A lot of work has been done on routing in MANETs. However, the proposed routing solutions deal only with the best effort data traffic. Connections with Quality of Service (QoS) requirements are not supported. The QoS routing has been receiving increasingly intensive attention in the wireline network domain. However, for MANETs only few QoS routing algorithms are proposed. For MANETs, approximated solutions and heuristic algorithms should be developed and QoS routing algorithms should be adaptive, flexible, and intelligent. In our previous work, we proposed a Genetic Algorithm (GA) based routing method for Mobile Ad-hoc Networks (GAMAN). In this paper, we enhance the proposed algorithm by adding an effective topology extraction algorithm to reduce the search space of GAMAN. We call this algorithm E-GAMAN. The E-GAMAN uses two QoS parameters for routing. The performance evaluation via simulations show that E-GAMAN has a good performance.


Propionibacterium acnes is a major commensal of the human skin. However, it is also the pathogen responsible for acne vulgaris and other diseases, such as medical‐device infections. Strains of Propionibacterium acnes have long been classified into several different types. Recently, typing systems for this bacterium have taken on an increased importance as different types of P. acnes have been found to be associated with different disease states, including acne. Genetic approaches based on individual or multiple genes have classified P. acnes into types, which have been supported by the sequencing of nearly 100 P. acnes genomes. These types have distinct genetic, transcriptomic and proteomic differences. Additionally, they may have different immune response profiles. Taken together, these factors may account for the different disease associations of P. acnes types.


The purpose of the study was to examine the association of parental personality, behavior, and substance use during adolescence and adulthood as related to the later parent-offspring relationship. The sample consisted of 297 parents (M age 32 yr.), who were first interviewed at earlier points in their lives in childhood and early adolescence at six points in time, extending from 1983 to 2002. Multiple regression models showed that parents with certain earlier personality and behavioral attributes, e.g., more rebelliousness and more frequent tobacco use, had a more difficult relationship with their children. Findings indicated an association between the cumulative number of psychosocial risk factors in the parents and difficulties in the parent-child relationship. The findings suggested that interventions designed to decrease youths' substance abuse may increase the likelihood that later when they are parents they will form nurturing relationships with their children.


We investigate error-correcting codes for a the rank-modulation scheme with an application to flash memory devices. In this scheme, a set of n cells stores information in the permutation induced by the different charge levels of the individual cells. The resulting scheme eliminates the need for discrete cell levels, overcomes overshoot errors when programming cells (a serious problem that reduces the writing speed), and mitigates the problem of asymmetric errors. In this paper, we study the properties of error-correcting codes for charge-constrained errors in the rank-modulation scheme. In this error model the number of errors corresponds to the minimal number of adjacent transpositions required to change a given stored permutation to another erroneous one-a distance measure known as Kendall's ¿ -distance. We show bounds on the size of such codes, and use metric-embedding techniques to give constructions which translate a wealth of knowledge of codes in the Lee metric to codes over permutations in Kendall's ¿-metric. Specifically, the one-error-correcting codes we construct are at least half the ball-packing upper bound.


[1] As an important component of the International Satellite Land Surface Climatology Project (ISLSCP) Initiative II data collection, eight state-of-the-art land cover/use data sets have been compiled and made consistent with the ISLSCP Initiative II land/water mask in support of global modeling efforts. These data sets contain new and improved global data sets at coarse resolutions (1/4, 1/2 and 1°) describing historical, recent and present land cover conditions and are a testament to the tremendous progress made in this area over the past decade. In addition to the historical data, data describing the subcell heterogeneity in land cover are also provided, both in terms of subcell proportions of land cover classes and vegetation continuous fields such as % tree, grass and bare cover. Here we present the various ISLSCPII land cover data sets and compare the principal satellite-derived data sets and the effect of their respective aggregation methods. We find that despite some notable disagreements among similar classes, the satellite-based data sets agree remarkably well over large portions of the Earth's surface (over 50% for all resolutions). We also find that the methods of aggregation, whether done by a strictly dominant type, or using more information on subcell tree cover, can have an important impact on the final output and need to be considered by the user. Finally, by integrating the vegetation continuous fields data into our analyses we are able to show that the principal differences in terms of discrete land cover classes are in fact transition zones between similar classes.


Drug eluting stents are associated with late stent thrombosis (LST), delayed healing and prolonged exposure of stent struts to blood flow. Using macroscale disturbed and undisturbed fluid flow waveforms, we numerically and experimentally determined the effects of microscale model strut geometries upon the generation of prothrombotic conditions that are mediated by flow perturbations. Rectangular cross-sectional stent strut geometries of varying heights and corresponding streamlined versions were studied in the presence of disturbed and undisturbed bulk fluid flow. Numerical simulations and particle flow visualization experiments demonstrated that the interaction of bulk fluid flow and stent struts regulated the generation, size and dynamics of the peristrut flow recirculation zones. In the absence of endothelial cells, deposition of thrombin-generated fibrin occurred primarily in the recirculation zones. When endothelium was present, peristrut expression of anticoagulant thrombomodulin (TM) was dependent on strut height and geometry. Thinner and streamlined strut geometries reduced peristrut flow recirculation zones decreasing prothrombotic fibrin deposition and increasing endothelial anticoagulant TM expression. The studies define physical and functional consequences of macro- and microscale variables that relate to thrombogenicity associated with the most current stent designs, and particularly to LST.


The effects of pyridine exposure on expression of cytochromes P450IIE1, IIB and IVB in rabbit hepatic microsomes and their respective role in pyridine N-oxide production has been examined. Immunoblot analysis revealed that pyridine administration caused a substantial increase in P450IIE1 levels, failed to affect P450IIB content and marginally increased the expression of P450IVB. In an effort to implicate specific forms of P450 in pyridine N-oxide production, the kinetics of pyridine N-oxide formation in uninduced and induced rabbit hepatic microsomal preparations were obtained. Pyridine-induced microsomes exhibited a single low Km value of 81 microM with a approximately 2.5-fold increase in Vmax (2.44 nmol/min/mg protein) relative to uninduced microsomes. Interestingly, pyridine N-oxide production in phenobarbital-induced microsomes were also monophasic, exhibiting a single, high Km value of 949 microM and a Vmax of 3.3 nmol/min/mg protein, a approximately 10-fold increase over the uninduced preparations. In contrast, uninduced and isosafrole-induced rabbit hepatic microsomes both exhibited biphasic kinetics; uninduced microsomes gave Km values of 85 and 973 microM, whereas isosafrole-induced microsomes yielded Km values of 229 and 1733 microM, respectively, with a Vmax somewhat less than uninduced microsomes. When kinetic data were normalized for P450 content, a pronounced substrate specificity was detected for both pyridine- and phenobarbital-induced microsomes. para-Nitrophenol hydroxylase activity was enhanced approximately 6-fold in pyridine-induced microsomes consistent with elevated levels of P450IIE1. para-Nitrophenol competitively inhibited (Ki = 13 microM) the production of pyridine N-oxide in pyridine-induced microsomes.(ABSTRACT TRUNCATED AT 250 WORDS)


Sarcoidosis is considered the archetype of immune granulomatous disorders, since immunoregulatory mechanisms that play a part in the development of the sarcoid granuloma may modulate pathogenetic events leading to granuloma development in other granulomatous diseases [1]. Remarkable advances have been made in understanding general immunological and molecular aspects of the mechanisms leading to granuloma formation and the development of fibrosis in sarcoidosis. In particular, the sarcoid granuloma is considered to be the consequence of a crippled immunological response against an unidentifed antigen that has persisted at sites of disease involvement, perhaps because of its low solubility and degradability. Indeed, although hypersensitivity reactions commonly resolve, the balance between events that mediate resolution or perpetuation of inflammatory responses may be altered in patients with chronic sarcoidosis. The persistence of the aetiological agents and/or an imbalance of mechanisms for the removal of inflammatory cells and their by-products ultimately lead to an ongoing inflammatory response. As a result, cytokines with pro-inflammatory destructive biological functions are locally produced; overall, these cytokines set the stage for the development of irreversible remodelling of lung tissue, progression toward pulmonary granuloma formation, and, in some individuals, irreversible development of pulmonary fibrosis. The aim of the present chapter is to provide an overview of the available knowledge concerning the mechanisms leading to the inflammatory processes that occur at common sites of involvement in sarcoidosis. A detailed description of the cellular interactions that govern the dynamics of granuloma formation is also included.


ABSTRACT This paper presents a new computational tool called NH SEDIMENT AND STATISTIC which performs hydrosedimentological and statistical calculations using Visual Basic. This computational tool was developed for studies related to calculations of sediment transport in rivers. The tool includes hydrosedimentological methods for calculating suspension loads, bed loads, and total solid discharge. In addition, it provides the user with the possibility of performing statistical tests such as the Kolmogorov-Smirnov normality test, F test and χ2 test of variance, Student's t-test, non-parametric Wilcoxon test, and statistical parameter calculations. The NH SEDIMENT AND STATISTIC automatically calculates and provides the main results for each of the methods, allowing the user to draw their own conclusions. This proposed computational tool supports hydrosedimentological studies, and is reliable and easy to use, contributing to the reduction of sediment-related problems in the areas of hydraulic engineering, geology, and soil and water conservation. Furthermore, this tool may be used in transdisciplinary scientific areas for complete planning and management of water resources.


In this research, we study inter-organizational collaboration from the perspective of multi-relational networks. We develop an agent-based model to simulate how a collaboration network among organizations emerges from organizations' interactions through another network: the inter-organizational communication network. Our model adds links (or edges) into the collaboration network on the basis of events, which correspond to organizations' formation of collaborative teams for joint projects. The proposed approach also models the competitive yet non-exclusive dissemination of information among organizations, organizations' dynamic prioritization of candidate projects, and network-based influence. Applying the model to a case study of the humanitarian sector, we configure and validate the agent-based simulation, and use it to analyze how to promote inter-organizational humanitarian collaboration by encouraging communication. The simulation results suggest that encouraging communication between peripheral organizations can better promote collaboration than other strategies.


