Homicide and Associated Steroid Acute Psychosis: A Case Report

We report the case of an old man treated with methylprednisolone for chronic lymphoid leukemia. After two months of treatment, he declared an acute steroid psychosis and beat his wife to death. Steroids were stopped and the psychotic symptoms subsided, but his condition declined very quickly. The clinical course was complicated by a major depressive disorder with suicidal ideas, due to the steroid stoppage, the leukemia progressed, and by a sudden onset of a fatal pulmonary embolism. This clinical case highlights the importance of early detection of steroid psychosis and proposes, should treatment not be stopped, a strategy of dose reduction combined with a mood stabilizer or antipsychotic treatment. In addition have been revised the risks of the adverse psychiatric effects of steroids

Coordination and control – limits in standard representations of multi-reservoir operations in hydrological modeling

Major multi-reservoir cascades represent a primary mechanism for dealing with hydrologic variability and extremes within institutionally complex river basins worldwide. These coordinated management processes fundamentally reshape water balance dynamics. Yet, multi-reservoir coordination processes have been largely ignored in the increasingly sophisticated representations of reservoir operations within large-scale hydrological models. The aim of this paper is twofold, namely (i) to provide evidence that the common modeling practice of parameterizing each reservoir in a cascade independently from the others is a significant approximation and (ii) to demonstrate potential unintended consequences of this independence approximation when simulating the dynamics of hydrological extremes in complex reservoir cascades. We explore these questions using the Water Balance Model, which features detailed representations of the human infrastructure coupled to the natural processes that shape water balance dynamics. It is applied to the Upper Snake River basin in the western US and its heavily regulated multi-reservoir cascade. We employ a time-varying sensitivity analysis that utilizes the method of Morris factor screening to explicitly track how the dominant release rule parameters evolve both along the cascade and in time according to seasonal high- and low-flow events. This enables us to address aim (i) by demonstrating how the progressive and cumulative dominance of upstream releases significantly dampens the ability of downstream reservoir rules\u27 parameters to influence flow conditions. We address aim (ii) by comparing simulation results with observed reservoir operations during critical low-flow and high-flow events in the basin. Our time-varying parameter sensitivity analysis with the method of Morris clarifies how independent single-reservoir parameterizations and their tacit assumption of independence leads to reservoir release behaviors that generate artificial water shortages and flooding, whereas the observed coordinated cascade operations avoided these outcomes for the same events. To further explore the role of (non-)coordination in the large deviations from the observed operations, we use an offline multi-reservoir water balance model in which adding basic coordination mechanisms drawn from the observed emergency operations is sufficient to correct the deficiencies of the independently parameterized reservoir rules from the hydrological model. These results demonstrate the importance of understanding the state–space context in which reservoir releases occur and where operational coordination plays a crucial role in avoiding or mitigating water-related extremes. Understanding how major infrastructure is coordinated and controlled in major river basins is essential for properly assessing future flood and drought hazards in a changing world

Microchannel reactors for fast periodic operation: the catalytic dehydrogenation of isopropanol

A microchannel reactor specially designed for periodic operation and a process to deposit a catalyst, g-alumina, inside the reactor channels were developed. The hydrodynamics of the reactor was characterised. Although the flow in the microchannels is laminar, a uniform radial concentration profile and consequently a narrow residence time distribution were obtained. Depending on the manufacturing method the Bodenstein number was found to be Bo=ud/Dm=~70. The catalytic coating had no influence on this distribution indicating a uniform deposition of the catalyst within the microchannels. As the inlet function was only slightly modified in the reactors, frequencies of up to 1 Hz could be imposed for periodic operation. The dehydration of isopropanol to propene was chosen as model reaction to study the dynamic behaviour of a microreactor under periodic concentration variations. The kinetics was firstly studied in a conventional fixed-bed reactor with the catalyst developed for the microreactor. Experimental results confirmed the theoretically predicted increase of the reactor performance under periodic operation exceeding the maximum obtainable performance under steady-state conditions

Enteric dysbiosis and fecal calprotectin expression in premature infants.

BackgroundPremature infants often develop enteric dysbiosis with a preponderance of Gammaproteobacteria, which has been related to adverse clinical outcomes. We investigated the relationship between increasing fecal Gammaproteobacteria and mucosal inflammation, measured by fecal calprotectin (FC).MethodsStool samples were collected from very-low-birth weight (VLBW) infants at ≤2, 3, and 4 weeks' postnatal age. Fecal microbiome was surveyed using polymerase chain reaction amplification of the V4 region of 16S ribosomal RNA, and FC was measured by enzyme immunoassay.ResultsWe enrolled 45 VLBW infants (gestation 27.9 ± 2.2 weeks, birth weight 1126 ± 208 g) and obtained stool samples at 9.9 ± 3, 20.7 ± 4.1, and 29.4 ± 4.9 days. FC was positively correlated with the genus Klebsiella (r = 0.207, p = 0.034) and its dominant amplicon sequence variant (r = 0.290, p = 0.003), but not with the relative abundance of total Gammaproteobacteria. Klebsiella colonized the gut in two distinct patterns: some infants started with low Klebsiella abundance and gained these bacteria over time, whereas others began with very high Klebsiella abundance.ConclusionIn premature infants, FC correlated with relative abundance of a specific pathobiont, Klebsiella, and not with that of the class Gammaproteobacteria. These findings indicate a need to define dysbiosis at genera or higher levels of resolution

Search for supersymmetry with a dominant R-parity violating LQDbar couplings in e+e- collisions at centre-of-mass energies of 130GeV to 172 GeV

A search for pair-production of supersymmetric particles under the assumption that R-parity is violated via a dominant LQDbar coupling has been performed using the data collected by ALEPH at centre-of-mass energies of 130-172 GeV. The observed candidate events in the data are in agreement with the Standard Model expectation. This result is translated into lower limits on the masses of charginos, neutralinos, sleptons, sneutrinos and squarks. For instance, for m_0=500 GeV/c^2 and tan(beta)=sqrt(2) charginos with masses smaller than 81 GeV/c^2 and neutralinos with masses smaller than 29 GeV/c^2 are excluded at the 95% confidence level for any generation structure of the LQDbar coupling.Comment: 32 pages, 30 figure

Programme evaluation training for health professionals in francophone Africa: process, competence acquisition and use

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