A Case of Pyoderma Gangrenosum

Case Report A 60-year-old man with past medical history of hypertension, post-traumatic stress disorder, major depression, hepatic steatosis, chronic kidney disease, and untreated hepatitis C virus (genotype 1b) initially presented to the outpatient primary care clinic with a chief complaint of an extremely painful right lower extremity ulcer that had developed and grown progressively larger after mild trauma against a metal corner 4 months prior to the appointment. He admitted to picking at the granulation tissue that would develop over the ulcer. He was treating the ulcer with antibiotic ointment. On initial exam, the ulcer was about 2x2 cm, located a few inches above the ankle on the lateral right leg, and associated with some lower extremity edema. His primary care physician was concerned at the time for a venous stasis ulcer. Initial plain films of the leg were obtained, and these did not show any evidence of osteomyelitis. A lower extremity doppler ultrasound did not reveal a deep vein thrombosis that could account for the edema. He had no signs of heart failure, ascites, or volume overload otherwise. He was referred to podiatry and wound care

On the stability analysis of periodic sine-Gordon traveling waves

We study the spectral stability properties of periodic traveling waves in the sine-Gordon equation, including waves of both subluminal and superluminal propagation velocities as well as waves of both librational and rotational types. We prove that only subluminal rotational waves are spectrally stable and establish exponential instability in the other three cases. Our proof corrects a frequently cited one given by Scott.Comment: 22 pages, 6 figure

Construction and evaluation of classifiers for forensic document analysis

In this study we illustrate a statistical approach to questioned document examination. Specifically, we consider the construction of three classifiers that predict the writer of a sample document based on categorical data. To evaluate these classifiers, we use a data set with a large number of writers and a small number of writing samples per writer. Since the resulting classifiers were found to have near perfect accuracy using leave-one-out cross-validation, we propose a novel Bayesian-based cross-validation method for evaluating the classifiers.Comment: Published in at http://dx.doi.org/10.1214/10-AOAS379 the Annals of Applied Statistics (http://www.imstat.org/aoas/) by the Institute of Mathematical Statistics (http://www.imstat.org

Long-term effect of antiepileptic drug switch on serum lipids and C-reactive protein.

BACKGROUND: Prior studies have shown that switching patients from inducing antiepileptic drugs (AEDs) to lamotrigine, levetiracetam, or topiramate reduces serum lipids and C-reactive protein (CRP). These studies were all of short duration, and some drugs, such as zonisamide, have not been investigated. METHODS: We recruited 41 patients taking phenytoin or carbamazepine who were being switched to zonisamide, lamotrigine, or levetiracetam. We measured serum lipids and CRP before the switch, \u3e6weeks after, and \u3e6months after. An untreated control group (n=14) underwent similar measurement. We combined these data with those of our previous investigation (n=34 patients and 16 controls) of a very similar design. RESULTS: There were no differences in outcome measures between the two inducing AEDs nor among the three noninducing AEDs. Total cholesterol (TC), atherogenic lipids, and CRP were higher under inducer treatment than in controls. All measures were elevated under inducer treatment relative to noninducer treatment, including TC (24mg/dL higher, 95% CI: 17.5-29.9, p CONCLUSIONS: We demonstrate that switching from inducing to noninducing AEDs produces an enduring reduction in serum lipids and CRP. These results provide further evidence that inducing AEDs may be associated with elevated vascular disease risk. These are the first vascular risk marker data in patients taking zonisamide, which shows a profile similar to that of other noninducing AEDs

Determinants of Agricultural Landowners’ Willingness to Supply Open Space Through Conservation Easements

