Campus Box

Chapel Hill, NC, United States

Campus Box

Chapel Hill, NC, United States

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Kumar A.,Campus Box | Brown R.,Campus Box | Dhar R.,Campus Box | Sampson T.,Campus Box | And 2 more authors.
Neurosurgery | Year: 2013

BACKGROUND:: Cerebral infarction is a major contributor to poor outcome after subarachnoid hemorrhage (SAH). Although usually considered a complication of delayed cerebral ischemia, infarcts may also occur early, in relation to initial brain injury or aneurysm-securing procedures. OBJECTIVE:: We analyzed the relative frequency and volume of early vs delayed infarcts after SAH and their relationship to hospital outcome. METHODS:: Retrospective review of consecutive patients admitted with aneurysmal SAH over 4 years who had follow-up brain imaging 7 days or later after admission. Imaging 24 to 48-hours after aneurysm-securing procedures was reviewed to classify infarcts seen on final imaging as early or delayed. Infarct volumes were measured by perimeter tracing and infarct burden calculated for each patient. RESULTS:: Of 250 eligible patients, 205 had follow-up imaging; infarcts were present in 61 patients. Of these, 29 had early infarcts, 16 had delayed infarcts, and 5 had both early and delayed infarcts. Eleven patients with infarcts did not undergo postprocedure computed tomography; these were presumptively classified as having late infarcts. Early and delayed infarcts contributed equally to infarct burden. Early infarcts were associated with aneurysm clipping (odds ratio: 4.2, 95% confidence interval: 1.8-9.5 compared with coiling), whereas delayed infarcts were almost always seen in association with angiographic vasospasm (odds ratio: 3.3, 95% confidence interval: 1.5-7.3). Patients with early as well as late infarcts, especially those with infarct burden more than 30 cm3 had worse hospital discharge disposition. CONCLUSION:: Early infarction occurs frequently after SAH and contributes as much as delayed cerebral ischemia to infarct burden and hospital outcome. Efforts to better understand and modify contributors to early infarction appear warranted. © Congress of Neurological Surgeons.


Noah T.L.,Campus Box | Noah T.L.,Center for Environmental Medicine | Zhou H.,Center for Environmental Medicine | Zhou H.,University of North Carolina at Chapel Hill | And 2 more authors.
Current Opinion in Allergy and Clinical Immunology | Year: 2012

Purpose of review: The purpose of this review is to highlight recent data regarding the impact of exposure to tobacco smoke on influenza virus infection. This is timely because of the continuing pattern for influenza to cause epidemics and pandemics. Recent findings: Experimental animal studies suggest tobacco smoke increases severity of respiratory disease with influenza. The interaction is complex and dependent on dose and chronicity of both virus and smoke exposure. Smoke-induced oxidant stress and suppression of innate immunity are mechanistic factors leading to worse disease. Experiments using human respiratory cells show that tobacco smoke increases viral replication through mechanisms including suppression of antiviral pathways and altered cytokine patterns in cell types with central roles in mucosal innate immunity, such as epithelium, dendritic cells, and natural killer cells. Studies also suggest a role for antioxidant strategies in reducing risk. Human volunteer studies using live attenuated influenza virus as a model appear to corroborate many of these findings. Summary: Exposure to tobacco smoke remains extremely prevalent worldwide. Although avoidance of exposure is a primary goal, it is important to understand the mechanisms underlying increased infection risk with tobacco smoke and other pollutant exposures, so that novel preventive or treatment strategies can be developed. © 2012 Wolters Kluwer Health.


Daugherty Z.,Dartmouth College | Ram A.,University of Melbourne | Virk R.,Campus Box
Selecta Mathematica, New Series | Year: 2013

The affine and degenerate affine Birman-Murakami-Wenzl (BMW) algebras arise naturally in the context of Schur-Weyl duality for orthogonal and symplectic quantum groups and Lie algebras, respectively. Cyclotomic BMW algebras, affine and cyclotomic Hecke algebras, and their degenerate versions are quotients of the affine and degenerate affine BMW algebras. In this paper, we explain how the affine and degenerate affine BMW algebras are tantalizers (tensor power centralizer algebras) by defining actions of the affine braid group and the degenerate affine braid algebra on tensor space and showing that, in important cases, these actions induce actions of the affine and degenerate affine BMW algebras. We then exploit the connection to quantum groups and Lie algebras to determine universal parameters for the affine and degenerate affine BMW algebras. Finally, we show that the universal parameters are central elements-the higher Casimir elements for orthogonal and symplectic enveloping algebras and quantum groups. © 2012 Springer Basel AG.


