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Rural communities are a vital segment of the US population; however, these communities are shrinking, and their population is aging. Rural women experience health disparities including increased risk of maternal morbidity and mortality. In this article, we will explore these trends and their determinants both within and external to the health care system. Health care providers, public health professionals, and policymakers should be aware of these social and structural factors that influence health outcomes and take action to reduce generational cycles of health disparity. Opportunities to improve the health and pregnancy outcomes for rural women and rural populations are highlighted.

The introduction to the EJSP special issue brings together recent literature on allyship. We present and discuss different definitions of allyship and highlight a multiple perspectives approach to understanding the predictors and consequences of allyship. This approach suggests that engagement in allyship can be driven by egalitarian and non-egalitarian motivations and that the behaviours identified as allyship can have different meanings, causes and consequences depending on whether researchers take into account the allies’ perspective or the disadvantaged groups’ perspective. We use this approach as an organizing principle to identify themes that emerge in the papers included in this special issue. We start with four papers that consider the perspective of the advantaged group, followed by two papers that consider the perspective of the disadvantaged group. Finally, we introduce two theoretical papers that examine the relations between disadvantaged groups and allies, and we set out directions for future research.

Background: Manufacturing companies nowadays have to cope with ever-increasing speed and complexity to manage their global supply chain. Information flow manage the supply chain needs to be more accurate and real-time than ever before. Item master data management is no exception as well. This research demonstrates the potential benefits of applying robotic process automation (RPA) technology in master data management based on two companies in the manufacturing industry. Methods: The method approached by the research was a qualitative method, utilizing interpretation of data extracted from literature and semi-constructed interviews. Results: The article proposes a framework for RPA implementation in the master data managing process. Automation with software robots can greatly benefit the organization, namely: lower processing time, reduce human errors, lower operations cost, improved compliance level and higher data accuracy. Conclusions: With the objective to examine the benefits of RPA in master data management, the researchers have investigated 2 companies in the manufacturing industry to understand how they have benefited from RPA for item master data management processes. The result showed that RPA is affirmed to bring about many benefits for the organizations through structured automation. The researchers have proposed a framework for implementing RPA to capture item master data based on the change management model and the framework is separated in 3 phases involving important tasks in each phase. Future researches might use this study as a stepping stone for further studies in cognitive RPA, utilizing cognitive technology in combination with RPA technology with the mean to achieve a higher level of automation.

Introduction: Transesophageal echocardiography (TEE) is routinely performed before catheter ablation of atrial tachyarrhythmias to rule out the presence of left atrial thrombi. However, data to support this practice are inconsistent. Methods: We analyzed consecutive pre-procedural TEE in a high-volume electrophysiology center for the presence of left atrial thrombi and a relevant flow reduction in the left atrial appendage (LAA) defined as LAA sludge or LAA emptying velocity (LAAEV) < 20 cm/s. The possible predictors of reduced flow were recorded and compared in a multivariate logistic regression analysis. Results: 1676 TEE were included (1122 before pulmonary vein isolation, 436 before atrial flutter ablation, 166 before other ablations). 543 patients (32%) were female and 991 (59%) were on DOAC. Nine patients (0.5%) had an LAA thrombus on pre-procedural TEE. Ninety-five further patients (5.7%) had a relevant reduction in LAA flow. The underlying rhythm showed a significant association with the presence of LAA thrombus or reduced LAA flow (p = 0.003). Patients in sinus rhythm and cavotricuspid isthmus-dependent atrial flutter exhibited the lowest risk. Additionally, reduced kidney function was associated with a reduction in LAA flow velocities (p = 0.04). Of note, two LAA thrombi occurred in patients in sinus rhythm and six out of nine patients with an LAA thrombus were on vitamin-K antagonists. Conclusions: LAA thrombus is a rare occurrence before an elective catheter ablation. The underlying rhythm and kidney function may serve as markers of a higher likelihood of significantly reduced LAAEV and LAA thrombus.

In the present research, we applied the dual process model of ideology and prejudice to beliefs and behavioral intentions toward animals. In Study 1 ( N = 126), we demonstrate in a community sample that right-wing authoritarianism (RWA) predicts support for restricting the distribution of wolves and bears in the wild mediated by perceived threat elicited from the animal outgroups. In contrast, social dominance orientation (SDO) had an indirect effect on the legitimization of meat consumption via endorsement of human supremacy beliefs. In Study 2 ( N = 223), we examined the causal direction of the dual process model using an experimental approach. Results show that RWA predicts support for restricting the free movement of a new animal species in the wild only when it is perceived to be threatening for humans. However, SDO predicted perceived legitimacy of meat consumption, regardless of whether the new animal species was characterized as lower or higher in status compared to other animals. Implications of these findings are discussed.

