Percentage Of Cases Research Articles

OP20 When Are Nationally Available Discounts Introduced In NICE Appraisals

Introduction:Offering a nationally available discount has become common to increase the chance of being recommended by the National Institute of Health and Care Excellence (NICE). This study reviewed all NICE technology appraisals (TAs) since October 2007 to determine whether a national available discount was submitted, and explore when these discounts were introduced.Methods:All TAs between October 2007 and August 2017 were reviewed. The timing of the nationally available discount submission was allocated into one of four categories: initially submitted; initially submitted but changed; introduced after submission; or, other discount. An analysis was conducted to examine whether there was a temporal pattern in the introduction of nationally available discounts before or after January 2014, when the current Pharmaceutical Price Regulation Scheme (PPRS) came into effect.Results:Before 1 January 2014, a nationally available discount was only used in the minority of cases across recommended (22 percent of cases) and not recommended (19 percent) technologies. In the period since 1 January 2014, use of a nationally available discount increased overall, but to a greater degree in technologies ultimately receiving a positive recommendation from NICE (not recommended: 19 percent to 39 percent; recommended: 22 percent to 59 percent). In the period since 1 January 2014, the proportion of technologies with a positive recommendation where implicit price flexibility during the appraisal was revealed increased (from 20/186) to 40/182.Conclusions:With the current PPRS, the majority of technologies have offered a nationally available discount, most commonly at the time of submission; however, there is increasing evidence of implicit price flexibility during the appraisal process to achieve a positive recommendation.

Prediction of Carbohydrate-Protein Interaction in Cassava Starch-Casein Blended Edible Films

The aim of this research was to study protein-carbohydrate interaction in edible films. Edible films were made from a blend of cassava starch and casein. Tensile Strength (TS), percentage elongation (%E) and Solubility (S) wereobserved to study their inter-relationships. Fourier Transform Infra Red (FTIR) Spectroscopy was used to monitor the molecular interactions. Interaction of carbohydrate and protein was studied at pH of 4, 7 and 9 and various casein percentages (0, 20, 40, 60, 80 and 100%, respectively). Increasingthe casein ratio decreased %E and S butimproved TS. Improving the %E decreased the TS and S when pH was increased (p<0.05). FTIR spectra of the samples at 100% cassava showed there werechangesin intensity at 3400-3600 cm-1 with the changesin pH and the lowest occured at pH 7. FTIR spectra of 100% casein films showed that intensitywas increasedby increasing the pH and the lowest intensity was at pH 4.The FTIR spectra of films from a blend of cassava starch-casein showed an absorbtion band similar to cassava starch films in the range 1200-1000 cm-1 and similar to casein films in the range 1700-1500 cm-1. Highest interaction between cassava starch and casein molecules occurred at pH 9 in all cases. At 3600-2800 cm-1 it was the 60% casein films. In the region 1700-1500 cm-1 it was the 80% caseinfilms and in the range 1200-1000 cm-1 was the 20% casein films.Presumable optimum interaction of carbohydrate-protein occurred at pH 9.

Total knee arthroplasty with the Medial-Pivot knee system: Clinical and radiological outcomes at 9.5years' mean follow-up.

The "ball-in-socket" design of the Medial-Pivot knee system (MicroPort Orthopedics, Arlington, Tennessee, USA) aims to reproduce normal knee kinematics by medializing its rotational axis. The goal of this study was to measure knee range of motion (ROM) with this implant after a mean follow-up of 10years and to report the survivorship and long-term clinical and radiological outcomes. We hypothesized the prosthetic knee would have at least 120° flexion at 10years. This was retrospective, single-centre study of 74Medial-Pivot knees implanted in 71patients (average age of 69years) between May2005 and November2007. All patients who received a Medial-Pivot knee were included consecutively. The mean follow-up was 10years. Clinical and radiological assessments were performed using the Knee Society Score (KSS) and Ewald's score. Kaplan-Meir survival analysis was used to calculate survivorship. Seven percent of cases were lost to follow-up. The knee ROM was 110° at 10years. The survivorship was 93% for all revision causes and 95.9% when revisions due to trauma or infection were excluded. The mean KSS score was 195. Stable radiolucent lines were found in 14% of cases. No aseptic loosening was observed. Our hypothesis was not confirmed. Knee flexion at the final follow-up was comparable to other semi-constrained implant designs but was not as large as expected. The survival of the Medial-Pivot knee at 10years is good. Its radiological and clinical outcomes are satisfactory. IV (retrospective cohort study).

