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10508 Background: The American Cancer Society has recently reported an increase in the percentage of patients with localized lung cancer from 2004 to 2018 with a corresponding improvement in survival for all patients combined. We analyzed the recent trends in stage distribution for lung cancer including tumor and demographic factors. Methods: We selected patients with lung cancer from the National Cancer Database (NCDB) public benchmark report diagnosed between 2010 and 2017. Patients with unknown stage were excluded. Stage distribution using the AJCC 7th edition of the TNM system was evaluated according to year of diagnosis, histology, age, gender, race, insurance and income. Results: Among the 1,447,470 patients from 1,384 hospitals identified in the database, 56,382 (3.9%) were excluded due to unknown stage or incorrect histology, leaving 1,391,088 patients eligible. The percentage of patients with stage I progressively increased from 23.5% in 2010 to 29.1% in 2017 while stage IV decreased from 45.5% to 43.1% during the same period (Table). The increased in percentages of stage I from 2010 to 2017 were 25.9% to 31.8% in non-small cell lung cancer (NSCLC) and 5.0% to 5.4% in small cell lung cancer (SCLC). Although the increased percentage of stage I lung cancer was observed in all subsets of patients, there were significant imbalances according to demographic and socio-economic factors. In the year 2017, the major gaps in stage I included insurance (31.4% for Medicare, 26.4% for private insurance, and 12.9% for uninsured), income (32.4% for the highest annual income and 25.4% for the lowest) and race (29.9% in whites and 24.3% in blacks). Conclusions: There has been a significant increase in the percentage of stage I lung cancer at diagnosis from 2010 to 2017 which occurred mostly in NSCLC. Disparities in diagnosis and access to treatment may account for the differences in the percentage of patients with stage I among selected demographic populations. The staging trends and recent treatment improvements may lead to better survival for lung cancer. [Table: see text]

Let D be a set of prime numbers. We investigate the chromatic number of graphs with vertex set of the integers and edges between any pair of vertices whose absolute difference falls in D. Such a graph is called a prime distance graph, and the set D is called the distance set. The chromatic number of prime distance graphs is known when the distance set D has at most four primes. In this paper we begin to classify prime distance graphs with a distance set of five primes. In particular, we completely classify the family of distance sets D = {2, 3, 7, 19, p} where p is any prime, and solve most of the more general family D = {2, 3, 7, p, q} for any primes p and q. The number theoretic function κ(D) is used as a tool, and some general properties about κ(D) are established.

To evaluate the ability of visual function and structural tests to identify the likely risk of progression from early/intermediate to advanced AMD, using the Age-Related Eye Disease Study (AREDS) simplified scale as a surrogate for risk of progression. The secondary aim was to determine the relationship between disease severity grade and the observed functional and structural deficits.A total of 100 participants whose AMD status varied from early to advanced were recruited. Visual function was assessed using cone dark adaptation, 14 Hz flicker and chromatic threshold tests and retinal structure was assessed by measuring drusen volume and macular thickness. The predictive value of the tests was estimated using ordinal regression analysis. Group comparisons were assessed using analysis of covariance.Change in cone dark adaptation (cone τ) and yellow-blue (YB) chromatic sensitivity were independent predictors for AMD progression risk (cone τ, pseudo R2 = 0.35, P0.001; YB chromatic threshold, pseudo R2 = 0.16, P0.001). The only structural predictor was foveal thickness (R2 = 0.05, P = 0.047). Chromatic sensitivity and cone dark adaptation were also the best functional tests at distinguishing between severity groups. Drusen characteristics clearly differentiated between participants with early and advanced disease, but were not able to differentiate between those with early AMD and controls. Mean differences in retinal thickness existed between severity groups at the foveal (P = 0.040) and inner (P = 0.001) subfields.This study indicates that cone τ, YB chromatic threshold and foveal thickness are independent predictors of likely risk of AMD progression.

