Search

A 40-year-old previously healthy, non-atopic woman was referred for evaluation of a possible immunodeficiency disorder in the setting of an unusual erosive cheilitis and history of recurrent methicillin-resistant Staphylococcus aureus (MRSA) infection. Extensive work-up was non-diagnostic, including screening for immunologic disorders. She had failed multiple therapeutic modalities, including corticosteroid and immunosuppressive therapy. Tissue biopsy from the lip proved pivotal in demonstrating changes suggestive of factitial disease. This led to further detailed history-taking, yielding evidence of considerable psychologic distress. The patient was diagnosed with exfoliative cheilitis related to factitial disease in association with underlying untreated anxiety and psychologic trauma. [ABSTRACT FROM AUTHOR]

Satellite altimetry has been designed for sea level monitoring over open ocean areas. However, for some years, this technology has also been used to retrieve water levels from reservoirs, wetlands and in general any inland water body, although the radar altimetry technique has been especially applied to rivers and lakes. In this paper, a new approach for the estimation of inland water level time series is described. It is used for the computation of time series of rivers and lakes available through the web service "Database for Hydrological Time Series over Inland Waters" (DAHITI). The new method is based on an extended outlier rejection and a Kalman filter approach incorporating cross-calibrated multi-mission altimeter data from Envisat, ERS-2, Jason-1, Jason-2, TOPEX/Poseidon, and SARAL/AltiKa, including their uncertainties. The paper presents water level time series for a variety of lakes and rivers in North and South America featuring different characteristics such as shape, lake extent, river width, and data coverage. A comprehensive validation is performed by comparisons with in situ gauge data and results from external inland altimeter databases. The new approach yields rms differences with respect to in situ data between 4 and 36 cm for lakes and 8 and 114 cm for rivers. For most study cases, more accurate height information than from other available altimeter databases can be achieved. [ABSTRACT FROM AUTHOR]

Satellite altimetry has been designed for sea level monitoring over open ocean areas. However, since some years, this technology is also used for observing inland water levels of lakes and rivers. In this paper, a new approach for the estimation of inland water level time series is described. It is used for the computation of time series available through the web service "Database for Hydrological Time Series over Inland Water" (DAHITI). The method is based on a Kalman filter approach incorporating multi-mission altimeter observations and their uncertainties. As input data, cross-calibrated altimeter data from Envisat, ERS-2, Jason-1, Jason-2, Topex/Poseidon, and SARAL/AltiKa are used. The paper presents water level time series for a variety of lakes and rivers in North and South America featuring different characteristics such as shape, lake extent, river width, and data coverage. A comprehensive validation is performed by comparison with in-situ gauge data and results from external inland altimeter databases. The new approach yields RMS differences with respect to in-situ data between 4 and 38 cm for lakes and 12 and 139 cm for rivers, respectively. For most study cases, more accurate height information than from available other altimeter data bases can be achieved. [ABSTRACT FROM AUTHOR]

A 38-year-old female patient presented with a painful swelling in the lateral part of the upper eyelid, a diffuse scleritis and slight hypoglobus of the right eye. An orbital biopsy showed a fibrotic idiopathic orbital inflammation (IOI) with, on immunohistochemical staining, an increased number of IgG4-positive plasma cells scored as >200 per high-power field, with IgG4/IgG ratio >0.50, indicating orbital IgG4 related autoimmune disease. On treatment with oral prednisone and azathioprine the symptoms resolved within 6 months. Twenty years prior, the patient had been diagnosed with an IOI of at the same side, for which at that time a biopsy had been taken similarly. Reclassification of the previous biopsy specimen with immunohistological staining also showed evidence of orbital IgG4 related disease. To our knowledge this is the first report of a biopsy-proven unilateral IgG4-related orbitopathy that recurred after 20 years. [ABSTRACT FROM AUTHOR]

Background Recent studies have demonstrated that cytomegalovirus ( CMV) infection and disease are associated with increased risk of graft loss and death in high-risk (donor CMV seropositive/recipient CMV seronegative) liver transplant recipients ( LTR) despite effective antiviral chemoprophylaxis. Predictors of CMV infection and disease in this important population are incompletely defined. Methods A retrospective cohort study of 227 high-risk first LTR who received primary anti- CMV chemoprophylaxis during the first 100 days after transplant was performed. A large number of patient, donor, operative, and post-transplant potential risk factors were collected. Associations of potential risk factors for CMV infection or disease that occurred during the first year after transplant were assessed using Cox regression models. After Bonferroni adjustment for multiple testing, P-values ≤0.00125 (associations with CMV infection) and ≤0.00122 (associations with CMV disease) were considered as statistically significant. Results CMV infection and disease occurred in 91 (40%) and 43 (19%) of LTR, respectively. In multivariable analysis, increased risk of CMV infection was observed for patients with lower model for end-stage liver disease ( MELD) score ( P = 0.025), lower total bilirubin ( P = 0.014), and longer operative time ( P = 0.038), whereas increased risk of CMV disease was seen in patients with lower MELD score ( P = 0.026), lower total bilirubin ( P = 0.044), and lower international normalized ratio ( P = 0.043). However, after adjustment for multiple testing, none of these findings approached statistical significance. Conclusion Our results suggest that interventions designed to prevent CMV infection and disease should be applied to all high-risk LTR until more definitive predictors of these complications are identified. [ABSTRACT FROM AUTHOR]

