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With the rising global tide of obesity, gestational diabetes mellitus (GDM) burgeoned into one of the most common antenatal disorders worldwide. Macrosomic babies born to diabetic mothers are more likely to develop risk factors for cardiovascular disease (CVD) before they reach adulthood. Rodent studies in offspring born to hyperglycemic pregnancies show vascular dysfunction characterized by impaired nitric oxide (NO)-mediated vasodilation and increased production of contractile prostanoids by cyclooxygenase 2 (COX-2). Vascular dysfunction is a key pathogenic event in the progression of diabetes-related vascular disease, primarily attributable to glucotoxicity. Therefore, glucose-induced vascular injury may stem directly from the hyperglycemic intrauterine environment of GDM pregnancy, as evinced by studies showing endothelial activation and inflammation at birth or in childhood in offspring born to GDM mothers. This review discusses potential mechanisms by which intrauterine hyperglycemia programs dysfunction in the developing vasculature.

Dermatologists are frustrated by payer constraints that limit their ability to optimize patient treatment. They can benefit from understanding the payer formulary process and places in that process where they can exert influence.pCollaboration between dermatologists and payers could improve access to medication not only for individual patients, but for the entire dermatologic patient population./ppemJ Drugs Dermatol. 2017;16(3):228-232./em/p.

The objective of the present work was to assess the influence of partial replacement of oats with dried unmolassed sugar beet pulp (SBP) and/or maize oil on nutrient utilisation in horses fed a traditional hay and concentrate diet. The total tract digestibility of nutrients, urinary excretion and plasma parameters were studied in a 4 x 4 Latin-square design experiment with purebred Arabian geldings. Horses fed the SBP diets responded with a reduced (P

The AVBCC Annual Meeting experiences exponential growth in attendance and participation as oncologists, payers, employers, managed care executives, patient advocates, and drug manufacturers convened in Hollywood, FL, on May 2-5, 2013, for the Third Annual Conference of the Association for Value-Based Cancer Care (AVBCC). The conference presented an all-inclusive open forum for stakeholder dialogue and integration across the cancer care continuum, facilitating an open dialogue among the various healthcare stakeholders to align their perspectives around the urgent need to address value in cancer care, costs, patient education, safety, outcomes, and quality. The AVBCC 2013 Steering Committee was held on the first day of the conference to define value in cancer care. The committee was divided into 7 groups, each representing a key stakeholder in oncology. The goal of the Steering Committee was to define value from the particular point of view of each of the stakeholder groups and to suggest how that particular perspective can contribute to the value proposition in oncology, by balancing cost, quality, and access to care to improve overall patient outcomes. The following summary highlights the major points addressed by each group.

The present experiment was performed according to a 4×4 Latin square design with diets composed of (on dry matter (DM) basis) the following ratios of grass hay to whole oats: 100:0 (O0), 80:20 (O20), 60:40 (O40) and 40:60 (O60). Four mature Standardbred geldings weighing 493 (S.D. 34) kg were used. The digestibility of DM, organic matter and energy (dE) increased in a curvilinear pattern with the increasing inclusion levels of oats. It is suggested that this was a reflection of the significantly lowered digestibility of nutrients and particularly of fibrous components for the O60 diet as compared with the other three rations, thus resulting in negative associative effects between grass hay and oats. On the basis of the present data, and excluding the results of the O60 diet, the digestibility of dE of oats was estimated to be 75%. As an expression of the associative effect at the O60 level, the dE of the total diet was estimated to be 58%, as compared with 63% when estimated on the oats value of 75% and the O0 diet, resulting in a depression of dE of the total diet by 8%, mainly affecting the utilization of fibrous components. Urinary energy losses decreased with increasing level of oats.

