Case Presentation A year old female with a past medical history of type diabetes, hypertension, congestive heart failure, coronary artery disease, strokes, myocardial infarctions, questionable history of pulmonary embolus twice, bipolar disorder, schizophrenia, and multiple asthma exacerbations presented to the Emergency Department (ED) with SOB and wheezing. Her symptoms began at home earlier that day and were not improved by bronchodilators. On arrival to the ED, she was lethargic in severe respiratory distress with laboring accessory muscle use. She had only an allergy to latex. Outpatient medications included albuterol inhaler, fluticasone/salmeterol inhaler, inhaled budesonide, furosemide, and warfarin for empiric treatment of an unidentified hypercoaguable disorder. She reported having a 15 pack year smoking history including marijuana and cocaine use up to several days prior to admission, but she denied any prior alcohol or intravenous (IV) drug abuse. Family history was non contributory. Her respiratory distress prohibited a thorough review of systems on admission, but the rest of her history was obtained through family at the time of arrival. They related that she had described some chest tightness earlier.


Three hundred physicians from Canada and abroad attended the 3rd World Congress of Medical Acupuncture and Natural Medicine held in Edmonton last summer. Speakers emphasized that physicians should view complementary health care services with an open mind and consider therapeutic options that may be used in addition to conventional medical therapy.


Context
Establishing healthy dietary practices at an early age is crucial, as dietary behaviors in childhood track to adulthood.

Objective
The purpose of this systematic review was to identify factors associated with successful nutrition education interventions conducted in children and published between 2009 and 2016.

Data Sources
Using the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines, relevant studies were identified through the PubMed, Web of Science, ScienceDirect, and ERIC (Educational Resources Information Center) databases.

Study Selection
Studies published in English between 2009 and 2016 that included a nutrition education intervention among children aged 2 to 19 years were included. Review articles, abstracts, qualitative or cross-sectional studies, and studies targeting children with special nutritional needs were excluded.

Data Extraction
Four authors screened and determined the quality of the studies using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) system and extracted the data from the articles.

Data Analysis
Forty-one studies were included: 7 targeted preschool children, 26 targeted elementary school children, and 8 targeted secondary school children. A total of 46% met their primary objectives of nutrition education intervention, while the rest either partially achieved or did not achieve their stated objectives.

Results
Successful interventions targeting school children engaged parents by means of face-to-face sessions, identified specific behaviors to be modified, and assured fidelity by training teachers or recruiting trained experts to deliver the intervention. In addition, they allowed adequate dosage, with an intervention duration of at least 6 months, and used age-appropriate activities.

Conclusions
Interventions with a multicomponent approach that were age appropriate and of adequate duration (≥ 6 months), that engaged parents, and that ensured fidelity and proper alignment between the stated objectives, the intervention, and the desired outcomes were more likely to succeed.


: Hepatic lesions induced by non-steroid antiinflammatory drugs are a common cause of disease, particularly among elderly patients. Although its clinical expression is polymorphous, occasional increases in serum transaminase values predominate. Sixteen cases of liver involvement by bendazac were studied. This NSAID is used in Spain for the treatment of cataracts, from a total of 112 patients observing such therapy. The clinical spectrum of liver disease induced by bendazac is discussed and emphasis is placed on the necessity to judiciously select the indications for NSAIDs.


Purpose of review Enthusiastic physicians and medical researchers are investigating the role of three-dimensional printing in medicine. The purpose of the current review is to provide a concise summary of the role of three-dimensional printing technology as it relates to the field of pediatric hepatology and liver transplantation. Recent findings Our group and others have recently demonstrated the feasibility of printing three-dimensional livers with identical anatomical and geometrical landmarks to the native liver to facilitate presurgical planning of complex liver surgeries. Medical educators are exploring the use of three-dimensional printed organs in anatomy classes and surgical residencies. Moreover, mini-livers are being developed by regenerative medicine scientist as a way to test new drugs and, eventually, whole livers will be grown in the laboratory to replace organs with end-stage disease solving the organ shortage problem. Summary From presurgical planning to medical education to ultimately the bioprinting of whole organs for transplantation, three-dimensional printing will change medicine as we know in the next few years.


Prostate cancer (PCa) is by far the most common male malignancy and the third leading cause of cancer-related death in the US. Regardless of a great response of hormonal therapy for metastatic PCa patients, eventually PCa relapses to an end-stage castration-resistant prostate cancer (CRPC) leading to mortality. Although introducing newer androgen receptor (AR) pathway inhibitors is encouraging, treatment resistance in CRPC continues to remain a clinical problem. Clinical evidence of treatment resistant CRPC indicates carcinoma cell undergoing transdifferentiation. However, the mechanism as well as cell lineage are not fully characterized, which highlights an unmet clinical need to uncover potential therapeutic targets for targeted therapy to improve the overall survival of CRPC patients. Exosome is characterized as nano-grade small extracellular vesicle derived from the endosomal system from many kinds of cells. Therefore, exosome can carry many kinds of message molecules as a delivery vehicle in a paracrine or endocrine manner. Overall, tumor-derived exosomes (TDE) has been shown to play a critical role in promoting cancer progression or drug resistance. Our recent data have shown that TDE from PCa cells is able to induce neuroendocrine differentiation of CRPC, which leads us to further elucidate the role of PCa-derived exosome. Previously by using xenograft model, we have reported that elevated caveolin-1 (Cav-1) in LNCaP cell can accelerate its tumor growth but also increase the tumor incidence of low tumorigenic cells in a paracrine manner, implying that Cav-1 can be secreted extracellualrly. However, the functional role of secreted Cav-1 in PCa is still being debated. The expression of Cav-1 was considered to function as a suppressor of cell transformation and as preventing the development and metastases of mammary tumor; on the other hand, Cav-1 served as an oncogene that correlates with PCa progression. Furthermore, recent studies have shown that Cav-1 expression is associated with chemoresistance in multiple cancers as well as cancer stem cell (CSC) property in lung cancer. CSC theory has raised significant attention in recent years because of its self-renewal and quiescent nature, which underlies its role as a cancer-initiating cell population responsible for recurrent tumor with treatment resistance. In this study, we purified TDE from various PCa cell lines including either Cav-1 positive (Cav-1High) or negative (Cav-1low) cells using membrane-based affinity chromatography, and further characterized its size and number using Zetaview (Particle Matrix, Mebane, NC) and Exocet quantitation kit (SBI, Palo Alto, CA) separately. We found that TDE derived from metastatic PCa cells without AR expression is capable of inducing CSC phenotypes in AR-expressing recipient cells. Further analyses demonstrated that the high accumulation of Cav-1 in TDE appears to be a potential candidate. Indeed, Cav-1High cells or exogenous Cav-1-treated PCa cell lines can increase CSC phenotypes in vitro and in vivo. Mechanistically, the presence of Cav-1 is able to increase stem cell transcription Yamanaka factors, including KLF4, SOX2, OCT4, and Nanog. Furthermore, from microarray screening, we found RPC32 as another potential Cav-1 downstream effector, which is characterized as a subunit of RNA polymerase III (Pol III). RPC32 has two different isoforms (α and β), and only RPC32α is known to be highly regulated and expressed in stem cell and transformed cells. Therefore, we hypothesize that RPC32α is responsible for the elevated Yamanaka factors protein expression leading to CSC development. Nevertheless, we conclude that the presence of Cav-1 in PCa TDE plays an inductive role in the appearance of treatment-resistant CRPC in a paracrine manner, which provides a potential prognostic marker and therapeutic target. Citation Format: Chun-Jung Lin, Andrew Dang, Elizabeth Hernandez, Jer-Tsong Hsieh. Caveolin-1 detected in tumor-derived exosomes induces cancer stem cell phenotypes in castration-resistant prostate cancer [abstract]. In: Proceedings of the AACR Special Conference: Prostate Cancer: Advances in Basic, Translational, and Clinical Research; 2017 Dec 2-5; Orlando, Florida. Philadelphia (PA): AACR; Cancer Res 2018;78(16 Suppl):Abstract nr A080.


The physics potential of detecting $^8$B solar neutrinos is exploited at the Jiangmen Underground Neutrino Observatory (JUNO), in a model independent manner by using three distinct channels of the charged-current (CC), neutral-current (NC) and elastic scattering (ES) interactions. Due to the largest-ever mass of $^{13}$C nuclei in the liquid-scintillator detectors and the potential low background level, $^8$B solar neutrinos would be observable in the CC and NC interactions on $^{13}$C for the first time. By virtue of optimized event selections and muon veto strategies, backgrounds from the accidental coincidence, muon-induced isotopes, and external backgrounds can be greatly suppressed. Excellent signal-to-background ratios can be achieved in the CC, NC and ES channels to guarantee the $^8$B solar neutrino observation. From the sensitivity studies performed in this work, we show that one can reach the precision levels of 5%, 8% and 20% for the $^8$B neutrino flux, $\sin^2\theta_{12}$, and $\Delta m^2_{21}$, respectively, using ten years of JUNO data. It would be unique and helpful to probe the details of both solar physics and neutrino physics. In addition, when combined with SNO, the world-best precision of 3% is expected for the $^8$B neutrino flux measurement.


The low learning outcomes of students from year to year in the department of informatics in the course of data structure affect the learning outcomes. The purpose of this research is to know the difference between Student Learning Result between Using Mobile Media Learning application with Conventional Learning. Using a Quasi-Experimental Design. The sampling technique used is Cluster Purposive Sampling. Samples were divided into two groups: experimental groups taught using media mobile learning apps, and control groups taught using conventional learning. The test result data were tested using the Shapiro-Wilk test to know the data normality, F test for data homogeneity, and t-test to know the difference of learning result value with significant level (α = 0.05). Based on the data analysis result, a normality test result with the Shapiro-Wilk test obtained the value of both groups of samples is the normal distribution and the result of the F test is homogeneous. T-test result obtained by probability = 1.830 with α = 0.05 so probability value <α = 0.05 which means H0 is rejected, hence there is the difference of result of student learning between using application of Mobile learning media with conventional learning


The field of global health has undergone remarkable growth and development over the past half century. Pediatric orthopedists have been at the forefront of much of this work. From the beginning, these individuals have understood what it means to perform global outreach and have helped our profession and Society focus on how to do so in meaningful and impactful ways. In 2001, the Children's Orthopedics in Underserved Regions (COUR) committee was formed to help POSNA members carry out this work in resource-limited environments. The COUR committee was initially approached and asked to consider changing the name to better reflect the modern verbiage used in the field. As we began to consider and explore this request, it became apparent that this also was an opportunity to recognize the evolved role the committee has for our membership and the Society. After a thorough process of consultation and debate, the committee recommended that the name be changed to the Pediatric Orthopedic Global Outreach (POGO) committee. After review, the Board of Directors approved this name change in September 2019. In this manuscript we present the history, rationale for change, and vision for the future. The mission of POGO will be carried out through a combination of Education, Coordination, and Research. While the name of the committee has changed to POGO, the principals that made COUR so successful remains at its core. This is an opportunity to build on the work of the visionary leaders who laid the foundation for us to shape the future.


