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Idiopathic generalized epilepsies (IGEs) may start in infancy, childhood, or adolescence, but some have an onset in adulthood. They are genetically determined and affect otherwise healthy people of both sexes and all races, and are generally lifelong. Some, however, are age related. IGEs account for nearly a third of all epilepsies. According to the International League Against Epilepsy (ILAE) proposed classification, the following IGEs are recognized in accordance with the age at onset (Engel, 2001): benign myoclonic epilepsy in infancy (BMEI), generalized epilepsies with febrile seizures plus (GEFS+), epilepsy with myoclonic-astatic seizures (EMAS), epilepsy with myoclonic absences (EMA), childhood absence epilepsy (CAE), and IGEs with variable phenotypes (IGEVP) that include juvenile absence epilepsy (JAE), juvenile myoclonic epilepsy (JME), and epilepsy with generalized tonic-clonic seizures only (EGTCSO). These IGEs raise a conceptual issue since some conditions are epilepsy syndromes (a combination of a given age of onset, seizure type(s), and interictal and clinical and EEG features) (i.e., BMEI, EMAS, EMA, CAE, JAE, JME) whereas others join several types of epilepsy in a given family (i.e., GEFS+and eventually IGEVP and EGTCSO). This chapter describes the electroclinical features, evolution, and therapeutic aspects of IGEs. | The GABAergic neurons of the thalamic reticular nucleus (nRt) provide the primary source of inhibition within the thalamus. Using physiology, pharmacology, and immunohistochemistry in mice, we characterized postsynaptic developmental changes in these inhibitory projection neurons. First, at postnatal days 3–5 (P3-5), inhibitory postsynaptic currents (IPSCs) decayed very slowly, followed by a biphasic developmental progression, becoming faster at P6-8 and then slower again at P9-11 before stabilizing in a mature form around P12. Second, the pharmacological profile of GABAA receptor (GABAAR)-mediated IPSCs differed between neonatal and mature nRt neurons, and this was accompanied by reciprocal changes in α3 (late) and α5 (early) subunit expression in nRt. Zolpidem, selective for α1- and α3-containing GABAARs, augmented only mature IPSCs, whereas clonazepam enhanced IPSCs at all stages. This effect was blocked by the α5-specific inverse agonist L-655,708, but only in immature neurons. In α3(H126R) mice, in which α3-subunits were mutated to become benzodiazepine insensitive, IPSCs were enhanced compared with those in wild-type animals in early development. Third, tonic GABAAR activation in nRt is age dependent and more prominent in immature neurons, which correlates with early expression of α5-containing GABAARs. Thus neonatal nRt neurons show relatively high expression of α5-subunits, which contributes to both slow synaptic and tonic extrasynaptic inhibition. The postnatal switch in GABAAR subunits from α5 to α3 could facilitate spontaneous network activity in nRt that occurs at this developmental time point and which is proposed to play a role in early circuit development. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,600 |
Recent advances in neuroimaging have highlighted the interest to differentiate hippocampal subfields for cognitive neurosciences and more notably in assessing the effects of normal and pathological aging. The main goal of the present study is to investigate the effects of normal aging onto the volume of the different hippocampal subfields. For this purpose, we developed a new magnetic resonance sequence together with reliable tracing guidelines to assess the volume of different subfields of the hippocampus using a 3 Tesla scanner, and estimated the validity of a simpler and less time-consuming method based on the widely-used automatic Voxel-Based Morphometry (VBM) technique. Three hippocampal regions of interest were delineated on the right and left hippocampi of 50 healthy subjects between 18 and 68 years old corresponding to the CA1, subiculum and other (including CA2-3-4 and Dentate Gyrus) subfields. A strong effect of age was found on the volume of the subiculum only, with a decrease paralleling that of the global gray matter volume, while CA1 and other subfields seemed relatively spared. Although less precise than the ROI-tracing technique, the VBM-based method appeared as a reliable alternative especially to distinguish CA1 and subiculum subfields. Our findings of a specific effect of age on the subiculum are consistent with the developmental hypothesis ("last-in first-out" theory). This contrasts with the predominant vulnerability of the CA1 subfield to Alzheimer's disease reported in several previous studies, suggesting that the assessment of hippocampal subfields may improve the discrimination between normal and pathological aging. | Structural imaging based on magnetic resonance is an integral part of the clinical assessment of patients with suspected Alzheimer dementia. Prospective data on the natural history of change in structural markers from preclinical to overt stages of Alzheimer disease are radically changing how the disease is conceptualized, and will influence its future diagnosis and treatment. Atrophy of medial temporal structures is now considered to be a valid diagnostic marker at the mild cognitive impairment stage. Structural imaging is also included in diagnostic criteria for the most prevalent non-Alzheimer dementias, reflecting its value in differential diagnosis. In addition, rates of whole-brain and hippocampal atrophy are sensitive markers of neurodegeneration, and are increasingly used as outcome measures in trials of potentially disease-modifying therapies. Large multicenter studies are currently investigating the value of other imaging and nonimaging markers as adjuncts to clinical assessment in diagnosis and monitoring of progression. The utility of structural imaging and other markers will be increased by standardization of acquisition and analysis methods, and by development of robust algorithms for automated assessment. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,601 |
Recently, GIS related research and applications have been making rapid progress. Computers with faster CPU and larger memory enable practical applications of time consuming and memory intensive algorithms, both for spatial analysis and visualization. Storage devices become cheaper and have larger space to store data of larger volume and more varieties including image, sound and video. For GIS data capture, novel technologies such as GPS, laser range finder, synthesize aperture radar are getting more and more popular, which bring us terrain data of higher precision at lower cost. Yet, our living environment is also changing rapidly, which makes it a task of high cost and complexity to maintain and manage geometric data such as cartographic or utility information. This paper proposes a system for efficient GIS data maintenance and management. It makes use of a spatiotemporal data model for describing various types of dynamic changes of GIS data, manipulating data in multidimensional space including time. The experiments performed on the initial implementation of the proposed system show its ability of efficient and accurate maintenance of dynamic GIS data. | Spatial and temporal databases are important and well-established sub-disciplines of database research. Some 350 papers in temporal databases have appeared, authored by almost 300 researchers. The literature on spatial databases is also substantial; the bibliography of Samet's landmark book on spatial data structures lists 823 references. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,602 |
Objectives To develop and validate a paediatric-targeted MRI scoring system for the assessment of disease activity and damage in juvenile idiopathic arthritis (JIA). To compare the paediatric MRI score with the adult-designed. Outcome Measures in Rheumatology Clinical Trials—Rheumatoid Arthritis MRI Score (RAMRIS), whose suitability for assessing growing joints was tested. Methods In 66 patients with JIA the clinically more affected wrist was studied. Thirty-nine patients had a 1-year MRI follow-up. Two readers independently assigned the paediatric score and the RAMRIS to all studies. Validation procedures included analysis of reliability, construct validity and responsiveness to change. A reduced version of the bone erosion score was also developed and tested. Results The paediatric score showed an excellent reproducibility (interclass correlation coefficient >0.9). The interobserver agreement of RAMRIS was moderate for bone erosions and excellent for bone marrow oedema (BMO). The paediatric score and RAMRIS provided similar results for construct validity. The responsiveness to change of the paediatric score was moderate for synovitis and bone erosion, and poor for BMO and did not improve when RAMRIS was applied. The reduced version of the bone erosion was valuable for the assessment of joint damage, and provided time-saving advantages. Conclusion The results demonstrate that the paediatric MRI score is a reliable and valid method for assessing disease activity and damage in JIA. Unexpectedly, the RAMRIS provides acceptable suitability for use in the paediatric age group. Further work, especially in a longitudinal setting, is required before defining the most suitable MRI scale for assessing growing joints. | OBJECTIVES ::: To compare DCE-MRI parameters and the relative number of time-intensity curve (TIC) shapes as derived from pixel-by-pixel DCE-MRI TIC shape analysis between knees of clinically active and inactive juvenile idiopathic arthritis (JIA) patients. ::: ::: ::: METHODS ::: DCE-MRI data sets were prospectively obtained. Patients were classified into two clinical groups: active disease (n = 43) and inactive disease (n = 34). Parametric maps, showing seven different TIC shape types, were created per slice. Statistical measures of different TIC shapes, maximal enhancement (ME), maximal initial slope (MIS), initial area under the curve (iAUC), time-to-peak (TTP), enhancing volume (EV), volume transfer constant (K(trans)), extravascular space fractional volume (V(e)) and reverse volume transfer constant (k(ep)) of each voxel were calculated in a three-dimensional volume-of-interest of the synovial membrane. ::: ::: ::: RESULTS ::: Imaging findings from 77 JIA patients were analysed. Significantly higher numbers of TIC shape 4 (P = 0.008), median ME (P = 0.015), MIS (P = 0.001) and iAUC (P = 0.002) were observed in clinically active compared with inactive patients. TIC shape 5 showed higher presence in the clinically inactive patients (P = 0.036). ::: ::: ::: CONCLUSIONS ::: The pixel-by-pixel DCE-MRI TIC shape analysis method proved capable of differentiating clinically active from inactive JIA patients by the difference in the number of TIC shapes, as well as the descriptive parameters ME, MIS and iAUC. ::: ::: ::: KEY POINTS ::: • The pixel-by-pixel TIC shape method differentiates clinically active and inactive JIA patients • Significantly higher numbers of TIC shape 4 were observed in clinically active patients • DCE-MRI parameters ME, MIS and iAUC differ between active and inactive patients • The pixel-by-pixel analysis method allows direct visualization of the heterogeneously distributed disease • The DCE-MRI TIC shape method may serve as a quantitative outcome measure. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,603 |
Although general anaesthesia has been of tremendous importance for the development of surgery, the underlying mechanisms by which this state is achieved are only just beginning to be understood in detail. In this review, we describe the neuronal systems that are thought to be involved in mediating clinically relevant actions of general anaesthetics, and we go on to discuss how the function of individual drug targets, in particular GABA(A)-receptor subtypes, can be revealed by genetic studies in vivo. | Propofol is primarily a hypnotic, and is widely used for induction and maintenance of anesthesia, as well as for sedation in various medical procedures. The exact mechanisms of its action are not well understood, although its neural mechanisms have been explored in in vivo and in vitro experiments. Accumulating evidence indicates that one of the major targets of propofol is the cerebral cortex. The principal effect of propofol is considered to be the potentiation of GABAA receptor-mediated inhibitory synaptic currents, but propofol has additional roles in modulating ion channels, including voltage-gated Na+ channels and several K+ channels. We focus on the pharmacological actions of propofol on cerebrocortical neurons, particularly at the cellular and synaptic levels. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,604 |
Suggests that, though local area networking is one of the fastest growing segments in the computer industry, the selection of appropriate features for inclusion in local area networks (LANs) can be confusing for both vendors and end‐users. Describes a system that measures the degree to which specific LAN features meet end‐user needs and contribute to profitability. Reveals that, in the analysis, the features file security and remote access had positive effects on the overall LAN price. Provides a methodology for selecting the most profitable features, such as remote access and gateways to PC networks, to include in a contemplated LAN product line. | Bank stability becomes one of the crucial pillars in maintaining economic growth. Therefore, the segmentation strategy is needed because it aims to improve the financial stability of the bank (decrease Non-Performing Loan-NPL / Non-Performing Financing-NPF). This study aims to determine the effect of segmentation on the quality of Islamic banks proxied with NPF. The method used is a quantitative method with multiple regression test and statistical tool Stata version 13. From the results of statistical data, it is known that the retail segment has a more significant influence than the wholesale segment, which is 92.61% and 56.05%. Therefore, sharia banks should have their business priorities in the retail segment, especially business in the microfinance segment by maintaining the quality of financing through selective financing channeling. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,605 |
The records of 58 federal offenders at the United States Penitentiary in Lewisburg who had made one or more suicide attempts were examined. The attempts were categorized as to seriousness and related to risk factors. The more serious attempt were positively related to (1) loss of a loved one, (2) method other than cutting, and (3) later separation from mother. These findings are essentially consistent with the pertinent literature. | To date there have been very few studies of attempted suicide occurring in prison. This study analyses 111 reports of attempted suicide occurring in a one-year period in the prisons of the Midlands and South West regions of England. Unlike the general population, where there are marked differences (age, sex, etc.) between those attempting and those completing suicide, the characteristics for both groups in prison are similar, high risk being associated with youth, with being on remand or recently sentenced, and with a history of mental or physical illness. There is some indication that those in Young Offender Establishments may be more likely to attempt suicide by hanging. The motivation given by the inmates most commonly stated some form of emotional stress relating to poor communication with family or friends, and in this respect they are similar to attempters outside prison. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,606 |
Associations were evaluated between plasma B12 (low in many Guatemalan infants), development at 12 mo, and responses to 9 mo supplemental B12 or beef. Recruitment criteria were age 12 mo, not waste... | This review evaluates evidence for benefits of including animal source foods (ASF) in the diets of children in developing countries. In observational studies, a higher usual intake of ASF in such countries is associated with better growth, status of some micronutrients, cognitive performance, motor development and activity. Only three randomized trials supplemented children with milk and compared outcomes with a nonintervention control group. Both height and weight growth were improved, although in Kenya height was increased only in younger schoolers who were stunted at baseline. Meat supplements have been evaluated in only two randomized controlled trials, in Kenya and Guatemala (mean baseline age 8 years and 1 year, respectively); growth was no better than in an equicaloric control group. Meat improved cognitive function and activity in Kenya; milk was less effective than meat for improving cognitive function and physical activity, perhaps due to its lower content of iron, zinc, or riboflavin. Meat and especially cow’s milk are excellent sources of vitamin B12, a micronutrient commonly deficient in populations which consume low amounts of ASF. Other micronutrients such as iron have been added to cow’s milk and resulted in improved nutritional outcomes for children. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,607 |
Given any countably infinite group G there exists a sequence a1, a2, … containing each element of G exactly once such that given any g ∈ G there is a unique k with a1, a2 … ak = g. Thus any countably infinite group is sequenceable. This sequence gives rise to an infinite quarter plane latin square C with the property that, given any (gi,gj) ∈ G × G there exists a unique (r, s) ∈ Z+ × Z+ such that crs = gi and crs+1 = gj; moreover, there exists a unique (t, u) ∈ Z+ × Z+ such that ctu = gi and ct+1u = gj. Thus, C is a complete infinite latin square. A similar result is given for an infinite full plane latin square D. | Regarding neighbor balance, we consider natural generalizations of $D$-complete Latin squares and Vatican squares from the finite to the infinite. We show that if $G$ is an infinite abelian group with $|G|$-many square elements, then it is possible to permute the rows and columns of the Cayley table to create an infinite Vatican square. We also construct a Vatican square of any given infinite order that is not obtainable by permuting the rows and columns of a Cayley table. Regarding orthogonality, we show that every infinite group $G$ has a set of $|G|$ mutually orthogonal orthomorphisms and hence there is a set of $|G|$ mutually orthogonal Latin squares based on $G$. We show that an infinite group $G$ with $|G|$-many square elements has a strong complete mapping; and, with some possible exceptions, infinite abelian groups have a strong complete mapping. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,608 |
The usefulness of computed tomography (CT) in diagnosing abdominal abscesses was evaluated prospectively in 69 septic patients who had suffered massive trauma. For the 82 abdominal CT scans obtained, the accuracy rate was 84%, the sensitivity was 92%, and the specificity was 79%. With the use of abdominal CT, 32 patients were spared a "blind" laparotomy in the search for the focus of infection. It is concluded that CT is of significant value in the diagnosis of abdominal abscess in the septic trauma patient. | Introduction ::: Unexplained lactic acidosis (LA) in a critically ill patient often prompts investigations to rule out any reversible intra-abdominal cause. Equivocal results can lead to an emergency laparotomy (EL) with subsequent high morbidity and mortality rates. Our objective was to determine the clinical impact of urgent diagnostic laparoscopy (UDL) in such patients. ::: ::: ::: Methods ::: This was a descriptive single-centre cohort study. UDL on 28 consecutive critically ill patients with unexplained LA who were referred to a single surgeon over 16 years period were analysed. UDL was proformed either at bedside or in theatre without prior computerised tomography (CT) scan. Patient's demographics, ASA grade, referral route and intraoperative findings were analysed. ::: ::: ::: Results ::: Eighteen patients underwent bedside UDL in the critical care setting and further 10 had UDL in theatre. Fourteen patients had normal UDL, out of these 10 had LA secondary to low cardiac output states. Fourteen patients had positive UDL findings. Seven patients had features of mesenteric ischaemia, two had gangrenous gallbladder, two had hepatic ischaemia, one patient had acute pancreatitis, one had gangrenous uterus and one had gastric volvulus. Five of the 14 patients with positive UDL were converted to laparotomy for definitive management. In total, of the 28 patients in the cohort, 23 patients avoided EL. ::: ::: ::: Conclusion ::: UDL is useful and feasible investigation for unexplained LA in the critically ill patients and it can avoid unnecessary EL in many patients. We would recommend the use of UDL as a safe and feasible investigation in such patients. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,609 |
In GWAS of imaging phenotypes (e.g., by the ENIGMA and CHARGE consortia), the growing number of phenotypes considered presents a statistical challenge that other fields are not experiencing (e.g. psychiatry and the Psychiatric Genetics Consortium). However, the multivariate nature of MRI measurements may also be an advantage as many of the MRI phenotypes are correlated and multivariate methods could be considered. Here, we compared the statistical power of a multivariate GWAS versus the current univariate approach, which consists of multiple univariate analyses. To do so, we used results from twin models to estimate pertinent vectors of SNP effect sizes on brain imaging phenotypes, as well as the residual correlation matrices, necessary to estimate analytically the statistical power. We showed that for subcortical structure volumes and hippocampal subfields, a multivariate GWAS yields similar statistical power to the current univariate approach. Our analytical approach is as accurate but ~ 1000 times faster than simulations and we have released the code to facilitate the investigation of other scenarios, may they be outside the field of imaging genetics. | This review summarizes the last decade of work by the ENIGMA (Enhancing NeuroImaging Genetics through Meta Analysis) Consortium, a global alliance of over 1400 scientists across 43 countries, studying the human brain in health and disease. Building on large-scale genetic studies that discovered the first robustly replicated genetic loci associated with brain metrics, ENIGMA has diversified into over 50 working groups (WGs), pooling worldwide data and expertise to answer fundamental questions in neuroscience, psychiatry, neurology, and genetics. Most ENIGMA WGs focus on specific psychiatric and neurological conditions, other WGs study normal variation due to sex and gender differences, or development and aging; still other WGs develop methodological pipelines and tools to facilitate harmonized analyses of "big data" (i.e., genetic and epigenetic data, multimodal MRI, and electroencephalography data). These international efforts have yielded the largest neuroimaging studies to date in schizophrenia, bipolar disorder, major depressive disorder, post-traumatic stress disorder, substance use disorders, obsessive-compulsive disorder, attention-deficit/hyperactivity disorder, autism spectrum disorders, epilepsy, and 22q11.2 deletion syndrome. More recent ENIGMA WGs have formed to study anxiety disorders, suicidal thoughts and behavior, sleep and insomnia, eating disorders, irritability, brain injury, antisocial personality and conduct disorder, and dissociative identity disorder. Here, we summarize the first decade of ENIGMA's activities and ongoing projects, and describe the successes and challenges encountered along the way. We highlight the advantages of collaborative large-scale coordinated data analyses for testing reproducibility and robustness of findings, offering the opportunity to identify brain systems involved in clinical syndromes across diverse samples and associated genetic, environmental, demographic, cognitive, and psychosocial factors. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,610 |
Summary This paper is an introduction to a set of primitives that will enable guided interpretation of seismic signals in the framework of seismic stratigraphy. A method capable of automatic detection of terminations is proposed. The new procedure can be run on an entire seismic volume or it may be restricted to a limited time interval. It detects terminations in an unguided manner without prior interpretation. The procedure may alternatively be guided by pre-existing interpretation, e.g., detecting terminations onto an interpreted horizon. In such a case, the density of terminations will be a new surface attribute. | Classifying textures is a problem that has been considered by many researchers. Many of the high performance methods are based on extracting features from the textures and performing classification in the feature space. In this paper, we consider the application of a new directional filter bank (DFB) to the problem of texture classification. The DFB is used to provide a compact and efficient representation in which fast classification can be performed using classical statistical methods. The resulting method is shown to yield higher performance than feature-based techniques reported previously. Furthermore, the approach has the added attraction that both the computational complexity and storage requirements are relatively low. Experimental comparisons using the Brodatz texture database are also presented. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,611 |
A prospective study was carried out to evaluate the effect of teleradiology on the diagnosis, treatment and prognosis of patients in primary care. A university hospital was sent 685 plain film examinations via an ISDN connection from a primary care centre, for a radiological report. The study was conducted in two phases: during phase 1 (446 cases) general practitioners (GPs) selected the examinations, and during phase 2 (239 cases) all consecutive examinations were transmitted. In phase 1, 40% of the examinations were of the chest and 24% were of the spine; the remaining 36% were mainly bone and sinus examinations. In phase 2, 28% of the examinations were of the chest and 19% were of the spine. The sensitivity and specificity of the GPs' interpretations (compared with the radiologists') were 0.85 and 0.62 respectively in the first phase, and 0.90 and 0.86 in the second. In at least one-third of all cases, teleradiology helped with the diagnosis, although completely new diagnoses were less common. An effect on treatment was noted in 15% of cases and on prognosis in 5%. However, an appropriate consultation level is required for these positive effects. Adequate accuracy and patient safety cannot be achieved if the examinations sent for radiological reporting are preselected by a GP. | RATIONALE AND OBJECTIVES ::: The purpose of this study is to compare the diagnostic accuracy of interpreting clinical neonatal radiographs using a commercially available digital workstation versus conventional radiographic images. ::: ::: ::: METHODS ::: The case sample consists of 100 chest or abdominal radiographs from the neonatal intensive care unit in which diagnosis was confirmed. Four radiologists served as observers. During two initial reading sessions, half of the studies were viewed on digital radiography monitors and the other half by plain film. Observers indicated whether each patient had normal or abnormal findings and their degree of confidence in this judgment. Six weeks later, observers viewed cases on the alternate presentation system. Two statistical analyses were performed: the data from each observer were treated as a separate experiment in the first analysis; the data from all observers were combined using a new method in the second analysis. ::: ::: ::: RESULTS ::: No differences between areas under receiver operating characteristic (ROC) curves for viewing on the picture archiving and communication system (PACS) console and plain film were found for any observer (0.86 versus 0.86, 0.89 versus 0.86, 0.88 versus 0.85, 0.83 versus 0.82). ::: ::: ::: CONCLUSIONS ::: The study suggests that for pediatric plain film images, video images offer diagnostic information comparable with that of conventional radiographs for neonatal examinations. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,612 |
