Journal articles on the topic 'Mold Max 60™'

Post-processing operations of extruded pet food kibbles involve coating the product with fats and flavorings. These processes increase the risk for cross-contamination with food-borne pathogens such as Salmonella and Shiga toxin-producing Escherichia coli (STEC), and mycotoxin-producing molds such as Aspergillus spp. after the thermal kill step. In this study, the antimicrobial effects of two types of organic acid mixtures containing 2-hydroxy-4-(methylthio) butanoic acid (HMTBa), Activate DA™ and Activate US WD-MAX™, against Salmonella enterica, STEC and Aspergillus flavus when used as a coating on pet food kibbles were evaluated. Using canola oil and dry dog digest as fat and flavor coatings, the efficacy of Activate DA (HMTBa + fumaric acid + benzoic acid) at 0%, 1% and 2%, and Activate US WD-MAX (HMTBa + lactic acid + phosphoric acid) at 0%, 0.5% and 1% was tested on kibbles inoculated with a cocktail of S. enterica serovars (Enteritidis, Heidelberg and Typhimurium) or Shiga toxin-producing E. coli (STEC) serovars (O121, and O26) at 37 °C for 0, 12, 24, 48, 72 h, 30 and 60 days. Similarly, their efficacy was tested against A. flavus at 25 °C for 0, 3, 7, 14, 21, 28 and 35 days. Activate DA at 2% and Activate US WD-MAX at 1% reduced Salmonella counts by ~3 logs after 12 h and 4–4.6 logs after 24 h. Similarly, STEC counts were reduced by ~2 logs and 3 logs after 12 h and 24 h, respectively. Levels of A. flavus did not vary up to 7 days, and afterwards started to decline by >2 logs in 14 days, and up to 3.8-log reduction in 28 days for Activate DA and Activate US WD-MAX at 2% and 1%, respectively. The results suggest that the use of these organic acid mixtures containing HMTBa during kibble coating may mitigate post-processing enteric pathogen and mold contamination in pet food kibbles, with Activate US WD-MAX being effective at a lower concentration (0.5–1%) compared to Activate DA.

Pada pengerajin timah pada umumnya masih menggunakan cara yang kurang efektif dalam proses pengecoran yaitu penggunaan jenis model yang terbuat dari logam yang menyulitkan dalam pembentukan variasi model, dan juga para pengrajin pun dalam pembuatan cetakan masih mengunakan cetakan pasir,logam,. Untuk menciptakan produk yang berkualitas dengan pengecoran menggunakan metode grafity casting maka dalam hal ini model akan dicetak menggunakan alat DLP 3D printer dengan bahan resin. Sehingga dapat menciptakan variasi model yang lebih detail lalu cetakan menggunakan silikon untuk membuat cetakan sehingga menciptakan cetakan yang mudah dibentuk terhadap variasi model yang detail. Faktor-faktor yang diselidiki adalah tekanan vakum cetakan dan media pendingin dengan respon kekerasan  dari spesimen uji. Pada proses pengujian menggunakan alat uji kekerasan ALBERT GNHEM HORGEN dan Profil Proyektor PJ-A3000 Mitutoyo. Data hasil tes dianalisis menggunakan metode ANOVA dengan desain level faktorial tipe 2, desain 2 interaksi faktorial (2FI), dan replikasi 3 dimodelkan oleh perangkat lunak Design-Expert (Trial).

Quinoa is the only single plant that can meet all the nutritional needs of human, and its potential for feed utilization has been continuously explored, becoming a prosperous industry for poverty alleviation. In order to further tap the feeding value of whole quinoa, develop quinoa as a feed substitute for conventional crops such as corn, and improve its comprehensive utilization rate, this experiment analyzed the silage quality and mycotoxin content of mixed silage of whole-plant quinoa (WPQ) with whole-plant corn (WPC) or stevia powder(SP) in different proportions, and further improved the silage quality of mixed silage by using two lactic acid bacteria preparations (Sila-Max and Sila-Mix). The quality, microbial population, and mycotoxin levels of quinoa and corn silage, as well as that of the mixed silage of quinoa and stevia, were evaluated using single-factor analysis of variance. The impact of various lactic acid bacteria preparations on the quality of whole-quinoa and whole-corn mixed silage was investigated through two-factor analysis of variance. WPQ and WPC were mixed at the ratio of 5:5 (QB5), 6:4 (QB6), 7:3 (QB7), 8:2 (QB8), 9:1 (QB9) and 10:0 (QB10). SP was mixed with WPQ at the supplemental levels of 0.2% (QB10S2), 0.4% (QB10S4), 0.6% (QB10S6), 0.8% (QB10S8) and 1.0% (QB10S10). After 60 days of silage, the silage indexes, the number of harmful microorganisms, and the mycotoxin levels were measured, to explore the appropriate ratio of mixed silage. The membership function analysis showed that the quality of mixed silage of WPQ with SP was better, and the optimal addition amount of SP was 0.6%. The results of Max and Mix on the quality improvement test of WPQ with WPC mixed silage showed that the two lactic acid bacteria formulations increased CP and AA content, and reduced NH3-N/TN; pH was significantly lower than the control group (p < 0.01), and LA was significantly higher than the control group (p < 0.01). The microbial count results showed that the addition of lactic acid bacteria preparation significantly reduced the number of molds and aerobic bacteria, and the effect of Mix was better than that of Max. When the mixing ratio was between QB7 and QB10, mold was not detected in the lactic-acid-bacteria preparation groups. Max and Mix significantly reduced the levels of mycotoxins, both of which were far below the range of feed safety testing, and 16S rRNA sequencing revealed that the silage microbiota varied with different mixing ratios and whether lactic acid bacteria preparations were used. Max and Mix increased the relative abundance of Firmicutes, with Mix having a more significant effect, especially in the QB6 (65.05%) and QB7 (63.61%) groups. The relative abundance of Lactobacillus was significantly higher than that of the control group (p < 0.05). The relative abundance of Enterobacteriaceae and Streptococcus were negatively and positively correlated with the addition level of quinoa, respectively. Comprehensive analysis showed that adding 0.6% SP to the WPQ and using Mix in mixed silage of WPQ and WPC with the proportion of WPQ no less than 70% had the best silage effect, and was more beneficial to animal health.

Plastic deformation forming with metal pipe blanks by contact blast loading inside pipes is an interesting moldless forming technique, also a complex and error-prone process. Some advantages are very characteristic of this forming technique such as no cost of mold, tooling and low energy consumption, no complicated control equipment compared to other forming techniques such as casting, rolling, tube hydrostatic forming, bending – welding. Up to now, the calculation and design of this forming technique mainly use some existing reference empirical formulas, so the experimental results are only suitable in the range of small pipe diameters, and still there are significant deviations for larger pipe diameters. In order to increase the predictability and accuracy of forming process by contact blast loading inside large pipes, this paper presents a study on the influence of the mass of highly explosive material – TNT to the forming ability of large steel pipes from API-5LX-42 mild steel materials by modern 3D numerical simulation – using Abaqus/Cae software. Four output criteria with maximum values are used to evaluate the efficiency of this forming process, including maximum diameter of the blast zone (Dmax£2D0), Von Mises stress (Smax£UTS), Hoop plastic strain component (PE22max£1), and Pipe wall thinning rate (eT-max£60 %). The results of this research on the plastic deformation forming process using numerical simulation can be used for the next experimental step to evaluate the difference between simulation and experiment, as well as use this data in the calculation and design of pipe products with circular or square cross-sections to save both time and money of trial and error before application in actual manufacturing

Abstract Introduction/Objective Lichtheimia and Scedosporium species are ubiquitous fungi associated with a range of clinical presentations. We report a complex soft tissue coinfection caused by Lichtheimia spp. and Scedosporium spp. following a puncture wound by a rooster spur. Methods/Case Report A 60-year-old immunosuppressed man with a history of heart transplant presented with a non-healing wound 2-months after sustaining a lower leg puncture secondary to a rooster spur. The patient was previously treated with Augmentin for presumed cellulitis without improvement. To characterize the ongoing disease process, the wound was sampled with tissue portions routed for both histopathologic review and culture. In short order, the biopsy demonstrated invasive hyaline pauciseptate fungal hyphae consistent with organisms of the Mucorales order. In congruence, culture rapidly revealed a mucoraceous mold, subsequently identified as a Lichtheimia spp. Thus, the patient was treated with liposomal amphotericin B. However, days later, a second fungus - a Scedosporium spp. - was isolated from the original specimen. Consequently, isavuconazonium sulfate therapy was added. Re-review of the initial biopsy enabled distinction of two populations of fungal hyphae plausibly representing both molds. Despite numerous debridements and optimal medical management, the patient was ultimately referred for amputation. Results (if a Case Study enter NA) NA. Conclusion When encountered in an immunocompromised host, providers understandably respond to an invasive mucoraceous mold with alarm followed by quick, decisive action. However, septate molds, such as the Scedosporium spp., can also be aggressive. Further, the presence of more than one invasive mold presents a treatment challenge as the mucormycetes may require surgery coupled with amphotericin B therapy; whereas, the a Scedosporium spp. may be wholly resistant to amphotericin B. This case illustrates the critical role that an alert pathologist plays in guiding management through integration of data from different diagnostic modalities. It also constitutes an emphatic reminder that an illness may be caused by more than one actionable, invasive fungus.

On 16th of November 2021, the PC slab had been fallen out and dropped to approximately 10M downstairs slab during the PC slab concrete pouring work on the rooftop floor of new logistics warehouse construction in Hwaseoung, Gyeonggi-do, and this accident was mainly caused by the bending fracture of concrete since the weaker strength of the upper compressed concrete compared to the tensile strength of central lower parts failed to withstand the high stress of upper topping concrete pouring. For the investigation of root-cause for above mentioned accident, the design compressive strength had been tested by utilizing the core sampling(extracting) method for the PC slab which was fallen out while pouring topping concrete, and as a result, the average compressive strength of three(3) concrete specimens collected from the relevant member through the destructive test was observed as 21.7MPa (No.1 – 20.6MPa, No.2 – 18.1MPa, No.3 – 26.5 MPa) which is only 55% level of the design compressive strength of 40MPa. The main cause that the average compressive strength was observed at about 55% level of the design compressive strength of 40MPa is the failure to comply with the required standard/specification for steam curing during the PC production processing. The required conditions to be complied for the steam curing are 60±10℃(Max. 80℃ or less) of curing temperature, 20℃/h or less of temperature rise rate and shall be managed by the concrete maturity, however, it was reported as a result of investigating the PC manufacturer that the strength had not reached to the standard strength before the mold deformation due to the steam curing with low temperature condition at opened space. The logistics warehouses have been continuously requested to be expanded after COVID-19 Pandemic, and the demand of PC which has merit in logistics warehouse construction work has been rapidly increasing. As a result, the operation rate of PC manufacturers currently reaches the maximum production limit, instead, PCs have been indiscriminately produced at small workplaces which have not able to satisfy the design compressive strength, construction quality and safety requirements. In the current situation, the construction site and workers are exposed to the potential risk of falling accidents since any relevant law or regulation on non-securing quality requirements such as the compressive strength is not stipulated yet. For this reason, the PC products with secured quality requirements shall delivered and construction safety management shall be improved by implementation of PC Factory Certification System at the earliest. For the purpose of this study, the PC factory certification system should be introduced, the research method was selected based on PC drop accidents and domestic and international operational cases of each country's certification system.

ABSTRACT Breast cancer in men is rare, it represents <1% of all male cancers, it usually presents between the ages of 60 and 70 years with an age peak at 67 years. Unlike in women, where screening studies are performed, in men, it is usually diagnosed later, because the low incidence of this cancer in male patients and the absence of early signs and symptoms lead to a delayed search for medical attention. Even though more data is emerging about this disease, the poor level of awareness often results in late presentation and delayed diagnosis in our country. The present study reported the case of a 63-year-old man who presented in the outpatient department with a large breast lump and a short history of 2 months; he was diagnosed on fine-needle aspiration cytology with an invasive ductal carcinoma. The case is presented for the rarity and to discuss awareness, regarding early diagnosis, and proper management.

Enzyme immobilization is a powerful method to improve the stability, reuse, and enzymatic properties of enzymes. The immobilization of the α-amylase enzyme from Aspergillus fumigatus on a chitin-bentonite (CB) hybrid has been studied to improve its stability. Therefore, this study aims to obtain the higher stability of α-amylase enzyme to reduce industrial costs. The procedures were performed as follows: production, isolation, partial purification, immobilization, and characterization of the free and immobilized enzymes. The CB hybrid was synthesized by bentonite, chitin, and glutaraldehyde as a cross-linker. The free enzyme was immobilized onto CB hybrid using 0.1 M phosphate buffer pH 7.5. The free and immobilized enzymes were characterized by optimum temperature, Michaelis constant (KM), maximum velocity V max , thermal inactivation rate constant (ki), half-life (t1/2), and transformation of free energy because of denaturation (ΔGi). The free enzyme has optimum temperature of 55°C, KM = 3.04 mg mL−1 substrate, V max = 10.90 μ molemL − 1 min − 1 , ki = 0.0171 min−1, t1/2 = 40.53 min, and ΔGi = 104.47 kJ mole−1. Meanwhile, the immobilized enzyme has optimum temperature of 60°C, KM = 11.57 mg mL−1 substrate, V max = 3.37 μ molemL − 1 min − 1 , ki = 0.0045 min−1, t1/2 = 154.00 min, and ΔGi = 108.17 kJ mole−1. After sixth cycle of reuse, the residual activity of the immobilized enzyme was 38%. The improvement in the stability of α-amylase immobilized on the CB hybrid based on the increase in half-life was four times of the free enzyme.

AbstractMethanol accumulates in maturing seeds, correlating with preharvest deterioration. Since the source of methanol may be from pectin de-methylation, methanol, cell wall uronic acid, pectin methyl esterification, pectinesterase (PE; EC 3.1.1.11) activity, and neutral sugar composition and partitioning of cell wall polysaccharides were determined during soybean (Glycine max[L.] Merrill) seed development, maturation, and desiccationin planta. Axis cell wall polysaccharides were more easily solubilized, richer in uronic acid, rhamnose, and xylose, and less rich in galactose than cotyledon cell wall polysaccharides. Methanol accumulated to 9.7 μg per two cotyledons and 0.5 μg per axis; total methanol decreased to 3 μg per two cotyledons during loss of green color. Total uronic acid increased from 0.12 to 0.27 mg per axis and 0.9 to 4 mg per cotyledon between 24 and 50 days after flowering (DAF). After loss of green color, pectin methyl esterification in axes increased from 7 to 24 mole% between 50 and 60 DAF but decreased to 14 mole%by 62 DAF in latter stages of seed desiccation. In cotyledons, methyl esterification ranged from 25 to 40 mole% and was 31 mole% after desiccation. PE activity increased 100 fold in axes, including a 30-fold increase in activity after loss of green color at 46 DAF. Cotyledon PE activity was 40-fold higher than in axes at 24 DAF, declined 75% by 56 DAF, and then increased 5 fold during desiccation. Pectin methyl de-esterification by PE is sufficient to be the sole source for methanol accumulation in seed tissues during development and maturation.

In current study, the effect of various coating formulations such as control (glycerol+acetic acid+distilled water); chitosan (CH) (glycerol+acetic acid+CH 1%); CH-Nano-ZnO (chitosan+Nano-ZnO (1%)); CH-Nano ZnO-EOs (Essential oils) (CH-Nano-ZnO+EOs (1%)) were investigated on postharvest physiological characteristics such as weight loss, browning index, enzymatic activity, microbiological, phenolic acid and total phenols of table grape fruits during the storage at 25 °C with an RH of 40–60% for 16 days. The effects of coating treatments were performed at 0, 4, 7, 14 and 16 days of storage. The application of CH-Nano ZnO-EOs coating was most significant to retarded the weight loss (6.12%), least browning (1.37). O2 concentrations in the control samples decreased slightly (8.45 kPa), Chitosan reached (11.01 kPa), CH-Nano ZnO was (11.07 kPa), and CH-Nano ZnO-EOs was (12.35 kPa). CH-Nano ZnO-EOs samples reached (14.88 mg CO2 · kg−1h−1) then CH-Nano ZnO-EOs showed the lowest values (11.35 mg CO2 · kg−1h−1) on 16 days of storage. Chitosan treatment did not effectively enhance the antimicrobial activities compared with nano-coatings. The lowest count for mold and yeast was detected in the CH-Nano ZnO-EOs coating treatment (49.45 CFU/ml). CH-Nano ZnO-EOs treatment recorded the highest phenolic acid contents; 9.98 μg−1FW for P-Coumaric Acid, 3.96 μg−1FW for Ferulic Acid, 5.70 μg−1FW for Gallic Acid, 1.35 μg−1FW for Coffeic Acid, and 11.73 μg−1FW for Reseratrol. The highest total phenol value was for CH-Nano ZnO-EOs 2.15 mg g−1FW followed by CH-Nano ZnO 2.05 mg g−1FW. The results showed that the nano-coating film with the addition of essential oil can extend the shelf life.

Abstract Glioblastoma (GBM) is a devastating malignant brain tumor with a dismal 15-month median survival. Current treatments have not been successful at preventing recurrence, thus novel therapeutic modalities are urgently needed. EGFR is a tyrosine kinase receptor that is commonly mutated in ~60% of GBM and is an attractive target for GBM precision oncology. Aberrant EGFR signaling drives tumor proliferation and maintenance, thus further study of common EGFR alterations in GBM, including interstitial deletions (EGFRvIII) and missense mutations (EGFRA289), is needed to develop effective EGFR-targeted therapies. This is especially important in the context of a retrospective study that showed EGFRA289 driven GBM was more clinically aggressive. EGFRA289 positive GBM had a unique, invasive radiographic signature on magnetic resonance imaging (MRI) and patients had a significantly shorter median overall survival of 6-months. We hypothesize that the malignant clinical phenotypes of EGFRA289 GBM are driven by unique epigenomic and transcriptomic, collectively referred to as (epi)genomic, programs linked to EGFRA289 signaling. Prior studies using established cell lines show that EGFRvIII overexpression drives malignant (epi)genomic programs mediated by transcription factor (TF) activation. To better understand variant specific EGFR biology in GBM, we have developed novel genetically engineered mouse astrocyte (mAc) models that overexpress wtEGFR (MA-WT), vIII (MA-v3), and EGFRA289V (MA-A289V). Phospho-immunoblots show that these mAc models have differential EGFR ligand dependance, which match published studies. Despite this difference in EGFR signaling, all mAc models have similar sensitivities to EGFR tyrosine kinase inhibitor (TKI) treatment. However, MA-A289V is more proliferative and migratory compared to the other mAc variants. Preliminary RNA-Seq on our mAc models has identified similar and unique TFs differentially expressed (DE) between MA-v3 and MA-A289V when compared to parental MA-C. Integration of RNA-Seq and CUT&RUN followed by mechanistic genetic interrogation will elucidate the relationship between EGFR variant-specific (epi)genomic mechanisms and their unique malignant phenotype.

The effects of pressing time were evaluated relative to the physical, mechanical, and morphological properties of flat-pressed composites made from Gmelina arborea bark and recycled polypropylene (RPP). Bark powder (5% moisture content) was mixed with RPP pellets in a weight ratio of 40:60 with added maleic anhydride (MAH) as compatibilizer. The materials were mixed in a rotary blender for 15 min at speed 80 rpm until homogeneous. The mixture was heated from 175 to 200 °C until RPP pellets were completely melted and then cooled to room temperature. Afterwards, the mixture was made into powder and molded using a steel plate mold at 175 to 200 °C and pressure of 30 kg/cm2 for 2, 4, and 6 min to a targeted density of 1.0 g/cm3. The tested physical properties were covered density, moisture content, water absorption, and thickness swelling. The mechanical properties modulus of elasticity (MOE) and modulus of rupture (MOR), tensile strength parallel to length of panel were also examined. Research results showed that the properties were significantly affected by pressing time and it can be concluded that the optimum condition was obtained at 4 min of pressing.

In this study, two compounds of TiNb2O7 and Ti2Nb10O29 were successfully synthesized by mechanochemical method and post-annealing as an anode material for lithium-ion batteries. The effect of annealing atmosphere on the morphology, particle size, and electrochemical characteristics of two compounds was investigated. For these purposes, the reactive materials were milled under an argon atmosphere with a certain mole ratio. Subsequently, each sample was subjected to annealing treatment in two different atmospheres, namely argon and oxygen. Phase and morphology identifications were carried out by X-ray diffraction (XRD) and field emission scanning electron microscopy (FESEM) to identify the phases and evaluate the morphology of the synthesized samples. The charging and discharging tests were conducted using a battery-analyzing device to evaluate the electrochemical properties of the fabricated anodes. Annealing in different atmospheres resulted in variable discharge capacities so that the two compounds of TiNb2O7 and Ti2Nb10O29 annealed under the argon atmosphere showed a capacity of 60 and 66 mAh/g after 179 cycles, respectively, which had a lower capacity than their counterpart under the oxygen atmosphere. The final capacity of the annealed samples in the oxygen atmosphere is 72 and 74 mAh/g, respectively.

Today, the area under strawberries is growing every year. Because it is valued for its unpretentiousness to soil conditions, early and rapid fruit ripening, stable yields and resistance to low temperatures. But researchers note a reduction in yields in areas occupied by industrial strawberry plantations in horticultural farms due to the negative impact of the spread of fungal diseases. Gray mold (Botrytis cinerea Pers), verticillium wilt (Verticillium albo-atrum Reinke et Berth.), white spot (Ramularia tulasnei Sacc) and brown spot (Marssonina potentillae P. magn. f. Fragaria Man.), late wilting (Phytophthora fragariae Hick), late blight (Phytophthora cactorum (Leb. et Cohn.) are the dominant fungal diseases of garden strawberries in Ukraine. White spot affects the leaves, petioles, peduncles, sepals and stalks of garden strawberries. When affected by the disease, the appearance of reddish-brown spots is observed, which eventually acquire a white color and a dark red rim appears around. Brown spot mainly damages the leaves of strawberries, which affects the photosynthesis of the plant. Signs of this disease are the appearance of light olive spots, which later turn yellow, and on the underside of the leaf a plaque from light gray to green-brown color is formed. Gray mold fungus affects the leaves, flowers and fruits of garden strawberries. A "fluff" of conidia is formed on berries. They soften, change color to brown and rot. Infection of strawberries with verticillium wilt occurs through the root system. After penetration of the pathogen into the plant, the formation of chlorotic spots is observed. Eventually, the leaves turn yellow, dry up, the conductive tissues are destroyed and the plant dies. Two forms of phytophthora wilting of garden strawberries are described. In the first form, the color of the leaves changes from red to yellow-brown, which then withers and dries. The plant itself lags behind in growth. The second form of the disease affects the root system. The roots turn gray or brown and die. Signs of late blight rot are visible on the roots of strawberries in late autumn, and on the aboveground organs in the spring. Brown ring spots are formed on the root neck, which turn into rot. Necrosis appears on the stem and veins of the leaves, after which the young leaves slow down their growth and dry up. When the plant is affected by pathogens, there is a decrease in yield: white spot causes 10–30 %, brown spot – up to 50 %, gray mold – 30 %, wilting (late blight, verticillium wilt) and late blight – up to 50–60 %. Therefore, since fungal diseases cause a decrease in yield and quality of the species composition of strawberries, it is necessary to develop a system of protection, using agronomic, biological and chemical methods of control.

ABSTRACT Aim The aim of this study was to evaluate the influence of immersion period in two disinfectant solutions on dimensional change of four elastomeric impression materials. Materials and methods Four representative materials of each class of elastomers: Xantopren (polydimethylsiloxane—PDS), Express (polyvinyl siloxane—PVS); Permlastic (polysulfide— PS) and Soft Impregum (polyether—EP) were mixed according to manufacturers’ instructions and then inserted into a metal matrix prepared according to the specification of ISO 4823. The molds were removed from the matrix after 7 minutes and immersed in disinfectant solutions (sodium hypochlorite 0.5 and 2% glutaraldehyde) for 5, 10, 20, 30 and 60 minutes (n = 7), except the control group, which was not immersed. Once removed from solutions, the test samples were washed in water for 15 seconds, dried and measured three times, using a comparative optical microscope, with accuracy of 0.0005 mm. The analysis of variance with three criteria and Tukey's test with significance level of 5% showed that differences in linear dimensions of the materials analyzed were not statistically significant (p > 0.05) after soaking in sodium hypochlorite 0.5 and 2% glutaraldehyde, for the tested periods of time. Clinical significance Combinations of molding material and disinfecting solution can be used in the dental clinic for infection control, without changing the dimensional molds, for immersion periods not longer than 20 minutes. How to cite this article Carvalhal CIO, de Mello JAN, Sobrinho LC, Correr AB, Sinhoreti MAC. Dimensional Change of Elastomeric Materials after Immersion in Disinfectant Solutions for Different Times. J Contemp Dent Pract 2011;12(4): 252-258.

