Lymphoproliferative malignancies in association with endemic African Kaposi’s Sarcoma

A CAJM study on Lymphoproliferative malignancies observed at a teaching hospital in South Africa among black Africans.The association of classical Kaposi’s sarcoma with lymphoproliferative disorders is well known. However, far less is known about lymphoproliferative malignancies in endemic African Kaposi’s sarcoma. A review of 47 patients with the endemic type of Kaposi’s sarcoma treated at the Johannesburg Teaching Hospital Complex between 1980 and 1992 revealed four patients (8,5 pc) in whom Kaposi’s sarcoma was associated with a malignant lymphoma. Possible pathogenetic mechanisms are suggested and the current literature is reviewed

Kaposi's sarcoma in renal transplant recipients: Experience at Johannesburg Hospital, 1966 - 1989

Between August 1966 and December 1989, 989 renal transplant recipients were followed up at the Renal Transplant Unit of Johannesburg Hospital. Seventy-five (7%) patients developed a total of 95 malignancies of which 5 (6%) were Kaposi's sarcoma. All patients received immunosuppressive agents; steroids, azathioprine and/or cyclosporin A. Clinical presentations included both limited skin involvement (1 patient) and disseminated forms of the disease: necrotic oral lesions (1 patient); disseminated skin involvement and lung metastases (1 patient); and widespread skin lesions with lymphadenopathy (2 patients). Four patients responded with complete tumour regression at all sites upon withdrawal of the immunosuppressive drugs. One patient suffered disease progression, and immunosuppression was continued, albeit at reduced dosages. These cases illustrate a relatively rare complication of immunosuppressive therapy. However, complete withdrawal of iInmunosuppressive drugs may result in sustained complete regression, despite the presence of advanced KS

Retrospective Study of Midazolam Protocol for Prehospital Behavioral Emergencies

Introduction: Agitated patients in the prehospital setting pose challenges for both patient care and emergency medical services (EMS) provider safety. Midazolam is frequently used to control agitation in the emergency department setting; however, limited data exist in the prehospital setting. We describe our experience treating patients with midazolam for behavioral emergencies in a large urban EMS system. We hypothesized that using midazolam for acute agitation leads to improved clinical conditions without causing significant clinical deterioration.Methods: We performed a retrospective review of EMS patient care reports following implementation of a behavioral emergencies protocol in a large urban EMS system from February 2014–June 2016. For acute agitation, paramedics administered midazolam 1 milligram (mg) intravenous (IV), 5 mg intramuscular (IM), or 5 mg intranasal (IN). Results were analyzed using descriptive statistics, Levene’s test for assessing variance among study groups, and t-test to evaluate effectiveness based on route.Results: In total, midazolam was administered 294 times to 257 patients. Median age was 30 (interquartile range 24–42) years, and 66.5% were male. Doses administered were 1 mg (7.1%) and 5 mg (92.9%). Routes were IM (52.0%), IN (40.8%), and IV (7.1%). A second dose was administered to 37 patients. In the majority of administrations, midazolam improved the patient’s condition (73.5%) with infrequent adverse events (3.4%). There was no significant difference between the effectiveness of IM and IN midazolam (71.0% vs 75.4%; p = 0.24).Conclusion: A midazolam protocol for prehospital agitation was associated with reduced agitation and a low rate of adverse events

Lymphoproliferative disorders in non-AIDS associated Kaposi's sarcoma

The association of the non-AIDS-related, classic fonn of Kaposi's sarcoma (KS) with secondary malignancies, especially Iymphoproliferative disorders, has frequently been noted. However, in endemic: African-type KS, such an association has been reported only rarely. A review of 62 non-AIDS-related cases of KS treated and followed up at Johannesburg General Hospital between 1980 and 1992 revealed 8 patients (13%)'in whom KS was associated with malignant Iymphoproliferative disorders. The prevalence of secondary Iymphoproliferative disorders was not significantly different among patients with classic KS (3/15; 20%) when compared with those who had African KS (4/47; 8%). In both forms of KS subtle disturbances of immunity have been described which may play a role in the pathogenesis of secondary Iymphoproliferative disorders, although the factors responsible and the pathogenetic mechanisms involved in malignant lymphoid transfonnation in these patients have not been fully elucidated

When are Non-Double-Couple Components of Seismic Moment Tensors Reliable?

