Diagnosis of a Chiari Malformation After a Concussion in a Junior College Football Player With a History of Chronic Headaches: A Case Report

The purpose of this report is to present the case of a National Junior Collegiate Athletic Association football player diagnosed with Chiari malformation postconcussion. A Chiari malformation is characterized by the cerebellum presenting below the level of the foramen. The uniqueness of this case stems from the patient’s health history, length of symptoms, and diagnosis. The effectiveness of treatment options, and the primary means to reduce the risk of catastrophic head injury in those with Chiari malformations are debatable. Clinicians should be familiar with the potential for the presence of a Chiari malformation with persistent symptoms postconcussion

A hypothesis-generating study to evaluate platelet activity in diabetics with chronic kidney disease

Background It is well described that diabetes mellitus is a hypercoagulable state. It is also known that patients with renal dysfunction have impaired platelet aggregation and function. It is not well described how renal dysfunction affects the hypercoagulability associated with diabetes. This post-hoc sub-group analysis compares platelet function, clot structure and thrombin generation time at baseline, and following enoxaparin exposure in three groups of subjects. Methods 30 total subjects were evaluated in the three groups: Group I: normal controls (n = 10), Group II: subjects with renal dysfunction but without diabetes (n = 13), and Group III: subjects with concomitant diabetes and renal dysfunction (n = 7). For each subject, platelet contractile force (PCF), clot elastic modulus (CEM) and thrombin generation time (TGT) were simultaneously measured in whole blood at baseline, and following increasing enoxaparin antifactor Xa activity exposure. The group means for each parameter were determined and compared using one-way analysis of variance, with post-hoc Tukey-Kramer test. Results At baseline, subjects in Group III (diabetics with concomitant renal dysfunction) display significantly enhanced platelet activity, as measured by PCF (p = 0.003) and CEM (p = 0.03), relative to the non-diabetic Groups I and II. Subjects in Group II (renal dysfunction without diabetes) had significantly prolonged TGT values relative to controls when the antifactor Xa activity concentration reached 0.5 (p = 0.007), 1.0 (p = 0.005) and 3.0 IU/mL (p \u3c 0.0001), respectively. There were no differences between Group II and Group III with respect to TGT at these antifactor Xa activity concentrations. When the antifactor Xa activity concentration reached 3.0 IU/mL, Groups II and III formed significantly less rigid blood clots (CEM p = 0.003) and also trended toward reduced PCF (p = 0.06) relative to Group I. Conclusion This hypothesis-generating sub-group analysis suggests that at baseline, patients with concomitant diabetes and renal dysfunction have significantly enhanced platelet activity (PCF), and form more rigid blood clots (CEM) compared to controls and subjects with renal dysfunction but no diabetes. This may suggest that the presence of renal dysfunction does not ameliorate the hypercoagulable state associated with diabetes. Secondly, it appears that subjects with renal dysfunction but without diabetes have an enhanced response to enoxaparin relative to controls

Utilization Patterns of IV Iron and Erythropoiesis Stimulating Agents in Anemic Chronic Kidney Disease Patients: A Multihospital Study

Intravenous (IV) iron and Erythropoiesis Stimulating Agents (ESAs) are recommended for anemia management in chronic kidney disease (CKD). This retrospective cohort study analyzed utilization patterns of IV iron and ESA in patients over 18 years of age admitted to University Health System Hospitals with a primary or secondary diagnosis of CKD between January 1, 2006 to December 31, 2008. A clustered binomial logistic regression using the GEE methodology was used to identify predictors of IV iron utilization. Only 8% (n = 6678) of CKD patients on ESA therapy received IV iron supplementation in university hospitals. Those receiving iron used significantly less amounts of ESAs. Patient demographics (age, race, primary payer), patient clinical conditions (admission status, severity of illness, dialysis status), and physician specialty were identified as predictors of IV iron use in CKD patients. Use of IV iron with ESAs was low despite recommendations from consensus guidelines. The low treatment rate of IV iron represents a gap in treatment practices and signals an opportunity for healthcare improvement in CKD anemic patients

Sex differences in condition dependence of natal dispersal in a large herbivore: dispersal propensity and distance are decoupled

International audienceEvolution should favour plasticity in dispersal decisions in response to spatial heterogeneity in social and environmental contexts. Sex differences in individual optimization of dispersal decisions are poorly documented in mammals, because species where both sexes commonly disperse are rare. To elucidate the sex-specific drivers governing dispersal, we investigated sex differences in condition dependence in the propensity and distance of natal dispersal in one such species, the roe deer, using fine-scale monitoring of 146 GPS-collared juveniles in an intensively monitored population in southwest France. Dispersal propensity increased with body mass in males such that 36% of light individuals dispersed, whereas 62% of heavy individuals did so, but there was no evidence for condition dependence in dispersal propensity among females. By contrast, dispersal distance increased with body mass at a similar rate in both sexes such that heavy dispersers travelled around twice as far as light dispersers. Sex differences in the strength of condition-dependent dispersal may result from different selection pressures acting on the behaviour of males and females. We suggest that females disperse prior to habitat saturation being reached, likely in relation to the risk of inbreeding. By contrast, natal dispersal in males is likely governed by competitive exclusion through male–male competition for breeding opportunities in this strongly territorial mammal. Our study is, to our knowledge, a first demonstration that condition dependence in dispersal propensity and dispersal distance may be decoupled, indicating contrasting selection pressures drive the behavioural decisions of whether or not to leave the natal range, and where to settle

