Diffusion of two particles with a finite interaction potential in one dimension.
We investigate the dynamics of two interacting diffusing particles in an infinite effectively one-dimensional system; the particles interact through a steplike potential of width b and height phi(0) and are allowed to pass one another. By solving the corresponding 2+1-variate Fokker-Planck equation, an exact result for the two-particle conditional probability density function (PDF) is obtained for arbitrary initial particle positions. From the two-particle PDF, we obtain the overtake probability, i.e., the probability that the two particles have exchanged positions at time t compared to the initial configuration. In addition, we calculate the trapping probability, i.e., the probability that the two particles are trapped close to each other (within the barrier width b) at time t, which is mainly of interest for an attractive potential, phi(0)<0. We also investigate the tagged particle PDF, relevant for describing the dynamics of one particle which is fluorescently labeled. Our analytic results are in excellent agreement with the results of stochastic simulations, which are performed using the Gillespie algorithm.


Development of a structural model for the cytoplasmic domain of an integrin.
The cytoplasmic tails of integrin heterodimers play central roles in controlling the activation states of integrins and in transmitting intracellular signals. Despite their short length, no structure of any integrin cytoplasmic domain has been determined. Therefore, molecular models for the cytoplasmic domain of alpha(IIb)beta3, the major platelet integrin, were generated, including models for the individual cytoplasmic tails, the binary alphaIIb-calcium complex, and the ternary alphaIIb-beta3-calcium complex. Structural analysis of circular dichroism spectra were compiled with data obtained from short homologous sequences within crystallized proteins, and with secondary structural predictions to develop starting models for each subunit. These models were subjected to a series of energy minimization and molecular dynamic simulations to generate final models. AlphaIIb was predicted to be ordered at its N-terminus and its C-terminus could accommodate a cation in a multicoordinated complex. The structure of beta3 was dominated by a beta-turn at its NPXY motif (beta3 744-747). In docking of alphaIIb to different sites within beta3, the conformation of the beta3 juxta-transmembrane (beta3 716-721) was greatly altered. This region was confirmed to be a conformational 'hot-spot' by circular dichroism. The conformational flexibility of this juxta-transmembrane region, which is highly conserved amongst integrins, is ideally located to regulate signaling.


Rapidly Progressive White Matter Involvement in Early Childhood: The Expanding Phenotype of Infantile Onset Pompe?
Glycogen accumulation in the central nervous system of patients with classical infantile onset Pompe disease (IOPD) has been a consistent finding on the few post-mortems performed. While delays in myelination and a possible reduction in processing speed have previously been noted, it has only been recently that the potential for clinically significant progressive white matter disease has been noted. The limited reports thus far published infer that in some IOPD patients, this manifests as intellectual decline in the second decade of life. We present a CRIM negative patient, immunomodulated with rituximab and methotrexate at birth, who despite an initial good clinical response to ERT, at the age of just under 4 years, presented with evolving spasticity in the lower limbs. The investigation of which revealed progressive central nervous system involvement. Given both the earlier onset of the symptoms and consanguineous familial pedigree, extensive biochemical and genetic investigation was undertaken to ensure no alternative pathology was elucidated. In light of these findings, we review the radiology and post-mortems of previous cases and discuss the potential mechanisms that may underlie this presentation.


Topoisomerase mutations and efflux are associated with fluoroquinolone resistance in Enterococcus faecalis.
To understand better the mechanisms of fluoroquinolone resistance in Enterococcus faecalis, fluoroquinolone-resistant mutants isolated from Ent. faecalis ATCC 29212 by stepwise selection with sparfloxacin (SPX) and norfloxacin (NOR) were analysed. The results showed the following. (i) In general, fluoroquinolone-resistance mechanisms in Ent. faecalis are similar to those in other Gram-positive bacteria, such as Staphylococcus aureus and Streptococcus pneumoniae, namely, mutants with amino acid changes in both GyrA and ParC exhibited high fluoroquinolone resistance, and single GyrA mutants and a single ParC mutant were more resistant to SPX and NOR, respectively, than the parent strain, indicating that the primary targets of SPX and NOR in Ent. faecalis are DNA gyrase and topoisomerase IV, respectively. (ii) Alterations in GyrB (DeltaKGA, residues 395-397) and ParE (Glu-459 to Lys) were associated with fluoroquinolone resistance in some mutants. Moreover, the facts that the NOR MIC, but not the SPX MIC, decreased in the presence of multidrug efflux pump inhibitors, that NOR accumulation decreased in the cells, and that the EmeA mRNA expression level did not change, strongly suggested that a NorA-like efflux pump, rather than EmeA, was involved in resistance to NOR.


Correlates of child mental health and substance use related emergency department visits in Ontario: A linked population survey and administrative health data study.
Knowledge of the sociodemographic, behavioural, and clinical characteristics of children visiting emergency departments (EDs) for mental health or substance use concerns in Ontario, Canada is lacking. Using data from a population-based survey linked at the individual level to administrative health data, this study leverages a provincially representative sample and quasi-experimental design to strengthen inferences regarding the extent to which children's sociodemographic, behavioural, and clinical characteristics are associated with the risk of a mental health or substance use related ED visit. 9,301 children aged 4-17 years participating in the 2014 Ontario Child Health Study were linked retrospectively (6 months) and prospectively (12 months) with administrative health data on ED visits from the National Ambulatory Care Reporting System. Modified Poisson regression was used to examine correlates of mental health and substance use related ED visits among children aged 4-17 years over a 12-month period following their survey completion date, adjusting for ED visits in the 6 months prior to their survey completion date. Subgroup analyses of youths aged 14-17 years who independently completed survey content related to peer victimisation, substance use, and suicidality were also conducted. Among children aged 4-17 years, older age, parental immigrant status, internalising problems, and perceived need for professional help were statistically significant correlates that increased the risk of a mental health or substance use related ED visit; low-income and suicidal ideation with attempt were statistically significant only among youths aged 14-17 years. Knowledge of the sociodemographic, behavioural, and clinical characteristics of children visiting EDs for mental health and substance use related concerns is required to better understand patient needs to coordinate effective emergency mental health care that optimises child outcomes, and to inform the development and targeting of upstream interventions that have the potential to prevent avoidable ED visits. Growing rates of child mental health and substance use related ED visits have been observed internationally.A population-based survey linked at the individual level to administrative health data was used to examine the extent to which children's sociodemographic, behavioural, and clinical characteristics are associated with the risk of a mental health or substance use related ED visit in Ontario, Canada.Older age, low-income, parental immigrant status, perceived need for professional help, internalising problems, and suicidality increase the risk of an ED visit.Knowledge of the characteristics of children visiting EDs can be used to coordinate effective emergency mental health care that optimises child outcomes, and to inform the development and targeting of upstream interventions that have the potential to prevent avoidable ED visits.


Analysis of surface proteins of rat spermatozoa during epididymal transit and identification of antigens common to spermatozoa, rete testis fluid and cauda epididymal plasma.
Spermatozoa from the testis and cauda epididymidis of the rat were surface labelled with radioactive iodide, extracted with detergent, and the radioactive proteins separated by two-dimensional polyacrylamide gel electrophoresis. In some instances spermatozoa were also surface labelled with tritiated borohydride in the presence of galactose oxidase. Soluble proteins in blood serum, rete testis fluid and cauda epididymal plasma were also iodinated and separated by gel electrophoresis. In addition, aliquants of the radioactive sperm extracts, blood serum and reproductive tract fluids were each immunoprecipitated with polyspecific antisera directed against either testicular sperm membranes, caudal sperm membranes, blood serum, rete testis fluid or cauda epididymal plasma before gel electrophoresis. From the patterns of radioactive proteins detected on the resultant gels, a two-dimensional map was created for each of the sperm extracts and for the various fluids. Proteins which were nonhomologous between testicular and caudal spermatozoa were identified, as well as proteins which were common to spermatozoa and reproductive tract fluids. Epididymal transit was characterized by the loss of certain proteins from the sperm surface, including three borohydride-labelled proteins of Mr 130 000, and by the addition of others, most notably a highly abundant protein of Mr 42 000. Several of the proteins lost from spermatozoa accumulated in the epididymal plasma whilst some of those added to the sperm surface could be identified as direct secretory products of the epididymis. Rete testis fluid contained blood proteins in addition to others presumed to be testis-specific, whilst the composition of cauda epididymal plasma was markedly different from blood serum or rete testis fluid.(ABSTRACT TRUNCATED AT 250 WORDS)


Hospital characteristics and racial disparities in hospital mortality from common medical conditions.
Less is known about racial disparities in mortality from medical conditions than for procedures. We determined whether black-white disparities in risk-adjusted hospital mortality exist for five common conditions (myocardial infarction, congestive heart failure, cerebral vascular accident, gastrointestinal hemorrhage and pneumonia), and to determine the role of hospital characteristics. We used the 2003 Nationwide Inpatient Sample. Where a mortality disadvantage for black patients was demonstrated, additional analyses assessed whether the degree of disparity varied by hospital characteristics. Mortality for black patients was equivalent to or lower than that for white patients for four of the five conditions. Black patients were more likely than white patients to die from gastrointestinal hemorrhage (1.5% vs. 1.1%, p<0.001). In multivariate analysis, hospital racial composition was the only characteristic associated with degree of disparity for gastrointestinal hemorrhage, with hospitals discharging fewer black patients demonstrating greater disparity. In a large, multistate sample, there was no evidence of disparities in mortality for four of five common conditions. Black-white racial disparities in mortality from gastrointestinal hemorrhage, however, may be associated with hospital racial composition.


Inhaled Isopropyl Alcohol for the Treatment of Nausea and Vomiting in a Patient Receiving Palliative Care: A Case Report.
Nausea and vomiting are distressing symptoms experienced by many patients receiving palliative care for serious illness. Common pharmacologic management strategies include 5-HT3 receptor antagonists, antipsychotics, antihistamines, and antimuscarinic agents; however, these agents incur risks of adverse effects. One of the most worrisome risks of commonly used antiemetics is prolonging the QT interval and the associated risk of torsades de pointes. To avoid the dangers of pharmacologic treatment of nausea and vomiting, previous studies in emergency medicine and postoperative settings suggest that inhaled isopropyl alcohol is an inexpensive, safe, and effective nonpharmacologic intervention. This case report highlights the successful use of inhaled isopropyl alcohol for managing nausea and vomiting in a patient with heart failure receiving palliative care.


