Objective: To our knowledge, there are no studies investigating the non-cognitive symptoms of patients with dementia such as depression, agitation, or delusions among general hospital inpatients. The aim of this study was to investigate the frequency of such non-cognitive symptoms among medical inpatients and to analyze their impact on the length of hospital stay and on admission to nursing homes. Method: The sample consisted of 372 elderly inpatients admitted to four internal medical departments (i.e., not including psychiatric wards) in Austria. Patients were investigated by research psychiatrists using the Clinical Interview Schedule. For the analyses of the non-cognitive symptomatology, only marked and severe symptoms were included. To identify predictors for the length of hospital stay and for nursing home placement, multivariate regression procedures were used. Results: Of all inpatients, 27.4% met criteria for dementia according to DSM-III-R. Of those with dementia, 27.8% had marked or severe non-cognitive symptoms. A diagnosis of dementia markedly increased the risk for nursing home referral and prolonged the duration of inpatient treatment. Among the demented, both, cognitive and non-cognitive symptoms turned out to be significant predictors for nursing home placement and for prolonged duration of acute hospital stay, even when controlling for other independent variables. Conclusions: Non-cognitive symptoms occur frequently among medical inpatients with dementia and considerably increase both the duration of inpatient treatment and the risk of nursing home placement. Since such non-cognitive symptoms are treatable, they should receive attention from the hospital staff.


Territorial stress (TS) elevates blood pressure (BP) in several mammalian species. However, cardiovascular pathology following chronic stress has not been consistently shown in a non‐genetic hypertension model. Therefore, the hypothesis tested was that social stress would directly increase: BP, collagen deposition in coronary and mesenteric arteries, and myocardial fibrosis. Wistar–Kyoto (WKY) male rats, four weeks of age, were divided into one of three groups: controls (n = 9), territorial stress (TS, n = 12), and social isolation followed by territorial stress (SITS, n = 11). Blood pressure was measured biweekly, and blood samples biweekly for serum testosterone, corticosterone, epinephrine and norepinephrine. Blood pressure significantly increased in the TS (130 mmHg, p < 0.05) and SITS (150 mmHg, p < 0.05) groups, compared to controls (120 mmHg, ANOVA, F = 6.7, p < 0.001). Coronary collagen was increased 47% in the TS group and 90% in the SITS group compared to controls ( p < 0.05). The coronary wall/lumen ratio increased significantly (45%, p < 0.05) in the SITS group compared to the controls. Myocardial fibrosis was increased 27% in the TS group and 74% in the SITS group compared to controls ( p < 0.05). In conclusion, stress treatments increased BP and cardiac pathology in a normotensive rat strain.


This paper presents a methodology and toolkit for creating a rule-based multi-domain conversational agent for transactions from (1) language annotations of the domains' database schemas and APIs and (2) a couple of hundreds of annotated human dialogues. There is no need for a large annotated training set, which is expensive to acquire. The toolkit uses a pre-defined abstract dialogue state machine to synthesize millions of dialogues based on the domains' information. The annotated and synthesized data are used to train a contextual semantic parser that interprets the user's latest utterance in the context of a formal representation of the conversation up to that point. Developers can refine the state machine to achieve higher accuracy. On the MultiWOZ benchmark, we achieve over 71% turn-by-turn slot accuracy on a cleaned, reannotated test set, without using any of the original training data. Our state machine can model 96% of the human agent turns. Our training strategy improves by 9% over a baseline that uses the same amount of hand-labeled data, showing the benefit of synthesizing data using the state machine.


This thesis examines geographical publishing in mid-Victorian Britain. Focusing specifically on literatures of travel and exploration, it considers the role of publishers and the publishing industry more widely in shaping the geographical understandings of a range of mid-Victorian readers. Through a detailed examination of the production, circulation and reception of four publishing projects, this thesis provides insights into the challenges and opportunities associated with different forms of publishing whilst also drawing attention to the broader print culture which was implicated in bringing knowledge of these works (and the geographies within them) to various reading publics. The first chapter offers a critical overview of recent work by historical geographers and historians of science concerning print culture, publishing and scientific knowledge. It also outlines the theoretical framework adopted within this thesis which emphasises the importance of considering production, circulation and reception simultaneously. The second chapter develops this discussion further by providing a rationale for a study of travel and exploration publishing specifically. It also explores the methodological implications of deploying an approach which simultaneously considers how particular works of geography were produced, replicated and consumed in the mid-Victorian period. Chapters 3-6 offer detailed case studies of particular publishing projects. Chapter 3 examines David Livingstone's Missionary Travels and Researches in South Africa (John Murray, 1857). Chapter 4 explores Francis Gabon's The Art o f Travel or, Shifts and Contrivances Available in Wild Countries (John Murray, 1855). Chapters 5 and 6 focus on multi-authored works. Chapter five considers the series Vacation Tourists and Notes o f Travel (Macmillan and Co., 1861-1864). Chapter 6 investigates the periodical Geographical Magazine (Trtibner, 1874-1878). Through these case studies, as the concluding chapter 7 highlights, this thesis offers new insights into the way that print figured in shaping particular geographical imaginations during the nineteenth century.


Abstract The M w 7.3 Landers earthquake produced approximately 80 km of surface faulting along a preexisting, integrated system of faults separated by complex intersection points. The earthquake was accompanied by distributed seismicity and triggered slip across a large area of the central Mojave desert known as the Mojave block. We synthesized surface mapping, geodetic, and seismicity data to develop a kinematic model for regional co-seismic deformation. We interpret that the earthquake simultaneously accommodated north-directed motion of blocks within the San Bernardino mountains, dextral shear on northwest-striking faults in the central Mojave block, and minor northwest-southeast extension of the eastern Mojave block. This pattern of distributed heterogeneous co-seismic deformation is similar to a kinematic model proposed for cumulative late Cenozoic deformation of the Mojave block in which dextral shear, north-south shortening, and northwest-southeast extension are partitioned into discrete domains bounded principally by strike-slip faults. Based on the similarity between the co-seismic deformation and patterns of cumulative late Cenozoic deformation, we propose that infrequent multiple fault-segment ruptures similar to those associated with the 1992 Landers earthquake are part of the process by which the Mojave block has changed size and shape during the late Cenozoic. This model suggests that combinations of multiple-fault or multiple-segment rupture may be assessed as relatively more or less likely, depending on whether a particular rupture scenario contributes proportionally to the cumulative regional deformation.


The purpose of this study is to derive periodical characteristics of the policy for the elderly in Japan by investigating the changes of social security system. The target period of 1946~2000 in Japan was divided into 3 periods for the understanding of periodical characteristics in the focuses of medical, welfare and pension system for the elderly; establishment of concept for the social security and welfare of Japan(1946,1950), appearance of social security system and the elderly problem(to late 1960's), infra construction for aging society(to late 1980's), development and reappraisal of practical policy for the elderly(to late 1990's). It is expected that this paper could provide basic data for the elderly-related policy making in our country.


A Novel of bidirectional DC-DC converter drive is presented in this paper. The circuit configuration of the proposed converter is very simple. The proposed converter employs a coupled inductor with same winding turns in the primary and secondary sides. In step-up mode, the primary and secondary windings of the coupled inductor are operated in parallel charge and series discharge to achieve high step-up voltage gain. In step-down mode, the primary and secondary windings of the coupled inductor are operated in series charge and parallel discharge to achieve high step-down voltage gain. Thus, the proposed converter has higher step-up and step-down voltage gains than the conventional bidirectional DC-DC boost/buck converter. Under same electric specifications for the proposed converter and the conventional bidirectional boost / buck converter, the average value of the switch current in the proposed converter is less than the conventional bidirectional boost / buck converter. The operating principle and steady-state analysis are discussed in detail. Finally, a 70 / 210 V simulation circuit is simulated in MATLAB/Simulink to verify the performance for the automobile dual battery drive system.


Abstract Introduction The normal coronary circulation is physiologically interconnected by intercoronary and intracoronary anastomoses that are functionally insignificant and cannot be visualized by conventional coronary angiography due to their small size. The development of significant coronary stenosis increases the flow through these anastomoses and hence their size, making them readily visible. Large intercoronary communications in the absence of obstructive coronary artery disease constitute a very rare coronary artery anomaly, which is thought to be congenital in origin and located in specific anatomic locations. Case presentation A 62-year-old man was admitted to our department due to typical anginotic pain. Coronary angiography revealed a subtotal occlusion of the proximal circumflex and a very unusual tortuous intercoronary communication between the left main coronary artery and the left anterior descending artery. A drug eluting stent was successfully deployed at the circumflex and the patient's symptoms resolved. Medical history was retaken revealing that he suffered a strong blunt trauma of the chest as an adolescent, which we believe could be a possible alternative explanation for the formation of the intercoronary communication. Comparison to a previous angiogram performed 4 years earlier showed that the intercoronary communication was already present and remained unchanged over the years. Discussion It is suggested that intercoronary communication arising from unusual locations and developing in disorganized fashion can be suspected as being of traumatic origin. We believe that there is no need for intervention to treat this type of anomaly.


Very few patients complain of the sexual repercussions of surgery for benign prostatic hyperplasia (one or two per year in a very active Parisian Urology department). However, when the patient presents such complaints, they are always dramatic and the patient is particularly critical of the surgeon who operated on him. In order to more clearly understand the importance of these exceptional complaints, associated with marked anxiety, the authors reviewed an IFOP survey concerning sexuality in the elderly: at the age when most prostatectomies are performed, orgasm is no longer considered to be essential. It is essential to always make sure that the patient has clearly understood the explanations given to him, which is particularly difficult in foreign patients. Prostatectomy is obviously an urological indication, but when it does not constitute an emergency, the urologist should defer the operation if his patient still has an active sex life (sexual intercourse once a week, for example).


BACKGROUND
The effectiveness of surgically placed wound catheters (SPWC) and local anaesthetic infusion in the management of post-operative pain following breast surgery is controversial. This meta-analysis was performed to assess efficacy SPWC compared to other techniques of pain management.

