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Background Lymph node (LN) status is an important predictor of overall survival for resected IHCC, yet guidelines for the extent of LN dissection are not evidence-based. We evaluated whether the number of LNs resected at the time of surgery is associated with overall survival for IHCC. Methods Patients undergoing curative-intent (R0 or R1) resection for IHCC between 2004 and 2012 were identified within the US National Cancer Database. LN thresholds were evaluated using maximal chi-square testing and five-year overall survival was modeled using Kaplan–Meier and Cox regressions. Results 57% (n = 1,132) of 2,000 patients had one or more LNs resected and pathologically examined. In the 631 patients undergoing R0 resection with pN0 disease, maximal chi-square testing identified ≥3 LNs as the threshold most closely associated with overall survival. Only 39% of resections reached this threshold. On multivariable survival analysis, no threshold of LNs was associated with overall survival, including ≥3 LNs (p = 0.186) and the current American Joint Committee on Cancer recommendation of ≥6 LNs (p = 0.318). Conclusion In determining the extent of lymphadenectomy at the time of curative-intent resection for IHCC, surgeons should carefully consider the prognostic yield in the absence of overall survival benefit. [ABSTRACT FROM AUTHOR]

The Ogallala Aquifer Program (OAP) was created in 2003 with support from Congressmen from Kansas and Texas. The OAP is a research-education consortium seeking solutions from problems arising from declining water availability from the Ogallala Aquifer in western Kansas and the Texas High Plains. The consortium is led by the Agricultural Research Service (ARS) laboratories in Bushland and Lubbock, TX, and the university partners are Kansas State University, Texas A&M AgriLife Research and Extension Service, Texas Tech University, and West Texas A&M University. The OAP has provided over $40 million to support research and education activities. About half of these funds were used to support permanent ARS scientists and ARS hired post-docs. The other half were used by university scientists to supplement on-going projects by providing support for supplies, sample analyses, temporary employees, etc. Initially, OAP activities were focused on seven priorities. In 2013, four objectives replaced the original seven priorities. A fifth priority was added in 2017. The current objectives are: 1) Develop and evaluate water management strategies and technologies that could reduce water withdrawals for irrigation by 20% in 2020 compared to 2012; 2) Develop and evaluate management strategies and technologies that would increase the productivity and profitability of dryland cropping systems; 3) Improve the understanding of hydrological and climatic factors that affect water use and agricultural profitability; 4) Determine the impacts of alternative water withdrawal/use policies on the economic viability of the agriculture industry of the Southern Ogallala Aquifer Region; and 5) Develop best management practices for production of high value and alternative crops for both dryland and irrigated systems. The objectives of the program and distribution of resources are decided by an executive committee with a member from each of the four universities, two from ARS, one from Bushland, and the other from Lubbock. Proposed projects that utilize resources from more than one participating institution, leverage existing resources, and address the stated objectives are more likely to be provided support. The impact of the OAP on research directed at agriculture on the High Plains has been recognized by three prestigious awards. [ABSTRACT FROM AUTHOR]

Background & objectives Multidisciplinary tumor boards (MDTBs) are frequently employed in cancer centers but their value has been debated. We reviewed the decision-making process and resource utilization of our MDTB to assess its utility in the management of pancreatic and upper gastrointestinal tract conditions. Methods A prospectively-collected database was reviewed over a 12-month period. The primary outcome was change in management plan as a result of case discussion. Secondary outcomes included resources required to hold MDTB, survival, and adherence to treatment guidelines. Results Four hundred seventy cases were reviewed. MDTB resulted in a change in the proposed plan of management in 101 of 402 evaluable cases (25.1%). New plans favored obtaining additional diagnostic workup. No recorded variables were associated with a change in plan. For newly-diagnosed cases of pancreatic ductal adenocarcinoma (n = 33), survival time was not impacted by MDTB (p = .154) and adherence to National Comprehensive Cancer Network guidelines was 100%. The estimated cost of physician time per case reviewed was $190. Conclusions Our MDTB influences treatment decisions in a sizeable number of cases with excellent adherence to national guidelines. However, this requires significant time expenditure and may not impact outcomes. Regular assessments of the effectiveness of MDTBs should be undertaken. [ABSTRACT FROM AUTHOR]

The surgical management of primary and secondary liver tumors is constantly evolving. Patient selection, particularly with regard to determining resectability, is vital to the success of programs directed toward invasive treatments of liver tumors. Particular attention should be paid toward determining whether patients are best served with surgical resection or ablative therapies. A multidisciplinary approach is necessary to provide optimal care to patients with liver malignancy. [ABSTRACT FROM AUTHOR]