Indications for identification and treatment of extracranial carotid artery disease in candidates for open-heart surgery (OHS) remain unsettled. We evaluated the efficacy of OPG-GEE screening and our nonrandomized use of carotid endarterectomy in 2312 OHS patients from 1975 to 1989. Data was analyzed using the chi 2 squared and Fisher's exact tests. OPG was performed in 1602/2312 (69%) of the patients. OPG was positive in 122/1602 patients (7.6%) and negative in 1480/1602 (92.4%) patients. Of the patients with positive OPG, 31 patients had insignificant carotid bifurcation disease, 32 patients had total internal carotid artery occlusion, and 59 patients had operable carotid bifurcation lesions. Selective use of angiography identified an additional 8 patients with operable carotid bifurcation lesions (total 67, 33 symptomatic and 34 asymptomatic). Overall stroke rate for 2312 patients was 40/2312 (1.7%) [30 day mortality rate 60/2312 (3.2%)]. Stroke incidence was significantly increased (P < 0.01) in patients with a positive OPG, 8/122 (6.60%) vs those with negative OPG (23/1480, 1.6%). However, it was most marked in patients with operable bifurcation lesions (6/67, 9.0%). Stroke was not increased in patients with carotid occlusion or positive OPG without significant carotid bifurcation disease (2/63, 3.20%). Carotid endarterectomy in patients with operable bifurcation lesions was associated with a decreased (P < 0.05) stroke rate after OHS (1/44, 2.30% vs 5/23, 21.7%). Our data suggests identification of significant carotid disease and carotid endarterectomy will decrease stroke after OHS.


This paper describes a problem in which end products, such as aircraft, are periodically serviced, owing to the failure or preventive maintenance of reparable items. Given the required sequence of item reinstallations, the item resupply times, and item repair probabilities, a relation between the item resupply times and the expected end-product service time is derived. We present an exact algorithm designed to minimize the total cost of repair subject to a constraint on the expected service time. A heuristic algorithm yielding the entire "minimum cost per expected service time" curve is also described.


Research subject. The paper presents data on the mineralogical, geochemical and fluid inclusion features of the Southern Ak-Dag gold-sulphide-quartz ore occurrence in Western Tuva.Methods. Mineral formation temperatures, salt composition and fluid salinity were examined using a Linkam TMS-600 cryostage and an Olympus BX 51 microscope. The chemical composition of samples was identified using a MIRA 3 LMU (Tescan Orsay Holding) scanning electron microscope equipped with INCA Energy 450+XMax 80 and INCA Wave 500 microanalysis systems; BSE photos were taken by Tescan Vega 3 and Hitachi ТМ-1000 SEM instruments.Results. The ores under study were found to contain both high-grade and medium-grade gold with an Ag content of up to 17.05 wt %. The average gold fineness comprised 904 ‰, ranging from 830 to 928 ‰. According to fluid inclusion data, gold-sulphide-quartz veins were formed at temperatures of 280–240 °C and pressures of 0.8–1.2 kbar from aqueous fluids having a salinity of 8.6–6.4 wt % NaCl eq. The narrow range of fluid salinity at decreasing temperatures and the prevalence of high-grade gold in sulphide-quartz veins indicate a relatively high rate of mineral formation in a narrow permeable zone without any significant interaction with host rocks or mixing with meteoric waters.Conclusions. Gold mineralization in the Southern Ak-Dag ore occurrence, which was formed within one ore substage, corresponds to the type of gold-galena-chalcopyrite with barite. The established similarity of native gold in the Southern Ak-Dag occurrence and other deposits in the Aldan-Maadyr ore cluster in terms of P-T parameters of ore formation and mineralogical and geochemical features, as well as association of the ore mineralization with beresites, indicate the possibility of discovering industrial ore deposits in the region and confirm its paragenetic relation with Devonian magmatic activity.


We analyze recycling decisions for bioplastics using a natural field experiment. The potential environmental benefits of these new plastics may not materialize if they are recycled incorrectly. The field experiment that we set up to test this recycling behavior exploits the setting of a lemonade tasting. In our experimental treatments, subjects are exposed to different types of bioplastics logos on their cups as well as varying amounts of recycling information. We use two types of bioplastics and compare these to conventional plastics in terms of whether subjects recycle the cups correctly. Our results show that over 90% of subjects dispose of their cup with plastic waste and that none of our treatments can snap subjects out of this default behavior. We interpret this finding as subjects having no clue how to recycle bioplastics. More generelly, these results point to skepticism regarding new products or varieties whose environmental benefits depend on proper use or disposal.


The author attempts to answer two questions: "how does the spatial distribution of population change during the process of development, and how do these changes relate to changes in the size distribution and regional distribution of income. The causal connection between population and income distribution is examined through a simulation model. The theoretical implications of the model's results are empirically examined at several spatial levels: at the national level, with longitudinal data from ten Asian and Latin American nations, and at the regional and subregional levels, with data from Japan, Brazil, and the Philippines. Finally, a multistage model of polarization reversal (with interconnected regional inequality changes) is proposed."


This study aimed to examine the relationship of physical activity and/or dietary quality and diabetes prevalence in the general population and within specific age groups. It was a cross-sectional study using 2011–2018 National Health and Nutrition Examination Survey and the US Department of Agriculture's Food Patterns Equivalents data (n = 15,674). Physical activity was measured by Global Physical Activity questionnaire; dietary quality was analyzed using the Healthy Eating Index 2015; diabetes prevalence was determined by reported diagnosis and glycohemoglobin or fasting glucose. Data were analyzed using multiple logistic regression adjusted for demographic variables and weight status. Results revealed that although no statistically significant or non-substantial relationships were observed between dietary quality or physical activity and diabetes prevalence, respondents who did not meet physical activity recommendations regardless of dietary quality had a higher odds of diabetes prevalence than those who met physical activity recommendations and had a higher dietary quality (p < 0.05). In conclusion, meeting physical activity recommendations is an important protective factor for diabetes especially in combination with a higher quality diet. A healthy lifestyle appears to have the greater impact on diabetes prevention in middle-aged men and women.


This book illuminates the authoritative voice of Solon of Athens by an integrated literary, historical, and philological approach and the use of a range of hermeneutic frameworks, from literary theory to oral poetics.


Aprotinin is a polypeptide with serine protease inhibitory activity of key enzymes associated with inflammatory, fibrinolytic, and hemostatic pathways. The drug binds directly to the fibrinolytic plasmin at the lower plasmin-inhibiting dose (plasma concentration, 137 KIU/mL), and the inflammatory mediator, kallikrein, using the higher kallikrein-inhibiting dose (plasma concentration, >250 KIU/mL). Aprotinin inhibits platelet glycoprotein loss (GpIb and GpIIb/IIIa receptors) associated with cardiopulmonary bypass and has been described as platelet sparing. Current literature supports direct anti-inflammatory effects through modulation of neutrophil activation, attachment, and transmigration, with resultant blunting in the rise of proinflammatory cytokine levels and deleterious tissue damaging enzymes. The pharmacologic properties of aprotinin may lead clinicians to consider this therapy for use as a hemostatic and anti-inflammatory agent in surgeries beyond its established use in coronary artery bypass graft surgery.


Introduction: Aedes aegypti is the vector of dengue, yellow fever, Zika and Chikungunya viruses, and Culex quinquefasciatus is the vector of St. Louis and West Nile encephalitis viruses. Objective: To evaluate infectivity of Heterorhabditis bacteriophora N4 in C. quinquefasciatus and A. aegypti larvae under laboratory conditions. Materials and methods: Thirty second-instar larvae of the two mosquito species were exposed each to different doses (0:1, 1:1, 5:1, 15:1, 100:1, 500:1, 750:1 and 1,500:1) of nematode infective juveniles. Four replications per dose were performed. Results: Parasitism varied between 2.5 and 80 % in C. quinquefasciatus , and between 4.2 and 92.5 % in A. aegypti , with significant differences between doses (p<0.0001). DL50 were: 160.8 infective juveniles per larva for C. quinquefasciatus and 113.6 infective juveniles per larva for A. aegypti . In C. quinquefasciatus , 4 to 6 % of the infective juveniles developed to adults and in A. aegypti , 12- 61 %. In A. aegypti the emergence of new infective juveniles occurred with 100:1, 500:1, 750:1 and 1,500:1 infective juveniles per larva, and in C. quinquefasciatus , with 1,500:1 infective juveniles per larva. Melanization of infective juveniles was observed in both mosquito species. Conclusion: The susceptibility of these mosquito species to parasitism of an indigenous isolate of H. bacteriophora in the laboratory was demonstrated. Heterorhabditis bacteriophora N4 could be an efficient biological control agent.


Bayesian neural networks often approximate the weight-posterior with a Gaussian distribution. However, practical posteriors are often, even locally, highly non-Gaussian, and empirical performance deteriorates. We propose a simple parametric approximate posterior that adapts to the shape of the true posterior through a Riemannian metric that is determined by the log-posterior gradient. We develop a Riemannian Laplace approximation where samples naturally fall into weight-regions with low negative log-posterior. We show that these samples can be drawn by solving a system of ordinary differential equations, which can be done efficiently by leveraging the structure of the Riemannian metric and automatic differentiation. Empirically, we demonstrate that our approach consistently improves over the conventional Laplace approximation across tasks. We further show that, unlike the conventional Laplace approximation, our method is not overly sensitive to the choice of prior, which alleviates a practical pitfall of current approaches.


