WorldWideScience

Sample records for sheet addison county

  1. VT Lidar Slope (1.6 meter) - 2012 - Addison County

    Vermont Center for Geographic Information — (Link to Metadata) This metadata applies to the following collection area(s): Addison County 2012 1.6m and related SLOPE datasets. Created using ArcGIS "SLOPE"...

  2. VT Lidar Aspect (1.6 meter) - 2012 - Addison County

    Vermont Center for Geographic Information — (Link to Metadata) This metadata applies to the following collection area(s): Addison County 2012 1.6m and related ASPECT datasets. This metadata complies with the...

  3. VT Lidar nDSM (1.6 meter) - 2012 - Addison County

    Vermont Center for Geographic Information — (Link to Metadata) This metadata applies to the following collection area(s): Addison County 2012 1.6m and related "normalized" Digital Surface Model (nDSM). Created...

  4. Addison Disease

    ... your blood pressure and water and salt balance. Addison disease happens if the adrenal glands don't make ... A problem with your immune system usually causes Addison disease. The immune system mistakenly attacks your own tissues, ...

  5. Addison disease

    Symptoms of Addison disease include: Chronic diarrhea, nausea, and vomiting Darkening of the skin in some places Dehydration Dizziness when standing up Low-grade fever Extreme weakness , fatigue , and slow, sluggish movement Darker ...

  6. [Addison's disease].

    Quinkler, M

    2012-09-01

    The clinical signs and symptoms of primary adrenal insufficiency are unspecific often causing a delayed diagnosis or even misdiagnosis. In the diagnostic work-up the short synacthen test is regarded as the gold standard. Hydrocortisone and fludrocortisone are the preferred therapy for Addison's disease. The management and surveillance of therapy requires experience and several aspects need to be followed to prevent side effects which might occur due to overtreatment or undertreatment. Very important aspects in therapy are the repeated teaching of the patient and relatives, the issuing of an emergency steroid card and the prescription of a glucocorticoid emergency set. Acute adrenal failure (adrenal crisis), which might be the first manifestation of adrenal insufficiency, is a life-threatening situation requiring immediate glucocorticoid administration and fluid substitution. The most common causes for an adrenal crisis are gastrointestinal infections and fever and discontinuation of glucocorticoid therapy. This article gives an up-to-date overview of diagnostic and therapeutic aspects of Addison's disease.

  7. Addison's Disease: Treatment

    Addison's disease Diagnosis Your doctor will talk to you first about your medical history and your signs and ... If your doctor thinks that you may have Addison's disease, you may undergo some of the following tests: ...

  8. Myopathy in Addison's disease.

    Mor, F; Green, P; Wysenbeek, A J

    1987-01-01

    Since the first description of primary adrenocortical insufficiency by Thomas Addison in 1855 several large series of patients with Addison's disease have been published. The common signs and symptoms include: weakness, hyperpigmentation, weight loss, gastrointestinal complaints, and hypotension. It is rare for patients with Addison's disease to present with musculoskeletal symptoms including flexion contractures, hyperkalaemic neuromyopathy, Guillain-Barré syndrome, migratory myalgia, sciati...

  9. Addison's Disease: A Diagnostic Dilemma.

    Afroz, S; Bain, S

    2017-07-01

    Adrenal insufficiency is a rare disease, but is life threatening when overlooked. Addison's disease may be an acquired form of adrenal insufficiency due to the destruction or dysfunction of the adrenal cortex. It affects both glucocorticoid and mineralocorticoid function. Main presenting symptoms of Addison's disease such as fatigue, anorexia, vomiting and convulsion often mimics central nervous system (CNS) infections. We describe a case of Addison's disease who was initially misdiagnosed as a case of meningo-encephalitis subsequently renal tubular acidosis and finally Addison's disease. Addison's disease can remain unrecognized until acute crisis and sometimes it may be misdiagnosed.

  10. Sarcoidosis Presenting Addison's Disease.

    Takahashi, Kentaro; Kagami, Shin-Ichiro; Kawashima, Hirotoshi; Kashiwakuma, Daisuke; Suzuki, Yoshio; Iwamoto, Itsuo

    2016-01-01

    We herein describe a second Japanese case of sarcoidosis presenting Addison's disease. A 52-year-old man was diagnosed with sarcoidosis based on clinical and laboratory findings, including bilateral hilar lymphadenopathy and elevated levels of serum angiotensin-converting enzyme and lysozyme, as well as the presence of noncaseating epithelioid granulomas. The patient also exhibited general fatigue, pigmentation, weight loss, hypotension and hyponatremia, suggestive of chronic adrenocortical insufficiency. An endocrine examination confirmed primary adrenocortical insufficiency. This case suggests the direct involvement of sarcoid granuloma in the adrenal glands.

  11. Autoimmune Addison's disease.

    Napier, Catherine; Pearce, Simon H S

    2012-12-01

    Addison's disease is a rare autoimmune disorder. In the developed world, autoimmune adrenalitis is the commonest cause of primary adrenal insufficiency, where the majority of patients have circulating antibodies against the key steroidogenic enzyme 21-hydroxylase. A complex interplay of genetic, immunological and environmental factors culminates in symptomatic adrenocortical insufficiency, with symptoms typically developing over months to years. Biochemical evaluation and further targeted investigations must confirm primary adrenal failure and establish the underlying aetiology. The diagnosis of adrenocortical insufficiency will necessitate lifelong glucocorticoid and mineralocorticoid replacement therapy, aiming to emulate physiological patterns of hormone secretion to achieve well-being and good quality of life. Education of patients and healthcare professionals is essential to minimise the risk of a life-threatening adrenal crisis, which must be promptly recognised and aggressively managed when it does occur. This article provides an overview of our current understanding of the natural history and underlying genetic and immunological basis of this condition. Future research may reveal novel therapeutic strategies for patient management. Until then, optimisation of pharmacological intervention and continued emphasis on education and empowerment of patients should underpin the management of individuals with autoimmune Addison's disease. Copyright © 2012. Published by Elsevier Masson SAS.

  12. Addison's disease and its associations

    Puttanna, Amar; Cunningham, Alana Rosaleen; Dainty, Philip

    2013-01-01

    Addison's disease is a relatively rare endocrine condition resulting from adrenal insufficiency due to various causes. Weight loss is a common feature; however, patients may be seen by a variety of specialists, even requiring acute admission before the diagnosis is made. Addison's disease is commonly associated with other autoimmune diseases. In some cases such as autoimmune polyendocrine syndromes (APS) types 1 and 2, these associations are more commonly found. We present a case of one such ...

  13. Addison's disease and its associations.

    Puttanna, Amar; Cunningham, Alana Rosaleen; Dainty, Philip

    2013-07-26

    Addison's disease is a relatively rare endocrine condition resulting from adrenal insufficiency due to various causes. Weight loss is a common feature; however, patients may be seen by a variety of specialists, even requiring acute admission before the diagnosis is made. Addison's disease is commonly associated with other autoimmune diseases. In some cases such as autoimmune polyendocrine syndromes (APS) types 1 and 2, these associations are more commonly found. We present a case of one such patient who presented to the acute medical team having been referred to the gastrointestinal services in the previous year for persistent vomiting and weight loss. On review of history, the cause of vomiting and weight loss was questioned and combined with subsequent biochemical testing a diagnosis of Addison's disease was made. The patient was also noted to have other associated endocrine and autoimmune conditions.

  14. An unusual coexistence of Addison's disease and ...

    2013-07-17

    Jul 17, 2013 ... Case Study: An unusual coexistence of Addison's disease and phaeochromocytoma. 164 ... strongly positive. ... Department of Endocrinology and Metabolism, Ondokuz Mayis University Medical School, Samsun, Turkey.

  15. Genetics Home Reference: autoimmune Addison disease

    ... common in particular ethnic groups? Genetic Changes The cause of autoimmune Addison disease is complex and not completely understood. A combination ... is not caused by an autoimmune reaction. Other causes include infections that ... adrenal glands. Addison disease can also be one of several features of ...

  16. Addison's disease and pregnancy: case report.

    Cosimo, Caterina; Franco, Ciro

    2009-10-01

    Addisonian crises, a rare but life-threatening event in pregnant women, may accompany stressful conditions such as labor, puerperium, infection, hyperemesis gravidarum or surgery. A 36-year-old woman, primigravida, with Addison's disease, diagnosed when she was 10 year-old and treated with cortisone and fludrocortisone. The therapy was regulated to avoid adrenal crisis during pregnancy. The woman underwent to caesarean section at 38th week and gave birth to a normal baby. The successful management of pregnant women with Addison's disease, regarding her state and that of the foetus, reassures those women that nowadays Addison's disease and pregnancy are not incompatible when proper monitoring and management is provided.

  17. Current and emerging therapies for Addison's disease.

    Napier, Catherine; Pearce, Simon H S

    2014-06-01

    The purpose of this article is to review the current therapy of Addison's disease and to highlight recent developments in this field. Conventional steroid replacement for Addison's disease consists of twice or three-times daily oral hydrocortisone and once-daily fludrocortisone; however, new treatment modalities such as modified-released hydrocortisone and continuous subcutaneous hydrocortisone infusion have recently been developed. These offer the potential for closer simulation of the physiological serum cortisol rhythm. Two studies have also looked at modifying the natural history of adrenal failure using adrenocorticotropic hormone (ACTH) stimulation and immunomodulatory therapies, leading to the concept of residual adrenal function in some Addison's disease patients. Following more than 60 years with no significant innovation in the management of Addison's disease, these new approaches hold promise for improved patient health and better quality of life in the future.

  18. Basic repository source term and data sheet report: Deaf Smith County

    1987-01-01

    This report is one of a series describing studies undertaken in support of the US Department of Energy Civilian Radioactive Waste Management (CRWM) Program. This study contains the derivation of values for environmental source terms and resources consumed for a CRWM repository. Estimates include heavy construction equipment; support equipment; shaft-sinking equipment; transportation equipment; and consumption of fuel, water, electricity, and natural gas. Data are presented for construction and operation at an assumed site in Deaf Smith County, Texas. 2 refs., 6 tabs

  19. Addison's Disease and Pituitary Enlargement.

    Winters, Stephen J; Vitaz, Todd; Nowacki, Michael R; Craddock, Durrett C; Silverman, Craig

    2015-06-01

    A 60-year-old man with Addison's disease, primary hypothyroidism and type 2 diabetes mellitus who was treated with stable doses of hydrocortisone and fludrocortisone developed increasing skin pigmentation and a bitemporal hemianopia. The plasma ACTH level was 14,464 pg/mL, and an invasive pituitary macroadenoma with suprasellar extension was found on magnetic resonance imaging leading to transnasal-transsphenoidal adenomectomy. The tumor demonstrated features of an eosinophilic adenoma and stained uniformly for ACTH. Residual tumor was treated with stereotactic radiotherapy. This case and the 13 cases published previously indicate that primary adrenal failure may predispose to corticotroph hyperplasia, and in some patients to the development of an invasive corticotroph adenoma. The ACTH level should be measured, and a pituitary magnetic resonance imaging is indicated when skin pigmentation increases in a patient with primary adrenal failure who is receiving customary treatment with glucocorticoids and mineralocorticoids.

  20. Treatment of Addison's disease during pregnancy.

    Oliveira, Diana; Lages, Adriana; Paiva, Sandra; Carrilho, Francisco

    2018-01-01

    Addison's disease, or primary adrenocortical insufficiency, is a long-term, potentially severe, rare endocrine disorder. In pregnancy, it is even rarer. We report the case of a 30-year-old pregnant patient with Addison's disease, referred to Obstetrics-Endocrinology specialty consult at 14 weeks gestation. She had been to the emergency department of her local hospital various times during the first trimester presenting with a clinical scenario suggestive of glucocorticoid under-replacement (nausea, persistent vomiting and hypotension), but this was interpreted as normal pregnancy symptoms. Hydrocortisone dose was adjusted, and the patient maintained regular follow-up. No complications were reported for the remainder of gestation and delivery. Pregnant patients with Addison's disease should be monitored during gestation and in the peripartum period by multidisciplinary teams. Adjustments in glucocorticoid and mineralocorticoid replacement therapy are often necessary, and monitoring should be based mainly on clinical findings, which becomes increasingly difficult during pregnancy. Patient education and specialized monitoring are key to avoiding complications from under- or over-replacement therapy in this period. An increase in glucocorticoid replacement dose is expected to be necessary during pregnancy in a woman with Addison's disease.Patient education regarding steroid cover and symptoms of acute adrenal crisis are fundamental.Monitoring in this period is challenging and remains mainly clinical.The increase in hydrocortisone dose often obviates the need to increase fludrocortisone dose.

  1. Computerised tomography in tuberculous Addison's disease

    Perry, M.C.; Eason, R.J.; Croxson, M.S.

    1983-01-01

    The important contribution computerised tomography played in the diagnosis of tuberculous Addison's disease is described. While conventional radiographic methods of demonstrating this disease are often unhelpful, C.T. is an excellent technique for demonstrating the morphology of normal and abnormal adrenal glands

  2. Addison's disease presenting with muscle spasm.

    Bhattacharjee, Rana; Sharma, A; Rays, A; Thakur, I; Sarkar, D; Mandal, B; Mookerjee, S K; Chatterjee, S K; Chowdhury, Pradip Roy

    2013-09-01

    Primary hypoadrenalism has various causes and protean manifestation. We report a young female patient who presented with severe muscle spasm as her primary complaint. On evaluation she was found to be a case of Addison's disease secondary to adrenal tuberculosis. Her muscle spasm disappeared rapidly with replacement dose of glucocorticoid.

  3. Clinical significance of adrenal computed tomography in Addison's disease

    Sun, Zhong-Hua; Nomura, Kaoru; Toraya, Shohzoh; Ujihara, Makoto; Horiba, Nobuo; Suda, Toshihiro; Tsushima, Toshio; Demura, Hiroshi; Kono, Atsushi

    1992-01-01

    Adrenal computed tomographic (CT) scanning was conducted in twelve patients with Addison's disease during the clinical course. In tuberculous Addison's disease (n=8), three of four patients examined during the first two years after disease onset had bilaterally enlarged adrenals, while one of four had a unilaterally enlarged one. At least one adrenal gland was enlarged after onset in all six patients examined during the first four years. Thereafter, the adrenal glands was atrophied bilaterally, in contrast to adrenal glands in idiopathic Addison's disease which was atrophied bilaterally from disease onset (n=2). Adrenal calcification was a less sensitive clue in tracing pathogenesis, i.e., adrenal calcification was observed in five of eight patients with tuberculous Addison's disease, but not idiopathic patients. Thus, adrenal CT scanning could show the etiology of Addison's disease (infection or autoimmunity) and the phase of Addison's disease secondary to tuberculosis, which may be clinically important for initiating antituberculous treatment. (author)

  4. Addison's Disease Mimicking as Acute Pancreatitis: A Case Report.

    Chaudhuri, Sayani; Rao, Karthik N; Patil, Navin; Ommurugan, Balaji; Varghese, George

    2017-04-01

    Over past two decades there has been significant improvement in medical field in elucidating the underlying pathophysiology and genetics of Addison's disease. Adrenal insufficiency (Addison's disease) is a rare disease with an incidence of 0.8/100,000 cases. The diagnosis may be delayed if the clinical presentation mimics a gastrointestinal disorder or psychiatric illness. We report a case of Addison's disease presenting as acute pain in abdomen mimicking clinical presentation of acute pancreatitis.

  5. Nonarteritic anterior ischaemic optic neuropathy in Addison's disease.

    Ross, A H; Haider, S; Bailey, C C

    2010-10-01

    To report three cases of Nonarteritic anterior ischaemic optic neuropathy (NAAION) in patients with Addison's disease. We present a retrospective review of patients presenting with NAAION with underlying Addison's disease. Three eyes of two young patients presented with NAAION. Both patients had underlying Addison's disease with episodes of prolonged hypotension. To our knowledge, this is the first published report of NAAION associated with Addison's disease. As hypotension may be one of the few situations, in which NAAION may be treatable and the visual loss reversible, it is important to recognize and treat sustained episodes of hypotension in these individuals.

  6. [Addison's disease: forms of presentation in paediatrics].

    Royo Gómez, M; Olmos Jiménez, M J; Rodríguez Arnao, M D; Roldán Martín, M B

    2013-06-01

    Addison's disease or primary adrenal insufficiency is a rare disease in children. The signs and symptoms at diagnosis are frequently non-specific and insidious. Since adrenal crisis represents an emergency, it is important to be aware and to have a high degree of suspicion of the disorder in order to achieve an early diagnosis and treatment. We present a retrospective study describing the epidemiological, clinical and etiological data at diagnosis of five patients with Addison's disease followed up in our hospital. Dehydration, hyponatremia and skin hyperpigmentation were the most prevalent signs and symptoms at onset of the disease. The patients had low serum cortisol levels and positive adrenal antibodies. One patient with negative antibodies presented with a polyglandular syndrome. Copyright © 2012 Asociación Española de Pediatría. Published by Elsevier España, S.L. All rights reserved.

  7. Genetic evaluation of Addison's disease in the Portuguese Water Dog

    Belanger JM

    2006-05-01

    Full Text Available Abstract Background Addison's disease, also known as hypoadrenocorticism, has been reported in many individual dogs, although some breeds exhibit a greater incidence than the population as a whole. Addison's is presumed to be an autoimmune mediated hereditary defect but the mode of inheritance remains unclear. In particular, the heritability and mode of inheritance have not been defined for the Portuguese Water Dog although Addison's is known to be prevalent in the breed. Results The analyses present clear evidence that establishes Addison's disease as an inherited disorder in the Portuguese Water Dog with an estimate of heritability of 0.49 (± 0.16; there were no differences in risk for disease across sexes (p > 0.49. Further, the complex segregation analysis provides suggestive evidence that Addison's disease in the Portuguese Water Dog is inherited under the control of a single, autosomal recessive locus. Conclusion The high heritability and mode of inheritance of Addison's disease in the Portuguese Water Dog should enable the detection of segregating markers in a genome-wide scan and the identification of a locus linked to Addison's. Though the confirmation of Addison's disease as an autosomal recessive disorder must wait until the gene is identified, breeders of these dogs may wish to keep the present findings in mind as they plan their breeding programs to select against producing affected dogs.

  8. A suspected case of Addison's disease in cattle.

    Lambacher, Bianca; Wittek, Thomas

    2015-09-01

    A 4.75-year old Simmental cow was presented with symptoms of colic and ileus. The clinical signs and blood analysis resulted in the diagnosis of suspected primary hypoadrenocorticism (Addison's disease). Although Addison's disease has been frequently described in other domestic mammals, to our knowledge, this disease has not previously been reported in cattle.

  9. Genetic evaluation of Addison's disease in the Portuguese Water Dog.

    Oberbauer, A M; Bell, J S; Belanger, J M; Famula, T R

    2006-05-02

    Addison's disease, also known as hypoadrenocorticism, has been reported in many individual dogs, although some breeds exhibit a greater incidence than the population as a whole. Addison's is presumed to be an autoimmune mediated hereditary defect but the mode of inheritance remains unclear. In particular, the heritability and mode of inheritance have not been defined for the Portuguese Water Dog although Addison's is known to be prevalent in the breed. The analyses present clear evidence that establishes Addison's disease as an inherited disorder in the Portuguese Water Dog with an estimate of heritability of 0.49 (+/- 0.16); there were no differences in risk for disease across sexes (p > 0.49). Further, the complex segregation analysis provides suggestive evidence that Addison's disease in the Portuguese Water Dog is inherited under the control of a single, autosomal recessive locus. The high heritability and mode of inheritance of Addison's disease in the Portuguese Water Dog should enable the detection of segregating markers in a genome-wide scan and the identification of a locus linked to Addison's. Though the confirmation of Addison's disease as an autosomal recessive disorder must wait until the gene is identified, breeders of these dogs may wish to keep the present findings in mind as they plan their breeding programs to select against producing affected dogs.

  10. Diagnosis and management of Addison's disease: insights gained ...

    The prevalence of Addison's disease in South Africa is lower than in Western countries. This is concerning, since patients could be dying, undiagnosed. Enhanced awareness of this highly treatable condition is warranted. The epidemiology, aetiology, clinical presentation, screening and management of Addison's disease ...

  11. Computed tomography in the diagnosis of Addison's disease

    Yamauchi, Teiyu; Yashiro, Naofumi; Iio, Masahiro

    1985-01-01

    The computed tomography (CT) findings of the adrenal glands were described in six patients with Addison's disease. Three of four patients due to tuberculosis showed calcification in bilateral adrenal glands. In all three, non-calcified portions of left adrenal glands were identified by CT. One showed bilaterally enlarged adrenal glands. Bilateral adrenal glands were small in a patient with idiopatic Addison's disease. One patient of metastatic infiltration of the adrenal glands showed nodular masses in bilateral adrenal beds. CT findings were useful to clarify the etiology of Addison's patients. (author)

  12. The neuropsychiatric aspect of Addison's disease: a case report.

    Abdel-Motleb, Mohamed

    2012-10-01

    Chronic adrenal insufficiency, known as Addison's disease, presents with a constellation of symptoms and signs. The neuropsychiatric aspect of this condition is not fully understood and not much has been documented about it in the English literature. This article presents a case of a 41-year old male patient who presented initially with depression after a recent life stressor. After his condition escalated and therapy continued to fail, the medical team revised its diagnosis to Addison's disease. Neuropsychiatric symptoms could be the first presentation of Addison's disease, and thus should be kept in mind whenever such a case presents to the physician.

  13. Immunology of Addison's disease and premature ovarian failure.

    Husebye, Eystein S; Løvås, Kristian

    2009-06-01

    Autoimmune Addison's disease and autoimmune ovarian insufficiency are caused by selective targeting by T and B lymphocytes to the steroidogenic apparatus in these organs. Autoantibodies toward 21-hydroxylase are a clinically useful marker for autoimmune Addison's disease. Autoantibodies to 21-hydroxylase are found in premature ovarian insufficiency, but others also can be present, notably antibodies against side-chain cleavage enzyme. The autoimmune response primarily targets the theca cells, yielding elevated concentrations of inhibin, which is emerging as a useful diagnostic marker for autoimmune etiology of ovarian insufficiency. Little is known about its immunogenetics, but in contrast to Addison's disease, several experimental models of autoimmune premature ovarian insufficiency are available for study.

  14. Cellular immunity and immunopathology in autoimmune Addison's disease.

    Bratland, Eirik; Husebye, Eystein S

    2011-04-10

    Autoimmune adrenocortical failure, or Addison's disease, is a prototypical organ-specific autoimmune disorder. In common with related autoimmune endocrinopathies, Addison's disease is only manageable to a certain extent with replacement therapy being the only treatment option. Unfortunately, the available therapy does not restore the physiological hormone levels and biorhythm. The key to progress in treating and preventing autoimmune Addison's disease lies in improving our understanding of the predisposing factors, the mechanisms responsible for the progression of the disease, and the interactions between adrenal antigens and effector cells and molecules of the immune system. The aim of the present review is to summarize the current knowledge on the role of T cells and cellular immunity in the pathogenesis of autoimmune Addison's disease. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  15. [Acute renal failure: a rare presentation of Addison's disease].

    Salhi, Houda

    2016-01-01

    Addison's disease is a rare condition. Its onset of symptoms most often is nonspecific contributing to a diagnostic and therapeutic delay. Acute renal failure can be the first manifestation of this disease. We report the case of a patient with Addison's disease who was initially treated for acute renal failure due to multiple myeloma and whose diagnosis was adjusted thereafter. Patient's condition dramatically improved after treatment with intravenous rehydration; injectable hydrocortisone.

  16. Addison's disease as a presentation of metastatic malignant melanoma.

    Srinivasan, B; Patel, M; Ethunandan, M; Ilankovan, V

    2016-01-01

    Melanoma accounts for 5% of all skin cancers. The risk of metastasis is related to the thickness of the tumour, and can affect local, regional and distant sites. Adrenal metastasis from melanoma of the head and neck is uncommon and often asymptomatic. Addison's disease as a presentation of metastatic melanoma is extremely rare and we are unaware of previous reports in the world literature. We report a case of a patient with metastatic melanoma presenting with signs and symptoms of Addison's disease.

  17. Sexuality and fertility in women with Addison's disease.

    Erichsen, Martina M; Husebye, Eystein S; Michelsen, Trond M; Dahl, Alv A; Løvås, Kristian

    2010-09-01

    Females with primary adrenal insufficiency (Addison's disease) have reduced levels of circulating androgens, which are allegedly important for sexual functioning. The aim was to determine peripheral androgen status, sexual functioning, and birth rates in Addison's disease females. In a postal survey, all 269 females in the Norwegian Addison's registry were invited to complete the Sexual Activity Questionnaire (SAQ) and registration of childbirths. Blood samples were analyzed for 5alpha-androstane-3alpha,17beta-diol-3-glucuronide (3alpha-Diol-G) and compared with blood donor levels. The SAQ scores were compared with 740 age-matched controls from the general population and 234 women subjected to risk-reducing salpingo-oophorectomy. Fertility was estimated as standardized incidence ratio for birth; the expected number of births was estimated from population statistics. The SAQ was completed by 174 (65%) of the Addison's patients. Those not taking DHEA had significantly lower 3alpha-Diol-G levels than blood donors (mean, 0.53 vs. 2.2 ng/ml; P Addison's disease females were equally sexually active as the controls, but they reported significantly higher pleasure and less discomfort. They reported lower pleasure but less discomfort than the risk-reducing salpingo-oophorectomy women. The fertility was significantly reduced in females with Addison's disease; 54 children were born to mothers with established diagnosis (87.5 expected), yielding a standardized incidence ratio for birth of 0.69 (confidence interval, 0.52-0.86). Despite androgen depletion, females with Addison's disease do not report impaired sexuality. The fertility is reduced after the diagnosis is made; the reasons for this remain unknown.

  18. Cure of Psoriasis and Arthritis when Addison's Disease Was Detected.

    Lind, Marcus

    2010-06-01

    INTRODUCTION: Corticoid therapy is well-known to improve the symptoms of psoriasis. Addison's disease is an autoimmune disease which leads to a loss of cortisol production in the adrenal glands. This case report describes a patient with wide-spread psoriasis for 34 years who was cured when Addison's disease was detected and substitution to reach normal biological cortisol levels was introduced. CASE REPORT: A 59-year-old man was diagnosed with Addison's disease. He had been tired for several years and had had difficulties in continuing his work. His brother had Addison's disease and recommended him to make a screen for the disease. Synacthen test diagnosed Addison's disease with a clear deficiency of cortisol production. After substitution with hydrocortisone the patient's constitution improved rapidly and he felt no longer tired during work. At the same time, all skin lesions of psoriasis disappeared as well as aches in several joints, both symptoms having been present for a couple of decades. Previously, salves of cortisol had been used to reduce the symptoms of psoriasis, but now, 1-2 years later, after the treatment of Addison's disease, no symptoms in the skin or joints have reoccurred. CONCLUSIONS: This report illustrates that Addison's disease, although a rare condition, should be kept in mind before treatment of psoriasis is started. Especially if other symptoms such as fatigue are present, a screening test of serum cortisol in the morning should be liberally made. The report also illustrates a need of examining corticoid levels in patients with psoriasis compared to the general population.

  19. Addison's disease secondary to connective tissue diseases: a report of six cases.

    Zhang, Zhuo-li; Wang, Yu; Zhou, Wei; Hao, Yan-jie

    2009-04-01

    Addison's disease is an autoimmune process. However, Addison's disease associated with connective tissue diseases (CTD) is only occasionally reported. Here, we report six cases of Addison's disease secondary to a variety of CTD, which include systemic lupus erythematosus, Takayasu arteritis, systemic sclerosis, ankylosing spondylitis (AS) and antiphospholipid antibody syndrome. The association of Addison's disease with Takayasu arteritis and AS is reported for the first time. We also found high prevalence of hypothyroidism as concomitant autoimmune disorder. Our case series highlight the autoimmune features of Addison's disease. Therefore, we suggest considering adrenal dysfunction in patients with CTD.

  20. Jane Austen and Addison's disease: an unconvincing diagnosis.

    White, K G

    2009-12-01

    Jane Austen's letters describe a two-year deterioration into bed-ridden exhaustion, with unusual colouring, bilious attacks and rheumatic pains. In 1964, Zachary Cope postulated tubercular Addison's to explain her symptoms and her relatively pain-free illness. Literary scholars later countered this posthumous diagnosis on grounds that are not well substantiated, while medical authors supported his conclusion. Important symptoms reported by contemporary Addison's patients-mental confusion, generalised pain and suffering, weight loss and anorexia-are absent from Jane Austen's letters. Thus, by listening to the patient's perspective, we can conclude it is unlikely that Addison's disease caused Jane Austen's demise. Disseminated bovine tuberculosis would offer a coherent explanation for her symptoms, so that Cope's original suggestion of infective tuberculosis as the cause of her illness may have been correct.

  1. Erythema induratum of Bazin associated with Addison's disease: first description

    Rodrigo Antonio Brandão Neto

    Full Text Available CONTEXT: Erythema induratum of Bazin (EIB is considered to be a tuberculid reaction and consists of recurrent painful nodules. The differential diagnosis includes diseases like nodular vasculitis, perniosis, polyarteritis nodosa and erythema nodosum. CASE REPORT: We report the case of a woman with EIB who developed Addison's disease during treatment with anti-tuberculosis drugs with good response to glucocorticoid replacement. The diagnosis was obtained through the clinical picture, positive tuberculin test and positive BCG (bacillus Calmette-Guérin test on the histological sample. Anti-tuberculosis drugs and glucocorticoid replacement led to disappearance of the signs and symptoms. CONCLUSIONS: This is the first description of an association between EIB and Addison's disease. It should be borne in mind that tuberculosis is an important etiological factor for Addison's disease.

  2. Addison's disease and ACTH-producing pituitary microadenoma

    S.S. Ortega

    2015-10-01

    Full Text Available A 28-year-old man diagnosed with primary adrenal insufficiency (Addison's disease in 2002. Following diagnosis, replacement therapy with hydrocortisone and fludrocortisone was indicated. Hydrocortisone replacement therapy was unsuccessful, and increased ACTH levels as high as 996 pg/dl were observed on outpatient follow-up. A pituitary MRI revealed a pituitary microadenoma. These findings raised three possibilities: (1 treatment is insufficient; (2 there is no relationship between Addison's disease and pituitary microadenoma; and (3 the microadenoma is similar to Nelson's syndrome. This latter is the most satisfactory explanation of this patient's clinical picture.

  3. An Unusual Presentation of Addison's Disease-A Case Report.

    Choudhary, Sandeep; Alam, Anwer; Dewan, Vivek; Yadav, Dinesh; Dubey, N K

    2011-07-01

    Addison's disease is most commonly due to autoimmune adrenalitis and tuberculosis and refers to primary hypoadrenalism caused by a total or near total destruction or dysfunction of both adrenal cortices. Usual manifestations involve chronic fatigue, muscle weakness, loss of appetite, nausea, vomiting, diarrhea, hypotension and hyperpigmentation of skin. We herein report a case of primary adrenal insufficiency presenting with fever and seizures in an 11-yr-old boy. His symptoms resolved after starting specific therapy. This kind of presentation of Addison's disease is rather unusual.

  4. AIRE variations in Addison's disease and autoimmune polyendocrine syndromes (APS)

    Bøe Wolff, A S; Oftedal, B; Johansson, S

    2008-01-01

    Autoimmune Addison's disease (AAD) is often associated with other components in autoimmune polyendocrine syndromes (APS). Whereas APS I is caused by mutations in the AIRE gene, the susceptibility genes for AAD and APS II are unclear. In the present study, we investigated whether polymorphisms...

  5. Hyperkalaemic periodic paralysis: a rare presentation of Addison's disease.

    Sowden, J. M.; Borsey, D. Q.

    1989-01-01

    A 44 year old man with longstanding diabetes mellitus gave a 6-month history of periodic attacks of flaccid quadriplegia. Following one of these episodes he was admitted for assessment. In view of persistent hyperkalaemia, hypoadrenalism was suspected and Addison's disease was confirmed biochemically. Adrenal replacement therapy restored the potassium levels to normal and resulted in no further attacks of paralysis. PMID:2594601

  6. Extended exome sequencing identifies BACH2 as a novel major risk locus for Addison's disease

    Eriksson, D.; Bianchi, Matteo; Landegren, Nils; Nordin, Jessika; Dalin, Frida; Mathioudaki, Argyri; Eriksson, G. N.; Hultin-Rosenberg, Lina; Dahlqvist, Johanna; Zetterqvist, H.; Karlsson, Andreas; Hallgren, Anna; Farias, F. H. G.; Murén, Eva; Ahlgren, Kerstin M.

    2016-01-01

    BackgroundAutoimmune disease is one of the leading causes of morbidity and mortality worldwide. In Addisons disease, the adrenal glands are targeted by destructive autoimmunity. Despite being the most common cause of primary adrenal failure, little is known about its aetiology. MethodsTo understand the genetic background of Addisons disease, we utilized the extensively characterized patients of the Swedish Addison Registry. We developed an extended exome capture array comprising a selected se...

  7. Addison's Disease Revisited in Poland: Year 2008 versus Year 1990

    Anna A. Kasperlik-Zaluska

    2010-01-01

    Full Text Available This study aimed at comparing two groups of patients with Addison's disease: A, including 180 patients described in 1991 and B, consisting of 138 patients registered since 1991. The incidence of coexisting autoimmune disorders was evaluated and etiological factors were analyzed. Immunological and imaging studies (computed tomography in group B were performed. Adrenal autoantibodies were examined by an indirect immunofluorescence technique in group A, and by the assay measuring autoantibodies against steroid 21-hydroxylase in group B. Adrenal autoantibodies were revealed in 37% of patients examined by the immunofluorescence method and in 63% investigated by the modern technique. Tuberculosis was found in 52 patients in the group A and in two patients in the group B; metastatic infiltrations of the adrenals in CT were detected in 16 patients. Probable autoimmune Addison's disease was diagnosed in 125/180 patients (69% in the group A and in 116/138 patients (84% in the group B.

  8. Addison's Disease Revisited in Poland: Year 2008 versus Year 1990

    Kasperlik-Zaluska, Anna A.; Czarnocka, Barbara; Jeske, Wojciech; Papierska, Lucyna

    2010-01-01

    This study aimed at comparing two groups of patients with Addison's disease: A, including 180 patients described in 1991 and B, consisting of 138 patients registered since 1991. The incidence of coexisting autoimmune disorders was evaluated and etiological factors were analyzed. Immunological and imaging studies (computed tomography in group B) were performed. Adrenal autoantibodies were examined by an indirect immunofluorescence technique in group A, and by the assay measuring autoantibodies against steroid 21-hydroxylase in group B. Adrenal autoantibodies were revealed in 37% of patients examined by the immunofluorescence method and in 63% investigated by the modern technique. Tuberculosis was found in 52 patients in the group A and in two patients in the group B; metastatic infiltrations of the adrenals in CT were detected in 16 patients. Probable autoimmune Addison's disease was diagnosed in 125/180 patients (69%) in the group A and in 116/138 patients (84%) in the group B. PMID:21188237

  9. What affects the quality of life in autoimmune Addison's disease?

    Meyer, G; Hackemann, A; Penna-Martinez, M; Badenhoop, K

    2013-02-01

    Several studies have shown a reduced quality of life in patients with Addison's disease, but little is known about the potential influences. We determined the quality of life in 200 patients with Addison's disease using an Addison's disease-specific quality-of-life questionnaire. Data about first symptoms, time to diagnosis and current medication were collected by questionnaires. With increasing latency between first symptoms and diagnosis of adrenal insufficiency, the quality of life decreased in highly significant manner (pdisease (p=0.05), atrophic gastritis (p=0.01) and primary ovarian failure (p=0.01) were highly correlated with reduced scores. Quality of life was significantly lower in female patients and in those with manifestation at older ages. With more autoimmune comorbidities, the quality of life scores dropped. The most important factor, however, was latency between first symptoms and diagnosis that affected patients' quality of life even years after manifestation of the disease. These results confirm and extend previous observations and emphasize the importance of a timely diagnosis. Therefore, medical awareness for this rare but easily treatable disorder needs to be sharpened. © Georg Thieme Verlag KG Stuttgart · New York.

  10. Addison's Disease and Dilated Cardiomyopathy: A Case Report and Review of the Literature.

    Mozolevska, Viktoriya; Schwartz, Anna; Cheung, David; Shaikh, Bilal; Bhagirath, Kapil M; Jassal, Davinder S

    2016-01-01

    Addison's disease is often accompanied by a number of cardiovascular manifestations. We report the case of a 30-year-old man who presented with a new onset dilated cardiomyopathy due to Addison's disease. The clinical presentation, treatment, and outcomes of this rare hormone mediated cardiac disorder are reviewed.

  11. Screening for Addison's disease in patients with type 1 diabetes mellitus and recurrent hypoglycaemia

    Likhari, Taruna; Magzoub, Saeed; Griffiths, Melanie J; Buch, Harit N

    2007-01-01

    Background Addison's disease may present with recurrent hypoglycaemia in subjects with type 1 diabetes mellitus. There are no data, however, on the prevalence of Addison's disease presenting with recurrent hypoglycaemia in patients with diabetes mellitus. Methods Three year retrospective study of diabetic patients with “unexplained” recurrent hypoglycaemia investigated with a short Synacthen test to exclude adrenocortical insufficiency. Results 95 patients with type 1 diabetes mellitus were studied. Addison's disease was identified as the cause of recurrent hypoglycaemia in one patient with type 1 diabetes mellitus. Conclusion Addison's disease is a relatively rare but remedial cause of recurrent hypoglycaemia in patients with type 1 diabetes mellitus. A low threshold for investigating patients with type 1 diabetes mellitus and recurrent hypoglycaemia to detect Addison's disease is therefore suggested. PMID:17551075

  12. Screening for Addison's disease in patients with type 1 diabetes mellitus and recurrent hypoglycaemia.

    Likhari, Taruna; Magzoub, Saeed; Griffiths, Melanie J; Buch, Harit N; Gama, R

    2007-06-01

    Addison's disease may present with recurrent hypoglycaemia in subjects with type 1 diabetes mellitus. There are no data, however, on the prevalence of Addison's disease presenting with recurrent hypoglycaemia in patients with diabetes mellitus. Three year retrospective study of diabetic patients with "unexplained" recurrent hypoglycaemia investigated with a short Synacthen test to exclude adrenocortical insufficiency. 95 patients with type 1 diabetes mellitus were studied. Addison's disease was identified as the cause of recurrent hypoglycaemia in one patient with type 1 diabetes mellitus. Addison's disease is a relatively rare but remedial cause of recurrent hypoglycaemia in patients with type 1 diabetes mellitus. A low threshold for investigating patients with type 1 diabetes mellitus and recurrent hypoglycaemia to detect Addison's disease is therefore suggested.

  13. Extended exome sequencing identifies BACH2 as a novel major risk locus for Addison's disease.

    Eriksson, D; Bianchi, M; Landegren, N; Nordin, J; Dalin, F; Mathioudaki, A; Eriksson, G N; Hultin-Rosenberg, L; Dahlqvist, J; Zetterqvist, H; Karlsson, Å; Hallgren, Å; Farias, F H G; Murén, E; Ahlgren, K M; Lobell, A; Andersson, G; Tandre, K; Dahlqvist, S R; Söderkvist, P; Rönnblom, L; Hulting, A-L; Wahlberg, J; Ekwall, O; Dahlqvist, P; Meadows, J R S; Bensing, S; Lindblad-Toh, K; Kämpe, O; Pielberg, G R

    2016-12-01

    Autoimmune disease is one of the leading causes of morbidity and mortality worldwide. In Addison's disease, the adrenal glands are targeted by destructive autoimmunity. Despite being the most common cause of primary adrenal failure, little is known about its aetiology. To understand the genetic background of Addison's disease, we utilized the extensively characterized patients of the Swedish Addison Registry. We developed an extended exome capture array comprising a selected set of 1853 genes and their potential regulatory elements, for the purpose of sequencing 479 patients with Addison's disease and 1394 controls. We identified BACH2 (rs62408233-A, OR = 2.01 (1.71-2.37), P = 1.66 × 10 -15 , MAF 0.46/0.29 in cases/controls) as a novel gene associated with Addison's disease development. We also confirmed the previously known associations with the HLA complex. Whilst BACH2 has been previously reported to associate with organ-specific autoimmune diseases co-inherited with Addison's disease, we have identified BACH2 as a major risk locus in Addison's disease, independent of concomitant autoimmune diseases. Our results may enable future research towards preventive disease treatment. © 2016 The Authors. Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine.

  14. Prevalence of coeliac disease in Italian patients affected by Addison's disease.

    Biagi, Federico; Campanella, Jonia; Soriani, Alessandra; Vailati, Alberto; Corazza, Gino R

    2006-03-01

    It is well known that coeliac disease is associated with autoimmune endocrine diseases, such as autoimmune thyroid disease and insulin-dependent diabetes mellitus. Recently, coeliac disease has been shown in approximately 10% of patients with autoimmune Addison's disease. Addison's disease is the most common cause of primary adrenocortical insufficiency and it shares several clinical features with coeliac disease. Although hyperpigmentation and hypotension are the most specific signs, gastrointestinal symptoms are common and can be the first complaints of the patients. The aim of our study was to investigate the prevalence of coeliac disease in Italian patients with Addison's disease. Seventeen consecutive patients affected by Addison's disease (14 F, mean age 53.9 years, range 26-79 years) were enrolled in the study. Eleven of them were affected by Addison's disease associated with autoimmune thyroid disease and/or insulin-dependent diabetes mellitus; the other 6 patients were suffering from isolated Addison's disease. Diagnosis had been performed at the age of 40.5 years (range 23-55). Steroid treatment had already been started in 16 of the patients. Endomysial antibodies were tested in all of them and a duodenal biopsy was taken in those found to be positive for antiendomysial antibody (EMA). One out of 17 patients was found to be EMA positive. Duodenal biopsy confirmed the diagnosis of coeliac disease by showing subtotal villous atrophy. Although we studied only a small sample, our preliminary results confirmed that Addison's disease is associated with coeliac disease, being present in 5.9% of patients with Addison's disease. Since the symptoms can be similar and treatment of Addison's disease can mask coeliac disease, this association should always be actively investigated.

  15. Addison disease in patients treated with glucocorticoid therapy.

    Cronin, C C

    2012-02-03

    Acute adrenal crisis in patients with unrecognized chronic adrenocortical failure is difficult to diagnose and potentially fatal. We describe 2 patients with acute adrenal crisis whose diagnoses were hindered because of concomitant glucocorticoid treatment. Acute adrenal insufficiency is primarily a state of mineralocorticoid deficiency. Prednisolone and prednisone, the most frequently prescribed anti-inflammatory corticosteroid agents, have minimal mineralocorticoid activity. Several conditions that may be treated with pharmacological glucocorticoids are associated with an increased risk of Addison disease. An acute adrenal crisis, against which concurrent glucocorticoid therapy does not confer adequate protection, may develop in such patients.

  16. Addison's disease with adrenal enlargement on sonography and computed toimography

    Renner, F.; Graninger, W.

    1986-01-01

    One of the major causes of chronic adrenal insufficiency (Addison's disease) is tuberculous adrenalopathy. Since sonography and computed tomography have become generally available in recent years and are of potential help in the diagnosis of this disease the merits of these methods are discussed in the light of 2 cases of adrenal tuberculosis, followed by a review of the literature. Adrenal calcification is the most significant, although not specific sign of adrenal insufficiency due to tuberculosis. Computed tomography has proven to be the method of choice in the non-invasive diagnosis of tuberculous adrenalopathy and in the monitoring of tuberculostatic treatment in this disease. Sonography is helpful as a preliminary investigation. (Author)

  17. Diagnosis and classification of Addison's disease (autoimmune adrenalitis).

    Brandão Neto, Rodrigo Antonio; de Carvalho, Jozélio Freire

    2014-01-01

    Autoimmune adrenalitis, or autoimmune Addison disease (AAD), is the most prevalent cause of primary adrenal insufficiency in the developed world. AAD is rare and can easily be misdiagnosed as other conditions. The diagnosis depends on demonstrating inappropriately low cortisol production and the presence of high titers of adrenal cortex autoantibodies (ACAs), along with excluding other causes of adrenal failure using other tests as necessary. The treatment corticosteroid replacement, and the prognosis following the treatment is the same as the normal population. Spontaneous recovery of adrenal function has been described but is rare. Copyright © 2014 Elsevier B.V. All rights reserved.

  18. Addison's Disease Caused by Tuberculosis with Atypical Hyperpigmentation and Active Pulmonary Tuberculosis.

    Namikawa, Hiroki; Takemoto, Yasuhiko; Kainuma, Shigeto; Umeda, Sakurako; Makuuchi, Ayako; Fukumoto, Kazuo; Kobayashi, Masanori; Kinuhata, Shigeki; Isaka, Yoshihiro; Toyoda, Hiromitsu; Kamata, Noriko; Tochino, Yoshihiro; Hiura, Yoshikazu; Morimura, Mina; Shuto, Taichi

    2017-01-01

    We herein report a case of Addison's disease caused by tuberculosis characterized by atypical hyperpigmentation, noted as exacerbation of the pigmentation of freckles and the occurrence of new freckles, that was diagnosed in the presence of active pulmonary tuberculosis. The clinical condition of the patient was markedly ameliorated by the administration of hydrocortisone and anti-tuberculosis agents. When exacerbation of the pigmentation of the freckles and/or the occurrence of new freckles are noted, Addison's disease should be considered as part of the differential diagnosis. In addition, the presence of active tuberculosis needs to be assumed whenever we treat patients with Addison's disease caused by tuberculosis, despite its rarity.

  19. Allegheny County Map Index Grid

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Map Index Sheets from Block and Lot Grid of Property Assessment and based on aerial photography, showing 1983 datum with solid line and NAD 27 with 5 second grid...

  20. Decontamination sheet

    Hirose, Emiko; Kanesaki, Ken.

    1995-01-01

    The decontamination sheet of the present invention is formed by applying an adhesive on one surface of a polymer sheet and releasably appending a plurality of curing sheets. In addition, perforated lines are formed on the sheet, and a decontaminating agent is incorporated in the adhesive. This can reduce the number of curing operation steps when a plurality steps of operations for radiation decontamination equipments are performed, and further, the amount of wastes of the cured sheets, and operator's exposure are reduced, as well as an efficiency of the curing operation can be improved, and propagation of contamination can be prevented. (T.M.)

  1. The role of patients' illness representations in coping and functioning with Addison's disease.

    Heijmans, M.

