Transfer of protons from bulk solution to the surface of poly(L-lactide) microcapsules.
Excessive proton transfer from bulk solution to the surface of poly(L-lactide) microcapsules was observed. In acidic solutions of pH less than 3.0, the zeta potential of the microcapsules became slightly positive, although poly(L-lactide) has only carbonyl groups and alcoholic hydroxyl groups which can be charged. In an NMR study, the signal of the water protons shifted towards a higher applied field with increasing interaction of water with the poly(L-lactide) microcapsule surface when the microcapsules were dispersed at low concentrations (up to 4 x 10(-3) per cent). In solutions of pH 3.2-7.6, the observed values of the zeta potential were in good accordance with theoretical values calculated assuming that the charged groups distribute uniformly in the microcapsule wall. In this pH range, the average density of charged groups in the wall was estimated to be 0.04 M. The average volume occupied by one polymer unit (one poly(L-lactide) molecule) in the microcapsule membrane was estimated to be (35 A)3, suggesting a rather tight polymer network in the poly(L-lactide) microcapsule membrane.


Evaluation of the Leptospira species microscopic agglutination test in experimentally vaccinated cats and Leptospira species seropositivity in aged azotemic client-owned cats.
The objectives of this study were to validate the microscopic agglutination test (MAT) using feline sera, determine cross-reactivity of Borrelia burgdorferi antibodies in the MAT, and evaluate if there is an association between Leptospira species seropositivity in aged (⩾10 years) client-owned cats with and without azotemia (creatinine >2 g/dl). A four-serovar canine leptospiral vaccine was administered to two specific pathogen-free (SPF) cats on days 0 and 14. The MAT was performed intermittently until day 42 for the serovars Canicola, Grippotyphosa, Hardjo, Icterohaemorrhagiae, Pomona and Bratislava, with a cut-off value of ⩾1:100. Five purpose-bred cats were infested with wild-caught Ixodes scapularis adults with an average B burgdorferi infection rate of 50%, and tested for antibodies against B burgdorferi C6 peptide and DNA in skin biopsies, as well as by MAT. Sera from 66 azotemic and 75 non-azotemic cats ⩾10 years of age were tested for Leptospira species antibodies using the MAT and results were compared by the χ(2) test. Both SPF cats seroconverted by week 3 and formed antibodies against at least one serovar. There was no cross-reactivity in the MAT using samples from cats with antibodies to B burgdorferi. MAT results were positive for 4/66 azotemic cats and 8/75 non-azotemic cats; these results were not statistically different. The MAT can be interpreted using feline serum and does not appear to cross-react in cats with B burgdorferi antibodies. There was no association between Leptospira species MAT results and azotemia in this group of aged client-owned cats but further studies are needed to determine if leptospirosis contributes to feline chronic kidney disease.


Reducing workers' compensation costs for latex allergy and litigation against glove manufacturing companies.
It has been well documented in the medical literature that powdered medical gloves can have serious consequences to patients and health-care workers. Adverse reactions to natural latex gloves, such as contact dermatitis and urticaria, occupational asthma, and anaphylaxis, have been documented as a significant cause of Workers' Compensation claims among health-care workers. While the cost of examination and surgical gloves is significant, this factor must be considered with the total cost of Workers' Compensation claims and possible litigation bestowed upon hospitals and glove manufacturing companies. In the United States, Canada, Belgium, and Germany, medical leaders have documented the dangers of powdered latex gloves and have implemented transition programs that are reducing Workers' Compensation claims filed by health-care workers. While attorneys view litigation against powdered glove manufacturers as the "next big tort", the authors of this article were not able to document all compensation costs to disabled workers because many settlements do not allow the claimant to disclose this information.


Identification and management of patients' nutritional needs.
As individuals age a number of physical and cognitive changes affect their nutritional intake. Sensory losses affect the ability to obtain food or eat independently, while cognitive changes, such as dementia, may affect a person's understanding of how to eat. This article aims to familiarise readers with the main concerns associated with caring for older people's nutritional needs while they are in hospital. Strategies to address these challenges are presented. If they are not addressed, they can have major implications for patient recovery and discharge planning.


Factors influencing undernutrition among children under 5 years from cocoa-growing communities in Bougainville.
Half the children under the age of 5 years in Papua New Guinea (PNG) are undernourished, more than double the global average with rural areas disproportionately affected. This study examines factors associated with stunting, wasting and underweight in cocoa growers' children (<5 years) in the Autonomous Region of Bougainville (ARoB), using data from a comprehensive 2017 cross-sectional livelihoods survey. Sixteen independent predictors for stunting, wasting and underweight were selected based on the UNICEF Conceptual Framework of Determinants of Undernutrition. We used multilevel logistic mixed regression models to measure the association of the explanatory variables with stunting, wasting and underweight. At the household level, the adjusted OR (aOR) of stunting (aOR=1.71,95% CI 1.14 to 2.55) and underweight (aOR=2.11, 95% CI 1.16 to 3.82) increased significantly among children from households with unimproved toilet facilities. The aOR for underweight also increased among children from households without access to clean drinking water (aOR=1.97, 95% CI 1.19 to 3.29). Short maternal stature was significantly associated with child stunting, the odds increased as maternal height decreased (from 150 to <155 cm, aOR=1.52, 95% CI 1.02 to 2.26) (<150 cm, aOR=2.37, 95% CI 1.29 to 4.35). At the individual level, the odds of a child being underweight increased with birth order (second born, aOR=1.92, 95% CI 1.09 to 3.36; third born, aOR=6.77, 95% CI 2.00 to 22.82). Compared with children less than 6 months, children aged 6-23 months and 24-59 months had a higher odds of being stunted (aOR=3.27, 95% CI 1.57 to 6.78 and aOR=2.82, 95% CI 1.40 to 5.67) and underweight (aOR=4.83, 95% CI 1.36 to 17.24 and aOR=4.59, 95% CI 1.29 to 16.26). No variables were found to be significant for wasting. Interventions that simultaneously target key life stages for women and children and the underlying social and environmental determinants are required for sustained improvements to undernutrition.


The impact of the Mukaiyama aldol reaction in total synthesis.
Four decades since Mukaiyama's first reports on the successful application of silicon and boron enolates in directed aldol reactions, the ability of this highly controlled carbon-carbon bond-forming method to simultaneously define stereochemistry, introduce complexity, and construct the carbon skeleton with a characteristic 1,3-oxygenation pattern has made it a powerful tool for natural product synthesis. This Minireview highlights a number of representative total syntheses that demonstrate the impact of the Mukaiyama aldol reaction and discusses the underlying mechanistic rationale that determines the stereochemical outcomes.


Indole-3-acetic acid induces microencephaly in rat fetuses.
Indole-3-acetic acid (IAA), known as natural auxin, induces cleft palate in rodents. However, there has been no report about the neurodevelopmental toxicity of IAA in rats. In the present study, we found microencephaly in the fetuses from the rats exposed to IAA. The purpose of this work was to examine the effects of IAA administration in pregnant rats on neuroepithelial cells in the embryos/fetuses. IAA was administered at 500 and 1,000 mg/kg on gestation days (days) 12, 13, and 14, and then embryos/fetuses were harvested on days 14.5, 15, 16, and 21. Cleft palate was induced at 1,000 mg/kg. The brain in treated groups exhibited reduction in the size and weight on day 21 in a dose-dependent manner. Histopathologically, apoptotic cells were observed mainly in the medial and dorsal layer of the neuroepithelium at 500 and 1,000 mg/kg on day 14.5. On day 15, they were observed in the medial and dorsal layer of the neuroepithelium, and preplate at 1,000 mg/kg. On day 16, they existed in the dorsal layer of the neuroepithelium and intermediate zone in the embryos from 1 dam at 1,000 mg/kg. On day 21, an increase in cell proliferative activity was observed in the neuroepithelium at 500 and 1,000 mg/kg. The reduction of the cortical plate, the enlargement of the neuroepithelium and a slight increase in neuron density in the intermediate zone were observed at 1,000 mg/kg. These findings indicated IAA might induce the neuronal apoptosis in the S phase and lead to microencephaly.


Experimental salivary pellicles formed on titanium surfaces mediate adhesion of streptococci.
The goal of this study was to characterize salivary components of titanium pellicles and to determine how experimental pellicles affect adhesion of several strains of streptococci to titanium surfaces. Titanium experimental pellicles were formed by incubation of fresh human parotid or human submandibular-sublingual saliva on pure titanium beads. Pellicle was recovered from the beads using sodium dodecyl sulfate buffer and was subjected to sodium dodecyl sulfate-polyacrylamide gel electrophoresis and Western blotting to identify adsorbed salivary components. Streptococcus anginosus, S. oralis, and S. salivarius recovered from in vivo titanium plaque and five reference strains of streptococci were used in adhesion assays to titanium beads with and without experimental salivary pellicles. The experimental pellicle formed on titanium was found to be composed of selected proteins from human parotid and human submandibular-sublingual saliva. Salivary alpha-amylase and proline-rich proteins were found in all experimental pellicles, while sIgA, high-molecular weight mucin, and proline-rich glycoproteins were detected in one of the experimental pellicles examined. Adhesion of fresh isolates and reference stains of S. anginosus, S. oralis, and S. salivarius to saliva-coated titanium was reduced compared to that of titanium without saliva coating. However, adhesion of laboratory strains of S. gordonii and S. sanguis was found to be significantly greater to experimental pellicles of human submandibular-sublingual saliva than was the adhesion of the fresh isolates, suggesting that streptococci-colonizing implant surfaces may be inherently less adhesive than other bacterial strains. This study found that salivary pellicles are selectively formed on titanium and mediate in vitro adhesion of streptococci.


Methylenetetrahydrofolate reductase (C677T and A1298C) polymorphisms, hyperhomocysteinemia, and ischemic stroke in Tunisian patients.
The present study evaluated the role of the methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C gene polymorphisms and correlated these results with plasma homocysteine (Hcy) levels in Tunisian ischemic stroke (IS) patients. Overall, 84 patients with IS were included and compared with 100 healthy controls. The most common stroke risk factors were investigated. Fasting plasma Hcy levels were measured. Genotyping of the MTHFR C677T and A1298 polymorphisms was studied by polymerase chain reaction. Aside from tobacco and alcohol use, the other studied factors were significant risk factors for IS. Mean plasma Hcy levels were significantly higher in IS patients than in controls (16.1 ± 8.28 μmol/L versus 8.76 ± 3.48 μmol/L, P < 10(-3)). Significant associations were found with both the MTHFR 677(CT + TT) and 1298 (AC + CC) genotypes in comparison with controls (P < 10(-3)). A significant synergistic interaction was also found with the double heterozygote MTHFR 677CT/1298AC (P < 10(-3)). Homocysteine levels were significantly higher in IS patients with the MTHFR C677T variant (CT and TT genotypes) (P < 10(-3)); however, the difference was not significant with the MTHFR A1298C variant (AC and CC genotypes) (P = .31). The MTHFR C677T and A1298 polymorphisms (individually or in concert) and hyperhomocysteinemia represent important risk factors for IS. Elevated Hcy levels were found to be associated with the MTHFR C677T variant; however, no significant association was found with the MTHFR A1298C variant.


