Glomerular filtration rate (GFR) is routinely estimated using endogenous biomarkers due to the complexity of direct measurement methods. Cystatin C is a protease inhibitor produced in all nucleated cells. It is freely filtered and then catabolized by renal tubular cells. Therefore, plasma concentration of cystatin C depends primarily on GFR. Serum cystatin C is less affected by muscle mass, diet, race, gender and age than creatinine. In the general population, equations to estimate GFR based on cystatin C do not have a better performance than those based on creatinine. However, formulas that combine creatinine and cystatin C are more accurate and precise. Estimation of GFR based on cystatin C could be useful in populations in which creatinine value may be biased, such as people with extremely low or high muscle mass, cirrhosis and chronic cardiorenal syndrome. Due to its higher cost in comparison to creatinine, we recommend measuring cystatin C on these clinical situations and when a more accurate estimation of GFR is required.


The study employed multi-variate methods to generate vulnerability maps for acid sulfate soils (AS) in the Norrbotten county of Sweden. In this study, the relationships between the reclassified datasets and each biogeochemical element was carefully evaluated with ANOVA Kruskal Wallis and PLS analysis. The sta-tistical results of ANOVA Kruskall-Wallis provided us a useful knowledge of the relationships of the preliminary vulnerability ranks in the classified datasets ver-sus the amount of each biogeochemical element. Then, the statistical knowledge and expert knowledge were used to generate the final vulnerability ranks of AS soils in the classified datasets which were the input independent variables in PLS analyses. The results of Kruskal-Wallis one way ANOVA and PLS analyses showed a strong correlation of the higher levels total Cu2+, Ni2+ and S to the higher vulnerability ranks in the classified datasets. Hence, total Cu2+, Ni2+ and S were chosen as the dependent variables for further PLS analyses. In particular, the Variable Importance in the Projection (VIP) value of each classified dataset was standardized to generate its weight. Vulnerability map of AS soil was a result of a lineal combination of the standardized values in the classified dataset and its weight. Seven weight sets were formed from either uni-variate or multi-variate PLS analyses. Accuracy tests were done by testing the classification of measured pH values of 74 soil profiles with different vulnerability maps and evaluating the areas that were not the AS soil within the groups of medium to high AS soil probability in the land-cover and soil-type datasets. In comparison to the other weight sets, the weight set of multi-variate PLS analysis of the matrix of total Ni2+& S or total Cu2+& S had the robust predictive performance. Sensitivity anal-ysis was done in the weight set of total Ni2+& S, and the results of sensitivity analyses showed that the availability of ditches, and the change in the terrain sur-faces, the altitude level, and the slope had a high influence to the vulnerability map of AS soils. The study showed that using multivariate analysis was a very good approach methodology for predicting the probability of acid sulfate soil.


Evidence of high efficacy of live attenuated influenza vaccine (LAIV) from randomized controlled trials is strong for children 2–6 years of age, but fewer data exist for older school-age children. We reviewed the published data on efficacy and effectiveness of LAIV in children ≥5 years. QUOSA (Elsevier database) was searched for articles published from January 1990 to June 2014 that included 'FluMist', 'LAIV', 'CAIV', 'cold adapted influenza vaccine', 'live attenuated influenza vaccine', 'live attenuated cold adapted' or 'flu mist'. Studies evaluated included randomized controlled trials, effectiveness and indirect protection studies. This review demonstrates that LAIV has considerable efficacy and effectiveness in school-age children.


This study attempted for the proposal and analysis of a combined cycle that consists of a wet ethanol-fueled and turbocharged homogeneous charge compression ignition (HCCI) engine coupled to ejector refrigeration cycle (ERC) and absorption refrigeration cycle (ARC) for the simultaneous generation of two distinct outputs, namely, power and refrigeration. Both first and second laws of thermodynamics were employed to develop a thermodynamic model, which has been applied to investigate the performance of combined cycle. Furthermore, performance of the combined cycle for ERC versus ARC was compared and assessed after altering operating parameters (turbocharger pressure ratio, turbocharger compressor efficiency, ambient temperature, and the entrainment ratio of ERC and generator temperature of ARC) to study their effect on engine power output, refrigeration load, exergy of refrigeration, and energy and exergy efficiencies of the cooling-power cogeneration cycle. Results show that the elevated pressure of turbocharger results in the enhancement of HCCI engine power and increase of the refrigeration of thermal load, simultaneously. However, the increasing ambient temperature shows the decline of HCCI engine efficiencies and energy efficiency of cogeneration, while the cogeneration cycle exergy efficiency is found increasing. Furthermore, the results are reported for the refrigeration performed by lithium bromide–water (LiBr–H2O)-operated ARC, and R134a- and R290-operated ERC, respectively. Mapping of exergy destruction for the presented cogeneration cycle discovered HCCI engine, boiler of ERC, generator of ARC, and catalytic convertor as the components of significant exergy destruction. Entrainment ratio and type of refrigerant employed in ERC and the generator temperature of ARC show a marginal impact on the COPs of these cycles.


The trobairitz, usually high-ranking noble
women who were known as domna, are the
female poets of courtly lyric. They can be regarded
as the female counterparts of the troubadours,
the lyric singers and poets of courtly
love, a culture that flourished in the courts of
southern France in the twelfth and thirteenth
centuries. Their work fits almost completely
into the socio-poetic code of the male troubadour
love lyric. The writing of a courtly
chanson caused a double-edged problem
for the trobairitz: in the first place they must
make their mark in a male dominated genre,
and they must also adapt the courtly code of
that genre, bound as it was by strict formality
and inflexible rules, to their own situation.
This meant they must replace the man as the
active and articulate lover, and manoeuvre
him into the passive role of the 'beloved'. The
central question of this article deals with the
breaching of the traditional courtly code and
its consequences for the gender identity of
the trobairitz, for their chosen perspective
and the manner in which this breach acquired
shape in the formal vocabulary of courtly lyric.


Steam condensation plays a key role in removing heat from the containment atmosphere, therefore the calculation of the steam condensation has a significant effect on the judgment of severe accident process. This paper discussed the calculation models of condensation used in severe accident integral codes.
 Firstly two kinds of condensation calculation models introduced and analyzed for application in integral codes: models based on experiment correlations — Uchida model, Dehbi model, and the models based on analogy of heat-mass transfer — Kreith model and Collier model. And then two calculation models based on Kreith model were proposed: simplified calculation model and completely iterative calculation model.
 After that, a heat structure calculation code was designed and the two model was applied. The results of the code with the two model along with Uchida and Dehbi models were compared with the experiment result of Wisconsin. It was found that the simplified model had a satisfied calculation speed and the relative errors were under 13% in total situations, which was acceptable for the integral code. Besides, it was shown that the completely iterative calculation model had smaller relative errors, which was under 11%. In addition, this paper also investigated the effects of some parameters on the heat transfer coefficient for these different models, the velocity of the bulk of gas, length of surface, pressure of the gas and mole fraction of air were selected and studied separately.


Abstract. Herein, we present the description of the Mechanism of Intermediate complexity for Modelling Iron (MIMI). This iron processing module was developed for use within Earth system models and has been updated within a modal aerosol framework from the original implementation in a bulk aerosol model. MIMI simulates the emission and atmospheric processing of two main sources of iron in aerosol prior to deposition: mineral dust and combustion processes. Atmospheric dissolution of insoluble to soluble iron is parametrized by an acidic interstitial reaction and a separate in-cloud reaction scheme based on observations of enhanced aerosol iron solubility in the presence of oxalate. Updates include a more comprehensive treatment of combustion iron emissions, improvements to the iron dissolution scheme, and an improved physical dust mobilization scheme. An extensive dataset consisting predominantly of cruise-based observations was compiled to compare to the model. The annual mean modelled concentration of surface-level total iron compared well with observations, but less so in the soluble fraction where observations are much more variable in space and time. Comparing model and observational data is sensitive to the definition of the average and the temporal and spatial range over which it is calculated. Through statistical analysis and examples, we show that a median or log-normal distribution is preferred when comparing with soluble iron observations. We redefined ocean deposition regions based on dominant iron emission sources and found that the daily variability in soluble iron simulated by MIMI was larger than that of previous model simulations. MIMI simulated a general increase in soluble iron deposition to Southern Hemisphere oceans by a factor of two to four compared with the previous version, which has implications for our understanding of the ocean biogeochemistry of these predominantly iron limited ocean regions.


The biological and geological research programme for James Cook cruise 36 was built around
a series of ROV video transects to determine variations in species and community structure and
composition in different geological and topographic settings down the canyon. ROV transects
were planned to undertake detailed studies of recognised biological hotspots on both hard and
soft substrates, to collect specimens for taxonomic studies, including molecular genetics, and to
carry out biological experiments, including the use of in situ incubation chambers and tracer
feeding experiments to study the physiology of deep-water fauna. Additional coring, CTD and
water column particulate sampling programmes were planned to investigate the recent
geological history of the canyon, and, in particular, to investigate whether significant sediment
is currently accumulating in any part of the canyon, to sample macro- and meiofauna in areas
of soft substrate, and to investigate the fate of organic carbon in the canyon.
JC36 was highly successful. The cruise built on the successful mapping of the canyon, using
swath bathymetry and 30 kHz sidescan sonar, undertaken during JC35. The main
achievements of JC36 included the completion of 26 ROV dives, totalling 340 hr. Seafloor
video and photographs along 12 transects from the eastern and western canyon branches
between 500 and 3600 m waterdepth were collected. A collection of over 240 biological
specimens was collected to verify species identification from the video transects. Pushcores for
sedimentology, organic geochemistry, biology and microbiology were also collected. Ultra
high-resolution swath bathymetry of the canyon floor using the multibeam system mounted on
the ROV was collected on 8 dives. A total of 10 dives were dedicated to placing, initiating and
recovering a variety of biological experiments on the seafloor, mainly to examine respiration
rates of individual animals or animal communities.
The coring programme completed 19 successful piston core stations and 29 successful
megacore stations. Most of the latter were processed for macrofauna and meiofauna but some
were subsampled for sedimentology and geochemistry. A preliminary assessment suggests that
most of the sediment recovered is late glacial in age, and that little Holocene sediment has been
deposited in the canyon.
6 CTD profiles and 5 SAPS (stand-alone pump) stations were completed to characterise the
suspended particulate matter above the canyon floor. A total of 30 pushcores and megacores
also sampled for organic geochemistry.


