The Military Sea Transportation Service

In the first place, l want to provide information about one of the most important operations in the Navy, one that is little appreciated—the Military Sea Transportation Service, more generally referred to as MSTS

Measuring-up in timber: A critical perspective on mid-and high-rise timber building design

Architects, engineers and researchers alike often cite practical reasons for building with wood. Since the development of curved glulam beams and columns over a century ago, the widespread use of massive structural timber elements has allowed architects and engineers to design and build in wood with unprecedented speed and scale. Moreover, rising concerns of climate change and the carbon-dioxide emissions associated with construction encourage the use of wood as a viable alternative to steel and concrete, due to CO2 sequestration in trees.In mid- and high-rise buildings, the current shift from steel and concrete towards massive structural timber elements like glulam, laminated-veneer lumber (LVL) and cross-laminated timber (CLT) is evident in a number of recently completed timber buildings in Europe, ranging from seven to nine storeys. Several speculative design proposals have also been made for ‘timber towers’ of thirty, fortytwo and even sixty-five storeys, recognising that designing with massive structural timber elements in high-rise buildings is still in its infancy. This paper offers a new perspective on building with wood at this scale, beyond carbon sequestrationand construction.This is the author's accepted manuscript. The final version has been published in Architectural Research Quarterly here: http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=9295856&fileId=S1359135514000268. Copyright © Cambridge University Press 201

Adaptive grid methods for Q-tensor theory of liquid crystals : a one-dimensional feasibility study

This paper illustrates the use of moving mesh methods for solving partial differential equation (PDE) problems in Q-tensor theory of liquid crystals. We present the results of an initial study using a simple one-dimensional test problem which illustrates the feasibility of applying adaptive grid techniques in such situations. We describe how the grids are computed using an equidistribution principle, and investigate the comparative accuracy of adaptive and uniform grid strategies, both theoretically and via numerical examples

Functional outcomes following ileal pouch-anal anastomosis (IPAA) in older patients: a systematic review

Aim Ileal pouch-anal anastomosis (IPAA) is performed in ulcerative colitis or familial adenomatous polyposis with a view to restoration of GI continuity and prevention of permanent faecal diversion. Debate exists as to its safety in older patients. This review aims to assess functional outcomes and safety of restorative proctocolectomy (RPC) in older compared to younger patients. Methods Literature search was performed for age-stratified studies which assessed functional outcomes of IPAA. Twelve papers were included overall. Patients were categorized into ‘older’ and ‘younger’ groups. Analysis was split into three separate parts: 1. Age cut-off of 50 ± 5 years (with sensitivity analysis); 2. Age cut-off of 65 ± years; 3. Long-term outcomes (>10 years). Results With an age cut-off of 50 years (4327 versus 513 patients), complication rates were comparable with the exception of an increased rate of small-bowel obstruction in the younger patients (p = 0.034). At 1 year, 24-h stool frequency was significantly higher in the older patient group (p < 0.0001). Daytime (p < 0.0001) and night-time (p < 0.0001) incontinence rates were also significantly higher in older patients. Overall, function deteriorated with time across all ages; however, after 10 years, there was no significant difference in incontinence rates between age groups. Dehydration and electrolyte loss was a significant problem in patients over 65 (p < 0.0001). Despite differences in postoperative function, quality of life was comparable between groups; however, only a few studies reported quality of life data. Conclusion IPAA is safe in older patients, although treating clinicians should bear in mind the increased risk of dehydration. Postoperative function is worse in older patients, but seems to level out with time and does not appear to significantly impact on overall quality of life and patient satisfaction. Assessment for suitability for RPC should not be based on chronological age in isolation. It is imperative that the correct support is given to older patients with worsened postoperative function in order to maintain patient satisfaction and adequate quality of life

