“Cheese wire” fenestration of a chronic aortic dissection flap for endovascular repair of a contained aneurysm rupture

A 70-year-old man presented with a contained aortic rupture above the aortic bifurcation in the setting of a chronic type B aortic dissection. The celiac and right iliac arteries were supplied by the false lumen, and the superior mesenteric, left iliac, and bilateral renal arteries were supplied by the true lumen. An open repair was not possible due to right-sided heart failure. The “cheese wire” maneuver is a technique used to fenestrate an intimal flap, alleviating malperfusion in aortic dissection. In our modification, a Glidewire (Terumo Medical, Somerset, NJ) was passed across the intimal flap using a Ross Modified Colapinto needle (Cook Medical, Bloomington, Ind) and pulled downward to shear through the membrane to the aortic bifurcation. The fenestration was followed by a unibody endograft stent repair across the contained rupture

Experiments with Lasers and Frequency Doublers

Solid state laser sources, such as diode-pumped Nd:YAG lasers, have given us CW laser light of high power with unprecedented stability and low noise performance. In these lasers most of the technical sources of noise can be eliminated allowing them to be operated close to the theoretical noise limit set by the quantum properties of light. The next step of reducing the noise below the standard limit is known as squeezing. We present experimental progress in generating reliably squeezed light using the process of frequency doubling. We emphasize the long term stability that makes this a truly practical source of squeezed light. Our experimental results match noise spectra calculated with our recently developed models of coupled systems which include the noise generated inside the laser and its interaction with the frequency doubler. We conclude with some observations on evaluating quadrature squeezed states of light

A bio-inspired image coder with temporal scalability

We present a novel bio-inspired and dynamic coding scheme for static images. Our coder aims at reproducing the main steps of the visual stimulus processing in the mammalian retina taking into account its time behavior. The main novelty of this work is to show how to exploit the time behavior of the retina cells to ensure, in a simple way, scalability and bit allocation. To do so, our main source of inspiration will be the biologically plausible retina model called Virtual Retina. Following a similar structure, our model has two stages. The first stage is an image transform which is performed by the outer layers in the retina. Here it is modelled by filtering the image with a bank of difference of Gaussians with time-delays. The second stage is a time-dependent analog-to-digital conversion which is performed by the inner layers in the retina. Thanks to its conception, our coder enables scalability and bit allocation across time. Also, our decoded images do not show annoying artefacts such as ringing and block effects. As a whole, this article shows how to capture the main properties of a biological system, here the retina, in order to design a new efficient coder.Comment: 12 pages; Advanced Concepts for Intelligent Vision Systems (ACIVS 2011

Porphyromonas gingivalis suppresses adaptive immunity in periodontitis, atherosclerosis and Alzheimer’s disease

Porphyromonas gingivalis, a keystone pathogen in chronic periodontitis, has been found to associate with remote body organ inflammatory pathologies including atherosclerosis and Alzheimer’s disease (AD). Although P. gingivalis has a plethora of virulence factors, much of its pathogenicity is surprisingly related to the overall immunosuppression of the host. This review focuses on P. gingivalis aiding suppression of the host’s adaptive immune system involving manipulation of cellular immunological responses specifically T- and B-cells in periodontitis and related conditions. In periodontitis this bacterium inhibits the synthesis of IL-2 and increases humoral responses. This reduces inflammatory responses related to T- and B-cell activation, and subsequent IFN-ɤ secretion by a subset of T cells. The T cells further suppresses upregulation of programmed cell death-1 (PD-1)-receptor on CD+-cells and its ligand PD-L1 on CD11b+- subset of T-cells. IL-2 down-regulates immune response-regulated genes, induces a cytokine pattern in which the Th17 lineage is favored thereby modulating the Th17/ T-regulatory cell (Treg) imbalance. The suppression of IFN-ɤ stimulated release of interferon-inducible protein-10 (IP-10) chemokine ligands [ITAC (CXCL11) and Mig (CXCL9)] by P. gingivalis capsular serotypes, triggers distinct T-cell responses, and contributes to local immune evasion by release of its outer membrane vesicles. In atherosclerosis P. gingivalis reduces Tregs and transforming growth factor beta-1 (TGF-1) and causes imbalance in the Th17 lineage of the Treg population. In Alzheimer’s disease P. gingivalis may affect the blood-brain barrier permeability, and inhibit local IFN-ɤ response by preventing entry of immune cells into the brain. The scarcity of adaptive immune cells in Alzheimer’s disease neuropathology implies P. gingivalis infection of the brain likely causes impaired clearance of insoluble amyloid and induces immunosuppression. By the effective manipulation of the armory of adaptive immune suppression through a plethora of virulence factors P. gingivalis may act as a keystone organism in periodontitis and in related systemic diseases and other remote body inflammatory pathologies

Linking Whole-Slide Microscope Images with DICOM by Using JPEG2000 Interactive Protocol

