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The Silurian Akkas Formation has been reported and described only in the subsurface of western Iraq. The formation is divided into the lower Hoseiba Member, which contains two high‐TOC "hot" shale intervals that together are around 60 m thick, and the overlying Qaim Member that is composed of lower‐TOC "cold" shales. This study investigates the source rock potential of Akkas Formation shales from the Akkas‐1and Akkas‐3 wells in western Iraq and assesses the relationship between their mineral and elemental contents and their redox depositional conditions and thermal maturity. Twenty‐six shale samples from both members of the Akkas Formation from the Akkas‐1and Akkas‐3 wells were analysed. The results showed that the upper, ~20 m thick"hot" shale interval in the lower Hoseiba Member has good source rock characteristics with an average TOC content of 5.5 wt% and a mean Rock‐Eval S2 of 10 kg/tonne. Taken together, the two "hot" shale intervals and the intervening "cold" shale of the Hoseiba Member are ~125‐150 m thick and have an average TOC of 3.3 wt% and mean S2 of 6.2 kg/tonne. The samples from the Hoseiba Member contain mixed Type II / III or Type III kerogen with an HI of up to 296 mgS2/gTOC. Visual organic‐matter analysis showed that the samples contain dark brown, opaque amorphous organic matter with minor amounts of vitrinite‐like and algal (Tasmanites) material. Pyrolysis – gas chromatography undertaken on a single sample indicated a mature (or higher) algal‐dominated Type II kerogen. High spore and acritarch colour index values and weak or absent fluorescence similarly suggest that the lower part of the Akkas Formation is late mature to early post‐mature for oil generation. "Cold" shales from the Qaim Member in the Akkas‐3 well may locally have good source rock potential, while samples from the upper part of the Qaim Member from the Akkas‐1 well have little source rock potential. Varied results from this interval may reflect source rock heterogeneity and limited sample coverage. Mineralogically, all the shale samples studied were dominated by clay minerals – illite and kaolinite with minor amounts of chlorite and illite mixed layers. Non‐clay minerals included quartz, carbonates, feldspars and pyrite along with rare apatite and anatase. Palaeoredox proxies confirmed the general link between anoxia and "hot" shale deposition; however, there was no clear relationship between TOC and U suggesting that another carrier of U could be present. Rare Earth Element (REE) contents suggested a slight change in sediment provenance during the deposition of the Akkas Formation. The presence of common micropores and fractures identified under SEM indicates that these shales could become potential unconventional reservoirs following hydraulic fracturing. Evidence for the dissolution of carbonate minerals was present along fractures, suggesting the possible passage of diagenetic fluids. Palynological analysis combined with existing graptolite studies support a Wenlock ‐ Pridoli/Ludlow age for the Akkas "hot"shales. This is younger than many other regional "hot shale" age estimates and warrants further detailed investigation. [ABSTRACT FROM AUTHOR]

The goal of this study was to evaluate the anti-tumour activity and toxicoses of vinorelbine as a palliative rescue therapy for dogs with primary urinary bladder carcinoma. Thirteen dogs refractory to prior chemotherapeutics and one dog naïve to chemotherapeutic treatment were enrolled. Vinorelbine (15 mg m−2 IV) was administered intravenously along with concurrent oral anti-inflammatory drugs, if tolerated. A median of six doses of vinorelbine (range: 1-16) was administered. Two dogs (14%) had partial responses, and eight (57%) experienced stable disease. Subjective improvement in clinical signs was noted in 11 dogs (78%). Adverse events were mild and primarily haematological in nature. Median time to progression was 93 days (range: 20-239 days). Median survival time for all dogs was 187 days; median survival for 13 pre-treated dogs was 207 days. Vinorelbine may have utility in the management of canine primary urinary bladder carcinoma and should be evaluated in a prospective study. [ABSTRACT FROM AUTHOR]