We describe 4 children (11–17 years in age) at our institution with acute appendicitis in the setting of SARS-CoV-2 infection, suggesting a possible association. Providers should consider testing for this infection in patients with severe gastrointestinal symptoms, in order to take appropriate transmission based precautions, until more is understood.

As industry continues the challenge to drive down the frequency of low- and medium-level injuries in the workplace, one of the key challenges for safety professionals is in the prevention of serious injuries and fatalities (SIFs). There has been significant research into this area, and it is apparent that the causal factors that often contribute to SIFs are different to those of other less-serious lagging indicators. This presentation describes one approach that has been developed and implemented globally across TechnipFMC to help identify key risk activities and implement a structured mitigation process based on the hierarchy of controls.

Avatars or digital human characters are traditionally associated with digital games, where they enhance story-based interaction and player engagement. However, interest in accurate and cost-effective avatar development has increased in fields such as serious gaming and simulation training. The interest from these fields stems from training needs where avatars, used create human emotional experiences, could aid in appropriate education. In this context, the area of avatar emotional expression is not well understood. Applications often result in avatars that produce feelings of uncanniness in end-users, which may have a negative impact on training outcomes. This paper aims to firstly explore how avatar fidelity or realism could influence the emotional experience of interactions between end users and virtual humans. Secondly, we examine how avatar facial features displaying emotional expressions affect participants perceived valence of the avatar. These affects were assessed through a combination of experimental and survey methodologies. An existing ‘Godspeed’ survey was used to measure an end-users’ perception of an avatars ‘humanness’, ‘eeriness’, and ‘attractiveness,’ together with a three-part experiment that measured participants’ startle reflex responses to avatars with differing fidelity and emotional expressions. The results indicated that participant gender played a role in their perception of avatars. Also, the gender of the avatar appeared to have a significant impact on participant responses. Avatars displaying sad expressions emerged as less unpleasant and possibly less uncanny than smiling expressions. This research represents an entry point in a broad, cross-disciplinary area of research. While there are important findings and a significant amount of data generated, these elements pose questions for future work in this area.

Fix a set $D$ of positive integers. We study the maximum density $\mu(D)$ of sequences of integers in which the separation between any two terms does not fall in $D$. The $D$-sets considered in this article are of the form $\{1,j,k\}$. The closely related function $\kappa(D)$, the parameter involved in the "lonely runner conjecture," is also investigated. Exact values of $\kappa(D)$ and $\mu(D)$ are found for some families of $D=\{1,j,k\}$. We prove that the boundary conditions in two earlier results of Haralambis are sharp. Consequently, our results declaim two conjectures posted recently, and extend some results by Gupta., Comment: 18 pages; added new related results

The objective of this paper is to examine the recent improvements in packer and plug design, minimizing packer element extrusion. Based on these changes, operators now have more intervention options at reduced risk. While applicable to both new completions and interventions, this paper will focus on intervention technology. For many years, extrusion gap has been controlled primarily by the use of a "Gauge Ring" as a packer back up. While successful, this approach dictates a large OD packer or plug to minimize extrusion gap. As our industry has developed more tortuous well bore geometry, large ODs have led to running and pulling problems. These designs have also prevented many operators from recovering failed zones. Water encroachment, gas migration and failed sand screens have often been dealt with by re-completion. Options were limited to inflatable systems, long elastomer or umbrella types of plugs. Horizontal completions further reduced that to only inflatable solutions, due to umbrella systems dependency on cement. Recent developments in high expansion products have opened up new opportunities to recover from these types of problems. High expansion elastomers and new design packer back-up systems allow for actual V-Rated packer, plug and straddle systems. With this benefit, comes the added value of a retrievable system. Intervention work always carries with it the risk of failure. Recovery from a failed intervention can sometimes be a return to the original work-over plan. The most successful of the new systems incorporate expanding packer back-ups. High expansion types of systems are now being used for: Horizontal sand control in failed screens Packer failure recovery Straddles, straddles with stand-alone screens Zonal isolations, (including straddles) P&A work This type of equipment allows for the recovery of a failed intervention, as well as recovery from a change in wellbore dynamics. If the intervention team set the high expansion style system in the wrong place, they simply recover that and re-run at the correct depth. Should wellbore changes dictate a change, all or part of that system can be recovered and modified to accommodate the change in pressure/gas/water/sand. In conclusion, the ability to reduce extrusion gap, while at the same time reducing OD of completion / re-completion components, brings operators new avenues of success with reduced risk. Exciting new applications include, high expansion style straddles with sliding sleeves, Smart valves, and chemical injection systems.

