Neuromuscular issues in cavovarus foot

Differential muscle weakness can cause a cavus foot deformity. Presenting complaints in the hindfoot may include ankle instability, secondary arthritis, or peroneal tendonitis. Presenting complaints in the forefoot may include stress fractures, callus formation over the lateral border of the foot, claw toes, first ray overload, and metatarsalgia. More general presenting complaints can include a drop-foot gait, decreased walking tolerance, and difficulty with shoe or orthotic fitting. To surgically correct the foot shape, soft tissue contractures need to be released, bone deformity corrected, and muscles balanced to optimize their strength and prevent recurrence of the deformity. This article reviews the diagnosis and management of the cavovarus foot secondary to longstanding muscle imbalance.

Ventricular tachycardia arising from the aortomitral continuity in structural heart disease: characteristics and therapeutic considerations for an anatomically challenging area of origin

BACKGROUND: The aortomitral continuity (AMC) has been described as a site of origin for ventricular tachycardias (VT) in structurally normal hearts. There is a paucity of data on the contribution of this region to VTs in patients with structural heart disease. METHODS AND RESULTS: Data from 550 consecutive patients undergoing catheter ablation for VT associated with structural heart disease were reviewed. Twenty-one (3.8%) had a VT involving the peri-AMC region (age, 62.7+/-11 years; median left ventricular ejection fraction, 43.6+/-17%). Structural heart disease was ischemic in 7 (33%), dilated cardiomyopathy in 10 (47.6%), and valvular cardiomyopathy in 4 (19%) patients, respectively. After 1.9+/-0.8 catheter ablation procedures (including 3 transcoronary ethanol ablations) the peri-AMC VT was not inducible in 19 patients. The remaining 2 patients underwent cryosurgical ablation. Our first catheter ablation procedure was less often successful (66.7%) for peri-AMC VTs compared with that for 246 VTs originating from the LV free wall (81.4%, P=0.03). During a mean follow-up of 1.9+/-2.1 years, 12 (57.1%) patients remained free of VT, peri-AMC VT recurred in 7 patients, and 1 patient had recurrent VT from a remote location. Three patients died. Analysis of 50 normal coronary angiograms demonstrated an early septal branch supplying the peri-AMC area in 58% of cases that is a potential target for ethanol ablation. CONCLUSIONS: VTs involving the peri-AMC region occur in patients with structural heart disease and appear to be more difficult to ablate compared with VTs originating from the free LV wall. This region provides unique challenges for radiofrequency ablation, but cryosurgery and transcoronary alcohol ablation appear feasible in some cases.

The basophil activation test in immediate-type drug allergy

Diagnosis of drug allergy involves first the recognition of sometimes unusual symptoms as drug allergy and, second, the identification of the eliciting drug. This is an often difficult task, as the clinical picture and underlying pathomechanisms are heterogeneous. In clinical routine, physicians frequently have to rely upon a suggestive history and eventual provocation tests, both having their specific limitations. For this reason both in vivo (skin tests) and in vitro tests are investigated intensively as tools to identify the disease-eliciting drug. One of the tests evaluated in drug allergy is the basophil activation test (BAT). Basophils with their high-affinity IgE receptors are easily accessible and therefore can be used as indicator cells for IgE-mediated reactions. Upon allergen challenge and cross-linking of membrane-bound IgE antibodies (via Fc-epsilon-RI) basophils up-regulate certain activation markers on their surface such as CD63 and CD203c, as well as intracellular markers (eg, phosphorylated p38MAPK). In BAT, these alterations can be detected rapidly on a single-cell basis by multicolor flow cytometry using specific monoclonal antibodies. Combining this technique with in vitro passive sensitization of donor basophils with patients' serum, one can prove the IgE dependence of a drug reaction. This article summarizes the authors' current experience with the BAT in the diagnostic management of immediate-type drug allergy mediated by drug-specific IgE antibodies.

