Effect of formal training in scaling, scoring and classification of the International Standards for Neurological Classification of Spinal Cord Injury.

STUDY DESIGN: Prospective, longitudinal cohort study. OBJECTIVES: To quantify the effect of formal training in the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) on the classification accuracy and to identify the most difficult ISNCSCI rules. SETTINGS: European Multicenter Study on Human Spinal Cord Injury (EMSCI). METHODS: EMSCI participants rated five challenging cases of full sensory, motor and anorectal examinations before (pre-test) and after (post-test) an ISNCSCI instructional course. Classification variables included sensory and motor levels (ML), completeness, ASIA Impairment Scale (AIS) and the zones of partial preservation. RESULTS: 106 attendees were trained in 10 ISNCSCI workshops since 2006. The number of correct classifications increased significantly (P<0.00001) from 49.6% (2628 of 5300) in pre-testing to 91.5% (4849 of 5300) in post-testing. Every attendee improved, 12 (11.3%) achieved 100% correctness. Sensory levels (96.8%) and completeness (96.2%) are easiest to rate in post-testing, while ML (81.9%) and AIS (88.1%) are more difficult to determine. Most of the errors in ML determination arise from sensory levels in the high cervical region (C2-C4), where by convention the ML is presumed to be the same as the sensory level. The most difficult step in AIS classification is the determination of motor incompleteness. CONCLUSION: ISNCSCI training significantly improves the classification skills regardless of the experience in spinal cord injury medicine. These findings need to be considered for the appropriate preparation and interpretation of clinical trials in spinal cord injury.

Reinventory of the vascular plants of Mormon Island Crane Meadows after forty years of restoration, invasion, and climate change.

The majority of tallgrass prairie has been lost from North America's Great Plains, but remaining tracts often support significant biodiversity. Despite permanent protections for some remnants, they continue to face anthropogenic threats including habitat fragmentation, invasive species, and climate change. Conservationists have sought to buffer remnants from threats using prairie restoration but limited research has assessed such practices at the landscape-level. We reexamine the flora of Mormon Island, the largest tract of lowland tallgrass prairie remaining in the Central Platte River Valley (CPRV) of Nebraska, USA, nearly 40-years after it was initially inventoried and following widespread restoration. We also conducted preliminary inventories of nearby Shoemaker Island and adjacent off-island habitats using an ecotope-based stratified random sampling approach. We examined change at Mormon Island between 1980-1981 and 2015-2020 and compared it to adjacent conservation lands using a number of vegetation indices. We documented 389 vascular plant species on Mormon Island, 405 on Shoemaker Island, and 337 on off-island habitats from 2015-2020, which represented an increase in native and exotic species richness on Mormon Island compared to 1980-1981 results. Floristic quality index (FQI) values increased at Mormon Island between 1980-1981 and 2015-2020. Paradoxically, the distribution of exotic-invasive species also expanded. Mormon Island from 2015-2020 was more similar to Shoemaker Island and off-island habitats from 2015-2020 than Mormon Island from 1980-1981. Widespread restoration introduced a number of high conservation value species native to Nebraska but novel to the CPRV, which improved FQIs despite increased exotic species invasion. These concurrent trends appear to have driven biological homogenization across the study area. Restoration did not fully buffer Mormon Island from exotic species invasion but it may have partially mitigated the impact considering the persistence of most native species across a 40-year period. We recommend using "local ecotype" seed for restorations to preserve distinctive local communities.

Time-resolved relaxation and fragmentation of polycyclic aromatic hydrocarbons investigated in the ultrafast XUV-IR regime.

Polycyclic aromatic hydrocarbons (PAHs) play an important role in interstellar chemistry and are subject to high energy photons that can induce excitation, ionization, and fragmentation. Previous studies have demonstrated electronic relaxation of parent PAH monocations over 10-100 femtoseconds as a result of beyond-Born-Oppenheimer coupling between the electronic and nuclear dynamics. Here, we investigate three PAH molecules: fluorene, phenanthrene, and pyrene, using ultrafast XUV and IR laser pulses. Simultaneous measurements of the ion yields, ion momenta, and electron momenta as a function of laser pulse delay allow a detailed insight into the various molecular processes. We report relaxation times for the electronically excited PAH*, PAH+* and PAH2+* states, and show the time-dependent conversion between fragmentation pathways. Additionally, using recoil-frame covariance analysis between ion images, we demonstrate that the dissociation of the PAH2+ ions favors reaction pathways involving two-body breakup and/or loss of neutral fragments totaling an even number of carbon atoms.