Effect of Blade Outlet Angle on the Flow Field and Preventing Overload in a Centrifugal Pump.
The influence of the blade outlet angle on preventing overload in a submersible centrifugal pump and the pump performance characteristics were studied numerically for a low specific speed multi-stage submersible pump. The tested blade outlet angles were 16°, 20°, 24°, 28°, and 32°. The results show that the blade outlet angle significantly affects the external flow characteristics and the power curve can be controlled to prevent overload by properly reducing the blade outlet angle. Increasing the blade outlet angle significantly increases the low pressure area at the impeller inlet, which makes cavitation more likely. Therefore, β2 = 16° provides the best anti-cavitation flow field. Increasing the blade outlet angle also increases the flow separation near the blade working face, which increases the size of the axial vortex along the blade working surface, which rotates in the direction opposite to the impeller rotation and then extends towards the impeller inlet.


Liquorice: a root cause of secondary hypertension.
We describe a patient presenting with hypertension and hypokalaemia who was ultimately diagnosed with liquorice- induced pseudohyperaldosteronism. This rare cause of secondary hypertension illustrates the importance of a methodical approach to the assessment of hypertension.


DIGE Analysis of ProteoMinerTM Fractionated Serum/Plasma Samples.
The discovery of clinically relevant biomarkers using gel-based proteomics has proven extremely challenging, principally because of the large dynamic range of protein abundances in biofluids such as blood and the fact that only a small number of proteins constitute the vast majority of total blood protein mass. Various separation, depletion, enrichment, and quantitative developments coupled with improvements in gel-based protein quantification technologies, specifically difference gel electrophoresis (DIGE), have contributed to significant improvements in the detection and identification of lower abundance proteins. One of these enrichment technologies, Proteominer, will be the focus of this chapter. The Proteominer technology a utilizes hexapeptide bead library with huge diversity to bind and enrich low-abundance proteins but at the same time suppressing the concentration of high-abundance proteins in subsequent analysis.


Anemia and hematinic deficiencies in anti-gastric parietal cell antibody-positive or all autoantibodies-negative recurrent aphthous stomatitis patients.
Approximately 13% of recurrent aphthous stomatitis (RAS) patients have serum anti-gastric parietal cell antibody (GPCA) positivity. This study assessed whether serum GPCA or RAS itself was a significant factor causing hematinic deficiencies and anemia statuses in GPCA-positive RAS (GPCA+/RAS) and all autoantibodies-negative RAS (Abs-/RAS) patients. The mean corpuscular volume (MCV) and mean blood hemoglobin (Hb), iron, vitamin B12, and folic acid levels were measured and compared between any two of three groups of 31 GPCA+/RAS patients, 240 Abs-/RAS patients, and 342 healthy control subjects. GPCA+/RAS patients had significantly lower mean Hb and serum iron level (for women only) as well as significantly greater frequencies of Hb, iron, and vitamin B12 deficiencies than healthy control subjects. Moreover, GPCA+/RAS patients had a significantly higher MCV and a significantly greater frequency of vitamin B12 deficiency than Abs-/RAS patients. Furthermore, Abs-/RAS patients did have significantly lower mean Hb, MCV, iron, and folic acid levels and significantly greater frequencies of Hb, iron, vitamin B12, and folic acid deficiencies than healthy control subjects. Of 31 GPCA+/RAS patients, 3 (9.7%) had PA, 6 (19.4%) had vitamin B12 deficiency, and 3 (9.7%) had macrocytosis. Moreover, normocytic anemia (54.0%) and iron deficiency anemia (26.4%) are the two more common types of anemia in our RAS patients. We conclude that serum GPCA plays a significant role in causing vitamin B12 deficiency and high MCV in GPCA+/RAS patients. RAS itself does play a significant role in causing anemia and hematinic deficiencies in both GPCA+/RAS and Abs-/RAS patients.


Apolipoprotein E*4 (APOE*4) Genotype Is Associated with Altered Levels of Glutamate Signaling Proteins and Synaptic Coexpression Networks in the Prefrontal Cortex in Mild to Moderate Alzheimer Disease.
It has been hypothesized that Alzheimer disease (AD) is primarily a disorder of the synapse. However, assessment of the synaptic proteome in AD subjects has been limited to a small number of proteins and often included subjects with end-stage pathology. Protein from prefrontal cortex gray matter of 59 AD subjects with mild to moderate dementia and 12 normal elderly subjects was assayed using targeted mass spectrometry to quantify 191 synaptically expressed proteins. The profile of synaptic protein expression clustered AD subjects into two groups. One of these was characterized by reduced expression of glutamate receptor proteins, significantly increased synaptic protein network coexpression, and associated withApolipoprotein E*4 (APOE*4) carrier status. The second group, by contrast, showed few differences from control subjects. A subset of AD subjects had altered prefrontal cortex synaptic proteostasis for glutamate receptors and their signaling partners. Efforts to therapeutically target glutamate receptors in AD may have outcomes dependent on APOE*4 genotype.


ZNC(C)PR Induces Phosphorylation of CREB in Rat Hippocampus.
ZNC(C)PR can facilitate the learning and memory in rat. Transgenic experiments have revealed that long-term memory depended on cyclic AMP-response element binding protein, CREB. CREB phosphorylation at serine-133 is essential for it's transcriptional activity. Here, it was demonstrated that ZNC(C)PR could induce CREB phosphorylation at serine-133 in both rat hippocampus and rat hippocampus slices. ZDC(C)PR antagnist of ZNC(C)PR , PTX(inhibitor of G(o)/G(I) protein coupled receptor), GF109203x(inhihitor of PKC), PD98059( inhibitor of MAPK ) but not KN-62(inhibitor of CaMKII) could inhibit the phosphorylation of CREB induced by ZNC(C)PR.


Analysis of the effective dose of ultraviolet light in corneal cross-linking.
To analyze the efficacy of ultraviolet (UV) light initiating corneal cross-linking (CXL). The time-dependent absorption of UV light due to the depletion of the initiator (riboflavin) was calculated. The effective dose of CXL with corneal surface covered by a thin layer of riboflavin was derived analytically. The cross linking time was calculated by the depletion level of the riboflavin concentration. A comprehensive method was used to derive analytic formulas. The effective dose of CXL was reduced by a factor (R) which was proportional to the thickness (d) and concentrations (C0) of the riboflavin surface layer. Our calculations showed that the conventional dose of 5.4 J/cm(2) had a reduced effective dose of 4.3 and 3.45 J/cm(2), for d was 100 and 200 µm, respectively, and C0=0.1%. The surface cross linking time was calculated to be T*=10.75s, for a depletion level of 0.135 and UV initial intensity of 30 mW/cm(2). The volume T* was exponentially increasing and proportional to exp (bdC0), with b being the steady state absorption coefficient. The effective dose of CXL is reduced by a factor proportional to the thickness and concentrations of the riboflavin surface layer. The wasted dose should be avoided by washing out the extra riboflavin surface layer prior to the UV light exposure.


Plasmodium falciparum DNA helicase 60. dsRNA- and antibody-mediated inhibition of malaria parasite growth and downregulation of its enzyme activities by DNA-interacting compounds.
Helicases are ubiquitous enzymes that play important roles in all types of DNA transaction in the cells. Recently we have reported the characterization of the first DEAD-box helicase [Plasmodium falciparum DNA helicase 60 (PfDH60)] from Plasmodium falciparum and have shown that it is a unique, dual bipolar helicase expressed in a stage-specific manner. In this study, we show the further characterization of PfDH60. For analyzing the significance of this enzyme in parasite growth, we studied the effect of dsRNA and specific antibodies on growth of the parasite. The studies indicate that the parasite cultures treated with PfDH60 dsRNA exhibited approximately 50% growth inhibition when compared with either untreated cultures or cultures treated with unrelated dsRNA. It was interesting to note that purified immunoglobulins against PfDH60 induced approximately 62% inhibition of in vitro growth of P. falciparum and that this inhibitory effect was associated with morphologic damage to the parasite. DNA-interacting compounds inhibit DNA helicase and ssDNA-dependent ATPase activities of PfDH60. Of various compounds tested, only actinomycin, daunorubicin, ethidium bromide, netropsin and nogalamycin were able to inhibit the enzyme activities of PfDH60, with apparent IC50 values for helicase inhibition of 0.8, 0.3, 2.0, 1.2 and 1.5 microm, respectively. It may be proposed that these compounds form a complex with DNA and specifically inhibit helicases due to obstruction in the translocation of the enzyme. These compounds also inhibited parasite growth in culture. This is the first study to show inhibition of growth of the parasite by the dsRNA of a helicase, and most probably this is due to interference with cognate mRNA expression.


Defining and integrating informatics competencies into a hospital nursing department.
Expanding use of complex patient information management systems and communication technology in healthcare organizations requires nurses to possess core competencies that until recently were not considered as integral to practice as those of a strictly clinical nature. Organizational changes necessary to formally integrate informatics competencies into nursing practice require strong partnerships among facility nursing leaders, educators, and informaticists. The authors describe a strategic initiative one acute care organization used to develop nursing practice that ensures use of system tools to manage patient information, support clinical decision making, optimize workflow, and communicate with members of the care team. The initiative involved defining nursing computer and informatics management skills for the clinical system applications and technologies utilized in the organization and integrating the introduction, evaluation, and on going professional development of the defined informatics competencies into organizational processes and tools to support the bedside nurse.


Application of the arbitrary decomposition to finite spot size Mueller matrix measurements.
Finite spot size Mueller matrix polarimetric measurements whereby the light spot impinges on two different areas of the sample, e.g., a grating and a substrate, are relatively frequently met in practice. It has been shown that if the Mueller matrix of one of the areas (the substrate) is known from an additional measurement then the Mueller matrix of the remaining medium (the grating) can be obtained from the (substrate-grating) overall response by the polarimetric subtraction method. We show that, provided a specific condition is fulfilled, the individual polarimetric responses of the two areas can be retrieved from the finite spot size measurement by using a special form of the arbitrary decomposition even if none of the individual responses is known a priori. The decomposition method is illustrated on a microelectronics grating structure and its accuracy, as well as limits of applicability, is discussed.


