This continued growth has resulted in environmental problems such as coastal wetland loss, habitat degradation, and water pollution, gas flaring, destruction of forest vegetation as well as a host of other issues. This underscores the urgent need to design new approaches for managing remote costal resources in sensitive tropical environments effectively in order to maintain a balance between coastal resource conservation and rapid economic development in developing countries for sustainability. Notwithstanding previous initiatives, there have not been any major efforts in the literature to undertake a remote sensing and GIS based assessment of the growing incidence of environmental change within coastal zone environments of the study area. This project is an attempt to fill that void in the literature by exploring the applications of GIS and remote sensing in a tropical coastal zone environment with emphasis on the environmental impacts of development in the Niger Delta region of Southern Nigeria. To deal with some of the aforementioned issues, several research questions that are of great relevance to the paper have been posed. The questions include, Have there been any changes in the coastal environment of the study area? What are the impacts of the changes? What forces are responsible for the changes? Has there been any major framework in place to deal with the changes? The prime objective of the paper is to provide a novel approach for assessing the state of coastal environments while the second objective seeks a contribution to the literature. The third objective is to provide a decision support tool for coastal resource managers in the assessment of environmental impacts of development in tropical areas. The fourth objective is to assess the extent of change in a tropical ecosystem with the latest advances in geo-spatial information technologies and methods. In terms of methodology, the paper draws from primary and census data sources analyzed with descriptive statistics, GIS techniques and remote sensing. The sections in the paper consist of a review of the major environmental effects and factors associated with the problem: initiatives and mitigation measures. The project offers some recommendations as part of the conservation strategies. In spite of concerted efforts by managers to address the problems, results revel that the study area experienced some significant changes in its coastal environments. These changes are attributed to socio-economic and environmental variables.In the last decades, the Niger Delta region has experienced rapid growth in population and economic activity with enormous benefits to the adjacent states and the entire Nigerian society. As the region embarks upon an unprecedented phase of economic expansion in the 21 In the last few decades, the Niger Delta region has experienced rapid growth in population and economic activity with enormous benefits to the adjacent states and the entire Nigerian society. From the time vast oil deposits was discovered in commercial quantities in the Delta in 1956 to the present, the Nigerian state profited immensely from the oil fortunes of the region. Since then the area has grown to become the source of foreign exchange earning for the country. Starting from the fiscal year 1975 to the new century, oil from the Delta region has on the average accounted for more than 90 percent of Nigerian exports and about 80 % of government revenues as of December, 1981.Although oil production activity in the Delta has carved a remarkable economic landscape for the country with an enormous contribution to foreign exchange earning, however, there is a negative side. Petroleum exploration has triggered adverse environmental impacts in the Delta through incessant environmental, socioeconomic and physical disasters that accumulated over the years due to limited scrutiny and lack of assessment . Such inElsewhere, the United States Department of Energy (USDOE) shows that since the inception of oil and gas activities, severe environmental pollution in the Niger Delta involving uninterrupted gas flaring and oil and spillage remains rampant in the region. According to the US DOE, the area has experienced 4,000 oil spills since 1960. One of the most noticeable impacts of the various oil spills and production activities has been the loss of mangrove trees. The mangrove was once a source of both fuel-wood for the local people and habitat for the area’s biodiversity, but now it is unable to withstand the high toxicity levels of petrochemicals ravaging its habitat. The spills have had adverse effects on marine life that have become contaminated, and that in turn poses enormous risks to human health from consuming contaminated seafood . Oil andThe state of the Niger Delta’s environment has attracted national and international attention due to the enormous deposits of oil and gas, and the resultant impacts coupled with a controversial revenue sharing formula that has impoverished the communities. Because of massive exploitation of oil, the ramifications for human health, local culture, indigenous self-determination and the environment are severe. Accordingly, the economic and political benefits are given more emphasis at the expense of environmental health –8. More st century. Thus as the region embarks upon an unprecedented phase of economic expansion in the 21st century, it faces several environmental challenges fuelled partly by the pressures caused by human activities through oil and gas exploration, housing development, and road construction for transportation, economic development and demographic changes . I. I17]. IThis paper stresses a mix scale approach involving the integration of primary and secondary data provided through government sources and data bases from other organizations. The raw spatial data and satellite images used in the research came from the United States National Aeronautical and Space Administration (NASA). To answer some of the research questions pertaining to the study area, the spatial data was analyzed with descriptive statistics and remote sensing technology.The first step involves the identification of the variables needed to assess environmental change at regional level. The variables consist of socioeconomic and environmental information, including the amount of cropland, human settlement, water bodies, forest types, and population, See  and 3. TTwo Landsat Thematic Mapper (TM) and Enhanced Thematic Mapper Plus (ETM+) images of 4 May 1985 and 12 June 2000 were obtained for this study. The Landsat TM and ETM+ satellite data were processed using ERDAS IMAGINE 8.7 image processing software.The images were imported into ERDAS using ERDAS native file format GEOTIFF. Since the images were in single bands, they were stacked together using ERDAS layer stack module to form a floating scene. The 1985 image was co-registered with the year 2000 image and later geo-linked to allow for the subset of both images of the study area. Enhancement of all the images using histogram equalization techniques was later performed. The images were classified using an unsupervised classification technique to identify land cover features within the study area. The remaining procedure involves spatial analysis and output (maps-tables-text) covering the study period, using ARCVIEW GIS. The spatial units of analysis consisted of the states located in the Delta region . OutputsThis section presents the results of the data analysis by first providing a brief synthesis of the descriptive statistics and geospatial analysis  of the assessment. Later, it highlights the factors associated with environmental change in the study area and frameworks in place to reverse the trends.The results of 1985 and 2000 classified images presented in th July 1979  etc [The frequency of oil spills from fire disasters quite rampant in the area have led to the death of thousands of community residents, contamination of water, explosions and destruction of vegetation and the freshwater ecosystem . Judgingbbl) etc , 19. SeeThe last decade has witnessed the influx of people to the area in search of oil jobs and other economic opportunities causing degradation of most of the vital environmental resources. As shown in Over the period of 1975 to date, more than 90 per cent of the nation’s exports earnings have, on average been generated from the region’s oil resources . BecauseThe first systematic surveys of the Delta’s flora and fauna conducted during the past decade showed that the forests and the animal populations of the Delta are under serious stress. The area’s most second important timber species (Abura) once common in the region has been removed by logging activities. Widespread disturbance on the Delta’s remaining forests originates from a rapidly growing Nigerian population as well as proliferation of development infrastructure that makes it easier to access the remaining areas of swamp forest. Considering the limited efforts in protected area planning in the Delta, the rapid levels of destruction epitomizes a bleak future awaiting its diverse habitats and species . As in aThe framework for oil operations in Nigeria is stipulated in the Petroleum Act, and other relevant legislations. This includes the Oil in Navigable Waters Act of 1968, the Oil Pipelines Act of 1956 as well as the Associated Gas Act of 1979, and the Petroleum (Drilling and Production) Regulations of 1969, promulgated under the Petroleum Act of 1988. Since 1988, the Federal regulations promulgated through Environmental Protection Agency (FEPA), govern environmental activities in the oil sector and other industries. The Department of Petroleum Resources (DPR) has also formulated various environmental guidelines and standards for the Petroleum Industry in Nigeria .Under the existing laws, oil companies are mandated by federal laws to use precautions including the provision of state of the art technologies to prevent pollution, and act appropriately in eradicating the problems arising from petroleum . Part of the oil sector’s legal obligations under the Environmental Impact Assessment (EIA) Act of 1992 require an EIA on the location of a proposed project that it is likely to significantly affect the environment  even thoPrevious policy efforts in economic development planning in the region have had a local flavour for years. This emphasis took for granted the socio economic and ecological impacts of development programs on the ecosystem of adjoining states, counties and communities where oil companies operated. Because the gravity of these problems that accumulated over the years in the Delta area, the federal government initiated a series of regional development programs to meet the challenges. The Niger Delta Development Commission (NDDC) that emerged from the process provides a platform for the focused development of the region. The NDDC’s community level process consists of three main parts: state-wide awareness and capacity building workshops to identity community problems and formulate projects for solving them, followed by community consultation and implementation, supported by a network of community research centers . Under tIn spite of the frameworks in place, the results not only reveal that the study area experienced some significant changes in its coastal environments, but the region remains an ecosystem under stress. The nature and extent of this change showed some variations across time and space. The changes attributed to socioeconomic and environmental variables reflect also a host of other factors. Over all the results point to a decline in water bodies, mangrove forests, and an increase in human settlements, mixed forests, cropland and agricultural intensification as well as several cases of oil spillages which posed a major threat to the environment and natural systems of the region. Other interesting findings touch on an impending population explosion in the coastal region of the Niger Delta in Southern Nigeria. Of particular concern is the growth rate in the Niger Delta and the massive concentration of human settlements in the Port Harcourt area of Rivers state. This trend is gradually turning the Delta region into an ecological time bomb waiting to explode. This will not only threaten the carrying capacity of an already fragile ecosystem but it poses enormous challenges for both environmental and natural resource managers and policy makers in the region if not confronted with the urgency it deserves.st century.In light of this finding, the practical use of a mix scale approach involving primary and census data, GIS and remote sensing in tracking coastal environment change stands an update to current literature on coastal resources management in the Niger Delta of Nigeria. Considering the little efforts in the past to assess the Delta ecosystem, GIS technology as used in this paper has fulfilled a useful purpose for storage, manipulation and mapping of coastal data with a spatial reference. It also stands as an effective tool for coastal resource management. Integrated data analysis using remotely sensed satellite imagery and GIS modeling, facilitated the analysis of the spatial distribution of environmental change involving land use, land cover classification, forest and hydrology and demographic issues facing the Niger Delta environment. Such information technology is highly indispensable for the decision makers in Nigeria as they grapple with the future of development activities along the Delta ecosystem in the 21Four recommendations for conservation strategies and environmental protection are listed below.The series of controversies surrounding the ecological decline of the Niger Delta have been partly attributed to several factors. Considering the role of policy lapses, inaction towards environmental safety of the communities and inequity, protecting the coastal environment will require active community input and equitable distribution of natural resources revenues. Thus, conserving the coastal environment of the Niger Delta demands an understanding of the socio economic needs of local communities who are constantly faced with the threat of a poisoned environment triggered by development activities. Under this setting, the authorities in Nigeria and the oil and gas industry and others should encourage the implementation of participatory approach in matters associated with oil and gas activities during the leasing process so that those communities closer to the problems can have a say on economic development matters and decisions likely to affect their local environment. This could also be achieved through meetings and training sessions on the assessment of the major environmental and social problems facing the Delta region with participation of local universities, non governmental organizations and the communities themselves, the oil sector and government agencies as well .The development activities along the Niger Delta region has for several decades escaped a rigorous environmental scrutiny required of any fragile ecosystem in advanced nations of the world. Surprisingly, the petroleum sector of the economy undertook oil exploration without proper environmental impact assessments a situation that is untenable in advanced countries that are home to the major oil companies. To deal with these anomalies environmental impact assessment of oil and gas development projects in the region should be required before the commencement of oil and gas activities. This approach can be developed by comparing the future costs and benefits of projects on the environment before approval. The proposed model places highest priority on sets of criteria and objectives in order to gauge how the proposed activities can impact wildlife, natural habitats, hydrology, soil, wetlands and social environment. This EIA process requires also the classification of preferred alternatives to reduce identified risks to the ecosystem of the Niger Delta. While the EIA process as suggested here are frequently used in advanced nations, it is a valuable benchmark for gauging where policy interventions can be most efficiently directed given the scanty resources and support system existing in the Niger Delta .An integrated costal resource management approach is needed to address such a broad range of social and environmental issues facing the Delta in a sustainable manner. Integrated coastal zone management implies holistic planning and coordinating process capable of guaranteeing that large economic and social benefits from resources in the Niger Delta are not dissipated by environmentally destructive polices. ICZM represents an ecologically and socially sensitive approach to environmental management with a major divergence from the more traditional technocratic rational planning models that have proven to be out of touch and ineffective in dealing with the complexities associated with coastal problems. To accomplish its purposes ICZM builds from several actions at the national and regional level as part of an action plan to correct past environmental degradation and to modify current activities that are environmentally harmful. These include the establishment of an appropriate policy framework to support coastal resources management and environmental conservation . This caCurrent attempts to assess the state of the environment and the environmental stewardship of economic development along the Niger Delta ecosystem are often handicapped by the lack of complete access to a comprehensive regional environmental information system. The design of a regional en vironmental information system on the ecology of the Niger Delta will serve as a decision support tool for policy makers, oil sector and research by facilitating data collection capabilities of users and access to a state of the art technical infrastructure of relevance to the management of the coastal zone. The expectation is that such an information system will help in displaying the interactions between the fragile ecosystem of the region and human activities and then sharpen the response mechanisms in dealing with the problems. It has the potential in offering a viable system for reviewing and implementing new coastal zone development projects as well as the development of effective technical infrastructure to oversee environmental monitoring of the coastal zone on a permanent basis. In this case, the paper recommends the design of a regional information system to stem the on going environmental decline of the region, as proposed by Merem .This project has explored the applications of GIS and remote sensing in a tropical coastal zone environment with emphasis on the environmental impacts of development in the Niger Delta region of Southern Nigeria. The paper presented a vivid overview of the issues in the literature, a review of the major environmental effects and factors associated with the problem, initiatives, and mitigation measures. Notwithstanding previous initiatives, there has not been any major effort in the literature to undertake a remote sensing and GIS based assessment of the growing incidence of environmental change within coastal zone environments of the study area. In spite of concerted efforts and initiatives to address the problems, results reveal that the study area experienced some significant changes in its coastal environments. These changes are attributed to socio-economic and environmental variables and a host of other factors.The results point to a decline in water bodies, mangrove forests, and an increase in human settlement, mixed forests, cropland and agricultural intensification as well as several cases of oil spillages. The other interesting findings touched on the potentials for a rapid population growth in the region and the implications. This will not only threaten the carrying capacity of an already fragile ecosystem, but it poses enormous challenges for environmental and resource managers, and policy makers in the region if not confronted with urgency. To deal with these problems, the project offers some recommendations as part of the conservation strategies for the region. The recommendations consist of participatory approach, periodic assessment, coastal zone management and the design of a regional information system.st century.The practical use of a mix scale approach involving GIS and remote sensing tools for the assessment of environmental change provided some interesting results for coastal resources management in the Niger Delta. Moreso, it is evident that GIS technology as used by scientists for storage, manipulation and mapping of data with a spatial reference stands as an effective tool for resource management. Using remotely sensed satellite imagery and GIS modeling, quickened the analysis of the spatial distribution of environmental change involving land use, land cover classification, forest and hydrology and demographic issues facing the Niger Delta. In closing, it is our belief that successful implementation of some of the strategies could lead to effective management of the coastal environment in the Niger Delta region. Furthermore, the paper serves as an essential tool for the design of geo-spatial decision support systems for coastal resource managers in the assessment of environmental impacts of development in tropical areas. This is highly indispensable if the Niger Delta is to recover from decades of environmental decline inflicted on the area by various development actives as we move further into the opening decades of the 21


