Because the Pexidartinib supplier heat transfer occurs essentially by conduction and convection, conventional thermal technologies are not homogeneous, causing the product in direct contact with the hot surfaces to overheat. Therefore, the preservation of the quality and the nutritional parameters of heat-treated fruit represents a major challenge for the traditional processing techniques for fruit pulp and other products. Innovative technologies have been widely research as alternatives to traditional thermal processing.

Among these technologies are high pressure processing (Rawson, Brunton, & Tuohy, 2012; Verbeyst, Crombruggen, Van der Plancken, Hendrickx, & Van Loey, 2011), pulsed electric fields (Charles-Rodríguez, Nevárez-Moorillón, Zhang, & Ortega-Rivas, 2007; Plaza et al., 2011) and ohmic heating. Ohmic heating (OH) appear as

a solution to reduce thermal damage because it heats materials in a rapid and homogeneous manner. This technique may allow improved retention of vitamins, pigments and nutrients because this type of heating is rapid and uniform, resulting in less thermal damage to labile substances (Castro, Teixeira, Salengke, Sastry, & Vicente, 2003, 2004; Eliot-Godéreaux, Zuber, & Goullieux, 2001; Ruan, Ye, Chen, Doona, & Taub, 2002; Sarang, Sastry, & Knipe, 2008). Ohmic heating, also known as electroconductive heating, can be defined as a process in which foods selleck inhibitor are heated by passing alternating electrical current (AC) through them. Most food products contain ionic constituents, such as salts and acids, that enable the conduction of electrical current (Palaniappan & Sastry, 1991). This process can be used to generate heat within the product, transforming electrical energy into thermal energy and

thus heating materials at exceptionally rapid rates without the need for a heating medium or surface (Sastry & Barach, 2000). Among ohmic heating applications in the food industry are blanching, evaporation, dehydration, pasteurization and extraction (FDA, 2000). The aim of this study was to analyze the effect of ohmic heating on blueberry pulp anthocyanins Florfenicol by applying a rotatable central composite design to identify the optimal processing conditions. A two-variable full factorial central composite and star design was employed to evaluate the influence of the applied voltage and the solids content (SC) on the level of anthocyanin degradation. Finally, the ohmic heating process was compared with conventional heating. Southern Brazil cultivars of highbush blueberries (Vaccinium corymbosum) were used in these experiments. The samples were purchased from Italbraz Company (Vacaria, Brazil) and kept at −18 °C until analysis. The blueberry pulp used in this study was prepared by grinding the fruits and diluting the resulting material to adjust the total solids content to five different values between 4 and 16 g/100 g. To prevent precipitation, 1 g/100 g xanthan gum (Hexus Foods, Portão, Brazil) was added to the mixture.

At the microscopic (matrix) scale, oim bone is mostly composed

of woven tissue [20] with unorganized collagen fibers, a high mineral/protein content ratio [21] and [22] and a high porosity [23]. This results in a low bone mineral density (content) measured by DXA on the whole bone level [24]. At the collagen/apatite scale (ultrastructure with nm length scale), oim bone apatite crystals are small and not well aligned [25] and [26] and their crystallinity and chemical composition is altered [21] and [22]. Numerous studies have examined the macroscopic mechanical properties of oim bone [15], [16], [18] and [19], the microscopic matrix mineral content [14], [21], [22] and [24], this website or the ultra-structure  [25]. Only Grabner et al. investigated both mechanics and mineralization at the microscopic scale [26]. The mechanical measures were however limited to measures of the Vicker’s micro-hardness, which provides no information on the bone matrix elastic properties. No previous study has examined the multi-scale changes in mineral structure, PD0325901 density, and elastic modulus in oim bone in order to explain how changes at the molecular level are translated into altered mechanical behavior at larger length scales. The objective of this study was to determine the multi-scale material properties in oim