OBJECTIVE ::: To determine the number of deliveries, the low-birth-weight rate and the perinatal mortality rate at provincial and province-aided hospitals and clinics in each planning region of the Cape Province. ::: ::: ::: DESIGN ::: A record of the number of deliveries, low-birth-weight infants, stillbirths and early neonatal deaths in provincial and province-aided hospitals and clinics in each planning region of the Cape Province between 1 January 1989 and 31 December 1991. ::: ::: ::: SETTING ::: All provincial and province-aided hospitals and clinics in the Cape Province. ::: ::: ::: PARTICIPANTS ::: Hospital and clinic staff of all provincial and province-aided hospitals and clinics in the Cape Province. ::: ::: ::: MAIN OUTCOMES MEASURED ::: Number of deliveries, low-birth-weight infants, stillbirths and early neonatal deaths in each planning region of the Cape Province. ::: ::: ::: RESULTS ::: A total of 373,768 births were recorded during the 3-year period with a low-birth-weight rate of 14.7%, a stillbirth rate of 17.9 per 1,000 and an early neonatal mortality rate of 9.1 per 1,000. All rates differed widely between regions. The regions with the highest perinatal mortality rates were in the northern and eastern Cape. ::: ::: ::: CONCLUSION ::: The perinatal demographics of most regions in the Cape Province are typical of a developing country. Regions which have been identified as having the highest low-birth-weight, stillbirth and early neonatal mortality rates are in greatest need of improved perinatal health care. | BackgroundThe number, rates and causes of early neonatal deaths in South Africa were not known. Neither had modifiable factors associated with these deaths been previously documented. An audit of live born infants who died in the first week of life in the public service could help in planning strategies to reduce the early neonatal mortality rate.MethodsThe number of live born infants weighing 1000 g or more, the number of these infants who die in the first week of life, the primary and final causes of these deaths, and the modifiable factors associated with them were collected over four years from 102 sites in South Africa as part of the Perinatal Problem Identification Programme.ResultsThe rate of death in the first week of life for infants weighing 1000 g or more was unacceptably high (8.7/1000), especially in rural areas (10.42/1000). Intrapartum hypoxia and preterm delivery are the main causes of death. Common modifiable factors included inadequate staffing and facilities, poor care in labour, poor neonatal resuscitation and basic care, and difficulties for patients in accessing health care.ConclusionPractical, affordable and effective steps can be taken to reduce the number of infants who die in the first week of life in South Africa. These could also be implemented in other under resourced countries. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,613 |
This purpose of this study is to identify and investigate whether there are similarities or differences between genders regarding the perceptions on physical activities of college university students in one of the largest University in Kuala Lumpur, Malaysia. The focus was on three main categories, namely general knowledge, physical education and scientific basis of physical activities. Each category contained questions which serve to evaluate their perceptions about physical activities. The questionnaire was adapted from a journal article on a study done by Mowatt, DePauw and Hulac (1988). This study investigates the perceptions of 113 students (55 males; 65 females) aged between 19 and 25 about physical activities, using the above-mentioned categories. Results of the t-test showed significant differences for general knowledge, t(23) = 3.9, p 0.05 no significant differences in means were found between the male and female students. | The sport participation has been a major part of our life in the societies. Studies on sports participation have found that sports have both positive and negative influence on character ::: buildings. It has been on-going debate on whether ‘sports build character’ but through literature analysis, author had found that ‘with the intention, sports do build character.’ Therefore, strategies of building character through sports are suggested in this paper. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,614 |
Diabetes-related foot complications such as soft-tissue infection, osteomyelitis, and neuropathic osteoarthropathy account for up to 20% of all diabetic-related North American hospital admissions. Radiography of the foot is usually appropriate as the initial screening examination in diabetic patients with suspected osteomyelitis of the foot. For follow-up examination, MRI of the foot with or without contrast enhancement demonstrates excellent soft-tissue contrast and sensitivity to marrow abnormalities with high-resolution detail in multiple anatomic planes and is usually appropriate when osteomyelitis or early neuropathic arthropathy is suspected. This publication of diabetes-related foot complications summarizes the literature and makes recommendations for imaging based on the available data. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. | To determine the diagnostic accuracy of an abbreviated magnetic resonance imaging (MRI) protocol of the foot for the diagnosis of osteomyelitis in patients with acute foot infection. This retrospective study evaluated adult patients (age 18 and over) visiting an academic medical center from 1 January 2013 to 31 December 2015 who were imaged with MRI for suspected acute pedal osteomyelitis. Examinations were performed utilizing the departmental standard protocol. All examinations were retrospectively interpreted by five radiologists under two protocols: a reference standard protocol consisting of all non-contrast sequences obtained at initial acquisition and an abbreviated protocol consisting of only coronal T1-weighted and sagittal T2-weighted fast multiplanar inversion-recovery (FMPIR) sequences. Interpretation of the two imaging subsets was separated in time by at least 6 weeks for each reader. Each examination was assigned a score to represent one of four diagnostic categories: normal; soft tissue infection without bone changes or bone changes specific to a non-infectious etiology; nonspecific bone marrow changes; or bone changes specific for osteomyelitis. Diagnostic accuracy of both protocols was determined based on clinical diagnosis and treatment of osteomyelitis, and histopathology when available. One hundred and two MRI examinations met inclusion criteria; participants ranged in age from 26 to 91 years, with a mean age of 59 years. Seventy examinations were performed for male participants (69%) and 32 for female participants (31%). Thirty-five had a confirmed diagnosis of osteomyelitis, while the remainder (n = 67) did not. An average of 6 non-contrast sequences was performed during each examination. The most common protocol (53/102 examinations) was comprised of the following 6 sequences: axial T1-weighted, axial fat-saturated proton density, sagittal T1-weighted, sagittal T2-weighted FMPIR, coronal T1-weighted, and coronal fat-saturated proton density. After patient positioning, the abbreviated protocol sequences (sagittal T2-weighted FMPIR and coronal T1-weighted) were performed in an average total of 8 min. The reference standard protocol required an average of 22 min to complete 6 sequences. Averaged across all readers, the AUC for the reference standard full protocol and the abbreviated protocols were 0.843 and 0.873, respectively. The difference in AUC between protocols was not statistically significant (p = 0.1297), with the abbreviated protocol showing a non-significantly greater AUC. An abbreviated MRI protocol, including only coronal T1-weighted and sagittal T2-weighted FMPIR images, is non-inferior to standard MRI protocol for the diagnosis of acute pedal osteomyelitis. It should be considered as a diagnostic alternative for reducing imaging time and improving patient access to MRI. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,615 |
OBJECTIVES ::: This study aimed to determine the incidence of elevated triage blood pressure (BP) in pediatric emergency patients and to evaluate its recognition by health care practitioners. ::: ::: ::: METHODS ::: This retrospective review randomly selected patients seen in a large academic pediatric emergency department for 13 months. Triage and subsequent BP measurements were recorded and categorized as normal or elevated (≥ 90th to < 95th, ≥ 95th-99th percentile plus 4 mm Hg, and ≥ 99th percentile plus 5 mm Hg). Physician recognition of elevated BP, training level, and specialty were collected. Demographic information and possible confounding variables (weight, pain, medications, and triage level) were also collected and analyzed. Exclusions included known hypertension or related conditions and those patients without a triage BP measurement. ::: ::: ::: RESULTS ::: Of the 978 charts reviewed, 907 were included for study (17.5% infants, 82.5% children 1 year and older to 18 years; 50% male, 50% female; 77% African American, 16% white, 4% Hispanic, and 3% other). Fifty-five percent (n = 497) had elevated triage BP (≥ 90th percentile) with only 1% (n = 7) recognized by practitioners as having elevated triage BP. Further, 152 (20%) of the 748 children 1 year and older to 18 years had severely elevated BP with only 5 recognized. ::: ::: ::: CONCLUSIONS ::: In this study, more than half of the patients had elevated triage BP (≥ 90th percentile), which was rarely recognized by emergency department practitioners regardless of specialty or experience. Early recognition of elevated triage BP offers opportunities for diagnosis of hypertension and related disorders but is challenging to accomplish. | OBJECTIVE ::: To present a new pediatric risk classification tool, CLARIPED, and describe its development steps. ::: ::: ::: METHODS ::: Development steps: (i) first round of discussion among experts, first prototype; (ii) pre-test of reliability, 36 hypothetical cases; (iii) second round of discussion to perform adjustments; (iv) team training; (v) pre-test with patients in real time; (vi) third round of discussion to perform new adjustments; (vii) final pre-test of validity (20% of medical treatments in five days). ::: ::: ::: RESULTS ::: CLARIPED features five urgency categories: Red (Emergency), Orange (very urgent), Yellow (urgent), Green (little urgent) and Blue (not urgent). The first classification step includes the measurement of four vital signs (Vipe score); the second step consists in the urgency discrimination assessment. Each step results in assigning a color, selecting the most urgent one for the final classification. Each color corresponds to a maximum waiting time for medical care and referral to the most appropriate physical area for the patient's clinical condition. The interobserver agreement was substantial (kappa=0.79) and the final pre-test, with 82 medical treatments, showed good correlation between the proportion of patients in each urgency category and the number of used resources (p<0.001). ::: ::: ::: CONCLUSIONS ::: CLARIPED is an objective and easy-to-use tool for simple risk classification, of which pre-tests suggest good reliability and validity. Larger-scale studies on its validity and reliability in different health contexts are ongoing and can contribute to the implementation of a nationwide pediatric risk classification system. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,616 |
PURPOSE OF REVIEW ::: Difficult discussions regarding end-of-life care are common in neurocritical care. Because of a patient's neurological impairment, decisions regarding continuing or limiting aggressive care must often be made by patients' families in conjunction with medical providers. This review provides perspective on three major aspects of this circumstance: prognostication, family-physician discussions, and determination of death (specifically as it impacts on organ donation). ::: ::: ::: RECENT FINDINGS ::: Numerous studies have now demonstrated that prediction models developed from populations of brain-injured patients may be misleading when applied to individual patients. Early care limitations may lead to the self-fulfilling prophecy of poor outcomes because of care decisions rather than disease course. A shared decision-making approach that emphasizes transmission of information and trust between families and medical providers is ethically appropriate in severely brain-injured patients and as part of the transition to end-of-life palliative care. Standard definitions of death by neurological criteria exist, although worldwide variation and the relationship to organ donation make this complex. ::: ::: ::: SUMMARY ::: End-of-life care in patients with severe brain injuries is common and represents a complex intersection of prognostication, family communication, and decision-making. Skills to optimize this should be emphasized in neurocritical care providers. | Objective:To compare the performance of formal prognostic instruments vs subjective clinical judgment with regards to predicting functional outcome in patients with spontaneous intracerebral hemorrhage (ICH). Methods:This prospective observational study enrolled 121 ICH patients hospitalized at 5 US tertiary care centers. Within 24 hours of each patient's admission to the hospital, one physician and one nurse on each patient's clinical team were each asked to predict the patient's modified Rankin Scale (mRS) score at 3 months and to indicate whether he or she would recommend comfort measures. The admission ICH score and FUNC score, 2 prognostic scales selected for their common use in neurologic practice, were calculated for each patient. Spearman rank correlation coefficients (r) with respect to patients' actual 3-month mRS for the physician and nursing predictions were compared against the same correlation coefficients for the ICH score and FUNC score. Results:The absolute value of the correlation coefficient for physician predictions with respect to actual outcome (0.75) was higher than that of either the ICH score (0.62, p = 0.057) or the FUNC score (0.56, p = 0.01). The nursing predictions of outcome (r = 0.72) also trended towards an accuracy advantage over the ICH score (p = 0.09) and FUNC score (p = 0.03). In an analysis that excluded patients for whom comfort care was recommended, the 65 available attending physician predictions retained greater accuracy (r = 0.73) than either the ICH score (r = 0.50, p = 0.02) or the FUNC score (r = 0.42, p = 0.004). Conclusions:Early subjective clinical judgment of physicians correlates more closely with 3-month outcome after ICH than prognostic scales. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,617 |
Molecular imaging in gastroenterology has become more feasible with recent advances in imaging technology, molecular genetics, and next-generation biochemistry, in addition to advances in endoscopic imaging techniques including magnified high-resolution endoscopy, narrow band imaging or autofluorescence imaging, flexible spectral imaging color enhancement, and confocal laser endomicroscopy. These developments have the potential to serve as "red flag" techniques enabling the earlier and accurate detection of mucosal abnormalities (such as precancerous lesions) beyond biomarkers, virtual histology of detected lesions, and molecular targeted therapy-the strategy of "one stone to kill two or three birds"; however, more effort should be done to be "blue ocean" benefit. This review deals with the introduction of Raman spectroscopy endoscopy, imaging mass spectroscopy, and nanomolecule development for theranostics. Imaging of molecular pathological changes in cells/tissues/organs might open the "royal road" to either convincing diagnosis of diseases that otherwise would only be detected in the advanced stages or novel therapeutic methods targeted to personalized medicine. | This study aims to evaluate the clinical utility of image-guided Raman endoscopy for in vivo diagnosis of neoplastic lesions in the stomach at gastroscopy. A rapid-acquisition image-guided Raman endoscopy system with 785-nm excitation has been developed to acquire in vivo gastric tissue Raman spectra within 0.5 sec during clinical gastroscopic examinations. A total of 1,063 in vivo Raman spectra were acquired from 238 tissue sites of 67 gastric patients, in which 934 Raman spectra were from normal tissue whereas 129 Raman spectra were from neoplastic gastric tissue. The swarm intelligence-based algorithm (i.e., ant colony optimization (ACO) integrated with linear discriminant analysis (LDA)) was developed for spectral variables selection to identify the biochemical important Raman bands for differentiation between normal and neoplastic gastric tissue. The ACO-LDA algorithms together with the leave-one tissue site-out, cross validation method identified seven diagnostically important Raman bands in the regions of 850–875, 1,090–1,110, 1,120–1,130, 1,170–1,190, 1,320–1,340, 1,655–1,665 and 1,730–1,745 cm−1 related to proteins, nucleic acids and lipids of tissue and provided a diagnostic sensitivity of 94.6% and specificity of 94.6% for distinction of gastric neoplasia. The predictive sensitivity of 89.3% and specificity of 97.8% were also achieved for an independent test validation dataset (20% of total dataset). This work demonstrates for the first time that the real-time image-guided Raman endoscopy associated with ACO-LDA diagnostic algorithms has potential for the noninvasive, in vivo diagnosis and detection of gastric neoplasia during clinical gastroscopy. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,618 |
Several efforts have shown that process calculi developed for reasoning about concurrent and mobile systems may be employed for modelling biological systems at the molecular level. In this paper, we initiate investigation of the meta-language framework bigraphical reactive systems, due to Milner et al., as a basis for developing rule-based languages for molecular biology. We describe a family of BΣ,R-calculi sharing a small set of familiar operators and operations, and provide them with a simple operational semantics. We show that BΣ,R-calculi and their reaction semantics correspond to a version of bigraphical reaction under non-aliasing contexts and with reaction rules extended to allow negative side-conditions for the subset of bigraphs corresponding to BΣ,R-processes. Finally, to illustrate the usage of BΣ,R, we show that with non-aliasing semantics the κ-calculus may be faithfully captured as a BΣ,R-calculus. | Recently, there has been substantial interest in using rule-based modelling approaches, such as the Kappa modelling language, to attack the combinatorial intractability of many biochemical systems. These approaches have allowed several novel static analyses to be developed, which motivates broadening their expressivity. In this paper, we build upon prior work giving Kappa an SPO-rewriting semantics to add containment structure, to model the various ways in which biological mixtures are partitioned and enclosed by membranes. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,619 |
This study aims to determine whether placental examination can be used to distinguish between pathologic fetal growth restriction (FGR) and constitutional fetal smallness. Data were extracted from a clinicoplacental database of high risk pregnancies during the period 1994-2013. These data were used to compare the 590 consecutive cases having birth weights below the 10th percentile with the 5201 remaining cases having gestational ages ≥20 weeks. The authors analyzed 20 clinical and 46 placental phenotypes using classical statistics, clustering analysis, and multidimensional scaling. Of the low-birth-weight babies, the following types of cases were compared: Four categories of placental phenotypes (those with features of poor uteroplacental perfusion, postuterine placental pathology, chronic inflammation, and a mixed category) better defined the presumably true FGR than did the clinical phenotypes. Maternal smoking and oligohydramnios were associated with fewer abnormal placental phenotypes than were maternal hypertensive diseases and abnormal Dopplers. Early-onset cases of fetal smallness clustered with placental features of poor uteroplacental perfusion, whereas late onset cases did not. Placental examination helps to retrospectively distinguish constitutionally small fetuses from those that are pathologically growth restricted. The latter correlate best with the clinical risk for FGR and with early-onset FGR. This correlation may have prognostic significance for the child and for future pregnancies, since hypoxic placental lesions can occur without clinical risk factors but with a tendency to recur in future pregnancies. | We aimed to compare placental histopathology and neonatal outcome between dichorionic diamniotic (DCDA) twins and singleton pregnancies complicated by small for gestational age (SGA). Medical files and placental pathology reports from all deliveries between 2008 and 2017 of SGA neonates, (birthweight < 10th percentile), were reviewed. Comparison was made between singleton pregnancies complicated with SGA (singletons SGA group) and DCDA twin pregnancies (Twins SGA group), in which only one of the neonates was SGA. Placental diameters were compared between the groups. Placental lesions were classified into maternal and fetal vascular malperfusion lesions (MVM and FVM), maternal (MIR) and fetal (FIR) inflammatory responses, and chronic villitis. Neonatal outcome parameters included composite of early neonatal complications. The twins SGA group (n = 66) was characterized by a higher maternal age (p = 0.011), lower gestational age at delivery (34.9 ± 3.1 vs. 37.7 ± 2.6 weeks, p < 0.001), and a higher rate of preeclampsia (p = 0.010), compared to the singletons SGA group (n = 500). Adverse composite neonatal outcome was more common in the twins SGA group (p < 0.001). Placental villous lesions related to MVM (p < 0.001) and composite MVM lesions (p = 0.04) were more common in the singletons SGA group. On multivariate logistic regression analysis, the singletons SGA group was independently associated with placental villous lesions (aOR 3.6, 95% CI 1.9–7.0, p < 0.001) and placental MVM lesions (aOR 2.44, 95% CI 1.29–4.61, p = 0.006). Placentas from SGA singleton pregnancies have more MVM lesions as compared to placentas from SGA twin pregnancies, suggesting different mechanisms involved in abnormal fetal growth in singleton and twin gestations. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,620 |
Computed tomography (CT) is now the investigation of choice for evaluating haematuria following major abdominal trauma. This pictorial review provides a logical framework for understanding the classification and features of urinary tract injuries, defines the indications and outlines the techniques for CT imaging in upper and lower urinary tract trauma. The use of other competing imaging modalities is also discussed. | 2test. Results: Twenty of the 74 patients had intraperitoneal bladder rupture. The sentinel clot sign was seen for 16 patients (80%) with intraperitoneal bladder rupture and for four patients (7%) without intraperitoneal bladder rupture (p < 0.001). Pelvic fracture was noted in five patients (25%) with intraperitoneal bladder rupture and in 39 patients (72%) without intraperitoneal bladder rupture (p < 0.001). Intraperitoneal free fluid was found in all patients (100%) with intraperitoneal bladder rupture, irrespective of an associated intraabdominal visceral injury, whereas 19 (35%) of the 54 patients without intraperitoneal bladder rupture had intraperitoneal free fluid (p < 0.001). | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,621 |
Oral Diseases (2011) 17, 309–313 ::: ::: ::: ::: Objectives: Oral Lichen Planus (OLP) is associated with hepatitis C virus (HCV) infection and resembles graft-versus-host disease (GVHD) both clinically and histologically. The killer cell immunoglobulin-like receptor (KIR) genes encode a family of receptors expressed on NK and T cells and are supposed to play a significant role in GVHD and HCV infection. The aim of this study was to analyze the association among OLP, HCV infection and variants in KIR gene expression. ::: ::: ::: ::: Methods: A total of 81 patients with OLP (36 HCV+ve and 45 HCV−ve) and 217 healthy controls (HCV−ve) were typed for the presence of eight KIR genes and of HLA-Cw* alleles by polymerase chain reaction-sequence specific primer. ::: ::: ::: ::: Results: There were no significant differences in the frequency of the KIR genes and HLA-C1/C2 group alleles between cases and controls. We only found a significant difference in the frequency of the gene KIR2DL2 between HCV+ve and HCV−ve OLP patients. ::: ::: ::: ::: Conclusions: The present data suggest that OLP is not associated with particular KIR genes or with HLA-Cw* alleles in patients without HCV infection. Contrarily, the role of the genes in OLP-HCV+ve patients remains unclear and might warrant further researches. | Analysis of receptor-ligand interactions in the context of diseases necessitates to understand how HLA-KIR genotypes function in diseases. Although CD56+ lymphocytes are derived from multiple lineages, they share a functional association with immunosurviellance and antimicrobial responses. The present study aimed to determine whether KIR phenotype in CD56 lymphocytes and corresponding HLA-class 1 ligands are associated with multidrug resistance tuberculosis (MDR-TB). We compared the frequencies of HLA-C and HLA-BW4 genes, the expression of KIRs 2DL1/2DS1, 2DL2/2DL3, 3DL1, and 2DS4 and the combinations of HLA/KIR in 32 Nifamycin and Isoniazid-resistant TB with those in 68 drug non resistant (NR) sputum smear positive pulmonary TB patients. PCR-SSP and flow cytometry were performed for HLA and KIRs typing, respectively. We showed no significant differences between inhibitory or activating KIRs as well as HLA ligands in MDR TB patients compared with NR-TB . The combinations of inhibitory KIR-HLA ligands in MDR-TB were much more prevalent, but not statistically significant than in NR patients (p=0.07). The frequency of MDR patients with all HLA-C and HLA-BW4 ligands was higher than NR-TB (p<0.009). Conversely, the percentage of MDR patients having only one kind of HLA gene was significantly lower than NR-TB (p<0.01). We conclude that the expression of inhibitory KIRs with corresponding HLA ligands genes, and/or co-existence of three HLA class 1 ligands for inhibitory KIRs may be associated with drug resistance in pulmonary tuberculosis. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,622 |
