Short-term effects of on-field combined core strength and small-sided games training on physical performance in young soccer players.
This study aimed to compare the effects of 6-weeks combined core strength and small-sided games training (SSGcore) vs. small-sided games (SSG) training on the physical performance of young soccer players. Thirty-eight amateur soccer players (age: 16.50 ± 0.51 years) were randomly assigned to either a SSGcore (n = 20) or a SSG group (n = 18). The SSGcore group performed upper and lower body core strength exercises combined with SSG including 2-, 3- and 4-a-sided soccer games third a week. The SSG group performed only the SSG periodization. Baseline and after the 6-week training period the Yo-Yo Intermittent Recovery Test level 1 (YYIRTL-1), 5-20-m sprint test, countermovement jump (CMJ), squat jump (SJ), triple-hop distance (THD), zigzag agility with ball (ZAWB) and without ball (ZAWOB), three corner run test (TCRT) and Y-balance test. The SSGcore group demonstrated meaningful improvements in 20 m sprint time (SSGcore: -9.1%, d = 1.42; SSG: -4.4%, d = 0.76), CMJ (SSGcore: 11.4%, d = 2.67; SSG: -7.7%, d = 1.43), SJ (SSGcore: 12.0%, d = 2.14; SSG: 5.7%, d = 1.28), THD (SSGcore: 5.0%, d = 1.39; SSG: 2.7%, d = 0.52) and TCRT (SSGcore: -3.7%, d = 0.69; SSG: -1.9%, d = 0.38). Furthermore, the SSGcore group demonstrated meaningfully higher improvement responses in both leg balance score (d = ranging from 2.11 to 2.75) compared with SSG group. These results suggest that the inclusion of core strength training to a SSG periodization is greatly effective to improve speed and strength-based conditioning in young soccer players.


Aromatherapy reduces fatigue among women with hypothyroidism: A randomized placebo-controlled clinical trial.
Background This randomized, blinded, placebo-controlled clinical trial identifies the effect of an aromatherapy blend of essential oils on fatigue, which is one of the most commonly unaddressed symptoms of hypothyroidism, by evaluating the effects of daily aromatherapy inhalation. Methods Participants included women aged 18-55 with a diagnosis of hypothyroidism. Women who had a history of thyroid cancer were excluded, due to the confounding effects of cancer on fatigue as the outcome of interest. Participants were randomized into two groups: the aromatherapy group, treated with inhalation of the essential oil blend, and the control group, treated with an odorless vegetable oil blend. The primary outcome was change from baseline in fatigue scores as measured by the Multidimensional Fatigue Symptom Inventory (MFSI), a validated instrument which measures multiple patterns of fatigue. Results After adjusting for baseline scores, no significant difference was found between the aromatherapy group and the control group at midpoint. Both groups experienced a reduction in symptoms during the first week of the intervention. At the endpoint, participants in the aromatherapy group had improved fatigue scores across all ten subscales, as compared to the control group. Not all improvements achieved statistical significance, indicating that the aromatherapy treatment has a greater effect on the subscales of global, affective, and general fatigue. Conclusions This is the first study to evaluate the effects of aromatherapy on fatigue among women with hypothyroidism. These findings provide evidence that regular inhalation of an aromatherapy blend may reduce fatigue among women with hypothyroidism, particularly in the areas of global, affective, and general fatigue.


Joint pathology and behavioral performance in autoimmune MRL-lpr Mice.
Young autoimmune MRL-lpr mice perform more poorly than age-matched controls in tests of exploration, spatial learning, and emotional reactivity. Impaired behavioral performance coincides temporally with hyperproduction of autoantibodies, infiltration of lymphoid cells into the brain, and mild arthritic-like changes in hind paws. Although CNS mechanisms have been suggested to mediate behavioral deficits, it was not clear whether mild joint pathology significantly affected behavioral performance. Previously we observed that 11-week-old MRL-lpr mice showed a trend for disturbed performance when crossing a narrow beam. The first aim of the present study was to test the significance of this trend by increasing the sample size and, second, to examine the possibility that arthritis-like changes interfere with performance in brief locomotor tasks. For the purpose of the second goal, 18-week-old mice that differ widely in severity of joint disease were selectively taken from the population and tested in beam walking and swimming tasks. It was expected that the severity of joint inflammation would be positively correlated with the degree of locomotor impairment. The larger sample size revealed that young MRL-lpr mice perform significantly more poorly than controls on the beam-walking test, as evidenced by more foot slips and longer traversing time. However, significant correlation between joint pathology scores and measures of locomotion could not be detected. The lack of such relationship suggests that mild joint pathology does not significantly contribute to impaired performance in young, autoimmune MRL-lpr mice tested in short behavioral tasks.


Sound diffusers based on sonic crystals.
A sound diffuser is proposed based on sonic crystals, structures formed by a periodic distribution of cylindrical scatterers in a host medium, which is usually air. The diffuser is a so-called biperiodic structure, as formed by two arrays of sonic crystals with slightly different periodicities. Large diffusivity at low frequencies is achieved when the typical scale of the blocks is much larger than the periodicity of the crystals, determined by its lattice constant. An interpretation of the low frequency behavior of the diffuser is given in the homogenization limit in terms of multiple reflections and interference between the fields scattered by the different blocks. It is also shown that sonic crystal based diffusers enhance time spreading in comparison with other conventional diffusers.


Spotlight on ertugliflozin and its potential in the treatment of type 2 diabetes: evidence to date.
Sodium-glucose cotransporter 2 (SGLT2) inhibitors are the latest therapeutic strategy in the treatment of type 2 diabetes mellitus (T2DM). Using an insulin-independent mechanism (glycosuria), they reduce glucose toxicity and improve insulin sensitivity and β-cell function. The promising results obtained in clinical trials show that SGLT2 significantly improves glycemic control and provides greater cardiovascular protection, combined with a reduction in body weight and blood pressure (BP). This review focuses on ertugliflozin, a new, highly selective, and reversible SGLT2 inhibitor. Clinical trials published to date show that ertugliflozin, both as a monotherapy and as an add-on to oral antidiabetic agents, is safe and effective in reducing glycosylated hemoglobin (HbA1c), body weight, and BP in T2DM patients.


The role of peak nasal and oral inspiratory flow in the evaluation of patients with sleep-related breathing disorders.
Sleep-related breathing disorders (SRBD) are common reported disorders in the adult population. The nose plays an important role in the development of SRBD; thus, the measurement of nasal respiratory function remains an important step in the management of these patients. Peak nasal inspiratory flow (PNIF) is a useful tool to assess nasal airflow and it has recently been studied together with peak oral inspiratory flow (POIF). The aim of the present study was to evaluate the role of PNIF and POIF in an adult population of patients affected by SRBD. Seventy consecutive adult patients with SRBD were included in the present study. All patients were evaluated with home-based sleep studies (type III), PNIF, POIF, SNOT-22 questionnaire, Epworth Sleepiness Scale test and VAS for nasal obstruction. Although PNIF and POIF showed to correlate with each other, no correlations were observed between Apnea Hypopnea index (AHI) and PNIF, POIF or NPI (PNIF/POIF). A further analysis showed a marginal correlation between SNOT- 22 and AHI and between SNOT-22 and POIF. Furthermore, in a multivariate analysis, also POIF marginally correlated with some of the sleep- related SNOT-22 items. In the present study neither PNIF nor POIF were found to be associated with OSAS severity. However, POIF values correlated better than PNIF with sleep related symptoms suggesting that POIF could be a more useful parameter for upper airway assessment in patients with SRBD. In addition, a correlation between OSAS severity, in terms of AHI, and SNOT-22 total score has been reported.


Analysis of the trfA region of broad host-range plasmid RK2 by transposon mutagenesis and identification of polypeptide products.
Broad host-range plasmid RK2 is a member of the Escherichia coli incompatibility group P. Unlike most other groups of plasmids, members of the P group are capable of efficient transfer between and maintenance in most gram-negative bacterial species. It is of interest whether this broad host-range results from differences between the mechanism of replication of broad and narrow host-range plasmids. The regions of RK2 required for replication in E. coli have previously been defined as an origin of vegetative replication, oriVRK2 , and a gene, trfA , specifying a positively required trans-acting product. In this study Tn1723 transposon insertions have been used to map the trfA gene and determine its functional gene product. The Tn1723 insertions define the outer limits of the gene, a promoter region, a "leader" region not essential for trfA activity and a coding region. Three polypeptides of 13 X 10(3), 43 X 10(3) and 32 X 10(3) molecular weight are produced from this region and the production of a 32 X 10(3) Mr polypeptide is shown to be correlated with trfA activity in E. coli. Analysis of polypeptides produced from transposon insertion derivatives in which all but 35 base-pairs of inserted DNA is deleted, along with the effect of these insertions on trfA activity, suggest that the 43 X 10(3) and 32 X 10(3) Mr polypeptide coding sequences overlap in the same reading frame and that all three polypeptides (13 X 10(3), 32 X 10(3) and 43 X 10(3) Mr) may be translated from the same initial transcript.


Liquid marbles: topical context within soft matter and recent progress.
The study of particle stabilized interfaces has a long history in terms of emulsions, foams and related dry powders. The same underlying interfacial energy principles also allow hydrophobic particles to encapsulate individual droplets into a stable form as individual macroscopic objects, which have recently been called "Liquid Marbles". Here we discuss conceptual similarities to superhydrophobic surfaces, capillary origami, slippery liquids-infused porous surfaces (SLIPS) and Leidenfrost droplets. We provide a review of recent progress on liquid marbles, since our earlier Emerging Area article (Soft Matter, 2011, 7, 5473-5481), and speculate on possible future directions from new liquid-infused liquid marbles to microarray applications. We highlight a range of properties of liquid marbles and describe applications including detecting changes in physical properties (e.g. pH, UV, NIR, temperature), use for gas sensing, synthesis of compounds/composites, blood typing and cell culture.


