WorldWideScience

Sample records for secondary hemophagocytic lymphohistiocytosis

  1. HEMOPHAGOCYTAL LYMPHOHISTIOCYTOSIS

    Directory of Open Access Journals (Sweden)

    M.A. Maschan

    2009-01-01

    Full Text Available Hemophagocytal lymphohistiocytosis is a rare and frequently fatal disorder of immune response regulation, based on defects of cell cytotoxicity and hyper production of pro inflammatory cytokines. This disease is devided to genetically determinate types of hemophagocytal lymphohistiocytosis and secondary hemophagocytal syndromes, associated to infections, malignant neoplasm, autoimmune disease and immunodeficiency. The article gives a brief description of pathogenesis, clinical symptoms, and methods of hemophagocytal lymphohistiocytosis treatment.Key words: hemophagocytal lymphohistiocytosis, immunosuppression, ciclosporin A, etoposide, dexamethasone.(Voprosy sovremennoi pediatrii — Current Pediatrics. 2009;8(3:66-75

  2. Hemophagocytic lymphohistiocytosis (HLH) secondary to disseminated histoplasmosis in the setting of Acquired Immunodeficiency Syndrome (AIDS).

    Science.gov (United States)

    Asanad, Samuel; Cerk, Brendan; Ramirez, Veronica

    2018-06-01

    Hemophagocytic lymphohistiocytosis (HLH) is a rare and aggressive disease involving immune system over-activation leading to hemophagocytosis. HLH requires early diagnosis and prompt treatment initiation, especially in patients with Acquired Immunodeficiency Syndrome (AIDS). We present a case of a middle-aged male with AIDS and renal failure, who developed HLH secondary to disseminated histoplasmosis. Etoposide chemotherapy as recommended by the HLH 2004 Guidelines was deferred and treatment focused instead on anti-fungal therapy. Anti-retroviral therapy followed thereafter.

  3. Mycobacterium iranicum bacteremia and hemophagocytic lymphohistiocytosis: a case report.

    Science.gov (United States)

    Grandjean Lapierre, Simon; Toro, Alexandre; Drancourt, Michel

    2017-08-08

    Mycobacterium iranicum has recently been recognised as an opportunistic human pathogen. Although infectious conditions represent frequent triggers for hemophagocytic lymphohistiocytosis, non-tuberculous mycobacterial infections are rarely associated with this entity. To this date, M. iranicum infection has never been reported in France, has never been associated with hemophagocytic lymphohistiocytosis and has never been found to be multi-resistant on standardized antimicrobial susceptibility testing. We report a case of a French Caucasian man with secondary hemophagocytic lymphohistiocytosis in the context of M. iranicum bacteraemia and Hodgkin's disease. We review available data concerning M. iranicum antimycobacterial susceptibility testing and treatment outcomes. We also review the association between hemophagocytic lymphohistiocytosis and non-tuberculous mycobacterial infections. Interpretation of M. iranicum positive cultures remains a clinical challenge and non-tuberculous mycobacterial infections need to be considered in secondary hemophagocytic lymphohistiocytosis differential diagnosis.

  4. Hemophagocytic lymphohistiocytosis: a case series of a Brazilian institution

    Directory of Open Access Journals (Sweden)

    Daniela Guimarães Rocha Ferreira

    2014-12-01

    Full Text Available Objective:To describe the clinical and laboratory presentation of hemophagocytic lymphohistiocytosis in children treated at a referral institution.Methods:A retrospective descriptive study was carried out of seven children diagnosed with hemophagocytic lymphohistiocytosis between 2010 and 2012. The criteria for diagnosis were those proposed by the Histiocyte Society. When indicated, immunochemotherapy was prescribed according to the HLH94 and HLH2004 protocols of the Histiocyte Society.Results:The patients' ages at diagnosis ranged from one month to nine years. All patients had splenomegaly, fever, anemia, thrombocytopenia, hyperferritinemia and hypertriglyceridemia. Bone marrow hemophagocytosis was detected in six patients. In six cases, infectious diseases triggered the syndrome. In two cases, associated with visceral leishmaniasis, remission was achieved after treatment of the underlying infection. Three patients, who had Epstein–Barr-related hemophagocytic lymphohistiocytosis, required treatment with immunochemotherapy. They are alive and in remission; one patient had symptoms of juvenile rheumatoid arthritis and another, who was suspected of having primary hemophagocytic lymphohistiocytosis, entered into remission after bone marrow transplantation. Two deaths (28.6% occurred in patients with suspected primary hemophagocytic lymphohistiocytosis; one whose clinical picture was triggered by cytomegalovirus infection did not respond to immunochemotherapy and the other died before any specific treatment was provided.Conclusion:As reported before, hemophagocytic lymphohistiocytosis has a multifaceted presentation with nonspecific signs and symptoms. In secondary forms, remission may be achieved by treating the underlying disease. In the primary forms, remission may be achieved with immunochemotherapy, but bone marrow transplantation is required for cure.

  5. Infection Associated Secondary Hemophagocytic Lymphohistiocytosis in Sepsis Syndromes - A Tip of an Iceberg.

    Science.gov (United States)

    Agarwal, Arun; Agarwal, Aakanksha

    2017-10-01

    Hemophagocytic lymphohistiocytosis (HLH) is a rare, underdiagnosed, fatal and devastating hyperinflammatory syndrome that has gained increasing recognition over the past decade. Patients with HLH present with clinical and laboratory evidence of uncontrolled inflammation. Delay in diagnosis and management inevitably leads to a rapidly progressive and fatal course. In this case series, we present 7 cases of secondary HLH (sHLH) in adults with their presentation, course, and outcomes. We retrospectively looked at the 7 cases of secondary HLH who were diagnosed and managed in our institute between January 2013 and august 2015. Medical records were retrieved from medical records department and data analyzed and tabulated. The median age at diagnosis was 35 years (age range 26-72 years). Diagnosis was based on HLH 2004 diagnostic criteria. We report profile of 7 adult patients with sHLH. All patients had a short history of illness (<2 weeks) and presented uniformly with prolonged fever, bi or trilineage cytopenia and multiorgan dysfunction syndrome (MODS) at admission or developed MODS during the course of their illness. None of them had prediagnosed HLH. All patients fulfilled 5 to 6 of 8 criteria as per HLH 2014 diagnostic criteria. The median length of hospital stay was 12 days (range 7-50 days) and the median time to diagnosis was 5 days (range 3 to 21 days). Mortality was 57%. HLH is a rare and under-diagnosed clinical syndrome and is rapidly fatal if not diagnosed and managed timely. The cases reported in literature probably represent a tip of an iceberg of large number of undiagnosed cases mostly labeled as sepsis with MODS in critical care units. sHLH should be suspected in any patient who present with persistent and prolonged fever, transaminitis, cytopenia, and high serum Ferritin or dramatically rising serial serum Ferritin. Early diagnosis and prompt aggressive treatment are vital for patients' survival and favorable outcome.

  6. Familial hemophagocytic lymphohistiocytosis in two Saudi siblings

    OpenAIRE

    Abbaker, Abdelakarim Ibrahim; Dammas, Ali Saeed

    2015-01-01

    Primary familial hemophagocytic lymphohistiocytosis (HLH; or familial erythrophagocytic lymphohistiocytosis [FEL]) is a heterogeneous autosomal recessive disorder more prevalent with parental consanguinity. There is aggressive proliferation of activated macrophages and histiocytes, which phagocytose red blood cells (RBCs), white blood cells (WBCs), and platelets, leading to anemia, neutropenia and thrombocytopenia. The exaggerated response of immune system in familial HLH can occur in the abs...

  7. Hemophagocytic Lymphohistiocytosis in Children: Pathogenesis and Treatment

    Science.gov (United States)

    Ishii, Eiichi

    2016-01-01

    Hemophagocytic lymphohistiocytosis (HLH) is a rare disorder in children that is characterized by persistent fever, splenomegaly with cytopenia, hypertriglyceridemia, and hypofibrinogenemia. Increased levels of various cytokines and soluble interleukin-2 receptor are biological markers of HLH. HLH can be classified into two major forms: primary and secondary. Familial hemophagocytic lymphohistiocytosis (FHL), a type of primary HLH, is an autosomal recessive disorder that typically occurs in infancy and can be classified into five different subtypes (FHL types 1–5). In Japan, >80% of patients with FHL have either PRF1 (FHL type 2) or UNC13D (FHL type 3) defects. FHL is considered to be a disorder of T-cell function because the activity of NK cells or cytotoxic T lymphocytes as target cells is usually impaired. Moreover, Epstein–Barr virus-associated HLH (EBV-HLH) is considered a major subtype of secondary HLH. Any genetic background could have an effect on the pathogenesis of secondary HLH because EBV-HLH is considered to be particularly prevalent in Asian countries. For primary HLH, hematopoietic stem cell transplantation is the only accepted curative therapy, although cord blood transplantation with a reduced-conditioning regimen has been used with superior outcomes. For secondary HLH, including EBV-HLH, immunochemotherapy based on the HLH-2004 protocol has been used. In the near future, the entire mechanism of HLH should be clarified to establish less toxic therapies, including cell therapy and gene targeting therapy. PMID:27242976

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

    Directory of Open Access Journals (Sweden)

    Katherine Devitt

    2014-01-01

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

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

    Science.gov (United States)

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

    2014-01-01

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

  10. Imaging characteristics of hemophagocytic lymphohistiocytosis

    International Nuclear Information System (INIS)

    Fitzgerald, Nancy E.; MacClain, Kenneth L.

    2003-01-01

    Hemophagocytic lymphohistiocytosis (HLH) is a nonmalignant disorder of immune regulation, with overproduction of cytokines and diminished immune surveillance. Symptoms are nonspecific and may affect multiple organs, including the central nervous system. Neuroimaging findings have been described in case reports and small series; body imaging findings have not been described extensively. To summarize findings of the most frequently performed imaging studies of the brain, chest and abdomen in patients with HLH. Retrospective review of chest radiographs and CT, abdominal ultrasound and CT, brain CT and MRI, skeletal surveys, and autopsy data. Twenty-five patients were diagnosed and treated for HLH at our institution over an 11-year period; 15 patients (60%) died. Common chest radiograph findings included alveolar-interstitial opacities with pleural effusions, often with rapid evolution and resolution. Hepatosplenomegaly, gallbladder wall thickening, hyperechoic kidneys and ascites were common abdominal findings, which resolved after therapy in some cases. Brain-imaging studies revealed nonspecific periventricular white-matter abnormalities, brain-volume loss and enlargement of extra-axial fluid spaces. Three infant cases, one with intracranial hemorrhage, one with multiple pathologic rib fractures and one with diaphyseal periosteal reaction involving multiple long bones on skeletal survey, raised suspicion of child abuse at presentation. Abuse was not substantiated in any case. Clinicians and radiologists should be aware of the radiographic manifestations of HLH, which are nonspecific and overlap with infectious, inflammatory and neoplastic disorders. Findings in the chest (similar to acute respiratory distress syndrome) and abdomen may progress rapidly and then regress with institution of appropriate anti-HLH therapy. CNS findings may be progressive. In some infants, initial imaging findings may mimic nonaccidental trauma. (orig.)

  11. Imaging characteristics of hemophagocytic lymphohistiocytosis

    Energy Technology Data Exchange (ETDEWEB)

    Fitzgerald, Nancy E. [E. B. Singleton Department of Diagnostic Imaging, Texas Children' s Hospital, 6621 Fannin Street, MC 2-2521, TX 77030, Houston (United States); MacClain, Kenneth L. [Texas Children' s Cancer Center, 6701 Fannin, Suite 1510, TX 77030, Houston (United States)

    2003-06-01

    Hemophagocytic lymphohistiocytosis (HLH) is a nonmalignant disorder of immune regulation, with overproduction of cytokines and diminished immune surveillance. Symptoms are nonspecific and may affect multiple organs, including the central nervous system. Neuroimaging findings have been described in case reports and small series; body imaging findings have not been described extensively. To summarize findings of the most frequently performed imaging studies of the brain, chest and abdomen in patients with HLH. Retrospective review of chest radiographs and CT, abdominal ultrasound and CT, brain CT and MRI, skeletal surveys, and autopsy data. Twenty-five patients were diagnosed and treated for HLH at our institution over an 11-year period; 15 patients (60%) died. Common chest radiograph findings included alveolar-interstitial opacities with pleural effusions, often with rapid evolution and resolution. Hepatosplenomegaly, gallbladder wall thickening, hyperechoic kidneys and ascites were common abdominal findings, which resolved after therapy in some cases. Brain-imaging studies revealed nonspecific periventricular white-matter abnormalities, brain-volume loss and enlargement of extra-axial fluid spaces. Three infant cases, one with intracranial hemorrhage, one with multiple pathologic rib fractures and one with diaphyseal periosteal reaction involving multiple long bones on skeletal survey, raised suspicion of child abuse at presentation. Abuse was not substantiated in any case. Clinicians and radiologists should be aware of the radiographic manifestations of HLH, which are nonspecific and overlap with infectious, inflammatory and neoplastic disorders. Findings in the chest (similar to acute respiratory distress syndrome) and abdomen may progress rapidly and then regress with institution of appropriate anti-HLH therapy. CNS findings may be progressive. In some infants, initial imaging findings may mimic nonaccidental trauma. (orig.)

  12. Hemophagocytic Lymphohistiocytosis Secondary to Unknown Underlying Hodgkin Lymphoma Presenting with a Cholestatic Pattern of Liver Injury

    Directory of Open Access Journals (Sweden)

    A.L. Booth

    2018-04-01

    Full Text Available Hemophagocytic lymphohistiocytosis (HLH is an uncommon disease that often presents with nonspecific findings. A high index of suspicion is necessary to make a prompt diagnosis and prevent fatal disease. A 45-year-old man presented with fever, hypotension, abdominal pain, nausea, and vomiting. Imaging showed hepatosplenomegaly and laboratory tests revealed pancytopenia, increased ferritin, and a cholestatic pattern of injury with elevated alkaline phosphatase and total bilirubin. Due to a history of Crohn disease, systemic lupus erythematous, and rheumatoid arthritis, the patient was on immunosuppressants, including infliximab. After multiple negative cultures, persistent fever, and days of empiric broad spectrum antibiotics, our differential shifted to fever of unknown origin. A liver wedge biopsy revealed areas of sinusoidal dilatation with enlarged, activated macrophages containing erythrocytes and intracytoplasmic iron, consistent with hemophagocytosis due to HLH. The portal tracts showed mixed lymphoplasmacytic inflammation, a prominent bile ductular reaction, periportal fibrosis, and scattered large cells with occasional binucleation and prominent nucleoli. These cells stained positive for Epstein-Barr virus encoding region in situ hybridization, PAX5, CD15, and CD30, and hepatic involvement by classic Hodgkin lymphoma was diagnosed and determined to be the cause of the HLH and cholestatic pattern of injury. Simultaneously, a bone marrow biopsy showed diffuse involvement by Hodgkin lymphoma with a similar staining pattern. Aggressive treatment failed and the patient succumbed to multiorgan failure. HLH is a rare, potentially fatal disease, with nonspecific signs and symptoms, and should be considered in any patient presenting with fever and pancytopenia, especially if they are immune compromised.

  13. Epstein–Barr Virus and Hemophagocytic Lymphohistiocytosis

    Directory of Open Access Journals (Sweden)

    Rebecca A. Marsh

    2018-01-01

    Full Text Available Epstein–Barr virus (EBV is a ubiquitous virus that infects nearly all people worldwide without serious sequela. However, for patients who have genetic diseases which predispose them to the development of hemophagocytic lymphohistiocytosis (HLH, EBV infection is a life-threatening problem. As a part of a themed collection of articles on EBV infection and human primary immune deficiencies, we will review key concepts related to the understanding and treatment of HLH.

  14. An unusual presentation of galactosemia: Hemophagocytic lymphohistiocytosis

    Directory of Open Access Journals (Sweden)

    Ahmet Afşin Kundak

    2012-12-01

    Full Text Available Hemophagocytic lymphohistiocytosis (HLH is a rare life-threatening condition. Uncontrolled proliferation of activated lymphocytes secreting high amounts of inflammatory cytokines seems to be the main pathogenesis. The diagnosis of HLH can often be difficult. It may presents in many forms such as fever of unknown origin, hepatitis, acute liver failure, and sepsis-like illness. Here we present a newborn galactosemia case presented with HLH. Close monitoring of the diagnostic criteria of HLH during the course of galactosemia-associated hemophagocytosis, both before and after dietary treatment, should be performed in order to fully determine if the triggering mechanism is infection or accumulation of metabolites.

  15. Neuromyelitis optica, atypical hemophagocytic lymphohistiocytosis and heterozygous perforin A91V mutation.

    Science.gov (United States)

    Palterer, Boaz; Brugnolo, Francesca; Sieni, Elena; Barilaro, Alessandro; Parronchi, Paola

    2017-10-15

    Neuromyelitis optica is an autoimmune demyelinating inflammatory disease characterized by optic neuritis and myelitis with anti-aquaporin 4 antibodies. Hemophagocytic lymphohistiocytosis is a severe systemic inflammatory syndrome that can present in a genetic primary form or secondarily to infective, neoplastic or autoimmune diseases. Our case discusses the first reported case of atypical late-onset hemophagocytic lymphohistiocytosis in a patient with neuromyelitis optica, with multiple triggering factors and carrying the common A91V hypomorphic perforin mutation, that blurs the distinction between primary and secondary forms. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. Neonatal-onset hemophagocytic lymphohistiocytosis associated with primary dengue infection

    Directory of Open Access Journals (Sweden)

    Madhumita Nandi

    2016-01-01

    Full Text Available A 40-day-old baby presented with prolonged fever, petechial spots, hepatosplenomegaly, generalized lymphadenopathy, and pancytopenia. Investigations revealed positive anti-dengue virus IgM antibody, and bone marrow examination demonstrated the presence of hemophagocytes. The diagnosis of hemophagocytic lymphohistiocytosis (HLH was made according to HLH-2004 guidelines. HLH associated with primary dengue in an infant who was symptomatic from neonatal age has hitherto not been reported in the literature.

  17. Typhoid Fever Complicated by Hemophagocytic Lymphohistiocytosis and Rhabdomyolysis.

    Science.gov (United States)

    Non, Lemuel R; Patel, Rupa; Esmaeeli, Amir; Despotovic, Vladimir

    2015-11-01

    Hemophagocytic lymphohistiocytosis (HLH) and rhabdomyolysis are rare complications of typhoid fever from Salmonella enterica serovar Typhi. Herein, we describe the clinical features in a 21-year-old female from India who presented to the intensive care unit with fever, severe pancytopenia, and rhabdomyolysis. © The American Society of Tropical Medicine and Hygiene.

  18. Successful management of a complicated clinical crisis: A patient with left-sided endocarditis and secondary hemophagocytic lymphohistiocytosis: a rare case report and literature review.

    Science.gov (United States)

    Xu, Peipei; Zeng, Hui; Zhou, Min; Ouyang, Jian; Chen, Bing; Zhang, Qiguo

    2017-12-01

    Hemophagocytic lymphohistiocytosis (HLH) secondary to methicillin-resistant Staphylococcus epidermidis (MRSE)-related left-sided infectious endocarditis had never been reported before. In the last decade, daptomycin, a novel lipopeptide antibiotic, showed its excellent role in anti-Gram-positive bacteria, including soft tissue infection, bloodstream and deep tissueinfection. An Asian women under sever condition due to the cooccurrence of HLH and MRSE-related endocarditis while also be allergic to vancomycin. The patient was cured by high-dose daptomycin monotheraphy, HLH-2004 protocol and cardiothoracic surgery to remove the valve at last, and was obviously benefit from the endeavor of a multidisciplinary team (MDT) strategy. IE was made on March 27according to the modified Duke criteria. HLH was diagnosed too. The patient was cured by high-dose daptomycin monotheraphy, HLH-2004 protocol and cardiothoracic surgery to remove the valve at last, and was obviously benefit from the endeavor of a multidisciplinary team (MDT) strategy. The patient was healthy andstable when we published this case. This case proves high-dose daptomycin monotheraphy could be used as an effective alternative regimen for vancomycin in treating MRSE-related left-sided endocarditis and highlight the importance of early diagnosis and appropriate management for HLH. Furthermore, our work suggests an MDT model as a practical strategy in managing similar clinical situation. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

  19. Wolman disease associated with hemophagocytic lymphohistiocytosis: attempts for an explanation.

    Science.gov (United States)

    Taurisano, Roberta; Maiorana, Arianna; De Benedetti, Fabrizio; Dionisi-Vici, Carlo; Boldrini, Renata; Deodato, Federica

    2014-10-01

    The lysosomal acid lipase (LAL) is the enzyme responsible of the hydrolysis of cholesteryl esters and triglycerides within endo-lysosomes. Loss of enzyme activity leads to accumulation of cholesteryl esters and triglycerides in the lysosome of most tissues. The complete deficiency of LAL is responsible of Wolman disease (WD), a severe systemic disease manifesting in the first days of life with vomiting, diarrhea, failure to thrive, hepatosplenomegaly, jaundice, anemia, and thrombocytopenia. Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening condition which may be genetically determined or secondary to infections, malignancies, immune deficiencies, and rheumatologic disorders. So far, some inborn errors of metabolism have been associated with HLH (e.g., lysinuric protein intolerance, Gaucher's disease), and it has been anecdotally described in three WD patients, without any specific pathogenetic hypothesis. Here, we report on a WD patient, showing clear clinical, biochemical, and histological features indicative of HLH. We discuss the pathophysiological role of cholesteryl ester-induced inflammasome activation in macrophages, leading to a secondary HLH. This case indicates that WD can cause secondary HLH and suggests that a careful metabolic workup should be performed when facing to a pediatric patient with HLH.

  20. Genetic predisposition to hemophagocytic lymphohistiocytosis: Report on 500 patients from the Italian registry

    OpenAIRE

    Cetica, Valentina; Sieni, Elena; Pende, Daniela; Danesino, Cesare; De Fusco, Carmen; Locatelli, Franco; Micalizzi, Concetta; Putti, Maria Caterina; Biondi, Andrea; Fagioli, Franca; Moretta, Lorenzo; Griffiths, Gillian M.; Luzzatto, Lucio; Aric?, Maurizio

    2016-01-01

    Background Hemophagocytic lymphohistiocytosis (HLH) is a rare life-threatening disease affecting mostly children but also adults and characterized by hyperinflammatory features. A subset of patients, referred to as having familial hemophagocytic lymphohistiocytosis (FHL), have various underlying genetic abnormalities, the frequencies of which have not been systematically determined previously. Objective This work aims to further our understanding of the pathogenic bases of this ra...

  1. Dengue fever as a cause of hemophagocytic lymphohistiocytosis.

    Science.gov (United States)

    Hein, Noely; Bergara, Gabriel Heiser; Moura, Nathalie Bianchini Vieira; Cardoso, Débora Morais; Hirose, Maki; Ferronato, Angela Espósito; Pastorino, Antônio Carlos; Lo, Denise Swei; Gilio, Alfredo Elias

    2015-01-01

    Dengue is endemic in more than 100 countries in Southeast Asia, the Americas, the western Pacific, Africa and the eastern Mediterranean regions. The virus is transmitted by Aedes mosquitoes. Dengue disease is the most prevalent arthropod-borne viral disease in humans and is a global and national public health concern in several countries. A seasonal pattern of dengue disease is consistently observed. The highest incidences usually correspond to the period of highest rainfall and humidity, providing suitable conditions for Aedes aegypti breeding and survival. In Brazil for instance it is from January to June. Dengue may cause marked changes in bone marrow that result in hypocellularity and, consequently, thrombocytopenia and leucopenia, along with an increase in hematocrit, which is secondary to capillary leakage. However, those abnormalities are usually self-limited, and do not warrant further investigations, such as a marrow biopsy or a myelogram. The occurrence of persistent reactive hemophagocytosis is uncommon and usually leads to serious adverse outcomes. The authors report the case of an 8-year old girl complaining of high-grade fever, malaise, headache, abdominal pain and a cutaneous rash. Laboratory examination revealed atypical lymphocytosis on peripheral blood count, hyperbilirrunemia, abnormal liver enzymes and clotting tests. Serology was positive for dengue. Because of the persistence of fever and laboratory examinations were consistent with hemophagocytic lymphohistiocytosis (HLH) a bone marrow aspiration was performed, which confirmed the presence of hemophagocytosis. Hence we report a rare presentation of dengue accompanied by self-limited HLH that hopefully evolve to favorable outcome.

  2. Genetics Home Reference: familial hemophagocytic lymphohistiocytosis

    Science.gov (United States)

    ... lymphohistiocytosis. Haematologica. 2010 Apr;95(4):538-41. doi: 10.3324/haematol.2009.019562. Citation on PubMed ... Clin Immunol. 2011 Dec;11(6):512-6. doi: 10.1097/ACI.0b013e32834c22f5. Review. Citation on PubMed ...

  3. Spontaneous Escherichia coli Meningitis Associated with Hemophagocytic Lymphohistiocytosis

    Directory of Open Access Journals (Sweden)

    Kuo-Hsuan Chang

    2006-01-01

    Full Text Available Spontaneous Escherichia coli meningitis has not been previously reported in association with hemophago-cytic lymphohistiocytosis (HLH. A previously healthy 72-year-old woman was admitted due to fever, nuchal rigidity, disturbed consciousness and splenomegaly. Anemia, thrombocytopenia and hyperfer-ritinemia developed on the 8th day of hospitalization. Cultures of cerebrospinal fluid and blood grew E. coli. Abundant macrophages overwhelmed erythrocytes in the bone marrow aspirate, confirming the presence of hemophagocytosis. E. coli meningitis was managed with a 40-day course of antibiotic treatment. However, the severity of anemia and thrombocytopenia progressed despite intensive transfusion therapy. The patient died of HLH on the 60th day of hospitalization.

  4. Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis: response to HLH-04 treatment protocol.

    Science.gov (United States)

    Jiménez-Hernández, Elva; Martínez-Villegas, Octavio; Sánchez-Jara, Berenice; Martínez-Martell, María Angélica; Hernández-Sánchez, Beatriz; Loza-Santiaguillo, Paloma Del Rocío; Pedro-Matías, Eduardo; Arellano-Galindo, José

    Hemophagocytic syndrome, macrophage activation syndrome, reactive histiocytosis or hemophagocytic lymphohistiocytosis (HLH) represent a group of diseases whose common thread is reactive or neoplastic mononuclear phagocytic system cells and dendritic cell proliferation. We present a case of an HLH probably associated with Epstein-Barr virus (EBV) in a 4-year-old male patient treated with HLH-04 protocol. Viral etiology in HLH is well accepted. In this case, clinical picture of HLH was assumed secondary to EBV infection because IgM serology at the time of clinical presentation was the only positive factor in the viral panel. Diagnosis of HLH is the critical first step to successful treatment. The earlier it is identified, the less the tissue damage and reduced risk of multiple organ failure, which favors treatment response. Copyright © 2016 Hospital Infantil de México Federico Gómez. Publicado por Masson Doyma México S.A. All rights reserved.

  5. ANCA Vasculitis and Hemophagocytic Lymphohistiocytosis following a Fecal Microbiota Transplant

    Directory of Open Access Journals (Sweden)

    Adam Amlani

    2018-01-01

    Full Text Available A 69-year-old female with antisynthetase syndrome, a history of multiple recurrent infections, and documented previous negative titres for anti-neutrophil cystoplasmic antibody (ANCA suddenly developed a de novo MPO-ANCA-associated glomerulonephritis three weeks after a fecal microbiota transplantation (FMT for recurrent Clostridium difficile infections. Six months following her FMT and less than two weeks following treatment for urosepsis, she developed severe cholestasis, a markedly elevated ferritin and hypertriglyceridemia. An initial liver biopsy was suggestive of drug-induced liver injury and thus she was treated with supportive care. After she failed to improve, a second liver biopsy supported the diagnosis of hemophagocytic lymphohistiocytosis (HLH. This case highlights difficulties surrounding the early diagnosis of HLH and also questions the role of FMT and/or recurrent infections as a trigger for ANCA-associated vasculitis.

  6. CNS Involvement in Hemophagocytic Lymphohistiocytosis: CT and MR Findings

    International Nuclear Information System (INIS)

    Chung, Tae Woong

    2007-01-01

    Hemophagocytic lymphohistiocytosis (HLH) is a rare disorder that is characterized by proliferation of benign histiocytes, and this commonly involves the liver, spleen, lymph nodes, bone marrow and central nervous system (CNS). We report here on the CT and MR imaging findings in a case of CNS HLH that showed multiple ring enhancing masses mimicking abscess or another mass on the CT and MR imaging. emophagocytic lymphohistiocytosis (HLH) is a rare disorder that is characterized by nonmalignant diffuse infiltration of multiple organs, including the central nervous system (CNS), by lymphocytes and histiocytes (1). Many radiologic reports describing diffuse white matter infiltrations, parenchymal atrophy and calcification have been published, but the characteristics of these findings remain non-specific, especially in immunocompromised patients. We present here a case of HLH in a 3-year-old boy who presented with multiple ring enhancing lesions involving the brain. In conclusion, although the CT and MRI findings of HLH with ring enhancing parenchymal lesions are nonspecific and mimic abscess, and especially in the immunosuppressed patients, increased diffusion at the center on DWI may be a finding of HLH to differentiate it from abscess, which has restricted diffusion at the center. However, the pathologic correlation with DWI according to the lesion stage certainly needs further study with a larger number of patients

  7. A case of hemophagocytic lymphohistiocytosis presenting as pyrexia of unknown origin

    Directory of Open Access Journals (Sweden)

    Indira Madhavan

    2015-01-01

    Full Text Available Hemophagocytic lymphohistiocytosis (HLH is a potentially fatal hyper inflammatory condition, which occurs as either primary (genetic or secondary (acquired due to impaired or absent function of natural killer cells and cytotoxic cells. Common secondary causes include viral and bacterial infections, autoimmune diseases, and hematological malignancies. Extensive phagocytosis of blood cells by histiocytes in bone marrow, spleen, liver and lymphnodes result in peripheral blood cytopenias, hepatosplenomegaly, and lymphadenopathy. We evaluated a case of pyrexia of unknown origin and found out that he fulfilled the criteria for diagnosing HLH. He was started on immunochemotherapy with etoposide, cyclosporine and steroids, but he succumbed to illness within 2 weeks of treatment. High index of suspicion is needed to diagnose HLH and prompt treatment on diagnosis can be lifesaving.

  8. Hemophagocytic lymphohistiocytosis preceded by Kikuchi disease in children

    International Nuclear Information System (INIS)

    Lim, Gye-Yeon; Cho, Bin; Chung, Nak Gyun

    2008-01-01

    Kikuchi disease (KD) is a type of benign, self-limiting lymphadenitis, but it has also been associated with hemophagocytic lymphohistiocytosis (HLH). To date, only a few reports have suggested an association between HLH and KD. To report the imaging findings and clinical characteristics of KD accompanied by HLH in children. Five children with a prolonged fever and cervical lymphadenopathy were diagnosed as having HLH accompanied by KD. The authors retrospectively analyzed the clinical characteristics and the imaging findings in these children. The histology of excision biopsy samples of cervical lymph nodes in all children confirmed the diagnosis of KD. HLH was confirmed by bone marrow biopsy and laboratory criteria provided by the Histiocyte Society. The greatest dimension of the enlarged nodes ranged from 0.5 cm to 2.5 cm and the nodes were most frequently located at level V. CT scans visualized perinodal infiltrates in most of the affected cervical nodes (four of five children) and extracervical nodes (three of three children). On enhanced CT scans, nonenhancing necrosis within the affected cervical nodes was noted in three children. KD might be related to HLH in children. Systemic evaluations and follow-up of children with KD might help to identify HLH related to KD. (orig.)

  9. Presentation of hemophagocytic lymphohistiocytosis due to a novel MUNC 13–4 mutation masked by partial therapeutic immunosuppression

    Directory of Open Access Journals (Sweden)

    Garrett Jackie P-D

    2012-05-01

    Full Text Available Abstract Hemophagocytic lymphohistiocytosis is a potentially fatal disease characterized by excessive macrophage and lymphocyte activity. Patients can be affected following immune activation after an oncologic, autoimmune or infectious trigger. An associated gene mutation may be found which impairs cytolytic lymphocyte function. We describe a pediatric case of hemophagocytic lymphohistiocytosis with a novel mutation of MUNC 13–4 whose diagnosis was confounded by concurrent immunosuppression. Clinical reassessment for hemophagocytic lymphohistiocytosis is necessary in persistently febrile patients with laboratory derangements in the setting of immunosuppressive agent exposure.

  10. Cytophagic histiocytic panniculitis, hemophagocytic lymphohistiocytosis and undetermined autoimmune disorder: reconciling the puzzle.

    Science.gov (United States)

    Pasqualini, Claudia; Jorini, Mauro; Carloni, Ines; Giangiacomi, Mirella; Cetica, Valentina; Aricò, Maurizio; de Benedictis, Fernando Maria

    2014-02-13

    Cytophagic histiocytic panniculitis is a rare disease, associated with either nonmalignant conditions or subcutaneous panniculitis-like T-cell lymphoma, and often also associated with hemophagocytic lymphohistiocytosis (HLH). We report the case of a 11-year-old boy with a history of secondary HLH who, after a local trauma, developed a painful, indurated plaque over the right thigh associated with relapsing HLH. Histopathologic findings from skin biopsy specimens revealed significant lobular panniculitis with benign histiocytes showing hemophagocytosis. High-dose intravenous methylprednisolone and cyclosporine A treatment was highly effective. A genetic study after a new, relapsing episode of HLH revealed an heterozygous missense mutation on STX 11 gene inherited from the mother.

  11. Germline heterozygous variants in genes associated with familial hemophagocytic lymphohistiocytosis as a cause of increased bleeding

    DEFF Research Database (Denmark)

    Fager Ferrari, Marcus; Leinoe, Eva; Rossing, Maria

    2018-01-01

    Familial hemophagocytic lymphohistiocytosis (FHL) is caused by biallelic variants in genes regulating granule secretion in cytotoxic lymphocytes. In FHL3-5, the affected genes UNC13D, STX11 and STXBP2 have further been shown to regulate the secretion of platelet granules, giving rise to compromised...

  12. Fulminant hemophagocytic lymphohistiocytosis induced by pandemic A (H1N1 influenza: a case report

    Directory of Open Access Journals (Sweden)

    Wacrenier Agnès

    2011-07-01

    Full Text Available Abstract Introduction Hemophagocytic lymphohistiocytosis induced by viral diseases is a well recognized entity. Severe forms of H5N1 influenza are known to be associated with symptoms very similar to a reactive hemophagocytic syndrome. We report a case of fulminant lymphohistiocytosis associated with the pandemic A (H1N1 variant. Case presentation A 42-year-old Caucasian woman developed a syndrome of fatal hemophagocytic lymphohistiocytosis shortly after H1N1 influenza. Initial symptoms of the viral disease were unusual, with acute abdominal involvement. Our patient's course was complicated by diffuse skin rash and ileal ischemia. Our patient died of refractory shock and multi-organ failure. Skin, ileum and colon histology was consistent with an acute apoptosis combined with an increased cellular regeneration. Conclusions Influenza may be complicated by severe forms of hemophagocytic lymphohistiocytosis. To ensure early recognition and treatment, physicians should be aware of the possible induction of the syndrome by the novel H1N1 variant. The rapid occurrence of a multi-organ involvement with evocative biological features of macrophage activation should alert clinicians.

  13. Diagnosing XLP1 in patients with hemophagocytic lymphohistiocytosis.

    Science.gov (United States)

    Meazza, Raffaella; Tuberosa, Claudia; Cetica, Valentina; Falco, Michela; Parolini, Silvia; Grieve, Sam; Griffiths, Gillian M; Sieni, Elena; Marcenaro, Stefania; Micalizzi, Concetta; Montin, Davide; Fagioli, Franca; Moretta, Alessandro; Mingari, Maria C; Moretta, Lorenzo; Notarangelo, Luigi D; Bottino, Cristina; Aricò, Maurizio; Pende, Daniela

    2014-12-01

    Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening, heterogeneous, hyperinflammmatory disorder. Prompt identification of inherited forms resulting from mutation in genes involved in cellular cytotoxicity can be crucial. X-linked lymphoproliferative disease 1 (XLP1), due to mutations in SH2D1A (Xq25) encoding signaling lymphocyte activation molecule-associated protein (SAP), may present with HLH. Defective SAP induces paradoxical inhibitory function of the 2B4 coreceptor and impaired natural killer (NK) (and T) cell response against EBV-infected cells. To characterize a cohort of patients with HLH and XLP1 for SAP expression and 2B4 function in lymphocytes, proposing a rapid diagnostic screening to direct mutation analysis. We set up rapid assays for 2B4 function (degranulation or (51)Cr-release) to be combined with intracellular SAP expression in peripheral blood NK cells. We studied 12 patients with confirmed mutation in SH2D1A and some family members. The combined phenotypic/functional assays allowed efficient and complete diagnostic evaluation of all patients with XLP1, thus directing mutation analysis and treatment. Nine cases were SAP(-), 2 expressed SAP with mean relative fluorescence intensity values below the range of healthy controls (SAP(dull)), and 1, carrying the R55L mutation, was SAP(+). NK cells from all patients showed inhibitory 2B4 function and defective killing of B-EBV cells. Carriers with SH2D1A mutations abolishing SAP expression and low percentage of SAP(+) cells showed neutral 2B4 function at the polyclonal NK cell level. Three novel SH2D1A mutations have been identified. Study of SAP expression is specific but may have insufficient sensitivity for screening XLP1 as a single tool. Combination with 2B4 functional assay allows identification of all cases. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. All rights reserved.

  14. Genetic predisposition to hemophagocytic lymphohistiocytosis: Report on 500 patients from the Italian registry.

    Science.gov (United States)

    Cetica, Valentina; Sieni, Elena; Pende, Daniela; Danesino, Cesare; De Fusco, Carmen; Locatelli, Franco; Micalizzi, Concetta; Putti, Maria Caterina; Biondi, Andrea; Fagioli, Franca; Moretta, Lorenzo; Griffiths, Gillian M; Luzzatto, Lucio; Aricò, Maurizio

    2016-01-01

    Hemophagocytic lymphohistiocytosis (HLH) is a rare life-threatening disease affecting mostly children but also adults and characterized by hyperinflammatory features. A subset of patients, referred to as having familial hemophagocytic lymphohistiocytosis (FHL), have various underlying genetic abnormalities, the frequencies of which have not been systematically determined previously. This work aims to further our understanding of the pathogenic bases of this rare condition based on an analysis of our 25 years of experience. From our registry, we have analyzed a total of 500 unselected patients with HLH. Biallelic pathogenic mutations defining FHL were found in 171 (34%) patients; the proportion of FHL was much higher (64%) in patients given a diagnosis during the first year of life. Taken together, mutations of the genes PRF1 (FHL2) and UNC13D (FHL3) accounted for 70% of cases of FHL. Overall, a genetic diagnosis was possible in more than 90% of our patients with FHL. Perforin expression and the extent of degranulation have been more useful for diagnosing FHL than hemophagocytosis and the cytotoxicity assay. Of 281 (56%) patients classified as having "sporadic" HLH, 43 had monoallelic mutations in one of the FHL-defining genes. Given this gene dosage effect, FHL is not strictly recessive. We suggest that the clinical syndrome HLH generally results from the combined effects of an exogenous trigger and genetic predisposition. Within this combination, different weights of exogenous and genetic factors account for the wide disease spectrum that ranges from HLH secondary to severe infection to FHL. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

  15. High Level of Perforin Expression Is Required for Effective Correction of Hemophagocytic Lymphohistiocytosis

    OpenAIRE

    Tiwari, Swati; Hontz, Adrianne; Terrell, Catherine E.; Arumugam, Paritha; Carmo, Marlene; Risma, Kimberly; Jordan, Michael; Malik, Punam

    2016-01-01

    Perforin-1 mutations result in a potentially fatal hemophagocytic lymphohistiocytosis (HLH) with heightened immune activation, hypercytokinemia, pancytopenia, and end-organ damage. At present, hematopoietic stem cell (HSC) transplantation is curative, but limited by donor availability and associated mortality, making gene therapy an attractive alternative approach for HLH. We reported that perforin expression driven by cellular promoters in lentiviral (LV) vectors resulted in significant, alb...

  16. Epstein-Barr virus induced hemophagocytic lymphohistiocytosis in X-linked lymphoproliferative disease

    Directory of Open Access Journals (Sweden)

    Senthilkumar Sankararaman

    2014-01-01

    Full Text Available X-linked lymphoproliferative disease (XLP is a rare, often fatal genetic disorder characterized by extreme vulnerability to Epstein-Barr virus (EBV. EBV-induced hemophagocytic lymphohistiocytosis (HLH is a known presentation in XLP. In EBV-induced HLH in XLP, the brain imaging findings in the acute phase include a non specific pattern. In this report, we highlight the magnetic resonance imaging and magnetic resonance spectroscopy findings in a child with EBV induced HLH in XLP.

  17. Epstein-Barr Virus-Associated Hemophagocytic Lymphohistiocytosis and Guillain-Barre Syndrome in a 16-Month-Old Child

    Directory of Open Access Journals (Sweden)

    Motohiro Matsui MD

    2016-03-01

    Full Text Available A 16-month-old girl was diagnosed with Epstein-Barr virus hemophagocytic lymphohistiocytosis and transferred to our hospital on the 58th day of the hemophagocytic lymphohistiocytosis after treatment failure according to the Hemophagocytic Lymphohistiocytosis-2004 protocol. On admission to our hospital, she had a flaccid paralysis of her lower limbs. Nerve conduction studies showed a acute motor axonal neuropathy, and a diagnosis of Guillain-Barre syndrome was established. Intravenous immunoglobulin G was started on the 57th day of the Guillain-Barre syndrome. To date, her neurological recovery is incomplete. For hemophagocytic lymphohistiocytosis, after treatment failure of THP-COP regimen (pirarubicin, cyclophosphamide, vincristine, and prednisone and 2 courses of ESCAP regimen (etoposide, prednisone, cytarabine, L-asparaginase, we are now in the process of coordinating unrelated umbilical cord blood transplantation. To the best of our knowledge, we report the youngest case of Guillain-Barre syndrome accompanied by Epstein-Barr virus hemophagocytic lymphohistiocytosis. Rapid progression of Guillain-Barre syndrome, the electrophysiological subtype of Guillain-Barre syndrome, and treatment delay possibly led to poor neurological outcome.

  18. Epstein-Barr Virus-Associated Hemophagocytic Lymphohistiocytosis and Guillain-Barre Syndrome in a 16-Month-Old Child.

    Science.gov (United States)

    Matsui, Motohiro; Shimizu, Mariko; Ioi, Aya; Mayumi, Azusa; Higuchi, Kohei; Sawada, Akihisa; Sato, Maho; Yasui, Masahiro; Yanagihara, Keiko; Inoue, Masami

    2016-01-01

    A 16-month-old girl was diagnosed with Epstein-Barr virus hemophagocytic lymphohistiocytosis and transferred to our hospital on the 58th day of the hemophagocytic lymphohistiocytosis after treatment failure according to the Hemophagocytic Lymphohistiocytosis-2004 protocol. On admission to our hospital, she had a flaccid paralysis of her lower limbs. Nerve conduction studies showed a acute motor axonal neuropathy, and a diagnosis of Guillain-Barre syndrome was established. Intravenous immunoglobulin G was started on the 57th day of the Guillain-Barre syndrome. To date, her neurological recovery is incomplete. For hemophagocytic lymphohistiocytosis, after treatment failure of THP-COP regimen (pirarubicin, cyclophosphamide, vincristine, and prednisone) and 2 courses of ESCAP regimen (etoposide, prednisone, cytarabine, L-asparaginase), we are now in the process of coordinating unrelated umbilical cord blood transplantation. To the best of our knowledge, we report the youngest case of Guillain-Barre syndrome accompanied by Epstein-Barr virus hemophagocytic lymphohistiocytosis. Rapid progression of Guillain-Barre syndrome, the electrophysiological subtype of Guillain-Barre syndrome, and treatment delay possibly led to poor neurological outcome.

  19. Hemophagocytic lymphohistiocytosis caused by primary Epstein-Barr virus in patient with Crohn's disease.

    Science.gov (United States)

    Virdis, Francesco; Tacci, Sara; Messina, Federico; Varcada, Massimo

    2013-11-27

    We present a case of a 19-year-old man with a 6-year history of Crohn's disease (CD), previously treated with 6-mercaptopurine, who was admitted to our department for Epstein-Barr virus (EBV) infection and subsequently developed a hemophagocytic lymphohistiocytosis (HLH). HLH is a rare disease which causes phagocytosis of all bone marrow derived cells. It can be a primary form as a autosomic recessive disease, or a secondary form associated with a variety of infections; EBV is the most common, the one with poorer prognosis. The incidence of lymphoproliferative disorders was increased in patients with inflammatory bowel disease (IBD) treated with thiopurines. Specific EBV-related clinical and virological management should be considered when treating a patient with IBD with immunosuppressive therapy. Moreover EBV infection in immunosuppressed patient can occur with more aggressive forms such as encephalitis and diffuse large B cell lymphoma. Our case confirms what is described in the literature; patients with IBD, particularly patients with CD receiving thiopurine therapy, who present 5 d of fever and cervical lymphadenopathy or previous evidence of lymphopenia should be screened for HLH.

  20. Poor outcomes of chronic active Epstein-Barr virus infection and hemophagocytic lymphohistiocytosis in non-Japanese adult patients

    NARCIS (Netherlands)

    Sonke, Gabe S.; Ludwig, Inge; van Oosten, Hannah; Baars, Joke W.; Meijer, Ellen; Kater, Arnon P.; de Jong, Daphne

    2008-01-01

    Chronic active Epstein-Barr virus infection manifests as a combination of persistent infectious mononucleosis-like symptoms and high viral load in apparently immunocompetent patients. It is closely related to Epstein-Barr virus associated hemophagocytic lymphohistiocytosis. These 2 abnormal

  1. Poor outcomes of chronic active Epstein-Barr virus infection and hemophagocytic lymphohistiocytosis in non-Japanese adult patients

    NARCIS (Netherlands)

    G.S. Sonke (Gabe); I. Ludwig (Inge); H. van Oosten (Hannah); J.W. Baars (Joke); E. Meijer (Ellen); A.P. Kater (Arnon); D. de Jong (Daphne)

    2008-01-01

    textabstractChronic active Epstein-Barr virus infection manifests as a combination of persistent infectious mononucleosis-like symptoms and high viral load in apparently immunocompetent patients. It is closely related to Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis. These 2

  2. EBV-Associated Lymphoproliferative Disorder and Hemophagocytic Lymphohistiocytosis in a Patient with Severe Celiac Disease

    Directory of Open Access Journals (Sweden)

    John Jacob Kinross-Wright

    2018-01-01

    Full Text Available Background. Epstein-Barr virus- (EBV- associated lymphoproliferative disease (LPD is a rare condition, usually occurring in immunocompromised patients. We report a case of EBV-associated LPD in a patient with severe celiac disease, the first report to describe this syndrome in a patient with this diagnosis. Case Summary. A 69-year-old Caucasian woman with recent diagnosis of celiac sprue presented to our hospital with persistent diarrhea, abdominal pain, weight loss, and fatigue despite adherence to gluten-free diet for a number of weeks prior to presentation. She underwent evaluation for occult malignancy and was found to have diffuse intra-abdominal mesenteric lymphadenopathy on CT scan. Biopsy of mesenteric nodes revealed an EBV positive, CD20 positive mixed lymphoproliferative process with T-cell predominance, but without a monoclonal cell population felt to be consistent with EBV-associated LPD. Bone marrow biopsy revealed hemophagocytic lymphohistiocytosis, complicating her course. She was treated with steroids and rituximab but continued to decline, eventually developing MSSA bacteremia and succumbing to her disease. Conclusion. To our knowledge, this is the first report of the constellation of celiac sprue, EBV-associated LPD, and hemophagocytic lymphohistiocytosis. Providers caring for patients with severe, uncontrolled celiac disease and adenopathy should consider EBV-associated LPD.

  3. Spectrum of clinical presentations in familial hemophagocytic lymphohistiocytosis type 5 patients with mutations in STXBP2

    DEFF Research Database (Denmark)

    Meeths, Marie; Entesarian, Miriam; Al-Herz, Waleed

    2010-01-01

    Hemophagocytic lymphohistiocytosis (HLH) is an often-fatal hyperinflammatory syndrome characterized by fever, hepatosplenomegaly, cytopenia, and in some cases hemophagocytosis. Here, we describe the mutation analysis, clinical presentation, and functional analysis of natural killer (NK) cells...... (FHL), the clinical findings included colitis, bleeding disorders, and hypogammaglobulinemia in approximately one-third of the patients. Laboratory analysis revealed impairment of NK-cell degranulation and cytotoxic capacity. Interleukin-2 stimulation of lymphocytes in vitro rescued the NK cell......-associated functional defects. In conclusion, familial HLH type 5 is associated with a spectrum of clinical symptoms, which may be a reflection of impaired expression and function of Munc18-2 also in cells other than cytotoxic lymphocytes. Mutations in STXBP2 should thus also be considered in patients with clinical...

  4. Etoposide-containing conditioning regimen reduces the occurrence of hemophagocytic lymphohistiocytosis after SCT.

    Science.gov (United States)

    Kobayashi, R; Tanaka, J; Hashino, S; Ota, S; Torimoto, Y; Kakinoki, Y; Yamamoto, S; Kurosawa, M; Hatakeyama, N; Haseyama, Y; Sakai, H; Sato, K; Fukuhara, T

    2014-02-01

    Hemophagocytic lymphohistiocytosis (HLH) is a rare life-threatening disease of severe hyperinflammation caused by uncontrolled proliferation of activated lymphocytes and macrophages that secrete high amounts of inflammatory cytokines. HLH occurring after SCT is difficult to diagnose. It is characterized by severe clinical manifestations and high mortality. Despite current therapeutic approaches, outcomes remain poor. We analyzed the incidence and risk factors of HLH after SCT and the response to treatment and prognosis of 554 patients with HLH after SCT. The cumulative incidence of HLH after SCT was 4.3% (24/554). Use of etoposide in the conditioning regimen was only factor that reduced HLH after SCT (P=0.027). All patients who received autologous transplantation were successfully treated. Patients with liver dysfunction (for example, high total bilirubin level, prolonged prothrombin time and high level of fibrinogen degradation products) had a poor response to treatment for HLH. Physicians should be cautious of HLH, while not using etoposide for conditioning regimen.

  5. Poor outcomes of chronic active Epstein-Barr virus infection and hemophagocytic lymphohistiocytosis in non-Japanese adult patients

    OpenAIRE

    Sonke, Gabe; Ludwig, Inge; Oosten, Hannah; Baars, Joke; Meijer, Ellen; Kater, Arnon; Jong, Daphne

    2008-01-01

    textabstractChronic active Epstein-Barr virus infection manifests as a combination of persistent infectious mononucleosis-like symptoms and high viral load in apparently immunocompetent patients. It is closely related to Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis. These 2 abnormal Epstein-Barr virus-associated diseases are seldom reported in individuals other than Japanese children and adolescents. We report a series of 2 adult non-Japanese patients with fatal chronic ac...

  6. Domestic dengue infection with hemophagocytic lymphohistiocytosis successfully treated by early steroid therapy.

    Science.gov (United States)

    Yoshifuji, Kota; Oshina, Takahiro; Sonokawa, Saeko; Noguchi, Yuma; Suzuki, Sayaka; Tanaka, Keisuke; Kumagai, Takashi

    2016-07-01

    A 34-year-old man, working at a park in Tokyo, Japan, was repeatedly bitten by mosquitoes while cutting grass. He was hospitalized with sudden fever, fatigue, and weakness. He was eventually diagnosed with dengue virus infection, detected using reverse transcription polymerase chain reaction for the genome and by the presence of nonstructural protein 1 in his peripheral blood. Symptomatic treatments such as acetaminophen for the fever were not effective. Moreover, peripheral blood examination showed drastically decreased white blood cells and platelets, as well as marked elevations of ferritin and soluble interleukin 2 receptor. Furthermore, bone marrow examination revealed increased macrophages with hemophagocytosis. Dengue infection with hemophagocytic lymphohistiocytosis (HLH) was ultimately diagnosed. Half-dose steroid pulse therapy for three days dramatically reduced his temperature, thereby ameliorating physical symptoms and restoring normal peripheral blood data. He was discharged 12 days after admission. Dengue infection with HLH is rare and this is the first report, to our knowledge, of domestic dengue infection with HLH in Japan. Early steroid therapy may be effective in such cases.

