5,792 research outputs found

    Perspectives about adult sibling relationships: a dyadic analysis of siblings with and without intellectual and developmental disabilities.

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    Most siblings of individuals with intellectual and developmental disabilities (IDD) report positive sibling relationships. However, extant research often only examines the perspective of the nondisabled sibling; it is unclear whether siblings with IDD report close sibling relationships. Thus, the aim of this study was to understand adult sibling relationships from the perspectives of both siblings with and without IDD. Using dyadic interviews, we examined the perspectives of eight adult sibling dyads. The study was conducted in the United States. Data were analyzed using constant comparative analysis and cross-case analysis to identify themes within and across dyads. Overall, siblings with and without IDD reported enjoying spending time with one another. However, siblings with and without Down syndrome (versus autism spectrum disorder) reported more reciprocal sibling relationships, more frequent contact, and a greater range of shared activities. Implications for future research and practice are discussed.Accepted manuscrip

    Targeting atherosclerosis using supramolecular micellar assemblies

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    Despite the high level of mortality, the cardiovascular field has not benefited to a similar degree as cancer from recent advances in nanomedicine. Applications of medical nanotechnology toward cancer far out-number those to cardiovascular disease by orders of magnitude. Similarly to cancer applications, nanomedicine can bring numerous powerful advantages, including early detection by amplification of small signals; local, as opposed to systemic, delivery of therapeutics; simultaneous delivery of a battery of agents. Within cardiovascular disease, atherosclerosis is known to be a leading contributor to morbidity and mortality. Current imaging modalities use techniques that focus on the severity of the blockage within arteries. However, the majority of plaques that rupture and cause a clinical event do not correlate with plaque size. Therefore, early detection is needed, and requires detecting molecular markers that characterize vulnerable plaques. Peptide-based nanomaterials are particularly useful for these applications as the peptide provides a tool to incorporate a biological epitope for specific homing, with inherent biocompatible and biodegradable characteristic. To this end, we have engineered supramolecular, peptide amphiphile micelles (sPAM) that bind to various stages of atherosclerosis and incorporated imaging agents to act as contrast agents for clinically relevant modalities such as magnetic resonance imaging (MRI). Micelles formed from PAs are advantageous because a locally concentrated display of a peptide on the exterior can be used to potentiate specific binding to a disease target of interest, minimizing systemic side effects. Moreover, the nanometer size provides favorable pharmacokinetic properties in vivo. And notably, due to the modularity of PAMs and their ability to incorporate multiple components, theranostic micelles can be easily constructed through simple mixing of the various amphiphilic molecules. Such micelles have the potential to be the next generation of nanoparticles with capabilities to bind to specific disease markers of interest, deliver a therapeutic, and monitor the progression and/or regression of the disease in real-time. We present micelles developed for early to late-stage atherosclerosis, and their potential as contrast-enhancing, diagnostic agents in vivo

    Second language processing of errors in Korean-to-English machine-translated output

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    While previous investigations on online machine translation (MT) in language learning have analyzed how second language (L2) learners use and post-edit MT output, no study as of yet has investigated how the learners process MT errors and what factors affect this process using response and reading times. The present study thus investigates L2 processing of MT errors that are caused by syntactic, morphological, and semantic differences between the source and target language and also examines how L2 proficiency and visual display affect this process. Forty-seven Korean learners of English participated in an acceptability judgment task in which they read a Korean sentence and then its translated counterpart in English and had to judge the accuracy of the translated sentence on a four-point scale. The response latencies for the accuracy judgment as well as the total reading times of source and target sentences were measured. The results revealed that (a) learners generally find it harder to reject mistranslations than to accept correct translations, (b) high and low proficiency learners focus on different aspects of language when processing translated output, and (c) constant visual access to the source text does not facilitate but rather interferes with processing MT errors

