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Purpose of Review To describe approaches to measuring deprescribing and associated outcomes in studies of patients approaching end of life (EOL). Recent Findings We reviewed studies published through 2020 that evaluated deprescribing in patients with limited life expectancy and approaching EOL. Deprescribing includes reducing the number of medications, decreasing medication dose(s), and eliminating potentially inappropriate medications. Tools such as STOPPFrail, OncPal, and the Unnecessary Drug Use Measure can facilitate deprescribing. Outcome measures vary and selection of measures should align with the operationalized deprescribing definition used by study investigators. Summary EOL deprescribing considerations include medication appropriateness in the context of patient goals for care, expected benefit from medication given life expectancy, and heightened potential for medication-related harm as death nears. Additional data are needed on how EOL deprescribing impacts patient quality of life, caregiver burden, and out-of-pocket medication-related costs to patients and caregivers. Investigators should design deprescribing studies with this information in mind.

Purpose To provide contemporary estimates of pain by level of cognitive impairment among US nursing home residents without cancer. Methods Newly admitted US nursing home residents without cancer assessed with the Minimum Data Set 3.0 at admission (2010-2016) were eligible (n=8,613,080). The Cognitive Function Scale was used to categorize level of cognitive impairment. Self-report or staff-assessed pain was used based on a 5-day look-back period. Estimates of adjusted prevalence ratios (aPR) were derived from modified Poisson models. Results Documented prevalence of pain decreased with increased levels of cognitive impairment in those who self-reported pain (68.9% no/mild, 32.9% severe) and those with staff-assessed pain (50.6% no/mild, 37.2% severe staff-assessed pain). Relative to residents with no/mild cognitive impairment, pharmacologic pain management was less prevalent in those with severe cognitive impairment (self-reported: 51.3% severe vs 76.9% in those with no/mild; staff assessed: 52.0% severe vs 67.7% no/mild). Conclusion Pain was less frequently documented in those with severe cognitive impairment relative to those with no/mild impairments. Failure to identify pain may result in untreated or undertreated pain. Interventions to improve evaluation of pain in nursing home residents with cognitive impairment are needed.

Chlorophyll measurements are commonly used to estimate phytoplankton biomass. However, phytoplankton readily acclimate to variations in light through a range of phenotypic responses, including major adjustments in chlorophyll pigmentation at the cellular level. The ratio of pigment chlorophyll to carbon concentration (Chl:C) is a commonly used metric in the oceanographic community to explore photoacclimation responses to varied light levels, yet is relatively rare in freshwater studies. Here we explore how nutrient variability impacted summertime Chl:C ratios of a natural phytoplankton community throughout the water column of a stratified oligotrophic lake. We utilized both long-term (18–24 years) and high-frequency (daily) data from Crater Lake, Oregon, a deep mountain lake with little anthropogenic disturbance. As expected, fluctuation in nutrients had a strong impact on phytoplankton particle density, primary productivity, light penetration, and water clarity. However, chlorophyll concentration did not register predictable changes even though the vertical location of the deep chlorophyll maximum was responsive to the overlying algal density. The impact of elevated nutrients on the Chl:C ratio was further complicated by upward shifts in chlorophyll distribution. The muted response of chlorophyll concentration to nutrients may be partially explained by variations in phytoplankton community composition or iron stress.

To evaluate the prevalence and factors associated with statin pharmacotherapy in long-stay nursing home residents with life-limiting illness.Cross-sectional.US Medicare- and Medicaid-certified nursing home facilities.Long-stay nursing home resident Medicare fee-for-service beneficiaries aged 65 years or older with life-limiting illness (n = 424 212).Prevalent statin use was estimated as any low-moderate intensity (daily dose low-density lipoprotein-cholesterol [LDL-C] reduction30%-50%) and high-intensity (daily dose LDL-C reduction50%) use via Medicare Part D claims for a prescription supply on September 30, 2016, with a 90-day look-back period. Life-limiting illness was operationally defined to capture those near the end of life using evidence-based criteria to identify progressive terminal conditions or limited prognoses (6 mo). Poisson models provided estimates of adjusted prevalence ratios and 95% confidence intervals for resident factors.A total of 34% of residents with life-limiting illness were prescribed statins (65-75 y = 44.0%, high intensity = 11.1%;75 y = 31.1%, high intensity = 5.4%). Prevalence of statins varied by life-limiting illness definition. Of those with a prognosis of less than 6 months, 23% of the 65 to 75 and 12% of the older than 75 age groups were on statins. Factors positively associated with statin use included minority race or ethnicity, use of more than five concurrent medications, and atherosclerotic cardiovascular disease or risk factors.Despite having a life-limiting illness, more than one-third of clinically compromised long-stay nursing home residents remain on statins. Although recent national guidelines have expanded indications for statins, the benefit of continued therapy in an advanced age population near the end of life is questionable. Efforts to deprescribe statins in the nursing home setting may be warranted. J Am Geriatr Soc 68:708-716, 2020.

