This paper proposes a reinforcement learning architecture containing multiple "experts", each of which is a specialist in a different region in the overall state space. The central idea is that the different experts use qualitatively different (but sufficiently Markov) state representations, each of which captures different information regarding the true underlying world state, and which for that reason is suitable for a different part of the state space. The experts themselves learn to switch to another state representation (other expert) by having switching actions. Value functions can be learned using standard reinforcement learning algorithms. This architecture has important advantages in RL problems that have large state spaces or where a sensor system must inherently choose between mutually exclusive state representations. Experiments in a small, proof-of-principle experiment as well as a larger, more realistic experiment illustrate the validity of this approach


Background: Previous research has focused on the association between hemorrhagic transformation (HT) incidence and pre-procedural variables (i.e., baseline variables) rather than the association between HT incidence and endovascular treatment (EVT) procedural variables (e.g., stent retriever passes). Objective: To assess the association, if any, that exists between the number of stent retriever passes per procedure and the incidence of HT for patients undergoing mechanical thrombectomy. Methods: An endovascular database from a comprehensive stroke center was used to collect data on EVT patients treated with Trevo, Solitaire, or Penumbra stent retrievers from the years 2012 to 2017. Statistical analyses were conducted on the stent retriever passes, demographics, morbidities, medication usage, and outcomes and their association with HT. Results: Of the 329 total patients, 46 (14%) had HT. The HT group had an average [SD] of 1.65 [0.67] and range of [1–3] passes per procedure while the non-HT group had an average [SD] of 1.63 [0.86] and range of [1–5] passes per procedure. Admission NIHSS score (p = 0.0003) and the incidence of diabetes mellitus (DM) (p = 0.05) were significantly higher in the HT group. Subdividing HT into symptomatic and asymptomatic ICH groups failed to display significant differences in the distribution of the stent retriever passes (p = 0.969). The number of passes failed to show any association with HT (p = 0.804) while admission NIHSS score was found to have an OR of 1.07 (95%CI: 1.029–1.121, p = 0.001) with HT incidence. Conclusion: No significant association was found between HT incidence and the stent retriever passes. Further multicenter studies are warranted to corroborate our results.


Aim. To realize the educational programs on reproductive health protection among students and pupils. Materials and methods. Medicodemographic situation in a large industrial city (Perm) was analyzed. There was formed a group of lecturers for introduction of educational programs. More than 800 lectures were read, the quantity of listeners exceeded 20 000. Results. The number of abortions in the group of 15 to17-year-olds decreased by 75,6% (2006 - 546 cases, 2012 - 133) and the absolute number of abortions in the group of 18 to19-year-olds - by 71,2% (2006 - 962, 2012 - 277). Conclusion. Realization of national projects led to stabilization of birth rate indices, however, the preserved high level of abortions and ageing of women of reproductive age indicate a low reproductive potential. Informational and educational programs for youth are to be considered high-efficient for preserving reproductive health.


Background Cerebral angiography, or intra-arterial digital subtraction angiography (DSA), is a fluoroscopic imaging technique. In China, until recently, transfemoral access (TFA) has been used, rather than transradial access (TRA). This retrospective study aimed to compare transfemoral cerebral angiography (TFCA) with transradial cerebral angiography (TRCA) consecutively performed by the same operator, at a single center in China, to determine whether there were benefits from the shift from TFA to TRA in terms of efficiency, safety, and feasibility. Material/Methods A review of 1,048 cerebral angiograms in 980 patients was performed by a single operator from June 2014 to May 2018, including the TFA group (n=513) and the transradial access (TRA) group (n=535), and 39 patients underwent both TFA and TRA. The total procedure time, duration of fluoroscopy, catheterization success rate, image quality, length of stay in hospital, complications of the procedure, and patient preference were compared between the groups. Results Compared with TFCA, TRCA resulted in significantly shorter total procedure time, a higher catheterization success rate, better image quality, and shorter duration of hospital stay (P<0.05). There was no significant difference between the TFA and TRA groups for cardiovascular, cerebral, and access site complications. Patients in the TRA group showed a significantly reduced fluoroscopy time at the early stages of operator training (P<0.05). Patient preference included TRA (76.74%), TFA (16.28%), and no preference (6.89%). Conclusions During four years at a single center, and with a single operator, TRCA was safe, feasible, and more rapid when compared with TFCA.


We describe how Menominee Native Americans and Euro-American hunters differ with respect to how they perceive and think about nature (here, specifically animals and plants of the forest) as well as the role of humans in it. We call these models epistemological frameworks—folk theories that allow individuals to make inferences in specific situations, guiding the acquisition and formation of new knowledge. Using an approach that combines ethnographic research from anthropology with experimental approaches from related cognitive sciences, we explore the within- and between-cultural distributions of ideas, values, and beliefs and their behavioral consequences. Findings indicate that stereotyping of other groups is largely driven by differences in epistemological frameworks and resulting categorizations and interpretations of observed or assumed behaviors.


Rubisco activase (Rca) facilitates the release of sugar-phosphate inhibitors from the active sites of Rubisco and thereby plays a central role in initiating and sustaining Rubisco activation. In Arabidopsis, alternative splicing of a single Rca gene results in two Rca isoforms, Rca-α and Rca-β. Redox modulation of Rca-α regulates the function of Rca-α and Rca-β acting together to control Rubisco activation. Although Arabidopsis Rca-α alone less effectively activates Rubisco in vitro, it is not known how CO2 assimilation and plant growth are impacted. Here, we show two independent transgenic Arabidopsis lines expressing Rca-α in the absence of Rca-β ('Rca-α only' lines) grew more slowly in various light conditions, especially under low light or fluctuating light intensity, and in a short day photoperiod compared to wild type. Photosynthetic induction was slower in the Rca-α only lines, and they maintained a lower rate of CO2 assimilation during both photoperiod types. Our findings suggest Rca oligomers composed of Rca-α only are less effective in initiating and sustaining the activation of Rubisco than when Rca-β is also present. Currently there are no examples of any plant species that naturally express Rca-α only but numerous examples of species expressing Rca-β only. That Rca-α exists in most plant species, including many C3 and C4 food and bioenergy crops, implies its presence is adaptive under some circumstances. Supporting Information.


The molecular chaperone heat shock protein 90 (HSP90) is essential for the folding stability, intracellular disposition and proteolytic turnover of many of the key regulators of cell growth, differentiation and survival. These essential functions are used by the cells during the oncogenesis process to allow the tumor transformation and facilitate the rapid somatic evolution. Inhibition of HSP90 would provide combinatorial blockade of a range of oncogenic pathways, antagonizing many of the hallmark traits of cancer. Several HSP90 inhibitors are currently under clinical trial investigation for the treatment of cancer. This review summarizes the current state and progress achieved in the development of HSP90 inhibitors targeting the N-terminal ATP pocket, C-terminal domain, different compartmentalized isoforms, and protein (cochaperones and/or client proteins)/HSP90 interactions. In the context of drug discovery, the most relevant patents which appeared recently in the literature are discussed as well.


1. Geography Matters 2. The Changing Global Context 3. Geographies of Population and Migration 4. People and Nature 5. Cultural Geographies 6. Language, Communication, and Belief 7. Interpreting Places and Landscapes 8. Geographies of Economic Development 9. Geographies of Food and Agriculture 10. Political Geographies 11. Urbanization and the Global Urban System 12. City Spaces: Urban Structure


A review of growth parameters should be a routine part of pediatric care. Children and parents need to be helped in understanding normal growth and development. Variations in growth should be explained, and concerns of parents and children openly discussed. Age appropriate educational materials are often helpful. Children with abnormal growth should be referred promptly for definitive diagnosis, selection of treatable candidates, and monitoring.


The purpose of this study is to characterise the composition of a dehydrated amnion and chorion graft and investigate how factors released from this graft interact with cells important to the wound microenvironment using in vitro models. Characterisation was completed by proteomic analysis of growth factors and cytokines, evaluation of matrix components and protease inhibition, immunohistochemistry, and in vitro release of key growth factors and cytokines. To evaluate the effect of released factors on cells found within the microenvironment, in vitro assays including: cell proliferation, migration, gene expression, protein production, and intracellular pathway activation were used; additionally, responses of fibroblasts in the context of inflammation were measured. We found that released factors from dehydrated amnion/chorion membranes (dACM) stimulated cell proliferation, migration, and altered gene and protein expression profiles of cells important for wound repair in vitro. When cells were cultured in the presence of pro‐inflammatory cytokines, the addition of releasate from dACM resulted in an altered production of cytokines, including a reduction of pro‐inflammatory regulated on activation, normal T cell expressed and secreted (RANTES). In sum, the results presented here characterise the components of dACM, and in vitro studies were used to evaluate interactions of dACM with cell types important in wound healing.


We investigate the electron transport through a graphene nanoribbon (GNR) junction with zigzag edges. It is shown that the edge state and the magnetization properties of a GNR greatly influence its electron transport properties. By applying sufficient back-gate voltages to the lead parts of a zigzag GNR, the magnetization of the edges is quenched in the leadings parts, but is preserved in the center part of the junction. Without applying external transverse electric field, we show that, by preparing the junction in a ferromagnetic state, a strongly spin-polarized electron current can be obtained even though the incident electron current has no spin polarization.


