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To compare two reciprocating NiTi systems operated by novices for use in curved root canals. Fifty mesial roots of extracted mandibular first molars, with 2-2 canal configuration, were scanned with micro-CT and divided into 2 groups according to canal length and curvature: Reciproc and WaveOne. Each system was used to prepare one of the two canals by fourth-year dental students, who were new to reciprocating files and were blinded to the system being used. After another scanning, the pre- and post-instrumentation images were compared 3-dimensionally in software. Some 43 to 46% of the canal wall area remained un-instrumented. Significantly higher proportions of canals were transported towards the isthmus or furcation aspect than the mesial or external aspect. Mean transported distance was the greatest in the coronal one-third. Remaining dentine wall was the thinnest at the furcal aspect near the middle root region. No significant difference was noted between the two brands in the parameters examined. Both brands of reciprocating file left similar amounts of un-instrumented canal wall, and resulted in similar extent of canal transportation. NiTi reciprocating files can safely be used by new users to prepare curved root canals into a predictable shape.

Background Suicide is a major cause of mortality for individuals with schizophrenia spectrum disorders (SSD). Understanding the risk factors for suicide at time of diagnosis can aid clinicians in identifying people at risk. Methods Records from linked administrative health databases in Ontario, Canada were used to identify individuals aged 16 through 45 years who received a first lifetime diagnosis of SSD (schizophrenia, schizoaffective disorder, psychotic disorder not otherwise specified (NOS)) using a validated algorithm between 01/01/1993 and 12/31/2010. The main outcome was death by suicide following cohort entry until 12/31/2012. Outcomes 75,989 individuals with a first SSD diagnosis (60.1% male, 39.9% female) were followed for an average of 9.56 years. During this period, 1.71% of the total sample (72.1% male, 27.9% female) died by suicide, after an average of 4.32 years. Predictors of suicide death included male sex (HR 2.00, 95% CI 1.76–2.27), age at diagnosis between 26 and 35 (HR 1.27, 95% CI 1.10–1.45) or 36–45 (HR 1.34, 95% CI 1.16–1.54), relative to 16–25, and suicide attempt (HR 2.23, 95% CI 1.86–2.66), drug use disorder (HR 1.21, 95% CI 1.04–1.41), mood disorder diagnosis (HR 1.32, 95% CI 1.17–1.50), or mental health hospitalization (HR 1.30 95% CI 1.13–1.49) in the 2 years prior to SSD diagnosis. Interpretation Death by suicide occurs in 1 out of every 58 individuals and occurred early following first diagnosis of SSD. Psychiatric hospitalizations, mood disorder diagnoses, suicide attempts prior to SSD diagnosis, as well as a later age at first diagnosis, are all predictors of suicide and should be integrated into clinical assessment of suicide risk in this population.

International audience; The photoinitiation abilities of three 1,2-diketones [i.e., acenaphthenequinone (ANPQ), aceanthrenequinone (AATQ), and 9,10-phenanthrenequinone (PANQ)]-based photoinitiating systems [PISs, with additives such as iodonium salt, N-vinylcarbazole (NVK), tertiary amine, and phenacyl bromide (R-Br)] for cationic photopolymerization and free-radical photopolymerization under the irradiation of ultraviolet (UV; 392 nm) or blue (455 nm) light-emitting diode (LED) bulb are investigated. All 1,2-diketones studied exhibit ground state absorption that match with the emission spectra of UV (392 nm) or blue LED (455 nm) better than that of the well-known blue-light-sensitive photoinitiator camphorquinone (CQ). In particular, AATQ/iodonium salt/NVK can show high photoinitiating ability (with epoxide conversion yield >70%) under the UV light irradiation due to the effect of NVK. In addition, 1,2-diketone/iodonium salt (and optional NVK) systems are capable of initiating free-radical photopolymerization of methacrylates, with conversions of 50–58%. Furthermore, some 1,2-diketone/tertiary amine (and optional R-Br) combinations are found to demonstrate high efficiency to initiate free-radical photopolymerization, and 71% of methacrylate conversion can be achieved with PANQ/tertiary amine/R-Br PIS. Some 1,2-ketone-based PISs can even exhibit higher efficiency than the CQ-based systems. The photochemical mechanism of the radical generation from the 1,2-diketone-based PISs is investigated and found to be consistent with the related photopolymerization efficiency.

The theory of Computational Singular Perturbation (CSP) has been widely used in the chemical kinetics and combustion community to understand complex chemistry, reduce chemical kinetic models and perform computational diagnostics in reacting flow simulations. Useful as it is, the application of CSP is nevertheless subject to computationally expensive eigen-decomposition of the chemical Jacobian matrix, especially for mechanisms involving a large number of species. In 2016–2017, a new CSP approach was developed by Lam, taking advantage of species lifetime and linearity in the governing equation of the fastest species. The corresponding quasi-state value of the current fastest species across the thin transition layer could be accurately predicted at each time step, during which period the concentration of the slower species is considered as constant. As a result, tedious explicit integration to resolve the apparent exponential transition layer, as those utilized in conventional implicit chemistry solvers (e.g., CVODE), is avoided and the integration time step could be largely extended. This method, referred to as linear CSP (LCSP), has been demonstrated to be useful in deriving reduced models and to numerically integrate stiff ODE systems. In 2018, an idea of nonlinear CSP (NCSP) following similar approach was further proposed by Lam, which abandons the enabling assumptions of the linearized governing equation for the fastest species and provides useful insights into the numerical integration of stiff chemical ODE systems. The development of CSP without expensive eigen-decomposition and computational evidence supporting its implementation are discussed and disseminated as a promising direction of advanced CSP theory. For general kinetic problems with complex couplings, a method based on sparse adaptive hybrid integration is introduced to demonstrate the redundancy issue and general stiffness in the fast subspace.

A cross-national qualitative suicide study was conducted by Tsinghua University and the University of Toronto with two samples of Chinese women in Beijing and Toronto. The aim of this article is to reflect on lessons learned from this collaborative study. A literature review guided the analysis. A focus group was conducted with members of both research teams. A semi-structured interview guide was developed to explore the researchers' experiences of participating in the cross-national study. Focus group transcript data and observations from authors informed the analysis, situated in the existing literature on cross-national qualitative health research and guided by Baistow's cross-national research frame. Our study highlights how cross-national research involves conceptual and practical challenges that require negotiation. Such research also holds many opportunities, including (1) using a different cultural lens to understand differences and clarify similarities cross-culturally; (2) co-constructing knowledge through collaboration; (3) deconstructing one's own assumptions; and (4) engaging in an inspiring and empowering experience in collaboration.

To compare two reciprocating NiTi systems operated by novices for use in curved root canals.Fifty mesial roots of extracted mandibular first molars, with 2-2 canal configuration, were scanned with micro-CT and divided into 2 groups according to canal length and curvature: Reciproc and WaveOne. Each system was used to prepare one of the two canals by fourth-year dental students, who were new to reciprocating files and were blinded to the system being used. After another scanning, the pre- and post-instrumentation images were compared 3-dimensionally in software.Some 43 to 46% of the canal wall area remained un-instrumented. Significantly higher proportions of canals were transported towards the isthmus or furcation aspect than the mesial or external aspect. Mean transported distance was the greatest in the coronal one-third. Remaining dentine wall was the thinnest at the furcal aspect near the middle root region. No significant difference was noted between the two brands in the parameters examined.Both brands of reciprocating file left similar amounts of un-instrumented canal wall, and resulted in similar extent of canal transportation.NiTi reciprocating files can safely be used by new users to prepare curved root canals into a predictable shape.

