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If instrumental dysphagia assessment is not available, clinical assessment should be performed instead. Therefore, it is not predictable whether or not dopaminergic treatment will have a beneficial effect on dysphagia, which has to be tested where necessary [180]. It does not involve any radiation, it needs only minimal cooperation of the patients and may be performed as a bedside method [17]. This method is often combined with impedance measurements, impedance manometry, which may increase the validity of the method [184e188]. Other techniques such as acoustical analysis of voice [189e191], acoustical analysis of swallowing or breathing sounds [192e194] lack high sensitivity or specificity and are not broadly available. However, there is little evidence about the effect of levodopa on swallowing function in patients with dysphagia. None randomized controlled trials have been design to explore this question, and only one meta-analysis [201] and one very well conducted systematic review of the literature [202] have been published on this topic. Some criticisms are published about this meta-analysis [203] (few studies, open-label, short in duration, small in sample size, not assessment of the effect of long duration levodopa treatment, inclusion of a variety of quality design studies, selection bias, poorly defined outcome parameters and dysphagia assessment tools that only explore one part of swallowing). The improvement in dysphagia probably is mediated through the improvement of motor symptoms (oral preparatory phase time, buccolinguofacial motor score, bradykinesia and rigidity of the tongue, and mandibular movement). Furthermore, the improvement of motor symptoms makes possible the adoption of compensatory postures that increase the airway protection during swallowing. Disease severity (based on the Hoehn and Yahr scale), on/off phase in which treatment was performed, and dysphagia assessment tool can be confounders to take into account in the design of such studies. We recommend to monitor side-effects and nutritional status and to intervene on an individually tailored basis. For levodopa, specific attention should be given to homocysteine levels and vitamin B status. These side-effects have been mentioned by patients to attribute to their weight loss, as well as changes in taste and smell of food [210]. The mechanism of drugs-related weight changes is still not well known and requires further investigation [126]. The use of levodopa may be associated with impaired nutritional status and risk for malnutrition. Association between nutritional risk and levodopa has also been shown by others [130]. Research has indicated weight loss among levodopa users, especially in women (which might be due to higher levodopa dose per kg of body weight), and after starting levodopa treatment [212]. In this study, the magnitude of levodopa dose did not seem to be related to weight loss, and was mostly due to reduction in body fat mass [212]. Yet, the true relationship between levodopa use and weight loss needs to be determined as it unknown whether higher levodopa use induce weight loss, or patients with more severe disease receive higher doses of levodopa per kg body weight. Indeed, in more advanced stages, higher doses of levodopa are required to improve the control of worsening motor symptoms. Higher (relative) doses in advanced stages are also associated to dyskinesias which, in turn, have been associated with weight loss [126]. The literature search included a study on metabolic effects (n ј 10), showing that levodopa/benserazide (200 mg/50 mg) caused metabolic changes in adipose tissue and skeletal muscles disturbing lipid and carbohydrate metabolism. Hence, these results indicate that levodopa/benserazide does not reduce fat wasting through modulation of adipose tissue metabolism. Results pointed towards reduction in muscle glucose uptake, which might induce glucose intolerance [214]. Another small study in seven geriatric Parkinsonian patients showed increased plasma free fatty acids, glucose, growth hormone and cortisol after levodopa administration which were significantly higher compared to young controls, and only slightly higher compared to aged controls [215]. Longterm treatment with levodopa induces hypersecretion of insulin and growth hormone [124]. After the pharmacological change, lipid oxidation remained unchanged but glucose oxidation fell and fasting glycaemia was raised [216]. However, the true interrelationships between those factors need to be established. One study showed dependency upon vitamin B status as assessed by folate, vitamin B12, and vitamin B6. Patients on levodopa seem to have higher requirements for these vitamins to maintain normal homocysteine levels, and supplementation might be warranted [217].

