3% CP and 2.23 Mcal of ME/kg of DM. At 14-d intervals, cows and calves were weighed and the amount of DM was adjusted to keep shrunk BW and BCS of cows constant. Beginning at 38 d of age, corn silage was available to calves ad libitum. Milk production at 42, 98, 126, and 180 d postpartum was measured using the weigh-suckle-weigh technique. At 190 d of age, calves were slaughtered

and body composition estimated using 9-10-11th-rib section to obtain energy deposition. Regression of BW change on daily ME intake (MEI) was used to estimate MEI at zero BW change. Increase in percentage Bos taurus had a significant effect on daily ME requirements (Mcal/d) during pregnancy (P < 0.01) and lactation (P < 0.01). Percentage Bos taurus had LY2835219 ic50 a positive linear effect on maintenance requirements of pregnant (P = 0.07) and lactating (P < 0.01) cows; during pregnancy, the ME requirements were 91 and 86% of those in lactation (131 +/- 3.5 vs. 145 +/- 3.4 Mcal.kg(-0.75).d(-1)) for the 0 and 50% B. taurus groups, respectively. The 50% B. taurus cows, ANL and SNL, suckling crossbred calves had greater total MEI (4,319 +/- 61 Mcal; P < 0.01) than

0% B. taurus cows suckling NL (3,484 +/- 86 Mcal) or ANL calves (3,600 +/- 91 Mcal). The 0% B. taurus cows suckling ANL calves were more efficient (45.3 +/- 1.6 Compound Library datasheet g/Mcal; P = 0.03) than straightbred NL (35.1 +/- 1.5 g/Mcal) and ANL or SNL pairs (41.0 +/- 1.0 g/Mcal). Under the conditions of this study, crossbreeding improved cow/ calf efficiency and showed an advantage for cows that have lower energy requirements.”
“We introduce an intradural approach to spinal cord stimulation for the relief of intractable pain, and describe the biophysical rationale that underlies its design and performance requirements. The proposed device relies on wireless, inductive coupling between a pial surface implant and its epidural controller, and we present the results of benchtop experiments that demonstrate the ability to transmit and receive a frequency-modulated 1.6 MHz carrier signal between micro-coil antennae scaled to the approximate to 1 cm dimensions of the implant, at power

levels of about 5 mW. Plans for materials selection, microfabrication, and other aspects of future development are presented and discussed. (C) 2011 American Institute of Physics. buy Napabucasin [doi:10.1063/1.3626469]“
“Children with juvenile idiopathic arthritis (JIA) may infrequently present with localized anterior knee pain or swelling, in addition to generalize knee pain induced by JIA. We report five cases of deep infrapatellar bursitis in children with JIA. The clinical features, radiological findings, management, and outcome of five children with JIA and deep infrapatellar bursitis are reviewed. Three boys and two girls with a mean age of 9.8 years (range 6-14 years) were reviewed. Four children had persistent oligoarticular JIA, and one child had extended oligoarticular JIA. The presentation of deep infrapatellar bursitis was variable.

increasing MC content led to a slight increase in water vapor permeability (WVP) without significant influence oil the moisture absorption (MA).”
“SETTING: In 2004, the tuberculosis (TB) contact screening strategy in Vila Nova de Gaia, Portugal, was changed from targeting only close contacts identified by interviews 3-deazaneplanocin A solubility dmso with the index patient (reflecting national policy) to include visits to the patient’s home and workplace.

OBJECTIVE:

To find out 1) whether the new strategy increased adherence to TB screening procedures, 2) whether the strategy identified more at-risk contacts and 3) whether the strategy increased prevention of TB.

METHODS: We compared TB contact tracing during the periods 2001-2003 and 2004-2006. The numbers of identified and screened contacts and the results of screening procedures (number of patients with active TB and latent TB infection [LTBI] detected per index case) were analysed. The number of instances of active TB prevented and the numbers of contacts that had to be screened to prevent one such instance were calculated and compared for both screening strategies.

RESULTS: Home and workplace visits helped to identify more at-risk contacts (8.4 per index patient) than interview (2.5 per index patient), and improved adherence (87.3% selleck products of identified

contacts were screened compared to 67.6% previously). More patients with active TB and LTBI were detected (1.4 per index patient compared with 0.75 per index patient previously), and more TB cases were prevented.

