Discussion Sample Clauses

Discussion. The Parties mutually desire that friendly collaboration will continue between them. Accordingly, they will endeavor, and they will cause their respective Group members to endeavor, to resolve in an amicable manner all disagreements and misunderstandings connected with their respective rights and obligations under this Agreement, including any amendments hereto. In furtherance thereof, in the event of any dispute or disagreement between any member of the CBS Group and any member of the Acquiror Group as to the interpretation of any provision of this Agreement or the performance of obligations hereunder (a “Dispute”), the Tax departments of the Parties shall negotiate in good faith to resolve the Dispute.
Discussion. The activities of the sanitation sector and national governments have been motivated largely by the Millennium Development Goal (MDG) target to increase coverage of ‘improved sanitation’, focusing efforts on the engineering and construction of toilets that separate human excreta from the physical environment. Our findings indicate that women need more than facilities that change their physical environment, but enable urinating, defecating, and managing menstruation independently, comfortably, safely, hygienically, privately, and as needed. We found that toilets alone do not address all of the needs and concerns women have when urinating, defecating and managing menstruation, which may help to explain suboptimal use for defecation in Orissa and elsewhere[4, 7, 8]. Many women with toilets indicated that they were of little benefit over open defecation fields: they lacked water access within for necessary post-defecation cleaning and flushing, many did not have roofs or doors to shelter from elements or provide privacy, they were too dark for use at night, and were not always cleaner or more comfortable than outdoor spaces. Those with doors and roofs were of use to women, particularly during monsoon rains or when they had competing obligations and little time. Still, women did not use them all of the time— rather, they enabled women to have access to another option that they could consider. They enabled a choice, not a solution. Participants in research from other states of India report open defecation to be pleasurable, convenient, comfortable and just as healthy as latrine use [7]. Routray et al (2015), who investigated drivers of open defecation among toilet owners in Orissa, found that open defecation enabled socialization among women, which was not always possible without the excuse of needing company for open defecation [29]. These and our findings collectively demonstrate that all of women’s needs are not currently met by available toilets and underscore the importance of preliminary research and community involvement prior to the implementation of large-scale programming to ensure that facilities cater to the range of needs and wants that women have. The majority of women in our study do not use toilets for urination or managing menstruation because toilets were deemed too dirty or unsuitable for these needs. Women’s menstrual hygiene needs are increasingly gaining attention and recognition as a public health issue,[30] however, to our knowledge, no s...
Discussion. This study examined data gathered by the GDPH from 2014 – 2016 on non-typhoidal Salmonella cases to describe any differences between testing methodologies and demographic information. This study also determined if any significant relationship existed with testing method and hospitalization status or timely reporting to public health status. Separating non-typhoidal Salmonella cases by testing method revealed stark contrasts between the two groups. Children < 5 years of age represented most culture-independent diagnoses. Cases tested with culture, however, had a more evenly spread out range of ages, yet the number of children < 5 nearly doubled any other age group. These data confirmed young children at-risk for salmonellosis and showed that pediatric clinics are using quicker and cheaper methods for diagnosis [11]. Quicker diagnoses may mean quicker treatment, but specimen isolates are less likely to be sent to state public health laboratories for serotyping and antibiotic testing. Favoring reducing diagnosis time also could also mean hampering public health’s ability to detect foodborne outbreaks and monitor antibiotic resistance. Patients tested with culture-independent tests had a higher chance of being sent to public health within seven days of disease onset when compared to patients tested with culture. Numerous challenges factor into the time it takes public health to be notified of a reportable illness, but the difference in time it takes to run a culture versus doing a PCR panel is an important factor to consider in the notification process. Shortening the notification time of disease improves public health’s ability to monitor trends and to conduct more timely interviews. Culture-positive patients were more likely to be hospitalized when compared to culture- independent patients. This finding could be explained by the preference of CIDT usage in private practice whereas hospitals perform more culture within their own laboratory capacity. This effect could also speak to the cost-saving benefits of CIDTs. A quicker diagnosis of salmonellosis allows physicians to rule out more serious disease, to prescribe antibiotic or antidiarrheal medication to rapidly resolve symptoms, and to ensure that patients do not incur hefty medical bills from other diagnostic tests and lengthy overnight stays in the hospital. This study had limitations. First, some salmonellosis cases lacked data on hospitalization status and certain demographics. In 2016, there were 2,83...
