Paracoccidioidomycosis in southern Rio Grande do Sul: a retrospective study of histopathologically diagnosed cases

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Silvana Pereira de Souza

2014-01-01

Full Text Available Paracoccidioidomycosis (PCM is a systemic mycosis caused by the fungus Paracoccidioides brasiliensis and is endemic to Brazil. The aim of this study was to perform a retrospective analysis of the PCM cases in the countryside south of Rio Grande do Sul, Brazil. The files from four histopathology laboratories located in the city of Pelotas were obtained, and all of the epidemiological and clinical data from the PCM diagnosed cases were collected for analysis. A total of 123 PCM cases diagnosed between 1966 and 2009 were selected. Of these patients, 104 (84.5% were male, and 17 were female. The patients ranged from 02 to 92 years of age. Fifty-two cases (41.9% were obtained from the oral pathology laboratory, and the remaining 71 cases (58.1% were obtained from the three general pathology laboratories. Of all of the patients studied, 65.2% lived in rural zones and worked in agriculture or other related fields. Data on the evolution of this disease was available for 43 cases, and the time frame ranged from 20 to 2920 days (mean = 572.3 days. An accurate diagnosis performed in less than 30 days only occurred in 21% of the cases. PCM is endemic to the countryside of Rio Grande do Sul. Therefore, it is recommended that PCM be included as a differential diagnosis, mainly for individuals between 30 and 60 years of age, living in rural zones and who have respiratory signs and associated-oropharyngeal lesions.

Disseminated paracoccidioidomycosis diagnosis based on oral lesions

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Liana Preto Webber

2014-01-01

Full Text Available Paracoccidioidomycosis (PCM is a deep mycosis with primary lung manifestations that may present cutaneous and oral lesions. Oral lesions mimic other infectious diseases or even squamous cell carcinoma, clinically and microscopically. Sometimes, the dentist is the first to detect the disease, because lung lesions are asymptomatic, or even misdiagnosed. An unusual case of PCM with 5 months of evolution presenting pulmonary, oral, and cutaneous lesions that was diagnosed by the dentist based on oral lesions is presented and discussed.

Periodontal aspects of the juvenile form of paracoccidioidomycosis

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MIGLIARI Dante A.

1998-01-01

Full Text Available Three cases of the juvenile form of paracoccidioidomycosis are reported. Emphasis has been given to the oral manifestations, particularly the periodontal involvement. The main periodontal findings were: generalized and progressive alveolar bone destruction leading to gingival recession with exposure of the tooth roots, and spontaneous tooth losses. The gingival mucosa was predominantly smooth, erithematous and slightly swollen. These aspects, although rare, may be the earliest signs of the disease and sometimes its only manifestation.

The lung in paracoccidioidomycosis: new insights into old problems

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Andre Nathan Costa

2013-04-01

Full Text Available OBJECTIVES: Chronic paracoccidioidomycosis can diffusely affect the lungs. Even after antifungal therapy, patients may present with residual respiratory abnormalities due to fungus-induced lung fibrosis. METHODS: A cross-sectional analysis of 50 consecutive inactive, chronic paracoccidioidomycosis patients was performed using high resolution computed tomography, pulmonary function tests, ergospirometry, the six-minute walk test and health-related quality of life questionnaires. RESULTS: Radiological abnormalities were present in 98% of cases, the most frequent of which were architectural distortion (90%, reticulate and septal thickening (88%, centrilobular and paraseptal emphysema (84% and parenchymal bands (74%. Patients typically presented with a mild obstructive disorder and a mild reduction in diffusion capacity with preserved exercise capacity, including VO2max and six-minute walking distance. Patient evaluation with the Saint-George Respiratory Questionnaire showed low impairment in the health-related quality of life, and the Medical Research Council questionnaire indicated a low dyspnea index. There were, however, patients with significant oxygen desaturation upon exercise that was associated with respiratory distress compared with the non-desaturated patients. The initial counterimmunoelectrophoresis of these patients was higher and lung emphysema was more prominent; however, there were no differences in the interstitial fibrotic tomographic abnormalities, tobacco exposure, functional responses, exercise capacity or quality of life. CONCLUSIONS: Inactive, chronic paracoccidioidomycosis patients show persistent and disseminated radiological abnormalities by high resolution computed tomography, short impairments in pulmonary function and low impacts on aerobic capacity and quality of life. However, there was a subset of individuals whose functional impairment was more severe. These patients present with higher initial serology and more

Paracoccidioidomicose: revisão de literatura = Paracoccidioidomycosis: Literature Review

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Yurgel, Liliane Soares

2005-01-01

Full Text Available Objetivo: Apresentar uma revisão da literatura sobre a paracoccidioidomicose, abordando aspectos clínicos importantes da doença. Fonte de dados: Foram consultados artigos indexados no Medline e livros-texto sobre o tema, ambos publicados no período de 1990 a 2004. Síntese de dados: A paracoccidioidomicose é uma doença sistêmica, endêmica, causada pelo fungo dimórfico Paracoccidioides brasiliensis. Embora a via primária de infecção seja a pulmonar, pela inalação de esporos ou partículas do fungo, vários sítios anatômicos podem ser acometidos pela disseminação linfoematogênica, inclusive a mucosa oral. Conclusão: A via primária de infecção da paracoccidioidomicose é pulmonar, mas a doença é, freqüentemente, diagnosticada a partir de manifestações orais. A abordagem clínica de pacientes portadores de lesões ulceradas crônicas de mucosa oral deve, portanto, considerar a paracoccidioidomicose como possibilidade diagnóstica. Purpose: The aim of this work was to present a literature review about paracoccidioidomycosis, focusing important clinical aspects of this disease. Data source: Articles indexed on Medline and scientific books, both published from 1990 to 2004, were reviewed. Data synthesis: Paracoccidioidomycosis is a systemic disease, with endemic profile, caused by the dimorphic fungus Paracoccidioides brasiliensis. The primary way of infection is pulmonary, by the inhalation of fungus spores or particles. Several anatomic sites can be involved by lymphohematogenic dissemination to other organs and systems, including oral mucosa. Conclusion: Although paracoccidioidomycosis affects lungs primarily, it is often diagnosed through oral manifestation. It is important to pay attention to chronic ulcerated lesions of oral mucosa, considering the possible diagnosis of this disease.

Validation and clinical application of a nested PCR for paracoccidioidomycosis diagnosis in clinical samples from Colombian patients.

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Gaviria, Marcela; Rivera, Vanessa; Muñoz-Cadavid, Cesar; Cano, Luz Elena; Naranjo, Tonny Williams

2015-01-01

Paracoccidioidomycosis is a systemic and endemic mycosis, restricted to tropical and subtropical areas of Latin America. The infection is caused by the thermal dimorphic fungus Paracoccidioides brasiliensis and Paracoccidioides lutzii. The diagnosis of paracoccidioidomycosis is usually performed by microscopic examination, culture and immunodiagnostic tests to respiratory specimens, body fluids and/or biopsies; however these methods require laboratory personnel with experience and several days to produce a result. In the present study, we have validated and evaluated a nested PCR assay targeting the gene encoding the Paracoccidioides gp43 membrane protein in 191 clinical samples: 115 samples from patients with proven infections other than paracoccidioidomycosis, 51 samples as negative controls, and 25 samples from patients diagnosed with paracoccidioidomycosis. Additionally, the specificity of the nested PCR assay was also evaluated using purified DNA isolated from cultures of different microorganisms (n=35) previously identified by culture and/or sequencing. The results showed that in our hands, this nested PCR assay for gp43 protein showed specificity and sensitivity rates of 100%. The optimized nested PCR conditions in our laboratory allowed detection down to 1fg of P. brasiliensis DNA. Copyright © 2015 Elsevier Editora Ltda. All rights reserved.

Registro de um caso de paracoccidioidomicose no Japão Paracoccidioidomycosis in Japan report of a case

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Taishiro Chikamori

1984-10-01

Full Text Available Os Autores descrevem um caso de paracoccidioidomicose em Tóquio, o segundo observado no Japão. A paciente residiu cerca de cinco anos na zona urbana de São Paulo, onde provavelmente adquiriu a primo-infecção. Não tomou corticóides, nem teve história de outras afecções que justificassem a paracoccidioidomicose. Após três anos do retorno ao Japão apresentou linfadenopatia, comprometimento hepatesplênico e ausência de lesões pulmonares. O presente caso, com exame histopatoló-gico e cultivo positivos para Paracoccidioides brasiliensis também apresentou quadro soroló-gico compatível. O aspecto blástico das lesões ósseas, raro em arcos costáis nesta micose, bem como a linfadenopatia generalizada são discutidos. Tratamento à base de anfotericina B e ketoconazol ofereceu resultados favoráveis. Neste trabalho os Autores discutem o problema de "patologia de importação", com suas implicações.The Authors report a non-autochthonous case of paracoccidioidomycosis in Tokyo, the second related in Japan. The patient lived for nearly five years in the urban area of São Paulo, where probably she acquired the primary infection. There was no history of corticoid therapy or other diseases that could explain paracoccidioidomycosis. Three years after her return to Japan, she presented lymphadenopathy, hepatosplenic involvement and absence of pulmonary lesions. The present case, with histopathological examination and culture positive to Paracoccidioides brasiliensis also showed compatible serological results. The blastic feature of bone lesions, rare in ribs in this mycosis, as well as the generalized lymphadenopathy are discussed. Treatment with amphotericin B and ketoconazole offered good results. In this paper the Authors discuss the problem of the "pathology of importation" with its implications.

Revisão radiológica de 173 casos consecutivos de paracoccidioidomicose Radiological review of 173 consecutive cases of paracoccidioidomycosis

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Henrique Simão Trad

2006-06-01

Full Text Available OBJETIVO: Revisar e determinar a incidência dos achados radiológicos mais importantes da paracoccidioidomicose, e verificar as possíveis variantes de suas apresentações. MATERIAIS E MÉTODOS: Foram revistos 173 casos consecutivos de paracoccidioidomicose, atendidos no período de 1970 a 1980. Os estudos radiológicos direcionados a cada caso foram reanalisados por no mínimo dois radiologistas experientes. RESULTADOS: Foram encontrados 94 casos de acometimento pulmonar isolado e 38 de acometimento pulmonar associado a lesões ganglionares, viscerais, ósseas e à tuberculose. Sem envolvimento pulmonar foram encontrados 41 casos, com lesões intestinais, viscerais, ósseas ou combinadas. Os principais achados radiológicos da forma pulmonar foram opacidade intersticial reticular e nodular bilateral, seguida por consolidação, também bilateral. As formas visceral e intestinal apresentaram lesões predominantes no fígado, jejuno e íleo. Na forma ganglionar houve predominância do comprometimento difuso abdominal e periférico, e no ósseo, áreas de lise principalmente em ossos longos e clavícula. CONCLUSÃO: A paracoccidioidomicose é doença granulomatosa comum no Brasil, acometendo principalmente o pulmão, tendo como porta de entrada a inalação dos esporos do fungo. Outras formas desta doença, menos freqüentes ou raras, devem ser permanentemente lembradas no diagnóstico diferencial.OBJECTIVE: To determine the incidence of most significant radiological findings of paracoccidioidomycosis and to verify its possible variants. MATERIALS AND METHODS: One hundred and seventy-three cases of paracoccidioidomycosis presented between 1970 and 1980 were reviewed, including their radiological workup reanalysis by at least two experienced radiologists. RESULTS: Ninety-four cases were pulmonary only and 38 were pulmonary associated with ganglial, visceral and osseous lesions or in association with tuberculosis. There was no pulmonary

Spontaneous pneumothorax in paracoccidioidomycosis patients from an endemic area in Midwestern Brazil.

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Cabrera, Lucas G G; Santos, Aline F; Andrade, Ursulla V; Guedes, Carlos Ivan A; Oliveira, Sandra M V L; Chang, Marilene R; Mendes, Rinaldo P; Paniago, Anamaria M M

2017-02-01

Paracoccidioidomycosis (PCM) is the most important systemic mycosis in Latin America. About 80% of PCM patients are present with its chronic form. The lungs are affected in most patients with the chronic form; however, pleural involvement has rarely been reported. We describe nine cases of PCM that presented with lung involvement and spontaneous pneumothorax. All patients, except one whose condition was not investigated, were smokers. PCM was diagnosed during the pneumothorax episode in three patients, and from 3 to 16 years before the pneumothorax episode in six patients. A total of six patients underwent chest drainage and one died as a direct result of the pneumothorax. We suggest that pneumothorax, although rare, should be considered in PCM patients who present with suddenly worsening dyspnoea. PCM should also be investigated in cases of pneumothorax in adult men from mycosis-endemic areas. © 2016 Blackwell Verlag GmbH.

Paracoccidioidomycosis in the state of Maranhão, Brazil: geographical and clinical aspects

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Wilma Batista de Matos

2012-06-01

Full Text Available INTRODUCTION: The study aimed to show the situation of paracoccidioidomycosis in the state of Maranhão, Brazil. METHODS: This study is a descriptive case series developed in two stages. First, a survey of cases originating from the state of Maranhão at the Instituto de Doenças Tropicais Natan Portela, Piauí (IDTNP from 1997 to 2007, and second, the clinical description of 29 cases diagnosed in the Centro de Referências em Doenças Infecciosas e Parasitárias, Maranhão (CREDIP from 2004 to 2010. RESULTS: Two hundred and sixteen cases have been cataloged at the IDTNP. West, east, and central regions of the state of Maranhão recorded 90.3% of cases proving to be important areas for study. The western region, with a prevalence of 10.8/100,000 inhabitants, has a significantly higher proportion of cases than the northern, southern, and eastern regions (p < 0.05. The occurrence was higher in men with 89.3% of cases, and the male-to-female ratio was 8.4:1. The majority of patients were older than 20 years, lived in rural areas, and had farming or soil management as main occupation (73.8%. At CREDIP, 29 cases were diagnosed, of which 26 (89.6% had multifocal manifestations. Mucous tissues were involved more (75.8% frequently, followed by lymph nodes, skin, and lungs with 65.5%, 39% and 37.9 %, respectively. The diagnosis was made by combining direct examination, culture, and histopathology. CONCLUSIONS: The study shows the geographical distribution and the epidemiological and clinical aspects of paracoccidioidomycosis, revealing the significance of the disease to the state of Maranhão.

Paracoccidioidomicosis perianal asociada a lepra lepromatosa: Presentación de un caso clínico Perianal paracoccidioidomycosis associated with lepromatous leprosy: A clinical case report

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M A Reyes

2008-06-01

Full Text Available Se presenta el caso de un paciente alcoholista con una ulceración perianal y manifestaciones cutáneas de enfermedad de Hansen. La biopsia de la lesión perianal y otros estudios arribaron al diagnóstico de una forma diseminada de paracoccidioidomicosis, así como también las biopsias cutáneas y los estudios baciloscópicos fueron diagnósticos de lepra lepromatosa. La respuesta a la terapéutica fue satisfactoria con desaparición de las lesiones cutáneas. La disminución de la respuesta inmunológica celular genera un terreno propicio para la infección de estos gérmenes y al compartir área endémica la asociación entre ambas patologías puede ocurrir.Lepra and Paracoccidioidomycosis are endemic diseases in Argentina. We report a case of a patient with an unusual perianal ulceration and cutaneous manifestations of Hansen's disease. The biopsy of perianal lesion and subsequent studies revealed a disseminated form of paracoccidioidomycosis, as well as skin biopsy and baciloscopic finding diagnostic of Lepromatous Leprosy. The main portal of entry of paracoccidioides is the lung. Hematogenous dissemination of the fungus may occur at this time, with the establishment of metastatic foci in any organ. Anal and perianal lesions are present only in 1.3 to 2.4% of the patients. The pathogenesis of anal lesions remains unclear, it may be secondary from a systemic or a local disease. The patient response to the therapeutic was notable, with disappearance of lesions up to the third month of started itraconazole orally 400 mg/day leading just atrophy scars in perianal areas. The treatment of Hansen's disease was made according to OMS guidelines for multibacillary disease.

Paracoccidioidomicose crônica multifocal tendo como primeira manifestação o envolvimento palpebral: relato de caso Chronical and multifocal paracoccidioidomycosis having the lid involvement as the first sign: case report

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Tiago Nelson de Oliveira Rassi

2009-12-01

Full Text Available O acometimento ocular da paracoccidioidomicose é raro e quando ocorre é geralmente secundário à disseminação hematogênica. Descrição de um caso de paracococcidioidomicose multifocal em homem de 73 anos com história de trauma contuso no olho direito por pedaço de madeira e que teve como primeira manifestação clínica lesão palpebro-conjuntival. Interroga-se possível infecção primária ocular por contiguidade e alerta-se para a manifestação da doença em idade mais avançada.Ocular involvement of paracoccidioidomycosis is rare and when it occurs it is usually secondary to hematogenic dissemination. A case of multifocal paracoccidioidomycosis in a 73 year-old male after history of blunt trauma in the right eye with a stick of wood that presented as the first clinical sign a lid-conjunctival lesion is described. The possible primary ocular infection spreading by contiguity is argued and the disease manifestation in an advanced age is highlighted.

Oral paracoccidioidomycosis: Retrospective analysis of 55 Brazilian patients.

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Trindade, Aline Heloísa; Meira, Henrique Côrtes; Pereira, Igor Figueiredo; de Lacerda, Julio César Tanos; de Mesquita, Ricardo Alves; Santos, Vagner Rodrigues

2017-08-01

Paracoccidioidomycosis (PCM) is a rare fungal infection in the world, but endemic and acquired exclusively in Latin America, with the highest prevalence in South America and Brazil, particularly. Changes in oral cavity are common and constitute the first clinical manifestation in many patients. The aim of this study was to describe the prevalence of oral PCM and analyse the profile of the disease and patients. Retrospective research, consisting of information present in the medical records in the period 1998-2015, whose histopathological diagnosis was oral PCM. Fifty-five oral PCM cases were confirmed. Of these patients, 90.9% were males and 9.1% were females. The average age was 49.66 years and the most reported occupation was rural workers. The painful symptomatology was present in 61.82% of patients. Erythematous lesions were predominant in 73% of them. In single lesions (22 cases), the most common locations were jugal mucosa and tongue. In multiple involvement (30 cases), the most affected regions were lips, jugal mucosa and alveolar ridge. Epidemiology of PCM, was similar to several other studies, especially in Brazil. This is the most important fungal infection in Latin America and the recognition of oral lesions is extremely important, as is often the first and in many cases the only manifestation of the disease. © 2017 Blackwell Verlag GmbH.

Paracoccidioidomicose sistêmica multifocal: desafio diagnóstico por manifestação cutânea tardia Multifocal paracoccidioidomycosis: a diagnostic challenge due to late cutaneous manifestation

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Priscilla Maria Rodrigues Pereira

2011-02-01

Full Text Available No Brasil, a paracoccidioidomicose é uma micose sistêmica endêmica frequente na zona rural e em homens adultos. É relatado caso em agricultor, usuário de drogas ilícitas, com manifestações insidiosas, atingindo rins, pulmões, gânglios, ossos e tardiamente pele, com atraso no diagnóstico e na terapêutica eficaz em mais de um ano. É importante incluir a paracoccidioidomicose como diagnóstico diferencial frente a um quadro sugestivo, mesmo na ausência de lesões cutâneas, para reconhecimento e tratamento precoce, em vista da elevada morbimortalidade desta entidade.Paracoccidioidomycosis is an endemic systemic mycosis in Brazil, frequent in the rural areas and often in adult men. It is reported the case of a farmer, who is an illicit drugs' user, with insidious manifestations affecting kidneys, lungs, lymphonodes, bones and lately, the skin, with a delay of more than one year in the diagnosis and effective therapy It is important to include paracoccidioidomycosis as differential diagnosis, even in the absence of cutaneous lesions, for early recognition and treatment, given the high mortality of this entity.

Comprometimento da medula óssea e eosinofilia na paracoccidioidomicose Bone marrow involvement associated with eosinophilia in paracoccidioidomycosis

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M.A. Shikanai-Yasuda

1992-04-01

Full Text Available São descritos 3 casos de paracoccidioidomicose com a forma aguda da doença, nos quais formas leveduriformes de Paracoccidioides brasiliensis foram visualizadas ao exame direto de medula óssea, sendo a cultura também positiva em um caso. Salienta-se o acometimento do sistema fagocítico-mononuclear e a ausência de resposta às provas cutâneas de hipersensibilidade tardia a antígenos microbianos e de P. brasiliensis em todos, bem como a gravidade do quadro clínico e lesões ósseas generalizadas em um caso, com 20.260 eosinófilos/mm³ no sangue periférico. Os autores discutem o possível papel do eosinófilo na interação hospedeiro-parasita na paracoccidioidomicose, sugerindo que a ativação de subpopulação TH 2 e o aumento de secreção de IL 5 e de GM-CSF possam estar relacionados à grande eosinofilia presente no caso mais graveThe authors described three acute paracoccidioidomycosis patients with bone marrow involvement. P. brasiliensis yeast forms were observed in bone marrow smears of all them, and in one case, culture also revealed fungus growth. The mononuclear phagocytic sistem involvement, the blood eosinophilia and the negative skin hipersensibility responses were emphasized in all of them, as well as the severity of the disease in one case, with disseminated bone lesions and 20.260 eosinophils/mm³ in peripheral blood. The authors discuss the possible role of eosinophil in the host-parasite interaction in paracoccidioidomycosis, suggesting that TH 2 subpopulation activation and increased IL 5 and GM-CSF secretions may be responsible by eosinophilia in the most severe case

Paracoccidioidomicose: freqüência, morfologia e patogênese de lesões tegumentares Paracoccidioidomycosis: frequency, morphology, and pathogenesis of tegumentary lesions

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Silvio Alencar Marques

2007-10-01

Full Text Available FUNDAMENTOS: Paracoccidioidomicose é micose sistêmica de alta prevalência no Brasil. As lesões orocutâneas são de importância para o diagnóstico e acompanhamento clínico. OBJETIVO: Quantificar e qualificar a presença de lesões cutâneas em pacientes com paracoccidioidomicose e correlacionar com forma clínica e gravidade dos casos. MÉTODOS: Realizou-se estudo clínico observacional de série de casos, classificados segundo a forma clínica, localização topográfica e morfologia da lesão quando presente. RESULTADOS: Foram estudados 152 pacientes classificados como forma crônica do adulto (87,5% ou como forma aguda-subaguda, tipo juvenil (12,5%. Lesão cutânea foi identificada em 61,2% dos pacientes. Não houve correlação estatística entre presença de lesão e forma clínica (p=1,000 ou entre presença de lesão e gravidade clínica (p= 0,5607. Houve correlação entre presença de lesão mucosa e a forma clínica crônica do adulto (pBACKGROUND: Paracoccidioidomycosis is a highly prevalent systemic mycosis in Brazil. The oral and cutaneous lesions are useful for diagnostic proposals and clinical follow-up. OBJECTIVE: To quantify and qualify skin lesions associated to active paracoccidioidomycosis and to correlate them with the clinical form and severity of cases. METHODS: An observational clinical study of cases was performed. Patients were classified according to the clinical form, topographic distribution and morphology of skin lesions. RESULTS: A total of 152 patients classified as chronic form (adult type (87.5% or acute-subacute form (juvenile type (12.5% were studied. Skin lesion was diagnosed in 61.2% of patients. There was no statistical correlation between presence of skin lesion and clinical form (p=1.000, nor between skin lesion and severity of disease (p=0.5607. There was statistical correlation between mucosal lesion and adult patients (p <0.001. The lesions were on the cephalic segment (47.6%, trunk (14

Paracoccidioidomycosis in a western Brazilian Amazon State: Clinical-epidemiologic profile and spatial distribution of the disease

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Gabriel de Deus Vieira

2014-01-01

Full Text Available Introduction: Paracoccidioidomycosis (PCM is a systemic infection caused by the fungus Paracoccidioides brasiliensis. PCM is considered one of the most important systemic mycoses in Latin America. Methods: This is a clinical, epidemiological, retrospective, quantitative study of PCM cases in patients attending the National Health Service in the State of Rondônia in 1997-2012. The examined variables included sex, age group, year of diagnosis, education level, profession, place of residence, diagnostic test, prior treatment, medication used, comorbidities and case progress. Results: During the study period, 2,163 PCM cases were registered in Rondônia, and the mean annual incidence was 9.4/100,000 people. The municipalities with the highest rates were located in the southeastern region of Rondônia, and the towns of Pimenteiras do Oeste and Espigão do Oeste had the highest rates in the state, which were 39.1/100,000 and 37.4/100,000 people, respectively. Among all cases, 90.2% and 9.8% were observed in men and women, respectively, and most cases (58.2% were observed in patients aged between 40 and 59 years. Itraconazole was used to treat 91.6% (1,771 of cases, followed by sulfamethoxazole in combination with trimethoprim (4.4% [85] of cases. One hundred thirty-one (6% patients died. Conclusions: The State of Rondônia has a high incidence of PCM, and the municipalities in the southeastern region of the state were found to have the highest incidence rates of this disease. Our findings suggest that Rondônia is the state in the northern region with the highest mortality rate for PCM.

Tendência da mortalidade relacionada à paracoccidioidomicose, Estado de São Paulo, Brasil, 1985 a 2005: estudo usando causas múltiplas de morte Paracoccidioidomycosis-related mortality trend, state of São Paulo, Brazil: a study using multiple causes of death

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Augusto Hasiak Santo

2008-05-01

Full Text Available OBJETIVO: Estudar a mortalidade relacionada à paracoccidioidomicose informada em qualquer linha ou parte do atestado médico da declaração de óbito. MÉTODOS: Os dados provieram dos bancos de causas múltiplas de morte da Fundação Sistema Estadual de Análise de Dados (SEADE de São Paulo entre 1985 e 2005. Foram calculados os coeficientes padronizados de mortalidade relacionada à paracoccidioidomicose como causa básica, como causa associada e pelo total de suas menções. RESULTADOS: No período de 21 anos ocorreram 1 950 óbitos, sendo a paracoccidioidomicose a causa básica de morte em 1 164 (59,7% e uma causa associada de morte em 786 (40,3%. Entre 1985 e 2005 observou-se um declínio do coeficiente de mortalidade pela causa básica de 59,8% e pela causa associada, de 53,0%. O maior número de óbitos ocorreu entre os homens, nas idades mais avançadas, entre lavradores, com tendência de aumento nos meses de inverno. As principais causas associadas da paracoccidioidomicose como causa básica foram a fibrose pulmonar, as doenças crônicas das vias aéreas inferiores e as pneumonias. As neoplasias malignas e a AIDS foram as principais causas básicas estando a paracoccidioidomicose como causa associada. Verificou-se a necessidade de adequar as tabelas de decisão para o processamento automático de causas de morte nos atestados de óbito com a menção de paracoccidioidomicose. CONCLUSÕES: A metodologia das causas múltiplas de morte, conjugada com a metodologia tradicional da causa básica, abre novas perspectivas para a pesquisa que visa a ampliar o conhecimento sobre a história natural da paracoccidioidomicose.OBJECTIVE: To investigate mortality in which paracoccidioidomycosis appears on any line or part of the death certificate. METHODS: Mortality data for 1985-2005 were obtained from the multiple cause-of-death database maintained by the São Paulo State Data Analysis System (SEADE. Standardized mortality coefficients were

Paracoccidioidomycosis mortality in the State of Paraná, Brazil, 1980/1998 Mortalidade por paracoccidiodomicose no Estado do Paraná, Brasil, 1980/1998

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Jeanine Izabel Margraf Bittencourt

2005-12-01

Full Text Available The paracoccidioidomycosis mortality rate in the State of Paraná, Brazil (1980/1998 was analyzed using the death registry data from the Brazilian Mortality Information System and the estimated population from the Brazilian Institute of Geography and Statistics. To qualify the deaths, we deployed ICD-9 for 1980/1995 and ICD-10 for the more recent years. During this period there were 551 deaths from paracoccidioidomycosis in the State of Paraná. Most of the deaths were in male in the 30-59-year age group. The average annual mortality rate was 3.48 per million inhabitants, showing a tendency to stabilize during the study period. Paracoccidioidomycosis was the fifth cause of mortality among the predominantly chronic infectious diseases and had the highest mortality rate among the systemic mycoses. Paracoccidioidomycosis was observed in 184 counties in the State of Paraná. Most deaths were recorded in the North-Central meso-region, and the highest mortality rate occurred in the West meso-region.Foi conduzido um estudo de mortalidade por paracoccidioidomicose no Estado do Paraná, Brasil, no período de 1980 a 1998, utilizando-se como fonte de dados os registros de óbitos do Sistema de Informação sobre Mortalidade e a população estimada pelo Instituto Brasileiro de Geografia e Estatística. Para classificação dos óbitos, empregou-se a CID-9 para os anos de 1980 a 1995 e a CID-10 para os anos mais recentes. Nesse período, no Paraná, ocorreram 551 óbitos por paracoccidioidomicose, com prevalência do sexo masculino, na faixa etária compreendida ente 30 a 59 anos. A taxa de mortalidade média anual foi de 3,48 por milhão de habitantes, demonstrando estabilidade no período de estudo. Destacou-se como a quinta causa de mortalidade entre as doenças infecciosas e parasitárias redominantemente crônicas, apresentando a mais alta taxa de mortalidade entre as micoses sistêmicas. Foi observada em 184 municípios, verificando-se, no estudo por

Use of immunoblotting assay improves the sensitivity of paracoccidioidomycosis diagnosis

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D. F. Silva

2008-01-01

Full Text Available The purpose of this work was to evaluate two serological assays: double immunodiffusion (DI and immunoblotting (IB in immunodiagnosis of paracoccidioidomycosis (PCM. We evaluated by IB assay 23 sera samples from patients with clinical confirmation of PCM, all of them with negative DI results against culture filtrate from Paracoccidioides brasiliensis isolate 113. For IB, as well as for comparative DI assay, we employed soluble components of the cell wall outer surface (SCCWOS from P. brasiliensis isolate 113 cultivated at 36°C in Fava-Neto's agar medium for 5 and 10 days. Among the 20 sera samples analyzed by DI, 13 (65% were negative and 7 (35% were positive against SCCWOS obtained on the 5th and 10th days. By IB assay, 95.4% and 100% of sera reacted against gp43 and gp70 present in SCCWOS from the 5th day and 95.6% recognized these fractions when evaluated against SCCWOS from the 10th day. Our results demonstrated that the use of an immunoenzymatic assay significantly improves the sensitivity of PCM immunodiagnosis and also suggests that at least two serological tests for antibody detection should be adopted in cases of questionable diagnosis.

Incubation Period and Early Natural History Events of the Acute Form of Paracoccidioidomycosis: Lessons from Patients with a Single Paracoccidioides spp. Exposure.

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Buccheri, Renata; Khoury, Zarifa; Barata, Luis Carlos Barradas; Benard, Gil

2016-06-01

Several aspects of the natural history of paracoccidioidomycosis are still poorly understood. Different from the most prevalent, chronic form of the disease, the acute form represents a continuum from the initial respiratory infection to the full-blown disease, thus providing an opportunity to elucidate the pathogenesis of the early phase of this mycosis. We describe, for the first time, two patients with a single time point exposure to Paracoccidioides spp., for whom we were able to determine the time lapsed between exposure to the fungus Paracoccidioides spp. and the onset of signs and symptoms. In case 1, the pulmonary infection was unapparent, and the first manifestations of the acute/subacute form of the disease presented 4 months after Paracoccidioides spp. In case 2, self-limited, non-specific respiratory and systemic symptoms presented 45 days after infection. Thus, our patients confirm that, within a few weeks of infection, Paracoccidioides spp. affects the pulmonary lymphatic system and initially causes no or mild-to-moderate self-limited symptoms, eventually causing abnormalities on a chest X-ray, all of which spontaneously subside. These cases provide some insight into the natural history of this mycosis, the extent of the host exposure to the fungus, and the determination of its incubation period.

Caso para diagnóstico Case for diagnosis

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Silvio Alencar Marques

2007-12-01

Full Text Available A paracoccidioidomicose é enfermidade potencialmente grave podendo levar ao óbito. Lesões cutâneas específicas são freqüentes e propícias ao diagnóstico precoce. A disseminação para órgãos do sistema monocítico-macrofágico corresponde à forma aguda-subaguda da enfermidade. Derrame pleural e ascite, raros na paracoccidioidomicose, no presente caso foram conseqüentes à pancreatite aguda hemorrágica. Nos casos graves a anfotericina B e o suporte hospitalar adequado são decisivos na recuperação.Paracoccidioidomycosis is a potentially severe disease that may lead to death. Specific skin lesions are common and suitable for early diagnosis. Dissemination to the reticuloendothelial system is the main characteristic of the acute and subacute clinical forms. Pleural exudate and ascitis are rare in paracoccidioidomycosis. In the present case, these followed an acute hemorrhagic pancreatitis. Amphotericin B and proper hospital care are crucial for the recovery of severe cases.

Avaliação do exame citopatológico como método para diagnosticar a paracoccidioidomicose crônica oral Evaluation of cytopathologic exam for diagnosis of oral chronic paracoccidioidomycosis

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Marcelo Sivieri de Araújo

2003-06-01

Full Text Available Com o objetivo de avaliar o exame citológico esfoliativo no diagnóstico das lesões orais da paracoccidioidomicose, foram estudados oito portadores desta doença. Em todos os casos, demonstrou-se o fungo através de esfregaços citológicos corados com impregnação pela prata Gomori-Grocott. Conclui-se que a citologia esfoliativa oral é um método diagnóstico útil e válido na paracoccidioidomicose, podendo auxiliar no controle terapêutico das formas orais desta micose.With the aim of evaluating exfoliative cytology for the diagnosis of paracoccidioidomycosis oral lesions, eight patients that presented the disease were studied. The presence of fungi was demonstrated in all these cases. It was concluded that the oral exfoliative cytology exam can be effectively used in the diagnosis of paracoccidioidomycosis and contribute to the therapeutic control of oral forms of this mycosis.

Paracoccidioidomicose: centenário do primeiro relato de caso Paracoccidioidomycosis: a century from the first case report

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Silvio Alencar Marques

2008-06-01

Full Text Available Há 100 anos Adolpho Lutz publicava relato pioneiro de enfermidade descrita como mycose pseudococcidica, hoje paracoccidioidomicose, em que discorria sobre suas manifestações clínico-histopatológicas e micológicas. Com precisão, em abril de 1908, descreveu que "O agrupamento de corpúsculos kysticos é bastante característico. Geralmente há um maior no centro e outros pequenos em redor, o que sempre me produziu a impressão de resultar de um processo de gemmação". Inaugurava-se novo campo para investigações científicas.One hundred years ago Adolpho Lutz published published the frist report of a patient with paracoccidioidomycosis, then referred as mycosis pseudococcidica. in his original article published in April 1908, he accurately informed that "The arrangement of cystic corpuscles is highly characteristic. Generally one finds a large central corpuscle surrounded by small ones, and this feature has always left me under the impression that it is the results of a gemulation process" A new field of scientific research was then opened.

Voice disorders in residual paracoccidioidomycosis in upper airways and digestive tract.

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da Costa, Ananda Dutra; Vargas, Amanda Pereira; Lucena, Marcia Mendonça; Ruas, Ana Cristina Nunes; Braga, Fernanda da Silva Santos; Bom-Braga, Mateus Pereira; Bom-Braga, Frederico Pereira; do Valle, Antonio Carlos Francesconi; Igreja, Ricardo Pereira; Valete-Rosalino, Cláudia Maria

Paracoccidioidomycosis (PCM) is a systemic mycosis of acute and chronic evolution, caused by species belonging to the genus Paracoccidioides. It is considered the most prevalent systemic endemic mycosis in Latin America, with cases in the tropical and subtropical regions. Residual PCM refers to the fibrotic scar sequelae resulting from the disease treatment which, when associated with collagen accumulation, leads to functional and anatomic alterations in the organs. The aim of this study was to evaluate the vocal function of patients with residual PCM in upper airways and digestive tract. We performed a cross-sectional study in 2010 in a cohort of 21 patients with residual PCM in upper airways and digestive tract. The average age was 49.48±9.1 years, and only two (9.5%) patients were female. The study was performed in the 1-113 month-period (median 27) after the end of drug treatment. Five (23.8%) patients had alterations in the larynx as a sequela of the disease. However, all patients had vocal changes in vocal auditory perceptual analysis by GRBASI scale. The computerized acoustic analysis using the software Vox Metria, showed that 11 patients (52.4%) presented alterations in jitter, 15 (71.4%) in shimmer, 8 (38.1%) in F0, 4 (19%) in glottal to noise excitation (GNE), 7 (33.3%) in the presence of noise and 12 (57.1%) in the presence of vibratory irregularity. The great frequency of alterations in residual PCM suggests that the patients in such phase could benefit from a multidisciplinary treatment, offering them integral monitoring of the disease, including speech rehabilitation after the PCM is healed. Copyright © 2017 Asociación Española de Micología. Publicado por Elsevier España, S.L.U. All rights reserved.

Amphotericin B: an antifungal drug in nanoformulations for the treatment of paracoccidioidomycosis

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Mônica Pereira Garcia

2013-12-01

Full Text Available The use of magnetic nanoparticles (MNPs in drug delivery vehicles must address issues such as drugloading capacity, desired release profile, aqueous dispersion stability, biocompatibility with cells and tissue, and retention of magnetic properties after interaction with macromolecules or modification via chemical reactions. Amphotericin B (AmB is still the first choice for the treatment of severe paracoccidioidomycosis, an important systemic fungal infection caused by Paracoccidoides brasiliensis. Unfortunately, AmB causes acute side effects (mainly urinary problems following intravenous administration, which limits its clinical use. The use of magnetic nanoparticles stabilized with biocompatible substances, together with the possibility of their conjugation with drugs has become a new nanotechnological strategy in the treatment of diseases for drug delivery to specific locations, such as the lungs in paracoccidoidiodomycosis. This review provides an overview of the disease, its etiologic agent and treatment with emphasis on the main strategies to improve the use of AmB in nanoformulations.

Un caso excepcional de paracoccidioidomicosis e histoplasmosis pulmonares de presentación concomitante Concomitant pulmonary paracoccidioidomycosis and pulmonary histoplasmosis: a rare case

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Veronica Torres Esteche

2012-04-01

Full Text Available La incidencia de las micosis pulmonares en Uruguay es muy baja, y estas usualmente aparecen en pacientes inmunocomprometidos. Se discute el caso de un paciente inmunocompetente proveniente de área rural, que presenta tos, disnea y fiebre de dos meses de evolución. La imagenología mostró una neumonitis extensa y fibrosis pulmonar. Los test micológicos directos, cultivo y serológicos muestran histoplasmosis y paraccocidioidomicosis en forma concomitante. El paciente presentó hipotensión arterial diagnosticándose una insuficiencia suprarrenal. A pesar de que la extensa fibrosis pulmonar y la neumonitis no fueron reversibles, el paciente mejoró clínicamente con el tratamiento antifúngico. Se trata de un caso excepcional de dos micosis pulmonares en un mismo paciente.The incidence of pulmonary fungal infections is very low in Uruguay, and such infections typically affect immunocompromised patients. We report the case of an immunocompetent patient presenting with a two-month history of cough, dyspnea, and fever. The patient resided in a rural area. Imaging tests revealed extensive pneumonitis and pulmonary fibrosis. On the basis of direct mycological examination, culture, and serological testing, we made a diagnosis of concomitant histoplasmosis and paracoccidioidomycosis. The patient presented arterial hypotension that was diagnostic of adrenocortical insufficiency. Although the pulmonary fibrosis and pneumonia were irreversible, the clinical condition of the patient improved after antifungal treatment. This was an exceptional case of two pulmonary fungal infections occurring simultaneously in the same patient.

Inapparent lung involvement in patients with the subacute juvenile type of paracoccidioidomycosis

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A. Restrepo

1989-02-01

Full Text Available Three patients with the diagnosis of subacute juvenile paracoccidioidomycosis who, at the time of their first visit, had no signs or symptoms of lung involvement, were studied. Initially the diagnosis was confirmed by the observation of P. brasiliensis in biopsy material obtained from clinically involved lymphadenopathies. The lung X-rays done in all patients, did not reveal pathologic changes, although it was possible to observe and isolate the fungus from sputum samples obtained from the three patients. This fact reinforces the pulmonary genesis of the mycosis and proofs the existence of a pulmonary primary infection, even in patients with the juvenile manifestations, in whom the lung component is obscured by the predominant lymph node involvement.

[Mycoses in Venezuela: Working Groups in Mycology reported cases (1984-2010)].

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Martínez Méndez, Dilia; Hernández Valles, Rosaura; Alvarado, Primavera; Mendoza, Mireya

2013-01-03

In 1984 the Venezuelan Work Groups in Mycology (VWGM) were created introducing an innovative approach to the study of the mycoses in Venezuela. To study the occurrence of the mycoses in Venezuela. Review the reported cases of mycoses by the newsletter Boletín Informativo Las Micosis en Venezuela (VWGM) from 1984 to 2010. The data collected showed 36,968 reported cases of superficial mycoses, 1,989 of deep systemic cases, and 822 of localized mycoses. Pityriasis dermatophytosis was the most common superficial infection, and paracoccidioidomycosis and histoplasmosis the most frequent deep systemic infection. Chromoblastomycosis was the most frequently diagnosed subcutaneous infection. The data provided showed the distribution by geographical area for each of the fungal infections studied, which may help to establish the endemic areas. Superficial mycosis is a public health problem due to its high morbidity and is probably responsible for some of the outbreaks in high-risk groups. Paracoccidioidomycosis and histoplasmosis were reported more often, which agrees with earlier reports prior to the formation of the VWGM. Cases of sporotrichosis and chromoblastomycosis in Venezuela can be considered unique due to the high number of cases. This study highlights the contribution of the VWGM to the behavior of the mycoses in Venezuela, its incidence, prevalence, and the recognition of these infections as a problem of public health importance. The VWGM should keep working in this endeavor, not only reporting new cases, but also unifying the clinical and epidemiological criteria, in order to properly monitor the evolving epidemiological changes reported in these types of infections. Copyright © 2012 Revista Iberoamericana de Micología. Published by Elsevier España, S.L. All rights reserved.

Gallium-67 scintigraphy for monitoring therapy response and follow-up of paracoccidioidomycosis

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Yamaga, L.Y.; Watanabe, T.; Hironaka, F.; Buchpiguel, C.; Cerri, G.; Benard, G.; Shikanai-Yasuda, M.A.

2002-01-01

Objectives: The current tools to evaluate patients' therapy response in paracoccidioidomycosis (PCM) are based on clinical, immunological and radiological data. However, these criteria may be of limited value in the follow-up of asymptomatic lesions, negative pre-treatment serological tests and in severe pulmonary involvement whose chest radiography usually doesn't differentiate active from fibrotic lesions. The purpose of this study was to determine the value of Ga imaging for monitoring therapy response and follow-up of PCM patients. Methods: We studied 45 patients with confirmed PCM. Each patient underwent 2 to 7 Ga scintigraphies (total:147 scans) during a follow-up period of 4 months to 8,5 years. The Ga findings were compared to the clinical outcome and serum specific antibody levels. Results: Most patients showed improvement in the sequential Ga scans during the treatment with progressive decrease in number and intensity of sites with active infectious process. Ga scan was performed in nine patients with clinical cure and negative or persistently low levels of serum antibody following prolonged treatment. The scintigraphy confirmed the absence of inflammatory disease in all of these cases. Three patients with clinically suspected recurrence after irregular treatment showed positive Ga scans, confirming disease reactivation. Conclusion: Ga imaging is helpful in monitoring therapy response of PCM patients. Moreover, this method may be used to evaluate disease activity by confirming apparent cure and clinical recurrence

Seroepidemiological survey of paracoccidioidomycosis infection among urban and rural dogs from Uberaba, Minas Gerais, Brazil.

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Fontana, Fabricio Fernandes; dos Santos, Celso Tadeu Barbosa; Esteves, Flavia Maria; Rocha, Ademir; Fernandes, Geisa Ferreira; do Amaral, Cristiane Candida; Domingues, Marcos Abel; De Camargo, Zoilo Pires; Silva-Vergara, Mario León

2010-03-01

There is some evidence that dogs can be naturally infected by Paracoccidioides brasiliensis in endemic areas of paracoccidioidomycosis. In order to evaluate canine infection with this fungus, a survey with 149 urban and 126 rural dogs was carried out using ELISA and intradermal tests with the gp43 antigen of P. brasiliensis in Uberaba, Minas Gerais state of Brazil. Forty-one out of 149 urban dogs were euthanatized and had their lungs, liver and spleen removed. One slice from each viscera was processed for histopathological examination and the remaining was homogenized and then cultivated on mycobiotic agar at room temperature and Fava-Netto medium at 35 degrees C and observed for 12 weeks. Of urban dogs, 75 (50.3%) were small adult females, 56 (36%) were strays, while 93 (64%) had been donated to the municipal zoonosis control center. Nine (6.2%) had a positive intradermal test without statistical differences regarding gender, race, nutritional status or origin. No colonies with microscopic or morphology appearances resembling P. brasiliensis were isolated, nor granulomatous process or fungal structures were observed from histopathological examination. Eighty (53.6%) of the urban dogs presented seroreactivity, without statistical differences regarding gender, race, nutritional state, origin, or positive intradermal test. Of 126 rural dogs, 102 (80.5%) presented antibodies against gp43 antigen, and this was statistically significant in relation to the reactivity detected in urban dogs (P = 0.0001). Thus, dogs are commonly infected with P. brasiliensis, but they probably present natural resistance to develop paracoccidioidomycosis.

Computed tomography findings of paracoccidiodomycosis in musculoskeletal system

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Lima Junior, Francisco Valtenor Araujo; Savarese, Leonor Garbin; Monsignore, Lucas Moretti; Martinez, Roberto; Nogueira-Barbosa, Marcello Henrique, E-mail: fvaltenor@gmail.com [Universidade de Sao Paulo (FM/USP), Ribeirao Preto, SP (Brazil). Fac. de Medicina

2015-01-15

Objective: to evaluate musculoskeletal involvement in paracoccidioidomycosis at computed tomography. Materials and methods: development of a retrospective study based on a review of radiologic and pathologic reports in the institution database. Patients with histopathologically confirmed musculoskeletal paracoccidioidomycosis and submitted to computed tomography were included in the present study. The imaging findings were consensually described by two radiologists. In order to avoid bias in the analysis, one patient with uncountable bone lesions was excluded from the study. Results: a total of seven patients were included in the present study. A total of 18 bone lesions were counted. The study group consisted of 7 patients. A total number of 18 bone lesions were counted. Osteoarticular lesions were the first manifestation of the disease in four patients (57.14%). Bone lesions were multiple in 42.85% of patients. Appendicular and axial skeleton were affected in 85.71% and 42.85% of cases, respectively. Bone involvement was characterized by well-demarcated osteolytic lesions. Marginal osteosclerosis was identified in 72.22% of the lesions, while lamellar periosteal reaction and soft tissue component were present in 5.55% of them. One patient showed multiple small lesions with bone sequestra. Conclusion: paracoccidioidomycosis can be included in the differential diagnosis of either single or multiple osteolytic lesions in young patients even in the absence of a previous diagnosis of pulmonary or visceral paracoccidioidomycosis. (author)

Paracoccidioidomycosis: high-resolution computed tomography - anatomo-pathological correlation; Paracoccidioidomicose: correlacao da tomografia computadorizada de alta resolucao com a anatomopatologia

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Marchiori, Edson; Muniz, Maria Angelica Soares; Santos, Maria Lucia de Oliveira [Universidade Federal Fluminense, Niteroi, RJ (Brazil). Inst. de Radiologia; Moraes, Heleno Pinto de [Universidade Federal Fluminense, Niteroi, RJ (Brazil). Inst. de Patologia; Capone, Domenico [Universidade do Estado, Rio de Janeiro, RJ (Brazil). Inst. de Pneumologia

2000-12-01

We reviewed the high-resolution computed tomography scans of 13 patients with paracoccidioidomycosis and correlated the findings with the anatomo-pathological findings of 5 patients. The most frequent findings observed were thickening of the interlobular septa, emphysema, ground glass areas, thickening of bronchial walls, tracheal dilatation, nodules, cavities and evidence of fibrosing disease such as architectural distortion, parenchymatous bands, spicular pleural thickening, intralobular reticulate and thickening with distortion off the axial interstitium. (author)

PARACOCCIDIOIDOMYCOSIS: CHALLENGES IN THE DEVELOPMENT OF A VACCINE AGAINST AN ENDEMIC MYCOSIS IN THE AMERICAS

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Carlos. P. TABORDA

2015-09-01

Full Text Available SUMMARYParacoccidioidomycosis (PCM, caused by Paracoccidioides spp, is an important endemic mycosis in Latin America. There are two recognized Paracoccidioides species, P. brasiliensis and P. lutzii, based on phylogenetic differences; however, the pathogenesis and disease manifestations of both are indistinguishable at present. Approximately 1,853 (~51,2% of 3,583 confirmed deaths in Brazil due to systemic mycoses from 1996-2006 were caused by PCM. Antifungal treatment is required for patients with PCM. The initial treatment lasts from two to six months and sulfa derivatives, amphotericin B, azoles and terbinafine are used in clinical practice; however, despite prolonged therapy, relapses are still a problem. An effective Th1-biased cellular immune response is essential to control the disease, which can be induced by exogenous antigens or modulated by prophylactic or therapeutic vaccines. Stimulation of B cells or passive transference of monoclonal antibodies are also important means that may be used to improve the efficacy of paracoccidioidomycosis treatment in the future. This review critically details major challenges facing the development of a vaccine to combat PCM.

The most common otorhinolaryngologic manifestations of granulomatous diseases

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Heshiki, Rosana Emiko

2008-09-01

Full Text Available Introduction: Granulomatous diseases result from immunopathologic processes in which there is a failure in the fagocitosis of intracellular organisms. They can cause oral, nasal and pharyngeal mucosa ulcers, vocal cords lesions, otorrhoea and oropharyngeal vegetant lesions. Objective: Describing the most frequent otorhinolaryngologic manifestations in common granulomatous diseases: hanseniasis, paracoccidioidomycosis, leishmaniasis. Method: A retrospective study has been carried out from records of patients diagnosed with the abovementioned diseases between January 1, 2005 and October 31, 2007 in an infectology ambulatory of a tertiary hospital. Results: 142 patients were evaluated; 93 with leishmaniasis, 39 with paracoccidioidomycosis and 10 with hanseniasis. In 93 cases of leishmaniasis, 16 (17.2% had mucosal affection, and the most common signs were septum perforation and nasal mucosal ulcers, both with 8 cases. In paracoccidioidomycosis, oropharyngeal ulcer was the most frequent, with 15 cases (38,4%. Conclusion: Head and neck signs and symptoms are common in patients with leishmaniasis and paracoccidioidomycosis. Nasal manifestations prevail in leishmaniasis and oropharyngeal ones in paracoccidioidomycosis.

Humoral response of paracoccidioidomycosis sera in hamsters with different Venezuelan isolates

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Lilian M Spencer

2009-09-01

Full Text Available Humoral response of paracoccidioidomycosis sera in hamsters with different Venezuelan isolates. Paracoccidioidomycosis (PCM is a progressive systemic mycosis caused by the fungus Paraccocidioides brasiliensis (Pb, endemic to Venezuela and Latin America. In this study, eight different Venezuelan isolates obtained from patients with PCM, were inoculated intraperitoneally in Syrian hamsters (Cricetus auratus and studied by immune-serum. Each strain was collected by gently scraping the surface of the culture medium (Sabouraud Dextrose Agar and suspended in 3ml of 0.15 M phosphate-buffered saline. The antigen obtained was called Paraccocidioides brasiliensis Crude Antigen (CAP. Immunoblotting results showed that the immune-sera from hamsters recognized at least 3 bands: one over 200 kDa, and two of 80 and 15-20 kDa. This study suggests that IgG anti-CAP can reveal a significant variability in the eight Venezuelan isolates. Sera from 88 infected hamsters were evaluated by ELISA with eight different CAPs and Western blot with CAP 37383. ELISA results showed that, the antigen of the virulent isolate 37383 had the highest percentage (38% of positivity, while the non-virulent isolate 1458 had the lowest one (13.6%. Furthermore, scanning densitometry revealed that the isolate 37383 had less bands than the non-virulent isolates. These results suggest that the ELISA test with CAP 37383 can detect circulating antibodies, and that this virulent isolate may be useful for the diagnosis of PCM, and to monitor disease responses to treatments. Rev. Biol. Trop. 57 (3: 505-513. Epub 2009 September 30.La Paracoccidioidomicosis (PCM, es una micosis sistémica causada por el hongo Paraccocidioides brasiliensis (Pb, endémica en Venezuela y Latino América. En este estudio ocho diferentes aislados venezolanos, obtenidos de pacientes con PCM, fueron inoculados intraperitonealmente en hámsteres y fueron estudiados por ELISA e inmunoblotting. Los antígenos obtenidos de P

Functional and phenotypic evaluation of eosinophils from patients with the acute form of paracoccidioidomycosis.

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Braga, Fernanda Gambogi; Ruas, Luciana Pereira; Pereira, Ricardo Mendes; Lima, Xinaida Taligare; Antunes, Edson; Mamoni, Ronei Luciano; Blotta, Maria Heloisa Souza Lima

2017-05-01

Eosinophilia is a typical finding of the acute/juvenile form of paracoccidioidomycosis (PCM), a systemic mycosis endemic in Latin America. This clinical form is characterized by depressed cellular immune response and production of Th2 cytokines. Moreover, it has been shown that the increased number of eosinophils in peripheral blood of patients returns to normal values after antifungal treatment. However, the role of eosinophils in PCM has never been evaluated. This study aimed to assess the phenotypic and functional characteristics of eosinophils in PCM. In 15 patients with the acute form of the disease, we detected expression of MBP, CCL5 (RANTES) and CCL11 (eotaxin) in biopsies of lymph nodes and liver. In addition, there were higher levels of chemokines and granule proteins in the peripheral blood of patients compared to controls. Isolation of eosinophils from blood revealed a higher frequency of CD69+ and TLR2+ eosinophils in patients compared to controls, and a lower population of CD80+ cells. We also evaluated the fungicidal capacity of eosinophils in vitro. Our results revealed that eosinophils from PCM patients and controls exhibit similar ability to kill P. brasiliensis yeast cells, although eosinophils of patients were less responsive to IL-5 stimulation than controls. In conclusion, we suggest that eosinophils might play a role in the host response to fungi and in the pathophysiology of PCM by inducing an intense and systemic inflammatory response in the initial phase of the infection.

