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Background: Urinary stone disease is the third most common affliction of the urinary tract after urinary tract infection and pathologic conditions of the prostate. Although the disease is commoner in the developed countries, the incidence is also increasing in the developing countries. In this study, we sought to determine the pattern and treatment given for patients with urinary stones in our institution. Patients and Method: A 5 year retrospective study of patients treated for urolithiasis was conducted in a Teaching Hospital in North-western Nigeria. The age, sex, clinical presentations, investigations and treatment offered to the patients were reviewed. Results: A total of seventy six patients were treated for urinary stones during the study period. 58(76.3%) were males and 18(23.7%) females. Majority of patients 39(51.3%) presented with loin pain as the main presenting symptom. The diagnosis of stones was by plain abdominal Xray(KUB) in 68 patients and abdominal ultrasound scan in 46 cases. Urine culture was positive in 27 patients with E. coli as the predominant organism. All had normal serum calcium, phosphate and uric acid. 56(73.7%) patients had stones in the upper urinary tract and 20 (26.3%) in the lower urinary tract. Thirty four (44.7%) patients were found to have predisposing factors. Most of the patients 50(65.7%) were treated by open surgery and 26(34.2%) by endoscopic removal/lithotripsy. Conclusion: Urinary stone disease is common in this environment. Majority of the stones are radio-opaque on plain xrays. Significant number of patients had a predisposing factor and majority of the stones were found in the upper tract. Most of the patients were treated by open surgery while a significant number were treated with endoscopic removal/lithotripsy. Keywords: Urinary stones, Northern Nigeria, Treatment


Our current understanding of the mutation spectrum of relapse/refractory patients is limited. Public sequencing efforts have focused by design, on primary tumors, while re-biopsy of patients who are refractory to first line therapy or who relapse on treatment is not standard protocol. We have performed whole exome sequencing on post standard of care biopsies from 3 patient cohorts, 47 DLBCL patients post-relapse following R-CHOP, 49 triple negative breast (TNBC) following taxol alone or in combination and 41 lung adenocarcinoma (LUAD) following platinum alone or in combination. Comparative analysis of the mutation spectrum of these cohorts was performed against available clinically matched primary tumor cohorts. Comparison of the mutational signatures, somatic variant frequencies and copy number variation between matched pre- and post-treatment samples, and treated-primary tumor cohorts were performed. Significant differences were identified in the frequency of oncogenic drivers including PIK3CA in TNBC and KRAS in LUAD. We also observed mutational signature differences between cohorts that could impact treatment regimens post standard of care. Collectively these data further highlight the value of re-assessing the tumor genetic landscape at the time of treatment rather than relying on primary tumor samples, which may not be representative of the cohort to be treated. Citation Format: Danielle Greenawalt, Austin Dulak, Manasa Ramakrishna, Zhongwu Lai, Justin Johnson, Hongyue Dai, Melissa Mitchell, Carl Barrett, Stephen Fawell, Jonathan Dry. Your targeted population might not be what you predict: Changes in tumor genetic landscapes post standard of care. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3168.


Wave propagation in heterogenous two dimensions porous media plays an important role for subsurface investigation. We consider solving dynamic wave propagation using discontinuous Galerkin method in frequency domain. This frequential approach allows us to take into account efficiently diffusive phenomena at the source and at any discontinuities including the free surface, related to Biot theory on porous medium. The propagation code is validated on simple cases with a reflectivity code which is working in wavenumber-frequency domain for stratified media. The frequency formulation better controls the energy balance at interfaces due to fluid/solid interactions. The main perspectives is focused on time differential imaging by full waveform techniques in porous media.


The energy yield of a system depends largely on how the photovoltaic (PV) panels perform at different weather conditions (particularly plane of array irradiance and module temperature) summed over the hourly meteorological data for a year at the given site. Some of the PV performance parameters such as 'efficiency at low light/efficiency at standard conditions' and the 'P MAX thermal coefficient' can vary between technologies and may be able to be improved by better production methods (for example, improving uniformity, reducing shunts, reducing series resistance or improving the thermal design). The sensitivity of energy yield (kilowatt hour/year) against PV input value will be site dependent, for example, high insolation sites will usually experience higher module temperatures so that improvements in temperature coefficients would be more beneficial at higher than at lower insolation. This study studies the effect of the sensitivity of energy yield at five different sites (from northern Europe to desert) of six different PV input values (including low-light efficiency, P MAX temperature coefficient and nominal operating cell temperature). It quantifies the benefits at each site of good temperature coefficients or improving the low-light efficiency and also the need for wide V MP inverter ranges at sites with wide seasonal temperature differences.


Although children with attention-deficit/hyperactivity disorder (ADHD) are at risk for impulsive, health-endangering behavior, few studies have examined nonsubstance, use-related risk-taking behaviors. This study examined whether adolescents and young adults with ADHD histories were more likely than those without ADHD histories to report frequent engagement in motorsports, a collection of risky driving-related activities associated with elevated rates of physical injury. Path analyses tested whether persistent impulsivity, comorbid conduct disorder or antisocial personality disorder (CD/ASP), and heavy alcohol use mediated this association. Analyses also explored whether frequent motorsporting was associated with unsafe and alcohol-influenced driving. Two hundred twenty-one adolescent and young adult males (16–25 years old) diagnosed with ADHD in childhood and 139 demographically similar males without ADHD histories reported their motorsports involvement. Persistent impulsivity, CD/ASP, heavy drinking, and hazardous driving were also measured in adolescence/young adulthood. Adolescents and young adults with ADHD histories were more likely to report frequent motorsports involvement than those without childhood ADHD. Impulsivity, CD/ASP, and heavy drinking partially mediated this association, such that individuals with ADHD histories, who had persistent impulsivity or CD/ASP diagnoses, were more likely to engage in heavy drinking, which was positively associated with frequent motorsporting. Motorsports involvement was associated with more unsafe and alcohol-influenced driving, and this association was more often found among those with, than without, ADHD histories. Adolescents and young adults with ADHD histories, especially those with persisting impulsivity, comorbid CD/ASP and heavy drinking tendencies, are more likely to engage in motorsports, which may heighten risk of injury.


Liver fluke infections are increasingly a bottleneck in the animal health of grazing (or fresh grass fed) ruminants. Liverfluke leads to disease with economic consequences and for lactating animals no anthelmintics are freely available. This project has been working on the development of the liver fluke instrument with the aim of providing dairy farmers insight and action perspective regarding the liverfluke situation on their farm.


The article presents study results of soda and low-titanium slag baking, where the slag is produced during processing of titanium magnetite concentrate. The purpose of baking is to change the mineralogical composition of Ti-containing phases and obtain a product suitable for chemical separation of titanium dioxide from impurities. The X-ray phase analysis revealed that the obtained titanium slag belonged to the spinel-anosovit type. The article studies the factors influencing the baking process: the slag to soda mass ratio, the process duration, the temperature and the size of slag particles. The thermal analysis of the slag and soda baking process revealed that the optimum process temperature was 900°C. This temperature ensured formation of sodium titanates and a cake of sufficient porosity. The article demonstrates that effective decomposition pro cess requires a pretreatment of titanium slag by fine grinding. It was found that grinding of titanium slag particles to 40 μm contributes to more complete decomposition of the anosovite and formation of sodium titanates. It was found that during titanium slag and soda baking at the slag to soda mass ratio of 1 : 1,05, decomposition of anosovite occurred, and virtually all titanium was bound to sodium titanates. Optimal process conditions were determined as follows: slag to soda mass ratio – 1 : 1,05, baking temperature – 900 ° C, duration – 60 minutes and slag particle size – 40 μm. During baking, the titanium-containing slag phases were converted into Na 2 TiO 3 and Na 8 Ti 5 O 14 . The presence of a significant amount of silicon dioxide and the sodium-magnesium silicate phase was observed in the cake. The electron microprobe analysis of the cake showed that impurity elements were adsorbed on the particles of formed Na 2 TiO 3 .


The study of Markov chains with two-way coupling leads to the solution of linear partially integral equations of the second kind in the space of functions continuous on the square. A characteristic feature of the equations is the permutation of variables for the unknown function under the integral sign and integration over part of the variables. Equations of such types are not Fredholm integral equations and for their study a well-developed theory of Fredholm integral equations of the second kind can't be directly applied. The equations considered in the article we call partially integral equations of Romanovskij, who first obtained them in the study of Markov chains with two-way coupling and studied these equations in the case of continuous kernels. An explicit solution of partially integral Romanovskij equations can be found in rare cases, and therefore the problem of studying approximate and numerical methods for solving such equations is vital. When using approximate and numerical methods, it should be taken into account that the linear partially integral operator in the Romanovskij equation is not completely continuous, and the direct application of methods associated with the complete continuity of operators for its solution requires justification. The justification of approximate and numerical methods for solving linear partially integral equations of Romanowskij is given in the annotated paper. The paper contains theorems on the solvability of equations, results on various approximate and numerical methods for their solution, the theorem on the solution of linear partially integral equations by Romanovskij, using the method of mechanical quadratures, together with an estimate of the rate of convergence of a numerical solution to an exact solution of this equation.


ABSTRACT Individual, cultural and structural barriers exist in reporting rape to the police. Our study's context is Norway, where reporting is more accepted than before and is even encouraged. Still, few who experience rape report the incident. Based on qualitative interviews we examine how women who refrain from reporting rapes give their choice meaning. We draw from Boltanski and Thévenot's version of cultural sociology, especially the idea that meaning-making in concrete situations relates to wider 'regimes of justification': particular framings that render choices and interpretations intelligible. The aftermath of rape leaves women with having to balance their own and others' needs and expectations. In talking about the rape and how they afterwards manoeuvre to reconcile conflicting norms and needs, the women activate two different regimes of justification; an instrumental and an ontological. They negotiate between expectations set out in an instrumental regime of justification, focusing on acts and actions, and a more ontological regime of justification, wherein focus lies on their sense of self and future identities. They position themselves as 'evolving selves', a position from where they are able to prevent further ruptures by deploying a developmental logic rather than answering the call to 'do the right thing' and report.


