Reduced Order Models for Beam-Wave Interaction in High Power Microwave Sources

We apply an asymptotic analysis to show that corrugated waveguides can be represented as cylindrical waveguides with smooth metamaterial coatings when the corrugtions are subwavelength. Here the metamaterial delivers an effective anisotropic surface impedance, effective dielectric constant, and imparts novel dispersive effects on signals traveling inside the waveguide. These properties arise from the subwavelength resonances of the metamaterial. For sufficiently deep corrugations, the waveguide exhibits backward wave propagation, which can be understood in the present context as a multi-scale phenomenon resulting from local resonances inside the subwavelength geometry. Our approach is well suited to numerical computation and we provide a systematic investigation of the effect of corrugation geometry on wave dispersion, group velocity, power flow, and gain factor per period

Acute eosinophilic pneumonia following recent cigarette smoking

AbstractIn this report we describe the case of an 18 year old female who presented with fever, shortness of breath, and chest pain. Chest X-ray revealed diffuse bilateral infiltrates and eosinophilia was reported from her broncholaveolar lavage (BAL) fluid. She started smoking 3 weeks prior to the onset of symptoms and based on her clinical presentation, BAL findings and dramatic improvement, acute eosinophilic pneumonia (AEP) was diagnosed

Removal Of Arsenic In Aqueous Solution By Low Cost Adsorbent: A Short Review

Abstract: The presence of arsenic in waters, especially groundwater, has become a worldwide problem in the past decades. High arsenic concentrations have been reported recently from the Argentina

Przewlekła poreumatyczna artropatia — zespół Jaccouda u 21-letniego chorego

Jaccoud’s arthropathy (JA) is a condition characterised clinically by ‘reversible’ joint deformities resulting from soft tissue abnormalities, rather than the destruction of bone joints. Although rare, it has been described in patients with chronic rheumatic heart disease. It typically involves metacarpophalangeal and metatarsophalangeal joints. JA has also been described in systemic lupus erythematosus (SLE), infections and neoplasia. Here, we report the case of a 21 year-old male who had presented with a 16-year history of polyarthralgia, deformities of the hands for the last four years, and a three-year history of exertional palpitation and dyspnoea. Physical examination revealed peripheral signs of aortic run off, with hyperdynamic left ventricle and chronic severe aortic and mitral regurgitation. On examination, gross deformities were noted in both hands in the form of ulnar deviation, swan neck, and ‘z’-thumb, involving interphalangeal joints, metacarpophalangeal and first carpometacarpal joints which were partially correctable. Laboratory investigations ruled out rheumatoid arthritis, SLE, and acute rheumatic fever. Chest X-ray, electrocardiogram and two-dimensional echocardiography and Doppler study were consistent with chronic severe aortic regurgitation and severe mitral regurgitation. Radiographs of both hands showed posterior subluxation of the carpometacarpal joints, which were completely correctable. JA involving a carpometacarpal joint is exceedingly rare.Artropatia (zespół) Jaccouda jest schorzeniem charakteryzującym się klinicznie „odwracalnymi” deformacjami stawówspowodowanymi zaburzeniami tkanek miękkich, a nie niszczeniem kostnych elementów stawów. Chociaż artropatia tawystępuje rzadko, to opisywano przypadki JA u chorych z przewlekłą chorobą reumatyczną serca. Zazwyczaj obejmujestawy śródręczno-paliczkowe i śródstopno-paliczkowe. Zespół ten obserwowano również w toczniu rumieniowatymukładowym (SLE), zakażeniach i chorobach nowotworowych. W niniejszej pracy przedstawiono przypadek 21-letniegochorego, u którego od 16 lat występowały bóle wielu stawów, od 4 lat — deformacje rąk i od 3 lat — wysiłkowe kołatanieserca i duszność. W badaniu przedmiotowym stwierdzono obwodowe objawy wstecznego przepływu krwi w aorcie orazhiperdynamiczną czynność lewej komory i przewlekłą ciężką niedomykalność aortalną i mitralną. W badaniu wzrokowymwyraźnie widoczne były deformacje obu rąk w postaci odchylenia łokciowego, deformacji typu „łabędzia szyja” i kciukaw kształcie litery „z”. Na podstawie wyników badań laboratoryjnych wykluczono reumatoidalne zapalenie stawów, SLEi ostrą gorączkę reumatyczną. Wyniki badań obrazowych — badania radiologicznego (RTG) klatki piersiowej, elektrokardiografii,echokardiografii dwuwymiarowej i badania doplerowskiego — wskazywały na przewlekłą ciężką niedomykalnośćaortalną i mitralną. W obrazie RTG obu rąk uwidoczniono podwichnięcia ku tyłowi w stawach nadgarstkowo-śródręcznych,które można było całkowicie skorygować. Artropatia Jaccouda obejmująca staw nadgarstkowo-śródręczny jestobserwowana wyjątkowo rzadko