  7. Hemophagocytic Lymphohistiocytosis after EBV reactivation and ibrutinib treatment in relapsed/refractory Chronic Lymphocytic Leukemia”

    Directory of Open Access Journals (Sweden)

    Maurizio Cavallari

    2017-01-01

    Full Text Available Hemophagocytic Lymphohistiocytosis (HLH is a rare syndrome characterized by ineffective T-cell and NK response. We report the clinical course of a patient with relapsed CLL who developed acute symptoms soon after starting ibrutinib. Hyperpyrexia, splenomegaly, hyperferritinemia, hypertriglyceridemia, cytopenias, and a typical cytokine pattern, i.e. high interleukin (IL−6, IL10 and IL18, were consistent with a diagnosis of HLH. Coexistent Epstein Barr virus reactivation was documented. Ibrutinib-induced impairment of NK degranulation, associated with EBV reactivation and CLL-related immunodeficiency may have contributed to the development of HLH in our patient.

  8. Incidence and Risk Factors for Developing Dengue-Associated Hemophagocytic Lymphohistiocytosis in Puerto Rico, 2008 - 2013

    Science.gov (United States)

    Ellis, Esther M.; Pérez-Padilla, Janice; González, Liza; Poole-Smith, B. Katherine; Lebo, Emmaculate; Baker, Charlotte; Delorey, Mark J.; Torres-Velasquez, Brenda; Ochoa, Eduardo; Rivera-Garcia, Brenda; Díaz-Pinto, Hector; Clavell, Luis; Puig-Ramos, Anabel; Janka, Gritta E.; Tomashek, Kay M.

    2016-01-01

    Background Hemophagocytic lymphohistiocytosis (HLH) is a rare, potentially fatal disorder characterized by fever, pancytopenia, hepatosplenomegaly, and increased serum ferritin. HLH is being increasingly reported as a complication of dengue, a common tropical acute febrile illness. Methodology/Principal Findings After a cluster of pediatric dengue-associated HLH patients was identified during the 2012–2013 dengue epidemic in Puerto Rico, active surveillance and a case-control investigation was conducted at four referral hospitals to determine the incidence of HLH in children and identify risk factors for HLH following dengue. Patients with dengue-associated HLH (cases) were matched by month of illness onset and admission hospital to dengue patients that did not develop HLH (controls). During 2008–2013, a total of 33 HLH patients were identified, of which 22 (67%) were associated with dengue and 1 died (dengue-associated HLH case-fatality rate: 4.5%). Two patients with dengue-associated HLH had illness onset in 2009, none had illness onset during the 2010 dengue epidemic, and 20 had illness onset during the 2012–2013 epidemic. Frequency of infection with either dengue virus (DENV)-1 or DENV-4 did not differ between cases and controls. Cases were younger than controls (median age: 1 vs. 13 years, p dengue-associated HLH cases that was temporally associated with the 2012–2013 epidemic, most patients with dengue-associated HLH were infants and had higher morbidity than dengue inpatients. Physicians throughout the tropics should be aware of HLH as a potential complication of dengue, particularly in patients with anemia and severe liver injury. PMID:27556807

  9. Splenectomy as a treatment for adults with relapsed hemophagocytic lymphohistiocytosis of unknown cause.

    Science.gov (United States)

    Jing-Shi, Wang; Yi-Ni, Wang; Lin, Wu; Zhao, Wang

    2015-05-01

    Our aim was to evaluate the clinical value of splenectomy as a treatment for relapsed hemophagocytic lymphohistiocytosis (HLH) of unknown cause in adults. We retrospectively reviewed the clinical data from medical records of 19 adults with relapsed HLH of unknown cause treated with splenectomy in our institution from June 2007 to March 2014. To rule out possible underlying diseases, including infection, autoimmune disease, neoplasms, and primary HLH, the patients had undergone examinations including F18 fluoro-2-deoxyglucose positron emission tomography/computed tomography, HLH-associated gene defects, and lymph node biopsies. Twelve patients (63.2%) achieved partial responses (PR), whereas seven patients (36.8%) had no response (NR) prior to splenectomy. Infection and hemorrhage were the main complications of splenectomy. Eighteen cases were evaluable after follow-up. Seven cases with histopathologic diagnoses of lymphoma had received chemotherapy, four of whom had achieved complete responses (CR), one PR, and two NR. Maintenance treatment was ceased 2 or 3 months after splenectomy in the other 11 cases, five of whom had CR, four PR, and two NR. Eleven of 18 cases (61.1%) survived with a median follow-up of 25 months (range 3-79 months) for survivors. Twelve- and 36-month progression-free survival rates were 48 and 24%, respectively; 12- and 36-month overall survival rates were 57 and 25%, respectively. Median survival time was 22 months. Our results indicate splenectomy may be an effective means of diagnosis and treatment of relapsed HLH of unknown cause. Further study is required to establish the mechanism and value of splenectomy in this disease.

  10. Outcomes of Children with Hemophagocytic Lymphohistiocytosis Given Allogeneic Hematopoietic Stem Cell Transplantation in Italy.

    Science.gov (United States)

    Messina, Chiara; Zecca, Marco; Fagioli, Franca; Rovelli, Attilio; Giardino, Stefano; Merli, Pietro; Porta, Fulvio; Aricò, Maurizio; Sieni, Elena; Basso, Giuseppe; Ripaldi, Mimmo; Favre, Claudio; Pillon, Marta; Marzollo, Antonio; Rabusin, Marco; Cesaro, Simone; Algeri, Mattia; Caniglia, Maurizio; Di Bartolomeo, Paolo; Ziino, Ottavio; Saglio, Francesco; Prete, Arcangelo; Locatelli, Franco

    2018-06-01

    We report on 109 patients with hemophagocytic lymphohistiocytosis (HLH) undergoing 126 procedures of allogeneic hematopoietic stem cell transplantation (HSCT) between 2000 and 2014 in centers associated with the Italian Pediatric Hematology Oncology Association. Genetic diagnosis was FHL2 (32%), FHL3 (33%), or other defined disorders known to cause HLH (15%); in the remaining patients no genetic abnormality was found. Donor for first transplant was an HLA-matched sibling for 25 patients (23%), an unrelated donor for 73 (67%), and an HLA-partially matched family donor for 11 children (10%). Conditioning regimen was busulfan-based for 61 patients (56%), treosulfan-based for 21 (20%), and fludarabine-based for 26 children (24%). The 5-year probabilities of overall survival (OS) and event-free survival (EFS) were 71% and 60%, respectively. Twenty-six patients (24%) died due to transplant-related causes, whereas 14 (13%) and 10 (9%) patients experienced graft rejection and/or relapse, respectively. Twelve of 14 children given a second HSCT after graft failure/relapse are alive and disease-free. Use of HLA-partially matched family donors was associated with higher risk of graft failure and thus with lower EFS (but not with lower OS) in multivariable analysis. Active disease at transplantation did not significantly affect prognosis. These data confirm that HSCT can cure most HLH patients, active disease not precluding successful transplantation. Because in HLH patients HLA-haploidentical HSCT performed through CD34 + cell positive selection was found to be associated with poor sustained engraftment of donor cells, innovative approaches able to guarantee a more robust engraftment are warranted in patients given this type of allograft. Copyright © 2018 The American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

  11. Hemophagocytic lymphohistiocytosis: a rare diagnosis, an even rarer opportunity to appraise our understanding of the immune system

    Directory of Open Access Journals (Sweden)

    José Alexandre Marzagão Barbuto

    2015-03-01

    Full Text Available The syndrome identified as hemophagocytic lymphohistiocytosis (HLH poses a rather difficult challenge to the physician. HLH was initially described as a familial disorder,1 which was later associated with various genetic defects that affect the cytotoxic machinery of CD8+ T and NK cells,2 but it also occurs sporadically, usually prompted by infections, rheumatic disorders, or neoplasia.3 Although its diagnostic criteria are established, its clinical presentation overlaps with many different conditions, requiring an enhanced awareness of the attending physician in order to reach the diagnosis and to initiate treatment early enough.

  12. Efficacy of Prompt Initiation of Antiretroviral Therapy in the Treatment of Hemophagocytic Lymphohistiocytosis Triggered by Uncontrolled Human Immunodeficiency Virus

    Directory of Open Access Journals (Sweden)

    Bryan P. Fitzgerald

    2017-01-01

    Full Text Available Hemophagocytic lymphohistiocytosis (HLH is a life-threatening, rapidly progressive hematologic disorder involving uncontrolled immune system activation. HLH has been associated with viral infections, including human immunodeficiency virus (HIV infections. We report a case of a critically ill 30-year-old female who was hospitalized with HIV-associated HLH, with a CD4 count of 4 cells/mL and HIV viral load of 1,842,730 copies/mL. After ruling out other potential infectious causes of HLH, antiretroviral therapy (ART was initiated with darunavir, ritonavir, tenofovir, and emtricitabine. Within one week of initiation of ART, the patient began to improve clinically and hematologically and was stable enough for discharge from the hospital three weeks after starting therapy. This case suggests that treatment with ART in patients with HIV-associated HLH should be considered even in critically ill patients with low CD4 counts.

  13. Subtypes of familial hemophagocytic lymphohistiocytosis in Japan based on genetic and functional analyses of cytotoxic T lymphocytes.

    Directory of Open Access Journals (Sweden)

    Kozo Nagai

    Full Text Available BACKGROUND: Familial hemophagocytic lymphohistiocytosis (FHL is a rare disease of infancy or early childhood. To clarify the incidence and subtypes of FHL in Japan, we performed genetic and functional analyses of cytotoxic T lymphocytes (CTLs in Japanese patients with FHL. DESIGN AND METHODS: Among the Japanese children with hemophagocytic lymphohistiocytosis (HLH registered at our laboratory, those with more than one of the following findings were eligible for study entry under a diagnosis of FHL: positive for known genetic mutations, a family history of HLH, and impaired CTL-mediated cytotoxicity. Mutations of the newly identified causative gene for FHL5, STXBP2, and the cytotoxicity and degranulation activity of CTLs in FHL patients, were analyzed. RESULTS: Among 31 FHL patients who satisfied the above criteria, PRF1 mutation was detected in 17 (FHL2 and UNC13D mutation was in 10 (FHL3. In 2 other patients, 3 novel mutations of STXBP2 gene were confirmed (FHL5. Finally, the remaining 2 were classified as having FHL with unknown genetic mutations. In all FHL patients, CTL-mediated cytotoxicity was low or deficient, and degranulation activity was also low or absent except FHL2 patients. In 2 patients with unknown genetic mutations, the cytotoxicity and degranulation activity of CTLs appeared to be deficient in one patient and moderately impaired in the other. CONCLUSIONS: FHL can be diagnosed and classified on the basis of CTL-mediated cytotoxicity, degranulation activity, and genetic analysis. Based on the data obtained from functional analysis of CTLs, other unknown gene(s responsible for FHL remain to be identified.

  14. Primary Epstein–Barr virus infection and probable parvovirus B19 reactivation resulting in fulminant hepatitis and fulfilling five of eight criteria for hemophagocytic lymphohistiocytosis

    Directory of Open Access Journals (Sweden)

    Matthias Karrasch

    2014-11-01

    Full Text Available A case of primary Epstein–Barr virus (EBV infection/parvovirus B19 reactivation fulfilling five of eight criteria for hemophagocytic lymphohistiocytosis (HLH is presented. Despite two coinciding viral infections, massive splenomegaly, and fulminant hepatitis, the patient had a good clinical outcome, probably due to an early onset form of HLH with normal leukocyte count, normal natural killer (NK cell function, and a lack of hemophagocytosis.

  15. Primary Epstein-Barr virus infection and probable parvovirus B19 reactivation resulting in fulminant hepatitis and fulfilling five of eight criteria for hemophagocytic lymphohistiocytosis.

    Science.gov (United States)

    Karrasch, Matthias; Felber, Jörg; Keller, Peter M; Kletta, Christine; Egerer, Renate; Bohnert, Jürgen; Hermann, Beate; Pfister, Wolfgang; Theis, Bernhard; Petersen, Iver; Stallmach, Andreas; Baier, Michael

    2014-11-01

    A case of primary Epstein-Barr virus (EBV) infection/parvovirus B19 reactivation fulfilling five of eight criteria for hemophagocytic lymphohistiocytosis (HLH) is presented. Despite two coinciding viral infections, massive splenomegaly, and fulminant hepatitis, the patient had a good clinical outcome, probably due to an early onset form of HLH with normal leukocyte count, normal natural killer (NK) cell function, and a lack of hemophagocytosis.

  16. Primary Epstein–Barr virus infection and probable parvovirus B19 reactivation resulting in fulminant hepatitis and fulfilling five of eight criteria for hemophagocytic lymphohistiocytosis

    OpenAIRE

    Karrasch, Matthias; Felber, Jörg; Keller, Peter M.; Kletta, Christine; Egerer, Renate; Bohnert, Jürgen; Hermann, Beate; Pfister, Wolfgang; Theis, Bernhard; Petersen, Iver; Stallmach, Andreas; Baier, Michael

    2014-01-01

    A case of primary Epstein–Barr virus (EBV) infection/parvovirus B19 reactivation fulfilling five of eight criteria for hemophagocytic lymphohistiocytosis (HLH) is presented. Despite two coinciding viral infections, massive splenomegaly, and fulminant hepatitis, the patient had a good clinical outcome, probably due to an early onset form of HLH with normal leukocyte count, normal natural killer (NK) cell function, and a lack of hemophagocytosis.

  17. Secondary Hemophagocytic Syndrome Associated with Herpes Virus Infections

    Directory of Open Access Journals (Sweden)

    S. R. Rodionovskaya

    2015-01-01

    Full Text Available Hemophagocytic syndrome is one of the complications of herpes virus infections. Here, we describe the case of a 8—year-old male with secondary hemophagocytic syndrome. The disease was diagnosed in the early stages. The patient received treatment with dexamethasone, intravenous immunoglobulin, which has led to a weakening of the ignition and the suppression of the disease with rapid treatment.

  18. Wolman disease in patients with familial hemophagocytic ...

    African Journals Online (AJOL)

    Major signs and symptoms include hepatomegaly, splenomegaly, anemia, leucopenia or thrombocytopenias which resemble many inborn errors of metabolism and lysosomal storage diseases in which hemophagocytic lymphohistiocytosis has also been reported as a secondary association. Case reports: We report three ...

  19. Hypoalbuminaemia is an independent predictor for hemophagocytic lymphohistiocytosis in childhood Epstein-Barr virus-associated infectious mononucleosis.

    Science.gov (United States)

    Huang, Shu-Ching; Chen, Jiann-Shiuh; Cheng, Chao-Neng; Yang, Yao-Jong

    2012-11-01

    Hemophagocytic lymphohistiocytosis (HLH) is a potentially fatal condition in children with Epstein-Barr virus (EBV)-associated infectious mononucleosis (IM). This study aimed to identify commonly available clinical and laboratory predictors that might help clinicians decide to perform the bone marrow and immunological tests for HLH in paediatric EBV-associated IM. A retrospective case-control study of patients aged 70% of patients) were fever, lymphadenopathy and hepatomegaly. In addition to the diagnostic criteria of HLH including fever, splenomegaly, cytopenia, hyperferritinaemia, hypertriglyceridemia and/or hypofibrinogenaemia, children with HLH had a significantly higher rate of prolonged fever >10 d, hepatomegaly, jaundice, general malaise, elevated aspartate aminotransferase, lactate dehydrogenase, C-reactive protein and hypoalbuminaemia compared to those with IM (all P < 0.01). Multiple logistic regression confirmed that hypoalbuminaemia (OR = 23.1, P = 0.01) was an independent predictor of paediatric HLH, with a high sensitivity (96%) and a good negative likelihood ratio (0.06) in patients with EBV-associated IM. Hypoalbuminaemia is a unique characteristic and potentially a valuable predictor for HLH in paediatric EBV-associated IM. © 2012 John Wiley & Sons A/S.

  20. Immunologic difference between hypersensitivity to mosquito bite and hemophagocytic lymphohistiocytosis associated with Epstein-Barr virus infection.

    Directory of Open Access Journals (Sweden)

    Wen-I Lee

    Full Text Available Hemophagocytic lymphohistiocytosis (HLH is a life-threatening, virus-triggered immune disease. Hypersensitivity to mosquito bite (HMB, a presentation of Chronic Active Epstein-Barr Virus infection (CAEBV, may progress to HLH. This study aimed to investigate the immunologic difference between the HMB episodes and the HLH episodes associated with EBV infection. Immunologic changes of immunoglobulins, lymphocyte subsets, cytotoxicity, intracellular perforin and granzyme expressions, EBV virus load and known candidate genes for hereditary HLH were evaluated and compared. In 12 HLH episodes (12 patients and 14 HMB episodes (4 patients, there were both decreased percentages of CD4+ and CD8+ and increased memory CD4+ and activated (CD2+HLADR+ lymphocytes. In contrast to HMB episodes that had higher IgE levels and EBV virus load predominantly in NK cells, those HLH episodes with virus load predominantly in CD3+ lymphocyte had decreased perforin expression and cytotoxicity that were recovered in the convalescence period. However, there was neither significant difference of total virus load in these episodes nor candidate genetic mutations responsible for hereditary HLH. In conclusion, decreased perforin expression in the HLH episodes with predominant-CD3+ EBV virus load is distinct from those HMB episodes with predominant-NK EBV virus load. Whether the presence of non-elevated memory CD4+ cells or activated lymphocytes (CD2+HLADR+ increases the mortality rate in the HLH episodes remains to be further warranted through larger-scale studies.

  1. Hemophagocytic lymphohistiocytosis and Pelger-Huët anomaly associated with colchicine intoxication

    Directory of Open Access Journals (Sweden)

    Baris Malbora

    2014-06-01

    Full Text Available Colchicine is frequently used in the treatment of familial Mediterranean fever (FMF. First symptoms of colchicine intoxication are gastrointestinal disturbances, such as abdominal cramps, diarrhea, pancytopenia and so on. Herein, we report a female FMF patient with pancytopenia and hemophagocytic lymphohitiocytosis (HLH, following colchicine intoxication for committing suicide. To our knowledge, this is the first reported case of a patient with HLH associated with colchicine intoxication.

  2. A case report of novel mutation in PRF1 gene, which causes familial autosomal recessive hemophagocytic lymphohistiocytosis.

    Science.gov (United States)

    Bordbar, Mohammad Reza; Modarresi, Farzaneh; Farazi Fard, Mohammad Ali; Dastsooz, Hassan; Shakib Azad, Nader; Faghihi, Mohammad Ali

    2017-05-03

    Hemophagocytic Lymphohistiocytosis (HLH) is a life-threatening immunodeficiency and multi-organ disease that affects people of all ages and ethnic groups. Common symptoms and signs of this disease are high fever, hepatosplenomegaly, and cytopenias. Familial form of HLH disease, which is an autosomal recessive hematological disorder is due to disease-causing mutations in several genes essential for NK and T-cell granule-mediated cytotoxic function. For an effective cytotoxic response from cytotoxic T lymphocyte or NK cell encountering an infected cell or tumor cell, different processes are required, including trafficking, docking, priming, membrane fusion, and entry of cytotoxic granules into the target cell leading to apoptosis. Therefore, genes involved in these steps play important roles in the pathogenesis of HLH disease which include PRF1, UNC13D (MUNC13-4), STX11, and STXBP2 (MUNC18-2). Here, we report a novel missense mutation in an 8-year-old boy suffered from hepatosplenomegaly, hepatitis, epilepsy and pancytopenia. The patient was born to a first-cousin parents with no previous documented disease in his parents. To identify mutated gene in the proband, Whole Exome Sequencing (WES) utilizing next generation sequencing was used on an Illumina HiSeq 2000 platform on DNA sample from the patient. Results showed a novel deleterious homozygous missense mutation in PRF1 gene (NM_001083116: exon3: c. 1120 T > G, p.W374G) in the patient and then using Sanger sequencing it was confirmed in the proband and his parents. Since his parents were heterozygous for the identified mutation, autosomal recessive pattern of inheritance was confirmed in the family. Our study identified a rare new pathogenic missense mutation in PRF1 gene in patient with HLH disease and it is the first report of mutation in PRF1 in Iranian patients with this disease.

  3. Protection from inflammatory organ damage in a murine model of hemophagocytic lymphohistiocytosis using treatment with IL-18 binding protein

    Directory of Open Access Journals (Sweden)

    Laura eChiossone

    2012-08-01

    Full Text Available Hemophagocytic lymphohistiocytosis (HLH is a life-threatening condition due to the association of an infectious agent with lymphocyte cytotoxicity defects, either of congenital genetic origin in children or presumably acquired in adults. In HLH patients, an excess of lymphocyte or macrophage cytokines, such as IFN-γ and TNFα is present in serum. In animal models of the disease, IFN-γ and TNF-α have been shown to play a central pathogenic role. In humans, unusually high concentrations of IL-18, an inducer of IFN-γ and TNF-α have been reported, and are associated with an imbalance between IL-18 and its natural inhibitor IL-18 binding protein (IL-18BP resulting in an excess of free IL-18. Here we studied whether IL-18BP could reduce disease severity in an animal model of HLH. Mouse cytomegalovirus infection in perforin-1 knock-out mice induced a lethal condition similar to human HLH characterized by cytopenia with marked inflammatory lesions in the liver and spleen as well as the presence of hemophagocytosis in bone marrow. IL-18BP treatment decreased hemophagocytosis and reversed liver as well as spleen damage. IL-18BP treatment also reduced both IFN-γ and TNF-α production by CD8+ T and NK cells, as well as Fas ligand expression on NK cell surface. These data suggest that IL-18BP is beneficial in an animal model of HLH and in combination with anti-infectious therapy may be a promising strategy to treat HLH patients.

  4. [The significance of pedigree genetic screening and rapid immunological parameters in the diagnosis of primary hemophagocytic lymphohistiocytosis].

    Science.gov (United States)

    Zhang, J; Wang, Y N; Wang, J S; Wu, L; Wei, N; Fu, L; Gao, Z; Chen, J H; Pei, R J; Wang, Z

    2016-07-01

    To investigate the significance of pedigree genetic screening and rapid immunological parameters in the diagnosis of primary hemophagocytic lymphohistiocytosis (HLH). Four cases of primary HLH patients with PRF1, UNC13D and SH2D1A gene mutations were conducted pedigree investigation, including family genetic screening and detections of immunological parameters (NK cell activity, CD107a degranulation and expression of HLH related defective protein), to evaluate the significance of these different indicators in the diagnosis of primary HLH and explore their correlations. The DNA mutations of the four families included missense mutation c.T172C (p.S58P) and non- frameshift deletions c.1083_1094del (p.361_365del), missense mutation c.C1349T (p.T450M) and frameshift mutation c.1090_1091delCT (p.T364fsX93) in PRF1 gene, missense mutation c.G2588A (p.G863D) in UNC13D gene and hemizygous mutation c.32T>G (p.I11S) in SH2D1A gene. The patients and their family members presented decreased NK cell activities. Individuals who carried mutations of PRF1 gene and SH2D1A gene showed low expression of perforin (PRF1) and signaling lymphocytic activation molecule associated protein (SAP). And the patient with UNC13D gene mutation and his family member with identical mutation showed significant reducing cytotoxic degranulation function (expression of CD107a). Pedigree genetic screening and rapid detection of immunological parameters might play an important role in the diagnosis of primary HLH, and both of them had good consistency. As an efficient detection means, the rapid immunological detection indicators would provide reliable basis for the early diagnosis of the primary HLH.

  5. The 253-kb inversion and deep intronic mutations in UNC13D are present in North American patients with familial hemophagocytic lymphohistiocytosis 3.

    Science.gov (United States)

    Qian, Yaping; Johnson, Judith A; Connor, Jessica A; Valencia, C Alexander; Barasa, Nathaniel; Schubert, Jeffery; Husami, Ammar; Kissell, Diane; Zhang, Ge; Weirauch, Matthew T; Filipovich, Alexandra H; Zhang, Kejian

    2014-06-01

    The mutations in UNC13D are responsible for familial hemophagocytic lymphohistiocytosis (FHL) type 3. A 253-kb inversion and two deep intronic mutations, c.118-308C > T and c.118-307G > A, in UNC13D were recently reported in European and Asian FHL3 patients. We sought to determine the prevalence of these three non-coding mutations in North American FHL patients and evaluate the significance of examining these new mutations in genetic testing. We performed DNA sequencing of UNC13D and targeted analysis of these three mutations in 1,709 North American patients with a suspected clinical diagnosis of hemophagocytic lymphohistiocytosis (HLH). The 253-kb inversion, intronic mutations c.118-308C > T and c.118-307G > A were found in 11, 15, and 4 patients, respectively, in which the genetic basis (bi-allelic mutations) explained 25 additional patients. Taken together with previously diagnosed FHL3 patients in our HLH patient registry, these three non-coding mutations were found in 31.6% (25/79) of the FHL3 patients. The 253-kb inversion, c.118-308C > T and c.118-307G > A accounted for 7.0%, 8.9%, and 1.3% of mutant alleles, respectively. Significantly, eight novel mutations in UNC13D are being reported in this study. To further evaluate the expression level of the newly reported intronic mutation c.118-307G > A, reverse transcription PCR and Western blot analysis revealed a significant reduction of both RNA and protein levels suggesting that the c.118-307G > A mutation affects transcription. These specified non-coding mutations were found in a significant number of North American patients and inclusion of them in mutation analysis will improve the molecular diagnosis of FHL3. © 2014 Wiley Periodicals, Inc.

  6. Secondary Hemophagocytic Syndrome: The Importance of Clinical Suspicion

    Directory of Open Access Journals (Sweden)

    Cristina Oliveira

    2014-01-01

    Full Text Available Hemophagocytic syndrome is a rare and potentially fatal disorder characterized by pathological immune activation associated with a primary familial disorder, genetic mutations, or occurring as a sporadic condition. The latter can be secondary to infections, malignancies, or autoimmune diseases. Clinically, patients present signs of severe inflammation, with unremitting fever, cytopenias, spleen enlargement, phagocytosis of bone marrow elements, hypertriglyceridemia, and hypofibrinogenemia. Increased suspicion is determinant to timely initiate treatment in an attempt to alter the natural history. The authors present three clinical cases of this syndrome, with a brief review of the diagnostic criteria and treatment.

  7. Structural and functional analysis of perforin mutations in association with clinical data of familial hemophagocytic lymphohistiocytosis type 2 (FHL2) patients

    Science.gov (United States)

    An, Omer; Gursoy, Attila; Gurgey, Aytemiz; Keskin, Ozlem

    2013-01-01

    Perforin plays a key role in the immune system via pore formation at the target cell membrane in the elimination of virus-infected and transformed cells. A vast number of observed mutations in perforin impair this mechanism resulting in a rare but fatal disease, familial hemophagocytic lymphohistiocytosis type 2 (FHL2). Here we report a comprehensive in silico structural analysis of a collection of 76 missense perforin mutations based on a proposed pore model. In our model, perforin monomers oligomerize having cyclic symmetry in consistent with previously found experimental constraints yet having flexibility in the size of the pore and the number of monomers involved. Clusters of the mutations on the model map to three distinct functional regions of the perforin. Calculated stability (free energy) changes show that the mutations mainly destabilize the protein structure, interestingly however, A91V polymorphism, leads to a more stable one. Structural characteristics of mutations help explain the severe functional consequences on perforin deficient patients. Our study provides a structural approach to the mutation effects on the perforin oligomerization and impaired cytotoxic function in FHL2 patients. PMID:23592409

  8. Hemophagocytic syndrome secondary to tuberculosis at 24-week gestation.

    Science.gov (United States)

    Fernández, Alexandra Arteaga; de Velasco Pérez, David Fernández; Fournier, M C Jiménez; Moreno Del Prado, J C; Torras, B Paraíso; Cañete Palomo, M L

    2017-01-01

    Hemophagocytic syndrome is a life-threatening disease characterized by the uncontrolled activation of macrophages, resulting in hemophagocytosis of blood cells in the bone marrow. A 20-year-old gravida at 23-week and 5-day gestation was admitted to hospital to evaluate fever up to 104°F of unknown origin, moderate cytopenia, and elevated levels of liver enzymes. Bone marrow biopsy confirmed hemophagocytic syndrome, and polymerase chain reaction came back positive for Mycobacterium tuberculosis. Supportive care and tuberculosis treatment resulted in clinical improvement. At 27 weeks and 5 days, premature rupture of the membranes occurred, and because of the high probability of reactivating the hemophagocytic syndrome, a cesarean section was performed at 29-week and 2-day gestation. Hemophagocytic syndrome is an uncommon disease which rarely appears during pregnancy. Early diagnosis and treatment can save both maternal and fetal lives.

  9. Hemophagocytic syndrome secondary to tuberculosis at 24-week gestation

    Directory of Open Access Journals (Sweden)

    Alexandra Arteaga Fernández

    2017-01-01

    Full Text Available Hemophagocytic syndrome is a life-threatening disease characterized by the uncontrolled activation of macrophages, resulting in hemophagocytosis of blood cells in the bone marrow. A 20-year-old gravida at 23-week and 5-day gestation was admitted to hospital to evaluate fever up to 104°F of unknown origin, moderate cytopenia, and elevated levels of liver enzymes. Bone marrow biopsy confirmed hemophagocytic syndrome, and polymerase chain reaction came back positive for Mycobacterium tuberculosis. Supportive care and tuberculosis treatment resulted in clinical improvement. At 27 weeks and 5 days, premature rupture of the membranes occurred, and because of the high probability of reactivating the hemophagocytic syndrome, a cesarean section was performed at 29-week and 2-day gestation. Hemophagocytic syndrome is an uncommon disease which rarely appears during pregnancy. Early diagnosis and treatment can save both maternal and fetal lives.

  10. Clinical characteristics and genetic analysis of childhood acute lymphoblastic leukemia with hemophagocytic lymphohistiocytosis: a Japanese retrospective study by the Kyushu-Yamaguchi Children's Cancer Study Group.

    Science.gov (United States)

    Moritake, Hiroshi; Kamimura, Sachiyo; Nunoi, Hiroyuki; Nakayama, Hideki; Suminoe, Aiko; Inada, Hiroko; Inagaki, Jiro; Yanai, Fumio; Okamoto, Yasuhiro; Shinkoda, Yuichi; Shimomura, Maiko; Itonaga, Nobuyoshi; Hotta, Noriko; Hidaka, Yasufumi; Ohara, Osamu; Yanagimachi, Masakatsu; Nakajima, Noriko; Okamura, Jun; Kawano, Yoshifumi

    2014-07-01

    This present study sought to analyze acute lymphoblastic leukemia (ALL) patients with hemophagocytic lymphohistiocytosis (HLH) registered in Kyushu-Yamaguchi Children's Cancer Study Group studies conducted between 1996 and 2007. Four of 357 patients, including two of 318 patients with B cell precursor acute lymphoblastic leukemia (BCP-ALL) and two of 39 of those with T cell acute lymphoblastic leukemia (T-ALL), were identified. HLH was observed more frequently in the T-ALL patients than in the BCP-ALL patients (P = 0.061). The mean age of 13.0 years at the diagnosis of leukemia in the HLH + ALL group was significantly higher than the 6.05 years observed in the remaining ALL groups (P = 0.001). A female predisposition was noted, as all four patients were female (P = 0.043). In two of four patients, the leukemic cells exhibited deletions on the long arm of chromosome 6 (P = 0.003). Three patients suffered from HLH during maintenance therapy. Parvovirus B19 infection and cytomegalovirus reactivation were identified as causes of HLH in one and two patients, respectively. All four patients are currently in complete remission, although one developed relapse of leukemia after receiving maintenance therapy. Based on the genetic analyses, non-synonymous single nucleotide polymorphisms (SNPs) in UNC13D, syntaxin 11, and STXBP2 were identified in all patients. Clinicians should therefore be aware of the risk of HLH during maintenance therapy, especially in older T-ALL patients with SNPs in familial HLH causative genes.

  11. The frequency of A91V in the perforin gene and the effect of tumor necrosis factor-α promoter polymorphism on acquired hemophagocytic lymphohistiocytosis

    Directory of Open Access Journals (Sweden)

    Hamza Okur

    2011-06-01

    Full Text Available Objective: Numerous acquired etiological factors, such as infections, malignancies, and collagen tissue disorders, are involved in the development of acquired hemophagocytic lymphohistiocytosis (AHLH. Not everyone with the same etiological factors developments AHLH, which suggests the role of additional genetic or environmental predisposing factors that remain to be identified. Materials and Methods: Perforin gene A91V missense transition (C>T change at position 272 in exon 2 of the perforin gene and TNF-α gene promoter-1031 T>C nucleotide substitution are 2 candidate genetic predisposing factors due to their potential to alter inflammatory responses. In the present study these changes were investigated in healthy controls and AHLH patients.Results: A91V transition was observed in 7 of the 159 (4.4% controls. Among the 44 AHLH patients, 5 (11.3% were heterozygous and the difference in the frequency of A91V transition, although striking (odds ratio: 2.8, was not statistically significant (p=0.09. All A91V-positive patients had infection. TNF-α-1031 T>C polymorphism was examined in 164 healthy controls and 40 AHLH patients, and the CC risk-elevating genotype was noted in 7 (4.3% of the controls and 1 (2.5% of the AHLH patients. The frequency of C and T alleles was 22.5% (n=18 and 77.5% (n=62 among the AHLH patients, and 22% (n=72 and 78% (n=259 among the controls, respectively. There wasn’t a statistically significant difference between the groups in terms of allele frequencies (p>0.05.Conclusion: The present results indicate that compared to controls, A91V mutation was 2.8-fold more prevalent (according to the odds ratio in the AHLH patients. A91V mutation is not uncommon in the general population and increases the risk of AHLH in patients with an underlying condition, especially those with an underlying infection.

  12. Characterization of Epstein-Barr virus (EBV) BZLF1 gene promoter variants and comparison of cellular gene expression profiles in Japanese patients with infectious mononucleosis, chronic active EBV infection, and EBV-associated hemophagocytic lymphohistiocytosis.

    Science.gov (United States)

    Imajoh, Masayuki; Hashida, Yumiko; Murakami, Masanao; Maeda, Akihiko; Sato, Tetsuya; Fujieda, Mikiya; Wakiguchi, Hiroshi; Daibata, Masanori

    2012-06-01

    Epstein-Barr virus (EBV) genotypes can be distinguished based on gene sequence differences in EBV nuclear antigens 2, 3A, 3B, and 3C, and the BZLF1 promoter zone (Zp). EBV subtypes and BZLF1 Zp variants were examined in Japanese patients with infectious mononucleosis, chronic active EBV infection, and EBV-associated hemophagocytic lymphohistiocytosis. The results of EBV typing showed that samples of infectious mononucleosis, chronic active EBV infection, and EBV-associated hemophagocytic lymphohistiocytosis all belonged to EBV type 1. However, sequencing analysis of BZLF1 Zp found three polymorphic Zp variants in the same samples. The Zp-P prototype and the Zp-V3 variant were both detected in infectious mononucleosis and chronic active EBV infection. Furthermore, a novel variant previously identified in Chinese children with infectious mononucleosis, Zp-V1, was also found in 3 of 18 samples of infectious mononucleosis, where it coexisted with the Zp-P prototype. This is the first evidence that the EBV variant distribution in Japanese patients resembles that found in other Asian patients. The expression levels of 29 chronic active EBV infection-associated cellular genes were also compared in the three EBV-related disorders, using quantitative real-time reverse transcription polymerase chain reaction analysis. Two upregulated genes, RIPK2 and CDH9, were identified as common specific markers for chronic active EBV infection in both in vitro and in vivo studies. RIPK2 activates apoptosis and autophagy, and could be responsible for the pathogenesis of chronic active EBV infection. Copyright © 2012 Wiley Periodicals, Inc.

  13. Iatrogenic T-Cell Lymphoma with Associated Hemophagocytic Lymphohistiocyotsis in a Patient with Long-Standing Rheumatoid Arthritis

    Directory of Open Access Journals (Sweden)

    X. A. Andrade

    2018-01-01

    Full Text Available Patients with rheumatoid arthritis are at increased risk of hematological malignancies, especially when exposed to immunosuppressive therapy. The mechanisms of lymphomagenesis remain poorly understood but factors implicated include high disease activity, exposure to antitumoral necrosis factor medications, and Epstein–Barr virus infection. Lymphoid malignancies of T-cell origin are uncommon in patients with rheumatoid arthirits. Clinical presentation with associated hemophagocytic lymphohistiocyotsis is rare and confers a poor prognosis. This case report illustrates a case of a patient with long-standing rheumatoid arthritis and an iatrogenic peripheral T-cell lymphoma with secondary hemophagocytic lymphohistiocytosis who achieved a complete response after intensive chemotherapy.

  14. Elevation of CD16+CD56+ NK-cells and down-regulation of serum interleukin-21 (IL-21) and IL-1α after splenectomy in relapsed hemophagocytic lymphohistiocytosis of unknown cause.

    Science.gov (United States)

    Wang, Jingshi; Han, Wei; Gao, Zhuo; Wang, Yini; Wu, Lin; Zhang, Jia; Lai, Wenyuan; Wang, Zhao

    2017-09-01

    Encouraging progress has been made in application of splenectomy in the treatment of relapsed hemophagocytic lymphohistiocytosis (HLH) of unknown cause. The aim was to determine the roles of lymphocyte subpopulations and inflammatory cytokines in splenectomy. We retrospectively analyzed changes in lymphocyte subpopulations and levels of inflammatory cytokines at different time-points before and after splenectomy in the patients with relapsed HLH of unknown cause, as well as the correlations between these changes and the disease prognosis. During the period from June 2006 to June 2016, we enrolled 107 patients with relapsed HLH of unknown cause, of whom 29 were treated with splenectomy. Among the 29 patients, 7 cases were non-Hodgkin lymphomas based on spleen pathology, 1 case withdrew and the remaining 21 non-lymphoma cases were available for analysis. Results showed a significant increase in both percentage of CD16 + CD56 + NK cells (P = 0.003) and NK cell activity (P = 0.028) at 24 wk after splenectomy compared to their baseline pre-surgery levels. We also examined seven patients for the changes in cytokine levels before and after splenectomy and found that IL-21 and IL-1α decreased at 4 wk after splenectomy (P splenectomy had significantly longer survival (P = 0.001) compared to the 24 patients with relapsed HLH of unknown cause who were also determined as NR but not treated by splenectomy. Splenectomy can improve clinical symptoms and survival of patients with relapsed HLH of unknown cause. The mechanism is likely related to the changes in percent NK cells and cytokines (IL-21 and IL-1α) after surgery.

  15. Nasopharyngeal Carcinoma Associated with Hemophagocytic Lymphohistiocytosis

    Directory of Open Access Journals (Sweden)

    Hsu Wu

    2015-03-01

    Conclusions: HLH is a disease with high fatality. Whenever there is a degree of clinical suspicion for HLH, etoposide-based chemotherapy should be started as soon as possible, and the underlying causes of the disease should be treated. We report this patient with NPC and HLH, which can be associated with either EBV or NPC. We treated both etiologies, and the patient's symptoms and liver function improved. The interactions between EBV, NPC, and HLH are interesting and merit further investigation.

  16. Secondary Hemophagocytic Syndrome Associated with Richter’s Transformation in Chronic Lymphocytic Leukemia

    Directory of Open Access Journals (Sweden)

    Nura El-Haj

    2014-01-01

    Full Text Available Hemophagocytic syndrome (HPS is an extremely rare condition arising from the overactivation of one’s own immune system. It results in excessive inflammation and tissue destruction. Prompt initiation of treatment is warranted in either scenario in order to decrease mortality. Most cases are triggered by infectious agents, malignancy, or drugs. We describe the first case of a CLL patient presenting with HPS due to acquisition of EBV-related large cell lymphoma in the setting of profound immunodeficiency.

  17. Wolman disease in patients with familial hemophagocytic ...

    African Journals Online (AJOL)

    Solaf Elsayed

    2015-09-26

    Sep 26, 2015 ... Marine Gil b ... many inborn errors of metabolism and lysosomal storage diseases in which hemophagocytic ... The diagnosis of secondary HLH is usually made in association with infection by viruses, bacteria, fungi, or para-.

  18. GENOTYPE-PHENOTYPE STUDY OF FAMILIAL HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS TYPE 3

    OpenAIRE

    Sieni , Elena; Cetica , Valentina; Santoro , Alessandra; Beutel , Karin; Mastrodicasa , Elena; Meeths , Marie; Ciambotti , Benedetta; Brugnolo , Francesca; Zur Stadt , Udo; Pende , Daniela; Moretta , Lorenzo; Griffiths , Gillian M.; Henter , Jan-Inge; Janka , Gritta; Arico , Maurizio

    2011-01-01

    Abstract Background: Mutations of UNC13D are causative for FHL3 (OMIM 608898). We present a genotype-phenotype study of 845 FHL3 patients. Methods: A consortium of 3 countries planned to pool in a common database data on presenting features and mutations from individual patients with biallelic UNC13D mutations. Results: 845 FHL3 patients (median age: 4.1 months) were reported from Florence, Italy (n=54), Hamburg, Germany (n=18), Stockholm, Sweden (n=123). Their ethnic origi...

  19. Dengue fever as a cause of hemophagocytic lymphohistiocytosis

    OpenAIRE

    Hein, Noely; Bergara, Gabriel Heiser; Moura, Nathalie Bianchini Vieira; Cardoso, D?bora Morais; Hirose, Maki; Ferronato, Angela Esp?sito; Pastorino, Ant?nio Carlos; Lo, Denise Swei; Gilio, Alfredo Elias

    2015-01-01

    Dengue is endemic in more than 100 countries in Southeast Asia, the Americas, the western Pacific, Africa and the eastern Mediterranean regions. The virus is transmitted by Aedes mosquitoes. Dengue disease is the most prevalent arthropod-borne viral disease in humans and is a global and national public health concern in several countries. A seasonal pattern of dengue disease is consistently observed. The highest incidences usually correspond to the period of highest rainfall and humidity, pro...

  20. Association of Monoclonal Expansion of Epstein-Barr Virus-Negative CD158a+ NK Cells Secreting Large Amounts of Gamma Interferon with Hemophagocytic Lymphohistiocytosis▿

    Science.gov (United States)

    López-Álvarez, María R.; Martínez-Sánchez, María V.; Salgado-Cecilia, María G.; Campillo, José A.; Heine-Suñer, Damian; Villar-Permuy, Florentina; Fuster, José L.; Bas, Águeda; Gil-Herrera, Juana; Muro, Manuel; García-Alonso, Ana M.; Álvarez-López, María R.; Minguela, Alfredo

    2009-01-01

    We report the first case of hemophagocytic lymphohistiocytosis (HLH) induced by the monoclonal expansion of Epstein-Barr virus (EBV)-negative NK cells. Consanguinity of the patient's parents made it necessary to discard familial HLH in the patient and her sister with identical HLA markers and demonstrate that no cause other than the expansion of NK cells, which secrete high levels of gamma interferon, was inducing HLH in this patient. PMID:19020108

  1. Wolman disease in patients with familial hemophagocytic lymphohistiocytosis (FHL negative mutations

    Directory of Open Access Journals (Sweden)

    Solaf Elsayed

    2016-07-01

    Conclusion: Wolman disease should be excluded in patients with clinical and laboratory characteristics of FHL and negative molecular testing especially if the fever is not prominent and is associated with relatively huge hepatomegaly and/or severe failure to thrive.

  2. Pregnancy-related hemophagocytic lymphohistiocytosis associated with cytomegalovirus infection: A diagnostic and therapeutic challenge

    Directory of Open Access Journals (Sweden)

    Nor Rafeah Tumian

    2015-08-01

    Conclusion: This case highlights the challenges and difficulties involved in the diagnosis and management of pregnancy-related HLH. Immunosuppressive treatment for HLH can precipitate life-threatening opportunistic infections, which need to be promptly diagnosed and treated.

  3. Hemophagocytic syndrome in classic dengue fever

    Directory of Open Access Journals (Sweden)

    Sayantan Ray

    2011-01-01

    Full Text Available A 24-year-old previously healthy girl presented with persistent fever, headache, and jaundice. Rapid-test anti-dengue virus IgM antibody was positive but anti-dengue IgG was nonreactive, which is suggestive of primary dengue infection. There was clinical deterioration during empiric antibiotic and symptomatic therapy. Bone marrow examination demonstrated the presence of hemophagocytosis. Diagnosis of dengue fever with virus-associated hemophagocytic syndrome was made according to the diagnostic criteria of the HLH 2004 protocol of the Histiocyte Society. The patient recovered with corticosteroid therapy. A review of literature revealed only a handful of case reports that showed the evidence that this syndrome is caused by dengue virus. Our patient is an interesting case of hemophagocytic syndrome associated with classic dengue fever and contributes an additional case to the existing literature on this topic. This case highlights the need for increased awareness even in infections not typically associated with hemophagocytic syndrome.

  4. Central nervous system involvement in adults with haemophagocytic lymphohistiocytosis: a single-center study.

    Science.gov (United States)

    Cai, Guilan; Wang, Yini; Liu, Xiaojing; Han, Yanfei; Wang, Zhao

    2017-08-01

    Hemophagocytic lymphohistiocytosis (HLH) is a rare multisystem disorder characterized by proliferation and diffuse infiltration multiple organs with histiocytes, including the central nervous system (CNS). Neurological manifestations of HLH have been recognized in different studies with children, but they remain relatively ill-defined in adults with HLH. From March 2008 to October 2014, 289 adult patients with HLH were admitted to our center. Clinical, radiological, and cerebral spinal fluid (CSF) data of the patients with CNS involvement were reviewed, and a retrospective study in our single-center was carried out. CNS involvement was observed in 29 patients (10%) either in their diagnosis process or during disease course. CNS symptoms included disturbance of consciousness, cranial nerve palsies, seizures, headache, limb paralysis, irritability, meningism, and memory loss. CSF analysis was conducted in 17 patients (59%). Among them, 11 patients (65%) were reported as having abnormal CSF. Neuroradiological studies were performed in 25 patients (86%). Among the 13 cases that underwent CT scan, one patient hemorrhaged. Single or multiple hypodense foci were detected in the other 2 patients. Magnetic resonance imaging (MRI) abnormalities were found in 15 patients, including focal lesions in cortical and adjacent subcortical regions with or without variable nodular or ring contrast-enhancement, multiple lesions in white matter, diffuse white matter signal changes, and meningeal enhancement. Basal ganglia, cerebellum, and brainstem lesions were also observed. CNS involvement could also be found in adult patients with HLH, but not as frequent as it was in children. The clinical manifestations could be diversified. By carrying out rigorous CNS examinations, an early diagnosis could be made and it was of the utmost importance for the prevention of further lesions.

  5. T Cell Depletion for Recipients of HLA Haploidentical Related Donor Stem Cell Grafts

    Science.gov (United States)

    2017-08-29

    Acute Lymphoblastic Leukemia; Non Hodgkins Lymphoma; Myelodysplastic Syndrome; Acute Myeloid Leukemia; Chronic Myelogenous Leukemia; Hemophagocytic Lymphohistiocytosis (HLH); Familial Hemophagocytic Lymphohistiocytosis (FLH); Viral-associated Hemophagocytic Syndrome (VAHS); X-linked Lymphoproliferative Disease (XLP)

  6. Post-hematopoietic stem cell transplant hemophagocytic lymphohistiocytosis or an impostor: Case report and review of literature.

    Science.gov (United States)

    Vatsayan, Anant; Pateva, Irina; Cabral, Linda; Dalal, Jignesh; Abu-Arja, Rolla

    2018-03-25

    HLH occurring after HSCT is a relatively rare disease. Many conditions may mimic or trigger HLH in post-HSCT period (eg, cytokine release syndrome, engraftment syndrome, graft rejection/failure, acute graft-vs-host disease, infections systemic inflammatory response syndrome/sepsis, and thrombotic microangiopathy). Moreover, this period is usually marked by febrile illness, cytopenia, and a "cytokine storm" leading to elevation of inflammatory biomarkers like ferritin and sCD25. These parameters overlap with the diagnostic criteria for HLH. Such confounding factors make the management of post-HSCT HLH quite challenging. We illustrate this critical issue with case report of a patient who was diagnosed with HLH after allogeneic HSCT for tAML. He received MP and CsA for HLH but VP-16 was not administered due to fear of severe myelosuppression. Fortunately, he responded well to treatment and remains in remission to date. We recommend caution while using HLH-94/HLH-2004 guidelines for the diagnosis and management of post-HSCT HLH. In this article, we pinpoint these issues with a brief review of all the pediatric cases and clinical studies of post-HSCT HLH along with a critical evaluation of its various diagnostic criteria. Finally, based on the limitations of current diagnostic criteria, we suggest a need for formulating disease-specific diagnostic criteria for post-HSCT HLH. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  7. Dengue infection associated hemophagocytic syndrome: Therapeutic interventions and outcome.

    Science.gov (United States)

    Wan Jamaludin, Wan Fariza; Periyasamy, Petrick; Wan Mat, Wan Rahiza; Abdul Wahid, S Fadilah

    2015-08-01

    Infection associated hemophagocytic syndrome is increasingly recognized as a potentially fatal complication of dengue fever. It should be suspected with prolonged fever beyond seven days associated with hepatosplenomegaly, hyperferritinemia, worsening cytopenias and development of multiorgan dysfunction. Surge of similar pro-inflammatory cytokines observed in dengue associated hemophagocytic syndrome and multiorgan dysfunction may indicate they are part of related inflammatory spectrum. A proportion of patients recovered with supportive therapy, however most required interventions with corticosteroids, intravenous immunoglobulin or chemotherapy. We report three cases of dengue associated IAHS with good outcome following early recognition and treatment with dexamethasone and intravenous immunoglobulin. Copyright © 2015 Elsevier B.V. All rights reserved.

  8. An update on renal involvement in hemophagocytic syndrome (macrophage activation syndrome).

    Science.gov (United States)

    Esmaili, Haydarali; Mostafidi, Elmira; Mehramuz, Bahareh; Ardalan, Mohammadreza; Mohajel-Shoja, Mohammadali

    2016-01-01

    Hemophagocytic syndrome (HPS) is mainly characterized by massive infiltration of bone marrow by activated macrophages and often presents with pancytopenia. Thrombotic microangiopathy (TMA) is also present with thrombocytopenia and renal involvement. Both conditions could coexist with each other and complicate the condition. Directory of Open Access Journals (DOAJ), EMBASE, Google Scholar, PubMed, EBSCO, and Web of Science with keywords relevant to; Hemophagocytic syndrome, macrophage activation syndrome, interferon-gamma and thrombotic microangiopathy, have been searched. Viral infection, rheumatologic disease and malignancies are the main underlying causes for secondary HPS. calcineurin inhibitors and viral infections are also the main underlying causes of TMA in transplant recipients. In this review, we discussed a 39-year-old male who presented with pancytopenia and renal allograft dysfunction. With the diagnosis of HPS induced TMA his renal condition and pancytopenia improved after receiving intravenous immunoglobulin (IVIG) and plasmapheresis therapy. HPS is an increasingly recognized disorder in the realm of different medical specialties. Renal involvement complicates the clinical picture of the disease, and this condition even is more complex in renal transplant recipients. We should consider the possibility of HPS in any renal transplant recipient with pancytopenia and allograft dysfunction. The combination of HPS with TMA future increases the complexity of the situation.

  9. An Animal Model for Human EBV-Associated Hemophagocytic Syndrome

    Science.gov (United States)

    Hayashi, Kazuhiko; Ohara, Nobuya; Teramoto, Norihiro; Onoda, Sachiyo; Chen, Hong-Li; Oka, Takashi; Kondo, Eisaku; Yoshino, Tadashi; Takahashi, Kiyoshi; Yates, John; Akagi, Tadaatsu

    2001-01-01

    Epstein-Barr virus-associated hemophagocytic syndrome (EBV-AHS) is often associated with fatal infectious mononucleosis. However, the animal model for EBV-AHS has not been developed. We reported the first animal model for EBV-AHS using rabbits infected with EBV-related herpesvirus of baboon (HVP). Eleven of 13 (85%) rabbits inoculated intravenously with HVP-producing cells developed fatal lymphoproliferative disorders (LPD) between 22 and 105 days after inoculation. LPD was also accompanied by hemophagocytic syndrome (HPS) in nine of these 11 rabbits. The peroral spray of cell-free HVP induced the virus infection with increased anti-EBV-viral capsid antigen-IgG titers in three of five rabbits, and two of these three infected rabbits died of LPD with HPS. Autopsy revealed hepatosplenomegaly and swollen lymph nodes. Atypical lymphoid T cells expressing EBV-encoded small RNA-1 infiltrated diffusely in many organs, frequently involving the lymph nodes, spleen, and liver. Hemophagocytic histiocytosis was observed in the lymph nodes, spleen, bone marrow, and thymus. HVP-DNA was detected in the tissues and peripheral blood from the infected rabbits by polymerase chain reaction or Southern blot analysis. Reverse transcriptase-polymerase chain reaction revealed both HVP-EBNA1 and HVP-EBNA2 transcripts, suggesting latency type III infection. These data indicate that the high rate of rabbit LPD with HPS induction is caused by HVP. This system is useful for studying the pathogenesis, prevention, and treatment of human EBV-AHS. PMID:11290571

  10. Endoperoxidation, hyperprostaglandinemia, and hyperlipidemia in a case of erythrophagocytic lymphohistiocytosis. Reversal with VP-16 and indomethacin.