Objectives To analyze the timing of appearance of conduction abnormalities (CAs) after transcatheter aortic valve implantation (TAVI), to identify predictors of delayed CAs requiring pacemaker (PM) implantation and to provide guidance regarding the duration of telemetry monitoring. Background How long patients remain at risk of development of CAs requiring PM implantation after TAVI and for how long they should be monitored remains unclear but is crucial when considering early discharge. Methods Development of CAs was studied in 701 consecutive patients treated with Edwards Sapien 3 valves and monitored with telemetry for 7 days in a single center. After excluding valve-in-valve procedures and patients with previous PM, 606 patients remained for analysis. Predictors of CAs requiring PM and the time of onset of CAs were analyzed. Results Of 606 patients 76 (12.5%) required a PM after TAVI. CAs requiring PM implantation occurred after 48 h in 22.4% (17 patients) and in 10.5% (8 patients) even after 5 days. Of the patients who developed high grade CAs requiring PM after 48 h, 47.1% had no CAs prior to TAVI, and 23.5% had neither pre-existing CAs nor new-developed CAs within the first 48 h after TAVI. Conclusion After TAVI using a new-generation balloon-expandable valve, delayed development of CAs requiring PM implantation is not uncommon, even after 5 days. More importantly, 23.5% of patients eventually requiring a delayed PM implantation had still no CAs at 48 h after TAVI in this study. These results question the safety of early discharge and support ECG monitoring for a longer time period. The most optimal way to monitor these patients is yet to be determined.

Background In patients with repaired Tetralogy of Fallot (ToF), implantable cardioverter defibrillators (ICD) are considered reasonable in selected adults with multiple risk factors for sudden cardiac death. Patients and methods We performed a retrospective cohort study of all 174 patients with repaired ToF who are followed at the University Hospital of Muenster. We analyzed data according to the risk score previously proposed by Khairy and coworkers and patient outcome. We analyzed data separately for patients without previous sustained ventricular tachycardia (VT) (risk stratification group, n = 157) and patients with VT/secondary prevention ICD (n = 17). Results In the risk stratification group, a mean of 4 ± 1 risk score parameters were available. All six risk parameters were known in 10%, five in 14%. Risk score increased with availability of parameters. 15 patients with secondary prevention ICD had a mean risk score of 6.3 ± 2.2 (range 2–10). 11 patients of the risk stratification group with primary prevention ICD had a mean risk score 5.8 ± 2.4 (range 3–8). During follow-up of up to 14 years, five patients died (3%): at age 58, two at 69 and two at 76 years. Conclusion In the majority of patients risk score variables were incomplete, severely limiting its applicability because the true score cannot be calculated. Risk scores were not different between patients with secondary prevention ICD and patients with ICD for primary prevention based on current guidelines. Standardization of follow-up and prospective evaluation of these standards in large prospective patient cohorts is desirable to improve risk stratification in patients with ToF.

The objective of this study was to observe the effect of medical cannabis in benign essential blepharospasm (BEB) as an adjunct to botulinum toxin. A retrospective chart review was performed on patients certified for medical cannabis use for BEB from September 2015 to May 2016. Patient demographics and responses, cannabis history, and severity indices were collected. Ten patients were certified for medical cannabis use. Five met the inclusion criteria, which was any patient with a diagnosis of BEB receiving standard botulinum toxin treatment who had started medical cannabis treatment by a registered distributor within the state, and was contactable by phone. Four patients discontinued use. Three out of four patients (75%) reported symptomatic improvement. Medical cannabis is an accepted therapy for muscle spastic disorders. Its potential as an adjunctive therapy for BEB remains unknown, and further investigations would be of benefit.

A 6-year-old girl had reduced fetal movements, numerous apneic spells, muscle hypotonia, and developmental motor delay. Her muscle biopsy tissue showed variation in myofiber diameters, small minicores by electron microscopy, and near-uniformity of type I fibers. Although no mutations were detected in RYR1, SEPN1, and DMPK genes, the RAPSN gene revealed one known mutation, p.Asn88Lys, from the mother, and one novel mutation, p.Cys366Gly, from the father. Life-saving pyridostigmine treatment suppressed her apneic spells and improved her motor development.

The aim of this article is to review the main indications for use of mitomycin in ophthalmology, the adverse effects after exposure, identify the mechanisms of accidental exposure to mitomycin by sanitary personnel and patients, and offer guidelines on safe handling of the drug. Various studies have revealed that repeated exposure to antineoplastic medications, such as mitomycin, can cause deleterious reproductive effects. Due to these concerns, several organizations have published official guidelines for safe handling of antineoplastic drugs, including mitomycin. Mitomycin C is a chemotherapeutic agent, used systemically for pancreatic and stomach neoplasms, that is also commonly used in ophthalmic surgery. Because of its role in operating rooms of hospitals and surgical centers around the world, the potential hazards and measures to assure safety of this chemotherapeutic drug need to be explained. All personnel that is in contact with this medicine needs to be informed of the risks of exposure and trained to prevent exposure, whether they participate in drug preparation, handling mitomycin before or during surgery, perform or assist in surgery, or manipulate the instruments and materials that have been in contact with mitomycin.

Objectives To investigate survival in patients with Eisenmenger syndrome based on a systematic review of the literature and reanalysis of data. We specifically tested the hypothesis that previous publications have been subject to immortal time bias, confounding survival analyses. Methods A systematic review of the literature was performed to evaluate survival in treatment naive patients with Eisenmenger syndrome and standardised mortality ratios were calculated. Furthermore, we used a contemporary cohort of 219 treatment naive patients with Eisenmenger syndrome from the own institution as a comparison group. Results Overall, 12 studies (published 1971–2013) were identified, including a total of 1131 patients. Only one study seemed to deal appropriately with immortal time bias in this setting. All other studies did not account for this effect, thus overestimating survival prospects of patients with Eisenmenger syndrome by up to 20 years. After accounting for this effect we found high standardised mortality ratios, a 10-year mortality rate approaching 30–40% and no evidence of superior survival prospects of current era patients compared with those seen in the 1970s, 1980s and 1990s. Only, a historical Eisenmenger-cohort from the 1950s/1960s had worse survival. Conclusions The current analysis challenges the traditional view of benign survival prospects of patients with Eisenmenger syndrome. In addition, survival prospects do not seem to have considerably improved over the last decades in untreated patients. These results support a proactive treatment strategy including a more aggressive approach trying to avoid the development of the condition.

