Maintainability Aspects of Process Plant Pipe Joints

The paper is concerned with the maintainability aspects of pipe joints, the most common type of which is the bolted flange. An appreciation of pipe joint maintenance practice is obtained from two plant studies and a review of alternatives to flanges is then made with respect to these practical observations. Guidelines are given to help select the most appropriate coupling for an application. In the absence of a generally acceptable replacement coupling, a novel bolt design for use with standard flanges is proposed to alleviate some of the maintenance difficulties experienced.

Inferior alveolar nerve injury and surgical difficulty prediction in third molar surgery: the role of dental panoramic tomography

OBJECTIVE

The purpose of this study was to evaluate the relationship between preoperative panoramic radiological findings and postoperative inferior alveolar nerve paresthesia following third molar surgery, and to assess the surgical difficulty.

METHODOLOGY

This retrospective study involved two groups of patients who were randomly selected. The first group presented with inferior alveolar nerve (IAN) paresthesia following surgery, and the second group presented with no complications, including IAN paresthesia. Radiological findings were collected from the panoramic radiographs of those patients and compared to postoperative paresthesia. The degree of surgical difficulty was also assessed radiographically.

RESULTS

The application of Chi-square testing on the numbness group and the control group, as well as the numbness group (two years postoperatively) and the control group, showed that parameters like type of impaction (fully impacted), depth of impaction (depth C), ramus/space (class 3), spatial relationship (distoangular and horizontal), number of roots (multiple and incomplete), shape of root (thick and incomplete), shape of the tip of root (curved and incomplete), and relation to IAN (touching, superimposed, or non-specific) are highly significant (p < 0.001) in predicting the incidence of temporary and permanent paresthesia. Logistic regression showed that a patient whose lower third molar is > or = 1 mm from IAC has a 98% probability of no numbness, while if the tooth is touching the IAC the probability of numbness between one week and < two years is 60%. Numbness probability of darkening of the root is 48% for > two years, deflection of the root has a 42% probability of > two years numbness, narrowing of the root has 87% of numbness between > one month and < two years, a dark and bifid root has a 97% of numbness between > six months and < two years, interruption of the IAC has a 54% chance of numbness between > one month and < two years, diversion of the canal has a 60% probability of > six months to > two years numbness, while narrowing of the canal has a probability of 100% of > six months to > two years numbness. By using logistic regression, cases that were recorded as "very difficult," according to the Pederson Difficulty Index, were more likely to develop permanent paresthesia (95%). The application of logistic regression on the radiological findings showed that we can use them in predicting nerve paresthesia following third molar surgery. A classification tree has been developed and found to be very accurate in predicting permanent numbness (95%) and no numbness (100%) in third molar surgery depending on the radiological findings.

CONCLUSION

Surgical difficulty of impacted third molars may be assessed radiographically through seven factors, including spatial relationship, depth of impaction, ramus relationship/space available, type of impaction, number and shape of roots, shape of the tip of the root, and relation of the root to the inferior alveolar nerve. The application of logistic regression on the radiological findings showed that we could use them in predicting nerve paresthesia following third molar surgery. By developing a classification tree, it is easier to predict the possibility of temporary or permanent paresthesia. A full collaboration between clinicians and radiologists may help to uncover more parameters that can lead to a more accurate prediction of temporary and permanent paresthesia.

[Isolated case of haemorrhagic fever observed in Gabon during the 2002 outbreak of Ebola but distant from epidemic zones]

During the last outbreak of Ebola virus haemorrhagic fever that occurred concurrently in Gabon and Congo, several primary foci were identified in the Ogooue Ivindo province (Northeast Gabon), where previous outbreaks had occurred. A 48-year-old woman living in Franceville located 580 Km from the epicentre presented fever with haemorrhagic signs. She was evacuated to Libreville where Ebola infection was suspected. Diagnosis was confirmed at the Centre International de Recherches Médicales of Franceville on the basis of detection of specific antibodies. Symptoms had already subsided by the time diagnosis was documented. An epidemiological investigation was undertaken to identify the source of contamination and detect secondary cases. No human or nonhuman primate source of contamination could be formally identified. Direct contact with the virus reservoir could not be ruled out. No secondary cases were detected. The favourable outcome, absence of secondary, and failure to identify a source of contamination suggest that epidemiologically undefined cases may go unnoticed during and outside of outbreaks.