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F c ing n I al a i ca e d, he ie a ed, Al h gh he e ha e been fe ca e of children infected with this novel strain of coronavirus, childcare is one of the most serious collateral concerns for Italian parents. M e e, the study suggests that through preliminary data collected, parents of children diagnosed with a mental or physical disease are experiencing higher levels of parental burnout and perceiving less social support, than other parents are. The National Academies of Sciences Engineering and Medicine released an extensive report that concludes school districts should prioritize reopening schools full-time, especially for grades K-5 and den ih ecial need. Keeping schools closed to in- person learning in Fall 2020 poses potential educational risks. Students of all ages benefit from in-person learning experiences in ways that cannot be fully replicated through di ance lea ning, he e ae. F he m e, O ening ch l b ilding me extent in Fall 2020 may provide benefits from families beyond educating children and youth. Working caregivers would have affordable, reliable childcare for school-age children, and families would be better able to access services offered through the school, ch a he i i n f meal and he famil. The e al ec mmend schools and districts take certain precautions to protect staff and students such as providing 153 doi. The Journal of Pediatrics and Child Care published an article in June 2020 prefacing the French Pediatric Society, and various Societies of pediatric specialties support on children returning to school. Finding your playmates should not be considered as exposing them to particular risks. It is urgent to recall that communities of children, nurseries or classes, continued to exist during confinement, especially for the children of nursing staff. No epidemic was noted in these groups of children, while viral circulation was high am ng ad l. Depression and anxiety symptoms were two of the driving health risks identified among students in Hubei Province, China. A total of 2330 students in grades 2 through 6 in 2 primary schools in Hubei province, of whom 845 were from Wuhan and 1485 were from Huangshi, were invited to complete a survey between February 28 and March 5, 2020. The information included sex, school grade, optimism about the epidemic, whether they worried about being infected by 154 155. Referencing students with disabilities, the authors stated tha Thi een e cen f blic den ha e a disability requiring an individual education plan, with nearly two-fold higher rates in lowincome communities. Of children with mental and behavioral health needs, 80% rely on school-based services. School closure means loss of critical resources for children with disabilities, including engagement with specialized educators and structured learning environments. Parents of children with high learning needs are unlikely to be equipped with resources to maintain remote learning. To offset worsening educational disparities in this population, we must prioritize strategies to safely resume in-person education for children with disabilities and advocate for resources to support expansion of assistive technologies fo h me. Al h gh em e learning presents a challenge for all families, those in poverty are at a greater disadvantage and thus at increased risk for widening educational disparities. One in seven children lacks home internet access, with a two-fold higher rate among low-income communities. K-12 teachers, half of them are, 159 under 41, 82% are under 55158, these are not high- i k age g said Dr. He he child en f cl ing ch l, hi i he bigge goes on to discuss the imminent consequences of distance learning such as significant drops in math and reading ability. Referencing data from countries that have opened schools, Atlas stressed the fact that children do not significan l can in i ha an mi he di ea e ad l. Wha child en l e b n being in ch e e ience ha i c i ical f l i en m; ch l a endance i a life-defining men, aid R h ed ca i nal, cial, and em i nal de el Faden, founder of Johns Hopkins Berman Institute of Bioethics. Johns Hopkins University unveiled a re-opening policy tracker for K-12 schools that contains an interactive map and 157 158 pediatrics. E en hen child en i h c m bidi ie a e being e ed a risk of severe disease, mortality was very rare. P lling da a f m ca e in den an ici a e an China, S ain, and S eden, he a h imi ic cena i 74. Referencing a survey taken by the mental health charity Young Minds, the author brings attention to the crippling number of problems students with disabilities face with em e lea ning.

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Clinical implementation of the method has resulted in the analysis of 7 families so far. Importantly, by including more than one extended family member, the chance of obtaining informative results in the interrogated locus increases. Based on meiosis mechanism, genome of a single oocyte can be deduced by analyzing its sibling polar bodies. Estimated aneuploidy rate for the studied group which resembles the total oocyte abnormality resulting from meiosis I errors rate was 33% (37/112 samples). Both whole chromosome nondisjunction (6 of 37 aneuploid samples) and abnormal chromatid pre-division and segregation were detected (31 of 37 aneuploid samples). The result is concordant with previous studies - abnormal chromatid segregation was the dominant aneuploidycausing mechanism. The study also contributes to a better understanding of the chromosome segregation patterns and maternal meiosis errors. Reproductive Medicine Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, Guangzhou, China. The larger chromosomes contained a higher proportion of deletions and duplications, with the exception for chromosome 6, while majority of duplications were observed in chromosome 20 and Y, and deletions mainly in chromosomes 2, 12, 17 and 22. Conclusion: the observed segmental abnormalities represent de novo findings of mitotic origin, with the majority being mosaics, showing no maternal age dependence. Reproducibility in the follow up testing and prevalence in pregnancy losses will be useful for consideration on their biological and clinical significance. Warsaw University of Life Sciences, Faculty of Veterinary Medicine, Department of Large Animal Diseases with Clinic, Veterinary Research Centre, Warsaw, Poland. The presence of antioxidant enzymes including selenoproteins across different mammalian species suggests that defence mechanisms are conserved and are likely to be important for the final steps of in vitro oocyte maturation. Domestic cat serves as a good animal model for future research in conservation breeding of endangered feline species, but also it is a valuable model for studying developmental pathways that can be affected by in vitro culture and maturation of oocytes for many mammalian species including human. Competence of in vitro development of cat oocytes is low in comparison with other model organisms. A major factor affecting the viability of cells during in vitro culture is an increased oxidative stress. Material and methods: Ovaries from healthy, feral, 8-12 months old female domestic cats (n=10), were obtained by ovariectomy in local veterinary clinic. Results: Results revealed that all three transcripts were detected, independently of the maturation stage. Nevertheless, significantly higher level of Gpx1 and Sephs2 expression was observed in oocytes, compared with their surrounding cumulus cells. Conclusions: In conclusion, our results indicate that Gpx1 and Sephs2 can be involved in in vitro maturation of oocytes and may be a part of anti-oxidant pathways induced by oxidative stress. Further studies should be conducted on the oxidative response pathways in relation to developmental potential of oocytes matured in vitro and conservation of the mechanism in human. The paternal pronuclei was of normal size and 7-9 micropronuclei appeared beneath the second polar body and migrated to the center of the cytoplasm. Six embryos were diagnosed as being chaotic aneuploid and one as being monosomy18 and nullisomy13. Material and Methods: A prospective non-selection study was performed from January 2018 to December 2018. Results: In order to avoid confusion related to the oocyte quality we included only egg donation cycles, therefore the average maternal age at time of oocyte retrieval was 26+ 4 years (range: 19. This difference was not related with the age of the egg donor neither the male factor (p>0. This technique allows doubling the number of oocytes suitable for fertilization, while maintaining the biological relationship of patient with the future child. The use of transfer in our practice has shown the ability of modified oocytes to form high morphological quality blastocysts and their euploidy have been evaluated in this study.

