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The challenges - and joys - of being married to a surgeon. [ABSTRACT FROM AUTHOR]

Background: Robotic-assisted surgery (RAS) offers improved visualisation and dexterity compared to laparoscopy. As a result, RAS is considered an attractive option for performing rectopexy, particularly in the confines of the lower pelvis. The aim of this study was to explore the benefits of RAS in rectopexy by analysing the views of a group of surgeons will have published on robotic rectopexy. Methods: A three-round Delphi process was performed. Combined qualitative, Likert scale and binary responses were utilised in rounds one and two with binary responses seeking overall consensus in round two and three. Particular areas that were studied included: clinical aspects of patient selection, technical aspects of using RAS to perform rectopexy, ergonomic factors, training, and consideration of the 'learning-curve'. Consensus was defined as agreement > 80% among participants. Potential experienced RAS rectopexy surgeons were identified using PubMed where authors of studies reporting outcomes from RAS rectopexy were searched and invited. Results: Twenty surgeons participated from the following countries: France, Germany, Ireland, Italy, Netherlands, Switzerland, UK, and USA. Participants had median operative experience of 75 (range 20–450) rectopexies (all techniques) and 11(range 0–300) robotic-rectopexies for all indications. All participants agreed that patient-reported functional outcomes and improved quality-of-life were the most important outcomes following rectopexy. Participants agreed the most significant benefits offered by RAS for rectopexy were improved precision due to better visualisation (80%), improved dexterity (90%) and improved overall accuracy e.g., for suture placement (90%). Ninety percent agreed that the superior ergonomics of RAS rectopexy improved their performance on several steps of the operation, in particular: mesh fixation (85%) and rectovaginal dissection (80%). Consensus on the learning curve for RAS abdominal rectopexy was not achieved: forty-five percent (n = 9) reported the learning curve as 11–20 cases and 55% (n = 11) as 21–30 cases. Conclusions: A panel of surgeons who had published on RAS view that it positively improves performance of rectopexy in terms of technical skills, improved dexterity and visualisation and ergonomics. [ABSTRACT FROM AUTHOR]

Background: Surgical repair of full-thickness rotator cuff tears in symptomatic patients is known to offer significant benefits. Despite this there remains a lack of universal appreciation that such surgery offers high clinical value, with some commissioners even limiting access to it. The value-based healthcare agenda provides a means to design, deliver and measure the impact of healthcare to a defined segment of patients. The aim of this study was to measure the value of surgically repairing primary symptomatic full-thickness rotator cuff tears when outcomes and costs were assessed over an entire care pathway. Methods: A prospective study of patients undergoing rotator cuff tears repair was undertaken. Patients were managed using a standardised integrated care pathway. Subsequent outcomes and costs were measured over the whole care pathway. Outcomes were assessed from both traditional and patient centric re-formatted prisms. Results: Significant improvement in clinical outcomes where recognised when assessed from either the traditional or re-formatted prisms. Economic review of this approach revealed the pathway generated a sustainable and notable positive margin. Discussion: This study evidences how a well-designed value-based healthcare shoulder approach can be delivered and measured. It demonstrates rotator cuff surgery to be a high value treatment for patients with symptomatic rotator cuff tears. [ABSTRACT FROM AUTHOR]

The risk for sexual victimization in college is high, and although there can be significant mental and physical consequences for the survivor, resource utilization for this issue is extremely low. The current study used the frameworks of both the ecological model and the theory of planned behavior to examine factors related to resource use in undergraduate survivors of unwanted sexual experiences. The sample consisted of 217 undergraduates who reported at least one unwanted sexual experience while in college (89% female, 76.5% Caucasian, M age 19.6). Data were collected in an online survey from a private liberal arts college, and were analyzed using decision tree modeling. Results suggested that resource use was less related to demographic or event characteristics, but rather related to victim response to the event as well as perceptions about control over potential resource use. In addition to key assault prevention efforts, it is thus important to also support survivor mental health and self-efficacy postassault. [ABSTRACT FROM AUTHOR]

Background: Mixed results are reported on clinical and cancer outcomes in laparoscopic rectal cancer surgery (LRCS) compared with robotic rectal cancer surgery (RRCS). However, more favourable functional outcomes are reported following RRCS. This study compared urinary and sexual function following RRCS and LRCS in male and female patients. Methods: A systematic review and meta-analysis of urinary and sexual function after RRCS and LRCS was performed following PRISMA and MOOSE guidelines, and registered prospectively with PROSPERO (ID:CRD42020164285). The functional outcome reporting tools most commonly included: the International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF) and Female Sexual Function Index (FSFI). Mean scores and changes in mean scores from baseline were analysed using RevMan version 5.3. Results: Ten studies were included reporting on 1286 patients. Some 672 patients underwent LRCS, of whom 380 (56.5 per cent) were men and 116 (17.3 per cent) were women (gender not specified in 176 patients, 26.2 per cent). A total of 614 patients underwent RRCS, of whom 356 (58.0 per cent) were men and 83 (13.5 per cent) were women (gender not specified in 175 patients, 28.5 per cent). Regarding urinary function in men at 6 months after surgery, IPSS scores were significantly better in the RRCS group than in the LRCS group (mean difference (MD) -1.36, 95 per cent c.i. -2.31 to -0.40; P=0.005), a trend that persisted at 12 months (MD -1.08, -1.85 to -0.30; P=0.007). DIIEF scores significantly favoured RRCS at 6 months [MD -3.11 (95%CI -5.77, -0.44) P <0.021] and 12 months [MD -2.76 (95%CI -3.63, -1.88) P <0.001] post-operatively. Mixed urinary and sexual function outcomes were reported for women. Conclusion: This meta-analysis identified more favourable urinary and erectile function in men who undergo robotic compared with conventional laparoscopic surgery for rectal cancer. Outcomes in women did not identify a consistently more favourable outcome in either group. As robotic rectal cancer surgery may offer more favourable functional outcomes it should be considered and discussed with patients. [ABSTRACT FROM AUTHOR]

