Pseudo-wound infection after a caesarean section:Case report of unrecognized Pyoderma Gangrenosum

Background: Pyoderma Gangrenosum (PG) is a rare auto-inflammatory disease, characterized by painful ulcerative skin-lesions often developing at sites of injury or surgery because of the typical pathergy phenomena. We describe an unusual case of PG after a caesarean section with excessive extra-cutaneous manifestation within internal organs. Presentation of case: A 21-year-old Dutch primigravida developed signs of sepsis after a caesarean section. Despite antibiotic treatment, fast clinical deterioration occurred. Exploration of the wound showed necrosis of the uterus and surrounding tissues. Due to the progression of necrosis, consecutive debridement procedures were executed resulting in a substantial abdominal wall defect. The progressive clinical course of the necrosis combined with absence of positive wound cultures and histology of prominent interstitial neutrophilic infiltration, led to the diagnosis ‘Pyoderma Gangrenosum’. Treatment with high dose corticosteroids led to rapid regression of the disease. After several weeks, the abdominal wall defect was surgically corrected under systemic corticosteroid therapy. Discussion: This case of PG is unique due to the excessive extra-cutaneous presentation, which contributed to delayed diagnosis. Several surgical interventions in the active stage of disease resulted in expansion of PG and substantial morbidity for the patient. Conclusion: Post-operative PG can mimic infectious diseases, but treatment is substantially different. This case of extensive PG highlights the importance of timely recognition and treatment of the disease to reduce iatrogenic morbidity

Emotion Recognition and Traffic-Related Risk-Taking Behavior in Patients with Neurodegenerative Diseases

Objectives : Neurodegenerative diseases (NDDs), such as Alzheimer's disease, frontotemporal dementia, dementia with Lewy bodies, and Huntington's disease, inevitably lead to impairments in higher-order cognitive functions, including the perception of emotional cues and decision-making behavior. Such impairments are likely to cause risky daily life behavior, for instance, in traffic. Impaired recognition of emotional expressions, such as fear, is considered a marker of impaired experience of emotions. Lower fear experience can, in turn, be related to risk-taking behavior. The aim of our study was to investigate whether impaired emotion recognition in patients with NDD is indeed related to unsafe decision-making in risky everyday life situations, which has not been investigated yet.  Methods: Fifty-one patients with an NDD were included. Emotion recognition was measured with the Facial Expressions of Emotions: Stimuli and Test (FEEST). Risk-taking behavior was measured with driving simulator scenarios and the Action Selection Test (AST). Data from matched healthy controls were used: FEEST (n = 182), AST (n = 36), and driving simulator (n = 18).   Results: Compared to healthy controls, patients showed significantly worse emotion recognition, particularly of anger, disgust, fear, and sadness. Furthermore, patients took significantly more risks in the driving simulator rides and the AST. Only poor recognition of fear was related to a higher amount of risky decisions in situations involving a direct danger.   Conclusions: To determine whether patients with an NDD are still fit to drive, it is crucial to assess their ability to make safe decisions. Measuring emotion recognition may be a valuable contribution to this judgment

Outcome of depression in later life in primary care: longitudinal cohort study with three years’ follow-up

Objectives To study the duration of depression, recovery over time, and predictors of prognosis in an older cohort (≥55 years) in primary care

Retrieval and validation of ozone columns derived from measurements of SCIAMACHY on Envisat

International audienceThis paper describes a new ozone column retrieval algorithm and its application to SCIAMACHY measurements. The TOSOMI algorithm is based on the Differential Optical Absorption Spectroscopy (DOAS) technique and implements several improvements over older algorithms. These improvements include aspects like (i) the explicit treatment of rotational Raman scattering, (ii) an improved air-mass factor formulation which is based on a simulation of the reflectivity spectrum and a subsequent DOAS fit of this simulated spectrum, (iii) the use of an improved ozone climatology and a column dependent air-mass factor, (iv) the use of daily varying ECMWF temperature profile analyses. The results of three validation exercises are reported. The TOSOMI columns are compared with an extensive set of ground-based observations (Brewer, Dobson) for the years 2003 and 2004. Secondly, a direct comparison for January?June 2003 with two new GOME retrievals, GDP Version 4 and TOGOMI, is presented. Third, data assimilation is used to study the dependence of the TOSOMI columns with retrieval parameters such as the viewing angle, cloud fraction and geographical location. These comparisons show a good consistency on the percent level between the GOME and SCIAMACHY algorithms. The present TOSOMI implementation (v0.32) shows an offset of about ?1.5% with respect to ground-based observations and the GOME retrievals