Objective Aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) is associated with a poor clinical outcome and its assessment therefore crucial. Quantification of AR by transthoracic echocardiography (TTE), however, remains challenging in this setting. The present study used quantitative flow measurement by cardiac MRI (CMR) with calculation of regurgitant fraction (RF) for the assessment of AR and compared the results with TTE. Methods and results We included 65 patients with a mean age of 82.2±8.1 years (38 women) who underwent successful TAVI with Edwards SAPIEN valves (52 transfemoral, 13 transapical). The postinterventional degree of AR was assessed by CMR and by TTE. There was agreement between CMR and TTE with regards to the absence of severe AR. However, TTE significantly underestimated the presence of moderate AR classifying it to be mild in 38 and moderate in only 5 patients, whereas CMR found mild AR in 23 and moderate in 16 patients. Overall, there was only fair agreement between CMR and TTE regarding the grading of AR with a weighted κ of 0.33. The rate of detection of TTE for more than mild AR was only 19%. Conclusions Using CMR for the quantification of AR in a sizeable group of TAVI patients, we demonstrate a strong tendency of TTE to underestimate AR compared with CMR. Since higher AR severity on echocardiography has been associated with worse patient outcome, the potential incremental prognostic value of CMR should be studied prospectively in this setting.

> But in no regard was he more peculiar than in his personal appearance. He was singularly tall and thin. He stooped much. His limbs were long and emaciated. His forehead was broad and low. > “A Tale of the Ragged Mountains”, Edgar Allan Poe, 1844 Marfan syndrome (MFS) is a connective tissue disease inherited in an autosomal dominant fashion and associated with a decreased life expectancy. Skeletal features as well as a particular facial appearance are some of its most memorable features and are thought by some to be described as early as 1844 in popular literature.w1 Its earliest description in the medical literature is believed to be by Antoine-Bernard Marfan in 1896, giving the condition its name. Clinically, aortic dilatation and dissection are the most important and life threatening manifestations, but cardiac, ocular, skeletal, and neurological involvement may also impose a considerable burden. In order to facilitate diagnosis and research, expert committees published and consecutively refined a number of consensus documents: The ‘Berlin Nosology’ of 1986, the ‘Ghent Nosology’ of 1996, and more recently the ‘Revised Ghent Nosology’ of 2010. Milestones of therapy were the use of β-blockers to slow progression of aortic dilation1 and the introduction of prophylactic aortic root replacement to avoid dissection.2 Since the discovery of the condition's autosomal dominant inheritance (1931), the abnormalities of the fibrillin-1 protein (1990), and identification of pathogenic mutations in the FBN-1 gene (1991), our pathophysiological understanding has come a long way. In this article we aim to highlight some of the more recent developments in the diagnosis and treatment of MFS in adults. Owing to the multi-systemic nature of the disease, establishing the diagnosis of MFS is like piecing together a puzzle. Because aortic and cardiac complications are of foremost importance, often the cardiologist will be at the …

Available information on the global distribution of research output in pediatric cardiology (PC) is sparse. This study took a bibliometric approach to characterize research output, assess the level of competition, describe the geographic distribution of the leading research centers in the field, and investigate determinants of research output. In addition, the study characterized the journals publishing PC research and identified temporal trends in research interest over time. Publications presenting original research in PC between 1995 and 2011 were identified. A total of 9,410 relevant articles were identified based on a PubMed search followed by subsequent electronic filtering and manual review. A dramatic increase in PC publications was seen during the study period (from 309 in 1995 to 1,075 in 2011). This was accompanied by an increase in impact factors and an overproportional rise in PC contributions relative to the general PubMed trend. Research in PC was shown to be highly competitive and becoming increasingly so (Herfindahl–Hirschman index of 1.64 %). Research output correlated with gross domestic product, national levels of corruption, education, urbanization, geography, and presence of national centers of excellence. The data presented in this report allow benchmarking of different cities and countries and provide insights into the potential determinants of high-quality publications and the spectrum of publishing journals. The report also highlights the central role of subspecialty journals and shows that PC research output is related to national wealth, surrogates of appropriate use of resources, an adequate workforce, and education. Additionally, it emphasizes the potential beneficial effects of establishing centers of excellence in the field.

Primary extracranial meningioma is a rare tumor, unlike its common intracranial counterpart. Infrequently found in the head and neck region, it can cause local or neurologic symptoms depending on its location and interaction with cranial nerves. While uncommon, it is an important diagnosis to have on the differential of periorbital lesions as surgical removal and prognosis are generally good. The authors present the first report of a patient with primary extracranial meningioma originating in the lacrimal sac fossa.

