Nivolumab-induced fulminant diabetic ketoacidosis followed by thyroiditis

Five days following the 3rd cycle of nivolumab, a monoclonal antibody, which acts as immune checkpoint inhibitor against the programmed cell death protein-1, for metastatic lung adenocarcinoma, a 56-year-old woman presented at the hospital critically ill. On admission, she had severe diabetic ketoacidosis (DKA), as evidenced by venous glucose of 47 mmol/L, blood ketones of 7.5 mmol/L, pH of 6.95 and bicarbonate of 6.6 mmol/L. She has had no personal or family history of diabetes mellitus (DM), while random venous glucose, measured 1 week prior to hospitalisation, was 6.1 mmol/L. On admission, her HbA1c was 8.2% and anti-GAD antibodies were 12 kIU/L (0–5 kU/L), while islet cell antibodies and serum C-peptide were undetectable. Nivolumab was recommenced without the development of other immune-mediated phenomena until 6 months later, when she developed hypothyroidism with TSH 18 U/L and low free T4. She remains insulin dependent and has required levothyroxine replacement, while she has maintained good radiological and clinical response to immunotherapy. This case is notable for the rapidity of onset and profound nature of DKA at presentation, which occurred two months following commencement of immunotherapy. Despite the association of nivolumab with immune-mediated endocrinopathies, only a very small number of patients developing type 1 DM has been reported to date. Patients should be closely monitored for hyperglycaemia and thyroid dysfunction prior to and periodically during immunotherapy

Structural health monitoring through dense instrumentation by community participants: the Community Seismic Network and Quake-Catcher Network

The Community Seismic Network and Quake-Catcher Network involve participants from communities at large to install low-cost accelerometers in houses and buildings for assessment of shaking intensity due to earthquakes. The seismometers are designed for two types of connec-tions: a USB-connected device which connects to the host’s computer, and a stand-alone sensor-plug-computer device that directly connects to the internet. The three-component sensors report both continuous data and amplitude anomalies in local acceleration to a Cloud computing service consisting of data centers geographically distributed across the continent, or to a distributed computing system. The continuous time series waveform data are being used to evaluate response parameters such as peak acceleration, peak velocity, and inter-story drift values. In addition, modal properties such as fundamental and higher mode frequencies and mode shapes are being computed from small and moderate earthquake data from the building. Building motion is computed for every floor of the building using only earthquake records from a single floor. Visualization models that map the instrumented buildings’ responses have been construct-ed using SketchUp and an associated plug-in to Matlab with recorded shaking data. This data visualization approach is different from other techniques because each building model is customized to show actual data recorded from that building on varying spatial scales, without the need for large-scale parallel computing facilities or complicated software that requires a steep learning curve

Apomorphine-induced brain modulation during sexual stimulation: a new look at central phenomena related to erectile dysfunction

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Advection, diffusion and delivery over a network

Many biological, geophysical and technological systems involve the transport of resource over a network. In this paper we present an algorithm for calculating the exact concentration of resource at any point in space or time, given that the resource in the network is lost or delivered out of the network at a given rate, while being subject to advection and diffusion. We consider the implications of advection, diffusion and delivery for simple models of glucose delivery through a vascular network, and conclude that in certain circumstances, increasing the volume of blood and the number of glucose transporters can actually decrease the total rate of glucose delivery. We also consider the case of empirically determined fungal networks, and analyze the distribution of resource that emerges as such networks grow over time. Fungal growth involves the expansion of fluid filled vessels, which necessarily involves the movement of fluid. In three empirically determined fungal networks we found that the minimum currents consistent with the observed growth would effectively transport resource throughout the network over the time-scale of growth. This suggests that in foraging fungi, the active transport mechanisms observed in the growing tips may not be required for long range transport.Comment: 54 pages including appendix, 10 figure

