A mass that has no (EBUS) echo.

We report findings for a patient that underwent endobronchial ultrasound (EBUS) guided transbronchial needle aspiration (TBNA) for diagnostic purposes after an abnormal chest CT. The patient initially presented with cough and shortness of breath. Chest CT revealed a 6 cm soft tissue mass with mildly enlarged right hilar lymph nodes (LNs) and a small right sided pleural effusion. Based on these radiologic findings, the patient underwent an EBUS guided FNA of the mass. To our surprise, the mass was hypoechoic by EBUS and on aspiration, the syringe filled with yellow fluid. This finding in combination with a re-review of the CT scans with a special focus on the Hounsfield Units of the lesion confirmed the diagnosis of a mediastinal bronchogenic cyst. This case demonstrates the role of Hounsfield units in analyzing mediastinal masses and highlights the effectiveness of EBUS guided TBNA in diagnosis and treatment of bronchogenic cysts

Child Neurology Curriculum

Provision of comprehensive health services to children and adolescents is a central role for school nurses. Children with chronic health conditions are at the intersection of the health and education systems. Recently, educators, neurology care providers (MD/NP/PA) have initiated discussions about the impact of a child’s health on their ability to learn. The purpose of this project was to develop a child neurology curriculum for school nurses. A needs assessment survey was distributed. The survey results revealed a need for further education and training in child neurology diagnoses. Four areas were chosen for curriculum development:seizures/ epilepsy, headaches/migraines, tics, and post-concussion management. The Healthy Learner Model (HLM) and Child Neurology Process-Oriented Triage (ChiNePOT) are the conceptual frameworks used in this curriculum. Associated findings include the need of school nurses for pertinent evidence-based research to guide their practice, which will ultimately lead to a healthier learner

Collective Phase Chaos in the Dynamics of Interacting Oscillator Ensembles

We study chaotic behavior of order parameters in two coupled ensembles of self-sustained oscillators. Coupling within each of these ensembles is switched on and off alternately, while the mutual interaction between these two subsystems is arranged through quadratic nonlinear coupling. We show numerically that in the course of alternating Kuramoto transitions to synchrony and back to asynchrony, the exchange of excitations between two subpopulations proceeds in such a way that their collective phases are governed by an expanding circle map similar to the Bernoulli map. We perform the Lyapunov analysis of the dynamics and discuss finite-size effects.Comment: 19 page

Desynchronizing two oscillators while stimulating and observing only one

Synchronization of two or more self-sustained oscillators is a well-known and studied phenomenon, appearing both in natural and designed systems. In some cases, the synchronized state is undesired, and the aim is to destroy synchrony by external intervention. In this paper, we focus on desynchronizing two self-sustained oscillators by short pulses delivered to the system in a phase-specific manner. We analyze a non-trivial case when we cannot access both oscillators but stimulate only one. The following restriction is that we can monitor only one unit, be it a stimulated or non-stimulated one. First, we use a system of two coupled Rayleigh oscillators to demonstrate how a loss of synchrony can be induced by stimulating a unit once per period at a specific phase and detected by observing consecutive inter-pulse durations. Next, we exploit the phase approximation to develop a rigorous theory formulating the problem in terms of a map. We derive exact expressions for the phase -- isostable coordinates of this coupled system and show a relation between the phase and isostable response curves to the phase response curve of the uncoupled oscillator. Finally, we demonstrate how to obtain phase response information from the system using time series and discuss the differences between observing the stimulated and unstimulated oscillator

Two Scenarios of Breaking Chaotic Phase Synchronization

Two types of phase synchronization (accordingly, two scenarios of breaking phase synchronization) between coupled stochastic oscillators are shown to exist depending on the discrepancy between the control parameters of interacting oscillators, as in the case of classical synchronization of periodic oscillators. If interacting stochastic oscillators are weakly detuned, the phase coherency of the attractors persists when phase synchronization breaks. Conversely, if the control parameters differ considerably, the chaotic attractor becomes phase-incoherent under the conditions of phase synchronization break.Comment: 8 pages, 7 figure

Toxic Megacolon in Granulomatous Colitis

Acute, toxic dilatation of the colon in granulomatous colitis occurs more frequently than heretofore reported, and is a more serious complication than its counterpart in ulcerative colitis. Twenty-six patients who had toxic megacolon were seen at the Henry Ford Hospital between 1961 and 1971. Fourteen of these had ulcerative colitis and 12 had granulomatous colitis. Coricosteroids were relatively ineffective in these 12 patients and all but two needed surgical intervention. Postoperative complications occurred in two cases, with two deaths. Although the initial clinical picture between the two conditions is identical, the clinical course In those with granulomatous colitis is more serious. The radiological picture is generally similar, but some differences were appreciated. Distension in granulomatous colitis was generally confined to the transverse colon with a noticeable lack of distension in the sigmoid segment. Inflammatory polyps were invariably present, and these tended to be more numerous and larger than those seen in distended colons in ulcerative colitis. In view of the more serious clinical course and ineffectiveness of medical management, early surgery is recommended in those patients with toxic distension of the colon complicating granulomatous colitis