    Treatment efficacy and safety of chlamydial infection in gynecologic diseases

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    Background: Chlamydia trachomatis is known to be the causative microorganism of multiple gynecologic diseases such as pelvic inflammatory disease (PID), tubo-ovarian abscess (T-O abscess), and Fitz-Hugh-Curtis syndrome (FHC syndrome). Due to its ability to destruct the celial lining of the fallopian tube and thereby obstructing the passage of the sperm and the egg, chlamydial infection may also result in female infertility. Therefore adequate care of the chlamydial infection is strongly advocated and the currently used treatment of choice is antibiotic coverage such as azithromycin or doxycycline.Methods: Medical records of the 50 patients who had been admitted to the department of Obstetrics and Gynecology, Ilsan hospital from May 2013 to May 2014, under the diagnosis of pelvic inflammatory disease, tubo-ovarian abscess, and Fitz-Hugh-Curtis syndrome with the confirmatory chlamydia trachomatis PCR positive result were taken into account. Patient’s characteristics, complications of the treatment, follow up results were analyzed.Results: Of the 37 patients given azithromycin 1000mg, 7 vomited completely (18.9%) requiring doxycycline to cover up. None of the patients taking doxycycline developed vomiting requiring second line of treatment. All of the patients were followed up in the outpatient clinic 4 weeks after being discharged from the hospital. 16.7% of the azithromycin taking group and 15.0% of the doxycycline taking group showed positive PCR result which showed no statistical significance.Conclusions: The advised 1000mg azithromycin single dosage to cover chlamydial infection is a convenient way of taking the medication, but as gastro-intestinal discomfort may follow, patients with a tendency to develop the complications should be advised to take doxycycline instead. Further research should focus on the test of cure evaluation method to differentiate reinfection from persisting disease

    Beta-lactam antimicrobial dosing optimization in obese patients compared to non-obese patients using population pharmacokinetic/pharmacodynamic approach

