The clinical implications of adult-onset henoch-schonelin purpura

Henoch-Schonlein Purpura (HSP) is a small vessel vasculitis mediated by IgA-immune complex deposition. It is characterized by the clinical tetrad of non-thrombocytopenic palpable purpura, abdominal pain, arthritis and renal involvement. Pathologically, it can be considered a form of immune complex-mediated leukocytoclastic vasculitis (LCV) involving the skin and other organs. Though it primarily affects children (over 90% of cases), the occurrence in adults has been rarely reported. Management often involves the use of immunomodulatory or immune-suppressive regimens

The Clinical Implications of Adult-Onset Henoch-Schonelin purpura

bHenoch-Schonlein Purpura (HSP) is a small vessel vasculitis mediated by IgA-immune complex deposition. It is characterized by the clinical tetrad of non-thrombocytopenic palpable purpura, abdominal pain, arthritis and renal involvement. Pathologically, it can be considered a form of immune complex-mediated leukocytoclastic vasculitis (LCV) involving the skin and other organs. Though it primarily affects children (over 90% of cases), the occurrence in adults has been rarely reported. Management often involves the use of immunomodulatory or immune-suppressive regimens

Direct generation of optical vortices

A detailed scheme is established for the direct generation of optical vortices, signifying light endowed with orbital angular momentum. In contrast to common techniques based on the tailored conversion of the wave front in a conventional beam, this method provides for the direct spontaneous emission of photons with the requisite field structure. This form of optical emission results directly from the electronic relaxation of a delocalized exciton state that is supported by a ringlike array of three or more nanoscale chromophores. An analysis of the conditions leads to a general formulation revealing a requirement for the array structure to adhere to one of a restricted set of permissible symmetry groups. It is shown that the coupling between chromophores within each array leads to an energy level splitting of the exciton structure, thus providing for a specific linking of exciton phase and emission wavelength. For emission, arrays conforming to one of the given point-group families’ doubly degenerate excitons exhibit the specific phase characteristics necessary to support vortex emission. The highest order of exciton symmetry, corresponding to the maximum magnitude of electronic orbital angular momentum supported by the ring, provides for the most favored emission. The phase properties of the emission produced by the relaxation of such excitons are exhibited on plots which reveal the azimuthal phase progression around the ring, consistent with vortex emission. It is proven that emission of this kind produces electromagnetic fields that map with complete fidelity onto the phase structure of a Laguerre-Gaussian optical mode with the corresponding topological charge. The prospect of direct generation paves the way for practicable devices that need no longer rely on the modification of a conventional laser beam by a secondary optical element. Moreover, these principles hold promise for the development of a vortex laser, also based on nanoscale exciton decay, enabling the production of coherent radiation with a tailor-made helical wave front

Komunikasi Pemasaran Terpadu dalam Mengembangkan Kapasitas Petani Padi di Provinsi Banten

Komunikasi pemasaran sesuai dengan perkembangan teknologi proses komunikasi juga mengalami perubahan, seperti akhir-akhir ini maraknya perkembangan internet. Tentunya ini juga akan berpengaruh terhadap pelaku pertanian baik penyuluh maupun petani dalam memperoleh informasi suatu produk atau jasa. Kapasitas petani adalah daya-daya yang dimiliki pribadi petani untuk dapat menetapkan tujuan usahatani secara tepat dan mencapai tujuan yang telah ditetapkan dengan cara yang tepat pula. Setiap individu (orang) secara alamiah selalu memiliki kapasitas yang melekat pada dirinya. Kemampuan petani untuk memenuhi kebutuhan sesuai dengan potensi yang dimiliki, maka tujuan penelitian ini adalah: (1) menganalisis karakteristik kewirausahaan, komunikasi pemasaran terpadu, dan kapasitas petani; (2) menganalisis faktor-faktor yang mempengaruhi kapasitas petani. Penelitian ini menggunakan paradigma positivistik dengan metodologi penelitian kuantitatif serta menggunakan motode survey.  Lokasi penelitian berada di empat kabupaten di Provinsi Banten, yaitu Kabupaten Lebak, Kabupaten Serang, Kabupaten Pandeglang dan Kabupaten Tenggerang. Populasinya adalah petani padi dengan jumlah 276.712 orang. Jumlah sampel ditetapkan dengan rumus Slovin dengan tingkat error 5 persen, diperoleh sebanyak 400 orang. Hasil penelitian menunjukkan bahwa: (1) karateristik kewirausahaan petani padi sudah cukup baik,  petani telah mampu melakukan komunikasi pemasaran terpadu, dan kapasita petani padi sudah cukup baik dalam menjalankan usaha; (2) kapasitas dipengaruhi secara langsung oleh karakteristik kewirausahaan, dan dipengaruhi secara tidak langsung oleh komunikasi pemasaran terpadu