In the United States, older women (aged ≥65 years) continue to receive routine screening mammography surveillance, despite limited evidence supporting the benefits to this subpopulation. This article reviews screening mammography guidelines and the potential harms of such screening for older women in the United States. Published guidelines and recommendations on screening mammography for older women from professional medical societies and organizations in the United States were reviewed from the mid-20th century to present. Observational data were then synthesized to present the documented harms from screening mammography among older women. In 1976, the American Cancer Society recommended to screen all women aged ≥40 years with no upper age limit. With time, other major U.S. medical societies adopted their own screening guidelines without a consensus on age of screening cessation. A population-wide screening effort has largely continued without an upper age limit and with it, a growing body of literature on the harms of screening older women. Reported harms from screening mammography procedures have included physical pain, psychological distress, excessive use of health services from overdiagnoses/false positives, and undue financial expenses. These costs are particularly pronounced among special populations with limited life expectancies such as those of very advanced age ≥80 years, long-term nursing home residents, and the cognitively impaired. When potential harms, remaining life years, and the viability of available treatments are considered, the burdens of screening mammography often outweigh the benefits for older women. For some cases, an individualized approach to recommendations would be appropriate. National guidelines should be updated to provide clear guidance for screening women of advanced age, especially those in special populations with limited life expectancies.

Worldwide, scientists have headstarted threatened and endangered reptiles to augment depleted populations. Not all efforts have been successful. For the threatened Agassiz's desert tortoise (Gopherus agassizii), one challenge to recovery is poor recruitment of juveniles into adult populations, and this is being addressed through headstart programs. We evaluated 8 cohorts of juvenile desert tortoises from 1 to 8 yrs old in a headstart program at Edwards Air Force Base, California, for health, behavior, and growth. We also examined capacities of the headstart pens. Of 148 juveniles evaluated for health, 99.3% were below a prime condition index; 14.9% were lethargic and unresponsive; 59.5% had protruding spinal columns and associated concave scutes; 29.1% had evidence of ant bites; and 14.2% had moderate to severe injuries to limbs or shell. Lifetime growth rates for juveniles 1–8 yrs of age were approximately two times less than growth rates reported for wild populations. Tortoises in older cohorts...

Deborah S Mack,1 Jacob N Hunnicutt,1 Bill M Jesdale,2 Kate L Lapane2 1Department of Quantitative Health Sciences, Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, USA; 2Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA Background: Racial disparities in pain management persist across health care settings and likely extend into nursing homes. No recent studies have evaluated racial disparities in pain management among residents with cancer in nursing homes at time of admission.Methods: Using a cross-sectional study design, we compared reported pain and pain management between non-Hispanic White and non-Hispanic Black newly admitted nursing home residents with cancer (n=342,920) using the de-identified Minimum Data Set version 3.0. Pain management strategies included the use of scheduled analgesics, pro re nata analgesics, and non-pharmacological methods. Presence of pain was based on self-report when residents were able, and staff report when unable. Robust Poisson models provided estimates of adjusted prevalence ratios (aPR) and 95% CIs for reported pain and pain management strategies.Results: Among nursing home residents with cancer, ~60% reported pain with non-Hispanic Blacks less likely to have both self-reported pain (aPR [Black versus White]: 0.98, 95% CI: 0.97–0.99) and staff-reported pain (aPR: 0.89, 95% CI: 0.86–0.93) documentation compared with Non-Hispanic Whites. While most residents received some pharmacologic pain management, Blacks were less likely to receive any compared with Whites (Blacks: 66.6%, Whites: 71.1%; aPR: 0.98, 95% CI: 0.97–0.99), consistent with differences in receipt of non-pharmacologic treatments (Blacks: 25.8%, Whites: 34.0%; aPR: 0.98, 95 CI%: 0.96–0.99).Conclusion: Less pain was reported for Black compared with White nursing home residents and White residents subsequently received more frequent pain management at admission. The extent to which unequal reporting and management of pain persists in nursing homes should be further explored. Keywords: nursing homes, cancer, pain, pain management, race&nbsp

