Diligent Search Research Articles

Clinical Significance of the Large Fetal Vessel Lesions in Placental Fetal Vascular Malperfusion

Fetal vascular malperfusion (FVM) is an important pattern of placental injury. Although the significance of distal villous FVM (clusters of sclerotic and/or mineralized chorionic villi) is well documented, the clinical significance of proximal (large vessel) lesions of FVM is less clear, which is the aim of this retrospective analysis. To evaluate the clinical significance and placental associations of single and coexisting categories of lesions of large vessel FVM, 24 clinical and 44 placental phenotypes of 804 consecutive placentas with at least 1 lesion of proximal vessel FVM from the second half of pregnancy, divided according to the type or category of the individual FVM lesion (fetal vascular ectasia, fetal vascular thrombi, intramural fibrin deposition, and stem vessel obliteration): 689, 341, 286, and 267 placentas, respectively (first analysis) and single or coexisting large fetal vessel lesions (1, 2, 3, and 4 coexisting categories of lesions: 276, 321, 162, and 45 placentas, respectively) were statistically compared (analysis of variance, χ2, univariate analysis). Because of multiple comparisons, Bonferroni-corrected P < .001 was used as a threshold of statistical significance. In this population of high-risk pregnancies dominated by fetal congenital anomalies, single individual or 1 to 2 coexisting categories of lesions of the large vessel FVM, including fetal vascular thrombi, did not consistently correlate with clinical or placental variables and were not prognostically useful, but the coexistence of 3 or 4 lesions was associated with the most advanced gestational age, fetal congenital anomalies, distal villous FVM, particularly high-grade, chorangioma or chorangiomatosis, hypercoiled umbilical cord, perivascular stem edema, and marginate or vallate placenta. Therefore, the finding of multiple lesions of the large vessel FVM not only merits a diligent search for the distal villous lesions including the CD34 immunostaining, but also justifies putting the large vessel (global) FVM on the final placental diagnosis line, which in the case of up to only 2 lesions may not be justified.

Thrombotic Microangiopathy in Renal Transplant Recipients

Background and Aim: Thrombotic microangiopathy (TMA) is a disease of microvasculature, triggered by numerous immunological and nonimmunological factors. The aim of this study is to identify the incidence, etiology, and clinical characteristics of posttransplant TMA in renal allografts and its impact on graft outcome. Patients and Methods: In this retrospective study, the records of patients who underwent renal transplantation between January 2013 and December 2017 were reviewed, and those recipients who had allograft biopsy-proven TMA were analyzed. Based on the clinical characteristics and investigations, the recipients were divided into two groups: those with systemic features of TMA and those with allograft-limited TMA. The clinical course and graft outcome of both the groups were compared and analyzed. Results: The number of patients who underwent renal transplantation during the study period was 212. Out of them, 16 patients had biopsy-proven TMA. Five patients had TMA with systemic features and the remaining 11 patients had allograft-limited TMA. In this study, the incidence of TMA among postrenal transplant recipients was 7.5%. The most common cause for TMA was acute antibody-mediated rejection (ABMR), followed by TMA due to tacrolimus toxicity. In one patient, TMA was secondary to disseminated tuberculosis (TB). TB as a cause of TMA is rarely reported. One-year graft survival in patients with allograft-limited TMA was 72.7% when compared to 50% in patients with systemic TMA, but this difference was statistically insignificant (P = 0.2). The graft loss was high in patients with TMA secondary to ABMR in both the groups. Conclusion: One-year graft survival is better in patients with allograft-limited TMA. Diligent search for an etiology for TMA should be made in all patients with TMA, as the treatment differs between each category.

Differences in the perceived spheres of control of selected college students in the aftermath of the pandemic

A diligent search of published studies revealed that there is an apparent lack of scientific literature on Filipinos’ sense of control, specifically in relation to the COVID-19 pandemic. This study attempted to ascertain the respondents’ perceived level of control. 46 college students from a private school in Metro Manila volunteered as respondents. The Spheres of Control Scale13, which measures an individual’s sense of Personal, Interpersonal and Socio-political control was administered on the respondents. Based on the computed composite means of the respondents’ scores in the three domains, Personal control had the highest composite mean of 5.223, followed by Interpersonal control with 4.592 and lastly by Socio-political control with 4.334. Significant differences were found between Personal and Interpersonal control as well as between Personal and Socio-political control. The respondents’ perceived sense of Personal control was significantly higher than their perceived sense of Interpersonal control and their perceived sense of Socio-political control. These results could imply that for the respondents of this study, their perceived sense of Interpersonal control and Socio-political control may have been adversely affected by the uncertainties that they had experienced during the COVID-19 pandemic.

