-educational assessments for children and young people who have a history of complex trauma, because of its known effects on development and learning. A case study is shared of a young woman with a history of complex trauma because of exposure to parental neglect, multiple…

  8. Average-Case Separation in Proof Complexity: Short Propositional Refutations for Random 3CNF Formulas

    CERN Document Server

    Müller, Sebastian


    Separating different propositional proof systems---that is, demonstrating that one proof system cannot efficiently simulate another proof system---is one of the main goals of proof complexity. Nevertheless, all known separation results between non-abstract proof systems are for specific families of hard tautologies: for what we know, in the average case all (non-abstract) propositional proof systems are no stronger than resolution. In this paper we show that this is not the case by demonstrating polynomial-size propositional refutations whose lines are $TC^0$ formulas (i.e., $TC^0$-Frege proofs) for random 3CNF formulas with $ n $ variables and $ \\Omega(n^{1.4}) $ clauses. By known lower bounds on resolution refutations, this implies an exponential separation of $TC^0$-Frege from resolution in the average case. The idea is based on demonstrating efficient propositional correctness proofs of the random 3CNF unsatisfiability witnesses given by Feige, Kim and Ofek [FOCS'06]. Since the soundness of these witnesse...

  9. Clinical Utility of Amyloid Imaging in a Complex Case of Corticobasal Syndrome Presenting with Psychiatric Symptoms. (United States)

    Bensaïdane, M R; M-P, Fortin; Damasse, G; Chenard, M; Dionne, C; Duclos, M; Bouchard, R W; Laforce, R


    Clinical indications of amyloid imaging in atypical dementia remain unclear. We report a 68-year-old female without past psychiatric history who was hospitalized for auditory hallucinations and persecutory delusions associated with cognitive and motor deficits. Although psychotic symptoms resolved with antipsychotic treatment, cognitive and motor impairments remained. She further showed severe visuoconstructive and executive deficits, ideomotor apraxia, elements of Gerstmann's syndrome, bilateral agraphesthesia and discrete asymmetric motor deficits. Blood tests were unremarkable. Structural brain imaging revealed diffuse fronto-temporo-parietal atrophy, which was most severe in the parietal regions. Meanwhile, FDG-PET suggested asymmetrical fronto-temporo-parietal hypometabolism, with sparing of the posterior cingulate gyrus. A diagnosis of possible corticobasal syndrome (CBS) was made. Amyloid-PET using the novel tracer NAV4694 was ordered, and revealed significant deposition of fibrillar amyloid (SUVR 2.05). The primary diagnosis was CBS with underlying Alzheimer pathology and treatment with a cholinesterase inhibitor was initiated. Determination of underlying pathological CBS subtype is not simple even when based on extensive investigation including clinical presentation, atrophy patterns on MRI, and regional hypometabolism on FDG-PET. By contrast, amyloid imaging quickly confirmed Alzheimer pathology, and allowed rapid initiation of treatment in this complex case with early psychiatric symptoms. This case study illustrates the clinical utility of amyloid imaging in the setting of atypical cases seen in a tertiary memory clinic.

  10. Treatment and Follow-up of a Complex Odontoma. A Case Report

    Directory of Open Access Journals (Sweden)

    Haidée Tamara Díaz Méndez


    Full Text Available Odontoma is the most common odontogenic tumor in the oral cavity. It consists of a mixture of odontogenic cells that form dentin and enamel. We present the case of a 12-year-old patient with retention of the upper right central incisor caused by a complex odontoma. Surgical enucleation of the odontoma was performed and follow-up was conducted mainly through radiographic studies. During this time, the patient wore an esthetic space maintainer. Eight months later, she underwent surgery to bond an orthodontic button on the vestibular surface of the tooth number 11. In the presence of the newly formed bone, a fixed appliance was placed in the upper arch to move and align the tooth in the dental arch. This type of lesion, which constitutes one of the causes of tooth retention, can be managed successfully by both surgical and orthodontic treatment.

  11. Contemporary Challenges in Requirements Discovery and Validation: Two Case Studies in Complex Environments (United States)

    Hansen, Sean; Lyytinen, Kalle

    Requirements have remained a key source of difficulty since the dawn of computing. Complicating this fact, recent substantive changes in systems development and associated requirements processes - as reflected in reliance on packaged software components, off-shore development, and software-as-a-service - demand a reappraisal of requirements challenges. Yet, there are few empirical studies focusing on what current requirements challenges are, why they emerge and how they affect requirements engineering (RE) efforts. In the present study, we assess the cognitive, social, and complexity-based impediments to effective requirements discovery through two exploratory case studies of large, multi-party development projects. We develop a rich understanding of the requirements challenges facing these development efforts, how these challenges interact and affect the requirements engineering process and outcomes. The analyses reveal significant consistency in the primary challenges of large RE efforts and the profoundly systemic nature of requirements-related impediments. Several recommendations for research and practice of RE are developed.

  12. Using cognitive behavioural therapy with complex cases: using the therapeutic relationship to change core beliefs. (United States)

    Binnie, James


    Cognitive Behavioural Therapy (CBT) is often perceived as a manualised, symptom focused, surface level approach. This article aims to reflect on working with complex clinical presentations and explore how third wave CBT can be effectively integrated into standard cognitive behavioural interventions. To achieve these aims, a case study of a CBT assessment and treatment is presented. The interventions used are described in detail. The focus changes from the more traditional symptom-led interventions to third wave approaches based on the therapeutic relationship. When the focus was redirected towards the therapeutic relationship then real change occurred, quickly and powerfully. Reflections on the process are discussed and the overall approach used was evaluated with an action plan developed to enhance future clinical practice. It is hoped that this study can help CBT be viewed as a comprehensive form of psychotherapy.

  13. Case Study of a Complex Informing System: Joint Interagency Field Experimentation (JIFX

    Directory of Open Access Journals (Sweden)

    Grandon Gill


    The present paper describes an exploratory case research study that was conducted over a one year period and involved both direct observation of the event and follow-up interviews with 49 past participants in the event. The goal of the research was to assess the nature of participant-impact resulting from attending JIFX and to consider the consistency of the findings with the predictions of various theoretical frameworks used in informing science. The results suggest that participants perceived that the event provided significant value from three principal sources: discovery, interaction with potential clients (users of the technologies involved, and networking with other participants. These findings were largely consistent with what could be expected from informing under conditions of high complexity; because value generally derives from combinations of attributes rather than from the sum of individual attributes, we would expect that overall value from informing activities will be perceived even though estimates of the incremental value of that informing cannot be made.

  14. Complex pattern of colon cancer recurrence including a kidney metastasis: A case report

    Institute of Scientific and Technical Information of China (English)

    Helfried Waleczek; Moritz N Wente; Jürgen Kozianka


    We report a case of a 77-year-old female with a local recurrence of cancer after right hemicolectomy which infiltrated the pancreatic head affording pancreatoduodenectomy, who developed 3 years later recurrent tumor masses localized in the mesentery of the jejunum and in the lower pole of the left kidney. Partial nephrectomy and a segment resection of the small bowel were performed. Histological examination of both specimens revealed a necrotic metastasis of the primary carcinoma of the colon. Although intraluminal implantation of colon cancer cells in the renal pelvic mucosa from ureteric metastasis has been described, metastasis of a colorectal cancer in the kidney parenchyma is extremely rare and can be treated in an organ preserving manner. A complex pattern of colon cancer recurrence with unusual and rare sites of metastasis is reported.

  15. Using virtual humans and computer animations to learn complex motor skills: a case study in karate

    Directory of Open Access Journals (Sweden)

    Spanlang Bernhard


    Full Text Available Learning motor skills is a complex task involving a lot of cognitive issues. One of the main issues consists in retrieving the relevant information from the learning environment. In a traditional learning situation, a teacher gives oral explanations and performs actions to provide the learner with visual examples. Using virtual reality (VR as a tool for learning motor tasks is promising. However, it raises questions about the type of information this kind of environments can offer. In this paper, we propose to analyze the impact of virtual humans on the perception of the learners. As a case study, we propose to apply this research problem to karate gestures. The results of this study show no significant difference on the after training performance of learners confronted to three different learning environments (traditional group, video and VR.

  16. Coincidence of hepatocelluar carcinoma and hepatic angiomyolipomas in tuberous sclerosis complex:A case report

    Institute of Scientific and Technical Information of China (English)

    Bin Yang; Wen-Hui Chen; Pei-Zhi Shi; Jing-Jing Xiang; Ru-Jun Xu; Ji-Hong Liu


    Tuberous sclerosis complex (TSC) is a dominantly inherited disorder which characterized by the growth of harmatomatous in multiple organs.Unlike the common development of renal angiomyolipoma,hepatic angiomyolipoma rarely occur in patients with TSC.We report here a patient with hepatic angiomyolipomas and concurrent hepatocellular carcinoma in TSC.This represents the first reported case in English literature.In this patient,multiple hepatic angiomyolipomas were diagnosed with recognition of their fat components and typical clinical settings.Hepatocellular carcinoma in the left liver lobe was definitely diagnosed by US guided biopsy.In such clinical settings,fat containing lesions in liver can be reasonably treated as angiomyolipomas,but non fat containing lesions must be differentiated from hepatocellular carcinoma,imaging guided biopsy can be adopted to confirm the diagnosis.

  17. Rapid spread of complex change: a case study in inpatient palliative care

    Directory of Open Access Journals (Sweden)

    Filipski Marta I


    Full Text Available Abstract Background Based on positive findings from a randomized controlled trial, Kaiser Permanente's national executive leadership group set an expectation that all Kaiser Permanente and partner hospitals would implement a consultative model of interdisciplinary, inpatient-based palliative care (IPC. Within one year, the number of IPC consultations program-wide increased almost tenfold from baseline, and the number of teams nearly doubled. We report here results from a qualitative evaluation of the IPC initiative after a year of implementation; our purpose was to understand factors supporting or impeding the rapid and consistent spread of a complex program. Methods Quality improvement study using a case study design and qualitative analysis of in-depth semi-structured interviews with 36 national, regional, and local leaders. Results Compelling evidence of impacts on patient satisfaction and quality of care generated 'pull' among adopters, expressed as a remarkably high degree of conviction about the value of the model. Broad leadership agreement gave rise to sponsorship and support that permeated the organization. A robust social network promoted knowledge exchange and built on an existing network with a strong interest in palliative care. Resource constraints, pre-existing programs of a different model, and ambiguous accountability for implementation impeded spread. Conclusions A complex, hospital-based, interdisciplinary intervention in a large health care organization spread rapidly due to a synergy between organizational 'push' strategies and grassroots-level pull. The combination of push and pull may be especially important when the organizational context or the practice to be spread is complex.

  18. Phylloid pattern of pigmentary disturbance in a case of complex mosaicism. (United States)

    Ribeiro Noce, T; de Pina-Neto, J M; Happle, R


    Among the various types of pigmentary disturbances associated with mosaicism, the phylloid pattern (Greek phyllon = leaf, eidos = form) is characterized by multiple leaf-like patches reminiscent of an art nouveau painting. The number of cases displaying this unusual pattern is so far limited. We describe a phylloid pattern of hypomelanosis in a 3-year-old girl with multiple congenital anomalies including microcephaly, midfacial hypoplasia, cleft lip, coloboma, posteriorly rotated ears, pectus carinatum, and pronounced mental and physical retardation. In addition, this child had oval or oblong patches of hyperpigmentation involving the trunk in a horizontal arrangement dissimilar from the phylloid hypomelanotic pattern. In peripheral blood lymphocytes a karyotype 46,XX,-13,+t(13q;13q) was consistently found, whereas cultured skin fibroblasts showed a complex form of mosaicism comprising three different abnormal cell lines (46,XX,-13,+t(13q;13q)/45,XX,-13/45,XX,-13,+frag). This case provides further evidence that the phylloid pattern represents a separate category of pigmentary disturbance to be distinguished from other types of cutaneous mosaicism such as the lines of Blaschko or the checkerboard arrangement.

  19. Mirror therapy in patients with causalgia (complex regional pain syndrome type II) following peripheral nerve injury: Two cases


    Selles, Ruud; Schreuders, Ton; Stam, Henk


    textabstractObjective: To describe the use of mirror therapy in 2 patients with complex regional pain syndrome type II following traumatic nerve injury. Design: Two case reports. Subjects: Two patients with complex regional pain syndrome type II. Methods: Two patients received mirror therapy with the painful hand hidden behind the mirror while the non-painful hand was positioned so that, from the perspective of the patient, the reflection of this hand was "superimposed" on the painful hand. P...

  20. Complex Bedforms and Complex Water Masses: A Case Study from the Tertiary to Present-day, Pelotas Basin, Offshore Uruguay (United States)

    Thompson, P.; Badalini, G.; Wrigley, S.; Walker, R.; Argent, J.; Hernandez-Molina, J.; de Santa Ana, H.; Soto, M.; Tomasini, J.


    Contour currents are commonly associated with bedform development on modern seabeds yet there is a general paucity of published examples from the ancient record. Recently acquired 3D seismic data, covering over 13000km2 of the Pelotas Basin, offshore Uruguay, provides a unique opportunity to study the architecture and development of a variety of bedform. The data shows that, throughout the Tertiary, contour currents were the dominant control on sedimentation along the Uruguayan margin. The first evidence of contour current activity is during the Early Tertiary in the form of a major regional unconformity that, even though it was fully subaqueous, does not show any major features associated with downslope sedimentation. In the mid-slope region, the unconformity coincides with an extensive (1500km2) intra-slope scour-field orientated parallel to the slope. Individual scours are up to 40m deep, 500m wide and 3km long. Coeval with these scours are a group of coalesced basin floor scours, which run parallel to the base of slope and extend over 400km2. Individual scours exhibit an asymmetric shape - similar to giant flute marks - that are up to 150m deep, 20km wide and extend for at least 40km along slope. The development of these scoured areas shows clear evidence of two major north-flowing water masses. Directly above this regional unconformity are a series of ribbon-like bedforms that developed oblique to the slope. Individual bedforms are up to 40km in length with wavelengths of 5km and heights up to 100m. These bedforms are overlain by a set of barchan-like dunes, up to 30km in length with wavelengths of 10km. Individual dunes are in the order of 100m thick and stack to form an overall package up to 500m thick. These features show a clear change from erosion/bypass to deposition/reworking that is linked to a decrease in ocean current velocity and/ or sediment supply. The features observed suggest a complex oceanic regime was present throughout the Tertiary that

  1. Complex Variant of Philadelphia Translocation Involving Chromosomes 9, 12, and 22 in a Case with Chronic Myeloid Leukaemia (United States)

    Malvestiti, F.; Agrati, C.; Chinetti, S.; Di Meco, A.; Cirrincione, S.; Oggionni, M.; Grimi, B.; Maggi, F.; Simoni, G.; Grati, F. R.


    Chronic myeloid leukemia (CML) is a hematopoietic stem cell disorder included in the broader diagnostic category of myeloproliferative neoplasms, associated with fusion by BCR gene at chromosome 22q11 to ABL1 gene at chromosome 9q34 with the formation of the Philadelphia (Ph) chromosome. In 2–10% of CML cases, the fusion gene arises in connection with a variant translocation, involving chromosomes 9, 22, and one or more different chromosomes; consequently, the Ph chromosome could be masked within a complex chromosome rearrangement. In cases with variant Ph translocation a deletion on der(9) may be more frequently observed than in cases with the classical one. Herein we describe a novel case of CML with complex variant Ph translocation involving chromosomes 9, 12, and 22. We present the hematologic response and cytogenetic response after Imatinib treatment. We also speculated the mechanism which had originated the chromosome rearrangement. PMID:25045550

  2. Complex Variant of Philadelphia Translocation Involving Chromosomes 9, 12, and 22 in a Case with Chronic Myeloid Leukaemia

    Directory of Open Access Journals (Sweden)

    F. Malvestiti


    Full Text Available Chronic myeloid leukemia (CML is a hematopoietic stem cell disorder included in the broader diagnostic category of myeloproliferative neoplasms, associated with fusion by BCR gene at chromosome 22q11 to ABL1 gene at chromosome 9q34 with the formation of the Philadelphia (Ph chromosome. In 2–10% of CML cases, the fusion gene arises in connection with a variant translocation, involving chromosomes 9, 22, and one or more different chromosomes; consequently, the Ph chromosome could be masked within a complex chromosome rearrangement. In cases with variant Ph translocation a deletion on der(9 may be more frequently observed than in cases with the classical one. Herein we describe a novel case of CML with complex variant Ph translocation involving chromosomes 9, 12, and 22. We present the hematologic response and cytogenetic response after Imatinib treatment. We also speculated the mechanism which had originated the chromosome rearrangement.

  3. Niche divergence builds the case for ecological speciation in skinks of the Plestiodon skiltonianus species complex (United States)

    Wogan, Guinevere O.U.; Richmond, Jonathan Q.


    Adaptation to different thermal environments has the potential to cause evolutionary changes that are sufficient to drive ecological speciation. Here, we examine whether climate-based niche divergence in lizards of the Plestiodon skiltonianus species complex is consistent with the outcomes of such a process. Previous work on this group shows that a mechanical sexual barrier has evolved between species that differ mainly in body size and that the barrier may be a by-product of selection for increased body size in lineages that have invaded xeric environments; however, baseline information on niche divergence among members of the group is lacking. We quantified the climatic niche using mechanistic physiological and correlative niche models and then estimated niche differences among species using ordination techniques and tests of niche overlap and equivalency. Our results show that the thermal niches of size-divergent, reproductively isolated morphospecies are significantly differentiated and that precipitation may have been as important as temperature in causing increased shifts in body size in xeric habitats. While these findings alone do not demonstrate thermal adaptation or identify the cause of speciation, their integration with earlier genetic and behavioral studies provides a useful test of phenotype–environment associations that further support the case for ecological speciation in these lizards.

  4. Neuroscience, neuropolitics and neuroethics: the complex case of crime, deception and FMRI. (United States)

    Henry, Stuart; Plemmons, Dena


    Scientific developments take place in a socio-political context but scientists often ignore the ways their innovations will be both interpreted by the media and used by policy makers. In the rush to neuroscientific discovery important questions are overlooked, such as the ways: (1) the brain, environment and behavior are related; (2) biological changes are mediated by social organization; (3) institutional bias in the application of technical procedures ignores race, class and gender dimensions of society; (4) knowledge is used to the advantage of the powerful; and (5) its applications may reinforce existing structures of power that pose ethical questions about distributive justice. The case of crime, deception and functional Magnetic Resonance Imaging (fMRI) shows the complexity, and the political and ethical challenges that confront those who seek to use neuroscience to explain the etiology of crime, and who base policy on its findings. An ethically grounded neuroscience needs to take account of existing structures of power and difference, and to develop a public neuropolitical consciousness that ensures that those subject to risk by the application of science and technology are participants in the decision-making processes involving the implementation of policies that affect them.

  5. Complex Odontoma: A Case Report with Micro-Computed Tomography Findings. (United States)

    Santos, L A N; Lopes, L J; Roque-Torres, G D; Oliveira, V F; Freitas, D Q


    Odontomas are the most common benign tumors of odontogenic origin. They are normally diagnosed on routine radiographs, due to the absence of symptoms. Histopathologic evaluation confirms the diagnosis especially in cases of complex odontoma, which may be confused during radiographic examination with an osteoma or other highly calcified bone lesions. The micro-CT is a new technology that enables three-dimensional analysis with better spatial resolution compared with cone beam computed tomography. Another great advantage of this technology is that the sample does not need special preparation or destruction in the sectioned area as in histopathologic evaluation. An odontoma with CBCT and microtomography images is presented in a 26-year-old man. It was first observed on panoramic radiographs and then by CBCT. The lesion and the impacted third molar were surgically excised using a modified Neumann approach. After removal, it was evaluated by histopathology and microtomography to confirm the diagnostic hypothesis. According to the results, micro-CT enabled the assessment of the sample similar to histopathology, without destruction of the sample. With further development, micro-CT could be a powerful diagnostic tool in future research.

  6. A case of complex regional pain syndrome with agnosia for object orientation. (United States)

    Robinson, Gail; Cohen, Helen; Goebel, Andreas


    This systematic investigation of the neurocognitive correlates of complex regional pain syndrome (CRPS) in a single case also reports agnosia for object orientation in the context of persistent CRPS. We report a patient (JW) with severe long-standing CRPS who had no difficulty identifying and naming line drawings of objects presented in 1 of 4 cardinal orientations. In contrast, he was extremely poor at reorienting these objects into the correct upright orientation and in judging whether an object was upright or not. Moreover, JW made orientation errors when copying drawings of objects, and he also showed features of mirror reversal in writing single words and reading single letters. The findings are discussed in relation to accounts of visual processing. Agnosia for object orientation is the term for impaired knowledge of an object's orientation despite good recognition and naming of the same misoriented object. This defect has previously only been reported in patients with major structural brain lesions. The neuroanatomical correlates are discussed. The patient had no structural brain lesion, raising the possibility that nonstructural reorganisation of cortical networks may be responsible for his deficits. Other patients with CRPS may have related neurocognitive defects.

  7. Complexation at the edges of hydrotalcite: the cases of arsenate and chromate. (United States)

    Jobbágy, Matías; Regazzoni, Alberto E


    Sorption of CrO(4)(2-) and HAsO(4)(2-) by hydrotalcite, in its chloride form, was studied as a function of anion concentration. In both cases, the shape of the isotherms is langmuirian. The maximum uptake of CrO(4)(2-) equals the ion-exchange capacity of the solid, whereas sorption of HAsO(4)(2-) saturates at a higher value. Chloride ions inhibit the uptake of both anions, the amount of sorbed CrO(4)(2-) declining rapidly to zero. The uptake of HAsO(4)(2-), however, attains a constant value at high chloride concentrations. The excess of arsenate uptake follows, at constant pH, a langmuirian dependence with equilibrium concentration and decreases with increasing pH, depicting a marked change in slope at pH≈pQ(a3). CrO(4)(2-) and HAsO(4)(2-) have notable, albeit different, effects on the electrophoretic behavior of hydrotalcite; the positive particle charge is screened almost completely by CrO(4)(2-), whereas sorption of HAsO(4)(2-) produces charge reversal. These results reflect the formation of inner-sphere arsenate surface complexes at the edges of hydrotalcite particles. The underlying rationale is discussed in terms of the crystal structure of hydrotalcite surfaces.

  8. Complex Odontoma: A Case Report with Micro-Computed Tomography Findings

    Directory of Open Access Journals (Sweden)

    L. A. N. Santos


    Full Text Available Odontomas are the most common benign tumors of odontogenic origin. They are normally diagnosed on routine radiographs, due to the absence of symptoms. Histopathologic evaluation confirms the diagnosis especially in cases of complex odontoma, which may be confused during radiographic examination with an osteoma or other highly calcified bone lesions. The micro-CT is a new technology that enables three-dimensional analysis with better spatial resolution compared with cone beam computed tomography. Another great advantage of this technology is that the sample does not need special preparation or destruction in the sectioned area as in histopathologic evaluation. An odontoma with CBCT and microtomography images is presented in a 26-year-old man. It was first observed on panoramic radiographs and then by CBCT. The lesion and the impacted third molar were surgically excised using a modified Neumann approach. After removal, it was evaluated by histopathology and microtomography to confirm the diagnostic hypothesis. According to the results, micro-CT enabled the assessment of the sample similar to histopathology, without destruction of the sample. With further development, micro-CT could be a powerful diagnostic tool in future research.

  9. Complex Odontoma: A Case Report with Micro-Computed Tomography Findings (United States)

    Santos, L. A. N.; Roque-Torres, G. D.; Oliveira, V. F.; Freitas, D. Q.


    Odontomas are the most common benign tumors of odontogenic origin. They are normally diagnosed on routine radiographs, due to the absence of symptoms. Histopathologic evaluation confirms the diagnosis especially in cases of complex odontoma, which may be confused during radiographic examination with an osteoma or other highly calcified bone lesions. The micro-CT is a new technology that enables three-dimensional analysis with better spatial resolution compared with cone beam computed tomography. Another great advantage of this technology is that the sample does not need special preparation or destruction in the sectioned area as in histopathologic evaluation. An odontoma with CBCT and microtomography images is presented in a 26-year-old man. It was first observed on panoramic radiographs and then by CBCT. The lesion and the impacted third molar were surgically excised using a modified Neumann approach. After removal, it was evaluated by histopathology and microtomography to confirm the diagnostic hypothesis. According to the results, micro-CT enabled the assessment of the sample similar to histopathology, without destruction of the sample. With further development, micro-CT could be a powerful diagnostic tool in future research. PMID:27293913

  10. Risk Determination, Prioritization, and Classifying in Construction Project Case Study: Gharb Tehran Commercial-Administrative Complex

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    Azadeh Sohrabinejad


    Full Text Available Construction projects play an important role in infrastructure projects in developing countries. According to type, size, and complexity of the project, the number and importance of each risk could be different and many projects cannot reach the project goals due to exposure to multiple risks. Many papers have been published on the subject of risk management in construction projects; unfortunately most of them have not been implemented in practical conditions. The aim of this study is to identify and prioritize risks in construction projects. The classical approach used probability and impact for risk assessment, but these criteria do not sufficiently address all aspects of projects risks and there might be a relationship between different criteria. This study proposes the hierarchical dependencies between criteria. A case study of construction project is presented to illustrate performance and usage of the proposed model. Utilizing library studies and interview with experts, managers, and specialists, decision criteria were identified through brain storming. Risks were categorized by the experts into eleven risks. Important risks were evaluated based on the fuzzy ANP, fuzzy DEMATEL, and fuzzy TOPSIS methods. The proposed model is more suitable than the traditional decision-making methods in prioritizing risk concerning cost, time, and quality.

  11. Spindle cell carcinoma of the breast as complex cystic lesion:a case report

    Institute of Scientific and Technical Information of China (English)

    Masahiro Kitada; Satoshi Hayashi; Yoshinari Matsuda; Kei Ishibashi; Keisuke Oikawa; Naoyuki Miyokawa


    Spindle cell carcinoma of the breast is a rare tumor. hTis tumor can proliferate rapidly and cause cystic changes because of internal tissue necrosis. We evaluated a 54-year-old woman with right breast lump. Mammography showed a category four mass with a diameter of 2.5 cm. Ultrasonography (US) revealed a complex cystic lesion, and ifne-needle aspiration (FNA) cytology demonstrated bloody fluid and malignant cells. Partial breast resection and sentinel lymph node biopsy were performed. Immunohistology revealed spindle cells with positive results for cytokeratin (AE1/AE3) and vimentin, partially positive results for s-100, and negative results for desmin and α-actin. The pathological stage was IIA, and biochemical characterization showed that the tumor was triple negative. Six courses of FEC-100 chemotherapy (5-fluorouracil 500 mg/m2, epirubicin 100 mg/m2, and cyclophosphamide 500 mg/m2) were administered. Radiotherapy was performed. hTis case is discussed with reference to the literature.

  12. Primary leiomyosarcoma of the nipple-areola complex: Report of a case and review of literature

    Institute of Scientific and Technical Information of China (English)

    Lai-ching WONG; Po-chi HUANG; Shi-ping LUH; Chiun-sheng HUANG


    Primary leiomyosarcoma of the nipple-areola complex is extremely rare. Less than ten such cases have been reported in English literature so far. Herein we describe a 52-year-old female presenting with a 1.5 cm× 1.1 cm×0.7 cm nodular lesion over her left nipple, and leiomyosarcoma was proved by pathological examination of the excised specimen. Positron emitted tomogram (PET) revealed no abnormal signal other than the primary site. Microscopically, this poorly circumscribed tumor was composed of interlacing bundles of smooth muscle cells with bizarre and pleomorphic nuclei, as well as prominent nucleoli. Its mitotic count was up to 7 mitoses per 10 high power fields (HPF). Immunohistochemical study of tumor cells revealed positive stain for α-smooth muscle actin and vimentin; and negative for cytokeratin, CD34 and S-100. Left simple mastectomy was undertaken and no residual mass lesion was noted on the resected specimen. Related literatures about the diagnosis and treatment for breast leiomyosarcoma will be presented here.

  13. PRKAR1A in the development of cardiac myxoma: a study of 110 cases including isolated and syndromic tumors. (United States)

    Maleszewski, Joseph J; Larsen, Brandon T; Kip, Nefize Sertac; Castonguay, Mathieu C; Edwards, William D; Carney, J Aidan; Kipp, Benjamin R


    Cardiac myxoma usually occurs as a solitary mass, but occasionally develops as part of a familial syndrome, the Carney complex (CNC). Two thirds of CNC-associated cardiac myxomas exhibit mutations in PRKAR1A. PRKAR1A mutations occur in both familial and sporadic forms of CNC but have not been described in isolated (nonsyndromic) cardiac myxomas. A total of 127 consecutive cardiac myxomas surgically resected at Mayo Clinic (1993 to 2011) from 110 individuals were studied. Clinical, radiologic, and pathologic findings were reviewed. Of these, 103 patients had isolated cardiac myxomas, and 7 patients had the tumor as a component of CNC. Age and sex distributions were different for CNC (mean 26 y, range 14 to 44 y, 71% female) and non-CNC (mean 62 y, range 18 to 92 y, 63% female) patients. PRKAR1A immunohistochemical analysis (IHC) was performed, and myxoma cell reactivity was graded semiquantitatively. Bidirectional Sanger sequencing was performed in 3 CNC patients and 29 non-CNC patients, to test for the presence of mutations in all coding regions and intron/exon boundaries of the PRKAR1A gene. IHC staining showed that all 7 CNC cases lacked PRKAR1A antigenicity and that 33 (32%) isolated cardiac myxomas were similarly nonreactive. Of tumors subjected to sequencing analysis, 2 (67%) CNC myxomas and 9 (31%) non-CNC myxomas had pathogenic PRKAR1A mutations. No germline mutations were found in 4 non-CNC cases tested. PRKAR1A appears to play a role in the development of both syndromic and nonsyndromic cardiac myxomas. Routine IHC evaluation of cardiac myxomas for PRKAR1A expression may be useful in excluding a diagnosis of CNC.

  14. Sporadic and genetic forms of paediatric somatotropinoma: a retrospective analysis of seven cases and a review of the literature

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    Nozières Cécile


    Full Text Available Abstract Background Somatotropinoma, a pituitary adenoma characterised by excessive production of growth hormone (GH, is extremely rare in childhood. A genetic defect is evident in some cases; known genetic changes include: multiple endocrine neoplasia type 1 (MEN1; Carney complex; McCune-Albright syndrome; and, more recently identified, aryl hydrocarbon receptor-interacting protein (AIP. We describe seven children with somatotropinoma with a special focus on the differences between genetic and sporadic forms. Methods Seven children who presented in our regional network between 1992 and 2008 were included in this retrospective analysis. First-type therapy was somatostatin (SMS analogues or transsphenoidal surgery. Control was defined as when insulin-like growth factor-1 (IGF-1 levels were within the normal range for the patient's age at 6 months after therapy, associated with decreasing tumour volume. Results Patients were aged 5-17 years and the majority (n = 6 were male. Four patients had an identified genetic mutation (McCune-Albright syndrome: n = 1; MEN1: n = 1; AIP: n = 2; the remaining three cases were sporadic. Accelerated growth rate was reported as the first clinical sign in four patients. Five patients presented with macroadenoma; invasion was noted in four of them (sporadic: n = 1; genetic: n = 3. Six patients were treated with SMS analogues; normalisation of IGF-1 occurred in one patient who had a sporadic intrasellar macroadenoma. Multiple types of therapy were necessary in all patients with an identified genetic mutation (4 types: n = 1; 3 types: n = 2; 2 types: n = 1, whereas two of the three patients with sporadic somatotropinoma required only one type of therapy. Conclusions This is the first series that analyzes the therapeutic response of somatotropinoma in paediatric patients with identified genetic defects. We found that, in children, genetic somatotropinomas are more invasive than sporadic somatotropinomas. Furthermore

  15. On the impedance of galvanic cells XXVI. Application of the complex plane method in the case of mixed currents

    NARCIS (Netherlands)

    Dekker, B.G.; Sluyters-Rehbach, M.; Sluyters, J.H.


    The applicability of the complex plane method for the evaluation of the impedance parameters in the case of two simultaneously proceeding electrode reactions is discussed. It is shown that the possibility of the evaluation depends strongly on the values of the irreversibility quotients of both react

  16. Thresholds of Knowledge Development in Complex Problem Solving: A Multiple-Case Study of Advanced Learners' Cognitive Processes (United States)

    Bogard, Treavor; Liu, Min; Chiang, Yueh-hui Vanessa


    This multiple-case study examined how advanced learners solved a complex problem, focusing on how their frequency and application of cognitive processes contributed to differences in performance outcomes, and developing a mental model of a problem. Fifteen graduate students with backgrounds related to the problem context participated in the study.…

  17. Case Study: Hidden Complexity of Medicines Use: Information Provided by a Person with Intellectual Disability and Diabetes to a Pharmacist (United States)

    Flood, Bernadette; Henman, Martin C.


    People with intellectual disabilities may be "invisible" to pharmacists. They are a complex group of patients many of whom have diabetes. Pharmacists may have little experience of the challenges faced by this high risk group of patients who may be prescribed high risk medications. This case report details information supplied by Pat, a…

  18. Negotiating between Restrictive Language Policies and Complex Teaching Conditions: A Case Study of Arizona's Teachers of English Learners (United States)

    Mackinney, Erin; Rios-Aguilar, Cecilia


    This article examines how Arizona's teachers of English learners negotiate between restrictive language policies and complex teaching conditions. This case study explores how middle school teachers in an urban school district make sense of the 4-hour English language development block, Arizona's recent English-only policy. Findings indicate that…

  19. Development and measurement properties of the self assessment version of the INTERMED for the elderly to assess case complexity

    NARCIS (Netherlands)

    Peters, Lilian L.; Boter, Han; Slaets, Joris P. J.; Buskens, Erik


    Objectives: The INFERMED for the Elderly Self Assessment (IM-E-SA) was developed to support health care professionals in providing demand driven elderly care. It assesses case complexity and health care needs as perceived by older adults themselves. By applying this instrument tailored care can be p

  20. Complex Childhood Trauma and School Responses: A Case Study of the Impact of Professional Development in One Elementary School (United States)

    VanderWegen, Terrie A.


    The purpose of this qualitative case study was to examine one public elementary school in Spokane, Washington that has received significant complex trauma professional development training provided by Washington State University Area Health Education Center (WSU-AHEC). The study explored teachers', specialists', and the principal's perceptions of…

  1. Understanding the lithosphere in complex tectonic scenarios by integrating geophysical data: The Pyrenees case study (United States)

    Campanyà, Joan; Fullea, Javier; Ledo, Juanjo; Queralt, Pilar; Marcuello, Alex; Liesa, Montserrat; Muñoz, Josep Anton


    Tectonic processes dominate the development of the outermost layer of the Earth over a timescale of millions of years. The locations where these processes take place provide a great opportunity for Earth scientists to study and understand the dynamics and properties of the lithosphere. The Pyrenees are a particular case of continental collision formed as a result of the collision between the Iberian and European plates, which caused the subduction of the Iberian lower crust below the European crust. Large amounts of geophysical data have been acquired in the area providing spectacular images of lithospheric subduction beneath the Western and Central Pyrenees, confirming the occurrence of this generally well-understood process. The Eastern Pyrenees, however, are a most puzzling part of the orogen and the geodynamical evolution of this area cannot be understood without the influence of the Neogene Mediterranean rifting, following the continental collision. The complexity of this area and the controversy of the geophysical results set in debate concepts well recognized in the other parts of the Pyrenees such as the subduction of the Iberian lower crust and the depth of the lithosphere-asthenosphere boundary. The aims of this study are to characterise major tectonic and geophysical variations along the Pyrenean mountain range at a lithospheric-scale and constrain the causes of the observed lateral variations. A preliminary model of the lithospheric configuration and dynamics, based on magnetotelluric geophysical results, has been developed and constrained using independent and available geophysical, geological and geochemical data. Computational petrology methods, using Litmod, were used for integrated modelling of all data.

  2. Unusually large complex odontoma in maxillary sinus associated with unerupted tooth. Report of case and review of literature. (United States)

    Singer, Steven R; Mupparapu, Muralidhar; Milles, Maano; Rinaggio, Joseph; Pisano, Dominic; Quaranta, Patrick


    An unusual case of a large complex odontoma with an associated impacted tooth is presented. Odontomas are hamartomatous growths of enamel, dentin, cementum and pulp tissue. Although they are usually tooth-sized or smaller, occasionally, the complex variant can exhibit considerable growth, as was seen in the case presented here. It occupied most of the maxillary sinus and displaced the floor of the orbit and the medial and posterior walls of the left maxillary sinus. Panoramic radiographs, as well as axial and coronal CT studies, showed the extent of the lesion in various dimensions. A differential diagnosis of various calcifying tumors was formulated on the basis of these findings. The lesion was surgically excised, and histologic analysis confirmed the radiographic impression. Although odontomas of this magnitude are rare, this case demonstrates the value of imaging, radiographic histopathologic diagnosis and surgical treatment planning prior to any definitive treatment.

  3. Characteristics of Urban Sustainability in the Cases of Multi Commercial Complexes from the Perspective of the “Ground”

    Directory of Open Access Journals (Sweden)

    Soomi Kim


    Full Text Available In the diverse research on Multi Commercial Complexes, rather than a technical and statistical approach, it is now time to focus on the quality of urban sustainability based on the daily experience of urban residents. Therefore, this research proposes a mechanism for making a sophisticated adjustment to the “Ground”, defined as the empty space of a designated site under the existing urban conditions, towards planning the sustainability of a Multi-Commercial Complex. For the first step, the elements of urban sustainability were extracted from the Figure-Ground Theory and the urban theory of Aldo Rossi and Kevin Lynch, respectively. The relationship between the methodology, which deals with the concept of “Ground” and its sustainable urban status, is analyzed using five selected multi-commercial complex cases. We derived the characteristics of “Ground” represented in each case, including “Responding”, “Contextual”, “Historical”, “Co-existing”, and “Hybrid” sustainability. In each case, the “Ground” was treated as a crucial common issue. In this paper, we suggest that preferential consideration and sensitive design of the “Ground” are crucial for maintaining urban sustainability in the planning of Multi Commercial Complexes. This paper can thus contribute to the body of research on urban sustainability along with existing technical studies.

  4. Dynamic Development of Complexity and Accuracy: A Case Study in Second Language Academic Writing (United States)



    This paper reports on the development of complexity and accuracy in English as a Second Language (ESL) academic writing. Although research into complexity and accuracy development in second language (L2) writing has been well established, few studies have assumed the multidimensionality of these two constructs (Norris & Ortega, 2009) or…

  5. The Interaction of Complexity and Grammatical Processability: The Case of Swedish as a Foreign Language (United States)

    Norrby, Catrin; Hakansson, Gisela


    The aim of this study is to discuss the interaction of linguistic complexity and morpho-syntactic development in foreign language learners. The analysis of morpho-syntactic structures was carried out within the framework of Processability Theory (Pienemann 1998). To capture the level of complexity we investigate the following: sentence length,…

  6. Characterizing complexity in socio-technical systems: a case study of a SAMU Medical Regulation Center. (United States)

    Righi, Angela Weber; Wachs, Priscila; Saurin, Tarcísio Abreu


    Complexity theory has been adopted by a number of studies as a benchmark to investigate the performance of socio-technical systems, especially those that are characterized by relevant cognitive work. However, there is little guidance on how to assess, systematically, the extent to which a system is complex. The main objective of this study is to carry out a systematic analysis of a SAMU (Mobile Emergency Medical Service) Medical Regulation Center in Brazil, based on the core characteristics of complex systems presented by previous studies. The assessment was based on direct observations and nine interviews: three of them with regulator of emergencies medical doctor, three with radio operators and three with telephone attendants. The results indicated that, to a great extent, the core characteristics of complexity are magnified) due to basic shortcomings in the design of the work system. Thus, some recommendations are put forward with a view to reducing unnecessary complexity that hinders the performance of the socio-technical system.

  7. Role of Ketamine and Methadone as Adjunctive Therapy in Complex Pain Management: A Case Report and Literature Review (United States)

    Faisal, Wasek; Jacques, Judith


    Assessment and management of complex cancer pain always remains a major challenge for any palliative care team, given its heterogeneity of underlying pathophysiology and limitations of any pharmacotherapy. Here, we present a case of complex pain management in a young patient with a life-limiting illness, highlighting the issues of organic and nonorganic contributors of pain and provide some insight into the role of ketamine and methadone as adjunctive therapy to opioid analgesics. A brief literature review is also done to provide the context of use of these adjunctive drugs in this setting. PMID:28216871

  8. A Case Study on the Application of a Structured Experimental Method for Optimal Parameter Design of a Complex Control System (United States)

    Torres-Pomales, Wilfredo


    This report documents a case study on the application of Reliability Engineering techniques to achieve an optimal balance between performance and robustness by tuning the functional parameters of a complex non-linear control system. For complex systems with intricate and non-linear patterns of interaction between system components, analytical derivation of a mathematical model of system performance and robustness in terms of functional parameters may not be feasible or cost-effective. The demonstrated approach is simple, structured, effective, repeatable, and cost and time efficient. This general approach is suitable for a wide range of systems.

  9. Time Series Analysis OF SAR Image Fractal Maps: The Somma-Vesuvio Volcanic Complex Case Study (United States)

    Pepe, Antonio; De Luca, Claudio; Di Martino, Gerardo; Iodice, Antonio; Manzo, Mariarosaria; Pepe, Susi; Riccio, Daniele; Ruello, Giuseppe; Sansosti, Eugenio; Zinno, Ivana


    The fractal dimension is a significant geophysical parameter describing natural surfaces representing the distribution of the roughness over different spatial scale; in case of volcanic structures, it has been related to the specific nature of materials and to the effects of active geodynamic processes. In this work, we present the analysis of the temporal behavior of the fractal dimension estimates generated from multi-pass SAR images relevant to the Somma-Vesuvio volcanic complex (South Italy). To this aim, we consider a Cosmo-SkyMed data-set of 42 stripmap images acquired from ascending orbits between October 2009 and December 2012. Starting from these images, we generate a three-dimensional stack composed by the corresponding fractal maps (ordered according to the acquisition dates), after a proper co-registration. The time-series of the pixel-by-pixel estimated fractal dimension values show that, over invariant natural areas, the fractal dimension values do not reveal significant changes; on the contrary, over urban areas, it correctly assumes values outside the natural surfaces fractality range and show strong fluctuations. As a final result of our analysis, we generate a fractal map that includes only the areas where the fractal dimension is considered reliable and stable (i.e., whose standard deviation computed over the time series is reasonably small). The so-obtained fractal dimension map is then used to identify areas that are homogeneous from a fractal viewpoint. Indeed, the analysis of this map reveals the presence of two distinctive landscape units corresponding to the Mt. Vesuvio and Gran Cono. The comparison with the (simplified) geological map clearly shows the presence in these two areas of volcanic products of different age. The presented fractal dimension map analysis demonstrates the ability to get a figure about the evolution degree of the monitored volcanic edifice and can be profitably extended in the future to other volcanic systems with

  10. Hospitals as complex adaptive systems: A case study of factors influencing priority setting practices at the hospital level in Kenya. (United States)

    Barasa, Edwine W; Molyneux, Sassy; English, Mike; Cleary, Susan


    There is a dearth of literature on priority setting and resource allocation (PSRA) practices in hospitals, particularly in low and middle income countries (LMICs). Using a case study approach, we examined PSRA practices in 2 public hospitals in coastal Kenya. We collected data through a combination of in-depth interviews of national level policy makers, hospital managers, and frontline practitioners in the case study hospitals (n = 72), review of documents such as hospital plans and budgets, minutes of meetings and accounting records, and non-participant observations of PSRA practices in case study hospitals over a period of 7 months. In this paper, we apply complex adaptive system (CAS) theory to examine the factors that influence PSRA practices. We found that PSRA practices in the case hospitals were influenced by, 1) inadequate financing level and poorly designed financing arrangements, 2) limited hospital autonomy and decision space, and 3) inadequate management and leadership capacity in the hospital. The case study hospitals exhibited properties of complex adaptive systems (CASs) that exist in a dynamic state with multiple interacting agents. Weaknesses in system 'hardware' (resource scarcity) and 'software' (including PSRA guidelines that reduced hospitals decision space, and poor leadership skills) led to the emergence of undesired properties. The capacity of hospitals to set priorities should be improved across these interacting aspects of the hospital organizational system. Interventions should however recognize that hospitals are CAS. Rather than rectifying isolated aspects of the system, they should endeavor to create conditions for productive emergence.

  11. Origin of plagiogranites in oceanic complexes: A case study of the Nicoya and Santa Elena terranes, Costa Rica (United States)

    Whattam, Scott A.; Gazel, Esteban; Yi, Keewook; Denyer, Percy


    The origin of minor leucocratic intrusions known as "plagiogranites" in oceanic complexes dominated by basaltic compositions have been debated in the literature. Here we use well preserved plagiogranites within the contrasting Santa Elena Ophiolite and the Nicoya Complex, NW Costa Rica, to investigate the origin and age of these leucocratic intrusions. Magmatic zircons of plagiogranites of the Santa Elena ophiolite and the Nicoya Complex, yield weighted mean SHRIMP 206Pb/238U ages of 125.3 ± 2.0 Ma and 90.9 ± 2.0 Ma to 88.5 ± 2.0 Ma (n = 5), respectively. These ages record the main magmatic phases of formation of these intrusions preserved in each complex. Relatively flat, unfractionated chondrite-normalized REE patterns of plagiogranites from both complexes mimic signatures of related mafic rocks, which is consistent with formation via fractional crystallization from a mafic source as opposed to partial melting of a mafic (basalt, amphibolite) protolith. In the case of the Nicoya Complex, modelling suggests that the Nicoya plagiogranites are consistent as 10-15% residual liquids after fractional crystallization from its mafic parental source. Trace element systematics of the plagiogranites are consistent with an oceanic arc origin for Santa Elena and a mostly mid-ocean ridge to oceanic-plateau origin for Nicoya.

  12. The Use of Best Practice in the Treatment of a Complex Diabetic Foot Ulcer: A Case Report


    Melodie Blakely


    Background and Purpose: Published guidelines for effective management of diabetic foot ulcers (DFU) include total contact casting (TCC). The purpose of this case study is to describe the application of best practice guidelines for the treatment of a diabetic foot ulcer (DFU) in a complex patient where TCC offloading could not be utilized. Case Description: The patient was a 47 year-old female with a five-plus year history of a full-thickness DFU on the left plantar mid-foot. Treatment include...

  13. Environmental management on the basis of Complex Regional Indicators Concept: case of the Murmansk region (United States)

    Kozlov, A.; Gutman, S.; Zaychenko, I.; Rytova, E.; Nijinskaya, P.


    The article presents an approach to sustainable environmental development of the Murmansk region of the Russian Federation based on the complex regional indicators as a transformation of a balance scorecard method. The peculiarities of Murmansk region connected with sustainable environmental development are described. The complex regional indicators approach allows to elaborate the general concept of complex regional development taking into consideration economic and non-economic factors with the focus on environmental aspects, accumulated environmental damage in particular. General strategic chart of sustainable environmental development of the Murmansk region worked out on the basis of complex regional indicators concept is composed. The key target indicators of sustainable ecological development of the Murmansk region are presented for the following strategic chart components: regional finance; society and market; industry and entrepreneurship; training, development and innovations. These charts are to be integrated with international environmental monitoring systems.

  14. Analysis of Engineered Nanomaterials in Complex Matricies (Environment and Biota): General Considerations and Conceptual Case Studies (United States)

    Advances in the study of the environmental fate, transport, and ecotoxicological effects of engineered nanomaterials (ENMs) have been hampered by a lack of adequate techniques for the detection and quantification of ENMs at environmentally relevant concentrations in complex media...


    Directory of Open Access Journals (Sweden)

    Ana Glória Slechticius


    Full Text Available This study aims to analyze what is the relationship between the concepts of complex project management and IT strategic planning in companies from the financial industry. To this end, from the literature review, we present four research assumptions that were analyzed empirically through the strategy of a single case study in a company in the financial sector with high representation in the Brazilian scenario. It was found that the strategic management of IT is related to the alignment between business and IT being the correct execution of complex projects in IT is naturally part of the strategic plans of the organizations due to the key role that IT plays in supporting the business. Additionally, it was found to be necessary alignment between strategic objectives and business of an organization that relies on IT to substantially that the implementation of a complex IT project has effective foundation to be properly implemented.

  16. The complexities in system building strategies — The case of personalized cancer medicines in England

    NARCIS (Netherlands)

    Kukk, P.; Moors, E.H.M.; Hekkert, M.P.


    Abstract Novel technologies often face difficulties in market uptake, especially when they differ significantly from already established technologies. In some cases, like personalized medicine, new technologies are composed of a number of parallel emerging technologies – in our case therapeutics and

  17. Computerized assessment of syntactic complexity in Alzheimer's disease: a case study of Iris Murdoch's writing. (United States)

    Pakhomov, Serguei; Chacon, Dustin; Wicklund, Mark; Gundel, Jeanette


    Currently, the majority of investigations of linguistic manifestations of neurodegenerative disorders such as Alzheimer's disease are conducted based on manual linguistic analysis. Grammatical complexity is one of the language use characteristics sensitive to the effects of Alzheimer's disease and is difficult to operationalize and measure using manual approaches. In the current study, we demonstrate the application of computational linguistic methods to automate the analysis of grammatical complexity. We implemented the Computerized Linguistic Analysis System (CLAS) based on the Stanford syntactic parser (Klein and Manning, Pattern Recognition, 38(9), 1407-1419, 2005) for longitudinal analysis of changes in syntactic complexity in language affected by neurodegenerative disorders. We manually validated CLAS scoring and used it to analyze writings of Iris Murdoch, a renowned Irish author diagnosed with Alzheimer's disease. We found clear patterns of decline in grammatical complexity consistent with previous analyses of Murdoch's writing conducted by Garrard, Maloney, Hodges, and Patterson (Brain, 128(250-260, 2005). CLAS is a fully automated system that may be used to derive objective and reproducible measures of syntactic complexity in language production and can be particularly useful in longitudinal studies with large volumes of language samples.

  18. Radiofrequency Ablation of Accessory Pathways in Chil- dren with Complex Congenital Cardiac Lesions: A Report of Three Cases

    Directory of Open Access Journals (Sweden)

    Mohammad Dalili


    Full Text Available Catheter ablation is an accepted, highly effective modality of treatment for cardiac arrhythmias in children. The success rate depends on the operator’s experience, especially in cases involving complex anatomies. We hereby report our recent experience of successful ablation of accessory pathways in three children with complex congenital heart diseases.The first case was a 7-year-old girl with tricuspid atresia and a previous Glenn shunt, in whom a sub-epicardial overt accessory pathway was successfully ablated via the coronary sinus. The second case, a 9-year-old girl, received accessory pathway ablation via the fenestration of an extracardiac Fontan pathway. The third case was a 14-year-old boy with dextrocardia, common atrium, common ventricle, and a previous extracardiac Fontan operation, in whom ablation of a concealed accessory pathway was carried out retrogradely from the aorta. All the ablations were done in Rajaie Cardiovascular, Medical and Research Center, Tehran, and all the patients were discharged from the hospital without any complication.

  19. Role of Occupational Therapy in Case Management and Care Coordination for Clients With Complex Conditions. (United States)

    Robinson, Monica; Fisher, Thomas F; Broussard, Kim


    Specific aspects of the profession of occupational therapy support a distinct value for its practitioners participating fully in the development of case management and care coordination systems. The expectation in the 21st century is that the U.S. health care system must be transformed from one that promotes volume of service to one that promotes value of care. Case management and care coordination will be critical components of that transformation. Occupational therapy's principles, education, practice, approach, and perspective offer much to benefit this increased attention to case management and care coordination. Occupational therapy practitioners should promote themselves and their profession as these system changes develop.

  20. Positioning matrix of economic efficiency and complexity: a case study in a university hospital. (United States)

    Ippolito, Adelaide; Viggiani, Vincenzo


    At the end of 2010, the Federico II University Hospital in Naples, Italy, initiated a series of discussions aimed at designing and applying a positioning matrix to its departments. This analysis was developed to create a tool able to extract meaningful information both to increase knowledge about individual departments and to inform the choices of general management during strategic planning. The name given to this tool was the positioning matrix of economic efficiency and complexity. In the matrix, the x-axis measures the ratio between revenues and costs, whereas the y-axis measures the index of complexity, thus showing "profitability" while bearing in mind the complexity of activities. By using the positioning matrix, it was possible to conduct a critical analysis of the characteristics of the Federico II University Hospital and to extract useful information for general management to use during strategic planning at the end of 2010 when defining medium-term objectives.

  1. Discovering complex interrelationships between socioeconomic status and health in Europe: A case study applying Bayesian Networks. (United States)

    Alvarez-Galvez, Javier


    Studies assume that socioeconomic status determines individuals' states of health, but how does health determine socioeconomic status? And how does this association vary depending on contextual differences? To answer this question, our study uses an additive Bayesian Networks model to explain the interrelationships between health and socioeconomic determinants using complex and messy data. This model has been used to find the most probable structure in a network to describe the interdependence of these factors in five European welfare state regimes. The advantage of this study is that it offers a specific picture to describe the complex interrelationship between socioeconomic determinants and health, producing a network that is controlled by socio-demographic factors such as gender and age. The present work provides a general framework to describe and understand the complex association between socioeconomic determinants and health.

  2. Prediction in complex systems: The case of the international trade network (United States)

    Vidmer, Alexandre; Zeng, An; Medo, Matúš; Zhang, Yi-Cheng


    Predicting the future evolution of complex systems is one of the main challenges in complexity science. Based on a current snapshot of a network, link prediction algorithms aim to predict its future evolution. We apply here link prediction algorithms to data on the international trade between countries. This data can be represented as a complex network where links connect countries with the products that they export. Link prediction techniques based on heat and mass diffusion processes are employed to obtain predictions for products exported in the future. These baseline predictions are improved using a recent metric of country fitness and product similarity. The overall best results are achieved with a newly developed metric of product similarity which takes advantage of causality in the network evolution.