    Science.gov (United States)

    Brown, R E; Bowman, W P; D'Cruz, C A; Pick, T E; Champion, J E

    1987-11-15

    Clinicopathologic and histopathologic evidence of both endoperoxidation with hyperprostaglandinemia and hyperlipidemia in a 5-week-old infant with a hemophagocytic syndrome is reported. Institution of histiocytolytic (VP-16) and cyclo-oxygenase inhibitor (indomethacin) therapies returned the prostaglandin levels and lipid profile to a nearly normal state coincidental with clinical recovery. It appears that by reducing the cell mass of histiocytes and controlling the over-production of prostaglandins, some types of hemophagocytic syndrome can be reversed.

  11. Rabbit Model for Human EBV-Associated Hemophagocytic Syndrome (HPS)

    Science.gov (United States)

    Hayashi, Kazuhiko; Jin, Zaishun; Onoda, Sachiyo; Joko, Hiromasa; Teramoto, Norihiro; Ohara, Nobuya; Oda, Wakako; Tanaka, Takehiro; Liu, Yi-Xuan; Koirala, Tirtha Raj; Oka, Takashi; Kondo, Eisaku; Yoshino, Tadashi; Takahashi, Kiyoshi; Akagi, Tadaatsu

    2003-01-01

    Epstein-Barr virus-associated hemophagocytic syndrome (EBV-AHS) is often associated with fatal infectious mononucleosis or T-cell lymphoproliferative diseases (LPD). To elucidate the true nature of fatal LPD observed in Herpesvirus papio (HVP)-induced rabbit hemophagocytosis, reactive or neoplastic, we analyzed sequential development of HVP-induced rabbit LPD and their cell lines. All of the seven Japanese White rabbits inoculated intravenously with HVP died of fatal LPD 18 to 27 days after inoculation. LPD was also accompanied by hemophagocytic syndrome (HPS) in five of these seven rabbits. Sequential autopsy revealed splenomegaly and swollen lymph nodes, often accompanied by bleeding, which developed in the last week. Atypical lymphoid cells infiltrated many organs with a “starry sky” pattern, frequently involving the spleen, lymph nodes, and liver. HVP-small RNA-1 expression in these lymphoid cells was clearly demonstrated by a newly developed in situ hybridization (ISH) system. HVP-ISH of immunomagnetically purified lymphoid cells from spleen or lymph nodes revealed HVP-EBER1+ cells in each CD4+, CD8+, or CD79a+ fraction. Hemophagocytic histiocytosis was observed in the lymph nodes, spleen, bone marrow, and thymus. HVP-DNA was detected in the tissues and peripheral blood from the infected rabbits by PCR or Southern blot analysis. Clonality analysis of HVP-induced LPD by Southern blotting with TCR gene probe revealed polyclonal bands, suggesting polyclonal proliferation. Six IL-2-dependent rabbit T-cell lines were established from transplanted scid mouse tumors from LPD. These showed latency type I/II HVP infection and had normal karyotypes except for one line, and three of them showed tumorigenicity in nude mice. These data suggest that HVP-induced fatal LPD in rabbits is reactive polyclonally in nature. PMID:12707056

  12. Distinct mutations in STXBP2 are associated with variable clinical presentations in patients with familial hemophagocytic lymphohistiocytosis type 5 (FHL5)

    DEFF Research Database (Denmark)

    Pagel, Julia; Beutel, Karin; Lehmberg, Kai

    2012-01-01

    the genetic and clinical spectrum of FHL5, we analyzed a cohort of 185 patients with suspected FHL for mutations in STXBP2. We detected biallelic mutations in 37 patients from 28 families of various ethnic origins. Missense mutations and mutations affecting 1 of the exon 15 splice sites were the predominant...... changes detectable in this cohort. Patients with exon 15 splice-site mutations (n = 13) developed clinical manifestations significantly later than patients with other mutations (median age, 4.1 year vs 2 months) and showed less severe impairment of degranulation and cytotoxic function of NK cells and CTLs....... Patients with FHL5 showed several atypical features, including sensorineural hearing deficit, abnormal bleeding, and, most frequently, severe diarrhea that was only present in early-onset disease. In conclusion, we report the largest cohort of patients with FHL5 so far, describe an extended disease...

  13. Genotype–phenotype study of familial haemophagocytic lymphohistiocytosis type 3

    Science.gov (United States)

    Sieni, Elena; Cetica, Valentina; Santoro, Alessandra; Beutel, Karin; Mastrodicasa, Elena; Meeths, Marie; Ciambotti, Benedetta; Brugnolo, Francesca; zur Stadt, Udo; Pende, Daniela; Moretta, Lorenzo; Griffiths, Gillian M; Henter, Jan-Inge; Janka, Gritta; Aricò, Maurizio

    2014-01-01

    Background Mutations of UNC13D are causative for familial haemophagocytic lymphohistiocytosis type 3 (FHL3; OMIM 608898). Objective To carry out a genotype–phenotype study of patients with FHL3. Methods A consortium of three countries pooled data on presenting features and mutations from individual patients with biallelic UNC13D mutations in a common database. Results 84 patients with FHL3 (median age 4.1 months) were reported from Florence, Italy (n=54), Hamburg, Germany (n=18), Stockholm, Sweden (n=12). Their ethnic origin was Caucasian (n=57), Turkish (n=10), Asian (n=7), Hispanic (n=4), African (n=3) (not reported (n=3)). Thrombocytopenia was present in 94%, splenomegaly in 96%, fever in 89%. The central nervous system (CNS) was involved in 49/81 (60%) patients versus 36% in patients with FHL2 (p=0.001). A combination of fever, splenomegaly, thrombocytopenia and hyperferritinaemia was present in 71%. CD107a expression, NK activity and Munc 13-4 protein expression were absent or reduced in all but one of the evaluated patients. 54 different mutations were observed, including 15 new ones: 19 missense, 14 deletions or insertions, 12 nonsense, nine splice errors. None was specific for ethnic groups. Patients with two disruptive mutations were younger than patients with two missense mutations (p<0.001), but older than comparable patients with FHL2 (p=0.001). Conclusion UNC13D mutations are scattered over the gene. Ethnic-specific mutations were not identified. CNS involvement is more common than in FHL2; in patients with FHL3 and disruptive mutations, age at diagnosis is significantly higher than in FHL2. The combination of fever, splenomegaly, thrombocytopenia and hyperferritinaemia appears to be the most easily and frequently recognised clinical pattern and their association with defective granule release assay may herald FHL3. PMID:21248318

  14. Typhoid fever causing haemophagocytic lymphohistiocytosis in a non-endemic country - first case report and review of the current literature.

    Science.gov (United States)

    Sánchez-Moreno, Paula; Olbrich, Peter; Falcón-Neyra, Lola; Lucena, Jose Manuel; Aznar, Javier; Neth, Olaf

    2018-06-07

    Development of secondary haemophagocytic lymphohistiocytosis (sHLH) in the context of typhoid fever (TF) is a very rare but serious complication. Description of the first pediatric case of typhoid fever acquired in a non-endemic area complicated by sHLH. A systematic literature review of sHLH in the context of TF was performed with extraction of epidemiological, clinical and laboratory data. The literature search revealed 17 articles (22 patients). Fifteen patients were eligible for data analysis (53.4% children). All patients had fever and pancytopenia. Transaminases and LDH were frequently elevated (46.6%). Salmonella typhi was detected mainly by blood culture (64.3%). All the patients received antibiotics whereas immunomodulation (dexamethasone) was used in two cases. A high suspicion index for this condition is needed even in non-endemic areas. The addition of immunmodulation to standard antimicrobial therapy should be considered in selected cases. Copyright © 2018 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  15. Serial brain MRI findings in CNS involvement of familial erythrophagocytic lymphohistiocytosis: a case report

    International Nuclear Information System (INIS)

    Cho, Kyung Soo; Yoo, Jeong Hyun; Suh, Jeong Soo; Ryu, Kyung Ha; Hong, Ki Sook; Kim, Hak Jin

    2002-01-01

    Familial erythrophagocytic lymphohistiocytosis is a fatal early childhood disorder characterized by multiorgan lymphohistiocytic infiltration and active hemophagocytosis. Involvement of the central nervous system (CNS) is not uncommon and is characterized by rapidly progressive tissue damage affecting both the gray and white matter. We encountered a case of familial erythrophagocytic lymphohistiocytosis with CNS involvement. Initial T2-weighted MRI of the brain demonstrated high signal intensity in the right thalamus, though after chemotherapy, which led to the relief of neurologic symptoms, this disappeared. After four months. however, the patient's neurologic symptoms recurred, and follow-up T2-weighted MR images showed high signal intensity in the thalami, basal ganglia, and cerebral and cerebellar white matter. Brain MRI is a useful imaging modality for the evaluation of CNS involvement and monitoring the response to treatment

  16. An animal model for human EBV-associated hemophagocytic syndrome: herpesvirus papio frequently induces fatal lymphoproliferative disorders with hemophagocytic syndrome in rabbits.

    Science.gov (United States)

    Hayashi, K; Ohara, N; Teramoto, N; Onoda, S; Chen, H L; Oka, T; Kondo, E; Yoshino, T; Takahashi, K; Yates, J; Akagi, T

    2001-04-01

    Epstein-Barr virus-associated hemophagocytic syndrome (EBV-AHS) is often associated with fatal infectious mononucleosis. However, the animal model for EBV-AHS has not been developed. We reported the first animal model for EBV-AHS using rabbits infected with EBV-related herpesvirus of baboon (HVP). Eleven of 13 (85%) rabbits inoculated intravenously with HVP-producing cells developed fatal lymphoproliferative disorders (LPD) between 22 and 105 days after inoculation. LPD was also accompanied by hemophagocytic syndrome (HPS) in nine of these 11 rabbits. The peroral spray of cell-free HVP induced the virus infection with increased anti-EBV-viral capsid antigen-IgG titers in three of five rabbits, and two of these three infected rabbits died of LPD with HPS. Autopsy revealed hepatosplenomegaly and swollen lymph nodes. Atypical lymphoid T cells expressing EBV-encoded small RNA-1 infiltrated diffusely in many organs, frequently involving the lymph nodes, spleen, and liver. Hemophagocytic histiocytosis was observed in the lymph nodes, spleen, bone marrow, and thymus. HVP-DNA was detected in the tissues and peripheral blood from the infected rabbits by polymerase chain reaction or Southern blot analysis. Reverse transcriptase-polymerase chain reaction revealed both HVP-EBNA1 and HVP-EBNA2 transcripts, suggesting latency type III infection. These data indicate that the high rate of rabbit LPD with HPS induction is caused by HVP. This system is useful for studying the pathogenesis, prevention, and treatment of human EBV-AHS.

  17. Crohn's disease complicated by Epstein-Barr virus-driven haemophagocytic lymphohistiocytosis successfully treated with rituximab.

    Science.gov (United States)

    Thompson, Grace; Pepperell, Dominic; Lawrence, Ian; McGettigan, Benjamin David

    2017-02-22

    We report a case of Epstein-Barr virus (EBV)-driven haemophagocytic lymphohistiocytosis (HLH) in a man with Crohn's disease treated with 6-mercaptopurine and adalimumab therapy who was successfully treated with rituximab therapy alone. This is the first published case in an adult patient with EBV-driven HLH in the setting of thiopurine use and inflammatory bowel disease to be successfully treated with rituximab therapy alone. Here, we will discuss putative immunological mechanisms which may contribute to this potentially life-threatening complication. 2017 BMJ Publishing Group Ltd.

  18. Rubella associated with hemophagocytic syndrome. First report in a male and review of the literature

    Directory of Open Access Journals (Sweden)

    Makram Koubaa

    2012-08-01

    Full Text Available A 22-year-old man was admitted to our hospital because of fever, skin rash and epistaxis. Physical examination revealed fever (39.5°C, generalized purpura, lymphadenopathy and splenomegaly. Blood tests showed pancytopenia. Bone marrow aspiration and biopsy showed hemophagocytosis with no evidence of malignant cells. Anti rubella IgM antibody were positif and the IgG titers increased from 16 to 50 UI/mL in 3 days. Therefore, he was diagnosed to have rubella-associated hemophagocytic syndrome. We report herein the first case in a man and the sixth case of rubella-associated hemophagocytic syndrome in the literature by search in Pub Med till March 2012.

  19. A rare complication of CMV infection in Crohn's disease - hemophagocytic syndrome: a case report.

    Science.gov (United States)

    Pop, Corina Silvia; Becheanu, Gabriel; Calagiu, Dorina; Jantea, Petruţa-Violeta; Rădulescu, Dragoş Mihai; Pariza, George; Mavrodin, Carmen-Iuliana; Bold, Adriana; Costache, Adrian; Nemeş, Roxana Maria

    2015-01-01

    We report a case of CMV (cytomegalovirus) infection in a Crohn's disease patient, resulting in severe hemophagocytic syndrome and death. A 63-year-old man with a 10-year history of ileal and colonic Crohn's disease presented with general malaise, loss of appetite and weight loss over the last month. He was in clinical remission for two years, with maintenance therapy 5-Aminosalicylic acid (5-ASA)-derived Mesalamine. The patient had no prior immunomodulators or suppressive treatment. A colonoscopy was performed and we found appearance suggestive of active Crohn's disease, confirmed by histopathological examination. A diagnosis of an exacerbation of Crohn's disease was established. Although the specific treatment was initiated, patient's general condition degraded progressively and diarrheal stools appeared, followed by an episode of massive gastrointestinal bleeding - hematochezia. We performed a new colonoscopy and the pathological examination revealed Crohn's ileocolitis with superimposed CMV infection. Despite the initiation of Ganciclovir alongside with other intensive care measures, he increasingly deteriorated and chest X-ray confirmed multilobar pneumonia. The occurrence of rapidly progressing pancytopenia and evidence for disseminated intravascular coagulopathy as well as hyperferritinemia, raised the suspicion of hemophagocytic syndrome confirmed by bone marrow aspiration. Hence, CMV-associated hemophagocytic syndrome in the context of recent corticotherapy for Crohn's disease was established. There is enough evidence that supports the gravity of the CMV infection in the case of inflammatory bowel disease (IBD) patients, especially the ones on immunomodulator treatment. The hemophagocytic syndrome reactively occurs in patients with infections in cases of immunodeficiency, displaying a hematological aspect of multiple organ dysfunction syndrome.

  20. Novel Munc13–4 mutations in children and young adult patients with haemophagocytic lymphohistiocytosis

    Science.gov (United States)

    Santoro, A; Cannella, S; Bossi, G; Gallo, F; Trizzino, A; Pende, D; Dieli, F; Bruno, G; Stinchcombe, J C; Micalizzi, C; De Fusco, C; Danesino, C; Moretta, L; Notarangelo, L D; Griffiths, G M; Aricò, M

    2006-01-01

    Familial haemophagocytic lymphohistiocytosis (FHL) is a genetically heterogeneous disorder characterised by constitutive defects in cellular cytotoxicity resulting in fever, hepatosplenomegaly and cytopenia, and the outcome is fatal unless treated by chemoimmunotherapy followed by haematopoietic stem‐cell transplantation. Since 1999, mutations in the perforin gene giving rise to this disease have been identified; however, these account only for 40% of cases. Lack of a genetic marker hampers the diagnosis, suitability for transplantation, selection of familial donors, identification of carriers, genetic counselling and prenatal diagnosis. Mutations in the Munc13–4 gene have recently been described in patients with FHL. We sequenced the Munc13–4 gene in all patients with haemophagocytic lymphohistiocytosis not due to PRF1 mutations. In 15 of the 30 families studied, 12 novel and 4 known Munc13–4 mutations were found, spread throughout the gene. Among novel mutations, 2650C→T introduced a stop codon; 441del A, 532del C, 3082del C and 3226ins G caused a frameshift, and seven were mis sense mutations. Median age of diagnosis was 4 months, but six patients developed the disease after 5 years of age and one as a young adult of 18 years. Involvement of central nervous system was present in 9 of 15 patients, activity of natural killer cells was markedly reduced or absent in 13 of 13 tested patients. Chemo‐immunotherapy was effective in all patients. Munc13–4 mutations were found in 15 of 30 patients with FHL without PRF1 mutations. Because these patients may develop the disease during adolescence or even later, haematologists should include FHL2 and FHL3 in the differential diagnosis of young adults with fever, cytopenia, splenomegaly and hypercytokinaemia. PMID:16825436

  1. Clinical analysis and prognostic significance of haemophagocytic lymphohistiocytosis-associated anaplastic large cell lymphoma in children.

    Science.gov (United States)

    Pasqualini, Claudia; Minard-Colin, Veronique; Saada, Veronique; Lamant, Laurence; Delsol, Georges; Patte, Catherine; Le Deley, Marie-Cécile; Valteau-Couanet, Dominique; Brugières, Laurence

    2014-04-01

    Haemophagocytic lymphohistiocytosis (HLH) has been rarely described in children treated for an anaplastic large-cell lymphoma (ALCL). We evaluated the incidence, the clinical and histological characteristics and the prognosis of HLH associated-ALCL. The medical, biological, cytological and histological data of patients treated for ALK-positive ALCL in the paediatric department of a single institution between 1975 and 2008 were analysed and assessed for HLH according to diagnosis criteria of the Histiocyte Society. Data concerning a series of 50 consecutive children with ALCL were reviewed. HLH-associated ALCL was observed in 12% of the patients. Lung involvement was significantly more frequent in HLH-associated ALCL patients than in the group without HLH (P = 0·004), as well as central nervous system (CNS) and bone marrow involvement (P = 0·001 and P = 0·007 respectively). The histological subtype in children with HLH-associated ALCL did not differ from that of the group without HLH. There was no significant difference between the two groups in 5-year EFS and OS (P = 0·91 and P > 0·99 respectively). In conclusion, HLH is not rare in paediatric ALCL. Despite a high incidence of visceral, CNS and bone marrow involvement, HLH does not seem to exert a significant impact on outcome in children treated for ALCL. © 2014 John Wiley & Sons Ltd.

  2. Infantile Hemophagocytic Lymphohistiocytosis in a Case of Chediak-Higashi Syndrome Caused by a Mutation in the LYST/CHS1 Gene Presenting With Delayed Umbilical Cord Detachment and Diarrhea

    DEFF Research Database (Denmark)

    Nielsen, Christian; Agergaard, Charlotte N; Jakobsen, Marianne A

    2015-01-01

    A 2-month-old female infant, born to consanguineous parents, presented with infections in skin and upper respiratory tract. She was notable for delayed umbilical cord detachment, partial albinism, and neurological irritability. Giant granules were present in white blood cells. The intracellular...... in this severe phenotype of Chediak-Higashi syndrome was probably induced by rotaviral infection. Interestingly, the intracellular perforin content in CD8 T cells seems to correlate to the immune activation state of the patient. Late separation of the umbilical cord in concordance with clinical symptoms should...

  3. Characterisation of successive Acinetobacter baumannii isolates from a deceased haemophagocytic lymphohistiocytosis patient.

    Science.gov (United States)

    Choi, Hyeon Jin; Kil, Min Cheol; Choi, Ji-Young; Kim, Sun Ju; Park, Ki-Sup; Kim, Yae-Jean; Ko, Kwan Soo

    2017-01-01

    In this study, 38 Acinetobacter baumannii isolates successively isolated from blood, skin swabs and tracheal aspirates from a single patient who died from haemophagocytic lymphohistiocytosis were investigated. The isolates were collected between March 2012 and August 2012. A. baumannii genotypes were determined by multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE). In vitro antimicrobial susceptibility testing was performed and colistin heteroresistance and persistence were evaluated. The structure of AbaR resistance islands was explored, and serum sensitivity was determined. Based on MLST analysis, all 38 A. baumannii isolates showed the same sequence type (ST138). However, PFGE analysis showed that isolates from blood samples belonged to different genotypes depending on the isolation time: whilst blood isolates obtained at the early stages showed restriction patterns similar to those of isolates from other sources, isolates obtained at later stages exhibited a distinct pattern. All isolates were resistant to imipenem, cefepime, ciprofloxacin and piperacillin/tazobactam. Five isolates from tracheal aspirates and one from a skin swab were resistant to polymyxins, and two isolates from skin swabs and one from another source were non-susceptible to tigecycline. All colistin-susceptible isolates showed heteroresistance to colistin, and four were persisters. Isolates from blood showed higher survival rates against human serum than those from other sources. This study shows that the patient was infected with more than one A. baumannii strain. Heteroresistance, persistence or evasion of the innate immune response may explain the failure of antimicrobial treatments in this patient. Copyright © 2016 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

  4. Primary EBV infection induces an expression profile distinct from other viruses but similar to hemophagocytic syndromes.

    Directory of Open Access Journals (Sweden)

    Samantha K Dunmire

    Full Text Available Epstein-Barr Virus (EBV causes infectious mononucleosis and establishes lifelong infection associated with cancer and autoimmune disease. To better understand immunity to EBV, we performed a prospective study of natural infection in healthy humans. Transcriptome analysis defined a striking and reproducible expression profile during acute infection but no lasting gene changes were apparent during latent infection. Comparing the EBV response profile to multiple other acute viral infections, including influenza A (influenza, respiratory syncytial virus (RSV, human rhinovirus (HRV, attenuated yellow fever virus (YFV, and Dengue fever virus (DENV, revealed similarity only to DENV. The signature shared by EBV and DENV was also present in patients with hemophagocytic syndromes, suggesting these two viruses cause uncontrolled inflammatory responses. Interestingly, while EBV induced a strong type I interferon response, a subset of interferon induced genes, including MX1, HERC5, and OAS1, were not upregulated, suggesting a mechanism by which viral antagonism of immunity results in a profound inflammatory response. These data provide an important first description of the response to a natural herpesvirus infection in humans.

  5. Primary EBV Infection Induces an Expression Profile Distinct from Other Viruses but Similar to Hemophagocytic Syndromes

    Science.gov (United States)

    Dunmire, Samantha K.; Odumade, Oludare A.; Porter, Jean L.; Reyes-Genere, Juan; Schmeling, David O.; Bilgic, Hatice; Fan, Danhua; Baechler, Emily C.; Balfour, Henry H.; Hogquist, Kristin A.

    2014-01-01

    Epstein-Barr Virus (EBV) causes infectious mononucleosis and establishes lifelong infection associated with cancer and autoimmune disease. To better understand immunity to EBV, we performed a prospective study of natural infection in healthy humans. Transcriptome analysis defined a striking and reproducible expression profile during acute infection but no lasting gene changes were apparent during latent infection. Comparing the EBV response profile to multiple other acute viral infections, including influenza A (influenza), respiratory syncytial virus (RSV), human rhinovirus (HRV), attenuated yellow fever virus (YFV), and Dengue fever virus (DENV), revealed similarity only to DENV. The signature shared by EBV and DENV was also present in patients with hemophagocytic syndromes, suggesting these two viruses cause uncontrolled inflammatory responses. Interestingly, while EBV induced a strong type I interferon response, a subset of interferon induced genes, including MX1, HERC5, and OAS1, were not upregulated, suggesting a mechanism by which viral antagonism of immunity results in a profound inflammatory response. These data provide an important first description of the response to a natural herpesvirus infection in humans. PMID:24465555

  6. Epstein-Barr virus-containing T-cell lymphoma presents with hemophagocytic syndrome mimicking malignant histiocytosis.

    Science.gov (United States)

    Su, I J; Hsu, Y H; Lin, M T; Cheng, A L; Wang, C H; Weiss, L M

    1993-09-15

    The previously designated malignant histiocytosis (MH) may include lymphoid neoplasms of T-cell lineage as well as patients with benign virus-associated hemophagocytic syndrome (VAHS). In this study, the association of Epstein-Barr virus (EBV) with T cell lymphomas which present with clinicopathologic features indistinguishable from malignant histiocytosis (MH) was investigated further. Four adult patients, three women and one man, were admitted because of fever, cutaneous lesions, hepatosplenomegaly, and jaundice. Laboratory examinations revealed pancytopenia, abnormal liver functions and coagulopathy. All patients ran a fulminant course terminating in a hemophagocytic syndrome within 1 month. Immunophenotypic study, Southern blot analysis, and in situ hybridization were performed on the specimens obtained from the four patients. The biopsy-necropsy specimens from skin, liver, spleen, and bone marrow showed infiltration of atypical large cells with reactive histiocytosis and florid hemophagocytosis activity. Based on the clinical and histologic findings, these cases would have been designated as MH by previous criteria. Immunophenotypic, Southern blot, and in situ hybridization studies, however, showed clonotypic proliferation of EBV genomes in the nuclei of the large atypical cells that expressed T-cell antigens. Therefore, these patients should be diagnosed as a recently described EBV-associated peripheral T-cell lymphoma (EBV-PTCL). EBV-PTCL may present with a fulminant hemophagocytic syndrome indistinguishable from the previously designated MH. This finding represents a step forward in our changing concept regarding MH, some of which only recently has been suggested to be of T-cell lymphoma origin. Differentiation from benign VAHS is clinically important. Features useful in this distinction are tabulated and discussed.

  7. Epstein-Barr virus-induced infectious mononucleosis after two separate episodes of virus-associated hemophagocytic syndrome.

    Science.gov (United States)

    Ohno, Tatsuharu; Ueda, Yo; Kishimoto, Wataru; Arimoto-Miyamoto, Kazue; Takeoka, Tomoharu; Tsuji, Masaaki

    2009-01-01

    A 24-year-old man, who had suffered previous two episodes of non- Epstein-Barr virus (EBV)-associated hemophagocytic syndrome (HPS) at the ages of 16 and 18, developed EBV-induced infectious mononucleosis. His antibody pattern to EBV highlighted the initial infection. The disease took a self-limited course without developing into HPS. No reactivation of EBV infection was noted over the following 6 years. The patient may have attained immune competency in adulthood, which was somehow impaired during his adolescence.

  8. A web-based delphi study for eliciting helpful criteria in the positive diagnosis of hemophagocytic syndrome in adult patients.

    Science.gov (United States)

    Hejblum, Gilles; Lambotte, Olivier; Galicier, Lionel; Coppo, Paul; Marzac, Christophe; Aumont, Cédric; Fardet, Laurence

    2014-01-01

    The diagnosis of the reactive form of hemophagocytic syndrome in adults remains particularly difficult since none of the clinical or laboratory manifestations are specific. We undertook a study in order to elicit which features constitute helpful criteria for a positive diagnosis. In this Delphi study, the features investigated in the questionnaire and the experts invited to participate in the survey were issued from a bibliographic search. The questionnaire was iteratively proposed to experts via a web-based application with a feedback of the results observed at the preceding Delphi round. Experts were asked to label each investigated criterion in one of the following categories: absolutely required, important, of minor interest, or not assessable in the routine practice environment. A positive consensus was a priori defined as at least 75% answers observed in the categories absolutely required and important. The questionnaire investigated 26 criteria and 24 experts originating from 13 countries participated in the second and final Delphi round. A positive consensus was reached for the nine following criteria: unilineage cytopenia, bicytopenia, pancytopenia, presence of hemophagocytosis pictures on a bone marrow aspirate or on a tissue biopsy, high ferritin level, fever, organomegaly, presence of a predisposing underlying disease, and high level of lactate dehydrogenase. A negative consensus was reached for 13 criteria, and an absence of consensus was observed for 4 criteria. The study constitutes the first initiative to date for defining international guidelines devoted to the positive diagnosis of the reactive form of hemophagocytic syndrome.

  9. Therapeutic trials for a rabbit model of EBV-associated Hemophagocytic Syndrome (HPS): effects of vidarabine or CHOP, and development of Herpesvirus papio (HVP)-negative lymphomas surrounded by HVP-infected lymphoproliferative disease.

    Science.gov (United States)

    Hayashi, K; Joko, H; Koirala, T R; Onoda, S; Jin, Z-S; Munemasa, M; Ohara, N; Oda, W; Tanaka, T; Oka, T; Kondo, E; Yoshino, T; Takahashi, K; Yamada, M; Akagi, T

    2003-10-01

    Epstein-Barr virus-associated hemophagocytic syndrome (EBV-AHS), which is often associated with fatal infectious mononucleosis or T-cell lymphoproliferative diseases (LPD), is a distinct disease characterized by high mortality. Treatment of patients with EBV-AHS has proved challenging. To develop some therapeutic interventions for EBV-AHS, we examined the effectiveness of an antiviral agent (vidarabine) or chemotherapy (CHOP), using a rabbit model for EBV-AHS. Fourteen untreated rabbits were inoculated intravenously with cell-free virions of the EBV-like virus Herpesvirus papio (HVP). All of the rabbits died of HVP-associated (LPD) and hemophagocytic syndrome (HPS) between 21 and 31 days after inoculation. Furthermore, three HVP-infected rabbits treated with vidarabine died between days 23 and 28 after inoculation, and their clinicopathological features were no different from those of untreated rabbits, indicating that this drug is not effective at all to treat HVP-induced rabbit LPD and HPS. Three of the infected rabbits that were treated with one course, with an incomplete set of three courses, or with three full courses of CHOP treatment died of HVP-induced LPD and HPS with a bleeding tendency and/or with opportunistic infections. They died on the 26th, 62nd and 105th day after virus inoculation, respectively. CHOP treatment transiently suppressed the HVP-induced LPD and contributed to the prolonged survival time of two infected rabbits. However, it did not remove all of the HVP-infected cells from the infected rabbits, and residual HVP-infected lymphocytes caused recurrences of rabbit LPD and HPS. The most interesting finding of this experiment was observed in the infected rabbit with the longest survival time of 105 days: HVP-negative lymphomas surrounded by HVP-induced LPD developed in the larynx and ileum of this rabbit, causing an obstruction of the lumen. We concluded that these were not secondary lymphomas caused by CHOP treatment, because no suspicious

  10. Spontaneous resolution of hemophagocytic syndrome associated with acute parvovirus B19 infection and concomitant Epstein-Barr virus reactivation in an otherwise healthy adult.

    Science.gov (United States)

    Larroche, C; Scieux, C; Honderlick, P; Piette, A M; Morinet, F; Blétry, O

    2002-10-01

    Reported here is the case of a patient who spontaneously recovered from hemophagocytic syndrome associated with acute B19 infection and concomitant Epstein-Barr virus reactivation. The previously healthy 37-year-old-man was hospitalized after 10 days of high fever, arthralgia and arthritis and was determined to have hemophagocytic syndrome. Immunoglobulin (Ig) M antibodies to Epstein-Barr virus (EBV) capsid antigen, early antigen and parvovirus B19 (B19) were found. B19 DNA and low-level EBV DNA were detected in bone marrow, serum and peripheral blood mononuclear cells. The patient recovered spontaneously without any treatment. Two months later anti-B19 IgG antibodies were detected, while at 9-month follow-up, anti-B19 IgM antibodies were no longer detectable and B19 DNA had disappeared from serum. To the best of our knowledge, this is the first report of spontaneous resolution of hemophagocytic syndrome associated with acute B19 infection and concomitant EBV reactivation in an otherwise healthy adult.

  11. Griscelli syndrome type 2: A rare and fatal syndrome in a South Indian boy

    Directory of Open Access Journals (Sweden)

    R Rajyalakshmi

    2016-01-01

    Full Text Available Griscelli syndrome (GS is a rare autosomal recessive disorder caused by mutation in the MYO5A (GS1, RAB27A (GS2, and MLPH (GS3 genes, characterized by a common feature, partial albinism. The common variant of three, GS type 2, in addition, shows primary immunodeficiency which leads to recurrent infections and hemophagocytic lymphohistiocytosis. We, herewith, describe a case of GS type 2, in a 4-year-old male child who presented with chronic and recurrent fever, lymphadenopathy, hepatosplenomegaly, and secondary neurological deterioration; highlighting the cytological and histopathological features of lymph nodes. Hair shaft examination of the child confirmed the diagnosis.

  12. Secondary Hypertension

    Science.gov (United States)

    Secondary hypertension Overview Secondary hypertension (secondary high blood pressure) is high blood pressure that's caused by another medical condition. Secondary hypertension can be caused by conditions that affect your kidneys, ...

  13. Emergence of anti-red blood cell antibodies triggers red cell phagocytosis by activated macrophages in a rabbit model of Epstein-Barr virus-associated hemophagocytic syndrome.

    Science.gov (United States)

    Hsieh, Wen-Chuan; Chang, Yao; Hsu, Mei-Chi; Lan, Bau-Shin; Hsiao, Guan-Chung; Chuang, Huai-Chia; Su, Ih-Jen

    2007-05-01

    Hemophagocytic syndrome (HPS) is a fatal complication frequently associated with viral infections. In childhood HPS, Epstein-Barr virus (EBV) is the major causative agent, and red blood cells (RBCs) are predominantly phagocytosed by macrophages. To investigate the mechanism of RBC phagocytosis triggered by EBV infection, we adopted a rabbit model of EBV-associated HPS previously established by using Herpesvirus papio (HVP). The kinetics of virus-host interaction was studied. Using flow cytometry, we detected the emergence of antibody-coated RBCs, as well as anti-platelet antibodies, at peak virus load period at weeks 3 to 4 after HVP injection, and the titers increased thereafter. The presence of anti-RBCs preceded RBC phagocytosis in tissues and predicted the full-blown development of HPS. The anti-RBC antibodies showed cross-reactivity with Paul-Bunnell heterophile antibodies. Preabsorption of the HVP-infected serum with control RBCs removed the majority of anti-RBC activities and remarkably reduced RBC phagocytosis. The RBC phagocytosis was specifically mediated via an Fc fragment of antibodies in the presence of macrophage activation. Therefore, the emergence of anti-RBC antibodies and the presence of macrophage activation are both essential in the development of HPS. Our observations in this animal model provide a potential mechanism for hemophagocytosis in EBV infection.

  14. Rabbit model for human EBV-associated hemophagocytic syndrome (HPS): sequential autopsy analysis and characterization of IL-2-dependent cell lines established from herpesvirus papio-induced fatal rabbit lymphoproliferative diseases with HPS.

    Science.gov (United States)

    Hayashi, Kazuhiko; Jin, Zaishun; Onoda, Sachiyo; Joko, Hiromasa; Teramoto, Norihiro; Ohara, Nobuya; Oda, Wakako; Tanaka, Takehiro; Liu, Yi-Xuan; Koirala, Tirtha Raj; Oka, Takashi; Kondo, Eisaku; Yoshino, Tadashi; Takahashi, Kiyoshi; Akagi, Tadaatsu

    2003-05-01

    Epstein-Barr virus-associated hemophagocytic syndrome (EBV-AHS) is often associated with fatal infectious mononucleosis or T-cell lymphoproliferative diseases (LPD). To elucidate the true nature of fatal LPD observed in Herpesvirus papio (HVP)-induced rabbit hemophagocytosis, reactive or neoplastic, we analyzed sequential development of HVP-induced rabbit LPD and their cell lines. All of the seven Japanese White rabbits inoculated intravenously with HVP died of fatal LPD 18 to 27 days after inoculation. LPD was also accompanied by hemophagocytic syndrome (HPS) in five of these seven rabbits. Sequential autopsy revealed splenomegaly and swollen lymph nodes, often accompanied by bleeding, which developed in the last week. Atypical lymphoid cells infiltrated many organs with a "starry sky" pattern, frequently involving the spleen, lymph nodes, and liver. HVP-small RNA-1 expression in these lymphoid cells was clearly demonstrated by a newly developed in situ hybridization (ISH) system. HVP-ISH of immunomagnetically purified lymphoid cells from spleen or lymph nodes revealed HVP-EBER1+ cells in each CD4+, CD8+, or CD79a+ fraction. Hemophagocytic histiocytosis was observed in the lymph nodes, spleen, bone marrow, and thymus. HVP-DNA was detected in the tissues and peripheral blood from the infected rabbits by PCR or Southern blot analysis. Clonality analysis of HVP-induced LPD by Southern blotting with TCR gene probe revealed polyclonal bands, suggesting polyclonal proliferation. Six IL-2-dependent rabbit T-cell lines were established from transplanted scid mouse tumors from LPD. These showed latency type I/II HVP infection and had normal karyotypes except for one line, and three of them showed tumorigenicity in nude mice. These data suggest that HVP-induced fatal LPD in rabbits is reactive polyclonally in nature.

  15. [Secondary hypertension].

    Science.gov (United States)

    Yoshida, Yuichi; Shibata, Hirotaka

    2015-11-01

    Hypertension is a common disease and a crucial predisposing factor of cardiovascular diseases. Approximately 10% of hypertensive patients are secondary hypertension, a pathogenetic factor of which can be identified. Secondary hypertension consists of endocrine, renal, and other diseases. Primary aldosteronism, Cushing's syndrome, pheochromocytoma, hyperthyroidism, and hypothyroidism result in endocrine hypertension. Renal parenchymal hypertension and renovascular hypertension result in renal hypertension. Other diseases such as obstructive sleep apnea syndrome are also very prevalent in secondary hypertension. It is very crucial to find and treat secondary hypertension at earlier stages since most secondary hypertension is curable or can be dramatically improved by specific treatment. One should keep in mind that screening of secondary hypertension should be done at least once in a daily clinical practice.

  16. Secondary Evaluations.

    Science.gov (United States)

    Cook, Thomas D.

    Secondary evaluations, in which an investigator takes a body of evaluation data collected by a primary evaluation researcher and examines the data to see if the original conclusions about the program correspond with his own, are discussed. The different kinds of secondary evaluations and the advantages and disadvantages of each are pointed out,…

  17. Secondary Headaches

    Science.gov (United States)

    ... in the medical history or examination to suggest secondary headache. Headache can be caused by general medical conditions such as severe hypertension, or by conditions that affect the brain and ...

  18. BMT Abatacept for Non-Malignant Diseases

    Science.gov (United States)

    2018-05-16

    Hurler Syndrome; Fanconi Anemia; Glanzmann Thrombasthenia; Wiskott-Aldrich Syndrome; Chronic Granulomatous Disease; Severe Congenital Neutropenia; Leukocyte Adhesion Deficiency; Shwachman-Diamond Syndrome; Diamond-Blackfan Anemia; Dyskeratosis-congenita; Chediak-Higashi Syndrome; Severe Aplastic Anemia; Thalassemia Major; Hemophagocytic Lymphohistiocytosis; Sickle Cell Disease

  19. X-linked inhibitor of apoptosis (XIAP) deficiency

    DEFF Research Database (Denmark)

    Speckmann, C.; Lehmberg, K.; Albert, M.H.

    2013-01-01

    X-linked inhibitor of apoptosis (XIAP) deficiency caused by mutations in BIRC4 was initially described in patients with X-linked lymphoproliferative syndrome (XLP) who had no mutations in SH2D1A. In the initial reports, EBV-associated hemophagocytic lymphohistiocytosis (HLH) was the predominant...

  20. CD34+ (Non-Malignant) Stem Cell Selection for Patients Receiving Allogeneic Stem Cell Transplantation

    Science.gov (United States)

    2017-07-13

    Bone Marrow Failure Syndrome; Severe Aplastic Anemia; Severe Congenital Neutropenia; Amegakaryocytic Thrombocytopenia; Diamond-Blackfan Anemia; Schwachman Diamond Syndrome; Primary Immunodeficiency Syndromes; Acquired Immunodeficiency Syndromes; Histiocytic Syndrome; Familial Hemophagocytic Lymphocytosis; Lymphohistiocytosis; Macrophage Activation Syndrome; Langerhans Cell Histiocytosis (LCH); Hemoglobinopathies; Sickle Cell Disease; Sickle Cell-beta-thalassemia

  1. A case report and clinical approach to silver blonde hair

    African Journals Online (AJOL)

    Sana Durrani

    2015-09-29

    Sep 29, 2015 ... Abstract Griscelli syndrome type 2 is a rare autosomal recessive disease caused by mutations in the. RAB27A gene. It is characterized by pigmentary dilution of the skin and hair causing silvery gray hair, hemophagocytic lymphohistiocytosis and characteristic light microscopy findings in scalp hair.

  2. Haemophagocytic lymphohistiocytosis: A fulminant syndrome ...

    African Journals Online (AJOL)

    ability of CTLs and NK cells to induce apoptosis of antigen- presenting cells and ... referred for stem cell transplantation.[8]. Much of our ... Five patients in whom acquired HLH was diagnosed, following bone marrow investigations .... Cases 1 and 2 were diagnosed with diffuse large B-cell lymphoma at the time of HLH ...

  3. Secondary osteoporosis.

    Science.gov (United States)

    Gennari, C; Martini, G; Nuti, R

    1998-06-01

    Generalized osteoporosis currently represents a heterogeneous group of conditions with many different causes and pathogenetic mechanisms, that often are variably associated. The term "secondary" is applied to all patients with osteoporosis in whom the identifiable causal factors are other than menopause and aging. In this heterogeneous group of conditions, produced by many different pathogenetic mechanisms, a negative bone balance may be variably associated with low, normal or increased bone remodeling states. A consistent group of secondary osteoporosis is related to endocrinological or iatrogenic causes. Exogenous hypercortisolism may be considered an important risk factor for secondary osteoporosis in the community, and probably glucocorticoid-induced osteoporosis is the most common type of secondary osteoporosis. Supraphysiological doses of corticosteroids cause two abnormalities in bone metabolism: a relative increase in bone resorption, and a relative reduction in bone formation. Bone loss, mostly of trabecular bone, with its resultant fractures is the most incapacitating consequence of osteoporosis. The estimated incidence of fractures in patients prescribed corticosteroid is 30% to 50%. Osteoporosis is considered one of the potentially serious side effects of heparin therapy. The occurrence of heparin-induced osteoporosis appeared to be strictly related to the length of treatment (over 4-5 months), and the dosage (15,000 U or more daily), but the pathogenesis is poorly understood. It has been suggested that heparin could cause an increase in bone resorption by increasing the number of differentiated osteoclasts, and by enhancing the activity of individual osteoclasts. Hyperthyroidism is frequently associated with loss of trabecular and cortical bone; the enhanced bone turnover that develops in thyrotoxicosis is characterized by an increase in the number of osteoclasts and resorption sites, and an increase in the ratio of resorptive to formative bone

  4. Secondary osteoporosis.

    Science.gov (United States)

    Boyle, I T

    1993-10-01

    Osteoporosis with attendant increased fracture risk is a common complication of many other diseases. Indeed, almost all chronic diseases make some impact on life-style, usually by restricting physical activity and hence reducing the anabolic effect of exercise and gravitational strains on the skeleton. Restricted appetite and modified gastrointestinal tract function is another commonplace finding that has an impact on bone nutrition and synthesis, as on other systems. Sex hormone status is of particular importance for the maintenance of the normal skeleton, and the postmenopausal woman is at particular risk for most causes of secondary osteoporosis. In dealing with secondary osteoporosis in the hypo-oestrogenic woman, the question of giving hormone replacement therapy in addition to other disease-specific therapy should always be considered, as, for example, in a young amenorrhoeic woman with Crohn's disease. Similarly, in hypogonadal men the administration of testosterone is useful for bone conservation. The wider availability of bone densitometry ought to make us more aware of the presence of osteoporosis in the many disease states discussed above. This is particularly important as the life span of such patients is now increased by improved management of the underlying disease process in many instances. Even in steroid-induced osteoporosis--one of the commonest and most severe forms of osteoporosis--we now have some effective therapy in the form of the bisphosphonates and other anti-bone-resorbing drug classes. The possibility of prophylaxis against secondary osteoporosis has therefore become a possibility, although the very long-term effects of such drug regimens are still unknown. In some situations, such as thyrotoxicosis, Cushing's syndrome and immobilization, spontaneous resolution of at least part of the osteoporosis is possible after cure of the underlying problem. The shorter the existence of the basic problem, the more successful the restoration of the

  5. A case of recurrent autoimmune hemolytic anemia during remission associated with acute pure red cell aplasia and hemophagocytic syndrome due to human parvovirus B19 infection successfully treated by steroid pulse therapy with a review of the literature.

    Science.gov (United States)

    Sekiguchi, Yasunobu; Shimada, Asami; Imai, Hidenori; Wakabayashi, Mutsumi; Sugimoto, Keiji; Nakamura, Noriko; Sawada, Tomohiro; Komatsu, Norio; Noguchi, Masaaki

    2014-01-01

    The patient was a 47-year-old man diagnosed as having autoimmune hemolytic anemia (AIHA) in April 2011. He also had a congenital chromosomal abnormality, a balanced translocation. Treatment with prednisolone (PSL) 60 mg/day resulted in resolution of the AIHA, and the treatment was completed in November 2011. While the patient no longer had anemia, the direct and indirect Coombs tests remained positive. In May 2013, he developed recurrent AIHA associated with acute pure red cell aplasia (PRCA) and hemophagocytic syndrome (HPS) caused by human parvovirus B19 (HPV B19) infection. Tests for anti-erythropoietin and anti-erythropoietin receptor antibodies were positive. Steroid pulse therapy resulted in resolution of the AIHA, PRCA, as well as HPS. The serum test for anti-erythropoietin antibodies also became negative after the treatment. However, although the serum was positive for anti-HPV B19 IgG antibodies, the patient continued to have a low CD4 lymphocyte count (CD4, B19 infection (HPV B19 DNA remained positive), suggesting the risk of recurrence and bone marrow failure.

  6. The enrichment secondary market

    International Nuclear Information System (INIS)

    Einbund, D.R.

    1986-01-01

    This paper will addresses two topics: the background to the present status of the enrichment secondary market and the future outlook of the secondary market in enrichment services, and the viability of the nuclear fuel brokerage industry. These two topics are inevitably connected, as most secondary market activity, not only in enrichment but also in natural uranium, has traditionally been conducted with the participation of brokers. Therefore, the author interrelates these topics

  7. Quantitative secondary electron detection

    Science.gov (United States)

    Agrawal, Jyoti; Joy, David C.; Nayak, Subuhadarshi

    2018-05-08

    Quantitative Secondary Electron Detection (QSED) using the array of solid state devices (SSD) based electron-counters enable critical dimension metrology measurements in materials such as semiconductors, nanomaterials, and biological samples (FIG. 3). Methods and devices effect a quantitative detection of secondary electrons with the array of solid state detectors comprising a number of solid state detectors. An array senses the number of secondary electrons with a plurality of solid state detectors, counting the number of secondary electrons with a time to digital converter circuit in counter mode.

  8. Familial haemophagocytic lymphohistiocytosis: rare cause of acute ...

    African Journals Online (AJOL)

    Arun Kumar Agnihotri

    prolonged fever, cytopenias, and hepatosplenomegaly. We describe a .... a), interleukin (IL), interferon alpha (INF-a), giving rise to the ... The diagnosis HLH can be established if one of either 1 or 2 below of the following criteria are fulfilled: 1.

  9. Secondary acute pneumonias

    International Nuclear Information System (INIS)

    Rozenshtraukh, L.C.; Rybakova, N.I.; Vinner, M.G.

    1987-01-01

    Pathological changes, promoting the development of secondary pneumonias, are investigated. To this group belong: blood circulation disturbance in small circle, bronchial passability disturbance, aspiration of liquids, gases and vapors, infections and purulent processes, intoxications, injuries, operative interference. Roetgenologic symptomatics of each secondary acute pneumonia form is presented in detail

  10. Secondary fuel delivery system

    Science.gov (United States)

    Parker, David M.; Cai, Weidong; Garan, Daniel W.; Harris, Arthur J.

    2010-02-23

    A secondary fuel delivery system for delivering a secondary stream of fuel and/or diluent to a secondary combustion zone located in the transition piece of a combustion engine, downstream of the engine primary combustion region is disclosed. The system includes a manifold formed integral to, and surrounding a portion of, the transition piece, a manifold inlet port, and a collection of injection nozzles. A flowsleeve augments fuel/diluent flow velocity and improves the system cooling effectiveness. Passive cooling elements, including effusion cooling holes located within the transition boundary and thermal-stress-dissipating gaps that resist thermal stress accumulation, provide supplemental heat dissipation in key areas. The system delivers a secondary fuel/diluent mixture to a secondary combustion zone located along the length of the transition piece, while reducing the impact of elevated vibration levels found within the transition piece and avoiding the heat dissipation difficulties often associated with traditional vibration reduction methods.

  11. Secondary and tertiary hyperparathyroidism.

    Science.gov (United States)

    Jamal, Sophie A; Miller, Paul D

    2013-01-01

    We reviewed the etiology and management of secondary and tertiary hyperparathyroidism. Secondary hyperparathyroidism is characterized by an increase in parathyroid hormone (PTH) that is appropriate and in response to a stimulus, most commonly low serum calcium. In secondary hyperparathyroidism, the serum calcium is normal and the PTH level is elevated. Tertiary hyperparathyroidism is characterized by excessive secretion of PTH after longstanding secondary hyperparathyroidism, in which hypercalcemia has ensued. Tertiary hyperparathyroidism typically occurs in men and women with chronic kidney disease usually after kidney transplant. The etiology and treatment of secondary hyperparathyroidism is relatively straightforward whereas data on the management of tertiary hyperparathyroidism is limited to a few small trials with short follow-up. Copyright © 2013 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

  12. Teaching secondary mathematics

    CERN Document Server

    Rock, David

    2013-01-01

    Solidly grounded in up-to-date research, theory and technology,?Teaching Secondary Mathematics?is a practical, student-friendly, and popular text for secondary mathematics methods courses. It provides clear and useful approaches for mathematics teachers, and shows how concepts typically found in a secondary mathematics curriculum can be taught in a positive and encouraging way. The thoroughly revised fourth edition combines this pragmatic approach with truly innovative and integrated technology content throughout. Synthesized content between the book and comprehensive companion websi

  13. Secondary amenorrhea (image)

    Science.gov (United States)

    Secondary amenorrhea is the cessation of menstrual flow for a period of 6 months or more in the absence ... as anxiety can be the root cause of amenorrhea. Treatment can range from behavior modification for excessive ...

  14. Towards secondary fingerprint classification

    CSIR Research Space (South Africa)

    Msiza, IS

    2011-07-01

    Full Text Available an accuracy figure of 76.8%. This small difference between the two figures is indicative of the validity of the proposed secondary classification module. Keywords?fingerprint core; fingerprint delta; primary classifi- cation; secondary classification I..., namely, the fingerprint core and the fingerprint delta. Forensically, a fingerprint core is defined as the innermost turning point where the fingerprint ridges form a loop, while the fingerprint delta is defined as the point where these ridges form a...

  15. Secondary Fire Analysis.

    Science.gov (United States)

    1981-09-01

    Megaton Weapons and Secondary Ignition There are very few well documented data on fires initiated by physical damage (i.e., secondary ignitions). Those data...where significant physical damage to buildings and/or contents can occur. Where this outer bound is located relative to the primary ignition range is...maintenance 7.9 Busline facilities, including shops 3.0 Convalescent homes8 3.1 Hospitals 8.0 Radio and television transmitters Collges and universities

  16. Lysinuric protein intolerance (LPI): a multi organ disease by far more complex than a classic urea cycle disorder.

    Science.gov (United States)

    Ogier de Baulny, Hélène; Schiff, Manuel; Dionisi-Vici, Carlo

    2012-05-01

    Lysinuric protein intolerance (LPI) is an inherited defect of cationic amino acid (lysine, arginine and ornithine) transport at the basolateral membrane of intestinal and renal tubular cells caused by mutations in SLC7A7 encoding the y(+)LAT1 protein. LPI has long been considered a relatively benign urea cycle disease, when appropriately treated with low-protein diet and l-citrulline supplementation. However, the severe clinical course of this disorder suggests that LPI should be regarded as a severe multisystem disease with uncertain outcome. Specifically, immune dysfunction potentially attributable to nitric oxide (NO) overproduction secondary to arginine intracellular trapping (due to defective efflux from the cell) might be a crucial pathophysiological route explaining many of LPI complications. The latter comprise severe lung disease with pulmonary alveolar proteinosis, renal disease, hemophagocytic lymphohistiocytosis with subsequent activation of macrophages, various auto-immune disorders and an incompletely characterized immune deficiency. These results have several therapeutic implications, among which lowering the l-citrulline dosage may be crucial, as excessive citrulline may worsen intracellular arginine accumulation. Copyright © 2012 Elsevier Inc. All rights reserved.

  17. Secondary metabolites from Ganoderma.

    Science.gov (United States)

    Baby, Sabulal; Johnson, Anil John; Govindan, Balaji

    2015-06-01

    Ganoderma is a genus of medicinal mushrooms. This review deals with secondary metabolites isolated from Ganoderma and their biological significance. Phytochemical studies over the last 40years led to the isolation of 431 secondary metabolites from various Ganoderma species. The major secondary compounds isolated are (a) C30 lanostanes (ganoderic acids), (b) C30 lanostanes (aldehydes, alcohols, esters, glycosides, lactones, ketones), (c) C27 lanostanes (lucidenic acids), (d) C27 lanostanes (alcohols, lactones, esters), (e) C24, C25 lanostanes (f) C30 pentacyclic triterpenes, (g) meroterpenoids, (h) farnesyl hydroquinones (meroterpenoids), (i) C15 sesquiterpenoids, (j) steroids, (k) alkaloids, (l) prenyl hydroquinone (m) benzofurans, (n) benzopyran-4-one derivatives and (o) benzenoid derivatives. Ganoderma lucidum is the species extensively studied for its secondary metabolites and biological activities. Ganoderma applanatum, Ganoderma colossum, Ganoderma sinense, Ganoderma cochlear, Ganoderma tsugae, Ganoderma amboinense, Ganoderma orbiforme, Ganoderma resinaceum, Ganoderma hainanense, Ganoderma concinna, Ganoderma pfeifferi, Ganoderma neo-japonicum, Ganoderma tropicum, Ganoderma australe, Ganoderma carnosum, Ganoderma fornicatum, Ganoderma lipsiense (synonym G. applanatum), Ganoderma mastoporum, Ganoderma theaecolum, Ganoderma boninense, Ganoderma capense and Ganoderma annulare are the other Ganoderma species subjected to phytochemical studies. Further phytochemical studies on Ganoderma could lead to the discovery of hitherto unknown biologically active secondary metabolites. Copyright © 2015 Elsevier Ltd. All rights reserved.

