Leukoencephalopathy and cerebral edema as the presenting manifestations of SLE in an ANA-negative adolescent female: a case report and review of literature

Background: Systemic lupus erythematosus (SLE) is an autoimmune disease with various clinical manifestations involving multiple organ systems. Neuropsychiatric manifestations of SLE have been associated with increased morbidity and mortality, thus it is important to recognize and diagnose the disease entity and treat early. When neuropsychiatric symptoms are involved, typically there are many other systemic features to aid in the diagnosis of SLE. Many autoantibodies have been discovered and are used to help diagnose SLE. The antibody present in most cases of pediatric SLE, as well as in many other rheumatic diseases, is the nonspecific antinuclear antibody (ANA). The ANA is a commonly used screening tool by primary care physicians when evaluating a patient with a possible rheumatic disorder. However, a small subset of SLE patients, 1-5%, present with a negative ANA, and it is important to keep SLE on the differential diagnosis in specific instances when a thorough infectious, metabolic and neurological workup has been completed and proven to be inconclusive. Case presentation: This case involves a Hispanic adolescent female with a negative ANA who presented with diffuse cerebral edema secondary to leukoencephalopathy due to SLE with central nervous system involvement. She was normotensive on presentation and relatively symptom free aside from headache. She had an extensive workup while inpatient involving metabolic, infectious disease, rheumatology, and neurology prior to obtaining the diagnosis of SLE. She was treated with cyclophosphamide and rituximab with appropriate disease response. Conclusions: A review of the literature revealed 12 cases with SLE presenting with or developing diffuse cerebral edema and/or leukoencephalopathy. Our patient's case differs in that she was also ANA negative despite other autoantibody positivity. While she did have low complements and transient leukopenia, she did not present with other signs of organ involvement, which made the diagnosis of SLE with neuropsychiatric involvement quite challenging. We discuss the importance of keeping SLE on the differential diagnosis despite a negative ANA in complex cases after thorough workup has been unrevealing, and to consider initial screening with not only the ANA but also dsDNA and complements to avoid missed diagnoses

Cue Switching in the Perception of Approximants: Evidence from Two English Dialects

A surprising dissimilarity is found in the perception of approximant sounds by speakers of American English (AE) and Standard Southern British English (SSBE) dialects. Eighteen subjects (6 AE and 12 SSBE speakers) performed an identification task in which they judged whether stimuli were more like /r/ or /w/. The stimuli comprised five sounds copy-synthesised from a source /r/, where formant values (F1-F3) were manually adjusted as follows: A: F1=355 F2=1201 F3=1682 (/r/-like formants) B: F1=355 F2= 963 F3=1682 (F2 at midpoint of /r/ and /w/; F3 /r/-like) C: F1=355 F2= 1201 F3=2541 (F2 /r/-like; F3 raised to /w/-like height) D: F1=355 F2= 725 F3=1682 (F2 lowered to /w/-like height; F3 /r/-like) E: F1=355 F2= 725 F3=2541 (/w/-like formants) The only significant difference (t=2.031, p\u3c.05) between the two dialect groups’ performance occurred with Stimulus D in which F3 was typical for /r/ and F2 was typical for /w/. AE speakers identified this stimulus as /r/ 90% of the time and SSBE speakers only 59% of the time. Such a disparity is unexpected given that alveolar approximant /r/ in both dialects is generally characterised acoustically by a low F3 (Delattre and Freeman 1968; Nolan 1983; Alwan et al. 1997; Stevens 1998; Espy-Wilson et al. 2000). Why then the significantly different results between the two groups when Stimulus D involves the canonical /r/ cue of a lowered F3? A possible solution to this problem lies in the well-documented existence of a non-standard realisation of /r/ in Southeast England which is increasingly common in adult speech as a sociolinguistic variable: labiodental /r/ (Foulkes & Docherty 2001; Trudgill 1988). This variant does not have a low F3 (Docherty and Foulkes 2001). The performance of the SSBE subjects here may be due to greater exposure to the labiodental /r/ variant in their community. SSBE speakers must tolerate a wider diversity of /r/-types, including /r/s without a canonically low F3. As a consequence, the /r/ category in SSBE may be becoming increasingly defined by F2, rather than by F3. If this were the case, SSBE speakers would weight F2 more than F3 in their perceptual categorization, and the F2 boundary between /w/ and /r/ would become sharper in SSBE relative to AE. AE speakers, who likely encounter labiodental /r/ less frequently, continue to attend more to F3 than F2. For them, the /r/-like low F3 in Stimulus D leads them to a definite /r/ categorization. For the SSBE speakers, the /w/-like F2 cue interferes with the low F3 cue to cause greater perceptual uncertainty. The implications of this apparent shift in perceptual weighting may be a further increase in production variability, even involving SSBE speakers who do not use labiodental /r/. As the cue for /r/ in SSBE shifts to F2, speakers may attend less to producing adequately low frequencies of F3 and therefore a gradual erosion of low F3 instances of /r/ can be predicted across SSBE

Distribution and trajectory of vital signs from high-frequency continuous monitoring during pediatric critical care transport