bone, and in particular correlations between local tissue mineralization and elastic modulus at the microscopic (μm) scale. We used 3-point bending to estimate whole bone elastic modulus, quantitative backscattered electron microscopy Interleukin-2 receptor (qBSEM) to quantify the amount of bone matrix mineral, nanoindentation to measure the bone matrix elastic and plastic properties, and transmission electron microscopy (TEM) to examine the apatite crystals size and organization. We propose a mechanistic interpretation linking the mechanical and structural properties observed at the matrix scale into a common composite material framework. With an understanding of how structural changes influence mechanical behavior, appropriate pharmaceutical

therapies might be targeted to address particular critical deficiencies in bone. Wild type B6C3Fe-a/a-+/+ mice (WT, 8♀, 7♂) and pathologic B6C3Fe-a/a-Col1a2Oim/Oim mice (oim, 8♀, 12♂) were culled at 8 weeks-old and long bones were collected, cleaned of soft tissues and stored in gauze soaked with a phosphate buffered saline solution at − 18 °C. For each specimen, the right femurs were tested until fracture by 3-point bending using a standard materials testing machine (5866 Instron). The femurs were loaded at the mid-diaphysis in the anterior–posterior direction with a deflection rate of 50 m/s. Force–deflection curves were analyzed with a custom program (Matlab, MathWorks) to measure the bending stiffness (S, N.mm) and ultimate force (Fult, N).

Considering this, it is relevant to study which hypothalamic

magnocellular nucleus mediates the cardiovascular Ribociclib response evoked by carbachol microinjection into the BST. Taking that into consideration, we evaluated the hypothesis that PVN and/or SON neurons are part of the neural pathway related to cardiovascular responses following carbachol microinjection into the BST of unanesthetized rats. For this, we investigated cardiovascular responses evoked by carbachol microinjection into the BST before and after PVN or SON pretreatment, either ipsilateral or contralateral in relation to BST microinjection site, with the nonselective neurotransmission blocker cobalt chloride (CoCl2). Microinjection of aCSF into the BST (n = 5) did not affect either MAP (99 ± 2 vs. 98 ± 3 mm Hg, t = 0.2, P > 0.05) or HR (379 ± 11 vs. 352 ± 9 bpm, t = 1.3, P > 0.05) baseline values. However, microinjection of carbachol into the BST caused significant pressor and bradycardiac responses in unanesthetized rats ( Fig. 1). Photomicrography of a coronal brain section showing a representative microinjection site into the BST is presented in Fig. 2. Diagrammatic representation of the BST indicating microinjection sites into the BST of all animals used in the present

study is also shown in Fig. 2. Microinjection of carbachol (n = 6) FK228 solubility dmso into the BST significantly increased plasma vasopressin content (aCSF: 2.3 ± 0.5 pg/mL vs. carbachol: 21.3 ± 3.6 pg/mL, t = 5, P < 0.005), when compared to the control group that received vehicle (aCSF) injection into the BST (n = 6). Microinjection of aCSF into the ipsilateral SON (n = 7) did not affect either MAP (98 ± 2 vs. 101 ± 3 mm Hg, t = 0.5, P > 0.05) or HR

(352 ± 7 vs. 367 ± 11 bpm, t = 1.5, P > 0.05) baseline values. Pretreatment of the ipsilateral SON with aCSF also did not affect the pressor (43 ± 2 vs. 38 ± 2 mm Hg, t = 2.3, P > 0.05) and bradycardiac (− 67 ± 7 vs. − 64 ± 8 bpm, t = 0.2, P > 0.05) response to carbachol microinjection into the BST ( Fig. 1A). Microinjection of CoCl2 into the ipsilateral SON (n = 7) did not affect either MAP (102 ± 2 vs. 100 ± 2 mm Hg, t = 0.6, P > 0.05) or HR (351 ± 6 vs. 356 ± 8 bpm, t = 0.7, P > 0.05) baseline values. However, ipsilateral SON pretreatment with CoCl2 significantly reduced the pressor (44 ± 2 vs. 6 ± 1 mm Hg, t = 16, P < 0.0001) and bradycardiac (− 74 ± 6 vs. − 12 ± 1 bpm, C1GALT1 t = 10, P < 0.0001) response to carbachol microinjection into the BST ( Fig. 1A). Time-course analysis indicated a significant effect of SON pretreatment with CoCl2 in carbachol cardiovascular effects (ΔMAP: F(1,456) = 468, P < 0.0001 and ΔHR: F(1,456) = 111, P < 0.0001), a significant effect over time (ΔMAP: F(37,456) = 23, P < 0.0001 and ΔHR: F(37,456) = 11, P < 0.0001), and an interaction between treatment and time (ΔMAP: F(37,456) = 20, P < 0.0001 and ΔHR: F(37,456) = 4, P < 0.0001) ( Fig. 1B). Microinjection of aCSF into the contralateral SON (n = 6) did not affect either MAP (100 ± 3 vs.