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Most natural channels have high width-to-depth ratios and complexity of channel form compared with engineered channels. Meanders are ubiquitous self-forming features in channels, created as accelerated flow around the outside of the meander entrains and transports more sediment, producing greater flow depths and eroding the bank, while decelerated flow on the inside of the meander results in deposition and the formation of lower water depth and bank gradients. These channels typically show small-scale alternation between larger cross sections with lower velocities and defining pools, and smaller cross sections with higher velocity flow in riffles. Braided streams form repeated subdivision and reconvergence of the channel in multiple threads, with reduced specific discharge compared to a single channel. Natural obstructions including woody debris, boulders, and other large (relative to channel dimensions) features all contribute to hydraulic and habitat heterogeneity. The complexity of these channel patterns contributes to hydraulic roughness, further dissipating stream energy by increasing the effective wetted perimeter of the channel through a valley and deflecting flow between banks. Embedded Standing Waterbodies Standing waterbodies include natural, constructed, or modified ponds and lakes and are characterized by low or near-zero lateral velocity. They can be thought of as extensions of pools within the drainage network, although there is no clear threshold at which a pool can be defined as a pond or lake. Therefore, standing waterbodies function as depositional zones, have higher residence times, and provide significant storage of water, sediment, nutrients, and other pollutants within the stream network. Riparian Zone the riparian area is a transitional zone between the active channel and the uplands, and between surface water and groundwater. The area typically has shallower groundwater levels and higher soil moisture than the surrounding uplands, and it may support wetlands or other vegetation communities that require higher soil moisture. Riparian zones provide important ecosystem functions and services, such as reducing peak flood flows, transforming bioavailable nutrients into organic matter, and providing critical habitat. In humid landscapes, a functioning riparian area commonly is an area where shallow groundwater forms discharge seeps, either directly to the surface and then to the stream channel or through subsurface flowpaths to the stream channel. The potential for high moisture and organic material content provides an environment conducive to anaerobic microbial activity, which can provide effective sinks for inorganic nitrogen by denitrification, reducing nitrate loading to the stream channel. However, the width of the effective riparian zone depends on local topographic gradients, hydrogeology, and the channel geomorphology (Lowrance et al. In steeply incised channels and valleys, or areas with deeper flowpaths, the riparian zone may be narrow and relatively well drained. Under more arid conditions with lower groundwater levels, riparian areas may be the only areas within the watershed with sufficient moisture levels to support significant vegetation canopy cover, even though saturation conditions may occur only infrequently. Subsurface flowpaths may be oriented most commonly from the channel to the bed and banks, forming the major source of recharge to this zone from periodic flooding. Floodplains the presence and distribution of alluvial depositional zones, including floodplains, is dependent on the distribution and balance of upstream sediment sources and sediment transport capacity, the temporal and spatial variability of discharge, and any geological structural controls on valley gradient. Lateral migration of streams contributes to the development of floodplains as the outer bank of the migrating channel erodes sediment and deposition occurs on the opposite bank. This leads to channels that are closely coupled to their floodplains, with frequent overbank flow and deposition, backwater deposits, wetlands, abandoned channels, and other floodplain features. Constructional landforms typical of urbanized watersheds, such as levees, tend to disconnect streams from their floodplains. Changes in Geomorphology from Urbanization Changes to channel morphology are among the most common and readily visible effects of urban development on natural stream systems (Booth and Henshaw, 2001). The actions of deforestation, channelization, and paving of the uplands can produce tremendous changes in the delivery of water and sediment into the channel network. In channel reaches that are alluvial, the responses are commonly rapid and often dramatic. Channels widen and deepen, and in some cases may incise many meters below the original level of their beds. Alternatively, channels may fill with sediment derived from farther upstream to produce a braided form where a singlethread channel previously existed. The clearest single determinant of urban channel change is the alteration of the hydrologic response of an urban watershed, notably the increase in stream-flow discharges. Increases in runoff mobilize sediment both on the land surface and within the stream channel. However, the low frequency of these events may result in decreasing cumulative sediment transport during the highest flows, as described by standard magnitude and frequency analysis (Wolman and Miller, 1960), such that the maximum time-integrated sediment transport occurs at moderate flows.