Skin diseases are one of the major health problems in the pediatric age group and are associated with significant morbidity. The prevalence of pediatric dermatoses in various parts of India has ranged from 8.7% to 35% in school-based surveys. Number of studies suggested overcrowding as an important determinant of skin disease. Objectives of the study is to assess the existing knowledge of institutionalized children regarding selected pediatric dermatoses, through structured interview schedule, to evaluate the effectiveness of child to child approach on knowledge regarding selected pediatric dermatoses by comparing pretest and post test scores, to find out the association between pretest knowledge score and selected demographic variables. The conceptual framework used for the study is based on Imogene King's Goal Attainment model. The study has been carried out in a Govt. Juvenile home in Shimoga. A total of 40 students were selected by non-probability purposive sampling method. The study adopted one group pre-test post-test design. Data collected by using structured interview schedule to assess knowledge of institutionalized children before and after the administration of child to child approach. Post-test was conducted on 7th day after the pretest, using the same structured interview schedule. The data were analyzed using descriptive and inferential statistics. Paired't' test was used to find the effectiveness of child to child approach and chi-square was used to find the association of pre-test knowledge score with selected demographic variables. The present study has been conducted to assess the knowledge of institutionalized children and to teach them regarding Pediatric Dermatoses. The mean percentage of pretest knowledge score was 40.7% whereas the mean percentage of posttest knowledge score was 81.3%. In pretest the highest percentage 77.5% of respondents had inadequate knowledge; and 22.5% of respondents had moderate knowledge regarding selected Pediatric Dermatoses. In the posttest 72.5% of the respondents had adequate knowledge and 27.5% of the respondents had moderate knowledge and none of the respondents had inadequate knowledge regarding selected Pediatric Dermatoses.The study had shown that majority of the children had inadequate knowledge on Pediatric Dermatoses; however, the knowledge has significantly improved after the administration of child to child approach, hence it was concluded that child to child approach is an effective teaching strategy in improving the knowledge of children.


We study the relation between two known n-norms on lp, the space ofp-summable sequences. One n-norm is derived from GÄahler's formula (1969), whilethe other is due to Gunawan (2001). We show in particular that the convergence inone n-norm implies that in the other. The key is to show that the convergence ineach of these n-norms is equivalent to that in the usual norm on lp.DOI : http://dx.doi.org/10.22342/jims.22.214.171.124-7


The article defines the essence of the internal environment as the basis of internal control in the enterprise. The balance and interaction between the elements of the internal environment leads to the creation of effective and profitable management of the entity. Defining the role of each element of the internal environment is tabulated by the authors. Each business entity has a methodological framework for analyzing its own internal environment, which is determined by its characteristics and the relevant groups of external and internal factors. As a result of the study conducted by the authors developed and proposed the optimal model of internal organization, which exists: the main reasons used in the modern place remain necessary (coordination of work of employees involved in the process of realization of goals, formation of long-term profitability, determination of optimal organizational structure taking into account the type of activity, efficient use of resources and technologies), goals (increasing the level of efficiency of the enterprise management tools), delays (identification of «critical points» in the operation of the enterprise, which become the basis for setting priorities in solving economic, technical, social problems), elements (goals of the organization, tasks, structure of the organization, system of technologies, personnel, culture of the organization, resources), symmetric method (Method of constructing a «tree» of goals (method of system analysis) and stage V of the need for economic systems (identification and clear formation of the ultimate goal, specifying the purpose of individual units, assessment of the level of quality and quantity of products, resource conservation, organizational and technical development of production, establishing a network of suppliers (customers), analysis of the growth of production and sales, market analysis, improving service and quality of service, improving the quality of life of employees, environmental protection, providing quantitative and qualitative assessment of unstructured and structured problems).


Model cheeses were manufactured according to a full factorial experimental design to help shed light on the individual and combined roles played by 3 native lactic acid bacteria (Lactococcus lactis ssp. lactis, Lactobacillus brevis, and Lactobacillus plantarum) upon proteolysis and organic acid evolution in cheese. The model cheeses were manufactured according to a generally representative Portuguese artisanal protocol, but the (ubiquitous) adventitious microflora in the cheesemaking milk were removed via sterilization before manufacture; therefore, the specific effects of only those lactic acid bacteria selected were monitored. In addition, 2 types of coagulant (animal and plant) and 3 types of cheesemaking milk (cow, sheep, and goat) were assessed to determine their influence on the final characteristics of the model cheeses. The nature of the coagulant appeared to be essential during the first stage of proteolysis as expected, whereas the contribution of those bacteria to the pools of total free AA and organic acids was crucial afterward. This was especially so in terms of the differences observed in the metabolisms of lactic acid (in the case of Lactococcus spp.) as well as acetic and citric acids (in the case of Lactobacillus spp.).


Summary To identify tumor antigens and tumor immunity in man, we have investigated the use of the blastogenic response of lymphocytes to tissue extracts. Extracts of malignant, benign, and normal tissues of 60 patients with cancer were used to stimulate their own lymphocytes, the lymphocytes of other patients with the same tumor and those of normal subjects. Autochthonous extracts of the neoplastic tissue stimulated blas-togenesis in 56% of patients and a linear dose-response curve was observed. This suggested the presence of TSA and specific tumor immunity, even in patients with advanced metastatic disease. However, stimulation of autochthonous lymphocytes by extracts of skin in 50% of patients cast doubt on the tumor specificity of the response to extracts. The release of nonspecific mitogens, or of usually concealed autoantigens, or the presence of tumor antigens in the skin of patients with malignant disease were hypothesized as the possible cause. Because of this lack of specificity it seemed that tumor extracts, used alone, will have limited value in the investigation of tumor immunity in man using the blastogenesis test.


Importance of the field: Treatment-resistant depression (TRD) is common and debilitating. Initial treatment is often insufficient to achieve full remission in a given depressive episode, resulting in more frequent episodes, worsened severity, and major disability. Areas covered in this review: This review surveys literature on the diagnosis and pharmacological management of TRD in light of recent developments. Evidence regarding commonly used treatment options is critically examined and key recommendations are offered. The review ends by considering drugs acting on the melatonin, acetylcholine, and glutamate systems that hold promise as future options for TRD. What the reader will gain: Recent trends and research findings have impacted how the evidence supporting different approaches to TRD should be evaluated. For example, many earlier TRD studies employed tricyclics as the primary antidepressant, but tricyclics have now been superseded by selective serotonin reuptake inhibitors (SSRIs) in routine clinical practice. This deficiency has been addressed by the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, the largest effectiveness study of TRD ever conducted. However, design characteristics of the STAR*D study preclude simple comparisons with earlier studies. Take home message: A shortcoming of most treatment recommendations for TRD is their reliance on older studies that do not reflect the current preeminence of SSRIs in clinical practice. This has distorted the prioritization of pharmacological strategies for TRD. Efforts to correct this distortion with effectiveness research, designed to better reflect current practice trends, require critical consideration of the strengths and limitations of this approach.


Contextual sequence mapping is one of the fundamental problems in Natural Language Processing (NLP). Here, instead of relying solely on the information presented in the text, the learning agents have access to a strong external signal given to assist the learning process. In this paper, we propose a novel family of Recurrent Neural Network unit: the Context-dependent Additive Recurrent Neural Network (CARNN) that is designed specifically to address this type of problem. The experimental results on public datasets in the dialog problem (Babi dialog Task 6 and Frame), contextual language model (Switchboard and Penn Tree Bank) and question answering (Trec QA) show that our novel CARNN-based architectures outperform previous methods.


Sheep are more resistent to larkspur poisoning than cattle. Grazing larkspur with sheep before cattle turn-in may reduce the threat of cattle poisoning. Two 2.1-ha pastures were established in Upper Ruby Valley in southwest Montana in 1987 and 1989. A band of sheep grazed 1 pasture in mid-June in both years. Sheep grazed 70% of larkspur stalks in 1987 and 35% in 1988. Because sheep grazed little larkspur in 1988, larkspur was hand decapitated to simulate the use obtained in 1987 for the subsequent cattle grazing portion of the trial. Five cows were placed in each pasture immediately following sheep grazing in 1987 and after a 3-week delay in 1998. Cattle diets were quantified by bite counts. Waxy larkspur consumption by cattle in the sheep-grazed pasture was lower than in the cattle-only pasture especially during and after rainstorms in 1987 and throughout the study in 1988. One cow died from larkspur poisoning in the cattle-only pasture in 1988. If sheep will graze waxy larkspur, subsequent consumption by cattle can apparently be reduced on this site, thus reducing the risk of poisoning.


Kawasaki disease (KD) is a common pediatric vasculitis with rising global incidence. Associated coronary artery aneurysms (CAA) can result in significant long-term morbidity and mortality. However, our understanding of the trends in incidence along with patient and disease characteristics for North American children over the past two decades remains limited, particularly in universal health care systems. This understanding can inform healthcare resource planning and identify knowledge gaps for educational initiatives.

 The objectives of this study were to: 1) compare patient, hospital and disease characteristics for children diagnosed with KD between two eras (1995-2001 and 2002-2017) and three age groups (0-4yr, 5-9yr, 10-18yr) and 2) determine trends in KD incidence across Ontario, Canada between 1995 to 2017.

 We used healthcare administrative databases housed at the Institute for Clinical Evaluative Sciences (ICES) to identify a population-based cohort of Ontario children (0-18 years) diagnosed with KD during hospital admission between April 1995 and March 2017. We excluded children with previous KD diagnosis. We compared eras and age groups by Chi-squared test. We determined the annual incidence of KD in Ontario, compared by Cochrane-Armitage test.

 We identified 4346 Ontario children diagnosed with KD between 1995-2017. The mean (SD) age at diagnosis was 3.4 years (± 2.9) and male:female ratio was 1.5:1. Median (IQR) length of hospital admission was 3 days (2-4) and 104 children (2.4%) required PICU admission. No child died within 90 days of diagnosis. Baseline CAA were observed in 106 children (2.4%). There was no difference in baseline CAA by era (2.3% [1995-2001] vs 2.5% [2002-2017], p=0.72). CAA were significantly more common in children aged 10-18 years (5.3% vs 2.4% [0-4yr] and 2.2% [5-9yr], p=0.03). Myo-/pericarditis occurred in 71 children (1.6%). Red blood cell transfusions were administered to 51 children (1.2%) and were significantly more common during 2002-2017 (≤0.5% vs 1.5%, p<0.001). The standardized incidence of KD increased significantly over the study period (p<0.0001), from 6.5 cases per 100,000 person-years (1995-2000) to 8.4 cases (2012-2017). Significant seasonal variation was observed; incidence was highest from November to March (OR 1.7 – 2.1, using August as reference month) and peaked in January (OR 2.1).