Predicting improvement of myocardial function after transcatheter aortic valve implantation (TAVI) for aortic stenosis (AS) remains a challenge. As ejection fraction (EF) may be of limited value in detecting early myocardial dysfunction and predicting outcome, we assessed the potential of echocardiographic longitudinal function in this setting.Left ventricular (LV) function was assessed using EF, mitral annular plane systolic excursion (MAPSE), peak longitudinal 2D strain (LS) and strain rate (SR) in101consecutive patients with severe symptomatic AS (age 81 ± 11 years) undergoing TAVI. Echocardiography and assessment of clinical status including NYHA functional class were performed prior and after intervention (median 70 days).Pre-interventional EF was 57 ± 17% and 32 patients (32%) had an EF50% while 58 patients (57%) were found to have an impaired LS. After TAVI there was no significant change in EF. In contrast, LS, SR and MAPSE improved significantly (-14.0 ± 4.4 vs. -15.5 ± 4.0%; p=0.007, 0.68 ± 0.24 vs. 0.78 ± 0.23/s, p=0.002; and 9.1 ± 3.2 vs. 10.2 ± 3.3mm, p=0.006, respectively). Receiver Operating Curve characteristic analysis identified a pre-TAVI LS-13.3% as the optimal cut-off value for predicting lack of LS recovery post TAVI. There was a marked improvement in NYHA FC after intervention (p=0.0002). Among the studied echocardiographic parameters LS change correlated closest with NYHA class improvement (r=0.42, p=0.0008).Overall, LS appears to be more sensitive for detecting early myocardial damage in patients with AS compared to conventional echocardiographic parameters. More importantly, pre-interventional LS may identify irreversible myocardial dysfunction and LS improvement correlates with symptomatic improvement after intervention.

Across two studies we show that engaging in violent video game play diminishes perceptions of our own human qualities. In addition, when other players are the targets of this violence it reduces our perceptions of their humanity also. In Study 1, we demonstrate that playing Mortal Kombat against another player reduces the perceived humanity of the self as well as the humanity of one's opponent (compared to playing a non-violent game). In Study 2 we replicate this effect on perceived humanity of the self when playing a violent game with a co-player. However, we find no dehumanization of co-players who are not the targets of violence. We demonstrate these effects cannot be reduced to mood, self-esteem, gender, or other characteristics of the game such as excitement and enjoyment. The findings provide a broader perspective from which to view previous work on the adverse effects of violent video games.

Purpose To translate the original English version of the Geriatric Oral Health Assessment Index (GOHAI) into Hindi and assess its validity and reliability for use among people in India. Materials and method After translation into Hindi, a total of 385 participants aged 55+ demonstrated acceptable validity and reliability when used for people in India. Individual GOHAI items were recorded and summed as originally recommended. The questionnaire sought information about socio-demographic characteristics and self-reported perception of general and oral health. Clinical examination included assessment of periodontal status and number of decayed teeth, missing teeth, filled teeth and crowned teeth. Result Mean GOHAI score was 40.9 (SD, 10.6; range, 12-60). Cronbach's alpha for the GOHAI score was 0.88, indicating a high degree of internal consistency and homogeneity between the GOHAI items. The test-retest correlation coefficient for add-GOHAI scores was 0.72, indicating good stability. Add-GOHAI scores increased with poorer perceived general and oral health. Convergent validity, construct validity and discriminant validity of the GOHAI were demonstrated. Conclusion It could therefore be used as a valuable instrument for measuring oral health-related quality of life for people in this region.

Engineering-to-order has steadily increased shares of total production. By its own nature, the order specific products often come without pre-defined bills-of-materials which undermines the starting point of prevailing inventory planning methods. Manufacturers often have to confront with difficult, if not impossible, choices for meeting the highly responsive service level without investing in costly inventory, particularly for long lead time items. In this paper, a novel inventory planning approach is presented. Based on predetermined inventory budget, customer responsiveness can be optimized by considering risks associated with supply chain uncertainty, component commonality, substitution possibility, market intelligence, and other salient factors.

Die Behandlung von Kindern und Jugendlichen mit chronisch entzundlichen Darmerkrankungen (CED) ist aufgrund einer schmalen wissenschaftlichen Basis fur Therapieentscheidungen nach wie vor problematisch. Daten aus Studien bei Erwachsenen sind mit Vorbehalt zu werten. Biologika (TNF-α-Blocker) haben die CED-Therapie bereichert. Studiendaten zeigen bei Kindern einen steroidsparenden und das Wachstum optimierenden Effekt. Bei Versagen einer Standardtherapie sowie bei extraintestinalem Befall und Fisteln werden TNF-α-Blocker zunehmend primar oder fruh im Therapiekonzept eingesetzt. Bei Kindern mit schwerer Colitis ulcerosa sind TNF-α-Blocker trotz fehlender Zulassung eine Alternative zu bisherigen Immunsuppressiva.

Purpose Percutaneous dilatational tracheotomy (PDT) is a well-established procedure in intensive care medicine. Several reports confirm a low acute and long-term complication rate. However, dilatational tracheotomy is still often postponed even in patients that are under ventilator support for more than 2 weeks. We present a retrospective study analyzing the subjective long-term results after percutaneous tracheotomy performed at our medical intensive care unit between 2002 and 2008. Methods We used a modified method described by Ciaglia for tracheotomy. We selected 649 patients eligible for the survey among those who had received PDT between 2002 and 2008 and had been dismissed from hospital alive. Results The return rate was 38.5% with 29.8% of the questionnaires being completed by the patients; in 32 cases, relatives reported of the patients' death. No patient experienced wound infection; none needed surgical wound revision. Dysarthria was reversible in all 16 cases; 2 patients reported a persistent hoarseness that was preexisting in both cases. One patient experienced a tracheal stenosis and received a tracheal stent; one other required a permanent tracheotomy because of a nonresectable granulation tissue. The overall rate of long-term complications associated with the long-term ventilation and the PDT was 1.8%. Conclusions Percutaneous dilatational tracheotomy is an easily performed, cost-saving method for long-term ventilated patients with a low rate of acute and long-term complications even in old and multimorbid internal medicine patients.