Discussion. Early accumulation of hyperphosphorylated tau is seen in the LC of young and cognitively unimpaired individuals and may represent the initial steps in the cascade of events leading to AD (Braak, Thal et al. 2011). This pre-tangle pathology often colocalizes with active caspases in the LC of AD brains, pointing towards its potential role in the characteristic degeneration of the nuclei (Wai, Liang et al. 2009). However, these observations rely solely on cross-sectional data and it is difficult to draw conclusions about the direct mechanism through which this aberrant protein accumulation could induce dysfunction. Here we show through in vitro experiments that the expression of hyperphosphorylation- prone tau significantly reduces LC neurite length. While this was not sufficient on its own to trigger cell death, the aberrant tau did sensitize the cells to a secondary insult. Together, these data suggest that early tau in the LC may compromise the morphology of its neurons and sensitize the LC to other insults that accumulate and promote dysfunction over time before resulting in the characteristic degeneration observed in AD. The effects of hyperphosphorylated tau on LC neuron morphology and survival In non-pathological conditions, tau is necessary for microtubule stability and plays an integral role in cytoskeletal structure and cell protein trafficking and signaling. Its aberrant hyperphosphorylation in disease conditions reduces its affinity for microtubules, which results in microtubule instability and dysfunction (Iqbal, Alonso Adel et al. 2005). On the cellular level, this has detrimental consequences for neurites, negatively impacting their outgrowth, stability, axonal transport and neurotransmission (Johnson and Stoothoff 2004, Alonso, Li et al. 2008, Sydow, Van der Jeugd et al. 2011, Khan and Bloom 2016, Medina, Hernandez et al. 2016). This integral role of tau has been further confirmed with transgenic mice expressing hyperphosphorylation-prone mutant human tau (such as the P301S tau mice used in this study) that first develop tau pathology and altered synaptic function, followed by neurodegeneration in aged animals (reviewed in (Dujardin, Colin et al. 2015). Consistent with these data, we found that expression of P301S tau reduced LC neurite length in in vitro primary cell culture, both in neuronal enriched as well as mixed neuron/glia environments. Average neurite lengths were higher in the mixed cultures for both P301S tau expressing and control ...
Discussion. Detection of worsening of glaucomatous damage is not a simple task. There are three main difficulties: first, differenti- ating real change from instrument variability; second, limited knowledge about the amount of change that is clinically relevant; and third, no gold standard test with which to compare the rest of the tests. In fact, consensus using conventional methods is difficult to achieve, even among glaucoma experts.6,24 The present study evaluated the agreement between two structural tests (optic disc stereo photos and SD-OCT) and the one functional test standard automated perimetry. The progression detection rate using stereo photos (6.9%) was similar to those observed by Alencar et al.5 (3.7%) and Heijl et al.25 (4%) in the treatment group of the EMGT study. Our results showed that SD-OCT GPA has a higher propensity to classify the presence of progression (25%) than VF GPA (15%) or photographs with the given definitions of change. In this study, conventional modalities detected fewer progressing cases. Are these OCT positive ratings ‘‘false positives’’? Or is it because over the span of 3 to 4 years few eyes will meet the requirements for being classified by SAP as possible progression or as abnormal change identified in series of photographs. Are these OCT positive ratings clinically useful? Will standard methods detect these progressing cases in future years? There is a clear necessity to expand the study and include more patients over a longer follow-up period in order to elucidate these questions. It seems evident, however, that these diagnostic modalities provide data about very different aspects of the glaucomatous disease process. Several studies suggest that test performances for detecting progression could vary throughout the different stages of the disease. Subtle progression of glaucoma in the early stages is probably undetectable in disc photos or VF but could be identified in RNFL, and in contrast, changes in advanced stages are better assessed by VF.1,17,26–28 All studies indicate the need to combine functional and structural tests when assessing changes in glaucoma3,29,30 and to thoroughly evaluate any progression algorithm. Our results agree with these statements. In our study, most OCT progressing cases, 37 of 63 cases (58.7%), were initially classified at baseline as OHT (33.3%) or as glaucoma suspect cases (25.4%). In contrast, most VF progressing cases, 21 of 37 cases (56.8%), were initially described as glaucoma cases. SAP d...