Gross intestinal adaptations in relation to broiler performance during chronic aflatoxin exposure.
The present trial was conducted to study some morphological, digestive, and electrophysiological variables of the small intestine during chronic exposure of broilers to aflatoxin B(1) (AFB(1)). Ross 308 male chicks (7 d old) were randomly allotted to control (no AFB(1)), low AFB(1) (0.07 mg of AFB(1)/kg), or high AFB(1) (0.75 mg of AFB(1)/kg) diet. The high AFB(1) diet resulted in reduced (P ≤ 0.002) bird performance during the first 4 wk of exposure, whereas the low AFB(1) diet temporarily reduced (P = 0.034) the bird performance during wk 3 of exposure. During wk 4 of exposure, a linear (P ≤ 0.013) decrease in the unit weight of both the duodenum and jejunum was observed with increasing levels of AFB(1). This reduction in unit weight appeared to progress from the proximal (duodenum) to the distal (jejunum) small intestine with increase in the length of exposure and was not accompanied by modulation of electrophysiological variables in jejunal epithelium. Response from amiloride, a specific blocker of epithelial sodium channel, was also similar among jejunal epithelia of birds under different treatments. Interestingly, a compensatory linear (P ≤ 0.002) increase in the length of the duodenum and jejunum under high AFB(1) diets was noted to occur during wk 4 of exposure. Thus, retention of DM and nitrogen was not negatively affected by the AFB(1) diets. These data indicate that the intestine in broilers may adapt to an ongoing dietary challenge to AFB(1).


Exhaled nitric oxide levels in military recruits with new onset asthma.
Approximately 800 United States Air Force basic military trainees (BMTs) are diagnosed with asthma, annually, resulting in separation from the military. With training costs of approximately 10,000 dollars/person, around 8 million dollarsis lost per year. Improved methods in diagnosing asthma would be beneficial. The aim of this study was to determine the fraction of exhaled nitric oxide (FENO), a marker of airway inflammation, in a military recruit population referred for an asthma evaluation. In BMTs referred for respiratory complaints during basic training, FENO levels were determined before an asthma evaluation consisting of a history, physical, baseline spirometry, and histamine bronchoprovocation. Of 172 BMTs who had symptoms suggestive of asthma and underwent histamine bronchoprovocation, 80% were diagnosed with asthma. FENO levels were significantly higher in asthmatic patients than nonasthmatic patients (mean, 30 parts per billion [ppb] versus 19 ppb, p < 0.001; median, 21 ppb versus 17 ppb, p < 0.02). Various FENO cutoff points provided a range of sensitivity and specificity for the diagnosis of asthma. However, an optimal FENO cutoff level for asthma was not obtained. An FENO value of 10.5 ppb provided a sensitivity of 86% for the diagnosis of asthma, but specificity was only 21%. In contrast, an FENO value of 46 ppb provided 100% specificity but only 17% sensitivity. FENO levels were significantly elevated in BMTs diagnosed with asthma but the lack of an optimal cutoff level limits the test as a diagnostic tool for asthma. Additional studies are necessary to determine the value of FENO for asthma screening in a military population.


Electrostatically self-assembled nanocomposite reactive microspheres.
Nanocomposite reactive microspheres with diameters of approximately 1-5 mum were created via electrostatic self-assembly of aluminum and cupric oxide nanoparticles. The ability to utilize this novel approach of bottom-up assembly to create these reactive materials allows for the potential for a more intimate mixture between the two nanoreactants and, thus, an overall more energetic combustion process. Experiments with the self-assembled material demonstrate the ability to achieve ignition and sustain a combustion wave in rectangular microchannels, which does not occur with material having similar amounts of organics mixed via the traditional sonication method.


Long-Distance Dispersal of Fungi.
Dispersal is a fundamental biological process, operating at multiple temporal and spatial scales. Despite an increasing understanding of fungal biodiversity, most research on fungal dispersal focuses on only a small fraction of species. Thus, any discussion of the dispersal dynamics of fungi as a whole is problematic. While abundant morphological and biogeographic data are available for hundreds of species, researchers have yet to integrate this information into a unifying paradigm of fungal dispersal, especially in the context of long-distance dispersal (LDD). Fungal LDD is mediated by multiple vectors, including meteorological phenomena (e.g., wind and precipitation), plants (e.g., seeds and senesced leaves), animals (e.g., fur, feathers, and gut microbiomes), and in many cases humans. In addition, fungal LDD is shaped by both physical constraints on travel and the ability of spores to survive harsh environments. Finally, fungal LDD is commonly measured in different ways, including by direct capture of spores, genetic comparisons of disconnected populations, and statistical modeling and simulations of dispersal data. To unify perspectives on fungal LDD, we propose a synthetic three-part definition that includes (i) an identification of the source population and a measure of the concentration of source inoculum and (ii) a measured and/or modeled dispersal kernel. With this information, LDD is defined as (iii) the distance found within the dispersal kernel beyond which only 1% of spores travel.


Aberration correction in 2D echocardiography.
An aberration correction algorithm has been implemented and demonstrated in an echocardiographic clinical trial using two-dimensional (2D) imaging. The method estimates and compensates arrival time errors between different sub-aperture processor (SAP) signals in a matrix array probe. Five standard views of channel data cineloops were recorded from 22 patients (11 male and 11 female) resulting in a total of 116 cineloops. The channel data were processed with and without the aberration correction algorithm, allowing for side-by-side comparison of images processed from the same channel data cineloops. The aberration correction algorithm improved image quality, as quantified by a coherence metric, in all 7,380 processed frames. In a blinded and left-right-randomized side-by-side evaluation, four cardiologists (two experienced and two in training) preferred the aberration corrected cineloops in 97% of the cases. The clinicians reported that the corrected cineloops appeared sharper with better contrast and less noise. Many structures like valve leaflets, chordae, endocardium, and endocardial borders appeared narrower and more clearly defined in the aberration corrected images. An important finding is that aberration correction improves contrast between the endocardium and ventricle cavities for every processed image. The gain difference was confirmed by the cardiologists in their feedback and quantified with a median global gain difference estimate between the aberration-corrected and non-corrected images of 1.2 dB. The study shows the potential value of aberration correction in clinical echocardiography. Systematic improvement of images acquired with state-of-art equipment was observed both with quantitative metrics of image quality and clinician preference.


Bedside enteral feeding tube placement into duodenum and jejunum.
A bedside method for placement of nasoenteric feeding tubes is described utilizing gravity and corkscrewing of the feeding tube to pass the pylorus and then air injection to verify position of the tube from the location and character of transmitted sounds to the stethoscope. Twenty-eight of 31 consecutive patients requiring enteral feeding had tubes successfully placed past the pylorus using this method, 25 on the first attempt and three on the second. This method is an effective and inexpensive alternative to endoscopic or fluoroscopic feeding tube placement.


Mass transfer in the biomolecular binding of a target against probe molecules on the surface of microbeads sequestered in wells in a microfluidic cell.
Diagnostic tools which screen the binding interactions of a protein target against a display of biomolecular probes to identify molecules which bind the target are central to cell proteomic studies, and to diagnostic assays. Here, we study a microfluidic design for screening interactions in which the probe molecules are hosted on microbeads sequestered in wells arranged at the bottom of a microfluidic flow channel. Assays are undertaken by streaming an analyte solution with a fluorescently labelled target through the cell, and identifying the fluorescing beads. Numerical simulations are first constructed for the analyte flow over the microbeads in the well array, and the increase in the target concentration on the microbead surface. The binding profile is expressed as a function of the ratio of the convective to the diffusive transport rates (Peclet number or Pe), and the ratio of the kinetic to the diffusive rates (Damkohler number, Da). For any Pe, as Da becomes small enough, the transport is determined by the intrinsic kinetic binding rate. As Pe increases, a thin concentration boundary layer develops over the top surface of the microbead because of the convective flow, and target binds more rapidly. However, the relatively stagnant layers of liquid in the well provide a diffusion barrier which slows the target transport, and for any Da and Pe the transport is slower than equivalent patches of probes arranged on the channel wall. Experiments are also undertaken at high Pe, using the binding of fluorescently labelled NeutrAvidin as a target to probes of its binding partner, biotin, on the microbead surface. The binding profile is compared to the simulations to measure the kinetic rate constant, and this comparison shows that the transport in the cell is not kinetically limited because of the diffusion barriers created by the stagnant liquid layer in the well. Simulations and experiments on microbeads which are only partially recessed in the well demonstrate an increase in the mass transfer rate as more of the microbead surface intersects the flow and the diffusion limitation due to the stagnant layer of liquid surrounding the bottom part of the microbead is minimized.


Perinatal exposure to PCB 153, but not PCB 126, alters bone tissue composition in female goat offspring.
The aim of this study was to investigate if environmentally relevant doses of the putative estrogenic non dioxin-like PCB 153 and the dioxin-like PCB 126 caused changes in bone tissue in female goat offspring following perinatal exposure. Goat dams were orally dosed with PCB 153 in corn oil (98 microg/kg body wt/day) or PCB 126 (49 ng/kg body wt/day) from day 60 of gestation until delivery. The offspring were exposed to PCB in utero and through mother's milk. The suckling period lasted for 6 weeks. Offspring metacarpal bones were analysed using peripheral quantitative computed tomography (pQCT) after euthanisation at 9 months of age. The diaphyseal bone was analysed at a distance of 18% and 50% of the total bone length, and the metaphyseal bone at a distance of 9%. Also, biomechanical three-point bending of the bones was conducted, with the load being applied to the mid-diaphyseal pQCT measure point (50%). PCB 153 exposure significantly decreased the total cross-sectional area (125 mm(2)+/-4) versus non-exposed (142 mm(2)+/-5), decreased the marrow cavity (38 mm(2)+/-4) versus non-exposed (50 mm(2)+/-3) and decreased the moment of resistance (318 mm(3)+/-10) versus non-exposed (371 mm(3)+/-20) at the diaphyseal 18% measure point. At the metaphyseal measure point, the trabecular bone mineral density (121 mg/cm(3)+/-5) was increased versus non-exposed (111 mg/cm(3)+/-3). PCB 126 exposure did not produce any observable changes in bone tissue. The biomechanical testing of the bones did not show any significant changes in bone strength after PCB 153 or PCB 126 exposure. In conclusion, perinatal exposure to PCB 153, but not PCB 126, resulted in altered bone composition in female goat offspring.


