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The Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) is a validated instrument for assessing organ damage in systemic lupus erythematosus (SLE). Trained physicians must complete it, thus limiting utility where this is impossible.We developed and pilot tested a self-assessed organ damage instrument, the Lupus Damage Index Questionnaire (LDIQ), in 37 SLE subjects and 7 physicians. After refinement, 569 English-speaking SLE subjects and 14 rheumatologists from 11 international SLE clinics participated in validation. Subjects and physicians completed the instruments separately. We calculated sensitivity, specificity, Spearman's correlations, and agreement using the SDI as the gold standard. Six hundred five SLE participants in the community-based National Data Bank for Rheumatic Diseases (NDB) study completed the LDIQ and we assessed correlations with outcome and disability measures.The mean LDIQ score was 3.3 (range 0-16) and the mean SDI score was 1.5 (range 0-9). The LDIQ had a moderately high correlation with the SDI (Spearman's r = 0.50, P0.001). Specificities of individual LDIQ items were80%, except for neuropathy. Sensitivities were variable and lowest for damage, with1% prevalence. Agreement between the SDI and LDIQ was85% for all but neuropathy, reduced renal function, deforming arthritis, and alopecia. In the NDB, the LDIQ correlated well with the comorbidity index (r = 0.45), the Short Form 36 physical component scale (r = 0.43), the Medical Research Council dyspnea scale (r = 0.40), disability (r = 0.37), and the Systemic Lupus Erythematosus Activity Questionnaire score (r = 0.37).The metric properties of the LDIQ are good compared with the SDI. It has construct validity and correlations with health assessments similar to the SDI. The LDIQ should allow expansion of SLE research. Its ultimate value will be determined in longitudinal studies.

Objective. We present a successful case of laparoscopic splenectomy for a massively enlarged spleen at 25 weeks of gestation for hairy cell leukemia in pregnancy in a woman with initial hemoglobin of 4.3 gm/dl and platelet count of 18,000/mm3. Study Design. Case report. Results. This report provides an approach to management that may be applicable in those cases where thrombocytopenia or other clinical imperatives preclude delaying treatment till after pregnancy. Conclusion. Hairy cell leukemia is a clonal B-Cell malignancy, for which there is very limited experience worldwide for its management when it occurs during pregnancy. Laparoscopic splenectomy should be considered as a therapeutic option, even with a significantly enlarged spleen, in order to avoid the risks of fetal exposure to chemotherapeutic agents. Unique considerations relating to pregnancy are highlighted.

For over 30 years, Blum’s Medial Axis Transform (MAT) has proven to be an intriguing tool for analyzing and computing with shape, but it is one that is notoriously difficult to apply in a robust and stable way. It is well documented how a tiny change to an object’s boundary can cause a large change in its MAT. There has also been great difficulty in using the MAT to decompose an object into a hierarchy of parts reflecting the natural parts-hierarchy that we perceive. This paper argues that the underlying cause of these problems is that medial representations embody both the substance of each part of an object and the connections between adjacent parts. A small change in an object’s boundary corresponds to a small change in its substance but may involve a large change in its connection information. The problems with Blum’s MAT are generated because it does not explicitly represent this dichotomy of information. To use the Blum MAT to it’s full potential, this paper presents a method for separating the substance and connection information of an object. This provides a natural parts-hierarchy while eliminating instabilities due to small boundary changes. The method also allows for graded, fuzzy classifications of object parts to match the ambiguity in human perception of many objects.

The Department of Defense and its budget has been subject to many changes over the last decade, The change in the Department of Defense's budget effects the financial condition of defense industry firms. These defense industries are critical to the Department of Defense, so their financial condition is of a vital concern. The purpose of this thesis was to analyze the financial data of defense industry firms to investigate whether change in financial condition within the defense industry, occurs along stable, identifiable dimensions. The research sample included fifty defense industry firms selected from the top one hundred Department of Defense contractors. Financial data of these firms covered the 1983 to 1992 time period. The analyses conducted involved examination of measures of change for thirty-six financial ratios. Factor analysis procedures were conducted to identify relationships that exist between these ratio changes. The results of the analyses provided evidence that change in financial condition occurs along six dimensions. These dimensions are independent of one another and represent aspects of a firm's financial condition. Specific ratios are identified to represent these dimensions. Collectively, these dimensions and the representative ratios provide a framework for conducting analysis of changes in financial condition. http://archive.org/details/primarydimension1094531454 NA NA U.S. Navy (U.S.N.) author.