Suicide is a complex and tragic outcome driven by biological, psychological, social and cultural factors. Women of Chinese descent and women who have immigrated to other countries have higher rates of suicidal ideation and behaviour, and immigration-related stress may contribute. To understand the experiences of immigration and their relationship with distress and suicide-related behaviour in Chinese women who have immigrated to Canada. 10 semi-structured qualitative interviews with Chinese women who have immigrated to Toronto, Canada and have a history of suicide-related behaviour were completed and analyzed using a constructivist grounded theory methodology. Immigration-related and acculturation stress stemmed from unmet expectations and harsh realities. These repeated experiences resulted in hopelessness, helplessness, and alienation, which are risk factors for suicide and suicide-related behaviour. However, immigration-related support can also increase hope, self-efficacy and connectedness to foster recovery and resilience. This is the first qualitative study focusing on immigration experiences and its relationship to suicide-related behaviour in Chinese immigrant women. Knowledge of immigration and acculturation stressors can a) help identify and support women at risk for suicide and b) form a target for social intervention for all immigrant women, regardless of suicide risk.

An efficient formulation of computational singular perturbation (CSP) is proposed for toy problems that consist of three variables. The essence of the new CSP formulation is to take advantage of sh...

This qualitative study explored the experiences and patterns of recovery of Chinese-born women living in Canada with a history of suicidal behaviour. It explores a number of dimensions of recovery including clinical, existential, functional, physical, and social. The women described engaging in “survival” recovery in the short term and “thriving” recovery in the long term, with survival strategies extending into the thriving phase of recovery during their complex path to it. The survival recovery phase included accessing culturally sensitive mental health care and obtaining social and instrumental support to help ensure safety, manage stress, and treat psychiatric symptoms. The thriving phase of recovery was described as involving six components: developing an explanatory model with their health care provider; undertaking a process of narrative reflection and prioritizing self-care; engaging in interdisciplinary care team support; engaging the support of family and friends; exploring spiritual and existential supports; and creating goals for the future and a sense of mastery. Through these six avenues, the women began to experience a sense of self-efficacy and agency that improved their ability to cope with stress and pressure, leading to building a life with meaning. The interviews provided insights into how clinical care can be improved and how practitioners can implement a more recovery-oriented approach to practice.

The effect of pH (5.0 or 7.0) and temperature (25.0, 65.0 and 95.0 °C) on the physicochemical and emulsifying properties of type-1 (with calcium, ALA-1) and type-3 (without calcium, ALA-3) alpha-lactalbumin (ALA) were examined. By increasing the temperature of pre-treatment, changes in ALA conformation allowed for greater surface hydrophobicity and caused changes in its surface charge. pH also influenced surface charge for ALA where enhanced repulsion at pH 7.00 was observed resulting in reduced aggregation despite having greater hydrophobicity. Findings indicate that changes to protein conformation using various pH and temperature pre-treatments influenced their surface chemistry, aggregation and ability to align at the oil–water interface. Overall, emulsions were found to be more stable at pH 7.0 than 5.0 due to the greater amount of electrostatic repulsive forces between droplets present at pH 7.0. Under the conditions examined in this study, ALA-3 pre-treated at 65 °C and at pH 7.00 resulted in the best emulsifying properties.

Biodegradable edible films have the potential to either replace or reduce the amount of synthetic packaging utilized by the food industry. The overall goal of this research was to investigate the effect of flax seed oil concentration (1–10%) on the mechanical, moisture barrier and swelling properties of soy protein isolate (SPI) (5.0% w/w SPI, 40% w/w glycerol) emulsion-based films. Film forming solutions showed a bimodal oil droplet distribution with peak sizes occurring at < 10 and ~ 100 μm. As the oil content increased, the size distribution shifted towards smaller droplet sizes. An equal size ratio was noted at the 5.0% oil content level. All film forming solutions were pseudoplastic in nature, where viscosity increased from 18 to 58 mPa (at 1 s− 1) as a function of oil content (3% to 10%). Tensile strength of formed films reached a maximum at 5.35 MPa at the 5% w/w oil level, whereas tensile elongation increased from 11.3% to 22.2% with increasing oil content. Puncture strength and deformation, as well as water vapour permeability was relatively independent of the oil content. Moisture content and swelling properties of formed films were found to both decrease from 22.8% to 18.7%, and from 3114% to 1209%, respectively as the oil content was raised from 1 to 10%, and films became darker, redder and more yellow in colour as the percentage of flax seed oil increased.

The overall goal of this research was to investigate the emulsifying properties of whey protein isolate (WPI) as a function of pH (3.0, 5.0, 7.0) and temperature pre-treatments (25, 55, 85 °C). Specifically, the physicochemical (charge and hydrophobicity, size, interfacial tension) and emulsifying (emulsification activity (EAI) and stability indices (ESI)) properties were assessed. Overall, hydrophobicity was greatest at pH 5.0/85 °C. Charge was found to decrease linearly from ∼ +40 mV at pH 3.0 to ∼ −40 mV at pH 7.0, where net neutrality was observed between pH 5.1 and 5.4. Aggregate size was greatest at pH 5.0 relative to the other pHs, however it declined in size at pH 5.0 from 1589 nm to 1450 nm and then to 832 nm as temperature pre-treatments increased from 25 °C to 55 °C and then to 85 °C, respectively. Interfacial tension was reduced from ∼28 mN/m to ∼14–18 mN/m for systems in the absence and presence of WPI, respectively, with little differences seen among treatments. EAI was found to increase under conditions where WPI aggregation was reduced, whereas ESI increased under conditions away from its isoelectric point where electrostatic repulsive forces were strongest and under conditions where surface hydrophobicity was reduced.

The rheological properties of whey protein isolate (WPI) and WPI with carrageenan (CG) (kappa-, iota- and lambda-types) mixtures during a slow acidification process were investigated in a non-emulsified and emulsified system. For all systems, electrostatically coupled networks were formed leading to the formation of a biopolymer or emulsion-based gel network. However, network strength differed depending on the CG-type. In the case of biopolymer gels, the storage modulus within the plateau zone for WPI–kappa-CG and WPI–iota-CG mixtures were ~ 93 and ~ 73 Pa, respectively, whereas the WPI–lambda-CG network was weaker (~ 8 Pa). The gel point corresponded to the pH where complex coacervation occurred. WPI–CG mixtures were also able to lower interfacial tension from 28 to 18–22 mN/m before gelation. Emulsion gels followed a similar trend as the biopolymer networks, except they were stronger (WPI–kappa-CG, WPI–iota-CG and WPI–lambda-CG systems had storage moduli of ~ 435, ~ 320 Pa and ~ 103 Pa, respectively). The presence of CG decreased the average droplet size of these emulsions from ~ 38 to ~ 32 μm, regardless of the CG type. Protein stabilized emulsion gels were presumed to form, where upon complexation with CG, flocculation between droplets was promoted until an electrostatic-stabilized gel network was formed within the continuous phase. The WPI control did not gel for both non-emulsified and emulsified systems.