A comprehensive meta-analysis of risk factors associated with osteosarcopenic obesity: a closer look at gender, lifestyle and comorbidities.

Osteosarcopenic obesity (OSO) represents a confluence of osteopenia/osteoporosis, sarcopenia, and obesity, contributing to increased morbidity and mortality risks. Despite escalating prevalence, its risk factors remain under-explored, necessitating this comprehensive systematic review and meta-analysis. A diligent search of PubMed, Scopus, and Cochrane databases was conducted for pertinent studies until June 2023. The random-effects model was employed to compute pooled odds ratios (ORs) and 95% confidence intervals (CIs), scrutinizing various risk factors like age, gender, lifestyle factors, and common comorbidities. Our meta-analysis incorporated 21 studies comprising 178,546 participants. We identified significant associations between OSO and factors such as female gender (OR 1.756, 95% CI 1.081 to 2.858), physical inactivity (OR 1.562, 95% CI 1.127-2.165), and hypertension (OR 1.482, 95% CI 1.207-1.821). Conversely, smoking (OR 0.854, 95% CI 0.672-1.084), alcohol consumption (OR 0.703, 95% CI 0.372-1.328), and dyslipidemia (OR 1.345, 95% CI 0.982-1.841) showed no significant associations. Remarkable heterogeneity was observed across studies, indicating considerable variation in effect sizes. Notably, OSO was strongly associated with frailty (OR 6.091; 95% CI 3.576-10.375). Our study underscored the substantial role of female gender, physical inactivity, and hypertension in the development of OSO, whilst suggesting a strong link between OSO and frailty. These findings emphasize the importance of early risk factor identification and targeted interventions in these groups. Further research is warranted to decode the complex pathophysiological interplay and devise effective prevention and management strategies.

Orphan works

Digitization, dissemination or publication of works or other objects protected by copyright or related copyright rights, in the conditions where the copyright holders are not identified or in the second situation when the holder, although identified, is not located represents a new institution by defining it as the institution of "orphan works". In the research we are undertaking, we intend to identify the status of "orphan work", which works have the status of "orphan work" and which category of works cannot acquire the status of "orphan work". In all situations, appropriate research activities are required to conduct a diligent search in good faith to verify the status of the work in question and to verify under what conditions a particular work has been declared an orphan work.

Abandoned But Not Forgotten

Under Canadian copyright law, archives and other cultural heritage institutions (CHIs) cannot legally share and distribute any orphan works in their collections. Orphan works are copyrighted materials whose copyright holders cannot be located or identified. To prove that a work is truly orphaned, the proposed user must demonstrate that the copyright holders could not be located after a diligent search. The burden of this rights clearance increases for CHIs that have large collections of orphan works. This paper reviews the current legal context for using orphan works in Canada, and the shortcomings. I propose a new system for orphan works rights clearance based on two parts. Firstly, formalizing the requirements for a diligent search to make them clear and objective. Secondly, creating a less stringent set of requirements specifically for use by CHIs, so that it is feasible for them to do diligent searches for large collections of materials. This paper also discusses and refutes multiple arguments against the proposed system.

Primary melanocytic melanoma of foramen magnum

Meningeal melanocytomas are a group of benign tumors that arise from the leptomeningeal melanocytes. According to the World Health Organization, they belong to primary melanocytic lesions. These rare lesions pose a diagnostic challenge to a neurosurgeon, especially in the absence of cutaneous melanosis and often because it masquerades as other benign tumors on imaging. Complete microsurgical excision, proper histological diagnosis, and diligent search for primary are essential for the complete cure. One of the rare complications of high-grade melanoma is a thromboembolic event which can prove catastrophic despite a complete surgical excision. We report a case of a 39-year-old male who was diagnosed with foramen magnum melanoma and eventually succumbed to thromboembolic complication despite an uneventful total excision.