Background: The ankle brachial index (ABI) is an objective diagnostic tool that is widely used for the diagnosis of peripheral arterial disease. Despite its usefulness, it is evident within the literature that many practitioners forgo using this screening tool due to limiting factors such as time. There is also no recommended technique for ABI measurement. The purpose of this study is to investigate the perceptions of the use of ABI clinically among Western Australian podiatrists. Methods: This study was a cross sectional survey which evaluated the perceptions of the ABI amongst registered podiatrists in Western Australia. The study sample was obtained from the register of podiatrists listed with the Podiatrists Registration Board of Western Australia. Podiatrists were contacted by telephone and invited to participate in a telephone questionnaire. Chi-square tests were performed to determine if there was a statistically significant relationship between use of the ABI and podiatrists' profile which included: sector of employment; geographical location; and length of time in practice. Results: There is a statistically significant relationship (p=0.004) between podiatrists' profile and the use of ABI, with higher usage in the tertiary hospital setting than in private practice. Length of time spent in practice had no significant impact on ABI usage (p=0.098). Time constraints and lack of equipment were key limiting factors to performing the ABI, and no preferred technique was indicated. Conclusion: Western Australian podiatrists agree that the ABI is a useful tool for lower limb vascular assessment, however, various factors influence uptake in the clinical setting. This study suggests that a podiatrists' profile has a significant influence on the use of the ABI, which may be attributed to different patient types across the various settings. The influence of time spent in practice on ABI usage may be attributed to differences in clinical training and awareness of lower limb pathology over time. The authors recommend publication of 'best practice' guidelines to ABI performance, as well as further education and financial rebates from health organizations to facilitate increased utility of the ABI based on the findings of this study. [ABSTRACT FROM AUTHOR]

Background: Bloating, flatulence, early satiety, and dysphagia resolve in more than 90% of patients early after fundoplication. Gastric dysfunction can persist, however, and a small number of patients develop severe gastric dysfunction (gastroparesis). Management of gastroparesis after antireflux procedures is generally conservative, but gastroparesis can become refractory to medical therapy. The aim of this study was to assess the role of gastric resection in the management of the unusual patient with severe postfundoplication gastric dysfunction. Methods: From January 1990 to October 2010, a total of 5,129 gastric resections were performed at our institution. From this cohort, we identified nine patients with postfundoplication gastric dysfunction managed with gastric resection. Clinical records were reviewed retrospectively for preoperative evaluation, perioperative course, and long-term outcomes. Results: Over 20 years, nine patients were treated with gastric resection for debilitating gastric dysfunction after antireflux surgery. Seven of the nine patients were female; the median preoperative body mass index was 25 kg/m (18-31 kg/m). Median follow-up was 23 months (1-97 months). Preoperatively, five patients required enteral feeding. Postoperatively, although there were no deaths, one patient required operative drainage of a subphrenic abscess, one developed temporary respiratory failure, and one was readmitted for partial small bowel obstruction. Six of the nine patients maintain their nutrition orally, but three are maintained with enteral nutrition. Only two patients are subjectively asymptomatic. Conclusions: Outcomes after gastric resection for postfundoplication gastric dysfunction are poor, with three of the nine patients requiring supplemental nutrition and seven of the nine having persistent symptoms. [ABSTRACT FROM AUTHOR]

