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A method to predict bare hull ship resistance is presented in this article. Hull resistance is assumed to consist of friction drag and residual drag. The friction drag coefficient is represented by an equivalent flat plate coefficient multiplied by a form factor to incorporate effects of body geometry and boundary layer (BL) characteristics on drag. Theories of form factors including the effect of BL transition locations have been successfully derived. Form factors are shown to have a noticeable effect on body drag at high Reynolds numbers (Re) and a significant effect at model Re. Residual drag coefficient is obtained from model tests with application of scaling formulae to relate model scale residual drag coefficient to full scale drag coefficient. To address the issue of laminar flow on models in residual drag measurements, a new device termed a "turbulent spot inducer" is introduced in model tests. Finally, a new scaling formula to relate model scale residual drag coefficient to full scale residual drag coefficient with the flow on body surface partly laminar and partly turbulent is derived. It is shown that a traditional 1þK scaling method used in the marine industry is a special case of the newly derived residual drag scaling formula.

Background The scientific literature cites wide health disparities for people with intellectual disabilities compared to the general population. This study seeks to gain an understanding of the effects of income status on oral health in a global population of people with intellectual disabilities. Methods Eighty-two thousand five hundred and seventy Special Olympics athletes were screened and eligible for inclusion in this study. The main exposure (income status) and selected oral health signs and symptoms (missing teeth, untreated decay, injury, gingivitis, and mouth pain) were used to conduct a cross-sectional analysis. Prevalence odds ratios were obtained through logistic regression. Results Study participants from low-income countries experienced adverse health outcomes at a lower rate than expected. Study participants from upper middle, lower middle, and low-income countries had higher odds of mouth pain and untreated decay, yet lower odds of missing teeth, injury, and gingivitis, than participants from high-income countries. Overall, a great number of individuals from every income group required maintenance or urgent care. Conclusion Oral health problems are not exclusive to low-income study participants. Unexpectedly high odds of missing teeth, injury, and gingivitis in high-income countries may be attributed to the high proportion of participants from the United States, which is considered a high-income country but has large income disparities. Health-determining circumstances in low-income countries provide some protection from the hypothesized gradient of oral health for all measured outcomes.

The liver is commonly affected by malignant tumours, both primary and secondary. The majority of liver tumours are diagnosed radiologically and MRI and CT scan are accurate at detecting even small tumours. Hepatocellular carcinoma (HCC) is the most common primary tumour and often presents on the background of liver cirrhosis. The curative options for HCC are liver resection and transplant. However non-curative management such as radiofrequency ablation (RFA) and trans-arterial chemo-embolization (TACE) can prolong survival in patients not suited to curative management. Cholangiocarcinoma is a less common malignancy but unfortunately has poorer outcomes. It affects the bile ducts and treatment relies on resection of the affected liver and biliary tree, requiring reconstruction of the biliary drainage system. Postoperative morbidity is high and long term survival is often short. Colorectal liver metastases (CLM) are the most common liver tumours. With improvements in preoperative chemotherapy and surgical techniques such as portal vein embolization (PVE) and two stage resections, curative resection with good long term outcomes are often achieved.

Liver resectional surgery has become increasingly popular and patient outcomes continue to improve. In order to optimize postoperative outcomes several key principles of liver surgery require careful consideration. Major resection of the liver requires assessment of the future liver remnant to ensure adequate postoperative functioning, particularly when underlying liver disease is present. Appropriate extent of resection is mandated in order to achieve optimum long-term outcome, and the underlying pathology and liver parenchyma must be considered when trying to achieve this. Surgical technique can be adjusted to reduce perioperative morbidity. Techniques focused on reduction of intra-operative blood loss are low central venous pressure (CVP) resection and inflow occlusion via intermittent portal triad clamping and these can contribute to help minimize blood loss and improve outcome. Recently, laparoscopic liver resection is increasing in popularity and has achieved good short-term results and is likely to be used more widely in the future.

A new method is presented for obtaining full-scale resistance predictions from model-scale submarine resistance tests. Traditionally, model-scale submarine resistance data is scaled using Froude’s Hypothesis, where the resistance is decomposed into frictional resistance and residual resistance. The frictional resistance is computed from a flat plate friction line formula at both model- and full-scale. The residual resistance coefficient is measured model-scale and is assumed to be independent of Reynolds number. Since the flow is assumed to be turbulent at fullscale, turbulence stimulators are placed at about 5% x/L to trip the flow in the model tests. The parasitic drag from the turbulence stimulators must be measured and subtracted from the model-scale resistance. In the new approach a momentum thickness simulator is used in place of a traditional turbulence stimulator. The purpose of the momentum thickness simulator is to achieve similarity for model-scale and full-scale normalized momentum thickness of the boundary layer at the stern of the vessel as momentum thickness is directly related to ship resistance. The size and location of the momentum thickness simulator is computed to assure the flow is turbulent downstream of the simulator and to produce similar momentum thickness on the body downstream of the simulator. With this approach the total resistance is scaled from model-scale to full-scale without decomposing the resistance into frictional resistance and residual resistance. The parasitic drag is not measured and subtracted, as the additional drag from the momentum simulator is computed to produce the correctly scaled momentum thickness. In the new approach the physics associated with resistance is more clearly expressed and improved accuracy of resistance predictions is expected.

Angiogenic sprouting is a complex, multi-step process involving highly integrated cell behaviours, initial interaction with the environment and signalling pathways. Endothelial cells (ECs) are central to the angiogenic process, with recent insights establishing how these cells communicate with each other and with their microenvironment to form branched vascular networks. Using pancreatic islets as a model for vascularized tissue, this review will present a general overview of EC behaviour dynamics in sprouting angiogenesis, particularly focusing on the interplay between VEGF and Notch pathways. A better understanding of molecular mechanisms associated with intra-islet EC cross-talk and its micro-environment may present exciting new perspectives on islet graft to host revascularization and in supporting islet graft survival.