    1999-01-01

    Objective: To examine the relationship between illness representations, coping behaviour and adaptive outcome in patients with Addison's disease (AD). Design: Cross-sectional. Following Leventhal's self-regulation model (Leventhal, Meyer & Nerenz, 1980), it was hypothesized that illness

  2. What is the optimal bone-preserving strategy for patients with Addison's disease?

    Lee, Paul; Greenfield, Jerry R

    2015-08-01

    Addison's disease is associated with low bone mineral density and increased risk of hip fractures. Causes are multifactorial, contributed by underlying adrenocortical hormonal deficiency, associated autoimmune endocrinopathies, electrolyte disturbances and, in some patients, supraphysiologic glucocorticoid replacement. Recent realization of physiologic cortisol production rate has revised downwards glucocorticoid replacement dosages. Meanwhile, new research has emerged suggesting complex interplay between sodium and calcium homoeostasis under the influence of mineralocorticoid and parathyroid hormone that may impact bone health. As the prevalence of Addison's disease is rising, and osteoporosis and fractures are associated with significant morbidity and increased mortality, attention to bone preservation in Addison's disease is of clinical relevance and importance. We suggest an approach to bone health in Addison's disease integrating physiologic adrenocortical hormonal replacement with electrolyte and mineral homoeostasis optimization. © 2015 John Wiley & Sons Ltd.

  3. Salivary cortisol day curves in assessing glucocorticoid replacement therapy in Addison's disease

    Smans, L.; Lentjes, E.G.W.M.; Hermus, A.R.; Zelissen, P.M.J.

    2013-01-01

    OBJECTIVE: Patients with Addison's disease require lifelong treatment with glucocorticoids. At present, no glucocorticoid replacement therapy (GRT) can exactly mimic normal physiology. As a consequence, under- and especially overtreatment can occur. Suboptimal GRT may lead to various side effects.

  4. The role of patients' illness representations in coping and functioning with Addison's disease.

    Heijmans, M.

    1999-01-01

    Objective: To examine the relationship between illness representations, coping behaviour and adaptive outcome in patients with Addison's disease (AD). Design: Cross-sectional. Following Leventhal's self-regulation model (Leventhal, Meyer & Nerenz, 1980), it was hypothesized that illness representations are directly associated with coping and, via coping, with adaptive outcome. Method: The illness representations held by 63 patients with a diagnosis of Addison's disease were explored using a q...

  5. Computed tomographic follow-up in a case of Addison's disease

    Pozzi Mucelli, R.S.; Pozzi Mucelli, F.; Muner, G.

    1985-01-01

    Addison's disease of the adrenal glands presents with different pathological findings depending on the stage. In the acute phase the adrenal glands are bilaterally enlarged while in the chronic phase the glands are small and calcified. A case of Addison's disease with follow-up over a period of a year by CT is reported. CT showed the evolution of the adrenal glands from bilateral masses to small calcified glands. The differential diagnostic problems in the acute phase are also discussed. (orig.)

  6. Screening for X-linked adrenoleukodystrophy among adult men with Addison's disease.

    Horn, Morten A; Erichsen, Martina M; Wolff, Anette S B; Månsson, Jan-Eric; Husebye, Eystein S; Tallaksen, Chantal M E; Skjeldal, Ola H

    2013-09-01

    X-linked adrenoleukodystrophy is an important cause of Addison's disease in boys, but less is known about its contribution to Addison's disease in adult men. After surveying all known cases of X-linked adrenoleukodystrophy in Norway in a separate study, we aimed to look for any missed cases among the population of adult men with nonautoimmune Addison's disease. Among 153 adult men identified in a National Registry for Addison's Disease (75% of identified male cases of Addison's disease in Norway), those with negative indices for 21-hydroxylase autoantibodies were selected. Additionally, cases with low autoantibody indices (48-200) were selected. Sera from subjects included were analysed for levels of very long-chain fatty acids, which are diagnostic for X-linked adrenoleukodystrophy in men. Eighteen subjects had negative indices and 17 had low indices for 21-hydroxylase autoantibodies. None of those with low indices and only one of those with negative indices were found to have X-linked adrenoleukodystrophy; this subject had already been diagnosed because of the neurological symptoms. Cases of Addison's disease proved to be caused by X-linked adrenoleukodystrophy constitute 1·5% of all adult male cases in Norway; the proportion among nonautoimmune cases was 15%. We found X-linked adrenoleukodystrophy to be an uncommon cause of Addison's disease in adult men. However, this aetiological diagnosis has far-reaching consequences both for the patient and for his extended family. We therefore recommend that all adult men with nonautoimmune Addison's disease be analysed for levels of very long-chain fatty acids. © 2013 John Wiley & Sons Ltd.

  7. Erythema induratum of Bazin associated with Addison's disease: first description Eritema indurado de Bazin associado à doença de Addison: primeira descrição

    Rodrigo Antonio Brandão Neto

    2012-01-01

    Full Text Available CONTEXT: Erythema induratum of Bazin (EIB is considered to be a tuberculid reaction and consists of recurrent painful nodules. The differential diagnosis includes diseases like nodular vasculitis, perniosis, polyarteritis nodosa and erythema nodosum. CASE REPORT: We report the case of a woman with EIB who developed Addison's disease during treatment with anti-tuberculosis drugs with good response to glucocorticoid replacement. The diagnosis was obtained through the clinical picture, positive tuberculin test and positive BCG (bacillus Calmette-Guérin test on the histological sample. Anti-tuberculosis drugs and glucocorticoid replacement led to disappearance of the signs and symptoms. CONCLUSIONS: This is the first description of an association between EIB and Addison's disease. It should be borne in mind that tuberculosis is an important etiological factor for Addison's disease.CONTEXTO: O eritema indurado de Bazin (EIB é considerado uma reação tuberculoide e consiste de nódulos dolorosos recorrentes. O diagnóstico diferencial inclui doenças como vasculite nodular, perniose, poliarterite nodosa e eritema nodoso. RELATO DE CASO: Nós reportamos o caso de uma mulher com EIB que desenvolveu doença de Addison durante tratamento com drogas tuberculostáticas e com boa resposta com reposição de glicocorticoide. O diagnóstico foi realizado pela apresentação clínica, teste tuberculínico positivo e positividade para BCG (bacilo Calmette-Guérin no espécime histológico. A reposição de glicocorticoides e drogas tuberculostáticas levou ao desaparecimento dos sinais e sintomas. CONCLUSÕES: Este é o primeiro caso reportando a associação entre EIB e doença de Addison. Tuberculose é um importante agente etiológico da doença de Addison.

  8. Adult cerebral adrenoleukodystrophy and Addison's disease in a female carrier.

    Chen, Xiaoyan; Chen, Zhiye; Huang, Dehui; Liu, Xiaofeng; Gui, Qiuping; Yu, Shengyuan

    2014-07-10

    We described a 38-year-old woman of rapidly progressive dementia with white matter encephalopathy and death. She had Addison's disease but the adrenal glands were hyperplastic. Brain magnetic resonance imaging revealed diffuse white matter lesion predominantly in the frontal lobe with band-like contrast enhancement. l-Methyl-11C-methionine positron emission tomography revealed accumulation of tracer in bilateral frontal lobes. Stereotactic biopsy demonstrated demyelination changes. A number of urinary organic acids were elevated. Adrenoleukodystrophy was diagnosed by elevated plasma very long chain fatty acid and ABCD1 gene mutation (C1544C/T). Adrenoleukodystrophy should be considered as a differential diagnosis in women with rapidly progressive white matter encephalopathy. Copyright © 2014 Elsevier B.V. All rights reserved.

  9. Addison hastalığı ve gebelik

    Bayrak, Z; Turan, V; Demirtaş, G; Erdoğan, M; Aşkar, N

    2011-01-01

    Primer adrenal yetmezlik nadir görülen bir endokrinolojik hastalıktır. Çoğu idiopatiktir. Tip 1 diabetes mellitus, hipertiroidizm, hipotiroidizm, pernisiyöz anemi gibi otoimmun hastalıklarla ilişkilidir. Yirmi sekiz yaşında 18 yıldır Addison hastalığı nedeni ile tedavi gören ve gebelik istemi olan olguyu gebeliğin ilk haftalarından doğuma ve puerperal döneme kadar takip ettik. Endokrinoloji kliniği ile birlikte takip ettiğimiz hastada kortikosteroid tedavisi ile antenatal ve postnatal dönemde...

  10. Delayed diagnosis of Addison's disease: an approach to management.

    Mascarenhas, Janice V; Jude, Edward B

    2014-07-18

    Addison's disease accounts for the majority of cases of adrenal failure that are detected during hospital admissions. Unfortunately, prompt diagnosis of this condition is often delayed due to varied atypical manifestations and inadequate assessment at the time of presentation. We report a case of a 52-year-old woman who was detected to have hypotension during routine colonoscopy for evaluation of anaemia and progressive weight loss. During admission for evaluation of hypotension, she was also detected to have hyponatremia. Hyponatremia and hypotension failed to improve despite fluid resuscitation. Our endocrinological opinion was sought for and on further evaluation she was diagnosed with primary adrenal insufficiency. Glucocorticoid and mineralocorticoid replacement therapy were eventually instituted, which was followed by restoration of blood pressure and normalisation of serum sodium levels. 2014 BMJ Publishing Group Ltd.

  11. Autoimmune Addison's disease - An update on pathogenesis.

    Hellesen, Alexander; Bratland, Eirik; Husebye, Eystein S

    2018-06-01

    Autoimmunity against the adrenal cortex is the leading cause of Addison's disease in industrialized countries, with prevalence estimates ranging from 93-220 per million in Europe. The immune-mediated attack on adrenocortical cells cripples their ability to synthesize vital steroid hormones and necessitates life-long hormone replacement therapy. The autoimmune disease etiology is multifactorial involving variants in immune genes and environmental factors. Recently, we have come to appreciate that the adrenocortical cell itself is an active player in the autoimmune process. Here we summarize the complex interplay between the immune system and the adrenal cortex and highlight unanswered questions and gaps in our current understanding of the disease. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

  12. Normal overall mortality rate in Addison's disease, but young patients are at risk of premature death.

    Erichsen, Martina M; Løvås, Kristian; Fougner, Kristian J; Svartberg, Johan; Hauge, Erik R; Bollerslev, Jens; Berg, Jens P; Mella, Bjarne; Husebye, Eystein S

    2009-02-01

    Primary adrenal insufficiency (Addison's disease) is a rare autoimmune disease. Until recently, life expectancy in Addison's disease patients was considered normal. To determine the mortality rate in Addison's disease patients. i) Patients registered with Addison's disease in Norway during 1943-2005 were identified through search in hospital diagnosis registries. Scrutiny of the medical records provided diagnostic accuracy and age at diagnosis. ii) The patients who had died were identified from the National Directory of Residents. iii) Background mortality data were obtained from Statistics Norway, and standard mortality rate (SMR) calculated. iv) Death diagnoses were obtained from the Norwegian Death Cause Registry. Totally 811 patients with Addison's disease were identified, of whom 147 were deceased. Overall SMR was 1.15 (95% confidence intervals (CI) 0.96-1.35), similar in females (1.18 (0.92-1.44)) and males (1.10 (0.80-1.39)). Patients diagnosed before the age of 40 had significantly elevated SMR at 1.50 (95% CI 1.09-2.01), most pronounced in males (2.03 (1.19-2.86)). Acute adrenal failure was a major cause of death; infection and sudden death were more common than in the general population. The mean ages at death for females (75.7 years) and males (64.8 years) were 3.2 and 11.2 years less than the estimated life expectancy. Addison's disease is still a potentially lethal condition, with excess mortality in acute adrenal failure, infection, and sudden death in patients diagnosed at young age. Otherwise, the prognosis is excellent for patients with Addison's disease.

  13. County Spending

    Montgomery County of Maryland — This dataset includes County spending data for Montgomery County government. It does not include agency spending. Data considered sensitive or confidential and will...

  14. Decreased physical activity, reduced QoL and presence of debilitating fatigue in patients with Addison's disease

    van der Valk, Eline S.; Smans, Lisanne C C J; Hofstetter, Hedwig; Stubbe, Janine H.; de Vries, Marieke; Backx, Frank J G; Hermus, Ad R M M; Zelissen, Pierre M J

    BACKGROUND: Health related quality of life in patients with Addison's disease has been assessed in various European countries, indicating a reduced quality of life. However, no studies have addressed the impact of Addison's disease on physical activity. OBJECTIVE: The aim of this study was to

  15. Decreased physical activity, reduced QoL and presence of debilitating fatigue in patients with Addison's disease

    Valk, E.S. Van der; Smans, L.C.C.J.; Hofstetter, H.; Stubbe, J.H.; Vries, M de; Backx, F.J.; Hermus, A.R.M.M.; Zelissen, P.M.J.

    2016-01-01

    BACKGROUND: Health-related quality of life in patients with Addison's disease has been assessed in various European countries, indicating a reduced quality of life. However, no studies have addressed the impact of Addison's disease on physical activity. OBJECTIVE: The aim of this study was to

  16. Decreased physical activity, reduced QoL and presence of debilitating fatigue in patients with Addison's disease

    Valk, E.S. van der; Smans, L.C.C.J.; Hofstetter, H.; Stubbe, J.H.; Vries, M. de; Backx, F.J.G.; Hermus, A.R.M.M.; Zelissen, P.M.J.

    2016-01-01

    Background: Health-related quality of life in patients with Addison's disease has been assessed in various European countries, indicating a reduced quality of life. However, no studies have addressed the impact of Addison's disease on physical activity. Objective: The aim of this study was to

  17. JST Thesaurus Headwords and Synonyms: Addison-Biermer貧血 [MeCab user dictionary for science technology term[Archive

    Full Text Available MeCab user dictionary for science technology term Addison-Biermer貧血 名詞 サ変接続 * * * * 悪性貧血... アクセイヒンケツ アクセイヒンケツ Thesaurus2015 200906044106165134 C LS51 UNKNOWN_2 Addison - Biermer 貧血

  18. Multifocal oral melanoacanthoma associated with Addison's disease and hyperthyroidism: a case report.

    Dantas, Thinali Sousa; Nascimento, Isabelly Vidal do; Verde, Maria Elisa Quezado Lima; Alves, Ana Paula Negreiros Nunes; Sousa, Fabrício Bitu; Mota, Mário Rogério Lima

    2017-01-01

    Oral melanoacanthoma is a mucocutaneous, pigmented, rare, benign, and probably reactive lesion. This paper reports for the first time in the literature a case of multifocal oral melanoacanthoma in a patient diagnosed with Addison's disease and concomitant Graves' disease with hyperthyroidism. The patient presented with oral pigmented lesions, which were hypothesized to be mucosal pigmentation associated with Addison's disease. Due to their unusual clinical pattern, these oral lesions were biopsied and diagnosed as oral melanoacanthoma on histopathology and immunohistochemistry for HMB-45. At the moment of this report, the patient was being treated for her systemic conditions, but the lesions had not regressed. Reactive hyperpigmentation of the skin and mucous membranes may be found in Addison's disease and hyperthyroidism. This case reinforces the hypothesis of a reactive nature for oral melanoacanthoma and highlights the need for investigation of endocrine disorders in patients with multifocal oral melanoacanthoma.

  19. Episodic memory impairment in Addison's disease: results from a telephonic cognitive assessment.

    Henry, Michelle; Thomas, Kevin G F; Ross, Ian L

    2014-06-01

    Patients with Addison's disease frequently self-report memory and attention difficulties, even when on standard replacement therapy. However, few published studies examine, using objective measures and assessing across multiple domains, the cognitive functioning of Addison's disease patients relative to healthy controls. The primary aim of this study was to investigate whether the previously reported subjective cognitive deficits in Addison's disease are confirmed by objective measures. Conducting comprehensive neuropsychological assessments of patients with relatively rare clinical disorders, such as Addison's disease, is challenging because access to those patients is often limited, and because their medical condition might prevent extended testing sessions. Brief telephonic cognitive assessments are a useful tool in such circumstances. Hence, we administered the Brief Test of Adult Cognition by Telephone to 27 Addison's disease patients and 27 matched healthy controls. The instrument provides objective assessment of episodic memory, working memory, executive functioning, reasoning, and speed of processing. Statistical analyses confirmed that, as expected, patients performed significantly more poorly than controls on the episodic memory subtest. There were, however, no significant between-group differences on the attention, executive functioning, reasoning, and speed of processing subtests. Furthermore, patients with a longer duration of illness performed more poorly across all domains of cognition. We conclude that, for Addison's disease patients, previously reported subjective cognitive deficits are matched by objective impairment, but only in the domain of episodic memory. Future research might investigate (a) whether these memory deficits are material-specific (i.e., whether non-verbal memory is also affected), and (b) the neurobiological mechanisms underlying these deficits.

  20. Development of a disease-specific quality of life questionnaire in Addison's disease.

    Løvås, Kristian; Curran, Suzanne; Oksnes, Marianne; Husebye, Eystein S; Huppert, Felicia A; Chatterjee, V Krishna K

    2010-02-01

    Patients with Addison's disease reproducibly self-report impairment in specific dimensions of general well-being questionnaires, suggesting particular deficiencies in health-related quality-of-life (HRQoL). We sought to develop an Addison's disease-specific questionnaire (AddiQoL) that could better quantify altered well-being and treatment effects. Design, Setting, Patients, Intervention, and Outcomes: We reviewed the literature to identify HRQoL issues in Addison's disease and interviewed patients and their partners in-depth to explore various symptom domains. A list of items was generated, and nine expert clinicians and five expert patients assessed the list for impact and clarity. A preliminary questionnaire was presented to 100 Addison's outpatients; the number of items was reduced after analysis of the distribution of the responses. The final questionnaire responses were assessed by Cronbach's alpha and Rasch analysis. Published studies of HRQoL in Addison's disease indicated reduced vitality and general health perception and limitations in physical and emotional functioning. In-depth interviews of 14 patients and seven partners emphasized the impact of the disease on the emotional domain. Seventy HRQoL items were generated; after the expert consultation process and pretesting in 100 patients, the number of items was reduced to 36. Eighty-six patients completed the final questionnaire; the responses showed high internal consistency with Cronbach's alpha 0.95 and Person Separation Index 0.94 (Rasch analysis). We envisage AddiQoL having utility in trials of hormone replacement and management of patients with Addison's disease, analogous to similar questionnaires in GH deficiency (AGHDA) and acromegaly (AcroQoL).

  1. MANAGEMENT OF ENDOCRINE DISEASE: Regenerative therapies in autoimmune Addison's disease.

    Gan, Earn H; Pearce, Simon H

    2017-03-01

    The treatment for autoimmune Addison's disease (AAD) has remained virtually unchanged in the last 60 years. Most patients have symptoms that are relatively well controlled with exogenous steroid replacement, but there may be persistent symptoms, recurrent adrenal crisis and poor quality of life, despite good compliance with optimal current treatments. Treatment with conventional exogenous steroid therapy is also associated with premature mortality, increased cardiovascular risk and complications related to excessive steroid replacement. Hence, novel therapeutic approaches have emerged in the last decade attempting to improve the long-term outcome and quality of life of patients with AAD. This review discusses the recent developments in treatment innovations for AAD, including the novel exogenous steroid formulations with the intention of mimicking the physiological biorhythm of cortisol secretion. Our group has also carried out a few studies attempting to restore endogenous glucocorticoid production via immunomodulatory and regenerative medicine approaches. The recent advances in the understanding of adrenocortical stem cell biology, and adrenal plasticity will also be discussed to help comprehend the science behind the therapeutic approaches adopted. © 2017 European Society of Endocrinology.

  2. CTLA-4 as a genetic determinant in autoimmune Addison's disease.

    Wolff, A S B; Mitchell, A L; Cordell, H J; Short, A; Skinningsrud, B; Ollier, W; Badenhoop, K; Meyer, G; Falorni, A; Kampe, O; Undlien, D; Pearce, S H S; Husebye, E S

    2015-09-01

    In common with several other autoimmune diseases, autoimmune Addison's disease (AAD) is thought to be caused by a combination of deleterious susceptibility polymorphisms in several genes, together with undefined environmental factors and stochastic events. To date, the strongest genomic association with AAD has been with alleles at the HLA locus, DR3-DQ2 and DR4. The contribution of other genetic variants has been inconsistent. We have studied the association of 16 single-nucleotide polymorphisms (SNPs) within the CD28-CTLA-4-ICOS genomic locus, in a cohort comprising 691 AAD patients of Norwegian and UK origin with matched controls. We have also performed a meta-analysis including 1002 patients from European countries. The G-allele of SNP rs231775 in CTLA-4 is associated with AAD in Norwegian patients (odds ratio (OR)=1.35 (confidence interval (CI) 1.10-1.66), P=0.004), but not in UK patients. The same allele is associated with AAD in the total European population (OR=1.37 (CI 1.13-1.66), P=0.002). A three-marker haplotype, comprising PROMOTER_1661, rs231726 and rs1896286 was found to be associated with AAD in the Norwegian cohort only (OR 2.43 (CI 1.68-3.51), P=0.00013). This study points to the CTLA-4 gene as a susceptibility locus for the development of AAD, and refines its mapping within the wider genomic locus.

  3. Primary Adrenal Insufficiency (Addison's Disease) Associated with Systemic Lupus Erythematosus: A Rare Occurrence.

    Godswill, Okwuonu Chimezie; Odigie, Ojeh-Oziegbe

    2014-10-01

    Coexistence of Addison's disease and systemic lupus erythematosus (SLE) is a rare occurrence with only few reported cases in the literature. We describe a 29-year-old woman who presented to us with clinical features of acute Addisonian crisis and SLE. Laboratory investigations were confirmatory of Addison's disease in a background of SLE. The patient made remarkable improvement on administration of steroids as replacement therapy for adrenal insufficiency and treatment of SLE. Clinicians need to have a high-index of suspicion of this possible coexistence in order to avoid the associated deleterious hemodynamic and metabolic consequences.

  4. Radioimmunoassay of gastrin level in duodenal ulcer, atrophic gostritis and Addison-Biermer's disease

    Hasik, J.; Kozal, H.; Kosowicz, J.; Hansz, J.

    1975-01-01

    Radioimmunoassay of gastrin level in the blood was performed in 20 controls, 12 patients with duodenal ulcer, 13 patients with atrophic gastritis and 14 patients with Addison-Biermer's disease. Gastrin level in the serum of the patients with duodenal ulcer did not differ significantly from that of controls. In atrophic gastritis and particularly in Addison-Biermer's disease gastrin level was found to be several times higher. This is probably a result of chronic gastrin secretion stimulation which is normally inhibited by gastric juice. (author)

  5. Decreased physical activity, reduced QoL and presence of debilitating fatigue in patients with Addison's disease.

    van der Valk, Eline S; Smans, Lisanne C C J; Hofstetter, Hedwig; Stubbe, Janine H; de Vries, Marieke; Backx, Frank J G; Hermus, Ad R M M; Zelissen, Pierre M J

    2016-09-01

    Health-related quality of life in patients with Addison's disease has been assessed in various European countries, indicating a reduced quality of life. However, no studies have addressed the impact of Addison's disease on physical activity. The aim of this study was to investigate the quality of life in Dutch patients with Addison's disease particularly regarding the presence of fatigue and the ability to be physically active. In this cross-sectional study, a postal survey was performed among Dutch patients with Addison's disease on stable glucocorticoid replacement therapy with hydrocortisone or cortisone acetate. For quality of life and physical activity assessment, patients completed general and health-related quality of life and physical activity questionnaires, and scores were compared to Dutch controls. A total of 328 patients with Addison's disease were studied. In patients with Addison's disease, only 45·7% met the standard of physical activity (Combinorm) compared to 67·8% of Dutch controls (P < 0·01). Forty-eight per cent of patients showed abnormal fatigue, while 61% had severe fatigue. The CIS fatigue scores were significantly higher compared to controls (P < 0·01). We found reduced general subjective health-related QoL scores in both male and female patients, especially in younger patients <65 years of age. Physical activity is decreased in patients with Addison's disease, combined with a reduced subjective health-related QoL and increased fatigue. © 2016 John Wiley & Sons Ltd.

  6. Recurrent hypoglycaemia in type-1 diabetes mellitus may unravel the association with Addison's disease: a case report.

    Passanisi, Stefano; Timpanaro, Tiziana; Lo Presti, Donatella; Caruso-Nicoletti, Manuela

    2014-09-12

    Primary adrenocortical insufficiency or Addison's disease is caused by a progressive destruction of the adrenal cortex, resulting into a reduction of glucocorticoids, mineralocorticoids, and androgens. Autoimmune Addison's disease is the most common etiological form, accounting for about 80% of all cases. We describe the case of a 16-year-old Caucasian boy affected by type-1 diabetes mellitus and autoimmune thyroiditis, who experienced recurrent hypoglycaemia as presenting symptom of Addison's disease. Hypoglycaemia is not a common presenting feature of Addison's disease, both in patients with type-1 diabetes mellitus and in non-diabetic patients. However, hypoglycaemia may occur in association with primary and secondary glucocorticoid deficiency as a result of an enhanced insulin sensitivity. Hypoglycaemia is the most common acute complication of insulin therapy in patients with type-1 diabetes mellitus. Addison's disease has been described in approximately 0.5% of patients with type-1 diabetes mellitus, being more frequent in females and occurring in middle-aged patients. An association among type-1 diabetes mellitus, autoimmune thyroiditis, and Addison's disease is found in the "Schmidt's syndrome", a rare disorder that may occur in the paediatric age. Our case suggests that the presence of Addison's disease should be taken into consideration in patients with type-1 diabetes mellitus and frequent episodes of hypoglycaemia. We wish to highlight that there are no specific indications to screen for the association between Addison's disease and type-1 diabetes mellitus, although an early diagnosis of Addison's disease in diabetic patients would prevent the morbidity and potential mortality of this association.

  7. Immunoglobulins of patients with idiopathic Addison's disease block the in vitro action of adrenocorticotropin

    Wulffraat, N. M.; Drexhage, H. A.; Bottazzo, G. F.; Wiersinga, W. M.; Jeucken, P.; van der Gaag, R.

    1989-01-01

    The presence of serum immunoglobulins (Ig) blocking ACTH-induced adrenal DNA synthesis and/or cortisol production was studied in 25 patients with idiopathic Addison's disease. For this purpose guinea pig adrenal segments kept in organ culture were exposed to ACTH and graded concentrations of patient

  8. Addison's disease due to bilateral post-traumatic adrenal haemorrhage: CT and MR findings

    Wilms, G.; Tits, J.; Vanstraelen, D.; Marchal, G.; Rigauts, H.; Baert, A.L.

    1991-01-01

    In a patient with Addison's disease, who gave a history of a severe car accident, CT showed bilateral enlargement of the adrenal glands. MRI, by demonstrating paramagnetic T1 shortening due to methaemoglobin and haemosiderin on T2-weighted images, confirmed the haemorrhagic nature of the lesions. (orig.)

  9. From Appearance of Adrenal Autoantibodies to Clinical Symptoms of Addison's Disease: Natural History.

    Betterle, Corrado; Garelli, Silvia; Presotto, Fabio; Furmaniak, Jadwiga

    2016-01-01

    Recent progress in the immunopathology field has greatly improved our understanding of the natural history of autoimmune diseases, particularly of Addison's disease. Addison's disease is known to be a chronic illness characterized by adrenocortical gland insufficiency that develops following a long and mainly asymptomatic period, characterized by the presence of circulating autoantibodies directed to adrenal cortex antigens. In this chapter we describe the groups of subjects at risk of developing Addison's disease, together with the diagnostic tests considered the most appropriate for evaluating adrenal function: determination of basal plasma adrenocorticotropic hormone (ACTH) levels, plasma renin activity, plasma aldosterone and cortisol levels, and cortisol levels after intravenous stimulation with ACTH (ACTH test). The employment of specific clinical, immunological and functional criteria in the subjects with autoantibodies to the adrenal cortex allows identifying those at risk of developing overt disease. The independent risk factors for the progression to adrenal failure have also been identified and they contribute to different risks of developing clinical Addison's disease. Based on the risk level, the subjects should be monitored over time to observe early signs of adrenal dysfunction, and start substitutive treatment as soon as possible. For patients presenting with high risk, prevention strategies and trials might be available. © 2016 S. Karger AG, Basel.

  10. Addison's disease due to tuberculosis in a 13-year-old girl

    Jagannath, A.; Brill, P.W.; Winchester, P.

    1986-01-01

    A 13-year-old girl developed Addison's disease during antituberculous therapy for presumed tuberculous ventriculitis. CT of the abdomen showed diffusely enlarged hypodense adrenals and a hypodense lesion in the lower pole of the left kidney. Biopsy of the renal lesion revealed caseating and noncaseating granolomas. (orig.)

  11. Residual adrenal function in autoimmune Addison's disease: improvement after tetracosactide (ACTH1-24) treatment.

    Gan, Earn H; MacArthur, Katie; Mitchell, Anna L; Hughes, Beverly A; Perros, Petros; Ball, Stephen G; James, R Andrew; Quinton, Richard; Chen, Shu; Furmaniak, Jadwiga; Arlt, Wiebke; Pearce, Simon H S

    2014-01-01

    Despite lifelong steroid hormone replacement, there is excess morbidity and mortality associated with autoimmune Addison's disease. In health, adrenocortical cells undergo continuous self-renewal from a population of subcapsular progenitor cells, under the influence of ACTH, suggesting a therapeutic possibility. We aimed to determine whether tetracosactide (synthetic ACTH1-24) could revive adrenal steroidogenic function in autoimmune Addison's disease. Thirteen patients (aged 16-65 y) with established autoimmune Addison's disease for more than 1 year were recruited at the Newcastle University Clinical Research Facility. The intervention included a 20-week study of regular sc tetracosactide (ACTH1-24) therapy. Serum and urine corticosteroids were measured during medication withdrawal at baseline and every 5 weeks during the study. Serum cortisol levels remained less than 100 nmol/L in 11 of 13 participants throughout the study. However, two women achieved peak serum cortisol concentrations greater than 400 nmol/L after 10 and 29 weeks of tetracosactide therapy, respectively, allowing withdrawal of corticosteroid replacement. Concurrently, urine glucocorticoid and mineralocorticoid metabolite excretion increased from subnormal to above the median of healthy controls. One of these responders remains well with improving peak serum cortisol (672 nmol/L) 28 months after stopping all treatments. The other responder showed a gradual reduction in serum cortisol and aldosterone over time, and steroid therapy was recommenced after a 28-week period without glucocorticoid replacement. This is the first study to demonstrate that established autoimmune Addison's disease is amenable to a regenerative medicine therapy approach.

  12. Misdiagnosis of Addison's disease in a patient with end-stage renal disease.

    Kocyigit, Ismail; Unal, Aydin; Tanriverdi, Fatih; Hayri Sipahioglu, Murat; Tokgoz, Bulent; Oymak, Oktay; Utas, Cengiz

    2011-01-01

    Addison's disease is a rare disorder in patients with end-stage renal disease (ESRD). In patients, the diagnosis of Addison's disease is difficult in clinical practice because most of the clinical findings of this disease are similar to those of the renal failure. We present a 51-year-old male patient, who underwent hemodialysis therapy for 8 years, diagnosed with Addison's disease after having myalgia, skin hyperpigmentation, weight loss, sweating, and nausea for the past few weeks. The physical examination was completely normal except for muscle weakness, hyperpigmentation on labial mucosa and skin in a patient. The laboratory tests revealed anemia and hypoglycemia. Serum cortisol, adrenocorticotropic hormone (ACTH) levels, and ACTH stimulation test results were consistent with Addison's disease. Adrenal computerized tomography revealed bilateral atrophic glands. Additionally, it was found that elevated serum thyroid stimulating hormone levels and antithyroid peroxidase antibody titer were positive. Our purpose is to emphasize that physicians should be alert to the potential for additional different conditions particularly in terms of adrenal failure in patients with ESRD.

  13. Apoptosis in subicular neurons: A comparison between suicide and Addison's disease

    Printha, K.; Hulathduwa, S. R.; Samarasinghe, K.; Suh, Y. H.; De Silva, K. R. D.

    2009-01-01

    Background: Stress and depression shows possible links to neuronal death in hippocampus. Subiculum plays a prominent role in limbic stress integration and direct effect of corticosteroids on subicular neurons needs to be defined to assess its subsequent impact on hippocampal plasticity. Aim: This study was intended to assess apoptosis in subicular neurons of a young depressed suicide victim, where presumably stress induced excess of corticosteroids and a case of young Addison's disease with low level of corticosteroids. Materials and Method: Both bilateral adrenal glands (Addison's) and subiculum (both cases) were initially stained with hematoxylin and eosin; subicular neurons of both cases were examined for the degree of apoptosis using ‘ApopTag Kit’. Apoptotic cell counts were expressed as average number of labeled cells/mm2 and the results were analysed statistically using a non-parametric Mann–Whitney U test. Result: Apoptotic neurons were detected in the subicular region of both suicide and Addison victims, and it is statistically significant in both right and left between the cases (P Addison disease where the number of neuronal cell death between right and left was statistically insignificant (P > 0.05). Conclusion: The present study confirms the vulnerability of the subicular neurons to apoptosis, possibly due to corticosteroids in both ends of spectrum. PMID:20048453

  14. Scott Foresman-Addison Wesley Elementary Mathematics. What Works Clearinghouse Intervention Report

    What Works Clearinghouse, 2010

    2010-01-01

    "Scott Foresman-Addison Wesley Elementary Mathematics" is a core curriculum for students at all ability levels in prekindergarten through grade 6. The program supports students' understanding of key math concepts and skills and covers a range of mathematical content across grades. The What Works Clearinghouse (WWC) reviewed 12 studies on…

  15. Scott Foresman-Addison Wesley Elementary Mathematics. What Works Clearinghouse Intervention Report. Updated

    What Works Clearinghouse, 2013

    2013-01-01

    "Scott Foresman-Addison Wesley Elementary Mathematics" is a core mathematics curriculum for students in prekindergarten through grade 6. The program aims to improve students' understanding of key math concepts through problem-solving instruction, hands-on activities, and math problems that involve reading and writing. The curriculum…

  16. Addisons disease in an Indian female – A rarity | Brar | Sudanese ...

    caused by autoimmune destruction of adrenal gland cortex. Those with Addisons disease have a deficiency of cortisol and aldostreone. These deficiencies are accompanied by adrenal androgen depletion. A case report of 43 year old female is hereby reported. The patient presented with hyperpigmentation of nipples, ...

  17. Addison's Disease in Evolution: An Illustrative Case and Literature Review.

    Hinz, Laura E; Kline, Gregory A; Dias, Valerian C

    2014-09-01

    To present a case of symptomatic autoimmune adrenal insufficiency with initially normal serum cortisol and to caution about limitations of the current diagnostic algorithm for adrenal insufficiency, which does not reflect the pathophysiology of early disease. We describe the clinical presentation and relevant investigations of a patient ultimately found to have Addison's disease, which is followed by a focused review of the literature. A 41-year-old Caucasian woman with autoimmune hypothyroidism, premature ovarian failure, and microscopic colitis presented with nausea, salt craving, increased skin pigmentation, and postural hypotension. Initial bloodwork revealed a normal morning cortisol of level of 19.2 μg/dL (normal, 7.2 to 25 μg/dL) but an adrenocorticotropic hormone (ACTH) level 10 times normal, at 513.6 pg/mL (normal, <52.5 pg/mL). Her potassium was normal, but her aldosterone level was 4.12 ng/dL (normal, 12.3 to 62.5 ng/dL) and her renin activity was increased (23.0 mg/dL/hour; normal, <6.0 mg/dL/hour). Six weeks after initial presentation, she was found to have anti-adrenal antibodies. It was not until 10 weeks after her initial symptomatic presentation that her morning cortisol level was found to be subnormal and a formal diagnosis of adrenal insufficiency was made. The present case and literature review reveal that common diagnostic approaches will miss patients with (possibly symptomatic) early adrenal insufficiency. We suggest that serum ACTH level testing or tests of mineralocorticoid function be included in the initial step of investigation for suspected primary adrenal insufficiency.

  18. VT Data - VTORTHO Black & White Imagery (0.15m) 2017, Addison County

    Vermont Center for Geographic Information — (Link to Metadata) This metadata record describes the acquisition and production of 15 centimeter ground sample distance (GSD) natural color and color infrared...

  19. VT Data - VTORTHO Color Imagery (0.15m) 2017, Addison County

    Vermont Center for Geographic Information — (Link to Metadata) This metadata record describes the acquisition and production of 15 centimeter ground sample distance (GSD) natural color and color infrared...

  20. Recovery of adrenal function in a patient with confirmed Addison's disease

    Baxter, M; Gorick, S; Swords, F M

    2013-01-01

    Summary Addison's disease is a condition characterised by immune-mediated destruction of the adrenal glands leading to a requirement of lifelong replacement therapy with mineralocorticoid and glucocorticoid. We present a case of a 53-year-old man who presented at the age of 37 years with nausea, fatigue and dizziness. He was found to have postural hypotension and buccal pigmentation. His presenting cortisol level was 43 nmol/l with no response to Synacthen testing. He made an excellent response to conventional replacement therapy with hydrocortisone and fludrocortisone and then remained well for 16 years. On registering with a new endocrinologist, his hydrocortisone dose was revised downwards and pre- and post-dose serum cortisol levels were assessed. His pre-dose cortisol was surprisingly elevated, and so his dose was further reduced. Subsequent Synacthen testing was normal and has remained so for further 12 months. He is now asymptomatic without glucocorticoid therapy, although he continues on fludrocortisone 50 μg daily. His adrenal antibodies are positive, although his ACTH and renin levels remain elevated after treatment. Addison's disease is generally deemed to lead to irreversible cell-mediated immune destruction of the adrenal glands. For this reason, patients receive detailed counselling and education on the need for lifelong replacement therapy. To our knowledge, this is the third reported case of spontaneous recovery of the adrenal axis in Addison's disease. Recovery may therefore be more common than previously appreciated, which may have major implications for the treatment and monitoring of this condition, and for the education given to patients at diagnosis. Learning points Partial recovery from Addison's disease is possible although uncommon.Patients with long-term endocrine conditions on replacement therapy still benefit from regular clinical and biochemical assessment, to revisit optimal management.As further reports of adrenal axis recovery

  1. Effect of steroid replacement on thyroid function and thyroid autoimmunity in Addison's disease with primary hypothyroidism.

    Sahoo, Jaya Prakash; Selviambigapathy, Jayakumar; Kamalanathan, Sadishkumar; Nagarajan, K; Vivekanandan, Muthupillai

    2016-01-01

    Steroid replacement without thyroxine supplementation normalizes thyroid function test (TFT) in some but not all Addison's disease patients with primary hypothyroidism. Both autoimmune and nonautoimmune mechanisms contribute to this improvement in TFT. However, the documentation of the change in thyroid autoimmunity after cortisol replacement is very limited in the literature. The aim of this study was to determine the effect of steroid replacement on TFT and anti-thyroid peroxidase antibody (anti-TPO-Ab) titer in Addison's disease with primary hypothyroidism. This observational study was conducted in a tertiary care center in South India. Six Addison's disease patients with primary hypothyroidism, who were only on steroid replacement, were included in the study. Low serum cortisol (22 pmol/L) and/or hyperpigmentation of skin/mucous membranes was considered as the diagnostic criteria for Addison's disease. Primary hypothyroidism (both overt and subclinical) was defined as high thyroid stimulating hormone (TSH) with/without low free thyroxine (fT4). TFT and anti-TPO-Ab were performed before and after steroid replacement in all of them. Poststeroid replacement, there was a normalization of TSH in all but one subjects. In overt hypothyroidism patients, fT4 also normalized. The improvement in TFT was not associated with decreasing titer of the anti-TPO-Ab in all six patients. However, there was a significant difference in TSH after steroid replacement compared to the baseline status. The concept of normalization of primary hypothyroidism with cortisol replacement in patients with Addison's disease should be recognized to avoid iatrogenic thyrotoxicosis caused by thyroxine replacement. Both autoimmune and nonautoimmune mechanisms contribute to these alterations.

  2. Recovery of adrenal function in a patient with confirmed Addison's disease.

    Baxter, M; Gorick, S; Swords, F M

    2013-01-01

    Addison's disease is a condition characterised by immune-mediated destruction of the adrenal glands leading to a requirement of lifelong replacement therapy with mineralocorticoid and glucocorticoid. We present a case of a 53-year-old man who presented at the age of 37 years with nausea, fatigue and dizziness. He was found to have postural hypotension and buccal pigmentation. His presenting cortisol level was 43 nmol/l with no response to Synacthen testing. He made an excellent response to conventional replacement therapy with hydrocortisone and fludrocortisone and then remained well for 16 years. On registering with a new endocrinologist, his hydrocortisone dose was revised downwards and pre- and post-dose serum cortisol levels were assessed. His pre-dose cortisol was surprisingly elevated, and so his dose was further reduced. Subsequent Synacthen testing was normal and has remained so for further 12 months. He is now asymptomatic without glucocorticoid therapy, although he continues on fludrocortisone 50 μg daily. His adrenal antibodies are positive, although his ACTH and renin levels remain elevated after treatment. Addison's disease is generally deemed to lead to irreversible cell-mediated immune destruction of the adrenal glands. For this reason, patients receive detailed counselling and education on the need for lifelong replacement therapy. To our knowledge, this is the third reported case of spontaneous recovery of the adrenal axis in Addison's disease. Recovery may therefore be more common than previously appreciated, which may have major implications for the treatment and monitoring of this condition, and for the education given to patients at diagnosis. Partial recovery from Addison's disease is possible although uncommon.Patients with long-term endocrine conditions on replacement therapy still benefit from regular clinical and biochemical assessment, to revisit optimal management.As further reports of adrenal axis recovery emerge, this may

  3. Effect of steroid replacement on thyroid function and thyroid autoimmunity in Addison's disease with primary hypothyroidism

    Sahoo, Jaya Prakash; Selviambigapathy, Jayakumar; Kamalanathan, Sadishkumar; Nagarajan, K.; Vivekanandan, Muthupillai

    2016-01-01

    Background: Steroid replacement without thyroxine supplementation normalizes thyroid function test (TFT) in some but not all Addison's disease patients with primary hypothyroidism. Both autoimmune and nonautoimmune mechanisms contribute to this improvement in TFT. However, the documentation of the change in thyroid autoimmunity after cortisol replacement is very limited in the literature. The aim of this study was to determine the effect of steroid replacement on TFT and anti-thyroid peroxidase antibody (anti-TPO-Ab) titer in Addison's disease with primary hypothyroidism. Materials and Methods: This observational study was conducted in a tertiary care center in South India. Six Addison's disease patients with primary hypothyroidism, who were only on steroid replacement, were included in the study. Low serum cortisol (22 pmol/L) and/or hyperpigmentation of skin/mucous membranes was considered as the diagnostic criteria for Addison's disease. Primary hypothyroidism (both overt and subclinical) was defined as high thyroid stimulating hormone (TSH) with/without low free thyroxine (fT4). TFT and anti-TPO-Ab were performed before and after steroid replacement in all of them. Results: Poststeroid replacement, there was a normalization of TSH in all but one subjects. In overt hypothyroidism patients, fT4 also normalized. The improvement in TFT was not associated with decreasing titer of the anti-TPO-Ab in all six patients. However, there was a significant difference in TSH after steroid replacement compared to the baseline status. Conclusions: The concept of normalization of primary hypothyroidism with cortisol replacement in patients with Addison's disease should be recognized to avoid iatrogenic thyrotoxicosis caused by thyroxine replacement. Both autoimmune and nonautoimmune mechanisms contribute to these alterations. PMID:27042409

  4. Primary anti-phospholipid antibody syndrome causing recurrent venous thrombosis and thrombocytopenia in a patient with Addison's disease.

    Elebrashy, Ibrahim; Yousief, Elham; Saif, Aasem

    2014-12-01

    We report a case of Addison's disease presenting with recurrent deep venous thrombosis and thrombocytopenia and proved to have primary anti-phospholipid antibody syndrome. The case report highlights the shared autoimmune nature of both diseases.

  5. Coma hiponatrêmico como manifestação de doença de Addison Hyponatremic coma as a manifestation of Addison's disease

    Paulo S.M. Esperon

    2001-08-01

    Full Text Available OBJETIVO: alertar sobre a importância de distúrbio hidroeletrolítico grave devido a doença crônica não previamente diagnosticada. MÉTODO: relato de um caso de coma hiponatrêmico devido a crise adrenal em criança portadora de doença de Addison não diagnosticada previamente, apesar de história clínica sugestiva desta doença há cerca de quatro anos. RESULTADO: Após atendimento inicial à emergência, com correção da hiponatremia grave com hipovolemia discreta, hipernatriúria e hiperpotassemia, o diagnóstico diferencial deste distúrbio hidroeletrolítico revelou tratar-se de uma crise adrenal secundária a uma insuficiência adrenal primária crônica. O tratamento com hidrocortisona oral possibilitou alta hospitalar com correção total dos distúrbios metabólicos. CONCLUSÃO: é importante manter um alto grau de suspeita de doença de Addison para evitar as graves conseqüências de seu diagnóstico tardio, como distúrbios hidroeletrolíticos graves, além de atraso de crescimento e desenvolvimento.OBJECTIVE: To show the importance of severe hydroelectrolytic disorder as a consequence of previously undiagnosed chronic disease. DESCRIPTION: Case report of hyponatremic coma caused by adrenal crisis in a child with previously undiagnosed Addison's disease despite suggestive clinical findings of this disease in the last four years. After correction of severe hyponatremia, mild hypovolemia, hypernatriuria and hyperkalemia, the differential diagnosis of this hydroelectrolytic disorder revealed an adrenal crisis resulting from a primary chronic adrenal insufficiency. Oral treatment with hydrocortisone was efficient in correcting the metabolic disorder and the patient was then discharged. COMMENTS: It is very important to highly suspect of Addison's disease in order to avoid the dangerous consequences of late diagnosis such as severe hydroelectrolytic disorders and retarded growth and development.

  6. First presentation of Addison's disease as hyperkalaemia in acute kidney injury.

    Maki, Sara; Kramarz, Caroline; Maria Heister, Paula; Pasha, Kamran

    2016-05-11

    Addison's disease is a rare endocrine disorder that frequently presents with non-specific symptoms, but may deteriorate rapidly into life-threatening Addisonian crisis if left untreated. Diagnosis can be difficult in patients without a suggestive medical history. We describe a case of a 37-year-old man who was admitted with acute kidney injury and hyperkalaemia, resistant to treatment with insulin/dextrose and calcium gluconate. On clinical examination, he was found to be hyperpigmented; a subsequent random serum cortisol of 49 nmol/L affirmed the preliminary diagnosis of Addison's disease. The patient's hyperkalaemia improved on treatment with hydrocortisone, and a follow-up morning adrenocorticotropic hormone of 1051 ng/L confirmed the diagnosis. 2016 BMJ Publishing Group Ltd.

  7. Prolonged Dyspnea after Interscalene Block: Attributed to Undiagnosed Addison's Disease and Myasthenia Gravis

    John G. Skedros

    2011-01-01

    Full Text Available This report describes a patient who had a series of daily interscalene nerve blocks to treat pain following a shoulder manipulation for postsurgical stiffness. She experienced acute respiratory compromise that persisted for many weeks. All typical and unusual causes of these symptoms were ruled out. Her treating pulmonologist theorized that the ipsilateral carotid body had been injured. However, it was subsequently determined that the constellation of symptoms and their prolonged duration were best explained by a poor stress response from Addison's disease coupled with exacerbation of early onset myasthenia gravis. This patient's case is not a typical reaction to interscalene nerve blocks, and thus preoperative testing would not be recommended for myasthenia gravis or Addison's disease without underlying suspicion. We describe this report to inform physicians to consider a workup for these diagnoses if a typical workup rules out all usual causes of complications from an interscalene block.