  3. The Physics of Life and Quantum Complex Matter: A Case of Cross-Fertilization

    Directory of Open Access Journals (Sweden)

    Nicola Poccia


    Full Text Available Progress in the science of complexity, from the Big Bang to the coming of humankind, from chemistry and biology to geosciences and medicine, and from materials engineering to energy sciences, is leading to a shift of paradigm in the physical sciences. The focus is on the understanding of the non-equilibrium process in fine tuned systems. Quantum complex materials such as high temperature superconductors and living matter are both non-equilibrium and fine tuned systems. These topics have been subbjects of scientific discussion in the Rome Symposium on the “Quantum Physics of Living Matter”.

  4. Tuberous sclerosis complex complicated with extraventricular cystic giant cell astrocytoma: case report

    Institute of Scientific and Technical Information of China (English)

    CHEN Xu-zhu; DAI Jian-ping


    @@ Tuberous sclerosis complex (TSC) is one of the most commonly identified neurocutaneous disorders with a prevalence of 1/6000 to 1/9000 in general population1,2 In the patients with TSC, 10%-15% have subependymal giant cell astrocytoma (SGCA) .3

  5. Manifestation of Chaos in Real Complex Systems: Case of Parkinson's Disease

    CERN Document Server

    Yulmetyev, R M; Hänggi, P; Yulmetyev, Renat M.; Demin, Sergey A.; H\\"{a}nggi, Peter


    In this chapter we present a new approach to the study of manifestations of chaos in real complex system. Recently we have achieved the following result. In real complex systems the informational measure of chaotic chatacter (IMC) can serve as a reliable quantitative estimation of the state of a complex system and help to estimate the deviation of this state from its normal condition. As the IMC we suggest the statistical spectrum of the non-Markovity parameter (NMP) and its frequency behavior. Our preliminary studies of real complex systems in cardiology, neurophysiology and seismology have shown that the NMP has diverse frequency dependence. It testifies to the competition between Markovian and non-Markovian, random and regular processes and makes a crossover from one relaxation scenario to the other possible. On this basis we can formulate the new concept in the study of the manifestation of chaoticity. We suggest the statistical theory of discrete non-Markov stochastic processes to calculate the NMP and t...

  6. [Serum immune complexes and cardiopulmonary bypass. A review of thirty-four cases (author's transl)]. (United States)

    Herreman, G; Poisson-Lespassailles, C; Puech, H; Vanetti, A; Delaunay, L; Yvart, J; Fermé, I


    The immunologic status of patients undergoing cardiopulmonary bypass as investigated. Rheumatoid factor, cryoglobulinemia and serum immune complexes were looked for. Studies were performed before the operation and eight or fifteen days later. From the results, it is concluded that the immunologic changes that occur in the immediate postoperative period cannot be interpreted because of the profound modifications resulting from cardiopulmonary bypass.

  7. The inter-Korean economic cooperation: the case of Kaesong Industrial Complex

    Directory of Open Access Journals (Sweden)

    Ángel Licona Michel


    Full Text Available The inter-Korean economic cooperation materialized with the development of Kaesong Industrial Complex shows that the governments of South Korea and North Korea despite having unstable political relations need to agree to enhance trade and increase productivity of industries seeking thereby to have more competitive economies to detonate the creation of more infrastructure.

  8. Communication Impairment in the AIDS Dementia Complex (ADC): A Case Report (United States)

    McCabe, Patricia J.; Sheard, Christine; Code, Chris


    This article details three examinations of communication impairment over 13 months in a man with AIDS dementia complex (ADC) and compares his performance on standardised language testing with that of two control participants. He had mild language impairments as measured on standardised tests but was severely impaired in pragmatic language skills.…

  9. How Humans Solve Complex Problems: The Case of the Knapsack Problem (United States)

    Murawski, Carsten; Bossaerts, Peter


    Life presents us with problems of varying complexity. Yet, complexity is not accounted for in theories of human decision-making. Here we study instances of the knapsack problem, a discrete optimisation problem commonly encountered at all levels of cognition, from attention gating to intellectual discovery. Complexity of this problem is well understood from the perspective of a mechanical device like a computer. We show experimentally that human performance too decreased with complexity as defined in computer science. Defying traditional economic principles, participants spent effort way beyond the point where marginal gain was positive, and economic performance increased with instance difficulty. Human attempts at solving the instances exhibited commonalities with algorithms developed for computers, although biological resource constraints–limited working and episodic memories–had noticeable impact. Consistent with the very nature of the knapsack problem, only a minority of participants found the solution–often quickly–but the ones who did appeared not to realise. Substantial heterogeneity emerged, suggesting why prizes and patents, schemes that incentivise intellectual discovery but discourage information sharing, have been found to be less effective than mechanisms that reveal private information, such as markets. PMID:27713516

  10. L2 Grammatical Gender in a Complex Morphological System: The Case of German (United States)

    Spinner, Patti; Juffs, Alan


    In order to determine the nature of naturalistic learners' difficulty with grammatical gender in a complex morphological system, the longitudinal production data of an early naturalistic L1-Italian and L1-Turkish learner who are acquiring German are examined in light of current theories of gender within Chomsky's (1995) Minimalist Program. After…

  11. Complexities in building innovation systems : the case of radical medical technologies

    NARCIS (Netherlands)

    Kukk, P.


    The main goal of this thesis is to facilitate a further understanding of how firms behind innovative technologies deal with different complexities in system-building strategies and the co-dependencies among different technologies, actors and system-building activities, while contributing to the buil

  12. Flexibility in Complex Enterprises: Case Studies from Military Operations and Acquisition (United States)


    on efficiency and minimizing error • Ref: Sah- Stiglitz ; Radner; Ioannides; Ranson, et al.; Volberda – Not as abstraction and complexity management...Ioannides; Sah and Stiglitz – Multi-organizational systems: fully functioning separate organizations that are also part of a larger

  13. Holocene glacier variability: three case studies using an intermediate-complexity climate model

    NARCIS (Netherlands)

    Weber, S.L.; Oerlemans, J.


    Synthetic glacier length records are generated for the Holocene epoch using a process-based glacier model coupled to the intermediate-complexity climate model ECBilt. The glacier model consists of a massbalance component and an ice-flow component. The climate model is forced by the insolation change

  14. A possibility to identify the vehicle driver through complex forensic and criminalistic expertise--case report. (United States)

    Păduraru, G; Knieling, A; Scripcaru, C; Iliescu, Diana Bulgaru


    Traffic accidents can have more or less dramatic consequences that involve penal and civil responsibility with amplitude extending over long periods of time. In many cases, substitution of the driver with the passenger in order to avoid criminal responsibility is often remarked. The substitution takes place with the passenger's agreement or, in cases with dramatic consequences (coma or death), without his/her consent. These situations are encountered in civil cases regarding insurance fraud. In addition to forensic medical expertise, to aid the experts, mathematical modeling and computer simulation of the dynamics of vehicle passengers is a tool that completes the criminal expertise of traffic accidents. This paper presents the method of identification of the person driving the vehicle based on the computer simulation of vehicle occupants' dynamics.

  15. Long-term outcome of orthotopic ileal neobladder (Camey Ⅱ) in the treatment of bladder cancer%Carney Ⅱ式原位回肠膀胱术的远期疗效分析

    Institute of Scientific and Technical Information of China (English)

    邢金春; 叶章群


    Objective To report the long-term follow-up results on treating bladder transitional cell carcinoma with orthotropic ileal neobladder after radical cystectomy.Methods Thirty-three male patients with a mean age of 64 years were subjected to Carney Ⅱ orthotropic ileal neobladder oper-ation after cystectomy.The entire length of ileum was opened along the antimesenteric border,placed into a transverse U shape,and sutured with a running suture.The bottom of the U shape was anasto-mosed with urethra to reconstruct the urinary continuity.The perioperation mortality,complications,urinary continence,renal function,image findings,and urodynamic examination were all retrospec-tively investigated.The quality of life was evaluated using the Functional Assessment of Cancer Ther-apy-Bladder(FATC) and International Prostate Symptom Score (IPSS).Results Thirty patients were followed up for 12-60 months.Urodynamics was carried out after oporation.The average ca-pacity of the urinary reservoir,the peak flow rate and postvoid residual were (380±65) ml,(12.6±2.3) ml/s and (25±11) ml,respectively.But the intra-reservoir pressure was significant lower than the intra-urethra pressure(20.4±8.7 cm H2O vs.57.2±10.5 cm H2O).Twenty-eight patients had a satisfactory daytime urinary continence and 26 patients had a satisfactory nocturnal urinary continence.The total FACT was 110.5±16.0 and IPSS was 14.5±4.2.Conclusion CamyⅡ ileal neobladder is a satisfactory method for treatment of invasive bladder cancer after radical cystectomy; it has few com-plication and is clinically valuable.%目的 评价CarneyⅡ式原位回肠膀胱术后患者的远期疗效.方法 膀胱移行细胞癌行根治性膀胱切除CarneyⅡ式原位回肠膀胱术患者33例.采用美国癌症患者生命质量量表(FACT)和国际前列腺症状评分(IPSS)衡量患者术后生活质量,采用膀胱容量、最大尿流率、残余尿量,充盈期膀胱压力等尿动力学结果

  16. The complex chemistry of outflow cavity walls exposed: the case of low-mass protostars

    CERN Document Server

    Drozdovskaya, Maria N; Visser, Ruud; Harsono, Daniel; van Dishoeck, Ewine F


    Complex organic molecules are ubiquitous companions of young low-mass protostars. Recent observations suggest that their emission stems, not only from the traditional hot corino, but also from offset positions. In this work, 2D physicochemical modelling of an envelope-cavity system is carried out. Wavelength-dependent radiative transfer calculations are performed and a comprehensive gas-grain chemical network is used to simulate the physical and chemical structure. The morphology of the system delineates three distinct regions: the cavity wall layer with time-dependent and species-variant enhancements; a torus rich in complex organic ices, but not reflected in gas-phase abundances; and the remaining outer envelope abundant in simpler solid and gaseous molecules. Strongly irradiated regions, such as the cavity wall layer, are subject to frequent photodissociation in the solid phase. Subsequent recombination of the photoproducts leads to frequent reactive desorption, causing gas-phase enhancements of several or...

  17. Complex networks for data-driven medicine: the case of Class III dentoskeletal disharmony (United States)

    Scala, A.; Auconi, P.; Scazzocchio, M.; Caldarelli, G.; McNamara, JA; Franchi, L.


    In the last decade, the availability of innovative algorithms derived from complexity theory has inspired the development of highly detailed models in various fields, including physics, biology, ecology, economy, and medicine. Due to the availability of novel and ever more sophisticated diagnostic procedures, all biomedical disciplines face the problem of using the increasing amount of information concerning each patient to improve diagnosis and prevention. In particular, in the discipline of orthodontics the current diagnostic approach based on clinical and radiographic data is problematic due to the complexity of craniofacial features and to the numerous interacting co-dependent skeletal and dentoalveolar components. In this study, we demonstrate the capability of computational methods such as network analysis and module detection to extract organizing principles in 70 patients with excessive mandibular skeletal protrusion with underbite, a condition known in orthodontics as Class III malocclusion. Our results could possibly constitute a template framework for organising the increasing amount of medical data available for patients’ diagnosis.

  18. Generalized friendship paradox in complex networks: the case of scientific collaboration. (United States)

    Eom, Young-Ho; Jo, Hang-Hyun


    The friendship paradox states that your friends have on average more friends than you have. Does the paradox "hold" for other individual characteristics like income or happiness? To address this question, we generalize the friendship paradox for arbitrary node characteristics in complex networks. By analyzing two coauthorship networks of Physical Review journals and Google Scholar profiles, we find that the generalized friendship paradox (GFP) holds at the individual and network levels for various characteristics, including the number of coauthors, the number of citations, and the number of publications. The origin of the GFP is shown to be rooted in positive correlations between degree and characteristics. As a fruitful application of the GFP, we suggest effective and efficient sampling methods for identifying high characteristic nodes in large-scale networks. Our study on the GFP can shed lights on understanding the interplay between network structure and node characteristics in complex networks.

  19. Generalized friendship paradox in complex networks: The case of scientific collaboration (United States)

    Eom, Young-Ho; Jo, Hang-Hyun


    The friendship paradox states that your friends have on average more friends than you have. Does the paradox ``hold'' for other individual characteristics like income or happiness? To address this question, we generalize the friendship paradox for arbitrary node characteristics in complex networks. By analyzing two coauthorship networks of Physical Review journals and Google Scholar profiles, we find that the generalized friendship paradox (GFP) holds at the individual and network levels for various characteristics, including the number of coauthors, the number of citations, and the number of publications. The origin of the GFP is shown to be rooted in positive correlations between degree and characteristics. As a fruitful application of the GFP, we suggest effective and efficient sampling methods for identifying high characteristic nodes in large-scale networks. Our study on the GFP can shed lights on understanding the interplay between network structure and node characteristics in complex networks.

  20. Governance of complex socio-environmental risks: the case of hazardous chemicals in the Baltic Sea. (United States)

    Karlsson, Mikael; Gilek, Michael; Udovyk, Oksana


    Complex socio-environmental risks challenge society. In response to scientific uncertainty and sociopolitical controversies, environmental governance, precaution, and the ecosystem approach to management are held forward as complements to governmental risk-based sector-restricted regulation. We analyze this development for hazardous substances in the Baltic Sea. Based on interviews and policy analysis, we study informal governance and, in particular, four central EU and international policies, and investigate how present governance relates to risks and objectives at hand. While showing emergence of broader governance approaches, we conclude that central objectives will not likely be met. Furthermore, we question the quest for broad environmental governance and emphasize the value of command and control regulation, if it implements precaution. These findings contribute to the theorizing on environmental (risk) governance. Finally, we provide some ideas that could help development and implementation of risk policies for hazardous chemicals in the Baltic Sea as well as other complex risks.

  1. Analysis of twenty pediatric cases of tuberous sclerosis complex: Are we doing enough?


    Jyoti Nath; Abhishek Dubey; Raj Pavan


    Background: Tuberous sclerosis complex (TSC) is a neuro-cutaneous disease characterized by hamartoma formation in various organs particularly the skin, brain, eye, kidney, heart and lungs. Patients usually have multisystem involvement and thus present to different medical specialties with varied complaints while the true nature of the disease and the hidden manifestations may remain unattended. A im: To assess the frequency and characteristics of various cutaneous and systemic manifestations ...

  2. Spontaneous Partitioning of Californium from Curium: Curious Cases from the Crystallization of Curium Coordination Complexes

    Energy Technology Data Exchange (ETDEWEB)

    Cary, Samantha K.; Silver, Mark A.; Liu, Guokui; Wang, Jamie C.; Bogart, Justin A.; Stritzinger, Jared T.; Arico, Alexandra A.; Hanson, Kenneth; Schelter, Eric J.; Albrecht-Schmitt, Thomas E.


    The reaction of 248CmCl3 with excess 2,6-pyridinedicarboxylic acid (DPA) under mild solvothermal conditions results in crystallization of the tris-chelate complex Cm(HDPA)3·H2O. Approximately half of the curium remains in solution at the end of this process, and evaporation of the mother liquor results in crystallization of the bis-chelate complex [Cm(HDPA)- (H2DPA)(H2O)2Cl]Cl·2H2O. 248Cm is the daughter of the α decay of 252Cf and is extracted in high purity from this parent. However, trace amounts of 249,250,251Cf are still present in all samples of 248Cm. During the crystallization of Cm(HDPA)3·H2O and [Cm(HDPA)(H2DPA)(H2O)2Cl]Cl·2H2O, californium(III) spontaneously separates itself from the curium complexes and is found doped within crystals of DPA in the form of Cf(HDPA)3. These results add to the growing body of evidence that the chemistry of californium is fundamentally different from that of earlier actinides.

  3. Topological Expansion in the Complex Cubic Log-Gas Model: One-Cut Case (United States)

    Bleher, Pavel; Deaño, Alfredo; Yattselev, Maxim


    We prove the topological expansion for the cubic log-gas partition function Z_N(t)= int _Γ \\cdots int _Γ prod _{1≤jcomplex parameter and Γ is an unbounded contour on the complex plane extending from e^{π i}∞ to e^{π i/3}∞. The complex cubic log-gas model exhibits two phase regions on the complex t-plane, with one cut and two cuts, separated by analytic critical arcs of the two types of phase transition: split of a cut and birth of a cut. The common point of the critical arcs is a tricritical point of the Painlevé I type. In the present paper we prove the topological expansion for log Z_N(t) in the one-cut phase region. The proof is based on the Riemann-Hilbert approach to semiclassical asymptotic expansions for the associated orthogonal polynomials and the theory of S-curves and quadratic differentials.

  4. A possible new syndrome with growth-hormone secreting pituitary adenoma, colonic polyposis, lipomatosis, lentigines and renal carcinoma in association with familial testicular germ cell malignancy: A case report

    Directory of Open Access Journals (Sweden)

    Mai Phuong L


    Full Text Available Abstract Background Germ-cell testicular cancer has not been definitively linked to any known hereditary cancer susceptibility disorder. Familial testicular cancer in the presence of other findings in affected and unaffected family members might indicate a previously-unidentified hereditary cancer syndrome. Case presentation The patient was diagnosed with a left testicular seminoma at age 28, and treated with left orchiectomy followed by adjuvant cobalt radiation. His family history is significant for testicular seminoma in his son, bladder cancer in his sister, and lipomatosis in his father. His evaluation as part of an etiologic study of familial testicular cancer revealed multiple colon polyps (adenomatous, hyperplastic, and hamartomatous first found in his 50 s, multiple lipomas, multiple hyperpigmented skin lesions, left kidney cancer diagnosed at age 64, and a growth-hormone producing pituitary adenoma with associated acromegaly diagnosed at age 64. The patient underwent genetic testing for Cowden syndrome (PTEN gene, Carney complex (PRKAR1A gene, and multiple endocrine neoplasia syndrome type 1 (MEN1 gene; no deleterious mutations were identified. Discussion The constellation of benign and malignant neoplasms in the context of this patient's familial testicular cancer raised the possibility that these might be manifestations of a known hereditary susceptibility cancer syndrome; however, genetic testing for the three syndromes that were most likely to explain these findings did not show any mutation. Alternatively, this family's phenotype might represent a novel neoplasm susceptibility disorder. This possibility cannot be evaluated definitively on the basis of a single case report; additional observations and studies are necessary to investigate this hypothesis further.

  5. Containing Pedagogical Complexity through the Assignment of Photography: Two Case Presentations (United States)

    Garrett, H. James; Matthews, Sara


    This article investigates the use of photography as a narrative approach to learning in the context of postsecondary education. Two cases are presented: a social studies methods course in a teacher education program in the South of the United States; and a senior undergraduate seminar on global violence at a university in southern Ontario, Canada.…

  6. A case of horseshoe lung and complex congenital heart disease in a term newborn

    Energy Technology Data Exchange (ETDEWEB)

    Jeewa, Aamir [British Columbia Children' s Hospital and University of British Columbia, Department of Pediatrics, Division of Cardiology, Vancouver (Canada); Culham, J.A.G. [British Columbia Children' s Hospital, Department of Radiology, Vancouver (Canada); Human, Derek G. [British Columbia Children' s Hospital and University of British Columbia, Department of Pediatrics, Division of Cardiology, Vancouver (Canada); B.C. Children' s Hospital, Children' s Heart Centre, Vancouver (Canada)


    We describe and illustrate a rare association of hypoplastic left heart syndrome, absent hilar left pulmonary artery, and an unusual bronchopulmonary malformation. This case highlights the utility of combination imaging of echocardiography and CT angiography in diagnosing a cyanotic newborn with a chest radiograph that is suspicious for lung hypoplasia. (orig.)

  7. Story-Making on the iPad When Children Have Complex Needs: Two Case Studies (United States)

    Kucirkova, Natalia; Messer, David; Critten, Val; Harwood, Jane


    The two case studies reported in this clinical exchange describe the way in which iPads can foster children's motivation to engage in communication and literacy-related activities such as story-sharing and story-creation. A detailed description of a particular iPad app (Our Story) is provided, along with observations of the implementation of this…

  8. Concept of Complex Environmental Monitoring Network - Vardzia Rock Cut City Case Study (United States)

    Elashvili, Mikheil; Vacheishvili, Nikoloz; Margottini, Claudio; Basilaia, Giorgi; Chkhaidze, Davit; Kvavadze, Davit; Spizzichino, Daniele; Boscagli, Franceso; Kirkitadze, Giorgi; Adikashvili, Luka; Navrozashvili, Levan


    Vardzia represents an unique cultural heritage monument - rock cut city, which unites architectural monument and Natural-Geological complex. Such monuments are particularly vulnerable and their restoration and conservation requires complex approach. It is curved in various layers of volcanic tuffs and covers several hectares of area, with chronologically different segments of construction. This monument, as many similar monuments worldwide, is subjected to slow but permanent process of destruction, expressed in following factors: surface weathering of rock, active tectonics (aseismic displacement along the active faults and earthquakes), interaction between lithologically different rock layers, existence of major cracks and associated complex block structure, surface rainwater runoff and infiltrated ground water, temperature variations, etc. During its lifetime, Vardzia was heavily damaged by Historical Earthquake of 1283 and only partly restored afterwards. The technological progress together with the increased knowledge about ongoing environmental processes, established the common understanding that the complex monitoring of the environment represents the essential component for resolving such a principal issues, as: Proper management and prevention of natural disasters; Modeling of environmental processes, their short and long term prognosis; Monitoring of macro and micro climate; Safe functioning and preservation of important constructions. Research Center of Cultural Heritage and Environment of Ilia State University in cooperation with Experts from ISPRA, with the funding from the State agency of Cultural Heritage, has developed a concept of Vardzia complex monitoring network. Concept of the network includes: monitoring local meteorological conditions (meteorological station), monitoring microclimate in caves (temperature and humidity in the air and rock), monitoring microtremors and ambient seismic noise in Vardzia (local strong motion network), monitoring

  9. Application of information and complexity theories to public opinion polls. The case of Greece (2004-2007)

    CERN Document Server

    Panos, C P


    A general methodology to study public opinion inspired from information and complexity theories is outlined. It is based on probabilistic data extracted from opinion polls. It gives a quantitative information-theoretic explanation of high job approval of Greek Prime Minister Mr. Constantinos Karamanlis (2004-2007), while the same time series of polls conducted by the company Metron Analysis showed that his party New Democracy (abbr. ND) was slightly higher than the opposition party of PASOK -party leader Mr. George Papandreou. It is seen that the same mathematical model applies to the case of the popularity of President Clinton between January 1998 and February 1999, according to a previous study, although the present work extends the investigation to concepts as complexity and Fisher information, quantifying the organization of public opinion data.

  10. How partnership accelerates Open Science: High Energy Physics and INSPIRE, a case study of a complex repository ecosystem

    CERN Document Server

    AUTHOR|(CDS)2079501; Hecker, Bernard Louis; Holtkamp, Annette; Mele, Salvatore; O'Connell, Heath; Sachs, Kirsten; Simko, Tibor; Schwander, Thorsten


    Public calls, agency mandates and scientist demand for Open Science are by now a reality with different nuances across diverse research communities. A complex “ecosystem” of services and tools, mostly communityDdriven, will underpin this revolution in science. Repositories stand to accelerate this process, as “openness” evolves beyond text, in lockstep with scholarly communication. We present a case study of a global discipline, HighDEnergy Physics (HEP), where most of these transitions have already taken place in a “social laboratory” of multiple global information services interlinked in a complex, but successful, ecosystem at the service of scientists. We discuss our firstDhand experience, at a technical and organizational level, of leveraging partnership across repositories and with the user community in support of Open Science, along threads relevant to the OR2013 community.

  11. Complexity analysis of blast-induced vibrations in underground mining:A case study

    Institute of Scientific and Technical Information of China (English)

    Cardu Marilena; Dompieri Mauricio; Seccatore Jacopo


    Blasting in geological bodies is an industrial process acting in an environment characterized by high uncertainties (natural joints,faults,voids,abrupt structural changes),which are transposed into the process parameters (e.g.energetic transfer to rock mass,hole deviations,misfires,vibrations,fly-rock,etc.).The approach to this problem searching for the "optimum" result can be ineffective.The geological environment is marked out by too many uncertainties,to have an "optimum" suitable to different applications.Researching for "Robustness" in a blast design gives rise to much more efficiency.Robustness is the capability of the system to behave constantly under varying conditions,without leading to unexpected results.Since the geology varies from site to site,setting a robust method can grant better results in varying environments,lowering the costs and increasing benefits and safety.Complexity Analysis (C.A.) is an innovative approach to systems.C.A.allows analyzing the Complexity of the Blast System and the criticality of each variable (drilling,charging and initiation parameters).The lower is the complexity,the more robust is the system,and the lower is the possibility of unexpected results.The paper presents the results obtained thanks to the C.A.approach in an underground gypsum quarry (Italy),exploited by conventional rooms and pillars method by drilling and blasting.The application of C.A.led to a reliable solution to reduce the charge per delay,hence reducing the impact of ground vibration on the surrounding structures.The analysis of the correlation degree between the variables allowed recognizing empirical laws as well.

  12. Fractures of the Zygomaticomaxillary Complex and Their Treatment: A Case Report

    Directory of Open Access Journals (Sweden)

    Bardhoshi Esat


    Full Text Available Fractures of the zygomaticomaxillary complex are the second most common of all facial fractures. Several fixation methods have been used over the years, including wire osteosynthesis, lag screw fixation, transfacial Kirschner wire fixation, titanium plate and screw fixation, and more recently, resorbable plating system. Internal fixation with titanium plates and screw provides the most rigid fixation and thus greater immobility of the fracture segments. The degree of immobilization created with titanium plates and screws also allows fixation at fewer anatomic points.

  13. Pulsed Radiofrequency Treatment of Complex Regional Pain Syndrome: A Case Series

    Directory of Open Access Journals (Sweden)

    Vlad Djuric


    Full Text Available BACKGROUND: Various forms of sympathetic chain neurolysis (sympathectomy have, at one time or another, held promise as effective treatment options for complex regional pain syndrome (CRPS. Complications, such as worsening pain and the development of new pain syndromes, have prevented sympathectomy from emerging as a standard intervention. In an effort to avoid poor outcomes associated with neurolysis, pulsed radiofrequency (PRF has been proposed as a potential treatment alternative for a number of chronic neuropathic pain states, including some forms of CRPS.

  14. No evidence for a genetic blueprint: The case of the "complex" mammalian photoreceptor

    Directory of Open Access Journals (Sweden)

    G Kumaramanickavel


    Full Text Available Despite the intensity of the search for genes causing inherited retinal degenerations over the past 3 decades, of the approximately 200 disease genes identified to date, all appear to be ordinary housekeeping genes specifying proteins playing basic structural and functional roles in the mature photoreceptor cells. No genes or genetic elements have been identified which can be construed as having a specific morphogenic role, directing the development of the cytoarchitecture of any particular retinal cell. The evidence suggests that the cytoarchitecture of the retinal photoreceptors, although enormously complex, arises from the self-organization of the cells constituents without any regulation or direction from an external genetic blueprint.

  15. A Case Report of Renal Sympathetic Denervation for the Treatment of Polymorphic Ventricular Premature Complexes (United States)

    Kiuchi, Márcio Galindo; Vitorio, Frederico Puppim; da Silva, Gustavo Ramalho; Paz, Luis Marcelo Rodrigues; Souto, Gladyston Luiz Lima


    Abstract Premature ventricular complexes are very common, appearing most frequently in patients with hypertension, obesity, sleep apnea, and structural heart disease. Sympathetic hyperactivity plays a critical role in the development, maintenance, and aggravation of ventricular arrhythmias. Recently, Armaganijan et al reported the relevance of sympathetic activation in patients with ventricular arrhythmias and suggested a potential role for catheter-based renal sympathetic denervation in reducing the arrhythmic burden. In this report, we describe a 32-year-old hypertensive male patient presenting with a high incidence of polymorphic premature ventricular complexes on a 24 hour Holter monitor. Beginning 1 year prior, the patient experienced episodes of presyncope, syncope, and tachycardia palpitations. The patient was taking losartan 100 mg/day, which kept his blood pressure (BP) under control, and sotalol 160 mg twice daily. Bisoprolol 10 mg/day was used previously but was not successful for controlling the episodes. The 24 hour Holter performed after the onset of sotalol 160 mg twice daily showed a heart rate ranging between 48 (minimum)–78 (average)–119 (maximum) bpm; 14,286 polymorphic premature ventricular complexes; 3 episodes of nonsustained ventricular tachycardia, the largest composed of 4 beats at a rate of 197 bpm; and 14 isolated atrial ectopic beats. Cardiac magnetic resonance imaging with gadolinium perfusion performed at rest and under pharmacological stress with dipyridamole showed increased left atrial internal volume, preserved systolic global biventricular function, and an absence of infarcted or ischemic areas. The patient underwent bilateral renal sympathetic denervation. The only drug used postprocedure was losartan 25 mg/day. Three months after the patient underwent renal sympathetic denervation, the mean BP value dropped to 132/86 mmHg, the mean systolic/diastolic 24 hour ambulatory BP measurement was reduced to 128/83

  16. Renal angiomyolipoma in Birt-Hogg-Dube syndrome: A case study supporting overlap with tuberous sclerosis complex. (United States)

    Dow, Eryn; Winship, Ingrid


    Birt-Hogg-Dube syndrome (BHD) is an autosomal dominant disease characterised by benign cutaneous lesions, pulmonary cysts, and an increased risk of renal tumors. This rare condition is due to a mutation in the folliculin (FLCN) gene on chromosome 17q11.2, which has a role in the mechanistic/mammalian target of rapamycin (mTOR) signaling pathway of tumorigenesis. This case illustrates a patient with BHD and a renal angiomyolipoma, a neoplastic lesion not usually associated with BHD but common in Tuberous Sclerosis Complex (TSC). There is both clinical and molecular overlap between BHD and TSC, which may arise from similarities in function of the TSC and FLCN proteins in the mTOR pathway; this case further demonstrates this potential correlation. © 2016 Wiley Periodicals, Inc.

  17. Optimization of the energy complex “NPP-accumulator” in case of force majeure (United States)

    Zaluzhnaya, G.; Zagrebaev, A.


    We consider a problem of optimization of NPP with accumulator operation mode in case of force majeure. A mathematical formulation and solving of problem of energy output’s time behavior is provided. A mathematical formulation and solving of problem of energy’s optimum allocation to consumers with different priorities. Mathematically, the problem reduces to linear programming problem. We received that optimal time behavior is uniform energy output, and one should start with consumer with highest priority.

  18. Long-term results of complex left ventricular reconstruction surgery: case report. (United States)

    Letsou, George V; Forrester, Matthew; Frazier, O H


    Left ventricular reconstruction is advocated as a surgical option for patients with severe congestive heart failure. Despite initial enthusiasm for this procedure, reports of long-term results are sparse. Herein, we describe a particularly gratifying case of left ventricular reconstruction in a 43-year-old man, who continues to have excellent left ventricular function 10 years postoperatively. This approach may be a reasonable alternative to cardiac transplantation in patients who lack other treatment options.

  19. A case of black hairy tongue responding to oral nystatin and vitamin B complex treatment

    Directory of Open Access Journals (Sweden)

    Ömer Kutlu


    Full Text Available Black hairy tongue, also known as lingua villosa nigra, is characterized by desquamation defects on the dorsal side of the tongue with reactive hypertrophy of the filiform papillae. Although the etiology of the disease is unknown, conditions such as smoking, alcohol and candidal infection are accused. In this study, a case of black hairy tongue which is considered to occur due to poor oral hygiene and candidal infection is presented.

  20. A case report of complex auricular neuralgia treated with the great auricular nerve and facet blocks (United States)

    Eghtesadi, Marzieh; Leroux, Elizabeth; Vargas-Schaffer, Grisell


    Background The great auricular nerve is a cutaneous branch of the cervical plexus originating from the C2 and C3 spinal nerves. It innervates the skin over the external ear, the angle of the mandible and the parotid gland. It communicates with the ansa cervicalis. Great auricular neuralgia is rarely diagnosed in clinical practice and can be refractory. We present a new approach using ultrasound-guided nerve blocks. Case We present a case of a 41-year-old female with paroxysmal ear pain accompanied by dysautonomia, tingling in the tongue, dysphagia, dysarthria and abdominal symptoms. No significant findings were found on cervical and brain imaging. The patient responded partially to a great auricular nerve block. A combined approach using this block with facet block of C2 and C3 induced a more pronounced and prolonged benefit. Conclusion Great auricular neuralgia is not often encountered in practice and can be accompanied by symptoms originating from the ansa cervicalis network. A combined approach of nerve blocks can be considered in refractory cases. PMID:28255253

  1. Test case for VVER-1000 complex modeling using MCU and ATHLET (United States)

    Bahdanovich, R. B.; Bogdanova, E. V.; Gamtsemlidze, I. D.; Nikonov, S. P.; Tikhomirov, G. V.


    The correct modeling of processes occurring in the fuel core of the reactor is very important. In the design and operation of nuclear reactors it is necessary to cover the entire range of reactor physics. Very often the calculations are carried out within the framework of only one domain, for example, in the framework of structural analysis, neutronics (NT) or thermal hydraulics (TH). However, this is not always correct, as the impact of related physical processes occurring simultaneously, could be significant. Therefore it is recommended to spend the coupled calculations. The paper provides test case for the coupled neutronics-thermal hydraulics calculation of VVER-1000 using the precise neutron code MCU and system engineering code ATHLET. The model is based on the fuel assembly (type 2M). Test case for calculation of power distribution, fuel and coolant temperature, coolant density, etc. has been developed. It is assumed that the test case will be used for simulation of VVER-1000 reactor and in the calculation using other programs, for example, for codes cross-verification. The detailed description of the codes (MCU, ATHLET), geometry and material composition of the model and an iterative calculation scheme is given in the paper. Script in PERL language was written to couple the codes.

  2. Hybrid Surgery Options for Complex Clinical Scenarios in Adult Patients with Congenital Heart Disease: Three Case Reports (United States)

    Rapetto, Filippo; Kenny, Damien; Turner, Mark; Parry, Andrew; Stoica, Serban; Uzun, Orhan; Caputo, Massimo


    The strategy for the management of adult patients with congenital heart disease (CHD) often represents a challenge for cardiac surgeons and cardiologists due to complex anatomy, wide range of clinical presentations, and a high-risk profile. However, hybrid approach may represent an attractive solution. We report three cases of adult patients previously operated for CHD and recently treated with a hybrid approach in our institution. Case 1: a 76-year-old woman with permanent atrial fibrillation, lung disease, chronic kidney disease, microcytic anemia, and type II diabetes mellitus, previously operated for atrial septal defect closure and pulmonary valvotomy, presented with severe pulmonary regurgitation and advanced right ventricular failure. In order to minimize the surgical risk, a hybrid approach was used: an extensive right ventricular outflow tract (RVOT) plication was followed by implantation of an Edwards Sapien XT prosthesis in the RVOT through the right ventricular apex, without cardiopulmonary bypass. Case 2: a 64-year-old man with previous atrial septum excision and pericardial baffle for partial anomalous pulmonary venous drainage with intact interatrial septum, presented with worsening dyspnea, right ventricular failure, and pulmonary hypertension caused by baffle stenosis. His comorbidities included coronary artery disease, atrial flutter, and previous left pneumonectomy. After performing a redo longitudinal median sternotomy, a 20-mm stent was implanted in the baffle with access through the superior vena cava. Case 3: a 50-year-old man, with previous atrioventricular septal defect repair, followed by mitral valve replacement with a mechanical prosthesis, subsequently developed a paravalvular leak (PVL) with severe mitral regurgitation and severe left ventricular dysfunction. He underwent a transapical PVL device closure with two Amplatzer Vascular Plugs. In our opinion, hybrid surgery is a promising therapeutic modality that increases the available

  3. Neuropsychiatric autoimmune encephalitis without VGKC-complex, NMDAR, and GAD autoantibodies: case report and literature review. (United States)

    Najjar, Souhel; Pearlman, Daniel; Devinsky, Orrin; Najjar, Amanda; Nadkarni, Siddhartha; Butler, Tracy; Zagzag, David


    We report a patient with a seronegative autoimmune panencephalitis, adding a subtype to the emerging spectrum of seronegative autoimmune encephalitis, and we review the sparse literature on isolated psychiatric presentations of autoimmune encephalitis. (A PubMed search for "seronegative autoimmune encephalitis," "nonvasculitic autoimmune inflammatory meningoencephalitis," and related terms revealed VGKC)-complex, N-methyl-D-aspartate receptor (NMDAR), and glutamic acid decarboxylase (GAD) autoantibodies. We excluded genetic, metabolic, paraneoplastic, degenerative, and infectious etiologies. The patient's symptoms remitted fully with immune therapy, but recurred in association with widespread bihemispheric brain lesions. Brain biopsy revealed mild nonvasculitic inflammation and prominent vascular hyalinization. Immune therapy with plasma exchanges cleared the MRI abnormalities but, 10 years after onset, the patient still suffers neuropsychiatric sequelae. We conclude that autoimmune panencephalitis seronegative for VGKC-complex, NMDAR, and GAD autoantibodies is a subtype of autoimmune encephalitis that can present with pure neuropsychiatric features and a normal brain MRI. Immunologic mechanisms may account for psychiatric symptoms in a subset of patients now diagnosed with classical psychotic disorders. Delay in starting immune therapy can lead to permanent neuropsychiatric sequelae. We propose a standardized classification system for the autoimmune encephalitides, integrating earlier pathology-oriented terms with more recently defined serologic and clinical phenotypes.

  4. Spin state relaxation of iron complexes: The case for OPBE and S12g

    Directory of Open Access Journals (Sweden)

    Gruden Maja


    Full Text Available The structures of nine iron complexes that show a diversity of experimentally observed spin ground states are optimized and analyzed with Density Functional Theory (DFT. An extensive validation study of the new S12g functional is performed, with the discussion concerning the influence of the environment, geometry and its overall performance based on the comparison with the well proven OPBE functional. The OPBE and S12g functionals give the correct spin ground state for all investigated iron complexes. Since S12g performs remarkably well it can be considered a reliable tool for studying spin state energetics in complicated transition metal systems. [Ministerio de Ciencia e Innovación (MICINN, project CTQ2011-25086/BQU, the Ministerio de Economia y Competitividad (MINECO, project CTQ2014-59212/BQU and the DIUE of the Generalitat de Catalunya (project 2014SGR1202, and Xarxa de Referència en Química Teòrica i Computacional; MICINN and the FEDER fund (European Fund for Regional Development under grant UNGI10-4E-801, and the Serbian Ministry of Education and Science (Grant No. 172035. This work was performed in the framework of the COST action CM1305 "Explicit Control Over Spin-states in Technology and Biochemistry (ECOSTBio" (STSM reference: ECOST-STSM-CM1305-27360.

  5. Comparison of four analytic strategies for complex survey data: a case-study of Spanish data.

    Directory of Open Access Journals (Sweden)

    Mohd Masood


    Full Text Available Purpose: The aim of this secondary data analysis was to investigate the effect of four different analytical strategies: Model Based Analysis (MBA, Design Based Analysis (DBA, Multilevel Model Based Analysis (MMBA, and Multilevel Design Based Analysis (MDBA, on the model estimates for complex survey data.Methods: Using data from the World Health Survey-Spain explanatory models for the outcome Metabolic Equivalent of Task (METs were calculated using MBA, DBA, MMBA, and MDBA. Regression coefficients, standard errors (SE and the Akaike Information Criterion (AIC from all the models were compared.Results: DBA showed highest estimates for most of the variables, including consistently higher SE than all other model - 20% to 48% higher than estimates for MBA, 10% to 37% for MMBA and 23% to 35% for MDBA. The SE for MDBA were 2.5% to 13% higher than estimates derived from MMBA in level 1 predictors, but SE in MMBA was higher by 18% for level 2 predictors. Values of AIC suggested the model derived by MDBA was the best fit and DBA the poorest fit of the four models.Conclusion: With minimum AIC, MDBA appeared to be the most appropriate approach to analyze complex survey data. To confirm the finding of present study a future work on a simulation data would be required.

  6. Proteins with complex architecture as potential targets for drug design: a case study of Mycobacterium tuberculosis.

    Directory of Open Access Journals (Sweden)

    Bálint Mészáros


    Full Text Available Lengthy co-evolution of Homo sapiens and Mycobacterium tuberculosis, the main causative agent of tuberculosis, resulted in a dramatically successful pathogen species that presents considerable challenge for modern medicine. The continuous and ever increasing appearance of multi-drug resistant mycobacteria necessitates the identification of novel drug targets and drugs with new mechanisms of action. However, further insights are needed to establish automated protocols for target selection based on the available complete genome sequences. In the present study, we perform complete proteome level comparisons between M. tuberculosis, mycobacteria, other prokaryotes and available eukaryotes based on protein domains, local sequence similarities and protein disorder. We show that the enrichment of certain domains in the genome can indicate an important function specific to M. tuberculosis. We identified two families, termed pkn and PE/PPE that stand out in this respect. The common property of these two protein families is a complex domain organization that combines species-specific regions, commonly occurring domains and disordered segments. Besides highlighting promising novel drug target candidates in M. tuberculosis, the presented analysis can also be viewed as a general protocol to identify proteins involved in species-specific functions in a given organism. We conclude that target selection protocols should be extended to include proteins with complex domain architectures instead of focusing on sequentially unique and essential proteins only.

  7. Aquifer characteristics and its modeling around an industrial complex, Tuticorin, Tamil Nadu, India: A case study

    Indian Academy of Sciences (India)

    N C Mondal; V S Singh; R Rangarajan


    Anthropogenic pollution of shallow groundwater resources due to industrial activities is becoming a cause of concern in the east coastal belt of the state of Tamil Nadu,India.Integrated hydrogeological,geophysical and tracer studies were carried out in the coastal region encompassing an industrial complex.The objective has been to gain knowledge of aquifer characteristics,ascertaining groundwater movement and its flow direction,which would in turn reveal the possibility of contamination of groundwater regime and its better management.The results of multi-parameters and model study indicate that the velocity of groundwater flow ranges from 0.013 m/d to 0.22 m/d in and around the industrial complex in upstream western part of the catchment and 0.026 m/d to 0.054 m/d in the downstream eastern part,near the coast.These parameters are vital for the development of groundwater management scheme.

  8. Urban water quality modelling: a parsimonious holistic approach for a complex real case study. (United States)

    Freni, Gabriele; Mannina, Giorgio; Viviani, Gaspare


    In the past three decades, scientific research has focused on the preservation of water resources, and in particular, on the polluting impact of urban areas on natural water bodies. One approach to this research has involved the development of tools to describe the phenomena that take place on the urban catchment during both wet and dry periods. Research has demonstrated the importance of the integrated analysis of all the transformation phases that characterise the delivery and treatment of urban water pollutants from source to outfall. With this aim, numerous integrated urban drainage models have been developed to analyse the fate of pollution from urban catchments to the final receiving waters, simulating several physical and chemical processes. Such modelling approaches require calibration, and for this reason, researchers have tried to address two opposing needs: the need for reliable representation of complex systems, and the need to employ parsimonious approaches to cope with the usually insufficient, especially for urban sources, water quality data. The present paper discusses the application of a be-spoke model to a complex integrated catchment: the Nocella basin (Italy). This system is characterised by two main urban areas served by two wastewater treatment plants, and has a small river as the receiving water body. The paper describes the monitoring approach that was used for model calibration, presents some interesting considerations about the monitoring needs for integrated modelling applications, and provides initial results useful for identifying the most relevant polluting sources.

  9. Multiscale Enaction Model (MEM): the case of complexity and "context-sensitivity" in vision. (United States)

    Laurent, Éric


    I review the data on human visual perception that reveal the critical role played by non-visual contextual factors influencing visual activity. The global perspective that progressively emerges reveals that vision is sensitive to multiple couplings with other systems whose nature and levels of abstraction in science are highly variable. Contrary to some views where vision is immersed in modular hard-wired modules, rather independent from higher-level or other non-cognitive processes, converging data gathered in this article suggest that visual perception can be theorized in the larger context of biological, physical, and social systems with which it is coupled, and through which it is enacted. Therefore, any attempt to model complexity and multiscale couplings, or to develop a complex synthesis in the fields of mind, brain, and behavior, shall involve a systematic empirical study of both connectedness between systems or subsystems, and the embodied, multiscale and flexible teleology of subsystems. The conceptual model (Multiscale Enaction Model [MEM]) that is introduced in this paper finally relates empirical evidence gathered from psychology to biocomputational data concerning the human brain. Both psychological and biocomputational descriptions of MEM are proposed in order to help fill in the gap between scales of scientific analysis and to provide an account for both the autopoiesis-driven search for information, and emerging perception.

  10. Multiscale Enaction Model (MEM: The Case of Complexity and Context-Sensitivity in Vision

    Directory of Open Access Journals (Sweden)

    Éric eLAURENT


    Full Text Available I review the data on human visual perception that reveal the critical role played by non-visual contextual factors influencing visual activity. The global perspective that progressively emerges reveals that vision is sensitive to multiple couplings with other systems whose nature and levels of abstraction in science are highly variable. Contrary to some views where vision is immersed in modular hard-wired modules, rather independent from higher-level or other non-cognitive processes, converging data gathered in this article suggest that visual perception can be theorized in the larger context of biological, physical, and social systems with which it is coupled, and through which it is enacted. Therefore, any attempt to model complexity and multiscale couplings, or to develop a complex synthesis in the fields of mind, brain, and behavior, shall involve a systematic empirical study of both connectedness between systems or subsystems, and the embodied, multiscale and flexible teleology of subsystems. The conceptual model (MEM that is introduced in this paper finally relates empirical evidence gathered from psychology to biocomputational data concerning the human brain. Both psychological and biocomputational descriptions of MEM are proposed in order to help fill in the gap between scales of scientific analysis and to provide an account for both the autopoiesis-driven search for information, and emerging perception.

  11. Hand-assisted laparoscopic surgery for complex gallstone disease: A report of five cases

    Institute of Scientific and Technical Information of China (English)

    Qi Wei; Lai-Gen Shen; He-Ming Zheng


    AIM: To describe the use of hand-assisted laparoscopic surg-ery (HALS) as an alternative to open conversion for complex gall-stone diseases, including Mirizzi syndrome (MS) and mimic MS.METHODS: Five patients with MS and mimic MS of 232 consecutive patients undergoing laparoscopic cholecystectomies were analyzed. HALS without a hand-port device was performed as an alternative to open conversion if the anatomy was still unclear after the neck of the gallbladder was reached.RESULTS: HALS was performed on three patients with MS type Ⅰ and 2 with mimic MS owing to an undear or abnormal anatomy, or an unusual circumstance in which an impacted stone was squeezed out from the infundibulum or the aberrant cystic duct impossible with laparoscopic approach. The median operative time was 165 min (range, 115-190 min). The median hand-assisted time was 75 min (range, 65-100 min). The median postoperative stay was 4 d (range, 3-5 d). The postoperative course was uneventful, except for 1 patient complicated with a minor incision infection. CONCLUSION: HALS for MS type Ⅰ and mimic MS is safe and feasible. It simplifies laparoscopic procedure, and can be used as an alternative to open conversion for complex gallstone diseases.

  12. Multiple dimensions of transitions in complex socio-ecological systems - A case from China (United States)

    Liu, Wei; Yang, Wu; Vina, Andres; Schröter, Dagmar; Liu, Jianguo


    Transitions in complex socio-ecological systems are intermediate phases between two successive and more stable periods or states and involve various societal, ecological, and biophysical changes that are often non-linear and inter-related. Understanding transitions is challenging but important for managing socio-ecological systems for achieving environmental sustainability and improving human well-being. Long-term and intensive research is warranted to disclose common patterns and mechanisms of socio-ecological transitions and to develop ideas and methods for studying and planning sustainable transitions. Based on a long-term research on human-nature relationships in Wolong Nature Reserve in China, we studied multiple concurrent social, economic, and ecological transitions during the last 15 years. As a UNESCO biosphere reserve, Wolong lies within a global biodiversity hotspot and a World Heritage site. It contains the largest populations of the world-famous endangered giant pandas and several thousand other animal and plant species. Like most nature reserves in China and many other developing countries, Wolong is also home to many local residents who undertake a variety of activities that involve interaction with ecosystem. For the majority of the 20th century, local people in Wolong lived under poverty line in a closed subsistence-based agricultural economy. Their demands on for wood (as fuel and raw materials) from the natural forests were high and resulted in severe deforestation, habitat degradation, and landslides. Since late 1990s, a series of major economic (e.g., tourism development) and environmental (e.g., payment for ecosystem services programs) policies have been implemented in the reserve as adaptive strategies to cope with poverty and ecological degradation. Within a decade, we have observed major transitions in land use (i.e., from extractive use to non-consumptive use), economic structure (i.e., from a subsistence-based agricultural economy to an

  13. Improved worst-case and liely accident definition in complex facilities for 40 CFR 68 compliance

    Energy Technology Data Exchange (ETDEWEB)

    O`Kula, K.R., Taylor, Robert P., Jr; Hang, P.


    Many DOE facilities potentially subject to compliance with offsite consequence criteria under the 40 CFR 68 Risk Management Program house significant inventories of toxic and flammable chemicals. The accident progression event tree methodology is suggested as a useful technical basis to define Worst-Case and Alternative Release Scenarios in facilities performing operations beyond simple storage and/or having several barriers between the chemical hazard and the environment. For multiple chemical release scenarios, a chemical mixture methodology should be applied to conservatively define concentration isopleths. In some instances, the region requiring emergency response planning is larger under this approach than if chemicals are treated individually.

  14. Stream computing for biomedical signal processing: A QRS complex detection case-study. (United States)

    Murphy, B M; O'Driscoll, C; Boylan, G B; Lightbody, G; Marnane, W P


    Recent developments in "Big Data" have brought significant gains in the ability to process large amounts of data on commodity server hardware. Stream computing is a relatively new paradigm in this area, addressing the need to process data in real time with very low latency. While this approach has been developed for dealing with large scale data from the world of business, security and finance, there is a natural overlap with clinical needs for physiological signal processing. In this work we present a case study of streams processing applied to a typical physiological signal processing problem: QRS detection from ECG data.

  15. Rhinophyma in tuberous sclerosis complex: case report with brief review of literature

    Directory of Open Access Journals (Sweden)

    Friedrich, Reinhard E.


    Full Text Available Tuberous sclerosis or tuberous sclerosis complex (TSC is an autosomal dominant inherited disease characterized by the triad epilepsy, hamartomas (angiofibroma and reduced intellectual capacity. Phenotype can vary considerably. Almost all patients with TSC have at least one characteristic dermatologic feature. Facial angiofibroma can cause severe disfigurement. It may involve the cheeks, perioral region and nose, resulting in thick layers of nodular and pustular skin. Aesthetic surgery of the face comprises an individually adapted ablation of the affected skin regions in order to improve physical appearance. Reports on the subject of surgery for nasal angiofibroma confirm the homogenous transformation of the connective tissues by this hamartoma. Hitherto there is only one report in the literature describing the typical epithelial alterations of the nasal skin compatible with a rhinophyma and adjacent angiofibroma. Here we report the successful electrosurgical treatment of a patient with TSC and extensive sebaceous glands giving rise to a rhinophyma in close association with angiofibroma.

  16. Integrated optimal allocation model for complex adaptive system of water resources management (II): Case study (United States)

    Zhou, Yanlai; Guo, Shenglian; Xu, Chong-Yu; Liu, Dedi; Chen, Lu; Wang, Dong


    Climate change, rapid economic development and increase of the human population are considered as the major triggers of increasing challenges for water resources management. This proposed integrated optimal allocation model (IOAM) for complex adaptive system of water resources management is applied in Dongjiang River basin located in the Guangdong Province of China. The IOAM is calibrated and validated under baseline period 2010 year and future period 2011-2030 year, respectively. The simulation results indicate that the proposed model can make a trade-off between demand and supply for sustainable development of society, economy, ecology and environment and achieve adaptive management of water resources allocation. The optimal scheme derived by multi-objective evaluation is recommended for decision-makers in order to maximize the comprehensive benefits of water resources management.

  17. Phases of school health promotion implementation through the lens of complexity theory: lessons learnt from an Austrian case study. (United States)

    Kremser, W


    The implementation of health promotion concepts in (school) settings is a complex undertaking on which little scientific knowledge exists. The purpose of this study was to better understand organizational influences on the implementation of school health promotion. An extended case study design that incorporated important insights from complexity science was used. This design influenced the focus of analysis and led to the use of multiple methods of data collection and analysis. A primary school in Vienna served as a case for observing and analysing the first year of implementing the health-promoting school concept. The study provided detailed insights into the implementation process. Results showed four chronologically overlapping implementation phases (starting health promotion, deciding what to do, planning health promotion projects, doing health promotion) on different system levels. In each phase, the original health-promoting school concept was adapted to the necessities and characteristics of each level and, therefore, changed considerably. Implications for possible adaptations of the health-promoting school concept to better fit the situation in schools are discussed.

  18. Calcifying odontogenic cyst associated with complex odontoma: case report and review of the literature. (United States)

    Gallana-Alvarez, Silvia; Mayorga-Jimenez, Francisco; Torres-Gómez, Francisco Javier; Avellá-Vecino, Francisco Javier; Salazar-Fernandez, Clara


    We report a calcifying odontogenic cyst associated with odontoma (COCaO) and an included permanent canine in the superior maxilla, in a 19 year-old-man. The calcifying odontogenic cyst (COC) was first described as a distinct entity by Gorlin et al in 1962. The lesion is a mixed odontogenic benign tumor, and although most of the cases present cystic characteristics, a few are of the solid type (15%), and its rare malignant transformation is well documented. The COC may occur in association with other odontogenic tumors, the most common is the odontoma, occurring in about 24% of the cases. For this association the term Odontocalcifying odontogenic cyst has been suggested. Radiographically is a well defined mixed lesion and histologically consists of a large cyst. In the central area of the cyst enamel and dentin deposits can be found, irregularly distributed in areas and in other parts it takes on a well defined organoid aspect. A thorough review of literature takes place and the pathogenesis is discussed.