The behavior of the force on a rudder changes significantly after the inception of stall, requiring different mathematical formulae to compute rudder forces prior-and poststall. Determining the inception angle at which stall occurs is important for predicting the rudder force on a maneuvering ship. A method to compute the inception angle of stall on a rudder is presented in this article. The theoretical formulation is based on a flow similarity approach, which relates three-dimensional rudder stall inception with two-dimensional airfoil data. Rudders are low-aspect ratio wings, and the three-dimensional lift is based on the low-aspect ratio wing theory. The two-dimensional airfoil stall data are obtained from National Advisory Committee for Aeronautics (NACA) reports. The derived theory is first validated with wind tunnel data from foils with a NACA 0015 profile of aspect ratios 1, 2, and 3. The theory is also validated with data from foils with a NACA 0012 profile and an aspect ratio of 2, 3, and 6.

Appendectomy is one of the most common emergency operations. Prophylaxis against infective complications involves post-operative antibiotics. There is no consensus as to the optimum antibiotic regimen. This study aimed to assess the relation between the duration of the post-operative antibiotic administration and intra-abdominal infections (IAIs).All patients who underwent appendectomy between September 1, 2009, and August 31, 2010, were identified. The appearance of the appendix at operation, post-operative antibiotics, white blood cell count, and temperature at the time of conversion of intravenous (IV) to oral antibiotics were compiled. IAIs were assessed as the final outcome.Two hundred sixty six patients underwent appendectomy-188 for simple appendicitis and 78 for complicated appendicitis. There were 18 IAIs (6.8%) overall, 10 (12.8%) after complicated appendicitis and eight (4.2%) after simple appendicitis. Prolonging antibiotics beyond the operation in the simple appendicitis group did not alter the incidence of IAI. Similarly, in the complicated appendicitis group, prolonging antibiotics beyond five days did not alter the incidence of IAI. Furthermore, in patients with complicated appendicitis, the presence of leukocytosis, fever, or both when IV antibiotics were converted to oral drugs was associated with the development of IAI (p=0.013).In simple appendicitis, post-operative antibiotics may not be beneficial at all. In complicated appendicitis, prolonging the course of antibiotics was not associated with a reduced IAI rate. However, cessation of IV antibiotics when fever or leukocytosis was present was associated with IAI development.

Background & Aims: Liver regeneration requires functional liver macrophages, which provide an immune barrier that is compromised after liver injury. The numbers of liver macrophages are controlled by macrophage colony-stimulating factor (CSF1). We examined the prognostic significance of the serum level of CSF1 in patients with acute liver injury and studied its effects in mice.Methods: We measured levels of CSF1 in serum samples collected from 55 patients who underwent partial hepatectomy at the Royal Infirmary Edinburgh between December 2012 and October 2013, as well as from 78 patients with acetaminophen-induced acute liver failure admitted to the Royal Infirmary Edinburgh or the University of Kansas Medical Centre. We studied the effects of increased levels of CSF1 in uninjured mice that express wild-type CSF1 receptor or a constitutive or inducible CSF1-receptor reporter, as well as in chemokine receptor 2 (Ccr2)-/- mice; we performed fate-tracing experiments using bone marrow chimeras. We administered CSF1-Fc (fragment, crystallizable) to mice after partial hepatectomy and acetaminophen intoxication, and measured regenerative parameters and innate immunity by clearance of fluorescent microbeads and bacterial particles.Results: Serum levels of CSF1 increased in patients undergoing liver surgery in proportion to the extent of liver resected. In patients with acetaminophen-induced acute liver failure, a low serum level of CSF1 was associated with increased mortality. In mice, administration of CSF1-Fc promoted hepatic macrophage accumulation via proliferation of resident macrophages and recruitment of monocytes. CSF1-Fc also promoted transdifferentiation of infiltrating monocytes into cells with a hepatic macrophage phenotype. CSF1-Fc increased innate immunity in mice after partial hepatectomy or acetaminophen-induced injury, with resident hepatic macrophage as the main effector cells.Conclusions: Serum CSF1 appears to be a prognostic marker for patients with acute liver injury. CSF1 might be developed as a therapeutic agent to restore innate immune function after liver injury.

Adverse medical events place a burden on patients and cause readmissions, which account for about half of all healthcare expenses. This study assessed adverse events as they relate to readmissions in the Military Health System (MHS). Among 142,579 admissions with an adverse event in the MHS between January 1, 2007 and December 31, 2014, those with adverse events related to procedures (n=58,934) and drugs (n=53,950) were the most prevalent. There was little year to year variation in the rate of adverse event-related admissions by type with the exception of procedure-related adverse events, which decreased noticeably over the nine years of study. While the percentage of readmission was higher after radiation-related adverse events, the majority of the burden of readmission stems from the two most common adverse event types: drugs and procedures. In order to reduce the total number of readmissions, special attention should be directed toward patients who are prone to experiencing drug- or procedure-related adverse events.

Background From 2004–2015, CDC received 82 reports of patients with Listeria monocytogenes (Lm) cultured from non-sterile sites. Whereas invasive listeriosis (Lm isolated from typically sterile sites) is nationally notifiable and well described, information about patients with “noninvasive” Lm (isolated from other sites) is limited to a small number of case reports. We summarize the demographic and clinical characteristics of a convenience sample of patients with noninvasive Lm and compare to patients with invasive Lm reported through routine surveillance. Methods The Listeria Initiative (LI) is a national surveillance system that collects demographic, clinical, laboratory, and food exposure information on laboratory-confirmed listeriosis cases in the United States. While not nationally notifiable, public health agencies can also submit similar information to LI for patients with noninvasive Lm. We reviewed all reports to LI from 2004–2015 and used a standardized approach to characterize isolate sources as invasive or noninvasive. We then compared demographic and clinical factors between patients with invasive and noninvasive Lm using Fisher’s exact and Wilcoxon rank-sum tests. Results The most common sources of noninvasive isolates (n = 82) were skin or soft tissue (n = 35, 43%), urine (n = 19, 23%), and stool (n = 17, 21%). Compared with patients with noninvasive Lm, patients with invasive Lm (n = 4599) were more likely to be older than 65 years (66% vs. 54% P = 0.03), to be associated with an outbreak (17% vs. 7%, P = 0.02), to be hospitalized (92% vs. 54%, P < 0.01), and to die (20% vs. 4%, P