MATERIAL AND METHODS
The meta-analysis included randomised control trials that compared SPWC with other forms of pain control. Post-operative opioid requirements and pain measured in visual analogue scale (VAS) were analysed using Comprehensive Meta-analysis Software version 2. Literature was reviewed for the safety of the SPWC and local anaesthetic infusion.

RESULTS
Four randomised controlled trials evaluating 147 women were included in the final analysis. The overall standard difference in means was 0.094 and 0.033 for post-operative opioid requirement and pain respectively favouring the SPWC and local anaesthetic infusion group. It is a safe technique with no major adverse events as a result.

CONCLUSION
Surgically placed wound catheters and local anaesthetic infusion is clinically safe in a wide range of surgical procedures on the breast and there appears to be a trend towards improved post operative pain relief. The studies analyzed in this review have several important drawbacks such as inadequate power to detect significant differences (none of them included more than 50 patients). A well designed RCT of patients undergoing breast surgery with an adequate number is of patients required to emphatically demonstrate if the operative site infusion with local anaesthetic solution postoperatively is safe and efficacious compared to opioid based regimens alone for post operative pain relief.


We developed a deeP architecturE for the LIght Curve ANalysis (PELICAN) for the characterization and the classification of supernovae light curves. It takes light curves as input, without any additional features. PELICAN can deal with the sparsity and the irregular sampling of light curves. It is designed to remove the problem of non-representativeness between the training and test databases coming from the limitations of the spectroscopic follow-up. We applied our methodology on different supernovae light curve databases. First, we tested PELICAN on the Supernova Photometric Classification Challenge for which we obtained the best performance ever achieved with a non-representative training database, by reaching an accuracy of 0.811. Then we tested PELICAN on simulated light curves of the LSST Deep Fields for which PELICAN is able to detect 87.4% of supernovae Ia with a precision higher than 98%, by considering a non-representative training database of 2k light curves. PELICAN can be trained on light curves of LSST Deep Fields to classify light curves of the LSST main survey, which have a lower sampling rate and are more noisy. In this scenario, it reaches an accuracy of 96.5% with a training database of 2k light curves of the Deep Fields. This constitutes a pivotal result as type Ia supernovae candidates from the main survey might then be used to increase the statistics without additional spectroscopic follow-up. Finally we tested PELICAN on real data from the Sloan Digital Sky Survey. PELICAN reaches an accuracy of 86.8% with a training database composed of simulated data and a fraction of 10% of real data. The ability of PELICAN to deal with the different causes of non-representativeness between the training and test databases, and its robustness against survey properties and observational conditions, put it in the forefront of light curve classification tools for the LSST era.


The switching performance of the semiconductor laser amplifier in a loop mirror (SLALOM) with a polarization-independent multiquantum-well SLA influenced by the carrier transport is discussed. It is shown that the switching window is polarization-dependent in the case of ultra-short pulses used as switching pulses because of the carrier transport effect between quantum wells. The influence of polarization can be suppressed by modifying the polarization state of local switching pulses.


Recently the second and fourth authors developed an iterative scheme for obtaining rough solutions of the 3D incompressible Euler equations in Holder spaces. The motivation comes from Onsager's conjecture. The con- struction involves a superposition of weakly interacting perturbed Beltrami ows on innitely many scales. An obstruction to better regularity arises from the errors in the linear transport of a fast periodic ow by a slow velocity eld. In a recent paper the third author has improved upon the methods, in- troducing some novel ideas on how to deal with this obstruction, thereby reaching a better Holder exponent | albeit weaker than the one conjec- tured by Onsager. In this paper we give a shorter proof of this nal result, adhering more to the original scheme of the second and fourth authors and introducing some new devices. More precisely we show that for any positive ", there exist periodic solutions of the 3D incompressible Euler equations that dissipate the total kinetic energy and belong to the Holder class C 1=5 " .


This issue of the Clinical and Social Intervention Journal is devoted to the topic of nutrition and physical activity while tackling the problem of metabolic syndrome. Nutrition is a factor of the external environment that significantly affects a per- son's quality of life and their health. It is intended to: prevent nutritional deficiencies; achieve high functional performance; prevent diseases of civilization (cardiovascular diseases, obesity, diabetes mellitus, osteoporosis, cancer, metabolic syndrome). Nu- trition effects the development of chronic diseases by up to 50%.


SIR: Dr T. C. Beard (Journal, August 7) rightly calls attention to the effectiveness of mebendazole in eliminating secondary hydatid (Echinococcus granulosus) cysts in experimental animals and the inferences which this work and that of Dr H. T. Goodman, in particular, have for the future treatment of human hydatid disease. In his letter, Dr Beard correctly quotes me as having intimated that, after the ingestion of mebendazole by Taenia pisiformis-infected rabbits, there is a concomitant loss of osmotic pressure and considerable increase in the thickness of the host capsule (adventitia). I should like to record the following data, which establish that the loss of osmotic pressure is a prelude to complete collapse and death of the parasite, and that the increase in thickness of the adventitia proceeds inwardly in the direction of the collapsing cyst, so that there is little alteration in overall dimensions. All measurements were taken from stained and mounted histological specimens of T. pisiformis lesions (cysticerci plus adventitia) removed from infected but untreated rabbits and from infected rabbits which had ingested mebendazole-medicated feed for a known number of days. The thickness of the adventitia was measured (with an eyepiece micrometer) at several points in every lesion, while the size of each lesion was measured across two diameters-a greater and a lesser-and a mean diameter computed. The mean diameters were then averaged for a large number of individual lesions. The minimum thickness of adventitia which I have recorded was 38.411, and this was from an untreated rabbit. After oral mebendazole treatment for two days the minimum thickness was 19211 and after three days 28811. The maximum thickness of adventitia, measured in a lesion from a three-day-treated rabbit, was 96011, and a notable feature of the host response was the appearance of dense new fibrous connective tissue in the space left by the rapidly shrinking parasite. Lesions from untreated rabbits had an average mean diameter of 4· 205 mm (range 2·024 to 5· 394 mm); those from rabbits which had ingested mebendazole for three days had an average mean diameter of 4·935 mm (range 4·347 to 5·355 mm), while those from rabbits which had ingested mebendazole-medicated feed for six days had an average mean diameter of 3·86 mm (range 2·728 to 5·254 mm). The average increase in mean lesion diameter from untreated to three-daytreated rabbits was 17%, while the lesions from six-day-treated rabbits were, on average, 8% smaller than those from untreated rabbits. All lesions removed from rabbits after ingestion of mebendazole-medicated feed for six days invariably contained totally collapsed cystercerci which were being invaded by inflammatory cells. Heath, Christie and Chevis' have shown that such lesions continue to shrink and finally resolve to small, hard nodules. Cysticerci of T. pisiformis bear a formal resemblance to some secondary hydatid cysts, since they occur in the peritoneal cavity of the rabbit, loosely attached to the omentum and surrounded by a thin, but active, host capsule (adventitia). The parasite is thus more vulnerable to chemotherapeutic attack than are primary hydatid cysts in large organs or bone. Evidence exists, however, to show that mebendazole has exceptional potency against a wide range of larval cestodes and this may be a reliable indication that even deeply embedded cysts will be amenable to treatment with mebendazole, under the appropriate treatment regimen; prolonged treatment is possible with a drug of such negligible toxicity. Mebendazole is a very potent, orally active anthelmintic currently in wide use in the treatment of both human and animal helminthiases (for reviews see Janssen? and Chevis'). The work reported by Heath and Chevis" has been extended by Campbell, McCracken and Blair," who have shown mebendazole to be the most active member of a group of nine benzimidazole derivatives used against the cystic stages of T. crassiceps in mice; they also record that mebendazole is highly active against cystic Echinococcus multi/ocularis in rats. In concert with Dr Beard, I believe that mebendazole offers both physicians and surgeons a further option in the management of hydatid disease, and its use should be energetically encouraged. Ethnor Pty Ltd, R. A. F. CHEVIS. The Oaks, N.S.W. 2570.


Patient drug adherence is a major problem especially in the prevention of cardiovascular disease of atherosclerotic origin. On one hand, antihypertensive drugs and hypolipidemic drugs/statins are among the most successful, ones the other hand, they are among the drugs which are most frequently skipped by the patients. Improvement could be realized by education of patients, more frequent follow-ups, as well as by the use of new technologies involving specific dispensers and other, even more sophisticated methods. Nevertheless, among the most successful strategies is the simplification of medication, particularly the use of drugs with a longer half-life and the use of combination of several drugs in a single tablet. Therefore, we have quite wide range of options to improve patient compliance. However, some disadvantages should be kept in mind associated with these techniques. The aim of this article is to discuss potential problems and solutions associated with patient adherence/compliance with respect to antihypertensive and hypolipidemic treatment with an emphasis on practical approach.Key words: drug adherence - dyslipidemia - hypertension - pharmacotherapy.


Nucleic acid aptamers isolated from the systematic evolution of ligands by exponential enrichment (SELEX) have the capacity to recognize various classes of target molecules with high affinity and specificity. In this context, the development of aptamer-based molecular recognition tools has become a very interesting and promising analytical strategy during the last few years. In this review, the molecular recognition features of aptamers as well as the key factors for their practical applicability to the chromatographic and capillary electrophoretic fields are summarized.


BACKGROUND
Maternal iron deficiency (ID) is associated with poor pregnancy and fetal outcomes. The effect is thought to be mediated by the placenta but there is no comprehensive assessment of placental responses to maternal ID. Additionally, whether the influence of maternal ID on the placenta differs by fetal sex is unknown.

OBJECTIVES
To identify gene and protein signatures of ID mouse placentas at mid-gestation. A secondary objective was to profile the expression of iron genes in mouse placentas across gestation.

METHODS
We used a real-time PCR-based array to determine the mRNA expression of all known iron genes in mouse placentas at embryonic day (E) 12.5, E14.5, E16.5, and E19.5 (n = 3 placentas/time point). To determine the effect of maternal ID, we performed RNA sequencing and proteomics in male and female placentas from ID and iron-adequate mice at E12.5 (n = 8 dams/diet).