Background The ways parents are supported at the end of their child's life and after death can profoundly affect the grieving process. Within children's hospices cold bedrooms, cooling blankets and cuddle cots are provided to enable families to be close and have unrestricted access to their child after death. Such facilities are thought to support parents in the initial stages of grief. However, there is wide variation in practice and almost no evidence to inform parents' decision-making during advance care planning. Aim We aim to map current practice and explore parents' experiences of using cold bedrooms and/or cooling blankets and/or cuddle cots – either in the hospice or at home – and the perceived impact of this on immediate and long term bereavement. Methods This study comprises two stages. First, a cross-sectional survey to gather data on previous and current practice, and reasons for inclusion of these facilities within the portfolio of care and support, collected via structured telephone interviews with heads of care in all UK children's hospices (n=52). Second, qualitative interviews with parents (n=30) exploring stories of the early days of bereavement and the support received from the hospice, their needs and desires in those early days and the perceived role of these facilities on early and subsequent experiences of bereavement. Survey data will be analysed using descriptive statistics and content analysis. Interviews will be analysed using narrative and thematic approaches. Results We will not have data to report but hope presenting this work will alert others to this research and generate connections and meaningful conversations with others with an interest in this area. Conclusions Findings will have implications for practice within children's hospices and also for statutory services which are beginning to offer this provision.


For design of deep-water riser arrays, consideration must be made of the possibility for mechanical contact between the different riser pipes. Both the anticipated frequency of collision and the resulting stresses in the pipes need to be estimated. Such an assessment need to cover a certain range of conditions regarding environmental loading and surface floater motions. The present paper outlines a procedure which admits the most "critical" conditions to be identified based on an iterative approach. For each "load case", which corresponds to a certain combination of environmental actions and surface floater motion, the corresponding contact stresses are computed. Furthermore, the accumulated damage for each load case (referred to a certain duration) is estimated. The numerical procedure for external load calculation is based on Computational Fluid Dynamics (CFD). For a given riser spacing, interpolation is performed during the response simulation in a pre-established data base. Contact between pipes is checked at each time step by looping through the nodal coordinates of the Finite Element Mesh which represents the pipe geometry. By assembling the response and accumulated damage which correspond to all the different load cases, the long-term probability distributions and weighted damage can be calculated. The procedure is applied to a particular example riser configuration. The effect of varying current direction (relative to the symmetry axis of the floater and riser configuration) on fatigue damage is focused upon in particular.© 2002 ASME


This study was aimed to screen the lignocellulolytic ability of selected fungi under laboratory conditions. In presence of lignin and hemicellulose will reduce the activity of cellulase. Wild type fungal strains which have cellulolytic activity along with lignolytic activity, hemicellulolytic activity, were isolated from different animal dung manure soils collected from Sri Venkateswara Go Samrakshanasaala, Tirupati. All starins were studied by cultural morphological characteristics and microscopic examinations. Seventy fungal strains were isolated and among which ten isolates found to have lingocellulolytic activity. The isolates namely Trichoderma, Aspergillus, Penicillum, Altrernaria, were found to be highly lingocellulolytic compared to the rest. This study showed that the fungal isolates with appreciable hydrolytic zones have good hydrolytic property of lignocelluloses.


This study focuses on the association between homeless veterans' prior utilization of medical, psychiatric, and substance abuse services and biopsychosocial characteristics reported at admission into a domiciliary care program. Given the large number of veterans in the US homeless population and their health care needs, understanding factors associated with health service use among homeless veterans is significant. Research participants were 429 homeless male veterans who had been admitted to the Domiciliary Care for Homeless Veterans Program site at the West Los Angeles Veterans Affairs Medical Center, between February 1988 and July 1992 for treatment of medical, psychiatric, or substance disorders. Results of logistic regression analyses indicated that self-reported need (chronic medical problems, serious psychiatric symptoms, combat stress, alcohol use) and evaluated need for care (evidence of liver dysfunction) were important to veterans' use of health services in the 6 months before program admission. Predisposing social structure factors (education, residential stability, and usual sleeping place) were also significant predictors of service utilization. Overall, need factors were more strongly related to service use. Supplementary logistic regression analyses indicated that comorbidity of need factors deserves attention in understanding homeless veterans' use of services. In conclusion, it is important to attend to predisposing social structure factors as potential barriers to care for homeless veterans.


Background Cardiovascular disease (CVD) is a major cause of morbidity and mortality in rheumatoid arthritis (RA). Increased cardiovascular risk in RA is attributed to both traditional risk factors and systemic inflammation over a long period. Limited experimental data exist on vascular involvement in arthritis models1,2,3. Thus, we developed a model that would mimic both vascular dysfunction and articular inflammation in RA, using collagen-induced arthritis (CIA) in in C57Bl/6 (B6) mice. Objectives To study the expression of vascular inflammatory markers and atheroma formation in CIA with and without concomitant hyperlipidic diet (HD). Methods CIA was induced in B6 mice with chicken type-II collagen (cCII) followed by a boost 21 days later. These mice were fed with a standard (chow) diet or with HD given for 12 weeks starting from the day of the boost. The control mice were not immunized (NI) but were fed either the standard diet or HD. Arthritis severity was evaluated using a validated clinical score. Aorta and synovial membranes were removed 15 weeks after the first cCII immunization. We analysed vascular cell adhesion molecule-1 (VCAM-1), inducible NO-synthase (iNOS) and interleukin-17 mRNA level in aorta with real-time quantitative PCR. VCAM-1 localisation in the aortic sinus was determined by immunohistochemistry. In addition, atherosclerotic plaques were assessed in the aorta. Results CIA was associated with high expression of VCAM-1, independently of the fed diet. VCAM-1 overexpression was detectable 4 weeks after cCII immunization and persisted at 15 weeks. HD induced atheroma plaque formation and aortic iNOS expression which were both independent from CIA. Concomitant CIA and HD had no additive effect on atheroma, VCAM-1 or iNOS expression. Conclusions In B6 mice, HD and CIA induce distinct and independent expression of large vessel inflammation markers. This model, sensitive to both CIA and experimental atherosclerosis may be relevant for the study of CVD in RA. References Asquith, D. L., Miller A. M., Hueber A. J., et al. Apolipoprotein E-deficient mice are resistant to the development of collagen-induced arthritis. Arthritis Rheum 2010.62:472-7. Postigo, J., Genre F., Iglesias M., et al. Exacerbation of type II collagen-induced arthritis in apolipoprotein E-deficient mice in association with the expansion of Th1 and Th17 cells. Arthritis Rheum 2011.63:971-80. Rose, S., Eren M., Murphy S., et al. A novel mouse model that develops spontaneous arthritis and is predisposed towards atherosclerosis. Ann Rheum Dis 2013.72:89-95. Disclosure of Interest None declared


Common buckwheat (Fagopyrum esculentum) is an annual self-incompatible plant that is widely grown. The genus Fagopyrum comprises more than 20 species, including F. cymosum, a perennial that, unlike common buckwheat, is highly resistant to excess water. In this study, we developed interspecific hybrids between F. esculentum and F. cymosum via embryo rescue, to improve undesirable traits of common buckwheat, such as low tolerance to excess water. The interspecific hybrids were confirmed by genomic in situ hybridization (GISH). We also developed DNA markers to confirm the identity of the hybrids and if genes derived from each genome were inherited by the next generation. Observations of pollen indicated that the interspecific hybrids were essentially sterile. Unpaired chromosomes and abnormal segregation during meiosis were likely responsible for the pollen sterility of the hybrids. These findings could facilitate buckwheat breeding to produce lines that can withstand harsh environments with wild or related species in the genus Fagopyrum.


A new design for skateboard trucks has been
developed and tested in an effort to reduce the uncomfortable
vibration experienced when riding a skateboard. The new design
interfaces with existing hardware but also features a split axle
geometry which allows the left and right wheels to move
independently. In order to determine whether the split axle trucks
improved rider comfort, the trucks were tested on a skateboard
outfitted with sensors that measure acceleration normal to the road
surface. Similar measurements were taken with standard skateboard
trucks to serve as a control. Multiple trials were run at each of
three different test speeds over a set course. Results showed that
the majority of the dominant vibration frequencies are in the range
of 20-450 Hz for both truck designs. The magnitude of the peak
acceleration and the arms were observed to increase faster with
speed for the standard truck design, and at the highest speed of 20
km/h the split axle design was shown (with 95% certainty) to have a
peak acceleration which was 96 m/s2 lower than that of the standard
truck. Overall the results suggest that the new split axle design
primarily improves rider comfort during localized vibration events
by reducing the peak acceleration that is experienced. This effect,
along with a reduction in the measured arms, become increasingly
apparent at higher speeds.


Background The aims of this study were to establish the prevalence of innocent cardiac murmurs in clinically healthy puppies, to investigate a possible correlation between the presence of an innocent murmur and hematocrit, and to describe the auscultation characteristics of innocent murmurs. Hypothesis Lower hematocrit contributes to the genesis of innocent murmurs. Animals Five hundred and eighty‐four client‐owned clinically healthy puppies, between 20 and 108 days old. Methods Two cross‐sectional surveys with a 1‐year (n = 389 pups) pilot and a half‐year (n = 195 pups) principal study periods. Cardiac auscultation was performed by a single, board‐certified cardiologist. Hematocrit was measured with an automatized hematology analyzer. Echocardiography was performed only on puppies with a cardiac murmur in the principal study. Results In the pilot study, 15% of the dogs had a murmur. Innocent murmur was diagnosed in 28% of the 195 dogs in the principal study. Innocent murmurs were systolic, mostly with a musical character and with a maximal intensity of 2 of 6, and mostly with the point of maximal intensity in the left cardiac base. The hematocrit was significantly lower in the group with a murmur compared to the group without (P = .023). Conclusions and Clinical Importance Innocent murmur was a common finding in puppies at the age when the first veterinary controls usually take place. Physiologic anemia contributes to the genesis of innocent murmurs in puppies. Rising hematocrit in growing puppies can explain the spontaneous disappearance of innocent murmurs with aging. Hematocrit did not differentiate innocent murmurs from abnormal murmurs.