Shame, self-identification with having a mental illness, and willingness to seek help in northeast Germany.

We examined a general population sample (n = 1330) from an epidemiological study (SHIP), investigating whether shame, social distance and reluctance to self-identify as having a mental illness interfere with willingness to seek help for mental health problems. Analyses were stratified for life-time diagnosis of any mental illness. Shame was the strongest negative predictor for willingness to seek help (beta = -0.183, p < .001). Structured Estimation Modelling showed shame being a full mediator of a negative association between social distance and willingness. Our results corroborate the important role of shame as an impediment to help-seeking for mental health problems in the general population.

From a black-box to a glass-box system: the attempt towards a plant-wide automation concept for full-scale biogas plants.

Biogas plants gain worldwide increasing importance due to several advantages. However, concerning the equipment most of the existing biogas plants are low-tech plants. E.g., from the point of view of instrumentation, control and automation (ICA) most plants are black-box systems. Consequently, practice shows that many biogas plants are operated sub-optimally and/or in critical (load) ranges. To solve these problems, some new biogas plants have been equipped with modern machines and ICA equipment. In this paper, the authors will show details and discuss operational results of a modern agricultural biogas plant and the resultant opportunities for the implementation of a plant-wide automation.

The HSG procedure for modelling integrated urban wastewater systems.

Whilst the importance of integrated modelling of urban wastewater systems is ever increasing, there is still no concise procedure regarding how to carry out such modelling studies. After briefly discussing some earlier approaches, the guideline for integrated modelling developed by the Central European Simulation Research Group (HSG - Hochschulgruppe) is presented. This contribution suggests a six-step standardised procedure to integrated modelling. This commences with an analysis of the system and definition of objectives and criteria, covers selection of modelling approaches, analysis of data availability, calibration and validation and also includes the steps of scenario analysis and reporting. Recent research findings as well as experience gained from several application projects from Central Europe have been integrated in this guideline.

Operational results of an agricultural biogas plant equipped with modern instrumentation and automation.

Agricultural biogas plants based on energy crops gain more and more importance because of numerous energetic, environmental and agricultural benefits. In contrast to older biogas plants, the newest generation of biogas plants is equipped with modern ICA equipment and reliable machines/engines. In this paper, the authors present technical details and operational results of a modern full-scale agricultural biogas plant using energy crops.

Instrumentation, control and automation for full-scale manure-based biogas systems.

In recent years manure-based biogas plants (MBBP) have won more and more importance, because of the numerous ecological advantages. The processes are similar to processes, which have been well known for many decades in anaerobic wastewater/sludge treatment. As a result of technical progress and permanently rising prices for non-renewable energy, MBBPs have become more and more economically reasonable. Because of the economies of scale law more and more larger MBBPs are being built (250-2000 kW(el)). With regard to investment costs, reactor volumes and complexity etc., these (centralized) plants are comparable with small wastewater treatment plants (WWTP). Consequently, as actually in the case of the small WWTPs a rising use of instrumentation, control and automation (ICA) for larger MBBPs can be observed.

Trends in instrumentation, control and automation and the consequences on urban water systems.

In recent years more and more on-line sensors have been used on different structures of urban water systems (UWS, i.e. wastewater treatment plants (WWTP), waterworks (WW), sewer systems). This development is influenced and driven by numerous trends, which will be discussed in this paper. For a better understanding, the discussion is illustrated with a factual example. The new possibilities of on-line measurement and automation technologies will also change the way as UWS will be planned, built and operated.

A comparison of continuous flow and sequencing batch reactor plants concerning integrated operation of sewer systems and wastewater treatment plants.

Integrated operation strategies for combined sewer and WWTP are becoming more and more popular because of numerous benefits. One can find many examples in literature, but many of these studies deal with partly fictitious systems and/or were accomplished within the planning. Hence most of these studies do not have to deal with the restrictions given by already built constructions. The authors, who worked on several integrated projects, will discuss the requirements of SBR and CFR plants concerning an implementation of integrated operation.