Aim: Real-time traveler information affects auto commuter’s travel behavior. Method: An ordered probit model is used to analyze auto commuter’s mode switching propensity under influence of simulated real-time multimodal traveler information. A travel preference survey is administered to car drivers to gather individual commuter’s travel decisions under integrated multimodal traveler information. Result: It is shown that integrated multimodal traveler information can influence willingness of car drivers to switch mode of travel, while socio-economic characteristics also influence the mode choice decision.

The rheological properties of 1.0% (w/w) whey protein isolate (WPI)-κ-/ι-carrageenan (CG) mixtures were investigated during a slow acidification process by glucono-δ-lactone from pH 7.00 to ∼4.20 as a function of biopolymer mixing ratio and in the presence and absence of oil droplets. In all cases, electrostatic coupled biopolymer and emulsion gel networks were formed at pH values corresponding to where attractive interactions between WPI and CG began. Formed WPI-CG complexes were found to be surface active, capable of lowering interfacial tension and forming viscoelastic interfacial films within emulsion-based systems. Both biopolymer and emulsion-based gels increased in strength and elasticity as the CG content increased, regardless of the type of CG present. However, WPI-ι-CG coupled networks were stronger than WPI-κ-CG networks, presumably due to the higher number of sulfate groups attracting the WPI molecules.

Purpose The pharmacology, pharmacokinetics, clinical efficacy, safety, and administration of pertuzumab in patients with metastatic human epidermal growth factor receptor type 2 (HER2)-positive breast cancer are reviewed. Summary Disease progression in HER2-positive breast cancer is often due to resistance to or a lack of efficacy of trastuzumab-based anti-HER2 therapy. Pertuzumab is the first humanized monoclonal antibody in a new class of drugs, the HER dimerization inhibitors, approved by the Food and Drug Administration for the first-line treatment of patients with metastatic HER2-positive breast cancer who have not received prior anti-HER2 therapy or chemotherapy for metastatic disease. Since pertuzumab binds to a different epitope than trastuzumab, combination therapy with pertuzumab and trastuzumab results in a more complete blockade of HER2 signaling than trastuzumab monotherapy. The efficacy of adding pertuzumab to trastuzumab–docetaxel dual therapy was demonstrated in a pivotal randomized multicenter Phase III trial, which showed a significant benefit in terms of progression-free survival, with improved overall survival, in favor of the triple therapy as an initial regimen in treatment-naive patients with metastatic HER2-positive breast cancer. The combination of pertuzumab and trastuzumab has been found to have a tolerable toxicity profile. As clinical trials of pertuzumab for adjuvant, neoadjuvant, and metastatic-disease treatment continue, its role in the treatment of HER2-positive breast cancer will continue to evolve. Conclusion Pertuzumab, a novel HER2 dimerization inhibitor, has been shown to be effective in the treatment of metastatic HER2-positive breast cancer when used in combination with trastuzumab and docetaxel and is recommended for first-line therapy.

The overall goal of this research was to investigate structure-function mechanisms associated the emulsifying properties β-lactoglobulin (β-LG). Specifically the physicochemical (i.e., surface charge and hydrophobicity, size and interfacial tension) and emulsifying (i.e., emulsification activity (EAI) and stability indices (ESI)) properties of β-LG were investigated in response to changes in pH (3.0, 5.0 and 7.0) and heat pre-treatment conditions (25, 55 and 85 °C). Hydrophobicity was found to be greatest at pH 5.0/85 °C, whereas at all conditions it was significantly lower. Surface charge on β-LG was found to be neutral at ~ pH 3.9, regardless of conditions. Aggregate size was also found to be highest at pH 5.0/85 °C (avg. hydrodynamic radii of ~714 nm), corresponding to a reduced net surface charge and high hydrophobicity. Little size dependence of aggregates was observed at pH 3.0 regardless to the temperature pre-treatments (radii ~120 nm). In contrast, at pH 7.0 slight temperature dependence was apparent, where treatments at 25, 55 and 85 °C led to radii of 412.8, 307.2 and 232.3 nm, respectively. Overall, the addition of β-LG to a canola oil–water system resulted in a decline in interfacial tension from ~28 mN/m to ~18 mN/m, however the effect of pH/temperature conditions was minimal. EAI was found to be highest when β-LG solutions displayed high surface charge combined with moderate hydrophobicity. In contrast, ESI was higher under conditions where β-LG solutions remained in a native (25 °C) or fully denatured state (85 °C) versus one in where partially unravelling may be occurring (55 °C).

The present study aimed to investigate the effectiveness of two types of learning, stroke order writing and radical knowledge training, for enhancing children's Chinese literacy skills in the context of parent-child joint Chinese writing. Eighty Hong Kong kindergarteners were pretested on nonverbal IQ, word reading, vocabulary knowledge, semantic-radical awareness tasks, writing dictation and single character reading. Then they were randomly assigned to one of three conditions: stroke training, radical training or control. After eight weeks of training, the radical condition yielded greater improvement compared with the control condition in dictation and semantic-radical awareness tasks. The findings of the study highlight the potential positive effects of parent-child joint writing on children's Chinese language and literacy skills. Findings also demonstrate that parents typically use multiple strategies in parent-child joint writing, and it is likely that different approaches to writing might f...

Oncology pharmacists face a constant challenge with patients who cannot swallow oral anticancer drugs, making extemporaneous oral liquid preparation a requirement. Improper extemporaneous preparation of these agents, especially with the traditional chemotherapy with a narrow therapeutic index, may increase the risk of over- or underdosing. In community pharmacies, multiple barriers exist that prevent these pharmacies from preparing extemporaneous oral anticancer drug formulations for a patient's use at home. In a home setting, patients or caregivers without proper counseling and education on how to safely handle chemotherapy are at increased risk for exposure to these drugs. Based on a review of the literature, compounding recipes are available for 46% of oral anticancer agents. A paucity of data exists on dose uniformity, bioequivalence, and stability of extemporaneous oral liquid formulations of anticancer drugs. Pharmacists must have an understanding of the basic scientific principles that are an essential foundation for the proper preparation of extemporaneous oral anticancer liquid formulations. The collaborative effort of a multidisciplinary team can also help identify different barriers in the community setting, especially in areas where community pharmacies may lack resources for the extemporaneous compounding of oral chemotherapy, and to find ways to coordinate better pharmaceutical care. There are great opportunities for oncology pharmacists, as well as community pharmacists, as a resource for educating and monitoring patients receiving oral chemotherapy to ensure dosing accuracy, safe administration, and proper disposal of hazardous drugs. Development of national guidelines to promote standards of practice in the community and/or home setting is urgently needed to help improve the safety of dispensing and handling oral chemotherapeutic agents, including extemporaneously compounded oral liquid formulations of these drugs.