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In some lines, the number of Bs increased or decreased sharply in a few generations of lab culture, as if B success was being molded by A background. Similar variation has been found in the progeny of an uninfected individual mating with an infected individual within the same population: some sublines have eliminated Bs entirely; 336 B Chromosomes and in some, they have proliferated. When a standard B found in 1 line was transferred into 3 other lines lacking Bs, it accumulated rapidly in 1 line but not in the other 2. A more elaborate series of crosses confirmed these results and also demonstrated variation within lines, so natural populations seem to be segregating for alleles at not less than 2 A loci that affect resistance to B drive (Nur and Brett 1987). There is no evidence in this species that Bs of different origin vary in their degree of drive against a constant A background (Nur and Brett 1985, 1987). Drive suppressor genes apparently work by interrupting the decondensation of the Bs so they no longer segregate preferentially with the euchromatic set (Nur and Brett 1988). These data suggested additive genetic variance for accumulation in the female line, perhaps due to a single A locus. Extensive crosses have been performed in rye lines selected for high and low rates of B transmission. Genes affecting B transmission on the male side in controlled crosses of rye are found on the Bs themselves (Puertas et al. These "genes" are hypothesized to be sites for chiasmata formation, because in lines selected for high transmission, pairing of 2 Bs occurs 88% of the time (and the B is inherited 83%) while in low lines, Bs form bivalents 19% of the time (and are inherited 44%; Jimйnez et al. It is interesting that, while rye Bs introduced into wheat undergo normal nondisjunction in both the male and female gametophyte (Mьntzing 1970), they are less efficient at pairing together at meiosis and so are prone to elimination (Mьntzing et al. Lower transmission through females in lines selected for low transmission could be the result of the same trait or it could be an independent one, located either on the As or on the B (Romera et al. Early observations suggested that the maternal parent affected B drive: pollen grains formed in 2B parents whose maternal parental was also 2B showed high B transmission, while 0B plants whose maternal parent was 2B were highly accepting of B pollen (Puertas et al. The B chromosome in maize, with 4 regions numbered that control nondisjunction of the B. The genetics of the various B factors that determine B chromosome accumulation are known only in some detail from maize, and even here, no protein-coding genes have been isolated, only regions of the B. Recall that in maize the Bs show nondisjunction at the second pollen grain mitosis, and then the sperm with the 2 Bs is disproportionately likely to fertilize the egg rather than contribute to the polar body. Three regions of the B are crucial for the occurrence of nondisjunction, and a fourth enhances the frequency of nondisjunction (Lin 1978, 1979, Carlson and Chou 1981, reviewed in Carlson and Roseman 1992;. In addition, there is at least 1 gene on the A chromosomes that is active in the haploid egg, determining whether it is preferentially fertilized by B-containing sperm, and another that controls whether the B shows drag at female meiosis (Chiavarino et al. Transmission Rates in Well-Studied Species Measures of B drive as a function of B number and sex of individual are known in some detail for about 15 species (Table 9. First, drive usually occurs in one sex and not the other; indeed, the B may suffer drag in the nondriving sex. Because individuals with 1 B are also usually the most common B-bearing individuals, drive as a univalent is usually the critical drive parameter affecting frequency. If the B shows drag, drag is strongest in the univalent and transmission increases with B number so as to become nearly Mendelian at the highest numbers. Absence of Drive Transmission data are available for Bs in about 70 species of plants and, according to Jones (1995), of these only about 60% show detectable drive. Half of these are in the Gramineae and typically show drive at second pollen mitosis via nondisjunction, with or without accumulation in the female germline. It is not clear how many of these are characterized by modest drive, rather than none at all. Jones (1995) suggests that it would be "grossly misleading" to regard all plant Bs as being selfish elements, maintained by drive. And, as we will see, in the grasshopper Eyprepocnemis there is clear evidence that successive B chromosomes have been neutralized, losing their drive and being partly replaced by new variants that reestablish drive, that are, in turn, neutralized. Degree of Outcrossing and Drive It has long been noted that Bs are preferentially found in outcrossing species. Moss (1969) reports doing a comparative study of plant families (but presents no details) and concludes that Bs are largely excluded from inbred and asexual species. In inbred or asexual species, all natural selection is between competing lines of descent and lines without Bs are expected to outcompete those with Bs (which suffer the phenotypic costs).