Current practice in the management of frontal sinus fractures

Fractures of the frontal sinus are seen predominantly, although not exclusively, in young men and are usually the result of road traffic accidents or falls. These types of injury may present to either ENT, Maxillofacial, Plastic or Neurosurgery teams, and understanding of a clear management protocol is desirable for each of the specialties. The optimal management of these injuries is becoming more uniformly adopted although some areas of contention still persist. The aim of treatment has always been directed at creating a 'safe sinus' that is not complicated by the late sequelae of infection or mucocele formation. The difficulty lies in being able to predict which patients are likely to develop these complications. The aim of this paper is to evaluate the literature and offer a rationale for the management of these injuries.

Molecular biodiversity of cassava begomoviruses in Tanzania: evolution of cassava geminiviruses in Africa and evidence for East Africa being a center of diversity of cassava geminiviruses

Cassava is infected by numerous geminiviruses in Africa and India that cause devastating losses to poor farmers. We here describe the molecular diversity of seven representative cassava mosaic geminiviruses (CMGs) infecting cassava from multiple locations in Tanzania. We report for the first time the presence of two isolates in East Africa: (EACMCV-[TZ1] and EACMCV-[TZ7]) of the species East African cassava mosaic Cameroon virus, originally described in West Africa. The complete nucleotide sequence of EACMCV-[TZ1] DNA-A and DNA-B components shared a high overall sequence identity to EACMCV-[CM] components (92% and 84%). The EACMCV-[TZ1] and -[TZ7] genomic components have recombinations in the same genome regions reported in EACMCV-[CM], but they also have additional recombinations in both components. Evidence from sequence analysis suggests that the two strains have the same ancient origin and are not recent introductions. EACMCV-[TZ1] occurred widely in the southern part of the country. Four other CMG isolates were identified: two were close to the EACMV-Kenya strain (named EACMV-[KE/TZT] and EACMV-[KE/TZM] with 96% sequence identity); one isolate, TZ10, had 98% homology to EACMV-UG2Svr and was named EACMV-UG2 [TZ10]; and finally one isolate was 95% identical to EACMV-[TZ] and named EACMV-[TZ/YV]. One isolate of African cassava mosaic virus with 97% sequence identity with other isolates of ACMV was named ACMV-[TZ]. It represents the first ACMV isolate from Tanzania to be sequenced. The molecular variability of CMGs was also evaluated using partial B component nucleotide sequences of 13 EACMV isolates from Tanzania. Using the sequences of all CMGs currently available, we have shown the presence of a number of putative recombination fragments that are more prominent in all components of EACMV than in ACMV. This new knowledge about the molecular CMG diversity in East Africa, and in Tanzania in particular, has led us to hypothesize about the probable importance of this part of Africa as a source of diversity and evolutionary change both during the early stages of the relationship between CMGs and cassava and in more recent times. The existence of multiple CMG isolates with high DNA genome diversity in Tanzania and the molecular forces behind this diversity pose a threat to cassava production throughout the African continent.

The 374 clinic: an outreach sexual health clinic for young men

OBJECTIVES

To describe the establishment of a community based walk-in outreach genitourinary medicine clinic, the "374 clinic," in south London to target young men under 25 in an area with high rates of sexually transmitted infections (STIs).

METHODS

The outreach clinic was set up within a Brook advisory centre, which already had gained the trust of local young people. Epidemiological, clinical, and laboratory data were obtained retrospectively for the first 24 weeks of the service.

RESULTS

134 attendances were recorded, including 94 new and 10 rebook events. The age range of the young men seen was 12-27 years (mean 18.2 years), the patients were mainly from black and ethnic minority groups, and all but one were heterosexual. Most men had heard about the clinic by "word of mouth," recommendation by Brook staff or through clinic promotional material. Condoms were used more frequently with non-regular sexual partners than with regular partners. The uptake of screening for gonococcal and chlamydial infections, mostly by urine based molecular techniques, was 98%. The uptake for HIV testing in men aged 16 or more was 72%. An overall STI prevalence rate of 26% was detected in the clinic population, which consisted almost equally of asymptomatic and symptomatic patients. The most prevalent STI was chlamydial infection (12%).

CONCLUSIONS

The young men who attended the outreach clinic were happy to undergo both non-invasive urine based testing for gonorrhoea and chlamydia as well as phlebotomy to test for HIV and syphilis. The 374 clinic approach may prove to be a useful model for further outreach services to combat poor sexual health of young men in inner city areas.

