I Met You Dear In Dreamland

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Rheumatoid meningitis sine arthritis.

Rheumatoid meningitis is a rare and very serious extra-articular manifestation of rheumatoid arthritis. We present a case of a 7()year-old female with no history of arthritis who developed stroke-like symptoms, seizures, psychosis and compulsive behavior. Serial brain magnetic resonance images (MRI) over four months demonstrated progressive interhemispheric meningeal thickening. She had mild lymphocytic pleocytosis on the cerebrospinal fluid analysis and serum anti-cyclic citrullinated peptide antibodies resulted positive in high titers. She underwent a brain biopsy showing necrotizing granulomas consistent with rheumatoid meningitis. Her symptoms resolved with treatment with glucocorticoids and cyclophosphamide. She has not been diagnosed with rheumatoid arthritis even after 1 year of follow up. Clinicians should be aware of the possibility of rheumatoid meningitis without rheumatoid arthritis and keep it on the differential for patients with aseptic meningitis and otherwise negative work up

The Influence of Autonomic Dysfunction Associated with Aging and Type 2 Diabetes on Daily Life Activities

Type 2 diabetes (T2D) and ageing have well documented effects on every organ in the body. In T2D the autonomic nervous system is impaired due to damage to neurons, sensory receptors, synapses and the blood vessels. This paper will concentrate on how autonomic impairment alters normal daily activities. Impairments include the response of the blood vessels to heat, sweating, heat transfer, whole body heating, orthostatic intolerance, balance, and gait. Because diabetes is more prevalent in older individuals, the effects of ageing will be examined. Beginning with endothelial dysfunction, blood vessels have impairment in their ability to vasodilate. With this and synaptic damage, the autonomic nervous system cannot compensate for effectors such as pressure on and heating of the skin. This and reduced ability of the heart to respond to stress, reduces autonomic orthostatic compensation. Diminished sweating causes the skin and core temperature to be high during whole body heating. Impaired orthostatic tolerance, impaired vision and vestibular sensing, causes poor balance and impaired gait. Overall, people with T2D must be made aware and counseled relative to the potential consequence of these impairments

The nexus of remittances, institutional quality, and financial inclusion

The present article adopted the dynamic panel data method to investigate the effect of the inflow of remittances on financial inclusion (FI), particularly focusing on high remittance-receiving developing countries between 2011 and 2018. The current research found that remittances that foster FI are associated with better institutional quality. The evidence revealed that the effect of remittances on FI is conditional upon individuals’ perception of the institutions. Positive coefficient on the interaction terms indicates that the impact of remittances on FI can be enhanced in the recipient countries, if the public trusts the financial institutions. Hence, the overall results of the current research suggest that the impact of remittances on FI is conditional on institutions. On a final note, the policy implications of these findings are thoroughly evaluated at the end of this articl

Improving the Estimation of Star formation Rates and Stellar Population Ages of High-redshift Galaxies from Broadband Photometry

We explore methods to improve the estimates of star formation rates and mean stellar population ages from broadband photometry of high redshift star-forming galaxies. We use synthetic spectral templates with a variety of simple parametric star formation histories to fit broadband spectral energy distributions. These parametric models are used to infer ages, star formation rates and stellar masses for a mock data set drawn from a hierarchical semi-analytic model of galaxy evolution. Traditional parametric models generally assume an exponentially declining rate of star-formation after an initial instantaneous rise. Our results show that star formation histories with a much more gradual rise in the star formation rate are likely to be better templates, and are likely to give better overall estimates of the age distribution and star formation rate distribution of Lyman break galaxies. For B- and V-dropouts, we find the best simple parametric model to be one where the star formation rate increases linearly with time. The exponentially-declining model overpredicts the age by 100 % and 120 % for B- and V-dropouts, on average, while for a linearly-increasing model, the age is overpredicted by 9 % and 16 %, respectively. Similarly, the exponential model underpredicts star-formation rates by 56 % and 60 %, while the linearly-increasing model underpredicts by 15 % 22 %, respectively. For U-dropouts, the models where the star-formation rate has a peak (near z ~ 3) provide the best match for age -- overprediction is reduced from 110 % to 26 % -- and star-formation rate -- underprediction is reduced from 58 % to 22 %. We classify different types of star-formation histories in the semi-analytic models and show how the biases behave for the different classes. We also provide two-band calibration formulae for stellar mass and star formation rate estimations.Comment: 28 pages, 7 figures, minor changes; published in Ap

Four Weeks of 16:8 Time-Restricted Feeding on Stress, Sleep, Quality of Life, Hunger Level, and Body Composition in Healthy Adults: A Pilot Study on Wellness Optimization