Background Payers and regulatory bodies are increasingly placing emphasis on cost containment, quality/outcome measurement and transparent reporting. Significant cost variation occurs in many operative procedures without a clear relationship with outcomes. Clear cost-benefit associations will be necessary to justify expenditures in the era of bundled payment structures. Methods All laparoscopic cholecystectomies ( LCCKs) performed within a single health system over a 1-year period were analysed for operating room (OR) supply cost. The cost was correlated with American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) outcomes. Results From July 2013 to June 2014, 2178 LCCKs were performed by 55 surgeons at seven hospitals. The median case OR supply cost was $513 ± 156. There was variation in cost between individual surgeons and within an individual surgeon's practice. There was no correlation between cost and ACS NSQIP outcomes. The majority of cost variation was explained by selection of trocar and clip applier constructs. Conclusions Significant case OR cost variation is present in LCCK across a single health system, and there is no clear association between increased cost and NSQIP outcomes. Placed within the larger context of overall cost, the opportunity exists for improved resource utilization with no obvious risk for a reduction in the quality of care. [ABSTRACT FROM AUTHOR]

The popularity of the term 'integrated curriculum' has grown immensely in medical education over the last two decades, but what does this term mean and how do we go about its design, implementation, and evaluation? Definitions and application of the term vary greatly in the literature, spanning from the integration of content within a single lecture to the integration of a medical school's comprehensive curriculum. Taking into account the integrated curriculum's historic and evolving base of knowledge and theory, its support from many national medical education organizations, and the ever-increasing body of published examples, we deem it necessary to present a guide to review and promote further development of the integrated curriculum movement in medical education with an international perspective. We introduce the history and theory behind integration and provide theoretical models alongside published examples of common variations of an integrated curriculum. In addition, we identify three areas of particular need when developing an ideal integrated curriculum, leading us to propose the use of a new, clarified definition of 'integrated curriculum', and offer a review of strategies to evaluate the impact of an integrated curriculum on the learner. This Guide is presented to assist educators in the design, implementation, and evaluation of a thoroughly integrated medical school curriculum. [ABSTRACT FROM AUTHOR]

BACKGROUND: Lenalidomide is an amino-substituted analog of thalidomide with potent immunomodulatory properties. The drug has been widely used for treatment of multiple myeloma and myelodysplastic syndrome (MDS) associated with 5q-abnormality. The most common side effects are cytopenias, infections, and deep venous thrombosis. CASE STUDY: We report a clinical observation of severe autoimmune hemolytic anemia (AIHA) due to cold agglutinin disease (CAD) that developed 11 days after initiation of lenalidomide treatment in a patient with MDS who relapsed after allogeneic bone marrow transplantation. RESULTS: CAD was diagnosed by the presence of hemolytic variables and cold agglutinin detected in patient's plasma. The antibody screen, which was performed at 37°C, was negative throughout. The direct antiglobulin test was positive only for complement (C3d). These findings supported the diagnosis of CAD associated with lenalidomide administration. Other causes of hemolysis including ABO incompatibility and infectious etiologies were ruled out. Rituximab therapy in conjunction with daily plasma exchange decreased the rate of hemolysis and transfusion requirement in our case. CONCLUSION: In addition to warm AIHA, lenalidomide use can also be associated with development of CAD. Rituximab given in conjunction with plasma exchange can be effective in treating CAD in this setting. [ABSTRACT FROM AUTHOR]

Poultry-litter applications to pastures can result in relatively high soil phosphorus (P) levels, which in turn can contaminate runoff and degrade surface water quality. New management protocols for temperate grasslands are needed to reduce the risk of P transport to surface water. The effects of three land-use treatments on soil characteristics related to P runoff were investigated using small watersheds with 8% slope near Booneville, Arkansas, U.S. The land use treatments were (1) haying of bermudagrass overseeded with winter annual forage (ryegrass or rye), (2) rotationally grazed, and (3) rotationally grazed with 12-m-wide tree buffer on the downhill portion of the plot. Plots and trees were established in 2003. Annual spring application of poultry litter (5.6 Mg ha−1) to the hayed or grazed portions of the plots was started in 2004. Grazing treatments were imposed shortly thereafter. By the summer of 2008 (4 years of treatments), soil concentrations of Bray 1–extractable P and soluble reactive P had increased significantly from approximately 40 and 4 mg P kg−1 soil, respectively, to more than 200 and 30 mg P kg−1 soil, respectively, in the areas of the plots receiving poultry litter. Soil bulk density in the portions of the plots being grazed had increased significantly also. The soil collected from the forested riparian buffer in 2008 had similar soil bulk densities and Bray 1–extractable P concentrations as the plots did in 2003 before treatments were imposed. [ABSTRACT FROM AUTHOR]

