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To compare survival outcomes between primary surgery and primary radiation therapy (RT) in patients with human papillomavirus (HPV)-negative oropharyngeal squamous cell carcinoma (OPSCC).A retrospective observational cohort study.National Cancer Database.A National Cancer Database review was conducted of 2635 patients with HPV-negative OPSCC who underwent surgery or RT ± chemotherapy between 2010 and 2014. Univariate analysis was performed on all variables and entered into a multivariate model. The main outcome was overall survival (OS).A total of 2635 patients with HPV-negative OPSCC were organized into 4 groups based on cancer staging. In group 1 (T1-2 N0-1; n = 774), up-front surgery had significantly better 5-year OS (76.2%) than RT (56.8%; adjusted hazard ratio [aHR], 1.76; P = .009; 95% CI, 1.15-2.69) and chemoradiation therapy (CRT; 69.5%; aHR, 1.56; P = .019; 95% CI, 1.08-2.26). In group 2 (T3-4 N0-1; n = 327), no significant difference existed between surgery and CRT (5-year OS, 51.3% vs 52.4%; aHR, 0.96; P = .88; 95% CI, 0.54-1.69). In group 3a (T1-2 N2-3; n = 807), surgery with adjuvant treatment showed significantly better 5-year OS than CRT (78.6% vs 68.8%; aHR, 1.51; P = .027; 95% CI, 1.05-2.18). In group 3b (T3-4 N2-3; n = 737), surgery with adjuvant treatment was not statistically associated with better 5-year OS as compared with CRT (61.0% vs 43.7%; aHR, 1.53; P = .06; 95% CI, 0.98-2.39).Primary surgery may provide improved survival outcomes in many cases of HPV-negative OPSCCs. These data should be used in weighing treatment options and may serve as a basis to better delineate treatment algorithms for HPV-negative disease.

This study explored how an alternative presentation of loan information affects financial-aid decisions among students (n = 204) at a large public university. Building from decision-aid literature and using an experimental design, we found that when financial-aid forms were formatted in a way that makes interest rates more accessible and salient, students tended to: (a) accept fewer high-cost private loans and (b) work more during the college years. Results indicate that minor revisions in financial-aid documentation can have a significant impact on students' financial-aid choices. Those working in the fields of higher education and financial counseling and planning can use this information to further educate borrowers prior to the encumbrance of student loan debt.

Background: In cancer patients receiving chemotherapeutic agents, cardiovascular toxicities still remains one of the most undesirable side effects. One of the best known cardiotoxic agents is doxorubicin, a very powerful chemotherapeutic molecules for breast cancer. Extra-virgin olive oil (EVOO) is rich in cancer preventive polyphenols endowed with anti-inflammatory, anti-oxidant activities which could exert protective effects on heart cells. A very interesting derivative of EVOO preparation is represented by purified extracts from olive mill waste waters (OMWW) rich in polyphenols. Here, we have investigated the anti-cancer activity of a OMWW preparation, named A009, on breast cancer cells when combined with chemotherapeutics, as well as its potential cardioprotective activities. We had previously reported additive effects with cisplatin in prostate cancer cells. In previous studies we have shown that the combination of A009 with cisplatin or 5-FU was effective in decreasing prostate and colon cancer cell growth, while it did not further reduce growth of rat cardiomyocytes also treated with cisplatin or 5-FU. Here we used 5-fluorouracil as comparison. Methods: Combination of A009 and chemotherapy was investigated in vitro on human breast cancer cell lines BT459, MDA-MB-234. The cardioprotective effects of the A009 extract were tested on H9C2 (cardiomyocytes) cells co-exposed to doxorubicin or 5-fluorouracil and in zebrafish embryos. Results: Adding A009 to doxorubicin or 5-FU was effective in decreasing breast cancer cell growth in monolayer. Breast tumor spheroids morphologically appeared less stable and with reduced diameter when treated with A009 extracts and with the chemotherapeutic agents 5-FU or Doxo, additive effects were observed. A009 mitigated toxicity of doxorubicin or 5-FU on rat cardiomyocytes cells H9C2. Cardioprotective effects were observed by the combination of OMWW extracts with Doxorubicin in Zebrafish embryos. In human cardiomyocytes, we observed 5-FU induced upregulation of the proinflammatory IL6 mRNA, which was reduced by OMWW treatment. Conclusions: Our study demonstrates that the polyphenol rich purified A009 extracts enhance the effect of chemotherapy of doxorubicin and 5-FU on breast cancer cells but mitigates chemotherapy adverse effects on heart in vivo and on cardiomyocytes, appearing as a potential cardio-oncological prevenzion agent. Citation Format: Adriana Albini, Marco M. Festa, Denisa Baci, Nadia Benedetto, Karolina Gutmanska, Nicoletta Macrì, Giovanna Finzi, Fausto Sessa, Serena Zacchigna, Antonino Bruno, Douglas M. Noonan. An extract of olive oil wastewater enhances chemotherapy effects on breast cancer cells without exacerbating cardiovascular toxicity [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 4044.