Przezskórna komisurotomia mitralna u nastolatka ze stenozą mitralną i tętniakiem lewego przedsionka — zabieg trudny technicznie

Percutaneous trans-mitral commissurotomy (PTMC) using an Accura balloon is an effective procedure for the mana- gement of patients with rheumatic mitral stenosis. It is not infrequent to encounter an aneurysmal left atrium (LA), especially in the developing world where patients often present very late. This is a technically challenging procedure as the septum often bulges into the right atrial side, making the puncture often difficult. Furthermore, it bulges anteriorly and inferiorly so it becomes even more challenging. Because of the vertical lie of the septum, the needle often dissects the septum rather than puncturing it.  Here, we describe the case of a 17 year-old boy with severe mitral stenosis with a giant, aneurysmal left atrium (LA — 13.5 × 16 cm) where an inter-atrial septal puncture was achieved by probing the fossa ovalis to enter the left atrium instead of a conventional transseptal puncture. PTMC was successfully done, increasing the mitral valve area from 0.8 cm2 to 1.9 cm2. Przezskórna komisurotomia mitralna (PTMC) przy użyciu balonu Accurato to skuteczny zabieg stosowany w leczeniu chorych ze stenozą mitralną (MS) spowodowaną chorobą reumatyczną. Nierzadko spotyka się u tych chorych tętniak lewego przedsionka (LA), zwłaszcza w krajach rozwijających się, gdzie pacjenci często bardzo późno zgłaszają się do lekarza. Zabieg ten jest trudny technicznie, ponieważ przegroda często wpukla się do prawego przedsionka, utrudniając wykonanie nakłucia. Co więcej, przegroda wybrzusza się w kierunku przednio-dolnym, co dodatkowo zwiększa trudność zabiegu. Ze względu na pionowe położenie przegrody igła często rozdziela przegrodę, zamiast ją przebić.  W niniejszej pracy opisano przypadek 17-letniego chłopca z ciężką MS i olbrzymim tętniakiem LA (LA — 13.5 × 16 cm). Aby dostać się do LA, sondowano otwór owalny zamiast konwencjonalnego nakłucia przegrody. Przeprowadzono z po- wodzeniem zabieg PTMC, zwiększając powierzchnię zastawki mitralnej z 0,8 cm2 do 1,9 cm2.

Artificial intelligence for dementia drug discovery and trials optimization

Drug discovery and clinical trial design for dementia have historically been challenging. In part these challenges have arisen from patient heterogeneity, length of disease course, and the tractability of a target for the brain. Applying big data analytics and machine learning tools for drug discovery and utilizing them to inform successful clinical trial design has the potential to accelerate progress. Opportunities arise at multiple stages in the therapy pipeline and the growing availability of large medical data sets opens possibilities for big data analyses to answer key questions in clinical and therapeutic challenges. However, before this goal is reached, several challenges need to be overcome and only a multi‐disciplinary approach can promote data‐driven decision‐making to its full potential. Herein we review the current state of machine learning applications to clinical trial design and drug discovery, while presenting opportunities and recommendations that can break down the barriers to implementation

Alcohol Consumption and Development of Acute Respiratory Distress Syndrome: A Population-Based Study

