Journal articles on the topic 'Progressive Carpenters'

Objective: To describe dentoalveolar findings in one pediatric patient with a very rare Carpenter syndrome or acrocephalopolysyndactyly type II, and using cone beam computed tomography (CBCT). Case report: We found a syndromic oligodontia, upper canine transmigration, and an exceptional agenesis of four lateral incisors. We also described the fourth case in the literature of a single solitary lower incisor on the midline, and the first case ever illustrated on CBCT. Conclusions: We proposed and illustrated the use of the system of progressive numbering of teeth on CBCT axial views to better understand complex dental clinical situations such as syndromic oligodontia.

Quality training in computational skills for life scientists is essential to allow them to deliver robust, reproducible and cutting-edge research. A pan-European bioinformatics programme, ELIXIR, has adopted a well-established and progressive programme of computational lab and data skills training from Software and Data Carpentry, aimed at increasing the number of skilled life scientists and building a sustainable training community in this field. This article describes the Pilot action, which introduced the Carpentry training model to the ELIXIR community.

This article reflects on the disappearing carpentry tradition in a rural village called Miaoxia in Sichuan Province China. Since 2015, villagers, social workers, architects, and university scholars have been collaborating to look for alternative development possibilities in Miaoxia Village. The idea of using the local carpentry tradition has been one of the key focusses in the process. Since the Chinese Economic Reform in 1978, the influence of urbanisation and market economy in China has led the Chinese government to rethink the value of rural customs and traditions. While the country has been encouraging progressive economic development, local making culture and development have subsequently been under threat. The collaborations between social workers and design professions in Miaoxia tested small-scale architecture interventions and educational workshops. These experiments have started to record and test out different ways to save carpentry traditions from extinction. This article outlines this process in Miaoxia and asks for new ideas to re-utilise this traditional making.

This article is an elaboration on the theoretical point made by Paul Cobb (1985) in “A Reaction to Three Early Number Papers” that appeared in the March issue of this journal. Cobb notes a discrepancy between a model of subtraction that posits a developmental progression from counting down to a choice between counting down and counting up (Baroody, 1984b) and longitudinal data (Carpenter & Moser, 1984) that indicate that counting up develops at least as early as counting down. He presents longitudinal data from four case studies that corroborate the model (and, I should add, the earlier cross-sectional data and position of Woods, Resnick, & Groen, 1975). To reconcile these results with those of Carpenter and Moser, Cobb argues that a child's use of an informal arithmetic procedure may not be an accurate reflection of his or her conceptual sophistication.

Objectifs de travail: Evaluer la région dento-alvéolaire chez un patient pédiatrique atteint d'un très rare syndrome de Carpenter ou d'acrocéphalopolysyndactylie de type II à l'aide de la tomodensitométrie volumique à faisceau conique (CBCT). Cas clinique: Nous avons retrouvé une oligodontie syndromique, une transmigration canine supérieure et une agénésie exceptionnelle des quatre incisives latérales. Nous avons également décrit le quatrième cas dans la littérature d'une seule incisive inférieure solitaire sur la ligne médiane, et le premier cas jamais illustré sur CBCT. Conclusions: Nous avons proposé et illustré l'utilisation du système de numérotation progressive des dents sur des vues axiales CBCT pour mieux comprendre les situations cliniques dentaires complexes telles que l'oligodontie syndromique.

Résumé Cette étude s'intéresse aux formes complexes prises par le discours descriptif, l'ekphrasis, dans une nouvelle fantastique d'André Carpentier, "La Bouquinerie d'Outre-Temps" (Rue Saint-DenisJ. Loin d'être statique, l'ekphrasis tend plutôt à faire voir en détail et de manière changeante le sujet et l'objet du discours, mais d'un discours à la fois économique, nouvellistique, qui s'attache à la représentation d'une forme complexe de savoir/non-savoir engagée dans un processus de renversement. Le texte de Carpentier s'inscrit ainsi sous le signe de la cotextualisation oxymoronique, en déployant dans son système prédicatifun discours où acteurCs) et chronotope(s) sont en continuelle transformation par le truchement de cas défigures antithétiques liées à la progression des isotopies du voir, du faire, du lire et, ultimement, à la problématique du savoir et du pouvoir du sujet actoriel.

This article, written by JPT Technology Editor Chris Carpenter, contains highlights of paper SPE 201130, “Novel Progressing-Cavity-Pump Configurations Address Operational Challenges,” by Lonnie Dunn, SPE, Ryan Rowan, and Abhishek Prakash, Lifting Solution, et al., prepared for the 2020 SPE Virtual Artificial Lift Conference and Exhibition-Americas, 10-12 November. The paper has not been peer reviewed. While downhole progressing-cavity-pump (PCP) designs provide options for end users, the numerous products available, combined with a lack of industry standardization, can make selection and application challenging. The complete paper provides an overview of the development of a PCP concept and implementation, which is not included in this synopsis, and then summarizes two novel PCP configurations deployed to address specific operational challenges. Design and Manufacturing, Configuration 1 A novel PCP configuration was developed from phased design trials and experience in cold heavy-oil production with sand (CHOPS) wells. This configuration uses a modified rotor to create alternating sections of contact and noncontact within a conventional stator (Fig. 1). The rotor is landed in the stator and operated until there is a performance decline. Then, the rotor is repositioned to move the active section of the rotor into the areas of the stator where there originally was no contact and, as such, normally no associated damage. Keeping the length of the alternating sections short simplifies the surface rotor positioning process, allowing it to be performed riglessly. The main benefit of this is that, rather than having to pull the rod string and run a different rotor, the same rotor is used and repositioned through lifting of the rod string at surface.

SUMMARYNeospora caninumis an apicomplexan, protozoan parasite, which causes severe disease in dogs and cattle. It has previously been isolated only in the United States. A 5-week-old Boxer pup with a progressive hindlimb paresis was diagnosed as suffering from neosporosis on the basis of clinical signs and the presence of anti-Neosporaantibodies in it, 2 litter-mates and its darn. Despite treatment with sulphonamides, the pup was euthanased 3 days later. The diagnosis of neosporosis was confirmed by immunohistochemical examination of muscle and CNS tissue sections from the pup. Parasites were isolated into Vero cell culture from the cerebrum, and confirmed asNeospora caninumby immunofluorescence with specific antibody, tachyzoite ultrastructure and 16S-like ribosomal RNA sequences. This isolate (designated NC-Liverpool) has been continuously passaged every 7–10 days. Its growth characteristics, ultrastructure and antigenic profile, as revealed by immunoblotting, have revealed no major differences from the American NC-1 isolate. Furthermore, no difference was seen when comparing the sequences of 16S-like ribosomal RNA and the ITS1 region of the two isolates.

AbstractProgressive Era school officials transformed public education in American cities by teaching male students trades like foundry, carpentry, and mechanics in classrooms outfitted like factories. Historians have demonstrated how this “vocational education movement” was championed by male administrators and business leaders anxious to train the next generation of expert tradesmen. But women also hoped vocational education could prepare female students for industrial careers. In the early twentieth century, members of the National Women’s Trade Union League demanded that public schools open trade programs to female students and teach future working women the history of capitalism and the philosophy of collective bargaining. Their ambitious goals were tempered by some middle-class reformers and club women who argued vocational programs should also prepare female students for homemaking and motherhood. This article uses Chicago as a case study to explore how Progressive Era women competed and collaborated to reform vocational education for girls, and how female students responded to new school programs designed to prepare them for work both in and outside the home.

This is a text derivated from the presentation “La fijeza: tiempo y espacio insulares”, in the 38th Conference of the Caribbean Studies Association, on June 4th, 2013 at Grenada Grand Beach Resort, Grand Anse, Grenada.Lezama Lima was a Cuban poet, essayist, and novelist considered as well as Alejo Carpentier, one of the greatest figures of the Caribbean island literature. His detailed knowledge of the baroque literature specially Góngora’s poetry, and also his necessity of fixing a Cuban identity, allowed him to propose a very innovative esthetic which goes beyond the disenchantment proper of the baroque. The verses of “La fijeza” are some examples of this vision. In this order of ideas, the purpose of this work in to present the analysis of some poems of “La fijeza” in order to explain the manner in which Lezama distances himself from the baroque disenchantment conception of the world and how, at the same time, he presents verses of hope, identity and universalism by means of presenting the poetic image of the Caribbean scenery and its spatio-temporal relationships in a way to explain a vision of the poetry as privileged way to re-create the world.

AbstractSeishinshugi 精神主義, a term associated with the work of Meiji Buddhist reformer Kiyozawa Manshi 清沢満之 (1863–1903), is often read as exemplifying a spiritual turn in mid-Meiji Japan, centering an inner realm of private experience in a reaction against the rationalization of the early Meiji period. This paper considers the use of the term seishin in Kiyozawa’s early work. It finds him treating seishin in two distinct but connected contexts: as a psychological term, influenced particularly by his reading of English physician William Benjamin Carpenter (1813–1885), and as a philosophical term, in conversation with Hegel’s philosophy of spirit. It suggests that an understanding of seishin as developing progressively toward more and more complex forms of consciousness or self-awareness found in both Kiyozawa’s psychological and philosophical writing sheds new light on other aspects of Kiyozawa’s early career.

The largely literate African employees of European businesses during the colonial and postcolonial period have not been studied as a group, unlike miners, railway workers and colonial intermediaries. This group has nevertheless been of great importance. Many of its members became part of the core of the management of African-owned enterprises and organizations, others started their own businesses or became successful politicians. African employees of European business, alongside government employees, formed the basis of the rapidly growing middle classes during the period after the Second World War. They gave their children a Western-style education, often at well-respected schools. In many local communities the “manager” became a figure of respect. Many employees were elected to traditional office as chiefs. Such successes were not limited to those employees who made it into management. For example, a carpenter with a steady career with a European company could build and own several houses. These African employees domesticated capitalism in West Africa, mediated changes in consumption and the rise of a consumer society, and adopted European expectations of career progression and life cycle. Working for a European business, they also found themselves at important sites of contestation during colonial and postcolonial political struggles.

This article, written by JPT Technology Editor Chris Carpenter, contains highlights of paper SPE 207290, “Intelligent Operating Envelope Integrated With Automated Well Models Improves Assetwide Progressing-Cavity-Pump Surveillance and Optimization,” by Mohammed Al Sawafi and Antonio Andrade, Petroleum Development Oman, and Nitish Kumar, Weatherford, et al. The paper has not been peer reviewed. The operator has completed a project in which the progressing-cavity-pump (PCP) well-modeling process is automated. Models are built and sustained automatically in a well-management system (WMS) for all active PCP wells, with a major effect on day-to-day operational activities. The complete paper discusses use of physics-based well models from the WMS to automatically update operating envelopes (OE), identify daily oil-gain potential, and enable real-time PCP performance through a well-management-visualization system (WMVS). Introduction PCPs have gained popularity in recent years and, thus, have increased their footprint within the operator’s assets. At the time of writing, PCP wells contribute 19% of the operator’s net oil production, with a minimal water-cut rate per well in comparison with all other artificial-lift wells. The number of PCPs has almost doubled since the inception of an exception-based-surveillance (EBS) system in 2015, and the effort in configuring and managing EBS alerts had become more challenging, with each engineer handling an average of 30 EBS alerts per week. In 2018, the operator’s PCP team completed a Lean project for sustainable PCP well modeling by automating the complete process in the WMS (a nodal-analysis-based real-time application) and delivering 100% real-time models for all active PCP wells. This was achieved by building and integrating the operator’s corporate database for PCP wells with the WMS. The system was developed for performing PCP well modeling by collecting well information automatically from various corporate databases such as an artificial-lift database, a subsurface database, a production database, and reservoir and pressure/volume/temperature databases, among others (Fig. 1).

