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Background Overeating and obesity are elevated in children of parents who have undergone weight loss surgery. Parents who have undergone weight loss surgery often report their personal history of obesity interferes with their knowledge, skills, and self-efficacy in developing their children’s healthy habits, thus reducing the likelihood of addressing obesogenic environmental factors. Objectives This study examines whether a 6-session parent-based prevention after bariatric surgery online intervention is feasible and acceptable for parents. The study also explores the program’s signal of efficacy in improving short-term outcomes related to decreased long-term risks for obesity by examining short-term impact on targeted parental cognitions, feeding practices, and child eating behaviors and physical activity habits. Setting University Hospital, United States. Methods Parents were recruited using flyers, clinician referrals, and social media. Measures assessed parental feeding practices, children’s eating behaviors, daily hours of screen time, and outdoor play. Results Ten families enrolled and 7 completed the study. Parents found the intervention relevant and suitable for addressing their parenting concerns. Parental feeding behaviors, such as restriction and pressure to eat, reduced while tracking of sweets and high-fat snacks increased. Children reduced both emotional overeating and undereating. Children’s daily hours of screen time reduced as well as their outdoor play time. Conclusions Parent-based prevention after bariatric surgery aimed at helping parents who have undergone weight loss surgery engineer healthier family lifestyles is feasible, acceptable, and associated with reduced obesogenic risk factors.

The offspring of parents with obesity are at an increased risk of developing this condition themselves because of genetic and environmental factors. One subgroup that may be at particularly high risk of developing obesity is the offspring of parents who have undergone weight loss surgery (PWLS). To date, little research has focused on these offspring or their parents. This systematic review addresses this gap by integrating available literature and assessing the quality of the evidence. To be included, studies were required to have researched characteristics of the offspring of PWLS or parental feeding practices within this population. After review, 12 studies met inclusion criteria. Findings include evidence for heightened risk of obesity among children of PWLS. However, research suggests these children may experience positive, although time-limited, health outcomes after their parents' surgeries. Quality of the evidence was rated as low, primarily because of the lack of randomized controlled studies and information regarding available interventions specifically targeting this vulnerable population. This review underscores the need for research to improve understanding of PWLS families to better support them and capitalize on postbariatric surgery benefits.

Introduction: Prolonged duration of untreated psychosis (DUP) has long-term deleterious effects on outcomes. Research has focused on identifying factors contributing to prolonged DUP and initiative...

The remarkable success of SARS CoV-2 mRNA-based vaccines and the ensuing interest in mRNA vaccines and therapeutics have highlighted the need for a scalable clinical-enabling manufacturing process to produce such products, and robust analytical methods to demonstrate safety, potency, and purity. To date, production processes have either not been disclosed or are bench-scale in nature and cannot be readily adapted to clinical and commercial scale production. To address these needs, we have advanced an aqueous-based scalable process that is readily adaptable to GMP-compliant manufacturing, and developed the required analytical methods for product characterization, quality control release, and stability testing. We also have demonstrated the products produced at manufacturing scale under such approaches display good potency and protection in relevant animal models with mRNA products encoding both vaccine immunogens and antibodies. Finally, we discuss continued challenges in raw material identification, sourcing and supply, and the cold chain requirements for mRNA therapeutic and vaccine products. While ultimate solutions have yet to be elucidated, we discuss approaches that can be taken that are aligned with regulatory guidance.

The ways families approach eating, shape, and weight can result in stress for individual family members and challenge the overall functioning of the family. This is further complicated among families with a parent who has history of obesity or undergone weight loss surgery (WLS). Although WLS can positively impact other family members, it can also exacerbate conflicts regarding feeding and weight. Such conflicts can involve uncertainty regarding the extent to which the entire family should make the dietary changes recommended for the post-WLS parent. Conflict might also center on the appropriate level of concern regarding the children's risk of developing (or maintaining) obesity. This paper uses two case examples to describe the application of a specialized, time-limited intervention: Parent-Based Prevention following Bariatric Surgery (PBP-B). The program was developed to address the unique challenges and concerns that arise after, or are exacerbated by, WLS. Each detailed case example illustrates a common child-feeding challenge and the employment of key PBP-B strategies throughout the course of treatment. In the first case, the parent who had undergone WLS believed the family's current eating behaviors were the same as those that had led to her own overeating, obesity, and co-occurring psychiatric symptoms, while her husband disagreed. In the second case, both parents were concerned about their son's weight, yet due to their prior eating histories, they felt unable to construct boundaries around the feeding experience. Both cases follow families through the entire intervention and illustrate key points and challenges. These cases underscore the need for novel treatment modalities to support families following parental WLS.Las maneras en las que las familias abordan la alimentación, la figura y el peso pueden causar estrés en los integrantes individuales de la familia y poner a prueba el funcionamiento general de la familia. Esto es aun más complicado entre las familias con un padre que tiene antecedentes de obesidad o que se sometió a una cirugía para adelgazar. Aunque la cirugía para adelgazar puede repercutir de manera positiva en otros miembros de la familia, también puede exacerbar conflictos con respecto a la alimentación y al peso. Dichos conflictos pueden consistir en la incertidumbre con respecto al grado en el cual toda la familia debería hacer los cambios alimentarios recomendados para el padre que se ha operado para adelgazar. El conflicto también podría centrarse en el nivel adecuado de preocupación en relación con el riesgo de los niños de desarrollar (o mantener) la obesidad. Este artículo utiliza dos ejemplos de casos para describir la aplicación de una intervención especializada y limitada temporalmente: “La prevención basada en los padres después de una cirugía bariátrica” (Parent-Based Prevention following Bariatric Surgery, PBP-B). El programa se desarrolló para abordar los desafíos y las preocupaciones particulares que surgen después de la cirugía para adelgazar o que son exacerbados por esta. Cada ejemplo de un caso detallado ilustra un desafío común con respecto a la alimentación de los niños y al empleo de estrategias fundamentales de la PBP-B a lo largo del transcurso del tratamiento. En el primer caso, la madre que se había sometido a la cirugía para adelgazar creía que los comportamientos alimentarios actuales de la familia eran los mismos que los que la habían conducido a su propia sobreingesta, obesidad, y síntomas psiquiátricos concomitantes, mientras que su esposo no estaba de acuerdo. En el segundo caso, ambos padres estaban preocupados acerca del peso de su hijo, sin embargo, debido a sus antecedentes alimentarios previos, se sentían incapaces de establecer límites en torno a la experiencia alimentaria. Ambos casos siguen a las familias durante toda la intervención e ilustran puntos clave y desafíos. Estos casos subrayan la necesidad de incorporar modalidades innovadoras de tratamiento orientadas a apoyar a las familias después de la cirugía para adelgazar de uno de los padres.一个家庭对待饮食、体形和体重的方式会对家中某单个家庭成员带来一定的压力，并挑战该家庭的整体运作。对于父母中曾有肥胖病史或进行过减肥手术（WLS）的家庭而言，情况则更加复杂。尽管WLS可以对其他家庭成员产生积极的影响，但也可能加剧在喂养和体重方面的矛盾。此类冲突可能涉及为了遵循给WLS后的父母推荐的饮食，整个家庭应在多大程度上相应调整改变的不确定性。冲突也可能集中有关对儿童患肥胖症（或维持肥胖症）的风险的适当关注上。本文使用两个案例来描述专门的限时干预措施的应用：减肥手术后基于父母的预防（PBP-B）。该程序的开发主要是针对解决在进行WLS之后出现的或者加剧的独特挑战和特殊问题。每个详细的病例示例都说明了常见的儿童喂养方面的挑战以及在整个治疗过程中如何采用关键的PBP-B策略。在第一种情况下，经历过WLS的母亲认为家庭目前的饮食行为与导致自己暴饮暴食、肥胖和与此同时出现的精神病症状的行为相同，而她的丈夫则不同意。在第二种情况下，父母双方都担心自己儿子的体重，但是由于他们以前的饮食历史，他们感到无法在喂养经历周围建立边界。这两个案例跟踪了在整个干预过程中的家庭表现，并阐明一些关键点和难点。这些病例强调需要新的治疗手段来支持父母做过WLS后的家庭。.