Objectives To estimate pain reporting among residents with cancer in relation to metropolitan area segregation and NH racial and ethnic composition. Design Cross-sectional study. Setting and Participants 383,757 newly admitted black (B), Hispanic (H), or white (W) residents with cancer in 12,096 US NHs (2011-2013). Methods Using the Minimum Data Set 3.0, pain in past 5 days was determined by self-report or use of pain management. The Theil entropy index, a measure of metropolitan area segregation, was categorized [high (up to 0.20), very high (0.20-0.30), or extreme (0.30-0.53)]. Results Pain prevalence decreased across segregation level (black: high = 77%, very high = 75%, extreme = 72%; Hispanic: high = 79%, very high = 77%, extreme = 70%; white: high = 80%, very high = 77%, extreme = 74%). In extremely segregated areas, all residents were less likely to have recorded pain [adjusted prevalence ratios: blacks, 4.6% less likely, 95% confidence interval (CI) 3.1%-6.1%; Hispanics, 6.9% less likely, 95% CI 4.2%-9.6%; whites, 7.4% less likely, 95% CI 6.5%-8.2%] than in the least segregated areas. At all segregation levels, pain was recorded more frequently for residents (black or white) in predominantly white (>80%) NHs than in mostly black (>50%) NHs or residents (Hispanic or white) in predominantly white NHs than mostly Hispanic (>50%) NHs. Conclusions and Implications We observed decreased pain recording in metropolitan areas with greater racial and ethnic segregation. This may occur through the inequitable distribution of resources between NHs, resident-provider empathy, provider implicit bias, resident trust, and other factors.

We evaluated the status of a population of Mojave Desert Tortoises (Gopherus agassizii), a threatened species, in the El Paso Mountains of the northwestern Mojave Desert in California, USA...

We studied recovery of 21 perennial plant species along a severely disturbed aqueduct corridor in a Larrea tridentata-Ambrosia dumosa plant alliance in the Mojave Desert 36 years after construction. The 97-m wide corridor contained a central dirt road and buried aqueduct pipeline. We established transects at 0 m (road verge), 20 m and 40 m into the disturbance corridor, and at 100 m in undisturbed habitat (the control). Although total numbers of shrubs per transect did not vary significantly with distance from the verge, canopy cover of shrubs, species richness, and species diversity were higher in the control than at the verge and other distances. Canopy cover of common shrubs (Ericameria nauseosa, Ambrosia salsola, A. dumosa, L. tridentata, Grayia spinosa) and perennial grasses (Elymus elymoides, Poa secunda) also varied significantly by location. Discriminant analysis clearly separated the four distances based on plant composition. Patterns of recovery were bidirectional: secondary succession from the control into the disturbance corridor and inhibition from the verge in the direction of the control. Time estimated for species composition to resemble the control is dependent on location within the disturbance corridor and could be centuries at the road verge. Our findings have applications to other deserts.

We studied recovery of winter annual plants in a 97-m wide disturbed aqueduct corridor in the Mojave Desert 36 years after construction. We established plots at 0, 20, and 40 m from the road verge at the corridor center and at 100 m in undisturbed vegetation. We recorded 47 annual species, of which 41 were native and six were exotic. Exotic species composed from 64 to 91% of total biomass. We describe a bilateral process of recovery: from the road verge to the outward edge of the corridor and from undisturbed habitat into the corridor. Native annual plants significantly increased in richness from road verge to undisturbed vegetation, but not in density, biomass, or cover. In contrast, exotic annual plants increased in density, biomass, cover and richness with increasing distance from the road verge. The species of colonizing shrubs and type of canopy cover affected density, biomass, and richness of annuals. Species composition of native annuals differed significantly by distance, suggesting secondary succession. In general, native annuals were closer to achieving recovery on the 40-m plots than at the road verge. Recovery estimates were in centuries and dependent on location, canopy type, and whether considering all annuals or natives only.