The modified Avrami model was found to accurately predict the induction time, maximum phase volume and dimensionality of crystal growth for stearic acid containing molecules when the experimental method employed measures as a function of phase volume. Four methods were examined to validate the model including: Fourier transformed infrared spectroscopy (FT-IR), differential scanning calorimetry (DSC), small deformation rheology and polarized light microscopy (PLM). PLM and FT-IR were able to detect the nucleation event prior to DSC and rheology. FT-IR and PLM provided the most accurate data due to the similarities between the experimental and fitted induction times (x0), maximal phase change (ymax) and the Avrami exponent (n). Further, the Avrami exponent, obtained from FT-IR, was sensitive to both the mode of nucleation and the dimensionality of crystal growth. Therefore, the apparent rate constants (kapp) obtained by FT-IR and PLM are useful in providing further insights into the kinetics of non-isothermal crystallization. The calculated apparent rate constants suggest a diffusion limited crystallization at slow cooling rates (i.e., below 5–7 °C min−1) and at cooling rates greater than 5–7 °C min−1, the incorporation of the gelator molecules onto the crystal lattice becomes limited by the reaction rate constant.

The formation kinetics of self-assembling tubules composed of phytosterol:gamma-oryzanol mixtures were investigated at the Canadian Light Source on the mid-IR beamline using synchrotron radiation and Fourier transform infrared spectroscopy (FT-IR). The Avrami model was fitted to the changing hydrogen bonding density occurring at 3450 cm(-1). The nucleation process was found to be highly dependent on the molecular structure of the phytosterol. The nucleation event for cholesterol:gamma-oryzanol was determined to be sporadic whereas 5alpha-cholestan-3beta-ol:gamma-oryzanol and beta-sitosterol:gamma-oryzanol underwent instantaneous nucleation. One-dimensional growth occurred for each phytosterol:gamma-oryzanol mixture and involved the evolution of highly specific intermolecular hydrogen bonds. More detailed studies on the cholesterol:gamma-oryzanol system indicated that the nucleation activation energy, determined from multiple rate constants, obtained using the Avrami model, was at a minimum when the two compounds were at a 1:1 weight ratio. This resulted in drastic differences to the microscopic structures and affected the macroscopic properties such as turbidity. The formation of the phytosterol:gamma-oryzanol complex was due to intermolecular hydrogen bonding, which was in agreement with the infrared spectroscopic evidence.

The lengths of the 12-hydroxystearic acid (12HSA) fibers are influenced by crystallographic mismatches resulting from the incorporation of 12HSA monomers into the crystal lattice in an imperfect manner. On a molecular level, this can be differentiated using synchrotron Fourier transform infrared (FTIR) spectroscopy by monitoring the change in area of the 1700 cm−1 and 3200 cm−1 peaks, corresponding, respectively, to the dimerization of the carboxylic acid groups and hydroxyl non-covalent interactions, during crystallization. The crystallographic mismatch is attributed to a plateau in the apparent rate constant for the dimerization of the carboxylic acid head groups while the hydroxyl interactions linearly increase as a function of cooling rate (ϕ). The rate constant for hydroxyl interactions linearly increases as a function of cooling rate while a plateau is observed for the rate of dimerization at cooling rates between 5 and 7 °C min−1. At cooling rates greater than 5 to 7 °C min−1 12HSA monomers do not effectively dimerize before being incorporated into the crystal lattice causing crystal imperfections impeding linear epitaxial crystal growth and produces branched fibers. At slow cooling rates (i.e., less than 5 to 7 °C min−1), long fibers are produced with a fractal dimension between 0.95 and 1.05 and for rapid cooling rates (i.e., greater than 5 to 7 °C min−1) short branched fibers are produced with a fractal dimension between 1.15 and 1.32.

Since breast-conserving surgery demonstrated identical long term survival on seven randomized trials, it has become the preferred treatment option over mastectomy. Oncoplastic surgery applying simple reshaping and displacement techniques allows inclusion of patients with large tumors in the group selected for breast-conserving surgery. However, the cosmetic outcome and the degree of patient satisfaction, especially in relation to the original breast volume and the percentage of breast tissue excised is not well documented.The present study was designed to assess patient satisfaction with cosmetic outcome after oncoplastic breast-conserving surgery, and to establish the correlation between patient satisfaction and percentage of breast volume excision (PBVE).A total of 169 Asian patients underwent breast-conserving surgery for primary breast cancer at either United Christian Hospital (UCH) or Hong Kong Sanatorium and Hospital (HKSH) from Nov 2007 to Jan 2008 by two breast surgeons. Among this group, 162 patients with breast-conserving surgery incorporating oncoplastic techniques were prospectively recruited for study. Tumor characteristics, patient satisfaction, cosmetic outcome and surgeons' score were prospectively documented. Breast volume (BV) calculation was based on preoperative mammography (BV = 1/3pir(1)r(2)h), which was validated by our previous study to correlate strongly with actual BV (r = 0.98). PBVE was calculated by dividing the fresh specimen weight by the calculated BV. A standardized questionnaire was used to assess patient satisfaction and surgeons' score on cosmetic outcome during the first 1-3 postoperative months. The correlation between PBVE and patient satisfaction was studied.The median age of the group of patients studied was 52 years (range: 20-96 years). The median tumor size was 2.5 cm (range: 0.6-5 cm). The median breast volume was 493 cm(3) (range: 210-1,588 cm(3)). The median PBVE was 7.4% (range: 1-42%), and 94% of patients were very satisfied or satisfied with the cosmetic outcome. In addition, 85% of patients felt that the treated breast was nearly identical with or only slightly different from the untreated breast. In scoring breast shape, surgeons indicated that 89% of the treated breasts were identical to or only minimally different from the untreated breast. Patient satisfaction decreased significantly when the PBVE exceeded 20%. Neither tumor location nor distance of the tumor from the nipple had any effect on patient satisfaction.This study showed high patient satisfaction and good cosmetic outcome after oncoplastic breast-conserving surgery, even in small breast sized Asian women. The application of oncoplastic technique allows large volume excision, and satisfaction remains high with breast volume excision less than 20% regardless of tumor location or distance of the tumor from the nipple. More complicated oncoplastic techniques, e.g., breast replacement, might be required if breast volume excision exceeds 20%.

The physical properties of a fat are determined by its thermal history, processing conditions, chemical composition, polymorphism and spatial distribution of mass. The mass fractal dimension of a fat crystal network can be determined from the slope of the log–log plot of the storage modulus (G′) versus the solid fat content (SFC). Different SFCs were obtained by melting the fat, diluting it to different extents in liquid oil, and crystallizing the blends under specific conditions. One of the major drawbacks of this method is the inability of characterizing the native structure of an already crystallized fat. In the thermo-mechanical method developed in this study, SFC is changed via temperature variations instead. At each temperature, the G′ and SFC were measured and the fractal dimension calculated as described above. The thermomechanical method proved to be a simpler and more reliable estimator of the fractal dimension of a fat crystal network than the dilution method.