Articolul prezintă rezultatele unui exercițiu de inventariere pe scară mică, realizat într-un arboret (u.a. 34B, U.P. I Săliște, Ocolul silvic Obștea Săliște) care include duglas verde (DF) și molid de Sitka (MOS, specie exotică utilizată foarte rar în România), instalat prin plantare (1,5 x 1,5 m) în anul 1962 în completarea regenerării naturale a fagului. La 60 de ani, duglasul se comportă mai bine decât molidul de Sitka în sens biometric, iar cele mai relevante caracteristici ale celor două specii sunt după cum urmează:
 - diametrul de bază maxim: 67,1 cm (DU) și 37,7 cm (MOS);
 - diametrul mediu al suprafeței de bază dg: 41,81 cm (DU) și 27,43 cm (MOS);
 - înălțimea maximă: 39,5 m (DU) și 30,5 m (MOS);
 - înălțimea corespunzătoare lui dg: 32,00 m (DU) și 24,95 m (MOS);
 - indicele de zveltețe mediu: 84 (DU) și 90 (MOS);
 - diametrul mediu al coroanei: 462 cm (DU) și 361 cm (MOS);
 - ambele specii prezintă un elagaj natural imperfect, ca și în alte culturi instalate în întreaga Europă.
 Duglasul verde s-a adaptat la condițiile locale ca și în alte părți din România, unde se întâlnește pe cca 12.700 ha, și prezintă un potențial ridicat de producție de lemn. Molidul de Sitka a fost capabil să supraviețuiască în condiții locale dificile (spre exemplu, altitudine mare, climat temperat-continental, foarte diferit de cel oceanic din arealul natural și de pe coastele nordice și vestice ale Europei), fără a produce la fel de mult lemn ca în alte țări europene gen Marea Britanie și Irlanda.

Fungal keratitis (FK) is a serious ocular infection that can result in various degrees of vision loss, including blindness. The aim of the study was to identify and retrospectively review all FK cases diagnosed between August 2012 and December 2020 at a tertiary care hospital in northern Thailand with a specific focus on epidemiologic features, including season, patient sex and age, the spectrum of pathogens, and presence of certain putative virulence factors. Of 1237 patients with corneal ulcers, 294 (23.8%) were confirmed by direct microscopic examination and/or fungal culture. For the positive cases, direct examinations of Calcofluor white (CW) stains and KOH mounts were found in 97.3% (286/294) and 76.5% (225/294), respectively (p < 0.05). Of the cases diagnosed by microscopy and culture, fungi were isolated in 152 (51.7%), with Fusarium spp. being the most frequently identified (n = 69, 45.5%) followed by dematiaceous fungi (n = 45, 29.6%) and Aspergillus spp. (n = 18, 11.8%). The incidence of FK was higher in the rainy season of July to October. The mean age was 54.4 ± 14.4 (SD) years, with a range of 9–88 years. Males (75.8%) were affected significantly more than females (24.2%) (p < 0.05). Of 294 patients, 132 (44.9%) were middle-aged adults (41–60 years) and 107 (36.4%) were older than 60 years. Trauma to the eye by soil or vegetative matter were the most common preceding factors (188/294; 64.0%). We assessed two virulence factors. First, 142 of the 152 culture-positive FK cases were due to molds, indicating that hyphal morphogenesis is extremely important in disease. We also demonstrated that fungal melanization occurs in the molds during the course of FK by applying a melanin-specific monoclonal antibody (MAb) that labeled fungal elements in corneal samples of patients, and melanin particles derived from the hyphae were also recovered after treatment of the samples with proteolytic enzymes, denaturant and hot concentrated acid. In summary, we demonstrate that northern Thailand has a high rate of FK that is influenced by season and males engaged in outside activities are at highest risk for disease. Moulds are significantly more commonly responsible for FK, in part due to their capacity to form hyphae and melanins. Future studies will examine models of fungal corneal interactions and assess additional factors of virulence, such as secreted enzymes, to more deeply decipher the pathogenesis of FK.

NASA’s carbon dioxide mission, Orbiting Carbon Observatory-2, began operating in September 2014. In this paper, we analyze four years (2015–2018) of global (60°S–60°N) XCO2 anomalies and their annual variations and seasonal patterns. We show that the anomaly patterns in the column-averaged CO2 dry air mole fraction, XCO2, are robust and consistent from year-to-year. We evaluate the method by comparing the anomalies to fluxes from anthropogenic, biospheric, and biomass burning and to model-simulated local concentration enhancements. We find that, despite the simplicity of the method, the anomalies describe the spatio-temporal variability of XCO2 (including anthropogenic emissions and seasonal variability related to vegetation and biomass burning) consistently with more complex model-based approaches. We see, for example, that positive anomalies correspond to fossil fuel combustion over the major industrial areas (e.g., China, eastern USA, central Europe, India, and the Highveld region in South Africa), shown as large positive XCO2 enhancements in the model simulations. We also find corresponding positive anomalies and fluxes over biomass burning areas during different fire seasons. On the other hand, the largest negative anomalies correspond to the growing season in the northern middle latitudes, characterized by negative XCO2 enhancements from simulations and high solar-induced chlorophyll fluorescence (SIF) values (indicating the occurrence of photosynthesis). The largest discrepancies between the anomaly patterns and the model-based results are observed in the tropical regions, where OCO-2 shows persistent positive anomalies over every season of every year included in this study. Finally, we demonstrate how XCO2 anomalies enable the detection of anthropogenic signatures for several local scale case studies, both in the Northern and Southern Hemisphere. In particular, we analyze the XCO2 anomalies collocated with the recent TROPOspheric Monitoring Instrument NO2 observations (used as indicator of anthropogenic fossil fuel combustion) over the Highveld region in South Africa. The results highlight the capability of satellite-based observations to monitor natural and man-made CO2 signatures on global scale.

Abstract Abstract 3941 Background: Monoclonal antibody (MAb) therapy has had a significant impact on the management of B-cell malignancies, but is most often used in combination with chemotherapy. We developed an ADC that combines SN-38, the active component of irinotecan, a topoisomerase I inhibitor, with the internalizing, humanized, anti-CD22 IgG, epratuzumab, and determined its activity alone and in combination with an anti-CD20 antibody therapy (veltuzumab). Methods: Epratuzumab was conjugated with SN-38 (E-SN-38) at a mole ratio of ∼6:1. The conjugate is designed specifically to be released slowly in the presence of serum (50% released over ∼1.5 days), allowing liberation of the drug when internalized, but also being released locally after being bound to the tumor. In vitro and in vivo studies were performed to assess the activity of the conjugate against several subcutaneously- or intravenously-inoculated B-cell lymphoma cell lines. In vivo studies also examined combination therapy using E-SN-38 and the veltuzumab (V). Results: In vitro studies in 4 B-cell lymphoma cells lines (Daudi, Raji, Ramos, WSU-FSCCL) and 4 acute lymphoblastic lymphoma cell lines (697, REH, MN-60, and RS4;11) expressing varying amounts of CD22 showed an IC50 for E-SN-38 in the nanomolar range, confirming potent activity. Nude mice bearing SC Ramos human lymphoma had significant selective anti-tumor activity compared to a control, non-targeting, IgG-SN-38 conjugate, at a dosing regimen of 75 to 250 μg of the conjugates given twice-weekly for 4 weeks. Significant anti-tumor activity was also found in several other cell lines. When combined with veltuzumab, significant improvement in therapeutic activity was observed. For example, median survival in a WSU-FSCCL human follicular B-cell lymphoma IV model with treatment initiated 5 days after implantation was 42 d (0/10 surviving at 160 d) and 91 d (2/10 surviving) for untreated and veltuzumab-treated animals, respectively; 63d (0/10 surviving after 160 d) and >160 d (with 6/10 surviving) for E-SN-38 and E-SN-38 + V, respectively; and 63 d (0/10) and 91 d (2/10) for non-targeting IgG-SN-38 conjugate alone and combined with V). The E-SN-38 conjugate combined with V was significantly better than all treatment or control groups (P ≤ 0.05). Conclusion: E-SN-38 ADC is a potent therapeutic, even at non-toxic dose levels, and shows significantly enhanced efficacy when combined with anti-CD20 immunotherapy, representing an important new ADC treatment regimen. Disclosures: Goldenberg: Immunomedics, Inc.: Membership on an entity's Board of Directors or advisory committees, Patents & Royalties. Govindan:Immunomedics, Inc.: Employment. Cardillo:Immunomedics, Inc.: Employment.

Titanium dioxide (TiO2), abundant in nature and possessing excellent longevity characteristics, is gaining attention as a next-generation anode material for Li-ion batteries. However, compact stacking of TiO6 octahedra induces repulsion between the inserted Li ions, reducing rate performance and achievable capacity. Herein, we propose a hollow mesoporous electrode composed of TiO2 nanoparticles under 30 nm to enhance the interface between the electrode and electrolyte, facilitating the Li-ion movement and promoting a shorter diffusion distance for the inserted Li-ions. Furthermore, the formation of hollow structures enabled Li ions to enter and exit both inside and outside the hollow shell, facilitating rapid charging and discharging characteristics. To produce this hollow mesoporous structure, TiO2 nanoparticles smaller than 20 nm synthesized by a sol-gel process were deposited on a spherical carbon support, and the support was subsequently removed. In particular, the thickness of the hollow shell was controlled to minimize the diffusional path area within the electrode through which Li ions move. Thin TiO2 shells facilitate ion migration via a reduced tortuosity while minimizing isolated pore formation, allowing D Li+ of 3.22×10-11 cm2 s-1 to be attained, 40 times higher than that of bulk-type TiO2. With its rapid Li ion diffusion rate and thin shell, the TiO2 anode exhibited the 70% highest rate capability (10 C vs. 1 C) and a capacity of 221 mAh g-1 at 0.5 C (Fig. 1). The facile Li-ion transport enables the insertion of 0.66 mol Li ions per mole of TiO2 at 0.5 C and 67% rate performance (10 C vs. 0.5 C). When evaluating the rate capability in actual LIBs, a full cell assembled with a LiFePO4 cathode showed a rate performance of 60% (2000 mA g-1 vs. 50 mA g-1), outperforming the 40% for commercial bulk-type TiO2 in a full cell. Hollow mesoporous TiO2 provided a potential anode for fast-charging Li-ion batteries as a thin mesoporous shell allows for rapid ion insertion and extraction with the extended interface of electrode/interface. Figure 1

Introduction:Psychiatry:Psychiatry is the branch of medicine focused on the diagnosis, treatment and prevention of mental, emotional and behavioural disorders.Depression is a prevalent mental illness. An estimated 5% of adults worldwide are depressed.  Depression affects more women than males. Suicide can result from depression. Depression, whether mild, moderate, or severe, can be effectively treated. The thyroid is a little gland at the front of your neck that resembles a butterfly. It produces hormones that regulate the body's energy consumption. These hormones regulate almost all of your body's vital processes and have an impact on almost every organ. Thyroid hormone imbalances, whether from excess or insufficiency, can lead to mood disorders, such as depression, which can be effectively treated with thyroid medication. A prospective cohort study is a kind of observational research that tracks a cohort of individuals throughout time to gather information on their exposure to a factor of interest.Materials And Methods:Place of study:The study “a prospective study on depression due to thyroid dysfunction’’ which was carried out in the Department of Psychiatry at Narayana Hospital, Nellore, in collaboration with a 1200 bedded multidisciplinary teaching hospital, under the guidance of dr .sasi kala mam. pharm d asistant professor of Narayana pharmacy college, Department of Pharmacy Practise, Narayana Medical college, Nellore.Study design:The study was a prospective observational clinical study in the Department of Psychiatry of tertiary care teaching hospitals.Study population:This study was conducted in 200 patients who came to the department of Psychiatry and General Medicine with the complications of depression due to Thyroid DysfunctionStudy durations:This study was conducted for a period of 6 months (September 2023-Feburary 2024)Results:Here in this study, we have collected the data from Psychiatry department. In this study maximum number patients reported in the Psychiatry department. Most of the people is suffering from the depression due Thyroid dysfunction. Females are more affected than males Discussion:The patients are mostly covered from the Psychiatry department most of the people are suffering from the depression due to the thyroid dysfunction in adults.They were treated anti thyroid medication and antidepression  medication. Our study is about Depression due to Thyroid dysfunction with its clinical approach in which the data was collected from the patients by using HMD scale of Depression.Out of 200 patients, 130 patients were suitable for study based on inclusion and exclusion criteria.In our  study we have categorized the patients using Depression due Thyroid dysfunction.Out of 200 patients 130 patients considered for the study, mostly were females i.e .85(65%) and males are fewer i.e.45(35%)among the age groups of 20-60 .Patients were categorized based on their age groups   and gender in which majority of them 30(36%) females were found in the between 40-50 years ,17(20%) in between 20-29years ,18 (21%) in between 30-39years ,24(20%)in between 50-60 years.In males majority were found in 15(33%) in between the age groups 40-49. 12 (27%) in between in age groups of 20-29.14(31%) in between in age groups of 30-39 .15(33%) in between in the age groups of 40-49. 4(9%) in the between age groups 50-60.conclusion:Our study concluded that most of the patients admitted in the Psychiatry department. Depression due to Thyroid dysfunction the production of neurotransmitters is slow so it leads Depression in Thyroid Dysfunction The synthesis and operation of neurotransmitters in the brain, such as serotonin, which is connected to mood regulation, may be impacted by low thyroid hormone levels.

625 Background: IMMU-130 is a CEACAM5-targeted ADC, labetuzumab-SN-38, with the drug being the active form of the topoisomerase I inhibitor, CPT-11, and substituted at 7-8 moles/mole of IgG. This agent is in phase I/II clinical trials in patients with relapsed mCRC (NCT01270698; NCT01605318). Methods: Therapy experiments were conducted in female athymic nude mice (n=5-10 per group), 4-6 weeks of age, bearing s.c. LS174T human colon carcinoma xenografts of ~0.2 cm3 size, or 2 weeks after lung metastases were generated by i.v. injection of GW-39 human colon carcinoma cells. Untreated controls, including a non-targeting ADC, were included. Biodistribution was examined in the s.c model using a single 12.5-mg/kg dose of the ADC or unconjugated labetuzumab, each spiked with 111In-labeled substrate. Tolerability studies were conducted in white New Zealand rabbits. Results: In the metastatic model, fractionated dosing of a total of 50 mg/kg of ADC showed that 2 × the schedules of twice-weekly × 2 weeks with 1 week off and once-weekly × 2 weeks with 1 week off doubled the median survival vs. untreated mice, and were better than a 25-mg/kg dose given on days 1 and 15 (p < 0.0474; log-rank). Pre-dosing with as much as twice the dose of labetuzumab as the ADC dose in the metastatic model did not affect median survival (p > 0.15). Therapy experiments in the s.c. model revealed that IMMU-130, with 50% of drug released in ~20 h, was superior to the conjugate with an ultrastable linker, that the ADC was better than an MTD of 5FU/leucovorin chemotherapy (p < 0.0001), and that the ADC could be combined with bevacizumab for improved efficacy (p < 0.031). Significantly better efficacy for the specific ADC vs. nonspecific ADC was observed. Pharmacokinetics in mice indicated ~25% longer half-life for the unconjugated MAb vs. ADC, but with minimal impact on tumor uptake. A tolerability study in rabbits showed the NOAEL to be the human equivalent dose of 40-60 mg/kg, given as two doses. Conclusions: Preclinical data show an excellent therapeutic window for IMMU-130, which appears to be translated into the clinical experience thus far. The potential for combination therapy is also indicated.

Abstract Hydrocyanic acid (HCN) is regulated in the European Union to max. 57 mg/kg dry matter (DM) in complete feed. The study evaluated the effect of two commercial silage inoculants on fermentation, dry matter loss, aerobic stability and the level of hydrocyanic acid of whole-plant sorghum. Sorghum [Sorghum bicolor (L.) Moench] variety Vilom ene was harvested at the soft dough maturity stage at 29.8 % DM. Ten mini-silos (1.5 l volume) for each treatment were filled with crop (193 kg DM/m3). Control forage (CON) was not inoculated. AS treatment was inoculated with SiloSolve AS (150,000 total CFU/g of forage), containing Lentilactobacillus buchneri (DSM22501), Lactiplantibacillus plantarum (DSM26571) and Enterococcus faecium (DSM22502). FC treatment was inoculated with SiloSolve FC (150,000 total CFU/g of forage), containing Lentilactobacillus buchneri (DSM22501) and Lactococcus lactis (DSM11037). After 60 d of fermentation at room temperature, five mini-silos per treatment were opened and sampled for proximate analysis, forage hygiene, and the fermentation profile. The content from the other five mini-silos was subjected to an aerobic stability test. Aerobic stability was defined as the time (hours) for the silage temperature to exceed 3.0°C above the ambient temperature. The data were analyzed as a completely randomized design using GLM of Minitab with treatments as a fixed effect. No significant effect of treatments was observed on dry matter loss. Both inoculants increased acetic acid levels in the silages compared with CON; P < 0.05), where FC showed a significantly greater level than AS (3.1, 2.5 and 1.7 % DM for FC, AS, and CON, respectively; Table 1). Both inoculants produced 1,2-propanediol (P < 0.05). FC silage had a greater level of 1,2-propanediol than AS (1.0, 0.4 and 0.0 % DM for FC, AS, and CON, respectively). The concentrations of lactic acid, ammonia-N and ethanol were not different between treatments. FC significantly reduced the count of yeasts (3.1, 4.1, and 4.3 Log10 CFU/g for FC, AS, and CON, respectively). The count of molds was below the detection level (< 2.0 Log10 CFU/g) in all silages. The FC silage markedly improved aerobic stability, extending it to 231 h, compared with 112 and 80 h for the AS and CON treatments (P < 0.001). AS tended to improve aerobic stability compared with CON (P = 0.08). No differences were observed in the concentration of the hydrocyanic acid between treatments. The ensiling process significantly reduced (P < 0.0001) the hydrocyanic acid from 86.4 mg/kg DM in the fresh crop to 58.4 mg/kg DM in silages. Such silage should be fed only together with HCN-free ingredients in a TMR. However, these results demonstrate that only the combination of L. buchneri (DSM22501) and Lactococcus lactis (DSM11037) effectively decreased the yeast count and consequently improved aerobic stability in whole-plant sorghum silage.

Iron(II), iron(III), chromium(VI) and chromiumr(III) in industrial waste water were determined using combination of UV-Visible spectrophotometry and atomic absorption spectrophotometry (AAS). Species of iron(II) was analyzed as its 1,10- phenantroline complex and Cr(VI) as its 1,5-diphenylcarbazide complex, whereas species of Fe(III) and Cr(VI) were calculated indirectly by the difference after analyzing the total Fe and Cr by AAS. For the determination of Fe(II) and Cr(VI) species using a spectrophotometer UV?Visible, the optimum conditions of analysis were first investigated. The optimum experimental conditions obtained were then applied for the analysis of Fe(II) and Cr(VI) in some industrial waste water samples using calibration curve techniques. For the analysis of total Fe and Cr, AAS was used. Finally, from these results of the two methods the concentration of Fe(III) and Cr(VI) were estimated by subtracting the concentration of species Fe(II) and Cr(VI) from the total concentration of Fe and Cr, respectively.From the study, it was obtained that optimum conditions for determining the species Fe(II) is at maximum wavelength of 510 nm, stability time up to 450 min, mole ratio of ligand to Fe = 7:1 and pH ? 6. For Cr(VI)-DPC complex it was found that ?max = 540 nm, stability time from 5–60 min, mole ratio of Cr(VI): ligand = 1:43 and pH ? 2.0. The metal speciation analysis results indicated that the concentration of Fe(II) in tannery waste water was 0.16–0.26 ppm, in metal plating wastes was 8.88 ppm, in textile wastes = 0.09–0.25 ppm, in Piyungan IPAL TPA waste water 0.09?4.26 ppm and in batik waste water 0.00–1.05 ppm. Species of Cr(VI) in tannery waste water was found to be 0.00?0.16 ppm, metal plating was 1427.4 ppm, textile waste was 0.01–0.03 ppm, the Piyungan IPAL TPA was 0.00–0.15 ppm and batik wastes was 0.00–0.02 ppm. The calculation result of Fe(III) species in tannery waste water was 0.07–0.26 ppm, in waste metal plating was 18.17 ppm, in textile was 0.09–0.521 ppm, in Piyungan IPAL TPA wastes was 0.03–2.35 ppm and in batik waste was 0.01–0.50 ppm. As for Cr(III) species in tannery waste water, it was found to be 0.00–1.88 ppm, in metal plating was 277.66 ppm, in textile 0.01–0.03 ppm, in Piyungan IPAL TPA 0.02–0.11 ppm and in batik 0.01–0.02 ppm. The results showed that UV-Visible spectrophotometric method in combination with AAS can be used for metal speciation analysis of Fe and Cr in environmental samples. ABSTRAKTelah dilakukan analisis spesies Fe(II), Fe(III) dan Cr(VI), Cr(III) dalam limbah cair industri menggunakan metode kombinasi spektrofotometri UV?tampak dan spektrofotometri serapan atom (AAS). Analisis spesies Fe(II) menggunakan ligan 1,10-fenantrolin dan Cr(VI) menggunakan ligan 1,5?difenilkarbazid sebagai pengompleks, spesies Fe(III) dan Cr(III) ditentukan secara tidak langsung dari selisih Fe dan Cr total dengan Fe(II) dan Cr(VI). Penentuan spesies Fe(II), Cr(VI) menggunakan spektrofotometer UV-tampak diawali dengan penentuan kondisi optimum analisis. Kondisi optimum percobaan yang diperoleh diaplikasikan dalam analisis spesies Fe(II) dan Cr(VI) dalam beberapa sampel limbah cair industri dengan teknik kurva kalibrasi. Metode AAS untuk menganalisis Fe total dan Cr total. Kemudian dari hasil tersebut berturut-turut dihitung selisih konsentrasi spesies Fe(II) dan Cr(VI) dengan Fe dan Cr total sehingga diperoleh konsentrasi spesies Fe(III) dan Cr(III). Kondisi optimum penentuan spesies Fe(II) adalah panjang gelombang maksimum 510 nm, waktu kestabilan sampai 450 menit, rasio mol ligan:Fe(II) = 7:1 dan pH larutan ? 6,0. Untuk kompleks Cr(VI)-DPC panjang gelombang maksimum 540 nm, waktu stabil kompleks dimulai menit ke-5 sampai ke-60, rasio mol Cr(VI):ligan = 1:43 dan pH larutan ? 2,0. Hasil spesiasi logam menunjukkan spesies Fe(II) dalam limbah cair industri penyamakan kulit sebesar 0,16–0,26 ppm, limbah pelapisan logam 8,88 ppm, limbah tekstil 0,09–0,25 ppm, limbah IPAL TPA Piyungan 0,09?4,26 ppm, limbah batik 0,00–1,05 ppm. Spesies Cr(VI) dalam limbah cair industri penyamakan kulit 0,00?0,16 ppm, limbah pelapisan logam 1427,40 ppm, limbah tekstil 0,01?0,03 ppm, limbah IPAL TPA Piyungan 0,00–0,15 ppm, limbah batik 0,00?0,02 ppm. Hasil penentuan spesies Fe(III) dalam limbah cair industri penyamakan kulit adalah 0,07–0,26 ppm, limbah pelapisan logam 18,17 ppm, limbah tekstil 0,09–0,52 ppm, limbah IPAL TPA Piyungan 0,03–2,35 ppm, limbah batik 0,01–0,50 ppm. Adapun untuk spesies Cr(III) dalam limbah cair industri penyamakan kulit diperoleh kadar 0,00–1,88 ppm, limbah pelapisan logam 277,66 ppm, limbah tekstil 0,01–0,03 ppm, limbah IPAL TPA Piyungan 0,02–0,11 ppm, limbah batik 0,01–0,02 ppm. Hasil penelitian menunjukkan bahwa metode spektrofotometri UV-tampak yang dikombinasikan dengan AAS dapat digunakan untuk analisis spesiasi logam Fe dan Cr dalam sampel lingkungan.