Previous studies have shown that in lipopolysaccharide (LPS)--stimulated human monocytes, interleukin-1 (IL-1) production is altered by quinoline derivative antibiotics (quinolones), in a way which depends both on the dose and on the agents used. Given that IL-1 and tumor necrosis factor alpha (TNF) are produced in response to LPS and have some overlapping and synergistic activities, we sought to determine if TNF production was altered under the above-mentioned conditions. We investigated the effects of three quinolones: ciprofloxacin (Cip), pefloxacin (Pef) and ofloxacin (Ofl). These quinolones were found to decrease extracellular TNF production in a dose-dependent manner at concentrations higher than 25 micrograms/ml as previously described by our laboratory with regard to IL-1 production. Moreover, the order of the extracellular decrease in TNF and IL-1 induced by each drug was similar. However, in contrast to IL-1 activity, the quinolones studied also reduced cell-associated TNF. The kinetics of TNF production suggested that the quinolones affected TNF production at a very early step, probably during TNF synthesis rather than during its secretion into the extracellular medium. Furthermore, the quinolone-induced accumulation of intracellular cAMP could explain the extracellular decrease in both IL-1 and TNF production.


Cell refractive index has been used to monitor peroxisome behaviour in the yeast Hansenula polymorpha by means of flow cytometry. Peroxisomes are inducible organelles which may occupy a large fraction of the cell volume when yeast cells are growing in methanol media. These organelles harbour a catalase that decomposes the hydrogen peroxide produced in methanol oxidation by alcohol oxidase, a peroxisomal enzyme whose subunits are arranged to form a regular crystalloid. Peroxisomes undergo a degradation process mediated by vacuoles whenever they and their enzymes become metabolically redundant (e.g. during growth on glucose). Flow cytometric analyses of side scattered light (depending on cell volume, morphology and structure) and fluorescein isothiocyanate retention (due to the vacuole) were made on two wild-type strains of H. polymorpha during exponential growth in glucose and methanol media and during nutritional shifts from one carbon source to the other. The same parameters were also analysed for a mutant strain only partially repressed by glucose. We show that both the parameters are substrate-dependent and appear to reflect peroxisome development in the cells. The data reported correlate well with the known cytological and biochemical data, showing the possibility of using flow cytometry, a fast and sensitive technique, to analyse the dynamics of peroxisome proliferation and degradation in response to environmental as well as genetic factors.


Estrogens control cell growth and viability in target cells via an interplay of genomic and extragenomic pathways not yet elucidated. Here, we show evidence that cell proliferation and survival are differentially regulated by estrogen in rat pituitary tumor PR1 cells. Pico- to femtomolar concentrations of 17beta-estradiol (E2) are sufficient to foster PR1 cell proliferation, whereas nanomolar concentrations of the same are needed to prevent cell death that occurs at a high rate in these cells in the absence of hormone. Activation of endogenous (PRL) or transfected estrogen-responsive genes occurs at the same, higher concentrations of E2 required to promote cell survival, whereas stimulation of cyclin D3 expression and DNA synthesis occur at lower E2 concentrations. Similarly, the pure antiestrogen ICI 182,780 inhibits estrogen response element-dependent trans-activation and cell death more effectively than cyclin-cdk activity, G1-S transition, or DNA synthesis rate. In antiestrogen-treated and/or estrogen-deprived cells, death is due predominantly to apoptosis. Estrogen-induced cell survival, but not E2-dependent cell cycle progression, can be prevented by an inhibitor of c-Src kinase or by blockade of the mitogen-activated protein kinase kinase/extracellular signal-regulated kinase signaling pathway. These data indicate the coexistence of two distinguishable estrogen signaling pathways in PR1 cells, characterized by different functions and sensitivity to hormones and antihormones.


Ferritic stainless steels were exposed to electrochemical polarization tests in 1N sulfuric acid solution. Some critical parameter to uniform corrosion, as critical intensity (Icr), passive intensity (Ip) and corrosion rate (Vcorr), were determined from the polarization tests. To understand uniform corrosion behavior of this family of stainless steel, a new equation has been determined taking the most relevant elements (Ni, Cr, Mo and N) into account. An excellent correlation between predicted and experimental results was obtained. The development of the new equation is really useful to simulate the relation between the uniform corrosion and the chemical composition in a defined Ferritic Stainless Steel.


In the traditional fuzzy logic, we can use "and"-operations (also known as t-norms) to estimate the expert's degree of confidence in a composite statement A&B based on his/her degrees of confidence d(A) and d(B) in the corresponding basic statements A and B. But what if we want to estimate the degree of confidence in A&B&C in situations when, in addition to the degrees of estimate d(A), d(B), and d(C) of the basic statements, we also know the expert's degrees of confidence in the pairs d(A&B), d(A&C), and d(B&C)? Traditional "and"-operations can provide such an estimate – but only by ignoring some of the available information. In this paper, we show that, by going beyond the traditional "and"and "or"-operations, we can find a natural estimate that takes all available information into account – and thus, hopefully, leads to a more accurate estimate.


Abstract Sudden death due to diaphragmatic hernia in an adult is exceptionally rare. A 43-year-old man was found dead by his cohabiting mother, lying supine on the floor in his house. He had complained of epigastric discomfort for 1 month, and respiratory symptoms occurred 1 day before his death. He had no history of trauma. Postmortem computed tomography scan revealed the enlarged fluid-filled stomach herniated into the left pleural cavity, compressing the left lung with a mediastinal shift to the right. At autopsy, the left pleural cavity was occupied by herniated abdominal contents with mediastinal shift. The herniation of the stomach, the whole spleen, a portion of the colon, and omentum into the left pleural cavity had occurred through a smooth oval 9 × 5-cm defect in the posterolateral part of the light diaphragm. The stomach was markedly distended and contained 1600 mL of yellowish brown liquid with food residue. Ischemic changes of the herniated organs were not observed. Death was attributed to respiratory failure from abdominal viscera herniation into the left pleural cavity.


Requirements today for machines have moved beyond functionality intoefficiency and reliability, gears are no exception. The presented work focuseson the analysis of the measurement, evolution and effect of running-in on geardrives from a surface roughness and efficiency point of view. With no consen-sus on a definition or observation of running-in of gear drives, measurementsof both efficiency and surface transformation during the predefined running-inis explored. A verified methodology on how to separate form, waviness androughness is presented. Two finishing methods, namely generation groundand superfinished, are analyzed in terms of efficiency and surface characteris-tics as manufactured, after running-in and after efficiency testing in order todetermine the effects of load level during running-in.Results show that separation of form can be achieved with a carefullychosen polynomial, while waviness is more subject to how the user definesa cut-off wavelength for the surface roughness. Ground gears show distinctsmoothening in terms of surface roughness at high running-in load, and nogeneral trend for low load. This behavior is also reflected in the efficiencysince higher loads gave overall lower efficiency after running-in when com-pared to lower loads. Superfinished gears in contrast show no running-in ef-fects in terms of efficiency. Additionally, ground gears exhibit general changein friction and surface roughness during the first cycles of running-in whenanalyzing high load. Overall gains in efficiency can be obtained from running-in; however, at most speeds improvements from polishing a surface, in thiscase superfinishing, proved to lead to higher efficiency.


ObjectiveThe transanal mucosectomy of the aganglionic segment is a critical step in the transanal endorectal pullthrough procedure for the treatment of Hirchsprung's disease. It exerts considerable traction on the anorectal tissue during dissection. Anal sphincter electromyography (EMG) is an indispensable parameter for the diagnosis of patients with any anorectal dysfunction.The aim of our study was to assess the integrity of the anorectal sphincter after transanal endorectal pullthrough using anal EMG. MethodsThis prospective study was carried out on 25 infants and children with Hirchsprung's disease who underwent the endorectal pullthrough (soave) procedure. Needle EMG was used to assess the sphincter preoperatively and postoperatively. ResultsPreoperative EMG showed positive neuropathic changes in 28% of the patients. Postoperative EMG showed neuropathic changes in 60% of the patients, of whom 28% showed preoperative changes and 32% showed absolute postoperative findings, mostly related to difficult operative dissection. ConclusionThe functional results of the endorectal pullthrough procedure were acceptable overall. SignificanceThe reduced sphincter function encountered postoperatively was because of a combination of preoperative and intraoperative influences.


Adhesive bonding of joints is one of the most commonly and widely used joining methods in piping systems. This work is concerned with the investigation of the influence of the non-linear behavior of the adhesive used in such bonded joints on their performance. The parametric analysis module of ABAQUS was used to model the joint. The model facilitated the analysis of different geometric, loading and material characteristics of the system, in particular the adhesive nonlinearity, which is of prime interest in this work. By using the Ramberg–Osgood plasticity model, the failure threshold of the adhesive for various joint lengths (hereafter referred to overlap length) was characterized. The plasticity model used in this study was fine-tuned using only a limited number of known parameters, through comparison with the results of the finite element (FE) simulation. The results obtained from the FE analysis were verified by experimental results. The FE strategy is demonstrated to be an effective means for predicting the capacity of such joints, where conducting a pure shear test is either impossible or difficult to accomplish. Contrary to the findings based on the elastic finite element analysis, the plasticity analysis revealed that the overlap length affects the ultimate strength of the joint.