Abstract Background: Heart failure due to iron-induced cardiomyopathy is rare yet remains one of the leading causes of death in patients with β thalassemia. Using myocardial T2* (mT2*) cardiovascular magnetic resonance (CMR) to estimate myocardial iron burden has improved the management of cardiac siderosis. Myocardial T2* >20 ms is considered normal and as iron accumulates, mT2* reduces, with values <10 ms associated with an increased risk of heart failure. As reported by Carpenter et al (2011), a calibration for CMR R2* against atomic emission spectroscopy-measured myocardial iron concentration (MIC), showing a curvilinear relationship between R2* and MIC, actual MIC can now also be assessed and affords an additional efficacy measure for patients undergoing iron chelation therapy. In a previous post-hoc analysis of the 3-year EPIC (Evaluation of Patients’ Iron Chelation with Exjade®) cardiac substudy, the long-term effects of deferasirox on mT2* and MIC were reported. Here, we report relative trends between mT2* and MIC as a representation of myocardial chelation efficacy by determining how far the patient has progressed from baseline toward reaching normal levels, in order to further understand the interpretation of these two parameters. Methods: Patients aged ≥10 years with mT2* >5 to <20 ms by CMR, left ventricular ejection fraction ≥56%, serum ferritin >2500 ng/mL, MR (R2) liver iron concentration >10 mg Fe/g dry weight (dw) and ≥50 lifetime transfused blood units were included in the study. Cardiac iron removal was analyzed over 3 years in patients with mT2* at baseline and each considered time point. Post-hoc calculation of MIC from mT2* values was conducted using the formula described by Carpenter et al as follows: [Fe] = 45.0 x (mT2*)−1.22 where [Fe] is measured in milligrams per gram dw and mT2* is measured in milliseconds. Data are presented descriptively as the percentage of the progression of the patients toward achieving normalization of mT2* (>20 ms) or MIC (>1.16 mg Fe/g dw as derived from the formula based on normal mT2*) by mT2* at baseline: >5 to <10 ms, 10 to <15 ms and 15 to <20 ms. Results: Data were analyzed at Month 12 (n=67: baseline mT2* >5 to <10 ms, n=24; 10 to <15 ms, n=19; 15 to <20 ms, n=24), Month 24 (n=66: baseline mT2* >5 to <10 ms, n=24; 10 to <15 ms, n=18; 15 to <20 ms, n=24) and Month 36 (n=63: baseline mT2* >5 to <10 ms, n=22; 10 to <15 ms, n=18; 15 to <20 ms, n=23). As previously reported (Pennell et al. 2012), geometric mean mT2* in the overall population significantly increased from 12.0 ms at baseline to 13.9 ms at Month 12, 15.6 ms at Month 24 and 17.1 ms at Month 36. In parallel, mean MIC significantly decreased from 2.43 mg Fe/g dw at baseline to 2.10 mg Fe/g dw at Month 12, 1.94 mg Fe/g dw at Month 24 and 1.80 mg Fe/g dw at Month 36. The median percentage progression of patients towards normalizing mT2* and MIC by baseline mT2* category are presented in the Figure. In patients with severe myocardial iron overload at baseline, the percentage toward normalization in mT2* in the first, second and third year was less than the percentage towards normalization in MIC. This difference was less pronounced, but still evident, in patients with mild-to-moderate myocardial iron overload. Figure 1 Figure 1. Discussion: The calibration of the relationship between CMR measurements and MIC by Carpenter et al allows an additional assessment to mT2* to determine chelator efficacy in terms of the actual concentration of iron in the myocardium. Here we show that, particularly in patients with severe myocardial iron overload, when analyzing the progression towards normalization, improvement in MIC is proportionally greater than that seen with mT2*. It could be interpreted that a small improvement (ie 1 ms) in mT2* when baseline values are >5 to <10 ms is not equivalent in terms of myocardial iron removal to a small improvement in patients with less severe myocardial iron overload at baseline; a consequence of the reciprocal relationship between mT2* and MIC. Therefore, analysis of mT2* only may underestimate the efficacy of iron chelation with respect to the myocardium in patients with severe myocardial iron loading (mT2* <10 ms) and thus MIC may better reflect response to chelation therapy. It would therefore be valuable if MIC were calculated and reported in parallel with mT2* when assessing and monitoring patients on iron chelation therapy across a range of baseline mT2* values. Disclosures Porter: Novartis: Consultancy, Honoraria, Research Funding; Shire: Consultancy, Honoraria; Celgene: Consultancy; Cerus: Membership on an entity's Board of Directors or advisory committees; Alnylam: Membership on an entity's Board of Directors or advisory committees. Taher:Novartis: Honoraria, Research Funding. Aydinok:Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau. El-Ali:Novartis: Employment. Barbier:Novartis: Employment. Cappellini:Novartis: Honoraria, Speakers Bureau; Genzyme: Honoraria.

Abstract Abstract 2012 Poster Board I-1034 Background: Cardiovascular magnetic resonance (CMR) is being increasingly used worldwide for monitoring chelation therapy in transfusion-dependent β-thalassemia patients. The assessment of cardiac iron loading using myocardial T2 star (T2*) is a reliable, quick and non-invasive method which can be combined with highly accurate and reproducible cardiac volume and function measurements. It has previously been noted that myocardial siderosis (T2*<20ms) is associated with progressive impairment in left ventricular (LV) function but little is known about the relation of T2* measurements to right ventricular (RV) function in these patients. This study assesses the impact of myocardial iron loading on the right ventricle. Methods: A retrospective analysis was performed of 323 consecutive β-thalassemia patients referred for their first CMR scan from 21 UK hematology centers. Only patients on a single chelating agent (deferoxamine) were included. All had received chelation from the mid-to-late 1970s or from an early age if born since then. Patients were excluded if there was significant cardiac, vascular or lung pathology (such as aortic stenosis, pulmonary artery stenosis, tetralogy of Fallot or pulmonary hypertension). All scans were performed using a 1.5T Sonata (Siemens Medical Systems, Germany). A single breath-hold multi-echo sequence with 8 different echo times (TE = 2.54-17.9ms) was used to measure T2* from a full-thickness region of interest in the septum of a mid-ventricular short axis slice. Myocardial T2* was calculated from the exponential signal intensity decay curve using a truncation method to account for background noise. RV and LV volumes and ejection fraction (EF) were calculated from a series of short axis ventricular slices (7mm thickness with 3mm gap). Results: In patients with normal T2* (>20ms), RV EF was within normal limits in 98% of cases (RV EF [mean ±SD] = 65.0 ±6.1%). In patients with myocardial siderosis (T2*<20ms), there was a progressive and significant fall in RV EF (r=0.43, p<0.001) and an increase in RV end-systolic volume index (r= -0.33, p<0.001). LV EF was within the normal range in 99% of patients with T2*>20ms (LV EF = 69.5 ±5.2%). Once again, where T2* fell below 20ms, there was a progressive decline in LV EF (r=0.40, p<0.001). 82.6% of the patients with low T2* and impaired RV ejection fraction also had an impaired LV EF and linear regression analysis showed a significant relation between RV and LV EF (r=0.69, p<0.001). Conclusions: There is a strong association between increasing myocardial iron loading and RV dysfunction which mirrors the decrease in LV ejection fraction seen with worsening myocardial siderosis. RV impairment may be a significant contributor to the syndrome of heart failure associated with severe myocardial siderosis. Disclosures: Carpenter: Swedish Orphan: Honoraria; Apotex: Honoraria. Porter:Novartis: Consultancy, Research Funding. He:Novartis: Consultancy. Smith:Novartis: Consultancy. Pennell:Siemens: Consultancy; Novartis: Consultancy; Apotex: Honoraria; Cardiovascular Imaging Solutions, London: Equity Ownership.

AbstractOBJECTIVESSince 1988, our centre employs vertical plication repair with deattachment and reattachment of the tricuspid valve for Ebstein anomaly. This study describes the characteristics and long-term outcomes of our single-centre cohort.METHODSData from all patients operated on between 1988 and 2016 were retrospectively collected. Kaplan–Meier analyses were done for survival data and mixed models were used to analyse longitudinally collected clinical and echocardiography data.RESULTSThirty-six patients (mean age: 25.4 ± 15.9 years, 36% male) were operated on using the Carpentier–Chauvaud 21 (58%) or Cone repair 15 (42%). One patient (3%) died in hospital. Two late deaths were observed, yielding a survival of 97 ± 3% at 25 years. Reoperation was performed in 6 patients after a mean follow-up of 14.1 ± 10.3 years, resulting in a freedom of reoperation of 80 ± 8% at 25 years. During follow-up, predicted probability of being in New York Heart Association III/IV did not exceed 10%. Modelling longitudinal evolution of tricuspid regurgitation showed no major changes over time. Additionally, a rigid ring repair was associated with a higher probability of tricuspid regurgitation, especially after the first years after the operation. A full Cone repair was associated with less progression of tricuspid regurgitation over time.CONCLUSIONSRepair of Ebstein abnomaly is associated with low mortality and morbidity, acceptable reoperation rate and excellent valve function over time, especially in patients with completed Cone repair. Therefore, we conclude that in our centre, repair of Ebstein abnomaly is a durable technique to treat patients.

Object. Most craniocerebral injuries are caused by mechanisms of acceleration and/or deceleration. Traumatic injuries following progressive compression to the head are certainly unusual. The authors reviewed clinical and radiological features in a series of patients who had sustained a special type of cranial crush injury produced by the bilateral application of rather static forces to the temporal region. Their aim was to define the characteristic clinical features in this group of patients and to assess the mechanisms involved in the production of the cranial injuries and those of the associated cerebral and endocrine lesions found in this peculiar type of head injury. Methods. Clinical records of 11 patients were analyzed with regard to the state of consciousness, cranial nerve involvement, findings on neuroimaging studies, endocrine symptoms, and outcome. Furthermore, an experimental model of bitemporal crush injury was developed by compressing a dried skull with a carpenter's vice. Seven of the 11 patients were 16 years old or younger. All patients presented with a characteristic clinical picture consisting of no loss of consciousness (six patients), epistaxis (nine patients), otorrhagia (11 patients), peripheral paralysis of the sixth and/or seventh cranial nerves (10 patients), hearing loss (five patients), skull base fractures (11 patients), pneumocephalus (11 patients), and diabetes insipidus (seven patients). Ten patients survived the injury and most recovered neurological function. Conclusions. Static forces applied to the head in a transverse axis produce fractures in the skull base that cross the midline structures without producing significant cerebral damage. Stretching of cranial nerves at the skull base explains the nearly universal finding of paralysis of these structures, whereas an increase in the vertical diameter of the skull accounts for the occurrence of diabetes insipidus in the presence of an intact function of the anterior pituitary lobe. The association of clinical, endocrine, and neuroimaging findings encountered in this peculiar type of head injury supports the idea that this subset of injured patients has a distinctive clinical condition, namely the syndrome of bitemporal crush injury to the head.

Abstract The tumor microenvironment of pancreatic ductal adenocarcinoma (PDA) includes abundant fibroblasts and infiltrating immune cells, the latter largely immunosuppressive. We previously showed that targeting regulatory T cell (Treg), a prevalent T cell population in pancreatic cancer, failed to relieve immunosuppression and led to accelerated tumor progression. We discovered that Treg depletion reprogrammed tumor associated fibroblasts and increased immunosuppressive myeloid cell recruitment, an effect that was partially mediated by CCLs/CCR1signaling. Thus, we sought to investigate the potential therapeutic effect of targeting CCR1 in pancreatic cancer. By single cell RNA sequencing, we found CCR1 to be mainly expressed by tumor associated macrophages (TAMs) and neutrophils (or granulocytes) in both human and mouse PDA. We then orthotopically transplanted syngeneic mouse pancreatic cancer cells in CCR1 knockout hosts, and observed reduced tumor growth which was rescued by CD8 T cell depletion. Histological analysis showed elevated Granzyme B expression in infiltrating T cells, as well as an increase in cleaved caspase 3 positive cancer cells in tumors implanted in Ccr1−/− mice. Through cytometry by time of flight (CyTOF) and co-immunofluorescence we also discovered that TAMs in tumors implanted in Ccr1−/− mice expressed less Arginase 1 and CD206 -both markers of immunosuppressive macrophages- compared to TAMs in wild type tumors. Thus, our data is consistent with the notion that tumor associated macrophages lacking CCR1 expression are less immunosuppressive, consequently allowing increased CD8 T cell-mediated anti-tumor immunity. We are currently exploring combination approaches targeting CCR1 in pancreatic cancer. Citation Format: Yaqing Zhang, Kristee L. Brown, Wei Yan, Zeribe C. Nwosu, Eileen K. Carpenter, Katelyn L. Donahue, Ashley Velez-Delgado, Sion Yang, Marina Pasca di Magliano. Targeting CCR1 reprograms tumor associated macrophages in pancreatic cancer [abstract]. In: Proceedings of the AACR Virtual Special Conference on Pancreatic Cancer; 2021 Sep 29-30. Philadelphia (PA): AACR; Cancer Res 2021;81(22 Suppl):Abstract nr PO-129.

ObjectiveMitral valve repair using an undersized complete annuloplasty ring in secondary mitral regurgitation with restricted leaflet motion during systole (Carpentier’s surgical classification of mitral valve pathology: type IIIb) only inadequately addresses the underlying left ventricular disease. This may lead to an ongoing ventricular remodelling and progressive papillary muscle displacement with increasing leaflet tethering. Several subannular techniques have been proposed to counteract the reoccurrence of mitral regurgitation after mitral valve repair. We aimed to evaluate the potential additive effect of such subannular techniques on the late reoccurrence rate of secondary mitral regurgitation.MethodsSystematic literature review and meta-analysis were performed on PubMed, Embase and Google Scholar for studies published up to March 2016 and reporting late reoccurrence of mitral regurgitation after mitral valve repair using standard annuloplasty (control group) versus annuloplasty with subannular correction (study group) cohorts. Primary endpoint was late reoccurrence of mitral regurgitation ≥2 after surgical mitral valve repair, as defined by follow-up echocardiography.ResultsThe cumulative number of 1093 patients in 12 included studies served as our study population. A total of 743 patients underwent combined mitral valve repair including annuloplasty and subannular manoeuvre (ie, study group), while the remaining 350 patients underwent an isolated ring annuloplasty (ie, control group). Secondary mitral regurgitation was caused by ischaemic heart disease in 733/743 patients in the study group and 334/350 patients in the control group. Mean echocardiographic follow-up was 42.7±13.9 months. Pooled outcome analysis demonstrated that the combination of subannular repair with ring annuloplasty was associated with a significantly lower reoccurrence rate of mitral regurgitation ≥2 as compared with annuloplasty alone (OR 0.27, 95% CI 0.19 to 0.38, P=0.0001).ConclusionThe combination of subannular reconstruction and mitral valve annuloplasty is associated with a lower late reoccurrence of mitral regurgitation after surgical mitral valve repair, as compared with annuloplasty alone.