The aim of this study is to report the control of lymphorrhea in the intensive treatment of elephantiasis, using an Unna boot. The case of a 29-year-old female patient is reported. This young patient evolved with the more serious form of lymphedema, elephantiasis, after surgical treatment of an abdominal neoplasm and radiotherapy. Warty excrescences were present on both legs and genitalia where lymphorrhea was constant. The patient arrived at the Godoy's Clinic for treatment. She was weighed and perimetric evaluations were made at the start of treatment and thereafter every day during an intensive outpatient treatment of eight hours daily for three weeks. Treatment included manual lymph drainage, mechanical lymph drainage using the RA Godoy device, and the continuous use of compression stockings with adjustments made every three hours. An Unna boot was employed as compression at sites of dermal lesions (warty excrescences) with overlapping use of individualized compression stockings that were individually adapted. The Unna boot was renewed every two days during the first week and every 3 days during the second and third weeks. By the end of this course of treatment, most of the warty excrescences had reduced in size or even disappeared and the lymphorrhea was controlled. Lymphedema usually affects poor populations; there is no cure and little prospect of therapies being developed by the private health sector. This situation is aggravated in less developed countries where the lack of government resources and specialized health care professionals has led to the marginalization of this disease .An association of therapies, which generally includes manual lymph drainage, compression therapy, exercises, and hygienic care, is recommended for the treatment of lymphedema , 2. MoreIntensive treatment of lymphedema, which offers the possibility of the rapid control of swelling, has been reported in the literature . HoweverThe aim of this study is to report on the use of an Unna boot that allowed the use of an associated compression mechanism with a resulting faster reduction in leg volume, thereby offering a new perspective in the treatment of wartyexcrescences and lymphorrhea in this most severe form of lymphedema.We report the case of a 29-year-old female patient with lymphedema of the lower limbs. The patient arrived at the Clinica Godoy in Sao Jose do Rio Preto for treatment in January 2011. The patient reported that the lymphedema started at the age of 12 or 13 years old when she was submitted to a surgery to remove a tumor in the abdomen, which started with pain and the diagnosis of appendicitis. During surgery a lymphoma was identified. After surgery, the patient was submitted to chemotherapy and radiotherapy sessions; she does not remember how many sessions due to her age at that time; her mother, who accompanied her, has passed away. The patient reported that the swelling began in the thigh region and spread to the feet; initially the edema got better with rest but eventually this improvement was no longer noted. Her vascular physician at the time prescribed lymph drainage, pressure therapy, and elastic compression hosiery. Even with treatment she noted that the edema increased and fibrosis developed in the abdominal region and eventually she abandoned treatment. With time the edema worsened further and wartyexcrescences began to develop on both legs and the genitalia with constant discharge of lymph. The patient was weighed and perimetric evaluations were made at the start of treatment and it was noted that the patient had difficulties to move the legs. Treatment consisted of an intensive  program with mechanical lymph drainage using the RAGodoy apparatus, Godoy and Godoy manual lymph drainage, and compression therapy.The RAGodoy is an electromechanical device that performs passive movements of the ankle joint (dorsiflexion and plantar flexion) adapted to the treatment of lymphedema. This device promotes the deep lymphatic drainage and the Godoy and Godoy lymphatic drainage technique performs manual compression followed by sliding over the lymphatic collectors to the corresponding lymph nodes.The Unna boots (Unnaflex) is an elastic bandage composed of zinc dioxide (which does not become stiff), glycerin, starches, castor oil, and white petrolatum. It adapts to the contour of the leg stretching softly and remaining flexible and is applied in the same way that one bandage, into spirals movements.Unna boots were employed on both legs to protect and for compression at the sites of dermal lesions (wartyexcrescences) with overlapping using individualized low-stretch compression stockings adapted to take into account the deformities made from a cotton-polyester fabric. Daily assessments of body weight and leg perimeter were made. The Unna boot was renewed every two days during the first week and every 3 days during the second and third weeks. The boot was employed for three weeks until most of the wartyexcrescences had reduced in size or even disappeared and the lymphorrhea was controlled Figures  and 2.Major deformities and the skin of the patient were monitored monthly. The patient was advised continuously about the need of hygienic care, to control the edema, and about the normalization of skin lesions.This study describes an alternative to treating major deformities where wartyexcrescences and lymphorrhea are aggravating factors. The use of compression without skin protection in these patients is associated with infection and worsening of the condition. Friction between the skin and the compression mechanism, without protection using creams, is associated to excoriation and infection.Recently an Unna boot has been employed in these cases as it protects against infections and allows a reduction in the volume of lymphedema with most wartyexcrescences disappearing during treatment. Even large lesions generally disappear spontaneously; when they do not, they can be eliminated by cauterization. In this case the approach was possible because the lesions were isolated; however when there are several lesions together, the friction between them may result in infections due to the development of skin injuries.The compression exerted by Unna boots is nonelastic and so useful in the treatment of lymphedema. The patient was prescribed penicillin-based antibiotics during this period as prophylaxis. This intensive approach allows large volume reductions of the legs; this patient lost about 31 kilos in 10 days of treatment. Thus, this quick reduction in weight helps to avoid injuries related to the wartyexcrescences which initially become flat and gradually disappear.This clinical approach reduced the necessity of surgical interventions of these excrescences, controlling lymphorrhea and protecting against the use of nonelastic compression mechanisms.We concluded that Unna boot is an option in the protection of warty excrescences and in control of lymphorrhea in patients with elephantiasis during the treatment of edema.