Accuracy and Precision of New Optical Biometer Designed for Myopia Management in Measurement of Ocular Biometry.
This study provides information about the repeatability of Myopia Master (Oculus, Wetzlar, Germany) and its agreement with Lenstar LS900, which might be useful for the practitioners involved in myopia management. Myopia Master is a new optical biometer that measures ocular biometry and refractive error. The purpose of this study was to assess its repeatability (intrasession and short-term intersession) and its agreement with Lenstar LS900 for the measurement of axial length and corneal curvature. A total of 304 participants including 254 children (mean ± standard deviation age, 13.7 ± 1.6 years) and 50 adults (24 ± 2.9 years) underwent measurements on Myopia Master and Lenstar LS900 to obtain axial length, flat K, and steep K. On a subset of 30 participants, measurements were obtained with Myopia Master in two sessions that were spread over 10 minutes to assess the short-term intersession repeatability. The mean standard deviation of Myopia Master in the measurement of axial length in the total sample was 0.01 mm for intrasession, when the best three measurements were considered. The short-term intersession mean standard deviation for axial length, flat K, and steep K was 0.06 mm, 0.15 D, and 0.21 D, respectively. There were statistically significant differences in mean values of axial length (-0.04 ± 0.06 mm), flat K (-0.07 ± 0.15 D), and steep K (-0.24 ± 0.29 D) between Lenstar LS900 and Myopia Master, with the Lenstar providing slightly longer axial length and steeper K values. Adults showed better repeatability with Myopia Master and better agreement between the biometers for axial length measurement than children. Neither axial length nor refractive error influenced the repeatability or agreement. Myopia Master is repeatable for the measurement of axial length and corneal curvature. Considering the differences in axial length between the Myopia Master and Lenstar LS900, caution must be applied when these biometers are used interchangeably.


Mycobacterium abscessus hand-and-foot disease in children: rare or emerging disease?
Mycobacterium abscessus is emerging as an important cause of cutaneous infections in sporadic cases and outbreak settings. Although immunosuppressed or elderly patients are most commonly affected, in 2006 an outbreak of clinically distinct cutaneous lesions on the hands and feet caused by M. abscessus in a population of healthy children using a public swimming pool was reported. This article describes an outbreak of skin infection in a population of healthy Italian children attending the same school and using the same swimming pool. In January 2010 we identified three children with multiple, painful nodules on the palms and soles. M. abscessus was isolated from one child's lesions. A public health investigation was conducted and a team of dermatologists and public health officers visited all of the children; 514 children were screened and 29 cases were identified overall. All of the affected children had used the school's swimming pool. These children were treated with oral clarithromycin for 4 to 8 weeks. Because of the long period of time between the presentation and diagnosis of the first cases, the possibility that the number of cases may have been underestimated cannot be excluded. To our knowledge, this is the second largest reported cluster of M. abscessus skin infection suspected to be related to swimming pool exposure in a population of otherwise healthy children. It is unclear whether this disease is rare or should be considered as an emerging clinical entity.


Validation of English and Spanish-language versions of a screening questionnaire for rheumatoid arthritis in an underserved community.
Questionnaires to screen for rheumatoid arthritis (RA) have been tested in groups that were primarily well educated and Caucasian. We sought to validate the RA questions of the Connective Tissue Disease Screening Questionnaire (CSQ) in ethnic minorities in an underserved community, and to test a Spanish-language version. The Spanish-language version was developed by 2 native speakers. Consecutive English-speaking or Spanish-speaking patients in a community-based rheumatology practice completed the questionnaire. Diagnoses were confirmed by medical record review. Sensitivity and specificity of the questionnaire for a diagnosis of RA were computed for each language version, using 2 groups as controls: patients with noninflammatory conditions, and participants recruited from the community. The English-language version was tested in 53 patients with RA (79% ethnic minorities; mean education level 11.3 yrs), 85 rheumatology controls with noninflammatory conditions, and 82 community controls. Using 3 positive responses as indicating a positive screening test, the sensitivity of the questionnaire was 0.77, the specificity based on rheumatology controls was 0.45, and the specificity based on community controls was 0.94. The Spanish-language version was tested in 55 patients with RA (mean education level 7.8 yrs), 149 rheumatology controls, and 88 community controls. The sensitivity of the Spanish-language version was 0.87, with specificities of 0.60 and 0.97 using the rheumatology controls and community controls, respectively. The sensitivity of the English-language version of the RA questions of the CSQ was lower in this study than in other cohorts, reflecting differences in the performance of the questions in different ethnic or socioeconomic groups. The Spanish-language version demonstrated good sensitivity, and both had excellent specificity when tested in community controls.


Coenzyme q10 and statin-induced mitochondrial dysfunction.
Coenzyme Q10 is an important factor in mitochondrial respiration. Primary and secondary deficiencies of coenzyme Q10 result in a number of neurologic and myopathic syndromes. Hydroxyl-methylglutaryl coenzyme A reductase inhibitors or statins interfere with the production of mevalonic acid, which is a precursor in the synthesis of coenzyme Q10. The statin medications routinely result in lower coenzyme Q10 levels in the serum. Some studies have also shown reduction of coenzyme Q10 in muscle tissue. Such coenzyme Q10 deficiency may be one mechanism for statin-induced myopathies. However, coenzyme Q10 supplements have not been shown to routinely improve muscle function. Additional research in this area is warranted and discussed in this review.


Extracorporeal CO2 removal by hemodialysis: in vitro model and feasibility.
Critically ill patients with acute respiratory distress syndrome and acute exacerbations of chronic obstructive pulmonary disease often develop hypercapnia and require mechanical ventilation. Extracorporeal carbon dioxide removal can manage hypercarbia by removing carbon dioxide directly from the bloodstream. Respiratory hemodialysis uses traditional hemodialysis to remove CO2 from the blood, mainly as bicarbonate. In this study, Stewart's approach to acid-base chemistry was used to create a dialysate that would maintain blood pH while removing CO2 as well as determine the blood and dialysate flow rates necessary to remove clinically relevant CO2 volumes. Bench studies were performed using a scaled down respiratory hemodialyzer in bovine or porcine blood. The scaling factor for the bench top experiments was 22.5. In vitro dialysate flow rates ranged from 2.2 to 24 mL/min (49.5-540 mL/min scaled up) and blood flow rates were set at 11 and 18.7 mL/min (248-421 mL/min scaled up). Blood inlet CO2 concentrations were set at 50 and 100 mmHg. Results are reported as scaled up values. The CO2 removal rate was highest at intermittent hemodialysis blood and dialysate flow rates. At an inlet pCO2 of 50 mmHg, the CO2 removal rate increased from 62.6 ± 4.8 to 77.7 ± 3 mL/min when the blood flow rate increased from 248 to 421 mL/min. At an inlet pCO2 of 100 mmHg, the device was able to remove up to 117.8 ± 3.8 mL/min of CO2. None of the test conditions caused the blood pH to decrease, and increases were ≤0.08. When the bench top data is scaled up, the system removes a therapeutic amount of CO2 standard intermittent hemodialysis flow rates. The zero bicarbonate dialysate did not cause acidosis in the post-dialyzer blood. These results demonstrate that, with further development, respiratory hemodialysis can be a minimally invasive extracorporeal carbon dioxide removal treatment option.


The implementation and evaluation of an evidence-based protocol to treat diabetic ketoacidosis: a quality improvement study.
This retrospective observational quality improvement study was conducted to determine whether an evidence-based protocol for the treatment of diabetic ketoacidosis improved patient outcomes in our academic medical center. This study evaluated fidelity of providers to the protocol, as well as time to resolution of diabetic ketoacidosis as measured by closure of the anion gap (AG). Other secondary outcomes included time to intravenous fluids, time to potassium replacement, and rates of hypoglycemia and hypokalemia.Two cohorts including historical (N = 41) and current (N = 37) were compared to evaluate the effectiveness of the protocol. There were no differences between group demographics at baseline. After implementation of the protocol, 43.2% of patients were treated using full protocol fidelity, 21.6% were treated with partial fidelity, and 35.1% were not treated using the protocol. Although none of the outcomes reached statistical significance, patients in the current group who were treated with full protocol fidelity had an average time to AG closure that was 3 hr less than those who were not treated according to the protocol, and an average time to potassium replacement that was 2 hr less. When comparing the historical cohort with the patients treated with full protocol fidelity, there was improvement in protocol-treated patients in time to AG closure (2 hr), time to dextrose replacement (1.7 hr), and time to potassium replacement (2 hr). The rates of hypokalemia were improved with protocol treatment; 37.5% of protocol-treated patients had hypokalemia as opposed to 63.4% of those not treated according to protocol.Overall, despite the low fidelity in our institution, the protocol promoted evidence-based practice and patients treated according to the protocol had decreased time to treatment outcomes including quicker AG closure, improved intravenous fluids resuscitation, and more accurate and timely electrolyte correction.


Translational hurdles with cannabis medicines.
Internationally, there has been widespread medical use of cannabis medicines before rigorous evaluations in randomised controlled trials (RCTs). Some advocates of medicinal use of cannabis argue that real-world evidence (RWE) can be a substitute for or at least supplement evidence from RCTs. We explore the utility, limitations and impact of RWE in the translation of cannabis medicines research into clinical practice using the established literature. A literature search was performed via Embase and Medline using a diverse range of cannabinoid and RWE search terms. The review provides a snapshot of cannabis medicine RWE initiatives from around the world. Diverse and novel sources of real-world data and RWE include international cannabis registries, surveys, post-marketing data collection and use of electronic or digital health records. The strengths and limitations of using RWE in translational research are highlighted, along with the identification of barriers to RCTs involving cannabis medicines. RWE promises to play a significant role in the evaluation of cannabis medicines around the world. When used appropriately RWE may complement RCT data by providing valuable insights into cannabis medicine safety and effectiveness. It is important that real-world evidence (RWE) is used to complement rather than replace randomised controlled trial (RCT) evidence on cannabis medicines. Technological advances have created the opportunity to explore diverse and novel sources of cannabis medicine RWE. Although RWE may be more reflective of real-world clinical practice, it cannot provide conclusive evidence of the safety and efficacy of cannabis medicines. While acknowledging its limitations, RWE may nonetheless provide some guidance on safety and adverse events of cannabis medicines. RWE has already had a significant impact on the regulation of cannabis medicines.


[A pony with "false" colic].
Report on the case of a pony with colic submitted a to the department of internal medicine. However, the animal was found to be affected with dilatation of the oesophagus which had given rise to acute pleurisy resulting from rupture of the wall of the oesophagus. The diagnosis was established after death.