Human activities are directly related to fossil fuel consumption and cause global warming and climate change effects by emitting greenhouse gas into the lower atmosphere. To reduce and adapt to such effects, renewable energy sources such as surface dams, including hydroelectric energy (HE) generation units, are gaining importance. In the current literature, HE potential calculations are based on formulations that are quite simple, clear and do not distinguish between different situations. In this paper, two classification methodologies are proposed for better assessment of HE production. The first one is based on the concept of the hypsographic curve to distinguish different drainage basin features into "Young," "Mature" and "Old." The second classification takes into account the newly defined energy index (EI) principle, which helps to classify the HE generation capability of drainage basins into "Very low," "Low," "Normal," "High" and "Very high." The application of the proposed methodology is presented for three drainage basins from the upstream sub‐basins of the Tigris River in Turkey. A comparison of the results shows that the proposed methodologies not only give numerical values but also sets linguistically rational and logical rules for the HE potential of a drainage basin. In the upstream basin of the Tigris River, the EI values vary between 0.705 and 0.122, corresponding to the "High" and "Low" categories, respectively. It is recommended that these two classification procedures be considered before the construction of any dam for HE production.


A 77-year-old female was referred to our hospital with hoarseness and an abnormal shadow on her chest X ray film. Computed tomography and aortography revealed aneurysms of the distal aortic arch and the infrarenal abdominal aorta. Total aortic arch replacement was performed successfully on the patient, utilizing hypothermic selective cerebral perfusion. The operation employed three technical characteristics for avoidance of cerebral complication. Those were as follows: First, total aortic arch replacement was performed instead of distal aortic arch replacement because of severe sclerosis of the proximal aortic arch. Secondly, to prevent cerebral embolism due to the thrombi on the wall of the abdominal aortic aneurysm, an arterial cannula for cardiopulmonary bypass was inserted in the ascending aorta initially and after completion of the distal anastomosis, it was placed on the graft. Thirdly, the so called "non clamping technique" operation was employed because clamping onto the sclerotic arteries might have caused cerebral embolism. There was no cerebral complication and the postoperative course was satisfactory.


Northern Apennines ophiolite complexes, consisting of peridotite-gabbro-basalt assemblages overlain by chert of Late Jurassic age, are probably fragments of oceanic crust created at a Mesozoic spreading center. Metalliferous sedimentary deposits are found at the base of the chert formation, close to the basalt-chert contact. The main mineral component of these deposits is braunite; the deposits are rich in Mn and contain less than 1 percent Fe; no equivalent Fe-rich sedimentary rocks have been observed. The geochemistry of the minor transition metals, of the rare-earth elements, Ba, U, and Th in these deposits, as well as their stratigraphic position, indicate that they are not similar to "hydrogenous" ferromanganese deposits from modern oceans; they instead show affinities to metalliferous deposits of hydrothermal origin associated with modern spreading centers. Fe-Cu-Zn-sulfide deposits are common in basalt of the Apennine ophiolite and are often close to the metalliferous sedimentary rocks. The metalliferous sedimentary rocks and the metal sulfide mineralizations probably originated as a result of the mobilization of metals from basalt during circulation of thermal waters in the basaltic-gabbroic crust close to a Mesozoic spreading center. Upper mantle volatiles may have provided additional metals to the thermal waters. The sulfide deposits formed during the subbottom convective circulation, whereas the manganiferous sediment originated from precipitation of the metals after discharge of the thermal solutions through the sea floor. Extensive metal fractionation may have occurred during the sub-bottom circulation, especially during deposition of the sulfide phases; the lack of Fe in the metalliferous sedimentary rocks may be due to such fractionation. This model can be applied to associations of sulfide ore and metalliferous sedimentary deposits in other ophiolitic complexes of various ages and to metallogenesis in modern spreading centers.


This thesis considers the transposition from short story into play, in the work of Verga and Pirandello, concentrating on a comparison between their methods of presenting the female characters in the two genres, and assessing what occurs when the voice of the narrator is replaced by the exchanges of the characters on stage. The main tenet is to challenge the critical view that women in the authors' work represent the weaker vessel. The close reading of the selected pairs of texts illustrates how, although the female characters take a subsidiary position in the triangular relationship in which they are involved, they nonetheless remain the catalysts of the action by precipitating the main events. Even though (off stage) women at the time were being denied a political voice, it is argued here that once the characters rely on dialogue in the passage from short story to play, they gain a voice of their own on stage. Their ability for articulation thus reveals the characters as women capable of discussing their thoughts and feelings for themselves, which ultimately enables them to break away from their traditional identification with nature and emotion – making an examination of this sort particularly relevant to the topic of women. Part of the investigation briefly discusses how contemporary (male) theatre critics responded to these leading roles, and takes into consideration the women who are instrumental in providing the link from the narrative genre to the theatrical: the role of the actress, particularly Eleonora Duse who had a significant influence on early interpretations of Verga's women and on Pirandello's developing notions of the merging of art and reality. In conclusion, the relationship between the techniques of the two authors in adapting their works from page to stage sheds new light on why the narrative genre is particularly suited to Verga's preoccupations, and why the dramatic form is more effective in exploring Pirandello's umorismo. Even though the diachronic overview of their theatre shows how Verga's approach veers towards the direction later taken by Pirandello, it also exemplifies how Pirandello exploits the means of the theatre to make significant innovations, spanning the transition from Realism to Modernism – a divergence from his predecessor which is emphasized through his treatment of the female voice on stage.


Abstract 3581

Poster Board III-518

We and others have previously shown that insertional activation of cellular genes caused by integrated retroviral vectors can lead to clonal dominance and malignant transformation. Pre-transplant diagnostics of vector flanking sequences and subsequent elimination of those clones that carry potentially dangerous integration sites prior to transplantation would dramatically improve the safety of clinical gene therapy regimens. Such a strategy requires efficient transduction of few or individual stem cells, their in vitro amplification and highly sensitive integration site determination before transplantation.

To define optimal time points for transduction and ascertain the transplantability of ex vivo expanded murine stem cell clones, single CD45+Lin−Rho+SP cells isolated from bone marrow of male C57BL/6J (B6J) mice were cultivated for 8-10 days in the presence of IL11, SCF and Flt3-L. 10% of the sorted cells formed clones in vitro . In 28% ± 5% of these clones, the first division occurred during the first 48 hours after sorting, another 32% ± 8% divided up to 72 hours after sorting and additional 33% ± 7% up to 96 hours after sorting. 7% ± 4% had undergone their first division at a later time point. To examine the transplantability after ex vivo expansion, individual cell clones (containing 12 to >600 cells) were transplanted together with 105 carrier cells into lethally irradiated sex-mismatched syngeneic mice. The presence of donor-derived cells in peripheral blood of 20 transplanted mice was analyzed by Y-chromosome specific PCR. 55% of the ex vivo expanded clones contributed to post-transplant hematopoiesis. 25% of these clones exhibited long-term activity for >6 months after transplantation. Interestingly, only cell clones that had undergone their first division 48-96 hours after cell sorting contributed to long-term post-transplant hematopoiesis.

For transduction, individual stem cell clones were spinoculated for 60 minutes with a GFP encoding lentiviral vector (MOI 100-5000). 5 days after transduction, 50% of cells generated by each clone were harvested, lysed and analyzed by LAM-PCR and integration site sequencing. After an additional 3 days, single clones were transplanted together with 105 carrier cells into lethally irradiated congeneic B6.SJL-PtprcaPepcb/BoyJ mice. Four weeks after transplantation, in 30% of these mice ≥0.4% CD45.1+ cells derived from single cell clones were detected in the peripheral blood. In 50% of these mice, the transduced clones contributed to myelopoiesis as well as lymphopoiesis for more than 24 weeks after transplantation, demonstrating that the longterm hematopoietic stem cell potential was retained after single cell marking and expansion.

These results demonstrate that single stem cell gene transfer and subsequent expansion is possible to allow integration site determination. Long-term stem cells with defined lentiviral integration sites can be selected for transplantation. In summary, we provide proof of concept that pre-transplant diagnostics of integration sites is feasible to increase the safety of gene therapy by eliminating stem cell clones from transplants that carry unwanted integration sites.

Disclosures: No relevant conflicts of interest to declare.


The L-H-L transitions have been analyzed mainly for high-field pulses (Bt ≈4 T) in JT-60U. The simultaneous response of electron temperature T e has been clearly observed during L-H-L transitions over a wide plasma region. This T e evolution is described as the result of the fast jump of electron heat diffusivity, δχ e, over the wide plasma region. Values of δχ e were obtained as 0.5 m2/s < | δχ e | < 1 m2/s, which usually increase with radius. The simultaneous response of ion temperature T i was also observed to be that of similar to the T e response. The jump of ion heat diffusivity, δχ i, is similar to that of δχ e and usually increases with radius, as does δχ e. In a low-field pulse (B t ≈2.5 T), | δχ i | is as large as 2 m2/s. Values of δχ are consistent with the change of the energy confinement time during transitions.


&NA; Causal inference with observational studies often relies on the assumptions of unconfoundedness and overlap of covariate distributions in different treatment groups. The overlap assumption is violated when some units have propensity scores close to 0 or 1, so both practical and theoretical researchers suggest dropping units with extreme estimated propensity scores. However, existing trimming methods often do not incorporate the uncertainty in this design stage and restrict inference to only the trimmed sample, due to the nonsmoothness of the trimming. We propose a smooth weighting, which approximates sample trimming and has better asymptotic properties. An advantage of our estimator is its asymptotic linearity, which ensures that the bootstrap can be used to make inference for the target population, incorporating uncertainty arising from both design and analysis stages. We extend the theory to the average treatment effect on the treated, suggesting trimming samples with estimated propensity scores close to 1.