This study evaluated patterns of sexual assault disclosures as well as the response and impact of that response on assault survivors. The sample consisted of 217 undergraduates with a history of sexual assault (89.5% female, 76.5% Caucasian). Participants reported the order in which they disclosed and the nature and impact of the response they received. Results indicated that the majority of participants told close peers first and perceived the first response to be supportive. These findings are encouraging but also demonstrate the need for improving the response that an assault survivor receives. [ABSTRACT FROM AUTHOR]

Background: Optimal management of the endometrium in patients with oestrogen receptor‐positive breast cancer taking extended tamoxifen therapy (for 10 years) remains uncertain. A meta‐analysis was performed to determine the cumulative risk ratio (RR) for endometrial malignancy following extended compared with standard tamoxifen treatment. A systematic review was undertaken to identify whether routine endometrial surveillance in patients receiving tamoxifen is associated with earlier detection and reduced incidence of endometrial malignancy. Methods: Two independent searches were undertaken in the Cochrane Library, PubMed and MEDLINE. A meta‐analysis was performed of RCTs reporting on endometrial malignancy risk in extended tamoxifen therapy. A systematic review included prospective studies investigating the benefit of endometrial surveillance during tamoxifen therapy. Results: Four RCTs reported on endometrial risk in extended tamoxifen therapy. The cumulative risk of endometrial malignancy increased twofold from 1·5 to 3·2 per cent with extended therapy compared with the standard 5 years of tamoxifen (RR 2·29, 95 per cent c.i. 1·60 to 3·28; P < 0·001). Four studies analysed the value of endometrial screening in 5‐year cohorts. Endometrial cancer rates of up to 2 per cent were reported, which is higher than rates in the large extended tamoxifen trials. Conclusion: Extended adjuvant tamoxifen is associated with an increase in endometrial cancer. No clear benefit has been shown for routine endometrial surveillance in asymptomatic patients on tamoxifen therapy. [ABSTRACT FROM AUTHOR]

Reports on a low-pressure metalorganic chemical vapor deposition of aluminum using triethylamine alane. Function of the liquid source; Activators for nucleation of aluminum; Electrical resistivities of the aluminum films on titanium-nitrogen.

Purpose: Complete mesocolic excision (CME) has been associated with improved oncological outcomes in treatment of colon cancer. However, widespread adoption is limited partly because of the technical complexity and perceived risks of the approach. The aim of out study was to evaluate the safety of CME compared to standard resection and to compare robotic versus laparoscopic approaches. Methods: Two parallel searches were undertaken in MEDLINE, Embase and Web of Science databases 12 December 2021. The first was to evaluate IDEAL stage 3 evidence to compare complication rates as a surrogate marker of perioperative safety between CME and standard resection. The second independent search compared lymph node yield and survival outcomes between minimally invasive approaches. Results: There were four randomized control trials (n = 1422) comparing CME to standard resection, and three studies comparing laparoscopic (n = 164) to robotic (n = 161) approaches. Compared to standard resection, CME was associated with a reduction in Clavien–Dindo grade 3 or higher complication rates (3.56% vs. 7.24%, p = 0.002), reduced blood loss (113.1 ml vs. 137.6 ml, p < 0.0001) and greater mean lymph node harvest (25.6 vs. 20.9 nodes, p = 0.001). Between the robotic and laparoscopic groups, there were no significant differences in complication rates, blood loss, lymph node yield, 5-year disease-free survival (OR 1.05, p = 0.87) and overall survival (OR 0.83, p = 0.54). Conclusions: Our study demonstrated improved safety with CME. There was no difference in safety or survival outcomes between robotic and laparoscopic CME. The advantage of a robotic approach may lie in the reduced learning curve and an increased penetration of minimally invasive approach to CME. Further studies are required to explore this. Prospero ID: CRD42021287065. [ABSTRACT FROM AUTHOR]

Background: Although there are a number of risks associated with problematic alcohol use, the proportion of people who seek help for alcohol-related issues is alarmingly low.Objective: This study investigated the potential social influences that are associated with alcohol-related help seeking, including perceived partner support, descriptive and injunctive subjective norms, and marital satisfaction.Methods: Participants included 133 individuals (50% female, 48% male, and 2% did not report) recruited nationwide through both print and electronic methods. Data were collected in an online survey in 2013. Respondents were 77% Caucasian, 16% African-American, 2% Asian, 2% American Indian, and 1% Hawaiian/Pacific Islander, with a mean age of 38 years (SD= 11.93). Data were analyzed using hierarchical multiple regression.Results: Results suggested that when considered independently, perceived partner support, injunctive social norms, and closest friend's level of drinking were significantly associated with help seeking behavior, while marital satisfaction was not. Results further indicated that examining support and norms together accounted for increased variance in help seeking over examining the variables separately. Significant interactions were found between gender and acceptance of drinking behavior, which suggested that acceptance of drinking behavior was important for men's help seeking but not for women's, and between positive support and acceptance, which indicated that the role of support varied by level of acceptance for both genders.Conclusion: Overall, this study suggests that social influences play an important role in a person's decision to seek help for alcohol related issues. [ABSTRACT FROM PUBLISHER]

