Perinuclear antineutrophil cytoplasmic antibodies in patients with Crohn's disease define a clinical subgroup

BACKGROUND & AIMS: Antineutrophil cytoplasmic antibodies (ANCA) have been consistently detected in a subgroup of patients with Crohn's disease (CD). This study was designed to determine whether serum ANCA expression in patients with CD characterizes an identifiable clinical subgroup. METHODS: The study population consisted of 69 consecutive patients with an established diagnosis of CD as determined by a combination of characteristic clinical, radiographic, endoscopic, and histopathologic criteria. Sera from the patients were analyzed for the presence of ANCAs using the fixed neutrophil enzyme-linked immunosorbent assay (ELISA) assay. Perinuclear ANCA (pANCA)-positive and cytoplasmic ANCA (cANCA)-positive results by ELISA were confirmed by indirect immunofluorescence staining. Clinical profiles of the ANCA-positive patients with CD were compared with those of patients with CD not expressing ANCA (ANCA-negative). RESULTS: pANCA-positive patients with CD have endoscopically and/or histopathologically documented left-sided colitis and symptoms of left-sided colonic inflammation, clinically reflected by rectal bleeding and mucus discharge, urgency, and treatment with topical agents. One hundred percent of patients with CD expressing pANCA had "UC-like" features. CONCLUSIONS: In patients with CD, serum pANCA expression characterizes a UC-like clinical phenotype. Stratification of CD by serum pANCA provides evidence of heterogeneity within CD and suggests a common intestinal mucosal inflammatory process among a definable subgroup of patients with CD and UC expressing this marker.     

Complexity results on labeled shortest path problems from wireless routing metrics

Metrics to assess the cost of paths through networks are critical to ensuring the efficiency of network routing. This is particularly true in multi-radio multi-hop wireless networks. Effective metrics for these networks must measure the cost of a wireless path based not only on traditional measures such as throughput, but also on the distribution of wireless channels used. In this paper, we argue that routing metrics over such networks may be viewed as a class of existing shortest path problems, the formal language constrained path problems.On this basis, we describe labeled path problems corresponding to two multi-radio wireless routing metrics: Weighted Cumulative Expected Transmission Time (WCETT), developed by Draves et al., and Metric for Interference and Channel-switch (MIC), developed by Yang et al. For the first, we give a concise proof that calculating shortest WCETT paths is strongly NP-Complete for a variety of graph classes. We also show that the existing heuristic given by Draves et al. is an approximator. For the second, we show that calculating loop-free (simple) shortest MIC paths is NP-Complete, and additionally show that the optimization version of the problem is NPO PB-Complete. This result implies that shortest simple MIC paths are only poorly approximable in the worst case.Furthermore, we demonstrate how the polynomial-time algorithm for shortest MIC paths is derivable from an existing language constrained shortest path algorithm. We use this as a basis to exhibit the general utility of viewing multi-channel wireless routing metrics as labeled graph problems, and discuss how a class of related polynomial-time computable metrics are derivable from this algorithm.     

The digital divide and t-government in the United States: using the technology acceptance model to understand usage

This paper applies the technology acceptance model to explore the digital divide and transformational government (t-government) in the United States. Successful t-government is predicated on citizen adoption and usage of e-government services. The contribution of this research is to enhance our understanding of the factors associated with the usage of e-government services among members of a community on the unfortunate side of the divide. A questionnaire was administered to members, of a techno-disadvantaged public housing community and neighboring households, who partook in training or used the community computer lab. The results indicate that perceived access barriers and perceived ease of use (PEOU) are significantly associated with usage, while perceived usefulness (PU) is not. Among the demographic characteristics, educational level, employment status, and household income all have a significant impact on access barriers and employment is significantly associated with PEOU. Finally, PEOU is significantly related to PU. Overall, the results emphasize that t-government cannot cross the digital divide without accompanying employment programs and programs that enhance citizens’ ease in using such services.     

Even in virtual environments women shop and men build: A social role perspective on Second Life

The present study examined whether traditional gender role expectations (Eagly, 1987) influence behaviors in non-traditional contexts such as online virtual environments. Participants were 352 Second Life users who reported their activities and experiences in Second Life. Results indicated that men and women differed in the types of activities they engaged in a manner predicted by social role theory. Specifically, as compared to women, men were more likely to report building things (e.g. objects), to own and work on their own virtual property, and were less likely to change their avatar’s appearance. Women, as compared to men, were more likely to meet people, shop, regularly change their avatar’s appearance, and buy clothes/objects for their avatar. The present study adds to our understanding of how traditional gender role expectations may carry over to online virtual worlds and influence online behavior.     

Laparoscopic vs. open wedge biopsy of the liver

The number of people smoking free-base cocaine, or "crack," has increased dramatically in recent years. Concomitantly, the literature describing complications of such use has grown as well. Adverse pulmonary effects are being increasingly noted, such as respiratory symptoms, pulmonary hemorrhage, pulmonary edema, asthma, and pulmonary barotrauma. These and other pulmonary effects are reviewed.     

