Anomalous Findings Research Articles

Nanopore Measurements of Filamentous Viruses Reveal a Sub-nanometer-Scale Stagnant Fluid Layer.

We report measurements and analyses of nanopore translocations by fd and M13, two related strains of filamentous virus that are identical except for their charge densities. The standard continuum theory of electrokinetics greatly overestimates the translocation speed and the conductance associated with counterions for both viruses. Furthermore, fd and M13 behave differently from one another, even translocating in opposite directions under certain conditions. This cannot be explained by Manning-condensed counterions or a number of other proposed models. Instead, we argue that these anomalous findings are consequences of the breakdown of the validity of continuum hydrodynamics at the scale of a few molecular layers. Next to a polyelectrolyte, there exists an extra-viscous, sub-nanometer-thin boundary layer that has a giant influence on the transport characteristics. We show that a stagnant boundary layer captures the essential hydrodynamics and extends the validity of the electrokinetic theory beyond the continuum limit. A stagnant layer with a thickness of about half a nanometer consistently improves predictions of the ionic current change induced by virus translocations and of the translocation velocity for both fd and M13 over a wide range of nanopore dimensions and salt concentrations.

Real-time Ultrasound Assessment of Astronaut Spinal Anatomy and Disorders on the International Space Station.

Back pain is one of the most common conditions of astronauts during spaceflight and is hypothesized to be attributed to pathologic anatomic changes. Ultrasound (US) represents the only available imaging modality on the International Space Station, but a formal US protocol for imaging the structures of the spinal column does not exist. This investigation developed a method of acquiring diagnostic-quality images of the anterior lumbar and cervical regions of the spine during long-duration spaceflight. Comprehensive spinal US examinations were conducted on 7 long-duration spaceflight astronauts before flight, in flight, and after flight and compared to preflight and postflight magnetic resonance imaging data. In-flight scans were conducted after just-in-time training assisted by remote expert tele-US guidance. Novice users were able to obtain diagnostic-quality spinal images with a 92.5% success rate. Thirty-three anomalous or pathologic findings were identified during the preflight US analysis, and at least 14 new findings or progressions were identified during the postflight US analysis. Common findings included disk desiccation, osteophytes, and qualitative changes in the intervertebral disk height and angle. Ultrasound has proven efficacy as a portable and versatile diagnostic imaging modality under austere conditions. We demonstrated a potential role for US to evaluate spinal integrity and alterations in the extreme environment of space on the International Space Station. Further investigations should be performed to corroborate this imaging technique and to create a larger database related to in-flight spinal conditions during long-duration spaceflight.

Development of standardized image interpretation for 68Ga-PSMA PET/CT to detect prostate cancer recurrent lesions.

After primary treatment, biochemical relapse (BCR) occurs in a substantial number of patients with prostate cancer (PCa). PET/CT imaging with prostate-specific membrane antigen based tracers (68Ga-PSMA) has shown promising results for BCR patients. However, a standardized image interpretation methodology has yet to be properly agreed. The aim of this study, which was promoted and funded by European Association of Nuclear Medicine (EANM), is to define standardized image interpretation criteria for 68Ga-PSMA PET/CT to detect recurrent PCa lesions in patients treated with primary curative intent therapy (radical prostatectomy or radiotherapy) who presented a biochemical recurrence. In the first phase inter-rater agreement between seven readers from seven international centers was calculated on the reading of 68Ga-PSMA PET/CT images of 49 patients with BCR. Each reader evaluated findings in five different sites of recurrence (local, loco-regional lymph nodes, distant lymph nodes, bone, and other). In the second phase the re-analysis was limited to cases with poor, slight, fair, or moderate agreement [Krippendorff's (K) alpha<0.61]. Finally, on the basis of the consensus readings, we sought to define a list of revised consensus criteria for 68Ga-PSMA PET/CT interpretation. Between-reader agreement for the presence of anomalous findings in any of the five sites was only moderate (K's alpha: 0.47). The agreement improved and became substantial when readers had to judge whether the anomalous findings were suggestive for a pathologic, uncertain, or non-pathologic image (K's alpha: 0.64). K's alpha calculations for each of the five sites of recurrence were also performed and evaluated. First Delphi round was thus conducted. A more detailed definition of the criteria was proposed by the project coordinator, which was then discussed and finally agreed by the seven readers. After the second Delphi round only four cases of disagreement still remained. These were evaluated for a final round, allowing a final agreement table to be written. We hope that by developing these consensus guidelines on the interpretation of 68Ga-PSMA PET/CT, clinicians reporting these studies will be able to provide more consistent clinical reports and that within clinical trials, abnormality classifications will be harmonized, allowing more robust assessment of its diagnostic performance.

