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Palpable thyroid nodules are present in approximately 5–7% of the adult population, and of these, only a small percentage (5–10%) harbor malignancy. Ultrasound (US) imaging of the neck is typically used to characterize thyroid nodules in order to triage lesions with the highest risk of malignancy. Fine needle aspiration (FNA) is recommended for thyroid lesions with radiographically suspicious features (as outlined below). FNA biopsy of the thyroid gland is an increasingly common procedure, with approximately 300,000–500,000 biopsies performed annually in the United States. The 2015 American Thyroid Association management guidelines underscore the importance of radiologic risk stratification.

Lewy body dementia (LBD) is an umbrella term for major neurocognitive disorders caused by Lewy body pathology. Parkinson's disease dementia (PDD) and Dementia with Lewy bodies (DLB) are the two main syndromes in LBD. LBDs typically present with cognitive impairment, cholinergic deficiency, neuropsychiatric symptoms such as visual hallucinations and paranoid delusions, as well as parkinsonian symptoms. Due to the urgency in diagnosing LBD early in the disease course to provide the most optimal management of these syndromes, it is important that clinicians elicit the most clinically significant symptoms during patient encounters. The focus of this chapter is to discuss current LBD classification systems and assessments, neuropathology of LBDs, behavioral symptomatology, contemporary management options, and possible future targets of treatment. PubMed was searched to obtain reviews and studies that pertain to classification, behavioral symptomatology, neurobiology, neuroimaging, and treatment of LBDs. Articles were chosen with a predilection to more recent clinical trials and systematic reviews or meta-analyses. Updates to diagnostic criteria have increased clinical diagnostic sensitivity and specificity. Current therapeutic modalities are limited as there is no current disease-modifying drug available. Cholinesterase inhibitors have been reported to be effective in decreasing neuropsychiatric and cognitive symptoms. Neuroleptics should be avoided unless clinically indicated. There is a paucity of studies investigating treatment options for mood symptoms. Current novel targets of treatment focus on decreasing α-synuclein burden. LBDs are a group of dementia syndromes that affect a significant portion of the elderly population. Early diagnosis and treatment is necessary to improve patient quality of life with current treatment options more focused on alleviating severe symptomatology rather than modifying disease pathology.

This research presents a predictive engine that integrates into an on-line optimal control planner for electrical microgrids. This controller models the behavior of the underlying system over a specified time horizon and then solves for a control over this period. In an electrical microgrid, such predictions are challenging to obtain in the presence of errors in the sensor information. The likelihood of instrumentation errors increases as microgrids become more complex and cyber threats more common. In order to overcome these difficulties, details are provided about a predictive engine robust to errors.

Chromaticity shift in light-emitting diode (LED) devices arises from multiple mechanisms, and at least five different chromaticity shift modes (CSMs) have been identified to date. This paper focuses on the impacts of irreversible phosphor degradation as a cause of chromaticity shifts in LED devices. The nitride phosphors used to produce warm white LEDs are especially vulnerable to degradation due to thermal and chemical effects such as reactions with oxygen and water. As a result, LED devices utilizing these phosphors were found to undergo either a green shift or, less commonly, a red shift depending on the phosphor mix in the LED devices. These types of chromaticity shifts are classified as CSM-2 (green shift) and CSM-5 (red shift). This paper provides an overview of the kinetic processes responsible for green and red chromaticity shifts along with examples from accelerated stress testing of 6″ downlights. Both CSMs appear to proceed through analogous mechanisms that are initiated at the surface of the phosphor. A green shift is produced by the surface oxidation of the nitride phosphor that changes the emission profile to lower wavelengths. As the surface oxidation reaction proceeds, reactant limitations slow the rate and bulk oxidation processes become more prevalent. We found that a red chromaticity shift arises from quenching of the green phosphor, also possibly due to surface reactions of oxygen, which shift the emission chromaticity in the red direction. In conclusion, we discuss the implications of these findings on projecting chromaticity.

Bladder pressure measurements (BPMs) are considered a key component in the diagnosis of abdominal compartment syndrome (ACS). The purpose of this observational review was to determine risk factors of ACS and associated mortality with particular focus on the role of BPM. A retrospective trauma registry and chart review was performed on trauma patients from January 2003 through December 2010. Comparisons were made between patients with and without ACS. There were 3172 patients included in the study of whom 46 had ACS. Patients with ACS were younger, more severely injured, with longer lengths of stay. Logistic regression determined Injury Severity Score (ISS) and urinary catheter days as independent predictors of ACS, whereas independent predictors of mortality included age, ISS, and ACS. Subset analysis demonstrated no association between BPM 20 mmHg or greater and diagnosis of ACS versus no ACS. Logistic regression indicated independent predictors of mortality were number of BPM 20 mmHg or greater and age. Patients with ACS are more severely injured with worse outcomes. An isolated BPM 20 mmHg or greater was not associated with ACS and may be inadequate to independently diagnose ACS. These findings suggest the need for repeat measurements with early intervention if they remain elevated in an effort to decrease mortality associated with ACS.