Histomorphological Spectrum and Diagnostic Challenges in Thymic Epithelial Neoplasms with their Prognostic Significance: A Case Series of 33 Cases at a Regional Cancer Center in Western India.

Jahnavi Gandhi, DCPObjective Pathological diagnosis of thymic epithelial neoplasms is challenging due to multiple subtypes, tumor heterogeneity, and variations in inter-observer reproducibility. Very few studies are available on their spectrum in the Indian subcontinent. In this study, we aimed to explore the morphological spectrum and diagnostic difficulties in the classification and subtyping of thymic epithelial neoplasms along with their prognostic significance in the Indian population. Material and Methods Retrospectively, all surgically resected thymectomy specimens operated at our institute as well as outside review cases during the period were included. Histomorphology and immunohistochemistry (IHC) slides were reviewed and correlated with clinicopathological variables. Statistical Analysis Microsoft Excel 2019 and SPSS version 20 were used for data analysis. Results Among the 33 thymic epithelial neoplasms operated during the study period, the commonest subtype was thymoma B2 type followed by AB, B1, A, and B3 types. A single case each of micronodular thymoma, microscopic thymoma, and thymic carcinoma were identified. Six cases of thymomas with more than one pattern (other than 'A') were noted. The male:female ratio was 2:1. Stage I in Modified Masaoka staging and pT1a in TNM staging were most common. Seven cases had metastasis, four during initial presentation and three during subsequent follow-up. Discussion and Conclusion Thymic epithelial neoplasms show morphological overlapping of features. Thorough sampling, morphology, and IHC for exact subtyping of thymoma and diligent search and documenting of lymphovascular invasion (LVI) are vital as both are separate risk factors for metastasis/recurrence and help the clinician in a better follow-up of patients.

Cytodiagnosis of rhinoscleroma and its morphological clues: Our experience with four cases

Rhinoscleroma, a chronic progressive inflammatory disease of the upper respiratory tract, has a prolonged course and passes through three overlapping clinicopathologic stages. The histopathology findings are well illustrated in the literature; however, there is a paucity of reports explaining cytomorphological features of rhinoscleroma. It is the proliferative stage when disease presents as a nodular mass which can be targeted for cytological study. Here, the authors report fine-needle aspiration (FNA) cytology of four cases of rhinoscleroma who presented with intranasal firm, nodular lesions; its cytology revealed numerous, large, singly scattered histiocytes in a dense inflammatory background of lymphocytes, plasma cells, and few eosinophils. The microorganisms were visualized as intracytoplasmic loosely clustered, short rods within the histiocytes (Mikulicz cells) in May-Grunwald-Giemsa (MGG) smears. FNA sampling of rhinoscleroma in its nodular stage can yield classic cytomorphology with demonstration of organisms on air-dried smears which can further substantiate the cytodiagnosis. Thus, high index of suspicion and diligent search can aid in early and accurate diagnosed even on cytology with the help of conventional wet fixed Pap and air-dried MGG stain; both being complementary to each other and further can be supported with special stains such as periodic acid–Schiff stain or Gram whenever required.

Coprolites in Cemented Pleistocene Deposits on the Cape South Coast of South Africa

Helm, C.W.; Bamford, M.K.; Carr, A.S.; Cawthra, H.C.; De Vynck, J.C.; Dixon, M.G.; Quick, L.J., and Stear, W., 2023. Coprolites in cemented Pleistocene deposits on the Cape south coast of South Africa. Journal of Coastal Research, 39(2), 221–233. Charlotte (North Carolina), ISSN 0749-0208. Ichnology, the study of trace fossils, has the potential to complement information from traditional body fossil studies. Six ichnosites, containing an array of features interpreted with varying degrees of confidence as vertebrate coprolites, have recently been identified on the Cape south coast of South Africa. They are embedded in Pleistocene deposits from Marine Isotope Stage 6 or 5e through Marine Isotope Stage 5a. Bovid, carnivoran, elephant, and reptile origins are inferred. In the majority of cases, vertebrate tracks occur in association with the coprolites. Petrography studies confirm an organic component in all samples, confirming the potential of coprolites to contribute to palaeoenvironmental reconstruction. Although initial palynology and phytolith studies were negative, a diligent search for further sites and further testing may help in realizing this potential. More broadly, the six ichnosites demonstrate the capacity of cemented dune and beach surfaces on the Cape south coast to preserve coprolites in open-air settings, compared with previously known coprolite records from carnivore dens and archaeological sites.

