High concordance between trained nurses and gastroenterologists in evaluating recordings of small bowel video capsule endoscopy (VCE)

Background & Aims: The video capsule endoscopy (VCE) is an accurate and validated tool to investigate the entire small bowel mucosa, but VCE recordings interpretation by the gastroenterologist is time-consuming. A pre-reading of VCE recordings by an expert nurse could be accurate and cost saving. We assessed the concordance between nurses and gastroenterologists in detecting lesions on VCE examinations. Methods: This was a prospective study enrolling consecutive patients who had undergone VCE in clinical practice. Two trained nurses and two expert gastroenterologists participated in the study. At VCE pre-reading the nurses selected any abnormalities, saved them as “thumbnails” and classified the detected lesions as a vascular abnormality, ulcerative lesion, polyp, tumor mass, and unclassified lesion. Then, the gastroenterologist evaluated and interpreted the selected lesions and, successively, reviewed the entire video for potential missed lesions. The time for VCE evaluation was recorded. Results: A total of 95 VCE procedures performed on consecutive patients (M/F: 47/48; mean age: 63 ± 12 years, range: 27−86 years) were evaluated. Overall, the nurses detected at least one lesion in 54 (56.8%) patients. There was total agreement between nurses and gastroenterologists, no missing lesions being discovered at a second look of the entire VCE recording by the physician. The pre-reading procedure by nurse allowed a time reduction of medical evaluation from 49 (33-69) to 10 (8-16) minutes (difference:-79.6%). Conclusions: Our data suggest that trained nurses can accurately identify and select relevant lesions in thumbnails that subsequently were faster reviewed by the gastroenterologist for a final diagnosis. This could significantly reduce the cost of VCE procedure

How Are We Doing? A Look at the Practice of Planning for Sustainable Development

The concept of sustainable development poses special challenges in the land use planning field as planning is fundamentally connected to the core themes found in the sustainability literature. These themes, often referred to as the three E's are: environmental protection, social equity, and economic development. From a local planning perspective, the themes are all affected by "what gets built and where." In the field of planning, present unsustainable land use patterns are noted as an indicator of larger societal sustainability problems. Calthorpe, for example, asserts that "[s]ettlement patterns are the physical foundation of our society and like our society, they are becoming more and more fractured" (Calthorpe 1993:16). Land use planning is also seen as the principal forum for addressing sustainability concerns and promoting fundamental sustainable principles (Beadey 1995; Rees 1995; Thomas 1994). Rees, for example, notes: In this increasingly fragmented and specialized world, planning is the one academic discipline and professional pursuit that explicitly attempts to be holistic or at least integrative at the level of society as a whole. At its best, planning provides a context in which the specialized knowledge of other disciplines comes together and begins to make unified sense. (Rees 1995:355) The primary manner in which planning can bring together and put into action the themes of sustainability is in the community comprehensive plan. The comprehensive planning process and subsequent plan provide a vehicle for the embodiment of sustainable development themes on a community level

Culture-based antibiotic susceptibility testing for Helicobacter pylori infection: a systematic review

Background Primary antibiotic resistance in Helicobacter pylori (H. pylori) strains is increasing worldwide, affecting therapy success. The use of therapies tailored on susceptibility pre-testing at culture has been proposed, but data are still conflicting. Method We performed a systematic review to evaluate the role of a culture-based therapeutic approach for H. pylori treatment, taking into account the sensitivity of culture and the success rates achieved with tailored therapies in different therapeutic steps. Results We analyzed data from 51 studies. Overall, H. pylori strains were isolated in 80.7% of 7889 patients, the success rates being 78.1%, 77.5%, 86.3% and 86.6%, before first-, second-, third-line or more therapies, respectively. In comparative studies, the infection was cured in 89.9% of 2052 patients treated with tailored therapies, and in 77.6% of 2516 patients receiving empiric therapy (P<0.001). However, in the subanalysis, the tailored approach achieved optimal eradication rates (>90%) only when it was applied before first-and second-line therapies, but not before third-line or more attempts (<80%). Moreover, no significant difference emerged between the 2 approaches when data from only the most recent (last 5 years) studies were considered, as well as in those performed in Western populations. Conclusions The attempt to achieve antibiotic susceptibility testing before treatment failed in 20% of infected patients managed in dedicated laboratories. Culture-tailored therapies administered after 2 or more therapies achieved suboptimal eradication rates. The role of bacterial culture in patients whose therapeutic management failed to eradicate H. pylori probably needs to be corroborated by further data

The influence of the synoptic conditions in the dispersion of the air pollution indicator – the sulphur dioxide (SO2) in the Slatina area.