Introduction High numbers of dental emergencies (DE) in military service members (approximately 15% per annum) prompted the inclusion of Dental Readiness as one of six conditions that determine service members’ Individual Medical Readiness (IMR). Additionally, even with the advances in body armor and helmet design, Cranio- and Oral-maxillofacial (CMF, OMF) injuries continue to occur in hostile environments. The objectives of this report are (1) to provide a comprehensive review of the incidence of DE and CMF/OMF injuries in US military personnel deployed in multiple environments and (2) to compare the rates of DE and CMF/OMF injuries occurring in the 20th century with the rates observed in the early 21st century. Materials and Methods Published and unpublished studies, as well as military reports of DE, OMF, and CMF injuries occurring in US military personnel were evaluated. Study publication dates included 1955 to 2017, with data collection periods from 1941 through 2014. Results The results of 30 investigations were reviewed. Overall, the reported annual DE rates varied widely among US military personnel between 1966 and 2012, ranging from 26 to 324 (mean 152.2) DE per 1,000 personnel per year (PPY). The average annual incidence of DE for personnel in hostile environments was 125.1 per 1,000 PPY. Thirteen studies reported rates of OMF-CMF injuries from 1941 to 2014. The overall mean OMF injury rate in Operation Enduring Freedom (OEF) was 2.8 per 1,000 PPY, while the mean rate during Operation Iraqi Freedom (OIF)/Operation New Dawn (OND) was 3.2 per 1,000 PPY. A mean of 22.3 CMF injuries per 1,000 PPY was calculated from two reports during OIF. Conclusions The percentage of DE and OMF casualties that can be expected in hostile environments is approximately 12%. Using the most recent data since 2000, the mean DE rate was 118.2 per 1,000 PPY and the OMF rate was 3.0 per 1,000 PPY. Future research should yield information which is representative of the evolving military environment. This information should be used to enhance military-specific dental therapies and to guide protection of the craniofacial region. More importantly, quality data are necessary (1) to enable the accurate prediction of DE, CMF, and OMF casualties to insure that troop levels are sufficient for mission success and (2) to insure that all outcome variables are available to measure policy success or failure.

Background Cancer patients are at increased risk of death from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Cancer and its treatment affect many haematological and biochemical parameters, therefore we analysed these prior to and during coronavirus disease 2019 (COVID-19) and correlated them with outcome. Patients and methods Consecutive patients with cancer testing positive for SARS-CoV-2 in centres throughout the United Kingdom were identified and entered into a database following local governance approval. Clinical and longitudinal laboratory data were extracted from patient records. Data were analysed using Mann–Whitney U test, Fisher's exact test, Wilcoxon signed rank test, logistic regression, or linear regression for outcomes. Hierarchical clustering of heatmaps was performed using Ward's method. Results In total, 302 patients were included in three cohorts: Manchester (n = 67), Liverpool (n = 62), and UK (n = 173). In the entire cohort (N = 302), median age was 69 (range 19-93 years), including 163 males and 139 females; of these, 216 were diagnosed with a solid tumour and 86 with a haematological cancer. Preinfection lymphopaenia, neutropaenia and lactate dehydrogenase (LDH) were not associated with oxygen requirement (O2) or death. Lymphocyte count (P < 0.001), platelet count (P = 0.03), LDH (P < 0.0001) and albumin (P < 0.0001) significantly changed from preinfection to during infection. High rather than low neutrophils at day 0 (P = 0.007), higher maximal neutrophils during COVID-19 (P = 0.026) and higher neutrophil-to-lymphocyte ratio (NLR; P = 0.01) were associated with death. In multivariable analysis, age (P = 0.002), haematological cancer (P = 0.034), C-reactive protein (P = 0.004), NLR (P = 0.036) and albumin (P = 0.02) at day 0 were significant predictors of death. In the Manchester/Liverpool cohort 30 patients have restarted therapy following COVID-19, with no additional complications requiring readmission. Conclusion Preinfection biochemical/haematological parameters were not associated with worse outcome in cancer patients. Restarting treatment following COVID-19 was not associated with additional complications. Neutropaenia due to cancer/treatment is not associated with COVID-19 mortality. Cancer therapy, particularly in patients with solid tumours, need not be delayed or omitted due to concerns that treatment itself increases COVID-19 severity., Highlights • Pre-infection haematological/biochemical characteristics are not associated with COVID-19 severity. • Significant haematological/biochemical changes occur upon infection with heterogeneity in response observed. • High not low neutrophils were associated with oxygen requirement and COVID-19 mortality – GCSF should be used with caution. Age, haematological cancer, high neutrophil:lymphocyte ratio, CRP and low albumin were significant predictors of death in multivariable analysis. No significant complications requiring readmission were seen upon restart of cancer therapy following diagnosis of COVID-19.

To provide a comparative analysis of short-term outcomes after open, laparoscopic, and robotic-assisted (RAS) ventral incisional hernia (VIH) repairs that include subject-reported pain medication usage and hernia-related quality of life (QOL).Subjects were ≥ 18 years old and underwent elective open, laparoscopic or RAS VIH repair without myofascial release. Perioperative clinical outcomes through 30 days were analyzed as were prescription pain medication use and subject-reported responses to the HerQLes Abdominal QOL questionnaire. Observed differences in baseline characteristics were controlled using a weighted propensity score analysis to obviate potential selection bias (inverse probability of treatment weighting, IPTW). A p value 0.05 was considered statistically significant.Three hundred and seventy-one subjects (RAS, n = 159; open, n = 130; laparoscopic, n = 82) were enrolled in the study across 17 medical institutions within the United States. Operative times were significantly different between the RAS and laparoscopic groups (126.2 vs 57.2, respectively; p 0.001). Mean length of stay was comparable for RAS vs laparoscopic (1.4 ± 1.0 vs 1.4 ± 1.1, respectively; p = 0.623) and differed for the RAS vs open groups (1.4 ± 1.0 vs 2.0 ± 1.9, respectively; p 0.001). Conversion rates differed between RAS and laparoscopic groups (0.6% vs 4.9%; p = 0.004). The number of subjects reporting the need to take prescription pain medication through the 2-4 weeks visit differed between RAS vs open (65.2% vs 79.8%; p 0.001) and RAS vs laparoscopic (65.2% vs 78.75%; p 0.001). For those taking prescription pain medication, the mean number of pills taken was comparable for RAS vs open (23.3 vs 20.4; p = 0.079) and RAS vs laparoscopic (23.3 vs 23.3; p = 0.786). Times to return to normal activities and to work, complication rates and HerQLes QOL scores were comparable for the RAS vs open and RAS vs laparoscopic groups. The reoperation rate within 30 days post-procedure was comparable for RAS vs laparoscopic (0.6% vs 0%; p = 0.296) and differed for RAS vs open (0.6% vs 3.1%; p = 0.038).Short-term outcomes indicate that open, laparoscopic, and robotic-assisted approaches are effective surgical approaches to VIH repair; however, each repair technique may demonstrate advantages in terms of clinical outcomes. Observed differences in the RAS vs laparoscopic comparison are longer operative time and lower conversion rate in the RAS group. Observed differences in the RAS vs open comparison are shorter LOS and lower reoperation rate through 30 days in the RAS group. The operative time in the RAS vs open comparison is similar. The number of subjects requiring the use of prescription pain medication favored the RAS group in both comparisons; however, among subjects reporting a need for pain medication, there was no difference in the number of prescription pain medication pills taken. While the study adds to the body of evidence evaluating the open, laparoscopic, and RAS approaches, future controlled studies are needed to better understand pain and QOL outcomes related to incisional hernia repair.ClinicalTrials.gov identifier: NCT02715622.