The attentions given to textual production in composition scholarship have led to a neglect of the dynamics of textual reception. Renewed acquaintance with the discipline of hermeneutics will provide scholars and instructors with a more comprehensive understanding of the relationship between interpretive processes and rhetorical strategies. Building on the work of Phelps, Mailloux, and Crusius, this article revisits Gadamer and Ricoeur, two of the more prominent scholars of modern hermeneutics, for the purpose of applying their principles to learning objectives and class assignments in college-level writing courses. [ABSTRACT FROM AUTHOR]

The article provides a critical reflection on the study of composition and rhetoric. It examines the connection between composition Studies and the humanities. The book "Arts of Living," by Kurt Spellmeyer about the state of the humanities in the academy is discussed. The article argues for balance in tendencies towards pragmatism under the context of composition studies or composition and rhetoric.

Abstract: Cationic, chiral arene ruthenium complexes of the type [Ru(η6-cym)(PPh3){κ2N,S-PhNC(S)R}]BPh4 were prepared in high yields by refluxing a mixture containing [(η6-cym)RuCl2]2, Ph3P, PhNHC(S)R, NaBPh4 and Et3N in MeOH. A series of seven complexes with different thioamide ligands was prepared and fully characterised by spectroscopic methods including NMR spectroscopy and electrospray mass spectrometry. The solid-state structures of two complexes were determined by single crystal X-ray diffraction. [Copyright &y& Elsevier]

Fungal polysaccharides and glucans, including lentinan from shiitakes, have been identified as promoting human health, and consequently, the sale of mushroom-based health products has increased significantly in recent years. Reliable methods for the quantitation of lentinan must be available if shiitakes or shiitake-derived products are to be promoted as health-promoting food. The objective of this study was to characterize two methods for the quantitation of β-glucans from aqueous extracts of shiitake mushrooms. The first method utilized ethanol precipitation and batch size exclusion chromatography to isolate a fraction enriched in lentinan, called high molecular weight polysaccharides, HMWP. Gel filtration chromatography characterization of HMWP fraction indicated that the size distribution of carbohydrates was similar to that of a lentinan standard. Analyses for total starch and glycogen, to a lesser extent, indicate these polysaccharides are less than 10% of the total carbohydrates in HMWP. These results suggest that the HMWP fraction had a high level of lentinan. The second method measured the production of glucose by enzymes that specifically hydrolyze plant β-glucans. The amount of carbohydrate detected by the enzymatic β-glucan assay was significantly less than the carbohydrate found in the HMWP fraction. The low content of β-glucan was not due to a failure of the assay's enzymes to function. In addition, no glucose was produced when a lentinan standard was subjected to the β-glucan assay. These results indicate that the carbohydrate content ofHMWPfraction was a better indicator of lentinan content of shiitakes compared to the mushroom's β-glucan content. [ABSTRACT FROM AUTHOR]

Soil chemical and physical reactions involving phosphorus (P) must be understood to predict the risk of P being transported from agricultural land to streams and lakes. The kinetics of P sorption by an Ultisols from West Virginia, USA, receiving P from fertilizers were compared to soils amended with turkey litter. Addition of 6.6 and 13.2 Mg turkey litter ha-1 increased Bray 1P levels to about the same level as adding 53 and 115 kg P ha-1, respectively. Phosphorus binding capacity decreased to a greater extent when P was added as fertilizer as compared to turkey litter. For example, P binding maximum was 360 mg P kg-1 dry soil when soil was amended with 6.6 Mg turkey litter ha-1 as compared to 260 mg P kg-1 dry soil when amended with 53 kg P ha-1. This study demonstrates that the decrease in P-binding capacity with increasing soil P is less when P is added as turkey litter. [ABSTRACT FROM AUTHOR]