  19. The use of cinacalcet in pregnancy to treat a complex case of parathyroid carcinoma (United States)

    Bailey, M; Chahal, H; Raja, O; Bhat, R; Gayle, C; Grossman, A B; Druce, M R


    Summary We present the case of a patient with metastatic parathyroid carcinoma whose hypercalcaemia was medically managed through two pregnancies. The diagnosis was made when the patient presented with chronic knee pain and radiological findings consistent with a brown tumour, at the age of 30. Her corrected calcium and parathyroid hormone (PTH) levels were significantly elevated. Following localisation studies, a right parathyroidectomy was performed with histology revealing parathyroid carcinoma, adherent to thyroid tissue. Aged 33, following biochemical recurrence of disease, the patient underwent a second operation. A subsequent CT and FDG–PET revealed bibasal pulmonary metastases. Aged 35, the patient was referred to our unit for treatment of persistent hypercalcaemia. The focus of treatment at this time was debulking metastatic disease using radiofrequency ablation. Despite advice to the contrary, the patient conceived twice while taking cinacalcet. Even though there are limited available data regarding the use of cinacalcet in pregnancy, both pregnancies continued to term with the delivery of healthy infants, using intensive medical management for persistent hypercalcaemia. Learning points Parathyroid carcinoma is a rare cause of primary hyperparathyroidism.Hypercalcaemia during pregnancy can result in significant complications for both the mother and the foetus.The use of high-dose cinacalcet in pregnancy has been shown, in this case, to aid in the management of resistant hypercalcaemia without teratogenicity. PMID:25298882

  20. The Design Features of Complex Vessels of Malyshev Neolithic Culture of Lower Priamurye (case study: Malyshevo 1 Settlement

    Directory of Open Access Journals (Sweden)

    Inga V. Filatova


    Full Text Available According to the author’s opinion, the solution for cultural genesis issues can be tackled through the analysis of structural peculiarities of hollow bodies of vessels of different ceramic complexes. The ceramics of the Malyshev Culture of the Lower Amur is no exception. The article traces the evolution of researchers’ views in regard to Neolithic culture in inner periodization of the region as well as cultural relevance of early complex ceramics by a well known Soviet archeologist academic A.P. Okladnykov – stage of Lower Amur Neolithic culture. Case study: visualization of ceramic collection of one-layer Neolithic settlement Malyshevo-1 (“At the craftsmen”. Here we identify two vessel groups, which differ through their morphological and decorative features. On the ground of technological assessments of manufacturing techniques by I. G. Glushkov (1996, including methodological developments by A. A. Bobrinsky (1978, the program of hollow body design is researched. The manufacturing techniques are identified (methods of fixing, build-up, straps oiling, types of molding, filling program, cutting and bottom fixing. The mixed programs of hollow body vessels are identified and locations of two pottery traditions are found. A competitive analysis for identifying the peculiarities of Malyshev ceramics and Neolithic materials of the Lower Amur and bordering seaside territories. There are similarities are drawn out between ceramic complexes of Osipov culture of early Neolithic (Lower Amur and Rudninsky culture (Rudninsky type, Sergeev type of early Neolithic (seaside territories.

  1. Emergent nested systems a theory of understanding and influencing complex systems as well as case studies in urban systems

    CERN Document Server

    Walloth, Christian


    This book presents a theory as well as methods to understand and to purposively influence complex systems. It suggests a theory of complex systems as nested systems, i. e. systems that enclose other systems and that are simultaneously enclosed by even other systems. According to the theory presented, each enclosing system emerges through time from the generative activities of the systems they enclose. Systems are nested and often emerge unplanned, and every system of high dynamics is enclosed by a system of slower dynamics. An understanding of systems with faster dynamics, which are always guided by systems of slower dynamics, opens up not only new ways to understanding systems, but also to effectively influence them. The aim and subject of this book is to lay out these thoughts and explain their relevance to the purposive development of complex systems, which are exemplified in case studies from an urban system. The interested reader, who is not required to be familiar with system-theoretical concepts or wit...

  2. Management of Complex Industrial Supplier Relations - a Case of Customer Attractiveness

    DEFF Research Database (Denmark)

    Ellegaard, Chris

    relationship management is proposed – the concept of Customer Attractiveness. Customer Attractiveness is founded on the revised understanding of the supplier relationship management task and focuses on influencing suppliers by being an attractive customer, hereby motivating the necessary commitment to long......Companies are increasingly relying on suppliers when developing and manufacturing industrial products. Therefore the supplier relationships of the company need to be managed. This dissertation looks at existing theoretical approaches to supplier relationship management. By studying a number...... of supplier relationships of the company Danfoss Drives, an alternative understanding of the supplier relationship management task is proposed. The case study methodology forms the basis for the applied research design. The alternative understanding sees the management task as one of influencing suppliers...

  3. The Complexities of Implementing Cluster Supply Chain - Case Study of JCH (United States)

    Xue, Xiao; Zhang, Jibiao; Wang, Yang

    As a new type of management pattern, "cluster supply chain" (CSC) can help SMEs to face the global challenges through all kinds of collaboration. However, a major challenge in implementing CSC is the gap between theory and practice in the field. In an effort to provide a better understanding of this emerging phenomenon, this paper presents the implementation process of CSC in the context of JingCheng Mechanical & Electrical Holding co., ltd.(JCH) as a case study. The cast study of JCH suggests that the key problems in the practice of cluster supply chain: How do small firms use cluster supply chain? Only after we clarify the problem, the actual construction and operation of cluster supply chain does show successful results as it should be.

  4. A rare case of massive carpal osteoblastoma requiring complex reconstructive surgery. (United States)

    Dunda, S E; Kauczok, J; Demir, E; Braunschweig, T; Pallua, N


    An osteoblastoma is a rare, commonly benign, osteoid-producing neoplasm of the bone with an incidence of 2% of all primary bone tumours. We present a case of a 54-year-old patient with persisting carpal pain and massive swelling of the hand for a period of 4 years. Incision biopsies revealed the histopathological finding of a carpal osteoblastoma. After complete tumour excision, including the carpal and, in parts, metacarpal bones, reconstructive surgery was performed with a free osteocutaneous iliac crest flap to obtain a natural hand contour and the best possible hand function. Follow-up revealed improvement of the hand function in terms of flexion, extension and strength without discomfort or further pain. Thus, ongoing carpal pain should lead to an intensive search with further diagnostic measures such as magnetic resonance imaging (MRI) scan as well as biopsies, if necessary, to obtain the correct diagnosis.

  5. Management of Complex Knee Deformities in Asian Population: Our Experience of 11 Cases

    Directory of Open Access Journals (Sweden)

    Syed Shahid Noor


    Total Knee Arthroplasty (TKA is a life changing procedure for such patients. Great improvements in quality of life and outcome measure scores have been observed in patients undergone TKA. Our patients are challenging further as compared to western population because they present late for consultation when the disease and deformity is advanced. Their expectations are high, as they wish to resume their ground base activities such as kneeling for prayers. Furthermore with financial constraints present with most of the patients, one has to be careful in choosing the type of implant and keep in consideration other alternative available options. This case series encompasses our experience of TKA on patients with variety of challenging deformities, their short term outcome and a review of the literature.

  6. The challenges of dysphagia management and rehabilitation after extensive thermal burn injury: a complex case. (United States)

    Rumbach, Anna F; Ward, Elizabeth C; Cornwell, Petrea L; Bassett, Lynell V; Muller, Michael J


    The role of the speech pathologist in the burns population is still emerging, with detailed discussion of the assessment and management of dysphagia limited to date. This report describes the case of a 60-year-old man who developed severe contractures of the head and neck and oropharyngeal dysphagia after sustaining 53.5% deep partial- and full-thickness burns. Although some aspects of rehabilitation were confounded by a preexisting mild intellectual disability, the patient was able to participate in an intensive regimen of active and passive exercise to rehabilitate his oropharyngeal dysphagia. Significant oral contractures remained; however, the patient was discharged without tracheostomy and consuming a texture-modified diet with no signs of aspiration. To our knowledge, this is one of a small handful of reports that document speech pathology management of the burns population, and a first that identifies and outlines specific characteristics of, and rehabilitation strategies for, dysphagia in a burned individual.

  7. Causes of Borehole Failure in Complex Basement Terrains: ABUAD Case Study, Southwestern Nigeria

    Directory of Open Access Journals (Sweden)

    1 Ogundana, A.K , 2 Aladesanmi A. O., 3 Okunade A., 4Olutomilola O.O


    Full Text Available A preliminary assessment of primary causes of borehole failure has being conducted using Afe Babalola University as a case study. A total of fourteen boreholes (namely borehole 1-14 were studied, vertical electrical soundings, depth sounding, flushing and pump testing were conducted on each of the boreholes to establish their status at the time of the study and possible evaluation of the groundwater potential of the wells. Four out of the fourteen boreholes (borehole 1-4 are productive and in-use, while the remaining ten (borehole 5-14 are out-of-use and abandoned for various. The productive holes were able to support continuous flow of water for over 3 hours without drop in volume of water flow. Seven of the holes (boreholes 5, 6, 8, 9, 11, 12 & 14 failed and were abandoned because of low yield (could not flow beyond 5 minutes, while the remaining three (boreholes 7, 10 & 13 failed and were abandoned due to wrong location and improper completion, caving/formation problems, and wrong installation/completion respectively. Proper well completion is essential in areas prone to caving and other formation related problems. Air drilling should be avoided in areas with thick and loose overburden. Right mixture of drilling mud should be applied to secure the hole wall while flushing should be continuous throughout drilling in such formation. Casing should be done immediately and such holes should be lined and grouted. Timers should be installed on low yield wells and regulated/programmed for 5 or 10 minutes flow depending on the recharge rate. Pump rating for installation should be strictly based on well recharge rate. Productive wells should be properly maintained and monitored for optimal performance.

  8. Impaired perception of harmonic complexity in congenital amusia: a case study. (United States)

    Reed, Catherine L; Cahn, Steven J; Cory, Christopher; Szaflarski, Jerzy P


    This study investigates whether congenital amusia (an inability to perceive music from birth) also impairs the perception of musical qualities that do not rely on fine-grained pitch discrimination. We established that G.G. (64-year-old male, age-typical hearing) met the criteria of congenital amusia and demonstrated music-specific deficits (e.g., language processing, intonation, prosody, fine-grained pitch processing, pitch discrimination, identification of discrepant tones and direction of pitch for tones in a series, pitch discrimination within scale segments, predictability of tone sequences, recognition versus knowing memory for melodies, and short-term memory for melodies). Next, we conducted tests of tonal fusion, harmonic complexity, and affect perception: recognizing timbre, assessing consonance and dissonance, and recognizing musical affect from harmony. G.G. displayed relatively unimpaired perception and production of environmental sounds, prosody, and emotion conveyed by speech compared with impaired fine-grained pitch perception, tonal sequence discrimination, and melody recognition. Importantly, G.G. could not perform tests of tonal fusion that do not rely on pitch discrimination: He could not distinguish concurrent notes, timbre, consonance/dissonance, simultaneous notes, and musical affect. Results indicate at least three distinct problems-one with pitch discrimination, one with harmonic simultaneity, and one with musical affect-and each has distinct consequences for music perception.

  9. Lumbar Sympathetic Block with Botulinum Toxin Type B for Complex Regional Pain Syndrome: A Case Study. (United States)

    Choi, Eunjoo; Cho, Chan Woo; Kim, Hye Young; Lee, Pyung Bok; Nahm, Francis Sahngun


    Lumbar sympathetic block (LSB) is an effective method for relief of sympathetically mediated pain in the lower extremities. To prolong the sympathetic blockade, sympathetic destruction with alcohol or radiofrequency has been used. The pre-ganglionic sympathetic nerves are cholinergic, and botulinum toxin (BTX) has been found to inhibit the release of acetylcholine at the cholinergic nerve terminals. Moreover, BTX type B (BTX-B) is more convenient to use than BTX type A. Based on these findings, we performed LSB on the 2 patients with complex regional pain syndrome (CRPS) in the lower extremity. Levobupivacaine 0.25% 5 mL mixed with BTX-B 5,000 IU was given under fluoroscopic guidance. Two months after LSB with BTX-B, pain intensity and the Leeds assessment of neuropathic symptoms and signs (LANSS) score were significantly reduced. Allodynia and coldness disappeared and skin color came back to normal. In conclusion, BTX-B can produce an efficacious and durable sympathetic blocking effect on patients with CRPS.

  10. Unravelling the complex antimicrobial interactions of essential oils--the case of Thymus vulgaris (thyme). (United States)

    Ahmad, Aijaz; van Vuuren, Sandy; Viljoen, Alvaro


    Thymus vulgaris has gained tremendous popularity as an ornamental, culinary herb and its use in phytotherapy is well established and supported in the literature. The objective of this study was to explore possible interactions between selected molecules within Thymus vulgaris essential oil (TvEO) to gain a better understanding of how this complex essential oil exerts its antimicrobial activity. Evaluation of the antimicrobial efficacy and interactions were assessed on the essential oil and volatile constituents against various pathogens. Interactions between molecules at various ratios were graphically observed through the construction of isobolograms. Gas chromatography-mass spectrometry (GC-MS) analysis revealed 22 compounds which collectively represent >95% of the oil composition. Based on their minimum inhibitory concentration (MIC) values, they were categorised into weak (≥4 mg mL⁻¹), moderate (2-4 mg mL⁻¹) and noteworthy active (≤2 mg mL⁻¹) compounds. For the combination study, 21% synergistic, 42% additive, 36% indifferent and 1% antagonistic interactions were observed. Most of the interactions were observed between the weak and highly active molecules, and interestingly, no synergistic interaction was observed between the highly active compounds. Synergistic and additive interactions between the strong and weaker antimicrobial constituents present in TvEO enhance the antimicrobial efficacy of this commercially important essential oil.

  11. Analysis of twenty pediatric cases of tuberous sclerosis complex: Are we doing enough?

    Directory of Open Access Journals (Sweden)

    Jyoti Nath


    Full Text Available Background: Tuberous sclerosis complex (TSC is a neuro-cutaneous disease characterized by hamartoma formation in various organs particularly the skin, brain, eye, kidney, heart and lungs. Patients usually have multisystem involvement and thus present to different medical specialties with varied complaints while the true nature of the disease and the hidden manifestations may remain unattended. A im: To assess the frequency and characteristics of various cutaneous and systemic manifestations in TSC and the total impact on different system in a cohort of pediatric patients. Methods: The study included 20 patients fulfilling the diagnostic criteria for TSC from dermatology, pediatrics, and neurology department. Detailed history, examination, and investigations such as chest X-ray, electrocardiography (ECG, ultrasonography (USG abdomen, echocardiography, fundoscopy, computed tomography (CT scan of brain and abdomen were done. Results: Dermatological manifestations included ash leaf macules, angiofibromas, shagreen patch, and fibrous plaque. Systemic findings observed were subependymal calcified nodules, subependymal giant cell astrocytoma, cortical tubers, renal cysts, angiomyolipomas, lung cyst, retinal hamartomas, mental deficits and epilepsy. Limitations: Wechsler′s Intelligence Scale for Children would have been more appropriate for assessing the intelligence. Dental check-up was not done in our group of patients. Conclusion: Our study highlights the wide variety of cutaneous and systemic manifestations of TSC. The study emphasizes the need for comprehensive multidisciplinary treatment and periodic follow-up which are necessary for appropriate management of this multisystem disorder. Counseling regarding education and rehabilitation of the patients and genetic counseling of parents are important.

  12. Juridical complexity of some cases; La complexite de la situation juridique des mines arretees

    Energy Technology Data Exchange (ETDEWEB)

    Petit, D. [Conseil General des Mines, Lorraine (France)


    The recent closure of many mining operations led French authorities to reconsider the mining legislation dating back to the Napoleon's era in order to determine the way the damages occurring after the mine decommissioning should be dealt with. According to the former mining legislation, the landowner recovers the full proprietorship of the mine workings: it is obvious that he cannot assume the risks associated with these damages (subsidence, water rise and quality, etc.). According to their nature, these risks have to be assumed either by the State, or the local Authorities, or the former mining operator (when it has not disappeared). To illustrate the complexity of the problem, some examples are presented in the paper: - Water rise at the Messeix collieries closed in 1989: new springs of acidic and mineralized water have appeared and have necessitated the installation of a neutralizing station to be operated during around 10 years; all the costs are borne by the former operator; - Water rise and fire-damp emanations at the Nord-Pas-de-Calais Collieries: since these problems may last over a period of time of say fifty years and concern several local communities, the State assumes the responsibility of the corresponding works; - A similar problem exists in the closed Lorraine iron ore mines, where there are emanations of air containing traces of radon, necessitating permanent ventilation of buildings. (authors)

  13. Matching a surface complexation model with ab initio molecular dynamics: montmorillonite case

    Energy Technology Data Exchange (ETDEWEB)

    Kulik, D.A.; Churakov, S.V. [Paul Scherrer Institute, Nuclear Energy and Safety Dpt., Lab. for Waste Management, CH-5232 Villigen PSI (Switzerland)


    Speciation modelling of sorption on mineral-water interfaces is performed with help of surface complexation models (SCM), suitable for diluted suspensions that seem to reach adsorption equilibrium within laboratory times. Electrostatic SCMs need several input parameters even for a relatively simple oxide mineral surface. Moreover, the electrolyte ion adsorption constants in triple layer (TL) or basic Stern (BS) models depend on the inner layer capacitance density Cl, but clear physical understanding of this parameter is missing so far. SCMs can fit acidimetric or metal titration data well at quite different combinations of input parameters, and this fact casts doubt on any interpretation of fitted parameter values in terms of microscopic physicochemical mechanisms. The problem is even deeper in SCMs for clay minerals like montmorillonite having at least two surface types: the edges exposing different (aluminol and silanol) functional groups, and the basal siloxane planes with permanent charge and ion exchange. A feasible way to overcome the caveat of SCMs is seen nowadays in relying on crystallographic data and ab initio calculations to restrict the EDL setup, species stoichiometries, and input parameter values when constructing the adsorption model. The aim of this contribution is to discuss how recent advances in sample surface characterization an d in quantum-chemistry calculations for pyrophyllite can help in putting together a multi-site-surface electrostatic SCM for montmorillonite implemented in GEM approach. The quality of macroscopic model fits is checked against the titration data. (authors)

  14. Difficult Geotechnical Conditions Under the Palace Complex, Case Study from Cianowice, Near Krakow, Poland (United States)

    Gil-Mastalerczyk, Joanna; Gil, Regina


    The palace complex in Cianowice near Krakow (Lesser Poland, Poland) built around 1890, after 1945 ceased to function as a residential, so the whole building underwent successive devastation. Military activities, ad hoc repairs and long-term shortage of funds in Poland, led to the destruction of the magnificent assumptions. Since 2006. Palace remained completely unsecured and unattended. Performed in 2012-2015 modernization of the historic palace with the expansion of the basement (for residential building multigenerational) has become the occasion for a thorough diagnosis of the prevailing geotechnical conditions and the state of preservation of threads stone and brick walls and vaults chambers basement. Difficult ground conditions, water penetration, lack of insulation of horizontal and vertical has become one of the main causes of the destruction of the foundations and walls of basements. Moisture from the ground, rising damp in the walls (with dissolved salts in it), evaporate causing erosion of the walls. The result it led to the weakening of the structural and breakout layers of walls. The phenomenon has become particularly clear after the geotechnical surveys, excavations and complete discovery of the basement walls. The conducted works related to general technical renovation and restoration, included foundations (lining and insulation), walls, floors and roof. The assumption palace in Cianowice, through appropriate interference with the use of modern and introduction of a new substance, in any manner that emphasizes value and historical monument became possible to restore the important significance of the object and place.

  15. Promoting employee acceptance of a consumer bill of rights in a complex medical care organization: a case study. (United States)

    Mullen, P D; Leifer, B H


    To develop strong health education programs, health educators working in complex medical care organizations must often secure professional cooperation across disciplines, coordination of services, and orientation of policies, procedures, and personnel toward patient preferences and needs. Frequently, they undertake these tasks against the tide, within a problematic organizational structure. The present case study illustrates the difficulties posed by introducing change in medical care organizations in the context of an education program to acquaint employees of a large HMO with a consumer bill of rights mandated by the consumer Board of Trustees. The underlying assumption was that in a bureaucratic institution, an employee-centered and modest system reform strategy would be effective in bringing about client-centered outcomes-in this case, increased recognition of client rights. The case analysis and results of a post-intervention, cross-sectional survey suggest that in units where a threshold level of participation was reached, there were improvements in knowledge about the Bill and employee attitudes. The program was less successful with hospital nurses whose feelings about physicians were not taken into account fully, and with physicians whose relative lack of integration into the policy and managerial domains made them harder to reach.

  16. Cases of limb-body wall complex: Early amnion rupture, vascular disruption, or abnormal splitting of the embryo? (United States)

    Crespo, Frank; Pinar, Halit; Kostadinov, Stefan


    We report two cases of limb-body wall complex (LBWC), also known as body stalk anomaly, a rare form of body wall defect incompatible with life. The first case was identified during a level II ultrasound examination performed at 7 wk gestational age. The delivery was by breech extraction at 39 wk and 4 days. The second case was delivered by spontaneous vaginal delivery at 35 wk and 5 days. Karyotype analysis was normal in both fetuses. The phenotype of LBWC is variable, but commonly identified features include: exencephaly, limb defects, and either facial clefts or thoraco-abdominoschisis. The exact etiology remains uncertain, as the disorder has been regarded as sporadic with low recurrence. Vascular disruption during early embryogenesis, early amnion rupture, abnormal splitting of the embryo, and failure of amnion fusion have been implicated in the pathogenesis of LBWC. A role for possible gene mutation and maternal use of alcohol, tobacco, or illicit drugs has also been suggested. Detailed ultrasonography along with biochemical screening may allow for early detection.

  17. Dynamics of a complex mass movement triggered by heavy rainfall: a case study from NW Turkey (United States)

    Ocakoglu, Faruk; Gokceoglu, Candan; Ercanoglu, Murat


    Following a period of heavy precipitation, a large and complex mass movement, namely the Dagkoy landslide, occurred in the West Black Sea Region of Turkey on May 21, 1998. This paper describes the conditioning factors of the landslide and interprets the mass transport processes in terms of a movement scenario. Geology, geomorphology and vegetation cover were considered as the conditioning factors of the failure. Observations showed that the gently sloping (about 10°) area is mostly covered by dense forest trees at the crown where the motion initiated. Significant intersection of the collapsed slope with dip of the local marls seems to have contributed to the formation and geometry of the landslide. The distance from the crown down to the toe of the landslide measured more than 600 m, with about 0.6 km 3 total earth material displaced. The landslide has both a block sliding characteristics in the upper portions and a debris flow/soil flow component around the margins of the sliding blocks in the middle parts and at the toe. The proposed scenario for the landslide reveals that the movement was initiated near crown as a result of the excess water content in the marls at the end of 3 days of heavy rainfall. The early perturbations (transverse cracks, ridges, etc.) lasted for 6-7 h, after which the central part of the zone started to move as a soil flow in which very large intact blocks were transported. Even though the movement was very rapid (1.2 m/min), there was no loss of life. However, the movement destroyed 38 houses, one mosque and a considerable amount of farmland.

  18. Connectivity among sinkholes and complex networks: The case of Ring of Cenotes in northwest Yucatan, Mexico (United States)

    Gomez-Nicolas, Mariana; Rebolledo-Vieyra, Mario; Huerta-Quintanilla, Rodrigo; Canto-Lugo, Efrain


    A 180-km-diameter semicircular alignment of abundant karst sinkholes (locally known as cenotes) in northwestern Yucatán, México, coincides approximately with a concentric ring of the buried Chicxulub structure, a circular feature manifested in Cretaceous and older rocks, that has been identified as the product of the impact of a meteorite. The secondary permeability generated by the fracturing and faulting of the sedimentary sequence in the Chicxulub impact, has favored the karstification process and hence the development of genuine underground rivers that carry water from the continent to the sea. The study of the structure and morphology of the crater has allowed researchers to understand the key role of the crater in the Yucatán hydrogeology. It is generally accepted that the Ring of Cenotes, produced by the gravitational deformation of the Tertiary sedimentary sequence within the crater, controls the groundwater in northern Yucatán. However, today there is not solid evidence about the connectivity among cenotes, which is important because if established, public policies could be designed to manage sanitary infrastructure, septic control, regulation of agricultural and industrial activities and the protection of water that has not been compromised by anthropogenic pollution. All these directly affect more than half a million people whose main source of drinking water lies in the aquifer. In this contribution we investigated a set of 16 cenotes located in the vicinity of a gravimetric anomaly of Chicxulub crater ring, using complex networks to model the interconnectivity among them. Data from a geoelectrical tomography survey, collected with SuperSting R1/IP equipment, with multi-electrodes (72 electrodes), in a dipole-dipole configuration was used as input of our model. Since the total number of cenotes on the ring structure amounts to about 2000, the application of graph theoretic algorithms and Monte Carlo simulation to efficiently investigate network

  19. Complex integrated method of dynamic meditation with Buddhists’ breathing in case of neurotic reactions

    Directory of Open Access Journals (Sweden)

    Omelyanenko V.I.


    Full Text Available Purpose: to elaborate complex integrated method of psychological influence upon sport dancers in time of training on base of Buddhists’ meditation “conscious breathing” for neurotic reactions elimination, professional skill improvement and psycho emotional stability advance. Material : twenty dancers at the age of 40-50 with neurotic reactions participated in the research. At the first stage of the research all the subjects’ ability to focus attention at breathing during sports dancing performance was examined. At the second stage training in method of dynamic meditation applied for martial arts of the experimental group of 10 subjects was conducted. Both individual and group training sessions were held. At the third stage the experimental group joined dynamic meditation and breathing at dance performance. At the fourth stage the experimental group’s results were compared with the control group’s results. Results : at the first stage of the research all the subjects noted difficulties in focusing attention on Buddhists’ nasal breathing and dance technique come-down. 3-5 sessions of training in method of dynamic meditation were necessary for the subjects of the experimental group at the second stage of the research. At the third stage of the research all the subjects of the experimental group could control their nasal breathing at dance performance without dance technique come-down. At the fourth stage the comparative evaluation of the results of the experimental and control groups revealed that it was necessary 3-7 sport dance practice sessions for elimination of the neurotic reactions. No such effect was observed in the control group. Conclusions : The results of the research prove that Buddhists’ meditation “conscious breathing” may be joined with dynamic meditation successfully. It’s impossible to focus attention continuously on breathing at time of sport dance performance. The elaborated technique of the integration of


    Directory of Open Access Journals (Sweden)

    Ana Maria Abreu Velez


    Full Text Available Introduction: Dermatitis herpetiformis (DH is an autoimmune, clinically pleomorphic, papulovesicular disorder sometimes associated with celiac disease and gluten sensitivity. DH is categorized by subepidermal vesicles and bullae on hematoxylin and eosin (H&E staining, and with immunoglobulin A deposits present along the dermal papillary tips on direct immunofluorescence (DIF. Case Report: We describe a 50 year old female that presented with sudden onset pruritus and clinical blisters, predominantly on extensor areas of the extremities. Biopsies for H&E examination, as well as immunohistochemistry (IHC and DIF analysis were performed. Results: H&E examination demonstrated subepidermal blistering; within the blister lumen, numerous neutrophils were present, with occasional eosinophils and lymphocytes also seen. DIF examination revealed linear deposits of IgA along the epidermal basement membrane zone, associated with other immunoglobulins and complement. IHC examination showed similar patterns of reactivity to IgA, and also to other immunoreactants. Cells positive for CD1a were present within the blisters, correlating with S-100 staining. Cells staining positive for CD8, CD45 and occasionally CD4 and Granzyme B were seen not only in the blister lumens, but also around neurovascular packages under the blisters. Finally, CD2 positive cells were found around the upper dermal blood vessels. Discussion: Focal DIF linear IgA deposition is the classic hallmark diagnostic finding in DH. However, it is possible that genetic susceptibility and environmental triggers also play a crucial role in the pathogenesis, often acting via cellular pathways exhibiting disease-associated polymorphisms. In tolerance breakthrough, the initiating antigen presenting cells likely lead to immune system cell differentiation, and activation of adaptive immunity.

  1. Complex regional pain syndrome associated with hyperattention rather than neglect for the healthy side: A comprehensive case study. (United States)

    Christophe, Laure; Delporte, Ludovic; Revol, Patrice; DePaepe, Annick; Rode, Gilles; Jacquin-Courtois, Sophie; Rossetti, Yves


    Complex regional pain syndrome (CRPS) is a dehabilitating chronic condition occurring with peripheral lesions. There is growing consensus for a central contribution to CRPS. Although the nature of this central body representation disorder is increasingly debated, it has been repeatedly argued that CRPS results in motor neglect of the affected side. The present article describes a comprehensive and quantitative case report demonstrating that: (1) not all patients with chronic CRPS exhibit decreased spatial attention for the affected side and (2) patients may actually exhibit a substantial, broad and reliable attentional bias toward the painful side, akin to spatial neglect for the healthy side. This unexpected result agrees with the idea that patients can be hyper-attentive toward their pathological side as a manifestation of lowered pain threshold, allodynia and kinesiophobia.

  2. Alignment of Configuration and Documentation for Highly Engineered Complex Product Configuration Systems: a Demonstration from a Case Study

    DEFF Research Database (Denmark)

    Shafiee, Sara; Kristjansdottir, Katrin; Hvam, Lars


    Adequate documentation is critical for successful implementation, maintenance and further developments of product configuration system (PCS) specially in companies making complex and highly engineered products. This article is based on experience of modelling and utilizing a PCS from an Engineer......-To-Order (ETO), where the main focus is on the challenges concerned with the documentation of the PCS, both in the development and production phase. Aligning the development of the PCS with an automatic documentation system creates value. Using the suggested method for documentation facilitates the following...... activities: (1) iterative testing of the system during the development, (2) communication with domain experts, (3) documentation and maintenance, and finally (4) updates without spending a lot of time and resources. This article is supplemented with a case study from an ETO company where the method...

  3. BAC-FISH assays delineate complex chromosomal rearrangements in a case of post-Chernobyl childhood thyroid cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kwan, Johnson; Baumgartner, Adolf; Lu, Chun-Mei; Wang, Mei; Weier, Jingly F.; Zitzelsberger, Horst F.; Weier, Heinz-Ulrich G.


    Structural chromosome aberrations are known hallmarks of many solid tumors. In the papillary form of thyroid cancer (PTC), for example, activation of the receptor tyrosine kinase (RTK) genes, RET and neurotrophic tyrosine kinase receptor type I (NTRK1) by intra- and interchromosomal rearrangements has been suggested as a cause of the disease. However, many phenotypically similar tumors do not carry an activated RET or NTRK-1 gene or express abnormal ret or NTRK-1 transcripts. Thus, we hypothesize that other cellular RTK-type genes are aberrantly expressed in these tumors. Using fluorescence in situ hybridization-based methods, we are studying karyotype changes in a relatively rare subgroup of PTCs, i.e., tumors that arose in children following the 1986 nuclear accident in Chernobyl, Ukraine. Here, we report our technical developments and progress in deciphering complex chromosome aberrations in case S48TK, an aggressively growing PTC cell line, which shows an unusual high number of unbalanced translocations.

  4. [Hypersensitivity pneumonitis-like disease caused by exposure to Mycobacterium avium complex in bathtub water at home: a case report]. (United States)

    Kanno, Kiyoshi; Akai, Masaya; Kato, Tomohiro; Tada, Toshihiko; Watanabe, Kizuku; Shiozaki, Kouhei; Hase, Mitsuo


    We report here a case of hypersensitivity pneumonitis-like disease in an adult, likely due to exposure to Mycobacterium avium complex (MAC) in his bathtub water at home. A 63-year-old man was referred to our hospital with exertional dyspnea. Chest computed tomography showed bilateral, diffuse, centrilobular ground-glass nodules. Bronchoalveolar lavage showed marked lymphocytosis. Transbronchial biopsy showed epithelioid cell granulomas and lymphocyte alveolitis. Cultures of the patient's sputum and bathtub water yielded MAC. Variable-number tandem repeat analysis of the MAC strains in the sputum and bathtub water samples showed that the strains were genetically identical. The clinical condition of the patient improved at home under chemotherapy by avoiding the use of the bathtub.

  5. BAC-FISH assays delineate complex chromosomal rearrangements in a case of post-Chernobyl childhood thyroid cancer.

    Directory of Open Access Journals (Sweden)

    Horst F Zitzelsberger


    Full Text Available Structural chromosome aberrations are known hallmarks of many solid tumors. In the papillary form of thyroid cancer (PTC, for example, activation of the receptor tyrosine kinase (RTK genes, RET and neurotrophic tyrosine kinase receptor type I (NTRK1 by intra- and interchromosomal rearrangements has been suggested as a cause of the disease. However, many phenotypically similar tumors do not carry an activated RET or NTRK-1 gene or express abnormal ret or NTRK-1 transcripts. Thus, we hypothesize that other cellular RTK-type genes are aberrantly expressed in these tumors. Using fluorescence in situ hybridization-based methods, we are studying karyotype changes in a relatively rare subgroup of PTCs, i.e., tumors that arose in children following the 1986 nuclear accident in Chernobyl, Ukraine. Here, we report our technical developments and progress in deciphering complex chromosome aberrations in case S48TK, an aggressively growing PTC cell line, which shows an unusual high number of unbalanced translocations.

  6. Colonization of a Central Venous Catheter by the Hyaline Fungus Fusarium solani Species Complex: A Case Report and SEM Imaging

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    Alberto Colombo


    Full Text Available The incidence of opportunistic infections by filamentous fungi is increasing partly due to the widespread use of central venous catheters (CVC, indwelling medical devices, and antineoplastic/immunosuppressive drugs. The case of a 13-year-old boy under treatment for acute lymphoblastic leukemia is presented. The boy was readmitted to the Pediatric Ward for intermittent fever of unknown origin. Results of blood cultures drawn from peripheral venous sites or through the CVC were compared. CVC-derived bottles (but not those from peripheral veins yielded hyaline fungi that, based on morphology, were identified as belonging to the Fusarium solani species complex. Gene amplification and direct sequencing of the fungal ITS1 rRNA region and the EF-1alpha gene confirmed the isolate as belonging to the Fusarium solani species complex. Portions of the CVC were analyzed by scanning electron microscopy. Fungi mycelia with long protruding hyphae were seen into the lumen. The firm adhesion of the fungal formation to the inner surface of the catheter was evident. In the absence of systemic infection, catheter removal and prophylactic voriconazole therapy were followed by disappearance of febrile events and recovery. Thus, indwelling catheters are prone to contamination by environmental fungi.

  7. The treatment of complex proximal humeral fractures: analysis of the results of 55 cases treated with PHILOS plate. (United States)

    Fattoretto, D; Borgo, A; Iacobellis, C


    Complex proximal humerus fractures are often difficult to treat. Their frequency is high, especially in the elderly, and their treatment is still controversial. The aim of this study was to analyze the clinical and radiological results achieved by patients with complex proximal humerus fractures, treated with PHILOS plate only. A cohort of 55 patients was selected. The mean age was 63.4 (range 33-89), while the mean follow-up time was 21.5 months (range 6-75). Clinical outcome was evaluated with the "Constant-Murley shoulder score." All the informations about the presence of complications were gathered, and radiological images were used to calculate the head-shaft angle. The overall mean Constant score was 61.93 ± 18.59, the Individual CS was 70 ± 20 % and the Relative CS was 83 ± 23 %. No significant differences were found between fractures Neer 3 and Neer 4 and between the surgical approaches (delta-split vs. delto-pectoral). Six patients had a fracture with dislocation, seven patients (12.7 %) had complications while in four patients a head-shaft angle beyond the normal range was found. Osteosynthesis with PHILOS plate is stable in the greater part of the cases, and it allows an earlier rehabilitation and so a good functional result, which could be compromised by a prolonged immobilization. Therefore, PHILOS plate is a good option for the treatment of complex proximal humerus fractures.

  8. Persistent neuroleptic-induced rigidity and dystonia in AIDS dementia complex: a clinico-pathological case report. (United States)

    Factor, S A; Podskalny, G D; Barron, K D


    Patients with AIDS dementia complex (ADC) appear to have an increased likelihood of developing acute onset parkinsonism and dystonia when treated with dopamine antagonists. It has been hypothesized, based on clinical evidence, that hypersensitivity to these drugs in ADC is probably related to direct invasion of the basal ganglia by the HIV virus and a secondary alteration in dopaminergic mechanisms. We report the first pathological description of a patient with ADC who developed acute onset, generalized rigidity and dystonia after a brief trial of low dose neuroleptic therapy administered for psychotic symptoms. An unusual clinical feature of this case was the persistence of his movement disorder. Pathological examination revealed a generalized encephalitic process with substantial neuronal loss observed primarily in the medial and lateral globus pallidus. Correlation with a current model of basal ganglia pathophysiology and other disorders with pallidal lesions is discussed. Clinical and pathological features of this case confirm the previous contention and indicate that dopamine antagonists should be utilized with extreme caution in patients with ADC.

  9. Collet-Sicard Syndrome from Thrombosis of the Sigmoid-Jugular Complex: A Case Report and Review of the Literature

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    Tom P. B. Handley


    Full Text Available Purpose. Collet-Sicard syndrome is a very rare condition characterised by unilateral palsy of the IX–XII cranial nerves. It is distinguished from Villaret syndrome by lack of presence of sympathetic involvement. Current literature contains only two cases of Collet-Sicard syndrome due to idiopathic internal jugular vein thrombosis. Method and Results. We report the case of Collet-Sicard syndrome in a 30-year-old man who presented with delayed development of XIth nerve dysfunction, due to internal jugular vein-sigmoid sinus thrombosis. A multidisciplinary team approach was employed in the management of this patient. At three-month followup, he had significantly improved swallowing, and repeat computed tomography neck scan showed partial recanalisation of the right internal jugular vein. Conclusion. In suspected Collet-Sicard syndrome, a focal primary lesion or metastasis to the temporal bone must be excluded, and sigmoid-jugular complex thrombosis should be considered in the differential diagnosis. Early recognition and treatment may result in significant functional recovery.

  10. Bladder exstrophy-epispadias complex and the role of methylenetetrahydrofolate reductase C677T polymorphism: A case control study

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    Venkat Shankar Raman


    Full Text Available Purpose: The Bladder Exstrophy-Epispadias Complex (BEEC is the most serious form of midline abdominal malformation. The etiology of BEEC is unknown and is thought to be multifactorial. Methylenetetrahydrofolate reductase (MTHFR polymorphism C677T is strongly associated with other midline abnormalities such as neural tube defects. No proper case-control study existed comparing MTHFR polymorphism with BEEC. We sought to find an association with MTHFR polymorphism and patients with bladder exstrophy (BE. Materials and Methods: The design of the study was a case-control study, involving 50 children with BEEC and 50 normal healthy school children. Genetic analysis for MTHFR 677 polymorphism was carried out after DNA extraction and polymerase chain reaction amplification. Epidemiological analysis was done by using the birth defect questionnaire on parents of BEEC. Results: Forty-two classical BE, two cloacal exstrophies (CE, four epispadias, and two exstrophy variant patients were a part of this study. Severe variety of BE had a significant association with C667T MTHFR polymorphism as compared to the normal control population (P = 0.01. Conclusion: C677T MTHFR polymorphism has a strong association with severe variety (CE of BEEC occurrence.

  11. Dynamical Responses to External Stimuli for Both Cases of Excitatory and Inhibitory Synchronization in A Complex Neuronal Network

    CERN Document Server

    Kim, Sang-Yoon


    For studying how dynamical responses to external stimuli depend on the synaptic-coupling type, we consider two types of excitatory and inhibitory synchronization (i.e., synchronization via synaptic excitation and inhibition) in complex small-world networks of excitatory regular spiking (RS) pyramidal neurons and inhibitory fast spiking (FS) interneurons. For both cases of excitatory and inhibitory synchronization, effects of synaptic couplings on dynamical responses to external time-periodic stimuli $S(t)$ (applied to a fraction of neurons) are investigated by varying the driving amplitude $A$ of $S(t)$. Stimulated neurons are phase-locked to external stimuli for both cases of excitatory and inhibitory couplings. On the other hand, the stimulation effect on non-stimulated neurons depends on the type of synaptic coupling. The external stimulus $S(t)$ makes a constructive effect on excitatory non-stimulated RS neurons (i.e., it causes external phase lockings in the non-stimulated sub-population), while $S(t)$ m...

  12. Complex Systems Education for natural Hazards and from down to up Pushing of Government and Officials: A Case Study (United States)

    Zvelebil, J.


    interplays of highly organized entities. Of course, such efforts mainly fail due to existence of qualitative differences between description of the same phenomena on different time-space scales or functional levels. Main features of a basic course "Application of nonlinear dynamics and Theory of Complex Systems for Physical Geographers" are described. They also partially follow the course reader's opinion about necessity of new reunion of modern philosophy and methodology of natural and human sciences Dangerous distortion of reflections of reality by the frequently proposed substitution of human science methodology by the natural science one is stressed. On the contrary, examples from philosophy (Bergson 1919, Wittgenstein 1953), which had anticipated and even defined some profound themes of Complex Systems (e.g. Kauffman 1993), as e.g. self-organizing, entropy decreasing behavior, or existence of discontinuities between description of the same phenomena on different time-space scales or functional levels. The second priority has information dissemination for decisions makers of natural Hazards management. Any successful Case history is better then ten popular lectures for those decision makers. A case history of highly computerized Integrated Information System (IIS) for unstable rock slope monitoring, on-line rock fall precursors diagnostics of time series and automated early warning launching, the both with the use of predominantly nonlinear tools is outlined. It stands to support author's opinion that pushing of officials is effective only if it is provided from down to up. That means it is based on satisfactory solution of specific community needs, instead of from up to down flowing more or less general directives of some far away sitting clerks. The third tactical item is rather long-distance run. Change of paradigm cannot be ordered, it is matter of generation change, as on scientific, as well as on decision makers (hopefully recruited from students already aware of

  13. [Application of hair analysis of selected psychoactive substances for medico-legal purposes. Part II. Cases of complex fatal poisonings: interactions of heroine - cocaine - amphetamines]. (United States)

    Rojek, Sebastian; Kłys, Małgorzata; Rzepecka-Woźniak, Ewa; Konopka, Tomasz


    The study represents an attempt at employing segmental hair analysis in complex poisonings with xenobiotic mixtures of heroine - cocaine - amphetamines in the context of the cause of death as a consequence of complex interaction mechanisms which occurred prior to death. Two cases of complex poisonings: heroine - cocaine and heroine - cocaine - amphetamines were analyzed and documented with macro- and microscopic examinations and complex toxicological examinations, including the analysis of classic biological material, i.e. samples of selective blood, and alternative material, i.e. hair samples. Determinations of opioids, cocaine and its metabolite and amphetamines in the hair biological matrix were performed using high performance liquid chromatography--atmospheric pressure chemical ionization--tandem mass spectrometry (HPLC-APCI-MS-MS). Segmental hair analysis of the investigated cases indicated a prolonged intake of similar psychoactive substances and a developed adaptation of the addicted to interaction mechanisms, which, however, led gradually to multiorgan anatomopathological changes, and in consequence to death.

  14. A multi-disciplinary approach to study coastal complex landslides: the case of Torino di Sangro (Central Italy) (United States)

    Sciarra, Marco; Carabba, Luigi; Urbano, Tullio; Calista, Monia


    This work illustrates the studies carried out on a complex landslide phenomenon between the Sangro and Osento River's mouths, near Torino di Sangro village in Southern Abruzzo Region (Italy). Historical activity of this landslide is well-documented since 1916; the activation/reactivation of the movements caused several interruptions of a national railway and the damage of few houses. The Torino di Sangro case study can be regarded as representative of many large landslides distributed along the central Adriatic coast (e.g., Ancona, Ortona, Vasto and Petacciato Landslides) that affect densely populated urban areas with a large amount of man-made infrastructure. The main controlling factors of these large and deep-seated landslides are still debated. From the geological and geomorphological viewpoint, the central Adriatic coast is characterized by a low-relief landscape (mesa) carved on clay-sandstone-conglomerate bedrock belonging to the Upper Pliocene - Lower Pleistocene marine deposits and locally to the Middle Pleistocene marine to continental transitional deposits. This high coast is widely affected by slope instability (rock falls, rotational, complex and shallow landslides) on both active and inactive sea cliffs, the first being mainly affected by wave-cut erosion and the latter influenced by heavy rainfall and changes of pore pressure. The main landslide has the typical characteristics of a deep-seated gravitation deformation. The landslide study was based on a multidisciplinary approach including: 1) definition and GIS mapping of geology and geomorphology factors (slope, aspect, topographic curvature, bedrock lithology, near-surface deposits, deposit thickness and land use), by means of DTM processing, multi-temporal analysis, and large-scale geomorphological field survey; 2) monitoring system in the landslide; 3) application of empiric models for the analysis of unstable sandstone-conglomerate escarpments; 4) slope stability analysis performed using a

  15. Vector control in a malaria epidemic occurring within a complex emergency situation in Burundi: a case study

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    D'Alessandro Umberto


    Full Text Available Abstract Background African highlands often suffer of devastating malaria epidemics, sometimes in conjunction with complex emergencies, making their control even more difficult. In 2000, Burundian highlands experienced a large malaria outbreak at a time of civil unrest, constant insecurity and nutritional emergency. Because of suspected high resistance to the first and second line treatments, the provincial health authority and Médecins Sans Frontières (Belgium decided to implement vector control activities in an attempt to curtail the epidemic. There are few reported interventions of this type to control malaria epidemics in complex emergency contexts. Here, decisions and actions taken to control this epidemic, their impact and the lessons learned from this experience are reported. Case description Twenty nine hills (administrative areas were selected in collaboration with the provincial health authorities for the vector control interventions combining indoor residual spraying with deltamethrin and insecticide-treated nets. Impact was evaluated by entomological and parasitological surveys. Almost all houses (99% were sprayed and nets use varied between 48% and 63%. Anopheles indoor resting density was significantly lower in treated as compared to untreated hills, the latter taken as controls. Despite this impact on the vector, malaria prevalence was not significantly lower in treated hills except for people sleeping under a net. Discussion Indoor spraying was feasible and resulted in high coverage despite being a logistically complex intervention in the Burundian context (scattered houses and emergency situation. However, it had little impact on the prevalence of malaria infection, possibly because it was implemented after the epidemic's peak. Nevertheless, after this outbreak the Ministry of Health improved the surveillance system, changed its policy with introduction of effective drugs and implementation of vector control to prevent new

  16. The Use of Best Practice in the Treatment of a Complex Diabetic Foot Ulcer: A Case Report

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    Melodie Blakely


    Full Text Available Background and Purpose: Published guidelines for effective management of diabetic foot ulcers (DFU include total contact casting (TCC. The purpose of this case study is to describe the application of best practice guidelines for the treatment of a diabetic foot ulcer (DFU in a complex patient where TCC offloading could not be utilized. Case Description: The patient was a 47 year-old female with a five-plus year history of a full-thickness DFU on the left plantar mid-foot. Treatment included sharp and ultrasound debridement, the use of a silver hydrofiber dressing, edema management via compression therapy, negative pressure wound therapy, offloading via customized 1/4 inch adhesive-backed felt applied to the plantar foot in addition to an offloading boot and use of a wheelchair, patient education regarding diabetes management, and the application of a bilayered living skin-equivalent biologic dressing. Outcomes: At 15 weeks the wound was closed and the patient was transitioned into diabetic footwear. Discussion: The felt offloading was a beneficial alternative to TCC. The patient’s longer than average healing rate may have been complicated by the duration of her wound, her 41 year history of diabetes, and the fact that gold standard offloading (TCC was not able to be used. Further research is needed regarding the use of felt for offloading, such as application technique for wounds on different areas of the foot, comparison of different types of felt, and the use of felt in conjunction with various offloading devices.

  17. Complex odontoma with dentigerous cyst:a case report%混合性牙瘤合并含牙囊肿1例

    Institute of Scientific and Technical Information of China (English)

    徐其章; 张红亮; 王晓宇; 王占基; 徐倩倩; 马琼


    混合性牙瘤是一种比较少见的牙齿发育异常,混合性牙瘤合并含牙囊肿更是少见。本文报道1例混合性牙瘤合并含牙囊肿病例。%Complex odontoma is a relatively rare dental dysplasia. In particular, a complex odontoma with dentigerous cyst is seldom observed. A case of complex odontoma with dentigerous cyst is reported in this paper.

  18. Gas-phase complexes of Ni2+ and Ca2+ with deprotonated histidylhistidine (HisHis): A model case for polyhistidyl-metal binding motifs (United States)

    Peckelsen, Katrin; Martens, Jonathan; Berden, Giel; Oomens, Jos; Dunbar, Robert C.; Meijer, Anthony J. H. M.; Schäfer, Mathias


    In the complex formed between the calcium cation (Ca2+) and a deprotonated HisHis dipeptide, the complex adopts a charge solvation (CS) structure. Ca2+, a weak binding main group metal cation, interacts with the oxygens of the peptide carbonyl moiety and the deprotonated C-terminus. In contrast, the much stronger binding Ni2+ cation deprotonates the peptide nitrogen and induces an iminolate (Im) ligand structure in the [Ni(HisHis-H)]+ complex ion. The combination of infrared multiple-photon dissociation (IRMPD) spectroscopy and quantum chemistry evidence these two representative binding motifs. The iminolate coordination pattern identified and characterized in the [Ni(HisHis-H)]+ complex serves as a model case for nickel complexes of poly-histidyl-domains and is thereby also of interest to better understand the fundamentals of immobilized metal ion affinity chromatography as well as of Ni co-factor chemistry in enzymology.

  19. Function of Rural Settlement Complex Ecosystem in Mountain Area: A Case Study of Raosi Village of Zuogong County, Tibet

    Institute of Scientific and Technical Information of China (English)

    LIU Shaoquan; CHEN Guojie


    Using energy analysis,the quantifying evaluation and study method on production,living and ecology functions and their sustainability of rural settlement ecosystem in mountain area is established with these energy index such as export of labor and products,export of water resource,internal energy reserve,energy consumption for human living,net energy of ecosystem function and net internal reserve.Taking rural settlement Raosi Village in Hengduan Mountains as a case study,and on the basis of the synthetic research into the ecological process of the complex ecosystem,the study shows that energy costs of production,human living and ecology functions are separately taking 1.36%,13.59% and 85.05% of the gross ecosystem functions,and the exertions of production and human living functions are close to a high-point state on the present using level of energy in the settlement.The study also shows that the most important function of a rural settlement in mountain area is its ecological rather productive function.

  20. Local development and globalization: the case of the formation of the agroindustrial complex of lemon in Colima, México

    Directory of Open Access Journals (Sweden)

    Saúl Martínez González


    Full Text Available The multinational company has been the main vehicle of internationalization of capital and trade integration between countries. The global expansion phase of the transnational corporation is associated with the hegemony of capitalism in the United States, whose influence has been decisive in the territories where it operates. This essay is a case of the influence of transnational company Coca Cola in the formation of the region of Tecoman, Colima, as providing an input to the company during the period dominated by Fordism. This region is formed from exogenous impulses of the needs of lemon essential oil by transnational companies which in turn have determined the stages of growth and expansion in the region that occur in phases of boom and bust. Dependence on oil exports Mexican lime by an American multinational company is determined, in turn, by the behavior of the economic cycle in the United States. This study highlights the stage of formation of the agroindustrial complex and does not attempt to analyze the current situation

  1. German Children's Use of Word Order and Case Marking to Interpret Simple and Complex Sentences: Testing Differences between Constructions and Lexical Items (United States)

    Brandt, Silke; Lieven, Elena; Tomasello, Michael


    Children and adults follow cues such as case marking and word order in their assignment of semantic roles in simple transitives (e.g., "the dog chased the cat"). It has been suggested that the same cues are used for the interpretation of complex sentences, such as transitive relative clauses (RCs) (e.g., "that's the dog that chased…

  2. Implementing a Case-Based E-Learning Environment in a Lecture-Oriented Anaesthesiology Class: Do Learning Styles Matter in Complex Problem Solving over Time? (United States)

    Choi, Ikseon; Lee, Sang Joon; Kang, Jeongwan


    This study explores how students' learning styles influence their learning while solving complex problems when a case-based e-learning environment is implemented in a conventional lecture-oriented classroom. Seventy students from an anaesthesiology class at a dental school participated in this study over a 3-week period. Five learning-outcome…

  3. Fatal Case of Polymicrobial Meningitis Caused by Cryptococcus liquefaciens and Mycobacterium tuberculosis Complex in a Human Immunodeficiency Virus-Infected Patient. (United States)

    Conde-Pereira, César; Rodas-Rodríguez, Lia; Díaz-Paz, Manuel; Palacios-Rivera, Hilda; Firacative, Carolina; Meyer, Wieland; Alcázar-Castillo, Myriam


    We describe a fatal case of polymicrobial meningitis in a human immunodeficiency virus-infected patient from Guatemala caused by Cryptococcus liquefaciens and Mycobacterium tuberculosis complex. Central nervous system infections caused concurrently by these species are extremely rare. This is also the first report of disseminated disease caused by C. liquefaciens.

  4. Predictive validity of a frailty measure (GFI) and a case complexity measure (IM-E-SA) on healthcare costs in an elderly population

    NARCIS (Netherlands)

    Peters, Lilian L.; Burgerhof, Johannes G. M.; Boter, Han; Wild, Beate; Buskens, Erik; Slaets, Joris P. J.