Emergence of acute/subacute infant-juvenile paracoccidioidomycosis in Northeast Argentina: Effect of climatic and anthropogenic changes?

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Giusiano, Gustavo; Aguirre, Clarisa; Vratnica, Claudia; Rojas, Florencia; Corallo, Teresa; Cattana, María Emilia; Fernández, Mariana; Mussin, Javier; de Los Angeles Sosa, María

2018-01-13

Argentina has two endemic areas of paracoccidioidomycosis (PCM). Bordering Paraguay and Brazil, Northeast Argentina (NEA) comprises the area with the highest incidence where the chronic adult clinical form has historically been reported. Juvenile form in children and adolescents is rare in this area since only one case was reported in the last 10 years. Despite this, between 2010 and 2012, several cases of acute/subacute clinical forms in children aged 10 to 16 (median 12) were detected. In the last decade, the NEA region has been exposed to ecological variations as consequences of certain climatic and anthropogenic changes, including El Niño-Southern Oscillation phenomenon during 2009, and deforestation. The region has also suffered from the significant ecological effects of the construction of one of the biggest hydroelectric dams of South America. This study aims to describe clinical and epidemiological aspects of acute/subacute PCM cases detected in children from NEA and to discuss climatic and anthropogenic changes as possible contributing factors in the emergence of this disease in children. This acute/subacute PCM cluster was characterized by severe disseminated and aggressive presentations to localized form, with a high spectrum of clinical manifestations uncommonly observed. Due to the lack of experience in acute/subacute PCM in children in the studied area and the atypical clinical manifestations observed, the diagnosis was delayed. In order to avoid misdiagnosis, a higher level of suspicion is now required in NEA and countries bordering the southern part of the endemic area, which are affected by the changes discussed in this article. © The Author(s) 2018. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Paracoccidioidomicose em hemisfério cerebral e tronco encefálico: relato de caso Paracoccidioidomycosis in cerebral hemisphere and brainstem: case report

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Manoel Baldoino Leal Filho

2006-09-01

Full Text Available Relata-se sobre um homem de 36 anos com passagem quatro anos antes pela selva amazônica. Admitido após seis meses do aparecimento progressivo de tetraparesia, ataxia de marcha, disfagia, disartria, dispnéia e soluço. A ressonância magnética revelou lesão parietoccipital à direita e no bulbo, sendo esta última maior. Investigações para tuberculose e síndrome da imunodeficiência adquirida tiveram resultados negativos. Foi submetido a microcirurgia da lesão do bulbo. O estudo anatomopatológico revelou paracoccidioidomicose. Recebeu tratamento com anfotericina B até 2100 mg, e sulfametoxazol-trimetoprim por três meses, e fisioterapia. Voltou às atividades após seis meses do término do tratamento. Comenta-se sobre a participação do sistema imunológico e das citocinas (interleucinas.We report on a 36 years-old man that had been at the Amazon forest four years before. Six months before the admission he had developed a progressive quadriparesis, gait ataxia, dysphagia, dysarthria, difficulty in breathing and hiccup. The gadolinium-enhanced T1-weighted MRI showed a lesion into the right parietoccipital area and another into the medulla, that was the largest. There was any evidence of tuberculosis or AIDS. The patient was submitted to microsurgical approach to the medulla. Pathological examination revealed paracoccidioidomycosis. Treatment with anphotericin B till 2100mg was administered followed by sulfamethoxazole-trimetoprim for three months plus physical therapy. The patient went back to his activities six months after the end of the treatment. Comments are presented about the participation of the immunological system and of the cytokines (interleukines.

Comparative genomic analysis of human fungal pathogens causing paracoccidioidomycosis.

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Christopher A Desjardins

2011-10-01

Full Text Available Paracoccidioides is a fungal pathogen and the cause of paracoccidioidomycosis, a health-threatening human systemic mycosis endemic to Latin America. Infection by Paracoccidioides, a dimorphic fungus in the order Onygenales, is coupled with a thermally regulated transition from a soil-dwelling filamentous form to a yeast-like pathogenic form. To better understand the genetic basis of growth and pathogenicity in Paracoccidioides, we sequenced the genomes of two strains of Paracoccidioides brasiliensis (Pb03 and Pb18 and one strain of Paracoccidioides lutzii (Pb01. These genomes range in size from 29.1 Mb to 32.9 Mb and encode 7,610 to 8,130 genes. To enable genetic studies, we mapped 94% of the P. brasiliensis Pb18 assembly onto five chromosomes. We characterized gene family content across Onygenales and related fungi, and within Paracoccidioides we found expansions of the fungal-specific kinase family FunK1. Additionally, the Onygenales have lost many genes involved in carbohydrate metabolism and fewer genes involved in protein metabolism, resulting in a higher ratio of proteases to carbohydrate active enzymes in the Onygenales than their relatives. To determine if gene content correlated with growth on different substrates, we screened the non-pathogenic onygenale Uncinocarpus reesii, which has orthologs for 91% of Paracoccidioides metabolic genes, for growth on 190 carbon sources. U. reesii showed growth on a limited range of carbohydrates, primarily basic plant sugars and cell wall components; this suggests that Onygenales, including dimorphic fungi, can degrade cellulosic plant material in the soil. In addition, U. reesii grew on gelatin and a wide range of dipeptides and amino acids, indicating a preference for proteinaceous growth substrates over carbohydrates, which may enable these fungi to also degrade animal biomass. These capabilities for degrading plant and animal substrates suggest a duality in lifestyle that could enable pathogenic

Mortality due to systemic mycoses as a primary cause of death or in association with AIDS in Brazil: a review from 1996 to 2006.

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Prado, Marli; Silva, Marcelo Barbosa da; Laurenti, Ruy; Travassos, Luiz R; Taborda, Carlos P

2009-05-01

Deaths caused by systemic mycoses such as paracoccidioidomycosis, cryptococcosis, histoplasmosis, candidiasis, aspergillosis, coccidioidomycosis and zygomycosis amounted to 3,583 between 1996-2006 in Brazil. When analysed as the underlying cause of death, paracoccidioidomycosis represented the most important cause of deaths among systemic mycoses (approximately 51.2%). When considering AIDS as the underlying cause of death and the systemic mycoses as associated conditions, cryptococcosis (50.9%) appeared at the top of the list, followed by candidiasis (30.2%), histoplasmosis (10.1%) and others. This mortality analysis is useful in understanding the real situation of systemic mycoses in Brazil, since there is no mandatory notification of patients diagnosed with systemic mycoses in the official health system.

Mortality due to systemic mycoses as a primary cause of death or in association with AIDS in Brazil: a review from 1996 to 2006

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Marli Prado

2009-05-01

Full Text Available Deaths caused by systemic mycoses such as paracoccidioidomycosis, cryptococcosis, histoplasmosis, candidiasis, aspergillosis, coccidioidomycosis and zygomycosis amounted to 3,583 between 1996-2006 in Brazil. When analysed as the underlying cause of death, paracoccidioidomycosis represented the most important cause of deaths among systemic mycoses (~ 51.2%. When considering AIDS as the underlying cause of death and the systemic mycoses as associated conditions, cryptococcosis (50.9% appeared at the top of the list, followed by candidiasis (30.2%, histoplasmosis (10.1% and others. This mortality analysis is useful in understanding the real situation of systemic mycoses in Brazil, since there is no mandatory notification of patients diagnosed with systemic mycoses in the official health system.

Dendritic Cells Primed with Paracoccidioides brasiliensis Peptide P10 Are Therapeutic in Immunosuppressed Mice with Paracoccidioidomycosis

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Leandro B. R. Silva

2017-06-01

Full Text Available Paracoccidioidomycosis (PCM is an endemic systemic mycosis in Latin America, with the highest prevalence in Brazil, Colombia, and Venezuela. Fungi of the Paracoccidioides genus are etiologic agents of the disease. The 15 amino acid peptide P10 is derived from gp43, the main diagnostic antigen of Paracoccidioides brasiliensis. We previously reported that P10-pulsed dendritic cells (DCs induce a protective response against P. brasiliensis. Presently, dexamethasone-treated BALB/c mice were intratracheally infected with P. brasiliensis Pb18 to establish the therapeutic efficacy of P10-pulsed DCs. Immunosuppressed and infected animals that received DCs had a reduction in their fungal burden, and this result was most pronounced in mice receiving DCs primed with P10. The efficacy of therapeutic DCs was significantly augmented by concomitant treatment with trimethoprim-sulfamethoxazole. Additionally, primed-DCs with or without the antifungal drug induced a beneficial Th1-biased immune response and significantly reduced tissue damage. In conclusion, these studies with immunocompromised mice demonstrate that P10-pulsed DCs with or without concomitant antifungal drugs are potently effective in combating invasive PCM. These findings support further translational studies to validate the use of P10-primed DCs for PCM in immunocompetent and immunosuppressed hosts.

Central nervous system paracoccidioidomycosis. Report of a case successfully treated with Itraconazol Paracoccidioidomicose do sistema nervoso central. Apresentação de um caso tratado com êxito com itraconazole

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Luis A. VILLA

2000-08-01

Full Text Available Paracoccidioidomycosis (PCM is a primary pulmonary infection that often disseminates to other organs and systems. Involvement of the central nervous system (CNS is rare and due to the fact that both clinical alertness and establishment of the diagnosis are delayed, the disease progresses causing serious problems. We report here a case of neuroparacoccidioidomycosis (NPCM, observed in a 55 year-old male, who consulted due to neurological symptoms (left hemiparesis, paresthesias, right palpebral ptosis, headache, vomiting and tonic clonic seizures of a month duration. Upon physical examination, an ulcerated granulomatous lesion was observed in the abdomen. To confirm the diagnosis a stereotactic biopsy was taken; additionally, mycological tests from the ulcerated lesion and a bronchoalveolar lavage were performed. In the latter specimens, P. brasiliensis yeast cells were visualized and later on, the brain biopsy revealed the presence of the fungus. Treatment with itraconazole (ITZ was initiated but clinical improvement was unremarkable; due to the fact that the patient was taking sodium valproate for seizure control, drug interactions were suspected and confirmed by absence of ITZ plasma levels. The latter medication was changed to clonazepam and after several weeks, clinical improvement began to be noticed and was accompanied by diminishing P. brasiliensis antigen and antibody titers. In the PCM endemic areas, CNS involvement should be considered more often and the efficacy of itraconazole therapy should also be taken into consideration.A paracoccidioidomicose (PCM é infecção pulmonar primária que algumas vezes pode se disseminar a outros órgãos e sistemas. O envolvimento do sistema nervoso central (SNC é raro e devido ao fato que a alerta clínica e o estabelecimento do diagnóstico são tardios, a doença progride e o paciente piora. Aquí apresentamos caso de neuroparacoccidioidomicose (NPCM observada em homem de 55 anos de idade que

Associação da rifampicina à anfotericina B no tratamento da paracoccidioidomicose: resultados em três pacientes tratados Association of Amphotericin B and Rifampicin in the treatment of paracoccidioidomycosis. Report of efficacy in three cases

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Bodo Wanke

1984-08-01

Full Text Available Trabalhos experimentais demonstraram que a anfotericina B, desorganizando funcionalmente a membrana celular fúngica, permite a penetração da rifampicina no citoplasma e sua conseqüente ação contra Histoplasma capsulatum, Blastomyces dermatitidis e Candida albicans. Com metade das doses habituais' de anfotericina B associada à rifampicina conseguem-se melhores resultados do que com a anfotericina B isoladamente em doses plenas. Os Autores discutem as possíveis aplicações desta associação no tratamento da paracoccidioidomi-cose e apresentam 3 casos desta micose em que a inatividade clínica e micológica só foi obtida após o emprego combinado destas drogas.Experimental data have shown that low concentration of amphotericin B disrupts of the fungal cellular membranes, enhancing entrance of rifampicin into citoplasm, where it acts specifically as an antifungal agent against Histoplasma capsulatum, Blastomyces dermatitidis and Candida albicans. Amphotericin B in half dosage combined with rifampicin is more effective than when used alone in full dosage. The Authors discuss the possible indications of this association in the therapy of paracoccidioidomycosis, and report its efficacy in three cases of this disease only controlled after its use.

The function of the adrenal cortex in patients with paracoccidioidomycosis: a study by radioimmunoassay of plasma ACTH

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Tendrich, M.; Vaisman, M.; Pedrosa, P.N.; Guimaraes, M.M.; Cordeiro, J.G.H.

1987-01-01

Fifteen patients with paracoccidioidomycosis were studied: ten with the chronic disseminated form (adult types), 4 with the acute or subacute disseminated form (juvenile type) and 1 with the progressive pulmonary form. Ten patients reported no previous treatment and 5 had relapse of the disease. In all cases P. brasiliensis was demonstrated in specimens obtained from the lesions by direct microscopy (KOH), histopathology and/or culture. The adrenocortical function was evaluated by means of basal plasma determination of ACTH and cortisol, and 24 hour urine determination of 17 hydroxisteroids (17 OHCS); after stimulation by ACTH determinations were repeated. Patients were classified in 3 groups: 1) plasma ACTH 58 pg/ml. According to the correlation between ACTH and cortisol level after simulation test 8 patients were classified in group 1, 2 of them with cortisol response lower than twice the basal levels; four patients were classified in group 3. All them had ACTH levels definitely above the normal, 2 of them had no cortisol response after stimulation in addition to signs and symptoms of Addison's disease, thus fulfilling the criteria of primary adrenal insufficiency. The correlation between ACTH and 17 OHCS after stimulation test demonstrated that in 7 out of 8 patientes from group 1 response was lower than twice the basal and that in 3 out of 4 patientes from group 3 proven primary adrenal insufficiency was present. (The other patient showed a 17 OHCS response three times higher than the basal levels). (author) [pt

Paracoccidioidomycosis in children in the state of Rio de Janeiro (Brazil: Geographic distribution and the study of a "reservarea"

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A. J. RIOS GONÇALVES

1998-01-01

Full Text Available Thirty six cases of acute disseminated paracoccidioidomycosis in 3 to 12 year-old children, natives of the state of Rio de Janeiro, were seen in the period 1981-1996. All patients were residents in the rural region of 15 counties, scattered on the Southwestern part of this state. The rural region of two neighboring counties, where 16 cases (44.4% occurred, was visited. It exhibited the environmental conditions that are considered favorable to the survival of P. brasiliensis. The most important of these conditions, abundant watercourses and autochthonous forest, are distributed on well defined and limited areas, in which the dwellings are also localized. Probably, a careful epidemiological study of forthcoming cases of the disease in children may facilitate the search for the micro-niche of the fungus.No período 1981-1996 foram observados 36 casos de paracoccidioidomicose aguda disseminada em crianças, entre 3 e 12 anos de idade, nativas do estado do Rio de Janeiro. Todos os pacientes residiam em região rural, distribuída por 15 municípios localizados na parte sudoeste do estado. Dois municípios vizinhos, onde haviam ocorrido 16 (44,4% dos casos, foram visitados. Na região rural de ambos, existem as condições climáticas e ambientais favoráveis à sobrevivência do P. brasiliensis. Dentre essas condições, as mais importantes, abundantes cursos de água e vegetação nativa, distribuem-se em áreas limitadas e bem definidas. Nessas áreas localizam-se, também, as casas dos rurículas. Provavelmente, um cuidadoso estudo epidemiológico de novos casos, que venham a ocorrer na região, facilitará a busca do nicho do fungo

Production of TNF-α, nitric oxide and hydrogen peroxide by macrophages from mice with paracoccidioidomycosis that were fed a linseed oil-enriched diet.

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Sargi, Sheisa Cyléia; Dalalio, Márcia Machado de Oliveira; Visentainer, Jesuí Vergílio; Bezerra, Rafael Campos; Perini, João Ângelo de Lima; Stevanato, Flávia Braidotti; Visentainer, Jeane Eliete Laguila

2012-05-01

Omega-3 polyunsaturated fatty acids (n-3 PUFA) can modulate the immune system and their primary effect is on macrophage function. Paracoccidioidomycosis (PCM) is an endemic systemic mycosis in Latin America that is caused by the dimorphic fungus Paracoccidioides brasiliensis (Pb). Macrophages are the main defence against this pathogen and have microbicidal activity that is dependent on interferon-Γ and tumour necrosis factor (TNF)-α. These cytokines stimulate the synthesis of nitric oxide (NO) and hydrogen peroxide (H₂O₂), leading to the death of the fungus. To study the effect of n-3 PUFA on the host immune response during experimental PCM, macrophages that were obtained from animals infected with Pb18 and fed a diet enriched by linseed (LIN) oil were cultured and challenged with the fungus in vitro. The macrophage function was analysed based on the concentrations of TNF-α, NO and H₂O₂. LIN oil seems to influence the production of TNF-α during the development of disease. A diet enriched with LIN oil influences the microbicidal activity of the macrophages by inducing the production of cytokines and metabolites such as NO and H₂O₂, predominantly in the chronic phase of infection.

Fungal infections of the mucous membrane.

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Marques, Silvio Alencar

2010-01-01

A clinical review of three potentially severe fungal diseases, which are characterized in many cases by mucosal involvement, is presented. They are paracoccidioidomycosis, histoplasmosis, and mucormycosis. Mucosal involvement for paracoccidioidomycosis and rhinocerebral mucormycosis is frequent. Thus, oral involvement may provide early clue for diagnosis. In paracoccidioidomycosis, the mucosal lesion classically shows superficial ulcers with granular appearance and hemorrhagic points, usually on lips, palate, and jugal mucosa. In mucormycosis, necrosis of the palate followed for purulent discharge is a hallmark of rhinocerebral disease. Treatment with amphotericin B desoxycholate or the new second-generation triazoles is highly efficacious.

Natural antibodies in paracoccidioidomycosis Anticorpos naturais na paracoccidioidomicose

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Carmelinda S. Unterkircher

2004-06-01

Full Text Available Recent attention has been focused on the natural antibodies as a component of natural immunity and as integral part of the idiotypic network. However, their functional role in different infections has rarely been studied. This work was undertaken to investigate the presence of natural antibodies in paracoccidioidomycosis (PCM. In addition, we analyzed anti-P. brasiliensis antibodies and their distribution in IgG subclasses in order to acquire better knowledge about the humoral immune response in this mycosis. Our findings show that the natural antibody response is not very much increased in PCM when compared with other parasite infections and this response is restricted to a few specificities, suggesting that P. brasiliensis moderately triggers CD5+ B cells. The anti-actin antibody was the main antibody specificity found in PCM. Specific antibodies to P. brasiliensis were mainly found in the IgG1 subclass in chronic patients of PCM.Recente atenção tem sido dada aos anticorpos naturais como componentes da imunidade natural e como parte integrante da rede idiotípica. Todavia, seu papel funcional em diferentes infecções tem, raramente, sido estudado. O objetivo deste trabalho foi investigar a presença de anticorpos naturais na paracoccidioidomicose (PCM. Em adição, analisamos os anticorpos específicos anti-P. brasiliensis e sua distribuição em subclasses a fim de adquirir mais conhecimento sobre a resposta imune humoral nesta micose. Nossos achados mostram que a resposta de anticorpos naturais não é acentuada na PCM quando comparada com outras infecções por parasitas e, é restrita a poucas especificidades, sugerindo que o P. brasiliensis estimula moderadamente as células B CD5+. O anticorpo anti-actina foi a principal especificidade encontrada na PCM. Os anticorpos especificos para P. brasiliensis, nos pacientes crônicos, eram, principalmente, da subclasse IgG1.

The contribution of ultrasonography and computed tomography in the evaluation of abdominal involvement in paracoccidioidomycosis

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Paula, Ivie Braga de [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Dept. de Radiologia; Pedroso, Enio Roberto Pietra; Ferreira, Cid Sergio, E-mail: enio@medicina.ufmg.br [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Fac. de Medicina

2014-01-15

Introduction: paracoccidioidomycosis (PCM) is a polymorphic systemic granulomatous inflammatory disease determined by Paracoccidioides brasiliensis, one of the 10 leading causes of morbidity and mortality among the parasitic diseases endemic in Brazil. Objective: To identify the following aspects of PCM by ultrasound (US) and computed tomography (CT): abdominal changes, intensity and characteristics of the observed images, frequency of changes depending on clinical presentation, differences from other nosological entities. Patients and methods: This was a retrospective, observational, cross-sectional study carried out with 35 patients with PCM treated at the Hospital das Clinicas (HC) at the Universidade Federal de Minas Gerais (UFMG). Patients with tuberculosis, bronchial asthma, generalized chronic obstructive pulmonary disease, or in contact with silica or mines, as well as those with granulomatous diseases at any point in their current or past clinical history and detected through serology, anatomopathology or microbiological exams were excluded. Collected data were transcribed into SPSS for Windows® for statistical analysis. The study was approved by the UFMG Ethics Committee (082/00). Results and conclusion: CT and U.S. showed involvement of abdominal organs in all forms of PCM, including lymphadenopathy (40%), hepatomegaly (37%), splenomegaly (37%) and adrenal involvement (17%). Gallbladder and retroperitoneal musculature involvement were also observed, along with ascites and pleural effusion. Lymph node calcification, adrenal involvement and ascites constituted evidence of high probability of PCM even though these findings are not enough to differentiate PCM from tuberculosis. Chronic and sequelae forms, abdominal involvement is more frequent than indicated by the clinical manifestations. (author)

Production of TNF-α, nitric oxide and hydrogen peroxide by macrophages from mice with paracoccidioidomycosis that were fed a linseed oil-enriched diet

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Sheisa Cyléia Sargi

2012-05-01

Full Text Available Omega-3 polyunsaturated fatty acids (n-3 PUFA can modulate the immune system and their primary effect is on macrophage function. Paracoccidioidomycosis (PCM is an endemic systemic mycosis in Latin America that is caused by the dimorphic fungus Paracoccidioides brasiliensis (Pb. Macrophages are the main defence against this pathogen and have microbicidal activity that is dependent on interferon-Γ and tumour necrosis factor (TNF-α. These cytokines stimulate the synthesis of nitric oxide (NO and hydrogen peroxide (H2O2, leading to the death of the fungus. To study the effect of n-3 PUFA on the host immune response during experimental PCM, macrophages that were obtained from animals infected with Pb18 and fed a diet enriched by linseed (LIN oil were cultured and challenged with the fungus in vitro. The macrophage function was analysed based on the concentrations of TNF-α, NO and H2O2. LIN oil seems to influence the production of TNF-α during the development of disease. A diet enriched with LIN oil influences the microbicidal activity of the macrophages by inducing the production of cytokines and metabolites such as NO and H2O2, predominantly in the chronic phase of infection.

Protective effect of the LevRad on treat of paracoccidioidomycosis

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Martins, Estefania M.N.; Andrade, Antero S.R.; Fernandes, Viviane Cristina; Morais, Elis Araujo; Goes, Alfredo M.; Resende, Maria Aparecida de

2011-01-01

Paracoccidioides brasiliensis is the agent of Paracoccidioidomycosis (PCM), the most prevalent deep mycosis of Latin America. The period of treat depend on the chemotherapeutic and the severity of disease and its administration not ensure the complete destruction of the fungus. The search for new alternatives is necessary. The aim of this study was to evaluate the protective effect of yeast cells of P. brasiliensis attenuated by gamma irradiation (LevRad) on therapeutic vaccination of BALB/c. The therapeutic potential of LevRad with or without fluconazole was assessed for the first time, intraperitoneally, in BALB/c, 60 days after intratracheal infection with a highly virulent non-irradiated P.brasiliensis isolate. The animals were divided in five experimental groups: uninfected (C-), infected (C+), infected treated with fluconazole (Inmed), infected treated with LevRad (InRad) and infected treated with fluconazole + LevRad (InRadMed). The organs (lungs, spleen and liver) were collected to analyze CFU (colony forming units) and histology. The sera were used to evaluate the immunization efficacy, and to assess IgG subtypes (IgG1, IgG2a, IgG2b, IgG3) and total IgG levels. There was significant decrease in the CFU counts of the lungs of InMed, InRadMed and InRad. No were visualized histopathological alterations in the organs of these groups, except in InRad there was granulomatous lesions unifocal, little and discrete. The levels of IgG and its subtypes IgG2a, IgG2b increased, probably due to the increase of cytokines that promote switching to these isotypes. These preliminary results can provide new prospect for immunotherapy of PCM, but it will be necessary new studies to evaluate administration dose and period treatment. (author)

Retrospective seroepidemiological analysis of patients with suspicion of paracoccidioidomycosis in São Paulo State, Brazil

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CM Kamikawa

2012-01-01

Full Text Available The geographic distribution of paracoccidioidomycosis (PCM in the Brazilian state of São Paulo was evaluated in a retrospective study using secondary data from serological analyses, carried out by double immunodiffusion assay of patients with PCM suspicion, from January 1999 to May 2010. Sixty percent of 10,176 patients, from 239 cities, were serologically reactive to P. brasiliensis. The cities that showed the most serological reactivity among patients were São João da Boa Vista (85%, Piracicaba (75%, Sorocaba (73%, Campinas (72% and São Paulo (62%. São Paulo state has an area of 248,209.4 km²; the climate is tropical and sub-tropical with annual temperatures between 18 and 24ºC, high rainfall (900 to 1800 mm/year, rainy summers and mild winters. It also features large areas composed of acidic soils, and is one of the greatest contributors to Brazilian agricultural production and, separately, the largest producer of orange juice and, the ninth greatest producer of soy and sugar cane and the fourth largest coffee producer. We suggest that the climatic characteristics associated with soil type and development of primary activities can contribute to the endemic potential of PCM in São Paulo state.

Paracoccidioidomicose: estudo clínico e epidemiológico de 422 casos observados no Estado de Mato Grosso do Sul Paracoccidioidomycosis: a clinical and epidemiological study of 422 cases observed in Mato Grosso do Sul

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Anamaria Mello Miranda Paniago

2003-07-01

Full Text Available São descritas as características clínicas e epidemiológicas de 422 casos de paracoccidioidomicose atendidos no Hospital Universitário da Universidade Federal do Mato Grosso do Sul (Campo Grande, Mato Grosso do Sul, Brasil no período de Janeiro de 1980 a Agosto de 1999. A média de idade foi de 43,4 anos e a proporção homem: mulher foi de 10:1. Quase metade (45,5% dos doentes era trabalhadora rural no momento do diagnóstico. A forma aguda/subaguda (tipo juvenil(15,4% dos casos revelou-se com importante comprometimento do sistema fagocítico-monocitário, manifestado principalmente por adenomegalia (95,4%; hepatomegalia (40%; esplenomegalia (23,1%. A forma crônica (tipo adulto(84,6% dos casos apresentou-se com maiores proporções de lesões em orofaringe (66,4%; rouquidão (31,4% e tosse (50,7%. Para o diagnóstico, foram utilizados o exame micológico direto em 365 pacientes e o histopatológico em 302, com positividade de 50,7% e 97,3%, respectivamente. O tratamento antifúngico preferencial foi a associação de sulfametoxazol e trimetoprim (co-trimoxazol, utilizado em 90,3% dos doentes. Seqüelas foram observadas em 30,3% e óbito em 7,6% dos casos.Clinical and epidemiological features of 422 cases of paracoccidioidomycosis attended at University Hospital of Universidade Federal de Mato Grosso do Sul (Campo Grande, Mato Grosso do Sul, Brazil from January 1980 to August 1999, were analysed. The mean age was 43.4 years old and the male: female ratio was 10:1. Nearly half (45.5% of the patients were agricultural workers at the moment of diagnosis. In the acute/subacute form (juvenile type the phagocytic-monocytic system was very much impaired and mainly marked by lymphadenopathy (95.4%, hepatomegaly (40%, splenomegaly (23.1%. The chronic form (adult type presents more lesions in oropharynx (66.4%, dysphonia (31.4% and cough (50.7%. Mycological diagnosis was obtained by direct microscopy of wet mounts in 185/365 (50.7% patients and by

Bilateral paracoccidioidomycotic iliopsoas abscess associated with ileo-colonic lesion

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Helena Duani

2012-10-01

Full Text Available This case report shows the clinical development of a patient with systemic paracoccidioidomycosis presenting with lymphatic-intestinalmanifestation. The patient initially had a substantial clinical improvement but had a recrudescence after six months of sulfamethoxazoletrimethoprim oral treatment, with the emergence of feverish syndrome, lumbar pain, and intermittent claudication, characterizing a bilateral iliopsoas muscle abscess, necessitating clinicosurgical therapeutics.

DISSEMINATED FUNGAL INFECTION WITH ADRENAL INVOLVEMENT: REPORT OF TWO HIV NEGATIVE BRAZILIAN PATIENTS

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Graziella Hanna PEREIRA

2015-12-01

Full Text Available Paracoccidioidomycosis and histoplasmosis are systemic fungal infections endemic in Brazil. Disseminated clinical forms are uncommon in immunocompetent individuals. We describe two HIV-negative patients with disseminated fungal infections, paracoccidioidomycosis and histoplasmosis, who were diagnosed by biopsies of suprarenal lesions. Both were treated for a prolonged period with oral antifungal agents, and both showed favorable outcomes.

Aspectos incomuns da paracoccidioidomicose infantil

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Achiléa Lisboa Bittencourt

1987-12-01

Full Text Available São relatados dois casos de paracoccidioidomicose (PCM infantil. Em um deles, a principal manifestação da doença foi tumoração abdominal, simulando linfoma maligno não Hodgkin. O outro apresentou acentuado envolvimento articular, com ruptura da cápsula. Representam o segundo e terceiro casos de PCM infantil observados na Bahia, ambos procedentes de áreas urbanas.The authors present two cases of infantil para-coccidioidomycosis. In one case the main presentation was an abdominal mass that mimicked non- Hodgkin lymphoma. In the other case the child had a joint swelling with rupture of the capsule and the clinical diagnosis was piogenic arthritis. They represent the second and third cases of infantile paracoccidioidomycosis observed in the state of Bahia, all coming from urban areas.

Hipercalcemia e lesões osteolíticas múltiplas em criança com paracoccidioidomicose disseminada e tuberculose pulmonar Hypercalcemia and multiple osteolytic lesions in a child with disseminated paracoccidioidomycosis and pulmonary tuberculosis

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Antonia T. Tresoldi

2005-08-01

Full Text Available OBJETIVO: Descrever o caso de uma criança com paracoccidioidomicose, que apresentou hipercalcemia associada a múltiplas lesões osteolíticas. DESCRIÇÃO: Menino de 6 anos, internado com história de febre e hepatoesplenomegalia há 1 mês. À internação, apresentava-se em regular estado geral, descorado, com linfonodomegalia generalizada e hepatoesplenomegalia. Os exames laboratoriais identificaram anemia (hemoglobina = 6,8 g/dl, eosinofilia (1.222/mm³, plaquetopenia (102.000/mm³ e hipoalbuminemia (albumina = 2,2 g/dl. Paracoccidioides brasiliensis foi identificado no mielograma. A partir da segunda semana de internação, apresentou artralgia, hipoatividade e dificuldade à deambulação, sendo constatada hipercalcemia (dosagem máxima de 14,9 mg% e redução da função renal, que duraram pouco mais de 2 semanas. No 42º dia de internação, foram vistas, na radiografia de tórax, múltiplas lesões líticas em clavículas, escápulas, costelas e úmeros, com escorregamento epifisário de úmero bilateral. Apresentou nefrocalcinose e nefrolitíase, com redução no clearance de creatinina e evidências de lesão tubular. No final do segundo mês de internação, na cultura do lavado gástrico, foi identificado Mycobacterium tuberculosis. Recebeu tratamento para paracoccidioidomicose e tuberculose e está há mais de 3 anos em acompanhamento, sem nenhuma seqüela. COMENTÁRIOS: O desenvolvimento da hipercalcemia sintomática, levando à lesão renal e associada a lesões ósseas múltiplas e disseminadas, nunca foi descrito em paracoccidioidomicose. Embora tenha sido diagnosticada tuberculose pulmonar, que pode estar relacionada à hipercalcemia, a forma abrupta como se instalou e como se normalizou sem o tratamento específico para tuberculose sugere que a lise óssea foi o fator mais importante na gênese da hipercalcemia.OBJECTIVE: To describe the case of a child with paracoccidioidomycosis who presented hypercalcemia with multiple

Tracheoesophageal fistula associated with paracoccidioidomicosis

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Antonio Carlos Nogueira

2011-09-01

Full Text Available Paracoccidioidomycosis is a systemic fungal disease caused byParacoccidioides brasiliensis, agent geographically distributed to certainareas of Central and South America. The infection by P. brasiliensis hasbeen reported from north Mexico to south Argentina. Paracoccidioidomycosispresents similar clinical findings of many other diseases whatever in acute or chronic scenarios. Chronic pulmonary paracoccidioidomycosis is frequentlymisdiagnosed as malignancy or tuberculosis. The authors present a caseof a 57 year-old man admitted to the hospital due to a chronic consumptivesyndrome. He underwent anti-tuberculous treatment with rifampin, isoniazid andpyrazinamide 1 year ago without resolution of the simptoms. During the clinicalinvestigation, pulmonary paracoccidioidomycosis with tracheoesophagealfistula was diagnosed. The systemic infection was treated with deoxicolate Bamphotericin followed by sulfametoxazole and trimetoprin due to acute renalfunction impairment. The fistula was endoscopically treated; inittialy with theprotection of left main bronchus with a tracheal prosthesis followed by theesophageal fistula’s ostium clipping.

Fungal Colitis by Paracoccidioides brasiliensis: a case report

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Carlos José Galeazzi

2011-12-01

Full Text Available Paracoccidioidomycosis (PBM is an infection caused by a dimorphic fungus called Paracoccidioides brasiliensis. It occurs in Latin America, with incidence of 1 to 3 per 100,000 inhabitants in endemic areas. The digestive tract is usually not affected, but when it occurs, it may lead to events similar to colorectal neoplasm and inflammatory bowel disease (IBD. This is a case report of a 68-year-old female patient, with diarrhea without blood or mucus for 6 months, weight loss of 8 kg over the period. Abdominal ultrasonography showed some mass in the right colon, suggestive of cancer and liver perihilar lymph node. Colonoscopy showed lesions suggestive of Crohn's disease. Biopsy showed chronic granulomatous colitis of fungal etiology: Paracoccidioidomycosis. The patient did not tolerate oral treatment with itraconazole and subsequently sulfadiazine, requiring hospital admission for the treatment with amphotericin B. The presence of Paracoccidioidomycosis in the digestive tract may be associated with bloody diarrhea, mucus, rectal hemorrhage, abdominal pain, malabsorption syndrome. Histopathological studies show the fungus and a chronic inflammatory infiltrate and granulation tissue. The differential diagnoses are tuberculosis, colorectal cancer and inflammatory bowel disease. The treatment is oral antifungal (itraconazole, sulfadiazine or intravenous (amphotericin B based. The case has caused diagnostic confusion between colon cancer (clinical and US and Crohn's disease (colonoscopy.Paracoccidioidomicose (PBM é uma infecção causada por um fungo dimórfico: Paracoccidioides brasiliensis. Ocorre na América Latina, com incidência de 1 a 3 por 100.000 habitantes em áreas endêmicas. O acometimento do trato digestivo é infrequente, sendo que pode levar a manifestações semelhantes à neoplasia colorretal e doença inflamatória intestinal (DII. Relatamos o caso da paciente feminina, 68 anos, com diarreia sem sangue ou muco há seis meses, com

In pulmonary paracoccidioidomycosis IL-10 deficiency leads to increased immunity and regressive infection without enhancing tissue pathology.

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Tânia A Costa

Full Text Available BACKGROUND: Cellular immunity is the main defense mechanism in paracoccidioidomycosis (PCM, the most important systemic mycosis in Latin America. Th1 immunity and IFN-γ activated macrophages are fundamental to immunoprotection that is antagonized by IL-10, an anti-inflammatory cytokine. Both in human and experimental PCM, several evidences indicate that the suppressive effect of IL-10 causes detrimental effects to infected hosts. Because direct studies have not been performed, this study was aimed to characterize the function of IL-10 in pulmonary PCM. METHODOLOGY/PRINCIPAL FINDINGS: Wild type (WT and IL-10(-/- C57BL/6 mice were used to characterize the role of IL-10 in the innate and adaptive immunity against Paracoccidioides brasiliensis (Pb infection. We verified that Pb-infected peritoneal macrophages from IL-10(-/- mice presented higher phagocytic and fungicidal activities than WT macrophages, and these activities were associated with elevated production of IFN-γ, TNF-α, nitric oxide (NO and MCP-1. For in vivo studies, IL-10(-/- and WT mice were i.t. infected with 1×10(6 Pb yeasts and studied at several post-infection periods. Compared to WT mice, IL-10(-/- mice showed increased resistance to P. brasiliensis infection as determined by the progressive control of pulmonary fungal loads and total clearance of fungal cells from dissemination organs. This behavior was accompanied by enhanced delayed-type hypersensitivity reactions, precocious humoral immunity and controlled tissue pathology resulting in increased survival times. In addition, IL-10(-/- mice developed precocious T cell immunity mediated by increased numbers of lung infiltrating effector/memory CD4(+ and CD8(+ T cells. The inflammatory reactions and the production of Th1/Th2/Th17 cytokines were reduced at late phases of infection, paralleling the regressive infection of IL-10(-/- mice. CONCLUSIONS/SIGNIFICANCE: Our work demonstrates for the first time that IL-10 plays a

Paracoctidioidomicose: atendimento a nível de assistência primária a saúde The treatment of paracoccidioidomycosis at primary health level

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Sérgio Pripas

1988-06-01

Full Text Available Discute-se o tratamento de pacientes com paracoccidioidomicose a nível de assistência primária a saúde. Foram tratados 8 pacientes no Centro de Saúde I, de São Carlos, SP (Brasil, empregando-se o cetoconazol, durante um ano, na dose de 400 mg diários, em uma única tomada. Em todos os pacientes tratados, houve remissão do quadro clínico e melhora dos exames laboratoriais. Não houve relato de efeitos colaterais. Conclui com proposta de tratamento da paracoccidioidomicose, a nível de rede básica de saúde.The treatment of paracoccidioidomycosis, with ketoconazole, at public health level is discussed. Eight patients were treated with single daily doses of 400 mg of ketoconazole for one year. The patients were treated at Health Center I in S. Carlos, Brazil. All patients treated showed clinical remission and an improvement in radiological findings. No side-effects were reported. The benefits of this treatment at Health Centers, under the administrative, social and economic aspects are stressed.

Case-Based Fault Diagnostic System

International Nuclear Information System (INIS)

Mohamed, A.H.

2014-01-01

Nowadays, case-based fault diagnostic (CBFD) systems have become important and widely applied problem solving technologies. They are based on the assumption that “similar faults have similar diagnosis”. On the other hand, CBFD systems still suffer from some limitations. Common ones of them are: (1) failure of CBFD to have the needed diagnosis for the new faults that have no similar cases in the case library. (2) Limited memorization when increasing the number of stored cases in the library. The proposed research introduces incorporating the neural network into the case based system to enable the system to diagnose all the faults. Neural networks have proved their success in the classification and diagnosis problems. The suggested system uses the neural network to diagnose the new faults (cases) that cannot be diagnosed by the traditional CBR diagnostic system. Besides, the proposed system can use the another neural network to control adding and deleting the cases in the library to manage the size of the cases in the case library. However, the suggested system has improved the performance of the case based fault diagnostic system when applied for the motor rolling bearing as a case of study

Case-Based FCTF Reasoning System

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Jing Lu

2015-10-01

Full Text Available Case-based reasoning uses old information to infer the answer of new problems. In case-based reasoning, a reasoner firstly records the previous cases, then searches the previous case list that is similar to the current one and uses that to solve the new case. Case-based reasoning means adapting old solving solutions to new situations. This paper proposes a reasoning system based on the case-based reasoning method. To begin, we show the theoretical structure and algorithm of from coarse to fine (FCTF reasoning system, and then demonstrate that it is possible to successfully learn and reason new information. Finally, we use our system to predict practical weather conditions based on previous ones and experiments show that the prediction accuracy increases with further learning of the FCTF reasoning system.

[Immunohistochemistry diagnosis of fungal infections].

Science.gov (United States)

Rocha, D C; Duarte, M I; Pagliari, C; de Oliveira, M S

1998-01-01

Because the mycosis incidence has increased a lot with the appearing of AIDS, the Immunohistochemistry study among fungus shows the importance of fast methods for their identification that have advantage of been a durable method in comparison with immunofluorescence and the possibility of making retrospective studies in material embedded in paraffin. The Immunohistochemistry reaction with Histoplasma capsulatum, Pneumocystis carinii; and Criptococcus neoformans antibodies were sensitive, specifics, and intensely positive in all the cases previously diagnosed as Histoplasmosis, Pneumocystosis and Cryptococcosis, without cross-reaction with other fungus; while the anti-Candida albicans antibody showed weak positiveness in four Histoplasmosis cases, in one of Paracoccidioidomycosis cases and Sporotrichosis case; and the reactions with the antibody anti-P. brasiliensis were intensely positive in all the Paracoccidioidomycosis cases and weakly positive in two Histoplasmosis and two of the four Candidiasis cases. The previous identification of each fungi on tissue sample was made by Grocott method. This preliminary study showed that it is necessary to use other kinds of antibody and fungus, in order to get more details about the possible occurrence of cross-reactions. We suggest the use of new antibodies, with new standardizations in order to find the best titles for each reaction and eliminate the cross-reactions.

A semi-nested PCR assay for molecular detection of Paracoccidioides brasiliensis in tissue samples Semi-nested PCR para a detecção molecular de Paracoccidioides brasiliensis em amostras de tecido

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Andrea Cristine Koishi

2010-12-01

Full Text Available INTRODUCTION: Paracoccidioidomycosis is a systemic infection caused by Paracoccidioides brasiliensis. METHODS: In this study, a semi-nested PCR for paracoccidioidomycosis diagnosis was developed. The primers ITS1 and ITS4 were used in the first reaction, while the primers MJ03 and ITS1 primer were used in the second reaction. The semi-nested PCR was used to investigate biopsies of five patients with oral lesions that resembled paracoccidioidomycosis. RESULTS: The semi-nested PCR was positive for four samples and negative for a sample from a patient later diagnosed with leishmaniasis. CONCLUSIONS: The new semi-nested PCR describe is useful for paracoccidioidomycosis diagnosis.INTRODUÇÃO: A paracoccidioidomicose é uma infecção sistêmica causada pelo Paracoccidioides brasiliensis. MÉTODOS: Neste estudo, uma semi-nested PCR foi desenvolvida para o diagnóstico da paracoccidioidomicose. Os oligonucleotídeos iniciadores ITS1 e ITS4 foram usados na primeira reação, enquanto os oligonucleotídeos iniciadores MJ03 e ITS1 foram usados na segunda reação. A semi-nested PCR foi usada para investigar biopsias de cinco pacientes com lesões orais que se assemelhavam a paracoccidioidomicose. RESULTADOS: A semi-nested PCR foi positiva para quatro amostras e negativa para a amostra de um paciente, posteriormente diagnosticado com leishmaniose. CONCLUSÕES: A semi-nested PCR descrita aqui é útil para o diagnóstico da paracoccidioidomicose.

Teaching Case: MiHotel--Applicant Processing System Design Case

Science.gov (United States)

Miller, Robert E.; Dunn, Paul

2018-01-01

This teaching case describes the functionality of an applicant processing system designed for a fictitious hotel chain. The system detailed in the case includes a webform where applicants complete and submit job applications. The system also includes a desktop application used by hotel managers and Human Resources to track applications and process…

Immunodiagnosis of paracoccidioidomycosis due to Paracoccidioides brasiliensis using a latex test: detection of specific antibody anti-gp43 and specific antigen gp43.

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Priscila Oliveira Dos Santos

2015-02-01

Full Text Available Paracoccidioidomycosis (PCM is a life-threatening systemic disease and is a neglected public health problem in many endemic regions of Latin America. Though several diagnostic methods are available, almost all of them present with some limitations.A latex immunoassay using sensitized latex particles (SLPs with gp43 antigen, the immunodominant antigen of Paracoccidioides brasiliensis, or the monoclonal antibody mAb17c (anti-gp43 was evaluated for antibody or antigen detection in sera, cerebrospinal fluid (CSF, and bronchoalveolar lavage (BAL from patients with PCM due to P. brasiliensis. The gp43-SLPs performed optimally to detect specific antibodies with high levels of sensitivity (98.46%, 95% CI 91.7-100.0, specificity (93.94%, 95% CI 87.3-97.7, and positive (91.4% and negative (98.9% predictive values. In addition, we propose the use of mAb17c-SLPs to detect circulating gp43, which would be particularly important in patients with immune deficiencies who fail to produce normal levels of immunoglobulins, achieving good levels of sensitivity (96.92%, 95% CI 89.3-99.6, specificity (88.89%, 95% CI 81.0-94.3, and positive (85.1% and negative (97.8% predictive values. Very good agreement between latex tests and double immune diffusion was observed for gp43-SLPs (k = 0.924 and mAb17c-SLPs (k = 0.850, which reinforces the usefulness of our tests for the rapid diagnosis of PCM in less than 10 minutes. Minor cross-reactivity occurred with sera from patients with other fungal infections. We successfully detected antigens and antibodies from CSF and BAL samples. In addition, the latex test was useful for monitoring PCM patients receiving therapy.The high diagnostic accuracy, low cost, reduced assay time, and simplicity of this new latex test offer the potential to be commercialized and makes it an attractive diagnostic assay for use not only in clinics and medical mycology laboratories, but mainly in remote locations with limited laboratory infrastructure

Estudo de 26 casos de Paracoccidioidomicose avaliados no Serviço de Otorrinolaringologia da Fundação Oswaldo Cruz (FIOCRUZ A study of 26 cases of Paracoccidioidomycosis evaluated at the Oswaldo Cruz Foundation (FIOCRUZ Otorhinolaryngology Service

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Francisco X. Palheta-Neto

2003-10-01

Full Text Available A Paracoccidioidomicose (PCM é uma micose profunda sistêmica causada por um fungo dimorfo, de aspecto microscópico similar a roda de leme de navio, o Paracoccidioides brasiliensis (Pb. A PCM apresenta distribuição geográfica restrita ao continente americano, acomete sobretudo indivíduos do sexo masculino, sem predileção por raça. Seu quadro clínico é bastante variado. OBJETIVO: Realizar análise epidemiológica de 26 casos de PCM avaliados no Setor de Otorrinolaringologia da Fundação Oswaldo Cruz - FIOCRUZ. FORMA DE ESTUDO: Clínico retrospectivo. MATERIAL E MÉTODO: Estudou-se retrospectivamente 26 prontuários de pacientes com manifestações otorrinolaringológicas da PCM atendidos no período de outubro de 1998 a setembro de 2001. Avaliou-se: sexo, idade, profissão, grau de escolaridade, se etilistas e/ou tabagistas, sintomatologia, local das lesões, presença de co-infecção, exames complementares realizados e opção terapêutica. RESULTADOS: 23 (88,5% pacientes eram do sexo masculino e 3 (11,5% do sexo feminino, com idade entre 32 e 72 anos. 11 (42,3% pacientes eram agricultores e 21 (80,8% tabagistas e/ou etilistas. Os locais mais comumente atingidos foram a epiglote e a parede nasal lateral. Utilizaram-se derivados sulfamídicos para o tratamento de 14 (53,9% pacientes e imidazólicos em 12 (46,1% casos. DISCUSSÃO: Lesões pulmonares podem ser confundidas com tuberculose, devido a suas semelhanças clínicas e radiográficas. A desnutrição pode predispor quadros clínicos de extrema gravidade. CONCLUSÃO: A anamnese detalhada dos pacientes portadores de PCM revela importantes aspectos, como procedência e hábitos pessoais. A atuação interdisciplinar, sobretudo de médicos e dentistas, colabora para um precoce diagnóstico e adequado acompanhamento do doente.Paracoccidioidomycosis (PCM is an acute systemic mycosis caused by a dimorphous fungus, Paracoccidioides brasiliensis (Pb, whose appearance under the

Intelligent Adaptation Process for Case Based Systems

International Nuclear Information System (INIS)

Nassar, A.M.; Mohamed, A.H.; Mohamed, A.H.

2014-01-01

Case Based Reasoning (CBR) Systems is one of the important decision making systems applied in many fields all over the world. The effectiveness of any CBR system based on the quality of the storage cases in the case library. Similar cases can be retrieved and adapted to produce the solution for the new problem. One of the main issues faced the CBR systems is the difficulties of achieving the useful cases. The proposed system introduces a new approach that uses the genetic algorithm (GA) technique to automate constructing the cases into the case library. Also, it can optimize the best one to be stored in the library for the future uses. However, the proposed system can avoid the problems of the uncertain and noisy cases. Besides, it can simply the retrieving and adaptation processes. So, it can improve the performance of the CBR system. The suggested system can be applied for many real-time problems. It has been applied for diagnosis the faults of the wireless network, diagnosis of the cancer diseases, diagnosis of the debugging of a software as cases of study. The proposed system has proved its performance in this field

Septic Systems Case Studies

Science.gov (United States)

A collection of septic systems case studies to help community planners, elected officials, health department staff, state officials, and interested citizens explore alternatives for managing their decentralized wastewater treatment systems.

Paracoccidioidomicosis asociada a otras patologías respiratorias en un hospital de Corrientes, Argentina Association of paracoccidioidomycosis with different pulmonary pathologies in a hospital in Corrientes province, Argentina

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A. M. Pato

2007-09-01

Full Text Available Se realizó la búsqueda sistemática de paracoccidioidomicosis (PCM en un conjunto de pacientes que fueron atendidos en un hospital de la ciudad de Corrientes dentro de un período de dos años. El criterio de inclusión fue: pacientes con tuberculosis (TBC, pacientes con diagnóstico presuntivo o confirmado de cáncer de pulmón (CA, pacientes con enfermedad pulmonar obstructiva crónica (EPOC y pacientes con imagen radiológica compatible con micosis pulmonar (IRXC. Se estudiaron 84 pacientes: 57 con TBC, 1 con CA, 5 con EPOC, 3 con TBC+CA, 4 con TBC+EPOC, 4 con EPOC+CA y 10 con IRXC. A todos se les realizó serología por inmunodifusión en gel de agar (IDGA y, en los casos en que se pudo obtener una muestra clínica, también se efectuaron estudios microbiológicos. Por IDGA se diagnosticaron 10 casos de PCM: 4 asociados a TBC, 1 a TBC+CA, 3 a EPOC y 2 a IRXC; 9 de ellos se corroboraron por el hallazgo del hongo. La búsqueda sistemática de PCM en habitantes del área endémica que presentan patología pulmonar favorecería el diagnóstico precoz y, por lo tanto, las posibilidades de un tratamiento eficaz.For 2 years, a systematic research of paracoccidioidomycosis (PCM had been conducted in a hospital in the city of Corrientes. The inclusion criterium used was: tuberculosis patients (TBC, presumptive or confirmed diagnosis of pulmonary cancer (CA, chronic obstructive pulmonary disease (COPD and/or X-ray images compatible with pulmonary mycosis (XRC. Eighty four patients were studied: 57 (TBC, 1 (CA, 5 (COPD, 3 (TBC+CA, 4 (TBC+COPD, 4 (COPD+CA and 10 (XRC. Serology tests by agar gel immunodiffusion (IDGA were performed on all patients, whereas microbiological studies were performed on those cases in which clinical samples could be obtained. Ten PCM were diagnosed by IDGA; 4 associated to TBC, 1 to TBC+CA, 3 to COPD and only 2 to XRC. PCM was mycologically proven in 9 of these cases. Systematic research of PCM would lead to an early

Avaliação Do Tratamento Da Paracoccidioidomicose Com O Ketoconazol Evaluation of ketoconazole in the treatment of paracoccidioidomycosis

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Jussara Marcondes

1984-04-01

Full Text Available Foram, tratados 12 doentes atendidos na Disciplina de Moléstias Infecciosas e Parasitárias da Faculdade de Medicina de Botucatu com diagnóstico etiológico de paracoccidioidomicose que apresentavam lesões orgânicas múltiplas e evolução prolongada. O tratamento foi realizado por 18 meses, com o ketoconazol, pela via oral, nas doses diárias de 400 mg no primeiro mês e de 200 mg nos meses seguintes. Todos os doentes foram acompanhados durante o tratamento e, em média 4 meses e meio após o mesmo, clínica, radiológica e sorologicamente pelas reações de imunofluorescência indireta, precipitinas e imunodifusão em gel. A competência imunitária foi avaliada em todos os doentes antes do tratamento e repetida em quatro, no final do mesmo. Os resultados mostraram que houve recaída em 5 doentes. A droga foi bem tolerada e a imunodifusão em gel e a hemossedimentação foram as provas que mostraram maior paralelismo com a evolução clínica.Twelve patients with chronical and sistemic lesions due to paracoccidioidomycosis were treated with Ketoconazole. The treatment lasted for 18 months and the Ketoconazole was ad ministered by oral route, in a once a day do sage of 400 mg during the first month and of 200 mg in the next 17 months. All patients were evaluated in the course of the treatment as well as for 135 days after the end of it, by means of clinical picture, chest X-Ray and serological tests. The immune response was observed in all patients before the treatment and in 4 of them at the end of it. Results showed that there was recrudescence in 5 patients and side effect was observed in only one patient (pruritus. The agar-gel difusion and the sedimentation rate were the laboratorial findings which paralleled the best the clinical picture.