Refractive Outcome and Influencing Factors of Postoperative Refraction in Cataract Surgery

Abstract Introduction. Phacoemulsification with intraocular lens implantation provide high visual acuity after procedure, increasing quality of life and vision. The aim of procedure is to gain a target refraction, in most cases emmetropia, when a patient does not need visual correction for a distant sight (1). Although the preoperative evaluation and surgery technique has developed in the last years, it is not possible to gain the target refraction in all cases. There still are patients with high postoperative error, which means that there are influencing factors that should be identified. Aim of the Study. Aim of the study was to evaluate the refractive outcome three months after cataract surgery in Pauls Stradins Clinical University Hospital and to find out the factors that influence postoperative refraction after cataract surgery. Material and methods. Retrospective study included 43 eyes of 38 patients who underwent phacoemulsification’s cataract surgery with intraocular lens implantation and fixed A constant. Surgeries were done at PSCUH from August, 2017 till January, 2018. Data were collected at postoperative follow-up three months after surgery (postoperative refraction). The difference between data intervals was evaluated using nonparametric tests - Mann-Whitney tests. The correlations between postoperative refraction and potentially influencing factors of refractive outcome were evaluated by nonparametric correlation tests - Spearman’s rho test. Results. Of the patients enrolled in the study, whose median age was 75 years (IQR = 78-68 years), 20,9 % (n=9) were men, 51,2% (n=22) had no comorbidities, 34,9% (n=15) had one comorbidity, but two comorbidities had 14% (n=6) patients. At the time of cataract surgery 16,3% (n=7) of patients had Diabetes mellitus, but 46,5 % (n=20) had Glaucoma. The absolute error between target refraction and postoperative refraction for all cases was 0.48 ± 0.41 D (mean + standard deviation). The main aim of surgery - emmetropic eye - was achieved in 30,2 percent of cases (n=13). In the study, 69.8 percent of cases (n=30) were within ±0.50 D difference between target and final postoperative refraction, and 90.7 percent of cases (n=39) were within ±1.00 D. The study showed moderate and negative correlation between the axial length of eye and refractive outcome of cataract surgery: correlation coefficient r= -0.412 (p=0.006). The study showed week correlation between the age of patients and refractive outcome of cataract surgery r=0.091 (p=0.562). The difference between IOL power calculated using Haigis formula and IOL power of lens implanted during surgery also had a week correlation with refractive outcome r=0.033 (p=0.833). Correlations between comorbidities and refractive outcome were week and negative - in case of diabetes mellitus r= -0.127 but in case of glaucoma r= -0.13. Conclusions. Cataract surgery outcome showed high quality of this procedure because of the insignificant mean postoperative refractive error. The study did not show statistically significant correlation between refractive outcome and the age of patients, presence of diabetes mellitus or glaucoma and the difference between calculated and implanted IOL power. The study revealed moderate and negative correlation between the axial length and refractive outcome. This correlation coincides with the results of the studies previously made. The refractive outcome is worse for smaller eyes.

Trends in types of calls managed by U.S. poison centers 2000–2015

Aim: The number of cases reported to poison centers has decreased since 2008 but there is evidence that the complexity of calls is increasing.Objectives: The objectives are to evaluate national poison center data for trends in reason and how these changes effect management site, medical outcomes, and poison center workload.Methods: Data regarding reason, age, management site, and medical outcome were extracted from annual reports of the National Poison Data System from 2000 to 2015. The proportion of cases by year were determined for unintentional and intentional exposures. Analysis of data from a single poison center from 2005 to 2015 compared the number of interactions between poison center staff and callers for unintentional versus intentional reasons.Results: Trend analyses found that from 2000 to 2015 the percent of unintentional cases decreased (from 85.9 to 78.4%, p < .0001) and the percent of intentional cases increased (from 11.3 to 17.6%, p < .0001). Age distribution changed with a decrease in children <13 years of age and increase in adolescents and adults. In these latter two age groups, the proportion due to intentional exposure increased while unintentional declined. The distribution of management sites changed over the 16-year period, with a decrease in non-HCF cases and significant increase in percent of cases treated in a HCF. The frequencies of moderate effect, major effect, and death were significantly higher for intentional exposures than for unintentional exposures. Analysis of data entry notes from a single center showed that the mean number of notes per unintentional case (1.61 ± 0.08) was significantly different from the mean number of notes per intentional case (9.23 ± 0.68) (p < .0001).Discussion: Poison centers are managing more intentional exposures and fewer unintentional exposures. Intentional exposures require more poison center staff expertise and time.Conclusion: Looking only at poison center total call volume may not be an adequate method to gauge productivity.

