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A series of both daily classroom activities and a long-term assignment in which secondary school language students actively use the Internet and the World Wide Web are described. Class activities target each of three proficiency levels (beginner, intermediate, advanced). They include having students check the weather, check out major products/industries/monuments of a region or city, convert currencies, choose a hotel and place to visit, research a specific historical figure/author/cultural event, report on current events, and visit a city or museum. The longer-term assignment involves having students work in pairs to plan all the details of a trip to a French- or Spanish-speaking country. Specific aspects of this assignment are outlined. Web sites for both French and Spanish language sources are listed, and several search engines are suggested. (MSE)

Tesla bladeless expanders are promising in energy harvesting and small-scale power generation applications due to their lower cost and simplicity in design. Although such expanders exhibit very high rotor efficiency (analytical total to static efficiency ~ 90%), it shows poor performance when coupled with a stator (experimental total to static efficiency ~30%) due to losses present in the stator and stator-rotor interaction. This paper presents the design and experiment of a novel, high-efficient Tesla bladeless expander concept. The concept arises from the loss phenomena in the stator-rotor interaction in conventional bladeless expanders, which are among the main causes of the low performance. This concept is believed to bring the bladeless expanders to the same performances as the traditional ones with vanes, compared to which however the bladeless machines boast greater simplicity, robustness, and the absence of performance decay as the size decreases, competing even in the contexts for traditional turbomachinery. The high-efficient bladeless expander prototype with water as a working fluid is designed and developed, representing the similitude case for a liquid butane heat pump. The available isentropic power across the throttling process in the butane case is 3.3 kW @10000 rpm. The turbine consists of 24 nozzles and 150 disks separated by 0.1 mm spacers. The turbine shaft is connected to the high-speed electric generator. The performance test on the expander is carried out at rotational speeds ranging from 3000 rpm to 6200 rpm and with differential pressure across the expander up to 14 bar. Experimental ventilation loss is characterised and its effect on the performance of the expander is discussed. The preliminary results of the expander under investigation showed satisfactory production of power with an acceptable efficiency range. It is also shown that the present concept is promising and able to address the major i.e., stator-rotor interaction which is the

Interests in small-scale turbomachinery are gaining momentum, particularly around waste heat recovery using Organic Rankine Cycle (ORC), energy harvesting, pico-hydro, refrigeration and heat pumps and small-scale power generation. These applications demand to have economical, simple construction, and reasonably efficient machines. The performance of bladed turbomachine at a small scale is poor mainly due to viscous losses and relatively large clearances. In some cases, like ORC, it requires a lubrication system, making it complex and costly. Bladeless or Tesla turbomachinery is seen as one of the solutions for these applications due to its simple construction and cost-effectiveness. However, the experimental efficiency of the bladeless turbines/compressors is found in the low region, < 40%. In this article, the performance of a bladeless turbine is investigated using a vaneless volute configuration, making the turbine stator-less (vaneless volute) and bladeless (vaneless rotor). This study presents numerical and experimental performance investigation with a volute as a stator of the bladeless rotor. 3D Numerical results show very promising performance of the turbine with total to static efficiencies calculated above 65%. In the second part of the article, turbine prototype components, assembly and test set-up are discussed. Experimental maximum efficiency of 41.5±0.88% at 3.5 kg/s@5000 rpm and power of 915 W is obtained. This is the highest recorded efficiency for the Tesla turbine in peer-reviewed research. The overall turbine performance from 3D numerical simulation with ventilation and mechanical losses is compared with experimental results. This work demonstrates that the proposed stator-less/volute configuration provides an efficient way for bladeless or Tesla turbines, particularly for low-head applications.

Details employment by occupation in 1994 and projected for 2005. Suggests that the economy is expected to continue generating jobs for all levels of education and training, but growth will be greater for occupations requiring a bachelor's degree or more. (SK)

From 1992 to 2005, occupations requiring postsecondary education will have faster than average growth rates. Most employment growth will be in services. Professional specialty is expected to be the fastest growing group. (SK)