The Nukak are a people of hunters and gatherers in the Colombian Amazon who call themselves Nukak baka', which can be translated as 'the true people'. More than a name, this denomination designates a shared moral and political project that enables this people to reproduce themselves materially and socially, to guide their individual conduct, to perpetuate and fertilize the cosmos and to steer their relationships with the other peoples of the universe. In this sense this project constitutes a biopolitics, or to put it differently, it is a politics oriented toward the creation and defense of life. This thesis, therefore, is an ethnographic research about what it means for the Nukak to live as a 'true people'. It shows that such a common project constitutes above all a set of practices that is continuously being actualized, both in terms of individual conduct as well as in terms of collective interactions and activities. These become materialized in aspects such as the preservation of the environment and the construction, and care, of the body. For that reason living as 'true people' is neither a given condition nor a status that once attained can be maintained until death. Being an incomplete process, for the Nukak the constitution of 'true people' is continuously under threat. This means that their reproduction and the continuity of the universe is always at risk. These threats originate in actions, emotions and amoral attitudes of the Nukak themselves, or of other beings in the cosmos, which express themselves in situations such as illness or inter-personal conflicts. As a result the everyday life of this group unfolds within a continuous tension between the actualization of the project of constituting 'true people' and the threat of biological and social extinction, even the destruction of the cosmos. From a different perspective, this thesis is concerned with practices of 'living together', of accompanying each other, of sharing, of establishing kin relations in order to strengthen the common, and of finding out what they have in common. It is also about how to deal with possible sources of division. Finally, the thesis sets out to show how this group actualizes a sense of unity and diversity that enables them to create Nukak baka, i.e. 'true people', thus articulating differences without denying them. In order to develop these topics, the thesis explores the major features of the project of creating, and living as, 'true people', as well as a number of strategies and mechanisms (or social dispositifs) that the Nukak have generated for its actualization. It also examines the ontological and mythical bearings, going back to the times of the creation of the cosmos, which enables us to understand, from the perspective of the Nukak, with what peoples and beings they are interacting. In this sense the thesis contributes to the actualization of basic ethnographic information and elaborates on Nukak's theories and practices concerning social life, the body, notions of the person, relations between kin, relations with other peoples and beings in the cosmos, shamanism, and narratives about the experiences of the ancestors who form part of their historical memory. This thesis also contributes to the documentation of the impact of the armed conflict in Colombia on the Nukak, clarifying the heterogeneity and complexity of the circumstances that have led to the forced displacement of different groups of Nukak, as well as the institutional and media attention that these groups have received.


The cricopharyngeal (CP) bar is a common radiographic finding that can cause oropharyngeal dysphagia (OPD). Treatment options include CP myotomy, which is problematic given that CP bars primarily affect elderly patients with comorbidities who are at higher risk for peri-operative complications. The aim of this study was to examine the effectiveness of endoscopic dilation in the management of dysphagia attributed to a CP bar. Review of upper endoscopic (EGD) and videofluoroscopic swallowing studies from 1999–2002 identified 32 patients with CP bars. CP bar was defined by radiology as a distinct posterior impression in the cervical esophagus inferior to the vocal cords. Six of these patients had dysphagia without any other identifiable cause aside from the CP bar. Each of these six patients underwent EGD with Savary (5) or balloon dilation (1) of the upper esophageal sphincter to a diameter of 51–60 Fr. Short- and long-term follow-up was conducted post-dilation at 1–4 weeks and 10–27 months, respectively. The median age of the 32 patients with CP bars was 63 yrs. The 6 symptomatic patients who underwent endoscopic therapy were women with median age of 62 yrs. Each of the 6 patients experienced immediate improvement in dysphagia. None of the patients developed complications of post-dilation pain, bleeding or perforation. Five patients had continued improvement of their OPD at short-term follow-up. One patient who was dilated to 51 Fr using a Savary dilator experienced return of globus sensation after 48 hours, although dysphagia and regurgitation had resolved. A second Savary dilation, one month after the initial procedure, resulted in complete elimination of symptoms at subsequent short-term follow-up. Four patients had continued complete resolution of OPD at long-term follow-up. The remaining two patients reported the recurrence of significant dysphagia after 6 and 8 months, which they stated was less severe than at initial presentation. None of the patients required surgical or endoscopic myotomy for residual or refractory dysphagia. Every patient was satisfied with the results and stated they would recommend endoscopic dilation to others with the same problem.(1) CP bar is an important cause of dysphagia that affects elderly patients. (2) Endoscopic dilation of symptomatic CP bars can produce long-term relief of dysphagia. (3) Further controlled studies are warranted to better define the efficacy and safety of endoscopic CP bar dilation as an alternative to surgical myotomy in symptomatic patients.


ABSTRACT On average, nearly 11% of the gross payroll or $5,415 is spent on medically related benefits per employee according to a United States Chamber of Commerce Survey in 2003 (U.S. Chamber of Commerce, 2003). The costs to both the employer and employee are constantly rising and debates are ongoing from conference rooms to Congress. Clearly, health insurance is an important area for employer spending and the employee. This study will discuss the different factors facing employers and employees in medical-related insurance matters. Both employers and employees should be aware the variety of health plans and the possible problems impacting this critical choice. INTRODUCTION Participants in the job market look for several factors when considering employment with a particular company. One of the most important issues, besides the salary, is the health benefit package provided by an employer. However, in today's insurance market, employers and employees are facing a crisis. Employers must recognize how heavily employees value health benefits programs. Further, it is imperative that employers and employees be aware of the factors affecting their selections. Health care costs are on the rise, as well as the number of uninsured individuals. Employers have to weigh the many insurance options while accounting for lower-income employees and future retirees. First, the study will look at a brief overview of some of the available plans. Next, the problems being faced by both the employee and employer are presented along with statistics that provide a image of the current situation. Following will be findings on methods employers are using to weather the health care crisis and other methods for employees to overcome the inherent problems. A brief summary and conclusion highlight the main points of the study. LITERATURE REVIEW Very few articles have been written on this subject as it is currently. The available articles emphasized only one particular factor related to this issue in their study. Elswick (2003) studied compensation-based premiums and profiled companies that are more likely to benefit from their use. She also described several well-known companies and their use of the premium program. Geisel (2002a, 2002b) highlighted the troubles with retiree health plans and emphasized the need for employers to support the economy by offering future retirees some variation of a health plan. Harwood (2002) also contributed information about the importance of offering health care coverage to employees. Economic factors and statistical data are presented along with the discussion. Another important work by Greenwald (2003) offers enlightenment in consumer-driven health plans by describing the implementation, advantages, and disadvantages of those plans. Finally, Trombly (2003) discussed various problems with health care, specifically in the distributing industry. However, his information is relevant across other industries. Definitions The following terms and phrases are used throughout the study. Indemnity - This was once the most common form of health insurance where the employee may use any doctor or hospital at any time and must pay a "reasonable and customary" charge for such services. Health Maintenance Organization (HMO) - Usually the least costly option for employers, it is basically a prepaid health plan providing comprehensive care for a monthly premium. The insured is limited to participating doctors and hospitals, and the plan requires the designation of a primary care provider. Primary Care Provider (PCP) - A doctor that is specified by the insured individual to provide service. All referrals to specialists are handled through the PCP. Most insurance plans have a restricted list of physicians. Preferred provider organizations (PPO) - Similar to an HMO with pre-negotiated rates with health care providers, but with higher premiums. …


The effect of chemical composition of the sintering atmosphere on the density, microstructure and mechanical properties of Fe-3%Mn-(Cr)-(Mo)-0.3%C is described. Pre-alloyed Astaloy CrM and CrL, ferromanganese and graphite powders were the starting powders. Following the pressing in rigid dies, compacts (green density approx. 6.8-7.1 g/cm3) were sintered at 1120 and 1250°C in atmospheres with different H2 and N2 content. The dew point of the sintering atmospheres was below -60°C. Subsequently samples were furnace cooled to room temperature. Tensile and transverse rupture strengths, elongation, R0.2 yield offset, impact toughness and apparent surface hardness were examined. Following the mechanical tests, to investigate microstructure optical microscopy was employed. As the results show, sintering in nitrogen-rich atmospheres allow to achieve comparable properties of the specimens with those of the specimens sintered in hydrogen-rich atmosphere. It means that it is possible to produce sintered Fe-Mn-Cr-Mo-C PM steels in safe and cheaper nitrogen-rich atmosphere.


INTRODUCTION
The reversal of hypogonadotropic hypogonadism (HH), occurring after discontinuation of testosterone therapy in adolescents with delayed puberty and in a small percentage of adults with congenital HH, suggests a role for androgens in favoring a spontaneous recovery of reproductive function.

AIM
We investigated the effect of androgens and leptin on gonadotropin-releasing hormone (GnRH) expression and secretion in human GnRH-secreting neuroblasts (FNC-B4).

METHODS
Quantitative real-time polymerase chain reaction RT-PCR for mRNA expression and radioimmunoassay for GnRH secretion were used. Immunohistochemical studies assessed GnRH protein expression. FNC-B4 migration was analyzed with multiwell Boyden chamber technique.

MAIN OUTCOME MEASURES
Effects of the non-aromatizable androgen dihydrotestosterone (DHT) and leptin in FNC-B4 were tested after 24 and 48 hours.

RESULTS
Exposure to increasing concentrations of DHT after 24 hours significantly stimulated GnRH mRNA in FNC-B4. This effect was still present after prolonged exposure (48 hours). Similarly, treatment with leptin significantly induced GnRH mRNA after 24 hours, but not at 48 hours. Interestingly, mRNA for leptin receptors (LEPR) was significantly reduced after 48 hours of leptin, while, at this time point, it was stimulated by DHT. Coincubation for 48 hours with leptin and DHT maintained the stimulatory effect on both GnRH and LEPR mRNA, suggesting that DHT could stabilize the leptin effect by preventing downregulation of LEPR. Similar results were obtained for GnRH protein expression analysis. Moreover, both DHT and leptin increased GnRH release into the culture medium. We also found that DHT or leptin treatment significantly increased FNC-B4 basal migration. As we previously found that GnRH stimulates FNC-B4 migration, we hypothesized that this effect could be mediated by DHT- and leptin-induced GnRH release. Accordingly, the GnRH antagonist cetrorelix inhibited DHT- and leptin-induced migration.

