Successful strategies for serving diverse populations.
Unique insights of key delivery staff and successful delivery strategies used to overcome cultural barriers were obtained through intensive interviews with fifty staff members. Participants in the study were identified as knowledgeable staff members by project coordinators. An open-ended qualitative methodology was used to interview staff members about barriers they faced in delivering services to new populations and strategies that were used to address these barriers. Fifty interviews were completed. Of those, forty-two interviewees were frontline staff members and eight were "hands-on" administrators. Fifteen of these staff members worked in programs that were targeted to urban dwelling Latino families and ten served urban African-Americans. Of the twenty-five staff members who worked in programs targeted to rural populations, eight worked to provide respite to African-American families while four served rural Latinos. The remaining thirteen interviewees served rural families of all ethnic groups. Interviews were tape recorded for accuracy and later transcribed. Emergent themes include: successful vs. unsuccessful service efforts, diversity of caregivers within ethnic groups, staff members' perceptions of their clients, staffing patterns, cultural views of Alzheimer's disease, service use in general, and government assistance. Concrete examples from staff members' experiences are used to illustrate these themes.


Cultural competence and health care disparities: key perspectives and trends.
Cultural competence has gained attention as a potential strategy to improve quality and eliminate racial/ethnic disparities in health care. In 2002 we conducted interviews with experts in cultural competence from managed care, government, and academe to identify their perspectives on the field. We present our findings here and then identify recent trends in cultural competence focusing on health care policy, practice, and education. Our analysis reveals that many health care stakeholders are developing initiatives in cultural competence. Yet the motivations for advancing cultural competence and approaches taken vary depending on mission, goals, and sphere of influence.


Insertion of removable self-expanding metal stents as a treatment for postoperative leaks and perforations of the esophagus and stomach.
Esophageal perforations and postoperative esophageal leaks are associated with substantial morbidity and mortality and pose a difficult therapeutic challenge. Toevaluate the outcome ofremovableself-expanding metallic stents (SEMS) as a treatment for postoperative leaks and perforations of the esophagus and stomach. We conducted a retrospective study of all patients in one medical center who underwent temporary insertion of a covered plastic stent for postoperative leaks and perforations of the esophagus and stomach from June 2009 to February 2010. Data were retrieved from hospital and outpatient clinical data charts. Data included indication for insertion, post-insertion outcome including stent complications, and follow-up after stent removal. The indications for stent insertion were postoperative leak in four patients and postoperative esophagopleural fistula in one patient. Three of the patients had a leak at the gastroesophageal junction following laparoscopic sleeve gastrectomy. In all cases the stent insertion was completed successfully. In three patients the stent migrated distally. In two of these three it was repositioned or replaced endoscopically, and in the third it was excreted in the feces. Stents were removed electively after 6 to 7 weeks. All patients recovered fully and were discharged from the hospital. SEMS insertion may have an important role in the management of postoperative leaks and perforations of the esophagus and stomach and should be considered in such cases.


Patterns of vulnerability to non-fatal injuries in Sudan: initial evidence from a national cross-sectional survey.
Successful injury prevention requires identification and targeting of particularly vulnerable groups. Little is known about injury vulnerability patterns in Sudan. This paper aimed to fill this gap using survey data. Data from the Sudan Household Health Survey were used. This was a national cross-sectional interview survey of 83,510 individuals selected by multistage cluster random sampling. Multivariable Poisson regression was used to investigate the association of cause-specific injury that received care by traditional healers, outpatient care and inpatient care, and those that received only inpatient care, with age, gender, area of residence (urban or rural), socioeconomic status and education. Relevant interactions were tested. Independent of other sociodemographic variables, men were at higher risk of road traffic injury (prevalence ratio (PR): 3.3 95% CI 2.4 to 4.7), falls (PR: 1.5, 95% CI 1.3 to 1.9), assault (PR: 3.0 95% CI 1.8-5) and mechanical injury (PR: 2.0 95% CI 1.2 to 3.1) that received any form of healthcare. Those aged 65 years and over also had the highest risk of those injury causes, while children under 5 years were the most likely to suffer burn injuries. Socioeconomic status was associated with assault (PR for the richest group 0.4 95% CI 0.2 to 0.8). Vulnerability patterns for injury that received inpatient care were fairly similar for some causes. In Sudan, existing disease prevention and health promotion programmes should expand to target men, children under 5 years, elderly people and those of low socioeconomic status with injury prevention interventions. Further research is needed to investigate the context-specific proximal risk factors that shape the various vulnerability patterns observed.


Coarse and reliable geometric alignment for protein docking.
We present an efficient algorithm for generating a small set of coarse alignments between interacting proteins using meaningful features on their surfaces. The proteins are treated as rigid bodies, but the results are more generally useful as the produced configurations can serve as input to local improvement algorithms that allow for protein flexibility. We apply our algorithm to a diverse set of protein complexes from the Protein Data Bank, demonstrating the effectivity of our algorithm, both for bound and for unbound protein docking problems.


[The nature of spontaneous and induced mutagenesis in a genetically unstable mutator strain of Drosophila melanogaster].
The spontaneous and induced frequencies of visible mutations by N-nitroso-N-ethylurea in male cells of Drosophila melanogaster genetically unstable mutator strain have been investigated. The spontaneous and induced by N-nitroso-N-ethylurea genetic instability in mutator strain have similar manifestation, that evidently testifies the existence of general mechanisms of the appearance of unstable mutations, namely the transpositions of the mobile genetic elements.


Activity ratio measurements reflect intracellular activation of adenosine 3',5'-monophosphate-dependent protein kinase in osteoblasts.
Parathyroid hormone, prostaglandin E2, and prostacyclin activate cAMP-dependent protein kinase in osteoblast-rich normal rat calvarial cells and in clonal rat osteogenic sarcoma cells of osteoblastic phenotype. The present study was undertaken to determine the activation of the enzyme in relation to cellular cAMP concentrations at increasing doses of the three hormones and also to test that the activity ratio measurement of the enzyme (ratio of the activity in the absence of cAMP to the activity in the presence of excess cAMP) was a true reflection of intracellular activation of the enzyme. With each hormone, using either normal or malignant osteoblasts, activation of the enzyme took place at hormone concentrations lower than those required to produce detectable changes in cAMP concentrations in the incubations. Stimulation of activity was abolished by addition of the heat-stable inhibitor of cAMP-dependent protein kinase, indicating that activation was of cAMP-dependent protein kinase alone. To demonstrate that protein kinase activation occurred intracellularly and not during sample preparation, charcoal was added at the time of cell disruption to absorb free cAMP. Under these conditions, no change was observed in the concentration of bovine parathyroid hormone required to cause activation of cAMP-dependent protein kinase. Finally, addition of purified cAMP-dependent protein kinase type I or type II to treated cells at the time of lysis did not result in significant activation of added isoenzyme, except at hormone concentrations sufficient to increase the total cAMP concentration of incubations. It is concluded that activity ratio measurement reflects the intracellular state of activation of cAMP-dependent protein kinase in the osteoblast-like cells treated by hormones and, furthermore, that only a fraction of the maximally generated cAMP is necessary for full enzyme activation.


An economic spreadsheet model to determine optimal breeding and replacement decisions for dairy cattle.
The aim of this paper is to describe a user-friendly spreadsheet culling model that was constructed to support economical, optimal breeding and replacement decisions on dairy farms. The model was based on the marginal net revenue technique. Inputs for the model can be entered for specific farm conditions, and the output is easily accessible. In the model, the retention pay-off (RPO) value of individual dairy cows was calculated. The RPO value of a cow is equal to the total additional profits that a producer can expect from trying to keep the cow until her optimal age, taking into account the changes of involuntary removal compared with her immediate replacement. To calculate the RPO values, the future production, revenues, and costs of dairy cows at different levels of milk production with different numbers of days open (DO) were determined. Furthermore, the ranges of carcass value, calf revenues, and the range of involuntary disposal rates of cows within and across lactations were taken into account. To illustrate the model, parameters in the model were chosen to represent a typical Holstein dairy herd in Pennsylvania. The results of this model are very comparable with earlier, more complex models that are more difficult to use on the farm. In addition to using the RPO values to evaluate the decision to breed or replace a cow, the costs per additional DO were estimated. Early conception was most profitable with the costs per additional DO varying from $0 to more than $3/d. The model can be used as a decision-supporting tool for producers, extension personnel, veterinarians, and consultants. In addition, researchers, economists, and government organizations can use the model to determine the costs of culling dairy cows in a disease control program. The model and manual are available at http://cahpwww.vet.upenn.edu/software/econcow.html.


Health-related quality of life in euthymic bipolar disorder patients: differences between bipolar I and II subtypes.
The aim of the present study was to compare health-related quality of life (HRQoL) measures in euthymic patients with bipolar I and II disorder. We included as comparison samples a group of subjects with recurrent major depression (RMD) and a group of non-psychiatrically ill individuals. HRQoL was assessed using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) in 253 subjects recruited in 5 Italian centers: 90 patients with bipolar I disorder, 52 patients with bipolar II disorder, 61 subjects with RMD, and 50 healthy comparison individuals. All subjects were evaluated with the Structured Clinical Interview for DSM-IV; psychiatric patients had to be in a euthymic state for at least 2 months prior to the inclusion in the study, as confirmed by a Hamilton Rating Scale for Depression total score < 8 and a Young Mania Rating Scale total score < 6. Data were drawn from a study that was performed from May 2003 to December 2004. When we compared the bipolar and RMD groups with the control group of non-psychiatrically ill individuals and controlled for differences in mean actual age, both bipolar subgroups and subjects with RMD had lower SF-36 mean scores on several subscales; differences in mean SF-36 scores were also detected between bipolar subtypes: bipolar II patients showed HRQoL that was poorer than that of bipolar I patients, even after controlling for age, age at onset, and length of illness, and equal to that of RMD subjects. Our study provides evidence that bipolar type II is associated with poorer HRQoL compared to type I even during sustained periods of euthymia and excluding residual symptoms. Interventions targeting rehabilitation and/or functional enhancement may be helpful to improve HRQoL, especially among patients with bipolar II disorder.