Action Spectra for Phycobiliprotein Synthesis in a Chromatically Adapting Cyanophyte, Fremyella diplosiphon.
The action spectra for phycocyanin production by the cyanophyte Fremyella diplosiphon shows maxima at 463 and 641 nm. The action spectrum for phycoerythrin production includes maxima at 387 and 550 nm. The maxima are based on a relative response rate well within the linear ascending portion of the dose response curves; the positions of the maxima are independent of the relative response rates chosen for reference over a 3-fold range although the comparative effectiveness of light at pairs of wavelengths varies with the standard used for comparison. These action spectra differ from those reported previously for Tolypothrix tenuis by Fujita and Hattori (Plant Cell Physiol. 3: 209-220) and by Diakoff and Scheibe (Plant Physiol. 51: 382-385) in that blue light strongly promotes phycobiliprotein synthesis in F. diphosiphon but has been reported to have little or no effect on T. tenuis.These data suggest that the photoreceptor or photoreceptors which regulate phycobiliprotein metabolism in F. diplosiphon may be either one or two metalloporphyrin complexes or double pigment systems consisting of a red or green light-absorbing photoreceptor which can be activated directly or by energy transferred from a blue light-absorbing receptor.


Plasma Biomarker Concentrations Associated With Return to Sport Following Sport-Related Concussion in Collegiate Athletes-A Concussion Assessment, Research, and Education (CARE) Consortium Study.
Identifying plasma biomarkers associated with the amount of time an athlete may need before they return to sport (RTS) following a sport-related concussion (SRC) is important because it may help to improve the health and safety of athletes. To examine whether plasma biomarkers can differentiate collegiate athletes who RTS in less than 14 days or 14 days or more following SRC. This multicenter prospective diagnostic study, conducted by the National Collegiate Athletics Association-Department of Defense Concussion Assessment, Research, and Education Consortium, included 127 male and female athletes who had sustained an SRC while enrolled at 6 Concussion Assessment, Research, and Education Consortium Advanced Research Core sites as well as 2 partial-Advanced Research Core military service academies. Data were collected between February 2015 and May 2018. Athletes with SRC completed clinical testing and blood collection at preseason (baseline), postinjury (0-21 hours), 24 to 48 hours postinjury, time of symptom resolution, and 7 days after unrestricted RTS. A total of 3 plasma biomarkers (ie, total tau protein, glial fibrillary acidic protein [GFAP], and neurofilament light chain protein [Nf-L]) were measured using an ultrasensitive single molecule array technology and were included in the final analysis. RTS was examined between athletes who took less than 14 days vs those who took 14 days or more to RTS following SRC. Linear mixed models were used to identify significant interactions between period by RTS group. Area under the receiver operating characteristic curve analyses were conducted to examine whether these plasma biomarkers could discriminate between RTS groups. The 127 participants had a mean (SD) age of 18.9 (1.3) years, and 97 (76.4%) were men; 65 (51.2%) took less than 14 days to RTS, and 62 (48.8%) took 14 days or more to RTS. Linear mixed models identified significant associations for both mean (SE) plasma total tau (24-48 hours postinjury, <14 days RTS vs ≥14 days RTS: -0.65 [0.12] pg/mL vs -0.14 [0.14] pg/mL; P = .008) and GFAP (postinjury, 14 days RTS vs ≥14 days RTS: 4.72 [0.12] pg/mL vs 4.39 [0.11] pg/mL; P = .04). Total tau at the time of symptom resolution had acceptable discrimination power (area under the receiver operating characteristic curve, 0.75; 95% CI, 0.63-0.86; P < .001). We also examined a combined plasma biomarker panel that incorporated Nf-L, GFAP, and total tau at each period to discriminate RTS groups. Although the analyses did reach significance at each time period when combined, results indicated that they were poor at distinguishing the groups (area under the receiver operating characteristic curve, <0.7). The findings of this study suggest that measures of total tau and GFAP may identify athletes who will require more time to RTS. However, further research is needed to improve our ability to determine recovery following an SRC.


Managing dental pain in the emergency department: dental disparities with practice implications.
This column critiques the findings from a retrospective medical record review, "Doctor, my tooth hurts, the costs of incomplete dental care in the emergency room," by . The study was designed to examine characteristics of patients presenting to emergency departments (EDs) with dental related problems and their associated costs of care. The study also looked at the frequency of dental related return visits speculated to represent ineffective ED treatment of underlying dental problems. We discuss the findings from this study in the context of growing concern about dental health disparities within the United States, including implications for advanced practice nurse management of dental related problems in the ED.


Casual sexual relationships and mental health in adolescence and emerging adulthood.
Casual sexual relationships are relatively common in emerging adulthood. Yet the mental health implications of engaging in these relationships are unclear; past research has found negative associations, positive associations, or no association with mental health. In addition, little research has accounted for mental health status prior to entering casual sexual relationships. Using data from the National Longitudinal Study of Adolescent Health (N = 12,401), we measured mental health prior to engaging in casual sexual relationships and subsequent mental health after engaging in these relationships. We found that suicidal ideation and depressive symptoms in adolescence were associated with entrance into casual sexual relationships in emerging adulthood. Furthermore, casual sexual relationships were associated with an increased likelihood of reporting suicidal ideation in emerging adulthood.


Intracranial entrapment of a haemodialysis catheter guidewire.
A 49-year-old man with chronic obstructive pulmonary disease was hospitalised due to pneumonia and pulmonary embolisms. After subsequently developing septic shock and acute renal failure, he required dialysis. A haemodialysis catheter was planned inserted into the right subclavian vein, the guidewire was introduced using the Seldinger technique. When the guidewire's 20 cm marker entered the introducer needle, it suddenly encountered resistance. Repeated attempts to remove the guidewire failed. Vital signs and haemodynamic parameters remained unchanged throughout the procedure. CT angiography revealed cranial displacement of the wire into the right internal jugular vein, with the tip of the wire just cranial to the jugular foramen in the right sigmoid sinus. Interventional radiological removal attempts were unsuccessful. Thoracic and neurosurgical interventions were considered impossible and the guidewire was left in place. Due to the pulmonary embolism and the foreign object in the patient, life-long anticoagulation was considered, with close monitoring of compliance with the patient's comorbidity and medication.


Comparison of a membrane surface adhesion recovery method with an IMS method for use in a polymerase chain reaction method to detect Escherichia coli O157:H7 in minced beef.
In this study, enrichment procedures and two recovery methods, a membrane surface adhesion technique and an immunomagnetic separation (IMS), were compared for use in conjunction with a multiplex polymerase chain reaction (PCR) method with a view to describing a fast (24 h) and economical test for detection of Escherichia coli O157:H7 in meat samples. The study showed no significant difference between three different enrichment media (BHI, E. coli (E.C.) broth+novobiocin, modified tryptone soya broth (mTSB)+novobiocin) or two incubation temperatures (37 or 41.5 degrees C) for growth of E. coli O157:H7 in minced beef. Minced beef samples inoculated with E. coli O157:H7 at 40 cfu g(-1) were incubated at 37 degrees C for 16 h in E.C. broth+novobiocin reaching numbers of (log(10)7.82-8.70). E. coli O157:H7 were recovered by attachment to polycarbonate membranes immersed in the enriched cultures for 15 min or by immunomagnetic separation. Subsequent treatment of recovered membranes or IMS beads with lysis buffer and phenol/chloroform/isoamyl alcohol was used to extract the DNA from the extracted E. coli O157:H7 cells. The results show when E. coli O157:H7 was present at high levels in the enriched meat sample (log(10)9.6-7.5 cfu ml(-1); >16-h enrichment), the membrane and IMS techniques recovered similar levels of the pathogen and the microorganism was detectable by PCR using both methods. At lower levels of E. coli O157:H7 (log(10)6.4), only the IMS method could recover the pathogen but at levels below this neither method could recover sufficient numbers of the pathogens to allow detection. The conclusion of the study is that with sufficient enrichment time (16 h) the membrane surface adhesion membrane extraction method used in combination with multiplex PCR has the potential for a rapid and economical detection method.


Temporal patterns in the intertidal faunal community at the mouth of a tropical estuary.
The use of intertidal sandy beaches by fish and macrocrustaceans was studied at different temporal scales at the mouth of a tropical estuary. Samples were taken along the lunar and diel cycles in the late dry and rainy seasons. Fish assemblage (number of species, density and biomass), crustaceans and wrack biomass, showed significant interactions among all studied factors, and the combination of moon phase and diel cycle, resulting in different patterns of environmental variables (depth, water temperature and dissolved oxygen), affected habitat use by the different species. Variances in faunal community were detected between seasons, stimulated by salinity fluctuations from freshwater input during the rainy season. These differences suggest an important cycling of habitats and an increase in connectivity between adjacent habitats (estuary and coastal waters). Moreover, the results showed that this intertidal sandy beach also provides an alternative nursery and protected shallow-water area for the initial development phase of many marine and estuarine species. In addition, this intertidal habitat plays an important role in the maintenance of the ecological functioning of the estuarine-coastal ecosystem continuum.


The impact of Geriatric Emergency Department Innovations (GEDI) on health services use, health related quality of life, and costs: Protocol for a randomized controlled trial.
Older adults (age 65 and older) use the emergency department (ED) at a rate of nearly 50 ED visits per 100 older adults, accounting for over 23 million ED visits in the US annually, up to 20% of all ED visits. These ED visits are sentinel health events as discharged patients often return to the ED, experience declines in health-related quality of life (HRQoL) and disability, or are later hospitalized. Those who are admitted incur increased costs and greater risk for poor outcomes including infections, delirium, and falls. The objective of this randomized controlled trial (RCT) is to evaluate the efficacy of the Geriatric Emergency Department Innovations (GEDI) program, an ED nurse-led geriatric assessment and care coordination program, in decreasing unnecessary health services use and improving Health-Related Quality-of-Life (HRQoL) for older adults in the ED. Community dwelling older adults aged 65 and older who are vulnerable or frail according to the Clinical Frailty Scale (CFS) during an ED visit will be randomized to either GEDI (n = 420) or to usual ED care (n = 420). Outcome variables will be assessed during the ED visit and at 7-11 days and 28-32 days post ED visit. The primary outcome is hospitalization or death within 30 days of the ED visit. Secondary outcomes include health service use outcomes (ED visits and hospitalizations), healthcare costs, and HRQoL outcomes [Patient-Reported Outcomes Measurement Information System (PROMIS) scores: PROMIS-Preference, Physical Function, Ability to Participate in Social Roles and Activities, Anxiety, and Depression]. Clinicaltrials.Gov identifier NCT04115371.