  8. Prolonged Dyspnea after Interscalene Block: Attributed to Undiagnosed Addison's Disease and Myasthenia Gravis.

    Skedros, John G; Kiser, Casey J; Mendenhall, Shaun D

    2011-01-01

    This report describes a patient who had a series of daily interscalene nerve blocks to treat pain following a shoulder manipulation for postsurgical stiffness. She experienced acute respiratory compromise that persisted for many weeks. All typical and unusual causes of these symptoms were ruled out. Her treating pulmonologist theorized that the ipsilateral carotid body had been injured. However, it was subsequently determined that the constellation of symptoms and their prolonged duration were best explained by a poor stress response from Addison's disease coupled with exacerbation of early onset myasthenia gravis. This patient's case is not a typical reaction to interscalene nerve blocks, and thus preoperative testing would not be recommended for myasthenia gravis or Addison's disease without underlying suspicion. We describe this report to inform physicians to consider a workup for these diagnoses if a typical workup rules out all usual causes of complications from an interscalene block.

  9. DOENÇA DE ADDISON: A DIFICULDADE DO DIAGNÓSTICO

    Clara Preto

    2016-07-01

    Discussão: A doença de Addison é uma patologia rara em idade pediátrica e o seu diagnóstico requer um elevado grau de suspeição, dada a inespecificidade da sintomatologia inicial. Os autores pretendem alertar para a suspeição necessária perante uma clínica de hiponatrémia associada a sintomas constitucionais e gastrointestinais.

  10. Male and female hypogonadism are highly prevalent in South Africans with Addison's disease.

    Ross, I L; Levitt, N S; Blom, D J; Haarburger, D

    2014-09-01

    Hypogonadism may complicate Addison's disease (primary hypoadrenalism), but prevalence and metabolic sequelae of hypogonadism in Addison's disease are poorly described. We recruited patients from the South African Addison's disease national registry who received stable replacement doses of hydrocortisone and had no acute illness. Male biochemical testosterone deficiency was defined as an early morning basal testosterone10 or 12 IU/l). Testosterone deficiency did not correlate with age, disease duration or hydrocortisone dose. Untreated male hypogonadal subjects had a higher (mean ± standard deviation) BMI compared to eugonadal subjects 29.2 ± 4.9 kg/m(2) vs. 24.7 ± 3.4 kg/m(2) (p=0.01) and a higher median (interquartile range) high-sensitive-CRP 6.4 (2.5-14.0) mg/l vs. 1.45 (0.6-2.8) mg/l (p=0.002). There were no differences between the 2 groups in lipids, lipoproteins and fasting glucose. The median (interquartile range) DHEAS was lower in the hypogonadal 0.31 (0.27-0.37) μmol/l, compared with the eugonadal group 0.75 (0.50-1.51) μmol/l (p=0.005). POF was documented in 11% of female patients. Male testosterone deficiency was highly prevalent in this cohort and was primarily due to secondary hypogonadism. Only BMI and hs-CRP were increased in untreated male hypogonadal subjects. Male and female hypogonadism appears to be a common complication of Addison's disease and may contribute to its morbidity. © Georg Thieme Verlag KG Stuttgart · New York.

  11. Addison's disease symptoms--a cross sectional study in urban South Africa.

    Ian Louis Ross

    Full Text Available BACKGROUND: Addison's disease is a potentially life-threatening disorder, and prompt diagnosis, and introduction of steroid replacement has resulted in near normal life-expectancy. There are limited data describing the clinical presentation of Addison's disease in South Africa. It is hypothesised that patients may present in advanced state of ill-health, compared to Western countries. PATIENTS: A national database of patients was compiled from primary care, referral centres and private practices. 148 patients were enrolled (97 white, 34 mixed ancestry, 5 Asian and 12 black. METHODS: Demographic and clinical data were elicited using questionnaires. Biochemical data were obtained from folder reviews and laboratory archived results. RESULTS: The majority of the cohort was women (62%. The median and inter-quartile age range (IQR of patients at enrolment was 46.0 (32.0-61.0 years, with a wide range from 2.8-88.0 years. The median and IQR age at initial diagnosis was 34.0 (20.0-45.0 years (range 0.02-77.0 years, indicating that at the time of enrolment, the patients, on average, were diagnosed with Addison's disease 12 years previously. Hyperpigmentation was observed in 76%, nausea and vomiting occurred in more than 40%, and weight loss was noted in 25%. Loss of consciousness as a presenting feature was recorded in 20%. with a 95% confidence interval [CI] of (14-28% and shock occurred in 5% CI (1.5-8.5%. Case-finding was recorded at 3.1 per million. CONCLUSIONS: The usual constellation of hyperpigmentation, nausea, vomiting and weight loss suggests Addison's disease, but a significant proportion present with an advanced state of ill-health and Addisonian crises. A lower prevalence rate, compared to Western countries is suggested.

  12. Tuberculous Addison's disease: Morphological and quantitative evaluation with multidetector-row CT

    Ma Ensen; Yang Zhigang; Li Yuan; Guo Yingkun; Deng Yuping; Zhang Xiaochun

    2007-01-01

    Objective: To determine the characteristics of tuberculous Addison's disease on the axial and multiplanar reformatted (MPR) images of the multidetector-row computed tomography (MDCT). Materials and methods: The unenhanced and contrast-enhanced MDCT features in 19 patients with tuberculous Addison's disease were retrospectively assessed for the location, contour, size, calcification, attenuation, and enhancement patterns. The correlation between the duration of Addison's disease and the percentage of calcification presence was evaluated. Results: The adrenal glands were infected bilaterally in all of the 19 cases (100%, 38 glands). Enlargement of the glands appeared in 18 cases (94.7%, 36 glands) and the remaining one case (5.3%, two glands) showed atrophy bilaterally. Of the 36 enlarged adrenals, 13 (36.1%) had preserved contours, and the other 23 (63.9%) were mass-like. The size of the adrenals ranged from 0.6 to 4.8cm (mean 1.92+/-0.96cm). Calcification was revealed in 16 adrenals (16/38, 42.1%), increasing in incidence with disease progression. Fourteen of the 36 (38.9%) enlarged adrenals showed peripheral enhancement while the remaining 22 (61.1%) demonstrated heterogeneous enhancement. The ΔCT value, the attenuation measurement of mass-like lesions, was less in the central area (7+/-4HU) than that in the peripheral area (32+/-14HU) (P<0.01) between the unenhanced and contrast-enhanced scan. Conclusion: MDCT can reveal the characteristic morphology and CT attenuation in the tuberculous Addison's disease. Combined with its clinical presentations and biochemical findings, we can diagnose and stage adrenal tuberculosis with high specificity and accuracy on MDCT

  13. A case of adrenoleukodystrophy presenting with manic symptoms in a patient on steroids for Addison's disease.

    Jyothi, K S; George, Cyriac; Shaji, K S

    2016-01-01

    Adrenoleukodystrophy (ALD) is an X-linked disorder with diverse clinical presentations. A 30-year-old male, previously diagnosed with Addison's disease, on steroid supplementation for 18 years, presented to us with manic symptoms for 4 years. He was found to have white matter hypodensities in computed tomography head and had white matter signal changes in magnetic resonance imaging, and therefore a diagnosis of ALD was made.

  14. Adrenal steroidogenesis after B lymphocyte depletion therapy in new-onset Addison's disease.

    Pearce, Simon H S; Mitchell, Anna L; Bennett, Stuart; King, Phil; Chandran, Sukesh; Nag, Sath; Chen, Shu; Smith, Bernard Rees; Isaacs, John D; Vaidya, Bijay

    2012-10-01

    A diagnosis of Addison's disease means lifelong dependence on daily glucocorticoid and mineralocorticoid therapy and is associated with increased morbidity and mortality as well as a risk of unexpected adrenal crisis. The objective of the study was to determine whether immunomodulatory therapy at an early stage of autoimmune Addison's disease could lead to preservation or improvement in adrenal steroidogenesis. This was an open-label, pilot study of B lymphocyte depletion therapy in new-onset idiopathic primary adrenal failure. Doses of iv rituximab (1 g) were given on d 1 and 15, after pretreatment with 125 mg iv methylprednisolone. Six patients (aged 17-47 yr; four females) were treated within 4 wk of the first diagnosis of idiopathic primary adrenal failure. Dynamic testing of adrenal function was performed every 3 months for at least 12 months. Serum cortisol levels declined rapidly and were less than 100 nmol/liter (3.6 μg/dl) in all patients by 3 months after B lymphocyte depletion. Serum cortisol and aldosterone concentrations remained low in five of the six patients throughout the follow-up period. However, a single patient had sustained improvement in both serum cortisol [peak 434 nmol/liter (15.7 μg/dl)] and aldosterone [peak 434 pmol/liter (15.7 ng/dl)] secretion. This patient was able to discontinue steroid medications 15 months after therapy and remains well, with improving serum cortisol levels 27 months after therapy. New-onset autoimmune Addison's disease should be considered as a potentially reversible condition in some patients. Future studies of immunomodulation in autoimmune Addison's disease may be warranted.

  15. Addison's disease symptoms--a cross sectional study in urban South Africa.

    Ross, Ian Louis; Levitt, Naomi S

    2013-01-01

    Addison's disease is a potentially life-threatening disorder, and prompt diagnosis, and introduction of steroid replacement has resulted in near normal life-expectancy. There are limited data describing the clinical presentation of Addison's disease in South Africa. It is hypothesised that patients may present in advanced state of ill-health, compared to Western countries. A national database of patients was compiled from primary care, referral centres and private practices. 148 patients were enrolled (97 white, 34 mixed ancestry, 5 Asian and 12 black). Demographic and clinical data were elicited using questionnaires. Biochemical data were obtained from folder reviews and laboratory archived results. The majority of the cohort was women (62%). The median and inter-quartile age range (IQR) of patients at enrolment was 46.0 (32.0-61.0) years, with a wide range from 2.8-88.0 years. The median and IQR age at initial diagnosis was 34.0 (20.0-45.0) years (range 0.02-77.0) years, indicating that at the time of enrolment, the patients, on average, were diagnosed with Addison's disease 12 years previously. Hyperpigmentation was observed in 76%, nausea and vomiting occurred in more than 40%, and weight loss was noted in 25%. Loss of consciousness as a presenting feature was recorded in 20%. with a 95% confidence interval [CI] of (14-28%) and shock occurred in 5% CI (1.5-8.5%). Case-finding was recorded at 3.1 per million. The usual constellation of hyperpigmentation, nausea, vomiting and weight loss suggests Addison's disease, but a significant proportion present with an advanced state of ill-health and Addisonian crises. A lower prevalence rate, compared to Western countries is suggested.

  16. Salivary cortisol day curves in assessing glucocorticoid replacement therapy in Addison's disease.

    Smans, Lisanne; Lentjes, Eef; Hermus, Ad; Zelissen, Pierre

    2013-01-01

    Patients with Addison's disease require lifelong treatment with glucocorticoids. At present, no glucocorticoid replacement therapy (GRT) can exactly mimic normal physiology. As a consequence, under- and especially overtreatment can occur. Suboptimal GRT may lead to various side effects. The aim of this study was to investigate the use of salivary cortisol day curves (SCDC) in the individual adjustment of GRT in order to approach normal cortisol levels as closely as possible, reduce over- and underreplacement and study the short-term effects on quality of life (QoL). Twenty patients with Addison's disease were included in this prospective study. A SCDC was obtained and compared to normal controls; general and disease specific QoL-questionnaires were completed. Based on SCDC assessment of over- and undertreatment (calculated as duration (h) × magnitude (nmol/L) at different time points, glucocorticoid dose and regime were adjusted. After 4 weeks SCDC and QoL assessment were repeated and the effect of adjusting GRT was analysed. At baseline, underreplacement was present in 3 and overreplacement in 18 patients; total calculated overreplacement was 32.8 h.nmol/L. Overreplacement decreased significantly to 13.3 h. nmol/L (p =0.005) after adjustment of GRT. Overreplacement was found particularly in the afternoon and evening. After reducing overreplacement in the evening, complaints about sleep disturbances significantly decreased. Individual adjustment of GRT based on SCDC to approach normal cortisol concentrations during the day can reduce overreplacement, especially in the evening. This can lead to a reduction of sleep disturbances and fatigue in patients with Addison's disease. A SCDC is a simple and patient-friendly tool for adjusting GRT and can be useful in the follow-up of patients with Addison's disease.

  17. Adrenal crisis in treated Addison's disease: a predictable but under-managed event.

    White, Katherine; Arlt, Wiebke

    2010-01-01

    Adrenal crisis is a life-threatening event that occurs regularly in Addison's patients receiving standard replacement therapy. Patient reports suggest that it is an underestimated and under-managed event. To assess the frequency of adrenal crisis in diagnosed patients and to understand the factors contributing to the risks of adrenal crisis. We conducted a postal survey of Addison's patients in four countries, UK (n=485), Canada (n=148), Australia (n=123) and New Zealand (n=85) in 2003, asking about patients' experiences of adrenal crisis and their demographic characteristics. In 2006, a shorter follow-up survey was conducted in the UK (n=261). The frequency and causes of adrenal crisis were compared across both surveys. Demographic data from the 2003 survey were analysed to establish the main variables associated with an elevated risk of crisis. Around 8% of diagnosed cases can be expected to need hospital treatment for adrenal crisis annually. Exposure to gastric infection is the single most important factor predicting the likelihood of adrenal crisis. Concomitant diabetes and/or asthma increase the frequency of adrenal crises reported by patients. The endocrinologist has a responsibility to ensure that Addison's patients have adequate access to life-saving emergency injection materials and repeated, practical training sessions in how to use them, while the general practitioner plays a vital role as in arranging prompt emergency admissions.

  18. Severe hyponatraemia with absence of hyperkalaemia in rapidly progressive Addison's disease.

    Thompson, Michael D; Kalmar, Eileen; Bowden, Sasigarn A

    2015-05-28

    We present a case of rapidly progressing Addison's disease in adrenal crisis with severe hyponatraemia and absence of hyperkalaemia in a 10-year-old girl. She presented with 2 weeks of vomiting, fatigue and weight loss. Her serum electrolytes obtained 1 week prior to presentation were normal, except for mild hyponatraemia at 131 mmol/L, which dropped to 112 mmol/L on admission. She had normal serum potassium, low-serum osmolality, with elevated urine sodium and osmolality, indistinguishable from syndrome of inappropriate antidiuretic hormone (SIADH). Subsequently, Addison's disease was diagnosed on the basis of gingival hyperpigmentation and undetectable cortisol on adrenocorticotropic hormone stimulation test. She rapidly responded to stress dose hydrocortisone, followed by hydrocortisone and fludrocortisone replacement therapy. The absence of hyperkalaemia in the presence of severe hyponatraemia cannot rule out Addison's disease in children. The mechanism of hypo-osmolar hyponatraemia in primary adrenal insufficiency and clinical clues to differentiate it from SIADH are discussed. 2015 BMJ Publishing Group Ltd.

  19. Management of hypertension and heart failure in patients with Addison's disease.

    Inder, Warrick J; Meyer, Caroline; Hunt, Penny J

    2015-06-01

    Addison's disease may be complicated by hypertension and less commonly by heart failure. We review the pathophysiology of the renin-angiotensin-aldosterone axis in Addison's disease and how this is altered in the setting of hypertension and heart failure. An essential first step in management in both conditions is optimizing glucocorticoid replacement and considering dose reduction if excessive. Following this, if a patient with Addison's disease remains hypertensive, the fludrocortisone dose should be reviewed and reduced if there are clinical and/or biochemical signs of mineralocorticoid excess. In the absence of such signs, where the renin is towards the upper end of the normal range or elevated, an angiotensin II (AII) receptor antagonist or angiotensin converting enzyme (ACE) inhibitor is the treatment of choice, and the fludrocortisone dose should remain unchanged. Dihydropyridine calcium channel blockers are clinically useful as second line agents, but diuretics should be avoided. In the setting of heart failure, there is an increase in total body sodium and water; therefore, it is appropriate to reduce and rarely consider ceasing the fludrocortisone. Loop diuretics may be used, but not aldosterone antagonists such as spironolactone or eplerenone. Standard treatment with ACE inhibitors, or as an alternative, AII receptor antagonists, are appropriate. Measurements of renin are no longer helpful in heart failure to determine the volume status but plasma levels of brain natriuretic peptide (BNP/proBNP) may help guide therapy. © 2014 John Wiley & Sons Ltd.

  20. Partial recovery of adrenal function in a patient with autoimmune Addison's disease.

    Smans, L C C J; Zelissen, P M J

    2008-07-01

    To our knowledge, no case of remission in autoimmune Addison's disease has previously been reported. We describe a patient with primary adrenal insufficiency caused by autoimmune adrenalitis in whom partial remission was observed after 7 yr. A 39-yr-old male was referred because of extreme fatigue, weight loss, anorexia, nausea, and bouts of fever. During physical examination hyperpigmentation was seen. Laboratory tests showed a plasma cortisol of 0.02 micromol/l (08:30 h). Cortisol failed to increase during the ACTH stimulation test (0.02 to 0.03 micromol/l) and ACTH was markedly elevated (920 pmol/l). Adrenal auto-antibodies were weakly positive. A CT-scan showed no evidence of calcifications or other abnormalities of the adrenal glands. The diagnosis of autoimmune Addison's disease was made and replacement therapy with hydrocortisone and fludrocortisone was started. During the following years the dose of hydrocortisone was gradually decreased. Eventually, the patient decided to stop his medication completely. A repeated ACTH-stimulation test revealed a basal cortisol of 0.25 micromol/l and a peak cortisol of 0.30 micromol/l with a basal ACTH of 178 pmol/l. The patient did not have any complaints. Recovery of adrenal insufficiency, due to causes other than autoimmune adrenalitis, has been reported in the past. If our case of partial recovery of autoimmune adrenalitis is not unique this could have profound effects on treatment and follow-up of Addison's disease.

  1. Addison's disease presenting with idiopathic intracranial hypertension in 24-year-old woman: a case report

    Moore Peter

    2010-02-01

    Full Text Available Abstract Introduction Idiopathic intracranial hypertension can rarely be associated with an underlying endocrine disorder such as Cushing's syndrome, hyperthyroidism, or with administration of thyroxine or growth hormone. Though cases of idiopathic intracranial hypertension associated with Addison's disease in children have been reported, there is only one documented case report of this association in adults. We describe a case of an acute adrenal insufficiency precipitated by idiopathic intracranial hypertension in a Caucasian female. Case presentation A 24-year-old Caucasian woman was acutely unwell with a background of several months of generalised fatigue and intermittent headaches. She had unremarkable neurological and systemic examination with a normal computerised tomography and magnetic resonance imaging of the brain. Normal cerebrospinal fluid but increased opening pressure at lumbar puncture suggested intracranial hypertension. A flat short synacthen test and raised level of adrenocorticotrophic hormone were consistent with primary adrenal failure. Conclusion Addison's disease can remain unrecognised until precipitated by acute stress. This case suggests that idiopathic intracranial hypertension can rarely be associated with Addison's disease and present as an acute illness. Idiopathic intracranial hypertension is possibly related to an increase in the levels of arginine vasopressin peptide in serum and cerebrospinal fluid secondary to a glucocorticoid deficient state.

  2. Chlamydia - CDC Fact Sheet

    ... Archive STDs Home Page Bacterial Vaginosis (BV) Chlamydia Gonorrhea Genital Herpes Hepatitis HIV/AIDS & STDs Human Papillomavirus ( ... sheet Pelvic Inflammatory Disease (PID) – CDC fact sheet Gonorrhea – CDC fact sheet STDs Home Page Bacterial Vaginosis ( ...

  3. GASN sheets

    2013-12-01

    This document gathers around 50 detailed sheets which describe and present various aspects, data and information related to the nuclear sector or, more generally to energy. The following items are addressed: natural and artificial radioactive environment, evolution of energy needs in the world, radioactive wastes, which energy for France tomorrow, the consequences in France of the Chernobyl accident, ammunitions containing depleted uranium, processing and recycling of used nuclear fuel, transport of radioactive materials, seismic risk for the basic nuclear installations, radon, the precautionary principle, the issue of low doses, the EPR, the greenhouse effect, the Oklo nuclear reactors, ITER on the way towards fusion reactors, simulation and nuclear deterrence, crisis management in the nuclear field, does nuclear research put a break on the development of renewable energies by monopolizing funding, nuclear safety and security, the plutonium, generation IV reactors, comparison of different modes of electricity production, medical exposure to ionizing radiations, the control of nuclear activities, food preservation by ionization, photovoltaic solar collectors, the Polonium 210, the dismantling of nuclear installations, wind energy, desalination and nuclear reactors, from non-communication to transparency about nuclear safety, the Jules Horowitz reactor, CO 2 capture and storage, hydrogen, solar energy, the radium, the subcontractors of maintenance of the nuclear fleet, biomass, internal radio-contamination, epidemiological studies, submarine nuclear propulsion, sea energy, the Three Mile Island accident, the Chernobyl accident, the Fukushima accident, the nuclear after Fukushima

  4. The acute effect of a mineralocorticoid receptor agonist on corticotrope secretion in Addison's disease.

    Berardelli, R; Karamouzis, I; D'Angelo, V; Fussotto, B; Minetto, M A; Ghigo, E; Giordano, R; Arvat, E

    2016-05-01

    Mineralocorticoid receptors (MR) in the hippocampus display an important role in the control of hypothalamic-pituitary-adrenal (HPA) axis, mediating the ''proactive'' feedback of glucocorticoids (GC). Fludrocortisone (FC), a potent MR agonist, has been shown to decrease HPA activity through a hippocampal mechanism. Since it has been demonstrated that FC shows a significant inhibition of the HPA axis response to hCRH stimulus in normal subjects, also at doses usually administered as replacement therapy in patients with Addison's disease, an FC effect at MRs in human pituitary or a GR-pituitary agonism stronger than believed until now has been postulated. Ten patients affected by autoimmune Addison's disease received: (1) placebo p.o. + placebo i.v., (2) hydrocortisone (H) 10 mg p.o. + placebo i.v., (3) FC 0.1 mg p.o. + placebo i.v., (4) FC 0.1 mg and H 10 mg p.o. + placebo i.v. to verify a possible GR FC-mediated effect that might display a repercussion on the GC-replacement therapy. H reduced ACTH (p < 0.01) and increased cortisol levels (p < 0.01) with respect to the placebo session, while FC did not affect either ACTH or cortisol levels compared to placebo, and higher ACTH and lower cortisol levels (p < 0.03 and p < 0.01) were observed compared with the H session; furthermore the co-administration of FC + H showed ACTH and cortisol profiles similar to that observed during H alone. Our study showed a lack of FC effect on corticotrope secretion in Addison's disease, thus making unlikely the hypothesis of its GR pituitary agonism and the risk of glucocorticoid excess in primary adrenal insufficiency.

  5. Detection of adrenocortical autoantibodies in Addison's disease with a peroxidase-labelled protein A technique

    R.C. Silva

    1998-09-01

    Full Text Available Adrenocortical autoantibodies (ACA, present in 60-80% of patients with idiopathic Addison's disease, are conventionally detected by indirect immunofluorescence (IIF on frozen sections of adrenal glands. The large-scale use of IIF is limited in part by the need for a fluorescence microscope and the fact that histological sections cannot be stored for long periods of time. To circumvent these restrictions we developed a novel peroxidase-labelled protein A (PLPA technique for the detection of ACA in patients with Addison's disease and compared the results with those obtained with the classical IIF assay. We studied serum samples from 90 healthy control subjects and 22 patients with Addison's disease, who had been clinically classified into two groups: idiopathic (N = 13 and granulomatous (N = 9. ACA-PLPA were detected in 10/22 (45% patients: 9/13 (69% with the idiopathic form and 1/9 (11% with the granulomatous form, whereas ACA-IIF were detected in 11/22 patients (50%: 10/13 (77% with the idiopathic form and 1/9 (11% with the granulomatous form. Twelve of the 13 idiopathic addisonians (92% were positive for either ACA-PLPA or ACA-IIF, but only 7 were positive by both methods. In contrast, none of 90 healthy subjects was found to be positive for ACA. Thus, our study shows that the PLPA-based technique is useful, has technical advantages over the IIF method (by not requiring the use of a fluorescence microscope and by permitting section storage for long periods of time. However, since it is only 60% concordant with the ACA-IIF method, it should be considered complementary instead of an alternative method to IIF for the detection of ACA in human sera.

  6. A case of Addison's disease accompanied with bilateral adrenal calcification on CT

    Lee, Li-Chik; Fujita, Naohisa; Ohba, Yachiyo

    1985-01-01

    A 62-year-old woman was admitted to our hospital with complaints of general malaise and hyperpigmentation. We diagnosed her case as primary adrenocortical insufficiency (Addison's disease) by endocrinological studies. CT demonstrated dense calcification in both adrenal beds without evidence of normal glandular remnants. Calcified adrenal is not specific to tuberculosis, but some points of CT findings are useful for pathogenetic approach. Recently, there have been several reports that ACTH producing pituitary tumors develop in patients treated with conventional corticosteroid replacement. Corticosteroid should be administered by monitoring of plasma cortisol and ACTH concentrations. (author)

  7. Addison's disease due to Histoplasma duboisii infection of the adrenal glands

    Mudawi, Hatim M.; Baraka, Omer Z.; El-Hassan, Ahmed M.; El-Amin, Elwaleed M.

    2008-01-01

    Histoplasmosis is a fungal infection caused by Histoplasma capsulatum. In the normal individual, both disseminated histoplasmosis and symptomatic adrenal histoplasmosis are rare. Herein, we describe the case of a 50-year-old gentleman residing in western Sudan who presented with 7-month history of generalized body weakness, easy fatigue and frequent attacks of vomiting and diarrhea. Physical examination and laboratory investigations confirmed the diagnosis of Addison's disease due to histoplasma capsulatum var duboisii infection of the adrenal glands. He was treated with intravenous hydrocortisone, followed by oral prednisolone and itraconazole. (author)

  8. Pulsatile luteinizing hormone secretion in patients with Addison's disease. Impact of glucocorticoid substitution

    Hangaard, J; Andersen, M; Grodum, E

    1998-01-01

    The physiological and pathophysiological role of cortisol in pulsatile LH release was investigated in 14 patients (5 men, 6 premenopausal women, and 3 postmenopausal women) with Addison's disease. The explicit effect of cortisol in relation to the effect of corticotropin-releasing factor (CRF......), ACTH, and opioids was ensured by hypo-, normo-, and hypercortisolism. Hypocortisolism was obtained by 24-h discontinuation of hydrocortisone (HC) followed by 23-h saline infusion. Eucortisolism was secured by infusion of HC (0.5 mg/kg) over 23 h. Stress-appropriate hypercortisolism was obtained...

  9. Incidence, prevalence and seasonal onset variation of Addison's disease among persons with type 1 diabetes mellitus: nationwide, matched cohort studies.

    Chantzichristos, Dimitrios; Persson, Anders; Eliasson, Björn; Miftaraj, Mervete; Franzén, Stefan; Svensson, Ann-Marie; Johannsson, Gudmundur

    2018-01-01

    We determined the incidence and prevalence of Addison's disease (AD) among persons with or without type 1 diabetes mellitus (T1DM) in nationwide, matched cohort studies. Persons with T1DM were identified from the Swedish National Diabetes Register and each was matched for age, sex, year and county to five controls randomly selected from the general population. Persons with AD were identified from the Swedish National Inpatient Register. Baseline demographics and seasonal onset variation of AD were presented by descriptive statistics. Prevalence and incidence were estimated by proportions and incidence rates, respectively. Times to AD were analyzed using the Cox proportional hazard model. Between 1998 and 2013, 66 persons with T1DM were diagnosed with AD at a mean age (s.d.) of 36.4 (13.0) years among 36 514 persons with T1DM, while 32 were diagnosed with AD at a mean age of 42.7 (15.2) years among 182 570 controls. The difference in mean age at diagnosis of AD between the groups was 6.3 years ( P value = 0.036). The incidence of AD for a person with or without T1DM was therefore 193 and 18 per million person-years, respectively. The adjusted relative risk increase of developing AD in T1DM was 10.8 (95% CI: 7.1-16.5). The highest incidence of AD was observed during February-March and September-October. The prevalence of AD in persons with or without T1DM in December 2012 was 3410 and 208 per million, respectively. The odds ratio for AD in persons with T1DM vs controls was 16.5 (95% CI: 11.1-24.5). The risk to develop AD among persons with T1DM is more than 10 times higher than in persons without T1DM. Persons with T1DM develop AD at a younger age. The incidence of AD may have a seasonal pattern. © 2018 European Society of Endocrinology.

  10. Value of the radioimmunological ACTH-determination in plasma for the diagnosis and therapy control of Addison's disease

    Wagner, H.; Degenhardt, G.; Wenning, N.

    1974-01-01

    The findings obtained before suggest that plasma ACTH determination is another valuable parameter supplementing the determination of plasma corticoids in the diagnosis of Addison's disease. In the assessment of the success of the treatment, plasma ACTH measurement is superior to the determination of plasma corticoids. (orig./AK) [de

  11. Metachronous adrenal metastasis from operated contralateral renal cell carcinoma with adrenalectomy and iatrogenic Addison's disease.

    Ozturk, Hakan; Karaaslan, Serap

    2014-09-01

    Metachronous adrenal metastasis from contralateral renal cell carcinoma (RCC) surgery is an extremely rare condition. Iatrogenic Addison's disease occurring after metastasectomy (adrenalectomy) is an even rarer clinical entity. We present a case of a 68-year-old male with hematuria and left flank pain 9 years prior. The patient underwent left transperitoneal radical nephrectomy involving the ipsilateral adrenal glands due to a centrally-located, 75-mm in diameter solid mass lesion in the upper pole of the left kidney. The tumour lesion was confined within the renal capsule, and the histo-pathological examination revealed a Fuhrman nuclear grade II clear cell carcinoma. The patient underwent transperitoneal right adrenalectomy. The histopathological examination revealed metastasis of clear cell carcinoma. The patient was diagnosed with iatrogenic Addison's disease based on the measurement of serum cortisol levels and the adrenocorticotropic hormone (ACTH) stimulation test, after which glucocorticoid and mineralocorticoid replacement was initiated. The patient did not have local recurrence or new metastasis in the first year of the follow-up. The decision to perform ipsilateral adrenalectomy during radical nephrectomy constitutes a challenge, and the operating surgeon must consider all these rare factors.

  12. Addison's disease due to adrenal tuberculosis: Contrast-enhanced CT features and clinical duration correlation

    Guo Yingkun; Yang Zhigang; Li Yuan; Ma Ensen; Deng Yuping; Min Pengqiu; Yin Longlin; Hu Jian; Zhang Xiaochun; Chen Tianwu

    2007-01-01

    Purpose: To describe CT morphology of untreated adrenal tuberculosis during the different stages of the natural history of the disease and to evaluate the diagnostic implications of CT features. Materials and methods: We retrospectively evaluated CT features in 42 patients with documented adrenal tuberculosis for the location, size, morphology, and enhancement patterns shown on CT images. The clinical duration were correlated with the CT features. Results: Of the 42 patients with untreated adrenal tuberculosis, bilaterally enlarged adrenal glands were revealed in 38 cases (91%), unilaterally enlarged in 3 cases (7%), and normal size in 1 case (2%). Of the 41 cases (98%) with enlargement, mass-like enlargement was seen in 20 cases (49%) and enlargement with preserved contours in 21 cases (51%). Peripheral rim enhancement presented in 22 cases (52%) on contrast-enhanced CT. Non-enhanced CT scan revealed calcification in 21 cases (50%). As the duration of Addison's disease increased, the presence of calcification and contour preservation increased concomitantly (p < 0.001), whereas peripheral rim enhancement and mass-like enlargement decreased concomitantly on CT images (p < 0.001). Conclusion: CT may be helpful in diagnosing adrenal tuberculosis when clinically suspected, and CT features are correlated to the clinical duration of Addison's disease

  13. Salivary cortisol day curves in Addison's disease in patients on hydrocortisone replacement.

    Ross, I L; Levitt, N S; Van der Walt, J S; Schatz, D A; Johannsson, G; Haarburger, D H; Pillay, T S

    2013-01-01

    Using salivary cortisol (SC) measurements, cortisol exposure in Addison's disease patients on hydrocortisone replacement was determined and compared with healthy controls. Cortisol pharmacokinetics was assessed in 31 patients with Addison's disease on replacement hydrocortisone doses (median daily dose 20 mg; range 5-50 mg) and 30 healthy control subjects. Saliva samples (n=16) were collected between 08:00 and 00:00 h in 1 day, using a passive drool technique. Cortisol exposure was evaluated by noncompartmental approach. In the patients, cortisol exposure was significantly higher than in controls: median inter-quartile range (IQR) peak cortisol (C(max)) 174.5 (59.3-837.0) vs. 6.50 (4.7-19.3) nmol/l, p=0.0001; area under the curve (AUC) 390.1 (177.1-928.9) vs. 21.4 (14.6-28.4) minutes*nmol/l, p=0.0001, trough cortisol level (C(min)) 0.49 (0.49-0.96) vs. 0.49 (0.49-0.49) nmol/l, p=0.02, occurring at 480.0 (0.1-660.0) vs. 405.0 (180.0-570.0) min, p=0.56. First peak cortisol was 174.5 (53.0-754.7) vs. 6.27 (3.90-8.47) nmol/l, p=0.0001 and second peak cortisol 18.90 (5.22-76.9) vs. 3.12 (1.76-4.79) nmol/l, p=0.0001. The time to first peak cortisol differed between the 2 groups, 30 (30-75) vs. 0.1 (0.1-30) minutes; p=0.0001. At doses studied, hydrocortisone replacement therapy results in cortisol pharmacokinetics being markedly different from endogenous cortisol profiles in healthy control subjects. Addison's disease patients had significantly higher SC levels compared to healthy control subjects. © Georg Thieme Verlag KG Stuttgart · New York.

  14. MAVS is not a Likely Susceptibility Locus for Addison's Disease and Type 1 Diabetes.

    Zurawek, Magdalena; Fichna, Marta; Kazimierska, Marta; Fichna, Piotr; Dzikiewicz-Krawczyk, Agnieszka; Przybylski, Grzegorz; Ruchala, Marek; Nowak, Jerzy

    2017-06-01

    Mitochondrial antiviral signaling (MAVS) protein is an intracellular adaptor molecule, downstream of viral sensors, retinoid acid-inducible gene I (RIG-I)-like receptors (RLRs). Impaired antiviral cell signaling might contribute to autoimmunity. Studies have recently shown variations in genes encoding RLRs as risk factors for autoimmune diseases. We investigated whether MAVS coding polymorphisms are associated with Addison's disease (AD) and type 1 diabetes (T1D) in Polish population. We genotyped 140 AD, 532 T1D patients and 600 healthy controls for MAVS rs17857295, rs7262903, rs45437096 and rs7269320. Genotyping was performed by TaqMan assays. Distribution of the MAVS genotypes and alleles did not reveal significant differences between patients and controls (p > 0.05). This analysis did not indicate the association of the MAVS locus with susceptibility to AD and T1D.

  15. Severe neuroinvasive West Nile virus infection in a child with undiagnosed Addison's disease

    Kevin Messacar

    2014-01-01

    Full Text Available This report describes a case of West Nile virus (WNV meningoencephalitis in a child who presented with fever, headache, seizures, and altered mental status, as well as hyponatremia and bronzing of the skin. Findings that led to the diagnosis of WNV included plasma-cell pleocytosis of the cerebrospinal fluid (CSF and linear chorioretinitis on ophthalmologic exam. The diagnosis was confirmed by a positive serum and CSF WNV IgM. The acute WNV infection triggered an adrenal crisis which uncovered a new diagnosis of underlying Addison's disease. This is the first case report of severe neuroinvasive WNV disease in a pediatric patient with primary adrenal insufficiency. Neuroinvasive WNV disease is uncommon in children, but may have a more severe presentation in those with certain underlying medical conditions.

  16. Altered DNA methylation profile in Norwegian patients with Autoimmune Addison's Disease.

    Bjanesoy, Trine E; Andreassen, Bettina Kulle; Bratland, Eirik; Reiner, Andrew; Islam, Shahinul; Husebye, Eystein S; Bakke, Marit

    2014-06-01

    Autoimmune Addison's Disease (AAD) is an endocrine and immunological disease of uncertain pathogenesis resulting from the immune system's destruction of the hormone producing cells of the adrenal cortex. The underlying molecular mechanisms are largely unknown, but it is commonly accepted that a combination of genetic susceptibility and environmental impact is critical. In the present study, we identified multiple hypomethylated gene promoter regions in patients with isolated AAD using DNA isolated from CD4+ T cells. The identified differentially methylated regions were distributed evenly across the 10.5-kb-promoter regions covered by the array, and a substantial number localized to promoters of genes involved in immune regulation and autoimmunity. This study reveals a hypomethylated status in CD4+ T cells from AAD patients and indicates differential methylation of promoters of key genes involved in immune responses. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  17. Coexistence of Cushing syndrome from functional adrenal adenoma and Addison disease from immune-mediated adrenalitis.

    Colucci, Randall; Jimenez, Rafael E; Farrar, William; Malgor, Ramiro; Kohn, Leonard; Schwartz, Frank L

    2012-06-01

    A 56-year-old woman presented with an incidental adrenal adenoma and physical examination findings that included moderate obesity, a slight cervicothoracic fat pad ("buffalo hump"), increased supraclavicular fat pads, and white abdominal striae. Biochemical workup revealed elevated levels of 24-hour urinary free cortisol but normal serum morning cortisol and suppressed levels of corticotropin, suggestive of adrenal-dependent Cushing syndrome. The resected adrenal gland revealed macronodular cortical hyperplasia with a dominant nodule. Other findings included an absent cortisol response to corticotropin stimulation, presence of serum anti-21-hydroxylase antibodies, and mononuclear cell infiltration--consistent with adrenalitis. The findings represent, to the authors' knowledge, the first known case of a patient with coexistent functional cortisol-secreting macronodular adrenal tumor resulting in Cushing syndrome and immune-mediated adrenalitis resulting in Addison disease.

  18. Addison's disease concomitant with corticotropin deficiency and pituitary CRH resistance - a case report.

    Lewandowski, Krzysztof C; Malicka, Katarzyna; Dąbrowska, Katarzyna; Lewiński, Andrzej

    2017-01-01

    A 36-year-old woman was found to have a low morning ACTH concentration despite a history of Addison's disease. Past medical history: At the age of 23 years the subject developed Graves's disease, which was treated with radioiodine. At about the same time, she claimed to have two episodes of pancreatitis treated with cholecystectomy. About seven months later she was euthyroid on L-thyroxine (TSH 1.51 mIU/mL) but was admitted with hypotension, hyponatraemia (sodium 109 mmol/L), and low morning cortisol (119 nmol/L). Further investigations confirmed primary adrenal failure with ACTH concentration of 779 pg/mL (ref. range 0-60) prior to the dose of hydrocortisone. About nine years later she complained about tiredness. Clinically she was normotensive and not pigmented. BMI 22.3 kg/m². Periods were regular. ACTH concentration was surprisingly low (ACTH 8.53 pg/mL, ref. range 0-46), despite very low cortisol (3.37 nmol/L). She was admitted for further assessment. Pituitary MRI scan was unremarkable. An insulin tolerance test was performed and showed a clear increase of ACTH (from 15.2 to 165 pg/mL). There was, however, hardly any increase of ACTH after CRH stimulation (from 6.05 pg/mL to 10.2 pg/mL), thus demonstrating central CRH resistance. In summary, this patient developed secondary adrenal failure in the setting of previous Addison's disease. Interestingly, hypoglycaemia (but not CRH) provided a stimulus for ACTH release, thus demonstrating CRH resistance. The case confirms that besides CRH, other factors are responsible for stimulation of the ACTH-cortisol axis during insulin tolerance test.

  19. COEXISTENCE OF ADDISON'S DISEASE AND PERNICIOUS ANEMIA: IS THE NEW CLASSIFICATION OF AUTOIMMUNE POLYGLANDULAR SYNDROME APPROPRIATE?

    Vrkljan, Ana Marija; Pašalić, Ante; Strinović, Mateja; Perić, Božidar; Kruljac, Ivan; Miroševć, Gorana

    2015-06-01

    A case of autoimmune polyglandular syndrome (APS) is presented. A 45-year-old man was admitted due to fatigue, malaise and inappetence. He had a history of primary hypothyroidism and was on levothyroxine substitution therapy. One year before, he was diagnosed with normocytic anemia and vitamin B12 deficiency, which was treated with vitamin B12 substitution therapy. Physical examination revealed hypotension and marked hyperpigmentation. Laboratory testing showed hyponatremia, hyperkaliemia and severe normocytic anemia. Endocrinological evaluation disclosed low morning cortisol and increased adrenocorticotropic hormone levels. Hence, the diagnosis of Addison's disease was established. Additional laboratory workup showed positive parietal cell antibodies. However, his vitamin B12 levels were increased due to vitamin B12 supplementation therapy, which was initiated earlier. Gastroscopy and histopathology of gastric mucosa confirmed atrophic gastritis. Based on prior low serum vitamin B12 levels, positive parietal cell antibodies and atrophic gastritis, the patient was diagnosed with pernicious anemia. Hydrocortisone supplementation therapy was administered and titrated according to urinary-free cortisol levels. Electrolyte disbalance and red blood cell count were normalized. This case report demonstrates rather unique features of pernicious anemia in a patient with Addison's disease. It also highlights the link between type II and type III APS. Not only do they share the same etiological factors, but also overlap in pathophysiological and clinical characteristics. This case report favors older classification of APS, which consolidates all endocrine and other organ-specific autoimmune diseases into one category. This is important since it might help avoid pitfalls in the diagnosis and treatment of patients with APS.

  20. Predicting the onset of Addison's disease: ACTH, renin, cortisol and 21-hydroxylase autoantibodies

    Baker, Peter R.; Nanduri, Priyaanka; Gottlieb, Peter A.; Yu, Liping; Klingensmith, Georgeanna J.; Eisenbarth, George S.; Barker, Jennifer M.

    2016-01-01

    Summary Context Autoantibodies to 21-hydroxylase (21OH-AA) precede onset of autoimmune Addison's disease (AD). Progression to AD can take months to years, and early detection of metabolic decompensation may prevent morbidity and mortality. Objective To define optimal methods of predicting progression to overt AD (defined by subnormal peak cortisol response to Cosyntropin) in 21OH-AA+ individuals. Design, Setting and Participants Individuals were screened for 21OH-AA at the Barbara Davis Center from 1993 to 2011. Subjects positive for 21OH-AA (n = 87) were tested, and the majority prospectively followed for the development of Addison's disease, including seven diagnosed with AD upon 21OH-AA discovery (discovered), seven who progressed to AD (progressors) and 73 nonprogressors. Main Outcome Measured Plasma renin activity (PRA), ACTH, baseline cortisol, peak cortisol and 21OH-AA were measured at various time points relative to diagnosis of AD or last AD-free follow-up. Results Compared with nonprogressors, in the time period 2 months–2 years prior to the onset of AD, progressors were significantly more likely to have elevated ACTH (11–22 pm, P < 1E-4), with no significant differences in mean PRA (P = 0·07) or baseline cortisol (P = 0·08), and significant but less distinct differences seen with 21OH-AA levels (P < 1E-4) and poststimulation cortisol levels (P = 6E-3). Conclusion Moderately elevated ACTH is a more useful early indicator of impending AD than 21OH-AA, PRA or peak cortisol, in the 2 months–2 years preceding the onset of AD. PMID:22066755

  1. Addison's Disease and Possible Cannabis Withdrawal Syndrome Presenting as an Eating Disorder in a Thirty-Year-Old Female.

    Lazare, Kimberly

    2017-01-01

    A 30-year-old female with a history of anxiety, cannabis use, and Avoidant/Restrictive Food Intake Disorder presented for residential treatment of a Cannabis Use Disorder. Upon arrival, she had not eaten for two days and was found to be hypotensive with electrolyte disturbances. She was admitted to a nearby hospital, where the Internist diagnosed her with Addison's disease. She was treated with corticosteroid therapy, with rapid normalization of her electrolytes, eating, and anxiety. This is the first published case of undiagnosed Addison's disease presenting as an eating disorder, with cannabis use likely contributing to symptoms. This case elucidates the importance of ruling out other biologic and psychologic causes of clinical presentations before an eating disorder diagnosis can be made.

  2. Two different cytochrome P450 enzymes are the adrenal antigens in autoimmune polyendocrine syndrome type I and Addison's disease.

    Winqvist, O; Gustafsson, J; Rorsman, F; Karlsson, F A; Kämpe, O

    1993-01-01

    Autoimmune polyendocrine syndrome type I (APS I) and idiopathic Addison's disease are both disorders with adrenal insufficiency but with differences in genetic background, clinical presentation, and extent of extraadrenal manifestations. In this study the major adrenal autoantigen identified with sera from patients with APS I was characterized by analyses using indirect immunofluorescence, Western blots of adrenal subcellular fractions and of recombinant proteins, immunoprecipitations of [35S...

  3. High frequency of cytolytic 21-hydroxylase-specific CD8+ T cells in autoimmune Addison's disease patients.

    Dawoodji, Amina; Chen, Ji-Li; Shepherd, Dawn; Dalin, Frida; Tarlton, Andrea; Alimohammadi, Mohammad; Penna-Martinez, Marissa; Meyer, Gesine; Mitchell, Anna L; Gan, Earn H; Bratland, Eirik; Bensing, Sophie; Husebye, Eystein S; Pearce, Simon H; Badenhoop, Klaus; Kämpe, Olle; Cerundolo, Vincenzo

    2014-09-01

    The mechanisms behind destruction of the adrenal glands in autoimmune Addison's disease remain unclear. Autoantibodies against steroid 21-hydroxylase, an intracellular key enzyme of the adrenal cortex, are found in >90% of patients, but these autoantibodies are not thought to mediate the disease. In this article, we demonstrate highly frequent 21-hydroxylase-specific T cells detectable in 20 patients with Addison's disease. Using overlapping 18-aa peptides spanning the full length of 21-hydroxylase, we identified immunodominant CD8(+) and CD4(+) T cell responses in a large proportion of Addison's patients both ex vivo and after in vitro culture of PBLs ≤20 y after diagnosis. In a large proportion of patients, CD8(+) and CD4(+) 21-hydroxylase-specific T cells were very abundant and detectable in ex vivo assays. HLA class I tetramer-guided isolation of 21-hydroxylase-specific CD8(+) T cells showed their ability to lyse 21-hydroxylase-positive target cells, consistent with a potential mechanism for disease pathogenesis. These data indicate that strong CTL responses to 21-hydroxylase often occur in vivo, and that reactive CTLs have substantial proliferative and cytolytic potential. These results have implications for earlier diagnosis of adrenal failure and ultimately a potential target for therapeutic intervention and induction of immunity against adrenal cortex cancer. Copyright © 2014 by The American Association of Immunologists, Inc.

