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Sample records for extremity hirayama disease

  1. Hirayama disease

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    Atul T Tayade

    2010-01-01

    Full Text Available A 17-year-old male, who gave up his favorite sport cricket and started playing football, presented with one-year history of slowly progressive atrophic weakness of forearms and hands. Neurological examination showed weak and wasted arms, forearms and hand but no evidence of pyramidal tract, spinothalmic tract and posterior column lesions. Plain cervical spine radiographs showed no abnormal findings. Cervical magnetic resonance imaging (MRI showed asymmetric cord atrophy; images obtained with neck flexed showed the anterior shifting of the posterior wall of the lower cervical dural sac resulting in cord compression. These findings suggest Hirayama disease, a kind of cervical myelopathy related to the flexion movements of the neck.

  2. Hirayama disease in Austria.

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    Finsterer, Josef; Löscher, Wolfgang; Wanschitz, Julia; Baumann, Matthias; Quasthoff, Stefan; Grisold, Wolfgang

    2013-10-01

    Hirayama disease (HD) is a segmental cervical myelopathy which affects the C7-D1 myotomes and presents with unilateral or asymmetric upper limb weakness/wasting. The study aimed at systematically collecting cases of HD in Austria and at describing and discussing their presentation on clinical and instrumental investigations and at comparing them with cases reported from other countries. Neurological Departments of secondary and tertiary centers and colleagues in outpatient units involved in the management of neuromuscular disorders in Austria were contacted and asked to provide standardised data about their HD cases. Altogether, nine unrelated cases were included. Mean age at onset was 18.3 years (range: 12.5-27 years). The female-to-male ratio was 0.29. Mean disease duration was 18.8 years. All patients presented with weakness or wasting of the distal upper limb muscles. A single arm (right: n=2, left: n=3) was affected in five cases and both arms in four. Six patients presented with tremor, two with fasciculations. EMG showed chronic neurogenic changes in all patients. Conventional cervical MRI was normal (n=1), showed focal atrophy (n=3), an intramedullary lesion (n=3), or abnormal straightening of the cervical spine (n=1). Dynamic MRI in a single patient showed anterior displacement of the dorsal dura, prominent epidural space, compressed cord over the posterior surface of vertebra C5-6, and a prominent crescent-shaped mass. Two patients received physiotherapy with beneficial effect in one. HD rarely also occurs in Austria, predominantly males are affected, and clinical presentation, course and outcome are not at variance from cases in other European or non-European countries. Copyright © 2012 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

  3. MRI findings in Hirayama disease

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    Raval Monali

    2010-01-01

    Full Text Available The objective of the study was to study the magnetic resonance imaging (MRI features of Hirayama disease on a 3 Tesla MRI scanner. Nine patients with clinically suspected Hirayama disease were evaluated with neutral position, flexion, contrast-enhanced MRI and fast imaging employing steady-state acquisition (FIESTA sequences. The spectrum of MRI features was evaluated and correlated with the clinical and electromyography findings. MRI findings of localized lower cervical cord atrophy (C5-C7, abnormal curvature, asymmetric cord flattening, loss of attachment of the dorsal dural sac and subjacent laminae in the neutral position, anterior displacement of the dorsal dura on flexion and a prominent epidural space were revealed in all patients on conventional MRI as well as with the dynamic 3D-FIESTA sequence. Intramedullary hyperintensity was seen in four patients on conventional MRI and on the 3D-FIESTA sequence. Flow voids were seen in four patients on conventional MRI sequences and in all patients with the 3D-FIESTA sequence. Contrast enhancement of the epidural component was noted in all the five patients with thoracic extensions. The time taken for conventional and contrast-enhanced MRI was about 30-40 min, while that for the 3D-FIESTA sequence was 6 min. Neutral and flexion position MRI and the 3D-FIESTA sequence compliment each other in displaying the spectrum of findings in Hirayama disease. A flexion study should form an essential part of the screening protocol in patients with suspected Hirayama disease. Newer sequences such as the 3D-FIESTA may help in reducing imaging time and obviating the need for contrast.

  4. Bimelic Hirayama Disease: Clinical Dilemma Solved by Imaging

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    Shalabh Jain

    2013-01-01

    Full Text Available Hirayama disease (juvenile muscular atrophy of distal upper extremity is a cervical myelopathy predominantly affecting adolescent males. It is characterized by progressive muscular weakness and atrophy of unilateral or asymmetrically bilateral distal upper limbs. We report a case of an 18-year-male painter, who presented with gradually progressive, symmetrical bilateral weakness of hands and forearm for the last two years. On the basis of clinical examination, a provisional diagnosis of lower motor neuron type of symmetrical distal weakness due to heavy metal intoxication was kept. However, imaging studies helped in making a definitive diagnosis of Hirayama disease. The patient was advised cervical collar, and there was no progression in symptoms after six months of followup. Due to the rarity of bilateral symmetrical involvement in Hirayama disease, it remains obscured or unsuspected clinically, and MRI plays a pivotal role in diagnosis.

  5. A study of dynamic F-waves in juvenile spinal muscular atrophy of the distal upper extremity (Hirayama disease).

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    Zheng, Chaojun; Zhu, Yu; Yang, Shuo; Lu, Feizhou; Jin, Xiang; Weber, Robert; Jiang, Jianyuan

    2016-08-15

    The study aimed to analyse changes in the upper limb F-waves during neck flexion in patients with Hirayama disease (HD). This study included 41 healthy subjects, 38 HD patients and 24 patients with amyotrophic lateral sclerosis (ALS). Bilateral F-waves were consecutively recorded 20 times with the neck both in the standard position and after persistent neck flexion for 30min. The persistence, minimal latencies, chronodispersion, F/M ratios and amplitudes of the F-waves and repeater F-waves were compared between the standard neck and neck flexion positions. During neck flexion, repeater F-waves were found in more HD patients, the percentage of both the ulnar and median repeater F-waves increased significantly, and higher F/M ratios were observed on the symptomatic side (Pneck flexion (P>0.05). HD might be more likely to present as a position-related dysfunction rather than a spinal cord-intrinsic disease. Thus, HD patients could be counselled to avoid neck flexion for long periods of time to prevent further damage, especially in the progressive stage of the disease. Copyright © 2016 Elsevier B.V. All rights reserved.

  6. Early-onset Hirayama disease in a female

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    Matthias Baumann; Josef Finsterer; Gizewski, Elke R.; Wolfgang N Löscher

    2017-01-01

    Objectives: Hirayama disease is a rare myelopathy, occurring predominantly in males with onset in the teens. Methods and results: Here, we report a young female patient who developed the first signs of Hirayama disease at 10.5 years of age. Prior to onset, she had experienced a growth spurt and grew about 8 cm. The disease progressed over 3 years and the typical clinical, electrophysiological, and neuroimaging signs of Hirayama disease were found. After this period and achievement of her fina...

  7. Hirayama's Disease: A Rare Clinical Variant of Amyotrophic Lateral Sclerosis

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    Swati C Aundhakar

    2017-01-01

    Full Text Available Hirayama's disease is a rare clinical variant of amyotrophic lateral sclerosis where distal muscles are involved more compared to proximal muscles and vice-versa occurs only in 10% cases and so it is differentiated from O'Sullivan McLeod syndrome which involves only small muscles of single limb. Here, we present a case of Hirayama's disease where disease achieved a plateau after 3 years with no further progression. His electrophysiological studies, and clinical picture, and magnetic resonance imaging findings were consistent with a diagnosis of Hirayama's disease.

  8. Early-onset Hirayama disease in a female

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    Matthias Baumann

    2017-01-01

    Full Text Available Objectives: Hirayama disease is a rare myelopathy, occurring predominantly in males with onset in the teens. Methods and results: Here, we report a young female patient who developed the first signs of Hirayama disease at 10.5 years of age. Prior to onset, she had experienced a growth spurt and grew about 8 cm. The disease progressed over 3 years and the typical clinical, electrophysiological, and neuroimaging signs of Hirayama disease were found. After this period and achievement of her final height, no further progression was noticed. Conclusions: This case highlights that pediatric neurologists should be aware of Hirayama disease, which can also occur in girls in early adolescence.

  9. Hirayama disease with juvenile myoclonic epilepsy: A case report

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    Jin-Sung Park

    2014-01-01

    Full Text Available Hirayama disease (HD is rare, but benign anterior horn cell disease, predominantly affecting young men. One of the symptoms, besides weakness, is abnormal movement in the hand. Juvenile myoclonic epilepsy (JME is one of the most common types of generalized epilepsies and can be recognized by a myoclonic jerk and electroencephalography (EEG features. We report the case of a 19-year-old male who had HD, with unilateral abnormal movement in the hand, which was diagnosed as JME. We should consider performing an EEG in patients with HD, who present with atypical hand movements, in order to differentiate it from seizure.

  10. Risk Factors for Surgical Results of Hirayama Disease: A Retrospective Analysis of a Large Cohort.

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    Song, Jian; Wang, Hong-Li; Zheng, Chao-Jun; Jiang, Jian-Yuan

    2017-09-01

    To explore risk factors affecting surgical results of Hirayama disease. A retrospective analysis of 210 patients was performed to identify risk factors affecting surgical results of Hirayama disease by using univariate and multivariate analyses. A receiver operating characteristic curve and area under the curve were applied to evaluate the significant results of the multivariate analysis and the optimal reference value. The mean follow-up period was 27.3 months (range, 14-45 months), and 194 patients with clinical and radiographic data completed the final follow-up. Multivariate analysis identified age of patients (cutoff value 22.5 years), duration of the disease (cutoff value 33 months), physiologic reflex, and pathologic reflex as independent risk factors for surgical results of Hirayama disease. The receiver operating characteristic curve analysis and area under the curve showed that good reference value was obtained for the risk factors. Age of patient, duration of the disease, physiologic reflex, and pathologic reflex are the main risk factors affecting surgical results of Hirayama disease. Receiver operating characteristic analysis shows that good reference value was obtained for the risk factors. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Cervical duraplasty with tenting sutures via laminoplasty for cervical flexion myelopathy in patients with Hirayama disease: successful decompression of a "tight dural canal in flexion" without spinal fusion.

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    Ito, Hirotaka; Takai, Keisuke; Taniguchi, Makoto

    2014-11-01

    Hirayama disease, juvenile muscular atrophy of the distal upper extremity, is a rare type of cervical flexion segmental myelopathy and its etiology is still being debated. Two theories have been proposed: a "contact pressure" theory and "tight dural canal in flexion" theory. Previously reported treatments, including conservative neck collar therapy and surgical spinal fusion, used fixation of the cervical spine with the aim of avoiding contact pressure between the cord and anterior structures. On the other hand, treatment by duraplasty without spinal fusion has also been used, which aims at decompressing a tight dural canal in flexion by preventing abnormal forward displacement of the posterior dura mater without restricting cervical motion in young patients. The authors developed a new surgical approach for treating a tight dural canal in flexion in patients with Hirayama disease: cervical duraplasty with tenting sutures via laminoplasty without spinal fusion. With this treatment they aimed to both decompress the spinal cord and preserve as much cervical motion as possible. The purpose of this study was to assess the clinical outcomes of patients who underwent this new surgical procedure and to investigate the etiology of Hirayama disease. Six male patients (age range 17-23 years) with Hirayama disease underwent surgery between 2006 and 2012. The pre- and postoperative anteroposterior diameters of the dural canal in the flexed neck position, grip strength of the bilateral upper extremities, cervical alignment (C2-7), and cervical local flexion range of motion were compared. The presence or absence of surgical complications was assessed. To investigate the comparison group of Hirayama disease treated with spinal decompression, the PubMed database was searched for all relevant English-language case reports and series published between 1990 and 2013. The postoperative anteroposterior diameters of the dural canal were significantly expanded in the flexed neck position

  12. [Cervical flexion F-waves in the patients with Hirayama diseases].

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    Zheng, Chaojun; Lyu, Feizhou; Ma, Xiaosheng; Xia, Xinlei; Jin, Xiang; Yin, Jun; Jiang, Jianyuan; Zhu, Yu

    2015-02-01

    To identify whether there is significant changes between the cervical neutral F-waves and cervical flexion F-waves in the patients with Hirayama disease. This study was performed on 25 normal subjects and 22 male patients with identified Hirayama disease (age: 15 to 44 years; height: 165 to 183 cm; duration: 6 to 240 months) between May 2010 and March 2014. Both cervical flexion F-wave (cervical flexion 45 °, 30 minutes) and conventional F-waves to median nerve stimulation and to ulnar nerve stimulation were performed in all subjects bilaterally. were analyzed by t-test or Fisher exact probability. In the normal subjects, all measurements of the bilateral F-waves didn't have any difference between the cervical flexion position and the cervical neutral position. On the cervical neutral position, the persistence (t = 5.209, P = 0.000), average latencies (t = 4.731, P = 0.022) and minimal latencies (t = 23.843, P = 0.006) of ulnar F-wave on the symptomatic heavier side from the patients with identified Hirayama disease were significantly lower or longer than those from the normal subjects, and the repeat F-waves were found in 3 patients (13.6%). On the symptomatic lighter side, the ulnar F-waves only had lower persistence (t = 22.306, P = 0.001) along with 5 repeat F-waves. Only lower persistence were found in the median F-wave on the both side (higher side t = 23.696, P = 0.000; lighter side t = 23.998, P = 0.000), along with 5 (22.7%) repeat F-waves on the symptomatic heavier side and 6 (27.3%) ones on the symptomatic lighter side. After cervical flexion maintaining 30 minutes, the increased maximal amplitudes (t = -2.552, P = 0.019), average amplitudes (t = -3.322, P = 0.003), duration (t = -3.323, P = 0.00), persistence (t = -2.604, P = 0.017) and frequency of repeat F-waves (9/22, 41%) (P = 0.044) were found on the symptomatic heavier side of ulnar F-wave, and 5 of 10 absent ulnar F-wave on the cervical neutral position were also recover. The median F-wave on

  13. Split hand index and ulnar to median ratio in Hirayama disease and amyotrophic lateral sclerosis.

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    Kalita, Jayantee; Kumar, Surendra; Misra, Usha K; Neyaz, Zafar

    2017-11-01

    We report the relative usefulness of split hand index (SHI) and ulnar to median (UM) ratio in Hirayama disease (HD) and amyotrophic lateral sclerosis (ALS). The patients with HD, ALS and matched controls were subjected to evaluation of UM ratio and SHI. Compound muscle action potentials (CMAPs) were recorded from abductor digit minimi (ADM) and first dorsal interosseous (FDI) by stimulating ulnar nerve at the wrist, and abductor pollicis brevis (APB) by stimulating median nerve at the wrist. UM ratio (ADM/APB) and SHI (APB × FDI/ADM) were calculated, and compared. Sensitivity and specificity of SHI and UM ratio in HD and ALS were calculated. Twenty-six HD and 31 ALS patients were included. Twenty-six matched controls for HD and 20 for ALS were also evaluated. The APB amplitude was significantly lower in ALS compared to HD (6.89 ± 2.0 mv vs. 2.13 ± 1.27 mv, p = 0.01). UM ratio ALS. UM ratio had a poor specificity for ALS (18.9%) and SHI for HD (34%). UM ratio is more sensitive and specific for HD and SHI for ALS patients.

  14. How does the neck flexion affect the cervical MRI features of Hirayama disease?

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    Hou, Chao; Han, Hongbin; Yang, Xiaohong; Xu, Xiaojuan; Gao, Hui; Fan, Dongsheng; Fu, Yu; Sun, Yu; Liu, Bo

    2012-10-01

    Although flexion cervical MRI has been recommended for the diagnosis of Hirayama disease (HD), no study focused on the MR features at different neck flexion angles. Moreover, no uniform flexion angle has been confirmed in clinical practice. The purpose of this study is to quantitatively investigate the MRI typical signs of HD patients in different neck flexion degree and gives a suggestion to the MR scanning. Cervical MRI in neutral and different flexion positions (cervical flexion angle 20°, 25°, 30°, 35°, and 40°) were performed in 45 HD patients. Three MRI features including anterior shifting of the posterior wall of the cervical dural canal (ASD), widening of cervical epidural space, and epidural flow voids (EFV) at each flexed position were summarized. To evaluate ASD quantitatively, the widest cervical epidural space with the maximum sagittal diameters (d) and cervical canal sagittal diameter (D) at the same level were measured. The d/D values at different angles were calculated and compared. ASD was demonstrated in 34 out of 45 cases (75.6%) at 20° and in all cases (100%) at other 4 angles (χ (2) = 25.728, P Neck flexion angles have effects on ASD, widening of cervical epidural space and EFV. 25° is recommended as the least effective diagnostic flexion angle for MRI diagnosis of HD, and 35° may be the best one.

  15. MRI findings of nonprogressive juvenile spinal muscular atrophy of the distal upper limbs (Hirayama's disease)

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    Lee, In Sook; Lee, Tae Hong; Kim, Hak Jin; Song, Jong Woon; Lee, Suk Hong; Choi, Kwang Dong; Park, Kyoung Pil; Choi, Ki Bok [Pusan National University College of Medicine, Pusan (Korea, Republic of)

    2003-05-01

    The aim of this study was to describe the dynamic changes of the cervical dural sac and the spinal cord during neck flexion in patients suffering from Hirayama's disease and to present the usefulness of flexion MR study for the diagnosis. Seven consecutive male patients (age ranging 17-43 years, mean age 23.7 years) with the clinical diagnosis of Hirayama's disease and 5 healthy subjects (aged 25-32 years) for controls had done cervical MRI from January 2001 through June 2002. Cervical MRI was done in neutral and neck flexed positions using 1.5T system (Sonata, Siemens, Germany) and obtained images were reviewed by two radiologists. We compared the cervical MRI findings of 7 patients with those of 5 healthy controls regarding neck flexion induced changes in the lower cervical segments. Neutral positioned cervical sagittal MR images revealed subtle or mild cord atrophy in only 2 patients. On maximal neck flexion, AP diameter of the cresent posterior epidural space was increased and also cord flattening with anterior shifting of posterior wall of the lower cervical dural canal was noted in all 7 patients. In all 7 cases, the level and side of spinal cord changes corresponded to the clinical phenotype. All control subjects showed neither cord flattening nor widening of posterior epidural space on neck flexion. In patients with the clinical diagnosis of Hirayama's disease, MRI scans obtained on maximal neck flexion showed characteristically dynamic flattening of lower cervical cord and widening of posterior epidural space. Therefore, a flexion MR study is needed to prove the diagnosis.

  16. MRI findings of nonprogressive juvenile spinal muscular atrophy of the distal upper limbs(Hirayama's disease)

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    Lee, In Sook; Lee, Tae Hong; Kim, Hak Jin; Song, Jong Woon; Lee, Suk Hong; Choi, Kwang Dong; Park, Kyoung Pil [Pusan National University College of Medicine, Pusan (Korea, Republic of); Choi, Ki Bok [Inje University College of Medicine, Pusan (Korea, Republic of)

    2003-05-01

    The aim of this study was to describe the dynamic changes of the cervical dural sac and the spinal cord during neck flexion in patients suffering from Hirayama's disease and to present the usefulness of flexion MR study for the diagnosis. Seven consecutive male patients (age ranging 17-43 years, mean age 23.7 years) with the clinical diagnosis of Hirayama's disease and 5 healthy subjects (aged 25-32 years) for controls had done cervical MRI from January 2001 through June 2002. Cervical MRI was done in neutral and neck flexed positions using 1.5 T system (Sonata, Siemens, Germany) and obtained images were reviewed by two radiologists. We compared the cervical MRI findings of 7 patients with those of 5 healthy controls regarding neck flexion induced changes in the lower cervical segments. Neutral positioned cervical sagittal MR images revealed subtle or mild cord atrophy in only 2 patients. On maximal neck flexion, AP diameter of the cresent posterior epidural space was increased and also cord flattening with anterior shifting of posterior wall of the lower cervical dural canal was noted in all 7 patients. In all 7 cases, the level and side of spinal cord changes corresponded to the clinical phenotype. All control subjects showed neither cord flattening nor widening of posterior epidural space on neck flexion. In patients with the clinical diagnosis of Hirayama's disease, MRI scans obtained on maximal neck flexion showed characteristically dynamic flattening of lower cervical cord and widening of posterior epidural space. Therefore, a flexion MR study is needed to prove the diagnosis.

  17. Effect of neck flexion on somatosensory and motor evoked potentials in Hirayama disease.

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    Abraham, A; Gotkine, M; Drory, V E; Blumen, S C

    2013-11-15

    Hirayama disease (HD) is a rare motor disorder mainly affecting young men, characterized by atrophy and weakness of forearm and hand muscles corresponding to a C7-T1 myotome distribution. The weakness is usually unilateral or asymmetric and progression usually stops within several years. The etiology of HD is not well understood. One hypothesis, mainly based on MRI findings, is that the weakness is a consequence of cervical flexion myelopathy. The aim of this study was to explore the function of corticospinal and ascending somatosensory pathways during neck flexion using evoked responses. 15 men with HD and 7 age-matched control male subjects underwent somatosensory evoked potentials (SSEP) and motor evoked potentials (MEP) studies with the neck in neutral position and fully flexed. SSEP studies included electrical stimulation of median and ulnar nerves at the wrist, and tibial nerve at the ankle with recording over the ipsilateral Erb's point, cervical spine, and contralateral sensory cortex. MEP recordings were obtained by magnetic stimulation of the motor cortex and the cervical lower spinal roots; the evoked responses were recorded from the contralateral thenar and abductor hallucis muscles. MEP recordings demonstrated significant lower amplitudes, and slightly prolonged latencies in HD patients on cervical stimulation, compared to control subjects. During neck flexion, MEP studies also demonstrated a statistically significant drop in mean upper limb amplitude on cervical stimulation in HD patients, as well as in control subjects, although to a lesser degree. In contrast, no significant differences were found in SSEP studies in HD patients compared to control subjects, or between neutral and flexed position in these groups. The study shows a negative effect of cervical flexion on MEP amplitudes in HD patients as well as in control subjects, requiring more studies to investigate its significance. Neck flexion did not have an influence on any SSEP parameters in

  18. CONTRAST DYNAMIC MR IMAGING IN HIRAYAMA DISEASE ON A 3-TESLA MRI SCANNER IN A TERTIARY CARE CENTRE IN EASTERN INDIA

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    Archana Singh

    2017-05-01

    Full Text Available BACKGROUND Hirayama disease, also termed non-progressive juvenile spinal muscular atrophy of the distal upper limbs, is a type of cervical myelopathy related to flexion movements of the neck. The objective of the study was to evaluate the role of Dynamic MR imaging findings in young patients with clinical suspicion of Hirayama disease. MATERIALS AND METHODS Thirteen patients (age range from 16 to 26 years with clinical suspicion of Hirayama disease underwent thorough clinical evaluation and dynamic cervical MRI in the Department of Radiology at IPGME&R within a time duration of June 2014 to September 2016. RESULTS All the thirteen patients showed anterior shifting of posterior dural sac, cord flattening, abnormal curvature, enhancing epidural component. Nine of them showed localised cord atrophy and intramedullary T2 hyperintensities. Ten patients showed prominent flow voids. CONCLUSION Hirayama disease, a rare disease affecting young adults almost always in the second to third decades of life, is characterised by insidious onset and slowly progressive course followed by static phase of unilateral or asymmetric atrophy of the hand(s and forearm(s with sparing of the brachioradialis, characterised as oblique amyotrophy. Dynamic contrast MRI has accurate and characteristic findings which help in early diagnosis and early institution of therapy.

  19. Non-progressive juvenile spinal muscular atrophy of the distal upper limb (Hirayama's disease: a clinical variant of the benign monomelic amyotrophy

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    NASCIMENTO OSVALDO J. M.

    2000-01-01

    Full Text Available Hirayama's disease (HD is frequently found in Asia, and is rarely referred among westerners. It affects young people with higher incidence in males. It is a focal distal amyotrophy with unilateral or asymmetric bilateral involvement of C7, C8 and T1 innervated muscles. HD appears sporadically and has a benign evolution with clinical stabilization in around one year. We report four young male patients with clinical and electrophysiological alterations described in HD, which were followed-up during 5 years. Electromyographic findings were indicative of lower motor neuron involvement. We analyzed cervical MRI aiming at understanding if a questionable spinal cord compression could be implicated in the pathogenesis, but no abnormality was verified. In view of its clinical, and EMG characteristics, HD is no more than a benign monomelic amyotrophy (BMA clinical variant, and not a specific disease. This eponym could be considered only for the distal upper limb variant (Hirayama's variant of the BMA.

  20. Effect of neck flexion on F wave, somatosensory evoked potentials, and magnetic resonance imaging in Hirayama disease.

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    Misra, U K; Kalita, J; Mishra, V N; Phadke, R V; Hadique, A

    2006-05-01

    Flexion myelopathy is one of the suggested mechanism for Hirayama disease (HD) but simultaneous radiological and neurophysiological evaluation is lacking. This study therefore evaluates the effect of neck flexion in HD using somatosensory evoked potentials (SEPs), F waves, and magnetic resonance imaging (MRI). Eight HD patients and seven matched controls were subjected to median and ulnar F wave (minimal latency, FM ratio, persistence, and chronodispersion), and SEPs evaluating N9, N13, and N20 potentials in neutral and neck flexion. Spinal MRI was carried out in neutral and neck flexion and evaluated for cord atrophy, signal changes, cord compression, posterior epidural tissue, and loss of dural attachment. The patients were aged 19 to 30 years. Minimal F latency, FM ratio, persistence, and chronodispersion in neutral and neck flexion did not show any change nor was there any change in N13 latency and amplitude on median and ulnar SEPs. The difference in these parameters in neutral and neck flexion were also not significant in HD compared with controls. The change in N13 was also not related to loss of dural attachment and posterior epidural tissue. Neck flexion does not produce significant changes in N13 and F wave parameters and is not related to dynamic MRI changes. The other mechanisms for HD should therefore be explored.

  1. Enfermedad de Hirayama en un adolescente

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    José Vargas Díaz

    Full Text Available La Enfermedad de Hirayama -o amiotrofia monomélica- es una afección de baja frecuencia y escasamente reportada en la edad pediátrica. Se presenta el caso clínico de un adolescente de 15 años de edad con disminución de la fuerza muscular y pérdida de la masa muscular, que comenzó a los 10 años de edad por la mano izquierda, y le afectó posteriormente el antebrazo. Mantuvo un curso progresivo durante 3 años, para luego mantenerse estable. El electromiograma de aguja arrojó lesión de axones motores o motoneuronas dependientes de los miotomas C7-T1, y en menor grado, C5-C6. En la tomografía axial computarizada con contraste endovenoso en marcada flexión cervical, se observó desde C7-T2 una evidente ectasia venosa posmedular asimétrica, predominantemente del lado izquierdo, por congestión del plexo venoso vertebral posterior interno. En este paciente la enfermedad se detuvo espontáneamente, en otros casos es necesario limitar la motilidad de la columna con el uso de un collar cervical, y solo llegar a la cirugía en los casos más severos de evolución rápida.

  2. Extreme weather events and infectious disease outbreaks

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    McMichael, Anthony J

    2015-01-01

    Human-driven climatic changes will fundamentally influence patterns of human health, including infectious disease clusters and epidemics following extreme weather events. Extreme weather events are projected to increase further with the advance of human-driven climate change. Both recent and historical experiences indicate that infectious disease outbreaks very often follow extreme weather events, as microbes, vectors and reservoir animal hosts exploit the disrupted social and environmental c...

  3. Extreme weather events and infectious disease outbreaks.

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    McMichael, Anthony J

    2015-01-01

    Human-driven climatic changes will fundamentally influence patterns of human health, including infectious disease clusters and epidemics following extreme weather events. Extreme weather events are projected to increase further with the advance of human-driven climate change. Both recent and historical experiences indicate that infectious disease outbreaks very often follow extreme weather events, as microbes, vectors and reservoir animal hosts exploit the disrupted social and environmental conditions of extreme weather events. This review article examines infectious disease risks associated with extreme weather events; it draws on recent experiences including Hurricane Katrina in 2005 and the 2010 Pakistan mega-floods, and historical examples from previous centuries of epidemics and 'pestilence' associated with extreme weather disasters and climatic changes. A fuller understanding of climatic change, the precursors and triggers of extreme weather events and health consequences is needed in order to anticipate and respond to the infectious disease risks associated with human-driven climate change. Post-event risks to human health can be constrained, nonetheless, by reducing background rates of persistent infection, preparatory action such as coordinated disease surveillance and vaccination coverage, and strengthened disaster response. In the face of changing climate and weather conditions, it is critically important to think in ecological terms about the determinants of health, disease and death in human populations.

  4. Extreme thrombocytosis predicts Kawasaki disease in infants.

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    Nigrovic, Lise E; Nigrovic, Peter A; Harper, Marvin B; Chiang, Vincent W

    2006-06-01

    Infants with Kawasaki disease are at high risk of developing life-threatening coronary complications, yet may elude timely diagnosis because they often lack the full complement of classic clinical features. We retrospectively studied 26,540 children 1 year of age or less who were evaluated at a tertiary care pediatric emergency department in whom a platelet count was performed. Among those infants with fever without a source identified, 8.5% with platelet counts of 800,000 cells/mm(3) or greater had Kawasaki disease compared to 0.4% with platelet counts of less than 800,000 cells/mm(3) (likelihood ratio for Kawasaki disease was 17 [95% confidence interval, 8-34]). Because many infants present atypically, Kawasaki disease should be considered in all children of 1 year or less with prolonged fever, extreme elevation of the platelet count, and no compelling alternative diagnosis.

  5. Early detection of asymptomatic carotid disease in patients with arteriosclerotic occlusive disease of the lower extremities

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    Rančić Zoran S.

    2002-01-01

    Full Text Available Prevalence of asymptomatic carotid artery stenosis in patients with lower extremities atherosclerosis is relatively high. Limiting screening of specific subgroups for any demographic or medical characteristics is ineffective. Screening for asymptomatic carotid artery stenosis is indicated in all patients with lower extremities atherosclerosis except in whom prophylactic carotid endarterectomy is not recommended because of comorbid disease or extreme age.

  6. Periodontal Disease and Cardiovascular Disease: An Extreme Interaction

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    Cruz Rodríguez, Mayerlin; Pontificia Universidad Javeriana; Cárdenas, Sebastián; Pontificia Universidad Javeriana; Moreno, Freddy; Pontificia Universidad Javeriana; Moreno, Sandra; Pontificia Universidad Javeriana

    2015-01-01

    Periodontitis is a multifactorial and complex chronic inflammatory and infectious disease which has been linked to various systemic complications, including cardiovascular disease. This association has been difficult to prove because epidemiological studies are biased or classic risk factors that are difficult to control, cardiovascular disease also includes a variety of multifactorial diseases also making it even more difficult to determine the cause-effect. The studies reported in the liter...

  7. Spa adjuvant therapy improves diabetic lower extremity arterial disease.

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    Qiu, Yongbin; Zhu, Yi; Jia, Wei; Chen, Songhua; Meng, Qingzhou

    2014-08-01

    To investigate the effect of spa adjuvant therapy on diabetic lower extremity arterial disease (LEAD). 128 patients with type II diabetes were separated into three groups according to the degree of lower extremity vascular stenosis. Patients within each group were then randomly divided to receive no treatment (control) or spa adjuvant therapy (treatment). Clinical symptoms, blood pressure and hemodynamic analyses were compared between control and treatment groups by Chi square or t-test. After adjuvant therapy with spa, patients' pain, numbness, and cold sensation were significantly improved compared with control groups (PSpa adjuvant therapy also significantly increased the dorsalis pedis pulse and systolic peak velocity ratio of patients with mild lower extremity vascular stenosis compared with control groups (P0.05). Both in the spa and control groups, there were no significant differences before and after medication for fasting, 2-h postprandial blood glucose and glycosylated hemoglobin (HbA1C) analyses (P>0.05). Spa adjuvant therapy can significantly alleviate lower extremity pain, numbness, and cold sensory symptoms in diabetic LEAD patients with stenosis. Moreover, in LEAD patients with mild stenosis, spa adjuvant therapy also improves the dorsalis pedis pulse and systolic peak velocity ratio, suggesting a potential role for spa therapy as an early intervention strategy to treat the initial stages of disease. Copyright © 2014 Elsevier Ltd. All rights reserved.

  8. Progression of disease preceding lower extremity amputation in Denmark

    DEFF Research Database (Denmark)

    Jensen, Pia Søe; Petersen, Janne; Kirketerp-Møller, Klaus

    2017-01-01

    OBJECTIVES: Patients with non-traumatic lower extremity amputation are characterised by high age, multi-morbidity and polypharmacy and long-term complications of atherosclerosis and diabetes. To ensure early identification of patients at risk of amputation, we need to gain knowledge about...... the progression of diseases related to lower extremity amputations during the years preceding the amputation. DESIGN: A retrospective population-based national registry study. SETTING: The study includes data on demographics, diagnoses, surgery, medications and healthcare services from five national registries....... Data were retrieved from 14 years before until 1 year after the amputation. Descriptive statistics were used to describe the progression of diseases and use of medication and healthcare services. PARTICIPANTS: An unselected cohort of patients (≥50 years; n=2883) subjected to a primary non...

  9. Neurofibromatosis and Caroli's disease: an extremely rare association.

    Science.gov (United States)

    Arfan ul Bari; Mehmood, Tariq; Hussain, Shahid H; Yousaf, Rizwan; Majeed, Shahid; ber Rahman, Simeen

    2004-04-01

    Neurofibromatosis type-1 (NF-1) is a rare genetic disorder with an extremely variable phenotype. A broad spectrum of associations have also been reported with it. We present a florid case of NF, presenting with unusual symptoms, which was found to have an associated Caroli's disease, a rare congenital disorder of the intrahepatic bile ducts. The case is reported along with a brief review of both the disorders.

  10. Lower extremity isokinetic muscle strength in patients with Parkinson's disease.

    Science.gov (United States)

    Durmus, Bekir; Baysal, Ozlem; Altinayar, Sibel; Altay, Zuhal; Ersoy, Yuksel; Ozcan, Cemal

    2010-07-01

    We evaluated lower extremity isokinetic muscle strength to determine affected muscle groups and their dependence on movement velocity, and to establish the relationship between muscle strength and clinical severity, as well as muscle strength and falls, in Parkinson's disease (PD). Twenty-five patients diagnosed with PD and 24 healthy volunteers were enrolled in this study. Lower extremity muscle strength was measured using an isokinetic dynamometer. Each participant's clinical status was examined in accordance with the Unified Parkinson's Disease Rating Scale; fall history was also recorded. We observed a significant decrease in isokinetic muscle strength in the patient group, especially in both hip and knee flexors and extensors. Decreased muscle strength was independent of velocity, and correlated with clinical severity and falls. Movement velocity-independent lower extremity isokinetic muscle weakness has been observed in patients with PD, especially in the knee and hip joints. The evaluation of isokinetic muscle strength may be a useful tool for the assessment of clinical severity and falls in PD.

  11. Relative hypoxia of the extremities in Fabry disease.

    Science.gov (United States)

    Inagaki, M; Ohno, K; Hisatome, I; Tanaka, Y; Takeshita, K

    1992-09-01

    A purine degradation study, thermography and near infrared spectroscopy of the extremities were performed on 2 young males with Fabry disease and 2 healthy controls. Two-minute semi-ischemic forearm exercise caused a distinct increase in lactate in all subjects, but venous hypoxanthine and ammonia were greatly increased only in the Fabry patients, suggesting a relatively hypoxic state of the extremities. Limb thermograms of the patients revealed glove and stocking type disturbance at rest. Poor recovery of the skin temperature of the hands and forearms after exercise was observed in the patients, but the sharp increase in oxygenated hemoglobin after total ischemia was found to be normal or near infrared spectroscopy. Neurotropin showed an analgesic effect, i.e. a strong and selective heat-productive action on the painful lesions, and suppressed the hypoxanthine level after exercise in 1 patient. Although the pathophysiology of the pain in Fabry disease has not been clearly elucidated, a relatively hypoxic state with peripheral hypothermia might play an important role in triggering of a painful attack or chronic burning paresthesia.

  12. Associations between lower extremity ischemia, upper and lower extremity strength, and functional impairment with peripheral arterial disease.

    Science.gov (United States)

    McDermott, Mary M; Tian, Lu; Ferrucci, Luigi; Liu, Kiang; Guralnik, Jack M; Liao, Yihua; Pearce, William H; Criqui, Michael H

    2008-04-01

    To identify associations between lower extremity ischemia and leg strength, leg power, and hand grip in persons with and without lower extremity peripheral arterial disease (PAD). To determine whether poorer strength may mediate poorer lower extremity performance in persons with lower arterial brachial index (ABI) levels. Cross-sectional. Academic medical centers. Four hundred twenty-four persons with PAD and 271 without PAD. Isometric knee extension and plantarflexion strength and handgrip strength were measured using a computer-linked strength chair. Knee extension power was measured using the Nottingham leg rig. ABI, 6-minute walk, and usual and fastest 4-m walking velocity were measured. Results were adjusted for potential confounders. Lower ABI values were associated with lower plantarflexion strength (P trend=.04) and lower knee extension power (P trend strength. Significant associations between ABI and measures of lower extremity performance were attenuated after additional adjustment for measures of strength. These results are consistent with the hypothesis that lower extremity ischemia impairs strength specifically in distal lower extremity muscles. Associations between lower extremity ischemia and impaired lower extremity strength may mediate associations between lower ABI values and greater functional impairment.

  13. La maladie de Hirayama: à propos de quatre observations tunisiennes et revue de la literature

    Science.gov (United States)

    Amor, Sana Ben; Hassine, Anis; Chatti, Ines; Khefifi, Anissa; Doggui, Mohamed; Harzallah, Mohamed Salah; Benammou, Sofien

    2015-01-01

    Nous rapportons les aspects cliniques et électriques de la maladie de Hirayama en Tunisie à travers une série de quatre observations diagnostiquées au service de neurologie Sahloul. Il s'agit de quatre femmes. L’âge moyen était 30,25 ans avec des extrêmes de 27 et 37 ans. Une patiente avait un antécédent de traumatisme cervical, trois avaient une profession favorisant la position prolongée du rachis cervical en flexion. Un déficit moteur distal et une amyotrophie de la main et de l'avant bras droits d'installation progressive étaient observés dans tous les cas. Il n'avait ni des troubles sensitifs objectifs ni de modification des reflexes ostéotendineux et cutanés. L'EMG montrait une dénervation motrice dans le territoire des muscles dépendants des racines C7, C8, et D1. L'IRM cervicale était sans anomalie dans tous les cas. L’évolution était marquée par la bilatéralisation de la symptomatologie chez une patiente et une stabilisation clinique chez les autres. Ainsi, les aspects cliniques et électriques de la maladie de Hirayama dans cette série tunisienne sont comparables à ceux rapportés dans la littérature en dehors d'une atteinte strictement féminine. PMID:26185570

  14. Prevalence of lower extremity arterial disease among elderly people in the community.

    OpenAIRE

    Coni, N; Tennison, B.; Troup, M

    1992-01-01

    To estimate the prevalence of lower extremity arterial disease, all patients aged over 65 years registered with a rural general practice near Cambridge were invited to attend for examination of the circulation to the lower extremities; 265 subjects (80%) accepted. Three methods were used to investigate the presence of lower extremity arterial disease - enquiring about symptoms of intermittent claudication; clinical examination (and particularly the detection of arterial bruits); and pressure ...

  15. The extremity function index (EFI), a disability severity measure for neuromuscular diseases : psychometric evaluation

    NARCIS (Netherlands)

    Bos, Isaac; Wynia, Klaske; Drost, Gea; Almansa, Josué; Kuks, Joannes

    2017-01-01

    OBJECTIVE: To adapt and to combine the self-report Upper Extremity Functional Index and Lower Extremity Function Scale, for the assessment of disability severity in patients with a neuromuscular disease and to examine its psychometric properties in order to make it suitable for indicating disease

  16. Blood glucose fluctuation aggravates lower extremity vascular disease in type 2 diabetes.

    Science.gov (United States)

    Jiao, X-M; Zhang, X-G; Xu, X U-P; Yi, C; Bin, C; Cheng, Q-P; Gong, Q-Q; Lv, X-F

    2014-01-01

    Lower-extremity vascular diseases are important complication of diabetes. In the present study, we investigated the influence of blood glucose fluctuation in type 2 diabetes-associated lower-extremity vascular diseases, and explore the possible mechanism. Patients with type 2 diabetes was assigned to Group B (without lower-extremity vascular disease) and group C (with lower-extremity vascular disease). Healthy subjects (Group A) served as normal controls. All patients received dynamic blood glucose monitoring for 72 h. The mean amplitude of glycemic excursion (MAGE) and the largest amplitude of glycemic excursion (LAGE) were estimated. The levels of von Willebrand factor (vWF), ischemia-modified albumin (IMA), glycosylated hemoglobin (HbA1c), and biochemical indices were examined, and the lower-extremity vascular diseases were scored in patients from group C. Groups B and C have higher systolic blood pressure (SBP), total cholesterol (TC) level, high-density lipoprotein cholesterol (HDL-C) level, HbA1c level, and vWF level and lower IMA level than those in Group A (p lower-extremity vascular diseases was associated with MAGE, LAGE, SBP, LDL-C, vWF, HbA1c, and IMA (p lower-extremity vascular diseases were involved with MAGE, IMA, and vWF. Enhanced fluctuation in patients with type 2 diabetes may promote the occurrence and development of lower-extremity vascular diseases through aggravating vascular endothelial injury.

  17. Extreme water-related weather events and waterborne disease.

    Science.gov (United States)

    Cann, K F; Thomas, D Rh; Salmon, R L; Wyn-Jones, A P; Kay, D

    2013-04-01

    Global climate change is expected to affect the frequency, intensity and duration of extreme water-related weather events such as excessive precipitation, floods, and drought. We conducted a systematic review to examine waterborne outbreaks following such events and explored their distribution between the different types of extreme water-related weather events. Four medical and meteorological databases (Medline, Embase, GeoRef, PubMed) and a global electronic reporting system (ProMED) were searched, from 1910 to 2010. Eighty-seven waterborne outbreaks involving extreme water-related weather events were identified and included, alongside 235 ProMED reports. Heavy rainfall and flooding were the most common events preceding outbreaks associated with extreme weather and were reported in 55·2% and 52·9% of accounts, respectively. The most common pathogens reported in these outbreaks were Vibrio spp. (21·6%) and Leptospira spp. (12·7%). Outbreaks following extreme water-related weather events were often the result of contamination of the drinking-water supply (53·7%). Differences in reporting of outbreaks were seen between the scientific literature and ProMED. Extreme water-related weather events represent a risk to public health in both developed and developing countries, but impact will be disproportionate and likely to compound existing health disparities.

  18. Magnetic resonance angiography for the evaluation of lower extremity arterial disease: a meta-analysis

    NARCIS (Netherlands)

    Koelemay, M. J.; Lijmer, J. G.; Stoker, J.; Legemate, D. A.; Bossuyt, P. M.

    2001-01-01

    CONTEXT: Magnetic resonance angiography (MRA) is a rapidly evolving technique that has been reported to be accurate for assessment of lower extremity arterial disease. OBJECTIVE: To obtain the best available estimates of the diagnostic performance of MRA in patients with lower extremity arterial

  19. Extremely refractory Kawasaki disease with disseminated intravascular coagulation.

    Science.gov (United States)

    Koh, Young Kwon; Lee, Jae Hee; Park, Yeong Bong

    2017-07-01

    Disseminated intravascular coagulation is a rare complication of Kawasaki disease and appears in Kawasaki disease patients. We report a case of refractory Kawasaki disease complicated with disseminated intravascular coagulation and giant coronary aneurysm. A 5-month-old boy presented with Kawasaki disease with coagulopathy. Although the coagulopathy improved after fresh-frozen plasma and antithrombin-III administration, the fever persisted despite two rounds of intravenous immunoglobulin, along with intravenous methylprednisolone pulse therapy and infliximab administration. Despite all efforts to treatment, the patient had giant coronary aneurysms and died suddenly.

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

    Directory of Open Access Journals (Sweden)

    Anna Weiss

    2015-09-01

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

  1. [The impacts of extreme events of weather and climate on infectious disease].

    Science.gov (United States)

    Qin, Juan; Zhang, Jinliang

    2009-11-01

    In this paper the articles on the impacts of extreme events of weather and climate on infectious disease were summarized, in which were published in China from 1995 to 2008. Among all kinds of extreme events of weather and climate, flood, warm winter, high temperature and drought had the most obvious effect on infectious disease. In this paper, the impact on epidemic and activities of vectors and infectious parasites, as well as the change of incidence and epidemic scale of related infectious disease were respectively reviewed.

  2. Extreme Weather Events and Impacts on Vector-borne Diseases and Agriculture

    Science.gov (United States)

    Extreme weather events during the period 2010-2012 impacted agriculture and vector-borne disease throughout the world. We evaluated specific weather events with satellite remotely sensed environmental data and evaluated crop production and diseases associated with these events. Significant droughts ...

  3. The relationship between lower limb muscle strength and lower extremity function in HIV disease

    OpenAIRE

    Peter C. Mhariwa; Hellen Myezwa; Mary L. Galantino; Douglas Maleka

    2017-01-01

    Background: Human immunodeficiency virus (HIV) negatively impacts muscle strength and function. This study aimed to establish the relationship between lower limb muscle strength and lower extremity function in HIV disease.Method: A cross-sectional study was undertaken with a sample of 113 HIV-positive participants. Lower limb muscle strength and self-reported function were established using dynamometry and the Lower Extremity Functional Scale (LEFS), respectively. Muscle strength and function...

  4. Endovascular Interventions for Acute and Chronic Lower Extremity Deep Venous Disease: State of the Art.

    Science.gov (United States)

    Sista, Akhilesh K; Vedantham, Suresh; Kaufman, John A; Madoff, David C

    2015-07-01

    The societal and individual burden caused by acute and chronic lower extremity venous disease is considerable. In the past several decades, minimally invasive endovascular interventions have been developed to reduce thrombus burden in the setting of acute deep venous thrombosis to prevent both short- and long-term morbidity and to recanalize chronically occluded or stenosed postthrombotic or nonthrombotic veins in symptomatic patients. This state-of-the-art review provides an overview of the techniques and challenges, rationale, patient selection criteria, complications, postinterventional care, and outcomes data for endovascular intervention in the setting of acute and chronic lower extremity deep venous disease. Online supplemental material is available for this article.

  5. Effects of extreme precipitation to the distribution of infectious diseases in Taiwan, 1994-2008.

    Directory of Open Access Journals (Sweden)

    Mu-Jean Chen

    Full Text Available The incidence of extreme precipitation has increased with the exacerbation of worldwide climate disruption. We hypothesize an association between precipitation and the distribution patterns that would affect the endemic burden of 8 infectious diseases in Taiwan, including water- and vector-borne infectious diseases. A database integrating daily precipitation and temperature, along with the infectious disease case registry for all 352 townships in the main island of Taiwan was analysed for the period from 1994 to 2008. Four precipitation levels, 350 mm, were categorized to represent quantitative differences, and their associations with each specific disease was investigated using the Generalized Additive Mixed Model and afterwards mapped on to the Geographical Information System. Daily precipitation levels were significantly correlated with all 8 mandatory-notified infectious diseases in Taiwan. For water-borne infections, extreme torrential precipitation (>350 mm/day was found to result in the highest relative risk for bacillary dysentery and enterovirus infections when compared to ordinary rain (<130 mm/day. Yet, for vector-borne diseases, the relative risk of dengue fever and Japanese encephalitis increased with greater precipitation only up to 350 mm. Differential lag effects following precipitation were statistically associated with increased risk for contracting individual infectious diseases. This study's findings can help health resource sector management better allocate medical resources and be better prepared to deal with infectious disease outbreaks following future extreme precipitation events.

  6. Effects of extreme precipitation to the distribution of infectious diseases in Taiwan, 1994-2008.

    Science.gov (United States)

    Chen, Mu-Jean; Lin, Chuan-Yao; Wu, Yi-Ting; Wu, Pei-Chih; Lung, Shih-Chun; Su, Huey-Jen

    2012-01-01

    The incidence of extreme precipitation has increased with the exacerbation of worldwide climate disruption. We hypothesize an association between precipitation and the distribution patterns that would affect the endemic burden of 8 infectious diseases in Taiwan, including water- and vector-borne infectious diseases. A database integrating daily precipitation and temperature, along with the infectious disease case registry for all 352 townships in the main island of Taiwan was analysed for the period from 1994 to 2008. Four precipitation levels, 350 mm, were categorized to represent quantitative differences, and their associations with each specific disease was investigated using the Generalized Additive Mixed Model and afterwards mapped on to the Geographical Information System. Daily precipitation levels were significantly correlated with all 8 mandatory-notified infectious diseases in Taiwan. For water-borne infections, extreme torrential precipitation (>350 mm/day) was found to result in the highest relative risk for bacillary dysentery and enterovirus infections when compared to ordinary rain (precipitation only up to 350 mm. Differential lag effects following precipitation were statistically associated with increased risk for contracting individual infectious diseases. This study's findings can help health resource sector management better allocate medical resources and be better prepared to deal with infectious disease outbreaks following future extreme precipitation events.

  7. Extremely low-frequency magnetic field exposure, electrical shocks and risk of Parkinson's disease

    NARCIS (Netherlands)

    van der Mark, Marianne; Vermeulen, Roel; Nijssen, Peter C G; Mulleners, Wim M; Sas, Antonetta M G; van Laar, Teus; Kromhout, Hans; Huss, Anke

    PURPOSE: Previous studies did not provide strong evidence for an increased Parkinson's disease (PD) risk after exposure to extremely low-frequency magnetic fields (ELF-MF), but were limited in their scope to address other exposures related to the use of electricity such as electrical shocks. We

  8. Extremely low-frequency magnetic field exposure, electrical shocks and risk of Parkinson's disease

    NARCIS (Netherlands)

    van der Mark, Marianne; Vermeulen, Roel; Nijssen, Peter C. G.; Mulleners, Wim M.; Sas, Antonetta M. G.; van Laar, Teus; Kromhout, Hans; Huss, Anke

    Previous studies did not provide strong evidence for an increased Parkinson's disease (PD) risk after exposure to extremely low-frequency magnetic fields (ELF-MF), but were limited in their scope to address other exposures related to the use of electricity such as electrical shocks. We evaluated the

  9. The relationship between lower limb muscle strength and lower extremity function in HIV disease

    Directory of Open Access Journals (Sweden)

    Peter C. Mhariwa

    2017-02-01

    Full Text Available Background: Human immunodeficiency virus (HIV negatively impacts muscle strength and function. This study aimed to establish the relationship between lower limb muscle strength and lower extremity function in HIV disease.Method: A cross-sectional study was undertaken with a sample of 113 HIV-positive participants. Lower limb muscle strength and self-reported function were established using dynamometry and the Lower Extremity Functional Scale (LEFS, respectively. Muscle strength and functional status were established in a subset of 30 HIV-negative participants to determine normative values.Results: Muscle strength for participants with HIV ranged from an ankle dorsiflexion mean of 9.33 kg/m2 to 15.79 kg/m2 in hip extensors. In the HIV-negative group, ankle dorsiflexors recorded 11.17 kg/m2, whereas hip extensors were the strongest, generating 17.68 kg/m2. In the HIV-positive group, linear regression showed a positive relationship between lower limb muscle strength and lower extremity function (r = 0.71, p = 0.00. Fifty per cent of the changes in lower extremity function were attributable to lower limb muscle strength. A simple linear regression model showed that lower limb ankle plantar flexors contributed the most to lower extremity function in this cohort, contrary to the literature which states that hip and trunk muscles are the most active in lower limb functional activities.Conclusion: Lower extremity strength impacts perceived function in individuals stabilised on antiretroviral therapy for HIV disease. These findings demonstrate that ankle plantar flexors produce more force over hip flexors. Careful attention should be paid to the implications for strength training in this population.

  10. Unicentric castleman's disease located in the lower extremity: a case report

    Directory of Open Access Journals (Sweden)

    Schweyer Stefan

    2011-08-01

    Full Text Available Abstract Background Castleman's disease is a rare form of localized lymph node hyperplasia of uncertain etiology. Although the mediastinum is the most common site of involvement, rare cases occurring in lymph node bearing tissue of other localization have been reported, including only a few intramuscular cases. Unicentric and multicentric Castleman's disease are being distinguished, the latter harboring an unfavorable prognosis. Case Presentation Here, we present a case of unicentric Castleman's disease in a 37-year-old woman without associated neoplastic, autoimmune or infectious diseases. The lesion was located in the femoral region of the right lower extremity and surgically resected after radiographic workup and excisional biopsy examinations. The tumor comprised lymphoid tissue with numerous germinal centers with central fibrosis, onion-skinning and rich interfollicular vascularization. CD23-positive follicular dendritic cells were detected in the germinal centers and numerous CD138-positive plasma cells in interfollicular areas. The diagnosis of mixed cellularity type Castleman's disease was established and the patient recovered well. Conclusions In conclusion, the differential diagnosis of Castleman's disease should be considered when evaluating a sharply demarcated, hypervascularized lymphatic tumor located in the extremities. However, the developmental etiology of Castleman's disease remains to be further examined.

  11. Arterial diseases of lower extremities in diabetic patients: current state and prospects of therapy

    OpenAIRE

    Gagik Radikovich Galstyan; Alla Yur'evna Tokmakova; Ol'ga Nikolaevna Bondarenko; Ivan Ivanovich Sitkin; Kira Yur'evna Pryakhina; Valeriy Afanas'evich Mitish; Lyubov' Petrovna Doronina

    2011-01-01

    Peripheral artery diseases (PAD) are most serious diabetic complications responsible for the high risk of amputation of lower extremities. The occurrence of PAD in diabetic patients is much higher than in subjects with undisturbed carbohydrate metabolism. PAD in diabetic patients is frequently an asymptomatic condition affecting distal portions of arterial segments and associated with pronounced mediacalcinosis. Standard diagnostic procedures for the screening of arterial lesions mus...

  12. Endovascular Management of Deep venous Thrombosis of Lower Extremity in Patients with Malignant Disease

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Su Jin; Kim, Jae Kyu; Jang, Nam Kyu; Han, Seung Min; Kang, Heoung Keun; Choi, Soo Jin Nah [Chonnam National University Hospital, Gwangju (Korea, Republic of)

    2009-07-15

    To evaluate the efficacy of endovascular management of lower extremity deep vein thrombosis (DVT) in patients with malignant disease. Between January 2002 and January 2008, six consecutive patients (5 male and 1 female, mean age-65 years) with lower extremity DVT and malignant disease underwent endovascular management. The duration of symptoms lasted 4-120 days (mean-31 days; 20 days or less in four patients and more than 20 days in two). A catheter-directed thrombolysis was performed via the ipsilateral popliteal vein or common femoral vein, used alone or combined with a percutaneous mechanical thrombectomy. Angioplasty or stent placement was performed in residual stenosis or occlusion of the vein. The follow-up period lasted 1-14 months (mean 7.6 months) and was performed via a color Doppler ultrasonography or computed tomographic venography. Technical success and relief from symptoms was achieved within two days was achieved in five patients. Minor hemorrhagic complications occurred in two cases: hematuria and a hematoma at the puncture site. Upon follow-up, a recurrent DVT occurred in three patients as well as a patent venous flow in two. One patient died within 1 month due to a metastatic mediastinal lymphadenopathy. Endovascular management of the lower extremity DVT is effective for quickly eliminating a thrombus, relieving symptoms, and decreasing hemorrhagic complications in patients with malignant disease.

  13. Extreme concentrations of endogenous sex hormones, ischemic heart disease, and death in women

    DEFF Research Database (Denmark)

    Benn, Marianne; Voss, Sidsel Skou; Holmegard, Haya N.

    2015-01-01

    Heart Study. During ≤30 years of follow-up, 1013 women developed ischemic heart disease and 2716 died. In women with a plasma estradiol below the fifth percentile compared with between the 10th and 89th percentiles, multifactorially adjusted risk of ischemic heart disease was 44% (95% confidence......OBJECTIVE - : Sex hormones may be critical determinants of ischemic heart disease and death in women, but results from previous studies are conflicting. To clarify this, we tested the hypothesis that extreme plasma concentrations of endogenous estradiol and testosterone are associated with risk...... of ischemic heart disease and death in women. APPROACH AND RESULTS - : In a nested prospective cohort study, we measured plasma estradiol in 4600 and total testosterone in 4716 women not receiving oral contraceptives or hormonal replacement therapy from the 1981 to 1983 examination of the Copenhagen City...

  14. Does treadmill training improve lower-extremity tasks in Parkinson disease? A randomized controlled trial.

    Science.gov (United States)

    Kurtais, Yesim; Kutlay, Sehim; Tur, Birkan Sonel; Gok, Haydar; Akbostanci, Cenk

    2008-05-01

    To investigate whether gait training with treadmill improves functional tasks of lower extremities in patients with Parkinson disease (PD). Randomized controlled trial including two groups, the treadmill training group and the nonintervention group. University hospital. Thirty consecutive patients diagnosed with idiopathic PD, who were on stable regimens of antiparkinsonian medication, able to walk independently, and had not participated in a rehabilitation program in the previous 3 months. Patients with severe cognitive impairments or severe musculoskeletal, cardiopulmonary, neurologic, or other systemic disorders were excluded. Twenty-four patients completed the study. Group I attended a training program on a treadmill for 6 weeks, and group II served as the control group. Both groups were instructed in home mobility exercises. The primary study outcome measures were timed functional lower-extremity tasks (walking at a corridor, U-turn, turning around a chair, stairs, standing on one foot, standing from a chair), and secondary outcome measures were exercise test and patient's global assessment. Assessments were performed at baseline and at the end of the study. There were significant improvements in functional lower-extremity tests, exercise test parameters, and patients' global assessment in group I, whereas no significant improvements were observed in group II. Even though long-term effects remain unknown and the study sample was small, it was concluded that treadmill training in PD patients led to improvements in lower-extremity tasks, thus improving patients' physical well-being in daily life.

  15. Understanding impacts of climatic extremes on diarrheal disease epidemics: Insights from mechanistic disease propagation models

    Science.gov (United States)

    Jutla, A.; Akanda, A. S.; Colwell, R. R.

    2013-12-01

    An epidemic outbreak of diarrheal diseases (primarily cholera) in Haiti in 2010 is a reminder that our understanding on disease triggers, transmission and spreading mechanisms is incomplete. Cholera can occur in two forms - epidemic (defined as sudden outbreak in a historically disease free region) and endemic (recurrence and persistence of the disease for several consecutive years). Examples of countries with epidemic cholera include Pakistan (2008), Congo (2008), and most recently Haiti (2010). A significant difference between endemic and epidemic regions is the mortality rate, i.e., 1% or lower in an endemic regions versus 3-7% during recent epidemic outbreaks. A fundamentally transformational approach - a warning system with several months prediction lead time - is needed to prevent disease outbreak and minimize its impact on population. Lack of information on spatial and temporal variability of disease incidence as well as transmission in human population continues to be significant challenge in the development of early-warning systems for cholera. Using satellite data on regional hydroclimatic processes, water and sanitation infrastructure indices, and biological pathogen growth information, here we present a Simple, Mechanistic, Adaptive, Remote sensing based Regional Transmission or SMART model to (i) identify regions of potential cholera outbreaks and (ii) quantify mechanism of spread of the disease in previously disease free region. Our results indicate that epidemic regions are located near regional rivers and are characterized by sporadic outbreaks, which are likely to be initiated during episodes of prevailing warm air temperature with low river flows, creating favorable environmental conditions for the growth of cholera bacteria. Heavy rainfall, through inundation or breakdown of sanitary infrastructure, accelerates interaction between contaminated water and human activities, resulting in an epidemic. We discuss the above findings in light of

  16. Recent Weather Extremes and Impacts on Agricultural Production and Vector-Borne Disease Outbreak Patterns

    Science.gov (United States)

    Anyamba, Assaf; Small, Jennifer L.; Britch, Seth C.; Tucker, Compton J.; Pak, Edwin W.; Reynolds, Curt A.; Crutchfield, James; Linthicum, Kenneth J.

    2014-01-01

    We document significant worldwide weather anomalies that affected agriculture and vector-borne disease outbreaks during the 2010-2012 period. We utilized 2000-2012 vegetation index and land surface temperature data from NASA's satellite-based Moderate Resolution Imaging Spectroradiometer (MODIS) to map the magnitude and extent of these anomalies for diverse regions including the continental United States, Russia, East Africa, Southern Africa, and Australia. We demonstrate that shifts in temperature and/or precipitation have significant impacts on vegetation patterns with attendant consequences for agriculture and public health. Weather extremes resulted in excessive rainfall and flooding as well as severe drought, which caused,10 to 80% variation in major agricultural commodity production (including wheat, corn, cotton, sorghum) and created exceptional conditions for extensive mosquito-borne disease outbreaks of dengue, Rift Valley fever, Murray Valley encephalitis, and West Nile virus disease. Analysis of MODIS data provided a standardized method for quantifying the extreme weather anomalies observed during this period. Assessments of land surface conditions from satellite-based systems such as MODIS can be a valuable tool in national, regional, and global weather impact determinations.

  17. Recent weather extremes and impacts on agricultural production and vector-borne disease outbreak patterns.

    Science.gov (United States)

    Anyamba, Assaf; Small, Jennifer L; Britch, Seth C; Tucker, Compton J; Pak, Edwin W; Reynolds, Curt A; Crutchfield, James; Linthicum, Kenneth J

    2014-01-01

    We document significant worldwide weather anomalies that affected agriculture and vector-borne disease outbreaks during the 2010-2012 period. We utilized 2000-2012 vegetation index and land surface temperature data from NASA's satellite-based Moderate Resolution Imaging Spectroradiometer (MODIS) to map the magnitude and extent of these anomalies for diverse regions including the continental United States, Russia, East Africa, Southern Africa, and Australia. We demonstrate that shifts in temperature and/or precipitation have significant impacts on vegetation patterns with attendant consequences for agriculture and public health. Weather extremes resulted in excessive rainfall and flooding as well as severe drought, which caused ∼10 to 80% variation in major agricultural commodity production (including wheat, corn, cotton, sorghum) and created exceptional conditions for extensive mosquito-borne disease outbreaks of dengue, Rift Valley fever, Murray Valley encephalitis, and West Nile virus disease. Analysis of MODIS data provided a standardized method for quantifying the extreme weather anomalies observed during this period. Assessments of land surface conditions from satellite-based systems such as MODIS can be a valuable tool in national, regional, and global weather impact determinations.

  18. Recent weather extremes and impacts on agricultural production and vector-borne disease outbreak patterns.

    Directory of Open Access Journals (Sweden)

    Assaf Anyamba

    Full Text Available We document significant worldwide weather anomalies that affected agriculture and vector-borne disease outbreaks during the 2010-2012 period. We utilized 2000-2012 vegetation index and land surface temperature data from NASA's satellite-based Moderate Resolution Imaging Spectroradiometer (MODIS to map the magnitude and extent of these anomalies for diverse regions including the continental United States, Russia, East Africa, Southern Africa, and Australia. We demonstrate that shifts in temperature and/or precipitation have significant impacts on vegetation patterns with attendant consequences for agriculture and public health. Weather extremes resulted in excessive rainfall and flooding as well as severe drought, which caused ∼10 to 80% variation in major agricultural commodity production (including wheat, corn, cotton, sorghum and created exceptional conditions for extensive mosquito-borne disease outbreaks of dengue, Rift Valley fever, Murray Valley encephalitis, and West Nile virus disease. Analysis of MODIS data provided a standardized method for quantifying the extreme weather anomalies observed during this period. Assessments of land surface conditions from satellite-based systems such as MODIS can be a valuable tool in national, regional, and global weather impact determinations.

  19. LOWER EXTREMITY MANIFESTATIONS OF PERIPHERAL ARTERY DISEASE: THE PATHOPHYSIOLOGIC AND FUNCTIONAL IMPLICATIONS OF LEG ISCHEMIA

    Science.gov (United States)

    McDermott, Mary McGrae

    2015-01-01

    Lower extremity peripheral artery disease (PAD) is frequently under-diagnosed, in part because of the wide variety of leg symptoms manifested by patients with PAD and in part because of the high prevalence of asymptomatic PAD. In primary care medical practices, 30% to 60% of PAD patients report no exertional leg symptoms and approximately 45–50% report exertional leg symptoms that are not consistent with classic intermittent claudication. The prevalence and extent of functional impairment and functional decline in PAD may also be underappreciated. Functional impairment and functional decline is common in PAD, even among those who are asymptomatic. Lower extremity ischemia is also associated with pathophysiologic changes in calf skeletal muscle including smaller calf muscle area, increased calf muscle fat content, impaired leg strength, and impaired metabolic function. People with severe PAD have poorer peroneal nerve conduction velocity compared to people with mild PAD or no PAD. The degree of ischemia-related pathophysiologic changes in lower extremity muscles and peripheral nerves of people with PAD are associated with the degree of functional impairment. New interventions are needed to improve functional performance and prevent mobility loss in the large number of PAD patients, including in those who are asymptomatic or who have exertional leg symptoms other than claudication. PMID:25908727

  20. Type 2 Diabetes Risk Alleles Demonstrate Extreme Directional Differentiation among Human Populations, Compared to Other Diseases

    Science.gov (United States)

    Chen, Rong; Corona, Erik; Sikora, Martin; Dudley, Joel T.; Morgan, Alex A.; Moreno-Estrada, Andres; Nilsen, Geoffrey B.; Ruau, David; Lincoln, Stephen E.; Bustamante, Carlos D.; Butte, Atul J.