Bacterial infections, especially cholangitis, are still common complications after liver transplantation (LTx). During recent years, multiresistant enterococci have become a nosocomial problem in transplant units. The present prospective study on 26 patients, including 24 patients with chronic liver disease, demonstrated that enterococci were the predominant micro-organism involved in post-LTx bacterial infections. They were cultured in the feces and in other sites of 10 out of 13 (77%) patients who underwent extensive examinations. Ampicillin-resistant Enterococcus faecium strains were isolated in urine or feces of 2 of the 13 patients prior to LTx. Similarly, resistance to ampicillin and gentamicin, the empirically used antibiotics for patients with fever of unknown origin, was found in E. faecium strains in 3 and 2 patients, respectively. Moreover, multiresistant E. faecium and E. faecalis strains were demonstrated in 46% of the patients in the postoperative period (3 months). However, no vancomycin-resistant enterococci were isolated. The use of antibiotics within 4 months prior to LTx significantly increased the risk of developing ampicillin-resistant bacteria at the time of LTx and of infections with bacteria of enteric origin after LTx (P = 0.03 and 0.01, respectively). We conclude that stool and urine cultures performed prior to LTX may be useful for selecting prophylactic antibiotic regimens.

Due to the relatively high occupational doses associated with interventional and diagnostic fluoroscopy procedures it is important to create awareness about and to quantify the radiation environment that medical staff are exposed to. A computer program was developed to analyze dose data collected from a dosimetry system that uses active personal dosimeters to monitor staff dose in real-time, to obtain an expanded analysis of the radiation environment that clinical staff are exposed to, on a procedural basis. The analyses that are made per procedure and staff member include: accumulated dose μSv, maximum and median dose rate mSv/h, the amount of time a staff member has been exposed to radiation compared to the total fluoroscopy time and the percentage of accumulated dose from 3 different dose rate intervals, including < 0.3 mSv/h, 0.3 - 2.6 mSv/h, and < 2.6 mSv/h. The developed computer program was used to analyze dose data collected from the dosimetry system at the Karolinska University Hospital to study the radiation environment that different categories of staff are exposed to during interventional aorta aneurysm treatment procedures. The analyses have provided the ability to know where to concentrate radiation safety training in interventional and diagnostic fluoroscopy and to ensure that operating rooms are equipped with adequate radiation protection (e.g., radiation protection barriers etc.). The developed computer program and dose data collected from the dosimetry system can be appropriated for other radiation environmental studies in diagnostic x-ray imaging.

The aim of this study was to identify the bacteria causing neonatal septicemia in a neonatal intensive care unit (NICU) in León, Nicaragua and its relation with bacteria isolated from the environment at the NICU. Our data showed that 74% (34/46) of the bacteria related to newborns with septicemia were Gram-negative and highly resistant to beta-lactams (85%) and aminoglycosides (80%), leading to treatment failure in 10 neonates with fatal outcome. Although, the prevalence of Gram-positive bacteria (26%) was lower than Gram-negative bacteria, Staphylococcus epidermidis was related to the death of three newborns. No clonal similarity was found among Enterobacter cloacae , Escherichia coli and Serratia liquefaciens isolated from the neonates with septicemia and the NICU environment. However, in order to improve the outcome for neonates with septicemia, infection control practices and appropriate empirical therapy should be considered to reduce the high prevalence of extended-spectrum beta-lactamase (ESBL)-producing Gram-negative bacteria isolated from neonates with septicemia (80%) and from the NICU environment (34%).

