The 11th edition of Harrison's Principles of Internal Medicine welcomes Anthony Fauci to its editorial staff, in addition to more than 85 new contributors. While the organization of the book is similar to previous editions, major emphasis has been placed on disorders that affect multiple organ systems. Important advances in genetics, immunology, and oncology are emphasized. Many chapters of the book have been rewritten and describe major advances in internal medicine. Subjects that received only a paragraph or two of attention in previous editions are now covered in entire chapters. Among the chapters that have been extensively revised are the chapters on infections in the compromised host, on skin rashes in infections, on many of the viral infections, including cytomegalovirus and Epstein-Barr virus, on sexually transmitted diseases, on diabetes mellitus, on disorders of bone and mineral metabolism, and on lymphadenopathy and splenomegaly. The major revisions in these chapters and many

Harrison's Principles of Internal Medicine

An overview of the self-organizing map algorithm, on which the papers in this issue are based, is presented in this article.

The Self-Organizing Map

In this paper we develop new Newton and conjugate gradient algorithms on the Grassmann and Stiefel manifolds. These manifolds represent the constraints that arise in such areas as the symmetric eigenvalue problem, nonlinear eigenvalue problems, electronic structures computations, and signal processing. In addition to the new algorithms, we show how the geometrical framework gives penetrating new insights allowing us to create, understand, and compare algorithms. The theory proposed here provides a taxonomy for numerical linear algebra algorithms that provide a top level mathematical view of previously unrelated algorithms. It is our hope that developers of new algorithms and perturbation theories will benefit from the theory, methods, and examples in this paper.

http://www-math.mit.edu/~edelman/publications/geometry_of_algorithms.pdf

The Geometry of Algorithms with Orthogonality Constraints

结节病易误诊,据王洪武等~([1])收集国内18篇关于此病误诊的文献,误诊率高达63.2%,当然有误诊就会有误治,如孙永昌等~([2])报道26例结节病在影像学检查诊断的第一印象中拟诊结核5例,其中就有2例完成规范的抗结核治疗,为此应引起临床对本病诊治的重视。

Sarcoidosis

Type 2 diabetes mellitus (T2DM) is an expanding global health problem, closely linked to the epidemic of obesity. Individuals with T2DM are at high risk for both microvascular complications (including retinopathy, nephropathy and neuropathy) and macrovascular complications (such as cardiovascular comorbidities), owing to hyperglycaemia and individual components of the insulin resistance (metabolic) syndrome. Environmental factors (for example, obesity, an unhealthy diet and physical inactivity) and genetic factors contribute to the multiple pathophysiological disturbances that are responsible for impaired glucose homeostasis in T2DM. Insulin resistance and impaired insulin secretion remain the core defects in T2DM, but at least six other pathophysiological abnormalities contribute to the dysregulation of glucose metabolism. The multiple pathogenetic disturbances present in T2DM dictate that multiple antidiabetic agents, used in combination, will be required to maintain normoglycaemia. The treatment must not only be effective and safe but also improve the quality of life. Several novel medications are in development, but the greatest need is for agents that enhance insulin sensitivity, halt the progressive pancreatic β-cell failure that is characteristic of T2DM and prevent or reverse the microvascular complications. For an illustrated summary of this Primer, visit: http://go.nature.com/V2eGfN.

Type 2 diabetes mellitus.

Background Frequent attendance affects delivery and cost of effective health services, quality of care, and burden on primary care physicians. The aim of this study was to investigate factors associated with frequent attendance, as well as types of health care utilization, in a Bedouin primary care setting. Methods A case-control study was conducted on adult frequent attenders (FAs) and controls in a primary care clinic serving a Bedouin population in southern Israel. Social, demographic and clinical data were manually extracted by reviewing the clinic's computerized medical records. The associations between these factors and frequent attendance were analyzed. Results The study included 118 cases and 121 controls (59% female, mean age: 39.6 +/- 14.9 years). FAs were more likely to use consultation referrals, prescriptions, investigative studies, laboratory tests, and emergency department referrals than controls and were prescribed more sick-leave days than controls. Controlling for age and gender, FAs were significantly more likely to have a chronic disease (OR = 4.46, 95% CI: 1.86-10.71), use chronic medications (OR = 3.31, 95% CI: 1.57-6.99), have a musculoskeletal disease (OR = 2.08, 95% CI: 1.02-7.49) and be of African Bedouin ethnicity (OR = 2.77, 95% CI: 1.02-7.49). Conclusions FAs in a Bedouin community pose a special challenge for the primary care clinic, as they are more likely to be chronically ill, and utilize referrals to various services and consultations more frequently than controls.