Discussion. We developed a set of three measures, which provide deeper understanding of the latent factors that determine hygienic food preparation and storage, handwashing at key times, and provision of safe play environment behaviors as they relate to growth faltering. A theory-informed mixed-methods approach was used to create the three measures, whose structure was developed using EFA and evaluated using CFA. The final hygienic food preparation and storage measure contained a total of 10 items in the Personal Beliefs and Social Opportunity latent factors; the handwashing at key times measure exhibited 15 total items in the Physical Opportunity, Social Opportunity, and Preventing Illness latent factors; the provision of safe play environment measure demonstrated 14 items across three factors titled Perceptions of Animal Feces, Social Opportunity, and Reflective Motivation. These three measures provide an opportunity to gauge the unobservable, latent factors which influence the uptake and application of caretaker hygiene behaviors in rural Kenya (Caruso et al., 2017; Dreibelbis et al., 2015). In applying those measures, we found that Social Opportunity factors held a strong influence over many key outcomes in two of three measures; the knowledge-related Preventing Illness factor in the handwashing at key times measure significantly correlated with other knowledge items but not of actionable behavior; many challenges remain both in defining and quantifying hygienic food preparation and storage; and a participant’s Perceptions around Animal Feces factor score was related to the presence of a safe play environment for the CU2. Each of the three measures included a Social Opportunity factor within the factor structure, and these factors both produced the greatest variability in responses and were statistically significantly related to the most outcomes of interest across all measures (Figure 2; Table 5). The role of social elements in sanitation and hygiene behaviors has long been considered influential (Chow & Mullan, 2010; Curtis, Danquah, & Aunger, 2009; Curtis et al., 2011; Hulland et al., 2015). In their 11-country formative research review, Curtis et al. found status and affiliation to be two of the most commonly cited motivators for handwashing, along with aspects such as disgust, comfort, and fear (2009). The score for the Social Opportunity factor of the handwashing at key times measure, unlike the scores relating to Reflective Motivation or Illness Prevention,...
Discussion. Bland–Altman plots from the current study and those of Howe et al15 suggest that routine data collection of height and weight shows little evidence of bias when compared to research data. However, both demonstrated relatively wide limits of agreement around the estimate. So, while population averages appear accurate, there were substantial differences for some individuals, with predicted differences between PCHR and research data ranging between −0.4–4.91 cm for height and −1.19–0.98 kg for weight. This may be related to measurement error, but may also be attributable to differences in the dates in which assess- ments were made. The current study only included PCHR data that were collected within 2 months of the research-collected data (with mean differences all less than 1 month); similar to the methodology applied previously by Howe et al.15 Using this approach, data were normalised for differences in the actual date that the data were collected; however, normalisation relies on the theory that infants track uniformly along a growth curve at a constant rate. In reality, individual variation in growth means that many infants do not always track uniformly along growth chart trajectories. We conducted additional sensitivity analysis to explore this bias; including only data collected within 1 month of each other. Findings suggest similar agreement in mean values but wider levels of agreement; however, the sample size was substantially reduced. Table 2 Mean (SD) differences for z-scores of height and weight, and mean differences with 95% levels of agreement for predicted height (cm) and weight (kg) between BiB1000 and PCHR data Mean BiB1000 Mean PCHR Mean height z-score Mean difference in predicted height (95% level of agreement; Assessment age height z-score(SD) height z-score (SD) (SD) difference mean differences ±1.96× SD) (cm) 6 months 0.49 (1.39) 0.29 (1.16) 0.21 (1.01) 0.46 (−3.99 to 4.91) 12 months 0.12 (1.16) 0.23 (1.27) −0.10 (0.85) −0.25 (−4.50 to 4.00) 24 months −0.23 (1.02) −0.13 (1.02) −0.10 (0.58) −0.32 (−4.00 to 3.36) Mean BiB1000 weight Mean PCHR weight Mean weight Mean difference in predicted weight (95% level of agreement; Assessment age z-score(SD) z-score (SD) z-score (SD) difference mean differences ±1.96× SD) (kg) 6 months −0.11 (1.06) −0.07 (1.08) −0.04 (0.37) −0.04 (−0.67 to 0.59) 12 months 0.27 (1.07) 0.33 (1.11) −0.05 (0.44) −0.06 (−1.10 to 0.98) 24 months 0.23 (1.02) 0.33 (1.01) −0.10 (0.35) −0.14 (−1.19 to 0.91) PCHR, Personal Chi...