PSUN139 Leukemoid Reaction in Severe Diabetic Ketoacidosis: An Indicator of Severity or Predictor of Infection?

Abstract Background Acute infectious illness can precipitate episodes of ketoacidosis in patients with diabetes mellitus. For this reason, a diligent search for a focus is essential in the initial evaluation of patients with DKA since patients often appear ill and may have non-specific symptoms. Clinical Case An 18-year old Filipino with Type 1 Diabetes Mellitus sought consult due to abdominal pain. He is on premixed NPH/regular insulin twice daily but was lost to follow-up due to the COVID-19 pandemic. He has no other comorbidities but asserted a prior history of poor compliance with both diet and insulin therapy besides an erratic sleep-wake cycle. Prior to consult, he reported 5 episodes of vomiting associated with generalized abdominal pain. Due to poor appetite, he missed due doses of insulin with subsequent worsening of condition. On admission, he was lethargic with Kussmaul's breathing. Initial vital signs were stable. He had dry lips and oral mucosa, sunken eyeballs and generalized abdominal tenderness. COVID-19 PCR was negative. Serum lipase (8.79, n: 8-78) and CT scan of abdomen were likewise unremarkable. Initial CBG was HIGH with elevated ketones (5.4, n: &amp;lt;0.6) and arterial blood gas revealed a pH of 7.0, pCO2 22, HCO3 incalculable, lactate 3.9, with high anion gap. The initial WBC was high (44.3×109/uL, n: 4.4-11) with 84% neutrophils, 10% lymphocytes, 1% metamyelocytes, and 5% monocytes. Hemoglobin (18.5 g/dl), hematocrit (51.7%) and platelet count (614k/uL) were also elevated. Peripheral blood smear revealed normal cell morphology. Urinalysis revealed elevated specific gravity, marked glycosuria and ketonuria, negative nitrites and leukocyte esterases. Blood specimen were obtained for culture. Therapy was instituted with intravenous fluids, insulin drip and broad spectrum antibiotics. The following day, glucose was 218 mg/dl, pH 7.16, bicarbonate 7.8 meq/L, hematocrit 44%, WBC 25.21×109/uL and platelet count was 401k/uL. LAP score was requested but was unavailable. On the fourth hospital day, the patient was well and tolerating diet, with normalization of blood glucose, WBC 9.87 (85% neutrophils, 10% lymphocytes, 5% monocytes) and control of acidosis. Since cultures were negative and patient was afebrile, antibiotics were discontinued. He was discharged stable on with basal-bolus insulin. Conclusion The association between DKA and leukocytosis in the absence of infection is described in literature. Exact mechanism is unknown but may in part be attributed to increased catecholamine release in response to stress and hemoconcentration from marked dehydration. Studies show a statistically significant relationship between pH, bicarbonate and leukocytes which denotes that WBC in DKA can be an indicator of the severity of ketoacidosis rather than a predictor of infection. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Clinicopathological spectrums and prognosis of primary appendiceal adenocarcinoma, goblet cell adenocarcinoma, and low-grade appendiceal mucinous neoplasms