Can Social Norm Activation Improve Audit Quality? Evidence from an Experimental Audit Market

We assert that audit quality can be improved to the extent that social norms for honesty and responsibility are activated in the auditor. To test this assertion, we use an experimental audit market setting found in the literature and manipulate factors expected to activate honesty and responsibility norms in the auditor. We find that auditor misreporting is reduced when the investor is another participant in the experiment rather than computer simulated, and thus, the interests of third-party investors are salient to the auditor. We also find that auditor misreporting is reduced when the auditor is required to sign-off on the audit report, but only when the investor is another participant in the experiment. Consistent with our underlying theory, we find that pre-experimental measures of sensitivity to honesty and responsibility norms help explain the effects of our manipulated variables. Finally, we find that these measures of social norm sensitivity are associated with the moral judgment that auditor misreporting is unethical. Our study helps explain previous anomalous findings in the literature and answers the call in Blay et al. (J Bus Ethics 2017. doi: 10.1007/s10551-016-3286-4 ) for empirical researchers to use social norm theory to develop stronger tests of moral reasoning in the market for auditing services.

Environmental injustice and flood risk: A conceptual model and case comparison of metropolitan Miami and Houston, USA.

This article outlines a conceptual model and comparatively applies it to results from environmental justice (EJ) studies of flood risk in the Miami, Florida, and Houston, Texas, metropolitan areas. In contrast to most EJ studies of air pollution, which have found that socially-vulnerable groups experience disproportionate risk, distributive EJ studies of flooding reveal inconsistent findings regarding the relationship between social vulnerability and flood exposure. Counterintuitively (from a conventional EJ perspective), some pre-flood EJ studies have found that socially-advantaged people experience the highest residential exposure to flood risks. To integrate those anomalous findings within an EJ perspective, our conceptual model focuses on (1) the differential capacities of social groups to deploy/access protective resources for reducing the threat of loss, even while they reside amid flood-prone environments, and (2) both flood hazards and water-based benefits. Application of this model in Miami reveals that environmental injustices materialize as socially-privileged groups expose themselves to residential flood risks by seeking coastal amenities, as the costs of mitigating risks are conveyed to the broader public; in the process, socially-vulnerable residents are relegated to areas with air pollution and/or inland flood risks, where they experience constrained access to protective resources and coastal amenities. Findings from Houston better align with conventional EJ expectations-with flood zones disproportionately inhabited by socially-vulnerable people-because many coastal lands there are used by petrochemical industries, which produce major residential-environmental disamenities. Results underscore the need to consider protective resources and locational benefits in future empirical research on the EJ implications of flood hazards.

It’s not just about ‘more’: A research project exploring satisfaction with opportunities to play, for children in two Welsh neighbouring communities

ABSTRACTThis paper discusses a research project undertaken during spring 2014, in response to the findings of the Play Sufficiency Assessment in one Welsh Local Authority. The results highlighted anomalous findings between two neighbouring communities regarding the children’s self-reported levels of satisfaction with opportunities to play. The research study aimed to identify factors which may have caused the disparity in satisfaction between the two communities. The findings of the research indicate that simply having more places to play is not automatically an indicator of satisfaction. Factors such as child and parental fear, socio-economic conditions and the development of a ‘play culture’ within communities have a more significant role in influencing children’s freedom and opportunities to play.

An overview of the results of hysterosonography prior to in vitro fertilization.

