OBJECTIVE
The overall aim of this article is to examine the self-defined role of romantic relationships, intimacy and sexuality in recovery from severe mental illness.

METHOD
Semistructured interviews were conducted with 35 people with severe mental illness, accompanied by participant observation. Data were analyzed using thematic analysis.

RESULTS
The vast majority of participants considered a supportive relationship that was emotionally or sexually intimate to be a key facilitator and indicator of recovery. However, only a small minority of participants were actually in such a relationship. Participants reported numerous barriers to forming and maintaining such relationships such as financial strain and enduring stigma against people with mental illness.

CONCLUSION AND IMPLICATIONS FOR PRACTICE
Addressing relational and intimate needs have not been a focus of traditional psychiatric services. As such, some form of "supported dating" within the field of psychosocial rehabilitation may be an essential development to foster an oft-overlooked but important aspect of recovery. (PsycINFO Database Record


The separation of alkane isomers, particularly C5-C6 alkanes, is of paramount importance in the petrochemical industry to achieve high quality gasoline. Upon catalytic isomerization reactions, less branched alkanes (with lower octane number) need to be separated from their more branched isomers (with higher octane number) in order to improve the octane rating of gasoline. To reduce the high energy input associated with distillations, the primary separation technique currently used in industry, adsorptive separation by porous solids has been proposed. For example, zeolite 5A has been used as the adsorbent material for adsorptive separation of linear alkanes from their branched isomers, as a supplement technology to distillations. However, due to the limited number of zeolite structures and the lack of porosity tenability in these compounds, the task has not been fully fulfilled by using zeolites. Metal-organic frameworks (MOFs), in light of their structural diversity and high tunability in terms of surface area, pore size, and pore shape, offer new opportunities for resolving industrially relevant separation of alkanes through selective adsorption. This Account summarizes recent development of microporous MOFs for the separation of alkanes, with an emphasis on C5-C6 alkane isomers, including early examples of alkane separation by MOFs, as well as the latest advancement on tailor-made microporous MOFs for size sieving of C5-C6 alkane isomers. The limitation of zeolite 5A as a sorbent material for the separation of C5-C6 alkane isomers lies in its relatively low adsorption capacity. In addition, it is not capable of separating branched alkanes, which is a crucial step for further improving the octane rating of gasoline. The high porosity and tunable pore size and pore shape of MOFs may afford them higher adsorption capacity and selectivity when used for alkane separation. MOFs with pore size slightly larger than the kinetic diameter of branched alkanes can effectively separate alkane isomers through thermodynamically controlled separation, as seen in the case of Fe2(bdp)3 (bdp2- = 1,4-benzenedipyrazolate). This MOF is capable of separating a mixture of hexane isomers by the degrees of branching, with higher adsorption capacity than zeolites under similar conditions but with relatively low selectivity. One effective strategy for obtaining MOFs with optimal pore size and pore shape for highly selective adsorption is to make use of reticular chemistry and precise ligand design. By applying topologically directed design strategy and precisely controlling the pore structure or ligand functionality, we have successfully synthesized a series of highly robust MOFs built on tetratopic carboxylate linkers that demonstrate high performance for the separation of C5-C6 alkane isomers. Zr-bptc (bptc4-= 3,3',5,5'-biphenyltetracarboxylate) adsorbs linear alkanes only and excludes all branched isomers. This size-exclusion mechanism is very similar to that of zeolite 5A. Yet, Zr-bptc has a significantly enhanced adsorption capacity for n-hexane, 70% higher than that of zeolite 5A under identical conditions. Zr-abtc (abtc4- = 3,3',5,5'-azobenzenetetracarboxylate) is capable of discriminating all three C6 alkane isomers via a thermodynamically controlled process, yielding a high separation factor for monobranched over dibranched isomers. MOFs with flexible framework may exhibit unexpected but desired adsorption properties. Ca(H2tcpb) (tcpb4- = 1,2,4,5-tetrakis(4-carboxyphenyl)-benzene) can fully separate binary or ternary mixtures of C5-C6 alkane isomers into pure form through selective molecular sieving as a result of its temperature- and adsorbate-dependent framework flexibility. The intriguing structural properties and exceptional tunability of these MOFs make them promising candidates for industrial implementation of adsorptive separation of alkane isomers.


The US research university is a very successful model of higher edudaction and research. We examine its core elements and follow the current discussion on a necessary reform. Focusing on the institutional structure, we review possible causes of shortcomings and frictions. During the last 50 to 60 years the environment of the research university changed. The single institution has become highly dependend on federal and industrial grants and of undergraduates' fees. This process has transformed the internal organization as well as the interaction with important stakeholders. It also had an effect on the relationship between university and faculty. As a result, the scientific production has grown reamarkably but not necessarily the overall competivity. We discuss the systemic challenges that threaten the US university landscape and its contribution to scientific progress and innovation.


ABSTRACT It has been theorized that state the levels of self-control depletion (as caused by negative affect and restraint) may lead to binge eating (BE) when individuals also endorse momentary expectancies that eating will make them feel better (EE). Given commonalities in precipitants of BE across populations, the current study tested this theory in a sample of adults with obesity using ecological momentary assessment (EMA). Fifty obese adults completed the EMA protocol during which they provided pre-eating episode ratings of negative affect, restraint, and EE, and post-eating episode ratings of BE. Generalized estimating equations (GEE) identified a 3-way interaction between within-person pre-eating episode variables: higher self-control depletion (e.g., higher restraint and higher negative affect) was predictive of BE episodes only when individuals also endorsed higher EE. To our knowledge, this is the first empirical test of this theory, highlighting the impact of momentary self-control depletion and EE on BE in obese adults.


Living systems are driven by molecular machines that are composed of folded polypeptide chains, which are assembled together to form multimeric complexes. Although replicating this type of system is a longstanding goal in polymer science, the complexity the structures impose is synthetically very challenging, and generating synthetic polymers to mimic the process of these assemblies appears to be a more appealing approach. To this end, we report a linear polymer programmable for stepwise folding and assembly to higher order structures. To achieve this, a diblock copolymer composed of 4-acryloylmorpholine and glycerol acrylate was synthesised with high precision via reversible addition fragmentation chain transfer polymerisation (Đ < 1.22). Both intramolecular folding and intermolecular assembly were driven by a pH responsive cross-linker, benzene-1,4-diboronic acid. The resulting intramolecular folded single chain nanoparticles were well defined (Đ < 1.16) and successfully assembled into a multimeric structure (Dh = 245 nm) at neutral pH with no chain entanglement. The assembled multimer was observed with a spherical morphology as confirmed by TEM and AFM. These structures were capable of unfolding and disassembling either at low pH or in the presence of sugar. This work offers a new perspective for the generation of adaptive smart materials.


Abstract: Marriage is a very important institution in society. The existence of this institution is to legalize the legal relationship between a man with a woman. Because of the importance of marriage in a State, required registration of marriages. In Indonesia has set the legal registration of marriages. With the recording obtained legality of marriage. Recording weddings will also protect the rule of law, as well as keeping the benefit of the community. While marriage Sirri is listed on the marriage without the legal institutions, the problems of marriage Sirri still a lot going on in the community. The impact becomes a complex problem in society, so it is still important to be studied. This paper will discuss the Sirri marriage between validity and consequences.


This book provides a framework within which existing or planned computer aided design/manufacturing (CAD/CAM) systems and simultaneous engineering, can be integrated into an organization to achieve maximum efficiency, utilization and control. Companies are looking towards these new tools and approaches as a response to the pressures, such as decreasing production development cycle time (time based competition) and the increasing demands of customers, which they are now facing. It is not enough simply to adopt and install these approaches, managing integration and treating the implementation as an on-going exercise has been shown to be a key element of a companies' success. In promoting this process of continual review and appraisal, attention is directed towards developing appropriate managerial and organizational integration between departments, functions and operations. The workbook consists of four stages: "strategy" - understanding the strategies involved; "audit" - auditing the current situation of CAD, CAD/CAM and the organization and the potential for simultaneous engineering; "change" - developing the organization and mechanisms for change; and "people" - organizing for the analysis and establishing the infrastructure for the change process. Worksheets are included which cover the necessary elements of each section and provide a basis for discussion within the implementation team. This workbook is a practical guide for managers, providing examples and guidance; it is managerial, rather than technical, and accommodates a wide skill base. The book should be of most use to operations, production and IT managers, engineers, designers and those involved with product development management, but it should also be of interest to managers in accounting, corporate strategy and marketing.


This paper explores the greenhouse effect and the measures being used such as geoengineering to reduce the heat and curtail radiation. The greenhouse effect has endangered ecosystems causing atmospheric and climatic changes resulting in devastation globally; drought, floods, melting glaciers, disease and death. (Choi, 2011; Biello, 2009 & 2010) This has caused alarm throughout the global community alarm to enter into a treaty to sustain the ecosystem and curtail greenhouse gases from CO2 / carbon dioxide emissions by 2020. (Biello, 2009) Geo-engineering has been the most successful tool used to control global warming; however, the unintended consequence can have a negative environmental impact resulting in drought, flooding, severe storms and monsoons. The advantages gained by preserving the ecosystem will reduce smog, reduce the more than 700K premature deaths, drought, and yield high crop productions making the long term investment in containment very important. (Biello, 2009) As with all new technology there is a chance of environmental impact and charlatans using the technology in a dark way; however, as with all new inventions there are risks.