Conservation of huemul (Hippocamelus bisulcus), an endangered South American deer, is hindered by a lack of quantitative information on its population dynamics. We conducted a 3-year study in Chilean Patagonia to assess the dynamics of huemul by monitoring known individuals. We fitted 55 deer of all sexage classes with either radiocollars, radio ear tags, or conventional ear tags, and identified 33 additional deer through natural marks. KaplanMeier estimates revealed that annual survival of adult females was high and stable (0•94 ± 0•07 SD), but survival of female fawns was low and variable (0•13 ± 0•18). Predation was the predominant cause of mortality for deer of all age classes. Fertility rates were lower (0•72 ± 0•20) than in other cervids of similar size. Simulations of the finite rate of increase (λ) suggest that the population is currently stable. Sensitivity analysis showed that any decrease in adult female survival would have drastic effects on λ. Consequently, management should maintain high adult survival and improve recruitment. Continued monitoring of individuals is required to provide baseline data for comparison with other populations and to inform recovery strategies of small and fragmented populations. © 2010 American Society of Mammalogists.

Additional details about methods, expanded data tables, statistical outputs, complete list of species and references included in dataset, link to website with raw data (complete dataset)

Purpose The purpose of this study is to investigate gender-based punishment bias in the type and severity of punishments imposed on a male-dominated profession using the accounting profession as a proxy. Design/methodology/approach Data were hand-collected from the population of certified public accountants disciplined for violations of the Code of Professional Conduct. Disciplinary actions were obtained from the American Institute of Certified Public Accountant’s website. A total of 404 observations were obtained for the study over a five-year period from January 2009 through June 2015, comprising the population of the captured infractions committed during this time frame. Findings Women are punished more harshly than men for equivalent infractions; the disparity in punishment between women and men increases with the severity of the infraction. Originality/value This paper answers the call by Wren (2006) for an increased examination of workplace punishment’s relationship to gender using real-world scenarios and data. This study provides empirical evidence of the gender-based punishment bias, which calls into question the neutrality of workplace punishment as executed by a male-dominated profession.

Self-leadership examines how individuals can motivate themselves through behavior focused strategies, constructive thought patterns, and natural reward strategies. This study examined the potential influence of self-leadership on financial self-efficacy, credit card debt, and student loan debt among college students. Data were collected from a survey of 197 graduate and undergraduate students at a major Midwestern university. The findings suggest students higher in self-leadership tend to have lower student loan debt. Additionally, financial self-efficacy and credit card debt mediate the relationship between self-leadership and student loan debt. The results have implications for the role self-leadership plays in credit card debt, financial self-efficacy, and student loan debt.

