Now there will be trouble

The paper considers sentences in which “now” occurs in initial position and shows that the meaning they convey differs from the meaning of sentences that are otherwise identical except for “now” occurring in final position. We argue that the occurrence of “now” in initial position triggers a particular kind of modal reading for the sentence to which the adverb is prefixed. A general notion of modal forcing is proposed to provide a uniform account of this kind of reading. Armed with this account, we offer a solution to two tense-modal puzzles, which have to do with fatalism and the possibility of a changing past

Identifying Critical Use Cases for a Plug-in Hybrid Electric Vehicle Battery Pack from Thermal and Ageing Perspectives

The current trend towards an increasing electrification of road vehicles brings to life a whole series of unprecedent design issues. Among these, the ageing process that affects the lifetime of lithium-ion based energy storage systems is of particular importance since it turns out to be extremely sensitive to the variation of battery operating conditions normally occurring especially in hybrid electric vehicles (HEVs). This paper aims at analyzing the impact of operating conditions on the predicted lifetime of a parallel-through-the-road plug-in HEV battery both from thermal and ageing perspectives. The retained HEV powertrain architecture is presented first and modeled, and the related energy management system is implemented. Dedicated numerical models are also discussed for the high-voltage battery pack that allow predicting its thermal behavior and cyclic ageing. A wide variety of operating conditions is subsequently simulated including different driving scenarios, ambient temperatures, vehicle payloads, and battery state-of-charge (SOC) conditions. Obtained results highlight considerable impacts of the HEV operating conditions on the battery lifetime even in the advised operating temperature interval ranging from 15°C to 35°C. Moreover, charge-depleting HEV operation and high ambient temperature are identified as the most influencing conditions concerning the criticality of the use case. On the other hand, vehicle payload and specific driving scenario appear to have a reduced impact. Presented results might help engineers to improve the effectiveness of current high-voltage battery temperature control systems to extend the battery lifetime while ensuring improved energy economy

Rapid recovery of Mycobacterium tuberculosis complex from clinical specimens using the BACTEC 9000 MB system, a new automated fluorimetric technique

Objective: To evaluate the new non-radioactive automated method BACTEC 9000 MB system for the rapid detection of mycobacteria in clinical specimens.Methods: Ninety clinical specimens from 90 patients with a clinical diagnosis of tuberculosis were tested by both BACTEC 9000 and standard microbiological methods, and the results compared.Results: The BACTEC 9000, in comparison with the standard method, showed significantly higher detection rates (45 of 90 positive versus 34), shorter time to culture positivity (mean time 18.8 versus 27.4 days) and lower contamination rate (2.2% versus 5.5%).Conclusions: These results encourage the use of this new system and suggest its use in microbiological laboratories involved in mycobacteriology

Insulin resistance and acne: a new risk factor for men?

The purpose of this study is to investigate the relationship between acne and insulin resistance as well as other metabolic impairment in young males. Acne is a skin disease that can be influenced by endocrine abnormalities. In females, it is associated with polycystic ovary syndrome, with peripheral insulin resistance and hyperinsulinemia, whereas few data are available in males. For investigating this, 22 young males with acne have been compared to 22 controls of comparable age and gender. Acne was scored using the global acne grading system score. Clinical as well as biochemical parameters of glucose and lipid metabolism, circulating levels of androgens, and IGF-1 were evaluated. Oral glucose tolerance test was performed and homeostasis model assessment of insulin resistance was calculated. The results thus obtained are as follows, patients had higher BMI (p = 0.003), WC (p = 0.002), WHR (p = 0.02), SBP (p = 0.0001), DBP (p = 0.001), basal (p = 0.01) and 120 min. oGTT serum insulin concentrations (p = 0.002), basal glucose concentrations (p = 0.03), HOMA-IR (p = 0.016), and lower HDL-cholesterol than controls (p = 0.001). Among the subgroup of subjects with BMI <24.9, HDL-cholesterol (p = 0.05) and 120 min. oGTT serum insulin concentrations (p = 0.009) resulted to be independent predictors of acne at multivariate analysis. In conclusion, these findings highlight a metabolic imbalance in young males affected with acne. Insulin resistance seems to play the main role for the development of acne in these subjects. Insulin resistance could represent an effective target for therapy in male acne

