Post-vaccine measles in a child with concomitant influenza, Sicily, Italy, March 2015

We describe the occurrence of measles in an 18 monthold patient in Sicily, Italy, in March 2015, who received the first dose of a measles-containing vaccine seven days before onset of prodromal symptoms. Measles virus infection was confirmed by PCR and detection of specific immunoglobulin; viral genotyping permitted the confirmation of a vaccine-associated illness. The patient had a concurrent influenza virus infection, during a seasonal epidemic outbreak of influenza

Intra-Tester Reliability and Concurrent Validity of Musculoskeletal Ultrasound and Vernier Calipre in Quantifying the Anteroposterior Diameter of the Common Extensor Origin of the Forearm and the Radial Nerve: A Cadaveric Study

Introduction: The literature reports an increase in anteroposterior diameter of the common extensor origin (CEO) of the extensor carpi radialis brevis (ECRB) and extensor digitorum communis (EDC) or the radial nerve in painful elbows diagnosed with lateral epicondylalgia (LE) or supinator syndrome. The edge-to-edge measurements of these anatomical structures are quantified using musculoskeletal ultrasound (MSUS). However, in the current literature, reports on the reliability and validity of MSUS measurements of the CEO (of ECRB and EDC) and the radial nerve are not found. In this study, reliability was measured for three testers in determining the anteroposterior diameter of the CEO (of ECRB and EDC) and the radial nerve. Moreover, the concurrent validity was determined of MSUS measurements with Vernier calipre measurements using formalin preserved elbows of human cadavers. Methodology: Cadaver measurements of the CEO (of ECRB and EDC) and the radial nerve were performed. Initially, the sonologist measured the anteroposterior diameter of the CEO (of ECRB and EDC) and the radial nerve. A month after scan, the formalin preserved cadavers were dissected. Consequently, the anteroposterior diameter of the exposed CEO (of ECRB and EDC) and the radial nerve was measured using the Vernier calipre. Results: Eight upper extremities of four embalmed Filipino cadavers (2 males: 2 females) were dissected. A total of seven (7) CEO of EDC, seven (7) CEO of ECRB, and eight (8) radial nerves at the level of the radial head in the elbows of four (4) cadavers were measured using the MSUS and the Vernier calipre. The MSUS and Vernier calipre protocol used in this study was found to be reliable, p \u3e 0.05. However, in all three levels of interest, the MSUS measurements were statistically different from the Vernier calipre measurements, p \u3c 0.05. Conclusion: MSUS and Vernier calipre measurements are reliable methods in measuring the CEO (of ECRB and EDC) and the radial nerve. While each of these methods is reliable in measuring the anteroposterior dimensions of the CEO (of the EDC and ECRB) and the radial nerve, substituting one for the other yielded statistically different measurement results

Intestinal tuberculosis in a child living in a country with a low incidence of tuberculosis: a case report

Background: Relatively common in adults, intestinal tuberculosis is considered rare in children and adolescents. The protean manifestations of intestinal tuberculosis mean that the diagnosis is often delayed (sometimes even for years), thus leading to increased mortality and unnecessary surgery. The main diagnostic dilemma is to differentiate intestinal tuberculosis and Crohn’s disease because a misdiagnosis can have dramatic consequences. Case presentation: A 13-year-old Caucasian, Italian female adolescent attended the Emergency Department complaining of abdominal pain, a fever of up to 38°C, night sweats, diarrhea with blood in stool, and a weight loss of about three kilograms over the previous two months. Physical examination revealed a marked skin pallor and considerable abdominal distension with relevant discomfort in all the abdominal quadrant. Laboratory tests revealed a decreased white blood cell count with anemia and increased C-reactive protein levels. The Mantoux tuberculin skin test was negative. A chest X-ray and an abdominal ultrasonography did not reveal any significant findings. The patient underwent colonoscopy that showed diffuse mucosal congestion and significant blood loss, and laparatomy showed small bowel and colon loops with a whitish appearance. A biopsy of the ileal mucosa revealed inflammation with noncaseating granulomas possibly due to bacterial infection. Given the suspicion of an opportunistic bacterial infection in a child with chronic inflammatory bowel disease (possibly Crohn’s disease), treatment with a third-generation cephalosporin was started. However, the abdominal pain, fever and poor general condition persisted and so, after 11 days, the patient underwent total body computed tomography and magnetic resonance imaging of the brain. On the basis of the radiological findings, miliary tuberculosis was suspected and bronchoscopy was performed and resulted positive for Mycobacterium tuberculosis. Miliary tuberculosis was confirmed and an effective treatment with four drugs was started. Conclusion: This case shows that the manifestations of intestinal tuberculosis can be very difficult to diagnose and mimic those of Chron’s disease. Total body computed tomography and laparotomy with an intestinal biopsy for the detection of Mycobacterium tuberculosis are the means of avoid the risks of a misdiagnosis in children with unexplained chronic abdominal problems

Real-time PCR for early diagnosis of Rickettsia conorii and prompt management in patients with septic shock and multiple organ failure: two case reports

We herein describe two severe cases of Mediterranean spotted fever caused by Rickettsia conorii. The ar- ticle presents polymerase chain reaction-restriction analysis as an early diagnostic tool for rickettsiosis caused by spotted fever group Rickettsiae. Timely microbiological diagnosis, the combined use of antibi- otics, intensive care measures and a multidisciplinary team approach are fundamental to manage these serious diseases

Reflected Light Curves, Spherical and Bond Albedos of Jupiter- and Saturn-like Exoplanets