Optimization of the Case Based Reasoning Systems

International Nuclear Information System (INIS)

Mohamed, A.H.

2014-01-01

Intrusion Detection System (IDS) have a great importance in saving the authority of the information widely spread all over the world through the networks. Many Case Based Systems concerned on the different methods of the unauthorized users/hackers that face the developers of the IDS. The proposed system introduces a new hybrid system that uses the genetic algorithm to optimize an IDS - case based system. It can detect the new anomalies appeared through the network and use the cases in the case library to determine the suitable solution for their behavior. The suggested system can solve the problem either by using an old identical solution or adapt the optimum one till have the targeted solution. The proposed system has been applied to block unauthorized users / hackers from attach the medical images for radiotherapy of the cancer diseases during their transmission through web. The proposed system can prove its accepted performance in this manner

A Database-Based and Web-Based Meta-CASE System

Science.gov (United States)

Eessaar, Erki; Sgirka, Rünno

Each Computer Aided Software Engineering (CASE) system provides support to a software process or specific tasks or activities that are part of a software process. Each meta-CASE system allows us to create new CASE systems. The creators of a new CASE system have to specify abstract syntax of the language that is used in the system and functionality as well as non-functional properties of the new system. Many meta-CASE systems record their data directly in files. In this paper, we introduce a meta-CASE system, the enabling technology of which is an object-relational database system (ORDBMS). The system allows users to manage specifications of languages and create models by using these languages. The system has web-based and form-based user interface. We have created a proof-of-concept prototype of the system by using PostgreSQL ORDBMS and PHP scripting language.

Case for real-time systems development - Quo vadis?

Science.gov (United States)

Erb, Dona M.

1991-01-01

The paper focuses on the distinctive issues of computer-aided software engineering (CASE) products for the development of real-time systems. CASE technologies and associated standardization efforts are evolving from sets of conflicting interests. The majority of case products are intended for use in the development of management information systems. CASE products to support the development of large, complex real-time systems must provide additional capabilities. Generic concerns include the quality of the implementation of the required method for the phase of the system's development and whether the vendor is stable and committed to evolving the products in parallel with nonproprietary standards. The CASE market is undergoing considerable consolidation. The paper describes the major forces, cooperating entities, and remaining uncertainties that need to be weighed in near-term CASE procurements to limit risk of loss of investment in project time, trianing, and money.

Implementing Case Tools in the Inteligent Telecommunication Systems

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Bahador Ghahramani

2003-02-01

Full Text Available This paper discusses an intelligent and Internet-based Telecommunication System Specification Model (TSSM using Computer Aided Systems Engineering tools (CASE tools. TSSM implements CASE tools to mechanize its lifecycle development maintenance and integration process. This model is developed to improve the system analysts (SA efforts in their design and development of major software and hardware initiatives. This model also improves the SA effectiveness by guiding them through the system's Lifecycle Development Process (LDP. The CASE tools are used to support, integrate, and monitor all LDP functions of the system.

Paracoccidioidomicose pulmonar: relato de caso clínico com aspetos em tomografia computorizada de alta resolução

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M. Armas

2012-07-01

Full Text Available Resumo: A Paracoccidioidomicose é uma micose sistémica endémica nas áreas rurais da América Latina, uma fonte importante de imigrantes e destino de emigração e turismo europeu, a maioria dos casos ocorrendo no Brasil, Argentina, Venezuela e Colômbia. Os autores descrevem o caso clínico de um paciente com 43 anos, anteriormente emigrado na Venezuela e residente em Portugal há 8 anos, que se apresenta com lesão cutânea isolada. Embora sem queixas relevantes do foro respiratório, apresentava extensas lesões do parênquima pulmonar caracterizadas por tomografia computorizada de alta resolução (TCAR. Foi realizada biópsia da lesão cutânea e exame micológico da expetoração que revelaram infeção por Paracoccidioides brasiliensis (PB. Abstract: Paracoccidioidomycosis is a systemic mycosis which is endemic in rural areas of Latin America, an important European source of immigrants and a growing European touristic destination as well, with most cases occurring in Brazil, Argentina, Venezuela and Colombia. The authors report a case of a 43 year old man who previously worked in Venezuela and is living in Portugal for 8 years, presenting with a single cutaneous lesion. Despite the absence of valuable respiratory complaints, severe lung damage was found with high-resolution computed tomography (HRCT. Biopsy of the cutaneous lesion and mycologic sputum examination were performed revealing Paracoccidioides brasiliensis infection. Palavras-chave: Paracoccidioidomicose, Paracoccidioides brasiliensis, Fibrose pulmonar, Tomografia computorizada de alta resolução, Keywords: Paracoccidioidomycosis, Paracoccidioides brasiliensis, Pulmonary fibrosis, High-resolution computed tomography

Enhancing Systems Engineering Education Through Case Study Writing

Science.gov (United States)

Stevens, Jennifer Stenger

2016-01-01

Developing and refining methods for teaching systems engineering is part of Systems Engineering grand challenges and agenda for research in the SE research community. Retention of systems engineering knowledge is a growing concern in the United States as the baby boom generation continues to retire and the faster pace of technology development does not allow for younger generations to gain experiential knowledge through years of practice. Government agencies, including the National Aeronautics and Space Administration (NASA), develop their own curricula and SE leadership development programs to "grow their own" systems engineers. Marshall Space Flight Center (MSFC) conducts its own Center-focused Marshall Systems Engineering Leadership Development Program (MSELDP), a competitive program consisting of coursework, a guest lecture series, and a rotational assignment into an unfamiliar organization engaged in systems engineering. Independently, MSFC developed two courses to address knowledge retention and sharing concerns: Real World Marshall Mission Success course and its Case Study Writers Workshop and Writers Experience. Teaching case study writing and leading students through a hands-on experience at writing a case study on an SE topic can enhance SE training and has the potential to accelerate the transfer of experiential knowledge. This paper is an overview of the pilot experiences with teaching case study writing, its application in case study-based learning, and identifies potential areas of research and application for case study writing in systems engineering education.

Implementing Case Tools in the Inteligent Telecommunication Systems

OpenAIRE

Bahador Ghahramani; Azad Azadmanesh

2003-01-01

This paper discusses an intelligent and Internet-based Telecommunication System Specification Model (TSSM) using Computer Aided Systems Engineering tools (CASE tools). TSSM implements CASE tools to mechanize its lifecycle development maintenance and integration process. This model is developed to improve the system analysts (SA) efforts in their design and development of major software and hardware initiatives. This model also improves the SA effectiveness by guiding them through the system's...

Isoniazid acetylating phenotype in patients with paracoccidioidomycosis and its relationship with serum sulfadoxin levels, glucose-6-phosphate dehydrogenase and glutathione reductase activities

Directory of Open Access Journals (Sweden)

Benedito Barraviera

1991-06-01

Full Text Available The authors evaluated the isoniazid acetylating phenotype and measured hematocrit, hemoglobin, glucose-6-phosphate dehydrogenase and glutathione reductase activities plus serum sulfadoxin levels in 39 patients with paracoccidioidomycosis (33 males and 6 females aged 17 to 58 years. Twenty one (53.84% of the patients presented a slow acetylatingphenotype and 18(46.16% a fast acetylating phenotype. Glucose-6-phosphate- dehydrogenase (G6PD acti vity was decreased in 5(23.80% slow acetylators and in 4(22.22% fast acetylators. Glutathione reductase activity was decreased in 14 (66.66% slow acetylators and in 12 (66.66% fast acetylators. Serum levels of free and total sulfadoxin Were higher in slow acetylator (p Os autores avaliaram o fenótipo acetilador da isoniazida, hematócrito, hemoglobina, atividade da glicose-6- fosfato desidrogenase, glutationa redutase e os níveis séricos de sulfadoxina de 39 doentes com paracoccidíoidomicose, senão 33 do sexo masculino e 6 do feminino, com idades compreendidas entre 17 e 58 anos. Vinte e um (53,84% doentes apresentaram fenótipo acetilador lento e 18 (46,16% rápido. A atividade da glicose-6-fosfato desidrogenase (G6PD esteve diminuída em 5 (23,80% acetiladores lentos e 4 (22,22% rápidos. A atividade da glutationa redutase esteve diminuída em 14 (66,66% acetiladores lentos e 12 (66,66% rápidos. Os níveis séricos de sulfadoxina livre e total foram maiores nos acetiladores lentos (p < 0,02. A análise dos resultados permite concluir que os níveis séricos de sulfadoxina relaciona-se com o fenótipo acetilador. Além disso, os níveis estiveram sempre acima de 50 µg/ml, níveis estes considerados terapêuticos. Por outro lado, a deficiência de glutationa redutase pode estar relacionada com a má absorção intestinal de nutrientes, entre eles riboflavina, vitamina precursora de FAD.

In Vitro Comparison of Activities of Terbinafine and Itraconazole against Paracoccidioides brasiliensis

Science.gov (United States)

Hahn, R. C.; Fontes, C. J. F.; Batista, R. D.; Hamdan, J. S.

2002-01-01

In vitro, terbinafine is highly active against a broad spectrum of pathogenic fungi. We evaluated the activities of terbinafine and itraconazole against 31 isolates of Paracoccidioides brasiliensis. The tests were conducted by using a broth macrodilution procedure. MICs, in micrograms per milliliter, were as follows: terbinafine, 0.015 to 1.0 (geometric mean, 0.1188); itraconazole, 0.007 to 0.5 (geometric mean, 0.03165). The usual therapy for paracoccidioidomycosis is sulfonamides, amphotericin B, and azole derivatives (ketoconazole, itraconazole, and fluconazole). In comparison to amphotericin B, azole derivatives allow shorter treatment courses, can be administered orally, and are equally effective. Itraconazole has as high efficacy as ketoconazole, but with superior tolerance. It is the current drug of choice for treatment of paracoccidioidomycosis. The data obtained in this study indicate that terbinafine is active against P. brasiliensis in vitro and suggest that this allylamine can be considered a new option as drug therapy for paracoccidioidomycosis. PMID:12149337

Long-term outcome of neuroparacoccidioidomycosis treatment

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Fabio Francesconi

2011-02-01

Full Text Available INTRODUCTION: Neuroparacoccidioidomycosis (NPCM is a term used to describe the invasion of the central nervous system by the pathogenic fungus Paracoccidioides brasiliensis. NPCM has been described sporadically in some case reports and small case series, with little or no focus on treatment outcome and long-term follow-up. METHODS: All patients with NPCM from January 1991 to December 2006 were analyzed and were followed until December 2009. RESULTS: Fourteen (3.8% cases of NPCM were identified out of 367 patients with paracoccidioidomycosis (PCM. A combination of oral fluconazole and sulfamethoxazole/trimethoprim (SMZ/TMP was the regimen of choice, with no documented death due to Paracoccidioides brasiliensis infection. Residual neurological deficits were observed in 8 patients. Residual calcification was a common finding in neuroimaging follow-up. CONCLUSIONS: All the patients in this study responded positively to the association of oral fluconazole and sulfamethoxazole/trimethoprim, a regimen that should be considered a treatment option in cases of NPCM. Neurological sequela was a relatively common finding. For proper management of these patients, anticonvulsant treatment and physical therapy support were also needed.

A SQL-Database Based Meta-CASE System and its Query Subsystem

Science.gov (United States)

Eessaar, Erki; Sgirka, Rünno

Meta-CASE systems simplify the creation of CASE (Computer Aided System Engineering) systems. In this paper, we present a meta-CASE system that provides a web-based user interface and uses an object-relational database system (ORDBMS) as its basis. The use of ORDBMSs allows us to integrate different parts of the system and simplify the creation of meta-CASE and CASE systems. ORDBMSs provide powerful query mechanism. The proposed system allows developers to use queries to evaluate and gradually improve artifacts and calculate values of software measures. We illustrate the use of the systems by using SimpleM modeling language and discuss the use of SQL in the context of queries about artifacts. We have created a prototype of the meta-CASE system by using PostgreSQL™ ORDBMS and PHP scripting language.

Teaching Case: Analysis of an Electronic Voting System

Science.gov (United States)

Thompson, Nik; Toohey, Danny

2014-01-01

This teaching case discusses the analysis of an electronic voting system. The development of the case was motivated by research into information security and management, but as it includes procedural aspects, organizational structure and personnel, it is a suitable basis for all aspects of systems analysis, planning and design tasks. The material…

Business cases for product configuration systems

DEFF Research Database (Denmark)

Shafiee, Sara; Kristjansdottir, Katrin; Hvam, Lars

In the recent years, product configuration systems (PCSs) have received greater attention from industries providing customized products as a response to increased demand to fulfil diverse customers’ needs for customized products. Before developing a PCS, a well-established business case has...... to be made in order to secure the success and delivery of the project as it will increase the commitment from the business side. This paper presents a framework for supporting the development of business cases for PCSs and discusses the experiences from multiple case studies benefiting from the suggested...

Case Studies in Library Computer Systems.

Science.gov (United States)

Palmer, Richard Phillips

Twenty descriptive case studies of computer applications in a variety of libraries are presented in this book. Computerized circulation, serial and acquisition systems in public, high school, college, university and business libraries are included. Each of the studies discusses: 1) the environment in which the system operates, 2) the objectives of…

Cyclophosphamide effect on paracoccidioidomycosis in the rat Efecto de la ciclofosfamida en ratas con paracoccidioidomicosis

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J. L. Blejer

1995-06-01

Full Text Available Paracoccidioidomycosis is an endemic fungal disease widely distributed throughout Latin America. The potent immunosuppressor cyclophosphamide (CY has been used to modulate host immune response to Paracoccidioides brasiliensis in an experimental model. Inbred male Buffalo/Sim rats weighing 250-300 g were inoculated with 5 x 10(6 P. brasiliensis cells of the yeast phase form by intracardiac route. One group of animals was treated with 20 mg/kg body weight at days +4, +5, +6, +7, +11 and +12 post-infection (pi., while a control group was infected alone. No mortality was recorded in either group. Treated rats presented: a a decrease in granuloma size, which contained less fungal cells; b a lack of specific antibodies up to 35 days pi., and c a significant increase in the footpad swelling test (DTH against paracoccidioidin. Splenic cell transfer from CY-treated P. brasiliensis-infected donors to recipients infected alone led to a significant increase in DTH response in the latter versus untreated infected controls. Likewise, in treated infected recipients transferred with untreated infected donor spleen cells, footpad swelling proved greater than in controls. Thus, it would seem that each successive suppressor T lymphocyte subset belonging to the respective cascade may be sensitive to repeated CY doses administered up to 12 days pi.. Alternatively, such CY schedule may induce the appearance of a T cell population capable of amplifying DTH response.La paracoccidioidomicosis es una enfermedad endémica fúngica ampliamente distribuida en Latino-América. La ciclofosfamida ha sido usada como potente inmunosupresor para modular la respuesta inmune, en un modelo experimental infectado con Paracoccidioides brasiliensis. Ratas machos Buffalo/Sim endocriadas de 250-300 gr. de peso, fueron inoculadas por via intracardiaca con 5.10 6 células de P. brasiliensis en fase levaduriforme. Un grupo de animales fue tratado con 20 mg/kg de peso de ciclofosfamida en

Case Report: An atypical case of systemic lupus erythematosus ...

African Journals Online (AJOL)

Background: Systemic lupus erythematosus (SLE) is a multisystem disease that can be a diagnostic conundrum. Case report: We describe a patient who presented with recurrent fleeting exudative and hemorrhagic pleural effusion. It took multiple visits over 3 months and renal biopsy to con rm the diagnosis of SLE.

Information system governance in Moroccan universities: case of ...

African Journals Online (AJOL)

Information system governance in Moroccan universities: case of student ... contribution of these systems to the overall performance of an organizational being. ... Keywords: Information System; Governance; Data Quality, Process Quality ...

Case-control study of gadodiamide-related nephrogenic systemic fibrosis

DEFF Research Database (Denmark)

Marckmann, Peter; Skov, Lone; Rossen, Kristian

2007-01-01

exposed to gadodiamide develop nephrogenic systemic fibrosis. METHODS: We conducted a case-control study of 19 histologically verified cases and 19 sex- and age-matched controls. All subjects had chronic renal failure when exposed to gadodiamide. Clinical, biochemical and pharmacological data were.......02). CONCLUSIONS: Increasing cumulative gadodiamide exposure, high-dose epoietin-beta treatment, and higher serum concentrations of ionized calcium and phosphate increase the risk of gadodiamide-related nephrogenic systemic fibrosis in renal failure patients. Severe cases seem to develop primarily among patients......BACKGROUND: Nephrogenic systemic fibrosis may be caused by gadolinium (Gd)-containing magnetic resonance imaging contrast agents. Most reported cases were associated with one particular agent, gadodiamide. Yet, unidentified cofactors might explain why only a minority of renal failure patients...

Guidelines for Conducting Positivist Case Study Research in Information Systems

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Graeme Shanks

2002-11-01

Full Text Available The case study research approach is widely used in a number of different ways within the information systems community. This paper focuses on positivist, deductive case study research in information systems. It provides clear definitions of important concepts in positivist case study research and illustrates these with an example research study. A critical analysis of the conduct and outcomes of two recently published positivist case studies is reported. One is a multiple case study that validated concepts in a framework for viewpoint development in requirements definition. The other is a single case study that examined the role of social enablers in enterprise resource planning systems implementation. A number of guidelines for successfully undertaking positivist case study research are identified including developing a clear understanding of key concepts and assumptions within the positivist paradigm; providing clear and unambiguous definitions of the units and interactions when using any theory; carefully defining the boundary of the theory used in the case study; using hypotheses rather than propositions in the empirical testing of theory; using fuzzy or probabilistic propositions in recognising that reality can never be perfectly known; selecting case studies carefully, particularly single case studies; and recognising that generalisation from positivist, single case studies is inherently different from generalisation from single experiments. When properly undertaken, positivist, deductive case study research is a valuable research approach for information systems researchers, particularly when used within pluralist research programs that use a number of different research approaches from different paradigms.

[Research and development of medical case database: a novel medical case information system integrating with biospecimen management].

Science.gov (United States)

Pan, Shiyang; Mu, Yuan; Wang, Hong; Wang, Tong; Huang, Peijun; Ma, Jianfeng; Jiang, Li; Zhang, Jie; Gu, Bing; Yi, Lujiang

2010-04-01

To meet the needs of management of medical case information and biospecimen simultaneously, we developed a novel medical case information system integrating with biospecimen management. The database established by MS SQL Server 2000 covered, basic information, clinical diagnosis, imaging diagnosis, pathological diagnosis and clinical treatment of patient; physicochemical property, inventory management and laboratory analysis of biospecimen; users log and data maintenance. The client application developed by Visual C++ 6.0 was used to implement medical case and biospecimen management, which was based on Client/Server model. This system can perform input, browse, inquest, summary of case and related biospecimen information, and can automatically synthesize case-records based on the database. Management of not only a long-term follow-up on individual, but also of grouped cases organized according to the aim of research can be achieved by the system. This system can improve the efficiency and quality of clinical researches while biospecimens are used coordinately. It realizes synthesized and dynamic management of medical case and biospecimen, which may be considered as a new management platform.

Signal Analysis of Automotive Engine Spark Ignition System using Case-Based Reasoning (CBR) and Case-based Maintenance (CBM)

International Nuclear Information System (INIS)

Huang, H.; Vong, C. M.; Wong, P. K.

2010-01-01

With the development of modern technology, modern vehicles adopt electronic control system for injection and ignition. In traditional way, whenever there is any malfunctioning in an automotive engine, an automotive mechanic usually performs a diagnosis in the ignition system of the engine to check any exceptional symptoms. In this paper, we present a case-based reasoning (CBR) approach to help solve human diagnosis problem. Nevertheless, one drawback of CBR system is that the case library will be expanded gradually after repeatedly running the system, which may cause inaccuracy and longer time for the CBR retrieval. To tackle this problem, case-based maintenance (CBM) framework is employed so that the case library of the CBR system will be compressed by clustering to produce a set of representative cases. As a result, the performance (in retrieval accuracy and time) of the whole CBR system can be improved.

Hybrid case-neural network (CNN) diagnostic system

International Nuclear Information System (INIS)

Mohamed, A.H.

2010-01-01

recently, the mobile health care has a great attention for the researcher and people all over the world. Case based reasoning (CBR) systems have proved their performance as world wide web (WWW) medical diagnostic systems. They were preferred rather than different reasoning approaches due to their high performance and results' explanation. But, their operations require a complex knowledge acquisition and management processes. On the other hand, it is found that, artificial neural network (ANN) has a great acceptance as a classifier methodology using a little amount of knowledge. But, ANN lacks of an explanation capability .The present research introduces a new web-based hybrid diagnostic system that can use the ANN inside the CBR , cycle.It can provide higher performance for the web diagnostic systems. Besides, the proposed system can be used as a web diagnostic system. It can be applied for diagnosis different types of systems in several domains. It has been applied in diagnosis of the cancer diseases that has a great spreading in recent years as a case of study . However, the suggested system has proved its acceptance in the manner.

Interactive Russian Grammar: The Case System

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Rimma Gam

2009-01-01

Full Text Available My paper addresses a problem many of us in North American college language programs confront regularly, the solution to which regularly and frustratingly remains just out of our reach. I refer to the teaching of the most basic and most crucial element of Russian grammar, namely, its case system, and teaching it to our students whose native language, English, does not have such a system. As I teach the Russian cases, I see vividly the disconnect between grammar presented for students (simplified, episodic, based on the "pick it up along the way" principle and the learned papers on Russian grammar by linguists, which are barely comprehensible to a non-linguist. Materials in the middle are lacking-materials to help a literature professor acting as a "de facto" language instructor understand and address the needs of students as they learn this crucial segment of basic Russian grammar. This core element of Russian grammar is presented to students in the first year of college language study, is revisited in the second year, and very often by the third year students either manage to completely block it out from their memory (as if it were some traumatic experience that happened "a long time ago"-that is, before .summer break-but most importantly due to the lack of practice or demonstrate a partial or even complete lack of understanding or misunderstanding of this system forcing us to deal with it again in the third year. Not only is it frustrating for both the students and the language instructor; but from the point of view of their overall proficiency, the lack of control of the case system holds our students back. There can be no talk of advanced language proficiency without a complete and automatic mastery of this basic system. Unfortunately, regardless of the specific textbooks used, the students very often manage not to have a general idea and mastery of this system even by the third year of study.

Exploring the business case for ambulatory electronic health record system adoption.

Science.gov (United States)

Song, Paula H; McAlearney, Ann Scheck; Robbins, Julie; McCullough, Jeffrey S

2011-01-01

Widespread implementation and use of electronic health record (EHR) systems has been recognized by healthcare leaders as a cornerstone strategy for systematically reducing medical errors and improving clinical quality. However, EHR adoption requires a significant capital investment for healthcare providers, and cost is often cited as a barrier. Despite the capital requirements, a true business case for EHR system adoption and implementation has not been made. This is of concern, as the lack of a business case can influence decision making about EHR investments. The purpose of this study was to examine the role of business case analysis in healthcare organizations' decisions to invest in ambulatory EHR systems, and to identify what factors organizations considered when justifying an ambulatory EHR. Using a qualitative case study approach, we explored how five organizations that are considered to have best practices in ambulatory EHR system implementation had evaluated the business case for EHR adoption. We found that although the rigor of formal business case analysis was highly variable, informants across these organizations consistently reported perceiving that a positive business case for EHR system adoption existed, especially when they considered both financial and non-financial benefits. While many consider EHR system adoption inevitable in healthcare, this viewpoint should not deter managers from conducting a business case analysis. Results of such an analysis can inform healthcare organizations' understanding about resource allocation needs, help clarify expectations about financial and clinical performance metrics to be monitored through EHR systems, and form the basis for ongoing organizational support to ensure successful system implementation.

Digital case-based learning system in school.

Science.gov (United States)

Gu, Peipei; Guo, Jiayang

2017-01-01

With the continuing growth of multi-media learning resources, it is important to offer methods helping learners to explore and acquire relevant learning information effectively. As services that organize multi-media learning materials together to support programming learning, the digital case-based learning system is needed. In order to create a case-oriented e-learning system, this paper concentrates on the digital case study of multi-media resources and learning processes with an integrated framework. An integration of multi-media resources, testing and learning strategies recommendation as the learning unit is proposed in the digital case-based learning framework. The learning mechanism of learning guidance, multi-media materials learning and testing feedback is supported in our project. An improved personalized genetic algorithm which incorporates preference information and usage degree into the crossover and mutation process is proposed to assemble the personalized test sheet for each learner. A learning strategies recommendation solution is proposed to recommend learning strategies for learners to help them to learn. The experiments are conducted to prove that the proposed approaches are capable of constructing personalized sheets and the effectiveness of the framework.

Digital case-based learning system in school.

Directory of Open Access Journals (Sweden)

Peipei Gu

Full Text Available With the continuing growth of multi-media learning resources, it is important to offer methods helping learners to explore and acquire relevant learning information effectively. As services that organize multi-media learning materials together to support programming learning, the digital case-based learning system is needed. In order to create a case-oriented e-learning system, this paper concentrates on the digital case study of multi-media resources and learning processes with an integrated framework. An integration of multi-media resources, testing and learning strategies recommendation as the learning unit is proposed in the digital case-based learning framework. The learning mechanism of learning guidance, multi-media materials learning and testing feedback is supported in our project. An improved personalized genetic algorithm which incorporates preference information and usage degree into the crossover and mutation process is proposed to assemble the personalized test sheet for each learner. A learning strategies recommendation solution is proposed to recommend learning strategies for learners to help them to learn. The experiments are conducted to prove that the proposed approaches are capable of constructing personalized sheets and the effectiveness of the framework.

Case prediction in BPM systems : a research challenge

NARCIS (Netherlands)

Reijers, H.A.

2007-01-01

The capabilities of Business Process Management Systems (BPMS's) are continuously extended to increase the effectiveness of the management and enactment of business processes. This paper identifies the challenge of case prediction, which for a specific case under the control of a BPMS deals with the

Intelligent Case Based Decision Support System for Online Diagnosis of Automated Production System

International Nuclear Information System (INIS)

Ben Rabah, N; Saddem, R; Carre-Menetrier, V; Ben Hmida, F; Tagina, M

2017-01-01

Diagnosis of Automated Production System (APS) is a decision-making process designed to detect, locate and identify a particular failure caused by the control law. In the literature, there are three major types of reasoning for industrial diagnosis: the first is model-based, the second is rule-based and the third is case-based. The common and major limitation of the first and the second reasonings is that they do not have automated learning ability. This paper presents an interactive and effective Case Based Decision Support System for online Diagnosis (CB-DSSD) of an APS. It offers a synergy between the Case Based Reasoning (CBR) and the Decision Support System (DSS) in order to support and assist Human Operator of Supervision (HOS) in his/her decision process. Indeed, the experimental evaluation performed on an Interactive Training System for PLC (ITS PLC) that allows the control of a Programmable Logic Controller (PLC), simulating sensors or/and actuators failures and validating the control algorithm through a real time interactive experience, showed the efficiency of our approach. (paper)

Higher education provision using systems thinking approach - case studies

Science.gov (United States)

Dhukaram, Anandhi Vivekanandan; Sgouropoulou, Cleo; Feldman, Gerald; Amini, Ardavan

2018-01-01

The purpose of this paper is to highlight the complexities involved in higher education provision and how systems thinking and socio-technical systems (STS) thinking approach can be used to understand the education ecosystem. Systems thinking perspective is provided using two case studies: the development of European Learner Mobility (EuroLM) service and the delivery of Enterprise System Management (ESM) course at the Birmingham City University, UK. The case studies present how systems thinking using STS approaches like applied organisational change and Cognitive Work Analysis can be used to capture a conceptual model of the education system for understanding the interactions and relationships between the people, technology, processes and the organisations. Using systems thinking perspective, EuroLM has developed a set of technical standards addressed to the European systems developers and ESM delivery ensures that students communicate and collaborate.

Case report 561: Systemic mastocytosis

Energy Technology Data Exchange (ETDEWEB)

Schweitzer, M.E.; Irwin, G.A.L. (Nassau County Medical Center, East Meadow, NY (USA). Dept. of Radiology)

1989-08-01

A case is presented of a 55-year-old man with systemic mastocytosis. CT studies showed mesenteric and retroperetoneal lymphadenopathy, hepatosplenomegaly and sclerotic lesions of lumbar vertebrae. Lesions of the skin were absent. Pathological studies of lymph nodes indicated the presence of mastocytosis. The clinical, radiological and pathological features of this disorder and its five forms were discussed. Prognosis and treatment were also considered. (orig./GDG).

Preliminary consideration of CFETR ITER-like case diagnostic system.

Science.gov (United States)

Li, G S; Yang, Y; Wang, Y M; Ming, T F; Han, X; Liu, S C; Wang, E H; Liu, Y K; Yang, W J; Li, G Q; Hu, Q S; Gao, X

2016-11-01

Chinese Fusion Engineering Test Reactor (CFETR) is a new superconducting tokamak device being designed in China, which aims at bridging the gap between ITER and DEMO, where DEMO is a tokamak demonstration fusion reactor. Two diagnostic cases, ITER-like case and towards DEMO case, have been considered for CFETR early and later operating phases, respectively. In this paper, some preliminary consideration of ITER-like case will be presented. Based on ITER diagnostic system, three versions of increased complexity and coverage of the ITER-like case diagnostic system have been developed with different goals and functions. Version A aims only machine protection and basic control. Both of version B and version C are mainly for machine protection, basic and advanced control, but version C has an increased level of redundancy necessary for improved measurements capability. The performance of these versions and needed R&D work are outlined.

Preliminary consideration of CFETR ITER-like case diagnostic system

International Nuclear Information System (INIS)

Li, G. S.; Liu, Y. K.; Gao, X.; Yang, Y.; Wang, Y. M.; Ming, T. F.; Han, X.; Liu, S. C.; Wang, E. H.; Yang, W. J.; Li, G. Q.; Hu, Q. S.

2016-01-01

Chinese Fusion Engineering Test Reactor (CFETR) is a new superconducting tokamak device being designed in China, which aims at bridging the gap between ITER and DEMO, where DEMO is a tokamak demonstration fusion reactor. Two diagnostic cases, ITER-like case and towards DEMO case, have been considered for CFETR early and later operating phases, respectively. In this paper, some preliminary consideration of ITER-like case will be presented. Based on ITER diagnostic system, three versions of increased complexity and coverage of the ITER-like case diagnostic system have been developed with different goals and functions. Version A aims only machine protection and basic control. Both of version B and version C are mainly for machine protection, basic and advanced control, but version C has an increased level of redundancy necessary for improved measurements capability. The performance of these versions and needed R&D work are outlined.

Making System Dynamics Cool IV : Teaching & Testing with Cases & Quizzes

NARCIS (Netherlands)

Pruyt, E.

2012-01-01

This follow-up paper presents cases and multiple choice questions for teaching and testing System Dynamics modeling. These cases and multiple choice questions were developed and used between January 2012 and April 2012 a large System Dynamics course (250+ 2nd year BSc and 40+ MSc students per year)

Making System Dynamics Cool III : New Hot Teaching & Testing Cases

NARCIS (Netherlands)

Pruyt, E.

2011-01-01

This follow-up paper presents seven actual cases for testing and teaching System Dynamics developed and used between January 2010 and January 2011 for one of the largest System Dynamics courses (250+ students per year) at Delft University of Technology in the Netherlands. The cases presented in this

Willowglen Systems Inc. : 8 case studies

Energy Technology Data Exchange (ETDEWEB)

NONE

2010-07-01

The various supervisory control and data acquisition (SCADA) systems designed by Willowglen Systems Inc. were described. The company provides custom SCADA technology products, automation systems, and technical services for various applications. Their remote terminal units (RTUs) were designed to have a very low power consumption rate, and can be operated from any power source. The company has also designed integrated metering and communications solutions for remote locations. The following 8 case studies of Willowglen System solutions were highlighted: (1) a SCADA system designed for the Northwest Territories Power Corporation, (2) a system of RTUs installed at the Shell Canada Ltd. Caroline Gas Complex, (3) a SCADA system designed to monitor a natural gas pipeline, (4) a SCADA system designed to monitor a transmission pipeline and distribution system in Singapore, (5) RTUs designed to monitor gas dehydration units in Bahrain, (6) a SCADA system designed for a refined petroleum products pipeline, (7) a SCADA system installed at an electric power utility in New Brunswick, and (8) a tank gauging system designed for a large oil refinery in Alberta. 7 figs.

Evaluating performance of local case-mix system by international comparison: a case study in Beijing, China.

Science.gov (United States)

Jian, Wei-Yan; Lu, Ming; Cui, Tao; Hu, Mu

2011-01-01

Case-mix is an important tool for health planning and management in many countries. As a major developing country, China is considering the introduction of the case-mix system in the health reform. Beijing, the capital of China, developed a local case-mix version whose performance needs to be evaluated before utilization. The objective of this study was to evaluate the performance of the case-mix system developed in Beijing by comparing it with those used in Australia and the U.S.A. A total of 1.3 million inpatient records from 154 hospitals in Beijing in 2008 were grouped respectively using three case-mix systems: (i) Beijing Diagnosis Related Groups (BJ-DRGs); (ii) US-based All Patient DRGs; and (iii) Australian Refined DRGs. Coefficient of variation (CV) and reduction in variance (RIV) were used to measure the performance of DRGs system. The BJ-DRGs produced the best CV and RIV results for expenditure. However, at the level of Major Diagnostic Category (MDC), three MDCs of BJ-DRGs gave the poorest RIVs for both expenditure and length of stay. Although the performance of BJ-DRGs was acceptable, further revision and improvement is needed. Comparisons with other mature DRGs versions can assist in identifying the improvement priorities of the local version. Copyright © 2011 John Wiley & Sons, Ltd.

Anthropocentric language theory and Serbian case systems

Directory of Open Access Journals (Sweden)

Topolinjska Zuzana

2002-01-01

Full Text Available The author understands case as a relationship of syntactic dependence between a subordinated noun phrase and the governing syntactic construction (predicative expression and/or another noun phrase. The above definition construes case as a universal category characteristics of all the languages sharing the nomen vs verbum opposition. Particular cases are conceived as primarily semantically motivated. The two relevant semantic parameters are /+/ -human / (or /+/ -animated/ and /+/ -localized/, i. e. - in other words - the so-called hierarchy of animateness and the spatial location of the objects that the corresponding noun phrases refer to. N and D are being characterized as /+ hum/, A and I as /-hum/ and L as belonging to another semantic paradigm is defined simply as /+ loc/. Results of the analyses of morphological syncretism's and of syntactic exponents of the NPs-dependence found in Serbian case systems support the above tentative interpretation of the case as a (semantic and syntactic category.

Fire protection in ventilation systems and in case of fire operating ventilation systems

International Nuclear Information System (INIS)

Zitzelsberger, J.

1983-01-01

The fire risks in ventilation systems are discussed. It follows a survey of regulations on fire prevention and fire protection in ventilation systems and smoke and heat exhaust systems applicable to nuclear installations in the Federal Republic of Germany. Fire protection concepts for normal systems and for systems operating also in case of fire will be given. Several structural elements for fire protection in those systems will be illustrated with regard to recent research findings

Geothermal systems: Principles and case histories

Science.gov (United States)

Rybach, L.; Muffler, L. J. P.

The classification of geothermal systems is considered along with the geophysical and geochemical signatures of geothermal systems, aspects of conductive heat transfer and regional heat flow, and geothermal anomalies and their plate tectonic framework. An investigation of convective heat and mass transfer in hydrothermal systems is conducted, taking into account the mathematical modelling of hydrothermal systems, aspects of idealized convective heat and mass transport, plausible models of geothermal reservoirs, and preproduction models of hydrothermal systems. Attention is given to the prospecting for geothermal resources, the application of water geochemistry to geothermal exploration and reservoir engineering, heat extraction from geothermal reservoirs, questions of geothermal resource assessment, and environmental aspects of geothermal energy development. A description is presented of a number of case histories, taking into account the low enthalpy geothermal resource of the Pannonian Basin in Hungary, the Krafla geothermal field in Northeast Iceland, the geothermal system of the Jemez Mountains in New Mexico, and extraction-reinjection at the Ahuachapan geothermal field in El Salvador.

Case report 369: Systemic mastocytosis

Energy Technology Data Exchange (ETDEWEB)

Rodenberg, J.C.; Maegaard, K.K.; Svanholm, H.

1986-05-01

In summary, the case of a 58-year-old woman with upper gastrointestinal symptoms and a reddish-brown skin rash over a number of years has been presented. Biopsies from various sites, including bone marrow, were negative initially. A repeat cutaneous biopsy demonstrated the presence of systemic mastocytis. The characteristic clinical and radiological aspects of mastocytosis were described and the pathological features also were considered. A relevant differential diagnosis of the sclerotic form of mastocytosis was presented.

Case Report: Systemic Lupus Erythematosus Presenting as Acute ...

African Journals Online (AJOL)

We hereby report a case of a 20 year‑old female who presented to us in an acute hypoadrenal state and was found to have Systemic lupus erythematosus with renal involvement. Patient was successfully managed with steroids and improved clinically. Keywords: Addison's disease, Autoimmune diseases, Systemic lupus ...

Implementation of hybrid parallel kanban-CONWIP system: A case study

Directory of Open Access Journals (Sweden)

Joshua Prakash

2014-12-01

Full Text Available The most common form of production control strategy in lean management is the pull system. One emerging form of pull system uses kanban and CONWIP systems to handle products with different demand patterns. Case studies have protractedly depicted the actual implementation of pull systems; however, the use of hybrid systems is rare. This paper examines the procedures involved in implementing a hybrid system in a low variety/low volume shop floor. This paper presents discussions on shop floor constraints in the proposed system and how the simplicity of a pull system is able to reduce work-in-process inventory by 23%. Guidelines for the replication of the system for similar production environments are also provided. The case study proves that pull systems can be successfully implemented in production environments that do not conform to the typical prerequisites of the kanban system.

A Unique Case of Systemic Lupus Erythematosus Pelvic Vasculitis

Directory of Open Access Journals (Sweden)

Pamela Traisak

2016-01-01

Full Text Available The clinical presentation of Systemic Lupus Erythematosus (SLE is diverse and vasculitis can be a potential manifestation. Cutaneous lesions involving small vessels are the most frequent presentation. However, medium and large vessel vasculitis may present with life-threatening visceral manifestations. We present a unique case of pelvic vasculitis mimicking a pelvic mass as an initial presentation of SLE. There are case reports of systemic vasculitis involving the female genital tract with giant cell arteritis (GCA, polyarteritis nodosa (PAN, and granulomatous with polyangiitis and microscopic polyangiitis (GPA/MPA, among others, but only a few cases attributed to SLE. Awareness of this condition and a prompt diagnosis are warranted as this is a severe and potentially life-threatening condition.

Analysis and Perspective from the Complex Aerospace Systems Exchange (CASE) 2013

Science.gov (United States)

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

2014-01-01

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

Systemic mastocytosis: Case report with literature review

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Mitrović Mirjana

2012-01-01

Full Text Available Introduction. Mastocytosis is a clonal neoplastic disorder of the mast cells. The clinical signs and symptoms of mastocytosis are heterogeneous ranging from indolent disease with a longterm survival to a highly aggressive neoplasm with survival of about 6 months. Systemic mastocytosis (SM is characterized by mastocyte infiltration of one or more organs, with or without skin involvment. Case Outline. The presented patient presents a highly challenging diagnostic and therapeutic case. A 46-year-old man was referred to our Centre due to the 7-year-long history of hepatosplenomegaly and mild thrombocytopenia. Ultrasound examination showed hepatosplenomegaly (liver 170 mm; spleen 200 mm, platelet count was 90Č109/L, serum tryptase level was elevated and bone marrow biopsy showed infiltration with mast cells (CD117, CD25 and mast cell tryptase positive. Our patient was diagnosed with aggressive systemic mastocytosis (SM according to WHO Classification (2008, although the clinical course of the disease was indolent, without complications for more than 7 years. Because of the ‘intermediate’ course, this patient was referred to as smouldering or intermediate SM and was not treated with cytostatics. Conclusion. Utilizing the established criteria, indolent SM can be discriminated from the aggressive subvariants of SM in most cases. However, a small group of patients, like our case belongs to the „grey zone“. Therapeutic approach to these patients is individual and prognosis is uncertain.

Decision making under risk in the case of nuclear power system development

International Nuclear Information System (INIS)

Pavelescu, M.; Szakats, A.; Ursu, I.

1981-01-01

The theory of risk preference as applied to decision making in the case of a nuclear power system consisting of PHWRs and PWRs integrated with LMFBRs, is examined. An econometric model of the system offers the cost price of annual energy generated by the system at the end of a given time interval for every possible state of any of nine development alternatives. Optimal development alternatives of the nuclear system in three cases: risk-preference, risk-indifference and risk-aversion are obtained and the solution in the last case is discussed in detail. (U.K.)

Case study field evaluation of a systems approach to retrofitting a residential HVAC system

Energy Technology Data Exchange (ETDEWEB)

Walker, Iain S.; McWiliams, Jennifer A.; Konopacki, Steven J.

2003-09-01

This case study focusing on a residence in northern California was undertaken as a demonstration of the potential of a systems approach to HVAC retrofits. The systems approach means that other retrofits that can affect the HVAC system are also considered. For example, added building envelope insulation reduces building loads so that smaller capacity HVAC system can be used. Secondly, we wanted to examine the practical issues and interactions with contractors and code officials required to accomplish the systems approach because it represents a departure from current practice. We identified problems in the processes of communication and installation of the retrofit that led to compromises in the final energy efficiency of the HVAC system. These issues must be overcome in order for HVAC retrofits to deliver the increased performance that they promise. The experience gained in this case study was used to optimize best practices guidelines for contractors (Walker 2003) that include building diagnostics and checklists as tools to assist in ensuring the energy efficiency of ''house as a system'' HVAC retrofits. The best practices guidelines proved to be an excellent tool for evaluating the eight existing homes in this study, and we received positive feedback from many potential users who reviewed and used them. In addition, we were able to substantially improve the energy efficiency of the retrofitted case study house by adding envelope insulation, a more efficient furnace and air conditioner, an economizer and by reducing duct leakage.

C++ and operating systems performance - A case study

Science.gov (United States)

Russo, Vincent F.; Madany, Peter W.; Campbell, Roy H.

1990-01-01

Object-oriented design and programming has many software engineering advantages. Its application to large systems, however, has previously been constrained by performance concerns. The Choices operating system, which has over 75,000 lines of code, is object-oriented and programmed in C++. This paper is a case study of the performance of Choices.

Systemic Case Formulation, Individualized Process Monitoring, and State Dynamics in a Case of Dissociative Identity Disorder.

Science.gov (United States)

Schiepek, Günter K; Stöger-Schmidinger, Barbara; Aichhorn, Wolfgang; Schöller, Helmut; Aas, Benjamin

2016-01-01

Objective: The aim of this case report is to demonstrate the feasibility of a systemic procedure (synergetic process management) including modeling of the idiographic psychological system and continuous high-frequency monitoring of change dynamics in a case of dissociative identity disorder. The psychotherapy was realized in a day treatment center with a female client diagnosed with borderline personality disorder (BPD) and dissociative identity disorder. Methods: A three hour long co-creative session at the beginning of the treatment period allowed for modeling the systemic network of the client's dynamics of cognitions, emotions, and behavior. The components (variables) of this idiographic system model (ISM) were used to create items for an individualized process questionnaire for the client. The questionnaire was administered daily through an internet-based monitoring tool (Synergetic Navigation System, SNS), to capture the client's individual change process continuously throughout the therapy and after-care period. The resulting time series were reflected by therapist and client in therapeutic feedback sessions. Results: For the client it was important to see how the personality states dominating her daily life were represented by her idiographic system model and how the transitions between each state could be explained and understood by the activating and inhibiting relations between the cognitive-emotional components of that system. Continuous monitoring of her cognitions, emotions, and behavior via SNS allowed for identification of important triggers, dynamic patterns, and psychological mechanisms behind seemingly erratic state fluctuations. These insights enabled a change in management of the dynamics and an intensified trauma-focused therapy. Conclusion: By making use of the systemic case formulation technique and subsequent daily online monitoring, client and therapist continuously refer to detailed visualizations of the mental and behavioral network and

Systemic Case Formulation, Individualized Process Monitoring, and State Dynamics in a Case of Dissociative Identity Disorder.

Directory of Open Access Journals (Sweden)

Guenter Karl Schiepek

2016-10-01

Full Text Available Objective. The aim of this case report is to demonstrate the feasibility of a systemic procedure (synergetic process management including modeling of the idiographic psychological system and continuous high-frequency monitoring of change dynamics in a case of dissociative identity disorder. The psychotherapy was realized in a day treatment center with a female client diagnosed with borderline personality disorder (BPD and dissociative identity disorder. Methods. A three hour long co-creative session at the beginning of the treatment period allowed for modeling the systemic network of the client’s dynamics of cognitions, emotions, and behavior. The components (variables of this idiographic system model (ISM were used to create items for an individualized process questionnaire for the client. The questionnaire was administered daily through an internet-based monitoring tool (Synergetic Navigation System, SNS, to capture the client’s individual change process continuously throughout the therapy and after-care period. The resulting time series were reflected by therapist and client in therapeutic feedback sessions. Results. For the client it was important to see how the personality states dominating her daily life were represented by her idiographic system model and how the transitions between each state could be explained and understood by the activating and inhibiting relations between the cognitive-emotional components of that system. Continuous monitoring of her cognitions, emotions, and behavior via SNS allowed for identification of important triggers, dynamic patterns, and psychological mechanisms behind seemingly erratic state fluctuations. These insights enabled a change in management of the dynamics and an intensified trauma-focused therapy. Conclusion. By making use of the systemic case formulation technique and subsequent daily online monitoring, client and therapist continuously refer to detailed visualizations of the mental and

A Study on Satellite Diagnostic Expert Systems Using Case-Based Approach

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Young-Tack Park

1997-06-01

Full Text Available Many research works are on going to monitor and diagnose diverse malfunctions of satellite systems as the complexity and number of satellites increase. Currently, many works on monitoring and diagnosis are carried out by human experts but there are needs to automate much of the routine works of them. Hence, it is necessary to study on using expert systems which can assist human experts routine work by doing automatically, thereby allow human experts devote their expertise more critical and important areas of monitoring and diagnosis. In this paper, we are employing artificial intelligence techniques to model human experts' knowledge and inference the constructed knowledge. Especially, case-based approaches are used to construct a knowledge base to model human expert capabilities which use previous typical exemplars. We have designed and implemented a prototype case-based system for diagnosing satellite malfunctions using cases. Our system remembers typical failure cases and diagnoses a current malfunction by indexing the case base. Diverse methods are used to build a more user friendly interface which allows human experts can build a knowledge base in as easy way.

Retrieval with Clustering in a Case-Based Reasoning System for Radiotherapy Treatment Planning

Science.gov (United States)

Khussainova, Gulmira; Petrovic, Sanja; Jagannathan, Rupa

2015-05-01

Radiotherapy treatment planning aims to deliver a sufficient radiation dose to cancerous tumour cells while sparing healthy organs in the tumour surrounding area. This is a trial and error process highly dependent on the medical staff's experience and knowledge. Case-Based Reasoning (CBR) is an artificial intelligence tool that uses past experiences to solve new problems. A CBR system has been developed to facilitate radiotherapy treatment planning for brain cancer. Given a new patient case the existing CBR system retrieves a similar case from an archive of successfully treated patient cases with the suggested treatment plan. The next step requires adaptation of the retrieved treatment plan to meet the specific demands of the new case. The CBR system was tested by medical physicists for the new patient cases. It was discovered that some of the retrieved cases were not suitable and could not be adapted for the new cases. This motivated us to revise the retrieval mechanism of the existing CBR system by adding a clustering stage that clusters cases based on their tumour positions. A number of well-known clustering methods were investigated and employed in the retrieval mechanism. Results using real world brain cancer patient cases have shown that the success rate of the new CBR retrieval is higher than that of the original system.

Retrieval with Clustering in a Case-Based Reasoning System for Radiotherapy Treatment Planning

International Nuclear Information System (INIS)

Khussainova, Gulmira; Petrovic, Sanja; Jagannathan, Rupa

2015-01-01

Radiotherapy treatment planning aims to deliver a sufficient radiation dose to cancerous tumour cells while sparing healthy organs in the tumour surrounding area. This is a trial and error process highly dependent on the medical staff's experience and knowledge. Case-Based Reasoning (CBR) is an artificial intelligence tool that uses past experiences to solve new problems. A CBR system has been developed to facilitate radiotherapy treatment planning for brain cancer. Given a new patient case the existing CBR system retrieves a similar case from an archive of successfully treated patient cases with the suggested treatment plan. The next step requires adaptation of the retrieved treatment plan to meet the specific demands of the new case. The CBR system was tested by medical physicists for the new patient cases. It was discovered that some of the retrieved cases were not suitable and could not be adapted for the new cases. This motivated us to revise the retrieval mechanism of the existing CBR system by adding a clustering stage that clusters cases based on their tumour positions. A number of well-known clustering methods were investigated and employed in the retrieval mechanism. Results using real world brain cancer patient cases have shown that the success rate of the new CBR retrieval is higher than that of the original system. (paper)

Selection of examples in case-based computer-aided decision systems

International Nuclear Information System (INIS)

Mazurowski, Maciej A; Zurada, Jacek M; Tourassi, Georgia D

2008-01-01

Case-based computer-aided decision (CB-CAD) systems rely on a database of previously stored, known examples when classifying new, incoming queries. Such systems can be particularly useful since they do not need retraining every time a new example is deposited in the case base. The adaptive nature of case-based systems is well suited to the current trend of continuously expanding digital databases in the medical domain. To maintain efficiency, however, such systems need sophisticated strategies to effectively manage the available evidence database. In this paper, we discuss the general problem of building an evidence database by selecting the most useful examples to store while satisfying existing storage requirements. We evaluate three intelligent techniques for this purpose: genetic algorithm-based selection, greedy selection and random mutation hill climbing. These techniques are compared to a random selection strategy used as the baseline. The study is performed with a previously presented CB-CAD system applied for false positive reduction in screening mammograms. The experimental evaluation shows that when the development goal is to maximize the system's diagnostic performance, the intelligent techniques are able to reduce the size of the evidence database to 37% of the original database by eliminating superfluous and/or detrimental examples while at the same time significantly improving the CAD system's performance. Furthermore, if the case-base size is a main concern, the total number of examples stored in the system can be reduced to only 2-4% of the original database without a decrease in the diagnostic performance. Comparison of the techniques shows that random mutation hill climbing provides the best balance between the diagnostic performance and computational efficiency when building the evidence database of the CB-CAD system.

Higher Education Provision Using Systems Thinking Approach--Case Studies

Science.gov (United States)

Dhukaram, Anandhi Vivekanandan; Sgouropoulou, Cleo; Feldman, Gerald; Amini, Ardavan

2018-01-01

The purpose of this paper is to highlight the complexities involved in higher education provision and how systems thinking and socio-technical systems (STS) thinking approach can be used to understand the education ecosystem. Systems thinking perspective is provided using two case studies: the development of European Learner Mobility (EuroLM)…

Neutrophils in oral paracoccidioidomycosis and the involvement of Nrf2.

Directory of Open Access Journals (Sweden)

Vera Cavalcanti Araújo

Full Text Available Neutrophils have been implicated in granuloma formation in several infectious diseases, in addition to their main phagocytic and pathogen destruction role. It has been demonstrated that Nrf2 regulates antioxidant protection in neutrophils, attenuating inflammation without compromising the hosts bacterial defense. In this study, we analyzed the presence of neutrophils in Paracoccidioides brasiliensis mycosis (PCM, as well as the immunoexpression of Nrf2. Thirty-nine cases of oral PCM were classified according to quantity of fungi and to the presence of loose or well-organized granulomas and microabscesses. An Nrf2 antibody was used for immunohistochemical analysis. The results showed that neutrophils are present in microabscesses and loose granulomas, but were absent in structured granulomas. A greater quantity of fungi was shown in cases with only loose granulomas when compared to loose and well organized granulomas. Nrf2 was observed in the nuclei of neutrophils of loose granulomas and abscesses, with its expression in loose granulomas maintained despite the additional presence of well organized granulomas in the same specimen. This study suggests that neutrophils participate in P. brasiliensis granuloma formation and that Nrf2 has a possible role in neutrophil survival, via modulation of the inflammatory response.

Worst-case tolerance optimization of antenna systems

DEFF Research Database (Denmark)

Schjær-Jacobsen, Hans

1980-01-01

The application of recently developed algorithms to antenna systems design is demonstrated by the worst-case tolerance optimization of linear broadside arrays, using both spacings and excitation coefficients as design parameters. The resulting arrays are optimally immunized against deviations...... of the design parameters from their nominal values....

Benchmarking of industrial control systems via case-based reasoning

International Nuclear Information System (INIS)

Hadjiiski, M.; Boshnakov, K.; Georgiev, Z.

2013-01-01

Full text: The recent development of information and communication technologies enables the establishment of virtual consultation centers related to the control of specific processes that are widely presented worldwide as the location of the installations does not have influence on the results. The centers can provide consultations regarding the quality of the process control and overall enterprise management as correction factors such as weather conditions, product or service and associated technology, production level, quality of feedstock used and others can be also taken into account. The benchmarking technique is chosen as a tool for analyzing and comparing the quality of the assessed control systems in individual plants. It is a process of gathering, analyzing and comparing data on the characteristics of comparable units to assess and compare these characteristics and improve the performance of the particular process, enterprise or organization. By comparing the different processes and the adoption of the best practices energy efficiency could be improved and hence the competitiveness of the participating organizations will increase. In the presented work algorithm for benchmarking and parametric optimization of a given control system is developed by applying the approaches of Case-Based Reasoning (CBR) and Data Envelopment Analysis (DEA). Expert knowledge and approaches for optimal tuning of control systems are combined. Two of the most common systems for automatic control of different variables in the case of biological wastewater treatment are presented and discussed. Based on analysis of the processes, different cases are defined. By using DEA analysis the relative efficiencies of 10 systems for automatic control of dissolved oxygen are estimated. The designed and implemented in the current work CBR and DEA are applicable for the purposed of virtual consultation centers. Key words: benchmarking technique, energy efficiency, Case-Based Reasoning (CBR

A case of systemic lupus erythematosus presenting as bilateral avascular necrosis of femur.