 The incidence of KD has increased significantly over the past 20 years in Ontario, Canada which may reflect increased awareness and improved diagnosis. However, the frequency of baseline CAA has not changed. Baseline CAA are more common in children 10-18 years. This may suggest delayed diagnosis in this age group.


The aim of this work is to trace the historical events surrounding primary education for Italian children between the Unification of Italy and the fall of Fascism (1861-1943). We focus particularly on the continuity and the changes in school policy promoted by the Italian government in relation to rural schools, offering an analysis, from an institutional point of view, of the evolution of the legislation and of the history of the state and private institutions in charge of organizing schools for young farmers between the half of the 19th and of the 20th century


Current data indicate the existence of post-acute COVID-19 syndrome frequently expressing as cardiovascular and respiratory health issues. The long-term evolution of these complications is not yet fully known or predictable. Among the most common clinical manifestations of post-acute COVID-19 syndrome are dyspnea, palpitations, and fatigue, in most cases being transient and without underlying any morphological or functional changes. A single-center retrospective observational study was performed on cases that had presented with new-onset cardiac symptoms post-COVID-19 infection. Records of three male patients without pre-existing chronic cardiovascular pathology who had presented for dyspnea, fatigue, and palpitations around four weeks post-COVID-19 acute phase were studied in detail. The three post-COVID-19 cases exhibited arrhythmic complications after completely healing from the acute phase of the infection. Palpitations, along with chest pain, and possible aggravation or appearance of dyspnea, with syncopal episodes, were found to be present. All the three cases were non-vaccinated against COVID-19 infection. Isolated case reports showing arrhythmic complications such as atrial fibrillation and ventricular tachycardia on a small number of patients with these complications indicate the need for arrhythmic evaluation of large groups of patients in the post-acute stage of the COVID-19 syndrome for a better understanding of the phenomenon and implicitly better care of these patients. It would also be useful to evaluate large groups of patients divided into vaccinated/non-vaccinated against COVID-19 categories to determine whether vaccination per se can provide protection in the occurrence of these types of complications.


The objective of this study was to investigate the effect of the previous calving intervals (CI) on milk yield (MY) in the current lactation for the Italian buffalo breed population. Data for 86,585 lactation records from the Italian Buffalo Breeders Association database, were analyzed. MY BLUP-estimates were obtained by including in the Animal Model the fixed effects of age-parity, previous CI, and herd-contemporary-group. The MY solutions for the months of CI were analyzed with the linear regression model where CI in months was the explanatory variable. 59.66% of the lactation records had CI between 11 and 14 months. 37.91 % of the lactation records were distributed between 15 and 24 months. The smaller percentage of records showed CI greater than 24 months. This CI distribution may be, in part, the result of herd management strategies. Dairy producers try to shorten the CI of their herd in order to get the most profit from early conceptions of the buffalo. The regression model and its parameters were statistically significant. The coefficient of determination was equal to 0.58. The intercept was equal to 72.42 kg; and the linear coefficient (b) was equal to -3.43. The negative value of b denotes a negative effect of CI on MY. This result indicates that there is a negative linear relationship between previous CI and MY in the current lactation. Therefore, shorten the CI may increase the profits of the farm through higher MY, because it has less of a negative effect on MY than longer CI.


Mobile location estimation has attracted a significant amount of attention in recent years. The network-based location estimation schemes have been widely adopted based on the radio signals between the mobile device and the base stations. The two-step Least-Squares (LS) method has been studied in related research to provide efficient location estimation of the mobile devices. However, the algorithm results in insufficient accuracy for location estimation with the existence of Non-Line-Of-Sight (NLOS) errors. A Geometry-Assisted Location Estimation (GALE) algorithm is proposed in this paper with the consideration of different geometric layouts between the mobile device and its associated base stations. In order to enhance the precision of the location estimate, the GALE scheme is designed to incorporate the geometric constraints within the formulation of the two-step LS method. The algorithm can be utilized to estimate both the two-dimensional and the three-dimensional positions of a mobile device. The proposed GALE scheme can both preserve the computational efficiency from the two-step LS algorithm and obtain a precise location estimation under NLOS environments. Moreover, the Cramer-Rao Lower Bound (CRLB) for various types of measurement signals is derived to facilitate the performance comparison between different location estimation schemes. Numerical results illustrate that the proposed GALE algorithm can achieve better accuracy compared with other existing network-based location estimation schemes.


Heterokaryons made from auxotrophic strains of the lignin-degrading basidiomycete Phanerochaete chrysosporium were induced to fruit. The isolation of wild-type and double-mutant phenotypes from these crosses indicated that genetic recombination had occurred. Cytological studies demonstrated that more than 90% of the basidiospores from the wild-type and auxotrophic strains and from forced heterokaryons were binucleate. Colonies of the wild-type strain of P. chrysosporium arising from single, predominantly uninucleate conidia were all capable of producing fruit bodies and basidiospores.


Purpose of reviewThis review will address recent developments in the transfusion management of massively transfused trauma patients, focusing on the use of fixed blood component ratios in massive transfusion protocols. Recent findingsThe majority of trauma centers have migrated from laboratory-based transfusion protocols to massive transfusion protocols with fixed blood component ratios. These protocols with red blood cell : plasma : platelet ratio of 1 : 1 : 1 are associated with improved survival in severely injured patients. However, alternate ratios have also demonstrated improved survival. Thus, the optimal ratio has not been determined. In addition, the use of medications, such as antifibrinolytics, and point of care testing, such as thromboelastography, are increasingly being used as part of massive transfusion protocols to adjust transfusion therapy and decrease bleeding. However, their optimal integration has yet to be determined. SummaryMassive transfusion protocols with fixed ratios of red blood cells to plasma and platelets have improved survival in both civilian and military trauma patients. Continued studies of ratios as well as integration of other therapies and testing are ongoing in order to continue to improve patient outcome.


The aim of this study was to identify individual and environmental factors associated with park and plaza use in adults from Curitiba, state of Paraná, Brazil. A cross-sectional study was conducted in 2008 with 749 participants (59.9% men) selected in areas for physical activity (PA) in four parks and four plazas. Poisson regression was used to examine the associations of sociodemographic (sex, age, education) and health (body mass index, perceived health) variables, company for park/plaza use, access (perception of distance, access and commuting to the places), and leisure time PA (walking and moderate/vigorous PA MVPA) with frequent use of parks and plazas (≥1 time/wk). The percentage of park and plaza use was 68%, and company (PR: 0.74; CI95%: 0.62-0.89) and higher levels of walking (PR: 1.30; CI95%: 1.03-1.64) and MVPA (PR: 1.39, CI95%: 1.07-1.80) were associated with the use of the places. These results can be used to guide interventions aimed at providing services and facilities for PA practice in parks and plazas.


The number of scientific papers published every year continues to increase, but scientific knowledge is not progressing at the same rate. Here we argue that a greater emphasis on falsification – the direct testing of strong hypotheses – would lead to faster progress by allowing well-specified hypotheses to be eliminated. We describe an example from neuroscience where there has been little work to directly test two prominent but incompatible hypotheses related to traumatic brain injury. Based on this example, we discuss how building strong hypotheses and then setting out to falsify them can bring greater precision to the clinical neurosciences, and argue that this approach could be beneficial to all areas of science.


In the teoretical part I introduce various psychological and pedagogical perspectives on learning and language acquisition (behaviorism, nativism, cognitivism, constructivism, model control) and today most commonly used didactic approaches in foreign language teaching to young learners (Audio-Lingual Approach, Communication Approach, CLIL (Content and Language Integrated Learning), Natural Approach, a Story Based Approach and Total Physical Response). Teachers use a variety of approaches in teaching English as a foreign language (EFL) and one of them is Total Physical Response (TPR), which is presented in greater details. TPR is based on the premise that children learn foreign languages best through physical movement. Further on, there are examples of TPR games, TPR (action) songs and rhymes and TPR storytelling (TPRS).

The empirical part presents the research on the following issues: whether teachers of EFL in the second cycle of the primary school, between the various approaches available to them, use the TPR as a didactic approach and how often, which TPR activity is used most often, how teachers rate the importance of movement in learning EFL and what are the benefits and restrictions of the TPR noticed by teachers who teach EFL.

The study shows that teachers of English in the second cycle of the primary school use the TPR activities, that they use these activities more frequently in the lower grades and that they have a positive attitude to the TPR as a didactic approach. The findings also point out that the frequency of using the TPR as a didactic approach in EFL teaching in the second triad is influenced by the teachers' perceptions of the importance of the movement and the texbook used in the class, while the age and the teachers' education do not affect the frequency of using the TPR as a didactic approach in EFL teaching.

The results of the research can have a considerable impact on the teaching approaches of EFL in primary schools. It is important that teachers are aware of the significance of physical activity for students in the foreign language classes as this contributes foreign language learning development.