High-order phase reduction for coupled 2D oscillators

Phase reduction is a general approach to describe coupled oscillatory units in terms of their phases, assuming that the amplitudes are enslaved. For such a reduction, the coupling should be small, but one also expects the reduction to be valid for finite coupling. This paper presents a general framework allowing us to obtain coupling terms in higher orders of the coupling parameter for generic two-dimensional oscillators and arbitrary coupling terms. The theory is illustrated with an accurate prediction of Arnold's tongue for the van der Pol oscillator exploiting higher-order phase reduction

A new approach to partial synchronization in globally coupled rotators

We develop a formalism to analyze the behaviour of pulse--coupled identical phase oscillators with a specific attention devoted to the onset of partial synchronization. The method, which allows describing the dynamics both at the microscopic and macroscopic level, is introduced in a general context, but then the application to the dynamics of leaky integrate-and-fire (LIF) neurons is analysed. As a result, we derive a set of delayed equations describing exactly the LIF behaviour in the thermodynamic limit. We also investigate the weak coupling regime by means of a perturbative analysis, which reveals that the evolution rule reduces to a set of ordinary differential equations. Robustness and generality of the partial synchronization regime is finally tested both by adding noise and considering different force fields.Comment: 5 pages, 3 eps figure

Strong Military Families Intervention Enhances Parenting Reflectivity And Representations In Families With Young Children

