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Straelensiosis is uncommonly described outside Europe. This report describes straelensiosis in two cats and in ten dogs diagnosed with the disease outside Europe. Both cats displayed erythematous macules or nodules on the abdominal skin. One cat was extremely pruritic, while in the other the lesions were incidental findings when the cat was presented for neutering. The mites were noted in skin scrapings in both cats and histopathologically in one cat. All dogs showed a general distribution of papules, and intense pruritus was noted in six dogs. The diagnosis in all dogs was based on histopathology. Treatment of the animals in this study varied, and among the various administrated treatments, amitraz showed promising results.

We report on the EPICA Dronning Maud Land (East Antarctica) deep drilling operation. Starting with the scientific questions that led to the outline of the EPICA project, we introduce the setting of sister drillings at NorthGRIP and EPICA Dome C within the European ice-coring community. The progress of the drilling operation is described within the context of three parallel, deep-drilling operations, the problems that occurred and the solutions we developed. Modified procedures are described, such as the monitoring of penetration rate via cable weight rather than motor torque, and modifications to the system (e.g. closing the openings at the lower end of the outer barrel to reduce the risk of immersing the drill in highly concentrated chip suspension). Parameters of the drilling (e.g. core-break force, cutter pitch, chips balance, liquid level, core production rate and piece number) are discussed. We also review the operational mode, particularly in the context of achieved core length and piece length, which have to be optimized for drilling efficiency and core quality respectively. We conclude with recommendations addressing the design of the chip-collection openings and strictly limiting the cable-load drop with respect to the load at the start of the run.

Laser resurfacing procedures in actinic skin damage and the treatment of disorders associated with skin ageing are becoming more popular. For both purposes Erbium:YAG laser-technology enables us to perform a highly precise skin ablative work, which can be most helpful in the removal of circumscribed skin lesions of ageing skin as well as in larger skin resurfacing procedures. In most circumstances, superficial skin ablation is not technically demanding, is not associated with major discomfort, and can be controlled with precision. Tissue sparing ablation is of special value in the treatment of disorders in atrophic skin of elderly patients or in more delicate areas, where it can avoid prolonged healing and unwarranted side-effects.

From 1993 to 1996, fish assemblage data were collected from 309 wadeable streams in the U.S. Mid-Atlantic Highlands region as part of the U.S. Environmental Protection Agency's Environmental Monitoring and Assessment Program. Stream sites were selected with a probabilistic sampling design that allowed regional estimates of stream condition. We examined responses of 58 fish assemblage metrics to physical, chemical, and landscape indicators of disturbance. Uni- variate and multivariate analyses of relationships among fish metrics, habitat integrity, and an- thropogenic disturbance were used to develop a fish index of biotic integrity (IBI) for assessing stream condition in the entire region. Of 58 candidate metrics 9 were selected and scored contin- uously from 0 to 10; the resulting IBI was scaled so that it ranged from 0 to 100. Regional estimates of stream conditions showed that 27% of the stream length in the Mid-Atlantic Highlands had fish assemblages in good or excellent ecological condition. Of the total wadeable perennial stream length in the region 38% was fair and 14% was poor. There were insufficient data to calculate IBIs for 21% of the wadeable stream length in the Mid-Atlantic Highlands; all of these streams were small (watershed area # 2k m 2) and lacked sufficient sample size (,10 individuals) to calculate

A novel deletion of residue 69 of the HIV-1 reverse transcriptase (RT) gene was detected in combination with mutations V75I/V and F77L/F in a patient with partial virological response to several antiretroviral drug regimens, including stavudine (D4T), didanosine (DDI), lamivudine (3TC), saquinavir (SQV), and nevirapine (NVP). Longitudinal analysis of samples revealed that this deletion emerged upon reinitiation DDI/D4T therapy following a toxicity-induced short discontinuation of all antiretrovirals. Analysis of the resistance phenotype showed a greater than 62-fold increase of the IC50 of NVP, but no significant change in sensitivity to other single nonnucleoside reverse transcriptase inhibitors (NNRTIs). The mutated virus showed only a moderately reduced sensitivity to DDI (6.7-fold) and D4T (4.8 fold). In a subsequent sample 3 months later additional RT mutations were found, including A62V, Y188L, and Q151M, conferring high-level cross-resistance to multiple nucleoside analogs. Our findings provide evidence that the deletion of RT residue 69 selectively confers high-level NVP resistance.