INTRODUCTION: In America 11.5% of infants are born prematurely, 15% to women without a history of preterm delivery. At St. Francis Hospital we offer transvaginal cervical length screening to all patients between 18 and 24 weeks gestation, as there is strong evidence to suggest screening may prevent preterm birth by identifying high-risk women earlier in pregnancy. As many women still refuse the test, our study compared obstetrical outcomes and characteristics of women who accept or decline transvaginal cervical length screening. METHODS: We conducted a retrospective medical record review of women undergoing second trimester anatomy scans between 18 and 24 wga from March 1, 2014 to September 31, 2014. Women with uterine anomalies, multiple gestations or prior preterm delivery were excluded. To assess the primary outcome, delivery <37 weeks, the screened group was compared to those who declined. Statistical analysis included Student's t test, Chi square analysis, and Fisher's exact test. RESULTS: Of 826 women, 420 (51%) accepted and 406 (49%) women declined screening. Nulliparous women were more likely to accept screening than multiparous women (P<.05). There was no difference in ethnicity between those that accepted or declined screening. There was a higher rate of preterm delivery in the group that declined screening than in the screened group (16% versus 12.4%, P<.05). CONCLUSION: We noted more rejections for cervical length screening than anticipated. Reasons for declining included prior term deliveries, cost concerns, and lack of adequate counseling. Further study will address the influence sonographers have in the acceptance of screening.


I survey some recent applications-oriented NL generation systems, and claim that despite very different theoretical backgrounds, these systems have a remarkably similar architecture in terms of the modules they divide the generation process into, the computations these modules perform, and the way the modules interact with each other. I also compare this 'consensus architecture' among applied NLG systems with psycholinguistic knowledge about how humans speak, and argue that at least some aspects of the consensus architecture seem to be in agreement with what is known about human language production, despite the fact that psycholinguistic plausibility was not in general a goal of the developers of the surveyed systems.


Even in simple geometries, many complex fluids display nontrivial flow fields, with regions where shear is concentrated. The possibility for such shear banding has been known for several decades, but in recent years, we have seen an upsurge in studies offering an ever-more precise understanding of the phenomenon. The development of new techniques to probe the flow on multiple scales with increasing spatial and temporal resolution has opened the possibility for a synthesis of the many phenomena that could only have been thought of separately before. In this review, we bring together recent research on shear banding in polymeric and soft glassy materials and highlight their similarities and disparities.


Susceptibility of 60 bacterial isolates to 15 antibiotics was determined by two methods in three laboratories: 48 Gram negative bacilli and 12 Staphylococci were selected because of "intermediate" susceptibility to at least one antibiotic. Results show a good correlation between the two methods: more than 90% for carbenicillin, cefazolin, cefoxitin, cefamandole, kanamycin, tobramycin, amikacin, erythromycin, pristinamycin and fusidic acid, between 80 and 90% for penicillin G, ampicillin, oxacillin, gentamicin, doxycycline, chloramphenicol, spiramycin and clindamycin, less than 80% for neomycin, tetracycline, minocycline and oleandomycin. Interpretation criteria are different in the two methods for rifampicin, colistin and cotrimoxazole. Between the three laboratories, correlation was 90,3% and 88,6% for disc diffusion method and ABAC system respectively.


The article substantiates the need for the use of botulinum therapy in the management of bruxism as a movement disorder. We present the technique of injecting a new Russian botulinum neuroprotein Relatox into the masticatory muscles of patients with bruxism. We have the positive clinical effects of botulinum therapy, a decrease in the level of pain on the visual analogue scale, normalization of muscle activity according to the surface electromyography of masticatory muscles, a decrease in number of nocturnal bruxism according to abrasion on the foil surface on Brux Checker are shown.


Simulation experiments have been done to get a better insight into human errors made by chemical-process operators. A chemical batch process was simulated. The human subjects were apprentice operators of process plants. Two factors were studied: 1] Training and experience, 2] Comprehensiveness of the task instruction. In the first series of experiments no process disturbances were introduced. That series showed a learning effect. The second series had process disturbances. No effect was observed of the comprehensiveness of the task instruction on the operator's ability to react to these disturbances.


Bioassay-guided fractionation of the mycelial extract of a basidiomycete culture collected in Kenya led to the isolation of two new cyathane diterpenoids named laxitextines A (1) and B (2). The producer strain was characterized by detailed taxonomic studies based on rDNA using the 5.8S gene region, the internal transcribed spacer 2 (ITS2), and part of the large subunit that identified the fungus as Laxitextum incrustatum. The structures of 1 and 2 were elucidated by NMR spectroscopic and mass spectrometric analyses. Both compounds exhibited moderate activities against Gram-positive bacteria Bacillus subtilis (DSM 10), Staphylococcus aureus (DSM 346), and methicillin-resistant Staph. aureus (DSM 1182). The two compounds also showed variable antiproliferative activities against mouse fibroblast (L929) and selected human cell lines (breast cancer MCF-7, epidermoid carcinoma A431, and umbilical vein endothelial HUVEC). The IC50 values with respect to the MCF-7 cell line for compounds 1 and 2 were 2.3 and 2.0 μM, respectively.


Given the potential vulnerability of sea turtles to climate change, a growing number of studies are predicting how various climatic processes will affect their nesting grounds. However, these studies are limited by scale, because they predict how a single climatic process will affect sea turtles but processes are likely to occur simultaneously and cause cumulative effects. This study addresses the need for a structured approach to investigate how multiple climatic processes may affect a turtle population. Here, we use a vulnerability assessment framework to assess the cumulative impact of various climatic processes on the nesting grounds used by the northern Great Barrier Reef (nGBR) green turtle population. Further, we manipulate the variables from this framework to allow users to investigate how mitigating different climatic processes individually or simultaneously can influence the vulnerability of the nesting grounds. Our assessment indicates that nesting grounds closer to the equator, such as Bramble Cay and Milman Island, are the most vulnerable to climate change. In the short‐term (by 2030), sea level rise will cause the most impact on the nesting grounds used by the nGBR green turtle population. However, in the longer term, by 2070 sand temperatures will reach levels above the upper transient range and the upper thermal threshold and cause relatively more impact on the nGBR green turtle population. Thus, in the long term, a reduction of impacts from sea‐level rise may not be sufficient, as rookeries will start to experience high vulnerability values from increased temperature. Thus, in the long term, reducing the threats from increased temperature may provide a greater return in conservation investment than mitigating the impacts from other climatic processes. Indeed, our results indicate that if the impacts from increased temperature are mitigated, the vulnerability values of almost all rookeries will be reduced to low levels.


: Lesions induced in each of 9 young colostrum-deprived calves closely resembled lesions seen in naturally occurring "weak calf syndrome" of eastern Idaho and southwestern Montana. The disease was experimentally induced by intravenous injection of bovine adenovirus type 5 that had been isolated from a calf with weak calf syndrome...


The article addresses the issue of the use of massive open online courses (MOOCs) in modern universities, their effectiveness in general as well as the restrictions MOOCs have in terms of allowing students to form the same level or a comparable level of competence in studying of various disciplines as the full-time study provides. The author focuses on the implementation of MOOCs in language acquisition and provides empirical study data on the phenomena linked to language acquisition in terms of both didactic aspects of conveying information and of personality traits of the students that are connected to academic achievement. The data presented in the article suggests that the current state of MOOCs is still inadequate to provide a quality language acquisition in most students as well as setting up a problem of development of better tools to use in MOOCs in terms of acquiring new language and forming a set of independent learning competencies in students. The author provides specific restrictions and outlines possible solutions and the technologies that can be used to improve language acquisition via self-paced courses.


OBJECTIVEThe goal of this study was to identify parameters from routine T1- and T2-weighted MR sequences and diffusion tensor imaging (DTI) that best predict the volumetric changes in a meningioma after treatment with Gamma Knife radiosurgery (GKRS).METHODSIn 32 patients with meningioma, routine MRI and DTI data were measured before GKRS. A total of 78 parameters derived from first-level texture analysis of the pretreatment MR images, including calculation of the mean, SD, 2.5th and 97.5th percentiles, and kurtosis and skewness of data in histograms on a voxel-wise basis, were correlated with lesion volume change after a mean follow-up period of 3 years (range 19.5-63.3 months).RESULTSSeveral DTI-derived parameters correlated significantly with a meningioma volume change. The parameter that best predicted the results of GKRS was the 2.5th percentile value of the smallest eigenvalue (L3) of the diffusion tensor (correlation coefficient 0.739, p ≤ 0.001), whereas among the non-DTI parameters, only the SD of T2-weighted images correlated significantly with a tumor volume change (correlation coefficient 0.505, p ≤ 0.05, after correction for family-wise errors using false-detection-rate correction).CONCLUSIONSDTI-derived data had a higher correlation to shrinkage of meningioma volume after GKRS than data from T1- and T2-weighted image sequences. However, if only routine MR images are available, the SD of T2-weighted images can be used to predict control or possible progression of a meningioma after GKRS.


Structural health monitoring and assessment (SHMA) is exceptionally essential for preserving and sustaining any mechanical structure's service life. A successful assessment should provide reliable and resolute information to maintain the continuous performance of the structure. This information can effectively determine crack progression and its overall impact on the structural operation. However, the available sensing techniques and methods for performing SHMA generate raw measurements that require significant data processing before making any valuable predictions. Machine learning (ML) algorithms (supervised and unsupervised learning) have been extensively used for such data processing. These algorithms extract damage-sensitive features from the raw data to identify structural conditions and performance. As per the available published literature, the extraction of these features has been quite random and used by academic researchers without a suitability justification. In this paper, a comprehensive literature review is performed to emphasise the influence of damage-sensitive features on ML algorithms. The selection and suitability of these features are critically reviewed while processing raw data obtained from different materials (metals, composites and polymers). It has been found that an accurate crack prediction is only possible if the selection of damage-sensitive features and ML algorithms is performed based on available raw data and structure material type. This paper also highlights the current challenges and limitations during the mentioned sections.