Blockchain technology is the underlying enabling technology developed for Bitcoin, the most common cryptocurrency. Blockchain technologies have become increasingly popular with the potential to become a powerful disruptive force. Individuals and organizations may benefit from blockchain with its ability to increase secure data exchange and to make that transaction simpler and easier between entities. We investigate factors that influence an individual's intention to use a blockchain cryptocurrency. We develop a model of cryptocurrency adoption grounded in the theory of planned behavior (TPB) to: identify the determinants for the acceptance of cryptocurrency and explore the relative importance of each construct. We offer empirical evidence for a better theoretical understanding of cryptocurrency adoption with practical implications in an e-government context.

none 5 no In the article titled "A Comparison between Piezoelectric Devices and Conventional Rotary Instruments in Bone Harvesting in Patients with Lip and Palate Cle: A Retrospective Study with Clinical, Radiographical, and Histological Evaluation" [1], an acknowledgment should be added as follows: e authors would like to acknowledge the Valere Project of the University of Campania Luigi Vanvitelli for the support to publish this article. none Rullo R.; Piccirillo A.; Femiano F.; Nastri L.; Festa V.M. Rullo, R.; Piccirillo, A.; Femiano, F.; Nastri, L.; Festa, V. M.

Caribou ( Rangifer tarandus (L., 1758)) play a central role in the ecology and culture of much of Canada, where they were once the most abundant cervid. Most populations are currently declining, and some face extirpation. In southern Canada, caribou range has retreated considerably over the past century. The ultimate reason for their decline is habitat alterations by industrial activities. The proximate causes are predation and, to a lesser extent, overharvest. The most southerly populations of “Mountain” caribou are at imminent risk of extirpation. Mountain caribou are threatened by similar industrial activities as Boreal caribou, and face increasing harassment from motorized winter recreational activities. Most populations of “Migratory Tundra” caribou are currently declining. Although these caribou fluctuate in abundance over decades, changing harvest technologies, climate change, increasing industrial development and human presence in the North raise doubts over whether recent declines will be followed by recoveries. The Peary caribou ( Rangifer tarandus pearyi J.A. Allen, 1902), a distinct subspecies endemic to Canada’s High Arctic, has suffered drastic declines caused by severe weather, hunting and predation. It faces an increasing threat from climate change. While some questions remain about the reasons for the decline of Migratory Tundra caribou, research has clearly identified several threats to the persistence of “Boreal”, Mountain, and Peary caribou. Scientific knowledge, however, has neither effectively influenced policies nor galvanized public opinion sufficiently to push governments into effective actions. The persistence of many caribou populations appears incompatible with the ongoing pace of industrial development.

Aims: To determine the outcome of children with neuromuscular disease (NMD) following admission to a tertiary referral paediatric intensive care (PICU). Methods: All children with chronic NMD whose first PICU admission was between July 1986 and June 2001 were followed up from their first PICU admission to time of study. The outcomes recorded were death in or outside of PICU, duration of PICU admission, artificial ventilation during admission and following discharge from PICU, and readmission to PICU. Results: Over 15 years, 28 children were admitted on 69 occasions. Sixteen (57%) children had more than one admission. The median duration of PICU admission was 4 days (range 0.5–42). Twenty three per cent of unplanned admissions resulted in the commencement of respiratory support that was continued after discharge from the PICU. Severity of functional impairment was not associated with longer duration of stay or higher PRISM scores. Ten children (36%) died, with four (14%) deaths in the PICU. A higher proportion of children with severe limitation of function were among children that died compared to survivors. Conclusion: Most children with NMD admitted to the PICU recover and are discharged without the need for prolonged invasive ventilation. However, in this group of children, the use of non-invasive home based ventilation is common and they are likely to require further PICU admission.

