Deutsche Gesellschaft für Parkinson und Bewegungsstörungen

OBJECTIVE: To determine the prevalence and outcome of intravenous gamma-globulin (IVIG) retreatment in patients with Kawasaki disease (KD). METHOD: Multicenter, retrospective survey of all children with KD evaluated at nine clinical centers across North America during a 15-month period. RESULTS: Data were available for 378 patients. At 48 h after completion of the initial IVIG infusion, 50 patients (13.2%) remained febrile, 29 (58.0%) of whom were retreated with IVIG, including 4 (13.8%) with coronary artery abnormalities before their first IVIG infusion. Among 25 retreated patients with a normal baseline echocardiogram, 5 (20.0%) developed coronary abnormalities and were termed "treatment failures." Among the 323 patients with a normal baseline echocardiogram, only 9 (2.8%) were treatment failures; treatment failure occurred in 4 of 282 (1.4%) patients who became afebrile post-IVIG and in 5 of 41 (12.2%) patients with persistent or recrudescent fever after their first course of IVIG therapy (P=0.002). CONCLUSIONS: The overall prevalence of new coronary abnormalities in KD patients treated with IVIG and aspirin remains low. Persistent or recrudescent fever after the first course of IVIG was associated with an increased risk of treatment failure (P=0.002). IVIG retreatment in patients who remain febrile after the first course of IVIG is now common (58.0%), although the efficacy of this practice requires assessment with a randomized trial.

OBJECTIVE: To describe prognostic factors, clinical course, and hospital outcome of patients with chronic obstructive pulmonary disease admitted to an intensive care unit for acute respiratory failure. DESIGN: Analysis of prospectively collected data. SETTING: A multidisciplinary intensive care unit of an inner-city university hospital. PATIENTS: Patients with chronic obstructive pulmonary disease admitted to an intensive care unit for acute respiratory failure from August 1995 through July 1998. MEASUREMENTS AND MAIN RESULTS: Data were obtained concerning demographics, arterial blood gas, Acute Physiology and Chronic Health Evaluation (APACHE) II score, sepsis, mechanical ventilation, organ failure, complications, and hospital mortality rate. Fifty-nine percent of patients were male, 63% white, and 36% African-American; the mean age was 63.1 +/- 8.9 yrs. Noninvasive mechanical ventilation was tried in 40% of patients and was successful in 54% of them. Invasive mechanical ventilation was required in 61% of the 250 admissions. Sepsis developed in 31% of patients, nonpulmonary organ failure in 20%, pneumothorax in 3%, and acute respiratory distress syndrome in 2%. Multiple organ failure developed in 31% of patients with sepsis compared with 3% without sepsis (p <.0001). Predicted and observed hospital mortality rates were 30% and 15%, respectively. Differences in age and arterial carbon dioxide and oxygen tensions between survivors and nonsurvivors were not significant. Arterial pH was lower in nonsurvivors than in survivors (7.21 vs. 7.25, p =.0408). The APACHE II-predicted mortality rate (p =.0001; odds ratio, 1.046; 95% confidence interval, 1.022-1.070) and number of organ failures (p <.0001; odds ratio, 5.524; 95% confidence interval, 3.041-10.031) were independent predictors of hospital outcome; invasive mechanical ventilation was not an independent predictor. CONCLUSIONS: Physiologic abnormalities at admission to an intensive care unit and development of nonrespiratory organ failure are important predictors of hospital outcome for critically ill patients with chronic obstructive pulmonary disease who have acute respiratory failure. Improved outcome would require prevention and appropriate treatment of sepsis and multiple organ failure.

Distributed acoustic sensing (DAS) is a novel technology that uses an optical fiber cable as a sensor for acoustic signals and can take almost any downhole fiber-optic installation or deployment and turn the fiber-optic cable into a large downhole seismic array. This array can provide enhanced vertical seismic profile (VSP) imaging and monitor fluids and pressure changes in the hydrocarbon-production reservoir. Walkaway VSP data acquired over a formerly producing well in northeastern China provided a rich set of high-quality DAS walkaway VSP data. A standard VSP data preprocessing workflow was applied, followed by prestack Kirchhoff time migration. In the DAS preprocessing step, we were faced with additional challenges: strong coherent noise due to cable slapping and ringing along the borehole casing. Compared with an earlier offset VSP data set using 327 levels acquired with conventional 3C downhole geophones in the same well, the final preprocessed DAS walkaway VSP has a larger vertical aperture, resulting in a wider lateral image. The single-well DAS walkaway VSP images provide a good result with higher vertical and lateral resolution than the surface seismic in the objective area. The vertical-well environment, which lacks the ability to effectively “clamp” the sensor to the borehole-casing wall by touching, creates a unique set of challenges. Although earth signal was recorded with almost all the shots, there was also a considerable amount of noise. Much of the noise was due to the physical placement of the wireline in the well and was expressed by slapping and ringing. Reported here are lessons learned in handling the wireline cable and subsequent special DAS data processing steps developed to remediate some of the practical wireline deployment issues. Optical wireline cable as a conveyance of fiber-optic cables for VSP in vertical wells will open the use of the DAS system to wider applications.