Primary appendiceal adenocarcinoma (APCA), goblet cell adenocarcinoma (GCA), and low/high-grade appendiceal mucinous neoplasms (LAMN/HAMN) are distinct entities with overlapping clinical presentation and histomorphology, leading to diagnostic challenges. We retrospectively reviewed our archived cases between 2010 and 2018 for diagnosis reappraisal and comparative analysis using updated terminology and modern parameters. A total of 87 cases (22 APCA, 40 GCA, and 25 LAMN pT≥3) were included. The entire cohort had 49 women and 38 men with a median age of 59.9 (range 26-88) years. There were no statistically significant differences in age and sex among the three groups. Clinically, patients with GCA were more likely to present with acute appendicitis (65%) and more likely to have appendectomy as initial surgery (68%). Both APCA and GCA were more likely to involve the proximal appendix while LAMN was more likely to involve the distal appendix (p<0.05). All APCAs were associated with mucosal precursor lesions, most commonly tubular, tubulovillous, or villous adenoma, flat LAMN/HAMN-pTis mucinous epithelium, or mixed, which correlated with distinct histomorphology, tumour differentiation, and stage. Although polypoid precursor lesions were rare in GCA, a significant proportion of GCA showed crypt atypia associated with neoplastic cells. Immunohistochemically, APCA had more frequent β-catenin nuclear positivity and loss of SATB2 expression (p<0.05). KRAS mutation was more common in APCA than in GCA (8/11 vs 1/7, p<0.01). We further validated the three-tiered grading system (G1, G2, G3) in GCA, which correlated well with tumour stage and patient survival. APCA had worse progression-free and disease-specific survivals than GCA and LAMN (pT≥3) with the latter being relatively indolent even when perforated with peritoneal spread. Our study is the first comprehensive comparison between all three appendiceal neoplasms. We also describe a spectrum of previously under-recognised crypt atypia in GCA, which should trigger a diligent search for GCA if present.

Decorative Multi-Walled Carbon Nanotubes by ZnO: Synthesis, Characterization, and Potent Anti-Toxoplasmosis Activity

Toxoplasmosis may become a fatal disease in immunodeficient, diabetic patients, pregnant women, and infants. Hence, the diligent search for new effective treatment is among the major concerns worldwide. The well-dispersed multi-walled carbon nanotubes lined with ZnO (ZnO-MWCNT), graphene oxide (GO-NPs), and zinc oxide (ZnO-NPs) were successfully synthesized through rapid and facile hydrothermal arc discharge technique (HTADT). The antiparasitic effects of ZnO-NPs, GO-NPs, and ZnO-MWCNT were investigated in mice infected with Toxoplasma gondii. The percent of tachyzoites reduction were detected. The observed results demonstrated that ZnO-MWCNT revealed a significant reduction in the parasite count reached 61% in brain tissues, followed by liver (52%), then spleen (45%). The assessments of antiparasitic, inflammatory, and anti-inflammatory cytokines confirmed the superior activity of ZnO-MWCNT as antiparasitic agent, which paves the way for the employment of ZnO-MWCNT as a treatment for the acute RH strain of T. gondii infection in vivo.

An objective framework for evaluating unrecognized bias in medical AI models predicting COVID-19 outcomes.

ObjectiveThe increasing translation of artificial intelligence (AI)/machine learning (ML) models into clinical practice brings an increased risk of direct harm from modeling bias; however, bias remains incompletely measured in many medical AI applications. This article aims to provide a framework for objective evaluation of medical AI from multiple aspects, focusing on binary classification models.Materials and MethodsUsing data from over 56 000 Mass General Brigham (MGB) patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), we evaluate unrecognized bias in 4 AI models developed during the early months of the pandemic in Boston, Massachusetts that predict risks of hospital admission, ICU admission, mechanical ventilation, and death after a SARS-CoV-2 infection purely based on their pre-infection longitudinal medical records. Models were evaluated both retrospectively and prospectively using model-level metrics of discrimination, accuracy, and reliability, and a novel individual-level metric for error.ResultsWe found inconsistent instances of model-level bias in the prediction models. From an individual-level aspect, however, we found most all models performing with slightly higher error rates for older patients.DiscussionWhile a model can be biased against certain protected groups (ie, perform worse) in certain tasks, it can be at the same time biased towards another protected group (ie, perform better). As such, current bias evaluation studies may lack a full depiction of the variable effects of a model on its subpopulations.ConclusionOnly a holistic evaluation, a diligent search for unrecognized bias, can provide enough information for an unbiased judgment of AI bias that can invigorate follow-up investigations on identifying the underlying roots of bias and ultimately make a change.