The surgical management of breast cancer has evolved over the years from extensive radical mastectomy to breast conservation surgery. Until the introduction of the sentinel lymph node biopsy (SLNB), all patients with invasive breast cancer would undergo complete axillary lymph node dissection (ALND) and thus be at risk of suffering from its associated high morbidity. SLNB has become the standard of care and represented significant progress toward reducing the invasive procedures for the management of the axilla. The most recent clinical trials (NSABP-B32 and ACOSOG Z0011) performed in patients that underwent SLNB support this procedure as an accurate predictor of the risk of further axillary node involvement and of breast cancer recurrence. Additionally, the ACOSOG Z0011 trial challenged the standard of practice in the management of the axilla, in which ALND is mandated for all the patients with a positive sentinel node. A similar outcome was demonstrated for a selected group of patients (treated with breast conserving surgery and radiotherapy) with positive SLNB then followed by ALND or SLNB only. In light of these results, the role of ALND in the current management of breast cancer is being reevaluated for specific patient subpopulations. In this special issue, this timely subject is provocatively reviewed in addition to other relevant topics, such as the controversial meaning of the presence of micrometastasis and isolated tumor cells in the SLN in relation to local recurrence and overall survival and the feasibility of performing SLNB after neoadjuvant treatment and transaxillary breast augmentation.Despite the advances in the lymphatic mapping and in the intraoperative methods for SLN analysis, the accurate identification of tumor cells in this node continues to be a challenge in clinical practice, and significant false-negative results in SLNB are still observed. In a research study published in this issue, a preferential cellular distribution of the malignant cells in the SLN is reported, suggesting that the pathological analysis directed to this area may contribute to a more precise identification of nodal metastasis. Additional progress in this direction involves the development of molecular markers, which would tackle not only the misdiagnosed SLN-negative patients but also the ones with low risk of recurrence that are unnecessarily submitted to SLNB. In this sense, the Bayesian-based nomogram developed by Westover et al. is proposed to be particularly useful, especially in cases where the SLNB assessment is predicted to be less sensitive. This nomogram would also lead to the identification of high-risk individuals for recurrence, based on the calculation of residual axillary disease risk, despite a negative SLNB. Several new reports, mostly based on gene expression profiling, have suggested that the different rates of recurrence can be due to the distinct molecular types of breast cancer. The development of a genomic signature that effectively discriminates patients by lymph node status, as the one proposed by Ellsworth et al., could stratify patients based on their need of surgical evaluation of the lymph nodes, sparing the ones in which disease will probably be limited to its primary site. The assessment of specific tumor markers in the lymph nodes is also discussed in this special issue, including a review of the prognostic and/or predictive implications of lymph node metastasis in tumors with elevated levels of CXCR4 (a protein chemokine receptor) and VEGF-C .From the Halsted radical mastectomy to the commercial gene expression profiling tests, axillary lymph node management and recurrence prediction are still evolving topics for patients with breast cancer. The continued improvement of molecular tumor profiling and bioinformatics from larger and better defined patient cohorts will certainly provide answers to many challenging questions regarding the axillary metastatic process. The clarification of this complex molecular mechanism and the identification of novel and integrative molecular markers that can reliably predict lymph node involvement that will affect risk of recurrence and survival will continue to form the basis of the contemporary approach for breast cancer management, where an early prediction of axillary metastasis and a personalized cancer treatment can be achieved.Luciane R. CavalliLuciane R. CavalliRachel E. EllsworthRachel E. EllsworthChristoph KleinChristoph KleinGiuseppe VialeGiuseppe Viale


Use of ultrasound introduced as part of intensive care therapy makes viable bedside invasive procedures and diagnosis. Due to portability, combined with team training, its use guarantees less complications related to insertion, as well as patients' safety. It also reduces severe conditions related to the catheter, such as pneumothorax among others. The aim of this study was to evaluate the accuracy related to ultrasound-guided venous catheter insertion in a low-cost famtoma among medical students of third-year graduation compared with experienced doctors and medical residents. We evaluated the success rate of insertion, the number of puncture attempts and the time related to the insertion of the needle from contact with the surface of the phantom and its correct placement in the vein.Study participants were 25 undergraduate students of medicine (third year) participating in the curriculum of emergency medicine and intensive care, nine medical residents  and nine critical care physicians. All participants had no previous experience with ultrasound-guided procedures, and medical students had no previous experience with central venous access puncture. There was a lecture prior to the study of 2 hours in ultrasound-guided venous cannulation. Evaluation of the average time between groups was performed by ANOVA using data processing in rank due to lack of homogeneity and the Tukey test for multiple comparisons. A possible relationship between the time needed until the puncture is performed and length of experience was assessed by Spearman correlation, due to lack of normality in the data.We found a success rate of 100% in the insertion of a catheter in phantom among all participants, a longer time in the group of graduate students (Table The use of ultrasound-guided cannulation is a reliable method of training associated with a high of success among graduate students and experienced professionals.


After the publication of this work , we becaMethods' section of the Abstract, the first sentence should have read:In the '"The clinical and follow-up data of 124 patients who were referred to our department for SIRT between June 2008 and October 2010 were evaluated retrospectively."Patients' section of the Patients and Method, the first sentence should have read:In The '"The clinical and follow-up data of 124 patients who were referred to our department for SIRT between June 2008 and October 2010 were evaluated retrospectively."Patients' section of the Results, the first sentence should have read:In the '"78 patients  received intra-arterial radionuclide treatments with 90 Y for liver metastasis or primary HCC between June 2008 and October 2010."


How can groups of neurons selectively encode different memories? We investigated a possible mechanism for the selective activation of regions of a network based on the resonance properties of individual neurons and heterogeneities in the network connectivity. In network simulations of coupled resonate and fire neurons, we incorporated the experimentally observed phenomena of resonance frequency shift based on membrane voltage changes. We aim to understand to what extent the resonance frequency shift allows for the separation of signals. We find that formation of neuronal subgroups, whether through higher connectivity strength or number of connections can lead to different activation properties from the rest of the network.