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These regulations had been informed by the National Urban Runoff Program, conducted from 1978 to 1983 to characterize the water quality of stormwater runoff from light industrial, commercial, and residential areas (Athayde et al. The study indicated that on an annual loading basis, some of the conventional pollutants were greater than the pollutant loadings resulting from municipal wastewater treatment plants. The Federal Highway Administration conducted studies over a ten-year period ending in 1990 to characterize the water quality of stormwater runoff from roadways (Driscoll et al. A total of 993 individual stormwater events at 31 highway sites in 11 states were monitored for eight conventional pollutants and three heavy metals. In addition, a subset of samples was analyzed for certain other conventional pollutant parameters. The studies found that urban highways had significantly higher pollutant concentrations and loads than non-urban highway sites. Also, sites in relatively dry semi-arid regions had higher concentrations of many pollutants than sites in humid regions. The main industrial sectors subject to the stormwater program are shown in Table 2-3 and include 11 regulatory categories: (i) facilities with effluent limitations, (ii) manufacturing, (iii) mineral, metal, oil and gas, (iv) hazardous waste treatment, storage, or disposal facilities, (v) landfills, (vi) recycling facilities, (vii) steam electric plants, (viii) transportation facilities, (ix) treatment works, (x) construction activity, and (xi) light industrial activity. Further, the regulations lowered the construction activities regulatory threshold for permit coverage for stormwater discharges from five acres to one acre. To give an idea of the administrative burden associated with the stormwater program and the different types of permits, Table 2-4 shows the number of regulated entities in the Los Angeles region that fall under either individual or general permit categories. Industrial and construction greatly outweigh municipal permittees, and stormwater permittees are vastly more numerous that traditional wastewater permittees. Efforts to meet the six minimum measures are documented in a stormwater management plan. Both industry and municipalities have argued that the dual inspection responsibilities are duplicative and redundant. The visual monitoring is performed by collecting a grab sample within the first hour of stormwater discharge and observing its characteristics qualitatively. To comply with the benchmark monitoring requirements, a grab sample must be collected within the first hour of stormwater discharge after a rainfall event of 0. Most of these facilities were covered under individual permits prior to 1987 and are generally required to stay covered under individual stormwater permits. In reality, individual permits, which would allow for the crafting of permit conditions to be better structured to the specific industrial facility based on its higher potential risk to water quality, and could include adequate monitoring for purposes of compliance and enforcement, have been sparsely used. Similarly, neither the watershed permitting strategy nor the industry category-specific permitting strategy has found favor in the absence of better federal guidance and funding. The construction general permit requires the implementation of stormwater pollution prevention plans to prevent erosion, control sediment in stormwater discharges, and manage construction waste materials. Operators of the construction activity are required to perform visual inspections regularly, but no sampling of stormwater discharge during rainfall events is required. Wisconsin requires weekly inspections and an inspection within 24 hours of a rain event of 0. Permit Creation, Administration, and Requirements For individual permits, the entity seeking coverage submits an application and one permit is issued. The conditions of the permit are based on an analysis of information provided in a rather lengthy permit application by the facility operator about the facility and the discharge. Generally, it takes six to 18 months for the permittee to compile the application information and for the permitting authority to finalize the permit. The permit must identify the area of coverage, the sources covered, and the process for obtaining coverage. All permits contain "effluent limitations" or "effluent guidelines," adherence to which is required of the permittee. Effluent limitations can be either technology-based or water quality-based requirements. Technology-based requirements establish pollutant limits for discharges on what the best pollution control technology installed for that industry would normally accomplish. Waterquality based requirements, by contrast, look to the receiving waters to determine the level of pollution reduction needed for individual sources. There are national technology-based standards available for many categories of point sources, including many industrial sectors and municipal wastewater treatment plants. In the absence of national standards, technology-based requirements are developed on a case-by-case basis using best professional judgment. Water quality-based effluent limitations are required where technology-based limits are found to be insufficient to achieve applicable water quality standards, including restoring impaired waters, preventing impairments, and protecting highquality waters.


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Primary keratins are those keratins which are always synthesized by the epithelial cells on a regular basis. Secondary keratins are those types of keratins which are produced by the epithelial cells in addition to or instead of primary keratins. During epidermal differentiation, low molecular weight keratins 5/14 of the basal layer are replaced by high molecular weight keratins 1/10,11 which can be used as a marker of keratinization. Based on distribution Soft keratin: Found in the epidermis of skin in the form of flattened non-nucleated scales that slough continually. The disulfide links are fewer in number which allows some stretching but returns to normal upon relaxation of tension. They differ from the epithelial keratins by their considerably higher sulfur content in their non-helical head and tail domains, which is mainly responsible forn the high degree of filamentous cross-linking by keratin associated proteins. Based on X-ray diffraction pattern Alpha: the X-ray diffraction pattern of this type resembles that of -helix with a 5. Based on molecular weight2 Low molecular weight keratins: Include keratins with a molecular weight of 40kDa. K8/18 is the primary keratin and K7 is the secondary keratin of the simple epithelium. Figure 3: Distribution of keratin in gingival epithelium (Reproduced from Presland and Dale 2000). Keratin distribution in epithelia K5/14 Basal cell layer of both the keratinized and non-keratinized stratified epithelium K1/10 Keratinized epidermis K6/16 Spinous cell layer of keratinized mucosa K4/13 Intermediate layer of non-keratinized