Starphenes are attractive compounds due to their characteristic physicochemical properties that are inherited from acenes, making them interesting compounds for organic electronics and optics. However, the instability and low solubility of larger starphene homologs make their synthesis extremely challenging. Herein, we present a new strategy leading to pristine [16]starphene in preparative scale. Our approach is based on a synthesis of a carbonyl-protected starphene precursor that is thermally converted in a solid-state form to the neat [16]starphene, which is then characterised with a variety of analytical methods, such as 13 C CP-MAS NMR, TGA, MS MALDI, UV-Vis and FTIR spectroscopy. Furthermore, high-resolution STM experiments unambiguously confirm its expected structure and reveal a moderate electronic delocalisation between the pentacene arms. Nucleus-independent chemical shifts NICS(1) are also calculated to survey its aromatic character.


Abstract How do businessmen counteract credit constraints when the financial market does not provide adequate external financing? Based on novel primary corporate data, network techniques and regression analysis, we explore the role of interlocking directorates with banks as a way for companies to face this limitation in early twentieth century Chile. Since both linkages and credit were unregulated, this setting provides us with a quasi-natural laboratory to test the role of interlocking directorates as a device for dealing with credit constraints. The paper finds that firms connected to banks had better access to credit as reflected in higher leverage ratios, had higher valuations, and better chances of surviving. These facts show that business networks, through interlocking directorates, can play a valuable role for companies in dealing with an environment of financial constraints.


50 children with Kawasaki disease were seen between September 1983 to March 1988. Their ages ranged from 3 months to 10 years with a mean age of 25 months. Male to Female ratio was 2.3 to 1. The diagnosis of Kawasaki disease was made between the fourth to fifteenth day of illness. Marked thrombocytosis, raised erythrocyte sedimentation rate, leucocytosis, mild anemia and sterile pyuria were common features. All patients had a normal ECG and chest X-ray. 2D echocardiogram was done in the sub-acute phase of the illness in every patient. Sixteen patients (32%) had coronary artery dilatation. Thirteen of these had serial 2D echocardiograms done over a period of more than one year. Twelve had echocardiographic resolution of the coronary lesion within 18 months of follow up. Patients with coronary artery dilatation were significantly younger. All had full clinical recovery with aspirin therapy. Kawasaki disease afflicts mostly young children and can present as a diagnostic problem. Coronary artery involvement is common, and except for age, it is not predictable by any clinical or laboratory parameter. Serial echocardiographic examinations are necessary in the management of these patients.


Aspirin sensitivity is divided into 2 main subgroups: the bronchospastic and the urticaria/angioedema type. The bronchospastic type of aspirin sensitivity is frequently associated with nonallergic asthma and nasal polyps, producing a classical triad. Nonsteroid anti-inflammatory drugs (NSAID) crossreact with aspirin in aspirin-sensitive patients. Desensitization to aspirin is possible, but should be carried out with caution in selected patients. Desensitization to aspirin also produces desensitization to NSAID. Acetaminophen and nonacetylated salicylic acid (neither are considered NSAID) cross-react with aspirin in a small number of aspirin-sensitive individuals, usually when large doses are administered. The pathogenic mechanism may involve arachidonic acid and prostaglandin metabolism in the bronchospastic type of aspirin sensitivity.


Background The Chronic Care Model (CCM) emerged in the 1990s as an approach to re-organize primary care and implement critical elements that enable it to proactively attend to patients with chronic conditions. The chronic care landscape has evolved further, as most patients now present with multiple chronic conditions and increasing psychosocial complexity. These patients face accumulating and overwhelming complexity resulting from the sum of uncoordinated responses to each of their problems. Minimally Disruptive Medicine (MDM) was proposed to respond to this challenge, aiming at improving outcomes that matter to patients with the smallest burden of treatment. We sought to critically appraise the extent to which MDM constructs (e.g., reducing patient work, improving patients' capacity) have been adopted within CCM implementations. Methods We conducted a systematic review and qualitative thematic synthesis of reports of CCM implementations published from 2011–2016. Results CCM implementations were mostly aligned with the healthcare system's goals, condition-specific, and targeted disease-specific outcomes or healthcare utilization. No CCM implementation addressed patient work. Few reduced treatment workload without adding additional tasks. Implementations supported patient capacity by offering information, but rarely offered practical resources (e.g., financial assistance, transportation), helped patients reframe their biography with chronic illness, or assisted them in engaging with a supportive social network. Few implementations aimed at improving functional status or quality of life, and only one-third of studies were targeted for patients of low socioeconomic status. Conclusion MDM provides a lens to operationalize how to care for patients with multiple chronic conditions, but its constructs remain mostly absent from how implementations of the CCM are currently reported. Improvements to the primary care of patients with multimorbidity may benefit from the application of MDM, and the current CCM implementations that do apply MDM constructs should be considered exemplars for future implementation work.


Cameroon has enormous potentials for small ruminant production which are still largely underexploited. The Far North Region harbors about 3/4 of the total population of small ruminants (goat and sheep) in the country. Above 80% of the region's population is involved in livestock rearing. Despite these potentials, the sustained challenges in the sector have been attributed to low investment in the sector. Production rate is low and does not meet up with the meat demands of an ever increasing population. To resolve this problem a number of projects have been put in place by the government and non-governmental organizations (NGOs) to work through the intermediary of common initiative groups to boost the production of livestock especially that of small ruminants. This work was carried out to examine how two of such livestock projects funded by two NGOs, Heifer International Project Cameroon (HPIC) and Comite Diocesain de Developement (CDD) in the Far North Region were managed and its effects on the quality of life of the producers. A case study was carried out on 200 producers organized in 17 common initiative groups. The result of the survey was analyzed using SPSS 20.0 English Version and the hypotheses tested using the Spearman's Rank Correlation. The results obtained from the field revealed that 90, 97.5, and 98% of the producers witnessed an increase in livestock production, revenue and satisfaction of social needs after assistance respectively. It is concluded that the proper management of small ruminant livestock projects through the intermediary of common initiative groups has a significant and positive impact on the quantity of livestock production and socio-economic development of producers. Other projects aimed at increasing livestock production could follow the management styles of HPIC and CDD.

 Key words: Management, socio-economic development, livestock projects, capacity building, inputs, monitoring, control.


In this paper, we study the episodic reinforcement learning (RL) problem modeled by finite-horizon Markov Decision Processes (MDPs) with constraint on the number of batches. The multi-batch reinforcement learning framework, where the agent is required to provide a time schedule to update policy before everything, which is particularly suitable for the scenarios where the agent suffers extensively from changing the policy adaptively. Given a finite-horizon MDP with $S$ states, $A$ actions and planning horizon $H$, we design a computational efficient algorithm to achieve near-optimal regret of $\tilde{O}(\sqrt{SAH^3K\ln(1/\delta)})$\footnote{$\tilde{O}(\cdot)$ hides logarithmic terms of $(S,A,H,K)$} in $K$ episodes using $O\left(H+\log_2\log_2(K) \right)$ batches with confidence parameter $\delta$. To our best of knowledge, it is the first $\tilde{O}(\sqrt{SAH^3K})$ regret bound with $O(H+\log_2\log_2(K))$ batch complexity. Meanwhile, we show that to achieve $\tilde{O}(\mathrm{poly}(S,A,H)\sqrt{K})$ regret, the number of batches is at least $\Omega\left(H/\log_A(K)+ \log_2\log_2(K) \right)$, which matches our upper bound up to logarithmic terms. Our technical contribution are two-fold: 1) a near-optimal design scheme to explore over the unlearned states; 2) an computational efficient algorithm to explore certain directions with an approximated transition model.


Porosity graded composite component can be found in applications such as fuel cells, filters or bio-scaffolds or implants. In this paper, two materials powder injection moulding is applied to manufacture bi-layer ceramic components with graded porosity. Ceramic spinel, AR7820, is selected to form the denser layer while the porous layer consists of AR7820 with starch or graphite pore former and spinel AR7845. The pore formers have proven to be feasible in producing porous structure in individual component. Porous layer with graphite and starch pore formers sintered at 1600oC has a porosity of 36% and 37% respectively. However delamination of the layers occurs when they are shaped together with AR7820. This is because the pore formers altered the shrinkage behaviour of the base material which resulted in discrepancies in the shrinkages between the two layers. On the other hand, defect free porosity graded composite component with good and continuous bonding between the layers was obtained when AR7845 is combined with AR7820.