Clinical emergence of entecavir-resistant hepatitis B virus requires additional substitutions in virus already resistant to Lamivudine

Entecavir (ETV) exhibits potent antiviral activity in patients chronically infected with wild-type or lamivudine (3TC)-resistant (3TC(r)) hepatitis B virus (HBV). Among the patients treated in phase II ETV clinical trials, two patients for whom previous therapies had failed exhibited virologic breakthrough while on ETV. Isolates from these patients (arbitrarily designated patients A and B) were analyzed genotypically for emergent substitutions in HBV reverse transcriptase (RT) and phenotypically for reduced susceptibility in cultures and in HBV polymerase assays. After 54 weeks of 3TC therapy, patient A (AI463901-A) received 0.5 mg of ETV for 52 weeks followed by a combination of ETV and 100 mg of 3TC for 89 weeks. Viral rebound occurred at 133 weeks after ETV was started. The 3TC(r) RT substitutions rtV173L, rtL180M, and rtM204V were present at study entry, and the additional substitutions rtI169T and rtM250V emerged during ETV-3TC combination treatment. Reduced ETV susceptibility in vitro required the rtM250V substitution in addition to the 3TC(r) substitutions. For liver transplant patient B (AI463015-B), previous famciclovir, ganciclovir, foscarnet, and 3TC therapies had failed, and RT changes rtS78S/T, rtV173L, rtL180M, rtT184S, and rtM204V were present at study entry. Viral rebound occurred after 76 weeks of therapy with ETV at 1.0 mg, with the emergence of rtT184G, rtI169T, and rtS202I substitutions within the preexisting 3TC(r) background. Reduced susceptibility in vitro was highest when both the rtT184G and the rtS202I changes were combined with the 3TC(r) substitutions. In summary, infrequent ETV resistance can emerge during prolonged therapy, with selection of additional RT substitutions within a 3TC(r) HBV background, leading to reduced ETV susceptibility and treatment failure.

Spermatogenesis and plasma testosterone levels in Western Australian burrowing desert frogs, Cyclorana platycephala, Cyclorana maini, and Neobatrachus sutor, during aestivation

Changes in testis size, histological status, and plasma levels of testosterone were monitored for males of three species of Western Australian desert frogs, Cyclorana maini, Cyclorana platycephala, and Neobatrachus sutor during aestivation. The frogs were induced to burrow and form cocoons soon after their capture and then disinterred at intervals in order to monitor changes in reproductive activity of the testes. All stages of spermatogenesis were evident in active frogs, which were collected a few days following rain from breeding choruses. Relative testis mass declined gradually in all species during the first 7 months of aestivation and then increased significantly at 16-19 months in the two species for which extended data were available (C. maini and N. sutor). A decrease in the number of sperm bundles 2-4 months after cocooning was associated with an initial increase in the number of free spermatazoa in all three species, which then returned to the levels seen in active animals after 7 months. Increases in the number of primary and secondary spermatogonia were most evident in C. platycephala after 4-7 months of aestivation, but early stages of spermatocytogenesis were evident in all species after 7 months of aestivation, especially in individuals that contained neither sperm bundles nor mature spermatazoa. Changes in plasma testosterone levels correlated significantly with variations in the diameter of the seminiferous tubules and the GSI, suggesting that this hormone plays a major role in controlling testicular recrudescence in aestivating, cocooned, desert frogs. Data from this study show that, in the absence of any external cues, testicular recrudescence is evident after approximately one year of aestivation in desert frogs which prepares them to breed again, once rain falls.

Water content, body weight and acid mucopolysaccharides, hyaluronidase and beta-glucuronidase in response to aestivation in Australian desert frogs

This study investigates the effects of aestivation on body water content, body mass, acid mucopolysaccharide (AMPS) and some of its degrading enzymes in different tissues for some Australian desert frogs. The AMPS component of the liver, kidney, skin and cocoon alter during aestivation to help retain water, which is unchanged in most tissues of all frog species, and to protect the frogs from desiccation during extended periods of aestivation. Hepatic AMPS was unaltered in Cyclorana maini, C. platycephala and Neobatrachus sutor but increased significantly after 2 months of aestivation in C. australis. The level of AMPS in the kidney was elevated in all four frog species after 5 months of aestivation. Skin AMPS content in the skin of awake frogs decreases with aestivation period and increases in the cocoon. AMPS in the cocoon probably works as a cement between the cocoons' layers and its physical presence presumably contributes to preventing water flux. Changes in AMPS content in different tissues were accompanied by significant changes in both hyaluronidase and beta-glucuronidase activities, which play an important role in AMPS metabolism. Alcian blue staining of control and digested skin of C. australis and C. platycephala with testicular hyaluronidase indicated the presence of AMPS, concentrated in a thin layer (called ground substance, GS) located between stratum compactum and stratum spongiosum, and acid mucin concentrated in the mucous glands and in a 'tubular' structure which could be observed in the epidermal layer. Hyaluronidase digestion of the cocoon slightly changed the Alcian Blue colour, suggesting the presence of a large amount of acid mucin similar to that found in the skin mucous gland. The results of this study present data for the redistribution of AMPS, which may help in reducing water loss across the cocoon and reabsorption of water in the kidney during aestivation.