Clinical criteria and several electrophysiological parameters for detecting nerve damage were compared in 99 patients with diabetes mellitus type 1 and type 2. Abnormal results were found in sural/radial amplitude ratio (51%), minimal F‐wave latency of the tibial nerve (36.4%), sensory conduction velocity of the sural nerve (29.8%), and sural sensory nerve action potential amplitude (29.3%) when pooling data from all patients and comparing them to age‐ and height‐matched normal control subjects. Analysis of all the parameters revealed large differences between the diabetes mellitus type 1 and type 2 groups, suggesting that the type of diabetes must be taken into account when comparing the sensitivity of nerve conduction tests. In diabetes mellitus type 1, the sural/radial ratio had the clearest correlation with course of illness and was the first parameter to show a significant reduction. We conclude that the simple ratio between sural and radial amplitudes is a very sensitive parameter and abnormalities in this ratio provide the means for earliest detection of neuropathy in diabetes mellitus type 1. © 1999 John Wiley & Sons, Inc. Muscle Nerve 22: 1667–1673, 1999


Ralph Peck introduced the concept of using a geotechnical case histories course to teach students problem solving and technical communications skills, beginning around 1956. This course was developed as a professional practice course at the graduate level, intended for civil engineers of diverse backgrounds as well as geoscientists. Students were required to prepare one-page summaries of each case history profiled in the course, a requirement that left an enormous impression on the students. A different approach was employed by the University of California, Berkeley, beginning around 1970. Berkeley offered two graduate courses in the mold of ABET "capstone courses," graduate soil mechanics laboratory, and advanced foundation construction. These courses were intended to prepare students for geotechnical problem solving and professional practice using a single term project, which required student teams to prepare a comprehensive report, similar to those prepared by private sector consultants. The background on each of these courses, the individuals who taught them, and the techniques employed by those instructors are briefly profiled and their pros and cons are compared.


A one of the greatest concerns with orthodontic mini-implants is risk of injury to dental roots during placement is, especially when they are inserted between teeth. Many techniques have been used to facilitate safe placement of interradicular miniscrews. Brass Wires or metallic markers are easy to place in the interproximal spaces, but because their relative positions may be inconsistent in different radio -graphic views, they are not always accurate. K.S. micro implant placement guide suggested in this article is simple design and easy in fabrication, required minimal equipment for fabrication and does not disturb the existing appliance system, clearly located in the radiograph and the mini-screw can be easily inserted through the guide reducing the chance of implant misplacement.


We introduce a new geometrical framework based on which natural flows for image scale space and enhancement are presented. We consider intensity images as surfaces in the (x, I) space. The image is, thereby, a two-dimensional (2-D) surface in three-dimensional (3-D) space for gray-level images, and 2-D surfaces in five dimensions for color images. The new formulation unifies many classical schemes and algorithms via a simple scaling of the intensity contrast, and results in new and efficient schemes. Extensions to multidimensional signals become natural and lead to powerful denoising and scale space algorithms.


This article offers 2n-point ternary non-stationary interpolating subdivision schemes, with the tension parameter, by using Lagrange identities. By choosing the suitable value of tension parameter, we can get different limit curves according to our own choice. Tightness or looseness of the limit curve depends upon the increment or decline the value of tension parameter. The proposed schemes are the counter part of some existing parametric and non-parametric stationary schemes. The main purpose of this article is to reproduce conics and the proposed schemes reproduce conics very well such that circle, ellipse, parabola and hyperbola. We also establish a deviation error formula which is useful to calculate the maximum deviation of limit curve from the original limit curve. The presentation and of the proposed schemes are verified by closed and open figures. The given table shows the less deviation of the limit curves by proposed scheme as compare to the existing scheme. Graphical representation of deviation error is also presented and it shows that as the number of control points increases, the deviation error decreases.


Abstract Inadequacy of planting materials is limiting the distribution of three high-β-carotene (pro-vitamin A) cassava varieties released in Nigeria to increase public vitamin A intake. However, studies have established the suitability of in vitro shoot culture for mass propagation of elite crop varieties for quick distribution to farmers. We investigated multiple shoot induction from axillary bud of three β-carotene enriched cassava varieties using BAP and assessed the genetic stability of the regenerated plants to establish mass propagation system. Multiple shoots were induced from BAP-enlarged axillary bud on basal medium supplemented with 10 mg/l BAP. Shootbuds were elongated on basal medium supplemented with 1.0 mg/l BAP and 10.0 IBA mg/l. Genetic stability of regenerated plants was assessed byeight RAPD markers. There were significant (P < 0.05) differences in survival of isolated axillary bud, shootbud formation, survival of shootbud, regenerated shoots, root formation and survived regenerated plants among cassava varieties. The order of shootbud formation among the cassava varieties was UMUCASS 37 > UMUCASS 36 >TMS 30555 > UMUCASS 38. The best (83.4%) shoot regeneration was recorded in TMS 30572 and lowest (47.8%) in UMUCASS 37, however, UMUCASS 36 recorded the best (98.5%) survival of regenerated shoot after hardening. Eight RAPD primers produced 56 bands, ranging from 200 to 3000 bp in size. RAPD analysis showed a uniform profile among regenerants and between mother plant and regenerants. The study concluded that multiple shoot formation could be induced in pro-vitamin A cassava varieties using BAP from axillary bud with no genetic infidelity of the regenerants.


Previous research has identified school bonding as protective against substance use during adolescence. However, there is still a question as to whether school involvement predicts changes in substance use or if substance use actually predicts changes in level of school bonding. This study investigated the relationship between school bonding and alcohol use, which is commonly recognized as gateway drug, during early adolescence. A three-wave longitudinal analysis was conducted on a sample composed of 161 Italian adolescents (51% boys, 49% girls, mean age = 11.14 years, standard deviation =.40). Associations were analyzed by using crossed-lagged autoregressive models in MPlus. Findings revealed that greater school involvement decreased alcohol consumption from Grade 6 to Grade 7. However, greater alcohol use decreased school involvement from Grade 7 to Grade 8. Findings of this study underlined the importance of choosing the right time for prevention.


P2x7 receptors are Purineric receptors that are extracellular ATP-gated ion channel. These receptors require high dose or prolonged exposure to ATP for initial activation. The Activation of these receptors facilitates the formation of inflammasome which activates caspase 1. The P20 and P10 subunits of caspase 1 form active enzyme that then releases active interleukin (IL)-1 β and IL-18, tumor necrosis Factor-α (TNF-α), IL-6 important proinflammatory cytokines which can induce inflammation Although other cytokines such as, IL-8, IL-1α, IL-2, IL-4, IL-13 Can be released by activation p2x7 receptors. P2X7 receptors are widely expressed in neurons, microglia, astrocytes, oligodendrocytes and Schwann cells where they can induce neuroinflammation also neuroinflammation is an essential step in neurodegenerative inflammatory diseases which include: multiple Sclerosis, Alzheimer's, Parkinson's, Huntington's disease, atrophic lateral sclerosis, frontotemporal dementia, and traumatic brain injury also previous study in recent years reports overexpression of p2x7 receptors in neuroinflammation subsequently neurodegenerative diseases. In this study we aim to overview the role of p2x7 receptors in neuroinflammation as a novel targets for the treatment of neuroinflammation. P2X7R emerges as a promising target to treat neuroinflammation because this receptor is involved in the release of proinflammatory cytokines that play an essential role in the development of neuroinflammation subsequently neurodegenerative diseases so an antagonist for this receptor might halt the inflammatory cascade and thus further progression of neurodegeneration.


Location independent working (LIW) is a term used by the case study organisation, Mercia University, to describe the practice of working in locations other than a traditional office setting. Staff wishing to become LIW sign up to a new working arrangement whereby they are provided with a laptop, printer and smartphone, and forgo the right to an office on-campus. A longitudinal ethnographic research strategy incorporating interviews, diaries and the author's own reflective journal were used to explore issues associated with academic employees following the formal introduction of an LIW scheme into the Business School. An interpretivist reading of labour process theory was adopted to examine and make sense of academics' daily, lived experiences. Data were analysed using the Framework method (Ritchie and Spencer 1994) and findings revealed an entrenched managerialist culture driven by private sector business models. Work intensification and long-work hours were common and this was exacerbated by constant connectivity to mobile technologies. Academics displayed a strong sense of academic identity and a desire to be treated as professionals. Nevertheless, a fundamental shift in the nature of the relationship between academics, managers and students was observed and socially constructed divisions arose between LIW and office-based academics. A new conceptual model of control-resistance-compliance is proposed to explain the complex interplay that exists at and between structural and organisational contexts, managerial strategies of control and individual experiences of academics. As such this study extends and refines existing theoretical understandings of the academic labour process. It is recommended this study be extended beyond the Business School and Mercia University to other establishments. Further research should also be carried out to consider gendered and cross-cultural perspectives on the issues raised and more investigation is needed into the impact of LIW on student and personal relationships. Finally, it is suggested formal adoption of LIW practices in other institutions could facilitate opportunities for academics to exercise greater levels of freedom, autonomy and control.


Among vertebrates, the sense of smell is mediated by olfactory receptors (ORs) expressed in sensory neurons within the olfactory epithelium. Comparative genomic studies suggest that the olfactory acuity of mammalian species correlates positively with both the total number and the proportion of functional OR genes encoded in their genomes. In contrast to mammals, avian olfaction is poorly understood, with birds widely regarded as relying primarily on visual and auditory inputs. Here, we show that in nine bird species from seven orders (blue tit, Cyanistes caeruleus; black coucal, Centropus grillii; brown kiwi, Apteryx australis; canary, Serinus canaria; galah, Eolophus roseicapillus; red jungle fowl, Gallus gallus; kakapo, Strigops habroptilus; mallard, Anas platyrhynchos; snow petrel, Pagodroma nivea), the majority of amplified OR sequences are predicted to be from potentially functional genes. This finding is somewhat surprising as one previous report suggested that the majority of OR genes in an avian (red jungle fowl) genomic sequence are non-functional pseudogenes. We also show that it is not the estimated proportion of potentially functional OR genes, but rather the estimated total number of OR genes that correlates positively with relative olfactory bulb size, an anatomical correlate of olfactory capability. We further demonstrate that all the nine bird genomes examined encode OR genes belonging to a large gene clade, termed γ-c, the expansion of which appears to be a shared characteristic of class Aves. In summary, our findings suggest that olfaction in birds may be a more important sense than generally believed.