  4. Nocturnal hypoglycemia identified by a continuous glucose monitoring system in patients with primary adrenal insufficiency (Addison's Disease).

    Meyer, Gesine; Hackemann, Annika; Reusch, Juergen; Badenhoop, Klaus

    2012-05-01

    Hypoglycemia can be a symptom in patients with Addison's disease. The common regimen of replacement therapy with oral glucocorticoids results in unphysiological low cortisol levels in the early morning, the time of highest insulin sensitivity. Therefore patients with Addison's disease are at risk for unrecognized and potentially severe nocturnal hypoglycemia also because of a disturbed counterregulatory function. Use of a continuous glucose monitoring system (CGMS) could help to adjust hydrocortisone treatment and to avoid nocturnal hypoglycemia in these patients. Thirteen patients with Addison's disease were screened for hypoglycemia wearing a CGMS for 3-5 days. In one patient we identified a hypoglycemic episode at 3:45 a.m. with a blood glucose level of 46 mg/dL, clearly beneath the 95% tolerance interval of minimal glucose levels between 2 and 4 a.m. (53.84 mg/dL). After the hydrocortisone replacement scheme was changed, the minimum blood glucose level between 2 and 4 a.m. normalized to 87 mg/dL. Continuous glucose monitoring can detect nocturnal hypoglycemia in patients with primary adrenal insufficiency and hence prevent in these patients an impaired quality of life and even serious adverse effects.

  5. Ice sheet in peril

    Hvidberg, Christine Schøtt

    2016-01-01

    Earth's large ice sheets in Greenland and Antarctica are major contributors to sea level change. At present, the Greenland Ice Sheet (see the photo) is losing mass in response to climate warming in Greenland (1), but the present changes also include a long-term response to past climate transitions...

  6. Mobility Balance Sheet 2009

    Jorritsma, P.; Derriks, H.; Francke, J.; Gordijn, H.; Groot, W.; Harms, L.; Van der Loop, H.; Peer, S.; Savelberg, F.; Wouters, P.

    2009-06-01

    The Mobility Balance Sheet provides an overview of the state of the art of mobility in the Netherlands. In addition to describing the development of mobility this report also provides explanations for the growth of passenger and freight transport. Moreover, the Mobility Balance Sheet also focuses on a topical theme: the effects of economic crises on mobility. [nl

  7. Addison's Disease

    ... of potassium and low levels of sodium. What causes Addison’s disease? Addison’s disease is caused by injury to your ... example, a problem with your pituitary gland can cause secondary Addison’s disease. Or, you may develop Addison’s disease if you ...

  8. Vitamin D effects on monocytes' CCL-2, IL6 and CD14 transcription in Addison's disease and HLA susceptibility.

    Kraus, A U; Penna-Martinez, M; Meyer, G; Badenhoop, K

    2018-03-01

    Addison's disease is a rare autoimmune disorder leading to adrenal insufficiency and life-long glucocorticoid dependency. Vitamin D receptor (VDR) polymorphisms and vitamin D deficiency predispose to Addison's disease. Aim of the current study was, to investigate potential anti-inflammatory vitamin D effects on monocytes in Addison's disease, focusing on inflammatory CCL-2 and IL6, as well on monocyte CD14 markers. Addison's disease is genetically linked to distinct HLA susceptibility alleles. Therefore we analyzed, whether HLA genotypes differed for vitamin D effects on monocyte markers. CD14 + monocytes were isolated from Addison's disease patients (AD, n=13) and healthy controls (HC, n=15) and stimulated with 1,25-dihydroxyvitamin D 3 and IL1β as an inflammatory stimulant. Cells were processed for mRNA expression of CCL-2, IL6 and CD14 and DNA samples were genotyped for major histocompatibility class (MHC) class II-encoded HLA- DQA1-DQB1 haplotypes. We found a downregulation of CCL-2 after vitamin D treatment in IL1β-stimulated monocytes both from AD patients and HC (AD p<0.001; HC p<0.0001). CD14 expression however, was upregulated in both HC and AD patients after vitamin D treatment (p<0.001, respectively). HC showed higher CD14 transcription level than AD patients after vitamin D treatment (p=0.04). Compared to IL1β-induced inflammation, HC have increased CD14 levels after vitamin D treatment (p<0.001), whereas the IL1β-induced CD14 expression of AD patients' monocytes did not change after vitamin D treatment (p=0.8). AD patients carrying HLA high-risk haplotypes showed an increased CCL-2 expression after IL1β-induced inflammation compared to intermediate-risk HLA carriers (p=0.05). Also HC monocytes' CD14 transcription after IL1β and vitamin D co-stimulation differed according to HLA risk profile. We show that vitamin D can exert anti-inflammatory effects on AD patients' monocytes which may be modulated by HLA risk genotypes. Copyright © 2017 Elsevier

  9. Recurrent nocturnal hypoglycaemia as a cause of morning fatigue in treated Addison's disease--favourable response to dietary management: a case report.

    Petersen, Kristina S; Rushworth, R Louise; Clifton, Peter M; Torpy, David J

    2015-10-24

    Addison's disease, or primary adrenal insufficiency, is often associated with reduced well-being and fatigue despite use of currently recommended adrenal hormone replacement. Hypoglycaemia is a known manifestation of glucocorticoid deficiency, but is generally considered rare in adults and not relevant to troubling ongoing symptoms in patients with Addison's disease. A 43 year old woman with a three year history of Addison's disease complained of severe morning fatigue and headaches, despite standard glucocorticoid replacement therapy in the form of thrice daily hydrocortisone and mineralocorticoid replacement with fludrocortisone. Alternative glucocorticoid replacement regimens and the addition of dehydroepiandrosterone replacement therapy had no effect. Nocturnal hypoglycaemia was suspected and a 4-day continuous glucose monitor system (CGMS) revealed hypoglycaemia (interstitial glucose < 2.2 mmol/L) between 0200-0400 h on 3 of 4 days. The patient was counselled to take an evening snack designed to ensure slow absorption of ingested carbohydrates. Nocturnal hypoglycaemia was then absent on follow up CGMS assessment. The patient noted a marked symptomatic improvement in morning symptoms, but with persistent fatigue during the day. Currently, the best strategy for control of non-specific symptoms in treated Addison's disease is unknown, but it may be that investigation for hypoglycaemia and treatment, where necessary, could assist some sufferers to achieve improved wellbeing. A systematic study of this phenomenon in Addison's disease is required.

  10. Vertebral fractures assessed with dual-energy X-ray absorptiometry in patients with Addison's disease on glucocorticoid and mineralocorticoid replacement therapy.

    Camozzi, Valentina; Betterle, Corrado; Frigo, Anna Chiara; Zaccariotto, Veronica; Zaninotto, Martina; De Caneva, Erica; Lucato, Paola; Gomiero, Walter; Garelli, Silvia; Sabbadin, Chiara; Salvà, Monica; Costa, Miriam Dalla; Boscaro, Marco; Luisetto, Giovanni

    2018-02-01

    to assess bone damage and metabolic abnormalities in patients with Addison's disease given replacement doses of glucocorticoids and mineralocorticoids. A total of 87 patients and 81 age-matched and sex-matched healthy controls were studied. The following parameters were measured: urinary cortisol, serum calcium, phosphorus, creatinine, 24-h urinary calcium excretion, bone alkaline phosphatase, parathyroid hormone, serum CrossLaps, 25 hydroxyvitamin D, and 1,25 dihydroxyvitamin D. Clear vertebral images were obtained with dual-energy X-ray absorptiometry in 61 Addison's disease patients and 47 controls and assessed using Genant's classification. Nineteen Addison's disease patients (31.1%) had at least one morphometric vertebral fracture, as opposed to six controls (12.8%, odds ratio 3.09, 95% confidence interval 1.12-8.52). There were no significant differences in bone mineral density parameters at any site between patients and controls. In Addison's disease patients, there was a positive correlation between urinary cortisol and urinary calcium excretion. Patients with fractures had a longer history of disease than those without fractures. Patients taking fludrocortisone had a higher bone mineral density than untreated patients at all sites except the lumbar spine. Addison's disease patients have more fragile bones irrespective of any decrease in bone mineral density. Supra-physiological doses of glucocorticoids and longer-standing disease (with a consequently higher glucocorticoid intake) might be the main causes behind patients' increased bone fragility. Associated mineralocorticoid treatment seems to have a protective effect on bone mineral density.

  11. Carbon sheet pumping

    Ohyabu, N.; Sagara, A.; Kawamura, T.; Motojima, O.; Ono, T.

    1993-07-01

    A new hydrogen pumping scheme has been proposed which controls recycling of the particles for significant improvement of the energy confinement in toroidal magnetic fusion devices. In this scheme, a part of the vacuum vessel surface near the divertor is covered with carbon sheets of a large surface area. Before discharge initiation, the sheets are baked up to 700 ∼ 1000degC to remove the previously trapped hydrogen atoms. After being cooled down to below ∼ 200degC, the unsaturated carbon sheets trap high energy charge exchange hydrogen atoms effectively during a discharge and overall pumping efficiency can be as high as ∼ 50 %. (author)

  12. Continuous subcutaneous hydrocortisone infusion therapy in Addison's disease: a randomized, placebo-controlled clinical trial.

    Gagliardi, Lucia; Nenke, Marni A; Thynne, Tilenka R J; von der Borch, Jenny; Rankin, Wayne A; Henley, David E; Sorbello, Jane; Inder, Warrick J; Torpy, David J

    2014-11-01

    Patients with Addison's disease (AD) report impaired subjective health status (SHS). Since cortisol exhibits a robust circadian cycle that entrains other biological clocks, impaired SHS may be due to the noncircadian cortisol profile achieved with conventional glucocorticoid replacement. Continuous subcutaneous hydrocortisone infusion (CSHI) reproduces a circadian cortisol profile, but its effects on SHS have not been objectively evaluated. The aim of this study was to determine the effect of CSHI on SHS in AD. This was a multicentre, double-blind, placebo-controlled trial of CSHI vs oral glucocorticoid therapy. Participants received in random order 4 weeks of: CSHI and oral placebo, and subcutaneous placebo and oral hydrocortisone, separated by a 2-week washout period. SHS was assessed using the Short-Form 36 (SF-36), General Health Questionnaire (GHQ-28), Fatigue Scale (FS), Gastrointestinal Symptom Rating Scale (GSRS); and Addison's Quality of Life Questionnaire (AddiQoL). Participants were asked their (blinded) treatment preference. Twenty-four hour urine free cortisol (UFC) and diurnal salivary cortisol collections compared cortisol exposure during each treatment. Ten participants completed the study. Baseline SHS scores (mean ± SE) were consistent with mild impairment: SF-36 physical component summary 48.4 (± 2.4), mental component summary 53.3 (± 3.0); GHQ-28 18.1 (± 3.3); GSRS 3.7 (± 1.6), and AddiQoL 94.7 (± 3.7). FS was similar to other AD cohorts 13.5 (± 1.0) (P = 0.82). UFC between treatments was not different (P = 0.87). The salivary cortisol at 0800 h was higher during CSHI (P = 0.03), but not at any other time points measured. There was no difference between the treatments in the SHS assessments. Five participants preferred CSHI, four oral hydrocortisone, and one was uncertain. Biochemical measurements indicate similar cortisol exposure during each treatment period, although a more circadian pattern was evident during CSHI. CSHI does not

  13. Takotsubo-like syndrome triggered by fludrocortisone overdose for Addison's disease: a case report.

    Campean, Radu; Hasun, Matthias; Stöllberger, Claudia; Bucher, Johannes; Finsterer, Josef; Schnack, Christoph; Weidinger, Franz

    2016-10-12

    Reversible left ventricular dysfunction, also termed Takotsubo cardiomyopathy, is rarely reported in Addison's disease after initiation of hormone replacement therapy. The pathogenesis of this cardiomyopathy is unknown. A 41-year-old white woman with a history of autoimmune Hashimoto thyroiditis diagnosed 3 years earlier and acute adrenal insufficiency diagnosed 3 weeks earlier presented with new onset of heart failure New York Heart Association class IV, which had started shortly after initiation of hormone replacement therapy with hydrocortisone 20 mg/day and fludrocortisone 0.3 mg/day. Nine days before admission she had collapsed because of dizziness and had a cerebral concussion and open fracture of her nasal bone, however, no further investigations were carried out at that time. A physical examination revealed leg edema, tachycardia, tachypnea, bilateral basal crepitations, and blood pressure 110/70 mmHg. An electrocardiogram showed sinus tachycardia, low voltage, negative T-waves in V 5 and V 6 and a corrected QT interval of 590 ms. Echocardiography revealed a reduced left ventricular systolic function with an ejection fraction of 30 %, and septal, apical, and anterior wall akinesia. Cardiac magnetic resonance imaging showed relative enhancement of gadolinium, indicating hyperemia and capillary leakage, and no myocardial scars. Because of the improvement in her cardiac function, lack of cardiovascular risk factors, and lack of signs for ischemia on magnetic resonance imaging, no coronary angiography was carried out. The results of sellar and renal magnetic resonance imaging were normal. Her troponin T was slightly elevated. Bisoprolol and ramipril were started. Her fludrocortisone dose was reduced to 0.05 mg/day. Her electrocardiogram and systolic function, documented by echocardiography and magnetic resonance imaging, normalized within 6 months. Although we could not exclude coronary artery disease by coronary angiography, her clinical course and

  14. Anesthesia Fact Sheet

    ... Education About NIGMS NIGMS Home > Science Education > Anesthesia Anesthesia Tagline (Optional) Middle/Main Content Area En español ... Version (464 KB) Other Fact Sheets What is anesthesia? Anesthesia is a medical treatment that prevents patients ...

  15. Structural Biology Fact Sheet

    ... NIGMS NIGMS Home > Science Education > Structural Biology Structural Biology Tagline (Optional) Middle/Main Content Area PDF Version (688 KB) Other Fact Sheets What is structural biology? Structural biology is the study of how biological ...

  16. Radiation protecting sheet

    Makiguchi, Hiroshi.

    1989-01-01

    As protection sheets used in radioactivity administration areas, a thermoplastic polyurethane composition sheet with a thickness of less 0.5 mm, solid content (ash) of less than 5% and a shore D hardness of less than 60 is used. A composite sheet with thickness of less than 0.5 mm laminated or coated with such a thermoplastic polyurethane composition as a surface layer and the thermoplastic polyurethane composition sheet applied with secondary fabrication are used. This can satisfy all of the required properties, such as draping property, abrasion resistance, high breaking strength, necking resistance, endurance strength, as well as chemical resistance and easy burnability in burning furnace. Further, by forming uneveness on the surface by means of embossing, etc. safety problems such as slippage during operation and walking can be overcome. (T.M.)

  17. Global ice sheet modeling

    Hughes, T.J.; Fastook, J.L.

    1994-05-01

    The University of Maine conducted this study for Pacific Northwest Laboratory (PNL) as part of a global climate modeling task for site characterization of the potential nuclear waste respository site at Yucca Mountain, NV. The purpose of the study was to develop a global ice sheet dynamics model that will forecast the three-dimensional configuration of global ice sheets for specific climate change scenarios. The objective of the third (final) year of the work was to produce ice sheet data for glaciation scenarios covering the next 100,000 years. This was accomplished using both the map-plane and flowband solutions of our time-dependent, finite-element gridpoint model. The theory and equations used to develop the ice sheet models are presented. Three future scenarios were simulated by the model and results are discussed

  18. Energy information sheets

    NONE

    1995-07-01

    The National Energy Information Center (NEIC), as part of its mission, provides energy information and referral assistance to Federal, State, and local governments, the academic community, business and industrial organizations, and the public. The Energy Information Sheets was developed to provide general information on various aspects of fuel production, prices, consumption, and capability. Additional information on related subject matter can be found in other Energy Information Administration (EIA) publications as referenced at the end of each sheet.

  19. Genome-wide copy number variation (CNV in patients with autoimmune Addison's disease

    Brønstad Ingeborg

    2011-08-01

    Full Text Available Abstract Background Addison's disease (AD is caused by an autoimmune destruction of the adrenal cortex. The pathogenesis is multi-factorial, involving genetic components and hitherto unknown environmental factors. The aim of the present study was to investigate if gene dosage in the form of copy number variation (CNV could add to the repertoire of genetic susceptibility to autoimmune AD. Methods A genome-wide study using the Affymetrix GeneChip® Genome-Wide Human SNP Array 6.0 was conducted in 26 patients with AD. CNVs in selected genes were further investigated in a larger material of patients with autoimmune AD (n = 352 and healthy controls (n = 353 by duplex Taqman real-time polymerase chain reaction assays. Results We found that low copy number of UGT2B28 was significantly more frequent in AD patients compared to controls; conversely high copy number of ADAM3A was associated with AD. Conclusions We have identified two novel CNV associations to ADAM3A and UGT2B28 in AD. The mechanism by which this susceptibility is conferred is at present unclear, but may involve steroid inactivation (UGT2B28 and T cell maturation (ADAM3A. Characterization of these proteins may unravel novel information on the pathogenesis of autoimmunity.

  20. Unusual Onset of Celiac Disease and Addison's Disease in a 12-Year-Old Boy.

    Miconi, Francesco; Savarese, Emanuela; Miconi, Giovanni; Cabiati, Gabriele; Rapaccini, Valentina; Principi, Nicola; Esposito, Susanna

    2017-07-29

    Celiac disease (CD) is an autoimmune disorder deriving from an aberrant adaptive immune response against gluten-containing grains in genetically predisposed subjects. In a number of patients, CD is associated with one or more other autoimmune diseases. Primary Addison's disease (AD) and CD may co-exist, although this association is relatively uncommon in children. In addition, it is not precisely defined whether a gluten-free diet influences the course of AD. A case of CD in a 12-year-old boy presenting as acute adrenal insufficiency is described here. A gluten-free diet had a significant therapeutic role in this case, wherein most of the clinical signs and symptoms of AD disappeared in a few days. In addition, the dosage of cortisol acetate, initially administered to treat the AD, was able to be rapidly reduced. This case highlights that CD can be associated with AD in children, and a gluten-free diet seems to positively influence the course of AD.

  1. Insulin gene polymorphisms in type 1 diabetes, Addison's disease and the polyglandular autoimmune syndrome type II

    Hahner Stefanie

    2008-07-01

    Full Text Available Abstract Background Polymorphisms within the insulin gene can influence insulin expression in the pancreas and especially in the thymus, where self-antigens are processed, shaping the T cell repertoire into selftolerance, a process that protects from β-cell autoimmunity. Methods We investigated the role of the -2221Msp(C/T and -23HphI(A/T polymorphisms within the insulin gene in patients with a monoglandular autoimmune endocrine disease [patients with isolated type 1 diabetes (T1D, n = 317, Addison's disease (AD, n = 107 or Hashimoto's thyroiditis (HT, n = 61], those with a polyglandular autoimmune syndrome type II (combination of T1D and/or AD with HT or GD, n = 62 as well as in healthy controls (HC, n = 275. Results T1D patients carried significantly more often the homozygous genotype "CC" -2221Msp(C/T and "AA" -23HphI(A/T polymorphisms than the HC (78.5% vs. 66.2%, p = 0.0027 and 75.4% vs. 52.4%, p = 3.7 × 10-8, respectively. The distribution of insulin gene polymorphisms did not show significant differences between patients with AD, HT, or APS-II and HC. Conclusion We demonstrate that the allele "C" of the -2221Msp(C/T and "A" -23HphI(A/T insulin gene polymorphisms confer susceptibility to T1D but not to isolated AD, HT or as a part of the APS-II.

  2. Computed tomography morphology of the adrenal glands of patients with Addison's disease

    Ammini, A.C.; Gupta, R.; Mukopadhyay, C.; Shah, P.; Sandhu, M.S.; Vijayaraghavan, M.; Berry, M.

    1996-01-01

    To study the morphology of the adrenal glands of patients with Addison's disease an ultrasound and a computed tomographic scan of the adrenal glands were performed in 28 patients. Thirteen patients had bilateral, asymmetric adrenal enlargement. In six of these patients, areas of necrosis and calcification were also seen. Six patients had atrophic glands with calcification and nine patients had normal/atrophic glands without calcification. After instituting appropriate treatment, computed tomography (CT) was repeated between 6 months and 3 years later in 10 of the 13 patients with adrenal enlargement. A reduction in gland size was noted in all patients and one had functional recovery. It is concluded that the appearance of the adrenal glands on CT depends not only on the nature of the underlying disease but also on the duration of the illness and the type of treatment. The results highlighted the importance of studying adrenal morphology during the initial evaluation of patients with adrenal insufficiency. 11 refs., 4 tabs., 4 figs

  3. Genome-wide copy number variation (CNV) in patients with autoimmune Addison's disease

    2011-01-01

    Background Addison's disease (AD) is caused by an autoimmune destruction of the adrenal cortex. The pathogenesis is multi-factorial, involving genetic components and hitherto unknown environmental factors. The aim of the present study was to investigate if gene dosage in the form of copy number variation (CNV) could add to the repertoire of genetic susceptibility to autoimmune AD. Methods A genome-wide study using the Affymetrix GeneChip® Genome-Wide Human SNP Array 6.0 was conducted in 26 patients with AD. CNVs in selected genes were further investigated in a larger material of patients with autoimmune AD (n = 352) and healthy controls (n = 353) by duplex Taqman real-time polymerase chain reaction assays. Results We found that low copy number of UGT2B28 was significantly more frequent in AD patients compared to controls; conversely high copy number of ADAM3A was associated with AD. Conclusions We have identified two novel CNV associations to ADAM3A and UGT2B28 in AD. The mechanism by which this susceptibility is conferred is at present unclear, but may involve steroid inactivation (UGT2B28) and T cell maturation (ADAM3A). Characterization of these proteins may unravel novel information on the pathogenesis of autoimmunity. PMID:21851588

  4. Allegheny County Air Quality

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Air quality data from Allegheny County Health Department monitors throughout the county. Air quality monitored data must be verified by qualified individuals before...

  5. Allegheny County Municipal Boundaries

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This dataset demarcates the municipal boundaries in Allegheny County. Data was created to portray the boundaries of the 130 Municipalities in Allegheny County the...

  6. Allegheny County Addressing Landmarks

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This dataset contains address points which represent physical address locations assigned by the Allegheny County addressing authority. Data is updated by County...

  7. Allegheny County Council Districts

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This dataset portrays the boundaries of the County Council Districts in Allegheny County. The dataset is based on municipal boundaries and City of Pittsburgh ward...

  8. Allegheny County Address Points

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This dataset contains address points which represent physical address locations assigned by the Allegheny County addressing authority. Data is updated by County...

  9. Disintegration of liquid sheets

    Mansour, Adel; Chigier, Norman

    1990-01-01

    The development, stability, and disintegration of liquid sheets issuing from a two-dimensional air-assisted nozzle is studied. Detailed measurements of mean drop size and velocity are made using a phase Doppler particle analyzer. Without air flow the liquid sheet converges toward the axis as a result of surface tension forces. With airflow a quasi-two-dimensional expanding spray is formed. The air flow causes small variations in sheet thickness to develop into major disturbances with the result that disruption starts before the formation of the main break-up region. In the two-dimensional variable geometry air-blast atomizer, it is shown that the air flow is responsible for the formation of large, ordered, and small chaotic 'cell' structures.

  10. Safety advice sheets

    HSE Unit

    2013-01-01

    You never know when you might be faced with questions such as: when/how should I dispose of a gas canister? Where can I find an inspection report? How should I handle/store/dispose of a chemical substance…?   The SI section of the DGS/SEE Group is primarily responsible for safety inspections, evaluating the safety conditions of equipment items, premises and facilities. On top of this core task, it also regularly issues “Safety Advice Sheets” on various topics, designed to be of assistance to users but also to recall and reinforce safety rules and procedures. These clear and concise sheets, complete with illustrations, are easy to display in the appropriate areas. The following safety advice sheets have been issued so far: Other sheets will be published shortly. Suggestions are welcome and should be sent to the SI section of the DGS/SEE Group. Please send enquiries to general-safety-visits.service@cern.ch.

  11. Ice Sheets & Ice Cores

    Mikkelsen, Troels Bøgeholm

    Since the discovery of the Ice Ages it has been evident that Earth’s climate is liable to undergo dramatic changes. The previous climatic period known as the Last Glacial saw large oscillations in the extent of ice sheets covering the Northern hemisphere. Understanding these oscillations known....... The first part concerns time series analysis of ice core data obtained from the Greenland Ice Sheet. We analyze parts of the time series where DO-events occur using the so-called transfer operator and compare the results with time series from a simple model capable of switching by either undergoing...

  12. Energy information sheets

    1993-12-02

    The National Energy Information Center (NEIC), as part of its mission, provides energy information and referral assistance to Federal, State, and local governments, the academic community, business and industrial organizations, and the general public. Written for the general public, the EIA publication Energy Information Sheets was developed to provide information on various aspects of fuel production, prices, consumption and capability. The information contained herein pertains to energy data as of December 1991. Additional information on related subject matter can be found in other EIA publications as referenced at the end of each sheet.

  13. Linkage Analysis in Autoimmune Addison's Disease: NFATC1 as a Potential Novel Susceptibility Locus.

    Anna L Mitchell

    Full Text Available Autoimmune Addison's disease (AAD is a rare, highly heritable autoimmune endocrinopathy. It is possible that there may be some highly penetrant variants which confer disease susceptibility that have yet to be discovered.DNA samples from 23 multiplex AAD pedigrees from the UK and Norway (50 cases, 67 controls were genotyped on the Affymetrix SNP 6.0 array. Linkage analysis was performed using Merlin. EMMAX was used to carry out a genome-wide association analysis comparing the familial AAD cases to 2706 UK WTCCC controls. To explore some of the linkage findings further, a replication study was performed by genotyping 64 SNPs in two of the four linked regions (chromosomes 7 and 18, on the Sequenom iPlex platform in three European AAD case-control cohorts (1097 cases, 1117 controls. The data were analysed using a meta-analysis approach.In a parametric analysis, applying a rare dominant model, loci on chromosomes 7, 9 and 18 had LOD scores >2.8. In a non-parametric analysis, a locus corresponding to the HLA region on chromosome 6, known to be associated with AAD, had a LOD score >3.0. In the genome-wide association analysis, a SNP cluster on chromosome 2 and a pair of SNPs on chromosome 6 were associated with AAD (P <5x10-7. A meta-analysis of the replication study data demonstrated that three chromosome 18 SNPs were associated with AAD, including a non-synonymous variant in the NFATC1 gene.This linkage study has implicated a number of novel chromosomal regions in the pathogenesis of AAD in multiplex AAD families and adds further support to the role of HLA in AAD. The genome-wide association analysis has also identified a region of interest on chromosome 2. A replication study has demonstrated that the NFATC1 gene is worthy of future investigation, however each of the regions identified require further, systematic analysis.

  14. Longitudinal AddiQoL scores may identify higher risk for adrenal crises in Addison's disease.

    Meyer, Gesine; Koch, Maike; Herrmann, Eva; Bojunga, Jörg; Badenhoop, Klaus

    2018-05-01

    Several studies have shown a reduced quality of life (QoL) in patients with Addison's disease (AD), but investigations of QoL over a long-term course are lacking. Adrenal crises (AC) are life-threatening complications in AD. The purpose of this prospective study was to test whether the repeated use of QoL-questionnaires can detect prodromal periods of an AC. 110 patients with AD were asked to complete the disease specific-QoL questionnaire AddiQoL and a short questionnaire about adverse events once monthly over a period of ten months. AC was defined if at least two of the following symptoms were reported: (a) hypotension, (b) nausea or vomiting, (c) severe fatigue, (d) documented hyponatremia, hyperkalemia, or hypoglycemia, and subsequent parenteral glucocorticoid administration was carried out. Prevalence of AC was 10.9/100 patient years. AddiQoL scores in patients with AC showed a trend (p = 0,08) to a wider fluctuation over time. Subjective precrises not meeting the criteria for AC were reported by 31 patients who had significantly lower AddiQoL scores (p = 0,018). These are the first data showing the course of QoL during a period of ten months in patients with AD. Incidence of AC exceeds previous data. Our data show, that subjective precrises in AD associate with lower QoL. AC, as well as precrises affect intraindividual AddiQol-scores over time with a trend to a stronger fluctuation. Longitudinal AddiQol scores and self-reporting of precrises via patient diaries are additional clinical tools to identify higher risk for critical events.

  15. Analysis of cellular and humoral immune responses against cytomegalovirus in patients with autoimmune Addison's disease.

    Edvardsen, Kine; Hellesen, Alexander; Husebye, Eystein S; Bratland, Eirik

    2016-03-09

    Autoimmune Addison's disease (AAD) is caused by multiple genetic and environmental factors. Variants of genes encoding immunologically important proteins such as the HLA molecules are strongly associated with AAD, but any environmental risk factors have yet to be defined. We hypothesized that primary or reactivating infections with cytomegalovirus (CMV) could represent an environmental risk factor in AAD, and that CMV specific CD8(+) T cell responses may be dysregulated, possibly leading to a suboptimal control of CMV. In particular, the objective was to assess the HLA-B8 restricted CD8(+) T cell response to CMV since this HLA class I variant is a genetic risk factor for AAD. To examine the CD8(+) T cell response in detail, we analyzed the HLA-A2 and HLA-B8 restricted responses in AAD patients and healthy controls seropositive for CMV antibodies using HLA multimer technology, IFN-γ ELISpot and a CD107a based degranulation assay. No differences between patients and controls were found in functions or frequencies of CMV-specific T cells, regardless if the analyses were performed ex vivo or after in vitro stimulation and expansion. However, individual patients showed signs of reactivating CMV infection correlating with poor CD8(+) T cell responses to the virus, and a concomitant upregulation of interferon regulated genes in peripheral blood cells. Several recently diagnosed AAD patients also showed serological signs of ongoing primary CMV infection. CMV infection does not appear to be a major environmental risk factor in AAD, but may represent a precipitating factor in individual patients.

  16. Impact of Month of Birth on the Risk of Development of Autoimmune Addison's Disease.

    Pazderska, Agnieszka; Fichna, Marta; Mitchell, Anna L; Napier, Catherine M; Gan, Earn; Ruchała, Marek; Santibanez-Koref, Mauro; Pearce, Simon H

    2016-11-01

    The pathogenesis of autoimmune Addison's disease (AAD) is thought to be due to interplay of genetic, immune, and environmental factors. A month-of-birth effect, with increased risk for those born in autumn/winter months, has been described in autoimmune conditions such as type 1 diabetes and autoimmune thyroid disease. Month-of-birth effect was investigated in 2 independent cohorts of AAD subjects. The monthly distribution of birth in AAD patients was compared with that of the general population using the cosinor test. A total of 415 AAD subjects from the United Kingdom cohort were compared with 8 180 180 United Kingdom births, and 231 AAD subjects from the Polish cohort were compared with 2 421 384 Polish births. Association between month of birth and the susceptibility to AAD. In the entire cohort of AAD subjects, month-of-birth distribution analysis showed significant periodicity with peak of births in December and trough in May (P = .028). Analysis of the odds ratio distribution based on month of birth in 2 cohorts of patients with AAD versus the general population revealed a December peak and May trough, and January peak and July trough, in the United Kingdom and Polish cohorts, respectively. For the first time, we demonstrate that month of birth exerts an effect on the risk of developing AAD, with excess risk in individuals born in winter months and a protective effect when born in the summer. Exposure to seasonal viral infections in the perinatal period, coupled with vitamin D deficiency, could lead to dysregulation of innate immunity affecting the risk of developing AAD.

  17. Autoantibody response against NALP5/MATER in primary ovarian insufficiency and in autoimmune Addison's disease.

    Brozzetti, Annalisa; Alimohammadi, Mohammad; Morelli, Silvia; Minarelli, Viviana; Hallgren, Åsa; Giordano, Roberta; De Bellis, Annamaria; Perniola, Roberto; Kämpe, Olle; Falorni, Alberto

    2015-05-01

    NACHT leucine-rich-repeat protein 5 (NALP5)/maternal antigen that embryo requires (MATER) is an autoantigen in hypoparathyroidism associated with autoimmune polyendocrine syndrome type 1 (APS1) but is also expressed in the ovary. Mater is an autoantigen in experimental autoimmune oophoritis. The objectives of the study were to determine the frequency of NALP5/MATER autoantibodies (NALP5/MATER-Ab) in women with premature ovarian insufficiency (POI) and in patients with autoimmune Addison's disease (AAD) and to evaluate whether inhibin chains are a target for autoantibodies in POI. Autoantibodies against NALP5/MATER and inhibin chains-α and -βA were determined by radiobinding assays in 172 patients with AAD without clinical signs of gonadal insufficiency, 41 women with both AAD and autoimmune POI [steroidogenic cell autoimmune POI (SCA-POI)], 119 women with idiopathic POI, 19 patients with APS1, and 211 healthy control subjects. NALP5/MATER-Ab were detected in 11 of 19 (58%) sera from APS1 patients, 12 of 172 (7%) AAD sera, 5 of 41 (12%) SCA-POI sera, 0 of 119 idiopathic POI sera and 1 of 211 healthy control sera (P < .001). None of 160 POI sera, including 41 sera from women with SCA-POI and 119 women with idiopathic POI, and none of 211 healthy control sera were positive for inhibin chain-α/βA autoantibodies. NALP5/MATER-Ab are associated with hypoparathyroidism in APS1 but are present also in patients with AAD and in women with SCA-POI without hypoparathyroidism. Inhibin chains do not appear to be likely candidate targets of autoantibodies in human POI.

  18. Role of the X-linked gene GPR174 in autoimmune Addison's disease.

    Napier, C; Mitchell, A L; Gan, E; Wilson, I; Pearce, S H S

    2015-01-01

    Autoimmune endocrinopathies demonstrate a profound gender bias, but the reasons for this remain obscure. The 1000 genes on the X chromosome are likely to be implicated in this inherent susceptibility; various theories, including skewed X chromosome inactivation and fetal microchimerism, have been proposed. GPR174 is an Xq21 putative purinergic receptor that is widely expressed in lymphoid tissues. A single-nucleotide polymorphism, rs3827440, encoding Ser162Pro, has recently been associated with Graves' disease in Chinese and Polish populations, suggesting a role of this X chromosome gene in autoimmune disease. We investigated the role of rs3827440 in a UK cohort of patients with autoimmune Addison's disease (AAD). Samples from 286 AAD cases and 288 healthy controls were genotyped using TaqMan single-nucleotide polymorphism genotyping assays (C_25954273_10) on the Applied Biosystems 7900HT Fast real-time PCR system. Using a dominant (present/absent) model, the serine-encoding T allele of rs3827440 was present in 189 of 286 AAD patients (66%) compared with 132 of 288 unaffected controls (46%) [P = .010, odds ratio 1.80 (5%-95% confidence interval 1.22-2.67)]. An allele dosage model found a significant excess of the T allele in AAD patients compared with controls [P = .03, odds ratio 1.34 (5%-95% confidence interval 1.07-1.67)]. We have demonstrated a significant association of this X chromosome-encoded immunoreceptor with AAD for the first time. This X-linked gene could have a more generalized role in autoimmunity pathogenesis: G protein-coupled receptors are promising drugable targets, and further work to elucidate the functional role of GPR174 is now warranted.

  19. Mortality in patients with diabetes mellitus and Addison's disease: a nationwide, matched, observational cohort study.

    Chantzichristos, Dimitrios; Persson, Anders; Eliasson, Björn; Miftaraj, Mervete; Franzén, Stefan; Bergthorsdottir, Ragnhildur; Gudbjörnsdottir, Soffia; Svensson, Ann-Marie; Johannsson, Gudmundur

    2017-01-01

    Our hypothesis was that patients with diabetes mellitus obtain an additional risk of death if they develop Addison's disease (AD). Nationwide, matched, observational cohort study cross-referencing the Swedish National Diabetes Register with Inpatient, Cancer and Cause of Death Registers in patients with diabetes (type 1 and 2) and AD and matched controls with diabetes. Clinical characteristics at baseline, overall, and cause-specific mortality were assessed. The relative risk of death was assessed using a Cox proportional hazards regression model. Between January 1996 and December 2012, 226 patients with diabetes and AD were identified and matched with 1129 controls with diabetes. Median (interquartile range) follow-up was 5.9 (2.7-8.6) years. When patients with diabetes were diagnosed with AD, they had an increased frequency of diabetes complications, but both medical history of cancer and coronary heart disease did not differ compared with controls. Sixty-four of the 226 patients with diabetes and AD (28%) died, while 112 of the 1129 controls (10%) died. The estimated relative risk increase (hazard ratio) in overall mortality in the diabetes and AD group was 3.89 (95% confidence interval 2.84-5.32) compared with controls with diabetes. The most common cause of death was cardiovascular in both groups, but patients with diabetes and AD showed an increased death rate from diabetes complications, infectious diseases and unknown causes. Patients with the rare combination of diabetes and AD showed a markedly increased mortality and died more frequently from infections and unknown causes than patients with diabetes alone. Improved strategy for the management of this combination of metabolic disorders is needed. © 2017 European Society of Endocrinology.

  20. Linkage Analysis in Autoimmune Addison's Disease: NFATC1 as a Potential Novel Susceptibility Locus.

    Mitchell, Anna L; Bøe Wolff, Anette; MacArthur, Katie; Weaver, Jolanta U; Vaidya, Bijay; Erichsen, Martina M; Darlay, Rebecca; Husebye, Eystein S; Cordell, Heather J; Pearce, Simon H S

    2015-01-01

    Autoimmune Addison's disease (AAD) is a rare, highly heritable autoimmune endocrinopathy. It is possible that there may be some highly penetrant variants which confer disease susceptibility that have yet to be discovered. DNA samples from 23 multiplex AAD pedigrees from the UK and Norway (50 cases, 67 controls) were genotyped on the Affymetrix SNP 6.0 array. Linkage analysis was performed using Merlin. EMMAX was used to carry out a genome-wide association analysis comparing the familial AAD cases to 2706 UK WTCCC controls. To explore some of the linkage findings further, a replication study was performed by genotyping 64 SNPs in two of the four linked regions (chromosomes 7 and 18), on the Sequenom iPlex platform in three European AAD case-control cohorts (1097 cases, 1117 controls). The data were analysed using a meta-analysis approach. In a parametric analysis, applying a rare dominant model, loci on chromosomes 7, 9 and 18 had LOD scores >2.8. In a non-parametric analysis, a locus corresponding to the HLA region on chromosome 6, known to be associated with AAD, had a LOD score >3.0. In the genome-wide association analysis, a SNP cluster on chromosome 2 and a pair of SNPs on chromosome 6 were associated with AAD (P <5x10-7). A meta-analysis of the replication study data demonstrated that three chromosome 18 SNPs were associated with AAD, including a non-synonymous variant in the NFATC1 gene. This linkage study has implicated a number of novel chromosomal regions in the pathogenesis of AAD in multiplex AAD families and adds further support to the role of HLA in AAD. The genome-wide association analysis has also identified a region of interest on chromosome 2. A replication study has demonstrated that the NFATC1 gene is worthy of future investigation, however each of the regions identified require further, systematic analysis.

  1. Clues for early detection of autoimmune Addison's disease - myths and realities.

    Saevik, Å B; Åkerman, A-K; Grønning, K; Nermoen, I; Valland, S F; Finnes, T E; Isaksson, M; Dahlqvist, P; Bergthorsdottir, R; Ekwall, O; Skov, J; Nedrebø, B G; Hulting, A-L; Wahlberg, J; Svartberg, J; Höybye, C; Bleskestad, I H; Jørgensen, A P; Kämpe, O; Øksnes, M; Bensing, S; Husebye, E S

    2018-02-01

    Early detection of autoimmune Addison's disease (AAD) is important as delay in diagnosis may result in a life-threatening adrenal crisis and death. The classical clinical picture of untreated AAD is well-described, but methodical investigations are scarce. Perform a retrospective audit of patient records with the aim of identifying biochemical markers for early diagnosis of AAD. A multicentre retrospective study including 272 patients diagnosed with AAD at hospitals in Norway and Sweden during 1978-2016. Scrutiny of medical records provided patient data and laboratory values. Low sodium occurred in 207 of 247 (84%), but only one-third had elevated potassium. Other common nonendocrine tests were largely normal. TSH was elevated in 79 of 153 patients, and hypoglycaemia was found in 10%. Thirty-three per cent were diagnosed subsequent to adrenal crisis, in whom electrolyte disturbances were significantly more pronounced (P < 0.001). Serum cortisol was consistently decreased (median 62 nmol L -1 [1-668]) and significantly lower in individuals with adrenal crisis (38 nmol L -1 [2-442]) than in those without (81 nmol L -1 [1-668], P < 0.001). The most consistent biochemical finding of untreated AAD was low sodium independent of the degree of glucocorticoid deficiency. Half of the patients had elevated TSH levels. Only a minority presented with marked hyperkalaemia or other nonhormonal abnormalities. Thus, unexplained low sodium and/or elevated TSH should prompt consideration of an undiagnosed AAD, and on clinical suspicion bring about assay of cortisol and ACTH. Presence of 21-hydroxylase autoantibodies confirms autoimmune aetiology. Anticipating additional abnormalities in routine blood tests may delay diagnosis. © 2017 The Association for the Publication of the Journal of Internal Medicine.

  2. Impaired quality and efficiency of sleep impairs cognitive functioning in Addison's disease.

    Henry, Michelle; Ross, Ian Louis; Wolf, Pedro Sofio Abril; Thomas, Kevin Garth Flusk

    2017-04-01

    Standard replacement therapy for Addison's disease (AD) does not restore a normal circadian rhythm. Periods of sub- and supra- physiological cortisol levels experienced by patients with AD likely induce disrupted sleep. Given that healthy sleep plays an important role in memory consolidation, the novelty of the current study was to characterise, using objective measures, the relationship between sleep and memory in patients with AD, and to examine the hypothesis that poor sleep is a biological mechanism underlying memory impairment in those patients. We used a within-subjects design. Ten patients with AD and 10 matched healthy controls completed standardised neuropsychological tests assessing declarative memory (Rey Auditory Verbal Learning Test) and procedural memory (Finger Tapping Task) before and after a period of actigraphy-measured sleep, and before and after a period of waking. Relative to healthy controls, patients with AD experienced disrupted sleep characterised by poorer sleep efficiency and more time spent awake. Patients also showed impaired verbal learning and memory relative to healthy controls (p=0.007). Furthermore, whereas healthy controls' declarative memory performance benefited from a period of sleep compared to waking (p=0.032), patients with AD derived no such benefit from sleep (p=0.448). Regarding the procedural memory task, analyses detected no significant between-group differences (all p's<0.065), and neither group showed significant sleep-enhanced performance. We demonstrated, using actigraphy and standardized measures of memory performance, an association between sleep disturbances and cognitive deficits in patients with AD. These results suggest that, in patients with AD, the source of memory deficits is, at least to some extent, disrupted sleep patterns that interfere with optimal consolidation of previously-learned declarative information. Hence, treating the sleep disturbances that are frequently experienced by patients with AD may

  3. The role of functionally defective rare germline variants of sialic acid acetylesterase in autoimmune Addison's disease

    Gan, Earn H; MacArthur, Katie; Mitchell, Anna L; Pearce, Simon H S

    2012-01-01

    Background Autoimmune Addison's disease (AAD) is a rare condition with a complex genetic basis. A panel of rare and functionally defective genetic variants in the sialic acid acetylesterase (SIAE) gene has recently been implicated in several common autoimmune conditions. We performed a case–control study to determine whether these rare variants are associated with a rarer condition, AAD. Method We analysed nine SIAE gene variants (W48X, M89V, C196F, C226G, R230W, T312M, Y349C, F404S and R479C) in a United Kingdom cohort of 378 AAD subjects and 387 healthy controls. All samples were genotyped using Sequenom iPlex chemistry to characterise primer extension products. Results A heterozygous rare allele at codon 312 (312*M) was found in one AAD patient (0.13%) but was not detected in the healthy controls. The commoner, functionally recessive variant at codon 89 (89*V) was found to be homozygous in two AAD patients but was only found in the heterozygous state in controls. Taking into account all nine alleles examined, 4/378 (1.06%) AAD patients and 1/387 (0.25%) healthy controls carried the defective SIAE alleles, with a calculated odds ratio of 4.13 (95% CI 0.44–97.45, two-tailed P value 0.212, NS). Conclusion We demonstrated the presence of 89*V homozygotes and the 312*M rare allele in the AAD cohort, but overall, our analysis does not support a role for rare variants in SIAE in the pathogenesis of AAD. However, the relatively small collection of AAD patients limits the power to exclude a small effect. PMID:23011869

  4. Gonadal function in males with autoimmune Addison's disease and autoantibodies to steroidogenic enzymes.

    Dalla Costa, M; Bonanni, G; Masiero, S; Faggian, D; Chen, S; Furmaniak, J; Rees Smith, B; Perniola, R; Radetti, G; Garelli, S; Chiarelli, S; Albergoni, M P; Plebani, M; Betterle, C

    2014-06-01

    Steroidogenic enzyme autoantibodies (SEAbs) are frequently present and are markers of autoimmune premature ovarian failure (POF) in females with autoimmune Addison's disease (AAD). The prevalence and significance of SEAbs in males with AAD have not yet been defined. We studied the prevalence of SEAbs in a large cohort of males with AAD and assessed the relationship between SEAbs positivity and testicular function. A total of 154 males with AAD (mean age 34 years) were studied. SEAbs included autoantibodies to steroid-producing cells (StCA), detected by immunofluorescence, and steroid 17α-hydroxylase (17α-OHAbs) and side chain cleavage enzyme (SCCAbs) measured by immunoprecipitation assays. Gonadal function was evaluated by measuring follicle-stimulating hormone (FSH), luteinizing hormone (LH), total testosterone (TT), sex hormone-binding globulin (SHGB), anti-müllerian hormone (AMH) and inhibin-B (I-B). Twenty-six males, 10 SEAbs((+)) and 16 SEAbs((-)), were followed-up for a mean period of 7·6 years to assess the behaviour of SEAbs and testicular function. SEAbs were found in 24·7% of males with AAD, with the highest frequency in patients with autoimmune polyendocrine syndrome type 1 (APS-1). The levels of reproductive hormones in 30 SEAbs((+)) males were in the normal range according to age and were not significantly different compared to 55 SEAbs((-)) males (P > 0·05). During follow-up, both SEAbs((+)) and SEAbs((-)) patients maintained normal testicular function. SEAbs were found with high frequency in males with AAD; however, they were not associated with testicular failure. This study suggests that the diagnostic value of SEAbs in males with AAD differs compared to females, and this may be related to the immunoprivileged status of the testis. © 2014 British Society for Immunology.

  5. Collisionless current sheet equilibria

    Neukirch, T.; Wilson, F.; Allanson, O.

