Sonographic visualization and ultrasound-guided block of the third occipital nerve: prospective for a new method to diagnose C2-C3 zygapophysial joint pain

BACKGROUND: Chronic neck pain after whiplash injury is caused by cervical zygapophysial joints in 50% of patients. Diagnostic blocks of nerves supplying the joints are performed using fluoroscopy. The authors' hypothesis was that the third occipital nerve can be visualized and blocked with use of an ultrasound-guided technique. METHODS: In 14 volunteers, the authors placed a needle ultrasound-guided to the third occipital nerve on both sides of the neck. They punctured caudal and perpendicular to the 14-MHz transducer. In 11 volunteers, 0.9 ml of either local anesthetic or normal saline was applied in a randomized, double-blind, crossover manner. Anesthesia was controlled in the corresponding skin area by pinprick and cold testing. The position of the needle was controlled by fluoroscopy. RESULTS: The third occipital nerve could be visualized in all subjects and showed a median diameter of 2.0 mm. Anesthesia was missing after local anesthetic in only one case. There was neither anesthesia nor hyposensitivity after any of the saline injections. The C2-C3 joint, in a transversal plane visualized as a convex density, was identified correctly by ultrasound in 27 of 28 cases, and 23 needles were placed correctly into the target zone. CONCLUSIONS: The third occipital nerve can be visualized and blocked with use of an ultrasound-guided technique. The needles were positioned accurately in 82% of cases as confirmed by fluoroscopy; the nerve was blocked in 90% of cases. Because ultrasound is the only available technique today to visualize this nerve, it seems to be a promising new method for block guidance instead of fluoroscopy.

Numerical and granulometric approaches to geophysical granular flows

Volcanic ash clouds can be fed by an upward-directed eruption column (Plinian column) or by elutriation from extensive pyroclastic-flows (coignimbrite cloud). For large-scale eruptions, there is considerable uncertainty about which mechanism is dominant. Here we analyze in a novel way a comprehensive grainsize database for pyroclastic deposits. We demonstrate that the Mount Pinatubo climactic eruption deposits were substantially derived from coignimbrite clouds, and not only by a Plinian cloud as generally thought. Coignimbrite ash-fall deposits are much richer in breathable <10 m ash (5–25 wt%) than pure Plinian ash at most distances from the source volcano. We also show that coignimbrite ash clouds, as at Pinatubo, are expected to be more water rich than Plinian clouds, leading to removal of more HCl prior to stratospheric injection, thereby reducing their atmospheric impact.

Mechanisms contributing to the deep chlorophyll maximum in Lake Superior

The seasonal appearance of a deep chlorophyll maximum (DCM) in Lake Superior is a striking phenomenon that is widely observed; however its mechanisms of formation and maintenance are not well understood. As this phenomenon may be the reflection of an ecological driver, or a driver itself, a lack of understanding its driving forces limits the ability to accurately predict and manage changes in this ecosystem. Key mechanisms generally associated with DCM dynamics (i.e. ecological, physiological and physical phenomena) are examined individually and in concert to establish their role. First the prevailing paradigm, “the DCM is a great place to live”, is analyzed through an integration of the results of laboratory experiments and field measurements. The analysis indicates that growth at this depth is severely restricted and thus not able to explain the full magnitude of this phenomenon. Additional contributing mechanisms like photoadaptation, settling and grazing are reviewed with a one-dimensional mathematical model of chlorophyll and particulate organic carbon. Settling has the strongest impact on the formation and maintenance of the DCM, transporting biomass to the metalimnion and resulting in the accumulation of algae, i.e. a peak in the particulate organic carbon profile. Subsequently, shade adaptation becomes manifest as a chlorophyll maximum deeper in the water column where light conditions particularly favor the process. Shade adaptation mediates the magnitude, shape and vertical position of the chlorophyll peak. Growth at DCM depth shows only a marginal contribution, while grazing has an adverse effect on the extent of the DCM. The observed separation of the carbon biomass and chlorophyll maximum should caution scientists to equate the DCM with a large nutrient pool that is available to higher trophic levels. The ecological significance of the DCM should not be separated from the underlying carbon dynamics. When evaluated in its entirety, the DCM becomes the projected image of a structure that remains elusive to measure but represents the foundation of all higher trophic levels. These results also offer guidance in examine ecosystem perturbations such as climate change. For example, warming would be expected to prolong the period of thermal stratification, extending the late summer period of suboptimal (phosphorus-limited) growth and attendant transport of phytoplankton to the metalimnion. This reduction in epilimnetic algal production would decrease the supply of algae to the metalimnion, possibly reducing the supply of prey to the grazer community. This work demonstrates the value of modeling to challenge and advance our understanding of ecosystem dynamics, steps vital to reliable testing of management alternatives.