From the Department of Pediatrics, State University of New York at Buffalo and Division of Infectious Diseases, Children's Hospital of Buffalo, Buffalo, NY (RCW, PLO); and the Department of Pediatrics, University of Texas Medical Branch at Galveston, TX (RPG). Reprints not available.

BACKGROUND: Routine childhood hepatitis A immunization is recommended in regions with incidence rates twice the national average, but it may be cost-effective in a wider geographic area. OBJECTIVE: To evaluate the costs and benefits of potential hepatitis A immunization of healthy US children in regions with varying hepatitis A incidences. METHODS: We considered vaccination of the 2000 US birth cohort in states defined by historic hepatitis A incidence rates. Infections among potential vaccinees and their personal contacts were predicted from age 2 through 85 years. Net vaccination costs were estimated from health system and societal perspectives and were compared with life-years saved and quality-adjusted life years (QALYs) gained using a 3% discount rate. RESULTS Nationally vaccination would prevent >75 000 cases of overt hepatitis A disease. Approximately two-thirds of health benefits would accrue to personal contacts rather than to vaccinees themselves. In states with incidence rates of > or =200%, 100 to 199%, 50 to 99% and <50% the national average, societal costs per QALY gained would be <0, <0, 13,800 and 63,000 US dollars, respectively. Nationally vaccination would cost 9100 US dollars per QALY gained from the perspective of the health system and 1400 US dollars per QALY gained from society's perspective. Results are most sensitive to vaccination costs and rates of disease transmission through personal contact. CONCLUSION: Childhood hepatitis A vaccination is most cost-effective in areas with the highest incidence rates but would also meet accepted standards of economic efficiency in most of the US. A national immunization policy would prevent substantial morbidity and mortality, with cost effectiveness similar to that of other childhood immunizations.

Abstract We present a least-squares solution for depth migration of the full reflected wavefield. The algorithm combines primary and high-order reflected energy and significantly enhances the image illumination and resolution compared to those of conventional migration. Least-squares full-wavefield migration (LS-FWM) directly computes the earth's reflectivity, thereby avoiding crosstalk noise often observed in imaging using high-order reflections. Iteratively solving an inversion problem is computationally intensive and can suffer from instability issues; however, we develop an efficient least-squares procedure by combining a fast and accurate one-way wave-equation propagator with an effective linear inversion solver. An advanced regularization method is also employed to stabilize the inversion by controlling the over-fitting problem. Successful applications to both synthetic and field data examples demonstrate that LS-FWM greatly improves the imaging illumination and resolution compared to conventional migration.

OBJECTIVE: To evaluate the safety and immunogenicity of diphtheria-tetanus toxoids-acellular pertussis (DTPa)-hepatitis B (HepB) combination vaccine given at 2, 4 and 6 months of age compared with monovalent HepB vaccine given at birth, 1 month and 6 months of age and DTPa vaccine given at 2, 4 and 6 months of age. METHODS: Healthy infants were randomized to receive a combination DTPa-HepB vaccine (diphtheria and tetanus toxoids, acellular pertussis antigens and hepatitis B surface antigen), concomitantly with type b and oral poliovirus vaccines at 2, 4 and 6 months of age (Group 1) or HepB vaccine given at birth, 1 month and 6 months of age and DTPa, type b and oral poliovirus vaccines given at 2, 4 and 6 months of age (Group 2). Antibody responses were evaluated at birth, 2 months and 7 months of age. Safety was evaluated after each immunization using diary cards and parental interviews. RESULTS: One month after the third dose (7 months of age), the geometric mean concentration of antibody to hepatitis B surface antigen was approximately 3.5-fold higher in Group 2 than in Group 1 infants (3643 and 1052 mIU/ml, respectively; < 0.001). Nevertheless the rates of seroprotection to HepB (antibody to hepatitis B surface antigen > or =10 mIU/ml) in Groups 1 and 2 were similar, 99 and 100%, respectively. Also the postvaccination geometric mean concentrations and rates of seroprotection or vaccine response to all of the other vaccine antigens evaluated were similar or greater in Group 1 than in Group 2. The rates of adverse events were similar between the two groups, with fussiness and soreness at any injection site reported most frequently. CONCLUSIONS: The DTPa-HepB combination vaccine was safe and immunogenic when given to infants at 2, 4 and 6 months of age. Equivalent rates of seroprotection to hepatitis B were achieved despite a reduction of the interval between the second and third doses from 5 months in Group 2 to 2 months in Group 1. Hepatitis B-containing combination vaccines should reduce the number of vaccine injections required in childhood and maintain excellent seroprotection against multiple pathogens.