First confirmed case of Neospora caninum-associated abortion outbreak in Portugal

In a dairy herd experiencing an abortion outbreak, 49% of the 119 cows were positive for Neospora caninum antibodies and the remaining 51% were seronegative. Using immunohistochemical analysis of foetal brain tissue, Neospora cysts and bradyzoite clusters were identified in two of the 15 aborted foetuses submitted for testing. Other agents that commonly cause abortions were not found. These results, coupled with neurological clinical symptoms in new-born calves, implicated N. caninum as the major cause of abortions in this dairy herd. This is the first report that associates N. caninum infection with bovine abortions in Portugal.

Noncontact dipole effects on channel permeation. IV. Kinetic model of 5F-Trp(13) gramicidin A currents

Nonlinear least squares fitting was used to assign rate constants for the three-barrier, two-site, double-occupancy, single-filing kinetic model for previously reported current-voltage relations of (5F-Indole)Trp(13) gramicidin A and gramicidin A channels (, 75:2830-2844). By judicious coupling of parameters, it was possible to reduce the parameter space from 64 parameters to 24, and a reasonable fit consistent with other experimental data was obtained. The main features of the fit were that fluorination increased the rate constant for translocation by a factor of 2.33, consistent with a free energy change in the translocation barrier of -0.50 kcal/mol, and increased first-ion binding affinity by a factor of 1.13, primarily by decreasing the first-ion exit rate constant. The translocation rate constant was 5.62 times slower in diphytanoyl phosphatidylcholine (DPhPC) bilayers than in monoolein (GMO) bilayers (coupled for the four combinations of peptide and salt), suggesting a 44.2-mV difference in the projection of the interfacial dipole into the channel. Thus fluorination caused increased currents in DPhPC bilayers, where a high interfacial dipole potential makes translocation more rate limiting because the translocation barrier was reduced, and decreased currents in GMO bilayers, where ion exit or entry is rate limiting because these barriers were increased.

The design of a corporate identity for a department of medical illustration: a case study

This paper outlines the author's attempt to design and introduce a corporate identity into the Department of Medical Illustration at the South Buckinghamshire NHS Trust. It is intended to furnish the reader with an insight into the process of designing a corporate identity and to relate one department's experience. This may be useful for those who wish to develop a corporate identity of their own or contribute, as a department, towards an identity for their own Trust or other institution. A major change in government policy about the identity of NHS Trusts has meant that use of the department's new logo has had to be abandoned in favour of the new NHS corporate identity.

Attitudes of patients towards the use of chaperones in primary care

There exists wide variation in practice regarding the use of chaperones for physical examination of the patient in primary care. Guidelines agree that a chaperone should be offered or used whenever a patient is undergoing an intimate examination. This paper aims to gauge patient views on the use of chaperones in primary care. Focus groups were used to identify themes surrounding the use of chaperones in primary care. Questionnaires were then mailed to 404 women and 400 men aged 16 years to 65 years identified from the lists of three research practices in the Northern and Yorkshire Region. The most important factor for the patient in an intimate examination is the attitude of the doctor; the patient views the offer of a chaperone as a sign of respect by the doctor. The development of shared decision-making within a consultation involving an intimate examination should be seen as more important than a rigid approach towards using a chaperone.

The treatment of pulp and paper mill effluent: a review

The manufacture of paper generates significant quantities of wastewater; as high as 60 m3/tonne of paper produced. The raw wastewaters from paper and board mills can be potentially very polluting. Indeed, a recent survey within the UK industry has found that their chemical oxygen demands can be as high as 11000 mg/l. This paper reviews the processes involved in paper making and examines the effects which they could have on the environment. It also evaluates the treatment processes which are used to minimise these effects. In line with the majority of UK practice, it focuses mainly on aerobic biological treatment and, in particular, on the activated sludge process. This means that there is an in-depth discussion about the problems associated with filamentous bacteria and sludge "bulking". The paper also discusses the way in which anaerobic digestion can be applied to the treatment of liquid wastes from the manufacture of paper.