Equilibrium fluid-solid coexistence of hard spheres.
We present a tethered Monte Carlo simulation of the crystallization of hard spheres. Our method boosts the traditional umbrella sampling to the point of making practical the study of constrained Gibbs' free energies depending on several crystalline order parameters. We obtain high-accuracy estimates of the fluid-crystal coexistence pressure for up to 2916 particles (enough to accommodate fluid-solid interfaces). We are able to extrapolate to infinite volume the coexistence pressure [p(co)=11.5727(10)k(B)T/σ(3)] and the interfacial free energy [γ({100})=0.636(11)k(B)T/σ(2)].


Comparison between preoperative hook-wire and liquid material localization for pulmonary nodules: a meta-analysis.
Computed tomography (CT)-guided liquid material (LM) and hook-wire (HW) are usually localized for pulmonary nodules (PNs) before video-assisted thoracic surgery (VATS) resection, but the relative advantages of these 2 techniques remain uncertain. This meta-analysis was conceived to juxtapose the efficacy and safety of HW localization (HWL) and LM localization (LML), both guided by CT, for the preoperative localization of PNs. The PubMed, Web of Science, and Wanfang databases were searched to identify relevant studies published as of March 2023, after which pooled analyses of study outcomes were conducted. A total of 7 studies were included in this meta-analysis from 142 relevant studies. These 7 studies included 551 patients (583 PNs) with CT-guided HWL and 551 patients (612 PNs) with LML. The successful localization rate was significantly higher in the LM group (LMG) than in the HW group (HWG) (p = 0.002). The LMG also exhibited significantly lower pooled total complication and lung haemorrhage rates than the HWG (p = 0.007 and 0.00001, respectively). Pooled localization duration, pneumothorax rates, and VATS procedure duration were comparable in both groups (p = 0.45, 0.15, and 0.74, respectively). Furthermore, the pooled postoperative hospital stay was significantly shorter in the LMG than in the HWG (p = 0.009). Significant heterogeneity was detected in the endpoints of localization duration and pneumothorax rate (I2 = 93% and 66%, respectively). CT-guided LML is safer and more successful than HWL for patients with PNs before VATS resection.


Quantitative parameters of enhanced dual-energy computed tomography for differentiating lung cancers from benign lesions in solid pulmonary nodules.
This study aimed to investigate the ability of quantitative parameters of dual-energy computed tomography (DECT) and nodule size for differentiation between lung cancers and benign lesions in solid pulmonary nodules. A total of 151 pathologically confirmed solid pulmonary nodules including 78 lung cancers and 73 benign lesions from 147 patients were consecutively and retrospectively enrolled who underwent dual-phase contrast-enhanced DECT. The following features were analyzed: diameter, volume, Lung CT Screening Reporting and Data System (Lung-RADS) categorization, and DECT-derived quantitative parameters including effective atomic number (Zeff), iodine concentration (IC), and normalized iodine concentration (NIC) in arterial and venous phases. Multivariable logistic regression analysis was used to build a combined model. The diagnostic performance was assessed by area under curve (AUC) of receiver operating characteristic curve, sensitivity, and specificity. The independent factors for differentiating lung cancers from benign solid pulmonary nodules included diameter, Lung-RADS categorization of diameter, volume, Zeff in arterial phase (Zeff_A), IC in arterial phase (IC_A), NIC in arterial phase (NIC_A), Zeff in venous phase (Zeff_V), IC in venous phase (IC_V), and NIC in venous phase (NIC_V) (all P < 0.05). The IC_V, NIC_V, and combined model consisting of diameter and NIC_V showed good diagnostic performance with AUCs of 0.891, 0.888, and 0.893, which were superior to the diameter, Lung-RADS categorization of diameter, volume, Zeff_A, and Zeff_V (all P < 0.001). The sensitivities of IC_V, NIC_V, and combined model were higher than those of IC_A and NIC_A (all P < 0.001). The combined model did not increase the AUCs compared with IC_V (P = 0.869) or NIC_V (P = 0.633). The DECT-derived IC_V and NIC_V may be useful in differentiating lung cancers from benign lesions in solid pulmonary nodules.


[Functional transcranial dopplerography in an atherosclerotic lesion of the carotid arteries].
Transcranial dopplerography (TDG) examination of the blood flow along the major intracranial arteries and cerebral vascular response to functional loads was performed in 51 patients with stenosis and/or occlusion of the internal carotid artery (ICA). The measurements were made on the equipment "Quantascope-103 PC" (Scimed, England). 74% (26 patients) of ICA occlusion subjects had asymmetry of the linear circulation rate (LCR) in the middle-size cerebral arteries (MCA). It occurred with LCR inhibition on the ipsilateral to the occlusion side. In half of ICA stenosis patients the ipsilateral MSA circulation was also reduced. The difference between the two groups in relation to MCA circulation asymmetry was significant (p < 0.001). Nitroglycerin and hypercapnia tests proved more informative than ortho- and antiorthostatic tests. A relationship was found out between overall stenosis of major brain arteries and blood flow along them.


Bilingual and monolingual children prefer native-accented speakers.
Adults and young children prefer to affiliate with some individuals rather than others. Studies have shown that monolingual children show in-group biases for individuals who speak their native language without a foreign accent (Kinzler et al., 2007). Some studies have suggested that bilingual children are less influenced than monolinguals by language variety when attributing personality traits to different speakers (Anisfeld and Lambert, 1964), which could indicate that bilinguals have fewer in-group biases and perhaps greater social flexibility. However, no previous studies have compared monolingual and bilingual children's reactions to speakers with unfamiliar foreign accents. In the present study, we investigated the social preferences of 5-year-old English and French monolinguals and English-French bilinguals. Contrary to our predictions, both monolingual and bilingual preschoolers preferred to be friends with native-accented speakers over speakers who spoke their dominant language with an unfamiliar foreign accent. This result suggests that both monolingual and bilingual children have strong preferences for in-group members who use a familiar language variety, and that bilingualism does not lead to generalized social flexibility.


Narcissistic dimensions and depressive symptoms in patients across mental disorders in cognitive behavioural therapy and in psychoanalytic interactional therapy in Germany: a prospective cohort study.
Narcissistic personality traits have been theorised to negatively affect depressive symptoms, therapeutic alliance, and treatment outcome, even in the absence of narcissistic personality disorder. We aimed to examine how the dimensional narcissistic facets of admiration and rivalry affect depressive symptoms across treatment modalities in two transdiagnostic samples. We did a naturalistic, observational prospective cohort study in two independent adult samples in Germany: one sample pooled from an inpatient psychiatric clinic and an outpatient treatment service offering cognitive behavioural treatment (CBT), and one sample from an inpatient clinic providing psychoanalytic interactional therapy (PIT). Inpatients treated with CBT had an affective or psychotic disorder. For the other two sites, data from all service users were collected. We examined the effect of core narcissism and its facets admiration and rivalry, measured by Narcissistic Admiration and Rivalry Questionnaire-short version, on depressive symptoms, measured by Beck's Depression Inventory and Patient Health Questionnaire-Depression Scale, at baseline and after treatment in patients treated with CBT and PIT. Primary analyses were regression models, predicting baseline and post-treatment depression severity from core narcissism and its facets. Mediation analysis was done in the outpatient CBT group for the effect of the therapeutic alliance on the association between narcissism and depression severity after treatment. The sample included 2371 patients (1423 [60·0%] female and 948 [40·0%] male; mean age 33·13 years [SD 13·19; range 18-81), with 517 inpatients and 1052 outpatients in the CBT group, and 802 inpatients in the PIT group. Ethnicity data were not collected. Mean treatment duration was 300 days (SD 319) for CBT and 67 days (SD 26) for PIT. Core narcissism did not predict depression severity before treatment in either group, but narcissistic rivalry was associated with higher depressive symptom load at baseline (β 2·47 [95% CI 1·78 to 3·12] for CBT and 1·05 [0·54 to 1·55] for PIT) and narcissistic admiration showed the opposite effect (-2·02 [-2·62 to -1·41] for CBT and -0·64 [-1·11 to -0·17] for PIT). Poorer treatment response was predicted by core narcissism (β 0·79 [0·10 to 1·47]) and narcissistic rivalry (0·89 [0·19 to 1·58]) in CBT, whereas admiration showed no effect. No effect of narcissism on treatment outcome was discernible in PIT. Therapeutic alliance mediated the effect of narcissism on post-treatment depression severity in the outpatient CBT sample. As narcissism affects depression severity before and after treatment with CBT across psychiatric disorders, even in the absence of narcissistic personality disorder, the inclusion of dimensional assessments of narcissism should be considered in future research and clinical routines. The relevance of the therapeutic alliance and therapeutic strategy could be used to guide treatment approaches. IZKF Münster. For the German translation of the abstract see Supplementary Materials section.


Morphometric evaluation of the neuroprotective effect of deprenyl on postaxotomic motor neuron losses.
Newborn rats were used to evaluate the neuroprotective effect of deprenyl on spinal motor neurons. The left sides were axotomized at age day 5 and the right sides were kept as a control. One hour after surgery, the operated animals received a daily dose of deprenyl intraperitoneally for 21 days. Each group received 0.25, 10, 30, 45, 60, or 75 mg/kg. The control side received the vehicle only. The number of motor neurons in the L4 through L6 spinal segments in all groups was counted, and the results were tested for normality using the Kolmogorov-Smirnov test. The number of the motor neurons at the axotomized treated sides were compared with those of the intact treated sides using analysis of variance. Significant differences (p < 0.05) were found in all groups except for the highest dose (75 mg/kg). The results in the untreated control showed a significant reduction in the percentage of motor neurons in the axotomized untreated group (-25.6%). The percentages of neuronal response and the percentages of maximal response were calculated, and the results show a sustained increase in percentage of neuronal response, with the highest response at a dose of 45 mg/kg followed by a decline. The results of the regression analysis show that there were two phases in the spinal motor neuron response: an initial neuroprotective phase followed by a neurotoxic declining phase. This study confirms the neuroprotectivity of motor neurons by deprenyl.