Frequency of neurolopsychological deficits after traumatic brain injury

El traumatismo craneoencefálico (TCE) puede conllevar impactantes cambios en la vida cotidiana, que incluyen alteraciones a nivel social, profesional, comunicativo y cognitivo (dificultades atencionales, mnemónicas y ejecutivas). Este estudio tuvo por objeto caracterizar la ocurrencia de déficits neuropsicológicos post-TCE y constatar el impacto ocasionado por el nivel de severidad del trauma en el desempeño cognitivo de los pacientes. Participaron 96 adultos en la muestra total, que fue dividida en dos grupos para evaluar el nivel de severidad del trauma: TCE leve (n=39) y TCE grave (n=77). La gravedad de la lesión se clasificó por medio de la Escala de Coma de Glasgow, por la duración de la pérdida de consciencia, o por la amnesia post-traumática. No había diferencias entre la edad y la escolaridad de los participantes. Para la comparación entre los grupos en cuanto a la distribución de ocurrencia de déficits neuropsicológicos, se utilizó el Chi-cuadrado. Se utilizó una batería de evaluación neuropsicológica flexible conformada por tareas verbales y visoespaciales de habilidades lingüísticas, mnemónicas y ejecutivas. Los grupos no se diferenciaron en cuanto a las variables sociodemográficas. Los pacientes con TCE leve tuvieron mejores puntajes comparados con los de TCE grave (número de errores y categorías completadas del Test de clasificación de tarjetas de Wisconsin- [WCST, por sus siglas en inglés]; errores en la parte B del Test de Hayling; y en la interferencia retro y proactiva del Test de aprendizaje auditivo verbal de Rey [RAVLT, por sus siglas en inglés]. El nivel de severidad del trauma parece mostrar diferencias en los individuos en cuanto al desempeño en memoria episódica de información nueva y en el control de interferencia entre los recuerdos; lo mismo se aplica a las funciones de flexibilidad e inhibición. Estos resultados sugieren que es necesaria una mayor inversión en acciones de políticas públicas, priorizando intervenciones neurocognitivas reeducativas y métodos de prevención de accidentes relacionados con lesiones traumáticas que tengan alta incidencia de secuelas.El traumatismo craneoencefálico (TCE) puede conllevar impactantes cambios en la vida cotidiana, que incluyen alteraciones a nivel social, profesional, comunicativo y cognitivo (dificultades atencionales, mnemónicas y ejecutivas). Este estudio tuvo por objeto caracterizar la ocurrencia de déficits neuropsicológicos post-TCE y constatar el impacto ocasionado por el nivel de severidad del trauma en el desempeño cognitivo de los pacientes. Participaron 96 adultos en la muestra total, que fue dividida en dos grupos para evaluar el nivel de severidad del trauma: TCE leve (n=39) y TCE grave (n=77). La gravedad de la lesión se clasificó por medio de la Escala de Coma de Glasgow, por la duración de la pérdida de consciencia, o por la amnesia post-traumática. No había diferencias entre la edad y la escolaridad de los participantes. Para la comparación entre los grupos en cuanto a la distribución de ocurrencia de déficits neuropsicológicos, se utilizó el Chi-cuadrado. Se utilizó una batería de evaluación neuropsicológica flexible conformada por tareas verbales y visoespaciales de habilidades lingüísticas, mnemónicas y ejecutivas. Los grupos no se diferenciaron en cuanto a las variables sociodemográficas. Los pacientes con TCE leve tuvieron mejores puntajes comparados con los de TCE grave (número de errores y categorías completadas del Test de clasificación de tarjetas de Wisconsin- [WCST, por sus siglas en inglés]; errores en la parte B del Test de Hayling; y en la interferencia retro y proactiva del Test de aprendizaje auditivo verbal de Rey [RAVLT, por sus siglas en inglés]. El nivel de severidad del trauma parece mostrar diferencias en los individuos en cuanto al desempeño en memoria episódica de información nueva y en el control de interferencia entre los recuerdos; lo mismo se aplica a las funciones de flexibilidad e inhibición. Estos resultados sugieren que es necesaria una mayor inversión en acciones de políticas públicas, priorizando intervenciones neurocognitivas reeducativas y métodos de prevención de accidentes relacionados con lesiones traumáticas que tengan alta incidencia de secuelas.Traumatic brain injury (TBI) can lead to significant changes in daily life, as well as in social, labor, communicative, and cognitive domains (attention, memory and executive functions). This study aimed to characterize the occurrence of post-TBI neuropsychological deficits as well as to determine whether there is an impact related to the level of severity of the trauma on the patient's performance. Ninety-six adults participated in the study, who were divided in two groups to assess the trauma's level of severity: mild TBI (n=39) and severe TBI (n=57). This severity was classified by the Glasgow Coma Scale, by the duration of consciousness loss, or by post-traumatic amnesia. There were no differences between the groups regarding variables of age and years of schooling. A Chi- square test was used to do a comparison between the two groups in terms of occurrence of neuropsychological deficits. Verbal, visuospatial, mnemonic, linguistic and executive tests composed a flexible neuropsychological battery. Patients with mild TBI had better scores compared to those with severe TBI (number of errors and in completed categories of the Modified Wisconsin Card Sorting Test (MWCST); errors in Part B of The Hayling Test; and proactive and retroactive interference in the Rey Auditory Verbal Learning Test (RAVLT). The severity of the trauma seems to differentiate individual's performance on episodic memory of new information and in the control of interference between memories; the same is applied to flexibility and inhibition functions. These results suggest the need for more investments in public health policy actions, prioritizing neurocognitive remedial intervention and prevention methods for such condition with high incidence of sequelae