Mycobacterium tuberculosis infection is one of many opportunistic infections in renal transplant recipients, arising either from reactivation of latent infection or de novo infection, occasionally donor derived. M. tuberculosis hepatitis has never been reported in patients who have received alemtuzumab as part of their renal transplant management. We describe 2 patients who underwent deceased-donor renal transplantation following alemtuzumab induction therapy and presented with a febrile syndrome, subsequently diagnosed as tuberculous hepatitis, one with disseminated disease. Both responded well to treatment without significant side effects, resulting in excellent graft function. The importance of chemoprophylaxis should be emphasized to minimize the risk of developing active tuberculosis in patients with latent tuberculosis infection undergoing solid organ transplantation. [ABSTRACT FROM AUTHOR]

Copyright of Huisarts En Wetenschap is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

SUMMARY A mean dynamic ocean topography (MDT) has been computed using a high resolution GOCE (Gravity field and steady-state Ocean Circulation Explorer) gravity model and a new mean sea surface obtained from a combination of satellite altimetry covering the period 1992 October till 2010 April. The considered gravity model is GO-CONS-GCF-2-TIM-R3, which computes geoid using 12 months of GOCE gravity field data. The GOCE gravity data allow for more detailed and accurate estimates of MDT. This is illustrated in the Southern Ocean where the commission error is reduced from 20 to 5 cm compared to the MDT computed using the GRACE gravity field model ITG-Grace2010. As a result of the more detailed and accurate MDT, the calculation of geostrophic velocities from the MDT is now possible with higher accuracy and spatial resolution, and the error estimate is about 7 cm s−1 for the Southern Ocean. [ABSTRACT FROM AUTHOR]

With the focus on the Southern Ocean circulation, results of assimilation of multi-mission-altimeter data and the GRACE/GOCE gravity data into the finite element ocean model (FEOM) are investigated. We use the geodetic method to obtain the dynamical ocean topography (DOT). This method combines the multi-mission-altimeter sea surface height and the GRACE/GOCE gravity field. Using the profile approach, the spectral consistency of both fields is achieved by filtering the sea surface height and the geoid. By combining the GRACE and GOCE data, a considerably shorter filter length can be used, which results in more DOT details. We show that this increase in resolution of measured DOT carries onto the results of data assimilation for the surface data. By assimilating only absolute dynamical topography data using the ensemble Kalman filter, we were able to improve modeled fields. Results are closer to observations which were not used for assimilation and lie outside the area covered by altimetry in the Southern Ocean (e.g. temperature of surface drifters or deep temperatures in the Weddell Sea area at 800m depth derived from Argo composite.) [ABSTRACT FROM AUTHOR]

In preparation of activities planned for the realization of the Global Geodetic Observing System (GGOS), a group of German scientists has carried out a study under the acronym GGOS-D which closely resembles the ideas behind the GGOS initiative. The objective of the GGOS-D project was the investigation of the methodological and information-technological realization of a global geodetic-geophysical observing system and especially the integration and combination of the space geodetic observations. In the course of this project, highly consistent time series of GPS, VLBI, and SLR results were generated based on common state-of-the-art standards for modeling and parameterization. These series were then combined to consistently and accurately compute a Terrestrial Reference Frame (TRF). This TRF was subsequently used as the basis to produce time series of station coordinates, Earth orientation, and troposphere parameters. In this publication, we present results of processing algorithms and strategies for the integration of the space-geodetic observations which had been developed in the project GGOS-D serving as a prototype or a small and limited version of the data handling and processing part of a global geodetic observing system. From a comparison of the GGOS-D terrestrial reference frame results and the ITRF2005, the accuracy of the datum parameters is about 5-7 mm for the positions and 1.0-1.5 mm/year for the rates. The residuals of the station positions are about 3 mm and between 0.5 and 1.0 mm/year for the station velocities. Applying the GGOS-D TRF, the offset of the polar motion time series from GPS and VLBI is reduced to 50 μas (equivalent to 1.5 mm at the Earth's surface). With respect to troposphere parameter time series, the offset of the estimates of total zenith delays from co-located VLBI and GPS observations for most stations in this study is smaller than 1.5 mm. The combined polar motion components show a significantly better WRMS agreement with the IERS 05C04 series (96.0/96.0 μas) than VLBI (109.0/100.7 μas) or GPS (98.0/99.5 μas) alone. The time series of the estimated parameters have not yet been combined and exploited to the extent that would be possible. However, the results presented here demonstrate that the experiences made by the GGOS-D project are very valuable for similar developments on an international level as part of the GGOS development. [ABSTRACT FROM AUTHOR]