Peer victimization and intentional injuries: quantitative and qualitative accounts of injurious physical interactions between students.
Studies have shown that peer victimization engenders physical injuries both indirectly (i.e. as a trigger of injurious events) and directly (i.e. through intentional physical harm). How those injuries occur has not been much researched. To highlight the various circumstances in which injuries are sustained by young teenagers when physically interacting with other students, and to characterize more specifically the context surrounding those injuries sustained resulting from violent actions. Data were extracted from information already available from structured interviews conducted during two consecutive school years with children aged 10-15 years who had been hospitalized due to injury and who were residing in Stockholm County (Sweden) (n = 634). The current study considers those injuries resulting from physical interactions between students and pays attention to the gender and age distribution of the victims. The free text descriptions of the "interaction" injuries resulting from violent actions were re-read and examined by means of content analysis. Of the injuries reported, 23.5% resulted from physical interactions between students. The most frequent context of their occurrence was sports and play. Other injuries resulted either from assaults where the victim was in a clear imbalance of power (n = 24) or from violent incidents in which the victim was not powerless (n = 27). The two latter situations were much more common among boys. Peer victimization has an impact on children's safety both within and outside the school arena. Students are injured by their peers not only from deliberate violence targeting them but also from violent physical interactions in which they play an active role. These injurious events have a clear gender and age component.


Dose reconstruction for residents living in buildings with moderate and minor 60Co contamination in rebar.
Previously, we have reconstructed cohort dependent individual doses for residents living in rebar buildings of high 60Co contamination. These reconstructions were carried out using intensively collected TLD data on exposure rates at locations of 1 m height and 1 m x 1 m intersections. The present work deals with dose reconstructions for residents living in rebar buildings of moderate and minor 60Co contamination. Since only limited data on exposure rates from survey meters were available, dose reconstructions were based on these data using interpolations. To utilize such data, we examined them with respect to all factors that influenced the dose uncertainties. The interpolated results were given in terms of contour plots (isodose curves) and compared with corresponding results derived from TLD data and Monte Carlo simulations. The comparison revealed that survey meter data could be used to provide reasonable and conservative estimates of residential doses. By applying the cohort-dependent room occupancy factor and the site-dependent area occupancy factor, we reconstructed cohort dependent individual doses and associated uncertainties. Results of dose reconstructions for all residents living in contaminated rebar buildings were provided to the Atomic Energy Council and health authorities for epidemiologic and medical uses.


Nature and intensity of selection pressure on CRISPR-associated genes.
The recently discovered CRISPR-Cas adaptive immune system is present in almost all archaea and many bacteria. It consists of cassettes of CRISPR repeats that incorporate spacers homologous to fragments of viral or plasmid genomes that are employed as guide RNAs in the immune response, along with numerous CRISPR-associated (cas) genes that encode proteins possessing diverse, only partially characterized activities required for the action of the system. Here, we investigate the evolution of the cas genes and show that they evolve under purifying selection that is typically much weaker than the median strength of purifying selection affecting genes in the respective genomes. The exceptions are the cas1 and cas2 genes that typically evolve at levels of purifying selection close to the genomic median. Thus, although these genes are implicated in the acquisition of spacers from alien genomes, they do not appear to be directly involved in an arms race between bacterial and archaeal hosts and infectious agents. These genes might possess functions distinct from and additional to their role in the CRISPR-Cas-mediated immune response. Taken together with evidence of the frequent horizontal transfer of cas genes reported previously and with the wide-spread microscale recombination within these genes detected in this work, these findings reveal the highly dynamic evolution of cas genes. This conclusion is in line with the involvement of CRISPR-Cas in antiviral immunity that is likely to entail a coevolutionary arms race with rapidly evolving viruses. However, we failed to detect evidence of strong positive selection in any of the cas genes.


Herpes simplex virus type 1 (HSV-1)--induced retinitis following herpes simplex encephalitis: indications for brain-to-eye transmission of HSV-1.
Herpes simplex encephalitis is a severe neurological disease with high mortality and morbidity rates. Reactivated herpes simplex virus type 1 (HSV-1) can cause relapses and might even spread to the retina, where it can induce a potentially blinding eye disease, known as acute retinal necrosis. In the present study, the HSV-1 strains in the brain and eye of 2 patients with acute retinal necrosis following an episode of herpes simplex encephalitis were genotyped. The HSV-1 strains in both the brain and eye were identical in each patient, but they differed interindividually. The data suggest brain-to-eye transmission of HSV-1 in these patients.


Measure of beliefs about improvements in mood associated with exercise.
Changes in mood following exercise are well documented; however, one particular limitation of research examining mood changes associated with exercise is that studies have not controlled for a possible expectancy effect. Given the difficulty associated with utilising a placebo control group in exercise settings and that no current questionnaires are available to measure beliefs concerning mood improvements during and after exercise, the present studies aimed to develop a suitable instrument for assessing these beliefs. In the first of these studies, 220 regular runners were respondents in developing the new scale. A logical approach to test construction, as proposed by Hase and Goldberg in 1967, produced two scales of acceptable reliability: a five-item subscale to measure beliefs concerning mood improvements during running (Cronbach alpha=.77) and a two-item subscale to measure beliefs about mood improvements following running (Cronbach alpha=.86). A second study, which involved the administration of these scales to 50 regular runners after a 60-min. treadmill run, indicated there were moderate associations between scores on these measures and mood changes during and after the run.


Racial and Ethnic Differences in Hospice Use Among Medicaid-Only and Dual-Eligible Decedents.
Hospice care enhances quality of life for people with terminal illness and is most beneficial with longer length of stay (LOS). Most hospice research focuses on the Medicare-insured population. Little is known about hospice use for the racially and ethnically diverse, low-income Medicaid population. To compare hospice use and hospice LOS by race and ethnicity among Medicaid-only individuals and those with dual eligibility for Medicare and Medicaid (duals) in the Connecticut Medicaid program who died over a 4-year period. This retrospective population-based cohort study used Medicaid and traditional Medicare enrollment and claims data for 2015 to 2020. The study included Connecticut Medicaid recipients with at least 1 of 5 most common hospice diagnoses who died from 2017 to 2020. Race and ethnicity. Hospice use (yes/no) and hospice LOS (1-7 days vs ≥8 days.) Covariates included sex, age, and nursing facility stay within 60 days of death. Overall, 2407 and 23 857 duals were included. Medicaid-only decedents were younger (13.8% ≥85 vs 52.5%), more likely to be male (50.6% vs 36.4%), more racially and ethnically diverse (48.7% non-Hispanic White vs 79.9%), and less likely to have a nursing facility stay (34.9% vs 56.1%). Race and ethnicity were significantly associated with hospice use and LOS in both populations: non-Hispanic Black and Hispanic decedents had lower odds of using hospice than non-Hispanic White decedents, and Hispanic decedents had higher odds of a short LOS. In both populations, older age and female sex were also associated with more hospice use. For duals only, higher age was associated with lower odds of short LOS. For decedents with nursing facility stays, compared with those without, Medicaid-only decedents had higher odds of using hospice (odds ratio [OR], 1.49; 95% CI, 1.24-1.78); duals had lower odds (OR, 0.60; 95% CI, 0.57-0.63). Compared with decedents without nursing facility stays, duals with a nursing facility stay had higher odds of short LOS (OR, 2.63; 95% CI, 2.43-2.85). Findings raise concerns about equity and timing of access to hospice for Hispanic and non-Hispanic Black individuals in these understudied Medicaid populations. Knowledge about, access to, and acceptance of hospice may be lacking for these low-income individuals. Further research is needed to understand barriers to and facilitators of hospice use for people with nursing facility stays.


Quercetin inhalation inhibits the asthmatic responses by exposure to aerosolized-ovalbumin in conscious guinea-pigs.
Effects of quercetin inhalation on immediate (IAR), late-phase (LAR) and late late-phase (LLAR) asthmatic responses by exposure to aerosolized-ovalbumin (AOA) (2w/v% in saline, inhalation for 3 min) were studied in conscious guinea-pigs sensitized with AOA. We measured specific airway resistance (sRaw), and recruitment of leukocytes, histamine and protein contents and phospholipase A2 (PLA2) activity in bronchoalveolar lavage fluid (BALF). Effects of quercetin (10 mg/mL, inhalation for 2 min) compared with cromolyn sodium, salbutamol, and dexamethasone inhalations, respectively. Quercetin inhalation decreased sRaw by 57.15 +/- 3.82% in IAR, 57.72 +/- 7.28% in LAR, and 55.20 +/- 5.69% in LLAR compared with AOA-inhaled control. Salbutamol inhalation (5 mg/mL) significantly inhibited sRaw in IAR, but inhalations of cromolyn sodium (10 mg/mL) and dexamethasone (5 mg/mL) significantly inhibited sRaw in IAR, LAR and LLAR, respectively. Inhibitory activity of quercetin inhalation on sRaw was similar to effect of its oral administration (10 mg/kg) in asthmatic responses. Quercetin (10 mg/mL, inhalation for 2 min) significantly decreased histamine and protein contents, PLA2 activity, and recruitments of leukocytes in BALF and also improved slightly infiltration of eosinophils and neutrophils in histopathological survey. Its anti-asthmatic activity was similar to cromolyn sodium and dexamethasone.


[Threshold of action of meproscillarin following intravenous administration].
A placebo-controlled double-blind trial was conducted, to determine the onset of effect of Meproscillarin (injected intravenously). 28 days apart six healthy volunteers were given double-blind 1,0 mg Meproscillarin or placebo and 60 days later 0,6 mg Digoxin, each drug as short infusion over four minutes. The total electromechanical systole corrected for heart rate (QS2c), was used as criterion of the inotropic effect of the glycoside. After placebo there no changes were observed over a period of two hours. Both glycosides shortened QS2c for about--16 ms. From Meproscillarin a 40% higher dosis was required, to achieve the same effect as with digoxin. After use of Meproscillarin the peak effect was reached after ten minutes; after digoxin a period of 60--120 minutes were required. The results show that intravenously given Meproscillarin is a fast acting glycoside.