[Optimal concentration of c-erbB2 antisense probe labeled with superparamagnetic iron oxide nanoparticles for magnetic resonance imaging in tumor-bearing nude mice].
To determine the optimal concentration of c-erbB2 antisense probe labeled with superparamagnetic iron oxide (SPIO) nanoparticles for in vivo tumor imaging in mice using magnetic resonance imaging (MRI). Thirty BALB/c mice bearing SK-Br-3 tumor were randomized into 5 groups to receive injections of different concentrations of SPIO-labeled c-erbB2 antisense probe (containing 6.0, 9.0, 12.0, 15.0, or 18.0 mg Fe/kg). MRI was performed before and 6 h after the injections, and the signal intensities of the tumor were compared among the groups. The tumor tissues were then dissected for microscopic examination with HE and Prussian blue staining. The tumor-bearing mice all survived after injections of the probe at doses of 6.0, 9.0 and 12.0 mg, but injections at higher doses (15.0 and 18.0 mg) caused death in some mice. Injections of the probe at the doses of 12.0, 15.0 and 18.0 mg resulted in significant signal enhancement of the tumor (P<0.001) to allow visual identification, but the changes showed no significant differences among the 3 groups (P>0.05). Pathological examination revealed irregular structures of the tumor issue containing numerous heterogeneous tumor cells aligned into cancer nests; Prussian blue staining visualized scattered blue iron particles in the tumor issue, which was especially obvious in mice injected with 12.0, 15.0 and 18.0 mg labeled probe. Injection of 12.0 mg/kg SPIO-labeled c-erbB2 antisense probe allows optimal tumor imaging in BALB/c mice using MRI.


Removal of Invisalign retention attachments: a new minimally invasive method.
Removal of Invisalign resin retention buttons without damaging underlying enamel is a major challenge. To date, the use of tungsten carbide burs is the most common and fastest--yet a risky-ablation method. Stainbuster, a fiber-reinforced resin bur, has been introduced for removal of surface stains and resin remnants from tooth surfaces. This comparative in vitro and in vivo study proved that a combined technique, using multifluted tungsten carbide burs for fast removal of the bulk of resin followed by Stainbuster grinding for gentle removal of the final resin layer, is a safe and minimally invasive procedure for removing composite buttons from enamel.


Reliability of quality measures of movement in lumbar spine flexion-extension radiography.
For center of rotation (COR) and centroid length variables in lumbar flexion-extension radiography, enough reliability information is not available. The objective of this study was to determine the intra-rater reliability of COR and centroid length of lumbar intervertebral movement. A methodological research for reliability was designed. Fifteen males with chronic non specific low back pain aged between 22-43 years participated in this study. Study variables included COR of full, flexion and extension arc and centroid length. The proposed method from Putto was used for flexion-extension radiography. Five x-rays were taken in neutral, full flexion and extension, mid-flexion and mid-extension positions. The variables were calculated using Computer Aided Radiographic Analysis of Spine (CARA) software after scanning. The intraclass correlation coefficient (ICC) and standard error of measurement (SEM) were utilized for relative and absolute reliability respectively. The results demonstrated high ICC values on x axis (range: 0.67-0.88) and y axis (range: 0.55-0.90) for full arc COR, high ICC values of flexion arc COR on x axis (range: 0.54-0.97) and y axis (range: 0.48-0.99). ICC values results of extension arc ranged between 0.19-0.60 for x axis and 0.16-0.83 for y axis. ICC values for centroid length ranged between 0.22-0.88. Results support previous studies which show very high reliability of full arc COR. In addition, flexion arc COR has desirable reliability and low measurement errors. But, extension arc COR and centroid length have moderate reliability and large measurement errors.


A mathematical model of the effects of anoctamin-1 loss on intestinal slow wave entrainment.
The interstitial cells of Cajal (ICC) generate electrophysiological events called slow waves that regulate the motility of the gastrointestinal (GI) tract. Recent studies have demonstrated that the Ca2+-activated Cl- -channel, encoded by the anoctamin1 (Ano1) protein, has a major role in regulating intestinal slow waves and motility. The main aim of this study was to develop a multi-scale mathematical model capable of simulating both normal slow wave entrainment and the effects of Ano1 knockout (KO) on the normal activity. A biophysically-based cell model was adapted to simulate the effects of Ano1 KO at the cellular level. A 10mm one-dimensional (1D) model was then developed to simulate entrained intestinal slow wave propagation. Cellular KO at levels of 100% and 20% were applied to a varying-sized middle region of the 1D model. The main finding was that the level of loss of entrainment increased as both cellular and spatial Ano1 KO levels increased, mostly manifesting as ectopic activation. In the future, this model will be extended and used in combination with Ca2+ -imaging data to quantitatively investigate the effects of Ano1 loss in ICC.


Role of atomic multiplets in the electronic structure of rare-earth semiconductors and semimetals.
We present a study of the effects of strong correlations in rare-earth pnictides, in which localized 4f states simultaneously retain atomiclike character and strongly influence the free-electron-like valence electron states. Using erbium arsenide as our example, we use a modern implementation of dynamical mean-field theory to obtain the atomic multiplet structure of the Er3+ 4f shell, as well as its unusually strong coupling to the electronic Fermi surfaces; these types of behavior are not correctly described within conventional electronic-structure methods. We are then able to explain the long-standing theoretical question of the quasisaturation of magnetization in an applied magnetic field, and to obtain the first quantitative agreement with experimental Shubnikov-de Haas frequencies of the Fermi-surface sheets.


Treatment Patterns and Outcomes Among Elderly Glioblastoma Patients in Riyadh, Saudi Arabia.
Management of elderly patients with glioblastoma (GBM) is a controversial scenario and needs careful assessment and selection for aggressive radical treatment and chemotherapy protocols vs short-course radiotherapy without chemotherapy. We evaluated treatment patterns and outcome among elderly GBM patients treated in KFMC, Riyadh. The primary endpoint is overall survival (OS) and the secondary endpoint is progression-free survival (PFS); patients were reviewed regarding radiotherapy (Rth) fractionation modalities, surgery, and chemotherapy (CTR) given in correlation to PFS, OS. Fifty-nine patients were recruited in our study with median age 66 (range: 60-81) years, and 47 (80%) were males. Thirty-seven patients (62.7%) had ECOG performance status (PS) ≥2, and 22 patients (37.3%) had PS <2. Gross total resection (GTR) and subtotal resection (STR) were done in 49 (82.9%) patients, and the median follow-up was 12 months. Thirty-eight (64%) patients received conventional Rth 60 Gray (Gy)/30 fractions or equal doses and 21 (36%) patients received hypofractionation Rth (40 Gy/15, 25 Gy/5 or 30 Gy/10 fractions). The median OS was 12 months (95%CI: 9.52-14.48). Receiving conventional Rth and completion of six months adjuvant CTR were significant factors for O.S (P=0.043 and 0.026), respectively. The median PFS was nine months (95%CI: 6.13-11.87). For univariate analysis, PS, time to start adjuvant treatment, and completion of six months CTR were significant factors for PFS. Conventional Rth and completion of adjuvant CTR lead to better OS, while earlier start of adjuvant treatment and the completion of adjuvant CTR were associated with a better PFS.


Bovine brain coated vesicles contain guanine nucleotide regulatory proteins.
Binding of [3H]guanosine triphosphate (GTP) with a high affinity was found to be present in the coated vesicle fraction prepared from bovine cerebral cortex. The binding was saturable and displaced by 1 microM of GTP, guanosine diphosphate and guanosine 5'-(3-O-thio)triphosphate. Incubation of the vesicles with islet-activating protein and [32P]NAD resulted in ADP-ribosylation of a 39,000-41,000-dalton polypeptide. Antibodies to the alpha-subunit of stimulatory guanine nucleotide regulatory proteins (G-proteins) immunoblotted 52,000- and 45,000-dalton polypeptides. The results indicated that stimulatory and inhibitory G-proteins are contained in a fraction of the bovine brain coated vesicles.


Field efficacy and nontarget effects of the mosquito larvicides temephos, methoprene, and Bacillus thuringiensis var. israelensis in Florida mangrove swamps.
We compared the efficacy and nontarget effects of temephos, Bacillus thuringiensis var. israelensis (B.t.i.), and methoprene applied by helicopter to control mosquito larvae in mangrove swamps on Sanibel Island, FL, in May 1997. Three sites per treatment and 3 untreated sites were used. Temephos (Abate) was applied at 37 ml/ha (43% active ingredient [AI]), B.t.i. granules (Vectobac G) were applied at 5.606 kg/ha (200 International Toxic Units/mg), and methoprene (Altosid ALL) was applied at 213 ml/ha (5% AI). Efficacy was quantified by monitoring the survival of caged and uncaged larval Aedes taeniorhynchus. We quantified mortality of sentinel nontarget amphipods (Talitridae) at all sites, monitored the effect of temephos on flying arthropods using light traps, and collected dead insects in tarps suspended under mangroves in areas treated with either temephos or methoprene. Each pesticide showed good overall efficacy but occasional failures occurred. No detectable mortality of amphipods or flying insects attributable to pesticides was found. The inconsistent field efficacies of the pesticides indicate a need for reinspection of treated sites in this habitat.


Time-dependent density functional theory study on the absorption spectrum of Coumarin 102 and its hydrogen-bonded complexes.
The effect of both solvent polarity and hydrogen bonding (HB) on the electronic transition energy of Coumarin 102 (C102) has been examined using the time-dependent density functional theory (TDDFT). Solvent effect on both geometry and electronic transition energy is evaluated using the polarizable continuum model (PCM). A linear relation of the absorption maximum of C102 with the solvent polarity function Δf is found using the TDDFT-PCM method for all solvents except dimethyl sulfoxide. The solvent polarity and the type B HB between the carbonyl oxygen and solvent hydrogen atom make the absorption wavelength redshift, whereas the type A HB between the amino nitrogen atom and solvent hydrogen atom has an opposite effect on the absorption wavelength. The calculated absorption wavelengths of C102 with two type B HB between the carbonyl oxygen and solvent hydrogen atom are in excellent agreement with experimental measurements. The solvatochromism of C102 is analyzed in terms of the Kamlet-Taft equation and the parameters s and a are discussed.