CONCLUSION
Our results suggest that androgens (adequate hormonal status) could have a positive effect on GnRH neuronal activity by synergizing with leptin (adequate energy status) in the regulatory mechanisms required for reproductive and sexual fitness.


Abstract Background: Ovarian carcinoma represents one of the most insidious and aggressive cancers. Ovarian carcinoma is the most lethal gynecological malignancy. To discover new relevant biomarkers to increase specificity and sensitivity for early diagnosis and prognosis of ovarian cancer is important and urgently needed. FOXO3a possesses a large series function including cellular proliferation, transformation, differentiation, and longevity. Jab1 is also known as subunit 5 (CSN5) of the COP9 signalosome (CSN), a multifunctional protein complex involved in modulating signal transduction, gene transcription, and protein stability. Objective: To investigate the importance of FOXO3a and Jab1 in ovarian cancer. Method: Immunohistochemical analysis was performed on formalin-fixed paraffin sections of 46 specimens. Statistical analysis was conducted using the Stat View 5.0 software package. Result: We found that Foxo3a expression correlates significantly with FIGO disease stage (p < 0.05) and lymph node involvement. Jab1 expression correlates significantly with disease stage and lymph node involvement (p < 0.05). A multivariate Cox proportional hazard model showed that Foxo3a and Jab1 were the strongest independent predictors of survival (p < 0.05), the second predictor being FIGO disease stage and lymph node involvement. Conclusion: Understanding the precise role of Jab1 and Foxo3a in ovarian cancer progression will not only increase our knowledge of the biology of ovarian cancer but may also enable development of an novel therapeutic strategy via suppression of Jab1.


Abstract Careful measurements of phase velocities in the Canadian shield have been made in the period range 3 to 90 sec for Rayleigh waves and 12 to 60 sec for Love waves by phase correlation of wave trains. The continental Love wave phase velocity data are the first to be reported in the literature. The phase and group velocities are higher than yet found in any other continental area, indicating relatively higher shear velocities in the crust and upper mantle. For paths in the Canadian shield a prominent Lg arrival with a velocity of about 3.65 km/sec is observed and an Sn arrival is recorded clearly to distances of about 4000 km with a velocity of about 4.72 km/sec. A theoretical layered model of the crust and upper mantle consistent with the various types of data has been derived by an inversion method employing least-squares curve-fitting of phase velocity data. This model has a three-layered crust 35.2 km thick with shear velocity increasing to about 3.85 km/sec in the lower crust. The upper mantle has a high speed layer with shear velocity 4.72 km/sec down to about 115 km below which the low velocity channel has a shear velocity of about 4.5 km/sec down to a depth of about 315 km. At greater depths the shear velocity closely follows the Gutenberg model. Higher mode phase velocity dispersion curves computed from the theoretical model are used for computing theoretical seismograms for the Canadian shield. These theoretical seismograms possess many of the features of the observed Lg arrivals, showing that Lg can be explained by normal mode wave propagation in a simple, layered crust. This paper shows that new methods of measuring and interpreting surface wave dispersion, combined with travel time data, can provide detailed and reliable information on shear wave velocity distribution down to depths of a few hundred kilometers in regions of horizontally uniform structure.


Objective: Although unwanted intrusive thoughts (UITs) generally have been studied with obsessive-compulsive disorder (OCD), transdiagnostic model of anxiety disorders proposed UITs can be seen in a variety of the disorders including eating disorders (EDs), body dysmorphic disorder (BDD), and hypochondriasis (HYP) instead of being OCD-specific. The aim of the study was to adapt The Questionnaire of Unwanted Intrusive Thoughts (QUIT) developed to evaluate several characteristics of the UITs in OCD, EDs, BDD and HYP into Turkish and to examine its psychometric properties. Methods: The sample was composed of 259 non-clinical university students. Having psychiatric illness within the past six months was an exclusion criterion, and the final analyses were conducted with 237 participants. Results: QUIT examines the UITs with three different criteria: frequency, discomfort and control/ appraisal strategies used for most distressing UITs. Reliability analyses indicated the internal consistencies were 0.84, 0.81 and 0.85 for obsessions; 0.91, 0.90 and 0.86 for physical appearance; 0.91, 0.90 and 0.88 for diet and physical exercise, 0.87, 0.85 and 0.89 for health related UITs, respectively for frequency, discomfort and control/ appraisal strategies. Confirmatory factor analyzes for all UIT contents' revealed original version of control/appraisal strategies part with 14 items and 5 subscales works at the desired level in Turkish sample. The validity analyses indicated that Turkish version of the QUIT had satisfactory convergent, divergent and criterion validity values. Conc-lusion: Psychometric properties of the Turkish version of the scale meet the criteria of being valid and reliable and therefore QUIT can be used among Turkish population.


The ruling on the Cowra abattoir case highlights the implications of the new IR rules, according to John Howe and Jill Murray WHEN an abattoir in Cowra threatened to sack 29 workers so that some of them could be rehired on lower pay and conditions, a media firestorm exploded. The Office of Workplace Services (OWS), the beefed-up federal labour inspectorate, "investigated" the Cowra situation following a telephone call from a political adviser to the Minister for Employment and Workplace Relations. The OWS then issued what was called a "ruling", which concluded that the Cowra Abattoir did not breach the Workplace Relations Amendment (Work Choices) Act 2005 because its decision was made for what the OWS said were "purely operational reasons". Incredibly, that report is not a public document, and only a media summary is available. The information on which the OWS reached this decision is also secret, so it is not possible to analyse its reasoning. This in itself marks a break with traditional labour regulation in Australia, as decisions (including reasons for decision) of the independent tribunal, the Australian Industrial Relations Commission (AIRC), are publicly available and its processes are open and transparent. The key issue here is the extent to which Work Choices expands the scope for employers to sack staff while avoiding sanctions under the unfair dismissal regimes at federal and state levels. There is no doubt the protection against unfair dismissal has been reduced. Under Work Choices, workers in firms covered by the Act with up to 100 employees can be sacked without recourse to the unfair dismissal jurisdiction of the AIRC. This means they can be sacked for any reason (they have red hair, the boss doesn't like them) or none at all, provided the dismissals are not discrimination as defined in the Act (based on sex, race, nationality, family responsibility etc). Unlawful termination of employment is still prohibited, but sackings on these grounds are uncommon, difficult to prove and expensive to prosecute. Since 1996, the commission has dealt with 50,000 unfair dismissal claims, while 147 unlawful termination cases have been heard by the Federal Court. Common law remedies for breach of contract remain, but these have virtually nothing to offer ordinary workers. Work Choices makes another important change to Australian's job security. Regardless of the size of the firm, workers who are sacked for "operational reasons" are prohibited from bringing an unfair dismissal claim. Under the Act, operational reasons are "reasons of an economic, technological, structural or similar nature relating to the employer's undertaking, establishment, service or business, or to a part of the employer's undertaking, establishment, service or business". In the parliamentary debates, the worplace relations minister Kevin Andrews said that this new provision related only to the concept of redundancy, long-recognised in Australian labour law. A redundancy occurs when the employer no longer wants the job performed by anyone, and terminates the employee for that reason. But is the new provision for "operational reasons" broader than the old concept of redundancy? And can workers who are sacked for "operational reasons" be re-employed on lower wages and conditions, as in the Cowra abattoir case? Under the pre-Work Choices law, a firm facing operational difficulties could sack staff in accordance with award or agreement provisions when the employer decided that s/he no longer wanted the job done by anyone. Redundant workers were entitled to notice and redundancy payments. In other words, the system had developed a clear definition of what was a genuine redundancy and an orderly, fair procedure that met the needs of both workers and firms. Workers could bring an unfair dismissal application to the AIRC even if their sacking was labelled a redundancy, and even if they received redundancy payouts. This was because a dismissal, even if all the redundancy obligations regarding notice and severance pay were met, could still be "harsh, unjust or unreasonable", which is the test of the unfair dismissal. It should be noted that the pre-Work Choices Act required the commission to consider whether or not there was a valid reason for the dismissal. One question it had to consider was whether or not the worker was dismissed in order to meet the operational requirements of the firm. In other words, firms which had genuinely responded to operational requirements had nothing to fear from the process. A redundancy could be unfair if the boss selected staff for redundancy on the basis of personal whim (all Collingwood supporters must go), or if the procedures were deficient (for example, if staff with many years of service were notified by email that their job had vanished). In parliament, Minister Andrews stressed the vice of "double-dipping" implicit in this overlap between the unfair dismissal regime and redundancy schemes. In fact, in the few such cases brought before it, the commission took into account the amount of redundancy payout when determining what remedies, if any, should be granted to a worker who was unfairly dismissed through the redundancy mechanism. How does the situation change after Work Choices? First, those who are sacked for reasons of genuine redundancy can no longer argue that their termination was unfair. More importantly, Work Choices means that the employer can sack without concluding that s/he no longer wants the job done by anyone. In other words, although there is no genuine redundancy, the worker sacked for the widely defined "operational grounds" has no job protection through the AIRC at all. For example, an employer may want to institute a new shift roster (say a move from three eight hour shifts to two twelve hour shifts per day). Workers who refuse to sign up for the twelve hour shifts could be sacked for operational reasons, and replaced with other workers. The meagre protection offered the sacked workers under the Act is that the AIRC is able to look into whether or not the operational reasons were genuine. Just what will constitute genuine operational reasons is not known, because the AIRC is yet to consider any applications. The OWS's Cowra ruling provides us with no insight, because of the secret nature of its investigations. The minister has warned that "sham" financial excuses will not be good enough and threatened employers with the intervention of the OWS. The capacity of the OWS to investigate any significant number of such cases is not clear. Nor is the legal effect of an OWS ruling, which is perhaps better characterised as an "opinion" or "interpretation" with no binding effect. The OWS's lack of independent status and secrecy of its methods do not bode well for the evolution of the law in this area. One possibility opened up by the broader "operational reasons" provision is that employers will capitalise on the opportunity to sack staff and rehire them on lower rates of pay and conditions. Before Work Choices, some protection was provided from employers whose reason for sacking or discriminating against staff to their detriment was to avoid giving workers the benefit of their award or collective agreement. Under Work Choices, this protection is limited to situations where the employer's "sole or dominant" reason is avoiding the award/agreement. In other words, where improving the financial standing of the firm is the most important reason, employers who sack in order to avoid the award will not be committing an offence under the Act. Once workers are legally sacked, Work Choices offers employers several pathways to re-employ them on lower pay and conditions. For example, it is legal to make signing an Australian Workplace Agreement (AWA) a mandatory condition of employment for "new" staff, which would include those legally dismissed for operational reasons. AWAs under Work Choices simply have to meet the low minimum pay and conditions standards in the Act. They operate so as to completely exclude any award or agreement binding the employer. This means that rates of pay could be lower, overtime and penalty rates removed, the protections of the collective agreement withheld and so on. Importantly, redundancy provisions won through the conciliation and arbitration systems are not part of the Work Choices statutory minima, so AWAs need not include any such protection. It is therefore legally possible that any re-employed workers will return to the firm into jobs of inferior quality. The government's argument underpinning Work Choices can be encapsulated in one phrase: any job is better than none. The government would no doubt argue that workers rehired on lower conditions are lucky to have a job at all. But, as we have argued in this article, the previous system allowed employers facing difficult economic conditions flexibility while at the same time ensuring decent trreatment of affected workers. Work Choices is drafted in such a way as to permit employers to utilise relatively minor shifts in operational matters as a reason to sack staff and rehire some or all on lower pay and conditions. This has the potential to undermine job security for workers in large enterprises. Just why this was necessary given the flexibility already in the system is a question the government has avoided answering. • John Howe and Jill Murray teach law at the University of Melbourne and Latrobe University respectively. Photo: Andrew Jeffrey