The mixed oxidation state complexes, α-XeOF 4 ·XeF 2 and β-XeOF 4 ·XeF 2 , result from the interaction of XeF 2 with excess XeOF 4 . The X-ray crystal structure of the more stable α-phase shows that the XeF 2 molecules are symmetrically coordinated through their fluorine ligands to the Xe(VI) atoms of the XeOF 4 molecules which are, in turn, coordinated to four XeF 2 molecules. The high-temperature phase, β-XeOF 4 ·XeF 2 , was identified by low-temperature Raman spectroscopy in admixture with α-XeOF 4 ·XeF 2 ; however, the instability of the β-phase precluded its isolation and characterization by single-crystal X-ray diffraction. The Raman spectrum of β-XeOF 4 ·XeF 2 indicates that the oxygen atom of XeOF 4 interacts less strongly with the XeF 2 molecules in its crystal lattice than in α-XeOF 4 ·XeF 2 . The 19 F and 129 Xe NMR spectra of XeF 2 in liquid XeOF 4 at −35 °C indicate that any intermolecular interactions that exist between XeF 2 and XeOF 4 are weak and labile on the NMR time scale. Quantum-chemical calculations at the B3LYP and PBE1PBE levels of theory were used to obtain the gas-phase geometries and vibrational frequencies as well as the NBO bond orders, valencies, and NPA charges for the model compounds, 2XeOF 4 ·XeF 2 , and XeOF 4 ·4XeF 2 , which provide approximations of the local XeF 2 and XeOF 4 environments in the crystal structure of α-XeOF 4 ·XeF 2 . The assignments of the Raman spectra (−150 °C) of α- and β-XeOF 4 ·XeF 2 have been aided by the calculated vibrational frequencies for the model compounds. The fluorine bridge interactions in α- and β-XeOF 4 ·XeF 2 are among the weakest for known compounds in which XeF 2 functions as a ligand, whereas such fluorine bridge interactions are considerably weaker in β-XeOF 4 ·XeF 2 .

Dissolution of the infinite chain polymer, (OsO3F2)∞, in CH3CN solvent at −40 °C followed by solvent removal under vacuum at −40 °C yielded fac-OsO3F2(NCCH3)·nCH3CN (n ≥ 2). Continued pumping at −40 °C with removal of uncoordinated CH3CN yielded fac-OsO3F2(NCCH3). Both fac-OsO3F2(NCCH3)·nCH3CN and fac-OsO3F2(NCCH3) are yellow-brown solids and were characterized by low-temperature (−150 °C) Raman spectroscopy. The crystal structure (−173 °C) of fac-OsO3F2(NCCH3)·2CH3CN consists of two co-crystallized CH3CN molecules and a pseudo-octahedral OsO3F2·NCCH3 molecule in which three oxygen atoms are in a facial arrangement and CH3CN is coordinated trans to an oxygen atom in an end-on fashion. The Os---N bond length (2.205(3) A) is among the shortest M---N adduct bonds observed for a d0 transition metal oxide fluoride. The 19F NMR spectrum of (OsO3F2)∞ in CH3CN solvent (−40 °C) is a singlet (−99.6 ppm) corresponding to fac-OsO3F2(NCCH3). The 1H, 15N, 13C, and 19F NMR spectra of 15N-enriched OsO3F2(NCCH3) were reco...

Stoichiometric amounts of XeF(6) and (OsO(3)F(2))(infinity) react at 25-50 degrees C to form salts of the known XeF(5)(+) and Xe(2)F(11)(+) cations, namely, [XeF(5)][mu-F(OsO(3)F(2))(2)], [XeF(5)][OsO(3)F(3)], and [Xe(2)F(11)][OsO(3)F(3)]. Although XeF(6) is oxophilic toward a number of transition metal and main-group oxides and oxide fluorides, fluoride/oxide metathesis was not observed. The series provides the first examples of noble-gas cations that are stabilized by metal oxide fluoride anions and the first example of a mu-F(OsO(3)F(2))(2)(-) salt. Both [XeF(5)][mu-F(OsO(3)F(2))(2)] and [Xe(2)F(11)][OsO(3)F(3)] are orange solids at room temperature. The [XeF(5)][OsO(3)F(3)] salt is an orange liquid at room temperature that solidifies at 5-0 degrees C. When the salts are heated at 50 degrees C under 1 atm of N(2) for more than 2 h, significant XeF(6) loss occurs. The X-ray crystal structures (-173 degrees C) show that the salts exist as discrete ion pairs and that the osmium coordination spheres in OsO(3)F(3)(-) and mu-F(OsO(3)F(2))(2)(-) are pseudo-octahedral OsO(3)F(3)-units having facial arrangements of oxygen and fluorine atoms. The mu-F(OsO(3)F(2))(2)(-) anion is comprised of two symmetry-related OsO(3)F(2)-groups that are fluorine-bridged to one another. Ion pairing results from secondary bonding interactions between the fluorine/oxygen atoms of the anions and the xenon atom of the cation, with the Xe...F/O contacts occurring opposite the axial fluorine and from beneath the equatorial XeF(4)-planes of the XeF(5)(+) and Xe(2)F(11)(+) cations so as to avoid the free valence electron lone pairs of the xenon atoms. The xenon atoms of [XeF(5)][mu-F(OsO(3)F(2))(2)] and [Xe(2)F(11)][OsO(3)F(3)] are nine-coordinate and the xenon atom of [XeF(5)][OsO(3)F(3)] is eight-coordinate. Quantum-chemical calculations at SVWN and B3LYP levels of theory were used to obtain the gas-phase geometries, vibrational frequencies, and NBO bond orders, valencies, and NPA charges of the ion pairs, [Xe(2)F(11)][OsO(3)F(3)], [XeF(5)][OsO(3)F(3)], and [XeF(5)][mu-F(OsO(3)F(2))(2)], as well as those of the free ions, Xe(2)F(11)(+), XeF(5)(+), OsO(3)F(3)(-), and mu-F(OsO(3)F(2))(2)(-). The Raman spectra (-150 degrees C) of the salts have been assigned based on the ion pairs observed in the crystal structures and the calculated vibrational frequencies and intensities of the gas-phase ion pairs.