RESULTS
In female placentas, 6 genes, including transferrin receptor (Tfrc) and solute carrier family 11 member 2, were significantly changed by maternal ID. An additional 154 genes were altered in male ID placentas. A proteomic analysis quantified 7662 proteins in the placenta. Proteins translated from iron-responsive element (IRE)-containing mRNA were altered in abundance; ferritin and ferroportin 1 decreased, while TFRC increased in ID placentas. Less than 4% of the significantly altered genes in ID placentas occurred both at the transcriptional and translational levels.

CONCLUSIONS
Our data demonstrate that the impact of maternal ID on placental gene expression in mice is limited in scope and magnitude at mid-gestation. We provide strong evidence for IRE-based transcriptional and translational coordination of iron gene expression in the mouse placenta. Finally, we discover sexually dimorphic effects of maternal ID on placental gene expression, with more genes and pathways altered in male compared with female mouse placentas.


Liver cirrhosis disease is an important cause of death worldwide. Therefore, early diagnosis of the disease is very important. Machine learning algorithms are frequently used due to its high performance in the field of health, as in many areas. In this study, Multilayer Perceptron‐Artificial Neural Networks, Decision Trees, Random Forest, Naïve Bayes, Support Vector Machines, K‐Nearest Neighborhood, and Logistic Regression classification algorithms are used to classify the factors affecting liver cirrhosis. The performances of these algorithms are compared according to the accuracy rate, F measure, sensitivity, specificity and Kappa score on real data obtained from 2000 liver cirrhosis patients, and the factors affecting the disease are classified with the most appropriate algorithm. In addition, more than 50 articles covering both liver disease and classification methods are reviewed and the latest developments are presented in the study.


Fairly large differences in seasonal climate variation have been determined to exist between Brazil and the southeastern United States. Differences in the seasonal variations in rainfall and temperature result significant recurring changes in the moisture content, bark content, and pins and fines content of Pinus taeda chips being processed in the Southern US, while only minor differences occur in Southern Brazil. The milder climate and the significantly reduced seasonal variation in Southern Brazil result in P. taeda trees with lower specific gravity and about three times more earlywood to latewood fibers than trees grown within the Southern US. The current study determined the magnitude of seasonal variations for both the Southern US and for Brazil. The study further determined the percentage of earlywood and latewood fibers in the two locations. Controlled laboratory pulping studies were performed to determine the impact of these fiber differences upon the resulting kraft pulp physical properties. The increased percentage of earlywood fibers results in bleachable grade pine pulp with reduced intrinsic fiber strength and reduced tear and tensile strength. The large percentage of earlywood fibers also results in a significant increase in the Pulmac fiber bonding index and increased Mullen strength. The rupture strength, measured as modulus of elasticity, of structural lumber produced from Southern Brazil pine is also significantly lower than


Proceedings: AACR 103rd Annual Meeting 2012‐‐ Mar 31‐Apr 4, 2012; Chicago, IL

Background: Tobacco smoke contains several myelotropic carcinogens (i.e., benzene, 1,3 butadiene and formaldehyde) and is strongly suspected of damaging pluripotential hematopoietic stem cells. Objective: To examine the role of tobacco smoking in the etiology of childhood acute lymphocytic leukemia (ALL) and myeloid leukemia (AML), defined by phenotypic feature and type of chromosomal aberrations at diagnosis, such as translocation t(12:21) or high hyperdiploidy (51+ chromosomes). Method: Children (0-14 years old) newly diagnosed with ALL (n=839) and AML (n=145) were enrolled in a case-control study in California (1995-2008). Population-based controls (n=1226) were matched to cases on age, sex, Hispanic status, and maternal race. Parents provided information on exposure to tobacco smoking before and after their child's birth. Conventional karyotype and fluorescence in situ hybridization (FISH) data were abstracted from the medical reports. Additional FISH assays using pre-treatment bone marrow specimens were conducted to complete cytogenetic classification. Unconditional logistic regression analyses were used to estimate the odds ratios (OR) and 95% confidence intervals (CI) for developing leukemia, using binary variable for ever/never smoked (ORbinary) and continuous variable for number of cigarettes smoked per day (ORcig). All models included the matching factors and household income. Results: In univariate analyses, elevated risks of B-cell ALL (n=722) were associated with pre-conception paternal smoking ("PCPS") (ORcig= 1.02; 95% CI:1.00-1.03; p=0.04) and child's passive smoking ("CPS") after birth (ORbinary=1.32; 95% CI:1.21-3.50; p=0.02). Analyses using mutually exclusive exposure variables (i.e., only "PCPS," only "CPS," and both "PCPS-CPS," compared to no smoking) showed that the elevated risk of B-cell ALL was limited to children exposed to both "PCPS-CPS" (OR=1.50, 95% CI:1.10-2.04). The magnitude of this association increased for 133 B-cell ALL cases harboring chromosomal translocation t(12;21) (OR=2.37; 95% CI:1.41-4.01). Weaker associations were seen between "PCPS" and "CPS" and B-cell ALL harboring other chromosome translocations (n=82) or deletions (n=63). Tobacco smoking did not appear to be associated with hyperdiploid B-cell ALL (n=228) and T-cell ALL (n=70). Child's passive smoking conferred a 1.5-fold increased risk of AML (95% CI:0.98-2.26; p=0.06), with a higher risk observed for those with chromosome aberrations linked to a "favorable" prognosis (ORbinary=1.94; p=0.07; n=80). No excess risks were seen with maternal smoking during pregnancy, after accounting for other sources of smoking. Conclusions: Exposure to tobacco smoking is an important predictor of childhood ALL, and possibly AML. The observed risks contrast by phenotypic and cytogenetic subtype, providing insights in the etiology of the disease.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 662. doi:1538-7445.AM2012-662


Sam Patrick, 2 August Geelmuyden, Sebastian Erne, Carlo F. Barenghi, and Silke Weinfurtner 6 Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, V6T 1Z1, Canada Institute of Quantum Science and Engineering, Texas A&M University, College Station, Texas, 77840, US School of Mathematical Sciences, University of Nottingham, University Park, Nottingham, NG7 2RD, UK Vienna Center for Quantum Science and Technology, Atominstitut, TU Wien, Stadionallee 2, 1020 Vienna, Austria Joint Quantum Centre Durham-Newcastle, School of Mathematics, Statistics and Physics, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK Centre for the Mathematics and Theoretical Physics of Quantum Non-Equilibrium Systems, University of Nottingham, Nottingham, NG7 2RD, UK (Dated: December 24, 2021)


Epidermal growth factor receptor (EGFR) is a tyrosine kinase receptor that stimulates cell proliferation and survival and becomes dysregulated in a range of solid tumours in man. It is recognized as a key oncogenic driver and has become a favoured therapeutic target and a prognostic and predictive marker of cancer in man. In animals, EGFR dysregulation is emerging as a potential factor in the development of a number of naturally occurring tumours including mammary, lung, glial and epithelial cancers. Comparative analyses suggest that these diseases share many features with equivalent diseases in man and EGFR may have value as a prognostic or a biological marker of animal disease. There is still little direct evidence that EGFR is a critical oncogenic driver in naturally occurring animal disease and there are no veterinary trials of EGFR-targeted therapy. These will be critical steps in establishing a role for EGFR in veterinary oncology.


Understanding spatial and temporal neuronal activities is crucial for finding the cure for brain related ailments and advancement of our knowledge about the brain itself. This paper discusses our recent finding of the patternable rough textured gold microwire for neurochemical sensing. We have successfully fabricated the ∼5 µm wide and ∼ 60 nm thick gold microwires based electrochemical sensor. We produced these microwires along the edge of lithographically patterned nickel thin film. A nickel thin film edge was shadowed by the photoresist overhang during electrochemical growth only to allowgold deposition along the edges. Our electrochemical growth conditions yielded very rough textured sensor. Rough textured biosensors are highly desirable for increasing surface/volume ratio for efficient electrochemical sensing. These rough-textured microwires were transformed into the functional neurochemical sensor to detect dopamine. Our voltammetry and chronoamperometry studies on rough textured microwires based sensor confirmed the successful detection of dopamine.


High Efficiency Video Coding (HEVC) is presently the advancing standard with enhanced compression arrangement when related with the former video (AVC) standards. This paper provides a survey on this standard and is being done on efficient implementation of de blocking filters. The De blocking filters used in this standard reduces the blocking artifacts which increases the video quality. The SAO (Sample Adaptive Offset) which is done subsequent to de blocking is the introduction of advanced loop filtering. High level parallelism tools are employed in this standard. This compression capability can be implemented in broadcasting applications. An estimation of quality, file size and compression ratio has been made in this paper by using Codec Visa simulation software which proves that H.265 has better efficiency than H.264.


In this paper, we describe a method for synthesizing inductive invariants for cyberphysical aerospace systems that are parameterized on the number of participants, such as the number of aircraft involved in a coordinated maneuver. The methodology is useful for automating the traditionally manual process of deductive verification of safety properties, such as collision avoidance, and establishes such properties regardless of the number of participants involved in a protocol. We illustrate the methodology using a simplified model of the landing protocol of the Small Aircraft Transportation System (SATS) as a case study. Each participant (aircraft) in the protocol is modeled as a hybrid automaton with both discrete and continuous states and potentially nondeterministic evolution thereof. Discrete states change instantaneously according to transitions and continuous states evolve according to rectangular differential inclusions. The invariant synthesis method enables a fully automatic verification of the main safety property of SATS, namely, safe separation of aircraft on approach to the runway. The method is implemented in a prototype verification tool called Passel. We present promising experimental results using the methodology, which has enabled a fully automatic proof of safe separation for the model of SATS.