Science.gov (United States)

Adikari, Madura; Gunawardane, Aloka; Illangantilaka, Sachithra; Atukorale, Himantha; Rubasinghe, Jeevanie

2016-08-05

Avascular necrosis occur as a result of diverse etiology. Chronic inflammatory conditions such as systemic lupus erythematosus considered as a recognize cause. Many cases were reported in systemic lupus erythematosus after treating with corticosteroids. We report a case of a corticosteroid naïve patient presented as bilateral avascular necrosis of femoral head and later progressed to a case of systemic lupus erythematosus. A 26 year old lady presented with right sided hip pain and diagnosed as avascular necrosis of the femoral head. After 6 months she presented a similar pain in left hip, which revealed avascular necrosis of left femoral head as well. A probable cause for her clinical presentation could not be found after extensive clinical and laboratory evaluation. Patient reported high erythrocyte sedimentation rate persistently, and over the next few years progressed as a case of systemic lupus erythematosus. Above case illustrated avascular necrosis could be an early musculoskeletal manifestation of systemic lupus erythematosus even in the absence of corticosteroid administration.

Performance of air sparging systems -- A review of case studies

International Nuclear Information System (INIS)

Bass, D.H.; Brown, R.A.

1995-01-01

In situ air sparging is a commonly used remediation technology which volatilizes and enhances aerobic biodegradation of contamination in Groundwater and saturated zone soil. Recently, some questions have been raised regarding the effectiveness of air sparging. To address these questions the results of 21 sparging case studies have been compiled to shed light on how well air sparging achieves permanent reduction in groundwater contaminant concentrations. The case studies included both chlorinated solvents and petroleum hydrocarbon contamination, and covered a wide range of soil conditions and sparge system parameters. In each case study, groundwater concentrations were compared before sparging was initiated, just before sparging was terminated, and in the months following shutdown of the sparging system

Progressive systemic scleroderma (A case report)

International Nuclear Information System (INIS)

Han, Jung Suh; Kwon, Chung Sik

1974-01-01

This is a report of a rare case of progressive systemic scleroderma involving the skin, lungs, bones, esophagus, duodenum, and colon in a 27 year old Korean female whose chief complaints were generalized edema, knee joint pain, hard and indurated skin lesions on the anterior chest, neck, both upper and lower extremities with loss of pain and touch sensation for one year. A review of literature is submitted

Progressive systemic scleroderma (A case report)

Energy Technology Data Exchange (ETDEWEB)

Han, Jung Suh; Kwon, Chung Sik [Chonnam University College of Medicine, Kwangju (Korea, Republic of)

1974-10-15

This is a report of a rare case of progressive systemic scleroderma involving the skin, lungs, bones, esophagus, duodenum, and colon in a 27 year old Korean female whose chief complaints were generalized edema, knee joint pain, hard and indurated skin lesions on the anterior chest, neck, both upper and lower extremities with loss of pain and touch sensation for one year. A review of literature is submitted.

Coding response to a case-mix measurement system based on multiple diagnoses.

Science.gov (United States)

Preyra, Colin

2004-08-01

To examine the hospital coding response to a payment model using a case-mix measurement system based on multiple diagnoses and the resulting impact on a hospital cost model. Financial, clinical, and supplementary data for all Ontario short stay hospitals from years 1997 to 2002. Disaggregated trends in hospital case-mix growth are examined for five years following the adoption of an inpatient classification system making extensive use of combinations of secondary diagnoses. Hospital case mix is decomposed into base and complexity components. The longitudinal effects of coding variation on a standard hospital payment model are examined in terms of payment accuracy and impact on adjustment factors. Introduction of the refined case-mix system provided incentives for hospitals to increase reporting of secondary diagnoses and resulted in growth in highest complexity cases that were not matched by increased resource use over time. Despite a pronounced coding response on the part of hospitals, the increase in measured complexity and case mix did not reduce the unexplained variation in hospital unit cost nor did it reduce the reliance on the teaching adjustment factor, a potential proxy for case mix. The main implication was changes in the size and distribution of predicted hospital operating costs. Jurisdictions introducing extensive refinements to standard diagnostic related group (DRG)-type payment systems should consider the effects of induced changes to hospital coding practices. Assessing model performance should include analysis of the robustness of classification systems to hospital-level variation in coding practices. Unanticipated coding effects imply that case-mix models hypothesized to perform well ex ante may not meet expectations ex post.

Coding Response to a Case-Mix Measurement System Based on Multiple Diagnoses

Science.gov (United States)

Preyra, Colin

2004-01-01

Objective To examine the hospital coding response to a payment model using a case-mix measurement system based on multiple diagnoses and the resulting impact on a hospital cost model. Data Sources Financial, clinical, and supplementary data for all Ontario short stay hospitals from years 1997 to 2002. Study Design Disaggregated trends in hospital case-mix growth are examined for five years following the adoption of an inpatient classification system making extensive use of combinations of secondary diagnoses. Hospital case mix is decomposed into base and complexity components. The longitudinal effects of coding variation on a standard hospital payment model are examined in terms of payment accuracy and impact on adjustment factors. Principal Findings Introduction of the refined case-mix system provided incentives for hospitals to increase reporting of secondary diagnoses and resulted in growth in highest complexity cases that were not matched by increased resource use over time. Despite a pronounced coding response on the part of hospitals, the increase in measured complexity and case mix did not reduce the unexplained variation in hospital unit cost nor did it reduce the reliance on the teaching adjustment factor, a potential proxy for case mix. The main implication was changes in the size and distribution of predicted hospital operating costs. Conclusions Jurisdictions introducing extensive refinements to standard diagnostic related group (DRG)-type payment systems should consider the effects of induced changes to hospital coding practices. Assessing model performance should include analysis of the robustness of classification systems to hospital-level variation in coding practices. Unanticipated coding effects imply that case-mix models hypothesized to perform well ex ante may not meet expectations ex post. PMID:15230940

Security And Privacy Issues in Healthcare Monitoring Systems: A Case Study

DEFF Research Database (Denmark)

Handler, Daniel Tolboe; Hauge, Lotte; Spognardi, Angelo

2017-01-01

Security and privacy issues are rarely taken into account in automated systems for monitoring elderly people in their home, exposing inhabitants to a number of threats they are usually not aware of. As a case study to expose the major vulnerabilities these systems are exposed to, this paper reviews...... a generic example of automated healthcare monitoring system. The security and privacy issues identified in this case study can be easily generalised and regarded as alarm bells for all the pervasive healthcare professionals....

Case Mix Management Systems: An Opportunity to Integrate Medical Records and Financial Management System Data Bases

Science.gov (United States)

Rusnak, James E.

1987-01-01

Due to previous systems selections, many hospitals (health care facilities) are faced with the problem of fragmented data bases containing clinical, demographic and financial information. Projects to select and implement a Case Mix Management System (CMMS) provide an opportunity to reduce the number of separate physical files and to migrate towards systems with an integrated data base. The number of CMMS candidate systems is often restricted due to data base and system interface issues. The hospital must insure the CMMS project provides a means to implement an integrated on-line hospital information data base for use by departments in operating under a DRG-based Prospective Payment System. This paper presents guidelines for use in selecting a Case Mix Mangement System to meet the hospital's financial and operations planning, budgeting, marketing, and other management needs, while considering the data base implications of the implementation.

Making the business case for hospital information systems--a Kaiser Permanente investment decision.

Science.gov (United States)

Garrido, Terhilda; Raymond, Brian; Jamieson, Laura; Liang, Louise; Wiesenthal, Andrew

2004-01-01

Further evidence in favor of the clinical IT business case is set forth in Kaiser Permanente's cost/benefit analysis for an electronic hospital information system. This article reviews the business case for an inpatient electronic medical record system, including 36 categories of quantifiable benefits that contribute to a positive cumulative net cash flow within an 8.5 year period. However, the business case hinges on several contingent success factors: leadership commitment, timely implementation, partnership with labor, coding compliance, and workflow redesign. The issues and constraints that impact the potential transferability of this business case across delivery systems raise questions that merit further attention.

Training and Assessing Interprofessional Virtual Teams Using a Web-Based Case System.

Science.gov (United States)

Dow, Alan W; Boling, Peter A; Lockeman, Kelly S; Mazmanian, Paul E; Feldman, Moshe; DiazGranados, Deborah; Browning, Joel; Coe, Antoinette; Selby-Penczak, Rachel; Hobgood, Sarah; Abbey, Linda; Parsons, Pamela; Delafuente, Jeffrey; Taylor, Suzanne F

2016-01-01

Today, clinical care is often provided by interprofessional virtual teams-groups of practitioners who work asynchronously and use technology to communicate. Members of such teams must be competent in interprofessional practice and the use of information technology, two targets for health professions education reform. The authors created a Web-based case system to teach and assess these competencies in health professions students. They created a four-module, six-week geriatric learning experience using a Web-based case system. Health professions students were divided into interprofessional virtual teams. Team members received profession-specific information, entered a summary of this information into the case system's electronic health record, answered knowledge questions about the case individually, then collaborated asynchronously to answer the same questions as a team. Individual and team knowledge scores and case activity measures--number of logins, message board posts/replies, views of message board posts--were tracked. During academic year 2012-2013, 80 teams composed of 522 students from medicine, nursing, pharmacy, and social work participated. Knowledge scores varied by profession and within professions. Team scores were higher than individual scores (P Web-based case system provided a novel approach to teach and assess the competencies needed for virtual teams. This approach may be a valuable new tool for measuring competency in interprofessional practice.

CASE technology and the Systems Development Life Cycle: a proposed integration of CASE tools with DoD STD-2167A

OpenAIRE

Batt, Gary Thomas

1989-01-01

Approved for public release; distribution unlimited The use of Computer Aided Software Engineering (CASE) t ools has been marketed as a remedy for the software development crisis by automating analysis, design, and coding. The Systems Development Life Cycle (SDLC) has been employed in an attempt to ease the development backlog by applying structured methods to the development of software systems. This study reviews CASE tool components and the future of CASE integrated toolkits, compares a...

Clinicopathological study of 81 cases of localized and systemic scleroderma.

Science.gov (United States)

Succaria, F; Kurban, M; Kibbi, A-G; Abbas, O

2013-02-01

Scleroderma is a connective tissue disease that includes localized and systemic forms. Our recent encounter with a morphea case exhibiting prominent perineural inflammation microscopically prompted us to assess the features of all patients diagnosed with morphea/scleroderma at our institution. To describe the clinicopathological features of all patients diagnosed with morphea/scleroderma at American University of Beirut Medical Center (AUB-MC) between 1999 and 2010, and compare our findings with those published in the literature. A total of 81 cases (63 women and 18 men) were identified, of which 73 were localized (morphea) and eight were systemic scleroderma. Clinically, plaque type morphea was the most common variant both in adults and children, and seven (9%) cases of morphea were associated with lichen sclerosis et atrophicus (LSA). Histopathologically, perineural inflammation was observed in 49% of cases, and may serve, in addition to other features including lichen sclerosis-like changes (observed in exclusively nine cases of morphea), more diffuse dermal and less subcutaneous sclerosis, and intense inflammation, as clues favouring diagnosis of morphea over systemic sclerosis. The features of morphea/scleroderma patients in this study are generally comparable to those published in the literature, with few differences. Clinically, plaque type morphea was the most common variant both in adults and children and LSA was a frequent association. Histopathologically, perineural inflammation was commonly observed and may serve in addition to lichen sclerosis-like changes and intense inflammation as clues favouring diagnosis of morphea over systemic sclerosis. © 2012 The Authors. Journal of the European Academy of Dermatology and Venereology © 2012 European Academy of Dermatology and Venereology.

CASE/A - COMPUTER AIDED SYSTEM ENGINEERING AND ANALYSIS, ECLSS/ATCS SERIES

Science.gov (United States)

Bacskay, A.

1994-01-01

Design and analysis of Environmental Control and Life Support Systems (ECLSS) and Active Thermal Control Systems (ATCS) for spacecraft missions requires powerful software that is flexible and responsive to the demands of particular projects. CASE/A is an interactive trade study and analysis tool designed to increase productivity during all phases of systems engineering. The graphics-based command-driven package provides a user-friendly environment in which the engineer can analyze the performance and interface characteristics of an ECLS/ATC system. The package is useful during all phases of a spacecraft design program, from initial conceptual design trade studies to the actual flight, including pre-flight prediction and in-flight anomaly analysis. The CASE/A program consists of three fundamental parts: 1) the schematic management system, 2) the database management system, and 3) the simulation control and execution system. The schematic management system allows the user to graphically construct a system model by arranging icons representing system components and connecting the components with physical fluid streams. Version 4.1 contains 51 fully coded and documented default component routines. New components can be added by the user through the "blackbox" component option. The database management system supports the storage and manipulation of component data, output data, and solution control data through interactive edit screens. The simulation control and execution system initiates and controls the iterative solution process, displaying time status and any necessary diagnostic messages. In addition to these primary functions, the program provides three other important functional areas: 1) model output management, 2) system utility commands, and 3) user operations logic capacity. The model output management system provides tabular and graphical output capability. Complete fluid constituent mass fraction and properties data (mass flow, pressure, temperature

A case-oriented web-based training system for breast cancer diagnosis.

Science.gov (United States)

Huang, Qinghua; Huang, Xianhai; Liu, Longzhong; Lin, Yidi; Long, Xingzhang; Li, Xuelong

2018-03-01

Breast cancer is still considered as the most common form of cancer as well as the leading causes of cancer deaths among women all over the world. We aim to provide a web-based breast ultrasound database for online training inexperienced radiologists and giving computer-assisted diagnostic information for detection and classification of the breast tumor. We introduce a web database which stores breast ultrasound images from breast cancer patients as well as their diagnostic information. A web-based training system using a feature scoring scheme based on Breast Imaging Reporting and Data System (BI-RADS) US lexicon was designed. A computer-aided diagnosis (CAD) subsystem was developed to assist the radiologists to make scores on the BI-RADS features for an input case. The training system possesses 1669 scored cases, where 412 cases are benign and 1257 cases are malignant. It was tested by 31 users including 12 interns, 11 junior radiologists, and 8 experienced senior radiologists. This online training system automatically creates case-based exercises to train and guide the newly employed or resident radiologists for the diagnosis of breast cancer using breast ultrasound images based on the BI-RADS. After the trainings, the interns and junior radiologists show significant improvement in the diagnosis of the breast tumor with ultrasound imaging (p-value  .05). The online training system can improve the capabilities of early-career radiologists in distinguishing between the benign and malignant lesions and reduce the misdiagnosis of breast cancer in a quick, convenient and effective manner. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Making System Dynamics Cool? Using Hot Testing & Teaching Cases

NARCIS (Netherlands)

Pruyt, E.

2009-01-01

This paper deals with the use of ‘hot’ real-world cases for both testing and teaching purposes such as in the Introductory System Dynamics course at Delft University of Technology in the Netherlands. The paper starts with a brief overview of the System Dynamics curriculum. Then the problem-oriented

Client-Controlled Case Information: A General System Theory Perspective

Science.gov (United States)

Fitch, Dale

2004-01-01

The author proposes a model for client control of case information via the World Wide Web built on principles of general system theory. It incorporates the client into the design, resulting in an information structure that differs from traditional human services information-sharing practices. Referencing general system theory, the concepts of…

Imaging Manifestations in Systemic Cat Scratch Disease: Case report

International Nuclear Information System (INIS)

Forero M, Julian F; Perez A, Maria C; Cerquera C, Fredy M

2011-01-01

Cat scratch disease is a zoonosis caused by Bartonella henselae, which is transmitted by scratches, bites or exposition to cats saliva (1). The disease typically manifests with local lymphadenitis after bacterial inoculation in the skin, however, there is an atypical systemic presentation in 5 to 10% of patients, which causes unspecific symptoms. There are several imaging findings that lead the radiologist to consider this diagnosis, in order to prevent an invasive procedure, especially if we consider that the majority of cases occur in the pediatric population (2,3). Although in the majority of cases the symptoms and imaging findings resolve spontaneously, there are specific indications like the systemic form of the disease,which requires antibiotic treatment. In the present article we are exposing a case report from Fundacion Cardioinfantil; we will review some epidemiologic aspects, clinical manifestations, diagnostic methods as well as imaging findings in Ultrasonography, Computed Tomography, Magnetic Resonance and Nuclear Medicine.

Imaging Manifestations in Systemic Cat Scratch Disease: Case report

International Nuclear Information System (INIS)

Forero Melo, Julian Francisco; Perez Alvarado, Maria Carolina; Cerquera Cabrera, Fredy Martin

2011-01-01

Cat scratch disease is a zoonosis caused by Bartonella henselae, which is transmitted by scratches, bites or exposition to cats saliva (1). The disease typically manifests with local lymphadenitis after bacterial inoculation in the skin, however, there is an atypical systemic presentation in 5 to 10% of patients, which causes unspecific symptoms. There are several imaging findings that lead the radiologist to consider this diagnosis, in order to prevent an invasive procedure, especially if we consider that the majority of cases occur in the pediatric population (2,3). Although in the majority of cases the symptoms and imaging findings resolve spontaneously, there are specific indications like the systemic form of the disease, which requires antibiotic treatment. In the present article we are exposing a case report from Fundacion Cardio infantil; we will review some epidemiologic aspects, clinical manifestations, diagnostic methods as well as imaging findings in Ultrasonography, Computed Tomography, Magnetic Resonance and Nuclear Medicine.

Heat shield manifold system for a midframe case of a gas turbine engine

Energy Technology Data Exchange (ETDEWEB)

Mayer, Clinton A.; Eng, Jesse; Schopf, Cheryl A.

2017-07-25

A heat shield manifold system for an inner casing between a compressor and turbine assembly is disclosed. The heat shield manifold system protects the outer case from high temperature compressor discharge air, thereby enabling the outer case extending between a compressor and a turbine assembly to be formed from less expensive materials than otherwise would be required. In addition, the heat shield manifold system may be configured such that compressor bleed air is passed from the compressor into the heat shield manifold system without passing through a conventional flange to flange joint that is susceptible to leakage.

Case management information systems: how to put the pieces together now and beyond year 2000.

Science.gov (United States)

Matthews, Pamela

2002-01-01

The case management process is a critical management and operational component in the delivery of customer services across the patient care continuum. Case management has transcended time and will continue to be a viable infrastructure process for successful organizations in the future. A key component of the case management infrastructure is information systems and technology support. Case management challenges include effective deployment and use of systems and technology. As more sophisticated, integrated systems are made available, case managers can use these tools to continue to expand effectively beyond the patient's episodic event to provide greater levels of cradle-to-grave management of healthcare. This article explores methods for defining case management system needs and identifying automation options available to the case manager.

A Textual Case-Based Mobile Phone Diagnosis Support System ...

African Journals Online (AJOL)

In this paper, a Mobile Phone Diagnosis Support System is presented as an extension to jCOLIBRI which accepts a problem and reasons with cases to provide a solution related to a new given problem. Experimental evaluation using some set of problems shows that the developed system predicts the solution that is ...

Toxocariasis of the central nervous system: with report of two cases

Directory of Open Access Journals (Sweden)

Moreira-Silva Sandra F.

2004-01-01

Full Text Available Clinical involvement of the nervous system in visceral larva migrans due to Toxocara is rare, although in experimental animals the larvae frequently migrate to the brain. A review of the literature from the early 50's to date found 29 cases of brain involvement in toxocariasis. In 20 cases, various clinical and laboratory manifestations of eosinophilic meningitis, encephalitis, myelitis or radiculopathy were reported. We report two children with neurological manifestations, in which there was cerebrospinal fluid pleocytosis with marked eosinophilia and a positive serology for Toxocara both in serum and CSF. Serology for Schistosoma mansoni, Cysticercus cellulosae, Toxoplasma and cytomegalovirus were negative in CSF, that was sterile in both cases. Improvement of signs and symptoms after specific treatment (albendazole or thiabendazole was observed in the two cases. A summary of data described in the 25 cases previously reported is presented and we conclude that in cases of encephalitis and myelitis with cerebrospinal fluid pleocytosis and eosinophilia, parasitic infection of the central nervous system should be suspected and serology should be performed to establish the correct diagnosis and treatment.

Telemedicine using an image transfer system in the treatment of neurosurgical emergent cases

International Nuclear Information System (INIS)

Saito, Atsushi; Numagami, Yoshihiro; Kamiyama, Hironaga; Furuno, Yuuichi; Nishimura, Shinjitsu; Nishijima, Michiharu

2007-01-01

Our department is located in the Tsugaru district, which is famous for heavy snow fall, and the small number of neurosurgeon centers in the urban areas leads to an inadequate distribution of neurosurgeons for patients in this region. Such geographical and social constraints have made it difficult to offer sufficient neurosurgical care to all patients in the region. We describe the usefulness of a telemedicine triage system using an image transfer system in the treatment of neurosurgical emergent cases. Image transfer systems have been installed at our hospital and 11 regional hospitals in the Tsugaru district, and have been utilized for teleconsultation regarding neurosurgical patients via transferred computed tomography images since 1989. Consultations regarding 2,858 cases were directed to our department between 1989 and 2006, including 1,615 cases of stroke, 869 cases of head trauma, 97 cases of brain tumor, and 277 cases with other disorders. 84% of subarachnoid hemorrhage cases and 22% of head trauma cases needed emergent transfer. The state of consciousness in intracerebral hemorrhage, and the state of consciousness and time of consultation in head trauma were statistically significant factors for emergent transfer. The presert telemedicine triage system was useful for ensuring correct diagnosis and appropriate primary neurosurgical care in the regional hospitals without neurosurgical units, resulting in a reinforcement of the relationships among the regional hospitals and the efficient transfer of emergent neurosurgical patients. (author)

Computer-Aided System Engineering and Analysis (CASE/A) Programmer's Manual, Version 5.0

Science.gov (United States)

Knox, J. C.

1996-01-01

The Computer Aided System Engineering and Analysis (CASE/A) Version 5.0 Programmer's Manual provides the programmer and user with information regarding the internal structure of the CASE/A 5.0 software system. CASE/A 5.0 is a trade study tool that provides modeling/simulation capabilities for analyzing environmental control and life support systems and active thermal control systems. CASE/A has been successfully used in studies such as the evaluation of carbon dioxide removal in the space station. CASE/A modeling provides a graphical and command-driven interface for the user. This interface allows the user to construct a model by placing equipment components in a graphical layout of the system hardware, then connect the components via flow streams and define their operating parameters. Once the equipment is placed, the simulation time and other control parameters can be set to run the simulation based on the model constructed. After completion of the simulation, graphical plots or text files can be obtained for evaluation of the simulation results over time. Additionally, users have the capability to control the simulation and extract information at various times in the simulation (e.g., control equipment operating parameters over the simulation time or extract plot data) by using "User Operations (OPS) Code." This OPS code is written in FORTRAN with a canned set of utility subroutines for performing common tasks. CASE/A version 5.0 software runs under the VAX VMS(Trademark) environment. It utilizes the Tektronics 4014(Trademark) graphics display system and the VTIOO(Trademark) text manipulation/display system.

Rough case-based reasoning system for continues casting

Science.gov (United States)

Su, Wenbin; Lei, Zhufeng

2018-04-01

The continuous casting occupies a pivotal position in the iron and steel industry. The rough set theory and the CBR (case based reasoning, CBR) were combined in the research and implementation for the quality assurance of continuous casting billet to improve the efficiency and accuracy in determining the processing parameters. According to the continuous casting case, the object-oriented method was applied to express the continuous casting cases. The weights of the attributes were calculated by the algorithm which was based on the rough set theory and the retrieval mechanism for the continuous casting cases was designed. Some cases were adopted to test the retrieval mechanism, by analyzing the results, the law of the influence of the retrieval attributes on determining the processing parameters was revealed. A comprehensive evaluation model was established by using the attribute recognition theory. According to the features of the defects, different methods were adopted to describe the quality condition of the continuous casting billet. By using the system, the knowledge was not only inherited but also applied to adjust the processing parameters through the case based reasoning method as to assure the quality of the continuous casting and improve the intelligent level of the continuous casting.

Unified modeling language and design of a case-based retrieval system in medical imaging.

Science.gov (United States)

LeBozec, C; Jaulent, M C; Zapletal, E; Degoulet, P

1998-01-01

One goal of artificial intelligence research into case-based reasoning (CBR) systems is to develop approaches for designing useful and practical interactive case-based environments. Explaining each step of the design of the case-base and of the retrieval process is critical for the application of case-based systems to the real world. We describe herein our approach to the design of IDEM--Images and Diagnosis from Examples in Medicine--a medical image case-based retrieval system for pathologists. Our approach is based on the expressiveness of an object-oriented modeling language standard: the Unified Modeling Language (UML). We created a set of diagrams in UML notation illustrating the steps of the CBR methodology we used. The key aspect of this approach was selecting the relevant objects of the system according to user requirements and making visualization of cases and of the components of the case retrieval process. Further evaluation of the expressiveness of the design document is required but UML seems to be a promising formalism, improving the communication between the developers and users.

The Case For Prediction-based Best-effort Real-time Systems.

Science.gov (United States)

1999-01-01

Real - time Systems Peter A. Dinda Loukas Kallivokas January...DISTRIBUTION STATEMENT A Approved for Public Release Distribution Unlimited DTIG QUALBR DISSECTED X The Case For Prediction-based Best-effort Real - time Systems Peter...Mellon University Pittsburgh, PA 15213 A version of this paper appeared in the Seventh Workshop on Parallel and Distributed Real - Time Systems

Hydropower recovery in water supply systems: Models and case study

International Nuclear Information System (INIS)

Vilanova, Mateus Ricardo Nogueira; Balestieri, José Antônio Perrella

2014-01-01

Highlights: • We present hydropower recovery models for water supply systems. • Hydropower recovery potential in water supply systems is highly variable. • The case studied could make the supply systems self-sufficient in terms of energy. • Hydropower recovery can reduce GHGs emissions and generate carbon credits. - Abstract: The energy efficiency of water supply systems can be increased through the recovery of hydraulic energy implicit to the volumes of water transported in various stages of the supply process, which can be converted into electricity through hydroelectric recovery systems. Such a process allows the use of a clean energy source that is usually neglected in water supplies, reducing its dependence on energy from the local network and the system’s operation costs. This article evaluates the possibilities and benefits of the use of water supply facilities, structures and equipment for hydraulic energy recovery, addressing several applicable hydroelectric models. A real case study was developed in Brazil to illustrate the technical, economic and environmental aspects of hydropower recovery in water supply systems

The burden of serious human fungal infections in Brazil.

Science.gov (United States)

Giacomazzi, Juliana; Baethgen, Ludmila; Carneiro, Lilian C; Millington, Maria Adelaide; Denning, David W; Colombo, Arnaldo L; Pasqualotto, Alessandro C

2016-03-01

In Brazil, human fungal infections are prevalent, however, these conditions are not officially reportable diseases. To estimate the burden of serious fungal diseases in 1 year in Brazil, based on available data and published literature. Historical official data from fungal diseases were collected from Brazilian Unified Health System Informatics Department (DATASUS). For fungal diseases for which no official data were available, assumptions of frequencies were made by estimating based on published literature. The incidence (/1000) of hospital admissions for coccidioidomycosis was 7.12; for histoplasmosis, 2.19; and for paracoccidioidomycosis, 7.99. The estimated number of cryptococcal meningoencephalitis cases was 6832. Also, there were 4115 cases of Pneumocystis pneumonia in AIDS patients per year, 1 010 465 aspergillosis and 2 981 416 cases of serious Candida infections, including invasive and non-invasive diseases. In this study, we demonstrate that more than 3.8 million individuals in Brazil may be suffering from serious fungal infections, mostly patients with malignant cancers, transplant recipients, asthma, previous tuberculosis, HIV infection and those living in endemic areas for truly pathogenic fungi. The scientific community and the governmental agencies should work in close collaboration in order to reduce the burden of such complex, difficult-to-diagnose and hard to treat diseases. © 2015 Blackwell Verlag GmbH.

Experience in Modelling Nuclear Energy Systems with MESSAGE: Country Case Studies

International Nuclear Information System (INIS)

2018-01-01

Member States have recognized the increasing need to model future nuclear power scenarios in order to develop strategies for sustainable nuclear energy systems. The IAEA model for energy supply strategy alternatives and their general environmental impacts (MESSAGE) code is a tool that supports energy analysis and planning in Member States. This publication documents the experience gained on modelling and scenario analysis of nuclear energy systems (NES) using the MESSAGE code through various case studies performed by the participating Member States on evaluation and planning for nuclear energy sustainability at the regional or national level. The publication also elaborates on experience gained in modelling of global nuclear energy systems with a focus on specific aspects of collaboration among technology holder and technology user countries and the introduction of innovative nuclear technologies. It presents country case studies covering a variety of nuclear energy systems based on a once-through fuel cycle and a closed fuel cycle for thermal reactors, fast reactors and advanced systems. The feedback from case studies proves the analytical capabilities of the MESSAGE model and highlight the path forward for further advancements in the MESSAGE code and NES modelling.

Using systems thinking in patient safety: a case study on medicines management.

Science.gov (United States)

Brimble, Mandy; Jones, Aled

2017-06-29

Systems thinking is used as a way of understanding behaviours and actions in complex healthcare organisations. An important premise of the concept is that every action in a system causes a reaction elsewhere in that system. These reactions can lead to unintended consequences, sometimes long after the original action, and so are not always attributed to them. This article applies systems thinking to a medicines management case study, to highlight how quality-improvement practitioners can use the approach to underpin planning and implementation of patient-safety initiatives. The case study is specific to transcribing in children's hospices, but the strategies can be applied to other areas. The article explains that, while root cause analysis tools are useful for identifying the cause of, and possible solutions to, problems, they need to be considered carefully in terms of unintended consequences, and how the system into which the solution is implemented can be affected by the change. Analysis of problems using a systems-thinking approach can help practitioners to develop robust and well informed business cases to present to decision makers.

The Application of Use Case Modeling in Designing Medical Imaging Information Systems

International Nuclear Information System (INIS)

Safdari, Reza; Farzi, Jebraeil; Ghazisaeidi, Marjan; Mirzaee, Mahboobeh; Goodini, Azadeh

2013-01-01

Introduction. The essay at hand is aimed at examining the application of use case modeling in analyzing and designing information systems to support Medical Imaging services. Methods. The application of use case modeling in analyzing and designing health information systems was examined using electronic databases (Pubmed, Google scholar) resources and the characteristics of the modeling system and its effect on the development and design of the health information systems were analyzed. Results. Analyzing the subject indicated that Provident modeling of health information systems should provide for quick access to many health data resources in a way that patients' data can be used in order to expand distant services and comprehensive Medical Imaging advices. Also these experiences show that progress in the infrastructure development stages through gradual and repeated evolution process of user requirements is stronger and this can lead to a decline in the cycle of requirements engineering process in the design of Medical Imaging information systems. Conclusion. Use case modeling approach can be effective in directing the problems of health and Medical Imaging information systems towards understanding, focusing on the start and analysis, better planning, repetition, and control

Improving School Leadership. Volume 2: Case Studies on System Leadership

Science.gov (United States)

Hopkins, David, Ed.; Nusche, Deborah, Ed.; Pont, Beatriz, Ed.

2008-01-01

This book explores what specialists are saying about system leadership for school improvement. Case studies examine innovative approaches to sharing leadership across schools in Belgium (Flanders), Finland and the United Kingdom (England) and leadership development programmes for system improvement in Australia and Austria. As these are emerging…

Development of INSTEC(INformation System of Trip Event Cases)

International Nuclear Information System (INIS)

Lee, Jeong Woon; Shim, Bong Sik; Park, Keun Oak; Cheon, Se Woo

1996-09-01

In this research, we established an incident analysis procedure based on the concept of interaction between plant components and developed INSTEC(INformation System of Trip Event Cases) which can manage data obtained as the result of incident analysis. The analysis procedure is consisted of the following steps; reconfiguration of incident context, identification of the paths and contents of the interaction between plant components, identification of unit event obstructing normal plant operation, identification of possible erroneous actions, decision of error modes, identification of likely causes, summarization of analysis results. INSTEC was developed to effectively present the result of incident analysis. This system offers the analyzed information such as analysis results of human error cases, operating issues and problems, recommendations to prevent a similar incident, etc. 24 tabs., 18 figs., 10 refs. (Author)

Nephrogenic systemic fibrosis: risk factors suggested from Japanese published cases

DEFF Research Database (Denmark)

Tsushima, Y; Kanal, E; Thomsen, H S

2010-01-01

The aim of this article is to review the published cases of nephrogenic systemic fibrosis (NSF) in Japan. The Japanese medical literature database and MedLine were searched using the keywords NSF and nephrogenic fibrosing dermopathy (January 2000 to March 2009). Reports in peer-reviewed journals...... and meeting abstracts were included, and cases with biopsy confirmation were selected. 14 biopsy-verified NSF cases were found. In seven of eight patients reported after the association between gadolinium-based contrast agent (GBCA) and NSF was proposed, GBCA administration was documented: five received only...

Data in support of quantitative proteomics to identify potential virulence regulators in Paracoccidioides brasiliensis isolates

Directory of Open Access Journals (Sweden)

Alexandre Keiji Tashima

2015-12-01

Full Text Available Paracoccidioides genus are the etiologic agents of paracoccidioidomycosis (PCM, a systemic mycosis endemic in Latin America. Few virulence factors have been identified in these fungi. This paper describes support data from the quantitative proteomics of Paracoccidioides brasiliensis attenuated and virulent isolates [1]. The protein compositions of two isolates of the Pb18 strain showing distinct infection profiles were quantitatively assessed by stable isotopic dimethyl labeling and proteomic analysis. The mass spectrometry and the analysis dataset have been deposited to the ProteomeXchange Consortium via the PRIDE partner repository with identifier PXD000804.

Average Case vs. Worst Case-Margins of Safety in System Design

DEFF Research Database (Denmark)

Probst, Christian; Gal, Andreas; Franz, Michael

2005-01-01

allocator by sending it a particularly difficult to solve graph-coloring puzzle. The same vulnerability can be exploited if the attacker has intimate knowledge of the data structures used in the attacked system. Similar problems occur in hardware, e.g. with respect to power variability or the heat...... dissipation of processors. Malicious programs can exploit which parts of computer chips dissipate power, thereby overheating regions of the chip that are known to contain no temperature sensors. This attack could be used to affect battery life or cause early chip aging. Unfortunately, worst case-based attacks...

Sensitivity of the Dengue Surveillance System in Brazil for Detecting Hospitalized Cases

Science.gov (United States)

2016-01-01

We evaluated the sensitivity of the dengue surveillance system in detecting hospitalized cases in ten capital cities in Brazil from 2008 to 2013 using a probabilistic record linkage of two independent information systems hospitalization (SIH-SUS) adopted as the gold standard and surveillance (SINAN). Sensitivity was defined as the proportion of cases reported to the surveillance system amid the suspected hospitalized cases registered in SIH-SUS. Of the 48,174 hospitalizations registered in SIH-SUS, 24,469 (50.7%) were reported and registered in SINAN, indicating an overall sensitivity of 50.8% (95%CI 50.3–51.2). The observed sensitivity for each of the municipalities included in the study ranged from 22.0% to 99.1%. The combination of the two data sources identified 71,161 hospitalizations, an increase of 97.0% over SINAN itself. Our results allowed establishing the proportion of underreported dengue hospitalizations in the public health system in Brazil, highlighting the use of probabilistic record linkage as a valuable tool for evaluating surveillance systems. PMID:27192405

SPECT/CT with radiolabeled somatostatin analogues in the evaluation of systemic granulomatous infections.

Science.gov (United States)

Monteiro, Paulo Henrique Silva; de Souza, Thiago Ferreira; Moretti, Maria Luiza; Resende, Mariangela Ribeiro; Mengatti, Jair; de Lima, Mariana da Cunha Lopes; Santos, Allan Oliveira; Ramos, Celso Darío

2017-01-01

To evaluate SPECT/CT with radiolabeled somatostatin analogues (RSAs) in systemic granulomatous infections in comparison with gallium-67 ( 67 Ga) citrate scintigraphy. We studied 28 patients with active systemic granulomatous infections, including tuberculosis, paracoccidioidomycosis, pneumocystosis, cryptococcosis, aspergillosis, leishmaniasis, infectious vasculitis, and an unspecified opportunistic infection. Of the 28 patients, 23 had started specific treatment before the study outset. All patients underwent whole-body SPECT/CT imaging: 7 after injection of 99m Tc-EDDA-HYNIC-TOC, and 21 after injection of 111 In-DTPA-octreotide. All patients also underwent 67 Ga citrate imaging, except for one patient who died before the 67 Ga was available. In 20 of the 27 patients who underwent imaging with both tracers, 27 sites of active disease were detected by 67 Ga citrate imaging and by SPECT/CT with an RSA. Both tracers had negative results in the other 7 patients. RSA uptake was visually lower than 67 Ga uptake in 11 of the 20 patients with positive images and similar to 67 Ga uptake in the other 9 patients. The only patient who did not undergo 67 Ga scintigraphy underwent 99m Tc-EDDA-HYNIC-TOC SPECT/CT-guided biopsy of a lung cavity with focal RSA uptake, which turned to be positive for aspergillosis. SPECT/CT with 99m Tc-EDDA-HYNIC-TOC or 111 In-DTPA-octreotide seems to be a good alternative to 67 Ga citrate imaging for the evaluation of patients with systemic granulomatous disease.

Getting to the bottom: Tesco's Casing Running System improves speed, efficiency and safety

Energy Technology Data Exchange (ETDEWEB)

Eaton, S.

2004-02-01

Tesco Corporation's newly-introduced Casing Running System that is gaining rapid mainstream acceptance in the drilling industry is discussed. The popularity of the system is due not only to its technical advances in conveying casing into the borehole, but also to the increased safety features that it provides drilling operators. While conventional casing operations limit the driller to either rotating or reciprocating the string, the Tesco system permits simultaneously to rotate, reciprocate and circulate the casing string. From the point of view of safety, the Tesco Casing Running System eliminates the need for the roughnecks to harness up in 'riding belts', to climb up the derrick to guide casing pipe and insert hoses into joints for mud circulation. Travelling rig elevators and power tongs, normally required to make joint connections, are also made superfluous by the Tesco System. The bulk of the paper is devoted to a discussion of design and operating characteristics of the tool and cost comparison with conventional power tongs. 3 photos.

Progressive Systemic sclerosis, manifested like malabsorption syndrome. Case report

International Nuclear Information System (INIS)

Ortiz Piza, Gabriel Jaime; Gonzalez Vasquez, Carlos Mario

2005-01-01

We report the case of a 32 year old woman whose first manifestation of systemic sclerosis was malabsorption syndrome. The small bowel series was the clue to the diagnosis, confirmed by laboratory tests and progression of the disease

An Integrated Textual Case-Based System A. Almu

African Journals Online (AJOL)

Almu: An Integrated Textual Case-Based System. 66. The semantic relationship in WordNet links the Four-. Part-Of-Speech of Nouns, Verbs, Adverbs and. Adjectives together to synonyms sets (Miller 1995). Therefore, the words or terms of the problem have to be tagged with their appropriate POS before passing them to the ...

Simulation of Benchmark Cases with the Terminal Area Simulation System (TASS)

Science.gov (United States)

Ahmad, Nash'at; Proctor, Fred

2011-01-01

The hydrodynamic core of the Terminal Area Simulation System (TASS) is evaluated against different benchmark cases. In the absence of closed form solutions for the equations governing atmospheric flows, the models are usually evaluated against idealized test cases. Over the years, various authors have suggested a suite of these idealized cases which have become standards for testing and evaluating the dynamics and thermodynamics of atmospheric flow models. In this paper, simulations of three such cases are described. In addition, the TASS model is evaluated against a test case that uses an exact solution of the Navier-Stokes equations. The TASS results are compared against previously reported simulations of these banchmark cases in the literature. It is demonstrated that the TASS model is highly accurate, stable and robust.

Systemic sarcoidosis complicated of acute renal failure: about 12 cases.

Science.gov (United States)

Mahfoudhi, Madiha; Mamlouk, Habiba; Turki, Sami; Kheder, Adel

2015-01-01

The sarcoidosis is a systemic granulomatosis affecting most frequently the lungs and the mediastinum. An acute renal failure reveals exceptionally this disease. It's a retrospective study implicating 12 cases of sarcoidosis complicated of acute renal failure. The aim of this study is to determine epidemiological, clinical, biological and histological profile in these cases and then to indicate the interest to consider the diagnosis of sarcoidosis in cases of unexplained renal failure. Extra-renal complications, therapeutic modalities and the outcome were determined in all patients. Our series involved 12 women with an average age of 40 years. Biological investigations showed an abnormal normocalcemia in 7 cases, a hypercalcemia in 5 cases, a hypercalciuria in 10 cases and polyclonal hypergammaglobulinemia in 7 cases. An acute renal failure was found in all patients with a median creatinin of 520 umol/L. For all patients, the renal echography was normal however, the kidney biopsy showed tubulo-interstitial nephritis. The extra-renal signs highlighting pulmonary interstitial syndrome in 5 cases, a sicca syndrome in 4 cases, mediastinal lymph nodes in 2 cases, a lymphocytic alveolitis in 3 cases, an anterior granulomatous uveitis in 2 cases and a polyarthritis in 5 cases. Five patients benefited of hemodialysis. The treatment consisted of corticosteroid in all cases. The follow up was marked by complete resolution of clinical and biological signs. The diagnosis of renal sarcoidosis must be done quickly to prevent renal failure.

Case Mix Management Systems: An Opportunity to Integrate Medical Records and Financial Management System Data Bases

OpenAIRE

Rusnak, James E.

1987-01-01

Due to previous systems selections, many hospitals (health care facilities) are faced with the problem of fragmented data bases containing clinical, demographic and financial information. Projects to select and implement a Case Mix Management System (CMMS) provide an opportunity to reduce the number of separate physical files and to migrate towards systems with an integrated data base. The number of CMMS candidate systems is often restricted due to data base and system interface issues. The h...

Healthcare waste generation and its management system: the case ...

African Journals Online (AJOL)

Healthcare waste generation and its management system: the case of health ... of an environmental risk to health care workers, the public and the environment at large. ... Only four out of ten health centers used local type of incinerators, while ...

Issues in Designing a Hypermedia Document System: The Intermedia Case Study.

Science.gov (United States)

Yankelovich, Nicole; And Others

1986-01-01

Intermedia, a hypermedia system developed at Brown University's Institute for Research (Rhode Island) in Information and Scholarship, is first described, and then used as a case study to explore a number of key issues that software designers must consider in the development of hypermedia document systems. A hypermedia document system is defined as…

A study of the transferability of influenza case detection systems between two large healthcare systems.

Science.gov (United States)

Ye, Ye; Wagner, Michael M; Cooper, Gregory F; Ferraro, Jeffrey P; Su, Howard; Gesteland, Per H; Haug, Peter J; Millett, Nicholas E; Aronis, John M; Nowalk, Andrew J; Ruiz, Victor M; López Pineda, Arturo; Shi, Lingyun; Van Bree, Rudy; Ginter, Thomas; Tsui, Fuchiang

2017-01-01

This study evaluates the accuracy and transferability of Bayesian case detection systems (BCD) that use clinical notes from emergency department (ED) to detect influenza cases. A BCD uses natural language processing (NLP) to infer the presence or absence of clinical findings from ED notes, which are fed into a Bayesain network classifier (BN) to infer patients' diagnoses. We developed BCDs at the University of Pittsburgh Medical Center (BCDUPMC) and Intermountain Healthcare in Utah (BCDIH). At each site, we manually built a rule-based NLP and trained a Bayesain network classifier from over 40,000 ED encounters between Jan. 2008 and May. 2010 using feature selection, machine learning, and expert debiasing approach. Transferability of a BCD in this study may be impacted by seven factors: development (source) institution, development parser, application (target) institution, application parser, NLP transfer, BN transfer, and classification task. We employed an ANOVA analysis to study their impacts on BCD performance. Both BCDs discriminated well between influenza and non-influenza on local test cases (AUCs > 0.92). When tested for transferability using the other institution's cases, BCDUPMC discriminations declined minimally (AUC decreased from 0.95 to 0.94, pdetection performance in two large healthcare systems in two geographically separated regions, providing evidentiary support for the use of automated case detection from routinely collected electronic clinical notes in national influenza surveillance. The transferability could be improved by training Bayesian network classifier locally and increasing the accuracy of the NLP parser.

Efficient Algorithm for a k-out-of-N System Reliability Modeling-Case Study: Pitot Sensors System for Aircraft Velocity

Directory of Open Access Journals (Sweden)

Wajih Ezzeddine

2017-08-01

Full Text Available The k-out-of-N system is widely applied in several industrial systems. This structure is a part of fault-tolerant systems for which both parallel and series systems are special cases. Because of the importance of industrial systems reliability determination for production and maintenance management purposes, a number of techniques and methods are incorporated to formulate and estimate its analytic expression. In this paper, an algorithm is put forward for a k-out-of-N system with identical components under information about the influence factors that affect the system efficiency. The developed approach is applied in the case of the Pitot sensors system. However, the algorithm application could be generalized for any device which during a mission is subject to environmental and operational factors that affect its degradation process.

Client-controlled case information: a general system theory perspective.

Science.gov (United States)

Fitch, Dale

2004-07-01

The author proposes a model for client control of case information via the World Wide Web built on principles of general system theory. It incorporates the client into the design, resulting in an information structure that differs from traditional human services information-sharing practices. Referencing general system theory, the concepts of controller and controlled system, as well as entropy and negentropy, are applied to the information flow and autopoietic behavior as they relate to the boundary-maintaining functions of today's organizations. The author's conclusions synthesize general system theory and human services values to lay the foundation for an information-sharing framework for human services in the 21st century.

The advocacy of an appraisal system for teachers: a case study ...

African Journals Online (AJOL)

Education systems all over the world, like all other organisations, have certain organisational goals that they set and wish to achieve. It is argued that for increased pupil performance, in the case of education systems, teachers must work harder and smarter. A performance system is regarded as part of the process to achieve ...

III Systems Symposium at Case Institute of Technology

CERN Document Server

1968-01-01

By J OHN A. HRONES Provost, Case Institute 0/ Technology SYSTEMS have been the subject of man's study for many hundreds of years. Thus, the solar system has been the concern of the astronomer. The study of the allocation of material and human resources within the boundaries of an industrial firm or a government has been the concern of the economist. The subject of such studies have been widely known as economic systems. Medieal men have worked with the human body. Thus, man has attempted to deal with a complicated array of interconnected elements since the very earliest of recorded time. In his attcmpt to improve his understanding of physieal systems the need to concentrate on a specific kind of system, e.g., the solar system. the human body, became more imperative. However in recent years there has begun to grow and develop an increasing number of people who are working on thc development of general systems theory and analysis. Such a development is based upon the belief that certain view points, certain kin...

iCBLS: An interactive case-based learning system for medical education.

Science.gov (United States)

Ali, Maqbool; Han, Soyeon Caren; Bilal, Hafiz Syed Muhammad; Lee, Sungyoung; Kang, Matthew Jee Yun; Kang, Byeong Ho; Razzaq, Muhammad Asif; Amin, Muhammad Bilal

2018-01-01

Medical students should be able to actively apply clinical reasoning skills to further their interpretative, diagnostic, and treatment skills in a non-obtrusive and scalable way. Case-Based Learning (CBL) approach has been receiving attention in medical education as it is a student-centered teaching methodology that exposes students to real-world scenarios that need to be solved using their reasoning skills and existing theoretical knowledge. In this paper, we propose an interactive CBL System, called iCBLS, which supports the development of collaborative clinical reasoning skills for medical students in an online environment. The iCBLS consists of three modules: (i) system administration (SA), (ii) clinical case creation (CCC) with an innovative semi-automatic approach, and (iii) case formulation (CF) through intervention of medical students' and teachers' knowledge. Two evaluations under the umbrella of the context/input/process/product (CIPP) model have been performed with a Glycemia study. The first focused on the system satisfaction, evaluated by 54 students. The latter aimed to evaluate the system effectiveness, simulated by 155 students. The results show a high success rate of 70% for students' interaction, 76.4% for group learning, 72.8% for solo learning, and 74.6% for improved clinical skills. Copyright © 2017 Elsevier B.V. All rights reserved.

Primary Systemic Amyloidosis Presenting as Swollen Dense Breast: A Case Report

International Nuclear Information System (INIS)

Lee, Byung Hoon; Kim, Mi Young; Kim, Su Young; Hwang, Yoon Joon; Han, Yoon Hee; Seo, Jung Wook; Kim, Yong Hoon; Cha, Soon Joo; Hur, Gham; Joo, Mee

2006-01-01

Breast involvement of primary systemic amyloidosis is rare. This is a rare case of breast amyloidosis presenting as a diffuse infiltrative lesion. We present the mammographic, ultrasound, and MR findings of a systemic primary amyloidosis involving the breast with diffuse infiltrative pattern

Applied Nuclear Accountability Systems: A Case Study in the System Architecture and Development of NuMAC

International Nuclear Information System (INIS)

Campbell, Andrea Beth

2004-01-01

This is a case study of the NuMAC nuclear accountability system developed at a private fuel fabrication facility. This paper investigates nuclear material accountability and safeguards by researching expert knowledge applied in the system design and development. Presented is a system developed to detect and deter the theft of weapons grade nuclear material. Examined is the system architecture that includes: issues for the design and development of the system; stakeholder issues; how the system was built and evolved; software design, database design, and development tool considerations; security and computing ethics. (author)

Making System Dynamics Cool II : New Hot Teaching and Testing Cases of Increasing Complexity

NARCIS (Netherlands)

Pruyt, E.

2010-01-01

This follow-up paper presents several actual cases for testing and teaching System Dynamics. The cases were developed between April 2009 and January 2010 for the Introductory System Dynamics courses at Delft University of Technology in the Netherlands. They can be used for teaching and testing

A study of the transferability of influenza case detection systems between two large healthcare systems.

Directory of Open Access Journals (Sweden)

Ye Ye

Full Text Available This study evaluates the accuracy and transferability of Bayesian case detection systems (BCD that use clinical notes from emergency department (ED to detect influenza cases.A BCD uses natural language processing (NLP to infer the presence or absence of clinical findings from ED notes, which are fed into a Bayesain network classifier (BN to infer patients' diagnoses. We developed BCDs at the University of Pittsburgh Medical Center (BCDUPMC and Intermountain Healthcare in Utah (BCDIH. At each site, we manually built a rule-based NLP and trained a Bayesain network classifier from over 40,000 ED encounters between Jan. 2008 and May. 2010 using feature selection, machine learning, and expert debiasing approach. Transferability of a BCD in this study may be impacted by seven factors: development (source institution, development parser, application (target institution, application parser, NLP transfer, BN transfer, and classification task. We employed an ANOVA analysis to study their impacts on BCD performance.Both BCDs discriminated well between influenza and non-influenza on local test cases (AUCs > 0.92. When tested for transferability using the other institution's cases, BCDUPMC discriminations declined minimally (AUC decreased from 0.95 to 0.94, p<0.01, and BCDIH discriminations declined more (from 0.93 to 0.87, p<0.0001. We attributed the BCDIH decline to the lower recall of the IH parser on UPMC notes. The ANOVA analysis showed five significant factors: development parser, application institution, application parser, BN transfer, and classification task.We demonstrated high influenza case detection performance in two large healthcare systems in two geographically separated regions, providing evidentiary support for the use of automated case detection from routinely collected electronic clinical notes in national influenza surveillance. The transferability could be improved by training Bayesian network classifier locally and increasing the

Tuberculosis and systemic lupus erythematosus: a case-control study in Mexico City.

Science.gov (United States)

Torres-González, Pedro; Romero-Díaz, Juanita; Cervera-Hernández, Miguel Enrique; Ocampo-Torres, Mario; Chaires-Garza, Luis Gerardo; Lastiri-González, Ernesto Alejandro; Atisha-Fregoso, Yemil; Bobadilla-Del-Valle, Miriam; Ponce-de-León, Alfredo; Sifuentes-Osornio, José

2018-04-20

To determine, among systemic lupus erythematosus patients, factors associated with active tuberculosis. We performed a case-control study, in a tertiary-care center in Mexico City. We defined cases as systemic lupus erythematosus patients with active tuberculosis and matched them 1:1 with systemic lupus erythematosus patients without tuberculosis (controls) by age, date of systemic lupus erythematosus diagnosis, and disease duration. We analyzed clinical variables, lupus disease activity (SLEDAI-2K), and accumulated damage (SLICC/ARC-DI). We performed a nonconditional logistic regression to determine factors associated with tuberculosis. We identified 72 tuberculosis cases among systemic lupus erythematosus patients, 58% were culture confirmed. Thirty-three percent (24/72) were pulmonary only, 47.2% (34/72) extrapulmonary only, and 19.4% both. After adjustment for age, gender, and socioeconomic status, SLEDAI-2K and SLICC/ARC-DI, a 1-year cumulative dose of prednisone ≥ 3 g (odds ratios (OR), 18.85; 95% confidence interval (95% CI), 6.91-51.45) was associated with tuberculosis, and the antimalarial treatment was protective (OR, 0.13; 95% CI, 0.04-0.36). Among systemic lupus erythematosus patients, cumulative dose of prednisone is associated with tuberculosis. Further research is required to elucidate the protective effect of antimalarial drugs for tuberculosis. Preventive strategies must be implemented in patients at risk.

