The King George Island Mounds site (16LV22): a late archaic mound complex along the lower Amite River

The King George Island Mounds site (16LV22) is one of four conical mound sites located along the lower Amite River in Livingston Parish, Louisiana. Gagliano originally reported the site in 1957 as containing two conical mounds. Initially, it was postulated that the Lower Amite River mounds might date to the Marksville period based on the similarities of shape. Recent research conducted at the site indicates that the site may contain up to five conical mounds that date to the Late Archaic period. Geomorphological, pedological, and archaeological data indicate an initial Archaic occupation. Archaic period artifacts were recovered from excavations above, in, and below a buried A horizon at the King George Island Mounds site. These included exotic lithic materials, dart points, four-sided drills, pebble-pointed hammerstones, and microlithic drills. Radiocarbon dates of the buried A horizon in the ridge provide a Late Archaic terminus post quem for activity at the site. Despite the recent research, site function remains unclear. The lack of evidence of residential features may indicate that the King George Island Mounds site served ceremonial and/or territorial functions

Oxidations of organic and inorganic substrates by superoxo-, hydroperoxo-, and oxo-compounds of the transition metals

The superoxochromium ions LCr(H2O)OO2+ (L = (H2O)4 and [14]aneN4) and chromyl ion CrIVaqO2+ were shown to oxidize hydroperoxometal ions of Rh and Co to their corresponding superoxides. Kinetic isotope effects support hydrogen atom transfer from hydroperoxo- to superoxometal as the rate limiting step. Rate constants were determined and lie in the range of 17 to 130 M-1 s-1 for LCr(H2O)OO 2+ as oxidant and 103-104 M-1 s-1 for CrIVaqO2+ as oxidant. These rate constants are compared against other known hydrogen atom transfer reactions of hydroperoxo-, superoxo-, and oxometal ions

Interventions to improve adherence to inhaled steroids for asthma.

BACKGROUND: Despite its proven efficacy in improving symptoms and reducing exacerbations, many patients with asthma are not fully adherent to their steroid inhaler. Suboptimal adherence leads to poorer clinical outcomes and increased health service utilisation, and has been identified as a contributing factor to a third of asthma deaths in the UK. Reasons for non-adherence vary, and a variety of interventions have been proposed to help people improve treatment adherence. OBJECTIVES: To assess the efficacy and safety of interventions intended to improve adherence to inhaled corticosteroids among people with asthma. SEARCH METHODS: We identified trials from the Cochrane Airways Trials Register, which contains studies identified through multiple electronic searches and handsearches of other sources. We also searched trial registries and reference lists of primary studies. We conducted the most recent searches on 18 November 2016. SELECTION CRITERIA: We included parallel and cluster randomised controlled trials of any duration conducted in any setting. We included studies reported as full-text articles, those published as abstracts only and unpublished data. We included trials of adults and children with asthma and a current prescription for an inhaled corticosteroid (ICS) (as monotherapy or in combination with a long-acting beta2-agonist (LABA)). Eligible trials compared an intervention primarily aimed at improving adherence to ICS versus usual care or an alternative intervention. DATA COLLECTION AND ANALYSIS: Two review authors screened the searches, extracted study characteristics and outcome data from included studies and assessed risk of bias. Primary outcomes were adherence to ICS, exacerbations requiring at least oral corticosteroids and asthma control. We graded results and presented evidence in 'Summary of findings' tables for each comparison.We analysed dichotomous data as odds ratios, and continuous data as mean differences or standardised mean differences, all using a random-effects model. We described skewed data narratively. We made no a priori assumptions about how trials would be categorised but conducted meta-analyses only if treatments, participants and the underlying clinical question were similar enough for pooling to make sense. MAIN RESULTS: We included 39 parallel randomised controlled trials (RCTs) involving adults and children with asthma, 28 of which (n = 16,303) contributed data to at least one meta-analysis. Follow-up ranged from two months to two years (median six months), and trials were conducted mainly in high-income countries. Most studies reported some measure of adherence to ICS and a variety of other outcomes such as quality of life and asthma control. Studies generally were at low or unclear risk of selection bias and at high risk of biases associated with blinding. We considered around half the studies to be at high risk for attrition bias and selective outcome reporting.We classified studies into four comparisons: adherence education versus control (20 studies); electronic trackers or reminders versus control (11 studies); simplified drug regimens versus usual drug regimens (four studies); and school-based directly observed therapy (three studies). Two studies are described separately.All pooled results for adherence education, electronic trackers or reminders and simplified regimens showed better adherence than controls. Analyses limited to studies using objective measures revealed that adherence education showed a benefit of 20 percentage points over control (95% confidence interval (CI) 7.52 to 32.74; five studies; low-quality evidence); electronic trackers or reminders led to better adherence of 19 percentage points (95% CI 14.47 to 25.26; six studies; moderate-quality evidence); and simplified regimens led to better adherence of 4 percentage points (95% CI 1.88 to 6.16; three studies; moderate-quality evidence). Our confidence in the evidence was reduced by risk of bias and inconsistency.Improvements in adherence were not consistently translated into observable benefit for clinical outcomes in our pooled analyses. None of the intervention types showed clear benefit for our primary clinical outcomes - exacerbations requiring an oral corticosteroid (OCS) (evidence of very low to low quality) and asthma control (evidence of low to moderate quality); nor for our secondary outcomes - unscheduled visits (evidence of very low to moderate quality) and quality of life (evidence of low to moderate quality). However, some individual studies reported observed benefits for OCS and use of healthcare services. Most school or work absence data were skewed and were difficult to interpret (evidence of low quality, when graded), and most studies did not specifically measure or report adverse events.Studies investigating the possible benefit of administering ICS at school did not measure adherence, exacerbations requiring OCS, asthma control or adverse events. One study showed fewer unscheduled visits, and another found no differences; data could not be combined. AUTHORS' CONCLUSIONS: Pooled results suggest that a variety of interventions can improve adherence. The clinical relevance of this improvement, highlighted by uncertain and inconsistent impact on clinical outcomes such as quality of life and asthma control, is less clear. We have low to moderate confidence in these findings owing to concerns about risk of bias and inconsistency. Future studies would benefit from predefining an evidence-based 'cut-off' for acceptable adherence and using objective adherence measures and validated tools and questionnaires. When possible, covert monitoring and some form of blinding or active control may help disentangle effects of the intervention from effects of inclusion in an adherence trial