Aims: To assess the impact of two paediatric intensive care unit retrieval teams on the performance of three mortality risk scoring systems: pre-ICU PRISM, PIM, and PRISM II. Methods: A total of 928 critically ill children retrieved for intensive care from district general hospitals in the south east of England (crude mortality 7.8%) were studied. Results: Risk stratification was similar between the two retrieval teams for scores utilising data primarily prior to ICU admission (pre-ICU PRISM, PIM), despite differences in case mix. The fewer variables required for calculation of PIM resulted in complete data collection in 88% of patients, compared to pre-ICU PRISM (24%) and PRISM II (60%). Overall, all scoring systems discriminated well between survival and non-survival (area under receiver operating characteristic curve 0.83–0.87), with no differences between the two hospitals. There was a tendency towards better discrimination in all scores for children compared to infants and neonates, and a poor discrimination for respiratory disease using pre-ICU PRISM and PRISM II but not PIM. All showed suboptimal calibration, primarily as a consequence of mortality over prediction among the medium (10–30%) mortality risk bands. Conclusions: PIM appears to offer advantages over the other two scores in terms of being less affected by the retrieval process and easier to collect. Recalibration of all scoring systems is needed.

On a yearly basis, large calf ranches rear thousands of neonatal cattle for replacement heifers, veal or dairy beef. Dairy beef ranches obtain bull-calves from multiple sources and with questionable colostrum intake histories. Such ranches accumulate large amounts of data that could be used to help them with calf purchasing and on-farm management practices to avoid losses. Our purpose was to describe some calf purchase factors associated with mortality in neonatal calves raised on a single large calf ranch. Computerized records describing 120,197 bull-calves purchased between January 1997 and November 1998 were used in a survival analysis. Risk factors for mortality within the first 4 weeks after arrival on the ranch included body weight on arrival, month of arrival, and the calf supplier. The strength of the effects was conditional on the week after arrival to the ranch.

Annexin A1 (ANXA1) has an important role in cell-cell communication in the host defense and neuroendocrine systems. In both systems, its actions are exerted extracellularly via membrane-bound receptors on adjacent sites after translocation of the protein from the cytoplasm to the cell surface of adjacent cells. This study used molecular, microscopic, and pharmacological approaches to explore the mechanisms underlying the cellular exportation of ANXA1 in TtT/GF (pituitary folliculo-stellate) cells. LPS caused serine-phosphorylation of ANXA1 (ANXA1-S27-PO4) and translocation of the phosphorylated protein to the cell membrane. The fundamental requirement of phosphorylation for membrane translocation was confirmed by immunofluorescence microscopy on cells transfected with wild-type or mutated (S27/A) ANXA1 constructs tagged with enhanced green fluorescence protein. The trafficking of ANXA1-S 27-PO4 to the cell surface was dependent on PI3-kinase and MAP-kinase. It also required HMG-coenzyme A and myristoylation. The effects of HMG-coenzyme A blockade were overcome by mevalonic acid (the product of HMG-coenzyme A) and farnesyl-pyrophosphate but not by geranyl- geranylpyrophosphate or cholesterol. Together, these results suggest that serine-27 phosphorylation is essential for the translocation of ANXA1 across the cell membrane and also identify a role for isoprenyl lipids. Such lipids could target consensus sequences in ANXA1. Alternatively, they may target other proteins in the signal transduction cascade (e.g., transporters). © FASEB.

Scoring systems used in meningococcal disease have been developed and validated to predict death or severity of illness in cohorts of patients, usually in the setting of intensive care. When using these scores, it is important to remember that any individual's score is only of limited value in prognosticating about that individual patient and can be misleading (1). The accuracy of any score is determined by how well its estimated pattern of mortality compares with that observed in the score's developmental cohort, rather than in individual patients. Scores cannot be considered interchangeable; different scores, comprised of different sets of variables to arrive at the probability of mortality, may arrive at the same overall aggregate risk of mortality in a population of patients with meningococcal disease, despite individual estimates within this cohort of patients differing widely between scores. The ability of a score to predict death for patients who die and survival for those that live is best-described by the area under the receiver operator characteristic (ROC) curve (2). This curve is a plot of sensitivity versus "(1 -specificity)", i.e., the true-positive to false-positive fractions, at different decision thresholds. The greater the discriminative ability of a test, the closer the area under the curve comes towards 1.0, where the true-positive fraction is 1.0 or 100% (perfect specificity) and the false-positive fraction is 0 (perfect sensitivity). No score, however, has sufficient accuracy for individual prognostication and the use of scores in this way is inappropriate for clinical practice or research (3).