The coronoid insertion of the human masseter muscle was well described in the 18th century

IntroductionA recent paper in Annals of Anatomy (The human masseter muscle revisited: First description of its coronoid part) claimed to have discovered a previously unrecognized anatomical component of the deep layer of the masseter muscle. The goal of this study is to emphasize the importance of undertaking comprehensive exploration of the historical literature before asserting primacy of an anatomical discovery. MethodsA search was conducted of historical texts describing the anatomical structure of the masseter muscle, spanning the 18th, 19th, and early 20th centuries. Historical sources were obtained via Google Books, the Internet Archive, and the digital collections of Stanford Lane Library Medical History Center, Paris University Numerical library Medica (France), and the State Library of Bavaria (Germany). Contemporary anatomical studies were identified via PUBMED search ResultsRather than a “first description” of newly discovered anatomical feature, the paper we comment upon has added important anatomical details of the length, width, thickness, and fiber orientation of coronoid portion of the deep layer of the masseter. As early as the 18th century, anatomists had described the masseter as possessing a three rather than two-layer structure with a deep layer which inserts on the coronoid process. DiscussionAssertions of primacy (ie. “first description”) of an anatomical structure in the 21st century necessitates a diligent search of literature, including sources which were published during the era when anatomical studies reigned supreme at the forefront of medical science. Systematic scanning of historical medical material has made older texts widely and freely available and digital translation tools have helped to remove language barriers. It is important to study original articles as secondary citations of historical material are less reliable. Without rigorous historical investigation, assertions of primacy cannot be made with confidence.

All Bleeding Stops, Eventually (But: The Sooner The Better!).

It's your first day as the surgery resident working in the cardiac surgery intensive care unit (ICU) and you are accepting the hand-off of a cardiac surgery patient that your senior resident has brought up from the operating room for admission to the ICU. During the handoff, your resident colleague tells you that the patient is 'oozing a lot and that the operating team, after a diligent search for bleeding sites, does not believe that the oozing is 'surgical.' She announces that your job will, therefore, be to stop the ongoing oozing, while, of course, being alert to the possible development of tamponade physiology.

Hard Times, Property Crimes, and the Perils of Making Shift: The Working Poor in Jacksonian-Era Cumberland County, Pennsylvania

Hard Times, Property Crimes, and the Perils of Making Shift:The Working Poor in Jacksonian-Era Cumberland County, Pennsylvania Michael B. McCoy (bio) Abstract This essay draws on an uninterrupted stretch of indictment records from 1827 to 1846 to consider the relationship between hard times and property crimes in rural Pennsylvania. Focusing on working poor defendants, the piece illustrates how struggling men and women used petty crime as a makeshift response to material hardship and how such a strategy often led to more hard times. By examining the ways in which economic conditions and crime together shaped the lives of laboring people in a rural setting, this essay adds to the rich historiographies of working-class experience and crime in Pennsylvania. Demonstrating that rural crime was born of the same struggle for survival as it was in the Jacksonian city, the essay ultimately suggests that, amid capitalist transformation, the material lives of urban and rural working people—if they were ever that different—grew increasingly uniform. Property Crime, The Working Poor, Jacksonian Economy, Rural Poverty, Makeshift Strategies James gutshall was no stranger to hard times. The Cumberland County, Pennsylvania, "laboring man" was perennially poor, owned little in the way of personal property, was consistently absent from the tax rolls, and struggled to support his "wife and large family." In January 1833, with his prospects few and his problems many, Gutshall crafted a crude $7 promissory note and went shopping at John Ross's Dickinson Township store. Riddled though it was with errors, the note was evidently passable enough to allow him to walk out of Ross's store with eight yards of fabric, three handkerchiefs, one bandana, three pounds of coffee, three rolls of tobacco, and a two-dollar credit toward future purchases. Realizing his mistake, Ross quickly sought the assistance of John Auld, a [End Page 55] justice of the peace. Auld ordered the sheriff to undertake a "diligent search in the day time" of Gutshall's home, secure any or all of the goods in question, and bring Gutshall before the justice "to be examined . . . and further to be dealt with according to the law." The next day, Gutshall was arrested and confined to the county jail. More than two months would pass before he would face trial. Appearing before the quarter sessions in April, Gutshall was swiftly indicted, convicted, and sentenced to three months' confinement, saddled with a $21 fine, and ordered to pay court costs. Already grim, Gutshall's financial situation deteriorated in the months following his conviction. From his jail cell in June 1833, he petitioned the court of common pleas for relief from mounting debts and legal fees. Time lost to imprisonment left him and his family with mounting debts to local storekeepers. Unable to work, he could not pay his court-imposed fine, let alone the ever-increasing jailers' fees. Freed sometime after his August 12, 1833, insolvency hearing, Gutshall turned his attention to recovering from the economic consequences of conviction. Lost time, lost wages, and a damaged reputation would, however, haunt him for years to come; in 1837, he would again seek the aid of the insolvency court.1 Confronted by the uncertainties and material hardships that attended the Jacksonian economy, Gutshall had few options for patching the holes in his family's budget—all of them temporary, and none of them very good.2 For Gutshall, and poor men and women like him, making ends [End Page 56] meet in the face of poverty and an uncertain market for their labor often meant making shift: relying upon a handful of short-term strategies, both licit and otherwise, including the poorhouse, outdoor relief, charitable assistance, buying on credit, and petty crime.3 Faced with the struggle for subsistence, Gutshall turned to property crime, a decision that led not to relief but instead to deeper financial hardship. Gutshall's experiences as a working man and a defendant offer insight into the convergence of economic insecurity and crime in the lives of rural working people.4 Indeed, his story, and the stories of those like him, illustrate how the working poor used crime as a makeshift response to material hardship and the...