Purpose To determine the efficacy and safety of weekly docetaxel and trastuzumab as first- or second-line therapy in women with HER-2–overexpressing metastatic breast cancer and to correlate the efficacy of trastuzumab with HER-2 status as determined by immunohistochemistry assay and fluorescent in situ hybridization (FISH). Patients and Methods Twenty-six women with HER-2–positive (HercepTest [Dako Corp, Carpenteria, CA]2 to 3+) metastatic breast cancer were enrolled onto this study of trastuzumab (4 mg/kg load; 2 mg/kg/wk administered intravenously) and docetaxel (35 mg/m2/wk for 6 weeks). Results Using an intent-to-treat analysis, the overall response rate was 50% (13 of 26 patients). Eight patients (31%) had a period of stable disease posttherapy. Among HER-2 3+ patients, the overall response rate was 63% (12 of 19 patients) compared with a 14% response rate (one of seven patients) for HER-2 2+ patients (P = .07). Patients with FISH-positive tumors experienced an overall response rate of 64%. Median time to progression was 12.4 months for the entire cohort (HER-2 3+ tumors, 12.3 months; HER-2 2+ lesions, 9.5 months) and median survival was 22.1 months. All HER-2 3+ patients were FISH-positive; the only HER-2 2+ patient responding to treatment was also FISH-positive. Grade 4 toxicities occurred in four patients; most toxicities were mild. Conclusion Trastuzumab plus docetaxel is an active and well-tolerated regimen in women with HER-2 3+ overexpressing or FISH-positive metastatic breast cancer.

Background: Our study is aimed at evaluating the mid-term surgical outcomes of mitral valve repair in children using various chordal reconstructive procedures (autologous in situ chords or artificial chords). Methods: A retrospective analysis of 154 patients who underwent mitral valve repair using various chordal reconstructive procedures from 1992 to 2012. Patients were divided into group A and group B based on use of artificial chords and autologous in situ chords, respectively, for the repair. There were 102 (66.2%) patients in group A and 52 (33.8%) patients in group B. The mean age at repair was 11.1 ± 4.5 years. Associated cardiac anomalies were found in 94 (61%) patients. Results: The median follow-up period was 4.2 years (Interquartile range: 2.0-9.9). There were two (1.3%) early deaths and five (3.2%) late deaths. There was no significant difference in survival at 15 years between the two groups (group A: 91.8% vs group B: 95.1%; P = .66). There was no significant difference in the freedom from reoperation at 15 years between group A (79.4%) and group B (97.2%; P = .06). However, there was significant difference in freedom from valve failure between group A (56.5%) and group B (74.1%; P = .03). Carpentier functional class III and postoperative residual mitral regurgitation (2+ MR, ie, mild–moderate MR) were the risk factors for valve failure. Conclusions: Severity of the disease and its progression has profound effect on the valve repair than the technique itself. Both chordal reconstructive procedures can be used to produce satisfactory results in children.

Abstract. Renewal of ultrafine aerosols in the marine boundary layer may lead to repopulation of the marine distribution and ultimately determine the concentration of cloud condensation nuclei (CCN). Thus the formation of nanometre-scale particles can lead to enhanced scattering of incoming radiation and a net cooling of the atmosphere. The recent demonstration of the chamber formation of new particles from the photolytic production of condensable iodine-containing compounds from diiodomethane (CH2I2), (O'Dowd et al., 2002; Kolb, 2002; Jimenez et al., 2003a; Burkholder and Ravishankara, 2003), provides an additional mechanism to the gas-to-particle conversion of sulphuric acid formed in the photo-oxidation of dimethylsulphide for marine aerosol repopulation. CH2I2 is emitted from seaweeds (Carpenter et al., 1999, 2000) and has been suggested as an initiator of particle formation. We demonstrate here for the first time that ultrafine iodine-containing particles are produced by intertidal macroalgae exposed to ambient levels of ozone. The particle composition is very similar both to those formed in the chamber photo-oxidation of diiodomethane and in the oxidation of molecular iodine by ozone. The particles formed in all three systems are similarly aspherical. When small, those formed in the molecular iodine system swell only moderately when exposed to increased humidity environments, and swell progressively less with increasing size; this behaviour occurs whether they are formed in dry or humid environments, in contrast to those in the CH2I2 system. Direct coastal boundary layer observations of molecular iodine, ultrafine particle production and iodocarbons are reported. Using a newly measured molecular iodine photolysis rate, it is shown that, if atomic iodine is involved in the observed particle bursts, it is of the order of at least 1000 times more likely to result from molecular iodine photolysis than diiodomethane photolysis. A hypothesis for molecular iodine release from intertidal macroalgae is presented and the potential importance of macroalgal iodine particles in their contribution to CCN and global radiative forcing are discussed.

The publication actualizes the experience of organizing out-of-school education in Ukraine in the Soviet period (1952–1991) and indicates the ways of its use in modern conditions. The author singles out progressive ideas of the experience in the organization of out-of-school education in Ukraine in the period under study, which deserve consideration in the context of their implementation in out-of-school education in modern conditions: development of regulatory framework (it is stressed that now we observe inconsistency between regulatory and legislative framework concerning budgetary financing of out-of-school educational institutions and payment of teachers, scientific staff, specialists of other qualifications working there); creation of an extensive infrastructure of out-of-school educational institutions (it is proposed to pay attention to the resumption of carpentry, turning, wickerwork for boys; cooking, embroidery, knitting, tailoring for girls when forming a network of out-of-school educational institutions); state financial support; establishing relations of out-of-school educational institutions with state, private and public organizations (it is noted that now every leader and teaching staff faces the problem of determining the mechanism of establishing partnership interaction of out-of-school educational institutions with public authorities, local governments, public organization ); forming leisure culture in students (it is emphasized that further development requires a network of various out-of-school institutions that create the necessary conditions for comprehensive harmonious development of teenagers, develop new forms and methods of out-of-school activities in the field of leisure, as well as ways of involving teenagers in various leisure activities both at school and in out-of-school clubs and creative centers); regulation and improvement of the system of professional training, retraining and advanced training of specialists in the system of out-of-school education; physical infrastructure support of out-of-school educational institutions (it is noted that physical infrastructure support should include all the necessary equipment, facilities and inventory for various forms of organization of out-of-school education (group, club, section, etc.).

This article, written by JPT Technology Editor Chris Carpenter, contains highlights of paper SPE 204153, “Reducing the Placement Cost of a Pound of Proppant Delivered Downhole,” by Jon Sochovka, SPE, Kyle George, and Howard Melcher, Liberty Oilfield Services, et al. The paper has not been peer reviewed. The shale industry has changed immensely during the last decade and is once again in rapid transition. The authors write that they are unsure about the nature of innovations to make US shale more competitive, but that they are certain that the current downturn will drive a further reduction in the total cost to lift a barrel of US shale oil to the surface ($/BO). In the complete paper, the authors discuss what components have contributed to this reduction and use several case studies, only three of which are discussed in this synopsis, to illustrate the potential for further cost reductions. Background The industry has been changing to address the issues of proppant delivery, constantly striving to find better chemical products while pumping fewer of them. First, a general desire exists to move away from more-expensive chemical-derivative guar systems to simpler low-concentration guar systems and fiction-reducer (FR) -based fluid systems. Second, both proppant-delivery and formation-treatment chemicals that are part of the fracture treatment have become more effective, fewer in number on the market, and smaller in quantity. The intended approach is to measure the individual and combined performance of these chemicals and the effect they have on physical rock and fluid parameters using a range of laboratory and field-testing tools and to compare the potential effects of these choices in the authors’ extensive production database. The elusive goal for fracturing fluids is to be composed 100% of water. In some cases, a water composition of 99.83% has been achieved. Higher rates still may be realized if pump rates for fracturing jobs continue to rise, proppant size reduces, and properties of some concentrated additives continue to improve as they have during the rapid progression to water experienced over the past 15 years of the shale revolution.

Abstract Pancreatic ductal adenocarcinoma (PDA) is a dismal disease with a 5-year survival rate of 11%. This poor prognosis is due in part to a lack of early disease detection and resistance to current therapies. The most common PDA precursor is pancreatic intraepithelial neoplasia (PanINs); a microscopic lesion that cannot be detected by imaging. Accumulation of a series of genomic mutations in pancreatic exocrine cells leads to formation of PanINs through mechanisms that remain unknown. While PanIN development has been well-studied in genetically engineered mouse models, its onset and pathogenesis in humans has remained elusive due to the inability to study tissue from pathologically normal pancreases. Due to its abundance in digestive enzymes, the pancreas degrades shortly after death and autopsy samples are not suitable for several research applications that require fresh tissue. Through collaboration with the Gift of Life Organ and Tissue donation program, we performed histological and transcriptomic analysis on ten normal pancreata that were refused for transplant. Histological analysis revealed the presence of PanIN lesions in 6 of the 10 donors as early as 25 years of age. To delineate the molecular, cellular, and spatial composition of PanIN lesions to those from acinar and ductal cells we combined single cell RNA sequencing analysis with spatial transcriptomics for the same sample. Annotation of cellular composition of distinct tissue regions demonstrated that PanIN transcriptome closely resembled that of invasive PDA. Using differential expression analysis, we identified factors that were highly expressed in PanINs, but not expressed in normal acini or ducts. We validated the transcript-based findings with immunostaining and RNA in-situ hybridization. We then sought to characterize the microenvironment of the normal pancreas and of PanIN lesions using multiplex immunohistochemical analysis. We observed abundant fibroblasts and macrophages in normal areas of the pancreas as well as surrounding PanIN lesions, while T cells were limited to the latter. Currently, we are characterizing the transcriptome profile of macrophages and fibroblasts. Uncovering the factors that promote the development of sporadic PanINs and their progression to malignancy could aid in designing preventative strategies for high-risk individuals. Citation Format: Padma Kadiyala, Eileen Carpenter, Ahmed Elhossiny, Yaqing Zhang, Sarah Nelson, Fatima Lima, Katelyn Donahue, Wenting Du, Jake McGue, Hannah Watkoske, Holly Attebury, Donnele Daley, Filip Bednar, Arvind Rao, Timothy Frankel, Marina Pasca Di Magliano. Investigating the role of pancreatic intraepithelial neoplasia in development of pancreatic ductal adenocarcinoma [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer; 2022 Sep 13-16; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2022;82(22 Suppl):Abstract nr C062.

This article, written by JPT Technology Editor Chris Carpenter, contains highlights of paper SPE 202290, “Digital Documentation and Data Management for Offshore Drilling,” by Zhong Cheng, SPE, Xi’an Shiyou University and CNOOC, and Rongqiang Xu and Xiaolong Yu, CNOOC, et al., prepared for the 2020 SPE Asia Pacific Oil and Gas Conference and Exhibition, originally scheduled to be held in Perth, Australia, 20–22 October. The paper has not been peer reviewed. The industry is expending significant effort into using instrumentation and software to optimize operations in all domains for exploration and production to move toward the digital oil field. The complete paper describes an integrated geological-engineering data-management project covering all aspects of well-engineering work flows, with the objective of providing a continuous improvement platform to users. Introduction CNOOC has spent more than 20 years on the progression of information construction. A private cloud platform was completed in 2018, and the characteristics of oil and gas data and critical storage-management technologies were studied systematically. At the same time, nearly 20 kinds of drilling- operation analysis software have been developed independently. From the perspective of engineering technology, these provide real-time monitoring, remote decision-making, technical training, and other information resource services and support for offshore drilling operations. However, the following problems restrict the efficient operation of such projects: - Because of the lack of a unified data-integration-application platform, data sharing has not yet been realized. - In the process of real-time monitoring and remote decision-making, more engineering information based on drilling operations lacks the support of geomechanical data. - The knowledge base and case library to guide the prevention and handling of drilling-operation accidents have not been established. System-Target Analysis The design goals of the platform are embodied in three aspects: function, safety, and operability, while system performance requirements are summarized as adaptability, response speed, scalability, maintainability, and the effective-ness of failure-handling mechanisms. According to the functional requirements of different users for offshore-drilling cloud technical services, users generally are divided into three categories: headquarters decision-making managers, drilling-operation project teams, and system-operation and maintenance-service providers. System Construction Goals and Architecture Construction Goals - Chief among these was to build a geological-engineering integrated data-management platform. Another important goal was to build a case-management platform. An intelligent search engine is established to retrieve the corresponding disposal knowledge through a comprehensive information model. A knowledge-management subsystem is established, and users are linked with internal knowledge-management processes with the help of the cloud. The specific operation process is carried out in the private cloud, and the results are fed back to the user through the human/computer interface.