Systemic provocation in doxycycline induced fixed drug eruption: a case report

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Anik Murwaningsih Rosmarini Estri Sih Hananti Niken Indrastuti

2014-04-01

Full Text Available Fixed drug eruption (FDE is recurrent lesions that upon repeated uptake of causative drug, always appears at the same skin and mucosal site. Determination of causal relationship in drug allergy is very important. In this case report, cases of doxycycline-induced FDE was reported. The subject of the research was a 29-year-old male, referred by dermatologist, with history of reccurent FDE. Physical examination revealed an oval well demarcated patch hyperpigmentation. Patch test was perfomed on previous involved and uninvolved site. The result of the patch test was irrelevant. Retesting patch test gave similar result. Systemic provocation test or drug provocation test (DPT  with doxcycline were done with suspected drug under ambulatory survelance and gave positive result. In this case, the DPT succeeded to identify doxycycline as the causal agent of FDE. The work-up of a suspected drug hypersensitivity includes a detailed clinical history, physical examination, skin tests, and provocation tests. The DPT is recommended to confirm drug’s hypersensitivity reactions. Systemic provocation test is considered as the gold standard for diagnosing FDE. Keywords:   fixed drug eruption - doxycycline - causal relationship - patch test - systemic provocation test

Improving the Reliability of Case-Based Reasoning Systems

Directory of Open Access Journals (Sweden)

Xu Xu

2010-09-01

also discussed in this paper, especially the property that whether inter-feature of case exists redundancy. After that, the reliability of an individual suggested solution is studied. To illustrate these ideas, some experiments and their results are discussed in this paper. The results of experiments show a new route concerning on how to improve the reliability of a CBR system at an overall level.

Using a Recommendation System to Support Problem Solving and Case-Based Reasoning Retrieval

Science.gov (United States)

Tawfik, Andrew A.; Alhoori, Hamed; Keene, Charles Wayne; Bailey, Christian; Hogan, Maureen

2018-01-01

In case library learning environments, learners are presented with an array of narratives that can be used to guide their problem solving. However, according to theorists, learners struggle to identify and retrieve the optimal case to solve a new problem. Given the challenges novice face during case retrieval, recommender systems can be embedded…

The Role of Information Systems and Technology in Case Management: a case study in health and welfare insurance

Directory of Open Access Journals (Sweden)

Helen Richardson

2003-05-01

Full Text Available This study reports the role of information system and technology (IST in supporting case management at the Accident Compensation Corporation (ACC of New Zealand. Case management is a managerial approach that seeks to gain improved business performance by enhancing both employee and customer satisfaction. Despite millions of dollars spent annually by health, social, and insurance agencies in automating case management, little research has been conducted into the role of IST in this practice. The findings of this study show that for ACC, IST’s most valuable role is enhancing the relationship between client and case manager rather than replacing it for, even after the addition of IST, the most valuable knowledge continues to accrue from the face to face interaction of client and case manager. The findings also show two distinct phases to the development of case managers as knowledge workers. The first phase focuses on control of the processes and the second on the delivery and sharing of information resources.

Integration of QR codes into an anesthesia information management system for resident case log management.

Science.gov (United States)

Avidan, Alexander; Weissman, Charles; Levin, Phillip D

2015-04-01

Quick response (QR) codes containing anesthesia syllabus data were introduced into an anesthesia information management system. The code was generated automatically at the conclusion of each case and available for resident case logging using a smartphone or tablet. The goal of this study was to evaluate the use and usability/user-friendliness of such system. Resident case logging practices were assessed prior to introducing the QR codes. QR code use and satisfactions amongst residents was reassessed at three and six months. Before QR code introduction only 12/23 (52.2%) residents maintained a case log. Most of the remaining residents (9/23, 39.1%) expected to receive a case list from the anesthesia information management system database at the end of their residency. At three months and six months 17/26 (65.4%) and 15/25 (60.0%) residents, respectively, were using the QR codes. Satisfaction was rated as very good or good. QR codes for residents' case logging with smartphones or tablets were successfully introduced in an anesthesia information management system and used by most residents. QR codes can be successfully implemented into medical practice to support data transfer. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Kluver–Bucy syndrome in one case with systemic lupus erythematosus

Directory of Open Access Journals (Sweden)

Hsiu-Fen Lin

2011-04-01

Full Text Available Kluver–Bucy syndrome (KBS is a collection of neuropsychiatric symptoms, including visual agnosia (prosopagnosia, hypermetamorphosis, placidity, hypersexuality, and hyperorality. Although neuropsychiatric manifestation is prevalent in cases with systemic lupus erythematosus (SLE, only one literature reported a case with SLE that had KBS previously. In this article, a 37-year-old woman with SLE who developed KBS and other neuropsychiatric symptoms is presented. Brain imaging proved the relevant structural lesion. The possible explanation of pathogenesis of KBS in SLE is discussed.

Association of systemic sclerosis and psoriatic arthritis: a case report

Directory of Open Access Journals (Sweden)

A. Musio

2011-09-01

Full Text Available The association of Systemic Sclerosis (SSc and Psoriatic Arthritis (PsA is unfrequent; only few cases are reported in literature. We describe a case of a patient with SSc following the onset of PsA. The disease begun with tenosynovitis, polyarthritis in association with psoriasis. After two years, Raynaud’s phenomenon and sclerodactyly appeared, and, later, pulmonary interstizial fibrosis and esophageal dysfunction. The existence of a common pathogenesis of the two diseases, SSc and PsA, is discussed.

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

CERN Document Server

Walloth, Christian

2016-01-01

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

Pneumocystis jirovecii pneumonia in systemic autoimmune rheumatic disease: A case-control study.

Science.gov (United States)

Tadros, Susan; Teichtahl, Andrew J; Ciciriello, Sabina; Wicks, Ian P

2017-06-01

Pneumocystis jirovecii pneumonia (PJP) is an opportunistic fungal infection that affects the immunocompromised. Patients with systemic autoimmune rheumatic disease are increasingly recognised as an at-risk clinical population with a high mortality. This case-control study examined differences in the characteristics and peripheral blood parameters between patients with systemic autoimmune rheumatic disease who developed PJP and gender, age and disease-matched controls. Historical data collected between 2002 and 2013 at the Royal Melbourne Hospital, Australia were reviewed. Cases were defined by having a systemic autoimmune rheumatic disease and a diagnosis of PJP (either a positive toluidine blue O stain or P. jirovecii PCR, with a concurrent respiratory illness that was clinically consistent with PJP). Controls were matched for age, gender and disease in a 4:1 ratio. Peripheral blood results were retrieved from an in-house pathology database. Clinical information including glucocorticoid exposure, PJP prophylaxis, comorbidities and month of admission were retrieved from medical notes. After adjustment for corticosteroid exposure and C-reactive protein, lymphocyte count on admission (0.4 vs. 1.3; p = 0.04) and at nadir (0.2 vs. 0.8 × 10 9 /L; p = 0.05) was significantly lower in cases than in controls. Cases (n = 11) were more frequently Caucasian rather than non-Caucasian (81.8% vs. 65.9%; p = 0.04). In addition, cases more commonly presented in autumn (March to May) than in other seasons (OR = 7.3; 95% CI: 1.4-38.7; p = 0.02). These data demonstrate that patients with systemic autoimmune rheumatic disease who develop PJP have significantly greater lymphopenia than age, gender and disease-matched controls, independent of corticosteroid exposure, as well as a potential ethnicity and seasonal predilection to PJP. This may help to inform prophylactic guidelines for PJP in these patients. Copyright © 2017 Elsevier Inc. All rights reserved.

Development of an online radiology case review system featuring interactive navigation of volumetric image datasets using advanced visualization techniques

International Nuclear Information System (INIS)

Yang, Hyun Kyung; Kim, Boh Kyoung; Jung, Ju Hyun; Kang, Heung Sik; Lee, Kyoung Ho; Woo, Hyun Soo; Jo, Jae Min; Lee, Min Hee

2015-01-01

To develop an online radiology case review system that allows interactive navigation of volumetric image datasets using advanced visualization techniques. Our Institutional Review Board approved the use of the patient data and waived the need for informed consent. We determined the following system requirements: volumetric navigation, accessibility, scalability, undemanding case management, trainee encouragement, and simulation of a busy practice. The system comprised a case registry server, client case review program, and commercially available cloud-based image viewing system. In the pilot test, we used 30 cases of low-dose abdomen computed tomography for the diagnosis of acute appendicitis. In each case, a trainee was required to navigate through the images and submit answers to the case questions. The trainee was then given the correct answers and key images, as well as the image dataset with annotations on the appendix. After evaluation of all cases, the system displayed the diagnostic accuracy and average review time, and the trainee was asked to reassess the failed cases. The pilot system was deployed successfully in a hands-on workshop course. We developed an online radiology case review system that allows interactive navigation of volumetric image datasets using advanced visualization techniques

Development of an online radiology case review system featuring interactive navigation of volumetric image datasets using advanced visualization techniques

Energy Technology Data Exchange (ETDEWEB)

Yang, Hyun Kyung; Kim, Boh Kyoung; Jung, Ju Hyun; Kang, Heung Sik; Lee, Kyoung Ho [Dept. of Radiology, Seoul National University Bundang Hospital, Seongnam (Korea, Republic of); Woo, Hyun Soo [Dept. of Radiology, SMG-SNU Boramae Medical Center, Seoul (Korea, Republic of); Jo, Jae Min [Dept. of Computer Science and Engineering, Seoul National University, Seoul (Korea, Republic of); Lee, Min Hee [Dept. of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon (Korea, Republic of)

2015-11-15

To develop an online radiology case review system that allows interactive navigation of volumetric image datasets using advanced visualization techniques. Our Institutional Review Board approved the use of the patient data and waived the need for informed consent. We determined the following system requirements: volumetric navigation, accessibility, scalability, undemanding case management, trainee encouragement, and simulation of a busy practice. The system comprised a case registry server, client case review program, and commercially available cloud-based image viewing system. In the pilot test, we used 30 cases of low-dose abdomen computed tomography for the diagnosis of acute appendicitis. In each case, a trainee was required to navigate through the images and submit answers to the case questions. The trainee was then given the correct answers and key images, as well as the image dataset with annotations on the appendix. After evaluation of all cases, the system displayed the diagnostic accuracy and average review time, and the trainee was asked to reassess the failed cases. The pilot system was deployed successfully in a hands-on workshop course. We developed an online radiology case review system that allows interactive navigation of volumetric image datasets using advanced visualization techniques.

Systemic-pulmonary arteriovenous fistula of traumatic origin: A case report

International Nuclear Information System (INIS)

Hirsch, M.; Maroko, I.; Gueron, M.; Goleman, L.

1983-01-01

Arteriovenous fistulas between the systemic circulation and the pulmonary artery are extremely rare. Continuous precordial murmur is the usual clinical sign while unilateral rib notching may be the only radiologic manifestation of this condition. Selective angiographic investigation is necessary to localize the site of such an arteriovenous (AV) fistula before surgery is performed. In a review of the literature of 15 published cases, the majority were of congenital origin, with four of these systemic-pulmonary AV fistulas of traumatic origin, of which one occurred after insertion of an intercostal catheter. We describe one case of traumatic origin 9 years after percutaneous thoracic drainage for spontaneous pneumothorax, in which transcatheter embolic occlusion of the feeding arteries of an AV fistula was attempted. The advantages and the disadvantages of the non-surgical and surgical therapeutic approaches are discussed. (orig.)

SPECT/CT with radiolabeled somatostatin analogues in the evaluation of systemic granulomatous infections

International Nuclear Information System (INIS)

Monteiro, Paulo Henrique Silva; Souza, Thiago Ferreira de; Moretti, Maria Luiza; Resende, Mariangela Ribeiro; Lima, Mariana da Cunha Lopes de; Santos, Allan Oliveira; Ramos, Celso Darío

2017-01-01

Objective: To evaluate SPECT/CT with radiolabeled somatostatin analogues (RSAs) in systemic granulomatous infections in comparison with gallium-67 ( 67 Ga) citrate scintigraphy. Materials And Methods: We studied 28 patients with active systemic granulomatous infections, including tuberculosis, paracoccidioidomycosis, pneumocystosis, cryptococcosis, aspergillosis, leishmaniasis, infectious vasculitis, and an unspecified opportunistic infection. Of the 28 patients, 23 had started specific treatment before the study outset. All patients underwent whole-body SPECT/CT imaging: 7 after injection of 99m Tc-EDDA-HYNIC-TOC, and 21 after injection of 111 In-DTPA-octreotide. All patients also underwent 67 Ga citrate imaging, except for one patient who died before the 67 Ga was available. Results: In 20 of the 27 patients who underwent imaging with both tracers, 27 sites of active disease were detected by 67 Ga citrate imaging and by SPECT/CT with an RSA. Both tracers had negative results in the other 7 patients. RSA uptake was visually lower than 67 Ga uptake in 11 of the 20 patients with positive images and similar to 67 Ga uptake in the other 9 patients. The only patient who did not undergo 67 Ga scintigraphy underwent 99m Tc-EDDA-HYNIC-TOC SPECT/CT-guided biopsy of a lung cavity with focal RSA uptake, which turned to be positive for aspergillosis. Conclusion: SPECT/CT with 99m Tc-EDDA-HYNIC-TOC or 111 In-DTPA-octreotide seems to be a good alternative to 67 Ga citrate imaging for the evaluation of patients with systemic granulomatous disease. (author)

SPECT/CT with radiolabeled somatostatin analogues in the evaluation of systemic granulomatous infections

Directory of Open Access Journals (Sweden)

Paulo Henrique Silva Monteiro

2017-10-01

Full Text Available Abstract Objective: To evaluate SPECT/CT with radiolabeled somatostatin analogues (RSAs in systemic granulomatous infections in comparison with gallium-67 (67Ga citrate scintigraphy. Materials and Methods: We studied 28 patients with active systemic granulomatous infections, including tuberculosis, paracoccidioidomycosis, pneumocystosis, cryptococcosis, aspergillosis, leishmaniasis, infectious vasculitis, and an unspecified opportunistic infection. Of the 28 patients, 23 had started specific treatment before the study outset. All patients underwent whole-body SPECT/CT imaging: 7 after injection of 99mTc-EDDA-HYNIC-TOC, and 21 after injection of 111In-DTPA-octreotide. All patients also underwent 67Ga citrate imaging, except for one patient who died before the 67Ga was available. Results: In 20 of the 27 patients who underwent imaging with both tracers, 27 sites of active disease were detected by 67Ga citrate imaging and by SPECT/CT with an RSA. Both tracers had negative results in the other 7 patients. RSA uptake was visually lower than 67Ga uptake in 11 of the 20 patients with positive images and similar to 67Ga uptake in the other 9 patients. The only patient who did not undergo 67Ga scintigraphy underwent 99mTc-EDDA-HYNIC-TOC SPECT/CT-guided biopsy of a lung cavity with focal RSA uptake, which turned to be positive for aspergillosis. Conclusion: SPECT/CT with 99mTc-EDDA-HYNIC-TOC or 111In-DTPA-octreotide seems to be a good alternative to 67Ga citrate imaging for the evaluation of patients with systemic granulomatous disease.

Energy Efficiency in Electrical Systems: A Case Study of an ...

African Journals Online (AJOL)

pc

2018-03-05

Mar 5, 2018 ... Energy Efficiency in Electrical Systems: A Case. Study of an .... industries in Morocco have a medium-voltage billing bellow, which is ... the circulation of the reactive energy on the distribution ... High voltage drops. Indeed, for ...

The revised WHO dengue case classification: does the system need to be modified?

Science.gov (United States)

Hadinegoro, Sri Rezeki S

2012-05-01

There has been considerable debate regarding the value of both the 1997 and 2009 World Health Organization (WHO) dengue case classification criteria for its diagnosis and management. Differentiation between classic dengue fever (DF) and dengue haemorrhagic fever (DHF) or severe dengue is a key aspect of dengue case classification. The geographic expansion of dengue and its increased incidence in older age groups have contributed to the limited applicability of the 1997 case definitions. Clinical experience of dengue suggests that the illness presents as a spectrum of disease instead of distinct phases. However, despite the rigid grouping of dengue into DF, DHF and dengue shock syndrome (DSS), overlap between the different manifestations has often been observed, which has affected clinical management and triage of patients. The findings of the DENCO study evaluating the 1997 case definitions formed the basis of the revised 2009 WHO case definitions, which classified the illness into dengue with and without warning signs and severe dengue. Although the revised scheme is more sensitive to the diagnosis of severe dengue, and beneficial to triage and case management, there remain issues with its applicability. It is considered by many to be too broad, requiring more specific definition of warning signs. Quantitative research into the predictive value of these warning signs on patient outcomes and the cost-effectiveness of the new classification system is required to ascertain whether the new classification system requires further modification, or whether elements of both classification systems can be combined.

Towards Geographic Information Systems (GIS) Implementation: A Case Study

Science.gov (United States)

Meaney, Miriam

2006-01-01

"Despite its central role in real-world geography, the Geographic Information System (GIS) has had little uptake to date in School Geography." (Wiegand, 2001) This statement can be accurately applied to the author's current school setting and was the focus of her and her colleagues' case study, commenced in 2004 and continued into 2005.…

Structural vulnerability in transmission systems: Cases of Colombia and Spain

International Nuclear Information System (INIS)

Correa, Gabriel J.; Yusta, José M.

2014-01-01

Highlights: • Vulnerability analysis of transmission electric systems in Colombia and Spain. • Based on scale-free graph statistic indexes. • Evaluating both current conditions and expansion plans of infrastructures. • Comparison of random error and deliberate attack tolerance evaluation. - Abstract: In this paper the authors apply methodological strategies for the structural vulnerability assessment in high voltage power networks based upon the combination of power flow models and scale-free graph statistic indexes. Thus, it is possible to study risk scenarios based on events that may trigger cascading failures within a power system. The usefulness of graph theory techniques has been validated on previous works of the authors, and may be applied in analysis of the vulnerability of different power electric networks. A case study for vulnerability analysis is carried out through methodologies that allow comparison on random error and deliberate attack tolerance evaluation in transmission electric systems from countries like Colombia and Spain. Such vulnerability assessment methodology takes into account the current conditions of the power networks (base case), as well as the impact of expansion plans into infrastructures as defined by their governments. Consequently, the authors show the advantage on the use of graph theory based techniques for vulnerability analysis of electrical power systems

ERP System for Custom Tailoring: A Case Study

Directory of Open Access Journals (Sweden)

Petr Sodomka

2017-04-01

Full Text Available The Case Study deals with the implementation and use of a global ERP system in Bernhardt Fashion CZ, which is one of the leading custom garment manufacturers in the market. The study describes the way this prestigious company has utilized a global ERP product to standardize a part of its processes as well as the areas that needed to be modified or custom adjusted. The crucial part of the study comprises a detailed description of key processes and their automation requirements that are specific in the clothing industry. Moreover, the study includes a complex evaluation of achieved benefits and significant functional improvements the company has developed by using the new system.

Simulation-Based Business Case for PSS: A System Dynamics Framework

DEFF Research Database (Denmark)

Rodrigues, Vinicius Picanco; Pigosso, Daniela Cristina Antelmi; McAloone, Tim C.

2017-01-01

of a business case for PSS implementation and management, based on a System Dynamics simulation framework. With amaturity-oriented theoretical perspective and the associated capability concepts, the study provides insights into how the development of PSScapabilities can potentially affect corporate performance...

Case studies of scenario analysis for adaptive management of natural resource and infrastructure systems

DEFF Research Database (Denmark)

Hamilton, M.C.; Thekdi, S.A.; Jenicek, E.M.

2013-01-01

Management of natural resources and infrastructure systems for sustainability is complicated by uncertainties in the human and natural environment. Moreover, decisions are further complicated by contradictory views, values, and concerns that are rarely made explicit. Scenario analysis can play...... of emergent conditions and help to avoid regret and belated action. The purpose of this paper is to present several case studies in natural resources and infrastructure systems management where scenario analysis has been used to aide decision making under uncertainty. The case studies include several resource...... and infrastructure systems: (1) water resources (2) land-use corridors (3) energy infrastructure, and (4) coastal climate change adaptation. The case studies emphasize a participatory approach, where scenario analysis becomes a means of incorporating diverse stakeholder concerns and experience. This approach...

Langerhans cell histiocytosis involving central nervous system: a case report

Energy Technology Data Exchange (ETDEWEB)

Moon, Won Jin; Park, Dong Woo; Lee, Seung Ro; Hahm, Chang Kok; Ju, Kyung Bin [Hanyang University College of Medicine, Seoul (Korea, Republic of); Kim, Sung Tae [Ulsan University College of Medicine, Seoul (Korea, Republic of)

1997-01-01

Langerhans cell histiocytosis(LCH) is a systemic disorder characterized by idiopathic proliferation of histiocytes in the reticuloendothelial system; CNS involvement outside the hypothalamus or pituitary gland is uncommon. We present a case of LCH involving the brainstem, cerebellum, and temporal lobes, and also showing hypothalamic involvement. The lesions were isointense or hypointense on T1WI and hyperintense on T2WI, and showed multifocal enhancing nodules on post-contrast CT and Gd-enhanced MRI.

Data Mining in Course Management Systems: Moodle Case Study and Tutorial

Science.gov (United States)

Romero, Cristobal; Ventura, Sebastian; Garcia, Enrique

2008-01-01

Educational data mining is an emerging discipline, concerned with developing methods for exploring the unique types of data that come from the educational context. This work is a survey of the specific application of data mining in learning management systems and a case study tutorial with the Moodle system. Our objective is to introduce it both…

Sources of information on lymphoma associated with anti-tumour necrosis factor agents: comparison of published case reports and cases reported to the French pharmacovigilance system.

Science.gov (United States)

Théophile, Hélène; Schaeverbeke, Thierry; Miremont-Salamé, Ghada; Abouelfath, Abdelilah; Kahn, Valentine; Haramburu, Françoise; Bégaud, Bernard

2011-07-01

Anti-tumour necrosis factor (TNF) agents, through their intense immunoregulatory effect, have been suspected to increase the risk of malignant lymphoma. However, the classical epidemiological approaches conducted over about the last 10 years have not totally succeeded in addressing the question of a causal or artifactual association. Therefore, the analysis of a substantial set of case reports, although usually considered as poorly generalizable to the general population, could be particularly informative. Two main sources of case reports in postmarketing settings are available; publications in medical journals and reports to pharmacovigilance systems. The aim of the study was to compare the characteristics of case reports from both these sources in order to understand whether they provided the same information for the investigation of the causal link between lymphoma and anti-TNF agents. All case reports of malignant lymphoma in patients treated with an anti-TNF agent published in MEDLINE and all reports to the French pharmacovigilance system up to 1 February 2010 were identified. Cases of malignant lymphoma identified in postmarketing surveillance from both sources were compared regarding the following variables: age, sex, anti-TNF agent involved, indication for use, type of lymphoma, prior or concomitant immunosuppressive drugs and time to onset of lymphoma. A total of 81 published case reports and 61 cases reported to the French pharmacovigilance system were compared. In published reports, patients were younger (p = 0.03) and more frequently receiving a first anti-TNF treatment (p = 0.03), particularly infliximab (p = 0.03). Conversely, in the pharmacovigilance system reports, a succession of different anti-TNFs (p = 0.03) and adalimumab (p French pharmacovigilance system differed markedly for all characteristics tested, except sex and the use of prior or concomitant immunosuppressive drugs. Published case reports favoured convincing arguments

Analyses of robot systems using fault and event trees: case studies

International Nuclear Information System (INIS)

Khodabandehloo, Koorosh

1996-01-01

Safety in the use of robotics outside factories or processing plants has become a matter of great international concern. Domestic robots and those intended to assist nurses and surgeons in hospitals are examples of cases where safety and reliability are considered critical. The safe performance of robot systems depends on many factors, including the integrity of the robot's hardware and software, the way it communicates with sensory and other production equipment, the reliable function of the safety features present and the way the robot interacts with its environment. The use of systematic techniques such as Fault and Event Tree analysis to examine the safety and reliability of a given robotic system is presented. Considerable knowledge is needed before the application of such analysis techniques can be translated into safety specifications or indeed 'fail-safe' design features of robotic systems. The skill and understanding required for the formulation of such specifications is demonstrated here based on a number of case studies

Duplex System with Ectopic Ureter Opens into the Posterior Urethra: Case Report.

Science.gov (United States)

Milicevic, Snjezana; Bijelic, Radojka; Krivokuca, Vladimir; Jakovljevic, Branislava

2018-04-01

Duplicated ureter or Duplex Collecting System is a congenital condition in which the ureteric bud, the embryological origin of the ureter, arises twice, resulting in two ureters draining a single kidney. This congenital anomaly is rare, and even rarer when the duplex system with ectopic ureter is present. This type of congenital anomaly is even more rarely diagnosed and surgically treated in adulthood. This case report presents a case of a 32-year-old male, who had a duplex collecting system with two ureters on the left side. Ectopic ureter, draining the upper pole of the left kidney, opened into the posterior urethra. In our patient, taking into account the clinical perspective, the renal tissue damaging of the upper pole which was not functional, partial nephrectomy and ureterectomy was successfully performed.

Collaborative Model-based Systems Engineering for Cyber-Physical Systems, with a Building Automation Case Study

DEFF Research Database (Denmark)

Fitzgerald, John; Gamble, Carl; Payne, Richard

2016-01-01

We describe an approach to the model-based engineering of cyber-physical systems that permits the coupling of diverse discrete-event and continuous-time models and their simulators. A case study in the building automation domain demonstrates how such co-models and co-simulation can promote early...

Using Interpretive Qualitative Case Studies for Exploratory Research in Doctoral Studies: A Case of Information Systems Research in Small and Medium Enterprises

Directory of Open Access Journals (Sweden)

Shana R. Ponelis

2015-12-01

Full Text Available The use of the case study method has gained mainstream acceptance in both entrepreneurship and information systems research to develop conceptual and theoretical models that are novel, yet grounded in the literature. In spite of many texts on the case study method and the growing acceptance and use of thereof, there are relatively few examples that discuss how to apply the case study method. The purpose of this paper is to provide such an example by drawing upon the author’s research for her doctoral dissertation in the discipline of information systems and entrepreneurship research. First, the use of qualitative case studies as research method is motivated, then the importance of the research paradigm is discussed and the interpretivist research paradigm justified followed by a detailed discussion of the research design. The paper concludes with a discussion of lessons learned and recommendations based on the author’s experience with using the case study method. The practical yet theoretically founded approach of this paper may be useful to doctoral students who are considering or using the case study method. Equally, supervisors and others involved in research training may find this paper useful as an illustrative example of the case study method for their students.

The final frontier: Tesco takes evolution of casing drilling system offshore

Energy Technology Data Exchange (ETDEWEB)

Polczer, S.

2000-04-01

Tesco Corporation is complementing its smaller 4 1/2-inch casing-while-drilling (CWD) tools by designing a series of 13 3/8-inch and a 9 5/8-inch underreamers and cutters to accommodate the larger diameter holes typical of offshore drilling. Tesco is building its own rig; it is a single rated to 3,000 metres that can be moved in seven loads with an overall 100 ton load rating. The unit features dimensional drilling capability in addition to features such as logging-while-drilling, and measurement-while-drilling. A conventional coring unit is employed via wireline. To date, Tesco has successfully overcome two of the main challenges in developing the new drilling process, i. e. to guarantee that casing can be run in high compression loads without damage to connections, and to develop an underreamer cutting structure to destroy rock at a rate comparable to conventional rotary drilling. The wireline retrieval system, which is 100 per cent reliable in running mode, but only 70 per cent successful in the retrieval mode, is the next challenge to be overcome. Tesco claims a 40 per cent reduction in overall 'spud to release' time, however, the main advantage claimed for the system is that the casing system protects the integrity of the hole as it is being drilled.

Prototype and Evaluation of AutoHelp: A Case-based, Web-accessible Help Desk System for EOSDIS

Science.gov (United States)

Mitchell, Christine M.; Thurman, David A.

1999-01-01

AutoHelp is a case-based, Web-accessible help desk for users of the EOSDIS. Its uses a combination of advanced computer and Web technologies, knowledge-based systems tools, and cognitive engineering to offload the current, person-intensive, help desk facilities at the DAACs. As a case-based system, AutoHelp starts with an organized database of previous help requests (questions and answers) indexed by a hierarchical category structure that facilitates recognition by persons seeking assistance. As an initial proof-of-concept demonstration, a month of email help requests to the Goddard DAAC were analyzed and partially organized into help request cases. These cases were then categorized to create a preliminary case indexing system, or category structure. This category structure allows potential users to identify or recognize categories of questions, responses, and sample cases similar to their needs. Year one of this research project focused on the development of a technology demonstration. User assistance 'cases' are stored in an Oracle database in a combination of tables linking prototypical questions with responses and detailed examples from the email help requests analyzed to date. When a potential user accesses the AutoHelp system, a Web server provides a Java applet that displays the category structure of the help case base organized by the needs of previous users. When the user identifies or requests a particular type of assistance, the applet uses Java database connectivity (JDBC) software to access the database and extract the relevant cases. The demonstration will include an on-line presentation of how AutoHelp is currently structured. We will show how a user might request assistance via the Web interface and how the AutoHelp case base provides assistance. The presentation will describe the DAAC data collection, case definition, and organization to date, as well as the AutoHelp architecture. It will conclude with the year 2 proposal to more fully develop the

A case of malignant hyperthermia captured by an anesthesia information management system.

Science.gov (United States)

Maile, Michael D; Patel, Rajesh A; Blum, James M; Tremper, Kevin K

2011-04-01

Many cases of malignant hyperthermia triggered by volatile anesthetic agents have been described. However, to our knowledge, there has not been a report describing the precise changes in physiologic data of a human suffering from this process. Here we describe a case of malignant hyperthermia in which monitoring information was frequently and accurately captured by an anesthesia information management system.

Systemic lupus erythematosus and myelofibrosis: A case report and revision of literature

Directory of Open Access Journals (Sweden)

F. Del Porto

Full Text Available Blood cytopenia represents one of the diagnostic criteria for systemic lupus erythematosus (SLE and may occur as the first symptom of the disease. Antibody-mediated peripheral destruction of blood cells is the main cause of cytopenia observed in patients affected by SLE, however, inflammatory anemia, nutritional deficiencies, immunosuppressive therapy and, more rarely, myelofibrosis (MF have also been documented. In the literature, 45 cases of autoimmune MF (AIMF and SLE have been previously reported. Here the 46th case of a 43-year-old female with a SLE and an underhand cytopenia, with a review of the literature. Keywords: Systemic lupus erythematosus, Autoimmune myelofibrosis, Blood cytopenia

Nephrogenic systemic fibrosis: risk factors suggested from Japanese published cases

DEFF Research Database (Denmark)

Tsushima, Y; Kanal, E; Thomsen, H S

2010-01-01

The aim of this article is to review the published cases of nephrogenic systemic fibrosis (NSF) in Japan. The Japanese medical literature database and MedLine were searched using the keywords NSF and nephrogenic fibrosing dermopathy (January 2000 to March 2009). Reports in peer-reviewed journals ...

Applying of component system development in object methodology, case study

Directory of Open Access Journals (Sweden)

Milan Mišovič

2013-01-01

Full Text Available To create computarization target software as a component system has been a very strong requirement for the last 20 years of software developing. Finally, the architectural components are self-contained units, presenting not only partial and overall system behavior, but also cooperating with each other on the basis of their interfaces. Among others, components have allowed flexible modification of processes the behavior of which is the foundation of components behavior without changing the life of the component system. On the other hand, the component system makes it possible, at design time, to create numerous new connections between components and thus creating modified system behaviors. This all enables the company management to perform, at design time, required behavioral changes of processes in accordance with the requirements of changing production and market.The development of software which is generally referred to as SDP (Software Development Process contains two directions. The first one, called CBD (Component–Based Development, is dedicated to the development of component–based systems CBS (Component–based System, the second target is the development of software under the influence of SOA (Service–Oriented Architecture. Both directions are equipped with their different development methodologies. The subject of this paper is only the first direction and application of development of component–based systems in its object–oriented methodologies. The requirement of today is to carry out the development of component-based systems in the framework of developed object–oriented methodologies precisely in the way of a dominant style. In some of the known methodologies, however, this development is not completely transparent and is not even recognized as dominant. In some cases, it is corrected by the special meta–integration models of component system development into an object methodology.This paper presents a case study

Surgical scheduling categorization system (SSCS): A novel classification system to improve coordination and scheduling of operative cases in a tertiary pediatric medical system.

Science.gov (United States)

Gantwerker, Eric A; Bannos, Cassandra; Cunningham, Michael J; Rahbar, Reza

2017-01-01

To describe a surgical categorization system to create a universal nomenclature, delineating patient complexity as a first step toward developing a true risk stratification system. Retrospective database review of all otolaryngology surgical procedures performed in a tertiary pediatric hospital system over one academic year (July 2012-June 2013). All otolaryngology surgical procedures were reviewed, encompassing 8478 procedures on 5711 patients. The attending otolaryngologist assigned surgical scheduling category (SSCS) at the time of case booking based on an institution specific guidelines. The guidelines are as follow: Category I was assigned to American Society of Anesthesiologists physical status classification (ASA) I/II patients, designating them appropriate for institution's suburban ambulatory surgery centers; Category II was ASA I/II patients with social or transportation issues; Category III was ASA I/II patients who required case coordination with other medical or surgical departments; Category IV was reserved for patients of any ASA class whom the surgeon designated to be of a higher complexity. 8478 total procedures analyzed with 7198 having complete records. 48% were Category I, 13.6% were Category II, 1.9% were Category III and 36.5% were Category IV. The ASA were 34.7% ASA I, 50% ASA II, 13.39% ASA III, and 1.9% ASA IV. Although the largest proportion of patients were ASA II (50%), 39.6% of all ASA II were Category IV. Category IV was split into 54.2% ASA II and 34% ASA III and shows that peri-operative surgical concerns were not encompassed by the ASA system. This surgical categorization system streamlines surgical scheduling in a tertiary pediatric hospital system, particularly with respect to the designation of cases as ambulatory surgery center or main operating room appropriate. The case mix complexity is also readily apparent, enhancing recognition of the coordination and attention required for the perioperative management of high complexity

Central nervous system vasculitis caused by propylthiouracil therapy: a case report and literature review.

Science.gov (United States)

Vanek, C; Samuels, M H

2005-01-01

Antineutrophil cytoplasmic antibodies (ANCA) are associated with vasculitis, including vasculitis induced by drugs such as the thionamides. The affected organ systems in thionamide-induced vasculitis have been primarily renal, musculoskeletal, and dermatologic. We describe the first case of thionamide-induced central nervous system vasculitis presenting as confusion, with complete resolution after discontinuation of propylthiouracil. We review the literature and summarize 42 additional cases of thionamide-induced ANCA-positive vasculitis since 1992. Propylthiouracil was responsible in 93% of cases and the predominant ANCA pattern on immunofluorescent staining was perinuclear (p-ANCA). Clinical improvement occurred after drug discontinuation in 93%, steroid therapy was used in some cases. The mean duration of treatment with thionamides was 35 months prior to presentation. Long-term medical treatment with thionamides for hyperthyroidism may increase the risk of this severe side effect.

Multiconfiguration hartree-fock theory for pseudorelativistic systems: The time-dependent case

KAUST Repository

Hajaiej, Hichem

2014-03-01

In [Setting and analysis of the multi-configuration time-dependent Hartree-Fock equations, Arch. Ration. Mech. Anal. 198 (2010) 273-330] the third author has studied in collaboration with Bardos, Catto and Mauser the nonrelativistic multiconfiguration time-dependent Hartree-Fock system of equations arising in the modeling of molecular dynamics. In this paper, we extend the previous work to the case of pseudorelativistic atoms. We show the existence and the uniqueness of global-in-time solution to the underlying system under technical assumptions on the energy of the initial data and the charge of the nucleus. Moreover, we prove that the result can be extended to the case of neutron stars when the number of electrons is less than a critical number N cr. © 2014 World Scientific Publishing Company.

Impact of payment system change from per-case to per-diem on high severity patient's length of stay.

Science.gov (United States)

Jang, Sung-In; Nam, Chung Mo; Lee, Sang Gyu; Kim, Tae Hyun; Park, Sohee; Park, Eun-Cheol

2016-09-01

A new payment system, the diagnosis-related group (DRG) system, and Korean diagnosis procedure combination (KDPC, per-diem) payment system were officially introduced in 2002 and in 2012, respectively. We evaluated the impact of payment system change from per-case to per-diem on high severity patient's length of stay (LOS).Claim data was used. A total of 36,240 case admissions and 72,480 control admissions were included in the analysis. Segmented regression analysis of interrupted time series between cases and controls was conducted. Hospitals that consistently participated in the DRG payment system and changed to the KDPC payment system were defined as case hospitals. Hospitals that consistently participated in the DRG payment system were defined as control hospitals.LOS increased by 0.025 days per month (P = 0.0055) for 3 surgical diagnosis-related admissions due to the bundled payment system change. LOS among emergency admissions also increased and showed an increasing tendency under the KDPC. The LOS increase was observed specifically for complex procedure admissions and high severity cases (CCI 0, 1: 0.022, P = 0.0142; CCI 2, 3: 0.026, P = 0.0288; CCI ≥ 4: 0.055, P = 0.0003).Although both payment systems are optimized to decrease LOS, incentives to reduce LOS are stronger under the DRG system than under the KDPC system. It is worth noting that too strong incentive for reducing LOS is suitable to high severity cases.

Hybrid Genetic Algorithm Optimization for Case Based Reasoning Systems

International Nuclear Information System (INIS)

Mohamed, A.H.

2008-01-01

The success of a CBR system largely depen ds on an effective retrieval of useful prior case for the problem. Nearest neighbor and induction are the main CBR retrieval algorithms. Each of them can be more suitable in different situations. Integrated the two retrieval algorithms can catch the advantages of both of them. But, they still have some limitations facing the induction retrieval algorithm when dealing with a noisy data, a large number of irrelevant features, and different types of data. This research utilizes a hybrid approach using genetic algorithms (GAs) to case-based induction retrieval of the integrated nearest neighbor - induction algorithm in an attempt to overcome these limitations and increase the overall classification accuracy. GAs can be used to optimize the search space of all the possible subsets of the features set. It can deal with the irrelevant and noisy features while still achieving a significant improvement of the retrieval accuracy. Therefore, the proposed CBR-GA introduces an effective general purpose retrieval algorithm that can improve the performance of CBR systems. It can be applied in many application areas. CBR-GA has proven its success when applied for different problems in real-life

Trends in prevalence of patient case-mix adjusters used in the Medicare dialysis payment system.

Science.gov (United States)

Hollenbeak, Christopher S; Rubin, Robert J; Tzivelekis, Spiros; Stephens, J Mark

2015-06-01

The Medicare End-Stage Renal Disease Prospective Payment System (PPS) used data from 2006-08 to set weights for each case-mix adjuster that is part of the bundled payment formula. The details of the population case-mix were not made public, and little is known about consistency of case-mix over time. This study estimated the prevalence of case-mix adjusters during 2006-2008 and analyzed changes in case-mix prevalence from 2000-2008. Cross-sectional cohort study using United States Renal Data System data for Medicare dialysis patients. Three 3-year cohorts (2000-02, 2003-05, 2006-08) were analyzed for changes over time in case-mix prevalence. Double-digit trends were observed in many case-mix categories between 2000-02 and 2006-08. Large declines were observed in prevalence of patients with low BMI, pericarditis, new to dialysis, and ages 18-44. Large increases were observed in chronic co-morbidities, pneumonia and age cohort 80+. Substantial changes in case-mix adjuster prevalence suggest the PPS payment formula should be regularly updated.

Systemic Cystic Angiomatosis Mimicking Metastatic Cancer: A Case Report and Review of the Literature

Directory of Open Access Journals (Sweden)

Vivek Kumar

2017-01-01

Full Text Available Systemic cystic angiomatosis is a rare benign disorder due to the maldeveloped vascular and lymphatic system with less than 50 cases reported in literature so far. We report here a case of systemic cystic angiomatosis (SCA with multisystem involvement affecting the neck, thyroid, thoracic cavity, and skeletal system. The patient initially presented in her 4th decade of life with isolated lymphangioma in the neck requiring surgery. However, she experienced full-blown manifestations of SCA in her 6th decade which closely mimicked metastatic cancer. The diagnosis of SCA could only be established after multiple biopsies. The radiological and histological features of SCA with its course over 31 years in this patient have been described.

Shifting Diagnostic Systems for Defining Intellectual Disability in Death Penalty Cases: Hall vs. Florida

Science.gov (United States)

Mukherjee, Mina; Westphal, Alexander

2015-01-01

The case of Hall vs. Florida tested Florida's so called "bright line rule" in determining intellectual disability in capital cases. The Supreme Court Decision reflects a more general trend from categorical to dimensional approaches in psychiatric diagnostic systems.

The Federated Satellite Systems paradigm: Concept and business case evaluation

Science.gov (United States)

Golkar, Alessandro; Lluch i Cruz, Ignasi

2015-06-01

This paper defines the paradigm of Federated Satellite Systems (FSS) as a novel distributed space systems architecture. FSS are networks of spacecraft trading previously inefficiently allocated and unused resources such as downlink bandwidth, storage, processing power, and instrument time. FSS holds the promise to enhance cost-effectiveness, performance and reliability of existing and future space missions, by networking different missions and effectively creating a pool of resources to exchange between participants in the federation. This paper introduces and describes the FSS paradigm, and develops an approach integrating mission analysis and economic assessments to evaluate the feasibility of the business case of FSS. The approach is demonstrated on a case study on opportunities enabled by FSS to enhance space exploration programs, with particular reference to the International Space Station. The application of the proposed methodology shows that the FSS concept is potentially able to create large commercial markets of in-space resources, by providing the technical platform to offer the opportunity for spacecraft to share or make use of unused resources within their orbital neighborhood. It is shown how the concept is beneficial to satellite operators, space agencies, and other stakeholders of the space industry to more flexibly interoperate space systems as a portfolio of assets, allowing unprecedented collaboration among heterogeneous types of missions.

Central nervous system tissue heterotopia of the nose: case report and review of the literature

Science.gov (United States)

Altissimi, G; Ascani, S; Falcetti, S; Cazzato, C; Bravi, I

2009-01-01

Summary The Authors present a case of heterotopic central nervous system tissue observed in an 81-year-old male in the form of an ethmoidal polyp. A review of the literature indicates that this is a rare condition characterised by a connective tissue lesion with astrocytic and oligodendrocytic glial cells, which may be located outside the nasal pyramid in some cases and inside the nasal cavity in others. The most important diagnostic aspect involves differentiating these from meningoencephalocele, which maintains an anatomical connection with central nervous system tissue. Contrast-enhanced imaging is essential for diagnosis, as in cases of heterotopic central nervous system tissue, it will demonstrate that there are no connections with intra-cranial tissue. Endoscopic excision is the treatment of choice. PMID:20161881

A Human Work Interaction Design (HWID) Case Study in E-Government and Public Information Systems

DEFF Research Database (Denmark)

Clemmensen, Torkil

2011-01-01

This paper first outlines a revised version of the general HWID framework, with a focus on what connects empirical work analysis and interaction design, and then presents a case study of the Danish government one-for-all authentication system NemID. The case is briefly analyzed, using ethnomethod...... in studying how human work analysis and interaction design in concrete cases are related and connected.......This paper first outlines a revised version of the general HWID framework, with a focus on what connects empirical work analysis and interaction design, and then presents a case study of the Danish government one-for-all authentication system NemID. The case is briefly analyzed, using...... ethnomethodology, work domain/task analysis, and the HWID approach, and comparing the results. Compared to the traditional approaches, the HWID focus on case-specific connections between human work and interaction design, gives different and supplementary answers. The conclusion is that there are benefits...

Diversity for security: case assessment for FPGA-based safety-critical systems

Directory of Open Access Journals (Sweden)

Kharchenko Vyacheslav

2016-01-01

Full Text Available Industrial safety critical instrumentation and control systems (I&Cs are facing more with information (in general and cyber, in particular security threats and attacks. The application of programmable logic, first of all, field programmable gate arrays (FPGA in critical systems causes specific safety deficits. Security assessment techniques for such systems are based on heuristic knowledges and the expert judgment. Main challenge is how to take into account features of FPGA technology for safety critical I&Cs including systems in which are applied diversity approach to minimize risks of common cause failure. Such systems are called multi-version (MV systems. The goal of the paper is in description of the technique and tool for case-based security assessment of MV FPGA-based I&Cs.

Using Web-Based, Group Communication Systems to Support Case Study Learning at a Distance

Directory of Open Access Journals (Sweden)

Liam Rourke

2002-10-01

Full Text Available This study explored the capacity of Web-based, group communication systems to support case-based teaching and learning. Eleven graduate students studying at a distance were divided into three groups to collaborate on a case study using either a synchronous voice, an asynchronous voice, or a synchronous text communication system. Participants kept a detailed log of the time they spent on various activities, wrote a 1,500-word reflection on their experience, and participated in a group interview. Analysis of these data reveals that each group supplemented the system that had been assigned to them with additional communication systems in order to complete the project. Each of these systems were used strategically: email was used to share files and arrange meetings, and synchronous voice systems were used to brainstorm and make decisions. Learning achievement was high across groups and students enjoyed collaborating with others on a concrete task.

Severe Rhabdomyolysis without Systemic Involvement: A Rare Case of Idiopathic Eosinophilic Polymyositis

Directory of Open Access Journals (Sweden)

Ayesha Farooq

2015-01-01

Full Text Available Introduction. Eosinophilic polymyositis (EPM is a rare cause of rhabdomyolysis characterized by eosinophilic infiltrates in the muscle. We describe the case of a young patient with eosinophilic polymyositis causing isolated severe rhabdomyolysis without systemic involvement. Case Presentation. A 22-year-old Haitian female with no past medical history presented with progressive generalized muscle aches without precipitating factors. Examination of the extremities revealed diffuse muscle tenderness. Laboratory findings demonstrated peripheral eosinophilia and high creatinine phosphokinase (CPK and transaminase levels. Workup for the common causes of rhabdomyolysis were negative. Her CPK continued to rise to greater than 100,000 units/L so a muscle biopsy was performed which showed widespread eosinophilic infiltrate consistent with eosinophilic polymyositis. She was started on high dose systemic corticosteroids with improvement of her symptoms, eosinophilia, and CPK level. Discussion. This case illustrates a systematic workup of rhabdomyolysis in the presence of peripheral eosinophilia. Many differential diagnoses must be considered before establishing a diagnosis of idiopathic eosinophilic polymyositis. To our knowledge, our case of eosinophilic polymyositis is unique as it presented with severe rhabdomyolysis without another organ involvement. Clinicians should maintain a high index of suspicion for this physically debilitating disease to aid in prompt diagnosis.

SPECT/CT with radiolabeled somatostatin analogues in the evaluation of systemic granulomatous infections

Energy Technology Data Exchange (ETDEWEB)

Monteiro, Paulo Henrique Silva; Souza, Thiago Ferreira de; Moretti, Maria Luiza; Resende, Mariangela Ribeiro; Lima, Mariana da Cunha Lopes de; Santos, Allan Oliveira; Ramos, Celso Darío, E-mail: paulohsm42@gmail.com [Universidade de Campinas (UNICAMP), SP (Brazil). Escola de Medicina; Mengatti Jair [Instituto de Pesquisas Energéticas e Nucleares (IPEN/CNEN-SP), São Paulo, SP (Brazil)

2017-11-15

Objective: To evaluate SPECT/CT with radiolabeled somatostatin analogues (RSAs) in systemic granulomatous infections in comparison with gallium-67 ({sup 67}Ga) citrate scintigraphy. Materials And Methods: We studied 28 patients with active systemic granulomatous infections, including tuberculosis, paracoccidioidomycosis, pneumocystosis, cryptococcosis, aspergillosis, leishmaniasis, infectious vasculitis, and an unspecified opportunistic infection. Of the 28 patients, 23 had started specific treatment before the study outset. All patients underwent whole-body SPECT/CT imaging: 7 after injection of {sup 99m}Tc-EDDA-HYNIC-TOC, and 21 after injection of {sup 111}In-DTPA-octreotide. All patients also underwent {sup 67}Ga citrate imaging, except for one patient who died before the {sup 67}Ga was available. Results: In 20 of the 27 patients who underwent imaging with both tracers, 27 sites of active disease were detected by {sup 67}Ga citrate imaging and by SPECT/CT with an RSA. Both tracers had negative results in the other 7 patients. RSA uptake was visually lower than {sup 67}Ga uptake in 11 of the 20 patients with positive images and similar to {sup 67}Ga uptake in the other 9 patients. The only patient who did not undergo {sup 67}Ga scintigraphy underwent {sup 99m}Tc-EDDA-HYNIC-TOC SPECT/CT-guided biopsy of a lung cavity with focal RSA uptake, which turned to be positive for aspergillosis. Conclusion: SPECT/CT with {sup 99m}Tc-EDDA-HYNIC-TOC or {sup 111}In-DTPA-octreotide seems to be a good alternative to {sup 67}Ga citrate imaging for the evaluation of patients with systemic granulomatous disease. (author)

A new variable stiffness suspension system: passive case

Directory of Open Access Journals (Sweden)

O. M. Anubi

2013-02-01

Full Text Available This paper presents the design, analysis, and experimental validation of the passive case of a variable stiffness suspension system. The central concept is based on a recently designed variable stiffness mechanism. It consists of a horizontal control strut and a vertical strut. The main idea is to vary the load transfer ratio by moving the location of the point of attachment of the vertical strut to the car body. This movement is controlled passively using the horizontal strut. The system is analyzed using an L2-gain analysis based on the concept of energy dissipation. The analyses, simulation, and experimental results show that the variable stiffness suspension achieves better performance than the constant stiffness counterpart. The performance criteria used are; ride comfort, characterized by the car body acceleration, suspension deflection, and road holding, characterized by tire deflection.

[Coexisting systemic lupus erythematosus and sickle cell disease: case report and literature review].

Science.gov (United States)

Robazzi, Teresa Cristina M V; Alves, Crésio; Abreu, Laís; Lemos, Gabriela

2015-01-01

To report a case of coexisting systemic lupus erythematosus (SLE) and sickle cell disease (SCD) with a review of the literature on the topic. Report of case and research of the association between SLE and SCD in literature through scientific articles in health sciences databases, such as LILACS, MEDLINE/Pubmed and Scielo, until May 2012. Descriptors used: 1. Sickle cell anemia; 2. Sickle cell disease; 3. Systemic lupus erythematosus; 4. Hemoglobinopathies. The authors describe an association between SLE and SS hemoglobinopathy in an eight-year-old female patient displaying articular, hematologic and neuropsychiatric manifestations during clinical evolution. Forty-five cases of association between SLE and SCD are described in literature, mostly adult (62.2%), women (78%) and with the SS phenotype in 78% of the cases, and different clinical manifestations. Compared with our patient, articular, hematologic and neuropsychiatric manifestations were present in 76%, 36% and 27% of the cases, respectively. SLE and SCD are chronic diseases that have several clinical and laboratory findings in common, meaning difficult diagnosis and difficulty in finding the correct treatment. Although the association between these diseases is not common, it is described in literature, so it is imperative that physicians who treat such diseases be alert to this possibility. Copyright © 2012 Elsevier Editora Ltda. All rights reserved.

CRM system benefits : A case study of banking sector

OpenAIRE

Murrawat, Adnan; Nasershariati, Foroozan

2011-01-01

Seminar Date: 05-11-2011 Level: Master Thesis in Information Technology Management,   15ECTS Institution: School of Sustainable Development of Society and Technology, Malardalen University Authors: Adnan Murrawat Khan [amt1001]         Foroozan Nasershariati [fni10002]                                              Title: CRM system benefits, a case study of banking sector Supervisor: Dr Ole Liljefors Problem statement: Customer relationship management (CRM) systems have been adopted to have b...

OPTIMIZED REAL-TIME CONTROL OF COMBINED SEWERAGE SYSTEMS: TWO CASE STUDIES

Science.gov (United States)

The paper presents results of two case studies of Real-Time Control (RTC) alternatives evaluations that were conducted on portions of sewerage systems near Paris, France and in Quebec City, Canada, respectively. The studies were performed at real-scale demonstration sites. RTC ...

Small invasive colon cancer with systemic metastasis: A case report

Directory of Open Access Journals (Sweden)

Sakamoto Taku

2011-05-01

Full Text Available ABSTRACT Background Recently, especially in Japan, several researchers have suggested that colorectal cancer can develop not only through an adenoma-carcinoma sequence but also from normal mucosa via a de novo pathway, and that these de novo cancers have more aggressive malignant potential. We report a case of aggressive colon cancer resulting in systemic metastasis despite small tumour size. Case Presentation A 35-year-old woman presented at the referring hospital with swelling of the left cervical lymph node. Biopsy of the lymph node revealed metastatic adenocarcinoma; however, CT scan and mammography were unable to identify the site of the primary lesion. She was diagnosed with unknown primary cancer and referred to our hospital for further examination. Immunohistochemical reevaluation showed the cervical lymph node biopsy specimen to be positive for CDX2 and CK20 and negative for CK7 expression, leading us to suspect the presence of a primary colorectal cancer. We performed a total colonoscopy, and detected a small protruding lesion in the transverse colon. The tumour was only 12 mm in diameter, with a central depressed component and a severely thickened stalk, which suggested direct cancer invasion of the deep submucosa. We concluded that this lesion was the site of origin of the metastasis despite the small tumour size, and performed diagnostic endoscopic mucosal resection. The lesion was found to have an intramucosal cancer component, demonstrating that this lesion represented primary colon cancer. The patient was referred to the gastrointestinal oncology division for systemic chemotherapy. Conclusions In this case, immunohistochemical findings strongly suggested the existence of a colorectal cancer. The non-polypoid gross appearance of the tumour suggested that it can originate de novo , thus providing a valuable case in support of the aggressive malignant potential of a de novo colorectal cancer pathway.