Stress resilience: a low-anxiety genotype protects male mice from the consequences of chronic psychosocial stress.
Chronic psychosocial stress is a risk factor for the development of affective as well as somatic disorders. However, vulnerability to adverse stress effects varies between individuals, with previous negative life events along with genetic predisposition playing a major role. In support, we previously showed that the consequences of chronic psychosocial stress induced by chronic subordinate colony housing (CSC, 19 days) can be amplified by pre-exposing mice to repeated maternal separation during early life. To test the significance of the genetic predisposition on the effects of CSC, mice selectively bred for high (mHAB) and low (mLAB) anxiety-related behavior and nonselected CD1 mice (mNAB) were exposed to CSC in the present study. In confirmation of our previous results, CSC mice of both mHAB and mNAB lines displayed chronic stress-related symptoms including increased adrenal weight, decreased adrenal in vitro ACTH sensitivity, lower plasma corticosterone to ACTH ratio, and increased interferon-γ secretion from isolated mesenteric lymph node cells compared with single-housed controls of the respective line. However, the CSC-induced anxiogenic effect found in mNAB was not confirmed in mHAB mice, possibly due to a ceiling effect in these highly anxious mice. Interestingly, mHAB were not more vulnerable to CSC than mNAB mice, whereas mLAB mice were resilient to CSC as indicated by all of the above mentioned parameters assessed. Taken together, our findings indicate that the genetic predisposition, in this case the innate anxiety of an individual, affects vulnerability to chronic psychosocial stress, with a low-anxiety phenotype mediating resilience to both affective and somatic consequences of CSC.


Human health effects of dioxins: cancer, reproductive and endocrine system effects.
Polychlorinated dioxins, furans and polychlorinated benzene constitute a family of toxic persistent environmental pollutants. In Europe, environmental concentrations increased slowly throughout this century until the late 1980s. Dioxins have been shown to be carcinogenic in animals and humans. In humans, excess risks were observed for all cancers, without any specific cancer predominating. In specific cohorts, excess risks were observed for reproductive cancers (breast female, endometrium, breast male, testis) but, overall, the pattern is inconsistent. In animals, endocrine, reproductive and developmental effects are among the most sensitive to dioxin exposure. Decreased sperm counts in rats and endometriosis in rhesus monkeys occur at concentrations 10 times higher than current human exposure. In humans, results are inconsistent regarding changes in concentrations of reproductive hormones. A modification of the sex ratio at birth was described in Seveso. There exist no data on effects such as endometriosis or time-to-pregnancy. Small alterations in thyroid function have occasionally been found. Increased risk for diabetes was seen in Seveso and a herbicide applicators cohort but, overall, results were inconsistent. Experimental data indicate that endocrine and reproductive effects should be among the most sensitive effects in both animals and humans. Epidemiological studies have evaluated only a few of these effects.


A robust multiplex immunoaffinity mass spectrometry assay (PromarkerD) for clinical prediction of diabetic kidney disease.
PromarkerD is a novel proteomics derived blood test for predicting diabetic kidney disease (DKD). The test is based on an algorithm that combines the measurement of three plasma protein biomarkers (CD5L, APOA4, and IBP3) with three clinical variables (age, HDL-cholesterol, and eGFR). The initial format of the assay used immunodepletion of plasma samples followed by targeted mass spectrometry (MRM-LCMS). The aim of this study was to convert the existing assay into an immunoaffinity approach compatible with higher throughput and robust clinical application. A newly optimised immunoaffinity-based assay was developed in a 96 well format with MRM measurements made using a low-flow LCMS method. The stability, reproducibility and precision of the assay was evaluated. A direct comparison between the immunoaffinity method and the original immunodepletion method was conducted on a 100-person cohort. Subsequently, an inter-lab study was performed of the optimised immunoaffinity method in two independent laboratories. Processing of plasma samples was greatly simplified by switching to an immunoaffinity bead capture method, coupled to a faster and more robust microflow LCMS system. Processing time was reduced from seven to two days and the chromatography reduced from 90 to 8 min. Biomarker stability by temperature and time difference treatments passed acceptance criteria. Intra/Inter-day test reproducibility and precision were within 11% CV for all biomarkers. PromarkerD test results from the new immunoaffinity method demonstrated excellent correlation (R = 0.96) to the original immunodepletion method. The immunoaffinity assay was successfully transferred to a second laboratory (R = 0.98) demonstrating the robustness of the methodology and ease of method transfer. An immunoaffinity capture targeted mass spectrometry assay was developed and optimised. It showed statistically comparable results to those obtained from the original immunodepletion method and was also able to provide comparable results when deployed to an independent laboratory. Taking a research grade assay and optimising to a clinical grade workflow provides insights into the future of multiplex biomarker measurement with an immunoaffinity mass spectrometry foundation. In the current format the PromarkerD immunoaffinity assay has the potential to make a significant impact on prediction of diabetic kidney disease with consequent benefit to patients.


Orbital blowout fracture with persistent mobility deficit due to fibrosis of the inferior rectus muscle and perimuscular tissue.
A case of orbital blowout fracture accompanied by fibrosis of the inferior rectus muscle resulting in an irreversible orbital mobility deficit is reported. An 8-year-old girl with an orbital blowout fracture was treated with steroids for 10 days, as with other cases in our department. She exhibited a disturbance of vertical eye movement and a positive forced duction test result. Although surgery was performed on day 13, and on day 27 due to poor recovery after the first operation, almost no improvement of the ocular movement was noted. The results of a traction test, performed during the second operation, suggested that the inferior rectus muscle had adhered to the periosteum. Magnetic resonance imaging performed 3 days after the second operation revealed fibrosis of the inferior rectus muscle and perimuscular tissue, resulting in an irreversible disturbance of the vertical ocular movement. The present findings suggest that the need for and timing of surgery in patients with blowout fractures should be determined on an individual basis.


Autoantibody-encoding kappa L chain genes frequently rearranged in lambda L chain-expressing chronic lymphocytic leukemia.
Patients with kappa L chain expressing chronic lymphocytic leukemia (CLL) frequently have leukemia cells reactive with a murine mAb, designated 17.109. Raised against a monoclonal IgM rheumatoid factor autoantibody, this mAb recognizes a major kappa-L chain-associated cross reactive Id, designated 17.109-CRI. Molecular studies reveal that the 17.109-CRI in CLL is a serologic marker for expression of a conserved kappa L chain V region gene (V Kappa gene) of the V Kappa 3 subgroup, designated Humkv325. We isolated an upstream gene fragment of Humkv325 to examine for Ig gene rearrangements of this and other closely related V Kappa 3 genes by Southern analyses. Consistent with Humkv325 encoding the 17.109-CRI, we find that the genomic DNA from all 17.109-reactive leukemia cell populations have gene rearrangements that are detected using this probe. In addition, we observe V Kappa 3 gene rearrangements frequently in the genomic DNA of lambda L chain-expressing leukemia cells. Of the genomic DNA from 33 lambda-L chain-expressing CLL samples, 8 (24%) had additional nongerm-line bands detected with the Humkv325 probe. Consistent with these bands representing Ig gene rearrangements, the additional band in each but one sample also hybridized with probes specific for the J Kappa region and/or the kappa-deleting element. Using the polymerase chain reaction (PCR), we examined the genomic DNA from all lambda L chain-expressing CLL for V Kappa 3 gene rearrangements to J Kappa and/or Kde. PCR on each DNA sample with V Kappa 3 gene rearrangements detected by Southern analysis generated gene fragments that hybridized specifically with oligonucleotides corresponding to framework or CDR of the Humkv325 gene. Nucleic acid sequence analyses of representative samples confirmed that these DNA contained abortive Humkv325 gene rearrangements. PCR for rearranged V Kappa 3 genes in the DNA of other lambda-L chain-expressing CLL either did not generate any PCR product or produced fragments that failed to hybridize with all Humkv325 oligonucleotide probes. Nucleic acid sequence analyses of the latter demonstrated that these represent abortive V Kappa gene rearrangements involving another conserved V Kappa 3 gene, designated Vg. These studies indicate that Humkv325 and Vg frequently may undergo Ig gene rearrangement independent of their expression. As such, the frequent use of Humkv325 in CLL may be secondary, in part, to an enhanced propensity of this V Kappa 3 gene to undergo genetic rearrangement during B cell ontogeny.


Two-electron quantum dot molecule: composite particles and the spin phase diagram.
We study a two-electron quantum dot molecule in a magnetic field by the direct diagonalization of the Hamiltonian matrix. The ground states of the molecule with the total spin S = 0 and S = 1 provide a possible realization for a qubit of a quantum computer. Switching between the states is best achieved by changing the magnetic field. Based on an analysis of the wave function, we show that the system consists of composite particles formed by an electron and flux quanta attached to it. This picture can also be used to explain the spin phase diagram.


The Motion Behavior of Micron Fly-Ash Particles Impacting on the Liquid Surface.
The motion behavior of particles impacting on the liquid surface can affect the capture efficiency of particles. It was found that there are three kinds of motion behaviors after particle impact on the liquid surface: sinking, rebound, and oscillation. In this paper, the processes of micron fly-ash particles impacting on the liquid surface were experimentally studied under normal temperature and pressure. The impact of fly-ash particles on the liquid surface was simulated by a dynamic model. Based on force analysis, the dynamic model was developed and verified by experimental data to distinguish between three motion behaviors. Then, the sinking/rebound critical velocity and rebound/oscillation critical velocity were calculated by the dynamic model. The critical velocities of particles impacting on the liquid surface under different particle sizes, receding angles, and surface tension coefficients were analyzed. As the particle size increased, sinking/rebound critical velocity and rebound/oscillation critical velocity decreased. As the receding angle increased, sinking/rebound critical velocity remained unchanged, and the rebound/oscillation critical velocity decreased. As the liquid surface tension coefficient increased, sinking/rebound critical velocity and rebound/oscillation critical velocity increased. On this basis, the behaviors of particles impacting on the liquid at low velocity were analyzed.


Negotiating the Intersection of Racial Oppression and Heteronormativity.
This qualitative study examines the narratives of seven heterosexual, cisgender individuals who identify both as persons of color and as positively disposed toward LGB and transgender-identified persons. Using psycho-discursive qualitative methodology, the authors will present the narrative strategies taken up by these positively disposed cisgender heterosexuals of color as they attempt to position themselves as supportive of LGB and transgender persons while negotiating the discourse of heteronormativity. The three narrative strategies have been titled differentiation, empathy, and coherence. In addition to mapping the three narrative strategies, the authors also explore why informants may choose certain strategies over others and argue that the intersection of social identities must be considered when attempting to understand social oppression. Implications for the human services fields will be discussed.