Previous experiments have shown that mechanical stress may alter the interactions between cells and extracellular matrix (ECM). The purpose of our study was to investigate the effects of mechanical load on metabolism and ECM expression of primary human periodontal cells. The influence of gravitational force on proliferation, lactate dehydrogenase (LDH) release, and tenascin expression of gingival (HGF) and periodontal ligament fibroblasts (HPDL), as well as their adhesion to various extracellular matrix (ECM) components, was determined. Cells were centrifuged in microplates or flat tubes for 16 hrs at 217 g. Neither an enhanced release of LDH nor an alteration of cell proliferation could be detected after centrifugation. However, the attachment of loaded gingival and periodontal ligament fibroblasts to all tested ECM components significantly decreased in comparison with controls (Wilcoxon-Mann-Whitney test; HGF, p < 0.05; HPDL, p < 0.01). Tenascin expression of mechanically stressed fibroblasts significantly increased in comparison with controls (p < 0.01).

Using redundancy analysis (RDA) and canonical correspondence analysis (CCA), we assessed relationships among chemical and physical characteristics and macroinvertebrate assemblages at stream sites sampled by the Regional Environmental Monitoring and Assessment Program (R-EMAP) in the mineral belt of the Southern Rockies Ecoregion in Colorado. We contrasted results of analyses where community structure was summarized as community metrics and analyses based on genera abundances. Our objective was to identify metrics or taxa diagnostic of major environmental stressors in these streams. When RDA was used to analyze the community metrics data, three axes were significant, accounting for 96% of the metric–environment relation. The first RDA axis was correlated with dissolved cadmium, sediment zinc, and total suspended solids, variables that indicate it was related to mining effects. The second and third RDA axes were correlated with water temperature, mean substrate embeddedness, mean canopy density at the bank...

A major goal of antiretroviral HIV-1 therapy is the reversal of HIV-1-associated immunological dysfunction. However, the pathogenetic mechanisms involved and their significance are largely unknown. On the basis of the life cycle of naive, activated, and memory CD4(+) T cell subsets, a mathematical model of immune reconstitution was developed and applied to data for T cell subsets in individuals with acute or chronic HIV-1 infection receiving antiretroviral therapy. The final model that most accurately fitted the data, and resulted in realistic estimates for CD4(+) T cell turnover, considered three pathways of immune reconstitution for naive cells, including thymic production, peripheral expansion, and redistribution of naive cells from lymphoid tissue. The reconstitution of the memory compartment was fitted through differentiation and expansion of naive cells and peripheral expansion of memory cells as well as redistribution of memory cells trapped in the lymphoid tissue. Estimated median half-lives for naive and memory CD4(+) T cells were 114 and 21 days, while total production rates were 9.1 x 10(7) and 2.4 x 10(9) cells/day, respectively. Peripheral expansion and thymic production contributed equally to the regeneration of naive cells, but peripheral expansion of memory cells was larger than production of these cells by differentiation of naive cells. A comparison of immune reconstitution in acute and chronic HIV-1 infection revealed that, after adjustment for age, the main difference was the more rapid release of a larger number of naive cells in treated acute HIV-1 infection. Thymic function and peripheral expansion rates, however, were similar in both cohorts.

SUMMARY 1. We intensively sampled 16 western Oregon streams to characterize: (1) the variability in macroinvertebrate assemblages at seven spatial scales; and (2) the change in taxon richness with increasing sampling effort. An analysis of variance (ANOVA) model calculated spatial variance components for taxon richness, total density, percent individuals of Ephemeroptera, Plecoptera and Trichoptera (EPT), percent dominance and Shannon diversity. 2. At the landscape level, ecoregion and among-streams components dominated variance for most metrics, accounting for 43‐72% of total variance. However, ecoregion accounted for very little variance in total density and 36% of the variance was attributable to differences between streams. For other metrics, variance components were more evenly divided between stream and ecoregion effects. 3. Within streams, approximately 70% of variance was associated with unstructured local spatial variation and not associated with habitat type or transect position. The remaining variance was typically split about evenly between habitat and transect. Sample position within a transect (left, centre or right) accounted for virtually none of the variance for any metric. 4. New taxa per stream increased rapidly with sampling effort with the first four to eight Surber samples (500 ‐1000 individuals counted), then increased more gradually. After counting more than 50 samples, new taxa continued to be added in stream reaches that were 80 times as long as their mean wetted width. Thus taxon richness was highly dependent on sampling effort, and comparisons between sites or streams must be normalized for sampling effort. 5. Characterization of spatial variance structure is fundamental to designing sampling programmes where spatial comparisons range from local to regional scales. Differences in metric responses across spatial scales demonstrate the importance of designing sampling strategies and analyses capable of discerning differences at the scale of interest.

Melanoma precursor lesions and stage I malignant melanomas are preferentially removed by excisional surgery. Several studies have supported the concept of a more conservative excision strategy. Reduced safety margins with a maximum of 2-3 cm enable us to cover most defects by simple skin flap techniques. In critical anatomical sites and in lentigo maligna melanoma micrographic surgery has recently gained importance. The value of adjuvant surgical procedures remains controversial. Possibly, the technique of sentinel-node-biopsy provides a better approach towards a more selective use of lymphadenectomy in patients with clinically occult micrometastases.