  18. Dynamics of secondary forests

    NARCIS (Netherlands)

    Breugel, van M.

    2007-01-01

    The succession of tropical secondary forests on abandoned agricultural fields has been studied since long, most often by comparing stands of different age since abandonment. These so-called chronosequence studies have yielded much insight in general patterns of succession and the constraints and

  19. Two secondary drops

    Indian Academy of Sciences (India)

    Figure shows formation of two secondary drops of unequal size and their merger. The process is same as the earlier process until t= 0.039 Tc with necking occurring at two places, one at the bottom of the column and the other at the middle. The necking at the middle of the liquid column is due to Raleigh instability.

  20. [Primary and secondary encopresis].

    Science.gov (United States)

    Lang-Langer, Ellen

    2007-01-01

    While the difficulty of the child to part with its faeces in primary encopresis is linked to the incapability to experience the object as separated and independent from himself, secondary encopresis is a progressed psychical state of development. In this case we have to deal with regression caused by conflict. Two case-studies show clearly the differences.

  1. [Secondary thrombotic microangiopathies].

    Science.gov (United States)

    Coppo, P

    2017-11-01

    Thrombotic microangiopathies (TMA) are termed secondary when associated to a specific context favouring their occurrence. They encompass mainly TMA associated with pregnancy, allogeneic hematopoietic stem cell transplantation, cancer, drugs, or HIV infection. Secondary TMA represent a heterogeneous group of diseases which clinical presentation largely depends on the associated context. It is therefore mandatory to recognize these conditions since they have a significant impact in TMA management and prognosis. A successful management still represents a challenge in secondary TMA. Significant progresses have been made in the understanding of pregnancy-associated TMA, allowing an improvement of prognosis; on the opposite, other forms of secondary TMA such as hematopoietic stem cell transplantation-associated TMA or TMA associated with chemotherapy remain of dismal prognosis. A better understanding of pathophysiology in these forms of TMA, in association with a more empirical approach through the use of new therapeutic agents that can also help in the understanding on new mechanisms a posteriori, should improve their prognosis. The preliminary encouraging results reported with complement blockers in this field could represent a convincing example. Copyright © 2017 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  2. Secondary coolant purification system

    International Nuclear Information System (INIS)

    Stiteler, F.Z.; Donohue, J.P.

    1978-01-01

    The present invention combines the attributes of volatile chemical addition, continuous blowdown, and full flow condensate demineralization. During normal plant operation (defined as no primary to secondary leakage) condensate from the condenser is pumped through a full flow condensate demineralizer system by the condensate pumps. Volatile chemical additions are made. Dissolved and suspended solids are removed in the condensate polishers by ion exchange and/or filtration. At the same time a continuous blowdown of approximately 1 percent of the main steaming rate of the steam generators is maintained. Radiation detectors monitor the secondary coolant. If these monitors indicate no primary to secondary leakage, the blowdown is cooled and returned directly to the condensate pump discharge. If one of the radiation monitors should indicate a primary to secondary leak, when the temperature of the effluent exiting from the blowdown heat exchanger is compatible with the resin specifications of the ion exchangers, the bypass valve causes the blowdown flow to pass through the blowdown ion exchangers

  3. Secondary hypertension in adults.

    Science.gov (United States)

    Puar, Troy Hai Kiat; Mok, Yingjuan; Debajyoti, Roy; Khoo, Joan; How, Choon How; Ng, Alvin Kok Heong

    2016-05-01

    Secondary hypertension occurs in a significant proportion of adult patients (~10%). In young patients, renal causes (glomerulonephritis) and coarctation of the aorta should be considered. In older patients, primary aldosteronism, obstructive sleep apnoea and renal artery stenosis are more prevalent than previously thought. Primary aldosteronism can be screened by taking morning aldosterone and renin levels, and should be considered in patients with severe, resistant or hypokalaemia-associated hypertension. Symptoms of obstructive sleep apnoea should be sought. Worsening of renal function after starting an angiotensin-converting enzyme inhibitor suggests the possibility of renal artery stenosis. Recognition, diagnosis and treatment of secondary causes of hypertension lead to good clinical outcomes and the possible reversal of end-organ damage, in addition to blood pressure control. As most patients with hypertension are managed at the primary care level, it is important for primary care physicians to recognise these conditions and refer patients appropriately. Copyright: © Singapore Medical Association.

  4. Secondary combined suicide pact.

    Science.gov (United States)

    Jayanth, S H; Girish Chandra, Y P; Hugar, Basappa S; Kainoor, Sunilkumar

    2014-03-01

    This article reports a combined suicide pact, where in a young couple; a 26 year old male and a 20 year old female committed suicide by using two methods. The couple had resorted to hanging and self-immolation to prevent failure of single method alone. In secondary combined suicides, several other methods of suicide are tried after the first method chosen has failed. It is primary combined suicide only when two or more methods are used simultaneously. Both types of combined suicide by one individual is well reported in the literature whereas the same by two persons together is rare. In this report, the deceased were disappointed lovers, poor and the family members were against their marriage. The investigation of scene, methods employed to commit suicide, autopsy findings and the interview with their relatives altogether suggested that it was a secondary combined suicide pact. Copyright © 2014 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  5. THE SECONDARY EXTINCTION CORRECTION

    Energy Technology Data Exchange (ETDEWEB)

    Zachariasen, W. H.

    1963-03-15

    It is shown that Darwin's formula for the secondary extinction correction, which has been universally accepted and extensively used, contains an appreciable error in the x-ray diffraction case. The correct formula is derived. As a first order correction for secondary extinction, Darwin showed that one should use an effective absorption coefficient mu + gQ where an unpolarized incident beam is presumed. The new derivation shows that the effective absorption coefficient is mu + 2gQ(1 + cos/sup 4/2 theta )/(1 plus or minus cos/sup 2/2 theta )/s up 2/, which gives mu + gQ at theta =0 deg and theta = 90 deg , but mu + 2gQ at theta = 45 deg . Darwin's theory remains valid when applied to neutron diffraction. (auth)

  6. Secondary Breast Augmentation.

    Science.gov (United States)

    Brown, Mitchell H; Somogyi, Ron B; Aggarwal, Shagun

    2016-07-01

    After studying this article, the participant should be able to: 1. Assess common clinical problems in the secondary breast augmentation patient. 2. Describe a treatment plan to correct the most common complications of breast augmentation. 3. Provide surgical and nonsurgical options for managing complications of breast augmentation. 4. Decrease the incidence of future complications through accurate assessment, preoperative planning, and precise surgical technique. Breast augmentation has been increasing steadily in popularity over the past three decades. Many of these patients present with secondary problems or complications following their primary breast augmentation. Two of the most common complications are capsular contracture and implant malposition. Familiarity and comfort with the assessment and management of these complications is necessary for all plastic surgeons. An up-to-date understanding of current devices and techniques may decrease the need to manage future complications from the current cohort of breast augmentation patients.

  7. Secondary victims of rape

    DEFF Research Database (Denmark)

    Christiansen, Dorte Mølgaard; Bak, Rikke; Elklit, Ask

    2012-01-01

    secondary victims, including family members, partners, and friends of male and female rape victims. We found that many respondents found it difficult to support the PV and that their relationship with the PV was often affected by the assault. Furthermore, the sample showed significant levels...... of social support for the respondent, and feeling let down by others. The respondents were generally interested in friend-, family-, and partner-focused interventions, particularly in receiving education about how best to support a rape victim...

  8. Characteristics and generation of secondary jets and secondary gigantic jets

    Science.gov (United States)

    Lee, Li-Jou; Huang, Sung-Ming; Chou, Jung-Kung; Kuo, Cheng-Ling; Chen, Alfred B.; Su, Han-Tzong; Hsu, Rue-Rou; Frey, Harald U.; Takahashi, Yukihiro; Lee, Lou-Chuang

    2012-06-01

    Secondary transient luminous events (TLEs) recorded by the ISUAL-FORMOSAT2 mission can either be secondary jets or secondary gigantic jets (GJs), depending on their terminal altitudes. The secondary jets emerge from the cloud top beneath the preceding sprites and extend upward to the base of the sprites at ˜50 km. The secondary jets likely are negative electric discharges with vertically straight luminous columns, morphologically resembling the trailing jet of the type-I GJs. The number of luminous columns in a secondary jet seems to be affected by the size of the effective capacitor plate formed near the base of the preceding sprites and the charge distribution left behind by the sprite-inducing positive cloud-to-ground discharges. The secondary GJs originate from the cloud top under the shielding area of the preceding sprites, and develop upward to reach the lower ionosphere at ˜90 km. The observed morphology of the secondary GJs can either be the curvy shifted secondary GJs extending outside the region occupied by the preceding sprites or the straight pop-through secondary GJs developing through the center of the preceding circular sprites. A key factor in determining the terminal height of the secondary TLEs appears to be the local ionosphere boundary height that established by the preceding sprites. The abundance and the distribution of the negative charge in the thundercloud following the sprite-inducing positive cloud-to-ground discharges may play important role in the generation of the secondary TLEs.

  9. Causes of secondary headache (image)

    Science.gov (United States)

    Temporomandibular joint, or TMJ, dysfunction, can be a cause of secondary headache. Secondary headaches result from underlying disorders which produce pain as a symptom. The TMJ may become painful and dysfunctional as a result ...

  10. Secondary beams at GANIL

    International Nuclear Information System (INIS)

    Doubre, H.

    1992-01-01

    GANIL, a user's facility since 1983, can deliver a broad spectrum of heavy-ion beams, from He to U, to well-equipped experimental areas. Their very large intensities are to be exploited to produce secondary beams, either using the fragmentation method (beams at energy per nucleon larger than 30 MeV/u), or the ISOL method. With the latter one, these ions have to be re-accelerated. The project of a cyclotron as a post-accelerator is described. (author) 11 refs.; 7 figs.; 3 tabs

  11. Secondary Vertex Finder Algorithm

    CERN Document Server

    Heer, Sebastian; The ATLAS collaboration

    2017-01-01

    If a jet originates from a b-quark, a b-hadron is formed during the fragmentation process. In its dominant decay modes, the b-hadron decays into a c-hadron via the electroweak interaction. Both b- and c-hadrons have lifetimes long enough, to travel a few millimetres before decaying. Thus displaced vertices from b- and subsequent c-hadron decays provide a strong signature for a b-jet. Reconstructing these secondary vertices (SV) and their properties is the aim of this algorithm. The performance of this algorithm is studied with tt̄ events, requiring at least one lepton, simulated at 13 TeV.

  12. SECONDARY (ENDOCRINE HYPERTENSION: LECTURE

    Directory of Open Access Journals (Sweden)

    M. Yu. Yukina

    2016-01-01

    Full Text Available Hypertension is a  very common disease with high morbidity and reduction in quality of life. Endocrine disorders are the most common cause of secondary hypertension affecting ~3% of the population. Primary aldosteronism can be the cause of endocrine hypertension more often than other endocrine disorders. Other less common causes of endocrine hypertension include Cushing syndrome, pheochromocytoma, thyroid disorders, and hyperparathyroidism. Endocrine hypertension is potentially curable if the underlying cause is identified and treated accordingly. Younger age at manifestation of resistance to multiple antihypertensive drugs, together with other clinical signs of an endocrine disorder, should raise the suspicion and prompt the appropriate evaluation.

  13. [Secondary osteoporosis in gynecology].

    Science.gov (United States)

    Taguchi, Y; Gorai, I

    1998-06-01

    Several diseases and medications are known to induce secondary osteoporosis. Among them, same situations are related to gynecological field. They include Turner's syndrome, anorexia nervosa, ovarian dysfunction, oophorectomy, GnRH agonist therapy, and osteoporosis associated with pregnancy. We briefly describe these secondary osteoporosis in this article as follows. Several studies have found osteoporosis to be a common complication of Turner's syndrome and hormone replacement therapy has been used as a possible management; in anorexic patient, low body weight, prolonged amenorrhea, early onset of anorexia nervosa, and hypercortisolism have been reported to be risks for bone demineralization; since oophorectomy which is a common intervention in gynecology leads osteoporosis, it is important to prevent osteoporosis caused by surgery as well as postmenopausal osteoporosis; GnRH agonist, which induces estrogen deficient state and affect bone mass, is commonly used as a management for endometriosis and leiomyoma of uterus; associated with pregnancy, post-pregnancy spinal osteoporosis and transient osteoporosis of the hip are clinically considered to be important and heparin therapy and magnesium sulfate therapy are commonly employed during pregnancy, affecting calcium homeostasis.

  14. Radioactive heavy ion secondary beams

    International Nuclear Information System (INIS)

    Bimbot, R.

    1987-01-01

    The production of secondary radioactive beams at GANIL using the LISE spectrometer is reviewed. The experimental devices, and secondary beam characteristics are summarized. Production of neutron rich secondary beams was studied for the systems Ar40 + Be at 44 MeV/u, and 018 + Be at 45 and 65 MeV/u. Partial results were also obtained for the system Ne22 + Ta at 45 MeV/u. Experiments using secondary beams are classified into two categories: those which correspond to fast transfer of nuclei from the production target to a well shielded observation point; and those in which the radioactive beam interacts with a secondary target

  15. Transitions in Secondary Education

    DEFF Research Database (Denmark)

    Larsen, Britt Østergaard; Jensen, Leif; Pilegaard Jensen, Torben

    2014-01-01

    statistical model of educational progression. By using this method, we parcel educational attainment into a series of transitions and the model is able to control for educational selection and unobserved heterogeneity. We apply counterfactual analyses to allow a formal decomposition of the effects of social......The purpose of this article is to investigate educational choices and attainment of children who experience social problems during their upbringing. The study explores the extent to which social problems can help explain the gaps in entry and dropout rates in upper secondary education in Denmark...... between students from different socioeconomic backgrounds. Population-based registers are used to include information on family upbringing, e.g. alcohol abuse, criminality, use of psychopharmaca and out-of-home placement. We estimate a parsimonious version of Cameron and Heckman's (2001) dynamic...

  16. [Secondary orbital lymphoma].

    Science.gov (United States)

    Basanta, I; Sevillano, C; Álvarez, M D

    2015-09-01

    A case is presented of an 85 year-old Caucasian female with lymphoma that recurred in the orbit (secondary ocular adnexal lymphoma). The orbital tumour was a diffuse large B-cell lymphoma according to the REAL classification (Revised European-American Lymphoma Classification). Orbital lymphomas are predominantly B-cell proliferations of a variety of histological types, and most are low-grade tumours. Patients are usually middle-aged or elderly, and it is slightly more common in women. A palpable mass, proptosis and blepharoptosis are the most common signs of presentation. Copyright © 2011 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

  17. HANARO secondary coolant management

    International Nuclear Information System (INIS)

    Kim, Seon Duk.

    1998-02-01

    In this report, the basic theory for management of water quality, environmental factors influencing to the coolant, chemicals and its usage for quality control of coolant are mentioned, and water balance including the loss rate by evaporation (34.3 m 3 /hr), discharge rate (12.665 m 3 /hr), concentration ratio and feed rate (54.1 m 3 /hr) are calculated at 20 MW operation. Also, the analysis data of HANSU Limited for HANARO secondary coolant (feed water and circulating coolant) - turbidity, pH, conductivity, M-alkalinity, Ca-hardness, chloride ion, total iron ion, phosphoric ion and conversion rate are reviewed. It is confirmed that the feed water has good quality and the circulating coolant has been maintained within the control specification in general, but some items exceeded the control specification occasionally. Therefore it is judged that more regular discharge of coolant is needed. (author). 6 refs., 17 tabs., 18 figs

  18. New secondary energy systems

    International Nuclear Information System (INIS)

    Schulten, R.

    1977-01-01

    As an introduction, the FRG's energy industry situation is described, secondary energy systems to be taken into consideration are classified, and appropriate market requirements are analyzed. Dealt with is district heating, i.e. the direct transport of heat by means of circulating media, and long-distance energy, i.e. the long-distance energy transport by means of chemical conversion in closed- or open-cycle systems. In closed-cycle systems heat is transported in the form of chemical latent energy. In contrast to this, chemical energy is transported in open-cycle systems in the form of fuel gases produced by coal gasification or by thermochemical water splitting. (GG) [de

  19. Secondary interactions in HIJET

    International Nuclear Information System (INIS)

    Longacre, R.S.

    1990-01-01

    This talk deals with the investigation of secondary interactions in proton-nucleus and nucleus-nucleus collisions using the Monte Carlo event generator HIJET. The HIJET generator considers p-A and A-A collisions to be a sum of independent N-N collisions, with the N-N cross section and scattering dynamics not dependent on whether the nucleon has previously participated in an interaction. It is very reasonable to assume that each collision should be well represented by an independent N-N collision, however the cross section for the forward going struck nucleon may be different. For each primary N-N interaction, a call is made to the MINBIAS routine of the program ISAJET - an event generator for high energy N-N interactions. MINBIAS computes the energy loss of the colliding nucleons and production of particles. MINBIAS is based on inclusive high energy N-N interactions forming multi-pomeron chains, with each chain fragmenting according to the Field-Feynman algorithm

  20. [Uveitic Secondary Glaucoma].

    Science.gov (United States)

    Lommatzsch, Claudia; Heinz, Carsten

    2018-05-01

    An intraocular pressure increase with development of glaucomatous damage is a common complication of uveitis. The prevalence has a wide range depending on various factors such as the underlying uveitis type and the duration of the disease. Pathogenetically, a distinction must be made between a secondary angle closure component and the more frequently occurring open-angle glaucoma. In diagnostics, in addition to the clinical optic nerve head assessment, perimetry and tonometry, the use of imaging examination equipment, such as OCT and HRT, are recommended. In the context of uveitic glaucoma, it must be considered in the evaluation, because the glaucoma-typical changes are generally less pronounced or can be concealed by retinal swelling in comparison with other forms of glaucoma. Therapeutically, drug therapy in the form of eye drops continues to be a first-line recommendation, with the use of topical carbonic anhydrase inhibitors or beta-blockers primarily preferred, depending on the contraindications. An operative therapy follows after unsuccessful or inadequate conservative therapy: the adequate surgical technique depends on the respective finding and includes actually techniques such as filtering procedures and glaucoma drainage devices. Georg Thieme Verlag KG Stuttgart · New York.

  1. Performance Art at Secondary Level

    Science.gov (United States)

    Horn, Sheridan

    2009-01-01

    This article considers the far-reaching potential and the particular characteristics of performance art within the secondary art curriculum. It discusses the means by which an art department has incorporated it into their teaching curriculum at a state secondary school with reference to installations and the work of different performance artists…

  2. Secondary standard dosimetry laboratory (SSDL)

    International Nuclear Information System (INIS)

    Md Saion bin Salikin.

    1983-01-01

    A secondary Standard Dosimetry Laboratory has been established in the Tun Ismail Research Centre, Malaysia as a national laboratory for reference and standardization purposes in the field of radiation dosimetry. This article gives brief accounts on the general information, development of the facility, programmes to be carried out as well as other information on the relevant aspects of the secondary standard dosimetry laboratory. (author)

  3. [Preventive dentistry 5. Secondary caries].

    NARCIS (Netherlands)

    Hollanders, A.C.C.; Kuper, N.K.; Opdam, N.J.M.; Huysmans, M.C.D.N.J.M.

    2017-01-01

    Secondary caries is reported as one of the most important reasons for replacing restorations. The patient's general caries risk plays an important role in the development of secondary caries. The connection, at the patient level, between various factors, the risk of caries and restoration factors,

  4. Secondary maxima in ozone profiles

    Directory of Open Access Journals (Sweden)

    R. Lemoine

    2004-01-01

    Full Text Available Ozone profiles from balloon soundings as well as SAGEII ozone profiles were used to detect anomalous large ozone concentrations of ozone in the lower stratosphere. These secondary ozone maxima are found to be the result of differential advection of ozone-poor and ozone-rich air associated with Rossby wave breaking events. The frequency and intensity of secondary ozone maxima and their geographical distribution is presented. The occurrence and amplitude of ozone secondary maxima is connected to ozone variability and trend at Uccle and account for a large part of the total ozone and lower stratospheric ozone variability.

  5. Secondary abdominal appendicular ectopic pregnancy.

    Science.gov (United States)

    Nama, Vivek; Gyampoh, Bright; Karoshi, Mahantesh; McRae, Reynold; Opemuyi, Isaac

    2007-01-01

    Although the case fatality rate for ectopic pregnancies has decreased to 0.08% in industrialized countries, it still represents 3.8% of maternal mortality in the United States alone. In developing countries, the case fatality rate varies from 3% to 27%. Laparoscopic management of tubal pregnancies is now the standard form of treatment where this technology is available. Abdominal pregnancies are rare, and secondary implantation of tubal ectopic pregnancies is the most common cause of abdominal gestations. We present an interesting case of secondary implantation of a tubal ectopic pregnancy to highlight the appendix as a possible secondary implantation site after a tubal ectopic pregnancy.

  6. Late-Onset Non-HLH Presentations of Growth Arrest, Inflammatory Arachnoiditis, and Severe Infectious Mononucleosis, in Siblings with Hypomorphic Defects in UNC13D

    Directory of Open Access Journals (Sweden)

    Paul Edgar Gray

    2017-08-01

    Full Text Available Bi-allelic null mutations affecting UNC13D, STXBP2, or STX11 result in defects of lymphocyte cytotoxic degranulation and commonly cause familial hemophagocytic lymphohistiocytosis (FHL in early life. Patients with partial loss of function are increasingly being diagnosed after presenting with alternative features of this disease, or with HLH later in life. Here, we studied two sisters with lymphocyte degranulation defects secondary to compound heterozygote missense variants in UNC13D. The older sibling presented aged 11 with linear growth arrest and delayed puberty, 2 years prior to developing transient ischemic attacks secondary to neuroinflammation and hypogammaglobulinemia, but no FHL symptoms. Her geno-identical younger sister was initially asymptomatic but then presented at the same age with severe EBV-driven infectious mononucleosis, which was treated aggressively and did not progress to HLH. The sisters had similar natural killer cell degranulation; however, while cytotoxic activity was moderately reduced in the asymptomatic patient, it was completely absent in both siblings during active disease. Following allogeneic bone marrow transplantation at the age of 15, the older child has completely recovered NK cell cytotoxicity, is asymptomatic, and has experienced an exceptional compensatory growth spurt. Her younger sister was also successfully transplanted and is currently disease free. The current study reveals previously unappreciated manifestations of FHL in patients who inherited hypomorphic gene variants and also raises the important question of whether a threshold of minimum NK function can be defined that should protect a patient from serious disease manifestations such as HLH.

  7. Biochemistry of plant secondary metabolism

    National Research Council Canada - National Science Library

    Wink, Michael

    2010-01-01

    ... (monoterpenes, sesquiterpenes, sterols, cardiac glycosides and steroid saponins). A chapter is also included covering the importance of secondary metabolites in taxonomy, as viewed from the perspective of molecular systematics...

  8. MARIJUANA SMOKING AMONG SECONDARY SCHOOL ...

    African Journals Online (AJOL)

    MARIJUANA SMOKING AMONG SECONDARY SCHOOL STUDENTS IN ZARIA, NIGERIA: FACTORS RESPONSIBLE AND ... Its medico-social effects could ruin the life and future of our youths. ... A comprehensive school health education

  9. Hormonal changes in secondary impotence

    International Nuclear Information System (INIS)

    Salama, F.M.; El-Shabrawy, N.O.; Nosseir, S.A.; Abo El-Azayem, Naglaa.

    1985-01-01

    Impotence is one of the problems which is still obscure both in its aetiology and treatment. The present study deals with the possible hormonal changes in cases of secondary infertility. The study involved 25 patients diagnosed as secondary impotence. Hormonal assay was performed for the following hormones: 1. Prolaction hormone. 2. Luteinising hormone (L.H.). 3. Testosterone. 4. Follicle stimulating hormone (F.S.H.). The assay was carried out by radioimmunoassay using double antibody technique. Results are discussed

  10. Secondary liquefaction in ethanol production

    DEFF Research Database (Denmark)

    2007-01-01

    The invention relates to a method of producing ethanol by fermentation, said method comprising a secondary liquefaction step in the presence of a themostable acid alpha-amylase or, a themostable maltogenic acid alpha-amylase.......The invention relates to a method of producing ethanol by fermentation, said method comprising a secondary liquefaction step in the presence of a themostable acid alpha-amylase or, a themostable maltogenic acid alpha-amylase....

  11. Secondary electron emission from insulators

    International Nuclear Information System (INIS)

    Kanaya, K.; Ono, S.; Ishigaki, F.

    1978-01-01

    The high yield of secondary electron emission from insulators due to electron bombardment may be the result of an increase of the depth of escape. The free-electron scattering theory is applied to the high energy of primary beams, but cannot be applied to the low energy of secondary escaping beams because of the large energy gap of the insulators. The plasmon loss with the valence electron is considered when the secondary electrons escape. Based on the energy retardation power formula of the penetration and energy loss of an electron probe into solid targets, secondary electron emissions from insulators are calculated from the assumptions that the distribution of the secondary electrons due to both incident and back-scattered electrons within the target is isotropic and that it follows the absorption law of the Lenard type. The universal yield-energy curve of the secondary electron emission, which is deduced as a function of three parameters such as ionisation potential, valence electron and the back-scattered coefficient in addition to the free-electron density effect, is found to be in good agreement with the experimental results. (author)

  12. Secondary reconstruction of maxillofacial trauma.

    Science.gov (United States)

    Castro-Núñez, Jaime; Van Sickels, Joseph E

    2017-08-01

    Craniomaxillofacial trauma is one of the most complex clinical conditions in contemporary maxillofacial surgery. Vital structures and possible functional and esthetic sequelae are important considerations following this type of trauma and intervention. Despite the best efforts of the primary surgery, there are a group of patients that will have poor outcomes requiring secondary reconstruction to restore form and function. The purpose of this study is to review current concepts on secondary reconstruction to the maxillofacial complex. The evaluation of a posttraumatic patient for a secondary reconstruction must include an assessment of the different subunits of the upper face, middle face, and lower face. Virtual surgical planning and surgical guides represent the most important innovations in secondary reconstruction over the past few years. Intraoperative navigational surgery/computed-assisted navigation is used in complex cases. Facial asymmetry can be corrected or significantly improved by segmentation of the computerized tomography dataset and mirroring of the unaffected side by means of virtual surgical planning. Navigational surgery/computed-assisted navigation allows for a more precise surgical correction when secondary reconstruction involves the replacement of extensive anatomical areas. The use of technology can result in custom-made replacements and prebent plates, which are more stable and resistant to fracture because of metal fatigue. Careful perioperative evaluation is the key to positive outcomes of secondary reconstruction after trauma. The advent of technological tools has played a capital role in helping the surgical team perform a given treatment plan in a more precise and predictable manner.

  13. Adrenal Mass Causing Secondary Hypertension.

    Science.gov (United States)

    Robinson, Darlene Y

    2015-11-01

    Most hypertensive patients have essential (primary) hypertension; only 5% to 10% have a secondary cause. Two clinical characteristics suggestive of secondary hypertension are early onset (hypertension (>180/110 mm Hg). When faced with these findings, clinicians should consider a secondary cause of hypertension. A 22-year-old woman being evaluated for asthma exacerbation in the emergency department was noted to have severe persistent hypertension. Additional evaluation revealed severe hypokalemia, metabolic alkalosis, and hypernatremia. The patient was admitted to the hospital for blood pressure management, electrolyte replacement, and further evaluation of presumed hyperaldosteronism. Diagnostic imaging revealed a large adrenal mass. Surgical resection was performed, leading to a diagnosis of hyperaldosteronism caused by adrenal carcinoma. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Secondary hypertension is far less common than essential hypertension; however, considering the large volume of patients seen in emergency departments, it is likely that some will have secondary hypertension. Emergency physicians should be aware of the clinical characteristics that suggest secondary hypertension so that the appropriate diagnostic and treatment pathways can be pursued. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Secondary School Student's Attitude towards Consumer

    African Journals Online (AJOL)

    FIRST LADY

    Keywords: Consumer Education, Attitude, Home Economics, Secondary. School Students. ... Home Management taught at Senior Secondary School level. Today ..... indicate that facilities for teaching Consumer Education especially textbooks.

  15. Cancer as secondary immunodeficiency. Review

    Directory of Open Access Journals (Sweden)

    María Eugenia Vargas-Camaño

    2016-05-01

    Full Text Available The secondary immunodeficiency’s, previously presented in immunocompetent individuals. The lack of primary or secondary response to the presence of a foreign antigen, in the case of infections is a sentinel data in the diagnosis of immunodeficiency (can be primary or secondary, in the case of a self antigen may generate the presence of Cancer. Cancer has shown an increase in the prevalence and incidence globally. Most current medical treatments in cancer are focused primarily on immunomodulatory actions (immunosuppression / immune stimulation or both. Knowledge of key concepts from the perspective of innate and acquired immunity lead to cancer development, engaging immune surveillance and escape mechanisms of this that contribute to better understand the origin, behavior and treatment of neoplasm’s. These treatments can cause immunological disorders such as allergy, anaphylaxis, lack of response immunogenicity care fields specialist in Allergy and Clinical Immunology.

  16. Function-related Secondary User Needs and Secondary Data

    African Journals Online (AJOL)

    Riette Ruthven

    basis of both a critical analysis of the theory and an examination of selected data types .... (2) "Secondary needs related to the user's linguistic and subject-specific ... understand the Afrikaans word skepe needs to know that skepe is the plural.

  17. Summarizing primary and secondary effects

    DEFF Research Database (Denmark)

    Karlson, Kristian Bernt

    2013-01-01

    Current methods for decomposing class differentials in educational decisions into primary and secondary effects produce many parameters, rendering them ill-equipped for parsimonious comparisons across countries or birth cohorts. This paper develops a parametric method that provides an optimal...... summary of primary and secondary effects across discrete class origins. Under the testable assumption that the pattern of effects of class origins on academic ability is proportional to the pattern of effects of class origins on educational choice net of academic ability, the method returns a single...

  18. Dynamic decoupling of secondary systems

    International Nuclear Information System (INIS)

    Gupta, A.K.; Tembulkar, J.M.

    1984-01-01

    The dynamic analysis of primary systems must often be performed decoupled from the secondary system. In doing so, one should assure that the decoupling does not significantly affect the frequencies and the response of the primary systems. The practice consists of heuristic algorithms intended to limit changes in the frequencies. The change in response is not considered. In this paper, changes in both the frequencies and the response are considered. Rational, but simple algorithms are derived to make accurate predictions. Material up to MDOF primary-SDOF secondary system is presented in this paper. MDOF-MDOF systems are treated in a companion paper. (orig.)

  19. Localized lesions in secondary syphillis

    International Nuclear Information System (INIS)

    Rasid, N.; Syphilis, S.

    2008-01-01

    The clinical manifestations of secondary syphilis are variable and can mimic many skin diseases, mostly being generalized and symmetrical in distribution. Localized lesions of secondary syphilis are rarely seen in dermatology clinics. We report an unusual presentation wherein a patient had localized lesions over face and soles only. There is a need for increased awareness on the part of physicians to recognize new patterns of syphilitic infection, together with a willingness to consider the diagnosis of syphilis in patients with unusual clinical features. (author)

  20. PWR secondary water chemistry guidelines

    International Nuclear Information System (INIS)

    Bell, M.J.; Blomgren, J.C.; Fackelmann, J.M.

    1982-10-01

    Steam generators in pressurized water reactor (PWR) nuclear power plants have experienced tubing degradation by a variety of corrosion-related mechanisms which depend directly on secondary water chemistry. As a result of this experience, the Steam Generator Owners Group and EPRI have sponsored a major program to provide solutions to PWR steam generator problems. This report, PWR Secondary Water Chemistry Guidelines, in addition to presenting justification for water chemistry control parameters, discusses available analytical methods, data management and surveillance, and the management philosophy required to successfully implement the guidelines

  1. 34 CFR 300.36 - Secondary school.

    Science.gov (United States)

    2010-07-01

    ... 34 Education 2 2010-07-01 2010-07-01 false Secondary school. 300.36 Section 300.36 Education... DISABILITIES General Definitions Used in This Part § 300.36 Secondary school. Secondary school means a nonprofit institutional day or residential school, including a public secondary charter school that provides...

  2. Primary expectations of secondary metabolites

    Science.gov (United States)

    My program examines the plant secondary metabolites (i.e. phenolics) important for human health, and which impart the organoleptic properties that are quality indicators for fresh and processed foods. Consumer expectations such as appearance, taste, or texture influence their purchasing decisions; a...

  3. Secondary syphilis presenting as vertigo

    International Nuclear Information System (INIS)

    Bari, A.U.; Mehmood, T.; Khan, B.; Malik, N.; Malik, K.Z.; Sukhera, A.M.

    2006-01-01

    Syphilis is a chronic, systemic and sexually transmitted infectious disease affecting most of the organs in the body. A young African man presented with vertigo, unsteadiness of gait and a skin rash suggestive of secondary syphilis. Diagnosis was confirmed on serology and was treated with two shots of long-acting penicillin, following which his symptoms settled. (author)

  4. Hydrocephalus secondary to subarachnoid hemorrhage

    International Nuclear Information System (INIS)

    Koga, Nobunori; Nakamura, Saburo; Kushi, Hidehiko; Yamamoto, Takamitsu; Tsubokawa, Takashi; Moriyasu, Nobuo

    1982-01-01

    The relationship between the extension and severity of subarachnoid hemorrhage, as demonstrated by computed tomography (CT), and hydrocephalus secondary to subarachnoid hemorrhage was studied. In 94 cases with subarachnoid hemorrhage, as analyzed by CT scan performed within 7 days after onset, high-density areas in the subarachnoid space were recognized in 61 cases (64%) and secondary hydrocephalus occurred in 22 cases (23%). 17 cases died within 2 weeks, before the occurrence of the hydrocephalus. The CT findings of subarachnoid hemorrhage was classified into 5 types, according to its severity and extension; especially the degree of high density in the basal cistern and/or cisterns around the brain stem was remarked. Secondary hydrocephalus after subarachnoid hemorrhage was observed in 90% of the cases; they had a density higher than a CT number of 60 in the basal cistern and/or cisterns around the brain stem (Type V). The mean interval between the onset of subarachnoid hemorrhage and the appearance of hydrocephalus was 20.6 days. We conclude that a significantly high density of extravasated blood in the subarachnoid space, especially in the basal cistern and/or the cisterns around the brain stem, can be predictive of secondary hydrocephalus after subarachnoid hemorrhage. (author)

  5. Teacher's Guide to Secondary Mathematics.

    Science.gov (United States)

    Duval County Schools, Jacksonville, FL.

    This is a teacher's guide to secondary school mathematics. Developed for use in the Duval County Public Schools, Jacksonville, Florida. Areas of mathematics covered are algebra, analysis, calculus, computer literacy, computer science, geometry, analytic geometry, general mathematics, consumer mathematics, pre-algebra, probability and statistics,…

  6. Portugal's Secondary School Modernisation Programme

    Science.gov (United States)

    Heitor, Teresa V.; Freire da Silva, Jose M. R.

    2009-01-01

    The aim of the Secondary School Modernisation Programme, being implemented in Portugal by "Parque Escolar, EPE", is based on the pursuit of quality and makes Portuguese education a potential international benchmark. This paper discusses the strategies adopted to reorganise school spaces. It describes the conceptual model and highlights…

  7. Confirmed efficacy of etoposide and dexamethasone in HLH treatment: long-term results of the cooperative HLH-2004 study

    Science.gov (United States)

    Bergsten, Elisabet; Horne, AnnaCarin; Aricó, Maurizio; Astigarraga, Itziar; Egeler, R. Maarten; Filipovich, Alexandra H.; Ishii, Eiichi; Janka, Gritta; Ladisch, Stephan; Lehmberg, Kai; McClain, Kenneth L.; Minkov, Milen; Montgomery, Scott; Nanduri, Vasanta; Rosso, Diego

    2017-01-01

    Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory syndrome comprising familial/genetic HLH (FHL) and secondary HLH. In the HLH-94 study, with an estimated 5-year probability of survival (pSu) of 54% (95% confidence interval, 48%-60%), systemic therapy included etoposide, dexamethasone, and, from week 9, cyclosporine A (CSA). Hematopoietic stem cell transplantation (HSCT) was indicated in patients with familial/genetic, relapsing, or severe/persistent disease. In HLH-2004, CSA was instead administered upfront, aiming to reduce pre-HSCT mortality and morbidity. From 2004 to 2011, 369 children aged <18 years fulfilled HLH-2004 inclusion criteria (5 of 8 diagnostic criteria, affected siblings, and/or molecular diagnosis in FHL-causative genes). At median follow-up of 5.2 years, 230 of 369 patients (62%) were alive (5-year pSu, 61%; 56%-67%). Five-year pSu in children with (n = 168) and without (n = 201) family history/genetically verified FHL was 59% (52%-67%) and 64% (57%-71%), respectively (familial occurrence [n = 47], 58% [45%-75%]). Comparing with historical data (HLH-94), using HLH-94 inclusion criteria, pre-HSCT mortality was nonsignificantly reduced from 27% to 19% (P = .064 adjusted for age and sex). Time from start of therapy to HSCT was shorter compared with HLH-94 (P = .020 adjusted for age and sex) and reported neurological alterations at HSCT were 22% in HLH-94 and 17% in HLH-2004 (using HLH-94 inclusion criteria). Five-year pSu post-HSCT overall was 66% (verified FHL, 70% [63%-78%]). Additional analyses provided specific suggestions on potential pre-HSCT treatment improvements. HLH-2004 confirms that a majority of patients may be rescued by the etoposide/dexamethasone combination but intensification with CSA upfront, adding corticosteroids to intrathecal therapy, and reduced time to HSCT did not improve outcome significantly. PMID:28935695

  8. SECONDARY OSTEOARTHRITIS IN RHEUMATOID ARTHRITIS

    Directory of Open Access Journals (Sweden)

    I. A. Starodubtseva

    2015-01-01

    Full Text Available The paper considers the problems of comorbidities in patients with rheumatoid arthritis (RA. Two or more RA-related conditions were diagnosed according to the results of the QUEST-RA program implemented in 34 countries. Osteoarthritis along with hypertension, hyperlipidemia, and osteoporosis was detected among the most commonly diseases. Owing to expanded diagnostic capabilities, the recognition and treatment of the comorbidities have recently received much attention, as embodied in the draft Association of Rheumatologists of Russia Guidelines for RA management (2014; Part 1. The concept and major characteristics of secondary osteoarthritis in RA are analyzed. It is precisely the inflammatory process and underlying disease-related risk factors, including treatment, that have impact on the development of secondary osteoarthritis and patients’ quality of life as a whole. All this allows an inference about the mechanisms closely intertwined with the underlying disease for the development of secondary osteoarthritis, which initiates cartilage damage and further remodeling. Primary and secondary osteoarthritis was comparatively analyzed. Particular emphasis is placed on current cartilage biomarkers, their diagnostic value and role in monitoring the efficiency of treatment in clinical trials. The paper provides a comparative analysis of detectable serum and urine biomarkers according to the results of the complex analysis made by the National Institutes of Health. Particular attention is given to cartilage oligomeric matrix protein (COMP. Foreign authors’ investigations suggest that there is a relationship between serum COMP levels and disease severity and joint X-ray changes. There is evidence for the efficacy of hyaluronic acid used in the treatment of secondary osteoarthritis in patients with RA. 

  9. Acute or chronic life-threatening diseases associated with Epstein-Barr virus infection.

    Science.gov (United States)

    Okano, Motohiko; Gross, Thomas G

    2012-06-01

    Infectious mononucleosis (IM) is one of the representative, usually benign, acute diseases associated with primary Epstein-Barr virus (EBV) infection. IM is generally self-limiting and is characterized mostly by transient fever, lymphadenopathy and hepatosplenomegaly. However, very rarely primary EBV infection results in severe or fatal conditions such as hemophagocytic lymphohistiocytosis together with fulminant hepatitis designated as severe or fatal IM or EBV-associated hemophagocytic lymphohistiocytosis alone. In addition, chronic EBV-associated diseases include Burkitt's lymphoma, undifferentiated nasopharyngeal carcinoma, Hodgkin lymphoma, T-cell lymphoproliferative disorder (LPD)/lymphoma, natural killer-cell LPD including leukemia or lymphoma, gastric carcinoma, pyothorax-associated lymphoma and senile B-cell LPD as well as chronic active EBV infection and LPD/lymphoma in patients with immunodeficiency. The number of chronic life-threatening diseases linked to the EBV infection is increasingly reported and many of these diseases have a poor prognosis. This review will focus on the historical, pathogenetic, diagnostic, therapeutic and prophylactic issues of EBV-associated life-threatening diseases.

  10. Gene transfer into hematopoietic stem cells reduces HLH manifestations in a murine model of Munc13-4 deficiency.

    Science.gov (United States)

    Soheili, Tayebeh; Durand, Amandine; Sepulveda, Fernando E; Rivière, Julie; Lagresle-Peyrou, Chantal; Sadek, Hanem; de Saint Basile, Geneviève; Martin, Samia; Mavilio, Fulvio; Cavazzana, Marina; André-Schmutz, Isabelle

    2017-12-26

    Patients with mutations in the UNC13D gene (coding for Munc13-4 protein) suffer from familial hemophagocytic lymphohistiocytosis type 3 (FHL3), a life-threatening immune and hyperinflammatory disorder. The only curative treatment is allogeneic hematopoietic stem cell (HSC) transplantation, although the posttreatment survival rate is not satisfactory. Here, we demonstrate the curative potential of UNC13D gene correction of HSCs in a murine model of FHL3. We generated a self-inactivating lentiviral vector, used it to complement HSCs from Unc13d -deficient (Jinx) mice, and transplanted the cells back into the irradiated Jinx recipients. This procedure led to complete reconstitution of the immune system (ie, to wild-type levels). The recipients were then challenged with lymphocytic choriomeningitis virus to induce hemophagocytic lymphohistiocytosis (HLH)-like manifestations. All the clinical and biological signs of HLH were significantly reduced in mice having undergone HSC UNC13D gene correction than in nontreated animals. This beneficial effect was evidenced by the correction of blood cytopenia, body weight gain, normalization of the body temperature, decreased serum interferon-γ level, recovery of liver damage, and decreased viral load. These improvements can be explained by the restoration of the CD8 + T lymphocytes' cytotoxic function (as demonstrated here in an in vitro degranulation assay). Overall, our results demonstrate the efficacy of HSC gene therapy in an FHL-like setting of immune dysregulation.

  11. Building a secondary containment system

    Energy Technology Data Exchange (ETDEWEB)

    Broder, M.F.

    1994-10-01

    Retail fertilizer and pesticide dealers across the United States are installing secondary containment at their facilities or are seriously considering it. Much of this work is in response to new state regulations; however, many dealers not facing new regulations are upgrading their facilities to reduce their liability, lower their insurance costs, or comply with anticipated regulations. The Tennessee Valley Authority`s (TVA) National Fertilizer and Environmental Research Center (NFERC) has assisted dealers in 22 states in retrofitting containment to their facilities. Simultaneous improvements in the operational efficiency of the facilities have been achieved at many of the sites. This paper is based on experience gained in that work and details the rationale used in planning secondary containment and facility modifications.

  12. Demarcation of secondary hyperalgesia zones

    DEFF Research Database (Denmark)

    Ringsted, Thomas K; Enghuus, Casper; Petersen, Morten A

    2015-01-01

    of analgesic drug effects in humans. However, since the methods applied in demarcating the secondary hyperalgesia zone seem inconsistent across studies, we examined the effect of a standardized approach upon the measurement of SHA following a first degree burn injury (BI). NEW METHOD: The study was a two.......0001). No day-to-day or observer-to-observer differences in SHAs were observed. Intraclass correlation coefficients, in the range of 0.51 to 0.84, indicated a moderate to almost perfect reliability between observers. COMPARISON WITH EXISTING METHODS: No standardized approach in SHA-assessment has hitherto been...... presented. CONCLUSIONS: This is the first study to demonstrate that demarcation of secondary hyperalgesia zones depends on the developed pressure of the punctate stimulator used....

  13. Vascular Morphodynamics During Secondary Growth.

    Science.gov (United States)

    de Reuille, Pierre Barbier; Ragni, Laura

    2017-01-01

    Quantification of vascular morphodynamics during secondary growth has been hampered by the scale of the process. Even in the tiny model plant Arabidopsis thaliana, the xylem can include more than 2000 cells in a single cross section, rendering manual counting impractical. Moreover, due to its deep location, xylem is an inaccessible tissue, limiting live imaging. A novel method to visualize and measure secondary growth progression has been proposed: "the Quantitative Histology" approach. This method is based on a detailed anatomical atlas, and image segmentation coupled with machine learning to automatically extract cell shapes and identify cell type. Here we present a new version of this approach, with a user-friendly interface implemented in the open source software LithoGraphX.

  14. Uranium resource processing. Secondary resources

    International Nuclear Information System (INIS)

    Gupta, C.K.; Singh, H.

    2003-01-01

    This book concentrates on the processing of secondary sources for recovering uranium, a field which has gained in importance in recent years as it is environmental-friendly and economically in tune with the philosophy of sustainable development. Special mention is made of rock phosphate, copper and gold tailings, uranium scrap materials (both natural and enriched) and sea water. This volume includes related area of ore mineralogy, resource classification, processing principles involved in solubilization followed by separation and safety aspects

  15. Secondary middle turbinate: case report

    Energy Technology Data Exchange (ETDEWEB)

    Aburjeli, Bruna de Oliveira Melim; Avila, Ana Flavia Assis de; Diniz, Renata Lopes Furletti Caldeira; Motta, Emilia Guerra Pinto Coelho; Ribeiro, Marcelo Almeida; Moreira, Wanderval, E-mail: bruninha86@hotmail.com [Radiology and Imaging Diagnosis, Hospital Mater Dei, Belo Horizonte, MG (Brazil)

    2012-11-15

    Secondary middle turbinate is an anatomical variant rarely observed in the nasal cavity, firstly described by Khanobthamchai et al. as a bone structure originating from the lateral nasal wall and covered by soft tissue. In most cases reported in the literature, this variant is bilateral, occurring without associated complications. In the present report, the authors describe the case of patient of their institution with such anatomical variation. (author)

  16. Monoparesis secondary to herpes zoster.

    LENUS (Irish Health Repository)

    Bilal, S

    2011-06-01

    We describe a 90-year-old woman with right upper limb monoparesis secondary to varicella zoster virus infection as a result of extensive inflammatory involvement of the entire brachial plexus at root level. To our knowledge, this is the first report of entire brachial plexus involvement in a living patient of such advanced age. Despite a delay in presentation and thus initiation of treatment, a favourable clinical response was observed.

  17. Linear morphea with secondary mucinosis

    Directory of Open Access Journals (Sweden)

    Khandpur Sujay

    2009-01-01

    Full Text Available Secondary mucin deposition in the skin is a common feature of lupus erythematosus and dermatomyositis. In scleroderma, it occurs uncommonly or in small amount. We describe a 7-year-old boy with progressive, linear, bound-down plaques involving the thighs, lower abdomen and back with no systemic involvement. Histopathology showed features of scleroderma with abundant mucin deposition in the reticular dermis. This report highlights excessive mucin deposition in lesions of morphea.

  18. Secondary middle turbinate: case report

    International Nuclear Information System (INIS)

    Aburjeli, Bruna de Oliveira Melim; Avila, Ana Flavia Assis de; Diniz, Renata Lopes Furletti Caldeira; Motta, Emilia Guerra Pinto Coelho; Ribeiro, Marcelo Almeida; Moreira, Wanderval

    2012-01-01

    Secondary middle turbinate is an anatomical variant rarely observed in the nasal cavity, firstly described by Khanobthamchai et al. as a bone structure originating from the lateral nasal wall and covered by soft tissue. In most cases reported in the literature, this variant is bilateral, occurring without associated complications. In the present report, the authors describe the case of patient of their institution with such anatomical variation. (author)

  19. Las histiocitosis Histiocytosis

    Directory of Open Access Journals (Sweden)

    Eva Svarch

    2001-12-01

    disease. Treatment depends on the spread of the process. An only lesion tends to spontaneously disappear. Also diagnostic biopsy with or without steroid injection may lead to healing. Those patients with multisystem disease may benefit from an steroid and cytostatic-based treatment or even from progenitor hematopoietic cell transplantation. Sinus histiocytosis with massive lymphadenopathies or Rosai Dorfman disease is a benign and usually self-limited disease which is caused by the macrophage proliferation; it generally affects children and young adults. Hemophagocytic lymphohistiocytosis is also caused by macrophage proliferation and is a rare disease with a high mortality rate. It can be familiar hemophagocytic lymphohistiocytosis (recessive autosomal or secondary to viral infections, being the latter form the most frequent in infants. At present, mainly in the familiar variant, the progenitor hematopoietic allogenic transplant may serve as the only curative option

  20. EELV Secondary Payload Adapter (ESPA)

    Science.gov (United States)

    Haskett, Scott A.; Weis, Steven C.; Doggrell, Leslie J.; Sciulli, Dino; Meink, Troy E.; Ganley, Jeff T.; Maly, Joseph R.; Jurisson, Karl

    2000-11-01

    Despite growing international interest in small satellites, high dedicated expendable launch vehicle costs and the lack of secondary launch opportunities continue to hinder the full exploitation of small satellite technology. In the United States, the Department of Defense (DoD), NASA, other government agencies, commercial companies, and many universities use small satellites to perform space experiments, demonstrate new technology, and test operational prototype hardware. In addition, the DoD continues to study the role of small satellites in fulfilling operational mission requirements. However, the US lacks sufficient small satellite launch capacity. Furthermore, US government agencies are restricted to the use of US launch vehicles, which eliminates many affordable launch opportunities. In an effort to increase the number of space experiments that can be flown with a small, fixed budget, the DoD Space Test Program (STP) has teamed with the Air Force Research Laboratory Space Vehicles Directorate (AFRL/VS) to develop a low-cost solution for the small satellite launch program. Our solution, which can be implemented on both Boeing and Lockheed-Martin Evolved Expendable Launch Vehicle-Medium (EELV-M) boosters, is called the EELV Secondary Payload Adaptor (ESPA). ESPA will increase the number of launch opportunities for 180kg-class (or smaller) satellites at prices highly competitive with other secondary launch services worldwide.

  1. Secondary effects of glyphosate on plants

    Science.gov (United States)

    Glyphosate is a unique herbicide with interesting secondary effects. Unfortunately, some have assumed that the secondary effects that occur in glyphosate-susceptible plants treated with glyphosate, such as altered mineral nutrition, reduced phenolic compound production and pathogen resistance, also ...

  2. Secondary Containers and Service Containers for Pesticides

    Science.gov (United States)

    Secondary containers and service containers are used by pesticide applicators in the process of applying a pesticide. EPA does not require secondary containers or service containers to be labeled or to meet particular construction standards. Learn more.

  3. Secondary Analysis for Results Tracking Database

    Data.gov (United States)

    US Agency for International Development — The Secondary Analysis and Results Tracking (SART) activity provides support for the development of two databases to manage secondary and third-party data, data...

  4. Ergonomics and safety in secondary wood processing

    Science.gov (United States)

    Rado Gazo; James D. McGlothlin; Yuehwern, Wiedenbeck, Jan Yih; Yuehwern Yih

    2002-01-01

    The main goal of the project was to initiate a pilot program in ergonomics for the secondary wood products industry. Case studies were conducted at three Midwest secondary wood product companies in 2000 and 2001.

  5. Secondary Highway Lines, US, 2015, NAVTEQ

    Data.gov (United States)

    U.S. Environmental Protection Agency — NAVTEQ Secondary Highways for the United States. The Secondary Highways layer contains Road Network features based on the Functional Class value on each link present...

  6. Secondary Syphilis: Uncommon Manifestations a Common Disease

    OpenAIRE

    McPhee, Stephen J.

    1984-01-01

    Reports of cases of primary and secondary syphilis are increasing in the United States, particularly in urban areas and among homosexual men. While primary syphilis poses little diagnostic difficulty, many physicians are unfamiliar with the multisystem nature of secondary lues. Patients who have secondary syphilis commonly present with systemic signs, skin rash, mucous membrane lesions and generalized adenopathy. Less commonly, secondary syphilis may occur as acute meningitis, sensorineural h...