Agassiz's Desert Tortoises (Gopherus agassizii) spend >95% of their lives underground in cover sites that serve as thermal buffers from temperatures, which can fluctuate >40°C on a daily and seasonal basis. We monitored temperatures at 30 active tortoise cover sites within the Soda Mountains, San Bernardino County, California, from February 2004 to September 2006. Cover sites varied in type and structural characteristics, including opening height and width, soil cover depth over the opening, aspect, tunnel length, and surficial geology. We focused our analyses on periods of extreme temperature: in summer, between July 1 and September 1, and winter, between November 1 and February 15. With the use of multivariate regression tree analyses, we found cover-site temperatures were influenced largely by tunnel length and subsequently opening width and soil cover. Linear regression models further showed that increasing tunnel length increased temperature stability and dampened seasonal temperature extrem...

Objective United States (US) guidelines regarding when to stop routine breast cancer screening remain unclear. No national studies to-date have evaluated the use of screening mammography among US long-stay nursing home residents. This cross-sectional study was designed to identify prevalence, predictors, and geographic variation of screening mammography among that population in the context of current US guidelines. Materials and Methods Screening mammography prevalence, identified with Physician/Supplier Part B claims and stratified by guideline age classification (65–74, ≥75 years), was estimated for all women aged ≥65 years residing in US Medicare- and Medicaid- certified nursing homes (≥1 year) with an annual Minimum Data Set (MDS) 3.0 assessment, continuous Medicare Part B enrollment, and no clinical indication for screening mammography as of 2011 (n = 389,821). The associations between resident- and regional- level factors, and screening mammography, were estimated by crude and adjusted prevalence ratios from robust Poisson regressions clustered by facility. Results Women on average were 85.4 (standard deviation ±8.1) years old, 77.9% were disabled, and 76.3% cognitively impaired. Screening mammography prevalence was 7.1% among those aged 65–74 years (95% Confidence Interval (CI): 6.8%–7.3%) and 1.7% among those ≥75 years (95% CI, 1.7%–1.8%), with geographic variation observed. Predictors of screening in both age groups included race, cognitive impairment, frailty, hospice, and some comorbidities. Conclusions These results shed light on the current screening mammography practices in US nursing homes. Thoughtful consideration about individual screening recommendations and the implementation of more clear guidelines for this special population are warranted to prevent overscreening.

Neomycin dimers synthesized using "click chemistry" with varying functionality and length in the linker region have been shown to be effective in targeting the HIV-1 TAR RNA region of the HIV virus. TAR (Transactivation Response) RNA region, a 59 base pair stem loop structure located at the 5'-end of all nascent viral transcripts interacts with its target, a key regulatory protein, Tat, and necessitates the replication of HIV-1 virus. Ethidium bromide displacement and FRET competition assays have revealed nanomolar binding affinity between neomycin dimers and wildtype TAR RNA while in case of neomycin, only a weak binding was detected. Here, NMR and FID-based comparisons reveal an extended binding interface for neomycin dimers involving the upper stem of the TAR RNA thereby offering an explanation for increased affinities. To further explore the potential of these modified aminosugars we have extended binding studies to include four TAR RNA mutants that display conformational differences with minimal sequence variation. The differences in binding between neomycin and neomycin dimers is characterized with TAR RNA mutants that include mutations to the bulge region, hairpin region, and both the bulge and hairpin regions. Our results demonstrate the effect of these mutations on neomycin binding and our results show that linker functionalities between dimeric units of neomycin can distinguish between the conformational differences of mutant TAR RNA structures.

In thermally processed multiphase systems such as cereal based foam, the material characteristics as well as the thermo-physical processes are of major impact on the internal heat transfer rate. Improving and optimizing this production step would contribute to an enormous amount of energy saving, considering the high demand on bakery products in the world. Bread baking is a high complex process and the determination of the included processes and their relevance is not simple, since the main processes are occurring in the micro-scale. Heat transfer in cereal based foam is expected to depend mainly on the evaporation–condensation mechanism, therefore it is crucial to determine heat and mass transfer phenomena inside the bread. Due to the hazardous surrounding conditions, such as high temperature and humidity it becomes challenging to find applicable sensors working reliable under such conditions. This study shows the application of micro-sensors to examine temperature and humidity distribution inside the foam during heating and gives insight in the impact of water vapor on the heating rate due to evaporation–condensation.