Cardiovascular diseases are among the most important causes of morbidity and mortality in the world. One of the important risk factors of cardiovascular disease is hyperlipidemia especially high levels of serum cholesterol. Due to the importance of hypercholesterolemia, being a serious condition, various treatments are used to control it, regardless of the cause, most of treatments, focused on reducing the level of serum lipids. This study aims to determine various view points for hypercholesterolemia in Iranian traditional medicine.We used several Iranian traditional medicine resources and literatures; then based on these texts; a pilot study was designed to assess their effects in 10 patients with high plasma cholesterol. The sign and symptoms in main digestive organs (Stomach and liver) were also evaluated.Some patients showed hepatic temperament but all patients had gastric temperament.With reference to Iranian traditional medical texts and literatures, the organs involved in the process of digestion, particularly the stomach and the liver play the most important role. Yet the proper function of stomach as the first step involved in the digestion chain should be emphasized. Lipids are body components which play important roles in energy storage and in the structure of the cell membranes, hormones and secondary mediators. Plasma lipid concentration depends on the balance between production, consumption and deposition of lipids. The hypeThe important point in atherosclerosis disorder is to modify the level of lipids; because improved lipid levels to prevent atherosclerosis is the foundation. There arThe Iranian traditional medicine system makes effort to propose the best possible ways by which a person can lead an optimum healthy life with least illness. The Iranian traditional medicine framework is based on some principals. One of the important principles is "Umore Tabiya". Umore Tabiya includes different parts: Arkan (Rokn), Amzaj , Akhlat , Aza (Ozv), Arvah (Rooh), Qova (Qova) and Afal (Fel), respectively.32]33][33]32][3[33]32][3"Mizaj" (temperament) is a quality which is a consequence of mutual interaction of the four contradictory primary qualities  residing within the elements. These elements are so meticulously intermixed with each other that they lie in a very intimate relationship to one another. Their opposite powers intermittently conquer and are conquered until a state of balance is reached which is uniform throughout the whole. This result was given the name of temperament (Mizaj).35]36] [36] 35][ [36] 35]Mizaj is one of the most important canons of Iranian traditional medicine system. It has an important function in maintaining the ideal healthy state of an individual. Vulnerability of its altered temperament which is called dystemperament (Sui' e Mizaj) leads to several different types of diseases."Humor" which is called in the Iranian traditional medicine texts as "Khelt" is a wet and fluid substance which foodstuffs in the first stage of permutation changes to it. Normally there are four humors in the human body: "Phlegm or Balgham, Blood or Dam, Yellow bile or Safra and Black bile or Sauda". Each of the humors was related with pairs of qualities including cold and wet, hot and wet, hot and dry, and cold and dry, respectively.39]40][[40][39][[[40][39]In the Iranian traditional medicine texts, there is no concept of hypercholesterolemia as such; but in many cases has been described it as a disorder. As far as the presence of fat (Lipids) is concerned in blood, Ibn Sina (Avicenna) an ancient Iranian traditional physician46]47][[47][46][[[47][46]Dosoomat of blood or the oily substance could be the lipids but as the biochemical analysis of blood was not available and they could not describe it as per modern parameters.2 According to the fundamentals of Iranian traditional medicine, the blood circulating in the vessels is a combination of four humors. ThereforBased on available evidences and the detailed descriptions of the Iranian traditional medicine resources, ingested food undergoes various stages of digestion before reaching the tissues.54] Ibn- Ibn-54] Each stage of the digestion is composed of specific processing of the food material that must be carried on until it becomes suitable for used by the body. In each digestion process, the following actions take place :55]55]1. In the gastric digestion, some of the traits and characteristics of food material changes and appropriate absorbable material named "Chylous" is absorbed via the mesenteric vessels to the liver for further digestion.2. In the hepatic digestion stage, the chylous is changed in to the "Chymous" that is composed of four humors , which will circulate in the vessels.3. In the vascular digestion stage, the food state gets closer to the tissue state.4. During the tissue digestion stage, food becomes quite similar to the end organ tissue.As it was expressed, the humors are the final products of the hepatic digestion and in order for the humors, to be of good quality two conditions must be met including (i) Normal liver function for proper digestion and (ii) The (Gastric chylous), which is used by the liver for the production of humors that must have an appropriate composition. The second condition would not be present unless the stomach function properly and the ingested food is of good quality.According the book "The Qanon of Medicine" (by Avicenna), the foundation of Iranian traditional medicine system was based on the balancing humors in the human body.57] Thei Thei57] As it was expressed previously, the continuity between the stages of digestion and even the organs involved is such that any disorder in one of them would bring about a disorder in other organs and stages. Abnormal vascular content may be a consequence of hepatic maldigestion. Also the hepatic maldigestion, itself may be a consequence of gastric maldigestion. In other word, abnormal gastric chylous results in abnormal hepatic chymous and abnormal hepatic chymous results in abnormal humors . It shouThe most important point is that due to the close relationship between different organs that contribute to the digestive chain, the impairment in each of the stages of digestion will ultimately cause production of abnormal humor. This abnormal humor does not have the quality to become the desired end product. In later stages of digestion, the abnormal humor affects the function of organs consuming it and furthermore may gradually cause dysfunction of the next responsible organ in the digestion chain.Based on the above hypothesis, to find the responsible organ causing hypercholesterolemia and to provide scientific basis for deeply studying the relation between body humors and hypercholesterolemia, a pilot study was designed to assess 10 patients with high plasma cholesterol. The sign and symptoms of the dystemperament (Sui' a Mizaj) of the main digestive organs (Stomach and liver) were obtained. Symptoms which according to them the medical history was taken, were derived from the traditional diagnostic and treatment books, like The Qanon of Medicine of Ibn Sina (Avicenna), the KholOur study indicated that only some of the patients had hepatic dystemperament (Sui' a Mizaj) and surprisingly all of the patients had gastric dystemperament. The significant difference between the results of gastric and hepatic dystemperament in our patients, suggests that the responsible organ involved in hypercholesterolemia is the stomach. Furthermore; the hepatic dysfunction, if not considered to be a consequence of gastric failure, will be the second responsible organ. Results of this study provide information for using Iranian traditional medicine in clinic and developing Iranian traditional medicine.With reference to Iranian traditional medical texts, one can reach the basic point that organs involved in the process of digestion, particularly the stomach and the liver play the most important role in determining the blood composition. However, the proper function of stomach as the first step involved in the digestion chain should be emphasized. If the gastric digestion is impaired, the rest of the organs involved in digestion like the liver, blood vessels and tissues cannot be provided with the necessary qualified raw material (chylous) and therefore may suffer dysfunction, thus causing abnormal product formation such as abnormal humors and blood composition.It can be concluded that the first and best action in the treatment of hypercholesterolemia is to treat the stomach dystemperament (Stomach Sui' a Mizaj) and if then the disorder persists, the dystemperament of the liver should be considered. Further clinical study is recommended to investigate this issue.


In 2006, even with the external support, most of the districts in Jharkhand state were unable to do health planning beyond an initial prospective planning. The key impediment was the lack of capacity to analyse the health situation in their districts and develop strategies and propose budgets to implement these. The Public Health Resource Network (PHRN) in partnership with the National Health Systems Resource Centre (NHSRC) developed a training curriculum and a fast-track capacity building programme in 2006 to address this gap.Jharkhand state adopted this training programme and trained selected officials from all districts in several batches beginning in the year 2008. Social workers from various civil society organisations were also trained on district health planning through a parallel distance-learning programme by PHRN. The trained personnel from both health department (n=155) and civil society groups (n=85) supported the district programme management unit in preparing district health action plan during November 2009 to March 2010.This study was done in order to assess the significance of the PHRN-led capacity building in enhancing the individual and institutional technical capacities at the district level. Study aimed to understand how the capacity building enhanced the district level planning and management of health service deliveries under the National Rural Health Mission (NRHM).A case study on district health planning processes was prepared through a desk review of reports, review of district health plan documents, focus group discussions with the district teams, and interviews with stakeholders.We found that at least 10 of the 24 districts developed in-house capacity to take forward the health planning processes at district level as a result of the capacity building programme. This Improved planning capacity at district level has enhanced the enthusiasm for decentralised planning replacing the earlier notion that planning is a normative compulsion under NRHM.The situation analysis and planning was better in the districts where the selection of personnel for the training was done. Involvement of civil society members improved compliance to the decentralized planning process. The capacity building intervention improved the focus on inclusive planning and equity through special plans for vulnerable areas and groups.All districts were able to prepare and submit their action plans on their own for the first time, with limited guidance and appraisal inputs from experts at the state level. Most of the plan proposals from the districts were incorporated in the state project implementation plan for 2010-11. The subsequent 2011-12 planning process has adopted the same strategy.There is a need to improve the competence of the district team for planning and management of public health systems through systematic capacity building. The selection of personnel for such capacity building programmes is crucial for the success of the programme. Even though several years have passed since the launch of NRHM, and there have been some capacity-building inputs, there are gaps especially in the regions where this is most needed. The key challenge is how these improvements can be institutionalised and maintained.Also, there is a need to ensure resource allocation based on the needs indicated by the district health plans. In absence of this, the enthusiasm created by the capacity building initiatives may diminish.