  7. Secondary Emission Calorimeter Sensor Development

    Science.gov (United States)

    Winn, David R.; Onel, Yasar

    2012-12-01

    In a Secondary Emission electron(SEe) detector module, Secondary Emission electrons (SEe) are generated from an SE surface/cathode, when charged hadronic or electromagnetic particles, particularly shower particles, penetrate an SE sampling module placed between absorber materials (Fe, Cu, Pb, W etc) in calorimeters. The SE cathode is a thin (10-50 nm thick) film (simple metal-oxides, or other higher yield materials) on the surface of a metal plate, which serves as the entrance “window” to a compact vacuum vessel (metal or metal-ceramic); this SE film cathode is analogous to a photocathode, and the SEe are similar to p.e., which are then amplified by dynodes, also is in a PMT. SE sensor modules can make use of electrochemically etched/machined or laser-cut metal mesh dynode sheets, as large as ~30 cm square, to amplify the Secondary Emission Electrons (SEe), much like those that compact metal mesh or mesh dynode PMT's use to amplify p.e.'s. The construction requirements easier than a PMT, since the entire final assembly can be done in air; there are no critical controlled thin film depositions, cesiation or other oxygen-excluded processes or other required vacuum activation, and consequently bake-out can be a refractory temperatures; the module is sealed by normal vacuum techniques (welding or brazing or other high temperature joinings), with a simple final heated vacuum pump-out and tip-off. The modules envisioned are compact, high gain, high speed, exceptionally radiation damage resistant, rugged, and cost effective, and can be fabricated in arbitrary tileable shapes. The SE sensor module anodes can be segmented transversely to sizes appropriate to reconstruct electromagnetic cores with high precision. The GEANT4 and existing calorimeter data estimated calorimeter response performance is between 35-50 Secondary Emission electrons per GeV, in a 1 cm thick Cu absorber calorimeter, with a gain per SEe > 105 per SEe, and an e/pi<1.2. The calorimeter pulse width is

  8. Intestinal Lymphangiectasia Secondary to Neuroblastoma

    Directory of Open Access Journals (Sweden)

    RM Reifen

    1994-01-01

    Full Text Available An eight month-old infant presented with a 10-day history of vomiting and diarrhea, and a one-week history of swelling of the lower extremities. Laboratory evaluations revealed hypoproteinemia and lymphocytopenia due to protein-losing enteropathy. Peroral small bowel biopsy showed intestinal lymphangiectasia. Subsequent onset of unexplained ecchymosis and obstructive jaundice resulted in additional studies which revealed an omental neuroblastoma as the underlying etiology of the infant’s symptoms. This report emphasizes the importance of considering secondary, obstructive causes for lymphangiectasia and protein-losing enteropathy.

  9. Fahr's Syndrome and Secondary Hypoparathyroidism.

    Science.gov (United States)

    Dos Santos, Vitorino Modesta; Da Mata, Ana Medeiros De Farias; Ribeiro, Kelle Regina Alves; Calvo, Isadora Cartaxo De Sousa

    2016-01-01

    A typical case of Fahr's syndrome is described in a 76-year-old Brazilian female who underwent a total thyroidectomy three decades ago. Six years before the current admission, she started with generalized tonic-clonic seizures. Associated disorders involved extra-pyramidal, cognitive, nocturnal terror and mood changes. With suspicion of hypocalcemia due to secondary hypoparathyroidism, laboratory determinations confirmed the diagnoses. Furthermore, imaging studies of the central nervous system detected multiple calcifications, with characteristic distribution of Fahr's syndrome. Clinical management was successful.

  10. Atoms in the secondary school

    International Nuclear Information System (INIS)

    Marx, G.

    1976-01-01

    A basic nuclear physics teaching programme, at present being used in a number of Hungarian secondary schools, is described in this and a previous article (Marx. Phys. Educ.; 11: 409 (1976)). Simple notions of quantum theory and general principles of superposition and de Broglie wavelength, the uncertainty relation and the exclusion principle are used. Using these principles, teaching of concepts concerning the excited states of the hydrogen atom, Pauli's exclusion principle, ion formation, covariant bonding and the shape of molecules, are discussed. (U.K.)

  11. Secondary emission monitor (SEM) grids.

    CERN Multimedia

    Patrice Loïez

    2002-01-01

    A great variety of Secondary Emission Monitors (SEM) are used all over the PS Complex. At other accelerators they are also called wire-grids, harps, etc. They are used to measure beam density profiles (from which beam size and emittance can be derived) in single-pass locations (not on circulating beams). Top left: two individual wire-planes. Top right: a combination of a horizontal and a vertical wire plane. Bottom left: a ribbon grid in its frame, with connecting wires. Bottom right: a SEM-grid with its insertion/retraction mechanism.

  12. [Inherited primitive and secondary polycythemia].

    Science.gov (United States)

    Barba, T; Boileau, J-C; Pasquet, F; Hot, A; Pavic, M

    2016-07-01

    Myeloproliferative disorders and secondary polycythemia cover most of the polycythemia cases encountered in daily practice. Inherited polycythemias are rare entities that have to be suspected when the classical causes of acquired polycythemia have been ruled out. Recent advances were made in the understanding of these pathologies, which are still little known to the physicians. This review reports the state of knowledge and proposes an algorithm to follow when confronted to a possible case of inherited polycythemia. Copyright © 2015 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  13. NPP Krsko secondary side analysis

    International Nuclear Information System (INIS)

    Fabijan, Lj.

    1987-01-01

    The purpose of this work is to analyze secondary side thermohydraulics response on steam generator tube plugging in order to ensure nominal NPP power. We had established that the additional opening of the governing valve No. 3 and 4 can compensate pressure drop caused by steam generator tube plugging. Two main steam flows with four governing valves were simulated. Steam expansion in turbine and feed water system was modeled separately. All important process point and steam moisture changes impact on nominal NPP power were analysed. (author)

  14. Secondary Hyperparathyroidism in Heart Failure.

    Science.gov (United States)

    Morsy, Mohamed S; Dishmon, Dwight A; Garg, Nadish; Weber, Karl T

    2017-10-01

    Secondary hyperparathyroidism (SHPT) is a well-known pathophysiologic feature of chronic renal failure. In recent years, SHPT has become recognized as a complication of the aldosteronism associated with congestive heart failure and where excretory Ca 2+ and Mg 2+ wasting results in plasma-ionized hypocalcemia and hypomagnesemia. Elevations in plasma parathyroid hormone have adverse systemic consequences, including intracellular Ca 2+ overloading of myocytes and vascular smooth muscle with the induction of oxidative stress. Herein, we briefly review the presence and adverse outcomes of SHPT in persons with heart failure. Copyright © 2017 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

  15. 40 CFR 133.102 - Secondary treatment.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 21 2010-07-01 2010-07-01 false Secondary treatment. 133.102 Section... TREATMENT REGULATION § 133.102 Secondary treatment. The following paragraphs describe the minimum level of effluent quality attainable by secondary treatment in terms of the parameters—BOD5, SS and pH. All...

  16. Rheumatic Heart Disease Associated with Secondary Renal ...

    African Journals Online (AJOL)

    ... non-specific chronic inflammatory changes. The patient's secondary amyloidosis was presumed to be related to the long standing RHD after exclusion of other causes of secondary amyloidosis. The patient finally died due to heart failure and acute pulmonary edema. Conclusion: Long standing RHD can lead to secondary ...

  17. Job Satisfaction of Secondary Content Area Leaders

    Science.gov (United States)

    Roberts, Christine K.

    2012-01-01

    Educational researchers have examined both observed and perceived influences of the job satisfaction levels of secondary teachers and post-secondary department chairs. However, researchers have largely ignored a third group of educators: secondary Content Area Leaders (CALs). The overall satisfaction levels and the potentially influencing factors…

  18. PWR secondary water chemistry guidelines: Revision 3

    International Nuclear Information System (INIS)

    Lurie, S.; Bucci, G.; Johnson, L.; King, M.; Lamanna, L.; Morgan, E.; Bates, J.; Burns, R.; Eaker, R.; Ward, G.; Linnenbom, V.; Millet, P.; Paine, J.P.; Wood, C.J.; Gatten, T.; Meatheany, D.; Seager, J.; Thompson, R.; Brobst, G.; Connor, W.; Lewis, G.; Shirmer, R.; Gillen, J.; Kerns, M.; Jones, V.; Lappegaard, S.; Sawochka, S.; Smith, F.; Spires, D.; Pagan, S.; Gardner, J.; Polidoroff, T.; Lambert, S.; Dahl, B.; Hundley, F.; Miller, B.; Andersson, P.; Briden, D.; Fellers, B.; Harvey, S.; Polchow, J.; Rootham, M.; Fredrichs, T.; Flint, W.

    1993-05-01

    An effective, state-of-the art secondary water chemistry control program is essential to maximize the availability and operating life of major PWR components. Furthermore, the costs related to maintaining secondary water chemistry will likely be less than the repair or replacement of steam generators or large turbine rotors, with resulting outages taken into account. The revised PWR secondary water chemistry guidelines in this report represent the latest field and laboratory data on steam generator corrosion phenomena. This document supersedes Interim PWR Secondary Water Chemistry Recommendations for IGA/SCC Control (EPRI report TR-101230) as well as PWR Secondary Water Chemistry Guidelines--Revision 2 (NP-6239)

  19. On the prediction of turbulent secondary flows

    Science.gov (United States)

    Speziale, C. G.; So, R. M. C.; Younis, B. A.

    1992-01-01

    The prediction of turbulent secondary flows, with Reynolds stress models, in circular pipes and non-circular ducts is reviewed. Turbulence-driven secondary flows in straight non-circular ducts are considered along with turbulent secondary flows in pipes and ducts that arise from curvature or a system rotation. The physical mechanisms that generate these different kinds of secondary flows are outlined and the level of turbulence closure required to properly compute each type is discussed in detail. Illustrative computations of a variety of different secondary flows obtained from two-equation turbulence models and second-order closures are provided to amplify these points.

  20. Secondary production in shallow marine environments

    International Nuclear Information System (INIS)

    Pomeroy, L.R.

    1976-01-01

    Recommendations are discussed with regard to population ecology, microbial food webs, marine ecosystems, improved instrumentation, and effects of land and sea on shallow marine systems. The control of secondary production is discussed with regard to present status of knowledge; research needs for studies on dominant secondary producers, food webs that lead to commercial species, and significant features of the trophic structure of shallow water marine communities. Secondary production at the land-water interface is discussed with regard to present status of knowledge; importance of macrophytes to secondary production; export to secondary consumers; utilization of macrophyte primary production; and correlations between secondary production and river discharge. The role of microorganisms in secondary production is also discussed

  1. Secondary emission electron gun using external primaries

    Science.gov (United States)

    Srinivasan-Rao, Triveni [Shoreham, NY; Ben-Zvi, Ilan [Setauket, NY

    2009-10-13

    An electron gun for generating an electron beam is provided, which includes a secondary emitter. The secondary emitter includes a non-contaminating negative-electron-affinity (NEA) material and emitting surface. The gun includes an accelerating region which accelerates the secondaries from the emitting surface. The secondaries are emitted in response to a primary beam generated external to the accelerating region. The accelerating region may include a superconducting radio frequency (RF) cavity, and the gun may be operated in a continuous wave (CW) mode. The secondary emitter includes hydrogenated diamond. A uniform electrically conductive layer is superposed on the emitter to replenish the extracted current, preventing charging of the emitter. An encapsulated secondary emission enhanced cathode device, useful in a superconducting RF cavity, includes a housing for maintaining vacuum, a cathode, e.g., a photocathode, and the non-contaminating NEA secondary emitter with the uniform electrically conductive layer superposed thereon.

  2. Portal hydatid with secondary cavernomatosis.

    Science.gov (United States)

    Rodríguez Sanz, Mª Belén; Roldán Cuena, Mª Del Mar; Blanco Álvarez, Carlos Alberto; Sánchez Jiménez, Raúl

    2017-03-01

    The hydatid cyst is a parasitic infection included within the category of zoonoses, in which there exists a direct or indirect relation with animals, particularly with dogs. We report a clinical case of a patient who has undergone surgery of hydatid cyst in the right hepatic lobe. Seven years later the patient presents hydatid cyst in portal vein with secondary cavernomatosis, which is a rare complication. There are few cases described in the literature. The symtomatology presented by hydatid cyst is variable and the diagnosis is made by ultrasonography, TC and/or RNM. The treatment of choice is the surgical removal of the cyst, prior to surgery Albendazol must be administered for 1-2 weeks and be maintained for 4 more weeks after surgery.

  3. Secondary ion mass spectroscopy (SIMS)

    International Nuclear Information System (INIS)

    Naik, P.K.

    1975-01-01

    Secondary Ion Mass Spectrometry (SIMS) which is primarily a method for investigating the chemical composition of the uppermost atomic layer of solid surfaces is explained. In this method, the specimen is bombarded with a primary positive ion beam of small current density monolayer. Positive and negative ions sputtered from the specimen are mass analysed to give the surface chemical composition. The analytical system which consists of a primary ion source, a target manipulator and a mass spectrometer housed in an ultrahigh vacuum system is described. This method can also be used for profile measurements in thin films by using higher current densities of the primary ions. Fields of application such as surface reactions, semiconductors, thin films emission processes, chemistry, metallurgy are touched upon. Various aspects of this method such as the sputtering process, instrumentation, and applications are discussed. (K.B.)

  4. Pulmonary involvement of secondary syphilis.

    Science.gov (United States)

    Ogawa, Yoshihiko; Imai, Yuichiro; Yoshihara, Shingo; Fujikura, Hiroyuki; Hirai, Nobuyasu; Sato, Masatoshi; Ogawa, Taku; Uno, Kenji; Kasahara, Kei; Yano, Hisakazu; Mikasa, Keiichi

    2018-01-01

    Pulmonary involvement in secondary syphilis is considered a rare occurrence; however, the number of cases has increased in the 2000s. This is likely due to the increased use of computed tomography scans and molecular diagnostic testing. We report a case of an HIV-positive man with pleural chest pain and bilateral subpleural nodules on chest computed tomography. His rapid plasma reagin and Treponema pallidum hemagglutination tests were positive, and the specimen of one of the pulmonary nodules obtained by transthoracic biopsy was positive for the polA gene of Treponema pallidum. Since clinical manifestations of syphilis are highly variable, clinicians should bear in mind that pleural chest pain with bilateral subpleural nodules can be caused by pulmonary syphilis.

  5. The secondary metabolite bioinformatics portal

    DEFF Research Database (Denmark)

    Weber, Tilmann; Kim, Hyun Uk

    2016-01-01

    . In this context, this review gives a summary of tools and databases that currently are available to mine, identify and characterize natural product biosynthesis pathways and their producers based on ‘omics data. A web portal called Secondary Metabolite Bioinformatics Portal (SMBP at http...... analytical and chemical methods gave access to this group of compounds, nowadays genomics-based methods offer complementary approaches to find, identify and characterize such molecules. This paradigm shift also resulted in a high demand for computational tools to assist researchers in their daily work......Natural products are among the most important sources of lead molecules for drug discovery. With the development of affordable whole-genome sequencing technologies and other ‘omics tools, the field of natural products research is currently undergoing a shift in paradigms. While, for decades, mainly...

  6. PWR secondary water chemistry study

    International Nuclear Information System (INIS)

    Pearl, W.L.; Sawochka, S.G.; Copley, S.E.; Siegwarth, D.P.

    1981-01-01

    Secondary water chemistry studies have been performed at ten operating PWRs for the past several years. The program includes seven PWRs with recirculating U-tube steam generators, and three once-through steam generator (OTSG) PWRs. Program results indicate that during periods of minimal condenser inleakage, condensate polishers do not remove significant quantities of sodium, chloride and sulfate. At higher inlet impurity levels, demineralizer removal efficiencies improve markedly. Corrosion product removal efficiencies generally are 60 to 95% depending on system design and operating practices. Significant quantities of sodium and chloride 'hide out' in steam generators with a portion returning during transients, particularly during plant shutdowns. In OTSG PWRs, a significant portion of the total sodium and chloride transported via the steam is removed with the moisture separator drains (MSD) and returned to the OTSG when MSDs are pumped forward. Partial return of MSDs to the condenser would result in reduced feedwater and steam impurity levels. (author)

  7. CLINICAL CASE OF TOCILIZUMAB THERAPY IN A PATIENT WITH SYSTEMIC JUVENILE IDIOPATHIC ARTHRITIS

    Directory of Open Access Journals (Sweden)

    E. I. Alexeeva

    2013-01-01

    Full Text Available The article presents a case of successful application of a monoclonal antibodies drug to interleukin 6 receptors (tocilizumab at severe systemic juvenile idiopathic arthritis with the development of secondary hemophagocytic syndrome. Tocilizumab treatment secured a decrease in clinical and laboratory parameters of the disease activity, life quality improvement, systemic juvenile idiopathic arthritis and hemophagocytic syndrome remission and allowed avoiding the per os prescription of glucocorticoids.

  8. Modelling secondary eclipses of Kepler exoplanets

    Directory of Open Access Journals (Sweden)

    Hambálek Lubomír

    2015-01-01

    Full Text Available We have selected several Kepler objects with potentially the deepest secondary eclipses. By combination of many single phased light-curves (LCs we have produced a smooth LC with a larger SNR and made the secondary eclipses more distinct. This allowed us to measure the depth of primary and secondary minimum with greater accuracy and then to determine stellar and planetary radii by simplex modelling.

  9. Wound infection secondary to snakebite

    Directory of Open Access Journals (Sweden)

    M Wagener

    2017-04-01

    Full Text Available Background. Snakebites can produce severe local and systemic septic complications as well as being associated with significant overall morbidity and even mortality. Objective. A prospective audit was undertaken to determine the bacterial causation of wound infection secondary to snakebite, and attempt to quantify the burden of disease. Methods. The audit was undertaken at Ngwelezane Hospital, which provides both regional and tertiary services for north-eastern KwaZulu-Natal Province, South Africa, over a 4-month period. Records of patients who required surgical debridement for extensive skin and soft-tissue necrosis were analysed. At the time of debridement, tissue samples of necrotic or infected tissue were sent for bacteriological analysis as standard of care. Microbiology results were analysed. Results. A total of 164 patients were admitted to hospital for management of snakebite, of whom 57 required surgical debridement and 42 were included in the final microbiological analysis. Children were found to be the most frequent victims of snakebite; 57.8% of patients in this study were aged ≤10 years and 73.7% ≤15 years. Culture showed a single organism in 32/42 cases, two organisms in 8 and no growth in 2. Eight different types of organisms were cultured, five of them more than once. Thirty-five specimens (83.3% grew Gram-negative Enterobacteriaceae, the most frequent being Morganella morganii and Proteus species. Thirteen specimens (31.0% grew Enterococcus faecalis. Gram-negative Enterobacteriaceae showed 31.4% sensitivity to ampicillin, 40.0% sensitivity to amoxicillin plus clavulanic acid, 34.3% sensitivity to cefuroxime, 97.1% sensitivity to ceftriaxone, and 100% sensitivity to ciprofloxacin, gentamicin and amikacin. E. faecalis was 92.3% sensitive to amoxicillin, 92.3% sensitive to amoxicillin plus clavulanic acid, 100% sensitive to ciprofloxacin, 92.3% resistant to erythromycin and 100% resistant to ceftriaxone. Conclusion. Children are

  10. Wound infection secondary to snakebite.

    Science.gov (United States)

    Wagener, M; Naidoo, M; Aldous, C

    2017-03-29

    Snakebites can produce severe local and systemic septic complications as well as being associated with significant overall morbidity and even mortality. A prospective audit was undertaken to determine the bacterial causation of wound infection secondary to snakebite, and attempt to quantify the burden of disease. The audit was undertaken at Ngwelezane Hospital, which provides both regional and tertiary services for north-eastern KwaZulu-Natal Province, South Africa, over a 4-month period. Records of patients who required surgical debridement for extensive skin and soft-tissue necrosis were analysed. At the time of debridement, tissue samples of necrotic or infected tissue were sent for bacteriological analysis as standard of care. Microbiology results were analysed. A total of 164 patients were admitted to hospital for management of snakebite, of whom 57 required surgical debridement and 42 were included in the final microbiological analysis. Children were found to be the most frequent victims of snakebite; 57.8% of patients in this study were aged ≤10 years and 73.7% ≤15 years. Culture showed a single organism in 32/42 cases, two organisms in 8 and no growth in 2. Eight different types of organisms were cultured, five of them more than once. Thirty-five specimens (83.3%) grew Gram-negative Enterobacteriaceae, the most frequent being Morganella morganii and Proteus species. Thirteen specimens (31.0%) grew Enterococcus faecalis. Gram-negative Enterobacteriaceae showed 31.4% sensitivity to ampicillin, 40.0% sensitivity to amoxicillin plus clavulanic acid, 34.3% sensitivity to cefuroxime, 97.1% sensitivity to ceftriaxone, and 100% sensitivity to ciprofloxacin, gentamicin and amikacin. E. faecalis was 92.3% sensitive to amoxicillin, 92.3% sensitive to amoxicillin plus clavulanic acid, 100% sensitive to ciprofloxacin, 92.3% resistant to erythromycin and 100% resistant to ceftriaxone. Children are particularly vulnerable to snakebite, and the consequences can be

  11. Intracranial abscess secondary to dental infection.

    Science.gov (United States)

    Brady, Paul; Bergin, Sarah; Cryan, Bartley; Flanagan, Oisin

    2014-01-01

    We report a case of Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans) bacteraemia and secondary brain abscess in a patient where periodontal disease was implicated as the probable source.

  12. Intracranial abscess secondary to dental infection

    OpenAIRE

    Brady, Paul; Bergin, Sarah; Cryan, Bartley; Flanagan, Oisin

    2014-01-01

    We report a case of Aggregatibacter actinomycetemcomitans (A.actinomycetemcomitans) bacteraemia and secondary brain abscess in a patient where periodontal disease was implicated as the probable source.

  13. Nigeria Secondary School Science Teachers‟ Awareness and ...

    African Journals Online (AJOL)

    First Lady

    2012-10-27

    Oct 27, 2012 ... Science teachers‟ computer illiteracy, inadequate infrastructures, ... development is human capital- the values, attitudes, knowledge, skills, ... raises questions concerning junior secondary education's focus on the.

  14. Qualitative Secondary Analysis: A Case Exemplar.

    Science.gov (United States)

    Tate, Judith Ann; Happ, Mary Beth

    Qualitative secondary analysis (QSA) is the use of qualitative data that was collected by someone else or was collected to answer a different research question. Secondary analysis of qualitative data provides an opportunity to maximize data utility, particularly with difficult-to-reach patient populations. However, qualitative secondary analysis methods require careful consideration and explicit description to best understand, contextualize, and evaluate the research results. In this article, we describe methodologic considerations using a case exemplar to illustrate challenges specific to qualitative secondary analysis and strategies to overcome them. Copyright © 2017 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

  15. Reactive hemophagocytic syndromes in children with rheumatic diseases

    Directory of Open Access Journals (Sweden)

    Piotr Gietka

    2011-04-01

    Full Text Available Reactive haemophagocytic syndrome (RHPS, also calledmacrophage activation syndrome (MAS, is a serious complicationof viral, rheumatic and malignant diseases, thought to be causedby the excessive activation of T lymphocytes and macrophages.MAS is characterized by polyorgan involvement with typical features:non-remitting fever, hepatic enlargement, considerable loweringof blood cell count and erythrocyte sedimentation rate (ESR,elevation of serum glutamic-oxaloacetic transaminase (SGOT,serum glutamic pyruvic transaminase (SGPT, lactate dehydrogenase(LDH and serum ferritin level, with hypofibrinogenemia. Themost characteristic feature is the presence of well differentiatedmacrophages, revealing an active haemophagocytosis in the bonemarrow aspirate. Because of rapid progression and fatal prognosisof the disease, prompt and immediate therapeutic intervention isvery important. Although there is no standardized treatment, commonlyapplied glucocorticoids (GCS, and cyclosporine A (CsA areused. The study was aimed to a general characteristics of pathogenicfactors, clinical picture, laboratory features and results oftreatment in 8 children with RHPS /MAS. Material and methods: The study included 8 children (5 girls and3 boys aged 3 to 16 years (mean age was 10 years and 3 monthshospitalized in the Clinic of Pediatrics at IPCZD and in the Departmentof Pediatric Rheumatology at the Institute of Rheumatology in Warsaw. The analysis covered potential etiological factors, consideringthe basic disease, clinical symptoms (Table II, results oflaboratory tests (Table III, including immunological tests, appliedtherapy. In 4 patients, systemic-onset juvenile idiopathic arthritiswas accompanied by MAS, and in 2 patients it was the first manifestationof sJIA. In one patient, EBV infection was confirmed bythe polymerase chain reaction (case 1. In patient 3, PCR evaluationrevealed Cytomegalovirus (CMV infection. Cytomegalovirus infectionwas also confirmed in case 4, however, simultaneously geneticas well as serological evaluation for Parvovirus B19 infectionrevealed positive results in this patient. In patient 5 CMV infectionand/or Toxocara canis infection could be a triggering factor forRHPS (Table I.In seven patients, haemophagocytosis was confirmed in bone marrowbiopsy. No response to GCS treatment, including pulse therapy,or IVIG therapy was observed. Remission was induced by treatmentwith CsA (Table IV. The diagnostic criteria for haemo phagocyticlymphohistiocytosis are presented in Table V.

  16. Perfectionism among Turkish Secondary Students

    Directory of Open Access Journals (Sweden)

    Fatih Camadan

    2012-12-01

    Full Text Available The aim of this study was to analyze perfectionism among Turkish secondary school students. Perfectionism was compared according to the some variables like academic achievement, type of school, field (Quantitative, Verbal and Equally Weighted and gender. The study was performed with271 female and 320 male students. In this study Frost Multidimentional Perfectionism Scale (FMPS adapted into Turkish by Özbay and Mısırlı-Taşdemir (2003, was used. At the end of the study, in all subscales of perfectionism scale, there was significant variation according to student’s academic success levels. There was significant variation according to the school types in all subscales except Personal Standards subscale. While there was significant variation according to the field, in Parental Criticism and Concern over Mistakes subscales; according to gender, there was significant variation only in Doubt about Actions subscale. To not acceptnonperfect situations while trying to reach a goal may cause that students have procrastination behaviors and more anxiety. Therefore, their academic achievement may be affected negatively. With individual and group psychological counseling to perfectionist students can help them to notice their characteristics well and determine realistic goal. In this way, their academic achievement can be contributed positively

  17. Emerging drugs for secondary hyperparathyroidism.

    Science.gov (United States)

    Cozzolino, Mario; Tomlinson, James; Walsh, Liron; Bellasi, Antonio

    2015-06-01

    Secondary hyperparathyroidism (SHPT), a common, serious, and progressive complication of chronic kidney disease (CKD), is characterized by elevated serum parathyroid hormone (PTH), parathyroid gland hyperplasia, and mineral metabolism abnormalities. These disturbances may result in CKD-mineral and bone disorder (CKD-MBD), which is associated with poor quality of life and short life expectancy. The goal of SHPT treatment is to maintain PTH, calcium, and phosphorus within accepted targeted ranges. This review highlights the pathogenesis of SHPT and current SHPT therapeutic approaches, including the use of low-phosphate diets, phosphate binders, 1,25-dihydroxyvitamin D3 (calcitriol) and its analogs, calcimimetics, and parathyroidectomy in addition to discussing emerging drugs in development for SHPT. Numerous studies indicate that mineral abnormalities occur early in the course of CKD, are prevalent by the time patients enter dialysis, and foreshadow a risk of cardiovascular and all-cause mortality. Several newly developed compounds may potentially overcome the limitations of current SHPT therapies. If emerging therapies can reduce PTH, normalize mineral metabolism, promote treatment adherence, and reduce the risk of side effects, they may provide the requisite features for improving long-term outcomes in patients with SHPT receiving dialysis and reduce the risks of CKD-MBD.

  18. PWR secondary water chemistry study

    International Nuclear Information System (INIS)

    Pearl, W.L.; Sawochka, S.G.

    1977-02-01

    Several types of corrosion damage are currently chronic problems in PWR recirculating steam generators. One probable cause of damage is a local high concentration of an aggressive chemical even though only trace levels are present in feedwater. A wide variety of trace chemicals can find their way into feedwater, depending on the sources of condenser cooling water and the specific feedwater treatment. In February 1975, Nuclear Water and Waste Technology Corporation (NWT), was contracted to characterize secondary system water chemistry at five operating PWRs. Plants were selected to allow effects of cooling water chemistry and operating history on steam generator corrosion to be evaluated. Calvert Cliffs 1, Prairie Island 1 and 2, Surry 2, and Turkey Point 4 were monitored during the program. Results to date in the following areas are summarized: (1) plant chemistry variations during normal operation, transients, and shutdowns; (2) effects of condenser leakage on steam generator chemistry; (3) corrosion product transport during all phases of operation; (4) analytical prediction of chemistry in local areas from bulk water chemistry measurements; and (5) correlation of corrosion damage to chemistry variation

  19. Gastrointestinal Bleeding Secondary to Calciphylaxis

    Science.gov (United States)

    Gupta, Nancy; Haq, Khwaja F.; Mahajan, Sugandhi; Nagpal, Prashant; Doshi, Bijal

    2015-01-01

    Patient: Female, 66 Final Diagnosis: Calciphylaxis Symptoms: Gastrointesinal haemorrhage Medication: None Clinical Procedure: Hemodialysis • blood transfusions Specialty: Gastroenterology and Hepatology Objective: Rare disease Background: Calciphylaxis is associated with a high mortality that approaches 80%. The diagnosis is usually made when obvious skin lesions (painful violaceous mottling of the skin) are present. However, visceral involvement is rare. We present a case of calciphylaxis leading to lower gastrointestinal (GI) bleeding and rectal ulceration of the GI mucosa. Case Report: A 66-year-old woman with past medical history of diabetes mellitus, hypertension, end-stage renal disease (ESRD), recently diagnosed ovarian cancer, and on hemodialysis (HD) presented with painful black necrotic eschar on both legs. The radiograph of the legs demonstrated extensive calcification of the lower extremity arteries. The hospital course was complicated with lower GI bleeding. A CT scan of the abdomen revealed severe circumferential calcification of the abdominal aorta, celiac artery, and superior and inferior mesenteric arteries and their branches. Colonoscopy revealed severe rectal necrosis. She was deemed to be a poor surgical candidate due to comorbidities and presence of extensive vascular calcifications. Recurrent episodes of profuse GI bleeding were managed conservatively with blood transfusion as needed. Following her diagnosis of calciphylaxis, supplementation with vitamin D and calcium containing phosphate binders was stopped. She was started on daily hemodialysis with low calcium dialysate bath as well as intravenous sodium thiosulphate. The clinical condition of the patient deteriorated. The patient died secondary to multiorgan failure. Conclusions: Calciphylaxis leading to intestinal ischemia/perforation should be considered in the differential diagnosis in ESRD on HD presenting with abdominal pain or GI bleeding. PMID:26572938

  20. Examining Practice in Secondary Visual Arts Education

    Science.gov (United States)

    Mitchell, Donna Mathewson

    2015-01-01

    Teaching in secondary visual arts classrooms is complex and challenging work. While it is implicated in much research, the complexity of the lived experience of secondary visual arts teaching has rarely been the subject of sustained and synthesized research. In this paper, the potential of practice as a concept to examine and represent secondary…

  1. Secondary School Students' Predictors of Science Attitudes

    Science.gov (United States)

    Tosun, Cemal; Genç, Murat

    2016-01-01

    The purpose of this study is to identify the factors that affect the secondary school students' attitudes in science. This study was conducted using survey method. The sample of the study was 503 students from four different secondary schools in Bartin and Düzce. Data were obtained using the Survey of Factors Affecting Students' Science Attitudes…

  2. SMOKING HABITS AMONG SECONDARY SCHOOL STUDENTS IN ...

    African Journals Online (AJOL)

    SMOKING HABITS AMONG SECONDARY SCHOOL STUDENTS IN SELECTED DISTRICTS IN ZIMBABWE. ... Journal of Child and Adolescent Mental Health ... Objective To examine the relationship between smoking habits and indicators of socioeconomic status, the urban/rural dimension and gender among secondary ...

  3. Efficacy of secondary isoniazid preventive therapy among ...

    African Journals Online (AJOL)

    Objective. To determine the efficacy of secondary preventive therapy against tuberculosis (TB) among goldminers working in South Africa. Design. An observational study. Methods. The incidence of recurrent TB was compared between two cohorts of HIV-infected miners: one cohort had received secondary preventive ...

  4. Secondary Teachers' Perceptions of Online Learning

    Science.gov (United States)

    Brown, Chris L.

    2016-01-01

    The purpose of this qualitative study was to describe secondary teachers' perceptions of online learning in Washington. This was done by distributing a survey to three districts in the State of Washington to identify the advantages and challenges of online learning according to participating secondary teachers. In addition, the teachers provided…

  5. Assessment of secondary aluminum reserves of nations

    DEFF Research Database (Denmark)

    Maung, Kyaw Nyunt; Yoshida, Tomoharu; Liu, Gang

    2017-01-01

    aluminum resources are accumulated in landfill sites. Understanding the sizes of primary and secondary aluminum reserves enables us to extend knowledge of efficient raw material sourcing from a narrow perspective of primary reserves alone to a broader perspective of both primary and secondary reserves...

  6. Waste management - textbook for secondary schools

    International Nuclear Information System (INIS)

    Chmielewska, E.; Kuruc, J.

    2010-09-01

    This text-book consist of five parts: (I) Waste management; (II) Solid waste management; (III) Recovery and recycling of secondary raw materials; (IV) Radioactive waste management; Examples of verification knowledge and testing of the secondary students through the worksheet. (V) Suggestions for leisure time activities. This text-book is assigned for high school students.

  7. Secondary Products (Markets, Competition, and Technological Improvements)

    Science.gov (United States)

    Philip A. Araman

    1988-01-01

    Competitiveness, imports, exports, and technological improvements--these are issues facing secondary wood-product manufacturers. The major problems focus on increasing foreign imports and the inability of U.S. industries to repell the imports. How and where should we, as researchers, allocate our efforts to enhance the competitiveness of secondary forest industries in...

  8. Assessing Participation in Secondary Education Quality Enhancement

    African Journals Online (AJOL)

    Assessing Participation in Secondary Education Quality Enhancement: Teachers, Parents and Communities in Cross River State. ... ailing economy, low moral values and philosophy of the end justifies the means were reasons for low parents and communities involvement in secondary education-quality improvement.

  9. Transcriptional regulatory network controlling secondary cell wall ...

    African Journals Online (AJOL)

    Secondary wall is an abundant component of plant biomass and has a potential to be a renewable resource of bioenergy and biomaterials. It is important to unravel the molecular mechanism underlying secondary wall formation and how it contributes to plant biomass production. In this review, we summarized the potential ...

  10. Secondary School Science Department Chairs Leading Change

    Science.gov (United States)

    Gaubatz, Julie A.

    2012-01-01

    Secondary school department chairs are content area specialists in their schools and are responsible for providing students with the most appropriate curricula. However, most secondary school department chairs have limited authority to institute change unilaterally (Gmelch, 1993; Hannay & Erb, 1999). To explore how these educational leaders…

  11. Secondary education in the 1990s

    NARCIS (Netherlands)

    H.M. Bronneman-Helmers; L.J. Herweijer; H.M.G. Vogels

    2002-01-01

    Original title: Voortgezet onderwijs in de jaren negentig. Many changes and innovations have been set in motion in Dutch secondary education in recent years: the introduction of basic secondary education, increases in scale, profiles and the 'house of study' in the second phase of senior

  12. Nucleic acid secondary structure prediction and display.

    OpenAIRE

    Stüber, K

    1986-01-01

    A set of programs has been developed for the prediction and display of nucleic acid secondary structures. Information from experimental data can be used to restrict or enforce secondary structural elements. The predictions can be displayed either on normal line printers or on graphic devices like plotters or graphic terminals.

  13. Factors associated with adolescent pregnancies among secondary ...

    African Journals Online (AJOL)

    To assess the factors associated with adolescent pregnancies among secondary students at Tanga municipality. A cross sectional descriptive analytical study which targeted all girls in secondary schools at Tanga municipality, Low socioeconomic status was found to be an important cause for adolescent pregnancies as ...

  14. 30 CFR 56.6312 - Secondary blasting.

    Science.gov (United States)

    2010-07-01

    ... Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR METAL AND NONMETAL MINE SAFETY AND HEALTH SAFETY AND HEALTH STANDARDS-SURFACE METAL AND NONMETAL MINES Explosives Use § 56.6312 Secondary blasting. Secondary blasts fired at the same time in the same work area shall be initiated from...

  15. Outcome Standards for Secondary Marketing Education.

    Science.gov (United States)

    Stone, James R., III

    1985-01-01

    Describes a study which sought to establish outcome standards very important for secondary marketing education. Business people, former students, and marketing educators were asked to judge the standards identified from the literature in terms of importance to secondary marketing education. (CT)

  16. Secondary School Administration in Anambra State Today ...

    African Journals Online (AJOL)

    The study, a descriptive survey research design was used to identify the challenges that impede secondary school administration today in Anambra State. The population of the study was all the 259 public secondary school principals in the state. Two research questions and two null hypotheses guided the study. A 20-item ...

  17. [Diagnostic of secondary hypertension in clinical practice].

    Science.gov (United States)

    Somlóová, Z; Rosa, J; Petrák, O; Strauch, B; Zelinka, T; Holaj, R; Widimský, J

    2011-09-01

    Arterial hypertension is a common worldwide disease with a prevalence of approximately 26%. Secondary cause is known in 5-10% of patients with hypertension. We should think of secondary hypertension in all patients with resistant hypertension, in patients with sudden deterioration in the control of hypertension and in patients with laboratory and clinical signs of diseases associated with secondary hypertension. It is important to distinguish between secondary hypertension and pseudo-resistance (noncompliance to treatment, white coat syndrome). Secondary causes of hypertension can be divided into endocrine (primary aldosteronism, pheochromocytoma, hypercortisolism, hyperparathyreoidism), renal - renovascular and renal parenchymal hypertension, and other causes as sleep apnoe syndrome, hypertension in pregnancy, coarctation of the aorta and intracranial tumors.

  18. [Secondary Arterial Hypertension: Uncertainties in Diagnosis].

    Science.gov (United States)

    Dinis, Paulo Gomes; Cachulo, Maria Carmo; Fernandes, Andreia; Paiva, Luis; Gonçalves, Lino

    2017-06-30

    Arterial hypertension is regarded today as a global public health problem, and the prevalence rate in Portugal is 26.9%. According to the etiology, is classified into primary or secondary arterial hypertension. In about 90% of cases it is not possible to establish a cause, so is called primary arterial hypertension. In the remaining 5 to 10%, it can be identified secondary causes, which are potentially treatable. For secondary arterial hypertension study to be cost-effective, it is essential to understand which patients investigate, and evaluate the best strategy to adopt. The main causes identified as responsible for secondary arterial hypertension are: kidney disease; endocrine and vascular diseases and obstructive sleep apnea. Among these some are consensual, and others more controversial in the literature. In this regard we present two cases of arterial hypertension, which are potentially secondary in etiology, but still focus of debate.

  19. Amyloid Goiter Secondary to Ulcerative Colitis

    Directory of Open Access Journals (Sweden)

    Bunyamin Aydin

    2016-01-01

    Full Text Available Diffuse amyloid goiter (AG is an entity characterized by the deposition of amyloid in the thyroid gland. AG may be associated with either primary or secondary amyloidosis. Secondary amyloidosis is rarely caused by inflammatory bowel diseases. Secondary amyloidosis is relatively more common in the patients with Crohn’s disease, whereas it is highly rare in patients with ulcerative colitis. Diffuse amyloid goiter caused by ulcerative colitis is also a rare condition. In the presence of amyloid in the thyroid gland, medullary thyroid cancer should be kept in mind in the differential diagnosis. Imaging techniques and biochemical tests are not very helpful in the diagnosis of secondary amyloid goiter and the definitive diagnosis is established based on the histopathologic analysis and histochemical staining techniques. In this report, we present a 35-year-old male patient with diffuse amyloid goiter caused by secondary amyloidosis associated with ulcerative colitis.

  20. Chromosomal abnormality in patients with secondary amenorrhea.

    Science.gov (United States)

    Safai, Akbar; Vasei, Mohammad; Attaranzadeh, Armin; Azad, Fariborz; Tabibi, Narjes

    2012-04-01

    Secondary amenorrhea is a condition in which there is cessation of menses after at least one menstruation. It is a symptom of different diseases, such as hormonal disturbances which range from pituitary to ovarian origin, as well as chromosomal abnormalities. Knowledge of the distinct cause of secondary amenorrhea is of tremendous benefit for the management and monitoring of patients. In this study, we determine the chromosomal abnormalities in patients with secondary amenorrhea in Southwest Iran. We selected 94 patients with secondary amenorrhea who referred to our Cytogenetic Ward from 2004 until 2009. For karyotyping, peripheral blood lymphocyte cultures were set up by conventional technique. In this study, 5.3% (n=5) of patients with secondary amenorrhea presented with chromosomal abnormalities, of which all contained an X element. The chromosomal abnormalities were: i) 45, X (n=1); ii) 47, XXX (n=1); iii) 45, X [13]/ 45, Xi(X)q[17] (n=1);  iv) 45, X[12]/46,X,+mar[12] (n=1); and v) 46,X,del(Xq)(q23q28) (n=1). Our study revealed that some causes of secondary amenorrhea could be due to chromosomal abnormalities. Therefore, cytogenetic studies should be important tests in the evaluation of patients with secondary amenorrhea.

  1. Uncertainty analysis for secondary energy distributions

    International Nuclear Information System (INIS)

    Gerstl, S.A.W.

    1978-01-01

    In many transport calculations the integral design parameter of interest (response) is determined mainly by secondary particles such as gamma rays from (n,γ) reactions or secondary neutrons from inelastic scattering events or (n,2n) reactions. Standard sensitivity analysis usually allows to calculate the sensitivities to the production cross sections of such secondaries, but an extended formalism is needed to also obtain the sensitivities to the energy distribution of the generated secondary particles. For a 30-group standard cross-section set 84% of all non-zero table positions pertain to the description of secondary energy distributions (SED's) and only 16% to the actual reaction cross sections. Therefore, any sensitivity/uncertainty analysis which does not consider the effects of SED's is incomplete and neglects most of the input data. This paper describes the methods of how sensitivity profiles for SED's are obtained and used to estimate the uncertainty of an integral response due to uncertainties in these SED's. The detailed theory is documented elsewhere and implemented in the LASL sensitivity code SENSIT. SED sensitivity profiles have proven particularly valuable in cross-section uncertainty analyses for fusion reactors. Even when the production cross sections for secondary neutrons were assumed to be without error, the uncertainties in the energy distribution of these secondaries produced appreciable uncertainties in the calculated tritium breeding rate. However, complete error files for SED's are presently nonexistent. Therefore, methods will be described that allow rough error estimates due to estimated SED uncertainties based on integral SED sensitivities

  2. Ruling out secondary causes of hypertension.

    Science.gov (United States)

    Ott, Christian; Schneider, Markus P; Schmieder, Roland E

    2013-05-01

    In the majority of hypertensive patients, no particular cause for abnormal blood pressure is evident (primary or essential hypertension). In contrast, in the minority of patients with secondary hypertension a specific underlying cause is responsible for the elevated blood pressure. The prevalence of secondary hypertension is higher in patients with resistant hypertension than in the general hypertensive population and increases with age. The list of secondary forms of hypertension is long and prevalence of the individual causes of secondary hypertension varies. Hence, this review divides them into two categories: common causes and rare causes. If appropriately diagnosed and treated, patients with a secondary form of hypertension might be cured, or at least show an improvement in their blood pressure control. Consequently, screening for secondary causes of hypertension plays an essential part in the care of patients with arterial hypertension. If the basal work-up raises the suspicion of a secondary cause of hypertension, specific diagnostic procedures become necessary, some of which can be performed by primary care physicians, while others require specialist input.

  3. Importance of secondary damage in downer cows.

    Science.gov (United States)

    Poulton, P J; Vizard, A L; Anderson, G A; Pyman, M F

    2016-05-01

    To investigate the relative importance in downer cows of the primary cause of recumbency in comparison with secondary complications. Downer dairy cows were monitored during their recumbency under field conditions in South Gippsland, Victoria, Australia. The cause of the original recumbency of the 218 cows was determined and secondary damage, status on day 7 and final outcome were recorded. Some type of secondary damage was found in 183/218 (84%) cows, of which 173/218 (79%) had damage deemed to be clinically important. By day 7, 52 (24%) had recovered and 69 (32%) eventually recovered. Of the 149 (68%) cows that were euthanased or died, 23 (15%) were deemed to have been lost solely from the primary cause, 107 (72%) from secondary damage and 19 (13%) from a combination of both. There was no difference in recovery among the five broad groups of causes of primary recumbency. Secondary damage was very common and presented in a large variety of ways, with many cows having multiple types of secondary damage concurrently. For most cows the secondary damage was more important than the initial primary damage in determining their fate. © 2016 Australian Veterinary Association.

  4. [Secondary glaucoma in Paraguay. Etiology and incidence].

    Science.gov (United States)

    Strohl, A; Pozzi, S; Wattiez, R; Roesen, B; Miño de Kaspar, H; Klauss, V

    1999-06-01

    Glaucoma is the third-most-frequent cause of blindness in the world, with a total of 5.2 million blind people as a result of this disease; 80% live in developing countries. In Paraguay, after cataract it is the second-most-frequent-cause. Early detection of the risk factors and groups can help to avoid progress of this disease. Trauma, cataract and infectious uveitis represent special risks for developing secondary glaucoma, which is a more frequent cause of blindness in third-world countries than in industrialized nations. Until now there has been little data regarding the causes, disease course, and options for therapy. Therefore, secondary glaucoma was examined in Paraguay to obtain information on the situation in Latin America. The aim of the study was to explore the causes of secondary glaucoma for programs concerning prevention and therapy. From November 1996 to February 1997 patients with secondary glaucoma were examined at the University Hospital of Asunción, Paraguay. After the clinical examination the secondary glaucomas were classified. Patients with primary glaucoma were included in the same period of time as well in order to get the rate of secondary glaucoma. Altogether 293 patients were examined: 61 with secondary and 232 with primary glaucoma. The causes of secondary glaucoma in 73 eyes were: 20 (27%) with pseudoexfoliation glaucoma, 19 (26%) with post-traumatic glaucoma, 16 (22%) with neovascular glaucoma, 4 (5%) with lens-related glaucoma, 3 (4%) with glaucoma associated with ocular surgery, 2 (3%) with pigmentary and 2 (3%) with corticoid-induced glaucoma. A ratio of 4:1 primary glaucomas to secondary glaucomas was found. The development of special measures for prevention and early therapy is only possible if the causes of this severe disease are explored. The results of this study represent basic information and could help to introduce of prevention programs.

  5. PARATHYROID CANCER OCCURRING IN RELAPSING SECONDARY HYPERPARATHYROIDISM

    Directory of Open Access Journals (Sweden)

    I. V. Kotova

    2016-01-01

    Full Text Available We present a clinical case of parathyroid cancer in a patient with relapsing secondary hyperparathyroidism at 4 years after subtotal parathyroidectomy. Its unique character is related to the combination of relapsing secondary hyperparathyroidism, parathyromatosis, ectopic of an adenomatous hyperplastic parathyroid gland into the thyroid gland, and parathyroid cancer. Several most complicated aspects of parathyroid surgery are disclosed, such as the choice of strategy for surgical intervention in secondary hyperparathyroidism, complexity of morphological and cytological diagnostics of this disorder.

  6. Principles for enabling deep secondary design

    DEFF Research Database (Denmark)

    Pries-Heje, Jan; Hansen, Magnus Rotvit Perlt

    2017-01-01

    design by analyzing two cases where secondary designers fundamentally change functionality, content and technology complexity level. The first case redesigns a decision model for agile development in an insurance company; the second creates a contingency model for choosing project management tools...... and techniques in a hospital. Our analysis of the two cases leads to the identification of four principles of design implementation that primary designers can apply to enable secondary design and four corresponding design implementation principles that secondary designers themselves need to apply....

  7. Secondary Amenorrhea among Female Athletes. Current Understandings.

    Science.gov (United States)

    Sasiene, Gwen Hagenbuch

    1983-01-01

    Research pertaining to female athletes' problems with secondary amenorrhea is reviewed. Studies point to stress, weight loss, anorexia nervosa, obesity, arduous athletic training, and age of onset of training as factors which may contribute to this disorder. (PP)

  8. Predicting Thermal Behavior of Secondary Organic Aerosols

    Science.gov (United States)

    Volume concentrations of steady-state secondary organic aerosol (SOA) were measured in 139 steadystate single precursor hydrocarbon oxidation experiments after passing through a temperature controlled inlet tube. Higher temperatures resulted in greater loss of particle volume, wi...

  9. Liquorice: a root cause of secondary hypertension

    OpenAIRE

    Varma, Ravi; Ross, Calum N.

    2017-01-01

    We describe a patient presenting with hypertension and hypokalaemia who was ultimately diagnosed with liquorice- induced pseudohyperaldosteronism. This rare cause of secondary hypertension illustrates the importance of a methodical approach to the assessment of hypertension.

  10. Predicting Thermal Behavior of Secondary Organic Aerosols

    Data.gov (United States)

    U.S. Environmental Protection Agency — Volume concentrations of secondary organic aerosol (SOA) are measured in 139 steady-state, single precursor hydrocarbon oxidation experiments after passing through a...

  11. Secondary metabolites of cyanobacteria Nostoc sp.

    Science.gov (United States)

    Kobayashi, Akio; Kajiyama, Shin-Ichiro

    1998-03-01

    Cyanobacteria attracted much attention recently because of their secondary metabolites with potent biological activities and unusual structures. This paper reviews some recent studies on the isolation, structural, elucidation and biological activities of the bioactive compounds from cyanobacteria Nostoc species.

  12. Modeling Secondary Neutral Helium in the Heliosphere

    International Nuclear Information System (INIS)

    Müller, Hans-Reinhard; Möbius, Eberhard; Wood, Brian E.

    2016-01-01

    An accurate, analytic heliospheric neutral test-particle code for helium atoms from the interstellar medium (ISM) is coupled to global heliospheric models dominated by hydrogen and protons from the solar wind and the ISM. This coupling enables the forward-calculation of secondary helium neutrals from first principles. Secondaries are produced predominantly in the outer heliosheath, upwind of the heliopause, by charge exchange of helium ions with neutral atoms. The forward model integrates the secondary production terms along neutral trajectories and calculates the combined neutral helium phase space density in the innermost heliosphere where it can be related to in-situ observations. The phase space density of the secondary component is lower than that of primary neutral helium, but its presence can change the analysis of primaries and the ISM, and can yield valuable insight into the characteristics of the plasma in the outer heliosheath. (paper)

  13. Secondary School Students Preferences for Instructional Strategies ...

    African Journals Online (AJOL)

    User

    Yet, value pertaining to discipline in sexual attitude among adolescent is gradually being eroded. ... education into the secondary school curriculum. .... hidden. This result also goes to confirm the researcher's opinion that parents tend to shy ...

  14. Debriefing Note Secondary Education Support Programme

    DEFF Research Database (Denmark)

    Webster, Neil; Vagnby, Bo Hellisen; Thomsen, Thomas J.

    Debriefing note regarding joint programming for the Secondary Education Support Programme (2003- 2007). The note specifies preparation of SIP Physical Guidelines; Training needs assessment for Physical School Status and Rapid Technical Assessments; SIP/DEP preparation; Selection criteria...

  15. Tdap Booster Requirements for Secondary Schools

    Science.gov (United States)

    ... Experts State Information Tdap booster requirements for secondary schools State Td or Tdap Mandate for Sec School ... Checklists Standing Orders Storage & Handling Talking with Parents Temperature Logs Top Handouts Translations Vaccine Index >> view all ...

  16. Predictors of examination malpractice among secondary school ...

    African Journals Online (AJOL)

    African Journal for the Psychological Study of Social Issues ... Validated scales were used to collect data and SPSS was used to carry out a t-test and stepwise ... Keywords: Examination, Malpractice, Text Anxiety, Secondary School Students.

  17. Perception of Sexuality Education amongst Secondary School ...

    African Journals Online (AJOL)

    Perception of Sexuality Education amongst Secondary School Students in Port ... Methods: A structured, anonymous and self-administered questionnaire, used as ... Only 7.6% acknowledged the school teacher as a source of information.

  18. Effective Classroom Management Techniques for Secondary Schools

    African Journals Online (AJOL)

    Effective Classroom Management Techniques for Secondary Schools. ... engagement of students in activities, use of innovative instructional strategies by teachers, ... and teachers in their perception regarding the effects of teachers classroom ...

  19. Pancreatic insufficiency secondary to abdominal radiotherapy

    International Nuclear Information System (INIS)

    Dookeran, K.A.; Thompson, M.M.; Allum, W.H.