epithelium K19 Basal layer of non-keratinized epithelium K9 Suprabasal cells of palmar and plantar epidermis Keratin expression in gingival K5/14 Basal cell layer K19 Basal cell layer of junctional epithelium and gingival margin K8, 18, 13, 16, 19 Superficial layers of junctional epithelium K4, 13, 16 Superficial layer of gingival margin K1/10, K6/16 and Superficial layers of outer gingival K2p epithelium Distribution of keratin in the dorsal aspect of the tongue (Dale et al 1990). K76 is produced in the upper layers of the stratified epithelium of the hard palate and gingiva. They are synthesized in the granular cell layer as a large precursor molecule (profilaggrin), stored in keratohyaline granules and converted to filaggrin upon transition of granular cells to fully differentiated cornified cells. They may also play a role in maintaining the osmolarity and flexibility of epidermis. Tricohyalin is expressed in keratinizing filiform papilla of tongue, nail matrix, new born foreskin epidermis and in isolated cells of normal adult epidermis. It may play a role in sequestering calcium and thus regulate the activity of calcium dependent enzymes. They help in attachment of keratin intermediate filament cytoskeleton to cell surface. They are inclusive of integral proteins (desmoglein and desmocollin), cytoplasmic adapter proteins (desmoplakin and plakoglobin) and plaque associated proteins (plakophilin, envoplakin, and periplakin). Proteins of cornified cell envelope are 15nm thick cross linked sheath of protein deposited on the inner face of plasma membrane of keratinocytes. They are expressed in the suprabasal layer and act as a barrier function of stratified keratinized epithelium. The most abundant cell envelope proteins are loricrin, involucrin and small proline rich proteins. Loricrin is expressed in granular cells of epithelium and other keratinized epithelia such as gingiva and hard palate. Involucrin is expressed in differentiating keratinocytes and consists of short polypeptide repeats rich in glycine, lysine and glutamine. Small proline rich proteins play a crucial role in epithelia that must be flexible. Protein K1/10 K13/19 K5, K16, K17 K4,K5, K14 Filaggrin Cornified cell envelope Desmosomes Effects Reduced expression Increased expression Slightly downregulated Not affected Reduced expression Suppressed Reduced in number Keratinization Disorders A wide range of disorders occur as a result of mutation in the gene encoding for the various keratin proteins. These disorders comprise of the lesions affecting the skin and mucous membrane depending on the distribution of keratin and certain disorders may present with both skin and oral manifestations. Disorders Defect in - helical rod pattern Epidermolysis bullosa K5/K14 simplex Epidermolytic ichthyosis K1/K10 Autosomal dominant Autosomal dominant Blistering of hands and feet which Intraepithelial clefting heal without scarring. Present at birth with generalized erythema, blistering, erosions and peeling of skin. Variously sized clear spaces around the nucleus in upper stratum spinosum and granulosum with indistinct cell boundaries. Defect Inheritance Clinical features Histopathological features Pachyonychia congenita K6/16, K17 Autosomal dominant Free margins of the nails are lifted due to accumulation of keratinaceous material in the nail beds resulting in pinched tubular configuration. Formation of painful blisters on soles of feet after few minutes of walking during warm weather.

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The magnitude of the design storm can be derived from data at a single gauge, or from synthesized regional data published by state or federal agencies. The simplest form of a design storm is a triangular hyetograph where the base is the duration and the height is adjusted so that the area under the curve equals the total precipitation. In instances where the hyetograph is to be used to estimate sequences of shorter duration intensities. Conversion of Precipitation to Runoff Dynamics of Watershed Flowpaths Precipitation falling on the land surface is subject to evaporative loss to the atmosphere by vegetation canopy and leaf litter interception, evaporation directly from standing water on the surface and upper soil layers or impervious surfaces, and later transpiration through root uptake by vascular plants. Snowpack is also subject to sublimation (conversion of snow or ice directly to vapor), which results in the loss of a portion of the snow prior to melt. The rate of evaporative loss depends on local weather conditions (temperature, humidity, wind speed, solar radiation) and the rate and duration of precipitation. Precipitation (or snowmelt) in excess of interception and potential evaporative loss rates is then partitioned into infiltration and direct runoff. Residence times generally increase from surface to subsurface flowpaths, with rapid surface flow 1 the term runoff is often used in two senses. In an area of 100 percent imperviousness, the runoff nearly equals the rainfall (especially for larger storms). Over greater time and space scales, surface water runoff refers to streamflow passing through the outlet of a catchment, including base flow from groundwater that has entered the stream channel. The raw units of runoff in either case are volume per time, but the volumetric flowrate (discharge) is often divided by contributing area to express runoff in units of depth per time. In this way, unit runoff rates from various-sized watersheds can be compared to account for differences other than the contributing area. Watershed characteristics that influence the relative dominance of surface versus subsurface flowpaths include infiltration capacity as affected by land cover, soil properties, and macropores; subsurface structure or soil horizons with varying conductivity; antecedent soil moisture and groundwater levels; and the precipitation duration and intensity for a particular storm. The distribution and activity of flowpaths result in changing patterns of soil moisture and groundwater depth, which result in patterns of soil properties, vegetation, and microbial communities. These ecosystem patterns, in turn, can have strong influences on the hydraulics of flow and biogeochemical transformations within the flowpaths, with important implications for sources, sinks, and transport of solutes and sediment in the watershed. Riparian areas, wetlands, and the benthos of streams and waterbodies are nodes of interaction between surface and groundwater flowpaths, yielding reactive environments in which "hot spots" of biogeochemical transformation develop (McClain et al. Thus, any alteration of surface and subsurface hydrologic flowpaths, for example due to urbanization, not only alters the properties of soil and vegetation canopy but also reforms the ecosystem distribution of biogeochemical transformations. Runoff Measurements Surface water runoff for a given area is measured by dividing the discharge at a given point in the stream channel by the contributing watershed area. The basic variables describing channel hydraulics include width, mean