Background: Central neuraxial blockade is associated with shivering in 40-60% of the patients. A popularly used drug to control shivering is pethidine. The present study was conducted to evaluate the effect of tramadol on shivering and compare it with the efficacy of pethidine. The study was also intended to compare the haemodynamics, complications and recurrence of shivering with the use of pethidine and tramadol. Subjects and Methods: This prospective comparative study was conducted in Department of Anaesthesiology, Akash Institute of Medical Sciences and Research Centre, Devanahalli, Bengaluru. In this study, 80 consenting patients of either gender, aged between 20-60 years, in American Society of Anesthesiologists (ASA) Grades 1, 2 and 3 according to ASA who experienced shivering during or immediately after elective surgeries under central neuraxial blockade (spinal, epidural and combined spinal and epidural) were randomized to receive either pethidine 1mg/kg or tramadol 1 mg/kg for control of shivering. The time interval for the onset of shivering after regional anaesthesia, onset of disappearance of shivering after drug administration, complete disappearance of shivering, hemodynamics, recurrence of shivering and complications were recorded. Results: There was no statistical difference in the onset of disappearance between the 2 groups (p=0.615). Time taken for complete disappearance of shivering after 5 minutes interval period was statistically more in Group T (17.5% vs 5% in Group P) with p= 0.154. Recurrence of shivering occurred more in the tramadol group as compared to pethidine group which was strongly significant statistically (27.5% vs 5.0%) with p=0.006. However the incidence of complications was higher with pethidine with a greater drop in mean blood pressure, increased indicators of respiratory depression, more sedation, greater nausea, vomiting and itching. Conclusion:  The present study results may conclude that tramadol is an effective drug in the control of shivering with more stable hemodynamic and fewer side effects such as sedation, respiratory depression, nausea, vomiting and itching. However one must be prepared for a slight delay in the onset of its action and expect a recurrence of shivering which may require further therapy. Pethidine, with its equal efficacy may be advocated in patients allergic to tramadol and where sedation is desirable.


Background CD47 interaction with SIRPɑ acts as a "do not eat me" signal, which is exploited by cancer cells to downregulate immune surveillance. Given mounting evidence regarding the pivotal role of this axis in bridging the innate and adaptive immunity, there has been intense interest to develop a mechanism of blockade for therapeutic purposes. Preliminary data from clinical trials are now being reported, and we aimed to summarize and analyze these findings. Methods We performed a comprehensive systematic review of relevant databases and conference abstracts. Eligible studies included clinical trials using CD47 and/or SIRPɑ inhibitors in cancer treatment reporting oncologic outcome or toxicity data. Nonlinear mixed models were applied for comparison of response, with study as a random effect. Results We retrieved 317 articles, 24 of which were eligible. These included a total of 771 response-evaluable patients with hematologic (47.1%) and solid tumors (52.9%). Of these, 6.4% experienced complete response, 10.4% partial response, and 26.1% stable disease for a 16.7% objective response rate (ORR), 42.8% disease control rate (DCR), and 4.8-month median duration of response (table 1). ORR was significantly higher for hematologic cancers (25.3%) than solid cancers (9.1%, p=0.042). Seven CD47 inhibitors and six SIRPɑ inhibitors were given alone or combined with checkpoint inhibitors, targeted therapy, and/or chemotherapy. In solid cancers, SIRPɑ inhibitors had a higher ORR (16.2%) than CD47 inhibitors (2.8%, p=0.079). This was particularly true for combination therapies using SIRPɑ inhibitors (ORR 28.3% vs 3.0% in CD47 inhibitors, p=0.010). Response was seen in head and neck, colorectal, endometrial, ovarian, hepatocellular, nonsmall cell lung, and HER2+ gastroesophageal cancers. Doselimiting toxicity (DLT) was seen in 3.3% of patients (5.4% CD47 inhibitors, 1.4% SIRPɑ inhibitors; p=0.01). The frequency of treatment-related adverse events(TRAEs) grade 3 was 18.0% and was similar between the two groups (p=0.082) and mostly laboratory abnormalities. For CD47 inhibitors, the most common toxicities included grade 1-2 fatigue (27.2%), headache (21.0%), anemia (20.5%), and infusion-related reaction (IRR, 17.6%). For SIRPɑ inhibitors, these included grade 1-2 IRR (23.1%), and fatigue (15.8%). CD47 inhibitors were significantly more likely than SIRPɑ inhibitors to cause grade 1-2 fever, chills, nausea/vomiting, headache, and anemia. Conclusions CD47-SIRPɑ inhibition shows promise in cancer therapy. SIRPɑ inhibitor combination therapies have higher response rates in solid tumors than CD47 inhibitor combination therapies. Hematologic changes were the main TRAEs, and SIRPɑ inhibitors seemed to have a better grade 1-2 toxicity profile. Overall, treatment was well-tolerated with minimal DLTs. Abstract 1387 Table 1 Patient-level data on the efficacy of CD47-SIRPɑ inhibitors


Purpose: This article discusses the use of mixed methods research in tourism. It provides the rationale for the use of mixed methods and discusses the context in which this was chosen and used. It outlines the major research philosophies, and their advantages and disadvantages, and discusses the systematic, sequential, step-by-step research processes that were employed. The article also analyses the potential usefulness of specific qualitative data collection techniques.

Method: The context of the article was a study investigating what tourists associate with tourism destination quality (henceforth referred to as the TDQ study). The article indicates the nature of the phases of research in the TDQ study, beginning with the qualitative exploratory research involved. It discusses how questions were designed, and the pre-testing and piloting of questions and research techniques. It provides details on the main qualitative and subsequent quantitative phases of the research.

Findings: The article argues that an initial systematic qualitative phase of research can be used within an overall mixed methods approach to precede a quantitative phase with a successful outcome in terms of robust and rigorous research findings. Additionally, the results of the pilot study data indicate the superiority of the in–depth interviews technique over focus group interviews and open-ended questionnaires in terms of the technique's effectiveness, efficiency, and ability to generate in-depth, detailed and unique data.

Research and conclusion limitation: The article discusses only one case study in detail.

Practical implication: Although not intended to be prescriptive, this article could be used as a blueprint for those involved in research involving similar methodology.

Originality: This article advances knowledge of the effectiveness of mixed method methodologies and techniques in tourism studies. By providing a detailed account of a systematic sequential mixed method approach, the paper provides insights into and a potential blueprint for researchers interested in conducting such research.

Type of paper: research methodology article.


This paper examines the phonotactic processes in Yoruba adaptation of English syllable structures. It investigates the nativization of English consonant structure in the word-initial and word-final positions by Yoruba-English bilinguals. From the contact and influence of the English language and Yoruba language in an ESL environment, the fundamental thrust of linguistics would be to explicate the influence that one language would have on another. In this case, the focus is on the effects the English has on Yoruba. When these effects are viewed, it is discovered that structural rules are affected. Our findings reveal that vowel epenthesis is not constantly the repair device. Analysis of data shows that consonants are either preserved or deleted which justifies the earlier position of scholars of foreign syllable modifications.


Resistance in Plasmodium falciparum to amodiaquine (AQ) can be reversed in vitro with with antihistaminic and tricyclic antidepressant compounds, but its significance in vivo is unclear. The present report presents the enhancement of the antimalarial efficacy of AQ by chlorpheniramine, an H1 receptor antagonist that reverses chloroquine (CQ) resistance in vitro and enhances its efficacy in vivo, in five children who failed CQ and/or AQ treatment, and who were subsequently retreated and cured with a combination of AQ plus CP, despite the fact that parasites infecting the children harboured mutant pfcrtT76 and pfmdr1Y86 alleles associated with AQ resistance. This suggests a potential clinical application of the reversal phenomenon.


Abstract. The Water Informatics in Science and Engineering Centre for Doctoral Training (WISE CDT) offers a postgraduate programme that fosters enhanced levels of innovation and collaboration by training a cohort of engineers and scientists at the boundary of water informatics, science and engineering. The WISE CDT was established in 2014 with funding from the
UK Engineering and Physical Sciences Research Council (EPSRC) amongst the
universities of Bath, Bristol, Cardiff and Exeter. The WISE CDT will
ultimately graduate over 80 PhD candidates trained in a non-traditional
4-year UK doctoral programme that integrates teaching and research elements
in close collaboration with a range of industrial partners. WISE focuses on
cohort-based education and equips the PhD candidates with a wide range of
skills developed through workshops and other activities to maximise
candidate abilities and experiences. We discuss the need for, the structure
and results of the WISE CDT, which has been ongoing from 2013–2022 (final year of graduation). We conclude with lessons learned and an outlook for PhD training, based on our experience with this programme.


Large-scale variation in chromosome size was analyzed in 35 natural isolates of Escherichia coli by physical mapping with a restriction enzyme whose sites are restricted to rDNA operons. Although the genetic maps and chromosome lengths of the laboratory strains E. coli K12 and Salmonella enterica sv. Typhimurium LT2 are highly congruent, chromosome lengths among natural strains of E. coli can differ by as much as 1 Mb, ranging from 4.5 to 5.5 Mb in length. This variation has been generated by multiple changes dispersed throughout the genome, and these alterations are correlated; i.e., additions to one portion of the chromosome are often accompanied by additions to other chromosomal regions. This pattern of variation is most probably the result of selection acting to maintain equal distances between the replication origin and terminus on each side of the circular chromosome. There is a large phylogenetic component to the observed size variation: natural isolates from certain subgroups of E. coli have consistently larger chromosome, suggesting that much of the additional DNA in larger chromosomes is shared through common ancestry. There is no significant correlation between genome sizes and growth rates, which counters the view that the streamlining of bacterial genomes is a response to selection for faster growth rates in natural populations.