The clinical and pathological records of 44 domestic, female rabbits with an age ranging from 6–124 months (median age: 63.5 month) were assessed retrospectively for ovarian lesions. Included were all rabbits that underwent an ovariohysterectomy with a subsequent pathological examination of the genital tract between March 1997 and June 2016. Pathological examination revealed ovarian lesions in 12 of the 44 rabbits including follicular cysts (n=7), cystic rete ovarii (n=3), widespread ovarian necrosis with dystrophic calcification (n=2), ovarian adenoma (n=1). Clinical examination including radiographs only suggested ovarian disorders in two cases of ovarian necrosis with dystrophic calcification and in two cases of cystic rete ovarii. Clinical significance was only conclusive in a case of cystic rete ovarii.


Objective: To identify markers that predict the synchronous or metachronous development of bladder cancer in patients with upper urinary tract (UUT) tumors. Materials and Methods: Between March 2001 and December 2005, we identified 38 consecutive patients who had been histologically diagnosed as having transitional cell carcinoma in the renal pelvis and ureter. These patients were divided into 2 groups (n = 19 per group): group 1 patients with metachronous or synchronous bladder cancer, and group 2 patients with UUT tumors only. We analyzed the differences between the 2 groups with respect to the expression of various biomarkers (p53, Rb, Ki-67, PTEN, and bcl-2) and in terms of clinical parameters. Results: The 2 groups differed significantly in terms of multiplicity (p = 0.029), papillary configuration (p = 0.001), the presence of lymphovascular emboli (p = 0.019), and Ki-67 overexpression (p = 0.029) in UUT tumors. Multivariate analysis revealed that Ki-67 overexpression in UUT tumor tissues significantly predicts bladder cancer development (HR 6.440; 95% CI 1.121–37.014; log rank p = 0.037). Conclusion: Ki-67 overexpression in UUT tumor tissues was found to be an independent predictor of the development of bladder cancer in UUT tumor patients.


The original "International Classification of Retinopathy of Prematurity" (ICROP), published in 1984, addressed the active stages of the disorder and has proved to be a very valuable contribution. 1 Classification of retinal detachment is the next logical step, and the article 2 on this topic in the present issue of theArchiveswill likely be even more useful. Investigators from several countries have pooled their efforts to provide this new classification of retinal detachment. Stage 4 of the original ICROP is expanded and a fifth stage is added in this article. The stages of retinal detachment are divided into the extrafoveal stage (4A), partial detachment including the fovea stage (4B), and total retinal detachment (stage 5). A much better understanding of the development of the more severe end stages of retinopathy of prematurity has been gained from further surgical experience and the observations on a substantial number of histopathologic specimens.


The reduction in fiber push-out stress by transformation plasticity in xenotime rare-earth orthophosphate fiber–matrix interphases was demonstrated. Processing methods for transformable xenotime coatings were explored. For conversion to xenotime during processing, (GdxDy1−x)PO4 solid solutions had to be more Dy-rich than those for pellets. Single-crystal alumina fibers were coated with 10–20 μm of (Gd0.4Dy0.6)PO4 xenotime and incorporated into polycrystalline alumina matrices. Coated fiber push-out stresses were between 10 and 80 MPa, significantly lower than those for fibers with other rare-earth orthophosphates coatings. Phase transformations and deformation mechanisms were characterized by SEM and TEM in fiber coatings after push out. Bands of deformed coating several micrometers in width formed during fiber push out. Cataclastic flow with fracture, granulation, translation, rotation, and intense plastic deformation of coating grains was observed. Three phase transformations may occur in heavily deformed particles in the deformation band: xenotime → monazite, xenotime → anhydrite, and anhydrite → monazite. Anhydrite was abundant as a fine lamellar phase on (100) planes in xenotime. Selected area electron diffraction and high-resolution TEM confirmed formation of monazite in a variety of heavily deformed particles. Issues for use of rare-earth orthophosphate transformation plasticity to lower fiber pull-out stress in ceramic matrix composites are discussed.


BACKGROUND AND PURPOSE
Patient participation is nowadays considered important for high quality patient care. Although the literature on health care professions provides some insights into this topic, specific aspects in the field of physiotherapy are less known. The objective of this review was to investigate how patients and physiotherapists perceive patient participation, especially in regards to what it means for them and the role patients play during physiotherapy treatment sessions.

METHODS
We used a narrative synthesis of qualitative studies. We conducted a systematic search in six databases using a set of key words, extracted relevant data, performed quality assessment and synthesized findings from the selected studies.

RESULTS
Out of 160 studies, 11 were retained. Two main themes emerged: the conceptualization of patient participation and the patients' role preferences. Patient participation included various activities including goal setting, information exchange, decision-making and exercise training and often influenced the power relation between patient and physiotherapist. Patients' willingness to participate varied, and they often did not play their desired role.

CONCLUSIONS
Patients and physiotherapists perceived participation to be valuable yet challenging. Problems of conceptualization, power inequalities, lack of health professionals' skills and lack of the right attitude to share power and responsibility from both sides were some of the barriers that impeded optimal participation.


The emergence of resistance to multiple antimicrobial agents in pathogenic bacteria is a significant public health threat, as there are limited effective antimicrobial agents for infections caused by multidrug-resistant (MDR) bacteria. Several MDR bacteria are now frequently detected. Carbapenem resistance in Enterobacteriaceae is often plasmid mediated, necessitating stringent infection control practices. Wedescribe an outbreak of carbapenem-resistant Providencia rettgeri involving 4 patients admitted to intensive care and high-care units at a tertiary hospital. Clinical and demographic characteristics of 4 patients with carbapenem-resistant P. rettgeri were documented. All P. rettgeri isolated in these cases had a carbapenem-resistant antibiogram, with resistance to imipenem, ertapenem and meropenem. These cases could be epidemiologically linked. A multiprong approach, simultaneously targeting antibiotic stewardship, universal precautions and appropriate transmission-based precaution practices, is integral to prevention and control of nosocomial infections.


It was shown that His3 of human copper transporter 1 (hCtr1) prompts the ATCUN-like Cu(II) coordination for model peptides of the hCtr1 N-terminus. Its high Cu(II) affinity is a potential driving force for the transfer of Cu(II) from extracellular Cu(II) carriers to hCtr1. Having a sequence similar to that of hCtr1, hCtr2 has been proposed as another human copper transporter. However, the N-terminal domain of hCtr2 is much shorter than that of hCtr1, with different copper binding motifs at its N-terminus. Employing a model peptide of the hCtr2 N-terminus, MAMHF-am, we demonstrated that His4 provides a unique pattern of Cu(II) complexes, involving Met sulfurs in their Cu(II) coordination sphere. The affinity of Cu(II) for MAMHF-am is a few orders of magnitude lower than that reported for the hCtr1 model peptides at the extracellular pH of 7.4, suggesting a maximal complementary role of Cu(II) binding to hCtr2 in the import of copper from the extracellular space to the cytoplasm. On the other hand, the ability of the hCtr2 model peptide to capture Cu(II) from amino acids and short peptides (potential degradation products of proteins) at pH 5.0 and the known predominant lysosomal localization of hCtr2 support an important potential role of the Cu(II)-hCtr2 interaction in the recovery of copper from lysosomes.


This thesis explores theoretical and practical aspects of iterative decoding algorithms when they are implemented on analog continuous-time platforms. Analog continuous-time iterative decoding was proposed a few years ago to improve the power/speed ratio of decoder chips that decode capacity achieving codes. It was commonly believed that replacing discrete-time processing modules with analog circuits would not change the dynamics of the iterative decoder. On the contrary, we show that not only does continuous-time iterative decoding have different dynamics, but also its error correcting performance can surpass that of conventional iterative decoders. We also present a simple model for ideal continuous-time iterative decoding.
As a direct consequence of our study on the dynamics of analog decoders, we show that by looking at the decoding as a numerical problem and using advanced numerical techniques, we are able to improve the convergence rate and decoding performance of iterative decoding algorithms.
Furthermore, we devise novel processing modules for implementing affordable high-speed analog min-sum iterative decoders by using strongly inverted CMOS transistors. This is favorable because previously reported analog decoders were either BiCMOS or weakly inverted CMOS designs. The former could be fast but is rather expensive and the latter would be low-power but it is not fast enough for many applications. Our design is modular and the main blocks are constructed based on current mirrors and virtually any accurate current mirror can be used as the main block in our design. As an example, we show how the building modules can be designed in deep submicron CMOS technologies. We also present an appropriate design methodology for implementing high-degree blocks that can drastically reduce silicon area and power consumption.
To prove the functionality of the proposed circuits, an analog min-sum iterative decoder chip for a (32,8) regular LDPC code was designed and fabricated in 0.18μm CMOS technology. This chip is the first analog min-sum iterative decoder. Also, it is the first functional analog iterative decoder for an LDPC code and is the fastest reported analog CMOS iterative decoder. Measurement results not only show that the proposed circuits are functional but also confirm the validity of our proposed model for ideal analog decoding. In fact, when noise in the channel is dominant compared to the imperfections in the analog iterative decoder, the simulation results based on our proposed model are close to the measurement results.


We review the involvement of a small molecule, oxytocin, in various effects of physical stimulation of somatosensory organs, mindfulness meditation, emotion and fragrance on humans, and then propose a hypothesis that complex human states and behaviors, such as well-being, social bonding, and emotional behavior, are explained by oxytocin. We previously reported that oxytocin can induce pain relief and described the possibility how oxytocin in the dorsal horn and/or the dorsal root ganglion relieves joint and muscle pain. In the present article, we expand our research target from the physical analgesic effects of oxytocin to its psychologic effects to upregulate well-being and downregulate stress and anxiety. For this purpose, we propose a "hypothalamic-pituitary-adrenal (HPA) axis-oxytocin model" to explain why mindfulness meditation, placebo, and fragrance can reduce stress and anxiety, resulting in contentment. This new proposed model of HPA axis-oxytocin in the brain also provides a target to address other questions regarding emotional behaviors, learning and memory, and excess food intake leading to obesity, aimed at promoting a healthy life.