ObjectiveThis study aimed to analyze the results of hysterosonography performed prior to in vitro fertilization (IVF) and to correlate anomalous findings with hysteroscopy.MethodsFindings from 197 hysterosonograms of patients examined in an assisted reproduction clinic between January 2012 and August 2014 were included. Enrollment criteria: patients in preparation for IVF not recently submitted to uterine examination through hysterosalpingography or hysteroscopy referred to hysterosonography. Uterine cavity evaluation was considered anomalous when one or more of the following were found: polyps, submucous myomas, uterine synechiae, Müllerian duct anomalies. Individuals with cavity abnormalities that might interfere with IVF results were referred to hysteroscopy.ResultsNormal test results were seen in 170/197 of the cases (86.3%). Eighteen of the 197 cases (9.1%) were suspected for polyps, two (1%) for submucous myoma, six (3.5%) for synechiae, and one (0.5%) for Müllerian duct anomalies. Sixteen of the patients diagnosed with abnormalities underwent hysteroscopy to confirm or treat the suspected pathology. In only two cases there was no agreement between tests: one patient suspected for synechiae and another for polyps were not confirmed; another individual suspected for polyps was found to have focal endometrial thickening in hysteroscopy. The positive predictive value (PPV) in our study was 93.7%.ConclusionIn most cases, the diagnoses obtained by hysterosonography showed normal uterine cavities. The most common anomalous findings were polyps, followed by synechiae, submucous myoma, and Müllerian duct anomalies. Hysterosonography is a good option for evaluating the uterus and offers a high positive predictive value, while hysteroscopy stands as the gold standard.

Fabrication and Characterization of Lithium-Silicon Thick-Film Electrodes for High-Energy-Density Batteries

We have developed a method to operate lithium-silicon (Li-Si) thick-film electrodes in a manner consistent with traction applications. Key to the operating strategy is the voltage control of the electrode. It is expected that strong reducing environments, created by operating the electrode at low potentials (near that of Li), reduce battery life. We show that operating Li-Si at higher potentials is also damaging, and this is counterintuitive in that common negative electrodes (e.g., graphites and titanates) do not suffer from this limitation. Arguments based on measured Coulombic efficiencies, cycle life tests, in-situ stress measurements, and high-resolution microscopy resolve the otherwise anomalous findings. We show that promising half-cell (cells constructed with a lithium counter electrode) cycling data are reflected in full cells that employ a 622-NMC positive electrode (Ni0.6Mn0.2Co0.2O2). Last, a modified hysteresis model, based in part on our earlier approach to treat NiMH (nickel metal hydride) cells, is shown to represent well the constant-current cycling data, and open questions associated with needed improvements in modeling Li-Si hysteresis and related low-current phenomena are highlighted.

Design and analysis choices for safety surveillance evaluations need to be tuned to the specifics of the hypothesized drug-outcome association.

We reviewed the results of the Observational Medical Outcomes Research Partnership (OMOP) 2010 Experiment in hopes of finding examples where apparently well-designed drug studies repeatedly produce anomalous findings. OMOP had applied thousands of designs and design parameters to 53 drug-outcome pairs across 10 electronic data resources. Our intent was to use this repository to elucidate some sources of error in observational studies. From the 2010 OMOP Experiment, we sought drug-outcome-method combinations (DOMCs) that met consensus design criteria, yet repeatedly produced results contrary to expectation. We set aside DOMCs for which we could not agree on the suitability of the designs, then selected for an in-depth scrutiny one drug-outcome pair analyzed by a seemingly plausible methodological approach, whose results consistently disagreed with the a priori expectation. The OMOP "all-by-all" assessment of possible DOMCs yielded many combinations that would not be chosen by researchers as actual study options. Among those that passed a first level of scrutiny, two of seven drug-outcome pairs for which there were plausible research designs had anomalous results. The use of benzodiazepines was unexpectedly associated with acute renal failure and upper gastrointestinal bleeding. We chose the latter as an example for in-depth study. The factitious appearance of a bleeding risk may have been partly driven by an excess of procedures on the first day of treatment. A risk window definition that excluded the first day largely removed the spurious association. One cause of reproducible "error" may be repeated failure to tie design choices closely enough to the research question at hand. Copyright © 2016 John Wiley & Sons, Ltd.