Billions of dollars have been expended in foreign assistance throughout the third world, with much of this aid being provided by the not-for-profit community. While frequently effective in facilitating short-term benefits, these projects often do not improve the continuing living conditions for the residents of the community. Not-for-profits generally are in the business of short-term crisis relief; consequently, they do not have a focus on job provisions in the affected community that would increase their living standards in the long-term. Entrepreneurs, on the other hand, are in the business of job creation, which not only provides long-term benefits for the entrepreneur, but also for the entire community. Microlending, a term coined originally by Muhammad Yunus to describe very small loans made in third-world countries, has had an enormous impact on the lives of entrepreneurs, their families, and their communities. Many not-for-profits may wish to employ the techniques illustrated by Yunus and other successful microlending institutions. They may find the task overwhelming, however, without employing business professionals, whose services can be costly. For not-for-profits who might be interested in starting such a program, this paper will describe the process of microlending, articulate methods of selecting a loan recipient, and show mechanisms for documenting a microloan.

Although it is generally expected that inbreeding would lower fitness, few studies have directly quantified the effects of inbreeding in wild mammals. We investigated the effects of inbreeding using long-term data from bighorn sheep on Ram Mountain, Alberta, Canada, over 20 years. This population underwent a drastic decline from 1992 to 2002 and has since failed to recover. We used a pedigree to calculate inbreeding coefficients and examined their impact on lamb growth, birth date and survival. Inbreeding had a substantial effect on female survival: for a given mass in September, the probability of overwinter survival for inbred female lambs was about 40% lower than that of noninbred ones. Contrary to our expectations, inbred female lambs were born earlier than noninbred ones. Earlier birth led to inbred female lambs being heavier by mid-September than noninbred ones. There was a nonsignificant trend for inbred female yearlings to weigh more than noninbred ones. A stronger mass-dependent viability selection for inbred compared to noninbred female lambs may explain why surviving inbred females were heavier than noninbred ones. Survival of male lambs was not affected by inbreeding. Sex-differential effects of inbreeding may be a general pattern in sexually dimorphic mammals, because of sex-biased maternal care or sexual differences in early development strategies.

Background Adverse drug reactions are noxious and unintended responses to a medicinal product. Many drugs have the potential to induce adverse reactions in the mouth. The extent of such reactions is unknown; however, because a lot of them are asymptomatic, many are believed to go unnoticed. Adverse oral drug reactions are responsible for oral lesions and manifestations that can mime local or systemic disease. Their pathogenesis, especially of the mucosal reactions, is largely unknown and appears to involve complex interactions between the drug in question, other medications, the patient’s underlying disease, genetics and lifestyle factors. Aim In this study, we have listed the principal signs and symptoms of oral and perioral adverse drug reactions and the responsible drugs. Diagnosis for adverse drug reaction is not easy given also the limited utility of laboratory tests. The association between a drug and an adverse drug reaction is mostly based on the disappearance of the reactions following discontinuance of the offending drug. Sometimes, it is useful to perform rechallenge tests reintroducing the drug to establish cause and effect. Conclusions Knowledge of adverse drug-induced oral effects helps health professionals to better diagnose oral disease, administer drugs and improve patient compliance during drug therapy and may foster a more rational use of drugs.