Chronic tic disorders are neurodevelopmental conditions characterized by the presence of motor and/or phonic tics and often accompanied by co-morbid behavioral problems. Chronic tic disorders can negatively affect the level of functioning of young patients across social and family domains, with possible repercussions on their self-perception. We conducted a systematic literature review to assess the clinical correlates of both components of self-perception (self-concept, i.e. what patients think about themselves, and self-esteem, i.e. how they feel about their self-concept) in patients with chronic tic disorders. Reported levels of self-perception varied widely across studies, partly due to the methodological heterogeneity of the reviewed literature. Poor self-concept and self-esteem appeared to be more strongly related to the presence of psychiatric co-morbidities (especially obsessive-compulsive disorder, attention-deficit and hyperactivity disorder, and anxiety disorders) than to tic severity. Poor peer relationship, social difficulties, as well as problems with parents' acceptance were identified as further risk factors for low self-perception. Finally, the reviewed studies highlighted a link between self-perception and quality of life in patients with chronic tic disorders, alongside the protective role of good social adjustment. This information can therefore assist treating clinicians in the choice of tailored therapeutic interventions for this patient population, including behavioral management techniques that can improve self-concept and self-esteem through increased self-efficacy.

Objective/Background. To describe an uncommon, life-threatening condition such as angiosarcoma of a fistula for hemodialysis occurring in a transplant recipient affected by Lowe's syndrome. Summary. We present the case of a 56-year-old male kidney transplant recipient affected by Lowe's syndrome, also known as oculocerebrorenal syndrome, a rare X-linked disorder characterized by congenital cataracts, hypotonia, intellectual disability, and Fanconi-like renal tubular dysfunction, who was diagnosed with angiosarcoma of a functioning arteriovenous fistula for hemodialysis. Conclusion. Angiosarcoma is a rare soft tissue tumor, and only 22 cases of angiosarcoma of arteriovenous fistulae were described so far; although a correlation between Lowe's syndrome and a higher risk of tumor compared to the general population has not been described so far, the mechanisms of disease causation could be an interesting starting point for future studies on a possible connection between the two events.

The most recent scientific evidence supports the consumption of cow’s milk and dairy products as part of a balanced diet. However, these days, the public and practicing physicans are exposed to a stream of inconsistent (and often misleading) information regarding the relationship between cow’s milk intake and health in the lay press and in the media. The purpose of this article, in this context, is to facilitate doctor–patient communication on this topic, providing physicians with a series of structured answers to frequently asked patient questions. The answers range from milk and milk-derived products’ nutritional function across the life span, to their relationship with diseases such as osteoporosis and cancer, to lactose intolerance and milk allergy, and have been prepared by a panel of experts from the Italian medical and nutritional scientific community. When consumed according to appropriate national guidelines, milk and its derivatives contribute essential micro- and macronutrients to the diet, especially in infancy and childhood where bone mass growth is in a critical phase. Furthermore, preliminary evidence suggests potentially protective effects of milk against overweight, obesity, diabetes, and cardiovascular disease, while no clear data suggest a significant association between milk intake and cancer. Overall, current scientific literature suggests that an appropriate consumption of milk and its derivatives, according to available nutritional guidelines, may be beneficial across all age groups, with the exception of specific medical conditions such as lactose intolerance or milk protein allergy. Key teaching points: Milk and its derivatives contribute essential micro and macronutrients to the diet, when consumed according to appropriate national guidelines, especially in infancy and childhood where bone mass growth is in a critical phase. Preliminary evidence suggests potentially protective effects of milk against overweight, obesity, diabetes and cardio

Presents current and projected occupational employment estimates that were developed by industry and are part of a national industry-occupational employment matrix. The data from this matrix will be the basis of the information in the 1984-85 education of the Occupational Outlook Handbook to be issued in the Spring of 1984. (NRJ)

Background: Gilles de la Tourette syndrome (GTS) is a childhood-onset neuropsychiatric disorder characterized by multiple tics and often associated with behavioral problems. Although there is evidence of significantly reduced self-esteem in children and adolescents with GTS, little is known about perceived self-concept and its clinical determinants at the transition age between adolescence and adulthood, a crucial age for personal development. Objective: This original study aimed to investigate self-concept in a clinical sample of young patients with GTS at the transition age between adolescence and adulthood. Methods: In addition to standard demographic and clinical data, we collected self-ratings using a standardized battery of psychometric instruments, as well as the Multidimensional Self Concept Scale, a comprehensive questionnaire developed to assess self-concept in subjects aged 9 to 19 years, tapping into the social, competence, affect, academic, family, and physical domains. Results: We found that patients diagnosed with at least one comorbid psychiatric disorder (“GTS-plus” phenotype) reported significantly lower self-concept than patients with “pure GTS,” whereas tic-related variables had no impact on self-concept. Anxiety symptoms were the main determinants of self-concept, especially trait anxiety with regard to social and affective domains. Affective symptoms could also have a negative impact on the physical, affective, competence, and social domains of self-concept. Conclusion: Routine screening for comorbid conditions, especially anxiety and affective symptoms, should be recommended in all patients with GTS seen at transition clinics from pediatric to adult care, in order to implement effective treatment interventions to improve self-concept whenever possible.