National survey of risk factors for non-communicable disease in Vietnam: prevalence estimates and an assessment of their validity.

BackgroundTo estimate the prevalence of non-communicable disease (NCD) risk factors at a provincial level in Vietnam, and to assess whether the summary estimates allow reliable inferences to be drawn regarding regional differences in risk factors and associations between them.MethodsParticipants (n = 14706, 53.5 % females) aged 25–64 years were selected by multi-stage stratified cluster sampling from eight provinces each representing one of the eight geographical regions of Vietnam. Measurements were made using the World Health Organization STEPS protocols. Data were analysed using complex survey methods.ResultsDifferences by sex in mean years of schooling (males 8.26 ± 0.20, females 7.00 ± 0.18), proportions of current smokers (males 57.70 %, females 1.73 %), and binge-drinkers (males 25.11 %, females 0.63 %), and regional differences in diet, reflected the geographical and socio-cultural characteristics of the country. Provinces with a higher proportion of urban population had greater mean levels of BMI (r = 0.82), and lesser proportions of active people (r = −0.89). The associations between the summary estimates were generally plausible (e.g. physical activity and BMI, r = −0.80) but overstated, and with some anomalous findings due to characterisation of smoking and hypertension by STEPS protocols.ConclusionsThis report provides an extensive description of the sex-specific and regional distribution of NCD risk factors in Vietnam and an account of some health-related consequences of industrialisation in its early stages. The STEPS protocols can be utilized to provide aggregate data for valid between-population comparisons, but with important caveats identified.

An updated re-analysis of the mortality risk from nasopharyngeal cancer in the National Cancer Institute formaldehyde worker cohort study.

BackgroundTo determine whether the National Cancer Institute’s (NCI) suggestion of a persistent increased mortality risk for nasopharyngeal cancer (NPC) in relation to formaldehyde (FA) exposure is robust with respect to alternative methods of data analysis.MethodsNCI provided the cohort data updated through 2004. We computed U.S. and local county rate-based standardized mortality ratios (SMRs) and internal cohort rate-based relative risks (RR) in relation to four formaldehyde exposure metrics (highest peak, average intensity, cumulative, and duration of exposure), using both NCI categories and alternative categorizations. We modeled the plant group-related interaction structure using continuous and categorical forms of each FA exposure metric and evaluated the impact of NCI’s decision to exclude non-exposed workers from the baseline category.ResultsOverall, our results corroborate the findings of our earlier reanalyses of data from the 1994 NCI cohort update. Six of 11 NPC deaths observed in the NCI study occurred in Plant 1, two (including the only additional NPC death) occurred in Plant 3 among workers in the lowest exposure category of highest peak, average intensity and cumulative FA exposure and in the second exposure category of duration of exposure, and the remaining cases occurred individually in three of eight remaining plants. A large, statistically significant, local rate-based NPC SMR of 7.34 (95 % CI = 2.69–15.97) among FA-exposed workers in Plant 1 contrasted with an 18 % deficit in NPC deaths (SMR = 0.82, 95 % CI = .17–2.41) among exposed workers in Plants 2–10. Overall, the new NCI findings led to: (1) reduced SMRs and RRs in the remaining nine study plants in unaffected exposure categories, (2) attenuated exposure-response relations for FA and NPC for all the FA metrics considered and (3) strengthened and expanded evidence that the earlier NCI internal analyses were non-robust and mis-specified as they did not account for a statistically significant interaction structure between plant group (Plant 1 vs. Plants 2–10) and FA exposure.ConclusionsOur updated reanalysis provided little or no evidence to support NCI’s suggestion of a persistent association between FA exposure and mortality from NPC. NCI’s suggestion continues to be driven heavily by anomalous findings in one study plant (Plant 1).Electronic supplementary materialThe online version of this article (doi:10.1186/s12995-016-0097-6) contains supplementary material, which is available to authorized users.