    1993-01-01

    Delayed post-irradiation steatorrhoea secondary to acute pancreatic insufficiency is rare. The authors describe a case occurring in a patient 23 years following radical abdominal radiotherapy for testicular seminoma. (Author)

  20. Pancreatic insufficiency secondary to abdominal radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Dookeran, K.A.; Thompson, M.M.; Allum, W.H. (Leicester Royal Infirmary (United Kingdom). Dept. of Surgery)

    1993-02-01

    Delayed post-irradiation steatorrhoea secondary to acute pancreatic insufficiency is rare. The authors describe a case occurring in a patient 23 years following radical abdominal radiotherapy for testicular seminoma. (Author).

  1. Holocaust Denial among Slovenian Secondary School Pupils

    Directory of Open Access Journals (Sweden)

    Maša Pavlič

    2015-06-01

    Full Text Available The article presents tendencies of Holocaust denial among secondary school pupils in Slovenia. It focuses on research implemented in January 2012, in which 400 Slovenian secondary school pupils were included. In spite of the assumption that Holocaust denial amongst the youth in Slovenia already exists, we also assumed that a degree of Holocaust denial amongs Slovenian pupils is lower that amongst their peers in other EU countries. Research also inquired about the level of anti-Semitism in conjunction with Holocaust denial. The research project confirmed that students on lower levels of high school education and with less history and sociology lessons in curriculum are more receptive for the Holocaust denial and anti-Semitism is more present in this demographic. The level of Holocaust denial amongst secondary school pupils is not negligible; it suggests that this topic should be more thoroughly discussed in secondary schools.

  2. Survey Review: ELT Coursebooks for Secondary Schools.

    Science.gov (United States)

    Campbell, C.; Laanemets, U.; Lillepea, M.; Loog, T.; Kammiste, T.; Kartner, P.; Magi, O.; Truus, K.

    1998-01-01

    Presents a review of English textbooks developed for secondary learners of English as a Second Language. The survey was prepared by a group of seven Estonian teachers and a British English language teaching consultant. (Author/JL)

  3. Secondary electron emission from textured surfaces

    Science.gov (United States)

    Huerta, C. E.; Patino, M. I.; Wirz, R. E.

    2018-04-01

    In this work, a Monte Carlo model is used to investigate electron induced secondary electron emission for varying effects of complex surfaces by using simple geometric constructs. Geometries used in the model include: vertical fibers for velvet-like surfaces, tapered pillars for carpet-like surfaces, and a cage-like configuration of interlaced horizontal and vertical fibers for nano-structured fuzz. The model accurately captures the secondary electron emission yield dependence on incidence angle. The model shows that unlike other structured surfaces previously studied, tungsten fuzz exhibits secondary electron emission yield that is independent of primary electron incidence angle, due to the prevalence of horizontally-oriented fibers in the fuzz geometry. This is confirmed with new data presented herein of the secondary electron emission yield of tungsten fuzz at incidence angles from 0-60°.

  4. Perception of Sexuality Education amongst Secondary School

    African Journals Online (AJOL)

    school students attending a series of Schools debates in Port. Harcourt Metropolis. ... 31(2): 109–113. Keywords:Perceptions, sexuality education, secondary school, students. ..... implications for counseling practices. European Journal of ...

  5. Knowledge of Sexually Transmitted Diseases among Secondary ...

    African Journals Online (AJOL)

    The study was carried out in three public secondary schools in Ogbondoroko and Laduba .... population live in the rural areas where information on sexually transmitted ..... Centers for Disease Control and Prevention (2009) Diagnoses of HIV ...

  6. COCHLEATA controls leaf size and secondary inflorescence ...

    Indian Academy of Sciences (India)

    2012-10-18

    Oct 18, 2012 ... sion promotes production of secondary branches from the axils of cauline leaves ... ASYMMETRIC LEAVES 2 transcription factor, which in turn represses the ...... Blixt S 1967 Linkage studies in Pisum VII. The manifestation of ...

  7. Secondary laser cooling of strontium-88 atoms

    Energy Technology Data Exchange (ETDEWEB)

    Strelkin, S. A.; Khabarova, K. Yu., E-mail: kseniakhabarova@gmail.com; Galyshev, A. A.; Berdasov, O. I.; Gribov, A. Yu.; Kolachevsky, N. N.; Slyusarev, S. N. [Federal State Unitary Enterprise “All-Russia Research Institute for Physicotechnical and Radio Engineering Measurements” (VNIIFTRI) (Russian Federation)

    2015-07-15

    The secondary laser cooling of a cloud of strontium-88 atoms on the {sup 1}S{sub 0}–{sup 3}P{sub 1} (689 nm) intercombination transition captured into a magneto-optical trap has been demonstrated. We describe in detail the recapture of atoms from the primary trap operating on the strong {sup 1}S{sub 0}–{sup 1}P{sub 1} (461 nm) transition and determine the recapture coefficient κ, the number of atoms, and their temperature in the secondary trap as a function of experimental parameters. A temperature of 2 µK has been reached in the secondary trap at the recapture coefficient κ = 6%, which confirms the secondary cooling efficiency and is sufficient to perform metrological measurements of the {sup 1}S{sub 0}–{sup 3}P{sub 1} (698 nm) clock transition in an optical lattice.

  8. Amino acid code of protein secondary structure.

    Science.gov (United States)

    Shestopalov, B V

    2003-01-01

    The calculation of protein three-dimensional structure from the amino acid sequence is a fundamental problem to be solved. This paper presents principles of the code theory of protein secondary structure, and their consequence--the amino acid code of protein secondary structure. The doublet code model of protein secondary structure, developed earlier by the author (Shestopalov, 1990), is part of this theory. The theory basis are: 1) the name secondary structure is assigned to the conformation, stabilized only by the nearest (intraresidual) and middle-range (at a distance no more than that between residues i and i + 5) interactions; 2) the secondary structure consists of regular (alpha-helical and beta-structural) and irregular (coil) segments; 3) the alpha-helices, beta-strands and coil segments are encoded, respectively, by residue pairs (i, i + 4), (i, i + 2), (i, i = 1), according to the numbers of residues per period, 3.6, 2, 1; 4) all such pairs in the amino acid sequence are codons for elementary structural elements, or structurons; 5) the codons are divided into 21 types depending on their strength, i.e. their encoding capability; 6) overlappings of structurons of one and the same structure generate the longer segments of this structure; 7) overlapping of structurons of different structures is forbidden, and therefore selection of codons is required, the codon selection is hierarchic; 8) the code theory of protein secondary structure generates six variants of the amino acid code of protein secondary structure. There are two possible kinds of model construction based on the theory: the physical one using physical properties of amino acid residues, and the statistical one using results of statistical analysis of a great body of structural data. Some evident consequences of the theory are: a) the theory can be used for calculating the secondary structure from the amino acid sequence as a partial solution of the problem of calculation of protein three

  9. Secondary acute leukemia - review of 15 cases

    Energy Technology Data Exchange (ETDEWEB)

    Venugopal, P; Rajni, A; Gopal, R; Saikia, T; Kurkure, P A; Nair, C N; Advani, S H

    1988-12-01

    Acute leukemia is a rare complication of long-term chemotherapy, immunosuppressive therapy and radiotherapy. With improved survival in cancer patients resulting from modern methods of investigations and treatment, more case of secondary leukemia have come to light. In this review, fifteen cases of secondary leukemia, its prognostic implications and methods to reduce the risk of its development are emphasised. Relevant literature is also reviewed. (author). 3 tabs., 24 refs.

  10. Principles and applications of lithium secondary batteries

    CERN Document Server

    Park, Jung-Ki

    2012-01-01

    Lithium secondary batteries have been key to mobile electronics since 1990. Large-format batteries typically for electric vehicles and energystorage systems are attracting much attention due to current energy and environmental issues. Lithium batteries are expected to play a centralrole in boosting green technologies. Therefore, a large number of scientists and engineers are carrying out research and development onlithium secondary batteries.The book is written in a straightforward fashion suitable for undergraduate and graduate students, as well as scientists, and engineer

  11. Heteronormativity in secondary schools in Zagreb

    OpenAIRE

    Bijelić, Nataša; Hodžić, Amir

    2015-01-01

    This paper analyses the presence and characteristics of heteronormativity in the context of the Croatian school system by focusing on secondary schools in the capital of Zagreb. We base our analysis on the results of a survey on opinions and attitudes regarding homosexuality conducted on a sample of 322 students and 117 teachers in nine secondary schools. The research reveals that stereotypes and prejudice towards lesbians and gays are omnipresent and widespread. Both students and teachers ho...

  12. Modes of failures: primary and secondary stresses

    International Nuclear Information System (INIS)

    Roche, R.L.

    1987-07-01

    The paper begins with a reminder that the purpose of stress classification is to ensure suitable margins with respect to failure modes. The distinction between primary stresses and secondary stresses is then examined and a method is given for assessing the degree of elastic follow up in the elastic plastic field. The importance of elastic follow up is then highlighted by an examination of the effect of primary and secondary stresses on crack behavior

  13. Ionic secondary emission SIMS principles and instrumentation

    International Nuclear Information System (INIS)

    Darque-Ceretti, E.; Migeon, H.N.; Aucouturier, M.

    1998-01-01

    The ionic analysis by secondary emission (SIMS) is one of material analysis based on the ions bombardment. That is micro-analysis method in taking into account that the dimensions of the analysed volume are under the micrometer. This paper details in a first part some ionic secondary emission principle to introduce a description of the instrumentation: microprobe, ions production, spectrometers. (A.L.B.)

  14. Basic aspects of secondary electron distributions

    International Nuclear Information System (INIS)

    Kim, Y.K.

    1975-07-01

    Graphical methods proposed by Platzman and by Fano are applied to the analysis of the basic features observed in secondary electron spectra. These methods are useful not only in checking the consistency of experimental data, but also in extrapolating the spectra to the range of primary- and secondary-electron energies not covered by experiments. Illustrative examples are presented for He, Ne, and NO. (U.S.)

  15. Protein secondary structure: category assignment and predictability

    DEFF Research Database (Denmark)

    Andersen, Claus A.; Bohr, Henrik; Brunak, Søren

    2001-01-01

    In the last decade, the prediction of protein secondary structure has been optimized using essentially one and the same assignment scheme known as DSSP. We present here a different scheme, which is more predictable. This scheme predicts directly the hydrogen bonds, which stabilize the secondary......-forward neural network with one hidden layer on a data set identical to the one used in earlier work....

  16. Storage and transmission of secondary energy

    International Nuclear Information System (INIS)

    Taube, M.

    1979-09-01

    In the area of the total energy flow, possibilities and limits of shifts in time (storage) and in space (transfer) of secondary energy, i.e. electrical, chemical and thermal energy are examined and formulated. These shifts are linked to the qualitative conversions of secondary energy. The multiple technological possibilities, the spectrum of governing factors and the numerous technical and economical parameters show that only a complex optimization is possible. (Auth.)

  17. Promoting Science in Secondary School Education.

    Science.gov (United States)

    Chiovitti, Anthony; Duncan, Jacinta C; Jabbar, Abdul

    2017-06-01

    Engaging secondary school students with science education is crucial for a society that demands a high level of scientific literacy in order to deal with the economic and social challenges of the 21st century. Here we present how parasitology could be used to engage and promote science in secondary school students under the auspice of a 'Specialist Centre' model for science education. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. Theory of Economic Development (Secondary Stage)

    OpenAIRE

    Mashkoor, Aasim; Ahmed, Ovais

    2015-01-01

    This is a secondary stage of theory of economic development. This research study is covering the secondary phase of development which rules the tactical plans of the main strategy. In this stage, the social and economical demands varies from country to country and we have developed the theory according to the Pakistani economic conditions. It requires great a lot of technical and strategic analysis to chose the accurate plans accordingly.

  19. Minimizing secondary coolant blowdown in HANARO

    International Nuclear Information System (INIS)

    Park, Y. C.; Woo, J. S.; Ryu, J. S.; Cho, Y. G.; Lim, N. Y.

    2000-01-01

    There is about 80m 3 /h loss of the secondary cooling water by evaporation, windage and blowdown during the operation of HANARO, 30MW research reactor. The evaporation and the windage is necessary loss to maintain the performance of cooling tower, but the blowdown is artificial lose to get rid of the foreign material and to maintain the quality of the secondary cooling water. Therefore, minimizing the blowdown loss was studied. It was confirmed, through the relation of the number of cycle and the loss rate of secondary coolant, that the number of cycle is saturated to 12 without blowdown because of the windage loss. When the secondary coolant is treated by high Ca-hardness treatment program (the number of cycle > 10) to maintain the number of cycle around 12 without blowdown, only the turbidity exceeds the limit. By adding filtering system it was confirmed, through the relation of turbidity and filtering rate of secondary cooling water, that the turbidity is reduced below the limit (5 deg.) by 2% of filtering rate without blowdown. And it was verified, through the performance test of back-flow filtering unit, that this unit gets rid of foreign material up to 95% of the back-flow and that the water can be reused as coolant. Therefore, the secondary cooling water can be treated by the high Ca-hardness program and filter system without blowdown

  20. Knowledge, attitude and practices of adolescent secondary school ...

    African Journals Online (AJOL)

    Knowledge, attitude and practices of adolescent secondary school students in Uvwie ... METHOD: A cross sectional study was carried out on 358 senior secondary ... secondary school students in Uvwie have a fairly good knowledge of AIDS, ...

  1. Secondary hypertension: the ways of management.

    Science.gov (United States)

    Rossi, Gian P; Seccia, Teresa M; Pessina, Achille C

    2010-11-01

    The prevalence of secondary hypertension is lower than that of primary (essential) hypertension, but it is likely that it has been underestimated because appropriate tests were not generally performed. Hence, before embarking on a search for secondary hypertension physicians are generally advised to select populations of patients with a high pre-test probability of secondary forms of hypertension in order to maximize the positive predictive value and the gain in "ruling in" of the diagnostic tests. Based on updated information on prevalence and pathophysiology we herein critically review the general diagnostic strategy and the management of the main forms of secondary hypertension. In particular, strategies for identifying primary aldosteronism, the most frequent form of endocrine secondary hypertension, and for determining its unilateral or bilateral causes are discussed in details, because of the differences of treatment that requires adrenalectomy in the unilateral forms and mineralocorticoid receptor blockade in the bilateral forms. The tests available for the diagnosing pheochromocytoma (pheo), which is much rarer but extremely important to identify, as it can be fatal if unrecognized are also discussed, with emphasis on the recent developments in genetic testing. Renovascular hypertension is also a common curable form of hypertension, which should be identified as early as possible to avoid the onset of cardiovascular target organ damage and events, is also discussed.

  2. Numerical study of jets secondary instabilities

    International Nuclear Information System (INIS)

    Brancher, Pierre

    1996-01-01

    The work presented in this dissertation is a contribution to the study of the transition to turbulence in open shear flows. Results from direct numerical simulations are interpreted within the framework of hydrodynamic stability theory. The first chapter is an introduction to the primary and secondary instabilities observed in jets and mixing layers. The numerical method used in the present study is detailed in the second chapter. The dynamics of homogeneous circular jets subjected to stream wise and azimuthal perturbations are investigated in the third chapter. A complete scenario describing the evolution of the jet is proposed with emphasis on the dynamics of vorticity within the flow. In the fourth chapter a parametric study reveals a three-dimensional secondary instability mainly controlled in the linear regime by the Strouhal number of the primary instability. In the nonlinear regime the dynamics of the azimuthal harmonies are described by means of model equations and are linked to the formation of stream wise vortices in the braid. The fifth chapter is dedicated to the convective or absolute nature of the secondary instabilities in plane shear layers. It is shown that there are flow configurations for which the two-dimensional secondary instability (pairing) is absolute even though the primary instability (Kelvin-Helmholtz) is convective. Some preliminary results concerning the three-dimensional secondary instabilities arc presented at the end of this chapter. The last chapter summarizes the main results and examines possible extensions of this work. (author) [fr

  3. Secondary metabolites in fungus-plant interactions

    Science.gov (United States)

    Pusztahelyi, Tünde; Holb, Imre J.; Pócsi, István

    2015-01-01

    Fungi and plants are rich sources of thousands of secondary metabolites. The genetically coded possibilities for secondary metabolite production, the stimuli of the production, and the special phytotoxins basically determine the microscopic fungi-host plant interactions and the pathogenic lifestyle of fungi. The review introduces plant secondary metabolites usually with antifungal effect as well as the importance of signaling molecules in induced systemic resistance and systemic acquired resistance processes. The review also concerns the mimicking of plant effector molecules like auxins, gibberellins and abscisic acid by fungal secondary metabolites that modulate plant growth or even can subvert the plant defense responses such as programmed cell death to gain nutrients for fungal growth and colonization. It also looks through the special secondary metabolite production and host selective toxins of some significant fungal pathogens and the plant response in form of phytoalexin production. New results coming from genome and transcriptional analyses in context of selected fungal pathogens and their hosts are also discussed. PMID:26300892

  4. Transformation of Taiwan's Upper Secondary Education System

    Directory of Open Access Journals (Sweden)

    Hueih-Lirng Laih

    1998-09-01

    Full Text Available This paper explores the policy issues circling around the structural "transition" in upper secondary education implicit in the twenty-year increase in secondary and third-level school enrollment rates in Taiwan. This expansion has taken place within a secondary school system which is rigidly divided into both general, i.e., academic, and vocational tracks and into public and private sectors: the majority of students are enrolled in the private vocational sector which is only loosely articulated with the university sector. These features of the school system are analysed against the background of social and economic developments in Taiwan as well as public opinion. The analysis suggests that the present structures of school must be "reformed" in ways that will result in a more unified secondary system with both greater public funding and better articulation of all school types with the third level. The policy options that circle around the possibility of such reforms in the areas of curriculum, examination structures and second level-third level articulation are discussed and a policy framework for the reform of the Taiwan secondary education sector is outlined.

  5. Strong eukaryotic IRESs have weak secondary structure.

    Directory of Open Access Journals (Sweden)

    Xuhua Xia

    Full Text Available BACKGROUND: The objective of this work was to investigate the hypothesis that eukaryotic Internal Ribosome Entry Sites (IRES lack secondary structure and to examine the generality of the hypothesis. METHODOLOGY/PRINCIPAL FINDINGS: IRESs of the yeast and the fruit fly are located in the 5'UTR immediately upstream of the initiation codon. The minimum folding energy (MFE of 60 nt RNA segments immediately upstream of the initiation codons was calculated as a proxy of secondary structure stability. MFE of the reverse complements of these 60 nt segments was also calculated. The relationship between MFE and empirically determined IRES activity was investigated to test the hypothesis that strong IRES activity is associated with weak secondary structure. We show that IRES activity in the yeast and the fruit fly correlates strongly with the structural stability, with highest IRES activity found in RNA segments that exhibit the weakest secondary structure. CONCLUSIONS: We found that a subset of eukaryotic IRESs exhibits very low secondary structure in the 5'-UTR sequences immediately upstream of the initiation codon. The consistency in results between the yeast and the fruit fly suggests a possible shared mechanism of cap-independent translation initiation that relies on an unstructured RNA segment.

  6. Resection for secondary malignancy of the pancreas.

    Science.gov (United States)

    Hung, Jui-Hsia; Wang, Shin-E; Shyr, Yi-Ming; Su, Cheng-Hsi; Chen, Tien-Hua; Wu, Chew-Wun

    2012-01-01

    This study tried to clarify the role of pancreatic resection in the treatment of secondary malignancy with metastasis or local invasion to the pancreas in terms of surgical risk and survival benefit. Data of secondary malignancy of the pancreas from our 19 patients and cases reported in the English literature were pooled together for analysis. There were 329 cases of resected secondary malignancy of the pancreas, including 241 cases of metastasis and 88 cases of local invasion. The most common primary tumor metastatic to the pancreas and amenable to resection was renal cell carcinoma (RCC) (73.9%). More than half (52.3%) of the primary cancers with local invasion to the pancreas were colon cancer, and nearly half (40.9%) were stomach cancer. The median metastatic interval was 84 months (7 years) for overall primary tumors and 108 months (9 years) for RCC. The 5-year survival for secondary malignancy of the pancreas after resection was 61.1% for metastasis and 58.9% for local invasion, with 72.8% for RCC metastasis, 69.0% for colon cancer, and 43.8% for stomach cancer with local invasion to the pancreas. Pancreatic resection should not be precluded for secondary malignancy of the pancreas because long-term survival could be achieved with acceptable surgical risk in selected patients.

  7. Pharmaceutically active secondary metabolites of marine actinobacteria.

    Science.gov (United States)

    Manivasagan, Panchanathan; Venkatesan, Jayachandran; Sivakumar, Kannan; Kim, Se-Kwon

    2014-04-01

    Marine actinobacteria are one of the most efficient groups of secondary metabolite producers and are very important from an industrial point of view. Many representatives of the order Actinomycetales are prolific producers of thousands of biologically active secondary metabolites. Actinobacteria from terrestrial sources have been studied and screened since the 1950s, for many important antibiotics, anticancer, antitumor and immunosuppressive agents. However, frequent rediscovery of the same compounds from the terrestrial actinobacteria has made them less attractive for screening programs in the recent years. At the same time, actinobacteria isolated from the marine environment have currently received considerable attention due to the structural diversity and unique biological activities of their secondary metabolites. They are efficient producers of new secondary metabolites that show a range of biological activities including antibacterial, antifungal, anticancer, antitumor, cytotoxic, cytostatic, anti-inflammatory, anti-parasitic, anti-malaria, antiviral, antioxidant, anti-angiogenesis, etc. In this review, an evaluation is made on the current status of research on marine actinobacteria yielding pharmaceutically active secondary metabolites. Bioactive compounds from marine actinobacteria possess distinct chemical structures that may form the basis for synthesis of new drugs that could be used to combat resistant pathogens. With the increasing advancement in science and technology, there would be a greater demand for new bioactive compounds synthesized by actinobacteria from various marine sources in future. Copyright © 2013 Elsevier GmbH. All rights reserved.

  8. Academic Procrastination of Secondary School Pupils

    Directory of Open Access Journals (Sweden)

    Branka Ribič Hederih

    2014-06-01

    Full Text Available Procrastination is a trait and/or a form of behavior that denotes an individual’s delay in an activity which should be done, and which causes discomfort. In the study we wished to determine the differences between high school students regarding gender, educational programme and learning success of the previous school year in three factors. On a sample of 284 high school students of different Slovenian secondary schools, we found that on average boys show statistically significantly more shortage of learning self-discipline than girls, while girls, on average, significantly more discomfort than boys. Comparison of secondary school students between programmes showed that, on average, gimnazija students show significantly more learning self-discipline than students in secondary technical education. The comparison in relation to different levels of learning success at the end of the previous school year and the factors of procrastination showed, however, no statistically significant differences.

  9. Cosmogenic Secondary Radiation from a Nearby Supernova

    Science.gov (United States)

    Overholt, Andrew

    2017-01-01

    Increasing evidence has been found for multiple supernovae within 100 pc of the solar system. Supernovae produce large amounts of cosmic rays which upon striking Earth's atmosphere, produce a cascade of secondary particles. Among these cosmic ray secondaries are neutrons and muons, which penetrate far within the atmosphere to sea level and even below sea level. Muons and neutrons are both forms of ionizing radiation which have been linked to increases in cancer, congenital malformations, and other maladies. This work focuses on the impact of muons, as they penetrate into ocean water to impact the lowest levels of the aquatic food chain. We have used monte carlo simulations (CORSIKA, MCNPx, and FLUKA) to determine the ionizing radiation dose due to cosmic ray secondaries. This information shows that although most astrophysical events do not supply the necessary radiation flux to prove dangerous; there may be other impacts such as an increase to mutation rate.

  10. Secondary Circuit Start Up Chemistry Optimisation

    International Nuclear Information System (INIS)

    Fontan, Guillaume; Morel, Pascal

    2012-09-01

    In a context of investment and renewal of equipment, Electricite De France (EDF) put enhanced efforts on operating practices during start-up of the secondary circuit, in order to improve operational performance and materials lifetime. This article focuses on the objective of optimizing the filling, the chemical conditioning and the thermal conditioning of the secondary fluid, while taking into account the following issues: - Limiting the time required to obtain a proper chemistry, - Limiting the amount of water and steam used, - Limiting the amount of effluent generated. The scope is all start-up conditions of secondary circuit, both after refuelling outage or fortuitous shutdowns of the plant. The recommendations produced are based on existing local procedures and good practices, which were collected and developed in order to propose a generic methodology understandable and useful both for operators, chemists and managers. (authors)

  11. Hypokalemic periodic paralysis: Three rare secondary causes

    Directory of Open Access Journals (Sweden)

    Prasanna Eswaradass Venkatesan

    2015-01-01

    Full Text Available Periodic paralysis is a rare neuromuscular disorder, related to a defect in muscle ion channels, characterized by episodes of painless muscle weakness, which may be precipitated by heavy exercise, fasting, or high-carbohydrate meals. Hypokalemic periodic paralysis may be familial (primary or secondary. Here, we report three cases of secondary causes of hypokalemic periodic paralysis. On evaluation, case 1 had distal renal tubular acidosis (RTA due to Sjogren′s syndrome, case 2 had drug induced proximal RTA (Fanconi′s syndrome and case 3 had thyrotoxicosis. Clinician must be aware of causes of secondary PP as recognition and diagnosis can completely prevent further attacks of periodic paralysis. Each of the above case is rare, but completely treatable if diagnosed. Low dose steroids with bicarbonate replacement in case 1, stopping tenofovir in case 2 and carbimazole therapy in case 3 prevented further attacks of periodic paralysis and cardiopulmonary complications.

  12. Secondary traumatic stress and secondary posttraumatic growth in a sample of Dutch police family liaison officers

    NARCIS (Netherlands)

    Kunst, Maarten; Saan, M.C.; Bollen, Lidewij; Kuijpers, Karlijn

    2017-01-01

    This study investigated secondary traumatic stress (STS) and secondary posttraumatic growth (SPG) in a sample of Dutch police family liaison officers (N = 224). Our study had two aims: (a) to identify potential risk and protective factors for STS and (b) to investigate the association between STS

  13. Financial Literacy of Secondary Students, and Its Place within Secondary Schools

    Science.gov (United States)

    Neill, Alex; Berg, Melanie; Stevens, Liesje

    2014-01-01

    This report investigates the behaviour, attitudes and experiences of New Zealand secondary students with money and financial products. It also looks at financial literacy programmes in New Zealand secondary schools and explores barriers to the implementation of financial literacy teaching. The research was commissioned by the Commission for…

  14. Function-related secondary user needs and secondary data? a crit ...

    African Journals Online (AJOL)

    The aim of this article is to contribute to the development of the modern theory of lexicographical functions by offering a critical examination of the following concepts associated with it: primary needs, primary data, secondary needs, secondary data, function-related needs, and function-related data. By way of introduction, ...

  15. Kenya's Constituency Development Fund, Free Secondary Education Policy, and Access to Secondary Education

    Science.gov (United States)

    Nzuki, Charles Kyalo

    2018-01-01

    The effects of the Constituency Development Fund (CDF) and the Free Secondary Education Policy (FSEP) on access to secondary school education in Kenya's Yatta sub-county have not been adequately explored in available public policy literature. Hence, this qualitative multiple-case study was designed to understand the effects of the 2 policies on…

  16. Factors Affecting Subsidized Free Day Secondary Education in Enhancing Learners Retention in Secondary Schools in Kenya

    Science.gov (United States)

    James, Asena Muganda; Simiyu, Aggrey Mukasa; Riechi, Andrew

    2016-01-01

    Learners are the key stakeholders of a school for it to be registered by the Department of Education. However the retention of these learners in Kenya's Secondary Level Education is a great challenge in Kenya. Every secondary school dropout signifies unfulfilled objective, goal and aim for the individual as well as the community at large. The…

  17. Belongingness in Early Secondary School: Key Factors that Primary and Secondary Schools Need to Consider.

    Directory of Open Access Journals (Sweden)

    Sharmila Vaz

    Full Text Available It is unknown if, and how, students redefine their sense of school belongingness after negotiating the transition to secondary school. The current study used longitudinal data from 266 students with, and without, disabilities who negotiated the transition from 52 primary schools to 152 secondary schools. The study presents the 13 most significant personal student and contextual factors associated with belongingness in the first year of secondary school. Student perception of school belongingness was found to be stable across the transition. No variability in school belongingness due to gender, disability or household-socio-economic status (SES was noted. Primary school belongingness accounted for 22% of the variability in secondary school belongingness. Several personal student factors (competence, coping skills and school factors (low-level classroom task-goal orientation, which influenced belongingness in primary school, continued to influence belongingness in secondary school. In secondary school, effort-goal orientation of the student and perception of their school's tolerance to disability were each associated with perception of school belongingness. Family factors did not influence belongingness in secondary school. Findings of the current study highlight the need for primary schools to foster belongingness among their students at an early age, and transfer students' belongingness profiles as part of the hand-over documentation. Most of the factors that influenced school belongingness before and after the transition to secondary are amenable to change.

  18. Technical specifications for PWR secondary water chemistry

    International Nuclear Information System (INIS)

    Weeks, J.R.; van Rooyen, D.

    1977-08-01

    The bases for establishing Technical Specifications for PWR secondary water chemistry are reviewed. Whereas extremely stringent control of secondary water needs to be maintained to prevent denting in some units, sound bases for establishing limits that will prevent stress corrosion, wastage, and denting do not exist at the present time. This area is being examined very thoroughly by industry-sponsored research programs. Based on the evidence available to date, short term control limits are suggested; establishment of these or other limits as Technical Specifications is not recommended until the results of the research programs have been obtained and evaluated

  19. Information Literacy in the Upper Secondary School

    DEFF Research Database (Denmark)

    Holm, Claus; Schreiber, Trine; Tønnesen, Pia Hvid

    The discussion paper is a publication from the project Information Literacy in the Upper Secondary School. The project is a collaboration between the National Library of Education at the Danish School of Education, Aarhus University, and the Royal School of Library and Information Science....... The project is funded by Denmark's Electronic Research Library (DEFF). The discussion paper is published in connection with the conference Information Literacy in the Upper Secondary School on 22 April 2010. See video streaming from the conference etc. at www.dpu.dk/info....

  20. English language knowledge for secondary teachers

    CERN Document Server

    Ross, Alison

    2013-01-01

    If teachers are to successfully develop their students' English language skills it is vital that they overcome any existing lack of confidence and training in grammar and language concepts. Language Knowledge for Secondary Teachers is an accessible book aiming to equip secondary teachers with the knowledge they need to teach language effectively. It clearly explains the essential concepts for language study, introduces the terminology needed for 'talking about language' and shows how this knowledge can be applied to the skills of reading, writing, speaking and listening. This

  1. Secondary standard dosimetry laboratory at INFLPR

    Energy Technology Data Exchange (ETDEWEB)

    Scarlat, F.; Minea, R.; Scarisoreanu, A.; Badita, E.; Sima, E.; Dumitrascu, M.; Stancu, E.; Vancea, C., E-mail: scarlat.f@gmail.com [National Institute for Laser, Plasma and Radiation Physics - INFLPR, Bucharest (Romania)

    2011-07-01

    National Institute for Laser, Plasma and Radiation Physics (INFLPR) has constructed a High Energy Secondary Standard Dosimetry Laboratory SSDL-STARDOOR - for performing dosimetric calibrations according to ISO IEC SR/EN 17025:2005 standards. This is outfitted with UNIDOS Secondary Standard Dosimeter from PTW (Freiburg Physikalisch-Technische Werksttaten) calibrated at the PTB-Braunschweig (German Federal Institute of Physics and Metrology). A radiation beam of the quality of Q used by our laboratory as calibration source are provided by INFLPR 7 MeV electron beam linear accelerator mounted in our facility. (author)

  2. Collaborative Tools in Upper Secondary School - Why?

    DEFF Research Database (Denmark)

    Mathiasen, Helle; Degn, Hans-Peter; Bech, Christian Winther

    2013-01-01

    The paper will discuss potentials of digital media to support student engagement and student production in Danish upper secondary education with a specific focus on group work and collaboration. With the latest school reform, upper secondary education in Denmark has experienced an increased focus...... on the system theoretical approach will be described. Third, the findings from the qualitative, and quantitative studies will be presented. The paper concludes that the study demonstrates changes in the way group work is organised by the students using digital media, and a tendency to develop student engagement...

  3. Overview of factors influencing the secondary market

    International Nuclear Information System (INIS)

    Bleistine, P.A.

    1982-01-01

    The major factor influencing secondary trading for the last few years has been the large contractural commitments built up by consumers for reactor programs which have proven to be unrealistic. The situation has intensified as a result of utilities needing to generate capital through inventory liquidation or reductions. The flexibilities in most contracts are inadequate to match the types of external and/or internal factors faced by the industry. This situation also suggests the need for secondary markets to help the industry adjust to unforeseen difficulties. They are very active markets at this time, but their influence in relation to the long-term method of doing business should not be exaggerated

  4. Secondary poisoning of owls by anticoagulant rodenticides

    Science.gov (United States)

    Mendenhall, Vivian M.; Pank, L.F.

    1980-01-01

    Anticoagulants-compounds that prevent clotting of the blood-are extensively used for control of small mammal pests. The potential secondary hazards of 6 anticoagulant rodenticides to birds of prey were examined in this study. Whole rats or mice were killed with each anticoagulant and were fed to 1-3 species of owls. Owls died of hemorrhaging after feeding on rats killed with bromadiolone, brodifacoum, or diphacinone; sublethal hemorrhaging occurred in owls fed rats killed with difenacoum. These results demonstrate potential secondary hazards of 4 anticoagulants to avian predators. No abnormalities were observed in owls fed rats killed with fumarin and chlorophacinone

  5. IFR code for secondary particle dynamics

    International Nuclear Information System (INIS)

    Teague, M.R.; Yu, S.S.

    1985-01-01

    A numerical simulation has been constructed to obtain a detailed, quantitative estimate of the electromagnetic fields and currents existing in the Advanced Test Accelerator under conditions of laser guiding. The code treats the secondary electrons by particle simulation and the beam dynamics by a time-dependent envelope model. The simulation gives a fully relativistic description of secondary electrons moving in self-consistent electromagnetic fields. The calculations are made using coordinates t, x, y, z for the electrons and t, ct-z, r for the axisymmetric electromagnetic fields and currents. Code results, showing in particular current enhancement effects, will be given

  6. Stem secondary growth of tundra shrubs

    DEFF Research Database (Denmark)

    Campioli, Matteo; Leblans, Niki; Michelsen, Anders

    2012-01-01

    Our knowledge of stem secondary growth of arctic shrubs (a key component of tundra net primary production, NPP) is very limited. Here, we investigated the impact of the physical elements of the environment on shrub secondary growth by comparing annual growth rates of model species from similar...... growth (stem apical growth, stem length, and apical growth of stem plus leaves), in some cases even with opposite responses. Thus caution should be taken when estimating the impact of the environment on shrub growth from apical growth only. Integration of our data set with the (very limited) previously...

  7. Magnetite deposition in PWR secondary systems

    International Nuclear Information System (INIS)

    Schneider, V.; Riess, R.; Ruehle, W.

    2000-01-01

    Recently, local magnetite (Fe 3 04) deposition has been observed at various locations within the secondary systems of Siemens-designed PWRs. These deposits sometimes limited operational flexibility and affected routine operation checks. In addition, these deposits may affect the heat transfer characteristics of heat exchangers. Prior to replacement of components or piping or other extensive maintenance activities it should be investigated whether any modification in secondary-side water chemistry might counteract this corrosion phenomenon, which has proven very effective in maintaining steam generator performance. A VGB study will make an assessment of available field information, and countermeasures will be elaborated. This paper describes the current status of the project. (orig.) [de

  8. Beam-ripple monitor with secondary electrons

    International Nuclear Information System (INIS)

    Sato, Shinji; Kanazawa, Mitsutaka; Noda, Koji; Takada, Eiichi; Komiyama, Akihito; Ichinohe, Ken-ichi; Sano, Yoshinobu

    1997-01-01

    To replace the scintillation-ripple monitor, we have developed a new monitor with a smaller destructive effect on the beam. In this monitor, we use secondary electrons emitted from an aluminum foil with a thickness of 2 μm. The signals of secondary electrons are amplified by an electron multiplier having a maximum gain of 10 6 . By using the new monitor, we could clearly observe the beam ripple with a beam intensity of 3.6x10 8 pps (particle per second). This monitor can also be used as an intensity monitor in the range of 10 4 - 10 9 pps. (author)

  9. 13 CFR 120.601 - SBA Secondary Market.

    Science.gov (United States)

    2010-01-01

    ... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false SBA Secondary Market. 120.601 Section 120.601 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION BUSINESS LOANS Secondary Market Fiscal and Transfer Agent (fta) § 120.601 SBA Secondary Market. The SBA secondary market...

  10. Patients with secondary amenorrhea due to tuberculosis ...

    African Journals Online (AJOL)

    Tuberculosis (TB) is a disease which can affect various organs, including human's genital organs such as the endometrium. Tuberculosis endometritis can cause clinical symptoms of secondary amenorrhea and infertility. Infertility in genital TB caused by the involvement of the endometrium. The case presentation is ...

  11. Secondary Vocational Horticulture Programs--An Assessment.

    Science.gov (United States)

    Burnett, Michael F.; Smith, Charles W.

    1983-01-01

    The objectives of the study were to determine characteristics of secondary horticulture teachers, the structure of horticulture departments, funding sources, nature and scope of facilities, types of supervised occupational experience programs in which horticulture students participated, and curriculum characteristics of vocational horticulture…

  12. Organic Horticulture in the Secondary School

    Science.gov (United States)

    Marrocco, Aldo

    2009-01-01

    This report is based on five years experience working with primary and secondary school teachers in Italy to develop organic farming as an activity for students. The tasks involved were intended to develop our students' environmental awareness, allow them to produce food organically and show that market gardening could be a productive hobby. In…

  13. Processes and problems in secondary star formation

    International Nuclear Information System (INIS)

    Klein, R.I.; Whitaker, R.W.; Sandford, M.T. II.

    1984-03-01

    Recent developments relating the conditions in molecular clouds to star formation triggered by a prior stellar generation are reviewed. Primary processes are those that lead to the formation of a first stellar generation. The secondary processes that produce stars in response to effects caused by existing stars are compared and evaluated in terms of the observational data presently available. We discuss the role of turbulence to produce clumpy cloud structures and introduce new work on colliding inter-cloud gas flows leading to non-linear inhomogeneous cloud structures in an intially smooth cloud. This clumpy morphology has important consequences for secondary formation. The triggering processes of supernovae, stellar winds, and H II regions are discussed with emphasis on the consequences for radiation driven implosion as a promising secondary star formation mechanism. Detailed two-dimensional, radiation-hydrodynamic calculations of radiation driven implosion are discussed. This mechanism is shown to be highly efficient in synchronizing the formation of new stars in congruent to 1-3 x 10 4 years and could account for the recent evidence for new massive star formation in several UCHII regions. It is concluded that, while no single theory adequately explains the variety of star formation observed, a uniform description of star formation is likely to involve several secondary processes. Advances in the theory of star formation will require multiple dimensional calculations of coupled processes. The important non-linear interactions include hydrodynamics, radiation transport, and magnetic fields

  14. Impact of effective communication in Secondary School ...

    African Journals Online (AJOL)

    The study examined the impact of effective communication in secondary school administration in Enugu State. It was a descriptive study. The study comprised 659 respondents made up of 28 principals and 631 teachers. The population of the study was obtained through random sampling technique. The instrument used for ...

  15. Quick Guide: Mental Health-Secondary Transition

    Science.gov (United States)

    National Technical Assistance Center on Transition, 2016

    2016-01-01

    Recently researchers have begun focusing on young adults with mental health disorders transitioning into adulthood. Research exploring the importance of mental health support in secondary transition have yielded positive outcomes. For example, strong collaboration between educational and mental health agencies ensuring academic, employment, and…

  16. Best Practices in Montessori Secondary Programs

    Science.gov (United States)

    Donahoe, Marta

    2013-01-01

    This article is the result of years of study, both formal and informal; hundreds of hours of traditional and Montessori classroom observations; reading and digesting articles and books on secondary education, Montessori education, adolescent brain research, leadership, and best practices in education; and most enlightening of all, 20 years of…

  17. Correlating continuous assessment scores to junior secondary ...

    African Journals Online (AJOL)

    This study investigated the relationship between continuous assessment scores and junior secondary school certificate examination(JSCE) final scores in Imo State. A sample of four hundred students were purposively selected from thirty eight thousand students who took the 1997 JSCE in Imo State. The data used were ...

  18. Secondary wastewater treatment by microalgae isolated from ...

    African Journals Online (AJOL)

    Microalgae play a fundamental role in primary and secondary wastewater treatment. In this work the growth, photosynthetic activity and removal of phosphorus from wastewater effluents by indigenous blue-green algal species, Spirulina and Oscillatoria, isolated from Gaborone oxidation ponds was studied. Oscillatoria and ...

  19. Investigating Declining Enrolments in Secondary Mathematics

    Science.gov (United States)

    Hine, Gregory

    2016-01-01

    This research paper examines the perspective of the Heads of Learning Area: Mathematics (HOLAMs) within all Western Australian secondary schools as to why they felt capable students were not enrolling in the two higher-level mathematics courses of study. All HOLAMs were invited to participate in a single, anonymous online survey comprising…

  20. Career information processing strategies of secondary school ...

    African Journals Online (AJOL)

    This study examined the strategies commonly adopted by Osun state secondary school students in processing career information. It specifically examined the sources of career information available to the students, the uses to which the students put the information collected and how their career decision making skills can be ...

  1. Preparing Future Secondary Computer Science Educators

    Science.gov (United States)

    Ajwa, Iyad

    2007-01-01

    Although nearly every college offers a major in computer science, many computer science teachers at the secondary level have received little formal training. This paper presents details of a project that could make a significant contribution to national efforts to improve computer science education by combining teacher education and professional…

  2. Secondary School Transition: Planning for Success.

    Science.gov (United States)

    Hemphill, Rae

    Parents of adolescents with attention deficit disorders are offered suggestions for easing the transition of their teen from elementary to secondary school. Careful scheduling of classes with the guidance counselor to "fit" the individual teen's needs is urged. The importance of ongoing communication with the school concerning class progress,…

  3. Secondary instabilities of hypersonic stationary crossflow waves

    Science.gov (United States)

    Edelman, Joshua B.

    A sharp, circular 7° half-angle cone was tested in the Boeing/AFOSR Mach-6 Quiet Tunnel at 6° angle of attack. Using a variety of roughness configurations, measurements were made using temperature-sensitive paint (TSP) and fast pressure sensors. High-frequency secondary instabilities of the stationary crossflow waves were detected near the aft end of the cone, from 110° to 163° from the windward ray. At least two frequency bands of the secondary instabilities were measured. The secondary instabilities have high coherence between upstream and downstream sensor pairs. In addition, the amplitudes of the instabilities increase with the addition of roughness elements near the nose of the cone. Two of the measured instabilities were captured over a range of axial Reynolds numbers of about 1 - 2 million, with amplitudes ranging from low to turbulent breakdown. For these instabilities, the wave speed and amplitude growth can be calculated. The wave speeds were all near the edge velocity. Measured growth before breakdown for the two instabilities are between e3 and e4 from background noise levels. The initial linear growth rates for the instabilities are near 50 /m. Simultaneous measurement of two frequency bands of the secondary instabilities was made during a single run. It was found that each mode was spatially confined within a small azimuthal region, and that the regions of peak amplitude for one mode correspond to regions of minimal amplitude for the other.

  4. Understanding reading problems in secondary schools: Some ...

    African Journals Online (AJOL)

    ... factors are discussed based on the evidence obtained by observations and research findings. The importance of teaching reading 'as a subject in the secondary school is hinted. Recommendations are made to ensure that reading as a tool to learning is given a prominent place in schools and libraries throughout Nigeria ...

  5. Changing Pattern of Bacteriuria among Asymptomatic Secondary ...

    African Journals Online (AJOL)

    Subjects and Methods: A survey of 628 adolescents attending secondary schools in Enugu was ... females in whom asymptomatic bacteriuria needs to be treated in pregnancy in order to prevent the attendant risks to the fetus. Thus, there is a ...

  6. Processes and problems in secondary star formation

    International Nuclear Information System (INIS)

    Klein, R.I.; Whitaker, R.W.; Sandford, M.T. II

    1985-01-01

    Recent developments relating the conditions in molecular clouds to star formation triggered by a prior stellar generation are reviewed. Primary processes are those that lead to the formation of a first stellar generation. The secondary processes that produce stars in response to effects caused by existing stars are compared and evaluated in terms of observational data presently available. We discuss the role of turbulence to produce clumpy cloud structures and introduce new work on colliding intercloud gas flows leading to nonlinear inhomogeneous cloud structures in an initially smooth cloud. This clumpy morphology has important consequences for secondary formation. The triggering processes of supernovae, stellar winds, and H II regions are discussed with emphasis on the consequences for radiation-driven implosion as a promising secondary star formation mechanism. Detailed two-dimensional, radiation-hydrodynamic calculations of radiation-driven implosion are discussed. This mechanism is shown to be highly efficient in synchronizing the formation of new stars in -- 1-3 x 10/sup 4/ yr and could account for the recent evidence for new massive star formation in several ultracompact H II regions. It is concluded that, while no single theory adequately explains the variety of star formation observed, a uniform description of star formation is likely to involve several secondary processes. Advances in the theory of star formation will require multi-dimensional calculations of coupled processes. Important nonlinear interactions include hydrodynamics, radiation transport, and magnetic fields

  7. 5. CASE SERIES OF MANIA SECONDARY

    African Journals Online (AJOL)

    Esem

    meeting the criteria for DSM IV- TR is increasing. What is not clear with this increase is whether it is primary mania or secondary mania linked with HIV. METHODS. This study design was a case series in which patients with acute manic episodes were admitted to. Chainama Hills College Hospital and University. Teaching ...

  8. Laboratory Technicians in Australian Secondary Schools

    Science.gov (United States)

    Hackling, Mark W.

    2009-01-01

    A number of reports have argued that secondary science education needs to be more inquiry oriented and involve authentic and practical investigations to develop scientific literacy and better engage students in learning science. Inquiry-oriented approaches, such as those advocated in the new science national curriculum, require that teachers have…

  9. [Pathogenetic and therapeutic aspects of secondary anorexia].

    Science.gov (United States)

    Laviano, A; Cascino, A; Muscaritoli, M; Rossi Fanelli, F

    2000-01-01

    Anorexia is an often underrated symptom in the clinical management of patients suffering from chronic diseases. Moreover, the anorexia accompanying chronic diseases (secondary anorexia) is often confused with anorexia nervosa, a typically neuropsychiatric disorder involving completely different pathogenic mechanisms and therapeutic strategies. Secondary anorexia is one of the main factors responsible for the development of malnutrition, which in turn negatively affects patient morbidity and mortality. Different mechanisms have been proposed to explain the pathogenesis of secondary anorexia. However, consistent experimental and clinical evidence seems to point to hypothalamic serotonergic system hyperactivity as a preeminent cause; this hyperactivity appears to be triggered by enhanced brain availability of tryptophan, the aminoacid precursor of serotonin. The hyperactive hypothalamic serotonergic system might also represent the final effector where different regulatory and modulating pathways, including cytokines, converge. The involvement of tryptophan and the hypothalamic serotonergic system is further supported by the effectiveness of a therapeutic strategy, based on the inhibition of tryptophan entry into the brain, in increasing the food intake of anorectic patients. Although these results represent an encouraging approach to the treatment of secondary anorexia, with possible beneficial effects on the nutritional status of patients, they need to be validated in larger trials.

  10. Substance Abuse Among Female Senior Secondary School ...

    African Journals Online (AJOL)

    Objective: To study the prevalence of substance abuse among female secondary school students in Anambra State. Design: This is a cross sectional study. Materials and Methods: A pre-tested structured questionnaire was used to obtain information on smoking, use of sedatives and alcohol drinking habits from 725 ...

  11. Evaluating Accounting Software in Secondary Schools.

    Science.gov (United States)

    Chalupa, Marilyn

    1988-01-01

    The secondary accounting curriculum must be modified to include computers and software. Educators must be aware of the computer skills needed on the job and of the accounting software that is available. Software selection must be tailored to fit the curriculum and the time available. (JOW)

  12. Secondary Hypertension: Discovering the Underlying Cause.

    Science.gov (United States)

    Charles, Lesley; Triscott, Jean; Dobbs, Bonnie

    2017-10-01

    Most patients with hypertension have no clear etiology and are classified as having primary hypertension. However, 5% to 10% of these patients may have secondary hypertension, which indicates an underlying and potentially reversible cause. The prevalence and potential etiologies of secondary hypertension vary by age. The most common causes in children are renal parenchymal disease and coarctation of the aorta. In adults 65 years and older, atherosclerotic renal artery stenosis, renal failure, and hypothyroidism are common causes. Secondary hypertension should be considered in the presence of suggestive symptoms and signs, such as severe or resistant hypertension, age of onset younger than 30 years (especially before puberty), malignant or accelerated hypertension, and an acute rise in blood pressure from previously stable readings. Additionally, renovascular hypertension should be considered in patients with an increase in serum creatinine of at least 50% occurring within one week of initiating angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy; severe hypertension and a unilateral smaller kidney or difference in kidney size greater than 1.5 cm; or recurrent flash pulmonary edema. Other underlying causes of secondary hypertension include hyperaldosteronism, obstructive sleep apnea, pheochromocytoma, Cushing syndrome, thyroid disease, coarctation of the aorta, and use of certain medications.

  13. Prophylactic immunoglobulin therapy in secondary immune deficiency

    DEFF Research Database (Denmark)

    Agostini, Carlo; Blau, Igor-Wolfgang; Kimby, Eva

    2016-01-01

    RT in secondary immune deficiencies (SID), and most published guidelines are mere extrapolations from the experience in PID. AREAS COVERED: In this article, four European experts provide their consolidated opinion on open questions surrounding the prophylactic use of IgRT in SID, based on their clinical...

  14. Peninsula Humane Society Teacher's Packet. Secondary Level.

    Science.gov (United States)

    Peninsula Humane Society, San Mateo, CA.

    Activities in this teacher's packet are designed to familiarize secondary school students with the responsibilities involved in pet ownership. Teaching plans are provided for a total of 12 lessons grouped under social studies, language arts, math, and health sciences. Activities focus on pet overpopulation, expressions of social responses in…

  15. Chemical composition, secondary metabolites, in vitro gas ...

    African Journals Online (AJOL)

    Chemical composition, secondary metabolites, in vitro gas production characteristics and acceptability study of some forage for ruminant feeding in South-Western Nigeria. ... Chemical composition and qualitative analysis of saponins, phenol and steroids of the plants were determined. In vitro gas production (IVGP) was ...

  16. SECONDARY ONOMATOPOEIA IN RUSSIAN (PRELIMINARY REPORT).

    Science.gov (United States)

    CROCKETT, DINA B.

    SECONDARY ONOMATOPOEIA, ALSO REFERRED TO AS "SOUND-SYMBOLISM," DESIGNATES THE REPRESENTATION IN SPEECH SOUNDS OF NON-ACOUSTIC EXPERIENCES. THE NON-ACOUSTIC EXPERIENCES DEALT WITH ARE VISUAL (IMPRESSIONS OF MAGNITUDE AND LUMINOSITY) AND EMOTIONAL (MOODS OF GLOOM AND HAPPINESS). THIS PAPER DESCRIBES AN EMPIRICAL STUDY DESIGNED TO EXPLORE…

  17. Career conversations in senior secondary vocational education

    NARCIS (Netherlands)

    Mittendorff, K.M.

    2010-01-01

    In the Netherlands, many schools for senior secondary vocational education are implementing competence-based curricula. These curricula start from a constructivist approach and are based on the idea that young people should learn to reflect on their personal ambitions and motives, and to undertake

  18. Directional Secondary Emission of a Semiconductor Microcavity

    DEFF Research Database (Denmark)

    Langbein, Wolfgang; Jensen, Jacob Riis; Hvam, Jørn Märcher

    2000-01-01

    We investigate the time-resolved secondary emission of a homogeneously broadened microcavity after resonant excitation. The sample consists of a 25nm GaAs single quantum well (QW) in the center of a wedged ¥ë cavity with AlAs/AlGaAs Bragg reflectors, grown by molecular beam epitaxy. At zero detun...

  19. Secondary hypertension | Ker | South African Family Practice

    African Journals Online (AJOL)

    Secondary hypertension is rare and the diagnosis may be challenging although, on occasion, there are clinical features indicative of a specific underlying cause. The more commonly encountered causes include renal parenchymal and vascular disease, phaeochromocytoma, endocrine causes, sleep apnoea and drugs.

  20. Finnish Secondary School Students' Interreligious Sensitivity

    Science.gov (United States)

    Holm, Kristiina; Nokelainen, Petri; Tirri, Kirsi

    2014-01-01

    The aim of this study was to assess the self-evaluations of Finnish secondary school students' (N?=?549) interreligious sensitivity. The data were collected from 12-16-year-old young people with a 15-item Interreligious Sensitivity Scale Questionnaire (IRRSSQ). The IRRSSQ is based on Abu-Nimer's Developmental Model of Interreligious Sensitivity,…

  1. Determination of Secondary Encasement Pipe Design Pressure

    Energy Technology Data Exchange (ETDEWEB)

    TEDESCHI, A.R.