Nowadays, plasmonic sensors are the most widely used and commercialized label-free optical biosensors and have become a widespread tool for studying chemical/biochemical interactions. Label-free, real-time, and direct measurements are the major benefits of the plasmonic sensors, including high-throughput surface bio-functionalization strategies without amplification or pretreatment of the sample [1]. The working principle of plasmonic sensing has been extensively described and reviewed over the decades [2], however, the possibility to develop cheap, effective, and clinically-accepted biosensors has recently become available due to the development of nanotechnology. Briefly, these nanostructures can be localized or can be arranged on 2D arrays of plasmonic metasurfaces, and can be fabricated by single-layer metallic films and a combination of metallic and dielectric films. The most popular plasmonic metals are gold and silver due to their high conductivity and low dielectric losses. Generally, top-down nanofabrication methods based on laser/e-beam lithography have been used, including nanostencil lithography based on shadow-masked nano-pattering and nanoimprint lithography [3]. Although such technologies have a high potential to achieve scalable and cost-effective nanofabrication at the wafer scale, these processes maintain the following main challenge: a master nano-mold/pattern is required to transfer metasurfaces with an associated high cost. Therefore, other technologies are the subject of research that overcomes this limitation and still offer an outstanding quality of metallic films, such as TDW (thermal dewetting) and GLAD (glancing angle deposition) (Fig.1). These techniques do not require master nano-mold/patterns; consequently, they can achieve lithography-free large-scale plasmonic metasurfaces [4]. TDW and GLAD usually generate quasi-ordered plasmonic metasurfaces compared to conventional lithographic methods. In this paper, the experimental results of the optical sensing properties of the sensors developed by the utilization of the combination of these two technologies in a single system are presented. The TWD/GLAD magnetron sputtering system has been designed and manufactured based on the Kurt J. Lesker MAG-Torus magnetrons, supplied with DC/RF power sources and an ECR manipulator that enables deposition at various angles with maximal 20 rpm rotation speed and heating option up to 850oC. The system is controlled by the software that enables deposition of the samples with the same parameters which pave the way for fabrication of the sensors on the industrial scale. The optical-sensing system was built based on an ST-VIS-50 spectrometer (Ocean Optics) and Tungsten Halogen Source (360-2000 nm, 2800 K, Ocean Optics) and optical table from Thorlabs. The obtained reflectance measurement has shown that the utilization of the GLAD technique decreases the reflectance peak in comparison with samples deposited without GLAD (flat samples). At the same time, angles in the range of 82-86oC seem to be preferable for nanostructure fabrication. Additionally, the utilization of the TWD technique, i.e. deposition at lower temperatures in the range of 60-100oC (depending on the substrate) and then annealed at higher temperatures such as 250oC and 300oC in a vacuum and under argon flow in the deposition chamber led to increased normalized response. However, the experiments have shown that the optimal annealing time is between 30-45 min depending on the SPR multi-structure, for example for Ag (6nm), Ti (2nm), and Au (2nm) the 30min at 250oC seems to be the best set. For such compositions, the surface sensitivity (nm/nm) and bulk sensitivity (nm/RIU) are more or less the same - 0.9 and 300, respectively. The obtained results are very promising for developing cheap, rapid, and very effective biosensors for various applications. Therefore, the obtained results seem to be very interesting for the ECS conference audience, for example, the developed Ag/Ti/Au multi-structures can be applied in novel organ-on-a-chip platforms for LADMET (liberations, absorption, distribution, metabolism, excretion, and toxicology) analysis [5]. Fig. 1. Schematic diagram representation of lithography free methods for developing quasi-ordered metamaterials from left to right: Thermal dewetting and glancing angle deposition. The insert shows the chiral plasmonic nanospirals fabrication by glanced angle deposition [4]. References: [1] LC Oliveira et al., Springer, 2019. ISBN: 9783030174859 [2] VG Kravets et al., Chem. Rev. 2018, 118, 12, 5912–5951. doi.org/10.1021/acs.chemrev.8b00243 [3] M. Zandieh et al., Analytical Biochemistry. 2018, 548, 96-101. doi.org/10.1016/j.ab.2018.02.023 [4] GA López-Muñoz et al., Front. Sens. 2022, 3:945525. doi: 10.3389/fsens.2022.945525 [5] J. Ramon, A. Rydosz, Human Organs-on-a-chip, 2023. ISBN: 9780443153846 The work was financially supported by the National Science Centre, Poland Sonata-BIS project no 2022/46/E/ST7/00008. Figure 1

All-solid-state lithium batteries with nonflammable inorganic solid electrolytes have attracted attention in terms of safety. Transition-metal sulfides are promising positive electrode active materials because of their relatively high electronic conductivities and capacities. Generally, higher specific capacities would be achieved by increasing the S content in transition-metal sulfide [1]. We have investigated electrochemical performance of all-solid-state cells using transition-metal sulfide active materials (TiS x [1−3], NbS x [4], MoS x [5,6] etc.). For example, amorphous molybdenum polysulfides exhibited higher capacities than MoS2 active materials by using anion redox reactions of sulfur [5,6]. In this study, amorphous MoS4 (a-MoS4) samples prepared by thermal decomposition of (NH4)2[Mo3S(S2)6]·H2O were applied to the electrode active materials for all-solid-state batteries. By XRD measurement, it was confirmed that amorphous materials were obtained through thermal decomposition of (NH4)2[Mo3S(S2)6]·H2O in an argon atmosphere. The molar ratio of S to Mo was determined to be 4 (MoS4) by CHNS elemental analysis. The Mo3d XPS spectrum of a-MoS4 indicated that the electronic state of Mo in a-MoS4 was close to that in MoS2. In the S2p XPS spectrum, two sets of doublet peaks were observed. Thus, in a-MoS4, sulfur would form the S-S bonds which enhance its capacity. The electronic conductivities of a-MoS4 measured by DC polarization were 5.0 × 10−4 S cm−1 at 25 ºC. Composite working electrodes were fabricated by mixing a-MoS4, Li3PS4 glass, and acetylene black (40 : 60 : 6 wt%). Li3PS4 glass and Li–In alloy were used as a solid electrolyte separator and a counter electrode, respectively. All-solid-state lithium cells using a-MoS4 active materials operated with a cut-off voltage of 0.9–2.2 V (vs. Li–In) at 25 ºC under a current density of 0.13 mA cm−2. The cells exhibited high reversible capacities of about 460 mAh g−1 for 150 cycles. In conclusion, amorphous MoS4 active materials were successfully prepared by thermal decomposition of (NH4)2[Mo3S(S2)6]·H2O. All-solid-state cells (Li-In / Li3PS4 glass / a-MoS4) showed relatively high capacities and good cyclabilities. References [1] A. Sakuda et al., J. Am. Chem. Soc., 139 (2017) 8796–8799. [2] A. Hayashi et al., Chem. Lett., 41 (2012) 886–888. [3] A. Sakuda et al., Electrochem. Commun., 31 (2013) 71–75. [4] A. Sakuda et al., ECS Electrochem. Lett., 3 (2014) A79. [5] T. Matsuyama et al., J. Mater. Chem. A, 3 (2015) 14142–14147. [6] G. Shirota et al., J. Ceram. Soc. Jpn., 130 (2022) 308–312.

ABSTRAK Penelitian ini ditujukan untuk mengetahui hubungan kualitas audit, komite audit, dan Dewan Pengawas Syariah (DPS) terhadap kinerja Bank Umum Syariah di Indonesia pada tahun 2015-2020 yang diproksikan dengan ROA, baik secara parsial dan simultan. Melalui pendekatan kuantitatif dengan teknik analisis regresi data panel, hasil penelitian ini menunjukkan bahwa secara parsial, kualitas audit yang dihasilkan KAP Big 4 berpengaruh positif signifikan terhadap kinerja bank umum syariah. Pada variabel komite audit, ukuran komite audit tidak mempengaruhi kinerja bank umum syariah, sedangkan kompetensi dan frekuensi komite audit berpengaruh negatif signifikan terhadap kinerja bank umum syariah. Pada variabel DPS, ukuran dan frekuensi rapat DPS berpengaruh negatif signfikan terhadap kinerja bank umum syariah, sedangkan kompetensi DPS berpengaruh positif signifikan terhadap kinerja bank umum syariah. Secara simultan, kualitas audit, komite audit, serta DPS berpengaruh positif signifikan terhadap kinerja bank umum syariah. Penelitian ini diharapkan dapat bermanfaat bagi manajemen perusahaan, sebagai bahan pertimbangan untuk meningkatkan efektivitas peran pengawasan dalam penerapan tata kelola perusahaan agar dapat mewujudkan kinerja perusahaan menjadi lebih baik. Kata Kunci: Kualitas audit, Komite audit, Dewan Pengawas Syariah, Kinerja Bank. ABSTRACT This study aims is to find out the relationship between audit quality, audit committee, and Sharia Supervisory Board (SSB) on the performance of Islamic Commercial Banks in Indonesia in 2015-2020 as proxied by ROA, both partially and simultaneously. Through a quantitative approach with panel data regression analysis techniques, the results of the study show that partially, the audit quality produced by KAP Big 4 has a significant positive effect on the performance of Islamic commercial banks. In the audit committee variable, the size of the audit committee does not affect the performance of Islamic commercial banks, while the competence and frequency of the audit committee have a significant negative effect on the performance of Islamic commercial banks. In the DPS variable, the size and frequency of DPS meetings have a significant negative effect on the performance of Islamic commercial banks, while DPS competence has a significant positive effect on the performance of Islamic commercial banks. Simultaneously, audit quality, audit committee, and DPS have a significant positive effect on the performance of Islamic commercial banks. This research is expected to be useful for company management, as a consideration for increasing the effectiveness of the supervisory role in the implementation of corporate governance in order to realize better company performance. Keywords: Audit Quality, Audit committee, Shariah Supervisory Board, Banks performance. 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Original Research Paper FUNCTIONAL OUTCOME OF BIPOLAR HEMIARTHROPLASTY IN DISPLACED INTRACAPSULAR FEMORAL NECK FRACTURE IN ELDERLY IN RURAL TERTIARY HOSPITAL <strong>Authors:</strong> <strong>¹</strong><strong>Dr. Saikrishna Rengerla</strong><strong>, </strong><strong>²</strong><strong>Dr. Akhil Lohkare, ³Dr. CM Badole</strong> <em>^1,2</em><em>Senior Resident, Dept of Orthopaedics, MGIMS Sevagram</em> <em>³</em><em>Director-Professor &amp; HOD, Dept of Orthopaedics, MGIMS Sevagram</em> Corresponding Author: Dr. Saikrishna Rengerla, Dept of Orthopaedics, MGIMS Sevagram <strong>Article Received:</strong>&nbsp; 10-08-2022&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <strong>Revised:</strong>&nbsp; 31-08-2022&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <strong>Accepted:</strong> 21-09-2022 <strong>ABSTRACT: </strong> Femoral neck fractures, one of the most common injuries in the elderly have always presented great challenges to orthopaedic surgeons. The present study was conducted in 42 elderly patients with closed displaced intracapsular fracture of femoral neck following all inclusion and exclusion criteria who were present to the Orthopaedics department from October 2019-May 2021 to evaluate functional outcome of bipolar hemiarthroplasty in displaced intracapsular femoral neck fracture in elderly who were followed for duration of 6 months at an interval of 6 weeks, 3 months and 6 months. Most of the patients were belonging to 65-69 years of age group accounting to 33.33%. Females outnumbered males accounting to 59.52% with female to male ratio of 1.47:1. Transcervical fractures outnumbered and accounted for 90.48%. There were more left sided fractures accounting for 71.43%. Most of the patients were operated within 7 days of fracture accounting for 45.24% with average hospital stay of 14.71&plusmn;4.79 days. Most common mode of injury was trivial trauma i.e.92.86%. 41mm Bipolar prosthesis size accounted for maximum of 28.6%. Harris Hip Score was used to evaluate the functional outcome of Bipolar Hemiarthroplasty was noted at regular follow ups. &nbsp;Mean Harris Hip score at 6 weeks was 74.21&plusmn;10.07, at 3 months was 77.66&plusmn;10.59, at 6 months was 80.40&plusmn;10.60 with upward trend in the mean score over follow up period. There was 2.38% cases of posterior dislocation noted at 1 month in Uncemented Bipolar Hemiathroplasty postoperatively, 4.76% cases of infection and 7.14% cases of lengthening, 7.14% cases of Bedsores. The final functional outcome at 6 months of follow up revealed excellent results in 13 patients(30.95%), Good in 11 patients(26.19), Fair in 12 patients(28.57%) and Poor results in 6 patients(14.29%). Our study concludes that Bipolar Hemiarthroplasty offers excellent, painless mobility and ease in rehabilitation and return to function. <strong><em>Key words: Bipolar hemiarthroplasty, Elderly patients, Harris hip score, Intracapsular femoral neck fracture, Complications, Functional Outcome.</em></strong> &nbsp; &nbsp; <strong>INTRODUCTION:</strong> Femoral neck fractures, one of the most common injuries in the elderly have always presented great challenges to orthopaedic surgeons. The prevalence of these fractures has increased with improvement in life expectancy, increased incidence of osteoporosis, poor vision, neuro-muscular incoordination and changes in lifestyle leading to sedentary habits⁽¹⁾. In the elderly with osteoporotic bones, a trivial fall is the cause of hip fractures in about 90% of cases⁽²⁾. The prevalence of the fracture also doubles for each decade of life after fifth decade⁽³⁾. Treatment of displaced femoral neck fractures in elderly has been controversial. Open reduction and internal fixation of these fractures in the elderly have poor outcome including high rate of nonunion and avascular necrosis⁽¹⁾. Various prosthesis have been designed which can be broadly divided into two types- unipolar and bipolar. Of unipolar prosthesis, the most commonly used are the THOMPSONS and AUSTIN MOORES prosthesis. Main problems with these prosthesis were stem loosening and migration⁽⁴⁾. In modern days the bipolar prosthesis with cement is the best option wherein they can be more active⁽⁵⁾. PMMA cement offers advantages as its use as a grouting agent to replace thinning trabecular bone thus greatly simplifying rehabilitation. The Bipolar prosthesis was introduced to prevent and retard acetabular wear. These prosthesis have a 22 to 32mm head that articulates with ultra-high-density polyethylene inner liner which is covered with a polished metal outer head that articulates with acetabular cartilage. It causes less articular wear⁽⁴⁾. Advantages of uncemented femoral components is including faster implantation and potential lower risk of fat and marrow embolism compared to cemented implants. Disadvantages of uncemented implants in elderly are potential for retarded osteointegration, osteopenia and concern for fracture and in patients with wide femoral canal has mismatch of proximal/distal diameters^(6,7,8). There was no significant difference in using cemented and uncemented bipolar prosthesis⁽⁹⁾. The aim of the study is to evaluate the functional outcome of Bipolar hemiarthroplasty in closed displaced intracapsular femoral neck fracture in elderly. <strong>METHODOLOGY: </strong> This was a follow up study and conducted in 42 elderly patients with closed displaced intracapsular fracture of femoral neck reported to the Orthopaedics Department of MGIMS and Kasturba hospital following all inclusion and exclusion criteria from October 2019-May 2021. Inclusion criteria was patients of age 60 years and above, nonunited/old fracture neck of femur. Exclusion criteria was pathological fractures of neck of femur, medically unfit for surgery, Bilateral fracture neck femur, Previously operated fracture neck femur of same and opposite side, Non ambulators, those who would not complete 6 months of final follow up. Informed consent was taken at the initiation of study, in English and in regional language, after explaining the procedure in detail. Preoperative Protocol consisted of thorough history taking and clinical examination and evaluation was done and then Anteroposterior radiographs of pelvis with both hip. All study Patients were put on skin traction, given oral or parenteral analgesics to relieve pain. Adequate medical management of associated comorbid conditions like diabetes mellitus, systemic hypertension, COPD and heart diseases was initialized to optimize patient&rsquo;s fitness for anaesthesia. All measures were taken so that the patient could be taken up for surgery at the earliest. Operative Approach was Moore&rsquo;s posterior approach for all patients in Lateral decubitus position on the operating table with the affected side facing up. A curved incision taken from a point 10cm distal to posterior superior iliac spine and extended distally and laterally parallel to the fibres of gluteus maximus to the posterior margin of greater trochanter. Deep fascia was exposed over gluteus maximus, was then split in the direction of its fibres by blunt dissection. By retracting the proximal fibres of the muscle proximally, the greater trochanter was exposed after trochanteric bursa excised. Distal fibres were retracted distally and divided at their insertion over linea aspera. The sciatic nerve was not usually exposed . It was protected with the finger in the lateral part of the incision and gently retracted out of the way. The gemelli and obturator internus and piriformis tendon were divided at their insertions after tagging them for easier identification and reattachment. The posterior part of the capsule thus exposed was incised from distal to proximal along the line of neck of femur and at right angle to it, thus making a L shaped opening in the capsule. The fractured head and neck of the femur were levered out of the acetabulum and size measured using femoral head gauge. The size was confirmed using trial prosthesis by its suction fit in the acetabulum. The acetabulum was prepared by excising remnants of ligamentum teres and soft tissue. The femoral shaft was rasped using a broach(rasp) and prepared for the insertion of the prosthesis. Femoral neck if long was nibbled keeping 2 to 2.5cm of calcar above the lesser trochanter. The appropriate sized prosthesis was then inserted into the femoral shaft(reamed canal) in taking care to place in 10⁰ to 15⁰ of anteversion and impacted into the femur. The reduction of prosthesis done using gentle traction of the thigh. If Prosthesis became loose intraoperatively, cemented procedure were performed. In these cases, the stem was cemented in place using standard cementing technique- lavage, cleaning, drying and plugging of the canal. Absolute haemostasis obtained. After suturing the capsule, the external rotators sutured. The wound closed in layers over a suction drain, were removed at the first changing of dressing after 48hours. Post operatively, patients were kept in the ward with limbs in wide abduction with the help of abduction pillow. Adduction, internal rotation and flexion were avoided. Static exercise in bed for quadriceps and breathing exercises along with active limb movement to decrease limb edema. Ambulation started within a week with walker and progressive weight bearing. Postoperatively DVT prophylaxis was added to high risk patients according to the advice given by Physician/Anaesthetist. Patients were advised not to sit cross legged or squat. All patients were followed up monthly for first 3 months and then at 6 months. Minimum follow up of 6 months and HARRIS HIP SCORE⁽¹⁰⁾was noted and radiographs of the affected hip were taken. Final evaluation of the study was done after completion of study according to criteria. <strong>RESULTS:</strong> 42 study participants fulfilling inclusion and exclusion criteria were selected and evaluated for associated comorbidities and operated by Bipolar Hemiarthroplasty and&nbsp; followed for duration of 6 months at an interval of 6 weeks, 3 months and 6 months during the study period. <strong>Age distribution:</strong> majority of the patients were belonging to 65-69 years of age group accounting to 33.33%, followed by 60-64 years of age group accounting 26.19%, followed by 70-74 years of age group accounting 21.43%, followed by 75-79 years of age group and 80-84 years of age group accounting 7.14% each and followed by &gt;84 years of age group accounting 4.76%. Mean age in general was 68.66 &plusmn; 7.03 with range of 60-85 years. <strong>Gender:</strong> In the present study, females outnumbered males accounting to 25(59.52%) and males proportion was 17(40.48%). Female to male ratio in our study was 1.47:1 <strong>Fracture side distribution:</strong> There were more left sided fractures accounting for 30 cases (71.43%) Garden classification: Patients with Type 4 of Garden classification accounted for maximum of 83.33%, followed by Type 3 for 9.52% and Type 2 for 7.14%. <strong>Anatomical Classification:</strong> Patients with Transcervical fractures outnumbered and accounted for 90.48%, followed by Subcapital fracture for 7.14% and followed by Basicervical for 2.38% <strong>Distribution of patients according to duration between fracture and surgery:</strong> Duration(days) No of patients Percentage &lt;7 days 19 45.24 7-30 days 18 42.86 &gt;30 days 5 11.90 Total 42 100 Mean&plusmn;SD 13.11 &plusmn; 16.20(2-95 days) <strong>Table 1</strong> <strong>Duration between admission and surgery: </strong>In our study, majority of the patients operated within 3-7 days of admission i.e. 26(61.90%) followed by more than 7days i.e. 9(21.43%) and within 3 days in only 7 patients i.e.16.67% <strong>Mode of injury: </strong>In our study most of the patients had trivial trauma which accounted for 39 cases (92.86%) followed by road traffic accident of 3 cases(7.14%) <strong>Distribution of patients according to comorbidities</strong> Comorbidities No of patients Percentage Asthma 4 9.52 Diabetes Mellitus 8 19.05 Chronic Kidney Disease 3 7.14 Hypertension 16 38.10 &nbsp;Rheumatoid Arthritis 1 2.38 Thyroid Disease 1 2.38 Ischemic heart disease 1 2.38 Lung consolidation 1 2.38 <strong>Table 2</strong> <strong>Average hospital stay:</strong> was 14.71&plusmn;4.79 days with maximum of 28 days and minimum of 4 days. <strong>Prosthesis Size:</strong> 41mm Bipolar prosthesis accounted for maximum of 28.6% in 12 cases and least used was 53mm Bipolar prosthesis in 1 case (2.4%) &nbsp; Frequency Percent P R O S T H E S I S 37 mm 2 4.8 39 mm 3 7.1 41 mm 12 28.6 43 mm 7 16.7 45 mm 5 11.9 47 mm 4 9.5 49 mm 6 14.3 51 mm 2 4.8 53 mm 1 2.4 Total 42 100.0 <strong>Table 3</strong> &nbsp; &nbsp; &nbsp; <strong>Position of stem:</strong> Position of stem No of patients Percentage Valgus 5 11.90 Varus 6 14.29 Neutral 31 73.81 Total 42 100 <strong>Table 4</strong> <strong>Intraoperative time and blood loss: </strong>average blood loss was 326.66 &plusmn; 109.18ml with range of 150-750ml and average intraoperative time was 63.45 &plusmn; 11.64 min with range of 45-90 min. <strong>Harris Hip Score: </strong>used to evaluate the functional outcome of Bipolar Hemiarthroplasty which was noted at regular follow ups at 6 weeks, 3 months and 6 months. The Mean Harris Hip score at 6 weeks was 74.21&plusmn;10.07 with range of 47-87. The Mean Harris Hip score at 3 months was 77.66&plusmn;10.59 with range of 50-90. The Mean Harris Hip score at 6 months was 80.40&plusmn;10.60 with range of 52-90. There was an upward trend in the mean score over follow up period. &nbsp; N Minimum Maximum Mean Std. Deviation 6 weeks 42 47.00 87.00 74.21 10.07 3 months 42 50.00 90.00 77.66 10.59 6 months 42 52.00 92.00 80.40 10.60 <strong>Table 5</strong> Graph 1: Distribution of patients according to Harris Hip Score &nbsp; &nbsp; <strong>Distribution of patients according to complications:</strong> Complications No of patients Percentage Dislocation 1 2.38 Infection 2 4.76 Lengthening 3 7.14 Other(Bed Sore) 3 7.14 <strong>Table 6</strong> &nbsp; <strong>Functional outcome: </strong>In our study, the final functional outcome at 6 months of follow up using Harris Hip Score. We observed excellent results in 13 patients(30.95%), Good in 11 patients(26.19), Fair in 12 patients(28.57%) and Poor results in 6 cases(14.29%). &nbsp; &nbsp; <strong>Distribution of patients according to functional outcome at final follow up(6 months)</strong> Functional Outcome No of patients Percentage Poor 6 14.29 Fair 12 28.57 Good 11 26.19 Excellent 13 30.95 Total 42 100 <strong>Table: 7</strong> <strong>DISCUSSION:</strong> Elderly patients with fracture neck of femur who were mobile before injury should be able to restore to their preoperative functional and ambulatory status. In active older patients especially needing early mobilization, conservative method of treatment is not acceptable because it results in non union with unstable hip and limitation of hip movement as well as complications of prolonged immobilization like bedsores, deep vein thrombosis and respiratory infections. Result for femoral neck fracture treatment illustrated by Leighton et al⁽¹¹⁾recommended prosthetic replacement for patients more than 60 years old having femur neck fracture. Bateman and Giliberty in 1974 introduced Bipolar hemiarthroplasty, which is a self articulating prosthesis. Advantage of Bipolar prosthesis is that erosion and protrusion of acetabulum would be less because, there is dual articulation between inner head and shell and acetabulum⁽¹²⁾. The Aim of present study was to evaluate the functional outcome of Bipolar Hemiarthroplasty in displaced intracapsular femoral neck fracture in elderly. 42 patients of fracture neck femur were treated using Bipolar Hemiarthroplasty, both cemented and uncemented. A concept that has been generally held by Orthopaedic surgeons is that Cemented femoral fixation is required in elderly patients because of poor bone stock⁽¹³⁾. However, cemented technique has also been associated with greater risk of fat embolization and hypotension⁽¹³⁾. Many Orthopaedic surgeons feel that stable femoral fixation can be achieved in elderly patients with cementless femoral stem⁽¹⁴⁾. The complications following the Bipolar Hemiarthroplasty is reported in varying incidences. Early surgical complications after Bipolar Hemiarthroplasty may be the origin of cascades leading to general complications and increased mortality. That is why their prevention is very important⁽¹⁵⁾. In present study, there was 1(2.38%) case of posterior dislocation noted in <em>(CASE 1)</em> 76 years old female with multiple co morbidities like right lower lung consolidation, Diabetes Mellitus, Hypertension, Chronic Kidney Disease, Asthma admitted on the same day of trauma with transcervical neck femur fracture of left side due to trivial trauma operated with Uncemented Bipolar Hemiathroplasty and postoperatively at 1 month there was posterior dislocation occurred due to sudden adduction of hip, which was managed by revision Cemented Bipolar Hemiarthroplasty immediately and later after 12 weeks she developed deep infection in wound which was managed by debridement which eventually healed with final Harris Hip Score of 72 at 6 months of follow up. In our study all cases were operated by posterior approaches. Dislocation of the Hip Hemiarthroplasty have been a concern for Orthopaedic surgeons since the advent of the procedure. Furthermore, early dislocation is associated with increased mortality rate⁽¹⁶⁾. Dislocation of the Bipolar prosthesis is a rare phenomenon. It has been reported in literature ranging from 1.1% at one year follow up to 5% at 20 years⁽¹⁷⁾. Saberi S et al⁽¹⁸⁾, in his study related to the complications following Bipolar Hemiarthroplasty amongst the 150 patients at 1 year follow up reported 6.5% dislocation rate. Rajak MK et al⁽¹⁹⁾, reported 3% prosthesis dislocation following Bipolar Hemiarthroplasty. Unwin et al⁽²⁰⁾, reported 6.5% of dislocation rate among all their patients with those having posterior approach being three times more likely to dislocate. &nbsp; <strong><em>CASE 1</em></strong> &nbsp; <strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Pre-operative X-RAY&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Post-operative X-RAY</strong> &nbsp; <strong>Dislocation At 1 Month</strong> &nbsp; <strong>Open Reduction of Dislocation with Revision Cemented Prosthesis and Drain Placement</strong> <strong>X-RAY At 3 Months&nbsp; of Revision Procedure</strong> &nbsp; <strong>X-RAY At 6 Months</strong> &nbsp; In our study there were 2(4.76%) cases of infection out of which 1 was superficial wound infection and 1 deep wound infection. 73 year old male patient with no comorbidities observed superficial infection after 4 months of Uncemented Bipolar Hemiarthroplasty who was managed by antibiotic and dressing. Another patient, 76 year old female with multiple comorbidities including Diabetes had developed deep wound infection after cemented Bipolar Hemiarthroplasty as a revision procedure following posterior dislocation after 6 weeks which was managed by debridement and appropriate antibiotic after culture and sensitivity and diabetic control. Naidu KA et al⁽²¹⁾, observed superficial wound infection in 2 patients in the 1^st week of operation, of which 1 patient was diabetic. Treated with proper antibiotic and dressing which resulted in prolongation of their hospital stay. The organism isolated in the above cases were Staphylococcus Aureus. Maruthi CV and Shivanna⁽⁵⁾, observed 1 patient(2%) had a superficial wound infection in the 1^st week of operation which led to the prolongation of the hospital stay treated with proper antibiotics and dressing. The organism isolated was Staphylococcus Aureus. In present study, we observed lengthening of the operated limb in 3 patients upto 1 cm(7.14%). Ponraj RK et al⁽⁹⁾, observed in two cases had limb lengthening(1 cm). Naidu KA et al⁽²¹⁾, reported limb length discrepancy seen in 2 patients(9.09%) of which lengthening was noted in both patients. Rajak MK et al⁽¹⁹⁾, observed limb lengthening in 1(3%) patient about 1.5cm which was managed by compensatory footwear in the opposite limb. While Marya SKS et al⁽²²⁾, observed limb lengthening in 7% of the cases. Limb lengthening of less than 3.5cm was not significant and did not affect outcome. Patel KC et al⁽²³⁾, in 84% of the patient there was no limb length discrepancy. No case showed limb shortening while 16% showed limb lengthening. All the cases in our series were assessed according to Harris Hip Score and graded accordingly as Excellent , Good, Fair and Poor. In present study, we evaluated mean Harris Hip score at the end of 6 months follow up which was 80.4 points. Our findings are consistent with the study of Rajak MR et al⁽¹⁹⁾,Bezwada HP et al⁽²⁴⁾, Ponraj RK et al⁽⁹⁾, Maruthi CV and Shivanna⁽⁵⁾<strong>. </strong> &nbsp; <strong>&nbsp;Studies with Harris Hip Score</strong> STUDIES MEAN HARRIS HIP SCORE Bezwada HP et al⁽²⁴⁾ At 3.5 years 82 points with range of 54-92 Shukla R et al⁽²⁾ At 6 months 74.68 points At 1 year 78.24 points At 2 years 81.40 Saberi S et al⁽¹⁸⁾ At 6 months 74.5 points At 1 year 80.7 points Maruthi CV and Shivanna⁽⁵⁾ At 6 months range of 35 to 94.6 Reddy YH et al⁽²⁵⁾ At 1 year 90.36points Rajak MK et al⁽¹⁹⁾ At 6 months 82.1 points At 1 year 83.1 points Ebrahimpour A et al⁽²⁶⁾ At 1 year 83.5 points Ponraj RK et al⁽⁹⁾ At 6 months 84.2 points Our study At 6 weeks 74.21 points At 3 months 77.66 points At 6 months 80.4 points <strong>Table 8</strong> <strong>Studies with Functional Outcome</strong> Study Duration Excellent Good Fair Poor Naidu KA et al⁽²¹⁾ 22 cases for 6 months 31.82% 54.55% 9.09% 4.54% Kalantri A et al⁽²⁷⁾ 30 cases for 6 months 53.33% 33.3% 16.67% 6.67% Ponraj RK et al⁽⁹⁾ 30 cases for minimum 6 months 23.33% 56.66% 13.33% 6.66% Jindal RC et al⁽²⁸⁾ 30 cases for 6 months 40% 40% 6.7% 13.3% Patel KC et al⁽²³⁾ 50 cases for 12 months 64% 28% 8% 0% Bezwada HP et al⁽²⁰⁾ 248 cases for 3.5 years 10% 55% 30% 5% Rajak MK et al⁽¹⁹⁾ 30 cases for 12 months 33.33% 43.33% 16.66% 6.66% Malhotra R et al⁽²⁹⁾ 32 cases 75% 15.6% 6.3% 3.1% Our study 42 cases for 6 months 30.95% 26.19% 28.57% 14.29% <strong>Table 9</strong> &nbsp; <strong>CONCLUSION:</strong> Our study concludes that Bipolar Hemiarthroplasty is a good method to manage intracapsular fracture neck femur in elderly patients . It offers excellent, painless mobility and ease in rehabilitation and return to function. The surgery is relatively easy to perform, takes less operating time and less blood loss with low complication rate. <strong>REFERENCES:</strong> Adapureddi HT, Kamareddy SB, Kumar A, Paturi SK, Anne S, Reddy JP. Prospective study of management of fracture neck of femur by Hemiarthroplasty with cemented Bipolar. Journal of Evolution of Medical and Dental Sciences. 2015; 4(98): 16309-16314. Shukla R, Singh M, Jain RK, Mahajan P, Kumar R. Functional Outcome of Bipolar Prosthesis versus Total Hip Replacement in the Treatment of Femoral Neck Fracture in Elderly Patients. Malaysian Orthopaedic Journal<em>.</em> 2017; 11(1): 1 -5. Leighton RK: Fractures of the Neck Femur. In: Bucholz RW, Heckman JD,Court-Brown CM. (eds.) Rockwood and Green&rsquo;s fracture in adults. 6^th edition. Philadelphia, Lippincott Williams &amp; Wilkins 2006; 1753-1791. Sharoff L, Nazeer M, Unnikrishnan R. Functional outcome of cemented bipolar hemiarthroplasty in fracture neck of femur in elderly: A prospective observational study. International Journal of Medical Research &amp; Health Sciences. 2016; 5(2): 70-76. Maruthi CV, Shivanna. Management of fracture neck of femur in elderly by hemiarthroplasty: A study. Indian Journal of Orthopaedics Surgery<em>. </em>2016; 2(2): 170-180. Parvizi J, Ereth MH, Lewallen DG. Thirty-Day Mortality Following Hip Arthroplasty for Acute Fracture. The Journal of Bone &amp; Joint Surgery. 2004; 86: 1983-1988. Parker MJ, Guruswamy KS, Azegami S.(2010). Arthroplasty(with and without bone cement)for proximal femoral fractures in adults. The Cochrane database of systematic reviews. 2010(6),CD001706-CD. Ahn J, Man LX, Park S, Sodl J F, Esterhai JL. Systematic Review of Cemented and Uncemented Hemiarthroplasty Outcomes for Femoral Neck Fractures. Clinical Orthopaedic Related Research. 2008; 466: 2513-2518. Ponraj RK, Arumugam S, Ramabadran P. Functional Outcome of Bipolar Hemiarthroplasty in Fracture Neck of Femur. Scholars Journal of Applied Medical Sciences. 2014; 2(5D): 1785-1790. Harris WH. Traumatic Arthritis of the Hip after Dislocation and Acetabular Fractures: Treatment by Mold Arthroplasty. The Journal of Bone &amp; Joint Surgery<em>. </em>1969; 51-A(4): 737-755. Leighton RK, Schmidt AH, Collier P, Trask K. Advances in the treatment of intracapsular hip fractures in the elderly. Injury 2007; 38: 24-34. Bateman JE. Single assembly Total hip prosthesis: Preliminary report. Orthop Dig. 1974; 2: 15-19. Dorr LD, Glousman R, Sew Hoy AL, et al. Treatment of femoral neck fractures with total hip replacement versus cemented and non cemented hemiarthroplasty. Journal of Arthroplasty<em>.</em> 1986; 1: 21. Keisu KS, Orozco F, Sharkey PF, et al. Primary cementless total hip arthroplasty in octagenarians: two to eleven year follow up<em>. </em>The Journal of Bone and Joint Surgery. 2001; 83: 359. Biber R, Brem M, Singler K, Moellers M, Sieber C, Bail HJ. Dorsal versus transgluteal approach for hip hemiarthroplasty: an analysis of early complications in seven hundred and four consecutive cases. International Orthopaedics<em>.</em> 2012; 36(11): 2219-23. Peterson MB, Jorgenson HL, Hansen K, Duus BR. Factors affecting postoperative mortality of patients with displaced femoral neck fracture<em>. </em>Injury<em>. 2006</em>; 37(8): 705-11. Sierra, Rafael J et al. Dislocation of Bipolar Hemiarthroplasty: Rate, Contributing Factors, and Outcome. Clinical Orthopaedics &amp; Related Research. 2006; 442: 230-238. Saberi S, Arabzadeh A, Khomeisi B, Berehnegard E, Mortazavi SMJ. Early Complications Following Bipolar Hemiarthroplasty for Femoral Neck Fracture in Elderly Patients. Academic Journal of Surgery. 2014; 1(3-4): 45-48. Rajak MK, Jha R, Kumar P, Thakur R. Bipolar hemiarthroplasty for intracapsular femorla neck fracturres in elderly patients. Journal of Orthopaedic Surgery. 2013; 21(3): 313-316. Unwin AJ, Thomas M. Dislocation after hemiarthroplasty of the hip: a comparison of the dislocation rate after posterior and lateral approaches to the hip. Ann of the Royal College of Surgeons of England. 1994; 76(5): 327-9. Naidu KA, Sunil T, Koduru SK. A clinical study of Management of intracapsular fracture neck of the femur in elderly with Bipolar Hemiarthroplasty. International Journal of Orthopaedic Sciences. 2020; 6(2): 319-325. Marya SKS, Thukral R, Hasan R, Tripathi M. Cementless bipolar hemiarthroplasty in femoral neck fractures in elderly. Indian Journal of Orthopaedics. 2011; 45(3): 236-242. Patel KC, Moradiya N, Gawatre P, Desai TV. Early outcome of hemireplacement arthroplasty using cemented bipolar prosthesis in fracture neck femur in elderly: A Study of 50 cases. International Journal of Orthopaedic Sciences. 2017; 3(1): 303-307. Bezwada HP, Shah AR, Harding SH, Baker J, Johanson NA, Mont MA. Cementless Bipolar Hemiarthroplasty for Displaced Femoral Neck Fractures in the Elderly<em>. </em>The Journal of Arthroplasty<em>. </em>2004; 19(7): 73-77. Reddy YH, Vishnu K. A study of management of intracapsular fracture neck femur using bipolar prosthesis. Indian Archives of Integrated Medicine. 2018; 5(1): 28-35. Ebrahimpour A, Zandi R, Ayazi M, Safdari F. The Outcomes of Treating Femoral Neck Fractures Using Bipolar Hemiarthroplasty. Trauma Monthly. 2017; 22(1): e61806. Kalantri A, Barod S, Kothari D, Kothari A, Nagla A, Bhambani P. Hemiarthroplasty for intra-capsular fracture neck of femur in elderly patients: a prospective observational study. International Journal of Research in Orthopaedics. 2017; 3(5): 991-997. Jindal RC, Gill SS, Singh M, Gautam RK. Functional Outcome of Bipolar Arthroplasty for Fracture Neck Femur in Elderly People. Indian Journal of Research. 2016; 5(11): 7-10. Malhotra R, Arya R, Bhan S. Bipolar hemiarthyroplasty in femoral neck fractures. Archives of Orthopaedic Trauma Surgery. 1995; 114(2): 79-82. &nbsp; &nbsp;