This paper introduces a new method for the prediction of ship maneuvering capabilities. The new method is added to a nonlinear six-degrees-of-freedom ship motion model named the digital, self-consistent ship experimental laboratory (DiSSEL). Based on the first principles of physics, when the ship is steered, the additional surge and sway forces and the yaw moment from the deflected rudder are computed. The rudder forces and moments are computed using rudder parameters such as the rudder area and the local flow velocity at the rudder, which includes contributions from the ship velocity and the propeller slipstream. The rudder forces and moments are added to the forces and moments on the hull, which are used to predict the motion of the ship in DiSSEL. The resulting motions of the ship influence the inflow into the rudder and thereby influence the force and moment on the rudder at each time step. The roll moment and resulting heel angle on the ship as it maneuvers are also predicted. Calm water turning circle predictions are presented and correlated with model test data for NSWCCD model 5514, a pre-contract DDG-51 hull form. Good correlations are shown for both the turning circle track and the heel angle of the model during the turn. The prediction for a ship maneuvering in incident waves will be presented in Part 2. DiSSEL can be applied for any arbitrary hull geometry. No empirical parameterization is used, except for the influence of the propeller slipstream on the rudder, which is included using a flow acceleration factor.

The adduct, (OsO3F2)2·2XeOF4, was synthesized by dissolution of the infinite chain polymer, (OsO3F2)∞, in XeOF4 solvent at room temperature followed by removal of excess XeOF4 under dynamic vacuum at 0 °C. Continued pumping at 0 °C resulted in removal of associated XeOF4, yielding (OsO3F2)2, a new low-temperature phase of OsO3F2. Upon standing at 25 °C for 11/2 h, (OsO3F2)2 underwent a phase transition to the known monoclinic phase, (OsO3F2)∞. The title compounds, (OsO3F2)∞, (OsO3F2)2, and (OsO3F2)2·2XeOF4 have been characterized by low-temperature (−150 °C) Raman spectroscopy. Crystallization of (OsO3F2)2·2XeOF4 from XeOF4 solution at 0 °C yielded crystals suitable for X-ray structure determination. The structural unit contains the (OsO3F2)2 dimer in which the OsO3F3 units are joined by two Os---F---Os bridges having fluorine bridge atoms that are equidistant from the osmium centers (2.117(5) and 2.107(4) A). The dimer coordinates to two XeOF4 molecules through Os−F···Xe bridges in which the Xe···F dista...

Study objective Many emergency departments and trauma centers utilize extensive radiologic studies during the assessment of trauma patients. A point of concern arises about the possible biological effects of these cumulative radiation doses. The objective of this study is to determine the amount of ionizing radiation received by adult blunt trauma patients at a Level I trauma center during the first 24 hours of their care. Methods This nonconcurrent case series reviewed the first 100 consecutive adult blunt trauma patients who presented to a Level I trauma center in 2006. All patients met hospital standards for the less acute major triage criteria. Individual radiation dose reports calculated by the computed tomography (CT) scanner were used to determine the radiation doses from each CT procedure. Standardized tables were used to determine radiation dose for plain radiographs. The median effective dose of radiation (millisieverts) was calculated for the first 24 hours of hospitalization. Results A total of 100 eligible patients presented between January 1, 2006, and March 20, 2006. Eighty-six patients had complete radiologic records available. The median age was 32 years, with an intraquartile range of 23 to 46 years; the median Injury Severity Score was 14, with an intraquartile range of 9 to 29; and the median number of CT scans was 3, with an intraquartile range of 3 to 4. The median effective total dose of ionized radiation was 40.2 mSv, with an intraquartile range of 30.5 to 47.2 mSv. A dose of 40.2 mSv is the equivalent of approximately 1,005 chest radiographs. Conclusion Trauma patients meeting the less acute major triage criteria are exposed to clinically important radiation doses from diagnostic radiographic imaging during the first 24 hours of their care.

Archaeological investigations of early modern European contexts at Ferryland and St John's, Newfoundland, produced sherds of a previously unidentified coarse earthenware. Petrological study, stylistic matching and ICP–MS/ICP–AES analysis indicate that they come from kilns at Saint-Jean-la-Poterie in south-east Brittany. Pottery from the same centre also reached early modern migratory fishing stations in Newfoundland's Great Northern Peninsula, where sherds closely resembling 17th-century wasters from kilns at Pabu-Guingamp in northern Brittany have also been found. The recovery of earthenwares from these areas is thought-provoking; the archaeological evidence offers a way to trace the intricacies of a vernacular economy which is only fitfully recorded in commercial records.

This report summarizes influenza activity among Department of Navy (DON) and Department of Defense (DOD) beneficiaries during the 2014-2015 influenza season. Using multiple electronic data sources (namely laboratory results, pharmacy transactions, immunization records, encounter and admission records, medical event reports) the impact of influenza on the DON beneficiary population was assessed and summarized. Each data source enabled the evaluation from a different clinical perspective, and further allows for the determination of the relationship between the sources.