Objectives: For irreparable rotator cuff tears, we developed a new surgical treatment—arthroscopic superior capsule reconstruction (SCR)—to restore superior shoulder stability, muscle balance, and shoulder function. The objective of this study was to assess (1) changes in functional outcome; (2) changes in graft thickness; (3) rates of graft tear; and (4) rates of glenohumeral osteoarthritis during a 5-year follow-up period. Methods: From 2007 to 2013, arthroscopic SCR using autograft of fascia lata was performed on 37 shoulders with irreparable rotator cuff tears. Seven patients were lost to follow-up. Consequently, 30 shoulders (mean age, 68.0 years) were enrolled in the study. Shoulder range of motion (ROM), American Shoulder and Elbow Surgeons (ASES) and Japanese Orthopaedic Association (JOA) scores, acromiohumeral distance (AHD), Hamada grade, and Goutallier grade were compared among before surgery, 1 year after SCR, and 5 years after SCR. Graft thickness, which was measured in MRI, was compared among 3 months, 1 year, and 5 years after SCR. One-way analysis of variance followed by Fisher’s LSD post-hoc test was performed for statistical analysis. In addition, rates of return to sport or work were investigated in those patients who had been employed (12 patients: 5 carpenters, 5 farmers, and 2 construction workers) or played sports (8 patients: 2 table tennis, 1 golf, 1 martial arts, 1 yoga, 1 badminton, 1 mountain-climbing, and 1 ground golf) before injury. Results: Both ASES and JOA scores after arthroscopic SCR improved significantly at both 1 year ( P < 0.001) and 5 years after SCR ( P < 0.001). ASES score at 5 years after SCR was significantly better than that at 1 year after SCR ( P = 0.02). Postoperative ASES scores at both 1 year and 5 years after SCR were better in healed patients (27 patients) than in unhealed patients suffering from graft tear (3 patients). Active elevation was significantly improved at both 1 year and 5 years after SCR ( P < 0.001). At five years after SCR, 11 patients were still working and one patient, who had returned to part-time work at 1 year, had retired. All 8 patients were still playing sport before their injuries at 5 years after SCR. AHD was increased significantly at both 1 and 5 years after SCR ( P < 0.001). There was no significant difference in AHD between 1 and 5 years after SCR ( P = 0.16). In the 27 patients in whom the graft remained intact, graft thickness did not differ significantly among 3 months, 1 year, and 5 years after SCR ( P = 0.67). Hamada grade was significantly improved at both 1 and 5 years after SCR (preoperative: 2.3 ± 0.8; 1 year: 1.3 ± 0.7; 5 years: 1.3 ± 0.7, P < 0.001). All patients who had graft healing had no progression of glenohumeral osteoarthritis during the 5-year follow-up period. Two of the 3 patients with graft tear were suffering severe glenohumeral osteoarthritis (with narrowing of the glenohumeral joint space) at 5 years after SCR. The Goutallier grade did not change significantly after SCR in any patients. Conclusion: In a 5-year follow-up study, arthroscopic SCR restored shoulder function and resulted in high rates of return to recreational sport and work. Shoulder function and ROM were likely to get better with time. Graft tear exacerbated the clinical outcome after SCR and caused glenohumeral osteoarthritis in 2 of 3 patients by 5 years after SCR. Graft thickness and postoperative AHD did not change significantly between 1 and 5 years of follow-up, suggesting that we can expect excellent functional outcomes with long-term follow-up. [Table: see text]

This article, written by JPT Technology Editor Chris Carpenter, contains highlights of paper OTC 30403, “Sand Production Management While Increasing Oil Production of a Gravel-Packed Well Equipped With Rate-Controlled-Production Autonomous Inflow-Control Devices in a Thin Heavy-Oil Reservoir Offshore China,” by Shuquan Xiong, Fan Li, and Congda Wei, CNOOC, et al., prepared for the 2020 Offshore Technology Conference Asia, originally scheduled to be held in Kuala Lumpur, 2–6 November. The paper has not been peer reviewed. Copyright 2020 Offshore Technology Conference. Reproduced by permission. A 2018 infill development campaign for a horizontal well offshore China targeted improved production through the installation of autonomous inflow-control devices (AICDs). However, because the well requires gravel packing to manage the sand, the integration of AICDs and the gravel pack was an issue. An integrated work flow was followed to deliver the AICD application successfully in an offshore heavy-oil reservoir with major uncertainties in remaining oil thickness and water/oil contacts. AICD completions ensured balanced contribution from all reservoir sections and limited water production significantly while the gravel pack kept the valves safe from the effects of sand. Field Description The field is a low-amplitude fault anticline oil field developed on the basement uplift. The structure is relatively gentle (Fig. 1). The reservoir lithology is mainly feldspathic quartz sandstone, with an average porosity of 22%, an average permeability of 397 md, a reservoir pressure coefficient of 1, an oil density of 0.92 g/cm3, and crude oil viscosity of 150 cp. The current methodology for gravel packing with ICDs/AICDs in the well uses a multiple alpha-wave technique whereby at least one conventional standalone screen joint is deployed at the toe of the well to provide a return path during the buildup of the alpha wave. The flow rate is reduced progressively to maximize the dune weight until screenout is observed. Once the gravel-packing operation is complete, the standalone-screen section at the toe is isolated before the well is placed on production. This technique does not allow a complete pack to be achieved and will allow more gravel to build up around the zonal isolation packers. This methodology is most applicable in unconsolidated sands with high net-to-gross reservoirs where borehole collapse will occur early in well life. One technique to provide sufficient flow path through the screen assembly is to integrate sliding sleeves into each screen joint. However, in long lateral wellbores, this may be prohibitively expensive and requires multiple manual manipulations as the wash pipe is retrieved. The use of a temporary bypass valve is recommended to enable standard gravel-packing operations to be performed with ICDs without significant additional cost, complexity, or compromise. The dissolvable material is used with a valve located within the ICD/AICD housing to provide a high-flow-area path from the annulus to the tubing during completion operations.

This article, written by JPT Technology Editor Chris Carpenter, contains highlights of paper SPE 203335, “Using MSE and Downhole Drilling Dynamics in Achieving a Record Extended-Reach Well Offshore Abu Dhabi,” by Nashat Abbas and Jamal Al Nokhatha, ADNOC, and Luis Salgado, Halliburton, et al., prepared for the 2020 Abu Dhabi International Petroleum Exhibition and Conference, Abu Dhabi, held virtually 9–12 November. The paper has not been peer reviewed. Complex extended-reach-drilling (ERD) wells often present challenges with regard to geological aspects of data requirement and transmittal, reactive geosteering response times, and accuracy of well placement. Such scenarios may require innovative approaches in Middle East carbonate reservoirs. The objective of the complete paper is to illustrate that, by assessing the details of reservoir geology and key operational markers relevant for best practices, drilling approaches can be customized for each reservoir or scenario. Reservoir Background and Geology The planned reservoir section is a single horizontal of approximately 25,000-ft lateral length at a spacing of 250 m from adjacent injectors. The well was drilled from an artificial island. Field A, a shallow-water oil field, is the second-largest offshore field and the fourth-largest field in the world. Horizontal drilling was introduced in 1989, and an extensive drilling campaign has been implemented since then using steerable drilling technologies. This study is concerned only with wells drilled to develop Reservoir B in Field A, which contributes to the main part of initial oil in place and production. The thick limestone reservoir is subdivided into six porous layers, labeled from shallow to deep as A, B, C, D, E, and F. Each porous layer is separated by thin, low-porosity stylolites. The reservoir sublayer B, consisting of approximately 18-ft-thick calcareous limestones, was selected as the target zone for the 25,420-ft horizontal section. ERD, constructed on artificial islands, began on 2014 with a measured depth (MD)/true vertical depth (TVD) ratio approaching 2.2:1 or 2.4:1. A recent ERD well, Well A, was drilled at the beginning of 2020 with a MD/TVD ratio of 5:1. This value is a clear indication of progressively increasing challenges since the start of the project. Mechanical specific energy (MSE) has long been used to evaluate and enhance the rate of penetration (ROP); however, its use as an optimization tool in ERD wells has not been equally significant. This may have been mostly because of historical use of surface-measured parameters, which do not necessarily indicate the energy required to destroy the rock, particularly in ERD wells. Using optimization tools as part of the bottomhole assembly (BHA) downhole close to the bit provides actual weight-on-bit (WOB) and torque-on-bit (TOB) applied to the drilling bit to destroy the rock and, thus, results in more-representative MSE measurements to optimize drilling parameters and ROP in ERD wells.

Abstract Background: Mutations drive the initiation and progression of cancer. A leading druggable source of mutation in cancer is enzymatic deamination of single-stranded DNA cytosines by cellular APOBEC3 enzymes. Cytosine-to-uracil deamination can result in a variety of different mutational outcomes including DNA breakage and chromosomal aberrations as well as single base substitution mutations. The latter are comprised of C-to-T and C-to-G mutations in TCA or TCT trinucleotides and attributable to the intrinsic preference of several APOBEC3 family members for binding to these motifs. This mutation pattern, commonly called the “APOBEC signature”, is evident in approximately one-quarter of primary breast tumors and one-third of metastatic breast tumors. Although multiple APOBEC3 enzymes have been implicated as a source of this signature in breast cancer (namely, APOBEC3A, APOBEC3B, and APOBEC3H), the literature is full of conflicting views and it is not clear which of these enzymes contributes most significantly to the mutational landscape of breast cancer. Methods: The near-haploid human cell line, HAP1, was engineered to express the HSV-1 TK gene as a mutation reporter. Candidate APOBEC3 enzymes were expressed individually and confirmed by immunoblotting and activity assays. DNA breakage was measured directly by COMET assays and DNA damage responses indirectly by phosphorylated gamma-H2AX staining. Mutation frequencies were quantified by assaying rates of drug resistance, and mutation patterns were analyzed by sequencing locally in TK and globally across whole genomes. Results: APOBEC3A and APOBEC3B both caused significant increases in chromosomal DNA breakage and DNA damage responses. These enzymes also elevated drug resistance mutation frequencies. In contrast, expression of active APOBEC3H or catalytic mutant derivatives of APOBEC3A and APOBEC3B failed to trigger increases beyond normal spontaneous levels. Interestingly, APOBEC3A and APOBEC3B both inflicted mutation signatures that were indistinguishable locally in TK and globally across whole genomes. The vast majority of these APOBEC signature mutations were dispersed (non-kataegic) and not associated with obvious mesoscale chromosomal features such as single-stranded loop regions of stem-loop structures. Computational comparisons of the broader pentanucleotide APOBEC3A and APOBEC3B mutation signatures and those extracted from 794 primary breast tumor genomes (ICGC cohort) revealed an APOBEC3A-biased subset, an APOBEC3B-biased subset, and a larger group of tumors best explained by combinatorial action of both of these enzymes. Conclusions: Our results indicate that APOBEC3A and APOBEC3B contribute combinatorially in most instances to the observed APOBEC mutation signature in breast cancer. These results provide a framework for developing diagnostic and therapeutic approaches for APOBEC-positive breast cancer. Citation Format: Reuben S Harris, Matthew C Jarvis, Michael A Carpenter, Margaret R Brown, Prokopios P Argyris, William Brown, Douglas Yee. Apobec mutation signature in breast cancer explained by combinatorial action of apobec3a and apobec3b [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-12-01.

_ This article, written by JPT Technology Editor Chris Carpenter, contains highlights of paper SPE 209475, “Unraveling the Mystery of Inhibitor-Resistant Calcite Affecting Onshore and Offshore Operations,” by Hugh M. Bourne, SPE, Adil A. Abbasov, and Ben E. Smith, BP. The paper has not been peer reviewed. _ Magnesian calcite has been identified as the main constituent of solids fouling in several of an operator’s facilities in the North Sea and Azerbaijan and in partner operations in other locations. These solids were, for many years, thought to be calcite scale. The complete paper describes how this “pseudoscale” was detected and its prevalence, using field case examples. The Discovery: Case 1 Soon after the start of operations in May 2017, fouling of the rundown coolers was observed on a North Sea floating production, storage, and offloading vessel. The increase in differential pressure across the coolers was believed to be the result of wax deposition. The cooler performance, however, progressively deteriorated with every dewaxing cycle to a point at which running the cooler without cooling medium had no effect on the differential pressure. One of the rundown coolers was removed and returned to the manufacturer for inspection and cleaning. This revealed that hard, scale-like solids were filling the space between the plates completely (Fig. 1). The retrieved solids dissolved in acid, were calcium-rich, and appeared visually and mechanically to be a scale; thus, they were assumed initially to be calcium carbonate. The first analysis of solids from the rundown cooler and other parts of the plant suggested that up to 33% of the composition of these solids was calcium, which would be equivalent to greater than 80% of these solids being calcium carbonate. Scaling in the rundown cooler was not expected and raised concerns about uncontrolled scaling in other parts of the plant. A wider review of plant performance was initiated, and more-detailed analysis of the solids collected in the rundown coolers was undertaken using X-ray diffraction spectroscopy (XRD). The rundown cooler solids analysis revealed an inorganic crystalline compound consisting of magnesian calcite (calcium/magnesium carbonate) that had the appearance of a compacted transported solid. The dewaxing frequency was increased to prevent this accumulation, which ultimately proved an effective mitigation strategy. The wider review of plant performance identified frequent fouling of the produced water-pump suction strainers and a gradual decrease in the performance of the crude-oil heaters. Analysis of the solids fouling the produced-water-pump suction strainers also was dominated by magnesian calcite, suggesting that the reservoir fines were transported in both the oil and the produced-water streams. Reservoir solids fouling is not uncommon, but, by the beginning of 2018, the decrease in the differential pressure trend across the crude-oil heaters became more prominent. By the end of the first quarter of 2018, the degradation was limiting the ability of the plant to meet temperature set points in the separators, potentially limiting production rates.

