Comparisons of AEROX computer program predictions of lift and induced drag with flight test data

The AEROX aerodynamic computer program which provides accurate predictions of induced drag and trim drag for the full angle of attack range and for Mach numbers from 0.4 to 3.0 is described. This capability is demonstrated comparing flight test data and AEROX predictions for 17 different tactical aircraft. Values of minimum (skin friction, pressure, and zero lift wave) drag coefficients and lift coefficient offset due to camber (when required) were input from the flight test data to produce total lift and drag curves. The comparisons of trimmed lift drag polars show excellent agreement between the AEROX predictions and the in flight measurements

An Atypical Presentation of Cystic Echinococcosis

Cystic echinococcosis (CE) is an infection caused by the Echinococcus granulosus tapeworm. CE generally manifests in the liver, but it may present in any organ. These patients often first present to the emergency department. Mortality over 10 years is significant for those who go undiagnosed. We report the case of a 34-year-old patient who immigrated from Yemen six years earlier. She presented with acute onset dysuria, suprapubic pain, and fever. Imaging revealed a primary multicystic mass on the right renal pole with a secondary lesion in the right hepatic lobe. On further investigation, the patient’s serum was positive for echinococcus antibodies

Mupirocin Ointment with and without Chlorhexidine Baths in the Eradication of Staphylococcus Aureus Nasal Carriage in Nursing Home Residents

Mupirocin ointment has been shown to be effective in eradicating Staphylococcus aureus nasal carriage in residents of a long- term care facility. Antiseptic soaps have been used as adjunct to this therapy. We compared the efficacy of short-term intranasal mupirocin ointment with and without chlorhexidine baths in the eradication of S. aureus nasal carriage with follow-up for 12 weeks. METHODS: Residents in four nursing homes known to have endemic methicillin-resistant S. aureus were screened for nasal carriage of S. aureus. Residents who had anterior nares cultures positive for S. aureus on two separate occasions were divided into two groups. Both groups received intranasal mupirocin ointment twice daily for 5 days and one group also received chlorhexidine baths for the first 3 days. Cultures of anterior nares, axilla, and groins were performed before treatment and 1 day and 1, 4, 8, and 12 weeks after treatment. RESULTS: After treatment, S. aureus nasal carriage was eradicated in all residents. Recolonization with S. aureus had occurred at 12 weeks in 24% of residents receiving mupirocin ointment alone (6/25) and in 15% of residents receiving mupirocin ointment plus chlorhexidine baths (4/27). CONCLUSIONS: A short course of mupirocin ointment was effective in eradicating nasal carriage of S. aureus in nursing home residents. There were no statistical differences in efficacy between the two regimens with respect to the eradication of nasal carriage and prevention of recolonization with S. aureus