The declining incidence of AIDS-related opportunistic diseases among people with HIV infection has shifted the focus of clinical management to prevention and treatment of comorbidities such as chronic liver disease. The increased risk of hepatitis C virus (HCV)-related advanced liver disease in people with HIV infection makes early HCV diagnosis a priority. To assess HCV prevalence and predictors of HIV/HCV coinfection, we have conducted a retrospective analysis of people enrolled in the CAESAR (Canada, Australia, Europe, South Africa) study, a multinational randomized placebo-controlled study of the addition of lamivudine to background antiretroviral therapy. The impact of HCV on HIV disease progression was also examined. Anti-HCV antibody testing on 1649 CAESAR study participants demonstrated a HIV/HCV coinfection prevalence of 16.1%, which varied from 1.9% in South Africa to 48.6% in Italy. The strongest predictor of HIV/HCV coinfection was HIV exposure category (P<0.0001), with odds ratios (ORs) compared to homosexual as follows: injecting drug use (IDU), 365 [95% confidence interval (CI): 179–742]; transfusion or blood products, 32.2 (95% CI: 15.2–67.6); homosexual and IDU, 22.9 (95% CI: 8.5–62.1). The prevalence of HIV/HCV was low (3.7%) among homosexual men without reported IDU. Other predictors of HIV/HCV coinfection were alanine aminotransferase (ALT), country of residence, ethnicity and stage of HIV disease. A history of IDU or ALT ≥ 40 U/L at baseline had a positive predictive value (PPV) of 35%, negative predictive value (NPV) of 96%, sensitivity of 82% and specificity of 71% for HIV/HCV coinfection. HIV disease progression was similar in HIV monoinfected and HIV/HCV coinfected patients. People with HIV and a history of IDU or elevated liver function tests should be targeted for HCV testing. The low prevalence of HIV/HCV coinfection among homosexual men without a history of IDU suggests low efficiency of sexual HCV transmission. [ABSTRACT FROM AUTHOR]

The Cenozoic evolution of the North China basin consists of early Tertiary rifting and differential subsidence, late Tertiary regional subsidence and Quaternary rifting and differential subsidence. Present Cenozoic sediment fill shows that Tertiary subsidence was greatest where the present thickness of pre-Cenozoic crust is least. In contrast, Quaternary subsidence has been greatest where the present thickness of pre-Cenozoic crust is greatest. The present crustal structure, geologic history and Cenozoic sediment fill of the basin suggest a nearly constant crustal thickness of ∼40 km at the onset of rifting (middle Eocene). If the present thickness of pre-Cenozoic crust is due solely to crustal thinning from early Tertiary mechanical extension then the central North China basin has been extended at least 30% of its initial width. This is greater than estimates of total Mesozoic plus Cenozoic extension derived from basement faulting, ∼20%. At the present time any possible discrepancies cannot be resolved due to uncertainties in the data. Tertiary subsidence of the basin, derived from backs tripping the present sedimentary sequence, is not satisfactorily explained by either a simple uniform or two-layer extensional model. No single extension parameter (uniform) or pair of extension parameters (two-layer) can account for the variable sediment thicknesses or the alternating horst and graben configuration of the basin. We can, however, use the parameters derived from simple one- or two-layer extensional modeling to infer lower bounds for both the average regional extension of the Bohai and the local extension of the depressions within the basin. For example, we find that the Neogene subsidence of a major part of the basin, the central Bozhong depression, has been nearly as rapid as that of young oceanic crust. Furthermore the present heat flow in this area is consistent with that for oceanic crust of 16-24 million years of age (post rift time). This indicates that the subsidence may be due to decay of a lithospheric thermal anomaly that is nearly as large as that in young oceanic crust. This is difficult to understand with a simple extensional framework because reported estimates of early Tertiary extension from basement faulting are only 10-30%. Possible sources of this excess heat are Mesozoic tectonics, effects of plate subduction at the Pacific margin, or energy input from regional tectonics during the early Tertiary. Our conclusions cast doubt upon the adequacy of simple extensional models to explain the Cenozoic evolution of the North China basin; however these conclusions can only be tentative due to inadequacies in the basic data set. [ABSTRACT FROM AUTHOR]

The Xialiao depression is one of several small depressions that comprise the North China basin. Formed during the Cenozoic era, the Xialiao depression is a wedge shaped rift basin with a central horst situated between two grabens. The basin is approximately 65 km wide and the grabens reach maximum depths of 6-7 km. We present a quantitative analysis of the evolution of the Xialiao depression (hereafter, the Xialiao basin) within the framework of simple models of crustal extension. We find that both uniform and modified (two-layer) extension modelling techniques provide reasonable regional estimates of the rate of extension and subsidence of the basin. However, estimations of heat flow and subsidence based on the parameters calculated using either modelling technique are not consistent with either the present basin configuration of a central horst flanked by two grabens or the high heat flow in the Xialiao basin. Combining the results of our attempts to model the extension of the basin with results from both body and surface wave studies of the crust and upper mantle beneath northeast China, we infer that the Xialiao basin has been extended at least 30% of its initial width. [ABSTRACT FROM AUTHOR]