Examining the Examiners: SEC Effectiveness in Identifying Financial Reporting Errors

The ability to detect misreporting is an important aspect of financial reporting regulation. I derive a measure of SEC error detection rates using information from comment letter reviews. Conditional on the SEC issuing a comment letter, I find that the review team detects an error resulting in a restatement in 4.6 percent of cases, while firms eventually restate financial reports for 13.6 percent of periods under review. My measure of SEC error detection rates is the ratio of reviews that detect an error to total reviews that could have detected an error. I document a positive association between detection rates and review team size. Using a novel approach to identify examiner characteristics, I show that this association is driven by the number of accountants on the review team. I find an economically insignificant association between individual examiner performance and economic or career incentives.

Does Frequency of ST-Segment Elevation Myocardial Infarction Presentation Impact Quality of Care?

ObjectivesThe volume of ST-Segment Elevation Myocardial Infarctions (STEMIs) presenting to an emergency department (ED) has been shown to affect treatment quality measures and patient outcomes. Almost half of ST-elevation-myocardial-infarction (STEMI) patients in New Brunswick (NB) present directly to community hospitals. This study seeks to determine if the quality of care received by STEMI patients presenting to EDs in NB is related to the volume of STEMI presentations at that center. MethodsThis retrospective registry-based study used data from the STEMI database at the New Brunswick Heart Centre (NBHC), identifying 1196 cases of STEMI in NB, Canada, between December 2010 and April 2013. Patients were stratified into three groups based on the annual volume of STEMIs seen at the presenting center. Quality of care determinants, consisting of the percent of cases adhering to door-to-ECG (D2E), ECG-to-needle (E2N), and door-to-needle (D2N) time guidelines were then compared between groups.ResultsThe mean age of the 1188 cases identified was 61.3 years, 73.8% were male, and 69.0% received thrombolysis. There was no difference in the rate of guideline adherence between the high, medium, and low-volume centers. The total rates of guideline adherence were 43.7%, 44.9%, and 47.5% for the D2E, E2N, and D2N times, respectively.ConclusionWe did not identify any relationship between the rates of adherence with STEMI care guidelines and the volume of STEMI patients presenting to a center. Adherence rates were lower than in previously reported series from other regions. Further efforts should be undertaken to identify the causes of delayed STEMI diagnosis and treatment in our population and to implement system changes to improve standards of care.

Factors associated with herd bulk milk composition and technological traits in the Italian dairy industry

The aim of the present study was to investigate sources of variation of milk composition and technological characteristics routinely collected in field conditions in the Italian dairy industry. A total of 40,896 bulk milk records from 620 herds and 10 regions across Italy were analyzed. Composition traits were fat, protein, and casein percentages, urea content, and somatic cell score; and technological characteristics were rennet coagulation time, curd firming time, curd firmness 30 min after rennet addition to milk, and titratable acidity. Data of herd bulk milks were analyzed using a model that included fixed effects of region, herd nested within region, and season of milk analysis. An average good milk quality was reported in the dairy industry (especially concerning fat, protein, and casein percentages), and moderate to high correlations between composition and technological traits were observed. All factors included in the statistical model were significant in explaining the variation of the studied traits except for region effect in the analysis of casein and somatic cell score. Northeast and central-southern Italian regions showed the best performance for composition and technological features, respectively. Traits varied greatly across regions, which could reflect differences in herd management and strategies. Overall, less suitable milk for dairy processing was observed in summer. Results of the present study suggested that a constant monitoring of technological traits in the dairy industry is necessary to improve production quality at herd level and it may be a way to segregate milk according to its processing characteristics.

