Wegener's granulomatosis in Finland in 1981-2000

Objectives: Wegener s granulomatosis (WG) is a vasculitis with a predilection for the airways and kidneys. An increasing incidence and improved prognosis of WG has been shown. The aim of this study was to evaluate the incidence, clinical presentation, diagnostic delay, risk of dialysis-dependent renal insufficiency and mortality of WG in 1981-2000. Patients and methods: Data was retrieved from the Finnish hospital discharge register and hospital case reports. Patients diagnosed with WG in 1981-2000 were included, and their demographic and clinical data recorded. The patients were crossed with the national kidney dialysis register and the national mortality statistics. Results: A total of 492 patients (243 ♂ , 249 ♀) were diagnosed at a mean age of 54 years (SD 18). The incidence increased from 1.9 to 9.3/ million/ year. The median diagnostic delay decreased from 17 to 4 months. Patients presented most often with symptoms of the ear, nose and throat (ENT) (45%), lung (36%), musculoskeletal system (22%) and kidney (11%). Initial lung involvement, constitutional symptoms, high erythrocyte sedimentation rate (ESR) and high ELK scores [(number of simultaneously involved organ groups (ENT, Lung, Kidney)] were associated with a shorter diagnostic delay. Medical treatment of WG patients remained similar in the 1980s and 1990s. Almost 90% of patients received cyclophosphamide (CYC) and more than 90% glucocorticoid medication at some point during the course of the disease. Eighty-four patients (17%) needed dialysis. Initial renal involvement and elevated serum creatinine values were related to an increased risk of dialysis-dependent kidney disease. In two-thirds of the patients, renal impairment was reversible. Dialysis became chronic (>3 months) in 32 patients (6.5%). Nineteen patients (3.9%) received a kidney transplant. Altogether 203 patients (99 men, 104 women) died before 30 June 2005. WG was the underlying cause of death in 37%. The crude one-year and five-year survival rates were 83.3% and 74.2%, respectively. The standardized mortality ratio was 3.43 (95% CI = 2.98 to 3.94). Older age and elevated creatinine level at diagnosis predicted shorter survival. ENT symptoms at presentation and treatment with CYC were associated with better outcome. There was no additional risk associated with male gender or with either of the decades (1981-1990 and 1991-2000) Conclusions: In 1981-2000, the incidence of WG increased ca. 4.5-fold and diagnostic delay decreased to ca. one-fourth, reflecting increased recognition of the disease and improved diagnostic means. WG patients are at great risk of developing dialysis-dependent renal insufficiency and an increased risk of dying. During the study period the treatment of WG did not change markedly, nor did the prognosis improve.

Models for spin-state transitions in solids

The model for spin-state transitions described by Bari and Sivardiere (1972) is static and can be solved exactly even when the dynamics of the lattice are included; the dynamic model does not, however, show any phase transition. A coupling between the octahedra, on the other hand, leads to a phase transition in the dynamical two-sublattice displacement model. A coupling of the spin states to the cube of the sublattice displacement leads to a first-order phase transition. The most reasonable model appears to be a two-phonon model in which an ion-cage mode mixes the spin states, while a breathing mode couples to the spin states without mixing. This model explains the non-zero population of high-spin states at low temperatures, temperature-dependent variations in the inverse susceptibility and the spin-state population ratio, as well as the structural phase transitions accompanying spin-state transitions found in some systems.

A numerical study of projectile impact on mild steel armour plates

The present article deals with the development of a finite element modelling approach for the prediction of residual velocities of hard core ogival-nose projectiles following normal impact on mild steel target plates causing perforation. The impact velocities for the cases analysed are in the range 818–866.3 m/s. Assessment of finite element modelling and analysis includes a comprehensive mesh convergence study using shell elements for representing target plates and solid elements for jacketed projectiles with a copper sheath and a rigid core. Dynamic analyses were carried out with the explicit contact-impact LS-DYNA 970 solver. It has been shown that proper choice of element size and strain rate-based material modelling of target plate are crucial for obtaining test-based residual velocity.The present modelling procedure also leads to realistic representation of target plate failure and projectile sheath erosion during perforation, and confirms earlier observations that thermal effects are not significant for impact problems within the ordnance range. To the best of our knowledge, any aspect of projectile failure or degradation obtained in simulation has not been reported earlier in the literature. The validated simulation approach was applied to compute the ballistic limits and to study the effects of plate thickness and projectile diameter on residual velocity, and trends consistent with experimental data for similar situations were obtained.