A frameshift mutation in ARMC3 is associated with a tail stump sperm defect in Swedish Red (Bos taurus) cattle.

BackgroundArtificial insemination is widely used in many cattle breeding programs. Semen samples of breeding bulls are collected and closely examined immediately after collection at artificial insemination centers. Only ejaculates without anomalous findings are retained for artificial insemination. Although morphological aberrations of the spermatozoa are a frequent reason for discarding ejaculates, the genetic determinants underlying poor semen quality are scarcely understood.ResultsA tail stump sperm defect was observed in three bulls of the Swedish Red cattle breed. The spermatozoa of affected bulls were immotile because of severely disorganized tails indicating disturbed spermatogenesis. We genotyped three affected bulls and 18 unaffected male half-sibs at 46,035 SNPs and performed homozygosity mapping to map the fertility disorder to an 8.42 Mb interval on bovine chromosome 13. The analysis of whole-genome re-sequencing data of an affected bull and 300 unaffected animals from eleven cattle breeds other than Swedish Red revealed a 1 bp deletion (Chr13: 24,301,425 bp, ss1815612719) in the eleventh exon of the armadillo repeat containing 3-encoding gene (ARMC3) that was compatible with the supposed recessive mode of inheritance. The deletion is expected to alter the reading frame and to induce premature translation termination (p.A451fs26). The mutated protein is shortened by 401 amino acids (46 %) and lacks domains that are likely essential for normal protein function.ConclusionsWe report the phenotypic and genetic characterization of a sterilizing tail stump sperm defect in the Swedish Red cattle breed. Exploiting high-density genotypes and massive re-sequencing data enabled us to identify the most likely causal mutation for the fertility disorder in bovine ARMC3. Our results provide the basis for monitoring the mutated variant in the Swedish Red cattle population and for the early identification of infertile animals.Electronic supplementary materialThe online version of this article (doi:10.1186/s12863-016-0356-7) contains supplementary material, which is available to authorized users.

Learning strategy refinement reverses early sensory cortical map expansion but not behavior: Support for a theory of directed cortical substrates of learning and memory

Primary sensory cortical fields develop highly specific associative representational plasticity, notably enlarged area of representation of reinforced signal stimuli within their topographic maps. However, overtraining subjects after they have solved an instrumental task can reduce or eliminate the expansion while the successful behavior remains. As the development of this plasticity depends on the learning strategy used to solve a task, we asked whether the loss of expansion is due to the strategy used during overtraining. Adult male rats were trained in a three-tone auditory discrimination task to bar-press to the CS+ for water reward and refrain from doing so during the CS− tones and silent intertrial intervals; errors were punished by a flashing light and time-out penalty. Groups acquired this task to a criterion within seven training sessions by relying on a strategy that was “bar-press from tone-onset-to-error signal” (“TOTE”). Three groups then received different levels of overtraining: Group ST, none; Group RT, one week; Group OT, three weeks. Post-training mapping of their primary auditory fields (A1) showed that Groups ST and RT had developed significantly expanded representational areas, specifically restricted to the frequency band of the CS+ tone. In contrast, the A1 of Group OT was no different from naïve controls. Analysis of learning strategy revealed this group had shifted strategy to a refinement of TOTE in which they self-terminated bar-presses before making an error (“iTOTE”). Across all animals, the greater the use of iTOTE, the smaller was the representation of the CS+ in A1. Thus, the loss of cortical expansion is attributable to a shift or refinement in strategy. This reversal of expansion was considered in light of a novel theoretical framework (CONCERTO) highlighting four basic principles of brain function that resolve anomalous findings and explaining why even a minor change in strategy would involve concomitant shifts of involved brain sites, including reversal of cortical expansion.