Effectiveness of participatory ergonomic interventions on health outcomes: a systematic review.
The objective of this study was to conduct a systematic review of the literature on the effectiveness of participatory ergonomic (PE) interventions for improving workers' health. The search strategy targeted six electronic databases and identified 442 potential articles. Each article was examined by pairs of reviewers for relevance (assessed a participative ergonomic workplace intervention, with at least one health outcome, published in English in peer reviewed literature). Twenty-three articles met relevance criteria and were then appraised for methodological strength. Using a best evidence synthesis approach, 12 studies that were rated as 'medium' or higher provided partial to moderate evidence that PE interventions have a positive impact on: musculoskeletal symptoms, reducing injuries and workers' compensation claims, and a reduction in lost days from work or sickness absence. However, the magnitude of the effect requires more precise definition.


Consanguinity trends and correlates in the Palestinian Territories.
Secondary analysis of the trends and correlates of consanguinity in the Palestinian Territories was conducted using data from two separate surveys in 1995 and 2004. The analysis was conducted on ever-married women aged 15-54 who were asked about their relation to their husband in both surveys. A total of 16,197 women in 1995 and 4971 women in 2004 were successfully interviewed. Consanguinity was found to be widely practised in the Palestinian Territories with rates of total consanguinity reaching 45% of all marriages in 2004. Analysis was conducted with the data from the two surveys combined and this indicated that consanguinity was significantly decreasing with time after controlling for other variables. Age of the women, their age at marriage, region and locality type they lived in and their standard of living were all found to be significant predictors of consanguinity. The education level of the women was not found to be significant. After controlling for the survey year, women's labour force status was also found to be a non-significant predictor of consanguinity. Although consanguinity was found to be significantly decreasing slowly with time after controlling for other variables, the future trends of consanguinity are not known due to the unstable political situation in the territories, which could have a direct effect on marriage patterns.


[Intraaneurysmal embolization and parent artery trapping to treat a giant partial thrombosed vertebral artery aneurysm after surgical proximal clipping].
We encountered a case with a giant partially-thrombosed vertebral artery aneurysm successfully treated by endovascular trapping following a surgical parent artery clipping two years previously. The patient complained only of headache on her admission. Initial CT showed no subarachnoid hemorrhage, and MRI of the left anterior aspect of the pons showed flow void and hematoma. The angiogram showed fusiform dilatation of the left vertebral artery just proximal to the vertebral union. At first, the patient was treated by surgical proximal clipping of the left vertebral artery, under a diagnosis of arterial dissection. Her symptom improved and the angiogram showed a slight retrograde aneurysmal filling after the operation. Two years later, she complained of dysphasia, right hemiparesis, and hemidysesthesia caused by the compression of the brain stem. On MRI study, a partially-thrombosed giant aneurysm was detected in the left anterior aspect of the brain stem. The retrograde filling did not change remarkably on the angiogram. We performed the GDC embolization of the left distal vertebral artery and non-thrombosed residual neck with an assisting balloon positioned through the right vertebral artery to the basilar artery. After the embolization, the patient's neurological deficits caused by the compression of the brain stem disappeared. MRI study showed the mass volume reducing gradually over a two-years follow-up period. Treatment for a partially-thrombosed giant vertebral artery aneurysm is difficult and controversial. It is necessary to shut off the blood flow into the aneurysm completely, so we consider that endovascular trapping with intraaneurysmal embolization is the most effective procedure.


Effects of Digestion, Cell Culture Media, and Mucous on the Physical Properties, Cellular Effects, and Translocation of Polystyrene and Polymethacrylate Nanoparticles.
The discovery of plastic and metal nanoparticles in organisms, foods, and beverages has generated numerous studies on the effects of these particles on the barrier cells and their subsequent absorption into the body. Following ingestion, nanoparticles travel down the gastrointestinal tract (GIT), and their physicochemical characteristics change in response to the change in proteins and pH during their digestion. We measured the translocation of digested nanoparticles across a co-culture monolayer of Caco-2 and various combinations (1:9, 5:5, and 9:1) of HT29-MTX-E12. The in vitro model of the intestine was used to determine the translocation of digested 20 nm polymethacrylate (PMA) particles and the accompanying monolayer barrier effects after a 72 h exposure. The in vitro digestion increased the agglomeration and hydrodynamic diameters and decreased the surface charge of the nanoparticles. For NH2-functionalized polymethacrylate nanoparticles (PMA-NH2), the diameters increased from 57 nm (water) to 3800 nm (media), or 2660 nm (chyme). These nanoparticles compromised the integrity of the monolayer (trans-epithelial electrical resistance, Lucifer yellow translocation) and translocated across all the cell ratio configurations. Digestion can have a large effect on nanoparticle agglomeration and surface charge. Excess mucous was not seen as a barrier to the translocation of PMA-NH2.


Nonmonotonic Temperature Dependence of the Pressure-Dependent Reaction Rate Constant and Kinetic Isotope Effect of Hydrogen Radical Reaction with Benzene Calculated by Variational Transition-State Theory.
The reaction between H and benzene is a prototype for reactions of radicals with aromatic hydrocarbons. Here we report calculations of the reaction rate constants and the branching ratios of the two channels of the reaction (H addition and H abstraction) over a wide temperature and pressure range. Our calculations, obtained with an accurate potential energy surface, are based on variational transition-state theory for the high-pressure limit of the addition reaction and for the abstraction reaction and on system-specific quantum Rice-Ramsperger-Kassel theory calibrated by variational transition-state theory for pressure effects on the addition reaction. The latter is a very convenient way to include variational effects, corner-cutting tunneling, and anharmonicity in falloff calculations. Our results are in very good agreement with the limited experimental data and show the importance of including pressure effects in the temperature interval where the mechanism changes from addition to abstraction. We found a negative temperature effect of the total reaction rate constants at 1 atm pressure in the temperature region where experimental data are missing and accurate theoretical data were previously missing as well. We also calculated the H + C6H6/C6D6 and D + C6H6/C6D6 kinetic isotope effects, and we compared our H + C6H6 results to previous theoretical data for H + toluene. We report a very novel nonmonotonic dependence of the kinetic isotope effect on temperature. A particularly striking effect is the prediction of a negative temperature dependence of the total rate constant over 300-500 K wide temperature ranges, depending on the pressure but generally in the range from 600 to 1700 K, which includes the temperature range of ignition in gasoline engines, which is important because aromatics are important components of common fuels.


Mucinous tumours of appendix and ovary: an overview and evaluation of current practice.
Mucinous lesions of the appendix and ovary are commonly encountered in routine practice. There are several published classification schemes for appendiceal mucinous neoplasms with resultant inconsistent use of terms and clinical doubt. While nomenclature is more settled with regards to ovarian mucinous neoplasms, the difficulty here lies with distinguishing primary from secondary mucinous tumours. This review highlights the terminology and nomenclature for appendiceal mucinous tumours, the relationship with ovarian mucinous neoplasms and pseudomyxoma peritonei, and the features that assist in separating primary from secondary ovarian mucinous tumours.


The Impact of Heavy Load Carrying on Musculoskeletal Pain and Disability Among Women in Shinyanga Region, Tanzania.
Heavy load carrying has been associated with musculoskeletal discomfort (MSD) and disability. However, there is a lack of research investigating this association in resource-constrained settings where heavy load carrying by women is common. We assessed the impact of heavy load carrying on musculoskeletal pain and disability among women in Shinyanga Region, Tanzania, in an exploratory cross-sectional study. Eligible participants were a convenience sample of women, at least 18 years of age, who passed a study recruitment site carrying a load. We collected information on load-carrying practices, including frequency and time spent carrying water, wood, agricultural products, coal, sand, or rocks, and measured the weight of the load carried at the time. Outcomes included self-reported MSDs, defined as experiencing pain lasting >3 days in the neck, head, back, knees, feet and/or ankles within the last 1 year, and related disability. Using multivariable logistic regression we assessed for associations between load carrying exposures and MSDs and disability. Results showed a high prevalence of MSDs across the body regions assessed and evidence to suggest a relationship of back pain and related disability with several measures of load-carrying, including duration, frequency, and weight. Multivariable analyses revealed associations of increased load carrying exposures with low back pain (LBP) and related disability, including statistically significant increases in odds of LBP with increasing weight, total duration of load carrying/week and cumulative loads/week. Findings indicate a substantial burden of MSDs and disability in this population of women who carry heavy loads daily. The extent of discomfort and disability increased with increasing exposure to various load-carrying measures, especially for LBP. Larger epidemiologic studies that definitively assess relationships of load carrying with MSDs and disability are warranted.


Distinct and flexible rates of online control.
Elliott et al. (Hum Mov Sci 10:393-418, 1991) proposed a pseudocontinuous model of online control whereby overlapping corrections lead to the appearance of smooth kinematic profiles in the presence of online feedback. More recently, it was also proposed that online control is not a singular process [see Elliott et al. (Psychol Bull 136(6):1023-1044, 2010)]. However, support for contemporary models of online control were based on methodologies that were not designed to be sensitive to different online control sub-processes. The current study sought to evaluate the possibility of multiple distinct (i.e., visual and non-visual) mechanisms contributing to the control of reaching movements completed in either a full-vision, a no-vision, or a no-vision memory-guided condition. Frequency domain analysis was applied to the acceleration traces of reaching movements. In an attempt to elicit a modulation in the online control mechanisms, these movements were completed at two levels of spatio-temporal constraint, namely with 10 and 30 cm target distances. One finding was that performance in the full-vision relative to both no-vision conditions could be distinguished via two distinct frequency peaks. Increases in the peak magnitude at the lower frequencies were associated with visuomotor mechanisms and increases in the peak magnitude at the higher frequencies were associated with non-visual mechanisms. In addition, performance to the 30-cm target led to a lower peak at a lower frequency relative to the 10 cm target, indicating that the iterative rates of visuomotor control mechanisms are flexible and sensitive to the spatio-temporal constraints of the associated movement.