This retrospective population-based study evaluated the effects of alcohol consumption on the development of acute respiratory distress syndrome (ARDS). Alcohol consumption was quantified based on patient and/or family provided information at the time of hospital admission. ARDS was defined according to American-European consensus conference (AECC). From 1,422 critically ill Olmsted county residents, 1,357 had information about alcohol use in their medical records, 77 (6%) of whom developed ARDS. A history of significant alcohol consumption (more than two drinks per day) was reported in 97 (7%) of patients. When adjusted for underlying ARDS risk factors (aspiration, chemotherapy, high-risk surgery, pancreatitis, sepsis, shock), smoking, cirrhosis and gender, history of significant alcohol consumption was associated with increased risk of ARDS development (odds ratio 2.9, 95% CI 1.3–6.2). This population-based study confirmed that excessive alcohol consumption is associated with higher risk of ARDS

Towards the prevention of acute lung injury: a population based cohort study protocol

<p>Abstract</p> <p>Background</p> <p>Acute lung injury (ALI) is an example of a critical care syndrome with limited treatment options once the condition is fully established. Despite improved understanding of pathophysiology of ALI, the clinical impact has been limited to improvements in supportive treatment. On the other hand, little has been done on the prevention of ALI. Olmsted County, MN, geographically isolated from other urban areas offers the opportunity to study clinical pathogenesis of ALI in a search for potential prevention targets.</p> <p>Methods/Design</p> <p>In this population-based observational cohort study, the investigators identify patients at high risk of ALI using the prediction model applied within the first six hours of hospital admission. Using a validated system-wide electronic surveillance, Olmsted County patients at risk are followed until ALI, death or hospital discharge. Detailed in-hospital (second hit) exposures and meaningful short and long term outcomes (quality-adjusted survival) are compared between ALI cases and high risk controls matched by age, gender and probability of developing ALI. Time sensitive biospecimens are collected for collaborative research studies. Nested case control comparison of 500 patients who developed ALI with 500 matched controls will provide an adequate power to determine significant differences in common hospital exposures and outcomes between the two groups.</p> <p>Discussion</p> <p>This population-based observational cohort study will identify patients at high risk early in the course of disease, the burden of ALI in the community, and the potential targets for future prevention trials.</p

Artificial intelligence for diagnostic and prognostic neuroimaging in dementia: a systematic review

Introduction: Artificial intelligence (AI) and neuroimaging offer new opportunities for diagnosis and prognosis of dementia. Methods: We systematically reviewed studies reporting AI for neuroimaging in diagnosis and/or prognosis of cognitive neurodegenerative diseases. Results: A total of 255 studies were identified. Most studies relied on the Alzheimer's Disease Neuroimaging Initiative dataset. Algorithmic classifiers were the most commonly used AI method (48%) and discriminative models performed best for differentiating Alzheimer's disease from controls. The accuracy of algorithms varied with the patient cohort, imaging modalities, and stratifiers used. Few studies performed validation in an independent cohort. Discussion: The literature has several methodological limitations including lack of sufficient algorithm development descriptions and standard definitions. We make recommendations to improve model validation including addressing key clinical questions, providing sufficient description of AI methods and validating findings in independent datasets. Collaborative approaches between experts in AI and medicine will help achieve the promising potential of AI tools in practice. Highlights: There has been a rapid expansion in the use of machine learning for diagnosis and prognosis in neurodegenerative disease Most studies (71%) relied on the Alzheimer's Disease Neuroimaging Initiative (ADNI) dataset with no other individual dataset used more than five times There has been a recent rise in the use of more complex discriminative models (e.g., neural networks) that performed better than other classifiers for classification of AD vs healthy controls We make recommendations to address methodological considerations, addressing key clinical questions, and validation We also make recommendations for the field more broadly to standardize outcome measures, address gaps in the literature, and monitor sources of bias

Palytoxin-induced acute respiratory failure

Palytoxin is one of the most potent toxins known to mankind and poses a high risk to humans through ingestion, inhalation and dermal routes [1,2]. Although the exact mechanism of action is unknown it is postulated that palytoxin binds to the Na+/K + ATPase pump resulting in K+ efflux, Ca2+ influx and membrane depolarization leading to widespread secondary pharmacological actions [2]. Palytoxin is highly toxic and can affect multiple organs causing severe symptoms including death. Palytoxin poisoning is mainly developed after ingesting seafood. We are reporting a case of suspected inhalational palytoxin poisoning in a healthy healthcare provider from who developed severe respiratory distress within 12 hours of exposure to vapors. We have highlighted diagnostic clues and clinical features in the patients' history that may help intensivists to diagnose a case of ARDS secondary to palytoxin poisoning