Anesthetic management of amniotic fluid embolism -- a multi-center, retrospective, cohort study

Introduction: Amniotic fluid embolism (AFE) is a rare and potentially lethal obstetric complication, commonly occurring during labor, delivery, or immediately postpartum. There is a paucity of data regarding incidence, risk factors, and clinical management. Our primary objective in this study was to evaluate clinical presentation of AFE and delineate anesthesia management of these cases.Methods: This 10 years retrospective multi-center cohort study was performed in five tertiary university-affiliated medical centers, between the years 2005 and 2015. All documented cases of AFE identified according to the ICD guidelines were reviewed manually to determine eligibility for AFE according to Clark’s criteria. All cases confirming Clark’s diagnosis were included in the cohort.Results: Throughout the study period, 20 cases of AFE were identified, with an incidence of 4.1 per 100,000 births. Average age at presentation was 35 ± 5 years. Seventy percent of cases presented during vaginal delivery, 20% occurred throughout a cesarean delivery, and 10% occurred during a dilation and evacuation procedure. The most common presenting symptom was sudden loss of consciousness in 12 parturients (66.7%), fetal bradycardia in 11 parturients (55%), and shortness of breath in 10 parturients (50%). Perimortem cesarean section was performed in 55% of cases, although only one case was performed in the delivery suite, while all others were performed in the operating room. Echocardiography was performed in 60% of the cases and all were pathological. Furthermore, 20% of cases were connected to an extracorporeal membrane oxygenation machine. There was a 15% mortality rate of 15%. A further 15% suffered major neurological disability, 25% suffered minor neurological morbidity, and 45% survived without severe complications.Conclusion: AFE is associated with significant maternal morbidity. This study highlights the importance of providing advanced training for the delivery suite staff for cases of maternal cardiovascular collapse secondary to AFE and increasing awareness for this rare and devastating obstetric condition.

Differences in Clinical Characteristics and Outcomes of Patients with Community-Onset Clostridium difficile Infection who Tested Positive by EIA Compared with NAAT through a Two-Step Algorithm

BackgroundThe low sensitivity of toxin enzyme immunoassay (EIA) for the diagnosis of Clostridium difficile infection (CDI) motivated many laboratories to add nucleic acid amplification tests (NAAT) to their testing protocol. However, NAAT do not distinguish between colonization and infection, and indiscriminant testing could lead to over treatment of CDI.MethodsActive, population-based CDI surveillance has been conducted through the Emerging Infections Program in Bernalillo County, NM since 2011, with test type collected at the individual level since 2014. Community-onset (CO) CDI cases with a first positive test diagnosed by a two-step algorithm (concurrent EIA/GDH, with discordant results reflexed to NAAT) in 2014–2015 were included. We analyzed clinical characteristics and outcomes of patients EIA positive compared with NAAT positive. Demographics, risk factors, treatment, and outcomes were assessed through medical record review.ResultsAmong 1,063 cases, 559 (52.6%) were EIA positive only and 504 (47.4%) were NAAT positive only. Of those with stool collected as a hospital inpatient, 57% were NAAT positive (P < 0.001); this increased from 43.4% if tested the day of admission to 61.4% when tested on day three. Conversely, 38.6% of patients with stool collected in an emergency department were NAAT positive (P = 0.004). Fewer cases with complicated outcomes were NAAT positive (40.7%, P = 0.023). Among those with no documentation of recent antibiotic use, 64.3% were NAAT positive (P < 0.001), and 67.8% of cases with no CDI treatment were NAAT positive (P = 0.005). Only 28.3% percent of cases with recurrent CDI were initially NAAT positive (P < 0.001).ConclusionEIA negative and NAAT positive CO-CDI cases tended to have a milder clinical presentation than those that were EIA positive. This suggests that some patients positive only by NAAT may have mild CDI or be colonized, rather than infected, with C. difficile. These individuals were less likely to have complicated outcomes, have recent documented antibiotic use, be treated for CDI, or have a recurrent CDI episode than those positive by EIA. Longer hospital stay correlated with increased proportion of testing NAAT positive. Providers may benefit from considering testing protocol and clinical correlation when assessing patients with positive C. difficile test results.Disclosures All authors: No reported disclosures.