Interferon-lambda (IFN-λ) is currently being investigated in a phase III clinical trial as a therapeutic against COVID-19. Exogenous IFN-λ restricts SARS-CoV-2 in vitro and in Balb/c and C57Bl/6 (WT) murine models of infection. However, roles of endogenously produced IFN-λ in SARS-CoV-2 pathogenesis are not currently known, and the overall mechanisms by which IFN-λ modulates the induction of protective immune responses in SARS-CoV-2 infections remains to be elucidated. We find that IFN-λ receptor deficient mice (Ifnlr1−/−) infected with mouse-adapted SARS-CoV-2 lose significantly more weight and have increased SARS-CoV-2 viral replication compared to WT through day 5 post infection. Intriguingly, Ifit3 and Ifitm3 are increased in the lungs of Ifnlr1−/− mice compared to WT following infection, despite similar IFN-α/β and IFN-λ mRNA levels, suggesting compensatory increases in type I IFN signaling are not driving the increased weight loss or ISG induction observed in Ifnlr1−/− mice. Global transcriptomics revealed induction of a suppressive immunoregulatory signature with increased IL-10 as a hallmark in Ifnlr1−/− lungs, suggesting IFN-λ is critically involved in regulating appropriate immune activation to limit SARS-CoV-2 pathogenesis. Histological analysis revealed a significant increase in CD45+ cells (but not neutrophils) in the lungs of Ifnlr1−/− mice compared to WT on day 5 post infection, and we identified increases in pathways associated with myeloid cell function and T cell activation in Ifnlr1−/− by comparative transcriptomics. Overall, broadening the understanding of how IFN-λ regulates SARS-CoV-2 infection, pathogenesis, and immunity will inform the utilization of IFN-λ as an immunotherapy and adjuvant.
 Supported by NIH Award K22 AI146141 to EAH.


Excitation of the 33D state of helium by electron impact has been studied by measurement of the linear and circular polarisation of the decay radiation emitted perpendicular to the scattering plane in a polarisation correlation experiment. Results are presented over the angular range 40-120' at an incident electron energy of 40 eV. Comparisons are made with recent measurements at scattering angles of 49 and 65' and with distorted-wave Born approximation calculations.


The Journal of Virology has experienced continuous growth since its inception in 1967. The first editor in chief, Bob Wagner, had an impressive vision for the journal, but I suspect that even he could not imagine the excitement that lay ahead. Our current impact factor is 5.308, and we are the no. 1 journal in virology as ranked by Eigenfactor score. The Journal of Virology was the top-cited journal in virology in 2008, with 86,000 citations. We were named one of the 100 most influential journals of the last 100 years in biology and medicine by the Special Libraries Association. The Journal of Virology authors, reviewers, and editors have a lot to be proud of.

Indeed, we are acquiring scientific knowledge at an unprecedented rate. Since all of us have grown up in this environment, it is difficult to imagine that it could be any other way. However, we must not forget that science as we know it is a remarkably fragile enterprise, and its most fundamental elements are challenged constantly. A sizable proportion of the public does not understand the basic principles or methods of science and technology, yet they demand treatments and cures. Scientists see solutions to the world's problems in the unfettered expansion and application of knowledge, but there are many nonscientists who yearn for simpler days when we didn't know as much. Some fear that science causes more problems than it solves. Some do not acknowledge facts as defined by science. Consequently, making decisions that depend on critical analyses of data has become increasingly difficult for the general public (witness the discussions in the news media of vaccination, obesity, genetically engineered food organisms, stem cell biology, cancer causes, global warming, etc.). Interestingly, United States taxpayers continue to provide substantial funding for science despite these disparate views.

How do we keep the scientific enterprise robust and engaged with the public? There are no easy solutions. It is not enough to do great research but to depend on others to keep the system functioning. We all must be involved in the care and feeding of our profession. Winston Churchill said, "We make a living by what we get; we make a life by what we give." All scientists must give more to sustain what we have. I encourage you to think about how you can make a contribution to promote scientific understanding in the general public. It need not be much, perhaps a letter to the editor of your local newspaper or a presentation about your work at a local high school, but enhancing an understanding of what we do and how we do it is essential if we are to solve the big problems that we face.

An activity of scientists that sustains and advances our profession is peer review. Where would we be without it? Volunteer peer reviewers are key to advancing scholarship and contributing to the quality of a research journal such as the Journal of Virology.

I take this opportunity to thank the 1,592 reviewers who reviewed all those manuscripts for the Journal of Virology last year (1 July 2008 to 19 June 2009). However, I want to single out twenty reviewers who were exceptional. Their efforts merit special recognition.

Dan Barouch, Beth Israel Deaconess Medical Center

Ben Berkhout, University of Amsterdam

Michel Brahic, Stanford University

Paul Clapham, University of Massachusetts Medical School

Bryan Cullen, Duke University Medical Center

Jean D. Dubuisson, Institut de Biologie de Lille and Institut Pasteur de Lille

Michael Emerman, Fred Hutchinson Cancer Research Center

Paul J. Farrell, Imperial College Faculty of Medicine

Thomas Gallagher, Loyola University Medical Center

Adam P. Geballe, Fred Hutchinson Cancer Research Center

Paul Goepfert, University of Alabama at Birmingham

Felicia Goodrum, University of Arizona

Ronald N. Harty, University of Pennsylvania School of Vet- erinary Medicine

Brett Lindenbach, Yale University

Karen L. Mossman, McMaster University

J.-H. James Ou, University of Southern California

Colin R. Parrish, Cornell University

James M. Pipas, University of Pittsburgh

Matthias J. Schnell, Thomas Jefferson University

John M. Taylor, Fox Chase Cancer Center

These twenty scientists stood out as defined by two important criteria. They reviewed 12 or more manuscripts in that period, and their average review time was 14 days or fewer. All authors appreciate a fast turnaround time, and these reviewers excelled at that. Their reviews were not only timely but also insightful; they improved the science that we published.

At a time when we all are asked to do more and more, such attention to reviewing manuscripts is simply outstanding. They set a high bar for all of us.


Implementation of an infrastructure to support digital pathology began in 2006 at Memorial Sloan Kettering Cancer Center. The public health emergency and COVID-19 pandemic regulations in New York City required a novel workflow to sustain existing operations. While regulatory enforcement discretions offered faculty workspace flexibility, a substantial portion of laboratory and digital pathology workflows require on-site presence of staff. Maintaining social distancing and offering staggered work schedules. Due to a decrease in patients seeking health care at the onset of the pandemic, a temporary decrease in patient specimens was observed. Hospital and travel regulations impacted onsite vendor technical support. Digital glass slide scanning activities onsite proceeded without interruption throughout the pandemic, with challenges including staff who required quarantine due to virus exposure, unrelated illness, family support, or lack of public transportation. During the public health emergency, we validated digital pathology systems for a remote pathology operation. Since March 2020, the departmental digital pathology staff were able to maintain scanning volumes of over 100 000 slides per month. The digital scanning team reprioritized archival slide scanning and participated in a remote sign-out validation and successful submission of New York State approval for a laboratory developed test. Digital pathology offers a health care delivery model where pathologists can perform their sign out duties at remote location and prevent disruptions to critical pathology services for patients seeking care at our institution during emergencies. Development of standard operating procedures to support digital workflows will maintain turnaround times and enable clinical operations during emergency or otherwise unanticipated events.


Context: Down syndrome (DS), which usually occurs due to an extra chromosome 21 or a partial trisomy, is the most common genetic cause of intellectual disability. The affected individuals usually present with characteristic clinical manifestations and are seen to be associated with various systemic defects. Aim: The aim of our study was to determine the major congenital anomalies associated with DS in the North Indian population. Methods: Blood samples of 51 children (0–10 years) who were screened for the suspicion of DS were collected. Karyotyping was conducted. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software version 21.0. Results: Out of the 51 suspected participants, karyotypes could be successfully obtained only for 40. Among these 40 participants, karyotypes of 35 were confirmed to be DS. Of these 35 confirmed cases, 21 (60%) were found to be associated with at least one major congenital anomaly, of which cardiac anomalies (34.2%) were most common, followed by gastrointestinal tract and genitourinary anomalies (11.4% each). Central nervous system and musculoskeletal anomalies constituted 5.7% each. Mosaic variant of DS was found to be least associated with congenital anomalies. Conclusion: The patients with DS should be carefully examined for systemic anomalies. Most cases are usually associated with at least one congenital anomaly.


It has been said that Candida albicans can be a better clinician than most physicians and may detect systemic abnormalities before they are recognizable at the laboratory level. Chronic mucocutaneous candidiasis developed in a 7-year-old boy long before a diagnosis of marked hypothyroidism (thyroid stimulating hormone, 825μU/ml; T 4 test [tetraiodothyronine], 0.3μg/100 ml) could be established. Normalization of the thyroid status by replacement therapy resulted in dramatic improvement of the infection which had previously been resistant to prolonged anticandidal treatment.


Abstract Autologous fat grafts have been used successfully for structural fat grafting in facial, lip, and hand rejuvenation, body contour improvement, and traumatic defect restoration. The purposes of this study were to define a new fat graft harvesting and processing technique, which is named the "Lopasce technique" (low-pressure aspiration and slow centrifugation technique), and to evaluate the late clinical outcomes of fat grafting by this technique for different indications. A retrospective study was performed using the medical records of 21 patients (17 women and four men). The mean injected fat volume was 33.2 ± 34 cc (range 6–125 cc). The mean follow-up period was 13.2 ± 5.6 months (range 6–26 months). Postoperative results were evaluated by subjective and objective methods. In the subjective evaluation, 19 patients stated that there had been little resorption and that it was not necessary to repeat the fat grafting, one patient reported that the fat was resorbed in part, and one patient reported that the fat was resorbed completely. In the objective evaluation, the amount of fat graft taken in the recipient sites was between 60%–80% (average 70%) when compared with preoperative and late postoperative photographs of the patients at the 6- and 26-month follow-ups. Fat grafting is a simple, effective, and reproducible technique with a high satisfaction rate and few disadvantages or complications. We consider that structural fat grafting with the lopasce technique is an easy, effective, and long-lasting treatment for correction of congenital or acquired defects associated with various medical conditions.