Growth of mammalian cells in the production of biotherapeutics often require the benefits of chemically defined media (CDM). Storage, handling and stability advantages of CDM powders govern the preponderance of their use across the industry. Physico-chemical property lot-to-lot variation of these multicomponent powders, however, continues to be a challenge. Process imposed degradation of amino acids and vitamins, for example, can influence cell density, specific titer, and the quality profile of the molecule expressed due to the lack of process understanding and suitable mitigation controls. Such degradation can materialize in either their manufacture or in downstream media dissolution steps. Colorimetry, in lieu of visual appearance, can be an effective surveillance method for the direct assessment of CDM quality as color change is indicative of chemical-physical variations. This work describes a series of studies aimed to establish relationships between quantitative color change and physico-chemical attribute variation of glucose-free and glucose-based powders. The results illustrate color change is indicative of amino acid glycation, vitamin degradation and particle size shifts. These relationships enable a colorimetric control strategy for the sensitive and rapid detection of relevant CDM variation to drive additional targeted assessments to improve the productivity and robustness of cell culture processes.

The current paradigm for raw material control in the biopharmaceutical industry remains a combination of compendial tests, function-based test and engineering controls. Moreover, ad hoc scale-down process studies remain the de facto approach to understand raw material variation challenges. The biopharmaceutical industry, however, continues to experience the impact of raw material variation are current approaches are insufficient to assess key raw material attributes. Here we review the current state of raw material variation and its biopharmaceutical impact along with analytical methods optimized for raw material characterization. A systematic raw material characterization and control strategy is then outlined as an integrated approach to address cell culture raw material variation challenges. This comprehensive long-term approach can be applied throughout the biopharmaceutical manufacturing process and across further modalities such as small molecules, proteins, and other cellular therapies.

Introduction Computer-aided design/computer-aided manufacturing (CAD/CAM) has gained increasing popularity since the first commercially viable dental system was introduced in the mid-1980s. Digitally milled dental restorations can be fabricated chairside in the course of one dental appointment, reducing time, cost, and manpower when compared with traditional laboratory-fabricated analog restorations. Clinical performance, physical properties, and esthetics of digital restorations have been shown to be comparable to traditional analog restorations. The Navy has incorporated CAD/CAM systems into dental clinics on multiple platforms to include ships. The efficiency of this technology has the potential to positively impact dental health and mission readiness. The objective of the present study was to evaluate placement rates of CAD/CAM restorations by Navy dental providers. Materials and methods Placement rates of CAD/CAM restorations from October 2011 to June 2017 (Department of Defense created codes specific to CAD/CAM restorations in 2011) and of laboratory-fabricated analog restorations from January 2008 to June 2017 were queried from the Dental Common Access System (DENCAS) and Corporate Dental Access system (CDA) and evaluated. Scatterplots for each dental restoration category were generated using monthly production data and overlaid with simple linear regression lines and 95% confidence intervals. Regression analysis was performed to determine whether changes in the monthly percentages of placements before and after CAD/CAM were increasing or decreasing and to determine whether the monthly percent change from before CAD/CAM implementation and after CAD/CAM implementation was significantly different from one another. Results A total of 20,512 CAD/CAM restorations were placed by Navy providers over the 68-month period. A year-over-year increase in digitally fabricated restorations was observed. As a percentage of total indirect restorations, CAD/CAM units surged from 13.8% in 2012 to 38.1% in 2017. All ceramic restorations fabricated by the classical analog method also increased significantly through the period. Traditional analog porcelain fused to metal (PFM) restorations and large amalgam restorations, which frequently serve a similar clinical purpose as indirect or direct full or partial tooth coverage restorations, both decreased significantly after CAD/CAM productivity tracking was initiated. Conclusions Implementation of CAD/CAM digital restorations has led to a significant decline in specific traditional analog procedures since productivity tracking of CAD/CAM was initiated in 2011. Navy dentistry has embraced CAD/CAM as an efficient means to prepare sailors and marines for deployments, improve operational dental readiness, and potentially decrease dental emergencies by reducing the need for provisional restorations. The trend toward increased utilization of digital dentistry is expected to continue for the following reasons: (1) incorporation of CAD/CAM technology into dental school curricula, (2) advancement of CAD/CAM systems equipped with fast-evolving user interfaces, (3) increased accessibility to CAD/CAM technology in Navy clinics, and (4) training of a greater proportion of dentists in digital CAD/CAM technology. Future studies should investigate the survival rate of CAD/CAM restorations placed within military settings, cost, and manpower of maintaining CAD/CAM units, and impact on military dental laboratories associated with increased CAD/CAM usage.

To evaluate and compare peri-operative outcomes through 30 days, including pain and quality of life (QOL) through 3 months across three cohorts of inguinal hernia repair (IHR) patients (robotic-assisted, laparoscopic, and open IHR). The Prospective Hernia Study is an ongoing, multicenter, comparative, open-label analysis of clinical and patient-reported outcomes from robotic-assisted surgery (RAS) versus open and RAS versus laparoscopic IHR procedures. Patient responses to the Carolinas Comfort Scale (CCS) questionnaire provided QOL outcomes. 504 enrolled patients underwent unilateral or bilateral IHR (RAS, n = 159; open, n = 190; laparoscopic, n = 155) at 17 medical institutions from May 2016 through December 2018. Propensity score matching provided a balanced comparison: RAS versus open (n = 112 each) and RAS versus laparoscopic (n = 80 each). Overall, operative times were significantly different between the RAS and laparoscopic cases (83 vs. 65 min; p

A fast, reproducible, non-destructive method to confirm raw material identification in real-time upon material receipt within a warehouse environment is desired. Current practices in pharmaceutical manufacturing often employ compendia methods for raw material identification tests, which require sample preparation prior to time-consuming chemical analysis and often employ subjective spectral comparisons. We have developed, qualified, and validated a rapid objective identity method ("Rapid ID") by Raman spectroscopy using the Bruker BRAVO handheld Raman spectrometer for 46 common raw materials used in upstream and downstream biopharmaceutical cell culture-based processes. Materials in the Raman identification library include amino acids and other solid neat organic chemicals, liquid organics, polyatomic salts, polymers, emulsifiers, peptides, aqueous solutions, and buffers. Selection of reference spectra and hit quality index limit(s) was based upon a comprehensive spectral survey across multiple suppliers and lots to account for normal cause spectral variation. Method repeatability and reproducibility, selectivity, and robustness against various operational and environmental factors (e.g., instrumental variance, material packaging, and thermal effects) were evaluated. Benefits of a handheld Raman Rapid ID approach include significant reduction of the time for raw material quality release from weeks to minutes, enhanced objectivity, and robust data integrity via autonomous electronic reporting. In addition, routine collection of rich spectroscopic data on raw materials can be leveraged to support further continuous improvement initiatives, including routine monitoring of method performance, continuous improvement of the library, proactive detection of shifts in raw material properties, and provision of data for investigations focused on raw materials. Rapid ID methods are consistent with the move toward the principles of Pharma 4.0-high automated processes with continuous process verification and a holistic control strategy.