CD4 count slope and mortality in HIV-infected patients on antiretroviral therapy: multicohort analysis from South Africa

BACKGROUND In many resource-limited settings monitoring of combination antiretroviral therapy (cART) is based on the current CD4 count, with limited access to HIV RNA tests or laboratory diagnostics. We examined whether the CD4 count slope over 6 months could provide additional prognostic information. METHODS We analyzed data from a large multicohort study in South Africa, where HIV RNA is routinely monitored. Adult HIV-positive patients initiating cART between 2003 and 2010 were included. Mortality was analyzed in Cox models; CD4 count slope by HIV RNA level was assessed using linear mixed models. RESULTS About 44,829 patients (median age: 35 years, 58% female, median CD4 count at cART initiation: 116 cells/mm) were followed up for a median of 1.9 years, with 3706 deaths. Mean CD4 count slopes per week ranged from 1.4 [95% confidence interval (CI): 1.2 to 1.6] cells per cubic millimeter when HIV RNA was <400 copies per milliliter to -0.32 (95% CI: -0.47 to -0.18) cells per cubic millimeter with >100,000 copies per milliliter. The association of CD4 slope with mortality depended on current CD4 count: the adjusted hazard ratio (aHRs) comparing a >25% increase over 6 months with a >25% decrease was 0.68 (95% CI: 0.58 to 0.79) at <100 cells per cubic millimeter but 1.11 (95% CI: 0.78 to 1.58) at 201-350 cells per cubic millimeter. In contrast, the aHR for current CD4 count, comparing >350 with <100 cells per cubic millimeter, was 0.10 (95% CI: 0.05 to 0.20). CONCLUSIONS Absolute CD4 count remains a strong risk for mortality with a stable effect size over the first 4 years of cART. However, CD4 count slope and HIV RNA provide independently added to the model.

IBPOWER Project, Intermediate band materials and solar cells for photovoltaics with high efficiency and reduced cost

IBPOWER is a Project awarded under the 7th European Framework Programme that aims to advance research on intermediate band solar cells (IBSCs). These are solar cells conceived to absorb below bandgap energy photons by means of an electronic energy band that is located within the semiconductor bandgap, whilst producing photocurrent with output voltage still limited by the total semiconductor bandgap. IBPOWER employs two basic strategies for implementing the IBSC concept. The first is based on the use of quantum dots, the IB arising from the confined energy levels of the electrons in the dots. Quantum dots have led to devices that demonstrate the physical operation principles of the IB concept and have allowed identification of the problems to be solved to achieve actual high efficiencies. The second approach is based on the creation of bulk intermediate band materials by the insertion of an appropriate impurity into a bulk semiconductor. Under this approach it is expected that, when inserted at high densities, these impurities will find it difficult to capture electrons by producing a breathing mode and will cease behaving as non-radiative recombination centres. Towards this end the following systems are being investigated: a) Mn: In1-xGax N; b) transition metals in GaAs and c) thin films.

Diaries of Benjamin Guild, 1776, 1778

These diaries of Benjamin Guild document his travels as a Presbyterian pastor in Massachusetts and Rhode Island. The daily entries describe people Guild met and dined with, the food he ate (including strawberries, currants, watermelon, English cherries, and lobster), the funerals he attended, and the sermons he gave. Many entries relate to his health concerns (the ague and eye trouble), sleeping habits, and widespread public health concerns (including smallpox, dysentery, "nervous fevers," consumption, and "putrid fever"). The diaries also contain passing references to the activities of American, British, French, and German soldiers during the American Revolution; the invasion of Canada and battles occurring in New York are noted. In August 1778, after visiting Providence, Rhode Island, Guild comments on the disordered state of the city after American soldiers passed through it. He also recounts a visit by officers of the French fleet to the Harvard College library in September 1778 and describes his dinner on board the French man-of-war, Sagitaire. One entry describes an elaborate ball sponsored by John Hancock, held for French soldiers and "Boston ladies," and another refers to the "incursion" of Indians. Many of Guild's diary entries pertain to his work as a Harvard College Tutor; these entries describe his lectures at the College, meetings with colleagues, personnel decisions, and the examination of students. He also describes books he is reading and his opinions of them, the purchase and sale of books, and his desire to learn Hebrew and French. In addition, multiple entries refer to a man named Prince, who was perhaps Guild's slave. Prince sometimes accompanied Guild on his travels.

Centennial International Exhibition Grounds, Philadelphia, Pennsylvania, 1876 (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: Pictorial map of the International Exhibition Grounds, presented by the Philadelphia, Wilmington and Baltimore Railroad. It was published by Van Ingen & Snyder & Gillett in 1876. Scale not given. The image inside the map neatline is georeferenced to the surface of the earth and fit to the Pennsylvania South State Plane Coordinate System NAD83 (in Feet) (Fipszone 3702). All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, index maps, legends, or other information associated with the principal map. This image pictorially shows the grounds of the Philadelphia Centennial Exhibition, 1876. It includes features such as roads, railroads, drainage, buildings with uses, and more. Includes inset engraving: Birds-eye Centennial International Exhibition from Sawyer's Observatory. Copyright 1875 by Theo. Leonhardt & Son and lists of United States Centennial Commissions officers. This layer is part of a selection of digitally scanned and georeferenced historic maps from The Harvard Map Collection as part of the Imaging the Urban Environment project. Maps selected for this project represent major urban areas and cities of the world, at various time periods. These maps typically portray both natural and manmade features at a large scale. The selection represents a range of regions, originators, ground condition dates, scales, and purposes.