A process-dependent real-time controller for sequencing batch reactor plants: results of full-scale operation.

This paper presents results of a research project, in which a process-dependent real-time control (RTC) strategy for a sequencing batch reactor plant was realised in full-scale. The cycle controller is based on NH4 analysers, NO3 probes, TSS probes and sludge level probes. With this new RTC strategy it was possible to increase the treatment capacity by 50%. By implementation of the new controller the TN, TP and NH4-N treatment efficiency could be improved significantly, too. The treatment efficiency concerning COD is comparable.

Upregulation of COX-2 during cardiac allograft rejection.

BACKGROUND: The hypothesis that cyclooxygenase-2 (COX-2) is involved in the myocardial inflammatory response during cardiac allograft rejection was investigated using a rat heterotopic abdominal cardiac transplantation model. METHODS AND RESULTS: COX-2 mRNA and protein in the myocardium of rejecting cardiac allografts were significantly elevated 3 to 5 days after transplantation compared with syngeneic controls (n=3, P<0.05). COX-2 upregulation paralleled in time and extent the upregulation of iNOS mRNA, protein, and enzyme activity in this model. COX-2 immunostaining was prominent in macrophages infiltrating the rejecting allografts and in damaged cardiac myocytes. Prostaglandin (PG) levels in rejecting allografts were also higher than in native hearts. Because NO has been reported to modulate PG synthesis by COX-2, additional transplants were performed using animals treated with a selective COX-2 inhibitor (SC-58125) and a selective inhibitor of the inducible nitric oxide synthase (iNOS) N-aminomethyl-L-lysine. At posttransplant day 5, inhibitor administration resulted in a significant reduction of COX-2 mRNA expression (3764+/-337 versus 5110+/-141 arbitrary units, n=3, P<0.05) and iNOS enzymatic activity (1.7+/-0.4 versus 22.8+/-14. 4 nmol/mg protein, n=3, P<0.01) compared with vehicle-treated allogeneic transplants. Allograft survival in treated animals was increased modestly from 5.4 to 6.4 days (P<0.05). However, apoptosis of cardiac myocytes (TUNNEL method) was only marginally reduced relative to vehicle controls in treated graft recipients. The intensity of allograft rejection was also similar in the treated and untreated allografts. CONCLUSIONS: The data indicates that COX-2 expression is enhanced in parallel with iNOS in the myocardium during cardiac allograft rejection.

Integrated real-time control for a sequencing batch reactor plant and a combined sewer system.

Integrated real-time control (RTC) concepts, which are trying to operate drainage systems and WWTPs depending on the current capacities of both systems, are becoming more and more important. While almost all publications in this field have been concentrating on continuous flow systems, this paper will present a project which has been initiated to realise an integrated RTC strategy for a Sequencing Batch Reactor (SBR) plant in simulation as well as in full-scale. The results of the simulation are that SBR plants can handle high hydraulic loads. The cost-benefit analysis shows that an integrated operation is reasonable concerning environmental and economic aspects. In order to verify the simulation results, full-scale operation has been started in January 2004. The first results seem to confirm the results of the simulation study.

Carbon allocation in ectomycorrhizas: identification and expression analysis of an Amanita muscaria monosaccharide transporter.

Ectomycorrhizas are formed between certain soil fungi and fine roots of predominantly woody plants. An important feature of this symbiosis is the supply of plant-derived carbohydrates to the fungus. As a first step toward a better understanding of the molecular basis of this process, we cloned a monosaccharide transporter from the ectomycorrhizal fungus Amanita muscaria. Degenerate oligonucleotide primers were designed to match conserved regions from known fungal sugar transporters. A cDNA fragment of the transporter was obtained from mycorrhizal mRNA by reverse transcription-polymerase chain reaction. This fragment was used to identify a clone (AmMst1) encoding the entire monosaccharide transporter in a Picea abies/A. muscaria mycorrhizal cDNA library. The cDNA codes for an open reading frame of 520 amino acids, showing best homology to a Neurospora crassa monosaccharide transporter. The function of AmMST1 as monosaccharide transporter was confirmed by heterologous expression of the cDNA in a Schizosaccharomyces pombe mutant lacking a monosaccharide uptake system. AmMst1 was constitutively expressed in fungal hyphae under all growth conditions. Nevertheless, in mycorrhizas as well as in hyphae grown at monosaccharide concentrations above 5 mM, the amount of AmMst1 transcript increased fourfold. We therefore suggest that AmMst1 is upregulated in ectomycorrhizas by a monosaccharide-controlled mechanism.