Background: Pathogenic mutations in breast cancer susceptibility gene 1 (BRCA1) are the common causes for germline as well as sporadic aggressive subtypes of breast cancer. This study was conducted to know BRCA1 expression in breast cancer by immunohistochemistry (IHC) testing. Methods: This was a cross-sectional study conducted in the Department of Medical Oncology, Vardhman Mahavir Medical College and Safdarjung hospital, New Delhi, from July 2016 to April 2018. The patients with confirmed diagnosis if breast cancer and aged >18 years were included in the study. BRCA1 expression, estrogen/progesterone receptor (ER/PR) status, and Human epidermal growth factor receptor 2 (Her 2-neu) were evaluated by IHC in all patients. Results: Of the 50 patients enrolled, the mean (± standard deviation) age was 53 (±11.76) years; 17 (34%) were in the range of 41–50 years, while 13 (26%) were in the range of 51–60 years. The distribution of patients with breast cancer according to risk factors showed that family history of cancer was present in 8 (16%), prebenign breast disease in 5 (10%), use of hormone replacement therapy/oral contraceptives pills in 31 (62%), exposure to radiation in 2 (4%) and history of smoking in 15 (30%) patients. Metastasis was seen in 43 (86%) patients and the prevalence of BRCA1 was 8% (n = 4); three patients in the age group of 41–50 years and one patient in the age group of 31–40 years. A negative BRCA1 expression was observed in 46 (92%) patients; 40/46 patients had >40 years and 39/46 patients had no family history of cancer. Similarly, of the 17 and 33 pre- and post-menopausal patients, 16 and 30 patients had negative BRCA1 expression, respectively. BRCA1 expression was negative in all the ER/PR receptor and Her-2-neu-positive patients. Histological Grade II tumors were observed in 26 (52%) patients, of whom 22 patients showed negative BRCA1 expression. Conclusion: The prevalence of BRCA1 among breast cancer patients was 8%. Studies with larger sample size are needed to further assess BRCA1 gene mutations and determine clinical usefulness as a potential biomarker by IHC.


The diagnosis of sacral neoplasms is often delayed because they tend to remain clinically silent for a long time. Imaging is useful at all stages of managing sacral bone tumors: from the detection of the neoplasm to the long-term follow-up. Radiographs are recommended as the modality of choice to begin the imaging workup of a patient with known or suspected sacral pathology. More sensitive examinations such as computerized tomography (CT), magnetic resonance (MRI), or scintigraphy are often necessary. The morphological features of the lesions on CT and MRI help to orientate the diagnosis. Although some imaging characteristics are helpful to limit the differential diagnosis, an imaging-guided biopsy is often ultimately required to establish a specific diagnosis. Imaging is of paramount importance even in the long-term follow-up in order to assess any residual tumor when surgical resection is incomplete, to assess the efficacy of adjuvant chemotherapy and radiotherapy, and to detect recurrence.


This paper aims to approach the policy discourse on appropriate policies for digital intellectual property from the vantage point of distributional justice. It argues that it is impossible to evaluate the adequacy of specific intellectual property arrangements from a distributive justice point of view without addressing broader issues. A thorough discussion of distributive justice issues inevitably raises more fundamental questions of how we think about intellectual property, what values we associate with it and how we perceive the involved trade-offs. The paper therefore opens with a brief review of the fundamental shared beliefs about the values that IP systems encode and promote (section II). The first part is all about imagination, a central factor when dealing with the 'what is?' and 'what should we do?' with regard to digital intellectual property. In short I attempt in this section to contribute to an imaginative rewiring of the intellectual property discourse. Sooner or later, the discussion of specific policy details runs up against what are often implicit descriptive and normative presumptions that heavily prejudge the discourse, despite their questionable validity. Making these presumptions explicit and exposing their tenuous nature is a necessary step for outlining plausible alternatives. The strategy of choice for this endeavour is creative destruction. The demolition work involves an examination of the predominant conceptual, empirical and normative templates that steer intellectual property policy-making. They are found to be incomplete and inconclusive at best, misleading and biased at worst.This conceptual reframing sets the stage for the second part (sections III and IV), a more open and imaginative discussion of practical concerns and trends with regard to intellectual property rules for the digital economy . Along the way I will emphasize 'distributive justice' as an analytical corrective and argue that it offers a fresh and richer perspective on intellectual property in the digital realm. The scope and complexity of the issues makes an exhaustive discussion impossible. I will confine myself to some high profile developments that illustrate what is at stake.In order to avoid instant obsolesce in a rapidly evolving socio-technical environment the analysis does not so much dwell on the status quo as it takes a forward-looking approach. A more speculative outlook directs attention from current benefits and costs to future opportunities and challenges. The added uncertainty and higher margin of error appears justified. It is offset by enhanced opportunities to move beyond reactive end-of the pipe fixes to more profound questions of institutional choice and thus consider a more encompassing, systemic notion of justice.The concluding part (section V) is the most positive. And the most difficult. It seeks to move from conceptual critique to practical ways forward. I will try to point out some feasible innovative proposals that translate concerns of fairness and global justice into workable institutional arrangements for ownership and access in the digital age. And I will argue that we have already moved beyond mere scenario-building and can already find incipient proof of concept, offering a reasonable justification for more imaginative digital IP policies.


An experiment was run to determine if androgynous people have transcended traditional sex roles or merely incorporated both sex roles into their repertoire. Masculine sex-typed, feminine sex-typed, and androgynous people listed as many masculine and feminine stereotypes as they could think of in a time-limited task. Highly sex-typed individuals showed more awareness of their own sex's attributes than the other sex's stereotypes. Androgynous people showed greater awareness of both sexes' attributes as compared with sex-typed people, indicating support for the incorporation hypothesis rather than the transcendance hypothesis. However, the stereotypes androgynous people listed were somewhat less evaluative in tone compared with those of sex-typed people, Overall, subjects listed more stereotypes of females than males, and female stereotypes were more negative than male stereotypes.


The purpose of this review is to present a concise overview of the types of radiation, methods of dispersal, injury patterns, and treatment considerations in a scenario involving radiation-based weapons of mass destruction. Radiation-related casualties, although uncommon, are a potential threat because more nations and organizations are developing the technology for producing radioactive substances capable of being used as weapons.


In the intensive care setting patient monitors generate many alarms. These alarms are frequently benign, but also unobserved as the caregiver is not at the location where the alarm is delivered. We developed a web-interface, integrated with an alarm manager that provides access to the "patient event" data. Alarm messages can be displayed by care unit and patient. Vital signs at the moment of the "patient event", as well as before and after can be displayed. The interface is compatible with the main Smartphone platforms (iPhone, Android, Blackberry, Windows Mobile and Symbian) and may facilitate a faster, more adequate response by caregivers to patient monitor alarms.


To test the hypothesis that an apoptotic process plays a role in the pathogenesis of cerebral lesions in cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), we examined samples from frontal, temporal, insular, and occipital regions, basal ganglia, and cerebellum from 4 patients with CADASIL, 2 with Binswanger disease, and 3 controls. Apoptotic cells were identified using in situ end labeling and activated caspase 3 immunostaining. Immunolabeling for Notch3, the &bgr;-amyloid protein precursor, and phosphorylated neurofilament protein was performed on successive sections. Apoptosis of vascular cells was markedly increased in status cribrosus in CADASIL, both in basal ganglia and subcortical white matter, suggesting that concomitantly with Notch3 deposition it may play a causative role in the dilatation of Virchow-Robin spaces. Neuronal apoptosis was found in CADASIL, mostly in cortical layers 3 and 5. Its severity correlated semiquantitatively with the extent of ischemic lesions and axonal damage in the underlying white matter. It was more severe in demented patients. Only occasional apoptotic neurons were found in the Binswanger cases and none in the controls. This supports the view that neuronal apoptosis may contribute to cortical atrophy and cognitive impairment in patients with CADASIL and that it may, at least partly, result from axonal damage in the underlying white matter.


A psychophysical experiment was performed to determine the behavioral correlates of visual acuity in the Northern bluejay (Cyanocitta cristata ). Maximum resolution for this species of jay was 3.4 minutes of arc between 0.0 and 1.0 log millilamberts . Evidence was obtained for two different components of the acuity function thought to be mediated by rods at low luminance levels and cones at higher luminance levels. Results were discussed and compared to other avian species with special reference to the functional significance of both foveal and extra-foveal regions of the retina.


In this paper, we introduce a new two-dimensional nonlinear oscillator with an infinite number of coexisting limit cycles. These limit cycles form a layer-by-layer structure which is very unusual. Forty percent of these limit cycles are self-excited attractors while sixty percent of them are hidden attractors. Changing this new system to its forced version, we introduce a new chaotic system with an infinite number of coexisting strange attractors. We implement this system through field programmable gate arrays.


Being the most common sulfide minerals, Arsenopyrite and pyrite under oxidizing conditions breaks down to release acids of As and S into the environment, leading to acid mine drainage with high concentrations of dissolved As. In this research, the dissolution of gold ore (with FeS2 and FeAsS as the main sulfides) from Tianli gold mine, Liaoning province, China was investigated. The experiments were conducted in 500mL conical flasks containing 200mL of three different media, 3% pulp density and 1.6 initial pH. The results indicated that treatment with mix culture medium resulted in the dissolution of 99% of Arsenic and 99% of iron, which was higher as compared with when treated in the same culture medium after centrifugation for 20 minutes which in turn higher in comparison with when treated in acidic and pure sterile system. The oxidation potential, Eh of the mix culture medium reached 680mV (vs.SCE) within the first three days of the experiment where as that of centrifuged, acidic and sterile media reached 580, 450 and 445mV (vs.SCE) respectively. The pH tends to increase within the first three days which eventually decreased to nearly one toward ending, courtesy of pyrite which is believed to be net acid releasing sulfide. The dissolution is suggested to be a combined effect of enzymes, ferric iron ions and organic acids. It was observed that enzymes and ferric ions played an essential role in the dissolution process.


Abstract: Umbilical cord prolapse is an uncommon obstetric emergency with high neonatal morbidity and mortality. It is a rare entity with incidence ranging from 0.1 to 0.6%. Timely recognition and immediate interventions are needed for better outcome. Here, we present a case of 28-year-old multigravida of term pregnancy with cord prolapse of seven hours following rupture of membrane. She was experiencing vaginal leakage in the absence of abdominal pain, and was referred from the peripheral health center with the provisional diagnosis of cord prolapse. She finally underwent emergency caesarean section with good neonatal outcome at tertiary care center.