Introduction: Sustainable methods of dietary lifestyle changes are essential to long term weight loss maintenance and enhancement in overall health and wellness. A novel modified alternative method to caloric restriction is Time-Restricted Feeding (TRF), a sub-type of Intermittent Fasting. The purpose of this pilot study was to determine the effect of four weeks of TRF (without caloric deficit) on body composition, stress levels, sleep quality, hunger level, and quality of life. Methods: Sixteen participants, 9 males and 7 females, mean age 34.0 ± 11.7 years, completed the four-week protocol. Fasting program was 16 hours from the time of last meal of the evening to start of first meal the following day. Participants were required to consume their normal daily caloric intake within an 8-hour period. Results: There were significant reductions in mean body fat percentage (26.2±2.4 vs. 25.5±2.6, p=0.01), visceral fat (cm2) (98.2±15.3 vs. 94.1±15.7, p=0.003), body fat mass (kg) (21.6±3.0 vs. 21.0±3.2, p= 0.02), trunk fat (kg) (11.5±1.6 vs. 11.0±1.6, p=0.001) and stress levels (14.1±1.9 vs. 11.0±1.4, p=0.03). There was a significant drop in hunger levels over time (χ2 = 16.4, p=0.001). There were no significant changes in sleep quality or quality of life. Conclusion: TRF may be an effective option to decrease stress, body fat, visceral fat, and obesity-related diseases while not disrupting sleep quality and Quality of Life. Our pilot study demonstrated potential health benefits that could be incorporated by healthcare workers into whole-person wellness programs

Neutrophilic eccrine hidradenitis secondary to pegfilgrastim in a patient with synovial sarcoma

A grant from the One-University Open Access Fund at the University of Kansas was used to defray the author's publication fees in this Open Access journal. The Open Access Fund, administered by librarians from the KU, KU Law, and KUMC libraries, is made possible by contributions from the offices of KU Provost, KU Vice Chancellor for Research & Graduate Studies, and KUMC Vice Chancellor for Research. For more information about the Open Access Fund, please see http://library.kumc.edu/authors-fund.xml.Key Clinical Message Here, we report a case of neutrophilic eccrine hidradenitis (NEH) in a teenage male with synovial sarcoma associated with extracutaneous manifestations including myositis and splenomegaly secondary to pegfilgrastim. To the best of our knowledge, NEH has not been previously reported to occur in association with extracutaneous manifestations

Optical Images and Source Catalog of AKARI North Ecliptic Pole Wide Survey Field

We present the source catalog and the properties of the $B-, R-$, and $I-$band images obtained to support the {\it AKARI} North Ecliptic Pole Wide (NEP-Wide) survey. The NEP-Wide is an {\it AKARI} infrared imaging survey of the north ecliptic pole covering a 5.8 deg$^2$ area over 2.5 -- 6 \micron wavelengths. The optical imaging data were obtained at the Maidanak Observatory in Uzbekistan using the Seoul National University 4k $\times$ 4k Camera on the 1.5m telescope. These images cover 4.9 deg$^2$ where no deep optical imaging data are available. Our $B-, R-$, and $I-$band data reach the depths of $\sim$23.4, $\sim$23.1, and $\sim$22.3 mag (AB) at 5$\sigma$, respectively. The source catalog contains 96,460 objects in the $R-$band, and the astrometric accuracy is about 0.15\arcsec at 1$\sigma$ in each RA and Dec direction. These photometric data will be useful for many studies including identification of optical counterparts of the infrared sources detected by {\it AKARI}, analysis of their spectral energy distributions from optical through infrared, and the selection of interesting objects to understand the obscured galaxy evolution.Comment: 39 pages, 12 figure

A task and performance analysis of endoscopic submucosal dissection (ESD) surgery

BACKGROUND: ESD is an endoscopic technique for en bloc resection of gastrointestinal lesions. ESD is a widely-used in Japan and throughout Asia, but not as prevalent in Europe or the US. The procedure is technically challenging and has higher adverse events (bleeding, perforation) compared to endoscopic mucosal resection. Inadequate training platforms and lack of established training curricula have restricted its wide acceptance in the US. Thus, we aim to develop a Virtual Endoluminal Surgery Simulator (VESS) for objective ESD training and assessment. In this work, we performed task and performance analysis of ESD surgeries. METHODS: We performed a detailed colorectal ESD task analysis and identified the critical ESD steps for lesion identification, marking, injection, circumferential cutting, dissection, intraprocedural complication management, and post-procedure examination. We constructed a hierarchical task tree that elaborates the order of tasks in these steps. Furthermore, we developed quantitative ESD performance metrics. We measured task times and scores of 16 ESD surgeries performed by four different endoscopic surgeons. RESULTS: The average time of the marking, injection, and circumferential cutting phases are 203.4 (σ: 205.46), 83.5 (σ: 49.92), 908.4 s. (σ: 584.53), respectively. Cutting the submucosal layer takes most of the time of overall ESD procedure time with an average of 1394.7 s (σ: 908.43). We also performed correlation analysis (Pearson's test) among the performance scores of the tasks. There is a moderate positive correlation (R = 0.528, p = 0.0355) between marking scores and total scores, a strong positive correlation (R = 0.7879, p = 0.0003) between circumferential cutting and submucosal dissection and total scores. Similarly, we noted a strong positive correlation (R = 0.7095, p = 0.0021) between circumferential cutting and submucosal dissection and marking scores. CONCLUSIONS: We elaborated ESD tasks and developed quantitative performance metrics used in analysis of actual surgery performance. These ESD metrics will be used in future validation studies of our VESS simulator