Carotid Surgery : A posse ad esse non valet consequentia

According to a large body of evidence, carotid endarterectomy (CEA) can prevent strokes, provided that appropriate inclusion criteria and high-quality perioperative treatment methods are utilised with low complication rates. From the patient s perspective, it is of paramount importance that the operation is as safe and effective as possible. From the community s point of view, it is important that CEA provision prevents as many strokes as possible. In order to define the stroke preventing potential of CEA in different communities, a comparison between eight European countries and Australia was performed including 53 077 carotid interventions. A more detailed evaluation was performed in Finland, the United Kingdom and Egypt. It could be estimated that many potentially preventable strokes occur due to insufficient diagnostics and CEA provision. The number of CEAs should be at least doubled in the Helsinki region. The theoretical power of CEA provision in stroke prevention varied significantly between the countries. Delay from symptom to surgery has been identified as one of the most important factors influencing the effectiveness of CEA. In 2008 only 11% of CEAs in Helsinki university central hospital (HUCH) were performed within the recommended14 days. Registered data of 673 CEAs in HUCH during 2000-2005 was analyzed. There was no systematic error that would have changed the outcome analysis. However it is important that registers are audited regularly and cross matching of different registries is possible. A previously unpublished method of combining medial mandibulotomy, neck incision and carotid artery interposition was carried out as a collaboration of maxillofacial, ear, nose and throat and vascular surgeons. Five patients were operated on with a technique that was feasible and possible to perform with little morbidity, but due to the significant risks involved, this technique should be reserved for carefully selected cases. In stroke prevention, organisational decisions seem far more important than details in interventional procedures when CEA is performed with low complication rates, as was the case in the present study. A TIA clinic approach with close co-operation between the on-call vascular surgeons, neurologists and radiologists should be available at all centres treating these patients. Patients should have a direct and fast admission to the hospital performing CEA.

Molecular profiling of indoor microbial communities in moisture damaged and non-damaged buildings

Epidemiological studies have shown an elevation in the incidence of asthma, allergic symptoms and respiratory infections among people living or working in buildings with moisture and mould problems. Microbial growth is suspected to have a key role, since the severity of microbial contamination and symptoms show a positive correlation, while the removal of contaminated materials relieves the symptoms. However, the cause-and-effect relationship has not been well established and knowledge of the causative agents is incomplete. The present consensus of indoor microbes relies on culture-based methods. Microbial cultivation and identification is known to provide qualitatively and quantitatively biased results, which is suspected to be one of the reasons behind the often inconsistent findings between objectively measured microbiological attributes and health. In the present study the indoor microbial communities were assessed using culture-independent, DNA based methods. Fungal and bacterial diversity was determined by amplifying and sequencing the nucITS- and16S-gene regions, correspondingly. In addition, the cell equivalent numbers of 69 mould species or groups were determined by quantitative PCR (qPCR). The results from molecular analyses were compared with results obtained using traditional plate cultivation for fungi. Using DNA-based tools, the indoor microbial diversity was found to be consistently higher and taxonomically wider than viable diversity. The dominant sequence types of fungi, and also of bacteria were mainly affiliated with well-known microbial species. However, in each building they were accompanied by various rare, uncultivable and unknown species. In both moisture-damaged and undamaged buildings the dominant fungal sequence phylotypes were affiliated with the classes Dothideomycetes (mould-like filamentous ascomycetes); Agaricomycetes (mushroom- and polypore-like filamentous basidiomycetes); Urediniomycetes (rust-like basidiomycetes); Tremellomycetes and the family Malasseziales (both yeast-like basidiomycetes). The most probable source for the majority of fungal types was the outdoor environment. In contrast, the dominant bacterial phylotypes in both damaged and undamaged buildings were affiliated with human-associated members within the phyla Actinobacteria and Firmicutes. Indications of elevated fungal diversity within potentially moisture-damage-associated fungal groups were recorded in two of the damaged buildings, while one of the buildings was characterized by an abundance of members of the Penicillium chrysogenum and P. commune species complexes. However, due to the small sample number and strong normal variation firm conclusions concerning the effect of moisture damage on the species diversity could not be made. The fungal communities in dust samples showed seasonal variation, which reflected the seasonal fluctuation of outdoor fungi. Seasonal variation of bacterial communities was less clear but to some extent attributable to the outdoor sources as well. The comparison of methods showed that clone library sequencing was a feasible method for describing the total microbial diversity, indicated a moderate quantitative correlation between sequencing and qPCR results and confirmed that culture based methods give both a qualitative and quantitative underestimate of microbial diversity in the indoor environment. However, certain important indoor fungi such as Penicillium spp. were clearly underrepresented in the sequence material, probably due to their physiological and genetic properties. Species specific qPCR was a more efficient and sensitive method for detecting and quantitating individual species than sequencing, but in order to exploit the full advantage of the method in building investigations more information is needed about the microbial species growing on damaged materials. In the present study, a new method was also developed for enhanced screening of the marker gene clone libraries. The suitability of the screening method to different kinds of microbial environments including biowaste compost material and indoor settled dusts was evaluated. The usability was found to be restricted to environments that support the growth and subsequent dominance of a small number microbial species, such as compost material.