Oladipupo S.S.,Campus Box | Hu S.,Brookings Biomedical | Santeford A.C.,Campus Box | Yao J.,Brookings Biomedical | And 7 more authors.
Blood | Year: 2011

Neovascularization is a crucial component of tumor growth and ischemia. Although prior work primarily used disease models, delineation of neovascularization in the absence of disease can reveal intrinsic mechanisms of microvessel regulation amenable to manipulation in illness. We created a conditional model of epithelial HIF-1 induction in adult mice (TetON-HIF-1 mice). Longitudinal photoacoustic microscopy (L-PAM) was coincidentally developed for noninvasive, labelfree serial imaging of red blood cellperfused vasculature in the same mouse for weeks to months. TetON-HIF-1 mice evidenced 3 stages of neovascularization: development, maintenance, and transgene-dependent regression. Regression occurred despite extensive and tight pericyte coverage. L-PAM mapped microvascular architecture and quantified volumetric changes in neocapillary morphogenesis, arteriovenous remodeling, and microvessel regression. Developmental stage endothelial proliferation downregulation was associated with a DNA damage checkpoint consisting of p53, p21, and endothelial γ-H2AX induction. The neovasculature was temporally responsive to VEGFR2 immuno-blockade, with the developmental stage sensitive, and the maintenance stage resistant, to DC101 treatment. L-PAM analysis also pinpointed microvessels ablated or resistant to VEGFR2 immuno-blockade. HIF-1-recruited myeloid cells did not mediate VEGFR2 inhibitor resistance. Thus, HIF-1 neovascularization in the absence of disease is self-regulated via cell autonomous endothelial checkpoints, and resistant to angiogenesis inhibitors independent of myeloid cells. © 2011 by The American Society of Hematology.


Though not necessarily one of the stated goals, tihs book goes a long way toward helping touch to shed its undeserved underdog status. The authors situate perception by touch (perhaps in its rightful place) at the intersection of a number of disciplines including psychophysics, cognitive psychology, neuroscience, low vision and blindness, applied psychology, and engineering. The authors have had long and distinguished careers investigating perception by touch in both visually impaired and sighted individuals and have made important contributions in these areas. To some extent, this book is an overview of this (and related) research, though it is also much more than that. As the title implies, the book places particular emphasis on the haptic abilities of visually impaired and blind individuals. However, it also focuses on using the haptic abilities of sighted individuals to understand those of blind individuals, and vice versa. This is perhaps its most valuable contribution. In addition, it provides useful historical and theoretical context for research on the haptic abilities of both populations of people. Finally, it not only provides an overview of the ground already covered but also a preview of the ground yet to be covered, especially considering the recent technological advances in haptic interfaces and related technology. © 2008-2011 IEEE.


Solanki P.,Campus Box | Ray B.,Campus Box
International Journal of Pavement Research and Technology | Year: 2015

In damage analysis of flexible pavement sections, the AASHTO 2002 design guide, also called as MEPDG (Mechanistic-Empirical Pavement Design Guide), adopted a mechanistic-empirical approach. In the MEPDG, the pavement performance is computed using different input parameters that characterize pavement materials, design features and condition. However, these input parameter values are expected to differ to varying degrees and, therefore, the predicted performance may also vary to some degree depending on the input parameter values. The current study evaluated the influence of four input parameters, namely, reliability level, climate, traffic characteristics and modulus values on the performance of selected pavement sections using MEPDG software. Knowledge gained from the sensitivity analysis of different pavement sections using MEPDG is expected to be useful to pavement designers and others using MEPDG for future pavement design. Specifically, this paper focuses on the sensitivity study of flexible pavement sections at four different locations namely, Chicago in Illinois, Grand Forks in North Dakota, Oklahoma City in Oklahoma, and Houston in Texas, for addressing sensitivity towards climatic conditions. For addressing effect of reliability and traffic three levels of reliability (80%, 90%, 95%) and traffic (low, medium, high) were used, respectively, for designing flexible pavement sections. Additionally, sensitivity towards modulus of subgrade soil was evaluated by designing pavement sections containing 6% lime, 15% class C fly ash (CFA), and 15% cement kiln dust (CKD). The performance of each pavement section was monitored for 240 months (20 years) using MEPDG software by generating plots for rutting, alligator cracking, and International Roughness Index (IRI). It was found that rut predicted by MEPDG is sensitive towards climate, modulus values of chemically stabilized layer and reliability level. IRI values showed sensitiveness toward only reliability and traffic level. Alligator cracking showed sensitiveness toward climate with unexpected trend, modulus of chemically stabilized layer, reliability and traffic level. © Chinese Society of Pavement Engineering.


Griffiths K.L.,Campus Box | Khader S.A.,Campus Box
Current Opinion in Immunology | Year: 2014

Vaccination against intracellular pathogens requires generation of a pool of memory T cells able to respond upon infection and mediate either killing of the infected cell or induce killing mechanisms in the infected cell. T cell-inducing vaccines must aim to target the antigen to antigen-presenting cells (APCs) so that it can be presented on MHC molecules on the cell surface. Methods to do this include making use of vectors such as plasmid DNA or viruses, live attenuated pathogens or subunit vaccines targeted and enhanced using adjuvants. The choice of approach should be guided by the phenotype and localization of the desired T cell response. This review will discuss current approaches in the pipeline for the development of T cell-inducing vaccines, including vectored, live attenuated, and subunit vaccines. © 2014 Elsevier Ltd.