This paper presents a control design methodology that begins to address high penetration of renewable energy sources into networked AC microgrid systems. To bring about high performing microgrid systems that contain large amounts of stochastic sources and loads is a major goal for the future of electric power systems. Alternative methods for controlling and analyzing AC microgrid systems will provide understanding into tradeoffs that can be made during the design phase. This paper utilizes a control design methodology, based on Hamiltonian Surface Shaping and Power Flow Control (HSSPFC) [1] that regulates renewable energy sources, loads and identifies energy storage requirements for an AC microgrid system. Both static and dynamic stability conditions are derived for the AC microgrid system. Numerical simulations are performed to demonstrate stability and performance. Two scenarios are considered; i) simple random stochastic renewable source and load AC Microgrid example and ii) a random variable pulse load application for Navy ship AC microgrid systems.

Major Depressive Disorder (MDD) contributes to a significant worldwide disease burden, expected to be second only to heart disease by 2050. However, accurate diagnosis has been a historical weakness in clinical psychiatry. As a result, there is a demand for diagnostic modalities with greater objectivity that could improve on current psychiatric practice that relies mainly on self-reporting of symptoms and clinical interviews. Over the past two decades, literature on a growing number of putative biomarkers for MDD increasingly suggests that MDD patients have significantly different biological profiles compared to healthy controls. However, difficulty in elucidating their exact relationships within depression pathology renders individual markers inconsistent diagnostic tools. Consequently, further biomarker research could potentially improve our understanding of MDD pathophysiology as well as aid in interpreting response to treatment, narrow differential diagnoses, and help refine current MDD criteria. Representative of this, multiplex assays using multiple sources of biomarkers are reported to be more accurate options in comparison to individual markers that exhibit lower specificity and sensitivity, and are more prone to confounding factors. In the future, more sophisticated multiplex assays may hold promise for use in screening and diagnosing depression and determining clinical severity as an advance over relying solely on current subjective diagnostic criteria. A pervasive limitation in existing research is heterogeneity inherent in MDD studies, which impacts the validity of biomarker data. Additionally, small sample sizes of most studies limit statistical power. Yet, as the RDoC project evolves to decrease these limitations, and stronger studies with more generalizable data are developed, significant advances in the next decade are expected to yield important information in the development of MDD biomarkers for use in clinical settings.

Determination of performance for fluid power systems through a range of operating conditions is a crucial aspect of safety assurance. Experimental confirmation supports the computational design and verification steps taken to ensure the mechanism will perform adequately. Pumps, valves and other devices destined for hydraulic can have their performance be subject to differences in the fluid properties of the liquid. This necessitates that a range of fluid properties be examined to ensure that the operating envelope is properly characterized. Past approaches to these experiments have involved modifying the system fluid manually and only investigating a sparse set of conditions. Proposed is a liquid property unit that is able to make changes to a system fluid of a bench testing apparatus used to evaluate hydraulic devices. The chosen fluid system for the initial release of this design is a water:glycerin composition. The intent is to have a fluid chemistry that has a broad range of densities and viscosities. This unit is controlled via a user interface and is able to execute set point changes to the system fluid and maintain the total system volume desired. The design of the system, validation of its operation and use of the fluid in exemplary trials will be covered.

Our goal was to determine the characteristics of trauma transfer patients with repeat imaging. A retrospective trauma registry review was performed to evaluate trauma patients who were transferred from referring institutions between January 2005 and December 2009. Patients were divided into those who had a duplicate computed tomography (CT) scan versus those who did not. There were 2678 patients included of whom 559 (21%) had at least one repeat CT scan, whereas 2119 (79%) did not have any repeat CT scans. Those with repeat CT scans were older (42.3 ± 27.3 years vs 37.3 ± 25.6 years), had a higher Injury Severity Score (ISS) (13.7 ± 8.7 vs 11.9 ± 8.8), and more likely to have blunt trauma (odds ratio, 4.7; confidence interval, 2.3 to 9.6) (P for all < 0.0007). Those with CT scans done only at the referring facility were younger, had a lower ISS, and shorter lengths of stay (P for all < 0.0003). ISS and age were independent predictors for repeat CT scans. Transfer patients had imaging repeated one-fifth of the time. The younger, less injured patient went without repeat imaging suggesting that they may have been adequately cared for at the outside institution.

