Disseminated tuberculosis: A neglected entity in immunocompromised hemodialysis patients

End‐stage renal disease is considered a factor predisposing to increased risk of tuberculosis with frequent extrapulmonary localization. Although extrapulmonary tuberculosis has been observed for decades, disseminated tuberculosis, a major cause of morbidity and mortality in immunocompromised hosts, remains rather neglected. We report an unusual case of an immunocompromised patient with a late diagnosis and delayed treatment of genitourinary tuberculosis that subsequently led to the diagnosis of vertebral and miliary tuberculosis (disseminating tuberculosis). Therefore, increased awareness is warranted from physicians dealing with hemodialysis patients in order to avoid delays in diagnosis and treatment initiation.     

The impact of the dependence structure in risk management: a focus on credit-risk

The aim of the paper is to discuss the important role of the dependence structure in risk management. Therefore, we focus on credit-risk and propose an innovative model to value the credit risk of a portfolio. This new approach (HYC for short) is based on a hierarchical hybrid copula and involves a clusterization of the portfolio in several risk's classes. The HYC model is classified as hybrid because the computation of the loss cdf depends on the class's cardinality: for large groups one is justified to apply a limiting approach, while for small ones one applies a procedure preserving the granularity of the group itself. In order to appreciate the impact of the dependence structure in credit-risk evaluation, a VaR analysis based on the HYC loss function is here compared to the CreditMetrics approach in an in-sample exercise and to the empirical VaR in an out-of sample exercise aimed to test the forecasting effectiveness of the model. This comparison allows us to appreciate over/under-valuation of the capital detained from the financial institution. Moreover, the impact of an enlargement of the dependence structure is discussed with respect to the systemic/contagious effects in the context of a portfolio optimisation with constraint on a sub-portfolio's risk.     

Clinical managers' identity at the crossroad of multiple institutional logics in it innovation: The case study of a health care organization in England

Clinical managers play a crucial role in securing the implementation and sustainability of information technology (IT) innovation in health care. Yet, not all clinical managers are willing and able to support IT innovation, particularly when the institutional logics of an IT innovation challenge their professional practice. We investigate how clinical managers use their hybrid identities to reconcile differences among competing institutional logics that affect IT innovation. Based on three examples of IT innovation (telehealth for obstructive sleep apnoea, telehealth for heart failure, and electrocardiograms) in a health care organization in England, we identify three roles in IT innovation (innovation advocate, innovation broker, and innovation laggard) that clinical managers enacted in response to three degrees of conflict between institutional logics (no conflict, moderate conflict, and high conflict), respectively. We make the following contributions. First, we demonstrate how clinical managers' perception of their hybrid role in relation to their professional identity influences their response to the conflicting institutional demands of IT innovation. We conclude that clinical managers' fragmented identities can compromise their ability to effectively manage IT innovation in health care. Second, our findings raise implications for understanding the role of professionals' hybrid identities in the implementation of digital transformation at the intersection of multiple institutional logics.     

Thin water films and particle morphology evolution in nanocrystalline MgO

A key question in the field of ceramics and catalysis is how and to what extent residual water in the reactive environment of a metal oxide particle powder affects particle coarsening and morphology. With X‐ray Diffraction (XRD) and Transmission Electron Microscopy (TEM), we investigated annealing‐induced morphology changes on powders of MgO nanocubes in different gaseous H₂O environments. The use of such a model system for particle powders enabled us to describe how adsorbed water that originates from short exposure to air determines the evolution of MgO grain size, morphology, and microstructure. While cubic nanoparticles with a predominant abundance of (100) surface planes retain their shape after annealing to T = 1173 K under continuous pumping with a base pressure of water p(H₂O) = 10^?5 mbar, higher water partial pressures promote mass transport on the surfaces and across interfaces of such particle systems. This leads to substantial growth and intergrowth of particles and simultaneously favors the formation of step edges and shallow protrusions on terraces. The mass transfer is promoted by thin films of water providing a two‐dimensional solvent for Mg²⁺ ion hydration. In addition, we obtained direct evidence for hydroxylation‐induced stabilization of (110) faces and step edges of the grain surfaces.     

On total internal reflection investigation of nanoparticles by integrated micro-fluidic system

We report on a novel sensor for characterization of nanoparticles colloidal suspensions. We employ a diffraction grating under total internal reflection for investigation of nanodisperse fluids passing through an integrated microfluidic channel. Dispersions containing polymeric, metallic, and ferromagnetic nanoparticles are studied. Using this device, we can accurately determine in real-time the specific refractive index for the nanoparticle suspension and the nanoparticle concentration. The nanoparticle concentrations can be calculated with a resolution of 0.3-0.5 wt% for polymeric nanoparticles, 0.03-0.05 wt% for metallic nanoparticles, and 0.05-0.1 wt% for ferromagnetic nanoparticles. This translates to an effective refractive index that can be determined with an accuracy of 7 x 10(-4) for the polymeric and 2 x 10(-4) for the metallic and ferromagnetic dispersions.     

A System-layer Infrastructure for SoC Diagnosis

During IC manufacturing phase, discriminating between good and faulty chips is not enough. In fact, especially in the first phase of the production of a new device, a complete understanding of the possible failures is quickly required to ramp up production yield. For test engineers, dealing with the manufacturing test of Systems-on-chip (SoCs) means to tackle the extraction of diagnostic data from faulty chips. Another equally important aim of diagnosis, in a later step of a product lifecycle, is to find the real root cause of silicon misbehaviors for field returns. At the core test layer, the adoption of diagnosis-oriented Design-for-Testability structures is almost mandatory and many solutions have been worked out for several types of cores; diagnosis data retrieval often consists in the execution of a set of self-test procedures whose application order and/or customization may depend on the obtained results themselves. This paper details the characteristics of a system-layer test architecture able to manage efficiently SoC self-diagnostic procedures. This architecture is composed of a diagnosis-oriented Test Access Mechanism (TAM) and an Infrastructure-IP owning enough intelligence to automatically manage core diagnostic procedures. Both of them have been designed in compliance with the IEEE 1500 Standard for Embedded Core Test and exploit the characteristics of Self-Test structures inserted for the diagnosis of memory, processor and logic cores. This approach to SoC diagnosis minimizes ATE memory requirements for pattern storage and drastically speeds up the complete execution of diagnostic procedures. Experimental results highlight the convenience of the approach with respect to alternative ATE driven diagnosis procedures, while resorting to negligible area overhead.

Interpolymer complexes of poly(acrylamide) and poly(N-isopropylacrylamide) with poly(acrylic acid): a comparative study

The interpolymer complexation, through successive hydrogen bonding, between poly(acrylamide) (PAAm) and poly(N-isopropylacrylamide) (PNiPAAm) with poly(acrylic acid) (PAA) in aqueous solution has been viscometrically and potentiometrically investigated. The stoichiometry of the complexes formed was determined. By comparing the strength of the two complexes the very important contribution of the hydrophobic interaction in their formation has been indicated.     

An Easy Entry to Optically Active Spiroindolinones: Chiral Brønsted Acid‐Catalysed Pictet–Spengler Reactions of Isatins

The first catalytic asymmetric Pictet–Spengler reaction of isatins is presented. BINOL‐derived phosphoric acids were found to be competent catalysts for this transformation, giving challenging spirooxindole structures bearing a quaternary stereocentre with generally good results. The 1,2,3,4‐tetrahydro‐β‐carboline products (spiroindolinones) are the core of some newly discovered anti‐malarial agents.