In this study, we tried to describe the characteristics of pain and explore the association between the incidence of pain and abnormal laboratory test results in patients during the acute phase of Guillain–Barré syndrome (GBS). This retrospective cohort study enrolled 252 patients with GBS who were in the acute phase of the disease. We collected data regarding the location and type of pain, the onset time, clinical variables and laboratory tests, including the levels of uric acid (UA), albumin, cerebrospinal fluid protein (CSFP), cerebrospinal fluid glucose (CSFG), fasting glucose upon admission, and blood creatinine. The pain descriptors were compared to the severity of disease and laboratory examination results. Around 34.5% of the patients reported pain during the acute phase of GBS. Pain was negatively correlated with the disease severity during the acute phase. In total, 29 of the 87 (33.3%) patients reported pain during the 2 weeks preceding the onset of weakness. The concentration of CSFP was positively associated with the incidence of pain, while the concentrations of UA and albumin were not correlated with the incidence of pain. We found that 33.3% of the GBS patients experienced pain within 2 weeks of onset, and the pain was positively associated with CSFP concentration but was not correlated with disease severity. | Free radical toxicity due to poorly maintained cellular redox levels is crucial events that have been associated with the pathogenesis of Guillain-Barre syndrome (GBS) patients. Uric acid (UA) and albumin correlate with oxidative stress in some degree. We aimed to evaluate the relationship between GBS and serum levels of UA and albumin in the present study.The serum levels of UA and albumin were determined in 203 individuals including 88 patients with GBS and 153 healthy controls (HC).We found that serum levels of UA and albumin in patients with GBS were significantly lower than those in HC group. Besides, similar phenomenon was observed when the male and female subgroups were estimated, respectively. Additionally, we found that there is no statistic difference among subgroups of GBS regarding UA and albumin. The univariate analysis revealed that both the high UA and high albumin were protective factors for patients with GBS (odds ratio [OR] 0.140; 95% confidence interval [CI]: 0.074-0.264; P < .001 and OR 0.016; 95% CI: 0.006-0.038; P < .001, respectively). It was further confirmed by the multivariable logistic regression analysis after adjusting for other potential confounding factors (OR 0.168; 95% CI: 0.055-0.514; P = .002 and OR 0.027; 95% CI: 0.011-0.071; P < .001, respectively).In conclusion, we found that patients with GBS had significantly low serum UA and albumin levels. Moreover, we demonstrated that both the high UA and high albumin were protective factors for patients with GBS. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,623 |
OBJECTIVE ::: To investigate whether an inflammatory response occurs in patients undergoing infrarenal aortic abdominal aneurysm repair, the localization and timing (ischemia and/or reperfusion) of this activation, and finally whether it affects postoperative pulmonary function. ::: ::: ::: DESIGN ::: Prospective, observational study. ::: ::: ::: SETTING ::: Academic referral center in Italy. ::: ::: ::: PATIENTS ::: We included 12 patients undergoing infrarenal aortic abdominal aneurysm repair and 12 patients undergoing major abdominal surgery. ::: ::: ::: INTERVENTIONS ::: Timed measurement of gene activation (angiotensinogen, angiotensin type 1 receptor, angiotensin-converting enzyme, and interleukin-6 genes) in muscle biopsies by reverse transcriptase-polymerase chain reaction (RT-PCR), and prospective assessment of interleukin-6 plasma concentration and pulmonary function (Pao2/FIO2 and Pao2/PAO2 ratios). ::: ::: ::: MEASUREMENTS AND MAIN RESULTS ::: After 30 mins of aortic clamping, angiotensinogen, angiotensin type 1 receptor, angiotensin-converting enzyme, and interleukin-6 genes were all overexpressed at RT-PCR studies in quadriceps muscle of patients undergoing aortic abdominal aneurysm repair, and the overexpression persisted after reperfusion. In situ hybridization and immunohistochemistry revealed that the inflammatory response was localized in endothelial cells. A significant increase in plasma interleukin-6 concentrations was then detectable at 6 and 12 hrs after reperfusion in aortic abdominal aneurysm surgery compared with patients undergoing abdominal surgery (p < .05). The increase in interleukin-6 plasma concentration was then followed (12 and 24 hrs after surgery) by a significant reduction of Pao2/ FIO2 and Pao2/PAO2 ratios (p < .05 vs. abdominal surgery). ::: ::: ::: CONCLUSIONS ::: The present study shows that a) during aortic surgery, the genes for interleukin-6 and for the components of the local renin-angiotensin system (angiotensinogen, angiotensin-converting enzyme, and angiotensin type 1 receptor subtype) are activated early in the ischemic muscle, and activation persists during reperfusion; b) interleukin-6 plasma concentration increases only in patients with tissue ischemia (aortic abdominal aneurysm), whereas no changes are detectable in patients with abdominal surgery; and finally c) the occurrence of systemic inflammatory reaction with increased interleukin-6 plasma concentrations is followed by impaired pulmonary function. | BACKGROUND ::: Remote ischemic preconditioning (RIPC) may confer the cytoprotection in critical organs. The authors hypothesized that limb RIPC would reduce intestinal and pulmonary injury in patients undergoing open infrarenal abdominal aortic aneurysm repair. ::: ::: ::: METHODS ::: In this single-center, prospective, double-blinded, randomized, parallel-controlled trial, 62 patients undergoing elective open infrarenal abdominal aortic aneurysm repair were randomly assigned in a 1:1 ratio by computerized block randomization to receive limb RIPC or conventional abdominal aortic aneurysm repair (control). Three cycles of 5-min ischemia/5-min reperfusion induced by a blood pressure cuff placed on the left upper arm served as RIPC stimulus. The primary endpoint was arterial-alveolar oxygen tension ratio. The secondary endpoints mainly included the intestinal injury markers (serum intestinal fatty acid-binding protein, endotoxin levels, and diamine oxidase activity), the markers of oxidative stress and systemic inflammatory response, and the scores of the severity of intestinal and pulmonary injury. ::: ::: ::: RESULTS ::: In limb RIPC group, a/A ratio was significantly higher than that in control group at 8, 12, and 24 h after cross-clamp release (66 ± 4 vs. 45 ± 4, P = 0.003; 60 ± 6 vs. 37 ± 4, P = 0.002; and 60 ± 5 vs. 47 ± 6, P = 0.039, respectively). All biomarkers reflecting intestinal injury increased over time, and there was significant differences between limb RIPC and control group (P < 0.001). The severity of intestinal and pulmonary injury was decreased by limb RIPC (P = 0.014 and P = 0.001, respectively). ::: ::: ::: CONCLUSIONS ::: Limb RIPC attenuates intestinal and pulmonary injury in patients undergoing elective open infrarenal abdominal aortic aneurysm repair without any potential risk. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,624 |
BACKGROUND ::: Composite valve graft replacement is currently the treatment of choice for a wide variety of lesions of the aortic root and the ascending aorta. In this study we report our experience with aortic root replacement using a composite graft. ::: ::: ::: METHODS ::: Between October 1978 and May 2001, 274 patients (79.6% male and 20.4% female) with a mean age of 53.5 years underwent composite graft replacement of the aortic root. One hundred sixty-one patients (70.8%) had annuloaortic ectasia and 46 (16.8%) aortic dissection. The classic Bentall technique was used in 94 patients (34.3%), the "button technique" in 172 patients (62.8%), and the Cabrol technique in 8 patients (2.9%). ::: ::: ::: RESULTS ::: The early mortality rate was 6.9% (19 of 274 patients). Cardiopulmonary bypass time longer than 180 minutes and associated coronary artery bypass grafting were found to be independent risk factors of early mortality. The actuarial survival rate was 77.7% at 5 years and 63% at 10 years. The independent risk factors for late mortality were coronary artery disease, chronic renal failure, and postoperative dialysis. The actuarial freedom from reoperation on the remaining aorta was higher among patients without Marfan syndrome (94.6% versus 79.6% at 10 years, p = 0.008). ::: ::: ::: CONCLUSIONS ::: Composite valve graft replacement can be performed with low hospital mortality and morbidity. The button technique offers some advantages and should be used whenever possible. In case of acute aortic dissection root replacement is usually not necessary. Marfan patients should be treated with early root replacement before dissection occurs. | Marfan syndrome (MFS) is a relatively rare disease of the connective tissue that affects several organs of the body. Cardiovascular abnormalities such as aortic root dilatation and mitral valve prolapse are the two main life-threatening complications associated with MFS. The complete pathogenesis of MFS is yet unclear. However, fibrillin-1 ( FBN1 ) gene mutations and mutations in the transforming growth factor-β (TGFβ) signaling pathway are the leading causes of this lethal disease. Detailed assessment based on several major and minor clinical manifestations has led to the evolution of different nosologies for MFS diagnoses with reliable accuracies. Nevertheless, heterogeneous disease advancement and overlapping clinical outcomes make MFS diagnosis challenging. Rapid strides in research and surgical avenues over the last two decades have improved the life expectancy and the quality of life of MFS patients remarkably. More specific diagnostic criteria have been established, novel therapeutic targets for pharmacotherapy have been identified and validated, and newer surgical techniques have been tested. Current research efforts are focusing on the identification of prognostic biomarkers, gene modifiers, drug targets, and surgical procedures. This review aims to provide a brief overview of these aspects associated with MFS. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,625 |
Radial access use has been growing steadily but, despite encouraging results, still varies greatly among operators, hospitals, countries and continents. Twenty years from its introduction, it was felt that the time had come to develop a common evidence-based view on the technical, clinical and organisational implications of using the radial approach for coronary angiography and interventions. The European Association of Percutaneous Cardiovascular Interventions (EAPCI) has, therefore, appointed a core group of European and non-European experts, including pioneers of radial angioplasty and operators with different practices in vascular access supported by experts nominated by the Working Groups on Acute Cardiac Care and Thrombosis of the European Society of Cardiology (ESC). Their goal was to define the role of the radial approach in modern interventional practice and give advice on technique, training needs, and optimal clinical indications. | Recurrent angina (RA) has an important influence on health status of patients after percutaneous coronary intervention (PCI). This study aimed to retrospectively investigate the effect of multiple clinical factors on both short-term and long-term development of RA. A total of 398 ST-segment elevation myocardial infarction (STEMI) patients were studied for up to 12 months. The primary clinical outcome, RA, was assessed at 1-month and 12-month. In multivariate analyses, the effect of clinical factors, including baseline demographics, medical history, infarction-related arteries, procedural characteristics of PCI, and the use of medicines, was investigated in patients with and without RA. The Logistic regression analysis showed that the patients with treatment through radial approach PCI (odds ratio [OR]: 0.42, 95% confidence interval [CI]: 0.18–0.96, P < 0.05) were less likely to have RA during 1-month assessment. During 12 months after PCI, male patients (OR: 0.53, 95% CI: 0.29–0.96, P < 0.05), and/or those treated with radial approach PCI (OR: 0.45, 95% CI: 0.21–0.97, P < 0.05) were less likely to have RA, whereas the patients with infarction related artery (IRA) in left anterior descending (LAD) (OR: 2.41, 95% CI: 1.20–4.84, P < 0.01) were more likely to have RA at follow-up. The Cox regression analysis further revealed that the patients with infarction of the LAD artery (hazard ratio [HR]: 2.08, 95% CI: 1.10–3.92, P < 0.05), but not with treatment through radial artery during PCI (HR: 0.42, 95% CI: 0.18–0.96, P < 0.05) had higher potential of development of RA during 12 months after PCI. We studied the effects of multiple clinical factors on the development of RA after PCI. Our findings suggest that patients with infarction of the LAD artery, and/or treatment not through radial artery during PCI were associated with higher risk of RA and may require close follow-up. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,626 |
Enteric infections, with or without overt diarrhea, have profound effects on intestinal absorption, nutrition, and childhood development as well as on global mortality. Oral rehydration therapy has reduced the number of deaths from dehydration caused by infection with an enteric pathogen, but it has not changed the morbidity caused by such infections. This Review focuses on the interactions between enteric pathogens and human genetic determinants that alter intestinal function and inflammation and profoundly impair human health and development. We also discuss specific implications for novel approaches to interventions that are now opened by our rapidly growing molecular understanding. | Background: Giardiasis is a common protozoan infection with clinical manifestations in children ranging from asymptomatic carriage to persistent diarrhoea with malabsorption. It can lead to growth and developmental retardation. Aim: The study evaluated risk factors for the initial symptomatic giardiasis (SG) episode among Arab-Bedouin children in Israel. Methods: A community-based, prospective cohort study was conducted in Rahat, a Bedouin township in southern Israel. Infants (n=238) were followed by weekly visits from birth to age 18 months. Giardia infection was identified by antigen detection in faecal specimens. Results: Approximately 26% of children experienced one or more SG episode. Mean (SD) age for first SG episode was 12.3 (3.3) months, with 95% of episodes occurring in children >6 months of age. Risk for the first SG in children >6 months of age was associated with it being spring or summer [odds ratio (OR) 6.16, p<0.001], exposure to livestock (OR 4.89, p=0.002) and prior infection wi... | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,627 |
In the past decade, granular computing (GrC) has been an active topic of research in machine learning and computer vision. However, the granularity division is itself an open and complex problem. Deep learning, at the same time, has been proposed by Geoffrey Hinton, which simulates the hierarchical structure of human brain, processes data from lower level to higher level and gradually composes more and more semantic concepts. The information similarity, proximity and functionality constitute the key points in the original insight of granular computing proposed by Zadeh. Many GrC researches are based on the equivalence relation or the more general tolerance relation, either of which can be described by some distance functions. The information similarity and proximity depended on the samples distribution can be easily described by the fuzzy logic. From this point of view, GrC can be considered as a set of fuzzy logical formulas, which is geometrically defined as a layered framework in a multi-scale granular system. The necessity of such kind multi-scale layered granular system can be supported by the columnar organization of the neocortex. So the granular system proposed in this paper can be viewed as a new explanation of deep learning that simulates the hierarchical structure of human brain. In view of this, a novel learning approach, which combines fuzzy logical designing with machine learning, is proposed in this paper to construct a GrC system to explore a novel direction for deep learning. Unlike those previous works on the theoretical framework of GrC, our granular system is abstracted from brain science and information science, so it can be used to guide the research of image processing and pattern recognition. Finally, we take the task of haze-free as an example to demonstrate that our multi-scale GrC has high ability to increase the texture information entropy and improve the effect of haze-removing. | Obtaining changeable granules quickly and accurately is one of the important issues in granular computing. The present work proposes a partial order relation and lattice computing to deal with the aforementioned issue. A hyperspherical granular computing classification algorithm (HSGrCCA) is developed in the framework of fuzzy lattices. HSGrCCA computes a fuzzy inclusion relation between two hyperspherical granules using an inclusion measure function based on a linear positive valuation function induced by the radius of a hyperspherical granule. A fuzzy lattice is formed on the hyperspherical granule set by the dilation operator, erosion operator, and partial order relation. HSGrCCA is trained by introducing control parameter ρ of the hyperspherical granule size and then obtains changeable hyperspherical granules. Experimental results on machine learning benchmark data sets show that the proposed algorithm increases the generalization ability. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,628 |
Over an 18 month period, 130 patients were sent to the radiology department for diagnostic CT scans to localize intraabdominal abscesses. Of these patients, 71 (55 percent) were diagnosed as having intraabdominal abscesses. Fifty-one surgical procedures and 17 radiologic drainage procedures were done. The cure rate of patients undergoing an operative procedure was 88 percent, and the major complication rate was 23 percent. The cure rate of patients undergoing CT guided catheter drainage was 47 percent and the complication rate was 6 percent. CT guided catheter drainage may be the initial treatment of choice in institutions that specialize in invasive procedures performed by radiologists. However, in institutions that have not concentrated their efforts on this problem, the results may not be as good, and it may not be wise to assume these data have general applicability. Greater cooperative efforts between departments of radiology and surgery should lead to better results in treatment of intraabdominal abscesses and better understanding of the best methods of treating them. | Background ::: Percutaneous abscess drainage (PAD) of the lower abdomen and pelvis has been reported to reduce morbidity and mortality, shorten hospital stay and cut costs compared to a surgical approach. However, the wide differences in outcome reported by different authors indicate the need for an overview and further evaluations. This review evaluates each point of the procedure to explain the possible causes for such discrepancies in results. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,629 |
The utility of the concept of the “Nine Nations of North America” for segmentation was tested by comparing several geographic segmentation systems with values in a probability sample of the coterminous United States. The evidence does not mandate abandoning the Bureau of Census regions. Managerial implications are discussed. | Though the general approach of psychographic segmentation was developed and significantly elaborated a few decades ago, there are numerous further research possibilities in this area. Typically, current researchers concentrate on more specific audiences and more a specific product-oriented lifestyles. However, use of traditional lifestyle segmentation models also can help exploring new relationships and behaviours. Authors analyzed lifestyles of current business and economics students, who will soon become an important group of business managers and consumers. It was observed very consistent distribution of respondents into just three VALS types. Statistically significant relationship between lifestyles and leisure spending preferences was disclosed. The relationship between VALS types and preferences in mobile telecommunications products and services was weaker, but some evidence suggests directions for further research. The analysis proved applicability of VALS methodology in exploratory studies that involve two-step survey procedure outside the US society. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,630 |
The paper approaches the feature-level fusion for biometric authentication, a big challenge for the actual biometric security systems design. A hierarchical inter-modal fusion method is proposed and evaluated for a reduced feature space. The feature generation and fusion are performed using regions of interest manually defined within the original images. The features are extracted using co-occurrence matrices, providing a common framework for feature generation among several human traits. The fusion is based on a functional combination of the features, an approach that is feasible if the feature vectors are homogeneous. The functional fusion avoids the concatenation that increases the feature space size, leading to curse of dimensionality and additional computational complexity costs. | The paper presents an optimized multimodal biometric system for identification applications. This solution is based on innovative and computational-efficient biometric data hierarchical classifiers (with detection and discrimination stages) and also with a post-classification fusion. The detection-based classification is very suitable for applications with several security levels in which the end-users have various authorization degrees. The proposed solution supports an optimal trade-off between the identification accuracy and the computational complexity, which is important for the medium- and large-scale identification biometric applications. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,631 |
In view of the widely recognized correlation between extent of surgical resection and length of survival of children with intracranial ependymoma and the statement that total resection is more likely to be achieved in supratentorial than infratentorial primaries, we decided to review our experience with supratentorial ependymomas and the pertinent literature to verify the importance of surgery in treating this subgroup of pediatric ependymal neoplasms. Of 23 patients operated on, 12 are still alive without evidence of disease 72–357 months after surgery (mean 227, median 237 months). One girl treated by surgery alone was lost to follow-up after 234 months when she, and 7 other patients in the series, had already passed the end of the period of risk for recurrence according to Collins’ law. Six surviving patients (2 with subependymoma and 4 with ependymoma) were treated by surgery alone and only 1, the oldest in the series, had to undergo a second operation for recurrence after 10 years. The idea of treating intracranial ependymoma by surgery alone was favored by eminent neurosurgeons in the past and has recently received renewed attention. This was in part the consequence of recognizing that unlike diffuse astrocytoma, in which neoplastic cells can be found up to several centimeters away from the apparent tumor borders, ependymoma has more or less well-defined margins and grows mainly by expansion. Early experience with the policy of electively deferring adjuvant therapy after radiologically controlled total resection of ependymoma seems encouraging, although postoperative MRI does not yet indicate absolute certainty. Close surveillance is recommended. The majority of ependymomas so far treated by surgery alone, with relatively good success, have been supratentorial. In conclusion, on the basis of our experience and a review of the literature we favor a change in attitude to the management of intracranial ependymomas, especially of the cerebrum, with radiologically controlled radical surgery alone followed by close surveillance with periodic MR imaging until the child passes the period of risk for recurrence according to Collins’ law as the initial option. In children less than 3 years old the period of surveillance should be doubled. In case of recurrence, reoperation should be considered first, particularly for supratentorial primaries. Radiotherapy continues to be a major option in malignant ependymoma and unresectable primary or recurrent benign ependymoma. | OBJECTIVE AND IMPORTANCE ::: The prognosis for patients with ependymomas is related to the adequacy of surgical clearance. It is, however, often not possible to obtain a macroscopically complete resection of tumors arising in the posterior fossa. This may be because of the involvement of structures, the sacrifice of which would result in unacceptable morbidity, or because of metastatic lesions at diagnosis. For those patients in whom initial surgery was incomplete, elective second-look surgery may allow more complete clearance of tumor. ::: ::: ::: INTERVENTION ::: We have performed second-look surgery for fourth ventricle ependymomas in five patients: two women, aged 26 and 27 years, and three male patients, aged 4 months, 19 months, and 18 years. The 19-month-old male patient underwent early second-look surgery without receiving any interim chemotherapy. Second-look surgery on the other four patients was performed after they had received chemotherapy. No additional major morbidity was associated with the subsequent surgery, which achieved macroscopically complete clearances in four of the five patients. Three of four patients who underwent macroscopically complete resections were well, without clinical or radiological evidence of recurrent tumor, at 23, 25, and 34 months after their second operations. The 10-month-old patient who underwent early second-look complete resection relapsed locally at 33 months after surgery. Complete resection was not possible in one patient who had progressive tumor 8 months after second-look surgery. ::: ::: ::: CONCLUSION ::: For patients in whom complete excision of fourth ventricle ependymomas is not possible at initial surgery, second-look procedures may enable macroscopic clearance to be achieved with little morbidity. A larger study is needed to evaluate this approach to treatment. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,632 |
Chronic post-operative inguinal pain (CPIP) is the most significant complication following inguinal hernia repair. Patients without a palpable hernia prior to surgery seemed to report more CPIP. Our aim was to evaluate the effects of surgery on patients with a clinically inapparent inguinal hernia as diagnosed using ultrasonography. A total of 179 hernia repairs in patients with a positive ultrasonography but negative physical examination were analysed retrospectively. Patients with recurrent hernias, femoral hernias or previous surgery to the inguinal canal were excluded. The primary outcome was the presence of chronic postoperative inguinal pain (pain > 3 months postoperatively). Data on preoperative complaints, surgical technique and findings during ultrasonography and surgery were also studied in relation to the development of CPIP. A quarter (25.1%) of the patients reported chronic postoperative pain. Female gender (p = 0.03), high BMI (p = 0.04) and atypical symptoms prior to surgery (p < 0.001) were significant univariate risk factors for developing CPIP. Logistic regression showed a significant association between atypical symptoms and CPIP [OR = 6.31, p < 0.001, 95% CI (2.32, 17.16)], which was still present after correction for the significant univariate variables [OR = 4.23, p = 0.02, 95% CI (1.26, 14.21)]. Patients with a clinically inapparent inguinal hernia as diagnosed using ultrasonography report a high incidence of CPIP after elective hernia repair. Patients with atypical groin pain prior to surgery are especially prone to CPIP. It is questionable whether these hernias should be classified and treated as symptomatic inguinal hernias. The results advocate taking other causes of groin pain into consideration before choosing surgical treatment. | Most patients who undergo surgery recover uneventfully and resume their normal daily activities within weeks. Nevertheless, chronic postsurgical pain develops in an alarming proportion of patients. The prevailing approach of focusing on established chronic pain implicitly assumes that information generated during the acute injury phase is not important to the subsequent development of chronic pain. However, a rarely appreciated fact is that every chronic pain was once acute. Here, we argue that a focus on the transition from acute to chronic pain may reveal important cues that will help us to predict who will go on to develop chronic pain and who will not. Unlike other injuries, surgery presents a unique set of circumstances in which the precise timing of the physical insult and ensuing pain are known in advance. This provides an opportunity, before surgery, to identify the risk factors and protective factors that predict the course of recovery. In this paper, the epidemiology of chronic postsurgical pain... | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,633 |
