University of Pittsburgh at Bradford

This case involves a homemaker 43 years of age who is addicted to using the Internet. This case was selected as it demonstrates that a nontechnologically oriented woman with a reportedly content home life and no prior addiction or psychiatric history abused the Internet which resulted in significant impairment to her family life. This paper defines addictive use of the Internet, outlines the subject's progression of addictive on-line use, and discusses the implications of such addictive behavior on the new market of Internet consumers.

Research over the last decade has identified Internet addiction as a new and often unrecognized clinical disorder that impact a user's ability to control online use to the extent that it can cause relational, occupational, and social problems. While much of the literature explores the psychological and social factors underlying Internet addiction, little if any empirical evidence exists that examines specific treatment outcomes to deal with this new client population. Researchers have suggested using cognitive behavioral therapy (CBT) as the treatment of choice for Internet addiction, and addiction recovery in general has utilized CBT as part of treatment planning. To investigate the efficacy of using CBT with Internet addicts, this study investigated 114 clients who suffered from Internet addiction and received CBT at the Center for Online Addiction. This study employed a survey research design, and outcome variables such as client motivation, online time management, improved social relationships, improved sexual functioning, engagement in offline activities, and ability to abstain from problematic applications were evaluated on the 3rd, 8th, and 12th sessions and over a 6-month follow-up. Results suggested that Caucasian, middle-aged males with at least a 4-year degree were most likely to suffer from some form of Internet addiction. Preliminary analyses indicated that most clients were able to manage their presenting complaints by the eighth session, and symptom management was sustained upon a 6-month follow-up. As the field of Internet addiction continues to grow, such outcome data will be useful in treatment planning with evidenced-based protocols unique to this emergent client population.

This paper investigates the relationship between intellectual capital disclosure and corporate governance variables, controlling for other firm‐specific characteristics, for a sample of 100 UK listed firms. Intellectual capital disclosure is measured by a disclosure index score, supported by word count and percentage of word count metrics to assess the variety, volume and focus of intellectual capital disclosure respectively. The independent variables comprise various forms of corporate governance structure: board composition, ownership structure, audit committee size and frequency of audit committee meetings, and CEO role duality. Results of the analysis based on the three measures of intellectual capital disclosure indicate significant association with all the governance factors except for role duality. The influence of corporate governance mechanisms on human, structural and relational capital disclosure, based on all three metrics, is also explored.

, where X is Cl, Br or I) and bismuth chalcogenides, including bismuth oxide, bismuth sulfide, bismuth selenide, and bismuth telluride, have been heavily investigated for therapeutic purposes. The pharmacokinetics of these BiNPs can be easily improved via the facile modification of their surfaces with biocompatible polymers and proteins, resulting in enhanced colloidal stability, extended blood circulation, and reduced toxicity. Desirable antibacterial effects, bone regeneration potential, and tumor growth suppression under NIR laser radiation are the main biomedical research areas involving BiNPs that have opened up a new paradigm for their future clinical translation. This review emphasizes the synthesis and state-of-the-art progress related to the biomedical applications of BiNPs with different structures, sizes, and compositions. Furthermore, a comprehensive discussion focusing on challenges and future opportunities is presented.

The value of parental participation is widely accepted, but participation is difficult to promote and maintain. Schools are becoming more diverse, and a great challenge facing educators is meeting the needs of all students. Closing the achievement gap and increasing student learning requires the collaboration of various interested groups, most notably parents. Families play an important role in creating a school that meets their child's needs, yet teachers admit they have little information or training on how to effectively work with diverse parents. In this article, numerous strategies for addressing barriers to school involvement and participation are presented. Methods for using families' cultures and experiences are also explored as a base for new learning and understanding.

Abstract Sugarcane is among the principal agricultural crops cultivated in tropical countries. The annual world production of sugarcane is ∼1.6 billion tons, and it generates ∼279 million metric tons (MMT) of biomass residues (bagasse and leaves). Sugarcane residues, particularly sugarcane bagasse (SB) and leaves (SL) have been explored for both biotechnological and non‐biotechnological applications. For the last three decades, SB and SL have been explored for use in lignocellulosic bioconversion, which offers opportunities for the economic utilization of residual substrates in the production of bioethanol and value‐added commercial products such as xylitol, specialty enzymes, organic acids, single‐cell protein, etc. However, there are still major technological and economic challenges to be addressed in the development of bio‐based commercial processes utilizing SB and SL as raw substrates. This article aims to explore SB and SL as cheaper sources of carbohydrates in the developing world for their industrial implications, their use in commercial products including commercial evaluation, and their potential to advance sustainable bio‐based fuel systems. Copyright © 2011 Society of Chemical Industry