Renal artery stenosis-when to screen, what to stent?

Renal artery stensosis (RAS) continues to be a problem for clinicians, with no clear consensus on how to investigate and assess the clinical significance of stenotic lesions and manage the findings. RAS caused by fibromuscular dysplasia is probably commoner than previously appreciated, should be actively looked for in younger hypertensive patients and can be managed successfully with angioplasty. Atheromatous RAS is associated with increased incidence of cardiovascular events and increased cardiovascular mortality, and is likely to be seen with increasing frequency. Evidence from large clinical trials has led clinicians away from recommending interventional revascularisation towards aggressive medical management. There is now interest in looking more closely at patient selection for intervention, with focus on intervening only in patients with the highest-risk presentations such as flash pulmonary oedema, rapidly declining renal function and severe resistant hypertension. The potential benefits in terms of improving hard cardiovascular outcomes may outweigh the risks of intervention in this group, and further research is needed

Hydrogen Infrastructure Project Risks in The Netherlands

This study aims to assess the potential risks of setting up a hydrogen infrastructure in the Netherlands. An integrated risk assessment framework, capable of analyzing projects, identifying risks and comparing projects, is used to identify and analyze the main risks in the upcoming Dutch hydrogen infrastructure project. A time multiplier is added to the framework to develop parameters. The impact of the different risk categories provided by the integrated framework is calculated using the discounted cash flow (DCF) model. Despite resource risks having the highest impact, scope risks are shown to be the most prominent in the hydrogen infrastructure project. To present the DCF model results, a risk assessment matrix is constructed. Compared to the conventional Risk Assessment Matrix (RAM) used to present project risks, this matrix presents additional information in terms of the internal rate of return and risk specifics

Casein - whey protein interactions in heated milk

Heating of milk is an essential step in the processing of various dairy products, like for example yoghurt. A major consequence of the heat treatment is the denaturation of whey proteins, which either associate with the casein micelle or form soluble whey protein aggregates. By combination of enzymatic fractionation and capillary electrophoresis we were able to quantitatively determine the distribution of denatured whey proteins after heat treatment. This thesis describes the relation between these quantitative studies and the acid-induced gelation properties and textural gel properties of milk derived products. In chapter 3 it was demonstrated that more severe heat treatment caused more denaturation and that the whey proteins both associate with the casein micelle and form whey protein aggregates. The formation of these aggregates was visualised and the size was estimated. We clearly demonstrated that at the natural pH of milk the ratio of denatured whey proteins associated with the casein micelle and present in aggregates remained constant and that the observed shift in gelation pH of heated milk is linearly correlated with the two fractions of denatured whey proteins. The shift in gelation pH was more thoroughly studied in chapter 6 and was directly related to whey protein denaturation. It was shown that b-lactoglobulin was principally responsible for the shift in gelation pH. a-lactalbumin caused neither alone nor in combination with b-lactoglobulin an effect on the gelation pH. Chapter 4 reports the effect of pH-adjustment of milk (pH range 6.9 to 6.35) prior to heat-treatment (10 min at 80?C) on the distribution of denatured whey proteins and on the homogeneity of the whey proteins coating of the casein micelles. After heat treatment at pH 6.9 most whey proteins are present in soluble whey protein aggregates while heating at pH 6.55 and lower causes association of all whey proteins with the casein micelle. Heating of milk at pH 6.35 causes a clearly more inhomogeneous coating than heating at pH 6.55. This pH-dependent whey protein denaturation is schematically depicted in a model and related to acid and rennet-induced gelation properties. In Chapter 7 we studied the formation of disulfide linked protein structures during the acidification step at ambient temperature. The time dependent formation of these structures attributed significantly to the mechanical properties of acid milk gels, resulting in gels with an increased storage modulus and hardness. The mechanical properties are shown to be the result of the contribution of denatured whey proteins to the protein network as such and the additional formation of disulfide bonds. Surprisingly, the formation of these disulfide bonds take place at ambient temperature and under acidic conditions. Therefore, the disulfide cross-linking is highly relevant also for textural properties of acid-milk products, like yogurt. In conclusion this work showed that seemingly minor variations in milk treatment may lead to considerable changes in the properties of the end product. Quantitative description will allow better control and tuning of the final gel properties