Cereal foam is a high complex material undergoing several temperature-dependent processes under thermal treatment, such as phase transitions, biochemical reactions and structural changes. Simultaneous heat and mass transfer plays an important role to investigate optimization studies in cereal-based foams. In porous media such as cereal foams, thermal conduction is of minor impact on the overall heat transfer, since the major part of heat is transferred through the gas phase filled with water vapor. This becomes evident comparing the thermal diffusivities of solid and gaseous components of the foam, where the difference is in the order of five magnitudes. The objective of this study is to model the coupled heat and mass diffusion processes in cereal-based foam under thermal treatment by means of Lattice Boltzmann methods. The proposed model is then used to perform parameter variation studies, showing the impact of material property changes offering the possibility on optimizing heat transfer through the foam.

During processing of complex multiphase systems several processes occur on different time and length scales simultaneously and influencing each other. To establish the main relevant driving process, time-scale analysis is an important tool in physics. This work outlines the physical and chemical kinetics occurring during cereal based foam processing and contributes to enlighten the impact of different characteristic times. Such analysis becomes beneficial if detailed micro-scale description of the whole process is required which may be used for process optimization. With regard to the latter, an important tool is numerical modeling where a sophisticated knowledge of the processes, time and length scales is required to produce realistic results. The time scale estimation shows the impact of each process on the whole macro scale behavior of the system and gives a critical review of previous physical and mathematical models and the related simulation approaches.

Alpine lakes may be particularly useful as sentinels of climate change because they are highly sensitive to environmental conditions. To explore the potential biotic consequences of climate change in these systems, we conducted paleo- and neoecological observational studies, as well as a short-term experiment to examine Daphnia responses to changing environmental conditions in Rocky Mountain alpine lakes. Our analysis of a sediment core from Emerald Lake representing two periods from the Holocene revealed a significant positive relationship between the abundance of Daphnia remains and fossil Aulacoseira lirata, a diatom associated with deeper mixing depths. In addition, we detected a significant increase in mean Daphnia density in the long-term record (1991–2005) from Pipit Lake, a trend that correlated well with increases in mean surface temperature. In our survey of Daphnia in 10 lakes in the Canadian Rocky Mountains, Daphnia abundance was positively correlated with both dissolved organic carbon concentration and temperature. Finally, our short-term incubation experiment demonstrated significant effects of physical conditions (i.e., temperature and/or UV radiation) and water chemistry on the juvenile growth rate of Daphnia. Overall, our findings highlight the sensitivity of Daphnia to changes in mixing depth, water temperature, and dissolved organic matter, three limnological variables that are highly sensitive to changes not only in air temperature, but also to precipitation and location of the treeline in alpine catchments. Thus, we conclude that Daphnia abundance could serve as a powerful sentinel response to climate change in alpine lakes of the Rocky Mountains.

Background and study aims: Endoscopic therapy of upper gastrointestinal bleeding remains challenging with conventional endoscopic devices. Use of Hemospray, where a nanopowder with clotting abilities is sprayed onto the bleeding site, had been highly effective for management of arterial bleeding in a heparizined animal model. The safety and effectiveness of Hemospray for hemostasis of active peptic ulcer bleeding in humans was evaluated. Patients and methods: In a prospective, single-arm, pilot clinical study, consecutive adults with confirmed peptic ulcer bleeding (Forrest score Ia or Ib), who had all given informed consent to participation, underwent upper gastrointestinal endoscopy and application of Hemospray within 24 hours of hospital admission once hemodynamically stable. Up to two applications of Hemospray, not exceeding a total of 150 g were allowed. Bleeding recurrence was monitored post procedurally, by second-look endoscopy (72 hours post treatment), and by phone at 30 days. Rate of hemostasis, recurrent bleeding, mortality, need for surgical intervention, and treatment-related complications were assessed. Results: 20 patients were recruited (18 men, 2 women; mean age 60.2 years). Acute hemostasis was achieved in 95 % (19 / 20) of patients; 1 patient had a pseudoaneurysm requiring arterial embolization. Bleeding recurred in 2 patients within 72 hours (shown by hemoglobin drop); neither had active bleeding identified at the 72-hour endoscopy. No mortality, major adverse events, or treatment- or procedure-related serious adverse events were reported during 30-day follow-up. Conclusion: These pilot results indicate that Hemospray is safe in humans. Hemospray was effective in achieving acute hemostasis in active peptic ulcer bleeding.