Study of particle movement in the nearshore region of Lake Superior with radioisotope tracers

Biogeochemical processes in the coastal region, including the coastal area of the Great Lakes, are of great importance due to the complex physical, chemical and biological characteristics that differ from those on either the adjoining land or open water systems. Particle-reactive radioisotopes, both naturally occurring (210Pb, 210Po and 7Be) and man-made (137Cs), have proven to be useful tracers for these processes in many systems. However, a systematic isotope study on the northwest coast of the Keweenaw Peninsula in Lake Superior has not yet been performed. In this dissertation research, field sampling, laboratory measurements and numerical modeling were conducted to understand the biogeochemistry of the radioisotope tracers and some particulate-related coastal processes. In the first part of the dissertation, radioisotope activities of 210Po and 210Pb in a variability of samples (dissolved, suspended particle, sediment trap materials, surficial sediment) were measured. A completed picture of the distribution and disequilibrium of this pair of isotopes was drawn. The application of a simple box model utilizing these field observations reveals short isotope residence times in the water column and a significant contribution of sediment resuspension (for both particles and isotopes). The results imply a highly dynamic coastal region. In the second part of this dissertation, this conclusion is examined further. Based on intensive sediment coring, the spatial distribution of isotope inventories (mainly 210Pb, 137Cs and 7Be) in the nearshore region was determined. Isotope-based focusing factors categorized most of the sampling sites as non- or temporary depositional zones. A twodimensional steady-state box-in-series model was developed and applied to individual transects with the 210Pb inventories as model input. The modeling framework included both water column and upper sediments down to the depth of unsupported 210Pb penetration. The model was used to predict isotope residence times and cross-margin fluxes of sediments and isotopes at different locations along each transect. The time scale for sediment focusing from the nearshore to offshore regions of the transect was on the order of 10 years. The possibility of sediment longshore movement was indicated by high inventory ratios of 137Cs: 210Pb. Local deposition of fine particles, including fresh organic carbon, may explain the observed distribution of benthic organisms such as Diporeia. In the last part of this dissertation, isotope tracers, 210Pb and 210Po, were coupled into a hydrodynamic model for Lake Superior. The model was modified from an existing 2-D finite difference physical-biological model which has previously been successfully applied on Lake Superior. Using the field results from part one of this dissertation as initial conditions, the model was used to predict the isotope distribution in the water column; reasonable results were achieved. The modeling experiments demonstrated the potential for using a hydrodynamic model to study radioisotope biogeochemistry in the lake, although further refinements are necessary.

Realistic Single Cell Modeling – from Experiment to Simulation

This tutorial gives a step by step explanation of how one uses experimental data to construct a biologically realistic multicompartmental model. Special emphasis is given on the many ways that this process can be imprecise. The tutorial is intended for both experimentalists who want to get into computer modeling and for computer scientists who use abstract neural network models but are curious about biological realistic modeling. The tutorial is not dependent on the use of a specific simulation engine, but rather covers the kind of data needed for constructing a model, how they are used, and potential pitfalls in the process.

Contributions of the W-boson propagator to the μ and τ leptonic decay rates

We derive closed expressions and useful expansions for the contributions of the tree-level W-boson propagator to the the muon and tau leptonic decay rates. Calling M and m the masses of the initial and final charged leptons, our results in the limit m=0 are valid to all orders in M^2/M_W^2. In the terms of O(m_j^2/M_W^2) (m_j=M,m), our leading corrections, of O(M^2/M_W^2), agree with the canonical value (3/5) M^2/M_W^2, while the coefficient of our subleading contributions, of O(m^2/M_W^2), differs from that reported in the recent literature. A possible explanation of the discrepancy is presented. The numerical effect of the O(m_j^2/M_W^2) corrections is briefly discussed. A general expression, valid for arbitrary values of M_W, M and m in the range M_W>M>m, is given in the Appendix. The paper also contains a review of the traditional definition and evaluation of the Fermi constant.