Studies regarding the effectiveness of homework assignments in cognitive-behavioral treatments have demonstrated mixed results. This study investigated predictors of compliance with homework recommendations and the time-varying relationship of recommendation completion with treatment response in a brief couples' intervention (N = 108). More satisfied couples and couples with more motivation to change completed more recommendations, whereas couples with children completed fewer. The association between recommendation completion and treatment response varied with the passage of time, with the strongest effect observed 6 months after the intervention, but no discernible differences at 1 year postintervention. Couples that completed more recommendations experienced more rapid treatment gains, but even those couples doing substantially fewer recommendations ultimately realized equivalent treatment effects, although they progressed more slowly. Implications are discussed. [ABSTRACT FROM AUTHOR]

Previous research suggests that studying the effect of dissociation is particularly important in survivors of intimate partner violence because of the risk of revictimization. The current study investigated demographic variables, child and current abuse characteristics, coping style, and cognitive distortions as predictors of peritraumatic, trait, and posttraumatic stress disorder (PTSD)–related dissociation in a sample of female intimate partner violence survivors. The sample consisted of 372 women, the majority African American, with an average age of 34.41 years (SD = 8.09). Peritraumatic dissociation was significantly predicted by child physical abuse, current abuse injury, cognitive distortions about safety, and problem disengagement coping. Trait dissociation was significantly predicted by minority race, personal income, and cognitive distortions about safety and self-worth. PTSD-related dissociation was significantly predicted by cognitive distortions about self-worth, problem and emotion disengagement coping, and peritraumatic dissociation. In the models predicting both trait and PTSD-related dissociation, abuse characteristics significantly predicted dissociation until the entry of cognitive variables into the model. The analysis indicated a significant indirect effect of cognitive distortions on the relationship between current sexual aggression and trait dissociation. Results also suggested that there were indirect effects of both cognitive distortions and peritraumatic dissociation on the relationships between current psychological abuse/injury and PTSD-related dissociation. Findings point to the importance of cognitions in the development and maintenance of dissociation and suggest that treatments designed to help clients accept and process traumatic events may help reduce dissociation and in turn prevent future revictimization. [ABSTRACT FROM AUTHOR]

An animal's trajectory is a fundamental object of interest in movement ecology, as it directly informs a range of topics from resource selection to energy expenditure and behavioral states. Optimally inferring the mostly unobserved movement path and its dynamics from a limited sample of telemetry observations is a key unsolved problem, however. The field of geostatistics has focused significant attention on a mathematically analogous problem that has a statistically optimal solution coined after its inventor, Krige. Kriging revolutionized geostatistics and is now the gold standard for interpolating between a limited number of autocorrelated spatial point observations. Here we translate Kriging for use with animal movement data. Our Kriging formalism encompasses previous methods to estimate animal's trajectories-the Brownian bridge and continuous-time correlated random walk library-as special cases, informs users as to when these previous methods are appropriate, and provides a more general method when they are not. We demonstrate the capabilities of Kriging on a case study with Mongolian gazelles where, compared to the Brownian bridge, Kriging with a more optimal model was 10% more precise in interpolating locations and 500% more precise in estimating occurrence areas. [ABSTRACT FROM AUTHOR]

Although the current cohort of returning veterans has engaged more fully with care from the Department of Veterans Affairs (VA) than have veterans from previous eras, concern remains regarding low engagement with VA services, particularly for specialty services for diagnoses that can most negatively impact quality of life. This study used the framework of the Andersen Model to examine factors related to VA health care use in Operation Enduring Freedom/Operation Iraqi Freedom veterans. Match between veterans' preferences for source of information about VA programs and veterans' actual sources of information about VA services was examined as an additional predictor of help seeking. The study included 1,161 veterans recruited from the southeast United States. Results suggested that veterans prefer to receive information from VA publications and the web, whereas they actually receive information from VA publications and other veterans. Logistic regression suggested that the number of deployments, income, distance to VA, VA disability rating, self-rated health, and match between preferred source of information and actual source of information were significantly related to the use of VA services since deployment. These results suggest that future outreach efforts should focus on targeting veterans' health needs and preferences for care and source of information. [ABSTRACT FROM AUTHOR]

Site-specific in-season corn ( Zea mays L.) nitrogen (N) rate recommendations based on remote sensing can increase nitrogen use efficiency (NUE) but most approaches require the corn to be at the V8 growth stage. Success in estimating N needs during early vegetative growth has been limited due to low plant biomass and background interference. The objective of this experiment was to measure the influence of soil series, soil moisture, surface crop residues, and sensor orientation on Normalized Difference Vegetation Index (NDVI) from soils prior to planting and corn from planting through the V6 growth stage. A controlled experiment was conducted in Virginia using four soil types commonly used for corn production. Spectral reflectance readings from the soils and four crop residues were measured using the GreenSeeker sensor at four sensor orientations. Sensor orientation affected NDVI readings from bare soils before planting, with a difference of up to 0.16 units among orientations. The 15 cm mask generally resulted in the lowest NDVI. Wetting soils resulted in greater NDVI values from all soils with differences of up to 0.18 units between the same soil wet and dry. Values for NDVI were initially influenced by crop residue type but no differences due to type were detected once corn reached the V4 stage. Altering sensor orientation generally changed NDVI values but none resulted in NDVI that was similar across all soil and residue backgrounds. Background (soil and residue) influenced NDVI readings during early vegetative corn growth so the sensing background for the calibration reference areas should be uniform and similar to the larger field for implementation of the GreenSeeker variable rate system. [ABSTRACT FROM AUTHOR]