Neonatal septicaemia despite recent advances in hygiene and introduction of potent antibiotics has remained a major cause of morbidity and mortality worldwide. The developing countries worse as the incidence is as 56.9/1000 live birth in Nigeria. In our environment, the risk factors were low socioeconomic factors, delivery at home, maternal fever and use of traditional concoctions were the common finding and late presentation was another problem. In neonatal period, child immune defense mechanism is very low as the neonate whether term or preterm, have qualitative and quantitative deficiencies in cellular and humoral immunity compared to adults. When bacterial pathogens invade neonatal blood system, pro-inflammatory cytokines such as TNF-α, TNF-γ, interleukins a response followed rapidly by a surge of anti-inflammatory cytokines which include IL-10, IL-1RA, IL-13, IL-14, etc. Early presentation and prompt treatment with potent antibiotics improve the outcomes as most of those babies that presented early to our health facility and had treatment instituted early recovered well with no residual complication.
Conclusion: Therefore counselling and empowerment of mother of sick neonates play an important role in the mother to present such ill neonate whom may turn out to be a septicaemic neonate. This means early presentation to health facility, early diagnosis and early appropriate treatment thereby saving the neonate.


Abstract Twitter is a tool for physicians to increase engagement of learners and the public, share scientific information, crowdsource new ideas, conduct, discuss and challenge emerging research, pursue professional development and continuing medical education, expand networks around specialized topics and provide moral support to colleagues. However, new users or skeptics may well be wary of its potential pitfalls. The aims of this commentary are to discuss the potential advantages of the Twitter platform for dialogue among physicians, to explore the barriers to accurate and high-quality healthcare discourse and, finally, to recommend potential safeguards physicians may employ against these threats in order to participate productively.


San Diego--A moderately strong association has been found between lower urinary tract symptoms and the rate of erectile dysfunction in men with moderate to severe symptoms of BPH and enlarged prostate glands, according to a presentation of data gleaned from the Proscar Long-Term Efficacy and Safety Study (PLESS).


We discuss the issue of parity violation in quantum gravity. In particular, we study the coupling of fermionic degrees of freedom in the presence of torsion and the physical meaning of the Immirzi parameter from the viewpoint of effective field theory. We derive the low-energy effective Lagrangian which turns out to involve two parameters: one measuring the nonminimal coupling of fermions in the presence of torsion, the other being the Immirzi parameter. In the case of nonminimal coupling the effective Lagrangian contains an axial-vector interaction leading to parity violation. Alternatively, in the case of minimal coupling there is no parity violation and the effective Lagrangian contains only the usual axial-axial interaction. In this situation the real values of the Immirzi parameter are not at all constrained. On the other hand, purely imaginary values of the Immirzi parameter lead to violations of unitarity for the case of nonminimal coupling. Finally, the effective Lagrangian blows up for the positive and negative unit imaginary values of the Immirzi parameter.


The relationships between academic attributional style (AAS), self-efficacy, gender and culture were investigated in this study. Three research questions "Is AAS influenced by self-efficacy, gender and culture?", "Does AAS operate in the same way in two different cultures?", and "How do AAS dimensions (internality, stability, globality) vary?" were examined with a sample of 261 university students studying in Turkey and Britain. Regression results showed that gender and culture were separately significant predictors of pessimistic AAS. However, self-efficacy did not add significantly to the prediction of AAS. Regarding AAS dimensions, MANOVA revealed a significant main effect of culture, suggesting that British students have more pessimistic attributional styles characterized by the internality dimension in explanations of negative events. Suggestions for future studies are discussed.


The Internet of Things is an important trend in the development of information technology after the Internet and the mobile communication network. It attracts college students through its advanced technical means and rich contents, and has brought far-reaching influence on the ideological and political education of college students. Therefore, it is of great theoretical and practical significance to explore the application of Internet of Things in ideological and political education in colleges and universities. This paper deeply analyzes the current situation of ideological and political education of college students in China under the background of Internet of Things, and finds that the application of technologies of the Internet of Things in education is mainly embodied in three aspects: classroom teaching, extracurricular learning and educational management. The main problems of ideological and political education in colleges and universities are that the interest of college students in ideological and political courses is generally low, the connection and integration between the technologies of the Internet of Things and ideological and political education needs to be strengthened, and the quality of ideological and political teachers needs to be improved. At the same time, based on the Internet of Things + Technologies, it is proposed that college students' ideological and political education should be innovated in the aspects of service function, teaching mode, learning mode and the construction of teachers' team, which has a strong guiding role in the reform of ideological and political education in colleges and universities in China.


Prior research addressing whether differences exist between traditional classroom education and web-based learning has provided inconclusive results (Li, 2002); this is especially true in graduate level classes. The proposed empirical research attempts to explore differences in outcomes from a graduate level MIS course which was taught in a traditional classroom setting as well as in a web-based learning environment. The purpose of the proposed study is to determine whether differences between the two approaches exist, and to identify whether student attributes (employment status and whether the student has children) or educational approach attributes (traditional classroom or web-based environment) affect a student's learning outcomes. From a qualitative research perspective, the study also will address how satisfied students in the traditional classroom and the web-based environment are with the learning experience.


Strains R1T (type strain) and R2, two new isolates of nonsulfur purple photosynthetic bacteria, were studied. The cells of these organisms were gramnegative nonsporeforming rods that were motile by means of a singleflagellum, and they multiplied by budding. The photosynthetic membrane systems of these strains were of the lamellar type parallel to the cytoplasmic membrane. Cells which formed under anaerobic conditions in the light were red. The cells of these strains contained bacteriochlorophyll a, ubiquinone 10, and carotenoids. No vitamins were required as growth factors, and reduced sulfur compounds could not be utilized by strains R1T and R2. These two strains produced molecular hydrogen anaerobically in the light. On the basis of this study, we propose a new species, Rhodopseudomonas rutila, for strains R1T and R2. The guanine-plus-cytosine contents of the deoxyribonucleic acids of strains R1T and R2 are 67.6 and 69.4 mol%, respectively. The type strain of this new species is strain R1 (= ATCC 33872).


Rapid development of the integrated optics and photonics makes it necessary to create cheap and simple technology of optical waveguide systems formation. Photolithography methods, widely used for these tasks recently, require the production of a number of precision amplitude and phase masks. This fact makes this technology expensive and the formation process long. On another side there is a cheap and one-step holographic record- ing method in photopolymer compositions. Parameters of the waveguide system formed by this method are determined by recording geometry and material ' s properties. Besides, compositions may contain liquid crystals that make it possible to create elements, control- lable by external electric field. In this chapter, the theoretical model of the holographic formation of controllable waveguide channels system in photopolymer liquid crystalline composition is developed. Special attention is paid to localization of waveguides in the media caused by light field attenuation during the formation process.


This paper examines six major terrorist attacks that occurred in France and Nigeria between 2011 and 2016. The sources used were the news websites of The New York Times, The Washington Post, and USA Today. Agenda-Setting Theory postulates that the media has the ability to determine the salience of topics in the public domain. "Salience" is the perceived importance of issues or subjects in the eyes of the public. An important conclusion of this analysis is that the U.S. media has been over-reporting terrorist events in France, while underreporting terrorist events in Nigeria. The results of this paper substantiate previous studies that found that U.S. news reports on terrorist attacks in the West gain more widespread media coverage and attention. Evidence of over-reporting and under-reporting of these terrorist incidents attests to the power of Agenda-Setting Theory in the U.S. media because, ultimately, this shapes public perception of the threat that international terrorism poses to innocent people in the West.


Variations in the arterial pattern of the upper limb have been observed frequently, either in routine dissections or in clinical practice. Understanding of the vascular patterns of forearm and hand is necessary for microsurgical techniques in reconstruction of hand and upper extremity.
To identify the variations of the posterior interosseous artery of forearm including the anastomosis patterns.
Total 100 forearms were dissected. Data analysis was carried out by using SPSS for windows standard version release 11.5 statistical software. Posterior interosseous artery (PIA) originated from the common interosseous artery (78%) and ulnar artery (22%). The distal end of PIA anastomosed with the posterior branch of anterior interosseous artery in the form of an arch at dorsal side of the wrist 1.9-2.2 cm above the head of ulna. On both sides, the anastomotic arch terminated by giving branch only to the ulnar head (14%), only to the dorsal carpal arch (38%) ,to the unlar head and dorsal carpal arch (45%), to the ulnar head, dorsal carpal arch and radius (1%)respectively. The branch to dorsal carpal arch passed through fifth extensor compartment of the hand. Absence of anastomosis between anterior and posterior interosseous arteries was 2%. This study confirms that the anastomosis between interosseous arteries regarded as an important and significant anatomical feature both academically and clinically. The various anastomotic patterns of posterior interosseous artery are of great help clinically for applying the interosseous skin flaps in plastic and reconstructive surgery of the hand.


•Francis Fukuyama asks: '… is liberal democracy prey to serious internal contradictions, contradictions so serious that they will eventually undermine it as a political system?' This paper argues that one of these 'internal contradictions' is the political communications process and it can be sufficiently serious to undermine the democratic system—but such an undermining is not inevitable. The problem can be described as follows: Democratic systems require that citizens are kept fully informed by governments (and others) in the interests of transparency and ultimately accountability. Hence, all political communications have, as their final objective, the accountability of politicians at the ballot box. Thus all political communications have what can be described as 'above' and 'below' the line content. The above-the-line is the actual content of the message, the below-the-line is the implicit one of 'think better of me and my colleagues think worse of my opponents'. Consequently, no matter how personally honest and open an individual politician might be, the democratic system requires her or him to be always thinking about securing a successful result at the ballot box. Thus we have the 'political communications paradox'. Voters want politicians to be honest and accountable but this very demand means that politicians, implicitly, always have to have another agenda in operation when they are communicating with the public, i.e. securing their approval and then their support. As a result the trust which is a fundamental to the workings of a democratic system is constantly being undermined. This has two effects. First, that governments are obliged to make communications, rather than delivery, their real priority and second trust, not just in politicians but in the political system as a whole, tends to wane over time, which in turn endangers the very system it was designed to underpin. But this decline is not inevitable because the system has some in-built self-correcting mechanisms These include: the rise of new parties and/or leaders who portray themselves as 'new' and 'untainted'—New Labour, New Conservatives, etc., an almost regular 're-balancing' of the power relationship that exists between politicians and the civil service, particularly in the communications field, the rise of new forms of communication that seek to by-pass the institutional roadblocks that are perceived as being the cause of the problems and finally increased attention by journalists and academics to the process of political communications makes it more difficult for politicians to continue with 'business as usual' as far as their communication activities are concerned.