3). Dynorphin1-13 (dyn A, YGGFLRRIRPKLK) was also hydrolyzed ISRIB mw by the crude venom of B. jararaca, showing at least two cleavage points (YGGFLR-RIRPK-LK), since the fragment RIRPK was detected by mass spectrometry analyses. Unlike angiotensin I, dyn A is hydrolyzed by both classes of proteases, metallo- and serine peptidases, so this activity was partially blocked by the commercial antibothropic serum. The pathophysiological mean of dyn A hydrolyzes is possibly correlated with pain sensation and inflammation ( Parikh et al., 2010 and Luo et al., 2008). Many factors,

including phylogeny, sex, geographic origin, season, age and prey preference, Volasertib cost may influence composition of the venoms (Chippaux et al., 1991, Mackessy et al., 2003 and Furtado et al., 2006). In addition to these considerations, the genus Bothrops shows the greatest diversity when it comes to number of species, morphology and natural history characteristics ( Campbell and Lamar, 2004). Given these characteristics, the development of a polyvalent antivenom against accidents involving this genus is an even greater challenge. Thus, the production

of better antivenoms should take into consideration the quality of poisons, and what poisons should be used to compose the pool of immunization. Finally, the preclinical efficacy of the antivenom must be carefully evaluated. The inter specimen venom composition may be evidenced by the different levels of chymotrypsin-like activity and by the different potential check blockers obtained with the antibothropic serum and the five different Bothrops venoms studied in this paper. These venom composition variations may be an important factor to explain the failure of the antibothropic serum and, additionally, three other factors also may be responsible for the overall presented result. The first factor suggests a lack of immunoglobulins acting against serine peptidases present in some venoms and

the second factor may be related to the failure of blocking by the antibodies, although they may be present. The third and important factor may be related to degradation of the serine peptidases by the metallo peptidases before the inoculation of horses with the pool of venoms used for the production of antivenom, and this degradation could destroy the epitopes responsible for the production of immunoglobulins. These hypotheses are under investigation in our laboratories through new experiments, with the objective of developing strategies to obtain a more effective antibothropic serum. The antibothropic serum produced by the Butantan Institute is one of the best in Latin America to reduce mortality by snake poisoning from this genus.

W tym samym roku został uznany za specjalistę

pierwszego stopnia w zakresie chorób wewnętrznych. W latach 1951–1955 pracował w Klinice Chorób Nerwowych Pomorskiej Akademii Medycznej, gdzie uzyskał pierwszy stopień specjalizacji z neurologii pod kierunkiem prof. Neratinib molecular weight Władysława Jakimowicza. W dniu 1.10.1956 roku wraca do Warszawy, gdzie podejmuje pracę w Klinice Neurologicznej Akademii Medycznej. Tu uzyskuje 2. stopień specjalizacji z neurologii pod kierunkiem prof. Ireny Hausmanowej. W roku 1958 przenosi się do Kliniki Terapii Chorób Dzieci AM w Warszawie, kierowanej przez wybitnego pediatrę prof. Henryka Brokmana i poświęca się całkowicie neurologii dziecięcej. Tu uzyskuje specjalizację 1. stopnia z pediatrii i w roku 1964 habilituje Trametinib nmr się na podstawie dotychczasowego dorobku naukowego oraz rozprawy na temat zastosowania tuberkulinowego testu leukergicznego w różnicowaniu gruźliczego zapalenia opon mózgowo-rdzeniowych i mózgu z innymi neuroinfekcjami. Praca oparta była na badaniach dzieci chorych na gruźlice oraz badaniach eksperymentalnych na zwierzętach laboratoryjnych (królikach). W latach 1959 i 1969 docent Michałowicz