ABSTRACT In Lactobacillus casei ATCC 393, the chromosomally encoded lactose operon, lacTEGF, encodes an antiterminator protein (LacT), lactose-specific phosphoenolpyruvate-dependent phosphotransferase system (PTS) elements (LacE and LacF), and a phospho-β-galactosidase. lacT, lacE, andlacF mutant strains were constructed by double crossover. The lacT strain displayed constitutive termination at a ribonucleic antiterminator (RAT) site, whereas lacE andlacF mutants showed an inducer-independent antiterminator activity, as shown analysis of enzyme activity obtained from transcriptional fusions of lac promoter (lacp) and lacpΔRAT with the Escherichia coli gusAgene in the different lac mutants. These results strongly suggest that in vivo under noninducing conditions, the lactose-specific PTS elements negatively modulate LacT activity. Northern blot analysis detected a 100-nucleotide transcript starting at the transcription start site and ending a consensus RAT sequence and terminator region. In a ccpA mutant, transcription initiation was derepressed but no elongation through the terminator was observed in the presence of glucose and the inducing sugar, lactose. Full expression oflacTEGF was found only in a man ccpA double mutant, indicating that PTS elements are involved in the CcpA-independent catabolite repression mechanism probably via LacT.


AIMS AND METHOD

Forty-seven UK mental health services participated in a 1-day audit of prescribing of antipsychotic drugs. Audit standards were derived from national guidelines and consensus statements.

RESULTS

Of the 3132 patients, 20% were prescribed a total dose of antipsychotic medication above that recommended by the British National Formulary . The majority of case notes failed to record an indication for high-dose prescribing or that the patient had been informed; only 8% had undergone an electrocardiogram. Forty-eight per cent of patients were prescribed more than one antipsychotic drug.

CLINICAL IMPLICATIONS

Antipsychotic prescribing for in-patients often runs counter to existing guideline recommendations. It is likely that many patients who are prescribed high doses or polypharmacy are unaware that their prescription is out of line with guideline recommendations and is inadequately monitored.


This valuable resource offers an alternative framework for middle and secondary English instruction. It demonstrates ways of engaging students in critical inquiry projects about the social worlds they inhabit or about those portrayed in literature and the media. It provides numerous examples of middle and high school students using various literacy tools (language, genres, narratives, signs, multimedia, and drama) to study, represent, critique, and transform these worlds. By engaging in these projects, students learn to understand how these literacy tools are used to construct social worlds.


A systematic study is made of embedding class 2 vacuum spacetimes for which the Petrov type is either D or N. It is shown that embedding class 2 can only occur (i) in Petrov type D for the Ehlers - Kundt classes A and B and (ii) in Petrov type N for the pp-waves and a subfamily of the Cahen - Spelkens metrics.


Abstract Mausehund, L and Krosshaug, T. Understanding bench press biomechanics—Training expertise and sex affect lifting technique and net joint moments. J Strength Cond Res 37(1): 9–17, 2023—The purpose of this study was to compare normalized net joint moments (NJMs), moment arms, and muscle activity in the bench press exercise between powerlifters and recreationally strength-trained lifters and between women and men. Thirty-four healthy adults, including 12 powerlifters (6 women and 6 men) and 22 recreational lifters (9 women and 13 men), performed a 6–8 repetition maximum set of the bench press, while elbow and shoulder NJMs and moment arms and electromyographic (EMG) activity of 6 upper extremity muscles were recorded. The results showed that training expertise and sex affected bench press technique substantially. Powerlifters applied a different bar path which impacted joint kinematics to a greater extent and joint kinetics to a lesser extent. Specifically, powerlifters had lower normalized peak elbow NJMs and shorter joint ROMs than recreational lifters (p ≤ 0.05), yet no differences in normalized shoulder NJMs and muscle activity were observed. Women showed lower normalized mean shoulder NJMs, higher normalized peak elbow NJMs, and higher mean elbow to shoulder NJM ratios than men (p ≤ 0.05). The muscle activity of the long head of the triceps brachii and the elbow to shoulder EMG ratio were higher, yet muscle activity of the sternocostal and abdominal head of the pectoralis major was lower for female than for male subjects (p ≤ 0.05). In conclusion, powerlifters and men are more shoulder dominant when performing the bench press than recreational lifters and women, respectively. These findings will have implications for resistance training program design, expected training adaptations and bench press performance.


Providing high quality explanations for AI predictions based on machine learning is a challenging and complex task. To work well it requires, among other factors: selecting a proper level of generality/specificity of the explanation; considering assumptions about the familiarity of the explanation beneficiary with the AI task under consideration; referring to specific elements that have contributed to the decision; making use of additional knowledge (e.g. expert evidence) which might not be part of the prediction process; and providing evidence supporting negative hypothesis. Finally, the system needs to formulate the explanation in a clearly interpretable, and possibly convincing, way. Given these considerations, ANTIDOTE fosters an integrated vision of explainable AI, where low-level characteristics of the deep learning process are combined with higher level schemes proper of the human argumentation capacity. ANTIDOTE will exploit cross-disciplinary competences in deep learning and argumentation to support a broader and innovative view of explainable AI, where the need for high-quality explanations for clinical cases deliberation is critical. As a first result of the project, we publish the Antidote CasiMedicos dataset to facilitate research on explainable AI in general, and argumentation in the medical domain in particular.


The coronavirus disease-2019 pandemic promote antibiotic resistance in bacteria due to overuse of antibiotics, and inhibit the spread of antibiotic-resistant bacteria due to numerous transmission control methods. The research is observational analytic with retrospective approach, aims to compare microorganism profile data, prevalence of multidrug-resistant microorganisms, and susceptibility patterns in patients treated at Dr. Soetomo Surabaya Hospital before and during the pandemic. The most species isolated before the pandemic: E. coli, K. pneumoniae, P. aeruginosa, S. aureus, A. baumannii, and Candida spp. The prevalence of multidrug resistant microorganisms before the pandemic: MRSA 28.4%, VRSA 3.57%, VRE 15.41%, ESBL 49.5% and carbapenem resistant 20.56%. The most species isolated during the pandemic: K. pneumoniae, E. coli, Candida spp, P. aeruginosa, A. baumannii, and S. aureus. Prevalence of multidrug resistant microorganisms during the pandemic: MRSA 29.3%, VRSA 1.5%, VRE 21.05%, ESBL 48.82% and carbapenem resistant 25.97%. The microorganism profiles are different before and during the pandemic, significant decrease in the prevalence of E. coli and S. aureus, significant increase in Candida spp. and carbapenem-resistant Enterobacteriaceae, particularly E. coli, E. cloacae, and Citrobacter spp, and significant alterations of susceptibility patterns in S. aureus, K. pneumoniae, E. coli, A. baumannii, and P. aeruginosa.


In this paper, we developed an optimal dispatching model of Smart Home Energy Management System (SHEMS) with distributed energy resources (DERs) and intelligent domestic appliances. In order to achieve multi-objective optimization between the saving money and living comfortable, we investigate the math models of various components and come up with the new concept "load value" for quantitative measure of users' comfort. Then we set up the control strategies with demand response and adjust the parameters of optimal dispatching model by the load characteristic in this system. Applying this model to one house with Photovoltaic (PV), wind turbine (WT), storage battery and time-of-use prices, the simulation at the end of this paper proves that the energy management system and optimal dispatching model can make users of smart home live in a comfortable and economical way.


A perennial problem encountered by both novices and experienced people using psychophysiological recording equipment and then using the displays as the basis for biofeedback and neurofeedback is that the equipment is frequently not doing what the users think it is. Hardware and software are frequently glitchy and setting the devices incorrectly makes matters worse. The key question to answer is whether the device reliably produces a display clearly related to the physiological signal produced by the person being recorded. The editorial emphasizes the need to view a raw signal so relationships between the physiology being recorded and the display can be accurately assessed. Seven key questions users of psychophysiological recording and biofeedback/neurofeedback equipment need to answer are delineated. They include: (1) Are the sensors mounted optimally for location and orientation, (2) Are the sensors mounted well enough to pick up a good signal, (3) Is the device's bandwidth set appropriately, (4) Is there noise in the signal, (5) Does the display accurately reflect changes in the signal, (6) Does the display change when the physiological signal does, and (7) Is the display set so users can accurately assess the signal? Users are encouraged to get the training they need to do a great job when performing recordings.


: Pediatric burns represent a significant public health problem. We analyzed the characteristics of pediatric burns in a reference center, in order to identify better strategies for prevention and care. Burn patients admitted to the pediatric departments of our hospital from January 2020 to June 2022 were retrospectively evaluated. Age, gender, the etiology of injuries, the total burn surface area (TBSA), the degree of burns, the length of hospital stay (LOS), concomitant SARS-CoV-2 infection, and burn surface microbial colonization were analyzed. Forty-seven patients were included in the analysis (M:F = 1:0.67). Most of the cases involved patients between 0 and 4 years of age (83%). Hot liquid burns accounted for 79% of cases, flame burns for 9%, thermal burns for 6%, scald burns for 4% and chemical burns for 2%. Mean TBSA was 14 ± 11%. A second-degree lesion was detected in 79% of patients and third-degree in 21%. Mean LOS was 17 days. No additional infection risks or major sequelae were reported in patients with SARS-CoV-2 infection. Fifteen different species of bacteria plus C. parapsilosis were isolated, while no anaerobic microorganisms were detected. In the light of our experience, we recommend a carefully planned and proactive management strategy, always multidisciplinary, to ensure the best care for the burned child.


Facial occlusions caused by HMD (Head-Mounted Display) make capturing user's face hard. In this paper, we propose a technique to classify the mouth shapes into 6 classes using optical sensors embedded in HMD and give labels to training dataset by vowel recognition. We conducted an experiment with 5 subjects to compare recognition rates of machine learning in manual labeling and automated labeling conditions. The result shows that proposed method achieved an average of 99.9% classification accuracy in the manual labeling condition, and of 96.3% classification accuracy in the automated labeling condition.


Abstract : Events in Europe in recent years have shaken the world and made assumptions about the present and presumptions regarding the future irrelevant almost overnight. Within this torrent of change and climate of uncertainty, a dominating issue of debate has been the future of European security and, in particular, the role of the United States. This is not the first time, however, that these questions have been addressed. In the post-World War II era, 1945- 1948, the same issues were the focus of American and European attention. That period of transition culminated in a common defense system and an American commitment that has lasted over four decades. In the current period of transition and reassessment, the answers to similar questions are not foreordained, and the decisions made are likely to shape the future of European security and the American role for years to come. This paper builds on an historical examination of events in 1945-1948, and then focuses on the determining factors in the current and near term, 1990-1993. Contrast and comparison of the two periods yields identification of common factors which will interact to influence how the United States participates in a future European security system.