Summary Since previous work has shown that 7,12-dimethylbenz[a]-anthracene (DMBA) causes less inflammation in AKR/J than in C57BL/6J mice, the genetic nature of this differential inflammatory response was investigated. The criterion for high reactivity was the formation of ulcers after skin application of DMBA. F 1 hybrids were slightly less high reacting than the C57BL/6J mice. Of the F 2 , 72% were high reacting. The back-cross of F 1 hybrids to C57BL/6J produced only high reactors, but to AKR/J high- and low-reacting mice. Mating of low-reacting F 1 backcross mice to C57BL/6J mice yielded 100%, and to AKR/J 0%, high reactors. Backcross of low-reacting F 2 mice to C57BL/6J gave 100%, and to AKR/J 0%, high-reacting mice. Backcross of high-reacting F 1 backcross and F 2 mice to C57BL/6J yielded only high-reacting, and to AKR/J high- and low-reacting, mice. These findings suggest that the low inflammatory response of the AKR/J mice is controlled by a single incompletely recessive factor. Results with DBA/2J mice, their F 1 hybrids, and backcrosses of these F 1 hybrids to AKR/J, also indicated inheritance by a single autosomal genetic factor. The higher inflammatory reactivity of the C57BL/6J mice was accompanied by higher susceptibility to subcutaneous tumor induction by DMBA. Furthermore, results with mice differing only in inflammatory reactivity showed that inflammatory reactivity and susceptibility to s.c. tumor induction are inherited together and are probably directly related.


Recent research has shown that language and the socio-cognitive phenomena associated with it can be aptly modeled and visualized through networks of linguistic entities. However, most of the existing works on linguistic networks focus only on the local properties of the networks. This study is an attempt to analyze the structure of languages via a purely structural technique, namely spectral analysis, which is ideally suited for discovering the global correlations in a network. Application of this technique to PhoNet, the co-occurrence network of consonants, not only reveals several natural linguistic principles governing the structure of the consonant inventories, but is also able to quantify their relative importance. We believe that this powerful technique can be successfully applied, in general, to study the structure of natural languages.


We prove the existence of quasi-left continuous semimartingales with continuous local semimartingale characteristics which satisfy a Lyapunov-type or a linear growth condition, where latter takes the whole history of the paths into consideration. The proof is based on an approximation and a tightness argument and the martingale problem method.


ABSTRACT Political parties rely heavily on clientelistic networks in Turkey. However, parties may change and pursue alternative strategies while appealing to voters. The goal of this study is to explain why political parties change their strategies from clientelistic to programmatic or vice versa. Therefore, the key question is: under what conditions do parties adopt a clientelistic strategy or a programmatic strategy? Based on field research in Istanbul, Turkey, concerning party-voter linkages, I argue that parties' access to state resources affects the changes in party strategy. When a party is involved in a governing coalition, the party is more likely to pursue a clientelistic strategy; conversely, when a party becomes the opposition, it is more likely to pursue a programmatic strategy. In order to support my arguments, this research observes government (1991–1995) and opposition (2002–2015) periods of the Republican People's Party (CHP, Cumhuriyet Halk Partisi). In this context, the CHP's electoral strategy and local organizations are observed in the more developed Kadıköy and less developed Esenler districts in Istanbul.


Studies assessing the Salmonella transmission chain in pig herds are the first step to start a control program.  The aims of this study were to compare the prevalence of Salmonella positive pigs at the beginning of the finishing phase and at slaughter, and to identify the possible sources of contamination in the farms. In three finishing farms, environmental swabs from the barns and from the feed silos were collected during the sanitary emptiness. Furthermore, samples of feces and blood from the animals on the day of housing; and aliquots from all feed lots were taken. At slaughter, blood, mesenteric lymph nodes (LM) and intestinal content (CI) were sampled. Blood samples were submitted to a S. Typhimurium ELISA-LPS test. All other samples were submitted to a Salmonella isolation protocol. Feed samples were also submitted to Polymerase Chain Reaction (PCR) targeting the invA gene. Feces samples from all pigs were Salmonella negative at the beginning of the finishing phase, in two farms seropositive animals were found. In two farms, residual environmental contamination was detected, and, in the third farm, one of the feed batches was Salmonella positive on the PCR assay. At slaughter, over 90% of the animals were positive on the ELISA-LPS test and, in all cohorts, a variable number (12%-92%) of carriers in LM and CI was detected. From this on, it was concluded that the finishing phase was critical for the amplification of Salmonella infection, and the residual environmental contamination in the farms as well as Salmonella positive feed batches were the probable infection sources. KEY WORDS: Isolation, finishing and slaughter, Salmonella, serology, swine.


Traditional therapeutic approaches for malignancies of the temporal bone have produced unacceptably low survival figures. The morbidity and mortality associated with temporal bone cancer justify extensive surgery. Total temporal bone resection can be performed successfully in the hands of an experienced skull-base surgical team. By circumscribing the tumor rather than transgressing it, this procedure follows generally accepted principles of oncologic surgery. This procedure also shows promise in resection of extensive, carefully selected, recurrent benign tumors. We believe this approach offers hope for improved survival in patients with malignancy of the temporal bone. Further refinements in technique are suggested by each new case. Additional experience and long-term follow-up are needed to assess the efficacy of this procedure. The interest, expertise, and active participation of the operating room nursing team are critical to the success of this surgery. Ideally, not only intraoperative participation but also preoperative assessment and postoperative support should be routine. Close cooperation and extensive communication among the surgeons and nurses are essential.


The paper presents a method for passively tracking a moving target using a sequence of bearings from a surveillance platform. The key assumption for the method is that the target is moving at a constant speed on a fixed heading during the data acquisition period. This is the same assumption that is made for Ekelund ranging. Parameter estimates are computed after bearings are taken as the tracking platforms maneuvers. No specific maneuver by the tracking platform is required. The estimators presented in this paper are approximately maximum likelihood when the target is distant from the platform.


Objective: The application of vacuum sealing drainage (VSD) nursing technology in wounds of soft tissue defects of extremities is discussed from various aspects. It seeks a nursing method that can prevent and reduce tube blockage, restore skin tissue, increase patient comfort, reduce treatment costs, and shorten hospital stay, and provide more ideal conditions for subsequent surgical treatment. Method: Patients were selected in Tangshan Gongren Hospital from June 2016 to June 2017 as subjects. Patients admitted to the hospital are randomly divided into four groups. Channel establishment and oxygen supply group (group 1): establish a negative pressure closed drainage channel and supply a local intermittent high concentration of oxygen; channel establishment group (group 2): establish a negative pressure closed drainage channel; oxygen supply group (group 3): supply negative pressure closed drainage intermittent high concentration oxygen; control group (group 4): routine care with simple negative pressure closed drainage. The differences and effects of each group in clogging the pipeline, restoring skin tissue, increasing patient comfort, reducing treatment costs, and shortening hospital stay are analyzed. Observe the response of the subjects after each experiment. That is, the number of cases of complications such as massive bleeding, post-debridement local infection, exposed bone and tendon degeneration, necrosis, and the number of cases in which no complications occurred during the treatment. The data of this experiment are statistically described and statistically inferred by SPSS17.0 software. The chi-square test is used to compare the count data, and the variance analysis test is used to compare the measurement data. Results: by comparison, channel establishment and oxygen supply group are superior to other groups in preventing and reducing tube blockage, restoring skin tissue, increasing patient comfort, reducing treatment costs, and shortening hospital stay. Conclusion: VSD care technology may be a new approach to the treatment of soft tissue defects of extremities. It has extensive clinical application value and promotion significance.


The field of pharmacogenetics has witnessed remarkable progress during the past several decades. Clinical observations of severe toxic reactions and findings of dramatic interindividual as well as cross-ethnic differences in response to therapeutic agents have been instrumental in fostering advances of the field. Research on cytochrome P450 isozymes may be of particular importance to the field of psychiatry, because most psychotropics depend on these enzymes for their biotransformation. This article traces the progress of research in this area and highlights the importance of clinical and cross-ethnic observations in providing the impetus and direction for the field. Knowledge derived from this line of research is likely to make important contributions toward establishment of rational guidelines for psychopharmacotherapy. In addition, research on these enzymes may also have profound implications in regard to the pathogenesis of a number of major disorders, including several types of commonly encountered cancers, as well as neuropsychiatric problems, including Parkinson's disease, tardive dyskinesia, addiction, and drug-induced neurotoxicity.


The first part of this study analyses and discusses astronomical timekeeping methods used in the New Kingdom. Diagonal star clocks are examined first, looking at classification of sources, decan lists, and the updating of the tables over time. The date list in the Osireion at Abydos is discussed, and issues concerning its place in the history of astronomical timekeeping are raised. The final stellar timekeeping method, the Ramesside star clock, is then examined. The conventional interpretation of the observational method behind the tables is challenged by a new theory, and a system of analysing the tables is introduced. The conclusions of the previous sections are then gathered together in a discussion of the development of stellar timekeeping methods.;The small instruments known as shadow clocks, and their later relatives the sloping sundials, are also examined. The established hypothesis that the shadow clock was completed by the addition of a crossbar is challenged and refuted.;The second part of this study is based on New Kingdom representations of the sky. Two major texts and several celestial diagrams are discussed in detail, beginning with the Book of Nut, which describes the motions of the sun and stars. New translations of the vignette and dramatic text are presented and discussed. Portions of the Book of the Day describing the behaviour of the sun and circumpolar group of stars are analysed.;Finally, celestial diagrams dating from the New Kingdom are discussed. Their composition and significance is discussed and the conceptual framework behind the diagrams is recreated. By introducing new theories and analysis methods, and using a modern but sympathetic approach to the original sources, this study attempts to update and extend our knowledge of these areas of ancient astronomy..