jako stypendysta WHO pogłębiał swoją wiedzę w klinikach neurologicznych we Wiedniu i Zurichu. Podczas pracy w klinice pediatrycznej opublikował wiele artykułów z pogranicza neurologii i pediatrii dotyczących wylewów i zakrzepów w naczyniach mózgowych w przebiegu biegunek toksycznych u niemowląt, objawów neurologicznych w przebiegu choroby Schoenleina i Henocha oraz u dzieci z wadami serca i u chorych na białaczkę. W dniu 1 lipca 1965 r., po odejściu

na emeryturę doc. Łukaszewicz-Dańcowej, obejmuje kierownictwo Kliniki Neurologii Dziecięcej w Instytucie Matki i Dziecka, które kontynuuje do roku 1977. Kieruje doświadczonym zespołem pracowników naukowo-badawczych i bierze czynny udział w pracach nad koordynacją i organizacją dziecięcego lecznictwa neurologicznego w Polsce, w owym czasie bowiem Instytut Matki i Dziecka pełni rolę nadzoru krajowego nad lecznictwem pediatrycznym. Liczba neurologów dziecięcych w Polsce była w tym okresie niewielka, w wielu województwach nie było ich Branched chain aminotransferase wcale. Opracowuje szereg wytycznych mających duże znaczenie dla postępowania z dziećmi z uszkodzonym ośrodkowym układem nerwowym, przede wszystkim z mózgowym porażeniem dziecięcym oraz padaczką. Jest założycielem i przewodniczącym Sekcji Neurologii Dziecięcej Polskiego Towarzystwa Pediatrycznego, która w roku 1973 przekształciła się w samodzielne Towarzystwo Neurologów Dziecięcych. W roku 1967 odbywa kilkumiesięczne szkolenie w klinikach neurologicznych w Kopenhadze (Dania), Sztokholmie i Upsali (Szwecja). W roku 1974 Rada Państwa nadaje mu tytuł naukowy profesora nadzwyczajnego. Jego dorobek naukowy w tym okresie obejmuje 102 pozycje piśmiennictwa, opublikowane w języku polskim, niemieckim, angielskim i rosyjskim.

A typical characterization of a real OFMSW can be observe in Table 1. The co-digestion of biological sludge and OFMSW has been considered by some authors without existing an agreement according to the optimum mixture, then a large range of ratios have

been considered in this study using weight percentages to get the desired mixtures. The concentration of each co-digestion has not being modified in order to study the problems derived of the TS concentration.Table 2 shows the four different co-digestion mixtures that were considered in this work. A full characterization of the substrates, co-digested mixtures and the inoculum used for the experiments are presented in Table 3 and Table 4. The characterization of the co-digestion mixtures was obtained from the theoretic mixture of the sole substrates OFMSW and biological sludge. The main characterization

of the inoculum and the co-substrates was accomplished following an internal method of the find more University of Valladolid (UVa) based on standard methods [3]. Total and volatile solids (TS, VS) and total chemical oxygen demand (CODt) were determined. To calculate the theoretical potential using several methodologies, an extended characterization EX 527 in vitro is necessary performed by external laboratories. Gravimetric techniques were used to determine grease content [15] and [12] and gross fiber (Weende Method), volumetric procedures [12] for carbohydrate content, and elemental analyses [31] for protein content and elemental composition. The BMP assays were performed following an internal method from the UVa based on standardized assays