Survey of blood cultures from five community hospitals in south-western Sydney, Australia, 1993-1994.
Blood culture results have profound implications for patients. Comprehensive overviews of blood cultures have been uncommon, and focused on tertiary referral hospitals. To present a review of blood culture results from a laboratory servicing community hospitals in Sydney, Australia. Retrospective chart review of patients with positive blood cultures from 1 June 1993 to 31 May 1994. During the survey period there were 107,382 hospital admissions; 12,109 blood culture sets from 9292 patients were processed. Of these 1197 sets were positive, representing 974 febrile episodes in 923 patients. There were 476 episodes of contamination. Of the episodes of true bacteraemia, Escherichia coli was isolated in 139, Staphylococcus aureus in 91 (22 methicillin-resistant), other enterobacteriaceae in 60, and Streptococcus pneumoniae in 5 1. The diagnoses attributable to bacteraemia included intravenous catheter-related sepsis (122 episodes), urinary tract infection (88), bacteraemia from unknown source (79), intra-abdominal and biliary sepsis (91), pneumonia (35), and meningitis (21). Sixty-eight patients died directly due to bacteraemia. Multivariate analysis showed underlying disease (OR 3.97) or shock (OR 28.1) predicted death. Blood cultures confirmed clinical diagnoses in 258 episodes, but made a de novo diagnosis in 205 episodes. This study describes the clinical and laboratory features of bacteraemias occurring in smaller public hospitals, as distinct from tertiary referral centres. It demonstrated that intravenous catheter-related sepsis was very common in smaller hospitals. The clinical diagnosis was frequently confirmed, and a de novo diagnosis was often established by a positive blood culture. Unfortunately nearly half the positive blood cultures represented contamination.


Impact of diet on mortality from stroke: results from the U.S. multiethnic cohort study.
Stroke is the fourth leading cause of death in the United States and stroke mortality rates vary by ethnicity. The purpose of this study was to examine the associations between food group consumption and risk of death from stroke among 5 ethnic groups in the United States. The Multiethnic Cohort includes >215,000 participants, the majority of whom are African American, Native Hawaiian, Japanese American, Latino, and Caucasian men and women recruited by mail survey in Hawaii and Los Angeles in 1993-1996. Deaths from stroke were identified by linkage to the state death files and the U.S. National Death Index. Diet was assessed using a validated food frequency questionnaire. Associations were examined using multivariable Cox proportional hazards models, stratified by ethnicity and gender. A total of 860 deaths from stroke were identified among the cohort participants. Vegetable intake was associated with a significant reduction in risk for fatal stroke among African American women (relative risk [RR]=0.60; 95% CI: 0.36-0.99). Among Japanese American women only, high fruit intake was significantly associated with a risk reduction for stroke mortality (RR=0.43; 95% confidence interval [CI]: 0.22-0.85), whereas meat intake increased risk (RR=2.36; 95% CI: 1.31-4.26). Among men, a significant reduction in stroke mortality was observed among Native Hawaiians (RR=0.26; 95% CI: 0.07-0.95). After pooling the data for the ethnic groups, the findings support an elevated risk for high meat intake among women overall (RR=1.56; 95% CI: 1.12-2.16); no significant effects of dietary intake on risk for fatal stroke were observed among men. Although some variations were observed for the associations between diet and stroke mortality among ethnic groups, the findings suggest that these differences are not substantial and may be due to dietary intake of specific food subgroups. Additional investigations including dietary subgroups and nutrients sources are needed to clarify these findings.


Advancing Equity in Blood Pressure Control: A Response to the Surgeon General's Call-to-Action.
Hypertension is an established risk factor for cardiovascular disease. Although controlling blood pressure reduces cardiovascular and stroke mortality and target organ damage, poor blood pressure control remains a clinical and public health challenge. Furthermore, racial and ethnic disparities in the outcomes of hypertension are well documented. In October of 2020, the U.S. Department of Health and Human Services published The Surgeon General's Call to Action to Control Hypertension. The Call to Action emphasized, among other priorities, the need to eliminate disparities in the treatment and control of high blood pressure and to address social determinants as root causes of inequities in blood pressure control and treatment. In support of the goals set in the Call to Action, this review summarizes contemporary research on racial, ethnic, and socioeconomic disparities in hypertension and blood pressure control; describes interventions and policies that have improved blood pressure control in minoritized populations by addressing the social determinants of health; and proposes next steps for achieving equity in hypertension and blood pressure control.


The effect of the platelet-rich plasma on osteogenic potential of the periosteum in an animal bone defect model.
This study aims to investigate whether plasma-rich plasma (PRP) enhances the osteogenic potential of periosteal grafts used to repair bone defects and maintains both histologically and biomechanically more durable bone tissue. A standard bone defect was formed to the left femurs of 54 Sprague-Dawley rats and three groups were formed. In the first group (n=18), no periosteal repair was done for bone defect. In the second group (n=18), periosteal graft tissue was sutured to cover the defect entirely. In the third group (n=18), before periosteal repair, a 1 mL of PRP fibrin was applied into the bone defect. All femoral specimens were compared histologically at four and six weeks and biomechanically by three-point bending test at six weeks after treatment. In the PRP applied group, healing of the bone defect at four weeks was significantly better than the other groups in terms of histological new bone formation (p<0.05). At six weeks, new bone formation in both of the periosteum preserved groups was superior to the first group (p<0.05, for both). There was no statistically significant difference between the second and third groups at the end of the sixth week in the biomechanical analysis, although both groups were significantly stronger than the first group (p<0.05). Stimulation of the periosteum with PRP application causes early osteogenic differentiation of precursor cells. Although, at biomechanical basis, PRP application does not create any significant difference, in the recovery of the bone defects at very early period, application of PRP may play a role to accelerate fracture healing and to decrease nonunions.


Epidermal growth factor receptor inhibition attenuates early kidney enlargement in experimental diabetes.
Renal enlargement is an early feature of both human and experimental diabetes. Although the precise mechanisms underlying its development are incompletely understood, locally active growth factors have been suggested to have a key role. Having previously documented increased expression of the proproliferative and antiapoptotic growth factor, epidermal growth factor (EGF), in early diabetes-related kidney growth, the present study sought to evaluate its pathogenetic role by blocking its action with a specific inhibitor. Sprague-Dawley rats were randomized to receive streptozotocin (diabetic) or buffer (control) and then further randomized to receive either vehicle or the inhibitor of the EGF receptor tyrosine kinase, PKI 166 (100 mg/kg/day) for 2 days and 3 weeks following streptozotocin administration. Experimental diabetes was associated with an increase in kidney weight and tubular epithelial cell proliferation as identified by increased expression of proliferating cell nuclear antigen (PCNA) and 5-bromo-2'-deoxyuridine (BrdU) incorporation. PKI 166 resulted in a 30% reduction in kidney weight in diabetic rats (P < 0.01) and reduced tubular epithelial cell proliferation (P < 0.01). In addition, EGF receptor inhibition also led to a 40% increase in tubular epithelial cell apoptosis at 3 weeks (P < 0.01). Diabetes-associated glomerular enlargement was similarly attenuated by PKI 166, although glomerular hyperfiltration was unaffected. These findings suggest that the EGF-EGF receptor (EGFR) axis has a significant role in the development of early diabetes-related kidney growth. The impact of EGFR inhibition on the later development of renal dysfunction, however, remains to be determined.


Computed tomography of the sternum.
The author presents his experience with computed tomography (CT) in the diagnosis of sternal anomalies. The normal anatomy of the sternum and the peristernal soft tissues are described. The embryology, pertinent to the understanding of congenital sternal anomalies, is reviewed. The technique used to image the sternum is briefly explained. Variants of the sternum, traumatic changes, iatrogenic alterations, inflammation, and neoplastic lesions are illustrated. It is concluded that CT offers definite advantages in the evaluation of presumed sternal pathology and should be the examination of choice in the appropriate clinical setting.


Electrical synapses mediate signal transmission in the rod pathway of the mammalian retina.
In the retina, AII (rod) amacrine cells are essential for integrating rod signals into the cone pathway. In addition to being interconnected via homologous gap junctions, these cells make extensive heterologous gap junctions with ON-cone bipolar cells (BCs). These gap junctions are the pathway for transfer of rod signals to the ON-system. To investigate the functional properties of these gap junctions, we performed simultaneous whole-cell recordings from pairs of AII amacrine cells and ON-cone bipolar cells in the in vitro slice preparation of the rat retina. We demonstrate strong electrical coupling with symmetrical junction conductance (approximately 1.2 nS) and very low steady-state voltage sensitivity. However, signal transmission is more effective in the direction from AII amacrine cells to ON-cone bipolar cells than in the other direction. This functional rectification can be explained by a corresponding difference in membrane input resistance between the two cell types. Signal transmission has low-pass filter characteristics with increasing attenuation and phase shift for increasing stimulus frequency. Action potentials in AII amacrine cells evoke distinct electrical postsynaptic potentials in ON-cone bipolar cells. Strong and temporally precise synchronization of subthreshold membrane potential fluctuations are commonly observed.


Application of a Biologically Contained Reporter System To Study Gain-of-Function H5N1 Influenza A Viruses with Pandemic Potential.
Natural adaptation of an antigenically novel avian influenza A virus (IAV) to be transmitted efficiently in humans has the potential to trigger a devastating pandemic. Understanding viral genetic determinants underlying adaptation is therefore critical for pandemic preparedness, as the knowledge gained enhances surveillance and eradication efforts, prepandemic vaccine design, and efficacy assessment of antivirals. However, this work has risks, as making gain-of-function substitutions in fully infectious IAVs may create a pathogen with pandemic potential. Thus, such experiments must be tightly controlled through physical and biological risk mitigation strategies. Here, we applied a previously described biological containment system for IAVs to a 2009 pandemic H1N1 strain and a highly pathogenic H5N1 strain. The system relies on deletion of the essential viral hemagglutinin (HA) gene, which is instead provided in trans, thereby restricting multicycle virus replication to genetically modified HA-complementing cells. In place of HA, a Renilla luciferase gene is inserted within the viral genome, and a live-cell luciferase substrate allows real-time quantitative monitoring of viral replication kinetics with a high dynamic range. We demonstrate that biologically contained IAV-like particles exhibit wild-type sensitivities to approved antivirals, including oseltamivir, zanamivir, and baloxavir. Furthermore, the inability of these IAV-like particles to genetically acquire the host-encoded HA allowed us to introduce gain-of-function substitutions in the H5 HA gene that promote mammalian transmissibility. Biologically contained "transmissible" H5N1 IAV-like particles exhibited wild-type sensitivities to approved antivirals, to the fusion inhibitor S20, and to neutralization by existing H5 monoclonal and polyclonal sera. This work represents a proof of principle that biologically contained IAV systems can be used to safely conduct selected gain-of-function experiments.IMPORTANCE Understanding how animal influenza viruses can adapt to spread in humans is critical to prepare for, and prevent, new pandemics. However, working safely with pathogens that have pandemic potential requires tight regulation and the use of high-level physical and biological risk mitigation strategies to stop accidental loss of containment. Here, we used a biological containment system for influenza viruses to study strains with pandemic potential. The system relies on deletion of the essential HA gene from the viral genome and its provision by a genetically modified cell line, to which virus propagation is therefore restricted. We show that this method permits safe handling of these pathogens, including gain-of-function variants, without the risk of generating fully infectious viruses. Furthermore, we demonstrate that this system can be used to assess virus sensitivity to both approved and experimental drugs, as well as the antigenic profile of viruses, important considerations for evaluating prepandemic vaccine and antiviral strategies.