Primal---dual interior point methods and the HKM method in particular have been implemented in a number of software packages for semidefinite programming. These methods have performed well in practice on small to medium sized SDPs. However, primal---dual codes have had some trouble in solving larger problems because of the storage requirements and required computational effort. In this paper we describe a parallel implementation of the primal---dual method on a shared memory system. Computational results are presented, including the solution of some large scale problems with over 50,000 constraints.

To achieve high performance operation of micro-grids that contain stochastic sources and loads is a challenge that will impact cost and complexity. Developing alternative methods for controlling and analyzing these systems will provide insight into tradeoffs that can be made during the design phase. This paper presents a design methodology, based on Hamiltonian Surface Shaping and Power Flow Control (HSSPFC) [1] for a hierarchical control scheme that regulates renewable energy sources and energy storage in a DC micro-grid. Recent literature has indicated that there exists a trade-off in information and power flow and that intelligent, coordinated control of power flow in a microgrid system can modify energy storage hardware requirements. Two scenarios are considered; i) simple two stochastic source with variable load renewable DC Microgrid example and ii) a three zone electric ship with DC Microgrid and varying pulse load profiles.

A 27-year-old male who presented to our clinic with a nine year history of painless hematochezia. Examination was remarkable for right thigh hypertrophy and large varicose veins in the right lateral thigh. His medical history was significant for a port-wine stain on his right thigh noted early in childhood, a right leg venectomy and iron deficiency anemia. Colonoscopy revealed grade I internal hemorrhoids. Prominent rectal veins were also visualized from 10cm to the anal verge. Vascular surgery was consulted and a right leg venogram was obtained demonstrating extensive pelvic venous collaterals and an aberrant sciatic vein. There was also communication from the common femoral vein to the venous collaterals in the knee and thigh. Pathology review from his previous venectomy revealed arteriovenous fistulas. These findings were consistent with the Klippel-Trenauny Weber Syndrome (KTWS). Our patient subsequently underwent endovenous ablation of his right sciatic vein. This was followed by ultrasound-guided foam sclerotherapy. Follow-up sigmoidoscopy revealed complete ablation of his rectal varices. The Klippel-Trenauny syndrome was described in 1900 as a rare, non-hereditary congenital abnormality of obscure etiology characterized by the clinical triad of soft tissue hypertrophy of an extremity, varicosities, and cutaneous hemangiomas or lymphangiomas. Increased venous pressure during defecation and direct mucosal trauma caused by feces can aggravate recurrent hematochezia. Endoscopy may show visible vessels or nodules and bluish angiomatous lesions. Endoscopic recognition of rectal varices, and determination of the etiology of hematochezia is important in guiding appropriate therapy and management. doi:10.4021/gr2009.05.1290 Publish ahead of print May 22, 2009

A step-by-step computational procedure for estimating planetary gear train efficiency is presented. This technique is especially useful for complex gear train systems, because it does not require re-arranging the power circuit to perform efficiency calculations for different power paths. A hardware test program validating the computation is also documented. The test results correlate well with the analytical model.Copyright © 2003 by ASME

Background: The purpose of this study was to examine the contribution of age and gender to outcome after treatment of blunt splenic injury in adults. Methods: Through the Multi-Institutional Trials Committee of the Eastern Association for the Surgery of Trauma (EAST), 1488 adult patients from 27 trauma centers who suffered blunt splenic injury in 1997 were examined retrospectively. Results: Fifteen percent of patients were 55 years of age or older. A similar proportion of patients ≥ 55 went directly to the operating room compared with patients < 55 (41% vs. 38%) but the mortality for patients ≥ 55 was significantly greater than patients < 55 (43% vs. 23%). Patients ≥ 55 failed nonoperative management (NOM) more frequently than patients < 55 (19% vs. 10%) and had increased mortality for both successful NOM (8% vs. 4%, p < 0.05) and failed NOM (29% vs. 12%, p = 0.054). There were no differences in immediate operative treatment, successful NOM, and failed NOM between men and women. However, women ≥ 55 failed NOM more frequently than women < 55 (20% vs. 7%) and this was associated with increased mortality (36% vs. 5%) (both p < 0.05). Conclusion: Patients ≥ 55 had a greater mortality for all forms of treatment of their blunt splenic injury and failed NOM more frequently than patients < 55. Women ≥ 55 had significantly greater mortality and failure of NOM than women < 55.