for research purposes [1]. The substrate and the inoculum were placed in a glass bottle of 2 L capacity at mesophilic conditions following a substrate/inoculum ratio of 1/1 in terms of VS. Micronutrients and macronutrients were added in order to ensure the activity of the inoculum [17]. Mesophilic inoculum coming from a reactor fed with mixed sludge was used for all the assays and finally the bottles were closed and placed in a rotational stirrer which mixed the substrate and inoculum perfectly. Triplicates were carried out for these experiments including a blank, which indicated the Nintedanib (BIBF 1120) productivity of the inoculum, in order to obtain the production of the sole substrate, and a control with cellulose to verify the activity of the inoculum. Periodical monitoring analyses of biogas production and composition were performed during the assays using a pressure meter and gas chromatography. The BMP were finished when a dairy production of less than 1% of the whole production occurred as it is indicated in Eq. (1) where “n” represents the day of the experiment. equation(1) Production%=((Gross prod(ml)n−(Gross prod(ml)n−1)Gross prod(ml)n)×100 The results provided by the BMP assays were obtained from the triplicate average for each bottle and were expressed as the net volume of methane per g of VS added (mlCH4/gVSadded).

The relative abundance of unilocular forms was not taken to perform factor analysis find more because their ecological preferences are not well known. Q-mode factor

analysis was performed on a reduced data set of the 51 highest ranked species (Table 1) at this site using a commercially distributed statistical package (SPSS 9.0) to establish the correlation between benthic foraminiferal assemblages and environmental conditions. This method involves principal component analysis followed by VARIMAX rotation. The benthic foraminiferal quantitative data were used to calculate Hurlbert’s diversity index, Sm (Hurlbert 1971). Hurlbert’s diversity index is defined by the function equation(1) Sm=∑i=1S1−CN−Ni,m/CNm, where Sm is the expected number of species in a random sub-sample of size m (m ≥ N). In the present study m = 100, which is well below the lowest number of specimens counted per sample. N is the number of specimens in the sample and S is the number of species in which N specimens are distributed. Ni is learn more the number of individuals in

the i-th species, ∑Ni=N. C(N − Ni, m) = (N − Ni)!/[m!(N − Ni − m)!] and C(N, m) = N!/[m!(N − M)!] for (N − Ni) ≥ m and N ≥ m respectively, and zero for (N − Ni) < m and N < m respectively (Smith & Grassle 1977). The percentages of shallow infaunal and other infaunal taxa were calculated following Wells et al. (1994), and the percentages of oxic and suboxic taxa were calculated following Kaiho (1994). We also compared the faunal diversity with some faunal abundance data. Benthic foraminifera were grouped into percentages

of total cylindrical elongate taxa (predominantly stilostomellids) following Hayward (2002) and Smart et al. (2007). High productivity taxa are explained as the sum of various infaunal taxa, i.e. Bulimina spp., Melonis spp., Uvigerina spp., Ehrenbergina spp., Eggerella bradyi, Sphaeroidina bulloides and Pullenia bulloides following Gooday, 1994 and Gooday, 2003 and Loubere (1996). The nannofossil datum levels, like those selected by Siesser et al. (1992), were used to construct the age model for Site 762B. But the Isotretinoin numerical ages were reassigned according to the timescale of Berggren et al. (1995) and Lourens et al. (2004) (Figure 2). Our age model for this site is thus the same as that in Siesser et al. (1992) in their interpretation of the biomagnetostratigraphy, with differences only in the update of the numerical ages of datum levels (Table 2). Pliocene-Pleistocene deep sea benthic foraminifera show major fluctuations and long-term changes at ODP Site 762B (Figure 3 and Figure 4). The most abundant species include Uvigerina proboscidea, Cibicides lobatulus, Cibicides wuellerstorfi, Bulimina aculeata, Bulimina alazanensis, Stilostomella lepidula, Oridorsalis umbonatus and Gyroidinoides cibaoensis.

, 1993) has an MHD of 0.2 μg, B-JussuMP-I from Bothrops jararacussu has an MHD of 4 μg ( Mazzi et al., 2006) and BaH4 from Bothrops asper has an MHD of 2 μg ( Franceschi et al., 2000). Based on these results, we consider Batroxase to be a weakly hemorrhagic metalloproteinase.