Stochastic bifurcations in a prototypical thermoacoustic system.
We study the influence of noise in a prototypical thermoacoustic system, which represents a nonlinear self-excited bistable oscillator. We analyze the time series of unsteady pressure obtained from a horizontal Rijke tube and a mathematical model to identify the effect of noise. We report the occurrence of stochastic bifurcations in a thermoacoustic system by tracking the changes in the stationary amplitude distribution. We observe a complete suppression of a bistable zone in the presence of high intensity noise. We find that the complete suppression of the bistable zone corresponds to the nonexistence of phenomenological (P) bifurcations. This is a study in thermoacoustics to identify the parameter regimes pertinent to P bifurcation using the stationary amplitude distribution obtained by solving the Fokker-Planck equation.


[Relationship between Helicobacter pylori infection and miR-24-3p expression during the development of gastric mucosa lesions].
Objectives: To explore the expression of micro RNA-24-3p (miR-24-3p) in different gastric mucosa lesions, and analyze the potential correlation between Helicobacter pylori (H.pylori) infection and miR-24-3p expression in different gastric lesions. Methods: 158 gastric biopsy specimens were divided into four groups, including 35 chronic superficial gastritis (CSG) samples, 43 chronic atrophic gastritis (CAG) samples, 41 intestinal metaplasia (IM) samples and 39 dysplasia (Dys) samples. Those samples were collected from patients undergoing gastroscopy at the Department of Gastroenterology, Aerospace Center Hospital, from September 2005 to June 2012. The expression of miR-24-3p was detected using in situ hybridization. H. pylori infection status was determined by rapid urease test and Warthin-Starry stain. Results: Higher expression rate of miR-24-3p was observed in CSG compared with those in CAG, IM and Dys, respectively. The miR-24-3p expression rate in CSG with H. pylori infection was significantly lower than that without H. pylori infection (P=0.001), but it was not observed in CAG, IM and Dys groups (all P>0.05). Conclusions: MiR-24-3p was highly expressed at the early stage of gastric mucosal lesion. Attenuation of miR-24-3p expression is associated with the development of severe gastric mucosa lesions. H. pylori may play a role in miR-24-3p regulation in the early stage of gastric mucosa lesions.


Regulation of carrier-mediated transport of folates and antifolates in methotrexate-sensitive and-resistant leukemia cells.
Prolonged cell culture of human leukemia cells at folate concentrations in the (sub)physiological range (1-5 nM) rather than at 'standard' supraphysiological concentrations of 2-10 microM folic acid elicited a number of regulatory aspects of the reduced folate carrier (RFC), the membrane transport protein for natural reduced folate cofactors and folate-based chemotherapeutic drugs such as methotrexate (MTX). One subline of human CCRF-CEM leukemia cells grown under folate-restricted conditions (CEM-7A) exhibited a 95-fold increased Vmax for uptake of [3H]-MTX. The increased uptake of MTX in CEM-7A cells is based on at least two factors: (a) a constitutive 10-fold overexpression of the RFC1 gene and RFC1 message; and (b) a 7-9-fold up-regulation of RFC transport activity under low intracellular reduced folate concentrations. This second component appeared to be regulatable by changes in the cellular folate, purine and methylation status as judged from a 7-9 fold down-regulation of RFC transport activity after short term (1-2 hr) incubation of CEM-7A cells with reduced folate cofactors (25 nM LV), purines (100 microM adenosine) or S-adenosylmethionine (100 microM), respectively. Gradual folate restriction in the cell culture medium of CEM/MTX cells, a subline of CCRF-CEM resistant to MTX due to defective transport via the RFC, revealed the up-regulated expression of an altered RFC protein that is characterized by a 35-fold decreased Km for folic acid and a 10-fold decreased Km for the reduced folate cofactor LV compared to the RFC expressed in CCRF-CEM and CEM-7A cells. As a result of the markedly increased efficiency of folic acid uptake in CEM/MTX cells, intracellular folate pools were 7-fold higher than in CCRF-CEM cells when both cell lines were incubated in the presence of 2 microM folic acid. The high intracellular folate pools in CEM/MTX cells appeared to impair the polyglutamylation of antifolates and confer resistance to ZD1694, an antifolate drug that depends on polyglutamylation for its biological activity. Collectively, these studies provide a better insight into the basic regulation of RFC-mediated membrane transport of clinically active antifolates. In addition, these studies may also provide an opportunity to exploit the transport system as a target for biochemical modulation by which it may contribute to an improved efficacy of folate-based chemotherapy in a clinical setting.


An Assessment of Pediatric Resident Disaster Preparedness for the Neonatal Intensive Care Unit.
To assess the level of neonatal intensive care unit (NICU) disaster preparedness among pediatric residents. A mixed-methods study including qualitative interviews and quantitative surveys was used. Interviews guided survey development. Surveys were distributed to residents who rotated through Children's National NICU. Questions assessed residents' background in disaster preparedness, disaster protocol knowledge, NICU preparedness, roles during surge and evacuation, and views on training and education. Survey response was 62.5% (n = 80) with 51.3% of invited residents completing it. Pediatric residents (PGY-2 and PGY-3) (n = 41) had low levels of individual disaster preparedness, particularly evacuations (86%). None were aware of specific NICU disaster protocols. Patient acuity, role ambiguity, knowledge, and training deficits were major contributors to unpreparedness. Residents viewed their role as system facilitators (eg, performing duties assigned, recruiting other residents, and clerical work like documentation). Resident training requests included disaster preparedness training every NICU rotation (48%) using multidisciplinary simulations (66%), role definition (56%), and written protocols (50%). Despite their unpreparedness, residents (84%) were willing to respond. Pediatric residents lacked knowledge of NICU disaster response but were willing to respond to disasters. Training should include multi-disciplinary simulations that can be refined iteratively to clarify roles, and residents should be involved in planning and execution.


The effect of presleep video-game playing on adolescent sleep.
Video-game use before bedtime has been linked with poor sleep outcomes for adolescents; however, experimental evidence to support this link is sparse. The present study investigated the capacity of presleep video-game playing to extend sleep latency and reduce subjective feelings of sleepiness in adolescents. The arousing psychophysiologic mechanisms involved and the impact of presleep video-game playing on sleep architecture were also explored. Thirteen male adolescent "evening types" (mean age = 16.6 years, SD = 1.1) participated in a counterbalanced, within-subjects design with experimental (active video gaming) and control (passive DVD watching) conditions. The experiment was conducted in the Flinders University Sleep Research Laboratory. Relative to the control condition, presleep video-game playing increased sleep-onset latency (Z= 2.45, p= .01) and reduced subjective sleepiness (Z = 2.36, p = .02)-but only slightly. Video gaming was related to changes in cognitive alertness (as measured by a power: p < 0.01) but not physiologic arousal (as measured by heart rate: p > 0.05). Contrary to previous findings, sleep architecture was unaffected (both rapid eye movement and slow wave sleep: p > 0.05). Results suggest the direct effect of presleep video-game playing on adolescent sleep may be more modest than previously thought, suggesting that surveys linking stimulating presleep activities to poor sleep need substantiating with empirical evidence.


Stimulant prescribing for the treatment of ADHD in Western Australia: socioeconomic and remoteness differences.
To identify whether the rate and average daily dose of stimulant prescribed for attention deficit hyperactivity disorder (ADHD) in Western Australia differed according to the geographical remoteness and socioeconomic status of the patient. Secondary analysis of population-based administrative pharmacy data from 2004, stratified by the Accessibility/Remoteness Index of Australia (ARIA+) categories and the Index of Relative Socio-Economic Disadvantage (IRSD) quintiles for WA (2001 Census). Rate ratios of stimulant prescription and mean average daily dose (in dex-equivalents) stratified by age (2-17, 18+ years), sex, ARIA+ category and IRSD quintile. The rate of stimulant prescription was 2.3 to 5.3 times greater in major cities in WA compared with remote and very remote parts of the state. The association between socioeconomic disadvantage and the rate of stimulant prescription was highly variable. Adults with the least socioeconomic disadvantage were significantly more likely to receive stimulants compared with their most disadvantaged counterparts; however, the reverse association was seen with children. The average daily dose of stimulant prescribed did not vary greatly across remoteness or socioeconomic categories. Remoteness and socioeconomic disadvantage are significantly associated with rate of stimulant prescription for ADHD in WA, but not associated with average daily dose of stimulant prescribed. Further research is needed to understand why considerable variation exists in the use of prescribed stimulants for ADHD.


Single cell and spatial transcriptomic analyses reveal microglia-plasma cell crosstalk in the brain during Trypanosoma brucei infection.
Human African trypanosomiasis, or sleeping sickness, is caused by the protozoan parasite Trypanosoma brucei and induces profound reactivity of glial cells and neuroinflammation when the parasites colonise the central nervous system. However, the transcriptional and functional responses of the brain to chronic T. brucei infection remain poorly understood. By integrating single cell and spatial transcriptomics of the mouse brain, we identify that glial responses triggered by infection are readily detected in the proximity to the circumventricular organs, including the lateral and 3rd ventricle. This coincides with the spatial localisation of both slender and stumpy forms of T. brucei. Furthermore, in silico predictions and functional validations led us to identify a previously unknown crosstalk between homeostatic microglia and Cd138+ plasma cells mediated by IL-10 and B cell activating factor (BAFF) signalling. This study provides important insights and resources to improve understanding of the molecular and cellular responses in the brain during infection with African trypanosomes.


Effects of visual experience on vascular endothelial growth factor expression during the postnatal development of the rat visual cortex.
The development of the cortical vascular network depends on functional maturation. External inputs are an essential requirement in the modeling of the visual cortex, mainly during the critical period, when the functional and structural properties of visual cortical neurons are particularly susceptible to alterations. Vascular endothelial growth factor (VEGF) is the major angiogenic factor, a key signal in the induction of vessel growth. Our study focused on the role of visual stimuli on the development of the vascular pattern correlated with VEGF levels. Vascular density and the expression of VEGF were examined in the primary visual cortex of rats reared under different visual environments (dark rearing, dark-rearing in conditions of enriched environment, enriched environment, and laboratory standard conditions) during postnatal development (before, during, and after the critical period). Our results show a restricted VEGF cellular expression to astroglial cells. Quantitative differences appeared during the critical period: higher vascular density and VEGF protein levels were found in the enriched environment group; both dark-reared groups showed lower vascular density and VEGF levels, which means that enriched environment without the physical exercise component does not exert effects in dark-reared rats.