Amentotaxus argotaenia (Taxaceae) is a vulnerable coniferous species with preference for shade and moist environment. Accurate estimation of genetic variation is crucial for its conservation, especially in the context of global warming. In this study, we acquired a transcriptome from A. argotaenia leaves using Illumina sequencing and de novo assembled 62,896 unigenes, of which 5510 EST-SSRs were detected. Twenty-two polymorphic EST-SSRs were successfully developed and further used to investigate genetic variation, linkage disequilibrium, and bottleneck signatures of A. argotaenia. The results showed that A. argotaenia had moderate genetic variation and high genetic differentiation, which may provide raw material to protect against climatic changes and accelerate local adaptation, respectively. No bottlenecks were found to occur in A. argotaenia. Our study not only showed that these EST markers are very effective in population genetic analysis but also lay a solid foundation for further investigating adaptive evolution and conservation strategies of A. argotaenia.


: Increasing incidence of gout and its importance as a risk factor for arteriosclerosis stimulate the practitioner to improve his knowledge about therapeutic possibilities. Therapy of gout includes (1) treatment of acute attack with colchicine and indometacin, (2) decrease of uric acid blood concentration in tophaceous gout using uricosurica, alkalinization of urin, increased diuresis, and blockade of de-novo synthesis of uric acid, and (3) maintenance therapy with allopurinol or uricosurica to avoid recurrent arthritis as well as tophi. In addition, surgical removal of larger tophi may be of benefit.


In Mediterranean environments, evaporation is a key component of lake water budgets. This applies to Lake Baratz in Sardinia, Italy, a closed lake that almost dried up in 2008 after a succession of years with low seasonal rainfall. We used the energy budget method and Penman's equation to estimate evaporation over Lake Baratz. We measured, using a raft station, water temperature at the surface, at 1, 2, 4, 6 m depth and at the bottom of the lake, as well as air temperature, relative humidity, wind speed, and net radiation over a period of 3 years. We also compared Penman's equation and the energy budget method in two other climatic zones using published data. Our results indicate that mean yearly evaporation over Lake Baratz was 950 mm. On an annual scale, evaporation estimated by Penman's method omitting heat storage as is usually done was 18% higher than by the energy budget method that included heat storage, with monthly differences ranging between −38 and +60%. Including the heat storage term in Penman's equation changed the monthly values but did not change the yearly value significantly. Solar radiation and heat storage were found to be the most important energy fluxes to and from the lake and had the greatest effect on evaporation rates for the energy budget method. The bias between the two methods has a seasonal cycle due to the storage and release of energy from the lake. Energy advected to and from the lake by precipitation, surface water and ground water had minor effect on evaporation rates. Lake Baratz, like other lakes in a Mediterranean environment, is particularly sensitive to the summer hot and dry climate. In contrast, we found that rates of evaporation estimated from Penman and the energy budget methods over tropical African lakes were nearly constant over the entire year and the difference between the two methods smaller. Difference between the two methods for North American lakes is also smaller probably owing to the ice-cover season and to lower radiation and lower temperatures during summer.


Recent technologies are an opportunity for creating advanced data analytics tools for various domains. There are diverse methods based on smart technologies for implementing and supporting data analytics in educational environments, e.g. descriptive methods (reports), diagnostic methods (automated analysis), predictive and prescriptive methods (recommendations, alerts). The educational data come from online surveys, biometric sources, but, mostly, from activities in learning management systems (LMS). The current paper presents a new learning analytics instrument - LeProVE - uCluster for Moodle LMS, which creates virtual profiles of the students and aggregates those profiles into clusters which are further used by teachers to optimize the teaching process. The tool is suitable for today's social and cultural values, as the students' performances (reflected in grades, completed assignments) are not analysed only based on a standard a priori settled by the teacher, but considering the colleagues' performances and social interactions as well. Thus, the teacher can use the results obtained by using LeProVE - uCluster to adjust the homework/exams difficulty to the class context and can recommend further useful resources to individual students and clusters of students. The technologies and methods which are used to implement our instrument are modern: Scala, Spark - a general engine for big data processing, Angular JS, data mining algorithms (K-Means) and Big Data Sampling algorithms. To validate the functionality of the proposed tool, we used 2167 anonymised students' profiles which were imported from a Moodle data set freely available for research purposes. Possible interpretations of data and directions to be followed by teachers to improve their teaching skills are also offered.


The changing demographic characteristics of the dental profession are reviewed in an effort to stimulate consideration of the evolving relationship that exists between the providers and the geriatric population.


Pro-inflammatory cytokines promote stressor-like behavioural and neurochemical variations and are implicated in depression. Despite being a preferential inducer of the depression-linked inflammatory enzyme indoleamine 2,3-dioxygenase, the T-helper type-1 cytokine interferon gamma (IFN-γ) has received little attention in preclinical animal models. In the current studies we set out to elucidate the role of IFN-γ in stressor-related psychological pathology. In Chapter 2 we show that IFN-γ deficiency in mice attenuated some of the corticosterone, cytokine and brain regional dopaminergic effects of chronic stress. Similarly, in Chapter 3 we report that a lack of IFN-γ not only protected against stressor-induced memory dysfunction but also appeared to facilitate memory performance following stress. Surprisingly, however, under basal conditions the IFN-γ knockout mice actually had increased plasma corticosterone levels, heightened brain regional noradrenergic and serotonergic activity, and impaired spatial memory function, suggesting that a certain basal level of IFN-γ is required for the homeostatic regulation of these behavioural and physiological systems. Building on the findings from these two IFN-γ knockout studies we next undertook to ascertain whether the cytokine proactively affects depression-relevant pathophysiological domains. In Chapters 4 and 5 we demonstrate that systemically administered IFN-γ (25000 IU) mobilized peripheral cytokine networks, stimulated brain regional monoaminergic activity and sensitized the plasma corticosterone response to psychological stress. However, the cytokine did not alter locomotor activity or cause sickness-type behaviours in either of these studies. Additionally, in Chapter 5 we show that the monoaminergic effects of IFN-γ and bacterial lipopolysaccharide were exaggerated in mice overexpressing a mutated form of the Parkinson's disease-linked factor leucine-rich repeat kinase 2 (i.e., LRRK2 G2019S). In this way, we provide preliminary proof-of-concept for an IFN-γ-LRRK2 signalling pathway that may be relevant for depression and other non-motor symptoms in PD. Overall the findings presented in this thesis support a role for IFN-γ in stressor-related pathology and provisionally implicate LRRK2 as a novel downstream mediator of the cytokine's depressogenic effect. Further studies are warranted to verify and extend the pathological significance of these findings.


The magnetic shielding tensor of (207)Pb is calculated for various solids exhibiting (1) a holodirected lead(II) center containing a stereochemically inactive lone pair, (2) a hemidirected lead(II) center with a stereochemically active lone-pair, or (3) a lead(IV) center. Tensors investigated at the scalar relativistic level are compared with those calculated with the full ZORA/spin-orbit Hamiltonian. The effect of using GGA density functionals is compared to the use of hybrid density functionals.


IN Philip Massinger's The City Madam, Anne, daughter of the prideful Lady Frugal, itemizes her conditions for marriage to her suitor Lacy. Among them is a "friend to place me at a masque" (2.2.115).1 The play locates masques and their audiences within a nexus of fashion, emulation, self-display, social ambition, and theatergoing, pointing to the masque as an object of desire, especially for the upwardly mobile.2 Yet while someone like Anne might be able simply to buy a box for herself and her retinue at the Blackfriars, she could not as easily attend a masque. Entrance to a masque could not be purchased, and the average Londoner had a much better chance of hearing the cry "A hall, a hall! Let no more citizens in there" at the door than of being admitted to the performance (3.2.81).3 This line, spoken by a gentleman usher in George Chapman's The Widow's Tears (c. 1605?; printed 1612), neatly sketches the tensions surrounding masquing spaces.4 Because access to spaces where masques were performed was so restricted, the embedded masques contained in a significant number of early modern English plays, most of them Jacobean and early Caroline, could sell a class-based voyeurism-with varying combinations of valorization and critique-to audiences in the commercial playhouses. Such voyeurism, which operates on the same principles as the more commonly discussed sexual voyeurism, lent an eroticism to the space of masque performance, whether actual or represented.Between the 1590s and 1642, around ninety plays included some version of a masque. As a point of comparison, nearly eighty commercial early modern plays contained dumbshows. However, more than half of these appeared before 1611, after which dumbshows experienced a precipitous and permanent drop-off. Embedded masques, on the other hand, while somewhat less common in each of the two decades between 1611 and 1630, not only maintained consistent numbers following their initial popularity, but actually became more widespread again from 1631 onwards. Despite the enduring and pervasive presence of embedded masques, scholarship to date has dealt with them in almost wholly aesthetic terms and made almost no attempt to account for the social and economic factors underpinning their use. This essay begins to address that lack by outlining some of the mechanisms by which embedded masques and their productions of space both responded to and participated in the turbulent changes to ideas of social order in early modern London.Many playgoers would never see a masque in the court or a great house. Admission to a court masque, for instance, depended upon having sufficient rank and connection to the court (for the most part, being an aristocrat or government official), and attendance was technically by invitation only. Even within Patricia Fumerton's picture of audiences growing increasingly large "as rich merchants and common gentry infiltrated the aristocratic elite," court officials enforced, to the best of their ability, restrictions on access.5 Mere wealth did not guarantee entry, nor did rank, as Fumerton herself notes regarding James's "response to complaints from ambassadors when they were not invited: 'a Masque is not a public function,' grumblers were informed, and therefore 'his Majesty is quite entitled to any Ambassador he may choose.'"6 Of course, court masques were always a mix of public and private. They were "private" by virtue of their restricted admission, but they were simultaneously "public" in the sense of participating in state matters and including persons of consequence in public life. Plays featuring masques stressed the former at the expense of the latter in a bid to increase their perceived exclusivity (along with the theater's perceived importance-it could provide access to the hidden practices of public persons), making masques "public" in the second sense: part of the market and available to anyone who could pay for them. Those admitted to actual masques always remained a subset of those who attempted or desired admission. …