We examined the cross-sectional association of the intakes of different types of fishes with bone mass and osteoporosis risk in postmenopausal Chinese women. We found that higher intake of sea fish is independently associated with greater bone mass and lower osteoporosis risk among postmenopausal Chinese women.Fish contains many important nutrients that are beneficial on bone health, but limited data on the relationship between fish intake and bone health are available. We examined the association of the intakes of different types of fishes with bone mineral density (BMD) and bone mineral content (BMC) and osteoporosis risk.This population-based cross-sectional study was conducted among 685 postmenopausal Chinese women. Habitual dietary intakes were assessed using food frequency questionnaire. BMD and BMC at the whole body, lumbar spine, and left hip were measured with dual-energy x-ray absorptiometry.After adjusting for the potential confounders, we observed dose-dependent relations between sea fish intake and BMDs, BMCs, and osteoporosis risk; the mean BMDs were 3.2-6.8% higher, and BMCs 5.1-9.4% higher in the top quintile groups (Q5) of sea fish intake than in the bottom quintile (Q1) at the whole body and hip sites (p0.05); the odds ratios (95% confidence interval (CI)) for osteoporosis (T-score-2.5) in Q5 were 0.23 (0.08-0.66), 0.12 (0.03-0.59), and 0.06 (0.01-0.44) compared with those in Q1 at the whole body, total hip, and femur neck, respectively. No independent association between consumption of freshwater fish or shellfish and bone mass was observed.Higher intake of sea fish is independently associated with greater bone mass and lower osteoporosis risk among postmenopausal Chinese women.

Objective. To review the pharmacology, pharmacokinetics, efficacy, and safety of two new thrombopoietic (TPO) receptor agonists, romiplostim and eltrombopag, in the treatment of chronic idiopathic thrombocytopenic purpura (ITP) in adults. Data sources. A MEDLINE search was conducted (1966 to March 2009) using the search terms romiplostim, AMG 531, eltrombopag, SB-497115, idiopathic thrombocytopenic purpura. Articles on phases 1—3 clinical trials in patients with ITP were identified and reviewed. References from manufacturer information, and abstracts from recent hematology meetings, were also evaluated. Study selection and data extraction. Controlled clinical trials evaluating romiplostim and eltrombopag for treatment of chronic ITP in adults were selected from the data sources. All published relevant abstracts were also included. Data synthesis. Limited randomized controlled trials and open-label ongoing long-term extension studies for romiplostim and eltrombopag, have shown that both TPO agonists are effective in improving the platelet count and reducing the bleeding episodes in adult patients with ITP unresponsive to at least one standard treatment. The most common adverse events associated with the drugs are mild to moderate headaches. The use of these agents has also been associated with rare but serious side-effects including bone marrow reticulin fibrosis, thrombotic events, and myeloid malignancies. Conclusions. Until more long-term follow-up data regarding the safety, as well as comparative studies that further define the role of TPO agonists versus other agents in the treatment of chronic ITP are available, these agents should be reserved for patients with ITP refractory or intolerant to standard therapy. J Oncol Pharm Practice (2010) 16: 89—103.

Objective: To evaluate the role of chemotherapy and/or rituximab for treatment of posttransplant lymphoproliferative disorder (PTLD) in solid organ transplantation. Data Sources: A MEDLINE search (1966–May 2007) was conducted using the key words posttransplant lymphoproliferative disorder, solid organ transplantation, chemotherapy, and rituximab. References of relevant articles and abstracts from recent hematology, oncology, and transplantation scientific meetings (2004–May 2007) were also reviewed. Study Selection and Data Extraction: Prospective and retrospective studies identified from the data sources were evaluated, and all information deemed relevant was included for this review. Data Synthesis: Overall response rates ranged from 53% to 68%, 25% to 83%, and 74% to 100% for rituximab monotherapy, chemotherapy, and chemotherapy plus rituximab, respectively. Positive response to treatment was influenced by prognostic factors, including presence of Epstein-Barr virus in tumor cells, normal lactate dehydrogenase levels, good performance status, early disease onset after transplantation, and early disease stages. These factors in study patients likely contribute to the variability in response rates seen between treatment options. Severe adverse effects, ranging from grade 3 neutropenia to infection resulting in death, occurred more frequently in patients receiving chemotherapy than in patients receiving only rituximab. Conclusions: Although reduction in immunosuppressive medications remains the first-line therapy for PTLD treatment, many cases do not respond to this treatment alone, especially monomorphic or more aggressive cases of lymphoma. Therefore, it is reasonable to begin active treatment including rituximab and/or chemotherapy initially, along with reduction in immunosuppression in many cases. Further prospective, comparative studies are urgently needed to confirm the efficacy of these treatment strategies as well as to clarify which subset of patients may benefit most from them.

In reacting flow problems involving large numbers of chemical species and reactions, reduced chemistry modeling is used to approximately describe, with fewer unknowns, the slow chemical evolutions after the rapid but brief initial transients have decayed. Diffusion transport terms, if present, are modified by the reduced chemistry approximations. This article reiterates that the use of unmodified diffusion terms along with reduced chemistry terms is unjustified in general, and discusses the potential impacts of diffusion on the use of “slow manifolds” to reduce the number of unknowns. In addition, the proper way to handle sidewall reactive-diffusion boundary layers is presented.

Literacy is a multilevel construct comprising word reading, spelling, and text reading comprehension. Understanding the key linguistic and cognitive factors that support word reading, spelling, and text reading comprehension is fundamentally important to elucidate the detailed nature of literacy acquisition. While most contemporary models of literacy acquisition are developed on the basis of English and other alphabetic writing systems, little attention has been paid to nonalphabetic writing system, such as Chinese. We focus on Chinese literacy acquisition and emphasize how different properties of the Chinese language (phonology, morphology, and orthography) may impact the development of different-level literacy skills. A systematic review of extant research on literacy acquisition, along with our own work on Chinese word reading, spelling, and reading comprehension, suggests that phonological awareness, morphological awareness, and orthographic skills are all important to Chinese literacy acquisition, but the relative importance of these skills varies across word reading, spelling, and reading comprehension. Moreover, the contribution of each of these linguistic and cognitive skills to a single component of literacy skills also varies in different developmental stages. This suggests that a full model of literacy acquisition should consider the linguistic features that are characteristics of the writing system, as well as developmental context.

Objective: To report a case of both successful maternal treatment outcome and normal fetal outcome in a patient who was diagnosed with Burkitt's lymphoma (BL) and aggressively treated with 6 different chemotherapy agents during the second and third trimesters of pregnancy. Case Summary: A 21-year-old white woman was diagnosed with stage II BL of the head and neck at 26 weeks' gestation. She was treated with 2 cycles of systemic intensive polychemotherapy, including cyclophosphamide, vincristine, doxorubicin, cytarabine, etoposide, ifosfamide, mesna, and intrathecal cytarabine with growth factor support during the second and third trimesters. She delivered a healthy, premature boy 6 weeks after diagnosis. At a follow-up 1 year after diagnosis, the patient remained disease-free and the baby remained healthy. Discussion: The prognosis of BL depends on the stage at diagnosis, as well as treatment aggressiveness. Previous reports indicate that most patients diagnosed with BL during pregnancy received either no treatment or only one chemotherapy agent, and the majority ultimately died of rapidly progressive diseases. The fetal outcomes seem to depend primarily on the time of exposure to chemotherapy and/or radiation, doses, specific chemotherapy agent given, and frequency of treatment during pregnancy. Limited retrospective data suggest that chemotherapy given after the first trimester is relatively safe and does not adversely affect the short-and long-term fetal outcomes. Conclusions: Treatment of BL during pregnancy can be very challenging because an aggressive approach is the main key to maximize the patient's long-term disease-free survival. However, the health of the unborn child should also be a concern when choosing treatment. This case demonstrates that combination chemotherapy given after the first trimester did not result in any congenital malformations or acute adverse effects in the fetus. Long-term follow-up of the child remains necessary to evaluate possible long-term complications.