During a drinking experiment 20 young male volunteers were asked to estimate the amount of their BAC and commented on their driving ability and their readiness to participate in road traffic. During the resorption phase the majority of the volunteers estimated their BAC too low, whereas in the early elimination phase most of their estimates were to high. The majority of the volunteers felt able to drive throughout the whole experiment which demonstrates an impairment of essential control functions as early as low to medium alcohol intoxication. | Drink-driving remains a major problem of public health (Alvarez and Del Rio, 1996). One of the most controversial issues is the choice of legal limit, as the ability to drive can be affected by alcohol levels well below current legal limits (Dunbar et al. , 1987; Howat et al. , 1991; Guppy, 1994). This study addressed the questions of the self-estimation of ability to drive, and its correlation with blood-alcohol concentration (BAC) measured with a breath-ethanol analyser in a population of non-professional male soldiers. ::: ::: In November 1997, at 23:00, during the last evening of a 3-week military course, in Geneva barracks, soldiers were asked to fill in a questionnaire including birth date, CAGE test, self-evaluation of ability to drive, and self-estimation of BAC. All gave informed consent and were instructed that the legal Swiss … | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,634 |
From October 1977 to May 1980, 243 stools collected in sedentary and semi-nomadic populations of the Ahaggar (Algerian Sahara) were examined using immunoelectronmicroscopy and tissue culture inoculation. Immunoelectronmicroscopy revealed the presence of rotaviruses in 8, coronaviruses in 26, adenoviruses in 5 and small round viruses in 4. Enteroviruses were isolated in tissue culture from 24 stools. Rotaviruses were present in the Ahaggar but were associated with little acute enteric disease. The high frequency of coronaviruses both in gastroenteritis patients and in patients without disease was surprising. The prevalence of enteroviruses in this hyperarid zone was similar to or higher than that found in noticeably more human countries. Further systematic bacterial, viral and parasitic examinations are required to clarify the role of the above viruses in the aetiology of gastroenteritis in this region. | Philippe Lefevre-Witier was born in Reims, France, on November 11, 1934, and died on November 15, 2011. A few years ago, he retired from CNRS in Toulouse but continued teaching Ecology at Toulouse University. After his primary and secondary education in northern France, Philippe received his M.D. degree in Paris in 1963. From 1963 1964, he served as the head of a department of clinical medicine in a hospital in Annaba, Algeria. In 1965, he became the head of the laboratory of physical anthropology in the Institute of Human Sciences at the University of Alger. He returned to France in 1968 as a Research Fellow (research on genetic polymorphisms of the blood) in the Center of Hemotypology at the Centre National de la Recherche Scientifique (CNRS) in Toulouse. In 1977 he became Maitre de Recherches (equivalent to assistant professor), followed by a promotion to Directeur de Recherches (Professor) in 1982. Philippe Lefevre-Witier conducted a series of long-term, inter-disciplinary field investigations on four different continents: Africa, Asia, the Americas, and Europe. From 1976 to 1987 he studied human adaptation, development, and ecology in the Algerian Sahara (in Hoggar and Tassili n’Ajjer). He also focused on Tuareg populations of Niger and Mali. He investigated the genetics and population dynamics in the village of Ideles in the Hoggar region of North Africa, and published a highly acclaimed volume on the Isseqqamaren genetic structure. Lefevre-Witier organized and conducted a joint research project with UNAM on an assortment of biocultural studies involving DNA analyses, serology, and parasitology (1983 1988) in the State of Oaxaca, Mexico, with the Mixteca Alta. He led field investigations on the hemotypology of Nepalese populations and Tibetan refugees in the Takhola Valley of Nepal. His research experience in Europe was limited to the population of the Capcir plateau in the French of eastern Pyrenees. He traced the contemporary gene pool through genealogies back to 1740. The dominant themes that appear throughout his research included bio-cultural adaptation, ecology, disease, and genetic markers. I first met Philippe during the International Congress of Anthropological and Ethnological Sciences in Chicago in 1974. I had contracted a particularly virulent form of the flu, and during most of the Congress was confined to my bed at the hotel. However, on learning about my condition, Philippe was extremely kind, and he organized visits by groups of colleagues bearing good cheer and appropriate libations. In 1979, when James Mielke and I organized a seminar | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,635 |
This study is to investigate hematuria in pregnant patients caused by renal arteriovenous malformation and to evaluate the efficacy of superselective renal angiography and embolization used for treatment of renal arteriovenous malformation. Two cases of hematuria in pregnant patients caused by renal arteriovenous malformation were enrolled. Case 1 was a 28-year-old woman with repeatedly intermittent hematuria at week 7 during gestation. Case 2 was a 30-year-old woman with repeatedly intermittent hematuria at week 8 during gestation. B ultrasound and CT were performed to detect hydronephrosis. Renal arteriovenous malformation was diagnosed by selective angiography. Both the patients were treated with embolization. The 2 cases were successfully embolized with different materials including gelfoam and coils. Both of the 2 patients were recovered well and discharged successful after the operation. In conclusion, superselective renal angiography and embolization are effective methods for diagnosis and treatment of renal arteriovenous malformation in pregnant patients. | OBJECTIVES ::: Congenital renal arteriovenous malformations (rAVMs) represent rare vascular diseases. The heterogeneous vascular architecture of each rAVM determines the endovascular treatment techniques employed. We reported our experience with the endovascular treatment of a series of rAVMs. ::: ::: ::: MATERIALS ::: This retrospective study consisted of 12 patients with 12 rAVMs who underwent renal arterial embolization (RAE) in our hospital. Embolic materials, including particles, liquid embolic agents (n-butyl 2-cyanoacrylate, Onyx, and ethanol), and coils, were selectively used based on the decisions of interventional radiologists. Technical success was defined as the complete occlusion of the feeding arteries and nidus on postprocedure renal arteriography. Clinical success was defined as the resolution of hematuria or the disappearance of rAVM-relevant symptoms. ::: ::: ::: RESULTS ::: The median follow-up period was 13.5 months (range: 4-72). The technical success based on 12 procedures in 12 patients was 83.3% (10 of 12). In the 2 procedures that technically failed, the existence of multiple fine feeding arteries arising from the proximal portion of different segmental renal arteries explains the incomplete embolization. One of the 2 patients achieved clinical success without additional RAE. The other patient had recurrent hematuria 25 months after initial treatment, which was successfully managed conservatively with hemostatic agents. Thus, the clinical success was 91.7% (11 of 12). ::: ::: ::: CONCLUSIONS ::: Renal artery embolization with the selective use of various embolic materials is an effective treatment for patients with rAVMs. The existence of multiple fine feeding vessels arising from the proximal portion of different segmental renal arteries is likely to affect the technical success of treatment. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,636 |
Bioinformatics-driven T-cell epitope-identification methods can enhance vaccine target selection significantly. We evaluated three unrelated computational methods to screen Pol, Gag and Env sequences extracted from the Los Alamos HIV database for HLA-A*0201 and HLA-B*3501 T-cell epitope candidates. The hidden Markov model predicted 389 HLA-B*3501-restricted candidates from 374 HIV-1 and 97 HIV-2 sequences. The artificial neural network (ANN) model, and Bioinformatics and Molecular Analysis Section (BIMAS) quantitative matrix predictions for A*0201 yielded 1122 HIV-1 and 548 HIV-2 candidates. The overall sequence coverage of the predicted A*0201 T-cell epitopes was 2.7% (HIV-1) and 3.0% (HIV-2). HLA-B*3501-predicted epitopes covered 0.9% (HIV-1) and 1.4% (HIV-2) of the total sequence. Comparison of 890 ANN- and 397 BIMAS-derived HIV-1 A*0201-restricted epitope candidates showed that only 13-19% of the predicted and 26% of the experimentally confirmed T-cell epitopes were captured by both methods. Extrapolating these results, we estimated that at least 247 predicted HIV-1 epitopes are yet to be discovered as active A*0201-restricted T-cell epitopes. Adequate comparison and combined usage of various predictive bioinformatics methods, rather than uncritical use of any single prediction method, will enable cost-effective and efficient T-cell epitope screening. | Cytotoxic T lymphocyte (CTL) epitopes are potential candidates for subunit vaccine design for various diseases. Most of the existing T cell epitope prediction methods are indirect methods that predict MHC class I binders instead of CTL epitopes. In this study, a systematic attempt has been made to develop a direct method for predicting CTL epitopes from an antigenic sequence. This method is based on quantitative matrix (QM) and machine learning techniques such as Support Vector Machine (SVM) and Artificial Neural Network (ANN). This method has been trained and tested on non-redundant dataset of T cell epitopes and non-epitopes that includes 1137 experimentally proven MHC class I restricted T cell epitopes. The accuracy of QM-, ANN- and SVM-based methods was 70.0, 72.2 and 75.2%, respectively. The performance of these methods has been evaluated through Leave One Out Cross-Validation (LOOCV) at a cutoff score where sensitivity and specificity was nearly equal. Finally, both machine-learning methods were used for consensus and combined prediction of CTL epitopes. The performances of these methods were evaluated on blind dataset where machine learning-based methods perform better than QM-based method. We also demonstrated through subgroup analysis that our methods can discriminate between T-cell epitopes and MHC binders (non-epitopes). In brief this method allows prediction of CTL epitopes using QM, SVM, ANN approaches. The method also facilitates prediction of MHC restriction in predicted T cell epitopes. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,637 |
Purpose To investigate the role of Pou4f1 and Pou4f2 in the survival of adult retinal ganglion cells (RGCs). Methods Conditional alleles of Pou4f1 and Pou4f2 were generated (Pou4f1loxP and Pou4f2loxP respectively) for the removal of Pou4f1 and Pou4f2 in adult retinas. A tamoxifen-inducible Cre was used to delete Pou4f1 and Pou4f2 in adult mice and retinal sections and flat mounts were subjected to immunohistochemistry to confirm the deletion of both alleles and to quantify the changes in the number of RGCs and other retinal neurons. To determine the effect of loss of Pou4f1 and Pou4f2 on RGC survival after axonal injury, controlled optic nerve crush (CONC) was performed and RGC death was assessed. Results Pou4f1 and Pou4f2 were ablated two weeks after tamoxifen treatment. Retinal interneurons and Muller glial cells are not affected by the ablation of Pou4f1 or Pou4f2 or both. Although the deletion of both Pou4f1 and Pou4f2 slightly delays the death of RGCs at 3 days post-CONC in adult mice, it does not affect the cell death progress afterwards. Moreoever, deletion of Pou4f1 or Pou4f2 or both has no impact on the long-term viability of RGCs at up to 6 months post-tamoxifen treatment. Conclusion Pou4f1 and Pou4f2 are involved in the acute response to damage to RGCs but are dispensable for the long-term survival of adult RGC in mice. | The proapoptotic molecule BAX is required for death of sympathetic and motor neurons in the setting of trophic factor deprivation. Furthermore, adult Bax-/- mice have more motor neurons than do their wild-type counterparts. These findings raise the possibility that BAX regulates naturally occurring cell death during development in many neuronal populations. To test this idea, we assessed apoptosis using TUNEL labeling in several well-studied neural systems during embryonic and early postnatal development in Bax-/- mice. Remarkably, naturally occurring cell death is virtually eliminated between embryonic day 11.5 (E11.5) and postnatal day 1 (PN1) in most peripheral ganglia, in motor pools in the spinal cord, and in the trigeminal brainstem nuclear complex. Additionally, reduction, although not elimination, of cell death was noted throughout the developing cerebellum, in some layers of the retina, and in the hippocampus. Saving of cells was verified by axon counts of dorsal and ventral roots, as well as facial and optic nerves that revealed 24-35% increases in axon number. Interestingly, many of the supernumerary axons had very small cross-sectional areas, suggesting that the associated neurons are not normal. We conclude that BAX is a critical mediator of naturally occurring death of peripheral and CNS neurons during embryonic life. However, rescue from naturally occurring cell death does not imply that the neurons will develop normal functional capabilities. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,638 |
Patient reported outcomes have become increasingly important in the evaluation of rheumatoid arthritis (RA) over recent years. Besides pain and functional capacity, fatigue, sleep and wellbeing are also important for RA patients. We will discuss here the importance of patient-reported outcomes, different domains of health, and how to evaluate them, with a focus on questionnaires available in Turkey. (Turk J Rheumatol 2010; 25: 99-104) | OBJECTIVE: To develop and validate a composite patient self-report disease activity scale for use in clinical practice and in observational studies and clinical trials. METHODS: A total of 9078 patients with rheumatoid arthritis completed detailed questionnaires that included measure of quality of life in the form of utilities. We evaluated several disease activity scales by measuring their agreement with the utility scales, and also their assessed ability to predict mortality and prescription for anti-tumor necrosis factor therapy. RESULTS: A composite index composed of a visual analog scale (VAS) for pain, a patient global VAS, and the Health Assessment Questionnaire (HAQ) or the HAQ II formed the Patient Activity Scale (PAS) and PAS-II. These scales performed as well as or better than longer, more complex scales. CONCLUSION: A simple, useful clinical scale, the PAS or PAS-II, can be formed by the use of common clinical variables. It is well correlated with and relevant to a wide range of clinical variables. This scale should be useful for comparative studies, clinical care, and regulatory documentation. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,639 |
Common music information retrieval methods are based upon editing distances, reductionism or functional analysis tecniques. We adopt an approach which looks into a thematic fragment (TF) globally. This leads to associate a musical graph to each TF which preserves its more abstract content. Then, necessary conditions for graph inclusion are introduced and we give a similarity function between graphs which allows to assign different weights to the elements belonging to different graph powers. The advantage is that graphs catch more musical transformations than other methods, like permutations of subfragments. | Existing solutions for searching for appropriate music content rely on methods like string edit distances or functional approaches (as for the symbolic level) or features extraction methods (as for the audio level) that cannot provide structural similarity information. Our results in structural similarity measures for music information retrieval rely on graph theory and provide new tools for extract characterizing structural quantities from musical data (both symbolic and audio) to be implemented within an integrated query environment. The improvements regard the use of the graph model of musical data at different levels, the MX format for the representation of musical work and the new user interfaces for the navigation of musical source material. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,640 |
OBJECTIVES/HYPOTHESIS ::: Characterize health care practice patterns for balance disorders in the elderly. ::: ::: ::: STUDY DESIGN ::: Cross-sectional analysis of national health care survey. ::: ::: ::: METHODS ::: Balance disorder cases in patients aged ≥65 years were extracted from the 2008 National Health Interview Survey. Records were analyzed for health professionals seen, diagnostic testing ordered, diagnoses given, and treatments offered. Relationships between diagnostic success, imaging studies, and specialty providers seen were compared. ::: ::: ::: RESULTS ::: Among 7.02 ± 0.22 million elderly persons reporting a balance problem, 50.0% (3.44 ± 0.16 million) saw a health professional, and 35.8% saw ≥3 providers; 59.6% of elderly patients reported a diagnosed cause for the balance problem. The most common causes were medication side effects (11.3%), inner ear infection (11.0%), heart disease (8.6%), and loose ear crystals (7.9%). Imaging studies had been obtained in 56.7% (2.00 ± 0.11 million cases). Among 24.3% of patients receiving some form of treatment, 61.7% had been taking prescription medication, most commonly diuretic agents (36.5%), anxiolytic agents (25.1%), and meclizine (21.4%). Seeing an otolaryngologist or neurologist was associated with a higher but similar rate of diagnostic imaging studies (70.1%, P = .029 and 78.5%, P < .001). However, obtaining an imaging study was not associated with a diagnosed cause of the balance disorder (61.5% with imaging vs. 56.9% without, P = .265). ::: ::: ::: CONCLUSIONS ::: Despite a high prevalence of balance problems in the elderly, a significant proportion do not come to a clear diagnosis. There is a noteworthy rate of prescription medication utilization in this population. Given an increasingly aging population, attention needs to be given to balance problems in the elderly to optimize diagnosis and health care utilization. ::: ::: ::: LEVEL OF EVIDENCE ::: 2b. | Background: Older adult population is increasing worldwide. Balance has an important role in conducting daily activities and mobility, with impaired balance it can lead to negative impacts for example fall. This study is conducted to obtain common factors and characteristics of older adults with balance disorder to provide better rehabilitation services. Method: A descriptive study was conducted in the Physical Medicine and Rehabilitation Clinic of Dr. Hasan Sadikin General Hospital, Bandung from August-October 2014 using total sampling method and a 5 times sit-to-stand (5STS) test was conducted. The total sample obtained was 34. Result: The characteristics of older adult with balance disorder in this study were mostly from young old (n=17), male gender (n=19), and mean 5STS test is 18.48 seconds. Most of the patients had high blood pressure (n=29), normal body mass index (BMI) (n=22), independent activity of daily living (ADL) (n=21), and use of greater than 3 medication (n=21).The most common disease found is musculoskeletal disease and majority of patients had one medical disease. Conclusion: Older adults categorized as young old has the greatest frequency of having balance disorder. Increase in age, increases the duration of 5STS test conducted. The most common problem among older adult is high blood pressure, musculoskeletal disease and hypertension and majority of the patients consume greater than 3 medication. Lastly, most of the BMI and the ADL of the older adults were normal. DOI: 10.15850/amj.v3n1.718 | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,641 |
AIM ::: Knowledge of the spectrum and frequencies of pediatric emergencies presenting to an emergency department (ED) of individual developing countries is vital in optimizing the quality of care delivered locally. ::: ::: ::: METHODS ::: A prospective 6 wk review of all pediatric (< 18 y) attendees to an urban ED was done, with patient age, presenting complaints, diagnoses, time of arrival and disposition recorded. ::: ::: ::: RESULTS ::: Complete data were available on 1172 patients, with an age range of 4 d to 18 y (mean +/- SD 6.9 +/- 5.6 y); 43% were aged < or = 4 y. The main presenting complaints were injuries (26.9%), fever (24%) and breathing difficulties (16.6%). The most common diagnosis was minor trauma (24.2%), with soft-tissue injuries predominating (80.6%). The other diagnoses were asthma (12.6%), upper respiratory infections (12.1%), other infections (12.1%) and gastroenteritis (11.8%). Equal proportions of patients were seen throughout the day. 25% of patients were admitted. Young age (< 1 y); presence of past medical history, general practitioner referrals, diagnosis of bronchiolitis and pneumonia were significantly associated with risk of admission. ::: ::: ::: CONCLUSION ::: A wide spectrum of paediatric illnesses was seen in the ED, with an overrepresentation of young children. This supports the decision to have either a separate pediatric ED or paediatric residents on the staff. The training curricula should emphasize the management of pediatric trauma, infections and asthma. Alternatively, developing guidelines for the five most common presenting complaints would account for 82% of all attendees and could be directed towards all staff on the ED. | Background ::: Emergency medicine is a young specialty in many low- and middle-income countries (LMICs). Although many patients seeking emergency or acute care are children, little information is available about the needs and current treatment of this group in LMICs. In this observational study, we sought to describe characteristics, chief complaints, management, and outcomes of children presenting for unscheduled visits to two Cambodian public hospitals. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,642 |
The lack of harmonisation between the procedures used by organisations concerned with the conservation of animal genetic resources leads to confusion and an inability to compare results effectively. It inhibits constructive interaction between governmental bodies and NGOs as different systems have been developed independently by the Food and Agriculture Organisation (FAO), European Union (EU), Rare Breeds International (RBI), European Association of Animal Production (EAAP), Rare Breeds Survival Trust (RBST) and other bodies. Most current systems consider only population size, and a model system is proposed which encompasses the other important factors of geographical concentration and genetic erosion. Its merits are discussed, and a standardised system is considered feasible, subject to minor refinements where necessary in some regions. The proposed system fulfils the fundamental requirements for endangered breeds, but is amenable to further refinement to assist effective monitoring of ongoing introgression, both official and illicit, which continues to threaten native breeds which are not classified as endangered. The inevitable lack of uniformity that arises from cultural and structural variations in different countries and regions will continue to present some discrepancies. | Reyna Creole cattle originated from Bos taurus cattle brought to Latin America during the Spanish colonization in the fifteenth century and are the only remaining local breed in Nicaragua. However, the current genetic status of this breed is unknown. Therefore, the population structure of three recorded Reyna Creole herds in Nicaragua was studied to estimate their level of inbreeding, effective population size, and generation intervals. Data from 2,609 animals born between 1958 and 2007 were analyzed. A pedigree completeness index higher than 0.8 was required to obtain reliable estimates of the level of inbreeding, and this criterion was met for 367 animals (14%) in two herds. The average level of inbreeding was 13.0%, with values ranging from 0% to 43.8% for individual animals. One of the herds had an average inbreeding level of 21.6%, primarily due to long periods in which the same bulls were used for mating, leading to excessive frequencies of matings between closely related animals. The effective population size differed between years and ranged from 28 to 46 animals, showing that the Reyna Creole cattle breed is endangered, close to critical status. The average generation interval was 6.9 years with values as high as 19.1 years for some sires that were used for artificial insemination over a long period of time. Due to the high level of inbreeding and small population size, urgent actions are required for the development of a breeding program to protect the breed and support its sustainable utilization. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,643 |
OBJECTIVE ::: To understand how routine bedside clinical neurologic assessments are performed in U.S. PICUs. ::: ::: ::: DESIGN ::: Electronic survey. ::: ::: ::: SETTING ::: Academic PICUs throughout the United States. ::: ::: ::: SUBJECTS ::: Faculty representatives from PICUs throughout the United States. ::: ::: ::: INTERVENTIONS ::: None. ::: ::: ::: MEASUREMENTS AND MAIN RESULTS ::: We surveyed how routine bedside neurologic assessments are reported to be performed in U.S. PICUs and the attitudes of respondents on the utility of these assessments. The survey contained questions regarding 1) components of neurologic assessments; 2) frequency of neurologic assessments; 3) documentation and communication of changes in neurologic assessment; and 4) optimization of neurologic assessments. Surveys were received from 64 of 67 institutions (96%). Glasgow Coma Scale and pupillary reflex were the most commonly reported assessments (80% and 92% of institutions, respectively). For patients with acute brain injury, 95% of institutions performed neurologic assessments hourly although assessment frequency was more variable for patients at low risk of developing brain injury and those at high risk for brain injury, but without overt injury. In 73% of institutions, any change detected on routine neuroassessment was communicated to providers, whereas in 27%, communication depended on the severity or degree of neurologic decline. Seventy percent of respondents thought that their current practice for assessing and monitoring neurologic status was suboptimal. Only 57% felt that the Glasgow Coma Scale was a valuable tool for the serial assessment of neurologic function in the ICU. Ninety-two percent felt that a standardized approach to assessing and documenting preillness neurologic function would be valuable. ::: ::: ::: CONCLUSIONS ::: Routine neurologic assessments are reported to be conducted in nearly all academic PICUs in the United States with fellowship training programs although the content, frequency, and triggers for communication vary between institutions. Most physicians felt that the current paradigms for neurologic assessments are suboptimal. These data suggest that optimizing and standardizing routine bedside nursing neurologic assessments may be warranted. | James' adaptation of the Glasgow coma scale (JGCS) was designed for young children. Intubated patients are not allocated a verbal score, however, so important changes in a patient's conscious level may be missed. A grimace score was therefore developed and assessed for use in intubated children. Two observers made a JGCS observation within 15 minutes of each other. One observer was the patient's nurse and the other a trained investigator. Interobserver reliability was determined between the first and second observation for each component of the scale. Reliability was measured using kappa and weighted kappa statistics. Seventy three children had 104 sets of observations. Interobserver reliability was moderate to good for all components, with the grimace score better than the verbal score. It is concluded that the grimace score is more reliable than the verbal score and may be useful in intubated patients in whom the verbal score cannot be used. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,644 |