Osei D.A.,Campus Box | Calfee R.P.,Campus Box | Stepan J.G.,University of Washington | Boyer M.I.,Campus Box | And 2 more authors.
Journal of Bone and Joint Surgery - American Volume | Year: 2014

Background: Over 60% of patients with carpal tunnel syndrome present with symptoms and findings of nerve compression in both hands. Our goal was to compare patient-rated difficulties in performing activities of daily living in the early postoperative period between those undergoing bilateral carpal tunnel release and those undergoing unilateral carpal tunnel release. Methods: This prospective cohort study enrolled consecutive patients with bilateral carpal tunnel syndrome undergoing bilateral carpal tunnel release (n = 47) or unilateral carpal tunnel release (n = 41). Patient function and disease severity were measured by an abbreviated form of the Disabilities of the Arm, Shoulder and Hand questionnaire, QuickDASH, and the Boston Carpal Tunnel Questionnaire at baseline, at postoperative visit 1 at a mean time (and standard deviation) of 10 ± 3 days, and at postoperative visit 2 at a mean time (and standard deviation) of 30 ± 6 days. Patients rated their difficulty in completing fifteen activities of daily living each day for the first postoperative week. Patients reported the factors that influenced their choice of surgery. Results: There was no difference in baseline function or disease severity between the two groups with regard to QuickDASH and the Boston Carpal Tunnel Questionnaire. Patients in both groups improved after carpal tunnel release with no difference between groups either at postoperative visit 1 for QuickDASH (p = 0.97) and the Boston Carpal Tunnel Questionnaire (p = 0.86) or at postoperative visit 2 for QuickDASH (p = 0.43) and the Boston Carpal Tunnel Questionnaire (p = 0.34). Patients undergoing bilateral carpal tunnel release had more difficulty only during postoperative days 1 to 2 in opening jars (p = 0.03), cooking (p = 0.008), and doing household chores (p = 0.02). Patients in the two groups did not differ (p > 0.05) in their abilities to perform activities of daily living necessary for personal hygiene or independence on any day during the first seven days following surgery with regard to using the bathroom, bathing, dressing, or eating. Although the most common reason why patients chose bilateral carpal tunnel release was to avoid two surgical procedures (42%), the most common reason why patients chose unilateral carpal tunnel release was concern for self-care (36%). Conclusions: Patients with bilateral carpal tunnel syndrome can anticipate more severe functional impairment during the first few postoperative days with bilateral carpal tunnel release compared with unilateral carpal tunnel release, but limitations beyond postoperative day 2 or 3 are similar for bilateral and unilateral carpal tunnel release. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2014 by The Journal of Bone and Joint Surgery, Incorporated.


This essay examines examples from the field of nuclear energy, including the 2011 disaster at Fukushima-Daiichi, through perspectives drawn from phenomenology, social systems theory, and constitutive communication theory. The essay argues that although prevailing approaches to nuclear risk analysis and risk communication seek to represent a world of preexisting phenomena, they also fundamentally constitute the world on which decision-makers, organizations, and communities act. Representations of nuclear risk are inevitably and problematically limited, with important implications for policy, practice, and communicative action. © 2012 Copyright Taylor and Francis Group, LLC.


Meltzer-Brody S.,Campus Box | Meltzer-Brody S.,University of North Carolina at Chapel Hill | Brandon A.R.,University of North Carolina at Chapel Hill | Pearson B.,University of North Carolina at Chapel Hill | And 4 more authors.
Archives of Women's Mental Health | Year: 2014

Women experiencing severe perinatal mental illness during pregnancy or postpartum have unique needs when psychiatric hospitalization is indicated. Although many countries have established mother-baby psychiatric units, similar facilities have not been available in the US. In 2011, the University of North Carolina at Chapel Hill inaugurated the first Perinatal Psychiatry Inpatient Unit in the US. We describe the unique characteristics of the patient population and report clinical outcomes guiding development and refinement of treatment protocols. Ninety-two perinatal patients were admitted between September 2011 and September 2012, and 91 completed self-report measures at admission and discharge. Perinatal unipolar mood disorder was the most frequent primary diagnosis (60.43 %), and 11 patients (12 %) were admitted with psychosis. The data document clinically and statistically significant improvements in symptoms of depression, anxiety, and active suicidal ideation between admission and discharge (p < 0.0001), as assessed by the Edinburgh Postnatal Depression Scale, Patient Health Questionnaire, and Generalized Anxiety Disorder Scale. Overall functioning was also improved, demonstrated by a significant mean difference of -10.96 in total scores of the Work and Social Adjustment Scale (p < 0.0001). Data suggest that delivering specialized and targeted interventions for severe maternal mental illness in a safe and supportive setting produces positive patient outcomes. © 2013 Springer-Verlag.

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