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    Obesity is a significant global health problem and has been associated with altered pharmacokinetics and pharmacodynamics of many drugs. However, little is known regarding the effect of obesity on the pharmacokinetics and pharmacodynamics of many broad-spectrum, beta-lactam antibiotics such as piperacillin/tazobactam, meropenem, and cefepime. The objective of this study is to evaluate the population pharmacokinetics and pharmacodynamics of piperacillin/tazobactam, meropenem, and cefepime in hospitalized obese patients in order to determine dosing regimens that provide similar exposures between obese and non-obese patients. ^ For piperacillin/tazobactam, a retrospective analysis was conducted using prospectively collected serum concentration-time data from two previous studies (Study 1 and Study 2) published by our research group. Hospitalized, adult patients who required antimicrobial therapy for a suspected or documented bacterial infection were eligible to participate in both studies. In Study 2, only patients with total body weight (TBW) greater than 120 kg were eligible to be enrolled. Patients were classified as either obese [body mass index (BMI) ¡Ý 30 kg/m2] or non-obese (BMI \u3c 30 kg/m2). In Study 1, all patients received piperacillin/tazobactam 4.5 g every 8 hours (q8h), infused over 4 hours. In Study 2, patients received piperacillin/tazobactam either 4.5 g or 6.75 g q8h, infused over 4 hours. After 2 or more days of therapy, serial blood samples were collected from an indwelling IV catheter immediately prior to drug administration, and at 1, 2, 3, 4 (end of infusion), 5, 6, 7 and 8 hours after the start of infusion. Piperacillin and tazobactam serum concentrations were determined by the previously validated high performance liquid chromatography (HPLC) method. Population pharmacokinetic parameters were estimated using NONMEM, and the final pharmacokinetic model was built by evaluating the effects of covariates on the pharmacokinetic parameters of piperacillin and tazobactam using the stepwise forward inclusion followed by the backward elimination process. Tested covariates included: 1) age; 2) sex; 3) body size descriptor, including TBW, ideal body weight (IBW), lean body weight (LBW), and BMI; 4) creatinine clearance (CRCL); and 5) admission to an intensive care unit (ICU; ICU=1, general medical ward=0). In the stepwise forward inclusion process, covariates that reduced the model objective function value (OFV) \u3e 3.84 (p \u3c 0.05; ¦Ö2 distribution; 1 df) were considered significantly associated with the pharmacokinetic parameters in the model. In the backward elimination process, a covariate was removed if its elimination increased the model OFV by \u3c 5.024 (p \u3e 0.025; ¦Ö2 distribution; 1 df). Using the final pharmacokinetic model, Monte Carlo simulations were performed for three 4-hour dosing regimens to calculate probability of target attainment (PTA) using ¡Ý 50%fT\u3eMIC. ^ Overall, a convenience sample of 27 patients (11 non-obese and 16 obese) were studied. TBW ranged from 60 kg to 211 kg, BMI from 19.7 kg/m2 to 72.9 kg/m2, and measured creatinine clearance (CRCL) from 23 mL/min to 260 mL/min. Patient demographics [median (range)] in non-obese vs. obese group are: age, 53 (27-76) vs. 48 (35-69) years; CRCL, 88 (23-148) vs. 111 (28-260) mL/min; height, 175 (163-190) vs. 175 (157-190) cm; TBW, 74 (60-100) vs. 151 (98-211) kg; LBW, 54 (39-72) vs. 78 (50-94) kg; IBW, 71 (55-84) vs. 71 (50-84) kg; BMI, 24.8 (19.7-29.4) vs. 50.1 (32.7-72.9) kg/m2. The number of male patients was seven in non-obese and ten in obese patient groups, and the number of patients admitted to an intensive care unit (ICU) was seven each in non-obese and obese patient groups. Compared to non-obese patients, obese patients had significantly larger TBW, LBW, and BMI (p \u3c 0.05); other demographics were similar between non-obese and obese patients. Observed serum concentration-time profiles of both piperacillin and tazobactam were best described by a one-compartment model with zero-order input and first-order, linear elimination. The final model for piperacillin was: clearance (CL; L/h) = 11.3 + [0.0646*(CRCL-105)] + [0.0579*(BMI-35)]; and volume of distribution (V; L) = 31.3 + [0.132*(TBW-120)]. The final model for tazobactam was: CL (L/h) = 10.1 + [0.0272*(CRCL-105)]; and V (L) = 34.3. For both piperacillin and tazobactam, obese patients had significantly increased CL and V compared to non-obese patients. The pharmacokinetic parameters [median (range)] in non-obese vs. obese patients were: piperacillin CL, 9.0 (4.8-14.2) vs. 13.1 (6.8-20.0) L/h (p=0.026); piperacillin V, 24.6 (17.1-37.8) vs. 32.5 (19.8-69.8) L (p=0.014); tazobactam CL, 6.8 (4.4-15.5) vs. 13.1 (5.6-26.4) L/h (p=0.005); and tazobactam V, 17.1 (9.4-70.3) vs. 45.5 (10.5-116.6) L (p=0.019). Based on the pharmacodynamic analysis using Monte Carlo simulation, at the piperacillin MICs ¡Ü 16 mg/L in the presence of tazobactam, which is the susceptibility breakpoint for Enterobacteriaceae and Pseudomonas aeruginosa, PTA was \u3e 90% for 4-hour infusion dosing regimens ¡Ý 3.375 g q8h in non-obese patients and ¡Ý 4.5 g q8h in obese patients, respectively. ^ For meropenem, a retrospective analysis was conducted using prospectively collected serum