Studies on Unsteady Pressure Fields in the Region of Separating and Reattaching Flows

Experimental studies on the measurement of pressure fields in the region of separating and reattaching flows behind several two-dimensional fore-bodies and one axisymmetric body are reported. In particular, extensive measurements of mean pressure, surface pressure fluctuation, and pressure fluctuation within the flow were made for a series of two-dimensional fore-body shapes consisting of triangular nose with varying included angle. The measurements from different bodies are compared and one of the important findings is that the maximum values of rms pressure fluctuation levels in the shear layer approaching reattachment are almost equal to the maximum value of the surface fluctuation levels.

Carotid Surgery : A posse ad esse non valet consequentia

According to a large body of evidence, carotid endarterectomy (CEA) can prevent strokes, provided that appropriate inclusion criteria and high-quality perioperative treatment methods are utilised with low complication rates. From the patient s perspective, it is of paramount importance that the operation is as safe and effective as possible. From the community s point of view, it is important that CEA provision prevents as many strokes as possible. In order to define the stroke preventing potential of CEA in different communities, a comparison between eight European countries and Australia was performed including 53 077 carotid interventions. A more detailed evaluation was performed in Finland, the United Kingdom and Egypt. It could be estimated that many potentially preventable strokes occur due to insufficient diagnostics and CEA provision. The number of CEAs should be at least doubled in the Helsinki region. The theoretical power of CEA provision in stroke prevention varied significantly between the countries. Delay from symptom to surgery has been identified as one of the most important factors influencing the effectiveness of CEA. In 2008 only 11% of CEAs in Helsinki university central hospital (HUCH) were performed within the recommended14 days. Registered data of 673 CEAs in HUCH during 2000-2005 was analyzed. There was no systematic error that would have changed the outcome analysis. However it is important that registers are audited regularly and cross matching of different registries is possible. A previously unpublished method of combining medial mandibulotomy, neck incision and carotid artery interposition was carried out as a collaboration of maxillofacial, ear, nose and throat and vascular surgeons. Five patients were operated on with a technique that was feasible and possible to perform with little morbidity, but due to the significant risks involved, this technique should be reserved for carefully selected cases. In stroke prevention, organisational decisions seem far more important than details in interventional procedures when CEA is performed with low complication rates, as was the case in the present study. A TIA clinic approach with close co-operation between the on-call vascular surgeons, neurologists and radiologists should be available at all centres treating these patients. Patients should have a direct and fast admission to the hospital performing CEA.

Electrochemical tuning and mechanical resilience of single-wall carbon nanotubes

Single-wall carbon nanotubes (SWNTs) are fascinating systems exhibiting many novel physical properties. In this paper, we give a brief review of the structural, electronic, vibrational, and mechanical properties of carbon nanotubes. In situ resonance Raman scattering of SWNTs investigated under electrochemical biasing demonstrates that the intensity of the radial breathing mode varies significantly in a nonmonotonic manner as a function of the cathodic bias voltage, but does not change appreciably under anodic bias. These results can be quantitatively understood in terms of the changes in the energy gaps between the 1 D van Hove singularities in the electron density of states, arising possibly due to the alterations in the overlap integral of pi bonds between the p-orbitals of the adjacent carbon atoms. In the second part of this paper, we review our high-pressure X-ray diffraction results, which show that the triangular lattice of the carbon nanotube bundles continues to persist up to similar to10 GPa. The lattice is seen to relax just before the phase transformation, which is observed at similar to10 GPa. Further, our results display the reversibility of the 2D lattice symmetry even after compression up to 13 GPa well beyond the 5 GPa value observed recently. These experimental results explicitly validate the predicted remarkable mechanical resilience of the nanotubes.