Background and study aims In a previous study we demonstrated the efficacy of second-look endoscopy with therapy within 16 - 24 hours after index endoscopy in reducing major recurrent peptic ulcer bleeding. In this study, we sought to identify factors that might predict further rebleeding after this scheduled second-look endoscopy. Patients and methods We studied 249 patients (181 men, 68 women) with acute bleeding peptic ulcers who were treated at the United Christian Hospital, Hong Kong from 1999 to 2002 and who underwent a scheduled second endoscopy. Those patients who developed rebleeding after the second endoscopy were evaluated, and possible predictive factors for rebleeding were analyzed using a logistic regression model. Results Of the 249 patients who underwent scheduled second-look endoscopy, 17 patients (6.8 %) developed rebleeding: seven of these patients were treated by another endoscopic therapy; ten patients required surgery. The overall mortality rate was 3.1 %. A logistic regression analysis performed on the possible predictive factors for rebleeding found that the following factors were associated with a significant risk of further rebleeding after scheduled second endoscopy: American Society of Anesthesiologists (ASA) grade III or grade IV status (odds ratio 3.81, 95 % CI 1.27 - 11.44), ulcer size greater than 1.0 cm (odds ratio 4.69, 95 % CI 1.60 - 13.80), and a finding of persistent stigmata of recent hemorrhage at the scheduled second endoscopy (odds ratio 6.65, 95 % CI 2.11 - 20.98). Conclusions Endoscopic factors, including large ulcer size and the persistence of endoscopic stigmata of recent hemorrhage are important predictors for recurrent bleeding after scheduled second endoscopy.

To evaluate the validity of currently recommended obesity cutoffs of body mass index (BMI, in kg/m(2)) and waist circumference (WC, in cm) for Asians by the WHO/IASO/IOTF and for Chinese by the Working Group on Obesity in China (WGOC) using the percentage body fat (%BF)-obesity criteria.A cross-sectional study.A total of 1122 community-based Hong Kong Chinese women aged between 41 and 63 years.Total %BF and percent truncal fat (%TF) were measured using dual-energy X-ray absorptiometry. Anthropometric indices were measured using standard methods.Regression analyses showed that the BMI cutoffs of 23, 24, 25, and 28 kg/m(2) corresponded to the %BF of 34.8, 35.9, 36.9 and 39.5%, and the 80 cm WC corresponded to 34% TF, respectively. Compared with the %BF obesity cutoff (/=40%), the WHO/IASO/IOTF BMI-obesity criterion (/=25) shows a good sensitivity (75%) and specificity (71%); and the WGOC criterion (BMI/=28) had a low sensitivity (41%) but an excellent specificity (93%), respectively. Corresponding to the BMI cutoffs of 23, 24, 25 and 28 kg/m(2), the %BF cutoffs associated with peak kappa statistic were 33, 34, 35 and 40%, and the relevant %TF linked with 80 cm WC was 33%, respectively.BMI and WC have a good accuracy in the prediction of obesity. Our findings suggest that the WGOC BMI cutoffs are appropriate, but 80 cm of WC is a very rigorous cutoff for this population when using the criteria of 34 and 40% of body fat or truncal fat for overweight and obesity.

The suitability of gellan, κ-carrageenan and a high-melting-fat-fraction of milk fat (HMFF) to encapsulate protease enzymes (Flavourzyme) and impact in accelerating Cheddar cheese ripening were studied. The rates of enzyme entrapment were 48.2%, 55.6%, and 38.9% for gellan, κ-carrageenan and HMFF, respectively. The enzyme capsules were incorporated into milk during cheese manufacture. The moisture content of cheeses with added gum capsules was higher than control cheeses. Casein (β) degradation was monitored by High-Performance Capillary Electrophoresis. All cheeses treated with encapsulated enzyme showed higher rates of proteolysis than the control cheese throughout the ripening period. The rate of proteolysis was greater with cheeses made incorporating κ-carrageenan capsules containing protease. Cheese texture and sensory quality were not significantly influenced by the type of encapsulating material (gum or milk fat). Differences in textural and sensory quality between treated and control cheeses were consistent with release of protease enzymes from capsules.

OBJECTIVE:To review the clinical evidence for the use of recombinant factor VIIa (rFVIIa) in the prevention and/or treatment of bleeding in non-hemophiliac patients.DATA SOURCES:A MEDLINE search (1966–December 2004) was conducted to identify pertinent literature. Results were limited to English-language reports and clinical trials. References of relevant articles and selected abstracts presented at scientific meetings were also reviewed.STUDY SELECTION AND DATA EXTRACTION:Human data from prospective and retrospective studies that examined the hemostatic effect of rFVIIa in non-hemophiliac patients were reviewed, with a focus on surgical prophylaxis, liver disease, intractable bleeding associated with trauma and surgery, and anticoagulation reversal.DATA SYNTHESIS:Results from limited controlled trials on the use of rFVIIa as an adjunct for prevention of bleeding in surgery and liver diseases have not been consistent. For treatment of intractable bleeding, earlier use of rFVIIa in one trauma trial was shown to decrease the number of blood transfusions, but no differences in terms of clinical outcomes were observed in all trials. Controlled trials do not suggest an increased risk of thrombotic events. Optimal dosing and timing of administration have yet to be defined.CONCLUSIONS:Until further prospective controlled data are available, it is recommended that conventional intervention for prevention and control of hemorrhage in non-hemophiliac patients should remain the standard of care. Close monitoring of coagulation parameters is recommended before, during, and after therapy, especially in high-risk patients. Pharmacoeconomic analysis may be useful to help control costs and maximize clinical benefits.