This paper is concerned with the problem of interpolating a smooth surface in a simple and automatic method. The interpolation method is based on the extension of the univariate nonuniform spline function as a tensor product. The local reconstruction method requires the computation of the control points network of the Bezier surface. This paper presents a new algorithm for recovering the control points whatever the Bezier surface degree. The algorithm proposes an efficient way of finding automatically the significant and relevant information to be extracted from the surface. The information to be selected by the algorithm concerns: the order of the cross derivatives, the vertices on which the derivatives are applied and the optimal neighborhood points required to approach the derivatives. The combination of the selected information provides not only solutions to the linear system of equations but also offers the best performances in term of the reconstructed surface quality.


Fretting wear of steam generator tubes due to vibration induced by fluid flow remains a serious problem in the nuclear industry. Azizian and Mureithi [1] have recently developed a hybrid friction model to simulate the friction behavior of tube-support interaction. However, identification of the model parameters remains unresolved.To identify the parameters of the friction model, the following quantities are required: contact forces (tangential force (friction) and normal force (impact)), the slip velocity and displacement in the contact region. Direct measurement of these quantities by using a steam generator tube interacting with its supports is difficult. To simplify the problem, a beam, clamped at one end and simply supported with consideration of friction effect at the other is used. The beam acts as a mechanical amplifier of the friction effects at the microscopic level. Using this simple setup, the contact forces, the sliding velocity and the displacement can be indirectly obtained from the beam's vibration response measurements.A new method based on nonlinear modal analysis was developed to calculate the contact forces. This method is based on the modal superposition principle and Fourier series expansion. The nonlinear normal modes (NNMs) and the generalized coordinates (GCs) have been identified experimentally as functions of the excitation level, the frequency, the preload in the contact area, with and without lubrication.Three hypotheses and related analyses to identify the NNMs and GCs were tested; the analysis based on the harmonic balance method gives the best results for reconstructing the accelerometer signals with an error less than 2% for all excitation levels compared to more than 2% for other methods.The successful signal reconstruction makes it possible to accurately identify the parameters of the Dahl friction model. This is also the first step to identify the parameters of the hybrid friction model.Copyright © 2014 by ASME


Patients with Behçet's disease (BD) have been recognized to be at an increased risk of thrombosis and thrombotic complications have been reported in 12%-40% of patients. The precise pathogenetic mechanisms underlying the thrombotic tendency of BD are not known. In recent researches, it is reported that procoagulant mutations might play a role in thrombotic process in BD patients. We aimed to evaluate the frequency of activated protein C resistance (APCR) in our BD patients and to investigate the association between thrombophlebitis and APCR. The study included 116 patients with BD who fulfilled the International Study Group criteria and 70 healthy individuals as a control group. APCR levels were measured by the clotting method. APCR levels were 129.63 ± 39.70 and 152.26 ± 22.62 in BD patients and control group, respectively (P<0.01). APCR was found in 47.4% and 8.6% of BD patients and control group, respectively (P<0.01). There was no statistically significant difference regarding APCR levels between patients with thrombophlebitis and without thrombophlebitis (46.4% vs. 48.3%). We found the frequency of APCR to be increased in BD patients with or without thrombophlebitis. The lack of association between thrombophlebitis and APCR in our series of BD patients suggests that some factors like endothelial abnormalities other than thrombophilia play a major role in the pathogenesis of thrombosis in BD.


Since the 1980s, museum professionals have increasingly committed to sharing collections with the descendants of people and communities from whom the collected artifacts originated. As late as the 1970s, Indigenous people were not considered stakeholders in the collection and exhibition of their own cultural artifacts. Recently, however, exemplary cases of collection sharing have occurred in North American and European museums. Museums have become "contact zones" as issues of decolonization have come to the fore. This article discusses the sharing of material culture and "double" position of anthropological museums, rooted in their own (colonial) history but in possession of another's culture. Ownership issues, access, and ethics are important for local communities but not always easy for museums to negotiate. This article describes thirteen examples of collaborative partnerships between museums, for the most part large, urban, European, postcolonial institutions, and Arctic Indigenous communities. I argue that open communication, collection research, and an increasing level of co-curation are prerequisites for changes in museum practice, and these changes will benefit both the institutions and the communities involved.


Calcium is an important mineral playing a vital role to maintain bone health. Calcium intake is considered as one of the most important determinants to assess the calcium status and to evaluate the calcium deficiency in the human body. Our study aims at estimating calcium intake in a sample of children and adolescent to be used in the global strategy to reduce calcium deficiency disorders in Morocco. Thus, 131 children and adolescents were recruited from public schools at Rabat and its regions in the framework of a descriptive cross-sectional study. For each participant, anthropometric parameters were measured. Calcium status was assessed by 24 h dietary recall. Food frequency questionnaire was used to evaluate children's nutritional habits and to assess the consumption of calcium-rich food. Overall, the mean calcium intake was 522.0 ± 297.0 mg/day, and 85.5% of subjects highlighted calcium deficiency, with no significant difference between boys and girls. Calcium intake was significantly different according to age groups, and high consumption of calcium was found in subjects aged from 14 to 18 years (776.86 ±290.07 mg/day), giving evidence of the low calcium status of the studied population. Daily food intake and food frequency analysis showed that bread, vegetables, and fruits are the most consumed food and the main source of daily calcium intake. Consumption of dairy products, considered as the best source of calcium, is lower and represents only 14% of total calcium intake. Our study clearly showed that calcium status is very lower in Moroccan children and adolescents and a large proportion of this population have inadequate calcium intake. Hence, there's an urgent need of specific strategies, including children sensitisation and nutritional education, to increase calcium intake and therefore reduce calcium deficiency disorders impacting the whole body during childhood and in adult age.


BACKGROUND: INCA estimated, for 2020 – 2022, Brazil would have 8,460
new pediatric cancer cases and 5% are bone cancer. Pain is the most
prevalent symptom and is present in 75% - 90%. Advanced ill patients
have 40% pain undertreated. OBJECTIVE: This study was to evaluate pain
in pediatric bone cancer patients and investigate if there was a
difference between those who survived and those at end-of-life.
PROCEDURE: Patients were registered at INCA Pediatric Department,
January 2011 – October 2016, with the diagnosis confirmed of primary
bone cancer and under 19 years old. Pain was evaluated and registered at
three moments during their treatment: at registration, three months
after and the last visit before the end of this study or patients death,
using pain scores. RESULTS: 157 patients were bone cancer, 15 (9.6%)
had lost the follow up; 142 were analyzed, osteosarcoma 69.7% and Ewing
sarcoma 30.3%, metastatic patients 50.7%. At the registration 53.5%
had pain, 69.71% were receiving pain treatment and 42.25% had pain
medications changed. Comparison of the three study moments was observed
a decrease of pain status, with the absence of excruciating pain, and an
increased use of opioids. There was no difference (p = 0.68) in pain
status between groups of who survived and who died (39.4%). CONCLUSION:
Pain management resulted in reduction of pain complaint and reduction in
pain intensity, together with increasing opioid use. End-of-life
patients did not have more pain than others, but disease progression was
associated to more pain.


Ecuador's government understands that capable research universities can help in solving the country's pressing socio-economic problems. However, research capabilities and research productivity in its national universities have historically been low, as professors primarily teach and often do not have the inclination, the ability, or the time to do research. Through several initiatives, which have been both praised and scorned, the government is attempting to instigate a new research culture among its institutions of higher education. This article describes these initiatives and focuses on the "Prometeo–Viejos Sabios" grant program from the perspective of a recent participant. The program was created to attract international scholars to assist Ecuador's universities in their research and development efforts.


Geographic information systems (GIS)are increasingly being used worldwide for the monitoring of important public health issues, proving its potential as a powerful tool in decision making. Studies on GIS in epidemiological studies for large areas is well documented, while other GISin health applications are restrained due to a current lack of coordination and communication within public health authorities and research networks. To overcome the mentioned constraint, the project described in this paper aims to establish a research agenda for the use of GIS in public health, in the Australian contexto


Type of funding sources: Other. Main funding source(s): Resuscitation Council (UK)

 Cardiopulmonary resuscitation (CPR) in hospital is a stressful experience for patients who witness it and for the healthcare professionals involved. Limited evidence and guidance exist regarding the experience of witnessing a fellow patient's CPR. Informed by a systematic review [1] and a multi-stakeholder consultation [2], the WATCH (Witnessing an Attempt of CPR in Hospital) study has explored the lived experiences of hospital patients and healthcare professionals on patient-witnessed CPR with the primary aim of understanding the impact of such an experience [3].

 The purpose of this study was to understand the meaning of CPR in the context of the hospital life-world of patients who witness CPR and of healthcare professionals.

 The WATCH study used a qualitative descriptive phenomenological design. The lived experiences of 16 witnessing patients admitted to nine clinical wards and of 20 healthcare professionals involved in CPR were explored through in-depth interviews and focus groups conducted in one hospital in the UK.

 Three themes were developed from analysis indicating that, despite a shared understanding of CPR as part of hospital life and as a potential result of emergencies, patients and healthcare professionals had different perspectives of hospital CPR. 1) Unfamiliarity vs Exposure: although patients were aware of CPR, witnessing CPR was often unexpected and traumatic, as many had not experienced it before. Instead, healthcare professionals with previous knowledge and expertise, held an emotional distance and focused on the clinical tasks of CPR. 2) Fiction vs Reality: healthcare professionals considered patients to have unrealistic expectations of CPR, often uninformed and influenced by distorted portrayal of CPR to the lay public through television. Patients acknowledged that witnessing hospital CPR helped their understanding of the reality of it, which differed from their initial idea. 3) Life vs Death: Patients felt disturbed by the presence of a dead body in their room after CPR, whilst daily activities of hospital life were carried out, highlighting a contrast between life and death in the same environment. Finally, healthcare professionals reflected on the meaning of performing CPR as a process to help the ones witnessing it to face and accept the reality of death.