Aim — 60 Vietnamese dry femurs were studied to design a carbon composite external fixator for intertrochanteric fracture. Its mechanical strength was evaluated. Material and Methods — The femurs were measured by standard goniometers. The fixator injection mold was created by a CNC machine. The fixator material included carbon fiber (30 – 40% content), BT4, and PA12 plastic. The fixator strength was calculated based on the Finite Element Method. Results — The average femoral neck-shaft angle, anteversion angle, bowing angle, head diameter, and neck width were respectively 124.850 (±7.12), 20.240 (±4.49), 14.900 (±3.27), 4.12cm (±0.30), and 3.05cm (±0.34). A mold and its resulting fixator were designed accordingly. The fixator elasticity modulus, tensile strength, Poisson ratio, and safety factor (K) were 1.32x1010 Pa, 2.21x108 Pa, 0.25, and 1.5, respectively, and max load, stress and transposition were 50-150 N, 1.21-1.38 x 108 Pa, and 0.4-1.27 mm, respectively. The composite fixator was more resistant against pressure across the x-axis but less against the y-axis than the chrome and Inox304 devices. Transposition was the smallest due to its tiny size. Load against z-axis pressure was safe for the patients. Conclusion — This study succeeded to design a prototype carbon composite external fixator with favorable mechanical traits compared with available metal fixators. Further clinical studies are needed to achieve an accurate evaluation of its effectiveness.

Purpose of review To summarize and comment recent analyses from the Seven Countries Study of Cardiovascular Diseases (SCS) on the role of Atherogenicity (ATI) and Thrombogenicity (THI) indexes (created by combining several types of dietary fatty acids) in predicting major cardiovascular disease (CVD) and mainly coronary heart disease (CHD) mortalities in a long follow-up observation of ecological procedures involving 16 cohorts of middle-aged men. Recent findings In a chain of steps, a dietary score [Mediterranean Adequacy Index (MAI)] was inversely correlated with the ATI (R = −0.91). ATI directly correlated with serum cholesterol (R = +0.73) and serum cholesterol directly correlated with 50-year CHD mortality (R = +0.78). Moreover, MAI was inversely correlated (R = −0.91) and ATI was directly correlated with CHD mortality (R = +0.93). THI produced comparable results. In 10 cohorts reaching the extinction after 60 years of follow-up, results were similar. The same dietary and metabolic indicators were instead unrelated to other major types of CVD fatalities (heart diseases of uncertain etiology and stroke) or even inverse. Summary ATI and THI indices assembled by pooling several types of dietary fatty acids are strongly associated with long-term CHD mortality but not with other major CVD types.

ABSTRACTTechnology of modern Silicon epitaxy at heterojunctions (Si) and Germanium (Ge) likes SiGe, MBE, (Molecular Beam Epitaxy), UHV/CVD (Ultra High Vacuum Chemical Vapor Deposition/) and LPCVD (Low Pressure Chemical Vapor Deposition) are used for the realization of profile Ge doping on the design of Bipolar Transistor Heterojunctions (HBT).This Research is conducted on simulation and analysis of Ge doping profile in HBT with a square profile shape, triangle and Trapezoid with mole fraction (x) 0.1 and0.2. The model design of the HBT Structure analyzed has wide collector (Wc) 350 nm, Doping the collector (Nc) 3.1017, Wide base (Wb) 40 nm, the concentration of base (Nb) 1019 cm-3, AE 0.25 × 10 µ m2, WE 10 nm, NE maximum 1021 cm-3. SiGe graded Profile with settings in the base gives the different influences on the frequency threshold and the maximum Frequency with different current gain (Ai) almost the same which is around 60 dB antil 70 dB. As such generated that Ge Profile rectangular generate scattering parameters required are wider than others i.e. for S11 0.18 &lt;-9 (min) and 178-0.278 &lt; (max.), S12 0.0175 &lt;-2 (min) and 0.3471 &lt;-171 (max.), S21 &lt; 2.88 9 (min) and 56 &lt; 178 (max) and S220.27 &lt; 12 (min) and, 0.42 &lt;-181 (maxKey words : profile graded , HBT SiGe, Scattering Paramater. ABSTRAKTeknologi epitaksi modern pada heterojunction Silikon (Si) dan Germanium (Ge) atau SiGe seperti MBE (Molecular Beam Epitaxy) , UHV/CVD (Ultra High Vacuum / Chemical Vapor Deposition) dan LPCVD (Low Pressure Chemical Vapor Deposition) digunakan untuk merealisasikan profile doping Ge pada rancangan Heterojunction Bipolar Transistor (HBT).Pada Penelitian ini dilaksanakan simulasi dan analisa profile doping Ge pada HBT dengan bentuk profile Segiempat, Segitiga dan Trapesium dengan mole fraction (x) 0.1 dan 0.2. Model rancangan Struktur HBT yang dianalisa memiliki Lebar Kolektor (Wc) 350 nm, Doping Kolektor (Nc) 3.1017 , Lebar basis (Wb) 40 nm, Konsentrasi basis (Nb) 1019 cm-3, AE 0,25×10 µm2 , WE 10 nm, NE maksimum 1021 cm-3. Dengan pengaturan Profile graded SiGe pada Basis memberikan pengaruh yang berbeda pada frekuensi threshold dan Frekuensi maksimum yang berbeda dengan current gain (Ai) yang hampir sama yaitu sekitar 60 dB sampai 70dB. Dengan demikian dihasilkan bahwa Profile Gesegi empat menghasilkan paramater scattering yang yang lebih lebar disbanding yang lain yaitu untuk S11 0.18&lt;-9 (min) dan 0.278&lt;-178 (maks), S12 0.0175&lt;-2 (min) dan 0.3471&lt;-171(maks), S21 2.88&lt;9(min) dan 56.99&lt;178 (maks) serta S22 0.27&lt;12(min) dan, 0.42&lt;-181(maks).Kata kunci : profile graded , HBT SiGe, Scattering Paramater

Abstract This paper presents research results on AlN/AlGaN heterojunction field-effect transistors (HFETs) with a high-AlN-mole-fraction Al0.72Ga0.28N channel grown on a single-crystal AlN substrate by metalorganic chemical vapor deposition. Material evaluation results confirmed that the grown AlGaN layer was 100% coherently strained for the underlying AlN substrate and thereby had superior crystal quality as well as the substrate. The fabricated AlGaN-channel HFETs with a gate length of 2 μm exhibited pinch-off characteristics with the max. current density (IDS_MAX) of 21 mA/mm, the on-state resistance of 250 Ωmm, the peak transconductance of 4.5 mS/mm with the threshold voltage of –4.6 V, and the on/off ratio of 4 × 105. The temperature dependence of DC characteristics confirmed that the IDS_MAX decreased by 15% and the off-leakage current increased from 60 nA/mm to 10μA/mm within the temperature range from the room temperature to 200℃.

The present study investigates the development of functional enriched sugarcane juice processed through ohmic heating. Currently, ready to drink functional enriched sugarcane juice with extended shelf life is not available in markets. As conventional heat processing methods reduce the taste, color, and flavor of juices, functional enriched sugarcane juice blended with amla and lemon juice extracts was developed with extended shelf life processed with minimal heat treatment by utilizing ohmic heating - a novel food processing technology. Ohmic Heating (OH) is an alternative thermal treatment as it causes volumetric heating of the sample with a short processing time and it causes minimum discoloration and maintains the nutritive value of the food. The preliminary trials were carried out to optimize the levels of sugarcane juice, amla juice and lemon juice for acceptable sensory attributes on 9 point hedonic scale. Response Surface Methodology (RSM) was used to determine the combinations of the experiment. The independent variables considered were sugarcane juice, amla juice and lemon juice. The responses considered were sensory Volume xxx | Issue xxxx | 2 attributes such as color, flavor, taste and overall acceptability. The optimum levels of sugarcane juice, amla juice and lemon juice were 91.998 mL, 4.720 mL, and 3.282 mL, respectively. The optimum levels were blended for the development of functionally enriched sugarcane juice. The standardized juice was processed using ohmic heating with two different treatments, viz., 50 °C (T1) and 60 °C (T2), for 3 minutes at 25 V/cm. The processed juice was collected in sterile glass bottles and stored at 5 ˚C for conducting storage studies at regular intervals. Microbial and sensory parameters of the untreated, control (pasteurized), and ohmic heated juice were analyzed using one-way analysis of variance (ANOVA). No significant difference (p&gt;0.05) was observed in sensory immediately after ohmic processing when compared to control samples but showed a highly significant difference (p&lt;0.01) in sensory during the storage period. There was a high significant difference (p&lt;0.01) in the total plate count of ohmic heated samples compared to control and during the storage period. No coliform was found in all ohmic heated and control samples. Yeast and mold were present in the untreated sample, but after ohmic heating, no growth was observed. Hence highest microbial reduction was observed in ohmic heating treatment T2 than T1 and control, and the shelf life also extended up to 4 weeks

BackgroundLarge fluctuations in blood glucose levels greatly impact the health and life span of elderly individuals. This study describes the characteristics of variability in glycemic indices in centenarians with the aim of emphasizing the importance of glycemic variability in elderly people.MethodsWe recruited individuals from Rugao City, Jiangsu Province, China from April 2020 to May 2021. The study cohort included 60 centenarians and 60 first-generation offspring, as well as 20 randomly selected non-cohabitant control individuals aged 60–80 years. A FreeStyle Libre H (hospital version) continuous glucose monitoring (CGM) device (Abbott Ireland UK) was used to measure glycemic variability. The indices measured included the time in target glucose range (TIR), time below target glucose range (TBR), time above target glucose range (TAR), mean amplitude of glycemic excursions (MAGE), mean of daily differences (MODD), coefficient of variation (CV), standard deviation of blood glucose (SDBG), continuous overlapping net glycemic action (CONGA), glucose management indicator (GMI) and estimated glycated hemoglobin (eHbA1c). Logistic regression was used to analyze the association between glycemic variability and longevity.ResultsMean blood glucose (MBG), eHbA1c, GMI, mean fasting plasma glucose (M-FPG) and CONGA were lower in the centenarian group (p all &amp;lt; 0.05). PPGE-2 was higher in the control group than that measured in the centenarian and first-generation offspring groups (p &amp;lt; 0.05). There were no differences between the groups in MAGE, MODD, MAG, or TIR (p &amp;gt; 0.05). The risk of not achieving longevity increased with each one unit increase in MBG by 126% [2.26 (1.05–4.91)], eHbA1c by 67% [1.67 (1.03–2.72)], GMI by 568% [6.68 (1.11–40.30)], M-FPG by 365% [4.65 (1.57–13.75)], M-PPG1h by 98% [1.98 (1.18–3.31)], CONGA1 by 102% [2.02 (1.01–4.06)], Li by 200% [3.00 (1.04–8.61)], and PPGE-2 by 150% [2.50 (1.39–4.50)]. However, the risk of achieving longevity decreased with each unit increase of LBGI by 53% [0.47 (0.28–0.80)], ADRR by 60% [0.40 (0.18–0.86)], and TBR by 11% [0.89 (0.80–0.98)].ConclusionFluctuation in blood glucose levels in centenarians is relatively small. Maintaining an average blood glucose level and keeping blood glucose fluctuations in the normal range is conducive to longevity.

Avaliou-se a qualidade microbiológica e físico-química de doces de leite e requeijões produzidos, na Ilha do Marajó – PA (Brasil), com leite de búfala. Não foi detectada a presença de Salmonellas e Staph ylococcus aureus nas amostras dos produtos analisados e os resultados obtidos para contagem de bactérias mesófilas e bolores e leveduras para o doce de leite demonstraram boas condições higiênicosanitárias do produto. Porém, 28,60% das amostras de requeijão apresentaram condições higiênico-sanitárias insatisfatórias, sendo 14,26% consideradas impróprias para o consumo humano. Na caracterização físico-química, 83,34% das amostras de doce de leite apresentaram teores de gordura superiores ao padrão (6,0 a 9,0%) e uma amostra mostrou-se acima do limite permitido (máx. 30%) para umidade. Verificou-se que 100% das amostras de requeijão apresentaram teores de proteínas (mín. 5%) e umidade (máx. 60%) de acordo com os padrões e apenas 14,86% enquadraram-se no padrão para gordura no extrato seco total (45 a 54,9%). Esses resultados sugerem que o requeijão de leite de búfala pode estar sendo produzido a partir de matérias-primas de qualidade microbiológica inadequada ou o produto está sendo contaminado durante a produção, o transporte, o armazenamento ou a comercialização. MICROBIOLOGICAL AND PHYSICAL-CHEMISTRY EVALUATION OF SWEETENED MILK AND SPREAD CHEESE PRODUCED WITH BUFALLO´S MILK IN MARAJO ISLAND - PA Abstract The microbiological and physical-chemistry quality of the Sweetened milk and the Spread cheese produced with Buffalo´s milk, in Marajó Island - PA, were evaluated. It was not detected the presence of Salmonella and Staphylococcus aureus in samples of the analysed products and the results obtained for mesophilic bacteria, molds and yeast counting for sweetened milk showed good sanitary conditions of the product. However, 28,60% of the Spread cheese samples presented insatisfactories conditions and 14,26% were inappropriate for human consumption. At the physical-chemistry characterization, 83,34% of the Sweetened milk samples presented contents of fat superior to the pattern (6,0 a 9,0), and about the humidity, just a sample was above the pattern (max.30%). For the Spread cheese, it was verified that 100% of the samples presented contents of proteins (min.5%) and humidity (max.60%) inside the pattern and only 14,86% were inside of the pattern for fat in total solids (45% to 54,9%). It may be inferred that Spread cheese produced with Buffalo´s milk has been either with milk of inadequate sanitary conditions or contaminated during the process, transportation, storage and commercialization.