A survey of real-time systems and the programming languages used in their development. Shows how modern real-time programming techniques are used in a wide variety of applications, including robotics, factory automation, and control. A critical requirement for such systems is that the software must

STUDY DESIGN: A retrospective study of patients with rigid coronal decompensation. OBJECTIVES: To determine if patients with rigid coronal decompensation can be safely and successfully treated by anterior-posterior vertebral column resection, spinal shortening, posterior instrumentation, and fusion to correct their deformities. SUMMARY OF BACKGROUND DATA: Previous investigators have described reconstructive techniques used to treat patients with sagittal and coronal spine deformities. These techniques include osteotomy and anterior or posterior fusion. Although a number of these studies consider the problems associated with failed back syndrome (flatback, coronal and axial imbalance, pseudarthrosis), they have not satisfactorily addressed the management of rigid coronal decompensation. The patient population of the current study, on average, presented with more severe, fixed deformities than those detailed in the literature, and required more extensive surgery than previously described. METHODS: Twenty-four patients (average age, 27 years) with rigid coronal decompensation underwent anterior-posterior vertebral column resection, spinal shortening, posterior instrumentation, and fusion. Degree of curvature was measured in the coronal and sagittal planes, and decompensation was assessed. Follow-up was from 2 to 10 years. RESULTS: Coronal and sagittal decompensation were corrected an average of 82% and 87%, respectively; T1 tilt and pelvic obliquity were improved by 65% and 53%, respectively; and scoliosis was improved by 52%. Complications occurred in 14 patients, but at follow-up all patients rated their results as either good or excellent. CONCLUSIONS: Patients with fixed, decompensated spinal deformity may be safely corrected by vertebrectomy, decancellation, spinal shortening, instrumentation, and fusion. Complications are transient, and the benefits in this select group of patients outweigh the risks.

Throughout this article, the reader will notice combinations of superscripted letters and numbers (eg, "Family Presence During Resuscitation Peds-003 "). These callouts are hyperlinked to evidence-based worksheets, which were used in the development of this article. An appendix of worksheets, applicable to this article, is located at the end of the text. The worksheets are available in PDF format and are open access.

BACKGROUND: Emergency laparotomies in the U.K., U.S.A. and Denmark are known to have a high risk of death, with accompanying evidence of suboptimal care. The emergency laparotomy pathway quality improvement care (ELPQuiC) bundle is an evidence-based care bundle for patients undergoing emergency laparotomy, consisting of: initial assessment with early warning scores, early antibiotics, interval between decision and operation less than 6 h, goal-directed fluid therapy and postoperative intensive care. METHODS: The ELPQuiC bundle was implemented in four hospitals, using locally identified strategies to assess the impact on risk-adjusted mortality. Comparison of case mix-adjusted 30-day mortality rates before and after care-bundle implementation was made using risk-adjusted cumulative sum (CUSUM) plots and a logistic regression model. RESULTS: Risk-adjusted CUSUM plots showed an increase in the numbers of lives saved per 100 patients treated in all hospitals, from 6.47 in the baseline interval (299 patients included) to 12.44 after implementation (427 patients included) (P < 0.001). The overall case mix-adjusted risk of death decreased from 15.6 to 9.6 per cent (risk ratio 0.614, 95 per cent c.i. 0.451 to 0.836; P = 0.002). There was an increase in the uptake of the ELPQuiC processes but no significant difference in the patient case-mix profile as determined by the mean Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity risk (0.197 and 0.223 before and after implementation respectively; P = 0.395). CONCLUSION: Use of the ELPQuiC bundle was associated with a significant reduction in the risk of death following emergency laparotomy.

STUDY DESIGN: The clinical records, radiographs, histologic sections, and operative reports of 52 consecutive patients with an aneurysmal bone cyst of the spine were reviewed to evaluate diagnostic and therapeutic options and to correlate treatment and outcome. OBJECTIVES: To define the incidence, clinical presentation, diagnostic and therapeutic options, and prognosis of patients with aneurysmal bone cyst of the spine. SUMMARY OF BACKGROUND DATA: There are special considerations in the management of spinal lesions: relative inaccessibility of the lesions, associated intraoperative bleeding, necessity of removing the entire lesion to avoid the possibility of recurrence, proximity of the lesion to the spinal cord and nerve roots, and potential postoperative bony spinal instability. METHODS: Fifty-two consecutive patients with an aneurysmal bone cyst of the spine were treated from 1910 to 1993. Forty patients initially treated for a primary lesion had operative treatment (19 intralesional excision and bone grafting and 21 intralesional excision); four also had adjuvant radiation therapy. Preoperative arterial embolization was performed in two. RESULTS: There was a recurrence rate of 10% within 10 years. All recurrences were noted less than 6 months after surgery. Of 12 patients treated for a recurrent lesion, two had a subsequent recurrence (16.7%) within 9 years. At last follow-up examination, 50 patients (96%) were free of the disease. One patient died of postradiation osteosarcoma, and one died of intraoperative bleeding. CONCLUSION: Current treatment recommendations involve preoperative selective arterial embolization, intralesional excision curettage, bone grafting, and fusion of the affected area if instability is present.