Purpose: To investigate the feasibility of using a 2D diode array system for clinical electron beam measurements Method and Materials:Dose distributions were measured for electron beams (EBs) generated on an Elekta Synergy LINAC (Elekta Ltd., UK). Beam data were measured using the Blue Phantom and converted on OmniPro‐Accept (Scanditronix Wellhofer, Bartlett, TN) according to AAPM TG 51. These data were used to commission Eclipse TPS (Varian, Mountain View, CA). MapCheck Model 1175 (Sun Nuclear, Melbourne, FL), a 2D diode array system, was exposed using largest applicator size 20cm×20cm at SSD 123.5cm for array calibration. Central axis dose was also calibrated. Plans were generated and measured by MapCheck for several different geometries. Exported plans were compared with measured dose map using comparison criteria of ±3% difference and ±3mm distance‐to‐agreement (DTA) within 10% isodose‐line threshold. Set‐ups include different cone sizes (field sizes) and energies at different SSD's, irregular surface, and different depths. Direct comparisons between MapCheck and ion chamber results were also performed. Results: Output factors measured with MapCheck and ion chamber agree within 1.3%. Comparison of measured and planned electron beamdose maps for 9MeV EB with 14cm×14cm applicator, SSD=100cm, depth=2cm showed 99.7% passing rate for stated criteria. Central axis dose differed by 1.6%. Passing rates and central axis dose differences for two electron applicators (10×10 and 14×14) at different SSD's (95.4, 100, and 104.4) were also summarized. Overall, >90% passing rates and <3% central axis dose differences can be achieved. Most of the failed points are at the edge. A stepped phantom was also tested and is under further investigation. Conclusions: Preliminary results show that MapCheck can be used to perform quick and relatively accurate electron beamdose map comparison. It may also prove useful for electron beam intensity‐modulated radiotherapy (EB‐IMRT) measurements in the future.


INTRODUCTION:

Aclidinium is a novel, long-acting muscarinic antagonist in development for COPD treatment. Pooled analyses of dyspnea and health status data are shown here.

METHODS:

Patients (N=1389) were randomized (1:1:1) to aclidinium 200 μg, 400 μg or pbo BID for 12- and 24-weeks for the ACCORD and ATTAIN trials, respectively. Endpoints for both studies included TDI focal score, SGRQ total score and rescue medication use.

RESULTS:

The 200 μg and 400 μg groups showed statistically significant improvements from baseline to Week 12 in TDI focal score vs pbo (200 μg, 0.58, p<0.01; 400 μg, 0.92, p<0.0001), with numerically greater improvements seen with the higher dose. Clinically significant improvements (≥1-unit increase) in TDI at Week 12 were seen in a significantly higher proportion of patients in the 200 μg (51.3%, p=0.0001) and 400 μg (54.8%, p<0.0001) groups vs pbo (38.8%). Both doses resulted in statistically significant improvements from baseline to Week 12 in SGRQ total score vs pbo (200 μg, -5.10; 400 μg, -5.51, both p<0.0001). Clinically significant improvements (≥4-unit decrease) in SGRQ total score were seen in a significantly higher percentage of patients in the 200 μg (51.0%) and 400 μg (51.8%) groups (both p<0.001) vs pbo (38.1%) at Week 12. Both doses of aclidinium resulted in a significant reduction over pbo in daily rescue medication use (-0.6 puffs, 200 µg; -0.9 puffs, 400 µg; both p<0.005).

CONCLUSIONS:

Aclidinium 200 μg and 400 μg BID resulted in significantly more COPD patients who experienced clinically meaningful benefits in dyspnea and health status (>12% more in every case) as well as less rescue medication use versus placebo.


The venture capital shakeout of the last two years has created a great deal of pain and suffering which is shared by all the players in the market, including investors, management teams, boards, and VCs. Yet capital is still flowing for good deals, although in many cases the valuations are being recalculated substantially downward. These revised values cause a host of problems as they set previously aligned parties against each other. This article discusses ways to deal with the inevitable conflicts that arise in these down rounds.


Falk claims that human language took a step forward when infants lost their ability to cling and were placed on the ground, increasing their fears, which mothers assuaged prosodically. This claim, which is unsupported by anthropological and psychological evidence, would have done little for the syllabic and segmental structure of language, and ignores infants' own contribution to the process.


Health and rehabilitation providers are adopting empowering approaches to increase consumer involvement in the service process. This practice trend has evolved in response to the emergence and adoption of consumer-driven models in health care. However, the processes of enabling opportunities for consumers to participate as partners in rehabilitation are difficult and complex. The purpose of this study was to develop a theoretical understanding of the strategies, actions, and interactions between consumers and providers that supported consumer involvement in vocational rehabilitation processes. Data from a grounded theory study involving in-depth interviews with a sample of seven consumers and seven providers were analyzed using the constant comparative approach and Glaser's analysis criteria. A conceptual model of how consumer participation is enacted emerged. Consumer and provider interactions focused on optimizing environments to support consumer partnering and self-direction through establishing shared expectations, advancing consumer potential in practice, and persistently pursuing goals in the community. Opportunities to enhance consumer participation in the social context, practice settings, and the community are elaborated.


Objective To describe the epidemiology of 2009 A/H1N1 influenza in critically ill pregnant women. Design Population based cohort study. Setting All intensive care units in Australia and New Zealand. Participants All women with 2009 H1N1 influenza who were pregnant or recently post partum and admitted to an intensive care unit in Australia or New Zealand between 1 June and 31 August 2009. Main outcome measures Maternal and neonatal mortality and morbidity. Results 64 pregnant or postpartum women admitted to an intensive care unit had confirmed 2009 H1N1 influenza. Compared with non-pregnant women of childbearing age, pregnant or postpartum women with 2009 H1N1 influenza were at increased risk of admission to an intensive care unit (relative risk 7.4, 95% confidence interval 5.5 to 10.0). This risk was 13-fold greater (13.2, 9.6 to 18.3) for women at 20 or more weeks' gestation. At the time of admission to an intensive care unit, 22 women (34%) were post partum and two had miscarried. 14 women (22%) gave birth during their stay in intensive care and 26 (41%) were discharged from an intensive care unit with ongoing pregnancy. All subsequently delivered. 44 women (69%) were mechanically ventilated. Of these, nine (14%) were treated with extracorporeal membrane oxygenation. Seven women (11%) died. Of 60 births after 20 weeks' gestation, four were stillbirths and three were infant deaths. 22 (39%) of the liveborn babies were preterm and 32 (57%) were admitted to a neonatal intensive care unit. Of 20 babies tested, two were positive for the 2009 H1N1 virus. Conclusions Pregnancy is a risk factor for critical illness related to 2009 H1N1 influenza, which causes maternal and neonatal morbidity and mortality.


Mobile IPv6 (MIPv6) allows Mobile Node (MN) to be always addressable by its home address. Route Optimization (RO) is standard in MIPv6 to route packets between MN and Correspondent Node (CN) using shortest possible path. It provides better bandwidth and faster transmission. RO greatly increases the security risk. This is one of the main reasons that IPv6 is not implemented yet. However IPSec is used to protect signaling between MN and Home Agent. In this paper, focus is given on enhanced security scheme in terms of RO based Test-bed evaluation experiment. An enhanced security algorithm is developed on top of MIPv6 RO to secure data and prepare a safe communication between MN and CN. This algorithm is able to detect and prevent the attacker from modifying the data with using an encryption algorithm by cost of little bit increase but tolerable delay. The real-time network Test-bed is implemented to prove the efficiency of proposed method. The experimental results show that the proposed security scheme increases the security performance of the network. This gives advantage of safe communication that can significantly improve the data security of RO while maintaining the quality of other network performance.


The environments of the aromatic residues (and of the single arginine residue) of azurin from Pseudomonas aeruginosa are investigated by means of natural-abundance 13C Fourier transform NMR spectroscopy. In the case of the diamagnetic Cu(I) azurin, all 17 nonprotonated aromatic carbons (and Czota of Arg-79) yield narrow resonances. Furthermore, a single-carbon amide carbonyl resonance with an unusual chemical shift (peak chi) is observed. The pH dependence of chemical shifts is used to identify the resonances of Cgamma of titrating histidines, and of Cgamma and Czota of the two tyrosines. The resonances of Cgamma and Cdelta2 of the single tryptophan residue (and Czota of Arg-79) are also identified. The pKa values of the two tyrosines are different from each other and higher than typical values of "solvent-exposed" tyrosine residues. Two of the four histidine residues do not titrate (in the pH range 4 to 11). The resonance of Cgamma of one histidine exhibits a pH titration with fast proton exchange behavior and a pKa of 7.5 +/- 0.2. The direction of the titration shift indicates that the imidazole form of this histidine is the Ndelta1-H tautomer. The Cgamma resonance of the other titrating histidine exhibits slow exchange behavior with a pKa of about 7. The imidazole form of this histidine is the Nepsilon2-H tautomer. When going to the paramagnetic Cu(II) protein, only 11 of the 19 carbons mentioned above yield resonances that are narrow enough to be detected. Also, some of the observed resonances exhibit significant paramagnetic broadening. A comparison of spectra of fully reduced azurin, mixtures of reduced and oxidized azurin, and fully oxidized azurin yields the following information. (i) Peak chi arises from an amide group that probably is coordinated to the copper. (ii) The two nontitrating histidine residues are probably copper ligands, with Ndelta1 coordinated to the metal. (iii) The side chains of Arg-79 and the two tyrosine residues are not coordinated to the copper, and Trp-48 is probably not a ligand either. (iv) The gamma carbons of Trp-48, the tyrosine with the lower pKa, the titrating histidine with slow exchange behavior, and three or four of the six phenylalanine residues are sufficiently close to the copper to undergo significant paramagnetic broadening in the spectrum of oxidized azurin.


Purpose: The article presents the results of an empirical analysis of the economic growth of Russian cities with a population of over 1 million people (megacities). Design/Methodology/Approach: The analyzed indicator is the city product calculated according to the UN methodology for the period from 2010 to 2016. The paper analyses the process of β- and σ-convergence across Russian megacities using methods of spatial econometrics in addition to the traditional β-convergence techniques from the neoclassical theoretical framework. Findings: The dynamics of the coefficient of variation confirmed the presence of σ-convergence in city product. Empirically, positive spatial autocorrelation has been confirmed. Beta-convergence for Russian megacities is found to be significant and the spatial location of megacities significantly affects β convergence. Control factors such as fixed capital investment per capita in 2010, average retail volume per capita in 2010, average annual number of employees of enterprises and organizations in 2010 and the dummy variable introduced for "federal cities" Moscow and St. Petersburg are all found to have positive and statistically significant impact on economic growth. Practical Implications: Policymakers may take the results into account under the planning of economical strategies for megacities and regions in Russia in order to facilitate the regional economic growth and the speed of convergence. Originality/Value: The main contribution of the study is the consideration of the economical growth for the megacities and not for the regions as it often used to be the case in similar studies. The important finding is that megacities' economies do converge and the influence of control factors is pronounced.


