Immune Thrombocytopenia in a Challenging Case of Disseminated Tuberculosis: A Case Report and Review of the Literature

Mycobacterium tuberculosis (MTB) continues to predominate the cause of morbidity, and mortality in the developing world. The disease affects all the organ systems, and presents in various pathologic disease states. We report an uncommon manifestation of this rather common infectious disease in a 19-year-old male. Immune-mediated thrombocytopenia occurring as a consequence of the tuberculosis infection itself is an exceedingly rare occurrence, and at the time of writing of this paper, only 15 such published reports exist in the English literature so far

Current Efficiency, Dielectric Measurements & Ion Mobility Studies of Anodic Oxide Films Formed on Tantalum in Aqueous Electrolytes

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Comparative efficacy of pregabalin and baclofen in the rodent chronic constriction injury model of neuropathic pain

Background: Neuropathic pain is associated with prolonged disability and is usually not responsive to conventional analgesics like NSAIDs and opioids. Even the recommended first-line drugs are effective in less than 50% patients. Thus, drugs with different mechanisms of action are needed. Baclofen, a GABA-B agonist has shown benefit in different types of neuropathic pains and is compared against pregabalin.Methods: The sciatic nerve was ligated in 2 groups of 6 rats each as per the chronic constriction injury model of neuropathic pain on day 0. After 14 days the effect of single doses of pregabalin (30mg/kg) and baclofen (5mg/kg) intraperitoneally were assessed over a 2 hours period. Thermal and mechanical hyperalgesia were assessed as measures of neuropathic pain by the hotplate and pin-prick method respectively.Results: Significant thermal and mechanical hyperalgesia was produced 14 days after sciatic nerve ligation in both the groups (p <0.05). Both pregabalin (p <0.001) and baclofen (p <0.01) were effective in decreasing thermal hyperalgesia throughout the two hours study period, but pregabalin was more effective as compared to baclofen (p <0.05) at 30, 60 and 120minutes. Both the drugs produced a significant decrease in mechanical hyperalgesia (p <0.01) throughout the study period. Again, pregabalin was the more effective drug (p <0.05) at all time points.Conclusions: Significant thermal and mechanical hyperalgesia was seen 14 days after sciatic nerve ligation. Both pregabalin and baclofen were effective in reversing the hyperalgesia, but pregabalin was the more effective of the two drugs at all time points

A comparative study of the anti-nociceptive potential of duloxetine and carbamazepine in an animal model of neuropathic pain

Background: Pain is one of the most common symptoms encountered in clinical practice. Of the various types of pain, neuropathic pain represents one of the most difficult pain states to treat, with treatments being far from satisfactory. The drugs used are not fully effective and a drug that shows good efficacy in one neuropathic pain state may be ineffective in another. This study was done to compare the antinociceptive potential of duloxetine and carbamazepine, two drugs with different mechanisms of action in an animal model of neuropathic pain.Methods: Antinociceptive effect of duloxetine (15 mg/kg intraperitoneally) and carbamazepine (20 mg/kg intraperitoneally) was evaluated in the sciatic chronic constriction injury (CCI) model of neuropathic pain in rats. Thermal hyperalgesia, evaluated by the hot plate method; and mechanical hyperalgesia, evaluated by the pinprick method were used as measures of neuropathic pain.Results: A significant degree of thermal and mechanical hyperalgesia (p ≤0.05) was produced in both the drug groups. Both drugs produced a significant decrease in thermal and mechanical hyperalgesia throughout the study period (p ≤0.01 for both drugs). In comparison to duloxetine, carbamazepine was less efficacious (p ≤0.05 at 30, 60 minutes; p ≤0.01 at 120 minutes) for thermal hyperalgesia as well as for mechanical hyperalgesia (p ≤0.05 at 30, 60 minutes; p≤0.01 at 120 minutes). Only duloxetine was able to almost completely reverse both thermal &amp; mechanical hyperalgesia to near pre-neuropathy levels.Conclusions: Duloxetine showed better antinociceptive potential as compared to carbamazepine as reflected by a more complete reduction in thermal &amp; mechanical hyperalgesia in the sciatic CCI model of neuropathic pain