The health risk assessment from exposure to a particular agent is preferred when the assessment is based on a relevant measure of internal dose  rather than simply the administered dose or exposure concentration. To obtain such measurements, the relevant biology, physicochemical properties, and biochemical mechanisms of a specific agent are used to construct biologically based models that can be used to predict its uptake, disposition, target tissue dose, and ensuing tissue responses in test animals and humans. The focus of this special issue is the state of the science underlying the development and application of a specific type of biologically based model  models) in risk assessment. The fourteen papers presented herein address critical issues and advances relating to their use in current risk assessment approaches with a focus on their use in emerging toxicology paradigms as well. The first paper in this issue  presents an overview that (1) briefly introduces the papers contained in this special issue; (2) provides context for how they inform best modeling practices and state-of-the-art risk assessment applications of PBPK models; (3) discusses limitations and bridges of modeling approaches for future applications and how papers within the issue fit into that emerging science. Specifically, novel approaches for estimation/characterization of metabolic parameters for PBPK models are examined in two articles  with application of PBPK models for determination of exposure and interpretation of biomarker data examined in three articles . The special issue contains several case studies that illustrate the development and/or use of quantitative models to address specific needs of risk assessment of selected chemicals  and chemical mixtures . The impact of human population subgroup variability on the magnitude of uncertainty factor developed as part of risk assessment of volatile organic chemicals is also described . A broader perspective on the use of PBPK models for addressing contemporary issues in risk assessment is presented along with a progress report on the development of a PBPK “tool-box” for more general applications . In summary, the collection of papers by leading experts in this field that comprise this special issue provides insight and tools for a wide spectrum of risk assessment applications. These papers can be used for (1) facilitation of the screening and prioritization of chemicals, (2) linkage of exposure to internal dose, (3) analysis of mechanistic information and prediction of risk to chemical mixtures, and (4) provision of computational techniques and tools to address uncertainty and variability questions related to identification and prediction of responses and pharmacokinetics in potentially sensitive subpopulations. We hope that this “snapshot” of the current state of the science, best practices, and challenges for application of these tools in emerging risk assessment approaches and data will be of tremendous interest to the regulatory and scientific communities internationally. This information can build a foundation for use of these predictive models for a variety of applications and for future reduction of uncertainty in those predictions.


Coherent optical phonon spectra show that femtosecond laser-irradiated crystallization threshold of the multilayer films relies obviously on the periodic number of the multilayer films and decreases with the increasing periodic number. The mechanism of the periodic number dependence is also studied. Possible mechanisms of reflectivity and thermal conductivity losses as well as the effect of the glass substrate are ruled out, while the remaining superlattice structure effect is ascribed to be responsible for the periodic number dependence. The sheet resistance of multilayer films versus a lattice temperature is measured and shows a similar periodic number dependence with one of the laser irradiation crystallization power threshold. In addition, the periodic number dependence of the crystallization temperature can be fitted well with an experiential formula obtained by considering coupling exchange interactions between adjacent layers in a superlattice. Those results provide us with the evidence to support our viewpoint. Our results show that the periodic number of multilayer films may become another controllable parameter in the design and parameter optimization of multilayer phase change films.The periodic number dependence of the femtosecond laser-induced crystallization threshold of [Si(5nm)/Sb The frequency of COP modes before and after crystallization appears at approximately 3.90 and 4.55 THz, respectively. The former is assigned to the phonon mode of amorphous Sb80Te20 layer, while the latter is assigned to the A1g optical phonon mode of crystalline Sb and is not related to the periodic number. In addition, the crystallization power threshold decreases with the increase of the periodic number. The periodic number dependence of the power threshold is attributed to the crystallization temperature decrease with the increase of the periodic number and is considered originating from superlattice structure effects. The periodic number of the multilayer films provides another additional degree of freedom to simultaneously optimize multiple parameters of the multilayer phase change films.The periodic number dependence of the femtosecond laser-induced crystallization of [Si/SbFFT: Fast Fourier-transformed; COP: Coherent optical phonons; CPS: Coherent phonon spectroscopy.The authors declare that they have no competing interests.CW, MS, and JZ carried out the sample preparation and electrical characterizations. WZ,SL, and TL conceived of the laser-induced crystallization studies and coordinated the experiment. All of the authors participated in the analysis of the data. WZ and TL wrote the manuscript. All authors read and approved the final manuscript.