To determine the mechanism underlying the induction of hemorrhage Vorinostat by Batroxase, its capacity to digest extracellular matrix components was assessed. Batroxase was able to hydrolyze type IV collagen and fibronectin molecules, and it also degraded the α 1, α and γ chains of laminin in Matrigel, but it was not able to digest isolated laminin. No nidogen proteolysis was detected. According to Bou-Gharios et al. (2004), the basement membranes of blood vessels consist mainly of laminin, collagen and fibronectin. Therefore, the ability of Batroxase to hydrolyze these components is consistent with its ability to induce hemorrhage by degrading extracellular matrix components of the blood vessel basement

membranes. Batroxase was able to digest fibrinogen by cleaving the α and β chains. Furthermore, the fibrinogen hydrolysis occurred in a concentration-dependent manner and was inhibited by EDTA and EGTA, which indicates that its metalloproteinase character was important for inducing proteolysis. According to Mosesson (2005), under physiological conditions, fibrin is formed by the cleavage of the fibrinogen α chain by thrombin. However, the results obtained showed that α and β chain cleavage by Batroxase suggests that the fibrin formed

might not be able to polymerize. Thus, the activity of Batroxase on the fibrinogen molecule likely indicates a consumption of this substrate Imatinib manufacturer and an inhibition of clot and thrombus formation. Several PI SVMPs are able to preferentially digest the α chain of the fibrinogen molecule, e.g., BnPI from Bothrops neuwiedi ( Baldo et al., 2008), BlaH1 from Bothrops lanceolatus ( Stroka et al., 2005), Atroxlysin-I from Bothrops atrox ( Sanchez et al., 2010), BmooMPα-I from Bothrops moojeni ( Bernardes et al., 2008) and Neuwiedase from Bothrops neuwiedi ( Rodrigues et al., 2001). Fibrinolytic activity has been reported for several PI-class SVMPs, such as Neuwiedase Phospholipase D1 (Rodrigues et al., 2001) and BnP1 from Bothrops neuwiedi ( Baldo et al., 2008), Bothrojaractivase from Bothrops jararaca ( Berguer et al., 2008), Berythractivase from Bothrops erythromelas ( Silva et al., 2003), BthMP from Bothrops moojeni ( Lopes et al., 2009) and Atroxlysin-1 from Bothrops asper ( Sanchez et al., 2010). Batroxase was able to induce fibrin digestion in a concentration-dependent manner up to 8 μg. The lack of further digestion at higher concentrations was probably the result of the total consumption of the fibrin in the gel. To confirm that the fibrinolytic hydrolysis mediated by Batroxase was not the result of the activation of plasminogen to generate plasmin, Batroxase was incubated with plasminogen, and the resulting fragments were analyzed.

, 2013 and Chitsaz et al., 2011) it is likely that these taxa also comprise ecologically distinct lineages. Conversely, the recently characterized SAR11 1C, or deep SAR11 clade, maintains high conservation of gene content and gene order when compared

to surface clades (Thrash et al., 2014) indicating that it employs a similar metabolic strategy. The majority of the organic carbon remineralization occurs below the photic zone (del Giorgio and Duarte, 2002) and genes associated with a particle attached lifestyle such as pilus synthesis, protein export, and polysaccharide and antibiotic synthesis genes, appear to be relatively more abundant in deep than surface waters (DeLong et al., 2006). There is also considerable autotrophic carbon assimilation or primary production

in the deep ocean (e.g. Karl et al., 1984, Walsh et al., 2009, Swan et al., 2011 and Anantharaman et al., Cilengitide in vivo 2013). This capacity is apparent selleck chemicals in many common and abundant deep sea lineages including the deltaproteobacterial SAR324 clade, and the gammaproteobacterial ARCTIC96BD-19, SUP05, Agg54 and Oceanospirillum clades ( Walsh et al., 2009, Swan et al., 2011 and Anantharaman et al., 2013). These organisms possess genes consistent with the ability to utilize dissimilatory sulfur oxidation for energetic support of autotrophic carbon fixation ( Walsh et al., 2009 and Swan et al., 2011). Mixotrophy and metabolic flexibility appear to be common lifestyle traits