The sulphur oxides are among the most common pollutants, because the sulphur can be found in various forms in most of fuels and ores. The sulphur dioxide (SO2) is a colorless, suffocating, irritating gas, which contributes significantly to the producing of the acid rains. The main objective of the study is to analyze the way of dispersion for the air pollution indicator – the sulphur dioxide (SO2), in the Slatina town area, in relation to the climatic and topographic factors, but also to the nature of the pollution sources. The analysis will highlight the atmospheric conservation role of the pollutants through the thermic inversions, the atmospheric calm and the high air moisture. At the end of the study, there are presented the authors’s conclusions formulated on the basis of the data from the German Meteorological Offenbach Service, the National Meteorological Administration and the Agency for Environmental Protection from the Olt County. The quantitative and qualitative analysis of an air pollution indicator constitutes a first step in ensuring the air quality management, which represents a component of the environmental management

Late snowfall and blizzards in Moldavia. April 2017 summary case of study

While these are normal phenomena for Romania’s geographical position, heavy snows and intense blizzards can have severely negative effects, especially when they occur unseasonably, before or after the typical period. The blizzard recorded on 19-20 April 2017 was particularly violent and one of the latest blizzard events in the history of meteorological observations. In comparison, the last significant late winter event, albeit lower in intensity, was recorded on 15-16 April 1996. However, the blizzard formation mechanism in the month of April in eastern regions is relatively similar. The presence of a high-pressure zone in the central-western European region led, in both cases, to fast large-scale penetrations of arctic air from high latitudes towards areas with high cyclogenetic potential in the Mediterranean Sea basin. Thus, the depressions of Mediterranean origin, which formed in the Genova Gulf area, advanced towards the Black Sea basin via trans-Balkan trajectories, where they regenerated and resulted in strong windintensification and abundant precipitation in the Moldavian region. With regard to the event this study analyses, the high thermobaric contrast and the presence of a sufficiently cold air mass favored, during the night between the 19th and the 20th of April, the occurrence of a strong blizzard event in Moldavia, following abundant wet snowfall during the day. At several meteorological stations across Moldavia and Transylvania, as well as in mountainous areas, the maximum winter snow layer thickness was exceeded on the 20th and 21st of April

Planning for Sustainability in Small Municipalities: The Influence of Interest Groups, Growth Patterns, and Institutional Characteristics

How and why small municipalities promote sustainability through planning efforts is poorly understood. We analyzed ordinances in 451 Maine municipalities and tested theories of policy adoption using regression analysis.We found that smaller communities do adopt programs that contribute to sustainability relevant to their scale and context. In line with the political market theory, we found that municipalities with strong environmental interests, higher growth, and more formal governments were more likely to adopt these policies. Consideration of context and capacity in planning for sustainability will help planners better identify and benefit from collaboration, training, and outreach opportunities

FAPRI 1999 U.S. Agricultural Outlook

Crop Production/Industries, Livestock Production/Industries,

Structural variability of E. coli thioredoxin captured in the crystal structures of single-point mutants

Thioredoxin is a ubiquitous small protein that catalyzes redox reactions of protein thiols. Additionally, thioredoxin from E. coli (EcTRX) is a widely-used model for structure-function studies. In a previous paper, we characterized several single-point mutants of the C-terminal helix (CTH) that alter global stability of EcTRX. However, spectroscopic signatures and enzymatic activity for some of these mutants were found essentially unaffected. A comprehensive structural characterization at the atomic level of these near-invariant mutants can provide detailed information about structural variability of EcTRX. We address this point through the determination of the crystal structures of four point-mutants, whose mutations occurs within or near the CTH, namely L94A, E101G, N106A and L107A. These structures are mostly unaffected compared with the wild-type variant. Notably, the E101G mutant presents a large region with two alternative traces for the backbone of the same chain. It represents a significant shift in backbone positions. Enzymatic activity measurements and conformational dynamics studies monitored by NMR and molecular dynamic simulations show that E101G mutation results in a small effect in the structural features of the protein. We hypothesize that these alternative conformations represent samples of the native-state ensemble of EcTRX, specifically the magnitude and location of conformational heterogeneity

Ti-Zr-Si-Nb nanocrystalline alloys and metallic glasses: Assessment on the structure, thermal stability, corrosion and mechanical properties

The development of novel Ti-based amorphous or \u3b2-phase nanostructured metallic materials could have significant benefits for implant applications, due to improved corrosion and mechanical characteristics (lower Young's modulus, better wear performance, improved fracture toughness) in comparison to the standardized \u3b1+\u3b2 titanium alloys. Moreover, the devitrification phenomenon, occurring during heating, could contribute to lower input power during additive manufacturing technologies. Ti-based alloy ribbons were obtained by melt-spinning, considering the ultra-fast cooling rates this method can provide. The titanium alloys contain in various proportions Zr, Nb, and Si (Ti60Zr10Si15Nb15, Ti64Zr10Si15Nb11, Ti56Zr10Si15Nb19) in various proportions. These elements were chosen due to their reported biological safety, as in the case of Zr and Nb, and the metallic glass-forming ability and biocompatibility of Si. The morphology and chemical composition were analyzed by scanning electron microscopy and energy-dispersive X-ray spectroscopy, while the structural features (crystallinity, phase attribution after devitrification (after heat treatment)) were assessed by X-ray diffraction. Some of the mechanical properties (hardness, Young's modulus) were assessed by instrumented indentation. The thermal stability and crystallization temperatures were measured by differential thermal analysis. High-intensity exothermal peaks were observed during heating of melt-spun ribbons. The corrosion behavior was assessed by electrocorrosion tests. The results show the potential of these alloys to be used as materials for biomedical applications