The corneal epithelium is connected by tight junctions and serves as a protective layer, but its resistance to penetration also presents a challenge to drug delivery. Upon injury, the cornea is sus...

In severe falciparum malaria with high parasitaemia, removal of parasitized erythrocytes is generally considered to be of value as adjunctive therapy in addition to standard chemotherapy. Such removal is commonly achieved by exchange transfusion but this procedure is time-consuming and may be associated with haemodynamic disturbance. Current-generation automated cell-separator hardware and software allows prompt red cell exchange, erythrocytapheresis, in a single continuous-flow isovolaemic procedure. We describe the application of this procedure to 5 cases of severe falciparum malaria in travellers returning to the UK from the tropics. All patients also received quinine and conventional supportive therapy. In all cases, dramatic reduction in parasitaemia was achieved within 2 h with subsequent complete clinical recovery. Erythrocytapheresis has significant advantages over exchange transfusion in terms of speed, efficiency, haemodynamic stability and retention of plasma components such as clotting factors and may thus represent an improvement in adjunctive therapy for severe malaria.

Removal of parasitized erythrocytes is generally considered to be of value as adjunctive therapy in severe falciparum malaria with high parasitaemia. This is commonly achieved by exchange transfusion. We describe three cases of severe falciparum malaria treated by automated erythrocytapheresis (red cell exchange) in addition to quinine and conventional supportive therapy. Erythrocytapheresis consists of removal of the red-cell fraction by apheresis. Plasma, leukocyte and platelet fractions are returned to the patient. In all cases, dramatic reduction in parasitaemia was achieved within 2 h with subsequent complete clinical recovery. Erythrocytapheresis has significant advantages over exchange transfusion in terms of speed, efficiency, haemodynamic stability and retention of plasma components such as clotting factors and may thus represent an improvement in adjunctive therapy for severe malaria.

Summary Heterosexual intercourse is the major mode of transmission of the human immunodeficiency virus (HIV) worldwide. Heterosexual transmission of HIV is particularly important in Africa and is increasing in the developed world. The mechanism of HIV infection of the female genital tract with HIV and subsequent events leading to clinical infection are not fully understood. In particular, the primary cellular targets of HIV infection in the female genital tract have not been determined. We have established an in vitro model for studying HIV infection of the human adult cervix by HIV. Human cervical mucosal explants were briefly exposed to HIV strains of different tropism and maintained in organ culture for 7 days. HIV infection detected by immunohistochemistry and in situ hybridization was only observed in cervical explants exposed to macrophage tropic strain HIV 1 Ba-L . HIV-infected cells were located in submucosa and had the morphology and distribution of macrophages. While CD4 + /CD3 + T cells were still present at day 7 in the organ culture tissue, no infection of cervical explants was seen with T cell tropic strains even in the presence of phytohaemagglutinin and IL2. This model system will enable study of the dynamics of HIV infection of the human cervix and analysis of possible prophylactic or therapeutic strategies.

Summary This case study estimates the cost (in terms of reduced royalty) of the current commitment to protecting non-wood values by retaining ecologically sensitive areas in a selectively logged blackbutt forest (Eucalyptus pilularis Sm.) Blackbutt is the most important native timber-producing species in N.S.W. Within these forests, which frequently have a history of relatively low impact logging (group selection), reserved or low-disturbance areas have been set in place to safeguard ecologically “sensitive areas”. These retained areas are expected to complement and interact with the selectively logged forest to improve the maintenance of non-wood values and provide a reference for the long-term impacts of logging. The current forms and extent of reserves and low disturbance areas are examined in the Coffs Harbour Management Area on the north coast of N.S.W. To broadly estimate some of the cost attributable to the commitment to non-wood values, the current royalty value of the harvestable timber set aside...