Open space provides a range of benefits to many people of a community, beyond the benefits that accrue to private landowners. Parks and natural areas can be used for recreation; wetlands and forests supply storm-water drainage and wildlife habitat; farms and forests provide aesthetic benefits to surrounding residents. Moreover, undeveloped land can give relief from congestion. Agricultural lands are an important source of open space, but many of these lands are under great development pressure. One tool that is currently being used to aid in the preservation of open space by landowners is conservation easements. The rate of land protection by state and local land trusts has tripled since the beginning of the decade, and the West is the fastest growing region for both the number of acres under conservation easements and number of land trusts according to the Land Trust Alliance. Given the increased demand for amenities provided by private agricultural lands and the increased use of conservation easements, it is interesting to note that there is a paucity of research related to landowners’ preferences regarding conservation easements. The specific research objective of this paper is to determine important factors affecting an agricultural landowners’ potential choice regarding the placement of a parcel of land under a conservation easement. Knowing these factors could be useful to communities, public organizations and land trusts trying to provide open space to meet a growing demand for this public good. Information to construct a survey was obtained through a series of focus groups held in Wyoming and Colorado. Results from these focus groups were then used to develop twelve versions of a stated choice survey instrument. The first part of the survey included questions about the landowner’s specific community. These Likert scale questions were to designed to elicit a measurement of the respondents’ “sense of place” regarding his or her community. The second part of the survey questioned participants about their land and their land’s attributes, including what the landowner felt his land was worth, types of production and non-production activities land was used for, the types of developmental pressures being felt by the landowner, and the kinds of amenities he would like to conserve on his property. The third section of the survey included questions about the landowner’s personal knowledge of easements and two stated choice questions regarding conservation easements. These stated choice questions focused on five attributes: contract length, managerial control, wildlife habitat, access and payment. The final section of the survey asked respondents about demographic characteristics. Data were analyzed as a multinomial logit random utility model in LIMDEP. Respondents preferred an easement that was in perpetuity over an easement that was term in length. Respondents were less likely to accept an easement if public access on their property was required. As payment proportion in relation to the respondents’ perception of the value of their land went up, so did the likelihood that they would accept the easement. Landowners in Colorado were more likely to accept an easement than landowners in Wyoming. This is somewhat expected as developmental pressures in Colorado are higher than Wyoming, and thus far more easements have been transacted in Colorado than in Wyoming. Years on the land and connection to community were significant in explaining the acceptance of an easement scenario. The more connected one was to their community, the more likely they were to accept an easement. The longer a respondent had lived on their land, the more likely they were to accept an easement as well. The level of education a respondent had achieved negatively impacted easement acceptance. If an easement was already in place on a respondents’ property, the likelihood of accepting an easement scenario increased significantly.Land Economics/Use,

Composition Effects on Kilonova Spectra and Light Curves: I

The merger of neutron star binaries is believed to eject a wide range of heavy elements into the universe. By observing the emission from this ejecta, scientists can probe the ejecta properties (mass, velocity and composition distributions). The emission (a.k.a. kilonova) is powered by the radioactive decay of the heavy isotopes produced in the merger and this emission is reprocessed by atomic opacities to optical and infra-red wavelengths. Understanding the ejecta properties requires calculating the dependence of this emission on these opacities. The strong lines in the optical and infra-red in lanthanide opacities have been shown to significantly alter the light-curves and spectra in these wavelength bands, arguing that the emission in these wavelengths can probe the composition of this ejecta. Here we study variations in the kilonova emission by varying individual lanthanide (and the actinide uranium) concentrations in the ejecta. The broad forest of lanthanide lines makes it difficult to determine the exact fraction of individual lanthanides. Nd is an exception. Its opacities above 1 micron are higher than other lanthanides and observations of kilonovae can potentially probe increased abundances of Nd. Similarly, at early times when the ejecta is still hot (first day), the U opacity is strong in the 0.2-1 micron wavelength range and kilonova observations may also be able to constrain these abundances

Realistic assumptions about spatial locations and clustering of premises matter for models of foot-and-mouth disease spread in the United States

Spatially explicit livestock disease models require demographic data for individual farms or premises. In the U.S., demographic data are only available aggregated at county or coarser scales, so disease models must rely on assumptions about how individual premises are distributed within counties. Here, we addressed the importance of realistic assumptions for this purpose. We compared modeling of foot and mouth disease (FMD) outbreaks using simple randomization of locations to premises configurations predicted by the Farm Location and Agricultural Production Simulator (FLAPS), which infers location based on features such as topography, land-cover, climate, and roads. We focused on three premises-level Susceptible-Exposed-Infectious-Removed models available from the literature, all using the same kernel approach but with different parameterizations and functional forms. By computing the basic reproductive number of the infection (R0) for both FLAPS and randomized configurations, we investigated how spatial locations and clustering of premises affects outbreak predictions. Further, we performed stochastic simulations to evaluate if identified differences were consistent for later stages of an outbreak. Using Ripley's K to quantify clustering, we found that FLAPS configurations were substantially more clustered at the scales relevant for the implemented models, leading to a higher frequency of nearby premises compared to randomized configurations. As a result, R0 was typically higher in FLAPS configurations, and the simulation study corroborated the pattern for later stages of outbreaks. Further, both R0 and simulations exhibited substantial spatial heterogeneity in terms of differences between configurations. Thus, using realistic assumptions when de-aggregating locations based on available data can have a pronounced effect on epidemiological predictions, affecting if, where, and to what extent FMD may invade the population. We conclude that methods such as FLAPS should be preferred over randomization approaches