depth, slope, roughness, and velocity. Channel discharge is the product of width, depth, and velocity and is typically estimated by either directly measuring each of these three components, or by development of a rating curve of measured discharge as a function of water depth, or stage relative to a datum, of the channel that is more easily estimated by a staff gauge or pressure transducer. The establishment of a gauging station to measure discharge typically requires a stable cross section so that stage can be uniquely related to discharge. Maintenance of reliable, long-term gauge sites is expensive and requires periodic remeasurement to update rating curves, as well as to remove temporary obstructions that may raise stage relative to unobstructed conditions. A major concern is the overall decline in the number of active gauges, particularly long-term gauges, as well as the representativeness of the stream gauge network relative to the needs of stormwater permitting. For example, restored streams typically lack any gauged streamflow or water quality information prior to or following restoration. This makes it very difficult to assess both the potential for successful restoration and whether project goals are met. Support of existing and development of new gauges is often in collaboration through a co-funding mechanism with other agencies. While this is beginning to change with municipal co-funding, headwater streams are still underrepresented in the National Water Information System relative to their ecological significance. Reliable records for stream discharge are vital because the frequency distribution and temporal trends of flows must be known to evaluate long-term loading to waterbodies. Magnitude and frequency analysis of sediment and other stream constituent loads consists of a transport equation as a function of discharge, integrated over the discharge frequency distribution. Different constituent loads have different forms of dependency on discharge, but are often nonlinear such that long-term or expected loads cannot be simply evaluated from mean flow conditions.

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Cross Reference Torticollis - 208 - Levitation L Lateropulsion Lateropulsion or ipsipulsion is literally pulling to one side. The term may be used to describe ipsilateral axial lateropulsion after cerebellar infarcts preventing patients from standing upright causing them to lean towards the opposite side. Lateral medullary syndrome may be associated with lateropulsion of the eye towards the involved medulla, and there may also be lateropulsion of saccadic eye movements. This spinal reflex manifests as flexion of the arms at the elbow, adduction of the shoulders, lifting of the arms, dystonic posturing of the hands, and crossing of the hands. Causes include retinoblastoma, retinal detachment, toxocara infection, congenital cataract, and benign retinal hypopigmentation. It is most often seen in corticobasal (ganglionic) degeneration, but a few cases with pathologically confirmed progressive supranuclear palsy have been reported. Although most commonly encountered (and originally described) in multiple sclerosis, it is not pathognomonic of demyelination and has been described with other local pathologies such as: subacute combined degeneration of the cord (vitamin B12 deficiency); nitrous oxide (N2 O) exposure; traumatic or compressive cervical myelopathy. Pathophysiologically, this movement-induced symptom may reflect the exquisite mechanosensitivity of axons which are demyelinated or damaged in some other way. Les douleurs а type de dйcharge electrique consйcutives а la flexion cйphalique dans la sclйrose en plaques: un case de forme sensitive de la sclйrose multiple. Conduction properties of central demyelinated axons: the generation of symptoms in demyelinating disease. The neurobiology of disease: contributions from neuroscience to clinical neurology. Ectropion may also be seen with lower lid tumour or chalazion, trauma with scarring, and ageing. Holmes­Adie pupil: dilated pupil showing strong but slow reaction to accommodation but minimal reaction to light (tonic > phasic). The most common cause of the locked-in syndrome is basilar artery thrombosis causing ventral pontine infarction (both pathological laughter and pathological crying have on occasion been reported to herald this event). Bilateral ventral midbrain and internal capsule infarcts can produce a similar picture. The locked-in syndrome may be mistaken for abulia, akinetic mutism, coma, and catatonia. The locked-in syndrome: what is it like to be conscious but paralyzed and voiceless? Cross References Echolalia; Festination, Festinant gait; Palilalia; Perseveration Logopenia Logopenia is a reduced rate of language production, due especially to wordfinding pauses, but with relatively preserved phrase length and syntactically complete language, seen in aphasic syndromes, such as primary non-fluent aphasia. Cross Reference Aphasia Logorrhoea Logorrhoea is literally a flow of speech, or pressure of speech, denoting an excessive verbal output, an abnormal number of words produced during each utterance. The term may be used for the output in the Wernicke/posterior/sensory type of aphasia or for an output which superficially resembles Wernicke aphasia but in which syntax and morphology are intact, rhythm and articulation are usually normal, and paraphasias and neologisms are few. Moreover, comprehension is better than anticipated in the Wernicke type of aphasia. Patients may be unaware of their impaired output (anosognosia) due to a failure of self-monitoring. Logorrhoea may be observed in subcortical (thalamic) aphasia, usually following recovery from lesions (usually haemorrhage) to the anterolateral nuclei. Similar speech output may be observed in psychiatric disorders such as mania and schizophrenia (schizophasia). It is often possible to draw a clinical distinction between motor symptoms resulting from lower or upper motor neurone pathology and hence to formulate a differential diagnosis and direct investigations accordingly. It may be seen in cerebellar disease, possibly as a reflection of the kinetic tremor and/or the impaired checking response seen therein (cf. Brief report: macrographia in high-functioning adults with autism spectrum disorder. This may occur because anastomoses between the middle and posterior cerebral arteries maintain that part of area 17 necessary for central vision after occlusion of the posterior cerebral artery. Cortical blindness due to bilateral (sequential or simultaneous) posterior cerebral artery occlusion may leave a small central field around the fixation point intact, also known as macula sparing. Macula splitting, a homonymous hemianopia which cuts through the vertical meridian of the macula, occurs with lesions of the optic radiation. Hence, macula sparing and macula splitting have localizing value when assessing homonymous hemianopia. Common causes include Diabetes mellitus: oedema and hard exudates at the macula are a common cause of visual impairment, especially in non-insulin-dependent diabetes mellitus.