This article, written by JPT Technology Editor Chris Carpenter, contains highlights of paper IPTC 21441, “First-Time Worldwide Application of Glass-Reinforced Epoxy-Lined Tubing for Prevention of Asphaltene Deposition in Tubing in Oil Wells: A Case Study From Kuwait,” by Reji E. Chinnappan, SPE, Milan Telang, SPE, and Riyad Quttainah, SPE, Kuwait Oil Company, et al., prepared for presentation at the virtual 2021 International Petroleum Technology Conference, 23 March–1 April. The paper has not been peer reviewed. Copyright 2021 International Petroleum Technology Conference. Reproduced by permission. Asphaltene deposition in production tubing represents a major flow-assurance challenge. Common strategies to mitigate asphaltene deposition downhole include mechanical or solvent cleanouts and chemical inhibition. These are associated with production deferment, high job costs, safety and environmental risks, and operational issues. An operator has addressed this challenge using production tubing lined with glass-fiber-reinforced epoxy (GRE). This technology was implemented in two trial wells. The paper describes the different mitigation strategies employed by the operator and presents the findings of successful trials. Background Jurassic wells of a Kuwait Oil Company asset are producing light crude from a tight matrix-type reservoir located at a depth of 13,000–15,000 ft. Reservoir pressure has depleted from approximately 9,500–10,000 psi to approximately 6,000 psi because of sustained production in the absence of any significant pressure support. Oil production rates per well have diminished to the 500- to 1,000-BOPD range. The oil features high asphaltene onset pressures (4,000–5,000 psi). When considering time-lapse plots of caliper logs from a well where asphaltene deposition used to occur, the plot indicates that significant asphaltene deposition in the well took place below 4,500 ft and progressively increased over time. In approximately 5 months, the average internal diameter of the tubing reduced from 2.75 in. to less than 2 in., thereby constricting the flow significantly and requiring cleaning of the tubing. In extreme cases, the tubing string could be fully plugged. Many field trials with different tools and chemicals using batch and continuous treatment have been conducted in past years to solve this problem but without satisfactory results. Application of GRE-Lined Tubing for Asphaltene Control The operator decided to apply a novel strategy of using tubing internally lined with GRE based on its established ability to retard, and even eliminate, scale nucleation and deposition. The technology uses a thin-walled, solid-filament-wound GRE/fiberglass tube run inside carbon steel production tubing. Cement is pumped into the annulus between the steel tubing and the GRE liner. The ability to prevent asphaltene from sticking to the inner wall of the tubing is attributed to the smoother internal surface. It is also corroborated by a higher Hazen Williams coefficient value of 150 for GRE as compared with 110 for carbon steel pipe, which provides for lesser frictional pressure loss during flow. The GRE liners used by the operator have a surface roughness of 0.00011 in., which, unlike bare steel, is retained over the life of the GRE. The GRE-lined tubing proved to withstand temperatures of up to 280°F and hydrogen sulfide concentrations of up to 50%. This is comfortably more than the process conditions for the trial wells in consideration.

Abstract Up to 85% of patients with resectable pancreatic ductal adenocarcinoma (PDAC) experience metastatic relapse after curative intent surgery with many recurring early. Detection of such occult metastases (those thought to be below the level of detection of standard of care imaging at the time of resection) could steer patients to a different treatment course rather than delaying systemic therapy until after recovery from inappropriate surgery. Here we investigate the potential of pancreas-specific circulating cell-free DNA (cfDNA) as a biomarker for the detection of occult metastatic disease and as a prognostic biomarker. Blood specimens were collected from 53 patients (15 negative control healthy subjects, 11 positive control metastatic PDAC patients, and 27 resectable PDAC patients prior to resection), processed to plasma, and banked. Plasma cfDNA was extracted, quantified, treated with bisulfite, and used as template for PCR amplification of 9 marker loci that are uniquely unmethylated in DNA of pancreatic acinar or duct cells. Following deep sequencing of PCR products, the fraction of cfDNA molecules derived from the pancreas was determined and multiplied by the total cfDNA concentration to yield pancreas-specific cfDNA. Recurrence and survival data were abstracted from the medical record and receiver operator curve analysis was utilized to determine statistical significance. Metastases were categorized as overt (present at diagnosis), occult (discovered during or within 4 months of curative intent surgery), or two-year (discovered during or within two years of curative intent surgery). Pancreas-derived cfDNA was significant for the detection of occult or overt metastases in our full cohort (18 of 52 evaluable subjects) with an area under the curve (AUC) of 0.86 (95% Confidence Interval, 0.74-0.80) and 0.91 (0.83-1.00) for liver-specific occult or overt metastases (15 of 52). It was borderline significant for the detection of occult metastases in the resectable sub-cohort (7 of 27) with an AUC of 0.71 (0.47-0.96) but significant for the detection of occult liver-specific metastases (5 of 27) with an AUC of 0.79 (0.62-0.96). Further, detection of overt metastases or two-year metastases (28 of 50) was significant with an AUC of 0.85 (0.74-0.96). In the resectable sub-cohort, it was also significant for the detection of two-year metastases (17 of 25) with an AUC of 0.79 (0.60-0.97) and prognostic for 2-year overall survival (12 of 24) with an AUC of 0.81 (0.62-1.00) in the resectable sub-cohort. Liver-derived cfDNA was also analyzed and was always outperformed by pancreas-specific cfDNA. In this pilot cohort, enumeration of pancreas-specific cfDNA shows promise as biomarker of occult metastatic disease, two-year metastatic progression, and two-year overall survival in resectable PDAC. Further investigation of a larger cohort and potential combination with other known markers like CA19-9 and tumor size is underway; results for an additional ~40 patients will be available by the time of the meeting. Citation Format: Jacob E. Till, Roni Ben-Ami, Ruth Shemer, Kristine Kim, Aseel Abdalla, Samuele Cannas, Charles M. Vollmer, Mark H. O'Hara, Ben Z. Stanger, Yuval Dor, Erica L. Carpenter. Pancreas-specific circulating cell-free DNA for detection of occult metastases and prognosis in resectable pancreatic ductal adenocarcinoma [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer; 2022 Sep 13-16; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2022;82(22 Suppl):Abstract nr A030.

Background:Systemic sclerosis (SSc) is a multi-system connective tissue disease1. Raynaud phenomenon (RP) is a frequent (>90%) manifestation in SSc2& if untreated could lead to complications such as digital ulcers, gangrene and amputation.Calcium antagonists are considered as first-line therapy for symptomatic SSc-RP. In refractory cases phosphodiesterase type 5 (PDE-5) inhibitors- Sildenafil and PGI2 analogue- Iloprost are used. A meta-analysis of trials indicate that PDE-5 inhibitors reduce the frequency and severity of SSc-RP attacks.In addition a study done with PGE1 inhibitors- Alprostadil 60 micrograms infusion given for six consecutive days, had shown immediate efficacy in SSc- RP; as demonstrated by increased blood flow, digitally measured by telethermography. Furthermore there was a reduction of the number, frequency and severity of attacks3.Due to unavailability of Iloprost in Sri Lanka, based on the above evidence some rheumatology centres use Alprostadil 60 microgram infusion for 3 consecutive days in refractory symptomatic SSc-RP.Objectives:To assess immediate (Day 4) and intermediate (Day 42) efficacy of Alprostadil 60 microgram infusions given for 3 consecutive days in treating SSc-RP.Methods:An observational longitudinal study was conducted at the Rheumatology unit, Teaching Hospital Anuradhapura- Sri Lanka during 01.09.2019- 30.12.2019.Twelve diagnosed Systemic Sclerosis patients with symptomatic Raynaud’s (Raynaud’s score of >5) despite receiving maximum tolerable doses of calcium antagonists consisted of the study sample.Pre and post (on day 4 and 42) treatment frequency of Raynaud’s attacks and Raynaud’s score was recorded using a pre-tested interviewer administered questionnaire. Statistical analysis was done using SPSS version 22 with Wilcoxon Signed Rank test at 5% significance level.Results:All recruits were females (n=12). Median (IQR) age of the study population and disease-duration were 45 (40 to 53.5) years and 6 (2.8 to 9.5) years respectively. Among participants, 58.3% and 25% had previous or current digital ulcers and gangrene respectively.Table 1.Pre and post treatment mean frequency of attacks and mean Raynaud’s scorePre treatmentmedian (IQR)Post treatmentDay 4 median (IQR) and significance of the difference between the pre-treatment valuesPost treatmentDay 42 median (IQR) and significance of the difference between the pre-treatment valuesMean frequency of Raynaud’s attacks/ past 24hrs4.0 (2.3 to 5.0)0.0 (0.0 to 1.0)P<0.05*2.0 (0.3 to 3.8)P<0.05*Mean duration of attack/24hrs21.3 (1.1 to 32.5)0.5 (0.5 to 3.0)P<0.05*7.5 (3.0 to 25.0)P>0.05Mean Raynaud’s score6.5 (5.0 to 8.8)2.0 (0.3 to 2.8)P<0.05*3.0 (0.1 to 5.0)P<0.05**statistically significantConclusion:Alprostadil 60 microgram infusions demonstrated a statistically significant immediate and intermediate efficacy in treating symptomatic SSc- RP with reduction of frequency of Raynaud’s attacks and Raynaud’s score at both. Only immediate efficacy was seen for mean duration of attacks. Based on these and the observed satisfactory safety level, we recommend the use of Alprostadil for symptomatic Raynaud’s in SSc-RP as an alternative to Iloprost. Further studies of larger samples are recommended.References:[1]Kowal-Bielecka O, Fransen J, Avouac J EUSTAR Coauthors, et al Update of EULAR recommendations for the treatment of systemic sclerosis. Annals of the Rheumatic Diseases 2017;76:1327-1339[2]Carpentier P, Satger B, Poensin D, et al. Incidence and natural history of Raynaud phenomenon: a long-term follow-up (14years) of a random sample from the general population. J Vasc Surg 2006;44:1023–8[3]Bartolone S, Trifiletti A, DeNuzzo G. Efficacy evaluation of prostaglandin E1 against placebo in patients with progressive systemic sclerosis and significant Raynaud’s phenomenon. Minerva Cardioangiol 1999; 47: 137–143Disclosure of Interests:None declared

