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Introduction: Hydroxyapatite deposition disease (HADD) is caused by the presence of hydroxyapatite crystals in periarticular spaces oftentimes leading to inflammation, pain, and decreased range of motion. Case Report: A 40-year-old right hand dominant female presented with three days of atraumatic right shoulder pain. Radiographs of the right shoulder were negative. Computed tomographyrevealed a hydroxyapatite deposit adjacent to the acromioclavicular joint. The patient was managed with nonsteroidal anti-inflammatory drugs and a referral to orthopedic surgery. Conclusion: Many instances of HADD will not be diagnosed on plain radiographs, and heightened awareness will provide confidence when ordering confirmatory imaging. Management is typically conservative, however, referral to orthopedic surgery is recommended to ensure improvement and to assess the need for more invasive procedures.

Usûlcülerin çoğu; ruḫṣat gibi konuların da dâhil olduğu ḳıyâstan ma‘dûl aṣıllarda, keffâretlerde ve ḥaddlerde ḳıyâsın câiz olduğu; Hanefî usûlcüler ise bunun câiz olmadığı görüşündedirler. İmâm Şâfi‘î ve onu takiben Cüveynî gibi Şâfi‘î usûlcüler; Hanefî usûlcülerin bu alanlarda ḳıyâsı câiz görmemelerine rağmen birçok hususta ḳıyâs uygulamalarına başvurmak suretiyle çelişkiye düştüklerini öne sürmekte; buna mukâbil Hanefî usûlcüler bunların, büyük ölçüde ḳıyâs formatı dışında kalan lafẓî delâlet tekniklerinden elde edildiğini savunmaktadırlar. Yine de Şâfi‘î usûlcüler, Hanefî usûlcülerin söz konusu ḳıyâs uygulamalarına, -istihsân gibi- ḳıyâstan dahi daha ileri düzeydeki birtakım istinbâṭ yöntemleriyle ulaşıldığı vurgusunda ısrarcıdırlar. Cüveynî’nin ta‘lîl algısının odağında münâsib ma‘na anlayışı yer almaktadır. O, en düşük düzeyli/gizli bir münâsib ma‘nanın varlığında dahi, ta‘lîl mekanizmasını aktifleştirmektedir. Cüveynî, “münâsib ma‘na” formülasyonunu, ḳıyâstan ma‘dûl aṣıllara, keffâretlere ve ḥaddlere başarılı bir şekilde uyarlamış ve neticede bu alanlarda, ḳıyâsın işlerlik/geçerlilik alanını genişletip ḳıyâsa kapalı alanları minimize etmiştir. Cüveynî’nin bu yaklaşımı, onun akılcı kişiliğiyle ve ḳıyâsa verdiği önemle uyum göstermektedir. Bu makalede, -Cüveynî’ye özel referansla- usûlcüler arasında bahsi geçen alanlar çerçevesinde meydana gelen görüş ayrılıkları tartışmalı bir şekilde irdelenip Cüveynî’ye göre ḳıyâsın sınırları ve sınırlılıkları tespit edilmeye çalışılmıştır.

ObjectiveTo evaluate the performance of two machine learning models in predicting the long-term complete pain resolution in patients undergoing ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT).Materials and methodsWithin a 3-year period, 100 consecutive patients who underwent US-PICT for rotator cuff disease were prospectively enrolled. The location, maximum diameter, and type of each calcification were recorded. The degree of calcium retrieval was graded as complete or incomplete. Shoulder pain was assessed with the visual analogue scale (VAS) at baseline, 1-week, 1-month, and 1-year post-treatment. Measurements related to procedural details, patient, and calcification characteristics were used to construct a machine learning model for the prediction of pain at 1-year post-US-PICT. Two distinct models were built, one including VAS data at 1 week and another additionally including pain data at 1-month post-treatment. Variable importance analysis was performed for the 1-week model. Model performance was evaluated by using receiver operating characteristics (ROC) curves and the respective areas under the curve (AUC).ResultsThe model exhibited an AUC of 69.2% for the prediction of complete pain resolution at 1 year. The addition of VAS scores at 1 month did not significantly alter the performance of the algorithm. Age and baseline VAS scores were the most important variables for classification performance.ConclusionThe presented machine learning model exhibited an AUC of almost 70% in predicting complete pain resolution at 1 year. Pain data at 1 month do not appear to improve the performance of the algorithm.

Hydroxyapatite deposition disease (HADD) is a mostly uniarticular, self-limiting condition caused by deposition of hydroxyapatite (HA) crystals in tendons or in the peritendinous soft tissues. Commonly, the glenohumeral joint is affected. More rarely, the HA depot can be cause of a carpal tunnel syndrome due to an acute inflammatory reaction and space-occupying soft tissue oedema. We report a case of acute HA depot located at the volar site of the right wrist with affection of the deep flexor tendons and intraosseous migration into the lunate bone in a 50-year-old female. There are two main goals of this case report: First, to remind the diagnosis of HADD as a cause of wrist pain and also of carpal tunnel syndrome, as this entity being often misdiagnosed clinically, and second, to report a rare case of intraosseous migration of HA crystals into the lunate bone.

Hydroxyapatite crystal deposition disease (HADD) poses diagnostic challenges in the emergency department (ED) as it may clinically present similarly to infection and other musculoskeletal conditions. Misdiagnosis often leads to unnecessary treatments and resource over-utilization. This review article provides an overview of HADD in seven patients who presented to the ED secondary to an acute presentation of this disease process. HADD is a prevalent pathology, which commonly involves the shoulder, followed by the hip, elbow, wrist, and knee. Predisposing risk factors, such as diabetes and certain genetic factors, have also been identified. Clinical history and imaging, particularly radiographs, play a vital role in diagnosing HADD, with characteristic calcification patterns observed in different stages of the disease. Conservative nonsurgical therapy is the mainstay of treatment, providing effective symptom relief in over 90% of cases. By recognizing HADD as a crucial differential diagnosis for patients with acute or chronic pain, healthcare resource utilization can be optimized, leading to improved patient care in the ED.