Maintaining threshold populations of inoculum microorganisms in the soil environment is important for such practical applications as biocontrol, plant growth-promotion, bioremediation, and nodulation. However, because of both technical and labor constraints in monitoring bacterial viability in nonsterile soils, few studies have reported on survival kinetics, particularly in relation to subtle alterations in soil acidity-related factors. A genetically modified strain Pseudomonas putida R20/lacZY or Rhizobium leguminosarum bv. trsfolii 162S7a/gusA was introduced into conditioned, nonsterile Gilpin (fine loamy, mixed mesic, Typic Hapludult) silt loam soil, limed at four low levels (pHw 4.71, 4.81, 4.92, and 4.99) or derivative soil solutions with highly correlated (R² ≥ 0.81) chemical properties. Immediate declines in viability of both strains were found in all soils, reaching 0.1 to 1% initial colony-forming unit (CFU) g-1 soil in 35 h for P. putida and in 68 h for R. leguminosarum bv. trifolii. Death rate constants (kd) for both strains were directly related to lime level (soil pH), although differences were not significant (P > 0.05) for the rhizobium. Use of soil solutions gave similar responses for both strains, but over much shorter incubation times. As with soils, kd values for both strains in soil solutions were directly related to lime level (solution pH). In both soil and soil solution experiments, survival (kd) was negatively correlated (R² ≥ -0.914) with pH and basic cation (Ca and Mg), and positively correlated (R² ≥ 0.933) with Al, concentrations. This relationship of viability to soil solution chemistry was broadly confirmed for both bacterial strains by use of fluorescent probes, suggesting increased cell membrane damage at lower pHs. These results demonstrate not only the alternative utility of using soil solutions, rather than nonsterile soils, for bacterial viability assessments, but also the positive effect of low-level liming (∼0.28 pH unit increase) on survival of beneficial root-colonizing bacteria in acidic soils. [ABSTRACT FROM AUTHOR]

Discusses the collision between the personal beliefs of students with the discourse of the natural sciences in composition courses. Definition of personal beliefs according to scholar Patricia Sullivan; Depiction of a agonistic relationship between the discourses of science and personal belief in the films "Contact" and "The Exorcism of Emily Rose"; Appropriateness of global warming as an issue to be used in introducing students to scientific discourse.

Acidic soils tend to limit the nodulation of forage legumes and roothairs are important for Rhizobia binding and the initiation of nodule formation. This study examined the effects of Ca, pH, and Al on the length of roothairs in nutrient solutions and soils with white clover (Trifolium repens L., cultivar Huia) seedlings. The lengths of roothairs of 1- to 2 -d-old seedlings was not affected by increases in solution Al up to 24 μM in nutrient solution experiments, but showed a pronounced optimum at a predicted root surface pH of 3.8. Roothair lengths of white clover seedlings 2 to 10 d after planting were also assessed in a Gilpin series silt loam collected from New, WV, and amended with various levels of lime. Soils ranged in pH from 46 to 5.3 and soil base saturation of Al from 46 to 8%. No significant differences in roothair lengths as a function of soil pH and/or soil available Al were observed. Previous results conducted under similar experimental conditions demonstrated that soil pH-soil-available Al adversely affected on root elongation and nodulation. When results from this and the previous reports are considered together, the combined results suggest that root elongation and nodulation were more sensitive than roothair length to acidic soil conditions. [ABSTRACT FROM AUTHOR]

Acidic soils can reduce the nodulation of forage legumes. Studies with a Gilpin series silt loam (fine loamy, mixed mesic, Typic Hapludult) from New, WV, were conducted to determine the effects of lime on root development, and to assess effects of soil Ca and pH on nodulation. Liming increased soil pH from 4.8 to 5.3, nodulation, and root growth of white clover (Trifolium repens L., cultivar Huia) 28 d after planting. Seedlings from unlimed soil formed fewer indeterminate and determinate roots. Next, soils were amended with either CaCO[sub 3] or a mixture of CaCO[sub 3] and CaSO[sub 4] to achieve a soil pH of 4.7 to 6.1 and soil Ca of 170 to 680 mg kg[sup -1] soil. There was a strong quadratic relationship between number of nodules per white clover seedling 28 d after planting and soil pH. Another experiment was conducted to determine if these trends were expressed under field conditions. In 1993, field plots were amended with lime or a coal combustion by-product that supplied Ca as CaSO[sub 4] and seeded in 1994 to cool-season grasses. In spring of 1998, plots were drilled with either red (Trifolium pratense, L.) or white clover. The nodules per primary root were determined in May (1998, 1999) and August (1998). Number of nodules per primary root was more closely associated with soil pH than soil Ca. These results indicate that changes in nodulation were more closely associated with changes in soil pH than soil Ca. [ABSTRACT FROM AUTHOR]