    2000-10-26

    This document published results of iterative calculations for maximum tank farm transfer secondary pipe (encasement) pressure upon failure of the primary pipe. The maximum pressure was calculated from a primary pipe guillotine break. Results show encasement pipeline design or testing pressures can be significantly lower than primary pipe pressure criteria.

  2. Antibacterial activity of secondary metabolites isolated from ...

    African Journals Online (AJOL)

    Aghomotsegin

    2015-10-28

    Oct 28, 2015 ... Alternaria spp. are cosmopolitan mould fungi and can be found in soils ... the secondary metabolites products from A. alternata and ..... Zone of inhibition (mm) of test bacterial strains to fungal products and standard antibiotics. Fungal ... marine actinomycetes from pulicat, Muttukadu, and Ennore estuaries.

  3. Biochemical and secondary metabolites changes under moisture ...

    African Journals Online (AJOL)

    The study showed the importance of carbohydrate and nitrogen cycle related metabolites in mediating tolerance in cassava by affecting their phenotypic expression in the plant. Keywords: Hydrothermal stress, bio-chemicals, pigments, secondary metabolites, cassava. African Journal of Biotechnology, Vol 13(31) 3173-3186 ...

  4. Secondary systems of PWR and BWR

    International Nuclear Information System (INIS)

    Schindler, N.

    1981-01-01

    The secondary systems of a nuclear power plant comprises the steam, condensate and feedwater cycle, the steam plant auxiliary or ancillary systems and the cooling water systems. The presentation gives a general review about the main systems which show a high similarity of PWR and BWR plants. (orig./RW)

  5. Helpers in Distress: Preventing Secondary Trauma

    Science.gov (United States)

    Whitfield, Natasha; Kanter, Deborah

    2014-01-01

    Those in close contact with trauma survivors are themselves at risk for trauma (e.g., Bride, 2007; Figley, 1995). Family, friends, and professionals who bear witness to the emotional retelling and re-enacting of traumatic events can experience what is called "secondary trauma" (Elwood, Mott, Lohr, & Galovski, 2011). The literature…

  6. Secondary Data Analysis in Family Research

    Science.gov (United States)

    Hofferth, Sandra L.

    2005-01-01

    This article first provides an overview of the part that secondary data analysis plays in the field of family studies in the early 21st century. It addresses changes over time in the use of existing omnibus data sets and discusses their advantages and disadvantages. The second part of the article focuses on the elements that make a study a…

  7. Methods for Handling Missing Secondary Respondent Data

    Science.gov (United States)

    Young, Rebekah; Johnson, David

    2013-01-01

    Secondary respondent data are underutilized because researchers avoid using these data in the presence of substantial missing data. The authors reviewed, evaluated, and tested solutions to this problem. Five strategies of dealing with missing partner data were reviewed: (a) complete case analysis, (b) inverse probability weighting, (c) correction…

  8. Whales of New England. Secondary Curriculum.

    Science.gov (United States)

    New England Aquarium, Boston, MA.

    Instructional materials and suggestions for conducting a whale watching field trip are contained in this curriculum packet for secondary science teachers. It is one unit in a series of curricular programs developed by the New England Aquarium Education Department. Activities and information are organized into three sections: (1) pre-trip…

  9. Secondary Teachers' Nutrition Knowledge, Attitudes, and Practices.

    Science.gov (United States)

    Penner, Karen P.; Kolasa, Kathryn M.

    The nutrition knowledge, attitudes, and practices of secondary teachers of health and physical education, home economics, science, and social studies were assessed. Of the 518 teachers who completed the survey instruments, 43 percent had never taken a food or nutrition course, and 63 percent had no inservice training in nutrition or food…

  10. Life Purposes of Iranian Secondary School Students

    Science.gov (United States)

    Hedayati, Nasibeh; Kuusisto, Elina; Gholami, Khalil; Tirri, Kirsi

    2017-01-01

    This article examines Iranian secondary students' (N = 336) life purposes. Economic and hedonistic life goals were the most valued. Relationships in terms of having a family and children were also appreciated. In the students' views, religiousness was associated with social goals such as helping others in need and volunteering in the community.…

  11. Factors Influencing Examination Malpractice in Secondary Schools ...

    African Journals Online (AJOL)

    The main purpose of this study was to investigate factors influencing examination malpractice in some selected secondary schools in Cross River State, Nigeria. A sample of one thousand two hundred (1200) students were selected across the three educational zones of Ogoja, Ikom and Calabar using stratified, random ...

  12. Gamma irradiation treatment of secondary sewage effluent

    International Nuclear Information System (INIS)

    Vajdic, A.H.

    The operation and monitoring of a pilot scale Co-60 gamma irradiation unit treating secondary sewage effluent is described. The disinfecting efficiency of the unit is compared to that of an experimental 'ideal' chlorination unit and to the plant chlorination process. A cost estimate for disinfection by gamma irradiation on a full plant scale is included. (author)

  13. Information training for secondary school level teachers

    International Nuclear Information System (INIS)

    Chateau Thierry, A. de

    1994-01-01

    The INSTN (National Institute for Nuclear Sciences and Techniques) in France, organizes each year an information training concerning the nuclear field for secondary school level teachers; created in 1957, the two-weeks session is concerned with radioactivity and nuclear reactor principles and a four-day practical teaching. Since 1968, 1150 teachers assisted to the session

  14. Secondary General Education Teachers' Attitudes toward Inclusion

    Science.gov (United States)

    Wilson, Valerie A.

    2014-01-01

    Since the inception of the Individuals with Disabilities Education Improvement Act, educators have struggled with including students with disabilities in the general education classroom with their nondisabled peers. The inclusion educational model was utilized in this study to explore secondary teachers' attitudes toward inclusive educational…

  15. Acquired secondary Grynfeltt's hernia: a case report

    International Nuclear Information System (INIS)

    Renck, Decio Valente; Lopes Junior, Joao Ivan

    2009-01-01

    Lumbar hernia is a rare condition whose diagnosis is hardly achieved. The prevalence is higher in elderly men. The present case report describes the case of a male, 78-year-old patient who underwent pleural effusion drainage 17 years before presenting with clinical manifestations and tomographic findings compatible with acquired secondary Grynfeltt's hernia. (author)

  16. Versatile secondary beam for the meson area

    International Nuclear Information System (INIS)

    Kirk, T.

    1982-03-01

    A new secondary beam design is outlined for the Meson M6 Beamline that combines versatility with economy. The beamline described will transport charged particles of either sign to 800 GeV/c and bring the beam to a focus in one of three potential experimental areas. The plan makes maximal use of existing civil construction

  17. Authentic Teaching Experiences in Secondary Mathematics Methods

    Science.gov (United States)

    Stickles, Paula R.

    2015-01-01

    Often secondary mathematics methods courses include classroom peer teaching, but many pre-service teachers find it challenging to teach their classmate peers as there are no discipline issues and little mathematical discourse as the "students" know the content. We will share a recent change in our methods course where pre-service…

  18. Should Secondary Schools Buy Local Area Networks?

    Science.gov (United States)

    Hyde, Hartley

    1986-01-01

    The advantages of microcomputer networks include resource sharing, multiple user communications, and integrating data processing and office automation. This article nonetheless favors stand-alone computers for Australian secondary school classrooms because of unreliable hardware, software design, and copyright problems, and individual progress…

  19. Direct amination of secondary alcohols using Ammonia

    NARCIS (Netherlands)

    Pingen, D.L.L.; Müller, C.; Vogt, D.

    2010-01-01

    Hydrogen shuttle: For the first time secondary alcohols and ammonia can be directly converted into primary amines with a selectivity of up to 99¿% by using a simple ruthenium/phosphine catalyst (see scheme; R1, R2= alkyl, aryl, alkenyl; M=[Ru3(CO)12]; and L=phosphine ligand).

  20. Food Literacy at Secondary Schools in Australia

    Science.gov (United States)

    Ronto, Rimante; Ball, Lauren; Pendergast, Donna; Harris, Neil D.

    2016-01-01

    Background: Food literacy can encourage adolescents to develop healthy dietary patterns. This study examined home economics teachers' (HET) perspectives of the importance, curriculum, self-efficacy, and food environments regarding food literacy in secondary schools in Australia. Methods: A 20-item cross-sectional survey was completed by 205 HETs.…

  1. Scoliosis secondary to an unusual rib lesion.

    LENUS (Irish Health Repository)

    Burke, N G

    2012-04-01

    Tumours of the chest wall are uncommon and are usually malignant. A bone haemangioma is a rare benign vascular neoplasm, which more commonly occurs in middle-aged patients. We present the case of a scoliosis caused by a rib haemangioma in an adolescent male. Other causes of scoliosis secondary to rib lesions are discussed.

  2. Preservice Secondary Mathematics Teachers' Knowledge of Students

    Science.gov (United States)

    Kilic, Hulya

    2011-01-01

    The aim of this paper is to present the nature of preservice secondary mathematics teachers' knowledge of students as emerged from a study investigating the development of their pedagogical content knowledge in a methods course and its associated field experience. Six preservice teachers participated in the study and the data were collected in the…

  3. Prejudices against Immigrants in Secondary School

    Science.gov (United States)

    Etxeberria, Felix; Murua, Hilario; Arrieta, Elisabet; Garmendia, Joxe; Etxeberria, Juan

    2015-01-01

    This paper presents the results of a study of prejudice against immigrants in secondary schools in the Basque Country, in Spain. We carried out a review of the best-known questionnaires and catalogues on prejudices regarding immigration and we drew up a new questionnaire, with positive and negative scales of prejudices, in order to apply them to…

  4. assessing participation in secondary education quality enhancement

    African Journals Online (AJOL)

    PROF. BARTH EKWEME

    for low parents and communities involvement in secondary education-quality improvement. It was recommended that the quality of instruction in ... concern on standard of education hinges on the quality of instruction the children are ... NTI, 2000). This implies that teachers have a duty of helping students under their care to.

  5. Live Imaging of Mouse Secondary Palate Fusion

    Czech Academy of Sciences Publication Activity Database

    Kim, S.; Procházka, Jan; Bush, J.O.

    jaro, č. 125 (2017), č. článku e56041. ISSN 1940-087X Institutional support: RVO:68378050 Keywords : Developmental Biology * Issue 125 * live imaging * secondary palate * tissue fusion * cleft * craniofacial Subject RIV: EB - Genetics ; Molecular Biology OBOR OECD: Developmental biology Impact factor: 1.232, year: 2016

  6. Secondary standard dosimetry laboratories: Development and trends

    International Nuclear Information System (INIS)

    1985-08-01

    This publication describes the work of the IAEA and the WHO in the establishment of a network of Secondary Standard Dosimetry Laboratories. Membership in the SSDL network has now risen to about 50 laboratories, of which 36 are in developing countries

  7. Industrializing Secondary Schools in Tanzania through Scientific ...

    African Journals Online (AJOL)

    Industrializing Secondary Schools in Tanzania through Scientific Innovations. ... Huria: Journal of the Open University of Tanzania ... Through review of various innovations developed by universities including SUA, it was established that there are several innovations in different fields especially in crop cultivation, animal ...

  8. Computer Activities in Illinois Secondary Schools.

    Science.gov (United States)

    Dennis, J. Richard; And Others

    A brief, non-technical questionnaire was sent to 875 secondary school administrators (primarily principals) in the State of Illinois. Information was collected in four areas: (1) general school characteristics, (2) availability and use of computers, (3) perceived need for and qualifications of teachers of computer science, and (4) perceived need…

  9. The Gender of Secondary School Principals.

    Science.gov (United States)

    Bonuso, Carl; Shakeshaft, Charol

    1983-01-01

    A study was conducted to understand why so few of the secondary school principals in New York State are women. Results suggest two possible causes: either sufficient women candidates do not apply for the positions, or sex discrimination still exists. (KH)

  10. Problems of implementing continuous assessment in secondary ...

    African Journals Online (AJOL)

    The paper examined problems of implementing continuous assessment in secondary schools in Obowo local government area of Imo State, Nigeria. Data were collected with the aid of a structured questionnaire administered to 100 randomly selected respondents in the study area. Descriptive statistics were used for data ...

  11. Vitamin D, secondary hyperparathyroidism, and preeclampsia.

    Science.gov (United States)

    Scholl, Theresa O; Chen, Xinhua; Stein, T Peter

    2013-09-01

    Secondary hyperparathyroidism, which is defined by a high concentration of intact parathyroid hormone when circulating 25-hydroxyvitamin D [25(OH)D] is low, is a functional indicator of vitamin D insufficiency and a sign of impaired calcium metabolism. Two large randomized controlled trials examined effects of calcium supplementation on preeclampsia but did not consider the vitamin D status of mothers. We examined the association of secondary hyperparathyroidism with risk of preeclampsia. Circulating maternal 25-hydroxyvitamin D [25(OH)D] and intact parathyroid hormone were measured at entry to care (mean ± SD: 13.7 ± 5.7 wk) using prospective data from a cohort of 1141 low-income and minority gravidae. Secondary hyperparathyroidism occurred in 6.3% of the cohort and 18.4% of women whose 25(OH)D concentrations were 20 ng/mL were not at increased risk. Intact parathyroid hormone was related to higher systolic and diastolic blood pressures and arterial pressure at week 20 before clinical recognition of preeclampsia. Energy-adjusted intakes of total calcium and lactose and circulating 25(OH)D were correlated inversely with systolic blood pressure or arterial pressure and with parathyroid hormone. Some women who are vitamin D insufficient develop secondary hyperparathyroidism, which is associated with increased risk of preeclampsia.

  12. Creativity of secondary school students: entrepreneurial skills ...

    African Journals Online (AJOL)

    The study adopted a quasi-experimental design using a pre-test, post-test control design in order to investigate the entrepreneurial skills and creative abilities of secondary school students in Physics. The study was carried out in Obio/Akpo Local Government Area of Rivers State of Nigeria, using purposive sampling ...

  13. Recovery of the secondary raw materials, recycling

    International Nuclear Information System (INIS)

    Chmielewska, E.

    2010-01-01

    In this chapter the recovery and recycling of secondary raw materials is explained. This chapter consists of the following parts: Paper and tetrapaks; Car wrecks; Scrap metal; Plastics; Used tires; Electrical and electronic equipment; Glass; Accumulators and batteries; Spent oil; Low-and non-waste technology.

  14. Initiation of secondary ice production in clouds

    Directory of Open Access Journals (Sweden)

    S. C. Sullivan

    2018-02-01

    Full Text Available Disparities between the measured concentrations of ice-nucleating particles (INPs and in-cloud ice crystal number concentrations (ICNCs have led to the hypothesis that mechanisms other than primary nucleation form ice in the atmosphere. Here, we model three of these secondary production mechanisms – rime splintering, frozen droplet shattering, and ice–ice collisional breakup – with a six-hydrometeor-class parcel model. We perform three sets of simulations to understand temporal evolution of ice hydrometeor number (Nice, thermodynamic limitations, and the impact of parametric uncertainty when secondary production is active. Output is assessed in terms of the number of primarily nucleated ice crystals that must exist before secondary production initiates (NINP(lim as well as the ICNC enhancement from secondary production and the timing of a 100-fold enhancement. Nice evolution can be understood in terms of collision-based nonlinearity and the phasedness of the process, i.e., whether it involves ice hydrometeors, liquid ones, or both. Ice–ice collisional breakup is the only process for which a meaningful NINP(lim exists (0.002 up to 0.15 L−1. For droplet shattering and rime splintering, a warm enough cloud base temperature and modest updraft are the more important criteria for initiation. The low values of NINP(lim here suggest that, under appropriate thermodynamic conditions for secondary ice production, perturbations in cloud concentration nuclei concentrations are more influential in mixed-phase partitioning than those in INP concentrations.

  15. Leishmania infantum and Epstein-Barr virus co-infection in a patient with hemophagocytosis

    Directory of Open Access Journals (Sweden)

    Zied Gaifer

    2017-01-01

    Full Text Available The authors describe a rare case of a 27-year old previously healthy male presenting with high grade fever, pancytopenia, hepatosplenomegaly, high levels of ferritin and triglyceride, suggesting a diagnosis of hemophagocytic lymphohistiocytosis (HLH syndrome. Other investigations showed a positive Leishmania infantum serology and high Epstein-Barr virus (EBV viremia. The diagnosis of a visceral leishmaniasis was confirmed by bone morrow biopsy, which showed Leishman-Donovan bodies and evidence of HLH. The patient received liposomal amphotericin B and he had a complete resolution of his symptoms and clearance of EBV viremia. This case of HLH associated with visceral leishmaniasis and EBV co-infection raises the question about the significance of EBV in patients with HLH. The treatment of actual etiological agent can lead to complete cure while using current recommend chemotherapy for HLH-related EBV in a patient with hidden infection may have deleterious effects.

  16. How genetic testing can lead to targeted management of XIAP deficiency-related inflammatory bowel disease

    DEFF Research Database (Denmark)

    Nielsen, Ole Haagen; LaCasse, Eric Charles

    2017-01-01

    infections, such as Epstein-Barr virus (EBV). Children with XIAP-related XLP-2 may present with either familial hemophagocytic lymphohistiocytosis, often triggered in response to EBV infection, or with a treatment-refractory severe pediatric form of inflammatory bowel disease (IBD) that might be diagnosed...... treatment history and patient morbidity/mortality since its original identification in 2006. Since XLP-2 is rare, cases are probably undergiagnosed or misdiagnosed. Consideration of XLP-2 in children with severe symptoms of IBD can prevent serious morbidities and mortality, avoid unnecessary procedures......, and expedite specific targeted therapy.Genet Med advance online publication 14 July 2016Genetics in Medicine (2016); doi:10.1038/gim.2016.82....

  17. The writing approaches of secondary students.

    Science.gov (United States)

    Lavelle, Ellen; Smith, Jennifer; O'Ryan, Leslie

    2002-09-01

    Research with college students has supported a model of writing approaches that defines the relationship between a writer and writing task along a deep and surface process continuum (Biggs, 1988). Based on that model, Lavelle (1993) developed the Inventory of Processes in College Composition which reflects students' motives and strategies as related to writing outcomes. It is also important to define the approaches of secondary students to better understand writing processes at that level, and development in written composition. This study was designed to define the writing approaches of secondary students by factor analysing students' responses to items regarding writing beliefs and writing strategies, and to compare the secondary approaches to those of college students. A related goal was to explore the relationships of the secondary writing approaches to perceived self-regulatory efficacy for writing (Zimmerman & Bandura, 1994), writing preferences, and writing outcomes. The initial, factor analytic phase involved 398 junior level high school students (11th grade) enrolled in a mandatory language arts class at each of three large Midwestern high schools (USA). Then, 49 junior level students enrolled in two language arts classes participated as subjects in the second phase. Classroom teachers administered the Inventory of Processes in College Composition (Lavelle, 1993), which contained 72 true-or-false items regarding writing beliefs and strategies, during regular class periods. Data were factor analysed and the structure compared to that of college students. In the second phase, the new inventory, Inventory of Processes in Secondary Composition, was administered in conjunction with the Perceived Self-Regulatory Efficacy for Writing Inventory (Zimmerman & Bandura, 1994), and a writing preferences survey. A writing sample and grade in Language Arts classes were obtained and served as outcome variables. The factor structure of secondary writing reflected three

  18. Reconstitution of a secondary cell wall in a secondary cell wall-deficient Arabidopsis mutant.

    Science.gov (United States)

    Sakamoto, Shingo; Mitsuda, Nobutaka

    2015-02-01

    The secondary cell wall constitutes a rigid frame of cells in plant tissues where rigidity is required. Deposition of the secondary cell wall in fiber cells contributes to the production of wood in woody plants. The secondary cell wall is assembled through co-operative activities of many enzymes, and their gene expression is precisely regulated by a pyramidal cascade of transcription factors. Deposition of a transmuted secondary cell wall in empty fiber cells by expressing selected gene(s) in this cascade has not been attempted previously. In this proof-of-concept study, we expressed chimeric activators of 24 transcription factors that are preferentially expressed in the stem, in empty fiber cells of the Arabidopsis nst1-1 nst3-1 double mutant, which lacks a secondary cell wall in fiber cells, under the control of the NST3 promoter. The chimeric activators of MYB46, SND2 and ANAC075, as well as NST3, reconstituted a secondary cell wall with different characteristics from those of the wild type in terms of its composition. The transgenic lines expressing the SND2 or ANAC075 chimeric activator showed increased glucose and xylose, and lower lignin content, whereas the transgenic line expressing the MYB46 chimeric activator showed increased mannose content. The expression profile of downstream genes in each transgenic line was also different from that of the wild type. This study proposed a new screening strategy to identify factors of secondary wall formation and also suggested the potential of the artificially reconstituted secondary cell walls as a novel raw material for production of bioethanol and other chemicals. © The Author 2014. Published by Oxford University Press on behalf of Japanese Society of Plant Physiologists.

  19. Contribution to diagnosis and treatment of bone marrow aspirate results in critically ill patients undergoing bone marrow aspiration: a retrospective study of 193 consecutive patients.

    Science.gov (United States)

    Calvet, Laure; Pereira, Bruno; Sapin, Anne-Françoise; Mareynat, Gabrielle; Lautrette, Alexandre; Souweine, Bertrand

    2017-01-01

    The purpose of the work was to assess the contribution to diagnosis and/or treatment (CDT) of bone marrow aspiration (BMA) in the critically ill patient. The retrospective study included 193 patients. On the basis of BMA findings, contribution to diagnosis was defined by one of four previously unestablished diagnoses (maturation arrest of granulocyte precursors, hemophagocytic lymphohistiocytosis, hematological malignancy, marrow infiltration with cancer cells) and to treatment as the initiation or withdrawal of a specific treatment including the decision to forgo life-sustaining treatment (DFLST). A CDT of BMA was observed in 40/193 patients (20.7%). BMA contributed to diagnosis in 37 cases (granulocyte precursor maturation arrest, N  = 10; hemophagocytic lymphohistiocytosis, N  = 12; hematological malignancy, N  = 15) and to treatment in 14, including three DFLSTs. In multivariate analysis, the factors associated with a CDT were hematological malignancy, cancer or non-malignant hematological abnormality known on admission, indication for BMA excluding isolated thrombocytopenia, higher pre-BMA HScore (calculated prior to BMA), and higher SOFA score with or without platelet-count SOFA subscore. In the 160 patients without hematological malignancy or cancer known on admission, non-malignant hematological abnormality known on admission, indication for BMA excluding isolated thrombocytopenia, higher pre-BMA HScore, and higher SOFA score calculated with or without platelet-count SOFA subscore were independently associated with a CDT of BMA. BMA can have a significant CDT in ICU patients with or without a known hematological malignancy or cancer on admission. An HScore calculated before BMA can be a valuable tool for predicting a CDT of BMA.

  20. Outbursts from the secondary component in OJ 287 and the secondary spin-up

    Directory of Open Access Journals (Sweden)

    Pihajoki P.

    2012-12-01

    Full Text Available At the end of March 2012 a prominent optical outburst was observed in the binary black hole system OJ 287. It does not fit the expected sequence of outbursts from the primary component and the bremsstrahlung outbursts from the accretion disk impacts of the secondary component. These occur in a well established pattern repeated with an approximately 12 year interval. In this work we discuss the possibility that the outburst originates from the secondary black hole. The timing of the 2012 outburst relative to the expected sequence would make it a counterpart of the precursor outbursts in 1993 and 2004, which occured before the main pattern of outbursts. If so, it appears that a precursor occurs when the secondary reaches a constant level above the mean accretion disk level of the primary component. It may be that this encounter induces an outburst in the secondary which is nearly as prominent as the outbursts in the expected sequence. The strength of these outbursts depends strongly on the spin of the secondary. In this work we investigate the limits on the secondary spin-up and spin alignment from interaction with the accretion disk of the primary component and its magnetic field.

  1. Mathematics anxiety in secondary students in England.

    Science.gov (United States)

    Chinn, Steve

    2009-02-01

    Whatever the changes that are made to the mathematics curriculum in England, there will always remain a problem with mathematics anxiety. Maths anxiety is rarely facilitative. This study examined aspects of mathematics in secondary schools and how students rated them as sources of anxiety. Over 2000 students in independent and mainstream schools in England completed a 20-item questionnaire designed to investigate maths anxiety levels. The same questionnaire was given to over 440 dyslexic males in specialist schools within the same age range. The results showed that examinations and tests create high levels of anxiety in approximately 4% of students. The results suggest that certain aspects and topics in the maths curriculum, such as long division, cause similar levels of anxiety for students in all year groups in secondary schools.

  2. Secondary Behavior of Drivers on Cell Phones.

    Science.gov (United States)

    Farmer, Charles M; Klauer, Sheila G; McClafferty, Julie A; Guo, Feng

    2015-01-01

    The objective of this study was to determine whether cell phone use by drivers leads to changes in the frequency of other types of potentially distracting behavior. There were 2 main questions of interest: (1) As each driver changes cell phone use, does he or she change the amount of driving time spent on other distracting behavior? (2) As each driver changes cell phone use, does he or she change the amount of driving time spent looking away from the driving task? Day-to-day driving behavior of 105 volunteer subjects was monitored over a period of 1 year. The amount of driving time during each trip spent on tasks secondary to driving (or looking away from the driving task) was correlated to the amount of time on a cell phone, taking into account the relationships among trips taken by the same driver. Drivers spent 42% of the time engaging in at least one secondary activity. Drivers were talking on a cell phone 7% of the time, interacting in some other way with a cell phone 5% of the time, and engaging in some other secondary activity (sometimes in conjunction with cell phone use) 33% of the time. Other than cell phone use, the most common secondary activities were interacting with a passenger (12% of driving time), holding but not otherwise interacting with an object (6%), and talking/singing/dancing to oneself (5%). Drivers were looking straight forward 81% of the time, forward left or right 5% of time, in a mirror 4% of the time, and elsewhere (eyes off driving task) 10% of time. On average, for each 1 percentage point increase in cell phone talking, the other secondary behavior rate decreased by 0.28 percentage points (P cell phone interaction per trip, the other secondary behavior rate decreased by 0.08 percentage points (P =.0558), but the rate of eyes off driving task increased by 0.06 percentage points (P cell phone can be distracting from the driving task, other secondary activities can be equally or more distracting, at least as measured by eye glances

  3. Acute renal failure secondary to rhabdomyolysis

    International Nuclear Information System (INIS)

    Kim, S.H.; Han, M.C.; Kim, S.; Lee, J.S.

    1992-01-01

    MR imaging of the kidney was performed in 6 patients with acute renal failure (ARF) secondary to rhabdomyolysis caused by snake bite (n = 4), crush injury (n = 1), and carbon monoxide poisoning (n = 1). A test for urine myoglobin was positive in all 6 patients and MR imaging was done 6 to 18 days after the causative event of the rhabdomyolysis. MR images in all 6 patients showed globular swelling of the kidneys, preserved corticomedullary contrast on T1-weighted images, and obliteration of corticomedullary contrast on T2-weighted images. Unlike other medical renal diseases in which corticomedullary contrast is lost on T1-weighted images, preservation of the corticomedullary contrast on T1-weighted MR images with globular renal swelling was a constant finding in patients with ARF secondary to rhabdomyolysis. (orig.)

  4. Monju secondary heat transport system sodium leak

    International Nuclear Information System (INIS)

    Suzuki, Takeo; Hiroi, Hiroshi; Usami, Shin; Iwata, Koji.

    1996-01-01

    On December 8, 1995, the sodium leakage from the secondary heat transport system (SHTS) occurred in the piping room of the reactor auxiliary building in Monju. The secondary sodium leaked through a temperature sensor, due to the breakaway of the tip of the well tube of the sensor installed near the outlet of the intermediate heat exchanger (IHX) in the C loop of SHTS. The reactor core remained cooled and thus, from the viewpoint of radiological hazards, the safety of the reactor was secured. There were no adverse effects for operating personnel or the surrounding environment. The cause of the well tube failure is considered to result from high cycle fatigue due to flow induced vibrations. Delay in draining the sodium from the leaking loop increased the consequential effects from sodium combustion products. (author)

  5. Perception of secondary victimization in gender violence

    Directory of Open Access Journals (Sweden)

    María Aranda López

    2014-08-01

    Full Text Available Gender violence is a complex phenomenon that does not end with the removal of the abuser, as the abused person can experience secondary victimization. This study examined this process in a sample of 38 battered women. A multicausal approach was used to assess satisfaction with health system, the police, and the judiciary. The study also assessed the role of two variables that have remained unaddressed: family support and perceived danger. The results indicate that dissatisfaction with judicial treatment and legal action plays a key role in the perception of secondary victimization. It was also found that women who perceive less risk value the judicial system more because they do not need the system to take protective measures or other measures for them. Moreover, women who receive family support are more satisfied with the police system.

  6. Manipulating bubbles with secondary Bjerknes forces

    Energy Technology Data Exchange (ETDEWEB)

    Lanoy, Maxime [Institut Langevin, ESPCI ParisTech, CNRS (UMR 7587), PSL Research University, 1 rue Jussieu, 75005 Paris (France); Laboratoire Matière et Systèmes Complexes, Université Paris-Diderot, CNRS (UMR 7057), 10 rue Alice Domon et Léonie Duquet, 75013 Paris (France); Derec, Caroline; Leroy, Valentin [Laboratoire Matière et Systèmes Complexes, Université Paris-Diderot, CNRS (UMR 7057), 10 rue Alice Domon et Léonie Duquet, 75013 Paris (France); Tourin, Arnaud [Institut Langevin, ESPCI ParisTech, CNRS (UMR 7587), PSL Research University, 1 rue Jussieu, 75005 Paris (France)

    2015-11-23

    Gas bubbles in a sound field are submitted to a radiative force, known as the secondary Bjerknes force. We propose an original experimental setup that allows us to investigate in detail this force between two bubbles, as a function of the sonication frequency, as well as the bubbles radii and distance. We report the observation of both attractive and, more interestingly, repulsive Bjerknes force, when the two bubbles are driven in antiphase. Our experiments show the importance of taking multiple scatterings into account, which leads to a strong acoustic coupling of the bubbles when their radii are similar. Our setup demonstrates the accuracy of secondary Bjerknes forces for attracting or repealing a bubble, and could lead to new acoustic tools for noncontact manipulation in microfluidic devices.

  7. [Secondary prevention of ischemic non cardioembolic stroke].

    Science.gov (United States)

    Armario, Pedro; Pinto, Xavier; Soler, Cristina; Cardona, Pere

    2015-01-01

    Stroke patients are at high risk for recurrence or new occurrence of other cardiovascular events or cardiovascular mortality. It is estimated that a high percentage of non-cardioembolic ischemic stroke can be prevented by a suitable modification of lifestyle (diet and exercise), reducing blood pressure (BP) with antihypertensive medication, platelet aggregation inhibitors, statins and high intake reducing consumption of. Unfortunately the degree of control of the different risk factors in secondary prevention of stroke is low. The clinical practice guidelines show clear recommendations with corresponding levels of evidence, but only if implemented in a general way they will get a better primary and secondary stroke prevention. Copyright © 2014 Sociedad Española de Arteriosclerosis. Published by Elsevier España. All rights reserved.

  8. Manipulating bubbles with secondary Bjerknes forces

    International Nuclear Information System (INIS)

    Lanoy, Maxime; Derec, Caroline; Leroy, Valentin; Tourin, Arnaud

    2015-01-01

    Gas bubbles in a sound field are submitted to a radiative force, known as the secondary Bjerknes force. We propose an original experimental setup that allows us to investigate in detail this force between two bubbles, as a function of the sonication frequency, as well as the bubbles radii and distance. We report the observation of both attractive and, more interestingly, repulsive Bjerknes force, when the two bubbles are driven in antiphase. Our experiments show the importance of taking multiple scatterings into account, which leads to a strong acoustic coupling of the bubbles when their radii are similar. Our setup demonstrates the accuracy of secondary Bjerknes forces for attracting or repealing a bubble, and could lead to new acoustic tools for noncontact manipulation in microfluidic devices

  9. A Ulysses Detection of Secondary Helium Neutrals

    Science.gov (United States)

    Wood, Brian E.; Müller, Hans-Reinhard; Witte, Manfred

    2017-12-01

    The Interstellar Boundary EXplorer (IBEX) mission has recently studied the flow of interstellar neutral He atoms through the solar system and discovered the existence of a secondary He flow that likely originates in the outer heliosheath. We find evidence for this secondary component in Ulysses data. By coadding hundreds of Ulysses He beam maps together to maximize signal-to-noise ratio, we identify a weak signal that is credibly associated with the secondary component. Assuming a laminar flow from infinity, we infer the following He flow parameters: V=12.8+/- 1.9 km s-1, λ =74\\buildrel{\\circ}\\over{.} 4+/- 1\\buildrel{\\circ}\\over{.} 8, β =-10\\buildrel{\\circ}\\over{.} 5+/- 4\\buildrel{\\circ}\\over{.} 1, and T=3000+/- 1100 K; where λ and β are the ecliptic longitude and latitude direction in J2000 coordinates. The secondary component has a density that is 4.9 ± 0.9% that of the primary component. These measurements are reasonably consistent with measurements from IBEX, with the exception of temperature, where our temperature is much lower than IBEX’s T = 9500 K. Even the higher IBEX temperature is suspiciously low compared to expectactions for the outer heliosheath source region. The implausibly low temperatures are due to the incorrect assumption of a laminar flow instead of a diverging one, given that the flow in the outer heliosheath source region will be deflecting around the heliopause. As for why the IBEX and Ulysses T values are different, difficulties with background subtraction in the Ulysses data are a potential source of concern, but the discrepancy may also be another effect of the improper laminar flow assumption, which could affect the IBEX and Ulysses analyses differently.

  10. Impact of Secondary Interactions in Asymmetric Catalysis

    OpenAIRE

    Frölander, Anders

    2007-01-01

    This thesis deals with secondary interactions in asymmetric catalysis and their impact on the outcome of catalytic reactions. The first part revolves around the metal-catalyzed asymmetric allylic alkylation reaction and how interactions within the catalyst affect the stereochemistry. An OH–Pd hydrogen bond in Pd(0)–π-olefin complexes of hydroxy-containing oxazoline ligands was identified by density functional theory computations and helped to rationalize the contrasting results obtained emplo...

  11. A Kernel for Protein Secondary Structure Prediction

    OpenAIRE

    Guermeur , Yann; Lifchitz , Alain; Vert , Régis

    2004-01-01

    http://mitpress.mit.edu/catalog/item/default.asp?ttype=2&tid=10338&mode=toc; International audience; Multi-class support vector machines have already proved efficient in protein secondary structure prediction as ensemble methods, to combine the outputs of sets of classifiers based on different principles. In this chapter, their implementation as basic prediction methods, processing the primary structure or the profile of multiple alignments, is investigated. A kernel devoted to the task is in...

  12. Secondary hypertension, issues in diagnosis and treatment.

    Science.gov (United States)

    Pullalarevu, Raghavesh; Akbar, Ghulam; Teehan, Geoffrey

    2014-12-01

    Secondary hypertension (SH) often implies a correctable form of nonessential hypertension. Often certain clinical clues prompt a more extensive evaluation of the causes of the hypertension. Renovascular disease, intrinsic renal disease, primary hyperaldosteronism, and obstructive sleep apnea represent the most common causes of SH. This article defines the disorder and details its epidemiology, prevalence, pathophysiology, physical findings, and treatment strategies. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. Emotional Laour in Teaching Secondary Physical Education

    OpenAIRE

    Ye Hoon Lee; Hyungil Harry Kwon; Hwajung Oh

    2016-01-01

    Background: Teaching physical education is an emotion-laden context which requires physical education teachers to engage in emotional labor in order to foster their well-being, as well as student’s outcomes. Objective: The purpose of this study was to investigate the predictability of emotional labour strategies on job satisfaction and emotional exhaustion among secondary physical education teachers in South Korea. Specifically, the four forms of emotional labour (i.e., surface acting, deep a...

  14. The secondary school teaching in Spain

    International Nuclear Information System (INIS)

    Pascualena, M.T.

    1994-01-01

    The Spanish educational system is to be completely re-shaped in 1995 (for the secondary grade level); the important work involved has clearly shown the information lack concerning energy, and especially nuclear energy. Energy instruction should be provided in a new way, spread on several years in various domains (natural science, physics, etc.). Forum Atomico Espanol, a nuclear energy organization, has provided information with various tools (books, conferences, etc.) for teacher's and pupil's training

  15. Particle Physics Outreach to Secondary Education

    Energy Technology Data Exchange (ETDEWEB)

    Bardeen, Marjorie G.; /Fermilab; Johansson, K.Erik; /Stockholm U.; Young, M.Jean

    2011-11-21

    This review summarizes exemplary secondary education and outreach programs of the particle physics community. We examine programs from the following areas: research experiences, high-energy physics data for students, informal learning for students, instructional resources, and professional development. We report findings about these programs' impact on students and teachers and provide suggestions for practices that create effective programs from those findings. We also include some methods for assessing programs.

  16. Parotitis with secondary syphilis: a case report.

    Science.gov (United States)

    Hira, S K; Hira, R S

    1984-01-01

    Painless swelling of the parotid salivary gland was observed in a patient presenting with secondary syphilis. This case is of special interest to venereologists and surgeons as parotitis associated with syphilis may be mistaken for common tumours of the parotid glands. A diagnosis of syphilitic parotitis should be considered in patients presenting with swollen parotid salivary glands in countries where syphilis is prevalent. PMID:6704695

  17. Fahr’s Syndrome and Secondary Hypoparathyroidism

    OpenAIRE

    Santos Vitorino Modesto dos; Da Mata Ana Medeiros De Farias; Ribeiro Kelle Regina Alves; Calvo Isadora Cartaxo De Sousa

    2016-01-01

    A typical case of Fahr’s syndrome is described in a 76-year-old Brazilian female who underwent a total thyroidectomy three decades ago. Six years before the current admission, she started with generalized tonic-clonic seizures. Associated disorders involved extra-pyramidal, cognitive, nocturnal terror and mood changes. With suspicion of hypocalcemia due to secondary hypoparathyroidism, laboratory determinations confirmed the diagnoses. Furthermore, imaging studies of the central nervous syste...

  18. Particle Physics Outreach to Secondary Education

    International Nuclear Information System (INIS)

    Bardeen, Marjorie G.; Johansson, K. Erik; Young, M. Jean

    2011-01-01

    This review summarizes exemplary secondary education and outreach programs of the particle physics community. We examine programs from the following areas: research experiences, high-energy physics data for students, informal learning for students, instructional resources, and professional development. We report findings about these programs' impact on students and teachers and provide suggestions for practices that create effective programs from those findings. We also include some methods for assessing programs.

  19. Secondary mechanisms in a gas discharge

    International Nuclear Information System (INIS)

    Fletcher, J.; Blevin, H.A.

    1978-05-01

    The technique for studying swarms of electrons in a gas discharge by observing the photon flux from the discharge has been adapted to investigate the role of the secondary mechanisms. First results, reported here, show that, contrary to previous indications, ion bombardment of the cathode plays only a negligible, if any, part in the low pressure discharge in hydrogen at E/N approx. less than 200Td

  20. Lipopolysaccharide (LPS) stimulation of fungal secondary metabolism

    Science.gov (United States)

    Khalil, Zeinab G.; Kalansuriya, Pabasara; Capon, Robert J.

    2014-01-01

    We report on a preliminary investigation of the use the Gram-negative bacterial cell wall constituent lipopolysaccharide (LPS) as a natural chemical cue to stimulate and alter the expression of fungal secondary metabolism. Integrated high-throughput micro-cultivation and micro-analysis methods determined that 6 of 40 (15%) of fungi tested responded to an optimal exposure to LPS (0.6 ng/mL) by activating, enhancing or accelerating secondary metabolite production. To explore the possible mechanisms behind this effect, we employed light and fluorescent microscopy in conjunction with a nitric oxide (NO)-sensitive fluorescent dye and an NO scavenger to provide evidence that LPS stimulation of fungal secondary metabolism coincided with LPS activation of NO. Several case studies demonstrated that LPS stimulation can be scaled from single microplate well (1.5 mL) to preparative (>400 mL) scale cultures. For example, LPS treatment of Penicillium sp. (ACM-4616) enhanced pseurotin A and activated pseurotin A1 and pseurotin A2 biosynthesis, whereas LPS treatment of Aspergillus sp. (CMB-M81F) substantially accelerated and enhanced the biosynthesis of shornephine A and a series of biosynthetically related ardeemins and activated production of neoasterriquinone. As an indication of broader potential, we provide evidence that cultures of Penicillium sp. (CMB-TF0411), Aspergillus niger (ACM-4993F), Rhizopus oryzae (ACM-165F) and Thanatephorus cucumeris (ACM-194F) were responsive to LPS stimulation, the latter two examples being particular noteworthy as neither are known to produce secondary metabolites. Our results encourage the view that LPS stimulation can be used as a valuable tool to expand the molecular discovery potential of fungal strains that either have been exhaustively studied by or are unresponsive to traditional culture methodology. PMID:25379339

  1. Iatrogenic hyperthyroidism secondary to dextrothyroxine administration

    Energy Technology Data Exchange (ETDEWEB)

    Hankins, J.H.; Heise, C.M.; Cowan, R.J.

    1984-01-01

    Two patients are reported who presented with clinical hyperthyroidism, increased serum thyroid function studies, and depressed radioactive iodine uptake, secondary to chronic ingestion of D-T4. Symptoms abated, and function studies returned to normal, following discontinuation of D-T4. This uncommon effect of D-T4 may be more prevalent than is generally realized and must be recognized as another potential cause of low radioiodine uptake in patients with clinical hyperthyroidism.

  2. "Negative symptoms"secondary to intracranial tumor

    Directory of Open Access Journals (Sweden)

    Natasha Kate

    2014-01-01

    Full Text Available Intracranial tumors are increasingly common in the elderly population. They may present with varied symptoms, some of which may be psychiatric in nature. In patients with known psychiatric disorders, these symptoms may be misattributed resulting in a delay in diagnosis and management. We present a case of an elderly female with paranoid schizophrenia and new onset symptoms secondary to intracranial tumor, which were initially misdiagnosed.

  3. Iatrogenic hyperthyroidism secondary to dextrothyroxine administration

    International Nuclear Information System (INIS)

    Hankins, J.H.; Heise, C.M.; Cowan, R.J.

    1984-01-01

    Two patients are reported who presented with clinical hyperthyroidism, increased serum thyroid function studies, and depressed radioactive iodine uptake, secondary to chronic ingestion of D-T4. Symptoms abated, and function studies returned to normal, following discontinuation of D-T4. This uncommon effect of D-T4 may be more prevalent than is generally realized and must be recognized as another potential cause of low radioiodine uptake in patients with clinical hyperthyroidism

  4. Secondary stroke prevention: challenges and solutions

    OpenAIRE

    Esenwa, Charles; Gutierrez, Jose

    2015-01-01

    Charles Esenwa, Jose GutierrezDepartment of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USAAbstract: Stroke is the leading cause of disability in the USA and a major cause of mortality worldwide. One out of four strokes is recurrent. Secondary stroke prevention starts with deciphering the most likely stroke mechanism. In general, one of the main goals in stroke reduction is to control vascular risk factors such as hypertension, diabetes, dy...

  5. Method for the secondary recovery of petroleum

    Energy Technology Data Exchange (ETDEWEB)

    Roth, H H

    1966-10-11

    A method for the secondary recovery of petroleum from subterranean formations consists of flooding these formations with aqueous fluids. These aqueous fluids contain one or more saline solutes which are either present before the flooding or which are dissolved from the formation during flooding. These fluids contain, as a thickening agent, a substantially linear, high molecular weight, water-soluble alkenylaromatic polymer which has sulfonic acid or sulfonate groups on the aromatic nuclei. This saline solute and polymer are mutually compatible. (5 claims)

  6. Preservice Secondary Mathematics Teachers’ Knowledge of Students

    OpenAIRE

    Kılıç, Hülya

    2011-01-01

    The aim of this paper is to present the nature of preservice secondary mathematics teachers’ knowledge of students as emerged from a study investigating the development of their pedagogical content knowledge in a methods course and its associated field experience. Six preservice teachers participated in the study and the data were collected in the forms of observations, interviews and written documents. Knowledge of students is defined as teachers’ knowledge of what mathematical concepts are ...

  7. Vocal fold paralysis secondary to phonotrauma.

    Science.gov (United States)

    Klein, Travis A L; Gaziano, Joy E; Ridley, Marion B

    2014-01-01

    A unique case of acute onset vocal fold paralysis secondary to phonotrauma is presented. The cause was forceful vocalization by a drill instructor on a firearm range. Imaging studies revealed extensive intralaryngeal and retropharyngeal hemorrhage. Laryngoscopy showed a complete left vocal fold paralysis. Relative voice rest was recommended, and the patient regained normal vocal fold mobility and function after approximately 12 weeks. Copyright © 2014 The Voice Foundation. All rights reserved.

  8. Secondary-water chemistry at Millstone 2

    International Nuclear Information System (INIS)

    Putkey, T.A.; Pearl, W.L.; Sawochka, S.G.

    1983-04-01

    Secondary system chemistry and steam generator corrosion observations at the Millstone 2 pressurized water reactor are summarized. Condenser retubing and retrofit of full-flow condensate polishers led to significant improvements in steam generator blowdown chemistry following observations of denting after one year of operation at elevated blowdown chloride levels. Notwithstanding the chemistry improvements, denting has continued but at a much reduced rate. In addition, extensive pitting of the Alloy 600 tubing between the tubesheet and first support plate has been reported recently

  9. [Advances in the treatment of secondary osteoporosis].

    Science.gov (United States)

    Galindo Zavala, R; Núñez Cuadros, E; Díaz Cordovés-Rego, G; Urda Cardona, A L

    2014-12-01

    Osteoporosis is being increasingly recognised in paediatric practice as a consequence of the increasing life expectancy of children who suffer from chronic diseases and other factors. There are many non-pharmacological measures that can improve children' bone health, for example, avoiding inflammatory activity and osteotoxic treatments; increasing sun exposure and weight-bearing exercise, and maintaining an adequate nutritional status. Vitamin D and calcium supplements have been proposed as a measure to increase bone mass, but their effect and therapeutic indications are not completely clear. On the other hand, bisphosphonates are currently the only pharmacological alternative for the patients with infantile secondary osteoporosis. However, more studies are required on the therapeutic indications, posology, and long term secondary effects of biphosphonates. The aim of this article is to analyze the scientific evidence of the effectiveness of the therapeutic alternatives for childhood secondary osteoporosis and their safety in children. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  10. Biomass resilience of Neotropical secondary forests.

    Science.gov (United States)

    Poorter, Lourens; Bongers, Frans; Aide, T Mitchell; Almeyda Zambrano, Angélica M; Balvanera, Patricia; Becknell, Justin M; Boukili, Vanessa; Brancalion, Pedro H S; Broadbent, Eben N; Chazdon, Robin L; Craven, Dylan; de Almeida-Cortez, Jarcilene S; Cabral, George A L; de Jong, Ben H J; Denslow, Julie S; Dent, Daisy H; DeWalt, Saara J; Dupuy, Juan M; Durán, Sandra M; Espírito-Santo, Mario M; Fandino, María C; César, Ricardo G; Hall, Jefferson S; Hernandez-Stefanoni, José Luis; Jakovac, Catarina C; Junqueira, André B; Kennard, Deborah; Letcher, Susan G; Licona, Juan-Carlos; Lohbeck, Madelon; Marín-Spiotta, Erika; Martínez-Ramos, Miguel; Massoca, Paulo; Meave, Jorge A; Mesquita, Rita; Mora, Francisco; Muñoz, Rodrigo; Muscarella, Robert; Nunes, Yule R F; Ochoa-Gaona, Susana; de Oliveira, Alexandre A; Orihuela-Belmonte, Edith; Peña-Claros, Marielos; Pérez-García, Eduardo A; Piotto, Daniel; Powers, Jennifer S; Rodríguez-Velázquez, Jorge; Romero-Pérez, I Eunice; Ruíz, Jorge; Saldarriaga, Juan G; Sanchez-Azofeifa, Arturo; Schwartz, Naomi B; Steininger, Marc K; Swenson, Nathan G; Toledo, Marisol; Uriarte, Maria; van Breugel, Michiel; van der Wal, Hans; Veloso, Maria D M; Vester, Hans F M; Vicentini, Alberto; Vieira, Ima C G; Bentos, Tony Vizcarra; Williamson, G Bruce; Rozendaal, Danaë M A

    2016-02-11

    Land-use change occurs nowhere more rapidly than in the tropics, where the imbalance between deforestation and forest regrowth has large consequences for the global carbon cycle. However, considerable uncertainty remains about the rate of biomass recovery in secondary forests, and how these rates are influenced by climate, landscape, and prior land use. Here we analyse aboveground biomass recovery during secondary succession in 45 forest sites and about 1,500 forest plots covering the major environmental gradients in the Neotropics. The studied secondary forests are highly productive and resilient. Aboveground biomass recovery after 20 years was on average 122 megagrams per hectare (Mg ha(-1)), corresponding to a net carbon uptake of 3.05 Mg C ha(-1) yr(-1), 11 times the uptake rate of old-growth forests. Aboveground biomass stocks took a median time of 66 years to recover to 90% of old-growth values. Aboveground biomass recovery after 20 years varied 11.3-fold (from 20 to 225 Mg ha(-1)) across sites, and this recovery increased with water availability (higher local rainfall and lower climatic water deficit). We present a biomass recovery map of Latin America, which illustrates geographical and climatic variation in carbon sequestration potential during forest regrowth. The map will support policies to minimize forest loss in areas where biomass resilience is naturally low (such as seasonally dry forest regions) and promote forest regeneration and restoration in humid tropical lowland areas with high biomass resilience.

  11. Essential hypertension vs. secondary hypertension among children.

    Science.gov (United States)

    Gupta-Malhotra, Monesha; Banker, Ashish; Shete, Sanjay; Hashmi, Syed Sharukh; Tyson, John E; Barratt, Michelle S; Hecht, Jacqueline T; Milewicz, Diane M; Boerwinkle, Eric

    2015-01-01

    The aim was to determine the proportions and correlates of essential hypertension among children in a tertiary pediatric hypertension clinic. We evaluated 423 consecutive children and collected demographic and clinical history by retrospective chart review. We identified 275 (65%) hypertensive children (blood pressure >95th percentile per the "Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents") from 423 children referred to the clinic for history of elevated blood pressure. The remainder of the patients had normotension (11%), white coat hypertension (11%), prehypertension (10%), and pending diagnosis (3%). Among the 275 hypertensive children, 43% (n = 119; boys = 56%; median age = 12 years; range = 3-17 years) had essential hypertension and 57% (n = 156; boys = 66%; median age = 9 years; range = 0.08-19 years) had secondary hypertension. When compared with those with secondary hypertension, those with essential hypertension had a significantly older age at diagnosis (P = 0.0002), stronger family history of hypertension (94% vs. 68%; P secondary hypertension. The phenotype of essential hypertension can present as early as 3 years of age and is the predominant form of hypertension in children after age of 6 years. Among children with hypertension, those with essential hypertension present at an older age, have a stronger family history of hypertension, and have lower prevalence of preterm birth. © American Journal of Hypertension, Ltd 2014. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  12. Secondary control for microgrids using potential functions

    Energy Technology Data Exchange (ETDEWEB)

    Mehrizi-Sani, A.; Iravani, R. [Toronto Univ., ON (Canada)

    2009-07-01

    Issues with power grids include reliability, aging infrastructure, limited use of communications, efficiency, and low asset utilization. The smart grid involves a vision of the future electric system. Core elements of the smart grid include information technology, communication, and power electronic devices. This presentation discussed and compared the current grid with the smart grid and presented operational requirements of the microgrid. The concept of potential functions for secondary control based on availability of communication within the microgrid was introduced. The smart grid vision requires the microgrid to remain in operation even when islanded. The existing primary control does not guarantee stable islanded operation. Other topics that were discussed included primary and secondary control; proposed secondary control; the control hierarchy; and advantages and differences over conventional methods. A case study involving different scenarios was presented. It was concluded that the microgrid central controller minimizes each potential function to determine the set points of the corresponding distributed energy resources unit associated with the minimum of the potential function. tabs., figs.

  13. Upgrade of the Proton West secondary beamline

    International Nuclear Information System (INIS)

    Spiegel, L.