concentration-time data from three previous studies (Study 3, Study 4, and Study 5) published by our research group. Hospitalized, adult patients who required antimicrobial therapy for a suspected or documented bacterial infection were eligible to participate in all three studies. Although patients with CRCL less than 50 mL/min were eligible to participate in Study 3, they were excluded in Study 4 and 5 due to different study objectives. In Study 3, only patients with BMI ¡Ý 40 kg/m2 were enrolled, and in Study 4, only patients with BMI ¡Ý 40 kg/m2 or TBW ¡Ý 100 pounds over their IBW were enrolled. Patients were classified as either obese (BMI ¡Ý 30 kg/m2) or non-obese (BMI \u3c 30 kg/m2). In Study 3, patients received the following meropenem dosing regimens: 500 mg q6h if CRCL \u3e 60 mL/min; 500 mg q8h if CRCL was 40 to 60 mL/min; and 500 mg q12h if CRCL was 10 to 39 mL/min. In Study 4, all patients received either 500 mg or 1000 mg q6h. In Study 5, all patients received 1000 mg q8h. In all studies, all dosing regimens were infused over 30 minutes. After 2 or more days of therapy, serial blood samples were collected from an indwelling IV catheter as scheduled in each study: immediately prior to drug administration, 0.5 (end of infusion), 0.75, 1, 1.5, 2, 3, 4, 5, 6, 8 (if receiving q8h or q12h dosing regimens), and 12 hours (if receiving q12h dosing regimens) after the start of infusion in Study 3; prior to drug administration, 0.5 (end of infusion), 1, 2, 3, 4, and 6 hours after the start of infusion in Study 4; and prior to drug administration, 0.5 (end of infusion), 1, 1.5, 2, 3, 4, 5, 6, and 8 hours after the start of infusion in Study 5. Serum meropenem concentrations were determined by previously described analytical methods: HPLC in Study 3 and Study 4; and ultraperformance liquid chromatography in Study 5. Population pharmacokinetic parameters were estimated using NONMEM, and the final pharmacokinetic model was built by evaluating the effects of covariates on the meropenem pharmacokinetic parameters using the stepwise forward inclusion followed by the backward elimination process. Tested covariates included: 1) age; 2) sex; 3) body size descriptor, including TBW, IBW, LBW, and BMI; 4) CRCL; and 5) admission to an ICU (ICU=1, general medical ward=0). In the stepwise forward inclusion process, covariates that reduced the model OFV \u3e 3.84 (p \u3c 0.05; ¦Ö2 distribution; 1 df) were considered significantly associated with the pharmacokinetic parameters in the model. In the backward elimination process, a covariate was removed if its elimination increased the model OFV by \u3c 5.024 (p \u3e 0.025; ¦Ö2 distribution; 1 df). Using the final pharmacokinetic model, Monte Carlo simulations were performed for five different meropenem dosing regimens to calculate PTA using ¡Ý 40%fT\u3eMIC. Each dosing regimen was simulated as 30-minute infusion, 3-hour infusion for q6h regimens, and 4-hour infusion for q8h and q12h regimens. Overall, a convenience sample of 40 patients (11 non-obese and 29 obese) were studied. TBW ranged from 57 kg to 305 kg, BMI from 19.2 kg/m2 to 88.8 kg/m2, and CRCL from 15 mL/min to 186 mL/min. Patient demographics [median (range)] in non-obese vs. obese group are: age, 59 (20-79) vs. 57 (26-76) years; CRCL, 58 (15-182) vs. 87 (20-186) mL/min; height, 170 (165-183) vs. 170 (150-193) cm; TBW, 72 (57-88) vs. 149 (73-305) kg; LBW, 49 (40-66) vs. 66 (38-114) kg; IBW, 64 (57-78) vs. 64 (34-87) kg; BMI, 25.0 (19.2-28.6) vs. 53.7 (30.6-88.8) kg/m2. The number of male patients was seven in non-obese and 13 in obese patient groups, and the number of patients admitted to an intensive care unit (ICU) was seven in non-obese and 18 in obese patient groups. Compared to non-obese patients, obese patients had significantly larger TBW, LBW, and BMI (p \u3c 0.05); other demographics were similar between non-obese and obese patients. Observed serum concentration-time profiles of meropenem were best described by a two-compartment model with zero-order input and first-order, linear elimination from the central compartment. The final meropenem model was: CL (L/h) = 8.62*(CRCL/85)0.533; volume of distribution in the central compartment (V1; L) = 13.6; inter-compartmental distribution clearance (Q; L/h) = 11.8; and volume of distribution in the peripheral compartment (V2; L) = 14.5. There was no significant difference in CL, V1, Q, and V2 between non-obese and obese patient groups. The meropenem pharmacokinetic parameters [median (range)] in non-obese vs. obese patients were: CL, 5.5 (3.3-17.7) vs. 8.2 (3.0-18.1) L/h; V1, 14.3 (10.1-20.7) vs. 12.3 (5.6-47.4) L; Q, 10.8 (5.0-25.9) vs. 14.6 (0.6-66.4) L/h; and V2, 12.6 (9.7-20.1) vs. 14.5 (5.6-27.1) L. Based on the pharmacodynamic analysis using Monte Carlo simulation, at MICs ¡Ü 2 mg/L, which is the susceptibility breakpoint for Pseudomonas aeruginosa, PTA was \u3e 90% for dosing regimens ¡Ý 500 mg q8h in both non-obese and obese patient groups. ^ For cefepime, a retrospective analysis was conducted using prospectively collected serum concentration-time data from three previous studies (Study 6, Study 7, and Study 8) published by our research group. Hospitalized, adult patients who required antimicrobial therapy for a suspected or documented bacterial infection were eligible to participate in all three studies. In Study 