Familial Exudative Vitreoretinopathy: Spectral-Domain Optical Coherence Tomography of the Vitreoretinal Interface, Retina, and Choroid

The in vivo microstructural features of familial exudative vitreoretinopathy (FEVR) have not been well described. We present new anatomic features of FEVR with functional and genetic correlations. Consecutive, retrospective, observational case series. Patients with FEVR treated from 2009 to 2014. We identified 346 patients with FEVR. Those imaged with spectral-domain optical coherence tomography (SD OCT) with or without enhanced depth imaging (EDI) were included, and images were correlated with best-corrected visual acuity (BCVA), widefield angiography, fundus autofluorescence (AF), and wnt signaling pathway mutations. Exploratory SD OCT findings and BCVA. A total of 225 imaging sessions were acquired in 74 eyes from 41 patients. Mean age was 19.0 years. Sixty-seven eyes (91%) had interpretable images, of which 50 (75%) had anomalous microstructural findings; all eyes with FEVR severity of stage 2 or greater had abnormalities. A broad spectrum of features were identified: various forms of posterior hyaloidal organization, vitreomacular traction (VMT), vitreopapillary traction, vitreo-fold traction, vitreo-laser scar adhesion, diminished foveal contour, persistent fetal foveal architecture, cystoid macular edema (CME), intraretinal exudates and subretinal lipid aggregation, dry or edematous radial folds, and disruption of the ellipsoid zone. Mean foveal, central macular, and choroidal thicknesses were 305±145 μm, 337±160 μm, and 216±64 μm, respectively. In stages 1 to 2, greater foveal and central macular thicknesses (Rho=0.493, 0.544, respectively; both P<0.001) correlated with poorer BCVA, but not choroidal thickness (Rho=0.032; P=0.868). Posterior hyaloidal organization (P<0.001), VMT (P<0.001), CME (P<0.001), exudation (P<0.001), and disruption of the ellipsoid zone (P<0.001) were associated with poorer BCVA. Disruption of the ellipsoid zone (β=0.699; P<0.001) and posterior hyaloidal organization (β=0.289; P=0.011) retained significance in multivariate modeling (R2=0.627; P<0.001). Spectral-domain OCT detected all cases of angiographic edema and areas of outer retinal dysfunction that were hypoautofluorescent on AF. Microstructural-genetic associations were not identified. Spectral-domain OCT imaging identified microstructural anomalies in the majority of patients with FEVR.

Abstract 80: Correlation of N-terminal pro-BNP Release with Myocardial Involvement in Acute Kawasaki Disease

N-terminal pro-BNP (NT-proBNP) is elevated at the onset of Kawasaki Disease (KD). This is based on the hypothesis of immune myocardial inflammation. We sought to study the relationship between NT-proBNP and cardiac function in KD. Parameters of myocardial involvement determined by ECG (PR and QTc intervals, QT dispersion, R-T axis) and by echocardiogram (systole and diastole) were correlated with levels of NT-proBNP in the acute (1 week), sub-acute (2-3 months) and chronic (6 months to 1 year) phases of KD. KD patients were compared to a febrile group. KD patients were further subdivided into 2 groups according to the levels of NT-proBNP; normal NT-proBNP (NT-proBNP Z-score &lt; 2), or elevated NT-proBNP (Z-score ≥ 2). There were 56 subjects (14 controls, 19 KD-1 and 23 KD-2 patients), with similar age at assessment (3.8±4.3 vs. 3.3±2.3 years-old, p=0.609). Myocardial contractility was significantly lower in KD patients in the acute phase with an ejection fraction of 57.4±7.5% compared to CTL 61.9±6.5%; p=0.049). Myocardial dysfunction was more significant in KD with high NT-proBNP compared to those with normal NT-proBNP, (shortening fraction Z-score of-1.6±1.5 versus -0.5±1.5; p=0.025) QTc interval was longer in KD compared to febrile CTL (412.3±21.0 mS vs. 390.6±14.6 mS, respectively; p=0.009). In contrast, there were no significant differences for left ventricular mass index (p=0.935) or LV end-diastolic diameter (p=0.565). Likewise, there were no significant differences for the PR interval (p=0.344), QT dispersion (p=0.288) or R-T axis (p=0.577). Otherwise, there was a significant correlation between coronary artery involvement (CA z-score ≥ 2.5) and the likelihood of lower LV ejection fraction (p=0.049) and higher NT-proBNP z-score (p=0.043), but no correlation with normalized LV shortening fraction (p=0.16) or QTc (p=0.14). The anomalous findings disappear in the sub-acute phase. On the other hand, a lengthening of QTc interval in the acute phase, irrespective of NT-proBNP status, resolves after 2-3 months. In acute KD, there is a reduction in myocardial function, to a higher extent in cases with elevated NT-proBNP. This correlates with coronary artery involvement. KD patients with elevated NT-proBNP z-score may warrant careful follow-up.