CONCLUSION: The newly implemented contact screening programme, PFTα datasheet featuring

home and workplace evaluation of TB patient contacts, improved adherence to screening procedures, identified more at-risk contacts and should prevent more TB cases in the future.”
“Primary hyperhidrosis is a disorder of excessive, bilateral and relatively symmetrical sweating occurring in the palms, soles and axillae regions without obvious etiology. There have been some reports of the epidemiology of primary hyperhidrosis abroad so far, but there has never been any research performed in Japan. We performed a questionnaire survey for people aged 5-64years who agreed with the purpose of this study at 20 companies or schools, and received 5807 valid responses. From this survey, each prevalence could broken down into 5.33% for primary palm hyperhidrosis, 2.79% for primary plantar hyperhidrosis, 5.75% for primary axillae hyperhidrosis and 4.7% for primary head hyperhidrosis. Patients with severe symptoms were estimated to be approximately 616000 for primary palmar hyperhidrosis and 2239000 for primary axillae hyperhidrosis in Japan. These findings reveal that many patients feel a decreased quality of life because of symptoms of hyperhidrosis every day. However, only 6.2% of the patients had visited medical institutions. Moreover, few patients take appropriate treatment even after visiting the hospital.

l. sampled in western Kenya in 2009 and 2010. Specimens were genotyped for kdr as above and identified to species via conventional

PCR. Field-collected larvae were reared to adulthood and tested for insecticide resistance using WHO bioassays.

Results: buy Lonafarnib Anopheles gambiae s.s. showed a dramatic increase in kdr frequency from 1996 – 2010, coincident with the scale up of insecticide-treated nets. By 2009-2010, the kdr L1014S allele was nearly fixed in the A. gambiae s.s. population, but was absent in A. arabiensis. Near Lake Victoria, A. arabiensis was dominant in samples, while at sites north of the lake A. gambiae s.s was more common but declined relative to A. arabiensis from 2009 to 2010. Bioassays demonstrated that A. gambiae s.s. had moderate phenotypic levels of resistance to DDT, permethrin and deltamethrin while A. arabiensis was susceptible to all insecticides tested.

Conclusions: The kdr L1014S allele has approached fixation in A. gambiae s.s. populations of western Kenya, and these same populations exhibit varying degrees

AR-13324 concentration of phenotypic resistance to DDT and pyrethroid insecticides. The near absence of A. gambiae s.s. from populations along the lakeshore and the apparent decline in other populations suggest that insecticide-treated nets remain effective against this mosquito despite the increase in kdr allele frequency. The persistence of A. arabiensis, despite little or no detectable insecticide resistance, is likely due to behavioural traits such as outdoor feeding and/or feeding on non-human

hosts by which this species avoids interaction with check details insecticide-treated nets.”
“Banff defines T-cell-mediated rejection (TCMR) using nonspecific lesions and arbitrary cutoffs, with no external gold standard. We reexamined features of TCMR using exclusively molecular definition independent of histopathology. The definition was derived from mouse kidney transplants with fully developed TCMR, and is based on high expression of transcripts reflecting IFNG effects and alternative macrophage activation. In 234 human kidney transplant biopsies for cause phenotyped by microarrays, we identified 26 biopsies meeting these criteria. After excluding three biopsies with unrelated diseases, all 23 biopsies had typical Banff lesions of TCMR (inflammation, tubulitis), with v lesions in 10/23. Banff histopathology diagnosed 18 as TCMR, 1 as mixed and 4 as borderline. Despite marked changes in transcriptome indicating tissue injury and dedifferentiation, all kidneys with molecularly defined TCMR, even with v lesions or late rejection, demonstrated excellent recovery of function at 6 months with no graft loss (mean follow-up 2.5 years). Thus TCMR defined exclusively by molecules manifests TCMR-related lesions and function impairment, but good recovery and survival, even with late rejection or arteritis. This combination of pathologic, clinical and molecular features constitutes the typical or canonical T-cell-mediated rejection.