The use of digitized histopathologic specimens (also known as whole-slide images (WSIs)) in clinical medicine requires compatibility with the Digital Imaging and Communications in Medicine (DICOM) standard. Unfortunately, WSIs usually exceed DICOM image object size limit, making it impossible to store and exchange them in a straightforward way. Moreover, transmitting the entire DICOM image for viewing is ineffective for WSIs. With the JPEG2000 Interactive Protocol (JPIP), WSIs can be linked with DICOM by transmitting image data over an auxiliary connection, apart from patient data. In this study, we explored the feasibility of using JPIP to link JPEG2000 WSIs with a DICOM-based Picture Archiving and Communications System (PACS). We first modified an open-source DICOM library by adding support for JPIP as described in the existing DICOM Supplement 106. Second, the modified library was used as a basis for a software package (JVSdicom), which provides a proof-of-concept for a DICOM client–server system that can transmit patient data, conventional DICOM imagery (e.g., radiological), and JPIP-linked JPEG2000 WSIs. The software package consists of a compression application (JVSdicom Compressor) for producing DICOM-compatible JPEG2000 WSIs, a DICOM PACS server application (JVSdicom Server), and a DICOM PACS client application (JVSdicom Workstation). JVSdicom is available for free from our Web site (http://jvsmicroscope.uta.fi/), which also features a public JVSdicom Server, containing example X-ray images and histopathology WSIs of breast cancer cases. The software developed indicates that JPEG2000 and JPIP provide a well-working solution for linking WSIs with DICOM, requiring only minor modifications to current DICOM standard specification

Globalisation, neo-liberalism and vocational learning: the case of English further education colleges

Further education (FE) has traditionally been a rather unspectacular activity. Lacking the visibility of schools or the prestige of universities, for the vast majority of its existence FE has had a relatively low profile on the margins of English education. Over recent years this situation has altered significantly and further education has undergone profound change. This paper argues that a combination of related factors – neo-liberalism, globalisation, and dominant discourses of the knowledge economy – has acted in synergy to transform FE into a highly performative and marketised sector. Against this backdrop, further education has been assigned a particular role based upon certain narrow and instrumental understandings of skill, employment and economic competitiveness. The paper argues that, although it has always been predominantly working class in nature, FE is now, more than ever, positioned firmly at the lower end of the institutional hierarchy in the highly class-stratified terrain of English education

An invitation to grieve: reconsidering critical incident responses by support teams in the school setting

This paper proposes that consideration could be given to an invitational intervention rather than an expectational intervention when support personnel respond to a critical incident in schools. Intuitively many practitioners know that it is necessary for guidance/counselling personnel to intervene in schools in and following times of trauma. Most educational authorities in Australia have mandated the formulation of a critical incident intervention plan. This paper defines the term critical incident and then outlines current intervention processes, discussing the efficacy of debriefing interventions. Recent literature suggests that even though it is accepted that a planned intervention is necessary, there is scant evidence as to the effectiveness of debriefing interventions in stemming later symptoms of post traumatic stress disorder. The authors of this paper advocate for an expressive therapy intervention that is invitational rather than expectational, arguing that not all people respond to trauma in the same way and to expect that they will need to recall and retell what has happened is most likely a dangerous assumption. A model of invitation using Howard Gardner’s (1983) multiple intelligences is proposed so that students are invited to grieve and understand emotionally what is happening to them following a critical incident

The Oregon Experiment — Effects of Medicaid on Clinical Outcomes

Background: Despite the imminent expansion of Medicaid coverage for low-income adults, the effects of expanding coverage are unclear. The 2008 Medicaid expansion in Oregon based on lottery drawings from a waiting list provided an opportunity to evaluate these effects. Methods: Approximately 2 years after the lottery, we obtained data from 6387 adults who were randomly selected to be able to apply for Medicaid coverage and 5842 adults who were not selected. Measures included blood-pressure, cholesterol, and glycated hemoglobin levels; screening for depression; medication inventories; and self-reported diagnoses, health status, health care utilization, and out-of-pocket spending for such services. We used the random assignment in the lottery to calculate the effect of Medicaid coverage. Results: We found no significant effect of Medicaid coverage on the prevalence or diagnosis of hypertension or high cholesterol levels or on the use of medication for these conditions. Medicaid coverage significantly increased the probability of a diagnosis of diabetes and the use of diabetes medication, but we observed no significant effect on average glycated hemoglobin levels or on the percentage of participants with levels of 6.5% or higher. Medicaid coverage decreased the probability of a positive screening for depression (−9.15 percentage points; 95% confidence interval, −16.70 to −1.60; P=0.02), increased the use of many preventive services, and nearly eliminated catastrophic out-of-pocket medical expenditures. Conclusions: This randomized, controlled study showed that Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years, but it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain.United States. Dept. of Health and Human Services. Office of the Assistant Secretary for Planning and EvaluationCalifornia HealthCare FoundationNational Institute on Aging (P30AG012810)National Institute on Aging (RC2AGO36631)National Institute on Aging (R01AG0345151)John D. and Catherine T. MacArthur FoundationRobert Wood Johnson FoundationAlfred P. Sloan FoundationSmith Richardson FoundationUnited States. Social Security Administration (5 RRC 08098400-03-00, to the National Bureau of Economic Research as part of the Retirement Research Consortium of the Social Security Administration)Centers for Medicare & Medicaid Services (U.S.

Ponderomotive entangling of atomic motions

We propose the use of ponderomotive forces to entangle the motions of different atoms. Two situations are analyzed: one where the atoms belong to the same optical cavity and interact with the same radiation field mode; the other where each atom is placed in own optical cavity and the output field of one cavity enters the other.Comment: Revtex file, five pages, two eps figure