Objective: To describe comprehensively the distribution and progression of high-frequency continuous vital signs monitoring data for children during critical care transport and explore associations with patient age, diagnosis, and severity of illness. // Design: Retrospective cohort study using prospectively collected vital signs monitoring data linked to patient demographic and transport data. // Setting: A regional pediatric critical care transport team based in London, England. // Patients: Critically ill children (age ≤ 18 years) transported by the Children’s Acute Transport Service (CATS) at Great Ormond Street Hospital (GOSH) between January 2016 and May 2021 with available high-frequency vital signs monitoring data. // Interventions: None. // Main results: Numeric values of heart rate (HR), blood pressure (BP), respiratory rate (RR), oxygen saturations (SpO2), and end-tidal carbon dioxide in ventilated children (etCO2) were extracted at a frequency of one value per second totalling over 40 million data points. Age-varying vital signs (HR, BP, and RR) were standardized using Z scores. The distribution of vital signs measured in the first 10 min of monitoring during transport, and their progression through the transport, were analyzed by age group, diagnosis group and severity of illness group. A complete dataset comprising linked vital signs, patient and transport data was extracted from 1711 patients (27.7% of all transported patients). The study cohort consisted predominantly of infants (median age of 6 months, IQR 0–51), and respiratory illness (36.0%) was the most frequent diagnosis group. Most patients were invasively ventilated (70.7%). The Infection group had the highest average (+ 2.5) and range (− 5 to + 9) of HR Z scores, particularly in septic children. Infants and pre-school children demonstrated a greater reduction in the HR Z score from the beginning to the end of transport compared to older children. // Conclusions: Marked differences in the distribution and progression of vital signs between age groups, diagnosis groups, and severity of illness groups were observed by analyzing the high-frequency data collected during paediatric critical care transport

Band-to-band transitions and critical points in the near-infrared to vacuum ultraviolet dielectric functions of single crystal urania and thoria

Band-to-band transition energy parameters for single-crystal actinide samples of uranium oxide and thorium oxide were determined and compared using spectroscopic ellipsometry and critical-point dielectric function analyses. Spectroscopic ellipsometry measurements from the near-infrared to the vacuum ultraviolet spectral region were used to determine the dielectric functions of uranium oxide and thorium oxide. The critical-point structure is similar between UO2 and ThO2 but strongly blue shifted for ThO2. We find bandgap energies of 2.1 eV and 5.4 eV for UO2 and ThO2, respectively

Infrared-active Phonon Modes in Single-crystal Thorium Dioxide and Uranium Dioxide

The infrared-active phonon modes, in single-crystal samples of thorium dioxide (ThO2) and uranium dioxide (UO2), were investigated using spectroscopic ellipsometry and compared with density functional theory. Both ThO2 and UO2 are found to have one infrared-active phonon mode pair [consisting of one transverse optic (TO) and one associated longitudinal optic (LO) mode], which is responsible for the dominant features in the ellipsometric data. At room temperature, our results for the mode pair’s resonant frequencies and broadening parameters are comparable with previous reflectance spectroscopy characterizations and density functional theory predictions. For ThO2, our ellipsometry and density function theory results both show that the LO mode broadening parameter is larger than the TO mode broadening. This signifies mode anharmonicity, which can be attributed to the intrinsic phonon–phonon interaction. In addition to the main mode pair, a broad low-amplitude impurity-like vibrational mode pair is detected within the reststrahlen band for both ThO2 and UO2. Elevated temperature measurements were performed for ThO2 in order to study the mechanisms by which the phonon parameters evolve with increased heat. The observed change in the TO resonant frequency is in excellent agreement with previous density functional calculations, which only consider volume expansion of the crystal lattice. This suggests that the temperature-dependent change in the TO frequency is primarily due to volume expansion. The change in the main mode pair’s broadening parameters is nearly linear within the temperature range of this study, which indicates the intrinsic anharmonic scattering (via cubic anharmonicities) as the main decay mechanism

Band-to-band Transitions and Critical Points in the Near-infrared to Vacuum Ultraviolet Dielectric Functions of Single Crystal Urania and Thoria

Band-to-band transition energy parameters for single-crystal actinide samples of uranium oxide and thorium oxide were determined and compared using spectroscopic ellipsometry and critical-point dielectric function analyses. Spectroscopic ellipsometry measurements from the near-infrared to the vacuum ultraviolet spectral region were used to determine the dielectric functions of uranium oxide and thorium oxide. The critical-point structure is similar between UO2 and ThO2 but strongly blue shifted for ThO2. We find bandgap energies of 2.1 eV and 5.4 eV for UO2 and ThO2, respectively

Navigating the First Year: Transition and Adjustment Experiences of International Students of Color at a Predominantly White Institution

International student mobility has been a highly discussed topic in higher education in the United States (U.S.). Yet current geo-political issues necessitate a re-examination of how international students, especially those who would be considered students of Color, are transitioning to U.S. higher education institutions. Findings from three interviews that spanned participants’ first year on campus include the importance of social interactions, challenges with academic adjustments, and navigating the effects of politics. Suggestions for student affairs practice are addressed, including pre-sojourn connections and peer engagement

Skunk River Review Fall 2004, vol 16

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