Thirty-three examples of pottery matching visually the wares made at the kiln sites of Donyatt, south Somerset, England, have been identified from five sites in Virginia and Maryland, the identifications of two vessels being confirmed by Inductively Coupled Plasma analysis. The paper presents a corpus of the finds identified, draws attention to the good quality of the dating evidence on some sites and offers a guide to the identification of such wares to stimulate further discoveries.

We investigated the effects of consuming a high-carbohydrate meal (HC), high-fat meal (HF), or no meal (CON) following exercise on fat and carbohydrate oxidation (FAT-OX, CHO-OX) in women with differing levels of body fat. Healthy, physically active females were divided into a Lower Fat (25% fat, n = 9) group and tested on 4 occasions. During session 1, body composition and maximal oxygen consumption were determined. During 3 treatment sessions, subjects preformed treadmill exercise at 55% of maximal oxygen consumption until 350 kcal were expended. At 10 min postexercise subjects consumed a liquid meal standardized to provide energy equal to 20% of 24-h energy expenditure plus the 350 kcal of exercise. The HC meal comprised 64% carbohydrate, 21.6% fat, and 14.4% protein. The HF meal comprised 24% carbohydrate, 62% fat, and 14% protein. CON consisted of water equal to the meal volume. During exercise and 2 h postexercise, expired gases were collected to determine FAT-OX and CHO-OX. During exercise CHO-OX was a significantly higher for the Lower Fat group and FAT-OX was significantly higher for the Lower Fat group for each of the meal conditions. A significant difference was observed across meals (p < 0.05) for CHO-OX (first hour) and for CHO-OX and FAT-OX (second hour) postexercise. There were no significant differences (p > 0.05) between the Lower Fat and Higher Fat groups for either recovery period. In physically active females, the macronutrient composition of the postexercise meal affects substrate oxidation, but the level of body fat does not.

The receptor tyrosine kinase Ron is a member of the receptor family that includes the proto-oncogene Met and the avian oncogene Sea. The interaction of Ron with its ligand, known as hepatocyte growth factor-like protein (HGFL) or macrophage stimulating protein (MSP), induces crucial cellular responses including invasive growth, proliferation, cell scattering, and branching morphogenesis. Based on the homology and functional similarities between Met and Ron it was hypothesized that Ron may be important in tumor formation and metastasis. To test this hypothesis, wild-type mouse Ron and three mutant forms of Ron containing mutations similar to those found in the Met gene in human hereditary papillary renal carcinoma (HPRC), were expressed in NIH3T3 cells. A transformed phenotype was produced in cell lines expressing either wild-type Ron or the mutated Ron proteins. Further, these cell lines displayed oncogenic potential by exhibiting increased proliferation and constitutive phosphorylation of Ron. These cell lines were also tested for the ability to form solid tumors. Cells expressing wild-type Ron and the three proteins with single amino acid substitutions were highly tumorigenic in vivo. In a model of experimental metastasis, two of the cell lines with altered Ron protein formed highly aggressive tumors in the lungs. These results suggest that Ron may be an aggressive oncogene when either overexpressed or when activated by mutation.

Suppose an OR needs a new floor, new sterilizers, a new ventilation system, overhead lights, or a floor-to-ceiling renovation. How can an OR manager or director manage a project of this magnitude and continue to provide safe, effective, and efficient patient care? This article explains how, with proper planning, construction projects can be managed safely, effectively, and efficiently for patients, staff members, physicians, and contractors.

We previously described the isolation and characterization of the cDNA for lung Kruppel-like factor (LKLF), a zinc finger transcription factor that is predominately expressed in the lung of adult mice. In this study, we report the complete structure and nucleotide sequence of the mouse LKLF gene, which is comprised of three exons and two small introns. Moreover, the identification of critical sequence elements required for expression is described using reporter constructs with the LKLF promoter transfected into LA-4 lung cells. Results from these constructs reveal an important region for transcriptional activity that lies between the −490/−72 bp upstream sequence. This region contains two canonical Sp1 binding sites that affect expression levels in a non tissue-specific manner. In addition, using a base-pair mutagenesis strategy, a region from −157/−72 bp was found to be necessary for upregulating expression. In transfection assays, mutations of the −138/−111 bp region resulted in approximately 70–80% loss of promoter activity. This cis -element does not appear to correspond to any known transcription factor consensus sequence. Moreover, mutations within this cis -region disrupt the binding of a protein complex from nuclear extracts of various tissues.

BackgroundLocal anaesthetic wound infiltration techniques reduce opiate requirements and pain scores. Wound catheters have been introduced to increase the duration of action of local anaesthetic by continuous infusion. The aim was to compare these infiltration techniques with the current standard of epidural analgesia.MethodsA meta-analysis of randomized clinical trials (RCTs) evaluating wound infiltration versus epidural analgesia in abdominal surgery was performed. The primary outcome was pain score at rest after 24 h on a numerical rating scale. Secondary outcomes were pain scores at rest at 48 h, and on movement at 24 and 48 h, with subgroup analysis according to incision type and administration regimen (continuous versus bolus), opiate requirements, nausea and vomiting, urinary retention, catheter-related complications and treatment failure.ResultsNine RCTs with a total of 505 patients were included. No differences in pain scores at rest 24 h after surgery were detected between epidural and wound infiltration. There were no significant differences in pain score at rest after 48 h, or on movement at 24 or 48 h after surgery. Epidural analgesia demonstrated a non-significant a trend towards reduced pain scores on movement and reduced opiate requirements. There was a reduced incidence of urinary retention in the wound catheter group.ConclusionWithin a heterogeneous group of RCTs, use of local anaesthetic wound infiltration was associated with pain scores comparable to those obtained with epidural analgesia. Further procedure-specific RCTs including broader measures of recovery are recommended to compare the overall efficacy of epidural and wound infiltration analgesic techniques.