Abstract and Introduction Steam Assisted Gravity Drainage (SAGD) is a steam-flood process that relies on thermal diffusion and gravity to mobilize bitumen in oil sands reservoirs and allow for recovery. A pair of parallel horizontal wells are drilled near the bottom of the pay zone with approximately 5 m vertical separation between them. After an initial circulation phase to establish communication, high quality steam is continuously injected down the injection well while the heated bitumen and condensate flow to the production well as a result of gravity. The volume of low oil saturation left behind is filled with steam and referred to as the steam chamber. The steam chamber grows vertically until it hits the cap-rock at which point it grows laterally away from the horizontal wells(1). A major cost of producing bitumen by SAGD is the energy required to produce steam; thus there is a great drive to improve the energy efficiency of a SAGD project. Solvent addition is expected to increase oil production and improve the energy efficiency of SAGD by combining the thermal process with the diluents mechanism of a solvent(2). A solvent is added to the steam chamber by injecting the solvent-steam mixture continuously from the injector well(3). Reservoir simulations of solvent-steam co-injection were done with a pseudo-compositional thermal reservoir simulator. The effects of co-injecting a multi-component solvent, naphtha, and a single component solvent, propane or pentane, were compared to SAGD. Three pseudo-components were used to model the multi-component behavior of naphtha. Co-injection of any of the solvents studied (propane, pentane, naphtha) resulted in an improved SOR. The greater the mole ratio of solvent to steam, the greater the improvement in SOR. Only naphtha co-injection resulted in an improved oil production rate. All components of naphtha travelled freely in the vapour chamber and accumulated along the vapour chamber front in both the vapour and oil phases. At higher solvent to steam ratios, the oil production rate decreased due to an accumulation of solvent gas at the vapour chamber front. Reservoir Model Description Simulations of a SAGD well pair were performed using a homogeneous, two-dimensional model of a vertical cross section perpendicular to the wells. Figure 1 shows the layout of the 100 m by 1 m by 20 m model made of 1 m cubes. Reservoir values typical to the MacKay River McMurray Formation were used and are listed in Table 1. The horizontal production well is in grid cell 50, 1, 18, and the horizontal injector is 5 m above the producer in grid cell 50, 1, 13. The model is bound on the top and bottom by impermeable cap and base rock. No mass or heat transfer can occur through the two other side boundaries of the model. The numerical models considered in this paper provide a preliminary analysis of the complex, three-dimensional system that is expected to exist in reality(4). The following assumptions were made in the course of the numerical study:Bitumen is modeled as "dead " oil, existing only in the oil phase;Water and oil are immiscible

Abstract Steam Assisted Gravity Drainage (SAGD) is an in situ thermal recovery technique used at Petro-Canada's MacKay River Project. The objective of this study is to develop an analytical well test method that would allow a measure of steam chamber volume and potentially the timing and location of steam chamber coalescence. This well test method would also prove useful in determining an analytical solution for near wellbore characteristics and reservoir boundaries. A pseudo-compositional thermal simulator was used to generate reservoir pressure responses by shutting off an injector at different periods of time and monitoring the pressure fall-off while continuing with production. Confined, unconfined, and coalesced 2-dimensional sink-source well pair models, based upon the geology and drilling pattern at Petro-Canada's MacKay River Project, were used in the study. The effect of the magnitude of the vertical permeability and the vertical to horizontal permeability ratio on the shut-in pressure response was also studied so that this method could be applied to other reservoirs of differing geology. Pressure response type curves were generated and the relationships between pressure drop at the injector, shut-in time, and steam chamber volume were determined. We show that the pressure response type curves are unique for different types of SAGD wells and levels of steam chamber development. This information will aid in determining the timing of operational conversions and determining recovery factors and possibly locations of reservoir boundaries, as well as steam chamber coalescence. Introduction In a commercial SAGD project, it can be expected that as the steam chambers mature and sweep through the reservoir, the well pairs will begin to interact with each other and the steam chambers will coalesce(1). Coalescence is defined as the point at which separate adjacent steam chambers merge to form one large steam chamber. Coalescence is used for timing operational conversions to secondary recovery schemes, such as solvent injection. As a result of the planning that is required for the operational conversion, a method of measuring the volume of the steam chamber would prove useful in estimating the timing of coalescence and the subsequent operational conversions. Considering there are 25 well pairs at MacKay River, it is also necessary to know which well pairs have coalesced so as to know the well pairs in which to institute operational conversions. For this reason, a well test method for determining which well pairs have coalesced is also required. The distance to and orientation of boundaries, flow regime, near wellbore characteristics (such as skin factor), and reservoir characteristics (such as effective permeability) can be determined through conventional pressure transient analysis. Conventional horizontal well testing has four different flow regimes that can be observed in the pressure response: early time radial flow, early time linear flow, pseudo steady state radial flow, and late time linear flow(2). The analytical solution is then applied in segments to the well test based upon the flow regime indicated by the pressure response. This segmental analysis can then be used to determine the reservoir characteristics.

PROMISE, a project in the DRIVE/ATT framework, is currently implementing pilot tests of traveller information services in two European cities. The two-way PROMISE traveller information services as they are implemented in the Gothenburg pilot installation are described. Based on the Groupe Spatiale Mobile cellular network and its Short Message Service (SMS), the users may request real-time traveller information from several existing information sources, e.g., for public transport, parking availability, road traffic information and road weather forecasts.