Military families face many challenges due to deployment and parental separation, and this can be especially difficult for families with young children. The Strong Military Families (SMF) intervention is for military families with young children, and consists of two versions: the Multifamily Group, and a Home‐based psychoeducational written materials program. The Multifamily Group was designed to enhance positive parenting through both educational components and in vivo feedback and support during separations and reunions between parents and children (n = 78 parents). In the present study, we examine parenting reflectivity and mental representations in mothers versus fathers in military families, service members versus civilian spouses/parenting partners, and before versus after participation in the SMF Multifamily Group and Home‐based interventions. Parenting reflectivity and mental representations were coded from the Working Model of the Child Interview (WMCI; C.H. Zeanah & D. Benoit, 1995). Results suggest that neither parenting reflectivity nor WMCI typology differs between mothers and fathers in military families, or between service members and civilian parenting partners. Furthermore, there was substantial stability in parenting reflectivity and WMCI typology from baseline to posttest, but participation in the Multifamily Group, relative to Home‐based, was associated with improvements in both parenting reflectivity and WMCI ratings from baseline to postintervention.RESUMENLas familias militares enfrentan muchos retos debido a las distantes asignaciones de servicio y la separación de los padres, lo cual puede ser específicamente difícil para familias con niños pequeños. La intervención Familias Militares Fuertes (SMF) es para familias militares con niños pequeños y consta de dos versiones: un Grupo Múltiple de Familias y un programa sicoeducativo de materiales escritos con base en casa. El Grupo Múltiple de Familias se diseñó para mejorar la crianza positiva tanto a través de componentes educativos como de reacciones y apoyo en vivo durante las separaciones y reuniones entre padres y niños (n = 78 padres). En el presente estudio, examinamos el poder de reflexión sobre la crianza y las representaciones mentales en mamás vs. papás en familias militares, miembros del servicio militar vs. cónyuges civiles/parejas conyugales en la crianza, y antes vs. después de la participación en el Grupo Múltiple de Familias SMF y en las intervenciones con base en casa. El poder de reflexión sobre la crianza y las representaciones mentales se codificaron usando el Modelo de Trabajo de la Entrevista del Niño –WMCI‐ (Zeanah y Benoit, 1995). Los resultados sugieren que ni el poder de reflexión ni la tipología del WMCI difieren entre mamás y papás en familias militares, o entre miembros del servicio militar y sus parejas conyugales civiles en la crianza. Es más, se dio una estabilidad de importancia en el poder de reflexión y la tipología WMCI entre el punto de referencia y la examinación posterior, pero la participación en el Grupo Múltiple de Familias, en relación con la intervención en casa, se asoció con mejoras tanto en el poder de reflexión como en los puntajes WMCI entre el punto de referencia y la intervención posterior.RÉSUMÉLes familles de militaires font face à de nombreux défis du fait des déploiements et de la séparation parentale, et cela peut s’avérer particulièrement difficile pour les familles avec de jeunes enfants. L’intervention Familles Militaires fortes (ici abrégé en français FMF, SMF en anglais, pour Strong Military Families) est destinée aux familles de militaires avec de jeunes enfants et consiste en deux versions: un Groupe Multifamilial, et une intervention à domicile avec programme de matériel psychoéducatif écrit. Le Groupe Multifamilial a été conçu afin de mettre en valeur le parentage positif à travers des composantes éducatives et du feedback in vivo et du soutien durant les séparations et les réunions entre les parents et les enfants (n = 78 parents). Dans cette étude nous examinons la réflectivité de parentage et les représentations mentales chez les mères et les pères de familles de militaires, les membres du service comparés aux épouses civiles et aux partenaires de parentage civils, et avant par rapport à après la participation au Groupe Multifamilial FMF et les interventions à domicile. La réflectivité de parentage et les représentations mentales ont été codées à partir du Modèle de Travail de l’Entretien de l’Enfant (Zeanah & Benoit, 1995). Les résultats suggèrent que ni la réflectivité de parentage ni le Modèle de Travail de l’Entretien de l’Enfant ne diffèrent entre les mères et les pères dans les familles militaires ou entre les membres du service et les partenaires de parentage civils. De plus il y avait une stabilité importante dans la réflectivité de parentage et la typologie du Modèle de Travail de l’Entretien de l’Enfant du niveau de référence jusqu’après le test, mais la participation au Groupe Multifamilial, par rapport à la participation à domicile, était liée à des améliorations dans à la fois la réflectivité de parentage et les scores du Modèle de Travail de l’Entretien de l’Enfant du niveau de référence à après l’intervention.ZUSAMMENFASSUNGMilitärische