The production of important molecules (as subunit vaccines) in plants is increasingly considered for relevant advantages: low costs of production, purification and delivery, no risks of contamination by pathogens and high scale production, but improvement and enhancement of transformation techniques are needed. MAR/SARs (Matrix/Scaffold Attachment Regions) have been reported as a network of proteinaceous fibrils that permeates the nucleus and organizes chromatin into a series of topologically isolated loop domains of 5-200 kb. These sequences may influence the structure of transgenes and their expression possibly reducing or eliminating some forms of gene silencing. Our research is addressed at the production of plant derived antigens to be used in veterinary prophylaxis. In this field, the optimisation of transgene expression is crucial, also because of the necessity of plant containment during the whole cultivation period. In particular, we sub-cloned Rb7, a MAR sequence from Nicotiana tabacum,, in the binary vector pAMPAT, inside LB and RB t-DNA terminations, in its two possible orientations. The vector expression cassette carries a 450bp portion of Fib, Fibrinogen Binding Protein, from Staphylococcus aureus, under the control of 35SS constitutive promoter. The Fib protein fragment was proved to be effective against S. aureus mastitis in dairy cattle. Nicotiana tabacum, var. Samsun was transformed via Agrobacterium tumefaciens with the four constructs carrying Rb7 elements in all their possible combinations. Statistical analysis was performed after four different experiments, showing an enhanced transformation efficiency for MAR containing constructs (higher shoot number and shorter shooting time). PCR analysis on genomic DNA and on retro-transcribed RNA, from transformed leaves, confirmed the transgene presence and transcription. Protein extraction was performed 40 Molecular and immunological analysis on transformed plants are now in progress, to define the transgene copy number and the resulting protein expression level.

In 10 patients who required extracorporeal circulation (ECC) during surgery, we studied the damage induced by surgery to the pulmonary surfactant and the effectiveness of ambroxol in preventing changes in the phospholipid pool. There were 5 control patients and 5 patients who were given 1 g/day of ambroxol on the 4 days prior to and the 4 days after surgery. To follow changes in phospholipid concentrations, bronchoalveolar lavage (BAL) was performed before surgery and 24 h and 8 days after ECC. Phospholipids were assayed in the BAL liquid by two-dimensional thin-layer chromatography. There were marked decreases in total phosphorus and quantitative alterations of individual phospholipid species in the surfactant of the control group, but not in the patients treated with ambroxol.

Heat-shock proteins (HSP) 90 exert a relevant role in the survival and response to therapy of many neoplastic cell types. Here, we show that the promoter of hsp90alpha gene, that encodes the inducible form of HSP90, is regulated by nuclear factor-kappaB (NF-kappaB) activity. Indeed, we found that NF-kappaB factors bound to one of the two putative consensus sequences present in the hsp90alpha-flanking region; mutation of such motif hampered the phorbol-myristate-13-acetate-stimulated expression of a luciferase reporter gene under the control of the hsp90alpha promoter. Furthermore, the downmodulation of NF-kappaB (p65) levels by a specific small interfering (si) RNA resulted in reducing the levels of endogenous HSP90alpha protein. These findings disclose a previously unrecognized mechanism that contributes to connect NF-kappaB factors and HSPs in cell defence machinery.

Introduction: Critically ill children are at an increased risk of malnutrition. Variability in feeding practices has been highlighted as a barrier to optimising nutrition during Paediatric Intensive Care Unit (PICU) admission. Introduction of a feeding algorithm has been shown to improve nutritional outcomes in this population. Study objective: To develop and implement a feeding algorithm for patients in a tertiary 22 bed PICU. Methods: The study was performed in three phases: Phase 1: A survey of nursing attitudes and perceived practices to enteral feeding. Phase 2: A three week prospective nutrition audit to evaluate the adequacy of energy and protein intake compared to estimated requirements. Phase 3: A multidisciplinary working group formed to devise, pilot and implement a feeding algorithm. Results: Phase 1: Demonstrated considerable variability and specific barriers to feeding. These included delayed medical approval to initiate feeds and multiple fasting for procedures and possible extubations. Phase 2: The mean time to feed initiation was 22 h (range 0–92 h). Within 72 h of admission, patients achieved 66% of estimated energy requirements (EER); and 36% of estimated protein requirements (EPR), with only 4 (15%) reaching their EER; none reached EPR. Phase 3: A multidisciplinary team (dietetics, medical and nursing) reviewed the results of phases 1 and 2 and developed a single page algorithm. This was piloted in April 2014 and the final algorithm initiated in May 2014. Conclusion: Barriers to nutrition in a tertiary children’s hospital PICU were identified by survey and audit tools. A feeding algorithm was developed by a multidisciplinary team utilising these results. A one page feeding algorithm was initiated in May 2014.