Designing Intelligent Tutoring Systems: A Personalization Strategy using Case-Based Reasoning and Multi-Agent Systems

Directory of Open Access Journals (Sweden)

Rosalía LAZA

2013-05-01

Full Text Available Intelligent Tutoring Systems (ITSs are educational systems that use artificial intelligence techniques for representing the knowledge. ITSs design is often criticized for being a complex and challenging process. In this article, we propose a framework for the ITSs design using Case Based Reasoning (CBR and Multiagent systems (MAS. The major advantage of using CBR is to allow the intelligent system to propose smart and quick solutions to problems, even in complex domains, avoiding the time necessary to derive those solutions from scratch. The use of intelligent agents and MAS architectures supports the retrieval of similar students models and the adaptation of teaching strategies according to the student profile. We describe deeply how the combination of both technologies helps to simplify the design of new ITSs and personalize the e-learning process for each student

A business case for Smart Grid technologies: A systemic perspective

International Nuclear Information System (INIS)

Giordano, Vincenzo; Fulli, Gianluca

2012-01-01

The digitalization of the electricity grid opens the way to bundle value added services to the electricity commodity, and possibly shift business value to electricity services in line with the notions of efficiency, conservation and sustainability. In this context, market forces should be mobilized within the boundaries of energy policy goals to contribute to the massive investments that are required to fulfill the Smart Grid vision. In this paper, we present a systemic perspective aimed at establishing technical and economic synergies that may improve the business cases of individual different Smart Grid technologies and contribute to reverse the consumption-driven paradigm of the electricity sector. Our analysis is supported by evidence from applications in the electric vehicle and smart meter ecosystems. Throughout the paper, an EU (European Union) perspective is primarily considered. - Highlights: ► We show how the analysis of systemic effects can play a fundamental role in offering a business case to Smart Grid technology and in providing some guidance to new policy interventions and initiatives. ► We base our discussion on two case studies: the set-up of business platforms for (1) Electric Vehicles and E-mobility services and (2) Smart Meters and Smart Home Services. ► We highlight how new business arrangements might leverage technological/business synergies, foster investments and shift business value to electricity services. ► We discuss possible downsides and challenges such as privacy concerns, dominant positions in new business platforms, and consumers' resistance.

A Human Proximity Operations System test case validation approach

Science.gov (United States)

Huber, Justin; Straub, Jeremy

A Human Proximity Operations System (HPOS) poses numerous risks in a real world environment. These risks range from mundane tasks such as avoiding walls and fixed obstacles to the critical need to keep people and processes safe in the context of the HPOS's situation-specific decision making. Validating the performance of an HPOS, which must operate in a real-world environment, is an ill posed problem due to the complexity that is introduced by erratic (non-computer) actors. In order to prove the HPOS's usefulness, test cases must be generated to simulate possible actions of these actors, so the HPOS can be shown to be able perform safely in environments where it will be operated. The HPOS must demonstrate its ability to be as safe as a human, across a wide range of foreseeable circumstances. This paper evaluates the use of test cases to validate HPOS performance and utility. It considers an HPOS's safe performance in the context of a common human activity, moving through a crowded corridor, and extrapolates (based on this) to the suitability of using test cases for AI validation in other areas of prospective application.

A case study in flow assurance of a pipeline-riser system using OLGA

Energy Technology Data Exchange (ETDEWEB)

Nemoto, Rafael Horschutz; Balino, Jorge Luis [Nucleo de Dinamica e Fluidos. Dept. de Engenharia Mecanica. Universidade de Sao Paulo (EP/USP), SP (Brazil)], e-mails: rafael.nemoto@usp.br, jlbalino@usp.br; Tanaka, Rafael Loureiro; Godinho, Carlos Alberto [Prysmian Cables and Systems, Cariacica, ES (Brazil)], e-mails: rafael.tanaka@prysmian.com, carlos.godinho@prysmian.com

2010-07-01

In this paper, a case study in flow assurance is performed considering an offshore operating system, using the software OLGA. As operating system we consider a pipeline-riser geometry with typical dimensions of offshore oil production systems, and a three-phase flow of oil, gas and water. The model developed in OLGA considers the composition and dimensions of the tubes, heat transfer parameters, process equipment and fluid sources. The fluids properties are calculated using the software PVTsim. Simulations are ran in order to determine the pipeline inner diameter and insulation required to satisfy pressure and temperature requirements. It is also possible to simulate the transient behavior of the system, which allows to evaluate if production instabilities are present. In case instabilities exist, two mitigation alternatives are evaluated: closure of a choke valve before the separator and gas lift. Considering a possible production shutdown, the tubes insulation is calculated in order to avoid hydrate formation. (author)

Towards a Structurational Theory of Information Systems: a substantive case analysis

DEFF Research Database (Denmark)

Rose, Jeremy; Hackney, R. H

2003-01-01

This paper employs the analysis of an interpretive case study within a Regional Train Operating Company (RTOC) to arrive at theoretical understandings of Information Systems (IS). Giddens’ ‘structuration theory’ is developed which offers an account of structure and agency; social practices develo...

Hospital accreditation, reimbursement and case mix: links and insights for contractual systems.

Science.gov (United States)

Ammar, Walid; Khalife, Jade; El-Jardali, Fadi; Romanos, Jenny; Harb, Hilda; Hamadeh, Ghassan; Dimassi, Hani

2013-12-05

Resource consumption is a widely used proxy for severity of illness, and is often measured through a case-mix index (CMI) based on Diagnosis Related Groups (DRGs), which is commonly linked to payment. For countries that do not have DRGs it has been suggested to use CMIs derived from International Classification of Diseases (ICD). Our research objective was to use ICD-derived case-mix to evaluate whether or not the current accreditation-based hospital reimbursement system in Lebanon is appropriate. Our study population included medical admissions to 122 hospitals contracted with the Lebanese Ministry of Public Health (MoPH) between June 2011 and May 2012. Applying ICD-derived CMI on principal diagnosis cost (CMI-ICDC) using weighing similar to that used in Medicare DRG CMI, analyses were made by hospital accreditation, ownership and size. We examined two measures of 30-day re-admission rate. Further analysis was done to examine correlation between principal diagnosis CMI and surgical procedure cost CMI (CMI-CPTC), and three proxy measures on surgical complexity, case complexity and surgical proportion. Hospitals belonging to the highest accreditation category had a higher CMI than others, but no difference was found in CMI among the three other categories. Private hospitals had a higher CMI than public hospitals, and those more than 100 beds had a higher CMI than smaller hospitals. Re-admissions rates were higher in accreditation category C hospitals than category D hospitals. CMI-ICDC was fairly correlated with CMI-CPTC, and somehow correlated with the proposed proxies. Our results indicate that the current link between accreditation and reimbursement rate is not appropriate, and leads to unfairness and inefficiency in the system. Some proxy measures are correlated with case-mix but are not good substitutes for it. Policy implications of our findings propose the necessity for changing the current reimbursement system by including case mix and outcome indicators in

Business Case Analysis of the Towed Gilder Air Launched System (TGALS)

Science.gov (United States)

Webb, Darryl W.; Nguyen, McLinton B.; Seibold, Robert W.; Wong, Frank C.; Budd, Gerald D.

2017-01-01

The Aerospace Corporation developed an integrated Business Case Analysis (BCA) model on behalf of the NASA Armstrong Flight Research Center (AFRC). This model evaluated the potential profitability of the Towed Glider Air Launched System (TGALS) concept, under development at AFRC, identifying potential technical, programmatic, and business decisions that could improve its business viability. The model addressed system performance metrics; development, production and operation cost estimates; market size and product service positioning; pricing alternatives; and market share.

The Value of SysML Modeling During System Operations: A Case Study

Science.gov (United States)

Dutenhoffer, Chelsea; Tirona, Joseph

2013-01-01

System models are often touted as engineering tools that promote better understanding of systems, but these models are typically created during system design. The Ground Data System (GDS) team for the Dawn spacecraft took on a case study to see if benefits could be achieved by starting a model of a system already in operations. This paper focuses on the four steps the team undertook in modeling the Dawn GDS: defining a model structure, populating model elements, verifying that the model represented reality, and using the model to answer system-level questions and simplify day-to-day tasks. Throughout this paper the team outlines our thought processes and the system insights the model provided.

Energy storage systems: power grid and energy market use cases

Directory of Open Access Journals (Sweden)

Komarnicki Przemysław

2016-09-01

Full Text Available Current power grid and market development, characterized by large growth of distributed energy sources in recent years, especially in Europa, are according energy storage systems an increasingly larger field of implementation. Existing storage technologies, e.g. pumped-storage power plants, have to be upgraded and extended by new but not yet commercially viable technologies (e.g. batteries or adiabatic compressed air energy storage that meet expected demands. Optimal sizing of storage systems and technically and economically optimal operating strategies are the major challenges to the integration of such systems in the future smart grid. This paper surveys firstly the literature on the latest niche applications. Then, potential new use case and operating scenarios for energy storage systems in smart grids, which have been field tested, are presented and discussed and subsequently assessed technically and economically.

The Relation of Shadow Systems and ERP Systems—Insights from a Multiple-Case Study

Directory of Open Access Journals (Sweden)

Melanie Huber

2016-01-01

Full Text Available ERP systems integrate a major part of all business processes and organizations include them in their IT service management. Besides these formal systems, there are additional systems that are rather stand-alone and not included in the IT management tasks. These so-called ‘shadow systems’ also support business processes but hinder a high enterprise integration. Shadow systems appear during their explicit detection or during software maintenance projects such as enhancements or release changes of enterprise systems. Organizations then have to decide if and to what extent they integrate the identified shadow systems into their ERP systems. For this decision, organizations have to compare the capabilities of each identified shadow system with their ERP systems. Based on multiple-case studies, we provide a dependency approach to enable their comparison. We derive categories for different stages of the dependency and base insights into integration possibilities on these stages. Our results show that 64% of the shadow systems in our case studies are related to ERP systems. This means that they share parts or all of their data and/or functionality with the ERP system. Our research contributes to the field of integration as well as to the discussion about shadow systems.

A Case Study of Obsolescence Management Constraints During Development of Sustainment-Dominated Systems

Science.gov (United States)

Welch, Jonathan

This case study focused on obsolescence management constraints that occur during development of sustainment-dominated systems. Obsolescence management constraints were explored in systems expected to last 20 years or more and that tend to use commercial off-the-shelf products. The field of obsolescence has received little study, but obsolescence has a large cost for military systems. Because developing complex systems takes an average of 3 to 8 years, and commercial off-the-shelf components are typically obsolete within 3 to 5 years, military systems are often deployed with obsolescence issues that are transferred to the sustainment community to determine solutions. The main problem addressed in the study was to identify the constraints that have caused 70% of military systems under development to be obsolete when they are delivered. The purpose of the study was to use a qualitative case study to identify constraints that interfered with obsolescence management occurring during the development stages of a program. The participants of this case study were managers, subordinates, and end-users who were logistics and obsolescence experts. Researchers largely agree that proactive obsolescence management is a lower cost solution for sustainment-dominated systems. Program managers must understand the constraints and understand the impact of not implementing proactive solutions early in the development program lifecycle. The conclusion of the study found several constraints that prevented the development program from early adoption of obsolescence management theories, specifically pro-active theories. There were three major themes identified: (a) management commitment, (b) lack of details in the statement of work, and (c) vendor management. Each major theme includes several subthemes. The recommendation is future researchers should explore two areas: (a) comparing the cost of managing obsolescence early in the development process versus the costs of managing later, (b

Clinical and endoscopic findings in the mucosae of the upper respiratory and digestive tracts in post-treatment follow-up of paracoccidioidomycosis patients Achados clínicos e endoscópicos na mucosa das vias aéreas e digestivas superiores no segmento pós-terapêutico de pacientes com paracoccidioidomicose

Directory of Open Access Journals (Sweden)

Antonio Carlos Francesconi do Valle

1995-10-01

Full Text Available Systematic examination of the upper respiratory and digestive tracts (URDT was performed in a group of 80 paracoccidioidomycosis (PCM patients submitted to post-treatment follow-up ranging from 8 months to 17 years. Mucosae of the URDT had been involved prior to specific treatment in 74 patients, distributed as follows: oropharynx, 50 (41 alone, 7 in association with the larynx, and 2 with the nasal mucosa; larynx, 30 (23 alone and 7 in association; and nasal mucosa, 3(1 alone and 2 in association. Inactive lesions were observed in all the 50 patients with lesions of the oropharynx, 3 of whom with deforming scars (1 with retraction of the tongue and 2 with narrowing of the oral orifice. One case presented a destructive lesion, with perfuration of the palate. Of the other 46 cases, examination showed nacreous white striated scars which were nearly imperceptible in some cases and in others displayed partial retraction of anatomical structures without any alteration of their features. Patients presented a high rate of missing teeth. In 3 patients with involvement of the nasal mucosa, none of whom presented active PCM lesions, 2 still had nasal voices. In 30 patients with lesions of the larynx, 1 suffered a relapse of PCM and 2 developed epidermoid carcinoma. Of the other 27 cases, none of whom had active PCM lesions, 15 presented dysphonia, 3 were tracheotomized, and 9 were asymptomatic.Foi realizado sistematicamente o exame das vias aero-digestivas superiores (VADS em grupo de 80 pacientes de paracoccidioidomicose (PCM acompanhados após o tratamento específico por período que variou de 8 meses a 17 anos. A mucosa das VADS estava comprometida antes do tratamento específico em 74 pacientes, assim distribuídos: orofaringe, 50 (41 isoladamente, 7 em associação com o laringe e 2 com a mucosa nasal; laringe, 30 (23 isoladamente e 7 em associação e nasal, 3 (1 isoladamente e 2 em associação. Em todos os 50 que apresentavam lesões no

Economic considerations for on-road wireless charging systems - A case study

NARCIS (Netherlands)

Shekhar, A.; Bolech, M.; Prasanth, V.; Bauer, P.

2015-01-01

Economic viability of on-road charging strongly depends on the choice of inductive power transfer (IPT) system configuration (static or dynamic charging), charging power level and the percentage road coverage of dynamic charging. In this paper, a case study is carried out to determine the expected

Case Studies in Low-Energy District Heating Systems: Determination of Dimensioning Methods for Planning the Future Heating Infrastructure

DEFF Research Database (Denmark)

Tol, Hakan; Nielsen, Susanne Balslev; Svendsen, Svend

suggests a plan for an energy efficient District Heating (DH) system with low operating temperatures, such as 55°C supply and 25°C return; connected to low-energy buildings. Different case studies referring to typical DH planning situations could show the rational basis for the integrated planning...... of the future’s sustainable and energy efficient heating infrastructure. In this paper, a case study which focuses on dimensioning method of piping network of low-energy DH system in a new settlement, located in Roskilde Municipality, Denmark, is presented. In addition to the developed dimensioning method......, results about the optimal network layout and substation type for low-energy DH systems are also pointed out regarding to this case study. A second case study, included in this paper, focuses on technical and economical aspects of replacing natural gas heating system to low-energy DH system in an existing...

Examining the Use of a Visual Analytics System for Sensemaking Tasks: Case Studies with Domain Experts.

Science.gov (United States)

Kang, Youn-Ah; Stasko, J

2012-12-01

While the formal evaluation of systems in visual analytics is still relatively uncommon, particularly rare are case studies of prolonged system use by domain analysts working with their own data. Conducting case studies can be challenging, but it can be a particularly effective way to examine whether visual analytics systems are truly helping expert users to accomplish their goals. We studied the use of a visual analytics system for sensemaking tasks on documents by six analysts from a variety of domains. We describe their application of the system along with the benefits, issues, and problems that we uncovered. Findings from the studies identify features that visual analytics systems should emphasize as well as missing capabilities that should be addressed. These findings inform design implications for future systems.

Risk identication of tailorable context-aware systems: a case study and lessons learned

NARCIS (Netherlands)

Zarifi Eslami, Mohammed; Sapkota, Brahmananda; Zarghami, Alireza; Vriezekolk, E.; van Sinderen, Marten J.; Wieringa, Roelf J.; Wieringa, P.A.

In this paper, we discuss possible risks posed by the application of tailorable context-aware systems in real-life practices. We use a tailorable context-aware system in the homecare domain as a case study to identify and analyse such risks. Next, we discuss which of these risks can be generalized

A Case with Systemic Sclerosis Following Exposure To Silica and Vibration

Directory of Open Access Journals (Sweden)

Aslı Ürkmez

2012-06-01

Full Text Available Systemic sclerosis is an autoimmune disease characterized by inflammatory, vascular and sclerotic changes in the internal organs. Although the etiology is not known with certainty; silica dust, which is one of the environmental risk factors, can lead to scleroderma by some immunological changes. In this case, a mine worker, who worked in a mercury mine during a 15-year period, developed systemic sclerosis due to exposure to chronic silica and vibration, is presented. (Turk J Dermatol 2012; 6: 45-7

Hotel Classification Systems: A Comparison of International Case Studies

Directory of Open Access Journals (Sweden)

Roberta Minazzi,

2010-12-01

Full Text Available Over the last few decades we have witnessed an increasing interest of scholars andespecially operators in service quality in the lodging business. Firstly, it is important to observe thatthe diverseness of the hospitality industry also affects the classification of hotel quality. We canactually find many programmes, classifications and seals of quality promoted by public authoritiesand private companies that create confusion in the consumer perceptions of hotel quality. Moreover,new electronic distribution channels and their ratings are becoming a new way to gather informationabout a hotel and its quality. Secondly, a point that can cause complications is that different countriesand regions can choose differing approaches depending on the features of the classification (numberof levels, symbols used, etc. and the nature of the programme (public, private. Considering theseassumptions and the recent changes in the Italian hotel classification system, this paper aims toanalyse the situation in Italy, underlining both its positive and negative aspects and comparing it withother European and North American cases. Based on a review of literature and tourism laws as wellas personal interviews with public authorities and exponents of the private sectors, we were able toidentify critical issues and trends in hotel classification systems. The comparison of case studiesshows a heterogeneous situation. Points in common are the scale and the symbol used but, if weanalyse the requirements of each category, we discover very different circumstances, also sometimesin the same country. A future European classification system could be possible only after astandardization of minimum requirements and criteria at a national level. In this situation brands andonline consumers’ feedbacks become even more considered by the customers in the hospitalityindustry.

Identifying Stakeholders and Their Preferences about NFR by Comparing Use Case Diagrams of Several Existing Systems

Science.gov (United States)

Kaiya, Haruhiko; Osada, Akira; Kaijiri, Kenji

We present a method to identify stakeholders and their preferences about non-functional requirements (NFR) by using use case diagrams of existing systems. We focus on the changes about NFR because such changes help stakeholders to identify their preferences. Comparing different use case diagrams of the same domain helps us to find changes to be occurred. We utilize Goal-Question-Metrics (GQM) method for identifying variables that characterize NFR, and we can systematically represent changes about NFR using the variables. Use cases that represent system interactions help us to bridge the gap between goals and metrics (variables), and we can easily construct measurable NFR. For validating and evaluating our method, we applied our method to an application domain of Mail User Agent (MUA) system.

Exergoeconomic analysis of geothermal district heating systems: A case study

International Nuclear Information System (INIS)

Ozgener, Leyla; Hepbasli, Arif; Dincer, Ibrahim; Rosen, Marc A.

2007-01-01

An exergoeconomic study of geothermal district heating systems through mass, energy, exergy and cost accounting analyses is reported and a case study is presented for the Salihli geothermal district heating system (SGDHS) in Turkey to illustrate the present method. The relations between capital costs and thermodynamic losses for the system components are also investigated. Thermodynamic loss rate-to-capital cost ratios are used to show that, for the devices and the overall system, a systematic correlation appears to exist between capital cost and exergy loss (total or internal), but not between capital cost and energy loss or external exergy loss. Furthermore, a parametric study is conducted to determine how the ratio of thermodynamic loss rate to capital cost changes with reference temperature and to develop a correlation that can be used for practical analyses. The correlations may imply that devices in successful district heating systems such as the SGDHS are configured so as to achieve an overall optimal design, by appropriately balancing the thermodynamic (exergy-based) and economic (cost) characteristics of the overall systems and their devices

Multiconfiguration hartree-fock theory for pseudorelativistic systems: The time-dependent case

KAUST Repository

Hajaiej, Hichem; Markowich, Peter A.; Trabelsi, Saber

2014-01-01

to the underlying system under technical assumptions on the energy of the initial data and the charge of the nucleus. Moreover, we prove that the result can be extended to the case of neutron stars when the number of electrons is less than a critical number N cr

It System Integration: Global Medical Acquisition of Health Tech Case Study

Science.gov (United States)

Russo, Mark; White, Bruce

2013-01-01

Mergers and Acquisitions are just part of life in business. For example, in the health care technology field in 2012, Veritas Capital Partners acquired Thomson Reuters' Healthcare. Other major active acquisition companies included: Medical Transcription Billing, T-System Technologies and Sharecare. In this case study, a larger health technology…

Control assessment for heat integrated systems. An industrial case study for ethanol recovery

DEFF Research Database (Denmark)

Mauricio Iglesias, Miguel; Huusom, Jakob Kjøbsted; Sin, Gürkan

2013-01-01

Heat integration is essential for reducing the energy consumption of process industries. However, it may render the dynamic operation more interactive and difficult to control. This paper assesses the implications of heat integration in controllability and performance in energy reduction....... The assessment, both on open loop and closed loop, was carried out based on an industrial case study and compared to a modified case without heat integration. Although the heat integrated system displayed a certain deterioration of controllability, the control system made possible an efficient operation....... The reduction of energy consumption achieved thanks to heat integration was considerably larger than the losses due to poor control of the process, confirming the importance of heat integration in energy intensive processes....

Dynamic simulation of operating cases and malfunctions of an IGCC power plant system

Energy Technology Data Exchange (ETDEWEB)

Koch, I.; Hannemann, F. [Siemens AG, Power Generation (KWU), Erlangen (Germany); Hoffmann, U. [Technische Univ. Clausthal, Clausthal-Zellerfeld (Germany). Inst. fuer Chemische Verfahrenstechnik

1999-07-01

Fully integrated IGCC plants consist of several units. This novel integration of various plant systems places stiff new requirements on power plant design, as prediction of operating and faulted behavior is made more difficult by many different interactions. This is especially the case for the gas turbine fuel system in an IGCC power plant, as it affects and is affected by all of the other major plant systems. (orig.)

Matrix metalloproteinases with gelatinolytic activity induced by Paracoccidioides brasiliensis infection

Science.gov (United States)

Nishikaku, Angela Satie; Ribeiro, Luciana Cristina; Molina, Raphael Fagnani Sanchez; Albe, Bernardo Paulo; Cunha, Cláudia da Silva; Burger, Eva

2009-01-01

Matrix metalloproteinases (MMPs) modulate extracellular matrix turnover, inflammation and immunity. We studied MMP-9 and MMP-2 in experimental paracoccidioidomycosis. At 15 and 120 days after infection (DAI) with virulent Paracoccidioides brasiliensis, MMP-9 was positive by immunohistochemistry in multinucleated giant cells, in mononuclear cells with macrophage and lymphocyte morphologies and also in fungal cells in the lesions of susceptible and resistant mice. Using gelatin zymography, pro- and active MMP-9 and active MMP-2 were detected in all infected mice, but not in controls. Gelatinolytic activity was not observed in P. brasiliensis extracts. Semiquantitative analysis of gelatinolytic activities revealed weak or absent MMP-2 and strong MMP-9 activity in both mouse strains at 15 DAI, declining at 120 DAI. Avirulent P. brasiliensis-infected mice had residual lesions with MMP-9-positive pseudoxantomatous macrophages, but no gelatinase activity at 120 DAI. Our findings demonstrate the induction of MMPs, particularly MMP-9, in experimental paracoccidioidomycosis, suggesting a possible influence in the pattern of granulomas and in fungal dissemination. PMID:19765107

Determining system boundaries on commercial broiler chicken production system using ISO 14040/14044 guideline: A case Study

Science.gov (United States)

Sidek, ‘A. A.; Suffian, S. A.; Al-Hazza, M. H. F.; Yusof, H. M.

2018-01-01

The demand of poultry product in Malaysia market shows an escalation throughout the year and expected to increase in the future. The expansion of poultry production has led to environmental concern in relation to their operational impact to environmentAt present, assessment of waste management of poultry production in Malaysia is lacking. A case study research was conducted in a commercial broiler farm to identify and assess the system boundaries in the lifecycle supply chain of broiler chicken production using ISO 14040/44 guidelines. ISO 14040/44 standard includes Life Cycle Assessment (LCA) framework guidelines to evaluate environmental influence associated with a product/process throughout its life span. All attributes associated with broiler operation is defined and the system boundaries is determined to identify possible inputs and outputs in the case study. This paper discuss the initial stage in the LCA process, which set the context of the research and prepare for the stage of Life Cycle Inventory.

Percutaneous CT-guided biopsy of the musculoskeletal system: Results of 2027 cases

International Nuclear Information System (INIS)

Rimondi, Eugenio; Rossi, Giuseppe; Bartalena, Tommaso; Ciminari, Rosanna; Alberghini, Marco; Ruggieri, Pietro; Errani, Costantino; Angelini, Andrea; Calabro, Teresa; Abati, Caterina Novella; Balladelli, Alba; Tranfaglia, Cristina; Mavrogenis, Andreas F.; Vanel, Daniel; Mercuri, Mario

2011-01-01

Introduction: Biopsy of the musculoskeletal system is useful in the management of bone lesions particularly in oncology but they are often challenging procedures with a significant risk of complications. Computed tomography (CT)-guided needle biopsies may decrease these risks but doubts still exist about their diagnostic accuracy. This retrospective analysis of the experience of a single institution with percutaneous CT-guided biopsy of musculoskeletal lesions evaluates the results of these biopsies for bone lesions either in the appendicular skeleton or in the spine, and defines indications. Materials and methods: We reviewed the results of 2027 core needle biopsies performed over the past 18 years at the authors' institution. The results obtained are subject of this paper. Results: In 1567 cases the correct diagnosis was made with the first CT-guided needle biopsy (77.3% accuracy rate), in 408 cases the sample was not diagnostic and in 52 inadequate. Within 30 days these 408 patients underwent another biopsy, which was diagnostic in 340 cases with a final diagnostic accuracy of 94%. Highest accuracy rates were obtained in primary and secondary malignant lesions. Most false negative results were found in cervical lesions and in benign, pseudotumoral, flogistic, and systemic pathologies. There were 22 complications (18 transient paresis, 3 haematomas, 1 retroperitoneal haematoma) which had no influence on the treatment strategy, nor on patient outcome. Conclusion: This technique is reliable and safe and should be considered nowadays the gold standard for biopsies of the musculoskeletal system.

Decision support in hierarchical planning systems: The case of procurement planning in oil refining industries

DEFF Research Database (Denmark)

Kallestrup, Kasper Bislev; Lynge, Lasse Hadberg; Akkerman, Renzo

2014-01-01

In this paper, we discuss the development of decision support systems for hierarchically structured planning approaches, such as commercially available advanced planning systems. We develop a framework to show how such a decision support system can be designed with the existing organization in mind...... and from the perspective of the organizational aspects involved. To exemplify and develop our framework, we use a case study of crude oil procurement planning in the refining industry. The results of the case study indicate an improved organizational embedding of the DSS, leading to significant savings...... in terms of planning efforts and procurement costs. In general, our framework aims to support the continuous improvement of advanced planning systems, increasing planning quality in complex supply chain settings....

Teaching Case: IS Security Requirements Identification from Conceptual Models in Systems Analysis and Design: The Fun & Fitness, Inc. Case

Science.gov (United States)

Spears, Janine L.; Parrish, James L., Jr.

2013-01-01

This teaching case introduces students to a relatively simple approach to identifying and documenting security requirements within conceptual models that are commonly taught in systems analysis and design courses. An introduction to information security is provided, followed by a classroom example of a fictitious company, "Fun &…

Dynamics of Technological Innovation Systems. The Case of Biomass Energy

International Nuclear Information System (INIS)

Negro, S.O.

2007-01-01

The starting point is that the current energy system largely depends on fossil fuels. This phenomenon, which is labelled as carbon lock-in, causes a long breakthrough period for renewable energy. The most suitable theoretical approach to analyse the development, diffusion and implementation of emergent technologies, such as renewable energy, is the Technological Innovation Systems' (TIS) perspective. This approach focuses on a particular technology and includes all those factors (institutions, actors, and networks) that influence its development. Recent research has identified several so-called System Functions that need to be fulfilled for a TIS to support successfully the evolution of a technology. In this paper we will use the following set of System Functions: F1: Entrepreneurial Activities, F2: Knowledge Development (learning), F3: Knowledge Diffusion through Networks, F4: Guidance of the Search, F5: Market Formation, F6: Resources Mobilisation, F7: Counteracting Resistance to Change (also Support from Advocacy Coalitions). By focusing on the System Functions the key processes that occur in a system which influence the development, diffusion and implementation of that technology will be identified and insight will be gained in the system dynamics. The System Functions are not independent but interact and influence each other. The nature of interactions whether they are positive or negative will influence the performance of the system respectively. Positive System Function fulfilment can lead to positive, i.e. virtuous cycles of processes that strengthen each other and lead to the building up of momentum that creates a process of creative destruction within the incumbent system. According to the same reasoning, a system in decline is characterised by one or more vicious cycles, where the System Functions interact and reinforce each other in a negative way. The results from the case studies showed that different functional patterns occurred for the Biomass

Strategic analysis methodology for energy systems with remote island case study

International Nuclear Information System (INIS)

Krumdieck, Susan; Hamm, Andreas

2009-01-01

A strategic analysis methodology is presented for adaptive energy systems engineering to realize an optimal level of service in the context of a community's social, economic, and environmental position. The groundwork stage involves characterizing the social context, assessing available energy resources, identifying environmental issues, setting eco-resource limits, and quantifying socio-economic constraints for a given region. A spectrum of development options is then constructed according to the range of energy service levels identified for the sector under study. A spectrum of conceptual energy systems is generated and infrastructure investments and resource use are modeled. The outcome is a matrix of energy system investment possibilities for the range of energy demand levels reflecting the values, ideas, and expectations expressed by the community. These models are then used to assess technical feasibility and economic, environmental and social risk. The result is an easily understood graphical depiction of local aspirations, investment options, and risks which clearly differentiates development opportunities from non-viable concepts. The approach was applied to a case study on Rotuma, an isolated Pacific Island. The case study results show a clear development opportunity space for Rotuma where desired energy services are in balance with investment sources, resource availability, and environmental constraints.

Patterns of enterprise system implementation - the case of Chinese aerospace corporate transformation

NARCIS (Netherlands)

Ma, Xiaofeng

2008-01-01

This dissertation aims to identify patterns in the managerial processes during an enterprise system implementation (ESI) period. An ESI remains a notorious challenge. In most cases, it concurrently involves business strategy change, organizational change, and technical innovation. This dissertation

Lyme Carditis: A Case Involving the Conduction System and Mitral Valve.

Science.gov (United States)

Patel, Lakir D; Schachne, Jay S

2017-02-01

Lyme disease is the most common tick-borne infection in the Northern hemisphere. Cardiac manifestations of Lyme disease typically include variable atrioventricular nodal block and rarely structural heart pathology. The incidence of Lyme carditis may be underestimated based on current reporting practices of confirmed cases. This case of a 59-year-old man with Lyme carditis demonstrates the unique presentation of widespread conduction system disease, mitral regurgitation, and suspected ischemic disease. Through clinical data, electrocardiograms, and cardiac imaging, we show the progression, and resolution, of a variety of cardiac symptoms attributable to infection with Lyme. [Full article available at http://rimed.org/rimedicaljournal-2017-02.asp].

Nephrogenic systemic fibrosis: Review of 408 biopsy-confirmed cases

Directory of Open Access Journals (Sweden)

Zhitong Zou

2011-01-01

Full Text Available Nephrogenic systemic fibrosis (NSF has now been virtually eliminated by the discovery of its association with gadolinium-based contrast agents (GBCAs and the consequent reduced use of GBCA-enhanced magnetic resonance imaging (MRI in severe renal failure patients. This review of 408 biopsy-confirmed cases shows how to minimize NSF risk when performing GBCA-enhanced MRI or magnetic resonance angiography. The absence of any NSF cases in patients less than 8 years old or greater than 87 years old suggests that infants and elderly patients are already protected. Limiting GBCA dose to a maximum of 0.1 mMol/kg, dialyzing dialysis patients quickly following GBCA administration, delaying administration of GBCA in acute renal failure until after renal function returns or dialysis is initiated, and avoiding nonionic linear GBCA in renal failure patients, especially when there are pro-inflammatory conditions, appear to have reduced NSF risk to the point where safe GBCA-enhanced MRI is possible in most patients.

Change And Continuity In Native Political Systems: The Case Of The ...

African Journals Online (AJOL)

Using Denkyira (an Akan tribal group in Ghana) as case study, the paper analyses the emergence, subsistence and declivity of indigenous political systems in post-colonial Africa. It argues that whilst there has been continuity in the cherished values of democracy and development, there has been a change in the political ...

Oral and periodontal manifestations associated with systemic sclerosis: A case series and review

OpenAIRE

Rekha Jagadish; Dhoom Singh Mehta; P Jagadish

2012-01-01

Systemic sclerosis is a rare connective tissue disorder with a wide range of oral manifestations. This case series reports significant oral and periodontal changes and also makes an attempt to correlate oral and systemic findings in these patients which enable the clinician for a better diagnosis and evolve a comprehensive treatment plan. Six patients with a known diagnosis of systemic sclerosis were included. After obtaining the patient's informed consent, relevant medical history, oral mani...

Blow-up Mechanism of Classical Solutions to Quasilinear Hyperbolic Systems in the Critical Case

Institute of Scientific and Technical Information of China (English)

无

2006-01-01

This paper deals with the blow-up phenomenon, particularly, the geometric blow-up mechanism, of classical solutions to the Cauchy problem for quasilinear hyperbolic systems in the critical case. We prove that it is still the envelope of the same family of characteristics which yields the blowup of classical solutions to the Cauchy problem in the critical case.

Towards a Business Process Modeling Technique for Agile Development of Case Management Systems

Directory of Open Access Journals (Sweden)

Ilia Bider

2017-12-01

Full Text Available A modern organization needs to adapt its behavior to changes in the business environment by changing its Business Processes (BP and corresponding Business Process Support (BPS systems. One way of achieving such adaptability is via separation of the system code from the process description/model by applying the concept of executable process models. Furthermore, to ease introduction of changes, such process model should separate different perspectives, for example, control-flow, human resources, and data perspectives, from each other. In addition, for developing a completely new process, it should be possible to start with a reduced process model to get a BPS system quickly running, and then continue to develop it in an agile manner. This article consists of two parts, the first sets requirements on modeling techniques that could be used in the tools that supports agile development of BPs and BPS systems. The second part suggests a business process modeling technique that allows to start modeling with the data/information perspective which would be appropriate for processes supported by Case or Adaptive Case Management (CM/ACM systems. In a model produced by this technique, called data-centric business process model, a process instance/case is defined as sequence of states in a specially designed instance database, while the process model is defined as a set of rules that set restrictions on allowed states and transitions between them. The article details the background for the project of developing the data-centric process modeling technique, presents the outline of the structure of the model, and gives formal definitions for a substantial part of the model.

Optimisation-based worst-case analysis and anti-windup synthesis for uncertain nonlinear systems

Science.gov (United States)

Menon, Prathyush Purushothama

This thesis describes the development and application of optimisation-based methods for worst-case analysis and anti-windup synthesis for uncertain nonlinear systems. The worst-case analysis methods developed in the thesis are applied to the problem of nonlinear flight control law clearance for highly augmented aircraft. Local, global and hybrid optimisation algorithms are employed to evaluate worst-case violations of a nonlinear response clearance criterion, for a highly realistic aircraft simulation model and flight control law. The reliability and computational overheads associated with different opti misation algorithms are compared, and the capability of optimisation-based approaches to clear flight control laws over continuous regions of the flight envelope is demonstrated. An optimisation-based method for computing worst-case pilot inputs is also developed, and compared with current industrial approaches for this problem. The importance of explicitly considering uncertainty in aircraft parameters when computing worst-case pilot demands is clearly demonstrated. Preliminary results on extending the proposed framework to the problems of limit-cycle analysis and robustness analysis in the pres ence of time-varying uncertainties are also included. A new method for the design of anti-windup compensators for nonlinear constrained systems controlled using nonlinear dynamics inversion control schemes is presented and successfully applied to some simple examples. An algorithm based on the use of global optimisation is proposed to design the anti-windup compensator. Some conclusions are drawn from the results of the research presented in the thesis, and directions for future work are identified.

Diffusion of interstitials in metallic systems, illustration of a complex study case: aluminum

Science.gov (United States)

David, Matthieu; Connétable, Damien

2017-11-01

While diffusion mechanisms of interstitial elements in fcc systems are generally well-known, especially in the case of H atoms, we show in this work that even in the case of a simple metallic system (aluminum), the diffusion of interstitials exhibits a wide variety of paths and mechanisms that depend on the specie. We used an approach based on first-principles calculations associated with kinetic Monte-Carlo simulations and a multi-state diffusion formalism to compute the diffusion coefficients of five interstitial elements: hydrogen, boron, carbon, nitrogen and oxygen. For instance, at the atomic scale, whilst we find that C atoms prefer to be located in octahedral sites (labeled o) rather than in tetrahedral positions (labeled t), we find one additional stable position in the lattice (M). The diffusion through these three stable positions are thus studied in detail. In the case of B atoms, for which the tetrahedral site is found unstable, the diffusion path is between o-o sites. Similarly, in the case of oxygen, t positions are found to be the only stable positions (o are unstable) and the path of migration, along t-t direction, is found through a twice degenerated asymmetric transition state. In the case of H and N atoms for which t and o sites are stable, we explain why the only path is along the t-o direction. Finally, we discuss explicit formulas to compute coefficients of diffusion of interstitials in fcc structures.

A Case for Implementation of Citizen Centric National Identity Management Systems

DEFF Research Database (Denmark)

Adjei, Joseph K.

of trust in transacting parties. Policy makers are therefore trying to implement identity policies to prevent identity abuses, promote the seamless flow of business transactions, and provide citizens the ability to exercise informational self-determination. Previously, the design of identity management...... and exposure, and a high level of literacy. But in developing countries infrastructural challenges, low literacy level, and physical verification of credentials hamper the effective use of identity management systems. This PhD study adapts the DeLone and McLean model of information systems success to the case...

Giant hydronephrosis in a case of ureterocele with duplex system: an entity yet not reported.

Science.gov (United States)

Aeron, Ruchir; Sokhal, Ashok Kumar; Kumar, Manoj; Sankhwar, Satyanarayan

2017-08-10

Ureterocele, which is a cystic dilatation of the terminal ureter, is usually associated with the upper moiety in a case of the duplex system. Giant hydronephrosis, a rare entity, is usually due to pelviureteric junction obstruction and is usually diagnosed in infants and children. We report a unique case of a unilateral complete duplex system with ureterocele with giant hydronephrosis of the upper moiety in an adult woman presenting as an abdominal lump. To the best of our knowledge, this is the first case of giant hydronephrosis associated with ureterocele in an adult patient. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Multiple Myeloma of the Central Nervous System: 13 Cases and Review of the Literature

Directory of Open Access Journals (Sweden)

Gergely Varga

2018-01-01

Full Text Available Central nervous system involvement is a rare complication of multiple myeloma with extremely poor prognosis as it usually fails to respond to therapy. We present 13 cases diagnosed at two centers in Budapest and review the current literature. The majority of our cases presented with high-risk features initially; two had plasma cell leukemia. Repeated genetic tests showed clonal evolution in 3 cases. Treatments varied according to the era, and efficacy was poor as generally reported in the literature. Only one patient is currently alive, with 3-month follow-up, and the patient responded to daratumumab-based treatment. Recent case reports show promising effectivity of pomalidomide and marizomib.

RARE CASE OF SYSTEMIC SCLEROSIS IN A CHILD AGED 4 MONTHS

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S.S. Postnikov

2007-01-01

Full Text Available The article provides a clinical and morphologic description of a rare case of systemic sclerosis along with the beginning of the diseases during the infancy. In the clinical picture, the researchers identified occurrences of the systemic vasculitis: abundant cyanotic and red spotty rash with atrophy in the middle, thick edemas of legs and ankles, necrosis of the nail bone of the left little finger, banti's syndrome. In the histological picture, most characteristic peculiarities were: 3 stages of systemic sclerosis process development — inflammation, hardening and atrophy; disorganization of collagenous corium fibers; nidi of calcification along the borderline of corium and hypoderm; multiple ulcers of small and large intestines, perforation of one of which caused peritonitis and fatal outcome of the patient.Key words: infants, vasculitis, systemic sclerosis.

The applicability of constructivist user studies: how can constructivist inquiry inform service providers and systems designers? Constructivist inquiry, Case study, Systems design, User behaviour

Directory of Open Access Journals (Sweden)

Alison Pickard

2004-01-01

Full Text Available This paper has attempted to clarify the ways in which individual, holistic case studies, produced via the process of constructivist inquiry, can be tested for trustworthiness and applied to other, similar situations. Service providers and systems designers need contextual information concerning their users in order to design and provide systems and services that will function effectively and efficiently within those contexts. Abstract models can only provide abstract insight into human behaviour and this is rarely sufficient detail upon which to base the planning and delivery of a service. The methodological issues which surround the applicability of individual, holistic case studies are discussed, explaining the concept of 'contextual applicability.' The relevance and usefulness of in-depth case study research to systems designers and service providers is highlighted.

A formulation to analyze system-of-systems problems: A case study of airport metroplex operations

Science.gov (United States)

Ayyalasomayajula, Sricharan Kishore

A system-of-systems (SoS) can be described as a collection of multiple, heterogeneous, distributed, independent components interacting to achieve a range of objectives. A generic formulation was developed to model component interactions in an SoS to understand their influence on overall SoS performance. The formulation employs a lexicon to aggregate components into hierarchical interaction networks and understand how their topological properties affect the performance of the aggregations. Overall SoS performance is evaluated by monitoring the changes in stakeholder profitability due to changes in component interactions. The formulation was applied to a case study in air transportation focusing on operations at airport metroplexes. Metroplexes are geographical regions with two or more airports in close proximity to one another. The case study explored how metroplex airports interact with one another, what dependencies drive these interactions, and how these dependencies affect metroplex throughput and capacity. Metrics were developed to quantify runway dependencies at a metroplex and were correlated with its throughput and capacity. Operations at the New York/New Jersey metroplex (NYNJ) airports were simulated to explore the feasibility of operating very large aircraft (VLA), such as the Airbus A380, as a delay-mitigation strategy at these airports. The proposed formulation was employed to analyze the impact of this strategy on different stakeholders in the national air transportation system (ATS), such as airlines and airports. The analysis results and their implications were used to compare the pros and cons of operating VLAs at NYNJ from the perspectives of airline profitability, and flight delays at NYNJ and across the ATS.

Using CASE-tools based on formal methods in real-life system development of distributed systems

International Nuclear Information System (INIS)

Stoelen, Ketil; Karlsen, Tore Willy; Mohn, Peter; Sandmark, Haaakon

1998-03-01

Within the OECD Halden Reactor Project (HRP) the development and application of formal methods to enhance system quality have been prioritised tasks for the last three years per periods. The three year programme 1997-1999 identifies the need to gain experience from applying formal methods in larger real-life system developments. This motivated the initiation of the HRP research activity Integration of Formal Specification in the Development of HAMMLAB 2000 (INT-FS). The principal objective of INT-FS is to experiment with formal methods in system developments connected to HAMMLAB 2000 and thereby gain a better understanding of their suitability to support practical software engineering. In particular, INT-FS will try to measure the effect of formal methods and gain experience in combining formal methods with traditional development techniques. INT-FS was started up in January 1997. This report describes the status of INT-FS by February 1998. The report identifies objectives and plans; it motivates the choice of formal methods, CASE-tool and software process; it motivates and defines metrics for measuring achievement and the effect of formalization. The report also provides preliminary results from an experimental development of a communication manager; it describes the component to be developed and the background of the participants; it offers some provisional statistics and summarises the experiences with methods and tools. The development of the communication manager is the first attempt ever to exploit state-of-the-art CASE-tools for formal methods in practical software engineering at the HRP. (author)

DDACE cogeneration systems : 10 case studies

Energy Technology Data Exchange (ETDEWEB)

NONE

2009-07-01

DDACE Power Systems are experts in green energy power generation and provide solutions that deal with waste and industrial by-products. The company develops practical energy solutions that address environmental and financial concerns facing both industrial and municipal customers. The following 10 case studies are examples of the installations that DDACE Power Systems have completed in recent years: (1) a combined heat and emergency power installation on the roof of a 19 storey apartment building on Bloor Street in Toronto, Ontario. The cogeneration package provides electricity and heat to the entire building, replacing an old diesel generator, (2) a combined heat and emergency power installation at the Villa Colombo extended care facility in Vaughan, Ontario. The cogeneration system provides heat and power to the building, as well as emergency power, (3) emergency standby power with demand response capabilities at Sobeys Distribution Warehouse in Vaughan, Ontario. The primary purpose of the 2.4 MW low emission, natural gas fuelled emergency standby generator is to provide emergency power to the building in the event of a grid failure, (4) a dual fuel combined heat and power installation at the Queensway Carleton Hospital in Ottawa, Ontario that provides electricity, hot water and steam to all areas of the hospital, (5) a tri-generation installation at the Ontario Police College in Aylmer, Ontario which provides power and heat to the building as well as emergency power in the event of a grid failure. An absorption chiller provides cooling in the summer and an exhaust emission control system reduces NOx emissions, (6) a biomass gasification installation at Nexterra Energy in Kamloops, British Columbia. The 239 kW generator is fueled by synthesis gas, (7) biogas utilization at Fepro Farms in Cobden, Ontario for treatment of the facility's waste products. The biogas plant uses cow manure, as well as fats, oil and grease from restaurants to produce electricity and

Design Flow Instantiation for Run-Time Reconfigurable Systems: A Case Study

Directory of Open Access Journals (Sweden)

Yang Qu

2007-12-01

Full Text Available Reconfigurable system is a promising alternative to deliver both flexibility and performance at the same time. New reconfigurable technologies and technology-dependent tools have been developed, but a complete overview of the whole design flow for run-time reconfigurable systems is missing. In this work, we present a design flow instantiation for such systems using a real-life application. The design flow is roughly divided into two parts: system level and implementation. At system level, our supports for hardware resource estimation and performance evaluation are applied. At implementation level, technology-dependent tools are used to realize the run-time reconfiguration. The design case is part of a WCDMA decoder on a commercially available reconfigurable platform. The results show that using run-time reconfiguration can save over 40% area when compared to a functionally equivalent fixed system and achieve 30 times speedup in processing time when compared to a functionally equivalent pure software design.

System-wide lean implementation in health care: A multiple case study.

Science.gov (United States)

Centauri, Federica; Mazzocato, Pamela; Villa, Stefano; Marsilio, Marta

2018-05-01

Background Lean practices have been widely used by health care organizations to meet efficiency, performance and quality improvement needs. The lean health care literature shows that the effective implementation of lean requires a holistic system-wide approach. However, there is still limited evidence on what drives effective system-wide lean implementation in health care. The existing literature suggests that a deeper understanding of how lean interventions interact with the organizational context is necessary to identify the critical variables to successfully sustain system-wide lean strategies. Purpose and methodology: A multiple case study of three Italian hospitals is conducted with the aim to explore the organizational conditions that are relevant for an effective system-wide lean implementation. A conceptual framework, built on socio-technical system schemas, is used to guide data collection and analysis. The analysis points out the importance to support lean implementation with an integrated and coordinated strategy involving the social, technical, and external components of the overall hospital system.

Exploring the Business Case Development Process in Inter-Organizational Enterprise System Implementations

NARCIS (Netherlands)

Eckartz, S.M.; Katsma, Christiaan; Daneva, Maia

Creating and negotiating an inter-organizational business case (BC) for multiple-stakeholder enterprise systems is a major challenge. This paper looks closer into the factors that influence the stakeholders’ willingness to share information necessary for the BC development. The authors develop an

Farm management information systems: A case study on a German multifunctional farm

Directory of Open Access Journals (Sweden)

Husemann Christoph

2014-01-01

Full Text Available Accurate and easy to use Farm Management Information Systems (FMIS are of fundamental importance for a successful operational farm management. However, still today many farmers do not use FMISs for various reasons, like lack of knowledge and the complexity of many available FMISs. In particular for small to medium-sized farms and for multifunctional farms appropriate FMISs hardly exist. This paper aims on the deduction of a concrete FMIS from a general FMIS. The concrete FMIS has to focus on the needs of medium-sized and multifunctional farms. This means that the farmer has to be empowered to allocate the scarce resources of the farm. Therefore, we picked a German farm from the state North Rhine Westphalia as a case-study to apply a system analysis. The case study farm helps to identify and to analyze relevant material and information flows, production processes, and their interconnections and synergies.

Using existing case-mix methods to fund trauma cases.

Science.gov (United States)

Monakova, Julia; Blais, Irene; Botz, Charles; Chechulin, Yuriy; Picciano, Gino; Basinski, Antoni

2010-01-01

Policymakers frequently face the need to increase funding in isolated and frequently heterogeneous (clinically and in terms of resource consumption) patient subpopulations. This article presents a methodologic solution for testing the appropriateness of using existing grouping and weighting methodologies for funding subsets of patients in the scenario where a case-mix approach is preferable to a flat-rate based payment system. Using as an example the subpopulation of trauma cases of Ontario lead trauma hospitals, the statistical techniques of linear and nonlinear regression models, regression trees, and spline models were applied to examine the fit of the existing case-mix groups and reference weights for the trauma cases. The analyses demonstrated that for funding Ontario trauma cases, the existing case-mix systems can form the basis for rational and equitable hospital funding, decreasing the need to develop a different grouper for this subset of patients. This study confirmed that Injury Severity Score is a poor predictor of costs for trauma patients. Although our analysis used the Canadian case-mix classification system and cost weights, the demonstrated concept of using existing case-mix systems to develop funding rates for specific subsets of patient populations may be applicable internationally.

Efficiency of an emissions payment system for nitrogen in sewage treatment plants - a case study.

Science.gov (United States)

Malmaeus, J Mikael; Ek, Mats; Åmand, Linda; Roth, Susanna; Baresel, Christian; Olshammar, Mikael

2015-05-01

An emissions payment system for nitrogen in Swedish sewage treatment plants (STPs) was evaluated using a semi-empirical approach. The system was based on a tariff levied on each unit of nitrogen emitted by STPs, and profitable measures to reduce nitrogen emissions were identified for twenty municipal STPs. This was done through direct involvement with the plant personnel and the results were scaled up to cover all treatment plants larger than 2000 person equivalents in the Swedish tributary areas of the Kattegat and the Baltic Proper. The sum of costs and nitrogen reductions were compared with an assumed command-and-control regulation requiring all STPs to obtain 80% total nitrogen reduction in their effluents. Costs for the latter case were estimated using a database containing standard estimates for reduction costs by six specified measures. For both cases a total reduction target of 3000 tonnes of nitrogen was set. We did not find that the emissions payment system was more efficient in terms of total reduction costs, although some practical and administrative advantages could be identified. Our results emphasize the need to evaluate the performance of policy instruments on a case-by-case basis since the theoretical efficiency is not always reflected in practice. Copyright © 2015 Elsevier Ltd. All rights reserved.

Failure of nitric oxide production by macrophages and decrease in CD4+ T cells in oral paracoccidioidomycosis: possible mechanisms that permit local fungal multiplication Falha na produção de óxido nítrico pelos macrófagos e diminuição de células T CD4+ na paracoccidioidomicose bucal: possíveis mecanismos que permitem a multiplicação fúngica local

Directory of Open Access Journals (Sweden)

Aline Carvalho Batista

2005-10-01

Full Text Available Paracoccidioidomycosis is a chronic granulomatous disease that induces a specific inflammatory and immune response. The participation of nitric oxide (NO, a product of the inducible nitric oxide synthase enzyme (iNOS, as an important fungicidal molecule against Paracoccidioides brasiliensis has been demonstrated. In order to further characterize the Oral Paracoccidioidomycosis (OP, we undertook an immunohistochemical study of iNOS+, CD45RO+, CD3+, CD8+, CD20+, CD68+ cells and mast cells. The samples were distributed in groups according to the number of viable fungi per mm². Our results showed weak immunolabeling for iNOS in the multinucleated giant cells (MNGC and in most of the mononuclear (MN cells, and the proportion of iNOS+ MN/MNGC cells in the OP were comparable to Control (clinically healthy oral tissues. Additionally, our analysis revealed a similarity in the number of CD4+ cells between the Control and the OP groups with higher numbers of fungi. These findings suggest that a low expression of iNOS and a decrease in the CD4+ T cells in OP may represent possible mechanisms that permit the local fungal multiplication and maintenance of active oral lesions.A paracoccidioidomicose é uma doença granulomatosa crônica que induz resposta inflamatória e imune específica. A participação do óxido nítrico (NO, produto da enzima óxido nítrico sintase induzível (iNOS, como uma importante molécula fungicida contra o fungo Paracoccidioides brasiliensis tem sido demonstrada. Com o objetivo de melhor caracterizar as lesões orais da paracoccidioidomicose (OP, propusemos estudo imunohistoquímico das células iNOS+ e das células CD45RO+, CD3+, CD8+, CD20+, CD68+ e mastócitos. As amostras foram distribuídas em grupos de acordo com o número de fungos viáveis por mm². Nossos resultados demonstraram leve imunomarcação para iNOS nas células gigantes multinucleadas (MNGC e na maioria das células mononucleares (MN, e a proporção de c

FoodCASE: A system to manage food composition, consumption and TDS data.