Recent interest has been shown in the potential beneficial effects of phytoestrogens on bone health. As the early years of menopause are a period of rapid bone loss, and the risk for osteoporosis increases substantially, the habitual intake of soy protein and isoflavones may play a role in the retardation of bone loss. This paper reports the results of the baseline cross-sectional analysis of the association between dietary soy protein intake and bone mineral density/content in a population-based study of Chinese women. The sample comprised 454 healthy Chinese women (mean age 55.1 +/- 3.57) within the first 12 years of postmenopause. We estimated the dietary intake of soy protein and isoflavones, and other key nutrients, including dietary protein and calcium, using the quantitative food frequency method. Bone mineral density (BMD) and content (BMC) at the spine, hip and total body were measured with a dual energy X-ray densitometer (Hologic 4500A). Soy protein consumption was categorized as quartiles of intake, and related to BMD values at the spine and hip, and BMC of total body. Stratified analyses were carried out among women within or at least 4 years postmenopausal. We observed few differences in BMD/BMC values among the intake quartiles in women within the first 4 years of menopause. However, among the later postmenopausal women, we noted a dose-response relationship with increasing higher BMD values at the trochanter, intertrochanter as well as the total hip and total body with increasing soy protein intake quartiles (P0.05 from tests for trend). The BMD values differed by about 4-8% between the first and fourth soy protein intake quartiles. Though women from the fourth intake quartile had a 2.9% higher BMD value compared with those from the first intake quartile, the difference was not statistically significant. Stepwise multiple linear regression analyses showed the association between soy intake quartiles and hip BMD as well as total body BMC values remained after adjusting for body weight, which was retained in the final model. Analyses based on soy isoflavones content yielded similar results. This study demonstrated that, among women after the initial few years postmenopausal, soy protein/isoflavones intake had a modest but significant association with hip BMD as well as total body BMC. The effects of soy protein and soy isoflavones on bone health should be further explored in populations with habitual dietary soy intake.

Animal studies have shown that soy isoflavones have an effect in preventing estrogen-related bone loss, but few data are available in humans, especially in the Asian populations. This double-blind, placebo-controlled, randomized trial examines the effects of soy isoflavones on bone loss in postmenopausal Chinese women, aged 48 – 62 yr. Two hundred and three eligible subjects were randomly assigned to three treatment groups with daily doses of placebo (1 g starch; n 67), middose (0.5 g starch, 0.5 g soy extracts, and 40 mg isoflavones; n 68), and high dose (1.0 g soy extracts and 80 mg isoflavones; n 68). All were given 12.5 mmol (500 mg) calcium and 125 IU vitamin D3. Bone mineral density (BMD) and bone mineral content (BMC) of the whole body, spine, and hip were measured using dual energy x-ray absorptiometry at baseline and 1 yr post treatment. Both univariate and multivariate analyses showed that women in the high dose group had mild, but statistically significantly, higher favorable change rate in BMC at the total hip and trochanter (P < 0.05) compared with the placebo and mid-dose groups, even after further adjustments for the potential confounding factors. Further stratified analyses revealed that the positive effects of soy isoflavone supplementation were observed only among women with lower initial baseline BMC (median or less). In conclusion, soy isoflavones have a mild, but significant, independent effect on the maintenance of hip BMC in postmenopausal women with low initial bone mass. (J Clin Endocrinol Metab 88: 4740 – 4747, 2003)

This paper presents an overview of new information on clinically relevant drug-drug interactions, particular focuses on negative drug interactions in oncology. We have generated a concise table of drug-drug interactions that provides a synopsis of the clinical outcome of the interaction along with a recommendation for management. We have also generated other tables that describe specific interactions with methotrexate and dosing guidelines for cytotoxic drugs in the presence of renal or hepatic dysfunction. Since warfarin is one of the non-anticancer drugs that is commonly used in cancer patients for the treatment and prevention of venous thromboembolism, its interactions with other anticancer drugs that have been reported in literatures were also reviewed in this paper. In general, drug interactions observed in cancer patients may be categorized into pharmacokinetic, pharmacodynamic and pharmaceutic interactions. Pharmacokinetic interactions involve one drug altering the absorption, distribution, metabolism, or excretion of another drug. Interpatient variability in the pharmacokinetic profile of many anticancer agents often complicates the predictability of the antitumor response and toxicities. Among four pharmacokinetic characteristics, drug interactions involving hepatic metabolism is probably the most common and important mechanism responsible for oncologic drug interactions. For example, several anticancer drugs including taxanes, vinca alkaloids, and irinotecan are known to be metabolized by cytochrome CYP3A4. Enzyme-inducing anticonvulsants have been shown to significantly decrease the plasma levels of these anticancer drugs, thereby compromising the anti-tumor effects. N ephrotoxicity or changes in hepatic function caused by some anticancer drugs (e.g., cisplatin, asparaginase) may also have an impact on the pharmacokinetics of the interacting agents. Pharmacodynamic interactions may occur when two or more drugs acting at a common receptor-binding site impact on the pharmacologic action of the object drug, without influencing the pharmacokinetics of each interacting agent. In clinical setting, a decrease of antitumor efficacy was observed in breast cell lines when gemcitabine or vinorelbine were used in combination with paclitaxel. On the other hand, a decreased incidence of thrombocytopenia was seen in patients receiving combination of carboplatin and palcitaxel compared to those receiving carboplatin alone. The third type of drug-drug interaction is known as pharmaceutic interaction. When one drug may alter the physical or chemical compatibility of another drug that utlimately leads to a change in appearance of the solution or a decrease of effectiveness of the drug due to drug inactivation or degradation.

In multi-component reacting flows, it is well-known that significant simplifications are available when the “all-Lewis-numbers-are-unity” assumption can be justified. Under this assumption, certain linear combinations of the dependent variables, commonly known as the Shvab-Zel’dovich (SZ) variables, are “decoupled” from the chemistry terms. A derivation is presented here showing that the same simplifications can be achieved under less-restrictive conditions. The means to check whether these conditions are satisfied is provided.

To examine the impact of glaucoma and visual acuity (VA) and visual field (VF) losses on psychosocial functioning (PF).Cross-sectional study.We compared PF between 192 participants with bilateral glaucoma with VA or VF losses and 40 controls from a tertiary eye hospital clinic in Singapore.Glaucoma was defined using the Hodapp-Anderson-Parish criteria. Four psychosocial outcomes of the Glaucoma Quality of Life 36 questionnaire were psychometrically assessed using Rasch analysis. Multivariate regression was performed to determine the independent impact of glaucoma and VA and VF losses on PF. The impact of VA and VF on PF were evaluated by restricted cubic spline analysis.Anxiety, self-image, psychological well-being, and confidence in health care.The mean age of participants was 66.2±11.0 years, and 63% were male. In the better eye, VA and mean deviation were Snellen 20/25 and -8.89±6.52 dB, respectively. In multivariate models, glaucoma patients had 63.0% greater anxiety (95% confidence interval [CI], -66.0% to -61.2%; P0.001), 71.0% lower self-image (95% CI, -74.1% to -68.5%; P0.001), 38.3% less psychological well-being (95% CI, -37.4% to -39.0%; P0.001), and 32.4% reduced confidence in health care than patients without glaucoma. The worst VA and VF categories had the most reduced PF (range, 26.0% to 81.5%; P0.001 for all associations) compared with controls. With worsening VA, there was a linear increase in anxiety (P=0.009) and decrease in self-image (P=0.005). With worsening VF from 0 to -12.1 dB (P=0.003), anxiety increased before plateauing. Self-image decreased as VF worsened from 0 to -10 dB (P0.001), and confidence in health care decreased when VF worsened from 0 to -9.3 dB (P=0.008). However, self-image and confidence in health care actually improved at greater levels of VF loss beyond these thresholds.Glaucoma negatively affects PF. Early stage glaucoma with mild VF loss adversely affects anxiety, self-image, and confidence in health care. As VA worsens in advanced glaucoma, anxiety further increases and self-image deteriorates. Ophthalmologists and glaucoma patients need to be aware that both VA and VF losses at different stages of glaucoma negatively impact PF.