Quantifying animals' home ranges is a key problem in ecology and has important conservation and wildlife management applications. Kernel density estimation (KDE) is a workhorse technique for range delineation problems that is both statistically efficient and nonparametric. KDE assumes that the data are independent and identically distributed (IID). However, animal tracking data, which are routinely used as inputs to KDEs, are inherently autocorrelated and violate this key assumption. As we demonstrate, using realistically autocorrelated data in conventional KDEs results in grossly underestimated home ranges. We further show that the performance of conventional KDEs actually degrades as data quality improves, because autocorrelation strength increases as movement paths become more finely resolved. To remedy these flaws with the traditional KDE method, we derive an autocorrelated KDE (AKDE) from first principles to use autocorrelated data, making it perfectly suited for movement data sets. We illustrate the vastly improved performance of AKDE using analytical arguments, relocation data from Mongolian gazelles, and simulations based upon the gazelle's observed movement process. By yielding better minimum area estimates for threatened wildlife populations, we believe that future widespread use of AKDE will have significant impact on ecology and conservation biology. [ABSTRACT FROM AUTHOR]

Background: Survivors of childhood cancer are at increased risk for several cardiometabolic complications. Obesity/overweight and metabolic syndrome have been widely reported in Western literature, but data from India are lacking.Aims: To perform an objective assessment of nutritional status in a cohort of childhood cancer survivors (CCSs) and to find risk factors for extremes in nutritional status.Settings and Design: The study was a retrospective chart review of CCSs who attended the late effects clinic of a referral pediatric oncology center over the period of 1 year.Materials and Methods: An objective assessment of nutritional status was done, and results were analyzed in two groups: Adult survivors (present age <18 years) and child and adolescent survivors (CASs) (<18 years). The data were then analyzed for possible risk factors.Results: Six hundred and forty-eight survivors were included in the study; of these, 471 were <18 years at follow-up, and 177 were 18 years or older. The prevalence of obesity, overweight, normal, and undernutrition was 2.6%, 10.8%, 62.7%, and 28.8% (CASs) and 0%, 8.5%, 62.7%, and 28.8% (adult survivors), respectively. Factors predictive of overweight/obesity were an initial diagnosis of acute lymphoblastic leukemia, or brain tumor and follow-up duration of >20 years or current age >30 years in adult survivors.Conclusions: The prevalence of obesity/overweight is lower in our cohort when compared to Western literature. It remains to be clarified whether this reflects the underlying undernutrition in our country, or whether our cohort of survivors is indeed distinct from their Western counterparts. Comparison with age/sex-matched normal controls and baseline parameters would yield more meaningful results. [ABSTRACT FROM AUTHOR]

Background: The splintering of general surgery into subspecialties in the past decade has brought into question the relevance of a continued emphasis on traditional general surgical training. With the majority of trainees now expressing a preference to subspecialise early, this study sought to identify if the requirement for proficiency in managing general surgical conditions has reduced over the past decade through comparison of general and specialty surgical admissions at a tertiary referral center. Methods: A cross-sectional review of all surgical admissions at Cork University Hospital was performed at three individual time points: 2002, 2007 & 2012. Basic demographic details of both elective & emergency admissions were tabulated & analysed. Categorisation of admissions into specialty relevant or general surgery was made using International guidelines. Results: 11,288 surgical admissions were recorded (2002:2773, 2007:3498 & 2012:5017), showing an increase of 81 % over the 10-year period. While growth in overall service provision was seen, the practice of general versus specialty relevant emergency surgery showed no statistically significant change in practice from 2002 to 2012 ( p = 0.87). General surgery was mostly practiced in the emergency setting (84 % of all emergency admissions in 2012) with only 28 % elective admissions for general surgery. A reduction in length of stay was seen in both elective (3.62-2.58 bed days, p = 0.342) & emergency admissions (7.36-5.65, p = 0.026). Conclusions: General surgical emergency work continues to constitute a major part of the specialists practice. These results emphasize the importance of general surgical training even for those trainees committed to sub-specialisation. [ABSTRACT FROM AUTHOR]

Objective: This study assessed the efficacy of the Marriage Checkup (MC) for improving relationship health and intimacy. Method: Cohabiting married couples (N = 215, Mage women = 44.5 years, men = 47 years, 93.1% Caucasian) recruited from a northeastern U.S. metropolitan area through print and electronic media were randomly assigned to MC treatment or wait-list control. Treatment but not control couples participated in assessment and feedback visits, at the beginning of the study and again 1 year later. All couples completed 9 sets of questionnaires over 2 years. Outcome measures included the Quality of Marriage Index, the Global Distress subscale of the Marital Satisfaction Inventory-Revised, the Intimate Safety Questionnaire, and the Relational Acceptance Questionnaire. Results: A latent growth curve model indicated significant between-group differences in intimacy at every measurement point after baseline (d ranged from .20 to .55, Md = .37), significant between-group differences in women's felt acceptance for every measurement point after baseline (d ranged from . 17 to .47, Md = .34), significant between-group differences in men's felt acceptance through the 1-year 2-week follow-up (d across follow-up ranged from .11 to .40, Md = .25), and significant between-group differences in relationship distress through 1-year 6-month follow-up (d across follow-up ranged from .11 to .39, Md = .23). Conclusions: Longitudinal analysis of the MC supports the hypothesis that the MC significantly improves intimacy, acceptance, and satisfaction. Implications for dissemination are discussed. [ABSTRACT FROM AUTHOR]