MR spectroscopy (MRS) is a unique and useful method for noninvasively evaluating biochemical metabolism in human organs and tissues, but its clinical dissemination has been slow and often limited to specialized institutions or hospitals with experts in MRS technology. The number of 3-T clinical MR scanners is now increasing, representing a major opportunity to promote the use of clinical MRS. In this review, we summarize the theoretical background and basic knowledge required to understand the results obtained with MRS and introduce the general consensus on the clinical utility of proton MRS in routine clinical practice. In addition, we present updates to the consensus guidelines on proton MRS published by the members of a working committee of the Japan Society of Magnetic Resonance in Medicine in 2013. Recent research into multinuclear MRS equipped in clinical MR scanners is explained with an eye toward future development. This article seeks to provide an overview of the current status of clinical MRS and to promote the understanding of when it can be useful. In the coming years, MRS-mediated biochemical evaluation is expected to become available for even routine clinical practice.


This paper addresses the phenomenon of technophobia which is a discouraging factor that obstructs the successful application of technology among the teachers. In doing so, it tries to look into the factors causing this sort of anxiety by considering some teachers' experiences. It, then, analyzing these factors wants to provide some preferred solutions. Mostly, it seems that society's expectations from educational systems and instructors to use computer in class with minimal anxiety has caused such critical situations for some instructors. It is observed that the use of technology is determined by a wide range of factors, ranging from external factors such as access to appropriate materials and professional development opportunities to more internal factors such as awareness of the benefits of technology and personal attitudes towards technological innovations, and the persistence of traditional education in some educational settings due to the absence of professional training leads the researcher to the conclusion that it is necessary to train teachers about new technologies, so that the  contents to be produced can be used letting instructors relieve from computer anxiety. Keywords: technophobia, teachers, professional development, anxiety


Caretaker recognition of clinical utility of respiratory signs and symptoms in the prediction of pneumonia was examined in a prospective study of infants and children in four cities in Egypt. In all 688 children aged 2 months-5 years presenting with a history and/or physical examination findings of cough and difficult or fast breathing were recruited from out-patient health facilities. The validity of caretaker terms was determined using paediatrician observation of standard respiratory signs and symptoms, x-ray diagnosis and pulse oximetry as standards. The sensitivity of 'nahagan' (Egyptian Arabic for fast breathing) for identifying elevated respiratory rate was 78% +/- 4, and was slightly higher for < 12 month olds (85% +/- 5) versus children aged 1-5 years (74% +/- 5). 'Sedro tale nazel', which describes the chest as moving up and down, was a sensitive (86% +/- 3) and specific (60% +/- 4) indicator of chest indrawing. 'Tazyeek' (wheeze) had a sensitivity of 75% +/- 3 and specificity of 66% +/- 4 when compared to paediatrician assessment of wheezing during physical examination. Although not specific, the caretaker terms, 'nahagan' or 'nafas seria' (fast breathing) and 'sedro tale nazel' (chest indrawing), either spontaneously or after asking, were sensitive (> 71%) indicators of radiologic pneumonia and oxygen desaturation, and therefore can be used to prompt timely health seeking behaviour in these settings.


Measurements of the interfacial diffusion coefficient of the surface hydration layer of lipid vesicles in dilute solutions are presented. This was made possible by the greatly enhanced sensitivity and unique contrast provided by the site-specific and selective Overhauser dynamic nuclear polarization of solvent molecules that approach nitroxide radical-based spin labels within <5-10 A. All experiments were carried out using minute microliter sample volumes of lipid vesicle solutions, using low spin label concentrations (<2 mol %) and under physiological conditions. This presents unprecedented sensitivity for analyzing interfacial solvent diffusion of macromolecules and their assemblies in solutions and highlights the feasibility of investigating precious samples. Interfacial diffusion on DOTAP (1,2-DiOleoyl-3-TrimethylAmmonium-Propane) and DPPC (1,2-DiPalmitoyl-sn-glycero-3-PhosphoCholine) surfaces are further analyzed as a function of temperature to determine the activation energy of their hydration layer dynamics. The temperature-dependent analysis across the phase transition of DPPC concludes that the hydration water with 100-200 ps dynamics displays Arrhenius behavior and does not undergo a phase transition unlike the lipid chains. We also discuss the advantages of determining the activation energy of diffusion as a general approach to comparing interfacial diffusivity on surfaces that have vastly different charge topologies and, thus, may display different distances of closest approach between the spin label placed at the surface and the protons of hydration water. The further development and application of this technique is expected to facilitate the study of membrane dynamics and their phase behavior, including the formation of lipid rafts, with lipid-specific resolution.


Objectives Kenya has long and porous borders with its neighbouring countries. These regions, predominantly inhabited by highly mobile rural communities with strong cross-border cultural ties, present major challenges in managing movement of people and COVID-19 preventive measures. Our study sought to assess knowledge of COVID-19 prevention behaviours, how these varied by socioeconomic (SEC) factors and the challenges of engagement and implementation, in two border counties of Kenya. Methods We conducted a mixed methods study using a household e-survey (Busia, N=294; Mandera, N=288; 57% females, 43% males), and qualitative telephone interviews (N=73: Busia 55; Mandera 18) with policy actors, healthcare workers, truckers and traders, and community members. Interviews were transcribed, English translated and analysed using the framework method. Associations between SEC (wealth quintiles, educational level) and knowledge of COVID-19 preventive behaviours were explored using Poisson regression. Results Participants were mostly educated to primary school level (54.4% Busia, 61.6% Mandera). Knowledge of COVID-19 prevention varied by behaviour: hand washing-86.5%, use of hand sanitiser-74.8%, wearing a face mask-63.1%, covering the mouth when sneezing or coughing-56.3% and social distancing-40.1%. Differences in knowledge by area, educational level and the wealth index were marked, greatest for Mandera, the less educated and the poor. Interviews with stakeholders revealed challenges in health messaging, psychosocial and socioeconomic factors, lack of preparedness for truck border crossings, language barrier, denial and livelihood insecurity as key challenges to engagement with and implementation of COVID-19 prevention behaviours in the border regions. Conclusion The influence of SEC disparities and border dynamics on knowledge and engagement with COVID-19 prevention behaviours calls for contextually appropriate risk communication strategies that are cognisant of community needs and local patterns of information flow. Coordinating response measures across border points is crucial in winning communities' trust and maintaining essential economic and social activities.


It has been generally presumed that circulating catecholamines have little if any effect on systemic vascular resistance in resting trout; however, this question has not been directly addressed. In the present study, the response of isolated vessel rings and perfused tissues to catecholamines and the importance of circulating epinephrine in the vasoconstrictor response of the splanchnic circulation to splanchnic nerve stimulation were examined. Epinephrine (EPI) and norepinephirine (NEPI) produced dose-dependent contractions of celiacomesenteric (CM) and epibranchial (EB) arteries, anterior cardinal (AC) veins, and increased vascular resistance in the perfused dorsal aorta (PDA; skeletal muscle-kidney-distal intestine) and perfused celiacomesenteric (PCM; splanchnic) vascular beds. In all instances the threshold catecholamine concentration for in vitro vasocnstriction was greater than plasma atecholamine concentrations in vivo. Neither EPI nor NEPI contracted ventral aorta rings. Addition of non-constrictor, but physiological, concentrations of EPI to the perfusate (10-9M) tripled the increase in PCM resistance produced by splanchnic nerve stimulation. Perfusate EPI also prevented or reversed splanchnic nerve fatigue and restored PCM resistance in fatigued preparations. These results indicate that a direct effect of circulating EPI may be an important source of neuronal catecholamine uptake and may be required to sustain neuronal sympathetic tone. © 1993 Wiley-Liss, Inc.


In its depictions of characters' processes of decision-making, Jane Austen's Emma incorporates a model of choice that later came to dominate neoclassical economics. This model is preferential choice, which asserts that individuals choose based on their subjective, idiosyncratic preferences rather than following socially sanctioned value systems. While Emma represents preferential choice and illustrates its connection to consumer capitalism, unlike neoclassical economists, the novel ultimately exhibits skepticism toward this modern model of decision-making. This skepticism is rooted in Emma's conservative economic and political vision. Its conservatism paradoxically gestures to a point that is important to some of today's progressive thought: that our valorization of preferential choice—of the idea that choices should be a matter of individual desire for one option among many—is not inevitable and comes with its own significant difficulties. This article shows that even as the novel distances itself from consumerism's mode of preferential choosing, Emma's representation of preferential choice acknowledges its aesthetic importance in the construction of interiorized characters and in open-ended narrative forms. Such an acknowledgment shows Austen's recognition that consumerist habits of mind are important to literary production, especially at a moment when novels vied for attention in a competitive literary marketplace. In such a marketplace, readers chose among many disparate titles; the late eighteenth- and early nineteenth-century literary field was, indeed, one of the first manifestations of modern consumerism wherein overflowing markets tried to convince shoppers to express their individuality through their preferences for some goods over others.


The successive colonization of Istria with culturally differentiated populations, and peripheral position of the peninsula regarding both the Latin and Slav worlds, has conditioned interesting phenomena which defines the traditional life of the province. On the spiritual level it is primarily reflected in two cultural dimensions: the language and traditional music.


Stimuli-responsive shape-memory materials are a category of fascinating smart materials, which undergo reversible shape transformation with environmental changes. Among a large number of stimuli-responsive shape-memory materials, light-driven materials have sparked tremendous attention because of their stability, remote operability and environmentally friendly. Herein, we report a novel strategy for the synthesis of a light-responsive shape-memory polymer that is made from carbon dots and polyvinyl alcohol. The as-prepared carbon dots are endowed with good visible light absorption and excellent photothermal conversion, which enable the carbon dot/polyvinyl alcohol composite polymer to serve as a light-responsive shape-memory polymer. The carbon dots not only work as photothermal agents but also offer additional hydrogen bond interaction, which accelerates the shape-memory recovery rate. The results show that the composite polymer can realize shape recovery using relatively low laser power. Most importantly, the as-prepared carbon dot/polyvinyl alcohol composite polymer not only possesses great research potential in different types of fields, such as medical and sensing, but also provides a effective and economic strategy for taking the advantage of light.