Philadelphia, Pennsylvania, Reed's map, 1774 (Raster Image) (Image 1 of 2)

This layer is a georeferenced raster image of the historic paper map entitled: Fac simile of Reed's map : to the honourable House of Representatives of the freemen of Pennsylvania this map of the city and liberties of Philadelphia with the catalogue of purchasers is humbly dedicated by their most obedient humble servant, Iohn Reed, James Smither sculp. Facsimile of a map originally published in 1774. Republished by Charles L. Warner in 1870. Scale [1:23,760]. Covers portions of Philadelphia, Pa. This layer is image 1 of 2 total images of the two sheet source map, representing the eastern portion of the map. The image inside the map neatline is georeferenced to the surface of the earth and fit to the Pennsylvania South State Plane Coordinate System NAD83 (in Feet) (Fipszone 3702). All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, index maps, legends, or other information associated with the principal map. Cadastral map showing property boundaries, areas, lot numbers, and names of landowers. Includes features such as roads, drainage, and more. Includes inset: A ground plan of the city of Philadelphia. Also includes extensive text and index of landowners. This layer is part of a selection of digitally scanned and georeferenced historic maps from The Harvard Map Collection as part of the Imaging the Urban Environment project. Maps selected for this project represent major urban areas and cities of the world, at various time periods. These maps typically portray both natural and manmade features at a large scale. The selection represents a range of regions, originators, ground condition dates, scales, and purposes.

Philadelphia, Pennsylvania, Reed's map, 1774 (Raster Image) (Image 2 of 2)

This layer is a georeferenced raster image of the historic paper map entitled: Fac simile of Reed's map : to the honourable House of Representatives of the freemen of Pennsylvania this map of the city and liberties of Philadelphia with the catalogue of purchasers is humbly dedicated by their most obedient humble servant, Iohn Reed, James Smither sculp. Facsimile of a map originally published in 1774. Republished by Charles L. Warner in 1870. Scale [1:23,760]. Covers portions of Philadelphia, Pa. This layer is image 2 of 2 total images of the two sheet source map, representing the western portion of the map. The image inside the map neatline is georeferenced to the surface of the earth and fit to the Pennsylvania South State Plane Coordinate System NAD83 (in Feet) (Fipszone 3702). All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, index maps, legends, or other information associated with the principal map. Cadastral map showing property boundaries, areas, lot numbers, and names of landowers. Includes features such as roads, drainage, and more. Includes inset: A ground plan of the city of Philadelphia. Also includes extensive text and index of landowners. This layer is part of a selection of digitally scanned and georeferenced historic maps from The Harvard Map Collection as part of the Imaging the Urban Environment project. Maps selected for this project represent major urban areas and cities of the world, at various time periods. These maps typically portray both natural and manmade features at a large scale. The selection represents a range of regions, originators, ground condition dates, scales, and purposes.

The Philadelphia Negro : a social study /

Includes bibliographical references and index.

Second Forum on Innovative Hazardous Waste Treatment Technologies, Domestic and International : Philadelphia, Pennsylvania, May 15-17, 1990 : technical papers.

Mode of access: Internet.

Municipal solid waste, resource recovery : proceedings of the seventh annual research symposium at Philadelphia, Pennsylvania, March 16-18, 1981, by the U.S. EPA Office of Research & Development, Municipal Environmental Research Laboratory, Solid and Hazardous Waste Research Division /

Mode of access: Internet.

Plain catechetical instruction for young communicants, designed to assist them in forming Scriptural views of the Lord's Supper. With an address to young persons not yet communicants, and a few meditations and helps for self-examination.

Mode of access: Internet.

The Reformed Presbyterian and covenanter.

Editors: 1863-73, Thomas Sproull (1863-66, with J.M. Willson; 1868-73, with J.W. Sproull); 1874-95, J.W. Sproull and D.B. Willson.