Reflected light curves observed for exoplanets indicate that a few of them host bright clouds. We estimate how the light curve and total stellar heating of a planet depends on forward and backward scattering in the clouds based on Pioneer and Cassini spacecraft images of Jupiter and Saturn. We fit analytical functions to the local reflected brightnesses of Jupiter and Saturn depending on the planet's phase. These observations cover broadbands at 0.59–0.72 and 0.39–0.5 μm, and narrowbands at 0.938 (atmospheric window), 0.889 (CH4 absorption band), and 0.24–0.28 μm. We simulate the images of the planets with a ray-tracing model, and disk-integrate them to produce the full-orbit light curves. For Jupiter, we also fit the modeled light curves to the observed full-disk brightness. We derive spherical albedos for Jupiter and Saturn, and for planets with Lambertian and Rayleigh-scattering atmospheres. Jupiter-like atmospheres can produce light curves that are a factor of two fainter at half-phase than the Lambertian planet, given the same geometric albedo at transit. The spherical albedo is typically lower than for a Lambertian planet by up to a factor of ~1.5. The Lambertian assumption will underestimate the absorption of the stellar light and the equilibrium temperature of the planetary atmosphere. We also compare our light curves with the light curves of solid bodies: the moons Enceladus and Callisto. Their strong backscattering peak within a few degrees of opposition (secondary eclipse) can lead to an even stronger underestimate of the stellar heating

Hazards Analysis and Failure Modes and Effects Criticality Analysis (FMECA) of Four Concept Vehicle Propulsion Systems

The primary objective of this research effort is to identify failure modes and hazards associated with the concept vehicles and to perform functional hazard analyses (FHA) and failure modes and effects criticality analyses (FMECA) for each. Boeing also created a Fault Tree Analysis (FTA) for each of the concept vehicles, as the FTA contains the connectivity between systems and is an accepted, top-down method to analyze the safety of an air-vehicle. Conceptual design of notional powertrain configuration for each of four (4) NASA RVLT (Revolutionary Vertical Lift Technology) Concept Vehicles were developed in as much detail as was necessary to support the reliability and safety analysis for this project. Functional block diagrams from each of the conceptual powertrain configurations were created and used to order the FHA, FMECA, and FTA. Hazards were identified and the severity of each were categorized in the FHA for use in a follow-up FMECA. The FTA took inputs from the FMECA and the functional block diagrams to develop the connectivity and develop a quantitative architecture that could be used to perform sensitivity studies, as related to vehicle safety.Guidelines for reliability targets for both the air vehicle and the operation in the UAM (Urban Air Mobility) mission are discussed. An industry literature search was performed in order to assess gaps in existing government regulations and industry specifications. The industry literature search led to air-vehicle and operational reliability discussions, as related to Distributed Electric/Hybrid-Electric Propulsion (DE/HEP) system operating in the UAM role. A discussion of results and recommendations for future work is also provided

An Oort cloud origin for the high-inclination, high-perihelion Centaurs

We analyse the origin of three Centaurs with perihelia in the range 15 AU to 30 AU, inclinations above 70 deg and semi-major axes shorter than 100 AU. Based on long-term numerical simulations we conclude that these objects most likely originate from the Oort cloud rather than the Kuiper Belt or Scattered Disc. We estimate that there are currently between 1 and 200 of these high-inclination, high-perihelion Centaurs with absolute magnitude H<8.Comment: Accepted for publication in MNRA

2006 SQ372: A Likely Long-Period Comet from the Inner Oort Cloud

We report the discovery of a minor planet (2006 SQ372) on an orbit with a perihelion of 24 AU and a semimajor axis of 796 AU. Dynamical simulations show that this is a transient orbit and is unstable on a timescale of 200 Myrs. Falling near the upper semimajor axis range of the scattered disk and the lower semimajor axis range of the Oort Cloud, previous membership in either class is possible. By modeling the production of similar orbits from the Oort Cloud as well as from the scattered disk, we find that the Oort Cloud produces 16 times as many objects on SQ372-like orbits as the scattered disk. Given this result, we believe this to be the most distant long-period comet ever discovered. Furthermore, our simulation results also indicate that 2000 OO67 has had a similar dynamical history. Unaffected by the "Jupiter-Saturn Barrier," these two objects are most likely long-period comets from the inner Oort Cloud

Spatial Structure and Coherent Motion in Dense Planetary Rings Induced by Self-Gravitational Instability

We investigate the formation of spatial structure in dense, self-gravitating particle systems such as Saturn's B-ring through local $N$-body simulations to clarify the intrinsic physics based on individual particle motion. In such a system, Salo (1995) showed that the formation of spatial structure such as wake-like structure and particle grouping (clump) arises spontaneously due to gravitational instability and the radial velocity dispersion increases as the formation of the wake structure. However, intrinsic physics of the phenomena has not been clarified. We performed local $N$-body simulations including mutual gravitational forces between ring particles as well as direct (inelastic) collisions with identical (up to $N\sim40000$) particles. In the wake structure particles no longer move randomly but coherently. We found that particle motion was similar to Keplerian motion even in the wake structure and that the coherent motion was produced since the particles in a clump had similar eccentricity and longitude of perihelion. This coherent motion causes the increase and oscillation in the radial velocity dispersion. The mean velocity dispersion is rather larger in a more dissipative case with a smaller restitution coefficient and/or a larger surface density since the coherence is stronger in the more dissipative case. Our simulations showed that the wavelength of the wake structure was approximately given by the longest wavelength \hs{\lambda}{cr} = 4\pi^2 G\Sigma/\kappa^2 in the linear theory of axisymmetric gravitational instability in a thin disk, where $G$, $\Sigma$, and $\kappa$ are the gravitational constant, surface density, and a epicyclic frequency.Comment: Accepted by Earth, Planets, and Space. 39 pages, 20 figures. PostScript files also available from http://www.geo.titech.ac.jp/nakazawalab/hdaisaka/works