Authors: Spencer Reisbick &amp; Patrick Willoughby ### Abstract This protocol describes an approach to preparing a series of Gaussian 09 computational input files for an ensemble of conformers generated in Spartan’14. The resulting input files are necessary for computing optimum geometries, relative conformer energies, and NMR shielding tensors using Gaussian. Using the conformational search feature within Spartan’14, an ensemble of conformational isomers was obtained. To convert the structures into a format that is readable by Gaussian 09, the conformers were first exported to a single “.sdf” file. A Python script was used to (i) read the structural information of each conformer within the “.sdf” file and (ii) write the corresponding atomic coordinates into a series Gaussian 09 input files. This approach decreases the amount of active effort required to compute NMR chemical shifts of a structure that populates an ensemble of conformers. ### Introduction NMR spectroscopy is the most useful tool for determining the structure of an unknown organic molecule. By coupling this approach with other analytical techniques (e.g. mass spectrometry) the structure of an unknown organic molecule can be elucidated. However, molecules of greater complexity continue to be isolated and/or prepared, and their associated analytical data are increasingly convoluted. Consequently, the assigned structures of these newly isolated compounds are sometimes incorrect, which leads to years of misguided effort “chasing molecules that were never there” (1). Modern computational chemistry software packages (e.g., Spartan (2,3), Gaussian 09 (4), and Jaguar (5,6)) have enabled the routine use of density functional theory (DFT) calculations for predicting spectroscopic properties of organic molecules. For example, one of us recently reported a protocol that described an approach using Gaussian 09 to compute NMR data for molecules that adopt conformational isomers (7). An important, early part of this protocol required the use of the software application, MacroModel (8) (part of the Schrödinger suite) to carry out a stochastic conformational search using the OPLS molecular mechanics force field. For each structure resulting from this conformational search, free energies and NMR shielding tensors were calculated. Using the free energy data, a Boltzmann factor was determined for each conformer, which was, in turn, converted into the relative mole fraction. The computed NMR data are averaged (using the mole fraction of each conformation), referenced, and scaled to generate a set of Boltzmann-weighted average chemical shifts. Due to the widespread use of Spartan for molecular mechanics calculations, we have prepared an addendum to this protocol that utilizes the structures resulting from a Spartan Conformer Distribution calculation. As discussed in our original protocol,(7) molecules of increasing complexity are often accompanied by many conformational isomers. We have developed a Python script (e.g., “write-g09-inputs-sdf.py”) that generates two Gaussian 09 input files for each structure resulting from the conformational search. For convenience, we have provided an additional script (e.g., “write-g03-inputs-sdf.py”) that prepares Gaussian 03 input files. These input files include an “-opt_freq” file for determining the optimal geometry and free energy along with an “-nmr” file for calculating NMR shielding tensor data. The Python script expedites the DFT computations by greatly simplifying the preparation of the Gaussian input files. More specifically, the script extracts structural information from a “.sdf” file generated in Spartan, and the coordinates of each conformation are written into the Gaussian input files. The “.sdf” file type is routinely used for storing molecular information for multiple structures and can be produced by myriad software applications. The script provided in this protocol will be useful for writing Gaussian input files from “.sdf” files prepared in other chemistry software applications. ### Equipment **Software required to carryout Python scripts** 1. Command-line interface application (Terminal in Mac OS X or Linux; or Command Prompt in Windows) - Python, version 2 or 3 (included with Mac OS X and Linux operating systems) - Python script editor (e.g., IDLE (see [http://www.python.org/download/](http://www.python.org/download/))) - Text editing application (e.g., TextEdit in Mac OS X or Notepad in Windows) **Software requirements for calculations** 1. This protocol has been written for use with Spartan’142,3; however, we have tested earlier versions of Spartan (e.g., Spartan’08) and found that they are also compatible with the following Procedure. - The approach described in the Procedure is amenable to any software application that is capable of performing a conformational search and exporting the family of conformers as a “.sdf” file (e.g., MacroModel8 and ChemBio3D9). **Hardware requirements for use of Python scripts** 1. Most standard personal computers built after 2008 are capable of executing the Python scripts included in this protocol. **Hardware requirements for conformational search calculation** 1. A CPU with 4 GB of RAM and a dual-core processor is capable of performing the conformational search calculation for generating a family of conformers of the candidate structure. The hardware requirements for carrying out the DFT calculations in Gaussian 09 are described in ref. 7. ### Procedure **Create input geometry and carry out a molecular mechanics conformational search in Spartan ● TIMING 30 min (Steps 1 – 8)** 1. Draw cis-3-methylcyclohexanol in the Spartan workspace. In Spartan select File → New to open the Model Kit toolbar. Change the Rings drop down menu to Cyclohexane and click inside the workspace to add a parent cyclohexane molecule. Select the Csp3 button within the Model Kit toolbar and click one of the yellow open valences on the cyclohexane ring. This operation will attach the methyl group. Select the Osp3 button within the Model Kit toolbar and click a yellow open valence on the cyclohexane ring that is both two carbons separated from and cis to the previously added methyl group. This will add an oxygen atom to the cyclohexane ring to give cis-3-methylcyclohexanol. Ensure that the overall structure is cis-3-methylcyclohexanol before continuing. - Quick and Crude Molecular Mechanics Geometry Optimization. Cleanup the preliminary geometry by clicking the Minimize button or selecting Build → Minimize. - Perform the conformational search. Select Setup → Calculations. A window will open. Change the Calculate: drop down menu selection to Conformer Distribution. Change the two drop down menus to the right so that they display Molecular Mechanics and MMFF. Check the box next to Maximum: and change the conformers examined to “1000”. Click Submit and a Save As window will appear. Change the computational filename to “cis-3-methylcyclohexanol”, change the directory (i.e. folder) to a location that is convenient for storing the associated computational files, and click Save. Click OK in the window that appears, which indicates that the conformational search has started. - After the conformational search has finished, a window confirming that the job has completed will appear. Click OK in this window. When prompted to open a new document select No. Select File → Close to clear the workspace. - Select File → Open and locate the conformational search output file “cis-3-methylcyclohexanol.spartan.” - Ensure that all expected conformers have been found by the calculation. Select Display → Spreadsheet to open a window containing an entry for each structure found during the conformational search. A conformational search of cis-3-methylcyclohexanol is expected to yield six unique conformers. - Export the library of conformers as a single “.sdf” file. Select File → Save As… to open a Save As window. Enter “cis-3-methylcyclohexanol” as the filename, change the Save as type: drop down menu selection to MDL SD (*.sdf) and click Save. If a popup window appears with the title Select molecules, click Write all molecules followed by OK. Click OK in the popup window that confirms the file export. This step will export all structures from the conformational search to a single “.sdf” file—“cis-3-methylcyclohexanol.sdf”—located in the same directory as the conformational search output file. - Examine the resulting “.sdf” file to ensure that the results of the conformational search were correctly exported (Optional). Open the “.sdf” file in a text-editing application (e.g., TextEdit in Mac OS X or Notepad in Windows) and check that an entry is included for all unique conformations. A unique entry typically begins with the text “Spartan” followed by a series of numbers. Additionally, structures are usually systematically labeled, for example, the first conformation is by default titled “M0001”. **Create Gaussian input files for each conformer ● TIMING 15 min (Steps 9 – 12)** - 9.Download the “write-g09-inputs-sdf.py” (or “write-g03-inputs-sdf.py” if using Gaussian 03) Python script from [Supplementary Data 1](http://www.nature.com/protocolexchange/system/uploads/3133/original/Supplementary_Data_1.zip?1398228281) to the directory containing the “.sdf” file created in Step 7 (see Step 3 for directory location). If using Python version 2, download the “write-g09-inputs-sdf.py” script located in the Python-Version-2 directory within [Supplementary Data 1](http://www.nature.com/protocolexchange/system/uploads/3133/original/Supplementary_Data_1.zip?1398228281). ▲ CRITICAL STEP Users must download the Python script from [Supplementary Data 1](http://www.nature.com/protocolexchange/system/uploads/3133/original/Supplementary_Data_1.zip?1398228281) that is compatible with the particular versions of both Python (i.e., either version 2 or 3) and Gaussian (i.e., either version 09 or 03) that are to be used. - 10.Editing the “write-g09-inputs-sdf.py” Python script to change the memory and number of processors used in Gaussian calculations (optional). To accommodate different users’ needs, we have prepared the “write-g09-inputs-sdf.py” Python script so that it is convenient to change the amount of memory and the number of the processors allocated to the computationally intensive Gaussian 09 jobs. Open the “write-g09-inputs-sdf.py” Python script in IDLE or any other Python script editor. Adjust the amount of memory used in the Gaussian 09 optimization/frequency and NMR jobs by changing the number to the right of “%mem=” on line 86 and 113, respectively. Adjust the number of core processors used in the Gaussian 09 optimization/frequency and NMR jobs by changing the number to the right of “%nproc=” on line 87 and 114, respectively. Save the edited script file in the same directory as the “.sdf” file created in Step 9. - 11.In a command line interface application (i.e. Terminal for Mac OS X or Linux or Command Prompt for Windows) navigate to the directory that contains the “.sdf” file, the “write-g09-inputs-sdf.py” Python script and the associated computational files. - 12.Execute the “write-g09-inputs-sdf.py” Python script (or the edited script that may have been created in Step 10 by entering the following command: *&gt; python write-g09-inputs-sdf.py cis-3-methylcyclohexanol.sdf* - The script will request the name of the candidate structure by displaying the following prompt: - Enter the name of the candidate structure: - Enter “cis-3-methylcyclohexanol” as the candidate structure name. Avoid using spaces when entering the name of the candidate structure. If the script executes successfully, the following message will be displayed: *The script successfully performed the task of creating Gaussian input files for each unique structure within the cis-3-methylcyclohexanol.sdf file and moved these input files to the cis-3-methylcyclohexanol-gaussian_files directory*. For each unique conformation within the associated “.sdf” file, the script will create two Gaussian input files. The script also creates a new directory labeled “cis-3-methylcyclohexanol-gaussian_files” and moves all of the Gaussian input files into this newly created directory. The Gaussian input files labeled “cis-3-methylcyclohexanol-opt_freq-conf-#.com” are the input files for geometry optimization and frequency calculation. The Gaussian input files labeled “cis-3-methylcyclohexanol-nmr-conf-#.com” are the input files for NMR shielding tensor calculations. ? TROUBLESHOOTING **Perform DFT calculations in Gaussian 09 (cf. Procedure in ref. 7) ● TIMING 1 h (Step 13)** - 13.To obtain the computed NMR data for the candidate structure, consult the Procedure in ref. 7 for instructions on using the resulting input files from Step 12 within Gaussian 09 to calculate (i) DFT-optimized conformer geometries, (ii) free energies using the “opt_freq-conf” input files, and (iii) NMR shielding tensors using the “nmr-conf” input files. Additionally, the Procedure in ref. 7 includes Python scripts and detailed instructions for (i) assembling the free energy and NMR shielding tensor data into well-organized spreadsheet files, (ii) referencing and scaling the NMR data, (iii) determining the Boltzmann weighting factors of all conformers, and (iv) applying these weighting factors to generate the set of Boltzmann-weighted chemical shifts for the candidate structure. Details with regard to the choice of computational methodology (e.g., DFT functional and basis set preferences) are discussed in ref. (7). Additionally, the previously reported protocol (7) highlights methods for determining the “best fit” for a candidate structure when comparing experimental spectral data to the computed NMR chemical shifts. Alternative approaches to determining the “best fit” have recently been reported by Goodman (10,11) and Sarotti (12,13), and more traditional approaches are described in several excellent reviews (14,15). ### Timing A novice user can complete the Procedure described above in less than one hour. The time required to complete the molecular mechanics conformational search will increase with molecular complexity. However, in our experience this increase has not been substantial. Subsequent Gaussian computations will require significantly more computational time to complete, but the amount of active effort by the user is minimized because several steps have been automated with the use of Python scripts. A summary of the time required to complete various steps in the Procedure is shown below. - Steps 1–4: &lt;10 min of active effort; ca. 1–30 minutes to complete the conformational search depending on the structural complexity of the candidate structure. - Steps 5–8: 15 min - Steps 9–12: 15 min - Step 13: ca. &lt;60 min for the 3-methylcyclohexanols; timing depends on the number of conformational isomers and the structural complexity of the candidate structure. ### Troubleshooting See [Supplementary Table](http://www.nature.com/protocolexchange/system/uploads/3141/original/Troubleshooting_Table.pdf?1398228281) for Troubleshooting. ### Anticipated Results Following successful completion of the steps of the Procedure, six conformations of cis-3-methylcyclohexanol will be generated from the conformational search in Spartan, and the structure coordinates for each conformation will be exported to a “.sdf” file. Following execution of the Python script, “write-g09-inputs-sdf.py”, the directory “cis-3-methylcyclohexanol-gaussian_files” will be created, which will contain two Gaussian 09 input files for each conformation of the candidate structure. Once submitted to Gaussian 09, the input files having “opt_freq” in their title will instruct Gaussian to perform a geometry optimization and frequency calculation of the included structural coordinates. Additionally, the input files having “nmr” in their title will instruct Gaussian to calculate NMR shielding tensors of the optimized geometry. For reference, we have provided the Spartan conformational search files and the “.sdf” file as [Supplementary Data 2](http://www.nature.com/protocolexchange/system/uploads/3135/original/Supplementary_Data_2.zip?1398228537) and [Supplementary Data 3](http://www.nature.com/protocolexchange/system/uploads/3137/original/Supplementary_Data_3.zip?1398228281), respectively. Additionally, the Gaussian 09 input files resulting from use of the Python script are included in [Supplementary Data 4](http://www.nature.com/protocolexchange/system/uploads/3139/original/Supplementary_Data_4.zip?1398228281). ### References 1. Nicolaou, K. C. &amp; Snyder, S. A. Chasing molecules that were never there: misassigned natural products and the role of chemical synthesis in modern structure elucidation. *Angew. Chem. Int. Ed*. 44, 1012–1044 (2005). - Hehre, W. J. A guide to molecular mechanics and quantum chemical calculations. Wavefunction, Inc., Irvine, CA, 2003. - Shao, Y., Molnar, L. F., Jung, Y., Kussmann, J. R., Ochsenfeld, C., Brown, S. T., Gilbert, A. T. B., Slipchenko, L. V., Levchenko, S. V., O Neill, D. P., DiStasio, R. A., Jr, Lochan, R. C., Wang, T., Beran, G. J. O., Besley, N. A., Herbert, J. M., Yeh Lin, C., Van Voorhis, T., Hung Chien, S., Sodt, A., Steele, R. P., Rassolov, V. A., Maslen, P. E., Korambath, P. P., Adamson, R. D., Austin, B., Baker, J., Byrd, E. F. C., Dachsel, H., Doerksen, R. J., Dreuw, A., Dunietz, B. D., Dutoi, A. D., Furlani, T. R., Gwaltney, S. R., Heyden, A., Hirata, S., Hsu, C.-P., Kedziora, G., Khalliulin, R. Z., Klunzinger, P., Lee, A. M., Lee, M. S., Liang, W., Lotan, I., Nair, N., Peters, B., Proynov, E. I., Pieniazek, P. A., Min Rhee, Y., Ritchie, J., Rosta, E., David Sherrill, C., Simmonett, A. C., Subotnik, J. E., Lee Woodcock, H., III, Zhang, W., Bell, A. T., Chakraborty, A. K., Chipman, D. M., Keil, F. J., Warshel, A., Hehre, W. J., Schaefer, H. F., III, Kong, J., Krylov, A. I., Gill, P. M. W. &amp; Head-Gordon, M. Advances in methods and algorithms in a modern quantum chemistry program package. *Phys. Chem. Chem. Phys*. 8, 3172 (2006). - Gaussian 09, Revision A, Frisch, M. J., Trucks, G. W., Schlegel, H. B., Scuseria, G. E., Robb, M. A., Cheeseman, J. R., Scalmani, G., Barone, V., Mennucci, B., Petersson, G. A., Nakatsuji, H., Caricato, M., Li, X., Hratchian, H. P., Izmaylov, A. F., Bloino, J., Zheng, G., Sonnenberg, J. L., Hada, M., Ehara, M., Toyota, K., Fukuda, R., Hasegawa, J., Ishida, M., Nakajima, T., Honda, Y., Kitao, O., Nakai, H., Vreven, T., Montgomery, J. A., Jr., Peralta, J. E., Ogliaro, F., Bearpark, M., Heyd, J. J., Brothers, E., Kudin, K. N., Staroverov, V. N., Kobayashi, R., Normand, J., Raghavachari, K., Rendell, A., Burant, J. C., Iyengar, S. S., Tomasi, J., Cossi, M., Rega, N., Millam, N. J., Klene, M., Knox, J. E., Cross, J. B., Bakken, V., Adamo, C., Jaramillo, J., Gomperts, R., Stratmann, R. E., Yazyev, O., Austin, A. J., Cammi, R., Pomelli, C., Ochterski, J. W., Martin, R. L., Morokuma, K., Zakrzewski, V. G., Voth, G. A., Salvador, P., Dannenberg, J. J., Dapprich, S., Daniels, A. D., Farkas, Ö., Foresman, J. B., Ortiz, J. V., Cioslowski, J., Fox, D. J. Gaussian, Inc., Wallingford CT, 2009. - Jaguar, version 8.0. http://www.schrodinger.com/citations/41/7/1/ (Schrödinger, LLC, New York, NY, 2013). - Bochevarov, A. D., Harder, E., Hughes, T. F., Greenwood, J. R., Braden, D. A., Philipp, D. M., Rinaldo, D., Halls, M. D., Zhang, J., Friesner, R. A. Jaguar: a high-performance quantum chemistry software program with strengths in life and materials sciences. *Int. J. Quantum Chem*. 113, 2110–2142 (2013). - Willoughby, P. H., Jansma, M. J. &amp; Hoye, T. R. A guide to small-molecule structure assignment through computation of (1H and 13C) NMR chemical shifts. *Nature Protocols* 9, 643–660 (2014) - MacroModel, version 10.0. http://www.schrodinger.com/citations/41/11/1/ (Schrödinger, LLC, New York, NY, 2013). - ChemBio3D Ultra 13.0 Suite. http://www.cambridgesoft.com/Ensemble_for_Biology/ChemBio3D/ - Smith, S. G. &amp; Goodman, J. M. Assigning the stereochemistry of pairs of diastereoisomers using GIAO NMR shift calculation. *J. Org. Chem*. 74, 4597–4607 (2009). - Smith, S. G. &amp; Goodman, J. M. Assigning stereochemistry to single diastereoisomers by GIAO NMR calculation: the DP4 probability. *J. Am. Chem. Soc*. 132, 12946–12959 (2010). - Sarotti, A. M. &amp; Pellegrinet, S. C. A multi-standard approach for GIAO 13C NMR calculations. *J. Org. Chem*. 74, 7254–7260 (2009). - Sarotti, A. M. Successful combination of computationally inexpensive GIAO 13C NMR calculations and artificial neural network pattern recognition: a new strategy for simple and rapid detection of structural misassignments. *Org. &amp; Biomol. Chem*. 11, 4847–4859 (2013). - Lodewyk, M. W., Siebert, M. R. &amp; Tantillo, D. J. Computational prediction of 1H and 13C chemical shifts: a useful tool for natural product, mechanistic, and synthetic organic chemistry. *Chem. Rev*. 112, 1839–1862 (2012). - Tantillo, D. J. Walking in the woods with quantum chemistry—applications of quantum chemical calculations in natural products research. *Nat. Prod. Rep*. 30, 1079–1086 (2013). ### Associated Publications 1. **A guide to small-molecule structure assignment through computation of (1H and 13C) NMR chemical shifts**. Patrick H Willoughby, Matthew J Jansma, and Thomas R Hoye. *Nature Protocols* 9 (3) 643 - 660 [doi:10.1038/nprot.2014.042](http://dx.doi.org/10.1038/nprot.2014.042) - **Analysis of Seven-Membered Lactones by Computational NMR Methods: Proton NMR Chemical Shift Data are More Discriminating than Carbon**. Daniel J. Marell, Susanna J. Emond, Aman Kulshrestha, and Thomas R. Hoye. *The Journal of Organic Chemistry* 79 (2) 752 - 758 17/01/2014 [doi:10.1021/jo402627s](http://dx.doi.org/10.1021/jo402627s) - **Case Study of Empirical and Computational Chemical Shift Analyses: Reassignment of the Relative Configuration of Phomopsichalasin to That of Diaporthichalasin**. Susan G. Brown, Matthew J. Jansma, and Thomas R. Hoye. *Journal of Natural Products* 75 (7) 1326 - 1331 27/07/2012 [doi:10.1021/np300248w](http://dx.doi.org/10.1021/np300248w) ### Acknowledgements S.A.R. thanks Great Lakes Higher Education Guaranty Corporation and the Ripon College Center for Social Responsibility for funding. Additionally, we thank Thomas R. Hoye for helpful input and Joseph D. Scanlon, Jordan Buhle, and Michael Enright for feedback during manuscript preparation. *Source: [Protocol Exchange](http://www.nature.com/protocolexchange/protocols/3143#/procedure). Originally published online 28 April 2014*.