This paper exploits the equivalence between constrained dynamics problems and a class of tracking control problems. An alternative derivation of the modern formulation of Parczewski and Blajer [J. Appl. Math. 56 (1989) 676-684] is presented, including some new analysis on the ''almost singular'' case, followed by a critique of the classical Lagrangian formulation. In addition, a new formulation which allows the constraints to be satisfied approximately is presented. A general closed-loop control law which depends on a user-specified threshold of constraint errors, @e, is proposed, transforming the default DAE problem into a stiff ODE initial-value problem which can be routinely solved on computers. It is shown that certain explosively unstable open-loop systems may be stabilized by the use of closed-loop control using a small but finite @e. An example is worked out using both the open-loop and the closed-loop control formulations.

This study aims to identify the demographics and hygiene behaviours associated with contact lens (CL)-related microbial keratitis in Singapore.The hygiene and social behaviours of lens wearers presenting with infectious keratitis in Singapore were examined using an externally validated questionnaire. Fifty-eight consecutive lens wearers who presented with infectious keratitis at Singapore National Eye Centre were surveyed using a self-administered questionnaire. Patients' demographics, CL-related behaviour, attitude to aftercare visits and microbial study results were collected and analysed.More than half (55%) of the patients surveyed were female, and the average age of the participants was 25.7 ± 6.4 years. Ninety-six percent of participants used soft CL, with the majority wearing monthly disposable lenses (74.1%). Myopia was the commonest reason for use of CL. CL overwear (81%), sleeping (50.9%) and swimming (33%) with their CL were the major non-compliant behaviours discovered. When encountered with eye discomfort as a result of lens-related infective keratitis, 83% of patients sought the advice of general medical practitioners prior to presentation at the hospital. Many (59%) patients have encountered media coverage but only 24% had any behavioural change as a result. Many patients relied on the recommendations of eyecare practitioners when purchasing disinfecting solutions (26%) and other hygiene practices. Pseudomonas Aeruginosa was the most common organism grown in 22.4% of patients while 47% of patients were culture-negative.Inadequate lens cleaning, poor aftercare, sleeping and swimming with CL were the major non-compliant behaviours among participants, and these are significant factors when assessing risks in acquiring CL-related infectious keratitis. General eyecare practitioners are the first-line of contact in patients presenting with keratitis symptoms and play an important role in emphasising the need for regular aftercare and good hygiene practices to CL wearers.

Proteins are of great interest due to their amphiphilic nature, which allows them to reduce the interfacial tension at the oil–water interface. The incorporation of proteins at the oil–water interface has allowed scientists to utilise them to form emulsions (O/W or W/O), which may be used in food formulations, drug and nutrient delivery. The systematic study of the proteins at the interface and the factors that affect their stability (i.e., conformation, pH, solvent conditions, and thermal treatment) has allowed for a broader use of these emulsions tailored for various applications. In this review, the factors affecting the stability of emulsions using food proteins will be discussed. The use of polysaccharides to complex with proteins will also be explored in relation to enhancing emulsion stability.

Inter/intramolecular hydrogen bonding of a series of hydroxystearic acids (HSAs) are investigated. Self-assembly of molecular gels obtained from these fatty acids with isomeric hydroxyl groups is influenced by the position of the secondary hydroxyl group. 2-Hydroxystearic acid (2HSA) does not form a molecular dimer, as indicated by FT-IR, and growth along the secondary axis is inhibited because the secondary hydroxyl group is unable to form intermolecular H-bonds. As well, the XRD long spacing is shorter than the dimer length of hydroxystearic acid. 3-Hydroxystearic acid (3HSA) forms an acyclic dimer, and the hydroxyl groups are unable to hydrogen bond, preventing the crystal structure from growing along the secondary axis. Finally, isomers 6HSA, 8HSA, 10HSA, 12HSA, and 14HSA have similar XRD and FT-IR patterns, suggesting that these molecules all self-assemble in a similar fashion. The monomers form a carboxylic cyclic dimer, and the secondary hydroxyl group promotes growth along the secondary axis.

The Lam and Rott theory of linearized unsteady boundary layers is revisited, and some new results are obtained. The exact outer eigen-solution for a flat plate found in the original paper is shown to be a special case of the Prandtl-Glauert transposition theorem. The streamwise coordinate-dependent factor of the inner eigen-solutions, first found by M. E. Goldstein for the flat plate, is generalized for arbitrary pressure gradients.

The conventional methods of simplified kinetics modeling through the use of partial-equilibrium and quasi-steady approximations are reviewed and critiqued. The method of computational singular pertutbation (CSP) is then presented with special emphasis on the interpretation of CSP data to obtain physical insights on massively complex reaction systems. A simple example is used to demonstrate how CSP deals with complex chemical kinetics problems without the benefits of intuition and experience.

Most differentiated thyroid carcinomas (DTC) are treated by total thyroidectomy in Hong Kong. This study investigates the outcome of tumour control in selected patients treated by hemithyroidectomy, which is beneficial in terms of having a lower operative morbidity.This is a retrospective study of prospectively collected data from our cancer registry. Patients with pathologically proven differentiated thyroid carcinoma were stratified into risk groups according to the patients' age, tumour size, extrathyroid spread and distant metastasis. Low-risk patients were managed with hemithyroidectomy without postoperative radioactive iodine. Central compartment lymph node dissection was also carried out if the diagnosis was confirmed preoperatively. The oncological outcome and surgical morbidity were evaluated.A total of 236 patients with the diagnosis of DTC underwent a thyroidectomy at our institution during a 24-year period. 93 patients were initially treated by hemithyroidectomy. Subsequent evaluation was focused on this subgroup. The mean follow-up period was 63.3 +/- 55.1 months. The mean tumour diameter was 22.1 +/- 20.8 mm. The histopathologic diagnoses were papillary carcinoma (69 cases; 74.2 percent), follicular carcinoma (20 cases; 21.5 percent) and Hurthle cell carcinoma (four cases; 4.3 percent). 23 (24.7 percent) patients underwent hemithyroidectomy coupled with central compartment dissection. Pathologically proven lymph node metastasis was diagnosed in 12 (12.9 percent) patients. Transient vocal cord palsy occurred in six (6.5 percent) patients, while permanent vocal cord palsy occurred in two (2.2 percent). Local tumour recurrence arose in only one (1.1 percent) patient. No patient succumbed to the thyroid cancer.Hemithyroidectomy coupled with central compartment dissection in selected cases of DTC can achieve excellent tumour control with minimal surgical morbidity.

The Yakhot and Orszag [J. Sci. Comput. 1, 3 (1986)] RNG theory of turbulence has generated a number of scaling law constants in reasonable quantitative agreement with experiments. The theory itself is highly mathematical, and its assumptions and approximations are not easily appreciated, particularly since several rather unconventional artifices are employed. The present paper reviews the RNG theory and recasts it in more conventional terms using a distinctly different viewpoint. A new formulation based on an alternative interpretation of the origin of the random force is presented, showing that the artificially introduced E in the original theory is an adjustable parameter, thus offering a plausible explanation for the remarkable record of quantitative success of the so‐called E‐expansion procedure.