Three instances of sensitivity to bithionol have been seen in the past year. A girl, aged 5, developed a flare-up of dermatitis on the chin, following the use of an antiseptic cream. Blind patch tests disclosed a three-plus reaction to the sample containing bithionol, which reproduced the initial patch test response to the antiseptic cream. The latter also contained hexachlorophene. This produced a one-plus patch test reaction. Recurrence of the dermatitis followed the use of a chap lotion containing this chemical. A male, aged 51, developed a weeping dermatitis of the forehead and scalp, with edema of the eyelids. A hair dressing containing bithionol produced a three-plus patch test reaction. Use of the same dressing at a later date initiated a prompt recurrence. A mother, aged 22, presented hands distended by a tight erythroedema. An intense zonal and weeping dermatitis occupied the dorsal surfaces. The next day, the inflammation had


The motion behaviour of three species of intertidal foraminifera, Ammonia tepida , Cribroelphidium excavatum and Haynesina germanica , was investigated continuously in the laboratory. We first infer the presence of geotactic and phototactic responses. Significant geotactic responses were observed for all three species; A. tepida was found to be negatively geotactic while C. excavatum and H. germanica showed positive geotaxis. In contrast, no response to light was ever observed. The detailed nature of motility, investigated in terms of both geometric and stochastic complexity of their motion behaviour, was consistently characterised by a strong inter-specific, inter-individual and intra-individual variability. Specifically, A. tepida and H. germanica were characterised by an intensive search behaviour (they explore their environment slowly with straighter trajectories), while C. excavatum adopted an extensive search strategy (it moves more rapidly with more convoluted trajectories). These observations are discussed in the specific context of the ecology of these species. We see their responses as adaptive advantages in spatially and temporally complex environments prone to a range of both predictable and unpredictable rapid stressors. From a methodological point of view, we showed that previous methods used to infer foraminiferal motion behaviour are likely to have systematically underestimated their speed and distance travelled by a factor ranging from 2 to 80.


Objectives: To provide basic data needed to develop national physical activity policy, this study was examined to identify the relationship among physical inactivity, physical activity, and chronic diseases. Methods: I have reviewed articles and research reports in relation to physical activity, health, and chronic disease published in national and international since 2005 through PubMed, RISS, and KISS. Results: physical activity should be the priority of public health for the prevention and management of chronic diseases as following reasons. 1) Prevalence of physical inactivity has been continuously increased. 2) There were strong evidences that sufficient physical activity could prevent and treat dozens of chronic diseases. Conclusions: Both central and local governments need to make the amount of physical activity to be increased by providing information and establishing a physical activity-friendly environment. Also, the local public health centers and the primary medical institutions are institutionally needed to counsel and prescribe every patient's exercise program at every visit.


A left thoracotomy for decortication of an infected haemothorax was performed on a 52-year-old man with a partially infarcted left lower lobe that occurred as a rare complication of a pulmonary venous embolus. Before the completion of surgery, after an uncomplicated 40 minutes of one-lung ventilation, the left lung was temporarily re-expanded to assess air leak. On the resumption of one-lung ventilation the SpO2 fell rapidly to 85%, despite apnoeic oxygenation of the non-ventilated lung. In the absence of evidence of double-lumen tube displacement, intra-pulmonary shunting as a consequence of impaired hypoxic pulmonary vasoconstriction in the newly expanded markedly pathological lung is considered the most likely mechanism.


A key focus in transforming the profession of ICT to one of contributing to a sustainable future is the education of students who may think and act as sustainable practitioners in computing. An important understanding in this is the relationship between ethics and sustainability in the student intake. This forms a baseline upon which higher education can build. It is argued that sustainability can be considered ethics expanded in time and space but it is not previously known if an ethical understanding relates to an ecological worldview or to desires for contributing to sustainability. This paper reports on a survey of the first year intake of a New Zealand polytechnic (n=52) and explores the link between ethics and sustainability in freshman students in their first week of higher education. A measure of ethical naivety was constructed based on standard measures of naive ethics (legalism, egoism, agency and relativism), the responses to this were compared to the standard measure of ecological worldview, the New Environmental Paradigm. The implications for education for ICT4S are discussed.


Objective: To study the risk factors for Cerebral Hyperperfusion Syndrome (CHS) following Carotid Angioplasty Stenting (CAS) in the elderly patients with carotid artery stenosis and to explore the intervention measures for prevention and treatment of CHS.
Methods: A total of 500 elderly patients with carotid artery stenosis enrolled in our hospital from May 2012 to May 2017 were selected as the objects. They all were treated with CAS, and divided according to presence of CHS into non CHS group (n=482) and CHS group (n=18), general data of patients were compared between the two groups, and independent risk factors were analysed by stratified method.
Results: The Univariate analysis showed that there was statistically significant difference between CHS group and non CHS group in diabetes and postoperative hypertension (P 0.05). CAS was performed on 532 cases in the two groups, including 18 cases in CHS group and 514 cases in non CHS group. There was no statistically significant difference between the two groups in operative MCA occlusion, operative PCoA opening, symptomatic focus, and operative ACAA1 segment dysgenesis (P>0.05). The stratified analysis showed that postoperative hypertension (OR=7.248, P<0.01) and diabetes mellitus (OR=5.906, P<0.01) were important risk factors for CHS after CAS.
Conclusion: In elderly patients with carotid artery stenosis, those with postoperative hypertension or diabetes history are more prone to CHS following CAS with poor prognosis, which should be controlled and prevented from a variety of perspectives through intervention measures.


This study uses aspects of company characteristics in the form of firm size, managerial specific aspect in the form of CEO's ability, and tax aggressiveness to be tested its relation to earnings quality of company. The sample used is a manufacturing company listed on the Indonesia Stock Exchange (IDX) period 2013-2014. Based on quantitative methods, the multiple linear regression is used to test the hypothesis. The results show that firm size has a positive relationship to the earnings quality. On the other hand, neither the ability of the CEO nor the tax aggressiveness have a significant relationship to earnings quality. Based on these findings can be concluded that the characteristics of the company in the form of company size is a determinant of earnings quality.


A dummy gate-assisted n-type metal oxide semiconductor field effect transistor (DGA n-MOSFET) layout was evaluated to demonstrate its effectiveness at mitigating radiation-induced leakage currents in a conventional n-MOSFET. In the proposed DGA n-MOSFET layout, radiation-induced leakage currents are settled by isolating both the source and drain from the sidewall oxides using a p+ layer and dummy gates. Moreover, the dummy gates and dummy Metal-1 layers are expected to suppress the charge trapping in the sidewall oxides. The inherent structure of the DGA n-MOSFET supplements the drawbacks of the enclosed layout transistor, which is also proposed in order to improve radiation tolerance characteristics. The Vg-Id simulation results of the DGA n-MOSFET layout demonstrated the effectiveness of eliminating such radiation-induced leakage current paths. Furthermore, the radiation exposure experimental results obtained with the fabricated DGA n-MOSFET layout also exhibited good performance with regard to the total ionizing dose tolerance.


Background/Aim: High-dose chemotherapy (HDCT) and stem cell transplantation (SCT) have been established as the standard of care in patients with relapsed germ cell tumours (GCTs). We evaluated the safety, efficacy and tolerability of HDCT/ SCT in patients with relapsed GCTs. Patients and Methods: Twenty-eight patients with relapsed GCTs, treated with HDCT, were included in this study. The conditioning regime was carboplatin, etoposide, cyclophosphamide and paclitaxel. Clinical, radiological imaging and tumour markers determined treatment outcomes. Results: Median age was 35 years (range=21-57 years) with 26 males and 2 females. Median time to first relapse was 6 months. Median time to progression after 2nd line chemotherapy was 17.3 months. Fourteen patients hadMedian survival was 62 months and 16 patients (57%) are in clinical follow-up with surveillance. Conclusion: In relapsed GCT patients, median survival may exceed 5 years post-HDCT and SCT.


The paper reviews the material inputs to the construction industry (i.e. those materials that are ultimately embodied in structures), and the wastes associated with materials processing. It also reviews the emissions associated with energy use for purposes of heating, air-conditioning, lighting, cooking and other energy services normally provided within structures. Of the two categories, the latter is more significant in terms of environmental damage. As regards abatement, the most promising strategy for reducing the damages associated with mining and processing the structural materials themselves is increased recycling, especially of metals. Two primary strategies suggest themselves with regard to reducing the environmental impact of energy services. The first is increased end-use efficiency e.g. by improved design, better thermal insulation and more efficient equipment, such as refrigerators and compact fluorescent lights). The second primary strategy is to shift as quickly as possible from dependence on fossil fuels for heating and cooking to electricity, especially by utilizing photovoltaic (PV) rooftop units together with heat pumps and microwave cookers. Government intervention may accelerate this shift in various ways, but policy issues are not discussed in the paper. 1. Background The construction sector, together with the production of associated durable goods and


Pontocerebellar hypoplasias (PCH) are characterized by lack of development and/or early neurodegeneration of cerebellum and brainstem. We report five patients referred for PCH, showing atypical clinical and magnetic resonance imaging (MRI) features suggestive of defects in the Reelin pathway. We screened for mutations in RELN or VLDLR and compared the phenotype of these patients with that of previously reported patients. All patients had profound cerebellar hypoplasia on MRI with peculiar cerebellar morphology, associated with flattened pons and neocortical abnormalities. Patient 1 had profound motor and intellectual disability with moderate lissencephaly suggestive of RELN mutations and was shown to harbor a splicing homozygous RELN mutation. The four other patients had a milder phenotype consistent with CARMQ1 (cerebellar ataxia and mental retardation with or without quadrupedal locomotion). These patients showed mild simplification or thickening of cortical gyration and had VLDLR mutations. Reelin signaling regulates neuronal migration in the developing mammalian brain. VLDLR is a key component of the Reelin pathway. Our patients had a very small and dysplatic cerebellar vermis that should suggest the involvement of these genes. Moreover, differences in clinical severity, involvement of the cerebellar hemispheres, together with the severity of the neocortical defect, enables RELN‐mutated patients to be distinguished from VLDLR‐mutated patients.