Summary

1. Riparian vegetation in dry regions is influenced by low-flow and high-flow components of the surface and groundwater flow regimes. The duration of no-flow periods in the surface stream controls vegetation structure along the low-flow channel, while depth, magnitude and rate of groundwater decline influence phreatophytic vegetation in the floodplain. Flood flows influence vegetation along channels and floodplains by increasing water availability and by creating ecosystem disturbance.

2. On reference rivers in Arizona's Sonoran Desert region, the combination of perennial stream flows, shallow groundwater in the riparian (stream) aquifer, and frequent flooding results in high plant species diversity and landscape heterogeneity and an abundance of pioneer wetland plant species in the floodplain. Vegetation changes on hydrologically altered river reaches are varied, given the great extent of flow regime changes ranging from stream and aquifer dewatering on reaches affected by stream diversion and groundwater pumping to altered timing, frequency, and magnitude of flood flows on reaches downstream of flow-regulating dams.

3. As stream flows become more intermittent, diversity and cover of herbaceous species along the low-flow channel decline. As groundwater deepens, diversity of riparian plant species (particularly perennial species) and landscape patches are reduced and species composition in the floodplain shifts from wetland pioneer trees (Populus, Salix) to more drought-tolerant shrub species including Tamarix (introduced) and Bebbia.

4. On impounded rivers, changes in flood timing can simplify landscape patch structure and shift species composition from mixed forests composed of Populus and Salix, which have narrow regeneration windows, to the more reproductively opportunistic Tamarix. If flows are not diverted, suppression of flooding can result in increased density of riparian vegetation, leading in some cases to very high abundance of Tamarix patches. Coarsening of sediments in river reaches below dams, associated with sediment retention in reservoirs, contributes to reduced cover and richness of herbaceous vegetation by reducing water and nutrient-holding capacity of soils.

5. These changes have implications for river restoration. They suggest that patch diversity, riparian plant species diversity, and abundance of flood-dependent wetland tree species such as Populus and Salix can be increased by restoring fluvial dynamics on flood-suppressed rivers and by increasing water availability in rivers subject to water diversion or withdrawal. On impounded rivers, restoration of plant species diversity also may hinge on restoration of sediment transport.

6. Determining the causes of vegetation change is critical for determining riparian restoration strategies. Of the many riparian restoration efforts underway in south-western United States, some focus on re-establishing hydrogeomorphic processes by restoring appropriate flows of surface water, groundwater and sediment, while many others focus on manipulating vegetation structure by planting trees (e.g. Populus) or removing trees (e.g. Tamarix). The latter approaches, in and of themselves, may not yield desired restoration outcomes if the tree species are indicators, rather than prime causes, of underlying changes in the physical environment.


Continually interested in the boundaries between artistic, social and political practices, Liu Ding's varied output includes: roundtable discussions and interviews, published theoretical texts, performances, lectures, curatorial projects, exhibitions and a commercial store, Liu Ding's Store. In addition to employing these differing channels, Liu Ding draws on many sources and collaborators that shape his practice and its reception, from hired traditional painters to professional actors.
His interest in broadening perspectives of history beyond national identity lends itself to discussions of global commonality and shared visual, physical or psychological

experiences. Liu Ding's central focus in the exhibition is the notion of the 'New Man'. This term appeared frequently in the Communist government's rhetoric and propaganda to enforce a vision of revolution, one of re-configured traditions and cultures that generate new aesthetics and new horizons. In terms of the individual, the figure of the 'New Man' suggests a wiliness to adapt oneself to a new ideological context. Combining the historical with the contemporary, the artist revisits the various stages of artistic reforms and formation as initiated by the Communist government since coming into power in the 1940s. He brings to the fore the construction of history and its relationship with contemporary art and subjectivity.
In 2009 Liu Ding was chosen to represent China at the 53rd Venice Biennale and in 2012 he had his first solo exhibition in the United States at the Frye Art Museum, Seattle. He has exhibited extensively in China, the UK and internationally including The Tanks and BMW Tate Live: Performance Room, Tate Modern, London; Prospect.3: Notes for Now, New Orleans Biennale; Witte de With, Rotterdam; Battersea Power Station, offsite Serpentine Gallery exhibition, London; Power Station of Art, Shanghai (10th Shanghai Biennale); Taipei Fine Arts Museum (Taipei 2012 Biennale); Seoul Museum of Art, Seoul and Museum of Modern Art, Oslo.


Although anemia is common in older adults, its prognostic significance is uncertain. A total of 17 030 community-dwelling subjects 66 years and older were identified between July 1 and December 31, 2001, and followed until December 31, 2004. Cox proportional hazards analyses were performed to determine the associations between anemia (defined as hemoglobin < 110 g/L) and hemoglobin and all-cause mortality, all-cause hospitalization, and cardiovascular-specific hospitalization. Overall, there were 1983 deaths and 7278 first hospitalizations. In patients with normal kidney function, adjusting for age, sex, diabetes mellitus, and comorbidity, anemia was associated with an increased risk for death (hazard ratio [HR], 4.29; 95% confidence interval [CI], 3.55-5.12), first all-cause hospitalization (HR, 2.16; 95% CI, 1.88-2.48), and first cardiovascular-specific hospitalization (HR, 2.49; 95% CI, 1.99-3.12). An inverse J-shaped relationship between hemoglobin and all-cause mortality was observed; the lowest risk for mortality occurred at hemoglobin values between 130 to 150 g/L for women and 140 to 170 g/L for men. Anemia is associated with an increased risk for hospitalization and death in community-dwelling older adults. Consideration should be given to redefine "normal" hemoglobin values in the elderly. Clinical trials are also necessary to determine whether anemia correction improves quality or quantity of life in this population.


Direct evidences of hydrogen loosely trapped between graphene layers in nanostructured graphite prepared by mechanical milling in a hydrogen atmosphere are presented, based on a combinational study of FT-IR, electron diffraction (ED) and electron energy-loss spectroscopy (EELS). The FT-IR spectrum of nanostructured graphite exhibited a new broad absorption band at very low frequencies around 660 cm-1, which almost disappeared by annealing up to 800 K. ED and plasmon peaks in EELS detected the unusual shrinkage and subsequent expansion of the fragmented graphene interlayer distance by hydrogen incorporation and desorption with annealing, well correlated with the change in intensity of the 660 cm-1 IR band. All the present results support our previous studies [S. Muto et al., Jpn. J. Appl. Phys. 44, 2061 (2005); T. Kimura et al, J. Alloys and Compounds 413, 150 (2006).].


Objective: To report a case of acute hepatic injury associated with varenicline. Case Summary: A 53-year-old white male with underlying alcoholic liver disease and history of hepatitis C virus infection experienced elevated aminotransferase and alkaline phosphatase levels consistent with acute hepatic injury after initiation of varenicline for smoking cessation. The hepatic injury manifested 4 weeks after initiation of varenicline therapy at 0.5 mg once daily for 3 days, 0.5 mg twice daily for 4 days, and then 1 mg twice daily. Following discontinuation of varenicline, the patient's aminotransferase levels continued to rise for 2 days before steadily decreasing and returning to baseline levels in approximately 4 months. Alkaline phosphatase continued to rise for 8 days after discontinuation of varenicline before returning to baseline within 1 month. Rechallenge was not attempted. Discussion: Varenicline is a novel, first-line agent for smoking cessation. The presentation of this patient is most consistent with an acute hepatic injury related to drug toxicity. The pattern of the patient's elevated hepatic enzyme levels is not consistent with his underlying alcoholic liver disease or hepatitis C. Using the Naranjo probability scale, as well as the Counsel for International Organizations of Medical Science/Roussel Uclaf Causality Assessment Method algorithm for drug-induced liver toxicity, we determined that varenicline was the probable cause of the acute hepatic injury. Varenicline was a possible cause of the acute hepatic injury using the algorithm for drug-induced liver toxicity developed by Maria and Victorino. To our knowledge, this is the first report of acute hepatic injury associated with varenicline. Conclusions: While the benefits of smoking cessation are likely greater than the risk of hepatic injury, clinicians should be cognizant of this reaction associated with varenicline.


INTRODUCTION
There is the need of a simple but highly reliable score system for stratifying the risk of mortality and Intensive Care Unit (ICU) transfer in patients with SARS-CoV-2 pneumonia at the Emergency Room.

PURPOSE
In this study, the ability of CURB-65, extended CURB-65, PSI and CALL scores and C-Reactive Protein (CRP) to predict intra-hospital mortality and ICU admission in patients with SARS-CoV-2 pneumonia were evaluated.

METHODS
During March-May 2020, a retrospective, single-center study including all consecutive adult patients with diagnosis of SARS-CoV-2 pneumonia was conducted. Clinical, laboratory and radiological data as well as CURB-65, expanded CURB-65, PSI and CALL scores were calculated based on data recorded at hospital admission.

RESULTS
Overall, 224 patients with documented SARS-CoV-2 pneumonia were included in the study. As for intrahospital mortality (24/224, 11%), PSI performed better than all the other tested scores, which showed lower AUC values (AUC=0.890 for PSI versus AUC=0.885, AUC=0.858 and AUC=0.743 for expanded CURB-65, CURB-65 and CALL scores, respectively). Of note, the addition of hypoalbuminemia to the CURB-65 score increased the prediction value of intra-hospital mortality (AUC=0.905). All the tested scores were less predictive for the need of ICU transfer (26/224, 12%), with the best AUC for extended CURB-65 score (AUC= 0.708).

CONCLUSION
The addition of albumin level to the easy-to-calculate CURB-65 score at hospital admission is able to improve the quality of prediction of intra-hospital mortality in patients with SARS-CoV-2 pneumonia.