    1989-01-01

    As originally designed and operated, protons entering PW6 were steered by a series of EPB dipoles into a single interaction length beryllium target, some 43 feet from the enclosure wall. Ensuing secondary beams, either p + /π + or p - /π - , were collected by a string of quadrupoles following the target, steered westward, away from the Proton Center line, through PW6 and PW7, and ultimately focussed on experiment production targets located within the large PW8 hall. Around the Spring of 1988 it was decided to upgrade the existing Proton West secondary beamline to allow for transport of a primary proton beam, anticipated to be either 800 or 900 GeV/c, through PW8. This upgrade project, which is now nearing completion, was largely motivated by the then recent approval of E-771, a hadronic beauty production experiment located in PW8. E-771 represents the third in a series of experiments for the large-acceptance dimuon spectrometer presently located at the end of the Proton West beamline. This Technical Memo is a summary of the upgrade --- an explanation of the underlying strategy and a documentation of the final locations of the secondary beamline elements. 6 refs., 2 figs., 2 tabs

  14. Rhabdomyolysis Secondary to Clenbuterol Use and Exercise.

    Science.gov (United States)

    Grimmer, Nicole M; Gimbar, Renee Petzel; Bursua, Adam; Patel, Meet

    2016-02-01

    The literature regarding rhabdomyolysis secondary to illicit drug use is sparse. Clenbuterol is a bronchodilator approved for veterinary use, which in high doses can increase protein deposition and lipolysis similarly to anabolic steroids, and is thereby abused for bodybuilding and weight loss effects. Clenbuterol has previously been described in case reports to be cardiotoxic, with patient presentations similar to overdoses of sympathomimetic substances, but reports of rhabdomyolysis are limited to a single case series in horses. We report the first case of rhabdomyolysis secondary to clenbuterol in a human. Our patient used clenbuterol for muscle-building effects in addition to exercise for multiple days prior to presentation. The patient's chief complaint at Emergency Department (ED) presentation was discolored urine. Workup for rhabdomyolysis was initiated, and an initial creatine kinase was measured at 122,933 units/L. Our patient's rhabdomyolysis was successfully treated with supportive therapy, and the patient was eventually discharged to home with no identifiable disability. The patient's kidney function remained at baseline, and no acute kidney injury was experienced secondary to rhabdomyolysis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Patients presenting to the ED may have been unintentionally exposed through cutting of illicit substances or through intentional use in bodybuilding. Clenbuterol has well-described cardiotoxic effects, and we report the additional toxicity of rhabdomyolysis with its use. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Paricalcitol for secondary hyperparathyroidism in renal transplantation.

    Science.gov (United States)

    Trillini, Matias; Cortinovis, Monica; Ruggenenti, Piero; Reyes Loaeza, Jorge; Courville, Karen; Ferrer-Siles, Claudia; Prandini, Silvia; Gaspari, Flavio; Cannata, Antonio; Villa, Alessandro; Perna, Annalisa; Gotti, Eliana; Caruso, Maria Rosa; Martinetti, Davide; Remuzzi, Giuseppe; Perico, Norberto

    2015-05-01

    Secondary hyperparathyroidism contributes to post-transplant CKD mineral and bone disorder. Paricalcitol, a selective vitamin D receptor activator, decreased serum parathyroid hormone levels and proteinuria in patients with secondary hyperparathyroidism. This single-center, prospective, randomized, crossover, open-label study compared the effect of 6-month treatment with paricalcitol (1 μg/d for 3 months and then uptitrated to 2 µg/d if tolerated) or nonparicalcitol therapy on serum parathyroid hormone levels (primary outcome), mineral metabolism, and proteinuria in 43 consenting recipients of renal transplants with secondary hyperparathyroidism. Participants were randomized 1:1 according to a computer-generated sequence. Compared with baseline, median (interquartile range) serum parathyroid hormone levels significantly declined on paricalcitol from 115.6 (94.8-152.0) to 63.3 (52.0-79.7) pg/ml (Psecondary hyperparathyroidism. Long-term studies are needed to monitor directly measured GFR, ensure that the bone remodeling and mineral effects are sustained, and determine if the reduction in proteinuria improves renal and cardiovascular outcomes. Copyright © 2015 by the American Society of Nephrology.

  16. Secondary pipe rupture at Mihama unit 3

    International Nuclear Information System (INIS)

    Hajime Ito; Takehiko Sera

    2005-01-01

    The secondary system pipe rupture occurred on August 9, 2004, while Mihama unit 3 was operating at the rated thermal power. The rupture took place on the condensate line-A piping between the No.4 LP heater and the deaerator, downstream of an orifice used for measuring the condensate flux. The pipe is made of carbon steel, and normally has 558.8 mm diameter and 10 mm thickness. The pipe wall had thinned to 0.4 mm at the point of minimum thickness. It is estimated that the disturbed flow of water downstream of the orifice caused erosion/corrosion and developed wall thinning, leading to a rupture at the thinnest section under internal pressure, about 1MPa. Observation of the pipe internal surface revealed a scale-like pattern typical in this kind of phenomenon. Eleven workers who were preparing for an annual outage that was to start from August 14 suffered burn injuries, of who five died. Since around 1975, we, Kansai Electric, have been checking pipe wall thickness while focusing on the thinning of carbon steel piping in the secondary system. Summarizing the results from such investigation and reviewing the latest technical knowledge including operating experience from overseas utilities, we compiled the pipe thickness management guideline for PWR secondary pipes, 1990. The pipe section that ruptured at the Mihama unit 3 should have been included within the inspection scopes according to the guideline but was not registered on the inspection list. It had not been corrected for almost thirty years. As the result, this pipe section had not been inspected even once since the beginning of the plant operation, 1976. It seems that the quality assurance and maintenance management had not functioned well regarding the secondary system piping management, although we were responsible for the safety of nuclear power plants as licensee. We will review the secondary system inspection procedure and also improve the pipe thickness management guideline. And also, we would replace

  17. Secondary School Teachers' Knowledge Level of the Concepts of ...

    African Journals Online (AJOL)

    Secondary School Teachers' Knowledge Level of the Concepts of Environmental ... Huria: Journal of the Open University of Tanzania ... level of the certificate of secondary education geography teachers when teaching the concepts of ...

  18. Knowledge and Attitude of Secondary School Teachers towards ...

    African Journals Online (AJOL)

    Knowledge and Attitude of Secondary School Teachers towards Reproductive Health Education in Schools. ... PROMOTING ACCESS TO AFRICAN RESEARCH ... A study was carried out among secondary school teachers in Ilorin, Kwara ...

  19. The Implementation of the Creative Arts Curriculum in Secondary ...

    African Journals Online (AJOL)

    Nekky Umera

    An International Multi-Disciplinary Journal, Ethiopia. Vol. 3 (3), April, 2009 ... secondary school level, but at the senior secondary school level, they are optional. ... this study will redirect educational planners to effect positive changes in the.

  20. Laboratory Course on "Streptomyces" Genetics and Secondary Metabolism

    Science.gov (United States)

    Siitonen, Vilja; Räty, Kaj; Metsä-Ketelä, Mikko

    2016-01-01

    The "'Streptomyces' genetics and secondary metabolism" laboratory course gives an introduction to the versatile soil dwelling Gram-positive bacteria "Streptomyces" and their secondary metabolism. The course combines genetic modification of "Streptomyces"; growing of the strain and protoplast preparation, plasmid…

  1. Secondary cycle design considerations for reduction of reactor transients frequency

    International Nuclear Information System (INIS)

    Bevilacqua, L.; Leal, M.R.L.V.

    1980-01-01

    The secondary cycle systems should not be considered of secondary importance to the pressurized water reactor safety. The advanced design and analysis techniques used for components related to nuclear safety are suggested. (E.G.) [pt

  2. ESPA Based Secondary Payload Orbit Maneuvering System, Phase I

    Data.gov (United States)

    National Aeronautics and Space Administration — Busek Co. Inc. proposes to develop/design an integrated propulsion, power, ACS, and separation module for secondary ESPA payloads. The standardized secondary payload...

  3. Metabolomics methods for the synthetic biology of secondary metabolism

    NARCIS (Netherlands)

    Quoc-Thai Nguyen, [No Value; Merlo, Maria E.; Medema, Marnix H.; Jankevics, Andris; Breitling, Rainer; Takano, Eriko; Just, Wilhelm; Reiss, Thomas

    2012-01-01

    Many microbial secondary metabolites are of high biotechnological value for medicine, agriculture, and the food industry. Bacterial genome mining has revealed numerous novel secondary metabolite biosynthetic gene clusters, which encode the potential to synthesize a large diversity of compounds that

  4. refractive errors among secondary school students in Isuikwuato

    African Journals Online (AJOL)

    Eyamba

    STUDENTS IN ISUIKWUATO LOCAL GOVERNMENT AREA OF ... the prevalence and types of refractive errors among secondary school students ... KEYWORDS: Refractive error, Secondary School students, ametropia, .... interviews of the teachers as regards the general performance of those students with obvious visual.

  5. Reid on olfaction and secondary qualities

    Science.gov (United States)

    Quilty-Dunn, Jake

    2013-01-01

    Thomas Reid is one of the primary early expositors of the “dual-component” theory of perception, according to which conscious perception constitutively involves a non-intentional sensation accompanied by a noninferential perceptual belief. In this paper, I will explore Reid's account of olfactory perception, and of odor as a secondary quality. Reid is often taken to endorse a broadly Lockean picture of secondary qualities, according to which they are simply dispositions to cause sensations. This picture creates problems, however, for Reid's account of how we perceive secondary qualities, including odors. Given Reid's insistence that we come to be aware of odors only by inferring a causal relation to obtain between them and our olfactory sensations, it seems that he cannot allow for direct, noninferential perceptual awareness of odors. Since his general account of perception invokes noninferential perceptual beliefs to explain perceptual awareness, it seems that Reid must either reject this general account for the case of olfactory perception (and supplant it with something else), or else deny that we ever actually perceive odors. I will attempt to reconcile these ideas by appeal to Reid's doctrine of “acquired perception,” which involves the incorporation of learned conceptual representations into perceptual states via perceptual learning. Reidian acquired perception enables genuine olfactory perceptual acquaintance with odors despite the dependence of the semantic properties of the relevant representations on causal relations to sensations. In exploring these issues, I hope to illuminate several features of Reid's account of perception and demonstrate its interest to contemporary theorizing about conscious perception—especially olfaction—in the process. Reid's theory of olfaction remains a live, coherent option for present-day theorists. PMID:24399987

  6. Reid on Olfaction and Secondary Qualities

    Directory of Open Access Journals (Sweden)

    Jake eQuilty-Dunn

    2013-12-01

    Full Text Available Thomas Reid is one of the primary early expositors of the dual-component theory of perception, according to which conscious perception constitutively involves a non-intentional sensation accompanied by a noninferential perceptual belief. In this paper, I will explore Reid's account of olfactory perception, and of odor as a secondary quality. Reid is often taken to endorse a broadly Lockean picture of secondary qualities, according to which they are simply dispositions to cause sensations. This picture creates problems, however, for Reid's account of how we perceive secondary qualities, including odors. Given Reid's insistence that we come to be aware of odors only by inferring a causal relation to obtain between them and our olfactory sensations, it seems that he cannot allow for direct, noninferential perceptual awareness of odors. Since his general account of perception invokes noninferential perceptual beliefs to explain perceptual awareness, it seems that Reid must either reject this general account for the case of olfactory perception (and supplant it with something else, or else deny that we ever actually perceive odors.I will attempt to reconcile these ideas by appeal to Reid's doctrine of acquired perception, which involves the incorporation of learned conceptual representations into perceptual states via perceptual learning. Reidian acquired perception enables genuine olfactory perceptual acquaintance with odors despite the dependence of the semantic properties of the relevant representations on causal relations to sensations. In exploring these issues, I hope to illuminate several features of Reid's account of perception and demonstrate its interest to contemporary theorizing about conscious perception--especially olfaction--in the process. Reid’s theory of olfaction remains a live, coherent option for present-day theorists.

  7. Advances in ambient temperature secondary lithium cells

    Science.gov (United States)

    Subbarao, S.; Shen, D. H.; Deligiannis, F.; Huang, C-K.; Halpert, G.

    1989-01-01

    The Jet Propulsion Laboratory is involved in a Research and Development program sponsored by NASA/OAST on the development of ambient temperature secondary lithium cells for future space applications. Some of the projected applications are planetary spacecraft, planetary rovers, and astronaut equipment. The main objective is to develop secondary lithium cells with greater than 100 Wh/kg specific energy while delivering 1000 cycles at 50 percent Depth of Discharge (DOD). To realize these ambitious goals, the work was initially focused on several important basic issues related to the cell chemistry, selection of cathode materials and electrolytes, and component development. The performance potential of Li-TiS2, Li-MoS3, Li-V6O13 and Li-NbSe3 electrochemical systems was examined. Among these four, the Li-TiS2 system was found to be the most promising system in terms of realizable specific energy and cycle life. Some of the major advancements made so far in the development of Li-TiS2 cells are in the areas of cathode processing technology, mixed solvent electrolytes, and cell assembly. Methods were developed for the fabrication of large size high performance TiS2 cathodes. Among the various electrolytes examined, 1.5M LiAsF6/EC + 2-MeTHF mixed solvent electrolyte was found to be more stable towards lithium. Experimental cells activated with this electrolyte exhibited more than 300 cycles at 100 percent Depth of Discharge. Work is in progress in other areas such as selection of lithium alloys as candidate anode materials, optimization of cell design, and development of 5 Ah cells. The advances made at the Jet Propulsion Laboratory on the development of secondary lithium cells are summarized.

  8. Spitzer secondary eclipses of Qatar-1b

    Science.gov (United States)

    Garhart, Emily; Deming, Drake; Mandell, Avi; Knutson, Heather; Fortney, Jonathan J.

    2018-02-01

    Aims: Previous secondary eclipse observations of the hot Jupiter Qatar-1b in the Ks band suggest that it may have an unusually high day side temperature, indicative of minimal heat redistribution. There have also been indications that the orbit may be slightly eccentric, possibly forced by another planet in the system. We investigate the day side temperature and orbital eccentricity using secondary eclipse observations with Spitzer. Methods: We observed the secondary eclipse with Spitzer/IRAC in subarray mode, in both 3.6 and 4.5 μm wavelengths. We used pixel-level decorrelation to correct for Spitzer's intra-pixel sensitivity variations and thereby obtain accurate eclipse depths and central phases. Results: Our 3.6 μm eclipse depth is 0.149 ± 0.051% and the 4.5 μm depth is 0.273 ± 0.049%. Fitting a blackbody planet to our data and two recent Ks band eclipse depths indicates a brightness temperature of 1506 ± 71 K. Comparison to model atmospheres for the planet indicates that its degree of longitudinal heat redistribution is intermediate between fully uniform and day-side only. The day side temperature of the planet is unlikely to be as high (1885 K) as indicated by the ground-based eclipses in the Ks band, unless the planet's emergent spectrum deviates strongly from model atmosphere predictions. The average central phase for our Spitzer eclipses is 0.4984 ± 0.0017, yielding e cos ω = -0.0028 ± 0.0027. Our results are consistent with a circular orbit, and we constrain e cos ω much more strongly than has been possible with previous observations. Tables of the lightcurve data are only available at the CDS via anonymous ftp to http://cdsarc.u-strasbg.fr (http://130.79.128.5) or via http://cdsarc.u-strasbg.fr/viz-bin/qcat?J/A+A/610/A55

  9. Otorhinolaryngology manifestations secondary to oral sex.

    Science.gov (United States)

    Fernández-López, Claudia; Morales-Angulo, Carmelo

    Over the last few years, oral and pharyngeal signs and symptoms due to oral sex have increased significantly. However, no review articles related to this subject have been found in the medical literature. The objective of our study was to identify otorhinolaryngological manifestations associated with orogenital/oroanal contact, both in adults and children, in the context of consensual sex or sexual abuse. We performed a review of the medical literature on otorhinolaryngological pathology associated with oral sex published in the last 20 years in the PubMed database. Otorhinolaryngological manifestations secondary to oral sex practice in adults can be infectious, tumoral or secondary to trauma. The more common signs and symptoms found in the literature were human papillomavirus infection (above all, condyloma acuminata and papilloma/condyloma), oral or pharyngeal syphilis, gonococcal pharyngitis, herpes simplex virus infection and pharyngitis from Chlamydia trachomatis. The incidence of human papillomavirus -induced oropharyngeal carcinoma has dramatically increased. In children past the neonatal period, the presence of condyloma acuminatus, syphilis, gonorrhoea or palatal ecchymosis (the last one, unless justified by other causes) should make us suspect sexual abuse. Sexual habits have changed in the last decades, resulting in the appearance of otorhinolaryngological pathology that was rarely seen previously. For this reason, it is important for primary care physicians to have knowledge about the subject to perform correct diagnosis and posterior treatment. Some sexual abuse cases in children may also be suspected based on the knowledge of the characteristic oropharyngeal manifestations secondary to them. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

  10. Scintigraphy of parathyroids in secondary hyperparathyroidism

    International Nuclear Information System (INIS)

    Hublo, D.; Beauchat, V.; Pattou, F.; Lecomte-Houcke, M.; Prangere, T.; Ziegels, P.; Carnaille, B.; Proye, C.; Marchandise, X.; Steiling, M.

    1997-01-01

    Use of pre-surgery imaging of parathyroids is still questioned. The goal of this study is to evaluate the sensitivity of the scintigraphy in the detection of secondary parathyroid anomalies with renal insufficiency. Thirty two patients (20 F, 12 M) of 14 - 74 years old were operated of secondary hyperparathyroidism with renal insufficiency. It was a matter of re-intervention in 9 cases. The acquisitions were achieved 20 min and 2 h after injection of 550 MBq of MIBI- 99m Tc or of Tetrofosmine - 99m Tc and 2 h after injection of 5.5 MBq of iodine 123. Eighty seven glands of 28 to 3820 mg were pulled out in 23 first surgeries while the parathyroid tissue was found in thymic prolongations in 5 of these patients. The masses of 41 glands, positive by scintigraphy (from 69 to 3829 mg), were significantly higher (Wilcoxon's test, p -8 ) than the 46 not-seen (from 28 to 1050 mg). The sensitivity of total detection is 47%, of 85% for the 33 glands of 500 mg or more and of 24% for the 54 glands of less than 500 mg. In 9 re-interventions, 12 abnormal glands were pulled out: 11 (of 430 to 4500 mg were positive by scintigraphy, while only one gland of 80 mg was not seen. In conclusion, the scintigraphy realised before first surgery for secondary hyperparathyroidism with renal insufficiency presents low sensitivity, related partly, at least, to the low mass of glands and justifies itself only by search for positive ectopic parathyroids. Instead, it appears performing and indispensable in case of re-intervention

  11. Ichthyosiform scaling secondary to megavoltage radiotherapy

    International Nuclear Information System (INIS)

    Ross, E.V.

    1991-01-01

    Acquired ichthyosis is a rare dermatosis associated with a number of malignancies. Side effects seen on the skin secondary to megavoltage radiotherapy are uncommon but may include fine dry desquamation and tanning. The authors present a case of ichthyosiform scaling limited to the radiation fields in a patient treated for brain metastases of a primary small cell lung carcinoma. The reader is reminded that side effects of megavoltage treatment do occur on the skin. A brief review of these effects is included. 5 references

  12. Aspects of quantitative secondary ion mass spectrometry

    International Nuclear Information System (INIS)

    Grauer, R.

    1982-05-01

    Parameters which have an influence on the formation of secondary ions by ion bombardment of a solid matrix are discussed. Quantitative SIMS-analysis with the help of calibration standards necessitates a stringent control of these parameters. This is particularly valid for the oxygen partial pressure which for metal analysis has to be maintained constant also under ultra high vacuum. The performance of the theoretical LTE-model (Local Thermal Equilibrium) using internal standards will be compared with the analysis with the help of external standards. The LTE-model does not satisfy the requirements for quantitative analysis. (Auth.)

  13. Depth resolution of secondary ion mass spectrometry

    International Nuclear Information System (INIS)

    Pustovit, A.N.

    2004-01-01

    The effect of the solid body discreteness in the direction of the normal to the sample surface on the depth resolution of the secondary ion mass spectrometry method is analyzed. It is shown that for this case the dependence of the width at the semi-height of the delta profiles of the studied elements depth distribution on the energy and angle of incidence of the initial ions should have the form of the stepwise function. This is experimentally proved by the silicon-germanium delta-layers in the silicon samples [ru

  14. Secondary biogeneous radiation of human organism

    International Nuclear Information System (INIS)

    Kuzin, A.M.; Surkenova, G.N.

    1999-01-01

    When studying samples of three types of tissues of alive healthy human organism (hands, surface of breast, hair) it is shown that hair permanently emit secondary biogeneous radiation (SBR) which may registered with biological detectors. The hypothesis is suggested that natural background radiation permanently exciting biopolymers (proteins, nuclei acids) being present in alive organism in condensed state induces permanently present electromagnetic field of SBR which is vitally important for human organism. The field partly extends beyond the organism, where it is registered with sensitive biological detectors [ru

  15. Pulmonary arterial hypertension secondary to chronic thromboemboli

    International Nuclear Information System (INIS)

    Crysikopoulos, H.; Forrest, J.V.; Olson, L.K.; Roberts, A.C.

    1989-01-01

    The authors report their experience in 150 patients with pulmonary arterial hypertension secondary to chronic pulmonary embolism (CPE). Plain film findings are variable, commonly nonspecific. Occasionally nonuniformity of pulmonary perfusion or truncation of central pulmonary arteries suggest CPE. Multiple, large, unmatched perfusion defects are the most common scintigraphic observations. CT can exclude conditions mimicking CPE, particularly fibrosing mediastinitis. Pulmonary arteriography depicts the location and distribution of emboli. CPE is becoming an increasingly important entity to recognize because of available surgical treatment. Thromboendarterectomy may improve functional status and survival. The diagnosis should be considered in any patient with pulmonary arterial hypertension

  16. Structure elucidation of secondary natural products

    International Nuclear Information System (INIS)

    Seger, C.

    2001-06-01

    The presented thesis deals with the structure elucidation of secondary natural products. Most of the compounds under investigation were terpenes, especially triterpenes, alkaloids and stilbenoids. Besides characterizing a multitude of already known and also new compounds, it was possible to detect and correct wrongly assigned literature data. The methodological aspect of this thesis lies - beside in the utilization of modern 2D NMR spectroscopy - in the evaluation of computer assisted structure elucidation (CASE) techniques in the course of spectroscopy supported structure elucidation processes. (author)

  17. Fahr’s Syndrome and Secondary Hypoparathyroidism

    Directory of Open Access Journals (Sweden)

    Santos Vitorino Modesto dos

    2016-03-01

    Full Text Available A typical case of Fahr’s syndrome is described in a 76-year-old Brazilian female who underwent a total thyroidectomy three decades ago. Six years before the current admission, she started with generalized tonic-clonic seizures. Associated disorders involved extra-pyramidal, cognitive, nocturnal terror and mood changes. With suspicion of hypocalcemia due to secondary hypoparathyroidism, laboratory determinations confirmed the diagnoses. Furthermore, imaging studies of the central nervous system detected multiple calcifications, with characteristic distribution of Fahr’s syndrome. Clinical management was successful.

  18. Multicultural Upper Secondary School Life in Denmark

    DEFF Research Database (Denmark)

    Mørck, Yvonne

    2007-01-01

    Education has played an important role in the development of the Nordic welfare states. As in other European countries, present day Denmark wrestles with the problem of finding ways to handle the increased diversity of its population in terms of, for instance, ethnicity, religion and language...... secondary school as a micro-sociological laboratory of the multicultural processes and developments taking place in society at large. It is recommended to reflect upon and implement different strategies that could support a ‘citizenship education' which is needed in order to advance the cohesion...

  19. Bilateral pneumothoraces secondary to acupuncture therapy.

    Science.gov (United States)

    Nguyen, Theresa M; Roy, Neil K; Zlupko, George R

    2011-09-01

    Acupuncture is becoming increasingly popular in the United States for a wide variety of uses, ranging from the treatment of chronic back pain to aiding in addiction therapy. As this form of complementary and alternative medicine becomes more prevalent in certain areas of the country, it is of paramount importance that the emergency physician be familiar with its methods and potential complications. In general, acupuncture is perceived as fairly safe. However, it is not without risks or side effects. In this case report, we discuss the history, methods, and common complications of acupuncture in the context of a patient who presented to the Emergency Department (ED) with bilateral pneumothoraces secondary to acupuncture therapy.

  20. Intestinal lymphangiectasia secondary to radiotherapy and chemotherapy

    International Nuclear Information System (INIS)

    Rao, S.S.; Dundas, S.; Holdsworth, C.D.

    1987-01-01

    We report a case of intestinal lymphangiectasia secondary to radiotherapy and chemotherapy. The patient also had small bowel bacterial overgrowth and pancreatic insufficiency. Lymphatic ectasia as a histological feature has been described previously in association with postradiotherapy malabsorption, but radiation-induced lymphangiectasia producing clinical manifestations has hitherto not been reported. Replacement of dietary long-chain fats with medium-chain triglycerides, pancreatic enzyme supplements, and a short course of oxytetracycline, resulted in dramatic clinical improvement. The possibility of intestinal lymphangiectasia should be borne in mind in patients with postradiotherapy malabsorption. A low serum albumin and lymphocyte count should draw attention to this possibility

  1. Neurological presentations of a secondary antiphospholipid syndrome

    Directory of Open Access Journals (Sweden)

    Yesaulenko I.E.

    2017-03-01

    Full Text Available The aim of the study is to turn the attention of specialists to antiphospholipid syndrome (APS, which is of interest to physicians of many specialties. The observation of the patient W., 32 years, with secondary APS was analyzed. Poor prognostic factors in CFA are the high frequency of thrombotic complications and thrombocytopenia, and laboratory markers — the presence of lupus anticoagulant. All patients with APS should be under medical supervision, whose main task is to assess the risk of recurrence of venous or arterial thrombosis and its prevention.

  2. PWR secondary water chemistry diagnostic system

    International Nuclear Information System (INIS)

    Miyazaki, S.; Hattori, T.; Yamauchi, S.; Kato, A.; Suganuma, S.; Yoshikawa, T.

    1989-01-01

    Water chemistry control is one of the most important tasks in order to maintain the reliability of plant equipments and extend operating life of the plant. We developed an advanced water chemistry management system which is able to monitor and diagnose secondary water chemistry. A prototype system had been installed at one plant in Japan since Nov. 1986 in order to evaluate system performance and man-machine interface. The diagnosis system has been successfully tested off line using synthesized plant data for various cases. We are continuing to improve the applicability and develop new technology which make it evaluate steam generator crevice chemistry. (author)

  3. Predicting Protein Secondary Structure with Markov Models

    DEFF Research Database (Denmark)

    Fischer, Paul; Larsen, Simon; Thomsen, Claus

    2004-01-01

    we are considering here, is to predict the secondary structure from the primary one. To this end we train a Markov model on training data and then use it to classify parts of unknown protein sequences as sheets, helices or coils. We show how to exploit the directional information contained...... in the Markov model for this task. Classifications that are purely based on statistical models might not always be biologically meaningful. We present combinatorial methods to incorporate biological background knowledge to enhance the prediction performance....

  4. Secondary Intracranial Hypotension: A Case Report

    Directory of Open Access Journals (Sweden)

    Pinar Gundogan Bozdag

    2014-04-01

    Full Text Available Intracranial hypotension is a clinical condition that characterized by postural (orthostatic headache and low pressure. It apperas with cerebrospinal fluid leak which occurs spontaneous or depending on the secondary attempts. 31 years old female patient which has diagnosis of acute appendicitis and underwent appendectomy under spinal anesthesia. postoperative 5.day she admitted with a postural headache, diplopia. Patient was treated with conservative methods after diagnosed with magnetic resonance imaging. We aim to asses an encountered complication after spinal anesthesia which widely applied for surgical procedures with imaging findings and literature.

  5. 340 Facility secondary containment and leak detection

    International Nuclear Information System (INIS)

    Bendixsen, R.B.

    1995-01-01

    This document presents a preliminary safety evaluation for the 340 Facility Secondary Containment and Leak Containment system, Project W-302. Project W-302 will construct Building 340-C which has been designed to replace the current 340 Building and vault tank system for collection of liquid wastes from the Pacific Northwest Laboratory buildings in the 300 Area. This new nuclear facility is Hazard Category 3. The vault tank and related monitoring and control equipment are Safety Class 2 with the remainder of the structure, systems and components as Safety Class 3 or 4

  6. Myelopathy secondary to cerebral and spinal neurocysticercosis

    Directory of Open Access Journals (Sweden)

    Carlos Huaraca-Hilario

    2016-02-01

    Full Text Available Neurocysticercosis is the most common CNS parasitic disease but spinal presentation of this condition is rare, with a higher incidence in developing countries like ours. We report the case of a male patient 61 of age diagnosed with generalized neurocysticercosis in addition to the secondary presentation of hypertensive hydrocephalus and compression of the spinal cord, the latter is characterized by the appearance of paraparesis, changes in sensitivity and urinary retention. The final diagnosis was made by an MRI, so we have to emphasize the importance of neuroimaging in the definitive diagnosis of this disease.

  7. Senior Secondary School Children's Understanding of Plant Nutrition

    Science.gov (United States)

    Mosothwane, Modise

    2011-01-01

    The purpose of this study was to assess children's understanding of plant nutrition. The research was done on a sample of secondary school pupils in the age range of 16 to 19 years in two senior secondary schools in Botswana. The sample contained 137 senior secondary pupils all in their final year of study. These children were above average…

  8. Mineralogy and heavy metal content of secondary mineral salts: A ...

    African Journals Online (AJOL)

    Secondary minerals associated with acid mine drainage play an important role in metal cycling and may pose a geochemical hazard. The occurrence of secondary minerals indicates prevailing and past geochemical conditions. Detecting and characterising secondary minerals is necessary to the planning of remediation ...

  9. Design of the GOES Telescope secondary mirror mounting

    Science.gov (United States)

    Hookman, Robert A.

    1989-01-01

    The GOES Telescope utilizes a flexure mounting system for the secondary mirror to minimize thermally induced distortions of the secondary mirror. The detailed design is presented along with a discussion of the microradian pointing requirements and how they were achieved. The methodology used to dynamically tune the flexure/secondary mirror assembly to minimize structural interactions will also be discussed.

  10. 40 CFR 133.105 - Treatment equivalent to secondary treatment.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 21 2010-07-01 2010-07-01 false Treatment equivalent to secondary treatment. 133.105 Section 133.105 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS SECONDARY TREATMENT REGULATION § 133.105 Treatment equivalent to secondary treatment...

  11. Impact of Cooperative Learning Approach on Senior Secondary ...

    African Journals Online (AJOL)

    This research work investigated the impact of cooperative learning approach on the performance of secondary school students in mathematics using some selected secondary schools. It employed one hundred and twenty students selected from the entire population of students offering mathematics at the senior secondary ...

  12. The Implementation of the Creative Arts Curriculum in Secondary ...

    African Journals Online (AJOL)

    This paper focuses on the status of the implementation of the creative arts curriculum at the secondary school level. The New National Policy on Education recognized the creative Arts as core subjects at the junior secondary school level, but at the senior secondary school level, they are optional. With very good laid down ...

  13. Noise in secondary electron emission: the low yield case

    Czech Academy of Sciences Publication Activity Database

    Frank, Luděk

    2005-01-01

    Roč. 54, č. 4 (2005), s. 361-365 ISSN 0022-0744 R&D Projects: GA AV ČR(CZ) IAA1065304 Keywords : secondary electrons * noise * SEM image noise * secondary emission noise * statistics of secondary electrons * non-Poisson factor Subject RIV: BM - Solid Matter Physics ; Magnetism Impact factor: 0.720, year: 2005

  14. Teaching Chemistry in Secondary Schools: A Case for Cooperative ...

    African Journals Online (AJOL)

    The study investigated the relative effectiveness of cooperative instructional strategy on students' performance in secondary school chemistry. Two hundred and fifty (250) Senior Secondary two (SS II) chemistry students were purposively sampled from three public secondary schools in Ilesa Local Government Area of Osun ...

  15. The Development of a Secondary School Health Assessment Model

    Science.gov (United States)

    Sriring, Srinual; Erawan, Prawit; Sriwarom, Monoon

    2015-01-01

    The objective of this research was to: 1) involved a survey of information relating to secondary school health, 2) involved the construction of a model of health assessment and a handbook for using the model in secondary school, 3) develop an assessment model for secondary school. The research included 3 phases. (1) involved a survey of…

  16. 7 CFR 930.57 - Secondary inventory reserve.

    Science.gov (United States)

    2010-01-01

    ... shall retain control over the release of any cherries from the secondary inventory reserve. No cherries... 7 Agriculture 8 2010-01-01 2010-01-01 false Secondary inventory reserve. 930.57 Section 930.57... Handling Regulations § 930.57 Secondary inventory reserve. (a) In the event the inventory reserve...

  17. 13 CFR 120.613 - Secondary Participation Guarantee Agreement.

    Science.gov (United States)

    2010-01-01

    ... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Secondary Participation Guarantee Agreement. 120.613 Section 120.613 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION BUSINESS LOANS Secondary Market Certificates § 120.613 Secondary Participation Guarantee Agreement. When a Lender...

  18. Under-Representation in Nationally Representative Secondary Data

    Science.gov (United States)

    Frederick, Karen; Barnard-Brak, Lucy; Sulak, Tracey

    2012-01-01

    There has been a significant increase in the use of secondary data sets. Many such data sets purport to be nationally representative. Secondary data sets include research commissioned by the National Center for Education Statistics, the Centers for Disease Control, and other public entities. Research increasingly utilizes these secondary data in…

  19. Idiopathic Oesophageal Dysmotility Disorder: Stridor Secondary to Megaesophagus

    Directory of Open Access Journals (Sweden)

    B. G. Natesh

    2013-01-01

    Full Text Available We present an interesting case of an elderly lady who presented with stridor caused by megaesophagus secondary to an acquired idiopathic dysmotility disorder. We discuss the aetiology and management of megaesophagus secondary to this condition and how it differs from megaesophagus secondary to achalasia.

  20. An Assessment of the Spatial Distribution of Government Secondary ...

    African Journals Online (AJOL)

    It reveals that the spatial distribution of Government Owned Secondary Schools in Zaria area is very uneven. The paper argues that uneven distribution of Government Owned Secondary education facilities as well as their inadequacy and inefficiency encourage the proliferation of Private Owned Secondary Schools (POSS) ...

  1. The evolution of development of vascular cambia and secondary growth

    Science.gov (United States)

    Andrew Groover; Rachel Spicer

    2010-01-01

    Secondary growth from vascular cambia results in radial, woody growth of stems. The innovation of secondary vascular development during plant evolution allowed the production of novel plant forms ranging from massive forest trees to flexible, woody lianas. We present examples of the extensive phylogenetic variation in secondary vascular growth and discuss current...

  2. Identifying secondary series for stepwise common singular spectrum ...

    African Journals Online (AJOL)

    Abstract. Common singular spectrum analysis is a technique which can be used to forecast a pri- mary time series by using the information from a secondary series. Not all secondary series, however, provide useful information. A first contribution in this paper is to point out the properties which a secondary series should ...

  3. Secondary electron emission studied by secondary electron energy loss coincidence spectroscopy (SE2ELCS)

    International Nuclear Information System (INIS)

    Khalid, R.

    2013-01-01

    Emission of secondary electrons is of importance in many branches of fundamental and applied science. It is widely applied in the electron microscope for the investigation of the structure and electronic state of solid surfaces and particle detection in electron multiplier devices, and generally it is related to the energy dissipation of energetic particles moving inside a solid. The process of secondary electron emission is a complex physical phenomenon, difficult to measure experimentally and treat theoretically with satisfactory accuracy. The secondary electron spectrum measured with single electron spectroscopy does not provide detailed information of the energy loss processes responsible for the emission of secondary electrons. This information can be accessed when two correlated electron pairs are measured in coincidence and the pair consists of a backscattered electron after a given energy loss and a resulting emitted secondary electron. To investigate the mechanisms responsible for the emission of secondary electrons, a reflection (e,2e) coincidence spectrometer named Secondary Electron Electron Energy Loss Coincidence Spectrometer (SE2ELCS) has been developed in the framework of this thesis which allows one to uncover the relation between the features in the spectra which are due to energy losses and true secondary electron emission structures. The correlated electron pairs are measured with a hemispherical mirror analyzer (HMA) and a time of flight analyzer (TOF) by employing a continuous electron beam. An effort has been made to increase the coincidence count rate by increasing the effective solid angle of the TOF analyzer and optimizing the experimental parameters to get optimum energy resolution. Double differential coincidence spectra for a number of materials namely, nearly free electron metals (Al, Si), noble metals (Ag, Au, Cu, W) and highly oriented pyrolytic graphite (HOPG) have been measured using this coincidence spectrometer. The

  4. Obesity among secondary school students in Bahrain.

    Science.gov (United States)

    Musaiger, A O; Matter, A M; Alekri, S A; Mahdi, A R

    1993-01-01

    The aim of this study is to estimate the prevalence of obesity and factors associated with it in Bahraini secondary school students. A cross-sectional study involving a sample of 825 students (417 boys and 408 girls) aged 15 to 21 years was obtained from secondary schools. Obesity was determined using body mass index (BMI = Wt/Ht2). The findings revealed that 15.6% of boys and 17.4% of girls were either overweight or obese (BMI > or = 25). Family size, parents education, and family history of obesity were significantly associated with obesity among boys, while family history was the only socio-economic factors statistically associated with obesity among girls. Meal patterns such as eating between meals, number of meals per day, and method of eating were not associated with obesity in students. Boys who ate alone were 3 times more likely to be obese than those who ate with family members (odd ratio = 3.4). Measures to prevent and control obesity among children are suggested.

  5. Thermal performance of the ATST secondary mirror

    Science.gov (United States)

    Cho, Myung K.; DeVries, Joe; Hansen, Eric

    2007-12-01

    The Advanced Technology Solar Telescope (ATST) has a 4.24m off-axis primary mirror designed to deliver diffractionlimited images of the sun. Its baseline secondary mirror (M2) design uses a 0.65m diameter Silicon Carbide mirror mounted kinematically by a bi-pod flexure mechanism at three equally spaced locations. Unlike other common telescopes, the ATST M2 is to be exposed to a significant solar heat loading. A thermal management system (TMS) will be developed to accommodate the solar loading and minimize "mirror seeing effect" by controlling the temperature difference between the M2 optical surface and the ambient air at the site. Thermo-elastic analyses for steady state thermal behaviors of the ATST secondary mirror was performed using finite element analysis by I-DEAS TM and PCRINGE TM for the optical analysis. We examined extensive heat transfer simulation cases and their results were discussed. The goal of this study is to establish thermal models by I-DEAS for an adequate thermal environment. These thermal models will be useful for estimating segment thermal responses. Current study assumes a few sample time dependent thermal loadings to synthesize the operational environment.

  6. Performance evaluations of the ATST secondary mirror

    Science.gov (United States)

    Cho, Myung K.; DeVries, Joseph; Hansen, Eric

    2007-09-01

    The Advanced Technology Solar Telescope (ATST) has a 4.24m off-axis primary mirror designed to deliver diffraction-limited images of the sun. Its baseline secondary mirror (M2) design uses a 0.65m diameter Silicon Carbide mirror mounted kinematically by a bi-pod flexure mechanism at three equally spaced locations. Unlike other common telescopes, the ATST M2 is to be exposed to a significant solar heat loading. A thermal management system will be developed to accommodate the solar loading and minimize "mirror seeing effect" by controlling the temperature difference between the M2 optical surface and the ambient air at the site. Thermo-elastic analyses for steady state thermal behaviors of the ATST secondary mirror was performed using finite element analysis by I-DEAS TM and PCFRINGE TM for the optical analysis. We examined extensive heat transfer simulation cases and their results are discussed. The goal of this study is to evaluate the optical performances of M2 using thermal models and mechanical models. Thermal responses from the models enable us to manipulate time dependent thermal loadings to synthesize the operational environment for the design and development of TMS.

  7. An Inclusive Secondary School in Bratislava

    Directory of Open Access Journals (Sweden)

    Gajdošová Eva

    2016-12-01

    Full Text Available The study presents a characterization of an inclusive secondary school in Bratislava and provides information about the forms and methods used in the work of the teachers, school psychologists, special teachers with regard to students with special needs (students with Attention and Hyperactivity Disorder, i.e. ADHD, with learning difficulties, with emotional and behaviour difficulties, etc., who are educated together with mainstream students. It also provides information on the first results of the measurements of the socio-emotional health of the students in the inclusive school, both as to its overall level (covitality index and as to the level of the four psychological dimensions of mental health. The pilot project of the inclusive school confirms that inclusive secondary schools and inclusive education operating within the intentions of positive psychology help the students to develop their cognitive and socio-emotional competences, to create favourable attitudes to diversity, to form the students’ scale of positive values and to encourage positive interpersonal relationships, social cohesion and social classroom climate.

  8. Artificial engineering of secondary lymphoid organs.

    Science.gov (United States)

    Tan, Jonathan K H; Watanabe, Takeshi

    2010-01-01

    Secondary lymphoid organs such as spleen and lymph nodes are highly organized immune structures essential for the initiation of immune responses. They display distinct B cell and T cell compartments associated with specific stromal follicular dendritic cells and fibroblastic reticular cells, respectively. Interweaved through the parenchyma is a conduit system that distributes small antigens and chemokines directly to B and T cell zones. While most structural aspects between lymph nodes and spleen are common, the entry of lymphocytes, antigen-presenting cells, and antigen into lymphoid tissues is regulated differently, reflecting the specialized functions of each organ in filtering either lymph or blood. The overall organization of lymphoid tissue is vital for effective antigen screening and recognition, and is a feature which artificially constructed lymphoid organoids endeavor to replicate. Synthesis of artificial lymphoid tissues is an emerging field that aims to provide therapeutic application for the treatment of severe infection, cancer, and age-related involution of secondary lymphoid tissues. The development of murine artificial lymphoid tissues has benefited greatly from an understanding of organogenesis of lymphoid organs, which has delineated cellular and molecular elements essential for the recruitment and organization of lymphocytes into lymphoid structures. Here, the field of artificial lymphoid tissue engineering is considered including elements of lymphoid structure and development relevant to organoid synthesis. (c) 2010 Elsevier Inc. All rights reserved.

  9. Innate lymphoid cells in secondary lymphoid organs.

    Science.gov (United States)

    Bar-Ephraïm, Yotam E; Mebius, Reina E

    2016-05-01

    The family of innate lymphoid cells (ILCs) has attracted attention in recent years as its members are important regulators of immunity, while they can also cause pathology. In both mouse and man, ILCs were initially discovered in developing lymph nodes as lymphoid tissue inducer (LTi) cells. These cells form the prototypic members of the ILC family and play a central role in the formation of secondary lymphoid organs (SLOs). In the absence of LTi cells, lymph nodes (LN) and Peyer's Patches (PP) fail to form in mice, although the splenic white pulp can develop normally. Besides LTi cells, the ILC family encompasses helper-like ILCs with functional distinctions as seen by T-helper cells, as well as cytotoxic natural killer (NK) cells. ILCs are still present in adult SLOs where they have been shown to play a role in lymphoid tissue regeneration. Furthermore, ILCs were implicated to interact with adaptive lymphocytes and influence the adaptive immune response. Here, we review the recent literature on the role of ILCs in secondary lymphoid tissue from the formation of SLOs to mature SLOs in adults, during homeostasis and pathology. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  10. Primary and secondary prevention of breast cancer.

    Science.gov (United States)

    Kolak, Agnieszka; Kamińska, Marzena; Sygit, Katarzyna; Budny, Agnieszka; Surdyka, Dariusz; Kukiełka-Budny, Bożena; Burdan, Franciszek

    2017-12-23

    Breast cancer is the most common cancer among women and is the second cancer frequently occurring worldwide of newly-diagnosed cancers. There is much evidence showing the influence of life style and environmental factors on the development of mammary gland cancer (high-fat diet, alcohol consumption, lack of physical exercise), the elimination of which (primary prevention) may contribute to a decrease in morbidity and mortality. Secondary prevention, comprising diagnostic tests (e.g. mammography, ultrasonography, magnetic resonance imaging, breast self-examination, as well as modern and more precise imaging methods) help the early detection of tumours or lesions predisposing to tumours. The aim of this study paper is to review current knowledge and reports regarding primary and secondary prevention of breast cancer. It is estimated that nearly 70% of malign tumours are caused by environmental factors, whereas in breast cancer this percentage reaches 90-95%. There are national programmes established in many countries to fight cancer, where both types of prevention are stressed as serving to decrease morbidity and mortality due to cancers. Cancer prevention is currently playing a key role in the fight against the disease. Behaviour modification, as well as greater awareness among women regarding breast cancer, may significantly contribute towards reducing the incidence of this cancer. Another important aspect is the number of women undergoing diagnostic tests, which still remains at an unsatisfactory level.

  11. Secondary isocurvature perturbations from acoustic reheating

    Science.gov (United States)

    Ota, Atsuhisa; Yamaguchi, Masahide

    2018-06-01

    The superhorizon (iso)curvature perturbations are conserved if the following conditions are satisfied: (i) (each) non adiabatic pressure perturbation is zero, (ii) the gradient terms are ignored, that is, at the leading order of the gradient expansion (iii) (each) total energy momentum tensor is conserved. We consider the case with the violation of the last two requirements and discuss the generation of secondary isocurvature perturbations during the late time universe. Second order gradient terms are not necessarily ignored even if we are interested in the long wavelength modes because of the convolutions which may pick products of short wavelength perturbations up. We then introduce second order conserved quantities on superhorizon scales under the conditions (i) and (iii) even in the presence of the gradient terms by employing the full second order cosmological perturbation theory. We also discuss the violation of the condition (iii), that is, the energy momentum tensor is conserved for the total system but not for each component fluid. As an example, we explicitly evaluate second order heat conduction between baryons and photons due to the weak Compton scattering, which dominates during the period just before recombination. We show that such secondary effects can be recast into the isocurvature perturbations on superhorizon scales if the local type primordial non Gaussianity exists a priori.

  12. Secondary abdominal appendicular pregnancy: Case report

    Directory of Open Access Journals (Sweden)

    Rosso Mićo

    2014-01-01

    Full Text Available Introduction. The case report describes a 29-year-old nulliparous woman that was admitted at the Department of Gynecology and Obstetrics of the Clinical Hospital Osijek complaining of mild abdominal pain without vaginal discharge. Case Outline. The patient’s menstrual cycle was irregular, from 30-45 days. An ultrasound examination showed suspicion of an ectopic pregnancy with a βHCG level of 1358 IU/L. Due to the presence of liquid in the pouch of Douglas the patient underwent emergency laparoscopy, which showed the presence of tumor mass between the right Fallopian tube and the appendix. These two structures associated with adhesions corresponded to secondary implantation after spontaneous tubal abortion which was confirmed by histopathologic analysis. Conclusion. Laparoscopy has emerged as the “gold standard” in the diagnosis and treatment of ectopic pregnancy, in this case the secondary abdominal pregnancy. From the diagnostic point of view, all women of reproductive age should be considered pregnant until proven otherwise, also keeping in mind that ectopic pregnancies can have different locations and many clinical features.

  13. RNA secondary structure prediction using soft computing.

    Science.gov (United States)

    Ray, Shubhra Sankar; Pal, Sankar K

    2013-01-01

    Prediction of RNA structure is invaluable in creating new drugs and understanding genetic diseases. Several deterministic algorithms and soft computing-based techniques have been developed for more than a decade to determine the structure from a known RNA sequence. Soft computing gained importance with the need to get approximate solutions for RNA sequences by considering the issues related with kinetic effects, cotranscriptional folding, and estimation of certain energy parameters. A brief description of some of the soft computing-based techniques, developed for RNA secondary structure prediction, is presented along with their relevance. The basic concepts of RNA and its different structural elements like helix, bulge, hairpin loop, internal loop, and multiloop are described. These are followed by different methodologies, employing genetic algorithms, artificial neural networks, and fuzzy logic. The role of various metaheuristics, like simulated annealing, particle swarm optimization, ant colony optimization, and tabu search is also discussed. A relative comparison among different techniques, in predicting 12 known RNA secondary structures, is presented, as an example. Future challenging issues are then mentioned.

  14. Advances in pharmacotherapy for secondary hyperparathyroidism.

    Science.gov (United States)

    Rodríguez, Mariano; Rodríguez-Ortiz, María E

    2015-01-01

    Secondary hyperparathyroidism is a frequent complication of chronic kidney disease. This review will discuss the various therapeutic options available for the management of hyperparathyroidism. The main therapeutic strategies available to prevent or slow down the progression of hyperparathyroidism will be detailed here. Reductions in phosphatemia may be achieved by controlling dietary phosphorus, administering phosphorus binders, or increasing the frequency of dialysis sessions. Vitamin D sterols reduce parathyroid hormone (PTH) secretion while normalizing calcium (Ca) and vitamin D levels. Calcimimetics decrease PTH levels, probably with an additional effect on hyperplasia. Percutaneous injections in parathyroids represent an option useful in cases of hyperparathyroidism resistant to pharmacological therapy. Pubmed was searched by combining the terms 'secondary hyperparathyroidism' and the name of each one of the drugs reported in this review. PTH increases from early stages of renal disease. One of the goals in pre-dialysis is the prevention of hyperphosphatemia and the maintenance of Ca levels in the normal range. The management of hyperparathyroidism in dialysis requires control of phosphorus level. In this stage, the decision to use calcimimetics and vitamin D derivatives should be made according to serum levels of Ca and phosphorus.

  15. Crisis Management for Secondary Education: A Survey of Secondary Education Directors in Greece

    Science.gov (United States)

    Savelides, Socrates; Mihiotis, Athanassios; Koutsoukis, Nikitas-Spiros

    2015-01-01

    Purpose: The Greek secondary education system lacks a formal crisis management system. The purpose of this paper is to address this problem as follows: elicit current crisis management practices, outline features for designing a formal crisis management system in Greece. Design/methodology/approach: The research is based on a survey conducted with…

  16. 16 de Septiembre, 1810 Module. Secondary Level. [16 of September, 1810 Module. Secondary Level.

    Science.gov (United States)

    Crystal City Independent School District, TX.

    Independence for Mexico took 11 years to achieve. Before its independence Mexico was ruled by Spain and had a basic caste system of indios, mestizos, criollos, and gachupines. The gachupines and criollos ruled the government and exploited the indios and mestizos. When the criollos became dissatisfied with being secondary to the gachupines, they…

  17. Barriers to Implementing the Response to Intervention Framework in Secondary Schools: Interviews with Secondary Principals

    Science.gov (United States)

    Bartholomew, Mitch; De Jong, David

    2017-01-01

    Despite the successful implementation of the Response to Intervention (RtI) framework in many elementary schools, there is little evidence of successful implementation in high school settings. Several themes emerged from the interviews of nine secondary principals, including a lack of knowledge and training for successful implementation, the…

  18. The Articulation of Secondary and Post-Secondary Vocational Education Programs. Workshop Products.

    Science.gov (United States)

    Keene State Coll., NH.

    As a result of the cooperative efforts in articulation by secondary/postsecondary instructor teams, six packages representing the occupational areas of child care, culinary arts, electronics, health occupations, power mechanics, and industrial welding were developed. Each package contains the following three components: a series of job titles…

  19. The Relationship between Subsidized Free Day Secondary Education and Retention in Secondary Schools in Kenya

    Science.gov (United States)

    James, Asena Muganda; Simiyu, Aggrey Mukasa; Riechi, Andrew

    2016-01-01

    A workforce that can adapt to the fast changing global dynamics is critical for sustainable growth and development. Secondary level segment in the education cycle of a Kenyan plays a key role in the development of this workforce and is important since it de-links one from elementary (primary) learning, provides a chance for one to complete the…

  20. Secondary traumatic stress in nurses: a systematic review.

    Science.gov (United States)

    Beck, Cheryl Tatano

    2011-02-01

    Is there a "cost of caring" for health care providers of traumatized patients? The aim of this study is to review the literature on secondary traumatic stress in nurses in order to answer the following questions: What studies have been conducted on secondary traumatic stress in nurses in all clinical specialties? What instruments were used to measure secondary traumatic stress in nurses and what psychometric properties were reported? A systematic review. CINAHL, PubMed, and PsycINFO databases were searched for the years 1981 to the present. Keywords used in the database searches included secondary traumatic stress, compassion fatigue, vicarious traumatization, secondary trauma, PTSD, and nurses. Research studies were reviewed for the following inclusion criteria: the sample included nurses, the secondary traumatic stress symptoms were measured, and the language was English. Seven studies were found in which researchers examined secondary traumatic stress in nurses. The samples in five of these studies consisted of all nurses, whereas in the remaining two studies, nurses were included in the samples but the results were not specifically reported for the subgroup of nurses. Presence of secondary traumatic stress was reported in forensic nurses, emergency department nurses, oncology nurses, pediatric nurses, and hospice nurses. Three instruments were identified that measured secondary traumatic stress in practitioners who care for traumatized populations: Secondary Traumatic Stress Scale, Compassion Fatigue Self Test for Helpers, and the Compassion Fatigue Scale-Revised. Presence of secondary traumatic stress in nurses was reported in all of the studies included in this literature review. The use of small samples and a number of different instruments to measure secondary traumatic stress symptoms, however, hindered the ability to make comparisons across studies and to draw conclusions. None of the studies conducted to date have focused on secondary traumatic stress in