In general contemporary usage, the term civil rights is related to the protection of the rights of minorities and civil liberties applies to the rights and freedoms of individuals that are, or ought to be, protected by government. Their expression in legal documents is both positive and negative, the latter being more traditional and common. This paper focuses on guarantees of civil liberties and civil rights in 16 recently rewritten or revised U.S. constitutions. These include 10 state charters adopted since 1950. The principal purpose of the analysis is to identify principal changes in civil liberties guarantees in recently revised state charters designed by constitution makers to meet current and future needs.

Extracts of Chaetomium globosum contained an unstable, NAD-dependent mannitol dehydrogenase, oxidizing mannitol to fructose. The enzyme had a low affinity for its substrates but showed high activity in vitro. Compared to fructose, exogenous mannitol was poorly utilized by the fungus. Raising the pH of the medium resulted in improved growth of the fungus on mannitol, in increased formation of ketose in the medium, and in stimulation of mannitol dehydrogenase formation. By contrast, glucokinase and fructokinase activities were depressed by growth at the higher pH. The possible involvement of a mannitol dehydrogenase in the utilization of exogenous mannitol is discussed, together with the factors probably contributing to the poor growth of the fungus on mannitol and the control of cellular mannitol formation. [ABSTRACT FROM AUTHOR]

Specific ATP-phosphotransferases for glucose, fructose and mannose, and glucosephosphate and mannosephosphate isomerases have been extracted from Chaetomium globosum. The fructokinase is stabilized by potassium whereas the glucokinase is activated by this cation, but is, otherwise, more stable than the former. The less-studied mannokinase showed no requirement for potassium. The inhibition of the fructokinase by glucose and mannose, and of the glucokinase by mannose are detailed, together with pH optima, K[Subm] values and other properties of the enzymes. The level of glucosephosphate isomerase was found to be higher in fructose-grown than in glucose-grown mycelium. The role of the enzyme systems in the absorption and utilization of exogenous hexoses is discussed. [ABSTRACT FROM AUTHOR]

The uptake of the hexoses, glucose, fructose and mannose, by resting mycelium of Chaetomium globosum results in synthesis of the reserve carbohydrates, trehalose and glycogen, which form, respectively, 5-7% and I2-23% of the dry mycelium. Glucose is the only free reducing sugar present in detectable amounts. The presence of galactose and mannose in acid extracts of mycelium suggests that polymers of the galacto-mannan type are important components of the cell wall. Mannitol forms a very small proportion of the total cellular carbohydrates but its level is two to three times greater in mycelium incubated on fructose or mannose than when incubated on glucose. There is an increase in the level of polyol during starvation of the mycelium as glycogen disappears and glucose accumulates. These observations are discussed in relation to the distribution and metabolism of fungal reserve carbohydrates in general. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which is concerned with the effects of magic in medical epidemiology.

The question of the linear independence of testing functions used in, the method of moments is studied. Using functional analysis a recent claim that certain testing functions are not linearly independent is shown to be incorrect. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding the effect of mental disorder on the physical health and behavior of individuals.

A letter to the editor is presented in response to the article "Do the protective effects fade away?," by Kari Poikolainen in the 2007 issue.

Responds on a comment on an article about the linear independence of testing functions used in the method of moments. Purpose of the comment; Semantics used; Criticisms made by the authors.