The fluctuation-dissipation relation is usually formulated for a system interacting with a heat bath at finite temperature, and often in the context of linear response theory, where only small deviations from the mean are considered. We show that for an open quantum system interacting with a nonequilibrium environment, where temperature is no longer a valid notion, a fluctuation-dissipation inequality exists. Instead of being proportional, quantum fluctuations are bounded below by quantum dissipation, whereas classically the fluctuations vanish at zero temperature. The lower bound of this inequality is exactly satisfied by (zero-temperature) quantum noise and is in accord with the Heisenberg uncertainty principle, in both its microscopic origins and its influence upon systems. Moreover, it is shown that there is a coupling-dependent nonequilibrium fluctuation-dissipation relation that determines the nonequilibrium uncertainty relation of linear systems in the weak-damping limit. [ABSTRACT FROM AUTHOR]

In this work we investigate the late-time steady states of open quantum systems coupled to a thermal reservoir in the strong coupling regime. In general such systems do not necessarily relax to a Boltzmann distribution if the coupling to the thermal reservoir is nonvanishing or equivalently if the relaxation time scales are finite. Using a variety of nonequilibrium formalisms valid for non-Markovian processes, we show that starting from a product state of the closed system = system + environment, with the environment in its thermal state, the open system which results from coarse graining the environment will evolve towards an equilibrium state at late times. This state can be expressed as the reduced state of the closed system thermal state at the temperature of the environment. For a linear (harmonic) system and environment, which is exactly solvable, we are able to show in a rigorous way that all multitime correlations of the open system evolve towards those of the closed system thermal state. Multitime correlations are especially relevant in the non-Markovian regime, since they cannot be generated by the dynamics of the single-time correlations. For more general systems, which cannot be exactly solved, we are able to provide a general proof that all single-time correlations of the open system evolve to those of the closed system thermal state, to first order in the relaxation rates. For the special case of a zero-temperature reservoir, we are able to explicitly construct the reduced closed system thermal state in terms of the environmental correlations. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate the association between mastitis events occurring during the previous lactation, the dry period, and the peripartum period on the incidence of early lactation mastitis in cows receiving ceftiofur hydrochloride or penicillin dihydrostreptomycin as intramammary dry cow antibiotic therapy. Cows (n = 402) from 2 large dairy farms in Central Florida were enrolled in the study at the time of dry-off processing and were randomly assigned to 1 of 2 dry cow therapies: ceftiofur hydrochloride or penicillin dihydrostreptomycin. Composite milk samples were collected at dry-off and after calving for bacteriological examination and somatic cell count. Peripartal health disorders were monitored during the first 30 d of lactation and included calving difficulty, metritis, ketosis, and left displaced abomasum. Milk production and individual somatic cell scores (SCS) were recorded monthly by the Dairy Herd Improvement Association. The main outcome variables were the risk of clinical mastitis during the first 30 and 60 d of lactation, and the risk of subclinical mastitis at the first 2 monthly Dairy Herd Improvement Association tests after calving (up to 70 d in milk). Additionally, the SCS and the presence of mastitis pathogens in milk at dry-off and at calving were analyzed. Explanatory variables consisted of events occurring during the previous lactation, at dry-off and during the dry period, at calving, and with-in the first 30 d after calving. Multiple events occurring during the previous lactation had a significant effect on the incidence of mastitis in the subsequent lactation. These events included low milk yield, intermediate lactation length, clinical mastitis, and lactation SCS average. Similarly, intramammary infections with environmental bacteria at dry-off increased the chances of clinical mastitis the first month after calving. Dry-off therapy had a significant effect on mastitis incidence; cows treated with ceftiofur hydrochloride had lower odds of having clinical and subclinical mastitis in the subsequent early lactation compared with cows treated with penicillin dihydrostreptomycin. [ABSTRACT FROM AUTHOR]

Although the barriers to couples' help seeking can be daunting, to date there is only a small body of literature addressing the factors that motivate couples to seek help. This study examined the association between attitudes toward relationship help seeking and relationship help seeking behaviors, as well as the association between marital quality and help seeking. This study was completed in the context of the Marriage Checkup, a brief intervention designed to reduce the barriers to help seeking. Results indicated that help seeking attitudes and behaviors were not related in couples, and that wives' marital quality was negatively associated with both wives' and husbands' help seeking. Husbands' marital quality was not associated with husbands' help seeking. Overall, this suggests that the process of couples' help seeking is distinct from that of individuals and seems to be driven primarily by the female partner. Further implications for theory and treatment are discussed. [ABSTRACT FROM AUTHOR]

The dependence of the dynamics of open quantum systems upon initial correlations between the system and environment is an utterly important yet poorly understood subject. For technical convenience most prior studies assume factorizable initial states where the system and its environments are uncorrelated, but these conditions are not very realistic and give rise to peculiar behaviors. One distinct feature is the rapid buildup or a sudden jolt of physical quantities immediately after the system is brought in contact with its environments. The ultimate cause of this is an initial imbalance between system-environment correlations and coupling. In this paper we demonstrate explicitly how to avoid these unphysical behaviors by proper adjustments of correlations and/or the coupling, for setups of both theoretical and experimental interest. We provide simple analytical results in terms of quantities that appear in linear (as opposed to affine) master equations derived for factorized initial states. [ABSTRACT FROM AUTHOR]