The aim of this study was to evaluate the association between timing of permanent tooth emergence with overweight and obesity in children from Brazilian Amazon region. The studied population consisted of 192 children, 09 to 12 year-old, from public schools at Manaus, Amazonas-Brazil. Clinical examination was performed and the tooth emergence was evaluated according to the number of permanent erupted teeth. Body mass index z-score was calculated. For the statistical analysis 'Overweight/obese' group was compared with 'Normal weight' group in a case to control ratio 1:2. The t-test based on age was used for means comparison between the groups. A linear regression analysis using age and gender as co-variants was used. The established alpha was 5%. One hundred twenty-seven children were classified as normal weight and 65 were classified as overweight/obese (49 were overweight and 16 were obese). Overweight/obesity condition was associated with the gender, in which boys had a higher chance to present higher weight conditions (OR=1.84; CI 95% 1.06-3.37; p=0.04). The mean number of permanent teeth was higher in the overweight/obesity group (p<0.001). Linear regression analysis demonstrated that nutritional status, gender and age were strongly associated with number of permanent erupted teeth (p<0.05). In conclusion, our study demonstrated that timing of permanent tooth emergence is associated with overweigh/obesity in children from Manaus, Brazil. | Background: To determine the mean eruption time of permanent teeth of Pakistani children and to evaluate the effects of gender, type of schools, height, weight and body mass index on it. Methods: This cross sectional study was conducted from September 2007 to April 2008. 4370 children of ‘just erupted’ teeth were obtained from 102 randomly selected schools from 18 towns of Karachi, using systematic random sampling procedure. The dental examination was carried out for the selected child. Height, weight and date of birth were also obtained. Two sample‘t’ test and paired ‘ t’ test were employed to compare the mean time of eruption between gender and type of schools (private/ public), and upper and lower jaws. Pearson and partial correlations were used to determine the significant relationship between eruption time with height, weight and BMI. Results: The right first molars of upper and lower jaws showed the minimum eruption time. Second molars were the last tooth to emerge. Only 3 teeth showed significant difference of eruption time between the genders. None of contralateral teeth showed any statistical significant difference. All the mandible teeth, except the premolars, erupted earlier than maxillary teeth. Private schools children showed early eruption than the public schools children. The Pearson and partial correlation were significant positively correlated with height. Eruption time of all the teeth, except one, showed positive correlation with weight. Conclusion: The eruption time of Pakistani children are different in many aspects with to other nationalities. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,645 |
To determine the incidence of acute pancreatitis in pancreatic carcinoma, a retrospective study was performed in 174 patients. Acute pancreatitis was found in 24 (13.8%), and hyperamylasaemia, but no clinical manifestation of acute pancreatitis, was found in 17 (9.8%) of these patients. The incidence of acute pancreatitis was higher when the papilla of Vater or the head of the pancreas was involved. Clinically, pancreatitis was slight to moderate, and the underlying disease was soon diagnosed with invasive procedures. Pancreatic carcinoma should be considered an etiological factor in patients with relapsing and/or unexplained pancreatitis of long duration. | ObjectiveThis study aimed to develop a diagnostic model that predicts acute pancreatitis (AP) risk before imaging.MethodsEmergency department patients with serum lipase elevated to 3 times the upper limit of normal or greater were identified retrospectively (September 1, 2013–August 31, 2015). An AP | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,646 |
Background. Recent reports have demonstrated an increase in the number of complications associated with delayed timing of fasciotomy for trauma. This study examines the effectiveness of early (less than 12 hours) versus late (more than 12 hours) fasciotomy in the injured extremity. Methods. This is a retrospective review of 88 patients undergoing fasciotomy for extremity trauma admitted to the University of Cincinnati from January 1990 through December 1995. Records were reviewed for demographics, compartment pressures, time and type of fasciotomy, complications, limb salvage, and mortality. Statistical analysis was determined with chi-squared, multivariant regression analysis, and Student's t test with significance at p less than 0.05. Results. Sixty-one (69%) patients had fasciotomy performed before 12 hours and twenty-seven (31%) after 12 hours. Although the rates of infection differed significantly between the two groups (7.3% for early versus 28% for late), the rates of limb salvage and neurologic sequelae were similar. Age, mechanism, shock, associated injuries, and time to fasciotomy were not predictive of complications. Conclusions. Fasciotomy for trauma is most efficacious when performed early. However, when performed late, it results in similar rates of limb salvage as compared with early fasciotomy but at the increased risk of infection. These results support aggressive use of fasciotomy in extremity trauma regardless of time of diagnosis. | Crush injuries can occur in considerable numbers following natural disasters or acts of war and terrorism. They can also occur sporadically after industrial accidents or following periods of unconsciousness from drug intoxication, anaesthesia, trauma or cerebral events. A common pathophysiological pathway has been elucidated over the last century describing traumatic rhabdomyolysis leading to myoglobinuric acute renal failure and a systemic ‘crush syndrome’ affecting many organ systems. If left unrecognised or untreated then mortality rates are high. If treatment is commenced early and the systemic effects are minimised then patients are often faced with significant morbidity from the crushed limbs themselves. We have performed a thorough review of the English language literature from 1940—2009 investigating crush injuries and crush syndrome and present a comprehensive, two-part summary. Part 1: The systemic injury, we concentrate on the systemic crush syndrome. We determine the pathophysiology, clinical ... | Berzelius failed to make use of Faraday's electrochemical laws in his laborious determination of equivalent weights. | eng_Latn | 14,647 |
PURPOSE ::: This study evaluated tolerability and efficacy of the ketogenic diet in infants less than 12 months of age. ::: ::: ::: METHODS ::: Infants less than 12 months of age, commencing the ketogenic diet between September 2007 and July 2016 were identified. Records were reviewed for epilepsy details, diet initiation details, efficacy and tolerability. ::: ::: ::: RESULTS ::: Twenty-seven infants commenced the ketogenic diet (56% male, median age seven months). Median age at seizure onset was 1.9 months and 92% had daily seizures. An epilepsy syndrome was noted in 19 (West-11, epilepsy in infancy with migrating focal seizures-5, early myoclonic encephalopathy-1, Ohtahara-1, Dravet-1). Infants were on a median of two and had failed a median of one medications for lack of efficacy. All initiated a traditional ketogenic diet at full calories without fasting, and all but one started the diet in hospital. Significant hypoglycemia during initiation was seen in two - both had emesis +/- decreased oral intake. Eighty-eight percent developed urinary ketosis by 48 hours and all were successfully discharged on the diet (median ratio 3:1). Of those continuing dietary therapy, responder rates at one, six and 12 months were 68%, 82% and 91%, with 20%, 29% and 27% achieving seizure freedom. By 12 months, two stopped the diet for serious adverse effects, five discontinued for lack of efficacy, six were lost to follow-up and two died of unrelated causes. ::: ::: ::: CONCLUSIONS ::: The ketogenic diet is an effective and well-tolerated treatment for infants with intractable epilepsy. In-hospital initiation is strongly recommended due to risk of hypoglycemia with emesis or reduced intake. | Noonan syndrome-like disorder with loose anagen hair-2 (NSLH2) is an extremely rare disease caused by a heterozygous mutation in the PPP1CB gene on chromosome 2p23. The syndrome causes not only numerous dysmorphic features but also hypotonia, developmental delay, and even intellectual disability. We report the first case of NSLH2 in Asia and the 16th in the world. Moreover, the first case of PPP1CB-related infantile spasms. The clinical and therapeutic significance is outlined in this paper. We found a male infant presented with severe intractable epileptic spasms. Although certain clinical features of somatic dysmorphism were noted, numerous laboratory and neuroimaging studies failed to identify the cause. To determine the underlying etiology, whole-exome sequencing was conducted. We identified a de novo heterozygous mutation, NM_206876.1: c.548A > C (p.Glu183Ala), in the PPP1CB gene. His seizures were almost refractory to conventional antiepileptic drugs but relative seizure control was eventually achieved with a ketogenic diet. This result expands the clinical spectrum of NSLH2 and strengthens the association between the PPP1CB gene and epileptic seizures. Furthermore, we suggest that the ketogenic diet can offer seizure reduction in particular drug-resistant epilepsy syndromes. Additional studies are warranted to clarify the pathogenic mechanisms underlying this PPP1CB mutation in epileptic seizures. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,648 |
In this paper, recursive extensions to the standard equidistant grid method are proposed whereby the gridding is adapted locally such that a prescribed distance is achieved between neighbouring points in the computed value set (template). Also presented is the Prune algorithm, which finds the outer border of a value set defined by a set of points whose nearest neighbour lies within a prescribed distance. The Prune algorithm is part of the recursive grid methods, but can also be used independently with other methods to compute value sets. As an alternative to analytical or search algorithms, a recursive grid algorithm is presented to compute Horowitz–Sidi bounds (QFT bounds, or boundaries). Isaac Horowitz's contribution to computational methods for QFT is outlined in the perspective of the presented algorithms. Copyright © 2006 John Wiley & Sons, Ltd. | In this paper, we revise the design of improved active Queue Management control scheme for time delay systems. We will use a reduction method to delay through time approach. Obtaining a system delay free, we will apply to it the fundamentals of control theory as the similarity transformation, the pole placement by feedback, and by duality, we construct an observer to the system. The resulting control laws are validated through numerical network estimations. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,649 |
The oil spill in the Gulf of Mexico poses direct threats to human health from inhalation or dermal contact with the oil and dispersant chemicals, and indirect threats to seafood safety and mental health. Physicians should be familiar with health effects from oil spills to appropriately advise, diagnose, and treat patients who live and work along the Gulf Coast or wherever a major oil spill occurs. | Along with other manmade and natural disasters, oil spills produce profound and long-term impacts on the behavioral health of their survivors. Although previous and ongoing research has focused on producing evidence of the breadth and depth of these impacts, future efforts must begin to translate this evidence into developing and implementing policies, programs, and practices that effectively contribute to their prevention and mitigation. Drawing upon a conceptual framework of the behavioral health impacts of oil spills developed from data collected in the aftermath of the Exxon Valdez oil spill in 1989, this paper examines potential interventions designed to prevent or mitigate biopsychosocial, interpersonal, and intrapersonal impacts on behavioral health. Future efforts to translate behavioral health research into effective practice will require the formation and maintenance of academic-community partnerships for the purpose of building resilience to these impacts and providing targeted services to those most vulnerable to their long-term consequences. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,650 |
BACKGROUND ::: Although case series suggest a higher burden of cardiovascular risk factors in patients with systemic lupus erythematosus (SLE) compared with the general population, the association between SLE and heart failure (HF) remains undefined. We sought to investigate the incidence and risk of HF in patients with SLE. ::: ::: ::: METHODS ::: In April 2016, we performed a retrospective cohort analysis using the Explorys platform, which provides aggregated electronic medical record data from 26 major integrated healthcare systems across the USA from 1999 to present. Demographic and regression analyses were performed to assess the impact of SLE on HF incidence. ::: ::: ::: RESULTS ::: Among 45 284 540 individuals in the database, we identified 95 400 (0.21%) with SLE and 98 900 (0.22%) with a new diagnosis of HF between May 2015 and April 2016. HF incidence was markedly higher in the SLE group compared with controls (0.97% vs 0.22%, relative risk (RR): 4.6 (95% CI 4.3 to 4.9)), as were other cardiovascular risk factors. In regression analysis, SLE was an independent predictor of HF (adjusted OR: 3.17 (2.63 to 3.83), p<0.0001). RR of HF was highest in young males with SLE (65.2 (35.3 to 120.5) for age 20-24), with an overall trend of increasing absolute risk but decreasing RR with advancing age in both sexes. Renal involvement in SLE correlated with earlier and higher incidence of HF. ::: ::: ::: CONCLUSIONS ::: The findings of this study suggest that patients with SLE have significantly higher risk of developing HF and a worse cardiovascular risk profile compared with the general population. These results need to be confirmed by prospective studies. | Most medical researchers, whether clinical or non-clinical, receive some background in statistics as undergraduates. However, it is most often brief, a long time ago, and largely forgotten by the time it is needed. Furthermore, many introductory texts fall short of adequately explaining the underlying concepts of statistics, and often are divorced from the reality of conducting and assessing medical research. ::: ::: Practical Statistics for Medical Research is a problem-based text for medical researchers, medical students, and others in the medical arena who need to use statistics but have no specialized mathematics background. ::: ::: The author draws on twenty years of experience as a consulting medical statistician to provide clear explanations to key statistical concepts, with a firm emphasis on practical aspects of designing and analyzing medical research. The text gives special attention to the presentation and interpretation of results and the many real problems that arise in medical research | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,651 |
The NP-hard Independent Set problem is to determine for a given graph G and an integer k whether G contains a set of k pairwise non-adjacent vertices. The problem has numerous applications in scheduling, including resource allocation and steel manufacturing. There, one encounters restricted graph classes such as 2-union graphs, which are edge-wise unions of two interval graphs on the same vertex set, or strip graphs, where additionally one of the two interval graphs is a disjoint union of cliques. | We consider auctions of items that can be arranged in rows. Examples of such a setting appear in allocating pieces of land for real estate development, or seats in a theater or stadium. The objective is, given bids on subsets of items, to find a subset of bids that maximizes auction revenue (often referred to as the winner determination problem). We describe a dynamic programming algorithm which, for a k-row problem with connected and gap-free bids, solves the winner determination problem in polynomial time. We study the complexity for bids in a grid, complementing known results in literature. Additionally, we study variants of the geometrical winner determination setting. We provide a NP-hardness proof for the 2-row setting with gap-free bids. Finally, we extend this dynamic programming algorithm to solve the case where bidders submit connected, but not necessarily gap-free bids in a 2-row and a 3-row problem. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,652 |
BACKGROUND ::: Endometrial and colorectal cancers are the most common cancers in Lynch syndrome. Consensus guidelines recommend annual endometrial biopsy (EMB) and regular colonoscopies. We assessed the feasibility of concurrently performing EMB and colonoscopy and evaluated women's perception of pain, satisfaction, and acceptability. ::: ::: ::: METHODS ::: From July 2002 to December 2009, women who had a gene mutation for Lynch syndrome, met the Amsterdam II criteria, or had a high-risk situation that required screening were prospectively enrolled. After conscious sedation, the procedures were sequentially performed. Patients completed pre- and postprocedure questionnaires assessing pain, level of satisfaction, and acceptability. The Wilcoxon rank test and Mann-Whitney test were used to compare pain scores. ::: ::: ::: RESULTS ::: Forty-two women completed the study. Median age was 37 years (range, 25 to 73). Nineteen had previously had an EMB in the office setting. Women reported significantly lower median levels of pain in the combined procedure compared with previous office setting biopsies (P < .001). Regardless of parity, women reported significantly less pain for an EMB as part of the combined screen compared with an office EMB (parous, P = .003; nulliparous, P = .026). Women also reported a high level of satisfaction and more convenience in the combined procedure. All participants preferred combined to separately scheduled procedures and would recommend the combined procedure to their relatives. ::: ::: ::: CONCLUSION ::: Combined colon and endometrial cancer screening is a patient-centered approach that is feasible, acceptable, and may improve adherence to Lynch syndrome screening recommendations. | Lynch syndrome (LS) is characterised by the development of colorectal cancer, endometrial cancer and various other cancers, and is caused by a mutation in one of the mismatch repair genes: MLH1, MSH2, MSH6 or PMS2. In 2007, a group of European experts (the Mallorca group) published guidelines for the clinical management of LS. Since then substantial new information has become available necessitating an update of the guidelines. In 2011 and 2012 workshops were organised in Palma de Mallorca. A total of 35 specialists from 13 countries participated in the meetings. The first step was to formulate important clinical questions. Then a systematic literature search was performed using the Pubmed database and manual searches of relevant articles. During the workshops the outcome of the literature search was discussed in detail. The guidelines described in this paper may be helpful for the appropriate management of families with LS. Prospective controlled studies should be undertaken to improve further the care of these families. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,653 |
The frequency of nontraumatic lower limb amputations in persons with diabetes has increased in the United States over the last decade. Currently two-thirds of all lower limb amputations occur in individuals with diagnosed diabetes. High geographic variation in age, sex, and race-adjusted amputation rates across U.S. populations suggest that important differences in practice patterns exist and that some patients may be receiving suboptimal care. Amputations reduce patient function and quality of life and place a heavy burden on individuals, families, and health care systems. In this chapter the epidemiology and risk factors for two major diabetic foot problems, ulcers and lower limb amputations, are described. Foot ulcer and amputation hospital discharge data are presented from two major U.S. surveys, the Nationwide Inpatient Sample (NIS), a database that also includes utilization and charge information, and the National Hospital Discharge Survey (NHDS) (1,2). Comparisons between persons with and without diabetes are clearly specified. Findings from analytic and experimental studies that used multivariable modeling techniques to determine risk factors are presented. The chapter concludes with information on the economic impact of diabetic foot problems. | OBJECTIVE ::: Diabetic foot ulceration is a preventable long-term complication of diabetes. A multicenter prospective follow-up study was conducted to determine which risk factors in foot screening have a high association with the development of foot ulceration. ::: ::: ::: RESEARCH DESIGN AND METHODS ::: A total of 248 patients from 3 large diabetic foot centers were enrolled in a prospective study. Neuropathy symptom score, neuropathy disability score (NDS), vibration perception threshold (VPT), Semmes-Weinstein monofilaments (SWFs), joint mobility, peak plantar foot pressures, and vascular status were evaluated in all patients at the beginning of the study. Patients were followed-up every 6 months for a mean period of 30 months (range 6-40), and all new foot ulcers were recorded. The sensitivity, specificity, and positive predictive value of each risk factor were evaluated. ::: ::: ::: RESULTS ::: Foot ulcers developed in 95 feet (19%) or 73 patients (29%) during the study. Patients who developed foot ulcers were more frequently men, had diabetes for a longer duration, had nonpalpable pedal pulses, had reduced joint mobility, had a high NDS, had a high VPT, and had an inability to feel a 5.07 SWE NDS alone had the best sensitivity, whereas the combination of the NDS and the inability to feel a 5.07 SWF reached a sensitivity of 99%. On the other hand, the best specificity for a single factor was offered by foot pressures, and the best combination was that of NDS and foot pressures. Univariate logistical regression analysis yielded a statistically significant odds ratio (OR) for sex, race, duration of diabetes, palpable pulses, history of foot ulceration, high NDSs, high VPTs, high SWFs, and high foot pressures. In addition, 94 (99%) of the 95 ulcerated feet had a high NDS and/or SWF which resulted in the highest OR of 26.2 (95% CI 3.6-190). Furthermore, in multivariate logistical regression analysis, the only significant factors were high NDSs, VPTs, SWFs, and foot pressures. ::: ::: ::: CONCLUSIONS ::: Clinical examination and a 5.07 SWF test are the two most sensitive tests in identifying patients at risk for foot ulceration, especially when the tests are used in conjunction with each other. VPT measurements are also helpful and can be used as an alternative. Finally, foot pressure measurements offer a substantially higher specificity and can be used as a postscreening test in conjunction with providing appropriate footwear. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,654 |
The management of large endometriomas was described in a series of 814 patients. Combined therapy using gonadotrophin-releasing hormone agonist (GnRHa) and carbon dioxide laser laparoscopy was proposed. Drainage and GnRHa for 12 weeks provoked a reduction of the endometrioma size up to 50% of the initial value. After vaporization of the internal wall, a cumulative pregnancy of 51% after 1 year was achieved. A recurrence rate of 8% was observed for a follow-up of 2-11 years. Histological data demonstrated that the epithelium covering the ovary which is the mesothelium can invaginate in the ovarian cortex. Some of the invaginations were seen to be continuous with endometrial tissue, strongly suggesting the metaplasia theory in the pathogenesis of ovarian endometrioma. | Ovarian mutilating surgery is not an option in the management of ovarian hyperstimulation syndrome (OHSS), except in cases with evident tissue necrosis after torsion. When severe OHSS occurs, preservation of fertility must be the target. Therefore, conservative management should be the only feasible approach, as recommended in literature worldwide. Individualization of controlled ovarian hyperstimulation, and an early active management when OHSS initiates, are the most effective measures for reducing the incidence and severity of this disease. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,655 |
What if flowing water simply ::: didn't erode precious ::: topsoil? That's a pretty ::: big "what if?" — not the ::: kind we usually deal with ::: as agricultural scientists. ::: We are more used to ::: modest incremental ::: improvements in management ::: or understanding ::: of natural processes. ::: Sometimes, ::: though, an innovation ::: occurs that changes ::: everything related to a ::: core idea. Such innovations go beyond ::: breakthroughs, because they do more ::: than just solve one problem. In today's ::: jargon, they are paradigm shifts — changes ::: so radical that they force a complete ::: rethinking of everything they rub against. ::: The sweep cultivator was a breakthrough; ::: 2,4-D was a paradigm shift ... airmail vs. ::: e-mail. | There has been a large shift to sprinkler irrigation in the USA. Beyond labor ::: considerations, this has been driven by soil and water resource conservation. ::: Some crops, however, do not tolerate wet canopies (e.g., seed beans). Furthermore, ::: the capital cost, energy use, and technological requirements are out of the ::: reach of many U.S. and third world irrigators. If inexpensive, effective, easy ::: erosion control were available, many furrow irrigation farmers could improve ::: resource conservation and water management. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,656 |