Introduction Gilles de la Tourette syndrome (GTS) is a childhood-onset neuropsychiatric disorder characterised by multiple tics and often associated with behavioural problems. Although there is evidence of significantly reduced self-esteem in children and adolescents with GTS, little is known about perceived self-concept and its clinical determinants at the transition age between adolescence and adulthood. We therefore set out to investigate self-concept in a clinical sample of young patients with GTS at this crucial age for personal development. Methods In addition to standard demographic and clinical data, we collected self-ratings using a standardised battery of psychometric instruments, as well as the Multidimensional Self Concept Scale, a comprehensive questionnaire developed to assess self-concept in subjects aged 9– to 19 years, tapping into the social, competence, affect, academic, family, and physical domains. Results We found that patients diagnosed with at least one co-morbid psychiatric disorder (“GTS-plus” phenotype) reported significantly lower self-concept than patients with “pure GTS”, whereas tic-related variables had no impact on self-concept. Anxiety symptoms were the main determinants of self-concept, especially trait anxiety with regard to social and affective domains. Affective symptoms could also have a negative impact on the physical, affective, competence, and social domains of self-concept. Conclusion Routine screening for anxiety and affective symptoms should be recommended in all patients with GTS seen at transition clinics from paediatric to adult care, in order to implement effective treatment interventions whenever possible.

BACKGROUND: Gilles de la Tourette syndrome (GTS) is a chronic childhood-onset neuropsychiatric disorder with a significant impact on patients' health-related quality of life (HR-QOL). Cavanna et al. (Neurology 2008; 71: 1410-1416) developed and validated the first disease-specific HR-QOL assessment tool for adults with GTS (Gilles de la Tourette Syndrome-Quality of Life Scale, GTS-QOL). This paper presents the translation, adaptation and validation of the GTS-QOL for young Italian patients with GTS. METHODS: A three-stage process involving 75 patients with GTS recruited through three Departments of Child and Adolescent Neuropsychiatry in Italy led to the development of a 27-item instrument (Gilles de la Tourette Syndrome-Quality of Life Scale in children and adolescents, C&A-GTS-QOL) for the assessment of HR-QOL through a clinician-rated interview for 6-12 year-olds and a self-report questionnaire for 13-18 year-olds. RESULTS: The C&A-GTS-QOL demonstrated satisfactory scaling assumptions and acceptability. Internal consistency reliability was high (Cronbach's alpha > 0.7) and validity was supported by interscale correlations (range 0.4-0.7), principal-component factor analysis and correlations with other rating scales and clinical variables. CONCLUSIONS: The present version of the C&A-GTS-QOL is the first disease-specific HR-QOL tool for Italian young patients with GTS, satisfying criteria for acceptability, reliability and validity.

Gilles de la Tourette syndrome (GTS) is a neurodevelopmental condition characterised by tics and co-morbid behavioural problems, affecting predominantly male patients. Tic severity typically fluctuates over time, with a consistent pattern showing improvement after adolescence in a considerable proportion of patients. Both tics and behavioural co-morbidities have been shown to have the potential to affect patients’ health-related quality of life (HR-QoL) in children and adults with persisting symptoms. In this study, we present the results of the first investigation of HR-QoL in patients with Gilles de la Tourette syndrome at the transition between adolescence and adulthood using a disease-specific HR-QoL measure, the Gilles de la Tourette Syndrome-Quality of Life-Children and Adolescents scale. Our results showed that patients with GTS and more severe co-morbid anxiety symptoms reported lower HR-QoL across all domains, highlighting the impact of anxiety on patient’s well-being at a critical stage of development. Routine screening for anxiety symptoms is recommended in all patients with GTS seen at transition clinics from paediatric to adult care, to implement effective behavioural and pharmacological interventions as appropriate.