We consider open quantum systems with dynamics described by master equations that have perturbative expansions in the system-environment interaction. We show that, contrary to intuition, full-time solutions of order-2n accuracy require an order-(2n + 2) master equation. We give two examples of such inaccuracies in the solutions to an order-2n master equation: order-2n inaccuracies in the steady state of the system and order-2n positivity violations. We show how these arise in a specific example for which exact solutions are available. This result has a wide-ranging impact on the validity of coupling (or friction) sensitive results derived from second-order convolutionless, Nakajima-Zwanzig, Redfield, and Born-Markov master equations. [ABSTRACT FROM AUTHOR]

Abstract: The electron stimulated chemistry of monolayers of (R)/(S)-methyl lactate ((S)/(R)-MLAc) adsorbed on Cu(111) has been investigated. Monolayers of MLAc undergo highly efficient electron stimulated processes predominately desorption, but also a significant fraction is converted to an adsorbed alkoxide moiety through the selective cleavage of the O–H bond. The efficiency of the depletion of the adsorbed MLAc state and the absence of significant non-selective fragmentation contrasts with previous studies of the electron beam irradiation of monolayers of oxygen containing organic molecules. [Copyright &y& Elsevier]

Abstract: The surface chemistry of an α-ketoester, methyl pyruvate, has been studied on a model Cu(111) single crystal surface. Monolayers of methyl pyruvate at 180K consist predominately (ca. 66%) of a chemisorbed methyl pyruvate moiety, with its keto-carbonyl bonded to the surface in a η2 configuration, this moiety desorbs intact at 365K. The rest of the monolayer contains weakly adsorbed methyl pyruvate, which desorbs at 234K, which interacts with the surface through the lone pair electrons of the oxygen atoms of the C adopting a η1 configuration. Previous studies of simple ketones on model noble metal surfaces have only observed weakly bonded η1 configurations. The observation of a strongly chemisorbed moiety in the present study is attributed to the activation of the keto-carbonyl by the electron withdrawing ester group. This behaviour is consistent with the homogeneous inorganic chemistry of ketones. Given both the formation of a η2 bonded methyl pyruvate moiety on Cu(111) and the known activity of Cu as a selective hydrogenation catalyst, it is suggested that it maybe worthwhile considering the possibility of testing the effectiveness of chirally modified supported Cu as an enantioselective catalyst. [Copyright &y& Elsevier]

Adult atopic dermatitis (AD) can seriously affect quality of life of patients and their families, and patients' disease is frequently not satisfactorily controlled with topical therapy. There is a need for alternatives to topical treatment in patients with moderate to severe AD.To investigate the efficacy and safety of oral pimecrolimus, and to determine the response to three different doses in the treatment of AD.In a double-blind, placebo-controlled, parallel-group, dose-finding study, patients with moderate to severe AD were randomized to receive either placebo, or oral pimecrolimus 10, 20 or 30 mg twice daily. The study consisted of a pretreatment phase, a 12-week double-blind treatment phase, and a 12-week post-treatment phase.In total, 103 patients were randomized. A clear, dose-dependent therapeutic effect of pimecrolimus treatment was observed, with a statistically significant onset of efficacy at week 2 and the greatest reduction from baseline of the Eczema Area and Severity Index of 66·6% at week 7 in the 30 mg twice daily dose group. Oral pimecrolimus was well tolerated and there were no signs of nephrotoxicity or the induction of hypertension.These data demonstrate the clinically relevant efficacy and short-term safety of oral pimecrolimus in adults with moderate to severe AD. Longer-term studies in larger cohorts are now required. [ABSTRACT FROM AUTHOR]

An explicit scheme of Saul'yev for parabolic equations has been used to solve the time-dependent parabolic equation of the mild-slope equation. Theoretical analysis has been presented for stability and consistency of the explicit scheme applied to the mild-slope equation. The explicit scheme is simpler than most existing numerical schemes for solving the mild-slope equation, including elliptical, hyperbolic and parabolic (time-dependent) types and it is faster than the generalised conjugate gradient (GCG) scheme. It has about the same convergent speed as the alternating direction implicit (ADI) scheme for the parabolic equation, but the scheme is simpler. Experimental data obtained by Berkhoff et al. have been used to test the model. A comparison of present model results, for the case of an elliptic shoal, against the results of the GCG model and ADI model has been made and good agreement has been achieved. A nested grid method has also been combined with the present explicit scheme for solving the mild-slope equation. The simplicity of the explicit scheme makes the nested grid method very attractive for problems of wave propagation from deep to shallow water, where in deep water a coarse mesh can be used and in the shallow water region the mesh can be refined to achieve greater accuracy. [ABSTRACT FROM AUTHOR]

Lentigo maligna (LM) is an in situ form of malignant melanoma, and surgical excision is often unsatisfactory. Imiquimod cream is an immune response modifier and induces a predominantly T-helper 1 type response. Assessment of histological and clinical response of surgically resectable LM after treatment with 5% imiquimod cream. Six patients with LM were treated with 5% imiquimod cream daily for 6 weeks. The whole site of the original lesion was then excised. Clinical and histological and appearances were measured using clinical response and histological grading scores. Complete or almost complete clearance of pigmentation with minimal residual histological evidence of LM was observed in four patients, one patient showed no clinical or histological improvement, and the remaining patient had almost no residual pigmentation clinically after treatment yet histopathological changes remained as severe as before treatment. Topical imiquimod cream merits further investigation as a new therapy for LM. [ABSTRACT FROM AUTHOR]