We examined the relationship between authoritative and authoritarian parenting styles and socio-emotional adjustment in elementary school children as reported from the parents' perspective. Mothers of first through fifth graders provided information about parenting style as well as children's competencies and problem behaviors. Teachers provided ratings of children's adjustment for a subset of the participants. Results indicated that authoritative parenting was associated negatively with parent- and teacher-rated maladaptive behavior, and positively with indicators of healthy adjustment. Correlations between authoritarian parenting and adjustment were either small or non-significant. Regression analyses indicated that authoritative parenting was more predictive of children's competence than maladaptation (22% versus 10% of variance). The effects of parenting style on adjustment were not moderated by demographic variables, such as the child's gender, grade level, ethnicity, and family income.

Tree age and size structures were compared within and among topographic categories in portions of a 35-km2 unlogged landscape and a comparable adjacent logged landscape. Tree density was generally higher in the logged landscape. One fifth of plots in the unlogged landscape had trees older than 400 years, but no trees older than 400 years remained in the logged landscape plots. Ten recruitment pulses were identified for the unlogged study area, accounting for 49% of all trees measured during 26% of the 421-year survival record. Recruitment pulses in the logged area accounted for fewer trees during a larger amount of time. Most recruitment periods in the unlogged landscape coincided with known past major fires. The mixed-severity historical fire regime created openings that persisted for as long as 148 years. The following components exist in the unlogged landscape: (i) forest patches having a distinct age cap reflecting regeneration following an earlier stand-replacing fire, (ii) uneven-aged forest patches having no evidence of an age cap, (ii) openings created by fire, and (iv) riparian areas. Results suggest that the logged landscape is poised to regain an old-growth age distribution, and tree removal in the logged landscape could restore the size distribution found in the unlogged landscape. However, the unlogged landscape has openings not found in the logged landscape that should be considered in restoration efforts at a landscape scale.

Objective To determine the long-term T-lymphocyte response to highly active antiretroviral therapy (HAART) and to define predictors of the immunological response. Design Cohort study, including 135 HIV-1-infected subjects at a city general practice who commenced HAART between 1996 and 1998. Methods Collection of plasma HIV-1 RNA, CD4+ and CD8+ T-lymphocyte data at 3-6 monthly time intervals over 2 years. Results Seventy-three subjects (54%) achieved suppression of plasma HIV-1 RNA to levels below 400 copies/ml during the observation period, 31 individuals (23%) had detectable plasma HIV-1 RNA below 10,000 copies/ml and 31 subjects (23%) had virological failures with viral loads above 10,000 copies/mL. Median CD4+ T lymphocytes increased from 246 to 463 x 10(6) cells/l, showing a median rise of 20 x 10(6) cells/l per month in the first 3 months and 7 x 10(6) cells/l per month thereafter. The proportion of individuals who reached CD4+ cell counts above 500 x 10(6) cells/l increased from 8% at baseline to 54% at 2 years. Treatment-naive individuals, subjects with a large reduction of HIV-1 RNA or a large early CD8+ increase had better early CD4+ responses. Long-term CD4+ T-cell increases were inversely correlated with mean plasma HIV-1 RNA levels. Baseline CD4+ T-cell count was the most important determinant of reaching CD4+ cell counts above 500 x 10(6) cells/l. Nineteen per cent of subjects had no further CD4+ T-cell increases in the second year of therapy despite undetectable viral load. Conclusions Immune reconstitution is a slow process, showing a large individual variability. The virological response to HAART was the most important determinant of the immunological short- and long-term response.

Periphyton assemblage data collected from 233 stream site-visits (49 in 1993, 56 in 1994, and 128 in 1995) throughout the Mid-Appalachian region were used to develop a periphyton index of biotic integrity (PIBI) based on 1) algal genera richness; 2) the relative abundances of diatoms, Cyanobacteria, dominant diatom genus, acidophilic diatoms, eutraphentic diatoms, and motile diatoms; 3) chlorophyll and biomass (ash-free dry mass) standing crops; and 4) alkaline phosphatase activity. Thirty-seven diatom genera and 38 non-diatom genera were collected. The relative richness and relative abundance (RA) of these genera were used to calculate the RA metrics of the PIBI. PIBI scores ranged from 48.0 to 85.1 among the 233 site-visits with an overall regional mean (±1 SE) of 66.1 ± 0.5. The 10 metrics and the PIBI were correlated with 27 chemical, 12 physical habitat, and 3 landscape variables. Overall, PIBI was inversely correlated with stream depth, stream water color, and Fe. Component metrics were sign...