    2012-01-01

    Many disease-susceptible SNPs exhibit significant disparity in ancestral and derived allele frequencies across worldwide populations. While previous studies have examined population differentiation of alleles at specific SNPs, global ethnic patterns of ensembles of disease risk alleles across human diseases are unexamined. To examine these patterns, we manually curated ethnic disease association data from 5,065 papers on human genetic studies representing 1,495 diseases, recording the precise risk alleles and their measured population frequencies and estimated effect sizes. We systematically compared the population frequencies of cross-ethnic risk alleles for each disease across 1,397 individuals from 11 HapMap populations, 1,064 individuals from 53 HGDP populations, and 49 individuals with whole-genome sequences from 10 populations. Type 2 diabetes (T2D) demonstrated extreme directional differentiation of risk allele frequencies across human populations, compared with null distributions of European-frequency matched control genomic alleles and risk alleles for other diseases. Most T2D risk alleles share a consistent pattern of decreasing frequencies along human migration into East Asia. Furthermore, we show that these patterns contribute to disparities in predicted genetic risk across 1,397 HapMap individuals, T2D genetic risk being consistently higher for individuals in the African populations and lower in the Asian populations, irrespective of the ethnicity considered in the initial discovery of risk alleles. We observed a similar pattern in the distribution of T2D Genetic Risk Scores, which are associated with an increased risk of developing diabetes in the Diabetes Prevention Program cohort, for the same individuals. This disparity may be attributable to the promotion of energy storage and usage appropriate to environments and inconsistent energy intake. Our results indicate that the differential frequencies of T2D risk alleles may contribute to the observed

  1. [Recent Knowledge of Smoking and Peripheral Arterial Disease in Lower Extremities].

    Science.gov (United States)

    Sotoda, Yoko; Hirooka, Shigeki; Orita, Hiroyuki; Wakabayashi, Ichiro

    2015-01-01

    Peripheral arterial disease (PAD) is an atherosclerotic obstructive disease of the arteries in lower extremities. Patients with PAD show high rates of mortality from coronary artery disease (CAD) and stroke. Smoking as well as diabetes is an important risk factor for PAD. A lesion of PAD in the lower extremities tends to be more proximal in smokers than in nonsmokers and to be more distal in patients with diabetes than in nondiabetics. By a systematic review, the odds ratio for PAD of smokers vs nonsmokers has been reported to be in the range of 1.7-7.4. Previous epidemiological studies suggest a stronger association of smoking with PAD than that with CAD. Nitric oxide (NO) is an important molecule suppressing the progression of atherosclerosis, but this function is compromised by smoking. Smoking decreases the bioactivity of NO and the expression level of NO synthase. In addition, smoking results in deteriorations of risk factors for atherosclerosis such as decreases in blood HDL (high-density lipoprotein) cholesterol and tissue plasminogen activator levels and increases in the levels of blood triglycerides, LDL (low-density lipoprotein) cholesterol, fibrinogen and the von Willebrand factor. Thus, smoking increases blood coagulability and deteriorates the blood lipid profile, resulting in thrombogenetic proneness and dyslipidemia. Smoking also increases the generation of atherogenic oxidized LDL in blood and decreases antiatherogenic prostacyclin production in the vascular endothelium. Smoking cessation is important for the prevention and therapy of PAD, and to this end, counseling by physicians and nicotine replacement therapy are useful and strongly recommended for patients with PAD.

  2. Decreasing incidence of coronary heart disease in extreme obesity (BMI≥40)-A single centre experience.

    Science.gov (United States)

    Barth, Sebastian; Zacher, Michael; Reinecke, Holger; Hautmann, Martina B; Kerber, Sebastian; Gietzen, Frank; Halbfass, Philipp; Schade, Anja; Deneke, Thomas; Schieffer, Bernhard; Hamm, Karsten

    The aim of our comprehensive single centre analysis was to evaluate the incidence of coronary heart disease (CHD) in extremely obese patients. Between 2005 and 2015 we investigated retrospectively 23,359 patients undergoing cardiac catheterisation in our institution. Patients were divided in six weight classes according to World Health Organization (WHO) criteria [1] (WHO, 2000). Cardiovascular risk factors, comorbidities, CCS stadium [2] (Cox and Naylor, 1992) and NYHA functional class [3] (The Criteria Committee of the New York Heart Association, 1994) were retrieved from electronic patient records. Using multivariable analysis the odds ratio for the target variable CHD with presence of >50% angiographic stenosis was ≥1 with regard to age (OR 1.049, 95% CI 1.045-1.052), male sex (OR 2.507, 95% CI 2.329-2.699), cardiovascular risk factors, atherosclerosis (OR 1.651, 95% CI 1.498-1.820), and presence of angina (OR 4.408, 95% CI 3.892-4.993). NYHA functional class I-IV, absence of angina (OR 0.818, 95% CI 0.729-0.918), and BMI≥40 (OR 0.592, 95% CI 0.494-0.709) resulted in an odds ratio of ≤1. Underweight patients had a higher (5.3%) and overweight (1.2%) and obese patients (class I 0.9% and II 1.1%) a slightly lower all-cause in-hospital mortality compared to extremely obese patients (1.6%). Severely obese patients treated in our hospital surprisingly showed a decreased incidence of CHD (46.1% in normal weight and 38.6% in extremely obese patients) while comorbidities increased CHD as expected. Although CHD burden was lower, obesity and associated comorbidities resulted in higher all-cause-in-hospital mortality. Copyright © 2016 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

  3. Teenager male with burning pain in extremities--suspect Fabry disease, 2 case reports.

    Science.gov (United States)

    Patil, Rajesh B; Joglekar, V K

    2014-01-01

    We present 2 cases of teenager males presented with burning pain in extremities and turned out to be cases of Fabry disease.The purpose of presenting this case is to highlight the fact that suspicion of Fabry disease in patients presenting with these symptoms will lead to early diagnosis and treatment of this condition before occurrences of complications. A 14-year-old male presented with severe burning pain in both hands and feet since last 4 yrs which persisted despite consumption of painkillers and becoming more disabling and without having any family history for such condition. On general examination patient had small reddish coloured lesions around the umbilicus, appearing like angiokeratomas. Skin biopsy confirmed the lesion. On enzyme assay his alpha galactosidase activity found to be '0' nmol/hr/mg of protein, confirming his diagnosis. Patient's creatinine and 2 D ECHO were normal and urine had 1+ proteinuria. Patient started on carbamazepine tablets for pain and referred to higher centre for genetic diagnosis and enzyme replacement therapy. CASE REPORT 2: An 18-year-old male referred to our hospital by general practitioner for fatigue and pedal oedema with deranged renal function tests. On history taking patient gave history of severe burning pain in both hands and feet since age of 9 yrs. Patient's general examination revealed hypertension with pallor, pedal oedema along with angiokeratomas in bathing suit distribution. Patient's ultrasonography of kidney revealed bilaterally normal sized kidneys with altered echotexture and urine examination showed fine granular foamy cells with sub nephrotic range proteinuria. 2 D ECHO revealed concentric left ventricular hypertrophy. Skin biopsy report supported the diagnosis of Fabry disease. Patient advised to undergo renal biopsy to confirm Fabry nephropathy but patient denied any further diagnostic workup for nephropathy or Fabry disease. Patient started on conservative treatment and carbamazepine in renal dose

  4. Endovascular management of deep venous thrombotic diseases of the lower extremity

    Energy Technology Data Exchange (ETDEWEB)

    Roh, Byung Suk [School of Medicine, Wonkwang Univ., Iksan (Korea, Republic of)

    2004-07-01

    Pulmonary embolism and venous ischemia are acute complications of deep vein thrombosis (DVT) of the lower extremities. Delayed complications include a spectrum of debilitating symptoms referred to as postthrombotic syndrome (PST). Because the early symptoms and patient signs are nonspecific for DVT, careful history taking and radiological evaluation of the extent and migration of thrombus should be used to establish an objective diagnosis and the need for treatment. Anticoagulation therapy is recognized as the mainstay treatment in acute DVT. However, there are few data to suggest any major beneficial effect of the early clearing of massive DVT and PTS. Endovascular, catheter-directed, thrombolysis techniques, used alone or in combination with mechanical thrombectomy devices, have been proven to be highly effective in clearing acute DVT, which may allow the preservation of venous valve function and the prevention of subsequent venous occlusive disease. Definitive management of the underlying anatomic occlusive abnormalities should also be undertaken.

  5. Patients With Diabetic Foot Disease Fear Major Lower-Extremity Amputation More Than Death.

    Science.gov (United States)

    Wukich, Dane K; Raspovic, Katherine M; Suder, Natalie C

    2018-02-01

    The aim of this study was to identify the most-feared complications of diabetes mellitus (DM), comparing those with diabetic foot pathology with those without diabetic foot pathology. We determined the frequency of patients ranking major lower-extremity amputation (LEA) as their greatest fear in comparison to blindness, death, diabetic foot infection (DFI), or end-stage renal disease (ESRD) requiring dialysis. We further categorized the study group patients (N = 207) by their pathology such as diabetic foot ulcer (DFU), Charcot neuroarthropathy, foot infection, or acute neuropathic fractures and dislocations. The control group (N = 254) was comprised of patients with diabetes who presented with common non-diabetes-related foot pathology. A total of 461 patients were enrolled in this study and included 254 patients without diabetic foot complications and 207 patients with diabetic foot problems. When comparing patients with and without diabetic disease, no significant differences were observed with regard to their fear of blindness, DFI, or ESRD requiring dialysis. Patients with diabetic foot disease (61 of 207, 31.9%) were 136% more likely (odds ratio [OR] = 2.36; 95% CI = 1.51-3.70; P = .002] to rank major LEA as their greatest fear when compared with diabetic patients without foot disease (42 of 254, 16.5%) and were 49% less likely (OR = 0.51; 95% CI = 0.34-0.79; P = .002) to rank death as their greatest fear compared with patients without diabetic foot disease. Patients with diabetic foot pathology fear major LEA more than death, foot infection, or ESRD. Variables that were associated with ranking LEA as the greatest fear were the presence of a diabetic-related foot complication, duration of DM ≥10 years, insulin use, and the presence of peripheral neuropathy. Level II: Prospective, Case controlled study.

  6. Structural and Mechanical Properties of Intermediate Filaments under Extreme Conditions and Disease

    Science.gov (United States)

    Qin, Zhao

    Intermediate filaments are one of the three major components of the cytoskeleton in eukaryotic cells. It was discovered during the recent decades that intermediate filament proteins play key roles to reinforce cells subjected to large-deformation as well as participate in signal transduction. However, it is still poorly understood how the nanoscopic structure, as well as the biochemical properties of these protein molecules contribute to their biomechanical functions. In this research we investigate the material function of intermediate filaments under various extreme mechanical conditions as well as disease states. We use a full atomistic model and study its response to mechanical stresses. Learning from the mechanical response obtained from atomistic simulations, we build mesoscopic models following the finer-trains-coarser principles. By using this multiple-scale model, we present a detailed analysis of the mechanical properties and associated deformation mechanisms of intermediate filament network. We reveal the mechanism of a transition from alpha-helices to beta-sheets with subsequent intermolecular sliding under mechanical force, which has been inferred previously from experimental results. This nanoscale mechanism results in a characteristic nonlinear force-extension curve, which leads to a delocalization of mechanical energy and prevents catastrophic fracture. This explains how intermediate filament can withstand extreme mechanical deformation of > 1 00% strain despite the presence of structural defects. We combine computational and experimental techniques to investigate the molecular mechanism of Hutchinson-Gilford progeria syndrome, a premature aging disease. We find that the mutated lamin tail .domain is more compact and stable than the normal one. This altered structure and stability may enhance the association of intermediate filaments with the nuclear membrane, providing a molecular mechanism of the disease. We study the nuclear membrane association

  7. Water-borne diseases and extreme weather events in Cambodia: review of impacts and implications of climate change.

    Science.gov (United States)

    Davies, Grace I; McIver, Lachlan; Kim, Yoonhee; Hashizume, Masahiro; Iddings, Steven; Chan, Vibol

    2014-12-23

    Cambodia is prone to extreme weather events, especially floods, droughts and typhoons. Climate change is predicted to increase the frequency and intensity of such events. The Cambodian population is highly vulnerable to the impacts of these events due to poverty; malnutrition; agricultural dependence; settlements in flood-prone areas, and public health, governance and technological limitations. Yet little is known about the health impacts of extreme weather events in Cambodia. Given the extremely low adaptive capacity of the population, this is a crucial knowledge gap. A literature review of the health impacts of floods, droughts and typhoons in Cambodia was conducted, with regional and global information reviewed where Cambodia-specific literature was lacking. Water-borne diseases are of particular concern in Cambodia, in the face of extreme weather events and climate change, due to, inter alia, a high pre-existing burden of diseases such as diarrhoeal illness and a lack of improved sanitation infrastructure in rural areas. A time-series analysis under quasi-Poisson distribution was used to evaluate the association between floods and diarrhoeal disease incidence in Cambodian children between 2001 and 2012 in 16 Cambodian provinces. Floods were significantly associated with increased diarrhoeal disease in two provinces, while the analysis conducted suggested a possible protective effect from toilets and piped water. Addressing the specific, local pre-existing vulnerabilities is vital to promoting population health resilience and strengthening adaptive capacity to extreme weather events and climate change in Cambodia.

  8. Water-Borne Diseases and Extreme Weather Events in Cambodia: Review of Impacts and Implications of Climate Change

    Science.gov (United States)

    Davies, Grace I.; McIver, Lachlan; Kim, Yoonhee; Hashizume, Masahiro; Iddings, Steven; Chan, Vibol

    2014-01-01

    Cambodia is prone to extreme weather events, especially floods, droughts and typhoons. Climate change is predicted to increase the frequency and intensity of such events. The Cambodian population is highly vulnerable to the impacts of these events due to poverty; malnutrition; agricultural dependence; settlements in flood-prone areas, and public health, governance and technological limitations. Yet little is known about the health impacts of extreme weather events in Cambodia. Given the extremely low adaptive capacity of the population, this is a crucial knowledge gap. A literature review of the health impacts of floods, droughts and typhoons in Cambodia was conducted, with regional and global information reviewed where Cambodia-specific literature was lacking. Water-borne diseases are of particular concern in Cambodia, in the face of extreme weather events and climate change, due to, inter alia, a high pre-existing burden of diseases such as diarrhoeal illness and a lack of improved sanitation infrastructure in rural areas. A time-series analysis under quasi-Poisson distribution was used to evaluate the association between floods and diarrhoeal disease incidence in Cambodian children between 2001 and 2012 in 16 Cambodian provinces. Floods were significantly associated with increased diarrhoeal disease in two provinces, while the analysis conducted suggested a possible protective effect from toilets and piped water. Addressing the specific, local pre-existing vulnerabilities is vital to promoting population health resilience and strengthening adaptive capacity to extreme weather events and climate change in Cambodia. PMID:25546280

  9. Water-Borne Diseases and Extreme Weather Events in Cambodia: Review of Impacts and Implications of Climate Change

    Directory of Open Access Journals (Sweden)

    Grace I. Davies

    2014-12-01

    Full Text Available Cambodia is prone to extreme weather events, especially floods, droughts and typhoons. Climate change is predicted to increase the frequency and intensity of such events. The Cambodian population is highly vulnerable to the impacts of these events due to poverty; malnutrition; agricultural dependence; settlements in flood-prone areas, and public health, governance and technological limitations. Yet little is known about the health impacts of extreme weather events in Cambodia. Given the extremely low adaptive capacity of the population, this is a crucial knowledge gap. A literature review of the health impacts of floods, droughts and typhoons in Cambodia was conducted, with regional and global information reviewed where Cambodia-specific literature was lacking. Water-borne diseases are of particular concern in Cambodia, in the face of extreme weather events and climate change, due to, inter alia, a high pre-existing burden of diseases such as diarrhoeal illness and a lack of improved sanitation infrastructure in rural areas. A time-series analysis under quasi-Poisson distribution was used to evaluate the association between floods and diarrhoeal disease incidence in Cambodian children between 2001 and 2012 in 16 Cambodian provinces. Floods were significantly associated with increased diarrhoeal disease in two provinces, while the analysis conducted suggested a possible protective effect from toilets and piped water. Addressing the specific, local pre-existing vulnerabilities is vital to promoting population health resilience and strengthening adaptive capacity to extreme weather events and climate change in Cambodia.

  10. Associations between extreme precipitation and childhood hand, foot and mouth disease in urban and rural areas in Hefei, China.

    Science.gov (United States)

    Cheng, Jian; Wu, Jinju; Xu, Zhiwei; Zhu, Rui; Wang, Xu; Li, Kesheng; Wen, Liying; Yang, Huihui; Su, Hong

    2014-11-01

    Understanding the relationship between extreme weather events and childhood hand, foot and mouth disease (HFMD) is important in the context of climate change. This study aimed to quantify the relationship between extreme precipitation and childhood HFMD in Hefei, China, and further, to explore whether the association varied across urban and rural areas. Daily data on HFMD counts among children aged 0-14 years from 2010 January 1st to 2012 December 31st were retrieved from Hefei Center for Disease Control and Prevention. Daily data on mean temperature, relative humidity and precipitation during the same period were supplied by Hefei Bureau of Meteorology. We used a Poisson linear regression model combined with a distributed lag non-linear model to assess the association between extreme precipitation (≥90th precipitation) and childhood HFMD, controlling for mean temperature, humidity, day of week, and long-term trend. There was a statistically significant association between extreme precipitation and childhood HFMD. The effect of extreme precipitation on childhood HFMD was the greatest at six days lag, with a 5.12% (95% confident interval: 2.7-7.57%) increase of childhood HFMD for an extreme precipitation event versus no precipitation. Notably, urban children and children aged 0-4 years were particularly vulnerable to the effects of extreme precipitation. Our findings indicate that extreme precipitation may increase the incidence of childhood HFMD in Hefei, highlighting the importance of protecting children from forthcoming extreme precipitation, particularly for those who are young and from urban areas. Copyright © 2014 Elsevier B.V. All rights reserved.

  11. Pelvic parameters of sagittal balance in extreme lateral interbody fusion for degenerative lumbar disc disease.

    Science.gov (United States)

    Johnson, R D; Valore, A; Villaminar, A; Comisso, M; Balsano, M

    2013-04-01

    There is increasing interest in the use of pelvic indices to evaluate sagittal balance and predict outcomes in patients with spinal disease. Conventional posterior lumbar fusion techniques may adversely affect lumbar lordosis and spinal balance. Minimally invasive fusion of the lumbar spine is rapidly becoming a mainstay of treatment of lumbar degenerative disc disease. To our knowledge there are no studies evaluating the effect of extreme lateral interbody fusion (XLIF) on pelvic indices. Hence, our aim was to study the effect of XLIF on pelvic indices related to sagittal balance, and report the results of a prospective longitudinal clinical study and retrospective radiographic analyses of patients undergoing XLIF in a single centre between January 2009 and July 2011. Clinical outcomes are reported for 30 patients and the retrospective analyses of radiographic data is reported for 22 of these patients to assess global and segmental lumbar lordosis and pelvic indices. Effect of XLIF on the correction of scoliotic deformity was assessed in 15 patients in this series. A significant improvement was seen in the visual analogue scale score, the Oswestry Disability Index and the Short Form-36 at 2months and 6months (p0.2). Global lumbar lordosis was not affected by XLIF (p>0.4). XLIF significantly increased segmental lumbar lordosis by 3.3° (psagittal balance. Long-term follow-up with a larger cohort will be required to further evaluate the effects of XLIF on sagittal balance. Copyright © 2012 Elsevier Ltd. All rights reserved.

  12. Aortic dissection: natural course of disease? Report of two cases representing the extremes of the condition

    Energy Technology Data Exchange (ETDEWEB)

    Tollefsen, Isak E-mail: isak.tollefsen@sensewave.come; Joergensen, Ingrid K.; Woie, Leik; Fossdal, Jan E

    2001-10-01

    Objective: In a time when diagnostic methods and above all, surgical as well as interventional radiological treatment for aortic aneurysms and aortic dissections have reached a point nobody could think of a few years back, the present authors feel that it is worth while to remind oneself of the natural course of disease in these conditions. Taking into consideration the high morbidity and mortality rate in surgically treated patients with aortic dissection, and the high complication rate per- and postoperatively, it also seems right to ask if a more expectative and conservative approach to the condition sometimes perhaps may be justified. Methods and material: Two case reports are given. One was a 15-year-old boy with Stanford (Daily) type B dissection who statistically ought to have a good prognosis, but who died within 2 h after onset of symptoms. The other patient, a middle-aged woman with Stanford type A dissection, survived for 25 years without operation. Conclusion: These two cases, though not unique viewed separately, we consider to represent the extremes of the condition and also a natural course of disease, while none of them was operated on.

  13. Prognostic value of biochemical variables for survival after surgery for metastatic bone disease of the extremities.

    Science.gov (United States)

    Sørensen, Michala Skovlund; Hovgaard, Thea Bechman; Hindsø, Klaus; Petersen, Michael Mørk

    2017-03-01

    Prediction of survival in patients having surgery for metastatic bone disease in the extremities (MBDex) has been of interest in more than two decades. Hitherto no consensus on the value of biochemical variables has been achieved. Our purpose was (1) to investigate if standard biochemical variables have independent prognostic value for survival after surgery for MBDex and (2) to identify optimal prognostic cut off values for survival of biochemical variables. In a consecutive cohort of 270 patients having surgery for MBDex, we measured preoperative biochemical variables: hemoglobin, alkaline phosphatase, C-reactive protein and absolute, neutrophil and lymphocyte count. ROC curve analyses were performed to identify optimal cut off levels. Independent prognostic factors for variables were addressed with multiple Cox regression analyses. Optimal cut off levels were identified as: hemoglobin 7.45 mmol/L, absolute lymphocyte count 8.5 × 10 9 /L, neutrophil 5.68 × 10 9 /L, lymphocyte 1.37 × 10 9 /L, C-reactive protein 22.5 mg/L, and alkaline phosphatase 129 U/L. Regression analyses found alkaline phosphatase (HR 2.49) and neutrophil count (HR 2.49) to be independent prognostic factors. We found neutrophil count and alkaline phosphatase to be independent prognostic variables in predicting survival in patients after surgery for MBDex. © 2016 Wiley Periodicals, Inc.

  14. Small infrarenal aortic diameter associated with lower-extremity peripheral artery disease in Chinese hypertensive adults.

    Science.gov (United States)

    Liu, Jie; Jia, Xin; Jia, Senhao; Qin, Xianhui; Zhang, Tao; Liu, Lishun; Li, Haibo; Rong, Dan; Zhou, Ziyi; Song, Yuxiang; Zuo, Shangwei; Duan, Chen; Wu, Zhongyin; Wei, Ren; Ge, Yangyang; Wang, Xian; Kong, Wei; Xu, Xiping; Khalil, Raouf A; Huo, Yong; Guo, Wei

    2017-11-06

    Several studies suggest that infrarenal aortic diameter is associated with lower-extremity peripheral artery disease (LE-PAD). However, data regarding the associations between infrarenal aortic diameter and LE-PAD are limited, especially in large sample populations and Asian or Chinese populations. Our analysis included 17279 Chinese hypertensive adults comprising 6590 men and 10689 women with a mean age of 64.74 ± 7.41 years. Participants were selected from 22693 candidates from two large population-based cohort-studies. The primary noninvasive test for diagnosis of LE-PAD is the ankle-brachial index (ABI) at rest and typically an ABI ≤ 0.90 is used to define LE-PAD. The prevalence of LE-PAD was found to significantly decrease as the aortic diameter increased according to the tertile of the aortic diameter. LE-PAD was significantly more prevalent in the lowest tertile (OR = 1.58, 95% CI = 1.29-1.94, p  0.05). In conclusion, Small aortic diameter (as opposed to large aortic diameter) is significantly associated with LE-PAD in Chinese hypertensive adults.

  15. Enteral zinc supplementation and growth in extremely-low-birth-weight infants with chronic lung disease.

    Science.gov (United States)

    Shaikhkhalil, Ala K; Curtiss, Jennifer; Puthoff, Teresa D; Valentine, Christina J

    2014-02-01

    Zinc deficiency causes growth deficits. Extremely-low-birth-weight (ELBW) infants with chronic lung disease (CLD), also known as bronchopulmonary dysplasia, experience growth failure and are at risk for zinc deficiency. We hypothesized that enteral zinc supplementation would increase weight gain and linear growth. A cohort of infants was examined retrospectively at a single center between January 2008 and December 2011. CLD was defined as the need for oxygen at 36 weeks postmenstrual age. Zinc supplementation was started in infants who had poor weight gain. Infants' weight gain and linear growth were compared before and after zinc supplementation using the paired t test. A total of 52 ELBW infants with CLD met entry criteria. Mean birth weight was 682 ± 183 g, and gestational age was 25.3 ± 2 weeks. Zinc supplementation started at postmenstrual age 33 ± 2 weeks. Most infants received fortified human milk. Weight gain increased from 10.9 before supplementation to 19.9 g · kg(-1) · day(-1) after supplementation (P supplementation improved growth in ELBW infants with CLD receiving human milk. Further investigation is warranted to reevaluate zinc requirements, markers, and balance.

  16. An atypical course of coxsackievirus A6 associated hand, foot and mouth disease in extremely low birth weight preterm twins

    NARCIS (Netherlands)

    Bruning, Andrea H. L.; van der Sanden, Sabine M. G.; ten Hoedt, Amber E.; Wolthers, Katja C.; van Kaam, Anton H.; Pajkrt, Dasja

    2015-01-01

    The incidence of coxsackievirus A6 (CV-A6) associated hand, foot and mouth disease (HFMD) has reportedly increased since 2008 with sometimes severe complications. We here describe an atypical course of CV-A6-associated HFMD in extremely low birth weight twins. The CV-A6-strains are genetically

  17. Extreme nonfasting remnant cholesterol vs extreme LDL cholesterol as contributors to cardiovascular disease and all-cause mortality in 90000 individuals from the general population

    DEFF Research Database (Denmark)

    Varbo, Anette; Freiberg, Jacob J; Nordestgaard, Børge G

    2015-01-01

    BACKGROUND: Increased nonfasting remnant cholesterol, like increased LDL cholesterol, is causally associated with increased risk for ischemic heart disease (IHD). We tested the hypothesis that extreme concentrations of nonfasting remnant and LDL cholesterol are equal contributors to the risk of IHD......, myocardial infarction (MI), and all-cause mortality. METHODS: We compared stepwise increasing concentrations of nonfasting remnant and LDL cholesterol for association with risk of IHD, MI, and all-cause mortality in approximately 90 000 individuals from the Danish general population. During up to 22 years...... of complete follow-up, 4435 participants developed IHD, 1722 developed MI, and 8121 died. RESULTS: Compared with participants with nonfasting remnant cholesterol cholesterol of 0.5-0.99 mmol/L (19.3-38.2 mg/dL) to 2...

  18. Epidemiology of diabetic foot disease and diabetes-related lower-extremity amputation in Australia: a systematic review protocol.

    Science.gov (United States)

    van Netten, Jaap J; Baba, Mendel; Lazzarini, Peter A

    2017-05-18

    Diabetic foot disease is associated with major morbidity, mortality, costs, and reduction of a person's quality of life. Investigating the epidemiology of diabetic foot disease is the backbone of diabetic foot research and clinical practice, yet the full burden of diabetic foot disease in Australia is unknown. This study aims to describe the protocol for a systematic review of the epidemiology of diabetic foot disease and diabetes-related lower-extremity amputation in Australia. The systematic review will be performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. PubMed and EMBASE will be searched for publications in any language and without restrictions to date. Two independent investigators will screen publications for eligibility, with publications reporting Australian population-based incidence or prevalence of diabetic foot disease or diabetes-related lower-extremity amputation to be included. Additionally, a forward literature search will be performed in Google Scholar, and a grey literature search will be performed to identify government publications. Quality assessment will be performed using customised checklists. The summary statistic used for each study will be an incidence or prevalence proportion of diabetic foot disease or diabetes-related lower-extremity amputation. The standard error for each proportion will be calculated. A meta-analysis will be performed when three or more publications of adequate quality, reporting on similar outcomes and in similar populations, are identified. The results of this systematic review can be used to adequately inform stakeholders in the field of diabetic foot disease on the extent of the problem in incidence and prevalence of diabetic foot disease in Australia, and to help guide appropriate use of resources to reduce the burden of this disease. PROSPERO CRD42016050740.

  19. Matrix Metalloproteinases in Remodeling of Lower Extremity Veins and Chronic Venous Disease.

    Science.gov (United States)

    Chen, Yunfei; Peng, Wei; Raffetto, Joseph D; Khalil, Raouf A

    2017-01-01

    The veins of the lower extremity are equipped with efficient wall, contractile vascular smooth muscle (VSM), and competent valves in order to withstand the high venous hydrostatic pressure in the lower limb and allow unidirectional movement of deoxygenated blood toward the heart. The vein wall structure and function are in part regulated by matrix metalloproteinases (MMPs). MMPs are zinc-dependent endopeptidases that are secreted as inactive pro-MMPs by different cells in the venous wall including fibroblasts, VSM, and leukocytes. Pro-MMPs are activated by other MMPs, proteinases, and other endogenous and exogenous activators. MMPs degrade various extracellular matrix (ECM) proteins including collagen and elastin, and could affect other cellular processes including endothelium-mediated dilation, VSM cell migration, and proliferation as well as modulation of Ca(2+) signaling and contraction in VSM. It is thought that increased lower limb venous hydrostatic pressure increases hypoxia-inducible factors and other MMP inducers such as extracellular matrix metalloproteinase inducer, leading to increased MMP expression/activity, ECM protein degradation, vein wall relaxation, and venous dilation. Vein wall inflammation and leukocyte infiltration cause additional increases in MMPs, and further vein wall dilation and valve degradation, that could lead to chronic venous disease and varicose veins (VVs). VVs are often presented as vein wall dilation and tortuosity, incompetent venous valves, and venous reflux. Different regions of VVs show different MMP levels and ECM proteins with atrophic regions showing high MMP levels/activity and little ECM compared to hypertrophic regions with little or inactive MMPs and abundant ECM. Treatment of VVs includes compression stockings, venotonics, sclerotherapy, or surgical removal. However, these approaches do not treat the cause of VVs, and other lines of treatment may be needed. Modulation of endogenous tissue inhibitors of

  20. Short-term effects of extremely low frequency electromagnetic fields exposure on Alzheimer's disease in rats.

    Science.gov (United States)

    Zhang, Yemao; Liu, Xingfa; Zhang, Jiangong; Li, Ni

    2015-01-01

    With the development and widespread use of electromagnetic field (EMF) technology, recent studies are focusing on the effects of EMF on human health. Recently, extremely low frequency electromagnetic fields (ELF-EMF) have been studied with great interest due to their possible effects on Alzheimer's disease (AD). The objective of the present study was to investigate the interaction between ELF-EMF exposure and memory impairment in rats. Twenty healthy male Sprague Dawley (SD) rats were randomly divided into two groups (n = 10). Animals were exposed to 100 μT/50 Hz ELF-EMF or subjected to sham exposure when 12 weeks old. After 12 weeks, the Morris water maze (MWM) was used to test the changes in cognitive and memory ability. Amyloid-beta (Aβ) content in cortex, hippocampus and plasma were measured by ELISA assays. The morphology of neuron was detected by H&E staining. After exposure, the body weight of rats showed no difference compared with the control group. The application of ELF-EMF did not induce any cognitive and memory impairment compared with the sham-exposure group. The determination of Aβ showed no significant change between the two groups, and there was no histological change in ELF-EMF exposure group. The present study indicated that short-term exposure of 100 μT/50 Hz ELF-EMF had no effects on cognition and memory of rats, and did not alter the expression of Aβ and the neuron morphology. However, more comprehensive studies are still required to elucidate the possible effects and underlying mechanisms of ELF-EMF exposure on living organisms.

  1. Extreme Learning Machine Framework for Risk Stratification of Fatty Liver Disease Using Ultrasound Tissue Characterization.

    Science.gov (United States)

    Kuppili, Venkatanareshbabu; Biswas, Mainak; Sreekumar, Aswini; Suri, Harman S; Saba, Luca; Edla, Damodar Reddy; Marinhoe, Rui Tato; Sanches, J Miguel; Suri, Jasjit S

    2017-08-23

    Fatty Liver Disease (FLD) is caused by the deposition of fat in liver cells and leads to deadly diseases such as liver cancer. Several FLD detection and characterization systems using machine learning (ML) based on Support Vector Machines (SVM) have been applied. These ML systems utilize large number of ultrasonic grayscale features, pooling strategy for selecting the best features and several combinations of training/testing. As result, they are computationally intensive, slow and do not guarantee high performance due to mismatch between grayscale features and classifier type. This study proposes a reliable and fast Extreme Learning Machine (ELM)-based tissue characterization system (a class of Symtosis) for risk stratification of ultrasound liver images. ELM is used to train single layer feed forward neural network (SLFFNN). The input-to-hidden layer weights are randomly generated reducing computational cost. The only weights to be trained are hidden-to-output layer which is done in a single pass (without any iteration) making ELM faster than conventional ML methods. Adapting four types of K-fold cross-validation (K = 2, 3, 5 and 10) protocols on three kinds of data sizes: S0-original, S4-four splits, S8-sixty four splits (a total of 12 cases) and 46 types of grayscale features, we stratify the FLD US images using ELM and benchmark against SVM. Using the US liver database of 63 patients (27 normal/36 abnormal), our results demonstrate superior performance of ELM compared to SVM, for all cross-validation protocols (K2, K3, K5 and K10) and all types of US data sets (S0, S4, and S8) in terms of sensitivity, specificity, accuracy and area under the curve (AUC). Using the K10 cross-validation protocol on S8 data set, ELM showed an accuracy of 96.75% compared to 89.01% for SVM, and correspondingly, the AUC: 0.97 and 0.91, respectively. Further experiments also showed the mean reliability of 99% for ELM classifier, along with the mean speed improvement of 40% using

  2. Effects of interactive metronome training on postural stability and upper extremity function in Parkinson's disease: a case study.

    Science.gov (United States)

    Kim, Arim; Lee, Hye-Sun; Song, Chiang-Soon

    2017-01-01

    [Purpose] The purpose of this study was to examine the effects of interactive metronome training on the postural stability and upper extremity function of an individual with Parkinson's disease. [Subject and Methods] The participant of this case study was a 75-year-old female with Parkinson's disease diagnosed 7 years prior. This study was a single-subject research with an A-B-A design. She received IM training during the treatment phase (B phase) for 40 minutes per session. She was assessed pretest and posttest using the Berg balance scale and Wolf motor function test, and at baseline and the treatment phase using the measured box-and-block test and a Tetrax system. [Results] After training, the patient's static and dynamic balance, functional activity, and performance time of the upper extremity improved. Interactive metronome therapy improved the manual dexterity of both hands. Interactive metronome therapy also improved the limit of stability of the Parkinson's disease. [Conclusion] Though a case study, the results of this study suggest that IM therapy is effective at restoring the postural stability and upper extremity function of patients with Parkinson's disease.

  3. Effects of interactive metronome training on postural stability and upper extremity function in Parkinson’s disease: a case study

    Science.gov (United States)

    Kim, Arim; Lee, Hye-Sun; Song, Chiang-Soon

    2017-01-01

    [Purpose] The purpose of this study was to examine the effects of interactive metronome training on the postural stability and upper extremity function of an individual with Parkinson’s disease. [Subject and Methods] The participant of this case study was a 75-year-old female with Parkinson’s disease diagnosed 7 years prior. This study was a single-subject research with an A-B-A design. She received IM training during the treatment phase (B phase) for 40 minutes per session. She was assessed pretest and posttest using the Berg balance scale and Wolf motor function test, and at baseline and the treatment phase using the measured box-and-block test and a Tetrax system. [Results] After training, the patient’s static and dynamic balance, functional activity, and performance time of the upper extremity improved. Interactive metronome therapy improved the manual dexterity of both hands. Interactive metronome therapy also improved the limit of stability of the Parkinson’s disease. [Conclusion] Though a case study, the results of this study suggest that IM therapy is effective at restoring the postural stability and upper extremity function of patients with Parkinson’s disease. PMID:28210066

  4. Guideline for the management of wounds in patients with lower-extremity neuropathic disease: an executive summary.

    Science.gov (United States)

    Crawford, Penny Ellen; Fields-Varnado, Myra

    2013-01-01

    This article summarizes the WOCN Evidence-Based Clinical Practice Guideline for Management of Wounds in Patients with Lower Extremity Neuropathic Disease. It is intended for use by physicians, nurses, therapists, and other health care professionals who work with adults who have or are at risk for, lower-extremity neuropathic disease (LEND), and includes updated scientific literature available from January 2003 through February 2012. The full guideline contains definitions of lower extremity neuropathic disorders and disease, prevalence of the problem, relevance and significance of the disorders, as well as comprehensive information about etiology, the nervous system, pathogenesis, and the overall management goals for patients at risk for developing neuropathic foot ulcers. A detailed assessment section describes how to conduct a full clinical history and physical examination. The guideline also provides two approaches to interventions. The first focuses on prevention strategies to reduce the risk of developing LEND wounds or recurrence, including life-long foot offloading, routine dermal temperature surveillance, use of adjunctive therapies, medication management, and implementing lower extremity amputation prevention measures and patient self-care education. The second approach summarized LEND wound management strategies including wound cleansing, debridement, infection management, maintenance of intact peri-wound skin, nutrition considerations, pain and paresthesia management, edema management, offloading and management of gait and foot deformity, medication management, surgical options, adjunctive therapies, patient education, and health care provider follow-up. A comprehensive reference list, glossary of terms, and several appendices regarding an algorithm to determine wound etiology, pharmacology, Lower Extremity Amputation (LEAP) Program, diabetes foot screening and other information is available at the end of the guideline.

  5. Effects of percutaneous lower-extremity arterial interventions on endothelial function and inflammation response in patients with both type 2 diabetes and lower-extremity peripheral arterial disease.

    Science.gov (United States)

    Du, Yaping; Wang, Fujun; Qi, Huiqing; Ding, Haixia; Hou, Lin; Gao, Qian; Tan, Miao; Liu, Yueqin; Xing, Na; Sun, Jin

    2015-01-01

    The high incidence and damage of PAD in people with diabetes has aroused wide attention. We aimed to examine effects of percutaneous lower-extremity arterial interventions (PLEAIs) on endothelial function and inflammation response in type 2 diabetes (T2D) patients with lower-extremity peripheral arterial disease (PAD). 78 T2D inpatients with PAD were selected into the treatment group. Their venous levels of von Willebrand Factor (vWF) and high sensitivity C reactive protein (hsCRP) were measured. Blood samples were collected from the arterial sheath for vWF and hsCRP tests. Venous levels of vWF and hsCRP were monitored at 24 hours, 48 hours, 1 week, and 2 weeks post PLEAIs. Prior to PLEAIs, venous levels of vWF and hsCRP in the treatment group were significantly higher than the control group. The arterial levels of vWF and hsCRP were 117.9%±15.1% and 5.19±0.76 mg/L in the control group, while those levels in the treatment group before intervention were also significantly higher than in the control group. In the treatment group prior to inventions, vWF and hsCRP levels of arterial ischemic regions were significantly higher than the non-ischemic regions. The vWF level of arterial ischemic regions after treatment was significantly higher than that prior to treatment. PLEAIs applied to those patients may lead to worse endothelial dysfunction and activated inflammatory response during treatment and 1 week after treatment, which indicates an emerging necessary of early protection or care on endothelial function and inflammatory reaction during and post PLEAIs.

  6. Effects of interactive metronome training on postural stability and upper extremity function in Parkinson?s disease: a case study

    OpenAIRE

    Kim, Arim; Lee, Hye-Sun; Song, Chiang-Soon

    2017-01-01

    [Purpose] The purpose of this study was to examine the effects of interactive metronome training on the postural stability and upper extremity function of an individual with Parkinson?s disease. [Subject and Methods] The participant of this case study was a 75-year-old female with Parkinson?s disease diagnosed 7?years prior. This study was a single-subject research with an A-B-A design. She received IM training during the treatment phase (B phase) for 40 minutes per session. She was assessed ...

  7. An Expert Diagnosis System for Parkinson Disease Based on Genetic Algorithm-Wavelet Kernel-Extreme Learning Machine.

    Science.gov (United States)

    Avci, Derya; Dogantekin, Akif

    2016-01-01

    Parkinson disease is a major public health problem all around the world. This paper proposes an expert disease diagnosis system for Parkinson disease based on genetic algorithm- (GA-) wavelet kernel- (WK-) Extreme Learning Machines (ELM). The classifier used in this paper is single layer neural network (SLNN) and it is trained by the ELM learning method. The Parkinson disease datasets are obtained from the UCI machine learning database. In wavelet kernel-Extreme Learning Machine (WK-ELM) structure, there are three adjustable parameters of wavelet kernel. These parameters and the numbers of hidden neurons play a major role in the performance of ELM. In this study, the optimum values of these parameters and the numbers of hidden neurons of ELM were obtained by using a genetic algorithm (GA). The performance of the proposed GA-WK-ELM method is evaluated using statical methods such as classification accuracy, sensitivity and specificity analysis, and ROC curves. The calculated highest classification accuracy of the proposed GA-WK-ELM method is found as 96.81%.

  8. Gadolinium-enhanced MR angiography of arterial occlusive disease in lower extremity : comparison with conventional digital subtraction angiography

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Sang June; Koh, Young Hwan; Cha, Joo Hee; Kim, Hyu Beom; Chung, Jin Wook; Park, Jae Hyung [College of Medicine and the Institute of Radiation Medicine, Seoul National University, Seoul (Korea, Republic of)

    2000-02-01

    To compare the diagnostic value of gadolinium-enhanced MR angiography with that of conventional digital subtraction angiography for the evaluation of lower extremity arterial occlusive diseases. In 26 patients with symptomatic lower extremity arterial occlusive disease, both conventional digital subtraction angiography (DSA) and gadolinium-enhanced MR angiography (CE-MRA) were performed during the same week. MR angiography was performed using three-dimensional gradient-echo acquisition before, and two sequential acquisitions after, the administration of gadolinium (0.2 mmol/kg). In 23 patients, two separate, contiguous areas were scanned using additional doses. In three patients, only one field with a suspicious lesion was scanned. Three radiologists independently analyzed the CE-MRA and DSA findings of each vascular segment (20 segments per arterial tree) for the presence of obstructive lesions; the grade assigned was either mild or none (less than 50%), stenotic (50%-99%), or occlusion (100%). From among a total of 462 segments, DSA detected 99 which were significantly narrowed (stenosis, 33; occlusion, 66). Using MR angiography, 102 segments (stenosis 39; occlusion, 63) were identified, and 94 lesions (stenosis, 32; occlusion, 62) were graded correctly. Seven lesions were overestimated and four were underestimated. For the detection of hemodynamically significant stenosis or occlusions using MR angiography, sensitivity, specificity, and diagnostic accuracy were 95%, 98%, and 98% (G=3D0.995, P less than 0.001), respectively. To prove the absence of lesions, we repeated DSA in two patients with arterial spasm due to puncture. Three occluded segments seen on DSA, which revealed intact segments on MR angiography, suggested slow distal flow after reconstitution. For the evaluation of lower extremity arterial occlusive disease, the diagnostic value of gadolinium-enhanced MR angiography is comparable with that of digital subtraction angiography. The advantages of the

  9. Diagnostic value of ankle-brachial index and toe-brachial index in arterial disease of lower extremity

    OpenAIRE

    Li, Lan; ZHAO, ZHI-GANG; Zhen-cheng YAN; Yin-xing NI; Sun, Fang; Sun, Jin; Xing-sen XU; Yu, Hao; Ying-sha LI; Dao-yan LIU; Zhi-ming ZHU

    2012-01-01

    Objective  To investigate the clinical application and its influencing factors of ankle-brachial index (ABI) and toe-brachial index (TBI) in the diagnosis of arterial disease of lower extremity. Methods  ABI and TBI were measured in 800 limbs of 402 patients with diabetes and/or hypertension hospitalized from July 2010 to February 2011. The patients were divided into narrow group (ABI < 0.9), normal group (0.9≤ABI < 1.3), and calcification group (ABI≥1.3) according to the value of ABI, and al...

  10. Respiratory and skeletal muscle strength in chronic obstructive pulmonary disease: impact on exercise capacity and lower extremity function.

    Science.gov (United States)

    Singer, Jonathan; Yelin, Edward H; Katz, Patricia P; Sanchez, Gabriela; Iribarren, Carlos; Eisner, Mark D; Blanc, Paul D

    2011-01-01

    We sought to quantify the impact of respiratory muscle and lower extremity strength on exercise capacity and lower extremity function (LEF) in patients with chronic obstructive pulmonary disease (COPD). In 828 persons with COPD, we assessed the impact of reduced respiratory (maximum inspiratory pressure, MIP) and lower extremity muscle strength (quadriceps strength, QS) on exercise capacity (6-minute walk test, 6MWT), and LEF (short physical performance battery). Multiple regression analyses taking into account key covariates, including lung function and smoking, tested the associations between muscle strength and exercise and functional capacity. For each 0.5 SD decrement in QS, men walked 18.3 m less during 6MWT (95% confidence interval [CI], -24.1 to -12.4); women 25.1 m less (95% CI, -31.1 to -12.4). For each 0.5 SD decrement in MIP, men walked 9.4 m less during 6MWT (95% CI, -15.2 to -3.6); women 8.7 m less (95% CI, -14.1 to -3.4). For each 0.5 SD decrease in QS, men had a 1.32 higher odds (95% CI, 1.11-1.15) of poor LEF; women had a 1.87 higher odds (95% CI, 1.54-2.27). Lower MIP (per 0.5 SD) was associated with increased odds of poor LEF in women (odds ratio = 1.18; 95% CI, 1.00-1.39), but not in men (odds ratio = 1.10; 95% CI, 0.93-1.31). In COPD, reduced respiratory and lower extremity muscle strength are associated with decreased exercise and functional capacity. Muscle weakness is likely an important component of impairment and disability in patients with COPD.

  11. Diagnosis of arterial occlusive disease of the lower extremities by laser Doppler flowmetry.

    Science.gov (United States)

    Van den Brande, P; Welch, W

    1988-01-01

    Laser Doppler Flowmetry offers the possibility of non-invasive and continuous recording of tissue blood flow. Skin blood flux in resting state and during postocclusive reactive hyperemia was measured at the pulpa of the toe in 21 normal lower limbs and in 58 limbs with arterial occlusive disease. Proper assessment of postischemic flux- and time- parameters (beginning of reactive hyperemia, peak flux, time of peak flux and duration of hyperemic flux) permits accurate separation of healthy and diseased limbs.

  12. Hyperbaric oxygenation effects determination in the therapy of chronic occlusive lower extremities arteries disease by the use of perfusion scintigraphy

    Directory of Open Access Journals (Sweden)

    Zoranović Uroš

    2010-01-01

    Full Text Available Background/Aim. Hyperbaric oxygenation (HBO is a medical treatment of a patient with 100% oxygen inspiration under the pressure higher than atmospheric in a special unit designed to let the whole patient's body rest in a chamber. The aim of the study was to determine the effect of the application of HBO treatment on the patient's lower extremities with chonic inoperabile occlusive disease by measning the parameters of perfusion scintigraphy (perfusion reserve, relative perfusion. Methods. This investigation included 22 patients (19 males and 3 famales. Following clinical assessment of lower extremities condition according to the skin appearance and its adnexa, claudication distance was performed. Clinical condition was graded by the use of 5-point nominal scale. In all of the patients 99mTctetraphosmine lower extremities scintigraphy was done ten days prior to the treatment start and ten days after the treatment with HBO. Lower legs were imaged from the posterior view. Prior to imaging the patients were obligatory lying approximately half an hour. Results. In 18 (86% of the patients there was an improvement manifested as better subjective condition and better skin and its adnexa appearance. Following HBO treatment there was a statistically significant change in collecting the radiopharmac at rest. This finding indicates an increased viability of muscles as well as an increased perfusion reserve. Perfusion reserve mean values increased from 39.99 to 50.86%, and from 38.46 to 49.33% for the right and the left lower leg, respectively. This parameter clearly indicates favorable effects of HBO treatment pertaining neoangiogenesis and, consequently, increased viability of the lower leg muscles. It was also obvious in visual analysis of the obtained images. Conclusion. The obtained results confirm that muscle perfusion measured by the parameters of perfusion scintigraphy using 99mTc-tetrophosmine (perfusion reserve, relative perfusion in patients with

  13. Acute steatohepatitis, due to extreme metabolic dysregulation, as the first presentation of non-alcoholic fatty liver disease

    Directory of Open Access Journals (Sweden)

    Georgios Kranidiotis

    2013-05-01

    Full Text Available Non-alcoholic fatty liver disease (NAFLD is a slowly progressive chronic disease, with a high prevalence among obese, dyslipidemic or diabetic people, commonly presented as an asymptomatic mild elevation of serum aminotransferases. We report a patient who experienced an acute form of non-alcoholic steatohepatitis, as the first manifestation of NAFLD, due to exacerbation of pre-existing metabolic disorders by an extremely unhealthy lifestyle. A 50-year old, obese, diabetic man presented with a one-week history of jaundice and malaise. Analysis revealed elevated liver enzymes, bilirubin, lipids, and glucose. Based on patient’s history, physical examination, laboratory results, and imaging findings, acute non-alcoholic steatohepatitis was established as a diagnosis of exclusion. The patient was started on a low-calorie diet free of carbohydrates and fats, in combination with insulin. A dramatic improvement of clinical and laboratory parameters was observed. In the context of extreme metabolic dysregulation, induced by unhealthy diet, NAFLD may present as an acute steatohepatitis.

  14. Association of lower extremity arterial calcification with amputation and mortality in patients with symptomatic peripheral artery disease.

    Directory of Open Access Journals (Sweden)

    Chi-Lun Huang

    Full Text Available OBJECTIVE: The clinical implication of the coronary artery calcium score (CS is well demonstrated. However, little is known about the association between lower extremity arterial calcification and clinical outcomes. METHODS AND RESULTS: Eighty-two patients with symptomatic peripheral artery disease (age 61.0±12.4 years were followed for 21±11 months. CSs, ranging from the common iliac artery bifurcation to the ankle area, were analyzed through noncontrast multidetector computed tomography images retrospectively. The primary endpoints of this study were amputation and mortality. Old age, diabetes, hyperlipidemia, and end-stage renal disease were associated with higher CSs. Patients with more advanced Fontaine stages also tended to have significantly higher CSs (p = 0.03. During the follow-up period (21±11 months, 29 (35% patients underwent amputation, and 24 (29% patients died. Among the patients who underwent amputation, there were no significant differences in CSs between the amputated legs and the non-amputated legs. In the Cox proportional hazard model with CS divided into quartiles, patients with CS in the highest quartile had a 2.88-fold (95% confidence interval [CI] 1.18-12.72, p = 0.03 and a 5.16-fold (95% CI 1.13-21.61, p = 0.04 higher risk for amputation and all-cause mortality, respectively, than those with CS in the lowest quartile. These predictive effects remained after conventional risk factor adjustment. CONCLUSION: Lower extremity arterial CSs are associated with disease severity and outcomes, including amputation and all-cause mortality, in patients with symptomatic peripheral artery disease. However, the independent predictive value needs further investigation in large scale, prospective studies.

  15. [Practical diagnosis of arterial occlusive diseases of the lower extremities (author's transl)].

    Science.gov (United States)

    Böhme, H

    1978-01-06

    A peripheral arterial occlusive disease can be diagnosed by a clinical examination. Technical methods serve for documentation, definition of localization and differentiation of doubtful findings and special therapeutic measures. A definite sequence of diagnostic procedures simplifies diagnosis. History (risk factors), individual clinical or biochemical findings, intermittent claudication, pain at rest are important for the assessment of peripheral arterial circulation when considered with the appropriate differential diagnosis of various internal disease conditions, inspection, palpation and especially auscultation at rest and on effort. Ratschow's circulation test provides information on the degree of compensation. Mechanical or electronic oscillography and Doppler echography have proved valuable as technical methods for measuring post-stenotic pressure.

  16. Unicentric castleman's disease located in the lower extremity : a case report

    NARCIS (Netherlands)

    Schaefer, Inga-Marie; Guennel, Harald; Schweyer, Stefan; Korenkov, Michael

    2011-01-01

    Background: Castleman's disease is a rare form of localized lymph node hyperplasia of uncertain etiology. Although the mediastinum is the most common site of involvement, rare cases occurring in lymph node bearing tissue of other localization have been reported, including only a few intramuscular

  17. Extreme Air Pollution Conditions Adversely Affect Blood Pressure and Insulin Resistance: The Air Pollution and Cardiometabolic Disease Study.

    Science.gov (United States)

    Brook, Robert D; Sun, Zhichao; Brook, Jeffrey R; Zhao, Xiaoyi; Ruan, Yanping; Yan, Jianhua; Mukherjee, Bhramar; Rao, Xiaoquan; Duan, Fengkui; Sun, Lixian; Liang, Ruijuan; Lian, Hui; Zhang, Shuyang; Fang, Quan; Gu, Dongfeng; Sun, Qinghua; Fan, Zhongjie; Rajagopalan, Sanjay

    2016-01-01

    Mounting evidence supports that fine particulate matter adversely affects cardiometabolic diseases particularly in susceptible individuals; however, health effects induced by the extreme concentrations within megacities in Asia are not well described. We enrolled 65 nonsmoking adults with metabolic syndrome and insulin resistance in the Beijing metropolitan area into a panel study of 4 repeated visits across 4 seasons since 2012. Daily ambient fine particulate matter and personal black carbon levels ranged from 9.0 to 552.5 µg/m(3) and 0.2 to 24.5 µg/m(3), respectively, with extreme levels observed during January 2013. Cumulative fine particulate matter exposure windows across the prior 1 to 7 days were significantly associated with systolic blood pressure elevations ranging from 2.0 (95% confidence interval, 0.3-3.7) to 2.7 (0.6-4.8) mm Hg per SD increase (67.2 µg/m(3)), whereas cumulative black carbon exposure during the previous 2 to 5 days were significantly associated with ranges in elevations in diastolic blood pressure from 1.3 (0.0-2.5) to 1.7 (0.3-3.2) mm Hg per SD increase (3.6 µg/m(3)). Both black carbon and fine particulate matter were significantly associated with worsening insulin resistance (0.18 [0.01-0.36] and 0.22 [0.04-0.39] unit increase per SD increase of personal-level black carbon and 0.18 [0.02-0.34] and 0.22 [0.08-0.36] unit increase per SD increase of ambient fine particulate matter on lag days 4 and 5). These results provide important global public health warnings that air pollution may pose a risk to cardiometabolic health even at the extremely high concentrations faced by billions of people in the developing world today. © 2015 American Heart Association, Inc.

  18. Differential Effects of Temperature Extremes on Hospital Admission Rates for Respiratory Disease between Indigenous and Non-Indigenous Australians in the Northern Territory.

    Science.gov (United States)

    Green, Donna; Bambrick, Hilary; Tait, Peter; Goldie, James; Schultz, Rosalie; Webb, Leanne; Alexander, Lisa; Pitman, Andrew

    2015-12-03

    The health gap between Indigenous and non-Indigenous Australians may be exacerbated by climate change if temperature extremes have disproportionate adverse effects on Indigenous people. To explore this issue, we analysed the effect of temperature extremes on hospital admissions for respiratory diseases, stratified by age, Indigenous status and sex, for people living in two different climates zones in the Northern Territory during the period 1993-2011. We examined admissions for both acute and chronic respiratory diagnoses, controlling for day of the week and seasonality variables. Our analysis showed that: (1) overall, Indigenous hospital admission rates far exceeded non-Indigenous admission rates for acute and chronic diagnoses, and Top End climate zone admission rates exceeded Central Australia climate zone admission rates; (2) extreme cold and hot temperatures were associated with inconsistent changes in admission rates for acute respiratory disease in Indigenous and non-Indigenous children and older adults; and (3) no response to cold or hot temperature extremes was found for chronic respiratory diagnoses. These findings support our two hypotheses, that extreme hot and cold temperatures have a different effect on hospitalisations for respiratory disease between Indigenous and non-Indigenous people, and that these health risks vary between the different climate zones. We did not, however, find that there were differing responses to temperature extremes in the two populations, suggesting that any increased vulnerability to climate change in the Indigenous population of the Northern Territory arises from an increased underlying risk to respiratory disease and an already greater existing health burden.

  19. Liver transplantation for massive hepatomegaly due to polycystic liver disease: an extreme case.

    Science.gov (United States)

    Gringeri, E; D'Amico, F E; Bassi, D; Mescoli, C; Bonsignore, P; Boetto, R; Lodo, E; Noaro, G; Polacco, M; D'Amico, F; Boccagni, P; Zanus, G; Brolese, A; Cillo, U

    2012-09-01

    Polycystic liver disease (PLD) is due to a genetic disorder and frequently coexists with polycystic kidney disease (PKD). If the cysts produce symptomatology owing to their number and size, many palliative treatments are available. When none of the liver parenchyma is spared, or kidney insufficiency is marked, the only potentially curable treatment is liver transplantation (LT). A 49-year old woman, diagnosed with PLD and PKD, was listed in January 2008 for combined LT and kidney transplantation (KT). A compatible organ became available 8 months later. Despite preserved liver function, the patient's clinical condition was poor; she experienced dyspnea, advanced anorexia, abdominal pain, and severe ascites. At LT, which took 9 hours and was performed using the classic technique, the liver was hard, massive in size (15.5 kg), and not dissociable from the vena cava. The postoperative course was complicated by many septic episodes, the last one being fatal for the patient at 4 months after transplantation. LT for PLD in many series shows a high mortality rate. The Model for End-Stage Liver Disease (MELD) score does not stage patients properly, because liver function is usually preserved. The liver can achieve a massive size causing many symptoms, especially malnutrition and ascites; in this setting LT is the only possible treatment. Patients with a low MELD score undergo LT with severe malnutrition that predisposes them to greater susceptibility to sepsis. To identify predictor factors, beyond MELD criteria that relate to the increased liver volume before development of late symptoms is essential to expeditiously treat patients with the poorest prognosis to improve their outcomes. Copyright © 2012 Elsevier Inc. All rights reserved.

  20. Climate Change, Extreme Weather Events, and Fungal Disease Emergence and Spread

    Science.gov (United States)

    Tucker, Compton J.; Yager, Karina; Anyamba, Assaf; Linthicum, Kenneth J.

    2011-01-01

    Empirical evidence from multiple sources show the Earth has been warming since the late 19th century. More recently, evidence for this warming trend is strongly supported by satellite data since the late 1970s from the cryosphere, atmosphere, oceans, and land that confirms increasing temperature trends and their consequences (e.g., reduced Arctic sea ice, rising sea level, ice sheet mass loss, etc.). At the same time, satellite observations of the Sun show remarkably stable solar cycles since the late 1970s, when direct observations of the Sun's total solar irradiance began. Numerical simulation models, driven in part by assimilated satellite data, suggest that future-warming trends will lead to not only a warmer planet, but also a wetter and drier climate depending upon location in a fashion consistent with large-scale atmospheric processes. Continued global warming poses new opportunities for the emergence and spread of fungal disease, as climate systems change at regional and global scales, and as animal and plant species move into new niches. Our contribution to this proceedings is organized thus: First, we review empirical evidence for a warming Earth. Second, we show the Sun is not responsible for the observed warming. Third, we review numerical simulation modeling results that project these trends into the future, describing the projected abiotic environment of our planet in the next 40 to 50 years. Fourth, we illustrate how Rift Valley fever outbreaks have been linked to climate, enabling a better understanding of the dynamics of these diseases, and how this has led to the development of an operational predictive outbreak model for this disease in Africa. Fifth, We project how this experience may be applicable to predicting outbreaks of fungal pathogens in a warming world. Lastly, we describe an example of changing species ranges due to climate change, resulting from recent warming in the Andes and associated glacier melt that has enabled amphibians to

  1. Minor rheumatology: Nonsystemic rheumatic disease of juxta-articular soft tissues of the upper extremity. Part 1

    Directory of Open Access Journals (Sweden)

    A. E. Karateev

    2015-01-01

    Full Text Available Rheumatic diseases of juxta-articular soft tissues (RDJAST (tendinitis, tenosynovitis, bursitis, etc. are one of the most common causes of disability and one the most common reasons for seeking medical advice. To manage patients with RDJAST is an important part of practising rheumatologists’ work. But unfortunately, the issues of diagnosis and therapy of this pathology have been relatively rarely discussed on the pages of Russian medical journals and at the scientific congresses and conferences of rheumatologists in recent years. This review is to refresh physicians’interest in this problem. Part 1 of this review briefly considers the general issues relating to the epidemiology, pathogenesis, and diagnosis of RDJAST of the upper extremity, such as rotator cuff tendinitis, lateral and medial epicondylitis, stenosing flexor tenosynovitis, de Quervain’s syndrome, and carpal tunnel syndrome.

  2. Effects of unilateral, low-frequency, neuromuscular stimulation on superficial circulation in lower extremities of patients with peripheral vascular disease.

    Science.gov (United States)

    Loubser, P G; Cardus, D; Pickard, L R; McTaggart, W G

    1988-04-01

    The effects of unilateral, low-frequency, neuromuscular stimulation on the circulation in skin of the lower extremities were studied in eight subjects with peripheral vascular disease and eight control subjects with normal peripheral vasculature. Sixty minutes of stimulation (at 2 Hz), of sufficient intensity to produce visible contraction of musculature, was applied through cutaneous electrodes placed over the common peroneal nerve and dorsum of the foot. Systolic and diastolic blood pressure, heart rate, bilateral great-toe photoplethysmographic waveform, and bilateral pedal skin temperature were recorded at 30-min intervals during stimulation and 30 min after stimulation. Mean differences in recordings before and after stimulation were then calculated for each parameter, showing in subjects with peripheral vascular disease significant increases of 5.3 +/- 2.1 mm and 0.5 +/- 0.1 degree C for ipsilateral photoplethysmographic waveform amplitude and pedal skin temperature, respectively. Mean differences for the remaining parameters were not significant. Recorded parameters in the control group did not change after stimulation. These results demonstrate that low-frequency, neuromuscular stimulation produces regional cutaneous vasodilation in subjects with peripheral vascular disease. No evidence of generalized vasodilation after neuromuscular stimulation was found.

  3. Transcutaenous electrical nerve stimulation to manage a lower extremity wound complicated by peripheral arterial disease: a case report.

    Science.gov (United States)

    Yarboro, Douglas D; Smith, Robert

    2014-07-01

    Transcutaneous electrical nerve stimulation (TENS) is used to alleviate muscle pain, and there is some evidence it may affect healing in chronic wounds. An 80-year-old male patient with a chronic left lower extremity wound and a history of peripheral arterial disease, type 2 diabetes, hypertension, chronic obstructive pulmonary disease, and lung cancer presented for treatment. Previous protocols of care, mainly consisting of sharp debridement and daily dressing changes, had not resulted in a decrease in wound size. The patient had right and left iliac artery stenosis - not amenable to surgical intervention - and an ankle brachial index (ABI) of 0.63 on the left and 0.59 on the right lower extremities. On presentation, the wound measured 3.0 cm x 2.0 cm with a depth of 0.3 cm and a 0.5-cm tract at the 5 o'clock position. Treatment was changed to application of an ionic silver-containing Hydrofiber™ dressing and low-frequency TENS. Electrodes were applied 2 cm superior and inferior to the wound margin at a frequency of 2 Hz with a pulse width of 250 microseconds and amplitude of 33 mA. Treatment time was 45 minutes, twice daily, for 3 months, performed at home by the patient and his caregiver. After 4 weeks, wound dimensions decreased by 1.51% per day, and the wound was completely healed (100% epithelialized) after 12 weeks. At that time, the ABI of the left (treated) leg had increased to 0.71. Research is needed to determine the efficacy and effectiveness of low-frequency TENS to help clinicians provide evidenced-based treatment for wounds complicated by decreased blood flow.

  4. Diagnostic value of ankle-brachial index and toe-brachial index in arterial disease of lower extremity

    Directory of Open Access Journals (Sweden)

    Lan LI

    2012-11-01

    Full Text Available Objective  To investigate the clinical application and its influencing factors of ankle-brachial index (ABI and toe-brachial index (TBI in the diagnosis of arterial disease of lower extremity. Methods  ABI and TBI were measured in 800 limbs of 402 patients with diabetes and/or hypertension hospitalized from July 2010 to February 2011. The patients were divided into narrow group (ABI < 0.9, normal group (0.9≤ABI < 1.3, and calcification group (ABI≥1.3 according to the value of ABI, and also into narrow group (TBI < 0.7 and normal group (TBI≥0.7 according to the value of TBI. The correlation of ABI with TBI was analyzed, and the differences in age, obesity parameters, biochemical indicators and other factors were compared between the groups. Influence of high-sensitivity C-reactive protein (hs-CRP on ABI and TBI was further analyzed. Results  Only when ABI < 0.9, ABI and TBI have significant correlation (r=0.826, P < 0.01. W hen the group comparison based on ABI values, it was shown that the age and hs-CRP were significantly higher in the narrow group than in the normal group and calcification group (P < 0.01. The comparison between groups based on TBI values indicated that the age, systolic blood pressure and hs-CRP in the narrow group were significantly higher than those in the normal group (P < 0.01 or P < 0.05. ABI and TBI in the normal hs-CRP group were significantly higher than those in high hs-CRP group (P < 0.05. Conclusion  Hs-CRP may play an important role in the development and progression in peripheral arterial atherosclerosis. Therefore, ABI and TBI measurements in combination with hs-CRP level can improve early diagnosis of arterial disease of lower extremity.