Thermo-mechanical fatigue lifetime assessment of spheroidal cast iron at different thermal constraint levels

In previous work on the thermo-mechanical fatigue (TMF) of compacted graphite iron (CGI), lifetimes measured under total constraint were confirmed analytically by numerical integration of Paris' crack-growth law. In current work, the results for CGI are further validated for spheroidal cast iron (SGI), while TMF tests at different constraint levels were additionally performed. The Paris crack-growth law is found to require a different C-Paris parameter value per distinct constraint level, indicating that Paris' law does not capture all physical backgrounds of TMF crack growth, such as the effect of constraint level. An adapted version of Paris' law is developed, designated as the local strain model. The new model considers cyclic plastic strains at the crack tip to control crack growth and is found to predict TMF lifetimes of SGI very well for all constraint levels with a single set of parameters. This includes not only full constraint but also over and partial constraint conditions, as encountered in diesel engine service conditions. The local strain model considers the crack tip to experience a distinct sharpening and blunting stage during each TMF cycle, with separate contributions to crack-tip plasticity, originating from cyclic bulk stresses in the sharpening stage and cyclic plastic bulk strains in the blunting stage

Development of a coupled wave-flow-vegetation interaction model

© The Author(s), 2016. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Computers & Geosciences 100 (2017): 76–86, doi:10.1016/j.cageo.2016.12.010.Emergent and submerged vegetation can significantly affect coastal hydrodynamics. However, most deterministic numerical models do not take into account their influence on currents, waves, and turbulence. In this paper, we describe the implementation of a wave-flow-vegetation module into a Coupled-Ocean-Atmosphere-Wave-Sediment Transport (COAWST) modeling system that includes a flow model (ROMS) and a wave model (SWAN), and illustrate various interacting processes using an idealized shallow basin application. The flow model has been modified to include plant posture-dependent three-dimensional drag, in-canopy wave-induced streaming, and production of turbulent kinetic energy and enstrophy to parameterize vertical mixing. The coupling framework has been updated to exchange vegetation-related variables between the flow model and the wave model to account for wave energy dissipation due to vegetation. This study i) demonstrates the validity of the plant posture-dependent drag parameterization against field measurements, ii) shows that the model is capable of reproducing the mean and turbulent flow field in the presence of vegetation as compared to various laboratory experiments, iii) provides insight into the flow-vegetation interaction through an analysis of the terms in the momentum balance, iv) describes the influence of a submerged vegetation patch on tidal currents and waves separately and combined, and v) proposes future directions for research and development.This study was part of the Estuarine Physical Response to Storms project (GS2-2D), supported by the Department of Interior Hurricane Sandy Recovery program

High-fidelity adiabatic inversion of a 31P^{31}\mathrm{P} electron spin qubit in natural silicon

The main limitation to the high-fidelity quantum control of spins in semiconductors is the presence of strongly fluctuating fields arising from the nuclear spin bath of the host material. We demonstrate here a substantial improvement in single-qubit gate fidelities for an electron spin qubit bound to a $^{31}$P atom in natural silicon, by applying adiabatic inversion instead of narrow-band pulses. We achieve an inversion fidelity of 97%, and we observe signatures in the spin resonance spectra and the spin coherence time that are consistent with the presence of an additional exchange-coupled donor. This work highlights the effectiveness of adiabatic inversion techniques for spin control in fluctuating environments.Comment: 4 pages, 2 figure

Randomized trial comparing proactive, high-dose versus reactive, low-dose intravenous iron supplementation in hemodialysis (PIVOTAL) : Study design and baseline data