Familien stehen durch den Einsatz und die Trennung der Eltern vor vielen Herausforderungen, was besonders für Familien mit Kleinkindern schwierig sein kann. Die Intervention „Strong Military Families“ (SMF) richtet sich an Militärfamilien mit Kleinkindern und besteht aus zwei Versionen: Aus einer Mehrfamiliengruppe und einem psychoedukativen schriftlichen Materialprogramm für Zuhause. Die Mehrfamiliengruppe wurde entwickelt, um die positive Elternschaft sowohl durch pädagogische Komponenten als auch durch in vivo Feedback und Unterstützung bei Trennungen und Wiedervereinigungen zwischen Eltern und Kindern (n = 78 Eltern) zu fördern. In der vorliegenden Studie untersuchen wir die Reflektivität und mentalen Repräsentationen von Eltern bei Müttern vs. Vätern in militärischen Familien, Dienstmitgliedern vs. zivilen Ehepartnern/Erziehungspartnern und vor vs. nach der Teilnahme an der SMF Mehrfamiliengruppe und psychoedukativen Intervention Zuhause. Die elterliche Reflektivität und mentalen Repräsentationen wurden aus dem “Working Model of the Child Interview” (WMCI; Zeanah & Benoit, 1995) kodiert. Die Ergebnisse deuten darauf hin, dass sich weder die elterliche Reflektivität noch die Typologie der WMCI zwischen Müttern und Vätern in Militärfamilien oder zwischen Dienstmitgliedern und zivilen Ehepartnern unterscheiden. Außerdem gab es eine beträchtliche Stabilität in der elterlichen Reflektivität und WMCI‐Typologie vom Beginn der Untersuchungen bis zum Post‐Test, aber die Teilnahme an der Mehrfamiliengruppe, im Vergleich zur psychoedukativen Intervention Zuhause, war mit Verbesserungen sowohl in der elterlichen Reflektivität als auch in der WMCI‐Bewertung vom Untersuchungsbeginn zur Post‐Intervention verbunden.抄録強い軍人家族介入 The Strong Military Families が、 幼い子どものいる家族における育児の内省性 Reflectivity と表象を増強する軍人家族は配属や親との分離のために多くの困難に直面する。そしてこれは幼い子どものいる家族には特に困難になり得る。強い軍人家族The Strong Military Families (SMF)介入は、幼い子どものいる軍人家族のためのもので、2つの型がある。それらは、複数家族グループと資料を用いて家庭で行う心理教育的プログラムである。複数家族グループは、教育的な要素および親子の分離と再会のその場でのフィードバックと支援の両者を通して、ポジティブな育児を増強するようにデザインされた(n = 78人の親)。この研究では、私たちは、軍人家族の母親対父親、軍人対民間人の配偶者/養育パートナー、そしてSMF複数家族グループと家庭での介入に参加前対参加後において、育児の内省性と心的表象を調査した。育児の内省性と心的表象は、the Working Model of the Child Interview (Zeanah & Benoit, 1995) によってコード化された。結果から、軍人家族の母親と父親、あるいは軍人と民間人の養育パートナーの間に、育児の内省性あるいはWMCIタイプについて違いは示されなかった。さらに、基準線からテスト後にかけて、育児の内省性およびWMCIタイプにかなりの安定性があったが、家庭におけるプログラムに比べて、複数家族グループに参加することは、育児の内省性およびWMCI評価の両者の基準線から介入後への改善と関連していた。摘要強大軍人家庭干預增強在有子女家庭中的育兒反思能力和表現由於軍事部署和父母在不同地方居住, 軍人家庭面臨許多挑戰, 這些挑戰對於有小孩的家庭尤其嚴重。強大軍人家庭干預 (SMF) 是為有小孩的軍人家庭進行的干預, 包括兩個版本: 一個多家庭小組和一個家庭式的心理教育書面材料計劃。多家庭小組旨在通過教育丶反饋和支持, 在父母與子女 (78名父母) 的分離和團聚期間, 加強積極的父母教養。在本研究中, 我們考察在軍人家庭丶服務人員與平民配偶/養育夥伴的父母, 以及參與 SMF 多家庭小組和家庭式干預前後的父母反思和心理表徵。我們以兒童訪談的工作模式 (Zeanah&Benoit, 1995), 編碼父母反思能力和心理表徵。結果表明, 在軍人家庭父母之間, 或服務人員和平民養育夥伴之間, 父母反思能力和WMCI類型學並無不同。此外, 從基線到測試後, 父母反思能力和WMCI類型相當穩定, 但和家庭式干預相比, 多家庭小組的參與, 與從基線到干預後的父母反思能力和WMCI評分之改善相關。ملخصالتدخل القوى عند العائلات العسكرية يعزز الأداء التأملي الوالدي والتمثيلات الذهنية في الرعاية الوالدية للعائلات تجاه أطفالهم الصغارالعائلات العسكرية تواجه كثيرا من التحديات بسبب حركات التنقل العسكري والانفصال بين الوالدين وهذا يكون أشد صعوبة بالنسبة للعائلات ذوي الأطفال الصغار. التدخل القوي للعائلات العسكرية (SMF) هو برنامج يتكون من جانبين: مجموعة متعددة الأسر وبرنامج منزلي للمواد التعليمية النفسية المكتوبة. تم تشكيل المجموعة متعددة الأسر لتعزيز الرعاية الوالدية الإيجابية من خلال مكونات تعليمية وتغذية مرتدة ودعم أثناء فترات انفصال الأسر ولم الشمل بين الوالدين والأطفال (n = 78). في الدراسة الحالية نستخدم الأداء التأملي الوالدي والتمثيلات الذهنية عند الأمهات مقابل الآباء في الأسر العسكرية وأفراد الخدمة بالمقارنة مع الأزواج والوالدين المدنيين وكذلك المقارنة بين قبل وبعد المشاركة في برنامج (SMF). تم ترميز الأداء التأملي الوالدي والتمثيلات الذهنية من خلال النموذج العامل للمقابلة الشخصية مع الطفل (زينة وبينوا 1995). تشير النتائج إلى عدم اختلاف الأداء التأملي الوالدي ونمط النموذج العامل لمقابلة الطفل (WMCI) بين الآباء والأمهات في الأسر العسكرية أو بين أفراد الخدمة والأزواج والآباء المدنيين. بالإضافة إلى ذلك كان هناك استقرار جوهري في الأداء التأملي الوالدي ونمط النموذج العامل بين خط البداية والاختبار البعدي ولكن المشاركة في مجموعة متعددة الأسر بالمقارنة مع البرنامج المنزلي كانت مقترنة بتحسن في كل من الأداء التأملي الوالدي وتقييمات (WMCI) بين خط البداية وتدخل الاختبار البعدي.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141683/1/imhj21690_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/141683/2/imhj21690.pd

Data driven optimal filtering for phase and frequency of noisy oscillations: application to vortex flowmetering

A new method for extracting the phase of oscillations from noisy time series is proposed. To obtain the phase, the signal is filtered in such a way that the filter output has minimal relative variation in the amplitude (MIRVA) over all filters with complex-valued impulse response. The argument of the filter output yields the phase. Implementation of the algorithm and interpretation of the result are discussed. We argue that the phase obtained by the proposed method has a low susceptibility to measurement noise and a low rate of artificial phase slips. The method is applied for the detection and classification of mode locking in vortex flowmeters. A novel measure for the strength of mode locking is proposed.Comment: 12 pages, 10 figure