  5. Towns with extremely low mortality due to ischemic heart disease in Spain

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    Medrano María

    2012-03-01

    Full Text Available Abstract Background The cause of coronary disease inframortality in Spain is unknown. The aim of this study is to identify Spanish towns with very low ischemic heart disease mortality, describe their health and social characteristics, and analyze the relationship with a series of contextual factors. Methods We obtained the number of deaths registered for each of 8,122 Spanish towns in the periods 1989-1998 and 1999-2003. Expected deaths, standardized mortality ratio (SMR, smoothed Relative Risk (RR, and Posterior Probability (PP of RR > 1 were calculated using Bayesian hierarchical models. Inframortality was defined as any town that displayed an RR below the 10th percentile, an SMR of under 1 for both sexes, and a PP of RR > 1 less than or equal to 0.002 for male and 0.005 for female mortality, during the two periods covered. All the remaining towns, except for those with high mortality classified as "tourist towns", were selected as controls. The association among socioeconomic, health, dietary, lifestyle and vascular risk factors was analyzed using sequential mixed logistic regression models, with province as the random-effects variable. Results We identified 32 towns in which ischemic heart disease mortality was half the national rate and four times lower than the European Union rate, situated in lightly populated provinces spread across the northern half of Spain, and revealed a surprising pattern of geographic aggegation for 23 of the 32 towns. Variables related with inframortality were: a less aged population (OR 0.93, 95% CI 0.89-0.99; a contextual dietary pattern marked by a high fish content (OR 2.13, 95% CI 1.38-3.28 and wine consumption (OR 1.50, 95% CI 1.08-2.07; and a low prevalence of obesity (OR 0.47, 95% CI 0.22-1.01; and, in the case of towns of over 1000 inhabitants, a higher physician-population ratio (OR 3.80, 95% CI 1.17-12.3. Conclusions Results indicate that dietary and health care factors have an influence on

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

    Science.gov (United States)

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

    2013-12-01

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

  7. Why do people buy dogs with potential welfare problems related to extreme conformation and inherited disease? A representative study of Danish owners of four small dog breeds

    DEFF Research Database (Denmark)

    Sandøe, Peter; Kondrup, Sara Vincentzen; Bennett, P.C.

    2017-01-01

    A number of dog breeds suffer from welfare problems due to extreme phenotypes and high levels of inherited diseases but the popularity of such breeds is not declining. Using a survey of owners of two popular breeds with extreme physical features (French Bulldog and Chihuahua), one with a high load...... of inherited diseases not directly related to conformation (Cavalier King Charles Spaniel), and one representing the same size range but without extreme conformation and with the same level of disease as the overall dog population (Cairn Terrier), we investigated this seeming paradox. We examined planning...... and motivational factors behind acquisition of the dogs, and whether levels of experienced health and behavior problems were associated with the quality of the owner-dog relationship and the intention to re-procure a dog of the same breed. Owners of each of the four breeds (750/breed) were randomly drawn from...

  8. Diagnosis of Alzheimer’s Disease Based on Structural MRI Images Using a Regularized Extreme Learning Machine and PCA Features

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    Ramesh Kumar Lama

    2017-01-01

    Full Text Available Alzheimer’s disease (AD is a progressive, neurodegenerative brain disorder that attacks neurotransmitters, brain cells, and nerves, affecting brain functions, memory, and behaviors and then finally causing dementia on elderly people. Despite its significance, there is currently no cure for it. However, there are medicines available on prescription that can help delay the progress of the condition. Thus, early diagnosis of AD is essential for patient care and relevant researches. Major challenges in proper diagnosis of AD using existing classification schemes are the availability of a smaller number of training samples and the larger number of possible feature representations. In this paper, we present and compare AD diagnosis approaches using structural magnetic resonance (sMR images to discriminate AD, mild cognitive impairment (MCI, and healthy control (HC subjects using a support vector machine (SVM, an import vector machine (IVM, and a regularized extreme learning machine (RELM. The greedy score-based feature selection technique is employed to select important feature vectors. In addition, a kernel-based discriminative approach is adopted to deal with complex data distributions. We compare the performance of these classifiers for volumetric sMR image data from Alzheimer’s disease neuroimaging initiative (ADNI datasets. Experiments on the ADNI datasets showed that RELM with the feature selection approach can significantly improve classification accuracy of AD from MCI and HC subjects.

  9. Alcohol Consumption Is a Risk Factor for Lower Extremity Arterial Disease in Chinese Patients with T2DM

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    Shanshan Yang

    2017-01-01

    Full Text Available Objective. To investigate the relationship between alcohol consumption and diabetic lower extremity arterial disease (LEAD in hospitalized patients with type 2 diabetes mellitus (T2DM. Methods. We evaluated 138 hospitalized patients with T2DM who consumed alcohol and 833 who did not. We used propensity score matching to reduce the confounding bias between groups. Additionally, a logistic regression analysis was performed with the matched data to evaluate the LEAD risk. Results. In total, 119 pairs of patients who did and did not consume alcohol were matched. According to the logistic regression analysis, patients who consumed >8 U of alcohol/day had a higher risk of LEAD (odds ratio (OR: 6.35, 95% confidence interval (CI: 1.78–22.65 than patients who did not consume alcohol. Additionally, after adjusting for age, gender, region, occupation, smoking status, body mass index, weight change, and duration of diabetes, the OR of peripheral artery disease after >20 years of alcohol consumption was 3.48 (95% CI: 1.09–11.15. Furthermore, we observed a significant dose-response relationship between alcohol consumption and LEAD. Conclusions. Alcohol consumption may be a risk factor of LEAD in patients with T2DM. Patients with T2DM should be advised to stop drinking, to prevent the onset of LEAD.

  10. Diagnosis of Alzheimer's Disease Based on Structural MRI Images Using a Regularized Extreme Learning Machine and PCA Features.

    Science.gov (United States)

    Lama, Ramesh Kumar; Gwak, Jeonghwan; Park, Jeong-Seon; Lee, Sang-Woong

    2017-01-01

    Alzheimer's disease (AD) is a progressive, neurodegenerative brain disorder that attacks neurotransmitters, brain cells, and nerves, affecting brain functions, memory, and behaviors and then finally causing dementia on elderly people. Despite its significance, there is currently no cure for it. However, there are medicines available on prescription that can help delay the progress of the condition. Thus, early diagnosis of AD is essential for patient care and relevant researches. Major challenges in proper diagnosis of AD using existing classification schemes are the availability of a smaller number of training samples and the larger number of possible feature representations. In this paper, we present and compare AD diagnosis approaches using structural magnetic resonance (sMR) images to discriminate AD, mild cognitive impairment (MCI), and healthy control (HC) subjects using a support vector machine (SVM), an import vector machine (IVM), and a regularized extreme learning machine (RELM). The greedy score-based feature selection technique is employed to select important feature vectors. In addition, a kernel-based discriminative approach is adopted to deal with complex data distributions. We compare the performance of these classifiers for volumetric sMR image data from Alzheimer's disease neuroimaging initiative (ADNI) datasets. Experiments on the ADNI datasets showed that RELM with the feature selection approach can significantly improve classification accuracy of AD from MCI and HC subjects.

  11. The accuracy of the physical examination for the detection of lower extremity peripheral arterial disease

    Science.gov (United States)

    Armstrong, David WJ; Tobin, Colleen; Matangi, Murray F

    2010-01-01

    BACKGROUND: Peripheral arterial disease (PAD) is a major risk factor for adverse cardiovascular events. There has been a definite push for wider use of the ankle-brachial index (ABI) as a simple screening tool for PAD. Perhaps this has occurred to the detriment of a thorough physical examination. OBJECTIVE: To assess the accuracy of the physical examination to detect clinically significant PAD compared with the ABI. METHODS: PADfile, the PAD module of CARDIOfile (the Kingston Heart Clinic’s cardiology database [Kingston, Ontario]), was searched for all patients who underwent peripheral arterial testing. Of 1619 patients, 1236 had all of the necessary data entered. Patients’ lower limbs were divided into two groups: those with a normal ABI between 0.91 and 1.30, and those with an abnormal ABI of 0.90 or lower. Peripheral pulses were graded as either absent or present. Absent was graded as 0/3, present but reduced (1/3), normal (2/3) or bounding (3/3). Femoral bruits were graded as either present (1) or absent (0). Using the ABI as the gold standard, the sensitivity, specificity, negative predictive value (NPV), positive predictive value and overall accuracy were calculated for the dorsalis pedis pulse, the posterior tibial pulse, both pedal pulses, the presence or absence of a femoral bruit and, finally, for a combination of both pedal pulses and the presence or absence of a femoral bruit. RESULTS: In 1236 patients who underwent PAD testing and who underwent a complete peripheral vascular physical examination (all dorsalis pedis and posterior tibial pulses palpated and auscultation for a femoral bruit), the sensitivity, specificity, NPV, positive predictive value and accuracy for PAD were 58.2%, 98.3%, 94.9%, 81.1% and 93.8%, respectively. CONCLUSIONS: The clinical examination of the peripheral arterial foot pulses and the auscultation for a femoral bruit had a high degree of accuracy (93.8%) for the detection or exclusion of PAD compared with the ABI using the

  12. Amputation trends for patients with lower extremity ulcers due to diabetes and peripheral artery disease using statewide data.

    Science.gov (United States)

    Humphries, Misty D; Brunson, Ann; Li, Chin-Shang; Melnikow, Joy; Romano, Patrick S

    2016-12-01

    This study reports all-payer amputation rates using state-based administrative claims data for high-risk patients with lower extremity (LE) ulcers and concomitant peripheral artery disease (PAD), diabetes mellitus (DM), or combination PAD/DM. In addition, we characterize patient factors that affect amputation-free survival. We also attempted to create a measure of a patient's ability to manage chronic diseases or to access appropriate outpatient care for ulcer management by accounting for hospital and emergency department (ED) visits in the preceding 60 days to determine how this also affects amputation-free survival. Patients admitted to nonfederal hospitals, seen in an ED, or treated in an eligible ambulatory surgery center within California from 2005 through 2013 with an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code for a disease-specific LE ulcer were identified in the California Office of Statewide Health Planning and Development database. All subsequent hospital, ED, and ambulatory surgery center visits and procedures are captured to identify whether a patient underwent major amputation. Yearly amputation rates were determined to analyze trends. Amputation-free survival for the PAD, DM, and PAD/DM groups was determined. Cox modeling was used to evaluate the effect of patient characteristics. There were 219,547 patients identified with an incident LE ulcer throughout the state. Of these, 131,731 were DM associated, 36,193 were PAD associated, and 51,623 were associated with both PAD and DM. From 2005 to 2013, the number of patients with LE ulcers who required inpatient admission, presented to the ED, or had outpatient procedures was stable. However, there was a statistically significant increase in overall disease-associated amputation rates from 5.1 in 2005 to 13.5 in 2013 (P amputation rates from 10 per 100 patients with LE ulcers in 2005 to 28 per 100 patients in 2013 (P amputation-free survival. Within

  13. Incidence of ipsilateral postoperative deep venous thrombosis in the amputated lower extremity of patients with peripheral obstructive arterial disease.

    Science.gov (United States)

    Matielo, Marcelo Fernando; Presti, Calógero; Casella, Ivan Benaduce; Netto, Baptista Muraco; Puech-Leão, Pedro

    2008-12-01

    Patients undergoing amputation of the lower limb due to peripheral arterial disease (PAD) are at risk of developing deep venous thrombosis (DVT). Few studies in the research literature report the incidence of DVT during the early postoperative period or the risk factors for the development of DVT in the amputation stump. This prospective study evaluated the incidence of DVT during the first 35 postoperative days in patients who had undergone amputation of the lower extremity due to PAD and its relation to comorbidities and death. Between September 2004 and March 2006, 56 patients (29 men), with a mean age of 67.25 years, underwent 62 amputations, comprising 36 below knee amputations (BKA) and 26 above knee amputations (AKA). Echo-Doppler scanning was performed preoperatively and on postoperative days 7 and 31 (approximately). All patients received acetylsalicylic acid (100 mg daily) preoperatively and postoperatively, but none received prophylactic anticoagulation. DVT occurred in 25.8% of extremities with amputations (10 AKA and 6 BKA). The cumulative incidence in the 35-day postoperative period was 28% (Kaplan-Meier). There was a significant difference (P = .04) in the incidence of DVT between AKA (37.5%) and BKA (21.2%). Age >or=70 years (48.9% vs 16.8%, P = .021) was also a risk factor for DVT in the univariate analysis. Of the 16 cases, 14 (87.5%) were diagnosed during outpatient care. The time to discharge after amputation was averaged 6.11 days in-hospital stay (range, 1-56 days). One symptomatic nonfatal pulmonary embolism occurred in a patient already diagnosed with DVT. There was no relation between other comorbidities and DVT. The multivariate analysis showed no association between risk factors and the occurrence of DVT in the amputated extremity. DVT ipsilateral to the amputation did not influence the mortality rate (9.7%). The incidence of DVT in the early postoperative period (or=70 years and for AKA. Patients with PAD who have recently undergone

  14. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease

    Science.gov (United States)

    Gerhard-Herman, Marie D.; Gornik, Heather L.; Barrett, Coletta; Barshes, Neal R.; Corriere, Matthew A.; Drachman, Douglas E.; Fleisher, Lee A.; Flowkes, Francis Gerry R.; Hamburg, Naomi M.; Kinlay, Scott; Lookstein, Robert; Misra, Sanjay; Mureebe, Leila; Olin, Jeffrey W.; Patel, Rajan A.G.; Regensteiner, Judith G.; Schanzer, Andres; Shishehbor, Mehdi H.; Stewart, Kerry J.; Treat-Jacobson, Diane; Walsh, M. Eileen; Halperin, Jonathan L.

    2017-01-01

    Preamble Since 1980, the American College of Cardiology (ACC) and American Heart Association (AHA) have translated scientific evidence into clinical practice guidelines with recommendations to improve cardiovascular health. These guidelines, based on systematic methods to evaluate and classify evidence, provide a cornerstone of quality cardiovascular care. In response to reports from the Institute of Medicine1,2 and a mandate to evaluate new knowledge and maintain relevance at the point of care, the ACC/AHA Task Force on Clinical Practice Guidelines (Task Force) modified its methodology.3–5 The relationships among guidelines, data standards, appropriate use criteria, and performance measures are addressed elsewhere.5 Intended Use Practice guidelines provide recommendations applicable to patients with or at risk of developing cardiovascular disease. The focus is on medical practice in the United States, but guidelines developed in collaboration with other organizations may have a broader target. Although guidelines may be used to inform regulatory or payer decisions, the intent is to improve quality of care and align with patients' interests. Guidelines are intended to define practices meeting the needs of patients in most, but not all, circumstances, and should not replace clinical judgment. Guidelines are reviewed annually by the Task Force and are official policy of the ACC and AHA. Each guideline is considered current until it is updated, revised, or superseded by published addenda, statements of clarification, focused updates, or revised full-text guidelines. To ensure that guidelines remain current, new data are reviewed biannually to determine whether recommendations should be modified. In general, full revisions are posted in 5-year cycles.3–6 Modernization Processes have evolved to support the evolution of guidelines as “living documents” that can be dynamically updated. This process delineates a recommendation to address a specific clinical

  15. Identification of a Novel NLRP12 Nonsense Mutation (Trp408X in the Extremely Rare Disease FCAS by Exome Sequencing.

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    Xiaoru Xia

    Full Text Available Familial cold autoinflammatory syndrome (FCAS is an extremely rare autosomal dominant inherited disease. Although there are four genes that have been linked with FCAS, its molecular diagnosis has been challenging in a relatively large proportion of cases. In this study, we aimed to investigate the genetic defect of a recruited FCAS family using exome sequencing followed by in-depth bioinformatics analysis. As a result, a novel heterozygous stop-gain mutation (Trp408X in NLRP12 was identified in autosomal dominant inherited FCAS with clinical features of recurrent fever and skin urticaria due to cold conditions. When combined with previous studies, all of the reported mutations were found to have occurred in a highly conserved region in the NACHT domain coding sequence in NLRP12 exon 3, suggesting that a screening strategy for FCAS should focus on this area of the gene. In conclusion, this study demonstrates the importance of exome sequencing for clinical diagnosis of genetic disorders and provides molecular insight into FCAS treatment and diagnosis.

  16. 2014 Guideline for Management of Wounds in Patients With Lower-Extremity Arterial Disease (LEAD): An Executive Summary.

    Science.gov (United States)

    Bonham, Phyllis A; Flemister, Bonny G; Droste, Linda R; Johnson, Jan J; Kelechi, Teresa; Ratliff, Catherine R; Varnado, Myra F

    2016-01-01

    The purpose of this article is to provide a summary of the recommendations from the 2014 Guideline for Management of Wounds in Patients With Lower-Extremity Arterial Disease (LEAD), published by the Wound, Ostomy and Continence Nurses Society (WOCN). This article provides an overview of the process used to update and develop the guideline, and specific recommendations from the guideline for assessment, referral for further evaluation, interventions (ie, debridement, dressings, infection, antibiotics, nutrition, pain management, compression issues, medications, surgical options, and adjunctive therapies), and patient education and risk-reduction strategies. The LEAD guideline is a resource for physicians, nurses, therapists, and other healthcare professionals who work with adults who have/or are at risk for wounds due to LEAD. The full text of the published guideline, which includes the available evidence supporting the recommendations and a complete reference list, is available from the WOCN Society, 1120 Rt. 73, Suite 200, Mount Laurel, NJ, 08054; Web site: www.wocn.org. Refer to the Supplemental Digital Content (Supplement Digital Content 1, http://links.lww.com/JWOCN/A31) associated with this article for the complete reference list for the guideline. The guideline has been accepted for publication by the National Guideline Clearinghouse (www.guideline.gov/).

  17. Risk of lower extremity arterial disease in a cohort of workers occupationally exposed to ionizing radiation over a prolonged period

    Energy Technology Data Exchange (ETDEWEB)

    Azizova, Tamara V.; Bannikova, Maria V.; Grigorieva, Evgenia S.; Bagaeva, Yaroslava P.; Azizova, Elena V. [Southern Urals Biophysics Institute, Ozyorsk Chelyabinsk Region (Russian Federation)

    2016-05-15

    In this study the incidence risk of lower extremity arterial disease (LEAD; international classification of diseases version 9 code 440.2) was assessed in a cohort of workers occupationally exposed to radiation over a prolonged period. The study cohort includes 22,377 workers of the Mayak Production Association (25 % of whom are females) first employed at one of the main facilities in 1948-1982 and followed up to the end of 2008. Dose estimates used in the study are provided by Mayak Worker Dosimetry System 2008. The mean total dose from external gamma-rays is 0.54 Gy for males and 0.44 Gy for females. The mean absorbed liver dose from internal alpha-radiation due to incorporated plutonium is 0.23 Gy in males and 0.44 Gy in females. Relative risks and excess relative risks per unit dose (ERR/Gy) are calculated based on maximum likelihood. A total of 943 cases of LEAD are registered in the study cohort during the follow-up of 512,801 person-years. A significant association of LEAD incidence with total dose from external gamma-rays (based on a linear model) was revealed, and the ERR/Gy is 0.27 (95 % confidence interval (CI) 0.11; 0.48). It turned out that a linear-exponential model provides a better fit of the data (∇AIC = 9.957). Inclusion of an adjustment for internal alpha-radiation dose resulted in the reduction of the ERR/Gy to 0.19 (95 % CI 0.05; 0.39), but the risk remains significant. No association of LEAD incidence with dose from internal alpha-radiation was found in the study worker cohort. It is concluded that this study provides evidence for an association of LEAD incidence with dose from external gamma-rays taking non-radiation factors into account. (orig.)

  18. Parenteral-nutrition-associated liver disease after intestinal perforation in extremely low-birthweight infants: consequent lethal portal hypertension.

    Science.gov (United States)

    Kubota, Akio; Mochizuki, Narutaka; Shiraishi, Jun; Nakayama, Masahiro; Kawahara, Hisayoshi; Yoneda, Akihiro; Tazuke, Yuko; Goda, Taro; Nakahata, Kengo; Sano, Hiroyuki; Hirano, Shinya; Kitajima, Hiroyuki

    2013-02-01

    Parenteral nutrition (PN)-associated liver dysfunction (PNALD) in term infants usually manifests as intrahepatic cholestasis, which recovers with enteral nutrition (EN) in most cases; however, as the number of extremely low-birthweight infants (ELBWI) has been increasing, and consequently intestinal diseases associated with ELBWI have been increasing, more intractable PNALD has been encountered after surgical treatment in ELBWI, which does not resolve or rather worsens with EN. Three cases of ELBWI with intestinal perforation, which developed PNALD and eventually died of hepatic failure with intractable portal hypertension, were reviewed. Their gestational age and birthweight ranged from 23 to 26 weeks, and from 434 to 968 g, respectively. The intestinal diseases included necrotizing enteritis in two and meconium-related ileus with focal intestinal perforation in one. The duration of total PN without EN in the three cases was 17, 24 and 24 days, respectively. The interval between the introduction of PN and the onset of PNALD was 14, 4 and 18 days, respectively. A marked elevation of serum endotoxin level was detected in both cases of necrotizing enteritis. Histopathological study of the liver revealed marked cholestasis, significant hepatic necrosis with fibrosis, and proliferation of ductules in all these cases, which was responsible for portal hypertension. PN after gastrointestinal disorders in ELBWI may cause refractory PNALD, which does not resolve, or rather worsens with the resumption of EN. Portal hypertension secondary to hepatic necrosis may be responsible for the exacerbation with the resumption of EN. © 2012 The Authors. Pediatrics International © 2012 Japan Pediatric Society.

  19. QUALITY OF LIFE IN PATIENTS WITH HYPERTENSION, CORONARY HEART DISEASE, AND ATHEROSCLEROTIC LESION OF LOWER EXTREMITY ARTERIES IN THE SECONDARY PREVENTION OF COMPLICATIONS

    Directory of Open Access Journals (Sweden)

    A. A. Karlov

    2014-07-01

    Full Text Available Atherosclerotic lesion of lower extremity arteries frequently complicates the long-term course of hypertension and it is generally associated with coronary heart disease. Our study has attempted to evaluate the impact of combination antihypertensive therapy involving amlodipine, bisoprolol, and lisinopril on quality of life in this category of patients.

  20. Short physical performance battery for middle-aged and older adult cardiovascular disease patients: implication for strength tests and lower extremity morphological evaluation

    OpenAIRE

    Yasuda, Tomohiro; Fukumura, Kazuya; Nakajima, Toshiaki

    2017-01-01

    [Purpose] To examine if the SPPB is higher with healthy subjects than outpatients, which was higher than inpatients and if the SPPB can be validated assessment tool for strength tests and lower extremity morphological evaluation in cardiovascular disease patients. [Subjects and Methods] Twenty-four middle aged and older adults with cardiovascular disease were recruited from inpatient and outpatient facilities and assigned to separate experimental groups. Twelve age-matched healthy volunteers ...

  1. Presentation, treatment, and outcome differences between men and women undergoing revascularization or amputation for lower extremity peripheral arterial disease.

    Science.gov (United States)

    Lo, Ruby C; Bensley, Rodney P; Dahlberg, Suzanne E; Matyal, Robina; Hamdan, Allen D; Wyers, Mark; Chaikof, Elliot L; Schermerhorn, Marc L

    2014-02-01

    Prior studies have suggested treatment and outcome disparities between men and women for lower extremity peripheral arterial disease after surgical bypass. Given the recent shift toward endovascular therapy, which has increasingly been used to treat claudication, we sought to analyze sex disparities in presentation, revascularization, amputation, and inpatient mortality. We identified individuals with intermittent claudication and critical limb ischemia (CLI) using International Classification of Diseases, Ninth Revision codes in the Nationwide Inpatient Sample from 1998 to 2009. We compared presentation at time of intervention (intermittent claudication vs CLI), procedure (open surgery vs percutaneous transluminal angioplasty or stenting vs major amputation), and in-hospital mortality for men and women. Regional and ambulatory trends were evaluated by performing a separate analysis of the State Inpatient and Ambulatory Surgery Databases from four geographically diverse states: California, Florida, Maryland, and New Jersey. From the Nationwide Inpatient Sample, we identified 1,797,885 patients (56% male) with intermittent claudication (26%) and CLI (74%), who underwent 1,865,999 procedures (41% open surgery, 20% percutaneous transluminal angioplasty or stenting, and 24% amputation). Women were older at the time of intervention by 3.5 years on average and more likely to present with CLI (75.9% vs 72.3%; odds ratio [OR], 1.21; 95% confidence interval [CI], 1.21-1.23; P procedures for both intermittent claudication (47% vs 41%; OR, 1.27; 95% CI, 1.25-1.28; P amputations declined from 18 to 11 per 100,000 in men and 16 to 7 per 100,000 in women, predating an increase in total CLI revascularization procedures that was seen starting in 2005 for both men and women. In-hospital mortality was higher in women regardless of disease severity or procedure performed even after adjusting for age and baseline comorbidities (.5% vs .2% after percutaneous transluminal angioplasty or

  2. How Admission to a Vascular Surgery Department Improves Medical Treatment in Patients with Lower Extremity Peripheral Arterial Disease.

    Science.gov (United States)

    Thiney, Martina; Della Schiava, Nellie; Feugier, Patrick; Lermusiaux, Patrick; Ninet, Jacques; Millon, Antoine; Long, Anne

    2017-04-01

    All patients with lower extremity peripheral arterial disease (LE-PAD) should benefit from recommended pharmacologic therapies including antiplatelet agents, angiotensin-converting enzyme (ACE) inhibitors, or angiotensin receptor blockers (ARBs), and hydroxy-methyl-glutaryl-coenzyme A reductase inhibitors (statins). In the present study, this triple therapy was defined as the best medical treatment. This study was designed to determine the number of patients who received best medical treatment at admission and at discharge from a vascular surgery department. We also examined the number of patients who received adapted medical treatment and every pharmacologic class separately. Finally, we investigated whether there were differences in prescribing rates according to patient characteristics and cardiovascular history, clinical grade of LE-PAD, and the type of surgery practiced. This study is a retrospective chart analysis of 140 consecutive patients admitted to the vascular surgery department of our university hospital, between January 1, 2013, and June 30, 2013. To be included, patients required a vascular surgery for peripheral arterial disease with atherosclerosis. Data from guideline-recommended classes of medications (antiplatelet agents, ACE, ARBs, and statins) at the time of admission and discharge were collected and compared. Best medical treatment was prescribed in 44% patients before hospital admission and in 50% at discharge (P = 0.10). Before hospital admission, 84% of patients had antiplatelet therapy compared with 96% at discharge (P = 0.0004); 73% had a statin, compared with 83% at discharge (P = 0.001); 64% had an ACE inhibitor or ARB, compared with 63% at the time of discharge (P = 1).The proportion of patients receiving best medical treatment at admission and discharge increased in case of coronary artery disease (P = 0.004). There was no difference in prescriptions of best medical treatment and best or adapted treatments at admission and

  3. Short physical performance battery for middle-aged and older adult cardiovascular disease patients: implication for strength tests and lower extremity morphological evaluation.

    Science.gov (United States)

    Yasuda, Tomohiro; Fukumura, Kazuya; Nakajima, Toshiaki

    2017-04-01

    [Purpose] To examine if the SPPB is higher with healthy subjects than outpatients, which was higher than inpatients and if the SPPB can be validated assessment tool for strength tests and lower extremity morphological evaluation in cardiovascular disease patients. [Subjects and Methods] Twenty-four middle aged and older adults with cardiovascular disease were recruited from inpatient and outpatient facilities and assigned to separate experimental groups. Twelve age-matched healthy volunteers were assigned to a control group. SPPB test was used to assess balance and functional motilities. The test outcomes were compared with level of care (inpatient vs. outpatient), physical characteristics, strength and lower extremity morphology. [Results] Total SPPB scores, strength tests (knee extensor muscle strength), and lower extremity morphological evaluation (muscle thickness of anterior and posterior mid-thigh and posterior lower-leg) were greater in healthy subjects and outpatients groups compared with inpatients. To predict total Short Physical Performance Battery scores, the predicted knee extension and anterior mid-thigh muscle thickness were calculated. [Conclusion] The SPPB is an effective tool as the strength tests and lower extremity morphological evaluation for middle-aged and older adult cardiovascular disease patients. Notably, high knee extensor muscle strength and quadriceps femoris muscle thickness are positively associated with high SPPB scores.

  4. [Effect of disease severity on upper extremity muscle strength, exercise capacity, and activities of daily living in individuals with pulmonary arterial hypertension].

    Science.gov (United States)

    Özcan Kahraman, Buse; Özsoy, İsmail; Acar, Serap; Özpelit, Ebru; Akdeniz, Bahri; Sevinç, Can; Savcı, Sema

    2017-07-01

    Pulmonary arterial hypertension (PAH) is a rare disease. Although muscle strength, exercise capacity, quality of life, and activities of daily living of patients with PAH are affected, it is not known how they are affected by disease severity. The purpose of the present study was to investigate effects of disease severity on upper extremity muscle strength, exercise capacity, and performance of activities of daily living in patients with PAH. Twenty-five patients with disease severity classified according to the New York Heart Association (NYHA) as functional class II (n=14) or class III (n=11) were included in the study. Upper-extremity exercise capacity and limitations in performing activities of daily living were assessed with 6-minute pegboard and ring test (6PBRT) and the Milliken activities of daily living scale (MAS), respectively. Shoulder flexion, elbow extension, elbow flexion muscle strength, and handgrip strength were measured with dynamometer. There were no significant differences in age, gender, body mass index, or mean pulmonary artery pressure between groups (p>0.05). The 6PBRT, MAS, and elbow flexion (right) and grip strength (right and left) results were significantly lower in NYHA III group than in NYHA II group (p=0.004, p=0.002, p=0.043, p=0.002 and p=0.003, respectively). There was no significant difference in shoulder flexion, elbow flexion (left), or elbow extension between groups (p>0.05). Results suggest that upper extremity exercise capacity, elbow flexion muscle strength (right), and handgrip strength decrease and that limitations in activities of daily living grow as disease severity increases in patients with PAH. When planning rehabilitation programs, disease severity should be considered and evaluations and treatments for the upper extremities should be included.

  5. Assessment of toe blood pressure is an effective screening method to identify diabetes patients with lower extremity arterial disease.

    Science.gov (United States)

    Sahli, David; Eliasson, Björn; Svensson, Maria; Blohmé, Göran; Eliasson, Mats; Samuelsson, Pär; Ojbrandt, Kristina; Eriksson, Jan W

    2004-01-01

    The authors evaluated a screening program for lower extremity arterial disease (LEAD) in diabetic patients and focused on the value of toe blood pressure assessment. They recruited 437 subjects, ages 30-70 years (134 healthy controls, 166 type 1 and 137 type 2 diabetic patients; control [Ctr], DM1, and DM2) with no previous history of LEAD. They were enrolled in a longitudinal study with a planned follow-up of 10 years. Patients were consecutively enrolled from outpatient diabetes units of 2 university hospitals. Subjects were screened with respect to peripheral circulation by use of established noninvasive techniques. These included arm, ankle (AP), and toe (TP) blood pressure measurements; evaluation of peripheral neuropathy; and a standardized physical examination. Results from the baseline examination are presented in this report. The number of patients who presented peripheral pressures or indices below normal (lower limb with a low TP, AP, toe/arm index (TI), or ankle/arm index (AI), and these subjects were mainly identified by using the toe/arm index. TI was independently and negatively associated with fasting blood glucose in both patient groups, and with smoking, age, and diabetes duration in DM1. The mean AP was higher in the DM1 and DM2 groups compared to Ctr, whereas overall TP, TI, and AI were similar in the groups. It was also shown that abnormally low TI was significantly more common than low AI among diabetics (pblood pressure and toe/arm blood pressure index to detect early LEAD in diabetic patients. Ankle blood pressure and indices alone are less efficient, owing probably to medial sclerosis in diabetic patients. Up to 30% of diabetic patients with no ischemic symptoms may have signs of impaired arterial circulation.

  6. The association between extreme weather conditions and work-related injuries and diseases. A systematic review of epidemiological studies.

    Science.gov (United States)

    Bonafede, Michela; Marinaccio, Alessandro; Asta, Federica; Schifano, Patrizia; Michelozzi, Paola; Vecchi, Simona

    2016-01-01

    The relationship between extreme temperature and population health has been well documented. Our objective was to assess the evidence supporting an association between extreme temperature and work related injuries. We carried out a systematic search with no date limits using PubMed, the Cochrane central register of controlled trials, EMBASE, Web of Science and the internet sites of key organizations on environmental and occupational health and safety. Risk of bias was evaluated with Cochrane procedure. Among 270 studies selected at the first step, we analyzed 20 studies according to inclusion criteria (4 and 16 referring to extreme cold and heat temperature, respectively). Despite the relevance for policy makers and for occupational safety authorities, the associations between extreme temperature and work related injuries is seldom analyzed. The estimation of risk, the identification of specific jobs involved and the characterization of the complex mechanisms involved could help to define prevention measures.

  7. Systemic vasculitis is associated with a higher risk of lower extremity amputation in patients with severe peripheral arterial occlusive disease: a secondary analysis of a nationwide, population-based health claims database.

    Science.gov (United States)

    Lu, Ming-Chi; Hsu, Honda; Lin, Ching-Hsing; Koo, Malcolm

    2017-11-01

    Previous research has shown that diabetes mellitus increases the risk of lower extremity amputation in patients with peripheral arterial occlusive disease. However, to our knowledge, no studies have investigated whether systemic autoimmune disease, in particular systemic vasculitis is associated with a higher risk of lower extremity amputation in these patients. To investigate the association between systemic autoimmune disease and lower extremity amputation in patients with severe peripheral arterial occlusive disease based on a secondary analysis of a nationwide, population-based health claims database. Using the inpatient datafile of the Taiwan's National Health Insurance Research Database (NHIRD), we identified 432 patients with severe peripheral arterial occlusive disease that required hospitalization between 2000 and 2012. We also identified patients who had undergone lower extremity amputation and their comorbidities using the same datafile. The risk of lower extremity amputation was assessed using multiple logistic regression analysis, adjusting for age, sex, insured amount, the urbanization level of residence, and the presence of comorbidities. Among patients with severe peripheral arterial occlusive disease, those with systemic vasculitis exhibited a significant higher risk of lower extremity amputation (adjusted odds ratio [aOR] = 6.82, p obstructive pulmonary disease (aOR = 2.87, p = 0.007) were also significantly associated with a higher risk of lower extremity amputation. Among patients with severe peripheral arterial occlusive disease, a significantly higher risk of lower extremity amputation was observed in those with systemic vasculitis.

  8. Minor rheumatology: Nonsystemic rheumatic disease of juxta-articular soft tissues of the upper extremity. Part 2. Drug and non-drug treatments

    OpenAIRE

    Andrei Evgenyevich Karateev; D. E. Karateev; Yu. A. Ermakova

    2015-01-01

    The treatment of rheumatic diseases of juxta-articular soft tissues (RDJAST) of the upper extremity (rotator cuff tendinitis, epicondylitis, de Quervain’s syndrome, trigger finger, carpal tunnel syndrome) entails a combination of drug and nondrug therapies. The basic agents that have been proven to be efficacious in this pathology are nonsteroidal anti-inflammatory drugs (NSAIDs) and glucocorticosteroids (GCs). The paper considers the largest and known studies that are an evidence base for th...

  9. Effects of dopamine replacement therapy on lower extremity kinetics and kinematics during a rapid force production task in persons with Parkinson disease.

    Science.gov (United States)

    Foreman, K Bo; Singer, Madeline L; Addison, Odessa; Marcus, Robin L; LaStayo, Paul C; Dibble, Leland E

    2014-01-01

    Postural instability appears to be a dopamine resistance motor deficit in persons with Parkinson disease (PD); however, little is known about the effects of dopamine replacement on the relative biomechanical contributions of individual lower extremity joints during postural control tasks. To gain insight, we examined persons with PD using both clinical and laboratory measures. For a clinical measure of motor severity we utilized the Unified Parkinson Disease Rating Scale motor subsection during both OFF and ON medication conditions. For the laboratory measure we utilized data gathered during a rapid lower extremity force production task. Kinematic and kinetic variables at the hip, knee, and ankle were gathered during a counter movement jump during both OFF and ON medication conditions. Sixteen persons with PD with a median Hoehn and Yahr severity of 2.5 completed the study. Medication resulted in significant improvements of angular displacement for the hip, knee, and ankle. Furthermore, significant improvements were revealed only at the hip for peak net moments and average angular velocity compared to the OFF medication condition. These results suggest that dopamine replacement medication result in decreased clinical motor disease severity and have a greater influence on kinetics and kinematics proximally. This proximally focused improvement may be due to active recruitment of muscle force and reductions in passive restraint during lower extremity rapid force production. Copyright © 2013 Elsevier B.V. All rights reserved.

  10. Progression of disease preceding lower extremity amputation in Denmark: a longitudinal registry study of diagnoses, use of medication and healthcare services 14 years prior to amputation

    Science.gov (United States)

    Petersen, Janne; Kirketerp-Møller, Klaus; Poulsen, Ingrid; Andersen, Ove

    2017-01-01

    Objectives Patients with non-traumatic lower extremity amputation are characterised by high age, multi-morbidity and polypharmacy and long-term complications of atherosclerosis and diabetes. To ensure early identification of patients at risk of amputation, we need to gain knowledge about the progression of diseases related to lower extremity amputations during the years preceding the amputation. Design A retrospective population-based national registry study. Setting The study includes data on demographics, diagnoses, surgery, medications and healthcare services from five national registries. Data were retrieved from 14 years before until 1 year after the amputation. Descriptive statistics were used to describe the progression of diseases and use of medication and healthcare services. Participants An unselected cohort of patients (≥50 years; n=2883) subjected to a primary non-traumatic lower extremity amputation in 2010 or 2011 in Denmark. Results The prevalence of atherosclerosis, hypertension and diabetes was 70%, 53% and 49%, respectively. Among patients with atherosclerosis, 42% had not received cholesterol-lowering treatment even though 87% had visited their general practitioner within the last year prior to amputation. Further, 16% were diagnosed with diabetes at the time of the amputation. The prevalence of cardiovascular diseases increased from 22% to 70%, atherosclerosis from 5% to 53% and diabetes from 17% to 35% over the 14 years preceding major amputation. Of all patients, 64% had been in contact with the hospital or outpatient clinics within the last 3 years, and 29% received a prescription of opioids 3 years prior to the amputation. Conclusion Among patients with non-traumatic lower extremity amputation, one-third live with undiagnosed and untreated atherosclerosis and one-sixth suffer from undiagnosed diabetes despite continuous contacts to general practitioner and the hospital. This study emphasises a need for enhanced focus, among both

  11. Hirayama’s Disease – A Rare Case Report with Review of Literature

    Directory of Open Access Journals (Sweden)

    Narayana Gowda BS

    2013-07-01

    Full Text Available Introduction: Hirayama’s disease is a rare benign disorder, also referred to as monomelic amyotrophy (MMA, Juvenile non progressive amyotrophy, Sobue disease. It is a focal, lower motor neuron type of disease. Mainly young males in their second and third decades of age are most commonly affected. It is seen most commonly in Asian countries like India and Japan. In majority of people cause of this disease is unknown. MRI of cervical spine in flexion will reveal the cardinal features of Hirayama disease. Case Report: A 22 year gentleman came with a history of insidious onset of weakness in both the hands begenning with left side followed by right of 4 years duration. On examination he had clawing of both hands with wasting of forearm muscles. Lower limbs had no abnormality with normal deep tendon reflexes. MRI showed thinning of cord from C4 to C7 level suggestive of cord atrophy. Based on these features a diagnosis of focal amyotrophy was made. A cervical collar was prescribed and patient is under regular follow up. Conclusion: Hirayama disease is a rare self-limiting disease. Early diagnosis is necessary as the use of a simple cervical collar which will prevent neck flexion, has been shown to stop the progression. Keywords: Hirayama’s disease, monomelic amyotrophy, Juvenile non-progressive amyotrophy, Sobue disease.

  12. The effect of extremity strength training on fibromyalgia symptoms and disease impact in an existing multidisciplinary treatment program.

    Science.gov (United States)

    Kas, Tamara; Colby, Megan; Case, Maureen; Vaughn, Dan

    2016-10-01

    The purpose of this study was to examine the effect of upper and lower body extremity strengthening exercise in patients with Fibromyalgia (FM) within an existing multidisciplinary treatment program. Patients between the ages of 18-65 with the medical diagnosis of FM. Comparative study design. The control and experimental group received the same multidisciplinary treatment except that the experimental group performed upper and lower extremity strengthening exercises. The Fibromyalgia Impact Questionnaire (FIQ) was administered at evaluation and discharge from the program in order to measure change in quality of life (QOL). Statistically significant changes in FIQ scores were found for both groups. The addition of extremity strengthening in the experimental group produced an average 4 points greater reduction in FIQ score, however, these results are not considered statistically significant. This study appears to validate the success of a multidisciplinary approach in treating patients with FM, with the possibility for further benefit with the addition of extremity strengthening. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. 'Recovered from cancer but still ill': strategies used to legitimise extreme persistent fatigue in disease-free cancer patients.

    Science.gov (United States)

    Rosman, S

    2009-01-01

    This article analyses the experience of former cancer patients who, many years after the treatment of their illness, suffer from 'extreme persistent fatigue'. The aim is to demonstrate how this symptom can be experienced as problematic and to detail coping strategies that individuals use in order to live with it. This qualitative exploratory study took place in the Netherlands and was based on semi-structured interviews with 12 former cancer patients suffering from extreme fatigue 7-10 years after their illness was treated. The aim of the informants is to achieve a medical diagnosis of cancer-related fatigue, which increases their chances of receiving care and understanding, and thus gives a social and medical legitimacy to their suffering. The search for legitimacy appeared to be especially evident in the demands for disability allowances. Counselling and care in cancer patients should be more focused on the prevention of persistent fatigue during and after cancer diagnosis and treatments.

  14. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: Executive Summary

    Science.gov (United States)

    Gerhard-Herman, Marie D.; Gornik, Heather L.; Barrett, Coletta; Barshes, Neal R.; Corriere, Matthew A.; Drachman, Douglas E.; Fleisher, Lee A.; Fowkes, Francis Gerry R.; Hamburg, Naomi M.; Kinlay, Scott; Lookstein, Robert; Misra, Sanjay; Mureebe, Leila; Olin, Jeffrey W.; Patel, Rajan A.G.; Regensteiner, Judith G.; Schanzer, Andres; Shishehbor, Mehdi H.; Stewart, Kerry J.; Treat-Jacobson, Diane; Walsh, M. Eileen; Halperin, Jonathan L.

    2017-01-01

    ). Members are restricted with regard to writing or voting on sections to which their RWI apply. For transparency, members' comprehensive disclosure information is available online. Comprehensive disclosure information for the Task Force is also available online. The Task Force strives to avoid bias by selecting experts from a broad array of backgrounds representing different geographic regions, sexes, ethnicities, intellectual perspectives/biases, and scopes of clinical practice, and by inviting organizations and professional societies with related interests and expertise to participate as partners or collaborators. Individualizing Care in Patients With Associated Conditions and Comorbidities Managing patients with multiple conditions can be complex, especially when recommendations applicable to coexisting illnesses are discordant or interacting.8 The guidelines are intended to define practices meeting the needs of patients in most, but not all, circumstances. The recommendations should not replace clinical judgment. Clinical Implementation Management in accordance with guideline recommendations is effective only when followed. Adherence to recommendations can be enhanced by shared decision making between clinicians and patients, with patient engagement in selecting interventions on the basis of individual values, preferences, and associated conditions and comorbidities. Consequently, circumstances may arise in which deviations from these guidelines are appropriate. The reader is encouraged to consult the full-text guideline9 for additional guidance and details with regard to lower extremity peripheral artery disease (PAD) because the executive summary contains limited information. PMID:27840332

  15. The Risk of Tuberculosis Reinfection Soon after Cure of a First Disease Episode Is Extremely High in a Hyperendemic Community.

    Directory of Open Access Journals (Sweden)

    Pieter Uys

    Full Text Available Elevated rates of reinfection tuberculosis in various hyperendemic regions have been reported and, in particular, it has been shown that in a high-incidence setting near Cape Town, South Africa, the rate of reinfection tuberculosis (TB disease after cure of a previous TB disease episode is about four times greater than the rate of first-time TB disease. It is not known whether this elevated rate is caused by a high reinfection rate due, for instance, to living circumstances, or a high rate of progress to disease specific to the patients, or both. In order to address that question we analysed an extensive data set from clinics attended by TB patients in the high-incidence setting near Cape Town, South Africa and found that, in fact, the (average rate of reinfection (as opposed to the rate of reinfection disease after cure of a previous TB disease episode is initially about 0.85 per annum. This rate diminishes rapidly over time and after about ten years this rate is similar to the rate of infection in the general population. Also, the rate of progress to disease after reinfection is initially high but declines in subsequent years down to the figure typical for the general population. These findings suggest that the first few months after cure of a TB disease episode form a critical period for controlling reinfection disease in a hyperendemic setting and that monitoring such cured patients could pre-empt a reinfection progressing to active disease.

  16. Extreme cosmos

    CERN Document Server

    Gaensler, Bryan

    2011-01-01

    The universe is all about extremes. Space has a temperature 270°C below freezing. Stars die in catastrophic supernova explosions a billion times brighter than the Sun. A black hole can generate 10 million trillion volts of electricity. And hypergiants are stars 2 billion kilometres across, larger than the orbit of Jupiter. Extreme Cosmos provides a stunning new view of the way the Universe works, seen through the lens of extremes: the fastest, hottest, heaviest, brightest, oldest, densest and even the loudest. This is an astronomy book that not only offers amazing facts and figures but also re

  17. Acute leukemia presenting with extramedullary diseases and completely normal hemogram: an extremely unusual manifestation unique to pre-B ALL

    National Research Council Canada - National Science Library

    Chen, Chih-Cheng; Weng, Hsu-Huei; Hwang, Cih-En; Lu, Chang-Hsien; Chen, Ping-Tsung; Gau, Jyh-Pyng

    2010-01-01

    Acute lymphoblastic leukemia (ALL) is a clonal hematological disease characterized by inadequate normal hematopoiesis secondary to excessive proliferation of leukemic blasts and their impaired differentiation...

  18. Why do people buy dogs with potential welfare problems related to extreme conformation and inherited disease? A representative study of Danish owners of four small dog breeds

    Science.gov (United States)

    Kondrup, S. V.; Bennett, P. C.; Forkman, B.; Meyer, I; Proschowsky, H. F.; Serpell, J. A.; Lund, T. B.

    2017-01-01

    A number of dog breeds suffer from welfare problems due to extreme phenotypes and high levels of inherited diseases but the popularity of such breeds is not declining. Using a survey of owners of two popular breeds with extreme physical features (French Bulldog and Chihuahua), one with a high load of inherited diseases not directly related to conformation (Cavalier King Charles Spaniel), and one representing the same size range but without extreme conformation and with the same level of disease as the overall dog population (Cairn Terrier), we investigated this seeming paradox. We examined planning and motivational factors behind acquisition of the dogs, and whether levels of experienced health and behavior problems were associated with the quality of the owner-dog relationship and the intention to re-procure a dog of the same breed. Owners of each of the four breeds (750/breed) were randomly drawn from a nationwide Danish dog registry and invited to participate. Of these, 911 responded, giving a final sample of 846. There were clear differences between owners of the four breeds with respect to degree of planning prior to purchase, with owners of Chihuahuas exhibiting less. Motivations behind choice of dog were also different. Health and other breed attributes were more important to owners of Cairn Terriers, whereas the dog’s personality was reported to be more important for owners of French Bulldogs and Cavalier King Charles Spaniels but less important for Chihuahua owners. Higher levels of health and behavior problems were positively associated with a closer owner-dog relationship for owners of Cavalier King Charles Spaniels and Chihuahuas but, for owners of French Bulldogs, high levels of problems were negatively associated with an intention to procure the same breed again. In light of these findings, it appears less paradoxical that people continue to buy dogs with welfare problems. PMID:28234931

  19. [The influence of the training of the muscular component of the musculo-venous pump in the lower extremities on the clinical course of varicose vein disease].

    Science.gov (United States)

    Kravtsov, P F; Katorkin, S A; Volkovoy, V V; Sizonenko, Ya V

    Investigations of the influence of the training of the muscular component of the musculo-venous pump in the lower extremities on the clinical course of varicose vein disease and correction of the step cycle are currently underway. The objective of the present study was to evaluate the impact of the training of the muscular component of the musculo-venous pump in the lower extremities and of the correction of the step cycle on the quality of life of the patients presenting with varicose vein disease. The study included 22 patients with varicose veins in the lower extremities (CEAP clinical class C3 or C4). All the patients performed, twice daily during a total of 60 days, a specially designed complex of 7 exercise intended to strengthen the posterior muscle group of the lower legs and correct the step cycle. After 60 days, all the patients reported the appearance of the subjective signs suggesting positive dynamics of their condition. The following statistically significant changes were documented: reduction of the malleolar circumference, improvement of integral characteristics of the quality of life as evaluated with the use of the international questionnaire for the patients with chronic lower limb venous insufficiency (CIVIQ), normalization of the frequency and amplitude of modal oscillations in the soleus muscle revealed by electromyography. The correction of foot rolling muscles and the sequence of activation of the muscles involved in the first five phases of the cycle step increases the strength of contraction of the soleus muscle, promotes venous blood flow in the proximal direction, and thereby enhances the efficiency of the venous outflow. The development of adequate gain skills, the correction of the step cycle, and the strengthening of the muscular component of the musculo-venous pump lead to the improvement of the clinical course of varicose vein disease. The proposed complex of physical exercises provides an effective and pathogenetically sound

  20. Why do people buy dogs with potential welfare problems related to extreme conformation and inherited disease? A representative study of Danish owners of four small dog breeds.

    Science.gov (United States)

    Sandøe, P; Kondrup, S V; Bennett, P C; Forkman, B; Meyer, I; Proschowsky, H F; Serpell, J A; Lund, T B

    2017-01-01

    A number of dog breeds suffer from welfare problems due to extreme phenotypes and high levels of inherited diseases but the popularity of such breeds is not declining. Using a survey of owners of two popular breeds with extreme physical features (French Bulldog and Chihuahua), one with a high load of inherited diseases not directly related to conformation (Cavalier King Charles Spaniel), and one representing the same size range but without extreme conformation and with the same level of disease as the overall dog population (Cairn Terrier), we investigated this seeming paradox. We examined planning and motivational factors behind acquisition of the dogs, and whether levels of experienced health and behavior problems were associated with the quality of the owner-dog relationship and the intention to re-procure a dog of the same breed. Owners of each of the four breeds (750/breed) were randomly drawn from a nationwide Danish dog registry and invited to participate. Of these, 911 responded, giving a final sample of 846. There were clear differences between owners of the four breeds with respect to degree of planning prior to purchase, with owners of Chihuahuas exhibiting less. Motivations behind choice of dog were also different. Health and other breed attributes were more important to owners of Cairn Terriers, whereas the dog's personality was reported to be more important for owners of French Bulldogs and Cavalier King Charles Spaniels but less important for Chihuahua owners. Higher levels of health and behavior problems were positively associated with a closer owner-dog relationship for owners of Cavalier King Charles Spaniels and Chihuahuas but, for owners of French Bulldogs, high levels of problems were negatively associated with an intention to procure the same breed again. In light of these findings, it appears less paradoxical that people continue to buy dogs with welfare problems.

  1. Assessment of Post-Occlusive Reactive Hyperaemia in the Evaluation of Endothelial Function in Patients with Lower Extremity Artery Disease

    Directory of Open Access Journals (Sweden)

    Carasca Cosmin

    2017-09-01

    Full Text Available Background: The aim was to assess endothelial function with photoplethysmography (PPG, by post-occlusive reactive hyperaemia (PORH combined with alprostadil challenge test in patients with peripheral artery disease (PAD.

  2. Acute leukemia presenting with extramedullary diseases and completely normal hemogram: an extremely unusual manifestation unique to pre-B ALL.

    Science.gov (United States)

    Chen, Chih-Cheng; Weng, Hsu-Huei; Hwang, Cih-En; Lu, Chang-Hsien; Chen, Ping-Tsung; Gau, Jyh-Pyng

    2010-09-01

    Acute lymphoblastic leukemia (ALL) is a clonal hematological disease characterized by inadequate normal hematopoiesis secondary to excessive proliferation of leukemic blasts and their impaired differentiation. As a result, patients usually manifest symptoms related to bone marrow failure. It's very uncommon for ALL patients to present with normal hemogram. Herein, we describe two patients who presented with excruciating bone pain at orthopedic clinics. Osteopathy involving multiple bones was noted initially, but acute leukemia was never considered as one of the differential diagnoses because of the completely normal hemogram in both cases. Consequently, the diagnosis of leukemia was slightly delayed. Upon literature review, we found that ALL patients with solely extramedullary diseases and nearly normal hemogram had exclusively pre-B disease. We also propose a putative hypothesis for this interesting finding.

  3. Bone pain and extremely low bone mineral density due to severe vitamin D deficiency in celiac disease

    NARCIS (Netherlands)

    Rabelink, N.M.; Westgeest, H.M.; Bravenboer, N.; Jacobs, M.A.J.M.; Lips, P.T.A.M.

    2011-01-01

    Case report A 29-year-old wheelchair-bound woman was presented to us by the gastroenterologist with suspected osteomalacia. She had lived in the Netherlands all her life and was born of Moroccan parents. Her medical history revealed iron deficiency, growth retardation, and celiac disease, for which

  4. Minor rheumatology: Nonsystemic rheumatic disease of juxta-articular soft tissues of the upper extremity. Part 1

    OpenAIRE

    A. E. Karateev; D. E. Karateev; E. S. Orlova; Yu. A. Ermakova

    2015-01-01

    Rheumatic diseases of juxta-articular soft tissues (RDJAST) (tendinitis, tenosynovitis, bursitis, etc.) are one of the most common causes of disability and one the most common reasons for seeking medical advice. To manage patients with RDJAST is an important part of practising rheumatologists’ work. But unfortunately, the issues of diagnosis and therapy of this pathology have been relatively rarely discussed on the pages of Russian medical journals and at the scientific congresses and confere...

  5. Differential Diagnosis of Chronic Total Occlusive and Subtotal Occlusive Disease of the Lower Extremity Arteries Using Reverse Attenuation Gradient Sign on CT Angiography.

    Science.gov (United States)

    Lee, Jung Eun; Park, Hee Jin; Lee, So Yeon; Chung, Eun Chul; Rho, Myung Ho; Cha, Jang Gyu; Lee, Sun Joo

    2015-11-01

    The purpose of this study is to evaluate the diagnostic usefulness of the reverse attenuation gradient sign in occlusive lower extremity arterial disease through CT angiography (CTA). This study sample enrolled 45 men and eight women in the chronic total occlusion group and 30 men and seven women in the subtotal occlusion group. Luminal CT attenuation (in Hounsfield units) was measured at three points from the end of the occlusion site to the first collateral vessel's insertion point. We also used Hounsfield units to measure the CT attenuation of the opposite side artery at the same level in a similar manner. We compared each value using the Mann-Whitney U test. The absolute value of the mean differences in the Hounsfield units among the proximal, middle, and distal portion of chronic total occlusions were higher than those of subtotal occlusions, and this result was statistically significant (p total occlusions were statistically significantly lower than those of subtotal occlusions. The reverse attenuation gradient sign can be applied to the lower extremity arteries and can be helpful for differential diagnosis of chronic total occlusions from subtotal occlusions using CTA.

  6. Bone pain and extremely low bone mineral density due to severe vitamin D deficiency in celiac disease

    OpenAIRE

    Rabelink, Noortje M.; Westgeest, Hans M.; Bravenboer, Nathalie; Jacobs, Maarten A. J. M.; Lips, Paul

    2011-01-01

    Case report A 29-year-old wheelchair-bound woman was presented to us by the gastroenterologist with suspected osteomalacia. She had lived in the Netherlands all her life and was born of Moroccan parents. Her medical history revealed iron deficiency, growth retardation, and celiac disease, for which she was put on a gluten-free diet. She had progressive bone pain since 2 years, difficulty with walking, and about 15 kg weight loss. She had a short stature, scoliosis, and pronounced kyphosis of ...

  7. Minor rheumatology: Nonsystemic rheumatic disease of juxta-articular soft tissues of the upper extremity. Part 2. Drug and non-drug treatments

    Directory of Open Access Journals (Sweden)

    Andrei Evgenyevich Karateev

    2015-01-01

    Full Text Available The treatment of rheumatic diseases of juxta-articular soft tissues (RDJAST of the upper extremity (rotator cuff tendinitis, epicondylitis, de Quervain’s syndrome, trigger finger, carpal tunnel syndrome entails a combination of drug and nondrug therapies. The basic agents that have been proven to be efficacious in this pathology are nonsteroidal anti-inflammatory drugs (NSAIDs and glucocorticosteroids (GCs. The paper considers the largest and known studies that are an evidence base for the expediency of using agents, such NSAIDs, local administration of GCs, hyaluronic acid, and plateletrich plasma, as well as different non-drug treatments, in RDJAST. The latter (physiotherapy, exercises, and rehabilitation programs should be regarded as a necessary component of the therapeutic process in patients with RDJAST-associated chronic pain. Preservation of obvious pain and impaired function despite medical therapy should be regarded as an indication for surgical treatment.

  8. A fast approach for detection of erythemato-squamous diseases based on extreme learning machine with maximum relevance minimum redundancy feature selection

    Science.gov (United States)

    Liu, Tong; Hu, Liang; Ma, Chao; Wang, Zhi-Yan; Chen, Hui-Ling

    2015-04-01

    In this paper, a novel hybrid method, which integrates an effective filter maximum relevance minimum redundancy (MRMR) and a fast classifier extreme learning machine (ELM), has been introduced for diagnosing erythemato-squamous (ES) diseases. In the proposed method, MRMR is employed as a feature selection tool for dimensionality reduction in order to further improve the diagnostic accuracy of the ELM classifier. The impact of the type of activation functions, the number of hidden neurons and the size of the feature subsets on the performance of ELM have been investigated in detail. The effectiveness of the proposed method has been rigorously evaluated against the ES disease dataset, a benchmark dataset, from UCI machine learning database in terms of classification accuracy. Experimental results have demonstrated that our method has achieved the best classification accuracy of 98.89% and an average accuracy of 98.55% via 10-fold cross-validation technique. The proposed method might serve as a new candidate of powerful methods for diagnosing ES diseases.

  9. Comparison of the severity of lower extremity arterial disease in smokers and patients with diabetes using a novel duplex Doppler scoring system.

    Science.gov (United States)

    Hiremath, Rudresh; Gowda, Goutham; Ibrahim, Jebin; Reddy, Harish T; Chodiboina, Haritha; Shah, Rushit

    2017-07-01

    The aim of this study was to validate the diagnostic feasibility of a novel scoring system of peripheral arterial disease (PAD) in smokers and patients with diabetes depending on duplex Doppler sonographic features. Patients presenting with the symptomatology of PAD were divided into three groups: diabetes only, smoking only, and smokers with diabetes. The patients were clinically examined, a clinical severity score was obtained, and the subjects were categorized into the three extrapolated categories of mild, moderate, and severe. All 106 subjects also underwent a thorough duplex Doppler examination, and various aspects of PAD were assessed and tabulated. These components were used to create a novel duplex Doppler scoring system. Depending on the scores obtained, each individual was categorized as having mild, moderate, or severe illness. The Cohen kappa value was used to assess interobserver agreement between the two scoring systems. Interobserver agreement between the traditional Rutherford clinical scoring system and the newly invented duplex Doppler scoring system showed a kappa value of 0.83, indicating significant agreement between the two scoring systems (PDoppler imaging is an effective screening investigation for lower extremity arterial disease, as it not only helps in its diagnosis, but also in the staging and grading of the disease, providing information that can be utilized for future management and treatment planning.

  10. Comparison of the severity of lower extremity arterial disease in smokers and patients with diabetes using a novel duplex Doppler scoring system

    Energy Technology Data Exchange (ETDEWEB)

    Hiremath, Rudresh; Gowda, Goutham; Ibrahim, Jebin; Reddy, Harish T.; Chodiboina, Haritha; Shah, Rushit [Radiodiagnosis and Imaging, KVG Medical College and Hospital, Sullia (India)

    2017-07-15

    The aim of this study was to validate the diagnostic feasibility of a novel scoring system of peripheral arterial disease (PAD) in smokers and patients with diabetes depending on duplex Doppler sonographic features. Patients presenting with the symptomatology of PAD were divided into three groups: diabetes only, smoking only, and smokers with diabetes. The patients were clinically examined, a clinical severity score was obtained, and the subjects were categorized into the three extrapolated categories of mild, moderate, and severe. All 106 subjects also underwent a thorough duplex Doppler examination, and various aspects of PAD were assessed and tabulated. These components were used to create a novel duplex Doppler scoring system. Depending on the scores obtained, each individual was categorized as having mild, moderate, or severe illness. The Cohen kappa value was used to assess interobserver agreement between the two scoring systems. Interobserver agreement between the traditional Rutherford clinical scoring system and the newly invented duplex Doppler scoring system showed a kappa value of 0.83, indicating significant agreement between the two scoring systems (P<0.001). Duplex Doppler imaging is an effective screening investigation for lower extremity arterial disease, as it not only helps in its diagnosis, but also in the staging and grading of the disease, providing information that can be utilized for future management and treatment planning.

  11. Generation and Measurement of Chlorine Dioxide Gas at Extremely Low Concentrations in a Living Room: Implications for Preventing Airborne Microbial Infectious Diseases.

    Science.gov (United States)

    Ogata, Norio; Sogawa, Koushirou; Takigawa, Yasuhiro; Shibata, Takashi

    2017-01-01

    Preventing respiratory diseases caused by airborne microbes in enclosed spaces is still not satisfactorily controlled. At extremely low concentrations (about 30 parts per billion), chlorine dioxide (ClO2) gas can inactivate airborne microbes and prevent respiratory disease. It has no toxic effect on animals at this level. However, controversies still remain regarding how to measure concentrations of ClO2 gas at such low levels. It is therefore necessary to prove that measured gas concentrations are accurate and reproducible. ClO2 gas was released from a gas generator and its concentration was measured by a novel highly sensitive gas analyzer. We compared its data with those from ion chromatography. We demonstrate that the gas concentrations measured in a room using the gas analyzer are accurate and reproducible after comparing the results with those from ion chromatography. However, the temperature dependence of the gas analyzer was found. Therefore, data correction is required for each temperature at which gas concentration is measured. A theoretical analysis of the gas concentrations predicted by the rate of ClO2 gas released from the ClO2 generator was also performed. Our results advance progress toward using low concentration ClO2 gas to prevent airborne infectious diseases such as influenza. © 2016 S. Karger AG, Basel.

  12. The relationships between the unified Parkinson's disease rating scale and lower extremity functional performance in persons with early-stage Parkinson's disease.

    Science.gov (United States)

    Song, Jooeun; Fisher, Beth E; Petzinger, Giselle; Wu, Allan; Gordon, James; Salem, George J

    2009-09-01

    The Unified Parkinson's Disease Rating Scale (UPDRS) is the "gold standard" assessment tool for characterizing impairments in persons with Parkinson's disease (PD); however, this scale's ability to predict functional capabilities across different functional tasks has not been adequately assessed in persons with early-stage PD. Thirty persons with PD within 3 years of diagnosis and without motor fluctuation performed self-selected walking, fast walking, and sit-to-stand and stair-climbing tasks. Pearson's correlation coefficients were used to calculate correlations with a standard UPDRS examination (Pdisease progression, and assess the efficacy of interventions.

  13. The burden of disease of dental anxiety : generic and disease-specific quality of life in patients with and without extreme levels of dental anxiety

    NARCIS (Netherlands)

    Vermaire, J. H.; van Houtem, C. M. H. H.; Ross, J. N.; Schuller, A. A.

    2016-01-01

    The aim of this study was to compare disease-specific (oral health-related) quality of life (OHRQoL), assessed using the Oral Health Impact Profile-14 (OHIP-14), and generic (health-related) quality of life (HRQoL), assessed using the EuroQol5D (EQ-5D-5L), in patients with severe dental anxiety (who

  14. Effects of an elastic band resistance exercise program on lower extremity muscle strength and gait ability in patients with Alzheimer's disease.

    Science.gov (United States)

    Ahn, Nayoung; Kim, Kijin

    2015-06-01

    [Purpose] This study examined the effects of a resistance exercise programs aiming to improve muscular function in order to prevent and treat Alzheimer's disease in elderly people. [Subjects and Methods] Elderly patients with mild dementia were randomly assigned to an elastic band resistance exercise group (74.21±6.09 years). The experimental group (n=23) performed upper and lower extremity exercises three times per week for five months. Physical fitness was measured according to chair leg squat, one-leg stance, timed up-and-go test, 2-minute walking test, and gait ability before and after exercise. [Results] Static balance ability in which the participant stood on one foot with eyes open (left and right) increased significantly, but the dynamic balancing ability in the timed up-and-go test did not improve significantly. Cardiorespiratory function and gait speed improved significantly. [Conclusion] The five-month elastic band resistance exercise program improved muscle strength and endurance, cardiovascular function, and gait speed. Therefore, it may be an effective rehabilitation program for elderly patients with Alzheimer's disease.

  15. Myelopathy due to degenerative and structural spine diseases.

    Science.gov (United States)

    Tavee, Jinny O; Levin, Kerry H

    2015-02-01

    This article reviews the current evaluation and treatment of patients with myelopathy due to cervical spondylotic disease and other structural disorders of the spine. In patients with cervical spondylotic myelopathy, symptom duration, severity at baseline, and possibly age have been identified as key prognostic markers of clinical course and postsurgical outcome. Other potential markers include specific MRI and EMG findings. The diagnosis and monitoring of syringomyelia is enhanced by the addition of phase contrast MRI, which evaluates CSF flow dynamics. Flexion MRI is helpful in establishing the diagnosis of Hirayama disease, which is now attributed to a tightened dural sac that is displaced anteriorly on neck flexion, compressing the cord. Advances in neuroimaging along with new insights into the pathophysiology of structural spine diseases can help guide clinical decision making and optimize patient outcomes.