Similarly to other existing historic ways, the route shown in this study originates from footpaths made by native Indians, at the time of their walking across the still virgin Brazilian lands. However, it was in the beginning of the 17th century that the construction of what is known today as the Estrada Real occurred. The Estrada Real was formed by royal ways, that is to say, ways belonging to the Portuguese Crown, built exclusively under its consent, to permit access to the gold and diamond reserves of the state of Minas Gerais in Brazil. Through those ways, the precious minerals reached the ports in the cities of Paraty and Rio de Janeiro, from where they were shipped to the Kingdom of Portugal. At that time, this route became the main method of communication and transportation of goods across the Brazilian lands, bringing growth to that region. Nowadays, the revival of ancient routes aimed at tourism purposes belongs to a group of modalities, which become more and more outstanding in the market of this sector. In this context, and by means of governmental initiative, the Estrada Real has been reactivated as part of a tourism itinerary that portrays the colonial Brazil of the past. This study has been carried out to discuss the importance of the development of routes that promote the creation of tourism nets, as well as learning about the perceptions of the communities of three important municipalities that form the Estrada Real, Diamantina, Serro and Conceicao do Mato Dentro, with regard to this route. The research has been conducted through group interviews with representatives of those communities and shows their involvement and participation in this process.


Introduction: The urinary tract is the second most common site for infection next to respiratory tract and urinary tract infection (UTI) occurs more frequently in persons with diabetes mellitus. The factors affecting UTI in diabetic patients are not well documented and there is lack of adequate surveillance information and characterization pertaining to urinary pathogens in diabetic cases in developing countries. Hence, the study aimed to look into the characterization and antibiotic susceptibility pattern of pathogens associated with UTI among diabetic and non-diabetic patients with special reference to Escherichia coli. Materials and Method: A total of 1695 non-repetitive urine samples were screened prospectively from symptomatic cases of diabetic and non-diabetic individuals by semi-quantitative calibrated loop culture technique between 2014 and 2016. Result: In our study, out of 1695 urine samples screened, 446 (24.9%) urine samples showed significant bacteriuria and Escherichia coli was accounted for 280 (62.7%) bacterial isolates. Though E.coli was the predominant organism, its occurrence was significantly high in non-diabetic subjects compared to diabetic subjects (70.6% Vs 55.2%, p<0.001). While Staphylococcus aureus (6.5% Vs 2.7%; p< 0.001) and Candida species (7% Vs 2.7%; p <0.001) were the more frequent cause of UTI in diabetic subjects. Among diabetic cases, 61% of the UTI cases were having long term diabetes of more than 10 years. The E.coli strains isolated from both groups showed increased resistance to ampicillin (86.7%), ceftazidime (63.2%), ciprofloxacin (52.5%) and trimethoprim/sulfamethoxazole (50%). Conclusion: E.coli was predominant organisms isolated from UTI in both diabetic and non-diabetic groups. Microorganisms encountered in UTI did not differ by diabetic status except for Candida species and Staphylococcus aureus, which were more frequently isolated from diabetic patients. Among diabetics, age of the patient, long duration and poor glycemic control were associated risk factors in the development of UTI.


We report a rare complication of knotting of the urethral catheter inside the urinary bladder of a 3 month old boy who was referred for voiding cystourethrogram. After unsuccessful attempts to remove the catheter, the baby was admitted to surgery. The catheter was removed under anesthesia after gentle but sustained traction. The complications of improper urethral catheterization are described and recommendations are made for their prevention.


Abstract Phase-only subdiffraction-limited depth of focus (DOF) elements are proposed and a relatively simple method is given which reduces the number of design parameters to four. A diffractive optical element with subdiffractive-limited DOF was experimentally demonstrated for the first time. Experimental results are in close agreement with numerical prediction. Several calculated examples show that the DOF for subdiffraction-limited elements can decrease by an amount, ranging from 37% to 71% compared to the DOF for a diffraction-limited element when ρ is chosen close to zero. The reduction is determined by the focal length of the element and the required distance between the primary peak (focal plane) and the secondary peak, both in units of wavelength. The latter, i.e. the peak-to-peak distance, determines the maximum applicable DOF. The influence of input laser beam parameters, such as phase distribution and beam size, on the focusing performance have also been investigated.


Geotrichum is a species of fungi that can be found in every environment in nature, in soil, in water and in air. As it can be found in plants and in cereals and milk products, it has also been shown to be found in normal human flora (mucus and faeces). Geotrichum candidum, mostly saprophytic, can cause clinical picture called Geotrichosis. Neoplasms, leukosis, HIV infection, diabetes mellitus, and kidney transplantation are generally the underlying diseases in such cases. In a case in which we detected G.candidum reproduction in urinary tract infection, we aimed to present the case with its clinic findings and to review the literature.


Nanostructures have been very popular for several years to do research on sensing. In this paper we will demonstrate the advantage of using nanowires of zinc oxide (ZnO) as one dimensional structure for potentiometric measurements in biological environments. The developed procedures show suitability for the accurate determination of most of the important metal ions and to characterize cells and thin bio-layers. We will also show how to use these structures for biosensing of glucose, cholesterol, and the application of extended gate metal oxide semiconductor field effect transistors as the signal transducer. In the second part, we will show how to use a two-dimensional nanostructure, specifically graphene, for cholesterol and glucose biosensing. © 2011 Published by Elsevier Ltd. * Corresponding author. Tel.: +46-13-281000; fax: +46-11-363270. E-mail address: email@example.com.


Introduction: Popliteal artery gains much importance because of the clinical conditions encountered and the surgeries carried out in the region of popliteal fossa. The variations in the branching pattern of popliteal artery is observed and studied by many as the knowledge of its variations will be of relavence during the vascular surgeries, fasciocutaneous flaps and surgeries of knee.
Materials and Methods:  Present study is conducted on 50 lower limb specimens belonging to the department of Anatomy of Karuna medical college by detailed dissection and tracing of all its branches.
Results and Discussion: Two out of 50 specimens showed the presence of superficial sural artery accompanying the sural nerve very rare but very important one. No variation in the course of the popliteal artery was encountered. Trifurcation of popliteal artery was not encountered in the present study.
Conclusion: The present study shows the importance of the superficial cutaneous branch of the popliteal artery with respect to the fasciocutaneous flaps an important finding for the plastic surgeons &  surgeries where fasciocutaneous free and pedicled flaps can be raised over the superficial cutaneous branches of Popliteal artery.

Keywords: Superficial sural artery, Fasciocutaneous flaps, Superficial sural artery flap.


Multi-stop truckload has been gaining importance in recent years as part of a shift away from Less-than-truckload freight. In our research, we sought to understand how the price and carrier behavior vary as the number of stops increases. Rational economic theory says that these shipments will be more expensive, and experience shows that in practice they also tend to get rejected more often. This thesis tested these two likely results together with other factors known for affecting price and rejection rates, such as lead time, clustering of the stops, etc. We used logistics regression to predict the acceptance ratio and ordinary least squares regression to model the price based on historical data. We found that there is an inherent cost associated with multi-stops, which depends on the number of stops and whether the stop is a pick or a drop. The proximity of these stops as well as the stop-off charge can also impact the price. Carrier acceptance and routing guide depth depends on the price structure and load characteristics. As the number of stops increases, it takes longer for a tender to be accepted and the shipment performance also deteriorates with an increased likelihood of late deliveryespecially if the initial pickup is late. Therefore, companies need to be aware of the hidden costs associated with multi-stop truckloads as they plan their transportation network. Thesis Supervisor: Dr. Chris Caplice Title: Executive Director, Center for Transportation and Logistics


We explore the Jacobi Last Multiplier as a means for deriving the Lagrangian of a fourth-order differential equation. In particular we consider the classical problem of the Pais-Uhlenbeck oscillator and write down the accompanying Hamiltonian. We then compare such an expression with an alternative derivation of the Hamiltonian that makes use of the Ostrogradski's method and show that a mapping from the one to the other is achievable by variable transformations. Assuming canonical quantization procedure to be valid we go for the operator version of the Hamiltonian that represents a pair of uncoupled oscillators. This motivates us to propose a generalized Pais-Uhlenbeck Hamiltonian in terms of the usual harmonic oscillator creation and annihilation operators by including terms quadratic and linear in them. Such a Hamiltonian turns out to be essentially non-Hermitian but has an equivalent Hermitian representation which is reducible to a typically position-dependent reduced mass form.