Klimaatverandering in de Grote Polder en Polder Groenendijk : Workshopverslag

Het klimaat verandert en dat merken we langzaam maar zeker. Maar wat zijn hiervan de gevolgen op lokaal niveau? Om hier een beeld van te vormen is informatie over klimaatverandering en (land)gebruik samengebracht voor de Grote Polder en Polder Groenendijk. Kunnen we een eerste beeld vormen van wat klimaatverandering betekent voor het bedrijfsleven op het bedrijvenpark, voor de Heineken-brouwerij, voor de gemeente Zoeterwoude, voor het Hoogheemraadschap van Rijnland, voor de boeren, voor de natuur, en voor de mensen die er wonen en recreëren? Tijdens een bijeenkomst op 28 september 2017, georganiseerd door het Hoogheemraadschap van Rijnland in het kader van de Groene Thema Cirkel Water, is met diverse partijen uit het gebied het beeld besproken en zijn een aantal verhaallijnen afgeleid. Deze verhaallijnen worden verder verwerkt in de ‘story maps’ van de klimaateffectatlas Zuid Holland

Critical behaviour of the Rouse model for gelling polymers

It is shown that the traditionally accepted "Rouse values" for the critical exponents at the gelation transition do not arise from the Rouse model for gelling polymers. The true critical behaviour of the Rouse model for gelling polymers is obtained from spectral properties of the connectivity matrix of the fractal clusters that are formed by the molecules. The required spectral properties are related to the return probability of a "blind ant"-random walk on the critical percolating cluster. The resulting scaling relations express the critical exponents of the shear-stress-relaxation function, and hence those of the shear viscosity and of the first normal stress coefficient, in terms of the spectral dimension $d_{s}$ of the critical percolating cluster and the exponents $\sigma$ and $\tau$ of the cluster-size distribution.Comment: 9 pages, slightly extended version, to appear in J. Phys.

Maximal height statistics for 1/f^alpha signals

Numerical and analytical results are presented for the maximal relative height distribution of stationary periodic Gaussian signals (one dimensional interfaces) displaying a 1/f^alpha power spectrum. For 0<alpha<1 (regime of decaying correlations), we observe that the mathematically established limiting distribution (Fisher-Tippett-Gumbel distribution) is approached extremely slowly as the sample size increases. The convergence is rapid for alpha>1 (regime of strong correlations) and a highly accurate picture gallery of distribution functions can be constructed numerically. Analytical results can be obtained in the limit alpha -> infinity and, for large alpha, by perturbation expansion. Furthermore, using path integral techniques we derive a trace formula for the distribution function, valid for alpha=2n even integer. From the latter we extract the small argument asymptote of the distribution function whose analytic continuation to arbitrary alpha > 1 is found to be in agreement with simulations. Comparison of the extreme and roughness statistics of the interfaces reveals similarities in both the small and large argument asymptotes of the distribution functions.Comment: 17 pages, 8 figures, RevTex

Moral enhancement: do means matter morally?

One of the reasons why moral enhancement may be controversial, is because the advantages of moral enhancement may fall upon society rather than on those who are enhanced. If directed at individuals with certain counter-moral traits it may have direct societal benefits by lowering immoral behavior and increasing public safety, but it is not directly clear if this also benefits the individual in question. In this paper, we will discuss what we consider to be moral enhancement, how different means may be used to achieve it and whether the means we employ to reach moral enhancement matter morally. Are certain means to achieve moral enhancement wrong in themselves? Are certain means to achieve moral enhancement better than others, and if so, why? More specifically, we will investigate whether the difference between direct and indirect moral enhancement matters morally. Is it the case that indirect means are morally preferable to direct means of moral enhancement and can we indeed pinpoint relevant intrinsic, moral differences between both? We argue that the distinction between direct and indirect means is indeed morally relevant, but only insofar as it tracks an underlying distinction between active and passive interventions. Although passive interventions can be ethical provided specific safeguards are put in place, these interventions exhibit a greater potential to compromise autonomy and disrupt identity

Determinants on lens spaces and cyclotomic units

The Laplacian functional determinants for conformal scalars and coexact one-forms are evaluated in closed form on inhomogeneous lens spaces of certain orders, including all odd primes when the essential part of the expression is given, formally as a cyclotomic unitComment: 18 pages, 1 figur