  16. Risk factors for foot ulceration and lower extremity amputation in adults with end-stage renal disease on dialysis: a systematic review and meta-analysis.

    Science.gov (United States)

    Kaminski, Michelle R; Raspovic, Anita; McMahon, Lawrence P; Strippoli, Giovanni F M; Palmer, Suetonia C; Ruospo, Marinella; Dallimore, Sarah; Landorf, Karl B

    2015-10-01

    Adults with end-stage renal disease are at increased risk of foot ulceration and lower extremity amputation. However, the central determinants of lower limb injury and loss are incompletely understood. We conducted a systematic review of non-randomized studies that quantified the major risk factors for foot ulceration and amputation in adults treated with dialysis and analysed patient populations in which risks were greatest. Random-effects meta-analysis was used to generate summary estimates. Thirty studies (48 566 participants) were identified. Risk factors for foot ulceration and amputation included previous foot ulceration (odds ratios, OR, 17.56 and 70.13), peripheral arterial disease (OR, 7.52 and 9.12), diabetes (OR, 3.76 and 7.48), peripheral neuropathy (OR, 3.24 and 3.36) and coronary artery disease (OR, 3.92 and 2.49). Participants with foot ulceration or amputation had experienced a longer duration of diabetes (mean difference, MD, 4.04 and 6.07 years) and had lower serum albumin levels (MD, -0.23 and -0.13 g/dL). Risk factors for foot ulceration also included retinopathy (OR, 3.03), previous amputation (OR, 15.50) and higher serum phosphorus levels (MD, 0.40 mg/dL), while risk factors for amputation also included male sex (OR, 1.50), current smoking (OR, 2.26) and higher glycated haemoglobin levels (MD, 0.75%). Dialysis patients who have markedly higher risks of ulceration or amputation include those with previous foot ulceration or amputation, peripheral neuropathy, diabetes or macrovascular disease. The temporal relationship between these risk factors and the development of foot ulceration and/or limb loss is uncertain and requires further study. Stable estimates of the key risk factors for ulceration and amputation can inform the design of future trials investigating clinical interventions to reduce the burden of lower limb disease in the dialysis population. © The Author 2015. Published by Oxford University Press on behalf of ERA-EDTA. All rights

  17. Extremely Low-Frequency Magnetic Exposure Appears to Have No Effect on Pathogenesis of Alzheimer’s Disease in Aluminum-Overloaded Rat

    Science.gov (United States)

    Zhang, Cheng; Li, Yue; Wang, Chao; Lv, Ruili; Song, Tao

    2013-01-01

    Objective Extremely low-frequency magnetic field (ELF-MF) has been reported to be of potential pathogenetic relevance to Alzheimer's disease (AD) for years. However, evidence confirming this function remains inconclusive. Chronic Al treatment has been identified as a contributing factor to cognitive function impairment in AD. This study aims to examine whether or not ELF-MF and Al have synergistic effects toward AD pathogenesis by investigating the effects of ELF-MF with or without chronic Al treatment on SD rats. Methods Sprague-Dawley (SD) rats were subjected one of the following treatments: sham (control group), oral Al (Al group), ELF-MF (100 µT at 50 Hz) with oral Al (MF+Al group), or ELF-MF (100 µT at 50 Hz) without oral Al (MF group). Results After 12 wk of treatment, oral Al treatment groups (Al and MF+Al groups) showed learning and memory impairment as well as morphological hallmarks, including neuronal cell loss and high density of amyloid-β (Aβ) in the hippocampus and cerebral cortex. ELF-MF without Al treatment showed no significant effect on AD pathogenesis. ELF-MF+Al treatment induced no more damage than Al treatment did. Conclusions Our results showed no evidence of any association between ELF-MF exposure (100 µT at 50 Hz) and AD, and ELF-MF exposure does not influence the pathogenesis of AD induced by Al overload. PMID:23951088

  18. Extremely low-frequency magnetic exposure appears to have no effect on pathogenesis of Alzheimer's disease in aluminum-overloaded rat.

    Science.gov (United States)

    Zhang, Cheng; Li, Yue; Wang, Chao; Lv, Ruili; Song, Tao

    2013-01-01

    Extremely low-frequency magnetic field (ELF-MF) has been reported to be of potential pathogenetic relevance to Alzheimer's disease (AD) for years. However, evidence confirming this function remains inconclusive. Chronic Al treatment has been identified as a contributing factor to cognitive function impairment in AD. This study aims to examine whether or not ELF-MF and Al have synergistic effects toward AD pathogenesis by investigating the effects of ELF-MF with or without chronic Al treatment on SD rats. Sprague-Dawley (SD) rats were subjected one of the following treatments: sham (control group), oral Al (Al group), ELF-MF (100 µT at 50 Hz) with oral Al (MF+Al group), or ELF-MF (100 µT at 50 Hz) without oral Al (MF group). After 12 wk of treatment, oral Al treatment groups (Al and MF+Al groups) showed learning and memory impairment as well as morphological hallmarks, including neuronal cell loss and high density of amyloid-β (Aβ) in the hippocampus and cerebral cortex. ELF-MF without Al treatment showed no significant effect on AD pathogenesis. ELF-MF+Al treatment induced no more damage than Al treatment did. Our results showed no evidence of any association between ELF-MF exposure (100 µT at 50 Hz) and AD, and ELF-MF exposure does not influence the pathogenesis of AD induced by Al overload.

  19. Extremely low-frequency magnetic exposure appears to have no effect on pathogenesis of Alzheimer's disease in aluminum-overloaded rat.

    Directory of Open Access Journals (Sweden)

    Cheng Zhang

    Full Text Available OBJECTIVE: Extremely low-frequency magnetic field (ELF-MF has been reported to be of potential pathogenetic relevance to Alzheimer's disease (AD for years. However, evidence confirming this function remains inconclusive. Chronic Al treatment has been identified as a contributing factor to cognitive function impairment in AD. This study aims to examine whether or not ELF-MF and Al have synergistic effects toward AD pathogenesis by investigating the effects of ELF-MF with or without chronic Al treatment on SD rats. METHODS: Sprague-Dawley (SD rats were subjected one of the following treatments: sham (control group, oral Al (Al group, ELF-MF (100 µT at 50 Hz with oral Al (MF+Al group, or ELF-MF (100 µT at 50 Hz without oral Al (MF group. RESULTS: After 12 wk of treatment, oral Al treatment groups (Al and MF+Al groups showed learning and memory impairment as well as morphological hallmarks, including neuronal cell loss and high density of amyloid-β (Aβ in the hippocampus and cerebral cortex. ELF-MF without Al treatment showed no significant effect on AD pathogenesis. ELF-MF+Al treatment induced no more damage than Al treatment did. CONCLUSIONS: Our results showed no evidence of any association between ELF-MF exposure (100 µT at 50 Hz and AD, and ELF-MF exposure does not influence the pathogenesis of AD induced by Al overload.

  20. Relationship between Serum 25-Hydroxyvitamin D and Lower Extremity Arterial Disease in Type 2 Diabetes Mellitus Patients and the Analysis of the Intervention of Vitamin D

    Directory of Open Access Journals (Sweden)

    Wan Zhou

    2015-01-01

    Full Text Available The aim of this study was to explore the relationship between serum 25-hydroxyvitamin D [25(OHD] concentrations and lower extremity arterial disease (LEAD in type 2 diabetes mellitus (T2DM patients and to investigate the intervention effect of vitamin D. 145 subjects were assigned to a control group (Group NC, T2DM group (Group DM1, and T2DM complicated with LEAD group (Group DM2; then Group DM2 were randomly divided into Group DM3 who received oral hypoglycemic agents and Group DM4 who received oral hypoglycemic drugs and vitamin D3 therapy. Compared to Group NC, 25(OHD was significantly lower in Group DM2 and marginally lower in Group DM1. In contrast to baseline and Group DM3, 25(OHD rose while low density lipoprotein (LDL, retinol binding protein 4 (RBP4, and HbA1c significantly lowered in Group DM4. Statistical analysis revealed that 25(OHD had a negative correlation with RBP4, duration, HbA1c, homeostasis model assessment for insulin resistance (HOMA-IR, and fasting plasma glucose (FPG. LDL, systolic blood pressure (SBP, FPG, and smoking were risk factors of LEAD while high density lipoprotein (HDL and 25(OHD were protective ones. Therefore, we deduced that low level of 25(OHD is significantly associated with the occurrence of T2DM complicated with LEAD.

  1. Minor rheumatology: Nonsystemic rheumatic disease of juxta-articular soft tissues of the pelvis and lower extremity: Diagnosis and treatment. Part 3

    Directory of Open Access Journals (Sweden)

    A. E. Karateev

    2015-01-01

    Full Text Available Pain associated with rheumatic diseases of juxta-articular soft tissues (RDJAST of the pelvis and lower extremity is a frequent reason for seeking advice from general practitioners and rheumatologists. However, the true cause of painful sensations is often overlooked by a physician and the patient is long and frequently treated unsuccessfully for lumbago, coxarthrosis, or gonarthrosis.The complexities of topical diagnosis are largely associated with the fact that instrumental methods virtually always determine these or those degenerative changes in the lumbar spine and hip joint (HJ, which formally supports the presence of nonspecific low back pain and coxarthrosis. Differential diagnosis can be made between these conditions if their clinical features are considered, by discriminating symptoms, such as pains in the back or buttock, and those located predominantly in the hip and groin area.The most known forms of RDJAST of the pelvis and HJ may include trochanteritis, hip abductor and adductor syndromes, iliopectineal bursitis, and ischial tuberosity bursitis.This review briefly describes the major forms of RDJAST of the mentioned area, their clinical manifestations, and topical diagnostic techniques. It also considers main therapeutic approaches: the administration of nonsteroidal antiinflammatory drugs, local injections of glucocorticoids and plateletrich plasma, and physiotherapy.

  2. ECG-triggered non-contrast-enhanced MR angiography (TRANCE) versus digital subtraction angiography (DSA) in patients with peripheral arterial occlusive disease of the lower extremities

    Energy Technology Data Exchange (ETDEWEB)

    Gutzeit, Andreas [Cantonal Hospital Winterthur, Department of Radiology, Winterthur (Switzerland); Paracelsus Medical University Salzburg, Department of Radiology, Salzburg (Austria); Sutter, Reto [Cantonal Hospital Winterthur, Department of Radiology, Winterthur (Switzerland); University Hospital Balgrist, Department of Radiology, Zurich (Switzerland); Froehlich, Johannes M.; Roos, Justus E.; Sautter, Thomas; Schoch, Erik; Giger, Barbara; Weymarn, Constantin von; Binkert, Christoph A. [Cantonal Hospital Winterthur, Department of Radiology, Winterthur (Switzerland); Wyss, Michael [University and ETH Zurich, Institute for Biomedical Engineering, Zurich (Switzerland); Graf, Nicole [University Hospital of Zurich, Clinical Trials Center, Center for Clinical Research, Zurich (Switzerland); Jenelten, Regula [Cantonal Hospital Winterthur, Department of Angiology, Winterthur (Switzerland); Hergan, Klaus [Paracelsus Medical University Salzburg, Department of Radiology, Salzburg (Austria)

    2011-09-15

    To prospectively determine the diagnostic value of electrocardiography-triggered non-contrast-enhanced magnetic resonance angiography (TRANCE) of the lower extremities including the feet versus DSA. All 43 patients with symptomatic peripheral arterial occlusive disease (PAOD) underwent TRANCE before DSA. Quality of MRA vessel depiction was rated by two independent radiologists on a 3-point scale. Arterial segments were graded for stenoses using a 4-point scale (grade 1: no stenosis; grade 2: moderate stenosis; grade 3: severe stenosis; grade 4: occlusion). Findings were compared with those of DSA. In the 731 vessel segments analysed, intra-arterial DSA revealed 283 stenoses: 33.6% moderate, 16.6% severe and 49.8% occlusions. TRANCE yielded a mean sensitivity, specificity, positive and negative predictive value and diagnostic accuracy to detect severe stenoses or occlusions of 95.6%, 97.4%, 87.2%, 99.2%, 97.1% for the thigh segments and 95.2%, 87.5%, 83.2%, 96.6%, 90.5% for the calf segments. Excellent overall image quality was observed for TRANCE in 91.4% versus 95.7% (DSA) for the thigh and in 60.7% versus 91.0% for the calves, while diagnostic quality of the pedal arteries was rated as insufficient. TRANCE achieves high diagnostic accuracy in the thigh and calf regions, whereas the pedal arteries showed limited quality. (orig.)

  3. Epidemiological characteristics of lower extremity arterial disease in Chinese diabetes patients at high risk: a prospective, multicenter, cross-sectional study.

    Science.gov (United States)

    Zhang, Xiaomei; Ran, Xingwu; Xu, Zhangrong; Cheng, Zhifeng; Shen, Feixia; Yu, Yanmei; Gao, Lin; Chai, Sanbo; Wang, Changjiang; Liu, Jianying; Liu, Jing; Sun, Zilin; Zhao, Jiajun; Ji, Linong

    2017-10-13

    To determine the epidemiological characteristics of lower extremity arterial disease (LEAD) in high-risk patients and identify practical gaps in LEAD management. This cross-sectional study consecutively enrolled 10681 patients with type 2 diabetes from 30 hospitals across China from June 2016 to January 2017. All patients were assessed for LEAD by the Ankle-Brachial Index in conjunction with lower limb ultrasonography according to local guidelines. The mean age of patients was 64.2 years, and the median duration of diabetes was 9.0 years. The overall prevalence of LEAD was 21.2%, with 10.6% of patients diagnosed with LEAD before enrollment and 11.8% newly diagnosed at the present visit. Patients with older age, hypertension and dyslipidemia as well as those who smoked were at higher risk of developing LEAD. Only 55.0%, 28.2%, and 42.5% of participating patients reached the guideline-recommended goals for glycemic, blood pressure, and lipid control, respectively. Anti-hypertensive agents, lipid lowering therapies, anti-platelet agents, and vasodilators were underused, especially in newly diagnosed LEAD patients (44.1%, 46.2%, 35.3%, and 31.7%, respectively). Despite the high prevalence of LEAD, it was still found to be underdiagnosed and undertreated in Chinese diabetes patients. More efforts should be directed at encouraging awareness of early LEAD and achieving guideline-recommended goals in type 2 diabetes patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Extremely low excretion of daptomycin into breast milk of a nursing mother with methicillin-resistant Staphylococcus aureus pelvic inflammatory disease.

    Science.gov (United States)

    Buitrago, Martha I; Crompton, Jason A; Bertolami, Shellie; North, Donald S; Nathan, Richard A

    2009-03-01

    Antibiotic treatment for pelvic inflammatory disease (PID) is often broad spectrum and targets a diverse range of vaginal flora. Treatment of PID in nursing mothers presents a particular clinical challenge because use of antimicrobials during breastfeeding poses several potential risks to infants. Excretion of drugs into breast milk can occur through different mechanisms and depends on the characteristics of both the drug and the mother. Whether daptomycin is excreted into breast milk is unknown, as is its subsequent exposure to breastfeeding infants and the associated risks. We describe a case of PID caused by methicillin-resistant Staphylococcus aureus, an uncommon pathogen in PID, in a breastfeeding mother who was successfully treated with daptomycin. Daptomycin concentrations in her breast milk were measured to determine potential exposure to her infant. These concentrations were extremely low, with an estimated milk:plasma ratio of 0.0012. Although additional confirmatory studies are needed, daptomycin may be a reasonable option in the treatment of PID caused by gram-positive organisms that are resistant to other antibiotics.

  5. Temporal Trends and Geographic Variation of Lower Extremity Amputation in Patients with Peripheral Artery Disease: Results from U.S. Medicare 2000–2008

    Science.gov (United States)

    Jones, W. Schuyler; Patel, Manesh R.; Dai, David; Subherwal, Sumeet; Stafford, Judith; Calhoun, Sarah; Peterson, Eric D.

    2014-01-01

    Objectives We sought to characterize temporal trends, patient-specific factors and geographic variation associated with amputation in patients with lower extremity peripheral artery disease (LE PAD) during the study period. Background Amputation represents the end stage failure for those with LE PAD and little is known about the rates and geographic variation in use of LE amputation. Methods Using data from the Centers for Medicare & Medicaid Services (CMS) from January 1, 2000 to December 31, 2008, we examined national patterns of LE amputation among patients 65 years or older with PAD. Multivariable logistic regression was used to adjust regional results for other patient demographic and clinical factors. Results Among 2,730,742 older patients with identified PAD, the overall rate of LE amputation declined from 7,258 per 100,000 PAD patients to 5,790 per 100,000 (p amputation. The adjusted odds ratio of LE amputation per year between 2000 and 2008 was 0.95 (95% CI, 0.95-0.95, pamputation rates decreased significantly among PAD patients. There however remains significant patient and geographic variation in amputation rates across the United States. PMID:23103040

  6. Prevalence of lower extremity diseases associated with normal glucose levels, impaired fasting glucose, and diabetes among U.S. adults aged 40 or older.

    Science.gov (United States)

    Gregg, Edward W; Gu, Qiuping; Williams, Desmond; de Rekeneire, Nathalie; Cheng, Yiling J; Geiss, Linda; Engelgau, Michael

    2007-09-01

    Peripheral arterial disease (PAD) and peripheral neuropathy (PN) are serious complications of diabetes, but early detection and intervention may reduce this morbidity. The degree to which PAD and PN develop before diabetes diagnosis has not been established among a representative sample of U.S. adults. To compare the prevalence of lower extremity diseases (LEDs) among U.S. adults aged 40 or older with previously diagnosed diabetes, undiagnosed diabetes, impaired fasting glucose, and normal glucose levels. We analyzed cross-sectional data of a nationally representative sample of 3607 U.S. adults from the 1999-2004 National Health and Nutrition Examination Surveys (NHANES). Subjects were divided into four groups on the basis of their fasting plasma glucose (FPG) levels and interview responses: normal glucose levels (FPG or =126 and no self-reported diabetes), and diagnosed diabetes. PN was assessed by monofilament testing at three sites on each foot and defined as > or =1 insensate area. PAD was defined as an ankle-brachial blood pressure index normal glucose (10.5%) and IFG (11.9%) and highest among those with undiagnosed (16.6%) and diagnosed diabetes (19.4%). PAD prevalence was also lowest among persons with normal glucose (3.9%), similar among those with IFG (5.4%), and significantly higher among those with undiagnosed (9.2%) and diagnosed diabetes (7.5%). Any LED was present in about 27% of persons with both undiagnosed diabetes and diagnosed diabetes. LED prevalence was nearly as high among persons with previously undiagnosed diabetes as among those with diagnosed diabetes, but it was not appreciably higher among persons with impaired fasting glucose than among those with normal glucose levels. These results suggest that LED detection efforts should be focused on persons with diabetes, including those with undiagnosed diabetes.

  7. Extremely low frequency electromagnetic fields stimulation modulates autoimmunity and immune responses: a possible immuno-modulatory therapeutic effect in neurodegenerative diseases

    Directory of Open Access Journals (Sweden)

    Fabio Guerriero

    2016-01-01

    Full Text Available Increasing evidence shows that extremely low frequency electromagnetic fields (ELF-EMFs stimulation is able to exert a certain action on autoimmunity and immune cells. In the past, the efficacy of pulsed ELF-EMFs in alleviating the symptoms and the progression of multiple sclerosis has been supported through their action on neurotransmission and on the autoimmune mechanisms responsible for demyelination. Regarding the immune system, ELF-EMF exposure contributes to a general activation of macrophages, resulting in changes of autoimmunity and several immunological reactions, such as increased reactive oxygen species-formation, enhanced phagocytic activity and increased production of chemokines. Transcranial electromagnetic brain stimulation is a non-invasive novel technique used recently to treat different neurodegenerative disorders, in particular Alzheimer's disease. Despite its proven value, the mechanisms through which EMF brain-stimulation exerts its beneficial action on neuronal function remains unclear. Recent studies have shown that its beneficial effects may be due to a neuroprotective effect on oxidative cell damage. On the basis of in vitro and clinical studies on brain activity, modulation by ELF-EMFs could possibly counteract the aberrant pro-inflammatory responses present in neurodegenerative disorders reducing their severity and their onset. The objective of this review is to provide a systematic overview of the published literature on EMFs and outline the most promising effects of ELF-EMFs in developing treatments of neurodegenerative disorders. In this regard, we review data supporting the role of ELF-EMF in generating immune-modulatory responses, neuromodulation, and potential neuroprotective benefits. Nonetheless, we reckon that the underlying mechanisms of interaction between EMF and the immune system are still to be completely understood and need further studies at a molecular level.

  8. Invasively-treated incidence of lower extremity peripheral arterial disease and associated factors in Taiwan: 2000-2011 nationwide hospitalized data analysis.

    Science.gov (United States)

    Chang, Nien-Tzu; Chan, Chien-Lung; Lu, Yu-Tzuen; Hsu, Jin-Chyr; Hsu, Yuan-Nian; Chu, Dachen; Yang, Nan-Ping

    2013-12-01

    Lower extremity (LE) peripheral artery disease (PAD), which is associated with a reduced quality of life and increased mortality from atherosclerotic cardio-/cerebro-vascular occlusion, is a significant public health problem, especial for an aging society such as that of Taiwan. Specific datasets of the 2000-2011 nationwide inpatient databases were analyzed. Two inclusion criteria, including one of the major diagnosis codes of PAD and one of three categorical invasive treatments of LE PAD, were used consecutively to select cases diagnosed as LE PAD and receiving invasive treatment. The epidemiology of invasively-treated PAD in Taiwan was estimated, and the influences of potential confounders on these invasively-treated methods were evaluated. In general, the invasively-treated incidence of PAD in Taiwan doubled, from 3.73/10,000 (in 2000) to 7.48/10,000 (in 2011). On average, the total direct medical cost of one hospitalized and invasively-treated PAD case ranged from $US 4,600 to $US 5,900. The annual cases of bypass surgery for the PAD cases averaged 1,000 and the cases for limb amputation ranged from 4,100 to 5,100 annually. However, the number of percutaneous transluminal angioplasty (PTA) procedures remarkably increased by 15 times, from 600/year to 9,100/year, from 2000 to 2011. 51.3% of all the enrolled cases were treated with limb amputations, and female, young and middle-aged people (30-65 years of age), DM patients and those on a low income had a tendency to undergo amputation due to PAD. 37.6% of all the enrolled cases were treated with PTAs related to hypertension, cardiovascular disease, hyperlipidemia and catastrophic Illness. 2-year PTA failure rates of 22.13%, 11.91% and 10.61% were noted among the first (2000-2001), second (2004-2005) and the third (2008-2009) cohort groups, respectively. In Taiwan, a gender difference and age and period effects on the invasively-treated incidence of LE PAD were observed. Female, young and middle-aged people (30

  9. Mycetoma of lower extremity

    Directory of Open Access Journals (Sweden)

    Sahariah S

    1978-01-01

    Full Text Available Ten cases of mycetoma of the lower extremity were seen and treated at the Postgraduate Institute of Medical Education & Research, Chandigarh, India, during the years 1973 to 1975. Six were treated by conservative method e.g. antibiotics, sulfonamides and immobilization of the part while remaining four were submitted t o surgery. Four out o f six from the first group had recurrence and has been put on second line of therapy. Recurrence occurred in only one case from the second group and he required an above knee amputation while the remaining three are free of disease and are well rehabilitated.

  10. Short physical performance battery for middle-aged and older adult cardiovascular disease patients: implication for strength tests and lower extremity morphological evaluation

    National Research Council Canada - National Science Library

    Yasuda, Tomohiro; Fukumura, Kazuya; Nakajima, Toshiaki

    2017-01-01

    [Purpose] To examine if the SPPB is higher with healthy subjects than outpatients, which was higher than inpatients and if the SPPB can be validated assessment tool for strength tests and lower extremity...

  11. Short physical performance battery for middle-aged and older adult cardiovascular disease patients : implication for strength tests and lower extremity morphological evaluation

    National Research Council Canada - National Science Library

    TOMOHIRO YASUDA; KAZUYA FUKUMURAL; TOSHIAKI NAKAJIMA

    2017-01-01

    [Abstract.] [Purpose] To examine if the SPPB is higher with healthy subjects than outpatients, which was higher than inpatients and if the SPPB can be validated assessment tool for strength tests and lower extremity...

  12. Extremely Preterm Birth

    Science.gov (United States)

    ... Education & Events Advocacy For Patients About ACOG Extremely Preterm Birth Home For Patients Search FAQs Extremely Preterm ... Pamphlets - Spanish FAQ173, June 2016 PDF Format Extremely Preterm Birth Pregnancy When is a baby considered “preterm” ...

  13. Relationship of lower extremity skin blood flow to the ankle brachial index in patients with peripheral arterial disease and normal volunteers.

    Science.gov (United States)

    Otah, Kenneth E; Otah, Eseroghene; Clark, Luther T; Salifu, Moro O

    2005-08-03

    Changes in posture of the lower extremities induce changes in skin blood flow, known as veno-arteriolar response (VAR). We investigated the relationship between ankle brachial index (ABI) and VAR in patients (ABInormal controls (ABI>1). We measured ankle pressure, ABI at rest, and post-exercise ABI. Using laser Doppler flowmetry, skin blood flow was measured with the lower extremity in extended and flexed positions and the fractional change (extended-flexed/extended) in blood flow (VAR) was calculated. With external pressure applied serially to the lower extremity in the extended position using a sphygmomanometer, the pressure (PVAR) at which the VAR was similar to that in the flexed position was recorded. Patients and controls did not differ by age or comorbidity, except higher cigarette smoking in patients (95.8% vs. 4.3%, p=0.001). VAR and PVAR were significantly lower in patients than controls (0.42+/-0.16 vs. 0.65+/-0.11 flux/min, p=0.001 and 29+/-8 vs. 48+/-9 mm Hg, p=0.001, respectively). There was significant correlation between ABI-post and VAR (r=0.6, p=0.01) and between the VAR and PVAR (r=0.8, p=0.001). VARblood flow by this method correlates with the presence and severity of an abnormal ABI. This may offer a method of monitoring the effect of therapy and regression of peripheral atherosclerosis.

  14. Weather and Climate Extremes

    National Research Council Canada - National Science Library

    Krause, Paul

    1997-01-01

    .... All extremes are presented in terms of their location and date and, where supportive information is available in the professional literature, detailed discussions of the extreme event are provided...

  15. Legacy to the extreme

    NARCIS (Netherlands)

    A. van Deursen (Arie); T. Kuipers (Tobias); L.M.F. Moonen (Leon)

    2000-01-01

    textabstractWe explore the differences between developing a system using extreme programming techniques, and maintaining a legacy system. We investigate whether applying extreme programming techniques to legacy maintenance is useful and feasible.

  16. Extreme environment electronics

    CERN Document Server

    Cressler, John D

    2012-01-01

    Unfriendly to conventional electronic devices, circuits, and systems, extreme environments represent a serious challenge to designers and mission architects. The first truly comprehensive guide to this specialized field, Extreme Environment Electronics explains the essential aspects of designing and using devices, circuits, and electronic systems intended to operate in extreme environments, including across wide temperature ranges and in radiation-intense scenarios such as space. The Definitive Guide to Extreme Environment Electronics Featuring contributions by some of the world's foremost exp

  17. Extreme value distributions

    CERN Document Server

    Ahsanullah, Mohammad

    2016-01-01

    The aim of the book is to give a through account of the basic theory of extreme value distributions. The book cover a wide range of materials available to date. The central ideas and results of extreme value distributions are presented. The book rwill be useful o applied statisticians as well statisticians interrested to work in the area of extreme value distributions.vmonograph presents the central ideas and results of extreme value distributions.The monograph gives self-contained of theory and applications of extreme value distributions.

  18. Incidental per-operative findings of anterior sacral meningocele during pull-through operation for Hirschsprung disease: An extremely rare case

    Directory of Open Access Journals (Sweden)

    Md Hadiuzzaman

    2017-01-01

    Full Text Available Anterior sacral meningocele (ASM and neural tube defect are well-known clinical entity. Hirschsprung's disease is rarely associated with ASM, but the association with anorectal malformation is common.

  19. Genome-wide association study of N370S homozygous Gaucher disease reveals the candidacy of CLN8 gene as a genetic modifier contributing to extreme phenotypic variation

    NARCIS (Netherlands)

    Zhang, Clarence K.; Stein, Philip B.; Liu, Jun; Wang, Zuoheng; Yang, Ruhua; Cho, Judy H.; Gregersen, Peter K.; Aerts, Johannes M. F. G.; Zhao, Hongyu; Pastores, Gregory M.; Mistry, Pramod K.

    2012-01-01

    Mutations in GBA1 gene result in defective acid beta-glucosidase and the complex phenotype of Gaucher disease (GD) related to the accumulation of glucosylceramide-laden macrophages. The phenotype is highly variable even among patients harboring identical GBA1 mutations. We hypothesize that modifier

  20. Genome-wide association study of N370S homozygous Gaucher disease reveals the candidacy of CLN8 gene as a genetic modifier contributing to extreme phenotypic variation.

    Science.gov (United States)

    Zhang, Clarence K; Stein, Philip B; Liu, Jun; Wang, Zuoheng; Yang, Ruhua; Cho, Judy H; Gregersen, Peter K; Aerts, Johannes M F G; Zhao, Hongyu; Pastores, Gregory M; Mistry, Pramod K

    2012-04-01

    Mutations in GBA1 gene result in defective acid β-glucosidase and the complex phenotype of Gaucher disease (GD) related to the accumulation of glucosylceramide-laden macrophages. The phenotype is highly variable even among patients harboring identical GBA1 mutations. We hypothesize that modifier gene(s) underlie phenotypic diversity in GD and performed a GWAS study in Ashkenazi Jewish patients with type 1 GD (GD1), homozygous for N370S mutation. Patients were assigned to mild, moderate, or severe disease categories using composite disease severity scoring systems. Whole-genome genotyping for >500,000 SNPs was performed to search for association signals using OQLS algorithm in 139 eligible patients. Several SNPs in linkage disequilibrium within the CLN8 gene locus were associated with the GD1 severity: SNP rs11986414 was associated with GD1 severity at P value 1.26 × 10(-6) . Compared to mild disease, risk allele A at rs11986414 conferred an odds ratio of 3.72 for moderate/severe disease. Loss of function mutations in CLN8 causes neuronal ceroid-lipofuscinosis, but our results indicate that its increased expression may protect against severe GD1. In cultured skin fibroblasts, the relative expression of CLN8 was higher in mild GD compared to severely affected patients, in whom CLN8 risk alleles were overrepresented. In an in vitro cell model of GD, CLN8 expression was increased, which was further enhanced in the presence of bioactive substrate, glucosylsphingosine. Taken together, CLN8 is a candidate modifier gene for GD1 that may function as a protective sphingolipid sensor and/or in glycosphingolipid trafficking. Future studies should explore the role of CLN8 in pathophysiology of GD. Copyright © 2012 Wiley Periodicals, Inc.

  1. [Change of paradigm in the surgical treatment of metastatic diseases of bone. Part I. Bony metastases of the extremities and pelvis].

    Science.gov (United States)

    Szendrői, Miklós; Kiss, János; Perlaky, Tamás; Antal, Imre; Szalay, Krisztián; Szendrői, Attila

    2017-10-01

    According to the statistical data of tumor registries the incidence of cancer has increased in the last decade, however the mortality shows only a slight change due to the new and effective multimodal treatments. The aim of our overview article is to present the changes in the survival of the metastatic patients, and to demonstrate which factors influence their prognosis. The improvement of survival resulted in a more active surgical role both in metastases of the bone of the extremities and the pelvis. We present a diagnostic flow chart and current options for the reconstruction of the different regions of the bone and skeleton, and we will discuss their potential advantages, disadvantages and complications. It is evident that apart from the impending and pathological fracture surgery it is not the first choice of treatment but rather a palliative measure. The aim of surgery is to alleviate pain, to regain mobility and improve quality of life. If possible minimal invasive techniques are performed, as they are less demanding and allow fast rehabilitation for the patient, and they are solutions that last for a lifetime. In optimal conditions radical curative surgery can be performed in about 10 to 15 per cent of the cases, and better survival is encouraging. Orv Hetil. 2017; 158(40): 1563-1569.

  2. An Efficient Diagnosis System for Parkinson’s Disease Using Kernel-Based Extreme Learning Machine with Subtractive Clustering Features Weighting Approach

    Directory of Open Access Journals (Sweden)

    Chao Ma

    2014-01-01

    Full Text Available A novel hybrid method named SCFW-KELM, which integrates effective subtractive clustering features weighting and a fast classifier kernel-based extreme learning machine (KELM, has been introduced for the diagnosis of PD. In the proposed method, SCFW is used as a data preprocessing tool, which aims at decreasing the variance in features of the PD dataset, in order to further improve the diagnostic accuracy of the KELM classifier. The impact of the type of kernel functions on the performance of KELM has been investigated in detail. The efficiency and effectiveness of the proposed method have been rigorously evaluated against the PD dataset in terms of classification accuracy, sensitivity, specificity, area under the receiver operating characteristic (ROC curve (AUC, f-measure, and kappa statistics value. Experimental results have demonstrated that the proposed SCFW-KELM significantly outperforms SVM-based, KNN-based, and ELM-based approaches and other methods in the literature and achieved highest classification results reported so far via 10-fold cross validation scheme, with the classification accuracy of 99.49%, the sensitivity of 100%, the specificity of 99.39%, AUC of 99.69%, the f-measure value of 0.9964, and kappa value of 0.9867. Promisingly, the proposed method might serve as a new candidate of powerful methods for the diagnosis of PD with excellent performance.

  3. Classifying Returns as Extreme

    DEFF Research Database (Denmark)

    Christiansen, Charlotte

    2014-01-01

    I consider extreme returns for the stock and bond markets of 14 EU countries using two classification schemes: One, the univariate classification scheme from the previous literature that classifies extreme returns for each market separately, and two, a novel multivariate classification scheme...... that classifies extreme returns for several markets jointly. The new classification scheme holds about the same information as the old one, while demanding a shorter sample period. The new classification scheme is useful....

  4. EXTREME AND TERMINAL STATES

    Directory of Open Access Journals (Sweden)

    P.F. Litvitsky

    2010-01-01

    Full Text Available Author brings modern conception of extreme and terminal states, their types, likenesses and differences, etiology, key common chains of pathogenesis, principles and methods of their treatment. Pathophysiological data on one of extreme states — collapse — is described in details. Next publications will present the data on shock and coma.Key words: extreme and terminal states, vicious circle of pathogenesis, extreme regulation, principles of treatment.(Voprosy sovremennoi pediatrii — Current Pediatrics. – 2010;9(3:74-80

  5. Co-circulation of two extremely divergent serotype SAT 2 lineages in Kenya highlights challenges to foot-and-mouth disease control

    DEFF Research Database (Denmark)

    Sangula, Abraham; Belsham, Graham; Muwanika, Vincent

    2010-01-01

    Amongst the SAT serotypes of foot-and-mouth disease virus (FMDV), the SAT 2 serotype is the most widely distributed throughout sub-Saharan Africa. Kenyan serotype SAT 2 viruses have been reported to display the highest genetic diversity for the serotype globally. This complicates diagnosis...... and control, and it is essential that patterns of virus circulation are known in order to overcome these difficulties. This study was undertaken to establish patterns of evolution of FMDV serotype SAT 2 in Kenya using complete VP1 coding sequences in a dataset of 65 sequences from Africa, collected over...

  6. Extremely low prevalence of Batrachochytrium dendrobatidis in frog populations from neotropical dry forest of Costa Rica supports the existence of a climatic refuge from disease.

    Science.gov (United States)

    Zumbado-Ulate, Héctor; Bolaños, Federico; Gutiérrez-Espeleta, Gustavo; Puschendorf, Robert

    2014-12-01

    Population declines and extinctions of numerous species of amphibians, especially stream-breeding frogs, have been linked to the emerging infectious disease chytridiomycosis, caused by the chytrid fungus, Batrachochytrium dendrobatidis. In Central America, most of the 34 species of the Craugastor punctariolus species group have disappeared in recent years in high- and low-elevation rainforests. Distribution models for B. dendrobatidis and the continuous presence of the extirpated stream-dwelling species, Craugastor ranoides, in the driest site of Costa Rica (Santa Elena Peninsula), suggest that environmental conditions might restrict the growth and development of B. dendrobatidis, existing as a refuge from chytridiomycosis-driven extinction. We conducted field surveys to detect and quantify the pathogen using Real-time PCR in samples from 15 species of frogs in two locations of tropical dry forest. In Santa Elena Peninsula, we swabbed 310 frogs, and only one sample of the species, C. ranoides, tested positive for B. dendrobatidis (prevalence dendrobatidis is at the edge of its distribution in these dry and hot environments of tropical dry forest. This study supports the existence of climatic refuges from chytridiomycosis and highlights the importance of tropical dry forest conservation for amphibians in the face of epidemic disease.

  7. Definition of drug resistance of Mycobacterium tuberculosis to antituberculosis drugs in patients with multidrugresistant tuberculosis and TB with extremely drug resistant depending on the case of the disease

    Directory of Open Access Journals (Sweden)

    Kryzhanovsky D.G.

    2014-11-01

    Full Text Available There was studied the profile of drug resistance to the main (I line and reserve (II line antituberculosis drugs in patients with MDR and XDR tuberculosis, depending of the case of the disease. According to the randomized retrospective research 200 patients with MDR and XDR tuberculosis, who received treatment in the clinic of hospital Municipal institution «Dnipropetrovsk rigional clinical association «Phthisiology» Dnipropetrovsk regional Council» during the period 2010 – 2012 were involved. Data about patients contained the data on a case of the disease and the results of the test of drug sensitivity to MBT. XDR – TB was revealed in 7.5% of patients with MDR tuberculosis. In patients with MDR tuberculosis as compared with patients with XDR tuberculosis «new cases» were diagnosed in 19.5% against 18.5% (p <0.05. In patients with MDR tuberculosis and with XDR tuberculosis resistance to the antituberculosis drug more commonly developed to S - 88.5%, E - 55% and Z - 24%. The presence of MDR-TB and XDR-TB prevails in patients, who underwent previous courses of treatment with anti-TB drugs in case history as compared with patients with «new cases» of treatment. The development of resistance to anti-TB drugs depends on the availability of these drugs in the previous treatment regimens.

  8. Co-circulation of two extremely divergent serotype SAT 2 lineages in Kenya highlights challenges to foot-and-mouth disease control.

    Science.gov (United States)

    Sangula, A K; Belsham, G J; Muwanika, V B; Heller, R; Balinda, S N; Siegismund, H R

    2010-10-01

    Amongst the SAT serotypes of foot-and-mouth disease virus (FMDV), the SAT 2 serotype is the most widely distributed throughout sub-Saharan Africa. Kenyan serotype SAT 2 viruses have been reported to display the highest genetic diversity for the serotype globally. This complicates diagnosis and control, and it is essential that patterns of virus circulation are known in order to overcome these difficulties. This study was undertaken to establish patterns of evolution of FMDV serotype SAT 2 in Kenya using complete VP1 coding sequences in a dataset of 65 sequences from Africa, collected over a period of 50 years. Two highly divergent lineages were observed to co-circulate, and occasional trans-boundary spread was inferred, emphasizing the value of constant monitoring and characterization of field strains for improved diagnosis and appropriate vaccine application as well as the need for regional approaches to control.

  9. The diagnostic value of non-contrast enhanced quiescent interval single shot (QISS) magnetic resonance angiography at 3T for lower extremity peripheral arterial disease, in comparison to CT angiography.

    Science.gov (United States)

    Wu, Gang; Yang, Jun; Zhang, Tianjing; Morelli, John N; Giri, Shivraman; Li, Xiaoming; Tang, Wenlin

    2016-10-20

    The high incidence of renal insufficiency in patients with Peripheral Arterial Disease raises the concern for nephrogenic systemic fibrosis (NSF) with respect to contrast enhanced MRA. The risk of NSF is eliminated with non-contrast enhanced magnetic resonance angiography. The purpose of the current study is to compare image quality and diagnostic performance of non-contrast enhanced Quiescent Interval Single Shot (QISS) magnetic resonance angiography at 3 T versus CT angiography for evaluation of lower extremity Peripheral Arterial Disease (PAD). 32 consecutive patients (23 male, 9 female, age range 40-81 years, average age 61.97 years) with clinically suspected lower extremity PAD underwent QISS MRA and CTA. 19 of 32 patients underwent Digital Subtraction Angiography (DSA). Image quality of MRA was compared with CTA by two radiologists with 10 and 8 years' experience according to a 4-point scale. The Kappa test was used to determine the intermodality agreement between MRA and CTA in stenosis assessment, and interobserver agreement with each method. Sensitivity and specificity of CTA and MRA in detecting hemodynamically significant stenosis (≥50 %) were compared, with DSA serving as reference standard when available. Image quality of QISS MRA was rated 3.70 ± 0.49 by reader 1, and 3.72 ± 0.47 by reader 2, significantly lower than that of CTA (3.80 ± 0.44 and 3.82 ± 0.42, P  0.05), and specificity of QISS was 96.70 and 97.75 % (versus 96.55 and 96.51 % for CTA, P > 0.05). For heavily calcified segments, sensitivity of QISS (95.83 and 95.83 %) was significantly higher than that of CTA (74.19 and 76.67 %, P < 0.05). QISS is a reliable alternative to CTA for evaluation of lower extremity PAD, and may be suitable as a first-line screening examination in patients with contraindications to intravenous contrast administration.

  10. Ultrasonography of the lower extremity veins: Anatomy and basic approach

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Dong Kyu; Ahn, Kyung Sik; Kang, Chang Ho; Cho, Sung Bum [Dept. of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul (Korea, Republic of)

    2017-04-15

    Ultrasonography is an imaging modality widely used to evaluate venous diseases of the lower extremities. It is important to understand the normal venous anatomy of the lower extremities, which has deep, superficial, and perforating venous components, in order to determine the pathophysiology of venous disease. This review provides a basic description of the anatomy of the lower extremity veins and useful techniques for approaching each vein via ultrasonography.

  11. Analysis of extreme events

    CSIR Research Space (South Africa)

    Khuluse, S

    2009-04-01

    Full Text Available ) determination of the distribution of the damage and (iii) preparation of products that enable prediction of future risk events. The methodology provided by extreme value theory can also be a powerful tool in risk analysis...

  12. Extreme bosonic linear channels

    Science.gov (United States)

    Holevo, A. S.

    2013-02-01

    The set of all channels with a fixed input and output is convex. We first give a convenient formulation of the necessary and sufficient condition for a channel to be an extreme point of this set in terms of the complementary channel, a notion of great importance in quantum information theory. This formulation is based on the general approach to extremality of completely positive maps in an operator algebra in the spirit of Arveson. We then use this formulation to prove our main result: under certain nondegeneracy conditions, environmental purity is necessary and sufficient for the extremality of a bosonic linear (quasifree) channel. It hence follows that a Gaussian channel between finite-mode bosonic systems is extreme if and only if it has minimum noise.

  13. Extreme environments and exobiology

    Science.gov (United States)

    Friedmann, E. I.

    1993-01-01

    Ecological research on extreme environments can be applied to exobiological problems such as the question of life on Mars. If life forms (fossil or extant) are found on Mars, their study will help to solve fundamental questions about the nature of life on Earth. Extreme environments that are beyond the range of adaptability of their inhabitants are defined as "absolute extreme". Such environments can serve as terrestrial models for the last stages of life in the history of Mars, when the surface cooled down and atmosphere and water disappeared. The cryptoendolithic microbial community in porous rocks of the Ross Desert in Antarctica and the microbial mats at the bottom of frozen Antarctic lakes are such examples. The microbial communities of Siberian permafrost show that, in frozen but stable communities, long-term survival is possible. In the context of terraforming Mars, selected microorganisms isolated from absolute extreme environments are considered for use in creation of a biological carbon cycle.

  14. Extreme lipoprotein(a) levels and improved cardiovascular risk prediction

    DEFF Research Database (Denmark)

    Kamstrup, Pia R; Tybjærg-Hansen, Anne; Nordestgaard, Børge G

    2013-01-01

    The study tested whether extreme lipoprotein(a) levels and/or corresponding LPA risk genotypes improve myocardial infarction (MI) and coronary heart disease (CHD) risk prediction beyond conventional risk factors.......The study tested whether extreme lipoprotein(a) levels and/or corresponding LPA risk genotypes improve myocardial infarction (MI) and coronary heart disease (CHD) risk prediction beyond conventional risk factors....

  15. Varus deformity of the left lower extremity causing degenerative lesion of the posterior horn of the left medial meniscus in a patient with Paget’s disease of bone

    Directory of Open Access Journals (Sweden)

    Al Kaissi, Ali

    2014-09-01

    Full Text Available [english] We report on a 42-year-old woman who presented with persistent pain in her left knee with no history of trauma. Sagittal T1-weighted MRI of the left knee showed discontinuity between the anterior and posterior horns of the left medial meniscus, causing effectively the development of degenerative lesion of the posterior horn. The latter was correlated to varus deformity of the left lower extremity associated with subsequent narrowing of the medial knee joint. The unusual craniofacial contour of the patient, the skeletal survey and the elevated serum alkaline phosphatase were compatible with the diagnosis of Paget’s disease of the bone. To alleviate the adverse effect of the mal-alignment of the left femur onto the left knee, corrective osteotomy of the left femoral diaphysis by means of fixators was performed. To the best of our knowledge this is the first clinical report describing the management and the pathological correlation of a unilateral varus deformity of the femoral shaft and degenerative lesions of the left knee in a patient with Paget’s disease of the bone.

  16. Extreme Programming: Maestro Style

    Science.gov (United States)

    Norris, Jeffrey; Fox, Jason; Rabe, Kenneth; Shu, I-Hsiang; Powell, Mark

    2009-01-01

    "Extreme Programming: Maestro Style" is the name of a computer programming methodology that has evolved as a custom version of a methodology, called extreme programming that has been practiced in the software industry since the late 1990s. The name of this version reflects its origin in the work of the Maestro team at NASA's Jet Propulsion Laboratory that develops software for Mars exploration missions. Extreme programming is oriented toward agile development of software resting on values of simplicity, communication, testing, and aggressiveness. Extreme programming involves use of methods of rapidly building and disseminating institutional knowledge among members of a computer-programming team to give all the members a shared view that matches the view of the customers for whom the software system is to be developed. Extreme programming includes frequent planning by programmers in collaboration with customers, continually examining and rewriting code in striving for the simplest workable software designs, a system metaphor (basically, an abstraction of the system that provides easy-to-remember software-naming conventions and insight into the architecture of the system), programmers working in pairs, adherence to a set of coding standards, collaboration of customers and programmers, frequent verbal communication, frequent releases of software in small increments of development, repeated testing of the developmental software by both programmers and customers, and continuous interaction between the team and the customers. The environment in which the Maestro team works requires the team to quickly adapt to changing needs of its customers. In addition, the team cannot afford to accept unnecessary development risk. Extreme programming enables the Maestro team to remain agile and provide high-quality software and service to its customers. However, several factors in the Maestro environment have made it necessary to modify some of the conventional extreme

  17. Electronics for Extreme Environments

    Science.gov (United States)

    Patel, J. U.; Cressler, J.; Li, Y.; Niu, G.

    2001-01-01

    Most of the NASA missions involve extreme environments comprising radiation and low or high temperatures. Current practice of providing friendly ambient operating environment to electronics costs considerable power and mass (for shielding). Immediate missions such as the Europa orbiter and lander and Mars landers require the electronics to perform reliably in extreme conditions during the most critical part of the mission. Some other missions planned in the future also involve substantial surface activity in terms of measurements, sample collection, penetration through ice and crust and the analysis of samples. Thus it is extremely critical to develop electronics that could reliably operate under extreme space environments. Silicon On Insulator (SOI) technology is an extremely attractive candidate for NASA's future low power and high speed electronic systems because it offers increased transconductance, decreased sub-threshold slope, reduced short channel effects, elimination of kink effect, enhanced low field mobility, and immunity from radiation induced latch-up. A common belief that semiconductor devices function better at low temperatures is generally true for bulk devices but it does not hold true for deep sub-micron SOI CMOS devices with microscopic device features of 0.25 micrometers and smaller. Various temperature sensitive device parameters and device characteristics have recently been reported in the literature. Behavior of state of the art technology devices under such conditions needs to be evaluated in order to determine possible modifications in the device design for better performance and survivability under extreme environments. Here, we present a unique approach of developing electronics for extreme environments to benefit future NASA missions as described above. This will also benefit other long transit/life time missions such as the solar sail and planetary outposts in which electronics is out open in the unshielded space at the ambient space

  18. Extremely deformable structures

    CERN Document Server

    2015-01-01

    Recently, a new research stimulus has derived from the observation that soft structures, such as biological systems, but also rubber and gel, may work in a post critical regime, where elastic elements are subject to extreme deformations, though still exhibiting excellent mechanical performances. This is the realm of ‘extreme mechanics’, to which this book is addressed. The possibility of exploiting highly deformable structures opens new and unexpected technological possibilities. In particular, the challenge is the design of deformable and bi-stable mechanisms which can reach superior mechanical performances and can have a strong impact on several high-tech applications, including stretchable electronics, nanotube serpentines, deployable structures for aerospace engineering, cable deployment in the ocean, but also sensors and flexible actuators and vibration absorbers. Readers are introduced to a variety of interrelated topics involving the mechanics of extremely deformable structures, with emphasis on ...

  19. Statistics of Extremes

    KAUST Repository

    Davison, Anthony C.

    2015-04-10

    Statistics of extremes concerns inference for rare events. Often the events have never yet been observed, and their probabilities must therefore be estimated by extrapolation of tail models fitted to available data. Because data concerning the event of interest may be very limited, efficient methods of inference play an important role. This article reviews this domain, emphasizing current research topics. We first sketch the classical theory of extremes for maxima and threshold exceedances of stationary series. We then review multivariate theory, distinguishing asymptotic independence and dependence models, followed by a description of models for spatial and spatiotemporal extreme events. Finally, we discuss inference and describe two applications. Animations illustrate some of the main ideas. © 2015 by Annual Reviews. All rights reserved.

  20. Adventure and Extreme Sports.

    Science.gov (United States)

    Gomez, Andrew Thomas; Rao, Ashwin

    2016-03-01

    Adventure and extreme sports often involve unpredictable and inhospitable environments, high velocities, and stunts. These activities vary widely and include sports like BASE jumping, snowboarding, kayaking, and surfing. Increasing interest and participation in adventure and extreme sports warrants understanding by clinicians to facilitate prevention, identification, and treatment of injuries unique to each sport. This article covers alpine skiing and snowboarding, skateboarding, surfing, bungee jumping, BASE jumping, and whitewater sports with emphasis on epidemiology, demographics, general injury mechanisms, specific injuries, chronic injuries, fatality data, and prevention. Overall, most injuries are related to overuse, trauma, and environmental or microbial exposure. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Extremal graph theory

    CERN Document Server

    Bollobas, Bela

    2004-01-01

    The ever-expanding field of extremal graph theory encompasses a diverse array of problem-solving methods, including applications to economics, computer science, and optimization theory. This volume, based on a series of lectures delivered to graduate students at the University of Cambridge, presents a concise yet comprehensive treatment of extremal graph theory.Unlike most graph theory treatises, this text features complete proofs for almost all of its results. Further insights into theory are provided by the numerous exercises of varying degrees of difficulty that accompany each chapter. A

  2. Acute lower extremity ischaemia

    African Journals Online (AJOL)

    In a nutshell. • A patient with sudden onset of a cold, weak, numb and painful foot has acute lower extremity ischaemia (ALEXI) until proven otherwise. Labelling patients as acute gout, acute phlegmasia (deep vein thrombosis), acute sciatica, etc. may result in unnecessary delays in treatment, with tragic consequences.

  3. Injuries in extreme sports.

    Science.gov (United States)

    Laver, Lior; Pengas, Ioannis P; Mei-Dan, Omer

    2017-04-18

    Extreme sports (ES) are usually pursued in remote locations with little or no access to medical care with the athlete competing against oneself or the forces of nature. They involve high speed, height, real or perceived danger, a high level of physical exertion, spectacular stunts, and heightened risk element or death.Popularity for such sports has increased exponentially over the past two decades with dedicated TV channels, Internet sites, high-rating competitions, and high-profile sponsors drawing more participants.Recent data suggest that the risk and severity of injury in some ES is unexpectedly high. Medical personnel treating the ES athlete need to be aware there are numerous differences which must be appreciated between the common traditional sports and this newly developing area. These relate to the temperament of the athletes themselves, the particular epidemiology of injury, the initial management following injury, treatment decisions, and rehabilitation.The management of the injured extreme sports athlete is a challenge to surgeons and sports physicians. Appropriate safety gear is essential for protection from severe or fatal injuries as the margins for error in these sports are small.The purpose of this review is to provide an epidemiologic overview of common injuries affecting the extreme athletes through a focus on a few of the most popular and exciting extreme sports.

  4. Deficiently extremal Gorenstein algebras

    Indian Academy of Sciences (India)

    For the given codimension g ≥ 3 and initial degree p ≥ 2, a Gorenstein algebra R/I with minimal multiplicity is extremal in the sense of Schenzel [8]. This has a nice structural implication: the minimal resolution of R/I must be pure and almost linear, and so their. Betti numbers are given by Herzog and Kühl [3] formulae.

  5. Hydrological extremes and security

    Directory of Open Access Journals (Sweden)

    Z. W. Kundzewicz

    2015-04-01

    Full Text Available Economic losses caused by hydrological extremes – floods and droughts – have been on the rise. Hydrological extremes jeopardize human security and impact on societal livelihood and welfare. Security can be generally understood as freedom from threat and the ability of societies to maintain their independent identity and their functional integrity against forces of change. Several dimensions of security are reviewed in the context of hydrological extremes. The traditional interpretation of security, focused on the state military capabilities, has been replaced by a wider understanding, including economic, societal and environmental aspects that get increasing attention. Floods and droughts pose a burden and serious challenges to the state that is responsible for sustaining economic development, and societal and environmental security. The latter can be regarded as the maintenance of ecosystem services, on which a society depends. An important part of it is water security, which can be defined as the availability of an adequate quantity and quality of water for health, livelihoods, ecosystems and production, coupled with an acceptable level of water-related risks to people, environments and economies. Security concerns arise because, over large areas, hydrological extremes − floods and droughts − are becoming more frequent and more severe. In terms of dealing with water-related risks, climate change can increase uncertainties, which makes the state’s task to deliver security more difficult and more expensive. However, changes in population size and development, and level of protection, drive exposure to hydrological hazards.

  6. Extremism and Disability Chic

    Science.gov (United States)

    Kauffman, James M.; Badar, Jeanmarie

    2018-01-01

    The word chic refers to something fashionable or stylish. Chic varies for individuals and groups and with time and place. Something chic may have desirable or undesirable long-term consequences. Disability and extremism are also changeable concepts, depending on comparison to social norms. People with disabilities should have the option of being…

  7. Non-extremal branes

    Directory of Open Access Journals (Sweden)

    Pablo Bueno

    2015-04-01

    Full Text Available We prove that for arbitrary black brane solutions of generic Supergravities there is an adapted system of variables in which the equations of motion are exactly invariant under electric–magnetic duality, i.e. the interchange of a given extended object by its electromagnetic dual. We obtain thus a procedure to automatically construct the electromagnetic dual of a given brane without needing to solve any further equation. We apply this procedure to construct the non-extremal (p,q-string of Type-IIB String Theory (new in the literature, explicitly showing how the dual (p,q-five-brane automatically arises in this construction. In addition, we prove that the system of variables used is suitable for a generic characterization of every double-extremal Supergravity brane solution, which we perform in full generality.

  8. Extremes in nature

    CERN Document Server

    Salvadori, Gianfausto; Kottegoda, Nathabandu T

    2007-01-01

    This book is about the theoretical and practical aspects of the statistics of Extreme Events in Nature. Most importantly, this is the first text in which Copulas are introduced and used in Geophysics. Several topics are fully original, and show how standard models and calculations can be improved by exploiting the opportunities offered by Copulas. In addition, new quantities useful for design and risk assessment are introduced.

  9. [The extremely violent child].

    Science.gov (United States)

    Berger, M; Bonneville, E

    2009-02-01

    More and more children have extremely violent behaviour which appears about the age of 15-16 months, when walking makes their hands free. This violence is individual, can appear suddenly at anytime, and is not accompanied by guilt. It is caused by early psychological and repeated traumas, whose importance is usually underestimated: unpredictable, violent parents, exposure to the spectacle of conjugal violence, distortion of the signals emitted by the toddler. These traumas bring about specific psychological structure. The prevention of these troubles exists but is impossible to realise in France.

  10. Extreme Programming Pocket Guide

    CERN Document Server

    Chromatic

    2003-01-01

    Extreme Programming (XP) is a radical new approach to software development that has been accepted quickly because its core practices--the need for constant testing, programming in pairs, inviting customer input, and the communal ownership of code--resonate with developers everywhere. Although many developers feel that XP is rooted in commonsense, its vastly different approach can bring challenges, frustrations, and constant demands on your patience. Unless you've got unlimited time (and who does these days?), you can't always stop to thumb through hundreds of pages to find the piece of info

  11. Lower extremity lipedema, upper extremity lipodystrophy and severe calcinosis complicating juvenile dermatomyositis.

    Science.gov (United States)

    Pavlov-Dolijanovic, Slavica R; Vujasinovic Stupar, Nada Z; Gavrilov, Nikola; Seric, Srdjan

    2014-11-01

    Juvenile dermatomyositis (JDM) is a rare but complex and potentially life-threatening autoimmune disease of childhood. Significant proportions of patients have residual weakness, muscle atrophy, joint contractures, and calcinosis. Recently, new clinical findings, such as lipodystrophy accompanied with increased fat deposition in certain areas, have been reported. So far, it is not known whether the redistribution of body fat may be the type of lipedema of lower extremity. We describe a 39-year-old woman who was diagnosed with JDM at the age of 7. Later she developed symmetrical lipodystrophy of upper extremities and symmetrical lipedema of lower extremities (making 2 and 58.3 % of total body fat mass, respectively), with multiple calcified nodules in the subcutaneous tissues. These nodules gradually increased in size despite therapy. Capillaroscopy findings showed scleroderma-like abnormalities. ANA and anti-U1RNP antibodies were positive. Similar cases with simultaneous occurrence of the lipedema of lower extremities, lipodystrophy of upper extremities, and severe calcinosis complicating JDM have not been published so far. We showed that the calcinosis and lipodystrophy were associated with short duration of active disease. Also, we display case that raises the question whether it is possible overlapping autoimmune diseases revealed during follow-up.

  12. DISEASES

    DEFF Research Database (Denmark)

    Pletscher-Frankild, Sune; Pallejà, Albert; Tsafou, Kalliopi

    2015-01-01

    Text mining is a flexible technology that can be applied to numerous different tasks in biology and medicine. We present a system for extracting disease-gene associations from biomedical abstracts. The system consists of a highly efficient dictionary-based tagger for named entity recognition...... of human genes and diseases, which we combine with a scoring scheme that takes into account co-occurrences both within and between sentences. We show that this approach is able to extract half of all manually curated associations with a false positive rate of only 0.16%. Nonetheless, text mining should...... not stand alone, but be combined with other types of evidence. For this reason, we have developed the DISEASES resource, which integrates the results from text mining with manually curated disease-gene associations, cancer mutation data, and genome-wide association studies from existing databases...

  13. Statistics of Local Extremes

    DEFF Research Database (Denmark)

    Larsen, Gunner Chr.; Bierbooms, W.; Hansen, Kurt Schaldemose

    2003-01-01

    The gust events described in the IEC-standard are formulated as coherent gusts of an inherent deterministic character, whereas the gusts experienced in real situation are of a stochastic nature with a limited spatial extension. This conceptual differencemay cause substantial differences in the load......, 1996]. However, dealing with wind turbine design, not only detailed knowledge on the spatial/time structure of the gust event is required. The probabilityof occurrence of a gust event with a given wind speed amplitude/magnitude is equally important. This theme is addressed in the present report......"Modelling of Extreme Gusts for Design Calculations " (NEWGUST), which is co-funded through JOULEIII on contract no. JOR3-CT98-0239....

  14. Moving in extreme environments:extreme loading; carriage versus distance

    OpenAIRE

    Lucas, Samuel J. E.; Helge, Jørn W.; Schütz, Uwe H W; Goldman, Ralph F.; Cotter, James D

    2016-01-01

    This review addresses human capacity for movement in the context of extreme loading and with it the combined effects of metabolic, biomechanical and gravitational stress on the human body. This topic encompasses extreme duration, as occurs in ultra-endurance competitions (e.g. adventure racing and transcontinental races) and expeditions (e.g. polar crossings), to the more gravitationally limited load carriage (e.g. in the military context). Juxtaposed to these circumstances is the extreme met...

  15. Lower extremity injuries in snowboarding.

    Science.gov (United States)

    Ishimaru, Daichi; Ogawa, Hiroyasu; Sumi, Hiroshi; Sumi, Yasuhiko; Shimizu, Katsuji

    2011-03-01

    In snowboarding, the upper extremity is known as the most common injury site and little information is available for lower extremity injuries. Here, we aim to discuss lower extremity injuries during snowboarding. We retrospectively analyzed the epidemiologic factors, injury types, and injury mechanisms for injured snowboarders (7,793 cases) between 2004-2005 and 2008-2009 seasons; information was gathered via questionnaires. Individuals were classified into a lower extremity injury group (961 cases) and a control group with other injuries (6,832 cases). The incidence of lower extremity injuries in snowboarding was 0.16 per 1,000 participant days, accounting for 12.3% of all snowboarding injuries. The mean age of the lower extremity injury group and injured control group was 26.1 years ± 5.9 years and 25.1 years ± 5.6 years, respectively. Approximately 90% of snowboarders in both the groups were equipped with soft-shelled boots. Skilled snowboarders tended to sustain lower extremity injuries (psnowboarding is lacerations/contusions caused by collision with other snow sport participants. Lower extremity injuries in snowboarding differ considerably from well-known upper extremity injuries in terms of injury types and mechanisms. The incidence of lower extremity injuries is high and deserves further attention. Copyright © 2011 by Lippincott Williams & Wilkins

  16. The Microbiota of the Extremely Preterm Infant.

    Science.gov (United States)

    Underwood, Mark A; Sohn, Kristin

    2017-06-01

    Colonization of the extremely preterm infant's gastrointestinal tract and skin begins in utero and is influenced by a variety of factors, the most important including gestational age and environmental exposures. The composition of the intestinal and skin microbiota influences the developing innate and adaptive immune responses with short-term and long-term consequences including altered risks for developing necrotizing enterocolitis, sepsis, and a wide variety of microbe-related diseases of children and adults. Alteration of the composition of the microbiota to decrease disease risk is particularly appealing for this ultra-high-risk cohort that is brand new from an evolutionary standpoint. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Extreme winds in Denmark

    Energy Technology Data Exchange (ETDEWEB)

    Kristensen, L.; Rathmann, O.; Hansen, S.O.

    1999-02-01

    Wind-speed data from four sites in Denmark have been analyzed in order to obtain estimates of the basic wind velocity which is defined as the 50-year wind speed under standard conditions, i.e. ten-minute averages at the height 10 m over a uniform terrain with the roughness length 0.05 m. The sites are, from west, Skjern (15 years), Kegnaes (7 years), Sprogoe (20 years), and Tystofte (15 years). The data are ten minute averages of wind speed, wind direction, temperature and pressure. The last two quantities are used to determine the air density {rho}. The data are cleaned for terrain effects by means of a slightly modified WASP technique where the sector speed-up factors and roughness lengths are linearly smoothed with a direction resolution of one degree. Assuming geotropic balance, all the wind-velocity data are transformed to friction velocity u{sub *} and direction at standard conditions by means of the geotropic drag law for neutral stratification. The basic wind velocity in 30 deg. sectors are obtained through ranking of the largest values of the friction velocity pressure 1/2{rho}u{sub *}{sup 2} taken both one every two months and once every year. The main conclusion is that the basic wind velocity is significantly larger at Skjern, close to the west coast of Jutland, than at any of the other sites. Irrespective of direction, the present standard estimates of 50-year wind are 25 {+-} 1 m/s at Skern and 22 {+-} 1 m/s at the other three sites. These results are in agreement with those obtained by Jensen and Franck (1970) and Abild (1994) and supports the conclusion that the wind climate at the west coast of Jutland is more extreme than in any other part of the country. Simple procedures to translate in a particular direction sector the standard basic wind velocity to conditions with a different roughness length and height are presented. It is shown that a simple scheme makes it possible to calculate the total 50-year extreme load on a general structure without

  18. disease

    African Journals Online (AJOL)

    Objective. To undertake an economic evaluation of the administration and monitoring costs of the two different forms of heparin in patients with unstable coronary artery disease (DCAD). Study design. Equivalent efficacy was found for low- molecular-weight heparin (LMWH) and for unfraction- ated heparin (UFH) in the ...

  19. Hirayama′s disease: The importance of flexion magnetic resonance imaging

    Directory of Open Access Journals (Sweden)

    S Jakhere

    2011-01-01

    Full Text Available Hirayama′s disease is a form of juvenile muscular atrophy affecting young individulas in their second to third decade. The underlying pathogenetic mechanism is believed to be an imbalanced growth between the individuals′ vertebral column and the spinal canal contents, which causes abutment of the anterior spinal cord against the vertebral column and detachment of the posterior dura, leading to microcirculatory disturbances and ischemic changes in the cord. This mechanism is exiquisitely demonstrated on magnetic resonance imaging (MRI, but requires additional imaging, with the neck in the flexed position. Neurphysiological imaging studies have provided supporting evidence by demonstrating changes in the N13 potential, with neck flexion. Nonetheless, few studies have also reported contradictory findings with MRI and somatosensory evoked potentials, in Hirayamas Disease. This condition is underdiagnosed because most clinicians are not familiar with this disorder and do not request a flexion MRI. Early recognition of this entity and differentiation from other causes of focal cord atrophy is important, because limitation of neck flexion by using a simple neck collar can prevent its further progression. We report the classical MRI findings in a young patient with Hirayama′s disease with neutral and flexion MRI.