Context- The oral cavity and the colon, though part of the alimentary tract are distantly located anatomically and hence are colonized by totally divergent microbes. The mouth is affected by several pathologies and so is the colon. So it is quite natural to investigate the probable connection between poor oral health and colorectal pathologies. Evidence acquisition- This article is a small attempt to identify the oral microbiota, how they translocate to the colon-rectum area and then how do they create pathology there. Pubmed indexed journals relating to this topic were screened and shortlisted to construct this article. Results- The organisms generally responsible for the oral diseases, namely Fusobacterium nucleatum and Porphyromonas gingivalis among others have been found in colon disorders resulting in intestinal dysbiosis and ultimately leading to colorectal cancer. Conclusions- If the disease pathogenesis is well understood, then it will open new ways on how to prevent or treat colorectal pathologies. However further studies are needed in this arena.


An online domain-independent competitive gaming system, called JOYCE, was devised to engage students in drill-and-practice exercises. In this paper, theories underpinning the system design are explained. As in the system students are allowed to compete with others in a face-to-face situation, and in network situations where an opponent's identify is revealed or concealed, a preliminary study was conducted to examine students' preferences towards different competition modes and satisfaction towards the learning experience. Results supported JOYCE's incorporation into the learning process and the design and development of the system. Based on the obtained data it was suggested that to increase its intrinsic value and to lessen the negative emotional states which is more easily exhibited in a face-to-face competition situation anonymity is a promising feature to be included in a competitive learning system. Furthermore, various competition modes should be built into e-learning environments to satisfy peoples' different learning mode preferences.


Proceedings: AACR 102nd Annual Meeting 2011‐‐ Apr 2‐6, 2011; Orlando, FL

Mutations in receptor tyrosine kinases, Ras or B-Raf frequently manifest constitutive activation of the Ras/Raf/Mek/Erk pathway in a variety of human cancers. The mitogen activated protein kinase Erk1/2 is an important regulator of cell proliferation and was shown to be over-activated by these dysregulated or mutated upstream signals.

AEZS-131 selectively inhibits Erk1/2 with an IC50 of 4 nM, blocks cellular Rsk-1 phosphorylation, modulates downstream cellular substrate activation, arrests tumor cells in G1 and inhibits the growth of multiple human tumor cell lines in the nanomolar range. We have studied the response of human cancer cells (Hct116) in in-vivo mouse xenograft experiments. AEZS-131 significantly inhibited tumor growth at daily doses of 30mg/kg. Currently, AEZS-131 is undergoing in-vivo combination experiments with PI3K inhibitors.

Since pharmacological inhibition of Erk1/2 reverses Ras and Raf activation also in cells demonstrating resistancy to common Raf inhibitors like GDC-0879 and PLX4720, it appears likely to put more attention on the downstream kinase Erk1/2 as therapeutic target. Furthermore, in instances of coincident activation of the Raf and PI3K pathways, combinations of AEZS-131 and PI3K inhibitors may prove efficacious.

Here we present the in-vitro and in-vivo characterisation of the first in-class Erk1/2 inhibitor showing in-vivo efficacy as single therapy agent.

Early development of the Erk1/2 inhibitor AEZS-131 by AEterna Zentaris is integral part of our in-house kinase research program comprising the investigation of different compounds for single Erk1/2 inhibition, single PI3K inhibition and dual kinase inhibitions. All compounds are exclusively synthesized by our Drug Discovery Department.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 3563. doi:10.1158/1538-7445.AM2011-3563


A prospective study was performed in 34 fasted healthy cats to describe the normal ultrasonographic anatomy of the cardia and pylorus. Measurements were obtained for the caudal esophageal wall thickness (Ew), cardia wall thickness (Cw), pyloric wall thickness (Pw), thickness of the pyloric muscularis (Mp), length of the thicker part of the proximal duodenal submucosa (Dl). Among the 34 cats, 24 were examined using a linear transducer, and 10 with a microconvex transducer. Ew and Cw could be measured in 70% of the cats when a linear transducer was used, in 100% of the cats when a microconvex probe was used, Pw and Mp could be measured in 100% of the cats whatever probe was used. The submucosa of the most proximal part of the duodenum was thicker in half of the cats in longitudinal section. The muscularis layer of the pylorus was triangular in longitudinal section and thicker than the muscularis of the proximal duodenum. The mean for Ew, Cw, Pw, Mp, and DI was 4.9 mm (SD = 1.1), 5 mm (SD = 0.6), 4.4 mm (SD = 0.6), 2.5 mm (SD = 0.5), and 4.7 mm (SD = 2.38), respectively. Three cats with abnormalities of the cardia and pylorus are also described to illustrate clinical implications.


OBJECTIVE
To examine treatment compliance and dosage administration associated with infliximab, etanercept, and methotrexate therapy for rheumatoid arthritis (RA).

STUDY DESIGN
Retrospective analysis using administrative and claims data from a large US health plan.

PATIENTS AND METHODS
Patients were Medicare or commercial enrollees in a health plan with a pharmacy benefit and had a diagnosis of RA. The first (index) claim for infliximab, etanercept, or methotrexate occurred between July 1, 1998, and December 31, 2000. Continuous enrollment in the plan was required from 182 days before to 365 days after the index claim. Treatment groups were compared according to compliance (defined as the actual number of therapy administrations or filled prescriptions divided by the expected number) and changes in dosage administration over time. The costs of infliximab therapy also were explored.

RESULTS
A total of 2662 patients (infliximab = 141; etanercept = 853; and methotrexate = 1668) were included in the analyses. Infliximab patients were older and more likely to have a Medicare benefit. In addition, infliximab patients had more comorbidities and had greater medical costs preceding the index claim. Compliance with at least 80% of the expected dosages was significantly lower for etanercept (odds ratio [OR] 0.462; 95% confidence interval [CI] 0.290-0.736) and methotrexate (OR 0.385; 95% CI 0.245-0.604) patients than infliximab patients. Methotrexate patients had the largest dosage increases (61.6%), followed by infliximab (37.4%) and etanercept (7.4%) patients. Assuming 6.5 dosages per year, the annual cost of infliximab was dollars 10446 to dollars 12363, or dollars 1887 to dollars 1902 per administration, depending on site of service.

CONCLUSIONS
Compliance is higher with infliximab compared with etanercept or methotrexate; whereas, fewer etanercept patients change dosages. The cost of infliximab was lower than expected based on previous predictions, even with a 37% increase in dosage.


Abstract— Exposure to uranium is a risk for the workers involved in uranium mining, purification, and manufacture, principally by its ingestion or inhalation. It is also a risk for the population at large in case of intake of contaminated water or food. Uranium induces nephropathy that is characteristic of heavy metals, which can lead to death. The toxic effects of uranium can be prevented by a biphosphonate, ethane-1-hydroxy-1,1-bisphosphonate (bisodic etidronate), administered orally or subcutaneously. Employing bisodic etidronate, our laboratory obtained satisfactory results in terms of survival in adult mice, adult rats, and suckling rats. The aim of the present study was to evaluate the efficacy of bisodic etidronate for preventing renal dysfunction induced by a lethal dose of uranyl nitrate, employing serum levels of urea and creatinine as end-points. Two experiments were performed over different time periods, i.e., Experiment A: 48 h, Experiment B: 14 d. Each experiment was performed with 4 groups of 20 male Balb/c mice each, 25 g average body weight. Three of these groups received 350 mg kg−1 of body weight of uranyl nitrate by gavage (forced oral administration). Two of the three exposed groups were treated with bisodic etidronate either by gavage in a dose of 500 mg kg−1 body weight or with a subcutaneous injection of 50 mg kg−1 body weight. The fourth group served as control. Survivors of the experimental groups were sacrificed at the end of the experiment by overdose of inhalation anesthetic (ether). The kidneys were routinely processed for histological analysis. Blood samples were taken by cardiac puncture to assess urea and creatinine serum levels. Urea and creatinine serum levels were markedly lower at 48 h in exposed animals treated with bisodic etidronate than in untreated exposed animals. On day 14 these values in exposed and treated animals did not differ significantly from control values. The renal function of animals treated with orally or subcutaneous bisodic etidronate that survived uranyl nitrate exposure was markedly improved compared to the controls of untreated exposed animals at 48 h. At 14 days, treatment with bisodic etidronate averted renal damage. At this time, the histologic study of kidneys showed images of tissue recovery. These results suggest that the use of EHBP may be of great value in reducing the renal damage.


Although cognitive deficits are recognized as a core feature in schizophrenia, their evolution over the course of the illness is still debated. Longitudinal studies of cognition in patients after a first episode of psychosis (FEP) provide extremely useful information, in that they include an adequate and realistic baseline measure of cognitive performance, while at the same time minimizing the effect of confounding variables associated with chronicity. The aim of this systematic review was to summarize findings of studies assessing the longitudinal course of neuropsychological deficits in patients with FEP for durations of at least one year. Overall, the neuropsychological deficits that are present following a first episode of psychosis appeared to remain stable over time for periods of up to ten years, the only possible exception being verbal memory deficits, where there is some evidence of further deterioration over the long term. However, further studies are needed to confirm this conclusion, especially in the (somewhat inconsistently defined) domain of executive function. Improvements in psychopathology appear to positively influence the course of cognitive deficits, although the effects of antipsychotic medication are not as clear.