A review of patients presenting to accident and emergency department with deliberate self-harm, KwaZulu-Natal, South Africa.
The World Health Organization has described deliberate self-harm (DSH) as a major global health challenge. Little is known about the profile of patients admitted following DSH at district and regional combo hospitals in KwaZulu-Natal, South Africa. The aim of this study was to assess the profiles of patients and reasons for admission following DSH. The study was conducted on data from a busy Accident and Emergency (A&E) department in a combination district and regional hospital situated in Empangeni in northern KwaZulu-Natal. This was a retrospective descriptive study. Data were collected from charts of all patients admitted to the A&E department from April 2012 to March 2013 following DSH. Variables assessed included age, gender, race, occupation, religion, education level, coexisting medical and mental health conditions, and reasons for DSH. Data were entered into SPSS and analysed descriptively. A total of 262 charts were identified and 215 (82%) were selected for inclusion. Most patients admitted following DSH were young, single African women with at least secondary-level education. Most (169/215;78%) admissions were for parasuicide, with relational issues contributing in more than 50% of cases and circumstance challenges contributing in just under 30%. Although an underestimation, DSH is not an uncommon reason for patients to present in the A&E at this district and regional combo hospital. Findings from this study are consistent with those of other studies on DSH and highlight the need for a validated screening tool for the identification of patients at risk of DSH. There is a need to explore community-based intervention, which could address reasons for DSH and prevent future admissions.


Comparison of acoustic particle acceleration detection capabilities in three shark species.
Behavioural studies have shown that sharks are capable of directional orientation to sound. However, only one previous experiment addresses the physiological mechanisms of directional hearing in sharks. Here, we used a directional shaker table in combination with the auditory evoked potential (AEP) technique to understand the broadscale directional hearing capabilities in the New Zealand carpet shark (Cephaloscyllium isabellum), rig shark (Mustelus lenticulatus) and school shark (Galeorhinus galeus). The aim of this experiment was to test if sharks are more sensitive to vertical (z-axis) or head-to-tail (x-axis) accelerations, and whether there are any differences between species. Our results support previous findings, suggesting that shark ears can receive sounds from all directions. Acceleration detection bandwidth was narrowest for the carpet shark (40-200 Hz), and broader for rig and school sharks (40-800 Hz). Greatest sensitivity bands were 40-80 Hz for the carpet shark, 100-200 Hz for the rig and 80-100 Hz for the school shark. Our results indicate that there may be differences in directional hearing abilities among sharks. The bottom-dwelling carpet shark was equally sensitive to vertical and head-to-tail particle accelerations. In contrast, both benthopelagic rig and school sharks appeared to be more sensitive to vertical accelerations at frequencies up to 200 Hz. This is the first study to provide physiological evidence that sharks may differ in their directional hearing and sound localisation abilities. Further comparative physiological and behavioural studies in more species with different lifestyles, habitats and feeding strategies are needed to further explore the drivers for increased sensitivity to vertical accelerations among elasmobranchs.


Clinical impact of overactive bladder.
Overactive bladder (OAB) is a medical condition with the symptoms of urinary frequency and urgency, with or without urge incontinence. Traditionally, epidemiologic studies have focused on the symptom of incontinence, and therefore the prevalence and clinical impact have been grossly underestimated. Recently, several population-based studies have been conducted that have provided insight into the true magnitude of OAB. This article will review the latest data on the prevalence of OAB and discuss the impact of the condition on quality of life. Furthermore, it will examine some of the comorbidities associated with OAB and look at the potential economic impact of OAB.


The effects of dose and radiation quality on the shape and power saturation of the EPR signal in alanine.
Variations in the shape and the power saturation of EPR spectra of L-alanine irradiated with photons, electrons, neutrons and protons are reported. It is shown that the ratio of the intensities of the satellite lines attributable to "spin flips" and the central line depend on the EPR microwave power, and it is proposed as a quantitative measure of the signal saturation effect. Dependence of this ratio on the microwave power is affected by the radiation quality and for doses in excess of 10 kGy by the absorbed dose. At high doses of low-LET radiation these changes are attributed to a high local density of free radicals, while for low doses of high-LET radiation these are due to changes induced in the crystal lattice. Consequently, the conventional peak-to-peak amplitude measurement of the EPR signal intensity is inaccurate when used for high doses and for comparison between radiations with different beam quality. The possibility to determine radiation quality from an EPR measurement is discussed.


Synthesis, structure and magnetism of homologous series of polycrystalline cobalt alkane mono- and dicarboxylate soaps.
Carboxylate-bridged chain complexes of Co(II) (the diaquacobalt(II) mono- and ,-dialkanoates) form two homologous series of layered compounds which have been fully characterised both structurally and magnetically. The crystal structures of two selected members, [Co[CH3(CH2)10COO]2(H2O)2] and [Co[CH3(CH2)18COO]2(H2O)2], have been solved by X-ray powder diffraction and selected-area electron diffraction methods, and refined by the Rietveld technique. Crystal data: monoclinic, P 2(1)/a; a=9.688(1), b=7.5495(9), c=37.281(5) A, =96.70(3) primary, Z=4; and monoclinic, P 2(1)/a; a=9.7260(7), b=7.5477(7), c=57.53(1) A, =94.66(4) primary, Z=4, respectively. Their isomorphous structures contain layers of octahedral diaquacobalt(II) ions bonded to two chemically inequivalent alkanoates, one chelating and one bridging two Co atoms about 6.3 A apart, thus confirming the rare anti-anti conformation mode of the -RCOO groups recently proposed for diaquacobalt(II) ,-dodecanedioate. Extensive magnetic characterisation allowed estimation of the feeble antiferromagnetic coupling, which is weaker in the mono- than in the dialkanoate series.


Combination of radiological and biochemical methods to assess bone mineral density of mandible in fully edentulous patients after chemotherapy: a 5-year prospective study.
Osteoporosis is of concern in breast cancer patients who are undergoing chemotherapy. This study compared the bone mineral density (BMD) index of the mandible and hip hinge between patients who were undergoing chemotherapy or breast cancer, and fully edentulous Chinese patients without cancer over a period of 5 years. 120 fully edentulous patients with an average age of 69 who had undergone mastectomy for grade two or three non-metastatic invasive breast ductal carcinoma. This was followed by administration of 5-fluorouracil, cyclophosphamide, and doxorubicin. The 118 fully edentulous cancer-free patients were included as a control group. The first assessment point was 6 months after chemotherapy treatment. The BMD and panoramic and side views of the mandible were measured by gamma-ray and the BMD of left hip hinge was measured using dual energy X-ray absorptiometry. The serum and urine level of bone-specific alkaline phosphatase (BAP), carboxyterminal cross-linked telopeptide of type I collagen (ICTP), as well as liver and renal function tests were determined. These examinations were performed annually for 5 years. The cancer patients demonstrated a statistically significant (p < 0.05) increase in bone resorption of mandible and hip, and an increase in BAP and ICTP levels when compared with the control group. Although data were collected annually there was no statistical significance for the first 3 years. Breast cancer patients undergoing chemotherapy displayed significant resorption of mandibular bones compared with the healthy control, which might result in difficulties in fitting dentures, as it would cause pain and mucosal friction. Thus, concurrent therapy to decrease mandibular bone loss and special considerations in dentures are warranted for these patients.


Frequency of thrombophilic genetic polymorphisms among Saudi subjects compared with other populations.
Thrombophilic mutations increase the tendency toward thromboembolic disease. The aim of this study was to estimate the prevalence of the genetic variants related to thrombophilia among Saudis compared with other populations. Real-time polymerase chain reaction (PCR) genotyping was carried out to determine the polymorphic variants of factor V Leiden 1695G/A, prothrombin 20210G/A, plasmin activator inhibitor 1 4G/5G, methylene tetrahydrofolate reductase (MTHFR) 677C/T, MTHFR 1298A/C, and angiotensin-converting enzyme (ACE) insertion/deletion (I/D) among a representative sample of healthy Saudi subjects. Carraige rate for each of the mutant variants of factor V Leiden (FVL) and FII genes constituted 2% of the surveyed subjects giving an allele frequency of 0.01, homozygous forms of plasminogen activator inhibitor-1 (PAI-1) gene 4G/4G, MTHFR 677TT, 1298CC, and ACE DD were present among 7.7, 2.55, 7, and 51.8% of subjects with a mutant allele frequency of 0.4, 0.19, 0.29, and 0.73, respectively. This study showed that the Saudi population has a peculiar pattern regarding thrombophilic mutations that might warrant additional considerations for prophylaxis.


Spleen rupture associated with septic emboli and endocarditis in a hemodialysis patient.
We present an uremic patient on chronic hemodialysis with splenic septic emboli associated with active infective endocarditis and anaerobic bacteremia complicated by ruptured spleen. A 62-year-old female patient was admitted because of fever and pain in the left upper abdomen and swelling and hematoma around the left brachiocephalic arteriovenous fistula. Transthoracic echocardiography revealed mobile hyperechoic mass (vegetation) on the anterior mitral valve. Abdominal ultrasound scan showed multiple hypoechoic lesions of the enlarged spleen, described as possible necroses or abscesses, and computed tomography showed low-density inhomogeneous lesions in the enlarged spleen with large perisplenic hematoma, with spleen rupture. Blood culture revealed anaerobic Gram-negative bacilli ( Bacteroides spp.), ampicillin resistant. This is the first report of splenic rupture associated with anaerobic bacteremia and splenic septic emboli in a uremic patient on chronic hemodialysis. Splenic septic emboli with abscess/infarction in hemodialysis patients are a rare disorder but could be a consequence of dialysis access site infection and might predispose to splenic rupture. Ultrasound scan of abdomen is fast, inexpensive and easy to perform. As mortality is high, early surgical intervention on vascular access is mandatory.