  20. Statistical Model of Extreme Shear

    DEFF Research Database (Denmark)

    Larsen, Gunner Chr.; Hansen, Kurt Schaldemose

    2004-01-01

    (PDF) of turbulence driven short-term extreme wind shear events, conditioned on the mean wind speed, for an arbitrary recurrence period. The model is based on an asymptotic expansion, and only a few and easily accessible parameters are needed as input. The model of the extreme PDF is supplemented...... by a model that, on a statistically consistent basis, describe the most likely spatial shape of an extreme wind shear event. Predictions from the model have been compared with results from an extreme value data analysis, based on a large number of high-sampled full-scale time series measurements...... are consistent, given the inevitabel uncertainties associated with model as well as with the extreme value data analysis. Keywords: Statistical model, extreme wind conditions, statistical analysis, turbulence, wind loading, statistical analysis, turbulence, wind loading, wind shear, wind turbines....

  1. Detectors in Extreme Conditions

    Energy Technology Data Exchange (ETDEWEB)

    Blaj, G. [SLAC National Accelerator Lab., Menlo Park, CA (United States); Carini, G. [SLAC National Accelerator Lab., Menlo Park, CA (United States); Carron, S. [SLAC National Accelerator Lab., Menlo Park, CA (United States); Haller, G. [SLAC National Accelerator Lab., Menlo Park, CA (United States); Hart, P. [SLAC National Accelerator Lab., Menlo Park, CA (United States); Hasi, J. [SLAC National Accelerator Lab., Menlo Park, CA (United States); Herrmann, S. [SLAC National Accelerator Lab., Menlo Park, CA (United States); Kenney, C. [SLAC National Accelerator Lab., Menlo Park, CA (United States); Segal, J. [SLAC National Accelerator Lab., Menlo Park, CA (United States); Tomada, A. [SLAC National Accelerator Lab., Menlo Park, CA (United States)

    2015-08-06

    Free Electron Lasers opened a new window on imaging the motion of atoms and molecules. At SLAC, FEL experiments are performed at LCLS using 120Hz pulses with 1012 - 1013 photons in 10 femtoseconds (billions of times brighter than the most powerful synchrotrons). This extreme detection environment raises unique challenges, from obvious to surprising. Radiation damage is a constant threat due to accidental exposure to insufficiently attenuated beam, focused beam and formation of ice crystals reflecting the beam onto the detector. Often high power optical lasers are also used (e.g., 25TW), increasing the risk of damage or impeding data acquisition through electromagnetic pulses (EMP). The sample can contaminate the detector surface or even produce shrapnel damage. Some experiments require ultra high vacuum (UHV) with strict design, surface contamination and cooling requirements - also for detectors. The setup is often changed between or during experiments with short turnaround times, risking mechanical and ESD damage, requiring work planning, training of operators and sometimes continuous participation of the LCLS Detector Group in the experiments. The detectors used most often at LCLS are CSPAD cameras for hard x-rays and pnCCDs for soft x-rays.

  2. Likelihood estimators for multivariate extremes

    KAUST Repository

    Huser, Raphaël

    2015-11-17

    The main approach to inference for multivariate extremes consists in approximating the joint upper tail of the observations by a parametric family arising in the limit for extreme events. The latter may be expressed in terms of componentwise maxima, high threshold exceedances or point processes, yielding different but related asymptotic characterizations and estimators. The present paper clarifies the connections between the main likelihood estimators, and assesses their practical performance. We investigate their ability to estimate the extremal dependence structure and to predict future extremes, using exact calculations and simulation, in the case of the logistic model.

  3. Overview of the biology of extreme events

    Science.gov (United States)

    Gutschick, V. P.; Bassirirad, H.

    2008-12-01

    Extreme events have, variously, meteorological origins as in heat waves or precipitation extremes, or biological origins as in pest and disease eruptions (or tectonic, earth-orbital, or impact-body origins). Despite growing recognition that these events are changing in frequency and intensity, a universal model of ecological responses to these events is slow to emerge. Extreme events, negative and positive, contrast with normal events in terms of their effects on the physiology, ecology, and evolution of organisms, hence also on water, carbon, and nutrient cycles. They structure biogeographic ranges and biomes, almost surely more than mean values often used to define biogeography. They are challenging to study for obvious reasons of field-readiness but also because they are defined by sequences of driving variables such as temperature, not point events. As sequences, their statistics (return times, for example) are challenging to develop, as also from the involvement of multiple environmental variables. These statistics are not captured well by climate models. They are expected to change with climate and land-use change but our predictive capacity is currently limited. A number of tools for description and analysis of extreme events are available, if not widely applied to date. Extremes for organisms are defined by their fitness effects on those organisms, and are specific to genotypes, making them major agents of natural selection. There is evidence that effects of extreme events may be concentrated in an extended recovery phase. We review selected events covering ranges of time and magnitude, from Snowball Earth to leaf functional loss in weather events. A number of events, such as the 2003 European heat wave, evidence effects on water and carbon cycles over large regions. Rising CO2 is the recent extreme of note, for its climatic effects and consequences for growing seasons, transpiration, etc., but also directly in its action as a substrate of photosynthesis

  4. ExtremeBounds: Extreme Bounds Analysis in R

    Directory of Open Access Journals (Sweden)

    Marek Hlavac

    2016-08-01

    Full Text Available This article introduces the R package ExtremeBounds to perform extreme bounds analysis (EBA, a sensitivity test that examines how robustly the dependent variable of a regression model is related to a variety of possible determinants. ExtremeBounds supports Leamer's EBA that focuses on the upper and lower extreme bounds of regression coefficients, as well as Sala-i-Martin's EBA which considers their entire distribution. In contrast to existing alternatives, it can estimate models of a variety of user-defined sizes, use regression models other than ordinary least squares, incorporate non-linearities in the model specification, and apply custom weights and standard errors. To alleviate concerns about the multicollinearity and conceptual overlap of examined variables, ExtremeBounds allows users to specify sets of mutually exclusive variables, and can restrict the analysis to coefficients from regression models that yield a variance inflation factor within a prespecified limit.

  5. Extreme Environments: Why NASA?

    Science.gov (United States)

    Meyer, M. A.

    2002-12-01

    Life on our planet is the only known example in the universe and so we are relegated to this planet for the study of life. However, life may be a natural consequence of planet formation, and so the study of the origin, evolution, distribution and future of life may be greatly informed by planetary exploration. Astrobiology has adopted several approaches to study life on Earth, for deducing our origins, for determining the likelihood of life elsewhere, and for enabling the search for evidence of past or present life. The first approach has been the Exobiology Program, centered around understanding the origins of life and which supports individual investigator research. Second has been the construction of consortia-type research in which researchers from different disciplines focus on a larger problem. This structure began with NASA Specialized Centers of Research and Training and has grown to include the Astrobiology Institute - a collection of competitively selected groups of researchers attacking problems in Astrobiology as individual teams and as a consolidated Institute. With the formation of an intellectual basis for exploring for life elsewhere, Astrobiology has initiated the competitive research and development program in instrument development (Astrobiology Science and Technology for Instrument Development [ASTID] Program) that would enable future mission instruments for the exploration of planetary bodies in the search for prebiotic chemistry, habitable environments (past or present), biomarkers, and possibly life itself. However, the act of exploring requires robust instrumentation, mobile robotic platforms, efficient operations, and a high level of autonomy. To this end, Astrobiology has started a new research activity that promotes scientifically-driven robotic exploration of extreme environments on Earth that are analogous to suspected habitable environments on other planetary bodies. The program is called Astrobiology Science and Technology for

  6. Evolution caused by extreme events.

    Science.gov (United States)

    Grant, Peter R; Grant, B Rosemary; Huey, Raymond B; Johnson, Marc T J; Knoll, Andrew H; Schmitt, Johanna

    2017-06-19

    Extreme events can be a major driver of evolutionary change over geological and contemporary timescales. Outstanding examples are evolutionary diversification following mass extinctions caused by extreme volcanism or asteroid impact. The evolution of organisms in contemporary time is typically viewed as a gradual and incremental process that results from genetic change, environmental perturbation or both. However, contemporary environments occasionally experience strong perturbations such as heat waves, floods, hurricanes, droughts and pest outbreaks. These extreme events set up strong selection pressures on organisms, and are small-scale analogues of the dramatic changes documented in the fossil record. Because extreme events are rare, almost by definition, they are difficult to study. So far most attention has been given to their ecological rather than to their evolutionary consequences. We review several case studies of contemporary evolution in response to two types of extreme environmental perturbations, episodic (pulse) or prolonged (press). Evolution is most likely to occur when extreme events alter community composition. We encourage investigators to be prepared for evolutionary change in response to rare events during long-term field studies.This article is part of the themed issue 'Behavioural, ecological and evolutionary responses to extreme climatic events'. © 2017 The Author(s).

  7. Spatial dependence of extreme rainfall

    Science.gov (United States)

    Radi, Noor Fadhilah Ahmad; Zakaria, Roslinazairimah; Satari, Siti Zanariah; Azman, Muhammad Az-zuhri

    2017-05-01

    This study aims to model the spatial extreme daily rainfall process using the max-stable model. The max-stable model is used to capture the dependence structure of spatial properties of extreme rainfall. Three models from max-stable are considered namely Smith, Schlather and Brown-Resnick models. The methods are applied on 12 selected rainfall stations in Kelantan, Malaysia. Most of the extreme rainfall data occur during wet season from October to December of 1971 to 2012. This period is chosen to assure the available data is enough to satisfy the assumption of stationarity. The dependence parameters including the range and smoothness, are estimated using composite likelihood approach. Then, the bootstrap approach is applied to generate synthetic extreme rainfall data for all models using the estimated dependence parameters. The goodness of fit between the observed extreme rainfall and the synthetic data is assessed using the composite likelihood information criterion (CLIC). Results show that Schlather model is the best followed by Brown-Resnick and Smith models based on the smallest CLIC's value. Thus, the max-stable model is suitable to be used to model extreme rainfall in Kelantan. The study on spatial dependence in extreme rainfall modelling is important to reduce the uncertainties of the point estimates for the tail index. If the spatial dependency is estimated individually, the uncertainties will be large. Furthermore, in the case of joint return level is of interest, taking into accounts the spatial dependence properties will improve the estimation process.

  8. Changing precipitation extremes in Europe

    Science.gov (United States)

    van den Besselaar, E. J. M.; Klein Tank, A. M. G.; van der Schrier, G.

    2010-09-01

    A growing number of studies indicate trends in precipitation extremes over Europe during recent decades. These results are generally based on descriptive indices of extremes which occur on average once (or several times) each year (or season). An example is the maximum one-day precipitation amount per year. Extreme value theory complements the descriptive indices, in order to evaluate the intensity and frequency of more rare events. Trends in more rare extremes are difficult to detect, because per definition only few events exist in the observational series. Although single extreme events cannot be simply and directly attributed to anthropogenic climate change, as there is always a finite chance that the event in question might have occurred naturally, the odds may have shifted to make some of them more likely than in an unchanging climate (IPCC, 2007). In this study we focus on climate extremes defined as rare events within the statistical reference distribution of rainfall that is monitored daily at a particular place. We examine the daily precipitation series from the European Climate Assessment and Dataset (ECA&D) project. Comparisons will be made between the trends in modest extremes detected using the descriptive indices and the trends in more rare extremes determined by fitting an extreme value distribution to the data in consecutive 20-yr periods of the record. The trends in multi-year return levels are determined for groups of stations in several subregions of Europe. Because the typical record length is about 50 yr, we will assess the trends in events that occur on average up to once in 50 yr.

  9. The Extreme Right Filter Bubble

    OpenAIRE

    O'Callaghan, Derek; Greene, Derek; Conway, Maura; Carthy, Joe; Cunningham, Pádraig

    2013-01-01

    Due to its status as the most popular video sharing platform, YouTube plays an important role in the online strategy of extreme right groups, where it is often used to host associated content such as music and other propaganda. In this paper, we develop a categorization suitable for the analysis of extreme right channels found on YouTube. By combining this with an NMF-based topic modelling method, we categorize channels originating from links propagated by extreme right Twitter accounts. This...

  10. Health status evaluation in extremely premature infants

    Directory of Open Access Journals (Sweden)

    M. Yu. Arkhipova

    2016-01-01

    Full Text Available The health status was analyzed in extremely preterm infants at a postconceptual age of 38–40 weeks and in the first year of life. All the infants in the analyzed group were shown to have respiratory disorders, severe perinatal CNS lesions, and the high incidence of bronchopulmonary dysplasia and infectious and inflammatory diseases. In the first year of life, these children belonged to a group of the frequently ill. Dysfunction of the digestive system and intestinal microflora and residual signs of rickets were detected in the majority of the patients; the manifestations of bronchopulmonary dysplasia persisted in 50%. 40% of the infants had disabling complications.

  11. Hall Sensors for Extreme Temperatures

    Directory of Open Access Journals (Sweden)

    Maciej Oszwaldowski

    2011-01-01

    Full Text Available We report on the preparation of the first complete extreme temperature Hall sensor. This means that the extreme-temperature magnetic sensitive semiconductor structure is built-in an extreme-temperature package especially designed for that purpose. The working temperature range of the sensor extends from −270 °C to +300 °C. The extreme-temperature Hall-sensor active element is a heavily n-doped InSb layer epitaxially grown on GaAs. The magnetic sensitivity of the sensor is ca. 100 mV/T and its temperature coefficient is less than 0.04 %/K. This sensor may find applications in the car, aircraft, spacecraft, military and oil and gas industries.

  12. Statistical Model of Extreme Shear

    DEFF Research Database (Denmark)

    Hansen, Kurt Schaldemose; Larsen, Gunner Chr.

    2005-01-01

    (PDF) of turbulence driven short-term extreme wind shear events, conditioned on the mean wind speed, for an arbitrary recurrence period. The model is based on an asymptotic expansion, and only a few and easily accessible parameters are needed as input. The model of the extreme PDF is supplemented...... by a model that, on a statistically consistent basis, describes the most likely spatial shape of an extreme wind shear event. Predictions from the model have been compared with results from an extreme value data analysis, based on a large number of full-scale measurements recorded with a high sampling rate......In order to continue cost-optimisation of modern large wind turbines, it is important to continuously increase the knowledge of wind field parameters relevant to design loads. This paper presents a general statistical model that offers site-specific prediction of the probability density function...

  13. Irrigation mitigates against heat extremes

    Science.gov (United States)

    Thiery, Wim; Fischer, Erich; Visser, Auke; Hirsch, Annette L.; Davin, Edouard L.; Lawrence, Dave; Hauser, Mathias; Seneviratne, Sonia I.

    2017-04-01

    Irrigation is an essential practice for sustaining global food production and many regional economies. Emerging scientific evidence indicates that irrigation substantially affects mean climate conditions in different regions of the world. Yet how this practice influences climate extremes is currently unknown. Here we use gridded observations and ensemble simulations with the Community Earth System Model to assess the impacts of irrigation on climate extremes. While the influence of irrigation on annual mean temperatures is limited, we find a large impact on temperature extremes, with a particularly strong cooling during the hottest day of the year (-0.78 K averaged over irrigated land). The strong influence on hot extremes stems from the timing of irrigation and its influence on land-atmosphere coupling strength. Together these effects result in asymmetric temperature responses, with a more pronounced cooling during hot and/or dry periods. The influence of irrigation is even more pronounced when considering subgrid-scale model output, suggesting that local effects of land management are far more important than previously thought. Finally we find that present-day irrigation is partly masking GHG-induced warming of extreme temperatures, with particularly strong effects in South Asia. Our results overall underline that irrigation substantially reduces our exposure to hot temperature extremes and highlight the need to account for irrigation in future climate projections.

  14. Management of mixed arterial venous lower extremity ulceration: A review.

    Science.gov (United States)

    Hedayati, Nasim; Carson, John G; Chi, Yung-Wei; Link, Daniel

    2015-10-01

    Mixed arterial venous disease is estimated to affect up to 26% of patients with lower extremity ulcerations. However, its clinical significance and pathophysiology are incompletely understood. Furthermore, there is no consensus on the optimal treatment modality, whether conservative or operative. In this review paper, we describe the current understanding of the pathophysiology of mixed arterial venous lower extremity ulcers. Guidelines for diagnostic tests for patients with mixed arterial venous diseases are discussed. We review some of the newer biological skin substitutes for conservative wound care. Finally, we propose a treatment algorithm based on current available data. © The Author(s) 2015.

  15. Ideologies and Discourses: Extreme Narratives in Extreme Metal Music

    Directory of Open Access Journals (Sweden)

    Bojana Radovanović

    2016-10-01

    Full Text Available Historically speaking, metal music has always been about provoking a strong reaction. Depending on the characteristics of different sub-genres, one can focus on the sound, technique, visual appearance, and furthermore, the ideologies and ideas that are the foundation for each of the sub-genres. Although the majority of the metal community rejects accusations of being racially intolerant, some ideologies of extreme sub-genres (such as black metal are in fact formed around the ideas of self-conscious elitism expressed through interest in pagan mythology, racism, Nazism and fascism. There has been much interest in the Nazi era within the extreme metal scene thus influencing other sub-genres and artists. The aim of this paper is to examine various appearances of extreme narratives such as Nazism and racism in  different sub-genres of metal, bearing in mind variations dependent on geographical, political, and other factors.

  16. Genetics Home Reference: paroxysmal extreme pain disorder

    Science.gov (United States)

    ... Health Conditions paroxysmal extreme pain disorder paroxysmal extreme pain disorder Printable PDF Open All Close All Enable Javascript to view the expand/collapse boxes. Description Paroxysmal extreme pain disorder is a condition characterized by skin redness ...

  17. Changes of Extreme Climate Events in Latvia

    OpenAIRE

    Avotniece, Z; Klavins, M; Rodinovs, V

    2012-01-01

    Extreme climate events are increasingly recognized as a threat to human health, agriculture, forestry and other sectors. To assess the occurrence and impacts of extreme climate events, we have investigated the changes of indexes characterizing positive and negative temperature extremes and extreme precipitation as well as the spatial heterogeneity of extreme climate events in Latvia. Trend analysis of long–term changes in the frequency of extreme climate events demonst...

  18. Rising Precipitation Extremes across Nepal

    Directory of Open Access Journals (Sweden)

    Ramchandra Karki

    2017-01-01

    Full Text Available As a mountainous country, Nepal is most susceptible to precipitation extremes and related hazards, including severe floods, landslides and droughts that cause huge losses of life and property, impact the Himalayan environment, and hinder the socioeconomic development of the country. Given that the countrywide assessment of such extremes is still lacking, we present a comprehensive picture of prevailing precipitation extremes observed across Nepal. First, we present the spatial distribution of daily extreme precipitation indices as defined by the Expert Team on Climate Change Detection, Monitoring and Indices (ETCCDMI from 210 stations over the period of 1981–2010. Then, we analyze the temporal changes in the computed extremes from 76 stations, featuring long-term continuous records for the period of 1970–2012, by applying a non-parametric Mann−Kendall test to identify the existence of a trend and Sen’s slope method to calculate the true magnitude of this trend. Further, the local trends in precipitation extremes have been tested for their field significance over the distinct physio-geographical regions of Nepal, such as the lowlands, middle mountains and hills and high mountains in the west (WL, WM and WH, respectively, and likewise, in central (CL, CM and CH and eastern (EL, EM and EH Nepal. Our results suggest that the spatial patterns of high-intensity precipitation extremes are quite different to that of annual or monsoonal precipitation. Lowlands (Terai and Siwaliks that feature relatively low precipitation and less wet days (rainy days are exposed to high-intensity precipitation extremes. Our trend analysis suggests that the pre-monsoonal precipitation is significantly increasing over the lowlands and CH, while monsoonal precipitation is increasing in WM and CH and decreasing in CM, CL and EL. On the other hand, post-monsoonal precipitation is significantly decreasing across all of Nepal while winter precipitation is decreasing

  19. Book review: Extreme ocean waves

    Science.gov (United States)

    Geist, Eric L.

    2017-01-01

    Extreme Ocean Waves”, edited by E. Pelinovsky and C. Kharif, second edition, Springer International Publishing, 2016; ISBN: 978-3-319-21574-7, ISBN (eBook): 978-3-319-21575-4The second edition of “Extreme Ocean Waves” published by Springer is an update of a collection of 12 papers edited by Efim Pelinovsky and Christian Kharif following the April 2007 meeting of the General Assembly of the European Geosciences Union. In this edition, three new papers have been added and three more have been substantially revised. Color figures are now included, which greatly aids in reading several of the papers, and is especially helpful in visualizing graphs as in the paper on symbolic computation of nonlinear wave resonance (Tobisch et al.). A note on terminology: extreme waves in this volume broadly encompass different types of waves, including deep-water and shallow-water rogue waves (which are alternatively termed freak waves), and internal waves. One new paper on tsunamis (Viroulet et al.) is now included in the second edition of this volume. Throughout the book, the reader will find a combination of laboratory, theoretical, and statistical/empirical treatment necessary for the complete examination of this subject. In the Introduction, the editors underscore the importance of studying extreme waves, documenting a dramatic instance of damaging extreme waves that recently occurred in 2014.

  20. Extreme hydrological events and security

    Directory of Open Access Journals (Sweden)

    Z. W. Kundzewicz

    2015-06-01

    Full Text Available Economic losses caused by hydrological extremes – floods and droughts – have been on the rise, worldwide. Hydrological extremes jeopardize human security and cause serious threats to human life and welfare and societal livelihood. Floods and droughts can undermine societies' security, understood as freedom from threat and the ability of societies to maintain their independent identity and their functional integrity against forces of change. Several dimensions of security are reviewed in the context of hydrological extremes. Floods and droughts pose a burden and serious challenges to the state, responsible to sustain economic development, societal and environmental security – the maintenance of ecosystem services, on which a society depends. It is shown that reduction of risk of hydrological disasters improves human security.

  1. Functional metagenomics of extreme environments.

    Science.gov (United States)

    Mirete, Salvador; Morgante, Verónica; González-Pastor, José Eduardo

    2016-04-01

    The bioprospecting of enzymes that operate under extreme conditions is of particular interest for many biotechnological and industrial processes. Nevertheless, there is a considerable limitation to retrieve novel enzymes as only a small fraction of microorganisms derived from extreme environments can be cultured under standard laboratory conditions. Functional metagenomics has the advantage of not requiring the cultivation of microorganisms or previous sequence information to known genes, thus representing a valuable approach for mining enzymes with new features. In this review, we summarize studies showing how functional metagenomics was employed to retrieve genes encoding for proteins involved not only in molecular adaptation and resistance to extreme environmental conditions but also in other enzymatic activities of biotechnological interest. Copyright © 2016 Elsevier Ltd. All rights reserved.

  2. Extreme solar-terrestrial events

    Science.gov (United States)

    Dal Lago, A.; Antunes Vieira, L. E.; Echer, E.; Balmaceda, L. A.; Rockenbach, M.; Gonzalez, W. D.

    2017-10-01

    Extreme solar-terrestrial events are those in which very energetic solar ejections hit the earth?s magnetosphere, causing intense energization of the earth?s ring current. Statistically, their occurrence is approximately once per Gleissberg solar cycle (70-100yrs). The solar transient occurred on July, 23rd (2012) was potentially one of such extreme events. The associated coronal mass ejection (CME), however, was not ejected towards the earth. Instead, it hit the STEREO A spacecraft, located 120 degrees away from the Sun-Earth line. Estimates of the geoeffectiveness of such a CME point to a scenario of extreme Space Weather conditions. In terms of the ring current energization, as measured by the Disturbance Storm-Time index (Dst), had this CME hit the Earth, it would have caused the strongest geomagnetic storm in space era.

  3. Extreme Conditions Modeling Workshop Report

    Energy Technology Data Exchange (ETDEWEB)

    Coe, R. G.; Neary, V. S.; Lawson, M. J.; Yu, Y.; Weber, J.

    2014-07-01

    Sandia National Laboratories (SNL) and the National Renewable Energy Laboratory (NREL) hosted the Wave Energy Converter (WEC) Extreme Conditions Modeling (ECM) Workshop in Albuquerque, NM on May 13th-14th, 2014. The objective of the workshop was to review the current state of knowledge on how to model WECs in extreme conditions (e.g. hurricanes and other large storms) and to suggest how U.S. Department of Energy (DOE) and national laboratory resources could be used to improve ECM methods for the benefit of the wave energy industry.

  4. Automation Rover for Extreme Environments

    Science.gov (United States)

    Sauder, Jonathan; Hilgemann, Evan; Johnson, Michael; Parness, Aaron; Hall, Jeffrey; Kawata, Jessie; Stack, Kathryn

    2017-01-01

    Almost 2,300 years ago the ancient Greeks built the Antikythera automaton. This purely mechanical computer accurately predicted past and future astronomical events long before electronics existed1. Automata have been credibly used for hundreds of years as computers, art pieces, and clocks. However, in the past several decades automata have become less popular as the capabilities of electronics increased, leaving them an unexplored solution for robotic spacecraft. The Automaton Rover for Extreme Environments (AREE) proposes an exciting paradigm shift from electronics to a fully mechanical system, enabling longitudinal exploration of the most extreme environments within the solar system.

  5. Effects of Extreme Temperatures on Cause-Specific Cardiovascular Mortality in China

    Directory of Open Access Journals (Sweden)

    Xuying Wang

    2015-12-01

    Full Text Available Objective: Limited evidence is available for the effects of extreme temperatures on cause-specific cardiovascular mortality in China. Methods: We collected data from Beijing and Shanghai, China, during 2007–2009, including the daily mortality of cardiovascular disease, cerebrovascular disease, ischemic heart disease and hypertensive disease, as well as air pollution concentrations and weather conditions. We used Poisson regression with a distributed lag non-linear model to examine the effects of extremely high and low ambient temperatures on cause-specific cardiovascular mortality. Results: For all cause-specific cardiovascular mortality, Beijing had stronger cold and hot effects than those in Shanghai. The cold effects on cause-specific cardiovascular mortality reached the strongest at lag 0–27, while the hot effects reached the strongest at lag 0–14. The effects of extremely low and high temperatures differed by mortality types in the two cities. Hypertensive disease in Beijing was particularly susceptible to both extremely high and low temperatures; while for Shanghai, people with ischemic heart disease showed the greatest relative risk (RRs = 1.16, 95% CI: 1.03, 1.34 to extremely low temperature. Conclusion: People with hypertensive disease were particularly susceptible to extremely low and high temperatures in Beijing. People with ischemic heart disease in Shanghai showed greater susceptibility to extremely cold days.

  6. Accuracy of Noncontrast Quiescent-Interval Single-Shot Lower Extremity MR Angiography Versus CT Angiography for Diagnosis of Peripheral Artery Disease Comparison With Digital Subtraction Angiography : Comparison With Digital Subtraction Angiography

    NARCIS (Netherlands)

    Varga-Szemes, Akos; Wichmann, Julian L; Schoepf, U Joseph; Suranyi, Pal; De Cecco, Carlo N; Muscogiuri, Giuseppe; Caruso, Damiano; Yamada, Ricardo T; Litwin, Sheldon E; Tesche, Christian; Duguay, Taylor M; Giri, Shivraman; Vliegenthart, Rozemarijn; Todoran, Thomas M

    2017-01-01

    OBJECTIVES This study sought to evaluate the image quality and diagnostic accuracy of noncontrast quiescent-interval single-shot (QISS) magnetic resonance angiography (MRA) versus iodine-contrast computed tomography angiography (CTA) in patients with peripheral artery disease (PAD), with invasive

  7. Extreme Energy Events Monitoring report

    CERN Document Server

    Baimukhamedova, Nigina

    2015-01-01

    Following paper reflects the progress I made on Summer Student Program within Extreme Energy Events Monitor project I was working on. During 8 week period I managed to build a simple detector system that is capable of triggering events similar to explosions (sudden change in sound levels) and measuring approximate location of the event. Source codes are available upon request and settings described further.

  8. Astrobiology: Life in Extreme Environments

    Science.gov (United States)

    Kaur, Preeti

    2011-01-01

    Astrobiology is the study of the origin, evolution and distribution of life in the universe. It seeks to answer two important scientific questions: how did we get here and are we alone in the universe? Scientists begin by studying life on Earth and its limits. The discovery of extremophiles on Earth capable of surviving extremes encourages the…

  9. Applied extreme-value statistics

    Energy Technology Data Exchange (ETDEWEB)

    Kinnison, R.R.

    1983-05-01

    The statistical theory of extreme values is a well established part of theoretical statistics. Unfortunately, it is seldom part of applied statistics and is infrequently a part of statistical curricula except in advanced studies programs. This has resulted in the impression that it is difficult to understand and not of practical value. In recent environmental and pollution literature, several short articles have appeared with the purpose of documenting all that is necessary for the practical application of extreme value theory to field problems (for example, Roberts, 1979). These articles are so concise that only a statistician can recognise all the subtleties and assumptions necessary for the correct use of the material presented. The intent of this text is to expand upon several recent articles, and to provide the necessary statistical background so that the non-statistician scientist can recognize and extreme value problem when it occurs in his work, be confident in handling simple extreme value problems himself, and know when the problem is statistically beyond his capabilities and requires consultation.

  10. Extreme conditions (p, T, H)

    Energy Technology Data Exchange (ETDEWEB)

    Mesot, J. [Lab. for Neutron Scattering ETH Zurich, Zurich (Switzerland) and Paul Scherrer Institute, Villigen (Switzerland)

    1996-11-01

    The aim of this paper is to summarize the sample environment which will be accessible at the SINQ. In order to illustrate the type of experiments which will be feasible under extreme conditions of temperature, magnetic field and pressure at the SINQ a few selected examples are also given. (author) 7 figs., 14 refs.

  11. Scintigraphic demonstration of lower extremity periostitis secondary to venous insufficiency

    Energy Technology Data Exchange (ETDEWEB)

    Gensburg, R.S.; Kawashima, A.; Sandler, C.M.

    1988-07-01

    The scintigraphic findings on bone imaging in two patients with extensive lower extremity periostitis secondary to venous insufficiency are presented. One of these patients had bilateral disease. The use of (/sup 67/Ga)citrate scanning in an attempt to exclude concurrent osteomyelitis is also addressed.

  12. Extreme events in Faraday waves

    Science.gov (United States)

    Punzmann, Horst; Shats, Michael; Xia, Hua

    2014-05-01

    Observations of extreme wave events in the ocean are rare due to their low statistical probability. In the laboratory however, the evolution of extreme wave events can be studied in great detail with high spatial and temporal resolution. The reported surface wave experiments in the short wavelength gravity-capillary range aim to contribute to the understanding of some of the underlying mechanisms for rogue wave generation. In this talk, we report on extreme wave events in parametrically excited Faraday waves. Faraday waves appear if a fluid is accelerated (normal to the fluid surface) above a critical threshold. A variety of novel tools have been deployed to characterize the 2D surface elevation. The results presented show spatio-temporal and statistical data on the surface wave conditions leading up to extreme wave events. The peak in wave amplitude during such an event is shown to exceed six times the standard deviation of the average wave field with significantly increased statistical probability compared to the background wave field [1]. The experiments also show that parametrically excited waves can be viewed as assembles of oscillons [2] (or oscillating solitons) where modulation instability seems to play a crucial role in their formation. More detailed studies on the oscillon dynamics reveal that the onset of an increased probability of extreme wave events correlates with the increase in the oscillons mobility and merger [3]. Reference: 1. Xia H., Maimbourg T., Punzmann H., and Shats M., Oscillon dynamics and rogue wave generation in Faraday surface ripples, Physical Review Letters 109, 114502 (2012) 2. Shats M., Xia H., and Punzmann H., Parametrically excited water surface ripples as ensembles of oscillons, Physical Review Letters 108, 034502 (2012) 3. Shats M., Punzmann H., Xia H., Capillary rogue waves, Physical Review Letters, 104, 104503 (2010)

  13. Extremal higher spin black holes

    Energy Technology Data Exchange (ETDEWEB)

    Bañados, Máximo [Instituto de Física, Pontificia Universidad Católica de Chile, Casilla 306, Santiago (Chile); Castro, Alejandra [Institute for Theoretical Physics, University of Amsterdam,Science Park 904, Postbus 94485, Amsterdam, 1090 GL (Netherlands); Faraggi, Alberto [Instituto de Física, Pontificia Universidad Católica de Chile, Casilla 306, Santiago (Chile); Jottar, Juan I. [Institut für Theoretische Physik, ETH Zürich,Zürich, CH-8093 (Switzerland)

    2016-04-13

    The gauge sector of three-dimensional higher spin gravities can be formulated as a Chern-Simons theory. In this context, a higher spin black hole corresponds to a flat connection with suitable holonomy (smoothness) conditions which are consistent with the properties of a generalized thermal ensemble. Building on these ideas, we discuss a definition of black hole extremality which is appropriate to the topological character of 3d higher spin theories. Our definition can be phrased in terms of the Jordan class of the holonomy around a non-contractible (angular) cycle, and we show that it is compatible with the zero-temperature limit of smooth black hole solutions. While this notion of extremality does not require supersymmetry, we exemplify its consequences in the context of sl(3|2)⊕sl(3|2) Chern-Simons theory and show that, as usual, not all extremal solutions preserve supersymmetries. Remarkably, we find in addition that the higher spin setup allows for non-extremal supersymmetric black hole solutions. Furthermore, we discuss our results from the perspective of the holographic duality between sl(3|2)⊕sl(3|2) Chern-Simons theory and two-dimensional CFTs with W{sub (3|2)} symmetry, the simplest higher spin extension of the N=2 super-Virasoro algebra. In particular, we compute W{sub (3|2)} BPS bounds at the full quantum level, and relate their semiclassical limit to extremal black hole or conical defect solutions in the 3d bulk. Along the way, we discuss the role of the spectral flow automorphism and provide a conjecture for the form of the semiclassical BPS bounds in general N=2 two-dimensional CFTs with extended symmetry algebras.

  14. Multidecadal oscillations in rainfall and hydrological extremes

    OpenAIRE

    Willems, Patrick

    2013-01-01

    Many studies have anticipated a worldwide increase in the frequency and intensity of precipitation extremes and floods since the last decade(s). Natural variability by climate oscillations partly determines the observed evolution of precipitation extremes. Based on a technique for the identification and analysis of changes in extreme quantiles, it is shown that hydrological extremes have oscillatory behaviour at multidecadal time scales. Results are based on nearly independent extremes extrac...

  15. Norwegian trends in numbers of lower extremity revascularisations and amputations including regional trends in endovascular treatments for peripheral arterial disease: a retrospective cross-sectional registry study from 2001 to 2014.

    Science.gov (United States)

    Wendt, Kjersti; Kristiansen, Ronny; Krohg-Sørensen, Kirsten; Gregersen, Fredrik Alexander; Fosse, Erik

    2017-11-14

    The numbers of lower extremity revascularisations and amputations are insufficiently reported in Norway. To support future policy decisions regarding the provision of vascular treatment, knowledge of such trends is important. This retrospective cross-sectional study from 2001 to 2014 used data from the Norwegian Patient Registry. The revascularisation treatments were categorised in multilevel, aortoiliac, femoral to popliteal and popliteal to foot levels and sorted as open, endovascular and hybrid. The sessions in amputations were divided in major (thigh and below knee) and minor (ankle, foot or digit). Incidence rates were assessed per 100 000 for patients in the age group >60 years. The diabetic prevalence was calculated and the endovascular numbers at the South-Eastern, Western, Central and Northern Norway Regional Health Authority were compared. The overall revascularisation rates increased from 308.7 to 366.8 (p=0.02). Open revascularisations decreased from 158.9 to 98.7 (p<0.01) while endovascular revascularisations increased from 142.2 to 243.4 (p<0.01). Hybrid revascularisations increased from 7.4 to 24.8 (p<0.01). Major amputation rates decreased from 87.8 to 48.7 (p<0.01) while minor amputations increased from 12.3 to 19.6 (p=0.01). The diabetic percentages increased from 12.2 to 22.3 (p<0.01) in revascularisations, from 26.5 to 30.8 (p=0.02) in major amputations and from 43.0 to 49.3 (p=0.13) in minor. (p values refer to average annual changes.) The regional trends in endovascular treatments varied within and between the vascular groups. From 2001 to 2014, the revascularisation rates increased due to the rise in endovascular procedures. Open revascularisations and major amputation rates decreased, minor increased. The regional variances in endovascular treatments indicate that the availability of this technology differed between the health regions of Norway. The increase in patients with diabetes requires continued awareness of diabetes and its

  16. Extreme Conditions Modeling Workshop Report

    Energy Technology Data Exchange (ETDEWEB)

    Coe, Ryan Geoffrey [Sandia National Laboratories (SNL-NM), Albuquerque, NM (United States); Neary, Vincent Sinclair [Sandia National Laboratories (SNL-NM), Albuquerque, NM (United States); Lawon, Michael J. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Yu, Yi-Hsiang [National Renewable Energy Lab. (NREL), Golden, CO (United States); Weber, Jochem [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2014-07-01

    Sandia National Laboratories (SNL) and the National Renewable Energy Laboratory (NREL) hosted the Wave Energy Converter (WEC) Extreme Conditions Modeling (ECM) Workshop in Albuquerque, New Mexico on May 13–14, 2014. The objective of the workshop was to review the current state of knowledge on how to numerically and experimentally model WECs in extreme conditions (e.g. large ocean storms) and to suggest how national laboratory resources could be used to improve ECM methods for the benefit of the wave energy industry. More than 30 U.S. and European WEC experts from industry, academia, and national research institutes attended the workshop, which consisted of presentations from W EC developers, invited keynote presentations from subject matter experts, breakout sessions, and a final plenary session .

  17. Large Extremity Peripheral Nerve Repair

    Science.gov (United States)

    2016-12-01

    axons, the effects of which worsen with time.5 Following trauma , priority is given to patient stabilization and wound decontamination before the onset...STATEMENT Approved for Public Release; Distribution Unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT In current war trauma , 20-30% of all extremity...wrap/ fixation method to be sutureless photochemical tissue bonding with the crosslinked amnion wrap. Autograft is often unavailable in wounded

  18. Moderate and extreme maternal obesity.

    LENUS (Irish Health Repository)

    Abdelmaboud, M O

    2012-05-01

    The aim of this study was to investigate the prevalence of moderate and extreme obesity among an Irish obstetric population over a 10-year period, and to evaluate the obstetric features of such pregnancies. Of 31,869 women delivered during the years 2000-2009, there were 306 women in the study group, including 173 in the moderate or Class 2 obese category (BMI 35-39.9) and 133 in the extreme or Class 3 obese category (BMI > or = 40).The prevalence of obese women with BMI > or = 35 was 9.6 per 1000 (0.96%), with an upward trend observed from 2.1 per 1000 in the year 2000, to 11.8 per 1000 in the year 2009 (P = 0.001). There was an increase in emergency caesarean section (EMCS) risk for primigravida versus multigravid women, within both obese categories (P < 0.001). However, there was no significant difference in EMCS rates observed between Class 2 and Class 3 obese women, when matched for parity. The prevalence of moderate and extreme obesity reported in this population is high, and appears to be increasing. The increased rates of abdominal delivery, and the levels of associated morbidity observed, have serious implications for such women embarking on pregnancy.

  19. Technology improves upper extremity rehabilitation.

    Science.gov (United States)

    Kowalczewski, Jan; Prochazka, Arthur

    2011-01-01

    Stroke survivors with hemiparesis and spinal cord injury (SCI) survivors with tetraplegia find it difficult or impossible to perform many activities of daily life. There is growing evidence that intensive exercise therapy, especially when supplemented with functional electrical stimulation (FES), can improve upper extremity function, but delivering the treatment can be costly, particularly after recipients leave rehabilitation facilities. Recently, there has been a growing level of interest among researchers and healthcare policymakers to deliver upper extremity treatments to people in their homes using in-home teletherapy (IHT). The few studies that have been carried out so far have encountered a variety of logistical and technical problems, not least the difficulty of conducting properly controlled and blinded protocols that satisfy the requirements of high-level evidence-based research. In most cases, the equipment and communications technology were not designed for individuals with upper extremity disability. It is clear that exercise therapy combined with interventions such as FES, supervised over the Internet, will soon be adopted worldwide in one form or another. Therefore it is timely that researchers, clinicians, and healthcare planners interested in assessing IHT be aware of the pros and cons of the new technology and the factors involved in designing appropriate studies of it. It is crucial to understand the technical barriers, the role of telesupervisors, the motor improvements that participants can reasonably expect and the process of optimizing IHT-exercise therapy protocols to maximize the benefits of the emerging technology. Copyright © 2011 Elsevier B.V. All rights reserved.

  20. Lower Extremity Abnormalities in Children.

    Science.gov (United States)

    Rerucha, Caitlyn M; Dickison, Caleb; Baird, Drew C

    2017-08-15

    Leg and foot problems in childhood are common causes of parental concern. Rotational problems include intoeing and out-toeing. Intoeing is most common in infants and young children. Intoeing is caused by metatarsus adductus, internal tibial torsion, and femoral anteversion. Out-toeing is less common than intoeing and occurs more often in older children. Out-toeing is caused by external tibial torsion and femoral retroversion. Angular problems include genu varum (bowleg) and genu valgum (knock knee). With pes planus (flatfoot), the arch of the foot is usually flexible rather than rigid. A history and physical examination that include torsional profile tests and angular measurements are usually sufficient to evaluate patients with lower extremity abnormalities. Most children who present with lower extremity problems have normal rotational and angular findings (i.e., within two standard deviations of the mean). Lower extremity abnormalities that are within normal measurements resolve spontaneously as the child grows. Radiologic studies are not routinely required, except to exclude pathologic conditions. Orthotics are not beneficial. Orthopedic referral is often not necessary. Rarely, surgery is required in patients older than eight years who have severe deformities that cause dysfunction.

  1. A Case Report on Upper Extremity Pain of Cardiac Origin

    Directory of Open Access Journals (Sweden)

    Turgay Altınbilek

    2016-08-01

    Full Text Available Upper extremity pain can originate from the musculoskeletal system, or be a reflection of problems originating from various organs. Therefore, it is highly important to perform a detailed clinical evaluation on patients during differential diagnosis. In this case report, we present a 61 year-old male patient who was admitted with pain in both upper extremities and the upper back that presumed to be of cardiac origin following our clinical evaluations. The patient was referred to the cardiology department, where he was diagnosed with coronary heart disease. The patient’s complaints of pain were fully resolved through the application of an intracoronary stent.

  2. Rainfall variability and extremes over southern Africa: Assessment of a climate model to reproduce daily extremes

    Science.gov (United States)

    Williams, C. J. R.; Kniveton, D. R.; Layberry, R.

    2009-04-01

    It is increasingly accepted that that any possible climate change will not only have an influence on mean climate but may also significantly alter climatic variability. A change in the distribution and magnitude of extreme rainfall events (associated with changing variability), such as droughts or flooding, may have a far greater impact on human and natural systems than a changing mean. This issue is of particular importance for environmentally vulnerable regions such as southern Africa. The subcontinent is considered especially vulnerable to and ill-equipped (in terms of adaptation) for extreme events, due to a number of factors including extensive poverty, famine, disease and political instability. Rainfall variability and the identification of rainfall extremes is a function of scale, so high spatial and temporal resolution data are preferred to identify extreme events and accurately predict future variability. The majority of previous climate model verification studies have compared model output with observational data at monthly timescales. In this research, the assessment of ability of a state of the art climate model to simulate climate at daily timescales is carried out using satellite derived rainfall data from the Microwave Infra-Red Algorithm (MIRA). This dataset covers the period from 1993-2002 and the whole of southern Africa at a spatial resolution of 0.1 degree longitude/latitude. The ability of a climate model to simulate current climate provides some indication of how much confidence can be applied to its future predictions. In this paper, simulations of current climate from the UK Meteorological Office Hadley Centre's climate model, in both regional and global mode, are firstly compared to the MIRA dataset at daily timescales. This concentrates primarily on the ability of the model to simulate the spatial and temporal patterns of rainfall variability over southern Africa. Secondly, the ability of the model to reproduce daily rainfall extremes will

  3. Extreme weather events and global crop production

    Science.gov (United States)

    Ray, D. K.; Gerber, J. S.; West, P. C.

    2014-12-01

    Extreme weather events can lead to significant loss in crop production and even trigger global price spikes. However it is still not clear where exactly and what types of extreme events have resulted in sharp declines in crop production. Neither is it clear how frequently such extreme events have resulted in extreme crop production losses. Using extreme event metrics with a newly developed high resolution and long time series of crop statistics database we identify the frequency and type of extreme event driven crop production losses globally at high resolutions. In this presentation we will present our results as global maps identifying the frequency and type of extreme weather events that resulted in extreme crop production losses and quantify the losses. Understanding how extreme events affects crop production is critical for managing risk in the global food system

  4. Domperidone effective in preventing rivastigmine-related gastrointestinal disturbances in patients with Alzheimer's disease

    Directory of Open Access Journals (Sweden)

    Kano O

    2013-09-01

    Full Text Available Osamu Kano,1 Yoshihisa Urita,2 Hirono Ito,1 Takanori Takazawa,1 Yuji Kawase,1 Kiyoko Murata,1 Takehisa Hirayama,1 Ken Miura,1 Yuichi Ishikawa,1 Tetsuhito Kiyozuka,3 Jo Aoyagi,3 Yasuo Iwasaki11Department of Neurology, 2Department of General Medicine and Emergency Care, Toho University Omori Medical Center, Tokyo, Japan; 3Department of Neurology, Federation of National Public Service Personnel Mutual Aid Associations, Mishuku Hospital, Tokyo, JapanObjective: While acetylcholinesterase inhibitors, such as donepezil, galantamine, and rivastigmine, are beneficial in treating behavioral symptoms of patients with Alzheimer's disease (AD, their dose-limiting effects include gastrointestinal disturbances, such as nausea, vomiting, and diarrhea. We aimed to predict the occurrence of these gastrointestinal disturbances with rivastigmine therapy for optimal drug choice and improved compliance.Materials and methods: Thirty patients with mild-to-moderate AD (scores 10–22 on the Mini-Mental State Examination were administered a rivastigmine 18 mg patch with domperidone 30 mg (RWD and without domperidone (RWOD; n = 15 each for 20 weeks. Gastrointestinal disturbances were evaluated using a frequency scale for symptoms of gastroesophageal reflux disease (FSSG, Bristol stool form scale, laboratory data (hemoglobin, albumin, total cholesterol, body weight, and amount of food intake.Results: After 12 weeks, FSSG scores were higher in the RWOD group compared to baseline scores; however, no significant differences were noted between the RWD and RWOD groups. We then subdivided each group based on high and low baseline scores; the RWOD high-score (≥4 subgroup showed increased FSSG after 12 weeks compared with the baseline score. In both RWD and RWOD groups, the low-score (≤3 subgroups showed no changes during the dose-escalation phase.Conclusion: For AD patients with higher FSSG scores at baseline, domperidone was effective in preventing rivastigmine

  5. Disease: H01020 [KEGG MEDICUS

    Lifescience Database Archive (English)

    Full Text Available arOAs are believed to be extremely rare. Neurodegenerative disease (OPA1) OPA1 [H...nnery PF ... TITLE ... Mitochondrial optic neuropathies - disease mechanisms and therapeutic strategies. ... JOU

  6. Outcomes for Extremely Premature Infants

    Science.gov (United States)

    Glass, Hannah C.; Costarino, Andrew T.; Stayer, Stephen A.; Brett, Claire; Cladis, Franklyn; Davis, Peter J.

    2015-01-01

    Premature birth is a significant cause of infant and child morbidity and mortality. In the United States, the premature birth rate, which had steadily increased during the 1990s and early 2000s, has decreased annually for four years and is now approximately 11.5%. Human viability, defined as gestational age at which the chance of survival is 50%, is currently approximately 23–24 weeks in developed countries. Infant girls, on average, have better outcomes than infant boys. A relatively uncomplicated course in the intensive care nursery for an extremely premature infant results in a discharge date close to the prenatal EDC. Despite technological advances and efforts of child health experts during the last generation, the extremely premature infant (less than 28 weeks gestation) and extremely low birth weight infant (ELBW) (premature labor improved neonatal mortality and morbidity in the late 1990s. The recognition that chronic postnatal administration of steroids to infants should be avoided may have improved outcomes in the early 2000s. Evidence from recent trials attempting to define the appropriate target for oxygen saturation in preterm infants suggests arterial oxygen saturation between 91–95% (compared to 85–89%) avoids excess mortality. However, final analyses of data from these trials have not been published, so definitive recommendations are still pending The development of neonatal neurocognitive care visits may improve neurocognitive outcomes in this high-risk group. Long-term follow up to detect and address developmental, learning, behavioral, and social problems is critical for children born at these early gestational ages. The striking similarities in response to extreme prematurity in the lung and brain imply that agents and techniques that benefit one organ are likely to also benefit the other. Finally, since therapy and supportive care continue to change, the outcomes of ELBW infants are ever evolving. Efforts to minimize injury, preserve

  7. Extreme Events: The Indian Experience

    Science.gov (United States)

    Murty, K. S.

    2008-05-01

    The geographical situation of India is such that it experiences varied types of climate in different parts of the country and invariably the natural events, extreme and normal, would affect such areas that are prone to them. Cyclones hit the eastern coast, while floods affect mostly northern India, while earthquakes hit any part of the country, particuarly when itbecame evident after the 1967 earthquake of Koyna that the peninsular part toois prone to seismic events. The National Commission on Floods estimated that nearly 40 millionn hectares of land is prone to flooding, which could rise to60 million soon. The cropped area thus affected annually is about 10 millionhectares. On an average 1500 lives are lost during floods annually, while the damage to property could run into billions of dollars. The total loss on account of floods damage to crops is estimated at about Rs 53,000 crores(crore= 100 lakhs), during the period 1953-1998. The other extreme natural event is drought which affects large parts of the country, except the northeast. Both floods and droughts can hit different parts of the country during the same period. The 2001 earthquake that hit Gujarat is perhaps the severest and studies on that event are still in progress. The 2004 tsunami which hit large parts of southeast Asia did not spare India. Its southern coast was battered and many lives were lost. In fact some geogrphic landmarks were lost, while some of the cities have suffered a shift in their position. It was estimated that about 1.2 billion dollars were required ro meet the rehabilitation and relief measures. The seismic zone map of India thus had to be revised more often than before. Apart from these, extreme rainfall has also caused floods in urban areas as in Mumbai in 2005, but this was mostly because of lack of proper drainage system and the existing system proved ineffective. Human hand in such cases is evident. There are systems working to forecast floods, cyclones, and droughts, though

  8. Promoting Exit from Violent Extremism

    DEFF Research Database (Denmark)

    Dalgaard-Nielsen, Anja

    2013-01-01

    a perspective on how these natural sources of doubt might best be brought to bear in connection with an exit program by drawing on social psychology and research into persuasion and attitude change. It is argued that an external intervention should stay close to the potential exiter’s own doubt, make......A number of Western countries are currently adding exit programs targeting militant Islamists to their counterterrorism efforts. Drawing on research into voluntary exit from violent extremism, this article identifies themes and issues that seem to cause doubt, leading to exit. It then provides...

  9. Communication path for extreme environments

    Science.gov (United States)

    Jorgensen, Charles C. (Inventor); Betts, Bradley J. (Inventor)

    2010-01-01

    Methods and systems for using one or more radio frequency identification devices (RFIDs), or other suitable signal transmitters and/or receivers, to provide a sensor information communication path, to provide location and/or spatial orientation information for an emergency service worker (ESW), to provide an ESW escape route, to indicate a direction from an ESW to an ES appliance, to provide updated information on a region or structure that presents an extreme environment (fire, hazardous fluid leak, underwater, nuclear, etc.) in which an ESW works, and to provide accumulated thermal load or thermal breakdown information on one or more locations in the region.

  10. Gravity and Extreme Magnetism SMEX

    Science.gov (United States)

    2012-01-01

    The Gravity and Extreme Magnetism SMEX mission will be the first mission to catalogue the X-ray polarisation of many astrophysical objects including black-holes and pulsars. This first of its kind mission is enabled by the novel use of a time projection chamber as an X-ray polarimeter. The detector has been developed over the last 5 years, with the current effort charged toward a demonstration of it's technical readiness to be at level 6 prior to the preliminary design review. This talk will describe the design GEMS polarimeter and the results to date from the engineering test unit.

  11. Statistical analysis on extreme wave height

    Digital Repository Service at National Institute of Oceanography (India)

    Teena, N.V.; SanilKumar, V.; Sudheesh, K.; Sajeev, R.

    The classical extreme value theory based on generalized extreme value (GEV) distribution and generalized Pareto distribution (GPD) is applied to the wave height estimate based on wave hindcast data covering a period of 31 years for a location...

  12. Extreme Biocatalyst Culture Collection for Unique Microorganisms

    National Research Council Canada - National Science Library

    Jain, Mahendra

    1997-01-01

    To develop an Extreme Biocatalyst Culture Collection (EBCC) as a resource center to supply pure, viable and authentic cultures of extremophilic Inicroorganisms which are non-conventional, novel, or of extreme nature...

  13. Climate change & extreme weather vulnerability assessment framework.

    Science.gov (United States)

    2012-12-01

    The Federal Highway Administrations (FHWAs) Climate Change and Extreme Weather Vulnerability : Assessment Framework is a guide for transportation agencies interested in assessing their vulnerability : to climate change and extreme weather event...

  14. Variational analysis critical extremals and Sturmian extensions

    CERN Document Server

    Morse, Marston

    2007-01-01

    This text presents extended separation, comparison, and oscillation theorems that replace classical analysis. Its analysis of related quadratic functionals shows how critical extremals can substitute for minimizing extremals. 1973 edition.

  15. Gender differences in diabetes-related lower extremity amputations.

    Science.gov (United States)

    Peek, Monica E

    2011-07-01

    Diabetes is a major cause of morbidity and mortality in the United States, with much of the economic and social costs related to macrovascular and microvascular complications, such as myocardial infarctions, renal failure, and lower extremity amputations. While racial/ethnic differences in diabetes are well documented, less attention has been given to differences in diabetes outcomes by gender. Does gender influence the rate of diabetes-related lower extremity amputations and/or the rate of mortality after amputation? I reviewed the literature utilizing peer-reviewed publications found through MEDLINE searches. WHERE ARE WE NOW?: Major complex gender differences exist in diabetes-related lower extremity amputations: men are more likely to undergo lower extremity amputations, but women apparently have higher mortality related to these procedures. The reasons for such differences are not entirely clear, but it appears biologic factors may play important roles (increased rates of peripheral vascular disease and peripheral neuropathy in men, interaction between gender and cardiac mortality in women). WHERE DO WE NEED TO GO?: More research is warranted to confirm gender differences in diabetes-related lower extremity amputation mortality and explore underlying mechanisms for the gender differences in lower extremity amputations and its associated mortality. HOW DO WE GET THERE?: Exploring gender disparities in diabetes-related outcomes, such as lower extremity amputations, will need to become a national priority from a research (eg, National Institutes of Health) and policy (eg, Centers for Medicare and Medicaid Services) perspective. Only when we have a better understanding of the causes of such differences can we begin to make strides in addressing them.

  16. Assessing Climate Variability using Extreme Rainfall and ...

    African Journals Online (AJOL)

    user1

    Future climate change is generally believed to lead to an increase in climate variability and in the frequency and intensity of extreme events. Extreme climate events such as floods and dry spells have significant impacts on society. As noted by the Bureau of Meteorology, Canada, to examine whether such extremes have ...

  17. Transradial approach to lower extremity interventions

    Directory of Open Access Journals (Sweden)

    Ravikiran Korabathina

    2010-07-01

    Full Text Available Ravikiran Korabathina1, Sidharth S Yadav1, John T Coppola2, Cezar S Staniloae21Department of Cardiovascular Medicine, Saint Vincents Catholic Medical Center, New York, NY, USA; 2Cardiac and Vascular Institute, New York University Medical Center, New York, NY, USAAbstract: Percutaneous interventions of the coronary and peripheral vessels have historically been performed using a femoral artery approach. There has been increasing recognition of postprocedural bleeding complications and its impact on short- and long-term mortality. Because of its now recognized safety, the transradial approach has recently emerged as a preferred method compared to the transfemoral approach. The limitations associated with the distance from the puncture site to the lesion location are being addressed as new tools are developed for the endovascular treatment of peripheral arterial disease. In this review, we discuss the many facets of the transradial approach to lower extremity endovascular interventions, highlighting its safety and efficacy. Approaches to special populations including individuals with prior surgical bypass, Leriche’s syndrome, and those committed to chronic anticoagulation are also reviewed.Keywords: peripheral arterial disease, endovascular interventions, transradial interventions, aorto-iliac angioplasty

  18. EXTREMAL CONTROL FOR PHOTOVOLTAIC PANELS

    Directory of Open Access Journals (Sweden)

    Genevieve DAPHIN TANGUY

    2016-11-01

    Full Text Available In this paper a methodology for extremal control of photovoltaic panels has been designed through the use of an embedded polynomial controller using robust approaches and algorithms. Also, a framework for testing solar trackers in a hard ware in the loop (HIL configuration has been established. Efficient gradient based optimization methods were put in place in order to determine the parameters of the employed photovoltaic panel, as well as for computing the Maximum Power Point (MPP. Further a numerical RST controller has been computed in order to allow the panel to follow the movement of the sun to obtain a maximum energetic efficiency. A robustness analysis and correction procedure has been done on the RST polynomial algorithm. The hardware in the loop configuration allows for the development of a test and development platform which can be used for bringing improvements to the current design and also test different control approaches. For this, a microcontroller based solution was chosen. The achieved performances of the closed loop photovoltaic panel (PP system are validated in simulation using the MATLAB / SIMULINK environment and the WinPim & WinReg dedicated software. As it will be seen further in this paper, the extremal control of this design resides in a sequential set of computations used for obtaining the new Maximum Power Point at each change in the system.

  19. Vascular quality of care pilot study: how admission to a vascular surgery service affects evidence-based pharmacologic risk factor modification in patients with lower extremity peripheral arterial disease

    Directory of Open Access Journals (Sweden)

    Steenhof N

    2014-06-01

    Full Text Available Naomi Steenhof,1,2 Francesca Le Piane,1 Kori Leblanc,1–3 Naomi R Eisenberg,4 Yvonne Kwan,1 Christine Malmberg,1,6 Alexandra Papadopoulos,5,7 Graham Roche-Nagle4,7,8 1Department of Pharmacy, University Health Network, 2Leslie Dan Faculty of Pharmacy, University of Toronto, 3Centre for Innovation in Complex Care, University Health Network, 4Division of Vascular Surgery, University Health Network, 5Faculty of Nursing, University of Toronto, Toronto, ON, 6Victoria General Hospital, Vancouver Island Health Authority, Victoria, BC, 7Peter Munk Cardiac Centre, University Health Network, 8Faculty of Medicine, University of Toronto, Toronto, ON, Canada Background: Peripheral arterial disease (PAD guidelines recommend aggressive risk factor modification to improve cardiovascular outcomes. Recommended pharmacologic therapies include antiplatelets, angiotensin converting enzyme (ACE inhibitors, and HMG-CoA-reductase inhibitors (statins. Purpose: We studied the degree to which patient admission to a vascular surgery service increased the use of these therapies. Patients and methods: The authors conducted a retrospective chart review of 150 patients with PAD admitted to the vascular surgery service at a large Canadian tertiary care hospital. The use of recommended pharmacologic therapies at the time of admission and discharge were compared. A multidisciplinary clinical team established criteria by which patients were deemed ineligible to receive any of the recommended therapies. Angiotensin receptor blockers (ARBs were considered an alternative to ACE inhibitors. Results: Prior to hospital admission, 64% of patients were on antiplatelet therapy, 67% were on an ACE inhibitor or ARB, and 71% were on a statin. At the time of discharge, 91% of patients were on an antiplatelet (or not, with an acceptable reason, 77% were on an ACE inhibitor or an ARB (or not, with an acceptable reason, and 85% were on a statin (or not, with an acceptable reason. While new

  20. Predictability of extreme values in geophysical models

    Directory of Open Access Journals (Sweden)

    A. E. Sterk

    2012-09-01

    Full Text Available Extreme value theory in deterministic systems is concerned with unlikely large (or small values of an observable evaluated along evolutions of the system. In this paper we study the finite-time predictability of extreme values, such as convection, energy, and wind speeds, in three geophysical models. We study whether finite-time Lyapunov exponents are larger or smaller for initial conditions leading to extremes. General statements on whether extreme values are better or less predictable are not possible: the predictability of extreme values depends on the observable, the attractor of the system, and the prediction lead time.

  1. Evolution of phenotypic plasticity in extreme environments.

    Science.gov (United States)

    Chevin, Luis-Miguel; Hoffmann, Ary A

    2017-06-19

    Phenotypic plasticity, if adaptive, may allow species to counter the detrimental effects of extreme conditions, but the infrequent occurrence of extreme environments and/or their restriction to low-quality habitats within a species range means that they exert little direct selection on reaction norms. Plasticity could, therefore, be maladaptive under extreme environments, unless genetic correlations are strong between extreme and non-extreme environmental states, and the optimum phenotype changes smoothly with the environment. Empirical evidence suggests that populations and species from more variable environments show higher levels of plasticity that might preadapt them to extremes, but genetic variance for plastic responses can also be low, and genetic variation may not be expressed for some classes of traits under extreme conditions. Much of the empirical literature on plastic responses to extremes has not yet been linked to ecologically relevant conditions, such as asymmetrical fluctuations in the case of temperature extremes. Nevertheless, evolved plastic responses are likely to be important for natural and agricultural species increasingly exposed to climate extremes, and there is an urgent need to collect empirical information and link this to model predictions.This article is part of the themed issue 'Behavioural, ecological and evolutionary responses to extreme climatic events'. © 2017 The Author(s).

  2. Climate Extremes: Observations, Modeling, and Impacts

    Science.gov (United States)

    Easterling, David R.; Meehl, Gerald A.; Parmesan, Camille; Changnon, Stanley A.; Karl, Thomas R.; Mearns, Linda O.

    2000-09-01

    One of the major concerns with a potential change in climate is that an increase in extreme events will occur. Results of observational studies suggest that in many areas that have been analyzed, changes in total precipitation are amplified at the tails, and changes in some temperature extremes have been observed. Model output has been analyzed that shows changes in extreme events for future climates, such as increases in extreme high temperatures, decreases in extreme low temperatures, and increases in intense precipitation events. In addition, the societal infrastructure is becoming more sensitive to weather and climate extremes, which would be exacerbated by climate change. In wild plants and animals, climate-induced extinctions, distributional and phenological changes, and species' range shifts are being documented at an increasing rate. Several apparently gradual biological changes are linked to responses to extreme weather and climate events.

  3. Pneumatic tourniquets in extremity surgery.

    LENUS (Irish Health Repository)

    Wakai, A

    2012-02-03

    Pneumatic tourniquets maintain a relatively bloodless field during extremity surgery, minimize blood loss, aid identification of vital structures, and expedite the procedure. However, they may induce an ischemia-reperfusion injury with potentially harmful local and systemic consequences. Modern pneumatic tourniquets are designed with mechanisms to regulate and maintain pressure. Routine maintenance helps ensure that these systems are working properly. The complications of tourniquet use include postoperative swelling, delay of recovery of muscle power, compression neurapraxia, wound hematoma with the potential for infection, vascular injury, tissue necrosis, and compartment syndrome. Systemic complications can also occur. The incidence of complications can be minimized by use of wider tourniquets, careful preoperative patient evaluation, and adherence to accepted principles of tourniquet use.

  4. Extreme ultraviolet capillary discharge lasers

    Science.gov (United States)

    Wilson, Sarah; West, Andrew; Tallents, Greg

    2017-10-01

    An extreme ultraviolet capillary discharge laser has recently been installed at the University of York. The laser produces EUV radiation of wavelength 46.9nm, with pulse durations of approximately 1.2ns and energies of up to 50 μJ. A population inversion is produced by a high voltage electrical discharge passing through an argon filled capillary tube. Within the capillary, radial pinching of the argon plasma through JxB force causes the pressure and temperature of the plasma to increase which causes amplification between 3p -3s (J = 0-1) transitions producing EUV radiation. Laser optimisation, calibration of detectors and designs for initial experiments to produce warm dense matter by focusing onto solid targets are presented. The plasmas formed by the EUV laser irradiation of solid targets can be shown to produce warm dense matter in a regime where the ionization equilibrium is dominated by radiative ionization.

  5. Generic Hurricane Extreme Seas State

    DEFF Research Database (Denmark)

    Wehmeyer, Christof; Skourup, Jesper; Frigaard, Peter

    2012-01-01

    Extreme sea states, which the IEC 61400-3 (2008) standard requires for the ultimate limit state (ULS) analysis of offshore wind turbines are derived to establish the design basis for the conceptual layout of deep water floating offshore wind turbine foundations in hurricane affected areas...... data is required for a type specific conceptual design. ULS conditions for different return periods are developed, which can subsequently be applied in siteindependent analysis and conceptual design. Recordings provided by National Oceanic and Atmospheric Administration (NOAA), of hurricanes along...... for hurricane generates seas by Young (1998, 2003, and 2006), requiring maximum wind speeds, forward velocity and radius to maximum wind speed. An averaged radius to maximum sustained wind speeds, according to Hsu et al. (1998) and averaged forward speed of cyclonic storms are applied in the initial state...