There has been considerable discussion as to how to assess when non-double-couple (NDC) components of seismic moment tensors represent real source processes. We explore this question by comparing moment tensors (MTs) of earthquakes in three global catalogs, which use different inversion procedures. Their NDC components are only weakly correlated between catalogs, suggesting that they are largely artifacts of the inversion. A monotonic decrease in the NDC components' standard deviation with magnitude indicates increased reliability of the NDC components for larger earthquakes. The standard deviation begins to decrease for large NDC components exceeding 60%, suggesting that they represent real source processes. Randomly generated NDC components with the same mean and standard deviation as in the MT catalogs only reproduce some of this decrease. Thus NDC components of large earthquakes and NDC components that exceed 60% are likely to represent real source processes

Geomagnetic Response to Rapid Increases in Solar Wind Dynamic Pressure: Event Detection and Large Scale Response

Discontinuities in the solar wind trigger a variety of processes in the magnetosphere-ionosphere system. A rapid increase in solar wind dynamic pressure causes compression of the magnetosphere. This manifests itself as a positive perturbation of the horizontal ground magnetic field at low/mid latitudes. In this study we present a method for detecting these discontinuities in situ solar wind data by using the random forest machine learning algorithm. Each detected event is propagated to Earth and its arrival time is aligned with a corresponding response in the low latitude ground magnetic field. A list of 3,867 events, detected between 1994 and 2019, is presented. We use the list in a superposed epoch analysis of the low/mid latitude response in the ground magnetic field at different local times, and of the high latitude response using the Polar Cap index. A dawn-dusk asymmetry is found at low/mid latitudes with weaker positive perturbations at dawn compared to any other local time sector. This suggests a stronger ring current contribution at dawn assuming the magnetopause contribution to be uniform. During northward IMF the initial response is asymmetric, but returns to symmetry after 30 min. During southward IMF the low/mid latitude response decays rapidly in all local sectors except dawn. After around 30 min the asymmetry has flipped such that the strongest positive perturbation is at dawn. This suggests an amplification of the partial ring current. In addition, a noon-midnight asymmetry is observed during southward IMF with the strongest positive perturbation on the night side suggesting a significant contribution from dipolarization of the geomagnetic field in the near tail. The complex geomagnetic response to rapid increases in solar wind dynamic pressure demonstrates a need for further statistical analyses. Event lists, such as the one presented here, are critical components in such studies.publishedVersio

Metrics for Assessing Earthquake-Hazard Map Performance

Abstract Recent large earthquakes that caused great damage in areas predicted to be relatively safe, illustrate the importance of criteria that assess how well earthquake hazard maps used to develop codes for earthquake-resistant construction are actually performing. At present, there is no agreed-upon way of assessing how well a map performed and thus determining whether one map performed better than another. The fractional site exceedance metric implicit in current maps, that during the chosen time interval the predicted ground motion will be exceeded only at a specific fraction of the sites, is useful but permits maps to be nominally successful even if they significantly underpredict or overpredict shaking, or permits them to be nominally unsuccessful but do well in terms of predicting shaking. We explore some possible metrics that better measure the effects of overprediction and underprediction and can be weighted to reflect the two differently and to reflect differences in populations and property at risk. Although no single metric alone fully characterizes map behavior, using several metrics can provide useful insight for comparing and improving hazard maps. For example, both probabilistic and deterministic hazard maps for Italy dramatically overpredict the recorded shaking in a 2200-yr-long historical intensity catalog, illustrating problems in the data (most likely), models, or both

Intergenerational correlations in size at birth and the contribution of environmental factors: The Uppsala Birth Cohort Multigenerational Study, Sweden, 1915-2002.

Sizes at birth of parents and their children are known to be correlated, reflecting in part the influence of fetal and maternal genes. Sociodemographic factors, regarded as aspects of the shared environment across generations, would also be expected to contribute, but evidence is limited. In the present study, the authors aimed to quantify the role of the shared environment in explaining intergenerational correlations in birth weight and length by using data across 3 consecutive generations from the Uppsala Birth Cohort Multigenerational Study in Uppsala, Sweden. That study included birth and sociodemographic data on 7,657 singletons born in Uppsala in 1915-1929 (generation 1) and their grandchildren (generation 3). Standard regression and biometric models were used to study the correlations in size at birth of generation 1-generation 3 pairs. The data showed stronger correlations in maternal pairs than in paternal pairs for birth weight (0.125 vs. 0.096, P = 0.02) but not for birth length (0.097 vs. 0.093, P = 0.77). These correlations were not reduced by adjustment for sociodemographic factors in regression models. In contrast, significant shared-environment contributions to the intergenerational correlations were identified in biometric models, averaging 14% for both birth measures. These models assumed a common latent factor for the sociodemographic variables. The present results show that the shared environment moderately but significantly contributes to intergenerational correlations

Ultrathin, freestanding, stimuli-responsive, porous membranes from polymer hydrogel-brushes

Responsive nanoporous polymeric membranes with tunable morphologies are fabricated by combining self-assembly of particles from liquid interfaces (SALI) and surface-initiated polymerization (SIP).</p