Finding sustainable and commercially viable sources of occlusive materials, as an alternative to petroleum, is of great interest. Inspired by the fundamental role of long chain fatty acids in maintaining skin barrier, ultralong fatty acyl derivatives with diverse structures (varied acyl chain length and different polar head; i.e. glycerol, ethylene glycol, and diethylene glycol) were synthesized. These molecules can be feasibly obtained via enzymatic esterification of fatty acids or fractionated from commercial glycerides mixture via short path distillation. The molecular packing behaviors of compounds were characterized via differential scanning calorimetry, Fourier transform infrared, and Langmuir isotherm measurements. The structure–property relationship study reveals that a glycerol molecule monoacylated with an ultralong fatty acyl is the derivative which entails the most occlusive properties of the series of ultralong chain fatty acid derivatives. Fast Fourier transform filtering (FFTF) analysis of ...

Many rabbits show fear behaviours when lifted off the ground. Estimates from owner surveys suggest that around 60% of pet rabbits struggle when lifted and fear-related aggression is common. This article integrates information from both laboratory and pet rabbit studies to formulate a list of recommendations for appropriate handling of rabbits. Reduction of the frequency of the stressor can be achieved by educating owners on alternative management practices to reduce the need to carry their rabbits. However, in some situations, it is unavoidable that a rabbit is lifted. Amelioration of the stress in these instances can be achieved by a 2 pronged strategy. First, the population of rabbits can be made more resilient to infrequent stressors by selectively breeding for confident rabbits and by better socialisation of unweaned kits, and, where possible, training of individual animals to permit handling. Secondly, any unavoidable lifting can be made less stressful by educating veterinary staff in appropriate methods of holding rabbits during both consultations and inpatient care. Better understanding of appropriate interactions with rabbits will improve welfare.

Background: Patients (pts) with cancer are at increased risk of severe COVID-19 infection and death Due to the heterogeneity of manifestations of COVID-19, accurate assessment of patients presenting to hospital is crucial Early identification of pts who are likely to deteriorate allows timely discussions regarding escalation of care It is equally important to identify pts who could be safely managed at home To aid clinical decision making, we developed a model to determine which pts should be admitted vs discharged at presentation to hospital Methods: Consecutive pts with solid or haematological malignancies presenting with symptoms who tested positive for SARS-CoV-2 at 10 UK hospitals from March-May 2020 were identified following institutional board approval Clinical and laboratory data were extracted from pt records Clinical outcome measures were discharge within 24 hours, requirement for oxygen at any stage during admission and death The associations between clinical features and outcomes were examined using ANOVA or Chi-squared tests A logistic model was developed using clinical features with p0 8) Using haematological cancer, NEWS2 score, dyspnoea, CRP and albumin, the model predicted requirement for admission with an area under the curve of 0 88 [Formula presented] Conclusions: We have developed a model to predict which pts require hospital admission Further refinement and validation in larger cohorts of pts will be presented Legal entity responsible for the study: The Christie NHS Foundation Trust Funding: Has not received any funding Disclosure: R Lee: Honoraria (self): Bristol Myers Squibb;Honoraria (self): Astra Zeneca;Research grant/Funding (institution): Bristol Myers Squibb M P Rowe: Travel/Accommodation/Expenses: Astellas Pharma L Horsley: Travel/Accommodation/Expenses: Lilly C Wilson: Honoraria (self), Advisory/Consultancy, Speaker Bureau/Expert testimony: Pfizer;Amgen;Novartis T Cooksley: Speaker Bureau/Expert testimony: Bristol Myers Squibb A Armstrong: Shareholder/Stockholder/Stock options, husband had shares now sold: Astra Zeneca All other authors have declared no conflicts of interest

Improved exploration strategies for the oil and gas fields involve high temperatures and pressures. This may induce Thermochemical Sulfate Reduction (TSR) risks. TSR is a complex succession of redox reactions that occur in deeply buried anhydrite-rich carbonate reservoirs under high temperatures. Such reactions lead to the formation of a high amount of H2S (toxic and corrosive gas) and a decrease in the quality of the hydrocarbons due to their oxidation. A new basin-scale approach was developed to compute a TSR risk index and, to assess the spatial distribution of H2S. The produced H2S can then be either dissolved in the formation water or released as a free gas phase. These two possibilities have been integrated into the TemisFlow™ software and were successfully applied to the Western Canadian Sedimentary Basin (WCSB). The Devonian carbonate reservoirs of WSCB are known to have experienced TSR reactions, some of them containing up to 30% of H2S. The obtained numerical results show high TSRI values for the Devonian petroleum system. These values increase with the burial associated to the Laramide orogeny. Our results are in agreement with the petrography analyses. Given our simulation criteria, the order of magnitude of average simulated H2S masses is the same as the one reported by Machel (2005).

PREMISE OF THE STUDY The persistence of rare and endangered plant species may depend on the distance pollinators travel when dispersing pollen. Pollinations between adjacent plants, which are often genetically similar, can decrease seed set, germination, and/or progeny vigor due to shared S-alleles or inbreeding depression. Interpopulation pollen dispersal is often suggested as a management tool to increase genetic diversity; however, long-distance pollinations also have the potential to decrease fitness. METHODS We performed experimental hand pollinations in the field and germination experiments in a growth chamber to determine the effect of intrapopulation pollination distance (1 m, 10 m, and 100 m) on seed set, seed germination, progeny growth, and progeny reproduction in Phlox hirsuta. In addition, we included interpopulation pollinations (6740 m) to determine whether artificial gene flow is a viable management option for this endangered species. KEY RESULTS Although pollination distance did not affect the number of healthy seeds produced or the likelihood of radicle emergence, it did significantly affect the ability of germinating seeds to successfully produce cotyledons. Outbreeding depression was observed during seed germination and early seedling development. Seedlings resulting from interpopulation pollinations developed more slowly and were less likely to survive to produce cotyledons than seedlings resulting from all three intrapopulation pollination distances. CONCLUSIONS Our results suggest that the success of P. hirsuta does not depend on the distance pollinators travel within populations and that conservation strategies that involve transporting genes between populations can be counterproductive.

Background Few studies have examined the causes or mechanisms of oral-maxillofacial (OMF) injury among deployed military populations. This study reports causes of OMF injuries to U.S. Department of Defense personnel deployed to Afghanistan in Operation Enduring Freedom (OEF) or to Iraq in Operation Iraqi Freedom (OIF) and Operation New Dawn (OND). This study provides follow-on analysis of a previous report of OMF injury rates among U.S. military personnel in Iraq and Afghanistan from 2001 to 2014. Methods The populations studied were military personnel deployed to Afghanistan in OEF or Iraq in OIF and OND, who sought care at a level III military treatment facility for one or more OMF injuries. Injuries were identified in the Department of Defense Trauma Registry using diagnosis codes associated with OMF battle and non-battle injuries. Causes associated with these injuries were identified by evaluation of the data field "dominant injury mechanism." All OMF injuries incurred from October 19, 2001, to June 30, 2014, were included. Findings/Results Approximately 89% of all OMF battle injuries in both OIF/OND and OEF were due to explosives or explosive devices. The three leading causes of OMF non-battle injuries for both OIF/OND and OEF were motor vehicle crashes/accidents (MVCs), falls, and "other blunt" trauma. MVCs as well as other blunt trauma accounted for a greater percentage of OMF non-battle injuries in OIF/OND than in OEF (p < 0.01). OMF non-battle injuries due to falls were more likely to occur in OEF (p = 0.05). Helicopter/plane crashes were responsible for a significantly higher percentage of OMF non-battle injuries in OEF compared with OIF/OND (p < 0.01). Discussion/Impact/Recommendations Across both theaters of war, Iraq and Afghanistan, the main causes of OMF battle and non-battle injuries were consistent. Battle injuries were primarily due to explosives or explosive devices and the three main causes of non-battle injuries were MVCs, falls, and other blunt trauma. However, the distribution of causes differed by war theater. Future studies should focus on potential reasons for cause distribution disparities in MVCs and helicopter/plane crashes as they can only be partially explained by topography and infrastructure differences between Iraq and Afghanistan. Further surveillance is needed to understand the scope of OMF injuries in military-armed conflicts and operations.