enabling successful habitation of the deep sea. All the above organisms are capable of heterotrophy and, at least for the SAR324, sulfur oxidation and carbon fixation as well as C1 utilization and heterotrophy may all operate in a population simultaneously Interleukin-2 receptor ( Sheik et al., 2014). Similarly, the highly abundant heterotrophic Thaumarchaeota also display significant chemoautotrophic metabolism, fuelled by oxidation of ammonia to nitrite ( Berg et al., 2007). Genomic plasticity in the SUP05 clade enables this group to optimize its energy metabolism to suite its local environment. For example, genes involved for H2 and sulfur oxidation are over expressed in hydrothermal plumes, an environment where these electron donors are enriched, while in the background deep-sea a second hydrogenase is more prevalent ( Anantharaman et al., 2013). While many traits have distributions that correlate strictly with the taxonomic structure of the underlying community, such as the variations in photosynthetic capacity described within the picocyanobacteria, other traits, such as nitrogen fixation (e.g. Mahaffey et al., 2005), display a habitat-dependant but taxon-independent distribution. Indeed, several re-analyses of the GOS metagenomics datasets examining different levels of metabolic complexity, including pathways, modules and operons (Gianoulis et al.

This data was then used to assess the effect of age and gender. To assess how various phrases were interpreted by clinicians, we administered an anonymous survey of attendees at RNA Synthesis inhibitor multi-disciplinary tumor boards. The survey asked respondents to estimate the degree of

certainty associated with eight diagnostic scenarios (Fig. 1). One diagnosis contained no expression of uncertainty while the other seven contained the following phrases: “cannot rule out”, “consistent with”, “highly suspicious”, “favor”, “indefinite for”, “suggestive of”, and “worrisome for”. The order of presentation of each phrase and the specific content or specimen type associated therewith was randomized between surveys. The clinical context of the diagnoses was also customized according to the specialty of the tumor board where the evaluation was performed. A total of 76 responses were received. Statistical analysis was by Student’s t-test and ANOVA. Subgroup analyses were performed based on level of training and clinical specialty (medical students, residents, fellows, attendings, medicine/medical subspecialists, pathologists/radiologists, and surgeons). Looking for viable solutions to reporting of uncertainty, we conducted a focus group by sending a more detailed

survey to seven senior physicians in various departments (surgery, oncology, radiation oncology, gynecologic oncology, and otolaryngology). In this survey, respondents rank ordered eight

phrases from least to most certain. We also asked respondents what their opinion for moving forward learn more to resolve this communication problem would be and assessed their response to examples of certain proposed solutions. Finally, to gain further input into possible solutions to this problem, we held an open discussion with attendees at a short course at a national pathology meeting in fall 2012. Of 1500 surgical pathology reports, we found expressions of uncertainty in 529 (35%). The most commonly used phrase at our institution was “consistent with” (50%), while the other oft-used phrases included “suggestive of”, “worrisome for”, “cannot rule out”, “highly suspicious for”, “favor”, and “indefinite for” (Fig. 2). We found no statistically significant difference in incidence of uncertainty phrase usage by either age or gender (Fig. 3). Uncertainty science phrases were used more often in biopsy cases (96 of 149 incidences, 64%) than in resection cases. Most often these involved a question of neoplasic or pre-neoplastic (83 of 149, 56%) rather than medical (66 of 149, 44%) disease. About one-fifth (22%) of incident usage dealt with a “trivial” matter (e.g. “consistent with lipoma”, “favor ganglion cyst”) and a similar number (29 of 149, 19%) dealt with a sub-classification issue (e.g. “serrated polyp, favor serrated adenoma” or “spindle cell sarcoma, consistent with undifferentiated pleomorphic sarcoma.