Sustainability of grasslands results from complex interactions involving climate, soil, and forage and livestock management. Soils from the central Appalachian region are acidic and thus unlikely to support legume production without substantial soil fertility management. A survey was conducted to determine if the level of legume forages in central Appalachian grasslands was sufficient for sustainable productivity and if the levels of soil nutrients are sufficient to maintain legumes. Results from this survey indicated that the soil in most fields had adequate levels of plant nutrients for satisfactory forage legume production; however, most fields had sub-optimal levels of forage legumes. These results suggest that increases in the abundance of legume forages in the central Appalachian grassland will occur with changes in livestock and forage management rather than increasing soil fertility. [ABSTRACT FROM AUTHOR]

Phosphine ligands containing mono- and multiply substituted aromatic substituents (1–13, 19a and 19b) are accessible in high yields by palladium-catalyzed P&z.sbnd;C coupling reactions between primary, secondary or disecondary phosphines and iodo- or bromoaromatic compounds. The reaction is of broad applicability and compatible with electron donor or electron acceptor substituents in ortho, meta or para position to the halogen in the aromatic ring systems. It may be performed in protic and aprotic solvents. The chiral spirocyclic boronato complex 15a is formed upon reaction of 3 with boric acid, while with benzeneboronic acid 15c with a peripheral Lewis acid group is obtained. The Pd-mediated P&z.sbnd;C coupling reaction of primary phosphines proceeds stepwise, tailor-made chiral secondary (16) and tertiary phosphines (17) being formed in high yields. Through combination with Suzuki-type C&z.sbnd;C coupling reactions, the scope of Pd-catalyzed P&z.sbnd;C coupling may be extended further, with novel ligands (20a, 20b, 21a, 21b) with biphenylyl substituents being accessible. The X-ray structures of the salicylic acid derivative 3 (space group P1¯) and of ortho-iso-propylphenyl-diphenylphosphine 6 (space group Pbca) have been determined. [Copyright &y& Elsevier]

Acidic soils limit the land available for crop production and increase the cost of production in many regions of the United States and the world. The use of Aluminum (Al)-resistant germplasm is one means of reducing the impact of acidic soils and development of such germplasm is limited by our understanding of the processes that confer resistance. This study sought to associate changes in root growth rate with Al entry into the tissue of two cultivars of wheat (Triticum aestivum L.) differing in sensitivity to Al. Changes in the spectral characteristics of morin were characterized to determine if a dual excitation or emission assay for Al could be developed. It was not possible to develop such a protocol. However, an assay based on changes in fluorescence intensity of morin was adopted from the work of Vitorello and Haug. Addition of Al to a total concentration of 5 μM resulted in a 50% decrease in root elongation rate with the Al-sensitive cultivar, Scout, but little change in root elongation with the Al-resistant cultivar, Atlas. Inhibition of root growth occurred without a noticeable lag. The addition of Al to the external solution of bathing Scout roots caused an increase in the fluorescence of intracellular morin, indicative of Al entry into the root cells. No increase in morin fluorescence was observed with Atlas roots exposed to 5 μM Al. Therefore, there was an association between morin fluorescence, thus presumably Al entry, and inhibition of root growth. [ABSTRACT FROM AUTHOR]

Examines the N-halogenation of (CF3)3B.NH3 using cesium hypochlorite or hypobromite and substitution of hydrogen by fluorine. Spectra and properties of the compounds; Description of the crystal structure; Formation of stable salts by replacement of hydrogen; Stability of the B-N bond.

Expounds on the nature of the growing inequality in wages across skill levels in the United States. Wage trends in the 1980s; Prominent explanations for the wage gap; Trends in the U.S. economy in the 1980s; Role of technological improvement in the wage gap.

Compares the 1990-91 recession and the surrounding period of sluggish growth with earlier recessionary episodes. Background on the 1990-91 recession; Extended slow growth period from 1989 to 1993; Salient features of the period; Effect of the output gap; Economic indicators.

Examines the origins, scope and sectoral profile of the New York City recession. The scope of the recession; Industrial composition and employment growth; Effect of the city's continuing economic imbalances; Conclusions.

Presents an overview of inflation measurements in the United States. Types of price indexes; Differences in the construction and coverage of the measurements; Issues affecting the measurement of prices for a broad range of goods and services; Comparisons between the three major inflation indexes; Specific inflation measures.

Examines whether the increased penetration of imports has been a major factor behind the sluggish growth of manufacturing wages in the United States. An overview of the data; Possible theoretical connections between an industry's exposure to competition from imports and the wages earned by its workers; Influence of imports on manufacturing wages; Conclusion. INSET: Box: Conceptual issues..