Science.gov (United States)

Presser, Karl; Weber, David; Norrie, Moira

2018-01-01

Food and nutrition scientists, nowadays, need to manage an increasing amount of data regarding food composition, food consumption and Total Diet Studies (TDS). The corresponding datasets can contain information about several thousand different foods, in different versions from different studies. FoodCASE is a system that has been developed to manage these different datasets. It also support flexible means of linking between datasets and generally provide support for the different processes involved in the acquisition, management and processing of data. In this paper, the most important concepts to implement existing guidelines and standards for proper food data management are presented, as well as different use cases of data import and proofs of concepts demonstrating the ability to manage data in FoodCASE. Copyright © 2016 Elsevier Ltd. All rights reserved.

NDT-Tool: A case tool to deal with requirements in web information systems

OpenAIRE

Escalona Cuaresma, María José; Torres Valderrama, Jesús; Mejías Risoto, Manuel

2003-01-01

Internet progress and the rising interest for developing systems in web environment has given way to several methodological proposals which have been proposed to be a suitable reference in the development process. However, there is a gap in case tool[3][4][6]. This work presents a case tool named NDT-Tool that allows to apply algorithms and techniques proposed in NDT (Navigational Development Techniques) [2], which is a methodological proposition to specify, analyze and desi...

Consensus Building Through Systems Thinking: the case of policy and planning in healthcare

Directory of Open Access Journals (Sweden)

Kambiz E. Maani

2002-05-01

Full Text Available This paper discusses a methodology and a case study using qualitative system dynamics to create consensus, team learning and shared vision in a public organisation. The case involves determining planning priorities for a Division of the Ministry of Health in New Zealand, leading to the creation of a business plan. The methodology involves Systems Thinking using Group Model Building (GMB - A three-step process starting with structured brainstorming using the partial KJ (Jiro Kawakita technique to identify priority areas and then clustering them into 'affinity' groups. Next, the priority clusters are used by the participants to construct causal loop diagrams representing 'systems of priorities'(in contrast with list of priorities. Finally, through a group process, leverage points or key priorities are identified as the basis for a business plan. While the above process was well agreed upon by the participants at the outset, strong group resistance was encountered when managers attempted to reduce the number of priority areas. Systems thinking approach was used to create consensus and the commitment to the outcome. The GMB approach offers significant promise in using qualitative system dynamics with non-systems experts. The methodology can be applied to change management initiative and complex decisions such as restructuring, reengineering, and supply chain design. The expected outcomes are greater commitment and shared vision.

Anforderungen von Studierenden an e-Learning-Systeme und an die Gestaltung elektronischer Fallbeispiele [Student’s specifications of e-learning systems for case-based teaching

Directory of Open Access Journals (Sweden)

von Müller, Lutz

2013-11-01

Full Text Available [english] Evolution of case-based teaching (CBT is influenced by student’s specifications and also by improvement of computer-based e-learning systems. In the present single center study of the University of Saarland Medical Center the medical students in the third year compared two case-based e-learning systems. CAMPUS-Classic-Player is an open system with almost unrestricted decision trees whereas the CAMPUS-Card-Player represents an educational structured e-learning platform. Learning from patients and also learning from students will be introduced as our pivotal principle for development of new e-learning strategies.A significantly better evaluation was found for the more structured CAMPUS-Card-Player with respect to profile, clarity, didactics, learning effects, and relevance for exam preparation. The student’s intentions for CBT were clearly focused on usability for preparation of future exams which can be better achieved by the help of more structured e-learning systems. The time to process and answer the cases was about for both players. We therefore propose that the time schedule for most users is limited per case irrespective of the complexity of decision trees, cases or e-learning systems. This remains to be mentioned for the design of future cases. [german] Die Weiterentwicklung von fallbasiertem Lernen wird durch die Anregungen der Studierenden („user“ und durch neue technische Entwicklungen und Möglichkeiten von e-Learning-Systemen bestimmt. In dieser prospektiven monozentrischen Studie am Universitätsklinikum des Saarlandes wurde von Studierenden des 1. und 2. klinischen Semesters Medizin eine offene (CAMPUS-Classic-Player und ein strukturierte e-Learning-Plattform (CAMPUS-Card-Player für die Darstellung elektronischer Fallbeispiele verglichen und bewertet. Signifikant besser evaluiert wurde der CAMPUS-Card-Player in Bezug auf Form, Übersichtlichkeit, Zusatzmaterialien, Didaktik, Lerneffekt, Prüfungsrelevanz und

Passive fire building protection system evaluation (case study: millennium ict centre)

Science.gov (United States)

Rahman, Vinky; Stephanie

2018-03-01

Passive fire protection system is a system that refers to the building design, both regarding of architecture and structure. This system usually consists of structural protection that protects the structure of the building and prevents the spread of fire and facilitate the evacuation process in case of fire. Millennium ICT Center is the largest electronic shopping center in Medan, Indonesia. As a public building that accommodates the crowd, this building needs a fire protection system by the standards. Therefore, the purpose of this study is to evaluate passive fire protection system of Millennium ICT Center building. The study was conducted to describe the facts of the building as well as direct observation to the research location. The collected data is then processed using the AHP (Analytical Hierarchy Process) method in its weighting process to obtain the reliability value of passive fire protection fire system. The results showed that there are some components of passive fire protection system in the building, but some are still unqualified. The first section in your paper

Lipomas of the central nervous system in the newborns – a report of eight cases

International Nuclear Information System (INIS)

Gradowska, Kinga; Czech-Kowalska, Justyna; Jurkiewicz, Elżbieta; Komornicka, Justyna; Dobrzańska, Anna

2011-01-01

Central nervous system lipomas are rare tumours. In most of the cases they are located in corpus callosum of the brain. The ultrasonographic image of lipomas tends to be quite characteristic. Final diagnosis is however done on a basis of brain resonance. The purpose of this work is to present proceeding in case of central nervous system lipomas with particular attention to diagnostic imaging. This work is based on own research. There are eight patients with central nervous system lipomas described in this work. The ultrasonographic imaging performed upon patients’ birth revealed features of agenesis of corpus callosum with presence of hyperechoic structure in the area of median line within corpus callosum. This image correlated with Nuclear Magnetic Resonance examination results. Our research confirms that patients with central nervous system lipomas represent rare diagnostic and therapeutic cases. Due to characteristic results of ultrasonographic imaging of the brain, recognition of agenesis of corpus callosum would not cause difficulties. However the presence of hyperechoic structure without vascular flow which may suggest lipomas of corpus callosum would require final verification of the diagnosis and wider assessment of brain with NMR examination. We did not recognize any relation between corpus callosum pathology and neuroinfection of cytomegalovirus etiology. In all of the eight research cases there were malformations diagnostics conducted. There were genetic irregularities in case of two of the neonates only. Until today, all of the patients remain under neurological care. Their psychomotor development is regularly controlled. Taking into consideration that numerous malformations occur altogether with brain lipomas, it is recommended to conduct appropriate diagnostics, to inform parents on an essence of diagnosis and on necessity of observing child’s psychomotor development. Obviously, it is crucial to secure a patient with paediatric and neurological

Integrated Comprehensive Care - A Case Study in Nursing Leadership and System Transformation.

Science.gov (United States)

Wheatley, Laura; Doyle, Winnie; Evans, Cheryl; Gosse, Carolyn; Smith, Kevin

2017-01-01

Calls for transformational change of our healthcare system are increasingly clear, persuasive and insistent. They resonate at all levels, with those who fund, deliver, provide and receive care, and they are rooted in a deep understanding that the system, as currently rigidly structured, most often lacks the necessary flexibility to comprehensively meet the needs of patients across the continuum of care. The St. Joseph's Health System (SJHS) Integrated Comprehensive Care (ICC) Program, which bundles care and funding across the hospital to home continuum, has reduced fragmentation of care, and it has delivered improved outcomes for patients, providers and the system. This case study explores the essential contribution of nursing leadership to this successful transformation of healthcare service delivery.

Studying the Behaviour of Model of Mirror Neuron System in Case of Autism

OpenAIRE

Anirban, Shikha; Hanif Ali, Mohammad

2012-01-01

Several experiment done by the researchers conducted that autism is caused by the dysfunctional mirror neuron system and the dysfunctions of mirror neuron system is proportional to the symptom severity of autism. In the present work those experiments were studied as well as studying a model of mirror neuron system called MNS2 developed by a research group. This research examined the behavior of the model in case of autism and compared the result with those studies conducting dysfunctions of m...

Validating the Johns Hopkins ACG Case-Mix System of the elderly in Swedish primary health care

Directory of Open Access Journals (Sweden)

Fridh Gerd

2006-06-01

Full Text Available Abstract Background Individualbased measures for comorbidity are of increasing importance for planning and funding health care services. No measurement for individualbased healthcare costs exist in Sweden. The aim of this study was to validate the Johns Hopkins ACG Case-Mix System's predictive value of polypharmacy (regular use of 4 or more prescription medicines used as a proxy for health care costs in an elderly population and to study if the prediction could be improved by adding variables from a population based study i.e. level of education, functional status indicators and health perception. Methods The Johns Hopkins ACG Case-Mix System was applied to primary health care diagnoses of 1402 participants (60–96 years in a cross-sectional community based study in Karlskrona, Sweden (the Swedish National study on Ageing and Care during a period of two years before they took part in the study. The predictive value of the Johns Hopkins ACG Case-Mix System was modeled against the regular use of 4 or more prescription medicines, also using age, sex, level of education, instrumental activity of daily living- and measures of health perception as covariates. Results In an exploratory biplot analysis the Johns Hopkins ACG Case-Mix System, was shown to explain a large part of the variance for regular use of 4 or more prescription medicines. The sensitivity of the prediction was 31.9%, whereas the specificity was 88.5%, when the Johns Hopkins ACG Case-Mix System was adjusted for age. By adding covariates to the model the sensitivity was increased to 46.3%, with a specificity of 90.1%. This increased the number of correctly classified by 5.6% and the area under the curve by 11.1%. Conclusion The Johns Hopkins ACG Case-Mix System is an important factor in measuring comorbidity, however it does not reflect an individual's capability to function despite a disease burden, which has importance for prediction of comorbidity. In this study we have shown that

Leadership change: A case study analysis of strategy and control systems development

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Alaudin Ahmadasri

2017-01-01

Full Text Available This paper reports on how a change of leadership at the CEO-level influences strategic practices and control systems development. The case study describes how the new chief executive developed and communicated his vision and strategy through control systems and structural change. The findings indicate that senior employees’ involvement in strategic plan development (through SLT mechanism in this case brought clarity and assurance to them. Meetings are important control mechanisms to structure the sharing of information and to enhance employee commitment and help decision making. It is argued leadership manifests through the interactions of leader with employees in many control practices. The findings have implications for family-owned businesses that are facing imminent change in leadership. They benefit founders/top managers that are about to change leadership of entrepreneurial firm to the next level by highlighting the importance of preparing leader’s capacity for an effective leadership role. The study also highlights some important factors which are seldom discussed in control theories.

Case Studies in a Physiology Course on the Autonomic Nervous System: Design, Implementation, and Evaluation

Science.gov (United States)

Zimmermann, Martina

2010-01-01

The introduction of case studies on the autonomic nervous system in a fourth-semester physiology course unit for Pharmacy students is described in this article. This article considers how these case studies were developed and presents their content. Moreover, it reflects on their implementation and, finally, the reception of such a transformation…

The Challenge of Implementing an ERP System in a Small and Medium Enterprise--A Teaching Case of ERP Project Management

Science.gov (United States)

Xu, Hongjiang; Rondeau, Patrick J.; Mahenthiran, Sakthi

2011-01-01

Enterprise Resource Planning (ERP) system implementation projects are notoriously risky. While large-scale ERP cases continue to be developed, relatively few new ERP cases have been published that further ERP implementation education in small to medium size firms. This case details the implementation of a new ERP system in a medium sized…

Secure E-Examination Systems Compared: Case Studies from Two Countries

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Andrew E. Fluck

2017-04-01

Full Text Available Aim/Purpose: Electronic examinations have some inherent problems. Students have expressed negative opinions about electronic examinations (e-examinations due to a fear of, or unfamiliarity with, the technology of assessment, and a lack of knowledge about the methods of e-examinations. Background: Electronic examinations are now a viable alternative method of assessing student learning. They provide freedom of choice, in terms of the location of the examination, and can provide immediate feedback; students and institutions can be assured of the integrity of knowledge testing. This in turn motivates students to strive for deeper learning and better results, in a higher quality and more rigorous educational process. Methodology\t: This paper compares an e-examination system at FUT Minna Nigeria with one in Australia, at the University of Tasmania, using case study analysis. The functions supported, or inhibited, by each of the two e-examination systems, with different approaches to question types, cohort size, technology used, and security features, are compared. Contribution: The researchers’ aim is to assist stakeholders (including lecturers, invigilators, candidates, computer instructors, and server operators to identify ways of improving the process. The relative convenience for students, administrators, and lecturer/assessors and the reliability and security of the two systems are considered. Challenges in conducting e-examinations in both countries are revealed by juxtaposing the systems. The authors propose ways of developing more effective e-examination systems. Findings: The comparison of the two institutions in Nigeria and Australia shows e-examinations have been implemented for the purpose of selecting students for university courses, and for their assessment once enrolled. In Nigeria, there is widespread systemic adoption for university entrance merit selection. In Australia this has been limited to one subject in one state, rather

Coexistence of systemic lupus erythematosus and multiple sclerosis. A case report and literature review.

Science.gov (United States)

Jácome Sánchez, Elisa Carolina; García Castillo, María Ariana; González, Victor Paredes; Guillén López, Fernando; Correa Díaz, Edgar Patricio

2018-01-01

Multiple sclerosis (MS) and systemic lupus erythematous (SLE) are autoimmune diseases, the coexistence of which is uncommon in patients. Owing to the rarity of this condition, the distinction between MS and SLE is a diagnostic challenge for neurologists. We present a case report in which MS and SLE were present in the same patient. There are few case reports in the world on the association between MS and SLE. The following case report is the first of its kind in which both MS and SLE are present in a patient from a country with low prevalence of MS such as Ecuador.

Logistics Cost Calculation of Implementation Warehouse Management System: A Case Study

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Kučera Tomáš

2017-01-01

Full Text Available Warehouse management system can take full advantage of the resources and provide efficient warehousing services. The paper aims to show advantages and disadvantages of the warehouse management system in a chosen enterprise, which is focused on logistics services and transportation. The paper can bring new innovative approach for warehousing and presents how logistics enterprise can reduce logistics costs. This approach includes cost reduction of the establishment, operation and savings in the overall assessment of the implementation of the warehouse management system. The innovative warehouse management system will be demonstrated as the case study, which is classified as a qualitative scientific method, in the chosen logistics enterprise. The paper is based on the research of the world literature, analyses of the internal logistics processes, data and finally enterprise documents. The paper discovers costs related to personnel costs, handling equipment costs and costs for material identification. Implementation of the warehouse management system will reduce overall logistics costs of warehousing and extend the warehouse management system to other parts of the logistics chain.

[Drug rash with eosinophilia and systemic symptoms syndrome induced by carbamazepine: Case report].

Science.gov (United States)

Marín, Jorge Alonso; Ortega, Mayra Alexandra; Sánchez, Isaura Pilar; Pacheco, José Armando

2017-06-01

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a hypersensitivity reaction associated with a variety of drugs, mainly anticonvulsants, which is characterized by systemic symptoms and erythematous lesions, common to other toxicodermas. It is an uncommon clinical entity that requires a high suspicion by clinical staff given its varied initial presentation, and the fact that symptoms can overlap with those of other adverse cutaneous reactions to drugs. Without early diagnosis and appropriate treatment, mortality increases.We report the case of a 22-year-old patient with impaired neurodevelopment who received treatment with carbamazepine. Two months later he presented with general symptoms and skin erythematous lesions that began on his trunk. The patient received outpatient care with antihistamines and antipyretics without an appropriate response. His case progressed with increased skin lesions and systemic symptoms that met the diagnostic criteria for DRESS syndrome. He was hospitalized and received medical treatment according to recommended guidelines. The patient's condition improved as his symptoms and associated complications resolved. He was discharged with gradual clearing of the steroid therapy.

Societal Constraints, Systemic Disadvantages and Homelessness: An Individual Case Study

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Carol Kauppi

2013-10-01

Full Text Available Research utilizing the individual case study method examined the complex issues related to pathways into and out of home-lessness for an Aboriginal man from a First Nation community on the western James Bay in Canada. This instrumental case study focused on an individual's story, rather than on a site or a group of individuals, an incident or a series of incidents, or a program [6] [15]. First, as a research tool, it provides insight into the issue of homelessness and some of its causes from the perspective of an Aboriginal person. Second, the in-depth data gathered allowed us to understand some of the factors that work and those that do not work in facilitating transitions out of homelessness. Third, as an educational tool, it allows people from the outside to have a better understanding of how systemic disadvantages contribute to individuals falling into homelessness.

Writing case studies in information systems research

NARCIS (Netherlands)

van der Blonk, H.C.

Case study research can be reported in different ways. This paper explores the various ways in which researchers may choose to write down their case studies and then introduces a subsequent typology of writing case studies. The typology is based on a 2 x 2 matrix, resulting in four forms of writing

Dramatic Response of a Case ofRecurrent Basal Cell Carcinoma toSystemic Chemotherapy

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Mohammad Mohammadianpanah

2010-10-01

Full Text Available Basal cell carcinoma (BCC is the most common cancer among humans, and the standard treatment is surgery. Other modalities are reserved as a second line of treatment. Topical chemotherapy may be used in primary BCC. Systemic chemotherapy has no role in the primary treatment of BCC, although it may be efficacious in metastatic cases. We report the case of a patient with persistent recurrent BCC following multiple surgeries and radiotherapy, who achieved a dramatic response with a cisplatinand 5-flourouracil chemotherapy regimen.

Computer-Aided Prototyping Systems (CAPS) within the software acquisition process: a case study

OpenAIRE

Ellis, Mary Kay

1993-01-01

Approved for public release; distribution is unlimited This thesis provides a case study which examines the benefits derived from the practice of computer-aided prototyping within the software acquisition process. An experimental prototyping systems currently in research is the Computer Aided Prototyping System (CAPS) managed under the Computer Science department of the Naval Postgraduate School, Monterey, California. This thesis determines the qualitative value which may be realized by ...

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

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E. I. Alexeeva

2013-01-01

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

Regenerative braking strategies, vehicle safety and stability control systems: critical use-case proposals

Science.gov (United States)

Oleksowicz, Selim A.; Burnham, Keith J.; Southgate, Adam; McCoy, Chris; Waite, Gary; Hardwick, Graham; Harrington, Cian; McMurran, Ross

2013-05-01

The sustainable development of vehicle propulsion systems that have mainly focused on reduction of fuel consumption (i.e. CO2 emission) has led, not only to the development of systems connected with combustion processes but also to legislation and testing procedures. In recent years, the low carbon policy has made hybrid vehicles and fully electric vehicles (H/EVs) popular. The main virtue of these propulsion systems is their ability to restore some of the expended energy from kinetic movement, e.g. the braking process. Consequently new research and testing methods for H/EVs are currently being developed. This especially concerns the critical 'use-cases' for functionality tests within dynamic events for both virtual simulations, as well as real-time road tests. The use-case for conventional vehicles for numerical simulations and road tests are well established. However, the wide variety of tests and their great number (close to a thousand) creates a need for selection, in the first place, and the creation of critical use-cases suitable for testing H/EVs in both virtual and real-world environments. It is known that a marginal improvement in the regenerative braking ratio can significantly improve the vehicle range and, therefore, the economic cost of its operation. In modern vehicles, vehicle dynamics control systems play the principal role in safety, comfort and economic operation. Unfortunately, however, the existing standard road test scenarios are insufficient for H/EVs. Sector knowledge suggests that there are currently no agreed tests scenarios to fully investigate the effects of brake blending between conventional and regenerative braking as well as the regenerative braking interaction with active driving safety systems (ADSS). The paper presents seven manoeuvres, which are considered to be suitable and highly informative for the development and examination of H/EVs with regenerative braking capability. The critical manoeuvres presented are considered to be

Pigmented villonodular synovitis of the hip in systemic lupus erythematosus: a case report

Directory of Open Access Journals (Sweden)

Anders Hans-Joachim

2011-09-01

Full Text Available Abstract Introduction Pigmented villonodular synovitis is a rare disease of unknown etiology mostly affecting the knee and foot. Until now an association with autoimmune diseases has not been reported. Case presentation The diagnosis of systemic lupus erythematosus was made in a 15-year-old Caucasian girl based on otherwise unexplained fatigue, arthralgia, tenosynovitis, leukopenia, low platelets and the presence of antinuclear and deoxyribonucleic antibodies. At the age of 20 a renal biopsy revealed lupus nephritis class IV and she went into complete remission with mycophenolate mofetil and steroids. She was kept on mycophenolate mofetil for maintenance therapy. At the age of 24 she experienced a flare-up of lupus nephritis with nephrotic syndrome and new onset of pain in her right hip. Magnetic resonance imaging, arthroscopy and subtotal synovectomy identified pigmented villonodular synovitis as the underlying diagnosis. Although her systemic lupus erythematosus went into remission with another course of steroids and higher doses of mycophenolate mofetil, the pigmented villonodular synovitis persisted and she had to undergo open synovectomy to control her symptoms. Conclusion Systemic lupus erythematosus is associated with many different musculoskeletal manifestations including synovitis and arthritis. Pigmented villonodular synovitis has not previously been reported in association with systemic lupus erythematosus, but as its etiology is still unknown, the present case raises the question about a causal relationship between systemic lupus erythematosus and pigmented villonodular synovitis.

Lipomas of the central nervous system in childhood. Apropos of 3 cases

International Nuclear Information System (INIS)

Delucchi Bottato, M.; Scavone Mauro, C.; Delfino Albornoz, A.

2004-01-01

Lipomas of the central nervous system occur as a phenomenon consequences developmental malformations of the central nervous system (CNS) and are not considered neoplasms . It is often associated with other congenital malformations. Representing 0.5 percent of intracranial tumors. Imaging studies are central CT or MRI for diagnosis. They are generally associated with other malformations of the CNS. The surgical treatment is always discussed by the high morbidity associated with it. We present three cases of children with lipomas of different topography. (author) [es

Inference for Ecological Dynamical Systems: A Case Study of Two Endemic Diseases

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Daniel A. Vasco

2012-01-01

Full Text Available A Bayesian Markov chain Monte Carlo method is used to infer parameters for an open stochastic epidemiological model: the Markovian susceptible-infected-recovered (SIR model, which is suitable for modeling and simulating recurrent epidemics. This allows exploring two major problems of inference appearing in many mechanistic population models. First, trajectories of these processes are often only partly observed. For example, during an epidemic the transmission process is only partly observable: one cannot record infection times. Therefore, one only records cases (infections as the observations. As a result some means of imputing or reconstructing individuals in the susceptible cases class must be accomplished. Second, the official reporting of observations (cases in epidemiology is typically done not as they are actually recorded but at some temporal interval over which they have been aggregated. To address these issues, this paper investigates the following problems. Parameter inference for a perfectly sampled open Markovian SIR is first considered. Next inference for an imperfectly observed sample path of the system is studied. Although this second problem has been solved for the case of closed epidemics, it has proven quite difficult for the case of open recurrent epidemics. Lastly, application of the statistical theory is made to measles and pertussis epidemic time series data from 60 UK cities.

Pulmonary dystrophic Calcinosis associated to systemic sclerosis: Report of the first case in Colombia

International Nuclear Information System (INIS)

Mendez Patarroyo, Paul; Rojas, Adriana; Restrepo Suarez, Jose Felix; Iglesias Gamarra, Antonio

2002-01-01

The association of pulmonary calcinosis with systemic sclerosis has not been described in the medical literature. There are two type of lung calcification: dystrophic and metastatic; in the collagen vascular diseases the most frequent is the dystrophic calcinosis, seen mainly in dermatomyositis and scleroderma. We describe the first case of dystrophic calcinosis associated with systemic sclerosis

Perform Thermodynamics Measurements on Fuel Cycle Case Study Systems

Energy Technology Data Exchange (ETDEWEB)

Martin, Leigh R. [Idaho National Lab. (INL), Idaho Falls, ID (United States)

2014-09-01

This document was prepared to meet FCR&D level 3 milestone M3FT-14IN0304022, “Perform Thermodynamics Measurements on Fuel Cycle Case Study Systems.” This work was carried out under the auspices of the Thermodynamics and Kinetics FCR&D work package. This document reports preliminary work in support of determining the thermodynamic parameters for the ALSEP process. The ALSEP process is a mixed extractant system comprised of a cation exchanger 2-ethylhexyl-phosphonic acid mono-2-ethylhexyl ester (HEH[EHP]) and a neutral solvating extractant N,N,N’,N’-tetraoctyldiglycolamide (TODGA). The extractant combination produces complex organic phase chemistry that is challenging for traditional measurement techniques. To neutralize the complexity, temperature dependent solvent extraction experiments were conducted with neat TODGA and scaled down concentrations of the ALSEP formulation to determine the enthalpies of extraction for the two conditions. A full set of thermodynamic data for Eu, Am, and Cm extraction by TODGA from 3.0 M HNO3 is reported. These data are compared to previous extraction results from a 1.0 M HNO3 aqueous medium, and a short discussion of the mixed HEH[EHP]/TODGA system results is offered.

Long-term optimization case studies for combined heat and power system

Directory of Open Access Journals (Sweden)

Polyzakis Apostolis L.

2009-01-01

Full Text Available In the next years distributed poly-generation systems are expected to play an increasingly important role in the electricity infrastructure and market. The successful spread of small-scale generation either connected to the distribution network or on the customer side of the meter depends on diverse issues, such as the possibilities of technical implementation, resource availability, environmental aspects, and regulation and market conditions. The aim of this approach is to develop an economic and parametric analysis of a distributed generation system based on gas turbines able to satisfy the energy demand of a typical hotel complex. Here, the economic performance of six cases combining different designs and regimes of operation is shown. The software Turbomatch, the gas turbine performance code of Cranfield University, was used to simulate the off-design performance of the engines in different ambient and load conditions. A clear distinction between cases running at full load and following the load could be observed in the results. Full load regime can give a shorter return on the investment then following the load. In spite combined heat and power systems being currently not economically attractive, this scenario may change in future due to environmental regulations and unavailability of low price fuel for large centralized power stations. Combined heat and power has a significant potential although it requires favorable legislative and fair energy market conditions to successfully increase its share in the power generation market.

From Use Cases to Activity Cases

DEFF Research Database (Denmark)

Bækgaard, Lars

2005-01-01

Use cases can be used to capture requirements and to subdivide IT-systems into functionally coherent units. Information systems are activity systems that carry out important business activities. Many systems development methods recognize activity modeling as an important development activity. Use...

Child-Sized Gaps in the System: Case Studies of Child Suicidality and Support within the Australian Healthcare System

Science.gov (United States)

McKay, Kathy; Shand, Fiona

2016-01-01

While children both understand the concept of, and have died by, suicide, little research has been conducted on children's experiences of healthcare systems during and after a suicidal crisis. This article focuses on three case studies of mothers with suicidal daughters and aims to describe the health service experiences of parents whose children…

Safety Justification and Safety Case for Safety-critical Software in Digital Reactor Protection System

International Nuclear Information System (INIS)

Kwon, Kee-Choon; Lee, Jang-Soo; Jee, Eunkyoung

2016-01-01

Nuclear safety-critical software is under strict regulatory requirements and these regulatory requirements are essential for ensuring the safety of nuclear power plants. The verification & validation (V and V) and hazard analysis of the safety-critical software are required to follow regulatory requirements through the entire software life cycle. In order to obtain a license from the regulatory body through the development and validation of safety-critical software, it is essential to meet the standards which are required by the regulatory body throughout the software development process. Generally, large amounts of documents, which demonstrate safety justification including standard compliance, V and V, hazard analysis, and vulnerability assessment activities, are submitted to the regulatory body during the licensing process. It is not easy to accurately read and evaluate the whole documentation for the development activities, implementation technology, and validation activities. The safety case methodology has been kwon a promising approach to evaluate the level and depth of the development and validation results. A safety case is a structured argument, supported by a body of evidence that provides a compelling, comprehensible, and valid case that a system is safe for a given application in a given operating environment. It is suggested to evaluate the level and depth of the results of development and validation by applying safety case methodology to achieve software safety demonstration. A lot of documents provided as evidence are connected to claim that corresponds to the topic for safety demonstration. We demonstrated a case study in which more systematic safety demonstration for the target system software is performed via safety case construction than simply listing the documents

Safety Justification and Safety Case for Safety-critical Software in Digital Reactor Protection System

Energy Technology Data Exchange (ETDEWEB)

Kwon, Kee-Choon; Lee, Jang-Soo [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of); Jee, Eunkyoung [KAIST, Daejeon (Korea, Republic of)

2016-10-15

Nuclear safety-critical software is under strict regulatory requirements and these regulatory requirements are essential for ensuring the safety of nuclear power plants. The verification & validation (V and V) and hazard analysis of the safety-critical software are required to follow regulatory requirements through the entire software life cycle. In order to obtain a license from the regulatory body through the development and validation of safety-critical software, it is essential to meet the standards which are required by the regulatory body throughout the software development process. Generally, large amounts of documents, which demonstrate safety justification including standard compliance, V and V, hazard analysis, and vulnerability assessment activities, are submitted to the regulatory body during the licensing process. It is not easy to accurately read and evaluate the whole documentation for the development activities, implementation technology, and validation activities. The safety case methodology has been kwon a promising approach to evaluate the level and depth of the development and validation results. A safety case is a structured argument, supported by a body of evidence that provides a compelling, comprehensible, and valid case that a system is safe for a given application in a given operating environment. It is suggested to evaluate the level and depth of the results of development and validation by applying safety case methodology to achieve software safety demonstration. A lot of documents provided as evidence are connected to claim that corresponds to the topic for safety demonstration. We demonstrated a case study in which more systematic safety demonstration for the target system software is performed via safety case construction than simply listing the documents.

Psychosis in primary angiitis of the central nervous system involving bilateral thalami: a case report.

Science.gov (United States)

Kim, Sangha; Kim, Doh Kwan

2015-01-01

To report a case of primary angiitis of the central nervous system (PACNS), a rare inflammatory disease restricted to the central nervous system (CNS), with unusual clinical presentation mimicking schizophrenia. Case report. A 45-year-old male presented with alteration of consciousness and confusion. Brain magnetic resonance imaging (MRI) scan showed a mass-like enhancing lesion involving bilateral thalami, and biopsy revealed findings compatible with PACNS. The patient was treated with corticosteroids. Psychotic symptoms crystallized over the initial 2 months after the diagnosis and persisted for over a year. Severity of his symptoms improved with gradual normalization of the radiologic findings and antipsychotic medication. Our case highlights the importance of considering PACNS as a differential diagnosis of a tumor-like mass lesion in the CNS and the significance of thalamic involvement in the pathogenesis of psychotic symptoms including delusions and hallucinations. Copyright © 2015. Published by Elsevier Inc.

First-Case Operating Room Delays: Patterns Across Urban Hospitals of a Single Health Care System

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Callie M. Cox Bauer

2016-08-01

Full Text Available Purpose: Operating room delays decrease health care system efficiency and increase costs. To improve operating room efficiency in our system, we retrospectively investigated delay frequencies, causes and costs. Methods: We studied all first-of-the-day nonemergent surgical cases performed at three high-volume urban hospitals of a large health system from July 2012 to November 2013. Times for patient flow from arrival to procedure start and documented reasons for delay were obtained from electronic medical records. Delay was defined as patient placement in the operating room later than scheduled surgery time. Effects of patient characteristics, late patient arrival to the hospital, number of planned procedures, years of surgeon experience, service department and hospital facility on odds of delay were examined using logistic regression. Results: Of 5,598 cases examined, 88% were delayed. Patients arrived late to the hospital (surgery in 65% of first cases. Mean time from arrival to scheduled surgery and in-room placement was 104.6 and 127.4 minutes, respectively. Mean delay time was 28.2 minutes. Nearly 60% of delayed cases had no documented reason for delay. For cases with documentation, causes included the physician (52%, anesthesia (15%, patient (13%, staff (9%, other sources (6% and facility (5%. Regression analysis revealed age, late arrival, department and facility as significant predictors of delay. Estimated delay costs, based on published figures and representing lost revenue, were $519,388. Conclusions: To improve operating room efficiency, multidisciplinary strategies are needed for increasing patient adherence to recommended arrival times, documentation of delay by medical staff and consistency in workflow patterns among facilities and departments.

Report and analysis on 'PR and PP evaluation. Example sodium fast reactor full system case study'

International Nuclear Information System (INIS)

Sagara, Hiroshi; Inoue, Naoko; Kawakubo, Yoko; Watahiki, Masaru

2011-01-01

The Generation IV (GEN IV) Nuclear Energy Systems International Forum (GIF) Proliferation Resistance and Physical Protection Working Group (PRPP WG) was established in December 2002 in order to develop the PR and valuation methodology for GEN IV nuclear energy systems. In the final report of 'PR and PP Evaluation: Example Sodium Fast Reactor (ESFR) Full System Case Study,' issued in October 2009, the demonstration study of PR and PP evaluation with the qualitative approach are summarized using ESFR with four scenario threats. The present paper reviews and analyzes some results of the ESFR case study, and identifies the challenges and direction for the PR and PP evaluation methodology with quantitative approach. (author)

Basic design of multimedia system for the representation of human error cases in nuclear power plants

Energy Technology Data Exchange (ETDEWEB)

Lee, Jung Woon; Park, Geun Ok [Korea Atomic Energy Research Institute, Taejon (Korea, Republic of)

1994-04-01

We have developed a multimedia system for the representation of human error cases with the education and training on human errors can be done effectively. The followings are major topics during the basic design; 1 Establishment of a basic concept for representing human error cases using multimedia, 2 Establishment of a design procedure for the multimedia system, 3 Establishment of a hardware and software environment for operating the multimedia system, 4 Design of multimedia input and output interfaces. In order to verify the results of this basic design, we implemented the basic design with an incident triggered by operator`s misaction which occurred at Uljin NPP Unit 1. (Author) 12 refs., 30 figs.,.

The Dubai Approach as a New Resolution System for Islamic Finance Dispute Cases

OpenAIRE

Kawamura, Ai

2013-01-01

This paper aims to clarify the new dispute resolution system for Islamic finance by examining its relationship with the conventional dispute resolution systems. Islamic finance has been developing rapidly and has expanded its presence in the Gulf region, especially in the United Arab Emirates (UAE). At the same time, special regulations and legislations were established in order to maintain the stability of this market. There have been discussions around how Islamic financial cases being hand...

Characterisation of Agri-Landscape Systems at a Regional Level: A Case Study in Northern Tuscany

Directory of Open Access Journals (Sweden)

Mariassunta Galli

2010-09-01

Full Text Available Preserving our landscape in sustainable development processes is now widely considered as fundamental. It is a complex and evolving issue that can be tackled from several perspectives. Agronomy can contribute to analyzing the relationships between agricultural production systems (cropping, farming and agricultural systems at different levels (field, farm, and region and the agricultural landscape (in terms of patches, matrixes, dynamics, etc. This is of particular interest where the relationships between “what and how” are produced by agricultural activities and the landscape are changing. In this case their own reciprocity may represent an opportunity to analyze complex systems, such as the characterization of agri-landscapes at a regional level. We propose a case study developed as an up-scaling analytical process from a farm to a regional level. The result was the identification of six main agri-landscape systems highlighting the landscape drivers that are changing the traditional landscape of a rural region in Northern Tuscany (Lunigiana.

Engineered barrier systems (EBS) in the context of the entire safety case

International Nuclear Information System (INIS)

2003-01-01

A joint NEA-EC workshop entitled 'Engineered Barrier Systems (EBS) in the Context of the Entire Safety Case' was organised in Oxford on 25-27 September 2002 and hosted by United Kingdom Nirex Limited. The main objectives of the workshop were to provide a status report on engineered barrier systems in various national radioactive waste management programmes considering deep geological disposal; to establish the value to member countries of a project on EBS; and to define such a project's scope, timetable and modus operandi. This report presents the outcomes of this workshop. (author)

Engineered Barrier Systems (EBS) in the Context of the Entire Safety Case

International Nuclear Information System (INIS)

2005-01-01

A joint NEA-EC workshop entitled ''Engineered Barrier Systems (EBS) in the Context of the Entire Safety Case'' was organised in Oxford on 25-27 September 2002 and hosted by United Kingdom Nirex Limited. The main objectives of the workshop were to provide a status report on engineered barrier systems in various national radioactive waste management programmes considering deep geological disposal; to establish the value to member countries of a project on EBS; and to define such a project scope, timetable and modus operandi. This report presents the outcomes of this workshop. (author)

Clinical aspects and relevance of molecular diagnosis in late mucocutaneous leishmaniasis patients in Paraná, Brazil

Directory of Open Access Journals (Sweden)

Andréa Thomaz-Soccol

2011-06-01

Full Text Available The aim of the present work was to study the clinical aspects and relevance of molecular diagnosis in late mucocutaneous leishmaniasis patients in Parana, Brazil. Twenty one suspected cases of mucocutaneous leishmaniasis (MCL in patients from the endemic areas of leishmaniasis were assessed. Different methods used in diagnosing the disease and the polymerase chain reaction (PCR technique were compared in order to establish the sensitivity of each method. Out of the 21 patients analyzed, 14.3% presented other etiologies such as vasculitis, syphilis, and paracoccidioidomycosis, with all tests negative for leishmaniasis. Out of the remaining 15 patients, 6.7% cases were confirmed for leishmaniasis by direct examination; 46.67% were positive for culture, which allowed isolating and identifying the parasite and - with the PCR technique - it was possible to diagnose 100% MCL patients for all the three repetitions of exams. The PCR optimized for the present work proved to be an auxiliary method for diagnosing leishmaniasis applicable in the patients carrying MCL due to Leishmania (Viannia braziliensis and did not need culture to be performed, resulting in a faster diagnosis.

Stellar Image Interpretation System using Artificial Neural Networks: Unipolar Function Case

Directory of Open Access Journals (Sweden)

F. I. Younis

2001-01-01

Full Text Available An artificial neural network based system for interpreting astronomical images has been developed. The system is based on feed-forward Artificial Neural Networks (ANNs with error back-propagation learning. Knowledge about images of stars, cosmic ray events and noise found in images is used to prepare two sets of input patterns to train and test our approach. The system has been developed and implemented to scan astronomical digital images in order to segregate stellar images from other entities. It has been coded in C language for users of personal computers. An astronomical image of a star cluster from other objects is undertaken as a test case. The obtained results are found to be in very good agreement with those derived from the DAOPHOTII package, which is widely used in the astronomical community. It is proved that our system is simpler, much faster and more reliable. Moreover, no prior knowledge, or initial data from the frame to be analysed is required.

Providing Power Supply to Other Use Cases Integrated in the System of Public Lighting

OpenAIRE

Perko, Jurica; Topić, Danijel; Šljivac, Damir

2017-01-01

Smart city is an attractive way of making the city more livable through intelligent solutions that are enabled by information and communication technology. Regarding the lighting system, it achieves the perfect balance between beautiful city ambience and preserving the darkness that makes cities more livable. As a smart city component, a public lighting system offers much more than light itself. Integration of other use cases has given a new dimension to the public lighting system in visual a...

Aligning strategy and performance management systems : the case of the wind-farm industry

NARCIS (Netherlands)

Vieira, R.; O'Dwyer, B.; Schneider, R.

This article presents a case study examining the problems and possibilities of performance management in a wind-farm company. Drawing on Ferreira and Otley’s recently developed performance management systems (PMSs) framework, the study demonstrates how the framework facilitates in-depth, holistic,

Optimized Real-Time Control of Combined Sewerage Systems: Two Case Studies (Proceedings Paper)

Science.gov (United States)

The paper presents results of two case studies of Real-Time Control (RTC) alternatives evaluations that were conducted on portions of sewerage systems near Paris, France and in Quebec City, Canada, respectively. The studies were performed at real-scale demonstration sites. RTC al...

Reduced computational cost in the calculation of worst case response time for real time systems

OpenAIRE

Urriza, José M.; Schorb, Lucas; Orozco, Javier D.; Cayssials, Ricardo

2009-01-01

Modern Real Time Operating Systems require reducing computational costs even though the microprocessors become more powerful each day. It is usual that Real Time Operating Systems for embedded systems have advance features to administrate the resources of the applications that they support. In order to guarantee either the schedulability of the system or the schedulability of a new task in a dynamic Real Time System, it is necessary to know the Worst Case Response Time of the Real Time tasks ...

A case of disseminated central nervous system sparganosis.

Science.gov (United States)

Noiphithak, Raywat; Doungprasert, Gahn

2016-01-01

Sparganosis is a very rare parasitic infection in various organs caused by the larvae of tapeworms called spargana. The larva usually lodges in the central nervous system (CNS) and the orbit. However, lumbar spinal canal involvement, as noted in the present case, is extremely rare. We report a rare case of disseminated CNS sparganosis involving the brain and spinal canal and review the literature. A 54-year-old man presented with progressive low back pain and neurological deficit at the lumbosacral level for 2 months. Imaging indicated arachnoiditis and an abnormal lesion at the L4-5 vertebral level. The patient underwent laminectomy of the L4-5 with lesionectomy and lysis of adhesions between the nerve roots. Microscopic examination indicated sparganum infection. Further brain imaging revealed evidence of chronic inflammation in the left parieto-occipital area without evidence of live parasites. In addition, an ophthalmologist reported a nonactive lesion in the right conjunctiva. The patient recovered well after surgery, although he had residual back pain and bladder dysfunction probably due to severe adhesion of the lumbosacral nerve roots. CNS sparganosis can cause various neurological symptoms similar to those of other CNS infections. A preoperative enzyme-linked immunosorbent assay is helpful for diagnosis, especially in endemic areas. Surgical removal of the worm remains the treatment of choice.

Phase aided 3D imaging and modeling: dedicated systems and case studies

Science.gov (United States)

Yin, Yongkai; He, Dong; Liu, Zeyi; Liu, Xiaoli; Peng, Xiang

2014-05-01

Dedicated prototype systems for 3D imaging and modeling (3DIM) are presented. The 3D imaging systems are based on the principle of phase-aided active stereo, which have been developed in our laboratory over the past few years. The reported 3D imaging prototypes range from single 3D sensor to a kind of optical measurement network composed of multiple node 3D-sensors. To enable these 3D imaging systems, we briefly discuss the corresponding calibration techniques for both single sensor and multi-sensor optical measurement network, allowing good performance of the 3DIM prototype systems in terms of measurement accuracy and repeatability. Furthermore, two case studies including the generation of high quality color model of movable cultural heritage and photo booth from body scanning are presented to demonstrate our approach.

Integrating solar PV (photovoltaics) in utility system operations: Analytical framework and Arizona case study

International Nuclear Information System (INIS)

Wu, Jing; Botterud, Audun; Mills, Andrew; Zhou, Zhi; Hodge, Bri-Mathias; Heaney, Mike

2015-01-01

A systematic framework is proposed to estimate the impact on operating costs due to uncertainty and variability in renewable resources. The framework quantifies the integration costs associated with sub-hourly variability and uncertainty as well as day-ahead forecasting errors in solar PV (photovoltaics) power. A case study illustrates how changes in system operations may affect these costs for a utility in the southwestern United States (Arizona Public Service Company). We conduct an extensive sensitivity analysis under different assumptions about balancing reserves, system flexibility, fuel prices, and forecasting errors. We find that high solar PV penetrations may lead to operational challenges, particularly during low-load and high solar periods. Increased system flexibility is essential for minimizing integration costs and maintaining reliability. In a set of sensitivity cases where such flexibility is provided, in part, by flexible operations of nuclear power plants, the estimated integration costs vary between $1.0 and $4.4/MWh-PV for a PV penetration level of 17%. The integration costs are primarily due to higher needs for hour-ahead balancing reserves to address the increased sub-hourly variability and uncertainty in the PV resource. - Highlights: • We propose an analytical framework to estimate grid integration costs for solar PV. • Increased operating costs from variability and uncertainty in solar PV are computed. • A case study of a utility in Arizona is conducted. • Grid integration costs are found in the $1.0–4.4/MWh range for a 17% PV penetration. • Increased system flexibility is essential for minimizing grid integration costs

Cross-system effects of dysphagia treatment on dysphonia: a case report

OpenAIRE

LaGorio, Lisa A; Carnaby-Mann, Giselle D; Crary, Michael A

2008-01-01

Traditionally, treatment of dysphagia and dysphonia has followed a specificity approach whereby treatment plans have focused on each dysfunction individually. Recently however, a therapeutic cross-system effect has been proposed between these two dysfunctions. At least one study has demonstrated swallowing improvement in subjects who completed a dysphonia treatment program. However, we are unaware of any evidence demonstrating the converse effect. In this paper, we present a case-report of a ...

Case-based reasoning

CERN Document Server

Kolodner, Janet

1993-01-01

Case-based reasoning is one of the fastest growing areas in the field of knowledge-based systems and this book, authored by a leader in the field, is the first comprehensive text on the subject. Case-based reasoning systems are systems that store information about situations in their memory. As new problems arise, similar situations are searched out to help solve these problems. Problems are understood and inferences are made by finding the closest cases in memory, comparing and contrasting the problem with those cases, making inferences based on those comparisons, and asking questions whe

Human Mobile Inverted Pendulum Transporter - a Mechatronic System Case Study

DEFF Research Database (Denmark)

Bech, Michael Møller; Hansen, Anders Hedegaard; Pedersen, Henrik C.

2011-01-01

procedure combined with the formulation and the solution of an optimization problem involving a number of constraints related to performance, costs, geometry, availability of components etc. In this paper, we present a case-study of a more traditional design procedure for a highly multi-disciplinary device......, which nevertheless illustrates the potentials of unifying classical engineering technologies (mechanics, electronics, control systems) with modern high-efficient inverter-fed permanent magnet AC motors and the latest MEMS sensor technology. A full-scale fully operational prototype of a two-wheel mobile...

A case study of intended versus actual experience of adaptivity in a tangible storytelling system

NARCIS (Netherlands)

Tanenbaum, K.; Hatala, M.; Tanenbaum, J.; Wakkary, R.L.; Antle, A.N.

2014-01-01

This article presents a case study of an adaptive, tangible storytelling system called "The Reading Glove". The research addresses a gap in the field of adaptivity for ubiquitous systems by taking a critical look at the notion of "adaptivity" and how users experience it. The Reading Glove is an

Purpuric halo around hemangioma as a clue for primary systemic amyloidosis: Case report and review of literature

Directory of Open Access Journals (Sweden)

Yin-Shuo Chang

2018-03-01

Full Text Available Mucocutaneous lesion appears in up to 40% of patients with primary systemic amyloidosis (AL amyloidosis. The cutaneous signs may be co-expressed with other organ involvement or even solely presented as the first clue. We reported a case of systemic AL amyloidosis who was initially presented as a solitary hemangioma with a purpuric halo. Excisional biopsy revealed a hemangioma with amyloid deposited in thickened vascular walls. Systemic AL amyloidosis was diagnosed after thorough survey. The stage of disease at the time of initial treatment is the greatest prognostic factor. To our knowledge, this is the first case of systemic AL amyloidosis initially presented as a purpuric halo around hemangioma in Taiwan. This target-like lesion should be linked to systemic AL amyloidosis and early diagnosis is extraordinary important.

Methods for Probabilistic Fault Diagnosis: An Electrical Power System Case Study

Science.gov (United States)

Ricks, Brian W.; Mengshoel, Ole J.

2009-01-01

Health management systems that more accurately and quickly diagnose faults that may occur in different technical systems on-board a vehicle will play a key role in the success of future NASA missions. We discuss in this paper the diagnosis of abrupt continuous (or parametric) faults within the context of probabilistic graphical models, more specifically Bayesian networks that are compiled to arithmetic circuits. This paper extends our previous research, within the same probabilistic setting, on diagnosis of abrupt discrete faults. Our approach and diagnostic algorithm ProDiagnose are domain-independent; however we use an electrical power system testbed called ADAPT as a case study. In one set of ADAPT experiments, performed as part of the 2009 Diagnostic Challenge, our system turned out to have the best performance among all competitors. In a second set of experiments, we show how we have recently further significantly improved the performance of the probabilistic model of ADAPT. While these experiments are obtained for an electrical power system testbed, we believe they can easily be transitioned to real-world systems, thus promising to increase the success of future NASA missions.

Studying the Behaviour of Model of Mirror Neuron System in Case of Autism

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Shikha Anirban

2012-04-01

Full Text Available Several experiment done by the researchers conducted that autism is caused by the dysfunctional mirror neuron system and the dysfunctions of mirror neuron system is proportional to the symptom severity of autism. In the present work those experiments were studied as well as studying a model of mirror neuron system called MNS2 developed by a research group. This research examined the behavior of the model in case of autism and compared the result with those studies conducting dysfunctions of mirror neuron system in autism. To perform this, a neural network employing the model was developed which recognized the three types of grasping (faster, normal and slower. The network was implemented with back propagation through time learning algorithm. The whole grasping process was divided into 30 time steps and different hand and object states at each time step was used as the input of the network. Normally the network successfully recognized all of the three types of grasps. The network required more times as the number of inactive neurons increased. And in case of maximum inactive neurons of the mirror neuron system the network became unable to recognize the types of grasp. As the time to recognize the types of grasp is proportional to the number of inactive neurons, the experiment result supports the hypothesis that dysfunctions of MNS is proportional to the symptom severity of autism. Keywords— Autism, MNS, mirror neuron, neural network, BPTT

Application case study of AP1000 automatic depressurization system (ADS) for reliability evaluation by GO-FLOW methodology

Energy Technology Data Exchange (ETDEWEB)

Hashim, Muhammad, E-mail: hashimsajid@yahoo.com; Hidekazu, Yoshikawa, E-mail: yosikawa@kib.biglobe.ne.jp; Takeshi, Matsuoka, E-mail: mats@cc.utsunomiya-u.ac.jp; Ming, Yang, E-mail: myang.heu@gmail.com

2014-10-15

Highlights: • Discussion on reasons why AP1000 equipped with ADS system comparatively to PWR. • Clarification of full and partial depressurization of reactor coolant system by ADS system. • Application case study of four stages ADS system for reliability evaluation in LBLOCA. • GO-FLOW tool is capable to evaluate dynamic reliability of passive safety systems. • Calculated ADS reliability result significantly increased dynamic reliability of PXS. - Abstract: AP1000 nuclear power plant (NPP) utilized passive means for the safety systems to ensure its safety in events of transient or severe accidents. One of the unique safety systems of AP1000 to be compared with conventional PWR is the “four stages Automatic Depressurization System (ADS)”, and ADS system originally works as an active safety system. In the present study, authors first discussed the reasons of why four stages ADS system is added in AP1000 plant to be compared with conventional PWR in the aspect of reliability. And then explained the full and partial depressurization of RCS system by four stages ADS in events of transient and loss of coolant accidents (LOCAs). Lastly, the application case study of four stages ADS system of AP1000 has been conducted in the aspect of reliability evaluation of ADS system under postulated conditions of full RCS depressurization during large break loss of a coolant accident (LBLOCA) in one of the RCS cold legs. In this case study, the reliability evaluation is made by GO-FLOW methodology to determinate the influence of ADS system in dynamic reliability of passive core cooling system (PXS) of AP1000, i.e. what will happen if ADS system fails or successfully actuate. The GO-FLOW is success-oriented reliability analysis tool and is capable to evaluating the systems reliability/unavailability alternatively to Fault Tree Analysis (FTA) and Event Tree Analysis (ETA) tools. Under these specific conditions of LBLOCA, the GO-FLOW calculated reliability results indicated

Formulating autism systemically: Part 2 - A 12-year prospective case study.

Science.gov (United States)

Brewerton, Nicky; Robson, Katrina; Crittenden, Patricia M

2017-07-01

This prospective case study illustrates the ideas on the developmental origins of some cases of autism that were described in Part 1 of this article. We explored and found support for several systemic hypotheses regarding the experience of 'Graeme' and his mother. Graeme's story is told prospectively from the age of 3 until 15. Three independent sources of information are reported: hypotheses from the literature and case review in Part 1 of this article, the school's experience, and observations from the assessments of attachment when Graeme was turning 6. These three streams of information are integrated here. The review of the literature and clinical cases gives us a wide-angle lens, empirically supporting our focus on danger in relationships. The school's experience describes working with a child with undiagnosed autism. The assessments of attachment both provide information about family members' psychological strategies for protection from danger and also include the mother's childhood history of family threat. Their synthesis permits us to construct a developmental history, from Graeme's mother's childhood history of being triangulated into her parents' hidden marital discord to it's repetition for Graeme in her own marriage. New observations included mum's postural/gestural communication to Graeme and her possible ambivalence about males. Strikingly, Graeme was a case study (Attachment & Family Therapy, ch. 6) before he was diagnosed with autism. That presentation focused on Graeme's feeling of rejection by his father. In the same book, an interpersonal formulation of autism was offered (ch. 3), but it was not connected to Graeme, showing that when one lacks crucial information, the clinical formulation is distorted. The crucial information in this case was the mother's psychological history. Our case suggests that filling the blind spot in the research on autism with information about family functioning over at least two generations might change the

Aplastic anemia as a feature of systemic lupus erythematosus: a case report and literature review.