Bax is activated during rotavirus-induced apoptosis through the mitochondrial pathway.
Rotaviruses are the leading cause of infantile viral gastroenteritis worldwide. Mature enterocytes of the small intestine infected by rotavirus undergo apoptosis, and their replacement by less differentiated dividing cells probably leads to defective absorptive function of the intestinal epithelium, which, in turn, contributes to osmotic diarrhea and rotavirus pathogenesis. Here we show that infection of MA104 cells by the simian rhesus rotavirus strain RRV induced caspase-3 activation, DNA fragmentation, and cleavage of poly(ADP-ribose) polymerase; all three phenomena are features of apoptosis. RRV induced the release of cytochrome c from mitochondria to the cytosol, indicating that the mitochondrial apoptotic pathway was activated. RRV infection of MA104 cells activated Bax, a proapoptotic member of the Bcl-2 family, as revealed by its conformational change. Most importantly, Bax-specific small interfering RNAs partially inhibited cytochrome c release in RRV-infected cells. Thus, mitochondrial dysfunction induced by rotavirus is Bax dependent. Apoptosis presumably leads to impaired intestinal functions, so our findings contribute to improving our understanding of rotavirus pathogenesis at the cellular level.


[Operatory strategies and information management of nursing work in the hospital context].
The paper examines the relationship between operatory strategies and information process used by nurses, in hospital context, in order to regulate their ongoing activities. As a conceptual framework, a cognitive ergonomics model was adopted, linking concepts of work regulation and representation to action. The Ergonomics Work Analyses tool (EWA) was used to collect data. The results show that the cognitive strategies used by nurses, in the decision-making process, are based on their ongoing activities as in the preparation of personal notes, aiming, in particular, at reducing their mental workload and assuring the viability of their actions.


[Lipopolysaccharide-induced hydrolysis of plasmalogenic phosphatidylethanolamine in human platelets].
The composition of human platelet major phospholipids-phosphatidylcholine (PC), phosphatidylinositol (PI), phosphatidylserine (PS), phosphatidic acid (PA), sphingomyelin (SM), plasmalogenic and diacyl species of phosphatidylethanolamine (PPE and APE, respectively) was quantitatively analyzed by high performance liquid chromatography. Incubation (10 min, 37 degrees C) of washed platelets with lipopolysaccharide B (LPS) of Salmonella typhimurium was found to produce (in the absence of aggregation) marked hydrolysis of PI (ca. 15%) and PPE (ca. 19%) containing the bulk of polyenic fatty acids. PC and APE were less degraded (8-9%), while the amounts of PS and SM were practically unchanged and the level of PA rose by 20%. Addition of thrombin to LPS-pretreated platelets resulted in their more rapid aggregation which was accompanied by a decreased and nearly equal hydrolysis of APE and PPE (7-8%) as compared with control platelets (10 and 12%, respectively). The extent to which PI was degraded (ca. 34%), by the action of thrombin was not affected by preliminary incubation with LPS. It is suggested that thrombin (as well as LPS) activating endogenous phospholipase(s) A2 can liberate from PPE not only arachidonic acid but also other essential polyenic fatty acids present in PPE in relatively high amounts. Besides, the agents studied may activate the intrinsic platelet system of rapid arachidonoyl transfer from diacyl PC and PE to PPE.


Halococcus qingdaonensis sp. nov., a halophilic archaeon isolated from a crude sea-salt sample.
A Gram-negative, extremely halophilic, coccoid archaeal strain, CM5(T), was isolated from a crude sea-salt sample collected near Qingdao, China. The organism grew optimally at 35-40 degrees C and pH 6.0 in the presence of 20 % (w/v) NaCl. Its colonies were red in colour and it could use glucose as a sole carbon source for growth. The 16S rRNA gene sequence of CM5(T) was most closely related to those of Halococcus species. Its pattern of antibiotic susceptibility was similar to those of other described Halococcus species. Biochemical tests revealed no sign of H(2)S production or gelatin liquefaction. The main polar lipids of strain CM5(T) were phosphatidylglycerol, phosphatidylglycerol methylphosphate and sulfated diglycosyl diether. No phosphatidylglycerol sulfate was present. The DNA G+C content of strain CM5(T) was 61.2 mol% and it gave DNA-DNA reassociation values of 33.7, 57.1 and 29.6 %, respectively, with Halococcus salifodinae DSM 8989(T), Halococcus dombrowskii DSM 14522(T) and Halococcus morrhuae ATCC 17082(T). Based on its morphological and chemotaxonomic properties and phylogenetic analysis of 16S rRNA gene sequence data, we propose that CM5(T) should be classified within a novel species, Halococcus qingdaonensis sp. nov., with strain CM5(T) (=CGMCC 1.4243(T)=JCM 13587(T)) as the type strain.


Decline in an Atlantic Puffin Population: Evaluation of Magnitude and Mechanisms.
Determining which demographic and ecological parameters contribute to variation in population growth rate is crucial to understanding the dynamics of declining populations. This study aimed to evaluate the magnitude and mechanisms of an apparent major decline in an Atlantic Puffin Fratercula arctica population. This was achieved using a 27-year dataset to estimate changes in population size and in two key demographic rates: adult survival and breeding success. Estimated demographic variation was then related to two ecological factors hypothesised to be key drivers of demographic change, namely the abundance of the main predator at the study site, the Great Skua Stercorarius skua, and Atlantic Puffin chick food supply, over the same 27-year period. Using a population model, we assessed whether estimated variation in adult survival and reproductive success was sufficient to explain the population change observed. Estimates of Atlantic Puffin population size decreased considerably during the study period, approximately halving, whereas Great Skua population estimates increased, approximately trebling. Estimated adult Atlantic Puffin survival remained high across all years and did not vary with Great Skua abundance; however, Atlantic Puffin breeding success and quantities of fish prey brought ashore by adults both decreased substantially through the period. A population model combining best possible demographic parameter estimates predicted rapid population growth, at odds with the long-term decrease observed. To simulate the observed decrease, population models had to incorporate low immature survival, high immature emigration, or increasingly high adult non-breeding rates. We concluded that reduced recruitment of immatures into the breeding population was the most likely cause of population decrease. This study showed that increase in the size of a predator population does not always impact on the survival of adult prey and that reduced recruitment can be a crucial determinant of seabird population size but can easily go undetected.


The relevance of rock shape over mass-implications for rockfall hazard assessments.
The mitigation of rapid mass movements involves a subtle interplay between field surveys, numerical modelling, and experience. Hazard engineers rely on a combination of best practices and, if available, historical facts as a vital prerequisite in establishing reproducible and accurate hazard zoning. Full-scale field tests have been performed to reinforce the physical understanding of debris flows and snow avalanches. Rockfall dynamics are - especially the quantification of energy dissipation during the complex rock-ground interaction - largely unknown. The awareness of rock shape dependence is growing, but presently, there exists little experimental basis on how rockfall hazard scales with rock mass, size, and shape. Here, we present a unique data set of induced single-block rockfall events comprising data from equant and wheel-shaped blocks with masses up to 2670 kg, quantifying the influence of rock shape and mass on lateral spreading and longitudinal runout and hence challenging common practices in rockfall hazard assessment.


Is dialysis modality a factor in the survival of patients initiating dialysis after kidney transplant failure?
Kidney transplant failure (TF) is among the leading causes of dialysis initiation. Whether survival is similar for patients treated with peritoneal dialysis (PD) and with hemodialysis (HD) after TF is unclear and may inform decisions concerning dialysis modality selection. Between 1995 and 2007, 16 113 adult dialysis patients identified from the US Renal Data System initiated dialysis after TF. A multivariable Cox proportional hazards model was used to evaluate the impact of initial dialysis modality (1 865 PD, 14 248 HD) on early (1-year) and overall mortality in an intention-to-treat approach. Compared with HD patients, PD patients were younger (46.1 years vs 49.4 years, p < 0.0001) with fewer comorbidities such as diabetes mellitus (23.1% vs 25.7%, p < 0.0001). After adjustment, survival among PD patients was greater within the first year after dialysis initiation [adjusted hazard ratio (AHR): 0.85; 95% confidence interval (CI): 0.74 to 0.97], but lower after 2 years (AHR: 1.15; 95% CI: 1.02 to 1.29). During the entire period of observation, survival in both groups was similar (AHR for PD compared with HD: 1.09; 95% CI: 1.0 to 1.20). In a sensitivity analysis restricted to a cohort of 1865 propensity-matched pairs of HD and PD patients, results were similar (AHR: 1.03; 95% CI: 0.93 to 1.14). Subgroups of patients with a body mass index exceeding 30 kg/m(2) [AHR: 1.26; 95% CI: 1.05 to 1.52) and with a baseline estimated glomerular filtration rate (eGFR) less than 5 mL/min/1.73 m(2) (AHR: 1.45; 95% CI: 1.05 to 1.98) experienced inferior overall survival when treated with PD. Compared with HD, PD is associated with an early survival advantage, inferior late survival, and similar overall survival in patients initiating dialysis after TF. Those data suggest that increased initial use of PD among patients returning to dialysis after TF may be associated with improved outcomes, except among patients with a higher BMI and those who initiate dialysis at lower levels of eGFR. The reasons behind the inferior late survival seen in PD patients are unclear and require further study.


Assessment of anterior and posterior corneal indices using two Scheimpflug analyzers.
To assess the agreement between the elevation and curvature measurements of the anterior and posterior corneal surfaces obtained using the Galilei Dual Scheimpflug Analyzer and those obtained using the Pentacam single Scheimpflug system. This prospective, noninterventional, diagnostic study was conducted at the Department of Ophthalmology at the American University of Beirut (Medical Center) and included 60 eyes of 60 consecutive patients. Measurements were obtained using 2 different Scheimpflug analyzers (Galilei and Pentacam). The best-fit sphere was set at 8 mm in both machines. Pachymetry (CCT), anterior elevation (AE) and posterior elevation (PE), and curvature were assessed. Pearson's correlation coefficients, comparison of means, and Bland-Altman plots were used to evaluate agreement between the 2 systems. The average CCT (at the corneal apex) was 533 ± 35 µm and 532 ± 37 µm (p=0.980), the average central AE was 1.25 ± 3.95 µm and 2.29 ± 5.28 µm (p=0.964), and the average central PE was 4.19 ± 8.18 µm and 5.42 ± 14.05 (p=0.956) µm with the Galilei and Pentacam, respectively. The Scheimpflug analyzers correlated well in the assessment of pachymetry, elevation, and curvature.