 The WATCH study highlighted that patients and healthcare professionals hold different perspectives of CPR in hospital. Awareness of different perspectives of hospital CPR will help healthcare professionals initiate CPR conversations with hospital patients. Education and accurate information should be offered to hospital patients around CPR to have realistic expectations. Further work is required to guide and support clinical practice around patient-witnessed CPR in hospital.


The purpose of this study was to investigate the relationships between weights of backpack and back and shoulder pains of elementary school students in Korea. A cross-sectional sample of 278 boys and 233 girls aged between 7 and 12 years were analyzed for this study. 49.1% of the participated children reported their backpacks were felt heavy, and the weights of their backpack were grater than 13.3% of their body weight. About 65.4% of students carried greater than 10% of their body weights. The weight of the backpack showed significant positive relationship with shoulder pain but not with their back pain. The results of this study suggested that overweighed backpack could cause the musculoskeletal pain to the elementary school students. Therefore, an effective backpack safety program for parents and students is necessary to educate them how to prevent possible musculosketal pain related to the weight of backpack within the perspective of the ergonomical approach.


The Securities and Exchange Commission (SEC) has undergone measured change in the last fifteen years in the way it executes its mission to protect investors. Since reforms adopted in 1996, the SEC has operated under a new mandate to consider the effect of new rules on efficiency, competition, and capital formation. That new guiding legal principle, accompanying pressure from courts, and oversight from Congress have spurred measured reforms at the SEC and have begun to change the structure and culture of the agency with respect to its rulemaking process.That process reform effort has been supported by a preliminary investment in a small group of new economists at the SEC, housed in the new Division of Economic and Risk Analysis (DERA). This Article argues that these developments are incomplete unless the SEC's economic analysis capability is similarly used to apply robust scrutiny to the SEC's enforcement process as well. This Article draws on lessons from the FTC's successful application of economic analysis to its enforcement process in order to develop practical reforms for the SEC.


The paper criticizes the novel approach of Miscevic to apriority and analyticity. In a nutshell, it aims to show that Miscevic has failed to appreciate the power and impact of semantic atomism in the theory of concepts. He simply assumes a clean distinction between concept-analyzing propositions and those that do not analyze concepts, misconstrue the way atomists understand concept-analyzing propositions, namely epistemically and not semantically, and fails to provide an answer to atomistic considerations. Finally, I analyze his examples of alleged a posteriori concept-analyzing propositions and I argue that they fail to support his theory.


This study examines the effects of including the summer period on value-added assessments (VAA) of teacher and school performance at the early grades. The results indicate that 40-62% of the variance in VAA estimates originates from the summer period, depending on the outcome. Furthermore, when summer is omitted from the VAA model, 51-61% of the teachers and 58-61% of the schools change performance quintiles, with many changing 2-3 quintiles. Extensive statistical controls for student background and classroom and school context reduce these differences, but 36-47% of the teachers and 42-49% of the schools are still in different quintiles. Besides misclassifying teachers and schools, including summer creates biases in VAA estimates against schools with concentrated poverty. These results suggest that removing summer effects from VAA estimates will likely require biannual achievement assessments (i.e., fall and spring).


Harsh environment electronic packaging is needed to assure the reliability of distributed electronic controls for operation at 200/spl deg/C ambient temperatures. The wire bond interconnects are a critical contributor to overall packaging reliability. The present study will investigate the use of aluminum wires on nickel metallized substrates. This metallurgy maintains the monometallic aluminum couple at the bond wire to die metallization interface while utilizing established nickel substrate metallization technology to provide a stable connection at the substrate. Thermal aging of Al-1%Si wires on nickel metallized substrates was conducted. Both a bulk nickel metallization on alumina and a nickel plate on silver thick film on alumina were evaluated. Intermetallic formation rates will be determined for both the Al/Ni couple and the Al/Ni/Ag thick film couple. In addition, fatigue tests will be conducted on Al-1%Si wires bonded to various substrate metallizations. The effects of intermetallic formation and fatigue on wire bond reliability will also be assessed.


This study investigates the concept, analysis, and design of the Permanent Magnet (PM) Trans-Rotary Magnetic Gear (TROMAG). The device converts linear motion to rotation and vice-versa through the magnetic field, and does the gearing action at the same time. It can convert the low speed high force linear motion of a translator to the low torque high speed rotation of a rotor; a promising capability for wave energy applications in particular. The structure of the TROMAG is presented, along with results of three-dimensional (3D) Finite Element Analysis (FEA), as well as the basic tenets of continuous force transmission in orthogonal directions by the elementary magnetic arrays. Moreover, a simple analytical method is set forth for calculating the force of the device. The method is based on the replacement of a PM by an equivalent current carrying coil and the electromagnetic image method theory. In addition, design and scaling of the TROMAG is discussed and the impact of several design parameters on the performance of the TROMAG is investigated through an accurate analytical model. Finally, transient performance of the TROMAG is discussed.


Background and Purpose- Traditional risk factors for ischemic stroke are body stressors that are related to autonomic autonomic system (ANS) dysfunction. The value of ABCD2 score (age, blood pressure, clinical features, duration of symptoms, diabetes) to predict ischemic stroke after transient ischemic attack is compromised by the inclusion of a limited number of stressors. We aimed to assess whether markers of ANS function and stress could predict the occurrence of secondary ischemic events after transient ischemic attack or minor stroke. Methods- This is a prospective cohort study in which 201 patients were recruited within 48 hours after initial transient ischemic attack or minor stroke and followed for 90 days to assess the development of secondary ischemic events. ABCD2 score, heart rate variability (HRV) parameters as markers of ANS function, and psychological stress were assessed. Logistic regression and area under the curve (AUC) were used to assess the models' predictive ability. Results- Morning high frequency (HF) HRV power and changes in HF HRV from morning to afternoon (daytime HF changes) were the most useful HRV predictors for both ischemic events (AUC=0.61 and 0.70) and ischemic stroke (AUC=0.62 and 0.72). Compared with ABCD2 score, 2 HRV-based stress models showed higher predictive ability for ischemic events (AUC=0.82 versus 0.63, 0.76 versus 0.63; P<0.05) and ischemic stroke (AUC=0.87 versus 0.64, 0.82 versus 0.64; P<0.05). Conclusions- Assessing the effects of stress on the ANS may be an innovative way to stratify the risk of ischemic events after transient ischemic attack or minor stroke. New risk stratification by assessing the dynamic features of ANS dysfunction and stress may help identify high-risk sub-populations that may benefit from added management.


We can only control what we can measure. In the case of dairy farming, nitrogen utilisation requires a higher level of control to reduce environmental pollution and improve farm economics. Nitrogen metabolism in the ruminant animal is a complicated system and accurate evaluation of protein utilisation by dairy cows is limited by current methods. This dissertation assesses various methods of analysing ruminal crude protein degradation and introduces a new method of assessing protein value of forages i.e. the protein available to the ruminant for absorption at the duodenum. The following procedures are included: in situ incubation, Cornell Net Carbohydrate and Protein System, in vitro enzymatic degradation and the modified Hohenheim gas test. The third section of this dissertation applies these methods to a controlled experiment investigating the effect of wilting on the protein value, protein characteristics and amino acid profile of grass silage. Conclusively, the results of this study aid in estimating protein supply from forages to dairy cows.


An obvious hypertriglyceridemia was detected in 22.8% of the 57 investigated patients with acute pancreatitis. A type IV or V hyperlipoproteinemia could precede the onset of pancreatitis but the level of serum triglyceride greatly increased during the acute attack and had a tendency towards normalization later on. Increased serum gamma-glutamyltransferase activity was found to be especially high in alcoholic patients and in those presenting biliary disease.


Tachycardiac and bradycardiac arrhythmias increase with age. Because cardiac arrhythmias at an advanced age are almost always caused by organic disease, one must face more frequently electrical complications (e.g. ventricular fibrillation). Owing to the decrease of arterial flow volume as well as mean arterial pressure, bradycardiac and tachycardiac arrhythmias result in cerebral symptoms more often in elderly than younger persons. The causes of this observation are the disturbed cerebral autoregulation of blood pressure, but also the insufficient capacity of adaptation of the ageing circulation. In this situation it is more frequently necessary in old people than in younger ones to treat cardiac arrhythmias by antiarrhythmic drugs. The cardiodepressant effect of most antiarrhythmic drugs must be taken into account in this context.


In this paper we introduce the concepts of $CD$-rings and $CD$-modules. Let $R$ be a ring and $M$ be an $R$-module. We call $R$ a $CD$-ring in case every cosingular $R$-module is discrete, and $M$ a $CD$-module if every $M$-cosingular $R$-module in $\sigma[M]$ is discrete. If $R$ is a ring such that the class of cosingular $R$-modules is closed under factor modules, then it is proved that $R$ is a $CD$-ring if and only if every cosingular $R$-module is semisimple. The relations of $CD$-rings are investigated with $V$-rings, $GV$-rings, $SC$-rings, and rings with all cosingular $R$-modules projective. If $R$ is a semilocal ring, then it is shown that $R$ is right $CD$ if and only if $R$ is left $SC$ with $Soc(_{R}R)$ essential in $_{R}R$. Also, being a $V$-ring and being a $CD$-ring coincide for local rings. Besides of these, we characterize $CD$-modules with finite hollow dimension.