To compare the perioperative outcomes of initial, consecutive robotic-assisted transabdominal preperitoneal (R-TAPP) inguinal hernia repair (IHR) cases with consecutive open cases completed by the same surgeons. Multicenter, retrospective, comparative study of perioperative results from open and robotic IHR using standard univariate and multivariate regression analyses for propensity score matched (1:1) cohorts. Seven general surgeons at six institutions contributed 602 consecutive open IHR and 652 consecutive R-TAPP IHR cases. Baseline patient characteristics in the unmatched groups were similar with the exception of previous abdominal surgery and all baseline characteristics were comparable in the matched cohorts. In matched analyses, postoperative complications prior to discharge were comparable. However, from post discharge through 30 days, fewer patients experienced complications in the R-TAPP group than in the open group [4.3% vs 7.7% (p = 0.047)]. The R-TAPP group had no reoperations post discharge through 30 days of follow-up compared with five patients (1.1%) in the open group (p = 0.062), respectively. Multivariate logistic regression analysis which demonstrated patient age > 65 years and the open approach were risk factors for complications within 30 days post discharge in the matched group [age > 65 years: odds ratio (OR) = 3.33 (95% CI 1.89, 5.87; p

Poloxamer P188 is a common nonionic surfactant additive used in cell culture media as a cellular protectant from the hydrodynamic forces and shear stress during bioprocessing. Presence of a hydrophobic high molecular weight impurity contaminant has been shown to compromise its protective properties and lead to batch failure. In this work we present, a reliable, sensitive, and rapid analytical method to detect and quantify the contaminant impurity in poloxamer 188. This method replaces a laborious and time-consuming functional test in the form of a shake flask assay. The method is based upon reversed-phase liquid chromatography with charged aerosol detection, simple mobile phase compositions, and a three-step gradient. The method was optimized to resolve the impurity from the main P188 fraction in less than 10 min. Analytical method qualification and functional test comparison demonstrate equivalent or better high throughput impurity screening performance. Attempts to identify the impurity and establish suitable method positive control standards are also discussed.

Objective The focus of this communication is the study of phospholipid structured-emulsions whose phase behavior is modified with monoalkyl fatty amphiphiles. Ideally these systems would mimic key physical and structural attributes observed in human stratum corneum (SC)7 so that they better alleviate xerotic skin conditions. Methods Phosphatidylcholine structured emulsions were prepared and their phase behavior modified with monoalkyl fatty amphiphiles. The effect of molecular volume, acyl chain length and head-group interactions was studied using a combination of physical methods. Water Vapor Transmission Rate (WVTR) was used as a primary test to assess occlusive character. Changes in the vibrational modes observed in Fourier transform infra-red (FTIR) spectroscopy and bilayer spacing measured by X-Ray Diffraction (XRD) were then applied to elucidate the lateral and lamellar micro-structural characteristics in the systems.28,29 Results WVTR demonstrated that as the phosphatidylcholine acyl chain length increased from C14, to C18, to C22 there was a corresponding increase in occlusive character. The addition of monoalkyl fatty amphiphiles such as behenic acid, behenyl alcohol or cetostearyl alcohol to a base formulation incorporating distearylphosphatidylcholine (C18) were seen to further increase barrier characteristics of the emulsions. FTIR methods used to probe lipid chain conformational ordering demonstrated that as phosphatidylcholine acyl chain lengths increased there was a corresponding improvement in acyl chain ordering, with an increase in thermal transition temperatures. The addition of a monoalkyl fatty amphiphile resulted in conformational order and thermal transition temperatures improvements trending towards those observed in stratum corneum. FTIR also demonstrated that systems containing behenic acid or behenyl alcohol exhibited features associated with orthorhombic character. X-Ray Diffraction data showed that addition of monoalkyl fatty amphiphile also resulted in thicker lamellar structures than when those agents are not present. Conclusion The generalized approach described herein is shown to mechanistically describe the occlusive character of phospholipid-structured formulations in the presence of long chain fatty acids or alcohols and that they exhibit characteristics mimicking those found in human SC lipids. This article is protected by copyright. All rights reserved.

A compact and portable LED array-based fluorescence sensor for rapid real-time monitoring is described. The intensity-based sensing scheme is equipped with an array of LEDs to exploit the optical power “fluorescence advantage”. This dynamic excitation control broadens the detection capacity and provides tailored detection capabilities required for process manufacturing and field (environmental) applications. Each sensor contains a specific energy LED array and a suitable emission filter for the target native fluorophore of interest. Excitation parameter effects on the emission signal behavior, fundamental response functions, and standard analytical merits (sensitivity, detection limits, etc.) are discussed to highlight and benchmark the unique capabilities of this new sensor technology. Integrated smart sensing capabilities such as incident excitation source referencing and other complementary transducers (e.g., temperature and position) are also discussed within the context of modern real-time intrinsic fluorometry applications.

Summary Background: The majority of individuals with major depressive disorder are diagnosed and treated in the primary-care setting. A quantifiable critical objective in the management of depression is to achieve and sustain full symptomatic remission. The HAMD-7 is a depression metric validated in both tertiary and primary-care settings. Methods: Herein, we further characterise the psychometric properties of the HAMD-7 in depressed patients treated in primary-care settings. Several cut-scores were evaluated for maximum agreement; diagnostic efficacy statistics with the original HAMD-7 items were also evaluated. We compared performance of the HAMD-7 in primary care to a previously characterised tertiary sample. Results: The depressive symptoms most frequently endorsed (≥ 70%) and most sensitive to change during antidepressant treatment in depressed primary-care patients were depressed mood, guilt, work and activities, psychic and somatic anxiety and fatigue. Limitations: This is a post hoc analysis of a primary-care database; assumptions regarding the definition of symptomatic remission in depression affect interpretation. Conclusion: Measurement-based care with the HAMD-7 quantifies the severity of commonly reported depressive items and their responsivity to treatment. The HAMD-7, inclusive of the suicide item, is capable of tracking symptom progress, with a validated remission cut-score.

Many rabbits show fear behaviours when lifted off the ground. Estimates from owner surveys suggest that around 60% of pet rabbits struggle when lifted and fear-related aggression is common. This article integrates information from both laboratory and pet rabbit studies to formulate a list of recommendations for appropriate handling of rabbits. Reduction of the frequency of the stressor can be achieved by educating owners on alternative management practices to reduce the need to carry their rabbits. However, in some situations, it is unavoidable that a rabbit is lifted. Amelioration of the stress in these instances can be achieved by a 2 pronged strategy. First, the population of rabbits can be made more resilient to infrequent stressors by selectively breeding for confident rabbits and by better socialisation of unweaned kits, and, where possible, training of individual animals to permit handling. Secondly, any unavoidable lifting can be made less stressful by educating veterinary staff in appropriate methods of holding rabbits during both consultations and inpatient care. Better understanding of appropriate interactions with rabbits will improve welfare.