Tourette syndrome is a neurodevelopmental disorder characterized by tics and comorbid behavioral problems. This study compared child- and parent-reported quality of life and everyday functioning. We assessed 75 children with Tourette syndrome, of which 42 (56%) had comorbid conditions (obsessive-compulsive disorder = 25; attention-deficit hyperactivity disorder = 6; both comorbidities = 4). All patients completed psychometric instruments, including the Gilles de la Tourette Syndrome-Quality of Life Scale for Children and Adolescents (child report) and the Child Tourette's Syndrome Impairment Scale (parent report). Data were compared for patients with pure Tourette syndrome, Tourette syndrome + obsessive-compulsive disorder, Tourette syndrome + attention-deficit hyperactivity disorder, and Tourette syndrome + both comorbidities. There were no group differences in quality of life. However, there were differences for total, school, and home activities impairment scores. Children and parents may not share similar views about the impact of Tourette syndrome on functioning. The measurement of health-related quality of life in Tourette syndrome is more complex in children than adults.

Tourette syndrome is a neurodevelopmental disorder characterized by multiple tics and is often associated with comorbid behavioral problems. Research with generic instruments in child populations showed that comorbid disorders can have a greater impact on health-related quality of life than tic severity. This study investigated the usefulness of a newly developed disease-specific instrument, the Gilles de la Tourette Syndrome-Quality of Life Scale for Children and Adolescents (GTS-QOL-C&A), in assessing health-related quality of life in young patients with Tourette syndrome with and without behavioral comorbidity. We recruited 75 patients with Tourette syndrome (60 males; age 12.4 ± 3.2 years). All participants were evaluated by a neuropsychiatrist and completed a standardized psychometric battery, including the GTS-QOL-C&A, Child Depression Inventory, and Multidimensional Anxiety Scale for Children. Forty-two patients (56%) fulfilled diagnostic criteria for at least one comorbidity: obsessive-compulsive disorder (n = 25 patients [33.3%]); attention deficit/hyperactivity disorder (n = 6 patients [8%]); both (n = 11 patients [14.7%]). The GTS-QOL-C&A demonstrated usefulness in differentiating "pure" Tourette syndrome from Tourette syndrome "plus" behavioral problems with regard to health-related quality of life scores for the obsessive-compulsive subscale. In addition to focusing on core tic symptoms, the GTS-QOL-C&A showed sensitivity to the impact of behavioral comorbidities on health-related quality of life and can usefully complement existing nonspecific instruments.

BACKGROUND: Multiple complex stenoses, plaque fissures, and widespread coronary inflammation are common in acute coronary syndromes. A systemic cause of atherosclerotic plaque instability is also suggested by studies of ischemic cerebrovascular disease. We investigated the association between coronary and carotid plaque instability and the potential common causal role of inflammation. METHODS AND RESULTS: The ultrasound characteristics of carotid plaques were evaluated retrospectively in patients scheduled for coronary bypass surgery, 181 with unstable and 92 with stable angina, and prospectively in a similar group of patients, 67 with unstable and 25 with stable angina, in whom serum C-reactive protein levels were also measured. The prevalence of carotid plaques was similar in the retrospective and prospective studies and >64% in both unstable and stable coronary patients. The prevalence of complex, presumably unstable carotid plaques was 23.2% in unstable versus 3.2% in stable patients (P<0.001) in the retrospective study and 41.8% versus 8.0% (P=0.002) in the prospective study. C-reactive protein levels were higher in patients with complex (7.55 mg/L) than in those with simple (3.94 mg/L; P<0.05) plaques or without plaques (2.45 mg/L; P<0.05). On multivariate analysis, unstable angina and C-reactive protein levels >3 mg/L were independently associated with complex carotid plaques (OR, 6.09; 95% CI, 1.01 to 33.72; P=0.039, and OR, 5.80; 95% CI, 1.55 to 21.69; P=0.009, respectively). CONCLUSIONS: In unstable angina, plaque instability may not be confined to coronary arteries, and inflammation may be the common link with carotid plaque instability. These observations may have relevant implications for understanding the mechanisms of acute widespread atherothrombotic plaque inflammation.