Understanding the regulatory properties of the activities of the V‐type adenosine triphosphatase (ATPase) on tonoplast membranes is important in determining the mechanisms by which this enzyme controls cytoplasmic and vacuolar pH. The possible existence of a regulatory site for adenine nucleotides was examined by comparing the effects of ADP, adenylylimidodiphosphate (AMP‐PNP) and 3′‐o‐(4‐benzoyl) benzoyladenine 5′‐triphosphate (BzATP) to those of the 2′,3′‐dialdehyde derivative of AMP (oAMP) and ATP by using highly purified tonoplast vesicles from maize (Zea mays L. cv. FRB 73) roots. The addition of either AMP‐PNP or BzATP reversibly inhibited the initial rate of proton transport catalyzed by the H+‐ATPase in a concentration‐dependent manner. Less than 20 μM AMP‐PNP or 50 μM BzATP was sufficient to inhibit half the initial rate of proton transport in the presence of 2 mM ATP and an excess of Mg. Both analogs increased the Km for ATP and reduced the maximum enzyme velocity. The presence of ADP also inhibited proton transport. The characteristics of ADP‐induced inhibition were similar to those of BzATP and AMP‐PNP. The addition of the periodated derivative of AMP (oAMP) irreversibly inhibited the ATPase in a concentration and time‐dependent manner similar to that reported previously (Chow et al. 1992, Plant Physiology 98: 44–52). Irreversible inhibition by oAMP reduced the maximum velocity of the tonoplast ATPase and was prevented by the addition of ATP. The presence of ADP, AMP‐PNP or BzATP had no effect on irreversible inhibition by oAMP. The effects of ADP, AMP‐PNP and BzATP on the kinetics of ATP utilization and the lack of protection against inhibition by oAMP argue in favor of at least two types of nucleotide binding sites on the V‐type ATPase from maize root tonoplast membranes. [ABSTRACT FROM AUTHOR]

The nitrate-sensitive proton-translocating adenosine triphosphatase (H+-ATPase) of tonoplast membranes plays an important role in regulating the flow of nutrients and metabolic waste between the cytoplasm and vacuole in the cells of plant roots. Relatively little information is available regarding the coupling between ATP hydrolysis and proton pumping by the nitrate-sensitive, tonoplast H+-ATPase. The coupling may be achieved either directly, i.e. the two reaction pathways share at least- one common molecular step, or indirectly, i.e. the two reaction pathways do not share an intermediate step. These coupling mechanisms may be differentiated by the responses of the two events to external perturbation. The effects of the presence of nitrate in the assay medium on the rates of ATP hydrolysis and proton transport catalyzed by the tonoplast H+-ATPase from maize (Zea mays L. cv. FRB 73) were investigated. The presence of nitrate inhibited proton transport activity of the tonoplast H+-ATPase to a much greater degree than ATP hydrolysis. This differential response of the two activities to nitrate is the basis for a proposed reaction model for the tonoplast H+-ATPase that features an indirect coupling mechanism between ATP hydrolysis and proton transport. [ABSTRACT FROM AUTHOR]

Protons pumps of the tonoplast may be involved in the regulation of cytosolic pH, but the effects of pH on the coupled activities of these transporters are poorly understood. The effects of pH on the activities of the H+-translocating pyrophosphatase (PPiase) and vacuolar-type H+-translocating adenosine triphosphatase (H+-ATPase) from maize (Zea mays L. cv. FRB 73) root membranes were assessed by changes in acridine orange absorbance, and the data were analyzed according to a model that simultaneously considers proton transport by the pump and those processes that reduce net transport. The addition of either pyrophosphate or ATP to either microsomal or tonoplast membranes generated a pH gradient. The pH gradient generated in the presence of both substrates was not the sum of the gradients produced by the two substrates added separately. When membranes were separated by sucrose density gradient centrifugation, pyrophosphate (PPi)dependent proton transport was associated with light density membranes having tonoplast H+-ATPase activity. These results indicate that some portion of the PPiase was located on the same membrane system as the tonoplast ATPase; however, tonoplast vesicles may be heterogeneous, differing slightly in the ratio of ATP- to PPi-dependent transport. Proton transport by both the PPiase and ATPase had maximal activity at pH 7.0 to 8.0. Decreases in proton transport by the ATPase at pH above the optimum were associated with increases in the processes that reduce net transport. Such an association was not observed at pH values below the optimum. These results are discussed in terms of in situ regulation of cytoplasmic pH by the two pumps. [ABSTRACT FROM AUTHOR]