Micro grid is an effective way to regulate the connection between distributed generation and power grid, which plays an important role in improving the performance of distributed generation. In order to better carry out voltage regulation and frequency regulation operation of micro grid and strengthen the application of distributed generation this paper introduces the typical outer loop control strategy of distributed power grid connected inverter in micro grid, and summarizes the droop control, constant power control and constant frequency control in outer loop control. The principles of these three control methods are analyzed, the applicable situations of each method are introduced, At last, the problems to be solved in current control technology of grid-connected inverter are pointed out, and the future development prospects are prospected. | To improve the cost and reliability of utility-tied PWM inverter, this paper investigates an AC voltage sensorless grid synchronization control, either in grid-parallel inverter mode or in boost PFC rectifier mode. Based on d-q coordinate, the sensorless technique utilizes an AC line voltage estimator and an angle-searching algorithm. By commanding a positive or negative d-axis current, the fast current loop regulator controls a bidirectional power flow. The method can detect when the grid is gone, as a possible built-in anti-islanding function. Experiments verified the validity of the proposed method. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,657 |
This paper presents up-to-date annual statistical reconstructions of industrial value added for the period 1861-1913 for Italy’s regions (nuts 2 units). Corresponding provincial (nuts 3 units) estimates for census years 1871, 1881, 1901, and 1911 are also provided. The present work aims to contribute in making the Italian case a major point of interest to regional economists and social scientists analyzing the long-term evolution of spatial economic aggregates. | The paper estimates a conditional s-convergence model of labor productivity growth in Italy’s manufacturing industry during 1871-1911, accounting for spatial dependence. The empirical evidence is based on a recent set of data at provincial (NUTS 3) level on manufacturing value added at 1911 prices, and a new set of data on human and social capital, political participation, and infrastructures. By focusing on a country and a time when the agglomeration forces and spillover effects advocated by the new economic geography were only starting to operate, we can investigate a particularly interesting case study. Our results suggest that human capital, a cooperative culture, and initial productivity in neighboring provinces can explain much of the geographical variability of productivity growth in manufacturing in nineteenth-century Italy. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,658 |
This paper studies the tail behavior of the fundamental period in the MAP/G/1 queue. We prove that if the service time distribution has a regularly varying tail, then the fundamental period distribution in the MAP/G/1 queue has also regularly varying tail, and vice versa, by finding an explicit expression for the asymptotics of the tail of the fundamental period in terms of the tail of the service time distribution. Our main result with the matrix analytic proof is a natural extension of the result in (de Meyer and Teugels, J. Appl. Probab. 17: 802---813, 1980) on the M/G/1 queue where techniques rely heavily on analytic expressions of relevant functions. | We reconsider the M/M/∞ queue with two-state Markov modulated arrival and service processes and the single-server retrial queue analyzed in Keilson and Servi [Keilson, J and L Servi (1993). The matrix M/M/∞ system: Retrial models and Markov modulated sources. Advances in Applied Probability, 25, 453–471]. Fuhrmann and Cooper type stochastic decomposition holds for the stationary occupancy distributions in both queues [Keilson, J and L Servi (1993). The matrix M/M/∞ system: Retrial models and Markov modulated sources. Advances in Applied Probability, 25, 453–471; Baykal-Gursoy, M and W Xiao (2004). Stochastic decomposition in M/M/∞ queues with Markov-modulated service rates. Queueing Systems, 48, 75–88]. The main contribution of the present paper is the derivation of the explicit form of the stationary system size distributions. Numerical examples are presented visually exhibiting the effect of various parameters on the stationary distributions. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,659 |
This work combines three paradigms of image processing: i) the total variation approach to denoising, ii) the superior structure of hexagonal lattices, and iii) fast and exact graph cut optimization techniques. Although isotropic in theory, numerical implementations of the $BV$ seminorm invariably show anisotropic behaviour. Discretization of the image domain into a hexagonal grid seems perfectly suitable to mitigate this undesirable effect. To this end, we recast the continuous problem as a finite-dimensional one on an arbitrary lattice, before focussing on the comparison of Cartesian and hexagonal structures. Minimization is performed with well-established graph cut algorithms, which are easily adapted to new spatial discretizations. Apart from producing minimizers that are closer in the $\ell^1$ sense to the clean image for sufficiently high degrees of regularization, our experiments suggest that the hexagonal lattice also allows for a more effective reduction of two major drawbacks of existing techniques: metrication artefacts and staircasing. For the sake of practical relevance we address the difficulties that naturally arise when dealing with non-standard images. | An ambient light display based on electrofluidic control of coloured pigment fluids is reported. Electromechanical pressure is used to move the pigment from a reservoir to the entire surface of a pixel on a timescale of tens of milliseconds. The display has a white light reflectivity of 55%. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,660 |
Objective: To evaluate the efficacy of first trimester combined screening for Down’s syndrome in Northern Finland during the first 10 years of practice. ::: Methods: During 1 January 2002 to 31 December 2011, 47,896 women participated voluntarily in combined screening during first trimester. The risk cutoff was 1:250. The study period was divided into two time periods; 2002–2006 and 2007–2011. ::: Results: During the first half of the study period, the detection rate (DR) was 77.3% with a 4.9% false-positive rate (FPR). During the latter half, the DR was 77.1% with a 2.8% FPR. ::: Conclusions: An important issue is the number of invasive procedures needed to detect one case of Down’s syndrome. The screening performance improved markedly in the latter five years period since the FPR lowered from 4.9% to 2.8% and the number of invasive procedures needed to detect one case of Down’s syndrome lowered from 15 to 11. | OBJECTIVE ::: To calculate a reliable estimate of the population prevalence of Down syndrome in the US. ::: ::: ::: STUDY DESIGN ::: The annual number of births of infants with Down syndrome were estimated by applying published birth prevalence rates of Down syndrome by maternal age to US data from the Centers for Disease Control and Prevention for the years for which births by maternal age were available (1940-2008). Death certificate data for persons with Down syndrome were available for the years 1968-2007. We estimated the number of people with Down syndrome on January 1, 2008, using a life table approach based on proportions of deaths by age. Monte Carlo sampling was used to create 90% uncertainty intervals (UIs) for our estimates. ::: ::: ::: RESULTS ::: We estimated the January 1, 2008, population prevalence of Down syndrome as approximately 250700 (90% UI, 185900-321700) based on proportions of deaths by age from the most recent 2 years (2006-2007) of death certificate data. This estimate corresponds to a prevalence of 8.27 people with Down syndrome per 10000 population (90% UI, 6.14-10.62). ::: ::: ::: CONCLUSION ::: Our estimate of Down syndrome prevalence is roughly 25%-40% lower than estimates based solely on current birth prevalence. The results presented here can be considered a starting point for facilitating policy and services planning for persons with Down syndrome. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,661 |
The first patient with strangulated hiatus hernia due to pyloric stenosis is reported. A 70-year-old male patient presented as an emergency with severe left-sided chest pain, tachycardia, tachypnea, dysphagia, and nausea but no vomiting. The diagnosis of strangulated hiatus hernia due to pyloric stenosis was suspected, because a CT scan done 24 h following a barium meal showed much retained barium in both infra- and supradiaphragmatic parts of the stomach. Recognition of this condition is important since absence of pneumoperitoneum should not delay the diagnosis. In this complication, the perforation is likely to be at the hiatus, not the fundus as occurs in other causes of strangulation. A gastric drainage procedure should be an essential part of treatment. | Three cases of iatrogenic diaphragmatic herniation are reported following thoracic and high abdominal surgery. Each case presented at least 6 months after the original surgery with symptoms of acute upper gastrointestinal obstruction. Diaphragmatic herniation was not considered in the initial differential diagnosis which lead to a delay in their referral. We emphasise the importance of checking the diaphragm following upper abdominal surgery and care when closing a defect. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,662 |
Background/Aim Children with severe neuro-disability are at increased risk of feeding problems resulting in approximately half of such children being undernourished with growth failure. While gastrostomy tube feeding in such patients has been shown to improve weight gain, there is uncertainty to its impact on survival, respiratory complications, parental and child quality of life, cost, and consequently leads to potentially avoidable variability in practice. The issue of lack of standardized outcomes for this population could be addressed through the development of a standardized core outcome set (COS). We aim to develop an evidenced based COS for children 0-18 years with severe neuro-disability and dependent gastrostomy. | Irish Research Council (New Foundations Award, Grant/Award Number: New Foundations Award 2015); Health Research Board (Interdisciplinary Capacity Enhancement Award, Grant/Award Number: ICE‐2015‐1026) | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,663 |
The demand for permanent make up and especially permanent lip liner has increased in recent years in Germany. Information about complications is not available in the medical literature, because tattooing is a trade whose results and problems are not monitored and documented, as is the case for medical procedures. A female patient with permanent lip liner experienced no complications for one year. Then, after intensive sun exposure she developed solid, linear papules along the outer margin of her lips. Histology revealed a granulomatous tissue reaction with a marked lymphohistiocytic infiltrate including epithelioid histiocytes. Treatment with topical steroids over three weeks led to a complete healing without relapse. To the best of our knowledge this is the first report on UV-light-induced granulomatous reaction to permanent lip liner. | Purpose of review Cosmetic and reconstructive medical tattooing techniques are being used with a higher frequency than ever before. The volume of scientific research into its basics, however, is too small to prevent the present occurrence of complications. This review shows that most of the recent articles on the subject are in fact case reports and that many of the complications described result from the failure to conduct more research. Recent findings Recent findings include few and relatively unimportant new techniques, studies describing tattoo removal with laser, magnetic displacement and chemical irritants, more findings about infections and allergies, and complications with high field-strength magnetic resonance imaging scans. Summary Recent literature contains very few useful studies because generally they are not supported by sufficient scientific research. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,664 |
Infants of insulin-dependent diabetic mothers are considered to be at high risk for birth trauma, presumably due to macrosomia. With current management of diabetes in pregnancy, including strict glycemic control, the rate and the severity of macrosomia should be decreased. The frequent use of ultrasound to assess fetal growth and weight and the use of cesarean delivery in case of fetal macrosomia should further decrease the risk for birth trauma in these infants. We therefore undertook this study to test the null hypothesis that with current management, insulin-dependent diabetic mothers have a rate of birth trauma similar to that of infants of nondiabetic mothers (normal glucose challenge test at 28 weeks' gestation) matched for gestational age at birth, presence or absence of labor, delivery method (vaginal versus cesarean), and race. We studied 118 insulin-dependent diabetic mothers (White classes B-RT) and 354 control subjects (three matches for each insulin-dependent diabetic mother). The rate of birth trauma was 3.4% in insulin-dependent diabetic mothers, not significantly different from controls (2.5%). Logistic regression analysis in which birth trauma was the dependent variable and diabetes, race, presence or absence of labor, mode of delivery (vaginal versus cesarean), infant weight, and infant head circumference were independent variables revealed that only vaginal delivery was a significant risk factor for birth trauma in infants in both groups (p = 0.01). Most frequently observed birth traumas were brachial plexus injury, facial nerve injury, and cephalohematoma. Of the three infants with brachial plexus injury (insulin-dependent diabetic mothers, two; controls, one), two were delivered with use of midforceps.(ABSTRACT TRUNCATED AT 250 WORDS) | OBJECTIVE ::: To describe the clinical outcome of infants born to mothers with gestational diabetes mellitus (GDM) and preexisting insulin-dependent diabetes mellitus (IDDM). ::: ::: ::: SETTING ::: A tertiary care regional perinatal center with a specialized diabetes-in-pregnancy program. ::: ::: ::: DESIGN ::: Case series. ::: ::: ::: RESULTS ::: Five hundred thirty infants were born to 332 women with GDM and 177 women with IDDM. Thirty-six percent of these 530 newborns were large for gestational age, 62% were appropriate for gestational age, and only 2% were small for gestational age. Seventy-six (14%) of all infants were born before 34 weeks' gestation, 115 (22%) between 34 and 37 weeks of gestation, and 339 (64%) at term. Two hundred thirty-three infants (47%) were admitted to the neonatal intensive care unit due to respiratory distress syndrome (RDS), prematurity, hypoglycemia, or congenital malformation. Hypoglycemia (more common among infants of maternal diabetic classes C through D-R) was documented in 137 (27%) of all newborns. One hundred eighty-two infants (34%) had RDS of varying severity. Polycythemia (5% of infants), hyperbilirubinemia (25%), and hypocalcemia (4%) were other morbidities present. Two hundred forty-four infants were admitted for routine care and enteral feedings. Forty-three of these newborns required subsequent transfer to the neonatal intensive care unit for treatment of hypoglycemia (16 cases), RDS (19 cases), or both (8 cases). Routine care failures were more common among infants whose mothers had advanced diabetes, but less frequent among breast-fed infants. ::: ::: ::: CONCLUSIONS ::: With modern management, fewer morbidities can be expected in infants of diabetic mothers. Those infants born to women with IDDM remain at risk for hypoglycemia, which can be treated in one half of the cases by enteral feedings alone. The majority of cases of RDS are mild and require short admissions to special care nurseries. Optimal care of infants of diabetic mothers is based on prevention, early recognition, and treatment of common conditions. Severe congenital malformations, significant prematurity, RDS, recurrent hypoglycemic episodes, and asymptomatic infants of women with advanced IDDM should be admitted to special care nurseries. Breast-feeding among women with GDM and IDDM should be encouraged. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,665 |
Objective To investigate the cross-sectional relationship between maternal parenting style and indicators of well-being among adolescents with diabetes. Methods Seventy-eight adolescents (ages 11.58–17.42 years, M ¼14.21) with type 1 diabetes and their mothers separately reported perceptions of maternal parenting style. Adolescents reported their own depressed mood, self-efficacy for managing diabetes, and diabetes regimen adherence. Results Adolescents’ perceptions of maternal psychological control were associated with greater depressed mood regardless of age and gender. Firm control was strongly associated with greater depressed mood and poorer self-efficacy among older adolescents, less strongly among younger adolescents. Adolescents’ perceptions of maternal acceptance were associated with less depressed mood, particularly for girls and with better self-efficacy for diabetes management, particularly for older adolescents and girls. Maternal reports of acceptance were associated only with adherence. Conclusions Maternal parenting style is associated with well-being in adolescents with diabetes, but this association is complex and moderated by age and gender. | OBJECTIVE ::: To determine prevalence rates, associated features and risk factors for psychiatric disorders subsequent to the diagnosis of IDDM in youths. ::: ::: ::: RESEARCH DESIGN AND METHODS ::: Using a longitudinal, naturalistic design, 92 youths from 8 to 13 years old at onset of IDDM were followed from their initial diagnosis. They were repeatedly assessed by semistructured interview and diagnosed by operational criteria. ::: ::: ::: RESULTS ::: By the 10th year of IDDM and the mean age of 20 years, an estimated 47.6% of the sample developed psychiatric disorder. Major depressive, conduct, and generalized anxiety disorders were the most prevalent, and major depression had a significantly higher estimated rate (27.5%) than each other disorder. The highest incidence rates were during the 1st year of the medical condition. Initial maternal psychopathology increased the risk of psychiatric disorder in the subjects, and maternal depression was a specific risk factor for depression in the subjects. Earlier psychiatric disorder in the subjects also increased the risk of later disorder. ::: ::: ::: CONCLUSIONS ::: The results converge with findings from other studies, suggesting elevated psychiatric morbidity in contemporary samples of young people with IDDM. The morbidity partly reflects the high incidence of major depression in adolescence and generalized anxiety disorder in young adulthood. Monitoring the psychological status of young patients and their mothers may help to identify diabetic children at risk for psychiatric disorder and facilitate prevention or treatment efforts. Monitoring may be particularly beneficial during the 1st year of the IDDM. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,666 |
In this paper we introduce a panel quantile estimator for count data with individual heterogeneity, by constructing continuous variables whose conditional quantiles have a one-to-one relationship with the conditional count response variable. The new method is needed as a result of the increased availability of Big Data, which allows us to track event counts at the individual level for a large number of activities from webclicks and retweets to store visits and purchases. At the same time, the presence of many different subpopulations in a large dataset requires us to pay close attention to individual heterogeneity. In this paper, we propose a penalized quantile regression estimator with fixed effects and investigate the conditions under which the slope parameter estimator is asymptotically Gaussian. We investigate solutions to the computational challenges resulting from the need to estimate tens of thousands of parameters in a Big Data setting and caution against penalizing in models with substantial zero inflation and endogenous covariates by using a series of Monte Carlo simulations. We present an empirical application to individual trip counts to the store based on a large panel of food purchase transactions. | The authors develop and test a new model of store choice behavior whose basic premise is that each shopper is more likely to visit the store with the lowest total shopping cost. The total shopping ... | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,667 |
In this paper, we focus on the problem of having a multitude of very simple mobile robots self-organize their relative positions so as to obtain a variety of spatial configurations. The problem has a variety of applications in mobile robotics, modular robots, sensor networks, and computational self-assembly. The approach we investigate in this paper attempts at minimizing the local capability of robots and at verifying how and to what extent a variety of global shapes can be obtained by exploiting simple self-organizing algorithms and emergent behaviors. Several experiments are reported showing the effectiveness of the approach. | ABSTRACTInspired by the chemotaxis interaction of living cells, we have developed an agent-based approach for self-organising shape formation. Since all our simulations begin with a different uniform random configuration and our agents move stochastically, it has been observed that the self-organisation process may form two or more stable final configurations. These differing configurations may be characterised via statistical moments of the agents' locations. In order to direct the agents to robustly form one specific configuration, we generate biased initial conditions whose statistical moments are related to moments of the desired configuration. With this approach, we are able to successfully direct the aggregating swarms to produce a desired macroscopic shape, starting from randomised initial conditions with controlled statistical properties. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,668 |
This paper documents exploratory drilling activity on offshore wildcat oil and gas leases in the Gulf of Mexico sold between 1954 and 1980. The authors calculate the empirical drilling hazard function for cohorts in specific areas. For each year of the lease, they study the determinants of the decision whether to begin exploratory drilling and their relationship to the outcome of any drilling activity. Their results indicate that equilibrium predictions of plausible noncooperative models are reasonably accurate and more descriptive than those of cooperative models of drilling timing. The authors discuss why noncooperative behavior may occur and the potential gains from coordination. Copyright 1996 by American Economic Association. | I study a game in which two players first bid for offshore tracts (below which oil and gas may be present) and next time their drilling decisions. High types bid more aggressively if the auctioneer discloses bids as this gives them useful information about the profitability of drilling. A low type fears that the disclosure of her "low" bid reduces the other player's incentive to drill. Hence, they bid more aggressively if the auctioneer does not disclose bids. If players are sufficiently patient, it is optimal to disclose bids. Otherwise, it may be optimal not to disclose them. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,669 |
Since 1965, when cor pulmonale secondary to enlarged tonsils and adenoids was first recognized, 4 of 36 cases (12%) have died. Six additional cases treated successfully, first medically and then surgically, are reported, one in detail. The early recognition and treatment of progressive upper airway obstruction is curative. | The decision to perform tonsillectomy and adenoidectomy for treatment of pediatric obstructive sleep apnea syndrome is often made on a clinical basis without formal polysomnography. To examine the accuracy of the clinical diagnosis of pediatric obstructive sleep apnea syndrome, we prospectively evaluated 30 children with obstructive symptoms by a standardized history, physical examination, and review of a tape recording of breathing during sleep. On the basis of this clinical evaluation, patients were divided into three predictive groups: (1) definite obstructive sleep apnea syndrome, (2) possible obstructive sleep apnea syndrome, and (3) unlikely to have obstructive sleep apnea syndrome. Nocturnal polysomnography was used to determine the presence or absence of true sleep apnea. Ten of 18 (55.6%) patients predicted clinically to have definite obstructive sleep apnea syndrome had positive nocturnal polysomnographies. Two of six (33.3%) patients predicted to have possible obstructive sleep apnea syndrome had positive nocturnal polysomnographies. One of six (16.7%) patients predicted to be unlikely to have obstructive sleep apnea syndrome had a positive nocturnal polysomnography. Six nocturnal polysomnographies negative by conventional criteria were suspicious for apnea, but considering these positive for obstructive sleep apnea syndrome did not improve the specificity of the clinical prediction. Our results show that clinical assessment of obstructive sleep apnea syndrome in children is sensitive (92.3%) but not specific (29.4%) for making the diagnosis of obstructive sleep apnea syndrome as compared with nocturnal polysomnography and may contribute to the decision to obtain nocturnal polysomnography in specific circumstances. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,670 |
subjective evaluation of outcome of patient treatment. Objectives: To predict the morbidity and mortality in patients presenting with acute upper gastrointestinal bleeding at Ibn-Sina Hospital using the Rockall score. Patients and methods: Prospective hospital-based study conducted from June 2007 through December 2007 at the Ibn-Sina Hospital Bleeding Centre. Demographic, data of history and physical examination and results of laboratory investigations of 238 patients were collected and allotted a Rockall score, Child-Pugh class and fed to Statistical Package of Social Sciences (SPSS) to calculate means and find the levels of statistical differences and define the predicted and observed mortality rates. Results: The mean (±SD) age 44.6 (±15.31) range (8 - 85) years. There were 190 (79%) males. Patients with oesophageal varices, peptic ulcer, and upper GI tumours were 215 (90.3%), 18 (7.6%), and 5 (2.1%) respectively. The mean predicted mortality was 3.8% while the actual observed mortality 3.8%. The mortality in cases of oesophageal varices was 8(3.4%), while that of bleeding peptic ulcers was one (0.4%). Conclusion: Rockall score is feasible, accurate, effective system for predicting outcome in patients with upper GI bleeding. The risk factor for mortality are Rockall score >3, age >70 and rebleeding. Key words : Mortality, morbidity, upper GIT bleeding, Rockall score. | Introduction: Upper gastrointestinal bleeding (UGIB) is one of the most common complications among hospital admitted patients. UGIB is defined as bleeding within the gastrointestinal tract lumen from any location between the upper oesophagus upto the ligament of Treitz of duodenum. Upper endoscopy has a crucial role in the diagnosis and treatment of upper gastrointestinal bleeding. ::: ::: Method: This is a retrospective analytical study in patients with UGIB admitted in Gastroenterology Unit, Department of Medicine, NAMS Bir Hospital, Kathmandu. The records of 112 patients who underwent endoscopy for UGIB over a period of one year (2014-April-14th to 2015-April-13th) was analyzed for this ::: study. ::: ::: Result: In this study total patients were 112. Among them 74.1% were male while 25.9% were female. Their ages ranged from 16-90 years with a mean of 48.7 years. Esophageal varices was the most frequent cause of bleeding 36(32.14%) followed by Peptic ulcer disease 31(27.67%), Erosive mucosal disease 18(16.07%), ::: Mallory weiss tear 7(6.25%), Gastric cancer 4(3.57%) and Fundal varices (1.78%). Dieulafoy’s Lesion, Inflamed sessile polyp and Esophageal candidiasis with erosive gastritis were rare causes with each accounting for 0.9% of the cases. In 10(8.92%) patients no source of bleeding could be identified. ::: ::: Conclusion: In this study, portal hypertension related esophageal varices was the commonest cause of UGIB , followed by peptic ulcer disease and erosive mucosal disease. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,671 |