Siblings of children with cancer are at risk for reduced emotional support. The role of emotional social support in the psychological adjustment of siblings of paediatric cancer patients was examined, in the context of age and gender. The sample consisted of two groups of siblings of children being treated for cancer: siblings referred for behaviour problems ( n = 47) and a comparison group of non-referred siblings ( n = 25). Forty-two were female, and 30 were male. The mean age was 10.31 years (SD = 2.71). Siblings completed measures of depression, anxiety, behaviour, and emotional social support. One parent of each sibling completed measures of sibling's behaviour and anxiety. Siblings who reported more social support endorsed significantly fewer symptoms of depression, anxiety, and fewer behaviour problems, and their parents reported less anxiety and fewer behaviour problems than siblings who reported lower social support. Parents of referred siblings reported significantly more behaviour problems than parents of non-referred siblings. Referred adolescent females reported significantly higher depression scores and were perceived as more anxious than referred adolescent males and non-referred adolescent females. Non-referred younger siblings with high social support were perceived by their parents as having the fewest behaviour problems. High level of social support appears to play a protective role in psychological adjustment of siblings of paediatric cancer patients, with age and gender as modifying factors. Although not all siblings develop behaviour or emotional problems, it is critical to identify those who do in order to intervene accordingly. [ABSTRACT FROM AUTHOR]

Evaluates the specialist registrar video-conference program established by the Scottish Dermatological Society in Scotland and in North East England. Aim of improving dermatological training; Topics discussed.

Abstract 1 Treatments against pathogens or pests are often very specific and, as a fundamental first step, require the ability to identify taxa correctly and unambiguously. We used PCR amplification techniques to successfully establish a molecular identification key for economically important thrips species. 2 A PCR amplified 433 bp long fragment of the mitochondrial COI coding gene was analysed by automated direct sequencing and RFLP. Sequencing of 264 individual thrips representing 10 named species detected 17 haplotypes. Variation within species was low, whereas among species variation was high resulting in an average sequence divergence of 18.6% and an average pairwise species differentiation (calculated as FST -value) of 0.9896. 3 Two restriction enzymes (Alu I, Sau 3AI) produced patterns that allowed unambiguous identification of all thrips species. 4 Statistical support for the quality of the key was given by (i) a highly significant permutation approach, assigning individual haplotypes to the correct species groups and (ii) a hierarchical NJ cluster analysis in which all conspecific individual sequences clustered together with maximal (100%) bootstrap support. 5 This study has shown that the use of genetic markers represents a valuable alternative for situations, such as epidemiological research, in which correct identification with classical morphological methods is either very difficult and time consuming or virtually impossible. [ABSTRACT FROM AUTHOR]

Summary Background There is continuing interest in pre-operative evaluation of cutaneous pigmented lesions with the aim of differentiating early melanoma, which requires excision from non-melanomatous pigmented lesions that may safely be left untreated. Objectives To establish, in the setting of a specialist pigmented lesion clinic, if use of the hand-held dermatoscope can prevent unnecessary excision of benign melanocytic pigmented lesions. Methods The study was carried out by three dermatologists experienced in the use of the dermatoscope. Patients had been referred by primary care physicians to the pigmented lesion clinic and had melanocytic lesions considered by dermatologists to merit excision on clinical grounds. A set of 74 sequentially observed lesions referred for excision, 37 melanomas and 37 melanocytic naevi, was used as the initial set and, thereafter, a second set of 52 lesions comprising 32 melanomas and 20 melanocytic naevi was used to validate conclusions drawn from the original set. Clinical features such as appearance and history, and also dermatoscope features were included in the assessment. Results In both sets of lesions, the most powerful identifying feature of lesions subsequently shown on pathological examination to be melanoma was the presence of three or more colours seen in the lesion on dermatoscopy. In the initial set of lesions, the age of the patient, an irregular edge and largest diameter of the lesion also contributed to diagnosis; however, in the second set of lesions these variables contributed little additional discriminatory value. The sensitivity and specificity of the three-colour dermatoscopy test for melanoma vs. naevus were 92% and 51%, respectively. Conclusions The use of the dermatoscope three-colour test could reduce excision of benign melanocytic naevi by 50%, and thus prevent both unnecessary minor surgical workload and patient morbidity. [ABSTRACT FROM AUTHOR]

We have surveyed Scottish dermatologists to establish the extent of patch testing, to assess the reasons for referral and to document resources and methods used by dermatologists. 104 questionnaires were sent to members of the Scottish Dermatological Society. 82 questionnaires (79%) were returned. 50% of respondents were consultants, 27% were trainees and 23% held staff grade or clinical assistant positions. The mean waiting time for a patch test appointment was 4.5 months. The most frequent reasons for patch testing were localized eczema, eczema not responding to conventional treatment, occupational eczema, history of contact sensitivity and eczema of uncertain cause. 17 of 82 respondents (21%) were the principal clinicians supervising patch testing in their hospitals. 11 of 17 read reactions at 2 and 4 days. Mean time spent on advising patients was 13 min per patients. 7 of 17 were dissatisfied with resources available for patient education and 16 of 17 felt they would benefit from a central source for patient information. Only 4 of 17 centres recorded patch test results on a database and 3 centres regularly reviewed their patch test results. In conclusion, we have identified areas of patch testing that require further improvement. [ABSTRACT FROM AUTHOR]