Alcohol intake and variations in blood pressure by day of examination.
The patterns of drinking and variations in blood pressure and gamma-glutamyl transferase (GGT) by day of examination have been examined in a large prospective study of cardiovascular disease in 7,735 middle-aged men drawn from general practices in 24 British towns. Overall, mean systolic and diastolic BP levels, as well as the prevalence of measured hypertension, were significantly higher on Mondays and lower on Fridays than on other weekdays. Among occasional, moderate weekend (3-6) and heavy weekend (greater than 6 drinks/day) drinkers, although mean BPs were higher in the heavier drinkers, there was little variation in BP from Monday to Thursday in these groups. In all three groups there was a significant fall in mean BP and in the prevalence of hypertension on Friday, more apparent for systolic than for diastolic pressure and more marked in older men. Among daily drinkers, BP tended to be high on Mondays but was not particularly low on Fridays. Heavy weekend drinkers had higher daily BPs than moderate daily drinkers except on a Friday, even though the estimated total weekly intake was similar. The variations in BP by day of examination were not mirrored by changes in GGT concentrations. The different effect of daily and weekend patterns of drinking on BP may explain some of the discrepancies observed between different alcohol-blood pressure studies. Findings from this study have important implications for the detection of hypertension in populations as well as for clinical practice.


Modulational instability and complex dynamics of confined matter-wave solitons.
We study the formation of bright solitons in a Bose-Einstein condensate of 7Li atoms induced by a sudden change in the sign of the scattering length from positive to negative, as reported in a recent experiment [Nature (London) 417, 150 (2002)]]. The numerical simulations are performed by using the Gross-Pitaevskii equation with a dissipative three-body term. We show that a number of bright solitons is produced and this can be interpreted in terms of the modulational instability of the time-dependent macroscopic wave function of the Bose condensate. In particular, we derive a simple formula for the number of solitons that is in good agreement with the numerical results. We find that during the motion of the soliton train in an axial harmonic potential the number of solitonic peaks changes in time and the density of individual peaks shows an intermittent behavior.


Acute cardiovascular effects of traffic-related air pollution (TRAP) exposure in healthy adults: A randomized, blinded, crossover intervention study.
Exposure to traffic-related air pollution (TRAP) may enhance the risk of cardiovascular disease. However, the short-term effects of TRAP components on the cardiovascular system are not well understood. We conducted a randomized, double-blinded, crossover intervention study in which 39 healthy university students spent 2 h next to a busy road. Participants wore a powered air-purifying respirator (PAPR) or an N95 mask. PAPRs were equipped with a filter for particulate matter (PM), a PM and volatile organic compounds (VOCs) filter or a sham filter. Participants were blinded to PAPR filter type and underwent randomized exposures four times, once for each intervention mode. Blood pressure (BP), heart rate (HR) and heart rate variability (HRV) were measured before, during and for 6 h after the roadside exposure. Linear mixed-effect models were used to evaluate the effects of the interventions relative to baseline controlling for other covariates. All HRV measures increased during and following exposure for all intervention modes. Some HRV measures (SDNN and rMSSD during exposure and SDNN after exposure) were marginally affected by PM filtration. Wearing the N95 mask affected VLF power and rMSSD responses to traffic exposure differently than the PAPR interventions. Both systolic and diastolic BP increased slightly during exposure, but then were generally lower than baseline after exposure for the sham and filter interventions. HR, which fell during exposure and mostly remained lower than baseline after exposure, was lower yet with all filter interventions compared to the sham mode following exposure. Therefore, short-term exposure to traffic acutely affects HRV, BP and HR, but N95 mask and PAPR interventions generally show little efficacy in reducing these effects. Removing the PM component of TRAP has some limited effects on HRV responses to exposure but exaggerates the traffic-related decrease in HR. HRV findings from N95 mask interventions need to be interpreted cautiously.


The benefits of prosocial power motivation in leadership: Action orientation fosters a win-win.
Power motivation is considered a key component of successful leadership. Based on its dualistic nature, the need for power (nPower) can be expressed in a dominant or a prosocial manner. Whereas dominant motivation is associated with antisocial behaviors, prosocial motivation is characterized by more benevolent actions (e.g., helping, guiding). Prosocial enactment of the power motive has been linked to a wide range of beneficial outcomes, yet less has been investigated what determines a prosocial enactment of the power motive. According to Personality Systems Interactions (PSI) theory, action orientation (i.e., the ability to self-regulate affect) promotes prosocial enactment of the implicit power motive and initial findings within student samples verify this assumption. In the present study, we verified the role of action orientation as an antecedent for prosocial power enactment in a leadership sample (N = 383). Additionally, we found that leaders personally benefited from a prosocial enactment strategy. Results show that action orientation through prosocial power motivation leads to reduced power-related anxiety and, in turn, to greater leader well-being. The integration of motivation and self-regulation research reveals why leaders enact their power motive in a certain way and helps to understand how to establish a win-win situation for both followers and leaders.


Cultural Values: Can They Explain Differences in Health Utilities between Countries?
Introduction. Health utilities are widely used in health care. The distributions of utilities differ between countries; some countries more often report worse than dead health states, while mild states are valued more or less the same. We hypothesize that cultural values explain these country-related utility differences. Research Question. What is the effect of sociodemographic background, methodological factors, and cultural values on differences in health utilities? Methods and Analyses. Time tradeoff data from 28 EQ-5D valuation studies were analyzed, together with their sociodemographic variables. The dependent variable was Δu, the utility difference between mild and severe states. Country-specific cultural variables were taken from the World Values Survey. Multilevel models were used to analyze the effect of sociodemographic background, methodology (3L v. 5L), and cultural values on Δu. Intraclass correlation (ICC) for country variation was used to assess the impact of the predicting variables on the variation between countries. Results. Substantial variation in Δu was found between countries. Adding cultural values did not reduce ICCs for country variation. Sociodemographic background variables were only weakly associated with Δu and did not affect the ICC. Δu was 0.118 smaller for EQ-5D-5L studies. Discussion.Δu varies between countries. These differences were not explained by national cultural values. In conclusion, despite correction for various variables, utility differences between countries remain substantial and unexplained. This justifies the use of country-specific value sets for instruments such as the EQ-5D.


Computer-based patient record: the essential data set approach.
The clamor for data to study the impact of care, to evaluate clinical performance and justify resource utilization is increasing. The data in demand normally should exist in the record of a clinical encounter. Advances in information technology and software techniques have provided us with tools to develop and implement computer-based patient record systems. The issues that constrain development are integral issues of clinical medicine, such as the variability in medical data, specialized practice of medicine, and differing demands of the numerous end-users of a medical record. This paper describes an approach to develop a computer-based patient record. The focus is on identification of the essential data set by infological data modeling and its implementation in a commercially available package for a physician's office.


Tissue receptor for cholera exotoxin: postulated structure from studies with GM1 ganglioside and related glycolipids.
By a double-diffusion precipitation-in-gel technique, isolated cholera toxin as well as its natural toxoid were shown to be fixed and precipitated by the ganglioside G(M1) but not by any of the related glycolipids G(M3), G(M2), G(M1)-GlcNAc, G(D1a), G(D1b), G(T1), globoside, G(A1), and tetrahexoside-GlcNAc. Twenty-five nanograms of G(M1) was enough to give a precipitation line with 1.2 mug of toxin, whereas about 50 ng was required with this amount of toxoid. G(M1) also inactivated the toxin in the ileal loop as well as in the intradermal models in rabbits. A 1: 1 molar ratio of ganglioside to toxin was found limiting, e.g., 100 pg of G(M1) could inactivate 5 ng (about 50 blueing doses) of isolated toxin. G(M1) inactivated crude toxin (culture fil rate) with the same efficiency as isolated toxin, and the inactivating capacity of G(M1) was unaffected by mixing with other gangliosides, indicating the specificity in the reaction between G(M1) and toxin. The other glycolipids tested did not inactivate toxin except G(D1a) and G(A1) which did so with approximately 1,000 times less efficiency than G(M1). This identified the portion Gal --> GalNAc [Formula: see text] as the critical region in G(M1) for toxin fixation, and it is postulated that this may be the tissue receptor structure for the cholera toxin.


Informed consent and the law--an English legal perspective.
'Informed consent' is a widely used term, but its application in a legal perspective can be varied. American and Commonwealth jurisdictions have developed a 'patient-based' true informed consent approach, whereas in the English legal system a 'doctor-based' approach has traditionally been applied in relation to disclosure of risk. This article will seek to compare these approaches and give a brief overview of some of the key legal rulings which have shaped the requirement of consent. The decision in the English case of Chester vs. Afshar is considered as showing the significance the court attached to the principle of autonomy and using ethical and policy considerations to depart from established principles of English law relating to consent to treatment and disclosure of risk. This review is intended as general information and not as legal advice which should be sought from defence organisation and specialist health care lawyers.


Total quality management implementation in home care agencies. Common questions and answers.
Practically oriented administrators are looking to quality experts to simplify the implementation of total quality management (TQM) in home care agencies. The author focuses on six questions commonly asked by home care administrators as they introduce TQM. She provides practical information on how to get started with a TQM initiative and how to facilitate a return on the investment by promoting results.


[Measuring quality in the German Guideline Programme in Oncology (GGPO)—methodology and implementation].
The German Guideline Programme in Oncology (GGPO) is a joint initiative between the German Cancer Society, the Association of the Scientific Medical Societies in Germany and German Cancer Aid. In accordance with the aims of the German National Cancer Plan, the GGPO supports the systematic development of high-quality guidelines. To enhance implementation and evaluation, the suggestion of performance measures (PMs) derived from guideline recommendations following a standardised methodology is obligatory within the GGPO. For this purpose, PM teams are convened representing the multidisciplinary guideline development groups including clinical experts, methodologists and patient representatives as well as those organisations that take an active part in and share responsibility for documentation and quality improvement, i.e., clinical cancer registries, certified cancer centres and, if appropriate, the institution responsible for external quality assurance according to the German Social Code (SGB). The primary selection criteria for PMs include strength of the underlying recommendation (strong, grade A), existing potential for improvement of care and measurability. The premises of data economy and standardised documentation are taken into account. Between May 2008 and July 2014, 12 guidelines with suggestions for 100 PMs have been published. The majority of the suggested performance measures is captured by the specific documentation requirements of the clinical cancer registries and certified cancer centres. This creates a solid basis for an active quality management and re-evaluation of the suggested PMs. In addition, the suspension of measures should be considered if improvement has been achieved on a broad scale and for a longer period in order to concentrate on a quality-oriented, economic documentation.