The observed Raman frequency downshift

with increasing temperature drug discovery can be described well by a model which has taken into account the contributions of the anharmonic, thermal expansion, and strain effects, revealing the dominant role of the phonon decay. Effects of Pd addition and annealing temperature on the Raman frequency and linewidth have been discussed. The introduction of Pd is found to reduce the Raman frequency downshift, demonstrating the favorable use of NiPdSi for microelectronics applications.”
“The effects of three intramuscular anesthesia protocols – detomidine 190 mu g/kg plus ketamine 2 mg/kg, detomidine 270 mu g/kg plus ketamine 1.4 mg/kg, and tiletamine 3.4 mg/kg plus zolazepam 3.4 mg/kg – on penis protrusion and ejaculation variables were compared in nine captive Spanish ibex (Capra pyrenaica) subjected to electroejaculation. Body temperature, heart, and respiratory rates, as well as a number of plasma biochemical variables were also recorded prior to and during anesthesia. The detomidine plus ketamine protocols induced bradycardia and increased respiratory rate. However, the tiletamine/zolazepam protocol did not affect heart and respiratory rates. None of the three protocols caused a substantial change in rectal temperature, yet all protocols caused a significant

increase in plasma glucose levels. Differences in anesthetic protocols did not affect sperm quality or quantity. However, choice of anesthetic YH25448 solubility dmso protocol affected (P < 0.05) the degree of penis protrusion and the electrical pulse sequence required to achieve ejaculation. Results of this study support a recommendation of detomidine 270 mu g/kg plus ketamine 1.4 mg/kg for anesthesia of Spanish ibex undergoing electroejaculation. (C) 2010 Published by Elsevier Ltd.”
“Quantitative analysis of miroestrol (1) and kwakhurin JNJ-26481585 Epigenetics inhibitor (3) by HPLC, leading to standardisation of commercially

available Thai miracle herb Kwao Keur’ which has been identified with Pueraria mirifica, was established using independent solvent systems. The simple isolation procedure of highly estrogenic miroestrol (1) and deoxymiroestrol (2) from P. mirifica was also proposed.”
“This work presents a study of H complexes in Zn deficient ZnO by density functional calculations. It is found that the location of two H atoms at the Zn vacancy (V-Zn) is energetically more preferable than the distant H and V-Zn. Each of the two H atoms saturates one dangling O bond by forming an O-H bond. The resulting defect can be considered to be a 2(O-H)-V-Zn complex. Since there are four O dangling bonds at the V-Zn, the site can host four H atoms. It is shown that V-Zn with four H atoms is energetically more preferable than distant H and V-Zn.

Additionally, pre- and postoperative pain, quality of life, and walking distance were assessed.

Results. As expected severe preoperative back and leg pain significantly decreased after decompressive surgery. This was associated with a significant increase in the quality of life. The incidence of erectile dysfunction before and after surgery was higher compared to population-based standard data, and surgery was associated with a significant decrease of erectile function at latest follow-up (9.7 months).

Conclusion. Lumbar spinal stenosis is associated with a neglected prevalence of erectile

dysfunction. Surprisingly, it does not improve after decompressive spinal surgery; moreover, a decline was observable. Cell Cycle inhibitor Underlying mechanisms of the postoperative decline remain obscure.”
“Despite its prevalence, clinical and prognostic impact, diabetic autonomic Galardin solubility dmso neuropathy, is widely under-diagnosed. The need for training and expertise to perform the cardiovascular tests (usually the task of diabetologists) is one possible reason. The availability of computer-assisted systems has allowed a wider diffusion of testing, but has

also highlighted the need for an adequate knowledge of physiopathological backgrounds for their correct application and interpretation. The recommendations presented here were developed by the Neuropathy Study Group of the Italian Society of Diabetology and then endorsed by the Italian Association for the Study of Neurovegetative System, to promote the widespread adoption of good clinical practice in diabetic cardiovascular autonomic testing by outlining main evidence-based aspects, i.e. which tests, how to perform them, adequate

interpretation of the results and their diagnostic use, confounding conditions that can impact on tests reliability. Therefore, these recommendations include buy AZD2014 the essential aspects of the physiopathological substrate of the tests, the controversial points in their analysis, their diagnostic characteristics, as well as safety. Detailed information is given on the physiological (age, weight, body position, resting heart rate and blood pressure, respiratory pattern, exercise, meals, acute blood glucose changes) and pathophysiological confounding factors, with emphasis on the effects of drugs. Instructions on how to perform the tests and interpret their results are also considered together with indications of candidate patients and periodicity of testing. A patient instruction sheet on why and how to perform the tests is included. Finally, the specific requirements for computerized systems to perform and evaluate cardiovascular tests are provided. (C) 2010 Elsevier B. V. All rights reserved.”
“Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome that results in renal phosphate wasting with hypophosphatemia.