Experimental adaptation of wild-type canine distemper virus (CDV) to the human entry receptor CD150.

Canine distemper virus (CDV), a close relative of measles virus (MV), is widespread and well known for its broad host range. When the goal of measles eradication may be achieved, and when measles vaccination will be stopped, CDV might eventually cross the species barrier to humans and emerge as a new human pathogen. In order to get an impression how fast such alterations may occur, we characterized required adaptive mutations to the human entry receptors CD150 (SLAM) and nectin-4 as first step to infect human target cells. Recombinant wild-type CDV-A75/17(red) adapted quickly to growth in human H358 epithelial cells expressing human nectin-4. Sequencing of the viral attachment proteins (hemagglutinin, H, and fusion protein, F) genes revealed that no adaptive alteration was required to utilize human nectin-4. In contrast, the virus replicated only to low titres (10(2) pfu/ml) in Vero cells expressing human CD150 (Vero-hSLAM). After three passages using these cells virus was adapted to human CD150 and replicated to high titres (10(5) pfu/ml). Sequence analyses revealed that only one amino acid exchange in the H-protein at position 540 Asp→Gly (D540G) was required for functional adaptation to human CD150. Structural modelling suggests that the adaptive mutation D540G in H reflects the sequence alteration from canine to human CD150 at position 70 and 71 from Pro to Leu (P70L) and Gly to Glu (G71E), and compensates for the gain of a negative charge in the human CD150 molecule. Using this model system our data indicate that only a minimal alteration, in this case one adaptive mutation, is required for adaptation of CDV to the human entry receptors, and help to understand the molecular basis why this adaptive mutation occurs.

Modeling microblogging adoption in the enterprise

Despite a broad range of collaboration tools already available, enterprises continue to look for ways to improve internal and external communication. Microblogging is such a new communication channel with some considerable potential to improve intra-firm transparency and knowledge sharing. However, the adoption of such social software presents certain challenges to enterprises. Based on the results of four focus group sessions, we identified several new constructs to play an important role in the microblogging adoption decision. Examples include privacy concerns, communication benefits, perceptions regarding signal-to-noise ratio, as well codification effort. Integrating these findings with common views on technology acceptance, we formulate a model to predict the adoption of a microblogging system in the workspace. Our findings serve as an important guideline for managers seeking to realize the potential of microblogging in their company.

Forest dynamics during the transition from the Oldest Dryas to the Bølling–Allerød at Gerzensee—a simulation study

The aim of this study was to explore potential causes and mechanisms for the sequence and temporal pattern of tree taxa, specifically for the shift from shrub-tundra to birch–juniper woodland during and after the transition from the Oldest Dryas to the Bølling–Allerød in the region surrounding the lake Gerzensee in southern Central Europe. We tested the influence of climate, forest dynamics, community dynamics compared to other causes for delays. For this aim temperature reconstructed from a δ18O-record was used as input driving the multi-species forest-landscape model TreeMig. In a stepwise scenario analysis, population dynamics along with pollen production and transport were simulated and compared with pollen-influx data, according to scenarios of different δ18O/temperature sensitivities, different precipitation levels, with/without inter-specific competition, and with/without prescribed arrival of species. In the best-fitting scenarios, the effects on competitive relationships, pollen production, spatial forest structure, albedo, and surface roughness were examined in more detail. The appearance of most taxa in the data could only be explained by the coldest temperature scenario with a sensitivity of 0.3‰/°C, corresponding to an anomaly of − 15 °C. Once the taxa were present, their temporal pattern was shaped by competition. The later arrival of Pinus could not be explained even by the coldest temperatures, and its timing had to be prescribed by first observations in the pollen record. After the arrival into the simulation area, the expansion of Pinus was further influenced by competitors and minor climate oscillations. The rapid change in the simulated species composition went along with a drastic change in forest structure, leaf area, albedo, and surface roughness. Pollen increased only shortly after biomass. Based on our simulations, two alternative potential scenarios for the pollen pattern can be given: either very cold climate suppressed most species in the Oldest Dryas, or they were delayed by soil formation or migration. One taxon, Pinus, was delayed by migration and then additionally hindered by competition. Community dynamics affected the pattern in two ways: potentially by facilitation, i.e. by nitrogen-fixing pioneer species at the onset, whereas the later pattern was clearly shaped by competition. The simulated structural changes illustrate how vegetation on a larger scale could feed back to the climate system. For a better understanding, a more integrated simulation approach covering also the immigration from refugia would be necessary, for this combines climate-driven population dynamics, migration, individual pollen production and transport, soil dynamics, and physiology of individual pollen production.