The effects of hypo-, normo- and hypercapnia on the variations in arterial oxygenation and their indices in critical patients with acute respiratory failure (ARF) receiving mechanical ventilation are studied. It is a prospective and randomized study carried out in multidisciplinary ICU. Fifteen ARF patients, intubated and mechanically ventilated, were studied within the first 48 h of evolution. Three stages were delimited: I) 30 min after the beginning of anaesthesia; II) 30 min after adding 30 cm of dead space (VD); III) 30 min after replacing the previous VD with VD of 60 cm. Ventilation parameters and FiO2 were kept stable. Stage I was characterized by respiratory alkalosis and stage II by normal acid-base balance with an increase in PaO2 (p < 0.01) and a decrease in intrapulmonary shunt (Qsp/Qt) (p < 0.001); the indices alveolar to arterial oxygen tension gradient [P(A-a)O2], respiratory index (R.I.) and estimated shunt (Est Shunt) also decreased significantly, whereas arterial to alveolar oxygen tension ratio (PaO2/PAO2) and arterial oxygen tension to inspired oxygen fraction ration (PaO2/FiO2) increased significantly. In stage III there was pure hypercapnic acidosis, with decreases in PAO2 (p < 0.001), P(A-a)O2 (p < 0.01) and R.I. (p < 0.05), while PaO2, Qsp/Qt, Est Shunt, PaO2/PAO2 and PaO2/FiO2 remained stable with respect to the previous situation. The observed PaO2 differs (p < 0.05) from the expected PaO2 in stage III. It is suggested that local or regional modifications of pulmonary perfusion are responsible for the observed variations. The P(A-a)O2 and R.I. indices do not make it possible to differentiate the causes of arterial hypoxemia in the presence of hypercapnia.


The important role that field-aligned Birkeland currents play in solar terrestrial coupling processes has been known from satellite observations for twenty years. Many satellites have been launched since the last Solar-Terrestrial Symposium with instruments capable of investigating the characteristics of Birkeland currents and their relationship to visible and UV auroral forms, particle precipitation, and convection flow patterns. An important result that has emerged is the close relationship between largescale Birkeland currents and the orientation of the interplanetary magnetic field. These observations emphasize the fact that Birkeland currents are involved in a wide range of space plasma processes which range from small-scale ionospheric instabilities and irregularities to global scale energy coupling processes between the magnetosphere and solar wind.


The stages followed in buying decision process vary across the consumer group. The reason for this variation is due to the change in demographic features of the consumers, occupational changes, and knowledge derived through education, disposable income and majorly thinking process differences amongst genders. Broadly consumers can be classified into two large groups, based on gender, male and female. Sensitivity of a few class of consumer, getting attached with the product / brand emotionally due to the influence of the various factors due to the cognitive changes amongst the two gender groups. Many consumers' buy the products which would reflect their self-image. Several internal & external factors influence the consumers of both the groups to act towards the buying process. The reasons may not be visible explicitly but subconsciously there will be lot of behavioural activities which will be going on in the minds of male and female consumers. These changes may be due to the cognitive and affective motives between these two genders. As a marketer, one has to understand these changing motives between the gender groups and plan their marketing / promotion activities in order to attract both the group of consumers. In this paper authors attempt to study and present empirically the characterisation of genders in consumer buying decision process in Indian organised retail industry. Keywords: Organised Retail Industry, Consumer Buying Decision Process, Gender Characterisation JEL Classifications: D11, L8, M31


New method for rapid and quantitative analysis of 6-benzylaminopurine (6-BA) residues in sprout beans was studied by using FAST-SPE and portable surface-enhanced Raman spectroscopy (SERS). With homemade sprout bean samples as blank control, 6-BA solutions extracted from inserted-treatment samples showed typical characteristic Raman peaks at 1002 cm(-1) tested by SERS, and normalized 1002 cm(-1) intensities had a good linear relationship with gradient concentrations of 6-BA insert-standard solutions. The high concentration linear range was 0.5-14 microg x mL(-1), and the low one was 0. 1-2 microg x mL(-1). The quantitative detection limit was down to 0.02 mg x kg(-1) that was below the maximum allowable residues (MAL) of 0. 2 mg kg(-1) in related National Standard. The recoveries were 82.3%-95.1% and the RSD was below 5%. This method with portable equipment and simple pre-treatment showed good reproducibility, short test time-consuming and easy operating, and thus it would provide efficient and sensitive solutions for large-scale on-site and rapid detections.


The effectiveness of different cryodevices (open-pulled straw (OPS), electron microscopy grid (EMG), and Cryotop was evaluated for vitrification of immature bovine oocytes. Polar body, metaphase II stage (MII), survivability, and subsequent developmental rates were determined. Only oocytes with four or five layers of cumulus cells were used. Oocytes were equilibrated in two vitrification solutions - 1: 10% DMSO + 10% ethylene glycol (EG) for 30-45sec and 2: 20% DMSO + 20% EG +0.5M sucrose for 25sec -, mounted on one of the cryodevices and directly plunged into liquid nitrogen for 10 days. Immature vitrified oocytes using Cryotop showed the highest rates of polar body extrusion (PB) and nuclear maturity (MII); 41 and 58% respectively. Vitrified oocytes using OPS and EMG showed 26 and 32%; and 35 and 46% of PB and MII rates, respectively. The highest survivability resulted from Cryotop and EMG groups and no significant difference was found between them. Vitrified oocytes using Cryotop had the highest cleavage and blastocyst rates. All of the mean rates for vitrified immature oocytes were significantly lower than that of control group (P<0.05). The results of this study showed the superiority of Cryotop device for vitrification of immature bovine oocytes


We consider the problem of scheduling packets transmission across the switching fabric in an input-queued switch. In order to achieve maximum throughput, scheduling algorithms usually employ the queue length as a parameter for determining the priority to serve a given queue. Unfortunately, optimal schedulers are too complex to be implemented directly in hardware, which is the only viable solution in high-end switches, since scheduling decisions must be taken in very short time, of order of ns. Conversely, implement able algorithms, based on parallel and greedy decisions, are inefficient in terms of throughput. In this work we do not propose any new scheduling algorithm or switching architecture, but a novel scheme to optimize the performance of a pre-existing scheduler. Indeed, we propose to assist the scheduling decision by considering "message" values instead of queue lengths. Such messages are obtained by running an iterative parallel algorithm (efficiently implement able in hardware and fully compatible with pre-existing schedulers), based on a rigorous Belief-Propagation approach. We show that BP-assisted scheduling is able to boost the performance of a given scheduler, reaching almost optimal throughput, even under critical traffic scenarios.


The extent of emergent vegetation can be a useful indicator of lake health and identify trends and changes over time. However, field data to characterize emergent vegetation may not be available (especially over longer time periods) or may be limited to small, isolated areas. We present a case study using Lands at data to generate indicators that represent emergent vegetation extent in the near-shoreline and tributary delta areas of Malheur Lake, Oregon, USA. Malheur Lake has a large non-native carp population that may significantly affect emergent vegetation and adversely impact reservoir health. This study evaluates long-term trends in emergent vegetation and correlation with common environmental variables other than carp, to determine if emergent vegetation changes can be explained. We selected late June images for this study as vegetation is relatively mature in late June and visible, but has not completely grown-in providing a better indication of vegetation coverage in satellite images. To explore trends in historic emergent vegetation extent, we identified eight regions-of-interest (ROI): three inlet areas, three wet-shore areas (swampy areas), and two dry-shore areas (less swampy areas) around Malheur Lake and computed the Normalized Difference Vegetation Index (NDVI) using 30 years of Lands at images from 1984 to 2013. For each ROI we generated time-series data to quantify the emergent vegetation as determined by the percent of area covered by pixels that had NDVI values greater than 0.2, using cutoff as an indicator of vegetation. For correlation, we produced a corresponding time series of the lake area using the Modified Normalized Difference Water Index (MNDWI) to identify water pixels. We investigated the correlation of vegetation coverage (an indicator of emergent vegetation) with lake area, June precipitation, and average daily maximum temperatures for a period from two months prior to one month after the June collection (April, May, June, and July); all parameters that could affect vegetation growth. We found minimal correlation over time of the vegetative extent in any of the eight ROIs with the selected parameters, indicating that there are other factors which drive emergent vegetation extent in Malheur Lake. This study demonstrates that Landsat data have sufficient spatial and temporal detail to provide insight into ecosystem changes over relatively long periods and offers a method to study historic trends in reservoir health and evaluate potential influences. We expect future work will explore other potential drivers of emergent vegetation extent in Malheur Lake, such as carp populations. Carp were not considered in this study as we did not have access to data that reflect carp numbers over this 30 year period.


One of the distinguishing features of anthropology is its reliance on the ethnographic method of sustained, long-term fieldwork in a given 'field' or set of 'fields'. This reliance on practical engagement, along with the rise in the popularity of practice theory, and embodiment as a paradigm of not only the acquisition and performance of knowledge but also as a founded mode of being-in-the-world, has resulted in discursive and epistemic deadlocks or limitations being translated into practical or methodological deadlocks. In this article I want to highlight the theoretical oversights of reliance on practicality as a means of dealing with issues which in essence are epistemic and categorial but which are translated as methodological problems. After exemplifying these categorial misnomers I want to propose that what we as anthropologists encounter in many cases as insufficiencies in our understanding of certain topics cannot be overcome with more sophisticated and nuanced methods, rather we gain more by acknowledging such insufficiencies as constituting the type of knowledge we are trying to gain.