BACKGROUND The prevalence and severity of lipodystrophy syndrome with long-term therapy for HIV-1 infection that includes a protease inhibitor is unknown. We studied the natural course of the syndrome to develop diagnostic criteria and identifying markers that predict its severity. METHODS We assessed 113 patients who were receiving HIV-1 protease inhibitors (mean 21 months) and 45 HIV-1-infected patients (28 with follow-up) never treated with a protease inhibitor. Lipodystrophy was assessed by questionnaire (including patients' rating of severity), physical examination, and dual-energy x-ray absorptiometry. Body composition and fasting lipid and glycaemic variables were compared with data obtained 8 months previously. Oral glucose tolerance was investigated. FINDINGS There was 98% concordance between patients' reports of the presence or absence of lipodystrophy (reported by 83% of protease-inhibitor recipients and 4% of treatment-naive patients; p=0.0001) and physical examination. Patients' ratings of lipodystrophy were significantly associated with declining total body fat (p=0.02). Lower body fat was independently associated with longer duration of protease-inhibitor therapy and lower bodyweight before therapy, and more severe lipodystrophy was associated with higher previous (p < 0.03) and current (p < or = 0.01) triglyceride and C-peptide concentrations, and less peripheral and greater central fat (p=0.005 and 0.09, respectively). Body fat declined a mean 1.2 kg over 8 months in protease-inhibitor recipients (p=0.05). The prevalence of hyperlipidaemia remained stable over time (74% of treated patients vs 28% of naive patients; p=0.0001). Impaired glucose tolerance occurred in 16% of protease-inhibitor recipients and diabetes mellitus in 7%; in all but three patients these abnormalities were detected on 2 h post-glucose load values. INTERPRETATION Diagnosis and rating severity of lipodystrophy is aided by the combination of physical examination, patient's rating, and measurement of body fat, fasting triglycerides, and C-peptide. Weight before therapy, fasting triglyceride, and C-peptide concentrations early in therapy, and therapy duration seem to predict lipodystrophy severity. Lipodystrophy was common and progressive after almost 2 years of protease inhibitor therapy, but was not usually severe. Hyperlipidaemia and impaired glucose tolerance were also common.

We attempted to identify spatial patterns and determinants for benthic algal assemblages in Mid-Atlantic streams. Periphyton, water chemistry, stream physical habitat, riparian conditions, and land cover/use in watersheds were characterized at 89 randomly selected stream sites in the Mid-Atlantic region. Cluster analysis (TWINSPAN) partitioned all sites into six groups on the basis of diatom species composition. Stepwise discriminant function analysis indicated that these diatom groups can be best separated by watershed land cover/use (percentage forest cover), water temperature, and riparian conditions (riparian agricultural activities). However, the diatom-based stream classification did not correspond to Omernik’s ecoregional classification. Algal biomass measured as chl a can be related to nutrients in habitats where other factors do not constrain accumulation. A regression tree model indicated that chl a concentrations in the Mid-Atlantic streams can be best predicted by conductivity, stream slope, total phosphorus, total nitrogen, and riparian canopy coverage. Our data suggest that broad spatial patterns of benthic diatom assemblages can be predicted both by coarse-scale factors, such as land cover/use in watersheds, and by site-specific factors, such as riparian conditions. However, algal biomass measured as chl a was less predictable using a simple regression approach. The regression tree model was effective for showing that ecological determinants of chl a were hierarchical in the Mid-Atlantic streams.

Aquatic monitoring aims to assess the condition of aquatic habitats and biota. To make statements about condition, the range of human activities and the risks they pose to aquatic ecosystems must be identified. Assessing relative risk and placing sample sites on a human disturbance gradient is necessary for interpreting biological response and distinguishing human disturbance from natural controls in aquatic systems. We describe a process that uses readily available sources, such as topographic maps, aerial photographs, and field information, to identify and prioritize stream reach and watershed stressors for 102 streams in the mid-Appalachian region of the United States. All perceptible human alterations to riparian and upland areas along with their number, type, intensity, and extent of impact were recorded and ranked; a relative risk index was developed to assign scores to the watersheds. The resulting risk index scores were consistent with measures of stream condition based on water chemistry and benthic macroinvertebrates. The risk index gives a cost-effective, regional picture of the relative risk of impairment to aquatic ecosystems in the mid-Appalachian region of the USA and could be modified for other regions or ecosystem types.