ABSTRACT The common ice plant, Mesembryanthemum crystallinum L. provides a useful model for the study of environmentally induced photosynthetic conversion and abiotic stresses tolerance. However, a procedure for the production of transgenic ice plant, which is essential for functional genomics, has not been fully established. Here we tested the factors on the transformation of cotyledonary nodes excised from the ice plant seedlings such as thidiazuron (TDZ), NaCl and phytosulfokine (PSK), a peptidyl plant growth factor using Agrobacterium tumefaciens strains EHA101 and EHA105 harboring binary vector plasmids pBI7EGFP and pCAMBIA1302, respectively. The established procedure is as follows: the explants (cotyledonary nodes) were co-cultivated with Agrobacterium for 3 days, and the explants were cultured in the medium with 0.5 mg l−1 kinetin and 100 mg l−1 carbenicillin for 72 h, and they were cultured in the medium with 0.5 mg l−1 kinetin and 100 nM PSKfor 4 weeks. Thidiazuron and NaCl enhanced the production of multiple adventitious shoot formation during regeneration but reduced the transformation efficiency due to the vitrification of adventitious shoots. PSK was effective in the production of healthy adventitious shoots. The transformation frequency at the stage of whole plants was 0.6% and 4.6% per inoculated cotyledonary nodes using the Agrobacterium strain EHA101 (pBI7EGFP) and EHA105 (pCAMBIA1302), respectively. Graphical abstract


Magnetic tweezers are able to manipulate cells or biomolecules for various applications and measurements. In this work, a horizontal magnetic tweezer is designed, modeled and controlled for single molecule manipulations. A method is presented for dynamic modeling of horizontal magnetic tweezers. A linear control method is designed to ensure a wide range of operation conditions with zero steady-state error. The horizontal magnetic tweezer is able to generate a wide range of piconewton scale forces on a superparamagnetic microparticle for single molecule separation, and biosensor developments.


The unsteady laminar flow and heat transfer characteristics for a pair of confined impinging air jets centered in a channel were studied numerically. The time-averaged heat transfer coefficient for a pair of heat sources centered in the channel and aligned with the jets was determined as well as the oscillating jet frequency for the unsteady cases. The present study continues the authors' previous investigation, which emphasized how single confined jets will remain steady at Reynolds numbers that make side-by-side jets highly unsteady. The nature of this unsteadiness depends on the proximity of the jet inlets, the channel dimensions and the jet Reynolds number. The jet unsteadiness causes the stagnation point locations to sweep back and forth over the impingement region, and the jets "wash" a larger surface area on the target wall. The results indicate that the dual jets become unsteady between a Reynolds number of 200 and 300. Also, in the range of Reynolds numbers studied, a fixed stagnation "bubble" was formed on the target wall between the two jets, which reduced the heat transfer removal from that region, leading in fact to a quasi-independence of the local heat transfer on flow conditions. The stagnant region contains slow moving warm air that forces the cool impinging air jets to flow to the sides of this target wall area. The oscillating frequency of the flow increases with Reynolds number for the unsteady cases. Also, the time-averaged heat transfer coefficient on the heat sources rises as the Reynolds number increases for the steady cases but there is a slight decrease when it transitions to unsteady flow, indicating again that the stagnation "bubble" occurring between the two heat sources affects the local heat transfer.Copyright © 2003 by ASME


Franchising has become a global phenomenon. Many brands have grown beyond their national markets and proved that this business expansion model can work around the world. Meanwhile, in comparison to growth on a national scale, it is clear that cross-border franchising involves additional divergent business models and requires solutions to different issues in order to succeed. This major new title, published in partnership with the International Bar Association, is a concise, practical guide for all those involved in planning and operating an international franchise programme, from in-house counsel to managing directors to those in private practice. It focusses exclusively on issues that typically arise in international franchise transactions. The book applies general know-how and industry experience to specific franchise industries such as hospitality, internet and technology, services and retail. The lack of a harmonised franchise regime or dispute resolution system across the major jurisdictions means that this is not a simple exercise from the legal perspective. In addition, many jurisdictions require specific pre-contractual disclosure and/or registration. In addition to classic legal questions, efficient tax planning is required to secure success. In parallel, the book reviews questions on data protection and intercultural communication during a franchise partnership as well as financing possibilities from various national perspectives. Uniquely, this title applies and reflects general practical and technical franchising know-how to specific franchised industries and highlights typical sector-by-sector questions and solutions in an international franchise context.


Colorectal cancer (CRC) is a major cause of mortality throughout the world and risk of CRC is known to be modulated by nutritional factors. Low intake of the micronutrient selenium (Se) has been implicated as a risk factor in CRC, and in this article we describe the biochemical functions of selenium in selenoproteins, review the evidence for an association of selenium status with CRC and adenoma risk and describe the genetic epidemiological data on selenoprotein genes and CRC risk. Epidemiological evidence linking Se intake to CRC risk is limited but there is strong evidence for a link to adenoma risk. Two studies show an association between a genetic variant in the selenoprotein S gene and CRC risk. Selenium intake modulates selenoprotein expression in the colon, especially selenoproteins W, H, M, 15 kDa selenoprotein and glutathione peroxidase 1, and downstream targets such as endoplasmic reticulum stress response, oxidative stress and inflammatory pathways. We hypothesis that Se, through the selenoproteins, plays a key role in the ability of colonic epithelial cells to respond to microbial and oxidative challenges and that a combination of low Se intake and SNP in selenoprotein genes can impair that role and so lead to increased risk of pre-neoplastic lesions. There is a need for both further studies of selenoprotein function in the colon and major genetic epidemiological and intervention studies.


The endo-lysosomal pathway is essential for intracellular transport and the degradation of extracellular cargo. The relationship between three populations of endo-lysosomal vesicles—Rab7-positive, LAMP1-positive, and both Rab7- and LAMP1-postive—was probed with fluorescence microscopy and single particle tracking. Of specific interest was determining if these vesicles were intermediate or terminal vesicles in the transport of extracellular cargo. We find that the major organelle in the endo-lysosomal pathway, both in terms of population and cargo transport, is positive for Rab7 and LAMP1. Dextran, a fluid phase cargo, shifts from localization within all three populations of vesicles at 30 minutes and 1 hour to primarily LAMP1- and Rab7/LAMP1-vesicles at longer times. This demonstrates that LAMP1- and Rab7/LAMP1-vesicles are terminal vesicles in the endo-lysosomal pathway. We tested two possible mechanisms for this distribution of cargo, delivery to mannose 6-phosphate receptor (M6PR)-negative vesicles and the fusion dynamics of individual vesicles. We find no correlation with M6PR but do find that Rab7-vesicles undergo significantly fewer fusion events than LAMP1- or Rab7/LAMP1-vesicles suggesting that the distribution of fluid phase cargo is driven by vesicle dynamics.


BACKGROUND
Many patients with previously implanted ventricular defibrillators are candidates for an upgrade to a device capable of atrial-ventricular sequential or multisite pacing. The prevalence of venous occlusion after placement of transvenous defibrillator leads is unknown. The purpose of this study was to determine the prevalence of central venous occlusion in asymptomatic patients with chronic transvenous defibrillator leads.

METHODS
Thirty consecutive patients with a transvenous defibrillator lead underwent bilateral contrast venography of the cephalic, axillary, subclavian, and brachiocephalic veins as well as the superior vena cava before an elective defibrillator battery replacement. The mean time between transvenous defibrillator lead implantation and venography was 45 +/- 21 months. Sixteen patients had more than 1 lead in the same subclavian vein. No patient had clinical signs of venous occlusion.

RESULTS
One (3%) patient had a complete occlusion of the subclavian vein, 1 (3%) patient had a 90% subclavian vein stenosis, 2 (7%) patients had a 75% to 89% subclavian stenosis, 11 (37%) patients had a 50% to 74% subclavian stenosis, and 15 (50%) patients had no subclavian stenosis.

CONCLUSIONS
The low prevalence of subclavian vein occlusion or severe stenosis among defibrillator recipients found in this study suggests that the placement of additional transvenous leads in a patient who already has a ventricular defibrillator is feasible in a high percentage of patients (93%).


The different properties of acceptor-doped (hard) and donor-doped (soft) lead zirconate titanate (PZT) ceramics are often attributed to different amounts of oxygen vacancies introduced by the dopant. Acceptor doping is believed to cause high oxygen vacancy concentrations, while donors are expected to strongly suppress their amount. In this study, La3+ donor-doped, Fe3+ acceptor-doped and La3+/Fe3+-co-doped PZT samples were investigated by oxygen tracer exchange and electrochemical impedance spectroscopy in order to analyse the effect of doping on oxygen vacancy concentrations. Relative changes in the tracer diffusion coefficients for different doping and quantitative relations between defect concentrations allowed estimates of oxygen vacancy concentrations. Donor doping does not completely suppress the formation of oxygen vacancies; rather, it concentrates them in the grain boundary region. Acceptor doping enhances the amount of oxygen vacancies but estimates suggest that bulk concentrations are still in the ppm range, even for 1% acceptor doping. Trapped holes might thus considerably contribute to the charge balancing of the acceptor dopants. This could also be of relevance in understanding the properties of hard and soft PZT.


The discussion includes the drawings associated with the marble David and the lost bronze David. There is an occasional departure from conventionally accepted attributions to given projects. An example is the sketch of David and the head of Goliath on the well-known Louvre sheet, 714 recto, long connected with the lost bronze David, which is, instead, Michelangelo's first visualization of the marble David. A drawing, assigned by Hartt to St. Lorenzo, Florence, as a study for a sculptured St. Lawrence, is actually a drawing for the lost bronze David. Another drawing, traditionally accepted as a rendering of the Apollo Belvedere, is, instead, a fighting young David. Four other drawings have been reassigned, as applicable, to the two Davids. The drawings have been placed in the context of an iconographic consistency proceeding from a study of the political aspects of the marble David.