Composition and Functional Diversity of Epiphytic Bacterial and Fungal Communities on Marine Macrophytes in an Intertidal Zone.
Marine macrophytes (seagrasses and macroalgae) and their epiphytic microorganisms play an important role in the ecological and biochemical processes of coastal oceans. However, simultaneous comparative studies on the biodiversity and functions of epiphytic bacteria and fungi associated with marine macrophytes have not been conducted. In this study, high-throughput sequencing technology was used to describe the epiphytic bacterial and fungal communities of 11 common macroalgae and 2 seagrasses from an intertidal zone of northern China and compare them with seawater communities. The results showed that Proteobacteria and Bacteroidota were the dominant bacterial phyla in marine macrophytes, whereas Ascomycota, Chytridiomycota, and Basidiomycota were the dominant fungal phyla. The alpha diversity of the bacterial and fungal communities in seagrasses was the highest of all macrophyte samples. This may have been related to their ability to recruit microorganisms from multiple sources. Host phylogeny may influence bacterial community structure, and geographical differences may influence fungal community structure. The FAPROTAX data indicated that C metabolic microbes were enriched in marine macrophytes, while the FUNGuild data indicated that undefined saprotroph, which participated in organic matter degradation, were also enriched in marine macrophytes. These findings provide a theoretical basis regarding the epiphytic microorganisms of macrophytes and may offer new insights to support the improved ecological restoration of seagrass and macroalgae beds.


Externalized conductors and insulation failure in Biotronik defibrillator leads: History repeating or a false alarm?
Conductor externalization and insulation failure are frequent complications with the recalled St. Jude Medical Riata implantable cardioverter-defibrillator (ICD) leads. Conductor externalization is a "unique" failure mechanism: Cables externalize through the insulation ("inside-out" abrasion) and appear outside the lead body. Recently, single reports described a similar failure also for Biotronik leads. Moreover, some studies reported a high rate of electrical dysfunction (not only insulation failure) with Biotronik Linox leads and a reduced survival rate in comparison with the competitors. In this paper we describe the case of a patient with a Biotronik Kentrox ICD lead presenting with signs of insulation failure and conductor externalization at fluoroscopy. Due to the high risk of extraction we decided to implant a new lead, abandoning the damaged one; lead reimplant was uneventful. Subsequently, we review currently available literature about Biotronik Kentrox and Linox ICD lead failure and in particular externalized conductors. Some single-center studies and a non-prospective registry reported a survival rate between 88% and 91% at 5 years for Linox leads, significantly worse than that of other manufacturers. However, the preliminary results of two ongoing multicenter, prospective registries (GALAXY and CELESTIAL) showed 96% survival rate at 5 years after implant, well within industry standards. Ongoing data collection is needed to confirm longer-term performance of this family of ICD leads.


Association of an extracellular protein (chondrocalcin) with the calcification of cartilage in endochondral bone formation.
We examined bovine fetal epiphyseal and growth plate cartilages by immunofluorescence microscopy and immunoelectron microscopy using monospecific antibodies to a newly discovered cartilage-matrix calcium-binding protein that we now call chondrocalcin. Chondrocalcin was evenly distributed at relatively low concentration in resting fetal epiphyseal cartilage. In growth plate cartilage, it was absent from the extracellular matrix in the zone of proliferating chondrocytes but was present in intracellular vacuoles in proliferating, maturing and upper hypertrophic chondrocytes. The protein then disappeared from the lower hypertrophic chondrocytes and appeared in the adjoining extracellular matrix, where it was selectively concentrated in the longitudinal septa in precisely the same location where amorphous mineral was deposited in large amounts as demonstrated by von Kossa staining and electron microscopy. Mineral then spread out from these "nucleation sites" to occupy much of the surrounding matrix. Matrix vesicles were identified in this calcifying matrix but they bore no observable morphological relationship to these major sites of calcification where chondrocalcin was concentrated. Since chondrocalcin is a calcium-binding protein and has a strong affinity for hydroxyapatite, these observations suggest that chondrocalcin may play a fundamental role in the creation of nucleation sites for the calcification of cartilage matrix in endochondral bone formation.


Circannual rhythms of body weight in pallid bats.
Body weights of pallid bats collected in the field were substantially greater during October and December than between April and September. When maintained in the laboratory under constant conditions of photoperiod and temperature, bats manifested circannual rhythms in body weight. These endogenous cycles were observed in adult and juvenile individuals of both sexes and in bats housed in long or short photoperiods (14 or 10 h of light/day). The period of the cycle averaged 10 mo. Photoperiod influenced the timing and magnitude of the body weight cycle; bats kept in short photoperiods achieved peak body weights earlier than animals housed in long day lengths. We propose that day length is one of the proximate factors for synchronization of circannual cycles of pallid bats.


Plasma and urine concentrations of acebutolol and its acetyl metabolite in patients with renal functional impairment.
This study was undertaken to examine the elimination of orally administered acebutolol and its major acetyl metabolite in four healthy controls and seven patients with varying degrees of renal functional impairment. Analysis of acebutolol and its metabolites was undertaken using a high performance liquid chromatographic method. Plasma concentrations of acebutolol and the acetyl metabolite were greater in patients with renal functional impairment than in controls. The elimination of acebutolol did not appear to be influenced by impaired renal function. However the elimination of the acetyl metabolite decreased as renal function diminished. Acebutolol has a major non-renal route of elimination, but the acetyl metabolite (also a beta-adrenoreceptor blocking drug) is primarily excreted by the kidney and may accumulate in renal failure.


Cancer nursing research in Queensland, Australia: barriers, priorities, and strategies for progress.
Nursing research is an integral component of improving the care of people with cancer; however, the literature suggests that many organizational, resource, and attitudinal barriers to research remain. The aim of the present study was to systematically describe the research experience, attitudes, and opinions of nurses in Queensland, Australia, about priorities and strategies for developing cancer nursing research. A mail survey was sent to all 589 members of the Oncology Nurses Group of Queensland to assess their research knowledge, experience, and attitudes. A response rate of 54.2% (319 nurses) was obtained. Results suggest that many nurses in this study have access to and are reading available research regularly. However, many nurses reported only limited education and skills in research, scarce resources, and limited time to participate in research. Few nurses were involved in developing research proposals, were presenting at conferences, or were writing for publication. Despite these constraints, most of the sample indicated high levels of interest in participating in conducting research. Furthermore, most nurses in this study viewed research as important to patient care and as being an important role for clinical nurses. The top 3 priority areas for cancer nursing research were identified as psychosocial support, pain management, and symptom management. Specific strategies identified for developing nursing research included providing information, support, mentorship, and resources. Professional groups were viewed as having an important role in the development of nursing research in education, lobbying, and facilitating networking among researchers.


[Effect of sodium salicylate on the cerebral blood circulation (an experimental and clinical study)].
The effect of sodium salicylate (100 mg/kg intravenously) on the circulation rate of the cerebral blood flow, total arterial pressure, oxygen tension in the cerebral tissue (by the polarographic method) and on the pressure in the brain venous vessels was studied on anesthetized cats with controlled respiration. In rheumatic patients the action of the drug (10 ml of a 10% solution, intravenously) on the rheoencephalographic findings and the total arterial pressure was investigated. Sodium salicylate was shown to raise the tonicity of the intra- and extracranial vessels, to lower the amplitude of the pulse fluctuations and to highten the total arterial pressure. The cerebral circulation depends upon changes in the tonicity of the cerebral vessels and on the total arterial pressure, i. e. with a significant rise of the latter it increases in spite of a greater vascular resistance. Changes in the blood flow are followed by corresponding variations in the PO2 of the brain tissue. No significant changes of the pressure in the venous system of the brain could be established.


No CLL transmission through blood transfusion.
In this issue of Blood, Hjalgrim et al used the Scandinavian Donations and Transfusions (SCANDAT2) database, which includes comprehensive information on donors and recipients of >20 million blood products handled by the Danish and Swedish blood banks between 1968 and 2010, to address the clinically relevant question of whether chronic lymphocytic leukemia (CLL) is transmitted through blood transfusions.


Pcgf1 gene disruption reveals primary involvement of epigenetic mechanism in neuronal subtype specification in the enteric nervous system.
The enteric nervous system (ENS) regulates gut functions independently from the central nervous system (CNS) by its highly autonomic neural circuit that integrates diverse neuronal subtypes. Although several transcription factors are shown to be necessary for the generation of some enteric neuron subtypes, the mechanisms underlying neuronal subtype specification in the ENS remain elusive. In this study, we examined the biological function of Polycomb group RING finger protein 1 (PCGF1), one of the epigenetic modifiers, in the development and differentiation of the ENS by disrupting the Pcgf1 gene selectively in the autonomic-lineage cells. Although ENS precursor migration and enteric neurogenesis were largely unaffected, neuronal differentiation was impaired in the Pcgf1-deficient mice, with the numbers of neurons expressing somatostatin (Sst+ ) decreased in multiple gut regions. Notably, the decrease in Sst+ neurons was associated with the corresponding increase in calbindin+ neurons in the proximal colon. These findings suggest that neuronal subtype conversion may occur in the absence of PCGF1, and that epigenetic mechanism is primarily involved in specification of some enteric neuron subtypes.