Biologika, insbesondere TNFα-Blocker (TNF: Tumornekrosefaktor), haben die Therapie chronisch-entzundlicher Darmerkrankungen optimiert. Infliximab ist als bisher einziger TNFα-Blocker fur Kinder mit moderatem bzw. schwerem Morbus Crohn zugelassen. Studiendaten ergaben bei ihnen einen Steroid sparenden und das Wachstum optimierenden Effekt. Bei Versagen einer Standardtherapie sowie bei extraintestinalem Befall und Fisteln ist Infliximab indiziert und wird zunehmend primar oder fruh im Therapiekonzept eingesetzt. Bei Kindern mit schwerer Colitis ulcerosa ist es trotz fehlender Zulassung eine mindestens gleichwertige Alternative zu bisherigen Immunsuppressiva. Bei Wirkungsverlust von Infliximab kann Adalimumab trotz fehlender Zulassung als Therapieversuch angewendet werden. Dies gilt sowohl fur den Morbus Crohn als auch fur die Colitis ulcerosa. In jedem Fall sind Eltern und Patienten entsprechend aufzuklaren und uber kurz- und langfristige Sicherheitsaspekte der Biologika vollstandig zu informieren.

Probiotika werden im Kindesalter zur Pravention und Therapie unterschiedlicher Krankheiten, Ernahrungs- und funktioneller Storungen eingesetzt. In zunehmendem Mas erfolgt dies auf der Basis evidenzbasierter Daten. Die Bewertung der Probiotika muss die Speziesspezifitat, den Applikationszeitpunkt, die Dosis-Wirkungs-Beziehung und den Wirkungsnachweis in randomisierten kontrollierten Studien (RCT) einschliesen. Zur Pravention der nekrotisierenden Enterokolitis (NEC), zur Pravention und Therapie der akuten viralen Gastroenteritis und – in begrenztem Rahmen – auch zur Remissionsinduktion und -erhaltung der Colitis ulcerosa existiert eine inzwischen gesicherte Datenlage, die den klinischen Einsatz definierter probiotischer Bakterien rechtfertigen lasst.

Es wird uber ein Kleinkind berichtet, das im Rahmen einer akzidentellen Verbruhung lokal zur Schmerztherapie mit EMLA®-Salbe behandelt worden war. Durch Anwendung auf verletzter Haut und Uberschreitung der empfohlenen Dosierung entwickelte sich eine symptomatische Methamoglobinvergiftung. Im Rahmen der operativen Wundversorgung zeigten sich klinisch eine Zyanose sowie eine vermindert gemessene periphere Sauerstoffsattigung, und postoperativ imponierten fragliche Symptome eines generalisierten Krampfanfalls. Unter symptomatischer Therapie mit Fortfuhrung der maschinellen Beatmung und antikonvulsiver Therapie bildete sich die Methamoglobinintoxikation innerhalb von 9 h spontan zuruck. Das Kind wurde nach Abschluss der Wundversorgung ohne zusatzliche neurologische Symptome entlassen.

Recent analytical global placers use density constraints to approximate nonoverlap constraints, and these show very successful results. This paper unifies a wide range of density smoothing techniques called global smoothing and presents a highly efficient method for computing the gradient of such smoothed densities used in several well-known analytical placers. This method reduces the complexity of the gradient computation by a factor of n compared with a naive method, where n is the number of modules. Furthermore, with this efficient gradient computation, it is able to support an efficient nonlinear programming-based placement framework, which supersedes the existing force-directed placement methods. Experiments show that replacing the approximated gradient computation in mPL6 with the exact gradient computation improves wire length by 15% on the IBM-HB+ benchmark and by 3% on average on the modified International Symposium on Physical Design 2005 (ISPD'05) and ISPD'06 placement contest benchmarks with movable macros. The results also show that the augmented Lagrangian method outperforms the quadratic penalty method with the exact gradient computation.

Children and adolescents suffering from inflammatory bowel disease (IBD) are at risk of developing osteoporosis as a result of treatment with corticosteroids as well as of nonsteroidal factors like inflammation and malnutrition. To study the impact of these factors on development of osteopathy, we compared the rate of osteoporosis in steroid-naive and steroid-treated pediatric IBD patients.In 90 patients (50 girls) with IBD (34 steroid-naive, 53 steroid-treated, 3 not known) aged 8.8 to 19.2 (14.4 +/- 2.2) years and 52 controls (27 girls) aged 6.1 to 17.6 (12.9 +/- 3.0) years, bone mineral density (BMD) of the lumbar spine was assessed with dual energy x-ray absorptiometry. Areal BMD values were transformed into volumetric densities called bone mineral apparent density (BMAD) and expressed as standard deviation scores (SDS) on the basis of the BMAD values of the controls.The rate of osteoporotic patients (BMAD-SDS-2) was 8% in girls and 20% in boys. There was a similar proportion of osteoporosis in steroid-naive (12%) and steroid-treated (11%) patients. SDS of body height showed a significant positive correlation with BMD-SDS but not with BMAD-SDS in almost all patient subgroups, indicating an interfering dependency of BMD from bone size.The prevalence of osteoporosis in pediatric patients with IBD is approximately the same as in adult patients. Osteoporosis is already present before steroid treatment. Data of dual energy x-ray absorptiometry measurements should be transformed into volumetric parameters to compensate for short stature. Otherwise, a lot of growth-stunted patients may be falsely diagnosed as osteopenic.