  6. Graph Embedded Extreme Learning Machine.

    Science.gov (United States)

    Iosifidis, Alexandros; Tefas, Anastasios; Pitas, Ioannis

    2016-01-01

    In this paper, we propose a novel extension of the extreme learning machine (ELM) algorithm for single-hidden layer feedforward neural network training that is able to incorporate subspace learning (SL) criteria on the optimization process followed for the calculation of the network's output weights. The proposed graph embedded ELM (GEELM) algorithm is able to naturally exploit both intrinsic and penalty SL criteria that have been (or will be) designed under the graph embedding framework. In addition, we extend the proposed GEELM algorithm in order to be able to exploit SL criteria in arbitrary (even infinite) dimensional ELM spaces. We evaluate the proposed approach on eight standard classification problems and nine publicly available datasets designed for three problems related to human behavior analysis, i.e., the recognition of human face, facial expression, and activity. Experimental results denote the effectiveness of the proposed approach, since it outperforms other ELM-based classification schemes in all the cases.

  7. Denying the Obvious: Four Extreme Cases of Neglected Tumors

    OpenAIRE

    Block, Lisa M.; Jee, Young M.; Baskaya, Mustafa K.; Bentz, Michael L.; Poore, Samuel O.

    2015-01-01

    Background: Little is known about the relatively common phenomenon of patients neglecting tumors as part of a denial mechanism to presumably cope with the obvious, outward and clearly visible signs of cancer. As a result of this tumor neglect, disease progression continues unchecked, resulting in excessive tumor growth, invasion of nearby structures, (often) metastatic spread, and significant disfigurement. Methods: In this case series, we present 4 extreme cases of neglected tumors that pose...

  8. An artist with extreme deuteranomaly.

    Science.gov (United States)

    Cole, Barry L; Nathan, Jonathan

    2002-09-01

    There has been speculation about the colour vision of some artists of earlier generations based on the uncertain evidence of how they used colour, but it seems that no major artist has been shown to have a colour vision defect. A few lesser artists are known to have abnormal colour vision and its influence on their painting has been reported in the literature. However, there has been only one report of a deuteranomalous artist and no detailed report of one with extreme deuteranomaly. An amateur artist was diagnosed as having extreme deuteranomaly using standard clinical tests. He was interviewed about his difficulty with colour when painting and the strategies he used to counter these problems. His work was studied to determine the colour palette he used and he was set the task of copying another painting to determine the nature of any errors he might make. The subject limits his palette to short-wave blues and blue-greens and long-wave yellow, orange and red. He avoids use of yellow-greens of which he is uncertain. He has adopted a few strategies that help him avoid mistakes in manipulating colour. Despite these difficulties, he is able to create attractive paintings. His early work tended toward monochrome but in his later work he has been able to create warm colourful effects with a limited palette. Defective colour vision is a handicap in those artistic activities using colour but it is not an insurmountable barrier. Optometrists should counsel patients with a colour deficiency who are considering a career in the graphic arts about the difficulties they will encounter and the strategies they can use to help minimise those problems.

  9. Extreme heat and runoff extremes in the Swiss Alps

    Directory of Open Access Journals (Sweden)

    M. Zappa

    2007-06-01

    Full Text Available The hydrological response of Swiss river basins to the 2003 European summer heatwave was evaluated by a combined analysis of historical discharge records and specific applications of distributed hydrological modeling. In the summer of 2003, the discharge from headwater streams of the Swiss Central Plateau was only 40%–60% of the long-term average. For alpine basins runoff was about 60%–80% of the average. Glacierized basins showed the opposite behavior. According to the degree of glacierization, the average summer runoff was close or even above average. The hydrological model PREVAH was applied for the period 1982–2005. Even if the model was not calibrated for such extreme meteorological conditions, it was well able to simulate the hydrological responses of three basins. The aridity index φ describes feedbacks between hydrological and meteorological anomalies, and was adopted as an indicator of hydrological drought. The anomalies of φ and temperature in the summer of 2003 exceeded the 1982–2005 mean by more than 2 standard deviations. Catchments without glaciers showed negative correlations between φ and discharge R. In basins with about 15% glacierization, φ and R were not correlated. River basins with higher glacier percentages showed a positive correlation between φ and R. Icemelt was positively correlated with φ and reduced the variability of discharge with larger amounts of meltwater. Runoff generation from the non-glaciated sub-areas was limited by high evapotranspiration and reduced precipitation. The 2003 summer heatwave could be a precursor to similar events in the near future. Hydrological models and further data analysis will allow the identification of the most sensitive regions where heatwaves may become a recurrent natural hazard with large environmental, social and economical impacts.

  10. BELM: Bayesian extreme learning machine.

    Science.gov (United States)

    Soria-Olivas, Emilio; Gómez-Sanchis, Juan; Martín, José D; Vila-Francés, Joan; Martínez, Marcelino; Magdalena, José R; Serrano, Antonio J

    2011-03-01

    The theory of extreme learning machine (ELM) has become very popular on the last few years. ELM is a new approach for learning the parameters of the hidden layers of a multilayer neural network (as the multilayer perceptron or the radial basis function neural network). Its main advantage is the lower computational cost, which is especially relevant when dealing with many patterns defined in a high-dimensional space. This brief proposes a bayesian approach to ELM, which presents some advantages over other approaches: it allows the introduction of a priori knowledge; obtains the confidence intervals (CIs) without the need of applying methods that are computationally intensive, e.g., bootstrap; and presents high generalization capabilities. Bayesian ELM is benchmarked against classical ELM in several artificial and real datasets that are widely used for the evaluation of machine learning algorithms. Achieved results show that the proposed approach produces a competitive accuracy with some additional advantages, namely, automatic production of CIs, reduction of probability of model overfitting, and use of a priori knowledge.

  11. The Extreme Case of Magnetars

    Science.gov (United States)

    Kouveliotou, Chryssa

    2011-01-01

    Magnetars are magnetically powered rotating neutron stars with extreme magnetic fields (over 10(exp 14) Gauss). They were discovered in the X- and gamma-rays where they predominantly emit their radiation. Very few sources (roughly 18) have been found since their discovery in 1987. NASA's Fermi Gamma-ray Space Telescope was launched June 11, 2009; since then the Fermi Gamma-ray Burst Monitor (GBM) recorded emission from four magnetar sources. Two of these were brand new sources, SGR J0501+4516, discovered with Swift and extensively monitored with Swift and GBM, SGR J0418+5729, discovered with GBM and the Interplanetary Network (IPN). A third was SGR J1550-5418, a source originally classified as an Anomalous X-ray Pulsar (AXP 1E1547.0-5408), but exhibiting a very prolific outburst with over 400 events recorded in January 2009. In my talk I will give a short history of magnetars and describe how this, once relatively esoteric field, has emerged as a link between several astrophysical areas including Gamma-Ray Bursts. Finally, I will describe the exciting new results of Fermi in this field and the current status of our knowledge of the magnetar population properties and magnetic fields.

  12. Lymphatic Filariasis Disseminating to the Upper Extremity

    Directory of Open Access Journals (Sweden)

    Catherine Maldjian

    2014-01-01

    Full Text Available Lymphatic filariasis is the most common cause of acquired lymphedema worldwide (Szuba and Rockson, 1998. It is endemic to tropical and subtropical regions, and its effects are devastating. With over 100 million infected persons, it ranks second only to leprosy as the leading cause of permanent and long-term disability. Wuchereria bancrofti is the etiologic agent in 90% of cases. There is a dearth of published MRI findings with pathologically proven active infections, making this entity even more of a diagnostic dilemma. Imaging may provide the first clue that one is dealing with a parasite and may facilitate proper treatment and containment of this disease. This is the first report of pathologic correlation with MRI findings in the extremity in active filariasis. The magnetic resonance images demonstrate an enhancing, infiltrative, mass-like appearance with partial encasement of vasculature that has not been previously described in filariasis. Low signal strands in T2-hyperintense dilated lymphatic channels are seen and may depict live adult worms. We hypothesize that the low signal strands correspond to the collagen rich acellular cuticle. This, in combination with the surrounding hyperintense T2 signal, corresponding to a dilated lymphatic channel, may provide more specific MRI findings for active nematodal infection, which can prompt early biopsy, pathological correlation, and diagnosis.

  13. On the Extreme Wave Height Analysis

    DEFF Research Database (Denmark)

    Burcharth, H. F.; Liu, Zhou

    1994-01-01

    The determination of the design wave height is usually based on the statistical analysis of long-term extreme wave height measurements. After an introduction to the procedure of the extreme wave height analysis, the paper presents new development concerning various aspects of the extreme wave...... height analysis. Finally, the paper gives a practical example based on a data set of the hindcasted wave heights for a deep water location in the Mediterranean Sea....

  14. Extreme Learning Machine for land cover classification

    OpenAIRE

    Pal, Mahesh

    2008-01-01

    This paper explores the potential of extreme learning machine based supervised classification algorithm for land cover classification. In comparison to a backpropagation neural network, which requires setting of several user-defined parameters and may produce local minima, extreme learning machine require setting of one parameter and produce a unique solution. ETM+ multispectral data set (England) was used to judge the suitability of extreme learning machine for remote sensing classifications...

  15. Extreme Events in Nature and Society

    CERN Document Server

    Albeverio, Sergio; Kantz, Holger

    2006-01-01

    Significant, and usually unwelcome, surprises, such as floods, financial crisis, epileptic seizures, or material rupture, are the topics of Extreme Events in Nature and Society. The book, authored by foremost experts in these fields, reveals unifying and distinguishing features of extreme events, including problems of understanding and modelling their origin, spatial and temporal extension, and potential impact. The chapters converge towards the difficult problem of anticipation: forecasting the event and proposing measures to moderate or prevent it. Extreme Events in Nature and Society will interest not only specialists, but also the general reader eager to learn how the multifaceted field of extreme events can be viewed as a coherent whole.

  16. Extreme evolved solar systems (EESS)

    Science.gov (United States)

    Gaensicke, Boris

    2017-08-01

    In just 20 years, we went from not knowing if the solar system is a fluke of Nature to realising that it is totally normal for stars to have planets. More remarkably, it is now clear that planet formation is a robust process, as rich multi-planet systems are found around stars more massive and less massive than the Sun. More recently, planetary systems have been identified in increasingly complex architectures, including circumbinary planets, wide binaries with planets orbiting one or both stellar components, and planets in triple stellar systems.We have also learned that many planetary systems will survive the evolution of their host stars into the white dwarf phase. Small bodies are scattered by unseen planets into the gravitational field of the white dwarfs, tidally disrupt, form dust discs, and eventually accrete onto the white dwarf, where they can be spectroscopically detected. HST/COS has played a critical role in the study these evolved planetary systems, demonstrating that overall the bulk composition of the debris is rocky and resembles in composition the inner the solar system, including evidence for water-rich planetesimals. Past observations of planetary systems at white dwarfs have focused on single stars with main-sequence progenitors of 1.5 to 2.5Msun. Here we propose to take the study of evolved planetary systems into the extremes of parameter ranges to answer questions such as: * How efficient is planet formation around 4-10Msun stars? * What are the metallicities of the progenitors of debris-accreting white dwarfs?* What is the fate of circumbinary planets?* Can star-planet interactions generate magnetic fields in the white dwarf host?

  17. Magnetotactic Bacteria from Extreme Environments

    Directory of Open Access Journals (Sweden)

    Christopher T. Lefèvre

    2013-03-01

    Full Text Available Magnetotactic bacteria (MTB represent a diverse collection of motile prokaryotes that biomineralize intracellular, membrane-bounded, tens-of-nanometer-sized crystals of a magnetic mineral called magnetosomes. Magnetosome minerals consist of either magnetite (Fe3O4 or greigite (Fe3S4 and cause cells to align along the Earth’s geomagnetic field lines as they swim, a trait called magnetotaxis. MTB are known to mainly inhabit the oxic–anoxic interface (OAI in water columns or sediments of aquatic habitats and it is currently thought that magnetosomes function as a means of making chemotaxis more efficient in locating and maintaining an optimal position for growth and survival at the OAI. Known cultured and uncultured MTB are phylogenetically associated with the Alpha-, Gamma- and Deltaproteobacteria classes of the phylum Proteobacteria, the Nitrospirae phylum and the candidate division OP3, part of the Planctomycetes-Verrucomicrobia-Chlamydiae (PVC bacterial superphylum. MTB are generally thought to be ubiquitous in aquatic environments as they are cosmopolitan in distribution and have been found in every continent although for years MTB were thought to be restricted to habitats with pH values near neutral and at ambient temperature. Recently, however, moderate thermophilic and alkaliphilic MTB have been described including: an uncultured, moderately thermophilic magnetotactic bacterium present in hot springs in northern Nevada with a probable upper growth limit of about 63 °C; and several strains of obligately alkaliphilic MTB isolated in pure culture from different aquatic habitats in California, including the hypersaline, extremely alkaline Mono Lake, with an optimal growth pH of >9.0.

  18. Fate of the contralateral limb after lower extremity amputation

    Science.gov (United States)

    Glaser, Julia D.; Bensley, Rodney P.; Hurks, Rob; Dahlberg, Suzanne; Hamdan, Allen D.; Wyers, Mark C.; Chaikof, Elliot L.; Schermerhorn, Marc L.

    2013-01-01

    Objective Lower extremity amputation is often performed in patients where both lower extremities are at risk due to peripheral arterial disease or diabetes, yet the proportion of patients who progress to amputation of their contralateral limb is not well defined. We sought to determine the rate of subsequent amputation on both the ipsilateral and contralateral lower extremities following initial amputation. Methods We conducted a retrospective review of all patients undergoing lower extremity amputation (exclusive of trauma or tumor) at our institution from 1998 to 2010. We used International Classification of Diseases-Ninth Revision codes to identify patients and procedures as well as comorbidities. Outcomes included the proportion of patients at 1 and 5 years undergoing contralateral and ipsilateral major and minor amputation stratified by initial major vs minor amputation. Cox proportional hazards regression analysis was performed to determine predictors of major contralateral amputation. Results We identified 1715 patients. Mean age was 67.2 years, 63% were male, 77% were diabetic, and 34% underwent an initial major amputation. After major amputation, 5.7% and 11.5% have a contralateral major amputation at 1 and 5 years, respectively. After minor amputation, 3.2% and 8.4% have a contralateral major amputation at 1 and 5 years while 10.5% and 14.2% have an ipsilateral major amputation at 1 and 5 years, respectively. Cox proportional hazards regression analysis revealed end-stage renal disease (hazard ratio [HR], 3.9; 95% confidence interval [CI], 2.3–6.5), chronic renal insufficiency (HR, 2.2; 95% CI, 1.5–3.3), atherosclerosis without diabetic neuropathy (HR, 2.9; 95% CI, 1.5–5.7), atherosclerosis with diabetic neuropathy (HR, 9.1; 95% CI, 3.7–22.5), and initial major amputation (HR, 1.8; 95% CI, 1.3–2.6) were independently predictive of subsequent contralateral major amputation. Conclusions Rates of contralateral limb amputation are high and predicted

  19. NCI study finds extreme obesity may shorten life expectancy up to 14 years

    Science.gov (United States)

    Extremely obese people have increased risks of dying from cancer and many other causes including heart disease, stroke, diabetes, and kidney and liver diseases, according to results of an analysis of data pooled from 20 large studies of people from three

  20. Thermodynamics of extremal rotating thin shells in an extremal BTZ spacetime and the extremal black hole entropy

    Science.gov (United States)

    Lemos, José P. S.; Minamitsuji, Masato; Zaslavskii, Oleg B.

    2017-02-01

    In a (2 +1 )-dimensional spacetime with a negative cosmological constant, the thermodynamics and the entropy of an extremal rotating thin shell, i.e., an extremal rotating ring, are investigated. The outer and inner regions with respect to the shell are taken to be the Bañados-Teitelbom-Zanelli (BTZ) spacetime and the vacuum ground state anti-de Sitter spacetime, respectively. By applying the first law of thermodynamics to the extremal thin shell, one shows that the entropy of the shell is an arbitrary well-behaved function of the gravitational area A+ alone, S =S (A+). When the thin shell approaches its own gravitational radius r+ and turns into an extremal rotating BTZ black hole, it is found that the entropy of the spacetime remains such a function of A+, both when the local temperature of the shell at the gravitational radius is zero and nonzero. It is thus vindicated by this analysis that extremal black holes, here extremal BTZ black holes, have different properties from the corresponding nonextremal black holes, which have a definite entropy, the Bekenstein-Hawking entropy S (A+)=A/+4G , where G is the gravitational constant. It is argued that for extremal black holes, in particular for extremal BTZ black holes, one should set 0 ≤S (A+)≤A/+4G;i.e., the extremal black hole entropy has values in between zero and the maximum Bekenstein-Hawking entropy A/+4 G . Thus, rather than having just two entropies for extremal black holes, as previous results have debated, namely, 0 and A/+4 G , it is shown here that extremal black holes, in particular extremal BTZ black holes, may have a continuous range of entropies, limited by precisely those two entropies. Surely, the entropy that a particular extremal black hole picks must depend on past processes, notably on how it was formed. A remarkable relation between the third law of thermodynamics and the impossibility for a massive body to reach the velocity of light is also found. In addition, in the procedure, it

  1. Extreme wind turbine response during operation

    DEFF Research Database (Denmark)

    Sørensen, John Dalsgaard; Nielsen, S.R.K.

    2007-01-01

    Estimation of extreme response values is very important for structural design of wind turbines. Due to the influence of control system and nonlinear structural behavior the extreme response is usually assessed based on simulation of turbulence time series. In this paper the problem of statistical...

  2. Assessing Climate Variability using Extreme Rainfall and ...

    African Journals Online (AJOL)

    As noted by the Bureau of Meteorology, Canada, to examine whether such extremes have changed over time a variety of extreme climate indices can be defined, such as the number of days per year ... was already experiencing variability in its climate pattern, as such an information would be very useful for decision making.

  3. Extremely strict ideals in Banach spaces

    Indian Academy of Sciences (India)

    Home; Journals; Proceedings – Mathematical Sciences; Volume 126; Issue 3 ... ({\\it Studia Math.} {\\bf 104} (1993) 13–59), in this article, we introduce and study the notion of an extremely strict ideal. For a Poulsen simplex K , we show that the space of affine continuous functions on K is an extremely strict ideal in the space of ...

  4. A Fourier analysis of extremal events

    DEFF Research Database (Denmark)

    Zhao, Yuwei

    is the extremal periodogram. The extremal periodogram shares numerous asymptotic properties with the periodogram of a linear process in classical time series analysis: the asymptotic distribution of the periodogram ordinates at the Fourier frequencies have a similar form and smoothed versions of the periodogram...

  5. Meaning and Forms of Political Extremism

    Directory of Open Access Journals (Sweden)

    Uwe Backes

    2007-12-01

    Full Text Available The article seeks to contribute to the conceptualisation of political extremism and to lay a foundation for further theoretical studies which are explanatory in nature. A sketch of the history of the concepts follows a discussion of structural characteristics and then a typological examination of forms of extremism, particularly those of the 20th and 21st century.

  6. New algorithm for extreme temperature measurements

    NARCIS (Netherlands)

    Damean, N.

    2000-01-01

    A new algorithm for measurement of extreme temperature is presented. This algorithm reduces the measurement of the unknown temperature to the solving of an optimal control problem, using a numerical computer. Based on this method, a new device for extreme temperature measurements is projected. It

  7. Climate extremes and the carbon cycle (Invited)

    Science.gov (United States)

    Reichstein, M.; Bahn, M.; Ciais, P.; Mahecha, M. D.; Seneviratne, S. I.; Zscheischler, J.

    2013-12-01

    The terrestrial biosphere is a key component of the global carbon cycle and its carbon balance is strongly influenced by climate. Ongoing environmental changes are thought to increase global terrestrial carbon uptake. But evidence is mounting that rare climate extremes can lead to a decrease in ecosystem carbon stocks and therefore have the potential to negate the expected increase in terrestrial carbon uptake. Here we explore the mechanisms and impacts of climate extremes on the terrestrial carbon cycle, and propose a pathway to improve our understanding of present and future impacts of climate extremes on the terrestrial carbon budget. In addition to direct impact on the carbon fluxes of photosynthesis and respiration via extreme temperature and (or) drought, effects of extreme events may also lead to lagged responses, such as wildfires triggered by heat waves and droughts, or pest and pathogen outbreaks following wind-throw caused by heavy storms, reduced plant health due to drought stress or due to less frequent cold extremes in presently cold regions. One extreme event can potentially override accumulated previous carbon sinks, as shown by the Western European 2003 heat wave.. Extreme events have the potential to affect the terrestrial ecosystem carbon balance through a single factor, or as a combination of factors. Climate extremes can cause carbon losses from accumulated stocks, as well as long-lasting impacts on (e.g. lagged effects) on plant growth and mortality, extending beyond the duration of the extreme event itself. The sensitivity of terrestrial ecosystems and their carbon balance to climate change and extreme events varies according to the type of extreme, the climatic region, the land cover, and the land management. Extreme event impacts are very relevant in forests due to the importance of lagged and memory effects on tree growth and mortality, the longevity of tree species, the large forest carbon stocks and their vulnerability, as well as the

  8. EPE The Extreme Physics Explorer

    Science.gov (United States)

    Garcia, Michael; Elvis, Martin; Bookbinder, Jay; Brenneman, Laura; Bulbul, Esra; Nulsen, Paul; Patnaude, Dan; Smith, Randall; Bandler, Simon; Okajima, Takashi; hide

    2012-01-01

    The Extreme Physics Explorer (EPE) is a mission concept that will address fundamental and timely questions in astrophysics which are primary science objectives of IXO. The reach of EPE to the areas outlined in NASA RFI NNH11ZDA018L is shown as a table. The dark green indicates areas in which EPE can do the basic IXO science, and the light green areas where EPE can contribute but will not reach the full IXO capability. To address these science questions, EPE will trace orbits close to the event horizon of black holes, measure black hole spin in active galactic nuclei (AGN), use spectroscopy to characterize outflows and the environment of AGN, map bulk motions and turbulence in galaxy clusters, and observe the process of cosmic feedback where black holes inject energy on galactic and intergalactic scales. EPE gives up the high resolution imaging of IXO in return for lightweight, high TRL foil mirrors which will provide >20 times the effective area of ASTRO-H and similar spatial resolution, with a beam sufficient to study point sources and nearby galaxies and clusters. Advances in micro-calorimeters allow improved performance at high rates with twice the energy resolution of ASTRO-H. A lower TRL option would provide 200 times the area of ASTRO-H using a micro-channel plate optic (MCPO) and a deployable optical bench. Both options are in the middle range of RFI missions at between $600M and $1000M. The EPE foil optic has direct heritage to ASTRO-H, allowing robust cost estimates. The spacecraft is entirely off the shelf and introduces no difficult requirements. The mission could be started and launched in this decade to an L2 orbit, with a three-year lifetime and consumables for 5 years. While ASTRO-H will give us the first taste of high-resolution, non-dispersive X-ray spectroscopy, it will be limited to small numbers of objects in many categories. EPE will give us the first statistically significant samples in each of these categories.

  9. Public Health System Response to Extreme Weather Events.

    Science.gov (United States)

    Hunter, Mark D; Hunter, Jennifer C; Yang, Jane E; Crawley, Adam W; Aragón, Tomás J

    2016-01-01

    Extreme weather events, unpredictable and often far-reaching, constitute a persistent challenge for public health preparedness. The goal of this research is to inform public health systems improvement through examination of extreme weather events, comparing across cases to identify recurring patterns in event and response characteristics. Structured telephone-based interviews were conducted with representatives from health departments to assess characteristics of recent extreme weather events and agencies' responses. Response activities were assessed using the Centers for Disease Control and Prevention Public Health Emergency Preparedness Capabilities framework. Challenges that are typical of this response environment are reported. Forty-five local health departments in 20 US states. Respondents described public health system responses to 45 events involving tornadoes, flooding, wildfires, winter weather, hurricanes, and other storms. Events of similar scale were infrequent for a majority (62%) of the communities involved; disruption to critical infrastructure was universal. Public Health Emergency Preparedness Capabilities considered most essential involved environmental health investigations, mass care and sheltering, surveillance and epidemiology, information sharing, and public information and warning. Unanticipated response activities or operational constraints were common. We characterize extreme weather events as a "quadruple threat" because (1) direct threats to population health are accompanied by damage to public health protective and community infrastructure, (2) event characteristics often impose novel and pervasive burdens on communities, (3) responses rely on critical infrastructures whose failure both creates new burdens and diminishes response capacity, and (4) their infrequency and scale further compromise response capacity. Given the challenges associated with extreme weather events, we suggest opportunities for organizational learning and

  10. Extreme Weather and Climate: Workshop Report

    Science.gov (United States)

    Sobel, Adam; Camargo, Suzana; Debucquoy, Wim; Deodatis, George; Gerrard, Michael; Hall, Timothy; Hallman, Robert; Keenan, Jesse; Lall, Upmanu; Levy, Marc; hide

    2016-01-01

    Extreme events are the aspects of climate to which human society is most sensitive. Due to both their severity and their rarity, extreme events can challenge the capacity of physical, social, economic and political infrastructures, turning natural events into human disasters. Yet, because they are low frequency events, the science of extreme events is very challenging. Among the challenges is the difficulty of connecting extreme events to longer-term, large-scale variability and trends in the climate system, including anthropogenic climate change. How can we best quantify the risks posed by extreme weather events, both in the current climate and in the warmer and different climates to come? How can we better predict them? What can we do to reduce the harm done by such events? In response to these questions, the Initiative on Extreme Weather and Climate has been created at Columbia University in New York City (extreme weather.columbia.edu). This Initiative is a University-wide activity focused on understanding the risks to human life, property, infrastructure, communities, institutions, ecosystems, and landscapes from extreme weather events, both in the present and future climates, and on developing solutions to mitigate those risks. In May 2015,the Initiative held its first science workshop, entitled Extreme Weather and Climate: Hazards, Impacts, Actions. The purpose of the workshop was to define the scope of the Initiative and tremendously broad intellectual footprint of the topic indicated by the titles of the presentations (see Table 1). The intent of the workshop was to stimulate thought across disciplinary lines by juxtaposing talks whose subjects differed dramatically. Each session concluded with question and answer panel sessions. Approximately, 150 people were in attendance throughout the day. Below is a brief synopsis of each presentation. The synopses collectively reflect the variety and richness of the emerging extreme event research agenda.

  11. The Impact of Lower Extremity Venous Ulcers due to Chronic Venous Insufficiency on Quality of Life

    OpenAIRE

    Koupidis, Sotirios A; Paraskevas, Kosmas I.; Stathopoulos, Vassilios; Mikhailidis, Dimitri P.

    2008-01-01

    Lower extremity venous ulcers comprise a complex medical and social issue. The conservative and/or surgical management of venous ulcers is often inadequate. In addition, the psychosocial aspect of the disease is often overlooked and most often undertreated. Common symptoms such as pain, low self-esteem and patient isolation are usually not recognized and therefore not adequately managed. This mini-review summarizes the current data on the management of lower extremity venous ulcers and their ...

  12. [Depression in older adults with extreme poverty belonging to Social Program in City Juarez, Chihuahua, Mexico].

    Science.gov (United States)

    Flores-Padilla, Luis; Ramírez-Martínez, Flor Rocío; Trueba-Gómez, Rocío

    2016-01-01

    To identify depression in older adults living in extreme poverty beneficiaries of social program in City Juarez, Chihuahua. Analytical study in 941 adults > 60 years, studied variables: age, sex, marital status, education and work, extreme poverty, place of residence, asylum. Yesavage Geriatric scale was used. X², IC work, incomplete education, living in asylum, have hypertension and pulmonary diseases increase depression risk (p < 0.05). Older Adults program beneficiaries living in extreme poverty depression is greater than that reported in the literature. The support granted by the Mexican Government to social programs that benefit older adults should be planned strategically with aims on improving the long-term health.

  13. Doppler ultrasonography of the lower extremity arteries: anatomy and scanning guidelines

    Directory of Open Access Journals (Sweden)

    Ji Young Hwang

    2017-04-01

    Full Text Available Doppler ultrasonography of the lower extremity arteries is a valuable technique, although it is less frequently indicated for peripheral arterial disease than for deep vein thrombosis or varicose veins. Ultrasonography can diagnose stenosis through the direct visualization of plaques and through the analysis of the Doppler waveforms in stenotic and poststenotic arteries. To perform Doppler ultrasonography of the lower extremity arteries, the operator should be familiar with the arterial anatomy of the lower extremities, basic scanning techniques, and the parameters used in color and pulsed-wave Doppler ultrasonography.

  14. Doppler ultrasonography of the lower extremity arteries: anatomy and scanning guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Ji Young [Dept. of Radiology, Ewha Womans University School of Medicine, Seoul (Korea, Republic of)

    2017-04-15

    Doppler ultrasonography of the lower extremity arteries is a valuable technique, although it is less frequently indicated for peripheral arterial disease than for deep vein thrombosis or varicose veins. Ultrasonography can diagnose stenosis through the direct visualization of plaques and through the analysis of the Doppler waveforms in stenotic and poststenotic arteries. To perform Doppler ultrasonography of the lower extremity arteries, the operator should be familiar with the arterial anatomy of the lower extremities, basic scanning techniques, and the parameters used in color and pulsed-wave Doppler ultrasonography.

  15. Deaths Related to Vessel Injuries in Extremities

    Directory of Open Access Journals (Sweden)

    Nursel Türkmen

    2003-12-01

    Full Text Available Lethal or non-lethal extremity injuries are often seen in medico-legal practice. In this study, we planned to investigate medico-legal properties of deaths related to vessel injuries in extremities. In forensic autopsies performed in Bursa, we examined total 4242 autopsy reports between 1996-2003 in included 40 (0,94% cases of deaths caused by vessel injuries in extremities. 90% of cases were male with median age 35.87 (17-66. Stabbing device account for 60% of injuries. Most frequent injuries were in femoral artery and branches. In 82.5% of cases, homicide was the origin of death. In 30% of cases, mean 159.33 mg/dl alcohol blood concentration was detected. In the scene investigation reports, 47.5% of documented incidents were outdoor and 47.5% of the cases died in the scene. As a conclusion, it is observed that alcoholic males of middle age are the risk group for vascular injuries in extremities. In the deaths related to isolated vessel injuries in extremities, the detection of injured vessel, localisation and number of total and lethal wounds would offer a solution for the evil intent; and as in the other violent death cases autopsy is required in the deaths due to vessel injuries in extremities. Key words: Vascular injuries, Extremity, Forensic autopsy.

  16. Extraction method of extreme rainfall data

    Science.gov (United States)

    Zakaria, Roslinazairimah; Radi, Noor Fadhilah Ahmad; Zanariah Satari, Siti

    2017-09-01

    This study is aimed to describe step by step procedure in extracting extreme rainfall data series. Basically, the extraction of extreme rainfall data can be achieved using two methods, block maxima (BM) and peak over threshold (POT) methods. The BM method considers extracting the extreme rainfall data recorded each year during a specific duration, meanwhile the POT method is extracting all extreme rainfall data above a predefined threshold. Using the BM method, the regional pooling of 1-, 3-, 5- and 10-day are used and the maximum rainfall data are chosen among the pooled day within each year. For POT method, two methods are presented. Method 1 of POT method determines a threshold based on 95% percentile while Method 2 determines the threshold graphically using mean residual life plot and threshold stability plot. Based on the selection of the threshold value, a simulation study is conducted to identify the range of appropriate quantile estimate for a proper selection of the threshold value. For illustration of the methodology, daily rainfall data from the rainfall station at Klinik Chalok Barat, Terengganu is chosen. Both methods used are able to identify the extreme rainfall series. This study is important as it helps in identifying the good set of extreme rainfall series for further use such as in extreme rainfall modelling.

  17. [Injury mechanisms in extreme violence settings].

    Science.gov (United States)

    Arcaute-Velazquez, Fernando Federico; García-Núñez, Luis Manuel; Noyola-Vilallobos, Héctor Faustino; Espinoza-Mercado, Fernando; Rodríguez-Vega, Carlos Eynar

    2016-01-01

    Extreme violence events are consequence of current world-wide economic, political and social conditions. Injury patterns found among victims of extreme violence events are very complex, obeying several high-energy injury mechanisms. In this article, we present the basic concepts of trauma kinematics that regulate the clinical approach to victims of extreme violence events, in the hope that clinicians increase their theoretical armamentarium, and reflecting on obtaining better outcomes. Copyright © 2016. Published by Masson Doyma México S.A.

  18. Extreme situations due to gender violence

    Directory of Open Access Journals (Sweden)

    Stela Meneghel

    2012-11-01

    Full Text Available This paper presents a synthesis of the third Critical Paths Seminar, held in Porto Alegre/Brazil in 2011, whose focus was extreme situations of gender violence. The extreme situations are human rights violations that include femicide or murder motivated by the situation of gender; LGBT murders, human rights violations of ethnic and racial minorities, sexual exploitation, violence to women in vulnerable situations and other violence caused by gender. The meeting objective was given space to share experiences, reflect critically and build strategies for facing violence and extreme situations resulting from gender systems.

  19. Long term oscillations in Danish rainfall extremes

    DEFF Research Database (Denmark)

    Gregersen, Ida Bülow; Madsen, Henrik; Rosbjerg, Dan

    The frequent flooding of European cities within the last decade has motivated a vast number of studies, among others addressing the non-stationary behaviour of hydrological extremes driven by anthropogenic climate change. However, when considering future extremes it also becomes relevant to search...... for and understand natural variations on which the anthropogenic changes are imposed. This study identifies multi-decadal variations in six 137-years-long diurnal rainfall series from Denmark and southern Sweden, focusing on extremes with a reoccurrence level relevant for Danish drainage design. By means of a Peak...

  20. Extreme Metal Music and Anger Processing

    OpenAIRE

    Sharman, Leah; Dingle, Genevieve A.

    2015-01-01

    The claim that listening to extreme music causes anger, and expressions of anger such as aggression and delinquency have yet to be substantiated using controlled experimental methods. In this study, 39 extreme music listeners aged 18–34 years were subjected to an anger induction, followed by random assignment to 10 min of listening to extreme music from their own playlist, or 10 min silence (control). Measures of emotion included heart rate and subjective ratings on the Positive and Negative ...

  1. Online transfer learning with extreme learning machine

    Science.gov (United States)

    Yin, Haibo; Yang, Yun-an

    2017-05-01

    In this paper, we propose a new transfer learning algorithm for online training. The proposed algorithm, which is called Online Transfer Extreme Learning Machine (OTELM), is based on Online Sequential Extreme Learning Machine (OSELM) while it introduces Semi-Supervised Extreme Learning Machine (SSELM) to transfer knowledge from the source to the target domain. With the manifold regularization, SSELM picks out instances from the source domain that are less relevant to those in the target domain to initialize the online training, so as to improve the classification performance. Experimental results demonstrate that the proposed OTELM can effectively use instances in the source domain to enhance the learning performance.

  2. Spectral density regression for bivariate extremes

    KAUST Repository

    Castro Camilo, Daniela

    2016-05-11

    We introduce a density regression model for the spectral density of a bivariate extreme value distribution, that allows us to assess how extremal dependence can change over a covariate. Inference is performed through a double kernel estimator, which can be seen as an extension of the Nadaraya–Watson estimator where the usual scalar responses are replaced by mean constrained densities on the unit interval. Numerical experiments with the methods illustrate their resilience in a variety of contexts of practical interest. An extreme temperature dataset is used to illustrate our methods. © 2016 Springer-Verlag Berlin Heidelberg

  3. MULTICOMPONENT SOLUTION FOR LOCAL ANAESTHESIA IN OPERATIONS ON EXTREMITIES

    Directory of Open Access Journals (Sweden)

    V.I. Sobolev

    2008-03-01

    Full Text Available The analysis of the results of local anaesthesia (LA in 89 patients aged 18 to 68 years with trauma and diseases of extremities has been carried out. The efficiency of perineural injected multicomponent solution of clonidine added to conventional mixture oflidocaine and phentanyl has been assessed. The multicomponent method has significantly prolonged the duration of local anaesthesia of 1% lidocaine solution providing reliable anaesthesia of plexus and peripheral nerves alongside the sufficient regional myoplegia and prolonged postoperative anesthetization. When there is no need of deep myoplegia Hallows to lower the concentration of lidocaine solution twofold, maintaining its efficiency, and to realize local anaesthesia of patients with high risk.

  4. Ollier disease

    Directory of Open Access Journals (Sweden)

    Jüppner Harald

    2006-09-01

    Full Text Available Abstract Enchondromas are common intraosseous, usually benign cartilaginous tumors, that develop in close proximity to growth plate cartilage. When multiple enchondromas are present, the condition is called enchondromatosis also known as Ollier disease (WHO terminology. The estimated prevalence of Ollier disease is 1/100,000. Clinical manifestations often appear in the first decade of life. Ollier disease is characterized by an asymmetric distribution of cartilage lesions and these can be extremely variable (in terms of size, number, location, evolution of enchondromas, age of onset and of diagnosis, requirement for surgery. Clinical problems caused by enchondromas include skeletal deformities, limb-length discrepancy, and the potential risk for malignant change to chondrosarcoma. The condition in which multiple enchondromatosis is associated with soft tissue hemangiomas is known as Maffucci syndrome. Until now both Ollier disease and Maffucci syndrome have only occurred in isolated patients and not familial. It remains uncertain whether the disorder is caused by a single gene defect or by combinations of (germ-line and/or somatic mutations. The diagnosis is based on clinical and conventional radiological evaluations. Histological analysis has a limited role and is mainly used if malignancy is suspected. There is no medical treatment for enchondromatosis. Surgery is indicated in case of complications (pathological fractures, growth defect, malignant transformation. The prognosis for Ollier disease is difficult to assess. As is generally the case, forms with an early onset appear more severe. Enchondromas in Ollier disease present a risk of malignant transformation of enchondromas into chondrosarcomas.

  5. Disease: H00742 [KEGG MEDICUS

    Lifescience Database Archive (English)

    Full Text Available Sokal EM Neonatal ichthyosis and sclerosing cholangitis syndrome: extremely variable liver disease severi...ty from claudin-1 deficiency. J Pediatr Gastroenterol Nutr 53:350-4 (2011) PMID:220

  6. Disease: H01451 [KEGG MEDICUS

    Lifescience Database Archive (English)

    Full Text Available H01451 Actinomycetoma Nocardia brasiliensis is a nonmotile, Gram-positive bacteriu...es, this organism causes actinomycetoma which is a chronic disease usually located on the extremities and is

  7. Extreme Heat in Southwest a Deadly Threat

    Science.gov (United States)

    ... https://medlineplus.gov/news/fullstory_166797.html Extreme Heat in Southwest a Deadly Threat Here's how to ... t take off in Phoenix on Tuesday, the heat wave scorching the Southwest for the next week ...

  8. SOI MESFETs for Extreme Environment Electronics Project

    Data.gov (United States)

    National Aeronautics and Space Administration — We are proposing a new extreme environment electronics (EEE) technology based on silicon-on-insulator (SOI) metal-semiconductor field-effect transistors (MESFETs)....

  9. Extreme Events in Deterministic Dynamical Systems

    Science.gov (United States)

    Nicolis, C.; Balakrishnan, V.; Nicolis, G.

    2006-11-01

    The principal signatures of a deterministic dynamics in the statistical properties of extreme events are identified. Explicit expressions are derived for generic classes of dynamical systems giving rise to quasiperiodic, strongly chaotic, and intermittent chaotic behaviors.

  10. Measuring extremal dependencies in web graphs

    NARCIS (Netherlands)

    Volkovich, Y.; Litvak, Nelli; Zwart, B.

    We analyze dependencies in power law graph data (Web sample, Wikipedia sample and a preferential attachment graph) using statistical inference for multivariate regular variation. The well developed theory of regular variation is widely applied in extreme value theory, telecommunications and

  11. Extreme Environment High Temperature Communication Systems Project

    Data.gov (United States)

    National Aeronautics and Space Administration — The purpose of this project is to develop and demonstrate a communications system capable of operation at extreme temperatures and pressures in hostile and corrosive...

  12. Overt Indicators of Islamic Extremism in Nigeria

    National Research Council Canada - National Science Library

    Genasci, Andy J

    2006-01-01

    This thesis examines characteristics of Islamic extremism in Nigeria. Specifically, the thesis examines the strategic indicators for an Islamic extremist safe haven and the presence of those indicators in Nigeria...

  13. Health Burden of Extreme Weather in Thailand

    Directory of Open Access Journals (Sweden)

    Jiraphan Plongmak

    2013-01-01

    Full Text Available This study assessed and evaluated the variation of the health burden in response to extreme weather events that occurred in Thailand from 2006 to 2010. The health burden was assessed using disability-adjusted life years (DALYs lost and deaths from injuries as its indicators. Thailand has a DALYs lost of over 16,274 from extreme weather events. Extreme weather events include floods, flash floods, and severe storms, and most of the DALYs in Thailand were lost from floods (approximately 12,872 DALYs. The second most impactful weather event was severe storms, with losses of approximately 2,019 DALYs, followed by flash floods, which caused losses of about 1,383 DALYs. Climate change is a cause of extreme weather events, and a relationship betweenclimate and health has been found worldwide. Improved long-term, high-quality data sets are needed to better analyze and improve accuracy of the health burden.

  14. Statistics of extremes theory and applications

    CERN Document Server

    Beirlant, Jan; Segers, Johan; Teugels, Jozef; De Waal, Daniel; Ferro, Chris

    2006-01-01

    Research in the statistical analysis of extreme values has flourished over the past decade: new probability models, inference and data analysis techniques have been introduced; and new application areas have been explored. Statistics of Extremes comprehensively covers a wide range of models and application areas, including risk and insurance: a major area of interest and relevance to extreme value theory. Case studies are introduced providing a good balance of theory and application of each model discussed, incorporating many illustrated examples and plots of data. The last part of the book covers some interesting advanced topics, including  time series, regression, multivariate and Bayesian modelling of extremes, the use of which has huge potential.  

  15. How does public opinion become extreme?

    CERN Document Server

    Ramos, Marlon; Reis, Saulo D S; Anteneodo, Celia; Andrade, José S; Havlin, Shlomo; Makse, Hernán A

    2014-01-01

    We investigate the emergence of extreme opinion trends in society by employing statistical physics modeling and analysis on polls that inquire about a wide range of issues such as religion, economics, politics, abortion, extramarital sex, books, movies, and electoral vote. The surveys lay out a clear indicator of the rise of extreme views. The precursor is a nonlinear relation between the fraction of individuals holding a certain extreme view and the fraction of individuals that includes also moderates, e.g., in politics, those who are "very conservative" versus "moderate to very conservative" ones. We propose an activation model of opinion dynamics with interaction rules based on the existence of individual "stubbornness" that mimics empirical observations. According to our modeling, the onset of nonlinearity can be associated to an abrupt bootstrap-percolation transition with cascades of extreme views through society. Therefore, it represents an early-warning signal to forecast the transition from moderate ...

  16. Assigning historic responsibility for extreme weather events

    Science.gov (United States)

    Otto, Friederike E. L.; Skeie, Ragnhild B.; Fuglestvedt, Jan S.; Berntsen, Terje; Allen, Myles R.

    2017-11-01

    Recent scientific advances make it possible to assign extreme events to human-induced climate change and historical emissions. These developments allow losses and damage associated with such events to be assigned country-level responsibility.

  17. Magnetic Logic Circuits for Extreme Environments Project

    Data.gov (United States)

    National Aeronautics and Space Administration — The program aims to demonstrate a new genre of all-magnetic logic circuits which are radiation-tolerant and capable of reliable operation in extreme environmental...

  18. Extremal dynamics and punctuated co-evolution

    Science.gov (United States)

    Sneppen, Kim

    1995-02-01

    Extremal dynamics opens up a new way for understanding the coherence that is observed in some large non-equilibrium systems. Extremal dynamics is characterized by quasistatic motion where only one part of the large system is active at a given instant: the part where a local variable assumes a global extremum value. Extremal dynamics may apply when the parts of the system nearly always are caught in metastable states. Examples from physics may include earthquakes, fluid invasion in porous media and possibly also dynamical roughening of interfaces. We discuss a simple model of extremal dynamics and its application to biological macroevolution. The model can be formulated as an ecology of adapting interacting species. The environment of any given species is affected by other species; hence it may change with time. For low mutation rate the model ecology expands at a self-organized critical state where periods of statis alternate with avalanches of evolutionary changes.

  19. Extreme values, regular variation and point processes

    CERN Document Server

    Resnick, Sidney I

    1987-01-01

    Extremes Values, Regular Variation and Point Processes is a readable and efficient account of the fundamental mathematical and stochastic process techniques needed to study the behavior of extreme values of phenomena based on independent and identically distributed random variables and vectors It presents a coherent treatment of the distributional and sample path fundamental properties of extremes and records It emphasizes the core primacy of three topics necessary for understanding extremes the analytical theory of regularly varying functions; the probabilistic theory of point processes and random measures; and the link to asymptotic distribution approximations provided by the theory of weak convergence of probability measures in metric spaces The book is self-contained and requires an introductory measure-theoretic course in probability as a prerequisite Almost all sections have an extensive list of exercises which extend developments in the text, offer alternate approaches, test mastery and provide for enj...

  20. Extreme learning machines 2013 algorithms and applications

    CERN Document Server

    Toh, Kar-Ann; Romay, Manuel; Mao, Kezhi

    2014-01-01

    In recent years, ELM has emerged as a revolutionary technique of computational intelligence, and has attracted considerable attentions. An extreme learning machine (ELM) is a single layer feed-forward neural network alike learning system, whose connections from the input layer to the hidden layer are randomly generated, while the connections from the hidden layer to the output layer are learned through linear learning methods. The outstanding merits of extreme learning machine (ELM) are its fast learning speed, trivial human intervene and high scalability.   This book contains some selected papers from the International Conference on Extreme Learning Machine 2013, which was held in Beijing China, October 15-17, 2013. This conference aims to bring together the researchers and practitioners of extreme learning machine from a variety of fields including artificial intelligence, biomedical engineering and bioinformatics, system modelling and control, and signal and image processing, to promote research and discu...

  1. A new Class of Extremal Composites

    DEFF Research Database (Denmark)

    Sigmund, Ole

    2000-01-01

    and for both well- and non-well-ordered isotropic constituent phases. The new class of composites constitutes an alternative to the three previously known extremal composite classes: finite rank laminates, composite sphere assemblages and Vigdergauz microstructures. An isotropic honeycomb-like hexagonal...... material phases in a periodic isotropic material structure such that the effective properties are extremized. (C) 2000 Elsevier Science Ltd. All rights reserved....

  2. International Conference on Extreme Learning Machine 2015

    CERN Document Server

    Mao, Kezhi; Wu, Jonathan; Lendasse, Amaury; ELM 2015; Theory, Algorithms and Applications (I); Theory, Algorithms and Applications (II)

    2016-01-01

    This book contains some selected papers from the International Conference on Extreme Learning Machine 2015, which was held in Hangzhou, China, December 15-17, 2015. This conference brought together researchers and engineers to share and exchange R&D experience on both theoretical studies and practical applications of the Extreme Learning Machine (ELM) technique and brain learning. This book covers theories, algorithms ad applications of ELM. It gives readers a glance of the most recent advances of ELM. .

  3. Extreme value distributions in chaotic dynamics

    Science.gov (United States)

    Balakrishnan, V.; Nicolis, C.; Nicolis, G.

    1995-07-01

    A theory of extremes is developed for chaotic dynamical systems and illustrated on representative models of fully developed chaos and intermitent chaos. The cumulative distribution and its associated density for the largest value occurring in a data set, for monotonically increasing (or decreasing) sequences, and for local maxima are evaluated both analytically and numerically. Substantial differences from the classical statistical theory of extremes are found, arising from the deterministic origin of the underlying dynamics.

  4. A Millennial Challenge: Extremism in Uncertain Times.

    Science.gov (United States)

    Fiske, Susan T

    2013-09-01

    This comment highlights the relevance and importance of the uncertainty-extremism topic, both scientifically and societally, identifies common themes, locates this work in a wider scientific and social context, describes what we now know and what we still do not, acknowledges some limitations, foreshadowing future directions, and discusses some potential policy relevance. Common themes emerge around the importance of social justice as sound anti-extremism policy.

  5. Prevention of Lower Extremity Injuries in Basketball

    Science.gov (United States)

    Taylor, Jeffrey B.; Ford, Kevin R.; Nguyen, Anh-Dung; Terry, Lauren N.; Hegedus, Eric J.

    2015-01-01

    Context: Lower extremity injuries are common in basketball, yet it is unclear how prophylactic interventions affect lower extremity injury incidence rates. Objective: To analyze the effectiveness of current lower extremity injury prevention programs in basketball athletes, focusing on injury rates of (1) general lower extremity injuries, (2) ankle sprains, and (3) anterior cruciate ligament (ACL) tears. Data Sources: PubMed, MEDLINE, CINAHL, SPORTDiscus, and the Cochrane Register of Controlled Trials were searched in January 2015. Study Selection: Studies were included if they were randomized controlled or prospective cohort trials, contained a population of competitive basketball athletes, and reported lower extremity injury incidence rates specific to basketball players. In total, 426 individual studies were identified. Of these, 9 met the inclusion criteria. One other study was found during a hand search of the literature, resulting in 10 total studies included in this meta-analysis. Study Design: Systematic review and meta-analysis. Level of Evidence: Level 2. Data Extraction: Details of the intervention (eg, neuromuscular vs external support), size of control and intervention groups, and number of injuries in each group were extracted from each study. Injury data were classified into 3 groups based on the anatomic diagnosis reported (general lower extremity injury, ankle sprain, ACL rupture). Results: Meta-analyses were performed independently for each injury classification. Results indicate that prophylactic programs significantly reduced the incidence of general lower extremity injuries (odds ratio [OR], 0.69; 95% CI, 0.57-0.85; P basketball athletes. Conclusion: In basketball players, prophylactic programs may be effective in reducing the risk of general lower extremity injuries and ankle sprains, yet not ACL injuries. PMID:26502412

  6. International Conference on Extreme Learning Machines 2014

    CERN Document Server

    Mao, Kezhi; Cambria, Erik; Man, Zhihong; Toh, Kar-Ann

    2015-01-01

    This book contains some selected papers from the International Conference on Extreme Learning Machine 2014, which was held in Singapore, December 8-10, 2014. This conference brought together the researchers and practitioners of Extreme Learning Machine (ELM) from a variety of fields to promote research and development of “learning without iterative tuning”.  The book covers theories, algorithms and applications of ELM. It gives the readers a glance of the most recent advances of ELM.  

  7. Two-Dimensional Extreme Learning Machine

    OpenAIRE

    Bo Jia; Dong Li; Zhisong Pan; Guyu Hu

    2015-01-01

    Extreme learning machine (ELM) has achieved wide attention due to faster learning speed compared with conventional neural network models like support vector machine (SVM) and back-propagation (BP) networks. However, like many other methods, ELM is originally proposed to handle vector pattern while nonvector patterns in real applications need to be explored, such as image data. We propose the two-dimensional extreme learning machine (2DELM) based on the very natural idea to deal with matrix...

  8. Asian monsoon extremes and humanity's response over the past millennium

    Science.gov (United States)

    Buckley, B. M.; Lieberman, V. B.; Zottoli, B.

    2012-12-01

    The first decade of the 21st century has seen significant development in the production of paleo proxies for the Asian monsoon, exemplified by the Monsoon Asian Drought Atlas that was comprised of more than 300 tree ring chronologies. Noteworthy among them is the Vietnamese cypress tree-ring record which reveals that the two worst droughts of the past 7 centuries, each more than a decade in length, coincided with the demise of the Khmer civilization at Angkor in the early 15th century CE. The 18th century was nearly as tumultuous a period across Southeast Asia, where several polities fell against a backdrop of epic decadal-scale droughts. At this time all of the region's charter states saw rapid realignment in the face of drought, famine, disease and a raft of related and unrelated social issues. Several other droughts, some more extreme but of lesser duration, punctuate the past millennium, but appear to have had little societal impact. Historical documentation is being used not only to provide corroborative evidence of tree-ring reconstructed climate extremes, but to attempt to understand the dynamics of the coupled human-natural systems involved, and to define what kinds of thresholds need to be reached before societies respond. This paleo perspective can assist our analyses of the role of climate extremes in the collapse or disruption of regional societies, a subject of increasing concern given the uncertainties surrounding projections for future climate across the highly populated areas of Asia.

  9. Extreme precipitation and emergency room visits for influenza in Massachusetts: a case-crossover analysis.

    Science.gov (United States)

    Smith, Genee S; Messier, Kyle P; Crooks, James L; Wade, Timothy J; Lin, Cynthia J; Hilborn, Elizabeth D

    2017-10-17

    Influenza peaks during the wintertime in temperate regions and during the annual rainy season in tropical regions - however reasons for the observed differences in disease ecology are poorly understood. We hypothesize that episodes of extreme precipitation also result in increased influenza in the Northeastern United States, but this association is not readily apparent, as no defined 'rainy season' occurs. Our objective was to evaluate the association between extreme precipitation (≥ 99th percentile) events and risk of emergency room (ER) visit for influenza in Massachusetts during 2002-2008. A case-crossover analysis of extreme precipitation events and influenza ER visits was conducted using hospital administrative data including patient town of residence, date of visit, age, sex, and associated diagnostic codes. Daily precipitation estimates were generated for each town based upon data from the National Oceanic and Atmospheric Administration. Odds ratio (OR) and 95% confidence intervals (CI) for associations between extreme precipitation and ER visits for influenza were estimated using conditional logistic regression. Extreme precipitation events were associated with an OR = 1.23 (95%CI: 1.16, 1.30) for ER visits for influenza at lag days 0-6. There was significant effect modification by race, with the strongest association observed among Blacks (OR = 1.48 (1.30, 1.68)). We observed a positive association between extreme precipitation events and ER visits for influenza, particularly among Blacks. Our results suggest that influenza is associated with extreme precipitation in a temperate area; this association could be a result of disease ecology, behavioral changes such as indoor crowding, or both. Extreme precipitation events are expected to increase in the Northeastern United States as climate change progresses. Additional research exploring the basis of this association can inform potential interventions for extreme weather events and influenza

  10. Are healthcare middle management jobs extreme jobs?

    Science.gov (United States)

    Buchanan, David A; Parry, Emma; Gascoigne, Charlotte; Moore, Cíara

    2013-01-01

    The purpose of this paper is to explore the incidence of "extreme jobs" among middle managers in acute hospitals, and to identify individual and organizational implications. The paper is based on interviews and focus groups with managers at six hospitals, a "proof of concept" pilot with an operations management team, and a survey administered at five hospitals. Six of the original dimensions of extreme jobs, identified in commercial settings, apply to hospital management: long hours, unpredictable work patterns, tight deadlines with fast pace, broad responsibility, "24/7 availability", mentoring and coaching. Six healthcare-specific dimensions were identified: making life or death decisions, conflicting priorities, being required to do more with fewer resources, responding to regulatory bodies, the need to involve many people before introducing improvements, fighting a negative climate. Around 75 per cent of hospital middle managers have extreme jobs. This extreme healthcare management job model was derived inductively from a qualitative study involving a small number of respondents. While the evidence suggests that extreme jobs are common, further research is required to assess the antecedents, incidence, and implications of these working practices. A varied, intense, fast-paced role with responsibility and long hours can be rewarding, for some. However, multi-tasking across complex roles can lead to fatigue, burnout, and mistakes, patient care may be compromised, and family life may be adversely affected. As far as the authors can ascertain, there are no other studies exploring acute sector management roles through an extreme jobs lens.

  11. Extreme Weather Events and Climate Change Attribution

    Energy Technology Data Exchange (ETDEWEB)

    Thomas, Katherine [National Academy of Sciences, Washington, DC (United States)

    2016-03-31

    A report from the National Academies of Sciences, Engineering, and Medicine concludes it is now possible to estimate the influence of climate change on some types of extreme events. The science of extreme event attribution has advanced rapidly in recent years, giving new insight to the ways that human-caused climate change can influence the magnitude or frequency of some extreme weather events. This report examines the current state of science of extreme weather attribution, and identifies ways to move the science forward to improve attribution capabilities. Confidence is strongest in attributing types of extreme events that are influenced by climate change through a well-understood physical mechanism, such as, the more frequent heat waves that are closely connected to human-caused global temperature increases, the report finds. Confidence is lower for other types of events, such as hurricanes, whose relationship to climate change is more complex and less understood at present. For any extreme event, the results of attribution studies hinge on how questions about the event's causes are posed, and on the data, modeling approaches, and statistical tools chosen for the analysis.

  12. Lower Extremity Permanent Dialysis Vascular Access.

    Science.gov (United States)

    Parekh, Vishal B; Niyyar, Vandana D; Vachharajani, Tushar J

    2016-09-07

    Hemodialysis remains the most commonly used RRT option around the world. Technological advances, superior access to care, and better quality of care have led to overall improvement in survival of patients on long-term hemodialysis. Maintaining a functioning upper extremity vascular access for a prolonged duration continues to remain a challenge for dialysis providers. Frequently encountered difficulties in clinical practice include (1) a high incidence of central venous catheter-related central vein stenosis and (2) limited options for creating a functioning upper extremity permanent arteriovenous access. Lack of surgical skills, fear of complications, and limited involvement of the treating nephrologists in the decision-making process are some of the reasons why lower extremity permanent dialysis access remains an infrequently used option. Similar to upper extremity vascular access options, lower extremity arteriovenous fistula remains a preferred access over arteriovenous synthetic graft. The use of femoral tunneled catheter as a long-term access should be avoided as far as possible, especially with the availability of newer graft-catheter hybrid devices. Our review provides a summary of clinical evidence published in surgical, radiology, and nephrology literature highlighting the pros and cons of different types of lower extremity permanent dialysis access. Copyright © 2016 by the American Society of Nephrology.

  13. Amlodipine-induced bilateral upper extremity edema.

    Science.gov (United States)

    Ganeshalingham, Anusha; Wong, William

    2007-09-01

    To report a case of bilateral upper extremity edema associated with amlodipine use in a child. A previously well and normotensive 6-year-old girl presented with a generalized vasculitis of unknown origin and severe hypertension. Large vessels predominantly affecting the neck, chest, and abdomen were found to be involved, resulting in abnormal arterial circulation and significant blood pressure differences between the upper and lower extremities. Multiple antihypertensive agents were initially required to control blood pressure. She was stabilized and discharged on amlodipine 10 mg each evening, atenolol 50 mg/day, and warfarin. Three days later she was noted to have facial and bilateral upper extremity pitting edema. Laboratory and radiologic assessments for possible etiologies were negative. Discontinuation of amlodipine resulted in resolution of edema. As of June 2007, there had been no cases of bilateral upper extremity edema associated with amlodipine use reported in the English literature. Adverse effects of amlodipine, a widely used antihypertensive, have been well reported. These include flushing, headache, and peripheral edema. Lower limb edema is the most common, while periocular and perioral edema have occurred less frequently. Anasarca edema has been described only once in the English literature. According to the Naranjo probability scale, amlodipine was a probable cause of bilateral upper extremity edema in this child. Bilateral upper extremity edema has been associated with amlodipine use in a child with an abnormal arterial circulation. The edema resolved upon discontinuation of the drug.

  14. Neurodevelopmental problems and extremes in BMI

    Directory of Open Access Journals (Sweden)

    Nóra Kerekes

    2015-07-01

    Full Text Available Background. Over the last few decades, an increasing number of studies have suggested a connection between neurodevelopmental problems (NDPs and body mass index (BMI. Attention deficit/hyperactivity disorder (ADHD and autism spectrum disorders (ASD both seem to carry an increased risk for developing extreme BMI. However, the results are inconsistent, and there have been only a few studies of the general population of children.Aims. We had three aims with the present study: (1 to define the prevalence of extreme (low or high BMI in the group of children with ADHD and/or ASDs compared to the group of children without these NDPs; (2 to analyze whether extreme BMI is associated with the subdomains within the diagnostic categories of ADHD or ASD; and (3 to investigate the contribution of genetic and environmental factors to BMI in boys and girls at ages 9 and 12.Method. Parents of 9- or 12-year-old twins (n = 12,496 were interviewed using the Autism—Tics, ADHD and other Comorbidities (A-TAC inventory as part of the Child and Adolescent Twin Study in Sweden (CATSS. Univariate and multivariate generalized estimated equation models were used to analyze associations between extremes in BMI and NDPs.Results. ADHD screen-positive cases followed BMI distributions similar to those of children without ADHD or ASD. Significant association was found between ADHD and BMI only among 12-year-old girls, where the inattention subdomain of ADHD was significantly associated with the high extreme BMI. ASD scores were associated with both the low and the high extremes of BMI. Compared to children without ADHD or ASD, the prevalence of ASD screen-positive cases was three times greater in the high extreme BMI group and double as much in the low extreme BMI group. Stereotyped and repetitive behaviors were significantly associated with high extreme BMIs.Conclusion. Children with ASD, with or without coexisting ADHD, are more prone to have low or high extreme BMIs than

  15. [Severe Lower Extremity Infections Treated with Hip Disarticulation - Case Series].

    Science.gov (United States)

    Patera, M; Mizera, R

    2017-01-01

    Hip disarticulation is a major ablative procedure with serious risks as well as consequences for the patient, performed rarely for a lower extremity infection. According to literature, the mortality rate in these procedures reaches up to 60%. Unfavourable prognostic factors are emergency surgeries without adequate preparation of the patient and surgeries indicated for an ischemic terrain infection. The authors present four cases of hip disarticulation for severe lower extremity infection. In one patient, the procedure was performed urgently for necrotising fasciitis in the lower extremity extending up to the groin area, in the other three patients for non-healing femoral stump infection following the lower extremity amputation for vascular causes, of which two cases got complicated by the presence of TKA. Two of the patients treated surgically for stump infection died two months after the surgery due to respiratory complications. The two surviving patients underwent the last check one year following the surgery, they are both capable of independent locomotion with two underarm crutches and use the prosthesis only rarely. In the discussion, the factors influencing the mortality rate of the procedure, the principles of surgical and antimicrobial therapy, and the use of the negative-pressure wound therapy are analysed. The underlying principles of the care for patients with severe infections of the musculoskeletal system are infection focus debridement with the removal of foreign material, antibiotic (anti-infective) therapy targeted based on the cultivation results, wound management aimed to prevent contamination with nosocomial strains, and multidisciplinary cooperation - orthopaedist/surgeon, infectious disease physician, intensive care specialist, nutrition and rehabilitation specialist, nursing and prosthetic care providers. Key words: hip disarticulation, infection, necrotizing fasciitis.

  16. Extreme conservation leads to recovery of the Virunga mountain gorillas.

    Directory of Open Access Journals (Sweden)

    Martha M Robbins

    Full Text Available As wildlife populations are declining, conservationists are under increasing pressure to measure the effectiveness of different management strategies. Conventional conservation measures such as law enforcement and community development projects are typically designed to minimize negative human influences upon a species and its ecosystem. In contrast, we define "extreme" conservation as efforts targeted to deliberately increase positive human influences, including veterinary care and close monitoring of individual animals. Here we compare the impact of both conservation approaches upon the population growth rate of the critically endangered Virunga mountain gorillas (Gorilla beringei beringei, which increased by 50% since their nadir in 1981, from approximately 250 to nearly 400 gorillas. Using demographic data from 1967-2008, we show an annual decline of 0.7%±0.059% for unhabituated gorillas that received intensive levels of conventional conservation approaches, versus an increase 4.1%±0.088% for habituated gorillas that also received extreme conservation measures. Each group of habituated gorillas is now continuously guarded by a separate team of field staff during daylight hours and receives veterinary treatment for snares, respiratory disease, and other life-threatening conditions. These results suggest that conventional conservation efforts prevented a severe decline of the overall population, but additional extreme measures were needed to achieve positive growth. Demographic stochasticity and socioecological factors had minimal impact on variability in the growth rates. Veterinary interventions could account for up to 40% of the difference in growth rates between habituated versus unhabituated gorillas, with the remaining difference likely arising from greater protection against poachers. Thus, by increasing protection and facilitating veterinary treatment, the daily monitoring of each habituated group contributed to most of the

  17. Comparison of spatial extreme value models for snow depth extremes in Austria

    Science.gov (United States)

    Schellander, Harald; Hell, Tobias

    2017-04-01

    In Alpine regions like Austria a spatial representation of extreme snow depth is of crucial importance for numerous purposes such as the designing of construction projects. Extreme value theory builds the well-established foundation of modeling extremes. Two different approaches for the spatial modeling of snow depth extremes have been extensively investigated lately: Smooth Spatial Modeling (Blanchet and Lehning, 2010) and different classes of max-stable processes (Blanchet and Davison, 2011; Nicolet et al., 2015), both outperforming classical interpolation techniques. While max-stable models are generally considered as improvement over smooth modeling, the methods have not been compared in the context of extreme snow depth. In the present study a great variety of different GEV models is fitted to seasonal snow depth maxima measured at more than 200 Austrian weather stations. Return levels of smooth spatial models and several max-stable representations (Schlather, Brown-Resnick, Geometric Gaussian, Extremal-t) and covariance models (Powered Exponential, Brown, Whittle-Matern), also allowing for anisotropic extremal dependence are compared by a modified Anderson-Darling score and a normalized RMSE. Preliminary results show, that for snow depth extremes in Austria smooth spatial modeling and a version with extremal coefficients as covariates deliver slightly better scores than (an)-isotropic max-stable models.