Home telemonitoring and remote feedback between clinic visits for asthma.

BACKGROUND: Asthma is a chronic disease that causes reversible narrowing of the airways due to bronchoconstriction, inflammation and mucus production. Asthma continues to be associated with significant avoidable morbidity and mortality. Self management facilitated by a healthcare professional is important to keep symptoms controlled and to prevent exacerbations.Telephone and Internet technologies can now be used by patients to measure lung function and asthma symptoms at home. Patients can then share this information electronically with their healthcare provider, who can provide feedback between clinic visits. Technology can be used in this manner to improve health outcomes and prevent the need for emergency treatment for people with asthma and other long-term health conditions. OBJECTIVES: To assess the efficacy and safety of home telemonitoring with healthcare professional feedback between clinic visits, compared with usual care. SEARCH METHODS: We identified trials from the Cochrane Airways Review Group Specialised Register (CAGR) up to May 2016. We also searched www.clinicaltrials.gov, the World Health Organization (WHO) trials portal and reference lists of other reviews, and we contacted trial authors to ask for additional information. SELECTION CRITERIA: We included parallel randomised controlled trials (RCTs) of adults or children with asthma in which any form of technology was used to measure and share asthma monitoring data with a healthcare provider between clinic visits, compared with other monitoring or usual care. We excluded trials in which technologies were used for monitoring with no input from a doctor or nurse. We included studies reported as full-text articles, those published as abstracts only and unpublished data. DATA COLLECTION AND ANALYSIS: Two review authors screened the search and independently extracted risk of bias and numerical data, resolving disagreements by consensus.We analysed dichotomous data as odds ratios (ORs) while using study participants as the unit of analysis, and continuous data as mean differences (MDs) while using random-effects models. We rated evidence for all outcomes using the GRADE (Grades of Recommendation, Assessment, Development and Evaluation Working Group) approach. MAIN RESULTS: We found 18 studies including 2268 participants: 12 in adults, 5 in children and one in individuals from both age groups. Studies generally recruited people with mild to moderate persistent asthma and followed them for between three and 12 months. People in the intervention group were given one of a variety of technologies to record and share their symptoms (text messaging, Web systems or phone calls), compared with a group of people who received usual care or a control intervention.Evidence from these studies did not show clearly whether asthma telemonitoring with feedback from a healthcare professional increases or decreases the odds of exacerbations that require a course of oral steroids (OR 0.93, 95% confidence Interval (CI) 0.60 to 1.44; 466 participants; four studies), a visit to the emergency department (OR 0.75, 95% CI 0.36 to 1.58; 1018 participants; eight studies) or a stay in hospital (OR 0.56, 95% CI 0.21 to 1.49; 1042 participants; 10 studies) compared with usual care. Our confidence was limited by imprecision in all three primary outcomes. Evidence quality ratings ranged from moderate to very low. None of the studies recorded serious or non-serious adverse events separately from asthma exacerbations.Evidence for measures of asthma control was imprecise and inconsistent, revealing possible benefit over usual care for quality of life (MD 0.23, 95% CI 0.01 to 0.45; 796 participants; six studies; I(2) = 54%), but the effect was small and study results varied. Telemonitoring interventions may provide additional benefit for two measures of lung function. AUTHORS' CONCLUSIONS: Current evidence does not support the widespread implementation of telemonitoring with healthcare provider feedback between asthma clinic visits. Studies have not yet proven that additional telemonitoring strategies lead to better symptom control or reduced need for oral steroids over usual asthma care, nor have they ruled out unintended harms. Investigators noted small benefits for quality of life, but these are subject to risk of bias, as the studies were unblinded. Similarly, some benefits for lung function are uncertain owing to possible attrition bias.Larger pragmatic studies in children and adults could better determine the real-world benefits of these interventions for preventing exacerbations and avoiding harms; it is difficult to generalise results from this review because benefits may be explained at least in part by the increased attention participants receive by taking part in clinical trials. Qualitative studies could inform future research by focusing on patient and provider preferences, or by identifying subgroups of patients who are more likely to attain benefit from closer monitoring, such as those who have frequent asthma attacks