Summary Analysis of stand growth-response patterns have shown that small increases in sawlog volume resulted from thinning fast grown, fire regenerated alpine ash (Eucalyptus delegatensis R.T. Bak.) from below to a range of regular tree-spacings, at age 28 years. No significant correlation was found between basal area growth response and increased spacing for four treatments that ranged from 3.7 m to 7.3 m. Rapid natural stocking-attrition occurred in both thinned and unthinned stands during the 31 post-thinning years of measurement. Maximum density diagrams indicated that these alpine ash stands were fully-stocked at lower densities than have been recorded for many other forest species. As a consequence of the propensity to self-thin, little additional stand growth was gained from the thinning treatments. The 150 trees ha−1 with the largest diameters from all thinned stands averaged a basal area increase of only 0.59 mha−1 over the 31 year period of measurement (

Heparin is the standard anticoagulant for patients undergoing cardiopulmonary bypass. There are some patients for whom heparin is unsuitable and ancrod (a defibrinogenating enzyme) has been used as an alternative. We present a patient with heparin-induced thrombocytopenia in whom treatment ancrod was ineffective. The addition of danaparoid sodium (a heparinoid) allowed safe cardiopulmonary bypass. We discuss the reasons for this and suggest that the combination of ancrod and danaparoid sodium is a logical one in such cases.

Compared with solid media, broth-based mycobacterial culture systems have increased sensitivity but also have higher false-positive rates due to cross-contamination. Systematic strain typing is rarely undertaken because the techniques are technically demanding and the data are difficult to organize. Variable number tandem repeat (VNTR) analysis by PCR is rapid and reproducible. The digital profile is easily manipulated in a database. We undertook a retrospective study of Mycobacterium tuberculosis isolates collected over an 18-month period following the introduction of the BACTEC MGIT 960 system. VNTR allele profiles were determined with early positive broth cultures and entered into a database with the specimen processing date and other specimen data. We found 36 distinct VNTR profiles in cultures from 144 patients. Three common VNTR profiles accounted for 45% of true-positive cases. By combining VNTR results with specimen data, we identified nine cross-contamination incidents, six of which were previously unsuspected. These nine incidents resulted in 34 false-positive cultures for 29 patients. False-positive cultures were identified for three patients who had previously been culture positive for tuberculosis and were receiving treatment. Identification of cross-contamination incidents requires careful documentation of specimen data and good communication between clinical and laboratory staff. Automated broth culture systems should be supplemented with molecular analysis to identify cross-contamination events. VNTR analysis is reproducible and provides timely results when applied to early positive broth cultures. This method should ensure that patients are not placed on unnecessary tuberculosis therapy or that cases are not falsely identified as treatment failures. In addition, areas where existing procedures may be improved can be identified.

The pfmdr 1 gene encodes a Plasmodium falciparum homologue of the human P-glycoprotein expressed on the surface of the parasite food vacuole. Variation in copy number and specific codon mutations of pfmdr 1 have been implicated in the development of parasite resistance to antimalarial drugs. We describe here the technique of Tandem-Competitive Polymerase Chain Reaction (TC-PCR), which allows accurate measurement of pfmdr 1 copy number in parasite DNA obtained directly from small quantities (100 microliters) of red blood cells. We reliably quantified pfmdr1 in previously well characterised strains of Plasmodium falciparum with differing pfmdr1 gene copy numbers using starting amounts of between 3,000 and 40,000 gene copies. We then used TC-PCR to determine pfmdr1 gene copy number in field specimens of venous blood taken from 10 patients with malaria contracted along the Thai-Burmese border. In this region of high grade parasite resistance to mefloquine greater than 70% of samples had a copy number greater than 1 of pfmdr1 determined with a repeatability coefficient of 0.58.