Objective: This study represents phase one of a three-year research project aiming to investigate the impact of reflective practice groups for nurses. Background: Evidence indicates that increased job demands, and inadequate support contribute to nursing burnout, reduced capacity and workplace attrition. There is some evidence that group interventions may help address such issues. Study Design/Methods: This study utilised a cross sectional, quantitative research methodology. Overall, 251 nurses completed questionnaires incorporating 11 validated subscales. Levels of compassion satisfaction, intolerance to uncertainty, inhibitory anxiety, group cohesiveness, psychological distress, and psychosocial safety were evaluated in relation to number of groups attended, for both individual nurses and work groups. The data was then examined alongside existing personal and job resources. Results: Individual nurses who attended 6–18 reflective practice groups demonstrated increased tolerance to uncertainty and less inhibitory anxiety, whilst those who attended more than 18 groups demonstrated increased compassion satisfaction and group cohesiveness. There was, however, no evidence to indicate more pervasive, work group benefits. Whilst the second part of the study confirmed that reflective practice group attendance was significantly correlated with increased compassion satisfaction, it was not able to explain changes in levels of burnout, secondary traumatic stress or compassion satisfaction over and above personal factors, job factors and levels of psychological distress. Conclusion: Professional quality of life involves a complex set of variables. Reflective practice group attendance is correlated with a number of benefits for nurses however cause and effect were not clearly determined. A subsequent study will focus on the more subtle mechanisms and indirect effects of the groups on nurses' personal resources. Relevance: This research supports the role of person and job factors in explaining professional quality of life for nurses and provides evidence to support a number of positive outcomes for nurses attending reflective practice groups; establishing a foundation for future studies to explore impacts and mediators in greater detail.
What is already known about the topic?

Personal and job resources can buffer against job demands to improve Professional Quality of Life (ProQoL).
Nurses who lack personal resources are more likely to report burnout.

What this paper adds:

Personal resources of autonomy, self-efficacy and optimism are particularly important for nursing ProQoL.
Higher levels of RPG attendance are correlated with improved tolerance to uncertainty, reduced inhibitory anxiety, increased compassion satisfaction and improved group cohesion.
An explanatory link between RPG and variations in ProQoL is still not clear as RPG attendance in itself was not found to account for changes in ProQoL over personal resources, job resources and job demands.
The study identifies a direction for further research into the role RPG may play in the development of personal resources for nurses.


A direct measurement of the crack-driving stress has been attempted by applying a nanoindentation-combined, stress-probing technique to the expected crack routes ahead of a Vickers impression. The nanoindentation curves close to the remnant indent were compared to those of an unstressed bare sample and were interpreted into quantitative stress values. In detail, from the difference of two stress distributions measured from uncracked and cracked indentation corners, the driving stress for the radial cracking was estimated; a rapid decaying response with a distance to the Vickers indent center with the peak value 406.7MPa. The fracture toughness of soda-lime glass, estimated by taking into account the results measured in this study was 0.74 ± 0.15 2 / 1 m MPa × and was comparable with that of the literature.


The escalating rate of obesity in the US highlights the importance of understanding the causes for this rise. In this paper I employ the First, Second, and Third National Health and Nutrition Examination Surveys to estimate a structural model of the determinants of adult obesity. To control for the potential endogeneity of some explanatory variables, such as caloric intake (adjusted for activity level) and smoking, a set of reduced form equations for these outcomes is estimated simultaneously with the obesity equation. To identify each equation, I use an array of state-level characteristics as instrumental variables. Trends in these variables shed light on the sources of the rapid increase in obesity since 1980.


In the paper a new computer program for the numerical analysis of injection and combustion processes video observations in the I.C. engine has been presented. It is a numerical tool called Picture Analysis and Transformation of the Engine Video Observations Pat-EV evaluated at the Poznan University of Technology, Dept. of Internal Combustion Engines. The application of the Pat-EV-program allows an objective, numerical analysis of every pixel of the picture stored in the AVL/Engine Video System 513D. This analysis makes it possible to determine some important parameters of fuel spray in the cylinder like cone angle, spray penetration velocity and its range, fuel mass distribution across the spray and others. For the combustion process observations it would be possible to determine soot luminescence intensity by different hue or saturation values. It could be useful by approximation of charge temperature in some points of the observed region of the combustion chamber. Further interpretation of the parameters of every pixel allows to determine regions of peak temperatures in the combustion chamber, direction and velocity of flame propagation, and main swirl vectors of the charge. Some examples of the Pat-EV-program application for the analysis of fuel spray and of combustion process video-observations have been presented in this paper. Its main feature and new advantage of the video pictures post-processing is the possibility of the parameterisation and quantitative interpretation of the video-sampled pictures of injection and combustion. They could be used for the engine optimal controlling process.


Veterans Administration physicians say they have discovered that the chances of long-term survival after coronary bypass surgery can be estimated beforehand by data from noninvasive tests. In particular, they say that they have found one new group of high-risk patients who stand to benefit from surgery despite the number of vessels affected by significant atherosclerosis. These findings were presented at the American College of Cardiology meeting in Houston by Timothy Takaro, MD, of the Oteen, NC, VA Hospital, who is surgical cochairman of the Veterans Administration Cooperative Group for the Study of Surgery for Coronary Arterial Occlusive Disease. Cardiovascular specialists present at Takaro's talk, however, advised cautious translation of these findings to clinical decision making. Using the same data base as did those who conducted the controversial prospective randomized VA trial which in 1977 showed no statistical difference in terms of patient outcome between medical and surgical therapy for non-left


Spina bifida myelomeningocele (SBM), a neural tube defect that is the product of a complex pattern of gene-environment interactions, is associated with naturally occurring, systematic variability in the neural phenotype and in environmental factors that lead to systematic variability in the cognitive phenotype. We characterize the basis for variability in the cognitive phenotype of children with SBM with reference to a model of key biological, cognitive, and environmental events unfolding over the course of development from infancy to middle age. The cognitive phenotype is not domain-specific, but represents manifestations of unobservable constructs involving associative and assembled processing, the latter directly reflecting the impact of the neural phenotype on core deficits involving movement, timing, and attention orienting. The expression of the cognitive phenotype is variable, being moderated by features of the neural phenotype involving secondary CNS insults (such as hydrocephalus) that impair assembled processing, as well as by environmental factors (such as poverty, parenting, and education) that impair associative processing. The preservation of strengths in associative processing depends in part on the severity of the CNS deficits in SBM and the impact of the environment. (JINS, 2006, 12, 285–296.)


Systemic lupus erythematosus (SLE) is a rare disease in males. There is evidence that a functional state of hypoandrogenism is important in the pathogenesis of the disease. We analysed the levels of several hormones (follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T), estradiol (E2), free estradiol (FE2) and prolactin (PRL)) in 17 male SLE patients and 17 male healthy controls with similar age distribution. Three lupus patients were excluded from the analysis due to previous cyclophosphamide therapy or pre-puberty. Thus 14 male lupus patients were eligible for the study. Six of the 14 SLE patients (43%) showed at least one abnormal level of FSH, LH or T. There were no abnormalities in these hormones in the 17 controls. This difference was significant (P < 0.01). In five of these 6 male patients (36% of all lupus patients) the hormonal profile was compatible with a functional state of hypoandrogenism (high LH and/or low T). The ratio E2/T (estradiol/testosterone:pmol/nmol) was also significantly higher in the SLE group (average = 6.5; SD 4.3) when compared with that of the control group (average 4.2; SD 1.2; Mann-Whitney rank sum test: P < 0.03). There were no significant differences in E 2, FE2 or PRL between lupus patients and controls. We did not confirm the notion that left-handedness is frequent in male lupus as all our patients were right-handed. We found a significantly higher prevalence of sex hormone abnormalities in male lupus patients when compared with healthy controls with a similar age distribution. These abnormalities were consistent with a functional state of hypoandrogenism although the levels of FE 2 were not different between male lupus and controls.


INTRODUCTION
Many Canadians report decreased mental health during the COVID-19 pandemic, and concerns have been raised about possible increases in suicide. This study investigates the pandemic's potential impact on adults' suicide ideation.

METHODS
We compared self-reported suicide ideation in 2020 versus 2019 by analyzing data from the Survey on COVID-19 and Mental Health (11 September to 4 December 2020) and the 2019 Canadian Community Health Survey. Logistic regression was conducted to determine which populations were at higher risk of suicide ideation during the pandemic.

RESULTS
The percentage of adults reporting suicide ideation since the pandemic began (2.44%) was not significantly different from the percentage reporting suicide ideation in the past 12 months in 2019 (2.73%). Significant differences in the prevalence of recent suicide ideation in 2020 versus 2019 also tended to be absent in the numerous sociodemographic groups we examined. Risk factors of reporting suicide ideation during the pandemic included being under 65 years, Canadian-born or a frontline worker; reporting pandemic-related income/job loss or loneliness/isolation; experiencing a lifetime highly stressful/traumatic event; and having lower household income and educational attainment.

CONCLUSION
Evidence of changes in suicide ideation due to the pandemic were generally not observed in this research. Continued surveillance of suicide and risk/protective factors is needed to inform suicide prevention efforts.


Dreams and visions, prophetic words from God about "dusty souls," speaking in tongues while "in the spirit"--narratives of these and similar events comprise the heart of Every Time I Feel the Spirit. This in-depth study of a Black congregation in Charleston, South Carolina provides a window into the tremendously important yet still largely overlooked world of African American religion as the faith is lived by ordinary believers. For decades, scholars have been preoccupied with the relation between Black Christianity, civil rights, and social activism. Every Time I Feel the Spirit is about black religion as religion. It focuses on the everyday experience of religion in the church, congregants' relationships with God, and the role that God and Satan play in congregants' lives--not only as objects of belief but as actual agents. It explores the concepts of religious experience and religious ritual, while emphasizing the attributions that people make to the operation of spiritual forces and beings in their lives. Through interviews and field work, Nelson uncovers what religious people themselves see as important about their faith while extending and refining sociological understandings of religious ritual and religious experience.