Parameters of fire regimes, including fire frequency, spatial extent of burned areas, fire severity, and season of fire occurrence, influence vegetation patterns over multiple scales. In this study, centuries-long patterns of fire events in a montane ponderosa pine ‐ Douglas-fir forest landscape surrounding Cheesman Lake in central Colorado were reconstructed from fire-scarred trees and inferences from forest stand ages. We crossdated 153 fire-scarred trees from an approximately 4000 ha study area that recorded 77 total fire years from 1197 to the present. Spatial extent of burned areas during fire years varied from the scale of single trees or small clusters of trees to fires that burned across the entire landscape. Intervals between fire years varied from 1 to 29 years across the entire landscape to 3 to 58 years in one stand, to over 100 years in other stands. Large portions of the landscape did not record any fire for a 128 year-long period from 1723 to 1851. Fire severity varied from low-intensity surface fires to large-scale, stand-destroying fires, especially during the 1851 fire year but also possibly during other years. Fires occurred throughout tree growing seasons and both before and after growing seasons. These results suggest that the fire regime has varied considerably across the study area during the past several centuries. Since fires influence plant establishment and mortality on the landscape, these results further suggest that vegetation patterns changed at multiple scales during this period. The fire history from Cheesman Lake documents a greater range in fire behavior in ponderosa pine forests than generally has been found in previous studies.

This study used curve-fitting techniques to detail the dynamics of human immunodeficiency virus (HIV)-1 and its relationship to circulating T lymphocyte changes in a cohort of 41 male patients (mean age 36+/-7 years) infected with HIV-1. The following characteristics of viral kinetics were obtained: virus load peak, 6. 35+/-0.71 log10 RNA copies/mL at 12.2+/-7.1 days; virus load drop from peak, 2.02+/-0.93 log10 copies/mL; viral decay rate from peak, 0.071+/-0.042 log10 RNA copies/mL/day; and steady state virus load, 4.57+/-0.68 log10 copies/mL at 135+/-81 days. Analysis of individual virus load curves revealed highly variable viral kinetics. Although these could be grouped into three distinct patterns, virus load and CD4 lymphocyte counts were similar in all patterns at 12 months, but the interval from infection to achievement of steady state virus load varied significantly.

In the past few years, major advances have been made in the field of primary HIV-1 infection. Several studies have reevaluated the clinical syndrome. The emergence of new molecular laboratory techniques has permitted a detailed analysis of viral dynamics and subsequent immunologic changes. Measurements of subsets of T-lymphocytes have allowed greater insight into the early pathogenesis of HIV-1 disease. There is now evidence that HIV-1-specific cytotoxic T-lymphocytes occur early during primary HIV-1 infection and are probably the most important immune defense against HIV-1. However, HIV-1 immune escape mutants have been identified during primary infection, which may be one reason for the failure of the immune system to completely eradicate the virus. Cytokines have been shown to play a role in primary HIV-1 infection, and the therapy of primary infection has gained more interest due to the introduction of potent triple combinations, including protease inhibitors.

BACKGROUND: Patients with repeat presentations to acute care hospitals for new injuries are trauma recidivists. Prospective identification of those patients at greatest risk will permit focusing of limited hospital prevention resources. METHODS: A population-based analysis of patients with recurrent trauma presenting to all hospitals in Nevada during a 5-year period was conducted. Records of 10,355 presentations representing 10,137 patients were analyzed. RESULTS: Recidivist trauma patients were younger than non-recidivists, with patients aged 20 to 24 years having significantly higher rates of recidivism. Males were 1.53 times more likely than females to become recidivists. Cutting/piercing and machinery-related injuries were most frequently associated with recidivism. Cutting/piercing wound survivors were 7.06 times more likely to be recidivists than were gunshot wound survivors. Recidivists in motor vehicles crashes were 1.92 times less likely to wear seat belts than nonrecidivists. Recidivism was also significantly associated with positive blood alcohol levels and longer initial hospital stays. CONCLUSION: The rate of trauma recidivism in this study was 2.0%. Population-based data can be used to identify cohorts at risk of recidivism.

We describe a general process for developing an index of fish assemblage integrity, using the Willamette Valley of Oregon, U.S.A., as an example. Such an index is useful for assessing the effects of humans on entire fish assemblages, and the general process can be applied to any biological assemblage and any region. First, a reference condition was determined from historical information, and then candidate metrics of ecological importance were listed. The variability of the candidate metrics in time and space was estimated and their responsiveness to independent measures of riparian and stream habitat quality assessed. Metrics were scored continuously from 0 to 10, producing an index of biological integrity (IBI) that was weighted to range from 0 to 100 regardless of the number of metrics. The index, developed from a set of 35 sites, was then tested on an independent set of eight urban sites sampled by the Oregon Department of Fish and Wildlife. Thirteen of the 16 candidate metrics were appropriate and produced an IBI with among-site variance triple that of revisit variance. The method distinguished sites with acceptable fish assemblages from marginally and severely impaired sites.