Clinicopathologic characteristics of 12 patients with vulvar sweat gland carcinoma.
The aim of this article was to evaluate the clinical and pathologic characteristics, therapy, and prognostic factors of vulvar sweat gland carcinoma. Clinical and pathologic data for 12 patients with vulvar sweat gland carcinoma treated at our institution from January 1958 to April 2009 were retrospectively analyzed. Of the 12 cases, 7 cases were vulvar sweat gland carcinoma, 3 cases were vulvar Paget disease with underlying sweat gland adenocarcinoma, 1 case was vulvar apocrine adenocarcinoma, and 1 case was adenoid cystic carcinoma of the vulvar sweat gland. Two patients were treated with simple vulvar tumor excision at other medical institutions without adjuvant therapy. Among the other 10 patients, 6 underwent radical vulvectomy; 3, wide local excision of the vulva; and 1, a simple vulvectomy. For 5 of the 12 patients, bilateral or unilateral inguinal lymph nodes excision and biopsy were performed. For 1 patient with bulky inguinal lymph nodes, only a biopsy was performed, and the patient received radiotherapy after vulvar surgery. A follow-up for 11 patients was conducted until death or April 1, 2009. Five of the 11 patients had recurrences after primary treatment. For 2 of these patients, recurrence was local 6 and 48 months after treatment. For 3 patients, distant metastasis was found 18, 5, and 31 months after surgery at our institution. Five of 11 patients died, 1 of whom died of irrelevant disease and 4 of tumor progression. The total survival periods of the 4 patients who died of tumor progression were 24, 36, 44, and 203 months. The other 6 patients have survived for more than 5 years without local failure. In total, there are 7 patients who have survived for 5 years or more. Vulvar sweat gland carcinoma is a very rare entity. Surgery is the primary treatment modality, and the function of radiotherapy and chemotherapy is uncertain. The vulvar tumor size and inguinal lymph nodes metastasis will influence the prognosis, with pathologic differentiation and surgical margin status being the probable prognostic factors.


Molecular characterization and antibacterial activity of a phage-type lysozyme from the Manila clam, Ruditapes philippinarum.
A phage-type lysozyme, designed as RpPLYZ, was cloned and characterized from the clam Ruditapes philippinarum. The full-length cDNA of RpPLYZ was of 699 bp with an open reading frame (ORF) of 534 bp, encoding a polypeptide of 177-amino acid with a calculated molecular mass of 19.6 kDa and an isoelectric point of 9.05. Multiple alignments and phylogenetic analysis strongly suggested that RpPLYZ was a new member of the phage-type lysozyme family. The mRNA transcript of RpPLYZ was found to be constitutively expressed in a wide range of tissues and mainly in hemocytes and mantle. The relative expression of RpPLYZ mRNA in hemocytes was significantly up-regulated at 6, 24, 48 and 72 h after Vibrio anguillarum challenge. The recombinant RpPLYZ (rRpPLYZ) showed high activity against Entherobacter cloacae and Staphyloccocus aureus, and less effective towards Entherobacter aerogenes and V. anguillarum. Moreover, the optimal pH, temperature and ionic strength for rRpPLYZ activity was determined to be 5.5, 50 °C and 5 mM, respectively. These results suggested that RpPLYZ was a member of the phage-type lysozyme family and perhaps played an important role in the immune responses against bacterial invasion.


Is sulfasalazine effective in ankylosing spondylitis? A systematic review of randomized controlled trials.
To evaluate the efficacy and toxicity of sulfasalazine (SSZ) for the treatment of ankylosing spondylitis (AS). We searched randomized and quasi-randomized trials in any language comparing SSZ with placebo in treatment of AS. Two reviewers independently selected the studies and assessed the methodological quality. Data were extracted from the chosen studies and metaanalysis was conducted with RevMan software. We identified 11 trials, in which a total of 895 patients were treated for periods ranging from 12 weeks to 3 years. The pooled analysis showed that differences between SSZ and placebo were statistically significant only in erythrocyte sedimentation rate (ESR) and the severity of spinal stiffness, favoring SSZ over placebo. Weighted mean differences were ESR -4.79 mm/h (95% CI -8.80 to -0.78) and spine stiffness -13.89 mm (95% CI -22.54 to -5.24) on 100 mm visual analog scale (where 0 = no stiffness, 100 = severe stiffness). Nissila 1988 is the only trial in which SSZ showed benefit in primary outcome analyses, including back pain, chest expansion, occiput-to-wall test, and patient's general well-being. Compared with other trials, patients in this trial had the shortest disease duration and highest level of baseline ESR, and it had the greatest proportion of patients with peripheral arthritis. Significantly more withdrawals for side effects (relative risk 1.47, 95% CI 1.01 to 2.13) were found in the SSZ than in the placebo group, although severe side effects were rare. Across all patients with AS, SSZ showed some benefit in reducing ESR and easing spinal stiffness, but no evidence of benefit in physical function, pain, spinal mobility, enthesitis, or patient and physician global assessment. Patients at an early stage of disease, with higher level of ESR (or active disease) and peripheral arthritis, might benefit from SSZ.


Protein A/G-based immunochromatographic test for serodiagnosis of pythiosis in human and animal subjects from Asia and Americas.
Pythiosis is a life-threatening infectious disease of both humans and animals living in Asia, Americas, Africa, and parts of Australia and New Zealand. The etiologic pathogen is the fungus-like organism Pythium insidiosum The disease has high mortality and morbidity rates. Use of antifungal drugs are ineffective against P. insidiosum, leaving radical surgery the main treatment option. Prompt treatment leads to better prognosis of affected individuals, and could be achieved by early and accurate diagnosis. Since pythiosis has been increasingly reported worldwide, there is a need for a rapid, user-friendly, and efficient test that facilitates the diagnosis of the disease. This study aims to develop an immunochromatographic test (ICT), using the bacterial protein A/G, to detect anti-P. insidiosum IgGs in humans and animals, and compare its diagnostic performance with the established ELISA. Eighty-five serum samples from 28 patients, 24 dogs, 12 horses, 12 rabbits, and 9 cattle with pythiosis, and 143 serum samples from 80 human and 63 animal subjects in a healthy condition, with thalassemia, or with other fungal infections, were recruited for assay evaluation. Detection specificities of ELISA and ICT were 100.0%. While the detection sensitivity of ELISA was 98.8%, that of ICT was 90.6%. Most pythiosis sera, that were falsely read negative by ICT, were weakly positive by ELISA. In conclusion, a protein A/G-based ICT is a rapid, user-friendly, and efficient assay for serodiagnosis of pythiosis in humans and animals. Compared to ELISA, ICT has an equivalent detection specificity and a slightly lower detection sensitivity.


Psychometric properties of vision-related quality of life questionnaires: a systematic review.
The increased attention for quality of life (QOL) as an outcome measure has led to the development of numerous questionnaires to assess this construct in the field of ophthalmology. This article presents a systematic review on QOL questionnaires for people with vision impairments. We systematically searched and selected the literature. Furthermore, a rating list with descriptive aspects (e.g. target population) and psychometric aspects (e.g. reproducibility) was developed. The 31 questionnaires that were included in the review were rated on the basis of criteria stated in this rating list. The questionnaires were mostly targeted at cataract patients or visually impaired persons in general. Only a few of the questionnaires demonstrated sufficient psychometric quality. A recent development is the (re-)evaluation of questionnaires with Rasch analysis. This is one of the most important issues to which future research in this field should be directed.


Immunotherapy response modeling by ex-vivo organ culture for lung cancer.
One of the major hurdles for the advancement of cancer immunotherapy is lack of robust, accessible experimental models. We aimed to produce an ex-vivo organ culture (EVOC) model of immunotherapy for non-small cell lung cancer (NSCLC). Freshly resected early stage tumors were collected from the operating room, fragmented to clusters < 450 µm and cultured with fetal calf serum and human autologous serum. The resulting EVOC includes cancer epithelial cells within tumor tissue clusters and immune cells. Original tissue features are reflected in the EVOCs. The response to immune checkpoint inhibitors (ICI) was assessed by IFNγ gene induction. Interestingly, IFNγ EVOC induction was numerically higher when anti-CTLA4 was added to anti-PD-L1 treatment, supporting the notion that anti-CTLA4 impacts cancer partly through tumor-resident immune cells. In parallel, immunohistochemistry (IHC) for key immune-related proteins was performed on the formalin-fixed paraffin embedded (FFPE) corresponding tumors. EVOC IFNγ induction by ICI correlated with basal non-induced IFNγ, CD8, CD4 and FOXP3 mRNA levels within EVOCs and with tumor-FFPE-IHC for CD8 and granzyme B. A weaker correlation was seen with tumor-FFPE-IHC for CD3, CD4, CD68, FOXP3 and tumor-PD-L1. Tertiary lymphoid structure density was also correlated with the ICI response. Our study provides novel data about biomarkers that correlate with ICI-induced response of early stage NSCLC. Retention of the microenvironment and minimal addition of exogenous factors suggest this model to reliably represent the original tumor. The cluster-based EVOC model we describe can provide a valuable, yet simple and widely applicable tool for the study of immunotherapy in NSCLC.


Blue-shifting of circular Bragg phenomenon by annealing of chiral sculptured thin films.
The wavelength regime of the circular Bragg phenomenon, exhibited by chiral sculptured thin films fabricated using the serial bideposition technique, blue shifts as a result of post-deposition annealing. This blue shift can be attributed to the net effect of three material changes that occur during annealing: a small reduction in helical pitch, an increase in the relative permittivity of the column material changing from amorphous to crystalline, and a density reduction due to columnar thinning from the same amorphous-to-crystalline transition.


Ligament and Bone Arch Partition of the Carpal Tunnel by Three-Dimensional Ultrasonography.
The carpal tunnel is geometrically irregular due to the complex composition of many carpal bones intercalated by numerous intercarpal ligaments. The purpose of the study was to investigate the relative contributions of the ligament and bone arches to carpal tunnel space at the proximal, middle, and distal tunnel regions. A catheter ultrasound probe acquired fan-like images inside cadaveric carpal tunnels for three-dimensional reconstruction of the tunnel. The total tunnel volume was 5367.6 ± 940.1 mm3 with contributions of 12.0%, 6.9%, and 4.1% by proximal, middle, and distal ligament arches, respectively, and 27.0%, 25.3%, and 24.7% by proximal, middle, and distal bone arches, respectively. The bone arch occupied more tunnel space than the ligament arch at all regions (p < 0.05). The ligament arch was largest at the proximal region of the tunnel and significantly decreased toward the distal region (p < 0.05). However, the bone arch significantly decreased only from the proximal to middle region (p < 0.05) but not from the middle to distal region (p = 0.311). Consequently, it was observed that the ligament arch was the key contributor to the unequal carpal tunnel space across regions. Partitional and regional tunnel morphometric information may provide a better understanding of tunnel abnormality associated with various wrist pathological conditions. The developed framework of ultrasonography and data processing can be applied to other areas of interest in the musculoskeletal system.