Cognitive science of religion (CSR) has inspired a number of debunking arguments against god‐belief. They aim to show that the belief‐forming processes that underlie belief in god(s) are unreliable. The debate surrounding these arguments gives the impression that CSR offers new scientific evidence that threatens the rationality of religious belief. This impression, however, is partly misleading. A close look at a few widely discussed debunking arguments shows, first, that CSR theories as such are far from providing sufficient empirical evidence that the belief‐forming processes behind god‐belief are unreliable. Thus, appealing solely to CSR theories makes a debunking argument weak. Second, there are strong arguments that also invoke CSR, but these gain their strength primarily from more familiar claims about evolutionary epistemology and religious diversity. What CSR actually does in these arguments is providing an explanation of why people might believe in gods even if gods did not exist. But explaining is not debunking.

Hydroxyapatite deposition disease (HADD) represents a multifaceted condition characterized by the accumulation of hydroxyapatite crystals in soft tissues, leading to subsequent inflammation and discomfort. The intricate etiology of HADD is the subject of this comprehensive review, which encompasses an in-depth analysis of the four proposed pathogenic mechanisms and a deliberation on the predisposing factors that instigate the development of this disease. In order to provide a thorough understanding of the disease’s progression, this manuscript delineates the stages of HADD—those preceding calcification, occurring during calcification, and following calcification—in meticulous detail. This chronology forms the basis of a complete portrayal of the evolution of HADD. Moreover, this review encompasses an examination of the radiological findings associated with HADD, furnishing an extensive discourse on imaging characteristics. The potential of HADD to mimic other diseases, thereby posing diagnostic challenges, is also articulated. The discourse continues with an investigation of HADD’s differential diagnosis. This section furnishes a robust framework for distinguishing HADD from other conditions based on imaging results. To enrich the understanding of this diagnostic process, case studies illustrating real-world applications are provided. An overview of treatment modalities for HADD, including both conservative and interventional approaches, forms the concluding discussion. The pivotal role of imaging specialists in the diagnosis and management of HADD is emphasized, highlighting their vital contribution to image-guided procedures and disease monitoring.

The Ras al Hadd oceanic dipole is a recurrent association of a cyclone (to the northeast) and of an anticyclone (to the southwest), which forms in summer and breaks up at the end of autumn. It lies near the Ras al Hadd cape, southeast of the Arabian peninsula. Its size is on the order of 100 km. Along the axis of this dipole flows an intense jet, the Ras al Had jet. Using altimetric data and an eddy detection and tracking algorithm (AMEDA: Angular Momentum Eddy Detection and tracking Algorithm), we describe the life cycle of this oceanic dipole over a year (2014–2015). We also use the results of a numerical model (HYCOM, the HYbrid Coordinate Ocean Model) simulation, and hydrological data from ARGO profilers, to characterize the vertical structure of the two eddies composing the dipole, and their variability over a 15 year period. We show that (1) before the dipole is formed, the two eddies that will compose it, come from different locations to join near Ras al Hadd, (2) the dipole remains near Ras al Hadd during summer and fall while the wind stress (due to the summer monsoon wind) intensifies the cyclone, (3) both the anticyclone and the cyclone reach the depth of the Persian Gulf Water outflow, and (4) their horizontal radial velocity profile is often close to Gaussian but it can vary as the dipole interacts with neighboring eddies. As a conclusion, further work with a process model is recommended to quantify the interaction of this dipole with surrounding eddies and with the atmosphere.

In the Arabian Sea, southeast of the Arabian peninsula, an oceanic dipole, named the Ras Al Hadd (RAH) dipole, is formed each year, lying near the Ras Al Hadd cape. The RAH dipole is the association of a cyclonic eddy (CE) to the northeast, with an anticyclonic eddy (AE) to the southwest. This dipole intensifies in the summer monsoon and disappears during the winter monsoon. This dipole has been described previously, but mostly for its surface expression, and for short time intervals. Here, we describe the 3D structure of this dipole over the 2000–2015 period, by combining colocalized ARGO float profiler data (a total of 7552 profiles inside and outside the RAH dipole) with angular momentum eddy detection and tracking algorithm (AMEDA) surface data. We show first the different water masses in and near the RAH dipole. The presence of the Persian Gulf water (PGW) below 200 m depth is confirmed in both eddies. Arabian Sea high salinity water (ASHSW) is found exclusively in the AE; a layer of fresh and cold water is observed above 100 m depth in both eddies. By analyzing the potential density structures, we show that the CE has a surface-intensified structure while the AE is subsurface-intensified. The sea level anomaly shows a 0.04 m elevation above the AE and a 0.2 m depression over the CE. The CE has a faster geostrophic velocity, (vertical velocity, respectively) 0.6 m s−1 than the AE, 0.15 m s−1 (respectively, 3 m day−1 for the CE and 0.6 m day−1 for the AE). After presenting the vertical structure of the dipole, we show the dominance of the nonlinear Ekman pumping in the CE over the linear pumping affecting the dipole. As a consequence, we explain the CE’s longer lifetime by its intensity and shallowness, and by its sensitivity to the interaction with the atmosphere (in particular the wind stress) and with neighboring eddies. We examined the possible (co)existence of symmetric, barotropic, and baroclinic instabilities in both eddies. These instabilities coexist near the surface in both eddies. They are intensified for the CE, which suggests that the CE is unstable and the AE is rather stable or may need a long time to be unstable.