[Background and Aims] Vibration-controlled transient elastography (VCTE), point shear wave elastography (pSWE), 2-dimensional shear wave elastography (2DSWE), magnetic resonance elastography (MRE), and magnetic resonance imaging (MRI) have been proposed as non-invasive tests for patients with non-alcoholic fatty liver disease (NAFLD). This study evaluated their diagnostic accuracy for liver fibrosis and non-alcoholic steatohepatitis (NASH)., [Methods] PubMED/MEDLINE, EMBASE and the Cochrane Library were searched for studies examining the diagnostic accuracy of these index tests, against histology as the reference standard, in adult patients with NAFLD. Two authors independently screened and assessed methodological quality of studies and extracted data. Summary estimates of sensitivity, specificity and area under the curve (sAUC) were calculated for fibrosis stages and NASH, using a random effects bivariate logit-normal model., [Results] We included 82 studies (14,609 patients). Meta-analysis for diagnosing fibrosis stages was possible in 53 VCTE, 11 MRE, 12 pSWE and 4 2DSWE studies, and for diagnosing NASH in 4 MRE studies. sAUC for diagnosis of significant fibrosis were: 0.83 for VCTE, 0.91 for MRE, 0.86 for pSWE and 0.75 for 2DSWE. sAUC for diagnosis of advanced fibrosis were: 0.85 for VCTE, 0.92 for MRE, 0.89 for pSWE and 0.72 for 2DSWE. sAUC for diagnosis of cirrhosis were: 0.89 for VCTE, 0.90 for MRE, 0.90 for pSWE and 0.88 for 2DSWE. MRE had sAUC of 0.83 for diagnosis of NASH. Three (4%) studies reported intention-to-diagnose analyses and 15 (18%) studies reported diagnostic accuracy against pre-specified cut-offs., [Conclusions] When elastography index tests are acquired successfully, they have acceptable diagnostic accuracy for advanced fibrosis and cirrhosis. The potential clinical impact of these index tests cannot be assessed fully as intention-to-diagnose analyses and validation of pre-specified thresholds are lacking., [Lay summary] Non-invasive tests that measure liver stiffness or use magnetic resonance imaging (MRI) have been suggested as alternatives to liver biopsy for assessing the severity of liver scarring (fibrosis) and fatty inflammation (steatohepatitis) in patients with non-alcoholic fatty liver disease (NAFLD). In this study, we summarise the results of previously published studies on how accurately these non-invasive tests can diagnose liver fibrosis and inflammation, using liver biopsy as the reference. We found that some techniques that measure liver stiffness had a good performance for the diagnosis of severe liver scarring., This work has been undertaken as part of the LITMUS (Liver Investigation: Testing Marker Utility in Steatohepatitis) project. The LITMUS project has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No. 777377. This Joint Undertaking receives support from the European Union’s Horizon 2020 research and innovation programme and Europen Federation of Pharmaceutical Industries and Associations (efpia.eu).

International audience; Due to their geographic location and traditional diet, rich in seafood and marine mammals, the Inuit living in Arctic Quebec are exposed to high amounts of pollutants, including organochlorine pesticides (OCPs). While the adverse developmental effects of these pesticides on child cognitive functions are well known, the effects of developmental exposure to OP on sensory processes have not been investigated. The aim of this longitudinal study was to assess the effects of prenatal and childhood exposure to 1,1,1-trichloro-2,2-bis(p-chlorophenyl)ethane (p,p'-DDT) and its major metabolite 1,1,-dichloro-2,2-bis(p-chlorophenyl)ethylene (p,p'-DDE), on visual processing in Inuit children in Nunavik (Arctic Québec). p,p'-DDT and p,p'-DDE concentrations were determined from umbilical cord and 5- and 11-year plasma samples. Visual evoked potentials (VEPs) were successfully recorded in 150 children at 4 contrast levels (95%, 30%, 12%, and 4%). Hierarchical multiple regressions were conducted to determine the association between p,p'-DDT, or p,p'-DDE, exposure and VEPs while controlling for the effects of various confounders, including fish nutrients and other contaminants. p,p'-DDE measured in umbilical cord plasma was significantly related to the amplitude of the N150 response at the lowest contrast (4%). In addition, 5-year p,p'-DDE plasma concentration was significantly associated with decreased N75 amplitude. These findings indicate that p,p'-DDE exposure, both pre- and postnatally, during early childhood is associated with visual processing impairment later in life.