We describe a new solution for recovering the long-wavelength features of a velocity model in gradient-based full-waveform inversion (FWI). The method uses reflected and transmitted wave modes to recover high-resolution velocity models. The new FWI gradient enables reliable velocity updates deeper than the maximum penetration depth of diving waves and reduces the FWI dependency on recording ultralong offsets. We also discuss a new FWI regularization scheme that overcomes the limitations of the inversion in the presence of high-contrast geobodies and cycle skipping. The solution utilizes a priori information about the earth model in the regularization as an extra term in the objective function. The implementation makes use of the split Bregman method, making it efficient and accurate. Results from applying the new FWI gradient to field data show that we can combine both transmitted and reflected energy in a global FWI scheme to obtain high-resolution velocity models without imprint of the reflectivity on the velocity updates. We illustrate the new regularization method's potential on the BP 2004 velocity benchmark model where our regularized FWI solution is capable of using a simple starting velocity model to deliver a high-quality reconstruction of salt bodies.

When lava flows and pyroclastic deposits exhibit sufficient porosity and permeability, extrusive igneous rocks have the potential to host large hydrocarbon accumulations. The porosity in these deposits can come from either vesicular porosity, or from secondary porosity that resulted from later fracturing and hydrothermal alteration. Recent studies (Feng, 2008) show that significant hydrocarbon reserves are contained in volcanic rocks in China which are primarily found in the Songliao, Bohai Bay, and Erlian basins. These hydrocarbon-rich reservoirs range from upper Jurassic to Tertiary in age.

BACKGROUND: The sensitivity, specificity and positive predictive value of baseline serum concentrations of HIV-1 immune complex-dissociated (ICD) p24 antigen for predicting disease progression and mortality were assessed and compared with results obtained for HIV-1 ICD p24 antigen with HIV-1 p24 antibody and for HIV-1 RNA with CD4+ lymphocyte percent. METHODS: Data from HIV-infected children enrolled in a North American clinical trial (National Institute of Child Health and Human Development Intravenous Immunoglobulin Clinical Trial) were analyzed. Disease progression was defined as growth failure, CD4+ lymphocyte percent decline to <15% after study entry or development of an AIDS-defining opportunistic infection. RESULTS: Baseline samples were available for ICD p24 antigen testing (median concentration, 319 pg/ml; range, <50 to 15,640) in 240 children. The combination of detectable ICD p24 antigen and low p24 antibody was more sensitive but less specific than the combination of high HIV-1 RNA and low CD4+ lymphocyte percent in predicting disease progression and mortality. Using receiver operating characteristic curves, the specificity of ICD p24 antigen with p24 antibody for classifying children's disease progression or mortality was as great as, or greater than, HIV-1 RNA with CD4+ lymphocyte percent at points on the curve corresponding to higher sensitivity. CONCLUSIONS: The use of ICD p24 antigen with p24 antibody to identify children at high risk of disease progression or mortality could be a viable alternative to the more expensive and technically difficult HIV-1 RNA and CD4+ lymphocyte assays in resource-poor settings, including developing countries where the majority of children with HIV-1 infection reside.

The time-frequency electromagnetic method (TFEM) has been developed and refined along with its applications in the last decade. BGP has contributed much to its development in areas of data acquisition, processing, and interpretation. For example, we have developed a super-powered transmitter, an on-site and in-house data processing and interpretation system, and a multiparameter inversion algorithm for induced polarization and resistivity (IPR). We have successfully applied TFEM in China and overseas for decades and obtained rewarding results. The method has two major functions: one is to evaluate the traps discovered by seismic data and the other is to determine optimal drilling locations. TFEM results can also serve as a key reference for seismic survey design. In this paper, we briefly review TFEM and present a set of examples.