Land use change directly increased soil erosion risk, which is a very sensitive environmental
issue in Central India. To evaluate the response of land use changes on soil erosion risk,
research was implemented using remote sensing techniques, coupled with ground
information, to develop an integrated modelling approach to study the factors driving land
use changes in the Man River basin, Central India. Results were used to assess the impact of
land use change on soil erosion risk.
First, a series of sub methods were applied to monitor and verify land use land cover change
in the study area which included pre-processing, classification and assessment of land use
transaction from 1971 to 2013 using Landsat time series imagery. Additionally, an
independent spatial assessment of deforestation, forest degradation and responsible drivers
for the period 2009-2013 was conducted to enable a deeper analysis of forestry activates
using the GIS based direct interpretation approach. The research also developed a robust
accuracy assessment method to check the quality of the 2009 and 2013 classification maps
using good quality Google Earth TM imagery and a field measured GPS dataset. These
approaches were largely based on the GOFC- GOLD (2010) and IPCC good
recommendations for land use land cover mapping and verification. The information
obtained from an accuracy assessment was also used to estimate deforestation area and
construct confidence intervals that reflect the uncertainty of the area estimates obtained.
Such analysis is rarely applied in current published verification assessments.
In the second phase of the study, a Geo-spatial interface for process-based Water Erosion
Prediction Project (GeoWEPP) was implemented, to estimate the response of land use and
land cover change on soil erosion risk in several scenarios derived from both ground and
satellite based precipitation, DEMs and vegetation change. GeoWEPP was used at the
hillslope scale in three selected watersheds within the Man River basin using Landsat, LISSIII,
Cartosat-1, ASTER, SRTM, TRMM and ground based datasets.
The results highlight that the study developed a realistic approach using remote sensing
techniques to understand the pattern and process of landscape change in the Man River basin
and its response on soil erosion risk. Over the last four decades, forest and agriculture areas
were found to be the most dynamic land use /land cover categories. During the last four
decades, around 54200 ha (33.7 %) forest area has been decreased due to the expansion of
agriculture, forest harvesting and infrastructure development. The direct interpretation
approach estimated similar patterns of deforestation and forest degradation associated with
iii
drivers for the 2009 to 2013 time period, but this approach also provided more accurate and
location specific information than automatic analysis. The overall correspondence between
the map and reference data are a good measure for 2009 and 2013; 94.03 % and 92.8 %
respectively. User's and producer's accuracies of individual classes range from 75 % to 99
%. Using the accuracy assessment data and a simple set of equations, an error-adjusted
estimate of the area of deforestation was obtained (± 95% confidence interval) of 23382 ±
550 ha.
The estimated average annual soil loss for all three watersheds is 21 T/ha which was found
to be comparable to similar studies carried out in the study region. The highest soil loss rates
occurred in areas of agriculture (301 T. /ha /yr) and fallow land (158 T/ha/yr), while the
lowest rates were recorded in forest land (33.45 T/ha/yr). Agriculture extension (316.5 ha)
due to forest harvesting (234 ha) in the last four decades is one of the significant drivers to
speed up soil erosion (7.37 T/ha/yr.) in all three watersheds. The spatial pattern of erosion
risk indicates that areas with forest cover have minimum rates of soil erosion, while areas
with extensive human intervention such as agriculture and fallow land, have high estimated
rates of soil erosion. The different DEMs generated varied topographic and hydrologic
attributes, which in turn led to significantly different erosion simulations. GeoWEPP using
Cartosat-1 (30 m) and SRTM (90 m) produced the most accurate estimation of soil loss
which was close to similar already published studies in the area. TRMM rainfall data has
good to use as a rainfall parameter for soil erosion risk mapping in study area.
Overall, the integrated approach using remote sensing and GIS allowed a clear
understanding of the factors that drive land use/land cover change to be developed and
enabled the impact of this change on soil erosion risk in the Man River basin, Central India
to be assessed.


Anesthesiology, V 123 • No 2 481 August 2015 To the Editor: The title of the publication by Kancir et al.1 implies lack of nephrotoxicity associated with the use of either 6% hydroxyethyl starch 130/0.4 or 0.9% NaCl during hip arthroplasty. The primary outcome variable was urinary concentrations of neutrophil gelatinase–associated lipocalin (u-NGAL). For all observation points, u-NGAL concentrations are reported as absolute and as values adjusted for creatinine (table 3). However, at the time of the highest u-NGAL concentrations (i.e., at discharge; observation point "urine 4"), values of neither creatinine clearance (table 3) nor plasma creatinine concentration (table 4) are provided. The authors describe the postoperative u-NGAL concentrations as only "slightly increased" and remaining "well below" the threshold of 100 ng/ml, considered to reflect acute kidney injury. However, at the time of patient discharge, median u-NGAL concentrations had increased 9to 11-fold over baseline values, and the 75% quartile values of u-NGAL at discharge were 160.5 and 116.3 ng/ml in the hydroxyethyl starch and NaCl groups, respectively (table 3). This indicates that several patients of each group had u-NGAL concentrations well above the critical concentration of 100 ng/ml, reflecting the development of some degree of nephrotoxicity. The authors mention in a somewhat passing fashion that their use of chloride-rich solutions may have contributed to the transient increases in u-NGAL concentrations. Infusion of 2 l of 0.9% NaCl in healthy individuals was associated with a 40% decrease of renal blood flow velocity and renal cortical tissue perfusion.2 This was accompanied by a mean increase in serum chloride concentrations from initially 103 to 108.5 mmol/l within 60 min of starting the infusion. Additional evidence supports the adverse renal effects of hyperchloremic solutions.3–5 Therefore, administration of hyperchloremic solutions might well have contributed to the clinically relevant increases in u-NGAL concentrations in some patients observed by Kancir et al.1 There are no large prospective clinical studies clearly documenting an adverse effect of perioperative administration of hyperchloremic solutions on outcome. Nevertheless, intraoperative infusion of hyperchloremic 0.9% NaCl carries a high potential of inducing hyperchloremic metabolic acidosis,6 and acute hyperchloremia and hyperchloremic acidosis have numerous adverse effects.7 It may thus be prudent to avoid the perioperative administration of hyperchloremic solutions altogether whenever possible. Competing Interests


We present a fast mapping-based algorithm to compute the mappability of each region of a reference genome up to a specified number of mismatches. Knowing the mappability of a genome is crucial for the interpretation of massively parallel sequencing experiments. We investigate the properties of the mappability of eukaryotic DNA/RNA both as a whole and at the level of the gene family, providing for various organisms tracks which allow the mappability information to be visually explored. In addition, we show that mappability varies greatly between species and gene classes. Finally, we suggest several practical applications where mappability can be used to refine the analysis of high-throughput sequencing data (SNP calling, gene expression quantification and paired-end experiments). This work highlights mappability as an important concept which deserves to be taken into full account, in particular when massively parallel sequencing technologies are employed. The GEM mappability program belongs to the GEM (GEnome Multitool) suite of programs, which can be freely downloaded for any use from its website (http://gemlibrary.sourceforge.net).


LETTERS To perform or not to perform liver biopsy: an alternative view I would like to thank Joy and Scott for their comments in their letter in response to my review (Gut 2002;51:9–10). 1 I entirely agree with their view that ultrasound is highly specific and sensitive for the diagnosis of fatty liver. However, I do not feel that the presence or absence of fatty liver is the issue here. It is established that approximately 30% of patients with fatty liver who have significant fibrosis will go on to develop chronic liver disease and cirrhosis, with all its complications, including hepatoma. 2 The purpose of histo-logical sampling is not to confirm the presence of fatty liver but to see whether fibrosis and other abnormalities are present, putting the patient at risk of developing chronic liver disease. This issue was addressed in a recent article by Saadeh and colleagues 3 who compared patients with non-alcoholic steatohepatitis (NASH) and those with steatosis (non-alcoholic fatty liver disease (NAFLD)) alone. The authors evaluated the role of various radiological modalities, including ultrasound, computed tomography, and magnetic resonance imaging, in the role of distinguishing between NASH and the less aggressive forms of NAFLD. Their conclusion was that none of the radiological modalities detected the presence of hepatocyte ballooning, Mallory's hya-line, or fibrosis, which are the important features in the diagnosis of NASH. The study showed that ultrasound had high sensitivity and specificity for the diagnosis of severe steatosis but it confirmed that ultrasound had no predictive value in the diagnosis of fibrosis or cirrhosis. On the basis of this article together with earlier studies, I can find no basis for the conclusion reached by Joy and Scott that ultra-sound is a reasonable alternative to liver biopsy for patients who have abnormal liver function tests with no diagnostic serology. References 1 Joy D, Scott BB. To perform or not to perform liver biopsy: an alternative view. The utility of radiological imaging in non-alcoholic fatty liver disease. The interesting comment of Heading (Gut 2002;50:592–3) on the work by Fibbe et al needs to be completed by considering the anatomical factor in the study of gastro-oesophageal reflux disease (GORD) before advocating any non-medical appropriate treatment (fundoplicator, Stratten procedure, Gastropexie, etc). The multiple controversies arising from all non-medical proposed treatments, with contradictory results, are due to the complete neglect of delimitating the cardio-oesophageal junction (CEJ) and the shape of the …


Salt marshes have among the highest carbon (C) burial rates of any ecosystem and often rely on C accumulation to gain elevation and persist in locations with accelerating sea level rise. Net ecosystem carbon balance (NECB), the accumulation or loss of C resulting from vertical CO2 and CH4 gas fluxes, lateral C fluxes, and sediment C inputs, varies across salt marshes; thus, extrapolation of NECB to an entire marsh is challenging. Anthropogenic nitrogen (N) inputs to salt marshes impact NECB by influencing each component of NECB, but differences in the impacts of fertilization between edge and interior marsh must be considered when scaling up. NECB was estimated for the 0.5 km2 Spartina alterniflora marsh area of Freeman Creek, NC, under control and fertilized conditions at both interior and edge berm sites. Annual CO2 fluxes were nearly balanced at control sites, but fertilization significantly increased net CO2 emissions at edge sites. Lateral C export, modeled using respiration rates, represented a significant C loss that increased with fertilization in both edge and interior marsh. Sediment C input was a significant C source in the interior, nearly doubling with fertilization, but represented a small source on the edge. When extrapolating C exchanges to the entire marsh, including edge which comprised 17% of the marsh area, the marsh displayed net loss of C despite a net C gain in the interior. Fertilization increased net C loss fivefold. Extrapolation of NECB to whole marshes requires inclusion of C fluxes for both edge and interior marsh.