ET AL . : Abciximab Usage in Percutaneous Coronary Intervention in High-Risk Patients: Early and Late Outcomes. Background: Clinical adverse cardiac events have been significantly reduced by the adjunctive usage of Glycoprotein IIb/IIIa receptor inhibitors in patients undergoing percutaneous coronary intervention (PCI). However, no information on its safety and efficacy is available for Asian. Methods: All patients who had PCI together with abciximab in the Prince of Wales Hospital from August 1998 to December 2000 were included. Hospital records, ECG records and laboratory results were reviewed retrospectively. The primary composite endpoint including death, myocardial infarction, target vessel revascularization or bypass surgery was assessed at index hospitalization, at 1 month, and 6 months after PCI. The safety of abciximab and any difference in outcomes between the prophylactic and standby group were studied. Results: One hundreds and five patients had PCI together with abciximab during the study period. All received bolus abciximab of 0.25 mg/kg followed by 0.125 µ g/kg/min infusion over 12 hours. Twenty-one patients had experienced the primary endpoint at the index hospitalization (7 from the prophylactic group and 14 from the standby group). Additional 3 patients in the prophylactic group had reached primary endpoint at 1 month. At 6 months, another 1 in the prophylactic group and 4 in the standby group reached primary endpoint. Total 5 deaths occurred during the index hospitalization, 2 from prophylactic group and 3 from standby group. The bleeding complication was similar in both groups and most of them were minor bleeding only. Three patients had severe thrombocytopenia (platelet count less than 20x10 9 /l) and total 6 patients had thrombocytopenia of <50x10 9 /l. Conclusion: There was a trend towards better clinical outcome in the abciximab prophylactic group and the benefit seemed to be sustained at 6 months. Low incidence of major bleeding was observed in the usage of abciximab, but the incidence of thrombocytopenia after abciximab usage in Chinese was much higher than reported in current published studies. (J HK Coll Cardiol 2001;9:171-175)


Modern software applications are growing in complexity and demand very intensive use of data. Therefore, a wide variety of data structures are utilized to facilitate the storage and access to these vast amounts of computed information. Additionally, the need for reliable software design and the development of large applications following the object-oriented paradigm increase the amount of dynamic buffers and redundant accesses to the data stored in these buffers. In this paper, we propose a systematic, design optimization methodology to remove these intermediate dynamic buffers, thereby reducing the memory accesses of the targeted applications without altering the input-output behaviour of the algorithms. The reduction is focused on sequences and is especially relevant for embedded systems, which have limited on-chip communication bandwidth and the energy consumption of the memory subsystem is high, due to the energy consumption associated with each memory access. The effectiveness of the proposed methodology is assessed in a 3D reconstruction multimedia application and shows a significant reduction in memory accesses. In addition, the general trends for memory improvement and the scalability of our approach are supported as well by a parameterized benchmark set.


Mobile learning is one of the most recent branches in educational research. In contrast to traditional classroom learning, mobile learning extends outside the classroom, allowing mobility and flexible interaction between formal and informal learning. Up to this date, only few music based mobile applications have been developed for educational purposes and especially for young children. In the present study, software JamMo will be designed for Nokia N810 Internet tablet. JamMo aims at child-centred, intelligent musical engineering and pedagogical design of stand-alone, ad hoc and networked creative music making. It is targeted to 3‐12-year-old children including those with moderate learning difficulties, such as attention deficit disorders, and those who are newly immigrated. This paper describes the developmental and pedagogical framework of the design and, the features and functions of the stand-alone sequencer software. The requirements for cognitive development and learning are described. The design encompasses software features and functions, structured learning materials, decision-making structures, support of attention, feedback, game features supporting motivation and, musical materials. The end product will be an accessible mobile learning device to be used in classroom and informal creative music learning, and tested with user groups mentioned to promote social inclusion of children.


This report was commissioned by Treasury in February 1999 as an input into its ongoing work programme on the regulation of network industries. Network industries are characterised by long-lived investments and increasing returns to scale. This raises two related concerns – protection of consumers from monopoly abuse and protection of investors from opportunistic behaviour by governments. This report reviews the underlying problems of economic regulation of network industries. In particular, it discusses the problems of monopoly and regulation, the objectives and principles of good regulation, the trade-offs that regulation must deal with, and international experience with network regulation in the UK, the US and Australia. Conclusions of the paper include that regulation should provide incentives for short and long-term efficiency, and that regulation should be based on the principles of openness, transparency, consistency and accountability.


Abstract. Time and again, discussions at the Institute of Geography in Bern regarding the choice of new faculty or debates about how to position ourselves scientifically have inspired us to re-examine our understanding of our discipline. The structural report, for example, which the Institute's board of directors presented to faculty and university directors in 1994, describes our scientific self-conception as follows: "Geography is concerned with humankind's physical-material environment. As such, it is an environmental science. The physical-material environment is analysed according to a dual perspective: as a condition and constraint of humankind and its cultural development; and as a product and result of economic, social, and political processes. This dual perspective requires that the natural sciences as well as the social sciences and humanities be employed to access geography's object of study. The natural science branches of geography examine essential parts of the ecosystem and associated productive, endangering, and limiting factors and processes; these branches use the methodology of the natural sciences and base their research concepts on the systems theories of the natural sciences. The social science and humanistic branches of geography investigate the economically, politically, and socioculturally motivated principles governing our use of the environment, as well as the significance of the physical-material world in the social constitution of the spatial arrangement of society. These branches of geography use the methods of the social sciences and humanities, applying the theories of both in their research concepts." (Direktorium des Geographischen Instituts der Universitat Bern 1994: 1)


Introduction
Aggressive antisocial behavior is a major challenge to society, and studies on the determinants of its persistence are essential to the development of strategies to prevent violence.

Aims & Methods
The overall aim of the thesis was to establish covariates of persistent aggressive antisocial behavior in a population-based cohort and in clinically evaluated, prospectively followed, offender groups. Specific aims were:
(1) to quantify the persistence of aggressive antisocial behavior,
(2) to identify risk factors for such persistence,
(3) to describe the distribution of psychopathic traits (according to the Psychopathy Checklist-Revised; PCL-R) in relation to clinical factors, and
(4) to determine thinking styles related to aggressive antisocial behavior.

Results
One percent of the Swedish general population was responsible for 63% of all violent crimes between 1973 and 2004. Risk factors for persistence of aggressive antisocial behavior included its early onset, conduct disorder, antisocial personality disorder, and substance-related disorders. In the PCL-R, the Antisocial facet outperformed all other facets and the total score as a predictor of persistence. The Interpersonal facet showed unique clinical attributes. A distorted thinking style characterized by antisocial features was related to aggressive antisocial behavior.

Conclusions
Aggressive antisocial behaviors and clinical factors including externalizing mental health problems aggregate within individuals. The best predictor of future aggressive antisocial behavior is a history of similar behaviors, especially with an early onset. Scientific and clinical efforts aimed to prevent violence have therefore to focus both on early-onset and persistent aggressive antisocial behavior, and their associated clinical and cognitive characteristics.


Ecology and cybernetics, in their everyday folk meanings at least, might seem to be completely dissociated fields: the first suggesting the study of living organisms in their environments, and the other conjuring images of automation, machines, and their control and management. They share however a concern with understanding systems, and as even the most cursory study shows, the histories of these concepts are intimately intertwined with each other. In fact,, and have in fact I argue that they have, a common structure in a certain abstract spatial imaginary which determines thinking about systems in modernity. This spatial abstraction itself emerges through a new division of labour which transformed our production and thinking about bodies, machines, and buildings. This is the story of three architectural typologies – — the bounded cell, the networked field, and the observatory tower – —, a story which raises questions about the nature of architecture and its relationship to other forms of technical and scientific knowledge, and to systems theory in general.


Eel larvae caught in the mid North Atlantic and along the continental slope off the Portuguese coast are studied together with samples of glass eels caught just before entering fresh water along the Dutch and French coasts.
During their migration from the mid Atlantic towards the continental slope the mean length of the larvae investigated increased from 56 to 66 mm, while the mean diameter of their otoliths increased from 0.17 to 0.23 mm. The animals from the mid Atlantic had three complete growth zones in their otoliths, while the majority of those from the continental slope had four complete growth zones.
The specimens from the mid Atlantic show typical larval aspects as e.g. position of the anus and reaction to preservation, this in contrast to most of the animals caught along the continental slope. In 70% of the latter the position of the anus is varying and they turned completely opaque after preservation in alcohol; the remaining animals showed all typical larval aspects.
In the glass eels the numbers of growth zones varied from two to six complete ones, about 40% of the animals having four or more growth zones in their otoliths.
The results indicate that the variation in age found in the glass eels most probably comes into existence along the continental slope, where a number of larvae lag behind in metamorphosis.
The growth zones in the otoliths seem to represent completed regular growth cycles which are supposed to be annual.


The complex underwater environment causes light to suffer from scattering effects and wavelength-dependent attenuation, and underwater images exhibit color deviation and low contrast, which hinder the progress of related underwater tasks. Deep learning algorithms now make extensive use of multi-scale features to improve underwater image quality, but the majority of these methods do not take channel differences into account while propagating features. To this end, we pro-pose a cross aggregation transformer (CAT), which utilizes three stages of projection-crossing-aggregation to adaptively select beneficial channels. This paper also designs a dynamic supplement underwater image enhancement network, which consists of a shallow network and an enhancement network. Through the encoder/decoder structure, the enhancement network re-stores the original appearance of the underwater image, while the shallow network extracts the shallow features at different scales. Both networks are designed to focus on under-enhanced regions and supplementary details in real time through the residual supplement module (RSM). The experimental findings demonstrate that CAT and RSM efficiently improve network performance and elevate the network above other advanced methods on various datasets.


SUMMARY: Zellweger syndrome (ZS), or cerebrohepatorenal syndrome, was the first described per-oxisomal biogenesis disorder. It represents the most severe phenotype, and some of its multiple congenital anomalies can manifest prenatally. Fetal hypokinesia, renal hyperechogenicity, and cerebral ventricular enlargement are the most common reported fetal features. Single and/or late detectable manifestations account for most of the difficulties of prenatal diagnosis, as well as the limitations of ultrasonography itself. Prenatal diagnosis, however, can be achieved through (1) assays of concentrations of peroxisomal metabolites (very-long-chain fatty acids, bile acids, intermediates, plasmalogens), (2) activities of peroxisomal enzymes (dihydroacetone-phosphate acyltransferase), or (3) molecular screening techniques, if available. We report on the contribution of MR imaging to the diagnosis of ZS in 2 unrelated fetuses. MR imaging was performed in the third trimester because of cerebral ventricular enlargement diagnosed on routine sonography examinations. In both cases, MR imaging revealed ZS-characteristic abnormal cortical gyral patterns, impaired myelination, and cerebral periventricular pseudocysts. In addition, MR imaging revealed renal microcysts and hepatosplenomegaly in one case. The high level of resolution of MR imaging, which allows analysis of cerebral gyration and myelination, facilitates the prenatal diagnosis of complex polymalformative syndromes such as ZS.