1. The rate of microbial respiration on fine-grained stream sediments was measured at 196 first- to third-order sites in the mid-Atlantic region of the United States. 2. Sample collection took place between April and July in 1993, 1994 and 1995. 3. Study streams were randomly selected from the United States Environmental Protection Agency’s (USEPA) River Reach File (RF3) using the sample design developed by USEPAs Environmental Monitoring and Assessment Programme (EMAP). 4. Respiration rate ranged from 0 to 0.622 g O2 g–1 ash-free dry mass (AFDM) h–1, and was significantly correlated with stream temperature, water chemistry and physical habitat. 5. Respiration rate was significantly higher in streams from the Chesapeake drainage area compared to those from the Ohio drainage area, and in streams from the Northern Appalachian Plateau and Uplands and Central Appalachian Valleys ecoregions compared with streams from the Blue Ridge and Central Appalachian Plateau ecoregions. 6. Respiration was not significantly different among stream orders or between years.

The predictive value of a two-compartment Bayesian feedback program for tobramycin dose optimization was retrospectively evaluated in 199 hospitalized patients and compared with that of a simple non-Bayesian one-compartment model. Before dose adjustment, 64% of the patients were underdosed indicating that tobramycin monitoring is still necessary to avoid ineffective antibiotic therapy. When physicians adhered to the dose instructions calculated with the Bayesian method, 90% of the patients had optimal concentration-time profiles as opposed to only 53% of the 43 patients in whom dose recommendations were not followed. In young patients with normal renal function, precision and accuracy of the Bayesian feedback and the one-compartment method were well correlated, whereas in elderly patients (> 60 years) and patients with impaired renal function (estimated creatinine clearance < 60 ml/minute), the Bayesian method was significantly more precise. Multiple regression analysis revealed that renal function was the only independent variable predicting the performance of the Bayesian program. The results of this study indicate that the Bayesian feedback method is a reliable method for the therapeutic tobramycin monitoring under clinical conditions and in particular, elderly patients in whom renal impairment is frequent.

Variations in the way that data are entered in ED record systems impede the use of ED records for direct patient care and deter their reuse for many other legitimate purposes. To foster more uniform ED data, the Centers for Disease Control and Prevention's (CDC) National Center for Injury Prevention and Control is coordinating a public-private partnership that has developed recommended specifications for many observations, actions, instructions, conclusions, and identifiers that are entered in ED records. The partnership's initial product. Data Elements for Emergency Department Systems, Release 1.0 (DEEDS), is intended for use by individuals and organizations responsible for ED record systems. If the recommended specifications are widely adopted, then problems--such as data incompatibility and high costs of collecting, linking, and using data--can be substantially reduced. The collaborative effort that led to DEEDS, Release 1.0 sets a precedent for future review and revision of the initial recommendations.

SummaryBenign and malignant tumours of the skin comprise a large variety of nevi, malformations and tumour entities, among which non-melanoma skin cancer, as well as malignant melanoma and its respective precursor lesions, are the most important. Most of the more common superficial benign and smaller skin tumours can be treated using diverse techniques, such as curettage or cryotherapy. Many of the vascular or epithelial nevi and several other benign skin tumours can be selectively destroyed using laser photothermolysis, or removed by circumscribed laser ablation, with excellent results. The major objective in the management of malignant skin tumours is early recognition and elimination of potential precursors, or initial tumour lesions. The latest preventive strategies include laser resurfacing of large actinically-damaged skin areas. Some of the premalignant (e.g. actinic keratosis) or in-situ tumours (e.g. Bowen's disease), as well as certain superficial basal cell carcinomas, can be cured by diverse s...

Using rat glioma C6 cells as a model, we have found a bimodal effect of alpha-thrombin on cell growth. In C6 cells treated with alpha-thrombin at concentrations from 0.02 nM to 1.0 nM, inhibition of cell proliferation was noted. Because the thrombin receptor agonist peptide TRAP-6 also induced inhibition of cell proliferation and the thrombin receptor antagonist peptide T1 prevented the inhibitory effect of alpha-thrombin on C6 glioma cell growth, thrombin receptor involvement in antiproliferative action of alpha-thrombin in C6 glioma cells is highly likely. However, stimulation of cell proliferation observed when C6 cells were treated with alpha-thrombin at higher doses (> 1.0 nM) seems to be mediated by as yet undefined thrombin receptor-independent biochemical mechanisms.

Introduction Data from the population-based Nevada State Trauma Registry were used to examine rates and determinants of restraint use in children who were involved in a car crash and seriously injured. Patterns of injuries in these children are also assessed. Methods Data were obtained from children 14 years of age or younger who entered the Nevada State Trauma Registry because of a serious injury caused by a car crash. The study period was from January 1, 1989, to December 31, 1992. Results Average annual age-specific crash injury rates per 100,000 were higher in rural areas than in urban areas. In children younger than two years old, 61% were restrained at the time of the crash; however, only about one third of all children over the age of three were restrained. In ages 0-4 years, only 5.3 % of the African-American children were restrained at the time of the crash compared with 47.2% of the Caucasian children. Children who were not restrained were more likely to have more adverse outcomes and to have different types of injury compared with their restrained counterparts. Conclusions The use of restraining devices in children who suffer a serious injury in a motor vehicle crash continues to be low and appears to be related to specific demographic characteristics. The findings indicated that restraint use at the time of the crash was related to less severe injury as indicated by certain outcome variables.