    Objectives: Measures of frailty (Groningen Frailty Indicator, GFI) and case complexity (INTERMED for the Elderly, IM-E-SA) may assist healthcare professionals to allocate healthcare resources. Both instruments have been evaluated with good psychometric properties. Limited evidence has been published

  5. [A case of an effective application of probiotics in the complex therapy of severe type 1 diabetes mellitus and intestinal disbacteriosis]. (United States)

    Rozanova, G N; Voevodin, D A


    The article presents a case illustrating an association between the severity of type 1 diabetes mellitus and disorder in the intestinal microbiocenosis. The authors stress that clinical signs of disbacteriosis are mostly manifested by disturbances in the metabolic processes. Clinical effectiveness of probioticotherapy in the complex treatment of the disease is shown.

  6. Complex odontoma. (United States)

    Preetha, A; Balikai, Bharati S; Sujatha, D; Pai, Anuradha; Ganapathy, K S


    Odontomas are hamartomatous lesions or malformations composed of mature enamel, dentin, and pulp. They may be compound or complex, depending on the extent of morphodifferentiation or their resemblance to normal teeth. The etiology of odontoma is unknown, although several theories have been proposed. This article describes a case of a large infected complex odontoma in the residual mandibular ridge, resulting in considerable mandibular expansion.

  7. Universal plant DNA barcode loci may not work in complex groups: a case study with Indian berberis species.

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    Sribash Roy

    Full Text Available BACKGROUND: The concept of DNA barcoding for species identification has gained considerable momentum in animals because of fairly successful species identification using cytochrome oxidase I (COI. In plants, matK and rbcL have been proposed as standard barcodes. However, barcoding in complex genera is a challenging task. METHODOLOGY AND PRINCIPAL FINDINGS: We investigated the species discriminatory power of four reportedly most promising plant DNA barcoding loci (one from nuclear genome--ITS, and three from plastid genome--trnH-psbA, rbcL and matK in species of Indian Berberis L. (Berberidaceae and two other genera, Ficus L. (Moraceae and Gossypium L. (Malvaceae. Berberis species were delineated using morphological characters. These characters resulted in a well resolved species tree. Applying both nucleotide distance and nucleotide character-based approaches, we found that none of the loci, either singly or in combinations, could discriminate the species of Berberis. ITS resolved all the tested species of Ficus and Gossypium and trnH-psbA resolved 82% of the tested species in Ficus. The highly regarded matK and rbcL could not resolve all the species. Finally, we employed amplified fragment length polymorphism test in species of Berberis to determine their relationships. Using ten primer pair combinations in AFLP, the data demonstrated incomplete species resolution. Further, AFLP analysis showed that there was a tendency of the Berberis accessions to cluster according to their geographic origin rather than species affiliation. CONCLUSIONS/SIGNIFICANCE: We reconfirm the earlier reports that the concept of universal barcode in plants may not work in a number of genera. Our results also suggest that the matK and rbcL, recommended as universal barcode loci for plants, may not work in all the genera of land plants. Morphological, geographical and molecular data analyses of Indian species of Berberis suggest probable reticulate evolution and thus

  8. Dynamic Parameter Identification of Subject-Specific Body Segment Parameters Using Robotics Formalism: Case Study Head Complex. (United States)

    Díaz-Rodríguez, Miguel; Valera, Angel; Page, Alvaro; Besa, Antonio; Mata, Vicente


    Accurate knowledge of body segment inertia parameters (BSIP) improves the assessment of dynamic analysis based on biomechanical models, which is of paramount importance in fields such as sport activities or impact crash test. Early approaches for BSIP identification rely on the experiments conducted on cadavers or through imaging techniques conducted on living subjects. Recent approaches for BSIP identification rely on inverse dynamic modeling. However, most of the approaches are focused on the entire body, and verification of BSIP for dynamic analysis for distal segment or chain of segments, which has proven to be of significant importance in impact test studies, is rarely established. Previous studies have suggested that BSIP should be obtained by using subject-specific identification techniques. To this end, our paper develops a novel approach for estimating subject-specific BSIP based on static and dynamics identification models (SIM, DIM). We test the validity of SIM and DIM by comparing the results using parameters obtained from a regression model proposed by De Leva (1996, "Adjustments to Zatsiorsky-Seluyanov's Segment Inertia Parameters," J. Biomech., 29(9), pp. 1223-1230). Both SIM and DIM are developed considering robotics formalism. First, the static model allows the mass and center of gravity (COG) to be estimated. Second, the results from the static model are included in the dynamics equation allowing us to estimate the moment of inertia (MOI). As a case study, we applied the approach to evaluate the dynamics modeling of the head complex. Findings provide some insight into the validity not only of the proposed method but also of the application proposed by De Leva (1996, "Adjustments to Zatsiorsky-Seluyanov's Segment Inertia Parameters," J. Biomech., 29(9), pp. 1223-1230) for dynamic modeling of body segments.

  9. Complex Controls on Groundwater Quality in Growing Mid-sized Cities: A Case Study Focused on Nitrate and Emerging Contaminants (United States)

    Ohr, C. A.; Godsey, S.; Welhan, J. A.; Larson, D. M.; Lohse, K. A.; Finney, B.; Derryberry, D.


    Many regions rely on quality groundwater to support urban growth. Groundwater quality often responds in a complex manner to stressors such as land use change, climate change, or policy decisions. Urban growth patterns in mid-sized cities, especially ones that are growing urban centers in water-limited regions in the western US, control and are controlled by water availability and its quality. We present a case study from southeastern Idaho where urban growth over the past 20 years has included significant ex-urban expansion of houses that rely on septic systems rather than city sewer lines for their wastewater treatment. Septic systems are designed to mitigate some contaminants, but not others. In particular, nitrates and emerging contaminants, such as pharmaceuticals, are not removed by most septic systems. Thus, even well-maintained septic systems at sufficiently high densities can impact down gradient water quality. Here we present patterns of nitrate concentrations over the period from 1985-2015 from the Lower Portneuf River Valley in southeastern Idaho. Concentrations vary from 0.03 to 27.09 nitrate-nitrogen mg/L, with average values increasing significantly over the 30 year time period from 3.15 +/- 0.065 to 3.57 +/- 0.43 mg/L. We examine temporal changes in locations of nitrate hotspots, and present pilot data on emerging contaminants of concern. Initial results suggest that high nitrate levels are generally associated with higher septic densities, but that this pattern is influenced by legacy agricultural uses and strongly controlled by underlying aquifer properties. Future work will include more detailed hydrological modeling to predict changes in hotspot locations under potential climate change scenarios.

  10. Switching industrial production processes from complex to defined media: method development and case study using the example of Penicillium chrysogenum

    Directory of Open Access Journals (Sweden)

    Posch Andreas E


    Full Text Available Abstract Background Filamentous fungi are versatile cell factories and widely used for the production of antibiotics, organic acids, enzymes and other industrially relevant compounds at large scale. As a fact, industrial production processes employing filamentous fungi are commonly based on complex raw materials. However, considerable lot-to-lot variability of complex media ingredients not only demands for exhaustive incoming components inspection and quality control, but unavoidably affects process stability and performance. Thus, switching bioprocesses from complex to defined media is highly desirable. Results This study presents a strategy for strain characterization of filamentous fungi on partly complex media using redundant mass balancing techniques. Applying the suggested method, interdependencies between specific biomass and side-product formation rates, production of fructooligosaccharides, specific complex media component uptake rates and fungal strains were revealed. A 2-fold increase of the overall penicillin space time yield and a 3-fold increase in the maximum specific penicillin formation rate were reached in defined media compared to complex media. Conclusions The newly developed methodology enabled fast characterization of two different industrial Penicillium chrysogenum candidate strains on complex media based on specific complex media component uptake kinetics and identification of the most promising strain for switching the process from complex to defined conditions. Characterization at different complex/defined media ratios using only a limited number of analytical methods allowed maximizing the overall industrial objectives of increasing both, method throughput and the generation of scientific process understanding.

  11. Variable coordinating activity of sulfur in silver(I) complexes with thiophene based N¹ -substituted thiosemicarbazones: First case of thiopheneyl-thione sulfur bridging in a dinuclear complex

    Indian Academy of Sciences (India)



    Thiophene-2-carbaldehyde / acetaldehyde-N¹-substituted thiosemicarbazones {R¹R²C² = N³ - N(H)- C¹(=S)N¹HR; R¹, R², R : C₄H₃S, H, Me, Httsc- NMe; C₄H₃S, H, Et, Httsc-NEt; C₄H₃S, H, Ph, Httsc-NPh; C₄H₃S, Me, Et, Hattsc-NEt} and furan-2-carbaldehyde-N-ethyl thiosemicarbazone (C₄H₃O, H, Et, Hftsc-NEt) were reacted with silver(I) halides/silver(I) acetate in presence of triphenylphosphine in organic solvents. These reactions yielded a series of dinuclear [Ag₂(μ-Br)₂ (κ-S-Httsc-NEt)2(PPh3)2]·2MeOH 1, [Ag2Cl2(κ1-SHttsc-NPh)2(μ-S,S-Httsc-NPh)2] 2, [Ag2Cl2(μ-S-Hftsc-NEt)2(κ1-S-Hftsc-NEt)2] 4, [Ag2(μ3-N3,S-ttsc-NMe)2 (Ph3P)2]·2(CH3)2CO 5, [Ag2 (μ3-N3,S-attsc-NEt)2(Ph3P)2]·0.5(CH3)2CO 6 and mononuclear [AgBr(κ1-SHttsc-NPh)(PPh3)2]· MeCN 3 complexes, all of which have been characterized using analytical techniques, IRand NMR spectroscopy, and X-ray crystallography. Thio-ligands bind in neutral form in complexes 1-4 and in anionic form in complexes 5-6. Further, the sulfur donor atoms have shown variable coordination modes incomplexes, namely, κ1-S in 1 and 3; κ1-S, μ-S in 4; κ1-S, μ-S,S (thiopheneyl-thione) in 2 and μ3- N3, S in 5 and 6. Tertiary-phosphine (PPh3) showed dual function of ligation/de-ligation towards silver(I) chloride during the synthesis of complexes 2 and 4. The bridge bonding of Httsc-NPh in 2 through thiopheneyl ring sulfur andthione sulfur is unprecedented in metal-thiosemicarbazone chemistry.

  12. [Immunologic study of subacute infectious endocarditis through the search for circulating immune complexes. Preliminary results apropos of 13 cases]. (United States)

    Herreman, G; Godeau, P; Cabane, J; Digeon, M; Laver, M; Bach, J F


    The detection of circulating immune complexes by precipitation by polyethylene glycol represents a valuable technique of study in sub-acute bacterial endocarditis. In a series of 13 patients, this measurement was carried out, confirming the quasi-constant presence of circulating immune complexes in active S.B.E. This might be of diagnostic value in forms with negative blood culture and, further, make it possible, subsequently, to find the antigen responsible by dissociation of the circulating immune complexes.

  13. Mycobacterium avium complex olecranon bursitis resolves without antimicrobials or surgical intervention: A case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Selene Working


    Conclusion: This case raises an important clinical question of whether close observation off antimicrobials is appropriate in select cases of immunocompetent patients with localized atypical mycobacterial disease of soft tissue and skeletal structures.

  14. Complexities within distal sheet turbidite deposits: case study 160,000ka Icod Turbidite, Moroccan Turbidite System (United States)

    Hunt, James; Wynn, Russell


    The Icod landslide from the northern flank of Tenerife not only generated a debris avalanche phase (Watts & Masson, 1995; Masson et al. 2002), but produced a volcaniclastic turbidite that spans three interconnected basins. The Icod turbidite (160,000ka) was reported and correlated during work in the Madeira Abyssal Plain (Pearce & Jarvis, 1992; Rothwell, Pearce & Weaver, 1992). Here it forms a series of vertically stacked sand bodies accumulating into a single event bed. However, the Madeira Abyssal Plain is fed from the Agadir Basin by a series of channels, thus invoking a level of complexity to the deposit with the flow exiting channels at different times. The Icod turbidite can be found deposited more proximally to source in the Agadir Basin as a 0.3-0.6m stacked sand with accompanying 0.2-1.5m mudcap. With this stacked sand facies present here a number of other mechanisms can still be viable: (1) multistage retrogressive landslide failure, (2) flow reflection and (3) internal waves. Geochemical methodologies including ICP-AES, ICP-MS, XRF, ITRAX micro-XRF, SEM EDS and laser-diffraction grain-size analysis have been employed here to investigate the potential of a retrogressive failure at source being the driver of this facies. Evidence suggests that this stacked sand facies in this case is derived from the failure mechanism at source. Five vertical sand packages have been identified and correlated through the Agadir Basin, with the initial basal package representing the thickest. However, this amalgamated sand displays degrees of complexity with correlated internal erosional surfaces marked by sand-sand grain-size breaks. There are also sand-sand grain-size breaks found at the transition between facies associated with flow properties i.e. Bouma Tb parallel laminations and Bouma Tc ripple laminations. Each of the stacked sand intervals also has a sand-mud grain-size break present at the top of the package. This sand-mud break could possibly indicate (1) bypass of

  15. The utility of 3D printing for surgical planning and patient-specific implant design for complex spinal pathologies: case report. (United States)

    Mobbs, Ralph J; Coughlan, Marc; Thompson, Robert; Sutterlin, Chester E; Phan, Kevin


    OBJECTIVE There has been a recent renewed interest in the use and potential applications of 3D printing in the assistance of surgical planning and the development of personalized prostheses. There have been few reports on the use of 3D printing for implants designed to be used in complex spinal surgery. METHODS The authors report 2 cases in which 3D printing was used for surgical planning as a preoperative mold, and for a custom-designed titanium prosthesis: one patient with a C-1/C-2 chordoma who underwent tumor resection and vertebral reconstruction, and another patient with a custom-designed titanium anterior fusion cage for an unusual congenital spinal deformity. RESULTS In both presented cases, the custom-designed and custom-built implants were easily slotted into position, which facilitated the surgery and shortened the procedure time, avoiding further complex reconstruction such as harvesting rib or fibular grafts and fashioning these grafts intraoperatively to fit the defect. Radiological follow-up for both cases demonstrated successful fusion at 9 and 12 months, respectively. CONCLUSIONS These cases demonstrate the feasibility of the use of 3D modeling and printing to develop personalized prostheses and can ease the difficulty of complex spinal surgery. Possible future directions of research include the combination of 3D-printed implants and biologics, as well as the development of bioceramic composites and custom implants for load-bearing purposes.

  16. Complexity in Decision Making: The Case of the Rotterdam Harbour Expansion : Connecting Decisions, Arenas and Actors in Spatial Decision Making

    NARCIS (Netherlands)

    E-H. Klijn (Erik-Hans); M.K.A. van Gils (Marcel)


    textabstractDecision making about spatial projects is very complex. Decisions to develop the Rotterdam harbour are taken in the context of a network of local, regional, national, European and international actors, both public and private. These decision-making processes exhibit a lot of complexity a

  17. Decomposition as a Complex-Skill Acquisition Strategy in Management Education: A Case Study in Business Forecasting (United States)

    Adya, Monica; Lusk, Edward J.; Balhadjali, Moncef


    Graduate business education has been criticized for utilizing simplistic teaching strategies that compromise the presentation of real-world complex skills in the classroom. In this article, we propose that complex management functions can be effectively taught using decomposition strategies. We demonstrate the usefulness of this strategy in the…

  18. Topical Treatment With Liposomal Sodium Copper Chlorophyllin Complex in Subjects With Facial Redness and Erythematotelangiectatic Rosacea: Case Studies. (United States)

    Vasily, David B


    Physicians are often presented with patients complaining of facial redness and difficult to control rosacea. The water soluble sodium copper chlorophyllin complex has been shown to have anti-oxidant, anti-inflammatory, and anti-bacterial activities in vitro and anti-redness, pore reduction, and anti-acne activities in pilot clinical studies. In these case studies, the safety and efficacy of a topical gel containing a liposomal suspension of sodium copper chlorophyllin complex was assessed in subjects with facial redness and erythematotelangiectatic rosacea.


    Directory of Open Access Journals (Sweden)

    Matsyura A.V.


    Full Text Available The problem of the mathematical analysis of the number dynamics of the nesting waterbirds for the islands of the south of Ukraine is examined. The algorithm of the evaluation of changes in the number of island birds is proposed. Data of the long-term monitoring of the number of birds were analyzed according to this algorithm. The necessity of the implementation of the statistical indices together with the graphic representation of island birds’ turnover is proved. The trends of population dynamics are determined for the key species. The discussed procedure of the complex evaluation is proposed for the management planning of the island bird species and their habitats. The performed analysis of the number dynamics of the key-stone breeding island birds showed that, with the exception of little tern, the population status and the prognosis of number are sufficiently favorable. From the data of long-term monitoring we came up with the conclusion about the existence of island habitats with carrying capacity to maintain the additional number of breeding birds. In the case of unfavorable conditions like strengthening of anthropogenic press, concurrent interrelations, deficiency of feed resources or drastic reduction of breeding biotopes, the birds due to turnover are capable to successfully react even without reducing their number and breeding success. The extinction rate of the breeding bird species from the island sites directly correlates with the number of breeding species. For the species with equal abundance, the extinction probability is higher for birds, whose numbers are unstable and characterized by significant fluctuations. This testifies the urgency of the constant monitoring and analysis of the number dynamics of breeding bird species in region. The suggested procedure of analysis is recommended for drawing up of management plans and performing of prognoses of number of breeding island bird species. More detail analysis with use of

  20. Modeling and hazard mapping of complex cascading mass movement processes: the case of glacier lake 513, Carhuaz, Peru (United States)

    Schneider, Demian; Huggel, Christian; García, Javier; Ludeña, Sebastian; Cochachin, Alejo


    that complex cascades of mass movement processes can realistically be modeled using different models and model parameters. The method to semi-automatically produce hazard maps is promising and should be applied in other case studies. Verification of model based results in the field remains an important requirement. Results from this study are important for the GLOF early warning system that is currently in an implementation phase, and for risk reduction efforts in general.

  1. Rare case of impalement of two occupants of a vehicle by the same object: insights into the management of complex thoracic impalements

    Institute of Scientific and Technical Information of China (English)

    Maneesh Singhal; Madduri Vijay Kumar; Prem Prakash; Amit Gupta; Subodh Kumar; Sushma Sagar


    Thoracic impalement injuries are very rare and the majority of patients do not survive to reach a medical care facility.In this case report,we describe the successful outcome of a case of double thoracic impalement by two steed tors,of which one steel tor had impaled two patients simultaneously.The case report highlights all aspects of managing such rare and complex cases right from prehospital care; extrication process which happened under controlled environment at the trauma centre itself,till the definitive management of the impaled thoracic objects.Thoracic impalement injuries are dramatic and appear very challenging.However presence of mind of the managing team,coordinated team effort and availability of adequate facilities can lead to a successful outcome.

  2. Glacial recession in the Tropical Andes from the Little Ice Age: the case of Ampato Volcanic Complex (Southern Peru (United States)

    Alcalá, J.; Palacios, D.; Zamorano, J. J.


    the Ampato volcanic complex (15º24´- 15º 51´ S, 71º 51´ - 73º W; 6.288 masl), one of the most important complexes of the northern sector of the CVZ. Photointerpretation of aerial photographs and teledetection through satellite images of Huayuray Valley (15º 41´ 14´´ S - 71º 51´ 53´´ W), located to the north of the complex, aided in accurately reconstructing the area occupied by the ice mass at different times (LIA, 1955, 2000 and 2008). Also the paleo-ELA (Equilibrium Line Altitude) and the ELA were calculated using the Accumulation Area (AA) method (Kaser and Osmaston, 2002; Osmaston, 2005) in a GIS. The ELA shows the relationship between climate and glacier mass balance (González Trueba, 2005). The data from Huayuray Valley show that the glaciers reached a minimum altitude of 5400 masl and covered an area of ~2.81 Km2 during the LIA. The paleo-ELA was located at ~5780 masl, ~120 m below the current ELA (~5900 m). Based on a vertical thermal gradient of 0.65ºC/100 m, the temperature during this event would have been about 0.7º C colder than present temperature in the Ampato volcanic complex. In 1955, Huayuray glacier covered ~2.45 km2, 12.8% less than in the LIA. In the same year, the glaciers in the Huayuray valley reached a minimum elevation of ~5660 masl and the ELA rose ~20 m, to 5800 masl. In only 45 years (1955 - 2000) the surface area of the ice was significantly reduced (~1 km2), i.e. 40.8%. The ELA continued to rise, until it reached 5890 masl in 2000. From 2000 - 2008, the Huayuray glacier was reduced to ~0.78 km2 and the ELA rised ~10 m to reach the 5900 masl These results from the CVZ confirm the dramatic recession of the glaciers in the tropical Andes during recent decades. They also suggest that if the rate of recession associated with the period 2000-2008 continues, glaciers in the Ampato volcanic complex will disappear in 10 years approximately. References González Trueba, J.J. (2005): La Pequeña Edad del Hielo en los Picos de

  3. The TOM Complex of Amoebozoans: the Cases of the Amoeba Acanthamoeba castellanii and the Slime Mold Dictyostelium discoideum. (United States)

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


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

  4. The complex tale of the achaete-scute complex: a paradigmatic case in the analysis of gene organization and function during development. (United States)

    García-Bellido, Antonio; de Celis, Jose F


    The achaete-scute gene complex (AS-C) contains four genes encoding transcription factors of the bHLH family, achaete, scute, lethal of scute, and asense located in 40 kb of DNA containing multiple cis-regulatory position-specific enhancers. These genes play a key role in the commitment of epidermal cells toward a neural fate, promoting the formation of both sensory organs in the peripheral nervous system (bristles) of the adult and of neuroblasts in the central nervous system of the embryo. The analysis of the AS-C initially focused on the variations in positional specificity of effects of achaete (ac) and scute (sc) alleles on macrochaete bristle pattern in the Drosophila adult epidermis, and from there it evolved as a key entry point into understanding the molecular bases of pattern formation and cell commitment. In this perspective, we describe how the study of the AS-C has contributed to the understanding of eukaryotic gene organization and the dissection of the developmental mechanisms underlying pattern formation.

  5. Complexity Plots

    KAUST Repository

    Thiyagalingam, Jeyarajan


    In this paper, we present a novel visualization technique for assisting the observation and analysis of algorithmic complexity. In comparison with conventional line graphs, this new technique is not sensitive to the units of measurement, allowing multivariate data series of different physical qualities (e.g., time, space and energy) to be juxtaposed together conveniently and consistently. It supports multivariate visualization as well as uncertainty visualization. It enables users to focus on algorithm categorization by complexity classes, while reducing visual impact caused by constants and algorithmic components that are insignificant to complexity analysis. It provides an effective means for observing the algorithmic complexity of programs with a mixture of algorithms and black-box software through visualization. Through two case studies, we demonstrate the effectiveness of complexity plots in complexity analysis in research, education and application. © 2013 The Author(s) Computer Graphics Forum © 2013 The Eurographics Association and Blackwell Publishing Ltd.

  6. Complex morphological and molecular genetic examination of amelogenesis imperfecta: a case presentation of two Czech siblings with a non-syndrome form of the disease. (United States)

    Kripnerova, Tereza; Krulisova, Veronika; Ptakova, Nikola; Macek, Milan; Dostalova, Tatjana


    Amelogenesis imperfecta (AI) is an overarching term for a group of rare inherited disorders of hard tooth tissues. It is characterized by various defects in proper enamel formation. AI is a severe disorder that affects both the aesthetics and function of the dentition, with affected teeth increasingly suffering from dental caries. Therefore, early diagnosis and lifelong stomatological interventions are important. Due to the complex nature of AI family history, stomatological, radiographic, and molecular genetic examinations should be part of the diagnostic portfolio. Additionally, we utilized new visualization methods for the assessment of teeth demineralization. We present a case report of two affected Czech sisters (6 and 8 years old) with clinically defined AI. These are the first Czech cases in which comprehensive clinical and genetic analysis had been carried out and reflect the complex clinical nature, positive treatment options, and limitations of candidate-gene molecular genetic testing.

  7. [Case of anti VGKC-complex antibody associated disorder presenting with severe pain and fasciculations predominant in unilateral upper extremity]. (United States)

    Hara, Kenju; Watanabe, Osamu; Shibano, Ken; Ishiguro, Hideaki


    A 21-year-old man complained of severe pain and muscle twitching localized in his right arm. Neurological examination showed muscle fasciculations in his right forearm but no myokymia or myotonia. Needle electromyography revealed fibrillation potentials in his biceps brachii muscle and extensor carpi radialis muscle at rest but no myokymic discharges. His serum anti-voltage-gated potassium channel (VGKC)-complex antibody level was significantly high (194.2pM; controls VGKC-complex antibody associated disorder.

  8. A case report on the treatment of complex chronic pain and opioid dependence by a multidisciplinary transitional pain service using the ACT Matrix and buprenorphine/naloxone (United States)

    Weinrib, Aliza Z; Burns, Lindsay C; Mu, Alex; Azam, Muhammad Abid; Ladak, Salima SJ; McRae, Karen; Katznelson, Rita; Azargive, Saam; Tran, Cieran; Katz, Joel; Clarke, Hance


    In an era of growing concern about opioid prescribing, the postsurgical period remains a critical window with the risk of significant opioid dose escalation, particularly in patients with a history of chronic pain and presurgical opioid use. The purpose of this case report is to describe the multidisciplinary care of a complex, postsurgical pain patient by an innovative transitional pain service (TPS). A 59-year-old male with complex chronic pain, as well as escalating long-term opioid use, presented with a bleeding duodenal ulcer requiring emergency surgery. After surgery, the TPS provided integrated pharmacological and behavioral treatment, including buprenorphine combined with naloxone and acceptance and commitment therapy (ACT) using the ACT Matrix. The result was dramatic pain reduction and improved functioning and quality of life after 40+ years of chronic pain, thus changing the pain trajectory of a chronic, complex, opioid-dependent patient.

  9. Tangled Narratives and Wicked Problems: A Complex Case of Positioning and Politics in a Diverse School Community (United States)

    Nguyen, Thu Suong Thi; Scribner, Samantha M. Paredes; Crow, Gary M.


    The case of Allen Elementary School presents tangled narratives and wicked problems describing the multidimensionality of school community work. Using multiple converging and diverging vignettes, the case points to the distinctiveness of individual experience in schools; the ways institutionalized organizational narratives become cultural…

  10. Complex odontoma of unusual size involving the maxillary sinus: report of a case and review of CT and histopathologic features. (United States)

    Mupparapu, Muralidhar; Singer, Steven R; Rinaggio, Joseph


    An unusually large complex odontoma of the maxilla, occupying the entire maxillary sinus with expansion into the floor of the orbit and left nasal fossa, is reported. Although occurrences of complex odontomas are not considered rare, odontomas attaining extremely large sizes, especially involving the entire maxillary sinus with extension to the orbital floor and nasal fossae, are indeed, rare. In this article, the literature is reviewed to identify the common clinical, radiographic, and histologic characteristics of such lesions, and the outcome of treatment is discussed. Complex odontomas occasionally have significant growth potential, especially in the first two decades of life. Early recognition and consideration for surgical excision are key to successful management of this common odontogenic lesion. When odontomas extend beyond the alveolar process into the fascial planes, nasal fossae, paranasal sinuses, and orbits, computed tomography can readily demonstrate the extent and boundaries of the lesion.

  11. Anterior dislocation of the sacroiliac joint with complex fractures of the pelvis and femur in children: a case report. (United States)

    Zhang, Hua; Jin, Libin; Li, Wanli; Li, Hang


    Pediatric sacroiliac joint injuries are uncommon lesions, especially when combined with anterior sacroiliac dislocation. Here, we present a rare case of anterior dislocation of the sacroiliac joint associated with ipsilateral acetabulum, subtrochanteric, and pubic rami fractures combined with a contralateral sacral fracture. This appears to be the first such case reported in the literature. At the 6-month follow-up, a favorable clinical outcome was achieved, with radiological healing of the lesion.

  12. Advances in Multi-Sensor Scanning and Visualization of Complex Plants: the Utmost Case of a Reactor Building (United States)

    Hullo, J.-F.; Thibault, G.; Boucheny, C.


    In a context of increased maintenance operations and workers generational renewal, a nuclear owner and operator like Electricité de France (EDF) is interested in the scaling up of tools and methods of "as-built virtual reality" for larger buildings and wider audiences. However, acquisition and sharing of as-built data on a large scale (large and complex multi-floored buildings) challenge current scientific and technical capacities. In this paper, we first present a state of the art of scanning tools and methods for industrial plants with very complex architecture. Then, we introduce the inner characteristics of the multi-sensor scanning and visualization of the interior of the most complex building of a power plant: a nuclear reactor building. We introduce several developments that made possible a first complete survey of such a large building, from acquisition, processing and fusion of multiple data sources (3D laser scans, total-station survey, RGB panoramic, 2D floor plans, 3D CAD as-built models). In addition, we present the concepts of a smart application developed for the painless exploration of the whole dataset. The goal of this application is to help professionals, unfamiliar with the manipulation of such datasets, to take into account spatial constraints induced by the building complexity while preparing maintenance operations. Finally, we discuss the main feedbacks of this large experiment, the remaining issues for the generalization of such large scale surveys and the future technical and scientific challenges in the field of industrial "virtual reality".

  13. Exploring Innovation Processes from a Complexity Perspective. Part II. Experiences from the Subsea Increased Oil Recovery Case (United States)

    Aasen, Tone Merethe Berg; Johannessen, Stig


    In this second part of the papers, exploring innovation processes from a complexity perspective, we present an empirical example to strengthen further the relevance of the approach. The example draws on a longitudinal research initiative conducted in cooperation with the Norwegian petroleum company Statoil ASA. We conducted our research into the…

  14. A Case Study: Application of the Systems Engineering Modeling in the early phases of a Complex Space System Project

    NARCIS (Netherlands)

    Bone, M.; Cloutier, R.L.; Gill, E.K.A.; Verma, D.


    There is increased recognition of the role of systems engineering in reducing the risk (technical, cost, and schedule) on complex space systems development and integration projects. A number of international systems engineering standards have been published in the last five years (ISO 15288, IEEE 12

  15. The Communications and Networks Collaborative Technology Alliance Publication Network: A Case Study on Graph and Simplicial Complex Analysis (United States)


    Definition and Background 20 3.2.1 Homology 21 3.2.2 Laplacian Matrices 23 iii 3.2.3 Representing Collaborations as a Simplicial Complex: The C&N CTA...G, Ziegler GM, editors. Polytopes—Combinatorics and Com- putation. Basel (Switzerland): Birkhäuser; 2000. p. 43–74. 51 1 (PDF) DEFENSE TECHNICAL

  16. Carbohydrate Content in the GDM Diet: Two Views: View 1: Nutrition Therapy in Gestational Diabetes: The Case for Complex Carbohydrates. (United States)

    Hernandez, Teri L


    IN BRIEF Restriction of dietary carbohydrate has been the cornerstone for treatment of gestational diabetes mellitus (GDM). However, there is evidence that a balanced liberalization of complex carbohydrate as part of an overall eating plan in GDM meets treatment goals and may mitigate maternal adipose tissue insulin resistance, both of which may promote optimal metabolic outcomes for mother and offspring.

  17. What Governs District Manager Decision Making? A Case Study of Complex Leadership in Dangme West District, Ghana

    NARCIS (Netherlands)

    Kwamie, Aku; Agyepong, Irene Akua; Dijk, Van Han


    Management and leadership in complex health systems
    have been little addressed as contributors toward improving maternal
    and newborn health. Widespread perceptions of weak district-level
    management and leadership have encouraged capacity strengthening
    interventions with a predominant

  18. Adaptive Capacity Within a Mega Project : A Case Study on Planning and Decision-Making in the Face of Complexity

    NARCIS (Netherlands)

    Giezen, Mendel; Bertolini, Luca; Salet, Willem


    There is a tendency in policy to reduce the complexity of planning and decision-making by simplifying both the process and the scope of projects. However, by framing a planning project's scope or process in a narrow way at an early stage, the possibility of adapting to changes in the context, and th

  19. Prenatal diagnosis of cerebral lesions in Tuberous sclerosis complex (TSC). Case report and review of the literature.

    NARCIS (Netherlands)

    Wortmann, S.B.; Reimer, A.G.; Creemers, J.W.; Mullaart, R.A.


    Tuberous sclerosis complex (TSC) is an autosomal-dominant neurocutaneous disorder with multi-organ involvement. The diagnosis is suspected at fetal ultrasound on the discovery of multiple cardiac rhabdomyomas (CRs). They typically develop in utero and undergo spontaneous regression during the first

  20. Randomization-Based Inference about Latent Variables from Complex Samples: The Case of Two-Stage Sampling (United States)

    Li, Tiandong


    In large-scale assessments, such as the National Assessment of Educational Progress (NAEP), plausible values based on Multiple Imputations (MI) have been used to estimate population characteristics for latent constructs under complex sample designs. Mislevy (1991) derived a closed-form analytic solution for a fixed-effect model in creating…

  1. Integrating seasonal optical and thermal infrared spectra to characterize urban impervious surfaces with extreme spectral complexity: a Shanghai case study (United States)

    Wang, Wei; Yao, Xinfeng; Ji, Minhe


    Despite recent rapid advancement in remote sensing technology, accurate mapping of the urban landscape in China still faces a great challenge due to unusually high spectral complexity in many big cities. Much of this complication comes from severe spectral confusion of impervious surfaces with polluted water bodies and bright bare soils. This paper proposes a two-step land cover decomposition method, which combines optical and thermal spectra from different seasons to cope with the issue of urban spectral complexity. First, a linear spectral mixture analysis was employed to generate fraction images for three preliminary endmembers (high albedo, low albedo, and vegetation). Seasonal change analysis on land surface temperature induced from thermal infrared spectra and coarse component fractions obtained from the first step was then used to reduce the confusion between impervious surfaces and nonimpervious materials. This method was tested with two-date Landsat multispectral data in Shanghai, one of China's megacities. The results showed that the method was capable of consistently estimating impervious surfaces in highly complex urban environments with an accuracy of R2 greater than 0.70 and both root mean square error and mean average error less than 0.20 for all test sites. This strategy seemed very promising for landscape mapping of complex urban areas.

  2. Learning from simple ebooks, online cases or classroom teaching when acquiring complex knowledge. A randomized controlled trial in respiratory physiology and pulmonology.

    Directory of Open Access Journals (Sweden)

    Bjarne Skjødt Worm

    Full Text Available BACKGROUND AND AIMS: E-learning is developing fast because of the rapid increased use of smartphones, tablets and portable computers. We might not think of it as e-learning, but today many new e-books are in fact very complex electronic teaching platforms. It is generally accepted that e-learning is as effective as classroom teaching methods, but little is known about its value in relaying contents of different levels of complexity to students. We set out to investigate e-learning effects on simple recall and complex problem-solving compared to classroom teaching. METHODS: 63 nurses specializing in anesthesiology were evenly randomized into three groups. They were given internet-based knowledge tests before and after attending a teaching module about respiratory physiology and pulmonology. The three groups was either an e-learning group with eBook teaching material, an e-learning group with case-based teaching or a group with face-to-face case-based classroom teaching. After the module the students were required to answer a post-test. Time spent and the number of logged into the system was also measured. RESULTS: For simple recall, all methods were equally effective. For problem-solving, the eCase group achieved a comparable knowledge level to classroom teaching, while textbook learning was inferior to both (p<0.01. The textbook group also spent the least amount of time on acquiring knowledge (33 minutes, p<0.001, while the eCase group spent significantly more time on the subject (53 minutes, p<0.001 and logged into the system significantly more (2.8 vs 1.6, p<0.001. CONCLUSIONS: E-learning based cases are an effective tool for teaching complex knowledge and problem-solving ability, but future studies using higher-level e-learning are encouraged.Simple recall skills, however, do not require any particular learning method.

  3. Critical analysis of the data on complexation of lanthanides and actinides by natural organic matter: particular case of humic substances; Analyse critique des donnees de complexation des lanthanides et actinides par la matiere organique naturelle: cas des substances humiques

    Energy Technology Data Exchange (ETDEWEB)

    Reiller, P.


    This document proposes a critical analysis of the models that describe the actinides and lanthanides complexation by natural organic matter in general and by humic substances in particular. In order to better delimit the particular properties of these substances the most influent physical and chemical properties on complexation are recalled as a preamble. Models as well as data that has been used are reviewed, compiled, and eventually compared to independent data in order to identify (i) their application domain, (ii) the possible simplifications which permit to obtain operational models, (iii) the conditions in which simplifications cannot be ascertained yet, and (iv) the data or fields of knowledge which are still too uncertain. A comparison between the different models is proposed in order to adapt parameters from one model to another minimising the experimental acquisitions, or at least to focus on missing data. Usually, data on the complexation of free ions M{sup z+} are reliable; as soon as hydrolysis, or competition with another ligand in general, in at stake data are much less reliable. Predictions from models are much more uncertain: formation of mixed complexes with hydroxide or carbonate anions is not univocal whatever the modelling strategy. Hints for transfer functions between models which are believed to be incompatible could be explored in order to justify necessary simplifications for using operational modelling. Influence on the solubility of oxides could be quantified, but it is difficult to clearly separate it from colloidal particles stabilisation. The account of the competition between cations by the models has also been tested. In view of the small number of available experimental data there still lie some uncertainties especially for the media that are close to neutrality and in the case of competition with magnesium, but overall in the case of the competition with aluminium and iron. The influence of redox activity of humic substances is

  4. Emergence of complex networks from diffusion on fractal lattices. A special case of the Sierpinski gasket and tetrahedron

    Energy Technology Data Exchange (ETDEWEB)

    Chełminiak, Przemysław, E-mail: [Faculty of Physics, A. Mickiewicz University, Umultowska 85, 61-614 Poznań (Poland)


    A new approach to the assemblage of complex networks displaying the scale-free architecture is proposed. While the growth and the preferential attachment of incoming nodes assure an emergence of such networks according to the Barabási–Albert model, it is argued here that the preferential linking condition needs not to be a principal rule. To assert this statement a simple computer model based on random walks on fractal lattices is introduced. It is shown that the model successfully reproduces the degree distributions, the ultra-small-worldness and the high clustering arising from the topology of scale-free networks. -- Highlights: ► A new mechanism of evolution for scale-free complex networks is proposed. ► The preferential attachment rule is not necessary to construct such networks. ► It is shown that they reveal some basic properties of classical scale-free nets.

  5. Theoretical models for a complex magnetic system: The case of CeNi{sub 1-x}Cu{sub x}

    Energy Technology Data Exchange (ETDEWEB)

    Marcano, N [Departamento de Fisica de la Materia Condensada, ICMA, CSIC-Universidad de Zaragoza, 50009 Zaragoza (Spain); Magalhaes, S G [Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul 97105-900 (Brazil); Coqblin, B [L.P.S., CNRS UMR 8502, Universite Paris-Sud, 91405-Orsay (France); Sal, J C Gomez; Espeso, J I [Departamento CITIMAC, Universidad de Cantabria, 39005 Santander (Spain); Zimmer, F M [Departamento de Fisica, Universidade do Estado de Santa Catarina, 89223-100, Joinville, SC (Brazil); Iglesias, J R, E-mail: marcanon@unizar.e [Instituto de Fisica, Universidade Federal do Rio Grande do Sul, 91501-970 Porto Alegre (Brazil)


    Special features in the phase diagram and in the low temperature hysteresis cycles have been experimentally observed in the complex CeNi{sub 1-x}Cu{sub x} system. We present also here theoretical approaches, based firstly on a Kondo lattice model which describes the coexistence between a spin glass or a cluster glass state, the Kondo regime and the ferromagnetic ordering. The second model is a Monte Carlo simulation on a 3D lattice with clusters and random anisotropy and reproduces the existence of steps in the magnetizations cycles at very low temperatures. The theoretical results are compared with the experimental data of the very complex magnetic behaviour of CeNi{sub 1-x}Cu{sub x} alloys. In particular, we can account for the existence of a cluster spin glass state which changes continuously into an inhomogeneous ferromagnetic phase at very low temperatures.


    Directory of Open Access Journals (Sweden)

    Kamen Kotsilkov


    Full Text Available INTRODUCTION: The modern Periodontology has various approaches to achieve a complete functional and aesthetic rehabilitation of the mucogingival complex. These techniques include application of flaps with apical or coronal advancement in order to achieve different treatment objectives. Complex cases with different pathology on adjacent teeth require several surgeries thereby increasing treatment time and patient discomfort. New combined approaches are needed to meet the challenges of such cases. OBJECTIVE: This report presents a case with a simultaneous application of a resective and a mucogingival technique in one dental sextant. METHODS: I.C. (36 with a localized chronic periodontitis, Miller Class I gingival recessions (13,14 and subgingival caries lesions (15,16. A combined approach with simultaneous crown lengthening with apically positioned flap for 16,15 and root coverage with enamel matrix derivate and a coronally advanced flap for 14,13 was applied in order to avoid multiple surgical procedures. RESULTS: On the third month after the surgical procedure a complete root coverage (13,14 was achieved. The crown lengthening procedure enabled the restoration of the caries lesions and the placement of new crowns (15,16. The result at the third year demonstrates a stable gingival margin with no recurrence of the gingival recessions. CONCLUSION: The applied combined procedure led to a complete resolution of the existing problems with a single surgery. The simultaneous application of different procedures seems a promising approach aimed to reduce the treatment time and to diminish patient discomfort.

  7. Use of synthesized data to support complex ad-hoc queries in an enterprise information warehouse: a diabetes use case. (United States)

    Rogers, Patrick; Erdal, Selnur; Santangelo, Jennifer; Liu, Jianhua; Schuster, Dara; Kamal, Jyoti


    The Ohio State University Medical Center (OSUMC) Information Warehouse (IW) is a comprehensive data warehousing facility incorporating operational, clinical, and biological data sets from multiple enterprise system. It is common for users of the IW to request complex ad-hoc queries that often require significant intervention by data analyst. In response to this challenge, we have designed a workflow that leverages synthesized data elements to support such queries in an more timely, efficient manner.

  8. Formation of metamorphic core complexes in non-over-thickened continental crust: A case study of Liaodong Peninsula (East Asia)


    Wang, Kun; Burov, Evgueni; Gumiaux, Charles; Chen, Yan; Lu, Gang; Mezri, Leila; Zhao, Liang


    International audience; Pre-thickened hot orogenic crust is often considered a necessary condition for the formation of continental metamorphic core complexes (MCCs). However, the discovery of MCCs in the Liaodong Peninsula, where the crust has a normal thickness (~ 35 km), challenges the universality of this scenario. Therefore, we implement a series of 2-D numerical thermo-mechanical modeling experiments in which we investigate the conditions of MCC formation in normal crusts, as well as th...

  9. Ambiguity in the Manifestation of Adult Separation Anxiety Disorder Occurring in Complex Anxiety Presentations: Two Clinical Case Reports (United States)

    Dudaee-Faass, Sigal; Marnane, Claire; Wagner, Renate


    Two case reports are described in which patients presented for the treatment of multiple comorbid anxiety disorders, all of which appeared to derive from prolonged separation anxiety disorder. In particular, these adults had effectively altered their lifestyles to avoid separation, thereby displaying only ambiguous separation anxiety symptoms that…

  10. Coinfection with Hymenolepis nana, Hymenolepis diminuta, Giardia intestinalis, and Human Immunodeficiency Virus: A Case Report with Complex Immunologic Interactions. (United States)

    Pérez-Chacón, Gladymar; Pocaterra, Leonor A; Rojas, Elsy; Hernán, Aurora; Jiménez, Juan Carlos; Núñez, Luz


    We describe the case of a 43-year-old human immunodeficiency virus-infected man receiving combined antiretroviral therapy and coinfected with Hymenolepis nana, Hymenolepis diminuta, and Giardia intestinalis, presenting as chronic diarrhea and critical weight loss. Immunological aspects of these interactions are reviewed.

  11. 复杂型直肠阴道瘘15例治疗经验%Treatment of complex rectovaginal fistula: an analysis of 15 cases

    Institute of Scientific and Technical Information of China (English)

    张士虎; 黄平; 程青


    Objective To evaluate the efficacy and clinical value of modified Bacon operation for repairing complex rectovaginal fistula.Methods 15 patients underwent modified Bacon operation for their complex rectovaginal fistula from February 2008 to June 2015 at the First Hospital Mfiliated to Nanjing Medical University,with 5 cases having open surgery and 10 cases laparoscopically.Results All operations were successful,all 15 cases were cured with good anal function and no relapse after follow-up for 6 months to 7 years.Conclusion The modified Bacon operation is safe,effective and feasible for complex rectovaginal fistula.%目的 评价改良Bacon术治疗复杂型直肠阴道瘘的疗效,探讨该术式治疗复杂型直肠阴道瘘的可行性.方法 2008年2月至2015年6月南京医科大学第一附属医院对15例复杂型直肠阴道瘘采用改良Bacon术手术治疗,其中经开腹途径5例,完全腹腔镜下途径10例.结果 15例复杂型直肠阴道瘘均一次手术治愈,随访6个月至7年,15例均无直肠阴道瘘复发,排便功能良好.结论 对于复杂型直肠阴道瘘,采用改良Bacon术是安全、有效、可行的.

  12. Ecohydrodynamics of cold-water coral reefs: a case study of the Mingulay Reef Complex (western Scotland.

    Directory of Open Access Journals (Sweden)

    Juan Moreno Navas

    Full Text Available Ecohydrodynamics investigates the hydrodynamic constraints on ecosystems across different temporal and spatial scales. Ecohydrodynamics play a pivotal role in the structure and functioning of marine ecosystems, however the lack of integrated complex flow models for deep-water ecosystems beyond the coastal zone prevents further synthesis in these settings. We present a hydrodynamic model for one of Earth's most biologically diverse deep-water ecosystems, cold-water coral reefs. The Mingulay Reef Complex (western Scotland is an inshore seascape of cold-water coral reefs formed by the scleractinian coral Lophelia pertusa. We applied single-image edge detection and composite front maps using satellite remote sensing, to detect oceanographic fronts and peaks of chlorophyll a values that likely affect food supply to corals and other suspension-feeding fauna. We also present a high resolution 3D ocean model to incorporate salient aspects of the regional and local oceanography. Model validation using in situ current speed, direction and sea elevation data confirmed the model's realistic representation of spatial and temporal aspects of circulation at the reef complex including a tidally driven current regime, eddies, and downwelling phenomena. This novel combination of 3D hydrodynamic modelling and remote sensing in deep-water ecosystems improves our understanding of the temporal and spatial scales of ecological processes occurring in marine systems. The modelled information has been integrated into a 3D GIS, providing a user interface for visualization and interrogation of results that allows wider ecological application of the model and that can provide valuable input for marine biodiversity and conservation applications.

  13. Ecohydrodynamics of cold-water coral reefs: a case study of the Mingulay Reef Complex (western Scotland). (United States)

    Moreno Navas, Juan; Miller, Peter I; Miller, Peter L; Henry, Lea-Anne; Hennige, Sebastian J; Roberts, J Murray


    Ecohydrodynamics investigates the hydrodynamic constraints on ecosystems across different temporal and spatial scales. Ecohydrodynamics play a pivotal role in the structure and functioning of marine ecosystems, however the lack of integrated complex flow models for deep-water ecosystems beyond the coastal zone prevents further synthesis in these settings. We present a hydrodynamic model for one of Earth's most biologically diverse deep-water ecosystems, cold-water coral reefs. The Mingulay Reef Complex (western Scotland) is an inshore seascape of cold-water coral reefs formed by the scleractinian coral Lophelia pertusa. We applied single-image edge detection and composite front maps using satellite remote sensing, to detect oceanographic fronts and peaks of chlorophyll a values that likely affect food supply to corals and other suspension-feeding fauna. We also present a high resolution 3D ocean model to incorporate salient aspects of the regional and local oceanography. Model validation using in situ current speed, direction and sea elevation data confirmed the model's realistic representation of spatial and temporal aspects of circulation at the reef complex including a tidally driven current regime, eddies, and downwelling phenomena. This novel combination of 3D hydrodynamic modelling and remote sensing in deep-water ecosystems improves our understanding of the temporal and spatial scales of ecological processes occurring in marine systems. The modelled information has been integrated into a 3D GIS, providing a user interface for visualization and interrogation of results that allows wider ecological application of the model and that can provide valuable input for marine biodiversity and conservation applications.

  14. Emergence of complex networks from diffusion on fractal lattices. A special case of the Sierpinski gasket and tetrahedron (United States)

    Chełminiak, Przemysław


    A new approach to the assemblage of complex networks displaying the scale-free architecture is proposed. While the growth and the preferential attachment of incoming nodes assure an emergence of such networks according to the Barabási-Albert model, it is argued here that the preferential linking condition needs not to be a principal rule. To assert this statement a simple computer model based on random walks on fractal lattices is introduced. It is shown that the model successfully reproduces the degree distributions, the ultra-small-worldness and the high clustering arising from the topology of scale-free networks.

  15. Evolution of DNA ligases of Nucleo-Cytoplasmic Large DNA viruses of eukaryotes: a case of hidden complexity

    Directory of Open Access Journals (Sweden)

    Koonin Eugene V


    Full Text Available Abstract Background Eukaryotic Nucleo-Cytoplasmic Large DNA Viruses (NCLDV encode most if not all of the enzymes involved in their DNA replication. It has been inferred that genes for these enzymes were already present in the last common ancestor of the NCLDV. However, the details of the evolution of these genes that bear on the complexity of the putative ancestral NCLDV and on the evolutionary relationships between viruses and their hosts are not well understood. Results Phylogenetic analysis of the ATP-dependent and NAD-dependent DNA ligases encoded by the NCLDV reveals an unexpectedly complex evolutionary history. The NAD-dependent ligases are encoded only by a minority of NCLDV (including mimiviruses, some iridoviruses and entomopoxviruses but phylogenetic analysis clearly indicated that all viral NAD-dependent ligases are monophyletic. Combined with the topology of the NCLDV tree derived by consensus of trees for universally conserved genes suggests that this enzyme was represented in the ancestral NCLDV. Phylogenetic analysis of ATP-dependent ligases that are encoded by chordopoxviruses, most of the phycodnaviruses and Marseillevirus failed to demonstrate monophyly and instead revealed an unexpectedly complex evolutionary trajectory. The ligases of the majority of phycodnaviruses and Marseillevirus seem to have evolved from bacteriophage or bacterial homologs; the ligase of one phycodnavirus, Emiliana huxlei virus, belongs to the eukaryotic DNA ligase I branch; and ligases of chordopoxviruses unequivocally cluster with eukaryotic DNA ligase III. Conclusions Examination of phyletic patterns and phylogenetic analysis of DNA ligases of the NCLDV suggest that the common ancestor of the extant NCLDV encoded an NAD-dependent ligase that most likely was acquired from a bacteriophage at the early stages of evolution of eukaryotes. By contrast, ATP-dependent ligases from different prokaryotic and eukaryotic sources displaced the ancestral NAD

  16. Linguistic and Cross-Cultural Complexities of A Specialized Legal Item: The ‘True And Fair’ Case

    Directory of Open Access Journals (Sweden)

    Annalisa Zanola


    The aim of our contribution is that of analysing the possible linguistic and cross-cultural contexts where the hendiadys true and fair was born, and exploring the meaning implications of the same ‘formula’ during the centuries. We start from the hypothesis that true and fair is a hendiadys, to show that the two terms take strength and completeness one from the other, so as to generate an only complex meaning, whose original usage was, last but not least,  a literary and poetical one. The analysis of the hendiadys moves from the non-legal to the legal context, following steps of the etymological and lexical research methodology.

  17. An Integrated Approach for Structural Characterization of Complex Solid State Electrolytes: The Case of Lithium Lanthanum Titanate

    Energy Technology Data Exchange (ETDEWEB)

    Cheng, Yongqiang [ORNL; Bi, [ORNL; Huq, Ashfia [ORNL; Feygenson, Mikhail [ORNL; Bridges, Craig A [ORNL; Paranthaman, Mariappan Parans [ORNL; Sumpter, Bobby G [ORNL


    Neutron scattering and first principles simulation are integrated to reveal the atomic-level to nanoscale structure of lithium lanthanum titanate (LLTO), a representative solid electrolyte material with applications in Li-ion batteries. The integrated approach solves the hierarchical local structure of LLTO in detail, including the coupled chemical order and topological distortion, as well as their correlation length scale and the spatial modulation with coherent boundaries. Ab initio molecular dynamics simulations are used to map out the distribution of the mobile ions and identify the migration pathway. Overall, this integrated approach provides a powerful means for detailed study of materials with complex local chemical and topological environment.

  18. Multi-Dimensional Analysis of Large, Complex Slope Instability: Case study of Downie Slide, British Columbia, Canada. (Invited) (United States)

    Kalenchuk, K. S.; Hutchinson, D.; Diederichs, M. S.