Contribution of Starlette, Stella, and AJISAI to the SLR-derived global reference frame

The contribution of Starlette, Stella, and AJI-SAI is currently neglected when defining the International Terrestrial Reference Frame, despite a long time series of precise SLR observations and a huge amount of available data. The inferior accuracy of the orbits of low orbiting geodetic satellites is the main reason for this neglect. The Analysis Centers of the International Laser Ranging Service (ILRS ACs) do, however, consider including low orbiting geodetic satellites for deriving the standard ILRS products based on LAGEOS and Etalon satellites, instead of the sparsely observed, and thus, virtually negligible Etalons. We process ten years of SLR observations to Starlette, Stella, AJISAI, and LAGEOS and we assess the impact of these Low Earth Orbiting (LEO) SLR satellites on the SLR-derived parameters. We study different orbit parameterizations, in particular different arc lengths and the impact of pseudo-stochastic pulses and dynamical orbit parameters on the quality of the solutions. We found that the repeatability of the East and North components of station coordinates, the quality of polar coordinates, and the scale estimates of the reference are improved when combining LAGEOS with low orbiting SLR satellites. In the multi-SLR solutions, the scale and the Z component of geocenter coordinates are less affected by deficiencies in solar radiation pressure modeling than in the LAGEOS-1/2 solutions, due to substantially reduced correlations between the Z geocenter coordinate and empirical orbit parameters. Eventually, we found that the standard values of Center-of-mass corrections (CoM) for geodetic LEO satellites are not valid for the currently operating SLR systems. The variations of station-dependent differential range biases reach 52 and 25 mm for AJISAI and Starlette/Stella, respectively, which is why estimating station dependent range biases or using station-dependent CoM, instead of one value for all SLR stations, is strongly recommended.This clearly indicates that the ILRS effort to produce CoM corrections for each satellite, which are site-specific and depend on the system characteristics at the time of tracking,is very important and needs to be implemented in the SLR data analysis.

Intermittent hemodialysis treatment in cefepime-induced neurotoxicity: Case report, pharmacokinetic modeling, and review of the literature

Cefepime is a broad-spectrum cephalosporin indicated for in-hospital treatment of severe infections. Acute neurotoxicity, an increasingly recognized adverse effect of this drug in an overdose, predominantly affects patients with reduced renal function. Although dialytic approaches have been advocated to treat this condition, their role in this indication remains unclear. We report the case of an 88-year-old female patient with impaired renal function who developed life-threatening neurologic symptoms during cefepime therapy. She was treated with two intermittent 3-hour high-flux, high-efficiency hemodialysis sessions. Serial pre-, post-, and peridialytic (pre- and postfilter) serum cefepime concentrations were measured. Pharmacokinetic modeling showed that this dialytic strategy allowed for serum cefepime concentrations to return to the estimated nontoxic range 15 hours earlier than would have been the case without an intervention. The patient made a full clinical recovery over the next 48 hours. We conclude that at least 1 session of intermittent hemodialysis may shorten the time to return to the nontoxic range in severe clinically patent intoxication. It should be considered early in its clinical course pending chemical confirmation, even in frail elderly patients. Careful dosage adjustment and a high index of suspicion are essential in this population.

Is the lateral extension of the acromion related to the outcome of shoulder injections?