Hsp90 governs dispersion and drug resistance of fungal biofilms

Fungal biofilms are a major cause of human mortality and are recalcitrant to most treatments due to intrinsic drug resistance. These complex communities of multiple cell types form on indwelling medical devices and their eradication often requires surgical removal of infected devices. Here we implicate the molecular chaperone Hsp90 as a key regulator of biofilm dispersion and drug resistance. We previously established that in the leading human fungal pathogen, Candida albicans, Hsp90 enables the emergence and maintenance of drug resistance in planktonic conditions by stabilizing the protein phosphatase calcineurin and MAPK Mkc1. Hsp90 also regulates temperature-dependent C. albicans morphogenesis through repression of cAMP-PKA signalling. Here we demonstrate that genetic depletion of Hsp90 reduced C. albicans biofilm growth and maturation in vitro and impaired dispersal of biofilm cells. Further, compromising Hsp90 function in vitro abrogated resistance of C. albicans biofilms to the most widely deployed class of antifungal drugs, the azoles. Depletion of Hsp90 led to reduction of calcineurin and Mkc1 in planktonic but not biofilm conditions, suggesting that Hsp90 regulates drug resistance through different mechanisms in these distinct cellular states. Reduction of Hsp90 levels led to a marked decrease in matrix glucan levels, providing a compelling mechanism through which Hsp90 might regulate biofilm azole resistance. Impairment of Hsp90 function genetically or pharmacologically transformed fluconazole from ineffectual to highly effective in eradicating biofilms in a rat venous catheter infection model. Finally, inhibition of Hsp90 reduced resistance of biofilms of the most lethal mould, Aspergillus fumigatus, to the newest class of antifungals to reach the clinic, the echinocandins. Thus, we establish a novel mechanism regulating biofilm drug resistance and dispersion and that targeting Hsp90 provides a much-needed strategy for improving clinical outcome in the treatment of biofilm infections

Qualitative research: exploring the multiple perspectives of osteopathy

This paper is offered as an introduction to qualitative research, with the hope that it informs and stimulates osteopaths and researchers who are unfamiliar with this area of research. This paper discusses the potential contribution of qualitative research in exploring the complex and multiple aspects of osteopathy and how the findings of qualitative studies may contribute to the knowledge base of osteopathy. A definition of qualitative research is provided, and a number of different methodologies are discussed. Finally it suggests examples of how the findings of qualitative research could potentially help inform osteopathic practice. © 2011 Elsevier Ltd

Functional outcomes with handsewn versus stapled anastomoses in the treatment of ultralow rectal cancer

Adequate oncological outcomes have been demonstrated with rectal resection and handsewn coloanal anastomosis (CAA) in tumours in close proximity to the internal anal sphincter. Our aim was to assess functional differences between handsewn CAA and ultralow stapled anastomosis. Participants were identified from a single-surgeon series. Included participants underwent anorectal physiology testing of anal sphincter function, in addition to completion of several questionnaires: Wexner Incontinence Score (WIS); Birmingham Bowel, Bladder and Urinary Symptom Questionnaire (BBUSQ); Low Anterior Resection Syndrome (LARS) Score; SF36. Non-parametric data compared using the Mann-Whitney U test. 20 participants were included; 11 stapled and 9 handsewn. Mean follow-up was 2.95 ± 1.97 years. The mean LARS score was 21.9 ± 1.97 years in the stapled group versus 29.4 ± 9.57 in the handsewn group (p = 0.133). The Wexner incontinence score was significantly higher in the handsewn group (p = 0.0076), with a mean score of 4.6 ± 3.69 versus 10.9 ± 4.76. The incontinence domain of the BBUSQ was also significantly worse in patients with a handsewn anastomosis (p = 0.001). With the exception of general health (p = 0.035) and social functioning (p = 0.035), which were worse in the handsewn groups, the other six domains of the SF-36 showed no statistical difference between groups. Anorectal physiology scores were not significantly different. Handsewn CAA anastomosis is known to be safe and oncologically feasible. Patient selection should be vigorous, with preoperative counseling regarding the likelihood of incontinence to manage patients' expectations and promote comparable quality of life in the long-term