The abdominojugular reflux sign.

PURPOSE: The abdominojugular reflux sign is useful in diagnosing right ventricular failure, but is often performed and interpreted incorrectly. Our objective was to review the history, epidemiology, and pathophysiology of the abdominojugular reflux sign. METHODS: We conducted a MEDLINE search of the English language reports published between 1966 and 1999 and a manual search of bibliographies of relevant papers. RESULTS: A positive abdominojugular reflux sign is defined by an increase in the jugular venous pressure of greater than 3 cm, sustained for greater than 15 seconds. In the absence of left heart failure, a positive abdominojugular reflux sign should prompt consideration of impaired right ventricular preload, a decrease in right ventricular compliance, a decrease in right ventricular systolic function or an elevation in right ventricular afterload. In patients presenting with dyspnea, the abdominojugular reflux is useful in predicting congestive heart failure (LR+ 6.0 (95% CI; 0.8-51); LR- 0.78; (95% CI: 0.62 to 0.98)) and suggests pulmonary capillary wedge pressures of greater than 15 mm Hg (LR+ 6. 7 (95% CI: 3.3 to 13.4); LR- 0.08 (95% CI: 0.01 to 0.52)). CONCLUSION: The abdominojugular reflux is not specific to any one disorder, but rather is a reflection of a right ventricle that cannot accommodate augmented venous return. Constrictive pericarditis, right ventricular infarction, and restrictive cardiomyopathy are common causes of a positive finding. Left ventricular failure may also induce the sign, but only when the pulmonary capillary wedge pressure is greater than 15. The one diagnosis not seen with abdominojugular reflux is cardiac tamponade.

Are physicians aware of which of their patients have indwelling urinary catheters?

PURPOSE: Although infections associated with indwelling urinary catheters are common, costly, and morbid, the use of these catheters is unnecessary in more than one-third of patients. We sought to assess whether attending physicians, medical residents, and medical students are aware if their hospitalized patients have an indwelling urinary catheter, and whether physician awareness is associated with appropriate use of these catheters. METHODS: The physicians and medical students responsible for patients admitted to the medical services at four university-affiliated hospitals were given a list of the patients on their service. For each patient, the provider was asked: "As of yesterday afternoon, did this patient have an indwelling urethral catheter?" Respondents' answers were compared with the results of examining the patient. RESULTS: Among 288 physicians and students on 56 medical teams, 256 (89%) completed the survey. Of 469 patients, 117 (25%) had an indwelling catheter. There were a total of 319 provider-patient observations among these 117 patients. Overall, providers were unaware of catheterization for 88 (28%) of the 319 provider-patient observations. Unawareness rates by level of training were 21% for students, 22% for interns, 27% for residents, and 38% for attending physicians (P = 0.06). Catheter use was inappropriate in 36 (31%) of the 117 patients with a catheter. Providers were unaware of catheter use for 44 (41%) of the 108 provider-patient observations of patients who were inappropriately catheterized. Catheterization was more likely to be appropriate if respondents were aware of the catheter (odds ratio = 3.7; 95% confidence interval, 2.1 to 6.7, P <0.001). CONCLUSION: Physicians are commonly unaware that their patients have an indwelling urinary catheter. Inappropriate catheters are more often "forgotten" than appropriate ones. System-wide interventions aimed at discontinuing unnecessary catheterization seem warranted.

Intrauterine contraception in diabetic women.

The results of intrauterine contraception using four different types of Antigen devices in 118 insulin-treated diabetic women are reported. The patients were followed for a total of 24 months. Cumulative closure rates for the 1st year were as follows: pregnancy, 3.5; expulsion, 13.1; removal for bleeding and/or pain, 7.9; and planned pregnancy, 1.2, giving a continuation rate of 74.3. Cumulative closure rates after 24 months were as follows: pregnancy, 6.5; expulsion, 14.4; removal for bleeding and/or pain, 17.1; and planned pregnancy, 8.3, giving a continuation rate of 56.7. These results are not significantly different from those found by us in nondiabetic women, No serious side effects occurred, in particular no pelvic inflammations or perforations. Intrauterine contraception using the Antigon appears to be a well-suited method for diabetic women.