A normally un-manned minimal floating platform can be used for several applications to support subsea development. The applications include enabling Long Subsea Tiebacks by supporting power generation and distribution equipment, when the host facility doesn't have excess power capacity (Power Buoy) or the required footprint and space to support the required power distribution hardware or locate the distribution equipment to distribute the power imported from shore. It can also serve as a partial processing host with functionality ranging from Chemicals and Artificial Lift all the way to Multi-Phase Pumping or Gas Compression, as required.
 An un-manned floating platform can be a cost-efficient solution, where the economics of a very Long Subsea Tieback or a Host Facility with full processing capacity become prohibitive for developing small to medium size fields. The substructures for these platforms have reduced and simplified systems resulting in lower Capex, Opex and minimal maintenance requirements. This platform is safer to operate than conventional host platforms because it is un-manned, and it also deploys robotics and remotely controlled equipment, using the latest advances in digital, robotics, and autonomous control technologies.
 The paper reviews the different floating unmanned minimal platform configurations that are designed for this purpose. The following aspects of the normally un-manned floating platform are discussed:
 Functionality Cost-Efficient Design alternatives Construction/Installation efficiency Operations/ Maintenance principles
 Possible applications of the normally un-manned floating platform include small to medium size fields, remote gas fields requiring compression to export gas to shore that would otherwise prove to be un-economical to develop. The normally un-manned floating platform helps improve the development economics and the operational safety of these fields. The industry's response to the oil price slump in the past few years combined with the latest advances in technology led to the evolution of these minimal unmanned floating platforms.


The sequences of S-, P- and D-wave Feshbach resonances in both singlet and triplet electron - hydrogen scatterings were located below the n = 2 H excitation threshold for the first time in an accurate calculation, employing the Harris - Nesbet variational method. The resonance positions and widths of a sequence were found to agree fairly well with the scaling law.


The engineers' approach to dielectric breakdown has traditionally been one of testing leading to life prediction and material comparison. On the other hand, the scientist has attempted to understand the mechanism of specific breakdown processes. It is shown here that the former approach is prone to ambiguity and that a need exists to understand not just the physics of breakdown processes but also their resulting statistics. A number of statistical models are developed and discussed with the aid of experimental data. Finally it is shown how the general trends obtained can be used to aid the interpretation of the engineers' data.


Regularities in the environment are used to decide what course of action to take and how to prepare for future events. Here we focus on the utilization of regularities for prediction and argue that the commonly considered measure of regularity - the strength of the contingency between antecedent and outcome events - does not fully capture the goodness of a regularity for predictions. We propose, instead, a new measure - the level of expected prediction accuracy (ExpPA) - which takes into account the fact that, at times, maximal prediction accuracy can be achieved by always predicting the same, most prevalent outcome, and in others, by predicting one outcome for one antecedent and another for the other. Two experiments, testing the ExpPA measure in explaining participants' behavior, found that participants are sensitive to the twin facets of ExpPA and that prediction behavior is best explained by this new measure.


The two-dimensional total routhian surface calculations have been carried out to study the triaxial superdeformed structure of a neutron-rich nucleus 173Hf firstly. In particular the effects of the rotational frequency ω and pairing-energy gap parameter Δ are discussed in detail in the course of shaping its triaxial superdeformation; additionally the neutron-shell correction energy is analyzed with emphasis in the confirmed triaxial superdeformed nucleus 173Hf. Finally, more systematical results have been investigated for some confirmed superdeformed nuclei experimentally and a few predicted triaxial superdeformed nuclei theoretically with quadropole deformation ε2 ≈ 0.4 and triaxial deformation γ ≈ 20° or 30° in the Z = 72 region.


The counting efficiencies of two TSI 3790 Condensation Particle Counters (CPCs) were investigated experimentally for graphite, poly-(alpha)-olefin (PAO), tetradecane (C14), and hexadecane (C16) particles at saturator-to-condenser temperature differences spanning from 5.6°C to 11.3°C. The efficiencies determined with PAO, C14, and C16 particles were broadly similar, while tests with graphite particles resulted in systematically lower counting efficiencies. The differences between PAO and graphite particles were reduced at elevated temperature differences, i.e., as the saturation ratios inside the condenser increased. The possibility to predict measured counting efficiencies by heterogeneous nucleation theory was also assessed. The results for PAO, C14, and C16 were representative of perfectly wettable particles, while graphite data could only be reproduced with a contact angle of 6–12°, for all temperatures examined. Line tension fits revealed a linear correlation with the graphite mobility diameter for all operating temperatures (5 × 10−11 N at 15 nm to 4 × 10−10 N at 70 nm). This could actually indicate that the mobility diameter underestimates the contact line for these complex geometry graphite aggregates. An examination of the calculated activation regions inside the condenser indicated that the upper part of the counting efficiency curve (>50%) is very sensitive to flow and temperature nonidealities. This observation is in quantitative agreement with systematic deviations observed between theoretical predictions and experimental data. Numerical calculations for a range of working fluids suggested that for a given affinity of the calibration particle to the examined vapors (i.e., for a finite contact angle), the benefit from shifting to a fluid alternative to butanol is limited. Further investigations on the reduction of the material dependence should focus on the identification of working fluids exhibiting greater affinity for different particle materials (e.g., lower contact angle). Copyright 2012 American Association for Aerosol Research


The devastating COVID-19 pandemic has created several gaps in the management of viral infections, leaving biocontainment and supportive measures as the only resorts for control. As such, there has been a dramatic increase in the use of dietary supplementations and herbal medicine for COVID-19. However, serious concerns regarding the efficacy, safety, and recommended doses of these medicines have been raised. In this study, we aimed to assess the population knowledge about alternative medicine administration for COVID-19 and the associated factors. Using a self-administered cross-sectional survey, we analyzed a total of 2042 valid responses. Most of the included participants were females (69.7%), with an overall mean age of 20.8 ± 11.8 years. Most respondents (62.8%) obtained their knowledge from social media while only 16.6% received knowledge from the health care workers. Half of the participants (50.6%) correctly identified all COVID-19 symptoms, where fever (18.5%) and loss of smell and taste (17.1%) were the most frequent answers. On the use of traditional medicines and supplements for COVID-19, 57.8% did not answer, 23.7% admitted regular use, and 18.5% used sometimes. Family members or friends suggested the use of traditional medicines and dietary supplements to 28.0% of the participants while only 14.7% were advised by a nutritionist, physician, pharmacist, nurse, or a health worker. Moreover, seniors and illiterate portions of society had lower knowledge scores and increased utilization of alternative medicine. Marital status, income, and previous COVID-19 were all significant predictors of the awareness and knowledge score. Thus, this study has identified overuse of unregulated medicinal products in the region, which potentially aggravates COVID-19 or other underlying risks of the disease, making clinical management challenging, particularly in geriatrics and women's health. Regulation of medicinal products and establishment of educational campaigns about the disease have become imperative.


Emmy Noether proved two deep theorems, and their converses, on the connection between symmetries and conservation laws. Because these theorems are not in the mainstream of her scholarly work, which was the development of modern abstract algebra, it is of some historical interest to examine how she came to make these discoveries. The present paper is an historical account of the circumstances in which she discovered and proved these theorems which physicists refer to collectively as Noether's Theorem. The work was done soon after Hilbert's discovery of the variational principle which gives the field equations of general relativity. The failure of local energy conservation in the general theory was a problem that concerned people at that time, among them David Hilbert, Felix Klein, and Albert Einstein. Noether's theorems solved this problem. With her characteristically deep insight and thorough analysis, in solving that problem she discovered very general theorems that have profoundly influenced modern physics.


The rule-based approach, i.e. following electromagnetic interference standards, is the basic methodology assumed to result in electromagnetic compatible systems operating properly in their intended environment. For complex systems we need a smarter approach, based on assessing and controlling the electromagnetic risks. This risk-based approach is described, and applied to naval ships.


This article reports on a pilot study that investigated the beliefs, values, and pedagogies of experienced high school teachers who worked with student populations of non-English speaking and economically disadvantaged immigrants or refugees in Australia. Qualitative research methods, including focus groups and in-depth individual interviews with teachers, produced data that were examined using Critical Discourse Analysis. Close reading of the teachers' comments suggests that there are a number of key discourses that teachers use to make sense of differences among culturally diverse and economically disadvantaged groups of students. Specifically, teachers distinguish between cultural groups on the basis of students' life experiences prior to arrival in Australia; students' collective and individual educational experiences; and the different social class positioning of students within the same ethnic group. In their comments, teachers at times categorised students in generalised and stereotypical ways but also were able to critique and reflect on their personal assumptions. An analysis of the teachers' reflections provides insights into how they made sense of "diversity" and how, as teachers, they try to work productively with ethnically diverse and economically disadvantaged students.


This paper describes a simulation method to compute oscillator phase noise which combines transient and periodic-transfer-function analyses, available in most of the commercial circuit simulators. The proposed calculation technique is simple to implement and provides the designer a deep insight into phase noise generation mechanisms for both stationary and cyclostationary sources, thus resulting a powerful tool to perform an optimum design in RF applications.


We present underpinning neural structures to represent various components of emotional dispositions. After a description of simple models of the dynamics, an even simpler multi-layer perceptron model is presented with three outputs. This leads to a high level of success in recognition of emotional dispositions from a database of faces, as well as an interpretation in terms of the underlying neural system. By extending the discrete classification approach to continuous variables in a three-dimensional state-space the recognition performance can be improved and the causes for classification errors can be studied. Key-Words: facial analysis, emotion recognition IMACS/IEEE CSCC'99 Proceedings, Pages:5341-5346


The security accident is increasing in industrial infrastructure. The security of industrial control system is caused not only by deliberate acts of external attacker but also by sometimes inadvertent threats of legitimate inner operator. The latter can ultimately have more devastating consequences. Industrial control system works deterministic and restrictive operation. The anomaly communication patterns may be relevant to attack activities or misconfiguration of operator. To detect these threats in industrial control system, we propose security data objects that describe operation and state of system and security correlation analysis system that collects and analyzes these objects and detects intrusion or anomaly state of system. Our approach may provide complementary detection ability for protecting internal threat of industrial infrastructure.