Field-dependent changeover from current-to voltage-limiting characteristics by non-linear n-type BaTiO3 ceramics

Non-linear resistors having current-limiting capabilities at lower field strengths, and voltage-limiting characteristics (varistors) at higher field strengths, were prepared from sintered polycrystalline ceramics of (Ba0.6Sr0.4)(Ti0.97Zr0.03)O3+0.3 at % La, and reannealed after painting with low-melting mixtures of Bi2O3 + PbO +B2O3. These types of non-linear characteristics were found to depend upon the non-uniform diffusion of lead and the consequent distribution of Curie points (T c) in these perovskites, resulting in diffuse phase transitions. Tunnelling of electrons across the asymmetric barrier at tetragonak-cubic interfaces changes to tunnelling across the symmetric barrier as the cubic phase is fully stabilized through Joule heating at high field strengths. Therefore the current-limiting characteristics switch over to voltage-limiting behaviour because tunnelling to acceptor-type mid-bandgap states gives way to band-to-band tunnelling.

Influence of non-geometrical factors on intracrystalline diffusion -- Role of sorbate-zeolite interactions

Molecular dynamics simulations on Xe in NaY and Ar in NaCaA zeolite are reported. Rates of cage-to-cage crossovers in the two zeolites exhibit trends which are contrary to that expected from geometrical considerations. The results suggest the important role of the sorbate-zeolite interactions in determining the molecular sieve properties of zeolites for small sized sorbates. The results are explained in terms of the barrier height for cage-to-cage crossover in the two zeolites.

Non-conservatively loaded stochastic columns

A new finite element method is developed to analyse non-conservative structures with more than one parameter behaving in a stochastic manner. As a generalization, this paper treats the subsequent non-self-adjoint random eigenvalue problem that arises when the material property values of the non-conservative structural system have stochastic fluctuations resulting from manufacturing and measurement errors. The free vibration problems of stochastic Beck's column and stochastic Leipholz column whose Young's modulus and mass density are distributed stochastically are considered. The stochastic finite element method that is developed, is implemented to arrive at a random non-self-adjoint algebraic eigenvalue problem. The stochastic characteristics of eigensolutions are derived in terms of the stochastic material property variations. Numerical examples are given. It is demonstrated that, through this formulation, the finite element discretization need not be dependent on the characteristics of stochastic processes of the fluctuations in material property value.

Non-Darcy mixed convection flow with thermal dispersion on a vertical cylinder in a saturated porous medium

The non-Darcy mixed convection flow on a vertical cylinder embedded in a saturated porous medium has been studied taking into account the effect of thermal dispersion. Both forced flow and buoyancy force dominated cases with constant wall temperature condition have been considered. The governing partial differential equations have been solved numerically using the Keller box method. The results are presented for the buoyancy parameter which cover the entire regime of mixed convection flow ranging from pure forced convection to pure free convection. The effect of thermal dispersion is found to be more pronounced on the heat transfer than on the skin friction and it enhances the heat transfer but reduces the skin friction.

Professional non-neutrality: criticising the third party in psychotherapy

Using audio-recorded data from cognitive-constructivist psychotherapy, the article shows a particular institutional context in which successful professional action does not adhere to the pattern of affective neutrality which Parsons saw as an inherent component of medicine and psychotherapy. In our data, the professional’s non-neutrality functions as a tool for achieving institutional goals. The analysis focuses on the psychotherapist’s actions that convey a critical stance towards a third party with whom the patient has experienced problems. The data analysis revealed two practices of this kind of critique: (1) the therapist can confirm the critique that the patient has expressed or (2) return to the critique from which the patient has focused away. These actions are shown to build grounds for the therapist’s further actions that challenge the patient’s dysfunctional beliefs. The article suggests that in the case of psychotherapy, actions that as such might be seen as apparent lapses from the neutral professional role can in their specific context perform the task of the institution at hand.