Digital has announced and shipped this first-generation, high-performance network for clusters, the Memory Channel for PCI network, and all SMP AlphaServers running Digital Unix support it. Digital has publicly demonstrated Memory Channel-connected systems running Windows/NT. The Memory Channel network does not require functionality beyond the PCI bus specification and works with any system having a PCI I/O slot. Production Memory Channel clusters can be as large as eight nodes (limited only by first-generation hardware) of 12 processors each (96 processors). One such cluster installed at Supercomputing 95 ran clusterwide applications using High Performance Fortran, PVM, and MPI. A four-node, 48 processor Memory Channel cluster, using Oracle Parallel Server, has held the record for TPC-C benchmarks since its introduction in April 1996. The same Memory Channel network used to connect this high-end database configuration also cost-effectively supports configuration of two-node, single-processor clusters. Latency over Memory Channel for a one-way, user-process-to-user-process message is 2.9 microseconds. The processor overhead is less than 150 ns for a 32-byte message. Standard message-passing APIs benefit greatly from this underlying capability.

Multiple Positive solutions are shown to exist for the third order difference equation satisfying conjugate boundary conditions when f is sublinear at one end point (zero or infinity) and superlinear at the other. The methods involve application of a fixed point theorem for operators on a cone.

ZusammenfassungBei einem dreijährigen Jungen fiel bereits bei der Geburt ein dyspropor-tionierter Überwuchs des linken Fußes sowie ein großer Naevus flam-meus mit nodulären Veränderungen im Bereich der linken Hüfte auf, so daß der Verdacht auf ein Klippel-Trenaunay-Syndrom geäußert wurde. Im Laufe der weiteren Entwicklung kam es zu einer kontinuierlichen Progredienz dieser Befunde, mit deutlicher Weichteilschwellung sowie pa-pillomatösen und verruziformen Vegetationen des Naevus. Darüber hinaus entwickelte sich auch unterhalb der rechten Schulter eine großflächige, flache Raumforderung sowie eine Makrodaktylie der I. und II. Zehe links. Trotz zahlreicher zwischenzeitlich durchgeführter diagnostischer Maßnahmen konnte die Verdachtsdiagnose bis zu diesem Zeitpunkt nicht bestätigt werden. Anläßlich einer ausgeprägten lokalen Infektion im Hüftbereich, die die Frage nach einer operativen Sanierung aufwarf, wurden – um eine längere Ruhigstellung des Jungen zu vermeiden – am gleichen Tag eine Lymphabflußszintigraphie, eine Radio-nuklidphlebographie und -ventrikulographie sowie eine Blutpool- und Skelettszintigraphie durchgeführt. Die Ergebnisse ließen ein Lymphangiom vermuten, das nach operativer Entfernung des Befundes histologisch bestätigt werden konnte. Unter Berücksichtigung aller Untersuchungsergebnisse dürfte es sich bei dem zugrundeliegenden Krankheitsbild nicht um ein Klippel-Trenaunay-Syndrom, sondern um das seltene Proteus-Syndrom handeln.

Phlebologic diseases have become extremely common and have major socio-economic impact. However, the percentage of dermatologists working in phlebology appears to be decreasing according to the data of the German Society of Phlebology (DGP).To investigate the reasons for this development, we--on behalf of the DGP--sent a questionnaire to 120 German Departments of Dermatology in autumn 2012.In 76 returned questionnaires, the number of physicians with additional fellowship training in phlebology averaged 1.5; the average number of those who fulfill the criteria for training fellows in phlebology was 0.9. In 71.1 % of the departments there was a phlebologist. A special phlebologic outpatient clinic existed in 73.7 % of the departments. Sonography with Doppler (89.5 %) and duplex (86.8 %) was used as the most frequent diagnostic tool. For therapy, compression (94.7 %), sclerotherapy (liquid 78.9 %, foam 63.2 %, catheter 18.4 %), endoluminal thermic procedures (radio wave 28.9 %, laser 17.1 %) and surgery (especially crossectomy and stripping 67.1 %, phlebectomy of tributaries 75 %) were used. The average number of treatments was very heterogenous in the different departments.Phlebology definitely plays an important role in dermatology. Most departments fulfill the formal criteria for the license to conduct advanced training in phlebology. A wide spectrum of phlebological diagnostic and therapeutic procedures is available.

In recent years negative pressure wound therapy (NPWT) has gained more and more supporters in dermatologic surgery. NPWT has become one of the standard therapeutic options, especially for non-healing diabetic, venous and arterial ulcers of the legs. When managing large wounds after tumor surgery, NPWT is frequently used to induce granulation tissue and reduce wound size before the wound is closed with split- or full-thickness skin grafts or local flaps. In addition to these well-established uses, NPWT can be also employed for a variety of "new" or rare indications, some of which are presented in this review.