Background: Multiple outcomes measures including exercise capacity and quality of life are necessary to get complete and accurate picture of cystic fibrosis (CF) progression. In this pilot study, we investigated these measures in CF longitudinally for a year to determine (a) minimal clinically important difference (MCID) for 6-minute walk distance (6MWD) and CF Health-Related Quality of Life Questionnaire (CFQ-R) domains and (b) how 6MWD, CFQ-R, and spirometry change during times of exacerbation and baseline health and their relationship among each other., Methods: Subjects with moderate and severe CF (baseline FEV 1 less than 70% predicted) at Akron Children's Hospital CF centre were followed for a full year longitudinally. All three tests (6MWT, CFQ-R, and spirometry) were done during each outpatient visit and weekly during inpatient admission. MCID was estimated for these parameters using distribution-based methods. Finally, data were examined visually using longitudinal graphs for each subject., Results: Twelve CF subjects (eight [67%] males and age range 13-46 years) were followed for a full year resulting in at least four encounters per subject. 6MWD (m) and CFQ-R respiratory had an MCID of 33 m and 7.3, respectively. MCIDs for FEV 1 (percentage predicted) and CFQ-R physical were 7.1 and 11.4, respectively. The longitudinal evaluation of multiple outcome measures during periods of disease exacerbation and baseline health showed that these parameters did not appear to change in accordance with each other., Conclusion: In this pilot study, MCIDs for 6MWD and CFQ-R domains were calculated for the first time to facilitate their use as additional outcome measures in CF. The disparity among multiple outcome measures highlights that these measures together may provide a more complete picture in CF than any single measure alone., (© 2019 John Wiley & Sons, Ltd.)

Objectives: Learning to perform physical examination of the abdomen is a challenge for medical students. Medical educators need to find engaging, effective tools to help students acquire competence and confidence in abdominal examination techniques. This study evaluates the added value of ultrasound training when Year 1 medical students learn abdominal examination., Methods: The study used a randomised trial with a wait-list control condition. Year 1 medical students were randomised into 2 groups: those who were given immediate ultrasound training, and those for whom ultrasound training was delayed while they received standard instruction on abdominal examination. Standardised patients (SPs) used a clinical skills assessment (CSA) checklist to assess student abdominal examination competence on 2 occasions - CSA-1 and CSA-2 - separated by 8 weeks. Students also estimated SP liver size for comparison with gold-standard ultrasound measurements. Students completed skills confidence surveys., Results: Proficiency in abdominal examination technique acquired from traditional instruction boosted with ultrasound training showed no advantage at CSA-1. However, at CSA-2 the delayed ultrasound training group showed significant improvement. Students uniformly underestimated SP liver sizes and the estimates were not affected by ultrasound training. Student confidence in both groups improved from baseline to CSA-1 and CSA-2., Conclusions: Ultrasound training as an adjunct to traditional means of teaching abdominal examination improves students' physical examination technique after students have acquired skills with basic examination manoeuvres.

A review of the current theories on the nature of the placental allograft and the evolution of placentation in the presence of a cellular immune response highlights the inability of current hypotheses to explain the success of both invertebrate and vertebrate placentation. Only one theory -- "the anatomical separation of the fetus from the mother" -- appears relevant. How this separation might develop during implantation is discussed.

Dialysis patients are at risk for toxicity from formaldehyde used in the reprocessing of dialyzers for reuse; therefore, replacing formaldehyde as a dialyzer sterilant would be advantageous. The potential for RenNew-D as a sterilizing agent was investigated in seven stable in-center hemodialysis patients over 20 consecutive dialyses with cuprammonium cellulose hollow-fiber dialyzers. Treatment with RenNew-D showed no toxicity to patients or dialyzers except for two blood leaks occurring in one patient. The mean number of dialyzer uses was 4.9. In all the dialyzers that passed functional testing small solute clearances were maintained with reuse. The ability of RenNew-D to improve the biocompatibility of reused dialyzers was documented with mean neutrophil counts falling to only 78% of initial values during first reuse of dialyzers processed with RenNew-D compared with a decrease in neutrophil count to 2% of initial values during first use of the same dialyzers. Our results suggest that RenNew-D may be a useful alternative to formaldehyde for the purpose of dialyzer reuse. A reuse procedure that includes processing with RenNew-D is associated with improved biocompatibility, possibly because of maintenance of the blood-derived membrane coating established during prior dialysis.