Several unmet needs have been identified in allergic rhinitis: identification of the time of onset of the pollen season, optimal control of rhinitis and comorbidities, patient stratification, multidisciplinary team for integrated care pathways, innovation in clinical trials and, above all, patient empowerment. MASK-rhinitis (MACVIA-ARIA Sentinel NetworK for allergic rhinitis) is a simple system centred around the patient which was devised to fill many of these gaps using Information and Communications Technology (ICT) tools and a clinical decision support system (CDSS) based on the most widely used guideline in allergic rhinitis and its asthma comorbidity (ARIA 2015 revision). It is one of the implementation systems of Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA). Three tools are used for the electronic monitoring of allergic diseases: a cell phone-based daily visual analogue scale (VAS) assessment of disease control, CARAT (Control of Allergic Rhinitis and Asthma Test) and e-Allergy screening (premedical system of early diagnosis of allergy and asthma based on online tools). These tools are combined with a clinical decision support system (CDSS) and are available in many languages. An e-CRF and an e-learning tool complete MASK. MASK is flexible and other tools can be added. It appears to be an advanced, global and integrated ICT answer for many unmet needs in allergic diseases which will improve policies and standards.

Opioid use disorders are a significant public health problem, affecting two million people in the United States. Treatment with buprenorphine, methadone, or both is predominantly offered in methadone clinics, yet many people do not receive the treatment they need. In 2002 the Food and Drug Administration approved buprenorphine for prescription by physicians who completed a course and received a waiver from the Drug Enforcement Administration, exempting them from requirements in the Controlled Substances Act. To determine the waiver program's impact on the availability of opioid agonist treatment, we analyzed data for the period 2002-11 to identify counties with opioid treatment shortages. We found that the percentage of counties with a shortage of waivered physicians fell sharply, from 98.9 percent in 2002 to 46.8 percent in 2011. As a result, the percentage of the US population residing in what we classified as opioid treatment shortage counties declined from 48.6 percent in 2002 to 10.4 percent in 2011. These findings suggest that the increase in waivered physicians has dramatically increased potential access to opioid agonist treatment. Policy makers should focus their efforts on further increasing the number and geographical distribution of physicians, particularly in more rural counties, where prescription opioid misuse is rapidly growing.

Mature Hereford cows (766) were mated to 97 sires from seven breeds (Jersey, Wagyu, Angus, Hereford, South Devon, Limousin, and Belgian Blue), resulting in 1,215 calves born over 4 yr (1994 to 1997). These cattle comprised Australia's 'Southern Crossbreeding Project." Heifers were slaughtered at an average of 16 mo with hot standard carcass weight of 219 kg and 9 mm fat over the rump. Steers were slaughtered at an average of 23 mo with carcass weight of 319 kg and 13 mm fat over the rump. Meat and fat samples were taken from the carcass on the day after slaughter for subsequent laboratory analysis of i.m. fat content and fatty acid composition. Data were analyzed using uni- and bivariate animal models containing fixed effects of cohort, management group, birth month, and sire breed. March-born calves had fat with a 0.5 degrees C lower melting point, 0.6% higher total monounsaturated fatty acids, and 0.7% higher fatty acid desaturation index than calves born in April. Steers born in 1997 were the only cohort finished on pasture, and they had much more yellow fat than the other cohorts. Four heavy breed crosses (Angus, South Devon, Limousin, and Belgian Blue) averaged 284 kg carcass weight, followed by purebred Hereford (268 kg), Wagyu (244 kg) and Jersey (236 kg). Angus had the greatest fat depth (14.3 mm), ahead of Hereford and Wagyu (11.9 mm), Jersey (10.7 mm), South Devon and Limousin (9.9 mm) and Belgian Blue (8.0 mm). Jersey, Wagyu, and Angus had themost i.m. fat (4.6%), followed by Hereford and South Devon (3.8%), and Limousin and Belgian Blue (3.1%). The highly marbled Jersey and Wagyu had softer fat (6% lower fat melting point) than the other breeds. Angus were more highly marbled, similar to Jersey and Wagyu, but had harder fat similar to the leaner breeds. Heritabilities for all traits were low to moderate (16 to 36%). Genetic correlations between fatty add composition and carcass traits were not significant, indicating little evidence of antagonisms between traits that would prevent genetic progress in both production and quality.