Background
 Sickle Cell Disease (SCD) is a genetic disorder caused by a single amino acid substitution in the ß-hemoglobin chain. Clinical manifestations of SCD are multisystemic and heterogeneous, with a wide range of organ damage between patients despite identical genetic mutations. The sub-phenotypes of SCD reflect damage to different organs arising from the pathophysiology of the disease. Biomarkers, such as N-terminal-pro-Brain natriuretic peptide (NT-proBNP), tricuspid regurgitant velocity (TRV), and hemolytic parameters provide readouts of the degree of different organ damage and are known risk markers. Dissecting its pathophysiology along known biological pathways has led to development of therapeutic targets, but we still do not fully understand the pathogenesis for much of the organ damage. Given the complexity of the pathophysiology of SCD that is likely to involve multiple overlapping and interacting biological pathways, an agnostic, network-based approach using gene expression data with annotated risk markers provides an attractive alternative. We assessed the plausibility of using such an approach with bilirubin levels as a phenotype. Bilirubin is a breakdown product of red blood cells (RBCs) that is measured in routine labs and a validated hemolytic and disease severity marker of SCD.
 Methods
 Using RNA-Seq data from 224 patients with SCD (80% HbSS and HbSBeta0 thalassemia combined, 15% HbSC, 5% HbSBeta+ thalassemia, and 0.4% HbSD), we performed a differential gene expression (DGE) analysis and weighted gene co-expression network analysis (WGCNA) of 12,450 genes. For the DGE analysis we used total bilirubin levels as a continuous variable for the main phenotype of interest, adjusting for age, sex, and hemoglobin genotype. We then conducted WGCNA to identify modules of genes with similar coexpression patterns, which we functionally annotated (via the ClusterProfiler R package) for interesting biological themes.
 Results
 Of the 12,450 genes, 10,604 were protein coding, and 1,560 were lncRNAs, and 286 were other non-coding transcripts. 3,509 (2,975 coding, 447 lncRNA, and 87 other non-coding) were considered differentially expressed (unadjusted p-value < 0.05) according to bilirubin level. Through the WCGNA, the genes clustered into 11 co-expression modules, representing a range of biological pathways. Four of these modules had representative eigengenes that were significantly correlated with bilirubin (p < 0.05), and we focused on 2 of these that had biologically interesting functions.
 The first module of interest (turquoise) consisted of 3,636 genes (3,371 protein-coding and 210 lncRNA) (25% differentially expressed, and 62% upregulated). Genes in this module have been associated with cellular functioning of younger RBCs, validating the presence of the significant Gene Ontology (GO) biological pathways listed in the bar graph (mitochondria gene expression, ribonucleotide processes, etc.), and aligning with expected processes as the young RBCs replace the degraded RBCs that had caused the high bilirubin. Notably, this module contained the biliverdin reductase A (BLVRA) gene (differentially expressed at p < 0.008), which reduces biliverdin to bilirubin.
 The other highlighted module (red) consisted of 914 genes (846 protein-coding and 57 lncRNA) (42% differentially expressed, and 97% upregulated). Multiple pathways in the red module were related to catabolic processes. As previously stated, bilirubin is the byproduct of hemoprotein catabolism, suggesting an interesting correlation. Additionally, this module contained 2 other pathways associated with porphyrin, which is a component of RBCs that contains the heme group and is involved in heme biosynthesis.
 Conclusion
 Taken together, these results provide interesting insights into the biological pathways driving one facet of sickle cell disease's many clinical manifestations.
 Figure 1

 No relevant conflicts of interest to declare.


Purpose: P-cadherin is a membrane glycoprotein that functionally mediates tumor cell adhesion, proliferation, and invasiveness. We characterized the biological properties of PF-03732010, a human monoclonal antibody against P-cadherin, in cell-based assays and tumor models. Experimental Design: The affinity, selectivity, and cellular inhibitory activity of PF-03732010 were tested in vitro. Multiple orthotopic and metastatic tumor models were used for assessing the antitumor and antimetastatic activities of PF-03732010. Treatment-associated pharmacodynamic changes were also investigated. Results: PF-03732010 selectively inhibits P-cadherin–mediated cell adhesion and aggregation in vitro. In the P-cadherin–overexpressing tumor models, including MDA-MB-231-CDH3, 4T1-CDH3, MDA-MB-435HAL-CDH3, HCT116, H1650, PC3M-CDH3, and DU145, PF-03732010 inhibited the growth of primary tumors and metastatic progression, as determined by bioluminescence imaging. Computed tomography imaging, H&E stain, and quantitative PCR analysis confirmed the antimetastatic activity of PF-03732010. In contrast, PF-03732010 did not show antitumor and antimetastatic efficacy in the counterpart tumor models exhibiting low P-cadherin expression. Mechanistic studies via immunofluorescence, immunohistochemical analyses, and 3′-[18F]fluoro-3′-deoxythymidine–positron emission tomography imaging revealed that PF-03732010 suppressed P-cadherin levels, caused degradation of membrane β-catenin, and concurrently suppressed cytoplasmic vimentin, resulting in diminished metastatic capacity. Changes in the levels of Ki67, caspase-3, and 3′-[18F]fluoro-3′-deoxythymidine tracer uptake also indicated antiproliferative activity and increased apoptosis in the tested xenografts. Conclusions: These findings suggest that interrupting the P-cadherin signaling pathway may be a novel therapeutic approach for cancer therapy. PF-03732010 is presently undergoing evaluation in Phase 1 clinical trials. Clin Cancer Res; 16(21); 5177–88. ©2010 AACR.


BCR-ABL tyrosine-kinase inhibitors are the first-line therapy for the majority of patients with chronic myelogenous leukemia (CML). Up to 20% of patients who have imatinib-treated CML in blast crisis (BC) experience a relapse in the central nervous system (CNS) due to the poor penetration of the drug by the blood-brain barrier. The present case reports a successful experience of using dasatinib-based combination therapy to treat a 22-year-old female who presented with initial symptoms of intermittent fever and easy bruising under the diagnosis of CML in BC. Although the patient eventually succumbed to profound sepsis, the CNS involvement was treated successfully using dasatinib-based combination therapy (cranial radiation and de-escalated intrathecal chemotherapy). This case demonstrates that dasatinib may be a viable option for those who are not medically fit for or are otherwise unwilling to receive high-dose chemotherapy. It appears that dose intensity is essential for optimal efficacy and should be maintained at 150 mg daily as far as possible.


We propose a new alternative to the Weakly Interacting Massive Particle (WIMP) paradigm for dark matter. Rather than being determined by thermal freeze-out, the dark matter abundance in this scenario is set by dark matter decay, which is allowed for a limited amount of time just before the electroweak phase transition. More specifically, we consider fermionic singlet dark matter particles coupled weakly to a scalar mediator S3 and to auxiliary dark sector fields, charged under the Standard Model gauge groups. Dark matter freezes out while still relativistic, so its abundance is initially very large. As the Universe cools down, the scalar mediator develops a vacuum expectation value (vev), which breaks the symmetry that stabilises dark matter. This allows dark matter to mix with charged fermions and decay. During this epoch, the dark matter abundance is reduced to give the value observed today. Later, the SM Higgs field also develops a vev, which feeds back into the S3 potential and restores the dark sector symmetry. In a concrete model we show that this "vev flip-flop" scenario is phenomenologically successful in the most interesting regions of its parameter space. We also comment on detection prospects at the LHC and elsewhere.


Prior studies mainly concern the function, practice, content and relevance of the shift report. When it comes to care in the shift report no scientific literature were found. The authors of this study consider care to be just as important as medicine in the patient care. The aim of this study is to shed light on care in the nurse-to-nurse shift report. An observational study was carried out in six divisions at a hospital. The data was recorded on tape to be transcribed, analyzed and interpreted. The results imply, through categorization into six main themes and ten sub themes, that care is evident during the nurse-to-nurse shift report. Patient's condition and which actions the nurses had executed were reported, as well as what the nurses, who were about to start their work shift, had to perform and keep in mind. The information being shared in the nurse-to-nurse shift report is in this study interpreted as care seeing that it make a good patient care possible.