Over the past several decades, advances in prenatal evaluation, neonatal care, diagnostic techniques, anesthesia, and clinical management have enhanced care of pediatric surgical patients. Neonates have their own physiologic characteristics that must govern their care. The most distinctive and rapidly changing functions occur during the neonatal period. This is due to the newborn infant's adaptation from complete placental support to the extrauterine environment, differences in physiologic maturity of individual neonates, small size of these patients, and demands of growth and development.1 Advances in neonatal care have resulted in survival of increasing numbers of extremely low birth weight infants. However, pediatric surgeons and neonatologists are now faced with more complex diseases due to extreme prematurity. Derangements in temperature regulation, fluid and electrolyte homeo stasis, glucose metabolism, hematologic indices, and immune function are magnified in this setting. Preterm infants are more vulnerable to specific problems such as intraventricular hemorrhage, hyaline membrane


The purpose of this study was to investigate the effect of various types and amounts of polysorbates on potassium chloride release. Potassium chloride, which is a highly water-soluble model drug, was embedded into wax (containing surfactants) to produce a sustained-release dosage form. Various kinds of polysorbates were chosen as surfactants to control the dissolution profile. The release of the model drug was tested by rotating paddle method of USP 23 and the dissolution process was characterized by the Weibull distribution. The surface tension of the aqueous solutions of polysorbates was determined by a computer-controlled Sigma 70 tensiometer. The application of polysorbates in more than 2% concentration did not alter either the release rate of the embedded potassium chloride, or the surface tension values of the aqueous solutions. The results of this study allow the determination of the optimal concentration of polysorbates in the case of the potassium chloride release.


With the reform booming in teaching fields,the author carried out Graded English teaching in her teaching classroom and achieved favorable efficiency.In this paper,the author mainly discusses the specific grading of exercise after class in implementing graded teaching,taking for example Section A,Unit 6(Go for it! SB for Grade Eight,Volume A,by People's Education Press and Thomson Learning,2004,2nded).


This compilation of state profiles from the 2010 National Survey of Nonprofit-Government Contracting and Grants, provides national and state-by-state snapshots of human service organizations that have contracts and grants with local, state and federal governments. The individual state profiles are designed to document the extent of nonprofit-government contracting, processes and problems. They also examine the impact of the recession on these organizations and the cutbacks they have made to keep their programs operating. States are also ranked according to number of grants, types of issues, and actions taken by human service nonprofits to address the challenges they face.


The paper presents comprehensive study of applicability of various language learning platforms to the development of foreign language that are indicated in the Common European Framework of Reference for Language (CEFR). To carry out the research, a number of language learning platforms that are used as an alternative to Learning Management Systems (such as Moodle) was selected and on their basis a questionnaire was designed. The quantitative research involved faculty students and lecturers of Vilnius College of Technologies and design. The results of the research permitted us to draw a list of recommendations on which language learning platforms are best to be used in EFL classrooms to facilitate the development of foreign language competences.


Several performance assessment (PA) analyses have been completed to estimate the release to the accessible environment of radionuclides from spent light water reactor (LWR) fuel emplaced in the proposed Yucca Mountain repository. Probabilistic methods were utilized based on the complexity of the repository system. Recent investigations have been conducted to identify the merits of a pyroprocess fuel cycle. This cycle utilizes high temperature molten salts and metals to partially separate actinides and fission products. In a closed liquid metal reactor (LMR) fuel cycle, this allows recycling of nearly all of the actinides. In a once-through cycle, this isolates the actinides for storage into a wasteform which can be specifically tailored for their retention. With appropriate front-end treatment, this Process can also be used to treat LWR spent fuel.


In the building energy performance simulation, the uncertainty analysis (UA) couples to the sensitivity analysis (SA) to handle ever-existing uncertainties; induced by the sources of uncertainty including random occupants behavior and degradation of building materials over time. As a building simulation tool reaches to a high level of complexity, it becomes more challenging for the sensitivity analysis to deliver reliable outputs; thus the accuracy of the SA results substantially depends upon the number of sample sets or the type of analysis performed. This paper describes a variance-based SA tool integrated into a building Resistance-Capacitance (RC) thermal model. Then, for a hypothetical residential building test case, three distinct first-order sensitivity index simulators and three total sensitivity index simulators are implemented and compared in terms of the dependency of results on the sample size, i.e., the demand for the computational cost.


Agrin, released by motor neurons, promotes neuromuscular synapse formation by stimulating MuSK, a receptor tyrosine kinase expressed in skeletal muscle. Phosphorylated MuSK recruits docking protein-7 (Dok-7), an adaptor protein that is expressed selectively in muscle. In the absence of Dok-7, neuromuscular synapses fail to form, and mutations that impair Dok-7 are a major cause of congenital myasthenia in humans. How Dok-7 stimulates synaptic differentiation is poorly understood. Once recruited to MuSK, Dok-7 directly stimulates MuSK kinase activity. This unusual activity of an adapter protein is mediated by the N-terminal region of Dok-7, whereas most mutations that cause congenital myasthenia truncate the C-terminal domain. Here, we demonstrate that Dok-7 also functions downstream from MuSK, and we identify the proteins that are recruited to the C-terminal domain of Dok-7. We show that Agrin stimulates phosphorylation of two tyrosine residues in the C-terminal domain of Dok-7, which leads to recruitment of two adapter proteins: Crk and Crk-L. Furthermore, we show that selective inactivation of Crk and Crk-L in skeletal muscle leads to severe defects in neuromuscular synapses in vivo, revealing a critical role for Crk and Crk-L downstream from Dok-7 in presynaptic and postsynaptic differentiation.


Phytate, being the major storage form of phosphorus in plants, is considered to be an anti-nutritional substance for human, because of its ability to complex essential micronutrients. In the present study, we describe the genetic analysis of phytate and phosphate concentrations in Brassica rapa using five segregating populations, involving eight parental accessions representing different cultivar groups. A total of 25 quantitative trait loci (QTL) affecting phytate and phosphate concentrations in seeds and leaves were detected, most of them located in linkage groups R01, R03, R06 and R07. Two QTL affecting seed phytate (SPHY), two QTL affecting seed phosphate (SPHO), one QTL affecting leaf phosphate and one major QTL affecting leaf phytate (LPHY) were detected in at least two populations. Co-localization of QTL suggested single or linked loci to be involved in the accumulation of phytate or phosphate in seeds or leaves. Some co-localizing QTL for SPHY and SPHO had parental alleles with effects in the same direction suggesting that they control the total phosphorus concentration. For other QTL, the allelic effect was opposite for phosphate and phytate, suggesting that these QTL are specific for the phytate pathway.


League regulators aim for an equitable competition where each team has an equal chance of winning the championship, termed competitive balance. It is generally assumed that closed leagues with stricter labor market regulations should demonstrate better competitive balance than open leagues with promotion and relegation. The aim of this research was to examine the competitive balance between and within seasons in the closed Australian National Rugby League (NRL) and open English Super League using five measures of concentration and dominance. Overall, the closed NRL competition demonstrated superior competitive balance. The practical and theoretical implications of the findings are discussed.


This study investigates predicting and eliminating malnutrition and anemia using ML Algorithms and comparing all the methods with various malnutrition-based parameters.

 The health of the nation is more important than the wealth of the nation. Malnutrition and anemia are serious health issues but the least importance is given to eradicate them.

 Proper nutrition is an essential component for the survival, growth, and development of infants, children, and women who in turn give birth to infants.

 In the proposed system, machine learning approaches are utilized to predict the malnutrition status of children under five years of age and anemia in men and women using old datasets and further providing a suitable diet recommendation to overcome the disease. Classification techniques are being used for malnutrition as well as anemia prediction.

 Algorithms such as Naïve Bayes classifier (NBC), Decision Tree (DT) algorithm, Random Forest (RF) algorithm, and K-Nearest Neighbor (k-NN) algorithm are utilized for prediction. The results obtained by these algorithms are 94.47%, 85%, 95.49%, and 63.15%. When compared, Naïve Bayes and random forest algorithm provided efficient results for malnutrition and anemia, respectively.

 By testing and validating, preventive actions can be taken with the help of medical experts and dieticians to reduce malnutrition and anemia conditions among children and elders, respectively.


Purpose Abdominal fat necrosis is a rare cause of abdominal acute pain, classified into primary or secondary according to the cause. Primary fat necrosis includes epiploic appendagitis or idiopathic infarction of the greater omentum. This retrospective study focuses on multislice computed tomography (MSCT) findings and diagnosis of primary abdominal fat necrosis as a cause of acute abdomen. Material and methods This was a retrospective study with 20 patients included, presented to emergency room with acute abdominal pain diagnosed as primary fat necrosis. Retrospective evaluation was made of the patients' clinical data, presentation, CT studies done at the acute stage, and their primary and final diagnosis. Results Twenty patients (eight male and 12 female, mean age 45 years, age range 20-70 years) diagnosed with abdominal fat necrosis (primary omental infarct) on CT imaging between October 2014 and June 2018 were evaluated. Clinically, five patients were suspected to be cholecystitis¸ eight patients as appendicitis, and four patients as diverticulitis. In addition, three patients had renal colic and were suspected to have ureteric stones; they showed suspected areas of abnormal fat density in non-contrast CT of the urinary tract. Idiopathic omental infarctions were detected in 13 patients on CT; all were on the right side. Laparoscopic excision was done for all. The other seven patients had epiploic appendagitis, seen on the left side, treated with conservative management. Conclusions Primary fat necrosis, although rare, can be presented as acute abdomen. MSCT is the main diagnostic tool for diagnosis of omental infraction and differentiation between other causes of acute abdomen.