Science.gov (United States)

Chalayer, Émilie; Ffrench, Martine; Cathébras, Pascal

2015-06-01

Peripheral cytopenias are common in systemic lupus erythematosus, but bone marrow involvement is rarely reported. Aplastic anemia is the result of immune-mediated destruction of hematopoietic stem cells causing pancytopenia and characterized by an empty bone marrow. This rare but serious disease has been described as an unusual manifestation of systemic lupus erythematosus. We reviewed the 25 cases published in the English language literature and discuss the clinical presentation, outcome, treatment, and pathophysiology of aplastic anemia as a complication of systemic lupus erythematosus. We report here the first case of aplastic anemia associated with systemic lupus erythematosus treated with an allogeneic hematopoietic stem cell transplant. Over one half of patients received concomitantly the diagnoses of systemic lupus erythematosus and aplastic anemia. No clinical or histological features can distinguish primary aplastic anemia from aplastic anemia occurring in systemic lupus erythematosus patients. The overall mortality is about 15% and corticosteroid-based therapy alone or in combination with other immunomodulatory drugs can restore bone marrow function. Systemic lupus erythematosus may be complicated by bone marrow involvement. The diagnosis of peripheral cytopenias should be confirmed by bone marrow aspiration. All these patients should receive cortisone as a first treatment. Plasma exchanges seem to have some efficacy. Other different immunomodulatory therapies were used with variable results.

Libman–Sacks endocarditis, and other echocardiographic findings in systemic lupus erythematosus: Case report

OpenAIRE

Hamza, Mohamed Atef; Allam, Lamyaa

2012-01-01

Case report of a 19 year-old female patient with systemic lupus erythematosus (SLE) who was presented to Ain Shams University Hospital complaining of dyspnea on moderate exertion. Echocardiography showed the presence of sterile vegetation on the mitral valve, Libman–Sacks endocarditis (LSE).

Diagnosis-related group (DRG)-based case-mix funding system, a promising alternative for fee for service payment in China.

Science.gov (United States)

Zhao, Cuirong; Wang, Chao; Shen, Chengwu; Wang, Qian

2018-05-13

Fee for services (FFS) is the prevailing method of payment in most Chinese public hospitals. Under this retrospective payment system, medical care providers are paid based on medical services and tend to over-treat to maximize their income, thereby contributing to rising medical costs and uncontrollable health expenditures to a large extent. Payment reform needs to be promptly implemented to move to a prospective payment plan. The diagnosis-related group (DRG)-based case-mix payment system, with its superior efficiency and containment of costs, has garnered increased attention and it represents a promising alternative. This article briefly describes the DRG-based case-mix payment system, it comparatively analyzes differences between FFS and case-mix funding systems, and it describes the implementation of DRGs in China. China's social and economic conditions differ across regions, so establishment of a national payment standard will take time and involve difficulties. No single method of provider payment is perfect. Measures to monitor and minimize the negative ethical implications and unintended effects of a DRG-based case-mix payment system are essential to ensuring the lasting social benefits of payment reform in Chinese public hospitals.

Online modelling of water distribution systems: a UK case study

Directory of Open Access Journals (Sweden)

J. Machell

2010-03-01

Full Text Available Hydraulic simulation models of water distribution networks are routinely used for operational investigations and network design purposes. However, their full potential is often never realised because, in the majority of cases, they have been calibrated with data collected manually from the field during a single historic time period and, as such, reflect the network operational conditions that were prevalent at that time, and they are then applied as part of a reactive, desktop investigation. In order to use a hydraulic model to assist proactive distribution network management its element asset information must be up to date and it should be able to access current network information to drive simulations. Historically this advance has been restricted by the high cost of collecting and transferring the necessary field measurements. However, recent innovation and cost reductions associated with data transfer is resulting in collection of data from increasing numbers of sensors in water supply systems, and automatic transfer of the data to point of use. This means engineers potentially have access to a constant stream of current network data that enables a new era of "on-line" modelling that can be used to continually assess standards of service compliance for pressure and reduce the impact of network events, such as mains bursts, on customers. A case study is presented here that shows how an online modelling system can give timely warning of changes from normal network operation, providing capacity to minimise customer impact.

On the Dynamics of Building Systems of Scientific Expertise: The Case of Ionizing Radiation

International Nuclear Information System (INIS)

Boudia, Soraya

2008-01-01

An examination of historical work shows that several systems of scientific expertise were shaped by public controversies. Taking the case of the health and environmental hazards of radioactivity as an example, this articles seeks to account for a twofold dynamic at work in building and/or reconfiguring systems of scientific expertise: expertise either as a resource to manage public mobilisation or as vector whereby some of the criticisms are incorporated into existing institutional systems by reconfiguring them or setting up new organisations

Overlap of Ankylosing Spondylitis and Systemic Lupus Erythematosus: A case report

Directory of Open Access Journals (Sweden)

Mahmood Akbaryan

2016-04-01

Full Text Available Ankylosing spondylitis is a typical, very heritable incendiary joint inflammation, influencing principally the spine and pelvis. Inflammatory arthritis in ankylosing spondylitis causes pain and stiffness and progressively leads to new bone formation and ankylosis (fusion of affected joints. Systemic lupus erythematosus (SLE, lupus is a highly complex and heterogeneous autoimmune disease that most often afflicts women in their child-bearing years. It is characterized by circulating self-reactive antibodies that deposit in tissues, including skin, kidneys, and brain, and the ensuing inflammatory response can lead to irreparable tissue damage. There are few reports of coexistence of Ankylosing spondylitis and Systemic lupus erythematosus which firmly emphasis on an overlap phenomenon between these two disorders. A 30 year old woman was admitted to our hospital due to signs of butterfly-shaped rash on her cheeks, which became prominent after exposure to sunlight and severe inflammatory low-back pain. About ten year earlier, AS had been diagnosed and treatment started with non-steroidal anti-inflammatory drug (NSAID. To the best of our knowledge, the present case is one of 10 reported cases of coexistence of these two disorders in English literature. The coexistence of these two diseases with different genetic backgrounds and clinical symptoms may implicate the importance of shared environmental factors.

Adult systemic Epstein-Barr virus-positive T-cell lymphoproliferative disease: A case report.

Science.gov (United States)

Wang, Youping; Liu, Xinyue; Chen, Yan

2015-09-01

Systemic Epstein-Barr virus (EBV)-positive T-cell lymphoproliferative disease (EBV + T-LPD) occurs mainly in Asia and South America and is extremely rare in adults. The disease is characterized by a clonal proliferation of EBV-infected T cells with a cytotoxic immunophenotype and is associated with a poor clinical outcome and can be life-threatening. The majority of the patients have evidence of systemic disease, often with lymph node, liver and spleen involvement. The present study describes a case of adult systemic EBV + T-LPD with high fever, systemic lymphadenopathy, hepatosplenomegaly, nose-pharynx neoplasm, pancytopenia, EB virus infection and proliferative bone marrow, with the aim of improving the understanding of the condition.

Parking information systems. [Case study Lyngby, Denmark]. Parkeringsinformationssystemer; Konsekvenser for energiforbrug og luftforurening

Energy Technology Data Exchange (ETDEWEB)

Bach, O.; Krawack, S.; Thordrup, J.

1989-08-15

Larger parking information system are evaluated in relation to their possible influence with regard to energy conservation and air pollution abatement. As a case in point, an analysis of the current parking situation in Lyngby was based on a detailed registration of the activities of each vehicle parked within the area during a certain period of time. The possible effect of a parking information system on the parking situation in this area was investigated. It is suggested that the utilization of such a system could result in a 10% reduction of air pollution in areas of towns where parking places are most in demand. However a parking information system's contribution to energy conservation was found to be negligable. (AB).

Development of case-based medication alerting and recommender system: a new approach to prevention for medication error.

Science.gov (United States)

Miyo, Kengo; Nittami, Yuki S; Kitagawa, Yoichiro; Ohe, Kazuhiko

2007-01-01

The purpose of this study was to develop a new alerting and recommender system for preventing medication errors. In recent years, alerting systems have been widely implemented, but because these systems apply a same static threshold for all patients in all cases, they produce excessive alerts and subject physicians to "alert fatigue". We believe that the most commonly-written prescription for a patient's status is the safest one. From this standpoint, we developed a real-time case-based medication alerting and recommender system linked to a database of past prescriptions. When a physician issues his or her prescription, our system dynamically compares it with past ones for similar patients in the database. An analysis of the 10 most frequently-used drugs in the University of Tokyo Hospital revealed that our system reduced the number of false alerts compared to the traditional static alert method. Our system contributes to the creation of alerts that are appropriate for patients' clinical conditions and based on physicians' empirical discretion.

Stuck in the middle: The emotional labours of case managers in the personal injury compensation system.

Science.gov (United States)

Newnam, Sharon; Petersen, Alan; Keleher, Helen; Collie, Alex; Vogel, Adam; McClure, Rod

2016-10-17

Case managers within injury compensation systems are confronted with various emotional demands. Employing the concept of emotional labour, this paper explores distinctive aspects of these demands. The findings are drawn from focus groups with 21 Australian case managers. Case managers work was characterised by extra-role commitments, emotional control, stress and balancing tensions arising from differing stakeholder expectations about outcomes related to compensation and return to work. By examining the experiences of case managers, the findings add to the literature on the emotional labour of front line service workers, especially with respect to the demands involved in managing the conflicting demands of work.

A levonorgestrel-releasing intrauterine system embedded in the omentum in a woman with abdominal pain: a case report

Directory of Open Access Journals (Sweden)

Phillips Kevin

2009-11-01

Full Text Available Abstract Introduction The Mirena intrauterine system has been licensed as a contraceptive in the United Kingdom since May 1995. The use of an intrauterine system as a primary method of contraception among women has been slowly increasing over the last few years and they now account for about 3% of contraceptive use in England. The Mirena intrauterine system now also has a license for the management of idiopathic menorrhagia. Women may be informed that the rate of uterine perforation associated with intrauterine contraceptive use is low (0-2.3 per 1000 insertions. The rate of perforation reported with the Mirena intrauterine system in a large observational cohort study was 0.9 per 1000 insertions. Case presentation In this case report, the diagnosis of an intraperitoneal Mirena intrauterine system was noted nearly four years after its insertion, despite the patient having had a vaginal hysterectomy and admissions to hospital in the interim with complaints of abdominal pain. Conclusion This case report demonstrates clearly that whenever there is a question of a intrauterine system having fallen out following an ultrasound scan report showing an empty uterus, clinicians should also perform an abdominal X-ray.

Unusual location of central nervous system langerhans cell histiocytosis: case report

International Nuclear Information System (INIS)

Kim, E. Yup; Lee, Jae Kyu; Kim, Chan Kyo; Lee, Chang Hyun; Kang, Chang Ho; Chung, Phil Wook

2003-01-01

Langerhans cell histiocytosis of the central nervous system (CNS) usually involves the hypothalamic-pituitary axis, and T1-weighted MR images normally demonstrate infundibular thickening and/or a mass lesion in the hypothalamus and the absence of a posterior pituitary 'bright spot'. We recently encountered a case of CNS langerhans cell histiocytosis with no posterior pituitary 'bright spot' and with lesions involving the cerebellum and basal ganglia but not the hypothalamic-pituitary axis

The MIND method: A decision support for optimization of industrial energy systems - Principles and case studies

International Nuclear Information System (INIS)

Karlsson, Magnus

2011-01-01

Changes in complex industrial energy systems require adequate tools to be evaluated satisfactorily. The MIND method (Method for analysis of INDustrial energy systems) is a flexible method constructed as decision support for different types of analyses of industrial energy systems. It is based on Mixed Integer Linear Programming (MILP) and developed at Linkoeping University in Sweden. Several industries, ranging from the food industry to the pulp and paper industry, have hitherto been modelled and analyzed using the MIND method. In this paper the principles regarding the use of the method and the creation of constraints of the modelled system are presented. Two case studies are also included, a dairy and a pulp and paper mill, that focus some measures that can be evaluated using the MIND method, e.g. load shaping, fuel conversion and introduction of energy efficiency measures. The case studies illustrate the use of the method and its strengths and weaknesses. The results from the case studies are related to the main issues stated by the European Commission, such as reduction of greenhouse gas emissions, improvements regarding security of supply and increased use of renewable energy, and show great potential as regards both cost reductions and possible load shifting.

Libman–Sacks endocarditis, and other echocardiographic findings in systemic lupus erythematosus: Case report

Directory of Open Access Journals (Sweden)

Mohamed Atef Hamza

2012-09-01

Full Text Available Case report of a 19 year-old female patient with systemic lupus erythematosus (SLE who was presented to Ain Shams University Hospital complaining of dyspnea on moderate exertion. Echocardiography showed the presence of sterile vegetation on the mitral valve, Libman–Sacks endocarditis (LSE.

PV-wind hybrid system performance. A new approach and a case study

International Nuclear Information System (INIS)

Arribas, Luis; Cano, Luis; Cruz, Ignacio; Mata, Montserrat; Llobet, Ermen

2010-01-01

Until now, there is no internationally accepted guideline for the measurement, data exchange and analysis of PV-Wind Hybrid Systems. As there is a need for such a tool, so as to overcome the barrier that the lack of confidence due to the absence of reliability means for the development of the market of Hybrid Systems, an effort has been made to suggest one tool for PV-Wind Hybrid Systems. The suggested guidelines presented in this work are based on the existing guidelines for PV Systems, as a PV-Wind Hybrid system can be roughly thought of as a PV System to which wind generation has been added. So, the guidelines for PV Systems are valid for the PV-Wind System, and only the part referred to wind generation should be included. This has been the process followed in this work. The proposed method is applied to a case study, the CICLOPS Project, a 5 kW PV, 7.5 kW Wind Hybrid system installed at the Isolated Wind Systems Test Site that CIEMAT owns in CEDER (Soria, Spain). This system has been fully monitored through a year and the results of the monitoring activity, characterizing the long-term performance of the system are shown in this work. (author)

PV-wind hybrid system performance. A new approach and a case study

Energy Technology Data Exchange (ETDEWEB)

Arribas, Luis; Cano, Luis; Cruz, Ignacio [Departamento de Energias Renovables, CIEMAT, Avda. Complutense 22, 28040 Madrid (Spain); Mata, Montserrat; Llobet, Ermen [Ecotecnia, Roc Boronat 78, 08005 Barcelona (Spain)

2010-01-15

Until now, there is no internationally accepted guideline for the measurement, data exchange and analysis of PV-Wind Hybrid Systems. As there is a need for such a tool, so as to overcome the barrier that the lack of confidence due to the absence of reliability means for the development of the market of Hybrid Systems, an effort has been made to suggest one tool for PV-Wind Hybrid Systems. The suggested guidelines presented in this work are based on the existing guidelines for PV Systems, as a PV-Wind Hybrid system can be roughly thought of as a PV System to which wind generation has been added. So, the guidelines for PV Systems are valid for the PV-Wind System, and only the part referred to wind generation should be included. This has been the process followed in this work. The proposed method is applied to a case study, the CICLOPS Project, a 5 kW PV, 7.5 kW Wind Hybrid system installed at the Isolated Wind Systems Test Site that CIEMAT owns in CEDER (Soria, Spain). This system has been fully monitored through a year and the results of the monitoring activity, characterizing the long-term performance of the system are shown in this work. (author)

Applications of an OO (Objected Oriented) methodology and case to a DAQ system

International Nuclear Information System (INIS)

Bee, C.P.; Eshghi, S.; Jones, R.

1996-01-01

The RD13 project has evaluated the use of the Object Oriented Information Engineering (OOIE) method during the development of several software components connected to the DAQ system. The method is supported by a sophisticated commercial CASE tool (Object Management Workbench) and programming environment (Kappa) which covers the full life-cycle of the software including model simulation, code generation and application deployment. This paper gives an overview of the method, CASE tool, DAD components which have been developed and we relate our experiences with the method and tool, its integration into our development environment and the spiral life cycle if supports. (author)

Using ADDIE and Systems Thinking as the Framework for Developing a MOOC: A Case Study

Science.gov (United States)

Croxton, Rebecca A.; Chow, Anthony S.

2015-01-01

This article presents a case study of how systems thinking and the instructional systems design ADDIE (analysis, design, development, implementation, and assessment) model were used to design and develop one of the first MOOCs at a mid-sized university in the southeastern United States. Contemporary issues surrounding MOOCs at both the macro…

An interesting case of systemic lupus erythematosus in a patient with Moebius syndrome.

Science.gov (United States)

Tenorio, Jefferson da Rocha; Figueiredo, Marília Andrade; Espindula, Aline; Gallottini, Marina; Ortega, Karem López

2018-03-01

Moebius' syndrome (MS) is characterized by a nonprogressive facial palsy associated with impairment in eye abduction, which can be uni- or bilateral. Some authors raise the possibility that patients with MS may suffer from social stigmatism due to their facial dysmorphism and that constant teasing and bullying perpetrated by people in the same social circle are adjuvants in the development of low self-esteem, behavioral problems, and even psychiatric disorders. Psychological stress, anxiety, and depression are factors contributing to both development and impairment of autoimmune diseases, such as systemic lupus erythematosus (SLE). The objective of this work is to report the case of a patient with MS who developed SLE. In the present case report, we have emphasized the importance of both clinical dental examination and surgeon-dentist in the early diagnosis of systemic diseases by considering that these conditions can affect both syndromic and normoreactive patients. © 2018 Special Care Dentistry Association and Wiley Periodicals, Inc.

Learning from Action Evaluation of the Use of Multimedia Case Studies in Management Information Systems Courses

Science.gov (United States)

Kawulich, Barbara B.

2011-01-01

This manuscript shares lessons learned from conducting an action evaluation of the use of multimedia case studies in Management Information Systems (MIS) courses. Three undergraduate MIS classes took part in the study. The purpose for using case studies in these classes was to teach students about the role of MIS in business. An action evaluation…

The Dynamic Genome and Transcriptome of the Human Fungal Pathogen Blastomyces and Close Relative Emmonsia

OpenAIRE

Muñoz, José F.; Gauthier, Gregory M.; Desjardins, Christopher A.; Gallo, Juan E.; Holder, Jason; Sullivan, Thomas D.; Marty, Amber J.; Carmen, John C.; Chen, Zehua; Ding, Li; Gujja, Sharvari; Magrini, Vincent; Misas, Elizabeth; Mitreva, Makedonka; Priest, Margaret

2015-01-01

Three closely related thermally dimorphic pathogens are causal agents of major fungal diseases affecting humans in the Americas: blastomycosis, histoplasmosis and paracoccidioidomycosis. Here we report the genome sequence and analysis of four strains of the etiological agent of blastomycosis, Blastomyces, and two species of the related genus Emmonsia, typically pathogens of small mammals. Compared to related species, Blastomyces genomes are highly expanded, with long, often sharply demarcated...

Perfil clínico-epidemiológico dos pacientes portadores de paracoccidioidomicose no Serviço de Estomatologia do Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul Clinical-epidemiologic profile of paracoccidioidomycosis at the Stomatology Department of São Lucas Hospital, Pontificia Universidade Católica of Rio Grande do Sul

Directory of Open Access Journals (Sweden)

Flaviana Dornela Verli

2005-05-01

Full Text Available No presente estudo, são descritas as características clínicas e epidemiológicas de 61 casos de paracoccidioidomicose, atendidos no Serviço de Estomatologia do Hospital São Lucas da PUCRS, no período de junho de 1976 a junho de 2004. O Rio Grande do Sul é considerado uma região endêmica da doença devido às condições eco-epidemiológicas para o desenvolvimento do fungo. Observou-se que a doença ocorreu em 58 (95% homens e 3 (5% mulheres, predominando a faixa etária de 40 a 59 anos (70,5%, e a profissão vinculada à agricultura em 27 (44,3% pacientes. O hábito de fumar foi prevalente em 52 (85,3% pacientes da amostra e muitos eram, também, etilistas. Todos os casos apresentavam manifestações estomatológicas, sendo que as lesões orais ocorreram predominantemente com aspecto ulcerado e moriforme, observadas em vários sítios anatômicos. As evidências radiográficas de lesões pulmonares estavam presentes em 32 (65,3% radiografias avaliadas.The aim of the article was to describe clinical and epidemiological features of 61 oral paracoccidioidomycosis cases from the Stomatology Department of São Lucas Hospital, analyzed from July 1976 to June 2004. The State of Rio Grande do Sul is an endemic region due to ecoepidemiologic conditions, that are favorable for the development of the yeast. Men are the most affected gender, with 58 (95% affected compared to 3 (5% women. Ii is most prevalent (70.5% between 40 and 59 years of age. Agricultural labor was the most common occupation with 27/61 (44.3% patients. Tobacco smoking was prevalent in 52 (85.3% of the sample, and alcoholism was a frequent finding. All the patients showed stomatologic manifestations, with ulcers and mulberry-like stomatitis the most prevalent, these oral lesions were also observed in many anatomical sites. Alterations were present in 32 (65.3% of the pulmonary radiographs.

The Paracoccidioides cell wall: past and present layers towards understanding interaction with the host

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Rosana ePuccia

2011-12-01

Full Text Available The cell wall of pathogenic fungi plays import roles in interaction with the host, so that its composition and structure may determine the course of infection. Here we present an overview of the current and past knowledge on the cell wall constituents of Paracoccidioides brasiliensis and P. lutzii. These are temperature-dependent dimorphic fungi that cause paracoccidioidomycosis, a systemic granulomatous and debilitating disease. Focus is given on cell wall carbohydrate and protein contents, their immune-stimulatory features, adhesion properties, drug target characteristics, and morphological phase specificity. We offer a journey towards the future understanding of the dynamic life that takes place in the cell wall and of the changes that it may suffer when living in the human host.

Appearance of Systemic Lupus Erythematosus in Patients with Myasthenia Gravis following Thymectomy: Two Case Reports

OpenAIRE

Park, Mi-Jeong; Kim, Yun-A; Lee, Shin-Seok; Kim, Byeong-Chae; Kim, Myeong-Kyu; Cho, Ki-Hyun

2004-01-01

We report two cases of systemic lupus erythematosus (SLE) in myasthenia gravis (MG) patients who had undergone thymectomy. SLE developed in the patients 3 months or 13 yr after thymectomy, and polyarthritis was the main clinical manifestation of SLE. Both patients fulfilled at least four of the revised criteria for the classification of SLE. In this report, we describe two postthymectomy lupus patients and perform a comparative review of previous cases.

Cryptococcosis in captive cheetah (Acinonyx jubatus : two cases : case report

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L.A. Bolton

1999-07-01

Full Text Available Cryptococcus neoformans is a yeast-like organism associated with pulmonary, meningoencephalitic, or systemic disease. This case report documents 2 cases of cryptococcosis with central nervous system involvement in captive cheetah (Acinonyx jubatus. In both cases the predominant post mortal lesions were pulmonary cryptococcomas and extensive meningoencephalomyelitis. Both cheetahs tested negative for feline immunodeficiency virus and feline leukaemia virus. The organism isolated in Case 2 was classified as Cryptococcus neoformans var. gattii, which is mainly associated with disease in immunocompetent hosts.

Barrier and system performances within a safety case: their functioning and evolution with time

International Nuclear Information System (INIS)

Hedin, A.; Voinis, S.; Fillion, E.; Keller, S.; Lalieux, Ph.; Nachmilner, L.; Nys, V.; Rodriguez, J.; Sevougian, D.; Wollrath, J.

2002-01-01

The following six questions were used as the basis for the discussions in a Working Group: - What is the role of each barrier as a function of time or in the different time frames? What is its contribution to the overall system performance or safety as a function of time? - Which are the main uncertainties on the performance of barriers in the timescales? To what extent should we enhance the robustness of barriers because of the uncertainties of some component behaviour with time? - What is the requested or required performance versus the expected realistic or conservative behaviour with time? How are these safety margins used as arguments in a safety case? - What is the issue associated with the geosphere stability for different geological systems? - How are barriers and system performances, as a function of time, evaluated (presented and communicated) in a safety case? - What kind of measures are used for siting, designing and optimising robust barriers corresponding to situations that can vary with time? Are human actions considered to be relevant? (authors)

Systemic Mastocytosis: A Rare Case of Increased Liver Stiffness

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Stefanie Adolf

2012-01-01

Full Text Available Assessment of liver stiffness (LS by transient elastography (Fibroscan has significantly improved the noninvasive diagnosis of liver fibrosis. We here report on a 55-year-old patient with drastically increased LS due to previously unknown systemic mastocytosis. The patient initially presented with increased weight loss, nocturnal pruritus, increased transaminases, bilirubinemia, and thrombocytopenia. Abdominal ultrasound showed ascites, hepatomegaly, and splenomegaly. In addition, LS was 75 kPa (IQR 0 kPa clearly exceeding the cut-off value for F4 cirrhosis of 12.5 kPa. However, histological analysis of the liver specimen indicated liver involvement by systemic mastocytosis and excluded liver cirrhosis. An additional CT scan detected disseminated bone lesions. After three months of treatment with Midostaurin, LS slightly decreased down to 31.9 kPa (IQR 8.3 kPa. This case illustrates that diffused sinusoidal neoplastic infiltrates are a pitfall in the non-invasive diagnosis of liver cirrhosis. In conclusion, refined clinical algorithms for increased LS should also include mastocytosis in addition to inflammation, congestion, and biliary obstruction.

Analytical method of waste allocation in waste management systems: Concept, method and case study

Energy Technology Data Exchange (ETDEWEB)

Bergeron, Francis C., E-mail: francis.b.c@videotron.ca

2017-01-15

Waste is not a rejected item to dispose anymore but increasingly a secondary resource to exploit, influencing waste allocation among treatment operations in a waste management (WM) system. The aim of this methodological paper is to present a new method for the assessment of the WM system, the “analytical method of the waste allocation process” (AMWAP), based on the concept of the “waste allocation process” defined as the aggregation of all processes of apportioning waste among alternative waste treatment operations inside or outside the spatial borders of a WM system. AMWAP contains a conceptual framework and an analytical approach. The conceptual framework includes, firstly, a descriptive model that focuses on the description and classification of the WM system. It includes, secondly, an explanatory model that serves to explain and to predict the operation of the WM system. The analytical approach consists of a step-by-step analysis for the empirical implementation of the conceptual framework. With its multiple purposes, AMWAP provides an innovative and objective modular method to analyse a WM system which may be integrated in the framework of impact assessment methods and environmental systems analysis tools. Its originality comes from the interdisciplinary analysis of the WAP and to develop the conceptual framework. AMWAP is applied in the framework of an illustrative case study on the household WM system of Geneva (Switzerland). It demonstrates that this method provides an in-depth and contextual knowledge of WM. - Highlights: • The study presents a new analytical method based on the waste allocation process. • The method provides an in-depth and contextual knowledge of the waste management system. • The paper provides a reproducible procedure for professionals, experts and academics. • It may be integrated into impact assessment or environmental system analysis tools. • An illustrative case study is provided based on household waste

Analytical method of waste allocation in waste management systems: Concept, method and case study

International Nuclear Information System (INIS)

Bergeron, Francis C.

2017-01-01

Waste is not a rejected item to dispose anymore but increasingly a secondary resource to exploit, influencing waste allocation among treatment operations in a waste management (WM) system. The aim of this methodological paper is to present a new method for the assessment of the WM system, the “analytical method of the waste allocation process” (AMWAP), based on the concept of the “waste allocation process” defined as the aggregation of all processes of apportioning waste among alternative waste treatment operations inside or outside the spatial borders of a WM system. AMWAP contains a conceptual framework and an analytical approach. The conceptual framework includes, firstly, a descriptive model that focuses on the description and classification of the WM system. It includes, secondly, an explanatory model that serves to explain and to predict the operation of the WM system. The analytical approach consists of a step-by-step analysis for the empirical implementation of the conceptual framework. With its multiple purposes, AMWAP provides an innovative and objective modular method to analyse a WM system which may be integrated in the framework of impact assessment methods and environmental systems analysis tools. Its originality comes from the interdisciplinary analysis of the WAP and to develop the conceptual framework. AMWAP is applied in the framework of an illustrative case study on the household WM system of Geneva (Switzerland). It demonstrates that this method provides an in-depth and contextual knowledge of WM. - Highlights: • The study presents a new analytical method based on the waste allocation process. • The method provides an in-depth and contextual knowledge of the waste management system. • The paper provides a reproducible procedure for professionals, experts and academics. • It may be integrated into impact assessment or environmental system analysis tools. • An illustrative case study is provided based on household waste

Unusual location of central nervous system langerhans cell histiocytosis: case report

Energy Technology Data Exchange (ETDEWEB)

Kim, E. Yup; Lee, Jae Kyu; Kim, Chan Kyo; Lee, Chang Hyun; Kang, Chang Ho; Chung, Phil Wook [Armed Forces Capital Hospital, Seongnam (Korea, Republic of)

2003-03-01

Langerhans cell histiocytosis of the central nervous system (CNS) usually involves the hypothalamic-pituitary axis, and T1-weighted MR images normally demonstrate infundibular thickening and/or a mass lesion in the hypothalamus and the absence of a posterior pituitary 'bright spot'. We recently encountered a case of CNS langerhans cell histiocytosis with no posterior pituitary 'bright spot' and with lesions involving the cerebellum and basal ganglia but not the hypothalamic-pituitary axis.

Experience of long-term belimumab use in patients with systemic lupus erythematosus (a case report

Directory of Open Access Journals (Sweden)

Natalia Gennadyevna Klyukvina

2013-01-01

Full Text Available In the past years considerable progress has been made in the treatment of systemic lupus erythe-matosus; however, not all questions have been answered. The range of medications has substan-tially increased. The paper describes a case of the long-term use of the new genetically engineered agent belimumab in a patient with systemic lupus erythematosus.

What Can Engineering Systems Teach Us About Social (In)Justices? The Case of Public Transportation Systems

DEFF Research Database (Denmark)

Valderrama Pineda, Andres Felipe

2013-01-01

Politicians, consultants and engineers develop public transportation systems using a variety of well-developed and established modeling tools to calculate different aspects of a system. Some of them are performance-capacity against investment models to determine the value of a given technical cho...... in at various stages in the process hides social injustices under the veil of neutrality. This chapter, thus, calls to engineers to become critically aware of how they can influence systems modeling in ways that are more socially just....... that the implicit assumptions and even the specific ways of estimating different constants to value input data in these models shape the results in ways that perpetuate social injustices built in the urban landscape of our cities. This chapter analyses the case of the design of Transmilenio in Bogotá, a public mass...... transportation system coined as one of the most progressive on the planet. Part of a political discourse to improve social justice in Bogotá, the project is successful in many respects but falls short of the original aims in many other respects. The chapter describes how the “rational modeling” brought...

Building a comprehensive geriatric health care system: a case study.

Science.gov (United States)

Bleiweiss, L; Simson, S

1976-01-01

This case study focuses on the efforts of three urban medical care institutions--a Health Maintenance Organization, a nursing home, and a university hospital--to form an interorganizational relationship. The purpose of the relationship was to utilize the services of the three organizations in order to respond to the comprehensive health needs of an urban geriatric population. Movements in this triadic organizational relationship are described and analyzed in terms of four conceptual stages--exploration, negotiation, interaction and performance, and termination. Problems arising during these stages were not resolved and the relationship was terminated after approximately two years of existence. A sociological discussion of the case focuses on why the relationship failed. The organizational relationship was disrupted by three stresses that occurred during the four stages of the relationship. Stresses emerged for each organization in the areas of organizational integration, professional coordination, and environmental adaptation, making it difficult for the three to become integrated into an organizational system. As a result, the HMO, the nursing home, and the hospital did not benefit from relationships that could have enabled them to develop the multi-organizational system necessary to sustain an innovative, comprehansive geriatric health project. If, as Whitehead said, the greatest invention of the nineteenth century was the invention of the method of invention, the task of the succedding century has been to organize inventiveness. The difference is not in the nature of invention or of inventors, but in the manner in which the context of social institutions is organized for their support.

Recall bias in a case-control surveillance system on the use of medicine during pregnancy

DEFF Research Database (Denmark)

Rockenbauer, M.; Olsen, Jørn; Czeizel, A.E.

2001-01-01

It is important to study possible teratogenic effects of drugs used during pregnancy. Many studies of this type rely upon case-control designs in which drug intake is recalled by the mothers after having given birth. Recall bias in this situation may lead to spurious associations. We looked...... study. A case-control surveillance system of this type may frequently cause spurious associations, with biased odds ratios up to a factor of 1.9....

Laparoscopic pyeloplasty for ureteropelvic junction obstruction of the lower moiety in a completely duplicated collecting system: a case report

Directory of Open Access Journals (Sweden)

Stravodimos Konstantinos G

2008-10-01

Full Text Available Abstract Introduction There are only a few reports on laparoscopic pyeloplasty in kidney abnormalities and only one case for laparoscopic pyeloplasty in a duplicated system. Increasing experience in laparoscopic techniques allows proper treatment of such anomalies. However, its feasibility in difficult cases with altered kidney anatomy such as that of duplicated renal pelvis still needs to be addressed. Case presentation We present a case of a 22-year-old white Caucasian female patient with ureteropelvic junction obstruction of the lower ureter of a completely duplicated system that was managed with laparoscopic pyeloplasty. Crossing vessels were identified and transposed. The procedure was carried out successfully and the patient's symptoms subsided. Follow-up studies demonstrated complete resolution of the obstruction. Conclusion Since laparoscopic pyeloplasty is still an evolving procedure, its feasibility in complex cases of kidney anatomic abnormalities is herein further justified.

Laparoscopic pyeloplasty for ureteropelvic junction obstruction of the lower moiety in a completely duplicated collecting system: a case report

Science.gov (United States)

Stravodimos, Konstantinos G; Anastasiou, Ioannis; Adamakis, Ioannis; Kapetanakis, Theodoros; Koritsiadis, Georgios; Constantinides, Constantinos

2008-01-01

Introduction There are only a few reports on laparoscopic pyeloplasty in kidney abnormalities and only one case for laparoscopic pyeloplasty in a duplicated system. Increasing experience in laparoscopic techniques allows proper treatment of such anomalies. However, its feasibility in difficult cases with altered kidney anatomy such as that of duplicated renal pelvis still needs to be addressed. Case presentation We present a case of a 22-year-old white Caucasian female patient with ureteropelvic junction obstruction of the lower ureter of a completely duplicated system that was managed with laparoscopic pyeloplasty. Crossing vessels were identified and transposed. The procedure was carried out successfully and the patient's symptoms subsided. Follow-up studies demonstrated complete resolution of the obstruction. Conclusion Since laparoscopic pyeloplasty is still an evolving procedure, its feasibility in complex cases of kidney anatomic abnormalities is herein further justified. PMID:18945370

Systemic sarcoidosis with bone marrow involvement responding to therapy with adalimumab: a case report

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Patel Supen R

2009-07-01

Full Text Available Abstract Introduction Sarcoidosis is an inflammatory disorder characterized by the presence of non-caseating granulomas in affected organs. The presence of CD4-positive T lymphocytes and macrophages in affected organs suggests an ongoing immune response. Systemic corticosteroids remain the mainstay of treatment, but therapy is often limited by adverse effects. This is the first report of the use of adalimumab (HUMIRA®, Abbott Laboratories, North Chicago, IL, USA, an anti-tumor necrosis factor monoclonal antibody, in a patient with systemic sarcoidosis with bone marrow involvement. Case presentation A 42-year-old African-American man with a medical history significant for hypertension and diabetes mellitus presented with anemia and thrombocytopenia of two months duration. The patient underwent physical examination, bone marrow aspiration and biopsy, chest X-ray, acid-fast bacilli stain, computed tomography with contrast, and additional laboratory tests. He was diagnosed with systemic sarcoidosis with splenomegaly and bone marrow involvement. Drug therapy included prednisone, which had to be discontinued owing to adverse effects, and adalimumab. Conclusion This is the first report describing the use of adalimumab in a patient with systemic sarcoidosis with bone marrow involvement. Tumor necrosis factor antagonism with adalimumab was efficacious and well-tolerated in this patient and may be considered as a treatment option for similar cases.

Qualitative analysis of round-table discussions on the business case and procurement challenges for hospital electronic prescribing systems.

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Kathrin M Cresswell

Full Text Available There is a pressing need to understand the challenges surrounding procurement of and business case development for hospital electronic prescribing systems, and to identify possible strategies to enhance the efficiency of these processes in order to assist strategic decision making.We organized eight multi-disciplinary round-table discussions in the United Kingdom. Participants included policy makers, representatives from hospitals, system developers, academics, and patients. Each discussion was digitally audio-recorded, transcribed verbatim and, together with accompanying field notes, analyzed thematically with NVivo9.We drew on data from 17 participants (approximately eight per roundtable, six hours of discussion, and 15 pages of field notes. Key challenges included silo planning with systems not being considered as part of an integrated organizational information technology strategy, lack of opportunity for interactions between customers and potential suppliers, lack of support for hospitals in choosing appropriate systems, difficulty of balancing structured planning with flexibility, and the on-going challenge of distinguishing "wants" and aspirations from organizational "needs".Development of business cases for major investments in information technology does not take place in an organizational vacuum. Building on previously identified potentially transferable dimensions to the development and execution of business cases surrounding measurements of costs/benefits and risk management, we have identified additional components relevant to ePrescribing systems. These include: considerations surrounding strategic context, case for change and objectives, future service requirements and options appraisal, capital and revenue implications, timescale and deliverability, and risk analysis and management.

Remaining life case history studies for high energy piping systems using equivalent stress

International Nuclear Information System (INIS)

Cohn, M.J.

1987-01-01

As the development of plant life extension for high energy piping systems is progressing, conventional piping system design methodologies are also being reevaluated. Traditional guidelines such as American National Standard Institute/American Society of Mechanical Engineers B31.1 (ANSI/ASME) were developed for plants having design lives in the 25- to 30-year regime based upon relatively short-term base metal creep data. These guidelines use a simplified approach for the piping analysis. Two types of stress criteria must be satisfied. The first type is longitudinal plus torsion stress checks for several types of loading conditions versus the material allowable stresses. The second type is an independent minimum wall thickness check which considers the hoop stress versus the material allowable stress. Seven case histories have been evaluated to estimate the minimum piping system creep life based on the current ANSI/ASME B31.1 finite element type of analysis, which is a traditional approach, versus a multiaxial stress state type of analysis. In nearly every case, the equivalent stress methodology predicted significantly higher stresses. Consequently, the equivalent stress methodology resulted in 11 to 96% lower time to rupture values as compared to the values predicted using ANSI/ASME B31.1 stresses

Electronic error-reporting systems: a case study into the impact on nurse reporting of medical errors.

Science.gov (United States)

Lederman, Reeva; Dreyfus, Suelette; Matchan, Jessica; Knott, Jonathan C; Milton, Simon K

2013-01-01

Underreporting of errors in hospitals persists despite the claims of technology companies that electronic systems will facilitate reporting. This study builds on previous analyses to examine error reporting by nurses in hospitals using electronic media. This research asks whether the electronic media creates additional barriers to error reporting, and, if so, what practical steps can all hospitals take to reduce these barriers. This is a mixed-method case study nurses' use of an error reporting system, RiskMan, in two hospitals. The case study involved one large private hospital and one large public hospital in Victoria, Australia, both of which use the RiskMan medical error reporting system. Information technology-based error reporting systems have unique access problems and time demands and can encourage nurses to develop alternative reporting mechanisms. This research focuses on nurses and raises important findings for hospitals using such systems or considering installation. This article suggests organizational and technical responses that could reduce some of the identified barriers. Crown Copyright © 2013. Published by Mosby, Inc. All rights reserved.

Corporate Taxation and Investment: The Case of the Split Rate Corporate Tax System in Macedonia

Directory of Open Access Journals (Sweden)

Ilija Gruevski

2018-12-01

Full Text Available The majority of experts agree that taxes are distortionary in nature. This is relatively true for all of the different groups of taxes, but for the corporate taxes is exceptionallyobvious. The existence of the corporate tax system can affect the company’s behavior in number of ways and one of the most criticized is the ability for distortion of the choice of the sources of finance. In the following article, we explore the effects from corporate taxation on investment, through the methodological frame of the effective marginal tax rates. The objective is to analyze the investment decision in the case of isolated implementation of corporate taxes which means that the effects from the so-called “double taxation”, induced by the personal taxes are not taken in consideration. We hope to prove that these conditions generate “uneven” distribution of the burden across the projects covered with different sources of finance. Also, we intend to test and explore the properties of some alternative corporate tax systems which are widely known as neutral, such as: the comprehensive business income tax system (CBIT, the imputation corporate tax system (ICT, the full imputation corporate tax system (FICT, the allowance for corporate equity tax system (ACE and the split rate corporate tax system (SRCT. In addition, we support our findings with a practical example: the case study from the implementation of the split rate corporate tax system in Macedonia.

A new data management system for the French National Registry of human alveolar echinococcosis cases

Directory of Open Access Journals (Sweden)

Charbonnier Amandine

2014-01-01

Full Text Available Alveolar echinococcosis (AE is an endemic zoonosis in France due to the cestode Echinococcus multilocularis. The French National Reference Centre for Alveolar Echinococcosis (CNR-EA, connected to the FrancEchino network, is responsible for recording all AE cases diagnosed in France. Administrative, epidemiological and medical information on the French AE cases may currently be considered exhaustive only on the diagnosis time. To constitute a reference data set, an information system (IS was developed thanks to a relational database management system (MySQL language. The current data set will evolve towards a dynamic surveillance system, including follow-up data (e.g. imaging, serology and will be connected to environmental and parasitological data relative to E. multilocularis to better understand the pathogen transmission pathway. A particularly important goal is the possible interoperability of the IS with similar European and other databases abroad; this new IS could play a supporting role in the creation of new AE registries.

Non-Hodgkin's lymphoma in patients with systemic lupus erythematosus: 2 case reports

International Nuclear Information System (INIS)

Ferri, M.; Mar, C.; Bhatia, R.S.

2002-01-01

The association between autoimmune rheumatic diseases and malignancy, and between lymphoproliferative disorders and systemic lupus erythematosus (SLE), in particular, has been documented. Although the imaging features of pulmonary lymphoma and of pulmonary manifestations of SLE have been described separately, the imaging features of the 2 together have not been demonstrated. We present the cases of 2 patients with SLE presenting with non-Hodgkin's lymphoma (NHL). (author)

On the case of Goryachev-Chaplygin and new examples of integrable conservative systems on S^2

OpenAIRE

Selivanova, E. N.

1998-01-01

The aim of this paper is to describe a class of conservative systems on $S^2$ possessing an integral cubic in momenta. We prove that this class of systems consists off the case of Goryachev-Chaplygin, the one-parameter family of systems which has been found by the author in the previous paper (dg-ga/9711005) and a new two-parameter family of conservative systems on $S^2$ possessing an integral cubic in momenta.

A case of vascular Ehlers-Danlos Syndrome with a cardiomyopathy and multi-system involvement.

Science.gov (United States)

Lan, Nick Si Rui; Fietz, Michael; Pachter, Nicholas; Paul, Vincent; Playford, David

Ehlers-Danlos Syndrome comprises a heterogeneous group of heritable connective tissue disorders resulting from various gene mutations. We present an unusual case of vascular Ehlers-Danlos Syndrome with distinctive physical characteristics and a cardiomyopathy with features suggesting isolated left ventricular non-compaction. The cardiac features represent the first report of a cardiomyopathy associated with a mutation in the COL3A1 gene. This case also illustrates the multi-system nature of Ehlers-Danlos Syndrome and the complexity of managing patients with the vascular subtype. Copyright © 2018 Elsevier Inc. All rights reserved.

VHDL vs. Bluespec system verilog: a case study on a Java embedded architecture

NARCIS (Netherlands)

Gruian, Flavius; Westmijze, M.

2008-01-01

This paper compares two hardware design flows, based on the classic VHDL on one side and the relatively new Blue-spec System Verilog (BSV) on the other side. The comparison is based on a case study of a Java embedded architecture, comprising a Java native processor and a memory management unit. The

Regime shifts under forcing of non-stationary attractors: Conceptual model and case studies in hydrologic systems.

Science.gov (United States)

Park, Jeryang; Rao, P Suresh C

2014-11-15

We present here a conceptual model and analysis of complex systems using hypothetical cases of regime shifts resulting from temporal non-stationarity in attractor strengths, and then present selected published cases to illustrate such regime shifts in hydrologic systems (shallow aquatic ecosystems; water table shifts; soil salinization). Complex systems are dynamic and can exist in two or more stable states (or regimes). Temporal variations in state variables occur in response to fluctuations in external forcing, which are modulated by interactions among internal processes. Combined effects of external forcing and non-stationary strengths of alternative attractors can lead to shifts from original to alternate regimes. In systems with bi-stable states, when the strengths of two competing attractors are constant in time, or are non-stationary but change in a linear fashion, regime shifts are found to be temporally stationary and only controlled by the characteristics of the external forcing. However, when attractor strengths change in time non-linearly or vary stochastically, regime shifts in complex systems are characterized by non-stationary probability density functions (pdfs). We briefly discuss implications and challenges to prediction and management of hydrologic complex systems. Copyright © 2014 Elsevier B.V. All rights reserved.

What Can We Learn from a Well-Adapted Enterprise System? A Case Study Approach

DEFF Research Database (Denmark)

Svejvig, Per; Jensen, Tina Blegind

how the system was highly integrated, accepted by its users, and well-aligned to the work processes. This leads to the research question: Why is the enterprise system so well-adapted in SCANDI and what can we learn from this case study? Building on the structural model of technology to investigate...... as a long-term institutionalization and legitimization course of events leading to secondary socialization as the key lessons learned in achieving successful ES adaptations....

Systemic lupus erythematosus associated with type 4 renal tubular acidosis: a case report and review of the literature

Directory of Open Access Journals (Sweden)

Young Larry

2011-03-01

Full Text Available Abstract Introduction Type 4 renal tubular acidosis is an uncommon clinical manifestation of systemic lupus erythematosus and has been reported to portend a poor prognosis. To the best of our knowledge, this is the first case report which highlights the successful management of a patient with systemic lupus erythematosus complicated by type 4 renal tubular acidosis who did not do poorly. Case presentation A 44-year-old Hispanic woman developed a non-anion gap hyperkalemic metabolic acidosis consistent with type 4 renal tubular acidosis while being treated in the hospital for recently diagnosed systemic lupus erythematosus with multi-organ involvement. She responded well to treatment with corticosteroids, hydroxychloroquine and mycophenolate mofetil. Normal renal function was achieved prior to discharge and remained normal at the patient's one-month follow-up examination. Conclusion This case increases awareness of an uncommon association between systemic lupus erythematosus and type 4 renal tubular acidosis and suggests a positive impact of early diagnosis and appropriate immunosuppressive treatment on the patient's outcome.

Actors’ Competencies or Methods? A Case Study of Successful Information Systems Development

DEFF Research Database (Denmark)

Omland, Hans Olav; Nielsen, Peter Axel

2009-01-01

and methods are exercised. Emphasising the intertwining of competencies and methods, we discuss the character of the intertwining process, how different actors relate to different methods, and how methods may be part of the problem rather than part of the solution to challenges in information systems...... between actors’ competencies and their deployment of methods, arguing that this relationship is described over-simplistically and needs a better explanation. Through a case study of a successful information systems development project we identify some central situations where a variety of competencies...... development. The paper suggests elements for a new model for explaining actors’ competencies and their use of methods....

Simulation and gaming as a support tool for lean manufacturing systems - a case example from industry

NARCIS (Netherlands)

van der Zee, DJ; Slomp, J; Kuhl, M.E.; Steiger, N.M.; Armstrong, F.B.; Joines, J.

2005-01-01

In this article we illustrate how simulation and gaming can be used to support lean manufacturing systems. More in particular we study a case example from industry - a manual assembly line for mail-inserting systems - for which we have developed a simulation game. This paper focuses on the

Radiology Reporting System Data Exchange With the Electronic Health Record System: A Case Study in Iran.

Science.gov (United States)

Ahmadi, Maryam; Ghazisaeidi, Marjan; Bashiri, Azadeh

2015-03-18

In order to better designing of electronic health record system in Iran, integration of health information systems based on a common language must be done to interpret and exchange this information with this system is required. This study provides a conceptual model of radiology reporting system using unified modeling language. The proposed model can solve the problem of integration this information system with the electronic health record system. By using this model and design its service based, easily connect to electronic health record in Iran and facilitate transfer radiology report data. This is a cross-sectional study that was conducted in 2013. The study population was 22 experts that working at the Imaging Center in Imam Khomeini Hospital in Tehran and the sample was accorded with the community. Research tool was a questionnaire that prepared by the researcher to determine the information requirements. Content validity and test-retest method was used to measure validity and reliability of questioner respectively. Data analyzed with average index, using SPSS. Also Visual Paradigm software was used to design a conceptual model. Based on the requirements assessment of experts and related texts, administrative, demographic and clinical data and radiological examination results and if the anesthesia procedure performed, anesthesia data suggested as minimum data set for radiology report and based it class diagram designed. Also by identifying radiology reporting system process, use case was drawn. According to the application of radiology reports in electronic health record system for diagnosing and managing of clinical problem of the patient, with providing the conceptual Model for radiology reporting system; in order to systematically design it, the problem of data sharing between these systems and electronic health records system would eliminate.

Reactor protection system software test-case selection based on input-profile considering concurrent events and uncertainties

International Nuclear Information System (INIS)

Khalaquzzaman, M.; Lee, Seung Jun; Cho, Jaehyun; Jung, Wondea

2016-01-01

Recently, the input-profile-based testing for safety critical software has been proposed for determining the number of test cases and quantifying the failure probability of the software. Input-profile of a reactor protection system (RPS) software is the input which causes activation of the system for emergency shutdown of a reactor. This paper presents a method to determine the input-profile of a RPS software which considers concurrent events/transients. A deviation of a process parameter value begins through an event and increases owing to the concurrent multi-events depending on the correlation of process parameters and severity of incidents. A case of reactor trip caused by feedwater loss and main steam line break is simulated and analyzed to determine the RPS software input-profile and estimate the number of test cases. The different sizes of the main steam line breaks (e.g., small, medium, large break) with total loss of feedwater supply are considered in constructing the input-profile. The uncertainties of the simulation related to the input-profile-based software testing are also included. Our study is expected to provide an option to determine test cases and quantification of RPS software failure probability. (author)

Indolent Systemic Mastocytosis – a Case Report

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Vujanović Ljuba

2017-09-01

Full Text Available Indolent systemic mastocytosis is a benign form of systemic mastocytosis characterized by an abnormal proliferation of mast cells either in the bone marrow or in numerous tissues. Case Report: A 27-year-old female patient was admitted to our department due to urticaria which started a month ago. Before the skin changes appeared, our patient suffered from a toothache, so she took various painkillers (nimesulide, ibuprofen, acetylsalicylic acid, paracetamol. During skin examination, individual hyperpigmented macules on the trunk and lower limbs were observed as incidental findings. The patient reported having them for the last two years. Darier's sign was positive. Following the examination, she was admitted due to suspected urticaria pigmentosa. Laboratory Findings: erythrocyte sedimentation rate: 9 mm/h; complete blood count, urine, blood glucose, total and direct bilirubin, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transferase, urea, creatinine, and uric acid were within normal ranges. Electrolytes: sodium, potassium, chlorine clearance, total calcium and calcium ionized, osteocalcin, and crosslaps were within normal ranges as well. Fibrinogen: 5.57 g/l; 5-Hydroxyindoleacetic acid: 49.8 umol/dU (10.4 - 31.2. Bone densitometry, chest x-ray and upper abdomen ultrasound findings were normal. The suspected clinical diagnosis of urticaria pigmentosa was confirmed by skin biopsy. Histopathological examination of the bone marrow showed moderately increased cellularity (60 - 70%. All three types of blood cells were slightly multiplied. Focal infiltrations were found in the perivascular area, consisting of elongated, oval cells with abundant eosinophilic granular cytoplasm. The nuclei were regular, oval shaped with finely granular chromatin and inconspicuous nucleoli. No nuclear atypia was found. These cells are highly CD117-positive. This finding strongly indicated bone marrow infiltration in systemic mastocytosis. The

Is there an association between Fahr′s disease and cardiac conduction system disease?: A case report

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Prashanth Panduranga

2012-01-01

Full Text Available Background: Fahr′s disease is a rare neurodegenerative disorder of unknown cause characterized by idiopathic basal ganglia calcification that is associated with neuropsychiatric and cognitive impairment. No case of Fahr′s disease with associated cardiac conduction disease has been described in the literature to date. The objective of this case report was to describe a young female with various cardiac conduction system abnormalities and bilateral basal ganglia calcifica-tion suggestive of Fahr′s disease. Case Report: A 19-year-old female was transferred to our hospital for a pacemaker insertion. Her past medical history included cognitive impairment and asymptomatic congenital complete heart block since birth. Her manifestations in-cluded cognitive impairment, tremors, rigidity, ataxia, bilateral basal ganglia calcification without clinical manifesta-tions of mitochondrial cytopathy. She also had right bundle branch block, left anterior fascicular block, intermittent complete heart block, atrial arrhythmias with advanced atrioventricular blocks and ventricular asystole manifested by Stokes-Adams seizures, which was diagnosed as epilepsy. Conclusions: According to our knowledge, this was the first case report of a su spected association between Fahr′s disease and isolated cardiac conduction system disease. In addition, this case illustrated that in patients with heart blocks and seizures, a diagnosis of epilepsy needs to be made with caution and such patients need further evaluations by a cardiologist or electrophysiologist to consider pacing and prevent future catastrophic events.

Radiographic findings of systemic lupus erythematosus enteritis (a report of 4 cases)

International Nuclear Information System (INIS)

Zhang Ailian; Li Ruilan; Gao Yu'ao

1999-01-01

Objective: To discuss the radiographic findings and diagnosis in lupus enteritis. Methods: 4 cases of lupus enteritis (male 1, female 3) were studied. Abdominal pain was the chief complaint in all these cases. Before and after steroid therapy, small bowel contrast study was performed. Results: In one patient abdominal plain film revealed slight dilatation of jejunum with air-fluid levels. Small bowel contrast study showed effacement and (or) nodules of the mucosal folds, thumb printing, spasm and some degree of rigidity and narrowing of the lumen. Clinical symptoms and radiographic findings became normal after steroid therapy. Conclusions: If a patient with systemic lupus erythematosus presents abdominal symptoms, small bowel contrast study should be done. It is important and helpful to assist the diagnosis, to decide therapeutic plan and to follow up the effect of treatment

Towards grid parity in insular energy systems: The case of photovoltaics (PV) in Cyprus