We assessed the effect of ketoprofen and prednisolone on the complement receptors (CR1 and CR3) and Fc gamma RIII expression on polymorphonuclears in an ex vivo study, using a randomized, single-blind, placebo-controlled, parallel design. Twenty-four healthy, male, Caucasian volunteers received either oral ketoprofen 100 mg twice daily, or prednisolone 5 mg twice daily, or placebo twice daily for 7.5 days. CR1, CR3 and Fc gamma RIII on unstimulated and FMLP-, C5a-, LTB4-, and GM-CSF-stimulated neutrophils were assessed using specific monoclonal antibodies and flow cytometry. No statistically significant drug effect was found for CR1, CR3, and Fc gamma RIII expression on polymorphonuclears. An in vitro study also yielded negative results. These findings do not support the hypothesis that the effect of non-steroidal antiinflammatory drugs on neutrophils is due to CR1, CR3, or Fc gamma RIII modulation.


Earthquakes constitute among the most feared natural hazards and these occur with no warning which can result in great destruction and loss of lives, particularly in developing countries. One way to mitigate the destructive impact of such earthquakes is to conduct a seismic hazard assessment and take remedial measures. This article aims at demonstrating significant contributions in the field of seismic zonation and microzonation studies in the Indian subcontinent. The contributions in the field of earthquake hazard have been very valuable and beneficial not only for science but also for society. The historical seismicity and seismic zonation studies as well as the present scenario of seismic hazard assessment in the Indian subcontinent, whether through probabilistic or deterministic approaches, are discussed. It has been found that many parts of the Himalayan region have peak acceleration values exceeding 0.6g. The epicentral areas of the great Assam earthquakes of 1897 and 1950 in northeast India represent the maximum hazard with acceleration values reaching 1.2–1.3g. The peak velocity and displacement in the same region is estimated as 120–177 cm s−1 and 60–90 cm, respectively. To mitigate seismic risk, it is necessary to define a correct response in terms of both peak ground acceleration and spectral amplification. These factors are highly dependent on local soil conditions and on the source characteristics of the expected earthquakes. This article will also present the findings of site-specific hazard assessment in megacities.


Generic guidance on the withdrawal of sheltering, withdrawal of evacuation and evacuation of sheltered populations (displacement) has been developed based on previously unpublished work in the UK and France and on input from stakeholder panels in Germany, Belgium, France and the UK. The guidance is a living document that can be developed further in the future, both in its generic form and also as customised versions in some Member States. The guidance outlines the many factors which influence the withdrawal of emergency countermeasures: official confirmation that any release has stopped; adequacy of monitoring data; radiological criteria; radiological protection advice; availability of resources; social and psychological needs; stakeholder dialogue; and communication strategy. The relative importance placed by decision makers on each of these criteria would vary according to the nature and scale of the accident and also on socio-political, economic and cultural perspectives. In the event of a radiological incident, decision makers will need to be in a position to construct a strategy for managing the withdrawal of emergency countermeasures. For larger scale, longer duration releases involving several nuclides, a management strategy is likely to be complex. The guidance therefore includes a series of checklists which have been developed in conjunction with stakeholders to take into account the main criteria and factors which should be considered.


UNJUST SENSE If you are interested in the social determinants of health and have not yet heard of The Health Gap: The Challenge of an Unequal World you might be in for a treat. It is written by Sir Michael Marmot, a Professor of Epidemiology and Public Health. He provides the well-reasoned argument for fairer societies. It is difficult not to be won over by this scientific yet emotive book; his 'evidencebased optimism' is quite catching. Whether it was subliminally intended or not, by the time I reached the end of the book, the image of a standing ovation had sprung to mind. Fairly early in the book he states that, 'Health is too important to be left solely to doctors.' As a GP, I was about to feel disheartened but then part of me was relieved and wanted to read more. He next takes you on a journey, meeting disadvantaged individuals from around the world and then places them in a much larger context of facts, figures, and evidence. He observes that, the poorer the area, the worse the life expectancy. Glasgow, for example, has a 20-year difference in average life expectancy between two areas (one rich, one poor) just miles apart. And if you ignore the extremes of social class and look at people in the middle, their life expectancies are, well, somewhere in the middle. I think to myself, yes, this all makes unjust sense. However, he then explains that nearly everyone in the UK has access to free medical care, schooling, and clean water supplies. Food is affordable and healthy lifestyle advice is readily available. He leaves the reader in suspense with the question, if it is not medical health care or even good public health, then what is creating 'the health gap'? In response, he presents a chapter on empowerment. He describes three types of empowerment: material, psychosocial, and having a voice (political). When people lack finances, opportunities, and structure to their lives they become disempowered and make choices that are perhaps less healthy, even if they know it is bad for them. He believes if people had fair conditions in which they are born, grow, work, live, and age, it would give them the freedom to make healthier decisions and engage in new positive challenges. What is interesting about the author is his refusal to take a one-sided political stance. Despite coming to conclusions about how society should be organised, he is quite assertive in telling us that the book is based on evidence and facts. He wants to appeal to all parties, because the health of society should be on every political agenda. However, I feel some political parties might be more enthusiastic about his strategies than others. I do like Marmot's vision. He remains firmly optimistic for the future and I think that is what people like about him. His reports nationally and globally have already led to action and he is keen to keep moving things forward. In his final chapter he talks of everyone working together so that we can achieve great things and makes reference to moving mountains. Some might find it a bit cheesy, but I think it is an important point. Clichéd ideas are fine when they are backed with science and evidence. I finished the book feeling he really does reach out to many. He makes simple points from complex evidence, with positive results.


The influence of acetylsalicylic acid (ASA) on the elimination of trichloroacetic acid and trichloroethanol in the urine, liver and kidney of cytochrome P-450-dependent monooxygenase systems in rats exposed to trichloroethylene (TRI) vapours were examined. The obtained results show that acetylsalicylic acid decreased the elimination of both trichloroethylene metabolites and induced cytochrome P-450 concentration in the liver, whereas slightly inhibited cytochrome b5 and activites of NADPH-cytochrome P-450 reductase and NADHcytochrome b5 reductase. After mixed exposures, acetylsalicylic acid elevated cytochrome P-450 concentration and NADPH-cytochrome P-450 reductase activity to values observed in the control group. The concentration of cytochrome b5 was much lower than after ASA or trichloroethylene alone. The activity of NADPH-cytochrome P-450 reductase was strongly inhibited by TRI, whereas in ASA the presence was elevated, but was still lower than in control. Acetylsalicylic acid stimulates cytochrome P-450; however, other compounds of the MFO system do not react positively on this ester.


Using the title almost as a stage direction, that could invite a thematic to anyone who chooses to take one up, the artists Cullinan Richards and Katrin Plavcak, open the scene [exhibition] with a propositional stage that is aligned with the season – Autumnal, hunting activity etc with all the colours and smells associated with the outdoors and the danger of the hunt implied. STAG is a title that incorporates and stages uncertain events, unstable colours, the unfixed and any painting performances that might happen and in so doing leaves the door open for the possibility that all the paintings have just left the building. After all the desire is in a belief and willingness to participate.


Hemoglobin (Hb) is one of the most common conserved molecules found in organisms belonging to all major kingdoms of life. Chironomid midge larvae are unique among the invertebrates being the only free-living group of organisms possessing extracellular hemoglobins (Hbs) in monomeric and dimeric forms floating in their hemolymph. Remarkable ability of individual species of chironomid midges to tolerate wide range of environmental stressors prevailing in their respective ecosystems has enabled chironomids to sustain as one of the most widely distributed insects in the world. Ability of different Chironomus spp to thrive under extreme hypoxic conditions as well as in the presence of chemical pollution made chironomid midges an efficient model system to assess the effect of environmental stress in different freshwater ecosystems. The modulation of Hb concentration has been found to be a function of different type of abiotic stressors and thus Hb of chironomid midges (Ch-Hb) has attracted the attention as a potential biomarker for environmental biomonitoring. Large body of literature on Ch-Hb accumulated mainly during sixties to eighties of twentieth century has enriched our understanding of its physiological, developmental and biochemical features. Empirical as well as in-silico studies carried out in recent years provided insights into many structure-function relationships of Ch-Hb. However, for the last few decades, majority of the studies were carried out to project and validate Ch-Hb as potential bioindicator for evaluating toxicants, chemical pollutants and environmental gradients of dissolved oxygen concentration. In this review, historical development of the subject has been compiled with notes on future implications of contemporary studies on Ch-Hb.


ABSTRACT l-(−)-Azetidine-2-carboxylate (AC) is a toxic, natural product analog of l-proline. This study revealed the genes and biochemical strategy employed by Pseudomonas sp. strain A2C to detoxify and assimilate AC as its sole nitrogen source. The gene region from Pseudomonas sp. strain A2C required for detoxification was cloned into Escherichia coli and sequenced. The 7.0-kb region contained eight identifiable genes. Four encoded putative transporters or permeases for γ-amino acids or drugs. Another gene encoded a homolog of 2-haloacid dehalogenase (HAD). The encoded protein, denoted l-azetidine-2-carboxylate hydrolase (AC hydrolase), was highly overexpressed by subcloning. The AC hydrolase was shown to catalyze azetidine ring opening with the production of 2-hydroxy-4-aminobutyrate. AC hydrolase was further demonstrated to be a new hydrolytic member of the HAD superfamily by showing loss of activity upon changing aspartate-12, the conserved active site nucleophile in this family, to an alanine residue. The presence of a gene encoding a potential export chaperone protein, CsaA, adjacent to the AC hydrolase gene suggested that AC hydrolase might be found inside the periplasm in the native Pseudomonas strain. Periplasmic and cytoplasmic cell fractions from Pseudomonas sp. strain A2C were prepared. A higher specific activity for AC hydrolysis was found in the periplasmic fraction. Protein mass spectrometry further identified AC hydrolase and known periplasmic marker proteins in the periplasmic fraction. A model was proposed in which AC is hydrolyzed in the periplasm and the product of that reaction is transported into and further metabolized in the cytoplasm.