Grasses and Legumes for Cellulosic Bioenergy

Human life has depended on renewable sources of bioenergy for many thousands of years, since the time humans fi rst learned to control fi re and utilize wood as the earliest source of bioenergy. The exploitation of forage crops constituted the next major technological breakthrough in renewable bioenergy, when our ancestors began to domesticate livestock about 6000 years ago. Horses, cattle, oxen, water buffalo, and camels have long been used as sources of mechanical and chemical energy. They perform tillage for crop production, provide leverage to collect and transport construction materials, supply transportation for trade and migratory routes, and create manure that is used to cook meals and heat homes. Forage crops—many of which form the basis of Grass: The 1948 Yearbook of Agriculture (Stefferud, 1948), as well as the other chapters of this volume—have composed the principal or only diet of these draft animals since the dawn of agriculture

Statistical properties of phases and delay times of the one-dimensional Anderson model with one open channel

We study the distribution of phases and of Wigner delay times for a one-dimensional Anderson model with one open channel. Our approach, based on classical Hamiltonian maps, allows us an analytical treatment. We find that the distribution of phases depends drastically on the parameter $\sigma_A = \sigma/sin k$ where $\sigma^2$ is the variance of the disorder distribution and $k$ the wavevector. It undergoes a transition from uniformity to singular behaviour as $\sigma_A$ increases. The distribution of delay times shows universal power law tails $~ 1/\tau^2$, while the short time behaviour is $\sigma_A$- dependent.Comment: 4 pages, 2 figures, Submitted to PR

Household packaging waste management

Household packaging waste (HPW) has an important environmental impact and economic relevance. Thus there are networks of collection points (named “ecopontos” in Portugal) where HPW may be deposited for collection by waste management companies. In order to optimize HPW logistics, accurate estimates of the waste generation rates are needed to calculate the number of collections required for each ecoponto in a given period of time. The most important factors to estimate HPW generation rates are linked to the characteristics of the population and the social and economic activities around each ecoponto location. We developed multiple linear regression models and artificial neural networks models to forecast the number of collections per year required for each location. For operational short term planning purposes, these forecasts need to be adjusted for seasonality in order to determine the required number of collections for the relevant planning period. In this paper we describe the methodology used to obtain these forecasts.This research has been partially supported by COMPETE: POCI-01-0145-FEDER007043 and FCT – Fundação para a Ciência e Tecnologia within the Project Scope: UID/CEC/00319/2013.info:eu-repo/semantics/publishedVersio