Corn (Zea mays L) plasma membranes from KI-washed microsomal fractions were further purified by isopycnic sucrose density centrifugation. An examination of separated fractions indicated that vesicles with nitrate-insensitive proton transport copurified with fractions containing vanadate-sensitive ATPase activity. The ATPase in purified plasma membrane was reconstituted into liposomes by a detergent dilution technique using deoxycholate. The reconstituted ATPase exhibited characteristics similar to those of the native enzyme. However, reconstituted preparations showed an enhanced sensitivity to vanadate, a diminished phosphatase activity and a high specific rate of ATP-dependent H+-transport Apparent Ki values of reconstituted and native enzymes with respect to vanadate were 20 and 50 μM, respectively, the Ki value of the H+-pumping of reconstituted ATPase was 30 μM. The proton pumping of reconstituted vesicles could be discharged rapidly by p-tnfluoromethoxy-phenyl hydrazone (FCCP), hexokinase and vanadate. The hydrolysis of Mg-ATP by both native and reconstituted ATPases obeyed simple Michaelis-Menten plots with a Km between 0.5 and 0.6 mM. The reconstituted ATPase retained a pH profile similar to that of native enzyme with a maximum of pH 6.5. [ABSTRACT FROM AUTHOR]

Sheds light on the relationship between labor costs and price inflation. Compensation growth in the services industry as predictor of prices; Previous studies of labor costs and inflation; Labor costs and price determination in the goods and services sector; Labor costs and core inflation; Consumer Price Index trends in different expenditure categories; Testing of compensation-price links.

Examines unemployment trends in New York City, as of the second quarter of 1997. Percentage increase of unemployment; Impact of the patterns in payroll and household employment; Factors boosting labor force participation; Other major economic trends.

Presents an overview of earnings inequality in the New York-New Jersey region. Defining a simple measure of inequality; National and regional trend on the earnings gap between upper income workers and lower income workers; Decade-by-decade comparison; Earnings disparities within the region.

Background: Hepatopancreatobiliary (HPB) and gastric oncologic operations are frequently performed at referral centers. Postoperatively, many patients experience care fragmentation, including readmission to "outside hospitals" (OSH), which is associated with increased mortality. Little is known about patient-level and hospital-level variables associated with this mortality difference.Study Design: Patients undergoing HPB or gastric oncologic surgery were identified from select states within the Healthcare Cost and Utilization Project database (2006-2014). Follow-up was 90 days after discharge. Analyses used Kruskal-Wallis test, Youden index, and multilevel modeling at the hospital level.Results: There were 7,536 patients readmitted within 90 days of HPB or gastric oncologic surgery to 636 hospitals; 28% of readmissions (n = 2,123) were to an OSH, where 90-day readmission mortality was significantly higher: 8.0% vs 5.4% (p < 0.01). Patients readmitted to an OSH lived farther from the index surgical hospital (median 24 miles vs 10 miles; p < 0.01) and were readmitted later (median 25 days after discharge vs 12; p < 0.01). These variables were not associated with readmission mortality. Surgical complications managed at an OSH were associated with greater readmission mortality: 8.4% vs 5.7% (p < 0.01). Hospitals with <100 annual HPB and gastric operations for benign or malignant indications had higher readmission mortality (6.4% vs 4.7%, p = 0.01), although this was not significant after risk-adjustment (p = 0.226).Conclusions: For readmissions after HPB and gastric oncologic surgery, travel distance and timing are major determinants of care fragmentation. However, these variables are not associated with mortality, nor is annual hospital surgical volume after risk-adjustment. This information could be used to determine safe sites of care for readmissions after HPB and gastric surgery. Further analysis is needed to explore the relationship between complications, the site of care, and readmission mortality. [ABSTRACT FROM AUTHOR]

Examines hydrogen bonding in the structure of 1-carbamoyl-guanidinium methylphosphonate monohydrate. Study of bond angles and bond length in the methylphosphonate anion; Planar structure of non-hydrogen-atom skeleton of the cation; Atoms that connect carbamoylguanidinium cation with methylphosphonate anion.

