Decision Support System for Stakeholder Involvement

Stakeholder involvement is essential to the development of a total maximum daily load (TMDL) and its implementation plan. A tool, beyond a simulation model, is needed to support the decision making process that requires negotiation and compromise among stakeholders. The decision support system (DSS) described herein has a TMDL module to calculate various combinations of point and nonpoint loads that can meet the water quality criteria. Its Consensus module allows stakeholders to formulate, evaluate, modify, and vote for alternatives. The DSS displays bar charts for pollution loads from various subwatersheds and attributes the nonpoint loads to land uses. The water quality consequence of the pollution loads is output in maps, which shows sections meeting criteria in green and those not in red. The DSS requires a front end effort of site specific adaptation and model calibration. An Internet-based stakeholder process was developed to allow more concerned citizens to participate in management decisions.     

Psychiatric diseases and their treatment in general practice in Germany. Results of a World Health Organization (WHO) study

As part of an international study initiated by the World Health Organization (WHO) about psychological disorders in primary health care, patients in the Federal Republic of Germany were compared with patients in other European centres. Patients from Germany do not differ from other European patients in respect to sociodemographic variables or psychiatric disorders. The most frequent CIDI-based diagnoses recorded in patients attending general practices are current depressive episodes (8.6%), generalized anxiety disorders (8.5%), neurasthenia (7.5%), and alcohol dependence (6.3%). In 20.9% of the patients at least one psychiatric diagnosis based on ICD-10 was recorded. In Germany significantly lower global ratings of health status are given than in other European centres although there is no difference in diagnostic prevalence rates. The recognition rate, i.e. the agreement between the CIDI-based ICD-10 diagnoses and the recognition as a case by the physician, is 56.2%-60.2%. On the other hand, the CIDI detects 90% of the patients described as psychologically ill by the physicians if subthreshold cases are also counted, or 46.4% if only defined diagnoses are taken into account. There is a significant correlation between severity of the psychiatric disorder and disability in social functioning. In Mainz and in the other European countries the disability rate of patients with a well-defined disorder is between 67.0% and 72.7%, whereas in Berlin this relation is not as clear, because especially in East Berlin there is a higher rate of unemployment in view of the political situation. Drug treatment is prescribed for 16.1% of the patients in primary care for psychiatric disorders. Half the patients recognized by physicians as cases receive medication. In the rest of Europe patients receive significantly more tranquillizers than in Germany, where the use of herbal drugs is more wide spread.     

Skin expansion screw and skin expander--modern techniques for increasing possibilities in adjacent flap-plasty and defect closure

There are various techniques for reconstructing skin and soft-tissue defects, among them skin expansion. During the past three years, we have tested a skin-stretching device based on the lag-screw principle of Hirshowitz et al. (1993). We have compared both techniques. The complication rate of both groups was acceptably low.     

Digital repository: preservation environment and policy implementation

Distributed digital repositories can be used to address critical issues of long-term digital preservation and disaster management for large data centers. A policy-driven system provides an ideal solution for managing distributed repositories that require high flexibility and high configurability. Recent studies demonstrate that the integrated Rule-Oriented Data System, a peer-to-peer server middleware, provides the requisite dynamic extensibility needed to manage time-varying policies, automate validation of assessment criteria, manage ingestion processes, manage access policies, and manage preservation policies. The policy management can be implemented underneath existing digital library infrastructure such as Fedora.     

A device for a noninvasive evaluation of coronary bypass grafts

A new device is presented for evaluating the patency of coronary bypass grafts. Bypass grafts are located within the chest cavity using a Compton backscatter imaging (CBI) technique that creates frontal plane tomographic images. The tomographic image pixels are mapped into computer memory and displayed. A display pointer is used to mark the position of the bypass graft. The computer uses that information to subsequently position a radiation detector, such that it "looks" at the location of the bypass graft within the closed chest. The patency of the graft is then evaluated by monitoring an X-ray induced iodine fluorescence transient in the graft, subsequent to a peripheral intravenous contrast injection. This imaging and graft evaluation device is relatively inexpensive and its application does not require cutdowns or catheterization. The associated radiation dose is 1/10 to 1/50 of that associated with alternative X-ray graft patency evaluation techniques. Preliminary testing has been performed on mechanical and animal models.     

Open Embedded Control

Embedded control devices today usually allow parameter changes, and possibly activation of different pre-implemented algorithms. Full reprogramming using the complete source code is not allowed for safety, efficiency, and proprietary reasons. For these reasons, embedded regulators are quite rigid and closed concerning the control structure. In several applications, like industrial robots, there is a need to tailor the low level control to meet specific application demands. In order to meet the efficiency and safety demands, a way of building more generic and open regulators has been developed. The key idea is to use pieces of compiled executable code as functional operators, which in the simplest case may appear as ordinary control parameters. In an object oriented framework, this means that new methods can be added to controller objects after implementation of the basic control, even at run-time. The implementation was carried out in industrially well accepted languages such as C and C++. The dynamic binding at run-time differs from ordinary dynamic linking in that only a subset of the symbols can be used. This subset is defined by the fixed part of the system. The safety demands can therefore still be fulfilled. Encouraged by results from fully implemented test cases, we believe that extensive use of this concept will admit more open, still efficient, embedded systems.     

N‐Benzyl‐4‐((heteroaryl)methyl)benzamides: A New Class of Direct NADH‐Dependent 2‐trans Enoyl–Acyl Carrier Protein Reductase (InhA) Inhibitors with Antitubercular Activity

Isoniazid (INH) remains one of the cornerstones of antitubercular chemotherapy for drug‐sensitive strains of M. tuberculosis bacteria. However, the increasing prevalence of multidrug‐resistant (MDR) and extensively drug‐resistant (XDR) strains containing mutations in the KatG enzyme, which is responsible for the activation of INH into its antitubercular form, have rendered this drug of little or no use in many cases of drug‐resistant tuberculosis. Presented herein is a novel family of antitubercular direct NADH‐dependent 2‐trans enoyl–acyl carrier protein reductase (InhA) inhibitors based on an N‐benzyl‐4‐((heteroaryl)methyl)benzamide template; unlike INH, these do not require prior activation by KatG. Given their direct InhA target engagement, these compounds should be able to circumvent KatG‐related resistance in the clinic. The lead molecules were shown to be potent inhibitors of InhA and showed activity against M. tuberculosis bacteria. This new family of inhibitors was found to be chemically tractable, as exemplified by the facile synthesis of analogues and the establishment of structure–activity relationships. Furthermore, a co‐crystal structure of the initial hit with the enzyme is disclosed, providing valuable information toward the design of new InhA inhibitors for the treatment of MDR/XDR tuberculosis.     

An apparatus for characterization and control of isolated muscle.

An apparatus for characterization and control of muscle tissue is presented. The apparatus is capable of providing generalized mechanical boundary conditions to muscle tissue, as well as implementing real-time feedback control via electrical stimulation. The system is intended to serve as an experimental platform for implementing a wide variety of muscle control and identification studies that will serve as fundamental investigations of muscle mechanics, energetics, functional electrical stimulation, and fatigue. In one illustration of the capabilities of the apparatus, pilot experimental results of muscle workloops against a finite-admittance passive load are presented, illustrating how richer boundary conditions may reveal interesting muscle behavior.