OBJECTIVE To assess patients' outcomes after subacromial or glenohumeral injections based on the degree of lateral extension of the acromion. METHODS 307 patients were prospectively included after therapeutic fluoroscopy-guided subacromial (n = 148) or glenohumeral (n = 159) injections with anaesthetic and long-acting corticosteroids. Pre- and post-injection outcomes at 1 week and 1 month were obtained using the 11-point numerical rating scale (NRS) for pain. Lateral extension of the acromion was quantified and categorized by the critical shoulder angle (CSA) and the acromion index (AI) on anteroposterior conventional radiographs. RESULTS Patients' outcomes at 1 week and 1 month were significantly improved (p < 0.001) compared to baseline for subacromial and glenohumeral injection patients. Patients with a CSA <35° showed significantly higher pain reduction 1 month after subacromial injection compared to patients with a CSA >35° (4.2 ± 2.6 vs. 3.2 ± 3.0, p = 0.04). A significant difference in the 1-month NRS change in pain scores is noted for smaller AIs after subacromial injection (4.3 ± 2.8 vs. 2.6 ± 2.9; p = 0.01). No significant association was noted between clinical outcome and the lateral extension of the acromion after glenohumeral joint injections. CONCLUSIONS A short lateral extension of the acromion was associated with better clinical outcomes in subacromial injection patients but not in glenohumeral injection patients. KEY POINTS • Patients' outcomes at 1 month improved significantly compared to baseline for subacromial injections. • Patients' outcomes at 1 month improved significantly compared to baseline for glenohumeral injections. • Short acromial lateralization was associated with better clinical outcome after subacromial injection. • The acromial lateralization was not associated with clinical outcome after glenohumeral injection.

A mixed-integer linear programming approach to the optimization of event-bus schedules: a scheduling application in the tourism sector

This paper deals with “The Enchanted Journey,” which is a daily event tour booked by Bollywood-film fans. During the tour, the participants visit original sites of famous Bollywood films at various locations in Switzerland; moreover, the tour includes stops for lunch and shopping. Each day, up to five buses operate the tour. For operational reasons, however, two or more buses cannot stay at the same location simultaneously. Further operative constraints include time windows for all activities and precedence constraints between some activities. The planning problem is how to compute a feasible schedule for each bus. We implement a two-step hierarchical approach. In the first step, we minimize the total waiting time; in the second step, we minimize the total travel time of all buses. We present a basic formulation of this problem as a mixed-integer linear program. We enhance this basic formulation by symmetry-breaking constraints, which reduces the search space without loss of generality. We report on computational results obtained with the Gurobi Solver. Our numerical results show that all relevant problem instances can be solved using the basic formulation within reasonable CPU time, and that the symmetry-breaking constraints reduce that CPU time considerably.

Distamycin-NA: A DNA Analog with an Aromatic Heterocyclic Polyamide Backbone. Part 1. Synthesis and structural analysis of monomers and dimers containing the nucleobase uracil

The synthesis of the monomeric building block 13 and its constitutional isomer 12 of a new type of DNA analog, distamycin-NA, is presented (Schemes 1 and 2). This building block consists of a uracil base attached to a thiophene core unit via a biaryl-like axis. Next to the biaryl-like axis on the thiophene chromophore, a carboxy and an amino substituent are located allowing for oligomerization via peptide coupling. The proof of constitution and the conformational preferences about the biaryl-like axis were established by means of X-ray analyses of the corresponding nitro derivatives 10 and 11. Thus, the uracil bases are propeller-twisted relative to the thiophene core, and bidentate H-bonds occur between two uracil bases in the crystals. The two amino-acid building blocks 12 and 13 were coupled to give the dimers 15 and 16 using dicyclohexylcarbodiimide (DCC) in THF/LiCl and DMF, respectively. While the dimer 15 showed no atropisomerism on the NMR time scale at room temperature, its isomer 16 occurred as distinct diastereoisomers due to the hindered rotation around its biaryl-like axis. Variable-temperature 1H-NMR experiments allowed to determine a rotational barrier of 19 ± 1 kcal/mol in 16. The experimental data were complemented by AM1 calculations.