Purpose: To quantify the change in registered patient and staff dose indicators, i.e., KAP and CAK, and to evaluate if any detrimental effects on the treatment response are introduced, by the clinical implementation of a noise reducing algorithm for neurointerventional procedures. Methods: An image processing algorithm, ClarityIQ, for the AlluraClarity (Product not yet available in the US) system has been developed by Philips (Philips Healthcare Best, The Netherlands) to achieve advanced real time noise reduction in fluoroscopy and digital subtraction angiography. With the implementation of the noise reducing algorithm, an equivalent image quality can be achieved with reduced exposure by optimizing the system settings, consequently modifying the emitted photon spectrum.A retrospective study was performed where exposure dose data with the new system settings (January–June 2012; 174 diagnostic and 138 interventional cases) was compared with data for the prior system settings (January–June 2010; 190 diagnostic and 112 interventional cases). The data was categorized according to type of diagnostic or interventional procedure. In order to evaluate the effect on the treatment response, the total number of acquisition images, duration of fluoroscopy, and total procedure time was collected. Results: The median of the total KAP and CAK (sum of frontal and lateral plane) for diagnostic and interventional procedures for the prior settings was 124 Gycm2 and 0.78 Gy, and 328 Gycm2 and 2.71 Gy, respectively. The median for diagnostic and interventional procedures with the new settings was 47 Gycm2 and 0.27 Gy, and 109 Gycm2 and 0.89 Gy, respectively. The difference in the total number of acquisition images, duration of fluoroscopy, and total procedure time was statistically negligible. Conclusion: The new system settings resulted in a significantly reduced KAP and CAK (approximately 60%), indicating reduction in both patient and staff doses, with no indication of change in treatment response. Two of the athors are employed by Philips Healthcare, Best, The Netherlands (S. Boon and M. Mauti). The project was partly financed by Philips Healthcare.

In this study 4 Standardbred geldings (age 3-8 years, weight 431-531 kg) were used. The horses were fed a hay and oat diet and the total sodium intake was about 32 mg/kg bwt (690 mmol/day). An exercise test (ET) which contained 3 phases was performed. Phase I consisted of 23.5 min of mainly submaximal exercise, Phase 2 of 2 h of box rest and Phase 3 of 26 min of exercise including an intensive trot over 2600 m at 90% of VO2max. The ET was repeated 3 times: the first at 20 degrees C (30-40% RH), the second at 35 degrees C (30-40% RH) and the third at 35 degrees C (30-40% RH) after a nasogastric administration of 10 litres of 0.9% NaCl solution (35 degrees C and saline load [+ F]). Blood samples were taken before, during and after exercise. To measure fluid loss, horses were weighted before and after the ETs. Total urine output was determined 2 days before the ET (control), throughout the exercise day and for 2 days after (recovery days). There were an increase in blood and rectal temperatures after both exercise phases and a significant higher blood temperature was observed after exercise at 35 degrees C compared to 20 degrees C. The horses lost about 2% of their bodyweight (bwt) during the ETs. The plasma protein concentration increased during the exercise phases and remained elevated 2 h after exercise at both 20 degrees C and 35 degrees C, even though the horses had free access to water. The plasma protein concentration had returned to pre-exercise levels 26 h post exercise. After the saline load, total plasma protein concentration fell and increased only at the end of each exercise phase. The major mechanism regulating fluid balance after exercise seemed to be a lowered urinary excretion since water intake did not increase significantly. Urinary potassium excretion was positive throughout the experiment. During control days there was a positive sodium balance, shown by a urinary sodium excretion of 260 mmol/day. Post exercise urinary sodium excretion fell and remained very low until the second day of recovery, except after saline loading. In addition, plasma sodium was lowered 26 h after exercise at 35 degrees C. This study shows that with a daily salt intake of 38 g it will take several days to compensate for a sodium loss caused by sweating. Therefore, it is recommended that extra salt be given during the exercise day. In the experimental situation, pre-exercise saline supplementation was beneficial since the recovery time was shortened.

