Fever of Unknown Origin: An Unusual Case

Recurrent episodic fever of unknown origin (FUO) arising from tumour of the gastrointestinal tract is rare. We report an otherwise healthy 62-year-old man with recurrent circumscribed bouts of fever and raised CRP for 3 years who has remained well and fever-free 2 years after the removal of a well-differentiated adenocarcinoma of the colon. Occult colonic neoplasm should be considered and sought when routine investigations for FUO are negative

Insular Carcinoma of Thyroid Presenting as a Giant Skull Lesion: A Dilemma in Treatment.

Thyroid surgeons are becoming increasingly more aware of a histologically distinct subset of thyroid carcinoma whose classification falls between well-differentiated and anaplastic carcinomas with respect to both cell differentiation and clinical behavior. This subtype of tumors has been categorized as poorly differentiated or insular carcinoma, based on its characteristic cell groupings. Although the differentiation of insular carcinoma from other thyroid carcinomas has important prognostic and therapeutic significance, relatively little about insular carcinoma has been published in the otolaryngology literature. In this article, we discuss a case of insular carcinoma of thyroid presenting with concurrent distant metastasis to skull, lung, ribs, and inguinal region with review of the literature. We conclude that insular thyroid carcinoma warrants aggressive management with total thyroidectomy and excision of accessible giant lesion followed by radioactive iodine ablation of any remaining thyroid tissue

Pion-less effective field theory for atomic nuclei and lattice nuclei

We compute the medium-mass nuclei $^{16}$O and $^{40}$Ca using pionless effective field theory (EFT) at next-to-leading order (NLO). The low-energy coefficients of the EFT Hamiltonian are adjusted to experimantal data for nuclei with mass numbers $A=2$ and $3$, or alternatively to results from lattice quantum chromodynamics (QCD) at an unphysical pion mass of 806 MeV. The EFT is implemented through a discrete variable representation in the harmonic oscillator basis. This approach ensures rapid convergence with respect to the size of the model space and facilitates the computation of medium-mass nuclei. At NLO the nuclei $^{16}$O and $^{40}$Ca are bound with respect to decay into alpha particles. Binding energies per nucleon are 9-10 MeV and 30-40 MeV at pion masses of 140 MeV and 806 MeV, respectively.Comment: 26 page

A New Simulation Metric to Determine Safe Environments and Controllers for Systems with Unknown Dynamics

We consider the problem of extracting safe environments and controllers for reach-avoid objectives for systems with known state and control spaces, but unknown dynamics. In a given environment, a common approach is to synthesize a controller from an abstraction or a model of the system (potentially learned from data). However, in many situations, the relationship between the dynamics of the model and the \textit{actual system} is not known; and hence it is difficult to provide safety guarantees for the system. In such cases, the Standard Simulation Metric (SSM), defined as the worst-case norm distance between the model and the system output trajectories, can be used to modify a reach-avoid specification for the system into a more stringent specification for the abstraction. Nevertheless, the obtained distance, and hence the modified specification, can be quite conservative. This limits the set of environments for which a safe controller can be obtained. We propose SPEC, a specification-centric simulation metric, which overcomes these limitations by computing the distance using only the trajectories that violate the specification for the system. We show that modifying a reach-avoid specification with SPEC allows us to synthesize a safe controller for a larger set of environments compared to SSM. We also propose a probabilistic method to compute SPEC for a general class of systems. Case studies using simulators for quadrotors and autonomous cars illustrate the advantages of the proposed metric for determining safe environment sets and controllers.Comment: 22nd ACM International Conference on Hybrid Systems: Computation and Control (2019

Unexpected sneezing after a peribulbar injection in a patient for elective cataract surgery

Sneezing or the sternutatory reflex, inborn in most animals, is a primitive neuromuscular physiological response to irritation. Sometimes, unusual sneezing occurs during and immediately after a peribulbar block, which is generally performed with a local anaesthetic in awake patients. We present a case report of an awake elderly male who experienced unexpected continuous sneezing immediately after the removal of the needle used for the peribulbar block, which was subsequently relieved with pheniramine maleate.Keywords: peribulbar block, pheniramine maleate, sneezin