This is the continuation of our research on development of a fully nonlinear, dynamically consistent, numerical ship motion model (DiSSEL). In this study we will report our results in predicting ship motions in unsteady maneuvering in calm water. During the unsteady maneuvering, both the rudder angle, and ship forward speed vary with time. Therefore, not only surge, sway, and yaw motions occur, but roll, pitch and heave motions will also occur even in calm water as heel, trim, and sinkage, respectively. When the rudder angles and ship forward speed vary rapidly with time, the six degrees-of-freedom ship motions and their interactions become strong. To accurately predict the six degrees-of-freedom ship motions in unsteady maneuvering, a universal method for arbitrary ship hull requires physics-based fully-nonlinear models for ship motion and for rudder forces and moments. The numerical simulations will be benchmarked by experimental data of the Pre-Contract DDG51 design and an Experimental Hull Form. The benchmarking shows a good agreement between numerical simulations by the enhancement DiSSEL and experimental data. No empirical parameterization is used, except for the influence of the propeller slipstream on the rudder, which is included using a flow acceleration factor.

TEMPEST is a computational tool that is being developed to predict the seakeeping and dynamic stability performance of a steered ship in large waves. The theory for TEMPEST is being developed in several levels. The difference between the theory levels is in the fidelity and complexity of the environment definition and the component force models. This report describes the Level-0 theory. The objective of the Level-0 version of TEMPEST is to establish a working computational tool that provides reasonable seakeeping predictions and to establish the framework of the TEMPEST tool into which the more accurate Level II and Level III models can be implemented. The Level-0 theory is based on simple models that include a linear hydrodynamic force model based on user-supplied added mass and damping coefficients, a nonlinear model for the hydrostatic and Froude-Krylov forces, and empirical models for the maneuvering forces and the forces from the bilge keels, rudders and propeller. This report is a compilation of the equations of motion, wave environment, and component-force theory white papers provided to the TEMPEST code developers, DRS Defense Solutions, for implementation of the Level-0 theory.

The interaction of XeF2 with excess XeOF4 leads to the formation of a mixture of α-XeOF4·XeF2 and β-XeOF4·XeF2.

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was 'In patients undergoing lung resection for non-small cell lung cancer, is lymph node dissection or sampling superior?' Altogether 845 papers were found using the reported search, of which 14 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that in stage I tumours there is little difference in survival when performing either mediastinal lymph node dissection (MLND) or lymph node sampling. However, survival is increased when performing MLND in stage II to IIIa tumours. Increased accuracy in staging is not observed with MLND. However, MLND reliably identifies more positive N2 nodes which may offer advantages in postoperative adjuvant treatment in more advanced disease.

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was 'Can thoracoscopic Heller's myotomy (THM) give equivalent results to the more usual laparoscopic Heller's myotomy (LHM) in the treatment of achalasia?' Altogether, more than 478 papers were found using the reported search, of which eight represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. THM and LHM are two recognised approaches to the performance of a distal oesophageal myotomy in the treatment of achalasia. Of the two meta-analyses on this subject, Campos et al. [Campos GM, Vittinghoff E, Rabl C, Takata M, Gadenstätter M, Lin F, Ciovica R. Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann Surg 2009;249:45-57] illustrated improved symptom control in LHM compared with THM. Wang et al. [Wang L, Li Y, Li L, Yu C. A systematic review and meta-analysis of the Chinese literature for the treatment of achalasia. World J Gastroenterol 2008;14:5900-5906], however, observed no difference in remission rates following either approach. Close scrutiny of comparison studies revealed superiority in long-term outcomes and symptoms following LHM in three studies. There were, however, studies that illustrated comparable outcome results for THM in both resolution of dysphagia and reflux. Morbidity rates following THM were noted to be similar to or slightly higher than those following LHM in five studies, but no statistically significant difference was illustrated in these studies. Operating time and length of stay were noted to be significantly shorter in LHM when compared with THM in three studies, although there were exceptions to this, with two studies illustrating shorter or equal operating times for THM. However, LHM operating times have been shown to improve with experience gained. We conclude that there is good evidence demonstrating the effectiveness and safety of LHM, and it has come to be regarded as the gold standard treatment of achalasia. When THM is compared with LHM, the long-term results approach parity on occasion but not consistently. The overall postoperative morbidity of THM is not significantly different from that of LHM. An advantage of LHM over THM that is demonstrated is that LHM offers a shorter hospital stay and reduced operative time.

The mouse microphthalmia phenotype is complex and consists of one or more of the following phenotypic alterations: a lack of pigmentation, small eyes, a mast cell defect, and bone abnormalities. The locus for this allele has been assigned to chromosome 6. A single gene defect that produces such a pleiotropic effect has suggested some involvement at a control point in development. Recently a mutant line of mice carrying a transgene insertion, which represents a new allelic form of mi, was described. The integration site of the transgene from these mi(tg) mice was cloned and analyzed. An exon sequence was discovered adjacent to the insertion. Computer analysis of this nucleotide sequence revealed the presence of a motif indicative of the helix-loop-helix class of transcription factors. The gene was expressed in a number of tissues from wild type animals but was absent in the tissue RNA from mi(tg) mice. Southern blot analysis demonstrated a deletion of some of the genetic material for this gene in the mi(tg) mice. This is consistent with the lack of expression in the mi(tg) mice. Interestingly, when DNA from other mi allelic variants was subjected to a similar analysis, a deletion was also observed in this gene in two other mi lines. Taken together, these data suggest that the gene encoding this new helix-loop-helix DNA-binding protein, and residing in the mi locus, is a strong candidate for the mi gene.