Background: Assessments of personality constructs increasingly use self-report and structured interview instruments, which allow for a multimethod measurement approach and decrease specific measurement method bias. The aim of this study was to develop a valid and reliable structured interview for assessing the alexithymia construct. Methods: Sixty interview questions were written initially, each with a set of scoring criteria and prompts and probes to elicit information assisting in the scoring of the respondents’ answers. Results: After pilot testing, the number of questions was reduced to 43, which were administered to 136 community participants and 97 psychiatric outpatients. A series of item and scale analyses further reduced the item pool to 24 items. Principal component analysis and confirmatory factor analysis of these 24 items revealed preliminary evidence of a hierarchical, four-factor structure, with four lower factors nested within two higher-order latent factors. This structural configuration resulted in the Toronto Structured Interview for Alexithymia (TSIA) with two domain scales and four facet scales. The TSIA and its six scales demonstrated acceptable levels of interrater, internal, and retest reliability. The TSIA and its scales correlated modestly but significantly with the 20-item Toronto Alexithymia Scale and its three factor scales, providing some support for the concurrent validity of this interview. Conclusion: The TSIA appears to be a promising structured interview for assessing alexithymia.

Background: Many factors, including personal experience and personality traits, contribute to the emotional difficulties that psychiatrists experience in their professional work. The nature of the work itself also plays a significant role. Objective: To determine those personal and professional characteristics that predict satisfaction with the practice of psychiatry. Method: We mailed a questionnaire that included items pertaining to aspects of personal and professional life to the entire population of psychiatrists in Ontario (N = 1574). Results: Of the 1574, 52% (n = 802) responded. We conducted a series of regression analyses to determine factors related to career satisfaction or regret. A belief in the intrinsic value of psychiatry, a low perceived degree of emotional burden from patients, financial success, and satisfaction with psychotherapeutic work emerged consistently as significant predictors. A subsequent discriminant function analysis indicated that all 4 of these variables accurately predicted those psychiatrists with extreme satisfaction or dissatisfaction with work. Conclusions: These results reveal several variables associated with career satisfaction in the practice of psychiatry that might be useful to discuss with residents who are beginning their careers. (Can J Psychiatry 2005;50:333-341) Information on author affiliations appears at the end of the article. Clinical Implications * Several variables accurately predicted psychiatrists who experience extreme satisfaction or dissatisfaction with work. Limitations * The study was limited to psychiatrists in Ontario. * The evaluation was cross-sectional. * We collected self-report data only. Key Words: career satisfaction, professional practice characteristics, emotional vulnerability Psychiatrists are known to be at risk for depression, anxiety, and burnout (1-4). The perceived stress associated with the practice of psychiatry is a factor in dissuading medical students of different cultural backgrounds from choosing psychiatry as a specialty (5). Many factors-including experience and personality traits-contribute to the emotional difficulties that psychiatrists experience (6). The nature of the work itself, however, clearly contributes further. The emotional burden of treating very ill patients, the relative isolation of the work, and an inability to balance personal and professional lives all play an important role. Recent studies from the US have also related career dissatisfaction to changing practice patterns, reimbursement, managed care, and increased competition from nonphysician mental health professionals (7-9). Nevertheless, psychiatrists also experience tremendous satisfaction in caring for others. There is now an expanded therapeutic armamentarium that includes evidence-based psychotherapies and newly developed medications, which affords a greater probability of treatment success. To possess the ability and perseverance necessary to successfully treat patients in serious emotional distress is for many psychiatrists intrinsically rewarding. Recently, using data from a survey of over 600 physicians, Sturm found that only 21.2% of psychiatrists in his sample reported being dissatisfied with their careers (10). Similar rates were found among a cohort of Dutch psychiatrists (11). Dissatisfaction in this cohort was predicted by feeling poorly managed and resourced, feeling devalued, and feeling a lack of intellectual stimulation, as well as by poor communicative responsiveness and social support from colleagues. An earlier report on another cohort of psychiatrists that the first author has been following for more than 20 years (12) found that personal satisfaction and external measures of career success were related to personality traits and to attributes associated with the psychiatrists' personal and professional lives. These findings, however, were based on a small sample of psychiatrists who graduated from their residency programs in the 1970s and were followed longitudinally, limiting the generalizability of the results. …

Objective: The authors investigated the impact of patient suicides on trainees and psychiatrists and their utilization of supports. Methods: Graduates in practice and trainees of the residency program of the University of Toronto from 1980–1995 (N = 495) were surveyed, retrospectively, with 239/495responding (48%). Demographic and educational information, exposure to suicide, impact of the suicide(s), use of support systems, acute stress disorder and posttraumatic stress disorder symptoms, and impact of events and social relationship scores were collected. Results: One-half of the respondents (120/239) experienced at least one suicide of a patient, 62% of them (74/120) during postgraduate training. Biologically oriented psychiatrists in practice were more at risk for patient suicide. An important minority (one-quarter) among those who experienced patient suicide had substantially higher (morbid) scores than the overall group. They also scored higher on an acute stress disorder and a posttraumatic stress disorder symptom checklist. The impact was more severe when the patient suicide occurred during training than after graduation and was inversely correlated with clinicians’ perceived social integration into their relational professional network. Conclusions: The experience of patient suicide is common during training and in clinical practice. The majority of trainees and clinicians are able to cope normally with the trauma, but in an important minority the emotional impact approaches morbid levels. Training programs should prepare students for this occupational hazard and implement systematic protocols to support those trainees who are especially vulnerable to their patient’s suicide and reduce their social isolation from their peer group. Formal and informal professional networks should heighten awareness of the impact of patient suicide on practicing colleagues and take adequate measures to support them.

The neutering of pet rabbits has become more common in recent years due to recognition of the importance of species-specific social contact and the perceived risk of reproductive malignancies in unspayed older females. Here, GUEN BRADBURY: and GREG DICKENS: argue that the benefits of neutering singly housed rabbits (still the majority in the UK) may not outweigh the adverse effects of the procedure.

Background: Few studies have examined the predictors of psychiatrists' perceived success and personal satisfaction with their careers. The present study examines self-reported success and personal satisfaction with their careers in a cohort of psychiatrists followed for more than 20 years. Methods: A total of 29 psychiatrists, all of whom had participated in a study during their residency 21 to 24 years earlier, completed a self-report questionnaire. The first set of questions addressed the type and characteristics of their professional practice; the second set assessed aspects of their nonprofessional practice; and the third set assessed aspects of their nonprofessional, personal lifestyles. The personality traits of neuroticism and extraversion were assessed during the residency years and were used as predictors. Composite measures of self-perceived external success and personal satisfaction were computed. Regression models were constructed to determine the best predictors of these composite measures. Results: Neuroticism proved to be a significant predictor of external success but not of personal satisfaction, with higher scores predicting a lower rating of perceived external success. There were 2 practice characteristics—involvement with research and practising from an orientation other than psychoanalytic—that predicted perception of success. One personal lifestyle characteristic—the perception that one's nonprofessional life sustained professional life—also predicted perception of success. The best predictor of personal satisfaction was overall satisfaction with nonprofessional aspects of life. Conclusions: Personality, nonprofessional social support, and engaging in research are associated with greater perceived success and personal satisfaction with a career in psychiatry.

