Quiet a Puzzle: A Case Report of 15 year Old Female with Severe Anemia Due To Scurvy

Scurvy is historically thought of a disease affecting sailors in the seventeenth century. Vitamin C deficiency is rare in the developed world. It is mainly found in patients with poor nutrition and specifically those with developmental delay. The spectrum of scurvy is varied and includes dermatological, dental, bone and systemic manifestations. We present to you a case of a 15 year old female with a history of trisomy 21 presenting with severe anemia as a direct cause of vitamin C deficiency. She presented with a one month history of progressive bilateral lower extremity bruising and inability to walk. Physical exam notable for trisomy 21 features. Bilateral swelling in lower extremities with the right calf more swollen than left. Perifollicular hyperkeratotic papules with surrounding pinpoint hemorrhage in upper extremities with coiled hair. Lower extremity had large areas of ecchymosis associated with significant tenderness. Reminder of the physical exam and review of the systems is unremarkable. Consent for photographs of exam findings were obtained from parents. She underwent extensive work up which showed normocytic anemia hgb 8.7 g/dL. Elevated D dimer. ANA +. Normal Iron studies, Comprehensive metabolic panel, coagulation studies. Autoimmune work was unremarkable. Hemolysis labs were grossly unremarkable. Hematological work up including ADAMTS12, Paroxysmal nocturnal hemoglobinuria , Factor deficiencies, platelet function assay, protein C , S were unremarkable. Duplex ultrasound , CT and CTA of lower extremities were unremarkable. Vitamin C levels were low and barely detectable at \u3c0.1mg/dl. Patient was started on Vitamin C supplementation of 250 mg twice a day and iron supplementation. She was found to have low B12 and vitamin D.. Significant improvement was notable in Three weeks of treatment as the patient was able to walk. In addition to near complete resolution of her ecchymosis and improvement in her anemia

Impact of Ultrasonication on Physicochemical Properties and Digestibility of Sorghum Starch

Sorghum, a highly nutritious grain, is usually not considered as a main staple in many families because it is not as easy to be digested as other grains such as rice or maize. But recent studies of ultrasonication shed a light on potential utilization of this world’s fifth important cereal other than being raw material source of biofuel or liquor. This experiment was meant to compare the differences between unsonicated and sonicated sorghum starch in terms of their physical chemical properties and digestion ability. Despite their similarities in shapes under microscopes and their thermal properties, but sonicated sorghum starch was higher than unsonicated sorghum in the results of water retention capacity, swelling power, solubility and especially digestibility. The results might provide the background for further research to broaden the practical usage of sonicated sorghum in foods

Effects of ethical context on earnings management, organizational-professional conflict and organizational commitment in Chinese enterprises

This study investigates the effects of the organizational ethical context (ethical climate and ethical culture) in Chinese enterprises on accounting professionals’ perceptions of earnings management, organizational-professional conflict (OPC) and affective organizational commitment (OC). We also test the effects of Machiavellianism on these factors, and the interactive effects of Machiavellianism and ethical context on OPC and OC. The findings, based on responses from 89 accounting professionals employed by Chinese enterprises at staff, supervisor and manager levels, indicate that in general the perceived ethical context did not affect judgments of the acceptability of earnings management. However, as anticipated, perceptions of a stronger benevolent/cosmopolitan climate (one that places more emphasis on the public interest) were associated with harsher judgments of accounting earnings management. Machiavellianism also had a marginally significant effect on judgments of accounting earnings management and a significant effect on judgments of operating earnings management, with high Machiavellians judging the actions to be more ethical. Two aspects of ethical culture, obedience to authority and ethical norms, were found to be significantly associated with organizational-professional conflict and affective organizational commitment. Contrary to our expectations, high Machiavellians appeared to be more, rather than less, sensitive to the perceived ethical context in their organization. Specifically, the perceived organizational ethical culture had a greater (lesser) impact on affective organizational commitment for high (low) Machiavellians

Approximations and Bounds for (n, k) Fork-Join Queues: A Linear Transformation Approach

Compared to basic fork-join queues, a job in (n, k) fork-join queues only needs its k out of all n sub-tasks to be finished. Since (n, k) fork-join queues are prevalent in popular distributed systems, erasure coding based cloud storages, and modern network protocols like multipath routing, estimating the sojourn time of such queues is thus critical for the performance measurement and resource plan of computer clusters. However, the estimating keeps to be a well-known open challenge for years, and only rough bounds for a limited range of load factors have been given. In this paper, we developed a closed-form linear transformation technique for jointly-identical random variables: An order statistic can be represented by a linear combination of maxima. This brand-new technique is then used to transform the sojourn time of non-purging (n, k) fork-join queues into a linear combination of the sojourn times of basic (k, k), (k+1, k+1), ..., (n, n) fork-join queues. Consequently, existing approximations for basic fork-join queues can be bridged to the approximations for non-purging (n, k) fork-join queues. The uncovered approximations are then used to improve the upper bounds for purging (n, k) fork-join queues. Simulation experiments show that this linear transformation approach is practiced well for moderate n and relatively large k.Comment: 10 page

High-Resolution Traffic Flow Prediction Model Based on Deep Learning

The traditional platoon dispersion model is based on the hypothesis of probability distribution, and the time resolution of the existing traffic flow prediction model is too big to be applied to the adaptive signal timing optimization. Based on the view of the platoon dispersion model, the relationship between vehicle arrival at downstream intersection and vehicle departure from the upstream intersection was analyzed. Then, the high-resolution traffic flow prediction model based on deep learning was proposed. The departure flow rate at the upstream was taking as the input and the arrival flow rate at downstream intersection was taking as the output in this model. Finally, the parameters of the proposed model were trained by the field survey data, and this model was implemented to predict the arrival flow rate of the downstream intersection. The result shows that the proposed model can better reflect the fluctuant characteristics of traffic flow and reduced the sum of the squared errors (SSE), MSE, and MAE by 13.17%, 13.21%, and 14.24%, compared with Robertson’s model. Thus, the proposed model can be applied for real-time adaptive signal timing optimization

Precise Request Tracing and Performance Debugging for Multi-tier Services of Black Boxes

As more and more multi-tier services are developed from commercial components or heterogeneous middleware without the source code available, both developers and administrators need a precise request tracing tool to help understand and debug performance problems of large concurrent services of black boxes. Previous work fails to resolve this issue in several ways: they either accept the imprecision of probabilistic correlation methods, or rely on knowledge of protocols to isolate requests in pursuit of tracing accuracy. This paper introduces a tool named PreciseTracer to help debug performance problems of multi-tier services of black boxes. Our contributions are two-fold: first, we propose a precise request tracing algorithm for multi-tier services of black boxes, which only uses application-independent knowledge; secondly, we present a component activity graph abstraction to represent causal paths of requests and facilitate end-to-end performance debugging. The low overhead and tolerance of noise make PreciseTracer a promising tracing tool for using on production systems