Konsep diri pada remaja broken home

The study aims to understand the effects of a broken home family on a teenager's concept of self and to understand the psychological condition of the teen affected by the broken home family. The method used in this article is that of literary study. In the study, researchers made a diligent search of the library that was needed in the study. Library or library studies are activities related to library methods of collecting data that can be found in books, journals, and articles by reading and writing and processing research materials (zed, 2003, h.3), in this article will discuss good youth concepts and how the spirit teacher's role in helping students cope.

A novel ensemble model for long-term forecasting of wind and hydro power generation

Power generation scenario modelling has become an integral part of long-term planning in power system due to high penetration of variable renewable energy. It requires accurate estimates of power generation from different resources to find cost-optimal mix of generations. Predicting the generation of weather dependent renewables in long-term is not feasible but an adaptive long-term forecasting model based on univariate time-series analysis can provide the solution. Therefore, an effort has been made through this paper to provide accurate medium to long-term forecasts (a week-ahead to a year-ahead) for wind and hydro power generation using a novel ensemble forecasting model. The proposed model is devised in three phases; Phase-I develops a hybrid model using ARIMA (Auto Regressive Integrated Moving Average) and Bi-LSTM (Bidirectional Long Short Term Memory) predictions. Phase-II integrates the forecasts of seasonal and off-season generation periods obtained via a Diligent Search Algorithm (DSA). DSA is an innovative algorithm, designed to identify the hidden seasonalities that are responsible for the intermittent behaviour of wind and hydro power generation time-series. Finally, Phase-III facilitates amalgamation of prediction results of Phase-I and Phase-II to build the proposed forecasting model. Results show that MAE (Mean Absolute Error) for wind and hydro power are 1.97% to 5.52% and 2.3% to 6.42% while RMSE (Root Mean Square Error) varies from 2.79% to 7.8% and 2.63% to 8.4% respectively in a week-ahead to a year-ahead scenarios. Since this model is specifically designed for a year-ahead forecasting scenario, its performance can become unstable beyond this time horizon.

Disseminated Histoplasmosis in a Retropositive Young Male: A Case Report

Disseminated histoplasmosis is caused by the dimorphic fungus Histoplasma capsulatum. This fungal infection is commonly seen in immunocompromised patients, especially in AIDS patients, children and elderly population. Here we present a case report of a 24-year-old male who was admitted with generalised fatigue and generalised lymphadenopathy. He was found to be retropositive on evaluation and FNAC of the node surprisingly revealed Histoplasmosis. Presence of these organisms were also seen on the peripheral smear which could be picked up only on reviewing the smear again. With this case report we wish to emphasize the need for careful and diligent search of these organisms in the peripheral smear.