In this work we examine the impact of assimilation of multi-mission-altimeter data and the GRACE/GOCE gravity fields into the finite element ocean model (FEOM), with the focus on the Southern Ocean circulation. In order to do so, we use the geodetic approach for obtaining the dynamical ocean topography (DOT), that combines the multi-mission-altimeter data and the GRACE/GOCE gravity fields, and requires that both fields be spectrally consistent. The spectral consistency is achieved by filtering of the sea surface height and the geoid using profile approach. Combining the GRACE and GOCE data, a considerably shorter filter length resolving more DOT details can be used. In order to specify the spectrally consistent geodetic DOT we applied the Jekeli-Wahr filter corresponding to 241 km, 121 km, 97 km and 81 km halfwidths for the GRACE/GOCE based gravity field model GOCO01S and to the sea surface. More realistic features of the ocean assimilation were obtained in the Weddel gyre area due to increased resolution of the data fields, particularly for temperature field at the 800m depth compared to Argo data. [ABSTRACT FROM AUTHOR]

Copyright of Tijdschrift Voor Kindergeneeskunde is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

To cite this article: van den Nieuwenhof L, Schermer T, Bosch Y, Bousquet J, Heijdra Y, Bor H, van den Bosch W, van Weel C. Is physician-diagnosed allergic rhinitis a risk factor for the development of asthma? Allergy 2010; 65: 1049–1055. Background: There is strong evidence that there is a relationship between allergic rhinitis (AR) and asthma, but it is unclear whether there is a causal relation between AR and asthma. The aim of this study was to assess prospectively whether AR is a risk factor for the diagnosis of asthma in a large primary care population. Methods: We performed a historic cohort study of life-time morbidity that had been recorded prospectively since 1967 in four general practices. Two groups of subjects were selected: (i) patients with diagnosis of AR, (ii) a control group matched using propensity scores. We assessed the risk of physician-diagnosed asthma in patients with physician-diagnosed AR compared to subjects without a diagnosis of AR (controls). Results: The study population consisted of 6491 subjects ( n = 2081 patients with AR). Average study follow-up was 8.4 years. In patients with AR, the frequency of newly diagnosed asthma was 7.6% ( n = 158) compared to 1.6% ( n = 70) in controls ( P < 0.001). After adjusting the effect of AR on asthma diagnosis for registration time, age, gender, eczema and socioeconomic status, having AR was a statistically significant risk factor for asthma (hazard ratio: 4.86, P < 0.001, 95% confidence interval: 3.50–6.73, controls as reference). Conclusion: A diagnosis of AR was an independent risk factor for asthma in our primary care study population. Having physician-diagnosed AR increased the risk almost fivefold for a future asthma diagnosis. [ABSTRACT FROM AUTHOR]

This study focuses on an accurate estimation of ocean circulation via assimilation of satellite measurements of ocean dynamical topography into the global finite-element ocean model (FEOM). The dynamical topography data are derived from a complex analysis of multi-mission altimetry data combined with a referenced earth geoid. The assimilation is split into two parts. First, the mean dynamic topography is adjusted. To this end an adiabatic pressure correction method is used which reduces model divergence from the real evolution. Second, a sequential assimilation technique is applied to improve the representation of thermodynamical processes by assimilating the time varying dynamic topography. A method is used according to which the temperature and salinity are updated following the vertical structure of the first baroclinic mode. It is shown that the method leads to a partially successful assimilation approach reducing the rms difference between the model and data from 16 cm to 2 cm. This improvement of the mean state is accompanied by significant improvement of temporal variability in our analysis. However, it remains suboptimal, showing a tendency in the forecast phase of returning toward a free run without data assimilation. Both the mean difference and standard deviation of the difference between the forecast and observation data are reduced as the result of assimilation. [ABSTRACT FROM AUTHOR]

Background: Dutch general practitioners have reorganized their out-of-hours primary health care to general practice cooperatives. Good insight into the quality of delivered medical care is important to make the accountability of health practitioners and managers transparent to society and to identify and minimize medical errors.Objective: Development of a set of quality indicators for internal quality improvement in out-of-hours primary clinical care.Method: A systematic approach combining the opinion of three different general practitioner expert panels, and an empirical test in daily practice. The indicators were based on clinical, evidence-based, national guidelines. We tested the validity, feasibility, reliability and opportunity for quality improvement.Results: Of the 80 available national clinical guidelines, 29 were approved and selected by the first general practitioner expert panel. Out of these 29 guidelines, 73 indicators concerning prescribing and referring were selected by the second panel. In an empirical test on 36 254 patient contacts, 7344 patient contacts (22.7%) were relevant for the assessment of these 73 indicators. Six indicators were excluded because they scored more than 15% missing values. In total, 38 indicators were excluded because the opportunity for quality improvement was limited (performance score > or =90%). In the final meeting, the third general practitioner expert panel excluded five indicators, leading to a final set of 24 indicators.Conclusion: This study shows the importance of subjecting indicators to an empirical test in practice. The national clinical guidelines are only partially applicable in the assessment of out-of-hours primary care. They need to be expanded with topics that are related to general practitioner care in an out-of-hours setting and acute medical problems. [ABSTRACT FROM AUTHOR]