    2018-01-01

    Current sheets are important for the structure and dynamics of many plasma systems. In space and astrophysical plasmas they play a crucial role in activity processes, for example by facilitating the release of magnetic energy via processes such as magnetic reconnection. In this contribution we will focus on collisionless plasma systems. A sensible first step in any investigation of physical processes involving current sheets is to find appropriate equilibrium solutions. The theory of collisionless plasma equilibria is well established, but over the past few years there has been a renewed interest in finding equilibrium distribution functions for collisionless current sheets with particular properties, for example for cases where the current density is parallel to the magnetic field (force-free current sheets). This interest is due to a combination of scientific curiosity and potential applications to space and astrophysical plasmas. In this paper we will give an overview of some of the recent developments, discuss their potential applications and address a number of open questions.

  6. Cholera Fact Sheet

    ... news-room/fact-sheets/detail/cholera","@context":"http://schema.org","@type":"Article"}; العربية 中文 français русский español ... that includes feedback at the local level and information-sharing at the global level. Cholera cases are ...

  7. Pseudomonas - Fact Sheet

    Public Health Agency

    2012-01-01

    Fact sheet on Pseudomonas, including:What is Pseudomonas?What infections does it cause?Who is susceptible to pseudomonas infection?How will I know if I have pseudomonas infection?How can Pseudomonas be prevented from spreading?How can I protect myself from Pseudomonas?How is Pseudomonas infection treated?

  8. NTPR Fact Sheets

    History Documents US Underground Nuclear Test History Reports NTPR Radiation Exposure Reports Enewetak Atoll Cleanup Documents TRAC About Who We Are Our Values History Locations Our Leadership Director Support Center Contact Us FAQ Sheet Links Success Stories Contracts Business Opportunities Current

  9. Production (information sheets)

    2007-01-01

    Documentation sheets: Geo energy 2 Integrated System Approach Petroleum Production (ISAPP) The value of smartness 4 Reservoir permeability estimation from production data 6 Coupled modeling for reservoir application 8 Toward an integrated near-wellbore model 10 TNO conceptual framework for "E&P

  10. Hibernia fact sheet

    Anon.

    1994-01-01

    This fact sheet gives details of the Hibernia oil field including its location, discovery date, oil company's interests in the project, the recoverable reserves of the two reservoirs, the production system used, capital costs of the project, and overall targets for Canadian benefit. Significant dates for the Hibernia project are listed. (UK)

  11. Ethanol Basics (Fact Sheet)

    2015-01-01

    Ethanol is a widely-used, domestically-produced renewable fuel made from corn and other plant materials. More than 96% of gasoline sold in the United States contains ethanol. Learn more about this alternative fuel in the Ethanol Basics Fact Sheet, produced by the U.S. Department of Energy's Clean Cities program.

  12. Rubella - Fact Sheet for Parents

    ... and 4 through 6 years Fact Sheet for Parents Color [2 pages] Español: Rubéola The best way ... according to the recommended schedule. Fact Sheets for Parents Diseases and the Vaccines that Prevent Them Chickenpox ...

  13. No Difference in Mood and Quality of Life in DHEA-S Deficient Adults with Addison's Disease vs. Type 2 Diabetes Patients with Normal DHEA-S Levels: Implications for Management of These Conditions.

    Heald, Adrian H; Walther, Andreas; Davis, Julian R E; Moreno, Gabriela Y C; Kane, John; Livingston, Mark; Fowler, Helen L

    2017-01-01

    Patients with Addison's disease have relatively high rates of depression and anxiety symptoms compared with population-based reference samples. Addison's disease results in deficiency of dehydroepiandrosterone (DHEA) and DHEA-sulfate (DHEA-S). There is considerable debate about the specific effects of DHEA deficiency on energy level and mood. We measured emotional well-being in 16 patients with Addison's disease and a group of 16 hospital attendees with type 2 diabetes. Participants completed the General Health Questionnaire-28 (GHQ-28), the Hospital Anxiety and Depression Scale (HADS), the World Health Organization's quality of life assessment (WHOQOL-BREF) and the Holmes-Rahe life event scale. DHEA-S was low in Addison's patients (Addison's men: 0.5 ± 0.1 μmol/l [normal range: 2.1-10.8] compared with diabetes men: 3.2 ± 1.2 μmol/l; Addison's women: 0.4 ± 0.01 μmol/l [normal range: 1.0-11.5] compared with diabetes women: 2.2 ± 0.71 μmol/l). Testosterone levels were similar in both groups studied. There were no differences in emotional well-being and quality of life (QOL) between patients with Addison's disease and Type 2 Diabetes Mellitus as measured by GHQ-28 (Addison's: 22.4 ± 2.6, Diabetes: 19.6 ± 2.7), HADS Depression (Addison's: 5.4 ± 0.9, Diabetes: 4.5 ± 1.4), HADS Anxiety and WHOQOL-BREF. There were no gender differences in affective symptomatology within the Addison's group. Life event scores were above average in both groups (Addison's: 195 ± 39.6, Diabetes: 131 ± 43.8), but not significant for difference between groups as was GHQ-28 total score. Both groups scored highly on the GHQ-28 and the life event scale, indicative of poorer health perceptions than the general population. This could be due to the chronicity of both disorders. We have not identified any specific effects of DHEA-S deficiency on mood or QOL.

  14. Film sheet cassette

    1981-01-01

    A novel film sheet cassette is described for handling CAT photographic films under daylight conditions and facilitating their imaging. A detailed description of the design and operation of the cassette is given together with appropriate illustrations. The resulting cassette is a low-cost unit which is easily constructed and yet provides a sure light-tight seal for the interior contents of the cassette. The individual resilient fingers on the light-trap permit the ready removal of the slide plate for taking pictures. The stippled, non-electrostatic surface of the pressure plate ensures an air layer and free slidability of the film for removal and withdrawal of the film sheet. The advantage of the daylight system is that a darkroom need not be used for inserting and removing the film in and out of the cassette resulting in a considerable time saving. (U.K.)

  15. Clean Cities Fact Sheet

    2004-01-01

    This fact sheet explains the Clean Cities Program and provides contact information for all coalitions and regional offices. It answers key questions such as: What is the Clean Cities Program? What are alternative fuels? How does the Clean Cities Program work? What sort of assistance does Clean Cities offer? What has Clean Cities accomplished? What is Clean Cities International? and Where can I find more information?

  16. Information sheets on energy

    2004-01-01

    These sheets, presented by the Cea, bring some information, in the energy domain, on the following topics: the world energy demand and the energy policy in France and in Europe, the part of the nuclear power in the energy of the future, the greenhouse gases emissions and the fight against the greenhouse effect, the carbon dioxide storage cost and the hydrogen economy. (A.L.B.)

  17. Biomolecular Science (Fact Sheet)

    2012-04-01

    A brief fact sheet about NREL Photobiology and Biomolecular Science. The research goal of NREL's Biomolecular Science is to enable cost-competitive advanced lignocellulosic biofuels production by understanding the science critical for overcoming biomass recalcitrance and developing new product and product intermediate pathways. NREL's Photobiology focuses on understanding the capture of solar energy in photosynthetic systems and its use in converting carbon dioxide and water directly into hydrogen and advanced biofuels.

  18. Sheet pinch devices

    Anderson, O.A.; Baker, W.R.; Ise, J. Jr.; Kunkel, W.B.; Pyle, R.V.; Stone, J.M.

    1958-01-01

    Three types of sheet-like discharges are being studied at Berkeley. The first of these, which has been given the name 'Triax', consists of a cylindrical plasma sleeve contained between two coaxial conducting cylinders A theoretical analysis of the stability of the cylindrical sheet plasma predicts the existence of a 'sausage-mode' instability which is, however, expected to grow more slowly than in the case of the unstabilized linear pinch (by the ratio of the radial dimensions). The second pinch device employs a disk shaped discharge with radial current guided between flat metal plates, this configuration being identical to that of the flat hydromagnetic capacitor without external magnetic field. A significant feature of these configurations is the absence of a plasma edge, i.e., there are no regions of sharply curved magnetic field lines anywhere in these discharges. The importance of this fact for stability is not yet fully investigated theoretically. As a third configuration a rectangular, flat pinch tube has been constructed, and the behaviour of a flat plasma sheet with edges is being studied experimentally

  19. Association of autoimmune Addison's disease with alleles of STAT4 and GATA3 in European cohorts.

    Anna L Mitchell

    Full Text Available Gene variants known to contribute to Autoimmune Addison's disease (AAD susceptibility include those at the MHC, MICA, CIITA, CTLA4, PTPN22, CYP27B1, NLRP-1 and CD274 loci. The majority of the genetic component to disease susceptibility has yet to be accounted for.To investigate the role of 19 candidate genes in AAD susceptibility in six European case-control cohorts.A sequential association study design was employed with genotyping using Sequenom iPlex technology. In phase one, 85 SNPs in 19 genes were genotyped in UK and Norwegian AAD cohorts (691 AAD, 715 controls. In phase two, 21 SNPs in 11 genes were genotyped in German, Swedish, Italian and Polish cohorts (1264 AAD, 1221 controls. In phase three, to explore association of GATA3 polymorphisms with AAD and to determine if this association extended to other autoimmune conditions, 15 SNPs in GATA3 were studied in UK and Norwegian AAD cohorts, 1195 type 1 diabetes patients from Norway, 650 rheumatoid arthritis patients from New Zealand and in 283 UK Graves' disease patients. Meta-analysis was used to compare genotype frequencies between the participating centres, allowing for heterogeneity.We report significant association with alleles of two STAT4 markers in AAD cohorts (rs4274624: P = 0.00016; rs10931481: P = 0.0007. In addition, nominal association of AAD with alleles at GATA3 was found in 3 patient cohorts and supported by meta-analysis. Association of AAD with CYP27B1 alleles was also confirmed, which replicates previous published data. Finally, nominal association was found at SNPs in both the NF-κB1 and IL23A genes in the UK and Italian cohorts respectively.Variants in the STAT4 gene, previously associated with other autoimmune conditions, confer susceptibility to AAD. Additionally, we report association of GATA3 variants with AAD: this adds to the recent report of association of GATA3 variants with rheumatoid arthritis.

  20. Multisteroid LC–MS/MS assay for glucocorticoids and androgens and its application in Addison's disease

    Methlie, Paal; Hustad, Steinar; Kellman, Ralf; Almås, Bjørg; Erichsen, Martina M; Husebye, Eystein S; Løvås, Kristian

    2013-01-01

    Objective Liquid chromatography–tandem mass spectrometry (LC–MS/MS) offers superior analytical specificity compared with immunoassays, but it is not available in many regions and hospitals due to expensive instrumentation and tedious sample preparation. Thus, we developed an automated, high-throughput LC–MS/MS assay for simultaneous quantification of ten endogenous and synthetic steroids targeting diseases of the hypothalamic–pituitary–adrenal axis and gonads. Methods Deuterated internal standards were added to 85 μl serum and processed by liquid–liquid extraction. Cortisol, cortisone, prednisolone, prednisone, 11-deoxycortisol, dexamethasone, testosterone, androstenedione and progesterone were resolved by ultra-high-pressure chromatography on a reversed-phase column in 6.1 min and detected by triple-quadrupole mass spectrometry. The method was used to assess steroid profiles in women with Addison's disease (AD, n=156) and blood donors (BDs, n=102). Results Precisions ranged from 4.5 to 10.1% relative standard deviations (RSD), accuracies from 95 to 108% and extraction recoveries from 60 to 84%. The method was practically free of matrix effects and robust to individual differences in serum composition. Most postmenopausal AD women had extremely low androstenedione concentrations, below 0.14 nmol/l, and median testosterone concentrations of 0.15 nmol/l (interquartile range 0.00–0.41), considerably lower than those of postmenopausal BDs (1.28 nmol/l (0.96–1.64) and 0.65 nmol/l (0.56–1.10) respectively). AD women in fertile years had androstenedione concentrations of 1.18 nmol/l (0.71–1.76) and testosterone concentrations of 0.44 nmol/l (0.22–0.63), approximately half of those found in BDs of corresponding age. Conclusion This LC–MS/MS assay provides highly sensitive and specific assessments of glucocorticoids and androgens with low sample volumes and is suitable for endocrine laboratories and research. Its utility has been

  1. Allegheny County Obesity Rates

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Obesity rates for each Census Tract in Allegheny County were produced for the study “Developing small-area predictions for smoking and obesity prevalence in the...

  2. Allegheny County Dam Locations

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This dataset shows the point locations of dams in Allegheny County. If viewing this description on the Western Pennsylvania Regional Data Center’s open data portal...

  3. Allegheny County Asbestos Permits

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Current asbestos permit data issued by the County for commercial building demolitions and renovations as required by the EPA. This file is updated daily and can be...

  4. Allegheny County Crash Data

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Contains locations and information about every crash incident reported to the police in Allegheny County from 2004 to 2016. Fields include injury severity,...

  5. Allegheny County Anxiety Medication

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — These Census Tract-level datasets described here provide de-identified diagnosis data for customers of three managed care organizations in Allegheny County (Gateway...

  6. Allegheny County Smoking Rates

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Smoking rates for each Census Tract in Allegheny County were produced for the study “Developing small-area predictions for smoking and obesity prevalence in the...

  7. Allegheny County Employee Salaries

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Employee salaries are a regular Right to Know request the County receives. Here is the disclaimer language that is included with the dataset from the Open Records...

  8. ROE County Data

    U.S. Environmental Protection Agency — This polygon dataset shows the outlines of states, counties, and county equivalents (Louisiana parishes, Alaska boroughs, Puerto Rico municipalities, and U.S. Virgin...

  9. Allegheny County Parcel Boundaries

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This dataset contains parcel boundaries attributed with county block and lot number. Use the Property Information Extractor for more control downloading a filtered...

  10. Allegheny County Tobacco Vendors

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — The tobacco vendor information provides the location of all tobacco vendors in Allegheny County in 2015. Data was compiled from administrative records managed by...

  11. Allegheny County Plumbers

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — All master plumbers must be registered with the Allegheny County Health Department. Only Registered Master Plumbers who possess a current plumbing license or...

  12. Allegheny County Traffic Counts

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Traffic sensors at over 1,200 locations in Allegheny County collect vehicle counts for the Pennsylvania Department of Transportation. Data included in the Health...

  13. Allegheny County Greenways

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Greenways data was compiled by the Allegheny Land Trust as a planning effort in the development of Allegheny Places, the Allegheny County Comprehensive Plan. The...

  14. Allegheny County Street Centerlines

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This dataset contains the locations of the street centerlines for vehicular and foot traffic in Allegheny County. Street Centerlines are classified as Primary Road,...

  15. Allegheny County Major Rivers

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This dataset contains locations of major rivers that flow through Allegheny County. These shapes have been taken from the Hydrology dataset. The Ohio River,...

  16. Allegheny County Depression Medication

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — These Census Tract-level datasets described here provide de-identified diagnosis data for customers of three managed care organizations in Allegheny County (Gateway...

  17. Taos County Roads

    Earth Data Analysis Center, University of New Mexico — Vector line shapefile under the stewardship of the Taos County Planning Department depicting roads in Taos County, New Mexico. Originally under the Emergency...

  18. Allegheny County Property Assessments

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Real Property parcel characteristics for Allegheny County, PA. Includes information pertaining to land, values, sales, abatements, and building characteristics (if...

  19. Allegheny County Hospitals

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — The data on health care facilities includes the name and location of all the hospitals and primary care facilities in Allegheny County. The current listing of...

  20. Allegheny County Parks Outlines

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Shows the size and shape of the nine Allegheny County parks. If viewing this description on the Western Pennsylvania Regional Data Center’s open data portal...

  1. Allegheny County Crash Data

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Contains locations and information about every crash incident reported to the police in Allegheny County from 2004 to 2017. Fields include injury severity,...

  2. Allegheny County Property Viewer

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Webmap of Allegheny municipalities and parcel data. Zoom for a clickable parcel map with owner name, property photograph, and link to the County Real Estate website...

  3. County Population Vulnerability

    City and County of Durham, North Carolina — This layer summarizes the social vulnerability index for populations within each county in the United States at scales 1:3m and below. It answers the question...

  4. Dense sheet Z-pinches

    Tetsu, Miyamoto

    1999-01-01

    The steady state and quasi-steady processes of infinite- and finite-width sheet z-pinches are studied. The relations corresponding to the Bennett relation and Pease-Braginskii current of cylindrical fiber z-pinches depend on a geometrical factor in the sheet z-pinches. The finite-width sheet z-pinch is approximated by a segment of infinite-width sheet z-pinch, if it is wide enough, and corresponds to a number of (width/thickness) times fiber z-pinch plasmas of the diameter that equals the sheet thickness. If the sheet current equals this number times the fiber current, the plasma created in the sheet z-pinches is as dense as in the fiber z-pinches. The total energy of plasma and magnetic field per unit mass is approximately equal in both pinches. Quasi-static transient processes are different in several aspects from the fiber z-pinch. No radiation collapse occurs in the sheet z-pinch. The stability is improved in the sheet z-pinches. The fusion criterions and the experimental arrangements to produce the sheet z-pinches are also discussed. (author)

  5. Addison disease’s in puppy, congenital adrenal hyperplasia (adrenal 21 alpha hydroxilase deficiency) and Hypoparathyroidism in Dogs

    Castillo, Víctor; Ortemberg, L.

    2009-01-01

    La enfermedad de Addison (EA), la hiperplasia adrenal congénita (HAC) por déficit de 21 αhidroxilasa adrenal y el hipoparatiroidismo (HoPTH) son de diagnóstico poco frecuente, representando el 3% (EA) y 0,5% (tanto HAC como HoPTH) de las enfermedades endócrinas atendidas. Se describen 1 caso de EA congénito (collie de 6 meses de edad), 2 casos de HAC (una caniche toy y una labradora, ambas de 2 años) y 2 de HoPTH (cocker spaniel de 11 meses y una mestiza de 7 años). Por la signología clínica ...

  6. Perforation of metal sheets

    Steenstrup, Jens Erik

    simulation is focused on the sheet deformation. However, the effect on the tool and press is included. The process model is based on the upper bound analysis in order to predict the force progress and hole characteristics etc. Parameter analyses are divided into two groups, simulation and experimental tests......The main purposes of this project are:1. Development of a dynamic model for the piercing and performation process2. Analyses of the main parameters3. Establishing demands for process improvements4. Expansion of the existing parameter limitsThe literature survey describes the process influence...

  7. Natural history of autoimmune primary ovarian insufficiency in patients with Addison's disease: from normal ovarian function to overt ovarian dysfunction.

    De Bellis, Annamaria; Bellastella, Giuseppe; Falorni, Alberto; Aitella, Ernesto; Barrasso, Mariluce; Maiorino, Maria Ida; Bizzarro, Elio; Bellastella, Antonio; Giugliano, Dario; Esposito, Katherine

    2017-10-01

    Women with autoimmune Addison's disease with normal ovulatory cycles but positive for steroid cell antibodies (StCA) have been considered at risk of premature ovarian insufficiency (POI). Thirty-three women younger than 40 years, with subclinical-clinical autoimmune Addison's disease but with normally ovulatory menses, were followed up for 10 years to evaluate the long-term time-related variations of StCA, ovarian function and follicular reserve. All patients and 27 control women were investigated at the start and every year for the presence and titre of StCA (by indirect immunofluorescence), serum concentrations of anti-Mullerian hormone (AMH) and ovarian function at four consecutive menses every year. At the start of the study StCA were present in 16 women (group 1), at low/middle titres (≤1:32) in seven of them (43.8%, group 1A), at high titres (>1:32) in the remaining nine patients (group 1B, 56.2%), while they were absent from 17 patients (group 2). During the follow-up period, all women in group 1A remained StCA-positive at low/middle titres with normal ovulatory menses and normal gonadotrophin and AMH levels, while all patients in group 1B showed a further increase of StCA titres (1:128-1:256) and progressed through three stages of ovarian function. None of the patients in group 2 and controls showed the appearance of StCA or ovarian dysfunction during the follow-up. The presence of StCA at high titres can be considered a good predictive marker of subsequent development of autoimmune POI. To single out the stages of autoimmune POI may allow a timely therapeutic choice in the subclinical and early clinical stages. © 2017 European Society of Endocrinology.

  8. Experiments on sheet metal shearing

    Gustafsson, Emil

    2013-01-01

    Within the sheet metal industry, different shear cutting technologies are commonly used in several processing steps, e.g. in cut to length lines, slitting lines, end cropping etc. Shearing has speed and cost advantages over competing cutting methods like laser and plasma cutting, but involves large forces on the equipment and large strains in the sheet material.Numerical models to predict forces and sheared edge geometry for different sheet metal grades and different shear parameter set-ups a...

  9. BClI polymorphism of the glucocorticoid receptor gene is associated with increased obesity, impaired glucose metabolism and dyslipidaemia in patients with Addison's disease.

    Giordano, Roberta; Marzotti, Stefania; Berardelli, Rita; Karamouzis, Ioannis; Brozzetti, Annalisa; D'Angelo, Valentina; Mengozzi, Giulio; Mandrile, Giorgia; Giachino, Daniela; Migliaretti, Giuseppe; Bini, Vittorio; Falorni, Alberto; Ghigo, Ezio; Arvat, Emanuela

    2012-12-01

    Although glucocorticoids are essential for health, several studies have shown that glucocorticoids replacement in Addison's disease might be involved in anthropometric and metabolic impairment, with increased cardiovascular risk, namely if conventional doses are used. As the effects of glucocorticoids are mediated by the glucocorticoid receptor, encoded by NR3C1 gene, different polymorphisms in the NR3C1 gene have been linked to altered glucocorticoid sensitivity in general population as well as in patients with obesity or metabolic syndrome. We investigated the impact of glucocorticoid receptor gene polymorphisms, including the BclI, N363S and ER22/23EK variants, on anthropometric parameters (BMI and waist circumference), metabolic profile (HOMA, OGTT and serum lipids) and ACTH levels in 50 patients with Addison's disease (34 women and 16 men, age 20-82 year) under glucocorticoids replacement. Neither N363S nor ER22/23EK variants were significantly associated with anthropometric, metabolic or hormonal parameters, while patients carrying the homozygous BclI polymorphism GG (n = 4) showed higher (P Addison's disease and may contribute, along with other factors, to the increase in central adiposity, impaired glucose metabolism and dyslipidaemia. © 2012 Blackwell Publishing Ltd.

  10. Soft Costs Fact Sheet

    None

    2016-05-01

    This fact sheet is an overview of the systems integration subprogram at the U.S. Department of Energy SunShot Initiative. Soft costs can vary significantly as a result of a fragmented energy marketplace. In the U.S., there are 18,000 jurisdictions and 3,000 utilities with different rules and regulations for how to go solar. The same solar equipment may vary widely in its final installation price due to process and market variations across jurisdictions, creating barriers to rapid industry growth. SunShot supports the development of innovative solutions that enable communities to build their local economies and establish clean energy initiatives that meet their needs, while at the same time creating sustainable solar market conditions.

  11. Photovoltaics Fact Sheet

    None

    2016-02-01

    This fact sheet is an overview of the Photovoltaics (PV) subprogram at the U.S. Department of Energy SunShot Initiative. The U.S. Department of Energy (DOE)’s Solar Energy Technologies Office works with industry, academia, national laboratories, and other government agencies to advance solar PV, which is the direct conversion of sunlight into electricity by a semiconductor, in support of the goals of the SunShot Initiative. SunShot supports research and development to aggressively advance PV technology by improving efficiency and reliability and lowering manufacturing costs. SunShot’s PV portfolio spans work from early-stage solar cell research through technology commercialization, including work on materials, processes, and device structure and characterization techniques.

  12. Systems Integration Fact Sheet

    None

    2016-06-01

    This fact sheet is an overview of the Systems Integration subprogram at the U.S. Department of Energy SunShot Initiative. The Systems Integration subprogram enables the widespread deployment of safe, reliable, and cost-effective solar energy technologies by addressing the associated technical and non-technical challenges. These include timely and cost-effective interconnection procedures, optimal system planning, accurate prediction of solar resources, monitoring and control of solar power, maintaining grid reliability and stability, and many more. To address the challenges associated with interconnecting and integrating hundreds of gigawatts of solar power onto the electricity grid, the Systems Integration program funds research, development, and demonstration projects in four broad, interrelated focus areas: grid performance and reliability, dispatchability, power electronics, and communications.

  13. Hyperspectral light sheet microscopy

    Jahr, Wiebke; Schmid, Benjamin; Schmied, Christopher; Fahrbach, Florian O.; Huisken, Jan

    2015-09-01

    To study the development and interactions of cells and tissues, multiple fluorescent markers need to be imaged efficiently in a single living organism. Instead of acquiring individual colours sequentially with filters, we created a platform based on line-scanning light sheet microscopy to record the entire spectrum for each pixel in a three-dimensional volume. We evaluated data sets with varying spectral sampling and determined the optimal channel width to be around 5 nm. With the help of these data sets, we show that our setup outperforms filter-based approaches with regard to image quality and discrimination of fluorophores. By spectral unmixing we resolved overlapping fluorophores with up to nanometre resolution and removed autofluorescence in zebrafish and fruit fly embryos.

  14. Settlement during vibratory sheet piling

    Meijers, P.

    2007-01-01

    During vibratory sheet piling quite often the soil near the sheet pile wall will settle. In many cases this is not a problem. For situations with houses, pipelines, roads or railroads at relative short distance these settlements may not be acceptable. The purpose of the research described in this

  15. Plasma dynamics in current sheets

    Bogdanov, S.Yu.; Drejden, G.V.; Kirij, N.P.; AN SSSR, Leningrad

    1992-01-01

    Plasma dynamics in successive stages of current sheet evolution is investigated on the base of analysis of time-spatial variations of electron density and electrodynamic force fields. Current sheet formation is realized in a two-dimensional magnetic field with zero line under the action of relatively small initial disturbances (linear regimes). It is established that in the limits of the formed sheet is concentrated dense (N e ∼= 10 16 cm -3 ) (T i ≥ 100 eV, bar-Z i ≥ 2) hot pressure of which is balanced by the magnetic action of electrodynamic forces is carried out both plasma compression in the sheet limits and the acceleration along the sheet surface from a middle to narrow side edges

  16. Vitamin and Mineral Supplement Fact Sheets

    ... website Submit Search NIH Office of Dietary Supplements Vitamin and Mineral Supplement Fact Sheets Search the list ... Supplements: Background Information Botanical Dietary Supplements: Background Information Vitamin and Mineral Fact Sheets Botanical Supplement Fact Sheets ...

  17. VT Boundaries - county polygons

    Vermont Center for Geographic Information — (Link to Metadata) The BNDHASH dataset depicts Vermont villages, towns, counties, Regional Planning Commissions (RPC), and LEPC (Local Emergency Planning Committee)...

  18. Selectively reflective transparent sheets

    Waché, Rémi; Florescu, Marian; Sweeney, Stephen J.; Clowes, Steven K.

    2015-08-01

    We investigate the possibility to selectively reflect certain wavelengths while maintaining the optical properties on other spectral ranges. This is of particular interest for transparent materials, which for specific applications may require high reflectivity at pre-determined frequencies. Although there exist currently techniques such as coatings to produce selective reflection, this work focuses on new approaches for mass production of polyethylene sheets which incorporate either additives or surface patterning for selective reflection between 8 to 13 μ m. Typical additives used to produce a greenhouse effect in plastics include particles such as clays, silica or hydroxide materials. However, the absorption of thermal radiation is less efficient than the decrease of emissivity as it can be compared with the inclusion of Lambertian materials. Photonic band gap engineering by the periodic structuring of metamaterials is known in nature for producing the vivid bright colors in certain organisms via strong wavelength-selective reflection. Research to artificially engineer such structures has mainly focused on wavelengths in the visible and near infrared. However few studies to date have been carried out to investigate the properties of metastructures in the mid infrared range even though the patterning of microstructure is easier to achieve. We present preliminary results on the diffuse reflectivity using FDTD simulations and analyze the technical feasibility of these approaches.

  19. Salivary Cortisol and Cortisone do not Appear to be Useful Biomarkers for Monitoring Hydrocortisone Replacement in Addison's Disease.

    Ross, I L; Lacerda, M; Pillay, T S; Blom, D J; Johannsson, G; Dave, J A; Levitt, N S; Haarburger, D; van der Walt, J-S

    2016-12-01

    Salivary cortisol has been used to monitor hydrocortisone replacement in patients with Addison's disease (AD). Since salivary cortisol is metabolised to salivary cortisone, it may be an adjunctive analyte to assess adequacy of hydrocortisone replacement in patients with AD. We aimed to characterise the exposure of salivary cortisol and cortisone in patients and healthy controls. We measured salivary cortisol and cortisone by liquid chromatography-tandem mass spectrometry and constructed a day curve (08:00 until 24:00 h) with 16 time points in 25 AD patients taking their usual hydrocortisone dose and in 26 healthy controls. The median (interquartile range) area under the curve (AUC) for cortisol was not different for patients, compared with controls [55.63 (32.91-151.07) nmol*min*l -1 vs. 37.49 (27.41-52.00) nmol*min*l -1 ; p=0.098, respectively], whereas the peak cortisol C max was higher in patients [32.61 (5.75-146.19) nmol/l vs. 8.96 (6.96-12.23) nmol/l; p=0.013], compared with controls. The AUC for cortisone [23.65 (6.10-54.76) nmol*min*l -1 vs. 227.73 (200.10-280.52) nmol*min*l -1 ; p≤ 0.001, respectively], and peak cortisone C max was lower in patients than in controls [11.11 (2.91-35.85) nmol/l vs. 33.12 (25.97-39.95) nmol/l; p=0.002]. The AUC for salivary cortisol and salivary cortisone were not correlated with any measures of hydrocortisone dose. The time-course and AUC of salivary cortisol were similar between Addison's patients and healthy controls. Patients had substantially lower salivary cortisone AUC, compared to healthy controls. Salivary cortisol AUC and pharmacokinetics were not related to hydrocortisone dose and thus are not likely useful markers for the adequacy of hydrocortisone replacement. © Georg Thieme Verlag KG Stuttgart · New York.

  20. The rs1990760 polymorphism within the IFIH1 locus is not associated with Graves' disease, Hashimoto's thyroiditis and Addison's disease

    Seidl Christian

    2009-12-01

    Full Text Available Abstract Background Three genes have been confirmed as major joint susceptibility genes for endocrine autoimmune disease:human leukocyte antigen class II, cytotoxic T-lymphocyte antigen 4 and protein tyrosine phosphatase non-receptor type 22. Recent studies showed that a genetic variation within the interferon induced helicase domain 1 (IFIH1 locus (rs1990760 polymorphism is an additional risk factor in type 1 diabetes and Graves' disease (GD. Methods The aim of the present study was to investigate the role of the rs1990760 polymorphism within the IFIH1 gene in German patients with GD (n = 258, Hashimoto's thyroiditis (HT, n = 106, Addison's disease (AD, n = 195 and healthy controls (HC, n = 227 as well as in 55 GD families (165 individuals, German and 100 HT families (300 individuals, Italian. Furthermore, the interaction between rs1990760 polymorphism with human leukocyte antigen (HLA risk haplotype DQ2(DQA*0501-DQB*0201, the risk haplotypes DQ2/DQ8 (DQA*0301-DQB*0302 and the status of thyroglobulin antibody (TgAb, thyroid peroxidase antibody (TPOAb and TSH receptor antibody (TRAb in patients and families were analysed. Results No significant differences were found between the allele and genotype frequencies for rs1990760 IFIH1 polymorphism in patients with GD, HT, AD and HC. Also no differences were observed when stratifying the IFIH1 rs1990760 polymorphism for gender, presence or absence of thyroid antibodies (GD:TRAb and HT:TPOAb/TgAb and HLA risk haplotypes (DQ2:for GD and HT, DQ2/DQ8:for AD. Furthermore the transmission analysis in GD and HT families revealed no differences in alleles transmission for rs1990760 IFIH1 from parents with or without HLA risk haplotype DQ2 to the affected offspring. In contrast, by dividing the HT parents according to the presence or absence of thyroid Ab titers, mothers and fathers both positive for TPOAb/TgAb overtransmitted the allele A of IFIH1 rs1990760 to their HT affected offspring (61.8% vs 38.2%;p = 0

  1. Total hip replacement infected with Mycobacterium tuberculosis complicated by Addison disease and psoas muscle abscess: a case report

    De Nardo Pasquale

    2012-01-01

    Full Text Available Abstract Introduction Prosthetic joint infection due to Mycobacterium tuberculosis is occasionally encountered in clinical practice. To the best of our knowledge, this is the first report of a prosthetic joint infection due to Mycobacterium tuberculosis complicated by psoas abscesses and secondary Addison disease. Case presentation A 67-year-old immunocompetent Caucasian woman underwent total left hip arthroplasty because of osteoarthritis. After 18 months, she underwent arthroplasty revision for a possible prosthetic infection. Periprosthetic tissue specimens for bacteria were negative, and empirical antibiotic therapy was unsuccessful. She was then admitted to our department because of complications arising 22 months after arthroplasty. A physical examination revealed a sinus tract overlying her left hip and skin and mucosal pigmentation. Her levels of C-reactive protein, basal cortisol, adrenocorticotropic hormone, and sodium were out of normal range. Results of the tuberculin skin test and QuantiFERON-TB Gold test were positive. Computed tomography revealed a periprosthetic abscess and the inclusion of the left psoas muscle. Results of microbiological tests were negative, but polymerase chain reaction of a specimen taken from the hip fistula was positive for Mycobacterium tuberculosis. Our patient's condition was diagnosed as prosthetic joint infection and muscle psoas abscess due to Mycobacterium tuberculosis and secondary Addison disease. She underwent standard treatment with rifampicin, ethambutol, isoniazid, and pyrazinamide associated with hydrocortisone and fludrocortisone. At 15 months from the beginning of therapy, she was in good clinical condition and free of symptoms. Conclusions Prosthetic joint infection with Mycobacterium tuberculosis is uncommon. A differential diagnosis of tuberculosis should be considered when dealing with prosthetic joint infection, especially when repeated smears and histology examination from infected

  2. Superfund fact sheet: The remedial program. Fact sheet

    1992-09-01

    The fact sheet describes what various actions the EPA can take to clean up hazardous wastes sites. Explanations of how the criteria for environmental and public health risk assessment are determined and the role of state and local governments in site remediation are given. The fact sheet is one in a series providing reference information about Superfund issues and is intended for readers with no formal scientific training

  3. Allegheny County Blazed Trails Locations

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Shows the location of blazed trails in all Allegheny County parks. This is the same data used in the Allegheny County Parks Trails Mobile App, available for Apple...

  4. Allegheny County Supermarkets & Convenience Stores

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Location information for all Supermarkets and Convenience Stores in Allegheny County was produced using the Allegheny County Fee and Permit Data for 2016.

  5. Allegheny County Watershed Boundaries

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This dataset demarcates the 52 isolated sub-Watersheds of Allegheny County that drain to single point on the main stem rivers. Created by 3 Rivers 2nd Nature based...

  6. Allegheny County Block Areas

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This dataset overlays a grid on the County to assist in locating a parcel. The grid squares are 3,500 by 4,500 square feet. The data was derived from original...

  7. LANDSLIDES IN SUCEAVA COUNTY

    Dan Zarojanu

    2017-07-01

    Full Text Available In the county of Suceava, the landslides are a real and permanent problem. This paper presents the observations of landslides over the last 30 years in Suceava County, especially their morphology, theirs causes and the landslide stopping measures. It presents also several details regarding the lanslides from the town of Suceava, of Frasin and the village of Brodina.

  8. 2012 Swimming Season Fact Sheets

    To help beachgoers make informed decisions about swimming at U.S. beaches, EPA annually publishes state-by-state data about beach closings and advisories for the previous year's swimming season. These fact sheets summarize that information by state.

  9. State Fact Sheets on COPD

    ... Submit Search The CDC Chronic Obstructive Pulmonary Disease (COPD) Note: Javascript is disabled or is not supported ... message, please visit this page: About CDC.gov . COPD Homepage Data and Statistics Fact Sheets Publications Publications ...

  10. Australian Government Balance Sheet Management

    Wilson Au-Yeung; Jason McDonald; Amanda Sayegh

    2006-01-01

    Since almost eliminating net debt, the Australian Government%u2019s attention has turned to the financing of broader balance sheet liabilities, such as public sector superannuation. Australia will be developing a significant financial asset portfolio in the %u2018Future Fund%u2019 to smooth the financing of expenses through time. This raises the significant policy question of how best to manage the government balance sheet to reduce risk. This paper provides a framework for optimal balance sh...

  11. Energy information sheets, July 1998

    NONE

    1998-07-01

    The National Energy Information Center (NEIC), as part of its mission, provides energy information and referral assistance to Federal, State, and local governments, the academic community, business and industrial organizations, and the public. The Energy Information Sheets was developed to provide general information on various aspects of fuel production, prices, consumption, and capability. Additional information on related subject matter can be found in other Energy Information Administration (EIA) publications as referenced at the end of each sheet.

  12. Energy information sheets, September 1996

    NONE

    1996-09-01

    The National Energy Information Center (NEIC), as part of its mission, provides energy information and referral assistance to Federal, State, and local governments, the academic community, business and industrial organizations, and the public. The Energy Information Sheets was developed to provide general information on various aspects of fuel production, prices, consumption, and capability. Additional information on related subject matter can be found in other Energy Information Administration (EIA) publications as referenced at the end of each sheet.

  13. Poor quality of life, depressed mood, and memory impairment may be mediated by sleep disruption in patients with Addison's disease.

    Henry, Michelle; Wolf, Pedro S A; Ross, Ian L; Thomas, Kevin G F

    2015-11-01

    Standard replacement therapy for Addison's disease (AD) does not restore a normal circadian rhythm. In fact, hydrocortisone replacement in AD patients likely induces disrupted sleep. Given that healthy sleep plays an important role in improving quality of life, optimizing cognition, and ensuring affect regulation, the aim of this study was to investigate whether poor quality of life, mood alterations, and memory complaints reported by AD patients are associated with their disrupted sleep patterns. Sixty patients with AD and 60 matched healthy controls completed a battery of self-report questionnaires assessing perceived physical and mental health (Short-Form 36), mood (Beck Depression Inventory-II), sleep quality (Pittsburgh Sleep Quality Index), and cognition (Cognitive Failures Questionnaire). A latent variable model revealed that although AD had a significant direct effect on quality of life, the indirect effect of sleep was significantly greater. Furthermore, although AD had no direct effect on cognitive functioning, the indirect effect of sleep was significant. The overall model showed a good fit (comparative fit index = 0.91, root mean square of approximation = 0.09, and standardized root mean square residual = 0.05). Our findings suggest that disrupted sleep, and not the disease per se, may induce poor quality of life, memory impairment, and affect dysregulation in patients with AD. We think that improving sleep architecture may improve cognitive, affective, and physical functioning. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. A Complex Interplay: Cognitive Behavioural Therapy for Severe Health Anxiety in Addison's Disease to Reduce Emergency Department Admissions.

    Daniels, Jo; Sheils, Elizabeth

    2017-07-01

    Addison's disease (AD) is a rare chronic illness caused by adrenocortical insufficiency. Due to the pivotal role of the regulating hormone cortisol in AD, there is a common symptom overlap between the presentation of anxiety and adrenal crisis. Previous literature has identified the prevalence of anxiety in endocrinological disorders, however there is a paucity of research examining the complex interplay between AD and anxiety. This paper describes a single case study of a patient with severe health anxiety and co-morbid AD. The aims of the study were to establish if standard cognitive behavioural therapy for health anxiety in AD can lead to a reduction in psychological distress, and whether this approach is an effective intervention for the reduction of Emergency Department admissions. A single case design was used, with pre- and post-measures of health anxiety, general anxiety and depression. Data on Emergency Department admissions prior to and following treatment were used to assess change in this domain. Reliable and clinically significant reductions were seen across all measures, from severe to sub-clinical levels. There was a complete amelioration of Emergency Department admissions in the 12 months following completion of treatment. This preliminary study provides a sound rationale for further research into AD complicated by anxiety. Findings support the clinical utility of the cognitive behavioural therapy model for complex presentations of AD, offering a potential treatment option where anxiety is elevated and interfering with self-management and leading to high levels of health service use.

  15. The natural history of autoimmune Addison's disease with a non-classical presentation: a case report and review of literature.

    Manso, Jacopo; Pezzani, Raffaele; Scarpa, Riccardo; Gallo, Nicoletta; Betterle, Corrado

    2018-05-24

    Autoimmune Addison's disease (AAD) is the most frequent cause of adrenocortical insufficiency. The natural history of AAD usually comprises five consecutive stages with the first stage characterized by the increase of plasma renin consistent with the impairment of pars glomerulosa, which is usually the first affected layer of the adrenal cortex. We describe a 19-year-old female with Hashimoto's thyroiditis (HT) who underwent an autoantibody screening due to having the personal and family history of other autoimmune diseases in the absence of relevant clinical manifestations. She was positive for adrenal cortex autoantibodies (ACA) and steroid 21-hydroxylase autoantibodies (21-OH Ab) at high titers. She had increased basal levels of ACTH with normal basal cortisol not responding to ACTH stimulation, reduced levels of dehydroepiandrosterone-sulfate but normal levels of orthostatic renin and aldosterone. This scenario was consistent with a subclinical AAD presenting with first impairments in pars fasciculata and reticularis and conserved pars glomerulosa function. Only subsequently, progressive deficiency in pars glomerulosa function has become evident. Review of the literature showed that there was only one case, reported to date, with a similar atypical natural history of AAD. The strategies for screening for ACA/21-OH Ab in patients with HT are discussed.

  16. Visceral Fat and Novel Biomarkers of Cardiovascular Disease in Patients With Addison's Disease: A Case-Control Study.

    Bergthorsdottir, Ragnhildur; Ragnarsson, Oskar; Skrtic, Stanko; Glad, Camilla A M; Nilsson, Staffan; Ross, Ian Louis; Leonsson-Zachrisson, Maria; Johannsson, Gudmundur

    2017-11-01

    Patients with Addison's disease (AD) have increased cardiovascular mortality. To study visceral fat and conventional and exploratory cardiovascular risk factors in patients with AD. A cross-sectional, single-center, case-control study. Patients (n = 76; n = 51 women) with AD and 76 healthy control subjects were matched for sex, age, body mass index (BMI), and smoking habits. The primary outcome variable was visceral abdominal adipose tissue (VAT) measured using computed tomography. Secondary outcome variables were prevalence of metabolic syndrome (MetS) and 92 biomarkers of cardiovascular disease. The mean ± standard deviation age of all subjects was 53 ± 14 years; mean BMI, 25 ± 4 kg/m2; and mean duration of AD, 17 ± 12 years. The median (range) daily hydrocortisone dose was 30 mg (10 to 50 mg). Median (interquartile range) 24-hour urinary free cortisol excretion was increased in patients vs controls [359 nmol (193 to 601 nmol) vs 175 nmol (140 to 244 nmol); P 1] and vasodilatory protective marker was decreased (FC, <1). Twenty-six patients (34%) vs 12 control subjects (16%) fulfilled the criteria for MetS (P = 0.01). Despite higher cortisol exposure, VAT was not increased in patients with AD. The prevalence of MetS was increased and several biomarkers of cardiovascular disease were adversely affected in patients with AD. Copyright © 2017 Endocrine Society

  17. A study of the epitopes on steroid 21-hydroxylase recognized by autoantibodies in patients with or without Addison's disease

    Volpato, M; Prentice, L; Chen, S; Betterle, C; Rees Smith, B; Furmaniak, J

    1998-01-01

    Steroid 21-hydroxylase (21-OH) autoantibodies are found in patients with autoimmune Addison's disease (AAD), either isolated or associated with autoimmune polyglandular syndrome (APS) type I and II and in adrenal-cortex autoantibody (ACA)-positive patients without AAD. In order to assess any differences in the 21-OH autoantibodies in these different patient groups, we have studied their reactivity with different epitopes on 21-OH using full length and modified 35S-labelled 21-OH proteins produced in an in vitro transcription/translation system. There were no major differences in the pattern of autoantibody reactivity with the different modified 21-OH proteins in patients with isolated AAD or with APS types I and II, and in 21-OH autoantibody-positive patients with clinical AAD, subclinical AAD and those maintaining a normal adrenal function. Our studies also indicate that the main epitopes for 21-OH autoantibodies in patients with different forms of autoimmune adrenal disease are located in the C-terminal end and in a central region of 21-OH. PMID:9486414

  18. The effect of types I and III interferons on adrenocortical cells and its possible implications for autoimmune Addison's disease.

    Hellesen, A; Edvardsen, K; Breivik, L; Husebye, E S; Bratland, E

    2014-06-01

    Autoimmune Addison's disease (AAD) is caused by selective destruction of the hormone-producing cells of the adrenal cortex. As yet, little is known about the potential role played by environmental factors in this process. Type I and/or type III interferons (IFNs) are signature responses to virus infections, and have also been implicated in the pathogenesis of autoimmune endocrine disorders such as type 1 diabetes and autoimmune thyroiditis. Transient development of AAD and exacerbation of established or subclinical disease, as well as the induction of autoantibodies associated with AAD, have been reported following therapeutic administration of type I IFNs. We therefore hypothesize that exposure to such IFNs could render the adrenal cortex susceptible to autoimmune attack in genetically predisposed individuals. In this study, we investigated possible immunopathological effects of type I and type III IFNs on adrenocortical cells in relation to AAD. Both types I and III IFNs exerted significant cytotoxicity on NCI-H295R adrenocortical carcinoma cells and potentiated IFN-γ- and polyinosine-polycytidylic acid [poly (I : C)]-induced chemokine secretion. Furthermore, we observed increased expression of human leucocyte antigen (HLA) class I molecules and up-regulation of 21-hydroxylase, the primary antigenic target in AAD. We propose that these combined effects could serve to initiate or aggravate an ongoing autoimmune response against the adrenal cortex in AAD. © 2014 British Society for Immunology.

  19. Fisiopatología de la expresividad "psicosomática" del Morbus Basedow y del de Addison

    J. Gurría

    1949-08-01

    Full Text Available El título de este trabajo pretende, además de consignar su objetivo, señalar una insuficiencia: la de la patología psicosomática, impregnada, desde su origen, por conceptos psicoanalíticos que han dado lugar a explicaciones demasiado subjetivistas y alejadas de las ideas fisiopatológicas no superadas, al menos clínicamente, por la moderna versión norteamericana de las antiguas y equilibradas doctrinas socráticas de integración. Perseguimos en esta comunicación dos propósitos: contrastrar las concepciones psicosomáticas y fisiopatológicas del Basedow y de la insuficiencia suprarrenal, en el intento de poner de manifiesto la insuficiencia del criterio psicosomático; y, estudiar la fisiopatología de los principales síntomas del Basedow y del Addison que se expresan por la doble vertiente somatopsíquica. Estos síntomas serán, en el hipertiroidismo, la hiperemotividad y, singularmente, la prisa; y en la insuficiencia suprarrenal, la astenia.