Foam materials play an important role in several industrial fields, especially in life science engineering, the texture and flavor release of food products is of major importance for taste, food quality and product acceptance by the consumers. Under the influence of heat, material characteristics of cereal based foam changes according to a chain of physical and biochemical processes including structural transformation, phase changes and the development of color and flavor. In the proposed material, surface color and flavor develop temperature dependent according to the Maillard reaction. The present research focuses on the flavor development in cereal based foams under thermal treatment and modeling the corresponding chemical reaction kinetics by the use of 3-D-Lattice-Boltzmann-Methods (LBM). The pathway for the development of the primary compound, 2-Acetyl-1-pyrroline, accounting for the typical aroma of the proposed products, is modeled according to a simplified reaction kinetic approach [1] . In addition, the heat flux through the material is modeled by introducing two differing thermal diffusivities for solid phases and gaseous phases, respectively. The results show the temperature dependent flavor formation occurring mainly in the boundary layer of the model foam material due to the higher temperature (T ∼ 150 °C) compared to the inner product (T ∼ 100 °C).

First-generation epigenetic drugs have proven clinically useful in several hematological cancers. But newer enzyme inhibitors in the pipeline aim to be more selective and promise to broaden the portfolio of therapeutic uses.

We report on the heteroepitaxial growth of thin films of rocksalt GdN on c-plane (0 0 0 1) wurtzite GaN by molecular beam epitaxy (MBE) using either an N2 plasma or NH3 as the nitrogen source. In both cases, epitaxial films with fully oriented GdN (1 1 1)∥GaN (0 0 0 1) were deposited as demonstrated by θ–2θ X-ray diffraction. φ scans of GdN peaks demonstrate 6-fold symmetry along the growth axis implying the presence of two 3-fold-symmetric GdN (1 1 1) crystal variants in-plane. Electrical transport and magnetometry measurements on films grown using N2 plasma show that these GdN films are ferromagnetic below TC=70 K and degenerately doped or metallic from 10 to 300 K with magnetotransport signatures associated with TC.

Drugs targeting microRNAs lie some way off, but diagnostics look promising and commercial interest is growing.

Sub-surface pressure (SSP) data from tide gauges at three bases on the Pacific coast of the Antarctic Peninsula, together with SSP information from a bottom pressure recorder deployed on the south side of the Drake Passage, have been used to study the relationships between SSP, Drake Passage transport, and the strength of Southern Ocean zonal winds as represented by the Southern Annular Mode. High correlations were obtained between all parameters, confirming results obtained previously with independent data sets, and demonstrating the value of information from the permanent Rothera base, the southern-most site considered. These are important findings with regard to the design, installation and maintenance of observation networks in Antarctica. In particular, they provide the necessary justification for Antarctic Peninsula tide gauge infrastructure investment in the lead up to International Polar Year. Data delivery from Rothera and Vernadsky is currently being improved and should soon enable the first near real-time system for monitoring Drake Passage transport variability on intraseasonal timescales, an essential component of a Southern Ocean Observing System.

This paper presents a Technical Cooperation Project associated with the FAO Special Programme for Food Security (SPFS) in Chad. The project entitled “Diversification Component of the SPFS in Chad”,...

The paper presents a global overview of the development of the poultry sector and of the role of small-scale, family-based poultry production in developing countries. Major initiatives undertaken to develop poultry as a tool for rural development and their rationale are presented. The constraints facing the future of small-scale poultry production are discussed, with a particular focus on poultry disease given the current outbreak of highly pathogenic avian influenza in Asia. Geographical ‘hotspots’ are identified where interventions are urgently required and where small-scale poultry has the potential to make a substantial impact. Finally, the paper stresses the need for more long-term and wider perspectives in the policies and strategies guiding the development of the poultry sector.