The distribution and frequency of occurrence of potato cyst nematodes, Globodera rostochiensis and a pallida, were examined in Northern Ireland. Globodera rostochiensis (pathotype Rol) was the most abundant species, while Pa1 and Pa3 pathotype reactions could be discerned within G. pallida. Unlike other parts of the UK, species proportions appear not to have changed over the last 20 years, probably as a result of the legislative control currently practised combined with the limited use of Rol -resistant cultivars within the country. Differences in the geographical distributions of the three pathotypes were observed, and these are discussed in relation to original potato cyst nematode introductions and subsequent agricultural practices. [ABSTRACT FROM AUTHOR]

The sociology of nursing, despite decisive interventions by recent commentators, continues to take as its main focus the subordination of nursing to biomedicine. This view reflects analytic stability, as well as institutional inertia. Far less attention has been paid by sociologists to the ways in which nursing is constructing its difference from medicine, and the exercise of the professional imagination that this involves. This paper suggests a strategy by which this might be remedied, which would focus on professional narratives. [ABSTRACT FROM AUTHOR]

Nineteen patients with psoriasis vulgaris and no other cause for systemic complement activation were studied for evidence of such activation. There was a marked elevation in serum C5b-A9 complexes with no other significant complement abnormalities, and no correlation between C5b-A9 levels and disease activity. This is the most detailed study of complement in psoriasis yet attempted and confirms that complement activation is a feature of psoriasis vulgaris. [ABSTRACT FROM AUTHOR]

The article discusses the case study of the 51-year-old man with history of inflammation of his nose and later complained about itchy rash on his chest, arms and back, consisting of erythematous papules with a surrounding collarette of scale. A skin biopsy from the nose showed loss of the superficial epidermis, and the chest epidermis was intact with clefting in the granular layer diagnosed with pemphigus foliaceous.

Describes a case of cutaneous larva migrans contracted in Scotland. History of an itching weeping plaque on the right buttock and a creeping eruption on the left flank; Microscopy and culture of fungal scrapings; Biopsy results; Assumption of ancylostoma or toxacara as the causative organism.

Presents a case of Rothmund-Thomson syndrome with myelodysplasia. Characteristics of the syndrome; Description on the cutaneous changes; Factor causing the development of the syndrome with myelodysplasia.

The results of patch testing with a series containing components of cigarettes and matches were reviewed. 2 years were reviewed, 1987 and 1997. 314 patients were patch tested to this series, 203 in 1987 and 111 in 1997. 31 patients had clinically relevant positive reactions to the series, 25 in 1987 and 6 in 1997. 26 patients had relevant positive tests to cigarette components in the series. There were 14 relevant positive reactions to phosphorus sesquisulfide in 1987 and one in 1997. All patients with relevant positive reactions to red match tips also had reactions to phosphorus sesquisulfide. There was a significant association between cigarette and fragrance hypersensitivity. The eczema in 3 of 4 patients who stopped smoking improved. A series containing match heads, smoked cigarette filters and remnants of tobacco from smoked cigarettes may be useful in smokers with eczema of the lace, neck or hands. [ABSTRACT FROM AUTHOR]

1203 patients attending for routine patch testing at 3 hospitals and 105 volunteers were tested with 0.5% and 0.05% gold sodium thiosulfate (GST). 38 patients (3.2%) and 5 volunteers (4.8%) had positive patch tests to GST There were no significant differences between volunteers and patients with respect to age, sex, atopy or exposure to gold in dental restorations, jewellery or through occupation. There were no significant differences in prevalence of GST hypersensitivity in the 3 hospitals, or between patients and controls. This is the 1st controlled study of hypersensitivity to GST, and suggests that routine patch testing to gold is of limited clinical benefit. [ABSTRACT FROM AUTHOR]

It has been suggested that allergic contact dermatitis (ACD) is uncommon in psoriasis, but associated with flexural and palmoplantar involvement. Previous studies have suggested an association between site and morphology of psoriasis and allergic contact sensitivity but it was found that a similar proportion of patients with and without positive patch test reactions had flexural, palmoplantar and chronic plaque psoriasis. Contact allergy to medicaments including dithranol has been recorded in psoriatics.

Sequential surface reactions of trimethylaluminum and water vapor have been used to deposit Al2O3 on Si(100) surfaces. The self-limiting nature of the surface reactions allows precise control of the thickness of the deposited layers and gives rise to films with highly conformal step coverage. High quality dielectrics have been deposited at temperatures as low as 100 °C. Resistivities of 1017 Ω cm, breakdown strengths of 8×106 V/cm, and interface-state densities of 1011 states/eV cm2 have already been achieved and they suggest possible applications as a gate insulator or a dielectric passivation layer. [ABSTRACT FROM AUTHOR]

Excimer laser photolysis of organoaluminum adlayers has been used to catalytically activate the deposition of Al via thermal decomposition of triisobutylaluminum. The process exhibits good spatial selectivity and patterns with 4 μm resolution have been accurately reproduced. Patterned Al metallizations have been performed on Si, SiO2, Al2O3, and GaAs substrates and show promise for practical applications. Electrical measurements probing Al/substrate interface quality indicate that this technique may be suitable for the fabrication of rectifying contacts on GaAs. [ABSTRACT FROM AUTHOR]