Effect of the Curing Temperature of Dental Composites evaluated with a Fluorescent Dye.
With the development of the light-emitting diode (LED) to photo-activate composite resin, greater intensities could be reached without greater elevation of temperature in the mass of the composite resin and in the dental structure arisen from the irradiance in comparison to halogen equipments. This new scenario created a necessity to investigate the influence of temperature over the composite polymerization. Several curing temperatures (Tcure- 0, 25, 50, 75, and 100°C) were used to polymerize a composite resin (Filtek Z250, 3M ESPE) for 40 and 60 s, using the halogen equipment Gnatus Optilight Digital (halogen) and two LEDs that use a new technology to assembly the diodes: LEC 1000 and bright LEC (MM Optics) (LED 1 and LED 2 respectively). The influence of curing temperature, added by the other variables studied, was evaluated using a methodology developed and improved at IFSC/USP, in which the penetration of a fluorescent dye in the body of the photopolymerized composite resin was quantified using fluorescence spectroscopy. According to the final data submitted to an analysis of variance, the presence of two groups of results could be verified: Between 0 and 25°C, both had a great percentage of the dye penetration compared with other Tcure with a variation in penetration from 69.26 ± 8.19% to 90.99 ± 3.38%. In this analysis, the effects of time and temperature were highly notable (p < 0.05) and the lesser value of dye penetration took place at 60 s of photoactivation This penetration was, in average, smaller with the Tcure of 25°C. The results showed that there was an interaction between the equipment and time and between time and temperature; the other group is regarding the Tcure was from 50, 75, and 100°C, despite the p = 0.05, the effect of temperature was notable. The penetration of the dye ranged from 8.87 ± 3.55 to 39.47 ± 8.9%. The effects of equipment and time were highly notable. The penetration with the time of 60 s was in average smaller. Except with the equipment LED 1, the percentages of the dye penetration were greater with the Tcure of 100°C. The smallest average was the Tcure of 50°C and 60 s of photoactivation. Based on the available data regarding the influence of curing temperature on the polymerization process of composite resins, was possible to concluded that small increments of heat increased the degree of conversion. We can assume that the energy supply through the generation of heat by the photopolymerizing devices can function as a heating medium for the reagent system by reducing its viscosity and increasing the mobility and agitation of its components. The dentist must be aware of the effects that exist between the activation devices on the light output and their heat transmission to the composite and the tooth itself. This heat transmission might create a polymer with better characteristics.


Effect of ultrasonic treatment of palygorskite on the catalytic performance of Pd-Cu/palygorskite catalyst for room temperature CO oxidation in humid circumstances.
Pd-Cu/palygorskite catalysts were prepared by a wet impregnation method using palygorskite (PC/N-Pal) and ultrasonic-treated palygorskite (PC/U-Pal) as the support. Their catalytic activities toward CO oxidation at room temperature and in humid circumstances were investigated. PC/U-Pal exhibits much higher catalytic activity and stability than PC/N-Pal under the conditions of 1.0 vol.% CO and 3.3 vol.% H2O in the feed gas. The X-ray diffraction results indicate that quartz impurities were eliminated from the Pal after the ultrasonic treatment, and more copper species exist in the form of Cu2Cl(OH)3 in PC/U-Pal. The temperature-programmed reduction results suggest that there is an enhanced reducibility of PC/U-Pal after ultrasonic treatment. Furthermore, the ultrasonic treatment can properly decrease the hydrophilicity of the support and catalyst, which may also contribute to the excellent catalytic performance.


Low-cost feedback-controlled syringe pressure pumps for microfluidics applications.
Microfluidics are widely used in research ranging from bioengineering and biomedical disciplines to chemistry and nanotechnology. As such, there are a large number of options for the devices used to drive and control flow through microfluidic channels. Commercially available syringe pumps are probably the most commonly used instruments for this purpose, but are relatively high-cost and have inherent limitations due to their flow profiles when they are run open-loop. Here, we present a low-cost ($110) syringe pressure pump that uses feedback control to regulate the pressure into microfluidic chips. Using an open-source microcontroller board (Arduino), we demonstrate an easily operated and programmable syringe pump that can be run using either a PID or bang-bang control method. Through feedback control of the pressure at the inlets of two microfluidic geometries, we have shown stability of our device to within ±1% of the set point using a PID control method and within ±5% of the set point using a bang-bang control method with response times of less than 1 second. This device offers a low-cost option to drive and control well-regulated pressure-driven flow through microfluidic chips.


[Pneumococcal meningitis mortality in children. Prognostic factors in a series of 73 cases].
Despite advances in antibiotic therapy strategies and pediatric intensive care, prognosis of Streptococcus pneumoniae meningitis remains very poor. To determine the factors associated with hospital mortality of children with pneumococcal meningitis. We conducted a retrospective study of 73 cases of childhood pneumococcal meningitis admitted in 4 teaching hospitals in the center of Tunisia during a 8-year period (1995-2002). Hospital mortality was 13.7% (10 of 71 patients), and neurologic sequela were observed in 34.5% of survivors. Based on univariable analysis, five variables were associated with the outcome: Pediatric Risk of Mortality score (p < 0.001), coma (p=0.0009), use of mechanical ventilation (p=0.0001), convulsions (p = 0.0449), and shock (p=0.0085). In multivariable analysis, only 2 factors were independently associated with in-hospital mortality: Pediatric Risk of Mortality score and the use of mechanical ventilation. 11.8% of pneumococcal isolates were intermediate and resistant to penicillin. Non-susceptible pneumococcus strains to penicillin and the use of steroids were not associated significantly with the mortality rate. Pneumococcal meningitis remains a devastating childhood disease. Two variables were independently associated with the in-hospital death in our series (high Pediatric Risk of Mortality score, and the use of mechanical ventilation). According to these data we may recommend the inclusion of vaccination against streptococcus pneumonia in the children's immunization program in Tunisia.


Osteoporotic Fracture Risk and Health Care Burden in Patients With Cirrhosis.
Risk factors for osteoporotic fracture as well as inpatient utilization and mortality have not been thoroughly studied in patients with cirrhosis. We analyzed data from a national database to determine fracture risk in patients with cirrhosis, specific risk factors, and the effect of fractures on health care utilization. We performed an observational study using serial cross-sectional data to examine fracture-related hospitalizations of patients with cirrhosis using the National Inpatient Sample from 2012 to 2013. We collected data on fracture-related hospitalizations and utilization in the form of length of stay (LOS), total hospital costs, and inpatient mortality. We used multivariate regression to determine risk factors for fracture and fracture-related mortality. Patients with cirrhosis and an osteoporotic fracture had a mean LOS of 10.4 days and incurred $26,582 per hospitalization, which were statistically different from noncirrhotic patients with fracture (LOS: 6.60 d, cost: $17,918) and cirrhotic patients without fracture (LOS: 7.84 d, $18,912). Malnutrition was associated with increased odds of fracture [odds ratio (OR), 1.29; 95% confidence interval (CI), 1.20-1.39] and inpatient mortality (OR, 1.40; 95% CI, 1.12-1.76). Obesity was protective against both fracture (OR, 0.78; 95% CI, 0.71-0.85) and fracture-related mortality (OR, 0.82; 95% CI, 0.59-1.14). Hospitalizations for osteoporotic fractures in patients with cirrhosis are a significant source of health care burden and mortality. More attention should be paid to screening patients with cirrhosis for low bone mass. Malnutrition is associated with increased fracture risk and fracture-related mortality, representing a modifiable risk factor worthy of addressing in patients with cirrhosis.


Prolactin-induced activation of nuclear factor kappaB in bovine mammary epithelial cells: role in chronic mastitis.
We sought to determine whether prolactin (PRL) could influence the neutrophilic inflammation that characterizes chronic mastitis. Most of the genes encoding inflammatory proteins depend on the nuclear factor kappaB (NF-kappaB) for their expression. We addressed the hypothesis that immunomodulatory activities of PRL might arise from an increase in NF-kappaB activity. MAC-T cells, a bovine mammary epithelial cell line, were stimulated with increasing concentrations of bovine PRL (1, 5, 25, 125, and 1,000 ng/mL). Level of NF-kappaB binding activity was measured and mRNA was evaluated for IL-1beta, IL-6, IL-8, granulocyte-macrophage colony-stimulating factor (GMCSF), IFN-gamma, and tumor necrosis factor (TNF)-alpha, cytokines known to require NF-kappaB for their maximal transcription. Prolactin activated NF-kappaB; maximal NF-kappaB activation was weaker with PRL than with TNF-alpha at 30 or 180 min poststimulation. In addition, PRL significantly amplified, in a dose-dependent manner, mRNA expression of IL-1beta, IL-6, IL-8, GMCSF, and TNF-alpha. We measured PRL concentrations in blood and milk from healthy and chronic mastitis-infected cows, and studied the relationship between the PRL concentration and the degree of inflammation in the mammary gland as indirectly assessed by somatic cell counts (SCC). Plasma PRL did not differ significantly between healthy and chronic mastitis-affected cows (63.7 and 67.5 ng/mL, respectively). Milk PRL concentration was significantly increased in chronic mastitis-affected quarters with the highest SCC, and had a positive significant correlation between SCC, as well as between the number of neutrophils present in milk samples. The present findings show that PRL promotes an inflammatory response in bovine mammary epithelial cells via NF-kappaB activation, and suggest a role for PRL in the pathogenesis of chronic mastitis.


AGE-modified basement membrane cooperates with Endo180 to promote epithelial cell invasiveness and decrease prostate cancer survival.
Biomechanical strain imposed by age-related thickening of the basal lamina and augmented tissue stiffness in the prostate gland coincides with increased cancer risk. Here we hypothesized that the structural alterations in the basal lamina associated with age can induce mechanotransduction pathways in prostate epithelial cells (PECs) to promote invasiveness and cancer progression. To demonstrate this, we developed a 3D model of PEC acini in which thickening and stiffening of basal lamina matrix was induced by advanced glycation end-product (AGE)-dependent non-enzymatic crosslinking of its major components, collagen IV and laminin. We used this model to demonstrate that antibody targeted blockade of CTLD2, the second of eight C-type lectin-like domains in Endo180 (CD280, CLEC13E, KIAA0709, MRC2, TEM9, uPARAP) that can recognize glycosylated collagens, reversed actinomyosin-based contractility [myosin-light chain-2 (MLC2) phosphorylation], loss of cell polarity, loss of cell-cell junctions, luminal infiltration and basal invasion induced by AGE-modified basal lamina matrix in PEC acini. Our in vitro results were concordant with luminal occlusion of acini in the prostate glands of adult Endo180(Δ) (Ex2-6/) (Δ) (Ex2-6) mice, with constitutively exposed CTLD2 and decreased survival of men with early (non-invasive) prostate cancer with high epithelial Endo180 expression and levels of AGE. These findings indicate that AGE-dependent modification of the basal lamina induces invasive behaviour in non-transformed PECs via a molecular mechanism linked to cancer progression. This study provides a rationale for targeting CTLD2 in Endo180 in prostate cancer and other pathologies in which increased basal lamina thickness and tissue stiffness are driving factors. © 2014 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.