Ixodes scapularis) vectors infected with Borrelia burgdorferi, are complex and vary across eastern North America. Despite study sites in the Thousand Islands being in close geographic proximity, host communities differed and both the abundance of ticks and the prevalence of B. burgdorferi infection in them varied among sites. Using this archipelago in a natural experiment, we examined the relative importance of various biotic and abiotic factors, including air temperature, vegetation, and host communities on Lyme disease risk in this zone of recent invasion. Deer abundance and temperature at ground level were positively associated with tick abundance, whereas the number of ticks in the environment, the prevalence of B. burgdorferi infection, and the number of infected nymphs all decreased with increasing distance from the United States, the presumed source of this new endemic population of ticks. Higher species richness was associated with a lower number of infected nymphs. However, the relative abundance of Peromyscus leucopus was an important factor in modulating the effects of species richness such that high biodiversity did not always reduce the number of nymphs or the prevalence of B. burgdorferi infection. Our study is one of the first to consider the interaction between the relative abundance of small mammal hosts and species richness in the analysis of the effects of biodiversity on disease risk, providing validation for theoretical models showing both dilution and amplification effects. Insights into the B. burgdorferi transmission cycle in this zone of recent invasion will also help in devising management strategies as this important vector-borne disease expands its range in North America.In the Thousand Islands region of eastern Ontario, Canada, Lyme disease is emerging as a serious health risk. The factors that influence Lyme disease risk, as measured by the number of blacklegged tick ( Borrelia burgdorferi, which is transmitted to humans by the bite of an infected blacklegged tick (Ixodes scapularis) B. burgdorferi and its vectors.In eastern North America, Lyme disease is a serious emerging health risk caused by the bacterium B. burgdorferi transmission cycle involves a number of mammalian and avian tick hosts Odocoileus virginianus) are essential for the establishment and maintenance of endemic I. scapularis populations B. burgdorferi infection. The effect of deer abundance on tick populations varies across eastern North America In addition to the tick vector, the Peromyscus leucopus) are considered to be the most competent reservoir for B. burgdorferi (most likely to transmit the pathogen to a tick while it is feeding) Tamias striatus) and shrews (Blarina brevicauda and Sorex cinereus) are also important competent hosts Sciurus carolinensis, Tamiasciurus hudsonicus), voles (Microtus spp.), raccoons (Procyon lotor), and some ground-foraging birds also provide blood meals to many I. scapularis larvae and nymphs, but are less competent reservoirs for B. burgdorferiWhite-footed mice  can affect the number of ticks, the prevalence of infection in ticks, and thus, human risk Environmental conditions, including temperature, relative humidity, canopy cover, and leaf litter, can affect the survival and development of ticks B. burgdorferi infection may be lower than the prevalence in bird-dispersed adventitious ticks B. burgdorferi transmission can cause the prevalence of infection in the local tick population to increase and eventually exceed the prevalence in adventitious ticks I. scapularis populations recognized in Ontario have been restricted to localized areas along the north shore of Lake Erie, Lake Ontario, and the St. Lawrence River B. burgdorferi are spreading across northeastern North America from original endemic foci in the United States and are increasingly being confirmed as endemic in parts of eastern Canada B. burgdorferi were discovered in the adjacent Thousand Islands region of eastern Ontario (unpublished data).Elevated tick numbers often represent established tick populations in which, in the early stages of establishment, the prevalence of I. scapularis nymphs, and relative abundance of mice in explaining the number of nymphs (NON), the prevalence of B. burgdorferi infection in nymphs (NIP), and the number of infected nymphs (NIN) in the heavily-visited Thousand Islands region. Given the diversity of small mammal communities in the Thousand Islands archipelago, we were also interested in whether species richness would affect NON, NIP and NIN differently depending on the relative abundance of mice. This information can guide management to control blacklegged ticks and reduce the risk of Lyme disease in the Thousand Islands as this vector-borne disease system expands its range in North America. Our study is one of the first to consider the interaction between the relative abundance of small mammal hosts and species richness in the analysis of the effects of biodiversity on disease risk, providing validation for theoretical models exploring dilution and amplification effects.Despite being distributed within an area about 28 km long and 8 km wide, there is variation among sites in the Thousand Islands in the number of blacklegged tick vectors, the prevalence of infection in those ticks, and the diversity of the small mammal host community 2 (one hectare) grid at each study site . The same trap locations were used for the duration of the study.The study area was comprised of 12 sites within Thousand Islands National Park in the Canadian Thousand Islands  following the protocols described for B. burgdorferi in Ixodes tick species All nymphs collected by drag sampling in 2009 and 2010 were counted and identified to species using the taxonomic key of Durden and Keirans Small mammals were trapped and handled in Thousand Islands National Park under a Research and Collection Permit approved by the Parks Canada Agency and in accordance with an Animal Utilization Protocol (09R039) approved by the University of Guelph Animal Care Committee following the guidelines of the Canadian Council on Animal Care.Peromyscus spp.) based on phenotype Peromyscus sp. were all confirmed as P. leucopus by genetic analysis of ear punch samples using methods described by Thompson Peromyscus were assumed to be white-footed mice. Ticks were collected from all animals as part of a concurrent study and animals were then released at their point of capture  were set at marked grid locations at each site for four consecutive nights in June and August. Traps were baited with sunflower seeds and contained polyester or natural cotton bedding. Traps were set in the evening and checked before 08∶00 the following morning. Animals were identified to species  positioned one to two cm above the ground near the centre of each one-hectare study site recorded air temperature and humidity at 30-minute intervals from July 2009 to the spring of 2011. Data were collected from the data loggers periodically (approximately every 300 days) and compiled using HOBOware Pro version 3.2.1 . The average daily minimum temperatures were calculated for three-month periods  because ticks are sensitive to extremes in microclimatic variation and climate variables are typically grouped seasonally to coincide with tick activity periods e.g., .2/100 square feet) around each trap location was recorded and survey plots were cleared of pellets. Each survey plot was assessed for pellet groups again in the spring of 2010. The accumulation of pellets from fall 2009 to spring 2010 was used to calculate the number of pellet groups per hectare, which was used as a relative index of deer abundance at each site.Relative white-tailed deer abundance was estimated by pellet counts Average leaf litter depth at each site was determined in September 2010 by inserting a ruler into the litter layer until bare ground was reached at 11 randomly selected trap locations. The percent canopy cover at each trap location was categorized  and used to calculate the average overall canopy cover for the study site.Distance to the United States was measured in ArcGIS  as the shortest straight-line distance to the American mainland from the shore of the island on which the study site was located or from the point on the Canadian shore of the St. Lawrence River closest to the mainland study site. Because some of the sites were located in close proximity to one another and model residuals showed significant autocorrelation by a Moran’s I test, an autocovariate term was used to account for the spatial non-independence of sites, calculated as an inverse distance-weighted function of the response variable in neighboring sites B. burgdorferi infection in ticks  captures of eight small mammal species were recorded during 22,895 trap nights in 2009 and 2010 , 127 models were considered; 19 were included in the 95% confidence set . BetweenB. burgdorferi transmission cycle in the Thousand Islands. The structure of the small mammal community was an important factor in modulating the effects of species richness on the number of nymphs and the prevalence of B. burgdorferi infection: depending on the relative abundance of mice, high biodiversity did not always reduce the factors that contribute to the measurement of human disease risk. Dilution was evident in the effect of small mammal species richness on the overall number of infected nymphs.Deer abundance, distance to the United States, small mammal species richness, relative mouse abundance, canopy cover, and air temperature were all associated with the complex B. burgdorferi are expanding from foci in the northeastern and north-central United States through the movement of migratory birds, deer, and possibly small mammal hosts B. burgdorferi and allow an assessment of changing disease risk. The pattern of fewer ticks farther from the United States suggests an expansion front that could be studied to learn more about the mechanisms of tick and B. burgdorferi establishment Geography played an important role in Lyme disease risk in the Thousand Islands. Distance to the United States was an important predictor and negatively correlated with NON, NIP, and NIN. This is consistent with previous studies that report blacklegged ticks and The positive effect of climate warming on expansion of tick populations was supported by our results, with higher average daily minimum summer temperature at ground level positively correlated with tick abundance. The topography and geography of the islands and mainland sites created varied microclimatic conditions and the mean daily minimum temperature in the summer months ranked as an important predictor of the number of nymphs. The moderating effect of the St. Lawrence River may have played a role in this pattern, as mean daily minimum temperature in the summer was also negatively correlated with island size, and the three mainland sites had the lowest mean temperatures The inclusion of island and mainland sites in our study area provided an opportunity to explore the effects of deer populations on Lyme disease risk The risk of encountering a nymphal tick can also be reduced by avoiding closed-canopy areas.The positive correlation we found between canopy cover and the number of nymphs is consistent with previous studies; ticks are more likely to inhabit forested areas than open fields B. burgdorferi infection in the population of nymphs decreased. This outcome may be the result of the recent emergence of the Lyme disease cycle in the Thousand Islands: tick populations may become established at new sites before B. burgdorferi, diluting the overall prevalence of B. burgdorferi infection that is largely restricted to adventitious ticks arriving on migratory birds Borrelia) B. burgdorferi infection, as evidenced by the large amount of variation in the data explained by the NON models in comparison to the NIP models. Therefore, an increase in the number of nymphs overwhelmingly increases the odds of encountering an infected nymph, despite a decrease in the overall prevalence of infection. Several studies examining the factors that affect disease risk have focussed on the prevalence of B. burgdorferi infection in nymphs as the outcome variable, assuming a strong link to the number of infected nymphs and, therefore, human risk Unexpectedly, as the number of nymphs increased, the overall prevalence of The small amount of variation in the data explained by the NIP models suggests that random variation or other factors that were not measured influence the prevalence of infection in nymphs. We did not examine the effects of the time since tick establishment B. burgdorferi infection in nymphs was lower with increasing biodiversity when the relative abundance of mice was low. As more species are added, some of those new species are likely to be less competent hosts and because hosts that are not mice make up a large proportion of the community, fewer ticks become infected with B. burgdorferi. The dilution theory was also evident when examining the effects of biodiversity on the number of nymphs. When mice comprised more than half of the small mammal community, higher species richness was correlated with lower nymph abundance. This may be because the other small mammals that comprised the species-rich communities where mice dominated were poor quality hosts, removing and eating a large proportion of feeding ticks through grooming Higher species richness was associated with a decrease in human disease risk, as measured by the number of infected nymphs. Also consistent with the dilution theory, the prevalence of B. burgdorferi infection in nymphs. Species richness had little effect on the prevalence of infection in ticks at sites with a high relative abundance of mice. This could be because mice are very competent hosts B. burgdorferiWe also found evidence for a context-dependent role of biodiversity, and situations that were not consistent with the dilution theory. The structure of the small mammal community, specifically the relative abundance of mice, modulated the effects of biodiversity on the number of nymphs and the prevalence of B. burgdorferi in a zone of Lyme disease emergence in eastern North America, these results contribute empirical evidence to the debate about the role of biodiversity in reducing human disease risk worldwide.Our study is one of the few to evaluate the predictions of theoretical models that explore dilution and amplification effects in the Lyme disease system in eastern North America


There is evidence of the growth of substance consumption throughout the world. However, there continues to be a broad gap between the scope of the problem and the use of preventive and treatment services. This situation is particularly acute near the border between Mexico and the United States, where drug use and availability are greater. Funding was obtained in both countries to conduct a feasibility study about the early identification of consumption at primary health care centers and to test the Quit Using Drugs Intervention Trial (QUIT) of brief intervention. Early identification and brief intervention have proven to be cost-effective and to encourage timely care and reduce the care gap. Men and women aged 18+ (approximately 1000 in each country) will be screened with the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Risky users (about 65 participants in each country) will be enrolled and randomized to either QUIT or a control condition. An electronic material management application (EMMA) and “talking touch-screen” wireless tablets will be used for screening, randomization, and data monitoring. The main results of the implementation phase are the creation of a binational research team; consolidation of the research design; adaptation of instruments and strategies of the ASSIST-QUIT intervention and the EMMA system; technology exchange; and identification of areas requiring cultural adaptation. An ethnographic approach to health centers in Tijuana, Mexico and Los Angeles was used to identify the differences and similarities between centers. Comparisons of the prevalence of drug consumption among participants in both countries will be presented. The main contribution is the identification of the challenges, scope, and cultural differences in the implementation of a program for early detection and treatment of drug consumption in primary health care centers in the border region. The results will underpin new research to apply this model among similar populations.