February 15, 1999 THE DIGITAL EXAM digital was such a sanitary hi-tech word until my urologist snuck up from behind and gave me the bird shocked and taken back I try to ignore the painful experience by pondering the conundrum of homosexuality there had to be more to it than that "You can get dressed now" was the good doctor’s way of saying "Pull up your pants, Dude, and I’ll see you back in my office." but his casual demeanor seemed to exude foreboding "There is a stiffness in the gland demanding further examination. I’d like to schedule a blood test, ultrasound and biopsy." the doctor’s lips kept moving but I couldn’t hear him through the sheet of white fear that guillotined between us CANCER! The big C! Me? I spent the rest of that day up to my genitals in the grave I was digging. Hamlet gazing full into the face of the skull "Alas poor Yorick, I knew him well, Horatio. Before scalpel took gland. Back when he sang in a bass baritone." desperate for encouragement I turn to the illustrated brochure the informative flyer detailing the upcoming procedure where in the ultrasound and biopsy probe resembled the head of a black water moccasin baring its fang "Dang!" says I jumping back relief came 36 hours later something about the PSA blood test the prostate specific-antigen results leading the doctor to now suspect infection prescribing an antibiotic of course five weeks from now the FOLLOW-UP APPOINTMENT! and as the date approaches tension will build like in those Mel Gibson Lethal Weapon films when you know there’s a snake in the grass and Danny Glover isn’t there to cover your ass *** April 2, 1999 As it turns out, at the follow-up appointment, things had worsened so the biopsy and bone scan were re-scheduled and it was discovered that I do have incurable metastatic advanced prostate cancer. Of course the doctor is most optimistic about all the new and miraculous treatments available. But before I go into that, I want you to know that I find myself experiencing a strange and wonderful kind of peace. Hell, I’ve lived 70 years already — done exactly what I wanted to do with my life. All worthwhile dreams have come true. Made my living since 1968 as a "Performance Poet" — Billie Barbara and I have been together for 47 years — growing closer with each passing day. We have four great kids, five neat and nifty grandchildren. All things considered, I’ve been truly blessed and whether my departure date is next year or 15 years from now I’m determined not to wreck my life by doing a lousy job with my death. LIKE HAROLD / LIKE HOWARD like Harold I don’t want to blow my death I don’t want to see a lifetime of pluck and courage rubbed out by five weeks of whiny fractious behavior granted Harold’s was a scary way to go from diagnosis to last breath the cancer moving fast but five weeks of bitching and moaning was more than enough to erase every trace of a man I have wanted to emulate his wife sending word that even she can’t remember what he was like before his undignified departure no — I don’t want to go like Harold like Howard let me come swimming up out of the deepening coma face serene as if seen through undisturbed water breaking the surface to eagerly take the hand of bedside well wishers unexpected behavior I must admit as Howard has always been a world class hypochondriac second only to me the two of us able to sit for hours discussing the subtle shade of a mole turning each other on with long drawn out organ recitals in the end one would have thought such a legendary self centered soul would cower and fold up completely like Harold but no — when my time comes let me go sweetly like Howard *** April 7, 1999 The treatment was decided upon. Next Monday, the good Doctor is going to pit my apricots. From here on the Sultan can rest easy when Masten hangs with his harem. Prognosis good. No more testosterone - no more growth. Now, don’t get me wrong, I’m not looking forward to giving up the family jewels. I must say that over the years they’ve done me proud and to be totally honest I don’t think Billie Barbara will be all that disappointed either. I’m told that Viagra will help in this area., However, I’m also told that the drug is very expensive. Something like twelve bucks a pop. But hell, Billie Barbara and I can afford twenty four dollars a year.. Some thoughts the morning of— Yesterday I did a program for the Unitarian Society of Livermore. About 60 people. I had a bet with the fellow who introduced me, that at least 7 out of the 60 would come up after the reading (which would include my recent prostate musings) and share a personal war story about prostate cancer. I was right. Exactly 7 approached with an encouraging tale about themselves, a husband, a brother, a son. I was told to prepare myself for hot flashes and water retention. To which Billie Barbara said "Join the club!" I ended the presentation with one of those inspirational poetic moments. A hot flash, if you will. "It just occurred to me," I said, " I’m going to get rich selling a bumper sticker I just thought of — REAL MEN DON’T NEED BALLS A couple of days after the event The Community Hospital of the Monterey Peninsula is referred to as CHOMP, and the afternoon of April 12th I must say this august institution certainly lived up to it’s name. The waiting room in the Out Patient Wing is an event unto itself. Patients huddled together with friends and family, everyone speaking in hushed voices. The doomed keeping a wary eye on the ominous swinging doors, where a big tough looking nurse appeared from time to time shouting: NEXT! Actually the woman was quite sweet and mild mannered, enunciating each patient’s name in a calm friendly manner. But waiting to have done to me what was going to be done to me - the chilling word "NEXT!" is what I heard and "Out Patient Wing" certainly seemed a misnomer to me. Wasn’t the "Out-Patient Wing" where you went to have splinters removed? Of course I knew better, because in the pre-op interview the young interviewer, upon reading "Bilateral Orchiectomy" winced visibly, exclaiming under her breath "Bummer!" I recently came across this haiku — bilateral orchiectomy the sound a patient makes when he learns what it is Our daughter April lives in New York and couldn’t join the Waiting Room rooting section so as her stand in she sent her best friend Molly Williams. Now, Molly works as a veterinarian in a local animal shelter and a when I told her my operation was supposed to take no more than half an hour, she laughed: "Heck Ric, I’ll do it in five minutes and not even use gloves." NEXT! My turn to be led through those swinging doors, pitifully looking back over my shoulder. Wife, family and friends, bravely giving me the thumbs up. Things blur and run together after that. I do remember telling the nurse who was prepping me that I was afraid of being put to sleep. "Not to worry" she said, I’d have a chance to express these fears to the anesthetist before the operation would begin. And as promised the man did drop by to assure me that I would get a little something to ease my anxiety before he put me under. When the moment finally arrived, he said that I might feel a slight prick as he gave me the relaxant. Of course, that is the last thing I remember - the prick! Obviously, I‘d been suckered in by the mask man’s modus operandi. On the other side of this I surface to begin the waiting. WAITING for the catheter to be removed — for the incision to heal — WAITING to see if the pain subsides and I can loose the cane — WAITING to learn if my PSA will respond to treatment. Waiting—waiting—waiting—and I’ve never been a cheerful waiter. *** May 7, 1999 The doctor tells me I must keep taking Casodex— one a day at eleven dollars a cap - for the rest of my life. And no more doctor freebees. No wonder the listed side effect of this pricey medication is depression. But the recent funk I’ve fallen into is much deeper than dollars and cents. In the past I’ve had my share of operations and illnesses and always during the recuperation I could look forward to being my old self again. But not this time .... Not this time. Funny bumper stickers can only hold reality at bay for a short while. And anyway Billie had me remove the homemade REAL MEN DON’T NEED BALLS bumper sticker from the back of our car — She didn’t like the dirty looks she got while driving around town alone. *** Eight months later BILATERAL ORCHECTOMY never could look up words in the dictionary in a high school assignment writing an autobiography I described my self as a unique person scribbled in the margin the teachers correction fairly chortled "unique" not "eunuch" how could he have known that one day I would actually become a misspelling backed against the wall by advanced prostate cancer I chose the operation over the enormous ongoing expense of chemical castration "No big deal." I thought at the time what’s the difference they both add up to the same thing but in the movies these days during the hot gratuitous sex scene I yawn…bored... wishing they’d quit dicking around and get on with the plot and on TV the buxom cuties that titillate around the products certainly arn’t selling me anything I realize now that although it would probably kill them the guys who went chemical still have an option I don’t philosophically I’m the same person but biologically I ‘m like the picture puzzle our family traditionally puts together over the holidays the French impressionist rendition of a flower shop interior in all it’s bright colorful confusion this season I didn’t work the puzzle quite as enthusiastically... and for good reason this year I know pieces are missing where the orchids used to be "So?" says I to myself "You’re still here to smell the roses." *** January 13, 2000 Real bad news! At the third routine follow-up appointment. My urologist informs me that my PSA has started rising again. The orchectomy and Casodex are no longer keeping the cancer in remission. In the vernacular, I have become "hormone refractory" and there was nothing more he, as a urologist could do for me. An appointment with a local oncologist was arranged and another bone scan scheduled. The "T" word having finally been said the ostrich pulled his head from the sand and began looking around. Knowing what I know now, I’m still annoyed at my urologist for not telling me when I was first diagnosed to either join a support group and radically change my diet or find another urologist. I immediately did both - becoming vegan and finding help on-line as well as at the local Prostate Cancer Support Group. This during the endless eighteen day wait before the oncologist could fit me in. *** IRON SOCKS time now for a bit of reverse prejudice I once purchased some stockings called "Iron Socks" guaranteed to last for five years they lasted ten! but when I went back for another pair the clerk had never heard of them as a cancer survivor… so far in an over populated world I consider the multi-billion dollar medical and pharmaceutical industries realizing that there is absolutely no incentive to come up with a permanent cure *** From here on, I’ll let the poems document the part of the journey that brings us up to the present. A place where I can say — spiritually speaking, that the best thing that ever happened to me is metastatic hormone refractory advanced prostate cancer. *** SUPPORT GROUPS included in this close fraternity... in this room full of brotherly love I wonder where I’ve been for the last 11 months no — that’s not quite right… I know where I’ve been I’ve been in denial after the shock of diagnosis the rude indignity of castration the quick fix of a Casodex why would I want to hang out with a bunch of old duffers dying of prostate cancer? ignoring the fact that everybody dies we all know it but few of us believe it those who do, however rack up more precious moments than the entire citizenry of the fools paradise not to mention studies showing that those who do choose to join a support group on average live years longer than the stiff upper lip recluse and while I’m on the subject I wonder where I’d be without the internet and the dear supportive spirits met there in cyber-space a place where aid care and concern are not determined by age, gender, race, physical appearance, economic situation or geological location and this from a die-hard like me who not ten years ago held the computer in great disdain convinced that poetry should be composed on the back of envelopes with a blunt pencil while riding on trains thank god I’m past these hang-ups because without a support system I doubt if this recent malignant flare-up could have been withstood how terrifying… the thought of being at my writing desk alone… disconnected typing out memos to myself on my dead father’s ancient Underwood *** PC SPES in the sea that is me the hormone blockade fails my urologist handing me over to a young oncologist who recently began practicing locally having retired from the stainless steel and white enamel of the high tech Stanford medical machine in the examination room numbly thumbing through a magazine I wait expecting to be treated like a link of sausage another appointment ground out in a fifteen minute interval what I got was an 18th century throw back a hands-on horse and buggy physician with seemingly all the time in the world it was decided that for the next three weeks (between blood tests) all treatment would cease to determine how my PSA was behaving this done, at the next appointment the next step would be decided upon and after more than an hour of genial give and take with every question answered all options covered it was I who stood up first to go for me a most unique experience in the annals of the modern medicine show however condemned to three weeks in limbo knowing the cancer was growing had me going online reaching out into cyberspace to see what I could find and what I found was PC SPES a botanical herbal alternative medicine well documented and researched but not approved by the FDA aware that the treatment was not one my doctor had mentioned (I have since learned that to do so would make him legally vulnerable) I decided to give it a try on my own sending off for a ten day supply taking the first dose as close after the second blood test as I could two days later back in the doctors office I confess expecting a slap on the wrist instead I receive a bouquet for holding off until after the second PSA then taking the PC SPES container from my hand and like a Native American medicine man he holds it high over his head shaking it "Okay then, this approach gets the first ride!" at the receptionist desk scheduling my next appointment I thought about how difficult it must be out here on the frontier practicing medicine with your hands tied *** PREJUDICE "It's a jungle out there!" Dr. J. George Taylor was fond of saying "And all chiropractors are quacks! Manipulating pocket pickers!" the old physician exposing his daughter to a prejudice so infectious I suspect it became part of her DNA and she a wannabe doctor herself infects me her son with the notion that if it wasn’t performed or prescribed by a licensed M.D. it had to be Medicine Show hoopla or snake oil elixir certainly today’s countless array of practitioners and patent remedies has both of them spinning in their grave but Ma you and Grandpa never heard the words hormone-refractory even the great white hunters of our prestigious cancer clinics don't know how to stop the tiger that is stalking me and so with a PSA rising again to 11.9 I get my oncologist to let me try PC SPES a Chinese herbal formula yes, the desperate do become gullible me, reading and re-reading the promotional material dutifully dosing myself between blood tests and this against the smirk of disapproval mother and grandfather wagging their heads in unison: "It won’t work." "It won’t work." having condemned myself beforehand the moment of truth finally arrives I pace the floor nervously the doctor appears at the door "How does it feel to be a man with a PSA falling to 4.8?" it seems that for the time being at least the tiger is content to play a waiting game which is simply great! Mother tell Grandpa I just may escape our families bigotry before it’s too late *** HELPLINE HARRY "Hi, how are you?" these days I'm never sure how to field routine grounders like this am I simply being greeted? or does the greeter actually want a list of grisly medical details my wife says it's easy she just waits to see if the "How is he?" is followed by a hushed "I mean… really?" for the former a simple "Fine, and how are you?" will do for the latter the news isn't great indications are that the miracle herbal treatment is beginning to fail my oncologist offering up a confusing array of clinical trials and treatments that flirt seductively but speak in a foreign language I don't fully understand so Harry, once again I call on you a savvy old tanker who has maneuvered his battle scared machine through years of malignant mine fields and metastatic mortar attacks true five star Generals know much about winning wars and such but the Command Post is usually so far removed from the front lines I suspect they haven't a clue as to what the dog-faces are going through down here in the trenches it's the seasoned campaigners who have my ear the tough tenacious lovable old survivors like you *** "POOR DEVIL!" in my early twenties I went along with Dylan Thomas boasting that I wanted to go out not gently but raging shaking my fist staring death down however this daring statement was somewhat revised when in my forties I realized that death does the staring I do the down so I began hoping it would happen to me like it happened to the sentry in all those John Wayne Fort Apache movies found dead in the morning face down — an arrow in the back "Poor devil." the Sergeant always said "Never knew what hit him." at the time I liked that... the end taking me completely by surprise the bravado left in the hands of a hard drinking Welshman still wet behind the ears older and wiser now over seventy and with a terminal disease the only thing right about what the Sergeant said was the "Poor devil" part "Poor devil" never used an opening to tell loved ones he loved them never seized the opportunity to give praise for the sun rise or drink in a sunset moment after moment passing him by while he marched through life staring straight ahead believing in tomorrow "Poor devil!" how much fuller richer and pleasing life becomes when you are lucky enough to see the arrow coming *** END LINE (Dedicated to Jim Fulks.) I’ve always been a yin / yang - life / death - up / down clear / blur - front / back kind of guy my own peculiar duality being philosopher slash hypochondriac win win characteristics when you’ve been diagnosed with advanced prostate cancer finally the hypochondriac has something more than windmills to tilt with the philosopher arming himself with exactly the proper petard an anonymous statement found in an e-mail message beneath the signature of a cancer survivor’s name a perfect end line wily and wise quote: I ask God: "How much time do I have before I die?" "Enough to make a difference." God replies *** STRUM lived experience taught them most of what they know so MD's treating men diagnosed with androgen-independent advanced prostate cancer tend to put us on death row and taking the past into account this negativity is understandable… these good hearted doctors watching us come and go honestly doing what they can like kindly prison guards attempting to make the life we have left as pleasant as possible to be otherwise a physician would have to be a bit delusional evangelical even… to work so diligently for and believe so completely in the last minute reprieve for those of us confined on cell block PC doing time with an executioner stalking it is exhilarating to find an oncologist willing to fly in the face of history refusing to call the likes of me "Dead man walking." *** BAG OF WOE there are always moments when I can almost hear the reader asking: "How can you use that as grist for your poetry mill? How can you dwell on such private property, at least without masking the details?" well... for the feedback of course the war stories that my stories prompt you to tell but perhaps the question can best be answered by the ‘bag of woe’ parable the "Once Upon a Time" tale about the troubled village of Contrary its harried citizens and the magical mystical miracle worker who showed up one dreary day saying: I am aware of your torment and woe and I am here to lighten your load! he then instructed the beleaguered citizens to go home and rummage through their harried lives bag up your troubles he said both large and small stuff them all in a sack and drag them down to the town square and stack them around on the wall and when everyone was back and every bag was there the magical mystical miracle worker said: "It’s true, just as I promised. You won’t have to take your sack of troubles home leave it behind when you go however, you will have to take along somebody’s bag of woe so the citizens of Contrary all went to find their own bag and shouldering the load discovered that it was magically and mystically much easier to carry --- End ---

Ethical Issues in EBM: Balancing evidence with patient autonomy By Pranjali Gangatire Under the Guidance of Madraimova Venera mam (Department of EBM) &nbsp;Abstract Evidence-Based Medicine (EBM) is a cornerstone of modern healthcare, guiding doctors to use the best research to make decisions that improve patient outcomes. However, it sometimes clashes with a patient&rsquo;s right to choose their own care, known as patient autonomy. This creates ethical dilemmas: How do doctors balance what science says is best with what a patient wants? This comprehensive exploration dives into the heart of these challenges, unpacking the tensions between evidence and autonomy in a human-centered way. We&rsquo;ll look at real-world examples&mdash;like a patient refusing life-saving treatment or demanding unproven remedies&mdash;and explore practical solutions like shared decision-making and clear communication. By weaving together ethical principles, patient stories, and actionable strategies, this discussion aims to show how doctors can honor both science and the deeply personal choices of their patients. Systemic issues, cultural influences, and the role of technology are also considered to paint a full picture of this complex balance. &nbsp;Introduction: The Heart of the Matter Imagine you&rsquo;re a doctor, and your patient, Sarah, has just been diagnosed with breast cancer. The evidence is clear: surgery and chemotherapy offer her the best chance of survival. But Sarah, a 45-year-old artist with a deep distrust of hospitals, refuses. She wants to try herbal remedies she read about online instead. You know these remedies lack scientific backing, but Sarah is adamant. What do you do? Push the evidence-based treatment and risk alienating her, or respect her choice and worry about her survival? This is the ethical tightrope of Evidence-Based Medicine (EBM) when it meets patient autonomy. EBM is like a roadmap for doctors, built on rigorous research&mdash;think randomized trials and systematic reviews&mdash;that shows what treatments work best. It&rsquo;s grounded in doing good (beneficence), avoiding harm (non-maleficence), and being fair (justice). But at its core, EBM also includes listening to patients&rsquo; values and preferences, which is where autonomy comes in. Autonomy means patients have the right to decide what happens to their bodies, based on their beliefs, fears, and hopes. When these two forces&mdash;evidence and autonomy&mdash;don&rsquo;t align, doctors face tough ethical questions. This exploration is about those questions. We&rsquo;ll walk through the ethical challenges of balancing EBM with autonomy, using real-life scenarios to make it relatable. We&rsquo;ll talk about why these tensions happen, how they affect patients and doctors, and what can be done to find a middle ground. Along the way, we&rsquo;ll touch on bigger issues, like access to care, cultural differences, and the role of technology, all while keeping the human experience front and center. &nbsp;What is EBM, and Why Does Autonomy Matter? EBM is like a recipe for good healthcare: take the best scientific evidence, mix in a doctor&rsquo;s experience, and season with what the patient cares about. It&rsquo;s been around since the 1990s, championed by folks like Dr. David Sackett, who wanted medicine to be more systematic and less guesswork. The goal? Better outcomes for patients, fewer mistakes, and treatments that are proven to work. Autonomy, on the other hand, is about freedom. It&rsquo;s the idea that you, as a patient, get to call the shots about your health, as long as you understand what&rsquo;s at stake. This comes from ethical principles like informed consent&mdash;where doctors explain risks and benefits so you can choose wisely&mdash;and self-determination, which says your values matter, whether they&rsquo;re shaped by culture, religion, or personal experience. In an ideal world, EBM and autonomy work hand in hand. A doctor shares the evidence, the patient weighs it against their values, and together they pick a path. But life isn&rsquo;t always ideal, and that&rsquo;s where the trouble starts. &nbsp;The Ethical Tug-of-War: Where Evidence and Autonomy Clash Let&rsquo;s break down the main ethical challenges, using stories and examples to bring them to life. &nbsp;1. When Patients Say &ldquo;No&rdquo; to Evidence-Based Care Picture John, a 60-year-old with high blood pressure. The evidence says he needs medication to avoid a stroke, but John&rsquo;s worried about side effects and wants to stick to diet and exercise. His doctor knows the data: lifestyle changes alone might not be enough. But John&rsquo;s stubborn, and pushing him too hard could make him ditch medical care altogether. - What&rsquo;s the Issue? The doctor wants to do what&rsquo;s best (beneficence) and avoid harm (non-maleficence), but John&rsquo;s autonomy means he can say no, even if it&rsquo;s risky. - Why It&rsquo;s Tough: If the doctor respects John&rsquo;s choice, they might feel they&rsquo;re failing him. If they push too hard, they risk sounding like a know-it-all, which can break trust. - What Can Be Done? The doctor could sit down with John, listen to his fears, and explain the evidence in plain language&mdash;like, &ldquo;This pill cuts your stroke risk by 30%, but let&rsquo;s try diet changes first and check your blood pressure weekly.&rdquo; This shared decision-making respects John&rsquo;s autonomy while keeping evidence in the picture. &nbsp;2. One-Size-Fits-All Evidence vs. Unique Patients EBM often comes from studies of thousands of people, but patients like Maria, a 70-year-old with diabetes and arthritis, don&rsquo;t always fit the mold. The evidence says insulin is best for her diabetes, but Maria&rsquo;s terrified of needles and wants pills instead, even if they&rsquo;re less effective. - What&rsquo;s the Issue? Studies don&rsquo;t always include people like Maria&mdash;older, with multiple health issues&mdash;so the evidence might not fully apply. Plus, ignoring her fear of needles feels dismissive. - Why It&rsquo;s Tough: Doctors might lean on the evidence too heavily, coming off as rigid or uncaring. This can feel like paternalism&mdash;when doctors act like they know best. - What Can Be Done? Maria&rsquo;s doctor could tweak the evidence to fit her life, maybe starting with pills and teaching her about insulin gradually. Listening to her fears and explaining why insulin helps shows respect for her as a person, not just a patient. &nbsp;3. Making Evidence Understandable Now meet Ahmed, who&rsquo;s deciding whether to take a cholesterol-lowering drug. His doctor throws out terms like &ldquo;5% risk reduction&rdquo; and &ldquo;number needed to treat,&rdquo; but Ahmed&rsquo;s lost. He&rsquo;s not stupid&mdash;he just doesn&rsquo;t speak &ldquo;medical jargon.&rdquo; - What&rsquo;s the Issue? For Ahmed to make an autonomous choice, he needs to understand the evidence. If he doesn&rsquo;t, his decision might not reflect what he really wants. - Why It&rsquo;s Tough: Not everyone has the same ability to grasp complex info, especially if they&rsquo;re stressed or have limited education. This can widen health gaps, which isn&rsquo;t fair (justice). - What Can Be Done? Ahmed&rsquo;s doctor could use simple language, like, &ldquo;This pill lowers your chance of a heart attack, but it might make your muscles ache.&rdquo; Visuals, like a chart showing risks, can help too. Giving Ahmed time to ask questions makes him feel empowered. &nbsp;4. When Evidence-Based Care Isn&rsquo;t an Option Consider Lisa, a single mom with heart failure. The best treatment is a new drug, but her insurance won&rsquo;t cover it, and she can&rsquo;t afford it. She&rsquo;s stuck with an older, less effective option. - What&rsquo;s the Issue? Lisa&rsquo;s autonomy is limited not by choice but by money and access, which clashes with fairness (justice). She can&rsquo;t pick the evidence-based treatment even if she wants to. - Why It&rsquo;s Tough: Doctors feel helpless when the system blocks good care. It&rsquo;s frustrating for patients, too, who might feel cheated. - What Can Be Done? Lisa&rsquo;s doctor could look for financial aid programs or cheaper alternatives that still follow evidence. On a bigger scale, doctors can push for policies that make care more accessible, so no one&rsquo;s left out. &nbsp;5. Patients Wanting Unproven Treatments Think of Tom, who&rsquo;s dealing with chronic back pain. He&rsquo;s seen ads for a &ldquo;miracle&rdquo; supplement online and wants to try it, even though studies show it doesn&rsquo;t work and might cause side effects. - What&rsquo;s the Issue? Tom&rsquo;s autonomy says he can try what he wants, but the doctor&rsquo;s duty is to steer him toward safe, proven treatments. Saying no might make Tom feel dismissed, but saying yes could harm him. - Why It&rsquo;s Tough: Social media and misinformation make this common. Doctors have to walk a fine line to keep trust without compromising care. - What Can Be Done? Tom&rsquo;s doctor could ask, &ldquo;What makes you interested in this supplement?&rdquo; and explain, &ldquo;Studies show it doesn&rsquo;t help and might hurt your kidneys. Can we try physical therapy instead?&rdquo; This respects Tom&rsquo;s curiosity while guiding him to evidence-based options. &nbsp;6. Doctors&rsquo; Own Biases Doctors are human, too. Imagine Dr. Lee, who&rsquo;s been to a conference sponsored by a drug company. She&rsquo;s excited about their new medication and pushes it on her patients, downplaying other options. - What&rsquo;s the Issue? If Dr. Lee&rsquo;s enthusiasm skews how she presents evidence, her patients can&rsquo;t make truly informed choices. This undermines autonomy and trust. - Why It&rsquo;s Tough: Biases are sneaky&mdash;Dr. Lee might not even realize she&rsquo;s being influenced. Plus, time pressures can make it hard to present every option fairly. - What Can Be Done? Dr. Lee should disclose any ties to drug companies and use tools like decision aids to stay neutral. Reflecting on her own choices&mdash;maybe with a colleague&rsquo;s input&mdash;helps keep things honest. &nbsp;7. Culture and Beliefs Shaping Choices Finally, meet Rachel, a Jehovah&rsquo;s Witness with severe anemia. The evidence says a blood transfusion could save her life, but her faith says no transfusions, period. - What&rsquo;s the Issue? Rachel&rsquo;s autonomy is tied to her religious beliefs, but her doctor worries that respecting her choice could mean letting her die. - Why It&rsquo;s Tough: Cultural and religious differences can feel like a wall between evidence and autonomy. Doctors want to respect beliefs but also save lives. - What Can Be Done? Rachel&rsquo;s doctor could explore &ldquo;bloodless&rdquo; alternatives, like medications to boost red blood cells, that align with her faith and the evidence. Talking openly about her beliefs builds trust and shows respect. &nbsp;How to Walk the Tightrope: Practical Solutions So, how do doctors balance evidence and autonomy without falling off the ethical tightrope? Here are some human-centered strategies: 1. Shared Decision-Making (SDM): Think of SDM as a conversation, not a lecture. Doctors and patients sit down as equals, talk through the evidence, and find a plan that fits both science and the patient&rsquo;s life. Tools like pamphlets or apps can make this easier. 2. Listening and Talking Like Humans: Doctors should ask, &ldquo;What&rsquo;s important to you?&rdquo; and really hear the answer. Explaining evidence in everyday words&mdash;like &ldquo;This treatment helps 9 out of 10 people&rdquo; instead of percentages&mdash;makes it real. 3. Empowering Patients: Give patients resources, like trusted websites or support groups, so they feel confident in their choices. Time is key&mdash;don&rsquo;t rush them. 4. Being Honest About What We Don&rsquo;t Know: Evidence isn&rsquo;t perfect. If a treatment&rsquo;s benefits are unclear, say so. This builds trust and lets patients make informed bets. 5. Training for Tough Moments: Doctors need practice handling these dilemmas, like role-playing tricky conversations. Reflecting on past cases helps them grow. 6. Fighting for Fairness: Doctors can push for policies that make evidence-based care affordable and available, so patients like Lisa aren&rsquo;t left out. &nbsp;Bigger Picture: What Else Shapes This Balance? &nbsp;Technology&rsquo;s Role Tech can be a game-changer. Apps in electronic health records can remind doctors of the latest evidence, but leaning on them too much might make care feel robotic. Patient portals let people read about their options at home, but they need to be easy to use for everyone. Artificial intelligence could tailor treatments to individual patients, but we have to watch out for privacy issues or biases in the data. &nbsp;Society and Systems Money talks in healthcare. Drug companies can influence what evidence gets published, which affects what doctors recommend. Access is another hurdle&mdash;rural patients or those without insurance might not get the best treatments, no matter what the evidence says. And in public health, like with vaccines, individual choices (like refusing a shot) can clash with what&rsquo;s best for everyone. &nbsp;Changing Times Patients today are more empowered, thanks to the internet and a shift toward shared power in healthcare. They&rsquo;re asking questions and expecting a say, which is great but can make things tricky when they bring unproven ideas to the table. Social media doesn&rsquo;t help&mdash;it&rsquo;s a megaphone for both good info and nonsense. &nbsp;Real Stories to Make It Click 1. Sarah&rsquo;s Cancer Choice &nbsp; &nbsp;Sarah, our artist with breast cancer, refuses surgery. Her doctor listens to her fears about hospitals, shares stats like &ldquo;90% of women with your cancer survive with treatment,&rdquo; and suggests a naturopath consultation alongside regular checkups. Sarah feels heard and agrees to monitor her condition, keeping surgery as an option. 2. Tom&rsquo;s Back Pain Battle &nbsp; &nbsp;Tom&rsquo;s sold on that &ldquo;miracle&rdquo; supplement. His doctor asks why he&rsquo;s drawn to it and explains, &ldquo;Tests show it doesn&rsquo;t help and might hurt you. Let&rsquo;s try exercises that worked for others.&rdquo; Tom agrees to physical therapy, and the doctor checks in to keep him on track. &nbsp;Wrapping It Up Balancing evidence and autonomy in EBM is like juggling science and soul. The evidence gives doctors a solid foundation, but patients&rsquo; values, fears, and circumstances bring the human element. Ethical challenges pop up when patients refuse proven treatments, when evidence doesn&rsquo;t fit their unique needs, or when barriers like cost or culture get in the way. By listening deeply, explaining clearly, and working together, doctors can bridge the gap. It&rsquo;s not easy&mdash;it takes time, empathy, and sometimes advocacy to change broken systems. But when done right, this balance honors both the rigor of science and the heart of every patient. &nbsp;References 1. Sackett, D. L., Rosenberg, W. M., Gray, J. A., Haynes, R. B., &amp; Richardson, W. S. (1996). Evidence-based medicine: What it is and what it isn&rsquo;t. BMJ, 312(7023), 71&ndash;72. 2. Beauchamp, T. L., &amp; Childress, J. F. (2019). Principles of Biomedical Ethics (8th ed.). Oxford University Press. 3. Elwyn, G., Frosch, D., Thomson, R., et al. (2012). Shared decision making: A model for clinical practice. Journal of General Internal Medicine, 27(10), 1361&ndash;1367. 4. Greenhalgh, T., Howick, J., &amp; Maskrey, N. (2014). Evidence-based medicine: A movement in crisis? BMJ, 348, g3725. 5. Bensing, J. (2000). Bridging the gap: The separate worlds of evidence-based medicine and patient-centered medicine. Patient Education and Counseling, 39(1), 17&ndash;25. 6. Montori, V. M., &amp; Guyatt, G. H. (2008). Progress in evidence-based medicine. JAMA, 300(15), 1814&ndash;1816. 7. Charles, C., Gafni, A., &amp; Whelan, T. (1997). Shared decision-making in the medical encounter: What does it mean? Social Science &amp; Medicine, 44(5), 681&ndash;692. 8. Emanuel, E. J., &amp; Emanuel, L. L. (1992). Four models of the physician-patient relationship. JAMA, 267(16), 2221&ndash;2226. 9. Tonelli, M. R. (1998). The philosophical limits of evidence-based medicine. Academic Medicine, 73(12), 1234&ndash;1240. 10. Straus, S. E., &amp; McAlister, F. A. (2000). Evidence-based medicine: A commentary on common criticisms. CMAJ, 163(7), 837&ndash;841. 11. Rogers, W. A. (2004). Evidence-based medicine and justice: A framework for ethical decision-making. Health Care Analysis, 12(4), 317&ndash;330. 12. Barry, M. J., &amp; Edgman-Levitan, S. (2012). Shared decision making&mdash;The pinnacle of patient-centered care. New England Journal of Medicine, 366(9), 780&ndash;781. 13. Coulter, A., &amp; Collins, A. (2011). Making Shared Decision-Making a Reality: No Decision About Me, Without Me. The King&rsquo;s Fund. 14. Gupta, M. (2011). Ethics and evidence-based medicine: Is there a conflict? Medscape General Medicine, 6(3), 42. 15. Hope, T. (1995). Evidence-based medicine and ethics. Journal of Medical Ethics, 21(5), 259&ndash;260. 16. Kaldjian, L. C. (2010). Patient autonomy and the ethics of clinical decision-making. The American Journal of Bioethics, 10(4), 1&ndash;2. 17. Stiggelbout, A. M., Van der Weijden, T., De Wit, M. P., et al. (2012). Shared decision making: Really putting patients at the centre of healthcare. BMJ, 344, e256. 18. Wyer, P. C., &amp; Silva, S. A. (2009). Where is the wisdom? The challenge of evidence-based medicine to clinical judgment. Journal of Evaluation in Clinical Practice, 15(6), 1033&ndash;1038. 19. L&eacute;gar&eacute;, F., Ratt&eacute;, S., Gravel, K., &amp; Graham, I. D. (2008). Barriers and facilitators to implementing shared decision-making in clinical practice: Update of a systematic review. Patient Education and Counseling, 73(3), 526&ndash;535. 20. McCullough, L. B. (2005). The ethical concept of medicine as a profession: Its relevance for evidence-based medicine. The American Journal of Bioethics, 5(2), 1&ndash;3. &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;