Suppression of spin-exciton state in hole overdoped iron-based superconductors.
The mechanism of Cooper pair formation in iron-based superconductors remains a controversial topic. The main question is whether spin or orbital fluctuations are responsible for the pairing mechanism. To solve this problem, a crucial clue can be obtained by examining the remarkable enhancement of magnetic neutron scattering signals appearing in a superconducting phase. The enhancement is called spin resonance for a spin fluctuation model, in which their energy is restricted below twice the superconducting gap value (2Δs), whereas larger energies are possible in other models such as an orbital fluctuation model. Here we report the doping dependence of low-energy magnetic excitation spectra in Ba1-xKxFe2As2 for 0.5 < x < 0.84 studied by inelastic neutron scattering. We find that the behavior of the spin resonance dramatically changes from optimum to overdoped regions. Strong resonance peaks are observed clearly below 2Δs in the optimum doping region, while they are absent in the overdoped region. Instead, there is a transfer of spectral weight from energies below 2Δs to higher energies, peaking at values of 3Δs for x = 0.84. These results suggest a reduced impact of magnetism on Cooper pair formation in the overdoped region.


ATMPK4, an Arabidopsis homolog of mitogen-activated protein kinase, is activated in vitro by AtMEK1 through threonine phosphorylation.
The modulation of mitogen-activated protein kinase (MAPK) activity regulates many intracellular signaling processes. In animal and yeast cells, MAP kinases are activated via phosphorylation by the dual-specificity kinase MEK (MAP kinase kinase). Several plant homologs of MEK and MAPK have been identified, but the biochemical events underlying the activation of plant MAPKs remain unknown. We describe the in vitro activation of an Arabidopsis homolog of MAP kinase, ATMPK4. ATMPK4 was phosphorylated in vitro by an Arabidopsis MEK homolog, AtMEK1. This phosphorylation occurred principally on threonine (Thr) residues and resulted in elevated ATMPK4 kinase activity. A second Arabidopsis MEK isoform, ATMAP2Kalpha, failed to phosphorylate ATMPK4 in vitro. Tyr dephosphorylation by the Arabidopsis Tyr-specific phosphatase AtPTP1 resulted in an almost complete loss of ATMPK4 activity. Immunoprecipitates of Arabidopsis extracts with anti-ATMPK4 antibodies displayed myelin basic protein kinase activity that was sensitive to treatment with AtPTP1. These results demonstrate that a plant MEK can phosphorylate and activate MAPK, and that Tyr phosphorylation is critical for the catalytic activity of MAPK in plants. Surprisingly, in contrast to the animal enzymes, AtMEK1 may not be a dual-specificity kinase but, rather, the required Tyr phosphorylation on ATMPK4 may result from autophosphorylation.


Timing matters: species-specific interactions between spawning time, substrate quality, and recruitment success in three salmonid species.
Substratum quality and oxygen supply to the interstitial zone are crucial for the reproductive success of salmonid fishes. At present, degradation of spawning grounds due to fine sediment deposition and colmation are recognized as main factors for reproductive failure. In addition, changes in water temperatures due to climate change, damming, and cooling water inlets are predicted to reduce hatching success. We tested the hypothesis that the biological effects of habitat degradation depend strongly on the species-specific spawning seasons and life-history strategies (e.g., fall- vs. spring-spawners, migratory vs. resident species) and assessed temperature as an important species-specific factor for hatching success within river substratum. We studied the species-specific differences in their responses to such disturbances using egg-to-fry survival of Danube Salmon (Hucho hucho), resident brown trout (Salmo trutta fario), and migratory brown trout (Salmo trutta lacustris) as biological endpoint. The egg incubation and hatching success of the salmonids and their dependence on temperature and stream substratum quality were compared. Hatching rates of Danube salmon were lower than of brown trout, probably due to higher oxygen demands and increased interstitial respiration in spring. Increases in maximum water temperature reduced hatching rates of resident and migratory brown trout (both fall-spawners) but were positively correlated with hatching rates of Danube salmon (a spring-spawner). Significantly longer incubation periods of resident and migratory brown trout coincided with relatively low stream substratum quality at the end of the egg incubation. Danube salmon seem to avoid low oxygen concentrations in the hyporheic zone by faster egg development favored by higher water temperatures. Consequently, the prediction of effects of temperature changes and altered stream substratum properties on gravel-spawning fishes and biological communities should consider the observed species-specific variances in life-history strategies to increase conservation success.


Dissecting aneurysm of the descending aorta. Improved surgical results in 91 patients.
Dissecting aneurysm of the descending thoraic aorta (type iii) is a specific disease process whose pathogenesis, pathologic description, surgical treatment, and prognosis is different from dissections of the ascending arota (types l and ll). From 1964 through 1974, 91 patients underwent surgical correction of type iii dissection. The operative mortality was 21% and late mortality, up to ten years follow-up, was 13%. During the past four years, operative mortality has dropped to 6.5%. Mortality was determined by extent of the aneurysm and underlying cardiac disease. Antihypertensive and negative ionotropic drugs have not been used as definitive treatment but as adjuncts in perioperative support. Based on our present mortality of 6.5%, with no late mortality, we urge early surgical treatment of acute and chronic dissecting aneurysms of the descending thoracic aorta before extension, rupture, or massive enlargement of the aneurysm occurs.


Disconnected brains: what is the role of fMRI in connectivity research?
In this paper we consider how functional Magnetic Resonance Imaging (fMRI) has been used to study cortical connectivity in autism and autistic spectrum disorders (ASD). We discuss those studies that have contributed to the evidence supporting a model of disordered cortical connectivity in autism and (ASD), with a focusing emphasis on the application to research into the underconnectivity model. We note that the analytical techniques employed are limited and do not allow interpretation in terms of effective, or directional connectivity, nor do they provide information about the temporal or spectral characteristics of the functional networks being studied. We highlight how currently the features of neural generators that are being assessed by functional connectivity in fMRI are unclear. In addition, we note the importance in clinical studies of considering the consequences of task choice for the nature of the imaging data that can be collected and also of individual differences in participant state and trait characteristics for the accurate interpretation of imaging data. We discuss how alternative techniques such as EEG/MEG may address the limitations of fMRI in assessing brain connectivity, and additionally consider the potential of multimodal approaches. We conclude that fMRI has made significant contributions towards our understanding of the brain in terms of neural systems but that the conclusions drawn from its application in the sphere of autism research need to be approached with caution. It is important in research of this kind that we are aware of the need to examine the methodological and analytical techniques closely when applying findings in clinical populations, not only when they are used to support the development of theoretical models but also to inform diagnostic or treatment decisions.


Universal dissociated anesthesia due to bilateral brain-stem infarcts.
A 59-year-old man had loss of pin-prick and temperature sensation over his head, face, neck, trunk, and all extremities while light touch, vibration, joint position sense, and deep pain were preserved. This was the cumulative result of infarctions in the territories of the right superior cerebellar and left posterior inferior cerebellar arteries that occurred three years apart. To our knowledge, a syndrome of bilateral discrete interruption of spinothalamic tracts and of the spinal tracts of the trigeminal system in the brain stem has not been reported. Dissociated sensory loss enveloping the entire body accompanied by truncal and limb ataxia without weakness demonstrated a striking clinical picture. The preservation of deep somatic and visceral pain when cutaneous pain sensation was lost was another notable feature. We review the causes of widespread dissociated sensory loss and discuss the implications of the dissociation of deep from superficial pain.


SEM studies of the morphology and chemistry of polar ice.
Determining the microphysical location of impurities in natural ice from the polar regions is necessary for understanding the physical properties of ice and for assuring the integrity of ice core records. SEM, using a cold stage and X-ray microanalytical techniques, has proved to be the most powerful method so far for undertaking such work. Methods are adapted from those used to study frozen hydrated biological material. Sublimation within the cryo-chamber is often needed in order to concentrate impurities onto a plane, but this can lead to artifacts that must be recognized. Over 100 samples from different depths and sites in Greenland and Antarctica have been examined. Typical physical features, including air bubbles, clathrate hydrates of air, and dust particles are identified. The dust is found preferentially at grain boundaries in some samples; by pinning the boundaries, it can slow grain growth. Of the soluble material, chloride seems to be found most frequently in the ice lattice. Other impurities are found at grain boundaries, and only when the bulk concentration exceeds a threshold, at triple junctions. These findings give new insights into processes determining the physical properties of ice samples and of ice sheets, and new impetus for theoretical studies of the energetics that lead to this distribution.


A prospective study on quality in endoscopic retrograde cholangiopancreatography (ERCP): trend in Italy from the REQUEST study.
Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) is a complex procedure with a relatively high rate of adverse events. Data on training of operators and fulfillment of quality indicators in Italy are scarce. The goal of this study was to assess the overall quality of ERCP in Italy compared to international standards. Patients and methods This was a prospective, observational study from different Italian centers performing ERCP. Operators answered a questionnaire, then recorded data on ERCPs over a 1-to 3-month period. Results Nineteen Italian centers participated in the study. The most common concern of operators about training was the lack of structured programs. Seven/19 centers routinely used conscious sedation for ERCP. Forty-one experienced operators and 21 trainees performed 766 ERCPs: a successful deep biliary cannulation in native-papilla patients was achieved in 95.1 % of cases; the post-ERCP pancreatitis (PEP) rate was 5.4 % in native-papilla patients; cholangitis rate was 1.0 %; bleeding and perforation occurred in 2.7 % and 0.4 % of the patients, respectively. Conclusions This study revealed that, overall, ERCP is performed in the participating Italian centers meeting good quality standards, but structured training and sedation practice are still subpar. The bleeding and perforation rate slightly exceeded the American Society of Gastrointestinal Endoscopy indicator targets but they are comparable to the reported rates from other international surveys.