Surgical findings &amp; audiological outcomes of Stapedotomy in patients with Otosclerosis

Objective: This study was focused on the assessment of patient’s improvement in hearing, as measured by pure tone audiometry after stapedotomy for primary otosclerosis. Materials and Methods: This prospective clinical study was performed in a total of 50 patients diagnosed with Primary Otosclerosis, who underwent Stapedotomy at the Department of ENT &amp; Head-Neck Surgery, Combined Military Hospital, Dhaka between June 2012 to January 2014. All patients were evaluated as per the candidacy criteria for stapedotomy and selected patients underwent surgery during the study period and were followed up for a period of 12 months in the Otology clinic. Pre-operative and Post-operative audiometric evaluation was done using conventional pure tone audiometry with standard calibrations. Post-operative audiometry was performed at 03 month, 06 months and 12 months. The bone-conduction &amp; air conduction thresholds and the Air- Bone gap (ABG), were documented and analysed at 0.5 KHz, 1 KHz, 2 KHz and 4 KHz frequencies respectively. The subjective outcomes in hearing were also recorded with a patient satisfaction questionnaire to assess improvement in quality of hearing after stapedotomy. Results: Overall, the frequency specific pre-operative mean averaged Air Conduction thresholds were 63.3dB at 500Hz, 57.5dB at 1 KHz, 55.1dB at 2 KHz and 45.7dB at 4 KHz. The frequency specific post-operative mean averaged Air conduction thresolds were 34.6 dB at 500Hz, 28.9 dB at 1Kz, 30.5dB at 2Kz and 33.3dB at 4Kz.The frequency specific mean average post operative Air Bone Gap (ABG) closure was achieved by 28.7dB at 500Hz, 27.6 dB at 1KHz, 24.6 dB at 2KHz and 12.4 dB at 4KHz by the time of completion of the study at 01 year. A successful closure of AB gap to less than 10dB was achieved in the speech frequencies of 2 KHz and 4 KHz in 84% of cases. Overall, the frequency specific bone-conduction thresholds were unchanged postoperatively in all cases except one, showing that no significant sensori-neural impairment had occured due to the stapedotomy procedure. 1 patient developed post-op severe vertigo which was self-limiting after six weeks. A few interesting cases with anomalous intra-operative findings were also documented and reported herewith. These included monopodal stapes (n=1), anomolous facial nerve (n=1), laterally placed chorda tympani nerve (n=1), high jugular bulb, Malleus ankylosis (n=1) and persistent stapedial artery (n=1). All patients included in our study had significant subjective audiological improvement and responded satisfactorily to the questionnaire formulated to assess their hearing quality after stapedotomy. Conclusions: Our case study confirms that stapedotomy is a safe and successful procedure providing long-term hearing improvement in primary otosclerosis. Obliterative otosclerosis, biscuit or floating footplate, monopodal stapes, anomalous facial nerve and persistent stapedial artery may be special scenarios encountered during stapedotomy and they need judicious management by an experienced surgeon. Our study shows that meticulous selection of cases for stapedotomy will result in highly successful audiological outcomes. DOI: http://dx.doi.org/10.3329/bjo.v20i2.22024 Bangladesh J Otorhinolaryngol; October 2014; 20(2): 87-92

The French Paradox: Implications for Variations in Global Convergence

Abstract A debate divides the cross-cultural community between advocates of global convergence and those foreseeing continued cultural divergence. Given competing evidence, we examine anomalous cultural findings of the ‘French Paradox’ to re-evaluate existing theory on convergence dynamics. By differentiating between the levels of analysis of micro individual values and macro societal practices, we question the regular processes of a top-down-bottom-up model of convergence. In addition, our analysis uncovers power structures interdependency ( PSI ) between the political and economic elites of a nation as a potential mediator explaining discrepant results.

