Robert L. Talley

Rituximab improves outcomes for persons with lymphoproliferative disorders and is increasingly used to treat immune-mediated illnesses. Recent reports describe 2 patients with systemic lupus erythematosus and 1 with rheumatoid arthritis who developed progressive multifocal leukoencephalopathy (PML) after rituximab treatment. We reviewed PML case descriptions among patients treated with rituximab from the Food and Drug Administration, the manufacturer, physicians, and a literature review from 1997 to 2008. Overall, 52 patients with lymphoproliferative disorders, 2 patients with systemic lupus erythematosus, 1 patient with rheumatoid arthritis, 1 patient with an idiopathic autoimmune pancytopenia, and 1 patient with immune thrombocytopenia developed PML after treatment with rituximab and other agents. Other treatments included hematopoietic stem cell transplantation (7 patients), purine analogs (26 patients), or alkylating agents (39 patients). One patient with an autoimmune hemolytic anemia developed PML after treatment with corticosteroids and rituximab, and 1 patient with an autoimmune pancytopenia developed PML after treatment with corticosteroids, azathioprine, and rituximab. Median time from last rituximab dose to PML diagnosis was 5.5 months. Median time to death after PML diagnosis was 2.0 months. The case-fatality rate was 90%. Awareness is needed of the potential for PML among rituximab-treated persons.

Click to increase image sizeClick to decrease image size Additional informationNotes on contributorsRobert L. TalleyRobert L. Talley, D.D.S.Dr. Talley is Director of The Temporomandibular Center in Norman, Oklahoma. He has been in practice in Norman since 1971. Dr. Talley is a graduate of the University of Oklahoma and the University of Missouri at Kansas City Dental School. He holds an Assistant Clinical Professorship at the University of Oklahoma Department of Occlusion. He holds memberships in many professional organizations including the American Equilibration Society, the Southwest Academy of Restorative Dentistry, the Cranial Academy, and the American Dental Association. Additionally, he is a Fellow of the Academy of General Dentistry, a Founding Member and Fellow of the Academy and Board of Head, Neck and Facial Pain and TMJ Orthopedics and is a Diplomate in the Academy of Pain Management.Gerald J. MurphyGerald J. Murphy, D.D.S.Dr. Murphy holds a Bachelor of Science Degree in Biology and is a 1972 graduate of the University of Nebraska Medical Center College of Dentistry. He maintains a private practice in Grand Island, Nebraska and a consulting practice in Omaha, Nebraska specializing in the diagnosis and treatment of craniomandibular disorders. He is a Fellow of the Academy of General Dentistry, Founding Member, Member of the Board of Directors and Chairman of the Membership Committee of the American Academy of Head, Neck, Facial Pain and TMJ Orthopedics. He is a Fellow of the International College of Craniomandibular Orthopedics, American Academy of Head and Neck Pain and a Diplomate of the American Academy of Pain Management.Stephen D. SmithStephen D. Smith, D.M.D.Dr. Smith is the Founder and Director of the Temporomandibular Center and Clinical Professor of Maxillo-Temporomandibular Disorders, Department of Otorhinolaryngology at the Philadelphia College of Osteopathic Medicine. He serves as the Temporomandibular Orthopedics Consultant at the Musculoskeletal Institute and the Osteopathic Medical Center/Hospital of Philadelphia. Dr. Smith has published numerous scientific papers and lectured extensively to medical, dental, physical therapy and legal societies throughout the United States and abroad. He is a fellow of the College of Physicians of Philadelphia, the Academy of General Dentistry and the Academy of Head, Neck, Facial Pain and TMJ Orthopedics. He is also a member of the American Academy of Craniomandibular Disorders, the Cranial Academy and the International College of Craniomandibular Orthopedics.Michael A. BaylinMichael A. Baylin, D.D.S.Dr. Baylin graduated Summa Cuma Laude from the University of Maryland in 1966. He spent two years in the Air Force and, in 1968, entered private practice in Baltimore. He has active membership in various professional organizations including the American Equilibration Society, the American Academy of Head, Neck, Facial Pain and TMJ Orthopedics (founding member), American Association of Functional Orthodontics (founding member), American Association for the Study of Headaches and Cranial Academy. Dr. Baylin attained Diplomate status in the Academy of Pain Management and has a multiple disciplinary practice related to Head, Neck and Facial Pain. He is a consultant to the Veterans Administration Hospital and is Director of the Baltimore T.M.J, and Facial Pain Center.Jack L. HadenJack L. Haden, D.D.S.Dr. Hayden received his D.D.S. from the University of Missouri at Kansas City in 1959. He is presently teaching courses in Kansas City at a facility next to his office that provides laboratory and clinical areas for learning. Dr. Haden is a clinical assistant professor at UMKC and also maintains a private practice. He holds membership in the American Equilibration Society, the American College of Dentists, the Pierre Fouchard Society and the American Dental Association, founder and past director of the Seminars on Occlusal Studies. Dr. Haden is on the editorial board of the Cranio Journal and is a Founding Member of the Academy and Board for Head, Neck, Facial Pain and TMJ Orthopedics. He has been lecturing throughout the United States and Canada since 1975.

This contract explored the Biefield-Brown effect which allegedly converts electrostatic energy directly into a propulsive force in a vacuum environment. The program emphasized the the experimental exploration of this electrostatic thrust-generation concept to confirm or deny its existence, to verify its operation under high vacuum conditions, and to establish an experimental database via tests with candidate devices to permit the nature and magnitude of its thrust to be determined. An improved laboratory test configuration was developed for quantifying electrostatically induced propulsive forces on selected devices. This configuration used a vacuum chamber and diffusion pump arrangement which extended conditions to the 1 microtorr range. While attempts were made to increase the driving DC voltage to 50 kV or more, the driving voltages were generally limited to about 19 kV to avoid electrical breakdown problems. Boundary effects arising from the presence of induced surface charges on the walls of the vacuum chamber surrounding the test devices were significant, and had to be taken into account in using the torsion pendulum system to make thrust force measurements. Direct experimental results indicate that no detectable propulsive force was electrostatically induced by applying a static potential difference up to 19 kV between the electrodes of test devices under conditions in which electrical breakdowns did not occur.

The present study has formulated and explored experimentally the feasibility of two concepts for controlling the interior ballistic process in medium caliber, bulk-loaded liquid propellant guns (BLPG). The general nature of ignition and combustion of liquid propellants (LP) in bulk-loaded LP guns-as currently understood-was reviewed to clearly indicate problems that need to be addresses in achieving successful combustion stability, progressivity, and reproducibility in such systems. According, several features were identified with the potential for modifying undesirable characteristics and for achieving various degrees of control of the combustion process in BLPGs. Based on these features, two concepts were formulated to control the BLPG interior ballistics process by gun chamber geometry to control the combustion. These concepts were evaluated in live gun test firings and found to be favorable in achieving significant degree of combustion control. The investigation recommends that further exploration and development of these concepts be undertaken to confirm feasibility, to demonstrate effective control and repeatability of the ballistic process and muzzle velocity, and to provide preliminary BLPG concepts for weaponization.