8, only patients with BMI ¡Ý 40 kg/m2 were enrolled while in Study 6 and Study 7, there was no weight restriction in the inclusion and exclusion criteria. Patients were classified as either obese (BMI ¡Ý 30 kg/m2) or non-obese (BMI \u3c 30 kg/m2). In Study 6, patients received cefepime 1 g q6h if CRCL was ¡Ý 60 mL/min and 1 g q8h or q12h if CRCL was \u3c 60 mL/min. Patients received 1 g q8h in Study 7 and 2 g q8h in Study 8, respectively. All doses were infused over 30 minutes in Study 6 and over 4 hours in Study 7 and Study 8. After 2 or more days of therapy, serial blood samples were collected from an indwelling IV catheter as scheduled in each study: immediately prior to drug administration, 0.5 (end of infusion), 0.75, 1, 1.5, 2, 3, 4, 6, 8 (if receiving q8h dosing regimens), and 12 hours (if receiving q12h dosing regimens) after the start of infusion in Study 6; and prior to drug administration, 1, 2, 3, 4 (end of infusion), 5, 6, 7, and 8 hours after the start of infusion in Study 7 and 8. Serum cefepime concentrations were determined by previously described HPLC method. Population pharmacokinetic parameters were estimated using NONMEM, and the final pharmacokinetic model was built by evaluating the effects of covariates on the cefepime pharmacokinetic parameters using the stepwise forward inclusion followed by the backward elimination process. Tested covariates included: 1) age; 2) sex; 3) body size descriptor, including TBW, IBW, LBW, and BMI; 4) CRCL; and 5) admission to an ICU (ICU=1, general medical ward=0). In the stepwise forward inclusion process, covariates that reduced the model OFV \u3e 3.84 (p \u3c 0.05; ¦Ö2 distribution; 1 df) were considered significantly associated with the pharmacokinetic parameters in the model. In the backward elimination process, a covariate was removed if its elimination increased the model OFV by \u3c 5.024 (p \u3e 0.025; ¦Ö2 distribution; 1 df). Using the final pharmacokinetic model, Monte Carlo simulations were performed for five different cefepime dosing regimens to calculate PTA using ¡Ý 60%fT\u3eMIC. Each dosing regimen was simulated as 30-minute infusion, 3-hour infusion for q6h regimens, and 4-hour infusion for q8h and q12h regimens. ^ Overall, a convenience sample of 30 patients (10 non-obese and 20 obese) were studied. TBW ranged from 54 kg to 276 kg, BMI from 18.5 kg/m2 to 92.5 kg/m2, and CRCL from 20 mL/min to 205 mL/min. Patient demographics [median (range)] in non-obese vs. obese group are: age, 44 (21-70) vs. 59 (32-81) years; CRCL, 101 (56-180) vs. 92 (20-205) mL/min; height, 178 (147-190) vs. 171 (147-183) cm; TBW, 74 (54-97) vs. 110 (81-276) kg; LBW, 60 (36-71) vs. 64 (42-96) kg; IBW, 73 (41-84) vs. 64 (41-78) kg; BMI, 22.5 (18.5-29.8) vs. 39.2 (30.9-92.5) kg/m2. The number of male patients was eight in non-obese and 13 in obese patient groups, and the number of patients admitted to an intensive care unit (ICU) was four in non-obese and 12 in obese patient groups. Compared to non-obese patients, obese patients were significantly older and had significantly larger TBW and BMI (p \u3c 0.05); other demographics were similar between non-obese and obese patients. Observed serum concentration-time profiles of cefepime were best described by a one-compartment model with zero-order input and first-order, linear elimination. The final cefepime model was: CL (L/h) = 8.06 + [0.0598*(CRCL-90)]; and V (L) = 39.2 + [0.323*(TBW-95)]. Obese patients had significantly increased V compared to non-obese patients (p \u3c 0.05), but CL was similar between non-obese and obese patients. The cefepime pharmacokinetic parameters [median (range)] in non-obese vs. obese patients were: CL, 8.0 (5.0-12.6) vs. 7.5 (3.6-27.9) L/h; and V, 27.6 (22.1-48.8) vs. 50.0 (19.3-94.5) L. Based on the pharmacodynamic analysis using Monte Carlo simulation, at MICs ¡Ü 2 mg/L, which is the susceptibility breakpoint for Enterobacteriaceae, PTA was \u3e 90% for dosing regimens ¡Ý 1 g q12h in both non-obese and obese patient groups. At an MIC of 4 mg/L, PTA was \u3e 90% for dosing regimens ¡Ý 1 g q8h in non- obese patients and ¡Ý 1 g q12h in obese patients. At an MIC of 8 mg/L, which is the susceptibility breakpoint for Pseudomonas aeruginosa, PTA was \u3e 90% for 30-minute infusions of 1 g q6h and 2 g q8h in non- obese patients and dosing regimens ¡Ý 1 g q8h in obese patients. When prolonging the infusion times to 3 to 4 hours, dosing regimens ¡Ý 1 g q12h achieved the PTA \u3e 90% at MICs ¡Ü 4 mg/L in both non-obese and obese patient groups. The PTA at an MIC of 8 mg/L was \u3e 90% for prolonged-infusion dosing regimens ¡Ý 1 g q8h in both non-obese and obese patient groups ^ In conclusion, piperacillin and tazobactam pharmacokinetics are altered in obesity, and larger doses (¡Ý 4.5 g q8h), infused over 4 hours, may be needed to provide similar exposures in obese patients compared with non-obese patients receiving ¡Ý 3.375 g q8h doses, infused over 4 hours. In contrast, meropenem pharmacokinetics are similar between obese and non-obese patients, so same dosages provide comparable pharmacodynamic exposures for susceptible organisms between obese and non-obese patients. Although cefepime pharmacokinetics are altered in obesity, same dosing regimens achieve similar pharmacodynamic exposures for susceptible organisms between obese and non-obese patients