Tuberculous Otitis Media with Facial Paralysis: A Clinical and Microbiological Diagnosis—A Case Report

The tuberculosis of the ear is rare, and in most cases the clinical picture resembles that of a chronic otitis media. The diagnosis is often delayed, and this can lead to irreversible complications such as hearing loss and/or facial paralysis. In view of its rare occurrence, we report a case of primary tuberculous otitis media in a 87-year-old female patient. The diagnosis was made on the basis of both histological and microbiological findings. In particular, gene amplification techniques such as real-time polymerase chain reaction are useful method for rapid diagnosis and detecting tuberculous bacilli usually present at very low number. Early diagnosis is essential for the prompt institution of antituberculous therapy

Minimally Invasive Laser Treatment of Ureterocele

Introduction: Ureterocelemay cause severe pyelo-ureteral obstruction with afebrile urinary tract infections in infants and children. Early decompressive treatment is advocated to reduce the risk of related renal and urinary tract damage. Endoscopic techniques of incision have been offered utilizing diathermic electrode. We adopted laser energy to release the obstruction of the ureterocele and reduce the need of further surgery. Our technique is described and results are presented, compared with a group of matched patients treated by diathermic energy.Materials and methods: Decompression was performed by endoscopic multiple punctures at the basis of the ureterocele. Holmium YAG Laser was utilized with 0.5–0.8 joule energy, through 8–9.8F cystoscope under general anesthesia. The control group received ureterocele incision by diathermic energy through pediatric resettoscope. Foley indwelling catheter was removed after 18–24 h. Renal ultrasound was performed at 1, 3, 6, and 12 months follow-up. Voiding cysto-urethrogram and radionuclide renal scan were done at 6–18 months in selected cases. Statistical analysis was utilized for data evaluation.Results: From January 2012 to December 2017, 64 endoscopic procedures were performed: 49 were ectopic and 15 orthotopicureteroceles. Fifty-three were in duplex systems, mostly ectopic. Mean age at endoscopy was 6.3 months (1–168). Immediate decompression of the ureterocele was obtained, but in five cases (8%) a second endoscopic puncture was necessary at 6–18 months follow-up for recurrent dilatation. Urinary tract infections and de novo refluxes occurred in 23.4 and 29.7% in the study group, compared to 38.5 and 61.5% in the 26 controls (p &lt; 0.05). Further surgery was required in 12 patients (18%) at 1–5 years follow-up (10 in ectopic ureteroceles with duplex systems): seven ureteral reimplantation for reflux, five laparoscopic hemy-nephro-ureterectomy. Orthotopic ureteroceceles had better outcome. Secondary surgery was necessary in 13 patients (50.0%) of control group (p &lt; 0.05).Conclusions: Early endoscopic decompression should be considered first line treatment of obstructing ureterocele in infants and children. Multiple punctures at the basis of the ureterocele, performed by low laser energy, is resulted a really minimally invasive treatment, providing immediate decompression of the upper urinary tract, and reducing the risk of further aggressive surgery

Use of cytobrush for bacteriological and cytological diagnosis of endometritis in mares

Background and Aim: A combined microbial and cytological examination of uterine samples is the main diagnostic method for endometritis in mares. This study aimed to describe a procedure for using the same uterine cytobrush (CB) for both bacteriological and cytological evaluation. Materials and Methods: The procedure consists of rolling the CB onto a sterilized glass slide immediately after collection and before the transfer into a sterile saline solution. In Experiment 1, a comparison between bacteriological results of the cotton swab (CS) and CB or pellet was made in 10 mares; in Experiment 2, bacteriological and cytological results were compared between different processing methods of CB in 28 mares; in other 6 mares, a CB was processed for cytology only, to investigate the reasons for the low cellularity of the pellet. Results: The agreement between culture results from the CB and CS was evaluated, and a comparison between the cytological data obtained by different processing methods of CB was performed. The perfect agreement between the CB and CS microbiological results was found. The described procedure enables useful diagnostic smears for cytology. Moreover, the seeding of both the tip of CB and the saline solution used for the transport produced accurate bacteriological results. Conclusion: The protocol described in this study for the use of CB for both cytological and bacteriological analysis could be used for the diagnosis of endometritis. To maximize diagnostic sample quality, cytology slides must be prepared with meticulous care in the field to preserve cellular integrity and minimize artifacts