Probiotische Bakterien haben in zahlreichen Studien klinische Wirkungen bei der Pravention und Therapie gastrointestinaler Krankheiten, z. B. der infektiosen Gastroenteritis, chronisch-entzundlichen Darmerkrankungen und Reizdarm, gezeigt. Basierend auf der so genannten Hygienehypothese sind Probiotika in den letzten Jahren auch bei Allergien im Sauglings- und Kindesalter, insbesondere zur Pravention und Therapie des allergischen Ekzems in Koinzidenz mit Kuhmilchallergien angewandt worden. Experimentelle Daten weisen aus, dass sich die Wirkungen von Probiotika (Laktobazillen, Bifidobakterien) auf immunmodulatorische Effekte und die Stabilisierung der Mukosabarriere zuruckfuhren lassen. Aufgrund des noch sehr begrenzten Pools an klinischen Daten sind generelle Empfehlungen zu ihrer Applikation bei Nahrungsmittelallergien im Kindesalter verfruht.

Wir berichten uber einen 15 Jahre alten Jungen mit schwerer, teils pustuloser Akne im Gesicht und oberen Stammbereich sowie zunehmenden Knochen- und Muskelschmerzen an zahlreichen Lokalisationen. Im MRT wurden eine Sakroileitis links sowie eine Osteitis im Bereich der BWS nachgewiesen. Wir behandelten mit Clindamycin, Cefuroxim und Ibuprofen. Eine Skelettszintigraphie wurde nicht durchgefuhrt. Aufgrund der Anamnese und der klinischen und bildgebenden Befunde stellten wir die Diagnose eines SAPHO-Syndroms (Synovitis, Akne, Pustulosis, Hyperostose und Osteitis bzw. Osteomyelitis). Dieses ist selten, sollte aber differenzialdiagnostisch bei pustulosen entzundlichen Hauterkrankungen und gleichzeitig auftretenden Knochenschmerzen unklarer Genese in Betracht gezogen werden.

A biosensor for the detection of pathogenic bacteria was developed for biosecurity applications. The sensor was fabricated using photolithography and incorporates heterobifunctional crosslinkers and immobilized antibodies. The sensor detected the change in impedance caused by the presence of bacteria immobilized on interdigitated gold electrodes and was fabricated from (100) silicon with a 2-/spl mu/m layer of thermal oxide as an insulating layer. The sensor has a large active area of 9.6 mm/sup 2/ and consists of two interdigital gold electrode arrays each measuring 0.8 /spl times/ 6 mm. Pathogenic Escherichia coli and Salmonella infantis were tested in serially diluted pure culture. Analyte specific antibodies were immobilized to the oxide between the electrodes to create a biological sensing surface. After immersing the biosensor in solution, the impedance across the interdigital electrodes was measured. Bacteria cells present in the sample solution attached to the antibodies and became tethered to the electrode array thereby causing a change in measured impedance. The biosensor was able to discriminate between different cellular concentrations from 10/sup 4/ - 10/sup 7/ CFU/mL (colony-forming units per milliliter) in solution. The sample testing process, including data acquisition, required 5 min. The design, fabrication, and testing of the biosensor is discussed along with the implications of these findings toward further biosensor development.

A high density microelectrode array biosensor was developed for the detection of Escherichia coli O157:H7. The biosensor was fabricated from (1 0 0) silicon with a 2 μm layer of thermal oxide as an insulating layer, an active area of 9.6 mm2 and consists of an interdigitated gold electrode array. The sensor surface was functionalised for bacterial detection using heterobifunctional crosslinkers and immobilised polyclonal antibodies to create a biological sensing surface. Bacteria suspended in solution became attached to the immobilised antibodies when the biosensor was tested in liquid samples. The change in impedance caused by the bacteria was measured over a frequency range of 100 Hz–10 MHz. The biosensor was evaluated for E. coli O157:H7 detection in pure culture and inoculated food samples. The biosensor was able to discriminate between cellular concentrations of 104–107 CFU/mL and has applications in detecting pathogens in food samples.

Synchrotron radiation was applied to recording a line profile across buried conductive paths in a silicon 〈100〉 wafer. For that purpose, Co ions were first implanted in a depth of 60 nm below the silicon surface with a dose of 1017 cm−2 and an energy of 100 keV. By means of a photoresist mask, small strips of ca 150 and 40 µm width were produced. The analytical characterization was performed at DESY/HASYLAB by concentrating the synchrotron beam with a cylindrical and a tapered capillary with an effective diameter of 10 and 4 µm, respectively. The implanted wafer was shifted in steps of 1 µm on a straight line along a capillary in order to record a line profile of the implanted element cobalt across the buried strips. An internal standard was used in order to compensate for the large long-term drift and the strong fluctuations of the synchrotron beam. A 0.1 µm thin Ti foil turned out to be a very simple standard easily placed in front of the implanted wafer. This aid facilitates an examination of buried layers with a flank down to only micrometer steepness and with a uniform plateau down to only 1% deviations. Copyright © 2002 John Wiley & Sons, Ltd.