    Downie Slide, one of the world's largest landslides, is a massive, active, composite, extremely slow rockslide located on the west bank of the Revelstoke Reservoir in British Columbia. It is a 1.5 billion m3 rockslide measuring 2400 m along the river valley, 3300m from toe to headscarp and up to 245 m thick. Significant contributions to the field of landslide geomechanics have been made by analyses of spatially and temporally discriminated slope deformations, and how these are controlled by complex geological and geotechnical factors. Downie Slide research demonstrates the importance of delineating massive landslides into morphological regions in order to characterize global slope behaviour and identify localized events, which may or may not influence the overall slope deformation patterns. Massive slope instabilities do not behave as monolithic masses, rather, different landslide zones can display specific landslide processes occurring at variable rates of deformation. The global deformation of Downie Slide is extremely slow moving; however localized regions of the slope incur moderate to high rates of movement. Complex deformation processes and composite failure mechanism are contributed to by topography, non-uniform shear surfaces, heterogeneous rockmass and shear zone strength and stiffness characteristics. Further, from the analysis of temporal changes in landslide behaviour it has been clearly recognized that different regions of the slope respond differently to changing hydrogeological boundary conditions. State-of-the-art methodologies have been developed for numerical simulation of large landslides; these provide important tools for investigating dynamic landslide systems which account for complex three-dimensional geometries, heterogenous shear zone strength parameters, internal shear zones, the interaction of discrete landslide zones and piezometric fluctuations. Numerical models of Downie Slide have been calibrated to reproduce observed slope behaviour

  19. Case histories : implementation of new liner hanger technology in south central Venezuela significantly improves operations in complex wells

    Energy Technology Data Exchange (ETDEWEB)

    Jimenez, C.; Soto, S.; Leon, A. [PDVSA Petroleos de Venezuela SA, Caracas (Venezuela, Bolivarian Republic of); Marval, P.; Schoener-Scott, M. [Halliburton, Houston, TX (United States)


    Liner hangers are used in deep drilling operations to eliminate the need for full casing strings. However, conventional liner-hanger system do not always permit tool rotation, and liner-hanger failures can result in the complete loss of the wellbore. This study discussed an expandable liner hanger designed to withstand aggressive reaming as well as drilling to depths. Three case histories of wells located in southern Venezuela were used to compare the use of traditional and expandable liner hanger systems. The studies considered liner weight, and the pressure differentials caused by the use of positive seals. The study showed that conventional liner systems are not suited to the extreme environments of the Venezuelan heavy oil reserves. Multiple leak paths were observed. The expandable liner system provided a gas-tight seal, improved flow paths, and reduced the need for remedial cement jobs. It was concluded that use of the expandable systems also increased worker safety. 6 refs., 13 figs.

  20. Controversial identification in a historical case is illustrative of the complexity of DNA typing in forensic research. Response to Charlier et al. (United States)

    Larmuseau, Maarten H D; Cassiman, Jean-Jacques; Decorte, Ronny


    The previously published genetic identification of presumptive samples attributed to two French kings, Henri IV and Louis XVI, by Charlier et al., was recently refuted by a genetic genealogic approach. This (provisional) refutation illustrates the difficulties in confirming the identification of historical DNA samples using limited genetic data. Therefore, we want to stress the necessity of including the genetic genealogic approach--which relies on DNA typing of living relatives of the presumptive donor as a confirmed reference--to validate genetic results in historical cases. Moreover, the popularity and broad media coverage of such studies are useful in bringing awareness to the general public, non-DNA forensic experts and lawyers about the complexity of DNA typing in forensic cases.

  1. Multiple lesions of the conduction system in a case of cardiac rhabdomyosarcoma with complex arrhythmias. An anatomic and clinical study. (United States)

    Thiene, G; Miraglia, G; Menghetti, L; Nava, A; Rossi, L


    Anatomic and electrocardiographic correlations in a case of primary cardiac rhabdomyosarcoma are examined. Interatrial and atrioventricular conduction disturbances were associated with multiple lesions involving the alleged internodal pathways, together with atrial-atrioventricular nodal connections. The clinicopathologic findings seem to be consistent with the hypotheses of the functional and morphologic value of Bachmann's fascicle, and of the inherent pathways of interatrial and internodal conduction in health and disease.

  2. Shwachman-Diamond syndrome: a complex case demonstrating the potential for misdiagnosis as asphyxiating thoracic dystrophy (Jeune syndrome

    Directory of Open Access Journals (Sweden)

    Keogh Steven J


    Full Text Available Abstract Background The differential diagnosis of a neonate or fetus presenting with a bell-shaped or long narrow thorax includes a wide range of bony dysplasia syndromes. Where this is accompanied by respiratory distress, asphyxiating thoracic dystrophy (ATD, Jeune syndrome is an important potential diagnosis. Shwachman-Diamond syndrome (SDS is widely recognised as a cause of exocrine pancreatic dysfunction, short stature and bone marrow failure. It is not so well appreciated that rib and/or thoracic cage abnormalities occur in 30–50% of patients and that, in severe cases, these abnormalities may lead to thoracic dystrophy and respiratory failure in the newborn. There are, however, at least three previous case reports of children who were initially diagnosed with ATD who were subsequently shown to have SDS. Case presentation This report details the case history of a patient misdiagnosed as having ATD as a neonate following the neonatal asphyxial death of her brother. She subsequently developed progressive pancytopenia but was only diagnosed with SDS at 11 years of age after referral for haematopoietic stem cell transplantation for bone marrow failure accompanied by trilineage dysplasia and clonal cytogenetic abnormalities on bone marrow examination. Subsequent testing revealed the presence of fat globules in stools, reduced faecal chymotrypsin, fat-soluble vitamin deficiency, metaphyseal dysplasia on skeletal survey and heterozygous mutations of the SBDS gene. Conclusion This report highlights the potential for diagnostic confusion between ATD and SDS. It is important to include SDS in the differential diagnosis of newborns with thoracic dystrophy and to seek expert clinical and radiological assessment of such children.

  3. Hyperspectral Sensor Data Capability for Retrieving Complex Urban Land Cover in Comparison with Multispectral Data: Venice City Case Study (Italy

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    Federico Santini


    Full Text Available This study aims at comparing the capability of different sensors to detect land cover materials within an historical urban center. The main objective is to evaluate the added value of hyperspectral sensors in mapping a complex urban context. In this study we used: (a the ALI and Hyperion satellite data, (b the LANDSAT ETM+ satellite data, (c MIVIS airborne data and (d the high spatial resolution IKONOS imagery as reference. The Venice city center shows a complex urban land cover and therefore was chosen for testing the spectral and spatial characteristics of different sensors in mapping the urban tissue. For this purpose, an object-oriented approach and different common classification methods were used. Moreover, spectra of the main anthropogenic surfaces (i.e. roofing and paving materials were collected during the field campaigns conducted on the study area. They were exploited for applying band-depth and sub-pixel analyses to subsets of Hyperion and MIVIS hyperspectral imagery. The results show that satellite data with a 30m spatial resolution (ALI, LANDSAT ETM+ and HYPERION are able to identify only the main urban land cover materials.

  4. The complexity of crime network data: a case study of its consequences for crime control and the study of networks.

    Directory of Open Access Journals (Sweden)

    Amir Rostami

    Full Text Available The field of social network analysis has received increasing attention during the past decades and has been used to tackle a variety of research questions, from prevention of sexually transmitted diseases to humanitarian relief operations. In particular, social network analyses are becoming an important component in studies of criminal networks and in criminal intelligence analysis. At the same time, intelligence analyses and assessments have become a vital component of modern approaches in policing, with policy implications for crime prevention, especially in the fight against organized crime. In this study, we have a unique opportunity to examine one specific Swedish street gang with three different datasets. These datasets are the most common information sources in studies of criminal networks: intelligence, surveillance and co-offending data. We use the data sources to build networks, and compare them by computing distance, centrality, and clustering measures. This study shows the complexity factor by which different data sources about the same object of study have a fundamental impact on the results. The same individuals have different importance ranking depending on the dataset and measure. Consequently, the data source plays a vital role in grasping the complexity of the phenomenon under study. Researchers, policy makers, and practitioners should therefore pay greater attention to the biases affecting the sources of the analysis, and be cautious when drawing conclusions based on intelligence assessments and limited network data. This study contributes to strengthening social network analysis as a reliable tool for understanding and analyzing criminality and criminal networks.

  5. The complexity of crime network data: a case study of its consequences for crime control and the study of networks. (United States)

    Rostami, Amir; Mondani, Hernan


    The field of social network analysis has received increasing attention during the past decades and has been used to tackle a variety of research questions, from prevention of sexually transmitted diseases to humanitarian relief operations. In particular, social network analyses are becoming an important component in studies of criminal networks and in criminal intelligence analysis. At the same time, intelligence analyses and assessments have become a vital component of modern approaches in policing, with policy implications for crime prevention, especially in the fight against organized crime. In this study, we have a unique opportunity to examine one specific Swedish street gang with three different datasets. These datasets are the most common information sources in studies of criminal networks: intelligence, surveillance and co-offending data. We use the data sources to build networks, and compare them by computing distance, centrality, and clustering measures. This study shows the complexity factor by which different data sources about the same object of study have a fundamental impact on the results. The same individuals have different importance ranking depending on the dataset and measure. Consequently, the data source plays a vital role in grasping the complexity of the phenomenon under study. Researchers, policy makers, and practitioners should therefore pay greater attention to the biases affecting the sources of the analysis, and be cautious when drawing conclusions based on intelligence assessments and limited network data. This study contributes to strengthening social network analysis as a reliable tool for understanding and analyzing criminality and criminal networks.

  6. Planned complex suicide by penetrating captive-bolt gunshot and hanging: case study and review of the literature. (United States)

    Viel, Guido; Schröder, Ann Sophie; Püschel, Klaus; Braun, Christian


    Captive-bolt guns or slaughterer's guns are devices widely used in meat industry and private farmer households for slaughtering animal stocks. They consist of a simple cylindrical metal tube (barrel) with a metal bolt placed in their centre (around 9-15cm long and 1-1.5cm wide). The bolt is actuated by a trigger pull and is propelled forward by compressed air or by the discharge of a blank powder gun cartridge. Violent deaths inflicted by captive-bolt guns are rarely encountered in forensic practice and are predominantly suicidal events. We report an unusual complex suicide by hanging and self-shooting with a slaughterer's gun in a 21-year-old boy. The victim after putting a ceiling fixed rope around his neck shot himself in the head (occipital region) with a Kerner captive-bolt gun. He used two mirrors (a cosmetic mirror and a man-sized one) in order to properly visualize his back and to target the occipital region of his head. Radiological data (computed tomography with three dimensional reconstruction) and autopsy findings are discussed according to the clinical and forensic literature. A brief review on planned complex suicides is also given.

  7. Microsatellite marker development by multiplex ion torrent PGM sequencing: a case study of the endangered Odorrana narina complex of frogs. (United States)

    Igawa, Takeshi; Nozawa, Masafumi; Nagaoka, Mai; Komaki, Shohei; Oumi, Shohei; Fujii, Tamotsu; Sumida, Masayuki


    The endangered Ryukyu tip-nosed frog Odorrana narina and its related species, Odorrana amamiensis, Odorrana supranarina, and Odorrana utsunomiyaorum, belong to the family Ranidae and are endemically distributed in Okinawa (O. narina), Amami and Tokunoshima (O. amamiensis), and Ishigaki and Iriomote (O. supranarina and O. utsunomiyaorum) Islands. Because of varying distribution patterns, this species complex is an intrinsic model for speciation and adaptation. For effective conservation and molecular ecological studies, further genetic information is needed. For rapid, cost-effective development of several microsatellite markers for these and 2 other species, we used next-generation sequencing technology of Ion Torrent PGM™. Distribution patterns of repeat motifs of microsatellite loci in these modern frog species (Neobatrachia) were similarly skewed. We isolated and characterized 20 new microsatellite loci of O. narina and validated cross-amplification in the three-related species. Seventeen, 16, and 13 loci were cross-amplified in O. amamiensis, O. supranarina, and O. utsunomiyaorum, respectively, reflecting close genetic relationships between them. Mean number of alleles and expected heterozygosity of newly isolated loci varied depending on the size of each inhabited island. Our findings suggested the suitability of Ion Torrent PGM™ for microsatellite marker development. The new markers developed for the O. narina complex will be applicable in conservation genetics and molecular ecological studies.

  8. SURFACE AREA AND MICRO-ROUGHNESS OF VOLCANIC ASH PARTICLES: A case study, Acigol Volcanic Complex, Cappadocia, Central Turkiye (United States)

    Ersoy, O.; Aydar, E.; Sen, E.; Atici, G.


    Every single ash particle may convey information about its own formation environment and conditions. Certain features on particles may give a hint about the fragmentation regime, the intensity of fragmentation and quantity of water that partakes in the fragmentation process, etc. On this account, this study majored in the analysis on finer pyroclastic material, namely volcanic ash particles. Here, we used volcanic ash particles from Quaternary Acigol Volcanic complex (West of Nevsehir, Cappadocia, Central Turkiye). Quaternary Acigol Volcanic complex lies between the towns of Nevsehir and Acigol. It consists of a shallow caldera, a thick pyroclastic apron, seven obsidian dome clusters, and scattered cinder cones and associated lavas (Druitt et al., 1995). The products of explosive volcanism of the region were distinguished as two main Quaternary tuffs by a recent study (Druitt et al., 1995). Samples are from ashfall beds in a sequence of intercalated pumice fall, ashfall, and ignimbrite beds. In this study in order to achieve surface properties of volcanic ash particles, surface areas and micro-roughness of ash particles were measured on digital elevation models (DEM) reconstructed from stereoscopic images acquired on Scanning Electron Microscope (SEM) at varying specimen tilt angles. Correlation between surface texture of volcanic ash particles and eruption characteristics was determined.

  9. [Health and work: the case of the gas emissions at the Industrial Complex of Mayagüez]. (United States)

    Cruz Chaulissant, M


    This article describes the effects of gas emissions on the health of the workers (mostly women) of garment Industry at the Guanajibo Industrial Complex in Mayagüez. The persons affected show the following diseases and conditions: peripherial neuropathy, alteration of time and space orientation, damage to the pulmonary system and the respiratory tract, allergies, degenerative diseases, and even death. The agencies concerned have been negligent alleging that the problem is caused by stress of mass hysteria, this without performing the necessary studies. Having evaluated the problem, the Committee concludes that its roots are in the establishment in Puerto Rico of industries without considering the negative effects over health due to the contamination they generate, and which they do not control properly, all to maintain jobs that in the long run will not solve our problems, but will surely affect the health of the people.

  10. Deep brain stimulation for Tourette’s syndrome: the case for targeting the thalamic centromedian-parafascicular complex.

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    Paola Testini


    Full Text Available Tourette syndrome is a neurologic condition characterized by both motor and phonic tics and is typically associated with psychiatric comorbidities, including obsessive-compulsive disorder/behavior and attention deficit hyperactivity disorder and can be psychologically and socially debilitating. It is considered a disorder of the cortico-striato-thalamo-cortical circuitry, as suggested by pathophysiology studies and therapeutic options. Among these, deep brain stimulation of the centromedian-parafascicular nuclear complex (CM-Pf of the thalamus is emerging as a valuable treatment modality for patients affected by severe, treatment resistant TS. Here we review the most recent experimental evidence for the pivotal role of CM-Pf in the pathophysiology of Tourette syndrome, discuss potential mechanisms of action that may mediate the effects of CM-Pf deep brain stimulation in Tourette syndrome, and summarize its clinical efficacy.

  11. Probing Effective Hamiltonian Operators by Single-Crystal EPR: A Case Study Using Dinuclear Cr(III) Complexes. (United States)

    Morsing, Thorbjørn J; Weihe, Høgni; Bendix, Jesper


    The use of a simple two-center model to describe exchange-coupled systems of various complexities is common in the field of coordination chemistry and molecular magnetism. In this work we investigate the applicability of this model experimentally, employing multifrequency, single-crystal EPR on axial dinuclear chromium(III) systems amenable to accurate parametrizations. The very high confidence with which zero-field splitting parameters can be determined by this technique, applied to the systems in question, allows for an in-depth analysis of the modeling. We experimentally demonstrate and qualitatively account for the energy-dependent modification of the spin-multiplet anisotropies, which is introduced by the exchange interaction. Even for the simple systems under consideration, we find that the standard modeling provides an inadequate parametrization of experimental data, and we present a convenient model extension, which improves the description.

  12. Thermodynamics of complexes formation by ITC in methanol/water = 9/1 (v/v) solution: A case study

    Energy Technology Data Exchange (ETDEWEB)

    Fisicaro, Emilia, E-mail: [University of Parma, Department of Pharmacy, Parco Area delle Scienze, 27/A, 43124 Parma (Italy); Compari, Carlotta; Bacciottini, Franco; Contardi, Laura [University of Parma, Department of Pharmacy, Parco Area delle Scienze, 27/A, 43124 Parma (Italy); Carcelli, Mauro; Rispoli, Gabriele; Rogolino, Dominga [University of Parma, Department of Chemistry, Parco Area delle Scienze, 17/A, 43124 Parma (Italy)


    Graphical abstract: Integrase strand transfert inhibitors chelate the metal ions in the active site of HIV integrase. - Highlights: • Development of inhibitors acting against those viral enzymes operating via a cooperative two-metal ion mechanism, such as HIV integrase (IN), requires optimizing the binding affinity to the target. • We have defined an experimental procedure for obtaining reliable thermodynamic data by ITC in methanol/water = 9/1 (v/v) as solvent. • Formation heats in mixed solvent of the complexes formed by a ligand, model of Raltegravir, with Mg(II), Mn(II), Co(II) and Zn(II) are here reported. - Abstract: Most enzymes that participate in the biochemistry of nucleic acids require divalent metal ion cofactors to promote activity. Development of potent inhibitors, acting against those viral enzymes operating via a cooperative two-metal ion mechanism, such as HIV integrase (IN) and RNase H, hepatitis C virus polymerase and influenza endonuclease, requires optimizing the binding affinity to the target, which is dictated by the binding free energy composed of both enthalpic and entropic contributions. They can be obtained by using isothermal titration microcalorimetry. We have defined an experimental procedure for obtaining reliable thermodynamic data in methanol/water = 9/1 0.1 M KCl as solvent, used to overcome solubility problems. In this way we have measured the heats of formation of the complexes formed by N-(4-fluorobenzyl)-5-hydroxy-2-isopropyl-1-methyl-6-oxo-1, 6-dihydroxypyrimidine-4-carboxylate (HL, a model of Raltegravir, the antiretroviral drug produced by Merck and Co.), and a series of divalent metal ions of biological interest (Mg(II), Mn(II), Co(II) and Zn(II)), whose speciation was previously determined by potentiometry.

  13. Selection, characterisation and mapping of complex electrochemical processes at individual single-walled carbon nanotubes: the case of serotonin oxidation. (United States)

    Güell, Aleix G; Meadows, Katherine E; Dudin, Petr V; Ebejer, Neil; Byers, Joshua C; Macpherson, Julie V; Unwin, Patrick R


    The electrochemical (EC) oxidation of the neurotransmitter, serotonin, at individual single-walled carbon nanotubes (SWNTs) is investigated at high resolution using a novel platform that combines flow-aligned SWNTs with atomic force microscopy, Raman microscopy, electronic conductance measurements, individual SWNT electrochemistry and high-resolution scanning electrochemical cell microscopy (SECCM). SECCM has been used to visualise the EC activity along side-wall sections of metallic SWNTs to assess the extent to which side-walls promote the electrochemistry of this complex multi-step process. Uniform and high EC activity is observed that is consistent with significant reaction at the side-wall, rather than electrochemistry being driven by defects alone. By scanning forward and reverse (trace and retrace) over the same region of a SWNT, it is also possible to assess any blocking of EC activity by serotonin oxidation reaction products. At a physiologically relevant concentration (5 μM), there is no detectable blocking of SWNTs, which can be attributed, at least in part, to the high diffusion rate to an individual, isolated SWNT in the SECCM format. At higher serotonin concentration (2 mM), oligomer formation from oxidation products is much more significant and major blocking of the EC process is observed from line profiles recorded as the SECCM meniscus moves over an SWNT. The SECCM line profile morphology is shown to be highly diagnostic of whether blocking occurs during EC processes. The studies herein add to a growing body of evidence that various EC processes at SWNTs, from simple outer sphere redox reactions to complex multi-step processes, occur readily at pristine SWNTs. The platform described is of general applicability to various types of nanostructures and nanowires.

  14. Clinical, pathological, and genetic evaluations of Chinese patient with otodental syndrome and multiple complex odontoma: Case report. (United States)

    Liu, Anqi; Wu, Meiling; Guo, Xiaohe; Guo, Hao; Zhou, Zhifei; Wei, Kewen; Xuan, Kun


    Otodental syndrome is a rare autosomal-dominant disease characterized by globodontia, associated with sensorineural, high-frequency hearing loss. Here, we describe the clinical, pathological, and genetic evaluations of a 9-year-old girl with otodental syndrome and multiple complex odontoma.The patient presented with a draining sinus tract in her left cheek, globodontia, and hearing loss. The odontomas which caused the cutaneous sinus tracts were extracted because of the odontogenic infection. The extracted odontoma and primary tooth was studied by micro-CT and further observed histopathologically. The micro-CT findings revealed that the primary tooth had three crowns with two separated pulp chambers, and their root canals were partially fused. The histological findings showed abnormal morphologies of odontoblasts and dentin, hyperplasia of enamel, and malformation of odontogenic epithelium. Furthermore, DNA sequencing and analyze of deafness associated gene GJB2, GJB3, and PDS had not revealed any SNP or mutation; but exon 3 of the causative gene FGF3 could not be amplified, which may be associated with the microdeletion at chromosome 11q13.3. Three month after surgery, the patient was found to be asymptomatic and even the evidence of the extra-oral sinus had disappeared.The dental abnormality of otodental syndrome included congenital missing teeth, globodontia, and multiple complex odontoma. Globodontia exhibited characteristic features of fusion teeth. In addition, gene FGF3 haploinsufficiency was likely to be the cause of otodental syndrome. The report provides some new information in the field of otodental syndrome, which would make dentists more familiar with this disease.

  15. A Complex Systems Approach to Energy Poverty in sub-Saharan Africa: Nigeria as a Case Study (United States)

    Chidebell Emordi, Chukwunonso

    Energy poverty is pervasive in sub-Saharan Africa. Nigeria, located in sub-Saharan West Africa, is the world's seventh largest oil exporting country and is a resource-rich nation. It however experiences the same levels of energy poverty as most of its neighboring countries. Attributing this paradox only to corruption or the "Dutch Disease", where one sector booms at the expense of other sectors of the economy, is simplistic and enervates attempts at reform. In addition, data on energy consumption is aggregated at the national level via estimates, disaggregated data is virtually non-existent. Finally, the wave of decentralization of vertically integrated national utilities sweeping the developing world has caught on in sub-Saharan Africa. However, little is known of the economic and social implications of these transitions within the unique socio-technical system of the region's electricity sector, especially as it applies to energy poverty. This dissertation proposes a complex systems approach to measuring and mitigating energy poverty in Nigeria due to its multi-dimensional nature. This is done via a three-fold approach: the first section of the study delves into causation by examining the governance institutions that create and perpetuate energy poverty; the next section proposes a context-specific minimum energy poverty line based on field data collected on energy consumption; and the paper concludes with an indicator-based transition management framework encompassing institutional, economic, social, and environmental themes of sustainable transition within the electricity sector. This work contributes to intellectual discourse on systems-based mitigation strategies for energy poverty that are widely applicable within the sub-Saharan region, as well as adds to the knowledge-base of decision-support tools for addressing energy poverty in its complexity.

  16. Submandibular cellulitis (Ludwig's angina) associated to a complex odontoma erupted into the oral cavity. Case report and literature review. (United States)

    Bertolai, R; Acocella, A; Sacco, R; Agostini, T


    The clinical presentation of Ludwig's angina consists in a severe expanding cellulitis causing swelling of the floor of the mouth, tongue and submandibular region, thus resulting in a possible obstruction of the airway and in a rapid progress in deep neck soft tissue infection and mediastinitis with potentially fatal consequences. Frequently, submandibular cellulitis develops from an acute infection spreading from the lower molar teeth. Mandibular fractures, traumatic laceration of the floor of the mouth, and peritonsillar abscesses are other concomitant clinical features. A case of Ludwig's angina associated with a large erupted odontoma and with a deeply impacted third molar displaced to the border of the mandible is described. The patient was affected by enlargement of submandibular space, marked face swelling causing an evident face deformity, tenderness and redness of the neck and limited movement of the neck and mouth. In the past, Ludwig's angina was frequently fatal, however aggressive surgical and medical therapy have significantly reduced the mortality rate. The reported case can be considered as important, not only because of the rarity of the odontoma eruption in the oral cavity, but mainly for the extent of the clinical manifestation of a lesion usually described in literature as asymptomatic.

  17. Applying genetic algorithms in a parallel computing environment for optimising parameters of complex cellular automata models: the case of SCIDDICA S3hex (United States)

    D'Ambrosio, D.; Iovine, G.


    Cellular Automata (CA) offer a valid alternative to the classic approach, based on partial differential equation, in order to simulate complex phenomena, when these latter can be described in terms of local interactions among their constituent parts. SCIDDICA S3hex is a two-dimensional hexagonal CA model developed for simulating debris flows: it has recently been applied to several real cases of landslides occurred in Campania (Southern Italy). The release S3hex has been derived by progressively improving an initial simplified CA model, originally derived for simulating simple cases of flow-type landslides. The model requires information related to topography, thickness of erodable regolith overlying the bedrock, and location and extension of landslide sources. Performances depend on a set of global parameters which are utilised in the transition function of the model: their value affect the elementary processes of the transition function and thus the overall results. A fine calibration is therefore an essential phase, in order to evaluate the reliability of the model for successive applications to debris-flow susceptibility zonation. The complexity of both the model and the phenomena to be simulated suggested to employ an automated technique of evaluation, for the determination of the best set of global parameters. Genetic Algorithms (GA) are a powerful optimization tool inspired to natural selection. In the last decades, in spite of their intrinsic simplicity, they have largely been successfully applied on a wide number of highly complex problems. The calibration of the model could therefore be performed through such technique of optimisation, by considering several real cases of study. Owing to the large number of simulations generally needed for performing GA experiments on complex phenomena, which imply long lasting tests on sequential computational architectures, the adoption of a parallel computational environment seemed appropriate: the original source code

  18. Joint impact of rainfall and tidal level on flood risk in a coastal city with a complex river network: a case study for Fuzhou city, China

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    J. J. Lian


    Full Text Available Coastal cities are particularly vulnerable to flood under the combined effect of multivariable variables, such as heavy rainfall, high sea level and large waves. For better assessment and management of flood risk the combined effect and joint probability should be considered. This paper aims to study the joint impact of rainfall and tidal level on flood risk by estimating the combined risk degree of flood and the joint flood probability. The area of case study is a typical coastal city in China, which has a complex river system. The flood in this city is mainly caused by inundation of river system. In this paper, the combined risk degree of flood is assessed by analyzing the behavior of the complex river network of the city under the combined effect of rainfall and tidal level with diverse return periods. The hydraulic model of the complex drainage network is established using HEC-RAS and verified by comparing the simulation results with the observed data during Typhoon "Longwang". The joint distribution and combined risk probability of rainfall and tidal level are estimated using the optimal copula function. The work carried out in this paper would facilitate assessment of flood risk significantly, which can be referred for the similar cities.

  19. Mycobacterium tuberculosis Complex and HIV Co-Infection among Extrapulmonary Tuberculosis Suspected Cases at the University of Gondar Hospital, Northwestern Ethiopia.

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    Alemu Fanosie

    Full Text Available Extrapulmonary Tuberculosis (EPTB and Human Immunodeficiency Virus (HIV infection are interrelated as a result of immune depression. The aim of this study was to determine the prevalence of Mycobacterium tuberculosis complex isolates and the burden of HIV co-infection among EPTB suspected patients.An institution based cross-sectional study was conducted among EPTB suspected patients at the University of Gondar Hospital. Socio-demographic characteristics and other clinical data were collected using a pretested questionnaire. GeneXpert MTB/RIF assay was performed to diagnosis Mycobacterium tuberculosis complex and Rifampicin resistance. All samples were also investigated by cytology and culture. The HIV statuses of all patients were screened initially by KHB, and all positive cases were further re-tested by STAT-pack. Data was analyzed using SPSS version 20 computer software and a P-value of < 0.05 was taken as statistically significant.A total of 141 extrapulmonary suspected patients were enrolled in this study. The overall prevalence of culture confirmed extrapulmonary tuberculosis infection was 29.8%, but the GeneXpert result showed a 26.2% prevalence of Mycobacterium tuberculosis complex infection. The 78.4% prevalence of extrapulmonary tuberculosis infection was found to be higher among the adult population. The prevalence of HIV infection among EPTB suspected patients was 14.1%, while it was 32.4% among GeneXpert-confirmed extrapulmonary TB cases (12/37. Tuberculosis lymphadenitis was the predominant (78.4% type of EPTB infection followed by tuberculosis cold abscess (10.7%. Adult hood, previous history of contact with known pulmonary tuberculosis patients, and HIV co-infection showed a statistically significant association with extrapulmonary tuberculosis infection (P<0.013.The prevalence of culture confirmed-EPTB infection was high, and a higher EPTB-HIV co-infection was also observed.

  20. Thermographic mapping of a complex vernacular settlement: the case study of Casalnuovo District within the Sassi of Matera (Italy) (United States)

    Cardinale, Tiziana; Balestra, Alessandro; Cardinale, Nicola


    Never as in the Sassi of Matera (Italy), the parties have a volumetric material identity and a special construction condition for which, first of all, you need to know the whole to which they give life, and then the individual components and their connections. The distribution of these building artifacts in symbiotic connection with the connective calcareous texture that hosts them, resulted in a spontaneously harmonious figurative balance that characterizes the constructive expedients employed and the distributive and morphological solutions. This is the reason why the Sassi, and the overlooking Park of Rupestrian Churches of Matera Murgia have been entered in 1993 in the UNESCO World Heritage List. Our research focuses on a largely abandoned area within the Casalnuovo District, situated in the extreme south of the city, probably the place of the future Demoethnoanthropological Museum. It is known today that the particular shape of the area is made up of settlements mainly in cave; during the time architectures above ground, in a very limited number, filled almost completely the limited building space. Here there are the most archaic types and forms of building and wine cellars within the Sassi, essentially derive from the natural cave only slightly structured by man. The exterior construction complete the elementary cave and it is called lamione. The complexity of a built space like this one determines the need for a non-traditional approach, so you have to combine last generation tools and canonical ones for survey and energy diagnosis within a dialectic between memory, tradition and innovation, in order to identify solutions for an environment friendly recover of a cultural heritage such this one. Since the evaluation of the historical buildings conservation state using destructive techniques should be avoided to prevent the integrity of the cultural heritage, the development of non-destructive and non-contact techniques is very important. For this reason, an

  1. Integrated package approach in delivering interventions during immunisation campaigns in a complex environment in Papua New Guinea: a case study. (United States)

    Vince, John David; Datta, Siddhartha Sankar; Toikilik, Steven; Lagani, William


    Papua New Guinea's difficult and varied topography, poor transport infrastructure, changing dynamics of population and economy in recent times and understaffed and poorly financed health service present major challenges for successful delivery of vaccination and other preventative health interventions to both the rural majority and urban populations, thereby posing risks for vaccine preventable disease outbreaks in the country. The country has struggled to meet the vaccination coverage targets required for the eradication of poliomyelitis and elimination of measles. Escalation of inter and intra country migration resulting from major industrial developments, particularly in extraction industries, has substantially increased the risk of infectious disease importation. This case study documents the evolution of immunisation programmes since the introduction of supplementary immunisation activities (SIAs). Single antigen SIAs have advantages and disadvantages. In situations in which the delivery of preventative health interventions is difficult, it is likely that the cost benefit is greater for multiple than for single intervention. The lessons learned from the conduct of single antigen SIAs can be effectively used for programmes delivering multiple SIA antigens, routine immunisations, and other health interventions. This paper describes a successful and cost effective multiple intervention programme in Papua New Guinea. The review of the last SIA in Papua New Guinea showed relatively high coverage of all the interventions and demonstrated the operational feasibility of delivering multiple interventions in resource constrained settings. Studies in other developing countries such as Lesotho and Ethiopia have also successfully integrated health interventions with SIA. In settings such as Papua New Guinea there is a strong case for integrating supplementary immunisation activity with routine immunisation and other health interventions through a comprehensive outreach

  2. SDHB immunohistochemistry: A useful tool in the diagnosis of Carney-Stratakis and Carney triad gastrointestinal stromal tumors

    NARCIS (Netherlands)

    J. Gaal (José); C.A. Stratakis (Constantine); M. Carney; E.R. Ball (Evan R.); E. Korpershoek (Esther); M.B. Lodish (Maya Beth); I. Levy (Isaac); P. Xekouki (Paraskevi); F.H. van Nederveen (Francien); M.A. den Bakker (Michael); M.J. O'Sullivan (Maureen); W.N.M. Dinjens (Winand); R.R. de Krijger (Ronald)


    textabstractMutations in the tumor suppressor genes SDHB, SDHC, and SDHD (or collectively SDHx) cause the inherited paraganglioma syndromes, characterized by pheochromocytomas and paragangliomas. However, other tumors have been associated with SDHx mutations, such as gastrointestinal stromal tumors

  3. Evaluating Complex Mixtures in the Zebrafish Embryo by Reconstituting Field Water Samples: A Metal Pollution Case Study

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    Ellen D. G. Michiels


    Full Text Available Accurately assessing the toxicity of complex, environmentally relevant mixtures remains an important challenge in ecotoxicology. The goal was to identify biological effects after exposure to environmental water samples and to determine whether the observed effects could be explained by the waterborne metal mixture found in the samples. Zebrafish embryos were exposed to water samples of five different sites originating from two Flemish (Mol and Olen, Belgium metal contaminated streams: “Scheppelijke Nete” (SN and “Kneutersloop” (K, and a ditch (D, which is the contamination source of SN. Trace metal concentrations, and Na, K, Mg and Ca concentrations were measured using ICP-MS and were used to reconstitute site-specific water samples. We assessed whether the effects that were observed after exposure to environmental samples could be explained by metal mixture toxicity under standardized laboratory conditions. Exposure to “D” or “reconstituted D” water caused 100% mortality. SN and reconstituted SN water caused similar effects on hatching, swim bladder inflation, growth and swimming activity. A canonical discriminant analysis confirmed a high similarity between both exposure scenarios, indicating that the observed toxicity was indeed primarily caused by metals. The applied workflow could be a valuable approach to evaluate mixture toxicity that limits time and costs while maintaining biological relevance.

  4. Evaluating Complex Mixtures in the Zebrafish Embryo by Reconstituting Field Water Samples: A Metal Pollution Case Study (United States)

    Michiels, Ellen D. G.; Vergauwen, Lucia; Hagenaars, An; Fransen, Erik; Dongen, Stefan Van; Van Cruchten, Steven J.; Bervoets, Lieven; Knapen, Dries


    Accurately assessing the toxicity of complex, environmentally relevant mixtures remains an important challenge in ecotoxicology. The goal was to identify biological effects after exposure to environmental water samples and to determine whether the observed effects could be explained by the waterborne metal mixture found in the samples. Zebrafish embryos were exposed to water samples of five different sites originating from two Flemish (Mol and Olen, Belgium) metal contaminated streams: “Scheppelijke Nete” (SN) and “Kneutersloop” (K), and a ditch (D), which is the contamination source of SN. Trace metal concentrations, and Na, K, Mg and Ca concentrations were measured using ICP-MS and were used to reconstitute site-specific water samples. We assessed whether the effects that were observed after exposure to environmental samples could be explained by metal mixture toxicity under standardized laboratory conditions. Exposure to “D” or “reconstituted D” water caused 100% mortality. SN and reconstituted SN water caused similar effects on hatching, swim bladder inflation, growth and swimming activity. A canonical discriminant analysis confirmed a high similarity between both exposure scenarios, indicating that the observed toxicity was indeed primarily caused by metals. The applied workflow could be a valuable approach to evaluate mixture toxicity that limits time and costs while maintaining biological relevance. PMID:28257097

  5. Geostatistical analysis to identify hydrogeochemical processes in complex aquifers: a case study (Aguadulce unit, Almeria, SE Spain). (United States)

    Daniele, Linda; Pulido Bosch, Antonio; Vallejos, Angela; Molina, Luis


    The Aguadulce aquifer unit in southeastern Spain is a complex hydrogeological system because of the varied lithology of the aquifer strata and the variability of the processes that can take place within the unit. Factorial analysis of the data allowed the number of variables to be reduced to 3 factors, which were found to be related to such physico-chemical processes as marine intrusion and leaching of saline deposits. Variographic analysis was applied to these factors, culminating in a study of spatial distribution using ordinary kriging. Mapping of the factors allowed rapid differentiation of some of the processes that affect the waters of the Gador carbonate aquifer within the Aguadulce unit, without the need to recur to purely hydrogeochemical techniques. The results indicate the existence of several factors related to salinity: marine intrusion, paleowaters, and/or leaching of marls and evaporitic deposits. The techniques employed are effective, and the results conform to those obtained using hydrogeochemical methods (vertical records of conductivity and temperature, ion ratios, and others). The findings of this study confirm that the application of such analytical methods can provide a useful assessment of factors affecting groundwater composition.

  6. A case-study of complex gas-water-rock-pollutants interactions in shallow groundwater: Šalek Valley (Slovenia) (United States)

    Giammanco, Salvatore; Justin, Barbara; Speh, Natalija; Veder, Marta


    The complex geochemical interactions in the groundwater of the industrial area of Šalek Valley (Slovenia) between natural and anthropogenic fluids were studied by means of major (Ca, Mg, Na, K, HCO3 -, Cl- and SO4 2-) and trace elements’ (As , Cd, Cu, Pb, Zn, Hg, Se and V) abundances, geochemical classification and statistical analysis of data. Cation abundances indicate mixing between a dolomitic end-member and an evaporitic or geothermal end-member. Anion abundances indicate mixing between bicarbonate waters and either sulphate-enriched waters (suggesting hydrothermalism) or chlorine-rich waters. Principal component analysis (PCA) allowed the extraction of seven factors, which describe, respectively: water-rock interaction mainly on dolomitic rocks; redox conditions of water; Cd-Zn enrichment in chlorine-rich waters (probably from industrial wastes); hydrothermal conditions in waters close to major faults; Pb and Cu pollution; V and K enrichments, indicating their common organic source; the role of partial pressure of CO2 dissolved in water, which is highest in three wells with bubbling gases. Average underground discharge rates of solutes from the Valley range between 0.09 t/a (V) and 1.8 × 104 t/a (HCO3 -) and indicate how natural fluids can significantly contribute to the levels of elements in the environment, in addition to the amount of elements released by human activities.

  7. Skills based constraints and complexities affecting small-scale-entrepreneurship: A case of communal cattle farmers in Vhembe District

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    Mavhungu Abel Mafukata


    Full Text Available This paper investigates constraints and complexities affecting entrepreneurial and Agri-business small-scale farming success and sustainability in the Vhembe District of Limpopo Province, South Africa. The respondent entrepreneur farmers were purposively selected (n=55 amongst 183 other farmers in the district for primary data collection through a semi-structured cross-language (Tshivenda questionnaire. Key Informant Interviews (KIIs and Focus Group Discussions (FGDs also formed part of data collection instruments. The results of this paper revealed that the entrepreneur farmers’ formal school educational levels and basic literacy skills in addition; subtraction; multiplication and division were reasonably higher while technological skills in farm risk management and production, and managerial competence in business financial skills; budgeting and marketing were low. Government sponsored extension service could be employed to improve some of these deficient skills through skills training amongst the entrepreneur farmers. Since the study area is in the proximity of the University of Venda and Madzivhandila Agricultural Colleges, these institutions could be enlisted to provide skills training to the entrepreneur farmers.

  8. Fidelity and moderating factors in complex interventions: a case study of a continuum of care program for frail elderly people in health and social care

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    Hasson Henna


    Full Text Available Abstract Background Prior studies measuring fidelity of complex interventions have mainly evaluated adherence, and not taken factors affecting adherence into consideration. A need for studies that clarify the concept of fidelity and the function of factors moderating fidelity has been emphasized. The aim of the study was to systematically evaluate implementation fidelity and possible factors influencing fidelity of a complex care continuum intervention for frail elderly people. Methods The intervention was a systematization of the collaboration between a nurse with geriatric expertise situated at the emergency department, the hospital ward staff, and a multi-professional team with a case manager in the municipal care services for older people. Implementation was evaluated between September 2008 and May 2010 with observations of work practices, stakeholder interviews, and document analysis according to a modified version of The Conceptual Framework for Implementation Fidelity. Results A total of 16 of the 18 intervention components were to a great extent delivered as planned, while some new components were added to the model. No changes in the frequency or duration of the 18 components were observed, but the dose of the added components varied over time. Changes in fidelity were caused in a complex, interrelated fashion by all the moderating factors in the framework, i.e., context, staff and participant responsiveness, facilitation, recruitment, and complexity. Discussion The Conceptual Framework for Implementation Fidelity was empirically useful and included comprehensive measures of factors affecting fidelity. Future studies should focus on developing the framework with regard to how to investigate relationships between the moderating factors and fidelity over time. Trial registration, NCT01260493.

  9. Acute unstable complex radial head and neck fractures fixed with a mini T-shaped plate in a 20-year-old man: a case report

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    Yu W


    Full Text Available Weiguang Yu,1,* Jun Hu,1,* Xinchao Zhang,2 Xingfei Zhu,2 Yinfeng Xu,1 Jianhua Yi,1 Yunjiang Liu1 1Department of Orthopedics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, 2Department of Orthopedics, Jinshan Hospital, Fudan University, Shanghai, People’s Republic of China *These authors contributed equally to this work Abstract: Acute unstable complex radial head and neck fractures in adults are seldom reported in the literature. Early recognition and appropriate management are essential to prevent long-term consequences of the loss of elbow function, forearm rotation, and chronic pain. Here, we describe an unusual case of a 20-year-old man who exhibited acute unstable complex fractures of the head and neck of the right radius without other injuries or comorbidity. An open reduction and mini T-shaped plate fixation were performed within 3 hours after injury, and the results were satisfactory. A long plaster fixation was continued for 3 weeks. A gradual mobilization was started after the removal of the plaster under the supervision of a physiotherapist. At the 12-month follow-up, no complications associated with the use of the mini T-shaped plate were noted, and the Mayo Elbow Performance Score was 97 (excellent. To our knowledge, acute unstable complex radial head and neck fractures in adults can be successfully treated with a mini T-shaped plate reconstruction technique. Keywords: unstable complex fractures, mini T-shaped plate, radial head, internal fixation, radial head replacement

  10. Improvement of pain and regional osteoporotic changes in the foot and ankle by low-dose bisphosphonate therapy for complex regional pain syndrome type I: a case series

    Directory of Open Access Journals (Sweden)

    Wada Takuro


    Full Text Available Abstract Introduction Complex regional pain syndrome is characterized by pain, allodynia, hyperalgesia, edema, signs of vasomotor instability, movement disorders, joint stiffness, and regional osteopenia. It is recognized to be difficult to treat, despite various methods of treatment, including physiotherapy, calcitonin, corticosteroids, sympathetic blockade, and nonsteroidal anti-inflammatory drugs. Pathophysiologically, complex regional pain syndrome reveals enhanced regional bone resorption and high bone turnover, and so bisphosphonates, which have a potent inhibitory effect on bone resorption, were proposed for the treatment of complex regional pain syndrome. Case presentation A 48-year-old Japanese man with complex regional pain syndrome type I had severe right ankle pain with a visual analog scale score of 59 out of 100 regardless of treatment with physiotherapy and nonsteroidal anti-inflammatory drugs for five months. Radiographs showed marked regional osteoporotic changes and bone scintigraphy revealed a marked increase in radioactivity in his ankle. One month after the start of oral administration of risedronate (2.5 mg per day, his bone pain had fallen from a VAS score of 59 out of 100 to 18 out of 100. Bone scintigraphy at 12 months showed a marked reduction in radioactivity to a level comparable to that in his normal, left ankle. On the basis of these results, the treatment was discontinued at 15 months. At 32 months, our patient had almost no pain and radiographic findings revealed that the regional osteoporotic change had returned to normal. A second 48-year-old Japanese man with complex regional pain syndrome type I had severe right foot pain with a visual analog scale score of 83 out of 100 regardless of treatment with physiotherapy and nonsteroidal anti-inflammatory drugs for nine months. Radiographs showed regional osteoporotic change in his phalanges, metatarsals, and tarsals, and bone scintigraphy revealed a marked increase

  11. Diagnosis and treatment for 60 cases of complex acetabular fractures at posterior wall%60例复杂髋臼后壁骨折的诊治

    Institute of Scientific and Technical Information of China (English)

    张昊; 胡亚威; 陈少初; 菅新民; 张弦; 周建华; 卢学有; 钱东阳


    目的:探讨复杂髋臼后壁骨折的诊断及手术疗效。方法自2008年1月至2013年3月,以三种体位X线平片、CT扫描、CT三维图像重建技术诊断髋臼后柱合并后壁骨折42例、横形骨折合并后壁骨折18例。采用俯卧位Kocher-Langenbeck 入路,开放复位髋臼重建接骨板和拉力螺钉固定,治疗复杂髋臼后壁骨折。结果按Matta 评定标准,骨折解剖复位率80.49%、满意复位率8.54%、不满意复位率10.97%。术后早期并发症:坐骨神经损伤1例,股神经损伤1例,髂外动脉损伤血栓形成1例,下肢深静脉血栓形成2例;晚期并发症:异位骨化3例,股骨头坏死1例,髋关节创伤性关节炎2例。结论复杂髋臼后壁骨折正确诊断主要依靠骨盆前后位、闭孔斜位、髂骨斜位X线平片检查,对于判断髋臼骨折部位、类型非常重要,CT扫描提供髋臼冠状面骨折线、骨折块等清晰图像,为复杂髋臼后壁骨折的治疗,提供选择手术入路和内固定术方案有重要意义。%Objective To analyze the diagnosis and therapeutic efficacy of the surgery for complex acetabular fractures at the posterior wall .Methods From January 2008 to March 2013, 60 cases of complex acetabular fractures were enrolled .X ray images of three positions , CT scans were performed and three dimentional image reconstruction technique of CT was used to diagnose the fractures .Among the 60 cases, 42 cases were complex acetabular fractures in posterior column and posterior wall , and 18 cases were transverse fracture combining posterior wall fracture of the acetabulum .All the patients underwent surgical treatment which applied Kocher-Langenbeck approach with prone position , open reduction and steel plates and lag screws fixation to reconstruct the acetabulum .Results According to Matta standards , the anatomical reduction rate was 80.49%, the rate of satisfied reduction was 8.54%, and the rate of

  12. Genesis of emulsion texture due to magma mixing: a case study from Chotanagpur Granite Gneiss Complex of Eastern India (United States)

    Gogoi, Bibhuti; Saikia, Ashima; Ahmad, Mansoor


    The emulsion texture is a rare magma mixing feature in which rounded bodies of one magmatic phase remain dispersed in the other coherent phase (Freundt and Schmincke, 1992). This type of special texture in hybrid rocks can significantly contribute toward understanding the mechanisms facilitating magma mixing and magma chamber dynamics involving two disparate magmas as the exact processes by which mixing occurs still remain unclear. Recent developments in microfluidics have greatly helped us to understand the complex processes governing magma mixing occurring at micro-level. Presented work uses some of the results obtained from microfluidic experiments with a view to understand the formation mechanism of emulsions preserved in the hybrid rocks of the Ghansura Rhyolite Dome (GRD) of Proterozoic Chotanagpur Granite Gneiss Complex (CGGC), Eastern India. The GRD has preserved hybrid rocks displaying emulsion texture that formed due to the interaction of a phenocryst-rich basaltic magma and host rhyolite magma. The emulsions are more or less spherical in shape and dominantly composed of amphibole having biotite rinds set in a matrix of biotite, plagioclase, K-feldspar and quartz. Amphibole compositions were determined from the core of the emulsions to the rim with a view to check for cationic substitutions. The amphibole constituting the emulsions is actinolite in composition, and commonly shows tschermakite (Ts) and pargasite (Prg) substitutions. From petrographical and mineral-chemical analyses we infer that when mafic magma, containing phenocrysts of augite, came in contact with felsic magma, diffusion of cations like H+, Al3+and others occurred from the felsic to the mafic system. These cations reacted with the clinopyroxene phenocrysts in the mafic magma to form amphibole (actinolite) crystals. The formation of amphibole crystals in the mafic system greatly increased the viscosity of the system allowing the amphibole crystals to venture into the adjacent felsic

  13. ITS polymorphisms shed light on hybrid evolution in apomictic plants: a case study on the Ranunculus auricomus complex. (United States)

    Hodač, Ladislav; Scheben, Armin Patrick; Hojsgaard, Diego; Paun, Ovidiu; Hörandl, Elvira


    The reconstruction of reticulate evolutionary histories in plants is still a major methodological challenge. Sequences of the ITS nrDNA are a popular marker to analyze hybrid relationships, but variation of this multicopy spacer region is affected by concerted evolution, high intraindividual polymorphism, and shifts in mode of reproduction. The relevance of changes in secondary structure is still under dispute. We aim to shed light on the extent of polymorphism within and between sexual species and their putative natural as well as synthetic hybrid derivatives in the Ranunculus auricomus complex to test morphology-based hypotheses of hybrid origin and parentage of taxa. We employed direct sequencing of ITS nrDNA from 68 individuals representing three sexuals, their synthetic hybrids and one sympatric natural apomict, as well as cloning of ITS copies in four representative individuals, RNA secondary structure analysis, and landmark geometric morphometric analysis on leaves. Phylogenetic network analyses indicate additivity of parental ITS variants in both synthetic and natural hybrids. The triploid synthetic hybrids are genetically much closer to their maternal progenitors, probably due to ploidy dosage effects, although exhibiting a paternal-like leaf morphology. The natural hybrids are genetically and morphologically closer to the putative paternal progenitor species. Secondary structures of ITS1-5.8S-ITS2 were rather conserved in all taxa. The observed similarities in ITS polymorphisms suggest that the natural apomict R. variabilis is an ancient hybrid of the diploid sexual species R. notabilis and the sexual species R. cassubicifolius. The additivity pattern shared by R. variabilis and the synthetic hybrids supports an evolutionary and biogeographical scenario that R. variabilis originated from ancient hybridization. Concerted evolution of ITS copies in R. variabilis is incomplete, probably due to a shift to asexual reproduction. Under the condition of

  14. ITS polymorphisms shed light on hybrid evolution in apomictic plants: a case study on the Ranunculus auricomus complex.

    Directory of Open Access Journals (Sweden)

    Ladislav Hodač

    Full Text Available The reconstruction of reticulate evolutionary histories in plants is still a major methodological challenge. Sequences of the ITS nrDNA are a popular marker to analyze hybrid relationships, but variation of this multicopy spacer region is affected by concerted evolution, high intraindividual polymorphism, and shifts in mode of reproduction. The relevance of changes in secondary structure is still under dispute. We aim to shed light on the extent of polymorphism within and between sexual species and their putative natural as well as synthetic hybrid derivatives in the Ranunculus auricomus complex to test morphology-based hypotheses of hybrid origin and parentage of taxa. We employed direct sequencing of ITS nrDNA from 68 individuals representing three sexuals, their synthetic hybrids and one sympatric natural apomict, as well as cloning of ITS copies in four representative individuals, RNA secondary structure analysis, and landmark geometric morphometric analysis on leaves. Phylogenetic network analyses indicate additivity of parental ITS variants in both synthetic and natural hybrids. The triploid synthetic hybrids are genetically much closer to their maternal progenitors, probably due to ploidy dosage effects, although exhibiting a paternal-like leaf morphology. The natural hybrids are genetically and morphologically closer to the putative paternal progenitor species. Secondary structures of ITS1-5.8S-ITS2 were rather conserved in all taxa. The observed similarities in ITS polymorphisms suggest that the natural apomict R. variabilis is an ancient hybrid of the diploid sexual species R. notabilis and the sexual species R. cassubicifolius. The additivity pattern shared by R. variabilis and the synthetic hybrids supports an evolutionary and biogeographical scenario that R. variabilis originated from ancient hybridization. Concerted evolution of ITS copies in R. variabilis is incomplete, probably due to a shift to asexual reproduction. Under the

  15. Using mitochondrial and nuclear sequence data for disentangling population structure in complex pest species: a case study with Dermanyssus gallinae. (United States)

    Roy, Lise; Buronfosse, Thierry


    Among global changes induced by human activities, association of breakdown of geographical barriers and impoverishered biodiversity of agroecosystems may have a strong evolutionary impact on pest species. As a consequence of trade networks' expansion, secondary contacts between incipient species, if hybrid incompatibility is not yet reached, may result in hybrid swarms, even more when empty niches are available as usual in crop fields and farms. By providing important sources of genetic novelty for organisms to adapt in changing environments, hybridization may be strongly involved in the emergence of invasive populations. Because national and international trade networks offered multiple hybridization opportunities during the previous and current centuries, population structure of many pest species is expected to be the most intricate and its inference often blurred when using fast-evolving markers. Here we show that mito-nuclear sequence datasets may be the most helpful in disentangling successive layers of admixture in the composition of pest populations. As a model we used D. gallinae s. l., a mesostigmatid mite complex of two species primarily parasitizing birds, namely D. gallinae L1 and D. gallinae s. str. The latter is a pest species, considered invading layer farms in Brazil. The structure of the pest as represented by isolates from both wild and domestic birds, from European (with a focus on France), Australian and Brazilian farms, revealed past hybridization events and very recent contact between deeply divergent lineages. The role of wild birds in the dissemination of mites appears to be null in European and Australian farms, but not in Brazilian ones. In French farms, some recent secondary contact is obviously consecutive to trade flows. Scenarios of populations' history were established, showing five different combinations of more or less dramatic bottlenecks and founder events, nearly interspecific hybridizations and recent population mixing within D

  16. Using mitochondrial and nuclear sequence data for disentangling population structure in complex pest species: a case study with Dermanyssus gallinae.