Dual rolling circle amplification-enabled ultrasensitive multiplex detection of exosome biomarkers using electrochemical aptasensors.
Breast cancer is one of the leading causes of cancer-related death. An effective diagnostic system that enables early cancer detection is required for timely diagnosis and better treatment outcomes. Here, we developed an ultrasensitive electrochemical aptasensor for the multiplex detection of exosome biomarkers based on the electrochemical signals of metal ions. Specifically, a screen-printed carbon electrode (SPCE) was first modified with a multi-walled carbon nanotube (MWCNT), ionic liquid (IL), and chitosan (CHT) composite, and then gold nanoparticles (GNPs) were deposited via electrodeposition (GNPs/MWCNT-IL-CHT). To capture target exosomes, an aptamer specific for CD63, the universal exosome surface protein, was immobilized on the GNPs/MWCNT-IL-CHT/SPCE. When EpCAM or HER-2 positive exosomes were present in the sample, they could bind to EpCAM or HER-2 aptamers with primer sequences that acted as a rolling circle amplification reaction initiator, thereby generating numerous poly-guanine and poly-thymine repeats of a metal ion binding sequence, which produced strong electrochemical signals upon complexation with copper and lead ions. Using the proposed, multiplex exosome analysis system, EpCAM- and HER-2-positive exosomes were simultaneously detected with high specificity and a detection limit of 1 particle mL-1. In addition, its clinical applicability was validated via spike-and-recovery experiments using human serum samples.


The risk of developing endemic nephropathy in subjects with proteinuria.
Endemic nephropathy is a chronic tubulointerstitial disease characterized by early damage to the proximal tubule, with low-molecular weight proteinuria being an important hallmark and possible tool for early diagnosis. The aim of this retrospective cohort study was to assess the risk of developing endemic nephropathy in subjects with proteinuria from the endemic region in Croatia. The cohort study included subjects with proteinuria determined by the sulfosalicylic acid method (after 1988 with strip method), involved in the field survey conducted in the Croatian endemic village of Kaniza in 1975 and followed up until 1997. Subjects with endemic nephropathy established at the first visit and patients that failed to present for follow up visits after 1975. were excluded. In the field survey group that consisted of 624 subjects (286 male and 338 female), proteinuria was established in 157 subjects. Upon the application of exclusion and inclusion criteria, the study cohort included 111 of 157 subjects. The mean follow up was 7.26 years (95% confidence interval 4.06-10.46 years). During the follow up period, 19 (17%) subjects with initial proteinuria developed endemic nephropathy. The incidence density of endemic nephropathy among subjects with proteinuria was 1.3 per 100 persons/year. Estimated risk was 0.0137 (confidence interval 0.0087-0.0214) per year of exposure. The presence of proteinuria determined by the sulfosalicylic acid or test strip in subjects from the endemic village indicated that endemic nephropathy would develop in 1.3 of 100 subjects with proteinuria per year.


Molding influences of prematurity: Interviews with adults born preterm.
Tremendous medical advancements over the last several decades have supported the survival of younger and sicker newborns. Substantial quantitative research exists about health and developmental outcomes following preterm birth, however, limited published literature has explored what this experience means to the survivors. The purpose was to describe, interpret and understand how adults born preterm perceive prematurity to have affected their lives. Qualitative thematic analysis. Semi-structured interviews were conducted with 33 adults born preterm from the RHODĒ Study, a longitudinal preterm birth cohort. A cross-section of participants with high and low early life medical and environmental risk was interviewed. Data were analyzed using a constructionist method of latent theme analysis. From the data, 3 themes were identified: 1) My parents call me their miracle, 2) It's not a big deal, I'm the same as everyone else, 3) I've overcome a lot. Themes represent a continuum of experience, from positive to neutral to negative. Common life experiences of family, education, friends, and health are subthemes that help to illuminate how participants assign meaning to their prematurity. Meaning was linked to how typical or not participants perceive their health, learning and friends compared to peers. Perceptions about prematurity and adversity are influenced by the ways parents and families represent prematurity in shared stories and actions. These findings should inform future research with adult survivors of prematurity. Participants identified ongoing need for support and advocacy, particularly from healthcare and education communities.


Detection of Helicobacter pylori antigen in stool samples for diagnosis of infection in children.
The study evaluated a non-invasive antigen test of stool samples for the diagnosis of Helicobacter pylori infection in children compared with histopathology of gastric biopsies (gold standard). The study included 96 children aged 1-15 years old with dyspeptic symptoms referred for endoscopy at Tabriz Children's Hospital, Tabriz, Islamic Republic of Iran from May 2003 to March 2004. Of 62 children who were positive by histology, 34 were H. pylori stool antigen positive and of 34 patients with negative histology, 27 had negative stool test. The sensitivity and specificity of the test were low (54.8% and 79.4% respectively) compared with the gold standard and the positive and negative predictive values were 82.9% and 49.9%. However, the test may be useful for mass screening for H. pylori.


The influence of sea breeze on mold spore dispersion.
Background: Many allergists consider the ocean breeze to be free of allergens and recommend visits to the coast for relief; however, the coast may perpetuate an allergenic environment. Objective: This study investigated the sea breeze's impact on spore dispersion between coastal and inland sites, and the potential implications of sea breeze on human health and coastal resources. Methods: Spore sampling occurred during 2006 by using pollen samplers. Samplers were located at the Rutgers University Institute of Marine and Coastal Sciences Marine Field Station and the Rutgers University Pinelands Field Station. Statistical analysis was performed on the spore data to compare concentrations from the various locations. The effect of sea breeze circulation on particulate matter was analyzed from meteorological data collected in 2006. Sea breeze data were collected from simulations, Doppler radar, and meteorological towers at varying heights. Results: There was no significant difference between the total spore concentration at the New Jersey coast and the New Jersey Pinelands canopy. Conclusion: Sea breeze has been shown to favor aerobiologic transfers from coastal seawater to land, but the immediate environment (floor) still remains a primary determinant of affecting an individual's allergic airway disease. Results of some studies have shown that coastal environments may favor the onset allergic airway, but in our study this seemed to be equivalent to the floor (or immediate locale) of an individual affected with allergy. However, the sea breeze effect seemed to have the ability to impact allergic airway disease (AAD) populations not only living along the coasts but of those living up to 130 km inland and potentially those living in the Philadelphia metropolitan area.


Analysis of a survey on orthopaedic residency training for fracture treatment in Korea.
Fracture surgery is the most frequently performed orthopaedic procedure and is considered an essential surgical procedure for orthopaedic surgeons in general. Although the approach and circumstances of orthopaedic residency training for fracture treatment may differ between countries, the goals of training, which is to educate the residents regarding the principles of the fracture treatment and foster conscientious orthopaedic specialists, remain unchanged. Thus, the aim of the this study was to determine a desirable course of orthopaedic residency training by investigating and analysing the reality of training associated with fracture surgery and treatment during the orthopaedic residency of 4th year orthopaedic residents in Korea. Using a questionnaire survey, a one-on-one interview was proposed to 266 applicants following the secondary board examination of residents who had completed the orthopaedic residency training course; the survey was conducted on January 19, 2016. Responses from 152 applicants (response rate: 57%) who accepted to participate in the survey were statistically analysed. During residency training, clinicians underwent fracture-related training for 3.5 h on average per month. Training consisted of various approaches and included lectures by professors, case briefings, textbook reading, and field training in an operating room. The residents largely differed in terms of experience in conducting fracture surgery: 47 (31%) responded that they had never performed fracture surgery during the training period, whereas 21 (14%) answered that they had conducted fracture surgery over 20 times. Experience in performing the surgical procedure was the most valuable in fracture training. To optimize fracture education among orthopaedic residents, the professors at teaching hospitals should understand the realities of fracture education, dedicate sufficient time for internal and external fracture teachings, and allow residents to perform fracture surgeries hands-on under their supervision, and also attempt to foster a social atmosphere that encourages all three factors.


A Smartphone Application to Reduce Time-to-Notification of Sexually Transmitted Infections.
To measure whether the implementation of Healthvana-an online patient engagement platform and smartphone application-reduced the number of days between sexually transmitted infection (STI) testing, notification, and treatment at AIDS Healthcare Foundation (AHF) Wellness Centers. We analyzed the retrospective data for 917 male clients who tested positive and received treatment for chlamydia, gonorrhea, or syphilis between January 1, 2014, and December 31, 2015. We included 8 AHF Wellness Centers from California and Florida in the study. We used regression models to evaluate the relationship between Healthvana implementation (pre-Healthvana vs post-Healthvana) and the number of days between the STI test, notification, and treatment. Following Healthvana implementation at the AHF Wellness Centers, the mean number of days decreased between the STI test and notification, from 8 to 6 days. The mean number of days between the overall STI test and treatment decreased from 12 to 10 days. Regression models found the reduction in the number of days from STI test to notification to be statistically significant. Smartphone applications like Healthvana are promising technologies to ensure clients are successfully and immediately notified of their STI test results.


Long noncoding RNA AFAP1-AS1 indicates a poor prognosis of hepatocellular carcinoma and promotes cell proliferation and invasion via upregulation of the RhoA/Rac2 signaling.
It has been shown that long noncoding RNAs (lncRNAs) play a critical role in the regulation of cellular processes including cancer progression and metastasis. However, the biological functions and clinical significance of lncRNA AFAP1-AS1 in hepatocellular carcinoma (HCC) remain unclear. Expression of AFAP1-AS1 was analyzed in 78 HCC tissues by real-time PCR. The effect of AFAP1-AS1 on cell proliferation was examined by MTT assay, cell apoptosis was detected by flow cytometric analysis and cell invasion was determined by Transwell assay. RhoA/Rac2 signaling and downstream factors were verified by western blotting. HCC cells infected with si-AFAP1-AS1 were injected into nude mice to investigate the effect of AFAP1-AS1 on the tumorigenesis in vivo. We found that increased expression of AFAP1-AS1 was significantly correlated with pathological staging (P=0.024) and lymph-vascular space invasion (LVSI) in HCC patients (P=0.007). Multivariate analyses indicated that AFAP1-AS1 represented an independent predictor for overall survival of HCC (P=0.029). Further experiments showed that knockdown of AFAP1-AS1 by si-AFAP1-AS1 decreased the proliferation and invasion in vitro and in vivo, induced cell apoptosis and blocked cell cycle in S phase via inhibition of the RhoA/Rac2 signaling. Taken together, our findings indicate that AFAP1-AS1 may promote the HCC development through upregulation of RhoA/Rac2 signaling and provide a potential therapeutic target for HCC.