Foundation is an important part of a building, as it safely transmits the entire building weight down to the earth. If the foundation fails, then the entire structure is likely to collapse. the type of foundation to be adopted for a building varies from soil to soil. There are a wide variety of soils ranging from soft black cotton soils to hard rock soils. It is a difficult task for structural engineers to determine the soil type, and thereby to decide the foundation that is suitable to that soil type. Automated Assistance For Foundation Engineers(AAFE) is a tool developed to assist the structural engineers to determine the soil type based on soil properties and soil test results, and thereby to further decide about the suitable foundation. This paper aims at elaborating the tool, its development and working scenarios.


Abstract. The South Pacific Subtropical High (SPSH) is a
predominant feature of the South American climate. The variability of this
high-pressure center induces changes in the intensity of coastal alongshore
winds and precipitation, among others, over southwestern South America. In
recent decades, strengthening and expansion of the SPSH have been observed
and attributed to the current global warming. These changes have led to an
intensification of the southerly winds along the coast of northern to
central Chile and a decrease in precipitation from central to southern
Chile. Motivated by improving our understanding about the regional impacts
of climate change in this part of the Southern Hemisphere, we analyzed SPSH
changes during the two most extreme climate events of the last millennium,
the Little Ice Age (LIA) and the Current Warm Period (CWP: 1970–2000), based
on paleoclimate records and CMIP5/PMIP3 model simulations. In order to
assess the level of agreement of general circulation models, we also compare
them with ERA-Interim reanalysis data for the 1979–2009 period as a
complementary analysis. Finally, with the aim of evaluating future SPSH
behavior, we include 21st century projections under a Representative Concentration Pathway (RCP8.5) scenario in
our analyses. Our results indicate that during the relative warm (cold)
period, the SPSH expands (contracts). Together with this change, alongshore
winds intensify (weaken) south (north) of ∼35∘ S; also, southern westerly winds become stronger
(weaker) and shift southward (northward). Model results generally
underestimate reanalysis data. These changes are in good agreement with
paleoclimate records, which suggest that these variations could be related
to tropical climate dynamics but also to extratropical phenomena. However,
although models adequately represent most of the South American climate
changes, they fail to represent the Intertropical Convergence Zone–Hadley cell system dynamics, emphasizing the importance of improving
tropical system dynamics in simulations for a better understanding of its
effects on South America. Climate model projections indicate that changes
recently observed will continue during the next decades, highlighting the need
to establish effective mitigation and adaptation strategies against their
environmental and socioeconomic impacts.


10% of elderly patients are functionally dependents and they therefore
need permanent assistance. Orodental alterations may evolve into a pathological
state in elderly people, which is increasing in the recent decades. The current
study analysed institutionalized patients in the district of Bari (Southern
Italy), who have been so far monitored. We assessed 125 elderly institutionalized
patients. The assessment has been carried out by an assessment questionnaire
aiming at evaluating the patient's psychophysical health status, objective
intraoral test and prosthetic rehabilitations. About 90% of enrolled patients
reported a good general health status. The main dental problems are due to the
complete lack of specific prevention and treatment programs, together with
handicap, presence of systemic diseases and medicines taken. The level of oral
hygiene is poor and the conditions of the residual dental elements are
precarious because of root caries and periodontal problems. Prostheses are
usually old (on average 15) and appear scarcely retentive and unstable. We
believe in the need for specific interventions aiming at the various issues
emerging from the present study, so as to achieve a smaller prevalence of
dental loss, periodontal disease and caries. These relatively simple
interventions are now lacking because of the non-demand of treatment from
patients and for economical reasons.


Direct force control (DFC) with the advantages of simple structure, fast force response, superior control performance, is developed from direct torque control (DTC). So, it is attracting more attention, increasingly becoming a research hot in the control field. It is a valuable research to improve the operation stability of PMLSM by the direct force control. In this paper, based on DFC principle analysis, the force control and flux control theory of DFC is studied according to the mathematical model of PMLSM. The structure and implementation method of DFC is analyzed, and then the DFC system simulation model for PMLSM is built by Matlab/Simulink. The simulation results show the feasibility of the simulation model, with good static and dynamic performance.


The so-called Madonna dei Palafrenieri di Palazzo is one of the key works in the mature artistic production of Caravaggio and obviously was the most prestigious of his Roman commissions. In point of fact, the painting, known also as Madonna del serpe, was to be placed over the altar of the Confraternity, which commissioned it, in the renovated St. Peter's Basilica in Vatican. Today this place is decorated with a mosaic depicting Archangel Michael, based on Guido Reni's altar painting at the church of Santa Maria della Concezione in Rome.

However, for unclear reasons Caravaggio's masterpiece had been rejected by the Sacred College of Cardinals and was handed over by the Parafrenieri to the Cardinal Nephew Scipione Borghese. In this way the canvas found itself in the Villa Borghese in Rome, where it can be seen today. There the cardinal had assembled his vast art collection. An avid art collector and a powerful person, he could have made use of his position as Plenipotentiary of Justice to quickly proclaim the painter subject to a pena capitale (which meant price on his head), and thus this could have been the last painting of Caravaggio. The artist was guilty of murdering Ranuccio Tomassoni of Terni in an alleged duel. Such was the outcome of a quarrel that took place at the pallacorda, or tennis court (with four men on each side), in a space still extant at Campo Marzio.

A picture painted by an assassin could not have been exhibited on an altar in the greatest church of Christianity. In the author's opinion, that is the very reason, and a not very improbable one, why the painting had been rejected. For the cardinal (due to his own sentence, condemning Caravaggio to death), it could have also been the last work done by the artist in whom he had became interested in those years (1605—1606) and whom he commissioned to paint an official portrait of his uncle pontiff (Paul V), to be later joined by the Saint Jerome Writing.

There could not have been any other reasons, since the charges against an unorthodox iconography of the painting: the "Immaculate Conception Corredentrix" in the presence of her mother, St. Anne, the patron saint of the Confraternity, are fully unfounded. This iconography had not been codified yet. Besides, equally ungrounded were accusations addressed at the painter's choice of "Lena, who is a woman of Michelangelo [Caravaggio]" as a model for Madonna. Caravaggio had already used her before, in the Madonna of the Pilgrims (Rome, Sant'Agostino) and the strict ecclesiastical commissions had nothing to object to the statuary beauty of the Mother of God, even if in the painting for St. Peter's Lena appears in radiant beauty, full of maternal carnality. Here, there was nothing to object to, unlike in the case of the Death of the Virgin (now in Louvre), painted for the church of Santa Maria della Scala and also rejected, for moral reasons. Nevertheless, it is obvious that at the base of both rejections lay, above all, the stains of blood "at the Pallacorda, in Campo Marzio" and the ensuing, eventful escape of the badly wounded Caravaggio from Rome. Lena (most probably Elena) was the person unwittingly and indirectly reputed guilty of rejection of the St. Peter's painting. The girl was courted by the notary, Mariano Pasqualone, who perhaps also had to square accounts with Caravaggio, as the painter had attacked him with a sword shortly before, in via della Scrofa. The motif is precisely known: it was Lena about whom the criminal records do not say anything but that she had connexions with the painter and that she lived with her mother "at the foot of Piazza Navona" ["in piedi a Piazza Navona"], that is to say, at the end of the square, in a house which belonged to the Consistorial advocate Sertorio Teofili (who never received any courtesans, and Lena has many times been reputed to be one).

This place has never been indicated as such by scholars. The present explanation was made possible thanks to a happy discovery of a plan of the city showing the real property in the course of being purchased by the Pamphilj family, with the intention of erecting there, on an area occupied by many smaller edifices, a palace for the family of the newly elected pope Innocent X. On that plan (preserved in the Doria Pamphilj Archives in Rome) are clearly indicated many earlier buildings, among which also that of Sertorio Teofili, which is the reason why his house, being the home of Lena, has never been identified. The "agonal lane" which sheltered the entrance to the residence, passing from Piazza Navona to the lateral Piazza di Pasquino and Via Santa Maria dell'Anima, does not exist any more, since it had been incorporated into the complex of buildings, which nowadays are housing the Gallery of Palazzo Pamphilj, frescoed by Pietro Da Cortona.


The idea of converting Scandinavia to Christianity had been enthusiastically pursued by the Emperor Louis the Pious and Archbishop Ebbo of Rheims in the 820s. Optimism such as theirs was, however, not to last, and little progress was made between the death of Archbishop Rimbert of Hamburg-Bremen in 888 and the conversion of Harald Bluetooth a century later. This article examines how Rimbert wrote a saint's Life about Anskar, his predecessor and 'apostle of the north', in an attempt to arrest the waning support for the mission. It considers how this was achieved by placing the text in the context of the clashes between Ebbo and his successor, Hincmar, the predestination debate and the idea that mission was fulfilling apocalyptic prophecies.


Cone-beam CT has a lot of advantages such as short time reconstruction, high spatial resolution, broad irradiation and computational efficiency and so on. However, because of large area of irradiation, cone-beam CT data may process very high scatter-to-primary ratios (SPR>;2), which will result in severe cupping artifacts, streaks and CT number inaccuracies in reconstructed images. It remains difficult to remove the scatter noise from the projection data compared with that of fan-beam CT. Therefore, it is an inevitable problem that how to effectively eliminate the scatter noise in the projection data and improve the resolution of reconstructed images. As so many new correction methods have been proposed in recent years, this paper gives an overview of scatter correction and then illustrates our experiment methods for reference.


general condition for further ultrasound follow-up. A repeat scan 6 weeks later showed complete disappearance of pyometra, right uterine cavity shrunken to the normal size, no evidence of any collection in the pelvis, left cornu with an active fetus of 24 weeks. Patient's WBC level decresaed (12.0 × 10 3/uL). At present she has no complaints and continues her pregnancy follow-up. Discussion: This is probably a case of unicornuate uterus with poorly communicating right rudimentary horn that explains formation of pyohaematometra and purulent discharge from it through the cervix. MRI and HSG needed to be performed postpartum to confirm the diagnosis. Management options: No data is available as for treatment options for the above described case. The treatment was designed to allow adequate drainage of the collected pus and not to disturb coexisting pregnancy. A similar technique has been described for treatment of blood collection in the paramesonephric vaginal cyst associated with unicornuate uterus. Conclusion: Ultrasound is of great help in diagnosis of Müllerian anomalies and management of related complications. This is particularly true during the pregnancy when more invasive techniques are not feasible.