Phagocytic properties of human keratocyte cultures.
The uptake of polystyrene latex beads (approximately 0.75 micrometers) and glutaraldehyde-treated erythrocytes by human corneal stromal keratocytes maintained in culture has been studied. Combined phase-contrast and scanning electron microscopic observations on individual cells after exposure to either beads or erythrocytes demonstrated that the majority of these particles were present intracellularly. Transmission electron microscopy revealed that the beads were membrane-bound within the cytoplasm of these cells. Thus the human keratocytes in culture are phagocytic and able to internalize particles ranging in size from approximately 0.75 to 6 micrometer. Kinetic studies showed continuous uptake of the polystyrene latex beads for at least 72 hr, with an approximate linear uptake rate between 4 and 48 hr. The extent of bead uptake was dependent on the initial bead concentration. The human keratocyte cultures were markedly more phagocytic than human skin fibroblasts or rabbit chondrocytes. It was also found that after extensive bead uptake the normal growth pattern of the keratocytes was affected. It is suggested that the phagocytic ability of the human keratocytes is involved in the turnover of the corneal stromal matrix as well as in the initial response of this avascular tissue to injury or bacterial infection.


Inflammatory and oxidative stress biomarkers in allergic rhinitis: the effect of smoking.
Accumulating evidence confirms the presence of pan-airway inflammation in allergic rhinitis patients. Smoking is known to affect the asthmatic airway inflammation. However, no study has evaluated the impact of smoking on airway inflammation of allergic rhinitis patients. The aim of the present study was to evaluate the impact of smoking on inflammatory and oxidative stress biomarkers in patients with seasonal allergic rhinitis, using non-invasive methods for sample collection. Forty patients with seasonal allergic rhinitis (20 smokers and 20 non-smokers) and 30 healthy subjects (15 smokers and 15 non-smokers) were recruited for the study during pollen season. All subjects were submitted to measurement of the fraction of exhaled NO (FeNO), exhaled breath condensate (EBC) collection, nasal lavage collection, pre- and post- bronchodilation spirometry and metacholine bronchial challenge testing. pH, leukotriene B(4) (LTB(4)) and 8-isoprostane were determined in EBC and nasal lavage samples. Patients with allergic rhinitis presented higher LTB(4) and 8-isoprostane levels in nasal lavage (P<0.0001 for both comparisons), with no significant differences between smokers and non-smokers. Patients with allergic rhinitis also presented higher LTB(4) levels and lower pH in EBC (P<0.001 and P=0.004, respectively), with prominent differences between smokers and non-smokers (P<0.0001 and P=0.003, for LTB(4) and pH, respectively). A significant correlation between nasal lavage and EBC LTB(4) values was observed (r(s)=0.313, P=0.048). Patients with allergic rhinitis present increased LTB(4) and 8-isoprostane in their nasal cavity, however, with no significant differences between smokers and non-smokers. In contrast, smokers with allergic rhinitis present higher LTB(4) levels and lower pH in EBC, suggesting that these patients may be more susceptible to the deleterious effects of smoking, compared with non-smokers.


Tissue inhibitor of metalloproteinase 1 adenoviral gene therapy alone is equally effective in reducing restenosis as combination gene therapy in a rabbit restenosis model.
Neointimal formation is a common feature after angioplasty, bypass grafting and stenting. Angioplasty damages endothelium, causing pathological changes in arteries which lead to smooth muscle cell proliferation, synthesis of extracellular matrix components and eventually restenosis formation. Adenoviruses offer an efficient transgene expression in the vascular system. In this study, we compared the effects of different gene combinations. We wanted to find out whether adenoviral catheter-mediated delivery of an additive combination of the vascular endothelial growth factor (VEGF)-A with VEGF-C is more effective than the combination of tissue inhibitor of metalloproteinase 1 (TIMP-1) alone or with VEGF-C in a rabbit balloon denudation model. Additionally, we wanted to clarify whether the combination therapy prolongs the treatment effect. It was found that TIMP-1 alone prevents restenosis and that the combination of VEGF-A and VEGF-C has a similar effect at the 2-week time point. However, the combination of VEGF-A and VEGF-C lost the treatment effect at the 4-week time point due to the catch-up growth of neointima. On the other hand, TIMP-1 and the combination of TIMP-1 with VEGF-C still had an extended treatment effect at the 4-week time point. When considering the gene combination used in this study, it is concluded that gene therapy with adenoviral TIMP-1 alone is sufficient in reducing restenosis and that combination gene therapy does not bring any significant advantages.


[Guideline 'Precautionary measures for contrast media containing iodine'].
Annually, 0.5-1 million injections of contrast media containing iodine are administered in the Netherlands. Almost all contrast media nowadays are low-osmolar and nonionic. Nevertheless, the development ofcontrast-induced nephropathy is still a relevant clinical problem. Through an initiative by the Radiological Society of the Netherlands and with aid of the Dutch Institute for Healthcare Improvement (CBO), a guideline was conceived for the intravascular use of iodine-containing contrast media, based on recent scientific literature. The guideline defines the risk factors for contrast-induced nephropathy. One of the major risk factors is an impaired renal function. It is important to measure the glomerular filtration rate (GFR) in patients with a possible impaired kidney function, preferably by using the 'Modification of diet in renal disease' (MDRD)-study formula. The key measures for avoidance of contrast nephropathy are: limiting the amount of contrast agent used and to assure good hydration, by infusion of sodium chloride 0.9% 12-16 ml/kg body weight, both prior to and after contrast infusion. If time is limited, intravenous administration of sodium bicarbonate is an option. The guideline recommends discontinuation of metformin use from the day of contrast injection, if the GFR < 60 ml/min/1.73 m2, and to restart metformin 2 days following contrast infusion providing the GFR has not significantly deteriorated. Only in the case of previous moderate or severe adverse reactions to contrast media, prophylaxis with corticosteroids and antihistamines is recommended. Iodine allergy or an atopic condition is not a contraindication for the use of iodine-containing contrast media, and no prophylaxis is required. No specific measures are indicated in case of hyperthyroidism, acute pancreatitis, or phaeochromocytoma. Injection of contrast media is not contraindicated in case of pregnancy or lactation.


Continuous tooth eruption adjacent to single-implant restorations in the anterior maxilla: aetiology, mechanism and outcomes - A review of the literature.
Dental trauma and congenital anodontia are common causes of anodontia in the anterior maxilla. The proposed restorative treatment constitutes a challenge for many dentists, particularly if it is a question of a young patient who has not yet completed skeletal and dental development. Current treatments for anterior maxillary anodontia include: fixed or removable partial dentures; orthodontic closure of interdental spaces; and dental implants. Dental implants do not move with the dento-alveolar complex during the growth period of the maxilla. Therefore, many researchers maintain that implants should be postponed until after adolescence, in order to prevent complications, such as infra-occlusion, that would require the replacement of the abutment and crown-implant restoration, or even invasive treatments, such as the removal of the implant in the future. The objective of this literature review is to investigate the aetiology of the phenomenon, and outcome. Continuous tooth eruption is not affected by age, so considerable changes may occur due to eruption of adjacent teeth. In addition, both women and men are affected by this phenomenon and, usually, there is no significant difference in the amount of growth between the short face and the long face. It can be concluded that continuous facial skeletal growth and teeth eruption are evident in the second and third decades. Where possible, it is advisable to delay placement of an anterior maxillary implant in the adolescent patient.


The genome-wide multi-layered architecture of chromosome pairing in early Drosophila embryos.
Genome organization involves cis and trans chromosomal interactions, both implicated in gene regulation, development, and disease. Here, we focus on trans interactions in Drosophila, where homologous chromosomes are paired in somatic cells from embryogenesis through adulthood. We first address long-standing questions regarding the structure of embryonic homolog pairing and, to this end, develop a haplotype-resolved Hi-C approach to minimize homolog misassignment and thus robustly distinguish trans-homolog from cis contacts. This computational approach, which we call Ohm, reveals pairing to be surprisingly structured genome-wide, with trans-homolog domains, compartments, and interaction peaks, many coinciding with analogous cis features. We also find a significant genome-wide correlation between pairing, transcription during zygotic genome activation, and binding of the pioneer factor Zelda. Our findings reveal a complex, highly structured organization underlying homolog pairing, first discovered a century ago in Drosophila. Finally, we demonstrate the versatility of our haplotype-resolved approach by applying it to mammalian embryos.


Amitraz poisoning in children: clinical and laboratory findings of eight cases.
Amitraz poisoning is a rare disorder characterised by central nervous system and respiratory depression, bradycardia, hypotension, hypothermia, hyperglycemia, vomiting, convulsion and glycosuria. In this study, eight pediatric patients with amitraz poisoning were presented. This study revealed that clinical manifestations of poisoning by oral and dermal route emerged within 30-120 min and that central nervous system depression which is the most important sign resolved with 8-18 h and others 36-48 h. All cases were discharged as recovered after 48 h. To our knowledge only six cases have been reported in the literature. Because of the limited information in the literature, the cases were reported.


Parallel growing and training of neural networks using output parallelism.
In order to find an appropriate architecture for a large-scale real-world application automatically and efficiently, a natural method is to divide the original problem into a set of subproblems. In this paper, we propose a simple neural-network task decomposition method based on output parallelism. By using this method, a problem can be divided flexibly into several subproblems as chosen, each of which is composed of the whole input vector and a fraction of the output vector. Each module (for one subproblem) is responsible for producing a fraction of the output vector of the original problem. The hidden structure for the original problem's output units are decoupled. These modules can be grown and trained in parallel on parallel processing elements. Incorporated with a constructive learning algorithm, our method does not require excessive computation and any prior knowledge concerning decomposition. The feasibility of output parallelism is analyzed and proved. Some benchmarks are implemented to test the validity of this method. Their results show that this method can reduce computational time, increase learning speed and improve generalization accuracy for both classification and regression problems.