    Directory of Open Access Journals (Sweden)

    Lise Roy

    Full Text Available Among global changes induced by human activities, association of breakdown of geographical barriers and impoverishered biodiversity of agroecosystems may have a strong evolutionary impact on pest species. As a consequence of trade networks' expansion, secondary contacts between incipient species, if hybrid incompatibility is not yet reached, may result in hybrid swarms, even more when empty niches are available as usual in crop fields and farms. By providing important sources of genetic novelty for organisms to adapt in changing environments, hybridization may be strongly involved in the emergence of invasive populations. Because national and international trade networks offered multiple hybridization opportunities during the previous and current centuries, population structure of many pest species is expected to be the most intricate and its inference often blurred when using fast-evolving markers. Here we show that mito-nuclear sequence datasets may be the most helpful in disentangling successive layers of admixture in the composition of pest populations. As a model we used D. gallinae s. l., a mesostigmatid mite complex of two species primarily parasitizing birds, namely D. gallinae L1 and D. gallinae s. str. The latter is a pest species, considered invading layer farms in Brazil. The structure of the pest as represented by isolates from both wild and domestic birds, from European (with a focus on France, Australian and Brazilian farms, revealed past hybridization events and very recent contact between deeply divergent lineages. The role of wild birds in the dissemination of mites appears to be null in European and Australian farms, but not in Brazilian ones. In French farms, some recent secondary contact is obviously consecutive to trade flows. Scenarios of populations' history were established, showing five different combinations of more or less dramatic bottlenecks and founder events, nearly interspecific hybridizations and recent

  17. A Retrospective Study of Causes of Low Vision in Saud Arabia, A Case of Eye World Medical Complex in Riyadh. (United States)

    Z Alotaibi, Abdullah


    Vision is the ability of seeing with a definite understanding of features, color and contrast, and to distinguish between objects visually. In the year 1999, the World Health Organization (WHO) and the International Agency for the Prevention of Blindness formulated a worldwide project for the eradication of preventable loss of sight with the subject of "Vision 2020: the Right to Sight". This global program aims to eradicate preventable loss of sight by the year 2020. This study was conducted to determine the main causes of low vision in Saudi Arabia and also to assess their visual improvement after using low vision aids (LVD).The study is a retrospective study and was conducted in low vision clinic at Eye World Medical Complex in Riyadh, Saudi Arabia. The file medical record of 280 patients attending low vision clinics from February 2008 to June 2010 was included. A data sheet was filled which include: age, gender, cause of low vision, unassisted visual acuity for long distances and short distances, low vision devices needed for long distances and short distances that provides best visual acuity. The result shows that the main cause of low vision was Optic atrophy (28.9%). Retinitis pigmentosa was the second cause of low vision, accounting for 73 patients (26%) followed by Diabetic retinopathy and Macular degeneration with 44 patients (15.7%) and 16 patients (5.7%) respectively. Inter family marriage could be one of the main causes of low vision. Public awareness should be embarked on for enlightenment on ocular diseases result in consanguineous marriage. Also, it is an important issue to start establishing low vision clinics in order to improve the situation.

  18. Formation of metamorphic core complexes in non-over-thickened continental crust: A case study of Liaodong Peninsula (East Asia) (United States)

    Wang, Kun; Burov, Evgueni; Gumiaux, Charles; Chen, Yan; Lu, Gang; Mezri, Leila; Zhao, Liang


    Pre-thickened hot orogenic crust is often considered a necessary condition for the formation of continental metamorphic core complexes (MCCs). However, the discovery of MCCs in the Liaodong Peninsula, where the crust has a normal thickness (~ 35 km), challenges the universality of this scenario. Therefore, we implement a series of 2-D numerical thermo-mechanical modeling experiments in which we investigate the conditions of MCC formation in normal crusts, as well as the relationships between the underlying mechanisms and the syn-rift basin evolution. In these experiments, we explore the impact of the lithostratigraphic and thermo-rheological structure of the crust. We also examine the lithosphere thickness, strain softening, extension rate, and surface erosion/ sedimentation processes. The experiments demonstrate that high thermal gradients and crustal heterogeneities result only in a symmetric spreading dome, which is geometrically incompatible with the observations of the MCCs in the Liaodong Peninsula. According to our further findings, the strain softening should play a key role in the development of asymmetric strain localization and domal topography uplift, while synchronous surface erosion controls the polarity of the syn-rift basin. The synthetic model data are compatible with the geological observations and cooling history based on the thermo-chronology for the eastern part of the East Asia during the late Mesozoic to the early Cenozoic. The model-predicted P-T-t paths are essentially different from those inferred for the other known MCCs, confirming the exceptional character of the MCC formation in the wide rift system of the East Asia.

  19. 新生儿复杂型心脏病1例并11例文献复习%1 case report of complex newborn heart disease and review of 11 cases reports

    Institute of Scientific and Technical Information of China (English)

    吴慧; 杨基龙


    Objective To investigate risk factors, clinical features and diagnostic experiences of complex neonatal single ventricle congenital heart disease, so as to provide basis for diagnosing and preventing this disease better. Methods Data of one case of newbern single atrium, single ventricle and persistent truncus arteriosus were reported and 11 cases reports of same disease seen in the past 10 years in our country were reviewed. Results The mothers of 5 cases had a determined history of abnormal pregnancy and/or history of viral infection during early pregnancy, history of exposure to toxins. 8 neonates with complex congenital heart diseases presented with dyspnea,facial cyanosis and other clinical manifestations within 24 hours after birth, and their cyanosis was difficult to be corrected by oxygen inhalation. 9 cases of complex congenital heart diseases were diagnozed with color Doppler ultrasonography, and diagnoses of 3 cases were confirmed by pathological autopsy. The prognosis of neonates with this disease was poor, 4 neonates died several days after birth, 6 neonates were given up treatment by their family members, 1 neonate improved and discharged afar treatment, only 1 neonate survived up to 11 years of age when the diagnosis was determined. Conclusion The causes of congenital heart disease are complex, at present the researchers considered preliminarily that complex congenital heart disease is related to genetic and environmental factors as well as viral infections, drugs, radiation and other related exposures. Clinical manifestations of heart failure and changes in radiogram of the neonate are not typical. Cardiac color Doppler ultrasonography is a non-invasive, rapid, highly accurate and most valuable method to early identify and diagnose congenital heart disease in neonatal period. The key measures to prevent neonatal congenital heart disease include strengthening maternal health, preventing maternal infections, strengthening prenatal examination and

  20. 40Ar- 39Ar dating of detrital muscovite in provenance investigations: a case study from the Adelaide Rift Complex, South Australia (United States)

    Haines, Peter W.; Turner, Simon P.; Kelley, Simon P.; Wartho, Jo-Anne; Sherlock, Sarah C.


    Detrital zircon ages are commonly used to investigate sediment provenance and supply routes. Here, we explore the advantages of employing multiple, complimentary techniques via a case study of the Neoproterozoic and Cambrian of the Adelaide Rift Complex, South Australia. Detrital muscovite Ar-Ar ages are presented from stratigraphic units, or equivalents, that have previously been the subject of U-Pb detrital zircon dating, and, in some cases, whole-rock Sm-Nd isotope studies. The zircon age ranges and whole-rock Sm-Nd isotope data suggest that early Neoproterozoic sediments from near the base of the Adelaide Rift Complex comprise a mixture of detritus derived from the adjacent Gawler Craton (Palaeoproterozoic to earliest Mesoproterozoic) and overlying Gairdner flood basalts. In contrast, detrital muscovites from this level have a broad scatter of Mesoproterozoic infrared (IR) laser total fusion Ar-Ar ages, while UV laser traverses indicate that the age spread reflects partial resetting by multiple heating events, rather than a mixture of sources. Younger Neoproterozoic sediments document replacement of the Gawler Craton by the more distant Musgrave and/or Albany-Fraser Orogens as the main provenance. The Cambrian Kanmantoo Group marks an abrupt change in depositional style and a new sediment source. The Kanmantoo Group have older Nd model ages than underlying strata, yet are dominated by near to deposition-aged (˜500-650 Ma) detrital zircons and muscovites, suggesting rapid cooling and exhumation of a tectonically active provenance region. Although this source remains uncertain, evidence points towards the distant Pan-African orogenic belts. Deposition in the Adelaide Rift Complex was terminated in the late Early Cambrian by the Delamerian Orogeny, and the results of previous detrital mineral dating studies from the Lachlan Fold Belt to the east are consistent with at least partial derivation of these sediments from reworked upper Adelaide Rift Complex (Kanmantoo

  1. Using learning networks to understand complex systems: a case study of biological, geophysical and social research in the Amazon. (United States)

    Barlow, Jos; Ewers, Robert M; Anderson, Liana; Aragao, Luiz E O C; Baker, Tim R; Boyd, Emily; Feldpausch, Ted R; Gloor, Emanuel; Hall, Anthony; Malhi, Yadvinder; Milliken, William; Mulligan, Mark; Parry, Luke; Pennington, Toby; Peres, Carlos A; Phillips, Oliver L; Roman-Cuesta, Rosa Maria; Tobias, Joseph A; Gardner, Toby A


    Developing high-quality scientific research will be most effective if research communities with diverse skills and interests are able to share information and knowledge, are aware of the major challenges across disciplines, and can exploit economies of scale to provide robust answers and better inform policy. We evaluate opportunities and challenges facing the development of a more interactive research environment by developing an interdisciplinary synthesis of research on a single geographic region. We focus on the Amazon as it is of enormous regional and global environmental importance and faces a highly uncertain future. To take stock of existing knowledge and provide a framework for analysis we present a set of mini-reviews from fourteen different areas of research, encompassing taxonomy, biodiversity, biogeography, vegetation dynamics, landscape ecology, earth-atmosphere interactions, ecosystem processes, fire, deforestation dynamics, hydrology, hunting, conservation planning, livelihoods, and payments for ecosystem services. Each review highlights the current state of knowledge and identifies research priorities, including major challenges and opportunities. We show that while substantial progress is being made across many areas of scientific research, our understanding of specific issues is often dependent on knowledge from other disciplines. Accelerating the acquisition of reliable and contextualized knowledge about the fate of complex pristine and modified ecosystems is partly dependent on our ability to exploit economies of scale in shared resources and technical expertise, recognise and make explicit interconnections and feedbacks among sub-disciplines, increase the temporal and spatial scale of existing studies, and improve the dissemination of scientific findings to policy makers and society at large. Enhancing interaction among research efforts is vital if we are to make the most of limited funds and overcome the challenges posed by addressing large

  2. A convergence zone triggering deep convection over complex terrain: COSMO simulations of a case study from COPS (United States)

    Barthlott, Ch.; Schipper, J. W.; Kalthoff, N.; Adler, B.; Kottmeier, Ch.


    A case study of an isolated deep convective cell from the Convective and Orographically induced Precipitation Study (COPS) is analysed with respect to its representation in the numerical weather prediction model of the Deutscher Wetterdienst COSMO-DE. The international field campaign COPS was performed in southwestern Germany and eastern France in summer 2007 as part of the Priority Programme SPP 1167 of the Deutsche Forschungsgemeinschaft (DFG). The overall goal of COPS was to advance the quality of forecasts of orographically-induced convective precipitation by four-dimensional observations and modeling of its life cycle. On July 15, deep convection developed in an area east of the Black Forest crest although convective available potential energy (CAPE) was only moderate and convective inhibition (CIN) was high. Data analysis revealed that convection was triggered by the superposition of a synoptically generated eastward moving mesoscale convergence zone and a thermally induced convergence zone along the mountain crests in the northern Black Forest. More in the south, radar observations also showed a convergence line hours before a single cell was initiated. The question if these convergence lines are connected can not be answered by measurements only. In the standard configuration (2.8 km grid resolution), COSMO simulations reveal a near-surface convergence line and the evolution of a line of low clouds northeast of Freiburg in good agreement with radar and satellite observations. In addition, model-derived values of CAPE were high (> 2000 J/kg) accompanied by almost vanishing CIN. However, no deep convective cell developed out of this line of clouds. For an improved representation of orographic effects, simulations with 1 km grid resolution were performed and compared to the results of the standard configuration. Although both simulations did not initiate deep convection, the results suggest hat in a situation with air mass convection without mid

  3. Successful Treatment of Phantom Limb Pain by 1 Hz Repetitive Transcranial Magnetic Stimulation Over Affected Supplementary Motor Complex: A Case Report (United States)

    Lee, Jong-Hoo; Byun, Jeong-Hyun; Choe, Yu-Ri; Lim, Seung-Kyu; Lee, Ka-Young


    A 37-year-old man with a right transfemoral amputation suffered from severe phantom limb pain (PLP). After targeting the affected supplementary motor complex (SMC) or primary motor cortex (PMC) using a neuro-navigation system with 800 stimuli of 1 Hz repetitive transcranial magnetic stimulation (rTMS) at 85% of resting motor threshold, the 1 Hz rTMS over SMC dramatically reduced his visual analog scale (VAS) of PLP from 7 to 0. However, the 1 Hz rTMS over PMC failed to reduce pain. To our knowledge, this is the first case report of a successfully treated severe PLP with a low frequency rTMS over SMC in affected hemisphere. PMID:26361601

  4. Assessment of the ARW-WRF model over complex terrain: the case of the Stellenbosch Wine of Origin district of South Africa (United States)

    Soltanzadeh, Iman; Bonnardot, Valérie; Sturman, Andrew; Quénol, Hervé; Zawar-Reza, Peyman


    Global warming has implications for thermal stress for grapevines during ripening, so that wine producers need to adapt their viticultural practices to ensure optimum physiological response to environmental conditions in order to maintain wine quality. The aim of this paper is to assess the ability of the Weather Research and Forecasting (WRF) model to accurately represent atmospheric processes at high resolution (500 m) during two events during the grapevine ripening period in the Stellenbosch Wine of Origin district of South Africa. Two case studies were selected to identify areas of potentially high daytime heat stress when grapevine photosynthesis and grape composition were expected to be affected. The results of high-resolution atmospheric model simulations were compared to observations obtained from an automatic weather station (AWS) network in the vineyard region. Statistical analysis was performed to assess the ability of the WRF model to reproduce spatial and temporal variations of meteorological parameters at 500-m resolution. The model represented the spatial and temporal variation of meteorological variables very well, with an average model air temperature bias of 0.1 °C, while that for relative humidity was -5.0 % and that for wind speed 0.6 m s-1. Variation in model performance varied between AWS and with time of day, as WRF was not always able to accurately represent effects of nocturnal cooling within the complex terrain. Variations in performance between the two case studies resulted from effects of atmospheric boundary layer processes in complex terrain under the influence of the different synoptic conditions prevailing during the two periods.

  5. Connections and consequences in complex systems: insights from a case study of the emergence and local impact of crisis resolution and home treatment services. (United States)

    Hannigan, Ben


    In this article the broad contours of a complexity perspective are outlined. Complexity ideas are then drawn on to frame an empirical examination of the connections running between different levels of organisation in health and social care, and to underpin investigation into the intended and unintended local system consequences of service development. Data are used from a study conducted in the UK's mental health field. Here, macro-level policy has led to the supplementing of longstanding community mental health teams by newer, more specialised, services. An example includes teams providing crisis resolution and home treatment (CRHT) care as an alternative to hospital admission. Using an embedded case study design, where 'the case' examined was a new CRHT team set in its surrounding organisational environment, ethnographic data (with interviews predominating) were generated in a single site in Wales over 18 months from the middle of 2007. In a large-scale context favourable to local decision-making, and against a background of a partial and disputed evidence base, the move to establish the new standalone service was contested. Whilst users valued the work of the team, and local practitioners recognised the quality of its contribution, powerful effects were also triggered across the locality's horizontal interfaces. Participants described parts of the interconnected system being closed to release resources, staff gravitating to new crisis services leaving holes elsewhere, and the most needy service users being cared for by the least experienced workers. Some community mental health team staff described unexpected increases in workload, and disputes over eligibility for crisis care with implications for system-wide working relations. Detailed data extracts are used to illustrate these connections and consequences. Concluding lessons are drawn on the use of evidence to inform policy, on the significance of local contexts and system interfaces, and on anticipating the

  6. Efficacy of Anakinra for Various Types of Crystal-Induced Arthritis in Complex Hospitalized Patients: A Case Series and Review of the Literature

    Directory of Open Access Journals (Sweden)

    A. Aouba


    Full Text Available Background. There are few data on anakinra use after failure of conventional medications for crystal-induced peripheral arthritis and/or crowned dens syndrome among complex hospitalized patients. Methods. We retrospectively analyzed the outcome of six patients affected with subacute crystal-induced arthritis who had received anakinra in second or third line therapy, including three patients with crowned dens syndrome and three others with gouty arthritis. Patients’ comorbidities, reasons for anakinra use and associated drugs, and outcomes were recorded. Results. All patients presented with elevated inflammatory syndrome, systemic symptoms with poly/oligoarthritis. Except for absolute contraindications, all patients were previously treated with full or decreased dose of NSAID, colchicine, and/or glucocorticoids, with unsatisfactory response. All three gouty patients exhibited complete responses in all acute involvements under anakinra within 3 to 5 days, including one of them who needed the reintroduction of colchicine treatment that was previously unsuccessful. Crowned dens syndrome patients, including two with pseudogout and one with subacute hydroxyapatite deposition disease, needed 9 to 11 days to achieve complete response. Tolerance to anakinra was good. Conclusion. In case series of complex hospitalized patients, anakinra showed good activity in crowned dens syndrome and associated crystal-induced peripheral arthritis, with longer treatment duration than in gouty arthritis.

  7. The complex clinical issues involved in an athlete's decision to retire from collision sport due to multiple concussions: a case study of a professional athlete

    Directory of Open Access Journals (Sweden)

    Andrew eGardner


    Full Text Available The issue of retirement from athletic participation due to repetitive concussive injuries remains controversial. The complexity of providing recommendations to elite athletes is highlighted by the prospect that offering inappropriate advice may foreseeably lead to engagement in a medico-legal challenge. Currently no evidenced-based, scientifically validated guidelines for forming the basis of such a decision exist. The current paper discusses the complexities of this challenge in addition to presenting a case study of a professional athlete. A number of central issues to consider when discussing athlete retirement revolve around the player’s medical and concussion histories, the current clinical profile, the athlete’s long-term life goals and understanding of the potential long-terms risks. Ensuring that thorough investigations of all possible differential diagnosis, that may explain the presenting symptoms, are conducted is also essential. Discussion pertaining to recommendations for guiding the clinical approach to the retirement issue for athletes with a history of multiple concussions is presented.

  8. Genetic analysis of TOR complex gene variation with human longevity: a nested case-control study of American men of Japanese ancestry. (United States)

    Morris, Brian J; Donlon, Timothy A; He, Qimei; Grove, John S; Masaki, Kamal H; Elliott, Ayako; Willcox, D Craig; Allsopp, Richard; Willcox, Bradley J


    The mechanistic target of rapamycin (mTOR) pathway is crucial for life span determination in model organisms. The aim of the present study was to test tagging single-nucleotide polymorphisms that captured most of the genetic variation across key TOR complex 1 (TORC1) and TOR complex 2 (TORC2) genes MTOR, RPTOR, and RICTOR and the important downstream effector gene RPS6KA1 for association with human longevity (defined as attainment of at least 95 years of age) as well as health span phenotypes. Subjects comprised a homogeneous population of American men of Japanese ancestry, well characterized for aging phenotypes and who have been followed for 48 years. The study used a nested case-control design involving 440 subjects aged 95 years and older and 374 controls. It found no association of 6 tagging single-nucleotide polymorphisms for MTOR, 61 for RPTOR, 7 for RICTOR, or 5 for RPS6KA1 with longevity. Of 40 aging-related phenotypes, no significant association with genotype was seen. Thus common genetic variation (minor allele frequency ≥10%) in MTOR, RPTOR, RICTOR, and RPS6KA1 is not associated with extreme old age or aging phenotypes in this population. Further research is needed to assess the potential genetic contribution of other mTOR pathway genes to human longevity, gene expression, upstream and downstream targets, and clinically relevant aging phenotypes.

  9. Factors affecting the implementation of complex and evolving technologies: multiple case study of intensity-modulated radiation therapy (IMRT in Ontario, Canada

    Directory of Open Access Journals (Sweden)

    Bak Kate


    Full Text Available Abstract Background Research regarding the decision to adopt and implement technological innovations in radiation oncology is lacking. This is particularly problematic since these technologies are often complex and rapidly evolving, requiring ongoing revisiting of decisions regarding which technologies are the most appropriate to support. Variations in adoption and implementation decisions for new radiation technologies across cancer centres can impact patients' access to appropriate and innovative forms of radiation therapy. This study examines the key steps in the process of adopting and implementing intensity modulated radiation therapy (IMRT in publicly funded cancer centres and identifies facilitating or impeding factors. Methods A multiple case study design, utilizing document analysis and key informant interviews was employed. Four cancer centres in Ontario, Canada were selected and interviews were conducted with radiation oncologists, medical physicists, radiation therapists, and senior administrative leaders. Results Eighteen key informants were interviewed. Overall, three centres made fair to excellent progress in the implementation of IMRT, while one centre achieved only limited implementation as of 2009. Key factors that influenced the extent of IMRT implementation were categorized as: 1 leadership, 2 training, expertise and standardization, 3 collaboration, 4 resources, and 5 resistance to change. Conclusion A framework for the adoption and implementation of complex and evolving technologies is presented. It identifies the key factors that should be addressed by decision-makers at specific stages of the adoption/implementation process.

  10. Characterization of a balanced complex chromosomal rearrangement carrier ascertained through a fetus with dup15q26.3 and del5p15.33: case report. (United States)

    Lledo, Belen; Ortiz, Jose Antonio; Morales, Ruth; Manchon, Irene; Galan, Francisco; Bernabeu, Andrea; Bernabeu, Rafael


    Complex chromosomal rearrangements (CCRs) are structural aberrations involving more than two chromosomes which rarely appear in individuals with normal phenotypes. These individuals report fertility problems, recurrent miscarriages, or congenital anomalies in newborn offspring as a consequence of either meiotic failure or imbalanced chromosome segregation. A CCR involving chromosomes 5, 15, and 18 was discovered in a phenotypically normal man through a fetus with congenital malformations and partial trisomy of chromosome 15 and monosomy of chromosome 5. Ultrasound examination at 20 weeks of gestation showed severe oligoamnios and hydrothorax. Prenatal cytogenetic analysis and array comparative genomic hybridization (array-CGH) revealed a female fetus with dup15q26.3 and del5p15.33. We diagnosed the CCR using three-color fluorescence in situ hybridization (three-color FISH), and a balanced CCR using array-CGH and FISH was diagnosed in the paternal karyotype. The father is a carrier of a balanced translocation 46,XY,t(5;15;18)(p15.31;q26.3;p11.2). Due to the complexity of these rearrangements the diagnosis is difficult and the reproductive outcome uncertain. Reporting such rare cases is important to enable such information to be used for genetic counseling in similar situations and help estimate the risk of miscarriage or of newborns with congenital abnormalities.

  11. Complex relationships between occupation, environment, DNA adducts, genetic polymorphisms and bladder cancer in a case-control study using a structural equation modeling. (United States)

    Porru, Stefano; Pavanello, Sofia; Carta, Angela; Arici, Cecilia; Simeone, Claudio; Izzotti, Alberto; Mastrangelo, Giuseppe


    DNA adducts are considered an integrate measure of carcinogen exposure and the initial step of carcinogenesis. Their levels in more accessible peripheral blood lymphocytes (PBLs) mirror that in the bladder tissue. In this study we explore whether the formation of PBL DNA adducts may be associated with bladder cancer (BC) risk, and how this relationship is modulated by genetic polymorphisms, environmental and occupational risk factors for BC. These complex interrelationships, including direct and indirect effects of each variable, were appraised using the structural equation modeling (SEM) analysis. Within the framework of a hospital-based case/control study, study population included 199 BC cases and 213 non-cancer controls, all Caucasian males. Data were collected on lifetime smoking, coffee drinking, dietary habits and lifetime occupation, with particular reference to exposure to aromatic amines (AAs) and polycyclic aromatic hydrocarbons (PAHs). No indirect paths were found, disproving hypothesis on association between PBL DNA adducts and BC risk. DNA adducts were instead positively associated with occupational cumulative exposure to AAs (p = 0.028), whereas XRCC1 Arg 399 (poccupational cumulative exposure to AAs with DNA adducts and BC risk, strengthening the central role of AAs in bladder carcinogenesis. However the lack of an association between PBL DNA adducts and BC risk advises that these snapshot measurements are not representative of relevant exposures. This would envisage new scenarios for biomarker discovery and new challenges such as repeated measurements at different critical life stages.

  12. Cushing’s Syndrome Secondary to isolated Micronodular Adrenocortical Disease (iMAD) associated with Rapid Onset Weight Gain and Negative Abdominal MRI Findings in a 3 year old Male (United States)

    Henry, Rohan K.; Keil, Margaret F.; Stratakis, Constantine A.; Fechner, Patricia Y.


    Cushing’s syndrome (CS) is uncommon in childhood. CS may be either dependent or independent of adrenocorticotrophic hormone (ACTH). ACTH independent micronodular adrenocortical (MAD) disease may present in the second to third decade of life or between ages 2–3years. It may occur in isolation, or as a part of the Carney complex and it represents an elusive entity to diagnose. We present a 3 year 7 month old boy with isolated MAD (iMAD). Abdominal CT revealed prominent mildly lobulated anteromedial margin of adrenals with nodular appearance. Cardiac echo, thyroid and testicular ultrasounds performed as a work up for Carney complex were normal. Bilateral adrenalectomy confirmed MAD as the cause of CS. We present the history’ and identification of a unique case of iMAD. PMID:20662336


    Directory of Open Access Journals (Sweden)

    Kandukuri Mahesh


    Full Text Available Hyalinizing Trabecular Adenoma (HTA of the thyroid is a rare neoplasm that was first described by Carney in 1987. It is a tumor of follicular derivation with peculiar nuclear, architectural, histochemical, and immunohistochemical features. We report a case of Hyalinizing trabecular adenoma in a 36-year-old woman with enlarged thyroid lobe. Ultrasonographic features and fine needle aspiration cytology (FNAC of the enlarged thyroid was performed and the diagnosis given was Papillary carcinoma of the thyroid. The patient underwent total thyroidectomy, with a histopathological diagnosis of hyalinizing trabecular Adenoma (HTA. We present this case in view of its rarity and to discuss the clinical and diagnostic approach, including the role of FNAC, and the pathologic features of HTA with special reference to the possible differential diagnosis and also review of literature. Although rare cases of malignant Hyalinizing trabecular adenoma (HTA have been documented, this tumor should be considered a benign neoplasm or at most, a neoplasm of extremely low malignant potential, however invasion of the capsule should be considered on histopathology. An awareness of hyalinizing trabecular adenomas and their characteristic features is valuable for their recognition and management as well as for the possible prevention of over diagnosis and over treatment for benign disease

  14. Decentralized Building of Complex Software Systems-an eCommerce Case Study%复杂软件系统的分散式构造:一个电子商务案例研究

    Institute of Scientific and Technical Information of China (English)

    KASSEL Stephan; WINKELMANN Sabine; TITTMANN Claudia


    Software development skills are only partially trained with traditional programming languages and software engineering courses. To achieve practical skills needed in software industry, complex examples are necessary which have to be generated in a project-like setting. This includes common solution finding, intensive communication and structured programming tasks. Here, a case study from the domain of eCommerce is presented, showing the complexity needed for these learning processes.

  15. Non-invasive investigative techniques for the diachronic study of territorial compartments: a case study for the documentation and analysis of architectural complexes. (United States)

    Di Lieto, Marco; Marchetta, Isabella; Ciriello, Rosanna; De Martino, Gregory; Della Mora, Dario


    The trend in the study of areas of land in their integrity and as dynamic, anthropic units in diachronic history has initiated long survey campaigns over several decades that have covered large areas mapping the evidence and attempting a reconstruction of the evolution of ancient settlements. The need for further study to disentangle the knots of modes and types of settlement boosted further investigations of targeted excavations, based on the quality and density of the findings from the field. Currently archaeological research can rely on non-invasive integrated methods to better define the areas to be investigated systematically obtaining new typologies of information and better management of time and research costs. In this paper we present a specific case study in which a variety of integrated survey methods have contributed to the documentation and analysis of monumental complexes linked to specific local contexts. The area under investigation lies in Italy, in the province of Potenza and, specifically in the town of Forenza. The survey activities, involving the entire municipality, have been running on and off for about 2 years and have already resulted in the collection of a lot of interesting data that will be useful to essential fieldwork. In particular, we carried out different types of investigation in three different sample sites: 1. monumental complex of Santa Maria de 'Armenis: to complement previous excavations which involved only a portion of the estimated area of interest, we carried out magnetometric and geo-electrical surveys aimed at a more precise definition of the true extent and interpretation of the monument in antiquity; 2. site of Monte Caruso: we carried out remote sensing using a remote-controlled UAV hexakopter drone with stereoscopic photogrammetric survey techniques aimed at the detailed documentation of the monumental evidence of a structure visible in elevation but in a context difficult to approach with traditional surveying

  16. Complex relationships between occupation, environment, DNA adducts, genetic polymorphisms and bladder cancer in a case-control study using a structural equation modeling.

    Directory of Open Access Journals (Sweden)

    Stefano Porru

    Full Text Available DNA adducts are considered an integrate measure of carcinogen exposure and the initial step of carcinogenesis. Their levels in more accessible peripheral blood lymphocytes (PBLs mirror that in the bladder tissue. In this study we explore whether the formation of PBL DNA adducts may be associated with bladder cancer (BC risk, and how this relationship is modulated by genetic polymorphisms, environmental and occupational risk factors for BC. These complex interrelationships, including direct and indirect effects of each variable, were appraised using the structural equation modeling (SEM analysis. Within the framework of a hospital-based case/control study, study population included 199 BC cases and 213 non-cancer controls, all Caucasian males. Data were collected on lifetime smoking, coffee drinking, dietary habits and lifetime occupation, with particular reference to exposure to aromatic amines (AAs and polycyclic aromatic hydrocarbons (PAHs. No indirect paths were found, disproving hypothesis on association between PBL DNA adducts and BC risk. DNA adducts were instead positively associated with occupational cumulative exposure to AAs (p = 0.028, whereas XRCC1 Arg 399 (p<0.006 was related with a decreased adduct levels, but with no impact on BC risk. Previous findings on increased BC risk by packyears (p<0.001, coffee (p<0.001, cumulative AAs exposure (p = 0.041 and MnSOD (p = 0.009 and a decreased risk by MPO (p<0.008 were also confirmed by SEM analysis. Our results for the first time make evident an association between occupational cumulative exposure to AAs with DNA adducts and BC risk, strengthening the central role of AAs in bladder carcinogenesis. However the lack of an association between PBL DNA adducts and BC risk advises that these snapshot measurements are not representative of relevant exposures. This would envisage new scenarios for biomarker discovery and new challenges such as repeated measurements at different

  17. Fatal Fusarium solani species complex infections in elasmobranchs: the first case report for black spotted stingray (Taeniura melanopsila) and a literature review. (United States)

    Fernando, Nimal; Hui, Suk-Wai; Tsang, Chi-Ching; Leung, Shui-Yee; Ngan, Antonio H Y; Leung, Raymond W W; Groff, Joseph M; Lau, Susanna K P; Woo, Patrick C Y


    Fusarium species are environmental saprophytic fungi. Among the many Fusarium species, members of the Fusarium solani species complex (FSSC) are the most prevalent and virulent in causing human and animal infections. In this study, we describe the first case of fatal FSSC infection in a black spotted stingray and three concomitant infections in scalloped hammerhead sharks. In the stingray, cutaneous lesions were characterised by ulcers and haemorrhage of the ventral pectoral fin, or 'ray', especially around the head; while cutaneous lesions in the sharks were characterised by ulcers, haemorrhage, as well as white and purulent exudates at the cephalic canals of the cephalofoil and lateral line. Histological sections of the cutaneous lesions revealed slender (1-4 μm in diameter), branching, septate fungal hyphae. Internal transcribed spacer region and 28S nrDNA sequencing of the fungal isolates from the fish showed two isolates were F. keratoplasticum (FSSC 2) and the other two were FSSC 12. Environmental investigation revealed the FSSC strains isolated from water and biofilms in tanks that housed the elasmobranchs were also F. keratoplasticum and FSSC 12. Fusarium is associated with major infections in elasmobranchs and FSSC 12 is an emerging cause of infections in marine animals. DNA sequencing is so far the most reliable method for accurate identification of Fusarium species.

  18. Restoration and conversion to re-use of historic buildings incorporating increased energy efficiency: A case study - the Haybarn complex, Hilandar Monastery, Mount Athos

    Directory of Open Access Journals (Sweden)

    Ivanović-Šekularac Jelena A.


    Full Text Available A proper approach to restoration of historic buildings is crucial for monumental heritage protection. The objective of the paper is to define a methodology for historic buildings restoration in order to increase energy efficiency and re-usability in accordance with modern standards. The main method used in the paper is the observation of historic buildings during their restoration and exploitation, analysis and evaluation of achieved results regarding energy efficiency and energy saving, through the examples of the buildings belonging to Hilandar Monastery, Mount Athos, in Greece. Mount Athos was inscribed on the UNESCO World Heritage List for its cultural and natural values. This case study discusses the abandoned and dilapidated historic buildings of the Haybarn Complex (Stable, Mulekeepers’ House and Haybarn, the achieved results regarding the restoration of these buildings, their energy efficiency and turning into the premises for occasional stays. The research results are recommendations for increasing energy efficiency while performing the restoration of historic buildings, so that these buildings could be re-used in a new way. The most significant contribution of the paper is the practical test of energy refurbishment of these historic buildings conducted using the principles and methods of energy efficiency, in compliance with conservation requirements and authenticity of historic buildings.

  19. Complex Regional Pain Syndrome type I of the upper limb - treatment based on Stress Loading Program: a case study

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    Aline Sarturi Ponte


    Full Text Available The daily life of an individual suffering from Complex Regional Pain Syndrome type I (CPRS I becomes limited, because this syndrome causes signs and symptoms located in the affected limb, and may occur in other parts. From this premise, this study aims to present the contributions of Occupational Therapy and the Rehabilitation Stress Loading Program for a subject with CRPS I in the upper limb, attended by the Group of Pain from the University Hospital of Santa Maria (HUSM, Rio Grande do Sul state. This research is characterized as a case study, experimental, which deals with pre and post occupational therapy intervention. The instruments used for data collection were the protocols of Disabilities of the Arm, Shoulder and Hand (DASH, the International Classification of Disability, Functioning and Health (ICF, the Canadian Occupational Performance Measure (COPM, the Visual Analogue Scale, and goniometry (EVA. After assessment, the subject was exposed to the treatment of compressive active resistive exercises; after this treatment was completed, the subject was reassessed. It was observed that the treatment applied has contributed to the reduction of the pain and to the improvement in the Range of Motion (ROM of the subject. The use of the stress protocol and active compression contributed significantly to the reduction of pain, ADM gain and occupational performance improvement.

  20. The complex case of V445 Lyr observed with Kepler: Two Blazhko modulations, a non-radial mode, possible triple mode RR Lyrae pulsation, and more

    CERN Document Server

    Guggenberger, E; Nemec, J M; Smolec, R; Benkő, J M; Ngeow, C -C; Cohen, J G; Sesar, B; Szabó, R; Catelan, M; Moskalik, P; Kinemuchi, K; Seader, S E; Smith, J C; Tenenbaum, P; Kjeldsen, H


    Rapid and strong changes in the Blazhko modulation of RR Lyrae stars, as they have recently been detected in high precision satellite data, have become a crucial topic in finding an explanation of the long-standing mystery of the Blazhko effect. We present here an analysis of the most extreme case detected so far, the RRab star V445 Lyr (KIC 6186029) which was observed with the Kepler space mission. V445 Lyr shows very strong cycle-to-cycle changes in its Blazhko modulation, which are caused both by a secondary long-term modulation period as well as irregular variations. In addition to the complex Blazhko modulation, V445 Lyr also shows a rich spectrum of additional peaks in the frequency range between the fundamental pulsation and the first harmonic. Among those peaks, the second radial overtone could be identified, which, combined with a metallicity estimate of [Fe/H]=-2.0 dex from spectroscopy, allowed to constrain the mass (0.55-0.65 M_sun) and luminosity (40-50 L_sun) of V445 Lyr through theoretical Pete...

  1. Natural disease course and genotype-phenotype correlations in Complex I deficiency caused by nuclear gene defects: what we learned from 130 cases.

    NARCIS (Netherlands)

    Koene, S.; Rodenburg, R.J.T.; Knaap, M.S. van der; Willemsen, M.A.A.P.; Sperl, W.; Laugel, V.; Ostergaard, E.; Tarnopolsky, M.; Martin, M.A.; Nesbitt, V.; Fletcher, J.; Edvardson, S.; Procaccio, V.; Slama, A.; Heuvel, L.P.W.J. van den; Smeitink, J.A.M.


    Mitochondrial complex I is the largest multi-protein enzyme complex of the oxidative phosphorylation system. Seven subunits of this complex are encoded by the mitochondrial and the remainder by the nuclear genome. We review the natural disease course and signs and symptoms of 130 patients (four new

  2. Complex communication signals: the case of the Blue-black Grassquit Volatinia jacarina (Aves, Emberizidae song. Part I - A structural analysis

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    Hernán Fandiño-Mariño


    Full Text Available The song of the Blue-black Grassquit Volatinia jacarina is different for every individual and the structural differences between individuals are quite complex. Samples of songs from different Brazilian localities, as well as from Venezuela and Mexico, were studied through a comparative analysis of their sonograms. From the structural point of view, the results show a song composed of a single note that is compacted in a ''window'' between 2 and 13 kHz and rarely occupying more than half of a second. The note is essentially pure and is repeatedly uttered with a high level of fidelity. A global frequency modulation decreases from the beginning to the end of the song. The main song components are referred to as ''Blocks'' and are of three types: ''Vibrations'' (Buzzes or Vibratos, ''Arabesques'' (complex notes and ''Isolated Modulations'' (simple syllables. Among other characteristics are double voices, which are quite diverse and probably function as codes for individual recognition. This song is considered a special case where a signature system has been developed to a high level of inter-individual variability.O canto do Tiziu Volatinia jacarina é único para cada indivíduo e as diferenças estruturais entre um e outro indivíduo são muito complexas. Cantos gravados em diversos lugares do Brasil e alguns da Venezuela e do México foram estudados através de uma análise comparativa dos seus sonogramas. Do ponto de vista estrutural, os resultados mostram que o canto é constituído por uma nota única que se encontra compactada numa ''janela'' entre 2 e 13 kHz e raramente ultrapassa meio segundo de duração. A nota, essencialmente pura, é repetida com alto grau de fidelidade entre uma emissão e outra. Constata-se uma modulação de freqüência global descendente do início ao fim do canto. Os principais componentes do canto do Tiziu foram denominados ''Blocos'' e são basicamente de três tipos: as ''Vibrações'' (Buzzes ou Vibratos, os

  3. Atomic modelling of crystal/complex fluid/crystal contacts—Part I. The genetic iterative multi-species (GIMS) approach and case of kaolinite/brine/kaolinite (United States)

    Jouanna, P.; Pèpe, G.; Dweik, J.; Gouze, P.


    Predicting the impact of underground engineering on the environment requires the knowledge of natural media at different scales. In particular, understanding basic phenomena controlling the properties of rocks in the presence of complex fluids necessitates a detailed atomic description of the solid/fluid/solid contacts, the subject of Part I of the present study. First, building the solid interspace between two different crystals in a non-periodic situation is achieved using the ab initio and molecular mechanics code GenMol TM. A description of the fluid confined within the interspace is then derived from the original genetic iterative multi-species (GIMS) algorithm implemented in the same code. This approach consists of equilibrating chemical potentials, cycle after cycle and species after species, between the confined fluid and the free natural fluid. An elementary iteration for a species k consists of different steps incrementing the number Nk of particles k, with other numbers Nk' remaining constant. At each step, an optimum fluid composition is obtained by a genetic process distributing the fluid particles on a grid by stochastic shots, followed in fine by a refining process. The effectiveness of the GIMS approach is demonstrated in the case study of a fluid confined between two (0 0 1) kaolinite faces, with apertures h varying between 4 and 10 Å, connected to a 9-species external solution [H 2O, Cl -, N a+, CO 2(aq), NaCl (aq), Ca 2+, Mg 2+, HCO3-, H 3O +] where concentrations are ranging from 55 to 10 -4 mol/L. The results show a drastic variation in the solute/solvent and cations/ions ratios in the confined fluid when aperture h is lowered to less than 1 nm. These results obtained with a very rapid convergence of the iterative algorithm combined with a very competitive genetic optimizer are validated with high precision on a free solution. This description of contacts between crystals is original and unattainable by standard crystal interface approaches

  4. Active faulting Vs other surface displacing complex geomorphic phenomena. Case studies from a tectonically active area, Abruzzi Region, central Apennines, Italy (United States)

    Lo Sardo, Lorenzo; Gori, Stefano; Falcucci, Emanuela; Saroli, Michele; Moro, Marco; Galadini, Fabrizio; Lancia, Michele; Fubelli, Giandomenico; Pezzo, Giuseppe


    could be possible to infer the genesis of the scarps as due to complex tectono-karstic phenomena. As for case (ii), our ongoing analyses are aimed to analyze the tectonic "significance" of some closed depressions, up to 4 km long and to 0,5-1 km large, that occur along the south-western slope of the Gran Sasso Range. All these small depression are NW-SE trending. As already described by Bosi et al. (1989), Galadini and Giuliani (1993), D'Agostino et al. (1998), Falcucci et al. (2015), these closed depressions are bounded by scarps carved onto the carbonate bedrock and, subordinately, onto early Quaternary slope deposits, reaching height of up to 5 m. These scarps are preferentially NE dipping, even if in few cases some SW dipping scarp are also present . The field work has permitted to attest that these scarps are related to shear planes that that displaced two subsequent of Early Pleistocene breccias formations (the Valle Valiano Fm. and Fonte Vedice Fm.; Bosi e Bertini, 1993; D'agostino et al., 1997). A paleoseismological trench was also performed across one of these scarps, attesting the activity of these shear planes also in recent times, providing indications result about the deformation style. Reference Bertini, T., & Bosi, C. (1993). La tettonica quaternaria della conca di Fossa (L'Aquila). Il Quaternario, 6(2), 293-314. Bertini, T., Bosi, C., & Galadini, F. (1989). La conca di Fossa-S. Demetrio dei Vestini. CNR, Centro di Studio per la Geologia Tecnica, ENEA, PAS in Elementi di tettonica pliocenicoquaternaria ed indizi di sismicita olocenica nell'Appennino laziale-abruzzese, Societa Geologica Italiana, L'Aquila, 26-58. Bosi, C., & Bertini, T. (1970). Geologia della media valle dell'Aterno. Memorie Società Geologica Italiana, 9(4), 719-777. D'Agostino, N., F. Speranza, & R. Funiciello., (1997) "Le Brecce Mortadella dell'Appennino Centrale: primi risultati di stratigrafia magnetica." Il Quaternario10.2: 385-388. D'Agostino, N., Chamot-Rooke, N., Funiciello, R

  5. SWI/SNF Complex-deficient Undifferentiated/Rhabdoid Carcinomas of the Gastrointestinal Tract: A Series of 13 Cases Highlighting Mutually Exclusive Loss of SMARCA4 and SMARCA2 and Frequent Co-inactivation of SMARCB1 and SMARCA2. (United States)

    Agaimy, Abbas; Daum, Ondrej; Märkl, Bruno; Lichtmannegger, Ines; Michal, Michal; Hartmann, Arndt


    Undifferentiated gastrointestinal tract carcinomas are rare highly aggressive neoplasms with frequent but not obligatory rhabdoid features. Recent studies showed loss of SMARCB1 (INI1), a core subunit of the SWI/SNF chromatin remodeling complex, in 50% of tested cases. However, the molecular pathways underlying histologically similar but SMARCB1-intact cases are unknown. We herein analyzed 13 cases for expression of 4 SWI/SNF complex subunits SMARCB1, SMARCA2, SMARCA4, and ARID1A and the mismatch-repair proteins MLH1, MSH2, MSH6, and PMS2 by immunohistochemistry. Patients included 12 men and 1 woman aged 32 to 81 years (median, 57 y). Site of origin was colon (5), small bowel (2), stomach (3), small+large intestine (1), small intestine+ampulla of Vater (1), and esophagogastric junction (1). All tumors showed anaplastic large to medium-sized cells with variable rhabdoid features, pleomorphic giant cells, and, rarely, spindle cell foci. Abortive gland formation was seen in 3 cases and bona fide glandular component in 1 case. Most cases strongly expressed vimentin and variably pancytokeratin. In total, 12/13 cases (92%) showed loss of at least 1 SWI/SNF component. Loss of SMARCB1 (5/13), SMARCA2 (10/13), SMARCA4 (2/13), and ARID1A (2/13) was observed either in combination or isolated. SMARCA2 loss was isolated in 5 cases and coexisted with lost SMARCB1 in 5 cases (all 5 SMARCB1-deficient tumors showed loss of SMARCA2 as well). Co-inactivation of SMARCB1 and SMARCA4 or of SMARCA2 and SMARCA4 was not observed. Two mismatch-repair-deficient cases (MLH1/PMS2) showed concurrent loss of SMARCB1, SMARCA2, and (one of them) ARID1A. This study illustrates for the first time loss of different components of the SWI/SNF complex other than SMARCB1 in undifferentiated gastrointestinal carcinomas including novel SMARCA4-deficient and SMARCA2-deficient cases. Our results underline the close link between SWI/SNF deficiency and the aggressive rhabdoid phenotype. Frequent loss of SMARCA

  6. Complex Beauty


    Franceschet, Massimo


    Complex systems and their underlying convoluted networks are ubiquitous, all we need is an eye for them. They pose problems of organized complexity which cannot be approached with a reductionist method. Complexity science and its emergent sister network science both come to grips with the inherent complexity of complex systems with an holistic strategy. The relevance of complexity, however, transcends the sciences. Complex systems and networks are the focal point of a philosophical, cultural ...

  7. A rare case of a three way complex variant positive Philadelphia translocation involving chromosome (9;11;22)(q34;p15;q11) in chronic myeloid leukemia: A case report (United States)

    Asif, Muhammad; Hussain, Abrar; Rasool, Mahmood


    The t(9;22)(q34;q11) translocation is present in 90–95% of patients with chronic myeloid leukemia (CML). Variant complex translocations have been observed in 5–8% of CML patients, in which a third chromosome other than (9;22) is involved. Imatinib mesylate is the first line breakpoint cluster region-Abelson gene (BCR/ABL)-targeted oral therapy for CML, and may produce a complete response in 70–80% of CML patients in the chronic phase. In the present study, a bone marrow sample was used for conventional cytogenetic analysis, and the fluorescence in situ hybridization (FISH) test was used for BCR/ABL gene detection. A hematological analysis was also performed to determine the white blood cell (WBC) count, red blood cell count, hemoglobin levels, packed and mean cell volumes, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration and platelet values of the patient. The hematological analysis of the patient indicated the increased WBC of 186.5×103 cells/µl, and decreased hemoglobin levels of 11.1 g/dl. The FISH test revealed that 67% cells demonstrated BCR/ABL gene translocation. The patient was treated with 400 mg imatinib mesylate daily, and was monitored at various intervals over a 6-month period. The present study reports the rare case of a patient that demonstrates a three-way Philadelphia chromosome-positive translocation involving 46XY,t(9;11;22)(q34;p15;q11)[10], alongside CML in the chronic phase. The translocation was analyzed using cytogenetic and FISH tests. PMID:27602125

  8. Complex Systems and Dependability

    CERN Document Server

    Zamojski, Wojciech; Sugier, Jaroslaw


    Typical contemporary complex system is a multifaceted amalgamation of technical, information, organization, software and human (users, administrators and management) resources. Complexity of such a system comes not only from its involved technical and organizational structure but mainly from complexity of information processes that must be implemented in the operational environment (data processing, monitoring, management, etc.). In such case traditional methods of reliability analysis focused mainly on technical level are usually insufficient in performance evaluation and more innovative meth

  9. Complex dynamics

    CERN Document Server

    Carleson, Lennart


    Complex dynamics is today very much a focus of interest. Though several fine expository articles were available, by P. Blanchard and by M. Yu. Lyubich in particular, until recently there was no single source where students could find the material with proofs. For anyone in our position, gathering and organizing the material required a great deal of work going through preprints and papers and in some cases even finding a proof. We hope that the results of our efforts will be of help to others who plan to learn about complex dynamics and perhaps even lecture. Meanwhile books in the field a. re beginning to appear. The Stony Brook course notes of J. Milnor were particularly welcome and useful. Still we hope that our special emphasis on the analytic side will satisfy a need. This book is a revised and expanded version of notes based on lectures of the first author at UCLA over several \\Vinter Quarters, particularly 1986 and 1990. We owe Chris Bishop a great deal of gratitude for supervising the production of cour...

  10. Significance of fragmented QRS complexes for identifying culprit lesions in patients with non-ST-elevation myocardial infarction: a single-center, retrospective analysis of 183 cases

    Directory of Open Access Journals (Sweden)

    Guo Rong


    Full Text Available Abstract Background Fragmented QRS (fQRS complexes are novel electrocardiographic signals, which reflect myocardial conduction delays in patients with coronary artery disease (CAD. The importance of fQRS complexes in identifying culprit vessels was evaluated in this retrospective study. Methods A 12-lead surface electrocardiogram was obtained in 183 patients who had non-ST-elevation myocardial infarction (NSTEMI and subsequently underwent coronary angiography (CAG. On the basis of the frequency of fQRS complexes, indices such as sensitivity, specificity, positive and negative predictive values, and likelihood ratio were evaluated to determine the ability of fQRS complexes to identify the culprit vessels. Results Among the patients studied, elderly patients (age ≥ 65 years and those with diabetes had a significantly higher frequency of fQRS complexes (p = 0.005, p = 0.003, respectively. The fQRS complexes recorded in the 4 precordial leads had the highest specificity (81.8% for indentifying the culprit vessel (left anterior descending artery. However, the specificity of fQRS complexes to identify lesions in the left circumflex and right coronary arteries was lower for the inferior and lateral leads than for the limb leads (65.5% versus 71.7%; however, the limb leads had higher sensitivity (92.3% versus 89.4%. And the total sensitivity and specificity of fQRS (77.1% and 71.5% were higher than those values for ischemic T-waves. Conclusions The frequency of fQRS complexes was higher in elderly and diabetic patients with NSTEMI. The frequency of fQRS complexes recorded in each of the ECG leads can be used to identify culprit vessels in patients with NSTEMI.

  11. Surgical management of a large complex odontoma of the mandibular angle-ramus region through intra-oral buccal approach--A case report. (United States)

    Ogunlewe, M O; Adeyemo, W L; Ladeinde, A L; Bamgbose, B O; Ajayi, O F


    Large complex odontomas of the jaws are rare. A report of a large complex odontoma of the mandibular angle-ramus region enucleated through intra-oral buccal approach is presented. A review of the literature on different modalities of treatment is also undertaken. A large expansile complex odontoma of the angle-ramus region of the mandible was excised through an intraoral buccal approach under general anaesthesia. Recovery and immediate post-operative period were uneventful. There was no altered sensation in the distribution of the inferior alveolar nerve and lingual nerve; and wound healing was satisfactory. Post-operative radiograph 2 years after the operation showed satisfactory bone regeneration. Intraoral buccal approach to large complex odontomas of the angle-ramus region of the mandible is a relatively safe procedure with minimal complication.

  12. An easy-to-use practical method to measure coincidence in the flow cytometer--the case of platelet-granulocyte complex determination. (United States)

    Bihari, Péter; Fent, János; Hamar, János; Furész, József; Lakatos, Susan


    Cell complexes composed of two different cells labeled with different fluorophores can be detected as double positive events in the flow cytometer. Double positivity can originate not only from real complexes but from non-interacting coinciding cells as well. Coincidence has a high impact on the determination of the amount of platelet-granulocyte complexes since platelet concentration is in the orders of magnitude higher than that of the granulocytes. Mixtures of non-interacting fluorescent beads as well as EDTA anticoagulated or citrated blood samples were analyzed in the flow cytometer in the presence and absence of fluorescent beads at various dilutions. Experimental data were evaluated by mathematical means. The bead or platelet concentration dependence of double positivity was converted into linear functions using Poisson distribution. This linearised form contains information on the detection volume as well as on the presence/absence of dilution independent complexes. The presence of appropriate fluorescent beads in the blood sample makes possible to estimate the fraction of double positivity originating from coincidence if data collection is triggered by the granulocytes or by the fluorescent beads, alternatively. Mixing fluorescent beads into a blood sample is a simple experimental method to distinguish double positivity originating from real cell-cell complexes from the coincidence of cells in a flow cytometer, thus providing a tool for the determination of the real amount of cell-cell complexes.

  13. Supporting complex search tasks

    DEFF Research Database (Denmark)

    Gäde, Maria; Hall, Mark; Huurdeman, Hugo


    There is broad consensus in the field of IR that search is complex in many use cases and applications, both on the Web and in domain specific collections, and both professionally and in our daily life. Yet our understanding of complex search tasks, in comparison to simple look up tasks, is fragme......There is broad consensus in the field of IR that search is complex in many use cases and applications, both on the Web and in domain specific collections, and both professionally and in our daily life. Yet our understanding of complex search tasks, in comparison to simple look up tasks......, and recommendations, and supporting exploratory search to sensemaking and analytics, UI and UX design pose an overconstrained challenge. How do we know that our approach is any good? Supporting complex search task requires new collaborations across the whole field of IR, and the proposed workshop will bring together...