Technical and economic problems of eflicient development of heavy oil resources receive large attention in all countries where these resources are abundant. This is particularly the case in Canada and Venezuela where some 70 per cent of the world reserves of heavy oil are located. World-wide experience to-date indicates that thermal methods, such as steam flood, in-situ combustion and steam-gas injection, are the only effective methods available for the in-situ recovery of the extensive heavy oil resources. In this respect, the emergence of horizontal drilling technology, as well as the slim hole technique, has opened up new perspectives. In the last few years, progress in drilling and completion of horizontal weils have brought this new production tool to a high level of achievement for a wide range of applications. This paper concentrates on the synergism of thermal methods with less conventional well

Maxillary sinusitis was induced in New Zealand white rabbits by local inoculation of 10(6) colony-forming units of Bacteroides fragilis NCTC 9343, and the serum IgG, IgA and IgM antibody responses to cell wall antigens were studied. Prior to inoculation, and one, two, three and four weeks after induction, serum samples were obtained and analysed for antibodies to the lipopolysaccharide and the capsular polysaccharide. Capsular polysaccharide from B. fragilis ATCC 23745 was used as control. The rise in IgG activity against NCTC 9343 capsular polysaccharide and lipopolysaccharide was most marked and sustained throughout the four weeks. The increases in IgA concentration were moderate and sometimes transient, and a more pronounced IgA increase was seen with IFA than with EIA. The IgM peak levels were weak and usually declined within two to three weeks. The development of antibody to the lipopolysaccharide was similar to that of the NCTC 9343 capsular polysaccharide antibodies, though somewhat delayed in time. No significant increase in antibody to the control capsular polysaccharide was seen.

Abstract The oil saturation inside the steam chamber during steamassisted gravity drainage (SAGD) has an important impact on economics and conservation. However, the SAGD residual oil saturation is difficult to determine and model because it involves long-term thermal effects and three-phase flow. SAGD has been widely studied and piloted, but improved understanding of longterm drainage effects represents a fundamental issue that requires improved understanding. In the first part of the paper, we represent a sensitivity test done on the shapes and the endpoints of the two-phase relative permeability curves. We find that the water relative permeability and oil relative permeability in the gas-oil system are the main factors that determine the magnitude and shape of the oil saturation curve as a function of time. Secondly, we demonstrate how to adjust the krog relative permeability curve to match a theoretically determined residual oil saturation, which is supported by laboratory data. We propose that, during SAGD, the flow of oil can be split into two regimes. In the first regime, close to the edge of the steam chamber, oil drains quickly in a short period of time. In the second regime, oil drains slowly within the steam chamber for a longer period of time, as it is produced by "film drainage." To capture these flow regimes, the oil relative permeability curve in the gas-oil system, krog, is split into two. At higher liquid saturations, the first flow regime is represented and, at lower liquid saturations, the second regime is modelled. Thirdly, the krog curve was adjusted so that the decrease in oil saturation with respect to time closely matched the theoretical curve while maintaining oil production rates expected for SAGD. Using this new curve at different pressures, we show that the residual oil saturation increases at lower SAGD operating pressures. Introduction In a steam-assisted gravity drainage (SAGD) process, bitumen drainage occurs mainly along the transition zone, which is the mobile liquid region at the boundary of the steam chamber. Bitumen drainage also continues to occur within the body of the steam chamber over a long period of time, such that the residual oil saturation gradually falls. In this paper, the term residual oil saturation refers to the average remaining oil saturation within the steam chamber where the steam chamber includes all grid blocks in a numerical model containing any amount of steam. It is difficult to obtain residual oil saturation data as a function of time in the field so, in this study, we relied on theoretical and laboratory data. We calibrated reservoir simulation results to the theoretical and laboratory data, and then used the simulator to investigate the effects of SAGD operating pressures on the residual oil saturation. Relative Permeability Formulation Multiphase flow in a porous medium can be described using Darcy's Law as follows

Summary The aim of this study was to investigate the effect of partly replacing oats with molassed sugar beet pulp in a traditional hay/oat diet on nutrient utilisation and metabolic parameters in exercising horses. In a change-over experiment, 4 Standardbred geldings were fed a hay and oat-based diet (Oat diet) and a hay and oat-based diet where oats was partially replaced with molassed sugar beet pulp (MSBP diet). Each experimental period was 21 days during which total collection of faeces and urine was made and an exercise test (ET) performed. The crude fat digestibility was lower on the MSBP diet (P