On the analytical formulation of excess noise in avalanche photodiodes with dead space

Simple, approximate formulas are developed to calculate the mean gain and excess noise factor for avalanche photodiodes using the dead-space multiplication theory in the regime of small multiplication width and high applied electric field. The accuracy of the approximation is investigated by comparing it to the exact numerical method using recursive coupled integral equations and it is found that it works for dead spaces up to 15% of the multiplication width, which is substantial. The approximation is also tested for real materials such as GaAs, InP and Si for various multiplication widths, and the results found are accurate within ∼ 15% of the actual noise, which is a significant improvement over the local-theory noise formula. The results obtained for the mean gain also confirm the recently reported relationship between experimentally determined local ionization coefficients and the enabled non-local ionization coefficients

Prediction of congenital hypothyroidism based on initial screening thyroid-stimulating-hormone

Background: In thyroid-stimulating-hormone (TSH)-based newborn congenital hypothyroidism (CH) screening programs, the optimal screening-TSH cutoff level is critical to ensuring that true cases of CH are not missed. Screening-TSH results can also be used to predict the likelihood of CH and guide appropriate clinical management. The purpose of this study is to evaluate the predictive value of various screening-TSH levels in predicting a diagnosis of CH in the Ontario Newborn Screening Program (ONSP). Methods: The initial screening and follow-up data of 444,744 full term infants born in Ontario, Canada from April 1, 2006 to March 31, 2010 were analyzed. Confirmed CH cases were based on local endocrinologists\u27 report and initiation of thyroxine treatment. Results: There were a total of 541 positive screening tests (~1/822 live births) of which 296 were true positives (~1:1,500 live births). Subjects were further subdivided based on screening-TSH and positive predictive values (PPV) were calculated. Twenty four percent in the 17-19.9 mIU/L range were true positives. In the 17-30 mIU/L range, 29 % were true positives with a significantly higher PPV for those sampled after (43 %) rather than before (25 %) 28 h of age (p \u3c 0.02). Seventy three percent of neonates with an initial screening-TSH of ≥ 30 mIU/L and 97 % of those with ≥ 40 mIU/L were later confirmed to have CH. Conclusions: Infants with modestly elevated screening positive TSH levels between 17 and 19.9 mIU/L have a significant risk (24 %) of having CH. The very high frequency of true positives in term newborns with initial TSH values ≥ 30mIU/L suggests that this group should be referred directly to a pediatric endocrinologist in an effort to expedite further assessment and treatment. Screen positives with a modestly elevated TSH values (17-19.9 mIU/L) need to be examined in more detail with extended follow-up data to determine if they have transient or permanent CH

Prediction of congenital hypothyroidism based on initial screening thyroid-stimulating-hormone