The paper presents details of a model checker for microcontroller-based embedded systems, called [mc] square. The purpose of the tool is to make model checking technology applicable in an embedded systems industry context. Consequently, it does not implement new theory but combines existing techniques to achieve the necessary efficiency and usability in a novel application area. One of the pragmatic requirements has been that model checking must be possible without any kind of manual preprocessing of the code. In its core, [mc]square is an explicit state, CTL model checker which builds the state space from the hardware-specific assembly code. The paper describes the tool features in detail and illustrates its abilities using two realistic examples. | Safety-critical nowadays include more and more embedded computer systems, based on different hardware platforms. These hardware platforms, reaching from microcontrollers to programmable logic devices, lead to fundamental differences in design. Major differences result from different hardware architectures and their robustness and reliability as well as from differences in the corresponding software design. This paper gives an overview on how these hardware platforms differ with respect to fault handling possibilities as fault avoidance and fault tolerance and the resulting influence on the safety of the overall system. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,672 |
The validity of the fibromyalgia syndrome (FMS) as a distinct clinical entity has been challenged for several reasons. Many skeptics express concern about the subjective nature of chronic pain, the subjectivity of the tender point (TeP) examination, the lack of a gold standard laboratory test, and the absence of a clear pathogenic mechanism by which to define FMS. Another expressed concern has been the relative nature of the pain-distress relationship in the rheumatology clinic. The apparently continuous relationship between TePs and somatic distress across a variety of clinical disorders is said to argue against FMS as a separate clinical disorder. The most aggressive challenges of the FMS concept have been from legal defenses of insurance carriers motivated by economic concerns. Other forms of critique have presented as psychiatric dogma, uninformed posturing, suspicion of malingering, ignorance of nociceptive physiology, and occasionally have resulted from honest misunderstanding. It is not likely that a few paragraphs of data and logic will cause an unbeliever to change an ingrained opinion. Therefore, this review describes the clinical manifestations of FMS, responds to some of the theoretic arguments against it, and discusses some possible pathophysiologic mechanisms by which FMS may develop and persist as a unique syndrome. | Objective Fibromyalgia syndrome (FMS) patients and their doctors frequently complain on interaction difficulties. We investigated the effects of a shared decision-making (SDM) intervention on physician–patient interaction and health outcome. Methods Sixty-seven FMS patients of an outpatient university setting that had been included in a randomized controlled trial were followed up. They were either treated in an SDM group or in an information group. Both groups saw a computer based information tool on FMS, but only the SDM group was treated by doctors which underwent a special SDM communication training. A comparison group of 44 FMS patients receiving treatment as usual was recruited in rheumatological practices. We assessed patients and their doctors using a combined qualitative and quantitative approach. Patients and doctors were followed-up after 3 months (T2) and after 1 year (T3). Results The significantly best quality of physician–patient interaction was reported by patients and doctors of the SDM group, followed by the information group. Coping had more often improved in the SDM group than in the information group. However directly health related outcome variables had not improved in any of the groups at T3. Conclusion An SDM intervention can lead to an improved physician–patient relationship from the patients’ and from the doctors’ perspective. Practice implications It should be considered to include SDM in standard care for FMS patients. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,673 |
The authors have investigated the role of gastric acidity in the evaluation of cardiohiatal anomalies. Results are given of maximal gastric acid (MAO) investigations made in 155 children. Children in whom postural therapy failed and those with an ulcerlike syndrome have much higher MAO values than does the group who responded well to postural therapy and to a control group. Hyperacidity indicates a high probability of a poor response to postural therapy. Therefore measurement of gastric acidity is advisable in all patients with hiatus hernia, and early surgical therapy should be recommended in those with hyperacidity. | 15 months) clinical manifestations of GER. All underwent routine ambulatory 24-h esophageal pH-monitoring and measurement of gastric acid secretion including gastric basal (BAO) (µmol/kg/h), maximal (MAO) and peak acid outputs (PAO) after pentagastrin (6 µg/kg sec) stimulation. Children with heartburn or abdominal pain underwent upper fiber-endoscopy. In group A (moderate GER, n=12), patients had a normal reflux index (pH 5.2%. When considering all children, esophageal pH (%) was significantly correlated with MAO and PAO, r=0.33, p=0.05 and r=0.37, p=0.04, respectively. Children of group B exhibited significantly higher BAO (75, 53.96-137.81), MAO (468, 394.1-671.3) and PAO (617, 518.8-782.3) than those of group A, BAO (27, 10.8-38.5), MAO (266, 243.2-348.2) and PAO (387, 322.5-452.7), p<0.05). The five children of group B with severe esophagitis exhibited significantly higher BAO, MAO and PAO than the other 13 children from the same group and those of group A, p<0.05. Children with long-lasting and severe GER hyper-secrete gastric acid. Individual variations in gastric acid secretion probably account for variations in gastric acid inhibitor requirements. Anti-secretory treatment is justified in children with long-lasting GER and high pH-metric reflux index. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,674 |
While pages on the Web contain more and more multimedia information, such as images, videos and audio, today's search engines are mostly based on textual information. There is an emerging need for a new generation of search engines that try to exploit the full multimedia information present on the Web. The approach presented in this paper is based on a multimedia model intended to describe the various multimedia components, their structure and their relationships with a pre-defined taxonomy of concepts, in order to support the information retrieval process. | To create efficiencies in the production process of revisable multimedia systems it is necessary to define processes for the control of content revision and regeneration with a workflow control of these processes. A model for managing Multimedia Run-time Systems (MRS) is presented as consisting of a revision control strategy for managing primary resources. Regeneration processes that move data from one process to the next incorporating derivative resources on the way, and ultimately producing run-time resources, and a workflow control process to regulate and maintain the integrity of the regeneration process. A case study of one approach to tackling these problems is presented. This MRS, known as the English to Basque Learning Environment (EBLE), is a reference library of three books and concomitant sound files for second language learning of Basque. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,675 |
We explored the regulatory mechanism of Leloir pathway genes in Streptococcus pneumoniae D39. Here, we demonstrate that the expression of galKT is galactose dependent. By microarray analysis and quantitative RT-PCR, we further show the role of the transcriptional regulator GalR, present upstream of galKT, as a transcriptional activator of galKT in the presence of galactose. Moreover, we predict a 19-bp regulatory site (5'-GATAGTTTAGTAAAATTTT-3') for the transcriptional regulator GalR in the promoter region of galK, which is also highly conserved in other streptococci. Growth comparison of D39 ΔgalK with the D39 wild type grown in the presence of galactose shows that galK is required for the proper growth of S. pneumoniae on galactose. | In this study, the regulatory mechanism of the ula (utilization of l-ascorbic acid) operon, putatively responsible for transport and utilization of ascorbic acid in Streptococcus pneumoniae strain D39, is studied. β-Galactosidase assay data demonstrate that expression of the ula operon is increased in the presence of ascorbic acid as compared with the effects of other sugar sources including glucose. The ula operon consists of nine genes, including a transcriptional regulator UlaR, and is transcribed as a single transcriptional unit. We demonstrate the role of the transcriptional regulator UlaR as a transcriptional activator of the ula operon in the presence of ascorbic acid and show that activation of the ula operon genes by UlaR is CcpA-independent. Furthermore, we predict a 16 bp regulatory site (5'-AACAGTCCGCTGTGTA-3') for UlaR in the promoter region of ulaA. Deletion of the half or full UlaR regulatory site in PulaA confirmed that the UlaR regulatory site present in PulaA is functional. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,676 |
Ocular biometrics refers to the imaging and use of characteristic features of the eyes for personal identification. Traditionally, the iris has been viewed as a powerful ocular biometric cue. However, the iris is typically imaged in the near infrared (NIR) spectrum. RGB images of the iris, acquired in the visible spectrum, offer limited biometric information for dark-colored irides. In this work, we explore the possibility of performing ocular biometric recognition in the visible spectrum by utilizing the iris in conjunction with the vasculature observed in the white of the eye. We design a weighted fusion scheme to combine the information originating from these two modalities. Experiments on a dataset of 50 subjects indicate that such a fusion scheme improves the equal error rate by a margin of 4.5% over an iris-only approach. | Biometrics is a rapidly evolving field with applications ranging from accessing ones computer to gaining entry into a country. The deployment of large-scale biometric systems in both commercial and government applications has increased public awareness of this technology. Recent years have seen significant growth in biometric research resulting in the development of innovative sensors, new algorithms, enhanced test methodologies and novel applications. This book addresses this void by inviting some of the prominent researchers in Biometrics to contribute chapters describing the fundamentals as well as the latest innovations in their respective areas of expertise. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,677 |
The effect of the site of operation on postoperative hypoxemia was studied in 104 patients undergoing thoraco-abdominal, thoracic, upper abdominal, lower abdominal, extra-abdominal and non-thoracic operations. The degree of postoperative hypoxemia was the most extensive in patients undergoing thoraco-abdominal, moderate in thoracic and upper abdominal operations, and minimal in lower abdominal and other operations. On the other hand, the duration of hypoxemia also differed with the surgical procedures. Arterial oxygen tension returned to almost control values by the 3rd postoperative day in cases of lower abdominal and extremity operations and by the 7th postoperative day in those undergoing thoracic and upper abdominal surgery. Postoperative hypoxemia, however, remained throughout the fourteen day study period, in patients undergoing thoraco-abdominal operation. True shunt was measured in 27 patients with thoraco-abdominal, thoracic and upper abdominal operations. An increase in true shunt was evident postoperatively in the entire group of patients. The increase was significantly larger and longer lasting in cases of thoraco-abdominal incision than that in cases of thoracic and upper abdominal incision alone. Differences in postoperative true shunt between cases of thoracic and upper abdominal incisions were nil. | THE present study was undertaken to determine if the pattern of ventilation, by itself, may influence oxygenation during anesthesia and surgery. The hypothesis was examined that progressive pulmona... | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,678 |
Federal aid was not found to stimulate spending for cities in Oregon during 1984-1989. Oregon cities relied primarily on their own-source revenues to finance spending increases. The exception was capital spending, where receipt offederal aid in 1989positively influenced the rate ofspending change. This most likely reflected lower spending by those cities that did not receive competitivefederal grants. The amount offederal aid received is greatly influenced by the grants skill available to the community. Growth in total direct current spending was significantly associated with increases in user fees and charges. A closer look at specific spending categories revealed a hierarchy of reliance on cities' ownsource revenues. Cities increased user fees and other benefit charges where possible, and seemingly only resorted to property-tax increases when these other revenues were inappropriate. | An earlier study found that certain Minnesota state aid programs stimulated city property tax levies to a high degree. If this is accurate, it suggests potentially serious problems with state property tax relief efforts. This article re-examines this question and finds that most aid programs have little direct effect on property tax levies. However, certain aid formulas that reduce the effective price of property taxes do indirectly stimulate property taxes. Therefore, states need to be careful in designing aid programs intended to reduce property taxes. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,679 |
Kommers's comprehensive work surveys the development of German constitutional doctrine between 1949, when the Federal Constitutional Court was founded, and 1996. Extensively revised and expanded to take into account recent developments since German unification, this second edition describes the background, structure, and functions of the Court and provides extensive commentary on German constitutional interpretation, and includes translations of seventy-eight landmark decisions. These cases include the highly controversial religious liberty and free speech cases handed down in 1995. | The presented article is devoted to the analysis of the legal positions of the Russian Federation Constitutional Court regarding the constitutionality of Russian legislation norms in the field of control and supervision activities. The generalization of the Constitutional Court practice of the Russian Federation allows you to group the decisions of the highest constitutional control body on several key issues: the limits of discretion by the legislator and law enforcer, the legal nature of state control and supervision measures, the balance of public and private interests in the sphere of relations under consideration and the guarantees of this balance. The team of authors concludes that the resolution of these problems is impossible without the Constitutional Court determining the content of a number of key concepts, developing the methodology for various constitutional principles and value balancing and, in general, focused efforts to constitutionalize Russian legislation. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,680 |
Local search algorithms use the neighborhood relations among search states and often perform well for a variety of NP-hard combinatorial search problems. This paper shows how quantum computers can also use these neighborhood relations. An example of such a local quantum search is evaluated empirically for the satisfiability (SAT) problem and shown to be particularly effective for highly constrained instances. For problems with an intermediate number of constraints, it is somewhat less effective at exploiting problem structure than incremental quantum methods, in spite of the much smaller search space used by the local method. | It is known that quantum computers can dramatically speed up the task of finding factors of large numbers, a problem of practical significance for cryptographic applications. Factors of an L -digit number can be found in ∼ L 2 time [compared to ∼exp( L 1/3 ) time] by a quantum computer, which simultaneously follows all paths corresponding to distinct classical inputs, obtaining the solution from the coherent quantum interference of the alternatives. Here it is shown how the decoherence process degrades the interference pattern that emerges from the quantum factoring algorithm. For a quantum computer performing logical operations, an exponential decay of quantum coherence is inevitable. However, even in the presence of exponential decoherence, quantum computation can be useful as long as a sufficiently low decoherence rate can be achieved to allow meaningful results to be extracted from the calculation. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,681 |
Effective heat and power supply to offshore installations leads to environmental benefits, but the efficiency is often limited by requirements and constraints connected to the offshore environment. An exergetic analysis of gas turbines exhaust heat recovery on offshore platforms is performed to identify optimal approaches to produce heat and power. Two different configurations are presented, with heat delivery at two temperature levels and power production by an organic Rankine cycle (ORC). In one system (cascade), the high temperature heat is taken from the exhaust after the ORC, while low temperature heat is taken from the ORC condenser. Alternatively, high and low temperature heat is taken from the exhaust gas before the ORC feeds on the remaining exhaust thermal energy (series system). Four different working fluids (three siloxanes, one refrigerant) are considered. In addition, the exergetic effects of the heat loads and heat source temperatures are investigated. The results revealed that MM and R124 are the best working fluids for the cascade and series system, respectively. A recuperated ORC in the series system improve the siloxane results, with MM as the best working fluid. Moreover, decreasing the ORC minimum pressure in the series system makes considerable improvement. | A multiobjective optimization of an organic Rankine cycle (ORC) evaporator, operating with toluene as the working fluid, is presented in this paper for waste heat recovery (WHR) from the exhaust gases of a 2 MW Jenbacher JMS 612 GS-N.L. gas internal combustion engine. Indirect evaporation between the exhaust gas and the organic fluid in the parallel plate heat exchanger (ITC2) implied irreversible heat transfer and high investment costs, which were considered as objective functions to be minimized. Energy and exergy balances were applied to the system components, in addition to the phenomenological equations in the ITC2, to calculate global energy indicators, such as the thermal efficiency of the configuration, the heat recovery efficiency, the overall energy conversion efficiency, the absolute increase of engine thermal efficiency, and the reduction of the break-specific fuel consumption of the system, of the system integrated with the gas engine. The results allowed calculation of the plate spacing, plate height, plate width, and chevron angle that minimized the investment cost and entropy generation of the equipment, reaching 22.04 m2 in the heat transfer area, 693.87 kW in the energy transfer by heat recovery from the exhaust gas, and 41.6% in the overall thermal efficiency of the ORC as a bottoming cycle for the engine. This type of result contributes to the inclusion of this technology in the industrial sector as a consequence of the improvement in thermal efficiency and economic viability. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,682 |
ARTICLE INFORMATION ABSTRACT Original Research Paper Received 07 April 2016 Accepted 02 June 2016 Available Online 02 July 2016 With the arrival of composite materials and because of their unique properties, ideas were presented in order to strengthen and improve their performance. The ideas were reason for building of Grid composite structures. These structures are widely used in the aerospace, missile and Marine industry because of their ideal mechanical properties: special stiffness and high strength against impact and fatigue. Grid composite plates are made from thin composite shell connected a series of composite ribs. Ribs network results in a significant increase in stiffness and strength of structure. In this research, experimental and numerical investigations of effect of Shape of ribs have been on flexural behavior of grid composite plates. For this purpose, three types of Grid plates were considered with triangle, square and rhombic ribs. For building these plates, silicone mold was designed and built and was also used for making plates from hand lay-up and hand-wound layer technique. Samples were subjected to threepoint bending test; for this purpose, the fixture was designed and built. From numerical solution of the problem and comparison of experimental results it was observed that there is very little difference between experimental and numerical results. Experimental results show that special flexural stiffness of plate with square rib is 1.92 and 1.88 plate with triangular and rhombic ribs, respectively. Also, the flexural strength of plate with square rib is 1.58 plate with triangular rib. Thus plate with square rib has the highest stiffness and bending strength. | Stiffened cylindrical shells are the major components of aerospace structures. In this study global buckling load for a generally cross and horizontal grid stiffened composite cylinder was determined. This was accomplished by developing an analytical model for determination of the equivalent stiffness parameters of a grid stiffened composite cylindrical shell. This was performed by taking out a unit cell and smearing the forces and moments due to the stiffeners onto the shell. Based on this analysis the extensional, coupling and bending matrices (A, B and D matrices, respectively) associated with the stiffeners were determined. This stiffness contribution of the stiffeners was superimposed with the stiffness contribution of the shell to obtain the equivalent stiffness parameters of the whole panel. Making use of the energy method the buckling load was solved for a particular stiffener configuration. Buckling test was also performed on a stiffened composite cylinder and compared with analytical results. Finally, using the analytical model developed, parametric analysis of some of the important design variables was performed and based on these results conclusions were drawn. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,683 |
MILS (Multiple Independent Levels of Security and Safety) is a high-assurance architecture for secure sharing of different security-level information. But the MILS security evaluation is facing a great challenge. Traditional Common Criteria (CC) method is not suitable for MILS system evaluation for its complexity, time consuming and qualitative description. To achieve quantitative security assessment, we proposes an AHP-GRAP based security evaluation model for MILS system within CC framework. AHP (Analytic Hierarchy Process) is used to obtain the weight of each component with respect to the final goal of the security evaluation. GRAP (Grey Relational Analytic Process) is adapted to analyze evaluation data to implement a quantitative integration evaluation. The new method overcomes the disadvantage of CC and realizes the quantitative description for MILS system security evaluation. The proposed method is used to evaluate the MILS system and the result shows that its security is Level 4. | Calculating arithmetic weighted average value of environmental quality comprehensive index is a common method in environmental quality comprehensive evaluation. The relative importance of each pollution factor in the Analytical Hierarchy Process (AHP) method comes from pooling expert opinions in general. Because expert opinions are based on their information and judgment criterion, it may lead to the uncertainty of determining weight. In order to overcome this uncertainty, an improved AHP method is developed. The process of the improved AHP method involves the following key procedures. First based on the environmental monitoring data of pollution factors two parameters yil and yi2 are calculated. Second the pollution factors are put in order according to the combinations of symbols and values of yi2 and yi2. Third the odd integers are given to pollution factors in light of seating order of factors. And forth the factor weights are achieved by the judgment matrix formed on the pair- wise comparison of factors. This shows that weights of pollution factors are completely related to the objective monitoring data through a standardization of procedure by the improved AHP method. The environmental comprehensive quality of sediment in Qinhuai River, Nanjing, China is evaluated by the method. The environmental quality comprehensive indices (EQCI) of sediment in 1996-2000 and 2001-2005 are 4.52 and 3.32, indicating that sediment contaminations decrease in the decade. Such results in accord with the fact bring the Qinhuai River under comprehensive control. However by the classical AHP method the EQCI of sediment may indicate that sediment contamination increases from 1996 to 2005. The judgment difference by experts leads to the uncertainty of assessment result. Therefore, the improved AHP method can avoid arbitrariness of subjective judgment and reflect objectively the changes of factors contribution to environment pollution in different periods or regions.School of Geographic and Oceanographic Sciences | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,684 |
A novel Y-branch waveguide for variable-ratio power dividing and transverse electrical-transverse magnetic (TE-TM) mode splitting depending on the applied voltage is presented. The Y-branch waveguide is formed by two closely coupled waveguides tabricated by nickel indiffusion (NI) and by magnesium-oxide induced lithium outdiffusion (MILO) in a y-cut lithium niobate (LiNbO3) substrate. The TE component of the randomly polarized light is tuned between these two waveguides, such that the device can be either a power divider or a mode splitter depending on the applied voltage. The measured TE mode extinction ratio is about 20 dB. | A novel wide-angle TE-TM mode splitter in a Z-cut lithium niobate is presented. A straight random polarization nickel-indiffused waveguide and a proton-exchanged waveguide bend with substrate prism on the bend corner were combined to form an asymmetric wide-angle Y-branch. The waveguide bend with substrate prism bends the TM wave to the proton-exchanged waveguide with large angle. Hence, the TE wave is left in the straight NI waveguide. The experimental results show that the splitting ratios are 26 dB for the TE mode and 28 dB for the TM mode even at a splitting angle of 7. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,685 |