An equation describing spread of membrane potential changes in a short segment of blood vessel.
The spread of membrane potential changes throughout certain cells and tissues plays an important role in their physiology. The attenuation of such changes in any tissue is usually characterized by the cable length constant lambda, which can be determined experimentally if the equations describing membrane potential spread in the tissue are known. Here we derive an equation describing spread of membrane potential changes in a short cable, which is an appropriate model for short segments of blood vessels. This equation is more general than those already published in that the positions of both the current source that gives rise to a potential change, and the point at which the change is measured, can be anywhere along the cable.


Models of borderline personality disorder: recent advances and new perspectives.
The purpose of this article is to review the most relevant conceptual models of borderline personality disorder (BPD), with a focus on recent developments in this area. Several conceptual models have been proposed with the aim of better understanding BPD: the borderline personality organization, emotion dysregulation, reflective (mentalization) dysfunction, interpersonal hypersensitivity and hyperbolic temperament models. These models have all been supported to some extent and their common components include disorganized attachment and traumatic early experiences, emotion dysregulation, interpersonal sensitivity and difficulties with social cognition. An attempt to integrate some components of the conceptual models of BPD has resulted in an emerging new perspective, the interpersonal dysphoria model, which emphasizes dysphoria as an overarching phenomenon that connects the dispositional and situational aspects of BPD. Various conceptual models have expanded our understanding of BPD, but it appears that further development entails theoretical integration. More research is needed to better understand interactions between various components of BPD, including the situational factors that activate symptoms of BPD. This will help develop therapeutic approaches that are more tailored to the heterogeneous psychopathology of BPD.


[The biochemical and immunological indices in the rehabilitation period of the victims of the accident on the Komsomolets atomic submarine].
Biochemical and immunological indexes of peripheral blood were compiled in military sanatorium "Divnomorskoe" in seamen who have suffered from general supercooling in the result of "Komsomolets" atomic submarine breakdown. The patients had the symptoms of metabolic disturbance, immunodepression, a great concentration of proteins in acute phase and activity of MB-fraction of creatine phosphokinase. Immunodepression after the general supercooling was mainly conditioned by oppression of differentiation, metabolic changes and functional activity of T-lymphocytes. A course of immunocorrective therapy was employed using "thymogen"--synthetic peptide of thymus. In the process of rehabilitation there was a gradual functional recovery, normalization of metabolism and immunological indexes.


A computer and video display based system for training eccentric viewing in macular degeneration with an absolute central scotoma.
A new approach designed to establish the most suitable area for eccentric viewing and to teach and train patients with severe age-related macular degeneration (AMD) to use the eccentric viewing technique is described. Using a computer and video display based system, as well as software written specifically for this purpose, we investigated and trained ten consecutive patients with AMD. The patients were 80.1 + or - 5.6 years old, on average. All of them had an absolute central scotoma. Mean visual acuity was 0.035 + or - 0.016. After 30 min of testing, instruction and reading on the screen, followed by 2.6 + or - 0.69 one-hour training sessions, on average, with the low vision therapist, reading newspaper and book texts with the aid of hyperoculars or aplanatic systems and a very short reading distance, the patients achieved a reading speed of 58.9 + or - 19.7 words/min, significantly (p<0.001) higher than the initial speed when reading on the screen, 11.5 + or - 4.5 words/min.


Hyperleptinemia in horses: responses to administration of a small dose of lipopolysaccharide endotoxin in mares and geldings.
Mares and geldings in good body condition selected for hyperleptinemia vs. normal leptin concentrations were studied to determine whether the hyperleptinemic condition affected various characteristics of the hematologic and hormonal systems after a challenge with lipopolysaccharide endotoxin. Four mares and 4 geldings that were determined to be hyperleptinemic (mean plasma leptin concentrations of 10.0 to 15.5 ng/mL) and 4 mares and 4 geldings with mean plasma leptin concentrations between 2.4 and 5.5 ng/mL were administered Escherichia coli O55:B5 endotoxin (35 ng/kg of BW in 500 mL of saline over a 30-min infusion), or saline only, in pairs in a single-switchback design, with horses and treatments randomly assigned for the first infusion. Physiological variables and blood components were monitored for 24 h after the onset of infusions. Treatments were switched and the second infusions were administered 8 d later. Relative to vehicle infusion, endotoxin infusion increased (P < 0.01) the rectal temperature, heart rate, respiration rate, plasma total protein concentration, and blood packed cell volume; there was an interaction of leptin status, endotoxin treatment, and time for heart rate (P = 0.039), respiration rate (P = 0.018), and plasma total protein concentration (P = 0.054). Blood concentrations of leukocytes, lymphocytes, and neutrophils all decreased (P < 0.001) after endotoxin infusion; there was an interaction (P = 0.0057) between sex and leptin status for blood platelet concentration. Plasma leptin concentrations increased (P = 0.013) after endotoxin infusion in both hyperleptinemic horses and those with reduced leptin concentrations. There were interactions (P < 0.037) of sex with endotoxin treatment and time for plasma concentrations of cortisol and prolactin, whereas plasma GH concentrations were affected (increased; P < 0.001) only by time after infusion. Given that the effects of hyperleptinemia were generally minor, it was concluded that the hyperleptinemic condition, and its associated type-2 diabetic symptoms, has a minimal impact on the components of the hematologic and hormonal systems studied.


Cloning of sporulation gene spoIIG in Bacillus subtilis.
Two specialized transducing phages carrying a sporulation gene, spoIIG , of Bacillus subtilis were constructed from B. subtilis temperate phages p11 and phi 105 by the "prophage transformation" method. Restriction enzyme analysis and transformation experiments showed that the spoIIG gene was present on a 6.2 X 10(6)-dalton (6.2-Md) EcoRI fragment in both transducing phage genomes. Further analysis showed that spoIIG + transforming activity resides on a 2.25-Md EcoRI-BamHI fragment within the 6.2-Md EcoRI fragment. The 2.25-Md fragment was subcloned into the region between the EcoRI and BamHI sites of pUB110, and deletion plasmids lacking PstI or HindIII fragments within the 2.25-Md fragment were constructed. The recombinant plasmid carrying the intact spoIIG gene restored sporulation of strain HU1002 ( spoIIG41 recE4 ) to a frequency of 10(4) spores per ml and inhibited sporulation of strain 4309 ( spo + recE4 ) to a level of 10(3) spores per ml.


An Improved Method to Produce Clinical-Scale Natural Killer Cells from Human Pluripotent Stem Cells.
Human natural killer (NK) cell-based adoptive anticancer immunotherapy has gained intense interest with many clinical trials actively recruiting patients to treat a variety of both hematological malignancies and solid tumors. Most of these trials use primary NK cells isolated either from peripheral blood (PB-NK cells) or umbilical cord blood (UCB-NK cells), though these sources require NK cell collection for each patient leading to donor variability and heterogeneity in the NK cell populations. In contrast, NK cells derived human embryonic stem cells (hESC-NK cells) or induced pluripotent stem cells (hiPSC-NK cells) provide more homogeneous cell populations that can be grown at clinical scale, and genetically engineered if needed. These characteristics make hESC-/iPSC-derived NK cells an ideal cell population for developing standardized, "off-the-shelf" immunotherapy products. Additionally, production of NK cells from undifferentiated human pluripotent stem cells enables studies to better define pathways that regulate human NK cell development and function. Our group previously has established a stromal-free, two-stage culture system to derive NK cells from hESC/hiPSC in vitro followed by clinical-scale expansion of these cells using interleukin (IL)-21 expressing artificial antigen-presenting cells. However, prior to differentiation, this method requires single-cell adaptation of hESCs/hiPSCs which takes months. Recently we optimized this method by adapting the mouse embryonic fibroblast-dependent hESC/hiPSC to feeder-free culture conditions. These feeder-free hESCs/hiPSCs are directly used to form embryoid body (EB) to generate hemato-endothelial precursor cells. This new method produces mature, functional NK cells with higher efficiency to enable rapid production of an essentially unlimited number of homogenous NK cells that can be used for standardized, targeted immunotherapy for the treatment of refractory cancers and infectious diseases.


Total hip arthroplasty in neglected congenital high dislocation of the hip. A comparison of four different surgical techniques.
The safest and easiest technique of performing a total hip replacement (THR) in neglected high congenitally dislocated hip (CDH) is still debatable. To find the best method, a prospective randomised trial comparing four different techniques was undertaken. A total of 48 THRs were performed on 40 patients with CDH. Average age was 40.6 years and average follow-up was 42 months. Four different techniques (n=12 each) were used: 1) THR into neo-acetabulum in a single operation, 2) THR into real acetabulum as a one stage procedure, 3) Campbell release operation followed by THR into real acetabulum after three weeks of traction, 4) THR with proximal femoral shortening. Even though shortening and one stage THR is technically more demanding we believe it superior to the other techniques. (Hip International 2002; 12: 308-13).


Sp100 colocalizes with HPV replication foci and restricts the productive stage of the infectious cycle.
We have shown previously that Sp100 (a component of the ND10 nuclear body) represses transcription, replication and establishment of incoming human papillomavirus (HPV) DNA in the early stages of infection. In this follow up study, we show that Sp100 does not substantially regulate viral infection in the maintenance phase, however at late stages of infection Sp100 interacts with amplifying viral genomes to repress viral processes. We find that Sp100 localizes to HPV16 replication foci generated in primary keratinocytes, to HPV31 replication foci that form in differentiated cells, and to HPV16 replication foci in CIN 1 cervical biopsies. To analyze this further, Sp100 was down regulated by siRNA treatment of differentiating HPV31 containing cells and levels of viral transcription and replication were assessed. This revealed that Sp100 represses viral transcription and replication in differentiated cells. Analysis of Sp100 binding to viral chromatin showed that Sp100 bound across the viral genome, and that binding increased at late stages of infection. Therefore, Sp100 represses the HPV life cycle at both early and late stages of infection.