Background: The objective of this study was to determine the prevalence of thermophilic Campylobacter spp. in asymptomatic school-going children and establish the antibiotic resistance patterns of the isolates towards the drugs used to treat campylobacteriosis, including macrolides, quinolones and tetracycline. Campylobacter spp. are a leading cause of enteric illness and have only recently shown resistance to antibiotics. Methods: This study isolated Campylobacter spp., including Campylobacter coli, Campylobacter jejuni and Campylobacter lari, in stool samples from asymptomatic school-going children in one of the biggest urban slums in Kenya. The disc diffusion method using EUCAST breakpoints was used to identify antibiotic-resistant isolates, which were further tested for genes encoding for tetracycline resistance using primer-specific polymerase chain reaction. Results: In total, 580 stool samples were collected from 11 primary schools considering both gender and age. Subjecting 294 biochemically characterized Campylobacter spp. isolates to genus-specific PCR, 106 (18.27% of stool samples) isolates were confirmed Campylobacter spp. Out of the 106 isolates, 28 (4.83%) were Campylobacter coli, 44 (7.58%) were Campylobacter jejuni while 11 (1.89%) were Campylobacter lari. Campylobacter jejuni had the highest number of isolates that were multi-drug resistant, with 26 out of the 28 tested isolates being resistant to ciprofloxacin (5 mg), nalidixic acid (30 mg), tetracycline (30 mg) and erythromycin (15 mg). Conclusions: In conclusion, asymptomatic school going children in the study area were found to be carriers of multidrug resistant Campylobacter coli, Campylobacter jejuni and Campylobacter lari at 84%. A one-health approach, which considers overlaps in environment, animals and human ecosystems, is recommended in addressing multidrug resistane in Campylobacter, since animals are the main reservoirs and environmental contamination is evident.


Given a diagram of schemes, we can ask if a geometric object over one of them can be built from descent data (usually objects of the same type over the various other schemes in the diagram, together with compatibility isomorphisms). Using the language of moduli stacks, we can rephrase this as follows: saying that descent problems for a given diagram have essentially unique solutions amounts to saying that the diagram in question is a (bicategorical) colimit diagram in a certain 2-category of stacks. In this paper we use generalized Tannaka duality to explicitly compute certain colimits in the 2-category of Adams stacks. Using this we extend recent results of Bhatt from algebraic spaces to Adams stacks and a result of Hall–Rydh to non-noetherian rings. We conclude the paper with a global version of the Beauville–Laszlo theorem, which states that a large class of schemes and stacks can be built by gluing the open complement of an effective Cartier divisor with the infinitesimal neighbourhood of the divisor.


Modelling of the charge transport in different types of organic semiconductors
(molecular crystals and semicrystalline polymers) is undertaken using a number of
different methods.
Using a polarisable force field we have determined the extent of the external
reorganisation energy for hole transport in molecular crystals. We have found that
this key parameter is very small for naphthalene, anthracene, tetracene, pentacene
and rubrene and discussed the implications of this finding in the context of charge
transport modelling.
Charge trapping in organic crystals due to defect states is studied by
computation of the rate of escape of a trapped charge carrier using non-adiabatic rate
theory. Two cases are considered, the first is hopping between separate identical
defect states and the second is hopping from a defect state into the bulk (delocalised)
states. This latter process is determined as the more likely to occur for a realistic
defect concentration. The necessity of the inclusion of an effective quantum mode of
vibration for the accurate computation of the rate is also demonstrated.
A linear scaling method based on the definition of a localised molecular
orbital set is devised for the computation of the electronic structure of a conjugated
polymer (poly(3-hexylthiophene) (P3HT)). Utilising a combined classical and
quantum chemical approach we show that charge carriers are localised in
correspondence with long-lived traps which are also present in the crystalline phase
of the polymer. The regio-regularity of P3HT is shown to have little impact on the
shape and tail of the density of states; we compute the 2D localised trap density as
~3.1×1013 cm-2, a value which is not found to significantly change with the regioregularity.
The states in the tail of the density of states are found to be
predominantly localised but energetically close to delocalised "quasi-band" states
which are accessible under device operation.


Background: The present study was aimed to explore the effects of ritonavir and primaquine combination given as a singledose or repeated-dose compared to ritonavir alone on ritonavir plasma concentration in the rats. Methods: In single-dose study, 30 male Spraque Dawley rats were randomly allocated to receive ritonavir 20 mg/kg BW or ritonavir 20 mg/kg BW + primaquine 1.2 mg/kg BW or ritonavir 20 mg/kg BW + ketokonazole 10 mg/kg BW. Ketokonazole was used as positive control of ritonavir metabolism inhibitor. In the repeated-dose study, thirty Spraque Dawley male rats were randomly allocated to receive ritonavir 20 mg/kg BW/day or ritonavir 20 mg/kg BW/day + primaquine 1.2 mg/kg BW/ day or ritonavir 20 mg/kg BW/day + rifampicin 100 mg/kg BW/day. Rifampicin was used as a positive control of ritonavir metabolism inducer. Results: In the single-dose study, ketokonazole increased the area under the plasma concentration (AUC) of ritonavir (↑ 114.8%, p 0.05). Repeated-dose study showed that rifampicin decreases the AUC of ritonavir (↓ 42.8%, p< 0.001), and primaquine decreased the AUC of ritonavir plasma concentration (↓ 46.6%, p< 0.001). Conclusion: Concomitant administration of primaquine and ritonavir decreases the AUC of ritonavir. This effect may result in the insuffi cient concentration of ritonavir as anti-HIV, which may lead to treatment failure with ritonavir. (Med J Indones 2011; 20:190-4)


Aim: We aimed to evaluate the complications of regional anesthesia techniques in caesarean operations. Material and Methods: Patients who underwent caesarean operation managed with regional anesthesia between January 2010 and January 2011 were included in this study. Demographic data, regional anesthesia method, position during approach, number of attempts, patient feelings during local anesthetic injection, dermatomal level, and complications were recorded. The results were analyzed and presented for each regional anesthesia technique. Results: A total of 425 were performed in the study period. Totally 269 caesarean sections under regional anesthesia were included in this study. Caesarean sections were performed at a rate of 1.5 % in patients below 20 years of age, 91.1 % in 20-34 years of age and 7.4 % in over the age of 35 years. Specifically, spinal anesthesia, epidural anesthesia, and combined spinal-epidural anesthesia were applied to 236, 9, and 24 patients, respectively. Spinal anesthesia was the most frequently applied regional anesthesia technique in this study. The most common sensation during local anesthetic injection was feeling of warmth at a rate of 54.6 %. Post dural puncture headache was observed at a rate of 6.3 % (n=15), and backpain 8.8 % (n=21) in the spinal anesthesia group. Neurological complications occurred in 2 patients. Discussion: The present study revealed that the complication rates of regional anesthesia techniques in our university had consistent results with the current literatures.


ABSTRACT Evaluation of liming and fertility properties of biochar on acid soil was studied in this work. Selected soil properties such as pH, electrical conductivity (EC), exchangeable acidity (Ex Ac), exchangeable Al (Ex Al), exchangeable Fe (Ex Fe), available P and, soil organic carbon (SOC) were examined under the effect of biochar amendments. The acid soil was treated with biochar issued from coffee husk (CH) and cocoa pods (CP) pyrolyzed at 350°C and 550°C for 4 hours at amendment rate of 0, 20, 40 and 80 g kg−1 and an incubation time of 7, 14, 30, 40 and 60 d. Biochar amendments significantly increased soil pH, soil EC with respect to control and decrease in exchangeable acidity was observed. Results show that biochar improved available P in acid soil, though re-adsorption occurred with increasing incubation time. A significant increase in SOC is observed as compared to control. The impact of biochar on these acid soil chemical properties is due to the properties which are dependent on the biochar type and pyrolysis temperature. Thus, biochar can play the dual role of a liming agent and a source of P fertilizer nutrients.


The first membrane-spanning domain (m1) of the M glycoprotein of avian coronavirus (formerly called E1) is sufficient to retain this protein in the cis-Golgi. When the membrane-spanning domain of a protein which is efficiently delivered to the plasma membrane (VSV G protein) is replaced with m1, the resulting chimera (Gm1) is retained in the Golgi (Swift, A. M., and C. E. Machamer. 1991. J. Cell Biol. 115:19-30). When assayed in sucrose gradients, we observed that Gm1 formed a large oligomer, and that much of this oligomer was SDS resistant and stayed near the top of the stacking gel of an SDS-polyacrylamide gel. The unusual stability of the oligomer allowed it to be detected easily. Gm1 mutants with single amino acid substitutions in the m1 domain that were retained in the Golgi complex formed SDS-resistant oligomers, whereas mutants that were rapidly released to the plasma membrane did not. Oligomerization was not detected immediately after synthesis of Gm1, but occurred gradually with a lag of approximately 10 min, suggesting that it is not merely aggregation of misfolded proteins. Furthermore, oligomerization did not occur under several conditions that block ER to Golgi transport. The lumenal domain was not required for oligomerization since another chimera (alpha m1G), where the lumenal domain of Gm1 was replaced by the alpha subunit of human chorionic gonadotropin, also formed an SDS-resistant oligomer, and was able to form hetero-oligomers with Gm1 as revealed by coprecipitation experiments. SDS resistance was conferred by the cytoplasmic tail of VSV G, because proteolytic digestion of the tail in microsomes containing Gm1 oligomers resulted in loss of SDS resistance, although the protease-treated material continued to migrate as a large oligomer on sucrose gradients. Interestingly, treatment of cells with cytochalasin D blocked formation of SDS-resistant (but not SDS- sensitive) oligomers. Our data suggest that SDS-resistant oligomers form as newly synthesized molecules of Gm1 arrive at the Golgi complex and may interact (directly or indirectly) with an actin-based cytoskeletal matrix. The oligomerization of Gm1 and other resident proteins could serve as a mechanism for their retention in the Golgi complex.