This paper extends the 1-D analytic wavelet transform to the 2-D monogenic wavelet transform. The transformation requires care in its specification to ensure suitable transform coefficients are calculated, and it is constructed so that the wavelet transform may be considered as both local and monogenic. This is consistent with defining the transform as a real wavelet transform of a monogenic signal in analogy with the analytic wavelet transform. Classes of monogenic wavelets are proposed with suitable local properties. It is shown that the monogenic wavelet annihilates anti-monogenic signals, that the monogenic wavelet transform is phase-shift covariant and that the transform magnitude is phase-shift invariant. A simple form for the magnitude and orientation of the isotropic transform coefficients of a unidirectional signal when observed in a rotated frame of reference is derived. The monogenic wavelet ridges of local plane waves are given. | Specific kernel functions for the continuous wavelet transform in higher dimension and new continuous wavelet transforms are presented within the framework of Clifford analysis. Their relationship with the heat equation and the newly introduced wavelet differential equation is established. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,686 |
— Let E be an elliptic curve defined over a number field F and K/F a quadratic extension. For a point P ∈ E(F) that is a local trace for every completion of K/F, we find necessary and sufficient conditions for P to lie in the image of the global trace map. These conditions can then be used to determine whether a quadratic twist of E, as a genus one curve, has rational points. In the case of quadratic twists of genus one modular curves X0(N) with squarefree N , the existence of rational points corresponds to the existence of Q-curves of degree N defined over K. | Algebraic Varieties.- Algebraic Curves.- The Geometry of Elliptic Curves.- The Formal Group of Elliptic Curves.- Elliptic Curves over Finite Fields.- Elliptic Curves over C.- Elliptic Curves over Local Fields.- Elliptic Curves over Global Fields.- Integral Points on Elliptic Curves.-Computing the Mordell Weil Group.- Appendix A: Elliptic Curves in Characteristics.-Appendix B: Group Cohomology (H0 and H1). | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,687 |
This paper tests the impact of different types of management within family businesses on digital innovation related to Industry 4.0 investments, from a geographical perspective. The data set consists of 3,000 Italian manufacturing small- and medium–sized enterprises. Using probit models, the results show that while in the more advanced area (center-north) external management affects the propensity for innovation significantly, in the less developed area (Southern Italy) external management requires an additional and simultaneous investment in R&D to drive a firm’s innovation. This suggests that innovation policy should define incentives that also help enhance new management business models and take into account behavioral features of different firms in relation to the level of the development of the geographical areas in which they operate. | Although family-owned and managed firms are the predominant form of business organization in the world today, little systematic research exists on these companies. This paper builds upon insights found in the emerging literature on these enterprises and upon our own observations to provide a conceptual framework to better understand these complex organizations. We introduce the concept of the Bivalent Attributes—a unique, inherent feature of an organization that is the source of both advantages and disadvantages— to explain the dynamics of the family firm. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,688 |
Purpose ::: ::: ::: ::: ::: This paper aims to provide evidence that theory-based effects of role-identity cultivation stages on self-symbolizing consumption activities do exist. ::: ::: ::: ::: ::: Design/methodology/approach ::: ::: ::: ::: ::: Specific focus is placed upon differing motives between rookie versus veteran role-identity actors and how these differences lead to symbolic self-completion and self-retention behaviors. Effects of these motives are examined in the context of college student identity transitions. ::: ::: ::: ::: ::: Findings ::: ::: ::: ::: ::: Evidence is found for a pattern, whereby role-identity rookies with fewer role-identity-related possessions are more likely to self-symbolize the role-identity outwardly than veteran consumers having more role-identity-related resources, such as possessions. Self-retention via possessions is also more evident with rookies making the transition from one role-identity to the next, replacement role-identity. Findings are replicated for both readily available and favorite possessions related to a role-identity. ::: ::: ::: ::: ::: Research limitations/implications ::: ::: ::: ::: ::: Future role-identity research in marketing may miss unique and important insights without accounting for role-identity cultivation stage. ::: ::: ::: ::: ::: Practical implications ::: ::: ::: ::: ::: Current evidence highlights the importance of identity cultivation stage, symbolic self-completion and self-retention as factors to consider in understanding market segments associated with respective role-identities. ::: ::: ::: ::: ::: Originality/value ::: ::: ::: ::: ::: Extant research does not yet account for how consumption activities serving both symbolic and functional purposes support role-identity transitions. This inquiry is directed at contributing to this need. | People are drawn towards personally meaningful places. Seeing or remembering those places improves mood and supports wellbeing. But existing evidence relies on self-reports and comparisons with unpleasant places. Using brain imaging techniques, we examined reactions towards images of personally meaningful places, meaningful objects, neutral places and objects, and pre-validated (IAPS) images, among 19 volunteers (10 female) between 19 and 53 years old. A whole brain analysis showed that meaningful places and IAPS images elicited the largest response in the amygdala, associated with the processing of emotion. Similarly high activity was found for the medial prefrontal cortex (mPFC), associated with self-referential processing, emotional appraisal, and memory processing. This was not found for meaningful objects or neutral places. The parahippocampal place area (PPA) showed enhanced activity only to personally meaningful places. Personally meaningful places clearly evoke distinctive neurological responses supporting the importance of this holistic and complex concept for human wellbeing and urban planning. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,689 |
Data collected on 400 12-year-old English school children were used to examine relations between measures of intelligence, creativity and academic achievement. Complex multiple regression models, which included terms to account for the possible interaction and curvilinear relations between intelligence, creativity and academic achievement were used to construct regression surfaces. The surfaces showed that the traditional threshold hypothesis, which suggests that beyond a certain level of intelligence academic achievement is related increasingly to creativity and ceases to be related strongly to intelligence, was not supported. For some areas of academic performance the results suggest an alternate proposition, that creativity ceases to be related to achievement after a threshold level of intelligence has been reached. It was also found that at high levels of verbal ability, non-verbal ability and creativity appeared to have differential relations with academic achievement. | The major purpose of this study was to investigate the level of development of creative potential among Hong Kong secondary school students, and to examine the relationship between school banding and students' creativity. Students' creative potential was measured by the Test of Creative Thinking Drawing Production (TCT-DP). A sample of2,411 participants aged between 12-16 randomly selected from 23 secondary schools took part in the study. Results from this investigation were briefly compared with data obtained from studies in other cultural settings. Hong Kong students aged 12 and 13, irrespective of the school banding, achieved rather lower scores on the TCT-DP as compared | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,690 |
Psychology has long been an important component of the services provided in Canadian hospitals. Most major centres' interdisciplinary teams include a number of psychologists. Nonetheless, recent restructurings have resulted in substantial negative consequences to hospital psychology staff and to their accessibility by patients. This article outlines the impact of recent changes on the recruitment and retention of hospital psychologists and offers recommendations for organizational changes to assist in overcoming these problems. | Hospital restructuring in North America has involved re-engineering, downsizing, reorganizing, and remodeling of traditional hierarchical functional organizations into multisite programmatic conglomerates. The implications for professional disciplines have been dramatic in that departments such as social work have been dismantled and social work practice has come under the domain of program managers representing multiple disciplines. In this study 12 hospitals in Ontario, Canada, that were studied in the early stages of restructuring in 1995 expanded to 22 sites by 1999. The effect of the mergers and moves to program management on the social work profession was examined. The key findings are that social work line positions were not lost, but accountability and recruitment were no longer in the hands of the discipline. These findings suggest that it is more critical now than ever for social workers to champion their contributions to health. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,691 |
The 11 original articles on emotional/psychological maltreatment are considered in terms of their addition to the litrature base, highlighting important conceptual and definitional issues, and signaling of future directions for research. In his commentary, it is argued that epidemiological work on normative parenting behaviors across child development is eeded to craft threshold parameters. Given the growing database on the contribution – including unique – of emotional buse and emotional neglect on impairment, consistent assessment consideration needs to be given in clinical child, parnting, and family assessment situations. With further clarity from population studies, better prevention targets can be solated. Although impairment may emerge temporally later than the maltreatment, cessation of emotional maltreatment is n imperative. Children and adolescents develop in context, and that context is primarily social and emotional. The impact f emotional maltreatment on self-care and physical health remains to be considered more fully. Psychological maltreatment may be thought of as a unifying concept that embodies the most significant components of all orms of child maltreatment. . .a repeated pattern of caregiver behavior or extreme incident(s) that convey. . .children. . .are orthless, flawed, unloved, unwanted, endangered, or only of value in meeting another’s needs. . .. (Hart et al., 2011, pp. 25–126). | Objective To examine evidence available in large-scale North American datasets on child abuse and neglect that can assist in understanding the complexities of child protection case classifications. Methods A review of child abuse and neglect data from large North American epidemiological studies including the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS), the National Child Abuse and Neglect Data System (NCANDS), and the National Incidence Studies of Reported Child Abuse and Neglect (NIS). Results The authors of this paper argue that recent evidence from large North American epidemiological studies examining the incidence of child abuse and neglect demonstrate that children and families identified as being at risk of maltreatment present with as many household and caregiver concerns as investigations that are substantiated. Conclusions In order to continue to develop appropriate services and policies for vulnerable children the authors urge continue definitional clarity for research in child maltreatment that considers the exemplars or indicators of categories, in tandem with parental and child characteristics which can provide one source of evidence-basis to meaningful child protection case classifications. Continued monitoring, refined by the dilemmas faced in practice, are critical for a continued public health investment in children's well-being, predicated upon upholding children's rights. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,692 |
A case-control study was carried out in Nottingham Health District, to establish whether children under five years of age admitted to hospital after a accidental injury were more likely to have previously attended the accident and emergency (A&E) department than community controls. The subjects were 342 case-control pairs matched on sex and date of birth, consisting of children under five years resident in the Health District, and the main exposure measures were attendance at the A&E department before the case's first admission, type of injury and number of earlier attendances. It was found that, after adjusting for social deprivation score and proximity to hospital, children who had been admitted after an accidental injury were twice as likely to have attended the A&E department than community controls, and were more likely to have had more than one earlier attendance. Odds ratios were significantly raised for soft-tissue injuries and lacerations. It is concluded that accidental injuries in pre-school children that require attendance at the A&E department predict accidental injuries requiring admission. Making attendances at A&E departments notifiable to health visitors would facilitate the undertaking of accident prevention work. Language: en | OBJECTIVE ::: To examine the relationship between risk factors for childhood unintentional injury and injury outcome and to assess the feasibility of using risk factors to identify children at high risk of injury. ::: ::: ::: SETTING ::: One general practice in Nottingham, UK. ::: ::: ::: METHOD ::: A postal questionnaire survey to all parents of children registered with the practice (n = 771) to obtain data on risk and sociodemographic factors. All children still registered with the practice one year later were followed up for occurrence of a medically attended injury. ::: ::: ::: RESULTS ::: The response rate was 78%. The injury rate over the follow up year was 246 injuries per 1000 children. Previous medically attended injury was associated with each of the injury outcomes (odds ratio (confidence interval) for all attendances, 2.33 (1.37 to 4.05); for accident and emergency attendances, 2.27 (1.15 to 4.4); and for primary health care team attendances, 2.58 (1.33 to 5.0)). Male sex was associated only with accident and emergency department attendance (odds ratio 2.13 (1.06 to 4.2)). Maternal age and previous injury were associated with a higher number of injuries in the subsequent year on univariate and multivariate analyses. The sensitivity and positive predictive value of the risk factors were low, except for previous injury and male sex. The number of children needing an injury prevention intervention to prevent one injury as identified by the risk factors was not significantly different from that required if a whole population approach were to be used. ::: ::: ::: CONCLUSION ::: Primary care based injury prevention programmes, at present, should not be targeted at children identified as being at 'high risk' of injury. Nevertheless, a larger study using a wider cross section of the population is needed to address this issue further. | Berzelius failed to make use of Faraday's electrochemical laws in his laborious determination of equivalent weights. | eng_Latn | 14,693 |
This article provides a macro-perspective on China's repositioning in the global and regional cultural economy, and in doing so questions the structural impact of past practices on future export aspirations. Whereas most accounts of China's media are predicated on top-down control models, the article proposes a media development framework appropriate to China' s aspirations in the first decade of the twenty-first century. The framework is most relevant to those creative content industries in which sunk costs – that is, one-off costs of creative content development – are more than 50 percent of total outlay. Starting from a low base – and constrained by a legacy of state censorship and widespread intellectual property abuse – China aspires to move from ‘made in China’ to ‘created in China’. | This article considers new approaches to media industry development and the field of Asian media studies. It argues that new patterns of integration have emerged within the global media economy. The rise of East Asian ‘newcomers’ such as South Korea, Taiwan and the People’s Republic of China has come about from a combination of institutional realignment and strategic (often state-assisted) responses to regional industrial growth. The article proposes a five-part framework of international exchange that encapsulates challenges confronting mid-level markets that are aspiring to target international content markets. The framework is also a critique of the US-centric approaches that argue that global integration effects are normatively disadvantageous to ‘peripheral’ industries and societies. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,694 |
The applicability of the definition of the borderline syndrome to children is questioned, as is the traditional view that its etiology lies in the type of interaction the child had with its parents. The redefinition of the syndrome of borderline proposed in prior publications using the conceptual framework of self psychology opens the door to new treatment approaches. This article addresses some of the issues related to these treatment approaches. | Although a growing body of literature shows that perceived family support (PFS) influences self-esteem in adults with dyslexia, little empirical attention has been given to the mechanisms through which this effect operates across early, middle, and late adulthood. The present study examined the mediational effect of emotional experience with dyslexia (EED, emotions stemming from living with an often misunderstood and stereotyped learning difficulty) that may account for the empirical link between PFS and self-esteem. The participants were 224 adults with self-identified dyslexia (average age=49.1years, males=64.7%) who participated in a Web-based survey. A bootstrapping analysis (a new approach to mediational analysis) revealed that EED mediated the relationship between PFS and self-esteem across the entire sample and in early and middle adulthood. The mediational effect was strongest in early adulthood. Implications of these findings are discussed. Copyright © 2011 John Wiley & Sons, Ltd. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,695 |
This chapter examines evolving relationships between the city and agriculture, focussing on the re-emergence of urban agriculture as a "new" urban typology. It traces the drivers and motivations that have led to this phenomenon and that together constitute a "wicked problem". Key concepts and protagonists of urban agriculture in the Global North are presented in the context of to popular desires in relation to food production and food culture. The concept of Continuous Productive Urban Landscape (CPUL) is introduced as an example of an urban design strategy capable of synthesising complex cultural, environmental and spatial objectives of the increasing practice of urban agriculture. It is argued that the idea of Second Nature could provide a cultural framework for articulating underlying desires within popular culture that are supportive of the wider-spread introduction of productive landscapes into cities. The chapter concludes with a review of issues affecting the success and reliability of enterprises that have pioneered the creation of urban agriculture initiatives within Germany, the UK and the USA. | Keywords: landscape infrastructure ; agrarian urbanism ; rural urban metabolism ; intergenerational legacy Reference EPFL-CHAPTER-204895 Record created on 2015-01-30, modified on 2016-08-09 | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,696 |
A self-administered, confidential survey of respondents' history of selected sexually transmitted disease (STD) was conducted in 1987-88 among adults enrolled in a multicenter study of cardiovascular disease. Respondents (and response rates) included 535 white men (78 percent), 694 white women (89 percent), 262 black men (48 percent), and 472 black women (64 percent), ages 21 to 40 years at the time of the survey. Among those who were heterosexually active, 43 percent of black women, 37 percent of black men, 33 percent of white women, and 21 percent of white men reported ever having had at least one STD in the survey. A history of syphilis or gonorrhea was more commonly reported by blacks than whites; a history of genital herpes, chlamydia, or genital warts was more commonly reported by women than men. Independent risk factors for having had at least one STD in the survey included female sex; use of cocaine, amphetamines, or opiates; and lifetime number of sex partners. The number of sex partners was the most predictive risk factor. Black race was a significant marker for other, unidentified STD risk factors. The data show a high prevalence of a lifetime history of STD among young heterosexual urban U.S. adults with possible implications for the future spread of human immunodeficiency virus infection. | INTRODUCTION: Black men who have sex with men (MSM) and women but who do not identify as gay or disclose their bisexual activities to main female partners, also known as men "on the down-low," have been cited as the main reason for the increase in HIV infections in black women. METHODS: Three online databases (PsychInfo, MEDLINE and AIDSLINE) were searched for scientific articles related to men on the down-low. A total of 24 articles and two conference abstracts were selected for review. RESULTS: Data from existing studies of MSM reveal low agreement between professed sexual identity and corresponding sexual behavior among black and other MSM; show that black MSM are more likely than MSM of other racial or ethnic groups to be bisexually active or identified; and, compared with white MSM, are less likely to disclose their bisexual or homosexual activities to others. However, black MSM who do not disclose their homosexual or bisexual activities engage in a lower prevalence of HIV risks than black MSM who do disclose; and black men who are currently bisexually active account for a very small proportion of the overall population of black men (2%). CONCLUSION: The high prevalence of HIV in the black community and the greater likelihood of bisexuality among black men place heterosexual black women at risk for HIV infection. However, the contribution of high-risk heterosexual black men to the rising HIV caseload among black women has been largely ignored. Future research must evaluate the relative contributions of bisexual men and exclusively heterosexual black men to HIV cases among black women. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,697 |
Drawing on qualitative data, this paper examines developments in human resource and employment policies and practices among a sample of joint venture and wholly owned foreign enterprises operating in China. The research reveals that the effects of parent company nationality and ownership form were most visible in the areas of remuneration, worker representation and aspects of employee selection. There was, however, little overt involvement of multinational parent companies in the management of human resources of their Chinese operations. The trend was towards indirect reporting relationships with regional sub-units of multinational companies rather than direct links with the parent headquarters. Overall, these intermediate sub-units were playing an important role in the integration of Chinese business units in the global management systems of multinational companies. | China’s rapid economic growth has presented numerous opportunities and challenges for foreign firms there. Many large corporations have established a China centre to coordinate and control their operations in the country. As firms have increased their presence in China, their concerns are increasingly focused on implementing successful management practices and strategies. This article describes the challenges and difficulties that multinational companies faced in Chinese market. It analyses roles played by the human resource function in these China, culture differences, social environment and other factors. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,698 |
Given the morbidity and difficulty of treating psychotic disorders, including schizophrenia, there has been a move toward identifying and treating adolescents and young adults who appear to be clinically at risk or “prodromal” to psychosis. The field now has greater specificity in identification, with rates of 40–50% conversion to frank psychosis within 1–2 years. There is further evidence that medications and other treatments may have some efficacy for “prodromal” patients, though with variable side effects. However, controversy remains about some of the inherent risks in prodromal research, such as medication exposure and stigma among false-positives. In this paper, we add to this discussion through an analysis of ethics in prodromal research from the more established field of predictive genetic testing. Issues are raised about the effects of information on patients, families, and institutions, as well as future insurability, the limits of confidentiality (as it relies on discretion of patients and families), the autonomy of minors with psychiatric symptoms, and even the risks for the true-positive patient. | BACKGROUND: Most disability produced by psychotic illnesses, especially schizophrenia, develops during the prepsychotic period, creating a case for intervention during this period. However, only recently has it been possible to engage people in treatment during this phase. METHODS: A randomized controlled trial compared 2 interventions in 59 patients at incipient risk of progression to first-episode psychosis. We termed this group ultra-high risk to emphasize the enhanced risk vs conventional genetic high-risk studies. Needs-based intervention was compared with specific preventive intervention comprising low-dose risperidone therapy (mean dosage, 1.3 mg/d) and cognitive behavior therapy. Treatment was provided for 6 months, after which all patients were offered ongoing needs-based intervention. Assessments were performed at baseline, 6 months, and 12 months. RESULTS: By the end of treatment, 10 of 28 people who received needs-based intervention progressed to first-episode psychosis vs 3 of 31 from the specific preventive intervention group (P=.03). After 6-month follow-up, another 3 people in the specific preventive intervention group became psychotic, and with intention-to-treat analysis, the difference was no longer significant (P=.24). However, for risperidone therapy-adherent patients in the specific preventive intervention group, protection against progression extended for 6 months after cessation of risperidone use. CONCLUSIONS: More specific pharmacotherapy and psychotherapy reduces the risk of early transition to psychosis in young people at ultra-high risk, although their relative contributions could not be determined. This represents at least delay in onset (prevalence reduction), and possibly some reduction in incidence. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,699 |
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