  20. AIRE variations in Addison's disease and autoimmune polyendocrine syndromes (APS): partial gene deletions contribute to APS I.

    Bøe Wolff, A S; Oftedal, B; Johansson, S; Bruland, O; Løvås, K; Meager, A; Pedersen, C; Husebye, E S; Knappskog, P M

    2008-03-01

    Autoimmune Addison's disease (AAD) is often associated with other components in autoimmune polyendocrine syndromes (APS). Whereas APS I is caused by mutations in the AIRE gene, the susceptibility genes for AAD and APS II are unclear. In the present study, we investigated whether polymorphisms or copy number variations in the AIRE gene were associated with AAD and APS II. First, nine SNPs in the AIRE gene were analyzed in 311 patients with AAD and APS II and 521 healthy controls, identifying no associated risk. Second, in a subgroup of 25 of these patients, AIRE sequencing revealed three novel polymorphisms. Finally, the AIRE copy number was determined by duplex quantitative PCR in 14 patients with APS I, 161 patients with AAD and APS II and in 39 healthy subjects. In two Scandinavian APS I patients previously reported to be homozygous for common AIRE mutations, we identified large deletions of the AIRE gene covering at least exon 2 to exon 8. We conclude that polymorphisms in the AIRE gene are not associated with AAD and APS II. We further suggest that DNA analysis of the parents of patients found to be homozygous for mutations in AIRE, always should be performed.

  1. FDTD modeling of thin impedance sheets

    Luebbers, Raymond J.; Kunz, Karl S.

    1991-01-01

    Thin sheets of resistive or dielectric material are commonly encountered in radar cross section calculations. Analysis of such sheets is simplified by using sheet impedances. In this paper it is shown that sheet impedances can be modeled easily and accurately using Finite Difference Time Domain (FDTD) methods.

  2. Comparison of NOAA lidar data at 1.5 and 3 meter resolutions, for adequate watershed delineation in Tift County, Georgia, USA

    The USDA Southeast Watershed Research Laboratory is located in Tifton, Ga, and performs ongoing watershed research for the Tift County area, as well as surrounding counties. Current watershed delineations are based on 1972-1977, 7.5-minute USGS Quadrangle sheets, and require updating. Light Detectio...

  3. On Jovian plasma sheet structure

    Khurana, K.K.; Kivelson, M.G.

    1989-01-01

    The authors evaluate several models of Jovian plasma sheet structure by determining how well they organize several aspects of the observed Voyager 2 magnetic field characteristics as a function of Jovicentric radial distance. It is shown that in the local time sector of the Voyager 2 outbound pass (near 0300 LT) the published hinged-magnetodisc models with wave (i.e., models corrected for finite wave velocity effects) are more successful than the published magnetic anomaly model in predicting locations of current sheet crossings. They also consider the boundary between the plasma sheet and the magnetotail lobe which is expected to vary slowly with radial distance. They use this boundary location as a further test of the models of the magnetotail. They show that the compressional MHD waves have much smaller amplitude in the lobes than in the plasma sheet and use this criterion to refine the identification of the plasma-sheet-lobe boundary. When the locations of crossings into and out of the lobes are examined, it becomes evident that the magnetic-anomaly model yields a flaring plasma sheet with a halfwidth of ∼ 3 R J at a radial distance of 20 R J and ∼ 12 R J at a radial distance of 100 R J . The hinged-magnetodisc models with wave, on the other hand, predict a halfwidth of ∼ 3.5 R J independent of distance beyond 20 R J . New optimized versions of the two models locate both the current sheet crossings and lobe encounters equally successfully. The optimized hinged-magnetodisc model suggests that the wave velocity decreases with increasing radial distance. The optimized magnetic anomaly model yields lower velocity contrast than the model of Vasyliunas and Dessler (1981)

  4. A rare case of Addison's disease, hepatitis, thyreoiditis, positive IgG anti-tissue transglutaminase antibodies and partial IgA deficiency.

    Baleva, Marta P; Mihaylova, Snejina; Yankova, Petja; Atanasova, Iliana; Nikolova-Vlahova, Milena; Naumova, Elissaveta

    2016-01-01

    Selective IgA deficiency (IgAD) is the most prevalent type of primary immune deficiencies, but partial IgA deficiency is even more common. Addison's disease is a rare condition associated with primary adrenal insufficiency due to infection or autoimmune destruction of the adrenals. The association between IgA deficiency and Addison's disease is very rare. We observed a 22-year-old male patient with marked darkening of the skin, especially on the palms and areolae, jaundice on the skin and sclera, astheno-adynamia, hypotension (80/50 mm Hg), and pain in the right hypochondrium. The laboratory investigations revealed increased serum levels of total and indirect bilirubin, AST, ALT, GGT and LDH, negative HBsAg, anti-HBc IgM, anti-HCV and anti-HAV IgM, very low serum IgA levels (0.16 g/l) with normal IgG and IgM, negative ANA, ANCA, AMA, LKM-1, anti-GAD-60, anti-IA-2, anti-thyroglobulin antibodies, a mild increase in anti-TPO antibodies titer, a marked increase in IgG anti-tissue transglutaminase antibodies, with no typical changes in cellular immunity, negative T-SPOT-TB test, HLA - A*01; B*08; DRB1*03; DQB1*02, karyotype - 46, XY. We present a rare case of partial IgA deficiency with Addison's disease, hepatitis, thyroiditis and positive anti-tissue transglutaminase antibodies. IgAD and some autoimmune disorders share several predisposing HLA genes, thus explaining the increased prevalence of IgAD in certain patient groups.

  5. Automobile sheet metal part production with incremental sheet forming

    İsmail DURGUN

    2016-02-01

    Full Text Available Nowadays, effect of global warming is increasing drastically so it leads to increased interest on energy efficiency and sustainable production methods. As a result of adverse conditions, national and international project platforms, OEMs (Original Equipment Manufacturers, SMEs (Small and Mid-size Manufacturers perform many studies or improve existing methodologies in scope of advanced manufacturing techniques. In this study, advanced manufacturing and sustainable production method "Incremental Sheet Metal Forming (ISF" was used for sheet metal forming process. A vehicle fender was manufactured with or without die by using different toolpath strategies and die sets. At the end of the study, Results have been investigated under the influence of method and parameters used.Keywords: Template incremental sheet metal, Metal forming

  6. Uranium mining sites - Thematic sheets

    2009-01-01

    A first sheet proposes comments, data and key numbers about uranium extraction in France: general overview of uranium mining sites, status of waste rock and tailings after exploitation, site rehabilitation. The second sheet addresses the sources of exposure to ionizing radiations due to ancient uranium mining sites: discussion on the identification of these sources associated with these sites, properly due to mining activities or to tailings, or due to the transfer of radioactive substances towards water and to the contamination of sediments, description of the practice and assessment of radiological control of mining sites. A third sheet addresses the radiological exposure of public to waste rocks, and the dose assessment according to exposure scenarios: main exposure ways to be considered, studied exposure scenarios (passage on backfilled path and grounds, stay in buildings built on waste rocks, keeping mineralogical samples at home). The fourth sheet addresses research programmes of the IRSN on uranium and radon: epidemiological studies (performed on mine workers; on French and on European cohorts, French and European studies on the risk of lung cancer associated with radon in housing), study of the biological effects of chronic exposures. The last sheet addresses studies and expertises performed by the IRSN on ancient uranium mining sites in France: studies commissioned by public authorities, radioactivity control studies performed by the IRSN about mining sites, participation of the IRSN to actions to promote openness to civil society

  7. Allegheny County Hydrology Areas

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — The Hydrology Feature Dataset contains photogrammetrically compiled water drainage features and structures including rivers, streams, drainage canals, locks, dams,...

  8. Allegheny County Walk Scores

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Walk Score measures the walkability of any address using a patented system developed by the Walk Score company. For each 2010 Census Tract centroid, Walk Score...

  9. Allegheny County Sheriff Sales

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — List of properties up for auction at a Sheriff Sale. Datasets labeled "Current" contain this month's postings, while those labeled "Archive" contain a running list...

  10. Allegheny County Older Housing

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Older housing can impact the quality of the occupant's health in a number of ways, including lead exposure, housing quality, and factors that may exacerbate...

  11. Allegheny County Dog Licenses

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — A list of dog license dates, dog breeds, and dog name by zip code. Currently this dataset does not include City of Pittsburgh dogs.

  12. Allegheny County Housing Tenure

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Home ownership provides a number of financial, social, and health benefits to American families. Especially in areas with housing price appreciation, home ownership...

  13. Allegheny County Hydrology Lines

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — The Hydrology Feature Dataset contains photogrammetrically compiled water drainage features and structures including rivers, streams, drainage canals, locks, dams,...

  14. Durham County Demographic Profile

    City and County of Durham, North Carolina — (a) Includes persons reporting only one race.(b) Hispanics may be of any race, so also are included in applicable race categories. D: Suppressed to avoid disclosure...

  15. Allegheny County Vacant Properties

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Mail carriers routinely collect data on address no longer receiving mail due to vacancy. This vacancy data is reported quarterly at census tract geographies in the...

  16. Root-growth-inhibiting sheet

    Burton, F.G.; Cataldo, D.A.; Cline, J.F.; Skiens, W.E.; Van Voris, P.

    1993-01-26

    In accordance with this invention, a porous sheet material is provided at intervals with bodies of a polymer which contain a 2,6-dinitroaniline. The sheet material is made porous to permit free passage of water. It may be either a perforated sheet or a woven or non-woven textile material. A particularly desirable embodiment is a non-woven fabric of non-biodegradable material. This type of material is known as a geotextile'' and is used for weed control, prevention of erosion on slopes, and other landscaping purposes. In order to obtain a root repelling property, a dinitroaniline is blended with a polymer which is attached to the geotextile or other porous material.

  17. Optimal swimming of a sheet.

    Montenegro-Johnson, Thomas D; Lauga, Eric

    2014-06-01

    Propulsion at microscopic scales is often achieved through propagating traveling waves along hairlike organelles called flagella. Taylor's two-dimensional swimming sheet model is frequently used to provide insight into problems of flagellar propulsion. We derive numerically the large-amplitude wave form of the two-dimensional swimming sheet that yields optimum hydrodynamic efficiency: the ratio of the squared swimming speed to the rate-of-working of the sheet against the fluid. Using the boundary element method, we show that the optimal wave form is a front-back symmetric regularized cusp that is 25% more efficient than the optimal sine wave. This optimal two-dimensional shape is smooth, qualitatively different from the kinked form of Lighthill's optimal three-dimensional flagellum, not predicted by small-amplitude theory, and different from the smooth circular-arc-like shape of active elastic filaments.

  18. Root-growth-inhibiting sheet

    Burton, Frederick G.; Cataldo, Dominic A.; Cline, John F.; Skiens, W. Eugene; Van Voris, Peter

    1993-01-01

    In accordance with this invention, a porous sheet material is provided at intervals with bodies of a polymer which contain a 2,6-dinitroaniline. The sheet material is made porous to permit free passage of water. It may be either a perforated sheet or a woven or non-woven textile material. A particularly desirable embodiment is a non-woven fabric of non-biodegradable material. This type of material is known as a "geotextile" and is used for weed control, prevention of erosion on slopes, and other landscaping purposes. In order to obtain a root repelling property, a dinitroaniline is blended with a polymer which is attached to the geotextile or other porous material.

  19. Ice sheet hydrology - a review

    Jansson, Peter; Naeslund, Jens-Ove [Dept. of Physical Geography and Quaternary Geology, Stockholm Univ., Stockholm (Sweden); Rodhe, Lars [Geological Survey of Sweden, Uppsala (Sweden)

    2007-03-15

    This report summarizes the theoretical knowledge on water flow in and beneath glaciers and ice sheets and how these theories are applied in models to simulate the hydrology of ice sheets. The purpose is to present the state of knowledge and, perhaps more importantly, identify the gaps in our understanding of ice sheet hydrology. Many general concepts in hydrology and hydraulics are applicable to water flow in glaciers. However, the unique situation of having the liquid phase flowing in conduits of the solid phase of the same material, water, is not a commonly occurring phenomena. This situation means that the heat exchange between the phases and the resulting phase changes also have to be accounted for in the analysis. The fact that the solidus in the pressure-temperature dependent phase diagram of water has a negative slope provides further complications. Ice can thus melt or freeze from both temperature and pressure variations or variations in both. In order to provide details of the current understanding of water flow in conjunction with deforming ice and to provide understanding for the development of ideas and models, emphasis has been put on the mathematical treatments, which are reproduced in detail. Qualitative results corroborating theory or, perhaps more often, questioning the simplifications made in theory, are also given. The overarching problem with our knowledge of glacier hydrology is the gap between the local theories of processes and the general flow of water in glaciers and ice sheets. Water is often channelized in non-stationary conduits through the ice, features which due to their minute size relative to the size of glaciers and ice sheets are difficult to incorporate in spatially larger models. Since the dynamic response of ice sheets to global warming is becoming a key issue in, e.g. sea-level change studies, the problems of the coupling between the hydrology of an ice sheet and its dynamics is steadily gaining interest. New work is emerging

  20. Modelling the Antarctic Ice Sheet

    Pedersen, Jens Olaf Pepke; Holm, A.

    2015-01-01

    to sea level high stands during past interglacial periods. A number of AIS models have been developed and applied to try to understand the workings of the AIS and to form a robust basis for future projections of the AIS contribution to sea level change. The recent DCESS (Danish Center for Earth System......The Antarctic ice sheet is a major player in the Earth’s climate system and is by far the largest depository of fresh water on the planet. Ice stored in the Antarctic ice sheet (AIS) contains enough water to raise sea level by about 58 m, and ice loss from Antarctica contributed significantly...

  1. Ice sheet hydrology - a review

    Jansson, Peter; Naeslund, Jens-Ove; Rodhe, Lars

    2007-03-01

    This report summarizes the theoretical knowledge on water flow in and beneath glaciers and ice sheets and how these theories are applied in models to simulate the hydrology of ice sheets. The purpose is to present the state of knowledge and, perhaps more importantly, identify the gaps in our understanding of ice sheet hydrology. Many general concepts in hydrology and hydraulics are applicable to water flow in glaciers. However, the unique situation of having the liquid phase flowing in conduits of the solid phase of the same material, water, is not a commonly occurring phenomena. This situation means that the heat exchange between the phases and the resulting phase changes also have to be accounted for in the analysis. The fact that the solidus in the pressure-temperature dependent phase diagram of water has a negative slope provides further complications. Ice can thus melt or freeze from both temperature and pressure variations or variations in both. In order to provide details of the current understanding of water flow in conjunction with deforming ice and to provide understanding for the development of ideas and models, emphasis has been put on the mathematical treatments, which are reproduced in detail. Qualitative results corroborating theory or, perhaps more often, questioning the simplifications made in theory, are also given. The overarching problem with our knowledge of glacier hydrology is the gap between the local theories of processes and the general flow of water in glaciers and ice sheets. Water is often channelized in non-stationary conduits through the ice, features which due to their minute size relative to the size of glaciers and ice sheets are difficult to incorporate in spatially larger models. Since the dynamic response of ice sheets to global warming is becoming a key issue in, e.g. sea-level change studies, the problems of the coupling between the hydrology of an ice sheet and its dynamics is steadily gaining interest. New work is emerging

  2. Sheet Beam Klystron Instability Analysis

    Bane, K.

    2009-01-01

    Using the principle of energy balance we develop a 2D theory for calculating growth rates of instability in a two-cavity model of a sheet beam klystron. An important ingredient is a TE-like mode in the gap that also gives a longitudinal kick to the beam. When compared with a self-consistent particle-in-cell calculation, with sheet beam klystron-type parameters, agreement is quite good up to half the design current, 65 A; at full current, however, other, current-dependent effects come in and the results deviate significantly

  3. The social balance sheet 2004

    Ph. Delhez; P. Heuse

    2005-01-01

    Each year, in the 4th quarter’s Economic Review, the National Bank examines the provisional results of the social balance sheets. As all the social balance sheets are not yet available for 2004, the study is based on a limited population of enterprises, compiled according to the principle of a constant sample. This population is made up of 38,530 enterprises employing around 1,331,000 workers in 2004. The main results of the analysis, in terms of employment, working hours, labour cost and tra...

  4. FOCUSED FEASIBILITY STUDY OF PHYTOREMEDIATION ALTERNATIVE FOR THE INDUSTRIAL EXCESS LANDFILL SITE IN STARK COUNTY, OHIO.

    Focused feasibility study of phytoremediation alternative for the Industrial Excess Landfill site in Stark County, Ohio. More information can be found on the NPL Fact Sheet for this site at www.epa.gov/region5/superfund/npl/ohio/OHD000377971.htm

  5. CYP21A2 polymorphisms in patients with autoimmune Addison's disease, and linkage disequilibrium to HLA risk alleles.

    Brønstad, Ingeborg; Skinningsrud, Beate; Bratland, Eirik; Løvås, Kristian; Undlien, Dag; Sverre Husebye, Eystein; Wolff, Anette Susanne Bøe

    2014-12-01

    Steroid 21-hydroxylase, encoded by CYP21A2, is the major autoantigen in autoimmune Addison's disease (AAD). CYP21A2 is located in the region of the HLA complex on chromosome 6p21.3, which harbours several risk alleles for AAD. The objective was to investigate whether CYP21A2 gene variants confer risk of AAD independently of other risk alleles in the HLA loci. DNA samples from 381 Norwegian patients with AAD and 340 healthy controls (HC) previously genotyped for the HLA-A, -B, -DRB1, and -DQB1 and MICA loci were used for genotyping of CYP21A2. Genotyping of CYP21A2 was carried out by direct sequencing. Linkage of CYP21A2 to the HLA loci was assessed using UNPHASED version 3.0.10 and PHASE version 2.1. Heterozygotes of the single-nucleotide polymorphisms (SNPs) rs397515394, rs6467, rs6474, rs76565726 and rs6473 were detected significantly more frequently in AAD patients compared with HC (P<0.005), but all SNPs were in a linkage disequilibrium (LD) with high-risk HLA-DRB1 haplotypes. rs6472C protected against AAD (odds ratio=0.15, 95% CI (0.08-0.30), P=3.8×10(-10)). This SNP was not in an LD with HLA loci (P=0.02), but did not increase protection when considering the effect of HLA-DRB1 alleles. Mutations causing congenital adrenal hyperplasia were found in heterozygosity in <1.5% of the cases in both groups. Genetic variants of CYP21A2 associated to AAD are in LD with the main AAD risk locus HLA-DRB1, and CYP21A2 does not constitute an independent susceptibility locus. © 2014 European Society of Endocrinology.

  6. Heritability of Addison's disease and prevalence of associated autoimmunity in a cohort of 112,100 Swedish twins.

    Skov, Jakob; Höijer, Jonas; Magnusson, Patrik K E; Ludvigsson, Jonas F; Kämpe, Olle; Bensing, Sophie

    2017-12-01

    The pathophysiology behind autoimmune Addison's disease (AAD) is poorly understood, and the relative influence of genetic and environmental factors remains unclear. In this study, we examined the heritability of AAD and explored disease-associated autoimmune comorbidity among Swedish twins. A population-based longitudinal cohort of 112,100 Swedish twins was used to calculate the heritability of AAD, and to explore co-occurrence of 10 organ-specific autoimmune disorders in twin pairs with AAD. Diagnoses were collected 1964-2012 through linkage to the Swedish National Patient Register. The Swedish Prescribed Drug Register was used for additional diagnostic precision. When available, biobank serum samples were used to ascertain the AAD diagnosis through identification of 21-hydroxylase autoantibodies. We identified 29 twins with AAD. Five out of nine (5/9) monozygotic pairs and zero out of fifteen (0/15) dizygotic pairs were concordant for AAD. The probandwise concordance for monozygotic twins was 0.71 (95% CI 0.40-0.90) and the heritability 0.97 (95% CI 0.88-99). Autoimmune disease patterns of monozygotic twin pairs affected by AAD displayed a higher degree of similarity than those of dizygotic twins, with an incidence rate ratio of 15 (95% CI 1.8-116) on the number of shared autoimmune diagnoses within pairs. The heritability of AAD appears to be very high, emphasizing the need for further research on the genetic etiology of the disease. Monozygotic twin concordance for multiple autoimmune manifestations suggests strong genetic influence on disease specificity in organ-specific autoimmunity.

  7. Autoantibodies against Cytochrome P450 Side-Chain Cleavage Enzyme in Dogs (Canis lupus familiaris) Affected with Hypoadrenocorticism (Addison's Disease).

    Boag, Alisdair M; Christie, Michael R; McLaughlin, Kerry A; Syme, Harriet M; Graham, Peter; Catchpole, Brian

    2015-01-01

    Canine hypoadrenocorticism likely arises from immune-mediated destruction of adrenocortical tissue, leading to glucocorticoid and mineralocorticoid deficiency. In humans with autoimmune Addison's disease (AAD) or autoimmune polyendocrine syndrome (APS), circulating autoantibodies have been demonstrated against enzymes associated with adrenal steroid synthesis. The current study investigates autoantibodies against steroid synthesis enzymes in dogs with spontaneous hypoadrenocorticism. Coding regions of canine CYP21A2 (21-hydroxylase; 21-OH), CYP17A1 (17-hydroxylase; 17-OH), CYP11A1 (P450 side-chain cleavage enzyme; P450scc) and HSD3B2 (3β hydroxysteroid dehydrogenase; 3βHSD) were amplified, cloned and expressed as 35S-methionine radiolabelled recombinant protein. In a pilot study, serum samples from 20 dogs with hypoadrenocorticism and four unaffected control dogs were screened by radio-immunoprecipitation assay. There was no evidence of reactivity against 21-OH, 17-OH or 3βHSD, but five dogs with hypoadrenocorticism showed immunoreactivity to P450scc compared with controls. Serum samples were subsequently obtained from 213 dogs diagnosed with hypoadrenocorticism and 110 dogs from a hospital control population. Thirty control dogs were randomly selected to establish a threshold for antibody positivity (mean + 3 × standard deviation). Dogs with hypoadrenocorticism were more likely to be P450scc autoantibody positive than hospital controls (24% vs. 1.2%, respectively; p = 0.0016). Sex was significantly associated with the presence of P450scc autoantibodies in the case population, with 30% of females testing positive compared with 17% of males (p = 0.037). Significant associations with breed (p = 0.015) and DLA-type (DQA1*006:01 allele; p = 0.017) were also found. This cross-sectional study indicates that P450scc autoantibodies are present in a proportion of dogs affected with hypoadrenocorticism.

  8. Autoantibodies against Cytochrome P450 Side-Chain Cleavage Enzyme in Dogs (Canis lupus familiaris Affected with Hypoadrenocorticism (Addison's Disease.

    Alisdair M Boag

    Full Text Available Canine hypoadrenocorticism likely arises from immune-mediated destruction of adrenocortical tissue, leading to glucocorticoid and mineralocorticoid deficiency. In humans with autoimmune Addison's disease (AAD or autoimmune polyendocrine syndrome (APS, circulating autoantibodies have been demonstrated against enzymes associated with adrenal steroid synthesis. The current study investigates autoantibodies against steroid synthesis enzymes in dogs with spontaneous hypoadrenocorticism. Coding regions of canine CYP21A2 (21-hydroxylase; 21-OH, CYP17A1 (17-hydroxylase; 17-OH, CYP11A1 (P450 side-chain cleavage enzyme; P450scc and HSD3B2 (3β hydroxysteroid dehydrogenase; 3βHSD were amplified, cloned and expressed as 35S-methionine radiolabelled recombinant protein. In a pilot study, serum samples from 20 dogs with hypoadrenocorticism and four unaffected control dogs were screened by radio-immunoprecipitation assay. There was no evidence of reactivity against 21-OH, 17-OH or 3βHSD, but five dogs with hypoadrenocorticism showed immunoreactivity to P450scc compared with controls. Serum samples were subsequently obtained from 213 dogs diagnosed with hypoadrenocorticism and 110 dogs from a hospital control population. Thirty control dogs were randomly selected to establish a threshold for antibody positivity (mean + 3 × standard deviation. Dogs with hypoadrenocorticism were more likely to be P450scc autoantibody positive than hospital controls (24% vs. 1.2%, respectively; p = 0.0016. Sex was significantly associated with the presence of P450scc autoantibodies in the case population, with 30% of females testing positive compared with 17% of males (p = 0.037. Significant associations with breed (p = 0.015 and DLA-type (DQA1*006:01 allele; p = 0.017 were also found. This cross-sectional study indicates that P450scc autoantibodies are present in a proportion of dogs affected with hypoadrenocorticism.

  9. 9β Polymorphism of the glucocorticoid receptor gene appears to have limited impact in patients with Addison's disease.

    Ian Louis Ross

    Full Text Available BACKGROUND: Addison's disease (AD has been associated with an increased risk of cardiovascular disease. Glucocorticoid receptor polymorphisms that alter glucocorticoid sensitivity may influence metabolic and cardiovascular risk factors in patients with AD. The 9β polymorphism of the glucocorticoid receptor gene is associated with relative glucocorticoid resistance and has been reported to increase the risk of myocardial infarction in the elderly. We explored the impact of this polymorphism in patients with AD. MATERIALS AND METHODS: 147 patients with AD and 147 age, gender and ethnicity matched healthy controls were recruited. Blood was taken in a non-fasted state for plasma lipid determination, measurement of cardiovascular risk factors and DNA extraction. RESULTS: Genotype data for the 9β polymorphism was available for 139 patients and 146 controls. AD patients had a more atherogenic lipid profile characterized by an increase in the prevalence of small dense LDL (p = 0.003, increased triglycerides (p = 0.002, reduced HDLC (p<0.001 an elevated highly sensitive C-reactive protein (p = 0.01, compared with controls. The 9β polymorphism (at least one G allele was found in 28% of patients and controls respectively. After adjusting for age, gender, ethnicity, BMI and hydrocortisone dose per metre square of body surface area in patients, there were no significant metabolic associations with this polymorphism and hydrocortisone doses were not higher in patients with the polymorphism. CONCLUSIONS: This study did not identify any associations between the 9β polymorphism and cardiovascular risk factors or hydrocortisone dose and determination of this polymorphism is therefore unlikely to be of clinical benefit in the management of patients with AD.

  10. Sexual dysfunctions in men affected by autoimmune Addison's disease before and after short-term gluco- and mineralocorticoid replacement therapy.

    Granata, Antonio; Tirabassi, Giacomo; Pugni, Valeria; Arnaldi, Giorgio; Boscaro, Marco; Carani, Cesare; Balercia, Giancarlo

    2013-08-01

    There is evidence suggesting that autoimmune Addison's disease (AD) could be associated with sexual dysfunctions probably caused by gluco- and mineralocorticoid deficiency; however, no study has yet treated this subject in males. To evaluate male sexuality and psychological correlates in autoimmune AD before and after gluco- and mineralocorticoid replacement therapy. Twelve subjects with a first diagnosis of autoimmune AD were studied before (baseline) and 2 months after (recovery phase) initiating hormone replacement therapy. Erectile function (EF), orgasmic function (OF), sexual desire (SD), intercourse satisfaction (IS), overall satisfaction (OS), depression, and anxiety were studied using a number of questionnaires (International Index of Erectile Function, Beck Depression Inventory, and Spielberger State-Trait Anxiety Inventory); clinical, biochemical, and hormone data were included in the analysis. At baseline, low values were found for EF, OF, SD, IS, and OS and high values for depression and anxiety; all of these parameters improved significantly in the recovery phase compared with baseline. EF variation between the two phases correlated significantly and positively with the variation of serum cortisol, urinary free cortisol, systolic blood pressure, and diastolic blood pressure and inversely with that of upright plasma renin activity. Multiple linear regression analysis using EF variation as dependent variable confirmed the relationship of the latter with variation of serum cortisol, urinary free cortisol, and upright plasma renin activity but not with variation of systolic and diastolic blood pressure. Our study showed that onset of autoimmune AD in males is associated with a number of sexual dysfunctions, all reversible after initiating replacement hormone therapy; cortisol and aldosterone deficiency seems to play an important role in the genesis of erectile dysfunction although the mechanism of their activity is not clear. © 2012 International Society

  11. VT Data - Lidar Slope (0.7m) 2013, Rutland Co., Grand Isle Co., Addison Co., Washington Co.

    Vermont Center for Geographic Information — (Link to Metadata) This metadata applies to the following collection area(s): Rutland/GI Counties 2013 0.7m and related SLOPE datasets. Created using ArcGIS "SLOPE"...

  12. VT Data - Lidar Aspect (0.7m) 2013, Rutland Co., Grand Isle Co., Addison Co., Washington Co.

    Vermont Center for Geographic Information — (Link to Metadata) This metadata applies to the following collection area(s): Rutland/GI Counties 2013 0.7m and related ASPECT datasets. This metadata complies with...

  13. VT Data - Lidar nDSM (0.7m) 2013, Rutland Co., Grand Isle Co., Addison Co., Washington Co.

    Vermont Center for Geographic Information — (Link to Metadata) This metadata applies to the following collection area(s): Rutland/GI Counties 2013 0.7m and related 'normalized' Digital Surface Model (nDSM)....

  14. Jane Austen's lifelong health problems and final illness: New evidence points to a fatal Hodgkin's disease and excludes the widely accepted Addison's.

    Upfal, A

    2005-06-01

    Jane Austen is typically described as having excellent health until the age of 40 and the onset of a mysterious and fatal illness, initially identified by Sir Zachary Cope in 1964 as Addison's disease. Her biographers, deceived both by Cassandra Austen's destruction of letters containing medical detail, and the cheerful high spirits of the existing letters, have seriously underestimated the extent to which illness affected Austen's life. A medical history reveals that she was particularly susceptible to infection, and suffered unusually severe infective illnesses, as well as a chronic conjunctivitis that impeded her ability to write. There is evidence that Austen was already suffering from an immune deficiency and fatal lymphoma in January 1813, when her second and most popular novel, Pride and Prejudice, was published. Four more novels would follow, written or revised in the shadow of her increasing illness and debility. Whilst it is impossible now to conclusively establish the cause of her death, the existing medical evidence tends to exclude Addison's disease, and suggests there is a high possibility that Jane Austen's fatal illness was Hodgkin's disease, a form of lymphoma.

  15. Learning from Balance Sheet Visualization

    Tanlamai, Uthai; Soongswang, Oranuj

    2011-01-01

    This exploratory study examines alternative visuals and their effect on the level of learning of balance sheet users. Executive and regular classes of graduate students majoring in information technology in business were asked to evaluate the extent of acceptance and enhanced capability of these alternative visuals toward their learning…

  16. Off-Balance Sheet Financing.

    Adams, Matthew C.

    1998-01-01

    Examines off-balance sheet financing, the facilities use of outsourcing for selected needs, as a means of saving operational costs and using facility assets efficiently. Examples of using outside sources for energy supply and food services, as well as partnering with business for facility expansion are provided. Concluding comments address tax…

  17. Whooping Cough (Pertussis) - Fact Sheet for Parents

    ... months 4 through 6 years Fact Sheet for Parents Color [2 pages] Español: Tosferina (pertussis) The best ... according to the recommended schedule. Fact Sheets for Parents Diseases and the Vaccines that Prevent Them Chickenpox ...

  18. Flood-inundation maps for Lake Champlain in Vermont and in northern Clinton County, New York

    Flynn, Robert H.; Hayes, Laura

    2016-06-30

    Digital flood-inundation maps for an approximately100-mile length of Lake Champlain in Addison, Chittenden, Franklin, and Grand Isle Counties in Vermont and northern Clinton County in New York were created by the U.S. Geological Survey (USGS) in cooperation with the International Joint Commission (IJC). The flood-inundationmaps, which can be accessed through the International Joint Commission (IJC) Web site at http://www.ijc.org/en_/, depict estimates of the areal extent flooding correspondingto selected water levels (stages) at the USGS lake gage on the Richelieu River (Lake Champlain) at Rouses Point, N.Y. (station number 04295000). In this study, wind and seiche effects (standing oscillating wave with a long wavelength) were not taken into account and the flood-inundation mapsreflect 11 stages (elevations) for Lake Champlain that are static for the study length of the lake. Near-real-time stages at this lake gage, and others on Lake Champlain, may be obtained on the Internet from the USGS National Water Information System at http://waterdata.usgs.gov/ or the National Weather Service Advanced Hydrologic Prediction Service at http:/water.weather.gov/ahps/, which also forecasts flood hydrographs at the Richelieu River (Lake Champlain) at Rouses Point.Static flood boundary extents were determined for LakeChamplain in Addison, Chittenden, Franklin, and Grand Isle Counties in Vermont and northern Clinton County in New York using recently acquired (2013–2014) lidar (light detection and ranging) and may be referenced to any of the five USGS lake gages on Lake Champlain. Of these five lakgages, USGS lake gage 04295000, Richelieu River (Lake Champlain) at Rouses Point, N.Y., is the only USGS lake gage that is also a National Weather Service prediction location. Flood boundary extents for the Lake Champlain static flood-inundation map corresponding to the May 201 flood(103.2 feet [ft], National Geodetic Vertical Datum [NGVD] 29) were evaluated by comparing these boundary

  19. 21 CFR 880.5180 - Burn sheet.

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Burn sheet. 880.5180 Section 880.5180 Food and... Burn sheet. (a) Identification. A burn sheet is a device made of a porous material that is wrapped aroung a burn victim to retain body heat, to absorb wound exudate, and to serve as a barrier against...

  20. Manifold free multiple sheet superplastic forming

    Elmer, John W.; Bridges, Robert L.

    2004-01-13

    Fluid-forming compositions in a container attached to enclosed adjacent sheets are heated to relatively high temperatures to generate fluids (gases) that effect inflation of the sheets. Fluid rates to the enclosed space between the sheets can be regulated by the canal from the container. Inflated articles can be produced by a continuous, rather than batch-type, process.

  1. On the possible eigenoscillations of neutral sheets

    Almeida, W.A.; Costa, J.M. da; Aruquipa, E.G.; Sudano, J.P.

    1974-12-01

    A neutral sheet model with hyperbolic tangent equilibrium magnetic field and hyperbolic square secant density profiles is considered. It is shown that the equation for small oscillations takes the form of an eigenvalue oscillation problem. Computed eigenfrequencies of the geomagnetic neutral sheet were found to be in the range of the resonant frequencies of the geomagnetic plasma sheet computed by other authors

  2. Allegheny County Fatal Accidental Overdoses

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Fatal accidental overdose incidents in Allegheny County, denoting age, gender, race, drugs present, zip code of incident and zip code of residence. Zip code of...

  3. Allegheny County Zip Code Boundaries

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This dataset demarcates the zip code boundaries that lie within Allegheny County.If viewing this description on the Western Pennsylvania Regional Data Center’s open...

  4. Allegheny County School District Boundaries

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This dataset demarcates the school district boundaries within Allegheny County If viewing this description on the Western Pennsylvania Regional Data Center’s open...

  5. 2015 Lowndes County (GA) Lidar

    National Oceanic and Atmospheric Administration, Department of Commerce — TASK NAME: NOAA OCM Lidar for Lowndes County, GA with the option to Collect Lidar in Cook and Tift Counties, GA Lidar Data Acquisition and Processing Production Task...

  6. Allegheny County Fast Food Establishments

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — The Allegheny County Health Department has generated this list of fast food restaurants by exporting all chain restaurants without an alcohol permit from the...

  7. Allegheny County Park Rangers Outreach

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Launched in June 2015, the Allegheny County Park Rangers program reached over 48,000 people in its first year. Park Rangers interact with residents of all ages and...

  8. Allegheny County Jail Daily Census

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — A daily census of the inmates at the Allegheny County Jail (ACJ). Includes gender, race, age at booking, and current age. The records for each month contain a...

  9. Allegheny County Mortgage Foreclosure Records

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This data includes filings related to mortgage foreclosure in Allegheny County. The foreclosure process enables a lender to take possession of a property due to an...

  10. Allegheny County Poor Housing Conditions

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This estimate of the percent of distressed housing units in each Census Tract was prepared using data from the American Community Survey and the Allegheny County...

  11. Providing engineering services to counties.

    2008-09-01

    An engineer is required by law to safeguard the health, safety and welfare of the public. The current Kansas : statute state, The Board of County Commissioners of each county shall appoint a licensed professional : engineer, whose title shall be c...

  12. Allegheny County Cell Tower Points

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This dataset portrays cell tower locations as points in Allegheny County. The dataset is based on outbuilding codes in the Property Assessment Parcel Database used...

  13. Curry County E-911 Roads

    Earth Data Analysis Center, University of New Mexico — Line attributes denoting all street centerlines in Curry County. Dataset includes all centerlines for all county maintained roads, all state and federal highways,and...

  14. Allegheny County Summer Food Sites

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This data set shows the Summer Food Sites located within Allegheny County for children (18 years and younger) for breakfast and lunch during summer recess. OPEN...

  15. Allegheny County Property Sale Transactions

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This dataset contains data on all Real Property parcels that have sold since 2013 in Allegheny County, PA. Before doing any market analysis on property sales, check...

  16. Allegheny County Land Use Areas

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Allegheny County land use as ascribed to areas of land. The Land Use Feature Dataset contains photogrammetrically compiled information concerning vegetation and...

  17. DOT Official County Highway Map

    Minnesota Department of Natural Resources — The County Highway Map theme is a scanned and rectified version of the original MnDOT County Highway Map Series. The cultural features on some of these maps may be...

  18. Allegheny County Primary Care Access

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — The data on health care facilities includes the name and location of all the hospitals and primary care facilities in Allegheny County. The current listing of...

  19. Geometry of thin liquid sheet flows

    Chubb, Donald L.; Calfo, Frederick D.; Mcconley, Marc W.; Mcmaster, Matthew S.; Afjeh, Abdollah A.

    1994-01-01

    Incompresible, thin sheet flows have been of research interest for many years. Those studies were mainly concerned with the stability of the flow in a surrounding gas. Squire was the first to carry out a linear, invicid stability analysis of sheet flow in air and compare the results with experiment. Dombrowski and Fraser did an experimental study of the disintegration of sheet flows using several viscous liquids. They also detected the formulation of holes in their sheet flows. Hagerty and Shea carried out an inviscid stability analysis and calculated growth rates with experimental values. They compared their calculated growth rates with experimental values. Taylor studied extensively the stability of thin liquid sheets both theoretically and experimentally. He showed that thin sheets in a vacuum are stable. Brown experimentally investigated thin liquid sheet flows as a method of application of thin films. Clark and Dumbrowski carried out second-order stability analysis for invicid sheet flows. Lin introduced viscosity into the linear stability analysis of thin sheet flows in a vacuum. Mansour and Chigier conducted an experimental study of the breakup of a sheet flow surrounded by high-speed air. Lin et al. did a linear stability analysis that included viscosity and a surrounding gas. Rangel and Sirignano carried out both a linear and nonlinear invisid stability analysis that applies for any density ratio between the sheet liquid and the surrounding gas. Now there is renewed interest in sheet flows because of their possible application as low mass radiating surfaces. The objective of this study is to investigate the fluid dynamics of sheet flows that are of interest for a space radiator system. Analytical expressions that govern the sheet geometry are compared with experimental results. Since a space radiator will operate in a vacuum, the analysis does not include any drag force on the sheet flow.

  20. Ice sheet hydrology from observations

    Jansson, Peter [Dept. of Physical Geography and Quaternary Geology, Stockholm Univ-, Stockholm (Sweden)

    2010-11-15

    The hydrological systems of ice sheets are complex. Our view of the system is split, largely due to the complexity of observing the systems. Our basic knowledge of processes have been obtained from smaller glaciers and although applicable in general to the larger scales of the ice sheets, ice sheets contain features not observable on smaller glaciers due to their size. The generation of water on the ice sheet surface is well understood and can be satisfactorily modeled. The routing of water from the surface down through the ice is not complicated in terms of procat has been problematic is the way in which the couplings between surface and bed has been accomplished through a kilometer of cold ice, but with the studies on crack propagation and lake drainage on Greenland we are beginning to understand also this process and we know water can be routed through thick cold ice. Water generation at the bed is also well understood but the main problem preventing realistic estimates of water generation is lack of detailed information about geothermal heat fluxes and their geographical distribution beneath the ice. Although some average value for geothermal heat flux may suffice, for many purposes it is important that such values are not applied to sub-regions of significantly higher fluxes. Water generated by geothermal heat constitutes a constant supply and will likely maintain a steady system beneath the ice sheet. Such a system may include subglacial lakes as steady features and reconfiguration of the system is tied to time scales on which the ice sheet geometry changes so as to change pressure gradients in the basal system itself. Large scale re-organization of subglacial drainage systems have been observed beneath ice streams. The stability of an entirely subglacially fed drainage system may hence be perturbed by rapid ice flow. In the case of Antarctic ice streams where such behavior has been observed, the ice streams are underlain by deformable sediments. It is

  1. Periodic folding of viscous sheets

    Ribe, Neil M.

    2003-09-01

    The periodic folding of a sheet of viscous fluid falling upon a rigid surface is a common fluid mechanical instability that occurs in contexts ranging from food processing to geophysics. Asymptotic thin-layer equations for the combined stretching-bending deformation of a two-dimensional sheet are solved numerically to determine the folding frequency as a function of the sheet’s initial thickness, the pouring speed, the height of fall, and the fluid properties. As the buoyancy increases, the system bifurcates from “forced” folding driven kinematically by fluid extrusion to “free” folding in which viscous resistance to bending is balanced by buoyancy. The systematics of the numerically predicted folding frequency are in good agreement with laboratory experiments.

  2. Ice sheet hydrology from observations

    Jansson, Peter

    2010-11-01

    The hydrological systems of ice sheets are complex. Our view of the system is split, largely due to the complexity of observing the systems. Our basic knowledge of processes have been obtained from smaller glaciers and although applicable in general to the larger scales of the ice sheets, ice sheets contain features not observable on smaller glaciers due to their size. The generation of water on the ice sheet surface is well understood and can be satisfactorily modeled. The routing of water from the surface down through the ice is not complicated in terms of procat has been problematic is the way in which the couplings between surface and bed has been accomplished through a kilometer of cold ice, but with the studies on crack propagation and lake drainage on Greenland we are beginning to understand also this process and we know water can be routed through thick cold ice. Water generation at the bed is also well understood but the main problem preventing realistic estimates of water generation is lack of detailed information about geothermal heat fluxes and their geographical distribution beneath the ice. Although some average value for geothermal heat flux may suffice, for many purposes it is important that such values are not applied to sub-regions of significantly higher fluxes. Water generated by geothermal heat constitutes a constant supply and will likely maintain a steady system beneath the ice sheet. Such a system may include subglacial lakes as steady features and reconfiguration of the system is tied to time scales on which the ice sheet geometry changes so as to change pressure gradients in the basal system itself. Large scale re-organization of subglacial drainage systems have been observed beneath ice streams. The stability of an entirely subglacially fed drainage system may hence be perturbed by rapid ice flow. In the case of Antarctic ice streams where such behavior has been observed, the ice streams are underlain by deformable sediments. It is

  3. Load Test in Sheet Pile

    Luis Orlando Ibanez

    2016-01-01

    In this work, are discussed experiences in the use of mathematical modeling and testing in hydraulic engineering structures. For this purpose the results of load tests in sheet pile, evaluating horizontal and vertical deformations that occur in the same exposed. Comparisons between theoretical methods for calculating deformations and mathematical models based on the Finite Element Method are established. Finally, the coincidence between the numerical model and the results of the load test ful...

  4. Ohm's law for a current sheet

    Lyons, L. R.; Speiser, T. W.

    1985-01-01

    The paper derives an Ohm's law for single-particle motion in a current sheet, where the magnetic field reverses in direction across the sheet. The result is considerably different from the resistive Ohm's law often used in MHD studies of the geomagnetic tail. Single-particle analysis is extended to obtain a self-consistency relation for a current sheet which agrees with previous results. The results are applicable to the concept of reconnection in that the electric field parallel to the current is obtained for a one-dimensional current sheet with constant normal magnetic field. Dissipated energy goes directly into accelerating particles within the current sheet.

  5. A Variant in the BACH2 Gene Is Associated With Susceptibility to Autoimmune Addison's Disease in Humans.

    Pazderska, Agnieszka; Oftedal, Bergithe E; Napier, Catherine M; Ainsworth, Holly F; Husebye, Eystein S; Cordell, Heather J; Pearce, Simon H S; Mitchell, Anna L

    2016-11-01

    Autoimmune Addison's disease (AAD) is a rare but highly heritable condition. The BACH2 protein plays a crucial role in T lymphocyte maturation, and allelic variation in its gene has been associated with a number of autoimmune conditions. We aimed to determine whether alleles of the rs3757247 single nucleotide polymorphism (SNP) in the BACH2 gene are associated with AAD. This case-control association study was performed in two phases using Taqman chemistry. In the first phase, the rs3757247 SNP was genotyped in 358 UK AAD subjects and 166 local control subjects. Genotype data were also available from 5154 healthy UK controls from the Wellcome Trust (WTCCC2) for comparison. In the second phase, the SNP was genotyped in a validation cohort comprising 317 Norwegian AAD subjects and 365 controls. The frequency of the minor T allele was significantly higher in subjects with AAD from the United Kingdom compared to both the local and WTCCC2 control cohorts (58% vs 45 and 48%, respectively) (local controls, P = 1.1 × 10 -4 ; odds ratio [OR], 1.68; 95% confidence interval [CI], 1.29-2.18; WTCCC2 controls, P = 1.4 × 10 -6 ; OR, 1.44; 95% CI, 1.23-1.69). This finding was replicated in the Norwegian validation cohort (P = .0015; OR, 1.41; 95% CI, 1.14-1.75). Subgroup analysis showed that this association is present in subjects with both isolated AAD (OR, 1.53; 95% CI, 1.22-1.92) and autoimmune polyglandular syndrome type 2 (OR, 1.37; 95% CI, 1.12-1.69) in the UK cohort, and with autoimmune polyglandular syndrome type 2 in the Norwegian cohort (OR, 1.58; 95% CI, 1.22-2.06). We have demonstrated, for the first time, that allelic variability at the BACH2 locus is associated with susceptibility to AAD. Given its association with multiple autoimmune conditions, BACH2 can be considered a "universal" autoimmune susceptibility locus.

  6. Interleukin-2 and subunit alpha of its soluble receptor in autoimmune Addison's disease--an association study and expression analysis.