BackgroundImmune checkpoint inhibitor therapy, or ICI, is currently the most successful treatment option for patients with renal cell carcinoma (RCC). However, only 20% of patients have a durable response,1 driving a significant need to improve treatment outcomes. The tumor microbiome has recently been shown to play a role in chemotherapy-based treatment outcomes, but, to our knowledge, no study has explored its role in response to ICIs.2–4MethodsTumor samples were collected from 22 patients with RCC as a part of the Total Cancer Care program at The Ohio State University Comprehensive Cancer Center. Raw RNA-seq reads from these biopsies, as well as data on the responses to ICI therapy were collected. Response evaluation was based on RECIST v1.1 criteria with complete or partial response, or stable disease classified as ”Responders,”, and progressive disease classified as ”Non-responsders”. The RNA-seq reads were processed through a pipeline developed by the Spakowicz lab, known as ExoTIC (Exogenous sequences in Tumor and Immune Cells), to carefully identify exogenous sequences.5 6 Reads that don’t align to the human reference genome are meticulously filtered of (1) common laboratory contaminants, (2) taxa that inversely correlate with input RNA quantity, and (3) taxa commonly found in the negative controls of microbiome experiments. DESeq2 was used to perform a differential abundance analysis on the comparison groups at every taxonomic level.ResultsThe 22 patients with RCC range from 22 to 74 years of age at diagnosis, are 72.7% male, and 54.5% responded to ICIs. Exogenous taxa are identified in the tumor RNAseq, including bacteria, fungi, and viruses (figure 1). Within the tumors responsive to immunotherapy, there was found to be a significant enrichment of certain microbial species, including Bacillus thuringiensis, Comamonas testosteroni, Colletotrichum higginsianum, and Elaeis guineesis. Comparatively, the cohort of non-responsive tumors was found to have a significant enrichment of Candidatus Promineofilum breve, Clostridioides difficile, Nocardia cyriacigeorgica, Streptomyces sp. CdTB01, and Streptomyces venezuelae (figure 2).Abstact 942 Figure 1Relative abundances of exogenous taxa found in tumor RNAseq are shown in a stacked bar plotAbstact 942 Figure 2Differential abundance analysis of taxa found within tumor RNAseq data by the exotic pipeline. Colored points represent significantly (pvalue < 0.05) enriched taxa with a high (>2.5) fold-difference in abundance between the groupsConclusionsWe found that prior to ICI treatment the tumor microbiome of patients with RCC whose tumors responded to immunotherapy vary from those that did not respond to treatment. This implies that a therapeutic target to modify the tumor microbiome to improve treatment outcomes. Future research will evaluate whether these correlations are causally associated with outcomes and will evaluate their effect on the tumor microenvironment including immune cell infiltration.AcknowledgementsThe authors acknowledge the support and resources of the Ohio Supercomputing Center (PAS1695).ReferencesCiccarese C, Di Nunno V, Iacovelli R, Massari F. Future perspectives for personalized immunotherapy in renal cell carcinoma. Expert opinion on biological therapy. Taylor & Francis. 2017;17(9):1049–1052.Geller LT, Barzily-Rokni M, Danino T, Jonas OH, Shental N, Nejman D, Gavert N, Zwang Y, Cooper ZA, Shee K, Thaiss CA, Reuben A, Livny J, Avraham R, Frederick DT, Ligorio M, Chatman K, Johnston SE, Mosher CM, Brandis A, Fuks G, Gurbatri C, Gopalakrishnan V, Kim M, Hurd MW, Katz M, Fleming J, Maitra A, Smith DA, Skalak M, Bu J, Michaud M, Trauger SA, Barshack I, Golan T, Sandbank J, Flaherty KT, Mandinova A, Garrett WS, Thayer SP, Ferrone CR, Huttenhower C, Bhatia SN, Gevers D, Wargo JA, Golub TR, Straussman R. Potential role of intratumor bacteria in mediating tumor resistance to the chemotherapeutic drug gemcitabine. Science 2017 September 15;357(6356):1156–1160. PMID: 28912244.Nejman D, Livyatan I, Fuks G, Gavert N, Zwang Y, Geller LT, Rotter-Maskowitz A, Weiser R, Mallel G, Gigi E, Meltser A, Douglas GM, Kamer I, Gopalakrishnan V, Dadosh T, Levin-Zaidman S, Avnet S, Atlan T, Cooper ZA, Arora R, Cogdill AP, Khan MAW, Ologun G, Bussi Y, Weinberger A, Lotan-Pompan M, Golani O, Perry G, Rokah M, Bahar-Shany K, Rozeman EA, Blank CU, Ronai A, Shaoul R, Amit A, Dorf-man T, Kremer R, Cohen ZR, Harnof S, Siegal T, Yehuda-Shnaidman E, Gal-Yam EN, Shapira H, Baldini N, Langille MGI, Ben-Nun A, Kaufman B, Nissan A, Golan T, Dadiani M, Levanon K, Bar J, Yust-Katz S, Barshack I, Peeper DS, Raz DJ, Segal E, Wargo JA, Sandbank J, Shental N, Straussman R. The human tumor microbiome is composed of tumor type–specific intracellular bacteria. Science 2020 May 29;368(6494):973–980.Poore GD, Kopylova E, Zhu Q, Carpenter C, Fraraccio S, Wandro S, Kosciolek T, Janssen S, Metcalf J, Song SJ, Kanbar J, Miller-Montgomery S, Heaton R, Mckay R, Patel SP, Swafford AD, Knight R. Microbi-ome analyses of blood and tissues suggest cancer diagnostic approach. Nature 2020;579(7800):567–574. PMID: 32214244.Malalur, Pannaga, Mo, Xiaokui, Hoyd, Rebecca, Hays, John, Carbone, David, Spakowicz, Daniel. Investigating intra-tumor microbes, blood microbes, and CEA for development of non-invasive biomarkers in colorectal cancer. Journal of Clinical Oncology 2021;39(15_suppl): 3551–3551.Malalur PG, Mo X, Hoyd R, Carbone DP, Spakowicz D. Intra-tumoral microbes and overall survival in colorectal cancer patients. Journal of Clinical Oncology 2020;38(15_suppl):4083–4083.Ethics ApprovalData were obtained through an IRB-approved Honest Broker protocol (2015H0185) supporting the Total Cancer Care protocol 2013H0199.

Discussions of the Neobaroque began to find an important position in Latin American circles during the twentieth century. The goal of these discussions was a reassessment of an American identity by using the Baroque as a historical catalyst for cultural transformation. One of the prominent figures during this period who connected the Baroque with questions revolving around Latin American identity was the Cuban writer Alejo Carpentier. The following article examines Carpentier's theories on the New World Baroque taken from various essays published in La novela lationamericana en visperas de un nuevo siglo (1981). Through these essays, Carpentier's perspective of the Baroque is relayed into cultural themes of Latin America such as the importance of American solidarity, historical constancy, cultural innovation/progression, the natural environment, and urbanism. Analyzing the connection of such themes with the arrival of the New World Baroque sheds light on the crucial theoretical developments of Latin American identity during the twentieth century.

Graphical models offer techniques for capturing the structure of many problems in real-world domains and provide means for representation, interpretation, and inference. The modeling framework provides tools for discovering rules for solving problems by exploring structural relationships. We present the Structural Affinity method that uses graphical models for first learning and subsequently recognizing the pattern for solving problems on the Raven's Progressive Matrices Test of general human intelligence. Recently there has been considerable work on computational models of addressing the Raven's test using various representations ranging from fractals to symbolic structures. In contrast, our method uses Markov Random Fields parameterized by affinity factors to discover the structure in the geometric analogy problems and induce the rules of Carpenter et al.'s cognitive model of problem-solving on the Raven's Progressive Matrices Test. We provide a computational account that first learns the structure of a Raven's problem and then predicts the solution by computing the probability of the correct answer by recognizing patterns corresponding to Carpenter et al.'s rules. We demonstrate that the performance of our model on the Standard Raven Progressive Matrices is comparable with existing state of the art models.

Introduction: Parkinson's disease (PD) is a chronic and progressive neurodegenerative disease characterized by motor symptoms such as bradykinesia, rigidity, postural instability, and tremor. The intervention currently described involves pharmacological treatment and multidisciplinary intervention. The case reported is a 74-year-old patient who was married and retired from civil engineering. This report presents the diagnosis of PD in the intermediate phase, and the implementation of a multidisciplinary intervention plan. Objective: To describe the case of a person with PD and their participation in significant activities, such as carpentry. Material and methods: The case reported is a 74-year-old patient diagnosed with moderate-phase PD who underwent a multidisciplinary intervention plan. In the evaluation, several instruments were used, such as the Functional Assessment Inventory for Adults and Elderly (IAFAI), the Quality-of-Life Scale and Functional Assessment, and the Chedoke Arm and Hand Activity Inventory. Occupational problems related to the patient's performance and participation in activities of daily living (ADLs) and activities of interest were identified due to motor, emotional and cognitive symptoms associated with PD. The described intervention plan focuses on stimulating deficient skills, using occupational therapy sessions to build a suspended flower box. Results: Carpentry increased motivation, feelings of well-being, and capability, proving to be a beneficial activity to alleviate many of the motor symptoms but mainly emotional and cognitive symptoms. Conclusion: Participation in significant activities such as carpentry contributes to helping some symptoms of PD while it is being performed. Participation in such activities produces satisfaction for the person, enhances their sense of competence, and increases their levels of confidence and predisposition in everyday life.

Objective: To develop a predictive model to identify persons with recent gestational diabetes (GDM) most likely to progress to impaired glucose tolerance postpartum. Study Design: We conducted an observational study among persons with GDM in their most recent pregnancy, defined by Carpenter-Coustan criteria. Participants were followed from delivery through 1-year postpartum. We used lasso regression with k-fold cross validation to develop a multivariable model to predict progression to impaired glucose tolerance, defined as HbA1c ≥ 5.7%, at 1 year postpartum. Predictive ability was assessed by the area under the curve (AUC), sensitivity, specificity, positive and negative predictive values. Results: Of 203 participants, 71(35%) had impaired glucose tolerance at 1 year postpartum. The final model had an AUC of 0.79 (95% CI 0.72, 0.85) and included eight indicators of weight, body mass index, family history of type 2 diabetes, GDM in a prior pregnancy, GDM diagnosis < 24 weeks’ gestation, and fasting and 2-hour plasma glucose at 2 days postpartum. A cut-point of ≥ 0.25 predicted probability had sensitivity 80% (95% CI 69, 89), specificity 58% (95% CI 49, 67), PPV 51% (95% CI 41, 61) and NPV 85% (95% CI 76, 91) to identify women with impaired glucose tolerance at 1 year postpartum. Conclusion: Our predictive model had reasonable ability to predict impaired glucose tolerance around delivery for persons with recent GDM.

IntroductionMitral stenosis (MS) is a widely known complication of mitral valve repair for non-rheumatic mitral regurgitation (MR). Few reports are available on the occurrence of MS after mitral valve repair for rheumatic MR in young populations.Case summaryA 14-year-old girl presented with orthopnea, abdominal distension, and bilateral lower-limb edema. She was cachectic, with a high-pitched holosystolic murmur best heard at the cardiac apex, bilateral basal crackles, tender hepatomegaly, pitting pedal edema, and jugular venous distension. Antistreptolysin O (ASO) titer was elevated. Transthoracic echocardiography (TTE) revealed the loss of central coaptation of the mitral valve with leaflet restriction and MR, annular dilatation of the tricuspid valve, and tricuspid regurgitation (TR). She had AHA/ACC stage D mitral and TR s. Tricuspid annuloplasty and mitral valve repair for rheumatic MR were performed using Carpentier Edwards numbers 30 and 34, respectively. Following surgery, the weight and body mass index (BMI) rapidly normalized. The patient also developed progressive MS.DiscussionPrevious studies in adults have described the etiopathogenesis of MS after non-rheumatic mitral valve repair. There is a paucity of reports describing the development of MS over the span of months after rheumatic MR valve repair in early pubescent children.ConclusionGrowth spurts during puberty can potentially affect MR repair, as the mitral valve prosthesis based on the preoperative Body Surface Area (BSA) is outgrown. There is a need for research on planning, prognostication, and development of an optimal, individualized, and adaptable approach to MR intervention in early pubescence.

Syringomyelia is a disease in which fluid-filled cavities, called syrinxes, form in the spinal cord causing progressive loss of sensory and motor functions. Invasive monitoring of pressure waves in the spinal subarachnoid space implicates a hydrodynamic origin. Poor treatment outcomes have led to myriad hypotheses for its pathogenesis, which unfortunately are often based on small numbers of patients due to the relative rarity of the disease. However, only recently have models begun to appear based on the principles of mechanics. One such model is the mathematically rigorous work of Carpenter and colleagues (2003, “Pressure Wave Propagation in Fluid-Filled Co-Axial Elastic Tubes Part 1: Basic Theory,” ASME J. Biomech. Eng., 125(6), pp. 852–856; 2003, “Pressure Wave Propagation in Fluid-Filled Co-Axial Elastic Tubes Part 2: Mechanisms for the Pathogenesis of Syringomyelia,” ASME J. Biomech. Eng., 125(6), pp. 857–863). They suggested that a pressure wave due to a cough or sneeze could form a shocklike elastic jump, which when incident at a stenosis, such as a hindbrain tonsil, would generate a transient region of high pressure within the spinal cord and lead to fluid accumulation. The salient physiological parameters of this model were reviewed from the literature and the assumptions and predictions re-evaluated from a mechanical standpoint. It was found that, while the spinal geometry does allow for elastic jumps to occur, their effects are likely to be weak and subsumed by the small amount of viscous damping present in the subarachnoid space. Furthermore, the polarity of the pressure differential set up by cough-type impulses opposes the tenets of the elastic-jump hypothesis. The analysis presented here does not support the elastic-jump hypothesis or any theory reliant on cough-based pressure impulses as a mechanism for the pathogenesis of syringomyelia.

Background Results of conservative surgery are well established in degenerative mitral valve (MV) insufficiency. However, there are controversies in rheumatic disease. This study is the evaluation of one center for rheumatic MV insufficiency based on a functional approach. Methods and Results From 1970 to 1994, 951 patients with rheumatic MV insufficiency were operated on with the reconstructive techniques elaborated by Alain Carpentier. Aortic valve diseases were excluded. Mean age was 25.8 years (4 to 75), and sinus rhythm was present in 63%. The functional classification used was type I, normal leaflet motion, 71 patients (7%); type II, prolapsed leaflet, 311 patients (33%); and type III, restricted leaflet motion, 345 patients (36%). The combined lesion of prolapse of the anterior leaflet and restriction of the posterior was present in 224 patients (24%). Surgical techniques used were implantation of a prosthetic ring in 95%, shortening of the chords and leaflet enlargement with autologous pericardium, and commissurotomy. Hospital mortality rate was 2%. The mean follow-up was 12 years (maximum, 29 years): 8618 patients per year. Actuarial survival was 89±19% at 10 years and 82±18% at 20 years. The rate of thromboembolic events was 0.4% patients per year (33 events), with 3 deaths. Freedom from reoperation was 82±19% at 10 years and 55±25% at 20 years. The main cause (83%) of reoperation was progressive fibrosis of the MV. The actuarial rate of reoperation was 2% patients per year and was correlated to the degree of preoperative fibrosis. Conclusions Conservative surgery of rheumatic MV insufficiency has a low hospital mortality rate and an acceptable rate of reoperation. The results are excellent regarding the minimal risk of thromboembolic events.