Abstract:Recent developments in literary studies that can be grouped under the umbrella term postcritique purport to restore, in our disciplinary practices, attention to affect, pleasure, and attachment, which postcritics believe the critical tradition has silenced and neglected. Postcritics depict critique as a violent hermeneutic practice of excavating a text's hidden truths. This essay claims that postcritique's understanding of critical theory is misguided and caricatural. By focusing on key thinkers of the critical tradition, particularly French philosophers, it argues that hermeneutic openness and nonmastery is a constant in many critical writings—and so is the question of pleasure. It suggests that many of postcritique's propositions, which postcritics affirm are innovative and claim critique has disavowed, have always been a recurring topic in the work of critical theorists.


Attempts were made to investigate and account for some aspects of the present status of the black-breasted lark (Melanocorypha bimaculata) as a pest of sorghum in one of the rain-fed semi-desert areas of the Sudan. Also some observations were conducted to understand the behavior and the feeding habits of the pest in relation to crop damage phenology. Problems encountered in the application of some control techniques were discussed and evaluated in order to suggest sound contr9l strategy .


This study examines the link between implementation of Strategies to Enhance Practice (STEPs) and outcomes. Twenty after-school programs (ASPs) participated in an intervention to increase children's accumulation of 30 minutes/day of moderate to vigorous physical activity (MVPA) and quality of snacks served during program time. Outcomes were measured via accelerometer (MVPA) and direct observation (snacks). STEPs implementation data were collected via document review and direct observation. Based on implementation data, ASPs were divided into high/low implementers. Differences between high/low implementers' change in percentage of boys accumulating 30 minutes/day of MVPA were observed. There was no difference between high/low implementers for girls. Days fruits and/or vegetables and water were served increased in the high/low implementation groups, while desserts and sugar-sweetened beverages decreased. Effect sizes (ES) for the difference in changes between the high and low group ranged from low (ES = 0.16) to high (ES = 0.97). Higher levels of implementation led to increased MVPA for boys, whereas girls MVPA benefited from the intervention regardless of high/low implementation. ESs of the difference between high/low implementers indicate that increased implementation of STEPs increases days healthier snacks are served. Programs in the high-implementation group implemented a variety of STEPs strategies, suggesting local adoption/adaptation is key to implementation.


A short cut review was carried out to establish whether electrical stimulation had any advantages over facial exercises in promoting recovery after Bell's palsy. Altogether 270 papers were found using the reported search, of which one presented the best evidence to answer the clinical question. The author, date, and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of this best paper are tabulated. A clinical bottom line is stated. Clinical scenario A 50 year old presents with Bell's palsy. You have heard that physiotherapy is an effective treatment but wonder whether facial exercises produce a better outcome than treatment with electrical stimulation. Three part question In [facial nerve palsy] are [facial exercises better than electrical stimulation] at improving [time to function/facial symmetry]? Search strategy Medline and CINAHL 1966–06/02, AMED 1985–04/02 using the OVID interface. Medline and CINAHL: [{facial nerve palsy.mp OR exp facial paralysis OR exp bells palsy}] AND ["trophic stimulation".mp OR exp physical therapy techniques OR "physiotherapy".mp OR exp electric stimulation/ OR exp electric stimulation therapy/ OR "electrical stimulation".mp OR electrotherapy.mp}] LIMIT to human AND English. AMED: {exp peripheral nerve disease} AND {exp electrotherapy}. Search outcome Medline and CINAHL: 253 papers were identified, AMED: 17 papers found 11 of which were relevant, but 10 papers were excluded as these described electromyographic feedback (EMG feedback training), which is not a form of electrical stimulation. The remaining paper is shown in table 1. Comment(s) No papers were found that involved physiotherapy treatment of Bell's palsy in the acute setting. The above paper describes significant differences in the outcomes used for patients with long term facial nerve palsy using electrical stimulation, however this was not a rigorous study. c CLINICAL BOTTOM LINE There is no evidence to suggest that either exercises or electrical stimulation is beneficial to patients with acute Bell's palsy. Evidence does exist to justify the use of electrical stimulation in patients with long term Bell's palsy, although the study could have been more rigorous. Farragher D, Kidd GL, Tallis R. Eutrophic stimulation for Bell's palsy. Clinical Rehabilitation 1987;1:265–71. White cell count and diagnosing appendicitis in children Report by Robert Williams, Clinical Fellow Checked by Kevin Mackway-Jones, Professor Abstract A short cut review was carried out to establish whether a single white cell count has clinical utility in the diagnosis of acute Best evidence topic reports (BETs) summarise the evidence pertaining to particular clinical questions. They are not systematic reviews, but rather contain the best (highest level) evidence that can be practically obtained by busy practicing clinicians. The search strategies used to find the best evidence are reported in detail in order to allow clinicians to update searches whenever necessary. The BETs published below were first reported at the Critical Appraisal Journal Club at the Manchester Royal Infirmary or placed on the BestBETs web site. Each BET has been constructed in the four stages that have been described elsewhere. The BETs shown here together with those published previously and those currently under construction can be seen at http://www.bestbets.org Eight BETs are included in this issue of the journal.A short cut review was carried out to establish whether a single white cell count has clinical utility in the diagnosis of acute Best evidence topic reports (BETs) summarise the evidence pertaining to particular clinical questions. They are not systematic reviews, but rather contain the best (highest level) evidence that can be practically obtained by busy practicing clinicians. The search strategies used to find the best evidence are reported in detail in order to allow clinicians to update searches whenever necessary. The BETs published below were first reported at the Critical Appraisal Journal Club at the Manchester Royal Infirmary or placed on the BestBETs web site. Each BET has been constructed in the four stages that have been described elsewhere. The BETs shown here together with those published previously and those currently under construction can be seen at http://www.bestbets.org Eight BETs are included in this issue of the journal. c Electrical stimulation and Bell's palsy c White cell count and diagnosing appendicitis in children c White cell count and diagnosing appendicitis in adults c Serum amylase or lipase to diagnose pancreatitis in patients presenting with abdominal pain c Management of acute ethylene glycol poisoning c Bed rest after lumbar puncture c Difficult intubation, the bougie and the stylet c To stab or slash: the percutaneous dilatation or standard surgical approach to cricothyroidotomy in prehospital care K Mackway-Jones Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; email@example.com 1 Carley SD, Mackway-Jones K, Jones A, et al. Moving towards evidence based emergency medicine: use of a structured critical appraisal journal club. J Accid Emerg Med 1998;15:220–2. 2 Mackway-Jones K, Carley SD, Morton RJ, et al. The best evidence topic report: a modified CAT for summarising the available evidence in emergency medicine. J Accid Emerg Med 1998;15:222–6. 3 Mackway-Jones K, Carley SD. bestbets.org: Odds on favourite for evidence in emergency medicine reaches the worldwide web. J Accid Emerg Med 2000;17:235–6. 428


ABSTRACT In this study, we explore men's perceptions, experiences, and attitudes toward wives experiencing natural menopause. We interviewed 20 men using the oral history method. Descriptive categories of experiences, such as misconceptions about menopause overcome through coexistence and recognition of women's perspectives; recognition of women's needs and efforts to provide support; coping with changes in marital relations and need to start a new time in couple's life; and existence of several needs as husbands of women experiencing menopause were explored. A better understanding by men about the changes experienced by menopausal women fosters the development of a better emotional support for their wives, which improves the quality of marital relations.


Subjects within the realm of a woman's reproductive health have been greatly debated for decades and the controversy that surrounds them does not appear to be dissipating any time soon. Thousands of articles are published annually on the topics of abortion, female sterilization, their associated ethical dilemmas, and the disparities that women face in the healthcare system. Although we have made great strides in creating an equitable healthcare system, there are still changes to be made. I would argue that women face a disproportional degree of stigmatization, bias, and unethical policy when it comes to their reproductive healthcare, and my aim is to highlight some realistic examples of what this may look like. Broadcasting these issues and encouraging others to think about them allows disparities to be more greatly recognized and thus better able to be dismantled.


In brass instruments the player's lips are used as a control valve that allows an oscillating flow of air into the instrument. The behaviour of this valve, the lip-reed, is determined by both the pressure difference across the lips and the open area between the lips. Computer simulations of brass instrument playing frequently represent the lips as an oscillating system with one degree of freedom, representing the height of the lip opening. This study aims to provide experimental evidence to determine values of an exponential coefficient q defining the area-height function for the lips of trombone players. A high speed digital video camera and transparent mouthpiece have been used to produce detailed images of the motion of the vibrating lips of a range of musicians and an artificial mouth over a large set of playing frequencies and sound levels. These images are analysed to investigate how the open area varies as a function of the height between the lips.


Use of research studies have been carried γ - alumina as an adsorbent in improving the quality of patchouli oil carried through the adsorption process flow system. Quality improvement based on analysis of patchouli oil quality parameters in accordance with SNI 06-2385-2006 about patchouli oil. These parameters include color, specific gravity, refractive index, acid value, the metal content of iron (Fe) and patchouli alcohol levels. Fe concentration measurements carried out using AAS instrument, and patchouli alcohol content measurement using GC instrument. Variations in the use of γ - alumina adsorbents include weight variation is 5, 10, 15, 20 grams and variation of flow rate is 5 and 10 drops/min. Percent increase of patchouli alcohol occurred in the use of alumina as an adsorbent as much as 10 grams with a flow rate of 10 drops / min, increase of 27.6775 %. Moreover, it has the smallest Fe metal content is 11.2201 mg / kg. Colour, specific gravity, refractive index, and levels of metals Fe after adsorption have met the quality standard patchouli oil. Keyword: patchouli oil, adsorption, γ - alumina, patchouli alcohol