Pleomorphic adenomas of salivary glands are benign lesions which may sometimes relapse even after complete surgical removal. This risk has led to the search for methods to provide predictive data on the biological behaviour of such neoplasia. The authors intend to evaluate the degree of cellular aggression of these tumours by finding prognostic data using the antigens involved in cellular proliferative activity. Therefore they have chosen for this study: p27kip1, cyclin B1 and Cyclin D3.Seventeen mixed tumours, 2 of them relapsed, underwent the direct immunohystochemical PAP technique for the determination of antigens p27kip1, cyclins B1 and D3 of the tissue.The results obtained show that the verification of these markers may reveal a potential risk of biological deviation and that their expression is independent of the degree of cellularity in neoplasias.On the basis of the results, the conclusion is drawn that there is no relation between the expressivity of the mentioned antigens and histological characters of pleomorphic adenomas.

Despite the risk of propofol infusion syndrome, a rare but often fatal complication of propofol infusion in ventilated children and possibly adults, propofol infusion remains in use in paediatric intensive care units (PICU). This questionnaire study surveys the current pattern of use of this sedative infusion in Australian and New Zealand PICUs. Thirty-three of the 45 paediatric intensive care physicians surveyed (73%), from 12 of the 13 intensive care units, returned completed questionnaires. The majority of practitioners (82%) use propofol infusion in children in PICU, the main indication being for short-term sedation in children requiring procedures. 39% of respondents consider propofol infusion useful in ventilated children requiring longer-term sedation. 67% of paediatric intensivists use maximum infusion doses that may be considered dangerously high (≥10 mg/kg/h). Nineteen per cent use propofol infusion for prolonged periods (> 72 hours). A smaller proportion (15%) of respondents indicate that they may use both higher doses and prolonged periods of infusion, a practice likely to lead to a greater chance of serious adverse events. Knowledge of local protocols for the use of propofol infusion is associated with a significantly greater level of monitoring for possible adverse events. We suggest that national guidelines for the use of propofol infusion in children should be developed. These should include clear indications and contraindications to its use, a maximum dose rate and maximum period of infusion, with a ceiling placed on the cumulative dose given and clearly stated minimum monitoring requirements.

The motivation of this paper is to try to define a framework for object-oriented audio coding, aimed at the development of the challenging idea of a generic coding architecture for audio signals. The inherent flexibility associated with the object-oriented approach allows one to foresee a possible combination of audio and video coding aspects when moving towards multimedia applications. This topic is addressed in the set of requirements of ISO/MPEG4. The MAVT (CSELT-BOSCH-MATRA) audio candidate for ISO/MPEG4 develops this idea mainly by the design of a flexible bit manipulation unit, capable of producing a variety of manipulated bit streams in respect to bit rate, level, and audio object selection. All of these with a unique flexible decoder algorithm.

The transjugular intrahepatic protosystemic shunt (TIPS) is a nonsurgical method with low mortality which does not interfere with subsequent liver transplantation. We describe the case of an old male patient with chronic hepatopathy who was admitted because of an episode of variceal bleeding. Due to the failure of the medical treatment and sclerotherapy, coronarian stomachic vein was embolized with a coil and a TIPS was performed during the acute episode of variceal bleeding. He evolved favorably and after a year of the procedure remains asymptomatic.