Bounded Expectations: Resource Analysis for Probabilistic Programs

This paper presents a new static analysis for deriving upper bounds on the expected resource consumption of probabilistic programs. The analysis is fully automatic and derives symbolic bounds that are multivariate polynomials of the inputs. The new technique combines manual state-of-the-art reasoning techniques for probabilistic programs with an effective method for automatic resource-bound analysis of deterministic programs. It can be seen as both, an extension of automatic amortized resource analysis (AARA) to probabilistic programs and an automation of manual reasoning for probabilistic programs that is based on weakest preconditions. As a result, bound inference can be reduced to off-the-shelf LP solving in many cases and automatically-derived bounds can be interactively extended with standard program logics if the automation fails. Building on existing work, the soundness of the analysis is proved with respect to an operational semantics that is based on Markov decision processes. The effectiveness of the technique is demonstrated with a prototype implementation that is used to automatically analyze 39 challenging probabilistic programs and randomized algorithms. Experimental results indicate that the derived constant factors in the bounds are very precise and even optimal for many programs

Optomagnetic composite medium with conducting nanoelements

A new type of metal-dielectric composites has been proposed that is characterised by a resonance-like behaviour of the effective permeability in the infrared and visible spectral ranges. This material can be referred to as optomagnetic medium. The analytical formalism developed is based on solving the scattering problem for considered inclusions with impedance boundary condition, which yields the current and charge distributions within the inclusions. The presence of the effective magnetic permeability and its resonant properties lead to novel optical effects and open new possible applications.Comment: 48 pages, 13 figures. accepted to Phys. Rev. B; to appear vol. 66, 200

Strong Interactions of Single Atoms and Photons near a Dielectric Boundary

Modern research in optical physics has achieved quantum control of strong interactions between a single atom and one photon within the setting of cavity quantum electrodynamics (cQED). However, to move beyond current proof-of-principle experiments involving one or two conventional optical cavities to more complex scalable systems that employ N >> 1 microscopic resonators requires the localization of individual atoms on distance scales < 100 nm from a resonator's surface. In this regime an atom can be strongly coupled to a single intracavity photon while at the same time experiencing significant radiative interactions with the dielectric boundaries of the resonator. Here, we report an initial step into this new regime of cQED by way of real-time detection and high-bandwidth feedback to select and monitor single Cesium atoms localized ~100 nm from the surface of a micro-toroidal optical resonator. We employ strong radiative interactions of atom and cavity field to probe atomic motion through the evanescent field of the resonator. Direct temporal and spectral measurements reveal both the significant role of Casimir-Polder attraction and the manifestly quantum nature of the atom-cavity dynamics. Our work sets the stage for trapping atoms near micro- and nano-scopic optical resonators for applications in quantum information science, including the creation of scalable quantum networks composed of many atom-cavity systems that coherently interact via coherent exchanges of single photons.Comment: 8 pages, 5 figures, Supplemental Information included as ancillary fil

On the lease rate, convenience yield and speculative effects in the gold futures market

By examining data on the gold forward offered rate (GOFO) and lease rates over the period 1996- 2009, we conclude that the convenience yield of gold is better approximated by the lease rate than the interest-adjusted spread of Fama & French (1983). Using the latter quantity, we study the relationship between gold leasing and the level of COMEX discretionary inventory and exhibit that lease rates are negatively related to inventories. We also show that Futures prices have increasingly exceeded forward prices over the period, and this effect increases with the speculative pressure and the maturity of the contracts

Fast cavity-enhanced atom detection with low noise and high fidelity

Cavity quantum electrodynamics describes the fundamental interactions between light and matter, and how they can be controlled by shaping the local environment. For example, optical microcavities allow high-efficiency detection and manipulation of single atoms. In this regime fluctuations of atom number are on the order of the mean number, which can lead to signal fluctuations in excess of the noise on the incident probe field. Conversely, we demonstrate that nonlinearities and multi-atom statistics can together serve to suppress the effects of atomic fluctuations when making local density measurements on clouds of cold atoms. We measure atom densities below 1 per cavity mode volume near the photon shot-noise limit. This is in direct contrast to previous experiments where fluctuations in atom number contribute significantly to the noise. Atom detection is shown to be fast and efficient, reaching fidelities in excess of 97% after 10 us and 99.9% after 30 us.Comment: 7 pages, 4 figures, 1 table; extensive changes to format and discussion according to referee comments; published in Nature Communications with open acces