This greatly expands the capabilities of bioanalyses performed on small model organisms and offers numerous and currently

inaccessible laboratory automation advantages. (C) 2012 American Institute of Physics. [http://dx.doi.org.elibrary.einstein.yu.edu/10.1063/1.3699971]“
“Olfactory perception, and especially hedonic evaluation of VX-770 nmr odors, is highly flexible, but some mechanisms involved in this flexibility remain to be elucidated. In the present study we aimed at better understanding how repeated exposure to odors can affect their pleasantness. We tested the hypothesis of an affective habituation to the stimuli, namely a decrease of emotional intensity over repetitions. More specifically, we tested whether this effect is subject to inter-individual

variability and whether it can also be observed at the olfactomotor level. Twenty-six participants took part in the experiment during which they had to smell two odorants, anise and chocolate, presented 20 times each. On each trial, sniff duration and volume were recorded Citarinostat and paired with ratings of odor pleasantness and intensity. For each smell, we distinguished between “”likers”" and “”dislikers,”" namely individuals giving positive and negative initial hedonic evaluations. Results showed a significant decrease in pleasantness with time when the odor was initially pleasant (“”likers”"), while unpleasantness remained stable or slightly decreased when the odor was initially unpleasant (“”dislikers”"). This deviation toward neutrality was interpreted as affective habituation. This effect was all the more robust as it was observed for both odors and corroborated by sniffing, an objective measurement of odor pleasantness. Affective habituation to odors can be interpreted as an adaptive response to stimuli that prove over time to be devoid of positive or negative outcome on the organism. This study contributes to a better

understanding of how olfactory preferences are shaped Crenigacestat in vivo through exposure, depending on the individual’s own initial perception of the odor.”
“Objective-To determine the association between results of endoscopic evaluation of arytenoid function (AF) and epiglottic structure (ES) in Thoroughbred yearlings and racing performance at 2 to 4 years of age.

Design-Retrospective case series.

Animals-2,954 Thoroughbred yearlings,

Procedures-Records of yearlings that had endoscopic evaluation of the larynx between 1998 and 2001 were obtained, and results were graded by use of standardized scales. A modified Havemeyer scale (grade II, II.1, II.2, III, or IV) was used to evaluate AF; ES was graded on a scale of 0 to IV Records were annotated if the epiglottis was subjectively short or narrow. Racing performance data were obtained from an online database.

Results-Horses with grade II.2 AF had significantly less earnings at 4 years of age, compared with earnings of horses with AF grades < II.2.

Again, following surgery on the left, both moyamoya symptoms and cluster attacks disappeared. Cluster headache secondary to moyamoya has not previously been described.”
“Melanin complex was isolated from mycelium of the basidiomycete Laetiporus sulphureus (Bull.: Fr.) Murr (with a yield of 2.49% of the dry weight). UV and IR spectroscopies, gel chromatography, and alkaline cleavage assay demonstrated that the isolated melanin was heterogeneous and belonged to the dihydronaphthalene

type. (13)C-NMR data suggested that aromatic fragments buy Fludarabine were dominant in the melanin structure. In vitro study of the antioxidant action demonstrated that the L. sulphureus melanin displayed a radical-scavenging activity and the ability to inactivate hydrogen peroxide and nitrogen(II) oxide molecules and to chelate iron(II) ions.”
“Objective: To explore the associations Selonsertib in vivo between beta-blocker use and clinical outcomes (death, hospitalisation with myocardial infarction (MI) or stroke, major amputation and recurrent vascular surgery) after primary vascular reconstruction.

Methods: Patients who had primary vascular surgical or endovascular reconstruction due to symptomatic peripheral arterial disease, in Denmark between 1996 and 2007 were included. We obtained data on filled prescriptions, clinical outcomes and confounding factors from population-based healthcare registries. Beta-blocker

users Apoptosis inhibitor were matched to non-users by propensity score,

and Cox-regression was performed. All medications were included as time-dependent variables.