Percutaneous endoscopic gastrostomy tube occlusion in malignant peritoneal carcinomatosis-induced bowel obstruction.
Percutaneous endoscopic gastrostomy (PEG) tube placement for decompression in advanced peritoneal carcinomatosis with bowel obstruction is a safe and feasible palliative procedure. We describe a rare, previously unreported phenomenon of PEG tube occlusion by gastric mucosal herniation. A consecutive case series of 73 patients with advanced abdominal carcinomatosis-induced bowel obstruction from January 2007 to June 2010. All patients had a 28 Fr (Bard) PEG tube placed for drainage. None of them were surgical candidates due to extensive peritoneal involvement. Patients with PEG tube occlusion as a result of gastric mucosal herniation were further evaluated. Nineteen patients were men and 54 were women. The mean age was 53.3 years. The most common cancer types were ovary, pancreas, colon, and stomach. All patients had PEG tube functioning well after the procedure with immediate relief of obstructive symptoms. Subsequently, 10 patients developed acute occlusion of PEG tubes with reoccurrence of obstructive symptoms. The time between the placement of the PEG tube and its occlusion ranged from 5 to 129 days. Repeat endoscopy showed the PEG tube occluded with gastric mucosa from the opposite wall. PEG tube was replaced with a 28 Fr balloon replacement tube leading to symptom improvement in all 10 patients. This rare but correctable phenomenon of obliteration of PEG tube from the gastric mucosa should be considered in any patient who develops intermittent occlusive symptoms. This phenomenon can be corrected by replacing the PEG tube with a ballooned replacement tube as well as occasional manipulation of the tube.


Hyoscyamine 6beta-hydroxylase, a 2-oxoglutarate-dependent dioxygenase, in alkaloid-producing root cultures.
Root cultures of various solanaceous plants grow well in vitro and produce large amounts of tropane alkaloids. Enzyme activity that converts hyoscyamine to 6beta-hydroxyhyoscyamine is present in cell-free extracts from cultured roots of Hyoscyamus niger L. The enzyme hyoscyamine 6beta-hydroxylase was purified 3.3-fold and characterized. The hydroxylation reaction has absolute requirements for hyoscyamine, 2-oxoglutarate, Fe(2+) ions and molecular oxygen, and ascorbate stimulates this reaction. Only the l-isomer of hyoscyamine serves as a substrate; d-hyoscyamine is nearly inactive. Comparisons were made with a number of root, shoot, and callus cultures of the Atropa, Datura, Duboisia, Hyoscyamus, and Nicotiana species for the presence of the hydroxylase activity. Decarboxylation of 2-oxoglutarate during the conversion reaction was studied using [1-(14)C]-2-oxoglutarate. A 1:1 stoichiometry was shown between the hyoscyamine-dependent formation of CO(2) from 2-oxoglutarate and the hydroxylation of hyoscyamine. Therefore, the enzyme can be classified as a 2-oxoglutarate-dependent dioxygenase (EC 1.14.11.-). Both the supply of hyoscyamine and the hydroxylase activity determine the amounts of 6beta-hydroxyhyoscyamine and scopolamine produced in alkaloid-producing cultures.


Qualification of tumour mutational burden by targeted next-generation sequencing as a biomarker in hepatocellular carcinoma.
Tumour mutational burden (TMB) predicts improved response and survival to immunotherapy. In this pilot study, we optimized targeted next-generation sequencing (tNGS) to estimate TMB in hepatocellular carcinoma (HCC). We sequenced 48 non-paired samples (21 fresh-frozen [FF] and 27 paraffin-embedded [FFPE]), among which 11 FFPE samples were pretreated with uracil-DNA glycosylase (UDG). Thirty samples satisfied post-sequencing quality control. High/low TMB was defined by median number of mutations/Mb (Mut/Mb), across different minimum allele frequency (MAF) thresholds (≥0.05, ≥0.1 and ≥0.2). Eligible patients (n = 29) were cirrhotic (84%) with TNM stage I-II HCC (75%). FFPE samples had higher TMB (median 958.39 vs 2.51 Mut/Mb, P < .0001), estimated deamination counts (median 1335.50 vs 0, P < .0001) and C > T transitions at CpG sites (median 60.3% vs 9.1%, P = .002) compared to FF. UDG-treated samples had lower TMB (median 4019.92 vs 353 Mut/Mb, P = .041) and deamination counts (median 6393.5 vs 328.5, P = .041) vs untreated FFPE. At 0.2 MAF threshold with UDG treatment, median TMB was 5.48 (range 1.68-16.07) and did not correlate with salient pathologic features of HCC, including survival. While tNGS on fresh HCC samples appears to be the optimal source of tumour DNA, the low median TMB values observed may limit the role of TMB as a predictor of response to immunotherapy in HCC.


Clinical Characteristics and Outcomes of Patients With Heart Failure With Reduced Ejection Fraction and Chronic Obstructive Pulmonary Disease: Insights From PARADIGM-HF.
Background Chronic obstructive pulmonary disease (COPD) is a common comorbidity in heart failure with reduced ejection fraction, associated with undertreatment and worse outcomes. New treatments for heart failure with reduced ejection fraction may be particularly important in patients with concomitant COPD. Methods and Results We examined outcomes in 8399 patients with heart failure with reduced ejection fraction, according to COPD status, in the PARADIGM-HF (Prospective Comparison of Angiotensin Receptor Blocker-Neprilysin Inhibitor With Angiotensin-Converting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure) trial. Cox regression models were used to compare COPD versus non-COPD subgroups and the effects of sacubitril/valsartan versus enalapril. Patients with COPD (n=1080, 12.9%) were older than patients without COPD (mean 67 versus 63 years; P<0.001), with similar left ventricular ejection fraction (29.9% versus 29.4%), but higher NT-proBNP (N-terminal pro-B-type natriuretic peptide; median, 1741 pg/mL versus 1591 pg/mL; P=0.01), worse functional class (New York Heart Association III/IV 37% versus 23%; P<0.001) and Kansas City Cardiomyopathy Questionnaire-Clinical Summary Score (73 versus 81; P<0.001), and more congestion and comorbidity. Medical therapy was similar in patients with and without COPD except for beta-blockade (87% versus 94%; P<0.001) and diuretics (85% versus 80%; P<0.001). After multivariable adjustment, COPD was associated with higher risks of heart failure hospitalization (hazard ratio [HR], 1.32; 95% CI, 1.13-1.54), and the composite of cardiovascular death or heart failure hospitalization (HR, 1.18; 95% CI, 1.05-1.34), but not cardiovascular death (HR, 1.10; 95% CI, 0.94-1.30), or all-cause mortality (HR, 1.14; 95% CI, 0.99-1.31). COPD was also associated with higher risk of all cardiovascular hospitalization (HR, 1.17; 95% CI, 1.05-1.31) and noncardiovascular hospitalization (HR, 1.45; 95% CI, 1.29-1.64). The benefit of sacubitril/valsartan over enalapril was consistent in patients with and without COPD for all end points. Conclusions In PARADIGM-HF, COPD was associated with lower use of beta-blockers and worse health status and was an independent predictor of cardiovascular and noncardiovascular hospitalization. Sacubitril/valsartan was beneficial in this high-risk subgroup. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01035255.


5-n-Butylpyridine-2-carboxylate-copper(II) and -iron(III) complexes.
In trans-bis(5-n-butylpyridine-2-carboxylato-kappa(2)N,O)bis(methanol-kappaO)copper(II), [Cu(C(10)H(12)NO(2))(2)(CH(4)O)(2)], the Cu atom lies on a centre of symmetry and has a distorted octahedral coordination. The Cu-O(methanol) bond length in the axial direction is 2.596 (3) A, which is much longer than the Cu-O(carboxylate) and Cu-N distances in the equatorial plane [1.952 (2) and 1.977 (2) A, respectively]. In mer-tris(5-n-butylpyridine-2-carboxylato-kappa(2)N,O)iron(III), [Fe(C(10)H(12)NO(2))(3)], the Fe atom also has a distorted octahedral geometry, with Fe-O and Fe-N bond-length ranges of 1.949 (4)-1.970 (4) and 2.116 (5)-2.161 (5) A, respectively. Both crystals are stabilized by stacking interactions of the 5-n-butylpyridine-2-carboxylate ligand, although hydrogen bonds also contribute to the stabilization of the copper(II) complex.


Behavioral and biochemical effects of job loss and unemployment stress.
Previous research on the effects of unemployment has focused upon both anticipation of job loss and long-term unemployment, typically using self-report and some biochemical measures of response to unemployment stress. The present study was concerned with behavioral and biochemical responses to unemployment. It was also designed to examine a somewhat different time course of unemployment than has been used in previous work. Results indicated that stress accompanies unemployment; looking at people who had been unemployed for up to four months, those who had been unemployed for greater lengths of time performed more poorly on a behavioral task and exhibited higher levels of urinary norepinephrine and epinephrine than did persons unemployed for shorter time periods or subjects who were employed.


Cost-Effective Implementation of Multiconformer Transition State Theory for Alkoxy Radical Unimolecular Reactions.
Alkoxy radicals are important intermediates in the gas-phase oxidation of volatile organic compounds (VOCs) determining the nature of the first-generation products. An accurate description of their chemistry under atmospheric conditions is essential for understanding the atmospheric oxidation of VOCs. Unfortunately, experimental measurements of the rate coefficients of unimolecular alkoxy radical reactions are scarce, especially for larger systems. As has previously been done for peroxy radical hydrogen shift reactions, we present a cost-effective approach to the practical implementation of multiconformer transition state theory (MC-TST) for alkoxy radical unimolecular (H-shift and decomposition) reactions. Specifically, we test the optimal approach for the conformational sampling as well as the best value for a cutoff of high-energy conformers. In order to obtain accurate rate coefficients at a reduced computational cost, an energy cutoff is employed to reduce the required number of high-level calculations. The rate coefficients obtained with the developed theoretical approach are compared to available experimental rate coefficients for both 1,5 H-shifts and decomposition reactions. For all but one of the reactions tested, the calculated MC-TST rate coefficients agree with experimental results to within a factor of 7. The discrepancy for the final reaction is about a factor of 15, but part of the discrepancy is caused by pressure effects, which are not included in MC-TST. Thus, for the fastest alkoxy reactions, deviation from the high-pressure limit even at 1 bar should be considered.