  14. Towards in vivo mutation analysis: knock-out of specific chlorophylls bound to the light-harvesting complexes of Arabidopsis thaliana - the case of CP24 (Lhcb6). (United States)

    Passarini, Francesca; Xu, Pengqi; Caffarri, Stefano; Hille, Jacques; Croce, Roberta


    In the last ten years, a large series of studies have targeted antenna complexes of plants (Lhc) with the aim of understanding the mechanisms of light harvesting and photoprotection. Combining spectroscopy, modeling and mutation analyses, the role of individual pigments in these processes has been highlighted in vitro. In plants, however, these proteins are associated with multiple complexes of the photosystems and function within this framework. In this work, we have envisaged a way to bridge the gap between in vitro and in vivo studies by knocking out in vivo pigments that have been proposed to play an important role in excitation energy transfer between the complexes or in photoprotection. We have complemented a CP24 knock-out mutant of Arabidopsis thaliana with the CP24 (Lhcb6) gene carrying a His-tag and with a mutated version lacking the ligand for chlorophyll 612, a specific pigment that in vitro experiments have indicated as the lowest energy site of the complex. Both complexes efficiently integrated into the thylakoid membrane and assembled into the PSII supercomplexes, indicating that the His-tag does not impair the organization in vivo. The presence of the His-tag allowed the purification of CP24-WT and of CP24-612 mutant in their native states. It is shown that CP24-WT coordinates 10 chlorophylls and 2 carotenoid molecules and has properties identical to those of the reconstituted complex, demonstrating that the complex self-assembled in vitro assumes the same folding as in the plant. The absence of the ligand for chlorophyll 612 leads to the loss of one Chl a and of lutein, again as in vitro, indicating the feasibility of the method. This article is part of a special issue entitled: photosynthesis research for sustainability: keys to produce clean energy.

  15. Bucolic Complexes

    CERN Document Server

    Brešar, Bostjan; Chepoi, Victor; Gologranc, Tanja; Osajda, Damian


    In this article, we introduce and investigate bucolic complexes, a common generalization of systolic complexes and of CAT(0) cubical complexes. This class of complexes is closed under Cartesian products and amalgamations over some convex subcomplexes. We study various approaches to bucolic complexes: from graph-theoretic and topological viewpoints, as well as from the point of view of geometric group theory. Bucolic complexes can be defined as locally-finite simply connected prism complexes satisfying some local combinatorial conditions. We show that bucolic complexes are contractible, and satisfy some nonpositive-curvature-like properties. In particular, we prove a version of the Cartan-Hadamard theorem, the fixed point theorem for finite group actions, and establish some results on groups acting geometrically on such complexes. We also characterize the 1-skeletons (which we call bucolic graphs) and the 2-skeletons of bucolic complexes. In particular, we prove that bucolic graphs are precisely retracts of Ca...

  16. Over-expression and purification strategies for recombinant multi-protein oligomers: a case study of Mycobacterium tuberculosis σ/anti-σ factor protein complexes. (United States)

    Thakur, Krishan Gopal; Jaiswal, Ravi Kumar; Shukla, Jinal K; Praveena, T; Gopal, B


    The function of a protein in a cell often involves coordinated interactions with one or several regulatory partners. It is thus imperative to characterize a protein both in isolation as well as in the context of its complex with an interacting partner. High resolution structural information determined by X-ray crystallography and Nuclear Magnetic Resonance offer the best route to characterize protein complexes. These techniques, however, require highly purified and homogenous protein samples at high concentration. This requirement often presents a major hurdle for structural studies. Here we present a strategy based on co-expression and co-purification to obtain recombinant multi-protein complexes in the quantity and concentration range that can enable hitherto intractable structural projects. The feasibility of this strategy was examined using the σ factor/anti-σ factor protein complexes from Mycobacterium tuberculosis. The approach was successful across a wide range of σ factors and their cognate interacting partners. It thus appears likely that the analysis of these complexes based on variations in expression constructs and procedures for the purification and characterization of these recombinant protein samples would be widely applicable for other multi-protein systems.

  17. Intervention description is not enough: evidence from an in-depth multiple case study on the untold role and impact of context in randomised controlled trials of seven complex interventions

    Directory of Open Access Journals (Sweden)

    Wells Mary


    Full Text Available Abstract Background A number of single case reports have suggested that the context within which intervention studies take place may challenge the assumptions that underpin randomised controlled trials (RCTs. However, the diverse ways in which context may challenge the central tenets of the RCT, and the degree to which this information is known to researchers or subsequently reported, has received much less attention. In this paper, we explore these issues by focusing on seven RCTs of interventions varying in type and degree of complexity, and across diverse contexts. Methods This in-depth multiple case study using interviews, focus groups and documentary analysis was conducted in two phases. In phase one, a RCT of a nurse-led intervention provided a single exploratory case and informed the design, sampling and data collection within the main study. Phase two consisted of a multiple explanatory case study covering a spectrum of trials of different types of complex intervention. A total of eighty-four data sources across the seven trials were accessed. Results We present consistent empirical evidence across all trials to indicate that four key elements of context (personal, organisational, trial and problem context are crucial to understanding how a complex intervention works and to enable both assessments of internal validity and likely generalisability to other settings. The ways in which context challenged trial operation was often complex, idiosyncratic, and subtle; often falling outside of current trial reporting formats. However, information on such issues appeared to be available via first hand ‘insider accounts’ of each trial suggesting that improved reporting on the role of context is possible. Conclusions Sufficient detail about context needs to be understood and reported in RCTs of complex interventions, in order for the transferability of complex interventions to be assessed. Improved reporting formats that require and encourage

  18. The management of complex system innovations. A theoretic approach to network formation and critical success factor identification using the case of fuel cell vehicles

    Energy Technology Data Exchange (ETDEWEB)

    Venghaus, Sandra


    Given the economic, ecological and social importance of automotive transportation, the development of alternative fueling and propulsion technologies requires a wise and sustainable political course of action. Not least the public debate on the impact of transport emissions on climate change and the call for limits to automotive CO-2-emissions reflect the relevance of the topic. In the search for innovative alternatives to the conventional gasoline or diesel propulsion technology, electromobility and hydrogen-based fuel cell vehicles constitute the two most widely discussed long-term options. The market introduction of fuel cell vehicles serves as an expedient example of a highly complex system innovation (CSI), which requires the cooperation of a variety of actors from formerly independent economic sectors in order to overcome the significant barriers to market entry. As will be discussed, such CSI can only be successfully implemented in an environment, within which the complexity-induced knowledge gap is reduced by a systematic exchange of information with respect to both the critical success factors identified by each of the involved stakeholders as well as their cooperation needs and expectations. Given this challenge, a framework is developed, which serves as the basis for a structured dialogue among the multiple stakeholders involved in the development process of a complex system innovation. The framework can thus best be classified as a corporate moderation and decision-support tool to achieve transparency in and impose structure on complex contexts. Methodically, the presented thesis addresses the development of a holistic approach to the management of complex system innovations from two perspectives: (1) a theoretical perspective of analyzing underlying structures and processes of CSI management (i.e., the CSI Management Framework), as well as (2) the development of a strategic approach for the practical implementation of CSI management in complex networks

  19. [An autopsy case of amyotrophic lateral sclerosis with prominent muscle cramps, fasciculation, and high titer of anti-voltage gated potassium channel (VGKC) complex antibody]. (United States)

    Sato, Aki; Sakai, Naoko; Shinbo, Junsuke; Hashidate, Hideki; Igarashi, Shuichi; Kakita, Akiyoshi; Yamazaki, Motoyoshi


    The patient was a 55-year-old male who had prominent fasciculation and muscle cramps. Muscle weakness and atrophy of the trunk, respiratory system, and extremities gradually progressed. On the basis of these features, we diagnosed this patient as having amyotrophic lateral sclerosis (ALS), however, the upper motor neuron signs were not significant. Following the detection of the anti-voltage gated potassium channel (VGKC) complex antibody at 907.5 pM (normal VGKC complex antibody in the development of cramp-fasciculation syndrome has been speculated. In this ALS patient, the antibodies might be associated with pathomechanisms underlying the characteristic symptoms.

  20. Learning from Simple Ebooks, Online Cases or Classroom Teaching When Acquiring Complex Knowledge. A Randomized Controlled Trial in Respiratory Physiology and Pulmonology



    BACKGROUND AND AIMS: E-learning is developing fast because of the rapid increased use of smartphones, tablets and portable computers. We might not think of it as e-learning, but today many new e-books are in fact very complex electronic teaching platforms. It is generally accepted that e-learning is as effective as classroom teaching methods, but little is known about its value in relaying contents of different levels of complexity to students. We set out to investigate e-learning effects on ...

  1. Angiomixoma cutáneo primario Primary cutaneous angiomyxoma

    Directory of Open Access Journals (Sweden)

    A. Moretti


    Full Text Available Se describe el caso de un paciente de 50 años de edad con angiomixoma cutáneo, sin evidencia del complejo de Carney y con compromiso de la región témporo-frontal. Dicho tumor cutáneo poseía el diagnóstico ecográfico erróneo de lipoma. El tratamiento fue la exéresis amplia; no se ha evidenciado recurrencia tras 4 años de seguimiento. Se describe el caso clínico debido a la rareza de la patología y a la confusión con otros tumores del tejido celular subcutáneo. Revisamos también los estudios histopatológicos y diagnósticos diferenciales, así como la terapéutica y los índices de recidiva.We present a 50 years old patient with a cutaneous angiomixoma without evidence of Carney"s complex that affected the temporo-frontal region. This tumour had an echography misdiagnosis of lipoma. The treatment was exeresis with safe margins. There was no evidence of recurrence of the tumour in a 4 year follow up. Due to the uncommonness of the pathology, we describe this clinical case, histopathology studies, differential diagnosis, as well as therapeutic and recurrence indexes.

  2. Learning from simple ebooks, online cases or classroom teaching when acquiring complex knowledge. A randomized controlled trial in respiratory physiology and pulmonology

    DEFF Research Database (Denmark)

    Worm, Bjarne Skjødt


    E-learning is developing fast because of the rapid increased use of smartphones, tablets and portable computers. We might not think of it as e-learning, but today many new e-books are in fact very complex electronic teaching platforms. It is generally accepted that e-learning is as effective...

  3. Clinical analysis of percutaneous nephrolithotomy in the treatment of 37 cases with complex renal calculi%信息化条件下三甲医院计量检测管理体系的建立

    Institute of Scientific and Technical Information of China (English)

    姜楠; 丁晖; 白凤英


    在三甲医院医疗设备管理中,只有切实加强计量检测管理,才能确保医疗的质量,这对现代医院管理的提高有着十分重要的意义.本文首先探讨了三甲医院计量检测管理的重要性,论述了当前三甲医院计量检测信息化管理存在的问题,建立了信息化条件下三甲医院计量检测管理体系,有很好的运行效果.同时本文还提出了相关的配套措施:加强规范化法律建设,建立医院计量检测制度和完善计量检测管理流程.%Objective To investigate the methods and efficacy of percutaneous nephrolithotomy (PCNL) in the treatment of complex renal calculi. Methods Clinical data of 37 cases with percutaneous nephrolithotomy for treatment of complex renal calculi were analyzed retrospectively,including 22 cases of ultrasound lithotripsy and 16 cases of combining pneumatic and ultrasound lithotripsy. Results The operative time of 37 cases were 90-200 minutes,the mean was 130 minutes. The rate of residual tones was 27.27% in the ultrasound lithotripsy,and 13.33% in the combining pneumatic and ultrasound lithotripsy,but cured in the second lithotripsy. The average hospitalization was 9.5 days. No complications occurred during 1 to 12 months follow-up. Conclusion PCNL has advantages of little trauma,fast recovery,few complication,less complications,safe,high cleaning rate and repeat. PCNL may be a good method for treating complex renal calculi.

  4. Immunohistochemical expression of minichromosome maintenance complex protein 2 predicts biochemical recurrence in prostate cancer: a tissue microarray and digital imaging analysis-based study of 428 cases. (United States)

    Toubaji, Antoun; Sutcliffe, Siobhan; Chaux, Alcides; Lecksell, Kristen; Hicks, Jessica; De Marzo, Angelo M; Platz, Elizabeth A; Netto, George J


    Prostate cancer remains a major health problem in the United States. Established clinicopathologic parameters such as Gleason score, T stage, and prostate-specific antigen levels are currently the guiding tools for prognostication and disease management. The addition of biomarkers could increase the accuracy of these parameters for predicting disease progression, response to therapy, and survival. In this regard, the goal of this study was to evaluate minichromosome maintenance complex protein 2 and Ki-67 immunohistochemical expression as predictors of outcome in prostate cancer. For this purpose, 11 tissue microarrays were constructed using tumor and nontumor samples from 428 patients. Patients were divided into short-term (mean, 2.9 years) and long-term (mean, 14.1 years) follow-up groups. End points were biochemical recurrence for the short-term follow-up group and prostate cancer-related death for the long-term follow-up group. All men in the long-term follow-up group had biochemical recurrence at the time of recruitment. Expression of both markers was higher in tumor than in nontumor glands. Percentage of minichromosome maintenance complex protein 2 was associated with Gleason score in both groups. Percentage of Ki-67 was associated with Gleason score and pathologic stage only in the short-term follow-up group. Higher minichromosome maintenance complex protein 2 percentages were associated with biochemical recurrence in the short-term follow-up group. In the long-term follow-up group, neither minichromosome maintenance complex protein 2 nor Ki-67 levels predicted prostate cancer death. In conclusion, our results suggest that in patients treated by radical prostatectomy for clinically localized prostate cancer, immunohistochemistry for minichromosome maintenance complex protein 2 expression could be used to predict biochemical recurrence, independent of other known clinicopathologic factors.

  5. Measuring Complexity through Average Symmetry


    Alamino, Roberto C.


    This work introduces a complexity measure which addresses some conflicting issues between existing ones by using a new principle - measuring the average amount of symmetry broken by an object. It attributes low (although different) complexity to either deterministic or random homogeneous densities and higher complexity to the intermediate cases. This new measure is easily computable, breaks the coarse graining paradigm and can be straightforwardly generalised, including to continuous cases an...

  6. Supporting complex search tasks

    DEFF Research Database (Denmark)

    Gäde, Maria; Hall, Mark; Huurdeman, Hugo;


    There is broad consensus in the field of IR that search is complex in many use cases and applications, both on the Web and in domain specific collections, and both professionally and in our daily life. Yet our understanding of complex search tasks, in comparison to simple look up tasks......, is fragmented at best. The workshop addressed the many open research questions: What are the obvious use cases and applications of complex search? What are essential features of work tasks and search tasks to take into account? And how do these evolve over time? With a multitude of information, varying from...... introductory to specialized, and from authoritative to speculative or opinionated, when to show what sources of information? How does the information seeking process evolve and what are relevant differences between different stages? With complex task and search process management, blending searching, browsing...

  7. Cryptic or pseudocryptic: can morphological methods inform copepod taxonomy? An analysis of publications and a case study of the Eurytemora affinis species complex. (United States)

    Lajus, Dmitry; Sukhikh, Natalia; Alekseev, Victor


    Interest in cryptic species has increased significantly with current progress in genetic methods. The large number of cryptic species suggests that the resolution of traditional morphological techniques may be insufficient for taxonomical research. However, some species now considered to be cryptic may, in fact, be designated pseudocryptic after close morphological examination. Thus the "cryptic or pseudocryptic" dilemma speaks to the resolution of morphological analysis and its utility for identifying species. We address this dilemma first by systematically reviewing data published from 1980 to 2013 on cryptic species of Copepoda and then by performing an in-depth morphological study of the former Eurytemora affinis complex of cryptic species. Analyzing the published data showed that, in 5 of 24 revisions eligible for systematic review, cryptic species assignment was based solely on the genetic variation of forms without detailed morphological analysis to confirm the assignment. Therefore, some newly described cryptic species might be designated pseudocryptic under more detailed morphological analysis as happened with Eurytemora affinis complex. Recent genetic analyses of the complex found high levels of heterogeneity without morphological differences; it is argued to be cryptic. However, next detailed morphological analyses allowed to describe a number of valid species. Our study, using deep statistical analyses usually not applied for new species describing, of this species complex confirmed considerable differences between former cryptic species. In particular, fluctuating asymmetry (FA), the random variation of left and right structures, was significantly different between forms and provided independent information about their status. Our work showed that multivariate statistical approaches, such as principal component analysis, can be powerful techniques for the morphological discrimination of cryptic taxons. Despite increasing cryptic species designations

  8. An erupted complex odontoma. (United States)

    Tozoglu, Sinan; Yildirim, Umran; Buyukkurt, M Cemil


    Odontomas are benign tumors of odontogenic origin. The cause of the odontoma is unknown, but it is believed to be hereditary or due to a disturbance in tooth development triggered by trauma or infection. Odontomas may be either compound or complex. Although these tumors are seen frequently, erupted odontomas are rare. The purpose of this study is to present a rare case of complex odontoma that erupted into the oral cavity.

  9. Complex variable HVPT

    Energy Technology Data Exchange (ETDEWEB)

    Killingbeck, John P [Mathematics Department, University of Hull, Hull HU6 7RX (United Kingdom); Grosjean, Alain [Laboratoire d' Astrophysique de l' Observatoire de Besancon (CNRS, UPRES-A 6091), 41 bis Avenue de l' Observatoire, BP 1615, 25010 Besancon Cedex (France); Jolicard, Georges [Laboratoire d' Astrophysique de l' Observatoire de Besancon (CNRS, UPRES-A 6091), 41 bis Avenue de l' Observatoire, BP 1615, 25010 Besancon Cedex (France)


    Complex variable hypervirial perturbation theory is applied to the case of oscillator and Coulomb potentials perturbed by a single term potential of the form Vx{sup n} or Vr{sup n}, respectively. The trial calculations reported show that this approach can produce accurate complex energies for resonant states via a simple and speedy calculation and can also be useful in studies of PT symmetry and tunnelling resonance effects. (addendum)

  10. Modelling and simulation of electrical energy systems through a complex systems approach using agent-based models. Case study: Under-frequency load shedding for refrigerators

    Energy Technology Data Exchange (ETDEWEB)

    Kremers, Enrique [Karlsruhe Institute of Technology (KIT), Karlsruhe (Germany). European Inst. for Energy Research (EIFER); Gonzalez de Durana, Jose Maria; Barambones, Oscar [Universidad del Pais Vasco, Vitoria (Spain). Escuela Universitaria de Ingenieria de Vitoria-Gasteiz


    One of the ways of studying complex systems is through modelling and simulation, which are used as tools to represent these systems in a virtual environment. Current advances in computing performance (which has been a major constraint in this field for some time) allow for the simulation these kinds of systems within reasonable time horizons. One of the tools for simulating complex systems is agent-based modelling. This individual-centric approach is based on autonomous entities that can interact with each other, thus modelling the system in a disaggregated way. Agent-based models can be coupled with other modelling methods, such as continuous models and discrete events, which can be embedded or run in parallel to the multi-agent system. When representing the electrical energy system in a systemic and multi-layered way, it is treated as a true socio-technical system, in which not only technical models are taken into account, but also socio-behavioural ones. In this work, a number of different models for the parts of an electrical system are presented, related to production, demand and storage. The models are intended to be as simple as possible in order to be simulated in an integrated framework representing the system as a whole. Furthermore, the models allow the inclusion of social behaviour and other, not purely engineering-related aspects of the system, which have to be considered from a complex point of view. (orig.)

  11. Investigation of the validity of BEM for simulation of wind turbines in complex load cases and comparison with experiment and CFD (United States)

    Rahimi, H.; Dose, B.; Stoevesandt, B.; Peinke, J.


    The aim of this work is to investigate the validity of simulation codes based on the Blade Element Momentum (BEM) theory for three important design load conditions. This paper includes the cases of yawed inflow, rotor tower interaction for downwind turbines and the standstill case. Computational Fluid Dynamics (CFD) and experimental data (when available) are used for the evaluation of the obtained results. For the yawed inflow, the results indicate that significant deviations between BEM and experiments & CFD can be observed. This discrepancy is caused by unsteady phenomena such as the advancing & retreating blade effect and the skewed wake effect. In the case of the rotor and tower interaction of the downwind turbine, the results show that the BEM based code overpredicts the sectional forces in terms of the normal and tangential forces by 20%. In the case of standstill, the evaluation of the results based on tip deflections shows clear differences in the output of both numerical approaches. While the flapwise deflections show a reasonable agreement, the CFD-based coupled solver predicts much larger edgewise vibrations.

  12. Can the Language of Rights Get Hold of the Complex Realities of Child Domestic Work?: The Case of Young Domestic Workers in Abidjan, Ivory Coast (United States)

    Jacquemin, Melanie


    This review examines refractions of children's rights in development practice from an anthropological point of view and considers the case of young domestic girls working in Abidjan. The author argues that child labour legislation and the children's rights perspective in Abidjan is permeated by patriarchal values that mask the exploitation of work…

  13. Prosthodontic treatment in a partially edentulous patient with a complex medical history of epilepsy and deep vein thrombosis: a case report. (United States)

    Kosyfaki, Panagiota; Woerner, Wolf; Att, Wael


    This report describes the prosthodontic rehabilitation of a partially edentulous patient by means of a maxillary implant-supported removable dental prosthesis and mandibular telescopic crown prosthesis. Due to the patient's contributory medical history for epilepsy and deep vein thrombosis, clinical management considerations are outlined along with an evidence-based, medically oriented treatment sequence concerning the surgical and prosthodontic stages of the case.

  14. Complexity in Design-Driven Innovation: A Case Study of Knowledge Transfer Flow in Subsea Seismic Sensor Technology and Design Education (United States)

    Pavel, Nenad; Berg, Arild


    To the extent previously claimed, concept exploration is not the key to product innovation. However, companies that are design-focused are twice as innovative as those that are not. To study design-driven innovation and its occurrence in design education, two case studies are conducted. The first is an example of design practice which includes…

  15. Environmental and complexation effects on the structures and spectroscopic signatures of organic pigments relevant to cultural heritage: the case of alizarin and alizarin-Mg(II)/Al(III) complexes. (United States)

    Carta, Luciano; Biczysko, Malgorzata; Bloino, Julien; Licari, Daniele; Barone, Vincenzo


    An integrated computational approach allowed an unbiased analysis of optical and structural properties of alizarin-based pigments, which can be directly compared with experimental results. Madder lake pigments have been modeled by Mg(II)- and Al(III)-coordinated alizarin taking into account solvation and metal-linkage effects, responsible for colour modifications. Moreover, different environmental conditions have been analyzed for free alizarin, showing in all cases semi-quantitative agreement with experimental spectroscopic data (UV-VIS). Our results point out the ability of in silico approaches to unravel the subtle interplay of stereo-electronic, dynamic, and environmental effects in tuning the physico-chemical properties of pigments relevant to cultural heritage.

  16. Integrating care for older people with complex needs: key insights and lessons from a seven-country cross-case analysis

    Directory of Open Access Journals (Sweden)

    Walter P Wodchis


    Full Text Available Background: To address the challenges of caring for a growing number of older people with a mix of both health problems and functional impairment, programmes in different countries have different approaches to integrating health and social service supports. Objective: The goal of this analysis is to identify important lessons for policy makers and service providers to enable better design, implementation and spread of successful integrated care models. Methods: This paper provides a structured cross-case synthesis of seven integrated care programmes in Australia, Canada, the Netherlands, New Zealand, Sweden, the UK and the USA. Key findings: All seven programmes involved bottom-up innovation driven by local needs and included: (1 a single point of entry, (2 holistic care assessments, (3 comprehensive care planning, (4 care co-ordination and (5 a well-connected provider network. The process of achieving successful integration involves collaboration and, although the specific types of collaboration varied considerably across the seven case studies, all involved a care coordinator or case manager. Most programmes were not systematically evaluated but the two with formal external evaluations showed benefit and have been expanded. Conclusions: Case managers or care coordinators who support patient-centred collaborative care are key to successful integration in all our cases as are policies that provide funds and support for local initiatives that allow for bottom-up innovation. However, more robust and systematic evaluation of these initiatives is needed to clarify the ‘business case’ for integrated health and social care and to ensure successful generalization of local successes.

  17. Evaluating the Performance of DFT Functionals in Assessing the Interaction Energy and Ground-State Charge Transfer of Donor/Acceptor Complexes: Tetrathiafulvalene−Tetracyanoquinodimethane (TTF−TCNQ) as a Model Case

    KAUST Repository

    Sini, Gjergji


    We have evaluated the performance of several density functional theory (DFT) functionals for the description of the ground-state electronic structure and charge transfer in donor/acceptor complexes. The tetrathiafulvalene- tetracyanoquinodimethane (TTF-TCNQ) complex has been considered as a model test case. Hybrid functionals have been chosen together with recently proposed long-range corrected functionals (ωB97X, ωB97X-D, LRC-ωPBEh, and LC-ωPBE) in order to assess the sensitivity of the results to the treatment and magnitude of exact exchange. The results show an approximately linear dependence of the ground-state charge transfer with the HOMO TTF-LUMOTCNQ energy gap, which in turn depends linearly on the percentage of exact exchange in the functional. The reliability of ground-state charge transfer values calculated in the framework of a monodeterminantal DFT approach was also examined. © 2011 American Chemical Society.

  18. Driver's Cognitive Workload and Driving Performance under Traffic Sign Information Exposure in Complex Environments: A Case Study of the Highways in China. (United States)

    Lyu, Nengchao; Xie, Lian; Wu, Chaozhong; Fu, Qiang; Deng, Chao


    Complex traffic situations and high driving workload are the leading contributing factors to traffic crashes. There is a strong correlation between driving performance and driving workload, such as visual workload from traffic signs on highway off-ramps. This study aimed to evaluate traffic safety by analyzing drivers' behavior and performance under the cognitive workload in complex environment areas. First, the driving workload of drivers was tested based on traffic signs with different quantities of information. Forty-four drivers were recruited to conduct a traffic sign cognition experiment under static controlled environment conditions. Different complex traffic signs were used for applying the cognitive workload. The static experiment results reveal that workload is highly related to the amount of information on traffic signs and reaction time increases with the information grade, while driving experience and gender effect are not significant. This shows that the cognitive workload of subsequent driving experiments can be controlled by the amount of information on traffic signs. Second, driving characteristics and driving performance were analyzed under different secondary task driving workload levels using a driving simulator. Drivers were required to drive at the required speed on a designed highway off-ramp scene. The cognitive workload was controlled by reading traffic signs with different information, which were divided into four levels. Drivers had to make choices by pushing buttons after reading traffic signs. Meanwhile, the driving performance information was recorded. Questionnaires on objective workload were collected right after each driving task. The results show that speed maintenance and lane deviations are significantly different under different levels of cognitive workload, and the effects of driving experience and gender groups are significant. The research results can be used to analyze traffic safety in highway environments, while

  19. Structure-function relationships within Keppler-type antitumor ruthenium(III) complexes: the case of 2-aminothiazolium[trans-tetrachlorobis(2-aminothiazole)ruthenate(III)]. (United States)

    Mura, Pasquale; Piccioli, Francesca; Gabbiani, Chiara; Camalli, Mercedes; Messori, Luigi


    Keppler-type ruthenium(III) complexes exhibit promising antitumor properties. We report here a study of 2-aminothiazolium[trans-tetrachlorobis(2-aminothiazole)ruthenate(III)], both in the solid state and in solution. The crystal structure has been solved and found to exhibit classical features. Important solvatochromic effects were revealed. Notably, we observed that introduction of an amino group in position 2 greatly accelerates chloride hydrolysis compared to the thiazole analogue; this latter finding may be of interest for a fine-tuning of the reactivity of these novel metallodrugs.

  20. Emergency management of major bleeding in a case of maxillofacial trauma and anticoagulation: utility of prothrombin complex concentrates in the shock room

    Directory of Open Access Journals (Sweden)

    Alessandro Morotti


    Full Text Available Life-threatening bleeding in anticoagulation with Warfarin is an emergency challenging issue. Several approaches are available to treat bleeding in either over-anticoagulation or propeanticoagulation, including vitamin K, fresh frozen plasma and prothrombin complex concentrates (PCC administration. In coexisting trauma-induced bleeding and anticoagulation, reversal of anticoagulation must be a rapid and highly effective procedure. Furthermore the appropriate treatment must be directly available in each shock rooms to guarantee the rapid management of the emergency. PCC require a simple storage, rapid accessibility, fast administration procedures and high effectiveness. Here we report the utility of PCC in management of a craniofacial trauma in proper-anticoagulation.

  1. Angioma cavernoso do meato acústico interno envolvendo o complexo VII e VIII nervos cranianos: relato de caso Cavernous hemangioma of the internal auditory canal encasing the VII and VIII cranial nerve complex: case report

    Directory of Open Access Journals (Sweden)

    Roberto Leal Silveira


    Full Text Available Relata-se o caso de homem de 21 anos, leucoderma, portador de angioma cavernoso do meato acústico interno direito envolvendo o complexo VII e VIII nervos cranianos tratado cirurgicamente. Apenas 18 casos de angiomas cavernosos dessa localização foram relatados na literatura. São comentados os aspectos clínicos, o diagnóstico diferencial e o tratamento.We report the surgically treated case of a 21-year-old caucasian male harboring a cavernous hemangioma of the right internal auditory canal encasing the seventh and eighth cranial nerves complex. Only 18 cases of cavernous hemangiomas of this location have been previously reported. The clinical features, the differential diagnosis and the treatment are discussed.

  2. Complex Laparoscopic Myomectomy with Severe Adhesions Performed with Proper Preventive Measures and Power Morcellation Provides a Safe Choice in Certain Infertility Cases

    Directory of Open Access Journals (Sweden)

    Jaime Alfaro-Alfaro


    Full Text Available Laparoscopic myomectomy offers a real benefit to infertile patients with uterine fibroids and peritoneal adhesions. The procedure requires a skilled surgeon and laparoscopy technique to minimize adhesion formation and other proven benefits. Restrictions arise since this procedure requires power morcellation for fibroid tissue extraction. Two years ago, the Food and Drug Administration in the United States of America (FDA issued the alert on power morcellation for uterine leiomyomas, addressing the risk of malignant cell spreading within the abdominal cavity (actual risk assessment from 1 in 360 to 1 in 7400 cases. We review a 30-year-old female, without previous gestations, hypermenorrhea, intermenstrual bleeding, and chronic pelvic pain. Transvaginal ultrasound reports multiple fibroids in the right portion of a bicornuate uterus. Relevant history includes open myomectomy 6 years before and a complicated appendectomy, developing peritonitis within a year. Laparoscopy revealed multiple adhesions blocking uterine access, a bicornuate uterus, and myomas in the expected site. Myomectomy was performed utilizing power morcellation with good results. FDA recommendations have diminished this procedure’s selection, converting many to open variants. This particular case was technically challenging, requiring morcellation, and safety device deployment was impossible, yet the infertility issue was properly addressed. Patient evaluation, safety measures, and laparoscopy benefits may outweigh the risks in particular cases as this one.

  3. Facilities Management Service Delivery in Public and Private High Rise Residential Buildings in Nigeria: A case study of Eko Court Complex and Niger Towers

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    Olanrele O. O.


    Full Text Available This study assessed and compared the delivery of Facilities Management (FM services in public and private high rise residential buildings in Lagos, Nigeria. While some facilities or services may not be available in some public estates, the efficiency of the available ones is inadequate in comparison with the adequacy and efficiency of services provided in private estates. The objectives set for the study include identification of services that are provided in the case studies, service delivery method, and an assessment of the residents’ satisfaction of the services. This study adopted questionnaire survey for collection of data. 127 questionnaires were distributed to the residents of the case studies and 93 were returned. Three of which were discarded for incompleteness, thus 90 were analysed. The study found that most but not all of the facilities services expected in high rise buildings are available in the case studies and the services are outsourced under a standard Service Level Agreement. The service delivery in private high rise residential building is better than the public residential high rise buildings as revealed by the study. The study recommends improved standardization of services, customized services and meeting customer’s expectation for improved service delivery.

  4. Nipple-areola complex sparing modified radical mastectomy for breast cancer: report of 159 cases%保留乳头乳晕的乳腺癌改良根治术159例报告

    Institute of Scientific and Technical Information of China (English)

    张晖; 王圣应; 彭德峰; 朱金海; 朱正志


    Objective To evaluate nipple-areola complex sparing modified radical mastectomy for breast cancer. Methods Clinical data of 159 breast cancer cases undergoing NAC sparing modified radical mastectomy from Jan 1998 to Dec 2009 were retrospectively analyzed.Results NAC sparing modified radical mastectomy was successfully carried out in 141 out of the 159 cases ( 88.68% ). In 14 cases (8. 81% ) the original operative protocol was changed to modified radical mastectomy or radical mastectomy during the operations because NAC ischemia in 4 (2. 52% )cases, NAC occult involvement or dysplasia in 5 cases (3. 14% ), Ⅲ level lymph node metastasis was found in 3 cases (1.89%). Postoperative complete nipple necrosis occurred in 4 (2. 52% ) cases. Other significant postoperative complications included nipple necrosis in 20 cases ( 12. 58% ), skin flap necrosis and infection in 11 cases ( 6.92% ), subcutaneous hydrops in 10 cases (6. 29% ). All patients got follow-up ranging from 15 to 96 months,median follow-up was 51 months. Local region recurrences were observed in 5 cases (3. 14% ), distant metastasis in 2 cases ( 1.26% ). There was no recurrence in the region of NAC. Conclusions Nipple-areola complex sparing modified radical mastectomy is oncologically safe by strict preoperative selection criteria and strict operative procedure.%目的 总结保留乳头乳晕复合体( nipple-areola complex,NAC)的乳腺癌改良根治术经验,以期提高手术成功率。方法 对1998年1月至2009年12月行保留NAC乳腺癌改良根治术的159例患者的临床病理资料进行回顾。结果 159例患者中成功实施保留NAC乳腺癌改良根治术141例(88.68%)。术中放弃保留NAC而改变为乳腺癌改良根治术或根治术14例(8.81%),其中4例(2.52%)为术中发现NAC缺血,5例(3.14%) NAC有癌浸润,2例(1.26%)为重度不典型增生,3例(1.89%)因术中发现Ⅲ级淋巴结肿大而更改术式;术后乳头

  5. Melting of a subduction-modified mantle source: A case study from the Archean Marda Volcanic Complex, central Yilgarn Craton, Western Australia (United States)

    Morris, P. A.; Kirkland, C. L.


    Subduction processes on early earth are controversial, with some suggestions that tectonics did not operate until the earth cooled to a sufficient point around the Archean-Proterozoic boundary. One way of addressing this issue is to examine well-preserved successions of Archean supracrustal rocks. Here we discuss petrography, whole-rock chemical and isotopic data combined with zircon Hf isotopes from andesites, high-magnesium andesites (HMA), dacites, high-magnesium dacites (HMD), rhyolites and coeval felsic intrusive rocks of the c. 2730 Ma Marda Volcanic Complex (MVC) in the central Yilgarn Craton of Western Australia. We demonstrate that these rocks result from melting of a metasomatized mantle source, followed by fractional crystallization in a crustal magma chamber. Contamination of komatiite by Archean crust, to produce the Marda Volcanic Complex andesites, is not feasible, as most of these crustal sources are too radiogenic to act as viable contaminants. The ɛNd(2730) of MVC andesites can be produced by mixing 10% Narryer semi-pelite with komatiite, consistent with modelling using Hf isotopes, but to achieve the required trace element concentrations, the mixture needs to be melted by about 25%. The most likely scenario is the modification of a mantle wedge above a subducting plate, coeval with partial melting, producing volcanic rocks with subduction signatures and variable Mg, Cr and Ni contents. Subsequent fractionation of cognate phases can account for the chemistry of dacites and rhyolites.

  6. Can the Diagnostics of Triangular Fibrocartilage Complex Lesions Be Improved by MRI-Based Soft-Tissue Reconstruction? An Imaging-Based Workup and Case Presentation

    Directory of Open Access Journals (Sweden)

    Niels Hammer


    Full Text Available Introduction. The triangular fibrocartilage complex (TFCC provides both mobility and stability of the radiocarpal joint. TFCC lesions are difficult to diagnose due to the complex anatomy. The standard treatment for TFCC lesions is arthroscopy, posing surgery-related risks onto the patients. This feasibility study aimed at developing a workup for soft-tissue reconstruction using clinical imaging, to verify these results in retrospective patient data. Methods. Microcomputed tomography (μ-CT, 3 T magnetic resonance imaging (MRI, and plastination were used to visualize the TFCC in cadaveric specimens applying segmentation-based 3D reconstruction. This approach further trialed the MRI dataset of a patient with minor radiological TFCC alterations but persistent pain. Results. TFCC reconstruction was impossible using μ-CT only but feasible using MRI, resulting in an appreciation of its substructures, as seen in the plastinates. Applying this approach allowed for visualizing a Palmer 2C lesion in a patient, confirming ex postum the arthroscopy findings, being markedly different from MRI (Palmer 1B. Discussion. This preliminary study showed that image-based TFCC reconstruction may help to identify pathologies invisible in standard MRI. The combined approach of μ-CT, MRI, and plastination allowed for a three-dimensional appreciation of the TFCC. Image quality and time expenditure limit the approach’s usefulness as a diagnostic tool.

  7. Complex network modeling of spectral remotely sensed imagery: A case study of massive green algae blooms detection based on MODIS data (United States)

    Sui, Yi; Shao, Fengjing; Wang, Changying; Sun, Rencheng; Ji, Jun


    Feature bands selection and targets classification is of great importance in spectral remotely sensed imagery interpretation. In this work, complex network is adopted for modeling spectral remotely sensed imagery. Subnet is constructed for each band based on spatial neighboring characteristic. Feature bands could be obtained by analyzing and comparing topological characteristics between subnets. After finding feature bands, subnets of feature bands are compounded. Targets classification could be measured by degree distribution of the composited network. This approach is evaluated with empirical experiments based on detecting massive green algae blooms with MODIS data. Feature bands found are coincided with spectral mechanism of green algae. By comparing with FAI, RVI, NDVI, EVI and OSABI methods, our approach improves correct classification rates.

  8. [Disseminated Mycobacterium avium complex infections in AIDS. Apropos of 100 cases. Groupe d'Epidémiologie clinique du SIDA en Aquitaine]. (United States)

    Lasseur, C; Maugein, J; Pellegrin, J L; Dupon, M; Ragnaud, J M; Morlat, P; Pellegrin, I; Constans, J; Monlun, E; Chene, G


    The improvement of survival of AIDS patients allowed the emergence of disseminated Mycobacterium avium Complex infections (D.MAC). Here we report the experience of the group of "Epidémiologie clinique du sida en Aquitaine (GECSA)" about 100 patients. There were no differences according to sex, age and route of acquisition of HIV. Clinical and biological characteristics of the infections were not specific. The mean TCD4+ lymphocytes count was 18/mm3. The diagnostic was generally established by systematic blood culture on Septi-Chek in patients with TCD4+ lymphocytes count below 75/mm3. The recommendations on therapy for D.MAC are to use regimen containing azithromycin or clarithromycin, ethambutol and one of the following drugs, rifabutin, clofazimine, amikacin, or ciprofloxacin. Rifabutin is recommended for prophylaxis in patients with lymphocytes TCD4+ count below 100/mm3.

  9. Relationship between physicochemical parameters of alpha-amino acids and those of the chlorinated solvents in the case of the L/L partition as supra molecular complexes

    Energy Technology Data Exchange (ETDEWEB)

    Oana popescu, D.; Constantinescu, T.; Mutihac, L.


    In order to explain the dependence of the distribution coefficient (D) between water and three different chlorinated solvents (methylene chloride, chloroform and 1,2-dichloroethane) of some alpha-amino acids (leucine, tryptophane, phenylalanine, methionine, valine and isoleucine), as supramolecular complexes of [EC...R-CH-(NH{sub 3})-COOH]``+A``- type, (EC=18-C-6; A``-=the anion originated in tropaeoline 00), a correlation was established by means of a multilinear regression analysis performed between different characteristics of the alpha-amino acids and those of the solvents involved. This study evidence a good correlation (r>0.81) between some of the characteristics of alpha-amino acids (pi, pH, pKa{sub 2}), and of the solvent Sigma Beta``H{sub 2}, pi``H{sub 2} R``H{sub 2} or sigma alpha``H{sub 2}, just mentioned. (Author) 21 refs.

  10. Studies on the power output of a MADE AE-30 operating on complex terrain. Annual Energy Production estimation and Multivariable analysis. A case of multi-stall effect

    Energy Technology Data Exchange (ETDEWEB)

    Cuerva, A.


    The main need of the EWTS-II Sub-project IV group is to have a suitable data-base which allows it to reach proper conclusions on the characteristics of power performance of wind turbines in complex terrain. With this aim, this document presents an analysis on the power output of the MADE AE-30 Wind turbine operating at Tarifa (also data from flat terrain are enclosed as a reference). An application of the bin method and AEP estimation for energy production method, in the two last issues a directional analysis and an study for two different turbulence intensity ranges are enclosed. Finally the Stepwise multirregression method is applied on the measurements to identify the stored parameters that have influence on the power output. A brief description of multi stall effect is enclosed. (Author)

  11. A conceptual framework for designing micro-worlds for complex work domains: a case study of the Cabin Air Management System. (United States)

    Sauer, J; Wastell, D G; Hockey, G R


    A conceptual framework for the design of micro-worlds is presented in this paper. This is illustrated by a micro-world, called Cabin Air Management System (CAMS), that has been used in a research program to investigate human behavior during work with complex systems. Although CAMS is based on the operational context of spaceflight, its underlying principles correspond to a process control task. The authors propose a theoretical framework for micro-world design, which was used to guide the development of the CAMS micro-world. This may provide a helpful guideline for researchers wishing to develop a micro-world by using a more structured approach. A detailed technical description of CAMS is given to demonstrate the kind of real-world scenarios that may be simulated with this task environment. Finally, general aspects of the utility of micro-world research are discussed.

  12. Low incidence of colonization and no cases of disseminated Mycobacterium avium complex infection (DMAC in Brazilian AIDS patients in the HAART era

    Directory of Open Access Journals (Sweden)

    Gadelha Ângela


    Full Text Available OBJECTIVE: Evaluate the incidence of mycobacterial disease and the colonization of the respiratory and gastrointestinal tracts by Mycobacterium avium complex (MAC bacteria in AIDS patients. METHODS: Inclusion criteria: HIV-positive individuals with at least one CD4+ count 100 cells/mm³ (HR = 0.18; CI = 0.05 - 0.70 predicted a lower risk of death (P<0.05 but was not protective for MAC colonization (HR=0.52;CI =0.62 - 4.35, P=0.55. CONCLUSION: The absence of DMAC infection in colonized individuals argues in favor of a HAART protective effect against; DMAC; however, restoration of CD4 counts did not protect patients against MAC colonization.

  13. MODIS GPP/NPP for complex land use area: a case study of comparison between MODIS GPP/NPP and ground-based measurements over Korea (United States)

    Shim, C.


    The Moderate Resolution Imaging Radiometer (MODIS) Gross Primary Productivity (GPP)/Net Primary Productivity (NPP) has been widely used for the study on global terrestrial ecosystem and carbon cycle. The current MODIS product with ~ 1 km spatial resolution, however, has limitation on the information on local scale environment (Pinus densiflora) agreed well with -0.2% of bias (1.6 gCm-2yr-1). The fairly comparable values of the MODIS here however, cannot assure the quality of the MOD17 over the complex vegetation area of Korea since the ground measurements except the eddy covariance tower flux measurements are highly inconsistent. Therefore, the comprehensive experiments to represents GPP/NPP over diverse vegetation types for a comparable scale of MODIS with a consistent measurement technique are necessary in order to evaluate the MODIS vegetation productivity data over Korea, which contains a large portion of highly heterogeneous vegetation area.

  14. [Alzheimer's disease cerebro-spinal fluid biomarkers: A clinical research tool sometimes useful in daily clinical practice of memory clinics for the diagnosis of complex cases]. (United States)

    Magnin, E; Dumurgier, J; Bouaziz-Amar, E; Bombois, S; Wallon, D; Gabelle, A; Lehmann, S; Blanc, F; Bousiges, O; Hannequin, D; Jung, B; Miguet-Alfonsi, C; Quillard, M; Pasquier, F; Peoc'h, K; Laplanche, J-L; Hugon, J; Paquet, C


    The role of biomarkers in clinical research was recently highlighted in the new criteria for the diagnosis of Alzheimer's disease. Cerebro-spinal fluid (CSF) biomarkers (total Tau protein, threonine 181 phosphorylated Tau protein and amyloid Aβ1-42 peptide) are associated with cerebral neuropathological lesions observed in Alzheimer's disease (neuronal death, neurofibrillary tangle with abnormal Tau deposits and amyloid plaque). Aβ1-40 amyloid peptide dosage helps to interpret Aβ1-42 results. As suggested in the latest international criteria and the French HAS (Haute Autorité de santé) recommendations, using theses CSF biomarkers should not be systematic but sometimes could be performed to improve confidence about the diagnostic of Alzheimer's disease in young subjects or in complex clinical situations. Future biomarkers actually in development will additionally help in diagnostic process (differential diagnosis) and in prognostic evaluation of neurodegenerative diseases.

  15. Is scale-up of community mobilisation among sex workers really possible in complex urban environments? The case of Mumbai, India.

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    Anine Kongelf

    Full Text Available In the last decade, community mobilisation (CM interventions targeting female sex workers (FSWs have been scaled-up in India's national response to the HIV epidemic. This included the Bill and Melinda Gates Foundation's Avahan programme which adopted a business approach to plan and manage implementation at scale. With the focus of evaluation efforts on measuring effectiveness and health impacts there has been little analysis thus far of the interaction of the CM interventions with the sex work industry in complex urban environments.Between March and July 2012 semi-structured, in-depth interviews and focus group discussions were conducted with 63 HIV intervention implementers, to explore challenges of HIV prevention among FSWs in Mumbai. A thematic analysis identified contextual factors that impact CM implementation. Large-scale interventions are not only impacted by, but were shown to shape the dynamic social context. Registration practices and programme monitoring were experienced as stigmatising, reflected in shifting client preferences towards women not disclosing as 'sex workers'. This combined with urban redevelopment and gentrification of traditional red light areas, forcing dispersal and more 'hidden' ways of solicitation, further challenging outreach and collectivisation. Participants reported that brothel owners and 'pimps' continued to restrict access to sex workers and the heterogeneous 'community' of FSWs remains fragmented with high levels of mobility. Stakeholder engagement was poor and mobilising around HIV prevention not compelling. Interventions largely failed to respond to community needs as strong target-orientation skewed activities towards those most easily measured and reported.Large-scale interventions have been impacted by and contributed to an increasingly complex sex work environment in Mumbai, challenging outreach and mobilisation efforts. Sex workers remain a vulnerable and disempowered group needing continued support

  16. A complex origin for the Kelso Dunes, Mojave National Preserve, California, USA: A case study using a simple geochemical method with global applications (United States)

    Muhs, Daniel R.; Lancaster, Nicholas; Skipp, Gary L.


    The Kelso Dune field in southern California is intriguing because although it is of limited areal extent ( 100 km2), it has a wide variety of dune forms and contains many active dunes ( 40 km2), which is unusual in the Mojave Desert. Studies over the past eight decades have concluded that the dunes are derived primarily from a single source, Mojave River alluvium, under a dominant, westerly-to-northwesterly wind regime. The majority of these studies did not, however, present data to support the Mojave River as the only source. We conducted mineralogical and geochemical studies of most of the 14 geomorphically defined dune groups of the Kelso Dune field as well as potential sand sources, alluvial sediments from the surrounding mountain ranges. Results indicate that sands in the nine western dune groups have K/Rb and K/Ba (primarily from K-feldspar) compositions that are indistinguishable from Mojave River alluvium (westerly/northwesterly winds) and Budweiser Wash alluvium (southwesterly winds), permitting an interpretation of two sources. In contrast, sands from the five eastern dune groups have K/Rb and K/Ba values that indicate significant inputs from alluvial fan deposits of the Providence Mountains. This requires either rare winds from the east or southeast or, more likely, aeolian reworking of distal Providence Mountain fan sediments by winds from the west, at a rate greater than input from the Mojave River or other western sources. The results indicate that even a small dune field can have a complex origin, either from seasonally varying winds or complex alluvial-fan-dune interaction. Application of K/Rb and K/Ba in K-feldspar as a provenance indicator could be used in many of the world's ergs or sand seas, where dune origins are still not well understood or are controversial. Four examples are given from Africa and the Middle East where such an approach could yield useful new information about dune sand provenance.

  17. pH-controlled dispersive liquid-liquid microextraction for the analysis of ionisable compounds in complex matrices: Case study of ochratoxin A in cereals. (United States)

    Campone, Luca; Piccinelli, Anna Lisa; Celano, Rita; Rastrelli, Luca


    A new sample preparation procedure, termed pH-controlled dispersive liquid-liquid microextraction (pH-DLLME), has been developed for the analysis of ionisable compounds in highly complex matrices. This DLLME mode, intended to improve the selectivity and to expand the application range of DLLME, is based on two successive DLLMEs conducted at opposite pH values. pH-DLLME was applied to determination of ochratoxin A (OTA) in cereals. The hydrophobic matrix interferences in the raw methanol extract (disperser, 1mL) were removed by a first DLLME (I DLLME) performed at pH 8 to reduce the solubility of OTA in the extractant (CCl(4), 400μL). The pH of the aqueous phase was then adjusted to 2, and the analyte was extracted and concentrated by a second DLLME (extractant, 150μL C(2)H(4)Br(2)). The main factors influencing the efficiency of pH-DLLME including type and volume of I DLLME extractant, as well as the parameters affecting the OTA extraction by II DLLME, were studied in detail. Under optimum conditions, the method has detection and quantification limits of 0.019 and 0.062μg kg(-1), respectively, with OTA recoveries in the range of 81.2-90.1% (n=3). The accuracy of the analytical procedure, evaluated with a reference material (cereal naturally contaminated with OTA), is acceptable (accuracy of 85.6%±1.7, n=5). The applicability of pH-DLLME to the selective extraction of other ionisable compounds, such as acidic and basic pharmaceutical products was also demonstrated. The additional advantages of pH-DLLME are a higher selectivity and the extension of this microextraction technique to highly complex matrices.

  18. Validation of sensitivity and reliability of GPR and microgravity detection of underground cavities in complex urban settings: Test case of a cellar (United States)

    Chromčák, Jakub; Grinč, Michal; Pánisová, Jaroslava; Vajda, Peter; Kubová, Anna


    We test here the feasibility of ground-penetrating radar (GPR) and microgravity methods in identifying underground voids, such as cellars, tunnels, abandoned mine-workings, etc., in complex urban conditions. For this purpose, we selected a cellar located under a private lot in a residential quarter of the town of Senec in Western Slovakia, which was discovered by chance when a small sinkhole developed on the yard just two meters away from the house. The size of our survey area was limited 1) by the presence of a technical room built at the back of the yard with a staircase leading to the garden, and 2) by the small width of the lot. Therefore the geophysical survey was carried out only in the backyard of the lot as we were not permitted to measure on neighbouring estates. The results from the GPR measurements obtained by the GSSI SIR-3000 system with 400 MHz antenna were visualized in the form of 2D radargrams with the corresponding transformed velocity model of studied cross-sections. Only the profiles running over the pavement next to the house yielded interpretable data because the local geological situation and the regular watering of the lawn covering prevailingly the backyard caused significant attenuation of the emitted GPR signal. The Bouguer gravity map is dominated by a distinctive negative anomaly indicating the presence of a shallow underground void. The quantitative interpretation by means of Euler deconvolution was utilized to validate the depth of the center and location of the cellar. Comparison with the gravitational effect of the cellar model calculated in the in-house program Polygrav shows a quite good correlation between the modelled and observed fields. Only a part of the aerial extent of the anomaly could be traced by the used geophysical methods due to accessibility issues. Nevertheless, the test cellar was successfully detected and interpreted by both methods, thus confirming their applicability in similar environmental and geotechnical

  19. Impacts of population structure and analytical models in genome-wide association studies of complex traits in forest trees: a case study in Eucalyptus globulus.

    Directory of Open Access Journals (Sweden)

    Eduardo P Cappa

    Full Text Available The promise of association genetics to identify genes or genomic regions controlling complex traits has generated a flurry of interest. Such phenotype-genotype associations could be useful to accelerate tree breeding cycles, increase precision and selection intensity for late expressing, low heritability traits. However, the prospects of association genetics in highly heterozygous undomesticated forest trees can be severely impacted by the presence of cryptic population and pedigree structure. To investigate how to better account for this, we compared the GLM and five combinations of the Unified Mixed Model ( UMM on data of a low-density genome-wide association study for growth and wood property traits carried out in a Eucalyptus globulus population (n = 303 with 7,680 Diversity Array Technology (DArT markers. Model comparisons were based on the degree of deviation from the uniform distribution and estimates of the mean square differences between the observed and expected p-values of all significant marker-trait associations detected. Our analysis revealed the presence of population and family structure. There was not a single best model for all traits. Striking differences in detection power and accuracy were observed among the different models especially when population structure was not accounted for. The UMM method was the best and produced superior results when compared to GLM for all traits. Following stringent correction for false discoveries, 18 marker-trait associations were detected, 16 for tree diameter growth and two for lignin monomer composition (S:G ratio, a key wood property trait. The two DArT markers associated with S:G ratio on chromosome 10, physically map within 1 Mbp of the ferulate 5-hydroxylase (F5H gene, providing a putative independent validation of this marker-trait association. This study details the merit of collectively integrate population structure and relatedness in association analyses in undomesticated, highly

  20. Automatic Complexity Analysis

    DEFF Research Database (Denmark)

    Rosendahl, Mads


    One way to analyse programs is to to derive expressions for their computational behaviour. A time bound function (or worst-case complexity) gives an upper bound for the computation time as a function of the size of input. We describe a system to derive such time bounds automatically using abstract...

  1. Engaging complexity

    Directory of Open Access Journals (Sweden)

    Gys M. Loubser


    Full Text Available In this article, I discuss studies in complexity and its epistemological implications for systematic and practical theology. I argue that engagement with complexity does not necessarily assurea non-reductionist approach. However, if complexity is engaged transversally, it becomes possible to transcend reductionist approaches. Moreover, systematic and practical the ologians can draw on complexity in developing new ways of understanding and, therefore, new ways of describing the focus, epistemic scope and heuristic structures of systematic and practical theology. Firstly, Edgar Morin draws a distinction between restricted and general complexity based on the epistemology drawn upon in studies in complexity. Moving away from foundationalist approaches to epistemology, Morin argues for a paradigm of systems. Secondly,I discuss Kees van Kooten Niekerk�s distinction between epistemology, methodology andontology in studies in complexity and offer an example of a theological argument that drawson complexity. Thirdly, I argue for the importance of transversality in engaging complexity by drawing on the work of Wentzel van Huyssteen and Paul Cilliers. In conclusion, I argue that theologians have to be conscious of the epistemic foundations of each study in complexity, and these studies illuminate the heart of Reformed theology.Intradisciplinary and/or interdisciplinary implications: Therefore, this article has both intradisciplinary and interdisciplinary implications. When theologians engage studies incomplexity, the epistemological roots of these studies need to be considered seeing thatresearchers in complexity draw on different epistemologies. Drawing on transversality wouldenhance such considerations. Furthermore, Edgar Morin�s and Paul Cilliers� approach tocomplexity will inform practical and theoretical considerations in church polity and unity.