A novel derivative pentacyclic triterpene and omega 3 fatty acid.
Adjuvant induced arthritis (AIA) is accompanied by marked changes in the levels of lysosomal enzymes, glycoproteins and metabolic turnover of collagen. The role of a pentacyclic triterpene and eicosapentaenoic acid (EPA) derivative--Lupeol-EPA (50 mg/kg body weight--orally) was tested in vivo in rats. The increased activities of lysosomal enzymes and glycoproteins associated with decreased collagen in arthritic animals were significantly altered to nearly that of controls. Indomethacin (3 mg/kg body weight) was used as a reference compound. The therapeutic usefulness of Lupeol-EPA derivative in inflammatory conditions is attractive and deserves further work in this direction.


Tree bark scrape fungus: A potential source of laccase for application in bioremediation of non-textile dyes.
Although laccase has been recognized as a wonder molecule and green enzyme, the use of low yielding fungal strains, poor production, purification, and low enzyme kinetics have hampered its large-scale application. Thus,this study aims to select high yielding fungal strains and optimize the production, purification, and kinetics of laccase of Aspergillus sp. HB_RZ4. The results obtained indicated that Aspergillus sp. HB_RZ4 produced a significantly large amount of laccase under meso-acidophilic shaking conditions in a medium containing glucose and yeast extract. A 25 μM CuSO4 was observed to enhance the enzyme yield. The enzyme was best purified on a Sephadex G-100 column. The purified enzyme resembled laccase of A. flavus. The kinetics of the purified enzyme revealed high substrate specificity and good velocity of reaction,using ABTS as a substrate. The enzyme was observed to be stable over various pH values and temperatures. The peptide structure of the purified enzyme was found to resemble laccase of A. kawachii IFO 4308. The fungus was observed to decolorize various dyes independent of the requirement of a laccase mediator system.Aspergillus sp. HB_RZ4 was observed to be a potent natural producer of laccase, and it decolorized the dyes even in the absence of a laccase mediator system. Thus, it can be used for bioremediation of effluent that contains non-textile dyes.


Rapid-onset dystonia-parkinsonism.
We studied a large family with a previously undescribed, autosomal dominant dystonia-parkinsonism syndrome. We chose to call the disorder "rapid-onset dystonia-parkinsonism" (RDP) based on the unusually rapid evolution of signs and symptoms. Affected individuals developed dystonia and parkinsonism between 14 and 45 years of age. The onset was acute in six individuals with the abrupt onset of symptoms over the course of several hours, and subacute in four others who had evolution over several days or weeks. Thereafter, progression of symptoms was usually very slow. Two had intermittent focal dystonia without parkinsonism, and one obligate gene carrier was asymptomatic at 68 years. CSF levels of homovanillic acid were decreased in the two individuals tested, but dopaminergic therapy provided only slight benefit. The DYT1 gene responsible for early-onset, generalized idiopathic torsion dystonia in Jewish and some non-Jewish families has been mapped to chromosome 9q34. Linkage analysis with three markers near the DYT1 gene showed several obligate recombinations, excluding DYT1 as a candidate gene for RDP. We believe RDP is unique and should be classified separately from other forms of hereditary dystonia-parkinsonism.


Current challenges and future perspectives of radiotherapy for locally advanced breast cancer.
To discuss current issues in the field of radiation oncology for locally advanced breast cancer (LABC). Large randomized studies involving nodal irradiation have recently been completed. The incremental benefit of treating the internal mammary nodes (IMNs) remains controversial. A randomized study specifically evaluating internal mammary node radiation (IMNR) failed to demonstrate significant benefit. A high impact, population-based study detected a proportional increase in major coronary events with increasing radiation dose. Advanced treatment techniques should be employed to reduce cardiac exposure. In patients with stage IV breast cancer (BCa), there is increasing evidence to suggest that locoregional treatments may improve overall survival (OS). Radiotherapy alone, without surgery, may provide equivalent local control and OS in patients with distant metastasis. High-dose stereotactic radiation regimens can be used to treat breast tumors with good local control rates in as few as three visits.BCa biomarkers are predictive of locoregional recurrence risk and should be used to guide radiotherapy in conjunction with standard staging. Clinically validated genetic profiling can measure tumor radiosensitivity and also help to predict normal tissue toxicity. We are entering an era of personalized radiotherapy for LABC. Radiation treatments must be tailored to each individual patient's risk and intrinsic tumor biology.


Results of clubfoot management using the Ponseti method: do the details matter? A systematic review.
Although the Ponseti method is accepted as the best choice for treatment of clubfoot, the treatment protocol is labor intensive and requires strict attention to details. Deviations in strict use of this method are likely responsible for the variations among centers in reported success rates. We wished to determine (1) to what degree the Ponseti method was followed in terms of manipulation, casting, and percutaneous Achilles tenotomy, (2) whether there was variation in the bracing type and protocol used for relapse prevention, and (3) if the same criteria were used to diagnose and manage clubfoot relapse. We conducted a systematic review of MEDLINE, EMBASE(TM), and the Cochrane Library. Studies were summarized according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement. Five hundred ninety-one records were identified with 409 remaining after deduplication, in which 278 irrelevant studies and 22 review articles were excluded. Of the remaining 109 papers, 19 met our inclusion criteria. All 19 articles were therapeutic studies of the Ponseti method. The details of manipulation, casting, or percutaneous Achilles tenotomy of the Ponseti method were poorly described in 11 studies, whereas the main principles were not followed in three studies. In three studies, the brace type deviated significantly from that recommended, whereas in another three studies the bracing protocol in terms of hours of recommended use was not followed. Furthermore no unified criteria were used for judgment of compliance with brace use. The indication for recognition and management of relapse varied among studies and was different from the original description of the Ponseti method. We found that the observed clinically important variation may have been the result of deviations from the details regarding manipulation, casting, percutaneous Achilles tenotomy, use of the bar-connected brace, and indication for relapse recognition and management recommended for the classic Ponseti approach to clubfoot management. We strongly recommend that clinicians follow the Ponseti method as it initially was described without deviation to optimize treatment outcomes.


Effects of Experimental Anterior Knee Pain on Muscle Activation During Landing and Jumping Performed at Various Intensities.
Although knee pain is common, some facets of this pain are unclear. The independent effects (ie, independent from other knee injury or pathology) of knee pain on neural activation of lower-extremity muscles during landing and jumping have not been observed. To investigate the independent effects of knee pain on lower-extremity muscle (gastrocnemius, vastus medialis, medial hamstrings, gluteus medius, and gluteus maximus) activation amplitude during landing and jumping, performed at 2 different intensities. Laboratory-based, pretest, posttest, repeated-measures design, where all subjects performed both data-collection sessions. Thirteen able-bodied subjects performed 2 different land and jump tasks (forward and lateral) under 2 different conditions (control and pain), at 2 different intensities (high and low). For the pain condition, experimental knee pain was induced via a hypertonic saline injection into the right infrapatellar fat pad. Functional linear models were used to evaluate the influence of experimental knee pain on muscle-activation amplitude throughout the 2 land and jump tasks. Experimental knee pain independently altered activation for all of the observed muscles during various parts of the 2 different land and jump tasks. These activation alterations were not consistently influenced by task intensity. Experimental knee pain alters activation amplitude of various lower-extremity muscles during landing and jumping. The nature of the alteration varies between muscles, intensities, and phases of the movement (ie, landing and jumping). Generally, experimental knee pain inhibits the gastrocnemius, medial hamstring, and gluteus medius during landing while independently increasing activation of the same muscles during jumping.


Age-dependent changes in DNA polymerase fidelity and proofreading activity during cellular aging.
DNA polymerase alpha and the 3'-->5' exonuclease involved in the proofreading of DNA synthesis were isolated from human diploid fetal lung fibroblast (TIG-1) cells at various population doubling levels (PDL). The final PDL of the TIG-1 cells used in these experiments was 70. The fidelity of DNA polymerase alpha remained high until late passage and fell suddenly just before the end of the life span between 65 and 69 PDL. The activities of the 3'-->5' exonuclease related to proofreading remained unchanged from 21 to 61 PDL, but the activity decreased rapidly in more aged cells. The 3'-->5' exonuclease activity at 69 PDL was about 50% of that in TIG cells at 21 PDL. In vitro DNA synthesis by DNA polymerase alpha from TIG-1 cells harvested at 69 PDL showed the amount of non-complementary nucleotides incorporated to be decreased by the addition of the 3'-->5' exonuclease from the same cells. However, not all errors were edited out since the ratio of DNA polymerase activity to 3'-->5' exonuclease activity was adjusted to reflect that in vivo and the infidelity of DNA synthesis by error-prone DNA polymerase alpha from aged cells was improved by the addition of the highly active 3'-->5' exonuclease from cells at 41 PDL. These results suggested that the mutation frequency rises just before the end of the life span of TIG-1 cells.


Transcatheter closure of coronary artery fistula using Guglielmi detachable coil.
Coronary artery fistula (CAF) is a rare anomaly. Transcatheter CAF closure has been introduced using various materials, but only few data are available on the Guglielmi detachable coil (GDC). The advantage of using GDC for transcatheter CAF closure is more controllable, therefore much safer when compared to other coils. This report is about our experience in transcatheter closure of CAF using fibered GDC in our hospital. METHODS #ENTITYSTARTX00026; From 2002 to 2007, there were 10 patients with CAFs (age range: 28 to 56 year-old, 7 males) who underwent transcatheter CAF closure. There were a total of 19 CAFs which originated from right coronary (n = 5), left circumflex (n = 3), left anterior descending artery (n = 10) and left main trunk (n = 1). Median number of coil deployment for each fistula was 3 (range: 1 to 6). The pulmonary artery was the most common site of the distal communication of CAFs (n = 14), followed by right atrium (n = 3), left atrium (n = 1) and left ventricle (n = 1). Immediate coronary angiography after GDC deployment revealed no residual shunt in 12 (63.2%) CAFs, significant reduction of the flow in 5 (26.3%), while 2 (10.5%) could not be closed due to small size. Nine (90%) patients underwent a repeated angiography within 3 to 8 months. Among 12 CAFs that were occluded immediately post-deployment, there were 2 CAFs with insignificant residual flow. Among 6 CAFs with significantly decreased flow immediately post-deployment, 2 were occluded totally in the follow-up angiography. In total, 12 (70.5%) CAFs were occluded completely and 5 (29.5%) CAFs still had insignificant residual flow, which did not need any additional coil deployment. During a mean follow up of 4.3 ± 0.7 year, all patients remained symptom and complication free. The fibered GDC is a safe and effective method for percutaneous closure of the CAFs.