Study objective: To determine the seroprevalence rates of hepatitis B virus (HBV) and human T-lymphotropic virus (HTLV-I/II) and to compare these rates with the HIV-1 seroprevalence rate in a sample of injured patients admitted through ten California emergency departments. Design: Prospective blinded testing for serologic markers for HBV, HTLV-I/II, and HIV-1 on routinely collected blood samples. Setting: Ten California hospitals were chosen to reflect geographic and demographic diversity. Type of participants: All injured adult patients who were admitted to a participating hospital through the ED during consecutive three-month periods from June through November 1989. Measurements: Serum samples were tested for HIV-1 antibody, HTLV-I/II antibody, and hepatitis B surface antigen (HBsAg) using standard methods. Mann-Whitney U tests, χ 2 tests for independence, sign tests, χ 2 tests for goodness of fit, and logistic regression were used as appropriate. Results: Seroprevalence rates were as follows: HBV, 2.6% (57 of 2,209); HTLV-I/II, 2.0% (46 of 2,262); and HIV-1, 1.4% (31 of 2,264). Conclusion: The seroprevalence rate of HBV was slightly higher than that of HIV-1 in this sample of injured patients. Mortality estimates suggest, however, that HBV and HIV-1 pose roughly similar risks to emergency personnel, although the risk of HBV infection can be markedly reduced by vaccination. The data from this and other studies suggest that the ED incidence of HTLV-I/II in United States is low. The relative health risks to emergency personnel from HTLV-I/II appear to be minimal at this time.

The adduct, (OsO(3)F(2))(2)2XeOF(4), was synthesized by dissolution of the infinite chain polymer, (OsO(3)F(2))(infinity), in XeOF(4) solvent at room temperature followed by removal of excess XeOF(4) under dynamic vacuum at 0 degrees C. Continued pumping at 0 degrees C resulted in removal of associated XeOF(4), yielding (OsO(3)F(2))(2), a new low-temperature phase of OsO(3)F(2). Upon standing at 25 degrees C for 1(1)/(2) h, (OsO(3)F(2))(2) underwent a phase transition to the known monoclinic phase, (OsO(3)F(2))(infinity). The title compounds, (OsO(3)F(2))(infinity), (OsO(3)F(2))(2), and (OsO(3)F(2))(2)2XeOF(4) have been characterized by low-temperature (-150 degrees C) Raman spectroscopy. Crystallization of (OsO(3)F(2))(2)2XeOF(4) from XeOF(4) solution at 0 degrees C yielded crystals suitable for X-ray structure determination. The structural unit contains the (OsO(3)F(2))(2) dimer in which the OsO(3)F(3) units are joined by two Os---F---Os bridges having fluorine bridge atoms that are equidistant from the osmium centers (2.117(5) and 2.107(4) A). The dimer coordinates to two XeOF(4) molecules through Os-F...Xe bridges in which the Xe...F distances (2.757(5) A) are significantly less than the sum of the Xe and F van der Waals radii (3.63 A). The (OsO(3)F(2))(2) dimer has C(i) symmetry in which each pseudo-octahedral OsO(3)F(3) unit has a facial arrangement of oxygen ligands with XeOF(4) molecules that are only slightly distorted from their gas-phase C(4v) symmetry. Quantum-chemical calculations using SVWN and B3LYP methods were employed to calculate the gas-phase geometries, natural bond orbital analyses, and vibrational frequencies of (OsO(3)F(2))(2), (OsO(3)F(2))(2)2XeOF(4), XeOF(4), OsO(2)F(4), and (mu-FOsO(3)F(2))(2)OsO(3)F(-) to aid in the assignment of the experimental vibrational frequencies of (OsO(3)F(2))(2), (OsO(3)F(2))(2)2XeOF(4), and (OsO(3)F(2))(infinity). The vibrational modes of the low-temperature polymeric phase, (OsO(3)F(2))(infinity), have been assigned by comparison with the calculated frequencies of (mu-FOsO(3)F(2))(2)OsO(3)F(-), providing more complete and reliable assignments than were previously available.

Study objectives: To measure the HIV seroprevalence of injured emergency department patients in a number of California hospitals and to examine the relationship between ED seroprevalence and local AIDS incidence. Design: Prospective blinded testing for HIV-1 antibody was performed on routinely collected blood samples. Setting: Ten California hospitals; group 1 included three hospitals from counties of high AIDS incidence (more than 40 cases per 100,000 population), group 2 included three hospitals from counties of intermediate AIDS incidence (20 to 40 cases per 100,000 population); and group 3 included four hospitals from counties of low AIDS incidence (less than 20 cases per 100,000 population). Type of participants: Eligible patients were all adult trauma victims admitted to a participating hospital through the ED during a consecutive three-month period occurring between June and November 1989. Measurements: HIV-1 antibody testing was done using enzyme immunoassay confirmed by immunofluorescence assay. Equivocal results were confirmed by Western blot. Mann-Whitney U test, χ 2 test, and multiple logistic regression were used where appropriate. Results: There were 2,264 patients with adequate blood samples for serologic testing. The seroprevalence rates for hospitals in groups 1, 2, and 3 were significantly different ( χ 2 = 8.44, P = .02): Group 1, 2.5% (19 of 756; 95% confidence interval [CI], 1.5% to 3.9%); group 2, 0.9% (10 of 1,078; CI, 0.5% to 1.7%); and group 3, 0.5% (two of 430; CI, 0.06% to 1.7%). Conclusion: This study suggests that local AIDS incidence rates do not necessarily predict the seroprevalence rates of injured patients who are admitted through local EDs.