A dipeptidyl carboxypeptidase activity in the Dunning rat prostate tumor was characterized. This enzyme demonstrated the most prominent properties of angiotensin converting enzyme (ACE): that is, it was stimulated by NaCl and Co(2+) and was potently inhibited by captopril. The enzyme solubilized by Triton X-100 had a molecular mass of 110 kDa as determined by gel filtration chromatography. The specific activity of ACE did not change with castration, indicating that ACE activities are not controlled by androgen. The role of ACE in the prostate and its tumors is not understood, but the ability of this enzyme to hydrolyze a number of bioactive peptides suggests that it may function in controlling the molecular forms or activity of regulatory peptides.

The progressive use of digital image-generating devices and digital communication technology in clinical and practice environments implies changes in radiological workflow and asks for adequate quality assurance in the whole process of radiology report preparation. This improvement potential has to be rigorously reinvestigated with regard to up-to-date procedures and the full exploitation of supporting technologies like linguistic analysis, help desk and trouble ticket systems, competitive allocation algorithms, time-and-event monitoring, and intelligent agents. These approaches are to be evaluated in combination with business process analysis and shall help to reduce turnaround times for radiology reports while maintaining or even increasing quality-assurance levels.

This article appraises the conceptual foundations of the new international division of labor (NIDL) literature. According to NIDL, the observed shift of international production from developed to less developed nations can be explained by an international verticalfragmentation of production in which different phases of production are undertaken in different nations, often by the samefirm. The purpose of this review is to examine the conceptual issues surrounding this theory, to analyze NIDL's intellectual relationship to key economic theories, and to draw a conceptual critique.

Heat storage is an important aspect in many applications like heat recovery of waste heat from industrial process or in renewable energy plants. The principle of the adsorption storage system is based on a gaseous working fluid, e.g., water, which gets adsorbed by a highly porous material, e.g., zeolite. This adsorption process is an exothermal one. In order to recharge the heat storage system, desorption of the working fluid is done by heating the porous material. A thermochemical method was used with a reversible adsorption/desorption process in order to improve the heat transfer and storage density. Therefore, an experimental sorption unit has been set to measure the invested and stored heat in the adsorbent packed bed. In addition, simulations were performed in order to predict the optimal operating conditions of the system. This gives also the possibility to virtually add and remove components to the heat storage unit. Experiments were carried out to validate the heat storage model. The results have shown good comparison to the simulation, with an average deviation of 2.4 %. The simulations also indicated that by applying a multiple-reactor system, the invested heat can be reduced by 15 %.

The Hypertension Initiative began in 1999 to help transition South Carolina from a leader in cardiovascular disease (CVD) to a model of heart and vascular health. Goals were to reduce heart disease and stroke by 50% by promoting healthy lifestyles and access to effective care and medications. Continuing medical education was used to train providers, encourage physicians to become American Society of Hypertension (ASH)-certified hypertension specialists and recruit practices into the community-based practice network (CBPN). Practice data audit with provider specific feedback is a key quality improvement tool. With ASH support, the CBPN has grown to 197 practices with approximately 1.6 million patients (approximately 700,000 hypertensives). Clinical data are obtained from electronic health records and quarterly provider feedback reports are generated. Hypertension, hypercholesterolemia, and diabetes control rose and South Carolina's ranking improved from 51st to 35th in CVD mortality from 1995 to 2006. The Hypertension Initiative expanded to the Outpatient Quality Improvement Network (O'QUIN) to encompass comparative effectiveness research and other chronic diseases. Lessons learned include: trust enables success, addressing practice priorities powers participation, infrastructure support must be multilateral, and strategic planning identifies opportunities and pitfalls. A collaborative practice network is attainable that produces positive, sustainable, and growing impacts on cardiovascular and other chronic diseases.

During the 1950s and 1960s, rural counties in the United States gained manufacturing employment at a significantly higher rate than did metropolitan counties. From a theoretical perspective, this was unexpected and appeared to contradict existing manufacturing location theory. The product cycle theory was proposed as an explanation, and it quickly gained acceptance. The product cycle model as applied in regional analysis predicts that manufacturing plants will locate in urban areas in early stages of product development to take advantage of highly skilled labor, external economies of subcontractors, and close ties to management. As production becomes standardized, manufacturing will shift to rural areas to take advantage of lower labor costs. There now exists a substantial literature, mostly empirical in nature, concerned with the product cycle theory. This article presents a review and evaluation of this literature in hopes of achieving two goals: the first is to provide a coherent summary of the literature for use by economic development planners. The second is to evaluate the strengths and weaknesses of the product cycle theory and to point out unresolved issues.