The characterization of crude oils in terms of source rock facies and depositional environment, as well as their maturity and alteration stage, is a crucial element in exploration studies. The present contribution has implications for oil-oil and oil-source rock correlations. In the past, numerous parameters have been used for this purpose most of which are based on the analysis of saturated and aromatic hydrocarbons (including sulphur aromatics) and also on stable isotope signatures and elemental compositions. Recently, molecular indicators based on dibenzothiophene (DBT), phenanthrene (PHE) and their methyl derivatives methyldibenzothiophene (MDBT) and methylphenanthrene, as well as pristane (PRI) and phytane (PHY), have also been proposed (Hughes et al., 1995). These studies have attempted to infer a crude oil's source rock facies and lithology, and to classify the source rock's depositional environment. In the present study, the above compounds have been quantified by solvent extraction, liquid chromatography and capillary gas chromatography in 98 core samples of the Lower Toarcian Posidonia Shale Formation, a source rock in NW Germany. Most samples, cored between depths of 7m and 70 m, came from the Hils Half-Graben in the Lower Saxony Basin. With a few exceptions from one borehole, the samples were unweathered marls or calcareous shales. The rocks contained mainly marine organic matter (Type II kerogen), the thermal maturity of which ranged from early mature to postmature (corresponding to 0.48-1.44% mean vitrinite reflectance), therefore encompassing the range over which effective petroleum generation had occurred. We found that the influences of organic matter type and maturity on the molecular distributions of the above compounds were not obvious when interpreted in terms of a DBT/PHE vs PRI/PHY diagram. However, Principal Component Analysis (PCA) of our data-set showed that alkylphenanthrene concentrations are strongly controlled by maturity, while the concentrations of PRI, PHY, and 1-MDBT display a distinct source effect.

This article discusses the ways in which fifteenth-century nuns financed, shaped and used works of art and architecture at the Benedictine convent of San Zaccaria in Venice. Evidence from chronicles, account books, liturgical manuscripts, reports of visits to the convent, and inscriptions on the works of art themselves shows that the nuns viewed art within their convent extremely proprietarily. While they accepted subsidies from the civic government, indulgences from popes, privileges from Byzantine emperors, and donations from private patrons, the nuns paid close attention to the administration of commissions within the convent church and committed substantial funds to artistic projects, making them their own.

A synthetic vision system (SVS) is described for aid in landing aircraft in poor weather conditions. The system consists of a scanning millimeter wave radar, heads-up display and real-time signal processing hardware. A suite of fast image processing algorithms are used for enhancing and displaying of the imagery. The system has been tested in number of tower and flight demonstration during actual adverse weather conditions. The significance of the work is in both system demonstration of the overall concept and the novelty of its signal processing algorithms.

Hintergrund: Die durch Muttermilch bewirkte Entstehung einer Bifidobakterien-dominierten intestinalen Mikroflora ist ein in der Natur einmaliges Phanomen. Es gibt Hinweise dafur, das gestillte Sauglinge in vieler Hinsicht von der Prasenz dieser Bakterien im mikrobiell besiedelten Dickdarm profitieren. Aus diesem Grund sind nach der Entdeckung der Bifidobakterien durch Tissier im Jahr 1900 zahlreiche Versuche unternommen worden, bifidogene Wirkungen in Sauglingsmilchnahrungen zu erzeugen. Im einzelnen wurden die niedrige Pufferkapazitat, niedrige Eiweis- und Eisenkonzentrationen, ein hoher Gehalt an Laktose, modifizierte Laktose und verschiedene andere Bifidusfaktoren fur die bifidogene Wirkung verantwortlich gemacht. Bis heute gibt es jedoch kein uberzeugendes Konzept fur die Produktion einer solchen Formelnahrung. Die wesentlichen Schwachpunkte in der Bewertung der bisher durchgefuhrten Studien zur Erprobung bifidogener Sauglingsnahrungen beinhalten die fehlerhafte Interpretation der Bifiduskeimzahlen im Verhaltnis zur Begleitflora, die Uberbewertung einzelner Komponenten bzw. die Nichtbeachtung des Zusammenwirkens der Gesamtheit aller fordernden und hemmenden Komponenten. Diskussion: Es steht jedoch auser Zweifel, das bifidogene Effekte erzielbar sind, wenn eine Annaherung an die Zusammensetzung der Muttermilch hinsichtlich der Quantitat (und Qualitat) des Eiweises und der fermentierbaren Kohlenhydrate erfullt ist. So haben unsere eigenen Untersuchungen mit modifizierten hydrolysierten Sauglingsmilchnahrungen ergeben, das eine Bifidusdominanz in 30–40% der Falle erzielt werden kann. Dies ist eine im Vergleich zur Muttermilch geringe Haufigkeit, die jedoch als vielversprechender Ausgangspunkt fur weitere Forschungen auf diesem Gebiet dienen kann.