Successful food-safety management relies on a clear identification of the hazards to be addressed. In the case of issues relating to food allergens the hazard may be defined as: The inadvertant consumption of a food allergen by a sensitive individual. Ensuring that the risk (probability) of this hazard occuring is maintained at an appropriately low level within the context of modern food-manufacturing often presents issues. These reflect the facts that modern food-processing businesses rely on the efficient use of both equipment and the associated manufacturing environment. Such reliance often predicates against the dedicated use of a particular manufacturing line, still less a manufacturing facility, for a single product. This multiplicity of products is often the source of many of the issues relating to food allergen cross-contaminantion. At a philosophical level, the issue of cross contamination presents a unique hazard in terms of food safety management since the contaminant is an integral part of a food and considered nutritious to most consumers. Furthermore levels of cross contamination capable of eliciting an adverse reaction are often lower than those associated with loss of consumer acceptability. Risk assessment cannot seen be seen in isolation and has to be considered within the additional context of risk management and risk communication. Risk management therefore requires an understanding but of both events taking place within the manufacturing facility but also within the suppliers of the raw materials used to make the finished product. As such successful management of food allergen issues places heavy reliance on pre-requisite programmes operating within the food business . Finally it is necessary to ensure that relevant information concerning any remaining hazards presented to the food allergic consumer are clearly communicated on the wrapper.


The management of empyema is still debated. Video-assisted thoracoscopic surgery (VATS) has revolutionized surgical management of patients with empyema. Currently thoracoscopic approach probably is the best choice in the management of second or third stage of empyema, particularly in those patients with chronic empyema and poor performance status. Multioculated empyemas generally make thoracoscopic procedure difficult therefore open procedures would be preferable. We evaluate the effectiveness of transthoracic ultrasound (TUS) in the planning of the best thoracoscopic approach in treatment of chronic empyema.From January 2007 to March 2013 28 patients with pleural empyema underwent preoperative transthoracic ultrasound. II stage of empyema was presented in 23 patients.Patients were examined in surgical position. TUS was used to analyze and localize multi loculations pockets of pleural effusion and pneumonia with consolidation, the hemidiaphragm and the major pockets of the pleural effusion were marked on the skin. In consideration of the TUS and the signs, a small working window and a thoracoscopic access were drawn on the skin of the patient. TUS accuracy was determinate on empyema staging, topography of multilocalations pleural effusion, hemidiaphragm localization and finally thoracoscopic accesses pianification.All patients underwent thoracoscopic treatment with a working window of about 10 cm and a second access of 10mm. In 4 cases  open-convertion was needed for pathology extention. Topography was correct in 26 cases  and good thoracoscopic approach was achieved in 24 . The presence of small and multiple loculations and a hyperechoic effusion were the main causes of failure.TUS is a very useful method in the planning of thoracoscopic treatment of pleural empyema. The utility of this method should be further extended in the treatment of this pathology.


To the Editor: The European Working Group for Legionella Infections (EWGLINET) conducts epidemiologic surveillance of Legionnaires' disease cases associated with travel    by using the protocol and database of EWGLINET. Both isolates showed identical SBT patterns .As soon as cultures from the 2 patients were available, the National Reference Laboratories of France and Spain shared their respective microbiologic results. Since both strains were identified as L. pneumophila serogroup 1  and had identical SBT patterns . Collaboration between public health authorities in France and Spain enabled us to eliminate the association of patient 2 with the Zaragoza outbreak and establish an association of both patients with the same site in France. Control measures were taken at the hotel, but we could not obtain environmental cultures for comparison with those of the patients. Lack of environmental data prevented investigation of the relationship with the other accommodation sites visited.Isolates from 4 patients in the Zaragoza outbreak were identified at the Spanish Reference Laboratory as L. pneumophila. The availability of an online database with accessible information is key for sharing results and determining the geographic distribution of isolates that cause Legionnaires' disease  (This study demonstrates the critical role of sharing results between countries that participate in a network. Agreement is essential on a standardized questionnaire that includes more information on the patient's exposure to a disease. Moreover, despite the performance of the urine antigen test, cultures of clinical samples should be encouraged by clinicians and microbiologists. This step would permit use of techniques, such as SBT, in reference laboratories and sharing of results. Our investigation would have been more difficult without this technique in identifying the site where the infection potentially originated.


We report a case of mucoid degeneration of the anterior cruciate ligament (ACL). Mucoid degeneration of the ACL is a very rare cause of knee pain. There have been only some reported cases of mucoid degeneration of the ACL in the English literature. We reviewed previous reports and summarized clinical features and symptoms, including those found in our case. Magnetic Resonance Imaging is the most useful tool for differentiating mucoid degeneration of the ACL from an intraligamentous ganglion or other lesions in the knee joint. If this disease is considered preoperatively, it can be diagnosed easily based on characteristic findings. The first description of cysts of the anterior cruciate ligament (ACL) in 1924 and was made by Caan . There aMRI identified two forms of cyst of the ACL. The first is the cyst fluid. This is the cystic form proper, well described in the literature, 4, 9. TA 45 year old woman who had no prior significant trauma was seen at our hospital for evaluation of left knee pain and flexion difficulty. Upon examination, there was no swelling, ballottement of patella or instability. The range of motion of the knee was limited from 0° to 120° with terminal flexion pain. There was a point of tenderness at the medial joint line of the knee. A plain X-ray showed a slight degenerative change in the medial side of the knee .MRI of the right knee showed an increased intraligamentous signal for the ACL with high inhomogeneous intensity and cracking of the external meniscus undisplaced . Based oMucoid degeneration of the ACL is a very rare cause of knee pain. This lesion of the ACL was first reported by Kumar et al  in 1999.This case shows the presence of intraligamentous mucoid degeneration in the ACL as a source of knee pain without instability. To assist in diagnosing the source of atypical knee pain, we recommend the use of MRI in conjunction with diagnostic arthroscopy. Partial ACL debridement does not preclude adequate knee stability. The chief complaint of knee pain correlated with the intraligamentous nature of mucoid degeneration in the ACL and may suggest involvement of the small nerve fibers found in the ACL. After resection of the cyst arthroscopy has no laxity was found and Robert  had studIn summary, MRI yields preoperative information that is useful in the diagnosis of and surgical treatment planning for mucoid degeneration of the ACL. If we consider this disease preoperatively, it can be easily diagnosed based on these characteristic findings. Partial excision of the yellow, sclerotic lesions of the ACL results in immediate pain relief and improves the range of movement without any symptom of instability.Arthroscopic resection of symptomatic degenerative ACL gives good results but leads to a subjective postoperative progressive laxity in some cases. The prognosis depends on the age and associated injuries. The diagnosis of mucoid degeneration of the ACL should be suspected posterior unusual pain with limitation of flexion. MRI and arthroscopy confirmed the diagnosis.


Modern pharmaceutical industry in India emerged in the 1900s and with that regulation of pharmaceuticals also evolved. The reforms of the 90s while improving the exports, also brought in improved standards of quality to be followed in the entire supply chain of drugs. While for the manufacturers it meant documentation, increased expenditure, and more export opportunities, for the consumer it has resulted in improved drugs, as the public health system also started emphasizing on selecting only those manufacturers with quality standards. However, governance and enforcement mechanisms have to improve to benefit the consumers and the entire healthcare system.Based on a review of literature on pharmaceutical regulations governing manufacturing standards, pharmacy education, and drug prices, this paper discusses the positive outcome of certain regulations and points out where explicit policy focus is needed. Specifically, the paper discusses (a) the positive outcomes of implementing good manufacturing practices (GMP) that has improved the standards of production; (b) the need for aggressive pharmacovigilence practices to enhance awareness on adverse drug reaction; (c) the need to integrate the pharmacy education with the needs of the health systems which functions with far minimal trained human resources particularly in the preventive health care; and (d) the impact of issues related to the drug price control orders on the consumers.Modern pharmaceutical industry in India emerged in the 1900s. Regulation of pharmaceuticals also emerged with the industry. The ultimatum given to the industry to adhere to the schedule M implementation has resulted in improving the standards of medicines produced. While the industry-centric regulations emphasize on quality, little attention is paid particularly to the pharmacovigilence practices to systematically document the adverse drug reactions. The pharmacy education in India has an industry bias. Every year, because of the spate of permissions for pharmacy colleges from the All India Council of Technical Education, pharmacists are churned out in thousands in the country. However, they do not find jobs in the industry. If the pharmacy education is oriented towards community pharmacy or hospital pharmacy, the human resources shortfall in the preventive health care could be improved.The Drug Price Control Order presently covers only 75 essential drugs and leaves out the new innovator drugs and the biotechnology based drugs, which are prohibitively expensive. While manufacturers wriggle out of price control by producing combinations so that they do not come under the purview of price control, consumers are inundated with irrational an combination that push up the cost of treatment but delays the course of treatment.The Drugs and Cosmetics Act needs to be revamped taking into consideration the changing industrial scenario. While manufacturers wriggle out of price control by producing combinations so that they do not come under the purview of price control, consumers are inundated with irrational combinations that push up the cost of treatment but delay the course of treatment. Pharmaceutical governance can be vastly improved if the regulatory authorities have more manpower with them.Jan-Aushadhi stores need to be addressed.In India generic drugs are sold in brand names, which push up the cost of treatment as doctors prescribe branded generics. Instead if drugs are sold in generic names, the cost could be contained. The bureaucratic bottlenecks particularly at the state level that delays the spread of The curriculum of pharmacy education should be revised thoroughly. Pharmacy education in India should include courses like community/hospital pharmacy, where the pharmacist actually assists the doctor in choosing the right medicine after analyzing patients’ case history.None declared.None declared