Purpose. To measure the rosmarinic acid content of eight commercial tinctures derived from fresh (n= 5) and dried (n=3) Melissa officinalis herb. Methods. Rosmarinic acid and the internal standard (esculin) were purchased from Aldrich Chemical Co. The column used was a Luna C18, 5 um (150 x 4.6 mm I.D., Phenomenex) maintained at ambient room temperature. The HPLC system consisted of a Shimadzu SCL-6B controller, Shimadzu LC-6A pumps, Shimadzu SPD-6A UV single wavelength spectrophotometric detector set to 320 nm and Shimadzu SIL-6B autosampler. Gradient elution of the samples and standard were performed using ammonium formate (0.02 M; pH 6.25 at 27 oC; eluent A) and methanol (eluent B). The gradient elution initial conditions were 2% of eluent B with linear gradient to 60% at 30 min, followed by linear gradient to 90% of eluent B at 31 min, this proportion being maintained for 4 min. The column was then returned to the initial condition at 36 min and maintained until the end of the run at 43 min. The flow rate was 1 mL/min. The assay was validated for sensitivity, accuracy and reproducibility. Results. The content of rosmarinic acid in commercial tinctures was significantly higher in the tinctures made from dried plant material (2.96 – 22.18 mg/mL) compared to fresh plant tinctures (

A model has been developed to investigate the operation of a distillation column with an external side reactor coupled to it (ESR). This system is compared to two more conventional process systems, namely a reactor followed by a single distillation column with recycle (R-D), and a reactor followed by two distillation columns in series with recycle (R-D-D). The toluene disproportionation reaction is used in the comparison. It is found that the reactor followed by a single column is an unattractive system as the overall conversion is low (14%) compared with 56% for the R-D-D system and 40% for the ESR system. An economic comparison of the two attractive processes was performed and the results show that the side reactor system requires similar capital costs, but reduced annual utility costs. The difference is approximately 12.5% which is significant, but below the 25-50% required to make a change in established technology viable. The side reactor system does not necessarily use new technology, but it does use the old technology in a new way. Therefore, it is still worth investigating these systems further and should be a possibility when designing a new plant.

This report documents the Maneuvering and Seakeeping Basin wavemaker performance from 2004 to 2007. This report contains benchmark wave cases for comparison with future evaluations of the wavemaker performance. Fifteen data sets were examined for wave amplitude and frequency variability due to spatial position, season, and wavemaker repairs. Wave amplitude variability from wave cycle-to-cycle and between runs was also quantified. Excel macros were developed to aid future comparisons.

Importance The optimal analgesic technique following open abdominal surgery within an enhanced recovery protocol remains controversial. Thoracic epidural is often recommended; however, its role is increasingly being challenged and alternative techniques are being suggested as suitable replacements. Objective To determine by meta-analysis whether epidurals are superior to alternative analgesic techniques following open abdominal surgery within an enhanced recovery setting in terms of postoperative morbidity and other markers of recovery. Data Sources A literature search was performed of EMBASE, Medline, PubMed, and the Cochrane databases from 1966 through May 2013. Study Selection All randomized clinical trials comparing epidurals with an alternative analgesic technique following open abdominal surgery within an enhanced recovery protocol were included. Data Extraction and Synthesis All studies were assessed by 2 independent reviewers. Study quality was assessed using the Cochrane bias assessment tool and the Jadad and Chalmers modified bias risk assessment tools. Dichotomous data were analyzed by random or fixed-effects odds ratios. Qualitative analysis was performed where appropriate Results Seven trials with a total of 378 patients were identified. No significant difference in complication rate was detected between epidurals and alternative analgesic methods (odds ratio, 1.14; 95% CI, 0.49-2.64; P = .76). Subgroup analysis showed fewer complications in the patient-controlled analgesia group compared with epidural analgesia (odds ratio, 1.97; 95% CI, 1.10-3.53; P = .02). Following qualitative assessment, epidural analgesia was associated with faster return of gut function and reduced pain scores; however, no difference was observed in length of stay. Conclusions and Relevance Epidurals may be associated with superior pain control but this does not translate into improved recovery or reduced morbidity when compared with alternative analgesic techniques when used within an enhanced recovery protocol.

AIM: To evaluate the use of ultrasound-guided percutaneous injection of thrombin for treatment of femoral artery pseudoaneurysms. METHOD: Nine patients with a confirmed femoral false aneurysm were included in the study. 0.5–1ml of a 2000U/ml solution of activated bovine thrombin was injected under ultrasound visualization into the neck of the aneurysm to induce thrombosis. The parent artery and adjacent major vessels were checked during and after the procedure to exclude propagation of thrombus. A check ultrasound examination was undertaken on the following day. RESULTS: Eight patients were successfully treated by a single injection. One patient required a second injection due to recurrence of their pseudoaneurysm 4 days after the initial treatment. The procedure was well tolerated in all cases and no complications were encountered. CONCLUSION: This small series provides further evidence that ultrasound-guided thrombin injection is a promising new method for the treatment of femoral false aneurysms.Hughes, M. J. et al . (2000). Clinical Radiology 55 , 749–751.

Lung Kruppel-like factor (LKLF) is a zinc finger transcription factor critical for embryonic development. We have previously identified and isolated the mouse LKLF gene and examined its role using gene targeting. In this report, we describe the isolation and molecular characterization of the human homolog of murine LKLF. The human and mouse LKLF homologs exhibit an 85% nucleotide identity and share 90% amino acid similarity. Furthermore, the 5′ sequence in the proximal promoter region and 3′ untranslated region are also conserved between the two species. Of particular interest is the finding that while sequences in the proximal promoter have diverged between mouse and human, a region of 75 nucleotides is essentially identical. Site-directed mutagenesis in this region impairs the ability of the LKLF promoter to drive reporter gene expression, indicating that it represents a novel transcriptional element important in the regulation of LKLF gene expression. The activation domain is highly proline-rich and, similar to mouse LKLF, contains 22% proline residues. The human LKLF transcriptional unit is located in a genomic region of approximately 3 kb on chromosome 19p13.1. This region of chromosome 19 is known to contain genes involved in various human diseases. Like mouse LKLF, human LKLF consists of three exons that are interrupted by two small introns. The locations of intron/exon boundaries and splice sites are conserved between two homologs. Northern analysis shows that LKLF is expressed in lung in addition to heart, skeletal muscle, placenta, and pancreas. The isolation and chromosomal mapping of human LKLF will make it possible to initiate studies devoted to assess the involvement of this gene in human disease(s).