Mean and fluctuating pressure in boat-tail separated flows at transonic speeds

Experiments were carried out investigating the features of mean and unsteady surface pressure fluctuations in boat-tail separated flows relevant to launch vehicle configurations at transonic speeds. The tests were performed on a generic axisymmetric body in the Mach-number range of 0.7-1.2, and the important geometrical parameters, namely, the boat-tail angle and diameter ratio, were varied systematically. The measurements made included primarily the mean and unsteady surface-pressure fluctuations on nine different model configurations. Flow-visualization studies employing a surface oil flow, and schlieren techniques were carried out to infer features like boundary-layer separation, reattachment, and shock waves in the flow. The features of mean and fluctuating surface pressures are discussed in detail including aspects of similarity. It has been observed that, on a generic configuration employed in the present study, the maximum levels of surface-pressure fluctuations in the reattachment zone are appreciably lower than those found on launch vehicle configurations having a bulbous or hammerhead nose shape. A simple correlation is suggested for the maximum value of rms pressure fluctuations in the reattachment zone at different freestream Mach numbers.

Nonlinear measures of respiration: Respiratory irregularity and increased chaos of respiration in patients with panic disorder

Background. Respiratory irregularity has been previously reported in patients with panic disorder using time domain measures. However, the respiratory signal is not entirely linear and a few previous studies used approximate entropy (APEN), a measure of regularity of time series. We have been studying APEN and other nonlinear measures including a measure of chaos, the largest Lyapunov exponent (LLE) of heart rate time series, in some detail. In this study, we used these measures of respiration to compare normal controls (n = 18) and patients with panic disorder (n = 22) in addition to the traditional time domain measures of respiratory rate and tidal volume. Methods: Respiratory signal was obtained by the Respitrace system using a thoracic and an abdominal belt, which was digitized at 500 Hz. Later, the time series were constructed at 4 Hz, as the highest frequency in this signal is limited to 0.5 Hz. We used 256 s of data (1,024 points) during supine and standing postures under normal breathing and controlled breathing at 12 breaths/min. Results: APEN was significantly higher in patients in standing posture during normal as well as controlled breathing (p = 0.002 and 0.02, respectively). LLE was also significantly higher in standing posture during normal breathing (p = 0.009). Similarly, the time domain measures of standard deviations and the coefficient of variation (COV) of tidal volume (TV) were significantly higher in the patient group (p = 0.02 and 0.004, respectively). The frequency of sighs was also higher in the patient group in standing posture (p = 0.02). In standing posture, LLE (p < 0.05) as well as APEN (p < 0.01) contributed significantly toward the separation of the two groups over and beyond the linear measure, i.e. the COV of TV. Conclusion: These findings support the previously described respiratory irregularity in patients with panic disorder and also illustrate the utility of nonlinear measures such as APEN and LLE as additional measures toward a better understanding of the abnormalities of respiratory physiology in similar patient populations as the correlation between LLE, APEN and some of the time domain measures only explained up to 50-60% of the variation. Copyright (C) 2002 S. Karger AG, Basel.

Structural changes in single-walled carbon nanotubes under non-hydrostatic pressures: x-ray and Raman studies

Using in situ x-ray diffraction and Raman scattering techniques, we have investigated the behaviour of single-walled carbon nanotubes bundles under non-hydrostatic pressures. It is seen that the diffraction line corresponding to the two-dimensional triangular lattice in the bundles is not reversible for pressures beyond 5 GPa, in sharp contrast to earlier results under hydrostatic pressure conditions. Most interestingly, radial breathing and tangential Raman modes of the pressure-cycled samples from 21 and 30 GPa match very well with those of the starting sample. Raman and x-ray results put together clearly suggest that the ordering of tubes in the bundles is only marginally regained with a very short coherence length on decompression.

Inception of Cavitation From a Backward Facing Step

Cavitation inception measurements are reported for flow past a downstream facing step with the height of the step varying from about 0.4 to 5 percent of the forebody diameter. The forebody was a 49 mm hemispherical nose and sigmai values were found to be very strong function of the height of the step. In addition, sigmai values were found to depend on whether the boundary layer approaching the step was laminar or turbulent. Generally sigmai values for turbulent case were lower.