The human immune system functions to provide continuous body-wide surveillance to detect and eliminate foreign agents such as bacteria and viruses as well as the body's own cells that undergo malignant transformation. To counteract this surveillance, tumor cells evolve mechanisms to evade elimination by the immune system; this tumor immunoescape leads to continuous tumor expansion, albeit potentially with a different composition of the tumor cell population (“immunoediting”). Tumor immunoescape and immunoediting are products of an evolutionary process and are hence driven by mutation and selection. Higher mutation rates allow cells to more rapidly acquire new phenotypes that help evade the immune system, but also harbor the risk of an inability to maintain essential genome structure and functions, thereby leading to an error catastrophe. In this paper, we designed a novel mathematical framework, based upon the quasispecies model, to study the effects of tumor immunoediting and the evolution of (epi)genetic instability on the abundance of tumor and immune system cells. We found that there exists an optimum number of tumor variants and an optimum magnitude of mutation rates that maximize tumor progression despite an active immune response. Our findings provide insights into the dynamics of tumorigenesis during immune system attacks and help guide the choice of treatment strategies that best inhibit diverse tumor cell populations. Immunologic surveillance is a function of the immune system which serves to constantly monitor the body for microorganisms, foreign tissue, and cancer cells. To evade this surveillance and subsequent elimination, cancer cells evolve strategies to prevent being recognized and killed by immune system cells; one mechanism is to increase the rate at which genetic and/or epigenetic variability is generated. The benefits of an increased variability of cancer cells to counteract immune surveillance, however, stands in contrast to the costs associated with such heightened mutation rates: the risk of an inability to maintain essential genome structure and functions. To study such situations arising in tumorigenesis, we designed a novel mathematical framework of tumor immunosurveillance and the evolution of mutation rates. We then utilized this framework to study how increased mutation rates and immunologic surveillance affect the abundance of tumor and immune system cells. We found that there exists an optimum number of tumor variants and an optimum magnitude of mutation rates that maximize tumor progression despite the presence of actively proliferating and functioning immune system cells. Our study contributes to an understanding of cancer development during immune system attacks and also suggests treatment strategies for heterogeneous tumor cell populations. In 1909, Paul Ehrlich was the first to propose the idea that the immune system scans for and eliminates nascent transformed cells in the human body Tumor immunoescape is driven by the generation of tumor cell variants An increased chance of accumulating (epi)genetic alterations during cell divisions enhances the rate of generating tumor cell variants that may evade the immune response; however, high rates of alterations may in turn lead to an error catastrophe in that a functioning genome cannot be sustained when error-prone replication produces excess damage Several mathematical models have been designed to provide insights into the dynamics of tumorigenesis under immunosurveillance or an error catastrophe of tumor cells During the early phases of tumorigenesis, immune system cells such as NK and CD8+ T cells attack tumor cells and may succeed in suppressing their expansion; this outcome is referred to as “tumor dormancy”. However, if the immune system cannot successfully eradicate a tumor, then eventually a subset of tumor cells will acquire the phenotypes necessary for immunoescape. Depending on the magnitude of the mutation rate of these cells, the tumor cell population may then be at risk of going extinct due to the generation of excess damage – the event of an error catastrophe. To investigate the dynamics, conditions, and likelihood of these events, we designed a mathematical model of tumor and immune system cells.In the context of our mathematical model, initially there is only a single type of tumor cells – those cells that originally founded the tumor. Denote the abundance of these original tumor cells by In addition to tumor cells, we also consider immune system cells that launch a specific immune response against each particular tumor variant. Denote the abundance of immune system cells specific to the original tumor clone by With these considerations, we define the basic mathematical model including tumor variants and their specific immune responses byBaseline values of model parameters and their respective ranges used for simulations are presented in Let us now discuss the possible outcomes of interactions between the immune system and the tumor cell population: there may be tumor dormancy, partial immunoescape, complete immunoescape, and the event of an error catastrophe. In the dormancy state, immunosurveillance serves to effectively suppress the tumor cell population. In the partial immunoescape state, some tumor variants  achieve immunoescape while in the complete immunoescape state, the immune response is completely unsuccessful. Finally, in the error catastrophe state, the original tumor clone, which has the highest division rate, goes extinct due to the accumulation of excess alterations. We now outline how the original tumor clone, the tumor cell variants, and the specific immune system cells behave during the accumulation of alterations and the evolution of higher mutation rates.The four qualitative outcomes of the interaction between tumor cells and the immune system – dormancy, partial and complete immunoescape as well as error catastrophe – are most significantly influenced by two systems parameters: the mutation rate generating tumor variants  while maintaining a functioning genome.Let us now investigate the system dynamics for varying mutation rates and identify those regimes in which the total tumor cell number is maximized. Every time a new tumor variant arises, the dynamics of tumor evolution rapidly converges to its steady state; we therefore analyze the dynamics in steady state. The total number of tumor cells depends on the number of variants as well as the mutation rate, and an optimum combination of these parameter values exists that maximizes the total tumor cell number. In In situations in which all tumor cells are effectively suppressed by the immune response (tumor dormancy), the total number of tumor cells increases with the number of variant types. In situations in which some tumor cell types manage to escape from immune surveillance, the total number of tumor cells increases as both the number of variant types and the mutation rate increase . Howeverand  see . In thisncreases , but theOur results demonstrate that there are two strategies to maximize the rate of tumor evolution so that the total tumor cell mass is maximally large: one is to maintain a low mutation rate, since then the tumor cell population can increase the number of variant types along the threshold  see ; anothersee  see . When boLet us now investigate how the division rate of variant tumor cells affects the evolution of tumor cells during their interaction with immune system cells. Recall that in the basic model, the division rate is Let us next consider additional effects arising during tumor progression such as competition among tumor cells of different variant types, the presence of an innate immune response such as NK cells, which non-specifically target all tumor variants, and differential growth rates among tumor cell variants. In order to investigate the conditions for outcomes such as tumor immunoescape and error catastrophe in these more complex scenarios, we established an extended model, given byThe dynamics of tumor progression considering these situations are shown in Finally, let us discuss the effects of different treatment modalities on the rates of cancer progression and the chance of immunoescape. Since the behavior of tumor cells and thus patient outcomes are to a considerable extent driven by the interactions between tumor and immune system cells, we considered both traditional chemotherapy and treatment options that stimulate the immune system to launch or sustain an attack against the tumor cell population. In general, immune therapies have not been proven to be very effective against many tumor types; one of the few exceptions is represented by adoptive cell therapy, which is used in the treatment of metastatic melanoma and causes regressions in about 50To study the effects of chemotherapy, immune therapy, and combination therapy on the dynamics of tumor evolution, we introduced a series of different treatment types into the mathematical framework and identified optimal treatment strategies for diverse tumor cell populations . These dWe then utilized this system to investigate optimum treatment strategies. First, let us consider the effects of chemotherapeutic agents which reduce the number of tumor cells by inducing cell deaths at a rate proportional to the cell number present within the tumor. Administration of such treatments decreases the total cell number, but may not be capable of leading to complete eradication of all tumor cells  unless iIn conclusion, our mathematical model predicts successful outcomes of combination therapy when (i) chemotherapy is administered which induces tumor cell death at a significantly large rate, or (ii) combination therapy is administered which reduces the number of tumor variants, induces tumor cell death, and replenishes immune cell populations. When the mutation rate of tumor cells is small, combination therapy is more effective than when variations arise at a large rate. An explanation of these findings can be found in In this paper, we have investigated the dynamics of tumor progression under immune system surveillance while considering the effects of increasing rates at which (epi)genetic alterations are generated. We defined specific situations that can arise due to the interactions of immune system cells and tumor cells. When the tumor cell population is able to persist under immunosurveillance without leading to tumor growth, then a state of tumor dormancy ensues. Should the immune system not be capable of efficiently suppressing the tumor cell population, then partial or complete immunoescape is possible, depending on whether some or all tumor clones evade immune system inhibition. Finally, an error catastrophe occurs when the tumor cells evolve mutation rates that are incompatible with the maintenance of a functioning genome due to excess error.The dynamics of the system and likelihood of these different states depend on the rate at which variability emerges in the population , in detail. The basic model can be considered qualitatively as a 4-dimensional ODE system  is a We investigated the existence conditions of the equilibria of model (1). The model has seven possible equilibria:While the equilibria Consider the situation in which This result implies that Let us now calculate the total number of tumor cells at equilibrium. Note that the dynamics of the basic model, equation (1), might not converge to an equilibrium, but may oscillate if When the number of tumor variants is