Polymer flooding as an EOR method that has boomed in the last decade as oil prices have been rising, and new and larger polymer flood projects are being realized. Some milestones and examples are the large-scale viscoelastic polymer flood implementation at the Daqing field in China, polymer injection in Marmul field, Oman, and the Dalia offshore polymer project. Polymer flood is a mature EOR technology, but as the reservoir targets get more diverse and the field conditions harsher, the current understanding of polymer flood is stretched to its limits. In order to explain viscous fingering in inter-mediate to heavy oil reservoirs and viscoelastic mobilization of residual oil there is a need for a better understanding of polymer flow mechanisms on the pore scale. Pore scale polymer flow characterization is very complex and involves several flow phenomena like; adsorption, viscous fingering, depleted layers, hydrodynamic retention, bridging/flow-induced adsorption, viscoelastic effects, in-accessible pore volume and more. In this study we have developed a Navier-Stokes model to analyse polymer flow and to compare against Newtonian fluids. The aim has been to identify the key parameters for polymer displacement. Examples of obtained results are that the depletion layer plays a major role in study of rheological properties. Increased depleted layer thickness lead to lower velocity at the centre of the pore and more slip effect near the pore wall. When a higher degree of shear thickening is included a larger drag on fluids in side channels will occur, this is consistent with oil mobilisation and lowering of residual oil saturation.

Objective The current study presents our experience with accessory parotid gland masses and reviews the literature on accessory parotid tumor incidence and surgical management. Based on our results, we advocate a standard parotidectomy approach with routine facial nerve dissection at the time of excision. Study Design We performed a retrospective chart review and comprehensive literature review on incidence of accessory parotid gland neoplasms. Methods A retrospective chart review of all patients with mid-cheek masses treated by the senior author was conducted from January 2003 to January 2009. The tumor size at presentation, FNA biopsy, pathologic diagnosis, and surgical treatment were recorded for 13 patients. Results In the case series, 54% of lesions were benign (n = 7) and 46% were malignant (n = 6) including benign pathologies of 4 pleomorphic adenomas, 2 lymphadenitis, 1 monomorphic adenoma and malignant pathologies of 2 mucoepidermoid carcinoma, 2 B-cell lymphomas, 1 adenocarcinoma, and 1 myofibrosarcoma. Surgical intervention was performed on all patients with standard parotidectomy incision for accessory parotid mass excision after identification and tracing of facial nerve and its branches. Conclusion The present study provides support for a standard parotid incision with identification of the facial nerve at the time of surgical incision as this resulted in successful excision of accessory parotid tumors with favorable cosmetic results and without facial paralysis or tumor recurrence. Literature review of 152 cases of accessory parotid gland lesions, revealed a pooled incidence of 70% benign and 30% malignant.

Neoplastic expression of the onconeuronal cerebellar degeneration-related antigen Cdr2 in ovary and breast tumors is associated with paraneoplastic cerebellar degeneration (PCD). Cdr2 protein expression is normally restricted to neurons, but aberrant Cdr2 expression has mainly been described for breast and ovarian tumors. Previously, we found strong Cdr2 protein expression in the papillary subtype of renal cell carcinoma (pRCC) and showed that Cdr2 interacts with the hypoxia-inducible factor (HIF) prolyl-4-hydroxylase PHD1. High Cdr2 protein levels are associated with decreased HIF-dependent gene expression in cells as well as in clinical pRCC samples, providing a possible explanation why pRCCs are the most hypovascular renal tumors. Here, we demonstrate that strong Cdr2 protein expression in clinical samples from pRCC patients correlates with elevated PHD1 protein levels, suggesting that increased PHD1 activity attenuates HIF-dependent gene expression. Interestingly, survival analysis revealed a significant correlation between high levels of Cdr2 expression and worse patient outcome in clear cell (cc) RCC patients. These findings provide evidence that Cdr2 might represent an important tumor antigen in kidney cancer and possibly in other cancer types as well. In contrast to ovary and breast tumor patients who develop PCD, no Cdr2 auto-antibodies were detected in the serum of pRCC patients, which is in line with the fact that pRCC patients have not been reported to display paraneoplastic neurodegenerative syndromes. This suggests that, despite a shared target antigen, tumor immunity and autoimmunity only partially overlap, and also highlights to which extent immuno-surveillance against cancer can be clinically silent.

Letters from: [ Bernhard Spengler, et al. ][1] [ Thomas Peter and Daniel M. Murphy ][1] In the Perspective “Airborne particle analysis for climate studies” ([6 Sept., p. 1352][2]), Thomas Peter discusses upcoming methods of online airborne-particle analysis using time-of-flight mass