Mortar is a significant glue used to tie building squares, for example, stones, squares, and solid square work units together, fill and seal the sporadic holes among them, and from time to time join flawless shades or models in workmanship dividers. In its broadest sense mortar wires pitch, dull top, and delicate mud or soil, for example, utilized between mud blocks The sort and degree of the fix mortar is coordinated by a mortar examination. There are a couple of sorts of bond mortars and included substance. The tamarind tree produces unit like common item, which contain a consumable crush that is used in cooking styles the world over. Various livelihoods of the crush join standard medicine and metal clean. The wood can be used for carpentry, and tamarind seed oil can be isolated from the seeds. Because of the tamarind's various uses, advancement has spread far and wide in tropical and subtropical zones. The magnificent gelling cum bond properties of the decorticated seed powder can incite a couple of uses in sustenance and pharmaceutical ventures which are evident by the amount of research papers similarly as patent applications. This article thusly bases on the possible results of using the seed in a couple of sustenance and non-sustenance endeavors with explicit reference to physical and structuring properties, hydration direct, rheological properties, valuable and healthy qualities, and the planning of the tamarind seed for progressively broad applications

Abstract Background The WHO estimates 512 million cases of COVID-19 and 6.2 million deaths globally as of May 4th, 2022. In Michigan (MI), the first case was diagnosed March 10th, 2020. We describe here outcomes of COVID-19 patients cared for in a large tertiary hospital in 2020 spanning two surges based on baseline lab values for C-reactive protein (CRP), Procalcitonin (PC), and D-Dimer (DD). Methods After IRB approval, adult patients diagnosed via PCR with COVID-19 during the two surges in 2020 and admitted to Beaumont Hospital, Royal Oak, an 1,131 beds tertiary care referral center in MI, were reviewed. Demographic, clinical and laboratory characteristics were obtained from the EMR. ICD-10 classification diagnoses were utilized to identify comorbidities, and patient BMIs were based on the admission values in the EMR. Outcomes were defined as death during current admission, transfer to nursing home or other facility, or discharge home. Using a tree-based model and the combined levels of the three labs we defined a hierarchy of four lab levels, each progressively having increased risk of death. We then analyzed the outcome for the four levels, adjusting for time period (surge), age, sex, race, BMI and comorbidities. Data was analyzed using SAS statistical software version 9.4 (SAS Institute). Results A total of 2197 patients were identified from March through December 2020, of whom 1118 had CRP, PC and DD available at baseline. The mean age was 66.7 years (SD 16.1) for the cohort in first surge (March-June), and 66.4 (15.6) in the latter surge (July-December, Table1). More patients had a PC of &gt;0.5 in the first surge (25.7%) than the second (13.2%). After adjusting for all other factors, the hierarchical lab levels are significantly associated with outcomes. Of note, baseline CRP value was not informative. Compared to the 2nd level (Table 2), the lowest level (PC &lt; 0.1) has significantly lower odds of death [OR=0.37, 95% CI (0.19, 0.73)], while the highest level, (DD &gt;1000 and PC ≥ 0.26) has significantly higher odds of death [OR=3.01, 95% CI (1.59, 5.72)]. Conclusion Baseline PC and DD, but not CRP, were informative in determining risk of death and can assist clinicians determine possible outcomes during COVID-19 hospitalization. Disclosures Christopher F. Carpenter, MD, MHSA, Atox Bio: Advisor/Consultant|GSK: Advisor/Consultant|Iterum Therapeutics: Advisor/Consultant|Takeda: Advisor/Consultant.

Objective: Lung cancer is the most common cancer type in men overall our country. It is fourth one in women after breast, thyroid and colorectal cancers. Enviromental factors have important role on the etiology such as tobacco is responsible from 80-90%. Namely as determined in epidemiological studies smokers has risk of lung cancer 20 times higher than non-smokers. Despite these knowledge near one million people worldwide are guessed to be tobacco smokers. Our aim in this study is to define distribution of lung cancer cases over 65 years and smoking ratios. Materials and Methods: 128 patients over 65 years involved the study from 351 lung cancer patients living in our region and referred to our clinic between 2015-2018. File records included clinical symptoms, histopathological data, clinical staging data, tobacco smoking habits, personal background, family history, applied treatment procedures and survival durations of the cases. Results: In our study 93.8 % (n=120) of the patients were men and 6.2% (n=8) were women. Mean age was 72.4±6.9 (65-87) years. Coughing (41,3%) was the mostly seen clinical symptom. Education data showed they were mostly (66,6%) graduated from primary school. 7,8% of them were non literated. We have seen carpenter, driver, miner and employee in our patients mainly (39,5%). Additionally 26,9% were farmer, 17,6% were tradespeople and 16% were whitecollar workers. Smoking ratio was 87,4% (n:97) in our lung cancer cases over 65 years. And 54,1% of these were smoking 2 packets/day, 19,8% were smoking 1 packet/day, 13,5% were smoking 3 packets/day. Duration of smoking was over 30 years in 72,1% of them. In lung cancer people over 65 years mostly seen histological subtype was squamosus cell cancer at 37,6% (n:46), adenocancer was at 30,1% (n:37), large cell cancer was at 14,6% (n:20), small cell cancer was at 16,3% (n:23) and mixed type was at 1,6% (n:2). Significant relation has found between smoking and histologycal type. Smokers had squamosus cell cancer (40,9%) whereas non-smokers had adenocancer (78,6%) mostly. 66,7% of the cases, most of them, were stage 4 at time of diagnose (n:84). 10,2% had performed surgery ,35,2% recieved chemoradiotherapy, 47,7% received chemotherapy and 12,5% had only received radiotherapy. In our clinic paclitaxel/carboplatin was used frequently 42,5% (n:37) as chemotherapy regimes in over 65 years. Overall survival were 339,440±424,494 days and progression free survival were 311,040±481,434 in our cases. Conclusion : Smoking rates are high in patients over 65 years with lung cancer living in our city. Stage of disease was mostly high at diagnose. Because of increasing treatment costs in addition to high mortality rates of lung cancer, we should support smoking cessation companies.

Abstract A description is provided for Torulopsis glabrata. Information is included on the disease caused by the organism, its transmission, geographical distribution, and hosts. DISEASE: Torulopsis glabrata is one of the more common yeast species to be associated with fungal infections in humans although its role as a pathogen has not yet been established. It has been implicated as a cause of both superficial and systemic infections. Meunier-Carpenter et al. (Am. J. Med 71: 363-370, 1981) isolated Torulopsis glabrata from the blood cultures of 22 from a total of 110 cancer patients with fungal septicaemia (Candida albicans and C. tropicalis were isolated from 40 and 25 of those patients, respectively). Although 19 of the patients from whom T. glabrata was isolated died, autopsy results showed this organism to be less invasive than the other two species. In an analysis of 247 human yeast isolates Torulopsis glabrata was found to be the second commonest yeast isolated overall (Mackenzie, Sabouraudia 1: 8-32, 1961). In this study it was the most commonly isolated yeast from urine (representing 5 from a total of 17 isolates) and also represented a significant proportion of isolates from sputum (15 from a total of 120 isolates). Similar results were obtained in a study by Stenderup et al. (Acta Pathol. Microbiol. Scand. 54: 462-472, 1962). In a major review of the literature Odds (1979) found T. glabrata to be the second most commonly reported isolate from urine (representing 21.0% of cases) and also from vaginal swabs. It is interesting that vaginal isolates of T. glabrata are apparently more common in healthy women than in women with vaginitis. Since this corresponds with an increasing incidence of Candida albicans it implies that T. glabrata may be more important as part of the commensal flora and less able to cause overgrowth or infection. Odds also noted the absence of reports of clinical isolates of the organism from Asia or South America but stated that this may be due to reporting or identification differences rather than actual differences in human yeast flora. Torulopsis glabrata has also been associated with endophthalmitis, oesophagitis and has been isolated from the oral cavity and faeces of humans. In a study of veterinary isolates Torulopsis glabrata was found to be the most commonly isolated yeast from cattle and the second most common from pigs and dogs (Chengappa et al., J. Clin. Microbiol. 19: 427-428, 1984). It has been associated with several cases of bovine abortion and has also been isolated from cases of endocarditis and pneumonia in cattle. Pathogenicity experiments with laboratory animals have shown Torulopsis glabrata to cause disease only in compromised hosts. Gastrointestinal overgrowth with subsequent dissemination to visceral organs has been demonstrated in antibiotic treated mice but not in untreated mice (Kennedy et al., Sabouraudia 21: 27-33, 1983). In an earlier study with cortison treated mice Hasenclever et al. demonstrated progressive kidney disease with a high fatality rate following intravenous inoculation of T. glabrata (Sabouraudia 2: 87-95, 1962). Similar treatment of normal mice produced no disease although the organisms survived in the tissue for up to 8 weeks and produced small focal lesions. In vitro studies with living porcine blood vessels showed that T. glabrata adhered to the endothelium but, in contrast to similar experiments with Candida albicans and C. tropicalis, there was no tissue invasion (Klotz et al., Infect. Immun. 42: 374-394, 1983). GEOGRAPHICAL DISTRIBUTION: Africa (Morocco, Somalia, South Africa, Sudan, Tunisia, Zaire); Asia (Japan, Singapore, Thailand), Australasia and Oceania (Fiji, New Zealand); Europe (many countries); North America (Canada, Mexico, USA); South America (Argentina, Brazil, Venezuela).