BACKGROUND AND OBJECTIVES
To investigate the effectiveness of recombinant human erythropoietin (r-HuEPO) on disease-related anemia in patients with B-chronic lymphocytic leukemia (B-CLL) and to explore whether improvement of anemia could delay the initiation of cytotoxic therapy.

DESIGN AND METHODS
Twenty five B-CLL patients (12 males and 13 females; median age 70 years) with disease-related anemia were treated with r-HuEPO. Patients were either on no treatment or on a standard regimen, and had at least Rai stage III disease, with a hematocrit (Hct) <32%. Eleven were newly diagnosed, whereas 14 developed anemia during follow-up. Treatment induction lasted for a maximum of 3 months, during which patients were receiving 150 IU/kg of r-HuEPO s.c. t.i.w. with an escalation to 300 IU/kg t.i.w. if response was slow after one month. Responding patients were placed on maintenance r-HuEPO with 150 IU/kg s.c. once weekly, continuously. Complete response (CR) was defined as an increase of Hct to 38% or more and partial response (PR) as an increase of >6% from pretreatment level.

RESULTS
CR was observed in 18/25 (72%) and PR in 2/25 (8%) of the patients. Six patients were downstaged to stage Rai 0, 9 to Rai I and 4 to Rai II. Response was sustained with maintenance therapy. At a median follow-up of 32 months only 4 of the responders required antileukemic treatment. The median survival of responders has not been reached, and 3-year survival is 84%.

INTERPRETATION AND CONCLUSIONS
r-HuEPO was efficient in downstaging Rai stage III B-CLL patients, and delayed the initiation of antileukemic therapy. Whether this effect can be translated into better survival rates remains to be clarified in randomized trials.


Background and study aim: Ideal control of training load and physiological recovery between training sessions and competitions are important aspects for training periodization and improve performance in competition. The aim of this study was the effects of 4-weeks of three different modes of high-intensity interval training (HIIT) on the heart rate variability (HRV), as well as perceptual, physiological and psychometric responses among judo athletes. Material and Methods: Thirty-five judo athletes were randomized into three training groups: 2 blocks of 10 sets of 20s all-out effort by 10s recovery twice a week using lower-body [high-intensity exercise (HIE) in cycle-ergometer for lowerlimbs with 4.5% of body mass]; upper-body (HIE in cycle-ergometer for upper-limbs with 3% of body mass); uchi-komi (HIE by means of technique-entrance) and a control group (judo trained only). The HRV was monitored at rest at the beginning of each week. The frequencies analysed were the root mean square of successive differences in the R-R intervals (rMSSD) and rMSSD/MRR (mean of R-R intervals) ratio. Blood samples were collected to measure hormone concentrations [free-testosterone and cortisol] and cellular damage markers [creatine kinase (CK), lactate dehydrogenase (LDH), aspartate aminotransferase (AST) and alanine aminotransferase (ALT)] before and after the training period. The ratings of perceived recovery (RPR) and exertion (RPE) were reported in each HIE-session. The psychometric questionnaires were applied weekly. Results: There was no difference for HRV, RPE, internal training load, psychometric questionnaires, hormonal levels, CK, AST and ALT (p>0.05). There was a moment effect for the uchi-komi group, with higher values for RPR in the first HIE-session when compared to the second (p = 0.014) and an increase of LDH to the upper-body group (p = 0.031) after 4-weeks. Conclusion: Thus, low-volume HIIT promoted only a moment effect for RPR in uchi-komi group and an elevation of LDH in the upper-body after 4-weeks.


Waste sludges produced from the recycling of concretes contain a large amount of aggregate powders and pre-reacted cements so that they have no more cementing properties. However, since they contain unreacted Ca(OH)2, pozzolanics such as blast slag or meta kaoline can activate the waste concrete, and they can be reused as low-grade cement or pozzolanics. When meta kaoline was added with some other pozzolanic materials such as gypsum or blast slags, the density was increased so that the compressive strength, especially early stage of curing time, was enhanced. When meta kaolin was added, more densified C-S-H gel networks were formed at aggregates, and ettringites were produced between the C-S-H gel networks.


To the Editor: The increase in nontuberculous mycobacteria (NTM) infections over the last 3 decades likely is multifaceted, including increased clinical awareness, improved laboratory diagnostics, growing numbers of immunocompromised patients, and an aging population.1,2 Historically, the majority of mycobacteria-related diseases are due to Mycobacterium tuberculosis, Mycobacterium bovis, and Mycobacterium leprae.3 Mycobacterium haemophilum is a slow-growing acidfast bacillus (AFB) that differs from other Mycobacterium species in that it requires iron-supplemented media and incubation temperatures of 30°C to 32°C for culture. As these requirements for growth are not standard for AFB cultures, M haemophilum infection may be underrecognized and underreported.3 Mycobacterium haemophilum infections largely are cutaneous and generally are seen in AIDS patients and bone marrow transplant recipients who are iatrogenically immunosuppressed.4,5 No species-specific treatment guidelines exist2; however, triple-drug therapy combining a macrolide, rifamycin, and a quinolone for a minimum of 12 months often is recommended. A 64-year-old man with a history of coronary artery disease, hypertension, hyperlipidemia, and acute myelogenous leukemia (AML) underwent allogenic stem cell transplantation. His posttransplant course was complicated by multiple deep vein thromboses, hypogammaglobulinemia, and graft-vs-host disease (GVHD) of the skin and gastrointestinal tract that manifested as chronic diarrhea, which was managed with chronic prednisone. Thirteen months after the transplant, the patient presented to his outpatient oncologist (M.K.) for evaluation of painless, nonpruritic, erythematous papules and nodules that had emerged on the right side of the chest, right arm, and left leg of approximately 2 weeks' duration. On review of systems by oncology, the patient denied any fevers, chills, or night sweats but noted chronic loose nonbloody stools without abdominal pain, likely related to the GVHD. The patient's medications included prednisone 20 mg once daily, fluconazole, amitriptyline, atovaquone, budesonide, dabigatran, metoprolol, pantoprazole, rosuvastatin, senna glycoside, spironolactone, tramadol, and valacyclovir. Physical examination revealed multiple singular erythematous nodules on the right side of the chest (Figure 1A), right arm (Figure 1B), and left leg. There was no regional Mycobacterium haemophilum: A Challenging Treatment Dilemma in an Immunocompromised Patient


We argue that prominent macro-quantitative studies in economics, medicine and public health, and political science fail to test for the effect of improved sanitation, on countries' average life expectancy scores. Our study adds sanitation to a basic model focusing on income and democracy as central explanatory factors. We use a cross-sectional design and ordinary least squares (OLS) regression with the most recent data, i.e., 2012 or the latest available numbers, and work with the Economist Intelligence Unit 2012 democracy data. All other data are derived from the CIA World Factbook . Including sanitation in a cross-sectional model with recent country-level data and controlling for income and democracy increases the explained variance by as much as 11% points. This work identifies sanitation as a crucial variable omitted from existing work on life expectancy. Future studies should aim at the effects of additional public goods apart from sanitation and work with panel data.


This paper reports on a study relevant to the psychology literature on pan-cultural self-enhancement; namely, what are some strategies by which people from non-western cultures raise their self-worth? I conducted an experiment to test hypotheses regarding culturally acceptable means of communicating positive feedback and its effect on changes in self-esteem. Japanese were expected to report elevated feelings of self-worth after receiving positive feedback from a friend, whereas Americans were expected to report higher feelings of self-worth after announcing their own positive feedback (given by an experimenter in front of a friend). One hundred and fifty-seven pairs of friends participated in an experiment in which one friend in each pair was the target of positive feedback from a simulated creativity test (delivered by self or friend). Analyses revealed that culture and source of feedback affected the global self-esteem of the test takers and appearance self-esteem of both the test taker and the friend. Relative to each culture, US Americans' self-esteem increased after self-delivered feedback, whereas the self-esteem of Japanese increased after feedback announced by a friend. The results highlight appropriate feedback situations leading to positive self-evaluation for Japanese and Americans. Implications for intercultural education are discussed.


: Cachexia is the most common paraneoplastic syndrome of malignancy and is characterized by anorexia, early satiety, severe body compositional change with weight loss, adipose and muscle loss, weakness (asthenia), anemia, and edema. Cause of death in as many as 20% of patients with cancer is associated with tumor-induced and treatment-related malnutrition and inanition. Early diagnosis of cancer malnutrition often is missed because of lack of attention by the oncology team. The importance of understanding the basics of nutritional oncology by the entire healthcare team (physician, nurse, pharmacist, dietitian, social worker, physical and speech therapists) and the patient and family is outlined with practical interventions being specified. An algorithm for an optimal nutritional approach in patients with cancer is included, with emphasis on early diagnosis and intervention for maintenance of nutritional, body compositional, and functional status of the oncology patients. Quality-of-life issues, pharmacologic intervention in cachexia, and necessity of cooperative oncology group involvement in nutritional oncology are discussed.


Drinking water at Shatila Palestinian Refugee Camp in Beirut, Lebanon is of poor quality and unpredictably intermittent quantity. We aimed to characterize drinking water sources and contamination at Shatila and determine how drinking water can be managed to reduce community health burdens. We interviewed the Popular Committee, well owners, water vendors, water shopkeepers and preschool administrators about drinking water sources, treatment methods and the population served. Water samples from the sources and intermediaries were analysed for thermotolerant faecal coliforms (FCs), Giardia lamblia, Cryptosporidium parvum and microsporidia, using immunofluorescent antibody detection for G. lamblia and C. parvum, and chromotrope-2 stain for microsporidia. All drinking water sources were contaminated with FCs and parasites. FC counts (cfu/mL) were as follows: wells (35-300), water vendors (2-178), shops (30-300) and preschools (230-300). Responsible factors identified included: unskilled operators; improper maintenance of wells and equipment; lack of proper water storage and handling; and misperception of water quality. These factors must be addressed to improve water quality at Shatila and other refugee camps.