Pitfalls in Unqualified Acceptance of Laboratory Data

One can never be absolutely certain that any single laboratory report is correct. As a general rule, therefore, do not undertake potentially serious action on behalf of any patient solely because of a single laboratory report. This is especially important if the result is unexpected or not in harmony with the rest of the clinical information available

Torts: Performer of Gratuitous Services on Private Premises: Invitee or Licensee?

Torts: Performer of Gratuitous Services on Private Premises: Invitee or Licensee

Propriety of Instruction on Comparative Negligence

Propriety of Instruction on Comparative Negligenc

Montana Annotations to the Restatement of the Law of Contracts

Montana Annotations to the Restatement of the Law of Contract

Dynamics of face and annular seals with two-phase flow

A detailed study was made of face and annular seals under conditions where boiling, i.e., phase change of the leaking fluid, occurs within the seal. Many seals operate in this mode because of flashing due to pressure drop and/or heat input from frictional heating. Some of the distinctive behavior characteristics of two phase seals are discussed, particularly their axial stability. The main conclusions are that seals with two phase flow may be unstable if improperly balanced. Detailed theoretical analyses of low (laminar) and high (turbulent) leakage seals are presented along with computer codes, parametric studies, and in particular a simplified PC based code that allows for rapid performance prediction: calculations of stiffness coefficients, temperature and pressure distributions, and leakage rates for parallel and coned face seals. A simplified combined computer code for the performance prediction over the laminar and turbulent ranges of a two phase flow is described and documented. The analyses, results, and computer codes are summarized

Female Education as Reflected in Victorian Fiction

Enduring literature is said to be an outcome of the times that produced it. Conversely, it may be said to be an open door into the life and place where it originated. Entering this open door into the Victorian period, it is my purpose to show to what extent one phase of that life is mirrored there

Ten-Year Minimum Follow-up Study of First Metatarsophalangeal Joint Fusion in Young vs Old Patients

BACKGROUND Painful degenerative joint disease (DJD) of the first metatarsophalangeal joint (MTP I), or hallux rigidus, mainly occurs in later stages of life. For end-stage hallux rigidus, MTP I arthrodesis is considered the gold standard. As young and active patients are affected considerably less frequently, it currently remains unclear, whether they benefit to the same extent. We hypothesized that MTP I arthrodesis in younger patients would lead to an inferior outcome with decreased rates of overall with lower rates of patient postoperative pain and function compared to an older cohort. METHODS All patients aged 60 years. Minimum follow-up was 10 years. Outcome measures were Tegner activity score (TAS), a "Virtual Tegner activity score" (VTAS), the visual analog scale (VAS), and the Foot Function index (FFI). RESULTS Sixty-one MTP I fusions (n = 28 young, n = 33 old) in 46 patients were included in our study at an average of 14 years after surgery. Younger patients experienced significantly more pain relief as reflected by changes in VAS and FFI Pain subscale scores. No difference in functional outcomes was found with change in the FFI function subscale or in the ability to have desired functional outcomes using the ratio of TAS to VTAS. Revision rate did not differ between the two groups apart from hardware removal, which was significantly more likely in the younger group. CONCLUSION In patients below the age of 50 years with end-stage DJD of the first metatarsal joint, MTP I arthrodesis not only yielded highly satisfactory postoperative results at least equal outcome compared to an older cohort of patients aged >60 years at an average 14 years' follow-up. Based on these findings, we consider first metatarsal joint fusion even for young patients is a valid option to treat end-stage hallux rigidus. LEVEL OF EVIDENCE Level III, a case-control study

Combining polynomial chaos expansions and genetic algorithm for the coupling of electrophysiological models

The number of computational models in cardiac research has grown over the last decades. Every year new models with di erent assumptions appear in the literature dealing with di erences in interspecies cardiac properties. Generally, these new models update the physiological knowledge using new equations which reect better the molecular basis of process. New equations require the fi tting of parameters to previously known experimental data or even, in some cases, simulated data. This work studies and proposes a new method of parameter adjustment based on Polynomial Chaos and Genetic Algorithm to nd the best values for the parameters upon changes in the formulation of ionic channels. It minimizes the search space and the computational cost combining it with a Sensitivity Analysis. We use the analysis of di ferent models of L-type calcium channels to see that by reducing the number of parameters, the quality of the Genetic Algorithm dramatically improves. In addition, we test whether the use of the Polynomial Chaos Expansions improves the process of the Genetic Algorithm search. We conclude that it reduces the Genetic Algorithm execution in an order of 103 times in the case studied here, maintaining the quality of the results. We conclude that polynomial chaos expansions can improve and reduce the cost of parameter adjustment in the development of new models.Peer ReviewedPostprint (author's final draft

Acoustic radiation controls friction: Evidence from a spring-block experiment

Brittle failures of materials and earthquakes generate acoustic/seismic waves which lead to radiation damping feedbacks that should be introduced in the dynamical equations of crack motion. We present direct experimental evidence of the importance of this feedback on the acoustic noise spectrum of well-controlled spring-block sliding experiments performed on a variety of smooth surfaces. The full noise spectrum is quantitatively explained by a simple noisy harmonic oscillator equation with a radiation damping force proportional to the derivative of the acceleration, added to a standard viscous term.Comment: 4 pages including 3 figures. Replaced with version accepted in PR

Supplemental measles vaccine antibody response among HIV-infected and -uninfected children in Malawi after 1- and 2-dose primary measles vaccination schedules.

BACKGROUND: The long-term antibody response to measles vaccine (MV) administered at age 6 months with or without subsequent doses is not well documented. METHODS: Measles serum antibody responses were evaluated after a supplemental dose of measles vaccine (sMV) administered at a median age of 20 months among Malawian children who had previously received 2 doses of measles vaccine (MV) at ages 6 and 9 months (HIV-infected and random sample of HIV-uninfected) or 1 dose at age 9 months (random sample of HIV-uninfected). We compared measles antibody seropositivity between groups by enzyme linked immunoassay and seroprotection by plaque reduction neutralization geometric mean concentrations. RESULTS: Of 1756 children enrolled, 887 (50.5%) received a sMV dose following MV at 9 months of age and had specimens available after sMV receipt, including 401 HIV-uninfected children who received one MV dose at 9 months, 464 HIV-uninfected and 22 HIV-infected children who received two doses of MV at ages 6 and 9 months. Among HIV-uninfected children, protective levels of antibody were found post sMV in 90-99% through ages 24-36 months and were not affected by MV schedule. Geometric mean concentration levels of measles antibody were significantly increased post-sMV among those HIV-uninfected children previously non-responsive to vaccination. Among HIV-infected children, the proportion seroprotected increased initially but by 9 months post-sMV was no higher than pre-sMV. CONCLUSIONS: Our findings support early 2-dose MV to provide measles immunity for young infants without risk of interference with antibody responses to subsequent MV doses administered as part of SIAs