Haematological abnormalities are often seen in patients infected with HIV. A number of mechanisms are thought to contribute to this bone marrow suppression, including impaired stromal function and direct infection of progenitor cells. Evidence suggests that both bone marrow progenitor cells and perhaps stromal cells are open to infection by HIV, which raises the possibility that bone marrow stromal cells may serve as a reservoir for HIV. This study investigated the cellular targets and kinetics of in vitro infection of stroma in long-term bone marrow culture (LTBMC) using both mono- and lymphocytotropic strains of HIV-1. p24 ELISA and reverse transcriptase (RT) assay demonstrated that stroma could be infected with HIV and release infectious virions. The target cells for infection were shown to be macrophages by immunohistochemistry (APAAP), dual immunofluorescence staining (using CD68 and p24) and electron microscopy. The data show that it was possible to infect stroma in LTBMC with HIV and that such infection was productive. The main target for infection was bone marrow macrophages. In contrast to peripheral blood derived macrophages, these cells were susceptible to both lymphocytotropic and monocytotropic strains of HIV-1. The data suggests that these bone marrow macrophages may act as a reservoir for HIV, Infection of bone marrow macrophages may affect haemopoiesis either by transmission of HIV infection to developing progenitor cells through direct cell-to-cell contact or by altering the ability of the stroma to support normal development.

Summary A patient with acute myeloid leukaemia (AML) with an activating N-RAS oncogene mutation was studied in a haemopoietic clonogenic progenitor cell assay. Individual colonies and clusters were analysed by polymerase chain reaction and oligonucleotide hybridization for the original mutation. The mutation was detected in a majority of leukaemic clusters, but also in almost half of the differentiated colonies. After chemotherapy the patient entered clinical remission. However, the mutation could still be detected in the bone marrow. Only differentiated colonies and no leukaemic clusters were grown from the remission bone marrow, but the original mutation was still detectable in almost half of the colonies.

Objective: This study was designed to compare the stress produced at the PDL of abutment teeth with two angles of cervical convergence, in otherwise similar settings. Materials and Methods: Two finite element models were designed for a second premolar and a removable partial denture frame containing an I-bar clasp. Maximum Principal Stress (S1) and Von Mises Stress (SEQV) were assessed along a cervicoapical path of nodes in the PDL. Results: Output data for S1 and SEQV were the same regarding the height of contour. A gradual decrease in both models was observed. A larger decrease was found in the model with the higher angle of cervical convergence. Conclusion: I-bars placed on teeth with lower angles of cervical convergence produce a higher stress to the PDL of abutments.

Despite technological advances banking still concerns people. Frontline personnel form a critical means of competition in the marketplace and motivating them is a key task. Internal marketing provides the framework for such activities. Data gathered and analysed prior to and after the implementaton of an internal marketing programme confirms that it does impact on the quality of the service provided, recognising the value of communication in informing and motivating staff and creating positive attitudes and a sense of belonging. Apart from size there is little to differentiate banks from one another as all carry a similar range of services and charge similar rates. The bank that shows its superiority in the customer contact area should have a competitive tool and a means of successfully differentiating itself from competitors.

Summary The growth of 60-year-old white cypress pine stands at five locations in the Pilliga Management Area of N.S.W. is analysed over a 20 year period following thinning. The growth pattern and the optimum thinning range differed from that previously reported for this species. At four of the five locations stand basal area increment was independent of basal area for a range of values forming a ‘plateau’ of maximum increment. For these sites, no stand basal area increment rise or decline was detected with increasing residual basal area, over the range 6 to 18 m2 ha−1. The other location exhibited a growth pattern akin to the phenomenon of “lock-up” where increment did not “plateau” but peaked at a basal area of about 8 m2 ha−1 and then declined markedly at higher basal area without corresponding mortality. The optimum thinning range, where both tree size and site utilisation are maximised, was determined to be within the range 6 to 10 m2 ha−1. Maximum basal area increment ranged from 0.30 to 0.40 m2 ha−1...