Renal Cysts in an Immigrant Patient: An Atypical Presentation of Echinococcosis

Introduction: Cystic echinococcosis (CE) is an infection caused by the Echinococcus tapeworm that results in the creation of cysts within a range of visceral organs. Ninety percent of these cysts are in the liver or lungs. In the United States, cases are quite rare and most are found in immigrants from endemic countries. Patients with CE may remain asymptomatic for years. If left undiagnosed and untreated, mortality from CE is estimated to be 90% by ten years. In this case, we discuss a patient who presented to the emergency department with genitourinary complaints and was diagnosed with CE of primary renal involvement, a rare anatomic location. Case Description: A previously healthy 34-year-old female presented to the emergency department with dysuria, suprapubic pain, myalgias and fever of one day duration. The patient had immigrated from Yemen 6 years prior. On presentation, she was febrile to 38.8C and tachycardic to 133. Complete blood count and lactic acid were within normal limits and urinalysis was not consistent with a urinary tract infection. Ultrasound revealed a mass on the right kidney and computerized tomography (CT) showed a subcapsular right renal cystic mass with septations as well as a secondary liver lesion. Further imaging by magnetic resonance confirmed the subscapular multi-cystic mass along the right kidney measuring 7 x 5.2 x 6.1 cm consistent with CE stage III and a 1.7 cm cystic lesion in the right hepatic lobe also consistent with CE. Serum IgG for echinococcus was positive. The patient was diagnosed with echinococcal disease and was initiated on albendazole 200mg BID for 3-4 months with future plans for surgical intervention. Discussion: Echinococcal disease is a parasitic infection with the majority of cases originating in the Middle East, South and Central America and sub-Saharan Africa. The clinical presentation of Echinococcus infection is largely dependent on the location and size of the cysts. Small cysts may be asymptomatic whereas larger cysts may cause mass effect or may present with toxic appearance with rupture. Some cysts present with symptoms up to several decades after initial infection or remain asymptomatic indefinitely. The most common sites of involvement are the liver (approximately 66%) followed by the lungs (25%). Less commonly reported sites include the brain, kidneys, muscle, bone and heart. Our patient’s primary renal cyst was large enough to cause mass effect, leading to dysuria and suprapubic pain. Generally, diagnosis of echinococcal disease is made with both imaging and serology. With regards to imaging, ultrasonography is 90-95% sensitive for CE and CT is only moderately better with 95-100% sensitivity; however, CT is superior to ultrasonography for evaluation of extrahepatic cysts. MRI offers no major advantage over CT. When considering serology, antibody detection has greater sensitivity than antigen detection. Our patient tested positive for echinococcal IgG. IgE and IgM were not pursued as IgG has better sensitivity. Management of these cysts are based on the WHO classification criteria and typically use a combination of observation, albendazole, PAIR (percutaneous puncture, aspiration, injection, re-aspiration) and surgery. Our patient’s renal cyst was classified as WHO stage III, for which the recommended treatment is albendazole followed by either PAIR or surgery. Conclusion: Although CE is uncommon in the United States, careful attention should be paid in individuals who have immigrated from endemic countries. While the liver and lungs are most commonly involved, cysts can be found in any organ and symptoms are often specific to the affected system. The best imaging modality for extrahepatic cysts in particular is by CT. The majority of these patients should be started on albendazole initially with definitive treatment often requiring evaluation by several subspecialists including Infectious Disease, Interventional Radiology and Surgery.https://scholarlycommons.henryford.com/merf2020caserpt/1123/thumbnail.jp

A PC parallel port button box provides millisecond response time accuracy under Linux

For psychologists, it is sometimes necessary to measure people's reaction times to the nearest millisecond. This article describes how to use the PC parallel port to receive signals from a button box to achieve millisecond response time accuracy. The workings of the parallel port, the corresponding port addresses, and a simple Linux program for controlling the port are described. A test of the speed and reliability of button box signal detection is reported. If the reader is moderately familiar with Linux, this article should provide sufficient instruction for him or her to build and test his or her own parallel port button box. This article also describes how the parallel port could be used to control an external apparatus

Prostate-specific antigen patterns in US and European populations:Comparison of six diverse cohorts

Objective: To determine whether there are differences in prostate-specific antigen (PSA) levels at diagnosis or changes in PSA levels between US and European populations of men with and without prostate cancer (PCa). Subjects and Methods: We analysed repeated measures of PSA from six clinically and geographically diverse cohorts of men: two cohorts with PSA-detected PCa, two cohorts with clinically detected PCa and two cohorts without PCa. Using multilevel models, average PSA at diagnosis and PSA change over time were compared among study populations. Results: The annual percentage PSA change of 4-5% was similar between men without cancer and men with PSA-detected cancer. PSA at diagnosis was 1.7 ng/mL lower in a US cohort of men with PSA-detected PCa (95% confidence interval 1.3-2.0 ng/mL), compared with a UK cohort of men with PSA-detected PCa, but there was no evidence of a different rate of PSA change between these populations. Conclusion: We found that PSA changes over time are similar in UK and US men diagnosed through PSA testing and even in men without PCa. Further development of PSA models to monitor men on active surveillance should be undertaken in order to take advantage of these similarities. We found no evidence that guidelines for using PSA to monitor men cannot be passed between US and European studies

Clinical impairment in premanifest and early Huntington's disease is associated with regionally specific atrophy.