Time Out is an album by the Dave Brubeck Quartet, released in 1959. A commercial hit, it was the first jazz album to sell over 500,000 copies. This success has been primarily accredited to Brubeck's innovative approach to rhythm, which was deemed to be unprecedented in the jazz world at the time of release. However, a detailed investigation of the social and musical contexts in which Brubeck was situated reveals that there was already precedent for such rhythmic experiments in a jazz environment. Furthermore, contemporaries of Brubeck were concurrently exploring rhythm in similar ways. This paper attempts to examine alternative reasons for the album's critical acclaim. Such factors include Brubeck's positionality as a white musician who was associated with the "cool" jazz movement, and the pervasiveness of racially-coded language regarding rhythm in jazz discourse. By deconstructing popular media and critical journals from the twentieth century, one can gain greater insight as to how these aspects helped perpetuate Brubeck's "clean-cut" image to the public. This, coupled with his engagement with universities and role as cultural ambassador for the U.S. State Department, imbued in Brubeck's music a sense of legitimacy previously not awarded to jazz musicians, and thus differentiated Brubeck from his contemporaries. Moreover, viewing Brubeck's music through a Eurological framework brings to the fore the lack of "hot" rhythm tropes present on Time Out , which was also a key element in facilitating the album's mainstream success.


We have identified the gene for human gamma-glutamyl transpeptidase [GGT; glutamine:D-glutamyl-peptide 5-glutamyltransferase (also called gamma-glutamyltransferase), EC 126.96.36.199] in a BCR gene-related region located in band q11----qter of chromosome 22. Two cDNAs complementary to the GGT mRNA have been isolated from a human placental library constructed in phage lambda gt11. The largest cDNA has a size of 2535 base pairs (bp) and an open reading frame of 1707 nucleotides encoding 569 amino acids. By using a probe corresponding to this cDNA, a mRNA of approximately 2.4 kilobases was detected by RNA blot-hybridization analysis in mouse kidney RNA. The GGT precursor encoded by the coding sequence would have an estimated Mr of 61,400. We compared our nucleotide and deduced amino acid sequences with the published results of rat kidney cDNAs. The human and rat amino acid sequences are similar; however, a considerable discrepancy in nucleotide sequence was found within a 180-bp fragment of the heavy chain, resulting in a completely different amino acid sequence for this region. In addition, the 5' untranslated sequence of the human cDNA (669 bp) is substantially larger than that determined in the rat cDNA (227 bp). Our results may be valuable for further studies on the protein structure of human GGT as well as studies on the regulation of the enzyme.


This Development Project Report discusses language teaching with a focus on motivation and favourable learning environment. The report tries to describe the concepts of motivation and favourable learning environment, and show which methods are most suitable for language teaching in adult education. The methods described in this report were used on an Academic Swedish course at the Jyvaskyla Open University. Also other suitable activities are gathered from literature and these methods form a hand book which can be utilised in language teaching in general. Language teaching utilises all forms of communication; and the aim of second language teaching is to rehearse communication skills (speaking, writing, listening) for future in communication with native speakers of other languages. Language learning also includes cooperation with other people with other cultural backgrounds. The students should also be taught how to utilise these skills in their future language studying. The report tries to describe the kind of activities and methods which enhance language learning and show how motivating the students and creating a favourable learning environment affects on good learning results. Most of the material is based on studies and experiences of good practices, articles and literature. Also the feedback given by the students of the Academic Swedish course is discussed. It will give some information on how these students define good teaching and what they think is important in language learning.


Few studies on remittances have focused on sub-Saharan Africa. This paper analyses a nationwide survey of 5998 households to determine the characteristics of both internal and overseas remittances in Ghana. Particular attention is paid to the poverty-alleviation potential of remittances. Furthermore this study uses a smaller scale pilot project with a matched sample of senders and receivers of remittances to identify some problems with using household-level surveys to assess the volume and impact of overseas remittances and offers some suggestions as to how to handle these problems. The paper estimates that foreign remittances may be three times as large as Bank of Ghana estimates bringing Ghana on par with large remittance receiving countries such as the Philippines and Mexico. The paper concludes that while foreign remittances are larger in value locally sent remittances reach poorer segments of the population. Both foreign and local remittances are unevenly geographically distributed being received more in the centre and southern regions than in northern Ghana where the poorest regions are. The paper argues a need to study multiplier effects of foreign remittances as these can be large and eventually accrue to rural populations. (authors)


Pentachloropyridine crystals in two polymorphic modifications: tetragonal and monoclinic were studied by dicherential scanning calorimetry and polarized IR and Raman spectroscopy in 20 to 200 cm-1 region and at different temperatures from melting point down to the liquid nitrogen temperature. The 4 K dicherence in melting points of both forms indicates the occurrence of moiiotropy. The spectra were discussed in terms of positional disorder in the studied crystals which often happen to be mixtures of the monoclinic crystal and the Land D-forms of the tetragonal one. The monotropic transition of the metastable tetragonal crystal into the stable monoclinic one was observed in the Raman spectra and under the polarizing microscope at temperatures ranging from 170 to 185 K and as an ankaly on the differential scanning calorymetry diagram at 193 K. PACS numbers: 64.70.Kb, 78.30.—j


In resent years, the Radio Frequency Identification technology (RFID) has been introduced as the new way of product recognition and identification of goods. Several large setups utilizing RFID have been reported the media. However, very few reports have covered the actual use and thus, the real penetration and impact of the technology are so far relatively unknown. Therefore, a survey covering the interest of RFID in Swedish companies was conducted with the purpose to find out to what extent RFID is used and the future plans for implementing RFID.
After identifying the most common characteristics of RFID, a questionnaire was sent to about eight hundred companies within various industries, inviting them to take part in the survey. From the about eight hundred questionnaires, 38.5 percent were collected and analysed.
The results from this first analysis of the survey imply that the actual use of RFID among the participating companies is surprisingly low. Surprisingly, only a few companies stated that they currently are using RFID. One fifth of the respondents stated that they have plans for, or have made pilot studies, on RFID. On the likelihood of them implementing RFID in logistics and production, the rate was slightly higher, about one out of ten had plans for a future implementation within the production area whereas the same rate for transportation and logistics was about one out of five. There are still many reasons for companies to postpone the decision to implement RFID, especially as many of them do not see the way the technology improve customer satisfaction. The return on investment seems to be too uncertain for most companies to jump on the RFID-train.


Light propagation in photoreceptor outer segments is affected by photopigment absorption and the phototransduction amplification cascade. Photopigment absorption has been studied using retinal densitometry, while recently, optoretinography (ORG) has provided an avenue to probe changes in outer segment optical path length due to phototransduction. With adaptive optics (AO), both densitometry and ORG have been used for cone spectral classification, based on the differential bleaching signatures of the three cone types. Here, we characterize cone classification by ORG, implemented in an AO line-scan OCT and compare it against densitometry. The cone mosaics of five color normal subjects were classified using ORG showing high probability (∼0.99), low error (<0.22%), high test-retest reliability (∼97%) and short imaging durations (< 1 hour). Of these, the cone spectral assignments in two subjects were compared against AOSLO densitometry. High agreement (mean: 91%) was observed between the two modalities in these 2 subjects, with measurements conducted 6-7 years apart. Overall, ORG benefits from higher sensitivity and dynamic range to probe cone photopigments compared to densitometry, and thus provides greater fidelity for cone spectral classification.


We have previously reported the presence of monoclonal, tumor-related B lineage cells in the blood of myeloma patients. The cells are continuously differentiating, and the majority are at a very late stage of B cell differentiation into plasma cells, consistent with the hypothesis that they comprise a precursor cell subset responsible for disseminating and possibly for relapse of the disease. The pattern of beta 1 integrin expression on monoclonal B lineage cells from blood and bone marrow of myeloma patients was evaluated using multiparameter flow cytometry in comparison to normal blood or tissue B cells and malignant B cells from B-CLL, B lymphoma, or plasma cell leukemia. The alpha 4 and beta 1 chains were found on the majority of normal B cells, usually with a higher expression of alpha 4 compared to beta 1. alpha 5 was detectable at low density on B cells from lymph node, bone marrow, and lamina propria. the alpha 2 and alpha 6 chains are absent on B cells localized in normal lymphoid tissues as well as on normal blood B cells and in vitro activated B cells. In myeloma, the blood B cells express alpha 2, alpha 5, and alpha 6, suggesting important functional differences between these tumor-related B cells and their normal counterparts. The plasma cells located in myeloma bone marrow express no alpha 2, and almost no alpha 6, although they have variable expression of alpha 4, alpha 5, and beta 1. Thus the end-stage plasma cells appear to lack receptors that would support a propensity for invasion of basement membranes and exit to extravascular spaces. In contrast, the circulating plasmablasts in a patient with plasma cell leukemia make up a large subset of early plasma cells expressing all integrin receptors analyzed, including alpha 2 and alpha 6. Malignant cells from B-CLL and B lymphoma express only the alpha 4 and beta 1 integrins, and some B-CLL have very low levels of alpha 3, but no alpha 2, alpha 5, or alpha 6, suggesting that they may be limited to the vascular spaces and do not extravasate, at least for the stages of disease analyzed here.(ABSTRACT TRUNCATED AT 400 WORDS)