Grape Seed Proanthocyanidin Affects Lipid Metabolism via Changing Gut Microflora and Enhancing Propionate Production in Weaned Pigs.
It is not clear whether dietary grape seed proanthocyanidin (GSP) affects mammalian lipid metabolism via the gut microbiota. The aim of this study was to evaluate the contribution of the gut microbiota to the effect of dietary GSP. This study was divided into 3 separate experiments using Duroc × Landrace × Yorkshire pigs (50% male) weaned at day 28 and then fed the same basal diet (NC). In Experiment 1, 90 pigs were fed NC or NC with 250 mg GSP/kg (GSP) or 400 mg betaine/kg [positive control (PC)] for 28 d. In Experiment 2, 30 pigs were fed NC, GSP, or GSP with antibiotics (GSP + Abx) diets for 14 d. In Experiment 3, pigs were fed NC, NC plus 1 g sodium propionate/kg (SP), or NC plus 1 g sodium butyrate/kg (SB) diet for 14 d. Serum biochemical indexes, SCFA concentrations, and microbial composition were determined. In Experiment 1, compared with the GSP group, visceral adipocyte area was higher in the NC (28.6%) and PC (18.2%) groups (P ≤ 0.05). Colonic propionate and butyrate concentrations were 30.2% and 3.6% higher in the GSP group than in the NC group, respectively (P ≤ 0.05). In Experiment 2, compared with the GSP group, the NC group had a 108% higher Firmicutes to Bacteroidetes ratio and had 50.4%, 61.2%, and 82.3% lower abundance of Akkermansia, Alistipes, and Bacteroides, respectively (P ≤ 0.05); antibiotics removed these effects of GSP. In Experiment 3, serum peptide YY was 19.5% higher in the SP group than in the NC group (P ≤ 0.05), and it did not differ between the SB and NC groups (P > 0.05). GSP affected lipid metabolism in weaned pigs, which is associated with changed gut microbiota and enhanced microbial propionate production. These findings provide potential mechanisms for GSP intake to improve lipid metabolism.


Why women choose compounded bioidentical hormone therapy: lessons from a qualitative study of menopausal decision-making.
In recent years, compounded bioidentical hormone therapy (CBHT) has emerged as a popular alternative to manufactured, FDA approved hormone therapy (HT)-despite concerns within the medical community and the availability of new FDA approved "bioidentical" products. This study aims to characterize the motivations for using CBHT in a U.S. sample of ordinary midlife women. We analyze data collected from 21 current and former users of CBHT who participated in a larger qualitative study of menopausal decision-making among U.S. women. Interviews and focus groups were audio-recorded, transcribed verbatim, and analyzed thematically using an iterative inductive and deductive process. Although women's individual motivations varied, two overarching themes emerged: "push motivations" that drove women away from conventional HT and from alternative therapies, and "pull motivations" that attracted women to CBHT. Push motivations focused on (1) fear and uncertainty about the safety of conventional HT, (2) an aversion to conjugated estrogens in particular, and (3) and overarching distrust of a medical system perceived as dismissive of their concerns and overly reliant on pharmaceuticals. Participants also voiced dissatisfaction with the effectiveness of herbal and soy supplements. Participants were attracted to CBHT because they perceive it to be (1) effective in managing menopausal symptoms, (2) safer than conventional HT, (3) tailored to their individual bodies and needs, and (4) accompanied by enhanced clinical care and attention. This study finds that women draw upon a range of "push" and "pull" motivations in their decision to use CBHT. Importantly, we find that women are not only seeking alternatives to conventional pharmaceuticals, but alternatives to conventional care where their menopausal experience is solicited, their treatment goals are heard, and they are engaged as agents in managing their own menopause. The significance of this finding goes beyond understanding why women choose CBHT. Women making menopause treatment decisions of all kinds would benefit from greater shared decision-making in the clinical context in which they are explicitly invited to share their experiences, priorities, and preferences. This would also provide an opportunity for clinicians to discuss the pros and cons of conventional HT, CBHT, and other approaches to managing menopause.


Empiric antibiotic treatment of erythema migrans-like skin lesions as a function of geography: a clinical and cost effectiveness modeling study.
The skin lesion of early Lyme disease, erythema migrans (EM), is so characteristic that routine practice is to treat all such patients with antibiotics. Because other skin lesions may resemble EM, it is not known whether presumptive treatment of EM is appropriate in regions where Lyme disease is rare. We constructed a decision model to compare the cost and clinical effectiveness of three strategies for the management of EM: Treat All, Observe, and Serology as a function of the probability that an EM-like lesion is Lyme disease. Treat All was found to be the preferred strategy in regions that are endemic for Lyme disease. Where Lyme disease is rare, Observe is the preferred strategy, as presumptive treatment would be expected to produce excessive harm and increased costs. Where Lyme disease is rare, clinicians and public health officials should consider observing patients with EM-like lesions who lack travel to Lyme disease-endemic areas.


Effects of exotic fish farms on bird communities in lake and marine ecosystems.
Salmon farming is a widespread activity around the world, also known to promote diverse environmental effects on aquatic ecosystems. However, information regarding the impact of salmon farming on bird assemblages is notably scarce. We hypothesize that salmon farming, by providing food subsidies and physical structures to birds, will change their local community structure. To test this hypothesis, we conducted a seasonal monitoring of bird richness, abundance, and composition at paired salmon pen and control plots in two marine and two lake sites in southern Chile, from fall 2002 to summer 2004. Overall, salmon farming had no significant effects on species richness, but bird abundance was significantly and noticeably higher in salmon pens than in controls. Such aggregation was mainly accounted for by the trophic guilds of omnivores, diving piscivores, carrion eaters, and perching piscivores, but not by invertebrate feeders, herbivores, and surface feeders. Species composition was also significantly and persistently different between salmon pens and controls within each lake or marine locality. The patterns described above remained consistent across environment types and seasons indicating that salmon farming is changing the community structure of birds in both lake and marine habitats by promoting functional and aggregation responses, particularly by favoring species with broader niches. Such local patterns may thus anticipate potential threats from the ongoing expansion of the salmon industry to neighboring areas in Chile, resulting in regional changes of bird communities, toward a less diverse one and dominated by opportunistic, common, and generalist species such as gulls, vultures, and cormorants.


The Neurological Hand Deformity Classification for children with cerebral palsy.
The purpose of this study was to evaluate the reliability of the Neurological Hand Deformity Classification and use it to describe changes in hand deformity over time in children with cerebral palsy. We identified 114 video clips of 26 children with cerebral palsy, aged 1-18 years (mean = 8.4, SD = 4.2), performing upper-limb tasks at multiple time points (n = 3-8) at least 6 months apart. Using the Neurological Hand Deformity Classification, three observers classified hand deformity in the video clips. Inter- and intra-observer reliabilities were estimated using Fleiss and Cohen's kappa (κ) and the temporal changes in classification of hand deformity were investigated. Inter- and intra-observer reliability respectively were κ = 0.87 and κ = 0.91. Hand deformity was identified in all children at all time points, even before the age of 2 years. Ten children did not change hand classification, wrist flexion increased in eight, and eight showed changes from wrist flexion to extension or vice versa. The Neurological Hand Deformity Classification is a reliable tool to classify hand deformity in children with cerebral palsy. For more than one-third of children hand deformity classification did not change. For the remaining children, two patterns of change in hand deformity over time were identified. It is recommended that children with cerebral palsy involving their upper limbs be monitored regularly. This is the first study to document longitudinal changes in hand deformity in children with cerebral palsy.


Selective growth of ZnO nanorods on microgap electrodes and their applications in UV sensors.
Selective area growth of ZnO nanorods is accomplished on microgap electrodes (spacing of 6 μm) by using a facile wet chemical etching process. The growth of ZnO nanorods on a selected area of microgap electrode is carried out by hydrothermal synthesis forming nanorod bridge between two electrodes. This is an attractive, genuine, direct, and highly reproducible technique to grow nanowire/nanorod onto the electrodes on selected area. The ZnO nanorods were grown at 90°C on the pre-patterned electrode system without destroying the electrode surface structure interface and geometry. The ZnO nanorods were tested for their application in ultraviolet (UV) sensors. The photocurrent-to-dark (Iph/Id) ratio was 3.11. At an applied voltage of 5 V, the response and recovery time was 72 and 110 s, respectively, and the response reached 2 A/W. The deposited ZnO nanorods exhibited a UV photoresponse that is promising for future cost-effective and low-power electronic UV-sensing applications.


Standardized Nigella sativa seed oil ameliorates hepatic steatosis, aminotransferase and lipid levels in non-alcoholic fatty liver disease: A randomized, double-blind and placebo-controlled clinical trial.
Nigella sativa (N. sativa) seeds are used in the Iranian traditional medicine for the treatment of liver diseases. To study the efficacy and safety of N. sativa seed oil in the treatment of patients with non-alcoholic fatty liver disease (NAFLD). Sixty patients received 2.5 mL fully standardized N. sativa seed oil every 12 h and 60 other patients received placebo for 3 months. At the baseline and endpoint, hepatic steatosis ultrasound grade and blood levels of triglycerides, LDL-C (low-density lipoprotein cholesterol), HDL-C (high-density lipoprotein cholesterol), ALT (alanine aminotransferase), AST (aspartate aminotransferase), blood urea nitrogen, creatinine and complete blood cell count as well as body mass index were determined in the oil and placebo groups and compared. Grade of hepatic steatosis was significantly reduced in the oil group compared to the placebo group (P = 0.004). Mean ± standard deviation of changes of variables in the oil and placebo groups were respectively 32.6 ± 16.6 and 14.2 ± 19.7% for ALT (P < 0/001), 29.4 ± 16.3 and 12.3 ± 16.8% for AST (P < 0.001), 10 ± 13.9 and 0.22 ± 18.2% for triglycerides (P = 0.001), 14.1 ± 9.8 and 9.2 ± 11.1% for LDL-C (P = 0.01), 9.5 ± 7.7 and 4.8 ± 6.5% for HDL-C (P = 0.001). However, the oil did not significantly affect the other outcome variables compared to the placebo (all P > 0.05). No adverse effect was observed. The N. sativa seed oil seems to be safe and improve liver steatosis and injury and blood levels of triglycerides, LDL-C and HDL-C in the NAFLD patients.