The response of goats to different starch/NDF ratios of concentrates on the milk chemical composition, fatty acid profile, casein fractions and rennet clotting properties

The partial substitution of corn grain (rich in starch) with agro-industrial by-products (rich in NDF) could be a good strategy to reduce ruminant dietary costs with no negative effects on milk properties. Thus, the present study aimed to investigate the effect of different starch/NDF ratios of concentrates, with fixed forage proportions, on the chemical composition and fatty acid profile as well as on the relative proportions of individual caseins and rennet clotting properties of goat’s milk. For this purpose, sixteen crossbred dairy goats were divided into two homogeneous sub-groups based on their mean body weight and milk fat corrected yield. Each goat of each group was fed individually with alfalfa hay, wheat straw and concentrates. The two concentrates of the two dietary treatments were formulated to produce difference starch/NDF ratios, which were 1.2 and 0.3 for high starch (HS) and low starch (LS), respectively. The results showed no significant effect on milk chemical composition between the two dietary treatments. Moreover, the different starch/NDF ratios of the concentrates had no effect on the casein profile and coagulation properties of goat’s milk. A significant reduction of κ- and αs2- casein percentages in the milk throughout the experimental period was found. Finally, the different starch/NDF ratios of the concentrates did not reveal remarkable differences in milk fatty acids except for the individual proportions of C4:0, C6:0, C18:0 and C18:2n:6t, which were significantly higher, while those of C14:1, C15:0, C16:1, C17:0, C17:1 and C20:3n-3 were significantly lower, in goats that were milk fed with the HS diet compared with those who consumed the LS. In conclusion, the 4 times decrease in the starch/NDF ratio of the concentrates without changing the forage/concentrate ratio of the goat’s diet could reduce the feeding cost without causing any problems in the rennet clotting properties of milk and consequently in the milk industry.

Manoeuvre to aid Endoscopic division of aryepiglottic folds (Aryepiglottoplasty).

Laryngomalacia, a congenital malformation of larynx is the commonest cause of stridor in young infants. Ninety percent of cases resolve by the age of 2 years without any active intervention (1).The most consistent abnormality seen in non-resolving cases is shortening of the aryepiglottic folds (picture 1).(2) This article is protected by copyright. All rights reserved.

The Association of Household Food Insecurity and the Risk of Calcium Oxalate Stones.

Food insecurity has been defined as 'limited or uncertain availability of nutritionally adequate and safe foods', which associated with adverse health consequences in human. Another alarming condition, which is related to several comorbidities is kidney stone. This study aimed to determine the association of household food insecurity and developing kidney stones (calcium oxalate) in adults referred to medical centers of Babol. This case-control study included 200 participants 18-65 years of ages (100 cases, 100 controls). An 18-items food insecurity questionnaire (USDA), a valid and reliable 147-item food frequency questionnaire (FFQ) and demographic characteristics were obtained via interviewing. Sixty eight percent of cases and 40% of controls were food insecure, respectively. Food insecurity was significantly associated with the risk of kidney stone (P < .05). Furthermore, body mass index (BMI) and family history of kidney stone were significantly associated with the risk of kidney stones (P < .05). Food insecurity and BMI were significantly associated with the kidney stone, which shows the importance of availability of nutritionally adequate and safe foods in prevention of the kidney stone.

MOLECULAR TYPES IN THE PROGNOSIS OF PAPILLARY THYROID CANCER BASED ON THE ANALYSIS OF THE STATUS OF BRAF V600E, INDEX AND KI-67 EXPRESSION