A comprehensive index for longitudinal monitoring of child health status.
The aim of this study was to develop a single comprehensive index of child mortality for longitudinal assessment of health status of children. The need for such a comprehensive index arose from conflicting trends in different child mortality indicators. The data for the study was taken from the Sample Registration System (SRS) reports of the Registrar General of India. SRS is known to provide reliable estimates of births and deaths at the State and the National level. The study included five child mortality indicators, namely, under five mortality rate (U5MR), infant mortality rate, neonatal mortality rate, perinatal mortality rate and still birth rate. These were available for fifteen states of India over the years 1972-1988. To develop this index we modified an earlier method based on factor analysis. Factor analysis of data on various indicators of child mortality revealed two factors which together explained 78% to 93% of the total variation in different years. The first factor was identified as representing mortality after birth and the second as before and during birth. The comprehensive index was obtained as a linear combination of these two factors. The resultant index thus fairly represented all five mortality indicators and provided a comprehensive and reasonably correct picture of child mortality. The lower the magnitude of this index, the better was the child health status. Trends in the index showed that the highest decline in the magnitude was in the state of Kerala followed by Punjab, Andhra Pradesh, Gujarat and Maharashtra in that order. This indicates steady improvement of the child health status over years in these states. In the State of Jammu and Kashmir, the index remained more or less constant over the years though the magnitude was low in the cross-sectional comparison with other states. Thus the comprehensive index developed by using factor analysis of the various mortality indicators can be used for the longitudinal monitoring of child health status in the states of India.


Pre-processing, registration and selection of adaptive optics corrected retinal images.
In this paper, the aim is to demonstrate enhanced processing of sequences of fundus images obtained using a commercial AO flood illumination system. The purpose of the work is to (1) correct for uneven illumination at the retina (2) automatically select the best quality images and (3) precisely register the best images. Adaptive optics corrected retinal images are pre-processed to correct uneven illumination using different methods; subtracting or dividing by the average filtered image, homomorphic filtering and a wavelet based approach. These images are evaluated to measure the image quality using various parameters, including sharpness, variance, power spectrum kurtosis and contrast. We have carried out the registration in two stages; a coarse stage using cross-correlation followed by fine registration using two approaches; parabolic interpolation on the peak of the cross-correlation and maximum-likelihood estimation. The angle of rotation of the images is measured using a combination of peak tracking and Procrustes transformation. We have found that a wavelet approach (Daubechies 4 wavelet at 6th level decomposition) provides good illumination correction with clear improvement in image sharpness and contrast. The assessment of image quality using a 'Designer metric' works well when compared to visual evaluation, although it is highly correlated with other metrics. In image registration, sub-pixel translation measured using parabolic interpolation on the peak of the cross-correlation function and maximum-likelihood estimation are found to give very similar results (RMS difference 0.047 pixels). We have confirmed that correcting rotation of the images provides a significant improvement, especially at the edges of the image. We observed that selecting the better quality frames (e.g. best 75% images) for image registration gives improved resolution, at the expense of poorer signal-to-noise. The sharpness map of the registered and de-rotated images shows increased sharpness over most of the field of view. Adaptive optics assisted images of the cone photoreceptors can be better pre-processed using a wavelet approach. These images can be assessed for image quality using a 'Designer Metric'. Two-stage image registration including correcting for rotation significantly improves the final image contrast and sharpness.


Relationship between psychological well-being and lung health status in patients with bronchiectasis.
Patients with bronchiectasis often complain of abnormal tiredness, difficulty in concentrating or low spirits. This study was carried out to examine levels of anxiety and depression in bronchiectasis and their relationship with other measures of lung health. One hundred and eleven patients with bronchiectasis determined by high-resolution computed tomography (CT) scan were studied using a range of physiological and psychological outcome measures. Patients completed anxiety and depression, health status (quality of life), fatigue and dypnoea questionnaires. Lung function was measured and exercise capacity was assessed using a shuttle walk test. Anxiety and depression scores formed a continuum. Moderate-severe anxiety was more frequent than equivalent levels of depression (17 vs 9% of patients). Anxiety and depression scores were associated with perceived health status (r=0.33 and 0.55). Neither anxiety nor depression was associated with the extent of bronchiectasis on CT scan. Depression was correlated with breathlessness and exercise performance (r=0.33 and 0.40), but anxiety was not. The correlation between depression and exercise performance was not simply due to the influence of somatic items in the depression questionnaire. We conclude that anxiety and depression are quite common in bronchiectasis in that 34% of patients had elevated scores for anxiety depression or both. The non-somatic components of depression were linked to dyspnoea and exercise performance, but anxiety was only related to perceived health. Therefore, treatment aimed at reducing symptoms and improving exercise capacity will not reduce levels of anxiety which need alternative therapy.


Predictors of Suicidal Ideation and Attempt among Patients with Major Depressive Disorder at a Tertiary Care Hospital, Puducherry.
Objectives Mental disorders have a large impact on death by suicide. Hence, this study aims to determine the prevalence of suicidal behaviors among major depressive disorder (MDD) patients and the associated factors. Materials and Methods This cross-sectional analytical study was conducted among individuals aged 18 to 65 years, diagnosed with MDD in the Psychiatry Outpatient Department of a Tertiary Care Center, Puducherry during March to October 2019. Severity of depression was assessed using Hamilton Depression Rating Scale and Columbia-Suicide Severity Rating Scale was used to find the suicidal behaviors. Results For 166 participants in the study, mean (standard deviation) age was 40 (11) years and majority were females (76%). More than one-third (37%) had severe or very severe depression, and the prevalence of suicidal ideation, plan, and attempts were 83, 24, and 35%, respectively. After adjusting the covariates, the severity of depression and unemployment were significantly associated with suicidal attempts (adjusted prevalence ratios [aPR] = 11.4 and 1.9), and very severe depression was associated with suicidal ideation (aPR = 1.6). Among 140 individuals with suicidal ideation, 45 (32%) had an ideation frequency of 2 to 3 times/week, 69 (50%) had ideation for 1 hour, 36 (26%) could control ideation with little difficulty, and 12% had suicidal ideation mostly to end or stop their pain. Conclusion Suicidal ideation and attempts were significantly high in MDD patients, and the severity of depression was significantly associated with it. Early identification of high-risk suicidal behavior and implementation of effective preventive interventions are necessary to reduce death by suicide in these groups.


Contrast-enhanced ultrasound for sentinel lymph node mapping in the routine staging of canine mast cell tumours: A feasibility study.
Canine mast cell tumours (MCTs) typically spread to lymph nodes (LNs) before reaching distant sites, and LN assessment is an important part of MCT staging. Sentinel LN (SLN) mapping techniques to identify draining LNs are being developed and could improve the accuracy of MCT staging. The primary objective of this feasibility study was to determine the safety and effectiveness of contrast-enhanced ultrasound (CEUS) to identify SLNs. Secondary objectives were to determine if the SLNs identified by CEUS coincided with the regional LN predicted by the anatomical lymphosomes, if previous MCT excision altered CEUS SLN findings, and if CEUS could identify MCT nodal metastases. Between June 2017 and March 2019, 59 dogs with 62 MCTs were enrolled. No adverse events related to CEUS were reported. CEUS detected at least 1 SLN in 59/62 MCTs (95.2%, 95% CI: 86.5-99.0%). In only 32/59 (54.2%) MCTs, clinicians would have correctly predicted the SLN(s) identified by CEUS. Among the 35 MCTs that had histological examination of the SLN(s), the prevalence of metastasis was 60% (95% CI: 42.1-76.1%). Additional staging procedures did not reveal any metastases in dogs with histologically non-metastatic SLNs. Integration of CEUS SLN mapping into the routine staging of MCTs is promising, but future studies are required to refine this procedure and to investigate if it would translate into a clinical benefit.


Abnormal vowel patterns in phonological disorder: some data and a hypothesis.
This article examines the vowel systems of a group of phonologically disordered children who show abnormalities in their vowel patterns. The conclusions emerging from the analysis of disordered speech are presented, along with examples from the data. It is argued that there are relatively common context-free processes of simplification of the vowel system in the data, and that these represent natural changes that may occur in normal development. Other less common processes may be idiosyncratic, and indicate some measure of disordered development. Some difficulties with vowels may relate to difficulties in the consonant system, or to difficulties with prosodic or paralinguistic features. Variability is an important part of the data, relevant to understanding the disorder and the process of development. It is hypothesised that the proposed framework will be relevant to clinical decision-making.


Ultrasound-guided fascia iliaca compartment block in orthopedic fractures: Bupivacaine 0.2% or 0.3%?
Background: Postoperative pain is one of the major problems in patients with femoral or hip fracture. Current study investigates the effect of 0.2% and 0.3% bupivacaine in ultrasound-guided fascia iliaca compartment block (FICB) on postoperative pain. Methods: This randomized clinical trial study was conducted in Rasoul Akram Hospital of Iran University of Medical Sciences. Forty-eight patients with femoral or hip fractures who were candidates for surgery underwent FICB, divided into two groups receiving bupivacaine in 0.2% and 0.3% concentrations. Pain was evaluated with Visual Analog Scale (VAS) at times 2, 6, 12, 24, and 48 hours after surgery. Need for opioids, nausea and vomiting after surgery, patients' satisfaction with pain control and motor block were also recorded. T-test or Mann- Whitney U test and Repeated measure ANOVA was used for analysis. Results: Pain score after surgery was significantly lower in groups receiving 0.3% than the group receiving 0.2% concentration. Patients' satisfaction with pain control in 0.2% group was significantly higher (p=0.04). Time to analgesic onset in both groups had no significant differences (p=0.5). The incidence of nausea and vomiting (p=0.5) and opioid consumption (p=0.1) between the two groups showed no significant difference. Conclusion: In femoral or hip fracture, bupivacaine with 0.3% concentration in fascia iliaca compartment block can cause lower pain score compared to bupivacaine with 0.2% concentration, but patients' satisfaction with pain control and severity of motor block is higher in bupivacaine 0.2%.