Discussion. For minor offenses by an employee, management has a responsibility to discuss such matters with the employee. Discussions of this type shall be held in private between the employee and the supervisor. Such discussions are not considered discipline and are not grievable. Following such discussions, there is no prohibition against the supervisor and/ or the employee making a personal notation of the date and subject matter for their own personal record(s). However, no notation or other information pertaining to such discussion shall be included in the employee’s personnel folder. While such discussions may not be cited as an element of prior adverse record in any subsequent disciplinary action against an employee, they may be, where relevant and timely, relied upon to establish that employees have been made aware of their obligations and responsibilities.
Discussion. We employed a mouse model to investigate clinically relevant variables and probe the mechanism of PVAN pathogenesis. Factors associated with an increased severity of PVAN in this model included acute infection rather than chronic or persistent infection, infection of the recipient as opposed to the donor, and infection with a high-titer viral inoculum. Unexpectedly, neither prolonged cold ischemic time of the transplanted kidney nor degree of MHC matching between donor and recipient affected graft survival. Finally, our data demonstrate that in the MPyV model, a high viral burden in the transplanted kidney in the absence of an adaptive immune response does not result in severe injury of the kidney allograft. When considering the implications of these findings for clinical renal transplantation, several caveats of this experimental model need to be considered. First, a general property of the mouse kidney transplant model is that allogeneic kidneys are not acutely rejected by immunocompetent mice. Additional caveats of the experimental design are that naïve recipients are acutely infected by MPyV and that recipient mice are not immunosuppressed. Despite these caveats, key similarities in the histologic pattern of kidney injury in this mouse model of PVAN and human BKVN, as well as the similarities in the natural history of MPyV and BKV (as discussed in the Introduction), suggest that this model may provide insights into the pathogenesis of polyomavirus infections in the setting of renal transplantation. The finding that acute but not persistent infection was associated with PVAN suggests that pre-existing immunologic memory for polyomavirus may provide partial 44 protection from the development of PVAN. Seroepidemiologic studies show that BKV infection occurs in the majority of individuals during the first decade of life, with 75% of individuals demonstrating antibodies to BKV by age 10 and 83% by age 20 (36). This model most closely resembles the clinical scenario encountered by young, BKV naïve children undergoing renal transplantation with kidneys from adult donors, who then develop primary BKV infections in the early post-transplant period. Indeed, two studies found that 30% and 44% of pediatric kidney recipients were seronegative for BKV at the time of transplantation (37, 38). This raises the possibility that some cases of pediatric PVAN may result from a primary BKV infection, rather than reactivation of preexisting BKV infection. Although seronegati...
Discussion. The delegates at Sports Hip 2016 proposed 118 research ques- tions about the diagnosis and management of FAI syndrome. During the consensus exercise, we identified 23 substantially different questions, which were ranked in order of priority by the panel (see online supplementary file B). The panel grouped the questions into four categories: aetiology, diagnosis, progno- sis and effect of treatment. Regarding aetiology, there was considerable interest in how cam and pincer morphologies develop, whether sporting activity in childhood may influence this, and why some patients develop symptoms and others do not. For diagnosis, we agreed that diagnostic criteria are imprecise and need to be improved, and that the utility of those we have is unclear. We would benefit considerably from better informa- tion on the long-term natural history of FAI syndrome, though the panel recognised that significant resources are needed to perform the necessary long-term prospective studies. Finally, there is an urgent need to compare the effectiveness of conser- vative, rehabilitation and surgical treatment strategies. Fortunately, several such studies are in progress (see table 2), and results will begin to appear in the next few years.