Background Patient education (PE) is broadly accepted as an integral part of the management of people with Rheumatoid arthritis (RA)(1), completing clinical care. However, previous reviews, till 2003,(2, 3) concluded that studies show small short-term results with lack of evidence of long-term benefits as well as updated results are not known on this evidence. Objectives To sistematically review the effectiveness of behavior and/or psychoeducational interventions on health status of patients with RA. Methods We searched on MEDLINE for randomized controlled trials (RCT's), evaluating long term (≥1year) outcomes, controlled with standard care and published between 2003 (inclusion date of latest systematic review) and 2012. Keywords used were "rheumatoid arthritis" in conjunction with each of the following "education AND group intervention/programme". Two reviewers examined and screened search results and evaluated their quality with a checklist (4). Results Forty-seven results were obtained. From thirteen RCT's published after 2003, four studies were included. Exclusions were due to: outcome evaluation inferior to 1 year (three); other disease than (only) RA (three); no behaviour and/or psychoeducational intervention (two); parallel intervention comparison (one). Three studies showed that PEP was associated with positive results at long-term, mainly on: adherence to joint protection behaviour; coping; knowledge; quality of life (symptoms); care satisfaction; early morning stiffness duration, functional capacity (AIMS2). One of these studies hasn't proved differences on functional capacity (HAQ). Only one study hasn't showed any statistical significant difference between groups in any outcome [functional capacity (AIMS2), self efficacy]. Conclusions Long-term efficacy was proven in some outcomes. However, primary outcomes and measures differ frequently between studies. Standard interventions are also difficult to be homogeneous. Better methodological quality studies are needed, even if good ones are already published5, 6. One of the most important decisions for future studies is to decide what (main/primary) outcomes should be used. References - van Eijk-Hustings, Y., et al. (2012). EULAR recommendations for the role of the nurse in the management of chronic inflammatory arthritis. Annals of the Rheumatic Diseases, 71(1):13- 19. - Riemsma, R.P. et al. (2003). Patient education for adults with rheumatoid arthritis. Cochrane Database of Systematic Reviews 2003, Issue 2. Art. No.: CD003688. - Niedermann, K. et al. (2004). Gap Between Short- and Long-Term Effects of Patient Education in Rheumatoid Arthritis Patients: A Systematic Review. Arthritis & Rheumatism, 51:3, 388–398. - Kmet, L.; Lee, R.; Cook, S. (2004). Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields. Alberta, Edmonton: Alberta Heritage Foundation for Medical Research. - Niedermann, K. et al. (2012). Six and 12 months' effects of individual joint protection education in people with rheumatoid arthritis: A randomized controlled trial. Scandinavian Journal of Occupational Therapy, 19: 360–9. - Quintrec, J. et al. (2007). Effect of a collective educational program for patients with rheumatoid arthritis: a prospective 12-month randomized controlled trial. J Rheumatol., 34(8):1684-91. Disclosure of Interest None Declared


Ethiopia's Justice System Reform Program has not achieved the pledges that were promised since 2002. One of the sources for the impediments was 'revolutionary democracy' because its 'democratic' limb represented the pursuits of justice system reform while its 'revolutionary' limb caused impediments to the reform. This involves various manifestations of 'revolutionary democracy' which include institutional discontinuity, ethnic politics and reluctance to land reform.  Disruptions owing to periodic changes in institutional structures (and mandates) adversely affect institutional memory and continuity in Ethiopia's justice system reform. The second impediment relates to problems in law and order owing to the risky experiment in ethnic politics that has nurtured ethnic radicalism and hostilities along linguistic lines thereby creating pressures on the justice sector. It has also impeded attainments in the first two dimensions of good governance, (i.e. voice and accountability) because genuine voice of citizens envisages rational choice as opposed to ethnicity. The third trap which is among the manifestations of 'revolutionary democracy' involves rigidity against reforming Ethiopia's land law which has handcuffed broad-based economic performance thereby impairing the resource base of all reform pursuits (including justice system reform). The way forward thus envisages not only addressing the external manifestations of the problems in the justice system, but also requires directly addressing the root causes of the impediments.  Key terms Justice system reform · Good governance · Nation building · Land tenure security; Ethnic politics · Ethiopia


The effectiveness of the application of LRM is disclosed through field tests to decrease the resistance of grounding in different configurations of grounding systems. In addition, a chemical electrode is implemented in the soil with greater resistivity to analyze its behavior with respect to other designs. The measurement of the resistivity of different soils, the modeling of each soil and the measurements of the grounding resistances are presented together with these methods. Therefore, with the results of this work and the existing equations for the calculation of the grounding resistance, it is possible to determine the value of the optimum grounding resistance to be obtained by applying LRM. This document aims to be a useful guide to the improvement of grounding systems for engineers and researchers who study, design and build innovative and effective grounding systems with the application of improved composites for safe electrical installations.


We report a case of the rare porokeratosis variant porokeratosis ptychotropica (PP). A circumferential perianal plaque and the characteristic histology of multiple cornoid lamellae with underlying dermal amyloid deposition were seen. Amyloid deposition was seen in the biopsied intertriginous area of the plaque only, which, in concordance with other cutaneous amyloid deposition disorders, may suggest a role for friction in the pathogenesis of this histological finding. We review the literature on PP and summarize the poor response seen to treatments.


A designated verifier proxy signature (DVPS), where only a designated verifier can verify the validity of a proxy signed message, is suitable for being applied in many scenarios. Many DVPS schemes have been proposed, but most of these schemes only provide informal proofs of security or incomplete formal proofs of security with limited power attackers (a weak security model), which make these schemes vulnerable to some attacks. To the best of their knowledge, none of the existing DVPS schemes provides a complete notion of security for DVPS. In this study, the authors first classify DVPS into weak DVPS (WDVPS) and strong DVPS (SDVPS). They then give a systematic analysis of the security requirements for WDVPS (SDVPS) and they present complete notions of security for WDVPS and SDVPS. They also propose WDVPS and SDVPS schemes, which are both provably secure, that is, satisfying their new notions of security in the random oracle model. Compared with other DVPS schemes (including WDVPS and SDVPS schemes), their schemes have more complete security and they are more efficient.


The properties of a sample of 172 charged intermediate vector bosons decaying in the (eνe) channel and 16 neutral intermediate vector bosons decaying in the (e+e-) channel are described. Masses, decay widths, decay angular distributions, and production cross-sections are given; they are shown to be in excellent agreement with the expectations of the SU2 ⊗ U1 standard model. A limit is put on the number of light-neutrino types Nν ≤ 10 at 90% c.l.


Going out for a sandwich after church is not unusual for many people, but buying and eating that sandwich at the church is a little unusual – except for those who attend True Bethel Baptist Church in Buffalo, New York. In September 2004 the church opened a SUBWAY® sandwich shop in the church. In fact, part of the church's choir stand had to be moved to make way for the retail sandwich business.


With the exponential growth of storage of digital images, retrieval has become an impending issue. Such large collection of data takes a considerable amount of time in retrieving images apart from picking relevant images with respect to the query. Despite advancements in introducing effective features, the search time still remains larger. In such scenario the search time could be minimized by categorizing the database scenes into indoor or outdoor. The objective of the paper is to categorize an image into indoor or outdoor scene. To support automatic scene classification at the concept level, an efficient illumination and rotation invariant low level features such as color from HSV color model and texture (GBWHGOPCA) features have been used in conjunction with Sparse Representative Classifier (SRC). Since these image features exhibit a distinctive disparity between images containing indoor or outdoor scenes, the proposed method achieves better performance in terms of classification accuracy. This work is evaluated on IITM-SCID2 (scene classification image database) and 15 scene category dataset and dataset of 3442 images collected from the web by authors.


In order to get the accurate rainfall data timely in the unattended wilderness environment, this paper presents a novel siphon rain gauge design based on a strain-type pressure sensor after an integrated consideration of the principles, operation methods, merits and faults of various types of rain gauges. This rain gauge not only keeps the advantages of the traditional siphon rain gauge such as low power and not subject to the restrictions of rainfall's intensity, but also ensures the measurement accuracy by a pressure sensor, besides, the rainfall in the process of siphon can be compensated by the least-squares algorithm. Finally, the algorithm optimized data can be transmitted over long-distance through the GSM module on the data collector, thus its scope of application will be greatly increased.


ABSTRACT Gerrity, B.; Phillips, M.R., and Chambers, C., 2018. Applying a Coastal Vulnerability Index to San Mateo County: Implications for Shoreline Management In: Shim, J.-S.; Chun, I., and Lim, H.S. (eds.), Proceedings from the International Coastal Symposium (ICS) 2018 (Busan, Republic of Korea). Journal of Coastal Research, Special Issue No. 85, pp. 1406–1410. Coconut Creek (Florida), ISSN 0749-0208. Climate change will cause increased coastal erosion and flooding along vulnerable shorelines and, therefore, to assess risk along the coastline and bayline of San Mateo County, a coastal vulnerability index (CVI) was used. San Mateo County is on a peninsula between the Pacific Ocean and San Francisco Bay, and therefore has both bay and ocean shorelines. The CVI measured physical parameters such as beach width, distance to 20 meter isobath, distance of vegetation behind the back beach, dune width and percentage rocky outcrop in order to produce relative vulnerabilities along both ocean and bay shorelines. Results found significant differences between overall vulnerabilities of the coastside and the bayside, which are important because governing bodies that manage San Mateo County are responsible for decision making on both sides. For example, when assessing distance to the 20 meter isobath, the coastside has several sites where it is very close to the shoreline, whereas the 20 meter isobath does not exist on the bayside because San Francisco Bay is very shallow adjacent to San Mateo County. The ramifications of this is that the bayside could be less vulnerable to storm powered wave damage compared to the coastside but is more vulnerable to flooding from sea level rise. Other findings revealed that the lack of sand dunes and beaches on the bayside will make the bayside more vulnerable to damage from wind waves, sea level rise or king tide events. San Mateo County does not have many areas with a high percentage of rocky outcrop on either bayside or coastside. This suggests that the San Mateo shoreline as a whole is vulnerable to waves since they will be breaking on weaker shore geology. Vulnerabilities are also compared with media coverage of property loss following recent storms with challenges faced by governing bodies identified.