English

Patent foramen ovale is rare in elderly, over the age of 60 years. It is most common form of atrial septal defect. It is experiencing increased clinical interest as a congenital cardiac lesion persisting into adulthood. Knowledge about PFO is very important for its association with various congenital & other valvular heart diseases. In the view of these considerations we are presenting a case report of a patent foramen ovale with length of 1.2 cm in an elderly male cadaver approximately 72 years of age. The person had a normal built up and appeared emaciated. With no other anomalous findings in the heart, it appears that the foramen ovale was probe patent. The present finding belongs to ostium secundum type of PFO. This study will focus on elderly patients with sizeable PFO who do not have other major associated cardiac defects. In the aged a well-defined clinical picture is often present, and may be seen with minimal impairment of cardiac function and no significant cardiac

A review of anomalous origination of a coronary artery from an opposite sinus of Valsalva (ACAOS) impact on major adverse cardiovascular events based on coronary computerized tomography angiography: a 6-year single center review.

Anomalous origination of a coronary artery from an opposite sinus of Valsalva (ACAOS) is a rare finding that is typically found on autopsy in a person with sudden cardiac death or during routine cardiovascular testing. The true prevalence is unknown for this reason. There is also question to the specific anatomy of the anomalies themselves and how best to correct them. We performed a retrospective chart review of all coronary computed tomography angiography (CCTA) studies to evaluate the incidence of all-cause mortality, nonfatal myocardial infarction, stroke and late revascularization (>90 days following CCTA) from January 2005 until July 2012. We describe the origin of the artery, its course, slit-like appearance and treatment in this population. We reviewed 1518 CCTA reports and identified 22 patients with ACAOS with an incidence of 1.4% of our original study population over a review period of 6 years with a resultant median follow-up period of 25 months [interquartile range (IQR)25,75 12-34 months]. The indication for CCTA was for chest pain in the majority of patients (73%). We had one patient undergo surgical repair and one with coronary bypass grafting for unrelated symptomatic coronary artery disease. ACAOS continues to be a rare but presumed fatal condition in subsets identified to carry high risk features. As the characteristics of the anomalous vessels that increase risk are still debated, over an intermediate to long follow up in a single large center, none of the different anomalous findings with varying degrees of high risk findings were associated with sudden death.

Understanding weekly cycles in suicide: an analysis of Austrian and Swiss data over 40 years.

Seasonal as well as weekly cycles in suicide have been described, replicated and poorly understood for a long time. In Western countries, suicides are typically least frequent on weekends and most frequent on Mondays and Tuesdays. To improve understanding of this phenomenon a strategy is required which focuses on anomalous findings beyond the regular patterns. Here, we focused on instances where the weekly suicide patterns disappear or are interrupted. We used data from Swiss and Austrian mortality statistics for the periods 1969-2010 and 1970-2010, respectively. First, the data were cross-tabulated by days of the week and the available socio-demographic information (sex, age, religious affiliation and region). Second, time series of cumulated daily frequencies of suicide were analysed by seasonal Autoregressive Integrated Moving Average (ARIMA) models which included intervention effects accounting for Easter and Pentecost (Whit) holidays. First, the cross tabulations showed that weekly cycles may be smoothed above all in young persons and smoothed in drowning, jumping and car gas exhaustion suicides. Second, the ARIMA analyses displayed occasional preventive effects for holidays Saturdays and Sundays, and more systematic effects for holiday Mondays. There were no after effects on Tuesdays following holiday Mondays. In general, the weekend dip and the Monday backlog effect in suicide show striking similarities to the Advent season effect and are interpretable within the same template. The turning points between low and high frequencies possibly provide promising frames for the timing of prevention activities.