Insulin resistance (IR) impairs cerebrovascular responses to several stimuli in Zucker obese (ZO) rats. However, cerebral artery responses after subarachnoid hemorrhage (SAH) have not been described in IR. We hypothesized that IR worsens vascular reactions after a mild SAH. Hemolyzed blood (300 μl) or saline was infused (10 μl/min) into the cisterna magna of 11-13-wk-old ZO (n = 25) and Zucker lean (ZL) rats (n = 25). One day later, dilator responses of the basilar artery (BA) and its side branch (BA-Br) to acetylcholine (ACh, 10(-6) M), cromakalim (10(-7) M, 10(-6) M), and sodium nitroprusside (10(-7) M) were recorded with intravital videomicroscopy. The baseline diameter of the BA was increased both in the ZO and ZL rats 24 h after the hemolysate injection. Saline-injected ZO animals showed reduced dilation to ACh (BA = 9 ± 3 vs. 22 ± 4%; and BA-Br = 23 ± 5 vs. 37 ± 7%) compared with ZL rats. Hemolysate injection blunted the response to ACh in both the ZO (BA = 4 ± 2%; and BA-Br = 12 ± 3%) and ZL (BA = 7 ± 2%; and BA-Br = 11 ± 3%) rats. Cromakalim (10(-6) M)-induced dilation was significantly reduced in the hemolysate-injected ZO animals compared with the saline control (BA = 13 ± 3 vs. 26 ± 5%; and BA-Br = 28 ± 8 vs. 44 ± 9%) and in the hemolysate-injected ZL rats compared with their saline control (BA = 24 ± 4 vs. 32 ± 4%; but not BA-Br = 39 ± 6 vs. 59 ± 9%). No significant difference in sodium nitroprusside reactivity was observed. Western blot analysis of the BA showed a lower baseline level of neuronal nitric oxide synthase expression and an enhanced cyclooxygenase-2 level in the hemolysate-injected ZO animals. In summary, cerebrovascular reactivity to both endothelium-dependent and -independent stimuli is severely compromised by SAH in IR animals.


The transition zone between terrestrial and freshwater habitats is highly dynamic, with large variability in environmental characteristics. Here, we investigate how these characteristics influence the nutritional status and performance of plant life forms inhabiting this zone. Specifically, we hypothesised that: (i) tissue nutrient content differs among submerged, amphibious and terrestrial species, with higher content in submerged species; and (ii) PNUE gradually increases from submerged over amphibious to terrestrial species, reflecting differences in the availability of N and P relative to inorganic C across the land-water ecotone. We found that tissue nutrient content was generally higher in submerged species and C:N and C:P ratios indicated that content was limiting for growth for ca. 20% of plant individuals, particularly those belonging to amphibious and terrestrial species groups. As predicted, the PNUE increased from submerged over amphibious to terrestrial species. We suggest that this pattern reflects that amphibious and terrestrial species allocate proportionally more nutrients into processes of importance for photosynthesis at saturating CO2 availability, i.e. enzymes involved in substrate regeneration, compared to submerged species that are acclimated to lower availability of CO2 in the aquatic environment. Our results indicate that enhanced nutrient loading may affect relative abundance of the three species groups in the land-water ecotone of stream ecosystems. Thus, species of amphibious and terrestrial species groups are likely to benefit more from enhanced nutrient availability in terms of faster growth compared to aquatic species, and that this can be detrimental to aquatic species growing in the land-water ecotone, e.g. Ranunculus and Callitriche.


Abstract. Accurate river streamflow forecasts are a vital tool in the fields of water security, flood preparation and agriculture, as well as in industry more generally. Over the last century, physics-based models traditionally used to produce streamflow forecasts have become increasingly sophisticated, with forecasts improving accordingly. However, the development of such models is often bound by two soft limits: empiricism – many physical relationships are represented by computationally efficient empirical formulae; and data sparsity – the calibration of these models often requires long time-series of high-resolution observational data at both surface and subsurface levels. Artificial neural networks have previously been shown to be highly effective at simulating nonlinear systems where knowledge of the underlying physical relationships is incomplete. However, they also suffer from issues related to data sparsity. Recently, hybrid forecasting systems, which combine the traditional physics-based approach with statistical forecasting techniques, have been investigated for use in hydrological applications. In this study, we test the efficacy of a type of neural network, the long-short term memory (LSTM), at predicting streamflow at ten river gauge stations across various climatic regions of the western United States. The LSTM is trained on the catchment-mean meteorological and hydrological variables from the ERA5 and GloFAS-ERA5 reanalysis as well as historical streamflow observations. The performance of these hybrid forecasts is evaluated and compared to the performance of both raw and bias-corrected output from the Copernicus Emergency Management Service (CEMS) physics-based Global Flood Awareness System (GloFAS). Two periods are considered, a testing phase (June 2019 to June 2020), during which the models were fed with ERA5 data to investigate how well they simulated streamflow at the ten stations; and an operational phase (September 2020 to October 2021), during which the models were fed forecast variables from ECMWF's Integrated Forecast System (IFS), to investigate how well they could predict streamflow at lead times of up to ten days. All three models performed well in the testing phase, with the LSTM performing the best (skilful at nine stations, of which six were highly skilful). Similarly, the LSTM forecasts beat the raw and bias-corrected GloFAS forecasts during the operational phase, with skilful 5-day forecasts at nine stations, of which five were highly skilful. Implications and potential improvements to this work are discussed. In summary, this is the first time an LSTM has been used in a hybrid system to create a medium-range streamflow forecast, and in beating established physics-based models, shows promise for the future of neural networks in hydrological forecasting.


Anatomic localization of spine lesions, shown by Tc-99m phosphonate SPECT, to facet joint or pedicle is often difficult due to limitations in resolution. Indirect localization, relating lesion position on sagittal reconstruction to the adjacent visible vertebral bodies and also to patient spine radiographs, might be required. Some laterally placed lesions, however, cannot be visualized in the more midline slices showing the vertebral bodies. Oblique tomographic reconstruction overcomes this limitation.


BACKGROUND AND PURPOSE: Type 2 FCD is one of the main causes of drug-resistant partial epilepsy. Its detection by MR imaging has greatly improved surgical outcomes, but it often remains overlooked. Our objective was to determine the prevalence of typical MR imaging criteria for type 2 FCD, to provide a precise MR imaging pattern, and to optimize its detection. MATERIALS AND METHODS: We retrospectively reviewed 1.5T MR imaging of 71 consecutive patients with histologically proved type 2 FCD. The protocol included millimetric 3D T1-weighted, 2D coronal and axial T2-weighted, and 2D or 3D FLAIR images. Two experienced neuroradiologists looked for 6 criteria: cortex thickening, cortical and subcortical signal changes, blurring of the GWM interface, the "transmantle" sign, and gyral abnormalities. The frequency of each sign and their combination were assessed. We compared the delay between epilepsy onset and surgery, taking into account the time of type 2 FCD detection by MR imaging. RESULTS: Only 42 patients (59%) had positive MR imaging findings. In this group, a combination of at least 3 criteria was always found. Subcortical signal changes were constant. Three characteristic signs (cortical thickening, GWM blurring, and transmantle sign) were combined in 64% of patients, indicating that MR imaging can be highly suggestive. However, typical features of type 2 FCD were overlooked on initial imaging in 40% of patients, contributing to a delay in referral for surgical consideration (17 versus 11.5 years when initial MR imaging findings were positive). CONCLUSIONS: A combination of 3 major MR imaging signs allows type 2 FCD to be recognized in clinical practice, thereby enabling early identification of candidates for surgery.


Background: Debriefing improves care and reduces error. To be effective, debriefs should be facilitated by trained individuals utilising structured and validated tools. Currently, in UK ambulance services there is no published evidence that structured processes utilising validated tools are being consistently delivered by trained facilitators, potentially impacting clinical practice. Methods: A pre-intervention survey related to debriefing was sent to 1000 clinicians within a specific geographical area of the trust via e-mail. In addition, 12 senior or advanced paramedics were recruited from the same area to participate in a training day and 12-week trial, utilising the Debrief Diamond as part of post-event debriefing. Following the trial period, all facilitators and participants of any recorded debriefs were invited to complete a post-intervention survey. Results: A total of 130 staff responded to the pre-intervention survey, with 22% reporting that previous debriefs had not identified areas for learning, and 13% reporting that previous debriefs had not identified good practice, learning opportunities or near misses. Post-intervention, 89% believed the process of debriefing was improved utilising a structured framework, 85% stated trained individuals improved the process, 93% reported the identification of good practice, 70% identified team level learning and 100% of facilitators reported improvements in identifying and supporting learning. Conclusion: Improvements in identifying good practice and learning opportunities were reported by both clinicians and facilitators in this evaluation, reflecting current evidence that structured and facilitated debriefs support safer care through the identification and subsequent reduction of human error. Consequently, the evaluation of appropriate debrief frameworks to provide consistency and validity to clinical debriefs in the pre-hospital environment should be considered to support safer clinical care.


Atherosclerotic renovascular disease (ARVD) accounts for >90% of renal artery stenosis (RAS) in Western populations; the remainder are due to fibromuscular disease (FMD). The epidemiology is quite different in the Indian subcontinent and the Far East where Takayasu's arteritis may be responsible for up to 60% of RAS cases. ARVD is very commonly associated with hypertension and renal dysfunction; it is a disease of ageing and is frequently observed in association with other vascular diseases. There is increasing evidence that in patients with ARVD and chronic renal dysfunction the aetiology of the latter is more often due to long-standing intra-renal vascular disease and parenchymal injury than to reversible ischaemia. This is reflected in the variability in renal functional outcome following revascularization, with an improvement in renal function being observed in only a minority of patients; the majority show no apparent change or even a decline in renal function. A major current challenge concerns the identification of patients who are likely to benefit from renal revascularization procedures, but technological advances in imaging offer potential in aiding this selection. Large-scale randomized controlled trials are required to determine the overall effects of renal artery intervention and, more specifically, to help identify which subgroups of patients will benefit from revascularization.