    Fichna, Marta; Żurawek, Magdalena; Bratland, Eirik; Husebye, Eystein S; Kasperlik-Załuska, Anna; Czarnocka, Barbara; Januszkiewicz-Lewandowska, Danuta; Nowak, Jerzy

    2015-03-01

    Autoimmune Addison's disease (AAD) results from T cell-mediated destruction of the adrenal cortex, commonly accompanied by autoantibodies to 21-hydroxylase (21OH). In order to gain insight into the obscure aetiology of this disease, we investigated the roles of the IL2 and IL2RA genes, encoding interleukin-2 and subunit alpha of its receptor (IL2Ra), respectively. The association of AAD with IL2 and IL2RA polymorphisms (rs6822844, rs2069762, rs3136534, rs11594656, rs3118470 and rs2104286) was tested in 223 patients and 672 healthy controls. Functional studies consisted of gene expression analysis in cultured PBMCs exposed to 21OH and evaluation of serum interleukin by ELISA assays. The frequency of the minor C allele of rs3136534 was significantly decreased in AAD subjects compared to controls (OR 0.71; 95%CI 0.561-0.887; p = 0.003). Only AAD cells responded to 21OH with an elevated IL2 and IL2RA mRNA synthesis (p = 0.004 and p = 0.009 versus controls, respectively), paralleled by increased supernatant levels of both cytokines (p = 0.031 and p = 0.001 versus controls). IL2 mRNA level in 21OH-stimulated AAD PBMCs correlated negatively with age (p = 0.036) and positively with serum antibodies to 21OH (p = 0.006). Carriers of the rs2104286 AA genotype demonstrated higher IL2RA mRNA (p = 0.022) and soluble IL2Ra secretion (p = 0.029) upon 21OH stimulation. Serum interleukin-2 in AAD subjects was significantly higher compared to controls (4.61 ± 4.3 versus 1.71 ± 3.2 pg/mL, p < 0.001), whereas sIL2Ra levels remained similar in both groups (p = 0.885). In conclusion, the study reveals an association between AAD and IL2 locus. It confirms specific 21OH-directed reactivity of the peripheral AAD lymphocytes, which display increased synthesis of interleukin-2 and sIL2Ra.

  7. Cardiovascular risk factors in patients with Addison's disease: a comparative study of South African and Swedish patients.

    Ian Louis Ross

    Full Text Available BACKGROUND: Patients with Addison's disease (AD in Scandinavia have an increased risk for premature death due to cardiovascular disease (CVD. Serum lipids are important risk factors for CVD and vascular mortality. Replacement doses of hydrocortisone have historically been higher in Sweden than South Africa. The primary aim was to study the lipid profiles in a large group of patients with AD with the hypothesis that the lipid profile in patients in Sweden would be worse than in South Africa. METHODS: In a cross-sectional study, 110 patients with AD (55 from South Africa, 55 from Sweden matched for age, gender, ethnicity and BMI were studied. Anthropometric measures, blood pressure, lipids, highly sensitive C-reactive protein (hs-CRP and adiponectin were studied. RESULTS: All patients were Caucasian and the majority were women N = 36 (65.5%. Mean (standard deviation; SD ages of the Swedish and South African patients were 52.9 (13.0 and 52.6 (14.4 years and BMI 25.3 (3.2 and 25.8 (4.1 kg/m2, respectively. The mean total daily hydrocortisone dose was greater in the Swedish patients than the South African patients, [33.0 (8.1 versus 24.3 (8.0 mg; p<0.0001]. South African patients had higher median (interquartilerange; IQR triglycerides (TG [1.59 (1.1-2.46 versus 0.96 (0.74-1.6 mmol/l; p<0.001], total cholesterol (TC [6.02(1.50 versus 5.13 (0.87 mmol/l; p<0.001], LDL-C [4.43 (1.44 versus 2.75 (0.80 mmol/l; p<0.001] and median hs-CRP [2.15 (0.93-5.45 versus 0.99 (0.57-2.10 mg/L; p<0.003] and lower HDL-C [0.80 (0.40 versus 1.86 (0.46 mmol/l; p<0.001] than the Swedish patients. Approximately 20% of the patients in both cohorts had hypertension and diabetes mellitus. CONCLUSIONS: South African patients with AD have worse lipid profiles and higher hs-CRP compared to their matched Swedish patients, despite lower doses of hydrocortisone. It is uncertain at this time whether these are due to genetic or environmental factors.

  8. High-dose vitamin D in Addison's disease regulates T-cells and monocytes: A pilot trial.

    Penna-Martinez, Marissa; Filmann, Natalie; Bogdanou, Dimitra; Shoghi, Firouzeh; Huenecke, Sabine; Schubert, Ralf; Herrmann, Eva; Koehl, Ulrike; Husebye, Eystein S; Badenhoop, Klaus

    2018-05-01

    On the basis of the immunomodulatory actions of vitamin D (VD), we investigated the effects of high-dose VD therapy over a 3 mo period on the immune response in patients with Addison's disease (AD). This randomized, controlled, crossover trial included 13 patients with AD who received either cholecalciferol (4000 IU/d) for 3 mo followed by 3 mo placebo oil or the sequential alternative placebo followed by verum. Glucocorticoid replacement doses remained stable. The primary outcome measures were changes in 25-hydroxyvitamin D3 (25(OH)D 3 ) levels and immune cells including T helper cells (Th; CD3 + CD4 + ), late-activated Th cells (CD3 + CD4 + HLA-DR + ), regulatory T cells (CD3 + CD4 + CD25 bright CD127 dim/neg ), cytotoxic T cells (Tc; CD3 + CD8 + ), late-activated Tc cells (CD3 + CD8 + HLA-DR + ), and monocytes. The explorative analysis included the correlation of changes with VD-related gene polymorphisms and 21-hydroxylase antibody titers. Ten of 13 patients (77%) were VD deficient. Median 25(OH)D 3 concentrations increased significantly to 41.5 ng/ml (median changes: 19.95 ng/ml; P = 0.0005) after 3 mo of cholecalciferol treatment. Within the T-cells, only the late-activated Th (median changes: 1.6%; P = 0.02) and late-activated Tc cells (median changes: 4.05%; P = 0.03) decreased, whereas monocytes (median changes: 1.05%; P = 0.008) increased after VD therapy. T-cell changes were associated with two polymorphisms (CYP27B1-rs108770012 and VDR-rs10735810), but no changes in the 21-hydroxylase antibody titers were observed. Three months of treatment with cholecalciferol achieved sufficient 25(OH)D 3 levels and can regulate late-activated T-cells and monocytes in patients with AD. Explorative analysis revealed potential genetic contributions. This pilot trial provides novel insights about immunomodulation in AD. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. HLA similarities indicate shared genetic risk in 21-hydroxylase autoantibody positive South African and United States Addison's disease.

    Ross, I L; Babu, S; Armstrong, T; Zhang, L; Schatz, D; Pugliese, A; Eisenbarth, G; Baker Ii, P

    2014-10-01

    Genetic similarities between patients from the United States and South African (SA) Addison's Disease (AD) strengthen evidence for genetic association. SA-AD (n = 73), SA healthy controls (N = 78), and US-AD patients (N = 83) were genotyped for DQA1, DQB1, DRB1, and HLA-B alleles. Serum was tested for the quantity of 21OH-AA and IFNα-AA at the Barbara Davis Center. Although not as profound as in US-AD, in SA-AD 21OH-AA + subjects the predominantly associated risk haplotypes were DRB1*0301-DQB1*0201 (DR3), DRB1*04xx-DQB1*0302 (DR4), and the combined DR3/4 genotype. DQB1*0302 associated DRB1*04xx haplotypes conferred higher risk than those DRB1*04xx haplotypes associated with other DQB1 alleles. We found negative association in 21OH-AA + SA-AD for DQA1*0201-DQB1*0202 and DQA1*0101-DQB1*0501 vs SA controls, and positive association for DQA1*0401-DQB1*0402 vs US-AD. Apart from the class II DR3 haplotype, HLA-B8 did not have an independent effect; however together DR3 and HLA-B8 conferred the highest risk vs 21OH-AA negative SA-AD and SA-controls. HLA-B7 (often with DR4) conferred novel risk in 21OH-AA + SA-AD vs controls. This study represents the first comparison between South African and United States AD populations utilizing genotyping and serology performed at the same center. SA-AD and US-AD 21OH-AA + patients share common HLA risk haplotypes including DR4 (with HLA-B7) and DR3 (with HLA-B8), strengthening previously described HLA associations and implicating similar genetic etiology. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  10. Positive autoantibodies to ZnT8 indicate elevated risk for additional autoimmune conditions in patients with Addison's disease.

    Fichna, Marta; Rogowicz-Frontczak, Anita; Żurawek, Magdalena; Fichna, Piotr; Gryczyńska, Maria; Zozulińska-Ziółkiewicz, Dorota; Ruchała, Marek

    2016-07-01

    Autoimmune Addison's disease (AAD) associates with exceptional susceptibility to develop other autoimmune conditions, including type 1 diabetes (T1D), marked by positive serum autoantibodies to insulin (IAA), glutamic acid decarboxylase (GADA) and insulinoma-associated protein 2 (IA-2A). Zinc transporter 8 (ZnT8) is a new T1D autoantigen, encoded by the SLC30A8 gene. Its polymorphic variant rs13266634C/T seems associated with the occurrence of serum ZnT8 antibodies (ZnT8A). This study was designed to determine the prevalence of serum ZnT8A and their clinical implication in 140 AAD patients. Other beta cell and thyroid-specific autoantibodies were also investigated, and ZnT8A results were confronted with the rs13266634 genotype. ZnT8A were detectable in 8.5 %, GADA in 20.7 %, IA-2A in 5.7 %, IAA in 1.6 % and various anti-thyroid antibodies in 7.1-67.8 % individuals. Type 1 diabetes was found in 10 % AAD patients. ZnT8A were positive in 57.1 % of T1D patients and 3.4 % non-diabetic AAD. Analysis of ZnT8A enabled to identify autoimmunity in two (14.3 %) T1D individuals previously classified as autoantibody-negative. ZnT8A-positive patients revealed significantly higher number of autoimmune conditions (p < 0.001), increased prevalence of T1D (p < 0.001) and other beta cell-specific autoantibodies. Carriers of the rs13266634 T-allele displayed increased frequency (p = 0.006) and higher titres of ZnT8A (p = 0.002). Our study demonstrates high incidence of ZnT8A in AAD patients. ZnT8A are associated with coexisting T1D and predictive of T1D in non-diabetic subjects. Moreover, positive ZnT8A in AAD indicate elevated risk for additional autoimmune conditions. Autoantibodies to beta cell antigens, comprising ZnT8, could be included in routine screening panels in AAD.

  11. Cardiovascular Risk Factors in Patients with Addison's Disease: A Comparative Study of South African and Swedish Patients

    Ross, Ian Louis; Bergthorsdottir, Ragnhildur; Levitt, Naomi; Dave, Joel Alex; Schatz, Desmond; Marais, David; Johannsson, Gudmundur

    2014-01-01

    Background Patients with Addison's disease (AD) in Scandinavia have an increased risk for premature death due to cardiovascular disease (CVD). Serum lipids are important risk factors for CVD and vascular mortality. Replacement doses of hydrocortisone have historically been higher in Sweden than South Africa. The primary aim was to study the lipid profiles in a large group of patients with AD with the hypothesis that the lipid profile in patients in Sweden would be worse than in South Africa. Methods In a cross-sectional study, 110 patients with AD (55 from South Africa, 55 from Sweden) matched for age, gender, ethnicity and BMI were studied. Anthropometric measures, blood pressure, lipids, highly sensitive C-reactive protein (hs-CRP) and adiponectin were studied. Results All patients were Caucasian and the majority were women N = 36 (65.5%). Mean (standard deviation; SD) ages of the Swedish and South African patients were 52.9 (13.0) and 52.6 (14.4) years and BMI 25.3 (3.2) and 25.8 (4.1) kg/m2, respectively. The mean total daily hydrocortisone dose was greater in the Swedish patients than the South African patients, [33.0 (8.1) versus 24.3 (8.0) mg; p<0.0001]. South African patients had higher median (interquartilerange; IQR) triglycerides (TG) [1.59 (1.1–2.46) versus 0.96 (0.74–1.6) mmol/l; p<0.001], total cholesterol (TC) [6.02(1.50) versus 5.13 (0.87) mmol/l; p<0.001], LDL-C [4.43 (1.44) versus 2.75 (0.80) mmol/l; p<0.001] and median hs-CRP [2.15 (0.93–5.45) versus 0.99 (0.57–2.10) mg/L; p<0.003] and lower HDL-C [0.80 (0.40) versus 1.86 (0.46) mmol/l; p<0.001] than the Swedish patients. Approximately 20% of the patients in both cohorts had hypertension and diabetes mellitus. Conclusions South African patients with AD have worse lipid profiles and higher hs-CRP compared to their matched Swedish patients, despite lower doses of hydrocortisone. It is uncertain at this time whether these are due to genetic or environmental factors. PMID:24603607

  12. Minnesota County Boundaries - lines

    Minnesota Department of Natural Resources — Minnesota county boundaries derived from a combination of 1:24,000 scale PLS lines, 1:100,000 scale TIGER, 1:100,000 scale DLG, and 1:24,000 scale hydrography lines....

  13. Minnesota County Boundaries

    Minnesota Department of Natural Resources — Minnesota county boundaries derived from a combination of 1:24,000 scale PLS lines, 1:100,000 scale TIGER, 1:100,000 scale DLG, and 1:24,000 scale hydrography lines....

  14. Maternal and neonatal outcomes of pregnancies in women with Addison's disease: a population-based cohort study on 7.7 million births.

    Schneiderman, M; Czuzoj-Shulman, N; Spence, A R; Abenhaim, H A

    2017-10-01

    To assess if pregnancies among women with Addison's disease (AD) are at higher risk of adverse maternal and neonatal outcomes. Population-based retrospective cohort study. All births in the United States' Healthcare Cost and Utilization Project-Nationwide Inpatient Sample from 2003 to 2011. Baseline characteristics were compared between women with AD and those without, and prevalence over time was measured. Logistic regression was used to estimate the effect of AD on maternal and neonatal outcomes by calculating the crude and adjusted odds ratios (OR) and corresponding 95% confidence intervals (95% CI). We calculated a prevalence of AD in pregnancy of 5.5/100 000, increasing from 5.6 to 9.6/100 000 (P = 0.0001) over the 9-year study period. Compared with women without AD, women with AD were more likely to deliver preterm (OR 1.50, 95% CI 1.16-1.95), deliver by caesarean section (OR 1.32, 95% CI 1.08-1.61), have impaired wound healing (OR 4.28, 95% CI 2.55-7.18), develop infections (OR 2.44, 95% CI 1.66-3.58) and develop thromboembolism (OR 5.21, 95% CI 2.15-12.63), require transfusions (OR 6.69, 95% CI 4.69-9.54), and have prolonged postpartum hospital admissions (OR 5.71, 95% CI 4.37-7.47). Maternal mortality was significantly higher than in the comparison group (OR 22.30, 95% CI 6.82-72.96). Congenital anomalies (OR 3.62, 95% CI 2.05-6.39) and small-for-gestational age infants (OR 1.78, 95% CI 1.15-2.75) were more likely in these pregnancies. Addison's disease significantly increases the risk of severe adverse maternal and neonatal outcomes, so pregnant women with AD are best managed in tertiary-care centres. Pregnancies complicated by Addison's disease have an increased risk of adverse maternal and neonatal outcomes. © 2016 Royal College of Obstetricians and Gynaecologists.

  15. Experimental formability analysis of bondal sandwich sheet

    Kami, Abdolvahed; Banabic, Dorel

    2018-05-01

    Metal/polymer/metal sandwich sheets have recently attracted the interests of industries like automotive industry. These sandwich sheets have superior properties over single-layer metallic sheets including good sound and vibration damping and light weight. However, the formability of these sandwich sheets should be enhanced which requires more research. In this paper, the formability of Bondal sheet (DC06/viscoelastic polymer/DC06 sandwich sheet) was studied through different types of experiments. The mechanical properties of Bondal were determined by uniaxial tensile tests. Hemispherical punch stretching and hydraulic bulge tests were carried out to determine the forming limit diagram (FLD) of Bondal. Furthermore, cylindrical and square cup drawing tests were performed in dry and oil lubricated conditions. These tests were conducted at different blank holding forces (BHFs). An interesting observation about Bondal sheet deep drawing was obtaining of higher drawing depths at dry condition in comparison with oil-lubricated condition.

  16. Buckling and stretching of thin viscous sheets

    O'Kiely, Doireann; Breward, Chris; Griffiths, Ian; Howell, Peter; Lange, Ulrich

    2016-11-01

    Thin glass sheets are used in smartphone, battery and semiconductor technology, and may be manufactured by producing a relatively thick glass slab and subsequently redrawing it to a required thickness. The resulting sheets commonly possess undesired centerline ripples and thick edges. We present a mathematical model in which a viscous sheet undergoes redraw in the direction of gravity, and show that, in a sufficiently strong gravitational field, buckling is driven by compression in a region near the bottom of the sheet, and limited by viscous resistance to stretching of the sheet. We use asymptotic analysis in the thin-sheet, low-Reynolds-number limit to determine the centerline profile and growth rate of such a viscous sheet.

  17. A rare case report of simultaneous presentation of myopathy, Addison's disease, primary hypoparathyroidism, and Fanconi syndrome in a child diagnosed with Kearns-Sayre syndrome.

    Tzoufi, Meropi; Makis, Alexandros; Chaliasos, Nikolaos; Nakou, Iliada; Siomou, Ekaterini; Tsatsoulis, Agathoklis; Zikou, Anastasia; Argyropoulou, Maria; Bonnefont, Jean Paul; Siamopoulou, Antigone

    2013-04-01

    Kearns-Sayre syndrome (KSS) is a rare mitochondrial DNA deletion syndrome defined as the presence of ophthalmoplegia, pigmentary retinopathy, onset less than age 20 years, and one of the following: cardiac conduction defects, cerebellar syndrome, or cerebrospinal fluid protein above 100 mg/dl. KSS may affect many organ systems causing endocrinopathies, encephalomyopathy, sensorineural hearing loss, and renal tubulopathy. Clinical presentation at diagnosis is quite heterogeneous and, usually, few organs are affected with progression to generalized disease early in adulthood. We present the case of a boy with KSS presenting at the age of 5 years with myopathy, Addison's disease, primary hypoparathyroidism, and Fanconi syndrome. The proper replacement treatment along with the administration of mitochondrial metabolism-improving agents had a brief ameliorating effect, but gradual severe multisystemic deterioration was inevitable over the next 5 years. This report highlights the fact that in case of simultaneous presentation of polyendocrinopathies and renal disease early in childhood, KSS should be considered.

  18. Adrenal insufficiency secondary to tuberculosis: the value of telemedicine in the remote diagnosis of Addison's disease in Ebeye, Republic of the Marshall Islands.

    Bush, Lisabeth A; Ruess, Lynne; Jack, Tom; Person, Donald A

    2009-01-01

    A young Marshallese woman presented with the insidious development of fever, cough, fatigue, profound weakness, massive weight loss, cachexia, alopecia, amenorrhea, and periumbilical hyperpigmentation. Limited laboratory studies revealed anemia, leukocytosis, and hyponatremia. Imaging studies, as well as digital photographs, transmitted over the Internet, using the secure Pacific Island Health Care Project (PIHCP), store-and-forward telemedicine system, suggested the diagnosis of disseminated tuberculosis, and antimycobacterial antibiotics were begun. Sputum cultures eventually grew Mycobacterium tuberculosis. Based on the constellation of clinical signs and symptoms, the transmitted images, and limited laboratory data, adrenal tuberculosis (Addison's disease) with adrenal insufficiency was diagnosed and corticosteroids were initiated. The patient responded dramatically This case underscores the utility of telemedicine in the diagnosis and treatment of patients with unusual conditions, rarely seen today in the United States, from remote sites in the Developing World.

  19. Polymorphisms of the GR and HSD11B1 genes influence body mass index and weight gain during hormone replacement treatment in patients with Addison's disease.

    Molnár, Ágnes; Kövesdi, Annamária; Szücs, Nikolette; Tóth, Miklós; Igaz, Péter; Rácz, Károly; Patócs, Attila

    2016-08-01

    Glucocorticoid substitution is essential in patients with chronic primary adrenocortical insufficiency (Addison's disease) and both over-treatment and inadequate dosage have deleterious effects. Individual sensitivity to glucocorticoids is partly genetically determined. To test the hypothesis whether the well-characterized SNPs of the GR and HSD11B1 genes may modulate the individual sensitivity to exogenous glucocorticoids and may influence clinical and/or laboratory parameters and the glucocorticoid substitution dosage in patients with Addison's disease. 68 patients with primary adrenocortical insufficiency were involved. Clinical and laboratory data, as well as the dosage of the hormone replacement therapy were collected. Peripheral blood DNA was isolated, and the GR and HSD11B1 SNPs were examined using allele-specific PCR or Taqman assay on Real Time PCR. The allele frequency of the GR N363S polymorphism was higher in patients compared to the control group and the disease appeared significantly earlier in patients harbouring the GR A3669G compared to noncarriers. These patients had higher ACTH level measured at the time of diagnosis. Homozygous BclI carriers had higher body mass index (BMI) and lower total hydrocortisone equivalent supplementation dose needed than heterozygous or noncarriers. The BMI and weight gain during hormone replacement therapy were also higher in carriers of the HSD11B1 rs4844880 treated with glucocorticoids other than dexamethasone. The BclI polymorphism of the GR gene and the rs4844880 of the HSD11B1 gene may contribute to weight gain and may affect the individual need of glucocorticoid substitution dose in these patients. © 2016 John Wiley & Sons Ltd.

  20. MicroRNA expressions in PMBCs, CD4+, and CD8+ T-cells from patients suffering from autoimmune Addison's disease.

    Bernecker, C; Halim, F; Haase, M; Willenberg, H S; Ehlers, M; Schott, M

    2013-08-01

    Autoimmune Addison's disease (AD) is a rare but potentially life threatening disease. The exact etiology of the immune response to the adrenal gland is still unknown. MicroRNAs (miRNAs) critically control gene-expression and play an important role in regulating the immune response. The aim of this study was to determine key immunoregulatory miRNAs influencing autoimmune adrenal insufficiency. For this purpose selected miRNAs were amplified by a semiquantitative SYBR Green PCR from blood mononuclear cells and after purification from CD4+ and CD 8+ cells of 6 patients with autoimmune adrenal insufficiency and 10 healthy controls. In CD4+ T-cells miRNA 181a*_1 (18.02 in AD vs. 11.99 in CG, p=0.0047) is significantly increased whereas miRNA 200a_1 (12.48 in AD vs. 19.40 in CG, p=0.0003) and miRNA 200a_2* (8.59 in AD vs. 17.94 in CG, p=0.0160) are significantly decreased. miRNA 200a_1 (12.37 in AD group vs. 18.12 in control group, p=0.001) and miRNA 200a_2* (10.72 in AD group vs. 17.84 in control group, p=0.022) are also significantly decreased in CD8+ T-cells. This study could show for the first time a significant change of three defined miRNAs in PBMCs, CD4+, and CD8+ T-cells of autoimmune AD patients in vivo. These data may help to better understand the cause of the autoimmune processes leading to autoimmune AD. They extend our very limited knowledge concerning miRNAs in autoimmune Addison's disease. © Georg Thieme Verlag KG Stuttgart · New York.

  1. Autoimmunity predominates in a large South African cohort with Addison's disease of mainly European descent despite long-standing disease and is associated with HLA DQB*0201.

    Ross, Ian; Boulle, Andrew; Soule, Steven; Levitt, Naomi; Pirie, Fraser; Karlsson, Anders; Mienie, Japie; Yang, Ping; Wang, Hongjie; She, Jin-Xiong; Winter, William; Schatz, Desmond

    2010-09-01

    We sought to determine whether autoimmunity is the predominant cause of Addison's disease in South Africa and whether human leucocyte antigen (HLA) DQ association exists. We compiled a national registry of patients from primary care, referral centres and private practices. A total of 144 patients, 94 of European descent, 34 Mixed Ancestry, 5 Asian and 11 Black Africans (mean age 45.9 years, range 2.7-88 years; mean duration of disease 13.1 years, range 0-50 years) and controls were matched for gender and ethnicity. All potential causes were investigated. Fifty one per cent of cases (74 patients) were autoimmune in aetiology. Either 21-hydroxylase autoantibodies (72 patients, 50% of entire patient group) or adrenocortical autoantibodies (35 patients, 24%) were present, while 23% of patients had both. None of the Asian (n = 5) or Black (n = 11) patients had evidence of autoimmune disease. Overall 8% of patients had tuberculosis, 4% adrenoleucodystrophy, 1% adrenocorticotrophic hormone resistance syndrome and 6% X-linked adrenal hypoplasia. In those with autoimmune disease primary hypothyroidism (47%), premature ovarian failure (8%) and type 1 diabetes (7%) were the most prevalent accompanying autoimmune conditions. HLA DQB1*0201 alleles predominated in the autoimmune group (DQB1*0201: 65%vs 43% of controls P = 0.017) with the *0201/*0302 heterozygous genotype being the most prevalent (28%vs 8%P = 0.02). While autoimmunity accounts for at least half of patients with Addison's disease in South Africa and is associated with HLA DQB1*0201, none of the Black Africans or Asians in this cohort had adrenal autoantibodies. Moreover, 21-hydroxylase autoantibodies were detectable in a higher proportion than adrenocortical autoantibodies, especially in those patients with a long history after disease onset.

  2. Strontium-90 fluoride data sheet

    Fullam, H.T.

    1981-06-01

    This report is a compilation of available data and appropriate literature references on the properties of strontium-90 fluoride and nonradioactive strontium fluoride. The objective of the document is to compile in a single source pertinent data to assist potential users in the development, licensing, and use of /sup 90/SrF/sub 2/-fueled radioisotope heat sources for terrestrial power conversion and thermal applications. The report is an update of the Strontium-90 Fluoride Data Sheet (BNWL-2284) originally issued in April 1977.

  3. Vietnamese Hurricane Response Fact Sheets

    Các tờ dữ kiện được cung cấp nơi đây mô tả vai trò của EPA trong việc đáp ứng với bão và cách các chương trình cụ thể cung cấp sự hỗ trợ. The Vietnamese fact sheets provided here describe EPA's role in a hurricane response.

  4. Limerick, City and County

    2011-01-01

    Postcard. Colour drawings of maps of Limerick city and county and Foynes - transatlantic air base flying boat, Dromore Castle, Glenstal Abbey, Ardagh Chalice, Askeaton; the Abbey, Gate Loge Adare Manor, Newcastlewest, King John's Castle, St. Mary's Cathedral (Church of Ireland), The Old Custom House, The Hunt Museum, The Old Mill and Bridge croom, The Coll (de Valera) Cottage Buree, Town Gate Kilmallock, Lough Gur Interpretive Centre, Hospital Ancient hostelry and The Treaty Stone. Copyright ...

  5. UNEMPLOYMENT IN HUNEDOARA COUNTY

    CLAUDIA ISAC

    2015-12-01

    Full Text Available Unemployment highlights a state of imbalance on the labour market which is characterized by a surplus of workforce in relation to job vacancies. This imbalance has been more apparent in Hunedoara County than in other counties, due to the fact that there are 3 mono-industrial areas that have been restructured over the past two decades. The effects are presented in this paper in the form of a complex statistical analysis. Thus, based on the evolution of the number of unemployed individuals in 1995, one can observe the periods of significant adverse effects upon the degree of employment. Moreover, one can make correlations with periods of international financial crisis and with the number of employees in the County in order to determine significant variables of the unemployment phenomenon. The content of this paper is significant and represents the analysis of the number of unemployed in the Jiu Valley, scattered across towns. As a form of financial protection, the unemployment benefit represents a financial instrument in the cases determined by this negative phenomenon, which is why in conclusion we make a comparison of the ways this aid is granted throughout several years and in various forms.

  6. AI applications in sheet metal forming

    Hussein, Hussein

    2017-01-01

    This book comprises chapters on research work done around the globe in the area of artificial intelligence (AI) applications in sheet metal forming. The first chapter offers an introduction to various AI techniques and sheet metal forming, while subsequent chapters describe traditional procedures/methods used in various sheet metal forming processes, and focus on the automation of those processes by means of AI techniques, such as KBS, ANN, GA, CBR, etc. Feature recognition and the manufacturability assessment of sheet metal parts, process planning, strip-layout design, selecting the type and size of die components, die modeling, and predicting die life are some of the most important aspects of sheet metal work. Traditionally, these activities are highly experience-based, tedious and time consuming. In response, researchers in several countries have applied various AI techniques to automate these activities, which are covered in this book. This book will be useful for engineers working in sheet metal industri...

  7. Dynamics of Radially Expanding Liquid Sheets

    Majumdar, Nayanika; Tirumkudulu, Mahesh S.

    2018-04-01

    The process of atomization often involves ejecting thin liquid sheets at high speeds from a nozzle that causes the sheet to flap violently and break up into fine droplets. The flapping of the liquid sheet has long been attributed to the sheet's interaction with the surrounding gas phase. Here, we present experimental evidence to the contrary and show that the flapping is caused by the thinning of the liquid sheet as it spreads out from the nozzle exit. The measured growth rates of the waves agree remarkably well with the predictions of a recent theory that accounts for the sheet's thinning but ignores aerodynamic interactions. We anticipate these results to not only lead to more accurate predictions of the final drop-size distribution but also enable more efficient designs of atomizers.

  8. Shape Optimization of Swimming Sheets

    Wilkening, J.; Hosoi, A.E.

    2005-03-01

    The swimming behavior of a flexible sheet which moves by propagating deformation waves along its body was first studied by G. I. Taylor in 1951. In addition to being of theoretical interest, this problem serves as a useful model of the locomotion of gastropods and various micro-organisms. Although the mechanics of swimming via wave propagation has been studied extensively, relatively little work has been done to define or describe optimal swimming by this mechanism.We carry out this objective for a sheet that is separated from a rigid substrate by a thin film of viscous Newtonian fluid. Using a lubrication approximation to model the dynamics, we derive the relevant Euler-Lagrange equations to optimize swimming speed and efficiency. The optimization equations are solved numerically using two different schemes: a limited memory BFGS method that uses cubic splines to represent the wave profile, and a multi-shooting Runge-Kutta approach that uses the Levenberg-Marquardt method to vary the parameters of the equations until the constraints are satisfied. The former approach is less efficient but generalizes nicely to the non-lubrication setting. For each optimization problem we obtain a one parameter family of solutions that becomes singular in a self-similar fashion as the parameter approaches a critical value. We explore the validity of the lubrication approximation near this singular limit by monitoring higher order corrections to the zeroth order theory and by comparing the results with finite element solutions of the full Stokes equations.

  9. Magnetic properties of sheet silicates

    Ballet, O.; Coey, J.M.D.

    1982-01-01

    Susceptibility, magnetisation and Moessbauer measurements are reported for a representative selection of 2:1 layer phyllosilicates. Eight samples from the mica, vermiculite and smectite groups include examples diluted in iron which are paramagnetic at all temperatures, as well as iron-rich silicates which order magnetically below 10 K. Anisotropic susceptibility of crystals of muscovite, biotite and vermiculite is quantitatively explained with a model where the Fe 2+ ions lie in sites of effective trigonal symmetry, the trigonal axis lying normal to the sheets. The ferrous ground state is an orbital singlet. Ferric iron gives an isotropic contribution to the susceptibility. Fe 2+ -Fe 2+ exchange interactions are ferromagnetic with Gapprox. equal to2 K, whereas Fe 3+ -Fe 3+ coupling is antiferromagnetic in the purely ferric minerals. A positive paramagnetic Curie temperature for glauconite may be attributable to Fe 2+ → Fe 3+ charge transfer. Magnetic order was found to set in inhomogeneously for glauconite at 1-7 K. One biotite sample showed an antiferromagnetic transition at Tsub(N) = 7 K marked by a well-defined susceptibility maximum. Its magnetic structure, consisting of ferromagnetic sheets with moments in their planes coupled antiferromagnetically by other, weak interactions, resembles that found earlier for the 1:1 mineral greenalite. (orig.)

  10. Weld Repair of Thin Aluminum Sheet

    Beuyukian, C. S.; Mitchell, M. J.

    1986-01-01

    Weld repairing of thin aluminum sheets now possible, using niobium shield and copper heat sinks. Refractory niobium shield protects aluminum adjacent to hole, while copper heat sinks help conduct heat away from repair site. Technique limits tungsten/inert-gas (TIG) welding bombardment zone to melt area, leaving surrounding areas around weld unaffected. Used successfully to repair aluminum cold plates on Space Shuttle, Commercial applications, especially in sealing fractures, dents, and holes in thin aluminum face sheets or clad brazing sheet in cold plates, heat exchangers, coolers, and Solar panels. While particularly suited to thin aluminum sheet, this process also used in thicker aluminum material to prevent surface damage near weld area.

  11. Predicting Pulsar Scintillation from Refractive Plasma Sheets

    Simard, Dana; Pen, Ue-Li

    2018-05-01

    The dynamic and secondary spectra of many pulsars show evidence for long-lived, aligned images of the pulsar that are stationary on a thin scattering sheet. One explanation for this phenomenon considers the effects of wave crests along sheets in the ionized interstellar medium, such as those due to Alfvén waves propagating along current sheets. If these sheets are closely aligned to our line-of-sight to the pulsar, high bending angles arise at the wave crests and a selection effect causes alignment of images produced at different crests, similar to grazing reflection off of a lake. Using geometric optics, we develop a simple parameterized model of these corrugated sheets that can be constrained with a single observation and that makes observable predictions for variations in the scintillation of the pulsar over time and frequency. This model reveals qualitative differences between lensing from overdense and underdense corrugated sheets: Only if the sheet is overdense compared to the surrounding interstellar medium can the lensed images be brighter than the line-of-sight image to the pulsar, and the faint lensed images are closer to the pulsar at higher frequencies if the sheet is underdense, but at lower frequencies if the sheet is overdense.

  12. Somerset County Renewable Energy Initiative

    Katula, Denise [County of Somerset, Somervile, NJ (United States)

    2014-05-07

    The County of Somerset, New Jersey, through the Somerset County Improvement Authority (SCIA), applied Federal funding through the U.S. Department of Energy to will apply project funds to buy-down the capital costs of equipment associated with the installation of solar photovoltaic (PV) systems at two sites owned by the County. This Renewable Energy Initiative allows the County to take advantage of clean renewable energy, without any adverse debt impacts, and at a price that results in operating budget savings beyond what is presently available in the marketplace. This project addressed the objectives of the Office of Energy Efficiency and Renewable Energy by making the acquisition of renewable energy more affordable for the County, thereby, encouraging other counties and local units to develop similar programs and increase the deployment of solar energy technologies. The two sites that were funded by the DOE grant are part of a much larger, ambitious, and unique renewable energy project, described in the next section.

  13. Buckling of Aluminium Sheet Components

    Hegadekatte, Vishwanath; Shi, Yihai; Nardini, Dubravko

    Wrinkling is one of the major defects in sheet metal forming processes. It may become a serious obstacle to implementing the forming process and assembling the parts, and may also play a significant role in the wear of the tool. Wrinkling is essentially a local buckling phenomenon that results from compressive stresses (compressive instability) e.g., in the hoop direction for axi-symmetric systems such as beverage cans. Modern beverage can is a highly engineered product with a complex geometry. Therefore in order to understand wrinkling in such a complex system, we have started by studying wrinkling with the Yoshida buckling test. Further, we have studied the buckling of ideal and dented beverage cans under axial loading by laboratory testing. We have modelled the laboratory tests and also the imperfection sensitivity of the two systems using finite element method and the predictions are in qualitative agreement with experimental data.

  14. 46 CFR 232.4 - Balance sheet accounts.

    2010-10-01

    ... 46 Shipping 8 2010-10-01 2010-10-01 false Balance sheet accounts. 232.4 Section 232.4 Shipping... ACTIVITIES UNIFORM FINANCIAL REPORTING REQUIREMENTS Balance Sheet § 232.4 Balance sheet accounts. (a.... (b) Purpose of balance sheet accounts. The balance sheet accounts are intended to disclose the...

  15. Case study: Khoramdareh County

    Vahid Riahi Riahi

    2016-10-01

    Full Text Available Environmental sustainability of rural settlements based on a systematic viewpoint may be defined as a realization of sustainable development in different social, economic and environmental aspects of rural areas. Achieving this goal requires that we pay more attention to effective elements and factors through a set of sustainability indices. This research was meant to analyze sustainable factors of rural settlement in three dimensions: environmental, social and economic context using multi-criteria decision analysis and explanation of the relationships between its active and effective factors in the rural area of the Khorramdarreh County in the province of Zanjan. The research method used is the descriptive analytic approach. Data from 287 households were sampled randomly from a total of 1143 households in the four villages including: Rahmat Abad, Alvand, Baghdareh and, Sukhariz (out of 15 villages in the Khorramdarreh County. In the process of doing this research and after calculating the weights, the difference in the sustainability of environmental, social, economic and physical aspects in rural areas of this county have been determined. Data was collected using library and field research through questionnaires. Data analysis was performed by the One-Sample t Test and the Vikur and path analysis techniques, using statistical software SPSS. The findings show that environmental sustainability in the study area is half desirable. Among the different aspects of environmental sustainability, the most effective factors are physical, economic, social and environmental aspects, respectively. Little attention of policy-making –system to socio-cultural and environmental aspects, especially in practice, and rapid and unplanned utilization of production resources are the most important factors affecting this situation in two given dimensions. Although, in programmed documents the planning system agents emphasize on the socio-cultural sustainability

  16. Fact Sheets on Pesticides in Schools.

    National Coalition against the Misuse of Pesticides, Washington, DC.

    This document consists of a collection of fact sheets about the use of pesticides in schools and how to reduce it. The sheets are: (1) "Alternatives to Using Pesticides in Schools: What Is Integrated Pest Management?"; (2) "Health Effects of 48 Commonly Used Pesticides in Schools"; (3) "The Schooling of State Pesticide…

  17. Balance velocities of the Greenland ice sheet

    Joughin, I.; Fahnestock, M.; Ekholm, Simon

    1997-01-01

    We present a map of balance velocities for the Greenland ice sheet. The resolution of the underlying DEM, which was derived primarily from radar altimetery data, yields far greater detail than earlier balance velocity estimates for Greenland. The velocity contours reveal in striking detail......, the balance map is useful for ice-sheet modelling, mass balance studies, and field planning....

  18. Advanced friction modeling for sheet metal forming

    Hol, J.; Cid Alfaro, M.V.; de Rooij, Matthias B.; Meinders, Vincent T.

    2012-01-01

    The Coulomb friction model is frequently used for sheet metal forming simulations. This model incorporates a constant coefficient of friction and does not take the influence of important parameters such as contact pressure or deformation of the sheet material into account. This article presents a

  19. Advanced friction modeling in sheet metal forming

    Hol, J.; Cid Alfaro, M.V.; Meinders, Vincent T.; Huetink, Han

    2011-01-01

    The Coulomb friction model is frequently used for sheet metal forming simulations. This model incorporates a constant coefficient of friction and does not take the influence of important parameters such as contact pressure or deformation of the sheet material into account. This article presents a

  20. Antibubbles and fine cylindrical sheets of air

    Beilharz, D.; Guyon, A.; Li, E.Q.; Thoraval, Marie-Jean; Thoroddsen, S.T.

    2015-01-01

    Drops impacting at low velocities onto a pool surface can stretch out thin hemispherical sheets of air between the drop and the pool. These air sheets can remain intact until they reach submicron thicknesses, at which point they rupture to form a myriad of microbubbles. By impacting a

  1. Molding cork sheets to complex shapes

    Sharpe, M. H.; Simpson, W. G.; Walker, H. M.

    1977-01-01

    Partially cured cork sheet is easily formed to complex shapes and then final-cured. Temperature and pressure levels required for process depend upon resin system used and final density and strength desired. Sheet can be bonded to surface during final cure, or can be first-formed in mold and bonded to surface in separate step.

  2. 2015 Resident Survey (City and County)

    City and County of Durham, North Carolina — The purpose of the annual City/County survey: To objectively assess citizen satisfaction with the delivery of City/County servicesTo set a baseline for future...

  3. Allegheny County Beltway System Street Centerlines

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Authoritative dataset of the beltway system in Allegheny County. The system was developed to help motorists navigate through Allegheny County on low-traffic roads....

  4. 2016 Resident Survey (City and County)

    City and County of Durham, North Carolina — The purpose of the annual City/County survey: To objectively assess citizen satisfaction with the delivery of City/County servicesTo set a baseline for future...

  5. Pressure balance between lobe and plasma sheet

    Baumjohann, W.; Paschmann, G.; Luehr, H.

    1990-01-01

    Using eight months of AMPTE/IRM plasma and magnetic field data, the authors have done a statistical survey on the balance of total (thermal and magnetic) pressure in the Earth's plasma sheet and tail lobe. About 300,000 measurements obtained in the plasma sheet and the lobe were compared for different levels of magnetic activity as well as different distances from the Earth. The data show that lobe and plasma sheet pressure balance very well. Even in the worst case they do not deviate by more than half of the variance in the data itself. Approximately constant total pressure was also seen during a quiet time pass when IRM traversed nearly the whole magnetotail in the vertical direction, from the southern hemisphere lobe through the neutral sheet and into the northern plasma sheet boundary layer

  6. 2006 Fulton County Georgia Lidar

    National Oceanic and Atmospheric Administration, Department of Commerce — The Light Detection and Ranging (LiDAR) LAS dataset is a survey of Fulton County. The Fulton County LiDAR Survey project area consists of approximately 690.5 square...

  7. Folded Sheet Versus Transparent Sheet Models for Human Symmetry Judgments

    Jacques Ninio

    2011-07-01

    Full Text Available As a contribution to the mysteries of human symmetry perception, reaction time data were collected on the detection of symmetry or repetition violations, in the context of short term visual memory studies. The histograms for reaction time distributions are rather narrow in the case of symmetry judgments. Their analysis was performed in terms of a simple kinetic model of a mental process in two steps, a slow one for the construction of the representation of the images to be compared, and a fast one, in the 50 ms range, for the decision. There was no need for an additional ‘mental rotation’ step. Symmetry seems to facilitate the construction step. I also present here original stimuli showing a color equalization effect across a symmetry axis, and its counterpart in periodic patterns. According to a “folded sheet model”, when a shape is perceived, the brain automatically constructs a mirror-image representation of the shape. Based in part on the reaction time analysis, I present here an alternative “transparent sheet” model in which the brain constructs a single representation, which can be accessed from two sides, thus generating simultaneously a pattern and its mirror-symmetric partner. Filtering processes, implied by current models of symmetry perception could intervene at an early stage, by nucleating the propagation of similar perceptual groupings in the two symmetric images.

  8. Tube sheet design for PFBR steam generator

    Chellapandi, P.; Chetal, S.C.; Bhoje, S.B.

    1991-01-01

    Top and bottom tube sheets of PFBR Steam Generators have been analysed with 3D and axisymmetric models using CASTEM Programs. Analysis indicates that the effects of piping reactions at the inlet/outlet nozzles on the primary stresses in the tube sheets are negligible and the asymmetricity of the deformation pattern introduced in the tube sheet by the presence of inlet/outlet and manhole nozzles is insignificant. The minimum tube sheet thicknesses for evaporator and reheater are 135 mm and 75 mm respectively. Further analysis has indicated the minimum fillet radius at the junction of tube sheet and dished end should be 20 mm. Simplified methodology has been developed to arrive at the number of thermal baffles required to protect the tube sheet against fatigue damage due to thermal transient. This method has been applied to PFBR steam generators to determine the required number of thermal baffles. For protecting the bottom tube sheet of evaporator against the thermal shock due to feed water and secondary pump trip, one thermal shield is found to be sufficient. Further analysis is required to decide upon the actual number to take care of the severe thermal transient, following the event of sudden dumping of water/steam, immediately after the sodium-water reaction. (author)

  9. Thermomechanical processing of plasma sprayed intermetallic sheets

    Hajaligol, Mohammad R.; Scorey, Clive; Sikka, Vinod K.; Deevi, Seetharama C.; Fleischhauer, Grier; Lilly, Jr., A. Clifton; German, Randall M.

    2001-01-01

    A powder metallurgical process of preparing a sheet from a powder having an intermetallic alloy composition such as an iron, nickel or titanium aluminide. The sheet can be manufactured into electrical resistance heating elements having improved room temperature ductility, electrical resistivity, cyclic fatigue resistance, high temperature oxidation resistance, low and high temperature strength, and/or resistance to high temperature sagging. The iron aluminide has an entirely ferritic microstructure which is free of austenite and can include, in weight %, 4 to 32% Al, and optional additions such as .ltoreq.1% Cr, .gtoreq.0.05% Zr .ltoreq.2% Ti, .ltoreq.2% Mo, .ltoreq.1% Ni, .ltoreq.0.75% C, .ltoreq.0.1% B, .ltoreq.1% submicron oxide particles and/or electrically insulating or electrically conductive covalent ceramic particles, .ltoreq.1% rare earth metal, and/or .ltoreq.3% Cu. The process includes forming a non-densified metal sheet by consolidating a powder having an intermetallic alloy composition such as by roll compaction, tape casting or plasma spraying, forming a cold rolled sheet by cold rolling the non-densified metal sheet so as to increase the density and reduce the thickness thereof and annealing the cold rolled sheet. The powder can be a water, polymer or gas atomized powder which is subjecting to sieving and/or blending with a binder prior to the consolidation step. After the consolidation step, the sheet can be partially sintered. The cold rolling and/or annealing steps can be repeated to achieve the desired sheet thickness and properties. The annealing can be carried out in a vacuum furnace with a vacuum or inert atmosphere. During final annealing, the cold rolled sheet recrystallizes to an average grain size of about 10 to 30 .mu.m. Final stress relief annealing can be carried out in the B2 phase temperature range.

  10. Plasma sheet behavior during substorms

    Hones, E.W. Jr.

    1983-01-01

    Auroral or magnetic substorms are periods of enhanced auroral and geomagnetic activity lasting one to a few hours that signify increased dissipation of energy from the magnetosphere to the earth. Data acquired during the past decade from satellites in the near-earth sector of the magnetotail have suggested that during a substorm part of the plasma sheet is severed from earth by magnetic reconnection, forming a plasmoid, i.e., a body of plasma and closed magnetic loops, that flows out of the tail into the solar wind, thus returning plasma and energy that have earlier been accumulated from the solar wind. Very recently this picture has been dramatically confirmed by observations, with the ISEE 3 spacecraft in the magnetotail 220 R/sub E/ from earth, of plasmoids passing that location in clear delayed response to substorms. It now appears that plasmoid release is a fundamental process whereby the magnetosphere gives up excess stored energy and plasma, much like comets are seen to do, and that the phenomena of the substorm seen at earth are a by-product of that fundamental process

  11. Radiation dominated relativistic current sheets

    Jaroschek, C.H.