Abstract Recent findings have suggested that iron oxide nanoparticles (IONPs) have some exceptional chemical characteristics which make them useful in both experimental physiology and cell biology research. These nanoparticles might be applied as drug delivery systems for anti-cancer and other medications. Also, IONPs might be a valuable part of many novel bioassays in various fundamental medical fields. In recent years, several studies have indicated that IONPs may have certain cytotoxic and genotoxic potential in living systems. During in vitro conditions, IONPs might induce generation of reactive oxygen species and cause oxidative stress in some cell populations. The toxicity of IONPs is not yet fully understood, and additional research is needed to confirm if IONPs have detrimental effects on human health. This short article focuses on the recent developments and trends in the fields of nanomedicine and nanobiology regarding iron oxide nanomaterials and their application in fundamental medical disciplines such as experimental physiology. We discuss our previously published works on structural effects of IONPs and other metallic nanoparticles on cell nucleus in in vitro conditions. We also describe our recent findings regarding the impact of IONPs on certain biophysical properties of subcellular components.


The charge and spin distribution in manganese-salen complexes were analyzed using different basis sets and density functionals. Five population analysis methods [Mulliken, Lowdin, Natural population analysis (NPA), atoms in molecules (AIM), and CHelpG] were used to characterize the charge distribution. Results show that NPA and AIM were the only methods capable of giving charges with the correct sign for all cases under study. According to the analysis of the natural charge and spin distributions, the salen ligand shows a complex behavior, counteracting the effect of the chloro and oxo ligands on the metal center. Furthermore, the presence of a chloride counter ion increases the oxo-radical character of Oxo-Mn(salen) complexes, which may play an important role in the rationalization of the catalytic properties of Mn(salen) complexes. © 2014 Wiley Periodicals, Inc.


Sensory epithelia are often spatially reiterated throughout their representation in the central nervous system. Differential expression of this representation can reveal specializations of the organism's behavioral repertoire. For example, the nature of the central representation of sound frequency in the auditory system has provided important clues in understanding ecological pressures for acoustic processing. In this context, we used electrophysiological techniques to map the frequency organization of the dorsal cochlear nucleus in nine cats. Frequency responses were sampled in increments of 100–200 μm along electrode tracks that entered the dosomedial border of the nucleus and exited at the ventrolateral border. Electrode tracks were oriented parallel to the long (or strial) axis of the nucleus so that each penetration sampled neural responses for most of the cat's audible frequencies and remained in or near the pyramidal cell layer for several millimeters. Nearly identical distance versus frequency relationships were obtained for different rostral‐caudal locations within the same cat as well as for different cats. Frequency responses systematically decreased from above 50 kHz at the most dorsomedial locations in the nucleus to below 1 kHz in the most ventrolateral regions. The rate of frequency change was roughly three times greater in high frequency regions than in low frequency regions. In addition, the highest pyramidal cell density and longest rostral‐caudal axis was observed for the middle third of the dorsal‐ventral axis of the nucleus. As a result, roughly half of all pyramidal cells responded to frequencies between 8–30 kHz. The representation of neural tissue for these frequencies may be related to the importance of spectral cues in sound localization. © 1993 Wiley‐Liss, Inc.


Purpose: P-glycoprotein (Pgp) is a major prognostic factor for chemotherapy failure in acute myeloid leukemia (AML). This study compared the influence of genetic and leukemia-specific factors on Pgp. Experimental Design: Eight hundred and seventeen samples were studied prospectively for Pgp protein expression and function and G1199A, G2677T, and C3435T polymorphisms in the encoding gene ABCB1. Results: Age, low WBC count, high bcl-2, secondary AML and myelodysplastic syndrome, and adverse cytogenetics all correlated strongly with high Pgp (MRK16) protein expression. However, ABCB1 3435TT homozygosity was negatively correlated with Pgp. Pgp protein is only expressed in 41% of samples such that the negative effect of the polymorphism was not seen at baseline Pgp levels but was marked in the upper 41% of samples (MRK16 Δmean fluorescence intensity of 75th centile sample = 9 units for TT variant samples and 26 units for CC/CT; P = 0.003). However, no association was found between genetic factors and Pgp function using rhodamine 123 accumulation. Conclusions: The genetic polymorphism 3435TT (which results in unstable mRNA) has a significant effect on Pgp expression, but this is only seen in ∼40% of cases in which mRNA and protein are detectable. Moreover, leukemia-specific factors, such as low WBC count and poor risk cytogenetics, have a much greater effect than genetic polymorphisms on Pgp expression in AML blasts.


Chromosome translocations involving the RUNX1 gene at 21q22 are recurring abnormalities in acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS), that is, t(8;21) and t(3;21) and in B‐cell acute lymphoblastic leukemia with t(12;21). These translocations result in the fusion of RUNX1 with RUNX1T1, MECOM, and ETV6, respectively, and are implicated in leukemogenesis. Here we describe 10 rare RUNX1 fusion gene partners, including six novel fusions, in myeloid neoplasia. Comprehensive molecular testing revealed the partner genes and features of these fusions in all the tested patients, and detected various recurring myeloid related gene mutations in eight patients. In two patients, RUNX1 mutations were identified. Most of these fusions were detected in patients with high‐grade MDS and AML with a relatively short survival. Integration of conventional chromosome analysis, FISH testing and molecular genetic studies allow a comprehensive characterization of these rare RUNX1 fusions. Our study may help define myeloid neoplasms with rare and novel RUNX1 translocations and support appropriate patient management.


Two methods for improving odometry using a pan-tilt range-finding laser is considered. The first method is a one-dimensional model that uses the laser with a sliding platform. The laser is used to determine how far the platform has moved along a rail. The second method is a two-dimensional model that mounts the laser to a mobile robot. In this model, the laser is used to improve the odometry of the robot. Our results show that one-dimensional model proves our basic geometry is correct, while the two-dimensional model improves the odometry, but does not completely correct it.


ABSTRACT
 Endocranial casts are the only available material to study the evolution of brain morphology through geologic time. However, these are not just casts of brain tissues but also include, e.g., meningeal tissues, blood vessels, and nerves. Tissues surrounding the brain are particularly thick in proboscideans, making the estimation of brain size in extinct proboscideans very tentative. Here the regression of brain mass over cranial capacity—based on data on intraindividual comparison between those two metrics in the literature—is used to estimate the 'true' brain mass of extinct mammals. This regression reveals that cranial capacity is allometrically related to brain mass in mammals. The larger the brain, the greater is the difference between brain mass and cranial capacity. Applied to proboscideans, this new method suggests that the thickness of non-neural tissues surrounding the brain has been greatly overestimated in extinct proboscidean species, resulting in the underestimation of brain mass. This data set suggests that a comparatively small brain is likely primitive for Proboscidea and that the representatives of the clade Elephantimorpha have inherited their large brain from their last common ancestor. The largest brain proportional to mass of all Proboscidea belongs to the Quaternary dwarf elephant of Sicily, which would have been comparable to modern humans in encephalization quotient.


This study evaluates the reproducibility of individual differences in behaviorally evoked cardiovascular reactivity among 39 young adult males. Presented also are initial data describing idiosyncratic patterns of hemodynamic adjustment that may underlie pressor responses to laboratory stressors. Subjects were administered three experimental stressors (mental arithmetic, mirror tracing, and bicycle exercise) on two occasions, four weeks apart. Heart rate, blood pressure, and impedance-derived measurements of cardiac pre-ejection period, stroke index, cardiac index, and total peripheral resistance were obtained during baseline and task periods at each session. To index task-induced "reactivity," residualized (baseline-adjusted) change scores were calculated for all variables; percentage change from baseline was also calculated for impedance-derived hemodynamic measurements. Test-retest (inter-session) correlations were significant for nearly all baseline, task, and change-score measurements. The few exceptions included diastolic blood pressure changes during mirror tracing and bicycle exercise and changes in stroke index and peripheral resistance during mental arithmetic. Although virtually all baseline and task correlations exceeded .60, reactivity indices yielded consistently lower retest correlations (significant r's = .35-.78; median r = .49). In subsequent analyses, subsets of individuals were identified whose reactions to mental arithmetic at the first laboratory session reflected changes in either cardiac output (CI reactors, n = 9) or total peripheral resistance (TPR reactors, n = 6), or a combination of cardiac and vascular influences (Mixed reactors, n = 8). This typology of hemodynamic response: (a) was corroborated by corresponding group differences in heart rate, pre-ejection period, and stroke index; (b) was reproducible on retesting; and (c) showed some generalization to the mirror tracing task, though not to bicycle exercise.


The aim of the study was to research the relationship of chemical and micromorphological properties of soils with the growth of Kochia prostrata . The objects of study were the soils on natural pastures of the North-Western part of the Caspian lowland. It was laid 4 soil pits (soils – light solonetz, solonetzic chestnut) with the maximum penetration depth of the main mass of roots of the studied plants. K. prostrata is a very plastic forage species that can grow on soils with a wide range of morphological properties, different salt content and their chemical composition. It is revealed that on the background of almost the same content of humus and high content of exchangeable magnesium micromorphological features represent the different degree of manifestation of primary pedogenic processes – humus accumulation, leaching of soluble salts, gypsum accumulation, carbonate enrichment, solonetzization. Despite the different content of exchangeable sodium, in all soils there are fresh clay or humus-clay illuvial coatings, indicating the manifestation of the modern eluvial-illuvial redistribution of fine matter (lessivage or illimerization).