Non-linearity in piezo-fiber reinforced composites: an asymptotic approach

An asymptotically correct analysis is developed for Macro Fiber Composite unit cell using Variational Asymptotic Method (VAM). VAM splits the 3D nonlinear problem into two parts: A 1D nonlinear problem along the length of the fiber and a linear 2D cross-sectional problem. Closed form solutions are obtained for the 2D problem which are in terms of 1D parameters.

Growth temperature induced effects in non-polar a-plane GaN on r-plane sapphire substrate by RF-MBE

Non-polar a-plane GaN films were grown on an r-plane sapphire substrate by plasma assisted molecular beam epitaxy (PAMBE). The effect of growth temperature on structural, morphological and optical properties has been studied. The growth of non-polar a-plane (1 1 - 2 0) orientation of the GaN epilayers were confirmed by high resolution X-ray diffraction (HRXRD) study. The X-ray rocking curve (XRC) full width at half maximum of the (1 1 - 2 0) reflection shows in-plane anisotropic behavior and found to decrease with increase in growth temperature. The atomic force micrograph (AFM) shows island-like growth for the film grown at a lower temperature. Surface roughness has been decreased with increase in growth temperature. Room temperature photoluminescence shows near band edge emission at 3.434-3.442 eV. The film grown at 800 degrees C shows emission at 2.2 eV, which is attributed to yellow luminescence along with near band edge emission. (C) 2010 Elsevier B.V. All rights reserved.

Theory of the non-Fermi-liquid transition point in the two-impurity Kondo model

We present an explicit solution of the problem of two coupled spin-1/2 impurities, interacting with a band of conduction electrons. We obtain an exact effective bosonized Hamiltonian, which is then treated by two different methods (low-energy theory and mean-field approach). Scale invariance is explicitly shown at the quantum critical point. The staggered susceptibility behaves like ln(T(K)/T) at low T, whereas the magnetic susceptibility and [S1.S2] are well behaved at the transition. The divergence of C(T)/T when approaching the transition point is also studied. The non-Fermi-liquid (actually marginal-Fermi-liquid) critical point is shown to arise because of the existence of anomalous correlations, which lead to degeneracies between bosonic and fermionic states of the system. The methods developed in this paper are of interest for studying more physically relevant models, for instance, for high-T(c) cuprates.

A non-cooperative game-theoretic approach to channel assignment in multi-channel multi-radio wireless networks

Channel assignment in multi-channel multi-radio wireless networks poses a significant challenge due to scarcity of number of channels available in the wireless spectrum. Further, additional care has to be taken to consider the interference characteristics of the nodes in the network especially when nodes are in different collision domains. This work views the problem of channel assignment in multi-channel multi-radio networks with multiple collision domains as a non-cooperative game where the objective of the players is to maximize their individual utility by minimizing its interference. Necessary and sufficient conditions are derived for the channel assignment to be a Nash Equilibrium (NE) and efficiency of the NE is analyzed by deriving the lower bound of the price of anarchy of this game. A new fairness measure in multiple collision domain context is proposed and necessary and sufficient conditions for NE outcomes to be fair are derived. The equilibrium conditions are then applied to solve the channel assignment problem by proposing three algorithms, based on perfect/imperfect information, which rely on explicit communication between the players for arriving at an NE. A no-regret learning algorithm known as Freund and Schapire Informed algorithm, which has an additional advantage of low overhead in terms of information exchange, is proposed and its convergence to the stabilizing outcomes is studied. New performance metrics are proposed and extensive simulations are done using Matlab to obtain a thorough understanding of the performance of these algorithms on various topologies with respect to these metrics. It was observed that the algorithms proposed were able to achieve good convergence to NE resulting in efficient channel assignment strategies.

