Constrictive pleuropericarditis: a dominant clinical manifestation in Whipple’s disease

Background: Whipple’s disease is a rare, multisystemic, chronic infectious disease which classically presents as a wasting illness characterized by polyarthralgia, diarrhea, fever, and lymphadenopathy. Pleuropericardial involvement is a common pathologic finding in patients with Whipple’s disease, but rarely causes clinical symptoms. We report the first case of severe fibrosing pleuropericarditis necessitating pleural decortication in a patient with Whipple’s disease. Case presentation: Our patient, an elderly gentleman, had a chronic inflammatory illness dominated by constrictive pericarditis and later severe fibrosing pleuritis associated with a mildly elevated serum IgG4 level. A pericardial biopsy showed dense fibrosis without IgG4 plasmacytic infiltration. The patient received immunosuppressive therapy for possible IgG4-related disease. His poor response to this therapy prompted a re-examination of the diagnosis, including a request for the pericardial biopsy tissue to be stained for Tropheryma whipplei. Conclusions: Despite a high prevalence of pleuropericardial involvement in Whipple’s disease, constrictive pleuropericarditis is rare, particularly as the dominant disease manifestation. The diagnosis of Whipple’s disease is often delayed in such atypical presentations since the etiologic agent, Tropheryma whipplei, is not routinely sought in histopathology specimens of pleura or pericardium. A diagnosis of Whipple’s disease should be considered in middle-aged or elderly men with polyarthralgia and constrictive pericarditis, even in the absence of gastrointestinal symptoms. Although Tropheryma whipplei PCR has limited sensitivity and specificity, especially in the analysis of peripheral blood samples, it may have diagnostic value in inflammatory disorders of uncertain etiology, including cases of polyserositis. The optimal approach to managing constrictive pericarditis in patients with Whipple’s disease is uncertain, but limited clinical experience suggests that a combination of pericardiectomy and antibiotic therapy is of benefit

Influence of interdiffusion on multilayered gradient refractive index (GRIN) lens materials

a b s t r a c t The interdiffusion of two materials used to fabricate polymeric gradient refractive index (GRIN) lenses was examined by varying contact time during multilayer films co-extrusion composed of alternating poly(methylmethacrylate) (PMMA) and poly(styrene-co-acrylonitrile) with 17 mol% acrylonitrile (SAN17). The model applied successfully described their interdiffusion, and a reasonable mutual diffusion coefficient of 7.0 Â 10 À13 m 2 /s was determined. Atomic force microscopy confirmed good agreement between modeled profiles and actual layer structure, and optical properties were investigated. Films with contact times of 160 s exhibited multiple refractive indices, while films with longer contact times, showed single refractive indices that followed an additive line. Though a single additive value requires layers a quarter-wavelength of light, these films exhibit such behavior with thicknesses 5Â greater than expected, though layer resolution is still present. Using the model profiles, it was determined that only a 1% reduction in material purity is required to reduce the effective layer thickness

Bigger, Better, Faster, More at the LHC

Multijet plus missing energy searches provide universal coverage for theories that have new colored particles that decay into a dark matter candidate and jets. These signals appear at the LHC further out on the missing energy tail than two-to-two scattering indicates. The simplicity of the searches at the LHC contrasts sharply with the Tevatron where more elaborate searches are necessary to separate signal from background. The searches presented in this article effectively distinguish signal from background for any theory where the LSP is a daughter or granddaughter of the pair-produced colored parent particle without ever having to consider missing energies less than 400 GeV.Comment: 26 pages, 8 Figures. Minor textual changes, typos fixed and references adde

To What Do I Owe This Visit? The Drawbacks and Benefits of In-Role and Non-Role Intrusions

Workplace intrusions—unexpected encounters initiated by another person that disrupt an individual’s work—are generally characterized as negative experiences that deplete resources, increase role and information overload, and promote strain. In contrast, our research argues that intrusions may also provide benefits to the employees who are intruded upon. Taking a multistudy approach, we investigate how intrusions impact the extent to which employees engage in their own work—work engagement—and the extent to which they engage in work with others—collaboration. We also investigate the indirect effects of intrusions on employees’ task-focused and person-focused citizenship behavior through these mechanisms. We tested our predictions with a within-person experimental critical incident study (Study 1), an experiment (Study 2), and an experience-sampling methodology study with a sample of scientists involved in research and development (Study 3). Our research investigates the dynamics of various types of workplace intrusions, with results suggesting that intrusions may lead to beneficial employee outcomes in addition to the adverse outcomes previously demonstrated in the literature. Given the ubiquitous nature of intrusions in organizations, our findings have both theoretical and practical significance

Supersymmetric Relations Among Electromagnetic Dipole Operators

Supersymmetric contributions to all leptonic electromagnetic dipole operators have essentially identical diagramatic structure. With approximate slepton universality this allows the muon anomalous magnetic moment to be related to the electron electric dipole moment in terms of supersymmetric phases, and to radiative flavor changing lepton decays in terms of small violations of slepton universality. If the current discrepancy between the measured and Standard Model values of the muon anomalous magnetic moment is due to supersymmetry, the current bound on the electron electric dipole moment then implies that the phase of the electric dipole operator is less than $2 \times 10^{-3}$. Likewise the current bound on $\mu \to e \gamma$ decay implies that the fractional selectron-smuon mixing in the left-left mass squared matrix, \delta m_{\smuon \selectron}^2 / m_{\slepton}^2, is less than $10^{-4}$. These relations and constraints are fairly insensitive to details of the superpartner spectrum for moderate to large $\tan \beta$.Comment: Latex, 38 pages, 2 figure

Diagnosing Spin at the LHC via Vector Boson Fusion

We propose a new technique for determining the spin of new massive particles that might be discovered at the Large Hadron Collider. The method relies on pair-production of the new particles in a kinematic regime where the vector boson fusion production mechanism is enhanced. For this regime, we show that the distribution of the leading jets as a function of their relative azimuthal angle can be used to distinguish spin-0 from spin-1/2 particles. We illustrate this effect by considering the particular cases of (i) strongly-interacting, stable particles and (ii) supersymmetric particles carrying color charge. We argue that this method should be applicable in a wide range of new physics scenarios.Comment: 5 pages, 4 figure

Increasing confidence and changing behaviors in primary care providers engaged in genetic counselling.