    Understanding decision making among individuals With Intellectual and Developmental Disabilities (IDD) and their siblings

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    Many siblings anticipate fulfilling caregiving roles for their brothers and sisters with intellectual and developmental disabilities (IDD). Given these roles and the importance of supported decision-making, it is crucial to understand how individuals with IDD and their siblings make decisions. Using dyadic interviews, we examined the perspectives of nine sibling dyads (N = 18) about decision-making in relation to self-determination, independent living, and employment. The ages of participants ranged from 19 to 57. Data were analyzed using constant comparative analysis to identify themes. Decision-making was characterized by: parents and siblings primarily identifying courses of action; the probability of respective consequences based on the person-environment fit; and the role of the sibling in making the final decision. Characteristics related to the individual with IDD, the family, the sibling, and the environment impacted decision-making. Individuals with IDD were more likely to make their own decisions about leisure activities, however, siblings were more likely to make formal decisions for their brothers and sisters.Accepted manuscrip

    Counterintuitive example on relation between ZT and thermoelectric efficiency

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    The thermoelectric figure of merit ZT, which is defined using electrical conductivity, Seebeck coefficient, thermal conductivity, and absolute temperature T, has been widely used as a simple estimator of the conversion efficiency of a thermoelectric heat engine. When material properties are constant or slowly varying with T, a higher ZT ensures a higher maximum conversion efficiency of thermoelectric materials. However, as material properties can vary strongly with T, efficiency predictions based on ZT can be inaccurate, especially for wide-temperature applications. Moreover, although ZT values continue to increase, there has been no investigation of the relationship between ZT and the efficiency in the higher ZT regime. In this paper, we report a counterintuitive situation by comparing two materials: although one material has a higher ZT value over the whole operational temperature range, its maximum conversion efficiency is smaller than that of the other. This indicates that, for material comparisons, the evaluation of exact efficiencies as opposed to a simple comparison of the ZTs is necessary in certain cases.Comment: 12 pages, 2 tables, 2 figure

    A New Species of the Genus Caminus (Astroporida: Geodiidae) from Korea

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    Caminus jejuensis n. sp was collected from depth of 20 m at Geomeunyeo, Seogwipo, Jejudo Island by a SCUBA diving from April 2004 to December 2008. This new species is similar to C. chinensis from China in the composition of spicules except for the spherasters and they differ in spicule size and growth form. This species has longer orthotriaenes and spherules, smaller sterrasters and oxyasters than those of C. chinensis. This species also has many spherasters in choanosome, but C. chinensis lacks. Morever, the new species is a massive shape with wrinkles, whereas C. chinensis is a club shape with smooth surface. Description and figures of the new species are provided
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