ABSTRACT: Single-case experimental design is a family of experimental methods that can be used to examine the efficacy of interventions by testing a small number of patients or cases. This article provides an overview of single-case experimental design research for use in rehabilitation as another option along with traditional group-based research when studying rare cases and rehabilitation interventions of unknown efficacy. Basic concepts related to single-case experimental design and the characteristics of common subtypes ( N-of-1 randomized controlled trial, withdrawal design, multiple-baseline design, multiple-treatment design, changing criterion/intensity design, and alternating treatment design) are introduced. The advantages and disadvantages of each subtype are discussed along with challenges in data analysis and interpretation. Criteria and caveats for interpreting single-case experimental design results and their use in evidence-based practice decisions are discussed. Recommendations are provided for appraising single-case experimental design articles as well as using single-case experimental design principles to improve real-world clinical evaluation.

Abstract Intracellular ionized magnesium concentrations ([Mg2+]i) were measured in erythrocytes by 31P nuclear magnetic resonance (NMR) and zero-point titration in 14 controls and seven patients with renal magnesium loss. The mean intracellular ionized magnesium concentration in controls measured by 31P NMR was 0.20 (SD 0.03) mmol/L cell water, compared with 0.55 (SD 0.12) mmol/L cell water by zero-point titration. Total erythrocyte magnesium content measured with the lysate method was 0.63 mmol/L cell water higher than estimated by 31P NMR, probably because not all magnesium complexes are fully visible to the NMR technique. We found a positive correlation between plasma ultrafiltrable magnesium and [Mg2+]i irrespective of the [Mg2+]i assay used. [Mg2+]i measured with 31P NMR correlated modestly but significantly with [Mg2+]i determined by zero-point titration (r = 0.58, P less than 0.02). Washing erythrocytes before the zero-point titration decreased the ATP content and the cell water fraction, which led to overestimation of [Mg2+]i by zero-point titration. Although absolute values for [Mg2+]i differ with the assay used, both methods determined significantly lower values for [Mg2+]i in patients with isolated renal magnesium loss.

Rayleigh waves always coexist with reflection waves in land seismic exploration. Many previous works have shown the value of Rayleigh waves in obtaining near-surface shear velocity, however, few of them show successful applications from exploration geophysics. With an aim of practical application of Rayleigh waves in exploration data, we discuss how to obtain an accurate and high-resolution dispersion curve, the inversion algorithm, and the comparison of velocity estimated from Rayleigh-wave inversion with refraction interpretation and tomographic inversion. We first analyze the resolution difference of f-v spectra calculated through f-k, τ-p, and phase-shift approaches and propose a two-step spectrum normalization scheme for accurate picking of the dispersion curve. We then adopt the weighted damped least-squares method as the inversion algorithm and find through synthetic data that the estimated shear velocity based on the algorithm is quite accurate and the inversion algorithm is fast and robust. Finally, we select seismic data from one land exploration project in China as an example for test, and find the inverted velocity from Rayleigh-wave dispersion has a good correlation with refraction interpretation and tomographic inversion.

) was prepared and characterized by various spectroscopic techniques. A deconvolution procedure was applied to the spectroscopic data to deconstruct the overlapped bands. A density functional theoretical approach was applied to get insights into the electronic structure of the ruthenium coordination site and the functional RI-PBE-D3/Def2TZVP basis set was used for the optimization. Relativistic effects were considered using the zero-order regular approximation (ZORA). The anchoring process, evinced for each step of the synthesis of the hybrid material, was tracked by FT-IR analyses. The transitions observed in the FT-IR spectra were verified by DFT analyses, which agree with the experimental data. In the DRS-UV-Vis spectra, three main bands were detected by the deconvolution procedure that correspond to the charge transfer transitions, with the main contributions from ruthenium-chlorine and imine-pyridine fragments. TD-DFT results reveal that ruthenium-chlorine antibonding orbitals act as main charge donors, while pyridine-imine is the main charge acceptor.