This study examined the world of Internet dating. It explored the motivations of daters, their styles of courtship, and how they negotiated problems of trust and deception. The authors employed in-depth interviews and participant observation with men and women who met online. Internet daters sought companionship, comfort after a life crisis, control over presentation of themselves and their environments, freedom from commitment and stereotypic roles, adventure, and romantic fantasy. The authors also studied the development of trust between daters, the risks they assume, and lying online. Most participants in the study eventually met, which sometimes resulted in abrupt rejection and loss of face, but other times ended in marriage.

Category management has been promoted as a mechanism to achieve closer working relations between suppliers and retailers. The premise has been that category management should result in a reduced reliance on the use of power as an element of the relationship and increased levels of cooperation. However, power is an element of any relationship and exists even when not activated. Further, the premise rests on the notion that cooperation is a polar opposite of power. This research confirms that food industry managers perceive the use of power in solely negative terms. Power can be defined operationally as the ability of one channel member to influence the marketing decisions of another channel member and hence must be related to cooperation. This paper reviews the nature of dependence, power and cooperation and explores the role of these constructs in the practice of category management. The results of continuing research in the area of category management relationships are reported.

The Delphi survey technique has merit in both qualitative and quantitative research, but fewer researchers are using it. This article reviews the Delphi technique and its use in nursing, medical and allied health literature between 1981 and 1998. The strengths and weaknesses of the technique are discussed.

We performed whole-genome sequencing on 170 clinical carbapenemase-producing Enterobacter spp. isolates collected globally during 2008-2014. The most common carbapenemase was VIM, followed by New Delhi metallo-β-lactamase (NDM), Klebsiella pneumoniae carbapenemase, oxacillin 48, and IMP. The isolates were of predominantly 2 species (E. xiangfangensis and E. hormaechei subsp. steigerwaltii) and 4 global clones (sequence type [ST] 114, ST93, ST90, and ST78) with different clades within ST114 and ST90. Particular genetic structures surrounding carbapenemase genes were circulating locally in various institutions within the same or between different STs in Greece, Guatemala, Italy, Spain, Serbia, and Vietnam. We found a common NDM genetic structure (NDM-GE-U.S.), previously described on pNDM-U.S. from Klebsiella pneumoniae ATCC BAA-214, in 14 different clones obtained from 6 countries spanning 4 continents. Our study highlights the importance of surveillance programs using whole-genome sequencing in providing insight into the molecular epidemiology of carbapenemase-producing Enterobacter spp.

Radionuclides in the environment are a major human and environmental health concern. Like the Chernobyl disaster of 1986, the Fukushima Daiichi nuclear disaster in 2011 is once again causing damage to the environment: a large quantity of radioactive waste is being generated and dumped into the environment, and if the general population is exposed to it, may cause serious life-threatening disorders. Bioremediation has been viewed as the ecologically responsible alternative to environmentally destructive physical remediation. Microorganisms carry endogenous genetic, biochemical and physiological properties that make them ideal agents for pollutant remediation in soil and groundwater. Attempts have been made to develop native or genetically engineered (GE) microbes for the remediation of environmental contaminants including radionuclides. Microorganism-mediated bioremediation can affect the solubility, bioavailability and mobility of radionuclides. Therefore, we aim to unveil the microbial-mediated mechanisms for biotransformation of radionuclides under various environmental conditions as developing strategies for waste management of radionuclides. A discussion follows of '-omics'-integrated genomics and proteomics technologies, which can be used to trace the genes and proteins of interest in a given microorganism towards a cell-free bioremediation strategy.

Epinephrine overdosage in intact rabbits caused significant modifications in plasma lipid distribution and transport, and phospholipid metabolism of plasma, liver and aorta. Aortic phospholipid synthesis was accelerated shortly after epinephrine injection and persisted for 24 hours, but plasma and liver turnover rates were maximally elevated after 48 hours. Changes in plasma neutral fat concentration were paralleled by alterations in the levels of S f 12-400 lipoproteins and a relationship between S f 0-12 and plasma cholesterol levels is suggested by the data.