  18. Susceptibility to mortality in weather extremes: effect modification by personal and small-area characteristics.

    Science.gov (United States)

    Zanobetti, Antonella; O'Neill, Marie S; Gronlund, Carina J; Schwartz, Joel D

    2013-11-01

    Extremes of temperature have been associated with short-term increases in daily mortality. We identified subpopulations with increased susceptibility to dying during temperature extremes, based on personal demographics, small-area characteristics, and preexisting medical conditions. We examined Medicare participants in 135 US cities and identified preexisting conditions based on hospitalization records before their deaths, from 1985 to 2006. Personal characteristics were obtained from the Medicare records, and area characteristics were assigned based on zip code of residence. We conducted a case-only analysis of over 11 million deaths and evaluated modification of the risk of dying associated with extremely hot days and extremely cold days, continuous temperatures, and water vapor pressure. Modifiers included preexisting conditions, personal characteristics, zip code-level population characteristics, and land cover characteristics. For each effect modifier, a city-specific logistic regression model was fitted and then an overall national estimate was calculated using meta-analysis. People with certain preexisting conditions were more susceptible to extreme heat, with an additional 6% (95% confidence interval = 4%-8%) increase in the risk of dying on an extremely hot day in subjects with previous admission for atrial fibrillation, an additional 8% (4%-12%) in subjects with Alzheimer disease, and an additional 6% (3%-9%) in subjects with dementia. Zip code level and personal characteristics were also associated with increased susceptibility to temperature. We identified several subgroups of the population who are particularly susceptible to temperature extremes, including persons with atrial fibrillation.

  19. [Upper-extremity deep vein thrombosis: current concepts in diagnosis and treatment].

    Science.gov (United States)

    Mitu, F; Leon, Maria Magdalena; Mitu, Magda

    2011-01-01

    Upper-extremity deep vein thrombosis is a rare manifestation of venous thromboembolic disease. In the past few decades, the clinical importance of upper-extremity deep vein thrombosis has increased because of the wider use of central venous catheters and the development of ultrasonography as a simple and accurate objective diagnostic method. Primary upper-extremity deep vein thrombosis is a rare disorder (2 per 100,000 persons per year), which comprises (1) Paget-Schroetter Syndrome, also known as effort thrombosis, and (2) idiopathic upper-extremity deep vein thrombosis. Secundary upper-extremity deep vein thrombosis develops in patients with upper extremity central venous catheters, pacemakers or cancer and accounts for most cases of upper-extremity deep vein thrombosis. The imaging modes used for diagnosis are: duplex ultrasound, magnetic resonance. Contrast venogram is the standard diagnostic test for characterization of the anatomy. A staged, multimodal approach to Paget-Schroetter Syndrome can effectively restore venous patency, reduce the risk of rethrombosis, and return the patient to normal function. Primary care physicians should be aware of this condition and its atypical presentations, because delayed recognition in a high-functioning persons can be potentially disabling.

  20. DIRECTIONS OF EXTREME TOURISM IN UKRAINE

    Directory of Open Access Journals (Sweden)

    L. V. Martseniuk

    2016-02-01

    Full Text Available Purpose. In the world market of tourist services the extreme tourism is very popular, as it does not require the significant financial costs and enables year on year to increase the offers of holiday packages, associated with active travel. Ukraine has significant potential for the development of extreme kinds of rest, but it is not developed enough. Forms of extreme tourism are unknown for domestic tourists, and therefore, they formed a negative attitude. The aim of the article is the analysis of extreme resort potential of Ukraine and promotion of the development of extreme tourism destinations in the travel market. Theoretical and methodological basis of research is the system analysis of the problems of ensuring the competitiveness of the tourism industry, theoretical principles of economic science in the field of the effectiveness of extreme tourism and management of tourist flows. Methodology. The author offers the directions of tourist flows control, which differ from the current expansion of services to tourists in Ukraine. The development of extreme tourism with the help of co-operation of railways and sport federations was proposed. Findings. During the research the author proved that the implementation of the tasks will be promote: 1 increase in budget revenues at all levels of the inner extreme tourism; 2 raise the image of Ukraine and Ukrainian Railways; 3 increase the share of tourism and resorts in the gross domestic product to the level of developed countries; 4 bringing the number of employees in tourism and resorts to the level of developed countries; 5 the creation of an effective system of monitoring the quality of tourist services; 6 the creation of an attractive investment climate for attracting the investment in the broad development of tourism, engineering and transport and municipal infrastructure; 7 improvement the safety of tourists, ensure the effective protection of their rights and legitimate interests and

  1. Lower extremity muscle activation during baseball pitching.

    Science.gov (United States)

    Campbell, Brian M; Stodden, David F; Nixon, Megan K

    2010-04-01

    The purpose of this study was to investigate muscle activation levels of select lower extremity muscles during the pitching motion. Bilateral surface electromyography data on 5 lower extremity muscles (biceps femoris, rectus femoris, gluteus maximus, vastus medialis, and gastrocnemius) were collected on 11 highly skilled baseball pitchers and compared with individual maximal voluntary isometric contraction (MVIC) data. The pitching motion was divided into 4 distinct phases: phase 1, initiation of pitching motion to maximum stride leg knee height; phase 2, maximum stride leg knee height to stride foot contact (SFC); phase 3, SFC to ball release; and phase 4, ball release to 0.5 seconds after ball release (follow-through). Results indicated that trail leg musculature elicited moderate to high activity levels during phases 2 and 3 (38-172% of MVIC). Muscle activity levels of the stride leg were moderate to high during phases 2-4 (23-170% of MVIC). These data indicate a high demand for lower extremity strength and endurance. Specifically, coaches should incorporate unilateral and bilateral lower extremity exercises for strength improvement or maintenance and to facilitate dynamic stabilization of the lower extremities during the pitching motion.

  2. Extreme Metal Music and Anger Processing

    Science.gov (United States)

    Sharman, Leah; Dingle, Genevieve A.

    2015-01-01

    The claim that listening to extreme music causes anger, and expressions of anger such as aggression and delinquency have yet to be substantiated using controlled experimental methods. In this study, 39 extreme music listeners aged 18–34 years were subjected to an anger induction, followed by random assignment to 10 min of listening to extreme music from their own playlist, or 10 min silence (control). Measures of emotion included heart rate and subjective ratings on the Positive and Negative Affect Scale (PANAS). Results showed that ratings of PANAS hostility, irritability, and stress increased during the anger induction, and decreased after the music or silence. Heart rate increased during the anger induction and was sustained (not increased) in the music condition, and decreased in the silence condition. PANAS active and inspired ratings increased during music listening, an effect that was not seen in controls. The findings indicate that extreme music did not make angry participants angrier; rather, it appeared to match their physiological arousal and result in an increase in positive emotions. Listening to extreme music may represent a healthy way of processing anger for these listeners. PMID:26052277

  3. Biological Extreme Events: A Research Framework

    Science.gov (United States)

    Gutschick, Vincent P.; BassiriRad, Hormoz

    2010-03-01

    Efforts designed to understand and predict adaptation responses of organisms and populations to global climate change must make a clear distinction between responses to changes in average conditions (e.g., doubling of atmospheric carbon dioxide concentration accompanied by an average increase of 1°-3°C in global air temperature by the end of this century) and responses resulting from increased incidence of extreme events [Loehle and LeBlanc, 1996; Easterling et al., 2000; Garrett et al., 2006]. Such distinction is critical because, unlike changes in average conditions, extremes (e.g., megadroughts, fire, flooding, hurricanes, heat waves, and pest outbreaks) are typically short in duration but challenge organisms and populations considerably further beyond their ability to acclimate than those expected from average trends in climate changes. There is growing evidence that climatic extremes have been rising in frequency or magnitude during the last part of the twentieth century and will continue to increase during the remainder of this century [Easterling et al., 2000; Meehl et al., 2000; Parmesan and Yohe, 2003; Barnett et al., 2006]. More important, the frequency of extremes is likely to increase even if the climatic means do not change substantially [Intergovernmental Panel on Climate Change (IPCC), 2001, chapter 10]. Therefore, it makes sense to pay special attention to extremes as major agents of biological adaption (genetic change) when considering global climate change.

  4. Extreme Metal Music and Anger Processing.

    Science.gov (United States)

    Sharman, Leah; Dingle, Genevieve A

    2015-01-01

    The claim that listening to extreme music causes anger, and expressions of anger such as aggression and delinquency have yet to be substantiated using controlled experimental methods. In this study, 39 extreme music listeners aged 18-34 years were subjected to an anger induction, followed by random assignment to 10 min of listening to extreme music from their own playlist, or 10 min silence (control). Measures of emotion included heart rate and subjective ratings on the Positive and Negative Affect Scale (PANAS). Results showed that ratings of PANAS hostility, irritability, and stress increased during the anger induction, and decreased after the music or silence. Heart rate increased during the anger induction and was sustained (not increased) in the music condition, and decreased in the silence condition. PANAS active and inspired ratings increased during music listening, an effect that was not seen in controls. The findings indicate that extreme music did not make angry participants angrier; rather, it appeared to match their physiological arousal and result in an increase in positive emotions. Listening to extreme music may represent a healthy way of processing anger for these listeners.

  5. Present-day irrigation mitigates heat extremes

    Science.gov (United States)

    Thiery, Wim; Davin, Edouard L.; Lawrence, David M.; Hirsch, Annette L.; Hauser, Mathias; Seneviratne, Sonia I.

    2017-02-01

    Irrigation is an essential practice for sustaining global food production and many regional economies. Emerging scientific evidence indicates that irrigation substantially affects mean climate conditions in different regions of the world. Yet how this practice influences climate extremes is currently unknown. Here we use ensemble simulations with the Community Earth System Model to assess the impacts of irrigation on climate extremes. An evaluation of the model performance reveals that irrigation has a small yet overall beneficial effect on the representation of present-day near-surface climate. While the influence of irrigation on annual mean temperatures is limited, we find a large impact on temperature extremes, with a particularly strong cooling during the hottest day of the year (-0.78 K averaged over irrigated land). The strong influence on extremes stems from the timing of irrigation and its influence on land-atmosphere coupling strength. Together these effects result in asymmetric temperature responses, with a more pronounced cooling during hot and/or dry periods. The influence of irrigation is even more pronounced when considering subgrid-scale model output, suggesting that local effects of land management are far more important than previously thought. Our results underline that irrigation has substantially reduced our exposure to hot temperature extremes in the past and highlight the need to account for irrigation in future climate projections.

  6. How does public opinion become extreme?

    Science.gov (United States)

    Ramos, Marlon; Shao, Jia; Reis, Saulo D S; Anteneodo, Celia; Andrade, José S; Havlin, Shlomo; Makse, Hernán A

    2015-05-19

    We investigate the emergence of extreme opinion trends in society by employing statistical physics modeling and analysis on polls that inquire about a wide range of issues such as religion, economics, politics, abortion, extramarital sex, books, movies, and electoral vote. The surveys lay out a clear indicator of the rise of extreme views. The precursor is a nonlinear relation between the fraction of individuals holding a certain extreme view and the fraction of individuals that includes also moderates, e.g., in politics, those who are "very conservative" versus "moderate to very conservative" ones. We propose an activation model of opinion dynamics with interaction rules based on the existence of individual "stubbornness" that mimics empirical observations. According to our modeling, the onset of nonlinearity can be associated to an abrupt bootstrap-percolation transition with cascades of extreme views through society. Therefore, it represents an early-warning signal to forecast the transition from moderate to extreme views. Moreover, by means of a phase diagram we can classify societies according to the percolative regime they belong to, in terms of critical fractions of extremists and people's ties.

  7. Community responses to extreme climatic conditions

    Directory of Open Access Journals (Sweden)

    Frédéric JIGUET, Lluis BROTONS, Vincent DEVICTOR

    2011-06-01

    Full Text Available Species assemblages and natural communities are increasingly impacted by changes in the frequency and severity of extreme climatic events. Here we propose a brief overview of expected and demonstrated direct and indirect impacts of extreme events on animal communities. We show that differential impacts on basic biological parameters of individual species can lead to strong changes in community composition and structure with the potential to considerably modify the functional traits of the community. Sudden disequilibria have even been shown to induce irreversible shifts in marine ecosystems, while cascade effects on various taxonomic groups have been highlighted in Mediterranean forests. Indirect effects of extreme climatic events are expected when event-induced habitat changes (e.g. soil stability, vegetation composition, water flows altered by droughts, floods or hurricanes have differential consequences on species assembled within the communities. Moreover, in increasing the amplitude of trophic mismatches, extreme events are likely to turn many systems into ecological traps under climate change. Finally, we propose a focus on the potential impacts of an extreme heat wave on local assemblages as an empirical case study, analysing monitoring data on breeding birds collected in France. In this example, we show that despite specific populations were differently affected by local temperature anomalies, communities seem to be unaffected by a sudden heat wave. These results suggest that communities are tracking climate change at the highest possible rate [Current Zoology 57 (3: 406–413, 2011].

  8. Extreme metal music and anger processing

    Directory of Open Access Journals (Sweden)

    Leah eSharman

    2015-05-01

    Full Text Available The claim that listening to extreme music causes anger and expressions of anger such as aggression and delinquency has yet to be substantiated using controlled experimental methods. In this study, 39 extreme music listeners aged 18 to 34 years were subjected to an anger induction, followed by random assignment to 10 minutes of listening to extreme music from their own playlist, or 10 minutes of silence (control. Measures of emotion included heart rate and subjective ratings on the Positive and Negative Affect Scale (PANAS. Results showed that ratings of PANAS hostility, irritability, and stress increased during the anger induction, and decreased after the music or silence. Heart rate increased during the anger induction and was sustained (not increased in the music condition, and decreased in the silence condition. PANAS active and inspired ratings increased during music listening, an effect that was not seen in controls. The findings indicate that extreme music did not make angry participants angrier rather it appeared to match their physiological arousal and result in an increase in positive emotions. Listening to extreme music may represent a healthy way of processing anger for these listeners.

  9. How does public opinion become extreme?

    Science.gov (United States)

    Ramos, Marlon; Shao, Jia; Reis, Saulo D. S.; Anteneodo, Celia; Andrade, José S.; Havlin, Shlomo; Makse, Hernán A.

    2015-05-01

    We investigate the emergence of extreme opinion trends in society by employing statistical physics modeling and analysis on polls that inquire about a wide range of issues such as religion, economics, politics, abortion, extramarital sex, books, movies, and electoral vote. The surveys lay out a clear indicator of the rise of extreme views. The precursor is a nonlinear relation between the fraction of individuals holding a certain extreme view and the fraction of individuals that includes also moderates, e.g., in politics, those who are “very conservative” versus “moderate to very conservative” ones. We propose an activation model of opinion dynamics with interaction rules based on the existence of individual “stubbornness” that mimics empirical observations. According to our modeling, the onset of nonlinearity can be associated to an abrupt bootstrap-percolation transition with cascades of extreme views through society. Therefore, it represents an early-warning signal to forecast the transition from moderate to extreme views. Moreover, by means of a phase diagram we can classify societies according to the percolative regime they belong to, in terms of critical fractions of extremists and people’s ties.

  10. Increased arterial wall stiffness limits flow volume in the lower extremities in type 2 diabetic patients.

    Science.gov (United States)

    Suzuki, E; Kashiwagi, A; Nishio, Y; Egawa, K; Shimizu, S; Maegawa, H; Haneda, M; Yasuda, H; Morikawa, S; Inubushi, T; Kikkawa, R

    2001-12-01

    To document an association between arterial wall stiffness and reduced flow volume in the lower-extremity arteries of diabetic patients. We recruited 60 consecutive type 2 diabetic patients who had no history or symptoms of peripheral arterial disease (PAD) in the lower extremities and normal ankle/brachial systolic blood pressure index at the time of the study (non-PAD group) and 20 age-matched nondiabetic subjects (control group). We used an automatic device to measure pulse wave velocity (PWV) in the lower extremities as an index of arterial wall stiffness. At the popliteal artery, we evaluated flow volume and the resistive index as an index of arterial resistance to blood flow using gated two-dimensional cine-mode phase-contrast magnetic resonance imaging. Consistent with previous reports, we confirmed that the non-PAD group had an abnormally higher PWV compared with that of the control group (P lower extremities of diabetic patients.

  11. Human Robotic Systems (HRS): Extreme Terrain Mobility Element

    Data.gov (United States)

    National Aeronautics and Space Administration — During 2014, the Extreme Terrain Mobility project element is developing five technologies:Exoskeleton Development for ISS EvaluationExtreme Terrain Mobility...

  12. Extreme events: dynamics, statistics and prediction

    Directory of Open Access Journals (Sweden)

    M. Ghil

    2011-05-01

    Full Text Available We review work on extreme events, their causes and consequences, by a group of European and American researchers involved in a three-year project on these topics. The review covers theoretical aspects of time series analysis and of extreme value theory, as well as of the deterministic modeling of extreme events, via continuous and discrete dynamic models. The applications include climatic, seismic and socio-economic events, along with their prediction.

    Two important results refer to (i the complementarity of spectral analysis of a time series in terms of the continuous and the discrete part of its power spectrum; and (ii the need for coupled modeling of natural and socio-economic systems. Both these results have implications for the study and prediction of natural hazards and their human impacts.

  13. Extreme exercise and oxidative DNA modification

    DEFF Research Database (Denmark)

    Poulsen, H E; Loft, S; Vistisen, K

    1996-01-01

    Extreme exercise increases oxygen uptake with a potential for increased formation of reactive oxygen species. Damage to biomolecules may occur if such an increase exceeds the protective capacity of antioxidant defence mechanisms. Vigorous exercise amounting to approximately 10 h a day for 30 days...... DNA and/or from cell turnover. Oxidative stress to DNA points to a risk for the development of cancer and premature ageing from extreme exercise.......Extreme exercise increases oxygen uptake with a potential for increased formation of reactive oxygen species. Damage to biomolecules may occur if such an increase exceeds the protective capacity of antioxidant defence mechanisms. Vigorous exercise amounting to approximately 10 h a day for 30 days...

  14. Flooding hazards from sea extremes and subsidence

    DEFF Research Database (Denmark)

    Sørensen, Carlo; Vognsen, Karsten; Broge, Niels

    2015-01-01

    If we do not understand the effects of climate change and sea level rise (SLR) we cannot live in low-lying coastal areas in the future. Permanent inundation may become a prevalent issue but more often floods related to extreme events have the largest damage potential, and the management of flooding...... hazards needs to integrate the water loading from various sources. Furthermore, local subsidence must be accounted for in order to evaluate current and future flooding hazards and management options. We present the methodology (Figure) and preliminary results from the research project “Coastal Flooding...... Hazards due to Storm Surges and Subsidence” (2014-2017) with the objective to develop and test a practice oriented methodology for combining extreme water level statistics and land movement in coastal flooding hazard mapping and in climate change adaptation schemes in Denmark. From extreme value analysis...

  15. Parsimonious Wavelet Kernel Extreme Learning Machine

    Directory of Open Access Journals (Sweden)

    Wang Qin

    2015-11-01

    Full Text Available In this study, a parsimonious scheme for wavelet kernel extreme learning machine (named PWKELM was introduced by combining wavelet theory and a parsimonious algorithm into kernel extreme learning machine (KELM. In the wavelet analysis, bases that were localized in time and frequency to represent various signals effectively were used. Wavelet kernel extreme learning machine (WELM maximized its capability to capture the essential features in “frequency-rich” signals. The proposed parsimonious algorithm also incorporated significant wavelet kernel functions via iteration in virtue of Householder matrix, thus producing a sparse solution that eased the computational burden and improved numerical stability. The experimental results achieved from the synthetic dataset and a gas furnace instance demonstrated that the proposed PWKELM is efficient and feasible in terms of improving generalization accuracy and real time performance.

  16. Extremity reconstruction using nonreplantable tissue ("spare parts").

    Science.gov (United States)

    Russell, Robert C; Neumeister, Michael W; Ostric, Srdjan Andrei; Engineer, Nitin J

    2007-04-01

    After a severe digital or extremity injury, the replantation surgeon should always seek to make the best use out of what tissue is available for reconstruction. Exercising sound surgical judgment and being creative allow the surgeon to restore function to critical areas of the hand or extremity by the judicious use of available tissues that would otherwise be discarded. The use of "spare parts" should, therefore, always be considered to facilitate digital or extremity reconstruction when routine replantation is not possible or is likely to produce a poor functional result. The surgeon should always try to use available nonreplantable tissue to preserve length, obtain soft tissue coverage, or most importantly improve the function of remaining less injured digits. This article presents several case studies that illustrate the principals of spare parts reconstruction performed at the time of the initial debridement using nonreplantable tissue to provide coverage or improve function.

  17. Extremal bootstrapping: go with the flow

    CERN Document Server

    El-Showk, Sheer

    2016-01-01

    The extremal functional method determines approximate solutions to the constraints of crossing symmetry, which saturate bounds on the space of unitary CFTs. We show that such solutions are characterized by extremality conditions, which may be used to flow continuously along the boundaries of parameter space. Along the flow there is generically no further need for optimization, which dramatically reduces computational requirements, bringing calculations from the realm of computing clusters to laptops. Conceptually, extremality sheds light on possible ways to bootstrap without positivity, extending the method to non-unitary theories, and implies that theories saturating bounds, and especially those sitting at kinks, have unusually sparse spectra. We discuss several applications, including the first high-precision bootstrap of a non-unitary CFT.

  18. Extremism without extremists: Deffuant model with emotions

    Science.gov (United States)

    Sobkowicz, Pawel

    2015-03-01

    The frequent occurrence of extremist views in many social contexts, often growing from small minorities to almost total majority, poses a significant challenge for democratic societies. The phenomenon can be described within the sociophysical paradigm. We present a modified version of the continuous bounded confidence opinion model, including a simple description of the influence of emotions on tolerances, and eventually on the evolution of opinions. Allowing for psychologically based correlation between the extreme opinions, high emotions and low tolerance for other people's views leads to quick dominance of the extreme views within the studied model, without introducing a special class of agents, as has been done in previous works. This dominance occurs even if the initial numbers of people with extreme opinions is very small. Possible suggestions related to mitigation of the process are briefly discussed.

  19. Changes in extreme events and the potential impacts on human health.

    Science.gov (United States)

    Bell, Jesse E; Brown, Claudia Langford; Conlon, Kathryn; Herring, Stephanie; Kunkel, Kenneth E; Lawrimore, Jay; Luber, George; Schreck, Carl; Smith, Adam; Uejio, Christopher

    2017-11-29

    Extreme weather and climate-related events affect human health by causing death, injury, and illness, as well as having large socioeconomic impacts. Climate change has caused changes in extreme event frequency, intensity and geographic distribution, and will continue to be a driver for change in the future. Some of these events include heat waves, droughts, wildfires, dust storms, flooding rains, coastal flooding, storm surge, and hurricanes. The pathways connecting extreme events to health outcomes and economic losses can be diverse and complex. The difficulty in predicting these relationships comes from the local societal and environmental factors that affect disease burden. More information is needed about the impacts of climate change on public health and economies to effectively plan for and adapt to climate change. This article describes some of the ways extreme events are changing and provides examples of the potential impacts on human health and infrastructure. It also identifies key research gaps to be addressed to improve the resilience of public health to extreme events in the future. Extreme weather and climate events affect human health by causing death, injury, and illness, as well as having large socio-economic impacts. Climate change has caused changes in extreme event frequency, intensity and geographic distribution, and will continue to be a driver for change in the future. Some of these events include heat waves, droughts, wildfires, flooding rains, coastal flooding, storm surge, and hurricanes. The pathways connecting extreme events to health outcomes and economic losses can be diverse and complex. The difficulty in predicting these relationships comes from the local societal and environmental factors that affect disease burden.

  20. Adolescent exposure to extremely violent movies.

    Science.gov (United States)

    Sargent, James D; Heatherton, Todd F; Ahrens, M Bridget; Dalton, Madeline A; Tickle, Jennifer J; Beach, Michael L

    2002-12-01

    To determine exposure of young adolescents to extremely violent movies. Cross-sectional school-based survey of middle school students at 15 randomly selected New Hampshire and Vermont middle schools. Each survey contained a unique list of 50 movies, randomly selected from 603 top box office hits from 1988 to 1999, 51 of which were determined by content analysis to contain extremely violent material. Movie titles only were listed, and adolescents were asked to indicate which ones they had seen. Each movie appeared on approximately 470 surveys. We calculated the percentage of students who had seen each movie for a representative subsample of the student population. We also examined characteristics associated with seeing at least one extremely violent movie. Complete survey information was obtained from 5,456 students. The sample was primarily white and equally distributed by gender. On average, extremely violent movies were seen by 28% of the students in the sample (range 4% to 66%). The most popular movie, Scream, was seen by two-thirds of students overall and over 40% of fifth-graders. Other movies with sexualized violent content were seen by many of these adolescents. Examples include The General's Daughter (rated R for "graphic images related to sexual violence including a rape scene and perverse sexuality") and Natural Born Killers (rated R for "extreme violence and graphic carnage, shocking images, language, and sexuality"), seen by 27% and 20%, respectively. Older students, males, those of lower socioeconomic status, and those with poorer school performance were all significantly more likely to have seen at least one extremely violent movie. This study documents widespread exposure of young adolescents to movies with brutal, and often sexualized, violence. Given that many of these films were marketed to teens, better oversight of the marketing practices of the film industry may be warranted.

  1. extRemes 2.0: An Extreme Value Analysis Package in R

    Directory of Open Access Journals (Sweden)

    Eric Gilleland

    2016-08-01

    Full Text Available This article describes the extreme value analysis (EVA R package extRemes version 2.0, which is completely redesigned from previous versions. The functions primarily provide utilities for implementing univariate EVA, with a focus on weather and climate applications, including the incorporation of covariates, as well as some functionality for assessing bivariate tail dependence.

  2. Washing Machine Injuries of the Upper Extremity

    Science.gov (United States)

    Suresh, S S

    2008-01-01

    Washing machines are part of every household and there are various reports of upper extremity injuries due to inadequate safety precautions while operating the machine. Most of the injuries occur when an attempt is made to remove the clothes from the machine and the hand gets caught in the spinning machine. The presentation can vary from minor soft tissue injuries to a mangled upper extremity. The chance of neurovascular damage resulting in compartment syndrome is very high. The author reports three cases of washing machine injuries to draw attention to this not so uncommon injury. The relevant literature is also considered. PMID:21654964

  3. Volkmann's ischemic contracture of the upper extremity.

    Science.gov (United States)

    Botte, M J; Keenan, M A; Gelberman, R H

    1998-08-01

    Upper extremity deformity of ischemic contracture usually includes elbow flexion, forearm pronation, wrist flexion, thumb flexion and adduction, digital metacarpophalangeal joint extension, and interphalangeal joint flexion. Treatment of mild contractures consists of either nonoperative management with a comprehensive rehabilitation program (to increase range of motion and strenght) or operative management consisting of infarct excision or tendon lengthening. Treatment of moderate-to-severe contractures consists of release of secondary nerve compression, treatment of contractures (with tendon lengthening or recession), tendon or free-tissue transfers to restore lost function, and/or salvage procedures for the severely contracted or neglected extremity.

  4. Homotopy of extremal problems theory and applications

    CERN Document Server

    Korovin, Sergey K; Emelyanov, Stanislav V; Bulatov, Alexander V

    2007-01-01

    This monograph provides a thorough treatment of parameter-dependent extremal problems with local minimum values that remain unchanged under changes of the parameter. The authors consider the theory as well the practical treatment of those problems, both in finite-dimensional as well as in infinite-dimensional spaces. Various applications are considered, e.g., variational calculus, control theory and bifurcations theory. Thorough treatment of parameter-dependent extremal problems with local minimum values. Includes many applications, e.g., variational calculus, control theory and bifurcations t

  5. Graph Extremities Defined by Search Algorithms

    Directory of Open Access Journals (Sweden)

    Jean-Paul Bordat

    2010-03-01

    Full Text Available Graph search algorithms have exploited graph extremities, such as the leaves of a tree and the simplicial vertices of a chordal graph. Recently, several well-known graph search algorithms have been collectively expressed as two generic algorithms called MLS and MLSM. In this paper, we investigate the properties of the vertex that is numbered 1 by MLS on a chordal graph and by MLSM on an arbitrary graph. We explain how this vertex is an extremity of the graph. Moreover, we show the remarkable property that the minimal separators included in the neighborhood of this vertex are totally ordered by inclusion.

  6. Properties of Extreme Point Rainfall I

    DEFF Research Database (Denmark)

    Harremoës, Poul; Mikkelsen, Peter Steen

    1995-01-01

    Extreme rainfall has been recorded by the larger municipalities in Denmark since 1933. National intensity-duration-frequency curves were produced on this basis for engineering application in the whole of Denmark. In 1979, on the initiative of The Danish Water Pollution Control Committee under...... The Society of Danish Engineers, the old municipal rain gauges for measuring extreme rain were exchanged with a modern system of gauges tabbed electronically from a central computer at The Danish Meteorological Institute. The data have revealed a geographical variability that calls for revision...

  7. Stochastic Extreme Load Predictions for Marine Structures

    DEFF Research Database (Denmark)

    Jensen, Jørgen Juncher

    1999-01-01

    Development of rational design criteria for marine structures requires reliable estimates for the maximum wave-induced loads the structure may encounter during its operational lifetime. The paper discusses various methods for extreme value predictions taking into account the non-linearity of the ......Development of rational design criteria for marine structures requires reliable estimates for the maximum wave-induced loads the structure may encounter during its operational lifetime. The paper discusses various methods for extreme value predictions taking into account the non...

  8. Elements of extreme wind modeling for hurricanes

    DEFF Research Database (Denmark)

    Larsen, Søren Ejling; Ejsing Jørgensen, Hans; Kelly, Mark C.

    The report summarizes characteristics of the winds associated with Tropical Cyclones (Hurricanes, Typhoons). It has been conducted by the authors across several years, from 2012-2015, to identify the processes and aspects that one should consider when building at useful computer support system...... for evaluation hurricane extreme wind conditions for a given offshore site. It was initiated by a grant from DNV that has as well been represented by one of the authors in this report. Finally, we wish to emphasize the debt of this report to an earlier work at the DTU-Wind Energy Department on “Extreme winds...

  9. Extreme Science (LBNL Science at the Theater)

    Energy Technology Data Exchange (ETDEWEB)

    Ajo-Franklin, Caroline; Klein, Spencer; Minor, Andrew; Torok, Tamas

    2012-02-27

    On Feb. 27, 2012 at the Berkeley Repertory Theatre, four Berkeley Lab scientists presented talks related to extreme science - and what it means to you. Topics include: Neutrino hunting in Antarctica. Learn why Spencer Klein goes to the ends of the Earth to search for these ghostly particles. From Chernobyl to Central Asia, Tamas Torok travels the globe to study microbial diversity in extreme environments. Andrew Minor uses the world's most advanced electron microscopes to explore materials at ultrahigh stresses and in harsh environments. And microbes that talk to computers? Caroline Ajo-Franklin is pioneering cellular-electrical connections that could help transform sunlight into fuel.

  10. Identification of victims in extreme events

    Science.gov (United States)

    Talipova, Yu.; Polukhina, O.

    2009-04-01

    Catastrophic natural disasters including tsunami events are increased the frequency in last years. One of very important problems here is the identification of personality of the victims. Due to difficult identification of the dead bodies lied into water for a long time the analysis of tooth-jaw system is proposed to apply because teeth are extremely stable to the destructive actions of environment. The method of identification of the age, sex and race of victims based on the mathematic model of pattern recognition and collected database is described. Some examples from extreme sea wave events are analyzed.

  11. Quantifying the relationship between extreme air pollution events and extreme weather events

    Science.gov (United States)

    Zhang, Henian; Wang, Yuhang; Park, Tae-Won; Deng, Yi

    2017-05-01

    Extreme weather events can strongly affect surface air quality, which has become a major environmental factor to affect human health. Here, we examined the relationship between extreme ozone and PM2.5 (particular matter with an aerodynamic diameter less than 2.5 μm) events and the representative meteorological parameters such as daily maximum temperature (Tmax), minimum relative humidity (RHmin), and minimum wind speed (Vmin), using the location-specific 95th or 5th percentile threshold derived from historical reanalysis data (30 years for ozone and 10 years for PM2.5). We found that ozone and PM2.5 extremes were decreasing over the years, reflecting EPA's tightened standards and effort on reducing the corresponding precursor's emissions. Annual ozone and PM2.5 extreme days were highly correlated with Tmax and RHmin, especially in the eastern U.S. They were positively (negatively) correlated with Vmin in urban (rural and suburban) stations. The overlapping ratios of ozone extreme days with Tmax were fairly constant, about 32%, and tended to be high in fall and low in winter. Ozone extreme days were most sensitive to Tmax, then RHmin, and least sensitive to Vmin. The majority of ozone extremes occurred when Tmax was between 300 K and 320 K, RHmin was less than 40%, and Vmin was less than 3 m/s. The number of annual extreme PM2.5 days was highly positively correlated with the extreme RHmin/Tmax days, with correlation coefficient between PM2.5/RHmin highest in urban and suburban regions and the correlation coefficient between PM2.5/Tmax highest in rural area. Tmax has more impact on PM2.5 extreme over the eastern U.S. Extreme PM2.5 days were more likely to occur at low RH conditions in the central and southeastern U.S., especially during spring time, and at high RH conditions in the northern U.S. and the Great Plains. Most extreme PM2.5 events occurred when Tmax was between 300 K and 320 K and RHmin was between 10% and 50%. Extreme PM2.5 days usually occurred when

  12. A rare case of the upper extremity diffuse large B-cell lymphoma mimicking soft tissue sarcoma in an elderly patient.

    Science.gov (United States)

    Mamorska-Dyga, Aleksandra; Ronny, Faisal M H; Puccio, Carmelo; Islam, Humayun; Liu, Delong

    2016-01-01

    Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma, with about 30% of new cases presenting with extranodal disease. Lesions originating from soft tissues of the upper extremities are extremely rare and may mimic other malignancies like sarcoma. We present a case of an elderly patient with right upper extremity (RUE) mass which was proven to be DLBCL instead of sarcoma. We emphasize the increasing need for investigating new therapeutic options for patients of extreme age and/or with underlying heart disease.

  13. Rodent models for resolving extremes of exercise and health.

    Science.gov (United States)

    Garton, Fleur C; North, Kathryn N; Koch, Lauren G; Britton, Steven L; Nogales-Gadea, Gisela; Lucia, Alejandro

    2016-02-01

    The extremes of exercise capacity and health are considered a complex interplay between genes and the environment. In general, the study of animal models has proven critical for deep mechanistic exploration that provides guidance for focused and hypothesis-driven discovery in humans. Hypotheses underlying molecular mechanisms of disease and gene/tissue function can be tested in rodents to generate sufficient evidence to resolve and progress our understanding of human biology. Here we provide examples of three alternative uses of rodent models that have been applied successfully to advance knowledge that bridges our understanding of the connection between exercise capacity and health status. First we review the strong association between exercise capacity and all-cause morbidity and mortality in humans through artificial selection on low and high exercise performance in the rat and the consequent generation of the "energy transfer hypothesis." Second we review specific transgenic and knockout mouse models that replicate the human disease condition and performance. This includes human glycogen storage diseases (McArdle and Pompe) and α-actinin-3 deficiency. Together these rodent models provide an overview of the advancements of molecular knowledge required for clinical translation. Continued study of these models in conjunction with human association studies will be critical to resolving the complex gene-environment interplay linking exercise capacity, health, and disease. Copyright © 2016 the American Physiological Society.

  14. Extreme Gleason Upgrading From Biopsy to Radical Prostatectomy: A Population-based Analysis.

    Science.gov (United States)

    Winters, Brian R; Wright, Jonathan L; Holt, Sarah K; Lin, Daniel W; Ellis, William J; Dalkin, Bruce L; Schade, George R

    2016-10-01

    To examine the risk factors associated with the odds of extreme Gleason upgrading at radical prostatectomy (RP) (defined as a Gleason prognostic group score increase of ≥2), we utilized a large, population-based cancer registry. The Surveillance, Epidemiologic, and End Results database was queried (2010-2011) for all patients diagnosed with Gleason 3 + 3 or 3 + 4 on prostate needle biopsy. Available clinicopathologic factors and the odds of upgrading and extreme upgrading at RP were evaluated using multivariate logistic regression. A total of 12,459 patients were identified, with a median age of 61 (interquartile range: 56-65) and a diagnostic prostate-specific antigen (PSA) of 5.5 ng/mL (interquartile range: 4.3-7.5). Upgrading was observed in 34% of men, including 44% of 7402 patients with Gleason 3 + 3 and 19% of 5057 patients with Gleason 3 + 4 disease. Age, clinical stage, diagnostic PSA, and % prostate needle biopsy cores positive were independently associated with odds of any upgrading at RP. In baseline Gleason 3 + 3 disease, extreme upgrading was observed in 6%, with increasing age, diagnostic PSA, and >50% core positivity associated with increased odds. In baseline Gleason 3 + 4 disease, extreme upgrading was observed in 4%, with diagnostic PSA and palpable disease remaining predictive. Positive surgical margins were significantly higher in patients with extreme upgrading at RP (P < .001). Gleason upgrading at RP is common in this large population-based cohort, including extreme upgrading in a clinically significant portion. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Reliability of the mangled extremity severity score in combat-related upper and lower extremity injuries

    Directory of Open Access Journals (Sweden)

    Tolga Ege

    2015-01-01

    Full Text Available Background: Decision of limb salvage or amputation is generally aided with several trauma scoring systems such as the mangled extremity severity score (MESS. However, the reliability of the injury scores in the settling of open fractures due to explosives and missiles is challenging. Mortality and morbidity of the extremity trauma due to firearms are generally associated with time delay in revascularization, injury mechanism, anatomy of the injured site, associated injuries, age and the environmental circumstance. The purpose of the retrospective study was to evaluate the extent of extremity injuries due to ballistic missiles and to detect the reliability of mangled extremity severity score (MESS in both upper and lower extremities. Materials and Methods: Between 2004 and 2014, 139 Gustillo Anderson Type III open fractures of both the upper and lower extremities were enrolled in the study. Data for patient age, fire arm type, transporting time from the field to the hospital (and the method, injury severity scores, MESS scores, fracture types, amputation levels, bone fixation methods and postoperative infections and complications retrieved from the two level-2 trauma center's data base. Sensitivity, specificity, positive and negative predictive values of the MESS were calculated to detect the ability in deciding amputation in the mangled limb. Results: Amputation was performed in 39 extremities and limb salvage attempted in 100 extremities. The mean followup time was 14.6 months (range 6–32 months. In the amputated group, the mean MESS scores for upper and lower extremity were 8.8 (range 6–11 and 9.24 (range 6–11, respectively. In the limb salvage group, the mean MESS scores for upper and lower extremities were 5.29 (range 4–7 and 5.19 (range 3–8, respectively. Sensitivity of MESS in upper and lower extremities were calculated as 80% and 79.4% and positive predictive values detected as 55.55% and 83.3%, respectively. Specificity of MESS

  16. Reliability of the mangled extremity severity score in combat-related upper and lower extremity injuries.

    Science.gov (United States)

    Ege, Tolga; Unlu, Aytekin; Tas, Huseyin; Bek, Dogan; Turkan, Selim; Cetinkaya, Aytac

    2015-01-01

    Decision of limb salvage or amputation is generally aided with several trauma scoring systems such as the mangled extremity severity score (MESS). However, the reliability of the injury scores in the settling of open fractures due to explosives and missiles is challenging. Mortality and morbidity of the extremity trauma due to firearms are generally associated with time delay in revascularization, injury mechanism, anatomy of the injured site, associated injuries, age and the environmental circumstance. The purpose of the retrospective study was to evaluate the extent of extremity injuries due to ballistic missiles and to detect the reliability of mangled extremity severity score (MESS) in both upper and lower extremities. Between 2004 and 2014, 139 Gustillo Anderson Type III open fractures of both the upper and lower extremities were enrolled in the study. Data for patient age, fire arm type, transporting time from the field to the hospital (and the method), injury severity scores, MESS scores, fracture types, amputation levels, bone fixation methods and postoperative infections and complications retrieved from the two level-2 trauma center's data base. Sensitivity, specificity, positive and negative predictive values of the MESS were calculated to detect the ability in deciding amputation in the mangled limb. Amputation was performed in 39 extremities and limb salvage attempted in 100 extremities. The mean followup time was 14.6 months (range 6-32 months). In the amputated group, the mean MESS scores for upper and lower extremity were 8.8 (range 6-11) and 9.24 (range 6-11), respectively. In the limb salvage group, the mean MESS scores for upper and lower extremities were 5.29 (range 4-7) and 5.19 (range 3-8), respectively. Sensitivity of MESS in upper and lower extremities were calculated as 80% and 79.4% and positive predictive values detected as 55.55% and 83.3%, respectively. Specificity of MESS score for upper and lower extremities was 84% and 86.6%; negative

  17. Extremal vectors and rectifiability | Enflo | Quaestiones Mathematicae

    African Journals Online (AJOL)

    The concept of extremal vectors of a linear operator with a dense range but not onto on a Hilbert space was introduced by P. Enflo in 1996 as a new approach to study invariant subspaces. Following this, there were several studies on analytic and geometric properties of backward minimal vectors and their applications to ...

  18. Discretization methods for extremely anisotropic diffusion

    NARCIS (Netherlands)

    B. van Es (Bram); B. Koren (Barry); H.J. de Blank

    2013-01-01

    textabstractIn fusion plasmas there is extreme anisotropy due to the high temperature and large magnetic field strength. This causes diffusive processes, heat diffusion and energy/momentum loss due to viscous friction, to effectively be aligned with the magnetic field lines. This alignment leads

  19. Extremely strict ideals in Banach spaces

    Indian Academy of Sciences (India)

    their fourth dual. Keywords. Extremely strict ideals; spaces of operators; injective tensor products. 2000 Mathematics Subject Classification. Primary: 46B20; Secondary: 47L05,. 46E40. 1. Introduction. Let X be a Banach space. We recall from [5] that a closed subspace Y ⊂ X is said to be an ideal, if there is a linear projection ...

  20. Recent changes in precipitation extremes in Romania

    Directory of Open Access Journals (Sweden)

    Adina-Eliza CROITORU

    2014-11-01

    Full Text Available Changes in daily extreme precipitations have been identified in many studies conducted at local, regional or global scales. In Romania, only little research on this issue has been done so far. The present study is focused on the analysis of the trends in daily extreme precipitations indices over a period of 53 years (1961-2013. Data sets of daily precipitation recorded in 34 weather stations were analyzed. Among them, three are located in the Carpathian Mountains area and four are located on the Black Sea Coast. The main goal was to find changes in extreme daily precipitation using a set of 13 indices adopted from the core indices developed by ETCCDMI with appropriate modifications to suit to the studied area. The series of the indices as well as their trends were generated using RClimDex software. The trends have been calculated using the linear mean square method. The findings are similar to those obtained at the global and European continental scales and the most noteworthy are: increasing trends dominate for the most of the indices, but only about 25% of them are statistically significant at α=0.05; decreasing trends are more specific to southern area of the country; decreasing trends of  R0.1, CDD and CWD dominate for the great majority of locations; the spatial distribution of the significant slopes in the area is extremely irregular.

  1. Isolated macrodactyly or extremely localized Proteus syndrome?

    NARCIS (Netherlands)

    van Bever, Y.; Hennekam, R. C.

    1994-01-01

    We report on a woman with unilateral macrosyndactyly of the second and third toes, a local plantar soft tissue lump, and radiographically an abnormal shape of the phalanges of the affected toes. This finding may represent either an isolated macrosyndactyly or an extremely localised form of Proteus

  2. Atmospheric rivers and extreme precipitation in Norway

    Science.gov (United States)

    Whan, Kirien; Haarsma, Rein; Sillmann, Jana

    2017-04-01

    'Atmospheric rivers' are long, narrow regions of high water vapour content that are responsible for the horizontal transport of moisture to higher latitudes. They are associated with the majority of extreme precipitation events in Norway throughout the observational record. These extreme precipitation events can be associated with flooding that has large impacts on society, such as the October 2014 event in Flåm. We examined changes in extreme precipitation between the current and future climates in the coupled global climate model, EC-EARTH, using high-resolution simulations ( 25 km) that can resolve extratropical storms and atmospheric rivers. We use the r-largest method (r=3) to fit stationary (no covariates) and non-stationary (with an index of atmospheric rivers as a covariate) generalised extreme value distributions to the block maxima of annual precipitation. The value of a regional 'index flood' type approach is explored and future changes in the largest precipitation events of the year that are associated with atmospheric rivers are presented.

  3. Widely tunable extreme ultraviolet frequency comb generation

    NARCIS (Netherlands)

    Pinkert, T. J.; Kandula, D. Z.; Gohle, Ch; Morgenweg, J.; Barmes, I.; Ubachs, W.; Eikema, K. S E

    2011-01-01

    Frequency comb lasers [1] have led to great advances in fields such as precision spectroscopy, optical atomic clocks, and attosecond science. We transfer the remarkable precision of frequency combs to extreme ultraviolet (XUV) wavelengths by parametric amplification and high-harmonic generation

  4. Extreme winds in the Western North Pacific

    DEFF Research Database (Denmark)

    Ott, Søren

    2006-01-01

    A statistical model for extreme winds in the western North Pacific is developed, the region on the Planet where tropical cyclones are most common. The model is based on best track data derived mostly from satellite images of tropical cyclones. The methodsused to estimate surface wind speeds from...

  5. Extreme morphogenesis in the central caucasus mountains

    Science.gov (United States)

    Bulanov, S. A.; Karavaev, V. A.; Seminozhenko, S. S.

    2016-05-01

    The results of field observations on exogenic morphogenesis in the upper reaches of the Cherek Balkarskii River (Kabardino-Balkaria) are presented. It is established that different components of the extreme morphogenetic process confined to the distribution area of unconsolidated Quaternary sediments are closely interrelated to form a peculiar geomorphological mechanism.

  6. Mathematical aspects of extreme water waves

    NARCIS (Netherlands)

    Karjanto, N.

    2006-01-01

    In this thesis we discuss mathematical aspects of extreme water wave generation in a hydrodynamic laboratory. The original problem comes from the Maritime Research Institute Netherlands (MARIN) to generate large amplitude and non-breaking waves to test ship and offshore construction. We choose the

  7. Magnetic Fields inside Extremely Fast Shock Waves

    NARCIS (Netherlands)

    Wiersma, J.

    2007-01-01

    The aim of my research on magnetic fields in extremely fast shock waves has been to predict the properties of shock waves that move almost with the speed of light. These shocks are created in the tenuous interstellar medium by catastrophic events such as the explosion of stars many times

  8. Extreme Networks' 10-Gigabit Ethernet enables

    CERN Multimedia

    2002-01-01

    " Extreme Networks, Inc.'s 10-Gigabit switching platform enabled researchers to transfer one Terabyte of information from Vancouver to Geneva across a single network hop, the world's first large-scale, end-to-end transfer of its kind" (1/2 page).

  9. Dependency in Hydrological Extreme Value Analysis.

    OpenAIRE

    Boniphace, Edwin

    2012-01-01

    Contents Dedication i Acknowledgments iii Contents v List of Figures vii 1 Introduction 1 1.1 Extreme value theory . . . . . . . . . . . . . . . . . . . . . . . . 1 1.2 Sum plots . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1.3 Quantile-quantile plots . . . . . . . . . . . . . . . . . . . . . . . 5 1.4 Impact of dependence in data on qq-plots . . . . . . . . . . . . 6 1.5 Scope of this thesis . . . . . . . . . . . . . . . . . . . . . . . . . 10 ...

  10. CFRP lightweight structures for extremely large telescopes

    DEFF Research Database (Denmark)

    Jessen, Niels Christian; Nørgaard-Nielsen, Hans Ulrik; Schroll, J.

    2008-01-01

    Telescope structures are traditionally built out of steel. To improve the possibility of realizing the ambitious extremely large telescopes, materials with a higher specific stiffness and a lower coefficient of thermal expansion are needed. An important possibility is Carbon Fibre Reinforced Plas...... Plastic (CFRP). The advantages of using CFRP for the secondary mirror support structure of the European overwhelmingly large telescope are discussed....

  11. How Vulnerable Is Nigeria to Islam Extremism?

    Science.gov (United States)

    2011-06-01

    significantly transforming 1 “Countering Radicalization Through Development Assistance – A Country...Abuja, Nigeria, Monday, June 14, 2004). 4 Schwartz, “Is Nigeria a Hotbed of Extremism?” 3. 5. Siri Aas Rustad, “Power-sharing Agreements...Radicalization Through Development Assistance – A Country Assessment Tool” (Copenhagen: Ministry of Foreign Affairs of Denmark, 2007), 16. 88. Ibid., 10

  12. "Extreme Programming" in a Bioinformatics Class

    Science.gov (United States)

    Kelley, Scott; Alger, Christianna; Deutschman, Douglas

    2009-01-01

    The importance of Bioinformatics tools and methodology in modern biological research underscores the need for robust and effective courses at the college level. This paper describes such a course designed on the principles of cooperative learning based on a computer software industry production model called "Extreme Programming" (EP).…

  13. Rotational deformities in the lower extremities.

    Science.gov (United States)

    Karol, L A

    1997-02-01

    Rotational abnormalities of the lower extremities remain a significant complaint among parents of pediatric patients. Intoeing can result from metatarsus adductus, internal tibial torsion, or femoral anteversion. Rarely is orthopedic treatment necessary. Current recommendations regarding the treatment of intoeing are given.

  14. Promoting Online Voices for Countering Violent Extremism

    Science.gov (United States)

    2013-01-01

    exposure ; posts are publicized via a Facebook page that has more...seen as an antidote to Islamic extremism, they also help counter anti-Muslim intolerance among other religious groups.91 Finally, while the U.S. needs... television and the silver screen to serve as important vectors.99 These artists can play a critical role in the counterradicalization debate both

  15. CASE REPORTS- Extremity haemangiopericytoma, a case report ...

    African Journals Online (AJOL)

    Haemangiopericytoma is an uncommon soft tissue sarcoma of vascular origin. It occurs more frequently in the extremities than elsewhere in the body although it can arise in any organ. Wide surgical excision is the mainstay of treatment. However, adjuvant radiotherapy and chemotherapy are desirable because the ...

  16. Doppler sonographic evaluation of venogenic extremity swellings ...

    African Journals Online (AJOL)

    Doppler ultrasound is very useful in the evaluation of extremity DVT. All clinically suspected cases should be evaluated with this modality due to limited sensitivity of clinical evaluation in the diagnosis of DVT. Further correlative studies in comparison to venography and hematologic indices are also recommended.

  17. "Extreme Bold" in the Faculty Ranks

    Science.gov (United States)

    Kuusisto, Stephen

    2013-01-01

    Boldness, defense, and the necessity of talking back remain as central to life with disability in one's time as in Francis Bacon's age. "Therefore all deformed persons are extreme bold," Bacon wrote, "first, as in their own defence, as being exposed to scorn, but in process of time, by a general habit." Perhaps no word carries…

  18. Extremal black holes in N=2 supergravity

    NARCIS (Netherlands)

    Katmadas, S.

    2011-01-01

    An explanation for the entropy of black holes has been an outstanding problem in recent decades. A special case where this is possible is that of extremal black holes in N=2 supergravity in four and five dimensions. The best developed case is for black holes preserving some supersymmetry (BPS),

  19. Botulinum toxin treatment of lower extremity spasticity

    Directory of Open Access Journals (Sweden)

    S. E. Khat’kova

    2017-01-01

    Full Text Available The article reviews the current concept of lower extremity spasticity, which is a frequent disabling consequence of stroke. Gait biomechanics, step cycle and main pathologic patterns of lower extremity are described (hip adduction, knee flexion, knee extension, foot plantar flexion, equinovarus foot position, toes flexion, hallux extension, including muscles involved in the pathological process. Additionally the article contains detailed information on pathologic principles of lower extremity spasticity development. Special focus is given to sarcomeregenesis as an essential element of the development of potential conditions for muscle tissue adaptation to a new state and restoration of muscle length and strength. At present Botulinum toxin A (BTA is used in a complex spasticity management programs. The results of clinical studies performed in the last decade supporting the efficacy of Botox® (Onabotulinumtoxin A in the treatment of spasticity are reviewed. Effective BTA doses are proposed. Authors came to the conclusion that BTA as a part of complex rehabilitation in patients with poststroke spasticity of lower extremity promotes treatment efficacy due to a decrease of muscle tone and increase of range of movements in the joints. BTA should be regarded as an essential part of standard rehabilitation programs. Further studies to define optimal muscles for intervention, BTA doses and rehabilitation schemes are still needed. 

  20. Extreme wave and wind response predictions

    DEFF Research Database (Denmark)

    Jensen, Jørgen Juncher; Olsen, Anders S.; Mansour, Alaa E.

    2011-01-01

    The aim of the paper is to advocate effective stochastic procedures, based on the First Order Reliability Method (FORM) and Monte Carlo simulations (MCS), for extreme value predictions related to wave and wind-induced loads.Due to the efficient optimization procedures implemented in standard FORM...

  1. QCD under extreme conditions: an informal discussion

    CERN Document Server

    Fraga, E.S.

    2015-05-22

    We present an informal discussion of some aspects of strong interactions un- der extreme conditions of temperature and density at an elementary level. This summarizes lectures delivered at the 2013 and 2015 CERN – Latin-American Schools of High-Energy Physics and is aimed at students working in experi- mental high-energy physics.

  2. Isolation and characterization of extreme halophilic archaea

    Energy Technology Data Exchange (ETDEWEB)

    Franze, Madlen; Cherkouk, Andrea [Helmholtz-Zentrum Dresden-Rossendorf e.V., Dresden (Germany). HZDR Young Investigator Group

    2017-06-01

    Extreme halophilic archaea from the family Halobactereacea represent a dominant part of the microbial community present in saline soils as well as rock salts. By using a culture-dependent approach different Haloarchaea could be isolated and were phylogenetic analysed. Interestingly, isolates closely related to different Halobacterium spp. were found in both environments.

  3. Computational Failure Modeling of Lower Extremities

    Science.gov (United States)

    2012-01-01

    State University, 2010. RTO-HFM-207 25- 17 Computational Failure Modeling of Lower Extremities [28] Kleb, B., “nato-rto—A LATEX Class and BIBTEX Style ...BIOMEDICAL SCIENCES A HEPPER D POPE RM 1A BLDG 245 PORTON DOWN SALISBURY WILTSHIRE SP4 OJQ UNITED KINGDOM 4 DRDC VALCARTIER

  4. Extreme Magnitude Earthquakes and their Economical Consequences

    Science.gov (United States)

    Chavez, M.; Cabrera, E.; Ashworth, M.; Perea, N.; Emerson, D.; Salazar, A.; Moulinec, C.

    2011-12-01

    The frequency of occurrence of extreme magnitude earthquakes varies from tens to thousands of years, depending on the considered seismotectonic region of the world. However, the human and economic losses when their hypocenters are located in the neighborhood of heavily populated and/or industrialized regions, can be very large, as recently observed for the 1985 Mw 8.01 Michoacan, Mexico and the 2011 Mw 9 Tohoku, Japan, earthquakes. Herewith, a methodology is proposed in order to estimate the probability of exceedance of: the intensities of extreme magnitude earthquakes, PEI and of their direct economical consequences PEDEC. The PEI are obtained by using supercomputing facilities to generate samples of the 3D propagation of extreme earthquake plausible scenarios, and enlarge those samples by Monte Carlo simulation. The PEDEC are computed by using appropriate vulnerability functions combined with the scenario intensity samples, and Monte Carlo simulation. An example of the application of the methodology due to the potential occurrence of extreme Mw 8.5 subduction earthquakes on Mexico City is presented.

  5. To the limit of extreme malnutrition

    DEFF Research Database (Denmark)

    Frølich, Jacob; Buskbjerg, Camilla Viola; Støving, Rene K

    2016-01-01

    Extreme malnutrition with body mass index (BMI) as low as 10 kg/m(2) is not uncommon in anorexia nervosa, with survival enabled through complex metabolic adaptations. In contrast, outcomes from hunger strikes and famines are usually fatal after weight loss to about 40% below expected body weight...... malnutrition has not previously been reported. The present case emphasizes the importance of adherence...

  6. Modeling Hydrological Extremes in the Anthropocene

    Science.gov (United States)

    Di Baldassarre, Giuliano; Martinez, Fabian; Kalantari, Zahra; Viglione, Alberto

    2017-04-01

    Hydrological studies have investigated human impacts on hydrological extremes, i.e. droughts and floods, while social studies have explored human responses and adaptation to them. Yet, there is still little understanding about the dynamics resulting from two-way feedbacks, i.e. both impacts and responses. Traditional risk assessment methods therefore fail to assess future dynamics, and thus risk reduction strategies built on these methods can lead to unintended consequences in the medium-long term. Here we review the dynamics resulting from the reciprocal links between society and hydrological extremes, and describe initial efforts to model floods and droughts in the Anthropocene. In particular, we first discuss the need for a novel approach to explicitly account for human interactions with both hydrological extremes, and then present a stylized model simulating the reciprocal effects between droughts, foods and reservoir operation rules. Unprecedented opportunities offered by the growing availability of global data and worldwide archives to uncover the mutual shaping of hydrological extremes and society across places and scales are also discussed.

  7. Deficiently extremal Cohen–Macaulay algebras

    Indian Academy of Sciences (India)

    /I has a p-linear resolution, its Betti numbers can be specified by Herzog and Kühl formulae. By manipulating the techniques of Herzog and Kühl, one can obtain some specific bounds for graded Betti numbers of nearly extremal CM algebras.

  8. Extreme swimming: The oceanic migrations of anguillids

    DEFF Research Database (Denmark)

    Righton, David; Aarestrup, Kim; Jellyman, Don

    2013-01-01

    to their natal habitat to spawn. In temperate species, the migrations are extreme, requiring larvae and adults to swim thousands of km before reaching their destination, but the migrations of tropical species (hundreds of km) are still remarkable in comparison with many other fish species. To achieve...

  9. Pathophysiology of upper extremity muscle disorders

    NARCIS (Netherlands)

    Visser, B.; van Dieen, J.H.

    2006-01-01

    A review of the literature on the pathophysiology of upper extremity muscle disorders (UEMDs) was performed. An overview is given of clinical findings and hypotheses on the pathogenesis of UEMDs. The literature indicates that disorders of muscle cells and limitations of the local circulation

  10. Quantitative release planning in extreme programming

    NARCIS (Netherlands)

    van Valkenhoef, Gert; Tervonen, Tommi; de Brock, Bert; Postmus, Douwe

    2011-01-01

    Context: Extreme Programming (XP) is one of the most popular agile software development methodologies. XP is defined as a consistent set of values and practices designed to work well together, but lacks practices for project management and especially for supporting the customer role. The customer

  11. Extreme Geomagnetic Storms – 1868–2010

    DEFF Research Database (Denmark)

    Vennerstrøm, Susanne; Lefèvre, L.; Dumbović, M.

    2016-01-01

    We present the first large statistical study of extreme geomagnetic storms basedon historical data from the time period 1868 – 2010. This article is the first of two companionpapers. Here we describe how the storms were selected and focus on their near-Earth characteristics.The second article...

  12. Extremely rare borderline phyllodes tumor in the male breast: a case report.

    Science.gov (United States)

    Kim, Jung Gyu; Kim, Shin Young; Jung, Hae Yoen; Lee, Deuk Young; Lee, Jong Eun

    2015-01-01

    Phyllodes tumor of the male breast is an extremely rare disease, and far fewer cases of borderline phyllodes tumors than benign or malignant tumors in the male breast have been reported. We report a case of borderline phyllodes tumor in the male breast with imaging findings of the tumor and pathologic correlation. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Prediction and monitoring upper-extremity motor recovery after severe stroke : clinical and neurophysiological studies

    NARCIS (Netherlands)

    Kuijk, Annemarie Albertha van

    2008-01-01

    Stroke is an important disease in Western Society with an estimated incidence of 30.000 patients/year in the Netherlands. In approximately 70 to 80% of the stroke survivors upper-extremity motor function is impaired and in almost one third of these patients motor impairments are severe. Among those

  14. Bilateral macrodystrophia lipomatosa of the upper extremities with syndactyly and multiple lipomas

    NARCIS (Netherlands)

    van der Meer, Saskia; Nicolai, Jean-Philippe A.; Schut, Simone M.; Meek, Marcel F.

    2011-01-01

    Macrodystrophia lipomatosa is a rare disease that causes congenital local gigantism of part of an extremity, which is characterised by an increase in all mesenchymal elements, particularly fibroadipose tissue. This is the first report to our knowledge of a case of histologically confirmed bilateral

  15. Models and Inference for Multivariate Spatial Extremes

    KAUST Repository

    Vettori, Sabrina

    2017-12-07

    The development of flexible and interpretable statistical methods is necessary in order to provide appropriate risk assessment measures for extreme events and natural disasters. In this thesis, we address this challenge by contributing to the developing research field of Extreme-Value Theory. We initially study the performance of existing parametric and non-parametric estimators of extremal dependence for multivariate maxima. As the dimensionality increases, non-parametric estimators are more flexible than parametric methods but present some loss in efficiency that we quantify under various scenarios. We introduce a statistical tool which imposes the required shape constraints on non-parametric estimators in high dimensions, significantly improving their performance. Furthermore, by embedding the tree-based max-stable nested logistic distribution in the Bayesian framework, we develop a statistical algorithm that identifies the most likely tree structures representing the data\\'s extremal dependence using the reversible jump Monte Carlo Markov Chain method. A mixture of these trees is then used for uncertainty assessment in prediction through Bayesian model averaging. The computational complexity of full likelihood inference is significantly decreased by deriving a recursive formula for the nested logistic model likelihood. The algorithm performance is verified through simulation experiments which also compare different likelihood procedures. Finally, we extend the nested logistic representation to the spatial framework in order to jointly model multivariate variables collected across a spatial region. This situation emerges often in environmental applications but is not often considered in the current literature. Simulation experiments show that the new class of multivariate max-stable processes is able to detect both the cross and inner spatial dependence of a number of extreme variables at a relatively low computational cost, thanks to its Bayesian hierarchical

  16. Clinical application of lower extremity CTA and lower extremity perfusion CT as a method of diagnostic for lower extremity atherosclerotic obliterans

    Energy Technology Data Exchange (ETDEWEB)

    Moon, Il Bong; Dong, Kyung Rae [Dept. Radiological Technology, Gwangju Health University, Gwangju (Korea, Republic of); Goo, Eun Hoe [Dept. Radiological Science, Cheongju University, Cheongju (Korea, Republic of)

    2016-11-15

    The purpose of this study was to assess clinical application of lower extremity CTA and lower extremity perfusion CT as a method of diagnostic for lower extremity atherosclerotic obliterans. From January to July 2016, 30 patients (mean age, 68) were studied with lower extremity CTA and lower extremity perfusion CT. 128 channel multi-detector row CT scans were acquired with a CT scanner (SOMATOM Definition Flash, Siemens medical solution, Germany) of lower extremity perfusion CT and lower extremity CTA. Acquired images were reconstructed with 3D workstation (Leonardo, Siemens, Germany). Site of lower extremity arterial occlusive and stenosis lesions were detected superficial femoral artery 36.6%, popliteal artery 23.4%, external iliac artery 16.7%, common femoral artery 13.3%, peroneal artery 10%. The mean total DLP comparison of lower extremity perfusion CT and lower extremity CTA, 650 mGy-cm and 675 mGy-cm, respectively. Lower extremity perfusion CT and lower extremity CTA were realized that were never be two examination that were exactly the same legions. Future through the development of lower extremity perfusion CT soft ware programs suggest possible clinical applications.

  17. Wind simulation for extreme and fatigue loads

    Energy Technology Data Exchange (ETDEWEB)

    Nielsen, M.; Larsen, G.C.; Mann, J.; Ott, S.; Hansen, K.S.; Pedersen, B.J.

    2004-01-01

    Measurements of atmospheric turbulence have been studied and found to deviate from a Gaussian process, in particular regarding the velocity increments over small time steps, where the tails of the pdf are exponential rather than Gaussian. Principles for extreme event counting and the occurrence of cascading events are presented. Empirical extreme statistics agree with Rices exceedence theory, when it is assumed that the velocity and its time derivative are independent. Prediction based on the assumption that the velocity is a Gaussian process underpredicts the rate of occurrence of extreme events by many orders of magnitude, mainly because the measured pdf is non-Gaussian. Methods for simulation of turbulent signals have been developed and their computational efficiency are considered. The methods are applicable for multiple processes with individual spectra and probability distributions. Non-Gaussian processes are simulated by the correlation-distortion method. Non-stationary processes are obtained by Bezier interpolation between a set of stationary simulations with identical random seeds. Simulation of systems with some signals available is enabled by conditional statistics. A versatile method for simulation of extreme events has been developed. This will generate gusts, velocity jumps, extreme velocity shears, and sudden changes of wind direction. Gusts may be prescribed with a specified ensemble average shape, and it is possible to detect the critical gust shape for a given construction. The problem is formulated as the variational problem of finding the most probable adjustment of a standard simulation of a stationary Gaussian process subject to relevant event conditions, which are formulated as linear combination of points in the realization. The method is generalized for multiple correlated series, multiple simultaneous conditions, and 3D fields of all velocity components. Generalization are presented for a single non-Gaussian process subject to relatively

  18. Historical influence of irrigation on climate extremes

    Science.gov (United States)

    Thiery, Wim; Davin, Edouard L.; Lawrence, Dave; Hauser, Mathias; Seneviratne, Sonia I.

    2016-04-01

    Land irrigation is an essential practice sustaining global food production and many regional economies. During the last decades, irrigation amounts have been growing rapidly. Emerging scientific evidence indicates that land irrigation substantially affects mean climate conditions in different regions of the world. However, a thorough understanding of the impact of irrigation on extreme climatic conditions, such as heat waves, droughts or intense precipitation, is currently still lacking. In this context, we aim to assess the historical influence of irrigation on the occurrence of climate extremes. To this end, two simulations are conducted over the period 1910-2010 with a state-of-the-art global climate model (the Community Earth System Model, CESM): a control simulation including all major anthropogenic and natural external forcings except for irrigation and a second experiment with transient irrigation enabled. The two simulations are evaluated for their ability to represent (i) hot, dry and wet extremes using the HadEX2 and ERA-Interim datasets as a reference, and (ii) latent heat fluxes using LandFlux-EVAL. Assuming a linear combination of climatic responses to different forcings, the difference between both experiments approximates the influence of irrigation. We will analyse the impact of irrigation on a number of climate indices reflecting the intensity and duration of heat waves. Thereby, particular attention is given to the role of soil moisture changes in modulating climate extremes. Furthermore, the contribution of individual biogeophysical processes to the total impact of irrigation on hot extremes is quantified by application of a surface energy balance decomposition technique to the 90th and 99th percentile surface temperature changes.