  2. Percutaneous nephrolithotomy combined with auxiliary method in the treatment of 40 complex calculus of kidney cases%经皮肾镜结合辅助方法治疗复杂肾结石40例

    Institute of Scientific and Technical Information of China (English)



    Objective To investigate clinical effect by percutaneous nephrolithotomy combined with auxiliary method in the treatment of complex calculus of kidney. Methods A total of 40 patients with complex calculus of kidney as study subjects received percutaneous nephrolithotomy combined with auxiliary methods for treatment. Their complete clearance rate and complications were observed. Results Among the 40 cases, 28 cases had single clearance, with single clearance rate as 70.0%, and 11 cases had secondary clearance, as their complete clearance rate was 97.5%. After treatment, complicated occurred in 13 cases, with incidence of complications as 32.5%. Conclusion Combination of percutaneous nephrolithotomy and auxiliary method provides good effect and high clearance rate in treating complex calculus of kidney. This method effectively relieve symptoms and reduce pain, along with highly medical significance, and it is worth clinical promotion.%目的:探究经皮肾镜结合辅助方法治疗复杂肾结石的临床效果。方法40例复杂肾结石患者作为观察对象,采用经皮肾镜结合辅助方法来进行治疗。观察患者结石完全清除率以及并发症情况。结果本组40例患者中,结石一次清除28例,一次清除率为70.0%,二次手术后结石清除11例,总结石清除率达97.5%;在治疗后,出现13例并发症,并发症发生率为32.5%。结论经皮肾镜结合辅助方法治疗复杂肾结石,效果较好,结石清除率较高,有效缓解患者的症状,减少痛苦,具有较高的医学意义,值得临床推广。

  3. Simplifying complexity

    NARCIS (Netherlands)

    Leemput, van de I.A.


    In this thesis I use mathematical models to explore the properties of complex systems ranging from microbial nitrogen pathways and coral reefs to the human state of mind. All are examples of complex systems, defined as systems composed of a number of interconnected parts, where the systemic behavior

  4. Complex narratives

    NARCIS (Netherlands)

    Simons, J.


    This paper brings together narratology, game theory, and complexity theory to untangle the intricate nature of complex narratives in contemporary cinema. It interrogates the different terms - forking-path narratives, mind-game films, modular narratives, multiple-draft films, database narratives, puz

  5. Computational Complexity

    Directory of Open Access Journals (Sweden)

    J. A. Tenreiro Machado


    Full Text Available Complex systems (CS involve many elements that interact at different scales in time and space. The challenges in modeling CS led to the development of novel computational tools with applications in a wide range of scientific areas. The computational problems posed by CS exhibit intrinsic difficulties that are a major concern in Computational Complexity Theory. [...

  6. The evolution of the paleomagnetic fold test as applied to complex geologic situations, illustrated by a case study from northern Spain (United States)

    Weil, Arlo B.; Van der Voo, Rob

    Paleomagnetic results are most useful if the age of the magnetization can be established with respect to the rock age or the age of specific structural or alteration events. The fold test is a particularly powerful tool; not only can it be used to determine whether magnetizations are pre-, syn- or post-folding, but it can also reassure us that structural corrections need (or need not) be applied to a given magnetization. This study traces the evolution of various fold and tilt tests developed in the 50-some years since the classical test of Graham was published. Syn-deformational magnetizations are a very special case, usually characterized as such by an incremental tilt test. In regions where rotations about (near-) vertical axes are to be expected, a strike test is the best tool for determining them. A case study of syn-deformational magnetizations in the Cantabria-Asturias Arc (CAA) of northern Spain is presented, which illustrates the application of the various tilt and strike tests. One ancient post-deformational and two syn-deformational magnetizations have been recorded in CAA Devonian carbonates, each characterized by different optimal (peak) percentages of unfolding in incremental fold tests. The structural corrections required to bring the individual site-mean magnetization directions into alignment can be used to restore the beds to their attitudes at the times when the magnetizations were acquired. Furthermore, these structural corrections provide robust constraints on the kinematics of the deformation phase that is being removed. In the CAA, removal of late-stage folding about steeply inclined fold axes, due to Permian oroclinal bending, restores the belt to its first folding and thrusting configuration, and produces north-south trending cylindrical folds that formed during the Late Carboniferous. The separate deformations, consisting of earlier folding and thrusting and later oroclinal bending, have implications for the final collisional movements

  7. In search for instructional techniques to maximize the use of germane cognitive resources: A case of teaching complex tasks in physics (United States)

    Sliva, Yekaterina

    The purpose of this study was to introduce an instructional technique for teaching complex tasks in physics, test its effectiveness and efficiency, and understand cognitive processes taking place in learners' minds while they are exposed to this technique. The study was based primarily on cognitive load theory (CLT). CLT determines the amount of total cognitive load imposed on a learner by a learning task as combined intrinsic (invested in comprehending task complexity) and extraneous (wasteful) cognitive load. Working memory resources associated with intrinsic cognitive load are defined as germane resources caused by element interactivity that lead to learning, in contrast to extraneous working memory resources that are devoted to dealing with extraneous cognitive load. However, the amount of learner's working memory resources actually devoted to a task depends on how well the learner is engaged in the learning environment. Since total cognitive load has to stay within limits of working memory capacity, both extraneous and intrinsic cognitive load need to be reduced. In order for effective learning to occur, the use of germane cognitive resources should be maximized. In this study, the use of germane resources was maximized for two experimental groups by providing a learning environment that combined problem-solving procedure with prompts to self-explain with and without completion problems. The study tested three hypotheses and answered two research questions. The first hypothesis predicting that experimental treatments would reduce total cognitive load was not supported. The second hypothesis predicting that experimental treatments would increase performance was supported for the self-explanation group only. The third hypothesis that tested efficiency measure as adopted from Paas and van Merrienboer (1993) was not supported. As for the research question of whether the quality of self-explanations would change with time for the two experimental conditions, it was

  8. Petrogenesis of the Neoproterozoic Ngondo Plutonic complex (Cameroon, west central Africa): a case of late-collisional ferro-potassic magmatism (United States)

    Tagne-Kamga, Gabriel


    The Ngondo complex is a late-collisional pluton, which was emplaced around 600 Ma along a N030° E strike-slip shear zone in the southwestern part of the Neoproterozoic Fold Belt of Cameroon. It comprises three successively emplaced plutonic groups of rocks: (i) mafic to felsic intrusive rocks (MFR), (ii) fine-grained granites (FGG) and (iii) coarse-grained granites (CGG). Late aplitic and pegmatite dykes were emplaced along brittle fractures in these plutons. The complex is metaluminous to weakly peraluminous, high-K, calc-alkaline to " trans-alkaline" ferro-potassic, with mineralogical and geochemical characteristic of I-type granites. The plutonic rocks are characterised by high Ba, Sr, Rb and ∑REE concentrations and low Ni and Cr contents in the mafic members. They also display chondrite-normalised REE patterns characterised by variable LREE enrichment, moderate to minor HREE fractionation with moderate to pronounced negative Eu anomalies (Eu/Eu∗: 0.6-0.9 (MFR), 0.2-0.5 (FGG), 0.3-0.7 (CGG)). Trace element distribution patterns for the three plutonic groups are similar with a distinctive depletion in Nb, Sr and Ti relative to other trace elements and a greater enrichment in LILE compared to HFSE. These plutonic groups present distinct evolutionary trends precluding their origin from differentiation of a single parental magma. The geochemical and isotopic data indicate that they derived from partial melting of heterogeneous (meta)-igneous mafic lower crustal materials, having possibly the composition of amphibolitised high-K calc-alkaline basaltic andesites and andesitic metagreywackes. Petrographic evidences such as the presence of quartz-ocelli, xenocrysts of feldspar, fragments of country rocks (migmatitic gneisses) strongly indicate that crustal contamination may have played an important role in the genesis of the plutonic rocks. This contamination process is further supported by the variation of major and trace elements together with Sr-Nd isotopic data

  9. Re-equilibration history and P- T path of eclogites from Variscan Sardinia, Italy: a case study from the medium-grade metamorphic complex (United States)

    Cruciani, Gabriele; Franceschelli, Marcello; Groppo, Chiara; Oggiano, Giacomo; Spano, Maria Elena


    Retrogressed eclogites are hosted within the Variscan low- to medium-grade metamorphic complex near Giuncana, north-central Sardinia. These rocks are medium to fine grained with garnet and amphibole as the most abundant mineral phases along with clinopyroxene, plagioclase, quartz, biotite, chlorite, epidote, ilmenite, rutile and titanite. Four stages of mineralogical re-equilibration have been distinguished. The stage I is characterized by the occurrence of omphacite, epidote, quartz, amphibole, rutile and ilmenite in garnet poikiloblasts. The stage II is characterized by two types of symplectitic microstructures: (1) amphibole + quartz symplectite and (2) clinopyroxene + plagioclase ± amphibole symplectite. The first symplectite type replaces omphacite included in garnet, whereas the second one is widespread in the matrix. Biotite droplets and/or lamellae intimately growing with fine-grained plagioclase resemble biotite + plagioclase symplectite after phengite. The stage III is characterized by the widespread formation of amphibole: (1) as zoned porphyroblasts in the matrix, (2) as corona-type microstructure replacing garnet. Subordinate plagioclase (oligoclase) is also present in the amphibole corona. The stage IV is characterized by the local formation of biotite replacing garnet, actinolite, chlorite, albite and titanite. P- T pseudosections calculated with Perple_X give P- T conditions 580 < T < 660 °C, 1.3 < P < 1.8 GPa for the stage I. After the stage I, pressure decrease and temperature increase led to the breakdown of omphacite with the formation of clinopyroxene + plagioclase ± amphibole symplectite at ~1.25-1.40 GPa and 650-710 °C (stage II). P- T conditions of the amphibolite-facies stage III have been defined at 600-670 °C, P = 0.65-0.95 GPa. P- T conditions of the latest stage IV are in the range of greenschist facies. The P- T path of the retrogressed eclogite hosted in the medium-grade micaschist and paragneiss of Giuncana recalls the P- T

  10. P-T path and timing of crustal thickening during amalgamation of East and West Gondwana: A case study from the Hafafit Metamorphic Complex, Eastern Desert of Egypt (United States)

    Abu El-Enen, Mahrous M.; Abu-Alam, Tamer S.; Whitehouse, Martin J.; Ali, Kamal A.; Okrusch, Martin


    The southeastern sector of the Hafafit Metamorphic Complex, southern Eastern Desert of Egypt comprises infrastructural orthogneisses of tonalite and syenogranite parentage, amphibolites, and a volcano-sedimentary association. These are overthrust by an obducted suprastructural ophiolite nappes via the Nugrus thrust. The protolith of the biotite-hornblende-gneisses was formed during island-arc accretion, while that of the garnet-biotite gneisses were formed in a within-plate regime, consistent with a transition to a post-collisional setting. The volcano-sedimentary association comprises interbedded and intercalated highly foliated metapelitic schists, metabasites, and leucocratic gneisses, deposited in a back-arc basin. The metapelites and the leucocratic gneisses originated from immature Fe-shales and arkoses derived from intermediate-mafic and acidic igneous rocks, respectively, via weak chemical weathering in a tectonically active island arc terrane. The intercalated amphibolites were derived from tholeiitic basalts generated in a back-arc setting. The volcano-sedimentary association was metamorphosed under upper-amphibolite facies conditions with pressures of 9-13 kbar and temperatures of 570-675 °C, as derived from conventional geothermobarometry and pseudosection calculation. A steep, tight clockwise P-T path is constrained and a geothermal gradient around 20 °C/km is estimated for the peak metamorphism. We assume that deformation and metamorphism are due to crustal thickening during the collision of East and West Gondwana, where peak metamorphism took place in the middle to lower crust at 33 km average crustal depth. This was followed by a subsequent quasi-isothermal decompression due to rapid exhumation during wrench tectonics. Sinistral transcurrent shearing with extensional denudation resulted in vertical ductile thinning that was accompanied by heat input from magmatism, as indicated by a higher geothermal gradient during retrograde metamorphism and

  11. Displaced/re-worked rhodolith deposits infilling parts of a complex Miocene multistorey submarine channel: A case history from the Sassari area (Sardinia, Italy) (United States)

    Murru, Marco; Bassi, Davide; Simone, Lucia


    In the Sassari area (north-western Sardinia, Italy), the Miocene Porto Torres sub-basin sequences represent the complex multistorey mixed carbonate-siliciclastic submarine feature called the Sassari Channel. During the late Burdigalian-early Serravallian, repeated terrigenous supplies from uplifted Paleozoic crystalline substrata fed the Sassari Channel system by means of turbidity and locally hyper-concentrated turbidity flows. Shelfal areas were the source of terrigenous clasts, but open shelf rhodalgal/foramol carbonate areas were very productive and largely also contributed to the channel infilling. Re-worked sands and skeletal debris were discontinuously re-sedimented offshore as pure terrigenous, mixed and/or carbonate deposits. Major sediment supply was introduced between the latest Burdigalian and the start of the middle Langhian, during which a large amount of carbonate, mixed and siliciclastic sediments reached the Porto Torres Basin (Sassari Channel I). Contributions from shallow proximal source areas typify the lower intervals (Unit A) in marginal sectors of the channel. Upward, these evolve into autochthonous rhodolith deposits, winnowed by strong currents in relatively shallow well lit settings within a complex network of narrow tidally-controlled channels (Unit D) locally bearing coral assemblages. Conversely, re-sedimented rhodoliths from the Units B and C accumulated under conditions of higher turbidity. In deeper parts of the channel taxonomically diversified rhodoliths point to the mixing of re-deposited skeletal components from different relatively deep bathmetric settings. In the latest early Langhian, major re-sedimentation episodes, resulting in large prograding bodies (Unit D), triggered by repeated regression pulses in a frame of persistent still stand. During these episodes photophile assemblages dwelled in the elevated margin sectors of the channel. A significant latest early Langhian drop in relative sea-level resulted in impressive mass

  12. Glacier meltwater flow paths and storage in a geomorphologically complex glacial foreland: The case of the Tapado glacier, dry Andes of Chile (30°S) (United States)

    Pourrier, J.; Jourde, H.; Kinnard, C.; Gascoin, S.; Monnier, S.


    The Tapado catchment is located in the upper Elqui river basin (4000-5550 m) in northern Chile. It comprises the Tapado glacial complex, which is an assemblage of the Tapado glacier and the glacial foreland (debris-covered glacier, rock glacier, and moraines). Although the hydrological functioning of this catchment is poorly known, it is assumed to actively supply water to the lower semi-arid areas of the Elqui river basin. To improve our knowledge of the interactions and water transfers between the cryospheric compartment (glacier, debris-covered glacier, and rock glacier) and the hydrological compartment (aquifers, streams), the results of monitoring of meteorological conditions, as well as discharge, conductivity and temperature of streams and springs located in the Tapado catchment were analyzed. The hydrological results are compared to results inferred from a ground penetrating radar (GPR) survey of the underground structure of the glacial foreland. Water production from the Tapado glacier was shown to be highly correlated with daily and monthly weather conditions, particularly solar radiation and temperature. The resulting daily and monthly streamflow cycles were buffered by the glacial foreland, where underground transfers took place through complex flow paths. However, the development of a thermokarst drainage network in a portion of the glacial foreland enabled rapid concentrated water transfers that reduced the buffer effect. The glacial foreland was shown to act as a reservoir, storing water during high melt periods and supplying water to downstream compartments during low melt periods. GPR observations revealed the heterogeneity of the internal structure of the glacial foreland, which is composed of a mixture of ice and rock debris mixture, with variable spatial ice content, including massive ice lenses. This heterogeneity may explain the abovementioned hydrological behaviors. Finally, calculation of a partial hydrological budget confirmed the

  13. The complexity of seat belt injuries including spinal injury in the pediatric population: a case report of a 6-year-old boy and the literature review. (United States)

    Papavasiliou, Athanasios; Stanton, Jeremy; Sinha, Prateek; Forder, Justin; Skyrme, Andrew


    We present, along with a literature review, the case report of a 6-year-old boy, involved in a high-speed motor vehicle accident, who sustained a seat belt injury of the lumbar spine. We discuss the clinical presentation of thoracolumbar fractures in children, the sensitivity of clinical examination and radiographic evaluation and the associated abdominal injuries that are commonly present with seat belt spinal injuries. Computerized tomography is limited in the detection of soft tissue spinal fractures because these fractures occur in the plain of the section. Plain lateral x-rays of the lumbar spine and computerized tomographic three-dimensional reconstruction images can be helpful but they cannot evaluate the extent of the soft tissue injury. The magnetic resonance imaging scan is the best diagnostic tool to provide the diagnosis.

  14. Foreshocks and short-term hazard assessment of large earthquakes using complex networks: the case of the 2009 L'Aquila earthquake (United States)

    Daskalaki, Eleni; Spiliotis, Konstantinos; Siettos, Constantinos; Minadakis, Georgios; Papadopoulos, Gerassimos A.


    The monitoring of statistical network properties could be useful for the short-term hazard assessment of the occurrence of mainshocks in the presence of foreshocks. Using successive connections between events acquired from the earthquake catalog of the Istituto Nazionale di Geofisica e Vulcanologia (INGV) for the case of the L'Aquila (Italy) mainshock (Mw = 6.3) of 6 April 2009, we provide evidence that network measures, both global (average clustering coefficient, small-world index) and local (betweenness centrality) ones, could potentially be exploited for forecasting purposes both in time and space. Our results reveal statistically significant increases in the topological measures and a nucleation of the betweenness centrality around the location of the epicenter about 2 months before the mainshock. The results of the analysis are robust even when considering either large or off-centered the main event space windows.

  15. A case of chronic myelogenous leukemia in pregnancy characterized by a complex translocation t(9;22;11(q34;q11.2;q13

    Directory of Open Access Journals (Sweden)

    Surachit Kumar


    Full Text Available The management of chronic myelogenous leukemia during pregnancy requires balancing the well-being of the mother with that of the fetus. We report a case of a 26-year-old lady who was diagnosed with chronic myelogenous leukemia (CML at 15 weeks gestation and who had an atypical chromosome t(9;22;11 (q34;q11.2;q13 translocation. She was observed through the remainder of the pregnancy and the disease remained stable; she delivered a normal boy. Treatment with imatinib mesylate was initiated shortly after delivery and she went into molecular complete remission. We discuss the course of the disease and suggest guidelines for managing pregnancy with respect to the currently available agents imatinib, dasatinib and nilotinib.

  16. Joint impact of rainfall and tidal level on flood risk in a coastal city with a complex river network: a case study of Fuzhou City, China

    Directory of Open Access Journals (Sweden)

    J. J. Lian


    Full Text Available Coastal cities are particularly vulnerable to flood under multivariable conditions, such as heavy precipitation, high sea levels, and storms. The combined effect of multiple sources and the joint probability of extremes should be considered to assess and manage flood risk better. This paper aims to study the combined effect of rainfall and the tidal level of the receiving water body on flood probability and severity in Fuzhou City, which has a complex river network. Flood severity under a range of precipitation intensities, with return periods (RPs of 5 yr to 100 yr, and tidal levels was assessed through a hydrodynamic model verified by data observed during Typhoon Longwang in 2005. According to the percentages of the river network where flooding occurred, the threshold conditions for flood severity were estimated in two scenarios: with and without working pumps. In Fuzhou City, working pumps efficiently reduce flood risk from precipitation within a 20-yr RP. However, the pumps may not work efficiently when rainfall exceeds a 100-yr RP because of the limited conveyance capacity of the river network. Joint risk probability was estimated through the optimal copula. The joint probability of rainfall and tidal level both exceeding their threshold values is very low, and the greatest threat in Fuzhou comes from heavy rainfall. However, the tidal level poses an extra risk of flood. Given that this extra risk is ignored in the design of flood defense in Fuzhou, flood frequency and severity may be higher than understood during design.

  17. Suitability evaluation and spatial capacity analysis for complex topography construction land area in southwest China:a case study of Tongzi county in Guizhou province

    Institute of Scientific and Technical Information of China (English)

    ZHOU Li-lei; YANG Hua; LIU Rui; GUAN Dong-jie; QIN Yue


    In the background of a new round reform and western development strategy, making suitability evaluation of construction land complex topography area in southwest China scientifically and accurately has an important guiding significance on the construction of local urban and rural development. We selected economic factor of construction, safety factor of construction, factor of the present situation of land use and ecological protection factor in Tongzicounty as evaluation indexes, and ascertained the weightof each elastic indicator using the analytic hierarchy process method. By the support of GIS and RS technology,wecombined the single-factor qualitative classification with the multi-factor weighted overlay analysis to make comprehensive suitability evaluation of construction land on the whole study area. And five different types of construction land were divided, namely, ‘excellent’, ‘very good’, ‘good’, ‘moderate’ and ‘poor’. The result shows that the area of ‘excellent’ construction land is 30.47km2(0.95%),101.46km2(3.16%) of‘very good’,550.34km2(17.16%)of ‘good’,and664.69km2 (20.72%)and 1860.65km2(58.01%)of ‘moderate’ and ‘poor’,respectively.The land space bearing capacity is a population of 791600, and the remaining population capacity is 170900 persons.

  18. Applicability of major histocompatibility complex DRB1 alleles as markers to detect vertebrate hybridization: a case study from Iberian ibex × domestic goat in southern Spain

    Directory of Open Access Journals (Sweden)

    Alasaad Samer


    Full Text Available Abstract Background Hybridization between closely related wild and domestic species is of great concern because it can alter the evolutionary integrity of the affected populations. The high allelic variability of Major Histocompatibility Complex (MHC loci usually excludes them from being used in studies to detect hybridization events. However, if a the parental species don’t share alleles, and b one of the parental species possesses an exceptionally low number of alleles (to facilitate analysis, then even MHC loci have the potential to detect hybrids. Results By genotyping the exon2 of the MHC class II DRB1 locus, we were able to detect hybridization between domestic goats (Capra hircus and free-ranging Iberian ibex (Capra pyrenaica hispanica by molecular means. Conclusions This is the first documentation of a Capra pyrenaica × Capra hircus hybridization, which presented us the opportunity to test the applicability of MHC loci as new, simple, cost-effective, and time-saving approach to detect hybridization between wild species and their domesticated relatives, thus adding value to MHC genes role in animal conservation and management.

  19. Metal complexes of a pentadentate N2O3bis(semicarbazone) Schiff-base. A case study of structure-spectroscopy correlation. (United States)

    Inoue, Mayara Hissami; Ribeiro, Ronny Rocha; Sabino, José Ricardo; Nunes, Fábio Souza


    Schiff condensation of 2,6-diformyl 4-methylphenol with semicarbazide hydrochloride in 1:2 molar ratio produces the bis(semicarbazone) ligand, herein called H3L. A comprehensive spectroscopic analysis of the compound was performed by (1)H and (13)C NMR, FTIR and electronic spectroscopies. Assignments to the UV-vis spectrum of H3L were supported by semi-empirical quantum mechanics ZINDO/S calculations. The ligand H3L forms monoclinic crystals in the space group P21/c and its structure is stabilized by classic hydrogen bonds with propanone molecules. It promptly reacts with first row metal ions to produce the following coordination compounds: [Co2(L)(μ-NO3)]·DMF, [Ni2(H2L)(μ-CH3COO)(CH3COO)2]·2H2O, [Cu2(L)(μ-NO3)(H2O)2]·H2O, [Cu2(L)(μ-CH3COO)(H2O)2]·H2O and [Cu2(H2L)(μ-Cl)Cl2]·3H2O, that have different compositions, depending on the degree of deprotonation of the ligand upon coordination. Electronic and EPR spectroscopies as well as effective magnetic moment measurements of the complexes were used in an attempt to better understand their mode of coordination, the microsymmetry around the metal ions and magnetic properties.

  20. Penile Circular Fasciocutaneous (McAninch) Flap as an Option for Complex Anterior Urethral Stricture in Case of Non-Viable Buccal Mucosal Graft (United States)

    Vijayganapathy, Sundaramoorthy; Mallya, Ashwin; Sreenivas, Jayaram


    The penile circular fasciocutaneous flap (FCF) is employed in the successful single stage reconstruction of long segment complex anterior urethral strictures especially when buccal mucosa is unavailable due to various reasons. A 65-year-old gentleman, chronic smoker and tobacco chewer, hypertensive on treatment, presented with obstructive lower urinary tract symptoms for 8 months. He had no prior urethral catheterization. On examination, he had circumcised penis, with stenosis of the external urethral meatus. Glans had no changes suggesting balanitis xerotica obliterans. Suprapubic cystostomy was done as he developed acute urinary retention during evaluation. Retrograde urethrogram (RGU) showed pan-anterior urethral stricture. He was planned for substitution urethroplasty. On oral cavity examination, he had moderate trismus with oral submucous fibrosis. As buccal mucosal graft was unavailable, he was planned for FCF. A ventral onlay tubularization FCF urethroplasty from meatus to bulbar urethra based on dartos dorsal pedicle was done. His postoperative recovery was uneventful. Pericatheter RGU did not show extravastion and he voided well with Qmax 14 ml/second. He is doing well at follow-up. PMID:27630900

  1. Beyond complex Langevin equations

    CERN Document Server

    Wosiek, Jacek


    A simple integral relation between a complex weight and the corresponding positive distribution is derived by introducing a second complex variable. Together with the positivity and normalizability conditions, this sum rule allows to construct explicitly equivalent pairs of distributions in simple cases. In particular the well known solution for a complex gaussian distribution is generalized to an arbitrary complex slope. This opens a possibility of positive representation of Feynman path integrals directly in the Minkowski time. Such construction is then explicitly carried through in the second part of this presentation. The continuum limit of the new representation exists only if some of the additional couplings tend to infinity and are tuned in a specific way. The approach is then successfully applied to three quantum mechanical examples including a particle in a constant magnetic field -- a simplest prototype of a Wilson line. Further generalizations are shortly discussed and an amusing interpretation of ...

  2. Familial gigantism

    Directory of Open Access Journals (Sweden)

    Wouter W. de Herder


    Full Text Available Familial GH-secreting tumors are seen in association with three separate hereditary clinical syndromes: multiple endocrine neoplasia type 1, Carney complex, and familial isolated pituitary adenomas.

  3. Managing Complexity

    DEFF Research Database (Denmark)

    Maylath, Bruce; Vandepitte, Sonia; Minacori, Patricia


    This article discusses the largest and most complex international learning-by-doing project to date- a project involving translation from Danish and Dutch into English and editing into American English alongside a project involving writing, usability testing, and translation from English into Dut...... and into French. The complexity of the undertaking proved to be a central element in the students' learning, as the collaboration closely resembles the complexity of international documentation workplaces of language service providers. © Association of Teachers of Technical Writing....

  4. Complex variables

    CERN Document Server

    Fisher, Stephen D


    The most important topics in the theory and application of complex variables receive a thorough, coherent treatment in this introductory text. Intended for undergraduates or graduate students in science, mathematics, and engineering, this volume features hundreds of solved examples, exercises, and applications designed to foster a complete understanding of complex variables as well as an appreciation of their mathematical beauty and elegance. Prerequisites are minimal; a three-semester course in calculus will suffice to prepare students for discussions of these topics: the complex plane, basic

  5. Rebuilding a macromolecular membrane complex at the atomic scale: case of the Kir6.2 potassium channel coupled to the muscarinic acetylcholine receptor M2. (United States)

    Sapay, Nicolas; Estrada-Mondragon, Argel; Moreau, Christophe; Vivaudou, Michel; Crouzy, Serge


    Ion channel-coupled receptors (ICCR) are artificial proteins built from a G protein-coupled receptor and an ion channel. Their use as molecular biosensors is promising in diagnosis and high-throughput drug screening. The concept of ICCR was initially validated with the combination of the muscarinic receptor M2 with the inwardly rectifying potassium channel Kir6.2. A long protein engineering phase has led to the biochemical characterization of the M2-Kir6.2 construct. However, its molecular mechanism remains to be elucidated. In particular, it is important to determine how the activation of M2 by its agonist acetylcholine triggers the modulation of the Kir6.2 channel via the M2-Kir6.2 linkage. In the present study, we have developed and validated a computational approach to rebuild models of the M2-Kir6.2 chimera from the molecular structure of M2 and Kir6.2. The protocol was first validated on the known protein complexes of the μ-opioid Receptor, the CXCR4 receptor and the Kv1.2 potassium channel. When applied to M2-Kir6.2, our protocol produced two possible models corresponding to two different orientations of M2. Both models highlights the role of the M2 helices I and VIII in the interaction with Kir6.2, as well as the role of the Kir6.2 N-terminus in the channel opening. Those two hypotheses will be explored in a future experimental study of the M2-Kir6.2 construct.

  6. Isotopic and hydrogeochemical characterization of high-altitude karst aquifers in complex geological settings. The Ordesa and Monte Perdido National Park (Northern Spain) case study

    Energy Technology Data Exchange (ETDEWEB)

    Lambán, L.J., E-mail: [Geological Survey of Spain (IGME) (Spain); Jódar, J., E-mail: [Department of Geotechnical Engineering and Geosciences, Technical University of Catalonia (UPC), Barcelona (Spain); Custodio, E., E-mail: [Department of Geotechnical Engineering and Geosciences, Technical University of Catalonia (UPC), Barcelona (Spain); Soler, A., E-mail: [Grup de Mineralogia Aplicada i Medi Ambient, Departament Cristal lografia Mineralogia i Dipòsits Minerals, Facultat de Geologia, Universitat de Barcelona (UB) (Spain); Sapriza, G., E-mail: [Global Institute for Water Security, National Hydrology Research Centre (Canada); Soto, R., E-mail: [Geological Survey of Spain (IGME) (Spain)


    The Ordesa and Monte Perdido National Park, located in the Southern Pyrenees, constitutes the highest karst system in Western Europe. No previous studies regarding its geochemical and isotopic groundwater characterization are available in this area. This work presents the results of field and sampling campaigns carried out between July 2007 and September 2013. The groundwater presents high calcium bicarbonate contents due to the occurrence of upper Cretaceous and lower Paleocene–Eocene carbonate materials in the studied area. Other relevant processes include dissolution of anhydrite and/or gypsum and incongruent dissolution of Mg-limestone and dolomite. The water stable isotopes (δ{sup 18}O, δ{sup 2}H) show that the oceanic fronts from the Atlantic Ocean are responsible for the high levels of precipitation. In autumn, winter, and spring, a deuterium excess is found in the recharge water, which could be related to local atmospheric transport of low-altitude snow sublimation vapour and its later condensation on the snow surface at higher altitude, where recharge is mostly produced. The recharge zones are mainly between 2500 m and 3200 m a.s.l. The tritium content of the water suggests short groundwater transit times. The isotopic composition of dissolved sulphate points to the existence of regional fluxes mixed with local discharge in some of the springs. This work highlights the major role played by the altitude difference between the recharge and discharge zones in controlling the chemistry and the vertical variability of the isotopic composition in high-altitude karst aquifers. - Highlights: • Environmental tracers are essential to study complex alpine karst aquifers. • The long presence of snow controls the deuterium excess in groundwater. • Seasonal δD content in springs depends on gap between recharge and discharge points. • The first hydrogeological characterization of the Ordesa National Park is presented. • Sulphate content in springs comes

  7. Genetic Sensitivity to the Environment: The Case of the Serotonin Transporter Gene and Its Implications for Studying Complex Diseases and Traits (United States)

    Caspi, Avshalom; Hariri, Ahmad R.; Holmes, Andrew; Uher, Rudolf; Moffitt, Terrie E.


    Evidence of marked variability in response among people exposed to the same environmental risk implies that individual differences in genetic susceptibility might be at work. The study of such Gene-by-Environment (G×E) interactions has gained momentum. In this article, the authors review research about one of the most extensive areas of inquiry: variation in the promoter region of the serotonin transporter gene (SLC6A4; also known as 5-HTT) and its contribution to stress sensitivity. Research in this area has both advanced basic science and generated broader lessons for studying complex diseases and traits. The authors evaluate four lines of evidence about the 5-HTT stress-sensitivity hypothesis: 1) observational studies about the serotonin transporter linked polymorphic region (5-HTTLPR), stress sensitivity, and depression in humans; 2) experimental neuroscience studies about the 5-HTTLPR and biological phenotypes relevant to the human stress response; 3) studies of 5-HTT variation and stress sensitivity in nonhuman primates; and 4) studies of stress sensitivity and genetically engineered 5-HTT mutations in rodents. The authors then dispel some misconceptions and offer recommendations for G×E research. The authors discuss how G×E interaction hypotheses can be tested with large and small samples, how G×E research can be carried out before as well as after replicated gene discovery, the uses of G×E research as a tool for gene discovery, the importance of construct validation in evaluating G×E research, and the contribution of G×E research to the public understanding of genetic science. PMID:20231323

  8. Multi temporal LiDAR-DTMs as a tool for modelling a complex landslide: a case study in the Rotolon catchment (Eastern Italian Alps

    Directory of Open Access Journals (Sweden)

    G. Bossi


    Full Text Available The geomorphological change detection through the comparison of repeated topographic surveys is a recent approach that benefits greatly from the latest developments in topographical data acquisition techniques. Among them, airborne LiDAR makes the monitoring of geomorphological changes a more reliable and accurate approach for natural hazard and risk management. In this study, two LiDAR-DTMs (2 m resolution were acquired just before and after a complex 340 000 m3 landslide event (4 November 2010 that generated a debris flow in the channel of the Rotolon catchment (Eastern Italian Alps. The analysis of these data was used to set up the initial condition for the application of a dynamic model. The comparison between the pre- and post-event DTMs allowed to identify erosion and depositional areas and the volume of the landslide. The knowledge of the phenomenon dynamics was the base of a sound back-analysis of the event with the 3-D numerical model DAN3D. This particular code was selected for its capability to modify the rheology and the parameters of the moving mass during run-out, as actually observed along the path of the 2010 debris flow. Nowadays some portions of Mt. Rotolon flank are still moving and show signs of detachment. The same soil parameters used in the back-analysis model could be used to simulate the run-out for possible future landslides allowing to generate reliable risk scenarios useful for awareness of civil defense and strategy on emergency plans.

  9. Reconstrucción del complejo areola-pezón: revisión de 60 casos Nipple-areola complex reconstruction: revision of 60 cases

    Directory of Open Access Journals (Sweden)

    R. Fernández García


    hay ninguna cuyos resultados se sobrepongan a las demás, pero sí una vez que se reconstruye la areola siendo la técnica que más satisface la del injerto inguinal. A pesar de ello, el aspecto más notable a mejorar está en la reconstrucción del pezón, dada la frecuente disconformidad de las pacientes con la proyección conseguida a lo largo del tiempo por la posible reabsorción del mismo.The creation of the nipple-areola complex is the latest time in breast reconstruction, transforming the reconstruction of the breast mound into a real breast. We have to consider the reconstruction of the areola and the nipple as the culmination of breast reconstruction. There are a lot of documented techniques for nipple-areola complex reconstruction. The aim of this study is to determine the grade of psychological satisfaction of patients after this reconstruction This study was designed as a retrospective clinic review of 60 patients. After reviewing medical histories, the patients were interviewed and asked to complete a questionnaire. The most common desired aspect was to correct the absence/lost of nipple projection. However, 22% of patients answered they would not change anything regarding their reconstruction. The satisfaction with the mammary mound was excellent or good for 68%, normal for 23 % and poor for 9 %. On the other hand, satisfaction for the nippleareola complex reconstruction was excellent or good for 50%, normal for 45% and poor for 5%. There were no statistical differences among the different techniques depending on the time between the mastectomy intervention and the third reconstruction (p=0,06. For nipple reconstruction, the contralateral nipple donation technique offered more satisfaction (2.67 points and projection (7.23 points. In spite of the differences in their means, there were no statistically significant differences. Taking into account the technique used for the areola reconstruction, the donation-graft of inguinal skin was the one that

  10. X-ray Damage to the Mn4Ca Complex in Single Crystals ofPhotosystem II: A Case Study for Metalloprotein Crystallography

    Energy Technology Data Exchange (ETDEWEB)

    Yano, Junko; Kern, Jan; Irrgang, Klaus-Dieter; Latimer, Matthew; Bergmann, Uwe; Glatzel, Pieter; Pushkar, Yulia; Biesiadka, Jacek; Loll,Bernhard; Sauer, Kenneth; Messinger, Johannes; Zouni, Athina; Yachandra,Vittal K.


    X-ray absorption spectroscopy was used to measure the damage caused by exposure to X-rays to the Mn4Ca active site in single crystals of photosystem II, as a function of dose and energy of X-rays, temperature, and time. These studies reveal that the conditions used for structure determination by X-ray crystallography cause serious damage specifically to the metal-site structure. The X-ray absorption spectra show that the structure changes from one that is characteristic of a high-valent Mn4(III2,IV2) oxo-bridged Mn4Ca cluster, to that of Mn(II) in aqueous solution. This damage to the metal site occurs at a dose that is more than an order of magnitude lower than that resulting in loss of diffractivity, and commonly considered safe for protein crystallography. These results establish the first quantitative X-ray dose parameters applicable to redox-active metallo-proteins. This case study shows that a careful evaluation of the structural intactness of the active sites by spectroscopic techniques can validate structures derived from crystallography, and it can be a valuable complementary method before structure-function correlations of metallo-proteins can be made on the basis of high resolution X-ray crystal structures.

  11. X-ray damage to the Mn4Ca complex in single crystals of photosystem II: a case study for metalloprotein crystallography. (United States)

    Yano, Junko; Kern, Jan; Irrgang, Klaus-Dieter; Latimer, Matthew J; Bergmann, Uwe; Glatzel, Pieter; Pushkar, Yulia; Biesiadka, Jacek; Loll, Bernhard; Sauer, Kenneth; Messinger, Johannes; Zouni, Athina; Yachandra, Vittal K


    X-ray absorption spectroscopy was used to measure the damage caused by exposure to x-rays to the Mn(4)Ca active site in single crystals of photosystem II as a function of dose and energy of x-rays, temperature, and time. These studies reveal that the conditions used for structure determination by x-ray crystallography cause serious damage specifically to the metal-site structure. The x-ray absorption spectra show that the structure changes from one that is characteristic of a high-valent Mn(4)(III(2),IV(2)) oxo-bridged Mn(4)Ca cluster to that of Mn(II) in aqueous solution. This damage to the metal site occurs at a dose that is more than one order of magnitude lower than the dose that results in loss of diffractivity and is commonly considered safe for protein crystallography. These results establish quantitative x-ray dose parameters that are applicable to redox-active metalloproteins. This case study shows that a careful evaluation of the structural intactness of the active site(s) by spectroscopic techniques can validate structures derived from crystallography and that it can be a valuable complementary method before structure-function correlations of metalloproteins can be made on the basis of high-resolution x-ray crystal structures.

  12. The Complex Surgical Management of the First Case of Severe Combined Immunodeficiency and Multiple Intestinal Atresias Surviving after the Fourth Year of Life (United States)

    Garofano, Salvatore; Teruzzi, Elisabetta; Vinardi, Simona; Carbonaro, Giulia; Cerrina, Alessia; Morra, Isabella; Montin, Davide; Mussa, Alessandro; Schleef, Jürgen


    Severe combined immunodeficiency (SCID) is a life-threatening syndrome of recurrent infections and gastrointestinal alterations due to severe compromise of T cells and B cells. Clinically, most patients present symptoms before the age of 3 months and without intervention SCID usually results in severe infections and death by the age of 2 years. Its association with intestinal anomalies as multiple intestinal atresias (MIA) is rare and worsens the prognosis, resulting lethal. We describe the case of a four year-old boy with SCID-MIA. He presented at birth with meconium peritonitis, multiple ileal atresias and underwent several intestinal resections. A targeted Sanger sequencing revealed a homozygous 4-bp deletion (c.313ΔTATC; p.Y105fs) in tetratricopeptide repeat domain 7A (TTC7A). He experienced surgical procedures including resection and stricturoplasty. Despite parenteral nutrition-associated liver disease, the patient is surviving at the time of writing the report. Precocious immune system assessment, scrutiny of TTC7A mutations and prompt surgical procedures are crucial in the management. PMID:25587526

  13. Fingerprinting stress: Stylolite and calcite twinning paleopiezometry revealing the complexity of progressive stress patterns during folding—The case of the Monte Nero anticline in the Apennines, Italy (United States)

    Beaudoin, Nicolas; Koehn, Daniel; Lacombe, Olivier; Lecouty, Alexandre; Billi, Andrea; Aharonov, Einat; Parlangeau, Camille


    In this study we show for the first time how quantitative stress estimates can be derived by combining calcite twinning and stylolite roughness stress fingerprinting techniques in a fold-and-thrust belt. First, we present a new method that gives access to stress inversion using tectonic stylolites without access to the stylolite surface and compare results with calcite twin inversion. Second, we use our new approach to present a high-resolution deformation and stress history that affected Meso-Cenozoic limestone strata in the Monte Nero Anticline during its late Miocene-Pliocene growth in the Umbria-Marche Arcuate Ridge (northern Apennines, Italy). In this area an extensive stylolite-joint/vein network developed during layer-parallel shortening (LPS), as well as during and after folding. Stress fingerprinting illustrates how stress in the sedimentary strata did build up prior to folding during LPS. The stress regime oscillated between strike slip and compressional during LPS before ultimately becoming strike slip again during late stage fold tightening. Our case study shows that high-resolution stress fingerprinting is possible and that this novel method can be used to unravel temporal relationships that relate to local variations of regional orogenic stresses. Beyond regional implications, this study validates our approach as a new powerful toolbox to high-resolution stress fingerprinting in basins and orogens combining joint and vein analysis with sedimentary and tectonic stylolite and calcite twin inversion techniques.

  14. Flow diversion in vasculitic intracranial aneurysms? Repair of giant complex cavernous carotid aneurysm in polyarteritis nodosa using Pipeline embolization devices: first reported case. (United States)

    Martinez Santos, Jaime; Kaderali, Zul; Spears, Julian; Rubin, Laurence A; Marotta, Thomas R


    Intracranial aneurysms in polyarteritis nodosa (PAN) are exceedingly rare lesions with unpredictable behavior that pose real challenges to microsurgical and endovascular interventions owing to their inflammatory nature. We introduce a safe and effective alternative for treating these aneurysms using Pipeline embolization devices (PEDs). A 20-year-old man presented with diplopia, headaches, chronic abdominal pain, and weight loss. Diagnostic evaluations confirmed PAN, including bilateral giant cavernous carotid aneurysms. Cyclophosphamide and steroids achieved significant and sustained clinical improvement, with a decision to follow the aneurysms serially. Seven years later the left unruptured aneurysm enlarged, causing a sudden severe headache and a cavernous sinus syndrome. Treatment of the symptomatic aneurysm was pursued using flow diversion (PED) and the internal carotid artery was successfully reconstructed with a total of four overlapping PEDs. At 6 months follow-up, complete exclusion of the aneurysm was demonstrated, with symptomatic recovery. This is the first description of using a flow-diverting technique in an inflammatory vasculitis. In this case, PEDs not only attained a definitive closure of the aneurysm but also reconstructed the damaged and fragile arterial segment affected with vasculitis.

  15. The political economy of corporate social responsibility and community development: a case study of Norway's Snoehvit natural gas complex

    Energy Technology Data Exchange (ETDEWEB)

    Klick, Matthew T.


    This project uses stakeholder evidence from semi-structured interviews to analyze the relative effectiveness of an oil company's stated 'corporate social responsibility' (CSR) initiatives in a new, Arctic host community. Specifically, this project analyzes the outcomes of StatoilHydro initiatives to date in Hammerfest, Norway, where the Snoehvit (Snow White) natural gas project began production in 2007. It gauges the ability of 'socially responsible' approaches to development to internalize negative externalisation and promote positive 'spin-offs'. Arctic countries are increasingly prioritizing petroleum development. The convergence of dramatic climate change, increasing energy demands, and high energy prices has made the Arctic an alluring frontier for the oil industry and Arctic governments. Small Arctic communities are increasingly playing host to large energy projects with the potential for dramatic cultural, social, environmental, and economic upheaval, but also economic growth and increased human capital. In this case study, CSR initiatives resulted in a broader accounting of social costs and benefits, an outcome that better internalized externalities, and pareto-improving trades between stakeholders and industry. (Author). 87 refs., 5 figs., 5 tabs

  16. Modification of wise pattern based design with free nipple areolar complex graft in a case of juvenile hypertrophy of the breasts

    Directory of Open Access Journals (Sweden)

    Theddeus O.H. Prasetyono


    Full Text Available Juvenile hypertrophy of the breast (JHB is a rare condition leading to gigantomastia unilaterally or bilaterally in peripubertal females. The pathology is limited usually to the breast, with otherwise normal growth and development and without any other deformities. The rapid bilateral or unilateral growth of the breast in adolescent girls leads to severe physical and psychological problems. The etiology remains elusive, but it is believed to represent an end-organ hypersensitivity during a period of intense endocrine regulatory stress. The best treatment is surgical whereas the younger patients better treated with mastectomy to anticipate the high recurrency rate, while older women is best treated with reduction mammaplasty. We report one case of a woman who had a unilateral JHB. The growth of the left breast started in her pubertal age and kept growing for one year. She was treated surgically with Wise pattern based design. After two years, she had no recurrent enlargement and aesthetically, the symmetry of both breasts is achieved with a satisfying scar. (Med J Indones 2008; 17: 13-9Keywords: juvenile hypertrophy of the breast, reduction mammaplasty, wise pattern based design

  17. 自拟白头翁汤用于复杂性肛瘘术后换药40例%Self Pulsatilla Decoction for Complex Anal Fistula Dressing 40 Cases

    Institute of Scientific and Technical Information of China (English)

    成川华; 李五生; 陈卫东; 徐玲; 马亮; 葛曼青


    目的:观察自拟白头翁汤用于复杂性肛瘘手术后换药的临床疗效。方法将复杂性肛瘘术后患者40例,分为治疗组和对照组各20例。两组患者都静脉滴注哌拉西林2.5g,bid;奥硝唑1g。患者便后用稀碘伏坐浴1次,治疗组给予自拟白头翁汤液与无菌敷料,制成药纱,塞入肛门,压迫创面。对照组以甲硝唑与无菌敷料,制成药纱,塞入肛门,压迫创面。结果治疗组平均治愈天数为低位复杂性肛瘘愈合时间(15.54±8.3)d,高位复杂性肛瘘愈合时间27d。对照组为低位复杂性肛瘘愈合时间(25.2±10.8)d,高位复杂性肛瘘愈合时间45d (P<0.01);治疗组疼痛不适在10 d以内缓解14例(70.O%),对照组为5例(25.0%)。结论自拟白头翁汤有较强的清热解毒、消肿镇痛、止血生肌的功效,治疗复杂性肛瘘术后疗效确切。%Objective:To observe the clinical ef ects of treating Complex anal fistula with pulsatil a decoction. Methods: patients with Complex anal fistula were randomly divided into two groups, 20 patients in each group. both groups of patients were given piperacil in by intravenous drip 2.5g,bid;ornidazole 1g. Treatment group to give the duck soup liquid with a sterile dressing, made into yarn, into the anus, oppressing the wound, and control group with metronidazole and sterile dressings, gauze, into the anus, oppressing the wound. Results:Treatment group average cure time, low complexity anal fistula healing time (15.54+8.3) d, high complex anal fistula healing time for 27 d. and compared with low complexity anal fistula healing time (25.2+10.8) d, high complex anal fistula healing time 45d (P<0.01);Treatment group could relive discomfort within 10d 14 cases (70.0%), control group for 5 cases (25.0%). Conclusion:Pulsatil a Decoction have stronger heat-clearing and detoxicating, detumescence and analgesic and hemostatic ef ect, Cure complexity anal fistula postoperative curative

  18. Symmetrical P4 cleavage at cobalt half sandwich complexes [(η5-C5H5)Co(L)] (L = CO, NHC)--a computational case study on the mechanism of symmetrical P4 degradation to P2 ligands. (United States)

    Zarzycki, Bartosz; Bickelhaupt, F Matthias; Radius, Udo


    A full theoretical mechanistic investigation on the symmetrical cleavage of P4 at the active complex fragments [(η(5)-C5H5)Co(L)] (L = CO, (i)Pr2Im; (i)Pr2Im = 1,3-di-iso-propylimidazolin-2-ylidene), which results in the formation of the complex [{(η(5)-C5H5)Co}2(μ,η(2:2)-P2)2] 9, is presented. The overall reaction mechanism is a complex, multistep process. Rate-determining steps of the reaction sequence are two consecutive dissociations of the co-ligands L, which induce the decisive structural rearrangements of the P4 unit. The choice of the co-ligand L ( = CO, (i)Pr2Im) influences the kinetic barrier as well as the energy balance of the overall reaction path significantly. The calculations further reveal a strong influence of the entropic effect on the overall reaction. As a consequence, the energy balance of the overall formation of 9 starting from [(η(5)-C5H5)Co(CO)] precursors is almost thermoneutral and has to overcome high kinetic barriers, whereas the reaction starting from [(η(5)-C5H5)Co((i)Pr2Im)] precursors is exothermic, featuring lower transition barriers with stabilized intermediates. From the direct comparison of both reaction coordinates it seems that the entropic effect of the co-ligands is even stronger than their electronic influence, as for both investigated systems the reactions' energy profiles are almost identical up to intermediate [{(η(5)-C5H5)Co(L)}2(μ,η(2:2)-P4)] 5 (L = CO, (i)Pr2Im). After the formation of 5, the first CO dissociation step renders the reaction endothermic for L = CO, whereas in the case of (i)Pr2Im dissociation the reaction progresses exothermically. Energy decomposition analysis and fragment analysis provide a picture of the bonding mechanisms between the metal complex fragments and P4 in the case of the most significant intermediates and the final product.

  19. Metal nanostructures with complex surface morphology: The case of supported lumpy Pd and Pt nanoparticles produced by laser processing of metal films (United States)

    Ruffino, F.; Maugeri, P.; Cacciato, G.; Zimbone, M.; Grimaldi, M. G.


    In this work we report on the formation of lumpy Pd and Pt nanoparticles on fluorine-doped tin oxide/glass (FTO/glass) substrate by a laser-based approach. In general, complex-surface morphology metal nanoparticles can be used in several technological applications exploiting the peculiarities of their physical properties as modulated by nanoscale morphology. For example plasmonic metal nanoparticles presenting a lumpy morphology (i.e. larger particles coated on the surface by smaller particles) can be used in plasmonic solar cell devices providing broadband scattering enhancement over the smooth nanoparticles leading, so, to the increase of the device efficiency. However, the use of plasmonic lumpy nanoparticles remains largely unexplored due to the lack of simply, versatile, low-cost and high-throughput methods for the controllable production of such nanostructures. Starting from these considerations, we report on the observation that nanoscale-thick Pd and Pt films (17.6 and 27.9 nm, 12.1 and 19.5 nm, respectively) deposited on FTO/glass surface irradiated by nanosecond pulsed laser at fluences E in the 0.5-1.5 J/cm2 range, produce Pd and Pt lumpy nanoparticles on the FTO surface. In addition, using scanning electron microscopy analyses, we report on the observation that starting from each metal film of fixed thickness h, the fraction F of lumpy nanoparticles increases with the laser fluence E and saturates at the higher fluences. For each fixed fluence, F was found higher starting from the Pt films (at each starting film thickness h) with respect to the Pd films. For each fixed metal and fluence, F was found to be higher decreasing the starting thickness of the deposited film. To explain the formation of the lumpy Pd and Pt nanoparticles and the behavior of F as a function of E and h both for Pd and Pt, the thermodynamic behavior of the Pd and Pt films and nanoparticles due to the interaction with the nanosecond laser is discussed. In particular, the

  20. Virtual Solar Energy Center: A Case Study of the Use of Advanced Visualization Techniques for the Comprehension of Complex Engineering Products and Processes (United States)

    Ritter, Kenneth August, III

    Industry has a continuing need to train its workforce on recent engineering developments, but many engineering products and processes are hard to explain because of limitations of size, visibility, time scale, cost, and safety. The product or process might be difficult to see because it is either very large or very small, because it is enclosed within an opaque container, or because it happens very fast or very slowly. Some engineering products and processes are also costly or unsafe to use for training purposes, and sometimes the domain expert is not physically available at the training location. All these limitations can potentially be addressed using advanced visualization techniques such as virtual reality. This dissertation describes the development of an immersive virtual reality application using the Six Sigma DMADV process to explain the main equipment and processes used in a concentrating solar power plant. The virtual solar energy center (VEC) application was initially developed and tested in a Cave Automatic Virtual Environment (CAVE) during 2013 and 2014. The software programs used for development were SolidWorks, 3ds Max Design, and Unity 3D. Current hardware and software technologies that could complement this research were analyzed. The NVIDA GRID Visual Computing Appliance (VCA) was chosen as the rendering solution for animating complex CAD models in this application. The MiddleVR software toolkit was selected as the toolkit for VR interactions and CAVE display. A non-immersive 3D version of the VEC application was tested and shown to be an effective training tool in late 2015. An immersive networked version of the VEC allows the user to receive live instruction from a trainer being projected via depth camera imagery from a remote location. Four comparative analysis studies were performed. These studies used the average normalized gain from pre-test scores to determine the effectiveness of the various training methods. With the DMADV approach