The 1950s era appears to hold a nostalgic place in contemporary memories and current cultural practices. While the 1950s is a period that can signify a time from the late 1940s to the early 1960s (Guffey, 100), the era is often represented as a liminal space or dream world, mediated to reflect current desires. It is a dream-like world, situated half way between the mediated vision of the 1950s and today. Modern participants of 1950s culture need to negotiate what is authentic and what is not, because as Piatti-Farnell and Carpenter remind us ‘history is what we want it to be’ (their emphasis). The world of the 1950s can be bent to suit differing interpretations, but it can never be broken. This is because nostalgia functions as a social emotion as well as a personal one (Davis, vii). Drawing on interviews conducted with 27 women and three men, this article critically examines how the 1950s are nostalgically reimagined in contemporary culture via fashion and car festivals. This article asks: in dreaming of the past, how authentic is the 1950s reimagined today from the point of view of the participants?Liminal spaces exist for participants to engage in their nostalgic reimagining of 1950s culture. Throughout Australia, and in several other countries, nostalgic retro festivals have become commonplace. In Australia prominent annual events include Cooly Rocks On (Coolangatta, Qld.), Chromefest (The Entrance, NSW) and Greazefest (Brisbane, Qld.). Festivals provide spaces where nostalgia can be acted out socially. Bennett and Woodward consider festivals such as these to be giving individuals an “opportunity to participate in a gathering of like-minded individuals whose collective investment in the cultural texts and artefacts on display at the festival are part of their ongoing lifestyle project” (Bennett and Woodward, 15). Festivals are important social events where fans of the 1950s can share in the collective re-imagining of the 1950s.MethodologyEthnographic interviews with 30 participants who self-identified as wearers of 1950s style fashion. The interviews were conducted in person, via telephone and Skype. The participants come from a range of communities that engage with 1950s retro culture, including pin-up, rockabilly, rock'n'roll dancers and car club members. Due to the commonality of the shared 1950s space, the boundaries between the various cohorts can be fluid and thus some participants were involved with multiple groups. The researcher also immersed herself in the culture, conducting participant observation at various events such as retro festivals, pin-up competitions, shopping excursions and car club runs. Participants were given the option to have their real names used with just a few choosing to be anonymised. The participants ranged in age from 23 to their 60s.NostalgiaOur relationship with past eras is often steeped in nostalgia. Fred Davis (16-26) identified three orders of nostalgia: simple, reflexive and interpreted. Simple nostalgia “harbors the common belief that THINGS WERE BETTER (MORE BEAUTIFUL) (HEALTHIER) (HAPPIER) (MORE CIVILIZED) (MORE EXCITING) THEN THAN NOW” (Davis, 18, his emphasis). This is a relatively straightforward depiction of a halcyon past that is uncritical in its outlook. The second order, reflexive nostalgia, sees subjects question if their view of the past is untainted: “was it really that way?” (21). The third and final order sees the subject question the reasons behind the feelings of nostalgia, asking “why am I feeling nostalgic?” (24).Davis argues that nostalgia “must in some fashion be a personally experienced psst” rather than knowledge acquired second-hand (Davis, 8). Others dispute this, noting a vicarious or second-hand nostalgia can be experienced by those who have no direct experience of the past in question (Goulding, “Exploratory”). Christina Goulding’s work at heritage museums found two patterns of nostalgic behaviour amongst visitors whom she termed the existentials and the aesthetics (Goulding, “Romancing”). For the existentials, experiencing the liminal space of a heritage museum validated their nostalgia “because of their ability to construct their own values and ideologies relating to a particular time period in history and then to transpose these values to a time belonging to their own experiences, whether real or partially constructed” (Goulding “Romancing”, 575). This attitude is similar to Davis’s first order or simple nostalgia. In comparison, aesthetics viewed history differently; their nostalgia was grounded in an interest in history and its authentic reconstruction, and a desire to escape into an imaginary world, if only for an hour or two. However, they were more critical of the realism presented to them and aware of the limits of accuracy in reconstruction.Second-Hand NostalgiaFor the participants interviewed for this research, second-hand nostalgia for the 1950s was apparent for many. This is not very surprising given the time and distance between now and then. That is, a majority of the participants had not actually lived in the 1950s. For many their interest in the 1950s connected them to key family members such as mothers, fathers and grandparents. Two participants, Noel and Charlie, discussed fathers who were keen listeners of 1950s rock'n'roll music. Women often discussed female family members whose 1950s fashion sense they admired. Statements such as “I look back at the photos now and I think it would have been awesome if I had grown up in that era” (Noel) were common in interviews; however, many of them later qualified this with a more critical analysis of the time.For some, the 1950s represented a time when things were ‘better’. The range of indicators ran from the personal to the social:Curves and shapeliness were celebrated a little bit more in that era than they are now … when you look at the 50s woman they were a little bit curvier, when you think of pin-up and that kind of stuff, like Marilyn Monroe and Betty Page and all that sort of style, whereas for so long that hasn’t been where fashion has been at. So the average woman is bigger, or is curvier, or… So that’s kind of, it just works with my body shape in a way that modern stuff just doesn’t necessarily. (Ashleigh)I get treated differently when I wear Rockabilly as opposed to modern clothes. People will treat me more like a lady, will open doors for me … . I think people respect more people that dress like ladies than girls that let it all show. People have respect for people who respect themselves and I think Rockabilly allows you to do that. Allows you to be pretty and feminine without letting it all show. (Becky)For others, their fascination with the 1950s was limited to the aesthetic as they drew a more critical analysis of the era:There’s a housewife’s guide. I’m sure you’ve read that a housewife is expected to have a bow in her hair when her husband gets home from work. And should have the children in bed or silent. And we should be appreciating that he’s had a very hard day at work, so he should come home and put his feet up and we should rub his feet and provide him with a hot meal … . The mindset was different between then and now, and it’s not really that big a gap in history. (Belinda)The majority of women interviewed noted that they would be unwilling to relinquish modern social attitudes towards women to return to an era where women were expected to remain in the domestic sphere. They cited a number of differences, including technology (modern washing machines, dishwashers, etc.), gender relations (one participant noted rape in marriage), expectations to marry and have children young, careers, own finances etc.Nooooo! Absolutely not. Nooooo! No way! Oh my gosh! The labour in housework. Almost daily I’m grateful for the dishwasher and the stick Dyson for the floors and I don’t know, the steam iron. So many of the conveniences that you know, you go down stairs in the rush before the walk to school, throw the clothes into the washing machine and know that in 30 minutes it’s done. … No way would I go back. I absolutely would not want to live in the 50s regarding the social mores. It’s a little bit too repressive … . Love the look though! (Anna)Despite this, ‘outsiders’ (those who do not participate in 1950s subcultures) will often assume that since adherents are dressed in fifties style they obviously wish they could return there:And it sometimes will open a conversation where people will say “you should have been born earlier” or “I bet you wished you lived in the 50s” and I always say “no, I’m glad I live in an era where there’s less racism and sexism and I can work. (Emma)In contrast, men who were interviewed had expressed fewer barriers to living in the 1950s. Both Charlie and Noel were quick to say yes when asked if they would be happy to live in the actual 1950s. Even Ashley, a homosexual man who dresses in 1950s drag as a woman on the weekends would “give it a go”. This perhaps reflects the privileged position that white heterosexual men enjoyed in the era. Ashley could, like many homosexual men at the time, easily disguise his sexual orientation in order to fit into this privileged position, keeping his overt drag behaviour to “safe gay spaces” (Cole, 45). Further, all three men are white, although Charlie, being from a Cypriot background, may experience a different social response if he was to return to the actual 1950s. Immigrants from southern Europe were not welcomed by all Australians, with some openly hostile to the immigrants (Murphy, 156-64). Women, on the other hand, would experience a retrograde transformation of their position within society; women of colour even more so. This echoes other studies of historically based cohorts where women in particular hold progressive modern views and are reluctant to return to time periods such as the 1960s (Jenss) and the 1970s (Gregson, Brooks, and Crewe).Popular Cultures as a Conduit to the PastNostalgia is often mediated through popular culture, with many participants referencing popular icons of the fifties such as Elvis, Rita Hayworth, and Marilyn Monroe. This was complicated by references to popular culture films and music which were themselves a product of 1950s nostalgia, such as the movie Grease (1978) and the band the Stray Cats (1979-present). The 1950s has been the ongoing subject of revivalism since at least the late 1960s (Reynolds, 277), and this layering complicates social understandings of the decade. One participant, Charlie (in his late 50s), notes how the 1950s revival in the 1970s gave him the opportunity to immerse himself in the culture he admired. For Charlie, popular culture gave him the opportunity to wear authentic 1950s clothing and surround himself with 1950s memorabilia, music, and cars.Alternative clothing allows people to create an identity outside the parameters of contemporary fashion. For women, the thin body, replete with small breasts and hips, has been held up as the ideal in both mass media and fashion from advent of Twiggy in the 1960s to the present day (Hackett and Rall). Yet, 1950s style clothing allows wearers the freedom to create a fashionable identity that presents a different body ideal; that of the hyper-feminine woman who is characterised by her exaggerated hour-glass figure. This body shape has recently become fashionable again with influencers such as Kim Kardashian promoting this as an alternate to the thin body ideal. For men, the clothes represent the complimentary ideal of the hyper-masculine man: tight shirts, worker jeans, working class suits. Some participants, like Charlie, wear original 1950s clothing. I’ve got my dad’s sports coat, and I still wear it today … that song … [Marty Robins – ‘A white sport coat and a pink carnation’] … it explains that coat. My dad had it when he first came to Australia … I’ve still got it today and I still wear it proudly. (Charlie)However, due to the age of available authentic clothing, complicated by the fact that many garments from that era have already been recycled, there remains limited supply of true 1950s clothing for today’s fans. Most rely upon reproduction clothing which varies in its level of authenticity. Some reproduction brands remake styles from the fifties, whereas others are merely inspired by the era. In her study of costume, Valerie Cumming argued that it was “rare for clothing from previous eras to be worn in an unaltered state as it offered an alternative construction of identity” (Cumming, 109). Contemporary body sizes and shapes are different from their mid-century counterparts due to range of issues, particularly the average increase in body size. Women’s bust and waist measurements, for example, have increased by about ten percent over the last century (Etchells, Kinkade, and Henneberg). Further, technological advances in fabric coupled with changing social mores around undergarments mean that the body upon which garments sit is shaped differently. Most of the women in this study feel no need to wear restrictive, body modifying undergarments such as girdles or merry widows beneath their clothes. This echoes other research which reports that re-enactors wear clothes that are not really authentic, but “approximations created for twenty-first century” fans (Kiesel). Despite this diluting of 1950s style to suit modern sensibilities, the superficial look of the clothes are, for the participants, strongly reminiscent of the 1950s.I have a very Rubensesque body shape, so when I was younger that was the sort of styles that was better on me. So I like the pencil skirts enhanced a bit that weren’t supposed to be enhanced because I came from a very conservative Christian background. But then the A-line skirts were what my mom put me in to go to church and everything. Anyway it just looked really nice. As I watched television and saw those styles on some of those older shows that my parents let me watch, that is what I got drawn too, that sort of silhouette. (Donna, early 40s)The act of dressing in this way separates participants from the mainstream. Here fashion, in particular, differentiates this look from subcultural style. Dick Hebdige argued that subcultures are rooted in working class struggles, creating an alternate society away from the mainstream, where clothing becomes a critical identifier of group membership. Some participants extend their consumption of 1950s goods into areas such as homewares, cars and music. 1950s cars, particularly large American cars such as Cadillacs and Australian-made Holdens, are lovingly restored. Charlie, a mechanic by trade, has restored numerous cars for both himself and other people. Restoring cars can often be an expensive endeavour, locking out many would-be owners. A number of participants spoke of their desire to own an original car, even if it was out of their budget.Cars too are often modified from their original incarnation. Sometimes this is due to comfort, such as having modern day air-conditioning systems or power-steering installed. Other times this is due to legal requirements. It is not uncommon to see cars at festivals installed with child safety seats, when children during the actual 1950s often rode in cars without seatbelts even installed. Like clothing, it appears for cars that if the aesthetic is strongly reminiscent of the 1950s, then the underlying structural changes are acceptable.Identities and SpacesRetro festivals as liminal spaces provide the opportunity for participants to play at being in the actual 1950s. As a shared space they rely upon a critical mass of people to create and maintain this illusion. Participants who attended these events expressed a lot of enthusiasm for them:I just love the atmosphere, looking around, looking at the stalls and other people’s outfits. Listening to the music and having a dance. (Kathleen, early 20s)Oh, that’s my favourite weekend of the year … I’ve been to every single one since the first one. Yeah, I think this is the nineteenth year … And we all kind of, there’s a bunch of us that go and we stay near there and we are there for the whole thing. Yeah, and I’ve already started sewing my wardrobe. Planning my outfits. I don’t know, we just love it. There’s people that I only see once a year at Greazefest and I get to catch up with people. And I flit around like a social butterfly, like I’m running around, and I also have a thing where I call it the weekend of a thousand selfies. So I just take hundreds of selfies with people and myself and I do a big thing up every year. Yeah. But I love it, I love the music mainly. But it’s a good excuse, another good excuse, to make some nice outfits and get dressed up in something different. (Vicki, early 40s)So I’m at shows basically every weekend. Shows, swap meets and in the garage, there’s always something. And when you get into this car life, it drags the 50s in with you, if that is your decade. It just follows you in. (Ashleigh, early 20s)The festival space becomes liminal as it is not truly part of the past, but it is not of the present either. As Valerie Cumming's statement above notes, clothes from the past that are worn today are usually altered to suit modern sensibilities. So too are festivals which are designed and enacted within our contemporary paradigm. This can be seen in Pin-Up competitions which are present at many of the festivals. Rather than a parade of young beauties, modern interpretations feature a diverse vision of womanhood, representing a range of ages, body sizes, genders, and beauty ideals. For some participants this is an empowering liminal space.I went through a stage where I had severe depression and I found the thing that was making me happy was when I put on my 50s clothes and it’s an entire separate personality, because there is me, I’m a very quiet, normal person and there is Chevy Belle … and it’s this whole extra style, this extra confidence that I have and that was helping me through depression. (Ashleigh, early 20s)A Contested DreamIf the liminal space of a re-imagined 1950s is to succeed, members must negotiate, whether explicitly or implicitly, what constitutes this space. When is someone bending the rules, and when is someone breaking them? Throughout the interviews there was an undercurrent of controversy as to certain elements.The Pin-Up community was the most critiqued. Pin-Up style often references styles from both the forties and fifties, merging the two eras into one. Vicki questioned if their style was even 1950s at all:I don’t really understand where some of the pin-up looks come from. Like, sort of like, that’s not 50s. That’s not really 50s looking, so don’t call it 50s if it’s not … some of the hairstyles I sort of go “I don’t know what, what that is”. I’m not quite sure why everybody’s got victory … like got victory rolls when they’re not 1950s … I get a bit funny and I know it sounds really pretentious when I say it out loud. Yeah, I don’t know. I sound pretentious, I don’t want to sound pretentious. (Vicki, early 40s)Here Vicki is conflicted by her wish to be inclusive with her desire to be authentic. The critique continues into the use of tattoos and the type of people who entered these competitions:I found the pin-up competitions seem to be more for people, for the bigger ladies that wanted to wear the tattoos … rather than something that was just about the fashion ... (Simone, early 50s)Coinciding with Corrie Kiesel’s findings about Jane Austen festivals, “what constitutes the authentic for the festival community is still under negotiation”. The 1950s liminal space is a shared dream and subject to evolution as our changing contemporary norms and the desire for authenticity come into conflict and are temporarily resolved, before being challenged again.ConclusionVia 1950s fashion, cars, music, and festivals, the participants of this study show that there exist multiple liminal spaces in which identity and social boundaries are made malleable. As a result, there exists mostly inclusive spaces for the expression of an alternative social and cultural aesthetic. While engagement with 1950s culture, at least in this research, is predominantly feminine, men do participate albeit in different ways. Yet for both men and women, both are dreaming of a past that is constantly imaged and re-imagined, both on a personal level and on a social level.As the temporal distance between now and the actual 1950s expands, direct experience of the decade diminishes. This leaves the era open to re-interpretation as contemporary norms and values affect understandings of the past. Much of the focus in the interviews were upon the consumption of nostalgic goods rather than values. This conflict can be most strongly seen in the conflicted responses participants gave about pin-up competitions. For some participants the pin-ups were lacking in an essential authenticity, yet the pin-ups with their tattoos and reinterpretation of the past demonstrate how fluid and malleable a culture based on a past era can be. The 1950s scene promises to become more fluid as it undergoes further evolutionary steps in the future.ReferencesBennet, Andy, and Ian Woodward. “Festival Spaces, Identity, Experience and Belonging.” The Festivalization of Culture. Eds. Jodie Taylor and Andy Bennett. New York: Routledge, 2014. 25-40.Cole, Shaun. “Don We Now Our Gay Apparel”: Gay Men’s Dress in the Twentieth Century. Oxford: Berg, 2000.Cumming, Valerie. Understanding Fashion History. London: Batsford, 2004.Davis, Fred. Yearning for Yesterday: A Sociology of Nostalgia. New York: Free Press, 1979.Etchells, Nick, Lynda Kinkade, and Maciej Henneberg. "Growing Pains: We've All Heard about Australia's Obesity Crisis But the Truth Is, We're Getting Bigger in More Ways than One. 2014.Goulding, Chrintina. "Romancing the Past: Heritage Visiting and the Nostalgic Consumer." Psychology and Marketing 18.6 (2001). 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