After-hours telephone coverage: the application of an area-wide telephone triage and advice system for pediatric practices

BACKGROUND: After-hours telephone calls are a stressful and frustrating aspect of pediatric practice. At the request of private practice pediatricians in Denver, a metropolitan area-wide system was created to manage after-hours pediatric telephone calls and after-hours patient care. This system, the After-Hours Program (AHP), uses specially trained pediatric nurses with standardized protocols to provide after-hours telephone triage and advice for the patients of 92 Denver pediatricians, representing 56 practices. OBJECTIVES: This report describes the AHP, presents data from 4 years' experience with the program, and describes results of our evaluation of the following aspects of the program: subscribing physician satisfaction, parent satisfaction, the accuracy and appropriateness of telephone triage, and program costs. METHODS: After-Hours Program records (including quality assurance data) for all 4 years of operation were retrospectively reviewed, tabulated, and analyzed. The results of two subscribing physician surveys and one parent caller satisfaction survey are presented. A retrospective review of after-hours patient care encounter forms assessed the necessity for after-hours visits triaged by the AHP. An analysis of the total cost of this program to 10 randomly selected subscribing physicians was conducted using current AHP data and a survey of the 10 physicians. RESULTS: In 4 years, 107,938 calls have been successfully managed without an adverse clinical outcome. Minor errors in using protocols occurred in one call out of 1450 after-hours calls. After-hours phoen calls necessitated an after-hours patient visit 20% of the time and generated one after-hours hospital admission out of every 88 calls. Just over half of the patients were managed with home care advice only, and 28% were given home care advice after-hours and seen the next day in the primary physician's office. Of all patients directed by the telephone triage nurses to be seen after hours, 78% were determined to have a condition necessitating after-hours care. Data are presented regarding call volumes by time of day, day of week, patient age, and patient's initial complaint. The 6 most common complaints accounted for more than one half of the calls, and 38 complaints accounted for more than 95% of all after-hours calls. Utilization by subscribing physicians is described. Satisfaction among subscribing pediatricians was 100%, and among parents was 96% to 99% on a variety of issues. The total cost to participating Denver pediatricians (which includes revenues "given up" as a result of not seeing patients after hours) ranged from 1% to 12% of their annual net income, depending on a variety of factors. CONCLUSIONS: Large-scale after-hours telephone coverage systems can be effective and well-received by patients, parents, and primary physicians. Data presented in this report can assist in planning the training of personnel who provide after-hours telephone advice and triage. Controversies associated with this type of program are discussed. Suggestions are made regarding the direction of future programs and research.     

Multiple reflections in a wide-angle Michelson interferometer

The effect of multiple reflections from a semireflecting surface such as an interference filter located in front of or behind a wide-angle Michelson interferometer (WAMI) is examined. By considering the instrument as a complex operator on the incident electric field, theoretical results are obtained which describe a large variety of configurations. Experimental results are presented which are consistent with these results. It is concluded that since the presence of these reflections changes the form of the observed fringes and affects measurements of the phase and visibility of the fringes, care must be taken to avoid such reflections in designing WAMIs.     

The measurement of shear compliances for oriented polyethylene terephthalate sheet

Two techniques have been used to measure the shear compliances of one-way drawn uniplanar-axially-oriented polyethylene terephthalate (PET) sheet, draw ratio 51; a torsional method for all three compliancesS ₄₄,S ₅₅ andS ₆₆, and a recently-developed simple-shear method forS ₄₄ andS ₆₆. The two techniques gave values for the compliances in common which agreed very well. An examination of end effects in torsion has also been made. The determination of the three shear compliances complete the determination of all nine independent compliances for this PET sheet. The overall mechanical anisotropy has been considered in the light of existing structural information, and comparison made with the elastic constants of isotropic PET and a highly oriented PET fibre on the basis of the single-phase aggregate model.     

An analysis of the mechanics of solid phase extrusion of polymers

An analysis is presented for the mechanics of the hydrostatic extrusion of polymers in the solid phase through a conical die. The analysis starts with the lower bound solution proposed by Hoffman and Sachs and includes the effects of strain, strain rate and pressure on the deformation behaviour. It is proposed that this involves knowledge of the tensile stress-strain-strain rate relationships for each polymer, and it is shown how such information for polyethylene and polyoxymethylene can be used to explain the observed behaviour of these materials in the solid-phase extrusion process.List of Symbols die cone semi-angle - normal stress coefficient of tensile flow stress - d ₀ initial diameter of billet - d _f die exit diameter - axial strain rate (plug flow) - _red shear strain (redundant strain) incurred on crossing die entry or exit boundary - _N In R _N=2ln (d ₀/d _f) nominal true strain in extrusion - _{f red}+ _N - L cot - normal stress coefficient of friction at die/billet interface - P experimental extrusion pressure=total work done per unit volume of material - P _F work done per unit volume against billet-die friction - P _I ideal deformation work done per unit volume of material - P _R total redundant work done per unit volume - P _W=P–P _I extra work required to overcome friction, pressure and redundant strain effects - r ₀ initial radius of billet - r _f die exit radius - r material radius at a point in the deformation zone - R _N=(r ₀/r _f)² nominal extrusion ratio - R=(r ₀/r)² extrusion ratio at a point in the deformation zone - ₀() axial tensile flow stress - _f() process flow stress path, related to die strain and strain rate fields - _h tensile haul-off stress - _x, _y die stresses in deformation zone - ₁, ₂ shear yield stress of material at die entry and exit boundaries, respectively - v _x axial velocity - v _f extrudate velocity at die exit