  19. Multifractal Conceptualisation of Hydro-Meteorological Extremes

    Science.gov (United States)

    Tchiguirinskaia, I.; Schertzer, D.; Lovejoy, S.

    2009-04-01

    Hydrology and more generally sciences involved in water resources management, technological or operational developments face a fundamental difficulty: the extreme variability of hydro-meteorological fields. It clearly appears today that this variability is a function of the observation scale and yield hydro-meteorological hazards. Throughout the world, the development of multifractal theory offers new techniques for handling such non-classical variability over wide ranges of time and space scales. The resulting stochastic simulations with a very limited number of parameters well reproduce the long range dependencies and the clustering of rainfall extremes often yielding fat tailed (i.e., an algebraic type) probability distributions. The goal of this work was to investigate the ability of using very short or incomplete data records for reliable statistical predictions of the extremes. In particular we discuss how to evaluate the uncertainty in the empirical or semi-analytical multifractal outcomes. We consider three main aspects of the evaluation, such as the scaling adequacy, the multifractal parameter estimation error and the quantile estimation error. We first use the multiplicative cascade model to generate long series of multifractal data. The simulated samples had to cover the range of the universal multifractal parameters widely available in the scientific literature for the rainfall and river discharges. Using these long multifractal series and their sub-samples, we defined a metric for parameter estimation error. Then using the sets of estimated parameters, we obtained the quantile values for a range of excedance probabilities from 5% to 0.01%. Plotting the error bars on a quantile plot enable an approximation of confidence intervals that would be particularly important for the predictions of multifractal extremes. We finally illustrate the efficiency of such concept on its application to a large database (more than 16000 selected stations over USA and

  20. Uncertainty in determining extreme precipitation thresholds

    Science.gov (United States)

    Liu, Bingjun; Chen, Junfan; Chen, Xiaohong; Lian, Yanqing; Wu, Lili

    2013-10-01

    Extreme precipitation events are rare and occur mostly on a relatively small and local scale, which makes it difficult to set the thresholds for extreme precipitations in a large basin. Based on the long term daily precipitation data from 62 observation stations in the Pearl River Basin, this study has assessed the applicability of the non-parametric, parametric, and the detrended fluctuation analysis (DFA) methods in determining extreme precipitation threshold (EPT) and the certainty to EPTs from each method. Analyses from this study show the non-parametric absolute critical value method is easy to use, but unable to reflect the difference of spatial rainfall distribution. The non-parametric percentile method can account for the spatial distribution feature of precipitation, but the problem with this method is that the threshold value is sensitive to the size of rainfall data series and is subjected to the selection of a percentile thus make it difficult to determine reasonable threshold values for a large basin. The parametric method can provide the most apt description of extreme precipitations by fitting extreme precipitation distributions with probability distribution functions; however, selections of probability distribution functions, the goodness-of-fit tests, and the size of the rainfall data series can greatly affect the fitting accuracy. In contrast to the non-parametric and the parametric methods which are unable to provide information for EPTs with certainty, the DFA method although involving complicated computational processes has proven to be the most appropriate method that is able to provide a unique set of EPTs for a large basin with uneven spatio-temporal precipitation distribution. The consistency between the spatial distribution of DFA-based thresholds with the annual average precipitation, the coefficient of variation (CV), and the coefficient of skewness (CS) for the daily precipitation further proves that EPTs determined by the DFA method

  1. The Extreme Climate Index: a novel and multi-hazard index for extreme weather events.

    Science.gov (United States)

    Cucchi, Marco; Petitta, Marcello; Calmanti, Sandro

    2017-04-01

    In this presentation we introduce the Extreme Climate Index (ECI): an objective, multi-hazard index capable of tracking changes in the frequency or magnitude of extreme weather events in African countries, thus indicating that a shift to a new climate regime is underway in a particular area. This index has been developed in the context of XCF (eXtreme Climate Facilities) project lead by ARC (African Risk Capacity, specialised agency of the African Union), and will be used in the payouts triggering mechanism of an insurance programme against risks related to the increase of frequency and magnitude of extreme weather events due to climate regimes' changes. The main hazards covered by ECI will be extreme dry, wet and heat events, with the possibility of adding region-specific risk events such as tropical cyclones for the most vulnerable areas. It will be based on data coming from consistent, sufficiently long, high quality historical records and will be standardized across broad geographical regions, so that extreme events occurring under different climatic regimes in Africa can be comparable. The first step to construct such an index is to define single hazard indicators. In this first study we focused on extreme dry/wet and heat events, using for their description respectively the well-known SPI (Standardized Precipitation Index) and an index developed by us, called SHI (Standardized Heat-waves Index). The second step consists in the development of a computational strategy to combine these, and possibly other indices, so that the ECI can describe, by means of a single indicator, different types of climatic extremes. According to the methodology proposed in this paper, the ECI is defined by two statistical components: the ECI intensity, which indicates whether an event is extreme or not; the angular component, which represent the contribution of each hazard to the overall intensity of the index. The ECI can thus be used to identify "extremes" after defining a

  2. A new index quantifying the precipitation extremes

    Science.gov (United States)

    Busuioc, Aristita; Baciu, Madalina; Stoica, Cerasela

    2015-04-01

    Events of extreme precipitation have a great impact on society. They are associated with flooding, erosion and landslides.Various indices have been proposed to quantify these extreme events and they are mainly related to daily precipitation amount, which are usually available for long periods in many places over the world. The climate signal related to changes in the characteristics of precipitation extremes is different over various regions and it is dependent on the season and the index used to quantify the precipitation extremes. The climate model simulations and empirical evidence suggest that warmer climates, due to increased water vapour, lead to more intense precipitation events, even when the total annual precipitation is slightly reduced. It was suggested that there is a shift in the nature of precipitation events towards more intense and less frequent rains and increases in heavy rains are expected to occur in most places, even when the mean precipitation is not increasing. This conclusion was also proved for the Romanian territory in a recent study, showing a significant increasing trend of the rain shower frequency in the warm season over the entire country, despite no significant changes in the seasonal amount and the daily extremes. The shower events counted in that paper refer to all convective rains, including torrential ones giving high rainfall amount in very short time. The problem is to find an appropriate index to quantify such events in terms of their highest intensity in order to extract the maximum climate signal. In the present paper, a new index is proposed to quantify the maximum precipitation intensity in an extreme precipitation event, which could be directly related to the torrential rain intensity. This index is tested at nine Romanian stations (representing various physical-geographical conditions) and it is based on the continuous rainfall records derived from the graphical registrations (pluviograms) available at National

  3. Extreme-Dipper Profile, Increased Aortic Stiffness, and Impaired Subendocardial Viability in Hypertension.

    Science.gov (United States)

    Amah, Guy; Ouardani, Rahma; Pasteur-Rousseau, Adrien; Voicu, Sebastian; Safar, Michel E; Kubis, Nathalie; Bonnin, Philippe

    2017-04-01

    In treated hypertensives, extreme-dippers with stable coronary artery disease (CAD) exhibit more severe nighttime cardiac ischemia than dippers. After excluding confounding factors such as diabetes, CAD or chronic kidney disease (CKD), we assessed whether subendocardial viability, determined by the Buckberg index, was more significantly impaired in extreme-dippers than in dippers. Two hundred thirteen consecutive treated hypertensives (156 dippers, 57 extreme-dippers), were included. After 24-hour ambulatory blood pressure (BP) monitoring, patients underwent radial applanation tonometry (with determination of: subendocardial viability ratio [SEVR], central augmentation index [AIx], and pulse pressure amplification [PPamp]), carotid-femoral pulse wave velocity (cfPWV) measurement, and cycle ergometer stress testing. Extreme-dippers showed higher cfPWV (8.99 ± 2.16 vs. 8.29 ± 1.69 m/s, P = 0.014), higher AIx (29.7 ± 9.4 vs. 26.4 ± 10.4%, P = 0.042), lower PPamp (1.22 ± 0.14 vs. 1.30 ± 0.15, P subendocardial viability compared to dippers. Extreme-dipper hypertensive patients, women in particular, may have a significantly higher risk of silent myocardial ischemia, thus justifying systematic screening.

  4. Stable and extreme resistance to common scab of potato obtained through somatic cell selection.

    Science.gov (United States)

    Wilson, Calum R; Tegg, Robert S; Wilson, Annabel J; Luckman, Gregory A; Eyles, Alieta; Yuan, Zi Qing; Hingston, Leon H; Conner, Anthony J

    2010-05-01

    Somatic cell selection with thaxtomin A as a positive selection agent was used to isolate variants of potato cv. Russet Burbank with strong to extreme resistance to common scab. Glasshouse and field trials identified 51 variants with significantly reduced disease incidence (frequency of infected tubers) and severity (tuber lesion coverage) compared with the parent cultivar. The most promising variants exhibited extreme disease resistance, rarely showing lesions, which were invariably superficial and shallower than those on the parent. Resistance traits were consistently expressed both in 10 glasshouse and two field trials at different locations, with varied inoculum and disease pressure. Disease-resistant variants differed in their response to thaxtomin A in tuber slice bioassays. Of 23 variants tested, 10 showed reduced thaxtomin A susceptibility, with the remaining 13 responding similar to that of the parent. Thus, toxin tolerance was not the only factor responsible for observed disease resistance; however, four of the five most disease-resistant variants had enhanced thaxtomin A tolerance, suggesting that this factor is important in the expression of strong disease resistance. Pathogenicity and toxin tolerance remained stable over a 6-year period, demonstrating that selected phenotypes were robust and genetic changes stable. The majority of disease-resistant variants had tuber yields equivalent to the parent cultivar in glasshouse trials. This suggests that selection for disease resistance was not associated with negative tuber attributes and that certain variants may have commercial merit, worthy of further agronomic testing.

  5. Radiographic characteristics of lower-extremity bowing in children.

    Science.gov (United States)

    Cheema, Jugesh I; Grissom, Leslie E; Harcke, H Theodore

    2003-01-01

    Lower-extremity bowing is common in infants and children and can result from a variety of conditions. At radiography, developmental bowing shows varus angulation centered at the knee, "metaphyseal beaking," thickening of the medial tibial cortices, and tilted ankle joints. Tibia vara (Blount disease) demonstrates genu varum and depression of the proximal tibia medially. Congenital bowing manifests as posteromedial bowing with cortical thickening along the concavity of the curvature and, in some cases, diaphyseal broadening. In rickets, radiographic changes occur primarily at sites of rapid growth and are predominantly metaphyseal, with widening of the zone of provisional calcification. Achondroplasia is characterized by shortening and thickening of the long bones with metaphyseal flaring and cupping. In neurofibromatosis, there may be anterolateral bowing of the tibia, and there is often focal narrowing and intramedullary sclerosis or cystic change at the apex of the angulation. The tibia is typically involved at the junction of the middle and distal thirds. Osteogenesis imperfecta demonstrates bowing from softening due to osteoporosis and multiple fractures and typically involves the entire skeleton. In camptomelic dysplasia, lower-extremity bowing is associated with a short trunk, short limbs, and deficiencies in pelvic bone development. Recognition of these pathologic conditions is important for differentiating those that will resolve spontaneously from those that require surgery or other treatment. Copyright RSNA, 2003

  6. Extreme Hypofractionated Image-Guided Radiotherapy for Prostate Cancer

    Directory of Open Access Journals (Sweden)

    Carlo Greco

    2013-09-01

    Full Text Available An emerging body of data suggests that hypofractionated radiation schedules, where a higher dose per fraction is delivered in a smaller number of sessions, may be superior to conventional fractionation schemes in terms of both tumour control and toxicity profile in the management of adenocarcinoma of the prostate. However, the optimal hypofractionation scheme is still the subject of scientific debate. Modern computer-driven technology enables the safe implementation of extreme hypo fractionation (often referred to as stereotactic body radiation therapy [SBRT]. Several studies are currently being conducted to clarify the yet unresolved issues regarding treatment techniques and fractionation regimens. Recently, the American Society for Radiation Oncology (ASTRO issued a model policy indicating that data supporting the use of SBRT for prostate cancer have matured to a point where SBRT could be considered an appropriate alternative for select patients with low-to-intermediate risk disease. The present article reviews some of the currently available data and examines the impact of tracking technology to mitigate intra-fraction target motion, thus, potentially further improving the clinical outcomes of extreme hypofractionated radiation therapy in appropriately selected prostate cancer patients. The Champalimaud Centre for the Unknown (CCU’s currently ongoing Phase I feasibility study is described; it delivers 45 Gy in five fractions using prostate fixation via a rectal balloon, and urethral sparing via catheter placement with on-line intra-fractional motion tracking through beacon transponder technology.

  7. Early warnings of extreme winds using the ECMWF Extreme Forecast Index

    DEFF Research Database (Denmark)

    Petroliagis, Thomas I.; Pinson, Pierre

    2014-01-01

    The European FP7 SafeWind Project aims at developing research towards a European vision of wind power forecasting, which requires advanced meteorological support concerning extreme wind events. This study is focused mainly on early warnings of extreme winds in the early medium-range. Three synoptic...... regimes. Overall, it becomes clear that the first indications of an extreme wind event might come from the ECMWF deterministic and/or probabilistic components capturing very intense weather systems (possible windstorms) in the medium term. For early warnings, all available EPS Extreme Forecast Index (EFI......) formulations were used, by linking daily maximum wind speeds to EFI values for different forecast horizons. From all possible EFI schemes deployed for issuing early warnings, the highest skill was found for the Gust Factor formulation (EFI-10FGI). Using EFI-10FGI, the corresponding 99% threshold could provide...

  8. Probabilistic forecasting of extreme weather events based on extreme value theory

    Science.gov (United States)

    Van De Vyver, Hans; Van Schaeybroeck, Bert

    2016-04-01

    Extreme events in weather and climate such as high wind gusts, heavy precipitation or extreme temperatures are commonly associated with high impacts on both environment and society. Forecasting extreme weather events is difficult, and very high-resolution models are needed to describe explicitly extreme weather phenomena. A prediction system for such events should therefore preferably be probabilistic in nature. Probabilistic forecasts and state estimations are nowadays common in the numerical weather prediction community. In this work, we develop a new probabilistic framework based on extreme value theory that aims to provide early warnings up to several days in advance. We consider the combined events when an observation variable Y (for instance wind speed) exceeds a high threshold y and its corresponding deterministic forecasts X also exceeds a high forecast threshold y. More specifically two problems are addressed:} We consider pairs (X,Y) of extreme events where X represents a deterministic forecast, and Y the observation variable (for instance wind speed). More specifically two problems are addressed: Given a high forecast X=x_0, what is the probability that Y>y? In other words: provide inference on the conditional probability: [ Pr{Y>y|X=x_0}. ] Given a probabilistic model for Problem 1, what is the impact on the verification analysis of extreme events. These problems can be solved with bivariate extremes (Coles, 2001), and the verification analysis in (Ferro, 2007). We apply the Ramos and Ledford (2009) parametric model for bivariate tail estimation of the pair (X,Y). The model accommodates different types of extremal dependence and asymmetry within a parsimonious representation. Results are presented using the ensemble reforecast system of the European Centre of Weather Forecasts (Hagedorn, 2008). Coles, S. (2001) An Introduction to Statistical modelling of Extreme Values. Springer-Verlag.Ferro, C.A.T. (2007) A probability model for verifying deterministic

  9. Kindergarten classroom functioning of extremely preterm/extremely low birth weight children.

    Science.gov (United States)

    Wong, Taylor; Taylor, H Gerry; Klein, Nancy; Espy, Kimberly A; Anselmo, Marcia G; Minich, Nori; Hack, Maureen

    2014-12-01

    Cognitive, behavioral, and learning problems are evident in extremely preterm/extremely low birth weight (EPT/ELBW, learning progress, and classroom characteristics. EPT/ELBW children require more teacher support and are less able to engage in instructional activities than their NBW classmates. Associations of classroom functioning with developmental history and cognitive and behavioral traits suggest that these factors may be useful in identifying the children most in need of special educational interventions. Copyright © 2014 Elsevier Ltd. All rights reserved.

  10. Extreme events in total ozone over Arosa – Part 1: Application of extreme value theory

    Directory of Open Access Journals (Sweden)

    H. E. Rieder

    2010-10-01

    Full Text Available In this study ideas from extreme value theory are for the first time applied in the field of stratospheric ozone research, because statistical analysis showed that previously used concepts assuming a Gaussian distribution (e.g. fixed deviations from mean values of total ozone data do not adequately address the structure of the extremes. We show that statistical extreme value methods are appropriate to identify ozone extremes and to describe the tails of the Arosa (Switzerland total ozone time series. In order to accommodate the seasonal cycle in total ozone, a daily moving threshold was determined and used, with tools from extreme value theory, to analyse the frequency of days with extreme low (termed ELOs and high (termed EHOs total ozone at Arosa. The analysis shows that the Generalized Pareto Distribution (GPD provides an appropriate model for the frequency distribution of total ozone above or below a mathematically well-defined threshold, thus providing a statistical description of ELOs and EHOs. The results show an increase in ELOs and a decrease in EHOs during the last decades. The fitted model represents the tails of the total ozone data set with high accuracy over the entire range (including absolute monthly minima and maxima, and enables a precise computation of the frequency distribution of ozone mini-holes (using constant thresholds. Analyzing the tails instead of a small fraction of days below constant thresholds provides deeper insight into the time series properties. Fingerprints of dynamical (e.g. ENSO, NAO and chemical features (e.g. strong polar vortex ozone loss, and major volcanic eruptions, can be identified in the observed frequency of extreme events throughout the time series. Overall the new approach to analysis of extremes provides more information on time series properties and variability than previous approaches that use only monthly averages and/or mini-holes and mini-highs.

  11. Extreme Low Frequency Acoustic Measurement System

    Science.gov (United States)

    Shams, Qamar A. (Inventor); Zuckerwar, Allan J. (Inventor)

    2017-01-01

    The present invention is an extremely low frequency (ELF) microphone and acoustic measurement system capable of infrasound detection in a portable and easily deployable form factor. In one embodiment of the invention, an extremely low frequency electret microphone comprises a membrane, a backplate, and a backchamber. The backchamber is sealed to allow substantially no air exchange between the backchamber and outside the microphone. Compliance of the membrane may be less than ambient air compliance. The backplate may define a plurality of holes and a slot may be defined between an outer diameter of the backplate and an inner wall of the microphone. The locations and sizes of the holes, the size of the slot, and the volume of the backchamber may be selected such that membrane motion is substantially critically damped.

  12. Thermal Implications for Extreme Fast Charge

    Energy Technology Data Exchange (ETDEWEB)

    Keyser, Matthew A [National Renewable Energy Laboratory (NREL), Golden, CO (United States)

    2017-08-14

    Present-day thermal management systems for battery electric vehicles are inadequate in limiting the maximum temperature rise of the battery during extreme fast charging. If the battery thermal management system is not designed correctly, the temperature of the cells could reach abuse temperatures and potentially send the cells into thermal runaway. Furthermore, the cell and battery interconnect design needs to be improved to meet the lifetime expectations of the consumer. Each of these aspects is explored and addressed as well as outlining where the heat is generated in a cell, the efficiencies of power and energy cells, and what type of battery thermal management solutions are available in today's market. Thermal management is not a limiting condition with regard to extreme fast charging, but many factors need to be addressed especially for future high specific energy density cells to meet U.S. Department of Energy cost and volume goals.

  13. Extreme gust wind estimation using mesoscale modeling

    DEFF Research Database (Denmark)

    Larsén, Xiaoli Guo; Kruger, Andries

    2014-01-01

    Currently, the existing estimation of the extreme gust wind, e.g. the 50-year winds of 3 s values, in the IEC standard, is based on a statistical model to convert the 1:50-year wind values from the 10 min resolution. This statistical model assumes a Gaussian process that satisfies the classical...... through turbulent eddies. This process is modeled using the mesoscale Weather Forecasting and Research (WRF) model. The gust at the surface is calculated as the largest winds over a layer where the averaged turbulence kinetic energy is greater than the averaged buoyancy force. The experiments have been...... done for Denmark and two areas in South Africa. For South Africa, the extreme gust atlases from South Africa were created from the output of the mesoscale modelling using Climate Forecasting System Reanalysis (CFSR) forcing for the period 1998 – 2010. The extensive measurements including turbulence...

  14. Extreme-scale Algorithms and Solver Resilience

    Energy Technology Data Exchange (ETDEWEB)

    Dongarra, Jack [Univ. of Tennessee, Knoxville, TN (United States)

    2016-12-10

    A widening gap exists between the peak performance of high-performance computers and the performance achieved by complex applications running on these platforms. Over the next decade, extreme-scale systems will present major new challenges to algorithm development that could amplify this mismatch in such a way that it prevents the productive use of future DOE Leadership computers due to the following; Extreme levels of parallelism due to multicore processors; An increase in system fault rates requiring algorithms to be resilient beyond just checkpoint/restart; Complex memory hierarchies and costly data movement in both energy and performance; Heterogeneous system architectures (mixing CPUs, GPUs, etc.); and Conflicting goals of performance, resilience, and power requirements.

  15. Extreme Learning Machines for spatial environmental data

    Science.gov (United States)

    Leuenberger, Michael; Kanevski, Mikhail

    2015-12-01

    The use of machine learning algorithms has increased in a wide variety of domains (from finance to biocomputing and astronomy), and nowadays has a significant impact on the geoscience community. In most real cases geoscience data modelling problems are multivariate, high dimensional, variable at several spatial scales, and are generated by non-linear processes. For such complex data, the spatial prediction of continuous (or categorical) variables is a challenging task. The aim of this paper is to investigate the potential of the recently developed Extreme Learning Machine (ELM) for environmental data analysis, modelling and spatial prediction purposes. An important contribution of this study deals with an application of a generic self-consistent methodology for environmental data driven modelling based on Extreme Learning Machine. Both real and simulated data are used to demonstrate applicability of ELM at different stages of the study to understand and justify the results.

  16. Extreme morphologies of mantis shrimp larvae

    DEFF Research Database (Denmark)

    Haug, Carolin; Ahyong, Shane T.; Wiethase, Joris H.

    2016-01-01

    Larvae of stomatopods (mantis shrimps) are generally categorized into four larval types: antizoea, pseudozoea (both representing early larval stages), alima and erichthus (the latt er two representing later larval stages). These categories, however, do not refl ect the existing morphological...... diversity of stomatopod larvae, which is largely unstudied. We describe here four previously unknown larval types with extreme morphologies. All specimens were found in the collections of the Zoological Museum, University of Copenhagen and were collected during the Danish Dana Expedition round the world...... 1928–30. These new larval types all represent erichthus-type larvae, especially diff ering in their shield morphologies. Th e shield morphology ranges from almost spherical to rather disc-like, with sometimes extremely elongated spines, but only a general systematic assignment of the larvae...

  17. Geomicrobiology of extremely acidic subsurface environments.

    Science.gov (United States)

    Johnson, David Barrie

    2012-07-01

    Extreme acidophiles (microorganisms with pH optima of Harz mountains in Germany) and a sulfidic cave (Frasissi, Italy) are reviewed. In addition, the contrasting geomicrobiology of two abandoned sulfide mineral mines in north Wales is described. Both are extremely acidic (pH~2) and low-temperature (8-9 °C) sites, but one (Cae Coch) is essentially a dry mine with isolated pockets of water, while the other (Mynydd Parys) contains a vast underground lake that was partially drained several years ago. The microbial communities in these two mines exhibit different relative abundances and often different species of archaea and bacteria. Wooden pit props, submerged in the underground lake, act as a slow-release source of organic carbon in the subterranean Mynydd Parys lake, supporting a microbial community that is more enriched with heterotrophic microorganisms. © 2011 Federation of European Microbiological Societies. Published by Blackwell Publishing Ltd. All rights reserved.

  18. Extreme Achalasia Presenting as Anorexia Nervosa

    Directory of Open Access Journals (Sweden)

    P. J. Goldsmith

    2012-01-01

    Full Text Available Background. Achalasia may lead to cachexia if not diagnosed in an early stage. Surgery in cachectic patients is hazardous and complications may result in a protracted recovery or even death. Different treatment options have been described. In this paper, we report a stepwise surgical laparoscopic approach which appears to be safe and effective. Methods. Over a one-year period, a patient with a body mass index (BMI below 17 being treated for anorexia nervosa was referred with dysphagia. Because of the extreme cachexia, a laparoscopic feeding jejunostomy (LFJ was fashioned to enable long-term home enteral feeding. The patient underwent a laparoscopic Heller myotomy (LHM when the BMI was normal. Results. The patient recovered well following this stepwise approach. Conclusion. Patients with advanced achalasia usually present with extreme weight loss. In this small group of patients, a period of home enteral nutrition (HEN via a laparoscopically placed feeding jejunostomy allows weight gain prior to safe definitive surgery.

  19. Properties of Extreme Poin Rainfall II

    DEFF Research Database (Denmark)

    Mikkelsen, Peter Steen; Harremoës, Poul; Rosbjerg, Dan

    1995-01-01

    As an alternative to the traditional non-parametric method the partial duration series approach with exponentially distributed exceedances is used to model extreme values of depth and maximum 10 min intensity per rainfall event, measured at gauges placed at different locations in Denmark. A stati......As an alternative to the traditional non-parametric method the partial duration series approach with exponentially distributed exceedances is used to model extreme values of depth and maximum 10 min intensity per rainfall event, measured at gauges placed at different locations in Denmark...... into account a possible intersite dependence structure, is developed. Adding one total design standard deviation to the regionally averaged T-year events yields increased design values between 5 and 17%. This result brings up a number of questions with respect to application of historical rainfall data...

  20. Detecting change-points in extremes

    KAUST Repository

    Dupuis, D. J.

    2015-01-01

    Even though most work on change-point estimation focuses on changes in the mean, changes in the variance or in the tail distribution can lead to more extreme events. In this paper, we develop a new method of detecting and estimating the change-points in the tail of multiple time series data. In addition, we adapt existing tail change-point detection methods to our specific problem and conduct a thorough comparison of different methods in terms of performance on the estimation of change-points and computational time. We also examine three locations on the U.S. northeast coast and demonstrate that the methods are useful for identifying changes in seasonally extreme warm temperatures.

  1. Seasonal Cycle in German Daily Precipitation Extremes

    Directory of Open Access Journals (Sweden)

    Madlen Fischer

    2018-01-01

    Full Text Available The seasonal cycle of extreme precipitation in Germany is investigated by fitting statistical models to monthly maxima of daily precipitation sums for 2,865 rain gauges. The basis is a non-stationary generalized extreme value (GEV distribution variation of location and scale parameters. The negative log-likelihood serves as the forecast error for a cross validation to select adequate orders of the harmonic functions for each station. For nearly all gauges considered, the seasonal model is more appropriate to estimate return levels on a monthly scale than a stationary GEV used for individual months. The 100-year return-levels show the influence of cyclones in the western, and convective events in the eastern part of Germany. In addition to resolving the seasonality, we use a simulation study to show that annual return levels can be estimated more precisely from a monthly-resolved seasonal model than from a stationary model based on annual maxima.

  2. Overuse lower extremity injuries in sports.

    Science.gov (United States)

    Fullem, Brian W

    2015-04-01

    When athletes train harder the risk of injury increases, and there are several common overuse injuries to the lower extremity. Three of the most common lower extremity overuse injuries in sports are discussed including the diagnosis and treatments: medial tibal stress syndrome, iliotibial band syndrome, and stress fractures. The charge of sports medicine professionals is to identify and treat the cause of the injuries and not just treat the symptoms. Symptomatology is an excellent guide to healing and often the patient leads the physician to the proper diagnosis through an investigation of the athlete's training program, past injury history, dietary habits, choice of footwear, and training surface. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Urachal Tumor: A Case Report of an Extremely Rare Carcinoma

    Directory of Open Access Journals (Sweden)

    José Palla Garcia

    2017-01-01

    Full Text Available The urachus is a tubular structure that connects the bladder to the allantois in the embryonic development, involuting after the third trimester. The urachus carcinoma is an extremely rare tumor that accounts for <1% of all bladder cancers. We report a case of a 46-year-old woman, with no past medical history, complaining of hematuria with 6-month duration and a physical exam and an abdominal computed topographic scan revealing an exophytic mass of 6.8 cm longer axis that grew depending on the anterior bladder wall, invading the anterior abdominal wall. Cystoscopy detected mucosal erosion. The biopsy showed structures of adenocarcinoma of enteric type. The surgical specimen showed urachus adenocarcinoma of enteric type with stage IVA in the Sheldon system and stage III in the Mayo system. This case has a 3-year follow-up without disease recurrence.

  4. Structural extremes in a cretaceous dinosaur.

    Directory of Open Access Journals (Sweden)

    Paul C Sereno

    Full Text Available Fossils of the Early Cretaceous dinosaur, Nigersaurus taqueti, document for the first time the cranial anatomy of a rebbachisaurid sauropod. Its extreme adaptations for herbivory at ground-level challenge current hypotheses regarding feeding function and feeding strategy among diplodocoids, the larger clade of sauropods that includes Nigersaurus. We used high resolution computed tomography, stereolithography, and standard molding and casting techniques to reassemble the extremely fragile skull. Computed tomography also allowed us to render the first endocast for a sauropod preserving portions of the olfactory bulbs, cerebrum and inner ear, the latter permitting us to establish habitual head posture. To elucidate evidence of tooth wear and tooth replacement rate, we used photographic-casting techniques and crown thin sections, respectively. To reconstruct its 9-meter postcranial skeleton, we combined and size-adjusted multiple partial skeletons. Finally, we used maximum parsimony algorithms on character data to obtain the best estimate of phylogenetic relationships among diplodocoid sauropods. Nigersaurus taqueti shows extreme adaptations for a dinosaurian herbivore including a skull of extremely light construction, tooth batteries located at the distal end of the jaws, tooth replacement as fast as one per month, an expanded muzzle that faces directly toward the ground, and hollow presacral vertebral centra with more air sac space than bone by volume. A cranial endocast provides the first reasonably complete view of a sauropod brain including its small olfactory bulbs and cerebrum. Skeletal and dental evidence suggests that Nigersaurus was a ground-level herbivore that gathered and sliced relatively soft vegetation, the culmination of a low-browsing feeding strategy first established among diplodocoids during the Jurassic.

  5. Empathy, autism and the extreme female brain

    OpenAIRE

    Dinsdale, Natalie Lisa

    2012-01-01

    Human cognition can be conceptualized as an axis whereby males tend toward relative strengths in mechanistic ('things' thinking) cognition and females tend toward relative strengths in mentalistic ('people'-thinking) cognition. Psychiatric conditions are hypothesized to reflect the extreme ends of this axis, with over-developed social cognition underlying the psychotic-affective spectrum in contrast to under-developed social cognition characterizing the autism spectrum. Consistent with this h...

  6. Countering Violent Extremism (CVE) Literature Review

    Science.gov (United States)

    2011-03-01

    are mentally ill and have used labels such as psychopathic or sociopathic (Piven, 2002; Taylor, 1988; Thackrah, 2004), narcissistic (Pearlstein, 1991...inform strategies. There are also divisions between different academic disciplines such as ‘intelligence studies’ and ‘terrorism studies’ (Ranstorp...responsibility of the private sector in approaches for countering violent extremism, “Research in this area should focus on the different agencies that

  7. Nonstationary modeling of extreme precipitation in China

    Science.gov (United States)

    Gao, Meng; Mo, Dingyuan; Wu, Xiaoqing

    2016-12-01

    The statistical methods based on extreme value theory have been traditionally used in meteorology and hydrology for a long time. Due to climate change and variability, the hypothesis of stationarity in meteorological or hydrological time series was usually not satisfied. In this paper, a nonstationary extreme value analysis was conducted for annual maximum daily precipitation (AMP) at 631 meteorological stations over China for the period 1951-2013. Stationarity of all 631 AMP time series was firstly tested using KPSS test method, and only 48 AMP time series showed non-stationarity at 5% significance level. The trends of these 48 nonstationary AMP time series were further tested using M-K test method. There were 25 nonstationary AMP time series mainly distributed in southern and western China showing significant positive trend at 5% level. Another 5 nonstationary AMP time series with significant negative trends were near northern urban agglomeration, Sichuan Basin, and central China. For these nonstationary AMP time series with significant positive or negative trends, the location parameter in generalized extreme value (GEV) distribution was assumed to be time-varying, and the trends were successfully characterized by the nonstationary GEV models. For the remaining 18 nonstationary AMP time series mainly in the eastern portion of China, no significant trend was detected. The correlation analysis showed that only 5 nonstationary AMP time series were significantly correlated with one or two of the four climate indices EASMI, WPI, SOI, and PDO. Then, the location and scale parameters in the GEV distribution were modeled as functions of the significantly correlated climate indices. The modeling results in this study showed that the nonstationary GEV distributions performed better than their stationary equivalents. Finally, 20-year and 50-year return levels of precipitation extremes at all 631 stations were estimated using the best fitting distribution for the year 1961

  8. Solar Power Generation in Extreme Space Environments

    Science.gov (United States)

    Elliott, Frederick W.; Piszczor, Michael F.

    2016-01-01

    The exploration of space requires power for guidance, navigation, and control; instrumentation; thermal control; communications and data handling; and many subsystems and activities. Generating sufficient and reliable power in deep space through the use of solar arrays becomes even more challenging as solar intensity decreases and high radiation levels begin to degrade the performance of photovoltaic devices. The Extreme Environments Solar Power (EESP) project goal is to develop advanced photovoltaic technology to address these challenges.

  9. Terrorism, ethnicity and Islamic extremism in Sahel

    OpenAIRE

    Galito, Maria Sousa

    2012-01-01

    Terrorism is a threat in the Sahel region, where peoples and rulers seem to be losing control of the situation. Yet, the true origins of the instability are questionable. Ethnical conflicts and the religious differences, especially those related with the spreading of Islamic extremism among the local population, are two of the main reasons. This research paper analyzes different theories so as to attain some answers to these issues.

  10. Terrorism, ethnicity and Islamic extremism in Sahel

    Directory of Open Access Journals (Sweden)

    Maria Sousa Galito

    2012-01-01

    Full Text Available Terrorism is a threat in the Sahel region, where peoples and rulers seem to be losing control of the situation. Yet, the true origins of the instability are questionable. Ethnical conflicts and the religious differences, especially those related with the spreading of Islamic extremism among the local population, are two of the main reasons. This research paper analyzes different theories so as to attain some answers to these issues.

  11. Teenagers born at extremely low birth weight

    OpenAIRE

    Whitfield, Michael F.; Grunau, Ruth E.

    2006-01-01

    Adolescence constitutes a major transition for extremely low birth weight (ELBW) teenagers. Recent studies of ELBW teenagers born in the 1980s have provided information about the growth and developmental characteristics of these individuals in adolescence and in early adulthood. ELBW teenagers are shorter and lighter than their full-term peers, and have a smaller head circumference. Cognitive and academic vulnerabilities documented during the school years, particularly difficulties with nonve...

  12. A Fourier analysis of extreme events

    DEFF Research Database (Denmark)

    Mikosch, Thomas Valentin; Zhao, Yuwei

    2014-01-01

    The extremogram is an asymptotic correlogram for extreme events constructed from a regularly varying stationary sequence. In this paper, we define a frequency domain analog of the correlogram: a periodogram generated from a suitable sequence of indicator functions of rare events. We derive basic ...... properties of the periodogram such as the asymptotic independence at the Fourier frequencies and use this property to show that weighted versions of the periodogram are consistent estimators of a spectral density derived from the extremogram....

  13. Understanding and modelling extreme El Nino events

    Science.gov (United States)

    Oreskes, N.; Guertin, L. A.; Kumano, Y.; Kelemen, P. B.; Guilyardi, E.

    2016-12-01

    The recent 2015/16 El Niño event was the third well observed extreme event since the development of Tropical Pacific observation system in the 1980s. Even though the sample remains small, we are now in a better position to understand, model and ultimately forecast these large impact events with a 2 to 3 season lead time. We know that when the heat recharge of the equatorial Pacific is high and when Westerly Wind Events (WWE) occur at the end of the boreal winter, the odds of having El Niño 6 to 9 months later increase significantly (and La Niña can be safely ruled out). These forecasts are essentially probabilistic as seen for instance in 2014 which had these precursors, but chose to follow the low probably outcome of a quite weak event. The current challenge is therefore to understand and identify if there are additional precursors that will increase the probability of having an extreme El Nino event. A few recent studies show that the subsequent occurrence of WWE during summer and fall significantly multiplies the odds of an extreme event, as seen in 2015 in contrast to 2014. Other intraseasonal events may play a role during the development phase of the event, such as easterly pulses of trade winds counteracting the amplifying Bjerknes feedback. This talk will review these recent findings and also address how models are able to reproduce the physical mechanisms at the source of extreme El Niño occurrence and predictability.

  14. Support For Distributed Programming In Extreme Style

    Directory of Open Access Journals (Sweden)

    Jacek Dajda

    2005-01-01

    Full Text Available The basic limitation emerging from practising eXtreme Programming methodology is theconstraint of close physical proximity between the members of the collaborating team including customer. This became the main idea behind research on XP supporting environmentfor geographically distributed teams. This work presents basic assumptions, elaborated architecture and selected implementation issues for the system of this type. Deliberations aresupplied with the initial results of the verification of its usability based on the users tests.

  15. Extreme value theory in emerging markets

    Directory of Open Access Journals (Sweden)

    Anđelić Goran

    2010-01-01

    Full Text Available This paper investigates the performance of extreme value theory (EVT with the daily stock index returns of four different emerging markets. The research covers the sample representing the Serbian (BELEXline, Croatian (CROBEX, Slovenian (SBI20, and Hungarian (BUX stock indexes using the data from January 2006 - September 2009. In the paper a performance test was carried out for the success of application of the extreme value theory in estimating and forecasting of the tails of daily return distribution of the analyzed stock indexes. Therefore the main goal is to determine whether EVT adequately estimates and forecasts the tails (2.5% and 5% at the tail of daily stock index return distribution in the emerging markets of Serbia, Croatia, Slovenia, and Hungary. The applied methodology during the research includes analysis, synthesis and statistical/mathematical methods. Research results according to estimated Generalized Pareto Distribution (GPD parameters indicate the necessity of applying market risk estimation methods, i.e. extreme value theory (EVT in the framework of a broader analysis of investment processes in emerging markets.

  16. Embedded I&C for Extreme Environments

    Energy Technology Data Exchange (ETDEWEB)

    Kisner, Roger A. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

    2016-04-01

    This project uses embedded instrumentation and control (I&C) technologies to demonstrate potential performance gains of nuclear power plant components in extreme environments. Extreme environments include high temperature, radiation, high pressure, high vibration, and high EMI conditions. For extreme environments, performance gains arise from moment-to-moment sensing of local variables and immediate application of local feedback control. Planning for embedding I&C during early system design phases contrasts with the traditional, serial design approach that incorporates minimal I&C after mechanical and electrical design is complete. The demonstration application involves the development and control of a novel, proof-of-concept motor/pump design. The motor and pump combination operate within the fluid environment, eliminating the need for rotating seals. Actively controlled magnetic bearings also replace failure-prone mechanical contact bearings that typically suspend rotating components. Such as design has the potential to significantly enhance the reliability and life of the pumping system and would not be possible without embedded I&C.

  17. Liquid Water Restricts Habitability in Extreme Deserts.

    Science.gov (United States)

    Cockell, Charles S; Brown, Sarah; Landenmark, Hanna; Samuels, Toby; Siddall, Rebecca; Wadsworth, Jennifer

    2017-04-01

    Liquid water is a requirement for biochemistry, yet under some circumstances it is deleterious to life. Here, we show that liquid water reduces the upper temperature survival limit for two extremophilic photosynthetic microorganisms (Gloeocapsa and Chroococcidiopsis spp.) by greater than 40°C under hydrated conditions compared to desiccated conditions. Under hydrated conditions, thermal stress causes protein inactivation as shown by the fluorescein diacetate assay. The presence of water was also found to enhance the deleterious effects of freeze-thaw in Chroococcidiopsis sp. In the presence of water, short-wavelength UV radiation more effectively kills Gloeocapsa sp. colonies, which we hypothesize is caused by factors including the greater penetration of UV radiation into hydrated colonies compared to desiccated colonies. The data predict that deserts where maximum thermal stress or irradiation occurs in conjunction with the presence of liquid water may be less habitable to some organisms than more extreme arid deserts where organisms can dehydrate prior to being exposed to these extremes, thus minimizing thermal and radiation damage. Life in extreme deserts is poised between the deleterious effects of the presence and the lack of liquid water. Key Words: Deserts-Extremophiles-Stress-High temperatures-UV radiation-Desiccation. Astrobiology 17, 309-318.

  18. Footwear traction and lower extremity noncontact injury.

    Science.gov (United States)

    Wannop, John W; Luo, Geng; Stefanyshyn, Darren J

    2013-11-01

    Football is the most popular high school sport; however, it has the highest rate of injury. Speculation has been prevalent that foot fixation due to high footwear traction contributes to injury risk. Therefore, the purpose of the study was to determine whether a relationship exists between the athlete's specific footwear traction (measured with their own shoes on the field of play) and lower extremity noncontact injury in high school football. For 3 yr, 555 high school football athletes had their footwear traction measured on the actual field of play at the start of the season, and any injury the athletes suffered during a game was recorded. Lower extremity noncontact injury rates, grouped based on the athlete's specific footwear traction (both translational and rotational), were compared. For translational traction, injury rate reached a peak of 23.3 injuries/1000 game exposures within the midrange of translational traction, before decreasing to 5.0 injuries/1000 game exposures in the high range of traction. For rotational traction, there was a steady increase in injury rate as footwear traction increased, starting at 4.2 injuries/1000 game exposures at low traction and reaching 19.2 injuries/1000 game exposures at high traction. A relationship exists between footwear traction and noncontact lower extremity injury, with increases in rotational traction leading to a greater injury rate and increases in translational traction leading to a decrease in injury. It is recommended that athletes consider selecting footwear with the lowest rotational traction values for which no detriment in performance results.

  19. Extreme neutrophil granulocytosis in a patient with anaplastic large cell lymphoma of T-cell lineage

    DEFF Research Database (Denmark)

    Engsig, Frederik Neess; Møller, Michael Boe; Hasselbalch, Hans K

    2007-01-01

    We describe a 47-year-old male admitted with fever and extreme neutrophil granulocytosis (up to 80 x 10(9)/L). All microbiology tests and test for autoimmune disease were negative. CT scan showed pulmonary infiltrates bilaterally, mediastinal lymphadenopathy and splenomegaly. Conventional patholo...... led to a diagnosis of anaplastic large cell lymphoma (ALCL) of T-cell lineage. Involvement of peripheral blood with leukemoid reaction is a rare manifestation of ALCL. This case emphasizes the importance of immunophenotyping in unexplained extreme granulocytosis....

  20. Forecasting extreme temperature health hazards in Europe

    Science.gov (United States)

    Di Napoli, Claudia; Pappenberger, Florian; Cloke, Hannah L.

    2017-04-01

    Extreme hot temperatures, such as those experienced during a heat wave, represent a dangerous meteorological hazard to human health. Heat disorders such as sunstroke are harmful to people of all ages and responsible for excess mortality in the affected areas. In 2003 more than 50,000 people died in western and southern Europe because of a severe and sustained episode of summer heat [1]. Furthermore, according to the Intergovernmental Panel on Climate Change heat waves are expected to get more frequent in the future thus posing an increasing threat to human lives. Developing appropriate tools for extreme hot temperatures prediction is therefore mandatory to increase public preparedness and mitigate heat-induced impacts. A recent study has shown that forecasts of the Universal Thermal Climate Index (UTCI) provide a valid overview of extreme temperature health hazards on a global scale [2]. UTCI is a parameter related to the temperature of the human body and its regulatory responses to the surrounding atmospheric environment. UTCI is calculated using an advanced thermo-physiological model that includes the human heat budget, physiology and clothing. To forecast UTCI the model uses meteorological inputs, such as 2m air temperature, 2m water vapour pressure and wind velocity at body height derived from 10m wind speed, from NWP models. Here we examine the potential of UTCI as an extreme hot temperature prediction tool for the European area. UTCI forecasts calculated using above-mentioned parameters from ECMWF models are presented. The skill in predicting UTCI for medium lead times is also analysed and discussed for implementation to international health-hazard warning systems. This research is supported by the ANYWHERE project (EnhANcing emergencY management and response to extreme WeatHER and climate Events) which is funded by the European Commission's HORIZON2020 programme. [1] Koppe C. et al., Heat waves: risks and responses. World Health Organization. Health and

  1. Extreme river flow dependence in Northern Scotland

    Science.gov (United States)

    Villoria, M. Franco; Scott, M.; Hoey, T.; Fischbacher-Smith, D.

    2012-04-01

    Various methods for the spatial analysis of hydrologic data have been developed recently. Here we present results using the conditional probability approach proposed by Keef et al. [Appl. Stat. (2009): 58,601-18] to investigate spatial interdependence in extreme river flows in Scotland. This approach does not require the specification of a correlation function, being mostly suitable for relatively small geographical areas. The work is motivated by the Flood Risk Management Act (Scotland (2009)) which requires maps of flood risk that take account of spatial dependence in extreme river flow. The method is based on two conditional measures of spatial flood risk: firstly the conditional probability PC(p) that a set of sites Y = (Y 1,...,Y d) within a region C of interest exceed a flow threshold Qp at time t (or any lag of t), given that in the specified conditioning site X > Qp; and, secondly the expected number of sites within C that will exceed a flow Qp on average (given that X > Qp). The conditional probabilities are estimated using the conditional distribution of Y |X = x (for large x), which can be modeled using a semi-parametric approach (Heffernan and Tawn [Roy. Statist. Soc. Ser. B (2004): 66,497-546]). Once the model is fitted, pseudo-samples can be generated to estimate functionals of the joint tails of the distribution of (Y,X). Conditional return level plots were directly compared to traditional return level plots thus improving our understanding of the dependence structure of extreme river flow events. Confidence intervals were calculated using block bootstrapping methods (100 replicates). We report results from applying this approach to a set of four rivers (Dulnain, Lossie, Ewe and Ness) in Northern Scotland. These sites were chosen based on data quality, spatial location and catchment characteristics. The river Ness, being the largest (catchment size 1839.1km2) was chosen as the conditioning river. Both the Ewe (441.1km2) and Ness catchments have

  2. Extremeness of meteorological variables as an indicator of extreme precipitation events

    Science.gov (United States)

    Müller, Miloslav; Kašpar, Marek; Řezáčová, Daniela; Sokol, Zbyněk

    2009-05-01

    Extreme large-scale precipitation events in central Europe are determined by the synoptic pattern, which is typically characterized by cyclones moving from the south into this region. Herein, we demonstrate that this synoptic pattern is accompanied by large-scale anomalies of dynamic and thermodynamic variables that occur in specific regions before or during the precipitation event. The extremeness of individual variables was evaluated by ERA-40 data relative to the corresponding climatology by the obtained distribution function values. Precipitation events leading to 14 significant summer floods in the period between 1958 and 2002 were used as reference events. The temporal correspondence of the anomalies among reference events was employed by selecting 26 synoptic predictors of extreme precipitation in the Czech Republic. A predictor evaluates the extremeness of a variable in a limited area on a specific day relatively to the start of the precipitation event (day D). While the predictors cover a five-day period from D - 2 to D + 2, most are relevant to the days with precipitation (from D to D + 2). The predictors cannot be considered individually because only opportune coincidences make the synoptic situations dangerous. In the present study, a combined EM index was used by evaluating the predictors as a whole, without considering their relationships. Days with minimum EM values correspond to significant flood events in the Czech Republic. Our results confirm that the synoptic pattern can be properly characterized by the extremeness of selected dynamic and thermodynamic variables, and that the anomalies are distinctly correlated with the extremity of large-scale precipitation and flood events in the Czech Republic. This approach is applicable to other regions where precipitation is significantly related to large-scale synoptic patterns, and could be employed also by operational detection of upcoming extreme precipitation events.

  3. Microbial diversity of extreme habitats in human homes

    Directory of Open Access Journals (Sweden)

    Amy M. Savage

    2016-09-01

    Full Text Available High-throughput sequencing techniques have opened up the world of microbial diversity to scientists, and a flurry of studies in the most remote and extreme habitats on earth have begun to elucidate the key roles of microbes in ecosystems with extreme conditions. These same environmental extremes can also be found closer to humans, even in our homes. Here, we used high-throughput sequencing techniques to assess bacterial and archaeal diversity in the extreme environments inside human homes (e.g., dishwashers, hot water heaters, washing machine bleach reservoirs, etc.. We focused on habitats in the home with extreme temperature, pH, and chemical environmental conditions. We found a lower diversity of microbes in these extreme home environments compared to less extreme habitats in the home. However, we were nonetheless able to detect sequences from a relatively diverse array of bacteria and archaea. Habitats with extreme temperatures alone appeared to be able to support a greater diversity of microbes than habitats with extreme pH or extreme chemical environments alone. Microbial diversity was lowest when habitats had both extreme temperature and one of these other extremes. In habitats with both extreme temperatures and extreme pH, taxa with known associations with extreme conditions dominated. Our findings highlight the importance of examining interactive effects of multiple environmental extremes on microbial communities. Inasmuch as taxa from extreme environments can be both beneficial and harmful to humans, our findings also suggest future work to understand both the threats and opportunities posed by the life in these habitats.

  4. [Extreme reactive thrombocytosis in a healthy 6 year-old child].

    Science.gov (United States)

    de Lama Caro-Patón, G; García-Salido, A; Iglesias-Bouzas, M I; Guillén, M; Cañedo-Villaroya, E; Martínez-Romera, I; Serrano-González, A; Casado-Flores, J

    2014-11-01

    Thrombocytosis is usually a casual finding in children. Reactive or secondary thrombocytosis is the more common form, being the infections diseases the most prevalent cause of it. Regarding the number of platelets there are four degrees of thrombocytosis; in its extreme degree the number of platelets exceeds 1,000,000/mm(3). We describe a case of extreme reactive thrombocytosis in a healthy 6-year-old child. He required critical care admission for diagnosis and treatment (maximum number of platelets 7,283,000/mm(3)). We review the different causes of thrombocytosis in childhood, the differential diagnosis, and the available treatments in case of extreme thrombocytosis. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  5. Extreme Insulin Resistance in a Patient with Diabetes Ketoacidosis and Acute Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Yin H. Oo

    2013-01-01

    Full Text Available Hyperglycemia is common in hospitalized patients and associated with adverse clinical outcomes. In hospitalized patients, multiple factors contribute to hyperglycemia, such as underlying medical conditions, pathophysiological stress, and medications. The development of transient insulin resistance is a known cause of hyperglycemia in both diabetic and nondiabetic patients. Though physicians are familiar with common diseases that are known to be associated with insulin resistance, the majority of us rarely come across a case of extreme insulin resistance. Here, we report a case of prolonged course of extreme insulin resistance in a patient admitted with diabetic ketoacidosis (DKA and acute myocardial infarction (MI. The main purpose of this paper is to review the literature to identify the underlying mechanisms of extreme insulin resistance in a patient with DKA and MI. We will also briefly discuss the different clinical conditions that are associated with insulin resistance and a general approach to a patient with severe insulin resistance.

  6. Management of an extremely displaced maxillary canine.

    Science.gov (United States)

    Grande, Torsten; Stolze, Annemarie; Goldbecher, Heiko

    2005-07-01

    Aligning a displaced maxillary canine into the dental arch is one of the most complicated problems in orthodontics. In cases of extremely high displacement, the tooth is frequently removed surgically. Because of the upper canines' significance to dental esthetics and functional occlusion, such a decision is a very serious one. This case report illustrates the treatment of an extremely high displaced maxillary canine. The main diagnosis was the displacement and the retention of tooth 13 (in nearly horizontal position, apical to the neighboring teeth); further diagnoses were: transversal maxillary deficiency with frontal crowding and a distal bite of one premolar in width, a deep bite of 6 mm with contact in the palatal mucosa, mandibular midline deviation of 2.5 mm to the right, lingual eruption of teeth 32 and 42, retroinclination of the maxillary incisors, and retarded eruption of the permanent teeth. Initial treatment with active and functional appliances to correct the distal bite, midline deviation and deep bite. Surgical exposure of the high displaced canine at the age of 14. Onset of cuspid elongation with removable appliances and elastics, further movement with a transpalatinal bar and welded arm, and full alignment of the upper and lower arches with fixed appliances in both jaws. Stabilization of the orthodontic treatment results with retention devices. Duration of treatment: 5 years and 8 months. For the alignment of tooth 13, 2 years and 10 months were required; 1 year and 4 months were necessary with complete fixed appliance. The aim of this case report was to demonstrate the potential of aligning an extremely displaced canine. Because of the esthetic and functional importance of the upper canines, therapeutic alignment should be initiated, provided there are no indications to the contrary.

  7. To The Question Of The Extremism Prevention

    Directory of Open Access Journals (Sweden)

    Anastasiya S. Vasnetsova

    2015-03-01

    Full Text Available In the present article authors examine issues of combating extremism in the modern world. It is noted that, despite the State and society actions in countering extremism in recent years, significant positive changes in the status, structure and dynamics of extremist offenses in the country did not happen. Authors analyze dynamics of extremist crimes registered over the past years, analyzing most dangerous type of activity - criminal activities of extremist communities associated with the commission of serious crimes. Authors point out, that the important aspect is halting spread of extremist materials. The most urgent problem is the problem of young people incitement to the extremist activity, including the aim of involving them in the preparation and holding of illegal mass protests. The necessary work to identify and bring to justice for inciting ethnic hatred and incitement to violence carried out in the Crimean Federal District. In the study authors note that the results of the work of law enforcement bodies of the Russian Federation shows that the destabilization of the situation in this area is one of the objectives of neo-Nazi organizations. Spread of extremist ideas becomes an increasing danger to public due to the increased aggressiveness of this ideology and the expansion of its advocacy in the community, and also due to the propagation of certain social groups in the views of the Russian society on the admissibility of the radical course of action to achieve its aims (political, religious, national, social, etc.. In the conclusion, authors summarize that the state and society have the primary responsibility in combating against extremism and terrorism. On this basis, implementation of initiated measures is required for the effective action to protect society against extremist and terrorist threats.

  8. Social networking among upper extremity patients.

    Science.gov (United States)

    Rozental, Tamara D; George, Tina M; Chacko, Aron T

    2010-05-01

    Despite their rising popularity, the health care profession has been slow to embrace social networking sites. These are Web-based initiatives, designed to bring people with common interests or activities under a common umbrella. The purpose of this study is to evaluate social networking patterns among upper extremity patients. A total of 742 anonymous questionnaires were distributed among upper extremity outpatients, with a 62% response rate (462 were completed). Demographic characteristics (gender, age, level of education, employment, type of health insurance, and income stratification) were defined, and data on computer ownership and frequency of social networking use were collected. Social network users and nonusers were compared according to their demographic and socioeconomic characteristics. Our patient cohort consisted of 450 patients. Of those 450 patients, 418 had a high school education or higher, and 293 reported a college or graduate degree. The majority of patients (282) were employed at the time of the survey, and income was evenly distributed among U.S. Census Bureau quintiles. A total of 349 patients reported computer ownership, and 170 reported using social networking sites. When compared to nonusers, social networking users were younger (pnetworking use. Most users (n = 114) regularly visit a single site. Facebook was the most popular site visited (n=142), followed by MySpace (n=28) and Twitter (n=16). Of the 450 upper extremity patients in our sample, 170 use social networking sites. Younger age, higher level of education, and computer ownership were associated with social networking use. Physicians should consider expanding their use of social networking sites to reach their online patient populations. Copyright 2010 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  9. Topological stability through extremely tame retractions

    DEFF Research Database (Denmark)

    Feragen, Aasa

    2012-01-01

    not know whether f will be topologically stable if we can find a pair of continuous retractions r and s. The class of extremely tame (E-tame) retractions, introduced by du Plessis and Wall, are defined by their nice geometric properties, which are sufficient to ensure that f is topologically stable....... In this article, we present the E-tame retractions and their relation with topological stability, survey recent results by the author concerning their construction, and illustrate the use of our techniques by constructing E-tame retractions for certain germs belonging to the E- and Z-series of singularities....

  10. Wireless Sensor Applications in Extreme Aeronautical Environments

    Science.gov (United States)

    Wilson, William C.; Atkinson, Gary M.

    2013-01-01

    NASA aeronautical programs require rigorous ground and flight testing. Many of the testing environments can be extremely harsh. These environments include cryogenic temperatures and high temperatures (greater than 1500 C). Temperature, pressure, vibration, ionizing radiation, and chemical exposure may all be part of the harsh environment found in testing. This paper presents a survey of research opportunities for universities and industry to develop new wireless sensors that address anticipated structural health monitoring (SHM) and testing needs for aeronautical vehicles. Potential applications of passive wireless sensors for ground testing and high altitude aircraft operations are presented. Some of the challenges and issues of the technology are also presented.

  11. Lens designs with extreme image quality features

    Science.gov (United States)

    Shafer, David

    2013-02-01

    In order to best assess the importance of new technologies to optical design, it is useful to consider what the limits are to what can be done with `old' technologies. That may show where something new is needed to overcome the limitations of existing optical designs. This article will give a survey of some remarkable high-performance designs, some of which are extremely simple, and most of which only use technology that has already been around for decades. Each of these designs has some limitation that would be nice to overcome. One new technology that will probably revolutionize optical design will be curved surfaces on image chips.

  12. Extreme aplasia cutis congenita involving the skull.

    Science.gov (United States)

    Shrager, Sebastian; Voin, Vlad; Iwanaga, Joe; Tubbs, R Shane; Johnston, James

    2017-08-01

    Aplasia cutis congenita (ACC) is a rare congenital malformation of primarily the skin; it is most commonly seen on the scalp but can occur anywhere on the body. The exact etiology is still unclear but there are many suggested causes. Classification systems have been proposed to help categorize patients and assist with treatment. Treatment options are controversial and range from conservative to surgical interventions. We report an extreme case of ACC that included a significant part of the skull. We discuss this case and review salient literature. Although such cases of ACC with bony involvement are rare, this aspect of the pathology should be kept in mind when treating or imaging such patients.

  13. High resolution extremity CT for biomechanics modeling

    Energy Technology Data Exchange (ETDEWEB)

    Ashby, A.E.; Brand, H.; Hollerbach, K.; Logan, C.M.; Martz, H.E.

    1995-09-23

    With the advent of ever more powerful computing and finite element analysis (FEA) capabilities, the bone and joint geometry detail available from either commercial surface definitions or from medical CT scans is inadequate. For dynamic FEA modeling of joints, precise articular contours are necessary to get appropriate contact definition. In this project, a fresh cadaver extremity was suspended in parafin in a lucite cylinder and then scanned with an industrial CT system to generate a high resolution data set for use in biomechanics modeling.

  14. Weather Extremes, Climate Change and Adaptive Governance

    Science.gov (United States)

    Veland, S.; Lynch, A. H.

    2014-12-01

    Human societies have become a geologic agent of change, and with this is an increasing awareness of the environment risks that confront human activities and values. More frequent and extreme hydroclimate events, anomalous tropical cyclone seasons, heat waves and droughts have all been documented, and many rigorously attributed to fossil fuel emissions (e.g. DeGaetano 2009; Hoyos et al. 2006). These extremes, however, do not register themselves in the abstract - they occur in particular places, affecting particular populations and ecosystems (Turner et al. 2003). This can be considered to present a policy window to decrease vulnerability and enhance emergency management. However, the asymmetrical character of these events may lead some to treat remote areas or disenfranchised populations as capable of absorbing the environmental damage attributable to the collective behavior of those residing in wealthy, populous, industrialized societies (Young 1989). Sound policies for adaptation to changing extremes must take into account the multiple interests and resource constraints for the populations affected and their broader contexts. Minimizing vulnerability to weather extremes is only one of many interests in human societies, and as noted, this interest competes with the others for limited time, attention, funds and other resources. Progress in reducing vulnerability also depends on policy that integrates the best available local and scientific knowledge and experience elsewhere. This improves the chance that each policy will succeed, but there are no guarantees. Each policy must be recognized as a matter of trial and error to some extent; surprises are inevitable. Thus each policy should be designed to fail gracefully if it fails, to learn from the experience, and to leave resources sufficient to implement the lessons learned. Overall policy processes must be quasi-evolutionary, avoiding replication without modification of failed policies and building on the successes

  15. Microstructured extremely thin absorber solar cells

    DEFF Research Database (Denmark)

    Biancardo, Matteo; Krebs, Frederik C

    2007-01-01

    In this paper we present the realization of extremely thin absorber (ETA) solar cells employing conductive glass substrates functionalized with TiO2 microstructures produced by embossing. Nanocrystalline or compact TiO2 films on Indium doped tin oxide (ITO) glass substrates were embossed...... by pressing a silicon stamp containing a mu m size raised grid structure into the TiO2 by use of a hydraulic press (1 ton/50 cm(2)). The performance of these microstructured substrates in a ETA cell sensitized by a thermally evaporated or chemical bath deposited PbS film and completed by a PEDOT:PSS hole...

  16. Residual impairment after lower extremity fracture

    DEFF Research Database (Denmark)

    Faergemann, C; Frandsen, P A; Röck, N D

    1998-01-01

    In a prospective follow-up study of 158 consecutive patients 18 to 64 years old with unilateral lower extremity fracture, our aim was to disclose the impairment and disability 6 months after the injury. The patients were interviewed within 1 week after the trauma, and all patients returned...... the functional status before the injury. Additionally, three major aspects of impairments were measured 6 months after the fractures: range of motion, muscle strength, and pain. Most patients had a significantly higher SIP score 6 months after the fracture(s) than pretraumatically. The mean overall SIP score...

  17. Configuration Management for eXtreme Programming

    DEFF Research Database (Denmark)

    Asklund, U.; Bendix, Lars Gotfred; Ekman, T.

    2003-01-01

    ) techniques. We report on our experience in providing many groups of novice developers with CM education, processes and tools to support the four CM-related XP practices in their projects. True to the spirit of XP both education and processes are very lightweight and we found that it was sufficient to focus......Extreme programming (XP) is a software development method that prescribes the use of 12 different practices. Four of these practices (collective code ownership, continuous integration, small releases and refactoring) can indeed be given good support by the use of simple configuration management (CM...

  18. Soft tissue sarcoma of the extremity.

    LENUS (Irish Health Repository)

    Cooper, T M

    2012-02-03

    A retrospective review of 33 cases of soft tissue sarcoma of the extremity presenting over a 10 year period was undertaken. The history, patterns of referral, diagnostic investigations, procedures undertaken and outcomes were studied. We found there was a frequent delay in diagnosis and sometimes misinterpretation of biopsy specimens. Patients were seen by a variety of specialists from disciplines such as general surgery, plastic surgery, orthopaedic surgery and rheumatology. Considerable progress has been made in the treatment of soft tissue sarcomas, often allowing local control of the tumour without amputation. We believe there should be early referral of patients having these tumours to a centre where a combined multidisciplinary approach can be undertaken.

  19. Extreme Precipitation and High-Impact Landslides

    Science.gov (United States)

    Kirschbaum, Dalia; Adler, Robert; Huffman, George; Peters-Lidard, Christa

    2012-01-01

    It is well known that extreme or prolonged rainfall is the dominant trigger of landslides; however, there remain large uncertainties in characterizing the distribution of these hazards and meteorological triggers at the global scale. Researchers have evaluated the spatiotemporal distribution of extreme rainfall and landslides at local and regional scale primarily using in situ data, yet few studies have mapped rainfall-triggered landslide distribution globally due to the dearth of landslide data and consistent precipitation information. This research uses a newly developed Global Landslide Catalog (GLC) and a 13-year satellite-based precipitation record from Tropical Rainfall Measuring Mission (TRMM) data. For the first time, these two unique products provide the foundation to quantitatively evaluate the co-occurence of precipitation and rainfall-triggered landslides globally. The GLC, available from 2007 to the present, contains information on reported rainfall-triggered landslide events around the world using online media reports, disaster databases, etc. When evaluating this database, we observed that 2010 had a large number of high-impact landslide events relative to previous years. This study considers how variations in extreme and prolonged satellite-based rainfall are related to the distribution of landslides over the same time scales for three active landslide areas: Central America, the Himalayan Arc, and central-eastern China. Several test statistics confirm that TRMM rainfall generally scales with the observed increase in landslide reports and fatal events for 2010 and previous years over each region. These findings suggest that the co-occurrence of satellite precipitation and landslide reports may serve as a valuable indicator for characterizing the spatiotemporal distribution of landslide-prone areas in order to establish a global rainfall-triggered landslide climatology. This research also considers the sources for this extreme rainfall, citing

  20. Radiation Hardened Electronics for Extreme Environments

    Science.gov (United States)

    Keys, Andrew S.; Watson, Michael D.

    2007-01-01

    The Radiation Hardened Electronics for Space Environments (RHESE) project consists of a series of tasks designed to develop and mature a broad spectrum of radiation hardened and low temperature electronics technologies. Three approaches are being taken to address radiation hardening: improved material hardness, design techniques to improve radiation tolerance, and software methods to improve radiation tolerance. Within these approaches various technology products are being addressed including Field Programmable Gate Arrays (FPGA), Field Programmable Analog Arrays (FPAA), MEMS Serial Processors, Reconfigurable Processors, and Parallel Processors. In addition to radiation hardening, low temperature extremes are addressed with a focus on material and design approaches.