The delivery of therapeutic aerosols through endotracheal tubes.

We used an in vitro model system to examine the sites of deposition of aqueous therapeutic aerosols administered through 3-mm, 6-mm, and 9-mm endotracheal tubes (commonly used in infants, children, and adults) at clinically relevant inspiratory flow rates. Aerosol was delivered to the endotracheal tube via a "T" piece and a 90 degree elbow. Aerosol exiting the endotracheal tube passed through an appropriately sized Plexiglas model of the trachea and mainstem bronchi, and then into an 80-liter bag. Aerosol deposited in the "T" and elbow, endotracheal tube, large airway model, and collection bag was quantitated separately using 0.1% uranine as a tracer. Study of a conventional aerosol typical of those in common clinical use (aerodynamic mass median diameter = 3.95 microns) showed that most of the aerosol delivered into each endotracheal tube was deposited before leaving the mainstem bronchi. Substitution of an alternative nebulizer that produced a much smaller aerosol particle size (aerodynamic mass median diameter = 0.54 micron) dramatically decreased aerosol deposition in the "T" and elbow, endotracheal tube, and large airway model, and increased the quantity of aerosol penetrating beyond the mainstem bronchi up to ninefold. The mass median particle diameter of the conventional aerosol was reduced during endotracheal tube and large airway passage by poorly defined aerodynamic mechanisms that selectively removed larger particles. The smaller submicron aerosol was not similarly affected. Thus, conventional therapeutic aerosols appear to penetrate poorly through endotracheal tubes. Use of smaller particle size aerosols in treatment of intubated patients may be an effective way to circumvent this problem.

Induction of pathogen resistance in barley by abiotic stress.

Enhanced resistance of barley (Hordeum vulgare L. cv. Ingrid) against barley powdery mildew (Blumeria graminis f. sp. hordei race A6) was induced by abiotic stress in a concentration-dependent manner. The papilla-mediated resistance was not only induced by osmotic stress, but also by proton stress. Resistance was directly correlated with increasing concentrations of various salts in the nutrient solution. Resistance induced by proton stress also depended on the stress intensity. Resistance induction occurred even at low stress intensities. Any specific ion toxicity affecting the fungal growth directly, and therefore leading to enhanced pathogen resistance, can be excluded because of the independence of resistance induction of the ion used and of the time course of sodium accumulation in the leaves. BCI-4, a marker for benzo[1,2,3]thiadiazolecarbothioic acid S-methyl ester (BTH)-induced resistance was not induced by these abiotic stresses. However, resistance was induced in the same concentration-dependent manner by the application of the stress hormone ABA to the root medium. During the relief of water stress, resistance did not decrease constantly. On the contrary, after a phase of decreasing resistance for 24 h the pathogen resistance increased again for 48 h before decreasing finally to control levels.

Contraception with long acting subdermal implants: I. An effective and acceptable modality in international clinical trials.

This paper presents results of a double blind, multi-centered and multi-national study of two progestin only subdermal implants used for contraception. A regimen of six capsules of levonorgestrel (Ng) used by 492 women had a net cumulative 12-month pregnancy rate of 0.6 percent and a continuation rate of 74.6 percent. 498 women used six capsules of norgestrienone (R2010) and experienced a net cumulative 12-month pregnancy rate of 3.5 percent and a continuation rate of 79.4 percent. The difference in the pregnancy rate was significant at P less than 0.01, while there was no significant difference in the continuation rates. Menstrual problems were the principal reason for termination of the levonorgestrel regimen, accounting for approximately half of all terminations. There were significantly fewer menstrual problems among users of the norgestrienone (R2010) capsules; the net cumulative 12-month termination rate for this reason was 4.3 percent. Results are compared with continuation and termination rates for acceptors of the Copper T 200 at the same clinics. The low pregnancy rate and reasonably high continuation rate of the norgestrel implants coupled with the fact that the expected effective lifetime of a set of capsules is of the order of 3-5 years appears to warrant further development of this contraceptive regimen.