In order to clarify the formation mechanisms of ethylene oxide (cyclic-C2H4O, hereafter c-C2H4O) and its structural isomer acetaldehyde (CH3CHO), we carried out survey observations of these two molecules toward 20 massive star-forming regions and two dark clouds. CH3CHO and c-C2H4O were detected in 10 massive star-forming regions, and CH3CHO was also detected in five others. The column densities and the rotational temperatures were derived using the rotation diagram method. The column densities of these molecules were derived to be (0.1-3.3) × 1014 and (0.2-5.0) × 1014 cm-2 for c-C2H4O and CH3CHO, respectively. The fractional abundances with respect to H2 are X(c-C2H4O) = 4 × 10-11 to 6 × 10-10 and X(CH3CHO) = 7 × 10-12 to 3 × 10-9. We also detected several transitions of methanol (CH3OH), ethanol (C2H5OH), dimethyl ether [(CH3)2O], methyl formate (HCOOCH3), formic acid (HCOOH), vinyl cyanide (C2H3CN), and ethyl cyanide (C2H5CN). Comparing the abundances of the detected molecules with physical conditions of each source, we found that the abundances of most of the molecules except for c-C2H4O and CH3CHO increase along with the dust temperature of each source. On the other hand, the abundances of c-C2H4O and CH3CHO show little correlation with the dust temperature. The rotation temperatures of c-C2H4O, CH3CHO, and HCOOH are low (10-40 K) in all sources in spite of the fact that the gas kinetic temperature greatly varies from cloud to cloud. This may indicate that the line emission from each molecular species is excited in regions with different physical conditions. We performed pseudo-time-dependent chemical reaction simulations based on pure gas-phase reactions and found that the calculated abundances of observed molecules decreased when the gas kinetic temperature was raised. We investigated the relationship between the column density of C2H5OH and that of the C2H4O group (c-C2H4O + CH3CHO) because C2H5OH is believed to be a precursor of c-C2H4O and CH3CHO in the gas-phase chemistry scheme. If this hypothesis is correct, it is expected that the column density of C2H5OH is related to that of the C2H4O group. We found that the column density of the C2H4O group is high in sources where the column density of C2H5OH is high. This result is consistent with the above-mentioned hypothesis. We also investigated the relationships between the column densities of several organic species [CH3OH, C2H5OH, (CH3)2O, HCOOCH3, C2H3CN, and C2H5CN] and the luminosity-to-mass ratio, LIR/M, in OMC-1, W51A, and Sgr B2(N). We found that the column densities of these molecules are high in sources where LIR/M is high. Since LIR/M is believed to be a measure of the star formation rate per unit mass, it indicates that the column densities of these molecules become higher in sources where high star formation activity leads to a higher dust temperature. This strongly suggests that the formation of these molecules involves processes on the dust grains and subsequent sublimation to the gas phase, where they can be observed.

We present high spectral resolution observations of eighteen molecules, including high-quality maps of CCS and HC7N in TMC-1, using NASA's Deep Space Network 70 m antenna to study the interaction between cloud dynamics and chemistry. Other molecules shown in our study are C18O, NH3, CS, C3S, C3H2, H2C3, H2C4, H2C6, HC3N, HC5N, DC5N, HC9N, C4H, C5H, C6H, and a successful detection of the rare C8H molecule. In addition, we have searched for and set meaningful abundance limits on several carbon chain and ring molecules such as C7H, H2C5, c-H2C5, and biogenic molecules such as pyrrole and glycine. All the species observed in TMC-1 show large spectral-line variations in both intensity and shape over extremely small scales (~0.03 pc). Maps of CCS and HC7N display abundance ratio variations of 3-5 along individual lines of sight. The high degree of clumpiness, transient nature of clumps, and gas-phase enrichment adequately explain the "early-time" chemistry and the molecular complexity in TMC-1. This enrichment has interesting implications for hydrocarbon chemistry in TMC-1, and presumably other clumpy, dark clouds. Specifically, the large number of clumps at various stages of early-time chemical evolution increases the chances for detection of complex hydrocarbons, since the probability of observing a clump at the time of peak abundance for a given molecular species is increased. We suggest two mechanisms for explaining the small-scale variations: (1) the passage of MHD waves in a clumpy medium and (2) grain impacts during clump-clump collisions. In the quiescent region far from any protostar, the MHD activity can be generated locally by clump collisions. The passage of MHD waves helps maintain early-time chemistry in the clumps. Both mechanisms provide enough energy to raise grain temperatures from 10 K to Tcrit ~ 30 K, sufficient to cause reactive radical explosions in grain mantles and thermal desorption. In this manner, the mantle injection causes TMC-1 to exhibit some aspects of "hot-core" chemistry, as seen in more massive star-forming regions. The transient nature of the clumps and the mantle-driven chemistry make TMC-1 a good target for future searches of complex molecular species.

A. T. Beck (1983) has proposed the existence of two personality dimensions, sociotropy and autonomy, as specific and influential factors in the onset, course, and treatment of major depression. In this study, the stability and discriminant validity of the Revised Personal Style Inventory (PSI-II), a measure designed to assess the sociotropy and autonomy dimensions, was examined with a sample of outpatients diagnosed with major depression receiving pharmacotherapy. Sociotropy and autonomy were found to be relatively stable across time, despite significant reductions in depression severity. The two personality dimensions also produced a distinct and thematically consistent pattern of correlations with the dimensions and facets of the five-factor model of personality. These results suggest that the sociotropy and autonomy dimensions, as measured by the PSI-II, are reliable and valid measures of these personality constructs.

We have carried out a comprehensive and self-consistent study of the physical and chemical state of the core of the dark cloud L134N (L183), whose molecular abundances provide a standard against which chemical models may be compared. We used observations of the NH3(1, 1) and (2, 2) rotation-inversion transitions to estimate the kinetic temperature, which was found to be consistent with 10 K and not varying with position. Densities were determined from multitransition statistical equilibrium calculations for HC3N, N2H+, and CS. The average density toward all lines of sight was 2 × 104 cm-3. As found by previous studies, the emission from various molecular species peaks in different positions: SO and SO2 peak west of the central position, which is the location of the strongest emission from (e.g.) N2H+ and CH3OH, with a second peak occurring for NH3 and HC3N to the north of the center. The most striking abundance variations occur in a north-south cut through the core center for HC3N, C2H, CS, SO, and SO2. A north to south decrease in the abundance of HC3N and CS and a dramatic change in the CS/SO ratio, which has been shown to be a sensitive tracer of chemical evolutionary state, suggests that the north is at a younger evolutionary state than the south. Despite the "youth" of the N position, the CS/SO ratio suggests that it is still as "old" as or older than the most evolved region in TMC-1 (the northwest end of the ridge).

Investigated the influence of child intellectual/adaptive functioning and maternal sensitivity on attachment security, using a sample of children with Down syndrome. Found a relationship between attachment security in DS related to the interaction of maternal sensitivity and cognitive competence.

The discovery of hydrogen isocyanide (HNC) in comet Hyakutake with an abundance (relative to hydrogen cyanide, HCN) similar to that seen in dense interstellar clouds raised the possibility that these molecules might be surviving interstellar material. The preservation of material from the Sun's parent molecular cloud would provide important constraints on the processes that took place in the protostellar nebula. But another possibility is that HNC is produced by photochemical processes in the coma, which means that its abundance could not be used as a direct constraint on conditions in the early Solar System. Here we show that the HNC/HCN ratio determined for comet Hale-Bopp varied with heliocentric distance in a way that matches the predictions of models of gas-phase chemical production of HNC in the coma, but cannot be explained if the HNC molecules were coming from the comet's nucleus. We conclude that HNC forms mainly by chemical reactions in the coma, and that such reactions need to be considered when attempting to deduce the composition of the nucleus from observations of the coma.