BACKGROUND Patients with diabetic peripheral neuropathy (DPN) suffer from numbness, burning feet, lightning pain, and pins-and-needles sensations. Recently, High resolution ultrasonography is commonly used for evaluation of peripheral nerve diseases because of its easy availability, time saving and non-invasiveness of the procedure. This study intended to compare the cross sectional area (CSA) of posterior tibial nerve (PTN) in type 2 diabetic patients with peripheral neuropathy with that of non-diabetic healthy adults using high resolution ultrasonography (HRU) and study the role of increase in HbA1c level and severity of DPN comparing with CSA of PTN. METHODS A cross sectional comparative descriptive study was conducted from November 2018 to May 2020 with 50 type 2 diabetic patients and 50 healthy adults. 50 type 2 diabetic patients, clinically diagnosed with DPN were analysed and using the Toronto Clinical Neuropathy Score (TCNS) System, the severity of neuropathy was determined. HbA1c level and other demographic data were collected. 50 healthy adults were taken as controls. The CSA of posterior tibial nerve was measured 3 cm proximal to the medial malleolus in both lower limbs using HRU. RESULTS The mean CSA of posterior tibial nerve in healthy subjects was 6.0 + / - 0.142 mm2 , and in diabetic patients with peripheral neuropathy was 11.77 + / - 0.291 mm2 . Upon comparing the mean CSA of posterior tibial nerve of diabetic subjects with peripheral neuropathy and control subjects were statistically significant (P < 0.001) in unpaired 't' test. In our study, CSA of the posterior tibial nerve correlated significantly with TCNS and HbA1c levels, at P < 0.001. CONCLUSIONS This study showed that there is a significant difference between the cross sectional areas of posterior tibial nerve in diabetic subjects with peripheral neuropathy and healthy adult subjects. HRU can detect cross sectional area changes in the posterior tibial nerve early. Thus, ultrasonography can be used as a good screening tool in these patients. KEYWORDS Diabetic Peripheral Neuropathy, Posterior Tibial Nerve, High Resolution Ultrasonography


The prevalence of maternal obesity is on the increase, compromising both maternal and foetal health. Previous intervention studies have been designed to limit the amount of gestational weight gain but in the absence of UK guidelines relating to optimum weight change in obese pregnancies and the negative experiences of obese women with regard to previous weight loss attempts it is reasonable to ask whether this is the most effective approach. It has been demonstrated that maternal dietary intake can impact on gestational weight gain and birth weight but there is little in the way of research into the impact that quality of diet has on outcomesAimsTo measure the quality of maternal dietary intake and weight change against pregnancy and birth outcomes and to explore and gain insight into the lived experience of obese pregnant women with a view to informing guidelines.MethodsPregnant women with a BMI≥35kg/m2 were recruited from antenatal clinic and asked to complete 3 day food diaries at 16,28 and 36 weeks gestation, The diaries were verified using a food atlas and analysed using Microdiet. A subset of women were then followed up and interviewed regarding their lived experience of obesity.ResultsThe women's dietary intake deteriorated over the duration of pregnancy and there were significant associations between some micronutrients and pregnancy and birth outcomes. Women with a BMI 35-39.9kg/m2 were most likely to gain weight.ConclusionThe dietary intake of obese pregnant women is an important predictor of pregnancy and birth outcomes and it was demonstrated that the quality of diet significant deteriorated over the duration of pregnancy. Interventions designed to increase the quality of diet are urgently required.


Abstract. Broadcast application is the typical application method for poultry litter, which is a mixture of poultry manure and a bedding material. Applying poultry litter in subsurface bands reduces concentrations of nutrients from the litter in surface runoff water, reduce loss of ammonia to volatilization, and has been shown to increase cotton lint yield, relative to conventional broadcast application. An impeller blower was developed for conveying poultry litter a short distance horizontally and downward to the soil. When relatively dry pine shavings-based broiler litter with a moisture content of 27% w.b. was used, and the impeller speed was 930 r min-1 [14.9 m s-1 (48.9 ft s-1) circumferential speed], the blower performed well conveying litter at a rate of 1.2 kg s-1 (2.6 lb s-1) [0.88 kg dry matter s-1 (1.9 lb dry matter s-1)]. The blower performance was unsatisfactory, however, when relatively moist litter with a moisture content of 45% w.b. was used because the litter adhered to the interior of the blower outlet and clogged the outlet. The blower was mounted beneath a litter hopper, and safety of people in the vicinity of the blower is a concern if the litter contains rocks or other hard objects, and there is no shield to prevent these objects from being flung upward, out of the hopper, from the blower inlet. When the blower was run at 889 ± 14 r min-1 without any litter, so it was conveying only air, as the area of the circular blower inlet increased by a factor of 25 from 0.00051 to 0.0127 m2 (0.79 to 19.6 in.2), the mean outlet air velocity increased by a factor of 4.0 from 3.0 to 12.0 m s-1 (9.8 to 39.4 ft s-1). The blower conveyed dry litter successfully for a single-band implement [1.2 kg s-1 (2.6 lb s-1) mass flow rate at 930 r min-1 impeller speed], for subsurface band application of poultry litter. Mesh chain conveyors, however, perform better for litter moisture contents up to 40% w.b. The mass flow rate of litter, up to 40% w.b. moisture content, can be controlled quite well with mesh chain conveyors (litter mass flow rate coefficients of variation typically 5% or less), but is more difficult to control with this impeller blower. Keywords: Animal waste, Band application, Impeller blower, Manures, Manure application equipment, Pneumatic conveying, Poultry manure, Subsurface banding.


ABSTRACT Objective: To describe initiatives undertaken by a network of community pediatricians to increase a city's surge capacity for patients presenting with influenza-like illnesses during the 2009 H1N1 influenza A pandemic. Methods: This was a descriptive quality improvement project detailing the measures employed by a network of private practice community pediatricians in Houston, Texas, caring for both insured and uninsured children. Results: Four categories of interventions were used: enhanced communication, increasing community pediatrician presence, vaccine distribution, and targeted viral diagnosis and antiviral utilization. Promoting communication between clinicians, families, and an affiliated local tertiary care children's hospital allowed for the efficient coordination of resources as well as a unified and consistent message. Increasing access of families to their primary medical home by employing additional clinicians, extending office hours, and locating additional space served to decrease the number of children with low-acuity illness seen in the local emergency centers. Vaccine distribution was enhanced by effective communication between clinicians and families. Finally, targeted antiviral testing and adherence to national recommendations on antiviral utilization enabled judicious utilization of a limited supply of antiviral medications. Conclusions: Effective communication and improved access to health care enabled children within the network with influenza-like illnesses to continue to be cared for in their medical home. The measures used in response to novel influenza virus outbreaks can be adapted for other situations requiring increased community surge capacity. (Disaster Med Public Health Preparedness 2012;6:113-116)


Cancer cell-intrinsic properties caused by oncogenic mutations have been well characterized, however, how specific oncogenes and tumor suppressors impact the tumor microenvironment (TME) is not well understood. Here, we present a novel non-cell-autonomous function of the retinoblastoma (RB) tumor suppressor in controlling the TME. RB inactivation stimulated tumor growth and neo-angiogenesis in a syngeneic and orthotropic murine soft tissue sarcoma model, which was associated with recruitment of tumor-associated macrophages (TAMs) and immunosuppressive cells such as Gr1+CD11b+ myeloid-derived suppressor cells (MDSCs) or Foxp3+ regulatory T cells (Tregs). Gene expression profiling and analysis of genetically engineered mouse models revealed that RB inactivation increased secretion of the chemoattractant CCL2. Furthermore, activation of the CCL2-CCR2 axis in the TME promoted tumor angiogenesis and recruitment of TAMs and MDSCs into the TME in several tumor types including sarcoma and breast cancer. Loss of RB increased fatty acid oxidation (FAO) by activating AMP-activated protein kinase (AMPK) which led to inactivation of Acetyl-CoA carboxylase (ACC) which suppresses FAO. This promoted mitochondrial superoxide production and JNK activation which enhanced CCL2 expression. These findings indicate that the CCL2-CCR2 axis could be an effective therapeutic target in RB-deficient tumors.


In Reply.— The "common sense" that Dr Smith attributes to the public's opinion as reported in our article is a dangerous guide for public policy. Just a few years ago, this same public opinion believed that acquired immunodeficiency syndrome was acquired like the common cold, through casual contact, and many people were prepared to impose quarantine and other restrictions on people with acquired immunodeficiency syndrome. 1 Ongoing scientific evaluation of the hazards posed by HIV-infected health care workers should be the main basis of policy in this area. Our purpose in publishing data on the concern some members of the public have about this issue was to demonstrate to physicians and policymakers that the public's perception of risk may differ from theirs and to remind them that in formulating policy about HIV-infected health care workers it is necessary to take into account the views of all stakeholders, including patients. We


BACKGROUND
We examined the association between substance use (SU) disorder and mortality among HIV-infected patients in a large, private medical care program.

METHODS
In a retrospective cohort design, HIV-infected patients (≥14 years old) from a large health plan (Northern California) were studied to examine mortality associated with diagnosis of SU dependence or abuse over an 11-year period.

RESULTS
At study entry or during follow-up, 2,279 (25%) of 9,178 HIV-infected patients had received a diagnosis of SU disorder. Diagnoses were categorized as alcohol dependence/abuse only, illicit drugs only, or both. Cause of death differed by the category of SU diagnosis. Mortality rates ranged from 35.5 deaths per 1,000 person-years in patients with an SU disorder to 17.5 deaths among patients without an SU disorder. Regression results indicated mortality risk was significantly higher in all categories of SU disorder compared to no SU diagnosis (hazard ratios ranging from 1.65 to 1.67) after adjustment for SU treatment and confounders.

CONCLUSIONS
A diagnosis of SU dependence/abuse is associated with higher mortality among HIV-infected patients for whom access to medical services is not a significant factor.