Digital ischemia and gangrene due to red blood cell aggregation induced by acquired dysfibrinogenemia

Digital gangrene was observed in a patient who had angiographic findings of digital arterial occlusion. The patient's blood showed a marked red blood cell aggregation with rouleaux formation in long chains, which could not be dispersed at shear rates up to 200 sec-1. Studies of the patient's blood revealed the presence of an abnormal fibrinogen capable of aggregating normal red blood cells. This fibrinogen was found by Raman spectroscopy to have an increased alpha-helical content, whereas the beta-sheet content was decreased. Defibrinogenation therapy with ancrod resulted in a dramatic symptomatic relief. The disappearance of the abnormal fibrinogen 6 months later and an absence of a family history indicate that this dysfibrinogenemia was acquired.     

Resource pool management: Reactive versus proactive or let’s be friends

The consolidation of multiple workloads and servers enables the efficient use of server and power resources in shared resource pools. We employ a trace-based workload placement controller that uses historical information to periodically and proactively reassign workloads to servers subject to their quality of service objectives. A reactive migration controller is introduced that detects server overload and underload conditions. It initiates the migration of workloads when the demand for resources exceeds supply. Furthermore, it dynamically adds and removes servers to maintain a balance of supply and demand for capacity while minimizing power usage. A host load simulation environment is used to evaluate several different management policies for the controllers in a time effective manner. A case study involving three months of data for 138 SAP applications compares three integrated controller approaches with the use of each controller separately. The study considers trade-offs between: (i) required capacity and power usage, (ii) resource access quality of service for CPU and memory resources, and (iii) the number of migrations. Our study sheds light on the question of whether a reactive controller or proactive workload placement controller alone is adequate for resource pool management. The results show that the most tightly integrated controller approach offers the best results in terms of capacity and quality but requires more migrations per hour than the other strategies.     

Observed and perceived parental overprotection in relation to psychosocial adjustment in preadolescents with a physical disability: The mediational role of behavioral autonomy.

The purpose of this study was to test a mediational model of associations between parental overprotectiveness (OP), behavioral autonomy, and psychosocial adjustment in 68 families with 8- and 9-year-old preadolescents with spina bifida and a demographically matched sample of 68 families with able-bodied children. Measures included questionnaire and observational assessments of parental OP; parent and child reports of behavioral autonomy; and parent, child, and teacher reports of preadolescent adjustment. On the basis of both questionnaire and observational measures of OP, mothers and fathers of children with spina bifida were significantly more overprotective than their counterparts in the able-bodied sample, although this group difference was partially mediated by children's cognitive ability. Both questionnaire and observational measures of parental OP were associated with lower levels of preadolescent decision-making autonomy as well as with parents being less willing to grant autonomy to their offspring in the future. For the questionnaire measure of OP, and only for the spina bifida sample, the mediational model was supported such that parental OP was associated with less behavioral autonomy, which was, in turn, associated with more externalizing problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Putting down roots: Afforestation and bank cohesion of Icelandic Rivers

Riparian vegetation is widely recognized as a critical component of functioning fluvial systems. Human pressures on woody vegetation including riparian areas have had lasting effects, especially at high latitude. In Iceland, prior to human settlement, native downy birch woodlands covered approximately 15%–40% of the land area compared to 1%–2% today. Afforestation efforts include planting seedlings, protecting native forest remnants, and acquiring land areas as national forests. The planted and protected nature of vegetation along rivers within forests provides a unique opportunity to evaluate the various taxa within riparian zones and the channel stabilizing characteristics of the vegetation used in afforestation. We investigated bank properties, sediment textures, and root characteristics within riparian zones along four rivers in forests in Iceland. Bank sediment textures are dominantly sandy loam overlying coarser textures. Undercut banks are common because of erosion of the less cohesive subsurface layer. Quantitative root data indicate that the woody taxa have greater root densities, rooting depths, and more complex root structures than forbs or graminoids. The native downy birch has the highest root densities, with <1 mm roots most abundant. Modeling of added bank cohesion indicates that willow provides up to six times and birch up to four times more added cohesion to the coarse sediment textures comprising stream banks compared to no vegetation. We conclude that planting and protecting the native birch and willow helps to reduce bank erosion, especially where long-term grazing exclusion can be maintained.     

Treatment of hypertension in nondiabetic renal disease

To clarify whether long-term impaired glucose tolerance (IGT) is associated with dysfunction of peripheral and autonomic nerves, age-matched men with IGT and diabetes mellitus were followed prospectively for 12-15 years, when peripheral and autonomic nerve function was assessed. The patients comprised four subgroups: (1) 51 IGT subjects (duration of IGT at least 12-15 years); (2) 35 diabetic patients, with IGT 12-15 years ago, who later developed diabetes; (3) 34 diabetic patients, duration of diabetes at least 12-15 years; and (4) 62 age-matched non-diabetic control subjects. Mean age of the whole study population was 61 +/- 2 years (mean +/- SD), not different in the four groups. Peripheral nerve function tests included nerve conduction velocities, amplitudes, distal latencies, F-reflexes, and sensory perception thresholds for heat, cold, and vibration. Autonomic nerve function tests included the heart rate reaction during deep breathing (expiration to inspiration ratio) and to tilt (acceleration and brake indices). Despite 12-15 years of IGT, peripheral nerve function did not differ between IGT and control subjects, whereas autonomic nerve function deviated; an abnormal expiration to inspiration ratio (a sign of vagal nerve dysfunction) was significantly more common (15/51 versus 5/62; p < 0.01) in IGT than in control subjects. Diabetic patients (groups 2 and 3) showed lower conduction velocities (in general 2-4 m s-1 lower) than IGT and control subjects in all tested nerves. In conclusion, diabetes but not IGT, is associated with peripheral nerve dysfunction.     

Effect of allowing for ethnic group in prenatal screening for Down's syndrome

We conducted a study to investigate ethnic group differences in levels of serum markers used in screening for Down's syndrome [serum alpha-fetoprotein (AFP), unconjugated oestriol (uE3), total human chorionic gonadotrophin (hCG), free alpha- and free beta-hCG, and dimeric inhibin-A], to estimate the extent to which maternal weight differences between ethnic groups explain these differences, and to estimate the effect of adjusting for ethnic group and maternal weight on screening performance. Serum measurements were taken from women who were screened prenatally for Down's syndrome. AFP, uE3, and hCG concentrations were available from 9462 white, 4215 black, and 4392 South Asian women with singleton pregnancies without Down's syndrome or neural tube defects between 15 and 22 weeks' gestational age. Frozen serum samples were available from a subset of 922 white, 449 black, and 135 South Asian women and were used for measurement of free alpha-hCG, free beta-hCG, and inhibin. Values were expressed as multiples of the median (MOM) for women of the same gestational age. There were statistically significant differences in the serum marker levels between ethnic groups that were not explained by differences in maternal weight. The main differences were found in black women compared with white women; black women had serum AFP levels 22 per cent higher (95 per cent confidence interval 20-24 per cent), total hCG levels 19 per cent higher (16-22 per cent), and free beta-hCG levels 12 per cent (3-21 per cent) higher. The other differences were less than 10 per cent. Adjusting for ethnic group only had a small estimated effect on screening performance: a maximum of about 0.5 per cent extra detection at a 5 per cent false-positive rate. At a fixed risk cut-off level, the false-positive rate will not be materially different between different ethnic groups. Adjusting serum markers for ethnic groups improves Down's syndrome screening performance to a very small extent. It is worthwhile because of its established value in AFP screening for open neural tube defects.