19 research outputs found
Scroll waves in isotropic excitable media : linear instabilities, bifurcations and restabilized states
Scroll waves are three-dimensional analogs of spiral waves. The linear
stability spectrum of untwisted and twisted scroll waves is computed for a
two-variable reaction-diffusion model of an excitable medium. Different bands
of modes are seen to be unstable in different regions of parameter space. The
corresponding bifurcations and bifurcated states are characterized by
performing direct numerical simulations. In addition, computations of the
adjoint linear stability operator eigenmodes are also performed and serve to
obtain a number of matrix elements characterizing the long-wavelength
deformations of scroll waves.Comment: 30 pages 16 figures, submitted to Phys. Rev.
Prevalence of diffuse pancreatic beta islet cell disease with hyperinsulinism: Problems in recognition and management
Among 77 patients with endogenous hyperinsulinism seen in 2 medical centers, diffuse islet cell disease accounted for 17 (22%) patients. Since diffuse islet cell disease poses special problems in management, its prevalence is emphasized in this report. Among these patients with diffuse islet cell disease, there were 11 patients with adenomatosis, 4 with nesidioblastosis, and 2 with islet cell hyperplasia. Six of the 77 patients were found in multiple endocrine neoplasia, type I kindreds; diffuse islet cell disease was documented in 4 of these patients. We outline principles of management in patients with diffuse islet cell disease. Frozen section microscopy failed to identify nesidioblastosis or islet cell hyperplasia. Chez 77 malades, provenant de 2 centres mĂ©dicaux, qui prĂ©sentaient un hyperinsulinisme endogène, 17 cas de lĂ©sions diffuses des Ă®lots de Langerhans ont Ă©tĂ© dĂ©nombrĂ©s. Ce fait est donc loin d'ĂŞtre exceptionnel et cette Ă©tude a pour but de le souligner. Parmi ces 17 malades, 11 prĂ©sentaient des adĂ©nomes multiples (adĂ©nomatoses), 4 des nĂ©sidoblastomes (anomalies tissulaires multifocales), 2 des hyperplasies cellulaires insulaires. Chez ces 77 malades, 6 cas de MEN type I furent individualisĂ©s, 4 d'entre eux prĂ©sentaient une maladie insulaire diffuse. Les auteurs, forts de cette expĂ©riences insistent sur les principes du traitement de ce type d'affection. Ils insistent sur le fait que l'Ă©tude histologique extemporanĂ©e ne permet pas d'identifier les nĂ©sidoblastomes et les hyperplasies cellulaires insulaires et que dans 70%–80% des cas les rĂ©sections pancrĂ©atiques ne permettent pas d'obtenir la guĂ©rison. Un problema constante para el cirujano que opera pacientes con hiperinsulinismo endĂłgeno es el de quĂ© hacer cuando no se encuentre patologĂa en el curso de la operaciĂłn una vez realizada la exploraciĂłn preliminar del páncreas. Los adenomas solitarios de cĂ©lulas beta pueden pasar desapercibidos cuando no son palpables; la identificaciĂłn de la enfermedad difusa de las cĂ©lulas insulares plantea muchos problemas. Reconocemos tres alteraciones principales de tipo difuso: adenomatosis de cĂ©lulas beta, nesidioblastosis e hiperplasia pancreática de cĂ©lulas beta. Además, mĂşltiples macroadenomas pueden coexistir o no con microadenomatosis o con hiperplasia en ciertos pacientes con hiperinsulinismo. Los desĂłrdenes de cĂ©lulas insulares de tipo multifocal son particularmente frecuentes en pacientes con Neoplasia Endocrina Multiple Tipo I.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41314/1/268_2005_Article_BF01654942.pd
Skilled for improvement? Learning communities and the skills needed to improve care: an evaluative service development
This report tells the story of the Learning Communities Initiative, in which an experienced research team used an action approach (combining action research and action learning) to study four improvement projects across two sites, while working with participants to facilitate the flow of knowledge and learning.The report provides a graphic and illuminating description of the difficulties and barriers which arise in improvement work