&lt;div class="page" title="Page 1"&gt;&lt;div class="layoutArea"&gt;&lt;div class="column"&gt;&lt;p&gt;A despeito da integralidade do cuidado em saúde, a dimensão da religiosidade/espiritualidade (R/E) pouco aparece na arena do debate, permanecendo à margem da reflexão acadêmica e da prática do serviço. O objetivo desse estudo quantitativo foi verificar o modo como a dimensão da R/E é vista e encaminhada na prática dos profissionais da área da saúde. A pesquisa foi realizada com 174profissionais/trabalhadores da saúde de variadas instituições públicas do Rio Grande do Sul. Os participantes responderam a um questionário com 35 questões em que constavam dados sociodemográficos e questões fechadas sobre a prática da R/E desses profissionais. O público foi de 143 mulheres e 31 homens, com idades entre 19 e 63 anos (média de 41,02 e DP de 10,79), de diferentes profissões da saúde. Sobre a afiliação religiosa, as respostas mais frequentes foram: espírita (21%), católico não praticante (18,2%), sem religião mas acredita em Deus (14,2%), afro-brasileiras (11,9%) e católico praticante (10,8%). Os dados apontam para a necessidade de estes profissionais estarem mais bem capacitados para lidar com a demanda religiosa/espiritual dos pacientes, para ausência desse tema na sua formação técnico-profissional e para a falta de espaços e estruturas institucionais que acolham essas demandas do usuário do sistema de saúde.&lt;/p&gt;&lt;/div&gt;&lt;/div&gt;&lt;div class="layoutArea"&gt;&lt;div class="column"&gt;&lt;p&gt;&lt;span&gt;P&lt;/span&gt;&lt;span&gt;ALAVRAS&lt;/span&gt;&lt;span&gt;-&lt;/span&gt;&lt;span&gt;CHAVE&lt;/span&gt;&lt;span&gt;: &lt;/span&gt;&lt;span&gt;Religiosidade/Espiritualidade. Profissionais/Trabalhadores da saúde. Formação profissional. &lt;/span&gt;&lt;/p&gt;&lt;p&gt;&lt;span&gt;A&lt;/span&gt;&lt;span&gt;BSTRACT &lt;/span&gt;&lt;/p&gt;&lt;p&gt;&lt;span&gt;Despite the integrality of health care, the dimension of religiosity /spirituality (R/ E) remains on the margins of academic reflection and service practice. The aim of this quantitative study was to investigate how the dimension of R/E is perceived and sent in the practice of health professionals. The survey was conducted with 174 health professionals from various public institutions of Rio Grande do Sul. The participants answered a survey with 35 questions that included socio-demographic data and closed questions about the practice of R/E of these &lt;/span&gt;professionals. The sampling was 143 women and 31 men, between the ages of 19 and 63 years (mean 41.02, SD10.79), of different health occupations. Regarding religious affiliation, the most frequent responses were: Spiritualist (21%), Lapsed Catholic (18.2%), no religion but believes in God (14.2%), Afro-Brazilian (11.9%) and Practicing Catholic (10.8%). The data point to the need for these professionals to be better able to deal with the R/E needs of patients, because of the lack of the presentation of this issue in technical and professional training and the lack of space and institutional structures which accommodate user demands for this aspect of the health system.&lt;/p&gt;&lt;div class="page" title="Page 2"&gt;&lt;div class="layoutArea"&gt;&lt;div class="column"&gt;&lt;p&gt;&lt;span&gt;K&lt;/span&gt;&lt;span&gt;EYWORDS&lt;/span&gt;&lt;span&gt;: &lt;/span&gt;&lt;span&gt;Religiosity/Spirituality. Health professionals. Professional education. &lt;/span&gt;&lt;/p&gt;&lt;/div&gt;&lt;/div&gt;&lt;/div&gt;&lt;/div&gt;&lt;/div&gt;&lt;/div&gt;

Spasmodic torticollis due to an identified focal brain stem lesion is uncommon and abrupt-onset spasmodic torticollis due to midbrain lesions in humans is rarely reported. A 9-year-old female child who had fallen off a bicycle and had lost consciousness for 10 min, vomiting 2-3 times, developed acute torticollis immediately after the injury. Examinations suggested hemorrhage in brain stem cavernoma. A search of the literature written in English revealed that this type of presentation has not been reported previously.

Near-surface statics are corrections for traveltime variations caused by the extremely strong lateral variation of the seismic velocity field near the surface of the Earth. The statics act like a smear on a glass window, distorting the seismic image of deeper structures. Correction for near-surface statics is among the major challenges for onshore and near-shore seismic processing. One promising remedy is tomostatics, which determines the near-surface static contribution to reflection seismic data based on velocity models derived from traveltime tomography.

The purpose of the article is to present the effects of work on developing a method for determining environmental channel flows that could be implemented as a tool for assessing the degree of possible use of water resources by humans without compromising the functioning of the broadly understood environment. Such a method is considered as an alternative to methods of minimum acceptable flow used so far in Poland, including for example the Kostrzewa method.

Abstract A new polymer, previously evaluated in the laboratory, has been successfully tested to shut off water production in two offshore high temperature gravel packed wells in the Gulf Coast. The polymer is shear resistant, thus easy to handle, and, since it maintains good permeability to oil in the zones into which it is injected, it does not require zone isolation during injection into the well. After treatment, a strong reduction in WOR was observed in both wells. The effect lasted over 2 years in one well and for several months in the second well. These treatments show that the polymer is stable in field applications at 190 and 200 °F (88 and 93 °C).