Ebselen is a potent non-competitive inhibitor of extracellular nucleoside diphosphokinase

Nucleoside di- and triphosphates and adenosine regulate several components of the mucocilairy clearance process (MCC) that protects the lung against infections, via activation of epithelial purinergic receptors. However, assessing the contribution of individual nucleotides to MCC functions remains difficult due to the complexity of the mechanisms of nucleotide release and metabolism. Enzymatic activities involved in the metabolism of extracellular nucleotides include ecto-ATPases and secreted nucleoside diphosphokinase (NDPK) and adenyl kinase, but potent and selective inhibitors of these activities are sparse. In the present study, we discovered that ebselen markedly reduced NDPK activity while having negligible effect on ecto-ATPase and adenyl kinase activities. Addition of radiotracer gamma P-32]ATP to human bronchial epithelial (HBE) cells resulted in rapid and robust accumulation of P-32]-inorganic phosphate ((32)Pi). Inclusion of UDP in the incubation medium resulted in conversion of gamma P-32]ATP to P-32]UTP, while inclusion of AMP resulted in conversion of gamma P-32]ATP to P-32]ADP. Ebselen markedly reduced P-32]UTP formation but displayed negligible effect on (32)Pi or P-32]ADP accumulations. Incubation of HBE cells with unlabeled UTP and ADP resulted in robust ebselen-sensitive formation of ATP (IC50=6.9 +/- 2 mu M). This NDPK activity was largely recovered in HBE cell secretions and supernatants from lung epithelial A549 cells. Kinetic analysis of NDPK activity indicated that ebselen reduced the V-max of the reaction (K-i=7.6 +/- 3 mu M), having negligible effect on KM values. Our study demonstrates that ebselen is a potent noncompetitive inhibitor of extracellular NDPK.

Bound states of two spin-1/2 fermions in a synthetic non-Abelian gauge field

We study the bound states of two spin-1/2 fermions interacting via a contact attraction (characterized by a scattering length) in the singlet channel in three-dimensional space in presence of a uniform non-Abelian gauge field. The configuration of the gauge field that generates a Rashba-type spin-orbit interaction is described by three coupling parameters (lambda(x),lambda(y),lambda(z)). For a generic gauge field configuration, the critical scattering length required for the formation of a bound state is negative, i.e., shifts to the ``BCS side'' of the resonance. Interestingly, we find that there are special high-symmetry configurations (e.g., lambda(x) = lambda(y) = lambda(z)) for which there is a two-body bound state for any scattering length however small and negative. Remarkably, the bound-state wave functions obtained for such configurations have nematic spin structure similar to those found in liquid He-3. Our results show that the BCS-BEC (Bose-Einstein condensation) crossover is drastically affected by the presence of a non-Abelian gauge field. We discuss possible experimental signatures of our findings both at high and low temperatures.

A Non-contact measurement technique to measure micro surface stress and obtain deformation profiles of the order of 1nm in Micro-cantilever based structures by single image Optical Diffraction method

A new method based on analysis of a single diffraction pattern is proposed to measure deflections in micro-cantilever (MC) based sensor probes, achieving typical deflection resolutions of 1nm and surface stress changes of 50 mu N/m. The proposed method employs a double MC structure where the deflection of one of the micro-cantilevers relative to the other due to surface stress changes results in a linear shift of intensity maxima of the Fraunhofer diffraction pattern of the transilluminated MC. Measurement of such shifts in the intensity maxima of a particular order along the length of the structure can be done to an accuracy of 0.01mm leading to the proposed sensitivity of deflection measurement in a typical microcantilever. This method can overcome the fundamental measurement sensitivity limit set by diffraction and pointing stability of laser beam in the widely used Optical Beam Deflection method (OBDM).

DNA polymerase alpha-primase complex from the silk glands of the non-mulberry silkworm Philosamia ricini.

The DNA content in the silk glands of the non-mulberry silkworm Philosamia ricini increases continuously during the fourth and fifth instars of larval development indicating high levels of DNA replication in this terminally differentiated tissue. Concomitantly, the DNA polymerase alpha activity also increases in the middle and the posterior silk glands during development, reaching maximal levels in the middle of the fifth larval instar. A comparable level of DNA polymerase delta/epsilon was also observed in this highly replicative tissue. The DNA polymerase alpha-primase complex from the silk glands of P. ricini has been purified to homogeneity by conventional column chromatography as well as by immunoaffinity techniques. The molecular mass of the native enzyme is 560 kDa and the enzyme comprises six non-identical subunits. The identity of the enzyme as DNA polymerase alpha has been established by its sensitivity to inhibitors such as aphidicolin, N-ethylmaleimide, butylphenyl-dGTP, butylanilino-dATP and antibodies to polymerase alpha. The enzyme possesses primase activity capable of initiating DNA synthesis on single-stranded DNA templates. The tight association of polymerase and primase activities at a constant ratio of 6:1 is observed through all the purification steps. The 180 kDa subunit harbours the polymerase activity, while the primase activity is associated with the 45 kDa subunit.