The aim of our research was to determine the possibilities to stratify patients with papillary thyroid cancer (PTC) on the group’s forecast, depending on the status of the mutation BRAF v600e and Ki-67 expression. The study included 89 PTC patients with the known prognosis for the period of 2005-2015. They were treated in the Altai regional oncology center and underwent surgery for PTC over the period of 2005-2013. Mutation p. Val600Glu (V600E) BRAF gene was determined with the use of allele-specific real-time PCR kit «Real-time-PCR-BRAF-V600E («BioLink»)». Immunohistochemical examination was performed with antibodies Ki-67 (clone MIB1, «DAKO») on stainer «Ventana XT» according to standard protocols. We revealed BRAF V600E not to be an independent predictor. Different variants of PTC, depending on the level of expression of Ki-67 in combination with a mutation of BRAF V600E was allowed to identify 3 groups of molecular types of PTC: a lack of mutation and a low Ki-67 (type I), with mutation and a low Ki-67 (type II) and with the presence and/or absence of a mutation and high level Ki-67 (type III). I molecular type PTC is the most favorable from the point of view of survival: 100% of patients live 10 years. Molecular type II is characterized by an intermediate prognosis: 76% of patients lived out up to 10 years. Molecular type III is characterized by the poor prognosis: only 36.8 percent of cases lived up to 10 years. In multivariate analysis of survival in PTC patients the independent prognostic factor happened to be the molecular type of tumor. In this case χ2 = 35 at p ≤ 0.000005.

Thrombolysis for stroke in Ireland: increasing access and maintaining safety in a challenging environment.

In the setting of a national audit of acute stroke services, we examined the delivery of thrombolytic therapy for ischaemic stroke and whether current practice was achieving safe outcomes and consistent delivery for patients. Data obtained from the recent national stroke audit was compared against previous Irish audit, the most recent SSNAP UK stroke audit and the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) study. Thrombolysis was provided in 27 acute hospitals throughout Ireland during the period assessed with 82% (22/27) providing 24/7 access, the remaining sites using redirect policies. Decision to thrombolyse was made by stroke trained consultants in 63% (17/27) of units, with general physicians and emergency medicine consultants covering the other units. Thrombolysis rate for non-haemorrhagic stroke was 11% (n=80/742, CI 95% ±2.23) versus a 1% rate in the 2008 audit. Sites receiving patients through a redirect policy had the highest thrombolysis rate, an average of 24%. Nearly 30% of cases were thrombolysed on the weekend. Eighty-three percent of cases were managed in a stroke unit at some time during admission versus 54% of the national total cases. Thirty-seven percent of patients were ≥80years old. The mortality rate was 11.3% versus the national mortality rate for non-thrombolysed ischaemic strokes of 10% (p>0.5), and this is comparable to the SITS-MOST 2007 study 3-month mortality rate of 11.3% (p>0.5). Stroke thrombolysis is being effectively and safely provided in acute stroke services in Ireland despite regular involvement of non-specialist staff. There is still potential to improve thrombolysis rate.

Association of candidate gene polymorphisms with milk technological traits, yield, composition, and somatic cell score in Italian Holstein-Friesian sires

Advances in DNA-based marker technology have enabled the identification of genomic regions underlying complex phenotypic traits in livestock species. The incorporation of detected quantitative trait loci into genetic evaluation provides great potential to enhance selection accuracies, hence expediting the genetic improvement of economically important traits. The objective of the present study was to investigate 96 single nucleotide polymorphisms (SNP) located in 53 candidate genes previously reported to have effects on milk production and quality traits in a population of highly selected Holstein-Friesian bulls. A total of 423 semen samples were used to genotype the bulls through a custom oligo pool assay. Forty-five SNP in 32 genes were found to be associated with at least 1 of the tested traits. Most significant and favorable SNP trait associations were observed for polymorphisms located in CCL3 and AGPAT6 genes for fat yield (0.037 and 0.033 kg/d, respectively), DGKG gene for milk yield (0.698 kg/d), PPARGC1A, CSN1S1, and AGPAT6 genes for fat percentage (0.127, 0.113, and 0.093%, respectively), GHR gene for protein (0.064%) and casein percentage (0.053%), and TLR4 gene for fat (0.090%), protein (0.066%), and casein percentage (0.050%). Somatic cell score was favorably affected by GHR (-0.095) and POU1F1 (-0.137), and interesting SNP-trait associations were observed for polymorphisms located in CSN2, POU1F1, and AGPAT6 genes for rennet coagulation time (-0.592, -0.558, and -0.462 min, respectively), and GHR and CSN2 genes for curd firmness 30 min after rennet addition (1.264 and 1.183 mm, respectively). In addition to the influence of individual SNP, the effects of composite genotypes constructed by grouping SNP according to their individual effects on traits considered in the analysis were also examined. Favorable and significant effects on milk traits were observed for 2 composite genotypes, one including 10 SNP and the other 4 SNP. The former was associated with an increase of milk (0.075 kg/d), fat (0.097 kg/d), protein (0.083 kg/d), and casein yields (0.065 kg/d), and the latter was associated with an increase of fat (0.244%), protein (0.071%), and casein percentage (0.047%). Although further research is required to validate the identified SNP loci in other populations and breeds, our results can be considered as a preliminary foundation for further replication studies on gene-assisted selection programs.