TRACK-HD is a multicentre longitudinal observational study investigating the use of clinical assessments and 3-Tesla magnetic resonance imaging as potential biomarkers for future therapeutic trials in Huntington's disease (HD). The cross-sectional data from this large well-characterized dataset provide the opportunity to improve our knowledge of how the underlying neuropathology of HD may contribute to the clinical manifestations of the disease across the spectrum of premanifest (PreHD) and early HD. Two hundred and thirty nine gene-positive subjects (120 PreHD and 119 early HD) from the TRACK-HD study were included. Using voxel-based morphometry (VBM), grey and white matter volumes were correlated with performance in four domains: quantitative motor (tongue force, metronome tapping, and gait); oculomotor [anti-saccade error rate (ASE)]; cognition (negative emotion recognition, spot the change and the University of Pennsylvania smell identification test) and neuropsychiatric measures (apathy, affect and irritability). After adjusting for estimated disease severity, regionally specific associations between structural loss and task performance were found (familywise error corrected, P < 0.05); impairment in tongue force, metronome tapping and ASE were all associated with striatal loss. Additionally, tongue force deficits and ASE were associated with volume reduction in the occipital lobe. Impaired recognition of negative emotions was associated with volumetric reductions in the precuneus and cuneus. Our study reveals specific associations between atrophy and decline in a range of clinical modalities, demonstrating the utility of VBM correlation analysis for investigating these relationships in HD

Optimising the Diagnosis of Prostate Cancer in the Era of Multiparametric Magnetic Resonance Imaging : A Cost-effectiveness Analysis Based on the Prostate MR Imaging Study (PROMIS)

Background The current recommendation of using transrectal ultrasound-guided biopsy (TRUSB) to diagnose prostate cancer misses clinically significant (CS) cancers. More sensitive biopsies (eg, template prostate mapping biopsy [TPMB]) are too resource intensive for routine use, and there is little evidence on multiparametric magnetic resonance imaging (MPMRI). Objective To identify the most effective and cost-effective way of using these tests to detect CS prostate cancer. Design, setting, and participants Cost-effectiveness modelling of health outcomes and costs of men referred to secondary care with a suspicion of prostate cancer prior to any biopsy in the UK National Health Service using information from the diagnostic Prostate MR Imaging Study (PROMIS). Intervention Combinations of MPMRI, TRUSB, and TPMB, using different definitions and diagnostic cut-offs for CS cancer. Outcome measurements and statistical analysis Strategies that detect the most CS cancers given testing costs, and incremental cost-effectiveness ratios (ICERs) in quality-adjusted life years (QALYs) given long-term costs. Results and limitations The use of MPMRI first and then up to two MRI-targeted TRUSBs detects more CS cancers per pound spent than a strategy using TRUSB first (sensitivity = 0.95 [95% confidence interval {CI} 0.92–0.98] vs 0.91 [95% CI 0.86–0.94]) and is cost effective (ICER = £7,076 [€8350/QALY gained]). The limitations stem from the evidence base in the accuracy of MRI-targeted biopsy and the long-term outcomes of men with CS prostate cancer. Conclusions An MPMRI-first strategy is effective and cost effective for the diagnosis of CS prostate cancer. These findings are sensitive to the test costs, sensitivity of MRI-targeted TRUSB, and long-term outcomes of men with cancer, which warrant more empirical research. This analysis can inform the development of clinical guidelines. Patient summary We found that, under certain assumptions, the use of multiparametric magnetic resonance imaging first and then up to two transrectal ultrasound-guided biopsy is better than the current clinical standard and is good value for money. The use of multiparametric magnetic resonance imaging before transrectal ultrasound-guided biopsy can detect more clinically significant prostate cancer and be cost effective compared with the use of imaging post-biopsy