Development of a High-Throughput Candida albicans Biofilm Chip

We have developed a high-density microarray platform consisting of nano-biofilms of Candida albicans. A robotic microarrayer was used to print yeast cells of C. albicans encapsulated in a collagen matrix at a volume as low as 50 nL onto surface-modified microscope slides. Upon incubation, the cells grow into fully formed “nano-biofilms”. The morphological and architectural complexity of these biofilms were evaluated by scanning electron and confocal scanning laser microscopy. The extent of biofilm formation was determined using a microarray scanner from changes in fluorescence intensities due to FUN 1 metabolic processing. This staining technique was also adapted for antifungal susceptibility testing, which demonstrated that, similar to regular biofilms, cells within the on-chip biofilms displayed elevated levels of resistance against antifungal agents (fluconazole and amphotericin B). Thus, results from structural analyses and antifungal susceptibility testing indicated that despite miniaturization, these biofilms display the typical phenotypic properties associated with the biofilm mode of growth. In its final format, the C. albicans biofilm chip (CaBChip) is composed of 768 equivalent and spatially distinct nano-biofilms on a single slide; multiple chips can be printed and processed simultaneously. Compared to current methods for the formation of microbial biofilms, namely the 96-well microtiter plate model, this fungal biofilm chip has advantages in terms of miniaturization and automation, which combine to cut reagent use and analysis time, minimize labor intensive steps, and dramatically reduce assay costs. Such a chip should accelerate the antifungal drug discovery process by enabling rapid, convenient and inexpensive screening of hundreds-to-thousands of compounds simultaneously

Sustainable shells: New African vaults built with soil-cement tiles

The Mapungubwe National Park Interpretive Centre, South Africa achieves economy of means, social improvement and low environmental impact in a remote World Heritage site. This paper outlines the design methodology and construction process for a series of thin shell domes and vaults in rural South Africa. We use the Valencian tradition of tile vaulting, a 700-year-old construction system, to create lightweight and durable buildings from thin soil-cement bricks. The load-bearing masonry is used to construct roof vaults achieving high structural strength with minimal material. The largest free-form vaults span 14.5m with an unreinforced masonry vault of 300mm thickness. We replaced fired-clay bricks with less energy-intensive stabilized earth tiles, which have a well-established tradition in sustainable practice. At Mapungubwe they are used to create sophisticated engineered forms by adapting a hand-press to locally manufacture tiles of sufficient strength. In addition to being structurally efficient, elegantly simple and environmentally sustainable, tile vaults have advantages for construction in developing areas. When compared to conventional construction, this system offers material and financial savings, waste reduction, and local employment with transferable outputs and skills for future projects. For this project, we introduced the structural masonry of tile vaults to South Africa, and for the first time we combined tile vaulting with locally made stabilized earth tiles that have low embodied energy. No steel reinforcing simplifies construction, lowers cost and reduces embodied energy. The vaults are built with minimal support, saving time, money and resources on formwork. The Centre represents a significant step forward in structure and material for sustainable construction

Development of a quality of life questionnaire for patients with pancreatic neuroendocrine tumours (the PANNET module)

Gastrinoma; Insulinoma; Pancreatic neuroendocrine tumourGastrinoma; Insulinoma; Tumor neuroendocrino pancreáticoGastrinoma; Insulinoma; Tumor neuroendocrí pancreàticPancreatic neuroendocrine tumours (panNET) are heterogeneous neoplasms usually characterised by slow growth and secretion of hormones, which often cause symptoms. The effect of these symptoms on quality of life (QoL) has not previously been examined in detail. EORTC (European Organisation for Research and Treatment of Cancer) guidelines were followed in phases 1–3 to produce a potential module of questions usable for trials in panNET, focusing on three common types of panNET. For two less common types, a list of symptoms was constructed. Following an extensive literature search and phase 1a interviews with patients and healthcare workers, a long list of potential issues (169) was obtained. This list was shown to 12 patients from three countries in phase 1b interviews to check that no items were missed. The list was reduced to 57 issues. The list of issues was converted to questions, mainly from existing validated questions within the EORTC item library. The list of questions was then used in a phase 3 international study in eight countries using seven languages. A provisional module of 24 items is presented for use in nonfunctioning panNET, gastrinoma and insulinoma. This module increases knowledge concerning QoL in this condition and may be a useful adjunct in clinical trials. A phase 4 trial is being considered for validation of this questionnaire