Background: In thyroid-stimulating-hormone (TSH)-based newborn congenital hypothyroidism (CH) screening programs, the optimal screening-TSH cutoff level is critical to ensuring that true cases of CH are not missed. Screening-TSH results can also be used to predict the likelihood of CH and guide appropriate clinical management. The purpose of this study is to evaluate the predictive value of various screening-TSH levels in predicting a diagnosis of CH in the Ontario Newborn Screening Program (ONSP). Methods: The initial screening and follow-up data of 444,744 full term infants born in Ontario, Canada from April 1, 2006 to March 31, 2010 were analyzed. Confirmed CH cases were based on local endocrinologists\u27 report and initiation of thyroxine treatment. Results: There were a total of 541 positive screening tests (~1/822 live births) of which 296 were true positives (~1:1,500 live births). Subjects were further subdivided based on screening-TSH and positive predictive values (PPV) were calculated. Twenty four percent in the 17-19.9 mIU/L range were true positives. In the 17-30 mIU/L range, 29 % were true positives with a significantly higher PPV for those sampled after (43 %) rather than before (25 %) 28 h of age (p \u3c 0.02). Seventy three percent of neonates with an initial screening-TSH of ≥ 30 mIU/L and 97 % of those with ≥ 40 mIU/L were later confirmed to have CH. Conclusions: Infants with modestly elevated screening positive TSH levels between 17 and 19.9 mIU/L have a significant risk (24 %) of having CH. The very high frequency of true positives in term newborns with initial TSH values ≥ 30mIU/L suggests that this group should be referred directly to a pediatric endocrinologist in an effort to expedite further assessment and treatment. Screen positives with a modestly elevated TSH values (17-19.9 mIU/L) need to be examined in more detail with extended follow-up data to determine if they have transient or permanent CH

Formulation and stabilization of a recombinant human Cytomegalovirus vector for use as a candidate vaccine for HIV-1

Vaccination using Cytomegalovirus (CMV) vectors have recently shown promising results in conferring protection in non-human primates against SIV and Mycobacterium tuberculosis infection (1-3). Since CMV vectors can stimulate the production of high concentrations of systemic effector memory T-cells, CMV vectors (containing the appropriate insert) have the potential to clear SIV/HIV and Mycobacterium tuberculosis infection, provided administration occurs at the onset of infection (1, 3). Despite the promising animal data, CMV vectors are prone to potency loss (i.e., degradation) by freeze-thaw and storage at 2-8°C. In this study, we wished to develop formulations with increased freeze-thaw and liquid stability for a recombinant human CMV vector (rHCMV-1) for use in initial clinical trials including i) reduce vector potency loss to \u3c0.5 log after 1 freeze-thaw cycle and ii) reduce vector potency loss to \u3c0.5 log after 4 hours at 2-8°C storage. To achieve these goals, we screened a library of ~50 pharmaceutical excipients and evaluated their effect on vector potency after 3 freeze-thaw cycles or incubation at 4°C for several days. We found that certain additives completely protected rHCMV-1 against freeze-thaw mediated potency loss. With regards to liquid stability, we found certain additives slowed the rate of rHCMV-1 titer loss when stored at 4°C. After screening various excipient combinations, we evaluated three candidate formulations and benchmarked them against the bulk drug substance (BDS) formulation buffer and another published formulation (4). The candidate formulations were significantly more stable than the formulations used for benchmarking in terms reducing rHCMV-1 titer loss due to freeze-thaw and incubation at 4°C for up to 30 days. Despite providing greater stability than the current BDS formulation buffer, rHCMV-1 titer loss was still observed at 4°C as a function of incubation time, which suggests further stabilization (i.e., lyophilization) is likely necessary for longer term development. This study highlights the utility of empirical design of a liquid formulation of a live viral vector where freeze-thaw and short-term liquid storage are necessary. References S. G. Hansen et al., Prevention of tuberculosis in rhesus macaques by a cytomegalovirus-based vaccine. Nat Med 24, 130-143 (2018). S. G. Hansen et al., Profound early control of highly pathogenic SIV by an effector memory T-cell vaccine. Nature 473, 523-527 (2011). S. G. Hansen et al., Immune clearance of highly pathogenic SIV infection. Nature 502, 100-104 (2013). T.-M. Fu, D. Wang, M. B. Medi, M. S. D. Corp, Ed. (2013). Acknowledgements: This work was funded by the Bill and Melinda Gates Foundation. *Current affiliation: Bill and Melinda Gates Foundation