Background: Intravenous (IV) iron supplementation is a standard maintenance treatment for hemodialysis (HD) patients, but the optimum dosing regimen is unknown. Methods: PIVOTAL (Proactive IV irOn Therapy in hemodiALysis patients) is a multicenter, open-label, blinded endpoint, randomized controlled (PROBE) trial. Incident HD adults with a serum ferritin 700 μg/L and/or TSAT ≥40%) or a reactive, low-dose IV iron arm (iron sucrose administered if ferritin <200 μg/L or TSAT < 20%). We hypothesized that proactive, high-dose IV iron would be noninferior to reactive, low-dose IV iron for the primary outcome of first occurrence of nonfatal myocardial infarction (MI), nonfatal stroke, hospitalization for heart failure or death from any cause. If noninferiority is confirmed with a noninferiority limit of 1.25 for the hazard ratio of the proactive strategy relative to the reactive strategy, a test for superiority will be carried out. Secondary outcomes include infection-related endpoints, ESA dose requirements, and quality-of-life measures. As an event-driven trial, the study will continue until at least 631 primary outcome events have accrued, but the expected duration of follow-up is 2-4 years. Results: Of the 2,589 patients screened across 50 UK sites, 2,141 (83%) were randomized. At baseline, 65.3% were male, the median age was 65 years, and 79% were white. According to eligibility criteria, all patients were on ESA at screening. Prior stroke and MI were present in 8 and 9% of the cohort, respectively, and 44% of patients had diabetes at baseline. Baseline data for the randomized cohort were generally concordant with recent data from the UK Renal Registry. Conclusions: PIVOTAL will provide important information about the optimum dosing of IV iron in HD patients representative of usual clinical practice. Trial Registration: EudraCT number: 2013-002267-25.Peer reviewedFinal Published versio

Bell's inequality violation with spins in silicon

Bell's theorem sets a boundary between the classical and quantum realms, by providing a strict proof of the existence of entangled quantum states with no classical counterpart. An experimental violation of Bell's inequality demands simultaneously high fidelities in the preparation, manipulation and measurement of multipartite quantum entangled states. For this reason the Bell signal has been tagged as a single-number benchmark for the performance of quantum computing devices. Here we demonstrate deterministic, on-demand generation of two-qubit entangled states of the electron and the nuclear spin of a single phosphorus atom embedded in a silicon nanoelectronic device. By sequentially reading the electron and the nucleus, we show that these entangled states violate the Bell/CHSH inequality with a Bell signal of 2.50(10). An even higher value of 2.70(9) is obtained by mapping the parity of the two-qubit state onto the nuclear spin, which allows for high-fidelity quantum non-demolition measurement (QND) of the parity. Furthermore, we complement the Bell inequality entanglement witness with full two-qubit state tomography exploiting QND measurement, which reveals that our prepared states match the target maximally entangled Bell states with $>$96\% fidelity. These experiments demonstrate complete control of the two-qubit Hilbert space of a phosphorus atom, and show that this system is able to maintain its simultaneously high initialization, manipulation and measurement fidelities past the single-qubit regime.Comment: 10 pages, 3 figures, 1 table, 4 extended data figure

ProxyFL: Decentralized Federated Learning through Proxy Model Sharing

Institutions in highly regulated domains such as finance and healthcare often have restrictive rules around data sharing. Federated learning is a distributed learning framework that enables multi-institutional collaborations on decentralized data with improved protection for each collaborator's data privacy. In this paper, we propose a communication-efficient scheme for decentralized federated learning called ProxyFL, or proxy-based federated learning. Each participant in ProxyFL maintains two models, a private model, and a publicly shared proxy model designed to protect the participant's privacy. Proxy models allow efficient information exchange among participants using the PushSum method without the need of a centralized server. The proposed method eliminates a significant limitation of canonical federated learning by allowing model heterogeneity; each participant can have a private model with any architecture. Furthermore, our protocol for communication by proxy leads to stronger privacy guarantees using differential privacy analysis. Experiments on popular image datasets, and a pan-cancer diagnostic problem using over 30,000 high-quality gigapixel histology whole slide images, show that ProxyFL can outperform existing alternatives with much less communication overhead and stronger privacy