BackgroundScreening and counseling for genetic conditions is an increasingly important part of primary care practice, particularly given the paucity of genetic counselors in the United States. However, primary care physicians (PCPs) often have an inadequate understanding of evidence-based screening; communication approaches that encourage shared decision-making; ethical, legal, and social implication (ELSI) issues related to screening for genetic mutations; and the basics of clinical genetics. This study explored whether an interactive, web-based genetics curriculum directed at PCPs in non-academic primary care settings was superior at changing practice knowledge, attitudes, and behaviors when compared to a traditional educational approach, particularly when discussing common genetic conditions.MethodsOne hundred twenty one PCPs in California and Pennsylvania physician practices were randomized to either an Intervention Group (IG) or Control Group (CG). IG physicians completed a 6 h interactive web-based curriculum covering communication skills, basics of genetic testing, risk assessment, ELSI issues and practice behaviors. CG physicians were provided with a traditional approach to Continuing Medical Education (CME) (clinical review articles) offering equivalent information.ResultsPCPs in the Intervention Group showed greater increases in knowledge compared to the Control Group. Intervention PCPs were also more satisfied with the educational materials, and more confident in their genetics knowledge and skills compared to those receiving traditional CME materials. Intervention PCPs felt that the web-based curriculum covered medical management, genetics, and ELSI issues significantly better than did the Control Group, and in comparison with traditional curricula. The Intervention Group felt the online tools offered several advantages, and engaged in better shared decision making with standardized patients, however, there was no difference in behavior change between groups with regard to increases in ELSI discussions between PCPs and patients.ConclusionWhile our intervention was deemed more enjoyable, demonstrated significant factual learning and retention, and increased shared decision making practices, there were few differences in behavior changes around ELSI discussions. Unfortunately, barriers to implementing behavior change in clinical genetics is not unique to our intervention. Perhaps the missing element is that busy physicians need systems-level support to engage in meaningful discussions around genetics issues. The next step in promoting active engagement between doctors and patients may be to put into place the tools needed for PCPs to easily access the materials they need at the point-of-care to engage in joint discussions around clinical genetics

Physics Opportunities of e+e- Linear Colliders

We describe the anticipated experimental program of an e+e- linear collider in the energy range 500 GeV -- 1.5 TeV. We begin with a description of current collider designs and the expected experimental environment. We then discuss precision studies of the W boson and top quark. Finally, we review the range of models proposed to explain the physics of electroweak symmetry breaking and show, for each case, the central role that the linear collider experiments will play in elucidating this physics. (to appear in Annual Reviews of Nuclear and Particle Science)Comment: 93 pages, latex + 23 figures; typos corrections + 1 reference adde

Space-based research in fundamental physics and quantum technologies

Space-based experiments today can uniquely address important questions related to the fundamental laws of Nature. In particular, high-accuracy physics experiments in space can test relativistic gravity and probe the physics beyond the Standard Model; they can perform direct detection of gravitational waves and are naturally suited for precision investigations in cosmology and astroparticle physics. In addition, atomic physics has recently shown substantial progress in the development of optical clocks and atom interferometers. If placed in space, these instruments could turn into powerful high-resolution quantum sensors greatly benefiting fundamental physics. We discuss the current status of space-based research in fundamental physics, its discovery potential, and its importance for modern science. We offer a set of recommendations to be considered by the upcoming National Academy of Sciences' Decadal Survey in Astronomy and Astrophysics. In our opinion, the Decadal Survey should include space-based research in fundamental physics as one of its focus areas. We recommend establishing an Astronomy and Astrophysics Advisory Committee's interagency ``Fundamental Physics Task Force'' to assess the status of both ground- and space-based efforts in the field, to identify the most important objectives, and to suggest the best ways to organize the work of several federal agencies involved. We also recommend establishing a new NASA-led interagency program in fundamental physics that will consolidate new technologies, prepare key instruments for future space missions, and build a strong scientific and engineering community. Our goal is to expand NASA's science objectives in space by including ``laboratory research in fundamental physics'' as an element in agency's ongoing space research efforts.Comment: a white paper, revtex, 27 pages, updated bibliograph

Spin Dependence of Massive Lepton Pair Production in Proton-Proton Collisions

We calculate the transverse momentum distribution for the production of massive lepton-pairs in longitudinally polarized proton-proton reactions at collider energies within the context of perturbative quantum chromodynamics. For values of the transverse momentum Q_T greater than roughly half the pair mass Q, Q_T > Q/2, we show that the differential cross section is dominated by subprocesses initiated by incident gluons, provided that the polarized gluon density is not too small. Massive lepton-pair differential cross sections should be a good source of independent constraints on the polarized gluon density, free from the experimental and theoretical complications of photon isolation that beset studies of prompt photon production. We provide predictions for the spin-averaged and spin-dependent differential cross sections as a function of Q_T at energies relevant for the Relativistic Heavy Ion Collider (RHIC) at Brookhaven, and we compare these with predictions for real prompt photon production.Comment: 34 pages, RevTeX including 17 figures in .ps file