In this paper, we study learning visual classifiers from unstructured text descriptions at part precision with no training images. We propose a learning framework that is able to connect text terms to its relevant parts and suppress connections to non-visual text terms without any part-text annotations. For instance, this learning process enables terms like beak to be sparsely linked to the visual representation of parts like head, while reduces the effect of non-visual terms like migrate on classifier prediction. Images are encoded by a part-based CNN that detect bird parts and learn part-specific representation. Part-based visual classifiers are predicted from text descriptions of unseen visual classifiers to facilitate classification without training images (also known as zero-shot recognition). We performed our experiments on CUBirds 2011 dataset and improves the state-of-the-art textbased zero-shot recognition results from 34.7% to 43.6%. We also created large scale benchmarks on North American Bird Images augmented with text descriptions, where we also show that our approach outperforms existing methods. Our code, data, and models are publically available link [1].


Our purpose was to investigate genes and molecular mechanisms involved in patients with Leber congenital amaurosis (LCA) and to model this type of LCA for drug screening. Fibroblasts from two unrelated clinically identified patients with a yet undetermined gene mutation were reprogrammed to pluripotency by retroviral transduction. These human induced pluripotent stem cells (hiPSCs) were differentiated into neural stem cells (NSCs) that mimicked the neural tube stage and retinal pigmented epithelial (RPE) cells that could be targeted by the disease. A genome-wide transcriptome analysis was performed with Affymetrix Exon Array GeneChip(®), comparing LCA-hiPSCs derivatives to controls. A genomic search for alteration in all genes known to be involved in LCA revealed a common polymorphism on the GUCY2D gene, referenced as the LCA type I (OMIM *600179 and #204000), but the causative gene remained unknown. The hiPSCs expressed the key pluripotency factors and formed embryoid bodies in vitro containing cells originating from all three germ layers. They were successfully differentiated into NSC and RPE cells. One gene, NNAT, was upregulated in LCA cell populations, and three genes were downregulated, GSTT1, TRIM61 and ZNF558, with potential correlates for molecular mechanisms of this type of LCA, in particular for protein degradation and oxidative stress. The two LCA patient-specific iPSC lines will contribute to modeling LCA phenotypes and screening candidate drugs.


Localised alveolar defects are frequently found in partially edentulous patients. This impairs the prosthetic restoration of damaged area causing esthetic, phonetic and oral hygiene complications. Esthetically correct treatment of an alveolar ridge defect is a frequent challenge to dentists. Long term growth and development of clinical research in soft tissue and hard tissues has provided a means of treating problems of inadequate alveolar ridges necessary for restorative procedures. Treatment modalities vary with the class of ridge deformities involving an interdisciplinary approach. Such defects can be overcome with different surgical techniques. The onlay graft technique is primarily designed to gain the ridge height. A case report has been presented here for a patient with alveolar ridge defect in the maxillary anterior region corrected with soft tissue ridge augmentation using onlay graft technique. This technique has favored gain in tissue volume without any postsurgical complications.


An attempt to graft a spiritual philosophy into a materialistic stock would seem to be a hopeless undertaking. But it is in a sense attempted in this book. The author recognizes ends and purposes in the universe since they are given in human experience. Yet the mechanical explanation of things is necessary everywhere. Man is a machine, but he is a willing and purposing machine. The fact that his choices are predetermined does not alter the fact that they are choices. Thus the author thinks the dignity of man is in no way imperiled by his view, which, he declares, is midway between materialism and theism. The argument, however, does not convince. The view of the ultimate principle or meaning of the world is very vague and unsatisfactory. Choice, which is not an expression of freedom, does not leave man's dignity unimpaired. A God described as "the divinely grand ~mmanentorder of consistency, which is the foundation of all the uniformities of natural phenomena" is nota satisfying conception. The author in the latter part of the book gives the views of several other writers on both sides of the subject which make interesting reading. E. Y. MULLINS.


Facility management is a multidisciplinary function requiring a deep knowledge of the entire business and physical planning cycle, including the buildings, infrastructure, and people. Technology systems, disaster recovery planning, zoning compliance, furnishings, recycling programs, grounds maintenance--it all falls under the facility management umbrella. The sheer scope of duties requires a far-reaching reference for staying abreast of the latest innovations and best practices.
The Facility Management Handbook is that one essential book. Insightful overviews, case studies, and practical guidelines pave the way for successful planning, budgeting, real estate transactions, construction, emergency preparedness, security, operations, maintenance, and more. This thoroughly revised fourth edition examines cutting-edge technologies and includes new information on Building Information Modeling (BIM), contracting and project management methods, FASB and IASB requirements, distributed working, and sustainability reporting.
Balancing an in-depth look at the fundamentals with a view toward what the future holds, the book is essential reading for every facility management professional.


This study is to test a model dealing with effect of accordance of self-picture on trade mark commitment- this model claims that accommodation of self-picture on trade mark commitment is of positive and significant influence through functional accordance, involving consumer with product and business relation quality. In this study automobiles made by Iran khodro were used because these products have higher costs than other ones made in Iran and most of consumers regard higher value made in Iran and most of consumers regard higher value for them. Polling was performed through questionnaire from Iran khodro corporation products. This study shows that self picture accommodation, functional accommodation and involving with product is of positive and significant influence on trade mark commitment.


In order to investigate the role of autoantibodies in the pathogenesis of autoimmune thyroid diseases and for clinicoimmunological control of treatment, an enzyme-linked immunosorbent assay (ELISA) for the determination of autoantibodies against human thyroid microsomal antigens (TMA) was developed. ELISA was evaluated using sera from 156 patients with different thyroid pathology and diabetes mellitus and from 54 healthy donors. In parallel experiments the same sera were analyzed by an indirect immunofluorescence method for the presence of autoantibodies against TMA. Comparing all these data, both techniques appeared to have the same specificity, however ELISA was more sensitive than the indirect immunofluorescence method. Another advantage of ELISA is a possibility of long-term storage of microplates with immobilized antigen material without loss of antigenic activity. ELISA can be used for the determination of autoantibodies against TMA in human sera as a routine technique in clinical practice and experiments.


Pectus excavatum is a deformity of the chest wall characterized by a sternal depression and possibly cardiac and pulmonary compression. Procedures performed during infancy for its correction may disrupt local anatomy and pose challenges to breast and reconstructive surgeons during mastectomy and reconstruction. We present a case report of a 45-year-old woman who had a Ravitch procedure for pectus excavatum correction in infancy who was diagnosed with right breast cancer undergoing bilateral nipple-sparing mastectomy with immediate deep inferior epigastric perforator flap reconstruction. A computed tomography angiography was used to study chest and abdominal anatomy before surgery. Patient safely underwent immediate breast reconstruction with deep inferior epigastric perforator flaps using the internal mammary vessels as recipient vessels. This case highlights the importance of preoperative vascular imaging and proper communication between the breast and plastic surgery teams during reconstructive surgery. It also displays the safety of performing immediate breast reconstruction using free tissue transfer and the internal mammary vessels as recipients for microvascular anastomosis.


Purpose: To describe a sac embolization technique modification for type II endoleak prevention that makes a totally percutaneous approach feasible during endovascular aneurysm repair (EVAR) using the Excluder stent-graft. Technique: Percutaneous access of the common femoral arteries is obtained and 2 suture-mediated closure systems are placed on each side. A 16-F or 18-F sheath is placed for delivery of the Excluder stent-graft main body and a 16-F sheath is used on the contralateral side. After the stent-graft and contralateral limb component are delivered to their intended positions, a standard 0.035-inch hydrophilic guidewire is placed into the aneurysm sac through the same 16-F sheath. Then a 5-F, straight, 65-cm-long catheter is advanced over the standard wire into the sac in parallel with the contralateral limb. The contralateral limb is deployed, the standard guidewire is removed; coils are released through the 5-F catheter into the sac, followed by injection of 5 to 10 mL of double-component fibrin glue. Conclusion: Totally percutaneous, nonselective sac embolization during EVAR, with a single access on each femoral artery, is feasible and helpful to physicians who wish to perform intraoperative sac embolization without relevant changes in their usual EVAR procedure.


OBJECTIVES
The authors examined the costs and outcomes resulting from a natural experiment during which direct public access to poison control centers was restricted and then restored.

METHODS
Both societal and health care purchaser perspectives were used. Probability data were obtained from a natural experiment during which public callers from a large county in California were electronically blocked from directly accessing the poison control center. Callers were referred to 911, which had direct access to the poison control center, if they thought they had a poisoning emergency. We conducted telephone interviews of: (a) persons who attempted to call the poison control center for a child's poisoning exposure but who did not have direct access (n = 270) and (b) persons who called the poison control center after direct access was restored (n = 279). Cost data were obtained from primary data collection and from other sources. The outcome measure was the appropriateness of the treatment location (at home or at a health care facility). Caller-reported outcomes were also examined.

RESULTS
The average additional cost per blocked call was $10.89 from a societal perspective, or $33.14 from a health care purchaser perspective. Fourteen percent of callers with restricted access were treated at an inappropriate location, compared with only 2% of callers with direct poison control center access. Also, 14% did not obtain any professional advice after they attempted to call the poison control center, although 66% of these cases involved potentially toxic substances. Results were robust across a range of sensitivity analyses.

CONCLUSION
Restricting direct public access to poison control centers created additional costs to society, the health care sector, and callers.


We propose two disease transmission models: the SI model with di®u-sive terms as a model for transmission of avian in°uenza viruses among °ock withconstant population density, and the host-vector SI model with di®usive terms fortransmission among °ock and human. There is a threshold number that determinewhether the diseases become epidemic or not. It depends on three parameters: theaverage length of the infective period, the contact parameter, and the density ofsusceptible population at the initial time. With di®usive terms in the model, thespatial spread of the infection is obvious. Threshold number greater than one isalso the necessary condition for the spreading of infection in the form of a travelingpulse. Its minimum velocity can be determined. We implement the MacCormackmethod, and simulate the generation of a traveling pulse starting from one infectedbird. Numerically, we obtain the percentage of survival in °ock and human afterthe epidemic. We also simulate the minimal portion of immunization in order toprevent further spread. DOI :  http://dx.doi.org/10.22342/jims.188.8.131.52-49