    2008-01-01

    Relativistic Current Sheets (RCS) feature plasma instabilities considered as potential key to magnetic energy dissipation and non-thermal particle generation in Poynting flux dominated plasma flows. We show in a series of kinetic plasma simulations that the physical nature of non-linear RCS evolution changes in the presence of incoherent radiation losses: In the ultra-relativistic regime (i.e. magnetization parameter sigma = 104 defined as the ratio of magnetic to plasma rest frame energy density) the combination of non-linear RCS dynamics and synchrotron emission introduces a temperature anisotropy triggering the growth of the Relativistic Tearing Mode (RTM). As direct consequence the RTM prevails over the Relativistic Drift Kink (RDK) Mode as competitive RCS instability. This is in contrast to the previously studied situation of weakly relativistic RCS (sigma ∼ 1) where the RDK is dominant and most of the plasma is thermalized. The simulations witness the typical life cycle of ultra-relativistic RCS evolving from a violent radiation induced collapse towards a radiation quiescent state in rather classical Sweet-Parker topology. Such a transition towards Sweet-Parker configuration in the late non-linear evolution has immediate consequences for the efficiency of magnetic energy dissipation and non-thermal particle generation. Ceasing dissipation rates directly affect our present understanding of non-linear RCS evolution in conventional striped wind scenarios. (author)

  12. World-sheet gauge fields in superstrings

    Porrati, M.; Tomboulis, E.T.

    1989-01-01

    We investigate the introduction of world-sheet 2-dimensional gauge fields in a manner consistent with world-sheet supersymmetry. We obtain the effective string action resulting from the exact integration over the world-sheet gauge fields to show that it generally describes string models with spontaneous breaking of gauge symmetries with continuous breaking parameters. We examine the question of spacetime supersymmetry spontaneous breaking, and show that breaking with continuous, in particular arbitrarily small breaking parameters does not occur; only breaking for discrete values of parameters is possible. (orig.)

  13. Bifurcation of Jovian magnetotail current sheet

    P. L. Israelevich

    2006-07-01

    Full Text Available Multiple crossings of the magnetotail current sheet by a single spacecraft give the possibility to distinguish between two types of electric current density distribution: single-peaked (Harris type current layer and double-peaked (bifurcated current sheet. Magnetic field measurements in the Jovian magnetic tail by Voyager-2 reveal bifurcation of the tail current sheet. The electric current density possesses a minimum at the point of the Bx-component reversal and two maxima at the distance where the magnetic field strength reaches 50% of its value in the tail lobe.

  14. Bifurcation of Jovian magnetotail current sheet

    P. L. Israelevich

    2006-07-01

    Full Text Available Multiple crossings of the magnetotail current sheet by a single spacecraft give the possibility to distinguish between two types of electric current density distribution: single-peaked (Harris type current layer and double-peaked (bifurcated current sheet. Magnetic field measurements in the Jovian magnetic tail by Voyager-2 reveal bifurcation of the tail current sheet. The electric current density possesses a minimum at the point of the Bx-component reversal and two maxima at the distance where the magnetic field strength reaches 50% of its value in the tail lobe.

  15. Water quality of streams in Johnson County, Kansas, 2002-07

    Rasmussen, T.J.

    2009-01-01

    Water quality of streams in Johnson County, Kansas was evaluated from October 2002 through December 2007 in a cooperative study between the U.S. Geological Survey and the Johnson County Stormwater Management Program. Water quality at 42 stream sites, representing urban and rural basins, was characterized by evaluating benthic macroinvertebrates, water (discrete and continuous data), and/or streambed sediment. Point and nonpoint sources and transport were described for water-quality constituents including suspended sediment, dissolved solids and major ions, nutrients (nitrogen and phosphorus), indicator bacteria, pesticides, and organic wastewater and pharmaceutical compounds. The information obtained from this study is being used by city and county officials to develop effective management plans for protecting and improving stream quality. This fact sheet summarizes important results from three comprehensive reports published as part of the study and available on the World Wide Web at http://ks.water.usgs.gov/Kansas/studies/qw/joco/. ?? 2009 ASCE.

  16. fibrin–chitosan–sodium alginate composite sheet

    sodium alginate composite (F–C–SA) in sheet form. F–C–SA composite was prepared and characterized for its physicochemical properties like water absorption capacity, surface morphology, FTIR spectra and mechanical properties.

  17. Single clay sheets inside electrospun polymer nanofibers

    Sun, Zhaohui

    2005-03-01

    Nanofibers were prepared from polymer solution with clay sheets by electrospinning. Plasma etching, as a well controlled process, was used to supply electrically excited gas molecules from a glow discharge. To reveal the structure and arrangement of clay layers in the polymer matrix, plasma etching was used to remove the polymer by controlled gasification to expose the clay sheets due to the difference in reactivity. The shape, flexibility, and orientation of clay sheets were studied by transmission and scanning electron microscopy. Additional quantitative information on size distribution and degree of exfoliation of clay sheets were obtained by analyzing electron micrograph of sample after plasma etching. Samples in various forms including fiber, film and bulk, were thinned by plasma etching. Morphology and dispersion of inorganic fillers were studied by electron microscopy.

  18. HIV/AIDS Clinical Trials Fact Sheet

    ... AIDS Drugs Clinical Trials Apps skip to content HIV Overview Home Understanding HIV/AIDS Fact Sheets HIV/ ... 4 p.m. ET) Send us an email HIV/AIDS Clinical Trials Last Reviewed: August 25, 2017 ...

  19. Advancing Concentrating Solar Power Research (Fact Sheet)

    None, None

    2014-02-01

    Researchers at the National Renewable Energy Laboratory (NREL) provide scientific, engineering, and analytical expertise to help advance innovation in concentrating solar power (CSP). This fact sheet summarizes how NREL is advancing CSP research.

  20. Greenland Radar Ice Sheet Thickness Measurements

    National Aeronautics and Space Administration — Two 150-MHz coherent radar depth sounders were developed and flown over the Greenland ice sheet to obtain ice thickness measurements in support of PARCA...

  1. Nanotechnology for Site Remediation: Fact Sheet

    This fact sheet presents a snapshot of nanotechnology and its current uses in remediation. It presents information to help site project managers understand the potential applications of this group of technologies at their sites.

  2. Hydrologic Outlets of the Greenland Ice Sheet

    National Aeronautics and Space Administration — The Hydrologic Outlets of the Greenland Ice Sheet data set contains GIS point shapefiles that include 891 observed and potential hydrologic outlets of the Greenland...

  3. Fact sheet: Ethanol from corn

    NONE

    1999-05-31

    This fact sheet is intended to provide an overview of the advantages of ethanol from corn, emphasizing ethanol`s contribution to environmental protection and sustainable agriculture. Ethanol, an alternative fuel used as an octane enhancer is produced through the conversion of starch to sugars by enzymes, and fermentation of these sugars to ethanol by yeast. The production process may involve wet milling or dry milling. Both these processes produce valuable by-products, in addition to ethanol and carbon dioxide. Ethanol contains about 32,000 BTU per litre. It is commonly believed that using state-of-the-art corn farming and corn processing processes, the amount of energy contained in ethanol and its by-products would be more than twice the energy required to grow and process corn into ethanol. Ethanol represents the third largest market for Ontario corn, after direct use as animal feed and wet milling for starch, corn sweetener and corn oil. The environmental consequences of using ethanol are very significant. It is estimated that a 10 per cent ethanol blend in gasoline would result in a 25 to 30 per cent decrease in carbon monoxide emissions, a 6 to 10 per cent decrease in net carbon dioxide, a slight increase in nitrous oxide emissions which, however, would still result in an overall decrease in ozone formation, since the significant reduction in carbon monoxide emissions would compensate for any slight increase in nitrous oxide. Volatile organic compounds emission would also decrease by about 7 per cent with a 10 per cent ethanol blend. High level blends could reduce VOCs production by as much as 30 per cent. 7 refs.

  4. Energized Oxygen : Speiser Current Sheet Bifurcation

    George, D. E.; Jahn, J. M.

    2017-12-01

    A single population of energized Oxygen (O+) is shown to produce a cross-tail bifurcated current sheet in 2.5D PIC simulations of the magnetotail without the influence of magnetic reconnection. Treatment of oxygen in simulations of space plasmas, specifically a magnetotail current sheet, has been limited to thermal energies despite observations of and mechanisms which explain energized ions. We performed simulations of a homogeneous oxygen background, that has been energized in a physically appropriate manner, to study the behavior of current sheets and magnetic reconnection, specifically their bifurcation. This work uses a 2.5D explicit Particle-In-a-Cell (PIC) code to investigate the dynamics of energized heavy ions as they stream Dawn-to-Dusk in the magnetotail current sheet. We present a simulation study dealing with the response of a current sheet system to energized oxygen ions. We establish a, well known and studied, 2-species GEM Challenge Harris current sheet as a starting point. This system is known to eventually evolve and produce magnetic reconnection upon thinning of the current sheet. We added a uniform distribution of thermal O+ to the background. This 3-species system is also known to eventually evolve and produce magnetic reconnection. We add one additional variable to the system by providing an initial duskward velocity to energize the O+. We also traced individual particle motion within the PIC simulation. Three main results are shown. First, energized dawn- dusk streaming ions are clearly seen to exhibit sustained Speiser motion. Second, a single population of heavy ions clearly produces a stable bifurcated current sheet. Third, magnetic reconnection is not required to produce the bifurcated current sheet. Finally a bifurcated current sheet is compatible with the Harris current sheet model. This work is the first step in a series of investigations aimed at studying the effects of energized heavy ions on magnetic reconnection. This work differs

  5. Peripheral Blood Cells from Patients with Autoimmune Addison's Disease Poorly Respond to Interferons In Vitro, Despite Elevated Serum Levels of Interferon-Inducible Chemokines.

    Edvardsen, Kine; Bjånesøy, Trine; Hellesen, Alexander; Breivik, Lars; Bakke, Marit; Husebye, Eystein S; Bratland, Eirik

    2015-10-01

    Autoimmune Addison's disease (AAD) is a disorder caused by an immunological attack on the adrenal cortex. The interferon (IFN)-inducible chemokine CXCL10 is elevated in serum of AAD patients, suggesting a peripheral IFN signature. However, CXCL10 can also be induced in adrenocortical cells stimulated with IFNs, cytokines, or microbial components. We therefore investigated whether peripheral blood mononuclear cells (PBMCs) from AAD patients display an enhanced propensity to produce CXCL10 and the related chemokine CXCL9, after stimulation with type I or II IFNs or the IFN inducer poly (I:C). Although serum levels of CXCL10 and CXCL9 were significantly elevated in patients compared with controls, IFN stimulated patient PBMC produced significantly less CXCL10/CXCL9 than control PBMC. Low CXCL10 production was not significantly associated with medication, disease duration, or comorbidities, but the low production of poly (I:C)-induced CXCL10 among patients was associated with an AAD risk allele in the phosphatase nonreceptor type 22 (PTPN22) gene. PBMC levels of total STAT1 and -2, and IFN-induced phosphorylated STAT1 and -2, were not significantly different between patients and controls. We conclude that PBMC from patients with AAD are deficient in their response to IFNs, and that the adrenal cortex itself may be responsible for the increased serum levels of CXCL10.

  6. Peripheral Blood Cells from Patients with Autoimmune Addison's Disease Poorly Respond to Interferons In Vitro, Despite Elevated Serum Levels of Interferon-Inducible Chemokines

    Bjånesøy, Trine; Hellesen, Alexander; Breivik, Lars; Bakke, Marit; Husebye, Eystein S.; Bratland, Eirik

    2015-01-01

    Autoimmune Addison's disease (AAD) is a disorder caused by an immunological attack on the adrenal cortex. The interferon (IFN)-inducible chemokine CXCL10 is elevated in serum of AAD patients, suggesting a peripheral IFN signature. However, CXCL10 can also be induced in adrenocortical cells stimulated with IFNs, cytokines, or microbial components. We therefore investigated whether peripheral blood mononuclear cells (PBMCs) from AAD patients display an enhanced propensity to produce CXCL10 and the related chemokine CXCL9, after stimulation with type I or II IFNs or the IFN inducer poly (I:C). Although serum levels of CXCL10 and CXCL9 were significantly elevated in patients compared with controls, IFN stimulated patient PBMC produced significantly less CXCL10/CXCL9 than control PBMC. Low CXCL10 production was not significantly associated with medication, disease duration, or comorbidities, but the low production of poly (I:C)-induced CXCL10 among patients was associated with an AAD risk allele in the phosphatase nonreceptor type 22 (PTPN22) gene. PBMC levels of total STAT1 and -2, and IFN-induced phosphorylated STAT1 and -2, were not significantly different between patients and controls. We conclude that PBMC from patients with AAD are deficient in their response to IFNs, and that the adrenal cortex itself may be responsible for the increased serum levels of CXCL10. PMID:25978633

  7. Copper contamination in thin stainless steel sheet

    Holbert, R.K. Jr.; Dobbins, A.G.; Bennett, R.K. Jr.

    1986-01-01

    The standard welding technique used at Oak Ridge Y-12 Plant for joining thin stainless sheet is the gas tungsten arc (GTA) welding process. One of the reoccurring problems with the sheet welds is surface cracking in the heat-affected zone (HAZ). Metallography shows that the cracks are only about 0.05 mm (0.002 in.) deep which is significant in a 0.25 mm (0.01 in.) thick sheet. Thus, welding requirements do not permit any surfacing cracking as detected by a fluorescent dye penetrant test conducted on every part after welding. Surface cracks have been found in both of the two most common weld designs in the thin sheet fabricated at the Oak Ridge Y-12 Plant. These butt joints are welded between two 0.25 mm thick stainless steel sheets and a tube with eyelet welded to a 25 mm (0.98 in.) thick sheet. The weld between the two sheets is made on a semiautomatic seam welding unit, whereas the tube-to-eyelet-to-sheet welds are done manually. The quality of both welds is very dependent on the welding procedure and the way the parts are placed in the weld fixturing. Metallographic examination has indicated that some welded parts with surface cracking in the weld region had copper particles on the surface, and the question of copper contamination has been raised. With the aid of a scanning electron microscope and an electron microprobe, the existence of copper in an around the surface cracks has been verified. The copper is on the surface of the parts prior to welding in the form of small dust particles

  8. Balance of the West Antarctic Ice Sheet

    2002-01-01

    For several decades, measurements of the West Antarctic Ice Sheet showed it to be retreating rapidly. But new data derived from satellite-borne radar sensors show the ice sheet to be growing. Changing Antarctic ice sheets remains an area of high scientific interest, particularly in light of recent global warming concerns. These new findings are significant because scientists estimate that sea level would rise 5-6 meters (16-20 feet) if the ice sheet collapsed into the sea. Do these new measurements signal the end of the ice sheet's 10,000-year retreat? Or, are these new satellite data simply much more accurate than the sparse ice core and surface measurements that produced the previous estimates? Another possibility is that the ice accumulation may simply indicate that the ice sheet naturally expands and retreats in regular cycles. Cryologists will grapple with these questions, and many others, as they examine the new data. The image above depicts the region of West Antarctica where scientists measured ice speed. The fast-moving central ice streams are shown in red. Slower tributaries feeding the ice streams are shown in blue. Green areas depict slow-moving, stable areas. Thick black lines depict the areas that collect snowfall to feed their respective ice streams. Reference: Ian Joughin and Slawek Tulaczyk Science Jan 18 2002: 476-480. Image courtesy RADARSAT Antarctic Mapping Project

  9. Antibubbles and fine cylindrical sheets of air

    Beilharz, D.

    2015-08-14

    Drops impacting at low velocities onto a pool surface can stretch out thin hemispherical sheets of air between the drop and the pool. These air sheets can remain intact until they reach submicron thicknesses, at which point they rupture to form a myriad of microbubbles. By impacting a higher-viscosity drop onto a lower-viscosity pool, we have explored new geometries of such air films. In this way we are able to maintain stable air layers which can wrap around the entire drop to form repeatable antibubbles, i.e. spherical air layers bounded by inner and outer liquid masses. Furthermore, for the most viscous drops they enter the pool trailing a viscous thread reaching all the way to the pinch-off nozzle. The air sheet can also wrap around this thread and remain stable over an extended period of time to form a cylindrical air sheet. We study the parameter regime where these structures appear and their subsequent breakup. The stability of these thin cylindrical air sheets is inconsistent with inviscid stability theory, suggesting stabilization by lubrication forces within the submicron air layer. We use interferometry to measure the air-layer thickness versus depth along the cylindrical air sheet and around the drop. The air film is thickest above the equator of the drop, but thinner below the drop and up along the air cylinder. Based on microbubble volumes, the thickness of the cylindrical air layer becomes less than 100 nm before it ruptures.

  10. Buckling Behavior of Substrate Supported Graphene Sheets

    Kuijian Yang

    2016-01-01

    Full Text Available The buckling of graphene sheets on substrates can significantly degrade their performance in materials and devices. Therefore, a systematic investigation on the buckling behavior of monolayer graphene sheet/substrate systems is carried out in this paper by both molecular mechanics simulations and theoretical analysis. From 70 simulation cases of simple-supported graphene sheets with different sizes under uniaxial compression, two different buckling modes are investigated and revealed to be dominated by the graphene size. Especially, for graphene sheets with length larger than 3 nm and width larger than 1.1 nm, the buckling mode depends only on the length/width ratio. Besides, it is revealed that the existence of graphene substrate can increase the critical buckling stress and strain to 4.39 N/m and 1.58%, respectively, which are about 10 times those for free-standing graphene sheets. Moreover, for graphene sheets with common size (longer than 20 nm, both theoretical and simulation results show that the critical buckling stress and strain are dominated only by the adhesive interactions with substrate and independent of the graphene size. Results in this work provide valuable insight and guidelines for the design and application of graphene-derived materials and nano-electromechanical systems.

  11. Antibubbles and fine cylindrical sheets of air

    Beilharz, D.; Guyon, A.; Li, E.  Q.; Thoraval, M.-J.; Thoroddsen, Sigurdur T

    2015-01-01

    Drops impacting at low velocities onto a pool surface can stretch out thin hemispherical sheets of air between the drop and the pool. These air sheets can remain intact until they reach submicron thicknesses, at which point they rupture to form a myriad of microbubbles. By impacting a higher-viscosity drop onto a lower-viscosity pool, we have explored new geometries of such air films. In this way we are able to maintain stable air layers which can wrap around the entire drop to form repeatable antibubbles, i.e. spherical air layers bounded by inner and outer liquid masses. Furthermore, for the most viscous drops they enter the pool trailing a viscous thread reaching all the way to the pinch-off nozzle. The air sheet can also wrap around this thread and remain stable over an extended period of time to form a cylindrical air sheet. We study the parameter regime where these structures appear and their subsequent breakup. The stability of these thin cylindrical air sheets is inconsistent with inviscid stability theory, suggesting stabilization by lubrication forces within the submicron air layer. We use interferometry to measure the air-layer thickness versus depth along the cylindrical air sheet and around the drop. The air film is thickest above the equator of the drop, but thinner below the drop and up along the air cylinder. Based on microbubble volumes, the thickness of the cylindrical air layer becomes less than 100 nm before it ruptures.

  12. 2009 SCDRN Lidar: Florence County

    National Oceanic and Atmospheric Administration, Department of Commerce — The South Carolina Department of Natural Resources (SCDNR) contracted with Sanborn to provide LiDAR mapping services for Florence County, SC. Utilizing multi-return...

  13. Allegheny County Soil Type Areas

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This dataset contains soil type and soil classification, by area. Additional info at: http://mcdc.cas.psu.edu/datawiz.htm;...

  14. Allegheny County Property Assessment Appeals

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Lists property assessment appeals filed and heard with the Board of Property Assessment Appeals and Review (BPAAR) and the hearing results, for tax years 2015 to...

  15. Allegheny County Basin Outlines Map

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This basins dataset was created to initiate regional watershed approaches with respect to sewer rehabilitation. If viewing this description on the Western...

  16. 2009 SCDNR Charleston County Lidar

    National Oceanic and Atmospheric Administration, Department of Commerce — Photoscience completed the original collection and classification of the multiple return LiDAR of Charleston County, South Carolina in the winter of 2006-2007. In...

  17. Allegheny County Certified MWDBE Businesses

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — According to the Federal Department of Transportation, Disadvantaged Business Enterprises (DBE) are for-profit small business concerns where socially and...

  18. County Boundaries with Shorelines (National)

    Department of Transportation — County boundaries with shorelines cut in (NTAD). The TIGER/Line Files are shapefiles and related database files (.dbf) that are an extract of selected geographic and...

  19. Allegheny County Land Cover Areas

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — The Land Cover dataset demarcates 14 land cover types by area; such as Residential, Commercial, Industrial, Forest, Agriculture, etc. If viewing this description on...

  20. 2009 Chatham County Georgia Lidar

    National Oceanic and Atmospheric Administration, Department of Commerce — LiDAR generated point cloud acquired in spring 2009 for Chatham County, Georgia for the Metropolitan Planning Commission. The data are classified as follows: Class 1...

  1. 2014 Mobile County, AL Lidar

    National Oceanic and Atmospheric Administration, Department of Commerce — Atlantic was contracted to acquire high resolution topographic LiDAR (Light Detection and Ranging) data located in Mobile County, Alabama. The intent was to collect...

  2. Uninsured Young Adults by County

    U.S. Department of Health & Human Services — This data file indicates the estimated number of uninsured individuals ages 19-25 in each U.S. county. These individuals may be eligible to join their parents health...

  3. Allegheny County Toxics Release Inventory

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — The Toxics Release Inventory (TRI) data provides information about toxic substances released into the environment or managed through recycling, energy recovery, and...

  4. Allegheny County Building Footprint Locations

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This dataset contains photogrammetrically compiled roof outlines of buildings. All near orthogonal corners are square. Buildings that are less than 400 square feet...

  5. County business patterns, 1996 : Nevada

    1998-11-01

    County Business Patterns is an annual series that : provides subnational economic data by industry. The series : is useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  6. County business patterns, 1997 : Wisconsin

    1999-09-01

    County Business Patterns is an annual series that provides : subnational economic data by industry. The series is : useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  7. County business patterns, 1997 : Arizona

    1999-09-01

    County Business Patterns is an annual series that provides : subnational economic data by industry. The series is : useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  8. County business patterns, 1997 : Wyoming

    1999-09-01

    County Business Patterns is an annual series that provides : subnational economic data by industry. The series is : useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  9. County business patterns, 1997 : Minnesota

    1999-09-01

    County Business Patterns is an annual series that provides : subnational economic data by industry. The series is : useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  10. County business patterns, 1996 : Colorado

    1998-11-01

    County Business Patterns is an annual series that : provides subnational economic data by industry. The series : is useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  11. County business patterns, 1996 : Montana

    1998-11-01

    County Business Patterns is an annual series that : provides subnational economic data by industry. The series : is useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  12. County business patterns, 1996 : Nebraska

    1998-11-01

    County Business Patterns is an annual series that : provides subnational economic data by industry. The series : is useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  13. County business patterns, 1996 : Kentucky

    1998-11-01

    County Business Patterns is an annual series that : provides subnational economic data by industry. The series : is useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  14. County business patterns, 1996 : Idaho

    1998-11-01

    County Business Patterns is an annual series that : provides subnational economic data by industry. The series : is useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  15. County business patterns, 1997 : Alabama

    1999-09-01

    County Business Patterns is an annual series that provides : subnational economic data by industry. The series is : useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  16. County business patterns, 1997 : Maryland

    1999-09-01

    County Business Patterns is an annual series that provides : subnational economic data by industry. The series is : useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  17. County business patterns, 1997 : Maine

    1999-09-01

    County Business Patterns is an annual series that provides : subnational economic data by industry. The series is : useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  18. County business patterns, 1996 : Utah

    1998-11-01

    County Business Patterns is an annual series that : provides subnational economic data by industry. The series : is useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  19. County business patterns, 1996 : Oklahoma

    1998-11-01

    County Business Patterns is an annual series that : provides subnational economic data by industry. The series : is useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  20. County business patterns, 1996 : Alaska

    1998-11-01

    County Business Patterns is an annual series that : provides subnational economic data by industry. The series : is useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  1. County business patterns, 1997 : Kansas

    1999-09-01

    County Business Patterns is an annual series that provides : subnational economic data by industry. The series is : useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  2. County business patterns, 1997 : Florida

    1999-09-01

    County Business Patterns is an annual series that provides : subnational economic data by industry. The series is : useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  3. County business patterns, 1997 : Oklahoma

    1999-09-01

    County Business Patterns is an annual series that provides : subnational economic data by industry. The series is : useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  4. County business patterns, 1997 : Michigan

    1999-09-01

    County Business Patterns is an annual series that provides : subnational economic data by industry. The series is : useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  5. County business patterns, 1997 : Tennessee

    1999-09-01

    County Business Patterns is an annual series that provides : subnational economic data by industry. The series is : useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  6. County business patterns, 1997 : Kentucky

    1999-09-01

    County Business Patterns is an annual series that provides : subnational economic data by industry. The series is : useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  7. County business patterns, 1996 : Louisiana

    1998-11-01

    County Business Patterns is an annual series that : provides subnational economic data by industry. The series : is useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  8. County business patterns, 1997 : Texas

    1999-09-01

    County Business Patterns is an annual series that provides : subnational economic data by industry. The series is : useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  9. County business patterns, 1997 : Virginia

    1999-09-01

    County Business Patterns is an annual series that provides : subnational economic data by industry. The series is : useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  10. County business patterns, 1996 : Delaware

    1998-11-01

    County Business Patterns is an annual series that : provides subnational economic data by industry. The series : is useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  11. County business patterns, 1997 : Idaho

    1999-09-01

    County Business Patterns is an annual series that provides : subnational economic data by industry. The series is : useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  12. County business patterns, 1997 : Nevada

    1999-09-01

    County Business Patterns is an annual series that provides : subnational economic data by industry. The series is : useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  13. County business patterns, 1996 : Wisconsin

    1998-11-01

    County Business Patterns is an annual series that : provides subnational economic data by industry. The series : is useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  14. County business patterns, 1996 : Arkansas

    1998-11-01

    County Business Patterns is an annual series that : provides subnational economic data by industry. The series : is useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  15. County business patterns, 1996 : Florida

    1998-11-01

    County Business Patterns is an annual series that : provides subnational economic data by industry. The series : is useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  16. County business patterns, 1997 : Mississippi

    1999-09-01

    County Business Patterns is an annual series that provides : subnational economic data by industry. The series is : useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  17. County business patterns, 1996 : Missouri

    1998-11-01

    County Business Patterns is an annual series that : provides subnational economic data by industry. The series : is useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  18. County business patterns, 1996 : Maryland

    1998-11-01

    County Business Patterns is an annual series that : provides subnational economic data by industry. The series : is useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  19. County business patterns, 1997 : Hawaii

    1999-09-01

    County Business Patterns is an annual series that provides : subnational economic data by industry. The series is : useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  20. County business patterns, 1996 : Ohio

    1998-11-01

    County Business Patterns is an annual series that : provides subnational economic data by industry. The series : is useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  1. County business patterns, 1996 : Alabama

    1998-11-01

    County Business Patterns is an annual series that : provides subnational economic data by industry. The series : is useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  2. County business patterns, 1997 : Alaska

    1999-09-01

    County Business Patterns is an annual series that provides : subnational economic data by industry. The series is : useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  3. County business patterns, 1996 : Iowa

    1998-11-01

    County Business Patterns is an annual series that : provides subnational economic data by industry. The series : is useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  4. County business patterns, 1996 : Georgia

    1998-11-01

    County Business Patterns is an annual series that : provides subnational economic data by industry. The series : is useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  5. County business patterns, 1996 : Michigan

    1998-11-01

    County Business Patterns is an annual series that : provides subnational economic data by industry. The series : is useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  6. County business patterns, 1996 : Texas

    1998-11-01

    County Business Patterns is an annual series that : provides subnational economic data by industry. The series : is useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  7. County business patterns, 1997 : Nebraska

    1999-09-01

    County Business Patterns is an annual series that provides : subnational economic data by industry. The series is : useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  8. County business patterns, 1997 : Massachusetts

    1999-09-01

    County Business Patterns is an annual series that provides : subnational economic data by industry. The series is : useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  9. County business patterns, 1997 : Indiana

    1999-09-01

    County Business Patterns is an annual series that provides : subnational economic data by industry. The series is : useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  10. County business patterns, 1996 : Pennsylvania

    1998-11-01

    County Business Patterns is an annual series that : provides subnational economic data by industry. The series : is useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  11. County business patterns, 1997 : Arkansas

    1999-09-01

    County Business Patterns is an annual series that provides : subnational economic data by industry. The series is : useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  12. County business patterns, 1997 : Colorado

    1999-09-01

    County Business Patterns is an annual series that provides : subnational economic data by industry. The series is : useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  13. County business patterns, 1996 : Arizona

    1998-11-01

    County Business Patterns is an annual series that : provides subnational economic data by industry. The series : is useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  14. County business patterns, 1997 : Oregon

    1999-09-01

    County Business Patterns is an annual series that provides : subnational economic data by industry. The series is : useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  15. County business patterns, 1997 : Georgia

    1999-09-01

    County Business Patterns is an annual series that provides : subnational economic data by industry. The series is : useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  16. County business patterns, 1997 : Missouri

    1999-09-01

    County Business Patterns is an annual series that provides : subnational economic data by industry. The series is : useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  17. County business patterns, 1997 : Illinois

    1999-09-01

    County Business Patterns is an annual series that provides : subnational economic data by industry. The series is : useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  18. County business patterns, 1997 : Utah

    1999-09-01

    County Business Patterns is an annual series that provides : subnational economic data by industry. The series is : useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  19. County business patterns, 1996 : Kansas

    1998-11-01

    County Business Patterns is an annual series that : provides subnational economic data by industry. The series : is useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  20. County business patterns, 1996 : Maine

    1998-11-01

    County Business Patterns is an annual series that : provides subnational economic data by industry. The series : is useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  1. County business patterns, 1997 : Pennsylvania

    1999-09-01

    County Business Patterns is an annual series that provides : subnational economic data by industry. The series is : useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  2. County business patterns, 1996 : Tennessee

    1998-11-01

    County Business Patterns is an annual series that : provides subnational economic data by industry. The series : is useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  3. County business patterns, 1997 : Ohio

    1999-09-01

    County Business Patterns is an annual series that provides : subnational economic data by industry. The series is : useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  4. County business patterns, 1996 : Vermont

    1998-11-01

    County Business Patterns is an annual series that : provides subnational economic data by industry. The series : is useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  5. County business patterns, 1996 : Wyoming

    1998-11-01

    County Business Patterns is an annual series that : provides subnational economic data by industry. The series : is useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  6. County business patterns, 1996 : Illinois

    1998-11-01

    County Business Patterns is an annual series that : provides subnational economic data by industry. The series : is useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  7. County business patterns, 1996 : Virginia

    1998-11-01

    County Business Patterns is an annual series that : provides subnational economic data by industry. The series : is useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  8. County business patterns, 1997 : Iowa

    1999-09-01

    County Business Patterns is an annual series that provides : subnational economic data by industry. The series is : useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  9. County business patterns, 1997 : Connecticut

    1999-09-01

    County Business Patterns is an annual series that provides : subnational economic data by industry. The series is : useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  10. County business patterns, 1996 : Hawaii

    1998-11-01

    County Business Patterns is an annual series that : provides subnational economic data by industry. The series : is useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  11. County business patterns, 1997 : Washington

    1999-09-01

    County Business Patterns is an annual series that provides : subnational economic data by industry. The series is : useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  12. County business patterns, 1997 : Vermont

    1999-09-01

    County Business Patterns is an annual series that provides : subnational economic data by industry. The series is : useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  13. County business patterns, 1996 : Oregon

    1998-11-01

    County Business Patterns is an annual series that : provides subnational economic data by industry. The series : is useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  14. County business patterns, 1996 : Minnesota

    1998-11-01

    County Business Patterns is an annual series that : provides subnational economic data by industry. The series : is useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  15. County business patterns, 1996 : California

    1998-11-01

    County Business Patterns is an annual series that : provides subnational economic data by industry. The series : is useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  16. County business patterns, 1996 : Indiana

    1998-11-01

    County Business Patterns is an annual series that : provides subnational economic data by industry. The series : is useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  17. County business patterns, 1997 : Delaware

    1999-09-01

    County Business Patterns is an annual series that provides : subnational economic data by industry. The series is : useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  18. County business patterns, 1997 : Montana

    1999-09-01

    County Business Patterns is an annual series that provides : subnational economic data by industry. The series is : useful for studying the economic activity of small areas; : analyzing economic changes over time; and as a benchmark : for statistical...

  19. Allegheny County WIC Vendor Locations

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This dataset contains the locations of Women, Infants, and Children (WIC) program vendors. If viewing this description on the Western Pennsylvania Regional Data...

  20. 2009 SCDNR Horry County Lidar

    National Oceanic and Atmospheric Administration, Department of Commerce — Sanborn Map Company completed the original classification of the multiple return LiDAR of Horry County, South Carolina in 2009. In 2013, Dewberry was tasked with...

  1. Soils - Volusia County Soils (Polygons)

    NSGIC Local Govt | GIS Inventory — Soils: 1:24000 SSURGO Map. Polygon boundaries of Soils in Volusia County, downloaded from SJRWMD and created by NRCS and SJRWMD. This data set is a digital version...

  2. Allegheny County Environmental Justice Areas

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Environmental Justice areas in this guide have been defined by the Pennsylvania Department of Environmental Protection. The Department defines an environmental...

  3. Allegheny County Illegal Dump Sites

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — The Illegal Dump Site dataset includes information on illegal dump sites, their type of trash, and the estimate tons of trash at each site. The information was...

  4. Allegheny County Wooded Area Boundaries

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This dataset demarcates stands of trees (coniferous and deciduous) too numerous to plot as individual trees. The area is delineated following a generalized line...

  5. 17 CFR 210.6-04 - Balance sheets.

    2010-04-01

    ... 17 Commodity and Securities Exchanges 2 2010-04-01 2010-04-01 false Balance sheets. 210.6-04... sheets. This rule is applicable to balance sheets filed by registered investment companies except for... of this part. Balance sheets filed under this rule shall comply with the following provisions: Assets...

  6. Best Manufacturing Practices. Report of Survey Conducted at Stafford County Public Schools, Stafford County, VA

    1994-01-01

    During the week of August 8, 1994, a Best Manufacturing Practices (BMP) survey was conducted at the Stafford County Public Schools located in Stafford County, Virginia, considered one of the fastest growing counties in the state...

  7. 2007 Lake County Board of County Commissioners Topographic LiDAR: Lake County, Florida

    National Oceanic and Atmospheric Administration, Department of Commerce — This metadata document describes the LiDAR point data in LAS format produced by Kucera covering the project area of Lake County, FL. The data produced is...

  8. Best Management Practice, Fact Sheet 2. Sheet Flow to Open Space

    Sample, David; Doumar, Lia

    2013-01-01

    This publication explains what sheet flow to open space is, where and how it is used, their limitations, routine and nonroutine maintenance, expected costs, and a glossary of terms. This fact sheet is one of a 15-part series on urban stormwater management practices.

  9. Bessel light sheet structured illumination microscopy

    Noshirvani Allahabadi, Golchehr

    Biomedical study researchers using animals to model disease and treatment need fast, deep, noninvasive, and inexpensive multi-channel imaging methods. Traditional fluorescence microscopy meets those criteria to an extent. Specifically, two-photon and confocal microscopy, the two most commonly used methods, are limited in penetration depth, cost, resolution, and field of view. In addition, two-photon microscopy has limited ability in multi-channel imaging. Light sheet microscopy, a fast developing 3D fluorescence imaging method, offers attractive advantages over traditional two-photon and confocal microscopy. Light sheet microscopy is much more applicable for in vivo 3D time-lapsed imaging, owing to its selective illumination of tissue layer, superior speed, low light exposure, high penetration depth, and low levels of photobleaching. However, standard light sheet microscopy using Gaussian beam excitation has two main disadvantages: 1) the field of view (FOV) of light sheet microscopy is limited by the depth of focus of the Gaussian beam. 2) Light-sheet images can be degraded by scattering, which limits the penetration of the excitation beam and blurs emission images in deep tissue layers. While two-sided sheet illumination, which doubles the field of view by illuminating the sample from opposite sides, offers a potential solution, the technique adds complexity and cost to the imaging system. We investigate a new technique to address these limitations: Bessel light sheet microscopy in combination with incoherent nonlinear Structured Illumination Microscopy (SIM). Results demonstrate that, at visible wavelengths, Bessel excitation penetrates up to 250 microns deep in the scattering media with single-side illumination. Bessel light sheet microscope achieves confocal level resolution at a lateral resolution of 0.3 micron and an axial resolution of 1 micron. Incoherent nonlinear SIM further reduces the diffused background in Bessel light sheet images, resulting in

  10. The transposition of the balance sheet to financial and functional balance sheet. Research and development

    Liana GĂDĂU

    2015-09-01

    Full Text Available As the title suggests, through this paper we want to highlight the necessity of treating again the content and the form of the balance sheet in order to adapt it to a more efficient analysis, this way surpassing the informational valences of the classic balance sheet. The functional and the financial balance sheet will be taken into account. These models of balance sheet permit the complex analyses regarding the solvability or the bankruptcy risk of an enterprise to take place, and also other analyses, like the analysis of the structure and the financial/ functional equilibrium, the analysis of the company on operating cycles and their role in the functioning of the company. Through the particularities offered by each of these two models of balance sheet, we want to present the advantages of a superior informing. This content of this material is based on a vast investigation of the specialized literature.

  11. Flapping dynamics of a thin liquid sheet

    Vadivukkarasan, M.; Kumaran, Dhivyaraja; Panchagnula, Mahesh; Multi-phase flow physics Group Team

    2017-11-01

    We attempt to delineate and describe the complete evolution of a thin soap film when air is blown through a nozzle in the normal direction. The sequence of events and its intrinsic dynamics are captured using high speed imaging. By careful observation, it was observed that multiple mechanisms occur in the same system and each event is triggered by an independent mechanism. The events include (a) flapping of a liquid sheet and pinching of the bubble, (b) onset of rupture on the liquid sheet, (c) formation of ligaments and (d) ejection of drops. From this study, it is shown that these events are predominantly governed by Kelvin-Helmholtz instability, Taylor - Culick law, Rayleigh-Taylor instability and capillary instability, respectively. The present experiments can be considered as an extension to the previous studies on soap films as well as thin flapping sheets which has direct relevance to coaxial atomizers used in aircraft applications.

  12. Symmetry breaking bifurcations of a current sheet

    Parker, R.D.; Dewar, R.L.; Johnson, J.L.

    1990-01-01

    Using a time evolution code with periodic boundary conditions, the viscoresistive hydromagnetic equations describing an initially static, planar current sheet with large Lundquist number have been evolved for times long enough to reach a steady state. A cosh 2 x resistivity model was used. For long periodicity lengths L p , the resistivity gradient drives flows that cause forced reconnection at X point current sheets. Using L p as a bifurcation parameter, two new symmetry breaking bifurcations were found: a transition to an asymmetric island chain with nonzero, positive, or negative phase velocity, and a transition to a static state with alternating large and small islands. These states are reached after a complex transient behavior, which involves a competition between secondary current sheet instability and coalescence

  13. Evolution of the MHD sheet pinch

    Matthaeus, W.H.; Montgomery, D.

    1979-01-01

    A magnetohydrodynamic (MHD) problem of recurrent interest for both astrophysical and laboratory plasmas is the evolution of the unstable sheet pinch, a current sheet across which a dc magnetic field reverses sign. The evolution of such a sheet pinch is followed with a spectral-method, incompressible, two-dimensional, MHD turbulence code. Spectral diagnostics are employed, as are contour plots of vector potential (magnetic field lines), electric current density, and velocity stream function (velocity streamlines). The nonlinear effect which seems most important is seen to be current filamentation: the concentration of the current density onto sets of small measure near a mgnetic X point. A great deal of turbulence is apparent in the current distribution, which, for high Reynolds numbers, requires large spatial grids (greater than or equal to (64) 2 ). 11 figures, 1 table

  14. Dipole-sheet multipole magnets for accelerators

    Walstrom, P.L.

    1993-01-01

    The dipole-sheet formalism can be used to describe both cylindrical current-sheet multipole magnets and cylindrical-bore magnets made up of permanent magnet blocks. For current sheets, the formalism provides a natural way of finding a finite set of turns that approximate a continuous distribution. The formalism is especially useful In accelerator applications where large-bore, short, high-field-quality magnets that are dominated by fringe fields are needed. A further advantage of the approach is that in systems with either open or cylindrically symmetric magnetic boundaries, analytical expressions for the three-dimensional fields that are suitable for rapid numerical evaluation can be derived. This development is described in some detail. Also, recent developments in higher-order particle-beam optics codes based on the formalism are described briefly

  15. Symmetry breaking bifurcations of a current sheet

    Parker, R.D.; Dewar, R.L.; Johnson, J.L.

    1988-08-01

    Using a time evolution code with periodic boundary conditions, the viscoresistive hydromagnetic equations describing an initially static, planar current sheet with large Lundquist number have been evolved for times long enough to reach a steady state. A cosh 2 x resistivity model was used. For long periodicity lengths, L p , the resistivity gradient drives flows which cause forced reconnection at X point current sheets. Using L p as a bifurcation parameter, two new symmetry breaking bifurcations were found - a transition to an asymmetric island chain with nonzero, positive or negative phase velocity, and a transition to a static state with alternating large and small islands. These states are reached after a complex transient behavior which involves a competition between secondary current sheet instability and coalescence. 31 refs., 6 figs

  16. Continuous liquid sheet generator for ion stripping

    Gavin, B.; Batson, P.; Leemann, B.; Rude, B.

    1984-10-01

    Many of the technical problems of generating a large thin liquid sheet from 0.02 to 0.20 μm thick (3 to 40 μgm/cm 2 ) have been solved. It is shown that this perennial sheet is stable and consonant in dimension. Several ion beam species from the SuperHILAC have been used for evaluation; at 0.11 MeV/n. In one of three modes this sheet serves as an equivalent substitute for a carbon foil. The second mode is characterized by a solid-like charge state distribution but with a varying fraction of unstripped ions. The third mode gives stripping performance akin to a vapor stripping medium. 9 references, 7 figures

  17. Improvement of anthropometric and metabolic parameters, and quality of life following treatment with dual-release hydrocortisone in patients with Addison's disease.

    Giordano, Roberta; Guaraldi, Federica; Marinazzo, Elisa; Fumarola, Federica; Rampino, Alessia; Berardelli, Rita; Karamouzis, Ioannis; Lucchiari, Manuela; Manetta, Tilde; Mengozzi, Giulio; Arvat, Emanuela; Ghigo, Ezio

    2016-02-01

    In patients with Addison's disease (AD), a dual-release preparation of hydrocortisone (Plenadren, PLEN) has been demonstrated to maintain cortisol levels in a more physiological range than conventional glucocorticoid therapy, and to exert positive effects. This study aimed to assess variations of anthropometric, metabolic, and hormonal parameters in patients with AD after switching from conventional hydrocortisone (HC) treatment to PLEN. In nineteen AD patients (15 F and 4 M, age 27-65 years) treated with HC 20 mg/day thrice daily, body weight, BMI, waist circumference, fasting glucose, HbA1c, serum lipids, plasma renin activity, electrolytes, and blood pressure were evaluated at baseline, and 1, 3, 6, and 12 months after switching from HC to PLEN. At baseline, and after 1 and 12 months of PLEN, blood ACTH and cortisol (at 0800 h at fasting, and 30, 60, 90, 120, and 240 min after drug ingestion), and health-related quality of life (HRQoL), using 30-AddiQoL questionnaire, were evaluated. During PLEN, waist and serum lipid progressively decreased. After 12 months of PLEN, a significant difference was observed in waist circumference (P = 0.007), HbA1c (P = 0.002), total and LDL-cholesterol levels (P < 0.05). ACTH levels at 240 min and the area under the curve (AUC) were lower (P < 0.05) during PLEN than HC, while cortisol peaks and AUC were similar. 30-AddiQoL total score also improved (P = 0.04) during PLEN. In AD patients, PLEN reduces central adiposity, and improves glucose and metabolism parameters and HRQoL.

  18. Circadian hormone profiles and insulin sensitivity in patients with Addison's disease: a comparison of continuous subcutaneous hydrocortisone infusion with conventional glucocorticoid replacement therapy.

    Björnsdottir, Sigridur; Øksnes, Marianne; Isaksson, Magnus; Methlie, Paal; Nilsen, Roy M; Hustad, Steinar; Kämpe, Olle; Hulting, Anna-Lena; Husebye, Eystein S; Løvås, Kristian; Nyström, Thomas; Bensing, Sophie

    2015-07-01

    Conventional glucocorticoid replacement therapy in patients with Addison's disease (AD) is unphysiological with possible adverse effects on mortality, morbidity and quality of life. The diurnal cortisol profile can likely be restored by continuous subcutaneous hydrocortisone infusion (CSHI). The aim of this study was to compare circadian hormone rhythms and insulin sensitivity in conventional thrice-daily regimen of glucocorticoid replacement therapy with CSHI treatment in patients with AD. An open, randomized, two-period, 12-week crossover multicentre trial in Norway and Sweden. Ten Norwegian patients were admitted for 24-h sampling of hormone profiles. Fifteen Swedish patients underwent euglycaemic-hyperinsulinaemic clamp. Thrice-daily regimen of oral hydrocortisone (OHC) and CSHI treatment. We measured the circadian rhythm of cortisol, adrenocorticotropic hormone (ACTH), growth hormone (GH), insulin-like growth factor-1, (IGF-1), IGF-binding protein-3 (IGFBP-3), glucose, insulin and triglycerides during OHC and CSHI treatment. Euglycaemic-hyperinsulinaemic clamp was used to assess insulin sensitivity. Continuous subcutaneous hydrocortisone infusion provided a more physiological circadian cortisol curve including a late-night cortisol surge. ACTH levels showed a near normal circadian variation for CSHI. CSHI prevented a continuous decrease in glucose during the night. No difference in insulin sensitivity was observed between the two treatment arms. Continuous subcutaneous hydrocortisone infusion replacement re-established a circadian cortisol rhythm and normalized the ACTH levels. Patients with CSHI replacement had a more stable night-time glucose level compared with OHC without compromising insulin sensitivity. Thus, restoring night-time cortisol levels might be advantageous for patients with AD. © 2015 John Wiley & Sons Ltd.

  19. Balance Velocities of the Greenland Ice Sheet

    Joughin, Ian; Fahnestock, Mark; Ekholm, Simon; Kwok, Ron

    1997-01-01

    We present a map of balance velocities for the Greenland ice sheet. The resolution of the underlying DEM, which was derived primarily from radar altimetry data, yields far greater detail than earlier balance velocity estimates for Greenland. The velocity contours reveal in striking detail the location of an ice stream in northeastern Greenland, which was only recently discovered using satellite imagery. Enhanced flow associated with all of the major outlets is clearly visible, although small errors in the source data result in less accurate estimates of the absolute flow speeds. Nevertheless, the balance map is useful for ice-sheet modelling, mass balance studies, and field planning.

  20. 1998 energy balance sheet of France

    Anon.

    1999-01-01

    This paper summarizes the results of the energy balance sheet of France for the year 1998 according to the data published by the energy observatory from the general direction of energy and raw materials (DGEMP) and according to the press communication given by C. Pierret, French state secretary of the industry. The following points are commented: the energy balance sheet (national production and energy independence, the energy shares in the consumption), the decay of the energy bill, and the details of the bill by energy type. (J.S.)