Single Cavity Trapped Vortex Combustor Simulations

The present work describes steady and unsteady computation of reacting flow in a Trapped Vortex Combustor. The primary motivation of this study is to develop this concept into a working combustor in modern gas turbines. The present work is an effort towards development of an experimental model test rig for further understanding dynamics of a single cavity trapped vortex combustor. The steady computations with and without combustion have been done for L/D of 0.8, 1 and 1.2; also unsteady non-reacting flow simulation has been done for L/D of 1. Fuel used for the present study is methane and Eddy-Dissipation model has been used for combustion-turbulence interactions. For L/D of 0.8, combustion efficiency is maximum and pattern factor is minimum. Also, primary vortex in the cavity is more stable and symmetric for L/D of 0.8. From unsteady non-reacting flow simulations, it is found that there is no vortex shedding from the cavity but there are oscillations in the span-wise direction of the combustor.

Effect of gas injection on drag and surface heat transfer rates for a 30 degrees semi-apex angle blunt body flying at Mach 5.75

Effect of coolant gas injection in the stagnation region on the surface heat transfer rates and aerodynamic drag for a large angle blunt body flying at hypersonic Mach number is reported for two stagnation enthalpies. A 60° apex-angle blunt cone model is employed for this purpose with air injection at the nose through a hole of 2mm diameter. The convective surface heating rates and aerodynamic drag are measured simultaneously using surface mounted platinum thin film sensors and internally mounted accelerometer balance system, respectively. About 35–40% reduction in surface heating rates is observed in the vicinity of stagnation region whereas 15–25% reduction in surface heating rates is felt beyond the stagnation region at stagnation enthalpy of 1.6MJ/kg. The aerodynamic drag expressed in terms of drag coefficient is found to increase by 20% due to the air injection.

Ballistic Studies on TiB2-Ti Functionally Graded Armor Ceramics

The objective of this paper is to discuss the results of the ballistic testing of spark plasma sintered TiB2-Ti based functionally graded materials (FGMs) with an aim to assess their performance in defeating small-calibre armor piercing projectiles. We studied the efficacy of FGM design and compared its ballistic properties with those of TiB2-based composites as well as other competing ceramic armors. The ballistic properties are critically analyzed in terms of depth of penetration, ballistic efficiency, fractographs of fractured surfaces as well as quantification of the shattered ceramic fragments. It was found that all the investigated ceramic compositions exhibit ballistic efficiency (eta) of 5.1 -5.9. We also found that by increasing the thickness of FGM from 5 mm to 7.8 mm, the ballistic property of the composite degraded. Also, the strength of the ceramic compositions studied is sufficient to completely fracture the nose of the pointed projectile used. Analysis of the ceramic fragments (2 mu m-10 mm) showed that harder the ceramic, coarser were the fragments formed. On comparing the results with available armor systems, it has been concluded that TiB2 based composites can show better ballistic properties, except B4C. SEM analysis of the fragments obtained after testing with FGM showed formation of cleavage steps as well as presence of intergranular cracks, indicating that the FGM fractured by mixed mode of failure. It can be concluded that the FGM developed has lower ballistic properties compared to its monolith TiB2-20 wt.% Ti.

Non-invasive human breath sensor

In this paper, the design and development of a novel low-cost, non-invasive type sensor suitable for human breath sensing is reported. It can be used to detect respiratory disorders like bronchial asthma by analyzing the recorded breathing pattern. Though there are devices like spirometer to diagnose asthma, they are very inconvenient for patient's use because patients are made to exhale air through mouth forcefully. Presently developed sensor will overcome this limitation and is helpful in the diagnosis of respiratory related abnormalities. Polyvinylidene fluoride (PVDF) film in cantilever configuration is used as a sensing element to form the breath sensor. Two identical sensors are mounted on a spectacle frame, such that the tidal flow of inhaled and exhale air will impinge on sensor, for sensing the breathing patterns. These patterns are recorded, filtered, analyzed and displayed using CRO. Further the sensor is calibrated using a U-tube water manometer. The added advantage of piezoelectric type sensing element is that it is self powered without the need of any external power source.