A quantitative analysis of Ureaplasma urealyticum and Ureaplasma parvum compared with host immune response in preterm neonates at risk of developing bronchopulmonary dysplasia.
Multiplex, real-time PCR for the identification of Ureaplasma urealyticum and Ureaplasma parvum was performed on nucleic acids extracted from sequential endotracheal aspirates obtained from preterm neonates born at <29 weeks of gestation and ventilated for more than 48 h admitted to two level 3 neonatal intensive care units. Specimens were obtained shortly after birth and sequentially up until extubation. One hundred fifty-two specimens (93.8%) contained material suitable for analysis. Ureaplasma spp. were identified in 5 of 13 neonates studied. In most cases, the DNA load of the detected Ureaplasma species was low and decreased over time. In addition, changes in detectable Ureaplasma species DNA did not relate to changes in the inflammatory marker C-reactive protein (CRP) or respiratory status. All but two blood samples obtained at times of suspected sepsis were culture positive for other microorganisms; the species cultured were typically coagulase-negative staphylococci and were associated with increased levels of CRP (>10 mg/liter). This study was limited by the small number of patients examined and does not have the power to support or contradict the hypothesis that postnatal lung infection with Ureaplasma parvum is causally related to bronchopulmonary dysplasia (BPD) or adverse respiratory outcomes after preterm birth. However, in this study, increases in CRP levels were not associated with patients in whom Ureaplasma parvum was detected, in contrast to the detection of other bacterial species.


Glargine insulin for treatment of naturally occurring diabetes mellitus in dogs.
To evaluate the effects of twice-daily glargine insulin administration in dogs with diabetes mellitus. Open-label, prospective clinical trial. 10 dogs with naturally occurring diabetes mellitus. Dogs with poorly regulated or newly diagnosed diabetes mellitus were enrolled if their owners agreed to return them to the hospital at 1- to 3-week intervals for 4 follow-up visits. During each follow-up visit, blood glucose concentrations were measured every 2 hours for at least 10 hours after feeding a diet high in insoluble fiber and after administration of glargine insulin (time 0). The initial glargine insulin dosage was 0.5 U/kg (0.23 U/lb) SC twice daily. All dogs had well-regulated diabetes mellitus at a mean ± SD of 38 ± 14 days (median, 43 days; range, 7 to 55 days) following study enrollment. At the time diabetes mellitus was well regulated, mean glargine insulin dosage was 0.5 ± 0.15 U/kg (0.23 ± 0.068 U/lb; median, 0.5 U/kg; range, 0.32 to 0.67 U/kg [0.15 to 0.30 U/lb]) twice daily, and 3 dogs were receiving a dosage < 0.4 U/kg (0.18 U/lb). In dogs with well-regulated diabetes mellitus, the mean minimum blood glucose concentration (163 ± 89 mg/dL; 95% confidence interval, 100 to 227 mg/dL) was detected 2 hours after administration of glargine insulin and the mean maximum blood glucose concentration (230 ± 95 mg/dL; 95% confidence interval, 64 to 323 mg/dL) was detected 12 hours after administration of glargine insulin. There was no significant difference between mean minimum and mean maximum blood glucose concentrations nor were there significant differences between blood glucose concentrations measured at other time points. Blood glucose concentration < 80 mg/dL was measured at least once in 7 of 10 dogs. Results of the present study suggested that, in diabetic dogs fed a diet high in insoluble fiber, glargine insulin is a peakless insulin that does not induce a distinct blood glucose concentration nadir. For glargine insulin, 0.3 U/kg (0.136 U/lb) SC twice daily is recommended as an initial dosage.


Relationship between adiposity and admixture in African-American and Hispanic-American women.
The objective of this study was to investigate whether differences in admixture in African-American (AFA) and Hispanic-American (HA) adult women are associated with adiposity and adipose distribution. The proportion of European, sub-Saharan African and Amerindian admixture was estimated for AFA and HA women in the Women's Heath Initiative using 92 ancestry informative markers. Analyses assessed the relationship between admixture and adiposity indices. The subjects included 11 712 AFA and 5088 HA self-identified post-menopausal women. There was a significant positive association between body mass index (BMI) and African admixture when BMI was considered as a continuous variable, and age, education, physical activity, parity, family income and smoking were included covariates (P<10(-4)). A dichotomous model (upper and lower BMI quartiles) showed that African admixture was associated with a high odds ratio (OR=3.27 (for 100% admixture compared with 0% admixture), 95% confidence interval 2.08-5.15). For HA, there was no association between BMI and admixture. In contrast, when waist-to-hip ratio (WHR) was used as a measure of adipose distribution, there was no significant association between WHR and admixture in AFA but there was a strong association in HA (P<10(-4); OR Amerindian admixture=5.93, confidence interval=3.52-9.97). These studies show that: (1) African admixture is associated with BMI in AFA women; (2) Amerindian admixture is associated with WHR but not BMI in HA women; and (3) it may be important to consider different measurements of adiposity and adipose distribution in different ethnic population groups.


Culture on Tissue-Specific Coatings Derived from α-Amylase-Digested Decellularized Adipose Tissue Enhances the Proliferation and Adipogenic Differentiation of Human Adipose-Derived Stromal Cells.
While extracellular matrix (ECM)-derived coatings have the potential to direct the response of cell populations in culture, there is a need to investigate the effects of ECM sourcing and processing on substrate bioactivity. To develop improved cell culture models for studying adipogenesis, the current study examines the proliferation and adipogenic differentiation of human adipose-derived stem/stromal cells (ASCs) on a range of ECM-derived coatings. Human decellularized adipose tissue (DAT) and commercially available bovine tendon collagen (COL) are digested with α-amylase or pepsin to prepare the coatings. Physical characterization demonstrates that α-amylase digestion generates softer, thicker, and more stable coatings, with a fibrous tissue-like ultrastructure that is lost in the pepsin-digested thin films. ASCs cultured on the α-amylase-digested ECM have a more spindle-shaped morphology, and proliferation is significantly enhanced on the α-amylase-digested DAT coatings. Further, the α-amylase-digested DAT provides a more pro-adipogenic microenvironment, based on higher levels of adipogenic gene expression, glycerol-3-phosphate dehydrogenase (GPDH) enzyme activity, and perilipin staining. Overall, this study supports α-amylase digestion as a new approach for generating bioactive ECM-derived coatings, and demonstrates tissue-specific bioactivity using adipose-derived ECM to enhance ASC proliferation and adipogenic differentiation.


Balancing Flexibility and Administrative Burden: Experiences of Family Managers Using Directly Funded Home Care in Manitoba, Canada.
Directly funded (DF) home care provides funding to home care recipients to coordinate their own care and supports, and is available across all Canadian provinces. Current research on DF home care focuses on the experiences of adults with disabilities self-directing their own care, but less is known about the experiences of family members managing services for adults 55 years of age and older. This article presents findings from a qualitative analysis of 24 semi-structured interviews with older adults and caregivers using the DF program in Manitoba, Canada, focusing on family manager experiences. We identify three themes in the interview data: (1) DF home care enhances choice and flexibility for older people and their caregivers, (2) choice and flexibility reduce caregiver strain, and (3) agency services reduce administrative burden. We discuss the importance of care relationships and the role of family managers. We recommend that traditional home care systems learn from DF, and that increased administrative support would reduce caregiver strain.


Metastatic breast cancer: overview of treatment.
Patients with metastatic breast cancer have a median survival of 2 to 3 years. Twenty percent of the patients who present with bone-only metastasis will be alive at 5 years from diagnosis. Current therapies are aimed at improving the quality of life, symptom control, and prolongation of survival. Newer endocrine and chemotherapeutic drugs are available to the medical oncologist for care of patients with metastatic breast cancer. We will briefly review the new advances in the treatment of metastatic breast cancer.


The cost of maternal cocaine abuse: I. Perinatal cost.
Although the clinical impact of maternal cocaine abuse has been well documented in recent years, there have been no reports on the direct and indirect costs of such abuse. This study compares hospital charges of a cocaine-abusing population with those of a control group. Ninety-one mother-infant pairs testing positive for cocaine at delivery were compared with a screened drug-free control population matched for socioeconomic status, age, and parity. When compared with controls, cocaine-positive mothers were more likely to deliver prematurely (37 versus 2%) and to have low birth weight (2613 versus 3340 g) or growth-retarded infants (12 versus 0%) with Apgar scores less than 7 at 5 minutes (8 versus 1%), signs of cocaine exposure (63 versus 0%), neonatal intensive care use (30 versus 3%), and extensive hospitalization (11 versus 3 days). As expected, there was a substantial cost difference between the study and control groups. Hospital charges for the labor, delivery, and postpartum care of cocaine-positive mothers in the study group averaged $3608, whereas maternal control charges averaged $3147 (P less than .05). Neonatal charges from the cocaine-positive study group averaged $13,222, whereas control charges averaged only $1297 (P less than .03). Most of the statistically significant differences in perinatal cost between the cocaine-positive and control populations can be traced to the association between cocaine abuse and premature birth. This information should benefit institutions and organizations trying to assess cost-benefit aspects of programs for prevention and treatment of cocaine abuse during pregnancy.


Sea cucumber aquaculture in the Western Indian ocean: challenges for sustainable livelihood and stock improvement.
The decline in sea cucumber fisheries that serve the Asian dried seafood market has prompted an increase in global sea cucumber aquaculture. The tropical sandfish (Holothuria scabra) has, in this context, been reared and produced with mixed success. In the Western Indian Ocean, villagers often participate in the export fishery for sea cucumbers as a source of income. However, with a growing concern of depleted stocks introduction of hatcheries to farm sandfish as a community livelihood and to replenish wild stocks is being promoted. This review identifies and discusses a number of aspects that constitute constraints or implications with regard to development of sandfish farming in the region. The conclusion is that for sandfish farming to live up to its expectations the possible impacts need to be further studied, and that improved evaluation of ongoing projects is required. In the interim, a precautionary approach toward new enterprise activities is suggested.