“Garihmato—Look after, to Care for” Melaleuca Alternifolia, commonly called Tea Tree, only grows naturally in the lands of the Bundjalung people from north coast New South Wales. The particular medicinal properties of the Tea Tree have been used for thousands of years, and the Tree and its effects on land, water, and people form part of Bundjalung oral histories and spiritual governance. This article explores media about Tea Tree from the 1990s to 2020s in print media through agricultural media and magazines, as well as online media through TikTok. This combination highlights the generational positionality between the authors as Mother/Daughter and as different consumers of media, with Kath mainly consuming print and Phoebe consuming online. It also utilises a synergy through timing, with the 1990s being when Kath was in her 20s and the 2020s being Phoebe’s time in her 20s. Through analysing the tropes and messaging surrounding Tea Tree, we as Bundjalung women unearth the continued colonisation and exploitation of First Nations knowledges by the health and wellbeing sector – from the mainstream pharmaceutical industry to alternative wellbeing to user-generated travel content. This article considers these areas. Ultimately, acknowledgements of Indigenous land or origins of knowledge are not enough. We call for a structural reaffirmation and recontextualisation of First Nations’ ancestral medicines. Cultural Positioning Our family has an audio recording of our Githabal ancestor Granny Dorothy (Williams) Webb being interviewed by Terry Crowley, a linguist who was recording the Bundjalung language in the 1970s. This recording of Granny forms part of the body of language resources published in the Crowley’s The Middle Clarence Dialects of Bandjalang. In one section of the recording, Crowley quizzes Granny on the names for different trees. When he asks about Tea Tree, Granny quickly responds “bulam” (also sometimes spelt “bulihm”) and then attempts to begin a story on how the bark “bulam-ga” was used for shelters. Crowley abruptly stops her reminiscence as he has no interest in the ethnographic detail, just the linguistic material. Had he allowed her to speak further, he would have known that Granny had much more to say on Tea Tree. Some parts of her knowledge would have not been spoken to him, however, as Tea Tree, in particular Ti Tree Lake, formed a part of her women’s knowledge. As Granny’s female descendants, we operationalise our cultural connection to Bulam/Tea Tree in this article while being mindful and respectful of the importance of keeping certain knowledge within our female genealogy. We remain faithful to Granny’s language and to her teachings which we are privileged to know through oral history from her daughters Gertie and Esther Webb and her granddaughter Julianne Butler. The Context of ‘Wellbeing’ The World Health Organisation states in its Constitution that “health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO). While noting that this definition is a significant improvement on exclusively bio-medical definitions, we argue that there is still room for a further expansion. In critiquing the WHO definition, Sartorius (662) notes a third dimension of health, which is “a state of balance, an equilibrium that an individual has established within himself and between himself and his social and physical environment”. The inclusion of the environment resonates more deeply with many Aboriginal philosophies but remains problematic due to its individualistic nature, removed from culture, community, and Connection to Country. Through industry research, understandings of ‘wellness’ from the ‘health and wellbeing’ sector at large appear to remain fluid to consumer demands. In a 2021 report, “Wellness in 2030”, research shows that “consumers are spending more on wellness than they ever have before. Wellness is now a $1.5 trillion market globally” (Chopra et al.). Rather than provide a definition of what ‘wellness’ means, the report focusses on six ‘wellness categories’ as identified by consumers: health, fitness, nutrition, appearance, sleep, and mindfulness. From this we can understand that the ‘health and wellness’ industry might not promote a secure philosophy of wellness because, as inherently capitalist enterprises, they want to be responsive to social trends in order to secure profit. For Aboriginal peoples, our understanding of wellbeing is much more concrete. Culture is inextricably connected to Country, and the guardianship of that relationship is a foundation for life and a key indicator of wellbeing (Grieves 2; Oliver 1). Put simply, “if the land is sick, you are sick” (Kenyon). Conversely, the belief that “if you look after the country, the country will look after you” (Weir et al.) has framed a multi-generational cultural governance grounded in The Dreaming. Therefore, this article proceeds on an understanding of wellbeing beyond the limitation of mainstream definitions – we understand wellbeing as being place-based, enculturated, and grounded in action not aspiration. Our case study on the wellbeing representations in media promoting Tea Tree in various forms such as oils and immersive experience speak to this framing. Bulam (Melaleuca Alternifolia) Many Australians are familiar with Tea Tree but are unaware that one particular variant, Melaleuca Alternifolia, only grows naturally within the lands of the Bundjalung people. In addition to continuing oral histories, it was noted in various journals in the early colonial period that Bundjalung people used Bulam (Tea Tree) for a range of uses – to cover shelter, to line the coolamons which held jarjum (children), and for a range of medicinal purposes for its antiseptic, antibacterial, and antifungal properties. Bulam could also be used as a diluted drink, or as a crushed oil rubbed on wounds, with the added advantage of also repelling insects (Murray 693). Additionally, Tea Tree occupies a revered place in Bundjalung beliefs and practices through its transformation of Country. We contend that the phrase “Country makes us healthy” is not a metaphor but a deeply held cultural norm with spiritual and physical attributes. In regard to Bulam/Tea Tree, it is important to acknowledge that there are bodies of water in Bundjalung Country which are ringed by Tea Tree, in particular Ti Tree Lake. The healing properties of the water are enhanced by the infusion from leaves into the water, giving it antibacterial properties; these waters are seen as Women’s sites and are particularly important as birthing places. It is contended that the name Tea Tree comes from the recording of Captain James Cook’s 1770 mapping of the Australian eastern coastline. Coming ashore, Cook and his party witnessed Bundjalung people making a ‘tea coloured’ drink from the leaves of the tree. A number of sailors also used the leaves for tea (Drury 11). Neither the sailors, nor Joseph Banks who collected samples, were aware of the potential health benefits of the Tea Tree. Some early colonists in the north coast region did use the leaves medicinally but it was widely unknown amongst non-Indigenous people until the twentieth century (Drury 19). It was not until the 1920s that Tea Tree was produced and marketed by Arthur Penfold, an Australian chemist. Marketed as an oil, it is claimed that soldiers during World War II were given Tea Tree oil for use in the trenches (Australian Tea Tree Industry Association). However, with the advent of antibiotics, Tea Tree fell out of favour as a remedy, but recent interest, from both pharmaceutical and alternative medicine sectors, has seen a steady growth in production and promotion of Tea Tree for viable wound care globally (Jones). Unpacking Ethnocentrism, ‘Common Sense’, and Settler-Colonial Extractivism Australia has since developed a flourishing market for ‘herbal remedies’ which is dominated by Western and Chinese medicinal products. While Indigenous Medicines are experiencing growing popularity, they have traditionally held a very small market share (Wohlmuth et al.). Interestingly, while some Indigenous medicines have been used to develop Indigenous-owned micro-economies (Oliver), Tea Tree products have predominantly been distributed by non-Indigenous people. This is problematic because it removes the product from its broader cultural context and does not recognise Indigenous Intellectual and Cultural Property Rights. In fact, the marketing of Tea Tree oil in some contexts displays a distinct ethnocentrism. We understand ‘ethnocentrism’ to refer to individual and systemically entrenched beliefs in the perceived ‘rightness’ of the perspectives and processes of a person’s own group. Ethnocentrism also identifies that this belief in the ‘rightness’ of their own community acts alongside an aversion and disdain for ‘outsiders’ and their ways. This belief often enforces loyalty along ethnic lines in order to consolidate power, wealth, and resources in order to deprive the ‘outsider’. Notions of ethnocentrism have been present in the Australian social, cultural, and political consciousness for centuries (Cole) Another idea to consider with Australian ethnocentrism is theorist Antonio Gramsci’s concept of ‘common sense’. He argues that, while individuals of a social group may hold its conception of the world, the same group may repeat rhetoric that is not their own due to the ideas' prevalence in ‘normal times’. This is when the repetition of ‘common sense’ understandings becomes “not independent and autonomous, but submissive and subordinate” (Gramsci). Many of the media representations we unpack later in this article can be understood as repetitions of settler-colonial ‘common sense’ which reinforce and value the supposed ‘supremacy’ of white non-Indigenous understandings while trivialising or disregarding First Nations ways. Consequently, this brings the issue of ethnocentrism beyond individual acts to highlight the extractive nature of settler-colonial nations, which premise themselves on the ‘elimination of the native’ and our ways of being, knowing, and doing (Kauanui). This elimination does not have to be purely genocidal but also includes the appropriation and assimilation of First Nations people, resources, and knowledge. Mississauga Nishnaabeg writer Leanne Simpson from northern Turtle Island (Canada) argues that extraction and assimilation go together. Colonialism has always extracted the indigenous … every part of our culture that is seemingly useful to the extractivist mindset gets extracted … and assimilated into the culture of the settlers without regard for the people and the knowledge that created it. (Klein) In our analysis of media representations below, we will see many examples of what this section seeks to explain. Media will trivialise or dismiss First Nations people and knowledge through extraction, appropriation, and assimilation of our resources into their own ethnocentric understandings. Tea Tree Oil Use in ‘Australia’, 1990s-2020s In the 1990s, as Tea Tree oil began to expand in the market, the Australian Financial Review published an article entitled “Bringing Tea-Tree Oil Out of the Swamp” (Brown). The article’s provocative introduction asserted: the world's first big plantation producer of tea-tree oil discovered early that its product's folksy image was not easy to shed. Decades of labelling as a bush remedy was a disadvantage when the product was eventually promoted as scientifically proven medicine. However, the company has succeeded in convincing consumers that the native product is a quality one, and the result has been the birth of a new industry. In deconstructing these assertions through a Bundjalung lens we have much to say! Firstly, it is a peculiarly Western lens which denigrates swampland. The late anthropologist Deborah Bird Rose (1996) gave voice to many of the Aboriginal perspectives which she had heard, contending that ‘wilderness’ is a construction of the West. For Aboriginal people, swamp is still sacred: it is the home of the Tea Tree and is not perceived as lesser, but rather as an interdependent element of the broader landscape, of the health of waterways, teeming with food and medicines. Secondly, we note the usage of “folksy image” and “bush remedy” as hurdles to be overcome. Given that both of these, particularly ‘bush medicines’, are coded to Aboriginality, this presents another layer of disconnection of the emplaced and enculturated nature of Tea Tree. In fact, later studies have shown that there is strong uptake and identification with traditional medicines exactly from that basis. For instance, interviewees from clinics distributing traditional remedies recall, “blackfellas and whitefellas come and tell us, ‘I’m feeling better from your bush medicine, can I get some more?’” (Oliver). Additionally, if we consider the global market, the WHO estimates that “60% of the world’s population relies on herbal medicine and about 80% of the population in developing countries depends almost totally on it for their primary health care needs” (Khan). Therefore, we contend that the ‘disadvantage’ is in targeting the ethnocentric Western market, which is masked by an apparent global outlook. This year, in “Three Tales from Tea Tree Farmers”, an article published in The Farmer Magazine, the developing ‘Australian’ Tea Tree industry is foregrounded in the by-line with “First Nations people have understood the value of Australian tea tree oil for thousands of years” (Hadgraft). This is particularly ironic given the content of the article itself: white face after white face come through the editorial shots of farmers with their crop, and not another whisper of the Aboriginal people and knowledges the article leads with. In this and other business-focussed articles, the Tea Tree narrative transcends its literal grounding. In contrast, a range of alternative medicine commentators do acknowledge the centrality of Bundjalung culture to Tea Tree’s curative potential, but place Aboriginal knowledges in a liminal space – a kind of choose-your-own-adventure – which samples across belief systems and practices to create a hybrid model which weakens Aboriginal cultural authority. We note that these erasures and slippages are not necessarily made from malice, but nevertheless constitute a problematic narrative through an Aboriginal lens. For example, Madelaine West, in “The Only Way to Create a Kinder World Together”, lauds the Tea Tree-infused lake waters in the Bundjalung nation as a kind of New Age transformative landscape. She comments: since time immemorial, these lakes have been a sacred Indigenous birthing place and meeting ground of the First Nation tribes of the Arakwal-Bundjalung people. Historically a ‘girls only’-type affair, many Indigenous men still observe this practice. It should be noted here that ‘girls only’ seems to hearken to the literary tradition of girls' adventure fiction – the self-sufficient tomboy who challenges gender norms. While this trope has, and can, continue to serve to empower young women, there has often been a racialised element to this narrative (McRobbie and McCabe 1981). In the context of Tea Tree, it is salient to note that Women’s Business transcends the girls-only trope as the framing of spiritual authority with severe consequences for those men who transgress this element of lore (Bird-Rose 36-8). Thus West’s contention of the personified Lake sits in direct contravention to her stated position that “it is not for me to interpret nor appropriate the culture of the traditional custodians of this region”. The warm, soothing waters of these lakes offer up their healing properties to one and all ... they don't discriminate along lines of colour, creed, residence or orientation. They just hold you in their fluid, forgiving embrace, wash you clean, heal your hurts and soothe your soul. (West) We note that there is no problem in personifying the body of water as this directly correlates to international movements to the legal personhood of waterways, such as the Whanganui River in Aotearoa (New Zealand), or recognition as a living entity such as the Yarra River in Victoria. What should be noted, however, is that within the context of international instruments like the United Nations Declaration on the Rights of Indigenous Peoples and various national and state policies, First Nations people (in particular Traditional Owners) are central to the representation of engagement with water (Pelizzon et al.). In this context it would include a culturally mediated guardianship on who may bathe in the waters, which speaks to a respect for cultural traditions and consultation for permission to use the waters. There is an ongoing tension for First Nations people attempting to negotiate this preferred power-sharing with local, state, and national governments while their Country continues to be desecrated by ignorant and selfish visitors. Despite lack of support from the state, First Nations peoples regularly attempt to exert their own environmental governance and authority over sacred sites on their Country, with one way being through the use of signs informing guests of the nature of the area. Similar to our special lakes in Bundjalung Country, Kuku Yalanji people from the Daintree have the Blue Hole Pool, which is a healing and birthing place reserved for women’s business. Kuku Yalanji Traditional Owners have struggled for years to protect this site, as non-Indigenous people have decided to make the pool a regular swimming spot. Multiple erected signs are constantly dismissed and a boom gate installed to stop vehicles has been broken multiple times by disgruntled visitors. (Hollis) Protecting these lakes has hit another obstacle with the rise of #traveltok in the 2020s, a subsection of media on the user-generated short form video-sharing app TikTok dedicated to sharing the best spots to travel. All someone has to search for is ‘swimming hole daintree’, and videos show overwhelmingly non-Indigenous tourists (of all genders) sharing their travels to the Blue Hole Pool. One video shows a girl with her friends trespassing past the aforementioned boom gate (TikTok a), and another video shows a young man filming himself in the sacred women’s pool with the caption “Add this to your bucket list in Queensland!” (TikTok b). Ironically, a number of commenters note that he would have had to ignore numerous signs warning him to not swim. However, the video still garnered 2,200 likes, and over 700 people have saved the video. A similar search for ‘Ti Tree Lake’ reveals comparable content. The first video belongs to a young woman, Rhiannon, presumably in her early 20s, who declares in a voiceover that “this is one of the best places to swim in Australia”, before listing off the health and wellbeing benefits of the Tea Tree-infused lake (TikTok c). While she acknowledges in the second half of the video that the lake is “valued” by Indigenous women after birth, she fails to name Bundjalung people for her audience of 508,000 views, and instead closes her content on how nice her hair felt afterwards. Through this type of media content creation, a young white woman has assumed the right to promote one of Bundjalung Nation’s most significant sites. Another video nearby in the search list shows a young man bathing in our women’s lake (TikTok d). West and Rhiannon are certainly not alone in their shaping of the lake as a natural healing place through a lens of wellbeing language. A letter to the editor complaining of men using the lake took a far different approach to a gender prohibition, adding dismay that the lake was being used by men seeking random sexual hook-ups. In speaking of the significance of the Country, the author writes, “once upon a time it was an Aboriginal birthing ground. Yeah fellas, a sacred women’s area”. Ironically the concern of what had been ‘lost’ was also framed through a nostalgic appreciation where 20 years ago I used to come here with my girlfriends and we would swim in the tea-tree lake, dive deep to retrieve the mineral rich mud from the bottom and lie in the sun until it had dried. It was the ultimate day spa. (Leonard) While noting this conversational tone, there is nevertheless a deep disjuncture between a sacred women's area and a day spa. We argue that the significance of Tea Tree lakes is not open to appropriation through reinterpretation, not through a female empowerment and revitalisation agenda nor a neo-spiritual agenda which arose in the 2015 media discussion on a non-Aboriginal Victorian couple’s decision to give birth in Taylors Lake, reported by the Byron Shire News. In the paper’s next weekly edition, they gave voice to Arakwal custodians who commented: Taylors Lake or Ti Tree Lake is the most significant Aboriginal women's site in the Byron Shire … . The lake belongs to all Bundjalung women and holds deep spiritual significance to us, and our men never go there out of respect … . This woman speaks about her respect for Aboriginal culture but did not ask our permission. We were horrified when we saw the picture in the paper of this man in the sacred women's lake. (Kay cited in C222morrow) This last example particularly exemplifies the attempted ‘elimination’ of First Peoples through the attempted appropriation and assimilation of Indigenous practice. This absorption of the practice of bathing in these lakes into non-Indigenous practices attempts to displace Indigenous peoples from our Country, our sacred sites, and our knowledge. Through the re-framing of these places as ‘wellness’ tools or feminist liberation, we are experiencing the continued colonisation of our special places, which are our birthright as encultured female members of First Nations groups. Calls to Action There is a trend in academic literature which provides the scope of problems which plague Indigenous peoples. Our article concludes not with a restatement of the issues, but with a series of Calls to Action. Every day that we do not empower Traditional Owners in the management of their own Country is another day that sites such as Ti Tree Lake are desecrated and culturally significant plants like bulam are exploited. This requires individual and broader systemic change: Non-Indigenous peoples seeking healing and enlightenment from Country must be mindful that they are guests in those spaces. Wilfully ignoring Indigenous protocols or seeing protocols as a “pick and mix” option devalues Country. Social media guidelines for platforms such as TikTok must include avenues to flag or remove or add warnings for culturally insensitive content. This requires ongoing collaboration with First Nations people to further refine what content breaches these guidelines. Content creators must also adapt to community feedback. There must be legal recognition of Indigenous Cultural and Intellectual Property (ICIP) regarding First Nations’ knowledge of Country. First Nations people must be empowered to economically benefit from their knowledge as business owners and entrepreneurs utilising their individual, familial, and communal knowledge. Local, state, and national governments must empower Traditional Ecological Governance systems. Acknowledgement is not enough, sovereignty and land back. #notyourdamndayspa. References Australian Tea Tree Oil Industry Association. “About Australian Tea Tree Oil.” 10 June 2023 &lt;https://teatree.org.au/teatree_about.php&gt;. Bird-Rose, Deborah. Nourishing Terrains: Australian Aboriginal Views of Landscape and Wilderness. Australian Heritage Commission, 1996. Brown, Jamie. “Bringing Tea-Tree Oil Out of the Swamp.” Financial Review 17 Apr. 1994. &lt;https://www.afr.com/companies/bringing-tea-tree-oil-out-of-the-swamp-19940117-kate3&gt;. C222morrow. “Arakwal Condemn Birth Plans for Women’s Lake.” 19 Feb. 2015. &lt;https://www.dailytelegraph.com.au/news/nsw/byron-shire/arakwal-condemn-birth-plans-for-womens-lake/news-story/2ff9913bd37ce6a3cb3fa1edb45af0f4&gt;. Chopra, Manish, et al. “Wellness in 2030.” 22 July 2021 &lt;https://www.mckinsey.com/industries/consumer-packaged-goods/our-insights/wellness-in-2030&gt;. Cole, Douglas. “‘The Crimson Thread of Kinship’: Ethnic Ideas in Australia, 1870–1914.” Historical Studies 14.56 (1971): 511-525. Crowley, Terry. The Middle Clarence Dialects of Bandjalang. Australian Institute of Aboriginal Studies, 1978. Drury, Susan. Tea Tree Oil: A Medicine Kit in a Bottle. Unity Press, 1996. Gramsci, Antonio. Selections from the Prison Notebooks. 6th ed. London: Wishart, 1980. Grieves, Vicki. Aboriginal Spirituality: Aboriginal Philosophy, the Basis of Aboriginal Social and Emotional Wellbeing. Cooperative Research Centre for Aboriginal Health, 2009. Hadgraft, Bev. “Three Tales from Tea Tree Farmers.” The Farmer 13 Feb. 2023. &lt;https://thefarmermagazine.com.au/tea-tree-tales/&gt;. Hollis, Hannah. “Ignoring 'No Entry' Signs at Women's Sacred Site Has Consequences, Says Custodian.” SBS 31 Mar. 2016 .&lt;https://www.sbs.com.au/nitv/article/ignoring-no-entry-signs-at-womens-sacred-site-has-consequences-says-custodian/2pvigi9gx&gt;. Jones, Greg. “Indigenous Medicine – A Fusion of Ritual and Remedy.” The Conversation 5 Dec. 2014. &lt;https://theconversation.com/indigenous-medicine-a-fusion-of-ritual-and-remedy-33142&gt;. Kahn, Mohd S.A., and Iqbal Ahmed. “Herbal Medicine: Current Trends and Future Prospects.” New Look to Phytomedicine. Academic Press, 2019. Kauanui, J. Kēhaulani. “‘A Structure, Not an Event’: Settler Colonialism and Enduring Indigeneity.” Emergent Critical Analytics for Alternative Humanities, 2016. &lt;https://csalateral.org/issue/5-1/forum-alt-humanities-settler-colonialism-enduring-indigeneity-kauanui/&gt;. Keyon, Georgia. “‘If the land is sick, you are sick’: An Aboriginal Approach to Mental Health in Times of Drought.” 8 Jun. 2023 &lt;https://scroll.in/pulse/921558/if-the-land-is-sick-you-are-sick-an-aboriginal-approach-to-mental-health-in-times-of-drought&gt;. Klein, Naomi. “Dancing the World into Being: A Conversation with Idle No More’s Leanne Simpson.” Yes Magazine 6 Mar. 2013. &lt;https://www.yesmagazine.org/social-justice/2013/03/06/dancing-the-world-into-being-a-conversation-with-idle-no-more-leanne-simpson&gt;. Leonard, Ali. “Stop Shagging at the Tea-Tree Lake.” 20 May 2023 &lt;https://www.echo.net.au/2018/01/stop-shagging-tea-tree-lake/&gt;. McRobbie, Angela, and Trisha McCabe. Feminism for Girls: An Adventure Story. Routledge, 2013. Murray, Michael. “Melaleuca Alternifolia (Tea Tree).” Textbook of Natural Medicine. 5th ed. 2020. 