Results: We studied 16,945 matched patients (7828 beta-blocker users and 9117 non-users) with a median follow-up period of 582 days (range, 30-4379 days). The cumulative risks were as follows: all-cause mortality, 17.9%; MI, 5.3%; stroke, 5.6%; major amputation, 9.1%; and recurrent vascular surgery, 23.1%. When comparing beta-blocker users with non-users: adjusted hazard ratio: MI, 1.52 (95% CI, 1.31-1.78); stroke, 1.21 (95% CI, 1.03-1.43); and major amputation, 0.80 (95% CI, 0.70-0.93).

Conclusion: Beta-blocker use after primary vascular surgery was associated with a lower risk of major amputation but an increased risk of hospitalisation with MI and stroke. No associations were found between beta-blocker use and all-cause mortality or the risk of recurrent vascular surgery. However; our results are not sufficient to alter the indication for beta-blocker use among symptomatic peripheral arterial disease patients. (C) 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.”
“One of the cardinal symptoms of compartment syndrome is pain. A literature review was undertaken in order to assess the association of epidural analgesia and compartment syndrome in children, whether epidural analgesia delays the diagnosis, and to identify patients who might be at risk.

6 +/- 2.2 ml/kg versus 1.2 +/- 1.2 ml/kg, P = 0.0002). Eighteen percent of adenotonsillectomy patients

lost greater than 5% of calculated circulating blood volume (95% Cl, 9.8-26). Linear regression models did not show an association between the amount of blood loss and patient age, clinical indication, or the surgeon’s experience with the microdebrider (P > 0.05).

Conclusions: Microdebrider tonsillectomy is associated with more intraoperative bleeding than electrocautery tonsillectomy. Approximately twice as much blood was lost with the microdebrider, but the absolute increase was Selleckchem Cyclopamine insignificant from a hemodynamic perspective. (C) 2012 Elsevier Ireland Ltd. All rights reserved.”
“Physical inactivity and low maximal exercise oxygen consumption (VO2max) are predictors of mortality and coronary events in adults, respectively. Lowering serum cholesterol and platelet aggregation benefits cardiovascular function in aging persons. D-003, a mixture of sugarcane wax acids, exhibits antiplatelet and cholesterol-lowering effects, and could benefit the performance

of middle-aged and older subjects in effort tests. This randomised, double-blinded, placebo-controlled study investigated the effects of D-003 (10 mg/day) for 12 weeks on the effort test in the static bicycle and the health status of 50 subjects (50-70 years old). Compared with baseline and placebo, D-003 improved significantly VO(2) (max) values, pain/discomfort and health perception EuroQoL scores, and the cardiovascular capacity assessed by the Specific Activity Scale. Also, D-003 GSK2879552 Epigenetics inhibitor displayed cholesterol-lowering learn more effects versus placebo, being well tolerated. There were no study withdrawals. Concluding, D-003 improved VO(2 max) values in the effort test, lipid profile, health perception and cardiovascular status

of study subjects.”
“Objective: To evaluate the auditory outcomes of children implanted in an ear with eighth nerve hypoplasia or aplasia and to determine whether preoperative characteristics are predictive of auditory performance achieved.

Methods: Study design: retrospective case review. Setting: tertiary care medical center. Patients: ten children implanted in an ear with eighth nerve hypoplasia or aplasia, as determined by high resolution magnetic resonance imaging. Main outcome measures: Neural response test measurements, detection and speech awareness thresholds, Meaningful Auditory Integration Scale scores, as well as speech perception level achieved.

Results: Post-implantation, three children demonstrated little to no detection of sound, three had improved detection and awareness of environmental sounds, one developed closed-set speech perception and spoken language, and three developed open-set speech perception and spoken language. No imaging findings appeared related to outcomes.