DNA methyltransferase DNMT3b protein overexpression as a prognostic factor in patients with diffuse large B-cell lymphomas.
Diffuse large B-cell lymphomas (DLBCL) are the most common type of aggressive lymphomas, with considerable heterogeneity in clinical presentation, molecular characteristics, and outcome. Previous studies have showed significant correlations between DNA methyltransferase (DNMT) overexpression and unfavorable prognosis in human cancers. Therefore, we investigated in this study the biological and prognostic significance of DNMT1, DNMT3a, and DNMT3b protein expression in DLBCL. DNA methyltransferase (DNMT) expression was analyzed by immunohistochemistry in 81 DLBCL cases and correlated with clinicopathological parameters. Kaplan-Meier curves were used to estimate survival rates, and the Cox proportional hazard regression model was used to evaluate the prognostic impact of DNMT expression. Our results showed that overexpression of DNMT1, DNMT3a, and DNMT3b were detected in 48%, 13%, and 45% of investigated cases, respectively. DNA methyltransferase 1 (DNMT1) and DNMT3b overexpression was significantly correlated with advanced clinical stages (P = 0.028 and P = 0.016, respectively). Moreover, concomitant expression of DNMT1 and DNMT3b was significantly correlated with resistance to treatment (P = 0.015). With regard to survival rates, although data was available only for 40 patients, DNMT3b overexpression was significantly correlated with shorter overall survival (P = 0.006) and progression-free survival (P = 0.016). Interestingly, multivariate analysis demonstrated that DNMT3b overexpression was an independent prognostic factor for predicting shortened overall survival (P = 0.004) and progression-free survival (P = 0.024). In conclusion, DNMT3b overexpression was identified as an independent prognostic factor for predicting shortened survival of patients with DLBCL and could be, therefore, useful in identifying patients who would benefit from aggressive therapy.


Ability of Antibodies Immobilized on Gold Nanoparticles to Bind Small Antigen Fluorescein.
The analytical applications of antibodies are often associated with their immobilization on different carriers, which is accompanied by a loss of antigen-binding activity for a sufficient proportion of the bound antibodies. In contrast to data on plain carriers, minimal data are available on the properties of antibodies on the surfaces of nanoparticles. Protein antigens have been predominantly investigated, for which space restrictions do not allow them to occupy all active sites of immobilized antibodies. This study considered a low-molecular-weight compound, fluorescein, as an antigen. Spherical gold nanoparticles with five different sizes, two differently charged forms of fluorescein, and three different levels of surface coverage by immobilized antibodies were tested. For gold nanoparticles with diameters from 14 to 35.5 nm with monolayers of immobilized antibodies, the percentage of molecules capable of binding carboxyfluorescein varied from 6% to 17%. The binding of aminofluorescein was more efficient; for gold nanoparticles with an average diameter of 21 nm, the percentage of active binding sites for the immobilized antibodies reached 27% compared with 13% for the carboxyfluorescein case. A fourfold reduction in the coverage of the nanoparticles' surface compared with that of the monolayer did not lead to reliable changes in the percentage of active binding sites. The obtained data demonstrate that an antigen's binding to immobilized antibodies is limited even for small antigens and depends on the size of the nanoparticles and the electrostatic repulsion near their surface.


RADIATION PROTECTION IN CANADA. II. THE ROLE OF THE RADIATION PROTECTION DIVISION IN SAFEGUARDING THE HEALTH OF RADIATION WORKERS.
The current status of radiation protection in Canada is discussed in the second of a three-part series and particular emphasis is placed on the role of the Radiation Protection Division of the Department of National Health and Welfare. Administrative and operational control procedures have been developed, involving prior approval of health safeguards in the radioisotope user's facilities and techniques, and systematic monitoring and inspection. Where necessary, a medical follow-up of accidents and excessive radiation exposures is carried out. In 1963 more than 1600 radioisotope licences were issued. Filmmonitoring service was provided to about 15,500 isotope and x-ray workers. Semiautomatic handling procedures have been developed to meet the increasing demand for film-monitoring services.Monitoring and inspection services have been provided for x-ray workers, and a committee has been formed to develop administrative procedures for health and safety control in x-ray work. Committees have also been set up to review the health and safety aspects of the operation of nuclear reactors and particle accelerators.


[Immunohistochemistry and the sweat glands].
By using a series of antibodies, we studied the immunohistological hallmarks of eccrine and apocrine sweat glands. Antibodies raised against cytokeratins 6 and 18 decorated the eccrine glands except the acrosyringium. The anti-CEA Ab revealed a uniform and exclusive staining of the eccrine glands. The anti-cytokeratins 8, 18 and 19 Ab labelled the apocrine glands and the secretory part of the eccrine glands. The acrosyringia were revealed by anti-EMA Ab. The immunostaining with anti S-100 protein was positive for the secretory part of the eccrine glands.


Management of high cervical-intracranial internal carotid artery traumatic aneurysms.
The successful surgical management of a patient with a traumatic aneurysm of the internal carotid artery (ICA) at the base of the skull and a second traumatic aneurysm of the ipsilateral superficial temporal artery is described. EC-IC bypass was not necessary, and graded occlusion of the ICA was employed. Direct repair was not chosen because of its high risk of distal embolization. Electrophysiologic monitoring techniques are helpful in predicting hemispheric ischemia.


A theoretical framework for the associations between identity and psychopathology.
Identity research largely emerged from clinical observations. Decades of empirical work advanced the field in refining existing approaches and adding new approaches. Furthermore, the existence of linkages of identity with psychopathology is now well established. Unfortunately, both the directionality of effects between identity aspects and psychopathology symptoms, and the mechanisms underlying associations are unclear. In the present paper, we present a new framework to inspire hypothesis-driven empirical research to overcome this limitation. The framework has a basic resemblance to theoretical models for the study of personality and psychopathology, so we provide examples of how these might apply to the study of identity. Next, we explain that unique features of identity may come into play in individuals suffering from psychopathology that are mostly related to the content of one's identity. These include pros and cons of identifying with one's diagnostic label. Finally, inspired by Hermans' dialogical self theory and principles derived from Piaget's, Swann's and Kelly's work, we delineate a framework with identity at the core of an individual multidimensional space. In this space, psychopathology symptoms have a known distance (representing relevance) to one's identity, and individual multidimensional spaces are connected to those of other individuals in one's social network. We discuss methodological (quantitative and qualitative, idiographic and nomothetic) and statistical procedures (multilevel models and network models) to test the framework. Resulting evidence can boost the field of identity research in demonstrating its high practical relevance for the emergence and conservation of psychopathology. (PsycINFO Database Record


Super-sampling SART with ordered subsets.
In tomography, the quality of the reconstruction is essential because the complete cascade of the subsequent analysis is based on it. To date, weighted back-projection (WBP) has been the most commonly used technique due to its versatility and performance in sub-tomogram averaging. Here we present super-sampling SART that is based on the simultaneous algebraic reconstruction technique. While algebraic reconstruction techniques typically produce better contrast and lately showed a significant improvement in terms of processing speed, sub-tomogram averages derived from those reconstructions were inferior in resolution compared to those derived from WBP data. Super-sampling SART, however, outperforms both in term of contrast and the resolution achieved in sub-tomogram averaging several other tested methods and in particular WBP. The main feature of super-sampling SART, as the name implies, is the super-sampling option - by which parameter-based up-sampling and down-sampling are used to reduce artifacts. In particular, the aliasing that is omnipresent in the reconstruction can be practically eliminated without a significant increase in the computational time. Furthermore, super-sampling SART reaches convergence within a single iteration, making the processing time comparable to WBP, and eliminating the ambiguity of parameter-controlled convergence times. We find that grouping of projections increases the contrast, while when projections are used individually the resolution can be maximized. Using sub-tomogram averaging of ribosomes as a test case, we show that super-sampling SART achieves equal or better sub-tomogram averaging results than WBP, which is of particular importance in cryo-electron tomography.


A guide to policy analysis as a research method.
Policy analysis provides a way for understanding how and why governments enact certain policies, and their effects. Public health policy research is limited and lacks theoretical underpinnings. This article aims to describe and critique different approaches to policy analysis thus providing direction for undertaking policy analysis in the field of health promotion. Through the use of an illustrative example in nutrition it aims to illustrate the different approaches. Three broad orientations to policy analysis are outlined: (i) Traditional approaches aim to identify the 'best' solution, through undertaking objective analyses of possible solutions. (ii) Mainstream approaches focus on the interaction of policy actors in policymaking. (iii) Interpretive approaches examine the framing and representation of problems and how policies reflect the social construction of 'problems'. Policy analysis may assist understanding of how and why policies to improve nutrition are enacted (or rejected) and may inform practitioners in their advocacy. As such, policy analysis provides researchers with a powerful tool to understand the use of research evidence in policymaking and generate a heightened understanding of the values, interests and political contexts underpinning policy decisions. Such methods may enable more effective advocacy for policies that can lead to improvements in health.


Impact of Prior Cytoreductive Nephrectomy on Efficacy in Patients with Synchronous Metastatic Renal Cell Carcinoma Treated with Avelumab plus Axitinib or Sunitinib: Post Hoc Analysis from the JAVELIN Renal 101 Phase 3 Trial.
Data on the effects of prior cytoreductive nephrectomy (CN) in patients with renal cell carcinoma (RCC) with synchronous metastases (M1 disease) before immune checkpoint inhibitor (ICI) treatment are limited. In this post hoc analysis of treatment-naive patients with advanced RCC from the phase 3 JAVELIN Renal 101 trial, we assessed efficacy outcomes in the avelumab + axitinib and sunitinib arms in patients who were initially diagnosed with M1 disease (n = 412) grouped by prior CN (yes vs no). Progression-free survival (PFS) and overall survival (OS) were analyzed using multivariable Cox regression, and objective response rates (ORRs) were analyzed using logistic regression. After adjusting for imbalances in baseline variables, the hazard ratio (HR) for PFS in the prior CN versus no prior CN subgroup was 0.79 (95% confidence interval [CI] 0.53-1.16) in the avelumab + axitinib arm, and 1.15 (95% CI 0.77-1.70) in the sunitinib arm. The corresponding HRs for OS were 0.59 (95% CI 0.38-0.93) and 0.86 (95% CI, 0.55-1.34), and the odds ratios for ORR were 2.67 (95% CI 1.32-5.41) and 2.02 (95% CI 0.82-4.94), respectively. Prospective studies of the potential benefits of CN and its appropriate timing in patients receiving first-line treatment with ICI-containing combinations are warranted. PATIENT SUMMARY: This study looked at patients with kidney cancer whose disease had already spread outside the kidneys when it was first detected. We found that patients whose kidney had been removed before starting treatment with avelumab + axitinib had better outcomes than those whose kidney had not been removed. For patients treated with sunitinib, the results were more similar between the groups with and without prior kidney removal. However, statistical tests did not find any significant differences. The JAVELIN Renal 101 trial is registered on ClinicalTrials.gov as NCT02684006.