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There is a perception that these devices promote mosquitoes, but that has not been found to be a problem when a healthy biological habitat is created (Greenway et al. These so-called irreducible effluent concentrations have been documented mainly for ponds and stormwater wetlands, as well as sand filters and grass channels (Schueler, 1998). Maintenance requirements for extended detention basins and wetlands include the removal of built-up sediment from the sediment forebay, harvesting of grasses to remove accumulated nutrients, and repair of berms and structures after storm events. While the basic hydrologic function of extended detention devices is well known, their performance on a watershed basis is not. Because they do not significantly reduce runoff volume and are designed on a site-by-site basis using synthetic storm patterns, their exclusive use as a flood reduction strategy at the watershed scale is uncertain (McCuen, 1979; Traver and Chadderton, 1992). Pollutant removal is effected by climate, shortcircuiting, and by the schedule of sediment removal and plant harvesting. Extreme events can resuspend captured sediments, thus reintroducing them into the environment. Although there is debate, it seems likely that plants will need to be harvested to accomplish nutrient removal (Reed et al. Designed for smaller storms, these are usually based on filtration, hydrodynamic separation, or small-scale bioretention systems that drain to a subsequent receiving water or other device. They can be very effective as pretreatment devices when used "higher up" in the watershed than infiltration structures. They are also one of the few urban retrofits available, due to the ability to implement them within traditional culvert systems. Figures 5-45 and 5-46 show designs for the Austin sand filter and the Delaware sand filter. Filters use sand, peat, or compost to remove particulates, similar to the processes used in drinking water plants. Biological material such as peat or compost provides adsorption of contaminants such as dissolved metals, hydrocarbons, and other organic chemicals. Hydrodynamic devices use rotational forces to separate the solids from the flow, allowing the solids to settle out of the flow stream. There is a recent class of bioretention-like manufactured devices that combine inlets with planters. In these systems, small volumes are directed to a soil planter area, with larger flows bypassing and continuing down the storm sewer system. Also all units have a maximum volume or rate of flow they can treat, such that higher flows are bypassed with no treatment. For filters, there is a wealth of experience from the water treatment community on their operations. For all manufactured devices there are several testing protocols that have been set up to validate the performance of the manufactured devices (the sufficiency of which is discussed in Box 5-9). Time is saved by the ability of the manufactures to quickly select a model matching the needs of the site. A city can minimize the cost of buying the product by requiring the different manufacturers to submit bids for the site. All the benefits of the service will have no meaning, however, if the cities cannot trust the performance claims of the different products. Money could be wasted on products that might have the lowest bid, but do not achieve the water quality goals of the city or state. Without a national testing program some states have taken a more regional approach to verifying the performance of proprietary practices, while most states do not have any type of verification or approval program. The State of Wisconsin has prepared a draft technical standard (1006) describing methods for predicting the sitespecific reduction efficiency of proprietary sedimentation devices. To meet the criteria in the standard the manufacturers can either use a model to predict the performance of the practice or complete a laboratory protocol designed to develop efficiency curves for each product. A new national testing program could reduce the cost by using laboratory testing instead of field testing. Each manufacturer would only have to do one series of tests in the lab and the results would be applicable to the entire country. The laboratory protocol in the Wisconsin Technical Standard 1006 provides a good example of what should be included to evaluate each practice over a range of particle sizes and flows.


  • https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/125377s073lbl.pdf
  • https://www.fasnj.com/docs/Nomir%20OM%20Results%20in%20JAPMA_in%20press.pdf
  • http://webcir.org/revistavirtual/articulos/2017/1_febrero/esp/rx_abdomen_eng.pdf
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