Effective recovery of casein from its highly diluted solution by using a technology of foam fractionation coupled with isoelectric precipitation

A technology of foam fractionation coupled with isoelectric precipitation was developed for effectively recovering casein from its highly diluted solution without using any surfactants as stabilizers due to its poor surface activity. The results showed that foam stability could be improved by using the pore diameter of gas distributor 125 μm and increasing the liquid phase height to 1750 mm. In the two-stage continuous foam fractionation, the enrichment ratio and the recovery percentage of casein were obtained as high as 12.1 and 92.3%, respectively. Then, the foamate was treated by precipitation and the supernatant could be used as the feed solution of the first stage foam fractionation. By using the coupled technology, the enrichment ratio was further increased to 52.6 and the recovery percentage was 91.7%. The concentration of casein 0.01 g/L and its mass percent 5% were got in the residual solution and the precipitated solution, respectively.

Where the wild things are: animal victimization in federal environmental crime cases

Although there has been a marked increase in studies of animal abuse from a variety of socio-legal and green criminological perspectives in the past two decades, we have a limited empirical understanding of the extent of animal victimization in environmental crime prosecutions in the United States. In order to better understand the nature and distribution of animal victimization in environmental crime prosecutions, we employ a content analysis of federal environmental crime cases, 2001–2011. Out of 972 cases, results show identifiable animal victimization plays a role in six percent of cases. Although animal victimization in environmental crime may be extensive, its role in environmental prosecutions appears secondary. We conclude with possibilities of expanding animal protection via wildlife and environmental law connections.

TWIN REVERSED ARTERIAL PERFUSION SEQUENCE (TRAP);

Twin reversed arterial perfusion sequence (TRAP sequence) is a condition thatoccurs only in identical twins that share a placenta (monochorionic), in which one twin lackinga functioning cardiac system “acardiac monster” receives blood from the normally developingtwin called the “pump twin”. This places an enormous demand on the heart putting the pumptwin at risk for cardiac failure. Left untreated, the pump twin will die in 50 percent to 75 percentof cases. Here we present the case report of a 20 years old G2P1at 32 weeks POG with amonochorionic twin pregnancy. One of the twins was “acardiac acephalous” and the other a“pump twin” with mild hydrocephalous.

Understanding Canadian and US tourists: A self-concept based segmentation study

This study aims to identify the distinctive market segments based on tourists’ self-concept, gain a better understanding of U.S. and Canadian tourists’ travel patterns, and provide implications that are beneficial to destination marketing organizations (DMOs). This study advances the knowledge of self-concept in the tourism context by validating its measurement and employing it as a segmentation base. This study used 2 percent of cases (N=1,012) of secondary data collected by an Ontario government agency, and a factor-cluster approach for analysis. Principal component analysis was utilized to identify specific characteristics of self-concept items and the results yielded three selves (extravert self, explorative self, and depressive self). Then, the study segmented U.S. and Canadian tourists by three self-concept factors and obtained four distinctive segments: Energetic Segment (ENT), Adventurous Segment (ADT), Conservative Segment (COT), and Escaping Segment (EST). ENT tourists are characterized as active, inquisitive and confident with a medium level of perceived value, satisfaction, and recommendation. ADT represents tourists who are older, open-minded, and optimistic with the highest level of perceived value, satisfaction, and recommendation. COT is relatively passive and had the lowest level of perceived value, satisfaction, and recommendation. EST is a group of nervous and stressful young female tourists who had a low level of perceived value and a medium degree of satisfaction and recommendation. This paper concludes with appropriate advertising and promotional strategies for the different segments.