A study was made to compare nerve regeneration of the anterior gastric wall following either seromyotomy or gastrotomy with eversion suturing; both approaches extending from the antrum to the fundus. Twenty-eight preadult Wistar rats were divided into three groups: Group I (control: sham operated animals; n = 8); Group II (seromyotomy with posterior truncal vagotomy; n = 10); and Group III (gastrotomy with posterior truncal vagotomy; n = 10). Nerve regeneration was evaluated immunohistochemically two months after the operation. Groups II and III presented gastric dilatation postmortem. Both groups showed complete denervation of the anterior gastric wall, with no vagal fibers crossing the section line. Amputation neuromas and Schwann cells were commonly observed. In conclusion, both seromyotomy and gastrotomy are efficient methods for denervating the anterior gastric wall.


Abstract Introduction: The exercise benefits for the most prevalent postural changes require proper investigation, with large samples, control group, and concealed allocation. Objective: To assess the effects of a muscular stretching and strengthening school-based exercise program on posture, trunk mobility, and musculoskeletal pain among elementary schoolchildren. Method: Three hundred students from three schools in Brazil were evaluated. Stretching and strengthening exercises, twice a week, for eight weeks in group sessions were provided by one physiotherapist. The control group did not undergo any intervention. Head, back and shoulder posture were qualitatively evaluated. Head and trunk alignment were evaluated using the Posture Assessment Software. Cervical, thoracic, low back and upper limb pain were assessed for the last seven days. The trunk mobility was recorded through the flexibility of the posterior chain. Posture, pain and trunk mobility were recorded at baseline and after the intervention. Groups were compared using χ2 test, two-way MANOVA, and two-way ANOVA, with α set at 5%. Results: Shoulder posture showed significant results (P = 0.04), the intervention group showed the lower worsening rate. In the quantitative evaluation, a statistically significant difference was observed between assessments (P < 0.01 for head and trunk; ES = 0.53) but not between groups. The intervention group had a higher percentage of improvement in the overall musculoskeletal pain (P = 0.04; ES = 0.54). Mobility decreased an average of 1.8° in the control group and increased 5.0° in the intervention group, without statistical significance. Conclusion: The program was effective in reducing pain level and shoulder misalignment at the intervention group.


BACKGROUND
In patients who underwent radical resection for gastric cancer, we investigate the relative efficacy of combined 5-fluorouracil+adriamycin or epirubicin and methotrexate with leucovorin rescue (FAMTX or FEMTX) compared with a control arm.

PATIENTS AND METHODS
This report is a prospective combined analysis of two randomized clinical trials conducted on patients who underwent radical resection for histologically proven adenocarcinoma of the stomach or esophago-gastric junction. Three hundred and ninety-seven untreated patients, 206 from 23 European Organization for Research and Treatment of Cancer (EORTC) institutions and 191 from 16 International Collaborative Cancer Group (ICCG) institutions, were randomized. Overall survival (OS) and disease-free survival (DFS) were estimated using the Kaplan-Meier method and the treatments were compared for these end-points by means of the log-rank test, retrospectively stratified by trial.

RESULTS
In a planned combined analysis of the two trials, no significant differences were found between the treatment and control arms for either DFS (hazards ratio: 0.98, P=0.87) or OS (hazards ratio: 0.98, P=0.86). The 5-year OS was 43% in the treatment arm and 44% in the control arm and the 5-year DFS was 41% and 42%, respectively.

CONCLUSION
Neither FAMTX nor FEMTX can be advocated as adjuvant treatment in patients who undergo resection for gastric cancer.


INTRODUCTION AND OBJECTIVES: Infected semen fuels the HIV pandemic. Despite the development of highly effective anti-retroviral drugs, more than 30,000 new cases are diagnosed annually in the U.S., only a 10% drop since 2005. Although it is recognized that semen infection is compartmentalized from blood, little is known about infection sites or effective treatment for semen HIV. To begin to develop treatment guidelines to eliminate HIV from semen, we have examined semen virus detection according to treatment regimen of HIV-infected men. METHODS: Review of a recently compiled blinded dataset of antiretroviral drug therapy, blood levels of HIV RNA and CD4+ lymphocytes, and HIV RNA or HIV proviral DNA in semen specimens submitted by 230 HIV-infected men undergoing semen screening from 2012 to 2015. Semen HIV was detected by RT-PCR. RESULTS: All men on antiretroviral therapy had undetectable levels of HIV RNA in blood. Overall, 112 (18%) of the specimens tested positive for virus, with 81 (35%) of men producing at least one positive specimen. Ten of fourteen men not on antiretroviral therapy because of persistently low blood virus levels produced at least one positive semen specimen with 13 (36%) of 36 specimens testing positive for HIV. Average CD 4 blood count (634) for men producing positive semen specimens was not significantly different from those producing no HIVpositive semen specimens (683). Twenty eight (20%) of the 137 men taking combinations of reverse transcriptase inhibitors produced at least one HIV-positive semen specimen; of the total of 403 specimens in this treatment group, 74 (18%) were positive. Nine (23%) of the 39 men whose treatment regimen included a protease inhibitor produced at least one positive specimen, with only 11 (10%) of the total of 107 specimens in this group testing HIV positive. Eighteen (41%) of the 44 men whose treatment included an integrase inhibitor with no protease inhibitor produced at least one positive specimen, with 23 (18%) of the total of 128 specimens testing HIV positive. CONCLUSIONS: Current antiretroviral treatment strategies do not eliminate HIV from semen as effectively as they eliminate HIV RNA in blood. These findings suggest anti-viral combinations containing a protease inhibitor may be more effective in reducing HIV in semen. A larger study cohort is urgently needed to test this possibility.


The international sepsis guidelines emphasize the importance of early identification along with the combined administration of fluids, antibiotics and vasopressors as essential steps in the treatment of septic shock in childhood. However, despite these recommendations, septic shock mortality continues to be very high, especially in countries with limited resources. Cardiovascular involvement is common and, in most cases, determines the outcomes. Early recognition of hemodynamic dysfunction, both in the macro and microcirculation, can help improve outcomes. Capillary refill time (CRT) is a useful, available and easily accessible tool at all levels of care. It is a clinical sign of capillary vasoconstriction due to an excessive sympathetic response which seeks to improve blood redistribution from the micro- to the macrocirculation. An important reason for functionally evaluating the microcirculation is that, in septic shock, the correction of macrocirculation variables is assumed to result in improved tissue perfusion. This has been termed "hemodynamic coherence." However, this coherence often does not occur in advanced stages of the disease. Capillary refill time is useful in guiding fluid resuscitation and identifying more seriously affected sepsis patients. Several factors can affect its measurement, which should preferably be standardized and performed on the upper extremities. In this review, we seek to clarify a few common questions regarding CRT and guide its correct use in patients with sepsis.


Abstract : Alcohol-related problems are a significant public health concern in the United States. Alcohol dependence, abuse, and problem drinking increase morbidity and mortality (McGinnis, 1993), and raise economic, social and health care costs (Institute for Health Policy, 1993; Rice, 1991; Manning, 1989; US Department of Health and Human Services, 1993). A recent study estimated that the total economic cost of alcohol-related problems was $148 billion in 1992: $18.8 billion in health care costs, $67.7 billion in lost productivity and $19.7 billion in crime (Harwood, 1998). Effective treatments exist for the entire spectrum of alcohol-related problems (Fleming, 1997; CSAT TIP #28; NIAAA, 1995), but fewer than half of those individuals who need treatment actually receive it (Institute of Medicine, 1990). One in 5 men and 1 in 10 women who visit their primary care providers meet the criteria for at-risk drinking, problem drinking or alcohol dependence (Manwell et al, 1998); (Flemming and Manwell, 1999). Primary care physicians (PCPs) are in an ideal position to screen for alcohol problems, begin treatment, and monitor progress. However, primary care systems are not set up to support PCPs in recognizing and treating alcohol use disorders. Since many of these patients do not consult alcohol treatment specialists on their own, important opportunities for identification and treatment are missed (Alcohol Research and Health, 2000). A recent national survey of primary care physicians and patients noted that more than nine in ten physicians fail to identify substance abuse in adults. The majority of patients with substance abuse say that their primary care physician did nothing to either assess or treat their substance abuse (CASA, 2000). A recent study of primary care physicians in Ohio in which 4454 patient visits were observed revealed that screening for alcohol problems took place during 3% of the visits, and only 1% of the patients received counseling on alcohol problems.


One hundred (100) staphylococci were isolated from several Egyptian hospitals and laboratories which include 85 clinical isolates and 15 from hospital surroundings. The isolates were identified by conventional and molecular techniques. Fifty (50) isolates were identified as Staphylococcus aureus (SA), 40 were Staphylococcus epidermidis (SE) while 10 were identified as Staphylococcus species (SS). Upon testing the resistance to methicillin and vancomycin, it was found that resistance is dominant in isolates from clinical samples than those from the surrounding surfaces. Moreover, the resistance to methicillin was higher than that to vancomycin. Multiplex polymerase chain reaction was carried out to characterize the staphylococci-specific region of 16S rRNA gene, mecA gene associated with methicillin resistance and the virulence marker-associated genes Panton-Valentine leukocidin (PVL) lukS/F-PV genes which are responsible for leukocyte destruction and tissue necrosis. All the methicillin resistant staphylococci (MRS) were found to be mecA+ while only five MRS carried lukS/F-PV genes. On the other hand, 30% of the methicillin sensitive staphylococci (MSS) were found to harbor the mecA gene while lacking the PVL. The results highlight the important role of horizontal gene transfer of virulence genes between staphylococci. In addition, this study indicates that the use of multiplex PCR is not sufficient for antibiotic susceptibility prediction and thus the simultaneous use of conventional and multiplex PCR technique is required for the identification of staphylococci and determination of their antibiotic susceptibility.

 Key words: Methicillin resistance, Staphylococcus aureus, Staphylococcus epidermidis, mecA, Panton-Valentine leukocidin (PVL).