A novel staining protocol for multiparameter assessment of cell heterogeneity in Phormidium populations (cyanobacteria) employing fluorescent dyes.
Bacterial populations display high heterogeneity in viability and physiological activity at the single-cell level, especially under stressful conditions. We demonstrate a novel staining protocol for multiparameter assessment of individual cells in physiologically heterogeneous populations of cyanobacteria. The protocol employs fluorescent probes, i.e., redox dye 5-cyano-2,3-ditolyl tetrazolium chloride, 'dead cell' nucleic acid stain SYTOX Green, and DNA-specific fluorochrome 4',6-diamidino-2-phenylindole, combined with microscopy image analysis. Our method allows simultaneous estimates of cellular respiration activity, membrane and nucleoid integrity, and allows the detection of photosynthetic pigments fluorescence along with morphological observations. The staining protocol has been adjusted for, both, laboratory and natural populations of the genus Phormidium (Oscillatoriales), and tested on 4 field-collected samples and 12 laboratory strains of cyanobacteria. Based on the mentioned cellular functions we suggest classification of cells in cyanobacterial populations into four categories: (i) active and intact; (ii) injured but active; (iii) metabolically inactive but intact; (iv) inactive and injured, or dead.


Epidemiology of malaria in infancy at Enugu, Nigeria.
This was a retrospective study to ascertain the prevalence and clinical features of malaria in infants in Enugu between January 1998 and January 2000. Case notes of two thousand children were reviewed, one hundred and fifty-five (7.75%) had a diagnosis of malaria, with a male/female ratio of 1.2:1. The age range was two days to twelve months with a mean of 5.06 +/- 3.24 months. Nine infants (5.8 %) were less than seven days old. Ninety-nine of the patients (63.9%) had temperature > or = 37.5 degrees C. Diarrhea was a symptom in 52 (33.5%) patients, while vomiting alone or in combination with diarrhea was a presenting feature in 37 (23.87%) of the children. Twenty-eight children (18.1%) had respiratory symptoms of which, two had bronchopneumonia. Other associated illnesses included. septicaemia: 6(3.8%). infective diarrhea; 5(3.2%), and urinary tract infection; 4 (2.6%). Malaria is common in infants less than 6 months of age and associated with symptoms common with other childhood illnesses.


p16 and p53 gene alterations and accumulations in the malignant evolution of intraductal papillary-mucinous tumors of the pancreas.
In general, intraductal papillary-mucinous tumors of the pancreas have a favorable prognosis. However, some invasive carcinomas show a rapid progression and a poor prognosis, such as invasive ductal carcinomas of the pancreas. The aim of this study was to clarify the genetic backgrounds underlying the evolution necessary for these tumors to become invasive carcinomas. Twenty-three patients with intraductal papillary-mucinous tumors, including 9 adenomas, 5 borderline tumors, 3 noninvasive carcinomas, and 6 invasive carcinomas, along with 24 patients with invasive ductal carcinomas were studied. After microdissection, K- ras mutation and loss of heterozygosity (LOH) of the p16 and p53 genes were investigated. In the intraductal papillary-mucinous tumors, K- ras mutations were frequently seen, without a relationship to histological grade. LOH of the p16 gene was observed increasingly with increasing degrees of histological atypia. LOH of the p53 gene was seen only in invasive carcinomas. The frequency of each genetic alteration in invasive carcinomas was the same as that in invasive ductal carcinomas. The accumulation of genetic alterations was as common in invasive carcinomas, as they were in invasive ductal carcinomas. The p16 and p53 gene alterations and accumulations observed are crucial events during the carcinogenesis and malignant progression of intraductal papillary-mucinous tumors of the pancreas.


Dynamic flexibility of the ATPase p97 is important for its interprotomer motion transmission.
The hexameric protein p97, a very abundant type II AAA ATPase (ATPase associated with various cellular activities), is involved in a diverse range of cellular functions. During its ATPase cycle p97 functions as an ATP motor, converting the chemical energy released upon hydrolysis of ATP to ADP into mechanical work, which is then directed toward the proteins that serve as substrates. A key question in this process is: How is the nucleotide-induced motion transmitted from the C-terminal ATPase domain (the D2 domain) of p97 to the distant N-terminal substrate-processing domain? We have previously reported the surprising finding that motion transmission between the two ATPase domains (the D2 and D1 domains) is mediated by the D1-D2 linker region of its neighboring protomer. In this study we report efforts to better understand this process. Our findings suggest that the amino acid sequence containing Gly-Gly that is located at the C terminus of the D1-D2 linker functions as a pivoting point that allows the dynamic movement of the D1-D2 linker. Furthermore, we found that locking the D1-D2 linker to the D2 domain by introducing disulfide bonds significantly impaired the motion-transmission process. These results support our previous model for interprotomer motion transmission, and provide more detailed information on how the motion transmission between the two ATPase domains of p97 is relayed by the flexible movement of the D1-D2 linker from its neighboring protomer.


What are the roles of eHealth literacy and empowerment in self-management in an eHealth care context? A cross-sectional study.
To examine the relationship among eHealth literacy, empowerment and self-management and the mediating effects of empowerment in diabetic kidney disease (DKD) patients in the eHealthcare context. Self-management is an essential aspect of healthcare in delaying disease progression for DKD. In the eHealthcare era, health services providing self-management are transforming. The ability and confidence of patients to use eHealth services is a critical issue that impacts the effectiveness of self-management, but little is known about the role of eHealth literacy and empowerment in self-management. A cross-sectional study guided by the STROBE. Overall, 127 Taiwanese patients were enrolled using convenience sampling. Data collection used structured questionnaires and chart reviews. Multiple regression was used to infer self-management predictors, and SPSS PROCESS macro and bootstrapping verified the mediating effects. Empowerment and eHealth literacy both showed significant positive correlations with self-management. Empowerment was the main predictor of self-management and had a complete mediating effect between eHealth literacy and self-management. Increasing patients' eHealth literacy can improve empowerment and prevent health inequality issues. Healthcare providers should consider improving patients' eHealth literacy to enhance their self-management. Healthcare service systems need to create user-friendly eHealthcare environments, and healthcare professionals can provide multifaceted instructions that fit patients' eHealth literacy levels to enhance their motivation and confidence in disease care, thus cultivating positive self-management behaviours. The popularity of eHealthcare services aimed at promoting self-management behaviours is increasing. However, the level of eHealth literacy is an essential factor that affects the effectiveness of self-management in the healthcare environment. In addition, empowerment is a major critical influence factor of self-management and a completely mediating variable between self-management and eHealth literacy. Consequently, healthcare providers should consider promoting patients' eHealth literacy to empower people using eHealthcare services for implementing self-management. The Strengthening the Reporting of Observational Studies in cross-sectional studies (STROBE) checklist was used to ensure comprehensive reporting. Patients were diagnosed with DKD in the study hospital. Physicians and case managers transferred patients to research assistants who screened them for the inclusion criteria and invited them to participate in this study if they met the requirements. After participants signed informed consent, the research nurse encouraged participants to respond to the research questionnaire face to face.


A description of the management and outcomes of vaginal birth after cesarean birth in the homebirth setting.
Our objective was to describe the outcomes of intended home birth among 57 women with a previous cesarean birth. Data were drawn from a larger prospective study of intended homebirth in nurse-midwifery practice. Available data included demographics, perinatal risk information, and outcomes of prenatal, intrapartum, postpartum, and neonatal care. The hospital course was reviewed for those transferred to the hospital setting. Fifty-three of 57 women (93%) had a spontaneous vaginal birth, 1 had a vacuum-assisted birth, and 3 (5.3%) had a repeat cesarean birth. Thirty-one of 32 (97%) women who had a previous vaginal birth after cesarean birth (VBAC) had a successful VBAC; 22 of 25 (88%) women without a history of VBAC successfully delivered vaginally. Fifty (87.7%) of these women delivered in the home setting, whereas 7 (12.3%) delivered in the hospital setting. None of the women experienced uterine rupture or dehiscence. One infant was stillborn. This event was attributed to a postdates pregnancy with meconium. Certified nurse-midwives with homebirth practices must be knowledgeable about the risks for mother and baby, screen clientele appropriately, and be able to counsel patients with regard to potential adverse outcomes. Given what is presently known, VBAC is not recommended in the homebirth setting. It is imperative in the light of current evidence and practice climate to advocate for the availability of certified nurse-midwife services and woman-centered care in the hospital setting.


A large beam high efficiency radio frequency neutron spin flipper.
A design for a radio frequency (RF) neutron spin flipper obtained from magneto-static and neutron spin transport simulations is presented. The RF flipper constructed from this design provides a flipping probability of 0.999 or better for a beam size 6 cm wide and 15 cm high and a wavelength band between 0.4 and 0.6 nm. Three permanent magnet guide field sections with air gaps provide a linear field gradient along the beam propagation direction over a large cross-sectional area. An RF oscillator based on coupling the resonant coil of a Hartley oscillator to the excitation coil was developed, which provides a higher current and, thereby, a larger RF amplitude, as compared to a conventional RF power amplifier. Two opaque He3 neutron spin filters were employed to measure the flipping probability of the flipper with very high precision. A spatially uniform flipping probability of 0.9995(2) or higher was measured over the large cross-sectional area neutron guide. This RF neutron spin flipper will be employed in a polychromatic beam reflectometer at the National Institute of Standards and Technology Center for Neutron Research. This design can be applied to other polarized neutron instruments or applications requiring a very high continuous flipping probability of the neutron spin for a large cross-sectional area beam.