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Introduction Many people interpret the word ‘cult’ through specific connotations, including, but not limited to, a community of like-minded people on the edge of civilization, often led by a charismatic leader, with beliefs that are ‘other’ to societal ‘norms’. Cults are often perceived as deviant, regularly incorporating elements of crime, especially physical and sexual violence. The adoption by some cults of a special uniform or dress code has been readily picked up by popular culture and has become a key ‘defining’ characteristic of the nature of a cult. In this article, we use the semiotic framework of myth, as discussed by Barthes, to demonstrate how cult uniforms become semiotic myths of popular culture. Narratively, the myth of the cult communicates violence, deviance, manipulation, and brainwashing. The myth of on-screen cults has derived itself from a reflexive pop culture foundation. From popular culture inspiring cults to cults inspiring popular culture and back again, society generates its cult myth through three key mechanisms: medicalisation, deviance amplification, and convergence. This means we are at risk of misrepresenting the true nature of cults, creating a definition incongruent with reality. This article traces the history of cults, the expectations of cult behaviour, and the semiotics of uniforms to start the discussion on why society is primed to accept a confusion between nature and the semiotic messaging of “what-goes-without-saying” (Barthes Mythologies 11). Semiotics and Myth Following the basic groundwork of de Saussure in the early 1900s, semiotics is the study of signs and how we use signs to derive meaning from the external world (de Saussure). Barthes expanded on this with his series of essays in Mythologies, adding a layer of connotation that leads to myth (Barthes Mythologies). Connotation, as described by Barthes, is the interaction between signs, feelings, and values. The connotations assigned to objects and concepts become a system of communication that is a message, the message becomes myth. The myth is not defined by the object or concept, but by the way society collectively understands it and all its connotations (Barthes Elements of Semiology 89-91). For scholars like Barthes, languages and cultural artifacts lend themselves to myth because many of our concepts are vague and abstract. Because the concept is vague, it is easy to impose our own values and ideologies upon it. This also means different people can interpret the same concept in different ways (Barthes Mythologies 132). The concept of a cult is no exception. Cults mean different things to different people and the boundaries between cults and religious or commercial organisations are often contested. As a pop culture artifact, the meaning of cults has been generated through repeated exposure in different media and genres. Similarly, pop culture (tv, films, news, etc.) often has the benefit of fiction, which separates itself from the true nature of cults (sensu Barthes Mythologies). Yet, through repeated exposure, we begin to share a universal meaning for the term and all the behaviours understood within the myth. Our repeated exposure to the signs of cults in pop culture is the combined effect of news media and fiction slowly building upon itself in a reflexive manner. We hear news reports of cults behaving in obscure ways, followed by a drama, parody, critique, or satire in a fictitious story. The audience then begins to see the repeated narrative as evidence to the true nature of cults. Over time the myth of the cult naturalises into the zeitgeist as concretely as any other sign, word, or symbol. Once the myth is naturalised, it is better used as a narrative device when affixed to a universally recognised symbol, such as the uniform. The uniform becomes an efficient device for communicating meaning in a short space of time. We argue that the concept of cult as myth has entered a collective understanding, and so, it is necessary to reflect on the mechanisms that drove the correlations which ultimately created the myth. Barthes’s purpose for analysing myth was “to track down, in the decorative display of what-goes-without-saying, the ideological abuse which, in my view, is hidden there” (Barthes Mythologies 11). For this reason, we must briefly look at the history of cults and their relationship with crime. A Brief History of Cults ‘Cult’ derives from the Latin root, cultus, or cultivation, and initially referred to forms of religious worship involving special rituals and ceremonies directed towards specific figures, objects, and/or divine beings. Early to mid-twentieth century sociologists adopted and adapted the term to classify a kind of religious organisation and later to signal new forms of religious expression not previously of primary or singular interest to the scholar of religion (Campbell; Jackson and Jobling; Nelson). The consequences were such that ‘cult’ came to carry new weight in terms of its meaning and reception, and much like other analytical concepts developed an intellectual significance regarding religious innovation it had not previously possessed. Unfortunately, this was not to last. By the early 1990s, ‘cult’ had become a term eschewed by scholars as pejorative, value-laden, and disparaging of its supposed subject matter; a term denuded of technical and descriptive meaning and replaced by more value-neutral alternatives (Dillon and Richardson; Richardson; Chryssides and Zeller). Results from well-published surveys (Pfeifer; Olson) and our own experience in teaching related subject matter revealed predominantly negative attitudes towards the term ‘cult’, with the inverse true for the alternative descriptors. Perhaps more importantly, the surveys revealed that for the public majority, knowledge of ‘cults’ came via media reportage of particularly the sensational few, rather than from direct experience of new religions or their members more generally (Pfeifer). For example, the Peoples Temple, Branch Davidian, and Heaven’s Gate groups featured heavily in news and mass media. Importantly, reporting of each of the tragic events marking their demise (in 1978, 1993, and 1997 respectively) reinforced a burgeoning stereotype and escalated fears about cults in our midst. The events in Jonestown, Guyana (Peoples Temple), especially, bolstered an anticult movement of purported cult experts and deprogrammers offering to save errant family members from the same fate as those who died [there]. The anticult movement portrayed all alleged cults as inherently dangerous and subject only to internal influences. They figured the charismatic leader as so powerful that he could take captive the minds of his followers and make them do whatever he wanted. (Crockford 95) While the term ‘new religious movement’ (NRM) has been used in place of cults within the academic sphere, ‘cult’ is still used within popular culture contexts precisely because of the connotations it inspires, with features including charismatic leaders, deprogrammers, coercion and mind-control, deception, perversion, exploitation, deviance, religious zealotry, abuse, violence, and death. For this reason, we still use the word cult to mean the myth of the cult as represented by popular culture. Representations of Cults and Expectations of Crime Violence and crime can be common features of some cults. Most NRMs “stay within the boundaries of the law” and practice their religion peacefully (Szubin, Jensen III, and Gregg 17). Unfortunately, it is usually those cults that are engaged in violence and crime that become newsworthy, and thus shape public ‘knowledge’ about the nature of cults and drive public expectations. Two of America’s most publicised cults, Charles Manson and the Manson Family and the Peoples Temple, are synonymous with violence and crime. Prior to committing mass suicide by poison in Jonestown, the Peoples Temple accumulated many guns as well as killing Congressman Leo Ryan and members of his party. Similarly, Charles Manson and the Manson Family stockpiled weapons, participated in illegal drug use, and murdered seven people, including Hollywood actor Sharon Tate. The high-profile victims of both groups ensured ongoing widespread media attention and continuous popular culture interest in both groups. Other cults are more specifically criminal in nature: for example, the Constanzo group in Matamoros, while presenting as a cult, are also a drug gang, leading to many calling these groups narco-cults (Kail 56). Sexual assault and abuse are commonly associated with cults. There have been numerous media reports worldwide on the sexual abuse of (usually) women and/or children. For example, a fourteen-year-old in the Children of God group alleged that she was raped when she disobeyed a leader (Rudin 28). In 2021, the regional city of Armidale, Australia, became national news when a former soldier was arrested on charges of “manipulating a woman for a ‘cult’ like purpose” (McKinnell). The man, James Davis, styles himself as the patriarch of a group known as the ‘House of Cadifor’. Police evidence includes six signed “slavery contracts”, as well as 70 witnesses to support the allegation that Mr Davis subjected a woman to “ongoing physical, sexual and psychological abuse and degradation” as well as unpaid prostitution and enslavement (McKinnell). Cults and Popular Culture The depiction of cults in popular culture is attracting growing attention. Scholars Lynn Neal (2011) and Joseph Laycock (2013) have initiated this research and identified consistent stereotypes of 'cults’ being portrayed throughout popular media. Neal found that cults began to be featured in television shows as early as the 1950s and 1960s, continually escalating until the 1990s before dropping slightly between 2000 and 2008 (the time the research was concluded). Specifically, there were 10 episodes between 1958-1969; 19 in the 1970s, which Neal attributes to the “rise of the cult scare and intense media scrutiny of NRMs” (97); 25 in the 1980s; 72 in the 1990s; and 59 between 2000 and 2008. Such academic research has identified that popular culture is important in the formation of the public perception, and social definition, of acceptable and deviant religions (Laycock 81). Laycock argues that representations of cults in popular culture reinforces public narratives about cults in three important ways: medicalisation, deviance amplification, and convergence. Medicalisation refers to the depiction of individuals becoming brainwashed and deprogrammed. The medicalisation of cults can be exacerbated by the cult uniform and clinical, ritualistic behaviours. Deviance amplification, a term coined by Leslie Wilkins in the 1960s, is the phenomenon of ‘media hype’, where the media selects specific examples of deviant behaviour, distorting them (Wilkins), such that a handful of peripheral cases appears representative of a larger social problem (Laycock 84). Following the deviance amplification, there is then often a 'moral panic' (a term coined by Stanley Cohen in 1972) where the problem is distorted and heightened within the media. Cults are often subject to deviance amplification within the media, leading to moral panics about the ‘depraved’, sexual, criminal, and violent activities of cults preying on and brainwashing innocents. Convergence “is a rhetorical device associated with deviance amplification in which two or more activities are linked so as to implicitly draw a parallel between them” (Laycock 85). An example of convergence occurred when the Branch Davidians were compared to the Peoples Temple, ultimately leading the FBI “to end the siege through an aggressive ‘dynamic entry’ in part because they feared such a mass suicide” (Laycock 85). The FBI transferred responsibility for the deaths to ‘mass suicide’, which has become the common narrative of events at Waco. Each of the three mechanisms have an important role to play in the popular culture presentation of cults to audiences. Popular media sources, fictional or not, are incentivised to present the most diabolical cult to the audience – and this often includes the medicalised elements of brainwashing and manipulation. This presentation reinforces existing deviance amplification and moral panics around the depraved activities of cults, and in particular sexual and criminal activities. And finally, convergence acts as a 'cultural script’ where the portrayal of these types of characteristics (brainwashing, criminal or violent behaviour, etc.) is automatically associated with cults. As Laycock argues, “in this way, popular culture has a unique ability to promote convergence and, by extension, deviance amplification” (85). The mechanisms of medicalisation, deviance amplification and convergence are important to the semiotic linking of concepts, signs, and signifiers in the process of myth generation. In efficiently understanding the message of the myth, the viewer must have a sign they can affix to it. In the case of visual mediums this must be immediate and certain. As many of the convergent properties of cults are behavioural (acts of violence and depravity, charismatic leaders, etc.), we need a symbol that audiences can understand immediately. Uniforms achieve this with remarkable efficiency. Upon seeing a still, two-dimensional image of people wearing matching garb it can be made easily apparent that they are part of a cult. Religious uniforms are one of the first visual images one conjures upon hearing the word cult: “for most people the word ‘cult’ conjures up ‘60s images of college students wearing flowing robes, chanting rhythmically and spouting Eastern philosophy” (Salvatore cited in Petherick 577; italics in original). The impact is especially pronounced if the clothes are atypical, anachronistic, or otherwise different to the expected clothes of the context. This interpretation then becomes cemented through the actions of the characters. In Rick and Morty, season 1, episode 10, Morty is imprisoned with interdimensional versions of himself. Despite some morphological differences, each Morty is wearing his recognisable yellow top and blue pants. While our Morty’s back is turned, five hooded, robed figures in atypical garb with matching facial markings approach Morty. The audience is immediately aware that this is a cult. The comparison between the uniform of Morty and the Morty cult exemplifies the use of cult uniform in the myth of Cults. The cult is then cemented through chanting and a belief in the “One true Morty” (Harmon et al.). Semiotics, Clothes, and Uniforms The semiotics of clothes includes implicit, explicit, and subliminal signs. The reasons we choose to wear what we wear is governed by multiple factors both within our control and outside of it: for instance, our body shape, social networks and economic status, access to fashion and choice (Barthes The Fashion System; Hackett). We often choose to communicate aspects of our identity through what we wear or what we choose not to wear. Our choice of clothing communicates aspects of who we are, but also who we want to be (Hackett; Simmel; Veblen) Uniforms are an effective and efficient communicative device. Calefato’s classification of uniforms is not only as those used by military and working groups, but also including the strictly coded dress of subcultures. Unlike other clothes which can be weakly coded, uniforms differentiate themselves through their purposeful coded signalling system (Calefato). To scholars such as Jennifer Craik, uniforms intrigue us because they combine evident statements as well as implied and subliminal communications (Craik). Theories about identity predict that processes similar to the defining of an individual are also important to group life, whereby an individual group member's conceptualisation of their group is derived from the collective identity (Horowitz; Lauger). Collective identities are regularly emphasised as a key component in understanding how groups gain meaning and purpose (Polletta and Jasper). The identity is generally constructed and reinforced through routine socialisation and collective action. Uniforms are a well-known means of creating collective identities. They restrict one’s clothing choices and use boundary-setting rituals to ensure commitment to the group. In general, the more obvious the restriction, the easier it is to enforce. Demanding obvious behaviours from members, unique to the community, simultaneously generates a differentiation between the members and non-members, while enabling self-enforcement and peer-to-peer judgments of commitment. Leaders of religious movements like cults and NRMs will sometimes step back from the punitive aspects of nonconformity. Instead, it falls to the members to maintain the discipline of the collective (Kelley 109). This further leads to a sense of ownership and therefore belonging to the community. Uniforms are an easy outward-facing signal that allows for ready discrimination of error. Because they are often obvious and distinctive dress, they constrain and often stigmatise members. In other collective situations such as with American gangs, even dedicated members will deny their gang affiliation if it is advantageous to do so (Lauger Real Gangstas). While in uniform, individuals cannot hide their membership, making the sacrifice more costly. Members are forced to take one hundred percent of the ownership and participate wholly, or not at all. Through this mechanism, cults demonstrate the medicalisation of the members. Leaders may want their members to be unable to escape or deny affiliation. Similarly, their external appearances might invite persecution and therefore breed resilience, courage, and solidarity. It is, in essence, a form of manipulation (see for instance Iannaccone). Alternatively, as Melton argues, members may want to be open and proud of their organisation, as displayed through them adopting their uniforms (15). The uniform of cults in popular media is a principal component of medicalisation, deviance amplification, and convergence. The uniform, often robes, offers credence to the medicalisation aspect: members of cults are receiving ‘treatment’ — initially, negative treatment while being brainwashed, and then later helpful/saving treatment when being deprogrammed, providing they survive a mass suicide attempt and/or, criminal, sexual, or violent escapades. Through portraying cult members in a distinctive uniform, there is no doubt for the audience who is receiving or in need of treatment. Many of the cults portrayed on screen can easily communicate the joining of a cult by changing the characters' dress. Similarly, by simply re-dressing the character, it is communicated that the character has returned to normal, they have been saved, they are a survivor. In Unbreakable Kimmy Schmidt, while three of the four ‘Mole women’ integrate back into society, Gretchen Chalker continues to believe in their cult; as such she never takes of her cult uniform. In addition, the employment of uniforms for cult members in popular culture enables an instant visual recognition of ‘us’ and ‘them’, or ‘normal’ and ‘abnormal’, and reinforces stereotypical notions of social order and marginalised, deviant (religious) groups (Neal 83). The clothing differences are obvious in The Simpsons season 9, episode 13, “Joy of Sect”: ‘Movementarian’ members, including the Simpsons, don long flowing robes. The use of cult uniform visualises their fanatical commitment to the group. It sets them apart from the rest of Springfield and society (Neal 88-89). The connection between uniforms and cults derives two seemingly paradoxical meanings. Firstly, it reduces the chances of the audience believing that the cult employed ‘deceptive recruiting’ techniques. As Melton argues, because of the association our society has with uniforms and cults, “it is very hard for someone to join most new religions, given their peculiar dress and worship practices, without knowing immediately its religious nature” (14). As such, within popular media, the presence of the uniform increases the culpability of those who join the cult. Contrarily, the character in uniform is a sign that the person has been manipulated and/or brainwashed. This reduces the culpability of the cult member. However, the two understandings are not necessarily exclusive. It is possible to view the cult member as a naïve victim, someone who approached the cult as an escape from their life but was subsequently manipulated into behaving criminally. This interpretation is particularly powerful because it indicates cults can prey on anyone, and that anyone could become a victim of a cult. This, in turn, heightens the moral panic surrounding cults and NRMs. The on-screen myth of the cult as represented by its uniform has a basis in the real-life history of NRMs. Heaven’s Gate members famously died after they imbibed fatal doses of alcohol and barbiturates to achieve their ‘final exit’. Most members were found laid out on beds covered in purple shrouds, all wearing matching black shirts, black pants, and black and white Nike shoes. The famous photos of Warren Jeffs’s polygamous Fundamentalist Church of Jesus Christ of Latter-Day Saints, the subject of Netflix’s Keep Sweet: Pray and Obey, depict multiple women in matching conservative dresses with matching hairstyles gathered around a photo of Jeffs. The image and uniform are a clear influence on the design of Unbreakable’s ‘Mole women’. A prime example of the stereotype of cult uniforms is provided by the Canadian comedy program The Red Green Show when the character Red tells Harold “cults are full of followers, they have no independent thought, they go to these pointless meetings ... they all dress the same” (episode 165). The statement is made while the two main characters Red and Harold are standing in matching outfits. Blurring Nature and Myth Importantly, the success of these shows very much relies on audiences having a shared conception of NRMs and the myth of the cult. This is a curious combination of real and fictional knowledge of the well-publicised controversial events in history. Fictional cults frequently take widely held perspectives of actual religious movements and render them either more absurd or more frightening (Laycock 81). Moreover, the blurring of fictional and non-fictional groups serves to reinforce the sense that all popular culture cults and their real-world counterparts are the same; that they all follow a common script. In this, there is convergence between the fictional and the real. The myth of the cult bleeds from the screen into real life. The Simpsons’ “The Joy of Sect” was televised in the year following the suicide of the 39 members of the Heaven’s Gate group, and the storyline in part was influenced by it. Importantly, as a piercing, satirical critique of middle-class America, the “Joy of Sect” not only parodied traditional and non-traditional religion generally (as well as the ‘cult-like’ following of mass media such as Fox); scholars have shown that it also parodied the ‘cult’ stereotype itself (Feltmate). While Heaven’s Gate influenced to a greater or lesser extent each of the TV shows highlighted thus far, it was also the case that the group incorporated into its eschatology aspects of popular culture linked primarily to science fiction. For example, group members were known to have regularly watched and discussed episodes of Star Trek (Hoffmann and Burke; Sconce), adopting aspects of the show’s vernacular in “attempts to relate to the public” (Gate 163). Words such as ‘away-team’, ‘prime-directive’, ‘hologram’, ‘Captain’, ‘Admiral’, and importantly ‘Red-Alert’ were adopted; the latter, often signalling code-red situations in Star Trek episodes, appeared on the Heaven’s Gate Website in the days just prior to their demise. Importantly, allusions to science fiction and Star Trek were incorporated into the group’s self-styled ‘uniform’ worn during their tragic ritual-suicide. Stitched into the shoulders of each of their uniforms were triangular, Star Trek-inspired patches featuring various celestial bodies along with a tagline signalling the common bond uniting each member: “Heaven’s Gate Away Team” (Sconce). Ironically, with replica patches readily for sale online, and T-shirts and hoodies featuring modified though similar Heaven’s Gate symbolism, this ‘common bond’ has been commodified in such a way as to subvert its original meaning – at least as it concerned ‘cult’ membership in the religious context. The re-integration of cult symbols into popular culture typifies the way we as a society detachedly view the behaviours of cults. The behaviour of cults is anecdotally viewed through a voyeuristic lens, potentially exacerbated by the regular portrayals of cults through parody. Scholars have demonstrated how popular culture has internationally impacted on criminological aspects of society. For instance, there was a noted, international increase in unrealistic expectations of jurors wanting forensic evidence during court cases after the popularity of forensic science in crime dramas (Franzen; Wise). After the arrest of James Davis in Armidale, NSW, Australia, the Sydney Morning Herald reported that Davis was the patriarch of the “House of Cadifor” and he was part of a “cult” (both reported in inverted commas). The article also includes an assumption from Davis's lawyer that, in discussing the women of the group, “the Crown might say ‘they’ve been brainwashed’”. Similarly, the article references the use of matching collars by the women (Mitchell). Nine News reported that the “ex-soldier allegedly forced tattooed, collared sex slave into prostitution”, bringing attention to the clothing as part of the coercive techniques of Davis. While the article does not designate the House of Cadifor as a cult, they include a quote from the Assistant Commissioner Justine Gough, “Mr Davis' group has cult-like qualities”, and included the keyword ‘cults’ for the article. Regrettably, the myth of cults and real-world behaviours of NRMs do not always align, and a false convergence is drawn between the two. Furthermore, the consistent parodying and voyeuristic nature of on-screen cults means we might be at fault of euphemising the crimes and behaviours of those deemed to be part of a ‘cult’. Anecdotally, the way Armidale locals discussed Davis was through a lens of excitement and titillation, as if watching a fictional story unfold in their own backyard. The conversations and news reporting focussed on the cult-like aspects of Davis and not the abhorrence of the alleged crimes. We must remain mindful that the cinematic semiology of cults and the myth as represented by their uniform dress and behaviours is incongruent with the nature of NRMs. However, more work needs to be done to better understand the impact of on-screen cults on real-world attitudes and beliefs. Conclusion The myth of the cult has entered a shared understanding within today’s zeitgeist, and the uniform of the cult stands at its heart as a key sign of the myth. Popular culture plays a key role in shaping this shared understanding by following the cultural script, slowly layering fact with fiction, just as fact begins to incorporate the fiction. The language of the cult as communicated through their uniforms is, we would argue, universally understood and purposeful. The ubiquitous representation of cults portrays a deviant group, often medicalised, and subject to deviance amplification and convergence. When a group of characters is presented to the audience in the same cult dress, we know what is being communicated to us. Fictional cults in popular culture continue to mirror the common list of negative features attributed to many new religious movements. Such fictional framing has come to inform media-consumer attitudes in much the same way as news media, reflecting as they do the cultural stock of knowledge from which our understandings are drawn, and which has little grounding in the direct or immediate experience of the phenomena in question. In short, the nature of NRMs has become confused with the myth of the cult. More research is needed to understand the impact of the myth of the cult. However, it is important to ensure “what-goes-without-saying” is not obfuscating, euphemising, or otherwise misrepresenting nature. References Barthes, Roland. Elements of Semiology. London: Jonathon Cape, 1967. ———. The Fashion System. U of California P, 1990. ———. Mythologies. Trans. 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