Data were analyzed using a Hierarchical Generalized Linear Model (HGLM) with species richness and presence of individual species as response variables and distance to nature reserve and application of AES as factors, controlling for possible confounding factors. Results were interpreted as the effects of AES on seed and site limitation of the species. The results showed that plant diversity decreased significantly with distance from source populations. There were considerable HSP inhibitor differences in species diversity between AES and non-AES ditch banks, with the former showing greater plant diversity especially in the first 200 m from nature reserves. Presences of

all individual species decreased with distance to nature reserve, but the strength of this relationship and the AES effects differed among species. AES ditch banks had lower site limitations for most plant species, but did not have lower seed limitation. (C) 2009 Elsevier Ltd. All rights reserved.”
“An optical switch based on liquid crystal dielectric loaded surface plasmon polariton waveguides is proposed and theoretically analyzed. The infiltration of the plasmonic structure with a nematic liquid crystalline material serving check details as the dielectric loading is shown to allow for extensive electrical tuning of its waveguiding characteristics. Both the electrical switching and optical properties of

the proposed waveguide are investigated in the context of designing a directional coupler optical switch, which is found to combine efficient voltage control, low power consumption, high extinction ratio, and relatively low insertion losses. (C) 2011 American Institute of Physics. [doi:10.1063/1.3658247]“
“Zonisamide is an antiepileptic drug that acts on voltage-sensitive

sodium and calcium channels, with a modulatory effect on GABA-mediated neuronal inhibition and an inhibitory effect on carbonic anhydrase. It is used mainly for the treatment of partial seizures, and is generally well tolerated at therapeutic doses. The most common reported adverse effects are somnolence, anorexia, dizziness, and headache. There are limited data on zonisamide selleck kinase inhibitor overdose in the literature, and no case of zonisamide mono-intoxication has been published to date. We describe the first case of zonisamide mono-intoxication in a 25-year-old woman who ingested 12.6 g of this substance with suicidal intent. Despite a plasma zonisamide concentration of 182 mg/L on admission, the patient exhibited a benign clinical course with vomiting and central nervous system depression, requiring brief intubation. Somnolence persisted for 50 hours, and normal-anion-gap metabolic acidosis and polyuria for several days. Complete recovery may be expected with supportive care, even after ingestion of large zonisamide overdoses. (C) 2011 Elsevier Inc. All rights reserved.

(C) 2011 American Institute of Physics. [doi:10.1063/1.3651392]“
“It is common for crude oil from wells to be accompanied by gas and water because of the presence selleckchem of natural surfactants in the oil that stabilize the associated water. This causes foaming during processing in gas/oil separators because of the constant agitation and shear forces, which reduce the efficiency of the process and require chemical control by the addition of defoaming additives, or antifoams. In this work, we evaluated the chemical and physicochemical properties of commercial antifoam products based on silicone polyethers along with their efficiency

in inhibiting foaming and water/oil (W/O) phase separation. The commercial surfactants were characterized by NMR spectroscopy, size exclusion chromatography, determination of solubility in different solvents, and measurement of the surface and interfacial tensions. A method to test the formation of foam in oil was used to mimic the operating conditions in gas/oil separators. Finally, tests were performed with the addition of aliquots of the additive solutions (30% p/v) in oil to evaluate their efficiency in breaking up the foam under different conditions. The results show that the most polar additive (SL2)

was the most efficient in breaking up the foam. Additive SP1, which formed a heterogeneous phase https://www.selleckchem.com/products/fg-4592.html in the oil, was also an efficient foam inhibitor and helped to separate these phases. The antifoam tests showed that these additives did not stabilize W/O emulsions, so they could be used in gravitational separation tanks in the field. (C) 2011 Wiley Periodicals, Inc. J Appl Polym Sci, 2012″
“Illness perceptions of health care professionals U0126 molecular weight are likely to affect patient care. This study describes the illness perceptions of two groups of health care staff toward epilepsy and psychogenic nonepileptic seizures (PNES). Sixty-one health care professionals (30 emergency care [EC] and 31 neuroscience ward [NW] staff) who regularly see patients with seizures completed the adapted Illness Perception Questionnaire Revised (IPQ-R) and the Symptom Attribution Question

for epilepsy and PNES. Respondents reported a poorer understanding of PNES than of epilepsy (P<0.001), thought epilepsy was a more chronic condition (P=0.001/P<0.001) and that patients with PNES had more “”personal control”" of their seizures (P=0.014/P<0.001). Staff from both departments identified psychological causes as most important for PNES (P<0.001). EC staff also attributed PNES to behavioral issues or alcohol. The Illness Perception Questionnaire Revised and Symptom Attribution Question demonstrated important differences in attitudes of health care staff toward epilepsy and PNES. The findings illustrate why some patients with PNES have traumatic encounters with health care professionals. (C) 2011 Elsevier Inc. All rights reserved.