Factors associated with frequent attendance in a Bedouin primary care setting

The authors introduce a modified approach to phoneme recognition. The new method is based on the assumption that efficient features for phoneme identification in connected speech, depend on the examined phoneme and on the surrounding phonemes. Hence in a given phonetic environment, each phoneme si best separated from other phonemes by means of an 'individual' feature set. This leads to a quadratic discriminant. Using the new approach an improvement of 8% in consonant recognition was demonstrated. A labeling algorithm for connected speech recognition is proposed. It employs accumulated information concerning the phonetic environment prior to consonant labeling. >

Selection of optimal features for phoneme recognition in different phonetic environments

In this paper, a novel approach for the design of cohort models for word spotting in continuous speech is presented. This new approach is based on modifying the probability density function of a conventional filler so that regions in the feature space that are related to the keyword will be reduced or removed. By modifying these regions, the filler and keyword models become more orthogonal in the sense that they represent different areas in the feature space, making the filler appropriate to be used as a cohort model. The algorithms, named Gaussian Subtraction (GS) and Gaussian Removal (GR), may be considered discriminative training algorithms.

Gaussian Subtraction (GS) Algorithms for Word Spotting in Continuous Speech

1 Shalom G, Magen E, Babaev M et al. Chronic urticaria and the metabolic syndrome: a cross-sectional community-based study of 11 261 patients. J Eur Acad Dermatol Venereol 2017; https://doi.org/10.1111/jdv.14548. 2 Lapi F, Cassano N, Pegoraro V et al. Epidemiology of chronic spontaneous urticaria: results from a nationwide, population-based study in Italy. Br J Dermatol 2016; 174: 996–1004. 3 Vena GA, Cassano N. The link between chronic spontaneous urticaria and metabolic syndrome. Eur Ann Allergy Clin Immunol 2017; 49: 208–212. 4 Alberti KGMM, Eckel RH, Grundy SM et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009; 120: 1640–1645. 5 Weller K, Groffik A, Church MK et al. Development and validation of the Urticaria Control Test: a patient-reported outcome instrument for assessing urticaria control. J Allergy Clin Immunol 2014; 133: 1365–1372, 1372.e1-6. 6 Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI)–a simple practical measure for routine clinical use. Clin Exp Dermatol 1994; 19: 210–216.

The Investigated Question and Study Design in Cross-sectional Studies Response to 'Chronic Urticaria and the Metabolic Syndrome: a Cross-sectional Community-based Study of 11,261 Patients': Authors' Reply.

A new bit-to-bit ratemeter based on rate multiplication is described. The ratemeter is part of a signal monitoring and processing system used to analyse, respiratory signals of neonates that are characterised by low and unstable rates. The advantages of the new ratemeter are discussed and a comparison is made with other meters. The response of the ratemeters is demonstrated by means of simulated signals as well as actual neonatal respiratory signals.

Arnon D. Cohen

Papers

Factors associated with frequent attendance in a Bedouin primary care setting

Selection of optimal features for phoneme recognition in different phonetic environments

Gaussian Subtraction (GS) Algorithms for Word Spotting in Continuous Speech

The Investigated Question and Study Design in Cross-sectional Studies Response to 'Chronic Urticaria and the Metabolic Syndrome: a Cross-sectional Community-based Study of 11,261 Patients': Authors' Reply.

Breathing ratemeter for neonatal intensive care.