The HCO+ J = 1-0 rotational transition at 89.189 GHz has been mapped in comet Hale-Bopp (C/1995 O1) over a total of 38 individual days spanning the period 1997 March 10-June 20 with the Five College Radio Astronomy Observatory 14 m antenna. HCO+ is detectable over an extended region of the comet, with the peak emission commonly located 50,000-100,000 km in the antisolar direction. Maps made throughout the apparition show significant variability in the structure of the HCO+ coma, sometimes on timescales of several hours. The HCO+ brightness is usually depressed at the nucleus position, and on some occasions, the emission is spread into a ring around the position of the nucleus. Individual spectra within the maps display broad (approximately 4 km s-1) lines redshifted by 1-2 km s-1 or more from the nominal velocity of the nucleus, with the redshift typically increasing in the antisolar direction. The spectra and maps may be generally explained by models in which the ions are accelerated tailward at a rate on the order of 10 cm s-2, provided that HCO+ is destroyed within 50,000-100,000 km of the nucleus.

Fava, Rosenbaum, McCarthy, Pava, Steingard and Bless (1991) have recently proposed the existence of a subtype of depressed patients who experience anger attacks. The aim of this study was to assess if depressed patients categorized as high angry hostile have symptoms and personality profiles distinct from depressed patients categorized as low angry hostile. From a sample of 125 depressed outpatients, 26 patients were classified as high angry hostile and 25 patients as low angry hostile. The symptom profiles of these tow groups were remarkably similar, with the high angry hostile patients exhibiting more interpersonal sensitivity. The high angry hostile patients were rated as less interpersonally agreeable and less conscientious than low angry hostile patients. These results provide only partial support for the angry hostile subtype of depression.

Maps of comet C/1995 O1 (Hale-Bopp) in the millimeter-wave emission of the ion HCO+ revealed a local minimum near the nucleus position, with a maximum about 100,000 km in the antisolar direction. These observed features of the HCO+ emission require a low abundance of HCO+ due to enhanced destruction in the inner coma of the comet, within a region of low electron temperature (Te). To set constraints on the formation of HCO+ in the coma, as well as the location and magnitude of the transition to higher Te, the data are compared with the results of ion-molecule chemistry models.

The abundance ratio of the isomers HCN and HNC has been investigated in comet Hale-Bopp (C/1995 O1) through observations of the J = 4-3 rotational transitions of both species for heliocentric distances 0.93 < r < 3 AU, both pre- and post-perihelion. After correcting for the optical depth of the stronger HCN line, we find that the column density ratio of HNC/HCN in our telescope beam increases significantly as the comet approaches the Sun. We compare this behavior to that predicted from an ion-molecule chemical model and conclude that the HNC is produced in significant measure by chemical processes in the coma; i.e., for comet Hale-Bopp, HNC is not a parent molecule sublimating from the nucleus.

HYPOTHESIS Open endarterectomy is an effective treatment for atherosclerosis,1 and, Percutaneous endovascular techniques are associated with faster recovery and reduced complication rates,2 and An atherosclerotic plaque is made up of broadly the same components across the population,3 so Endovascular application of an enzyme/emulsifier mixture to an isolated vessel will allow the degradation, emulsification and removal of the atherosclerotic plaque and intima. VASCULAR SURGICAL APPROACHES to atherosclerotic vessels involve physical methods to treat atherosclerotic arteries vary between the use of stents or balloons to endarterectomy or bypass. Open-vessel endarterectomy has been established as an effective technique for the surgical management of arteries severely stenosed by atherosclerosis.1 However, endarterectomy requires open dissection, and its success depends on the skill of the operator. Furthermore, this technique usually is feasible only for short lengths of affected arteries. If a percutaneous technique could be developed, it would allow for endarterectomy to be performed with less dissection, leading to decreased operating times, decreased operative trauma, and faster recovery rates.

We examined differences between personality characteristics of euthymic bipolar disorder patients (BD) (n = 34) and recovered unipolar depressed patients (UD) (n = 74) using the taxonomy of the Five-Factor Model of personality (FFM) as measured by composite scales derived from the NEO Personality Inventory (NEO PI) and the revised NEO PI (NEO PI-R). Euthymic BD patients scored significantly higher on the Openness (O) dimension and the Positive Emotions facet of the E dimension than did recovered UD patients. For O, euthymic BD patients scored higher on the Feelings facet. These results suggest not only that euthymic BD patients are more likely to experience positive affects than recovered UD patients, but also that euthymic BD patients are more receptive to their positive and negative feelings than are recovered UD patients.

A new interstellar molecular ion, H2COH+ (protonated formaldehyde), has been detected toward Sgr B2, Orion KL, W51, and possibly in NGC 7538 and DR21(OH). Six transitions were detected in Sgr B2(M). The 1(1,0)-1(0,1) transition was detected in all sources listed above. Searches were also made toward the cold, dark clouds TMC-1 and L134N, Orion (3N, 1E), and a red giant, IRC + 10216, without success. The excitation temperatures of H2COH+ are calculated to be 60-110 K, and the column densities are on the order of 10(12)-10(14) cm-2 in Sgr B2, Orion KL, and W51. The fractional abundance of H2COH+ is on the order of 10(-11) to 10-(9), and the ratio of H2COH+ to H2CO is in the range 0.001-0.5 in these objects. The values in Orion KL seem to be consistent with the "early time" values of recent model calculations by Lee, Bettens, & Herbst, but they appear to be higher than the model values in Sgr B2 and W51 even if we take the large uncertainties of column densities of H2CO into account. We suggest production routes starting from CH3OH may play an important role in the formation of H2COH+.

We report a search in cold, quiescent and in 'hot core' type interstellar molecular clouds for the small cyclic molecule oxiranecarbonitrile (C3H3NO), which has been suggested as a precursor of important prebiotic molecules. We have determined upper limits to the column density and fractional abundance for the observed sources and find that, typically, the fractional abundance by number relative to molecular hydrogen of C3H3NO is less than a few times 10(-10). This limit is one to two orders of magnitude less than the measured abundance of such similarly complex species as CH3CH2CN and HCOOCH3 in well-studied hot cores. A number of astrochemical discoveries were made, including the first detection of the species CH3CH2CN in the massive star-forming clouds G34.3+0.2 and W51M and the first astronomical detections of some eight rotational transitions of CH3CH2CN, CH3CCH, and HCOOCH3. In addition, we found 8 emission lines in the 89 GHz region and 18 in the 102 GHz region which we were unable to assign.

OF THESIS COLOR YOUR PLATE: A PILOT NUTRITION EDUCATION INTERVENTION TO INCREASE FRUIT AND VEGETABLE INTAKE AMONG OLDER ADULTS PARTICIPATING IN THE CONGREGATE MEAL SITE PROGRAM IN KENTUCKY SENIOR CENTERS The purpose of this study was to determine if the amount and variety of fruit and vegetable intake increased among community-dwelling older adults participating in Kentucky’s congregate meal site program following a series of educational nutrition lessons. A convenience sample (n=35) of community-dwelling older adults at two intervention (n=19) and two control (n=16) senior centers in central Kentucky participated in this quasi-experimental pre-post pilot study. Following the intervention there was a trend towards increased self-reported intake in the variety of fruit and vegetables among the intervention group (range:0.03+3.31 to 1.32+2.75 servings per week); a significant increase in the number of days participants incorporated at least 4.5 servings of fruits and vegetables per day intake; significant increases in the incorporation of fruits and vegetables in evening meal, and all meals (p