Tryptophan (TRP) is the limiting amino acid in low-protein infant formulas. This is mainly due to lower alpha-lactalbumin (alpha LA) content in cow's milk whey as compared with human milk protein. To study the effect of alpha LA-enrichment on the TRP supply, cross-over studies were carried out in 20 healthy infants up to 3 months of age. In this study, two protein-reduced (1.3%) infant formulas (moderate TRP content of 1.88% and higher TRP content of 2.10%) were alternately fed over a 2 week period in two groups of infants. Serum TRP levels of the formula-fed infants with the higher TRP content did not differ significantly from an exclusively breastfed control group of 11 infants (10.5 +/- 4.8 versus 10.9 +/- 4.7 mg l-1, p = 0.841), whereas levels of the formula-fed infants with the moderate TRP content were significantly lower (7.4 +/- 3.9, p = 0.038). The supplementation of alpha LA resulting in a higher TRP supply to low-protein diets is a further step towards the production of infant formulas more closely adapted to human breast milk.

Dopamine-somatostatin interactions were investigated in the rat striatum using in vivo microdialysis. Somatostatin-14 and somatostatin-28 (10(-4), 10(-5), 10(-6) M) were infused, and the levels of dopamine and its metabolites DOPAC and HVA were assessed using high pressure liquid chromatography with electrochemical detection. Somatostatin-14 was more effective than somatostatin-28 in producing a dose-dependent increase in dopamine levels with no significant alterations in the levels of the metabolites. To assess the effect of dopamine on somatostatinergic neurons, dopaminergic agents were administered and somatostatin levels measured using a radioimmunoassay. The nonselective agonist apomorphine was administered subcutaneously (0.00, 0.05, 0.10, 0.50, 1.00 mg/kg) or directly infused (10(-4), 10(-5) M) in the striatum. The selective D1 and D2 dopamine antagonists SCH23390 and sulpiride, respectively, were also infused at concentrations of 10(-4) and 10(-5) M. None of these agents elicited any significant changes in the somatostatin release in the striatum, while altering dopamine release. This study provides for the first time evidence regarding dopamine-somatostatin interactions in the awake and freely moving animal. The results confirm that somatostatin modulates the function of dopaminergic neurons in the striatum and provide new evidence that somatostatin-14 may differentially regulate dopamine release. Furthermore, our findings suggest that dopamine does not play a major role in the regulation of somatostatin neurons.

Today's manufacturing companies offer products catered to customers' needs within tight schedules and stringent cost control. Commonly make-to-order strategies are employed for which production is frequently scheduled ahead of order commitment while considering the stochastic nature of modern manufacturing systems. Inventory at the right stage may reduce the entailed risk of tardiness. But today's inventory planning approaches don't fully consider scheduling risk. This paper addresses this shortcoming, presenting an evaluation of inventory allocations along the risks of production schedule and stock out allowing identification of critical items to mitigate delays. A case study in the machine tools industry verifies applicability. (C) 2013 CIRP.

The concentration of 131 polycyclic aromatic compounds (PAC) has been determined by capillary gas chromatography in the solvent extracts of eight bituminous coals with vitrinite reflectance (Rr) in the range of 0.9–1.9%. The distributions of PAC that eluted between naphthalene and coronene are dominated by naphthalenes, biphenyls, fluorenes, phenanthrenes, fluoranthenes, pyrenes and their C1-C3 derivatives, oxygen-containing compounds (dibenzofurans), and sulphur heterocycles (dibenzothiophenes, benzo[b]-naphthothiophenes) which were selectively measured by an electrolytic conductivity detector. Discrepancies in concentration profiles among PAC can generally be related to differences in kinetic rather than thermodynamic stabilities. However, thermodynamic equilibration is indicated in certain instances, e.g., with methylphenanthrenes and methyldibenzothiophenes extracted from coals having reflectance values between 0.9 and 1.3% Rr where the total concentration of each group of isomers remains fai...

Control of rising groundwater levels in Australia's Murray Basin requires the pumping of groundwater, and natural salt lakes seem ideal areas in which to dispose of the pumped water. A thorough understanding of the interaction of chemical and physical processes in particular geologic settings should be the basis for selection and management of appropriate disposal sites. In this work we use chemical modeling to predict the equilibrium evolutionary path of evaporating brines in two operating disposal basins and two natural salt lake complexes in the Murray Basin. Evaporative brines from an engineered and a natural, salt lake, groundwater disposal basin showed close correspondence with the predicted equilibrium evaporation pathways for the relevant inlet waters. There was no evidence of re-solution of salts during evaporation in the salt lake disposal basin. The predicted evaporite suites for these two disposal basins differ because the inlet waters are derived from different sedimentary regions of the basin. In the two natural salt lake complexes studied, the comparison of field samples with predicted evaporation of regional groundwater indicates that brine evolution is a complex process of evaporation and re-solution of salts, and this is strongly influenced by the lithostratigraphic setting. Re-solution is favored where thick clayey sediments overlie the regional, unconfined aquifer, and such a site is favorable for disposal of pumped groundwater.

Advances in dentistry, as well as the increased desire of patients to maintain their dentition, have led to treatment of teeth that once would have been removed. Mandibular first molars are the most commonly extracted teeth due to dental caries and periodontal disease. These teeth are the major standpoint for occlusion, and also have a wide pericemental area. Hence, any defect in the root either mesial or distal, extraction is the most common treatment planned. Under specific conditions, only the diseased part of the tooth can be extracted after an endodontic treatment. A modified fixed partial denture design is fabricated to splint the remaining portion of the tooth to adjacent teeth. This procedure though daunting can be easily achieved and maintained successfully.