Background: With increased scrutiny on the quality and cost of health care, surgeons must be mindful of their outcomes and resource use. We evaluated surgeon-specific intraoperative supply cost (ISC) for pancreaticoduodenectomy and examined whether ISC was associated with patient outcomes.Study Design: Patients undergoing open pancreaticoduodenectomy between January 2012 and March 2015 were included. Outcomes were tracked prospectively through postoperative day 90, and ISC was defined as the facility cost of single-use surgical items and instruments, plus facility charges for multiuse equipment. Multivariate logistic regression was used to test associations between ISC and patient outcomes using repeated measures at the surgeon level.Results: There were 249 patients who met inclusion criteria. Median ISC was $1,882 (interquartile range [IQR] $1,497 to $2,281). Case volume for 6 surgeons ranged from 18 to 66. Median surgeon-specific ISC ranged from $1,496 to $2,371. Greater case volume was associated with decreased ISC (p < 0.001). Overall, ISC was not predictive of postoperative complications (p = 0.702) or total hospitalization expenditures (p = 0.195). At the surgeon level, surgeon-specific ISC was not associated with the surgeon-specific incidence of severe complication or any wound infection (p > 0.227 for both), but was associated with delayed gastric emptying (p = 0.004) and postoperative pancreatic fistula (p < 0.001).Conclusions: In a single-institution cohort of 249 pancreaticoduodenectomies, high-volume surgeons tended to be low-cost surgeons. Across the cohort, ISC was not associated with outcomes. At the surgeon level, associations were noted between ISC and complications, but these may be attributable to unmeasured differences in the postoperative management of patients. These findings suggest that quality improvement efforts to restructure resource use toward more cost-effective practice may not affect patient outcomes, although prospective monitoring of safety and effectiveness must be of the utmost concern. [ABSTRACT FROM AUTHOR]

The goal of this pilot study was to track patient outcomes after an expedited discharge after enhanced recovery after surgery (ERAS) pathway for pancreaticoduodenectomy (PD). A quantitative content analysis approach was used. All PD patients in a single academic medical center between February 2017 and June 2018 were called twice by specialized physician extenders after discharge. A semi-structured interview approach was used to identify patient's symptoms or concerns, proactively educate them, and provide outpatient management when indicated. A detailed narrative of the conversation was documented. Ninety patients (mean age 66.3; 58.1% males) were included in the study. Of all, 88.9 per cent of the patients received follow-up phone calls in accordance with our PD ERAS protocol. Among the 80 patients called, 71 (88.8%) reported at least one symptom, issue, or self-care need. The most common issues involved bowel movements and nutrition. A total of 147 interventions were performed to address patient needs including medication management, local care coordination, and outpatient referral to a healthcare provider. The intervention led to the identification of 15 patients for earlier evaluation. This identification was associated with the total number of reported symptoms (X² = 15.6, P = 0.004). Most patients require additional care after discharge after traditional ERAS pathways. ERAS transitional care protocols uncovered an unmet need for additional patient support after PD. [ABSTRACT FROM AUTHOR]

Background: Operative site drainage (OSD) after elective hepatectomy remains widely used despite data suggesting limited benefit. Multi-institutional, quality-driven databases and analytic techniques offer a unique source from which the utility of OSD can be assessed.Study Design: Elective hepatectomies from the 2014 American College of Surgeons (ACS) NSQIP Targeted Hepatectomy Database were propensity score matched on the use of OSD using preoperative and intraoperative variables. The influence of OSD on the diagnosis of postoperative bile leaks, rates of subsequent intervention, and other outcomes within 30 days were assessed using paired testing.Results: Operative site drainage was used in 42.2% of 2,583 eligible hepatectomies. There were 1,868 cases matched, with 7.2% experiencing a post-hepatectomy bile leak. The incidence of bile leak initially requiring intervention was no different between the OSD and no OSD groups (n = 32 vs n = 24, p = 0.278), and OSD was associated with a greater number of drainage procedures to manage post-hepatectomy bile leak (n = 27 in the OSD group, n = 13 in the no OSD group, p = 0.034, relative risk [RR] 2.1 [95% CI 1.1 to 4.0]). The OSD group had a greater mean length of stay (+0.8 days, p = 0.004) and more 30-day readmissions (p < 0.001, RR 1.6 [95% CI 1.2 to 2.1]). On multivariate analysis, post-hepatectomy bile leak and receipt of additional drainage procedures were stronger predictors of increased length of stay and readmissions than OSD.Conclusions: In a propensity score matched cohort, OSD did not improve the rate of diagnosis of major bile leaks and was associated with increased interventions, greater length of stay, and more 30-day readmissions. These data suggest that routine OSD after elective hepatectomy may not be helpful in capturing clinically relevant bile leaks and has additional consequences. [ABSTRACT FROM AUTHOR]